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Ben-Ami R, Wang QL, Zhang J, Supplee JG, Fahrmann JF, Lehmann-Werman R, Brais LK, Nowak J, Yuan C, Loftus M, Babic A, Irajizad E, Davidi T, Zick A, Hubert A, Neiman D, Piyanzin S, Gal-Rosenberg O, Horn A, Shemer R, Glaser B, Boos N, Jajoo K, Lee L, Clancy TE, Rubinson DA, Ng K, Chabot JA, Kastrinos F, Kluger M, Aguirre AJ, Jänne PA, Bardeesy N, Stanger B, O'Hara MH, Till J, Maitra A, Carpenter EL, Bullock AJ, Genkinger J, Hanash SM, Paweletz CP, Dor Y, Wolpin BM. Protein biomarkers and alternatively methylated cell-free DNA detect early stage pancreatic cancer. Gut 2024; 73:639-648. [PMID: 38123998 PMCID: PMC10958271 DOI: 10.1136/gutjnl-2023-331074] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/26/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Pancreatic ductal adenocarcinoma (PDAC) is commonly diagnosed at an advanced stage. Liquid biopsy approaches may facilitate detection of early stage PDAC when curative treatments can be employed. DESIGN To assess circulating marker discrimination in training, testing and validation patient cohorts (total n=426 patients), plasma markers were measured among PDAC cases and patients with chronic pancreatitis, colorectal cancer (CRC), and healthy controls. Using CA19-9 as an anchor marker, measurements were made of two protein markers (TIMP1, LRG1) and cell-free DNA (cfDNA) pancreas-specific methylation at 9 loci encompassing 61 CpG sites. RESULTS Comparative methylome analysis identified nine loci that were differentially methylated in exocrine pancreas DNA. In the training set (n=124 patients), cfDNA methylation markers distinguished PDAC from healthy and CRC controls. In the testing set of 86 early stage PDAC and 86 matched healthy controls, CA19-9 had an area under the receiver operating characteristic curve (AUC) of 0.88 (95% CI 0.83 to 0.94), which was increased by adding TIMP1 (AUC 0.92; 95% CI 0.88 to 0.96; p=0.06), LRG1 (AUC 0.92; 95% CI 0.88 to 0.96; p=0.02) or exocrine pancreas-specific cfDNA methylation markers at nine loci (AUC 0.92; 95% CI 0.88 to 0.96; p=0.02). In the validation set of 40 early stage PDAC and 40 matched healthy controls, a combined panel including CA19-9, TIMP1 and a 9-loci cfDNA methylation panel had greater discrimination (AUC 0.86, 95% CI 0.77 to 0.95) than CA19-9 alone (AUC 0.82; 95% CI 0.72 to 0.92). CONCLUSION A combined panel of circulating markers including proteins and methylated cfDNA increased discrimination compared with CA19-9 alone for early stage PDAC.
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Affiliation(s)
- Roni Ben-Ami
- Department of Developmental Biology and Cancer Research, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Qiao-Li Wang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Jinming Zhang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Julianna G Supplee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Johannes F Fahrmann
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roni Lehmann-Werman
- Department of Developmental Biology and Cancer Research, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lauren K Brais
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Nowak
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Chen Yuan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Maureen Loftus
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Ana Babic
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Ehsan Irajizad
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tal Davidi
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Aviad Zick
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Ayala Hubert
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Daniel Neiman
- Department of Developmental Biology and Cancer Research, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sheina Piyanzin
- Department of Developmental Biology and Cancer Research, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofer Gal-Rosenberg
- Department of Developmental Biology and Cancer Research, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amit Horn
- Department of Developmental Biology and Cancer Research, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ruth Shemer
- Department of Developmental Biology and Cancer Research, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Benjamin Glaser
- Department of Developmental Biology and Cancer Research, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Israel
| | - Natalia Boos
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Kunal Jajoo
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Linda Lee
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas E Clancy
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Douglas A Rubinson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John A Chabot
- Department of Surgery, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York, USA
| | - Fay Kastrinos
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Cancer and the Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Michael Kluger
- Department of Surgery, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York, USA
| | - Andrew J Aguirre
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pasi A Jänne
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nabeel Bardeesy
- Massachusetts General Hospital Cancer Center, Center for Cancer Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ben Stanger
- Department of Medicine, Division of Gastroenterology, Abramson Family Cancer Research Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mark H O'Hara
- Department of Medicine, Division of Hematology-Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacob Till
- Department of Medicine, Division of Hematology-Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anirban Maitra
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Erica L Carpenter
- Department of Medicine, Division of Hematology-Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea J Bullock
- Division of Hematology and Oncology, Beth-Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jeanine Genkinger
- Department of epidemiology, Mailman school of public health, Columbia university, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia university Irving Medical Center, New York, New York, USA
| | - Samir M Hanash
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cloud P Paweletz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Yuval Dor
- Department of Developmental Biology and Cancer Research, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Brian M Wolpin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Yoon C, Lu J, Jun Y, Kim BJ, Till J, Kim JH, Keshavjee S, Ryeom S, Yoon S. Abstract 2451: KRAS activation in gastric cancer stem-like cells promotes tumor angiogenesis and metastasis. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-2451] [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: 04/07/2023]
Abstract
Abstract
Our previous work showed that KRAS activation in gastric cancer cells leads to activation of an epithelial-to-mesenchymal transition (EMT) program and generation of cancer stem-like cells (CSCs). Here we analyze how this KRAS activation in gastric CSCs promotes tumor angiogenesis and metastasis. Gastric cancer CSCs were found to secrete pro-angiogenic factors such as vascular endothelial growth factor A (VEGF-A), and inhibition of KRAS markedly reduced secretion of these factors. In a genetically engineered mouse model, gastric tumorigenesis was markedly attenuated when both KRAS and VEGF-A signaling were blocked. In orthotropic implant and experimental metastasis models, silencing of KRAS and VEGF-A using shRNA in gastric CSCs abrogated primary tumor formation, lymph node metastasis, and lung metastasis far greater than individual silencing of KRAS or VEGF-A. Analysis of gastric cancer patient samples using RNA sequencing revealed a clear association between high expression of the gastric CSC marker CD44 and expression of both KRAS and VEGF-A, and high CD44 and VEGF-A expression predicted worse overall survival. In conclusion, KRAS activation in gastric CSCs enhances secretion of pro-angiogenic factors and promotes tumor progression and metastasis.
Citation Format: Changhwan Yoon, Jun Lu, Yukyung Jun, Bang- Jin Kim, Jacob Till, Jong Hyun Kim, Sara Keshavjee, Sandra Ryeom, Sam Yoon. KRAS activation in gastric cancer stem-like cells promotes tumor angiogenesis and metastasis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2451.
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Affiliation(s)
- Changhwan Yoon
- 1Columbia University Irving Medical Center, New York, NY
| | - Jun Lu
- 1Columbia University Irving Medical Center, New York, NY
| | - Yukyung Jun
- 2Korea Institute of Science and Technology Information, Seoul, Republic of Korea
| | - Bang- Jin Kim
- 1Columbia University Irving Medical Center, New York, NY
| | - Jacob Till
- 3Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Sara Keshavjee
- 1Columbia University Irving Medical Center, New York, NY
| | - Sandra Ryeom
- 1Columbia University Irving Medical Center, New York, NY
| | - Sam Yoon
- 1Columbia University Irving Medical Center, New York, NY
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Nabavizadeh A, Bagley SJ, Doot RK, Ware JB, Young AJ, Ghodasara S, Zhao C, Anderson H, Schubert E, Carpenter EL, Till J, Henderson F, Pantel AR, Chen HI, Lee JYK, Amankulor NM, O'Rourke DM, Desai A, Nasrallah MP, Brem S. Distinguishing Progression from Pseudoprogression in Glioblastoma Using 18F-Fluciclovine PET. J Nucl Med 2022:jnumed.122.264812. [PMID: 36549916 DOI: 10.2967/jnumed.122.264812] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Rationale: Accurate differentiation between tumor progression (TP) and pseudoprogression remains a critical unmet need in neuro-oncology. 18F-fluciclovine is a widely available synthetic amino acid PET radiotracer. In this study, we aimed to assess the value of 18F-fluciclovine PET for differentiating pseudoprogression from TP in a prospective cohort of patients with suspected radiographic recurrence of glioblastoma. Methods: We enrolled 30 glioblastoma patients with radiographic progression after first-line chemoradiotherapy who were planned for surgical resection. Patients underwent pre-operative 18F-fluciclovine PET and MRI. Relative percentages of viable tumor and therapy-related changes observed in histopathology were quantified and categorized as TP (≥50% viable tumor), mixed TP (<50% and >10% viable tumor), or pseudoprogression (≤10% viable tumor). Results: Eighteen patients had TP, 4 mixed TP, and 8 pseudoprogression. Patients with TP/mixed TP had significantly higher 40-50 minutes SUVmax (6.64+ 1.88 vs 4.11± 1.52, P = 0.009) compared to patients with pseudoprogression. A 40-50 minutes SUVmax cut-off of 4.66 provided 90% sensitivity and 83% specificity for differentiation of TP/mixed TP from pseudoprogression (Area under the curve (AUC)=0.86). Relative cerebral blood volume (rCBVmax) cut-off 3.672 provided 90% sensitivity and 71% specificity for differentiation of TP/mixed TP from Pseudoprogression (AUC=0.779). Combining a 40-50 minutes SUVmax cut-off of 4.66 and a rCBVmax cut-off of 3.67 on MRI provided 100% sensitivity and 80% specificity for differentiating TP/mixed TP from Pseudoprogression (AUC=0.95). Conclusion: 18F-fluciclovine PET uptake can accurately differentiate pseudoprogression from TP in glioblastoma, with even greater accuracy when combined with multi-parametric MRI. Given the wide availability of 18F-fluciclovine, larger, multicenter studies are warranted to determine whether amino acid PET with 18F-fluciclovine should be used in the routine assessment of post-treatment glioblastoma.
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Nabavizadeh A, Bagley S, Ware JB, Doot RK, Young A, Ghodasara S, Zhao C, Anderson H, Schubert E, Carpenter EL, Till J, Henderson F, Pantel AR, Chen I, Lee JYK, Amankulor N, O'Rourke D, Desai A, Nasrallah M, Brem S. NIMG-45. DISTINGUISHING PROGRESSION FROM PSEUDOPROGRESSION IN GLIOBLASTOMA: COMBINED USE OF 18F-FLUCICLOVINE PET AND MULTI-PARAMETRIC MRI. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.663] [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] Open
Abstract
Abstract
PURPOSE
Differentiation of tumor progression (TP) from pseudoprogression (PsP) is a major unmet need in post-treatment glioblastoma (GBM). 18F-Fluciclovine is a synthetic amino acid PET radiotracer with higher uptake in tumor tissue vs. areas of treatment-related change. We investigated the value of 18F-Fluciclovine PET for differentiating PsP from TP independent from and in combination with multi-parametric MRI.
