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Patel N, Leffler DA, Al-Toma A, Mulder CJ, Elli L, Gan G, Patil P, Atsawarungruangkit A, Kuijpers KC, Del Gobbo A, Goldsmith J, Hintze Z, Pacheco MC, Vieth M, Melcher B, Salomao M, Pai R, Hart J, Olivas A, Naini B, Meyerson C, Choi WT, Kakar S, Westerhoff M, Cheng J, Gopal P, Hammer S, Moreno Prats M, Bronner MP, Robert ME. Clinical Data Do Not Reliably Predict Duodenal Histology at Follow-up in Celiac Disease: A 13 Center Correlative Study. Am J Surg Pathol 2024; 48:212-220. [PMID: 37994653 DOI: 10.1097/pas.0000000000002150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Validated nonbiopsy methods to assure duodenal mucosal healing in celiac disease are lacking, yet ongoing mucosal injury is associated with anemia, osteoporosis, and lymphoma. Most providers utilize clinical data as surrogates of mucosal status to avoid additional esophagogastroduodenoscopy. The reliability of such surrogates to predict mucosal recovery has been incompletely evaluated. The aim of this study was to rigorously assess patterns of histologic mucosal recovery at follow-up in celiac disease and to correlate findings with clinical data. Gastrointestinal pathologists from 13 centers evaluated initial and follow-up duodenal biopsies from 181 celiac disease patients. Marsh scores and intraepithelial lymphocytes (IELs)/100 enterocytes were assessed blindly. Histology at follow-up was correlated with symptoms, immunoglobulin A anti-tissue transglutaminase titers and gluten-free diet adherence. Fifty-six/181 (31%) patients had persistent villous blunting and 46/181 (25%) patients had just persistently elevated IELs at follow-up, with only 79/181 (44%) patients having complete histologic remission. IEL normalization (82/181; 45%) lagged villous recovery (125/181;69%). In a minority of patients, villous blunting was limited to proximal duodenal biopsies. No correlation was found between Marsh scores and symptoms, normalization of immunoglobulin A anti-tissue transglutaminase serology, or diet adherence. Children showed greater recovery of Marsh score ( P <0.001) and IELs ( P <0.01) than adults. Persistent mucosal injury is common in celiac disease, with discordant villous/IEL normalization. Pathologist awareness of expected findings in celiac disease follow-up biopsies, including their frequent lack of correlation with clinical data, is important for patient management, and has implications for eligibility criteria for therapeutics currently in development.
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Affiliation(s)
| | | | | | - Chris J Mulder
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Luca Elli
- Center for Prevention and Diagnosis of celiac disease, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Italy
| | | | | | | | | | - Alessandro Del Gobbo
- Division of Pathology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Italy
| | | | | | | | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Balint Melcher
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | | | | | - John Hart
- University of Chicago Medical Center, Chicago, IL
| | | | | | | | - Won-Tak Choi
- Department of Pathology, University of California, San Francisco, CA
| | - Sanjay Kakar
- Department of Pathology, University of California, San Francisco, CA
| | | | - Jerome Cheng
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Purva Gopal
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Suntrea Hammer
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Mary P Bronner
- University of Utah Health Sciences Center and ARUP Labs, Salt Lake City, UT
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Desai N, Kudose S, Remotti HE, Del Portillo A, Fazlollahi L, Lee MJ, Xiong Y, Moreira RK, Salomao M, Fiel MI, Gonzalez RS, Misdraji J, Gill RM, Hart J, Kleiner DE, Drebber U, Bellizzi AM, Lagana SM. Erythrophagocytosis is not a reproducible finding in liver biopsies, and is not associated with clinical diagnosis of hemophagocytic lymphohistiocytosis. Virchows Arch 2024; 484:61-69. [PMID: 37924345 DOI: 10.1007/s00428-023-03683-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/12/2023] [Accepted: 10/20/2023] [Indexed: 11/06/2023]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare disease with high mortality. Liver involvement is common (based on elevated liver function tests) with most patients demonstrating acute hepatitis. Liver biopsies are frequently obtained in the setting of suspected HLH for the purpose of identification of erythrophagocytosis, and if present, this finding is thought to suggest or support the diagnosis of HLH. However, there are problems with this approach; in particular, we do not know whether this finding is reproducible or whether it is specific to HLH. Therefore, we conducted a multi-institutional study in which experienced liver pathologists reviewed images taken from liver biopsies from patients with normal liver, acute hepatitis, possible HLH, and clinical HLH to determine if there was agreement about the presence or absence of erythrophagocytosis, and to ascertain whether the finding corresponds to a clinical diagnosis of HLH. Twelve liver pathologists reviewed 141 images in isolation (i.e., no clinical information or diagnosis provided). These came from 32 patients (five normal, 17 acute hepatitis, six HLH, four possible HLH). The pathologists classified each image as negative, equivocal, or positive for erythrophagocytosis. Kappa was .08 (no agreement) for case-level and 0.1 for image-level (1.4% agreement, based on two images which were universally considered negative). There was no difference in the proportion of pathologists who diagnosed erythrophagocytosis among those with different diagnoses at case or image-level (p = 0.82 and p = 0.82, respectively). Thus, erythrophagocytosis is an entirely unreliable histologic parameter in liver, as it is irreproducible and not demonstrably associated with a clinical disease (namely, HLH). Unless and until more reliable guidelines can be established, pathologists should refrain from commenting on the presence or absence of erythrophagocytosis in liver biopsy.
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Affiliation(s)
- Niyati Desai
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 622 W 168th St.VC14-209A, New York, NY, 10032, USA
| | - Satoru Kudose
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 622 W 168th St.VC14-209A, New York, NY, 10032, USA
| | - Helen E Remotti
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 622 W 168th St.VC14-209A, New York, NY, 10032, USA
| | - Armando Del Portillo
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 622 W 168th St.VC14-209A, New York, NY, 10032, USA
| | - Ladan Fazlollahi
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 622 W 168th St.VC14-209A, New York, NY, 10032, USA
| | - Michael J Lee
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 622 W 168th St.VC14-209A, New York, NY, 10032, USA
| | - Yuqing Xiong
- Department of Pathology, Mass General Brigham, Boston, MA, USA
| | - Roger K Moreira
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Maria Isabel Fiel
- Department of Pathology, Mount Sinai School of Medicine, New York, NY, USA
| | - Raul S Gonzalez
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, USA
| | | | - Ryan M Gill
- Department of Pathology, University of California, San Francisco, San Francisco, USA
| | - John Hart
- Department of Pathology, University of Chicago, Chicago, USA
| | - David E Kleiner
- Laboratory of Pathology, National Cancer Institute, Bethesda, USA
| | - Uta Drebber
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | | | - Stephen M Lagana
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 622 W 168th St.VC14-209A, New York, NY, 10032, USA.