METHODS
We prospectively enrolled 30 patients with GBM with a new or enlarging contrast-enhancing lesion on MRI after chemoradiotherapy who were planned for surgical resection of the lesion. Patients underwent pre-operative 18F-Fluciclovine PET and multi-parametric MRI. Following surgery, the relative percentages of viable tumor and therapy-related changes observed in histopathology were quantified. Patients were categorized as TP if viable tumor represented ≥ 50% of the specimen, mixed TP if < 50% and > 10%, and PsP if ≤ 10%.
RESULTS
18 patients had TP, 4 had mixed TP, and 8 PsP. Patients with TP/mixed TP had a significantly higher 40-50 minutes SUVmax (6.64 + 1.88 vs 4.11± 1.52, p=0.009) and an SUVmax cut-off of 4.66 provided 90% sensitivity and 83% specificity for differentiation of TP/mixed TP from PsP (AUC=0.856). A maximum cerebral blood volume (CBVmax) cut-off of 3.67 provided 90% sensitivity and 71% specificity for differentiation of TP/mixed TP from PsP (AUC=0.779). Combining a 40-50 minutes SUVmax cut-off of 4.662 and a relative CBVmax cut-off of 3.67 provided 100% sensitivity and 80% specificity for differentiating TP/mixed TP from PsP (AUC=0.95). The time activity curve patterns and time to peaks were not different between the groups. Normalization of PET parameters to normal brain parenchyma were not helpful to differentiate the groups due to variability in radiotracer uptake in normal brain between subjects.
CONCLUSION
18F-Fluciclovine PET uptake can accurately differentiate PsP from TP in GBM patients, with even more accurate differentiation achieved when combined with MRI.
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Affiliation(s)
- Ali Nabavizadeh
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | - Stephen Bagley
- Hospital of the University of Pennsylvania , Philadelphia, PA , USA
| | - Jeffrey B Ware
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | - Robert K Doot
- Hospital of the University of Pennsylvania , Phiadelphia , USA
| | - Anthony Young
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | | | - Chao Zhao
- Children's Hospital of Philadelphia , Philadelphia , USA
| | - Hannah Anderson
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | - Erin Schubert
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | | | - Jacob Till
- University of Pennsylvania , Philadelphia , USA
| | | | - Austin R Pantel
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | - Isaac Chen
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | - John Y K Lee
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | - Nduka Amankulor
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | - Donald O'Rourke
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia , USA
| | - Arati Desai
- Hospital of the University of Pennsylvania , Philadelphia, PA , USA
| | - MacLean Nasrallah
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Steven Brem
- Hospital of the University of Pennsylvania , Philadelphia , USA
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5
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Abdalla A, Till J, Yee S, O'Rourke D, Brem S, Amankulor N, Chen I, Binder ZA, Desai A, Phillips R, Hussain J, Kry Y, Caldwell M, Beaubier N, Bagley S, Carpenter EL. BIOM-24. TARGETED NEXT-GENERATION SEQUENCING (NGS) OF TEMPORALLY MATCHED CEREBROSPINAL FLUID (CSF) AND TUMOR TISSUE IN PATIENTS WITH RECURRENT GLIOBLASTOMA (GBM). Neuro Oncol 2022. [PMCID: PMC9660962 DOI: 10.1093/neuonc/noac209.034] [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] Open
Abstract
Abstract
BACKGROUND
GBM genomic profiling relies on sequencing a limited tumor tissue sample, which is invasive and may underrepresent molecular heterogeneity. CSF, which can be obtained less invasively, is in intimate contact with tumor lesions and may better capture the full genomic profile of the tumor. However, datasets with contemporaneously collected CSF and tissue to support this claim have been lacking. To evaluate the performance of CSF NGS, we conducted a pilot study in patients with GBM undergoing a resection for suspected recurrence following first-line chemoradiotherapy.
METHODS
Paired CSF and tissue samples were sequenced using a hybrid capture-based NGS assay. Clinically meaningful variants were defined as those that are potentially targetable using off-label or clinical trial options, exhibit prognostic value, or may predict response or resistance to specific treatments.
RESULTS
Eighteen patients were enrolled, and 13 of 18 CSF samples (72.2%) were sequenced successfully. At least one variant was detected in all CSF samples analyzed. A median of 7 variants (range 1—67) was detected per sample across 54 genes. The median variant allele fraction was 0.6% (range 0.2—72.4%). Among 38 clinically meaningful genes, 102 variants were detected; 25 (24.5%) were detected in both tissue and CSF, while 60 (58.8%) were detectable solely in CSF. Hypermutation was detected by CSF in one patient. Of the 82 variants detected in this patient’s tumor, 15 (18.3%) were identified in both tissue and CSF, 15 (18.3%) were identified only in the tissue, and 52 (63.2%) were identified only in the CSF.
CONCLUSIONS
CSF NGS detects clinically meaningful variants at a substantial rate and frequently identifies mutations not detected by matched tissue NGS. These results suggest that CSF may be a suitable source material for tumor profiling, overcoming the limitations of tissue, and may also provide a more comprehensive tumor profile.
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Affiliation(s)
| | - Jacob Till
- University of Pennsylvania , Philadelphia , USA
| | | | - Donald O'Rourke
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia , USA
| | - Steven Brem
- Hospital of the University of Pennsylvania , Philadelphia, PA , USA
| | - Nduka Amankulor
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | - Isaac Chen
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | - Zev A Binder
- University of Pennsylvania , Philadelphia, PA , USA
| | - Arati Desai
- Hospital of the University of Pennsylvania , Philadelphia, PA , USA
| | | | - Jasmin Hussain
- Hospital of the University of Pennsylvania , Philadelphia , USA
| | - Yolanda Kry
- Hospital of the University of Pennsylvania , Philadelphia, PA , USA
| | | | | | - Stephen Bagley
- Hospital of the University of Pennsylvania , Philadelphia, PA , USA
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Bagley SJ, Alanio C, Till J, Abdalla A, Binder Z, Desai A, Brem S, O’Rourke DM, Carpenter E, Wherry EJ. IMMU-38. DEEP IMMUNOPROFILING OF HUMAN GLIOBLASTOMA (GBM) REVEALS DIFFERENCES IN THE TUMOR IMMUNE CELL INFILTRATE IN PATIENTS WITH HIGH VS. LOW PLASMA CELL-FREE DNA (CFDNA). Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.397] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
We have previously demonstrated that high baseline plasma cfDNA concentration is associated with poor survival in patients with newly diagnosed GBM. The mechanism of this association remains unknown. To explore whether differences in the immune landscape between high- vs. low-cfDNA patients may play a role in their divergent clinical outcomes, we phenotyped tumors from patients with high vs. low cfDNA using mass cytometry by time of flight (CyTOF).
METHODS
We performed CyTOF on frozen tumor infiltrate suspension from a pilot cohort of patients with previously untreated GBM with known baseline plasma cfDNA concentration (Bagley, Clin Cancer Res 2020). CyTOF was used to simultaneously measure expression of 39 molecules related to immune cell lineage, differentiation state, and function. Differences in immune cell infiltrates between high- and low-cfDNA patients were assessed using Mann-Whitney U tests.
RESULTS
Four patients with high cfDNA (median 57, range 33-90 ng/mL) were compared to six patients with low cfDNA (median 12, range 7-16 ng/mL). Immune cell infiltrates with increased adaptive cells (high monocytes and T cells, p=0.05) were present in high-cfDNA compared to low-cfDNA patients. While > 70% of the infiltrating T cells were exhausted in both groups, the pattern of exhaustion was significantly different in high- vs. low-cfDNA patients, with less CXCR5+CD69+ and more CXCR5-CD69- (p=0.008) progenitor exhausted T cells in cfDNA-high patients.
CONCLUSIONS
In this GBM pilot study, we demonstrated differences in the tumor immune infiltrate in patients with high vs. low baseline plasma cfDNA concentration. Preclinical studies will be needed to determine if this explains the association between high plasma cfDNA and poor outcomes previously observed in patients. Our results may have implications for the use of cfDNA concentration as a predictive biomarker for immunotherapy, as tumors with more intermediate progenitor (CXCR5-CD69-) exhausted T cells may respond better to PD-1 checkpoint blockade.
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Affiliation(s)
| | | | - Jacob Till
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Zev Binder
- University of Pennsylvania, Philadelphia, PA, USA
| | - Arati Desai
- University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Brem
- University of Pennsylvania, Philadelphia, PA, USA
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Bagley SJ, Till J, Abdalla A, Nasrallah M, Lauterman T, Tavassoly I, Oklander B, Zviran A, Carpenter E. BIOM-23. A PILOT STUDY OF WHOLE GENOME SEQUENCING (WGS) OF PLASMA CELL-FREE DNA (cfDNA) FOR ULTRASENSITIVE DETECTION OF TUMOR DNA IN PATIENTS WITH GLIOBLASTOMA (GBM). Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Plasma circulating tumor DNA (ctDNA) is rarely detectable by traditional methods in patients with GBM. As a result, unlike in lung and other cancers, serial next generation sequencing of ctDNA for monitoring GBM tumor burden has been challenging. In light of the low tumor fraction (TF) of DNA fragments in GBM patient plasma and the urgent need to improve upon MRI for tracking GBM tumor burden, we conducted a pilot study in patients with newly diagnosed GBM using the C2 intelligence platform (C2i Genomics), which leverages genome-wide mutational integration for highly sensitive ctDNA detection.
METHODS
Plasma was collected pre- and post-operatively in patients with newly diagnosed GBM undergoing surgical resection/biopsy. cfDNA was extracted, quantified, and analyzed for fragment size. Genomic DNA (gDNA) was extracted from matched tumor tissue. Whole genome sequencing (WGS) was performed on both gDNA and cfDNA. A specific copy number alteration (CNA) compendium was created for each patient to generate a readout of TF (Zviran, Nat Medicine 2020). We assessed the association between TF at post-operative day 1 (a surrogate for residual disease) and OS, adjusting for other prognostic factors using Cox regression.
RESULTS
37 patients were enrolled. For samples with high tumor fraction (n=5), a statistically significant (p< 1e-4) correlation between CNA profiles of tumor tissue and plasma samples was observed. Post-operative TF above the median value was associated with inferior OS (median 7.7 vs. 19.3 months, p=0.019). This association persisted after adjusting for age, O6-methylguanine-DNA methyltransferase methylation status, extent of resection, and performance status (adjusted HR 2.5, 95% CI 1.1-5.6, p=0.03).