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Urcuyo JC, Curtin L, Langworthy JM, De Leon G, Anderies B, Singleton KW, Hawkins-Daarud A, Jackson PR, Bond KM, Ranjbar S, Lassiter-Morris Y, Clark-Swanson KR, Paulson LE, Sereduk C, Mrugala MM, Porter AB, Baxter L, Salomao M, Donev K, Hudson M, Meyer J, Zeeshan Q, Sattur M, Patra DP, Jones BA, Rahme RJ, Neal MT, Patel N, Kouloumberis P, Turkmani AH, Lyons M, Krishna C, Zimmerman RS, Bendok BR, Tran NL, Hu LS, Swanson KR. Image-localized biopsy mapping of brain tumor heterogeneity: A single-center study protocol. PLoS One 2023; 18:e0287767. [PMID: 38117803 PMCID: PMC10732423 DOI: 10.1371/journal.pone.0287767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/13/2023] [Indexed: 12/22/2023] Open
Abstract
Brain cancers pose a novel set of difficulties due to the limited accessibility of human brain tumor tissue. For this reason, clinical decision-making relies heavily on MR imaging interpretation, yet the mapping between MRI features and underlying biology remains ambiguous. Standard (clinical) tissue sampling fails to capture the full heterogeneity of the disease. Biopsies are required to obtain a pathological diagnosis and are predominantly taken from the tumor core, which often has different traits to the surrounding invasive tumor that typically leads to recurrent disease. One approach to solving this issue is to characterize the spatial heterogeneity of molecular, genetic, and cellular features of glioma through the intraoperative collection of multiple image-localized biopsy samples paired with multi-parametric MRIs. We have adopted this approach and are currently actively enrolling patients for our 'Image-Based Mapping of Brain Tumors' study. Patients are eligible for this research study (IRB #16-002424) if they are 18 years or older and undergoing surgical intervention for a brain lesion. Once identified, candidate patients receive dynamic susceptibility contrast (DSC) perfusion MRI and diffusion tensor imaging (DTI), in addition to standard sequences (T1, T1Gd, T2, T2-FLAIR) at their presurgical scan. During surgery, sample anatomical locations are tracked using neuronavigation. The collected specimens from this research study are used to capture the intra-tumoral heterogeneity across brain tumors including quantification of genetic aberrations through whole-exome and RNA sequencing as well as other tissue analysis techniques. To date, these data (made available through a public portal) have been used to generate, test, and validate predictive regional maps of the spatial distribution of tumor cell density and/or treatment-related key genetic marker status to identify biopsy and/or treatment targets based on insight from the entire tumor makeup. This type of methodology, when delivered within clinically feasible time frames, has the potential to further inform medical decision-making by improving surgical intervention, radiation, and targeted drug therapy for patients with glioma.
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Affiliation(s)
- Javier C Urcuyo
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Lee Curtin
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Jazlynn M. Langworthy
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Gustavo De Leon
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Barrett Anderies
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Kyle W. Singleton
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Andrea Hawkins-Daarud
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Pamela R. Jackson
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Kamila M. Bond
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Sara Ranjbar
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Yvette Lassiter-Morris
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Kamala R. Clark-Swanson
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Lisa E. Paulson
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Chris Sereduk
- Department of Cancer Biology, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Maciej M. Mrugala
- Department of Neurology, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Oncology, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Alyx B. Porter
- Department of Neurology, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Oncology, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Leslie Baxter
- Department of Neurophysiology, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Marcela Salomao
- Department of Pathology, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Kliment Donev
- Department of Pathology, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Miles Hudson
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Jenna Meyer
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Qazi Zeeshan
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Mithun Sattur
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Devi P. Patra
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Breck A. Jones
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Rudy J. Rahme
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Matthew T. Neal
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Naresh Patel
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Pelagia Kouloumberis
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Ali H. Turkmani
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Mark Lyons
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Chandan Krishna
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Richard S. Zimmerman
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Bernard R. Bendok
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Nhan L. Tran
- Department of Cancer Biology, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Leland S. Hu
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Kristin R. Swanson
- Mathematical NeuroOncology Lab, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Cancer Biology, Mayo Clinic, Phoenix, Arizona, United States of America
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, United States of America
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Akarca FG, Yozu M, Alpert L, Kővári BP, Zhao L, Salomao M, Liao X, Westerhoff M, Lauwers GY, Choi WT. Non-conventional dysplasia is frequently associated with low-grade tubuloglandular and mucinous adenocarcinomas in inflammatory bowel disease. Histopathology 2023. [PMID: 37055929 DOI: 10.1111/his.14922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/06/2023] [Accepted: 03/30/2023] [Indexed: 04/15/2023]
Abstract
There is limited information regarding the clinicopathological features of low-grade tubuloglandular (LGTGA) and mucinous (MAC) adenocarcinomas occurring in inflammatory bowel disease (IBD), especially with regard to their precursor lesions. METHODS AND RESULTS: Forty-six IBD colectomy specimens with LGTGA (n = 17) or MAC (n = 29) with adjacent precursor lesions were analysed. As controls, 12 IBD colectomy specimens with well- to moderately differentiated adenocarcinoma that lacked any mucinous, signet ring cell, low-grade tubuloglandular or serrated features were also analysed. Compared with MACs and controls, LGTGAs more often had a flat/invisible macroscopic appearance (LGTGAs = 88%, MACs = 34%, controls = 25%, P < 0.001). MACs were more likely to have high-grade differentiation (MACs = 31%, LGTGAs = 0%, controls = 0%, P = 0.002) and a higher pathological stage (pT3 and pT4 MACs = 76%, LGTGAs = 35%, controls = 33%, P = 0.007) than LGTGAs and controls. LGTGAs (70%) and MACs (53%) were more frequently associated with non-conventional dysplasia than controls (0%) (P < 0.001). Crypt cell (40%) and hypermucinous (34%) dysplasias were the most common non-conventional subtypes associated with LGTGAs and MACs, respectively. Synchronous dysplasia often demonstrated non-conventional features in the LGTGA (33%) and MAC (47%) groups (versus 0% for the control group, P = 0.074). Synchronous cancer frequently showed similar histological features as the main tumour (LGTGA group = 60%, MAC group = 38%, control group = 100%). CONCLUSIONS: Crypt cell and hypermucinous dysplasias are the most common precursor lesions associated with LGTGAs and MACs, respectively, and may serve as a marker of increased risk for these cancer subtypes.
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Affiliation(s)
- Fahire Goknur Akarca
- Department of Pathology, University of California at San Francisco, San Francisco, CA, USA
| | - Masato Yozu
- Histopathology Department, Middlemore Hospital, Auckland, New Zealand
| | - Lindsay Alpert
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Bence P Kővári
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Lei Zhao
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Xiaoyan Liao
- Department of Pathology, University of Rochester, Rochester, NY, USA
| | - Maria Westerhoff
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Gregory Y Lauwers
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Won-Tak Choi
- Department of Pathology, University of California at San Francisco, San Francisco, CA, USA
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Lin WH, Smadbeck J, Barrett M, Feathers R, Dorsay S, Johnson S, Karagouga G, Harris F, Murphy S, Quiñones-Hinojosa A, Kizilbash S, Burns T, Jaeckle K, Mrugala M, Bendok B, Moniz-Garcia D, Fortin-Ensign S, Rosenfeld S, Ida C, Jentoft M, Salomao M, Yang L, Emanuel A, Schaefer-Klein J, Mansfield A, Borad M, Cheville J, Vasmatzis G, Anastasiadis P. EXTH-20. IDENTIFICATION OF EX VIVO THERAPEUTIC VULNERABILITIES IN DIFFUSE GLIOMAS USING A FUNCTIONAL GENOMICS APPROACH. Neuro Oncol 2022. [PMCID: PMC9661043 DOI: 10.1093/neuonc/noac209.819] [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
Diffuse gliomas are aggressive brain tumors that lack effective therapies. Despite advances in the molecular characterization of gliomas, targeted treatments have failed to improve patient outcomes to date. Here, we employed a functional genomics approach to rapidly identify therapeutic vulnerabilities and provide a strategy to individualize patient treatment. Our process combined comprehensive genomic and transcriptomic tumor profiling, custom algorithms and visualization software for data integration, and preclinical 3-dimensional ex vivo models (mcancers) for drug screening to assess response to therapeutic agents targeting specific molecular alterations. A total of 32 cases, including 5 oligodendrogliomas (1 primary and 4 recurrent), 5 astrocytomas (1 primary and 4 recurrent), and 22 glioblastomas (5 primary and 17 recurrent), were included in the study. Immunohistochemistry and integrated genomics confirmed that mcancers maintain key molecular alterations, including mutations, chromosomal rearrangements and focal amplifications, cellularity, and heterogeneity, faithfully recapitulating the original tumor. A total of 119 single drugs and 183 combinations were tested, including a panel of 26-brain penetrant targeted agents (18 single drugs and 8 combinations) that was curated to target common glioma oncogenic pathways and was tested across all cases. A strong correlation was observed between therapeutic vulnerabilities of glioma mcancers to targeted agents (EGFR, MET, PDGFR, HDAC inhibitors, etc.) and clinical experience. Single agent activity of panel compounds in the ex vivo setting was generally poor, with only 35% mCancers exhibiting > 70% growth inhibition at Cmax. In contrast, combination strategies, especially ones including epigenetic drugs, were significantly more effective (affecting 22 out of 32 mCancers), underscoring the molecular complexity of gliomas and the need for clinical trials testing combination treatments. Our data identified a number of novel combination treatments with significant efficacy across glioma subtypes and molecular profiles, suggesting that our functional genomics pipeline can guide treatment selection and inform clinical trial enrollment for gliomas.
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Affiliation(s)
- Wan-Hsin Lin
- Department of Cancer Biology, Mayo Clinic , Jacksonville , USA
| | - James Smadbeck
- Biomarker DiBiomarker Discovery Program, Center for Individualized Medicine, Mayo Clinic, Mayo Clinic, , Rochester , USA
| | - Michael Barrett
- Department of Internal Medicine, Division of Hematology/Oncology, Mayo Clinic, , Scottsdale , USA
| | - Ryan Feathers
- Department of Cancer Biology, Mayo Clinic , Jacksonville , USA
| | - Sadeghian Dorsay
- Department of Laboratory Medicine and Pathology, Mayo Clinic, , Rochester , USA
| | - Sarah Johnson
- Biomarker Discovery Program, Center for Individualized Medicine, Mayo Clinic , Rochester , USA
| | - Giannoula Karagouga
- Biomarker Discovery Program, Center for Individualized Medicine, Mayo Clinic, , Rochester , USA
| | - Faye Harris
- Biomarker Discovery Program, Center for Individualized Medicine, Mayo Clinic, , Rochester , USA
| | - Stephen Murphy
- Biomarker Discovery Program, Center for Individualized Medicine, Mayo Clinic , Rochester , USA
| | | | - Sani Kizilbash
- Department of Medical Oncology, Mayo Clinic , Rochester, MN , USA
| | - Terry Burns
- Mayo Clinic, Rochester MN , Rochester, MN , USA
| | | | - Maciej Mrugala
- Mayo Clinic College of Medicine and Science, Mayo Clinic , Phoenix, AZ , USA
| | | | | | | | | | | | | | - Marcela Salomao
- Department of Laboratory Medicine and Pathology, Mayo Clinic , Scottsdale , USA
| | - Lin Yang
- Biomarker Discovery Program, Center for Individualized Medicine , Rochester , USA
| | - Angela Emanuel
- Precision Cancer Therapeutics Program, Center for Individualized Medicine, , Rochester , USA
| | - Janet Schaefer-Klein
- Precision Cancer Therapeutics Program, Center for Individualized Medicine, Mayo Clinic, , Rochester , USA
| | - Aaron Mansfield
- Precision Cancer Therapeutics Program, Center for Individualized Medicine, , Rochester , USA
| | - Mitesh Borad
- Precision Cancer Therapeutics Program, Center for Individualized Medicine, , Scottsdale , USA
| | - John Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic , Rochester , USA
| | - George Vasmatzis
- Biomarker Discovery Program, Center for Individualized Medicine , Rochester , USA
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Lizaola-Mayo B, Salomao M, Horsley-Silva JL. Diffuse Hemorrhagic Enterocolitis in the Setting of 2019 Coronavirus. Clin Gastroenterol Hepatol 2022; 20:A27-A28. [PMID: 33059039 PMCID: PMC7550062 DOI: 10.1016/j.cgh.2020.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 02/07/2023]
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7
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Choi WT, Salomao M, Zhao L, Alpert L, Setia N, Liao X, Drage MG, Westerhoff M, Cheng J, Lauwers GY, Ko HM. Hypermucinous, Goblet Cell-Deficient and Crypt Cell Dysplasias in Inflammatory Bowel Disease are Often Associated with Flat/Invisible Endoscopic Appearance and Advanced Neoplasia on Follow-Up. J Crohns Colitis 2022; 16:98-108. [PMID: 34232295 DOI: 10.1093/ecco-jcc/jjab120] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Several different types of non-conventional dysplasia have been recently described in inflammatory bowel disease [IBD]. Hypermucinous, goblet cell-deficient and crypt cell dysplasias have received most attention, but there is limited information regarding their clinicopathological features and clinical outcomes. METHODS A total of 126 cases of hypermucinous [n = 55], goblet cell-deficient [n = 26] and crypt cell [n = 45] dysplasias from 97 IBD patients were collected from seven different institutions and analysed. RESULTS The cohort included 62 [64%] men and 35 [36%] women with a mean age of 49 years [range: 20-78]. The majority of affected patients had longstanding IBD [mean duration: 18 years]. Nineteen [20%] patients had a concurrent history of primary sclerosing cholangitis. As a group, non-conventional dysplasia was predominantly found in patients with ulcerative colitis [UC] [n = 68; 70%] and occurred in the left colon [n = 80; 63%]; however, hypermucinous dysplasia [57%] was the least frequently associated with UC compared with goblet cell-deficient [74%] and crypt cell [89%] dysplasias [p = 0.016]. Fifty [52%] patients had a history of conventional dysplasia, detected in the same colonic segment as non-conventional dysplasia at a rate of 33%. Goblet cell-deficient dysplasia [74%] was more frequently associated with conventional dysplasia than hypermucinous [43%] and crypt cell [48%] dysplasias [p = 0.044]. While hypermucinous dysplasia often had a polypoid appearance [58%], crypt cell [96%] and goblet cell-deficient [65%] dysplasias were more likely to present as flat/invisible lesions [p < 0.001]. Most lesions were low-grade [87%] at diagnosis, but goblet cell-deficient dysplasia [31%] more often showed high-grade dysplasia [HGD] compared with hypermucinous [15%] and crypt cell [0%] dysplasias [p = 0.003]. Hypermucinous dysplasia usually demonstrated a tubulovillous/villous architecture [76%], whereas goblet cell-deficient dysplasia was predominantly tubular [92%]. A flat architecture was exclusively associated with crypt cell dysplasia [100%] [p < 0.001]. Immunohistochemical stain results for p53 were available for 33 lesions; 14 [42%] showed strong [3+] and patchy [10-50%] to diffuse [>50%] nuclear overexpression or null staining pattern, including four [33%] of 12 hypermucinous, two [29%] of seven goblet cell-deficient and eight [57%] of 14 crypt cell dysplastic lesions [p = 0.726]. Follow-up biopsies or resections were available for 92 low-grade lesions from 71 patients; 55 [60%] lesions, including 19 [49%] of 39 hypermucinous, 10 [59%] of 17 goblet cell-deficient and 26 [72%] of 36 crypt cell dysplastic lesions [p = 0.116], were associated with subsequent detection of HGD [n = 34; 37%] or adenocarcinoma [n = 21; 23%] at the site of previous biopsy or in the same colonic segment within a mean follow-up time of 12 months [range: <1-73]. CONCLUSIONS Hypermucinous, goblet cell-deficient and crypt cell dysplasias have distinct clinicopathological features but appear to have a similar high risk of association with advanced neoplasia [HGD or adenocarcinoma]. More than half of the lesions [66%] presented as flat/invisible dysplasia, suggesting that IBD patients may benefit from random biopsy sampling in addition to targeted biopsies. Although not uncommonly associated with conventional dysplasia, non-conventional dysplasia may be the only dysplastic subtype identified in IBD patients. Therefore, it is important to recognize these non-conventional subtypes and recommend complete removal and/or careful examination and follow-up.