CONCLUSION
Genome-wide mutational integration enables ultra-sensitive detection of ctDNA in GBM patient plasma. Post-operative TF measured by the C2i test is independently associated with OS in newly diagnosed GBM, providing the foundation to evaluate this technology for personalized prognostication and disease monitoring.
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Affiliation(s)
| | - Jacob Till
- University of Pennsylvania, Philadelphia, PA, USA
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Cazzoli I, Till J, Rowlinson G, Wong L. Supraventricular Tachycardia in a Neonate Repeatedly Induced by Ectopic Ventricular Couplet During Breast-feeding. Indian J Pediatr 2021; 88:188. [PMID: 32607668 DOI: 10.1007/s12098-020-03431-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ilaria Cazzoli
- Pediatric Electrophysiology and Inherited Cardiac Conditions, Department of Pediatrics, Royal Brompton Hospital & Harefield Hospital, London, UK.
| | - J Till
- Pediatric Electrophysiology and Inherited Cardiac Conditions, Department of Pediatrics, Royal Brompton Hospital & Harefield Hospital, London, UK
| | - G Rowlinson
- Pediatric Unit, Department of Pediatrics, Royal Brompton Hospital & Harefield Hospital, London, UK
| | - L Wong
- Pediatric Electrophysiology and Inherited Cardiac Conditions, Department of Pediatrics, Royal Brompton Hospital & Harefield Hospital, London, UK
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Bagley SJ, Till J, Abdalla A, Sangha HK, Yee SS, Freedman J, Black TA, Hussain J, Binder ZA, Brem S, Desai AS, O'Rourke DM, Long Q, Nabavizadeh SA, Carpenter EL. Association of plasma cell-free DNA with survival in patients with IDH wild-type glioblastoma. Neurooncol Adv 2021; 3:vdab011. [PMID: 33615225 PMCID: PMC7883768 DOI: 10.1093/noajnl/vdab011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background We aimed to determine whether plasma cell-free DNA (cfDNA) concentration is associated with survival in patients with isocitrate dehydrogenase (IDH) wild-type glioblastoma (GBM). Methods Pre-operative and post-chemoradiotherapy blood samples were prospectively collected from patients with newly diagnosed IDH wild-type GBM. Patients underwent surgical resection or biopsy and received adjuvant radiotherapy with concomitant temozolomide. Cell-free DNA (cfDNA) was isolated from plasma and quantified using SYBR Green-based q polymerase chain reaction (qPCR). Results Sixty-two patients were enrolled and categorized into high vs. low cfDNA groups relative to the pre-operative median value (25.2 ng/mL, range 5.7–153.0 ng/mL). High pre-operative cfDNA concentration was associated with inferior PFS (median progression-free survival (PFS), 3.4 vs. 7.7 months; log-rank P = .004; hazard ratio [HR], 2.19; 95% CI, 1.26–3.81) and overall survival (OS) (median OS, 8.0 vs. 13.9 months; log-rank P = .01; HR, 2.43; 95% CI, 1.19–4.95). After adjusting for risk factors, including O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status, pre-operative cfDNA remained independently associated with PFS (HR, 2.70; 95% CI, 1.50–4.83; P = .001) and OS (HR, 2.65; 95% CI, 1.25–5.59; P = .01). Post-hoc analysis of change in cfDNA post-chemoradiotherapy compared to pre-surgery (n = 24) showed increasing cfDNA concentration was associated with worse PFS (median, 2.7 vs. 6.0 months; log-rank P = .003; HR, 4.92; 95% CI, 1.53–15.84) and OS (median, 3.9 vs. 19.4 months; log-rank P < .001; HR, 7.77; 95% CI, 2.17–27.76). Conclusions cfDNA concentration is a promising prognostic biomarker for patients with IDH wild-type GBM. Plasma cfDNA can be obtained noninvasively and may enable more accurate estimates of survival and effective clinical trial stratification.
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Affiliation(s)
- Stephen J Bagley
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Glioblastoma Translational Center of Excellence, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jacob Till
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Aseel Abdalla
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Hareena K Sangha
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Stephanie S Yee
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jake Freedman
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Taylor A Black
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jasmin Hussain
- Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Zev A Binder
- Glioblastoma Translational Center of Excellence, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Steven Brem
- Glioblastoma Translational Center of Excellence, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Arati S Desai
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Glioblastoma Translational Center of Excellence, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Donald M O'Rourke
- Glioblastoma Translational Center of Excellence, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Qi Long
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Seyed Ali Nabavizadeh
- Glioblastoma Translational Center of Excellence, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Erica L Carpenter
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Glioblastoma Translational Center of Excellence, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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10
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Fathi Kazerooni A, Bashyam V, Akbari H, Sako C, Mamourian E, Till J, Abdalla A, Yee S, Binder Z, Nabavizadeh SA, Carpenter E, Davatzikos C, Bagley S. NIMG-22. INTEGRATION OF A RADIOMIC SIGNATURE, CLINICAL VARIABLES AND PLASMA CELL-FREE DNA IN ADULT PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA PREDICTS PATIENT SURVIVAL AND IMPROVES DISEASE STRATIFICATION. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.635] [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: 11/14/2022] Open
Abstract
Abstract
PURPOSE
We have previously demonstrated the potential role of liquid biopsy, specifically plasma cell-free DNA (cfDNA), as a non-invasive biomarker for prognostication in patients with glioblastoma. In separate prior studies, we have also developed MRI-based radiomic signatures to predict survival outcomes in glioblastoma. In this study, for the first time, we evaluated the potential of combining radiomic signatures, epidemiological and clinical variables, and plasma cfDNA quantification for upfront prediction of overall survival (OS) in patients with newly diagnosed glioblastoma.
METHODS
Quantitative radiomic features were extracted from multiparametric MRI (T1, T1Gd, T2, T2-FLAIR) scans of a discovery cohort of 505 and an independent replication cohort of 50 IDH-wildtype glioblastoma patients. For the independent replication cohort, pre-surgical plasma cfDNA was extracted and quantified. In the first stage, a radiomic signature was created for stratification of patients into categories of short (OS ≤ 6 months) and long (OS ≥ 18 months) survivors using a cross-validated XGBoost method based on the discovery cohort, which was tested independently on the replication cohort. In the second stage, the radiomic signature and clinical variables were integrated to build a second-stage signature using a cross-validated support vector machine (SVM) classifier to stratify the patients into short and long survivor categories. In the third stage, the value of the second-stage signature integrated with cfDNA concentration was assessed through a cross-validated SVM regression method.
RESULTS
The combination of radiomic, clinical, and cfDNA variables resulted in the best overall predictive accuracy, with Pearson’s correlation coefficient of 0.59 (p< 0.0001) between actual and predicted OS.
CONCLUSION
In this study, we evaluated the value of combining plasma cfDNA, radiomic, and clinical variables for predicting OS, and showed that it could act as an effective non-invasive prognostic and patient stratification tool in patients with newly diagnosed glioblastoma.
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Affiliation(s)
| | | | - Hamed Akbari
- University of Pennsylvania, Philadelphia, PA, USA
| | - Chiharu Sako
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jacob Till
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Zev Binder
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Stephen Bagley
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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11
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Peltenburg P, Lieve K, Van Der Werf C, Wilde A, Brugada R, Till J, Ackerman M, Probst V, Haugaa K, Swan H, Kammeraad J, Horie M, Sanatani S, Schwartz P, Leenhardt A. Atenolol is not effective in reducing ventricular arrhythmia severity on exercise stress test in patients with catecholaminergic polymorphic ventricular tachycardia. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Patients with catecholaminergic polymorphic ventricular tachycardia (CPVT) are at risk for malignant ventricular arrhythmias during exercise and emotions which may lead to sudden cardiac death. Beta-blockers (BB) are the mainstay of therapy in patients with CPVT, but studies comparing the efficacy of different types of BB are scarce. Our objective was to determine the efficacy of different types of BB in reducing the ventricular arrhythmia (VA) severity on exercise stress test (EST) in patients with CPVT.
Data was derived from the International CPVT Registry, a large retrospective cohort study. We included patients who had an EST before (pre-EST) and after start of BB (post-EST). We divided the cohort into five groups based on the first prescribed BB and compared pre-EST and post-EST.
We included 428 patients (median age 18.5 [11.7–39.6] years, 240 (56.%) female), 155 (36.2%) probands) of whom 38 (8.9%) used atenolol, 131 (30.6%) bisoprolol, 82 (19.2%) metoprolol, 124 (29.0%) nadolol and 53 (12.4%) propranolol. Sex and history of aborted cardiac arrest were similar in all groups. The age at start of BB differed (p<0,001): patients using bisoprolol were oldest (35.0 [15.7–35.3]) while patients using propranolol were youngest (12.3 [8.8–24.9]). Median daily BB dose in mg/kg was: 1.0 [0.8–2.3] for atenolol, 0.06 [0.05–0.10] for bisoprolol, 0.9 [0.6–1.5] for metoprolol, 1.1 [0.9–1.6] for nadolol and 1.5 [1.1–2.8] for propranolol. Resting heart rate on pre-EST and post-EST was similar in all groups. Patients using metoprolol had a significantly higher maximum heart rate post-EST compared to nadolol and propranolol (161±18 vs 136±19 and 130±22 bpm, p=0,002 and p=0,001, respectively). The VA severity decreased significantly after BB (147 (37.9%) (non-sustained) ventricular tachycardia ((NS)VT) and 120 (30.9%) no or isolated ventricular premature beat (iVPB) pre-EST vs 46 (11.4%) (NS)VT and 184 (45.7%) iVPB post-EST, p<0,001). Examining the different groups, the VA severity decreased significantly after BB in all but atenolol (13 (40.6%) (NS)VT and 8 (25.0%) iVPB pre-EST vs 9 (25.0%) (NS)VT and 15 (41.7%) iVPB post-EST, p=0,103).
Based on these results we conclude that all beta-blockers except atenolol are effective in reducing the VA severity on EST in patients with CPVT.
Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): E-Rare Joint Transnational Call for Proposals 2015 “Improving Diagnosis and Treatment of Catecholaminergic Polymorphic Ventricular Tachycardia: Integrating Clinical and Basic Science”
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Affiliation(s)
- P Peltenburg
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - K.V.V Lieve
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - C Van Der Werf
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - A.A.M Wilde
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | | | - J Till
- Royal Brompton Hospital, London, United Kingdom
| | - M.J Ackerman
- Mayo Clinic, Rochester, United States of America
| | - V Probst
- Institut du Thorax, Nantes, France
| | - K Haugaa
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - H Swan
- Helsinki University Hospital, Helsinki, Finland
| | - J.A.E Kammeraad
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - M Horie
- Shiga University of Medical Science, Otsu, Japan
| | - S Sanatani
- BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - P Schwartz
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - A Leenhardt
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Paris, France
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12
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Norrish G, Chubb H, Field E, McCleod K, Till J, Stuart G, Hares D, Linter K, Bhole V, Bowes M, Uzun O, Sadagopan S, Rosenthal E, Mangat J, Kaski J. Clinical outcomes and programming strategies of implantable cardioverter defibrillator (ICD) devices during childhood in hypertrophic cardiomyopathy: a UK national cohort study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sudden cardiac death (SCD) is the most common mode of death in childhood hypertrophic cardiomyopathy (HCM). ICDs have been shown to be effective at terminating malignant ventricular arrhythmias but at the expense of a high incidence of complications. The optimal device and programming strategies to reduce complications in this patient group are unknown.
Purpose
To describe the programming strategies and clinical outcomes of ICD implantation in childhood HCM.
Methods
Anonymised, non-invasive clinical data were collected from a retrospective, longitudinal multi-centre cohort of children (<16 years) with HCM (n=687) and an ICD in-situ from the United Kingdom.
Results
96 patients (61 male (64%), 6 non-sarcomeric (6%)) underwent ICD implantation at a median age 14yr (IQR 11–16, range 3–16) and weight 52.3 kg (IQR 34.8–63.1). Indication for ICD was primary prevention in 72 (75%). 82 (85%) had an endovascular system, 3 (3%) epicardial and 11 (12%) subcutaneous system. 61 patients (74%) were receiving one or more cardioactive medications at implantation [B blockers n=66, 70%, disopyramide n=14, 15%, amiodarone n=7, 7%, calcium channel blocker n=7, 9%, other n=5, 6%]. Programming practices varied: all had VF therapies activated (median 220bpm, IQR 212–230); 70 (73%) had a VT zone programmed (median rate 187 bpm, SD 20.9), of which 26 (27%) had therapies activated. 50 patients (61%) had antitachycardia pacing (ATP) activated. Over a median follow up of 53.6 months (IQR 27.3,108.4), 4 patients (4.2%) died following arrhythmic events despite a functioning device. 25 patients had 53 appropriate therapies (ICD shock n=47, ATP n=8), incidence rate 5.22 (95% CI 3.5–7.8). On univariable analysis, secondary prevention indication for ICD implantation was the only predictor of therapy [16 (64%) vs 8 (11.3%), p value <0.001]. 8 (8.3%) patients had 9 inappropriate therapies (ICD shock n=4, ATP n=5), incidence rate 1.37 (95% CI 0.65–2.8), caused by T wave oversensing (n=2), lead migration (n=1), supraventricular tachycardia (n=1). Device complications were seen in 30 patients (31%), including lead complications (n=16) and infection (n=10). No clinical characteristics predicted time to inappropriate therapy or lead complication.
Conclusions
In a contemporary cohort of children with HCM, the incidence of inappropriate therapies is lower than previously reported, yet complication rates remain higher than reported in adult patients. No clinical, device or programming strategies were associated with inappropriate therapies or lead complications.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): British Heart Foundation
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Affiliation(s)
- G Norrish
- Great Ormond Street Hospital for Children, Inherited Cardiovascular Disease, London, United Kingdom
| | - H Chubb
- Stanford University Medical Center, Paediatric Heart Centre, Stanford, United States of America
| | - E Field
- Great Ormond Street Hospital for Children, Inherited Cardiovascular Disease, London, United Kingdom
| | - K McCleod
- Royal Hospital for Children, Glasgow, United Kingdom
| | - J Till
- Stanford University Medical Center, Paediatric Heart Centre, Stanford, United States of America
| | - G Stuart
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - D Hares
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - K Linter
- Glenfield Hospital, Leicester, United Kingdom
| | - V Bhole
- Birmingham Children's Hospital, Birmingham, United Kingdom
| | - M Bowes
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - O Uzun
- Children's Hospital for Wales, Cardiff, United Kingdom
| | - S Sadagopan
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - E Rosenthal
- Guy's and St Thomas' NHS Foundation Trust, Greater London, United Kingdom
| | - J.P Mangat
- Great Ormond Street Hospital for Children, Inherited Cardiovascular Disease, London, United Kingdom
| | - J.P Kaski
- Great Ormond Street Hospital for Children, Inherited Cardiovascular Disease, London, United Kingdom
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13
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Bagley SJ, Nabavizadeh SA, Till J, Abdalla A, Sanga H, Mays J, Prior T, Jurgielewicz A, Guiry S, Davtyan K, Yee SS, Binder ZA, O'Rourke DM, Brem S, Desai AS, Carpenter EL. A prospective validation cohort study of baseline plasma cell-free DNA (cfDNA) as a prognostic biomarker in newly diagnosed glioblastoma (GBM). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.2508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2508 Background: Due to significant interpatient heterogeneity, survival outcomes vary widely in patients with GBM. Novel prognostic biomarkers are needed. We aimed to determine the prognostic impact of baseline plasma cfDNA concentration in patients with GBM. Methods: We analyzed 84 patients with newly diagnosed GBM and at least 7 months of follow-up time. The first 41 patients comprised a previously published derivation cohort (Bagley, Clin Cancer Res 2020). The subsequent 43 patients served as an independent validation cohort. cfDNA was extracted from plasma collected prior to initial surgical resection and quantified by qPCR for a 115 bp amplicon of the human ALU repeat element. Receiver operating characteristic (ROC) curve analysis was used in the derivation cohort to (1) assess the accuracy of plasma cfDNA concentration for predicting progression-free survival status at 7 months (PFS-7), a landmark based on the median PFS for newly diagnosed GBM (Stupp, N Engl J Med 2005), and (2) derive the optimal cutoff for dichotomizing patients into high- and low-cfDNA groups. In the validation cohort, logistic regression was used to measure the association of plasma cfDNA concentration (high vs. low) with PFS-7, adjusted for age, isocitrate dehydrogenase ( IDH) 1/2 mutational status, 0-6-methylguanine-methyltransferase ( MGMT) methylation, extent of resection, and performance status. Multivariate Cox regression was used for overall survival (OS) analysis. Results: In the derivation cohort, the optimal cutoff for plasma cfDNA was 25.0 ng/mL (area under the curve [AUC] = 0.663), with inferior PFS and OS in patients with cfDNA above this cutoff (PFS, median 4.9 vs. 9.5 months, log-rank p = 0.001; OS, median 8.5 vs. 15.5 months, log-rank p = 0.03). In the validation cohort, baseline plasma cfDNA concentration over the cutoff was independently associated with a lower likelihood of being alive and progression-free at 7 months (adjusted OR 0.13, 95% CI 0.02 – 0.75, p = 0.02). OS was also worse in in the validation cohort in patients with high plasma cfDNA (adjusted HR 3.0, 95% CI 1.1 – 8.0, p = 0.03). Conclusions: In patients with newly diagnosed GBM, high baseline plasma cfDNA concentration is associated with worse survival outcomes independent of other prognostic factors. Further validation in a larger, multicenter study is warranted.
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Affiliation(s)
| | - Seyed Ali Nabavizadeh
- Division of Neuroradiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jacob Till
- University of Pennsylvania, Philadelphia, PA
| | | | | | - Jazmine Mays
- Division of Hematology/Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | - Stephanie S. Yee
- University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | | | | | - Steven Brem
- University of Pennsylvania, Philadelphia, PA
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14
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Bagley S, Nabavizadeh S, Mays J, Till J, Yee S, Ware J, Guiry S, Nasrallah M, Levy S, Sarchiapone W, Hussain J, Prior T, Cucciara A, Binder Z, O’Rourke D, Brem S, Desai A, Carpenter E. PATH-49. CLINICAL UTILITY OF PLASMA CELL-FREE DNA IN ADULT PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA – A PILOT PROSPECTIVE STUDY. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.645] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Liquid biopsy has been not been widely utilized in patients with glioblastoma (GBM) compared to other solid tumors. However, the clinical utility of plasma cell-free DNA (cfDNA) in GBM has not been assessed prospectively or at the time of initial diagnosis.
METHODS
We conducted a prospective cohort study of patients with newly diagnosed GBM. Whole blood was collected in Streck® tubes at baseline prior to initial surgical resection and longitudinally during the course of adjuvant chemoradiotherapy. Plasma cfDNA concentration (ng/mL) was quantified by qPCR for a 115 bp amplicon of the human ALU repeat element, correlated with radiographic tumor burden by volumetry at multiple time points using Spearman rank correlation, and assessed for its impact on progression-free (PFS) and overall survival (OS) by Cox regression.
RESULTS
Prior to initial resection, GBM patients (N=42) had higher plasma cfDNA concentration compared to age-matched healthy controls (N=42) (mean 13.43 vs. 6.70 ng/mL, p< 0.001). Plasma cfDNA concentration was correlated with radiographic tumor burden on subjects’ first post-radiation MRI scan (r=0.77, p=0.003) and tended to rise prior to or concurrently with radiographic tumor progression. Pre-operative plasma cfDNA concentration above the mean (>13.4 ng/mL) was associated with inferior PFS (median 4.9 vs. 9.5 months, p=0.038) and OS (median 8.9 vs. 14.8 months, p=0.078). The impact on PFS persisted after adjusting for age, extent of resection, performance status, MGMT promoter methylation, and IDH1/2 mutational status (HR 2.48, 95% CI 1.1–6.1, p=0.046).
CONCLUSIONS
Plasma cfDNA may be an effective prognostic tool and noninvasive surrogate of tumor burden in newly diagnosed GBM. Tumor tissue samples from our cohort have been subjected to targeted next generation sequencing (NGS), and baseline plasma samples have been sent to Guardant Health for NGS. Plasma NGS results and concordance with matched tissue NGS will be included at time of presentation.