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Affiliation(s)
- Won-Tak Choi
- University of California at San Francisco, Department of Pathology, San Francisco, CA, USA
| | | | - Lei Zhao
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, USA
| | - Lindsay Alpert
- University of Chicago, Department of Pathology, Chicago, IL, USA
| | - Namrata Setia
- University of Chicago, Department of Pathology, Chicago, IL, USA
| | - Xiaoyan Liao
- University of Rochester, Department of Pathology, Rochester, NY, USA
| | - Michael G Drage
- University of Rochester, Department of Pathology, Rochester, NY, USA
| | - Maria Westerhoff
- University of Michigan, Department of Pathology, Ann Arbor, MI, USA
| | - Jerome Cheng
- University of Michigan, Department of Pathology, Ann Arbor, MI, USA
| | - Gregory Y Lauwers
- H. Lee Moffitt Cancer Center, Department of Pathology, Tampa, FL, USA
| | - Huaibin Mabel Ko
- Icahn School of Medicine at Mount Sinai, Department of Pathology, New York, NY, USA
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Wang L, Yoon H, Hawkins-Daarud A, Singleton K, Clark-Swanson K, Smith K, Nakaji P, Eschbacher J, Baxter L, Gonzalez A, Nespodzany A, Bendok B, Patra D, De Leon G, Zimmerman R, Porter A, Krishna C, Salomao M, Hoxworth J, Zhou Y, Mrugala M, Tran N, Wu T, Swanson K, Li J, Hu L. NIMG-52. UNCERTAINTY QUANTIFICATION IN RADIOMICS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.721] [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
INTRODUCTION
The quantification of intratumoral heterogeneity – through radiomics-based approaches - can help resolve the regionally distinct genetic drug targets that may co-exist within a single Glioblastoma (GBM) tumor. While this offers potential diagnostic value under the paradigm of individualized oncology, clinical decision-making must also consider the degree of uncertainty associated with each model. In this study, we evaluate the performance of a novel machine-learning (ML) algorithm, called Gaussian Process (GP) modeling, that can quantify the impact of multiple sources of uncertainty in ML model development and prediction accuracy, including variabilities in the copy number measurement, radiomics features, training sample characteristics, and training sample size.
METHOD
We collected 95 image-localized biopsies from 25 primary GBM patients. We coregistered stereotactic locations with preoperative multi-parametric MRI features (conventional MRI, DSC perfusion, Diffusion Tensor Imaging) to generate spatially matched pairs of MRI and copy number variants (CNV) for for each biopsy. We developed a Gaussian Process (GP) model to predict CNV for Epidermal Growth Factor Receptor (EGFR) based on MRI radiomic features in each patient. We used leave-one-patient-out cross validation to quantify prediction accuracy and model uncertainty. Spatial prediction and uncertainty (p-value) maps were overlaid to help visualize regional genetic variation of EGFR and uncertainty of the radiomic predictions. RESULT: The initial GP radiomics model for EGFR amplification (CNV > 3.5) produced a sensitivity of 0.8 and specificity of 0.8. Samples/regions associated with high uncertainty (p-value >0.05) correlated with either 1) extrapolation of radiomic features from the training set-defined feature space or 2) insufficient training samples in the feature space.
CONCLUSION
We present a ML-based model that quantifies spatial genetic heterogeneity in GBM, while also estimating model uncertainties that result from multi-source data variabilities. This approach lays the groundwork for prospective clinical integration of modeling-based diagnostic approaches in the paradigm of individualized medicine.
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Affiliation(s)
- Lujia Wang
- Arizona State University, Tempe, AZ, USA
| | | | | | | | | | - Kris Smith
- Mayo Clinic Arizona, Scottsdale, AZ, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nhan Tran
- Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Teresa Wu
- Arizona State University, Tempe, AZ, USA
| | | | - Jing Li
- Arizona State University, Tempe, AZ, USA
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9
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Zhu C, Kim K, Wang X, Bartolome A, Salomao M, Dongiovanni P, Meroni M, Graham MJ, Yates KP, Diehl AM, Schwabe RF, Tabas I, Valenti L, Lavine JE, Pajvani UB. Hepatocyte Notch activation induces liver fibrosis in nonalcoholic steatohepatitis. Sci Transl Med 2018; 10:10/468/eaat0344. [PMID: 30463916 PMCID: PMC6822168 DOI: 10.1126/scitranslmed.aat0344] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/03/2018] [Accepted: 10/31/2018] [Indexed: 01/07/2023]
Abstract
Fibrosis is the major determinant of morbidity and mortality in patients with nonalcoholic steatohepatitis (NASH) but has no approved pharmacotherapy in part because of incomplete understanding of its pathogenic mechanisms. Here, we report that hepatocyte Notch activity tracks with disease severity and treatment response in patients with NASH and is similarly increased in a mouse model of diet-induced NASH and liver fibrosis. Hepatocyte-specific Notch loss-of-function mouse models showed attenuated NASH-associated liver fibrosis, demonstrating causality to obesity-induced liver pathology. Conversely, forced activation of hepatocyte Notch induced fibrosis in both chow- and NASH diet-fed mice by increasing Sox9-dependent Osteopontin (Opn) expression and secretion from hepatocytes, which activate resident hepatic stellate cells. In a cross-sectional study, we found that OPN explains the positive correlation between liver Notch activity and fibrosis stage in patients. Further, we developed a Notch inhibitor [Nicastrin antisense oligonucleotide (Ncst ASO)] that reduced fibrosis in NASH diet-fed mice. In summary, these studies demonstrate the pathological role and therapeutic accessibility of the maladaptive hepatocyte Notch response in NASH-associated liver fibrosis.
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Affiliation(s)
- Changyu Zhu
- Department of Medicine, Columbia University, New York, NY 10032, USA
| | - KyeongJin Kim
- Department of Medicine, Columbia University, New York, NY 10032, USA
| | - Xiaobo Wang
- Department of Medicine, Columbia University, New York, NY 10032, USA
| | - Alberto Bartolome
- Department of Medicine, Columbia University, New York, NY 10032, USA
| | - Marcela Salomao
- Department of Pathology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Paola Dongiovanni
- Department of Pathophysiology and Transplantation, Università degli Studi Milano, and Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca’ Granda Ospedale Policlinico, Milan 20122, Italy
| | - Marica Meroni
- Department of Pathophysiology and Transplantation, Università degli Studi Milano, and Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca’ Granda Ospedale Policlinico, Milan 20122, Italy
| | | | - Katherine P. Yates
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Anna Mae Diehl
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Robert F. Schwabe
- Department of Medicine, Columbia University, New York, NY 10032, USA
| | - Ira Tabas
- Department of Medicine, Columbia University, New York, NY 10032, USA
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, Università degli Studi Milano, and Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca’ Granda Ospedale Policlinico, Milan 20122, Italy
| | - Joel E. Lavine
- Department of Pediatrics, Columbia University, New York, NY 10032, USA
| | - Utpal B. Pajvani
- Department of Medicine, Columbia University, New York, NY 10032, USA.,Corresponding author.
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10
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Fernandes DM, Pantangi V, Azam M, Salomao M, Iuga AC, Lefkowitch JH, Gill J, Morotti R, Lavine JE, Mencin AA. Pediatric Nonalcoholic Fatty Liver Disease in New York City: An Autopsy Study. J Pediatr 2018; 200:174-180. [PMID: 29903531 DOI: 10.1016/j.jpeds.2018.04.047] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/26/2018] [Accepted: 04/20/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the prevalence and severity of nonalcoholic liver disease (NAFLD) in children in a diverse population sample in New York City. STUDY DESIGN Liver specimens were examined from children 2-19 years old who died of unexpected causes within 48 hours of medical presentation and underwent autopsy in New York City from 2005 to 2010. Records were reviewed for age, sex, weight, height, and race. Two hepatopathologists evaluated each liver specimen to determine pathologic diagnosis. RESULTS The final study cohort (n = 582) was 50% black, 33% Hispanic, 12% white, 3% Asian, and 2% other; 36% had a body mass index >85%. There were 26 cases of NAFLD (4.5%) of which 10 had nonalcoholic steatohepatitis (1.7%). There were no cases with severe fibrosis or cirrhosis. One percent (3/290) of black children had NAFLD and none had nonalcoholic steatohepatitis. White and Hispanic children had the highest percentages of NAFLD at 8.3% and 7.9%, respectively. In multiple logistic regression models, we observed that body mass index z-score (P < .001) was associated with NAFLD, and that white (P = .003) and Hispanic (P = .005) children had higher odds of having NAFLD compared with black children. CONCLUSIONS This review of liver tissue demonstrates a lower prevalence and severity of NAFLD in black children compared with the general obese pediatric population. Hispanic children did not have a significantly increased rate of NAFLD compared with white children, most likely related to the large proportion of Caribbean Hispanic children in New York City.
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Affiliation(s)
| | | | - Muhammad Azam
- St. George's University Hospital, London, United Kingdom
| | | | - Alina C Iuga
- Columbia University Medical Center, New York, NY
| | | | - James Gill
- Office of the Chief Medical Examiner, Farmington, CT
| | | | | | - Ali A Mencin
- Columbia University Medical Center, New York, NY.
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11
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DeLeon T, Lee DD, Salomao M, Girardo ME, Rosen CB, Heimbach J, Moss AA, Mathur A, Harnois DM, Aqel BA, Rizvi SH, Mody K, Sonbol MB, Kosiorek HE, Borad MJ. Assessing clinical outcomes following liver transplantation in intrahepatic cholangiocarcinoma and mixed hepatocellular carcinoma-cholangiocarcinoma patients: The Mayo Clinic experience. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16114] [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: 11/20/2022] Open
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12
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Oklu R, Yu X, Salomao M, Albadawi H. 4:21 PM Abstract No. 100 Needle-based piezoelectric systems for guided biopsy tissue targeting. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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13
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DeLeon T, Alberts SR, McWilliams RR, Hubbard JM, Ahn DH, Bekaii-Saab TS, Mody K, Roberts LR, Salomao M, Kipp B, Halfdanarson TR, Murtaza M, Ramanathan RK, Dueck AC, Borad MJ. A pilot study of ponatinib in cholangiocarcinoma patients with FGFR2 fusions. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.tps532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS532 Background: Recent studies have shown that FGFR2 fusions may represent recurrent (prevalence ~10-15% in larger cohorts) driver events amenable to therapeutic targeting in patients with advanced, intrahepatic cholangiocarcinoma. Methods: This single arm pilot study (NCT02265341) is being conducted at 3 centers (Mayo Clinic Arizona, Mayo Clinic Florida and Mayo Clinic Rochester; enrollment initiated December 2014). Next-generation sequencing based assays and a FISH-break apart assay are used to identify tumors with FGFR2 fusions. Patients must additionally have histologically/cytologically confirmed cholangiocarcinoma, ECOG performance score 0-2, measurable disease, preserved hematologic/renal and hepatic function and absence of cardiac events/stroke in the preceding 6 months. Ponatinib is administered at 45 mg once daily. Patients will be treated until disease progression, intolerable toxicity or patient decision to not pursue further therapy. The primary objective of the study is to estimate the clinical benefit rate (defined as composite of partial response rate, complete response rate and stable disease rate ≥ 4 months; as defined by RECIST criteria v1.1). Secondary endpoints include estimation of progression-free survival, overall survival, CA19-9 response rate (defined as > 50% reduction from baseline) and evaluation of the overall adverse event profile of ponatinib in this patient population. Translational objectives include serial circulating DNA (ct-DNA) monitoring, target knockdown assessments in tumor tissue (p-FGFR2, p-FRS2, p-Akt and p-ERK) and evaluation of mechanisms of resistance through comparison of baseline and progression biopsy samples using multi-platform sequencing (exome, RNA-Seq and methyl-Seq). Additionally, quality of life assessments will be evaluated using EORTC-QLQ-C30 and BIL21 tools. A total of 30 patients will be enrolled into the study (12 of 30 patients have been enrolled). The trial is designed using an underlying assumption of clinical benefit rate (CBR) of 5% with significance level of 0.15 and 80% power to detect a 20% CBR. Clinical trial information: NCT02265341.
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14
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DeLeon T, Salomao M, Aqel BA, Sonbol MB, Bryce AH, Borad MJ. Pilot evaluation of PD-1 inhibition in metastatic cancer patients with liver transplantations (LT): The Mayo Clinic experience. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
328 Background: Patients with a history of solid organ transplants have been excluded from PD-1/PD-L1 inhibitor clinical trials due to concern for graft rejection. Only 2 case reports of PD-1 inhibitor use in patients with liver transplantation (LT) have been reported thus far. Here, we report our experience with using checkpoint inhibitors in metastatic cancer patients with LT. Methods: A single center pilot evaluation was conducted to evaluate the safety and efficacy of PD-1/PD-L1 inhibitors in patients with LT. PD-L1 staining on both the tumor and allograft were assessed if there was available tissue. The primary endpoint was evaluation of the risk for allograft rejection. Secondary endpoints included RECIST v1.1 and Immune-Related Response criteria (iRC) response rates, progression free survival (PFS) and overall survival (OS). Translational objectives included the relationship of PD-L1/PD-1 staining of tumor/allograft with response and rejection. Results: Six metastatic cancer patients with a history of LT received PD-1 inhibitor therapy (hepatocellular n=5, melanoma n=1). 3 patients were on mTOR inhibitor as immunosuppressive regimen and 3 on calcineurin inhibitor. Overall, allograft rejection was observed in 1/6 patients (on mTOR inhibitor). One patient achieved a CR (melanoma), 3 patients had PD and 2 patients discontinued therapy prior to restaging assessments. A single response (by both RECIST v1.1 and iRC) and rejection were reported in patients who received mTOR inhibitors (1 of 3). Three patients were tested for PD-L1 staining in the allograft tissue and all of them were negative (0% staining) with no graft rejections observed. Four patients had tumor PD-L1 evaluated (2 patients tested positive with 1 patient obtained a CR). The median OS, PFS and duration of therapy were 1.2, 1.8 and 1.2 months respectively. Conclusions: In this pilot evaluation of PD-1/PD-L1 inhibitors in LT patients both preliminary efficacy (1 of 4) and allograft rejection (1 of 6) was exhibited. Larger, prospective trials are needed to elucidate optimal patient and immunosuppressive regimen selection in these patients.
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Abstract
OBJECTIVES Graft-vs-host disease (GVHD) is a donor T-cell-mediated disorder affecting the recipient's skin, gastrointestinal tract, lungs, and liver. It complicates up to 70% of hematopoietic cell transplantation and is associated with high morbidity and mortality rates. METHODS An extensive review of the literature has been performed to include the most current consensus on the histopathologic diagnosis of gastrointestinal and liver GVHD. RESULTS In this review, we present an overview of GVHD, with emphasis on the histopathologic evaluation of gastrointestinal and liver specimens, including the most important differential diagnoses and possible pitfalls. CONCLUSIONS Histopathologic examination remains the mainstay of diagnosis of gastrointestinal and liver GVHD and is interpreted in conjunction with clinical and laboratory data.
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Affiliation(s)
- Marcela Salomao
- From the Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY;
| | - Kathleen Dorritie
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh Medical Center and the University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - Markus Y Mapara
- Department of Medicine, Division of Hematology/Oncology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Antonia Sepulveda
- From the Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY
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16
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Margolskee E, Bao F, de Gonzalez AK, Moreira RK, Lagana S, Sireci AN, Sepulveda AR, Remotti H, Lefkowitch JH, Salomao M. Hepatocellular adenoma classification: a comparative evaluation of immunohistochemistry and targeted mutational analysis. Diagn Pathol 2016; 11:27. [PMID: 26961851 PMCID: PMC4784347 DOI: 10.1186/s13000-016-0475-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/24/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Four subtypes of hepatocellular adenomas (HCA) are recognized: hepatocyte-nuclear-factor-1α mutated (H-HCA), β-catenin-mutated type with upregulation of glutamine synthetase (b-HCA), inflammatory type (IHCA) with serum-amyloid-A overexpression, and unclassified type. Subtyping may be useful since b-HCA appear to have higher risk of malignant transformation. We sought to apply subtype analysis and assess histological atypia, correlating these with next-generation sequencing analysis. METHODS Twenty-six HCA were stained with serum amyloid A (SAA), liver fatty acid-binding protein (LFABP), glutamine synthetase (GS), and β-catenin IHC, followed by analysis with a targeted multiplex sequencing panel. RESULTS By IHC, 4 HCA (15.4 %) were classified as b-HCA, 11 (42.3 %) as IHCA, 9 (34.6 %) as H-HCA, and two (7.7 %) unclassifiable. Eight HCA (30.8 %) showed atypia (3 b-HCA, 4 IHCA and 1 H-HCA). Targeted sequencing confirmed HNF1A mutations in all H-HCA, confirming reliability of LFABP IHC in identifying these lesions. CTNNB1 mutations were detected in 1 of 4 (25 %) of GS/β-catenin-positive cases, suggesting that positive GS stain does not always correlate with CTNNB1 mutations. CONCLUSIONS Immunohistochemistry does not consistently identify b-HCA. Mutational analysis improves the diagnostic accuracy of β-catenin-mutated HCA and is an important tool to assess risk of malignancy in HCA.