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Affiliation(s)
| | | | - Jazmine Mays
- University of Pennsylvania, Philadelphia, PA, USA
| | - Jacob Till
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jeffrey Ware
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Scott Levy
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | - Zev Binder
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Steven Brem
- University of Pennsylvania, Philadelphia, PA, USA
| | - Arati Desai
- University of Pennsylvania, Philadelphia, PA, USA
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15
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Yoon C, Till J, Cho SJ, Chang K, Lin JX, Ryeom S, Yoon S. Abstract 4680: KRAS activation in gastric adenocarcinoma stimulates epithelial-to-mesenchymal transition to cancer stem-like cells and promotes metastasis. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-4680] [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
BACKGROUND:
Our previous work showed that in a mouse model of gastric adenocarcinoma (GA) with loss of p53 and Cdh1 that adding oncogenic Kras (a.k.a triple conditional or Tcon mice) accelerates tumorigenesis and metastasis. The Receptor Tyrosine Kinase (RTK)-RAS signaling pathway is altered in 60% of GAs, and KRAS is amplified or mutated in 17% of GAs. There is some evidence that RTK-RAS signaling and oncogenic KRAS are important in the epithelial-to-mesenchymal transition (EMT) and maintenance of cancer stem-like cells (CSCs). We hypothesized that RTK-RAS activation in GA CSCs increases the metastatic potential of these cells.
METHODS:
The RTK-RAS pathway and KRAS were examined in nontransformed HFE-145 gastric epithelial cells, tumor-derived organoids derived from Tcon mice, human GA cell lines (AGS and KATOIII), AGS xenografts, and a tissue microarray of human GAs from 115 patients undergoing surgical resection. KRAS was inhibited using shRNA, and the RTK-RAS pathway was blocked using a MEK inhibitor PD0325901.
RESULTS:
Kras activity was much higher in GA cell lines grown as spheroids compared to GA cell lines grown monolayers. Metastasis following KRAS activation in GA cells results from stimulation of epithelial-to-mesenchymal transition (EMT) to cancer stem-like cells (CSCs). In organoids derived from our mouse model, Kras knockdown decreased spheroid formation, expression of EMT-related proteins, migration, and invasion; similar effects, as well as reversal of chemoresistance, were observed following KRAS knockdown in patient tumor-derived GA cell lines. KRAS inhibition in GA spheroid cells led to reduced flank xenograft growth, loss of the infiltrative tumor border, fewer lung metastases, and increased survival. Supporting clinical relevance, high tumor levels of CD44 (a marker of CSCs) and KRAS activation were independent predictors of worse overall survival in 115 GA patients.
CONCLUSION:
In this study, we show that the addition of oncogenic KRAS into gastric epithelial cells leads to EMT and acquisition of CSC phenotypes. Inhibition of KRAS in GA cell lines and in tumor derived organoids reverses EMT and inhibit CSC phenotypes. We conclude that metastasis following KRAS activation in GA cells likely results from stimulation of EMT and transition to CSCs.
Citation Format: Changhwan Yoon, Jacob Till, Soo-Jeong Cho, Kevin Chang, Jian-Xian Lin, Sandra Ryeom, Sam Yoon. KRAS activation in gastric adenocarcinoma stimulates epithelial-to-mesenchymal transition to cancer stem-like cells and promotes metastasis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4680.
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Affiliation(s)
| | - Jacob Till
- 2University of Pennsylvania, Philadelphia, PA
| | - Soo-Jeong Cho
- 3Seoul National University Hospital, Seoul, Republic of Korea
| | - Kevin Chang
- 1Mem. Sloan Kettering Cancer Ctr., New York, NY
| | - Jian-Xian Lin
- 4Fujian Medical University Union Hospital, Fujian, China
| | | | - Sam Yoon
- 1Mem. Sloan Kettering Cancer Ctr., New York, NY
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16
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Yoon C, Till J, Cho SJ, Chang KK, Lin JX, Huang CM, Ryeom S, Yoon SS. KRAS Activation in Gastric Adenocarcinoma Stimulates Epithelial-to-Mesenchymal Transition to Cancer Stem-Like Cells and Promotes Metastasis. Mol Cancer Res 2019; 17:1945-1957. [PMID: 31217166 DOI: 10.1158/1541-7786.mcr-19-0077] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/07/2019] [Accepted: 06/10/2019] [Indexed: 12/15/2022]
Abstract
Our previous work showed that in a mouse model of gastric adenocarcinoma with loss of p53 and Cdh1 that adding oncogenic Kras (a.k.a. Tcon mice) accelerates tumorigenesis and metastasis. Here, we sought to examine KRAS activation in epithelial-to-mesenchymal transition (EMT) and generation of cancer stem-like cells (CSC). Transduction of nontransformed HFE-145 gastric epithelial cells with oncogenic KRASG12V significantly decreased expression of the epithelial marker E-cadherin, increased expression of the mesenchymal marker vimentin and the EMT transcription factor Slug, and increased migration and invasion by 15- to 17-fold. KRASG12V also increased expression of self-renewal proteins such as Sox2 and increased spheroid formation by 2.6-fold. In tumor-derived organoids from Tcon mice, Kras knockdown decreased spheroid formation, expression of EMT-related proteins, migration, and invasion; similar effects, as well as reversal of chemoresistance, were observed following KRAS knockdown or MEK inhibition in patient tumor-derived gastric adenocarcinoma cell lines (AGS and KATOIII). KRAS inhibition in gastric adenocarcinoma spheroid cells led to reduced AGS flank xenograft growth, loss of the infiltrative tumor border, fewer lung metastases, and increased survival. In a tissue microarray of human gastric adenocarcinomas from 115 patients, high tumor levels of CD44 (a marker of CSCs) and KRAS activation were independent predictors of worse overall survival. In conclusion, KRAS activation in gastric adenocarcinoma cells stimulates EMT and transition to CSCs, thus promoting metastasis. IMPLICATIONS: This study provides rationale for examining inhibitors of KRAS to block metastasis and reverse chemotherapy resistance in gastric adenocarcinoma patients.
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Affiliation(s)
- Changhwan Yoon
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jacob Till
- Department of Cancer Biology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Soo-Jeong Cho
- Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Kevin K Chang
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jian-Xian Lin
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Gastric Surgery, Fujian Medical University Union Hospital, Fujian, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fujian, China
| | - Sandra Ryeom
- Department of Cancer Biology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sam S Yoon
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
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Bagley S, Till J, Mays J, Nabavizadeh S, Yee S, Levy S, Desai A, Carpenter E. PATH-41. PLASMA CELL-FREE DNA (cfDNA) CONCENTRATION IS INDEPENDENTLY ASSOCIATED WITH RADIOGRAPHIC TUMOR BURDEN IN NEWLY DIAGNOSED GLIOBLASTOMA (GBM) PRIOR TO INITIAL SURGICAL RESECTION. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stephen Bagley
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jacob Till
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jazmine Mays
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Seyed Nabavizadeh
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie Yee
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Scott Levy
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Arati Desai
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Erica Carpenter
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Wong L, Kontogeorgis A, Brett L, Edwards M, Wilkinson S, Ware J, Morris-Rosendahl D, Homfray T, Till J. 61Prevalence and spectrum of genetic variants in a single-centre cohort of Brugada syndrome. Europace 2017. [DOI: 10.1093/europace/eux283.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lieve K, Verhagen J, Bos J, Van Der Werf C, Frohn-Mulder I, Aiba T, Crijns H, Blank A, Wiesfeld A, Sumitomo N, Chen S, Till J, Ackerman M, Van Der Laar I, Wilde A. 1215Neurodevelopmental disorders in patients with RYR2-associated catecholaminergic polymorphic ventricular tachycardia. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yoon C, Chang KK, Till J, Ryeom SW, Yoon SS. Abstract 2897: Oncogenic Kras activation in gastric adenocarcinoma promotes cancer stem cell phenotypes including metastasis & chemotherapy resistance. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2897] [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:
The Cancer Genome Atlas found that the receptor tyrosine kinase (RTK)-Ras signaling pathway is altered in half of gastric adenocarcinomas (GAs). We added oncogenic Kras to the Atp4b-Cre;Cdh1fl/fl;Trp53fl/fl mouse model of GA and found accelerated tumorigenesis and metastasis. We also found Kras activity to be higher in gastric cancer stem-like cells (CSCs). Thus we hypothesized that Kras activty is critical for maintenance of gastric CSCs and promotes CSC phenotypes.
METHODS:
Human and murine GA cell lines were examined. The effect of Kras pathway inhibition was examined in GA spheroid cells and monolayer cells in various in vitro assays. Kras activity and Kras pathway inhibition was examined in CSCs, primary tumors and metastases in our GA mouse model. The combination of chemotherapy and Kras pathway inhibition was tested in human GA xenografts.
RESULTS:
Kras inhibition with shRNA or MEK inhibitor PD0325901 decreased the ability of GA cells to form spheroids and deceased expression of the stem cell transcription factor, Sox2. CD44(+) gastric CSCs had 65.8-75.4% higher migration, 64.2-79.5% higher invasion, and 63.1-70.2% more anchorage-independent growth compared to unselected cells. These properties could all blocked by 71.1-82.7% with Kras shRNA or PD0325901. In our GA mouse model, PD0325901 starting at 6 weeks of life increased median survival from 76 days to 95 days. Primary tumors and metastases from these mice with and without treatment with MEK inhibition are being analyzed for level of CD44 CSCs, Kras activity, and extent of metastases. Gastric CSCs were resistant to 5-fluorouracil and cisplatin chemotherapy, and this chemotherapy resistance could be reversed in human GA xenografts transducing cells with Kras shRNA.
CONCLUSION:
Kras is more active in gastric CSCs than non-CSCs and promotes malignant phenotypes including metastasis and chemotherapy resistance. Kras pathway inhibition can block these CSC phenotypes, and thus may prove useful in various combination therapies.
Note: This abstract was not presented at the meeting.