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Affiliation(s)
- Elizabeth Margolskee
- Department of Pathology and Cell Biology, Columbia University Medical Center, 630 W 168th Street, VC14-238, New York, NY, 10032, USA.
| | - Fei Bao
- Department of Pathology, Scripps Clinic, La Jolla, CA, USA.
| | - Anne Koehne de Gonzalez
- Department of Pathology and Cell Biology, Columbia University Medical Center, 630 W 168th Street, VC14-238, New York, NY, 10032, USA.
| | | | - Stephen Lagana
- Department of Pathology and Cell Biology, Columbia University Medical Center, 630 W 168th Street, VC14-238, New York, NY, 10032, USA.
| | - Anthony N Sireci
- Department of Pathology and Cell Biology, Columbia University Medical Center, 630 W 168th Street, VC14-238, New York, NY, 10032, USA.
| | - Antonia R Sepulveda
- Department of Pathology and Cell Biology, Columbia University Medical Center, 630 W 168th Street, VC14-238, New York, NY, 10032, USA.
| | - Helen Remotti
- Department of Pathology and Cell Biology, Columbia University Medical Center, 630 W 168th Street, VC14-238, New York, NY, 10032, USA.
| | - Jay H Lefkowitch
- Department of Pathology and Cell Biology, Columbia University Medical Center, 630 W 168th Street, VC14-238, New York, NY, 10032, USA.
| | - Marcela Salomao
- Department of Pathology and Cell Biology, Columbia University Medical Center, 630 W 168th Street, VC14-238, New York, NY, 10032, USA.
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17
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Lagana SM, Salomao M, Remotti HE, Knisely AS, Moreira RK. Bile salt export pump: a sensitive and specific immunohistochemical marker of hepatocellular carcinoma. Histopathology 2015; 66:598-602. [PMID: 25378077 DOI: 10.1111/his.12601] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 08/18/2014] [Accepted: 11/02/2014] [Indexed: 12/14/2022]
Abstract
AIMS Bile salt export pump (BSEP) is a transporter expressed exclusively at hepatic canaliculi and drives bile-salt efflux. Minimal data exist about BSEP expression in tumours. We hypothesized that BSEP immunohistochemistry would be specific for hepatocellular carcinoma (HCC). METHODS AND RESULTS Tissue microarrays, including 48 HCC, 41 cholangiocarcinomas and 24 metastatic tumours in liver, were immunostained for BSEP. Expression was compared with common markers of hepatocytic differentiation including CD10, hepatocyte paraffin-1 antigen (HepPar-1), carcinoembryonic antigen, arginase-1 (ARG) and glypican-3 (GPC-3). BSEP expression was assessed in normal tissues. Special attention was given to adrenal gland (normal and neoplasia). BSEP was easy to interpret and showed no background staining. Canalicular expression was seen in all normal livers, but not in other normal tissue. BSEP was 90% sensitive and 100% specific for HCC (canalicular in 33 of 43 positive cases). The sensitivity of ARG was slightly higher, but specificity was slightly lower (94% for both). HepPar-1 was 90% sensitive and 97% specific. CD10, polyclonal carcinoembryonic antigen (pCEA) and GPC-3 all had lower sensitivity (74, 81 and 54%, respectively). CONCLUSIONS In malignant tumours in the liver, BSEP marking was 100% specific and 90% sensitive for HCC. The specificity of BSEP for HCC obviates the need to identify a 'canalicular' pattern, which can limit the utility of other canalicular markers.
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Affiliation(s)
- Stephen M Lagana
- Department of Pathology and Cell Biology, Columbia University/New York Presbyterian Hospital, New York, NY, USA
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18
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Salomao M, Gonda TA, Margolskee E, Eguia V, Remotti H, Poneros JM, Sethi A, Saqi A. Strategies for improving diagnostic accuracy of biliary strictures. Cancer Cytopathol 2015; 123:244-52. [PMID: 25564796 DOI: 10.1002/cncy.21509] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 08/25/2014] [Revised: 10/14/2014] [Accepted: 11/03/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Brush cytology is the initial intervention when evaluating biliary strictures. Biliary brush cytology is known for its low sensitivity (but high specificity) and may be accompanied by biopsies and/or fluorescent in situ hybridization (FISH) to improve diagnostic yield. This study aimed to identify features to enhance cytological sensitivity, and assess which sampling method(s) improve identification of pancreatobiliary adenocarcinomas (PBCa). METHODS Seventy-three biliary stricture cases were retrieved (38 PBCa and 35 control benign strictures). Biliary brushings, FISH, and biopsies were reviewed. Cytology specimens were evaluated for cellularity and presence of drunken honeycomb (DH), loosely cohesive clusters of round cells (LCCRC), large atypical cells with foamy cytoplasm (LACF), and single vacuolated malignant cells (SCs). Biopsies were examined for the presence of stromal invasion (SI). RESULTS Biliary brushings were scantly cellular in 47.4% of PBCa and 51.4% of controls, resulting in 69.6% nondiagnostic/false-negative cytology diagnoses. DH, LACF, and SCs were significantly associated with adenocarcinoma (P < .00001, .0033, and .00002, respectively). By univariate analysis, SCs and LACF were predictors of malignancy in brushings (P = .0002 and .05). By multivariate analysis, only SCs were predictive of malignancy (P = .002). SI facilitated the diagnosis in 9 biopsies. Sensitivity/specificity of brush cytology, FISH, and biopsy were 39.5%/94.3%, 63.9%/94.3%, and 84.2%/100%, respectively. CONCLUSIONS The low sensitivity of biliary brushings results from limited cellularity. Identification of LACF, DH, and SCs improves sensitivity. Sampling of stromal tissue may facilitate PBCa diagnosis. Concurrent biopsies and FISH are helpful in enhancing the diagnostic yield of PBCa.
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Affiliation(s)
- Marcela Salomao
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
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19
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Siegel AB, Goyal A, Salomao M, Wang S, Lee V, Hsu C, Rodriguez R, Hershman DL, Brown RS, Neugut AI, Emond J, Kato T, Samstein B, Faleck D, Karagozian R. Serum adiponectin is associated with worsened overall survival in a prospective cohort of hepatocellular carcinoma patients. Oncology 2014; 88:57-68. [PMID: 25300295 DOI: 10.1159/000367971] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/24/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the third leading cause of cancer deaths worldwide. The rise in metabolic syndrome has contributed to this trend. Adipokines, such as adiponectin, are associated with prognosis in several cancers, but have not been well studied in HCC. METHODS We prospectively enrolled 140 patients with newly diagnosed or recurrent HCC with Child-Pugh (CP) class A or B cirrhosis. We examined associations between serum adipokines, clinicopathological features of HCC, and time to death. We also examined a subset of tumors with available pathology for tissue adiponectin receptor (AR) expression by immunohistochemistry. RESULTS The median age of subjects was 62 years; 79% were men, 59% had underlying hepatitis C, and 36% were diabetic. Adiponectin remained a significant predictor of time to death (hazard ratio 1.90; 95% confidence interval 1.05-3.45; p = 0.03) in a multivariable adjusted model that included age, alcohol history, CP class, stage, and serum α-fetoprotein level. Cytoplasmic AR expression (AR1 and AR2) in tumors trended higher in those with higher serum adiponectin levels and in those with diabetes mellitus, but the association was not statistically significant. CONCLUSIONS In this hypothesis-generating study, we found the serum adiponectin level to be an independent predictor of overall survival in a diverse cohort of HCC patients. IMPACT Understanding how adipokines affect the HCC outcome may help develop novel treatment and prevention strategies.