Citation Format: Changhwan Yoon, Kevin K. Chang, Jacob Till, Sandra W. Ryeom, Sam S. Yoon. Oncogenic Kras activation in gastric adenocarcinoma promotes cancer stem cell phenotypes including metastasis & chemotherapy resistance [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 2897. doi:10.1158/1538-7445.AM2017-2897
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Affiliation(s)
| | | | - Jacob Till
- 2Abramson Family Cancer Research Institute, Philadelphia, PA
| | - Sandra W. Ryeom
- 2Abramson Family Cancer Research Institute, Philadelphia, PA
| | - Sam S. Yoon
- 1Memorial Sloan Kettering Cancer Center, New York, NY
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Kontogeorgis A, Starling L, Wong L, Chivers S, Roses-Noguer F, Till J, Clague J. 598Outcome of transvenous lead extraction in young children-a sixteen year paediatric case series. Europace 2017. [DOI: 10.1093/ehjci/eux144.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Robinson D, Till J. IMPACT OF POINT OF CARE CRP TESTING ON THE MANAGEMENT OF PATIENTS WITH SUSPECTED COMMUNITY ACQUIRED PNEUMONIA IN THE ED. Arch Emerg Med 2016. [DOI: 10.1136/emermed-2016-206402.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Philippsen T, Orini M, Martin C, Volkova E, Ormerod J, Sohaib S, Elamin N, Blake S, Sawhney V, Ahmad S, Waring O, Bowers R, Raiman L, Hazelwood T, Mills R, Corrado C, Honarbakhsh S, Von Maydell A, Norrish G, Chubb H, Chubb H, Chubb H, Toledano M, Ruiz A, van Zalen J, Foley P, Pearman C, Rehal O, Foley P, Wong L, Foley P, Pearman C, Brahmbhatt D, Khan H, Wardley J, Akbar S, Christensen L, Hansen M, Brandes A, Tinker A, Munroe P, Lambiase P, Honarbakhsh S, McLean A, Lambiase P, Schilling R, Lane J, Chow A, Earley M, Hunter R, Khan F, Lambiase P, Schilling R, Sporton S, Dhinoja M, Camm C, Xavier R, de Sousa M, Betts T, Shun-Shin M, Wright I, Lim E, Lim P, Koawing M, Lefroy D, Linton N, Davies D, Peters N, Kanagaratnam P, Francis D, Whinnett Z, Khan M, Bowes R, Sahu J, Sheridan P, Rogers D, Kyriacou A, Kelland N, Lewis N, Lee J, Segall E, Diab I, Breitenstein A, Ullah W, Sporton S, Earley M, Finlay M, Dhinoja M, Schilling R, Hunter R, Ahmed M, Petkar S, Davidson N, Stout M, Pearce KP, Leo M, Ginks M, Rajappan K, Bashir Y, Balasubramaniam R, Sopher S, Betts T, Paisey J, Cheong J, Roy D, Adhya S, Williams S, O'Neill M, Niederer S, Providencia R, Srinivasan N, Ahsan S, Lowe M, Segal O, Hunter R, Finlay M, Earley M, Schilling R, Lambiase P, Stella S, Cantwell C, Chowdhury R, Kim S, Linton N, Whinnett Z, Koa-Wing M, Lefroy D, Davies DW, Kanagaratnam P, Lim PB, Qureshi N, Peters N, Cantarutti N, Limongelli G, Elliott P, Kaski J, Williams S, Lal K, Harrison J, Whitaker J, Kiedrowicz R, Wright M, O'Neill M, Harrison J, Whitaker J, Williams S, Wright M, Schaeffter T, Razavi R, O'Neill M, Karim R, Williams S, Harrison J, Whitaker J, Wright M, Schaeffter T, Razavi R, O'Neill M, Montanes M, Ella Field E, Walsh H, Callaghan N, Till J, Mangat J, Lowe M, Kaski J, Ruiz Duthil A, Li A, Saba M, Patel N, Beale L, Brickley G, Lloyd G, French A, Khavandi A, McCrea W, Barnes E, Chandrasekaran B, Parry J, Garth L, Chapman J, Todd D, Hobbs J, Modi S, Waktare J, Hall M, Gupta D, Snowdon R, Papageorgiou N, Providência R, Falconer D, Sewart E, Ahsan S, Segal O, Ezzat V, Rowland E, Lowe M, Lambiase P, Chow A, Swift M, Charlton P, James J, Colling A, Barnes E, Starling L, Kontogeorgis A, Roses-Noguer F, Wong T, Jarman J, Clague J, Till J, Colling A, James J, Hawkins M, Burnell S, Chandrasekaran B, Coulson J, Smith L, Choudhury M, Oguguo E, Boyett M, Morris G, Flinn W, Chari A, Belham M, Pugh P, Somarakis K, Parasa R, Allata A, Hashim H, Mathew T, Kayasundar S, Venables P, Quinn J, Ivanova J, Brown S, Oliver R, Lyons M, Chuen M, Walsh J, Robinson T, Staniforth A, Ahsan A, Jamil-Copley S. POSTERS (2)96CONTINUOUS VERSUS INTERMITTENT MONITORING FOR DETECTION OF SUBCLINICAL ATRIAL FIBRILLATION IN HIGH-RISK PATIENTS97HIGH DAY-TO-DAY INTRA-INDIVIDUAL REPRODUCIBILITY OF THE HEART RATE RESPONSE TO EXERCISE IN THE UK BIOBANK DATA98USE OF NOVEL GLOBAL ULTRASOUND IMAGING AND CONTINUEOUS DIPOLE DENSITY MAPPING TO GUIDE ABLATION IN MACRO-REENTRANT TACHYCARDIAS99ANTICOAGULATION AND THE RISK OF COMPLICATIONS IN PATIENTS UNDERGOING VT AND PVC ABLATION100NON-SUSTAINED VENTRICULAR TACHYCARDIA FREQUENTLY PRECEDES CARDIAC ARREST IN PATIENTS WITH BRUGADA SYNDROME101USING HIGH PRECISION HAEMODYNAMIC MEASUREMENTS TO ASSESS DIFFERENCES IN AV OPTIMUM BETWEEN DIFFERENT LEFT VENTRICULAR LEAD POSITIONS IN BIVENTRICULAR PACING102CAN WE PREDICT MEDIUM TERM MORTALITY FROM TRANSVENOUS LEAD EXTRACTION PRE-OPERATIVELY?103PREVENTION OF UNECESSARY ADMISSIONS IN ATRIAL FIBRILLATION104EPICARDIAL CATHETER ABLATION FOR VENTRICULAR TACHYCARDIA ON UNINTERRUPTED WARFARIN: A SAFE APPROACH?105HOW WELL DOES THE NATIONAL INSTITUTE OF CLINICAL EXCELLENCE (NICE) GUIDENCE ON TRANSIENT LOSS OF CONSCIOUSNESS (T-LoC) WORK IN A REAL WORLD? AN AUDIT OF THE SECOND STAGE SPECIALIST CARDIOVASCULAT ASSESSMENT AND DIAGNOSIS106DETECTION OF ATRIAL FIBRILLATION IN COMMUNITY LOCATIONS USING NOVEL TECHNOLOGY'S AS A METHOD OF STROKE PREVENTION IN THE OVER 65'S ASYMPTOMATIC POPULATION - SHOULD IT BECOME STANDARD PRACTISE?107HIGH-DOSE ISOPRENALINE INFUSION AS A METHOD OF INDUCTION OF ATRIAL FIBRILLATION: A MULTI-CENTRE, PLACEBO CONTROLLED CLINICAL TRIAL IN PATIENTS WITH VARYING ARRHYTHMIC RISK108PACEMAKER COMPLICATIONS IN A DISTRICT GENERAL HOSPITAL109CARDIAC RESYNCHRONISATION THERAPY: A TRADE-OFF BETWEEN LEFT VENTRICULAR VOLTAGE OUTPUT AND EJECTION FRACTION?110RAPID DETERIORATION IN LEFT VENTRICULAR FUNCTION AND ACUTE HEART FAILURE AFTER DUAL CHAMBER PACEMAKER INSERTION WITH RESOLUTION FOLLOWING BIVENTRICULAR PACING111LOCALLY PERSONALISED ATRIAL ELECTROPHYSIOLOGY MODELS FROM PENTARAY CATHETER MEASUREMENTS112EVALUATION OF SUBCUTANEOUS ICD VERSUS TRANSVENOUS ICD- A PROPENSITY MATCHED COST-EFFICACY ANALYSIS OF COMPLICATIONS & OUTCOMES113LOCALISING DRIVERS USING ORGANISATIONAL INDEX IN CONTACT MAPPING OF HUMAN PERSISTENT ATRIAL FIBRILLATION114RISK FACTORS FOR SUDDEN CARDIAC DEATH IN PAEDIATRIC HYPERTROPHIC CARDIOMYOPATHY: A SYSTEMATIC REVIEW AND META-ANALYSIS115EFFECT OF CATHETER STABILITY AND CONTACT FORCE ON VISITAG DENSITY DURING PULMONARY VEIN ISOLATION116HEPATIC CAPSULE ENHANCEMENT IS COMMONLY SEEN DURING MR-GUIDED ABLATION OF ATRIAL FLUTTER: A MECHANISTIC INSIGHT INTO PROCEDURAL PAIN117DOES HIGHER CONTACT FORCE IMPAIR LESION FORMATION AT THE CAVOTRICUSPID ISTHMUS? INSIGHTS FROM MR-GUIDED ABLATION OF ATRIAL FLUTTER118CLINICAL CHARACTERISATION OF A MALIGNANT SCN5A MUTATION IN CHILDHOOD119RADIOFREQUENCY ASSOCIATED VENTRICULAR FIBRILLATION120CONTRACTILE RESERVE EXPRESSED AS SYSTOLIC VELOCITY DOES NOT PREDICT RESPONSE TO CRT121DAY-CASE DEVICES - A RETROSPECTIVE STUDY USING PATIENT CODING DATA122PATIENTS UNDERGOING SVT ABLATION HAVE A HIGH INCIDENCE OF SECONDARY ARRHYTHMIA ON FOLLOW UP: IMPLICATIONS FOR PRE-PROCEDURE COUNSELLING123PROGNOSTIC ROLE OF HAEMOGLOBINN AND RED BLOOD CELL DITRIBUTION WIDTH IN PATIENTS WITH HEART FAILURE UNDERGOING CARDIAC RESYNCHRONIZATION THERAPY124REMOTE MONITORING AND FOLLOW UP DEVICES125A 20-YEAR, SINGLE-CENTRE EXPERIENCE OF IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD) IN CHILDREN: TIME TO CONSIDER THE SUBCUTANEOUS ICD?126EXPERIENCE OF MAGNETIC REASONANCE IMAGING (MEI) IN PATIENTS WITH MRI CONDITIONAL DEVICES127THE SINUS BRADYCARDIA SEEN IN ATHLETES IS NOT CAUSED BY ENHANCED VAGAL TONE BUT INSTEAD REFLECTS INTRINSIC CHANGES IN THE SINUS NODE REVEALED BY
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(F) BLOCKADE128SUCCESSFUL DAY-CASE PACEMAKER IMPLANTATION - AN EIGHT YEAR SINGLE-CENTRE EXPERIENCE129LEFT VENTRICULAR INDEX MASS ASSOCIATED WITH ESC HYPERTROPHIC CARDIOMYOPATHY RISK SCORE IN PATIENTS WITH ICDs: A TERTIARY CENTRE HCM REGISTRY130A DGH EXPERIENCE OF DAY-CASE CARDIAC PACEMAKER IMPLANTATION131IS PRE-PROCEDURAL FASTING A NECESSITY FOR SAFE PACEMAKER IMPLANTATION? Europace 2016. [DOI: 10.1093/europace/euw274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Camacho-Vanegas O, Till J, Miranda-Lorenzo I, Ozturk B, Camacho SC, Martignetti JA. Shaking the family tree: identification of novel and biologically active alternatively spliced isoforms across the KLF family of transcription factors. FASEB J 2012; 27:432-6. [PMID: 23134681 DOI: 10.1096/fj.12-220319] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Alternative splicing represents a unique post-transcriptional mechanism that increases the complexity of the eukaryotic proteome-generating protein isoforms whose functions can be novel, diverse, and/or even antagonistic when compared to its full-length transcript. The KLF family of genes consists of ≥17 members, which are involved in the regulation of numerous critical cellular processes, including differentiation, cell proliferation, growth-related signal transduction, angiogenesis, and apoptosis. Using a strategy based on RT-PCR, selective cloning, and promoter-based assays of cancer-relevant genes, we identify and characterize the existence of multiple biologically active KLF splice forms across the entire family of proteins. We demonstrate biological function for a number of these isoforms. Furthermore, we highlight a possible functional interaction between full-length KLF4 and one of its splice variants in up-regulating cellular proliferation. Taken together, this report identifies for the first time a more complete view of the genomic and proteomic breadth and complexity of the KLF transcription factor family, revealing the existence of highly expressed and biologically active isoforms previously uncharacterized. In essence, knowing that these KLF isoforms exist provides the first step toward understanding the roles of these genes in human health and disease.