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Affiliation(s)
- Abby B Siegel
- Department of Medicine, Columbia University Medical Center, New York, N.Y., USA
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Hassid BG, Lucas AL, Salomao M, Weng C, Liu F, Khanna LG, Kumar S, Hwang C, Chabot JA, Frucht H. Absence of pancreatic intraepithelial neoplasia predicts poor survival after resection of pancreatic cancer. Pancreas 2014; 43:1073-7. [PMID: 24987871 PMCID: PMC4161626 DOI: 10.1097/mpa.0000000000000161] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Pancreatic intraepithelial neoplasia (PanIN), thought to represent the dominant precursor of pancreatic adenocarcinoma (PDAC), is often found synchronously adjacent to resected PDAC tumors. However, its prognostic significance on outcome after PDAC resection is unknown. METHODS A total of 342 patients who underwent resection for PDAC between 2005 and 2010 at a single institution were identified and stratified according to highest grade of PanIN demonstrated surrounding the tumor. Clinical and pathologic characteristics of each patient and tissue were recorded and analyzed. The primary outcome was length of survival after resection. RESULTS An absence of PanIN lesions was identified in 32 patients (9%), low grade PanIN without synchronous high grade lesions was identified in 52 patients (15%), and high grade PanIN was found in 258 patients (75%). Median survival were 12.8 months for the non-PanIN group, 26.3 months for the low-grade PanIN group, and 23.8 months for the high-grade PanIN groups (P = 0.043). In multivariable analysis, absence of PanIN was independently associated with poor survival (P = 0.002). CONCLUSIONS The patients who demonstrate an absence of PanIN in the pancreatic tissue adjacent to the resected PDAC tumor have shorter postresection survival compared with those who demonstrate a PanIN lesion.
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Affiliation(s)
- Benjamin G. Hassid
- Department of Medicine, Columbia University, New York, New York, United States
| | - Aimee L. Lucas
- Department of Medicine, Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Marcela Salomao
- Department of Pathology and Cell Biology, Columbia University New York, New York, United States
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - Feng Liu
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - Lauren G. Khanna
- Department of Medicine, Columbia University, New York, New York, United States
| | - Sheila Kumar
- Department of Medicine,Stanford University, Stanford, California, United States
| | - Caroline Hwang
- Department of Medicine, Keck School of Medicine of University of Southern California, California, United States
| | - John A. Chabot
- Department of Surgery, Columbia University, New York, New York, United States
| | - Harold Frucht
- Department of Medicine, Columbia University, New York, New York, United States
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21
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Salomao M, Levy B, Nahum O, Chen J, Mansukhani M, Borczuk AC. Genomic alterations in pulmonary adenocarcinoma in situ in an adolescent patient. Arch Pathol Lab Med 2014; 138:559-63. [PMID: 24678688 DOI: 10.5858/arpa.2012-0741-cr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lung cancer is a rare event in the pediatric and adolescent population. To date, only a few case reports and small case series have been published, and little is known about the risk factors associated with this entity in children and adolescents. We describe a case of adenocarcinoma in situ in a 15-year-old adolescent girl with previous surgical treatment for malignant melanoma. We provide a detailed genomic characterization of this neoplasm by comparative genomic hybridization, genome-wide single-nucleotide polymorphism array, and fluorescence in situ hybridization analyses. We identify chromosomal regions with copy number changes and correlate the corresponding genes within these regions with the available literature in the area.
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Affiliation(s)
- Marcela Salomao
- From the Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
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22
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Salomao M, Remotti H, Allendorf JD, Poneros JM, Sethi A, Gonda TA, Saqi A. Fine-needle aspirations of pancreatic serous cystadenomas: improving diagnostic yield with cell blocks and α-inhibin immunohistochemistry. Cancer Cytopathol 2013; 122:33-9. [PMID: 23939868 DOI: 10.1002/cncy.21347] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 06/17/2013] [Accepted: 07/12/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND The diagnosis of serous cystadenoma (SCA), a rare benign pancreatic neoplasm, can alter the management of patients with pancreatic masses. Although characteristic imaging findings and fluid chemical analysis have been described, SCAs are not always recognized preoperatively. Furthermore, scant cellular yield on fine-needle aspiration (FNA) often leads to a nondiagnostic or nonspecific benign diagnosis. α-Inhibin (AI), a sensitive marker for SCA, is infrequently required for diagnosis in surgical specimens due to their characteristic histologic appearance. The objective of the current study was to determine whether AI staining can improve SCA diagnosis on FNA specimens. METHODS Fifteen confirmed cases of SCA with prior FNA specimens were selected for this study. FNAs were evaluated for cellularity, cellular arrangement, and cytomorphology. Resection specimens were reviewed. RESULTS Of the 15 FNA cases, approximately 75% demonstrated scant cellularity (11 of 15 cases). On smears, the cells were arranged as flat sheets, corresponding to strips of cells on cell block sections. The cells were small and round to cuboidal, with clear cytoplasm; occasional plasmacytoid cells and oncocytic cells were identified. Flattened cells, corresponding to attenuated epithelial cells lining macrocysts on the resections, were also noted. Stromal fragments were present in 5 FNAs and correlated with the hyalinized stroma in the resection specimens. AI immunostaining was positive in 88% of cases (7 of 8 of cases), thereby supporting the diagnosis of SCA. CONCLUSIONS The results of the current study indicate that low cellularity and bland cytology are inherent to SCAs. Performing cell blocks and AI staining on FNA specimens is useful for establishing the diagnosis of SCA. An immunohistochemical panel including AI, chromogranin, and synaptophysin may enhance the diagnostic accuracy of pancreatic FNA specimens.
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Affiliation(s)
- Marcela Salomao
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
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23
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Moreira RK, Salomao M. The steatohepatitic variant of hepatocellular carcinoma and its association with underlying steatohepatitis—Reply. Hum Pathol 2012. [DOI: 10.1016/j.humpath.2011.12.015] [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: 10/28/2022]
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25
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Blanc L, Salomao M, Guo X, An X, Gratzer W, Mohandas N. Control of erythrocyte membrane-skeletal cohesion by the spectrin-membrane linkage. Biochemistry 2010; 49:4516-23. [PMID: 20433199 DOI: 10.1021/bi1003684] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Spectrin tetramer is the major structural member of the membrane-associated skeletal network of red cells. We show here that disruption of the spectrin-ankyrin-band 3 link to the membrane leads to dissociation of a large proportion of the tetramers into dimers. Noncovalent perturbation of the linkage was induced by a peptide containing the ankyrin-binding site of the spectrin beta-chain, and covalent perturbation by treatment with the thiol reagent, N-ethylmaleimide (NEM). This reagent left the intrinsic self-association capacity of the spectrin dimers unaffected and disturbed only the ankyrin-band 3 interaction. The dissociation of spectrin tetramers on the membrane into functional dimers was confirmed by the binding of a spectrin peptide directed against the self-association sites. Dissociation of the tetramers resulted, we infer, from detachment of the proximal ends of the constituent dimers from the membrane, thereby reducing their proximity to one another and thus weakening their association. The measured affinity of the interaction of the peptides with the free dimer ends on the membrane permits an estimate of the equilibrium between intact and dissociated tetramers on the native membrane. This indicates that in the physiological state the equilibrium proportion of the dissociated tetramers may be as high as 5-10%. These findings enabled us to identify an additional important functional role for the spectrin-ankyrin-band 3 link in regulating spectrin self-association in the red cell membrane.
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Affiliation(s)
- Lionel Blanc
- Red Cell Physiology Laboratory, New York Blood Center, New York, New York 10065, USA.