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Affiliation(s)
- Olga Camacho-Vanegas
- Department of Genetics and Genomic Sciences, Mt. Sinai School of Medicine, New York, NY 10029, USA
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Camacho-Vanegas O, Camacho S, Till J, Miranda-Lorenzo I, Terzo E, Ramirez M, Schramm V, Cordovano G, Watts G, Mehta S, Kimonis V, Hoch B, Philibert K, Raabe C, Bishop D, Glucksman M, Martignetti J. Primate genome gain and loss: a bone dysplasia, muscular dystrophy, and bone cancer syndrome resulting from mutated retroviral-derived MTAP transcripts. Am J Hum Genet 2012; 90:614-27. [PMID: 22464254 DOI: 10.1016/j.ajhg.2012.02.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 01/19/2012] [Accepted: 02/16/2012] [Indexed: 10/28/2022] Open
Abstract
Diaphyseal medullary stenosis with malignant fibrous histiocytoma (DMS-MFH) is an autosomal-dominant syndrome characterized by bone dysplasia, myopathy, and bone cancer. We previously mapped the DMS-MFH tumor-suppressing-gene locus to chromosomal region 9p21-22 but failed to identify mutations in known genes in this region. We now demonstrate that DMS-MFH results from mutations in the most proximal of three previously uncharacterized terminal exons of the gene encoding methylthioadenosine phosphorylase, MTAP. Intriguingly, two of these MTAP exons arose from early and independent retroviral-integration events in primate genomes at least 40 million years ago, and since then, their genomic integration has gained a functional role. MTAP is a ubiquitously expressed homotrimeric-subunit enzyme critical to polyamine metabolism and adenine and methionine salvage pathways and was believed to be encoded as a single transcript from the eight previously described exons. Six distinct retroviral-sequence-containing MTAP isoforms, each of which can physically interact with archetype MTAP, have been identified. The disease-causing mutations occur within one of these retroviral-derived exons and result in exon skipping and dysregulated alternative splicing of all MTAP isoforms. Our results identify a gene involved in the development of bone sarcoma, provide evidence of the primate-specific evolution of certain parts of an existing gene, and demonstrate that mutations in parts of this gene can result in human disease despite its relatively recent origin.
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Anselme F, Padeletti L, Goscinska-Bis K, Wintherhalter M, Renesto F, Ritter P, Bocchiardo M, Schauerte P, Meyer Zu Vilsendorf D, Militello C, Lippert M, Czygan G, Gaita F, Stellbrink CH, Perzanowski C, Zilo P, Silva E, Sitges M, Delgado V, Tamborero D, Vidal B, Godoy MA, Mont L, Brugada J, Vollkron M, Lippert M, Muessig D, Orlov MV, Di Cori A, Zucchelli G, Segreti L, Soldati E, Bandera F, Solarino G, De Lucia R, Bongiorni MG, Silva E, Tamborero D, Sitges M, Andreu D, Vidal B, Berruezo A, Mont L, Brugada J, Rademakers L, Van Hunnik A, Lampert A, Kuiper M, Auricchio A, Echt D, Maessen J, Prinzen F, Zucchelli G, Soldati E, Segreti L, Di Cori A, Coluccia G, De Lucia R, Solarino G, Bongiorni MG, Johar S, Jones DG, Lyne JC, Kaba RA, Till J, Clague JR. Moderated Posters: Cardiac resynchronisation therapy. Europace 2009. [DOI: 10.1093/europace/euq218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Walter JH, Patterson A, Till J, Besley GTN, Fleming G, Henderson MJ. Bloodspot acylcarnitine and amino acid analysis in cord blood samples: efficacy and reference data from a large cohort study. J Inherit Metab Dis 2009; 32:95-101. [PMID: 19191006 DOI: 10.1007/s10545-008-1047-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 11/07/2008] [Accepted: 11/20/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND In order to test the feasibility of cord blood screening for inherited metabolic disease, a two-year cohort study of births in six obstetric units from five towns in the north of England was undertaken. These towns have a high prevalence of consanguineous marriages, largely among the immigrant Asian community. The purpose of the study was to determine whether early detection of metabolic disease was possible and whether early intervention would improve prognosis. METHODS Following parental consent, cord blood samples were collected at birth and analysed for acylcarnitine and amino acid profiles by tandem mass spectrometry in one of two laboratories. One laboratory used butylated derivatives, the other used underivatized samples. The same laboratories performed routine blood spot neonatal screening at 5-7 days of age on these babies. Patients with positive results were investigated and treated by a metabolic paediatrician as soon as possible. RESULTS 24,983 births were examined. 12,952 samples were analysed as butyl derivatives, 12,031 samples were analysed underivatized. The following disorders were detected: medium-chain acyl-CoA dehydrogenase (MCAD) deficiency (1 case), 3-methylcrotonyl-CoA carboxylase (MCC) deficiency (2 cases), maternal carnitine transporter defect (2 cases), maternal MCC (1 case). The following disorders were diagnosed subsequently but were not detected by the cord blood screening: phenylketonuria (PKU) (1 case), maple syrup urine disease (MSUD) (2 cases), argininosuccinic aciduria (1 case), methylmalonic acidaemia (MMA) (1 case), glutaric aciduria type 2 (1 case), MCAD deficiency (2 cases), 3-hydroxy-3-methylglutaryl-CoA lyase deficiency (1 case). Comprehensive reference data for all analytes by both methods were obtained. CONCLUSIONS Cord blood testing is of limited value in detecting inherited metabolic disease. The metabolites associated with most disorders examined were not elevated in cord blood. Some maternal disorders, carnitine transporter defect and 3-methlycrotonyl-CoA carboxylase deficiency, are detected. These remain of uncertain clinical significance. Comprehensive reference data have been obtained that will facilitate future interpretation of studies in cord blood.
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Affiliation(s)
- J H Walter
- Willink Biochemical Genetics Unit, Royal Manchester Children's Hospital, Manchester, UK.
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Bain MD, Till J, Jones MG, Besley GTN, Lee P, Oliveira D, Chalmers RA. Methylmalonic aciduria: follow-up and enzymology on the original case after 36 years. J Inherit Metab Dis 2005; 28:1179-80. [PMID: 16435224 DOI: 10.1007/s10545-005-0244-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 36-year follow-up on the original patient described with methylmalonic aciduria has shown that she has methylmalonyl-CoA apomutase deficiency. The main clinical problem associated with her methylmalonic aciduria is progressive renal impairment requiring commencement of haemodialysis at 42 years of age.
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Affiliation(s)
- M D Bain
- Paediatric Metabolism Unit, Division of Child Health, Department of Clinical Developmental Sciences, St George's Hospital Medical School, London, UK.
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Till J, Sand G, Engell S, von Trotha T, Schembecker G. ReadOpt– Reaktor-Design- Optimierung durch Heuristik- gestützte MINLP-Methoden. CHEM-ING-TECH 2004. [DOI: 10.1002/cite.200403421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Till J, Sand G, Engell S, Schembecker G, von Trotha T. READOPT– Reaktor-Design-Optimierung durch heuristikgestützte MINLP-Methoden. CHEM-ING-TECH 2003. [DOI: 10.1002/cite.200390317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
We describe a new model for laser-induced retinal damage. Our treatment is prompted by the failure of the traditional approach to accurately describe the image size dependence of laser-induced retinal injuries and by a recently reported study which demonstrated that laser injuries to the retina might not appear for up to 48 h post exposure. We propose that at threshold a short-duration, laser-induced, temperature rise melts the membrane of the melanosomes found in the pigmented retinal epithelial cells. This results in the generation of free radicals which initiate a slow chain reaction. If more than a critical number of radicals are generated then cell death may occur at a time much later than the return of the retina to body temperature. We show that the equations consequent upon this mechanism result in a good fit to the recent image size data although more detailed experimental data for rate constants of elementary reactions is still required. This paper contributes to the current understanding of damage mechanisms in the retina and may facilitate the development of new treatments to mitigate laser injuries to the eye. The work will also help minimize the need for further animal experimentation to set laser eye safety standards.
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Affiliation(s)
- S J Till
- Defence Science and Technology Laboratory, Room PE206, Dstl. St. Andrews Road, Malvern, Worcestershire WR14 3PS, UK.
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Abstract
A child with familial atrial standstill and a ventricular pacemaker had syncope due to atrial flutter that was treated by His-bundle ablation. Bradycardia protection alone may be insufficient in patients with atrial standstill.
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Affiliation(s)
- S Balaji
- Royal Brompton Hospital, London, United Kingdom
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Walter JH, Wraith JE, White FJ, Bridge C, Till J. Strategies for the treatment of cystathionine beta-synthase deficiency: the experience of the Willink Biochemical Genetics Unit over the past 30 years. Eur J Pediatr 1998; 157 Suppl 2:S71-6. [PMID: 9587030 DOI: 10.1007/pl00014308] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Strategies for the treatment of cystathionine beta-synthase (CBS) deficiency include (1) increasing residual enzyme activity by giving pyridoxine in those patients with vitamin responsive variants, (2) reducing the load on the affected pathway with a low methionine diet and supplementing the diet with cysteine; and (3) giving betaine in order to utilise alternative pathways to remove homocyst(e)ine. In our experience of over 30 years in the diagnosis and management of patients with CBS deficiency, a normal outcome can only be achieved in patients diagnosed and treated from infancy. Pyridoxine combined with folic acid prevents further deterioration in pyridoxine responsive patients. Dietary treatment of patients with non-pyridoxine responsive CBS deficiency becomes more difficult outside childhood but since late complications are not uncommon must be continued for life. Betaine can be effective in this group but compliance is often poor.