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26
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Murphy SC, Fernandez-Pol S, Chung PH, Prasanna Murthy SN, Milne SB, Salomao M, Brown HA, Lomasney JW, Mohandas N, Haldar K. Cytoplasmic remodeling of erythrocyte raft lipids during infection by the human malaria parasite Plasmodium falciparum. Blood 2007; 110:2132-9. [PMID: 17526861 PMCID: PMC1976375 DOI: 10.1182/blood-2007-04-083873] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Studies of detergent-resistant membrane (DRM) rafts in mature erythrocytes have facilitated identification of proteins that regulate formation of endovacuolar structures such as the parasitophorous vacuolar membrane (PVM) induced by the malaria parasite Plasmodium falciparum. However, analyses of raft lipids have remained elusive because detergents interfere with lipid detection. Here, we use primaquine to perturb the erythrocyte membrane and induce detergent-free buoyant vesicles, which are enriched in cholesterol and major raft proteins flotillin and stomatin and contain low levels of cytoskeleton, all characteristics of raft microdomains. Lipid mass spectrometry revealed that phosphatidylethanolamine and phosphatidylglycerol are depleted in endovesicles while phosphoinositides are highly enriched, suggesting raft-based endovesiculation can be achieved by simple (non-receptor-mediated) mechanical perturbation of the erythrocyte plasma membrane and results in sorting of inner leaflet phospholipids. Live-cell imaging of lipid-specific protein probes showed that phosphatidylinositol (4,5) bisphosphate (PIP(2)) is highly concentrated in primaquine-induced vesicles, confirming that it is an erythrocyte raft lipid. However, the malarial PVM lacks PIP(2), although another raft lipid, phosphatidylserine, is readily detected. Thus, different remodeling/sorting of cytoplasmic raft phospholipids may occur in distinct endovacuoles. Importantly, erythrocyte raft lipids recruited to the invasion junction by mechanical stimulation may be remodeled by the malaria parasite to establish blood-stage infection.
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Affiliation(s)
- Sean C Murphy
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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27
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An X, Zhang X, Salomao M, Guo X, Yang Y, Wu Y, Gratzer W, Baines AJ, Mohandas N. Thermal stabilities of brain spectrin and the constituent repeats of subunits. Biochemistry 2007; 45:13670-6. [PMID: 17087521 PMCID: PMC4401158 DOI: 10.1021/bi061368x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The different genes that encode mammalian spectrins give rise to proteins differing in their apparent stiffness. To explore this, we have compared the thermal stabilities of the structural repeats of brain spectrin subunits (alphaII and betaII) with those of erythrocyte spectrin (alphaI and betaI). The unfolding transition midpoints (T(m)) of the 36 alphaII- and betaII-spectrin repeats extend between 24 and 82 degrees C, with an average higher by some 10 degrees C than that of the alphaI- and betaI-spectrin repeats. This difference is reflected in the T(m) values of the intact brain and erythrocyte spectrins. Two of three tandem-repeat constructs from brain spectrin exhibited strong cooperative coupling, with elevation of the T(m) of the less stable partner corresponding to coupling free energies of approximately -4.4 and -3.5 kcal/mol. The third tandem-repeat construct, by contrast, exhibited negligible cooperativity. Tandem-repeat mutants, in which a part of the "linker" helix that connects the two domains was replaced with a corresponding helical segment from erythroid spectrin, showed only minor perturbation of the thermal melting profiles, without breakdown of cooperativity. Thus, the linker regions, which tolerate few point mutations without loss of cooperative function, have evidently evolved to permit conformational coupling in specified regions. The greater structural stability of the repeats in alphaII- and betaII-spectrin may account, at least in part, for the higher rigidity of brain compared to erythrocyte spectrin.
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Affiliation(s)
- Xiuli An
- Red Cell Physiology Laboratory, New York Blood Center, New York, New York 10021, USA.
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28
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Abstract
The ternary complex of spectrin, actin, and 4.1R (human erythrocyte protein 4.1) defines the nodes of the erythrocyte membrane skeletal network and is inseparable from membrane stability under mechanical stress. These junctions also contain tropomyosin (TM) and the other actin-binding proteins, adducin, protein 4.9, tropomodulin, and a small proportion of capZ, the functions of which are poorly defined. Here, we have examined the consequences of selective elimination of TM from the membrane. We have shown that the mechanical stability of the membranes of resealed ghosts devoid of TM is grossly, but reversibly, impaired. That the decreased membrane stability of TM-depleted membranes is the result of destabilization of the ternary complex of the network junctions is demonstrated by the strongly facilitated entry into the junctions in situ of a beta-spectrin peptide, containing the actin- and 4.1R-binding sites, after extraction of the TM. The stabilizing effect of TM is highly specific, in that it is only the endogenous isotype, and not the slightly longer muscle TM that can bind to the depleted membranes and restore their mechanical stability. These findings have enabled us identify a function for TM in elevating the mechanical stability of erythrocyte membranes by stabilizing the spectrin-actin-4.1R junctional complex.
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Affiliation(s)
- Xiuli An
- Red Cell Physiology Laboratory, New York Blood Center, New York, NY 10021, USA.
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29
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An X, Guo X, Zhang X, Baines AJ, Debnath G, Moyo D, Salomao M, Bhasin N, Johnson C, Discher D, Gratzer WB, Mohandas N. Conformational Stabilities of the Structural Repeats of Erythroid Spectrin and Their Functional Implications. J Biol Chem 2006; 281:10527-32. [PMID: 16476728 DOI: 10.1074/jbc.m513725200] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The two polypeptide chains of the erythroid spectrin heterodimer contain between them 36 structural repeating modules, which can function as independently folding units. We have expressed all 36 and determined their thermal stabilities. These vary widely, with unfolding transition mid-points (T(m)) ranging from 21 to 72 degrees C. Eight of the isolated repeats are largely unfolded at physiological temperature. Constructs comprising two or more adjacent repeats show inter-repeat coupling with coupling free energies of several kcal mol(-1). Constructs comprising five successive repeats from the beta-chain displayed cooperativity and strong temperature dependence in forced unfolding by atomic force microscopy. Analysis of aligned sequences and molecular modeling suggests that high stability is conferred by large hydrophobic side chains at position e of the heptad hydrophobic repeats in the first helix of the three-helix bundle that makes up each repeat. This inference was borne out by the properties of mutants in which the critical residues have been replaced. The marginal stability of the tertiary structure at several points in the spectrin chains is moderated by energetic coupling with adjoining structural elements but may be expected to permit adaptation of the membrane to the large distortions that the red cell experiences in the circulation.
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Affiliation(s)
- Xiuli An
- Red Cell Physiology Laboratory, New York Blood Center, 310 E. 67th Street, New York, NY 10021, USA.
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Salomao M, An X, Guo X, Gratzer WB, Mohandas N, Baines AJ. Mammalian alpha I-spectrin is a neofunctionalized polypeptide adapted to small highly deformable erythrocytes. Proc Natl Acad Sci U S A 2006; 103:643-8. [PMID: 16407147 PMCID: PMC1334653 DOI: 10.1073/pnas.0507661103] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mammalian red blood cells, unlike those of other vertebrates, must withstand the rigors of circulation in the absence of new protein synthesis. Key to this is plasma membrane elasticity deriving from the protein spectrin, which forms a network on the cytoplasmic face. Spectrin is a tetramer (alphabeta)(2), made up of alphabeta dimers linked head to head. We show here that one component of erythrocyte spectrin, alphaI, is encoded by a gene unique to mammals. Phylogenetic analysis suggests that the other alpha-spectrin gene (alphaII) common to all vertebrates was duplicated after the emergence of amphibia, and that the resulting alphaI gene was preserved only in mammals. The activities of alphaI and alphaII spectrins differ in the context of the human red cell membrane. An alphaI-spectrin fragment containing the site of head-to-head interaction with the beta-chain binds more weakly than the corresponding alphaII fragment to this site. The latter competes so strongly with endogenous alphaI as to cause destabilization of membranes at 100-fold lower concentration than the alphaI fragment. The efficacies of alphaI/alphaII chimeras indicate that the partial structural repeat, which binds to the complementary beta-spectrin element, and the adjacent complete repeat together determine the strength of the dimer-dimer interaction on the membrane. Alignment of all available alpha-spectrin N-terminal sequences reveals three blocks of sequence unique to alphaI. Furthermore, human alphaII-spectrin is closer to fruitfly alpha-spectrin than to human alphaI-spectrin, consistent with adaptation of alphaI to new functions. We conclude that alphaI-spectrin represents a neofunctionalized spectrin adapted to the rapid make and break of tetramers.
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Affiliation(s)
- Marcela Salomao
- Red Cell Physiology Laboratory, New York Blood Center, New York, NY 10021, USA
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