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Affiliation(s)
- J H Walter
- Willink Biochemical Genetics Unit, Royal Manchester Children's Hospital, UK.
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Affiliation(s)
- L E Heptinstall
- Willink Biochemical Genetics Unit, Royal Manchester Children's Hospital, UK
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Besley GT, Lendon M, Broadhead DM, Till J, Heptinstall LE, Phillips B. Mitochondrial complex deficiencies in a male with cardiomyopathy and 3-methylglutaconic aciduria. J Inherit Metab Dis 1995; 18:221-3. [PMID: 7564252 DOI: 10.1007/bf00711772] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- G T Besley
- Willink Biochemical Genetics Unit, Royal Manchester Children's Hospital, UK
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Abstract
It has been suggested that QT dispersion recorded on the surface electrocardiogram may be a predictor of arrhythmic events in patients with congenital QT prolongation. To evaluate this, 9 patients (6 female, mean age 17.6 years) with congenital long QT syndromes, all of whom had syncope and documented torsades de pointes, were studied. Patients were studied off treatment and during therapy with beta-blocking agents. Three patients were also studied after left stellate ganglionectomy. An age-matched control group was also studied. Good quality 12-lead electrocardiograms were recorded from all patients. For each lead, QT and RR intervals were measured, and QTc value was calculated. QT and QTc dispersions were calculated for each patient. Patients had a significantly longer mean QT interval compared with that of the control group (450 +/- 100 vs 359 +/- 63 ms; p = 0.015) at similar mean RR intervals (736 +/- 231 vs 783 +/- 289 ms), with a longer mean QTc value (0.53 +/- 0.08 vs 0.41 +/- 0.02 s1/2; p = 0.004). Patients also had longer QT and QTc dispersions compared with those of the control group (110 +/- 45 vs 43 +/- 12 ms [p = 0.004], and 0.108 +/- 0.03 vs 0.05 +/- 0.02 s1/2 [p = 0.002], respectively). QT and QTc dispersions on and off beta-blocking agents were not significantly different. Comparing patients with frequent and those with infrequent symptoms, there was no difference in QT or QTc dispersion either off treatment or during therapy with beta-blocking agents.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- N J Linker
- St. George's Hospital and Medical School, Department of Cardiological Sciences, London, England
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Abstract
OBJECTIVE To highlight the association between atrial flutter and accessory connections in the fetus and young infant. DESIGN A retrospective review from January 1985 to January 1990. PATIENTS Fetuses, neonates, and young infants with atrial flutter. RESULTS Four fetuses and five infants presented with atrial flutter. In two fetuses and one infant sinus rhythm returned spontaneously. The other six required cardioversion. Three of them developed orthodromic atrioventricular re-entry tachycardia and each had evidence of an accessory connection. CONCLUSIONS Because atrial flutter in the fetus and neonate is rare, the high incidence of accessory connections in this group points to a possible aetiology of "idiopathic" atrial flutter in this age group.
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Affiliation(s)
- J Till
- Department of Paediatric Cardiology, Royal Brompton National Heart and Lung Hospital, London
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Affiliation(s)
- M Simpson
- Toronto-Bayview Regional Cancer Centre, University of Toronto, Ontario, Canada
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Abstract
This study examines the differences in workload estimates of three patient classification systems in nursing, within selected Case Mix Groups (CMGs). The amount of variation explained by selected patient-specific variables within CMGs on average nursing workload by each system is also analyzed. Results show that, when patient classification data are used to explain nursing time within the Diagnosis Related Group (DRG) context, absolute hours of care estimates of the various systems may not be equivalent. This inequality may result in biased budget review practices unless relational statements are developed between systems.
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Till J, Shinebourne EA, Rigby ML, Clarke B, Ward DE, Rowland E. Efficacy and safety of adenosine in the treatment of supraventricular tachycardia in infants and children. Heart 1989; 62:204-11. [PMID: 2789912 PMCID: PMC1216763 DOI: 10.1136/hrt.62.3.204] [Citation(s) in RCA: 98] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
One hundred and seventeen episodes of supraventricular tachycardia in 50 children, including 28 infants, were treated with intravenous adenosine. Adenosine was prepared in a sterile solution of 0.9% saline (1 mg/ml) and given in incremental doses of 0.05 mg/kg every two minutes to a maximum of 0.25 mg/kg. Ninety of the 117 episodes were terminated. This included 88 of the 102 episodes of junctional tachycardia (79 of the 92 episodes of atrioventricular reentry tachycardia, seven of the eight episodes of atrioventricular nodal reentry tachycardia, and both of the episodes of long R-P' tachycardia). Only one of four episodes of His bundle tachycardia and one of the eight episodes of ectopic atrial tachycardia were terminated. None of the three episodes of atrial flutter were terminated. Side effects were frequent but mild and included transient complete atrioventricular block (less than 6 s), sinus bradycardia (less than 40 s), ventricular extrasystoles, flushing, nausea, headache, and respiratory disturbance. Reinitiation (within 5 s) of supraventricular tachycardia occurred in 13 of the terminated episodes. Although reinitiation limited its clinical efficacy in some patients, intravenous adenosine offered a safe and efficient method of rapid termination of most episodes of supraventricular tachycardia and in some cases facilitated diagnosis of the mechanism.
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Affiliation(s)
- J Till
- Department of Paediatric Cardiology, Brompton Hospital, London
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O'Brien-Pallas L, Leatt P, Deber R, Till J. A comparison of workload estimates using three methods of patient classification. Can J Nurs Adm 1989; 2:16-23. [PMID: 2486682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This research examined the equivalence of the workload estimates of three commonly used patient classification systems in nursing (GRASP, PRN and Medicus). Patient classification systems are used for program costing and formulation of the nursing budgets. The findings suggest that the estimates of absolute hours of care provided by the three systems differ significantly when all three tools are used on the same patient population, particularly in the Intensive Care Units (ICUs). The data suggest that these differences result from the weights assigned to individual indicators within each system. Although hours of care estimates are significantly different, they are highly correlated. This research suggests that the estimates of hours and costs provided by different patient classification systems may involve clinically important differences. These discrepancies could result in inequitable funding practices unless mechanisms are developed for showing the relationships between systems.
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Abstract
Adenosine (0.05-0.25 mg/kg intravenously) successfully terminated resistant supraventricular tachycardia (SVT) in three seriously ill newborn infants and one older child. Termination of tachycardia was achieved in each case within 20 s. Adenosine, unlike many other anti-arrhythmic agents, has no substantial negative inotropic effect under these circumstances and may become the drug of choice in haemodynamically compromised children with SVT. However, it has no value in prophylaxis against recurrent SVT.
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Meadows NJ, Till J, Leaf A, Hughes E, Jani B, Larcher V. Screening for intrauterine growth retardation using ratio of mid-arm circumference to occipitofrontal circumference. Br Med J (Clin Res Ed) 1986; 292:1039-40. [PMID: 3083992 PMCID: PMC1340107 DOI: 10.1136/bmj.292.6527.1039] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Uncritical application of standard weight percentile charts, derived from white infants, to infants from different ethnic groups may result in an overestimate of the incidence of intrauterine growth retardation in those groups. The ratio of mid-arm circumference to occipitofrontal circumference was studied in 194 babies (49 Asian, 58 black, and 87 white). In contrast with birth weight the ratio did not vary among the ethnic groups; it was also independent of sex. In a prospective study of 64 neonates whose weight was below the 10th percentile on standard charts the ratio of mid-arm circumference to occipitofrontal circumference was a more accurate predictor than weight of those infants who would develop symptoms associated with intrauterine growth retardation. The ratio of mid-arm circumference to occipitofrontal circumference therefore provides a simple, accurate, and cheap way of assessing intrauterine growth retardation in areas with a large multiethnic population, where birth weight varies greatly.
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Maurer G, Till J. [Lesions of the gastric mucosa caused by blunt abdominal injury]. Z Gesamte Inn Med 1984; 39:105-6. [PMID: 6730583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Within a casuistic is reported on an 8-year-old boy who suffered from an intestinal haemorrhage due to a blunt abdominal trauma. Due to the endoscopic possibilities which are nowadays at our disposal appeared an alteration of the gastric mucous membrane in our opinion conditioned by contusion which from the macroscopic standpoint let us think of an ulceration. Theoretical fundaments as well as the anamnesis and the clinical course are correlated with our opinion to this case.
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Epstein CM, Gammon JA, Gemmill M, Till J. Visual evoked potential pattern generation, recording, and data analysis with a single microcomputer. Electroencephalogr Clin Neurophysiol 1983; 56:691-3. [PMID: 6197289 DOI: 10.1016/0013-4694(83)90038-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A single microcomputer is used to generate multiple sets of checkerboard patterns, simultaneously record EEG data for visual evoked potentials, and analyze the results by fast Fourier transform in very rapid sequence under operator control. This system permits efficient estimates of visual acuity in infants with ophthalmological and neuro-ophthalmological disease.
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Abstract
This investigation compared the simple reaction times of 10 idiopathic spasmodic dysphonic women and 10 normal-speaking women matched individually for age and handedness. The reaction time stimulus in all response conditions was the offset of a 1000-Hz pure tone. Two of the experimental conditions required right and left forefinger button pressing. The remaining four experimental conditions required phonatory responses. The nonspeech phonatory responses consisted of inspiratory phonation and expiratory throat clearing; the speech-like phonatory responses required abrupt initiation of the isolated vowel and the word. The spasmodic dysphonic patients differed (p less than or equal to .05) from their matched controls only during production of. The results are compared to previous reaction time investigations and are related to factors which potentially can influence sensory-motor pathways prior to and during speech.
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Abstract
This investigation compared the reaction times of thirteen stuttering and thirteen nonstuttering adults for forefinger button pressing, nonspeech vocal initiation, and speech-mode vocal initiation. The stutterers and nonstutterers were matched individually for age, sex, and handedness. The reaction-time stimulus in all response conditions was the offset of a 1000-Hz pure tone. Two of the experimental conditions required button pressing with the right and left forefingers. The remaining four responses required vocal-fold vibration. The nonspeech vocal activity consisted of inspiratory phonation and expiratory throat clearing. The speech-mode vocal activity required production of the isolated vowel and the word. The results demonstrated that stuttering and nonstuttering adults differed significantly only on tasks requiring speech phonation. These results are compared to previous reaction-time investigations and related to factors which may influence sensory-motor pathways prior to and during speech.
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