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Nyholm I, Sjöblom N, Pihlajoki M, Hukkinen M, Lohi J, Heikkilä P, Mutka A, Jahnukainen T, Davenport M, Heikinheimo M, Arola J, Pakarinen MP. Deep learning quantification reveals a fundamental prognostic role for ductular reaction in biliary atresia. Hepatol Commun 2023; 7:e0333. [PMID: 38051554 PMCID: PMC10697619 DOI: 10.1097/hc9.0000000000000333] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/17/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND We aimed to quantify ductular reaction (DR) in biliary atresia using a neural network in relation to underlying pathophysiology and prognosis. METHODS Image-processing neural network model was applied to 259 cytokeratin-7-stained native liver biopsies of patients with biliary atresia and 43 controls. The model quantified total proportional DR (DR%) composed of portal biliary epithelium (BE%) and parenchymal intermediate hepatocytes (PIH%). The results were related to clinical data, Sirius Red-quantified liver fibrosis, serum biomarkers, and bile acids. RESULTS In total, 2 biliary atresia biopsies were obtained preoperatively, 116 at Kasai portoenterostomy (KPE) and 141 during post-KPE follow-up. DR% (8.3% vs. 5.9%, p=0.045) and PIH% (1.3% vs. 0.6%, p=0.004) were increased at KPE in patients remaining cholestatic postoperatively. After KPE, patients with subsequent liver transplantation or death showed an increase in DR% (7.9%-9.9%, p = 0.04) and PIH% (1.6%-2.4%, p = 0.009), whereas patients with native liver survival (NLS) showed decreasing BE% (5.5%-3.0%, p = 0.03) and persistently low PIH% (0.9% vs. 1.3%, p = 0.11). In Cox regression, high DR predicted inferior NLS both at KPE [DR% (HR = 1.05, p = 0.01), BE% (HR = 1.05, p = 0.03), and PIH% (HR = 1.13, p = 0.005)] and during follow-up [DR% (HR = 1.08, p<0.0001), BE% (HR = 1.58, p = 0.001), and PIH% (HR = 1.04, p = 0.008)]. DR% correlated with Sirius red-quantified liver fibrosis at KPE (R = 0.47, p<0.0001) and follow-up (R = 0.27, p = 0.004). A close association between DR% and serum bile acids was observed at follow-up (R = 0.61, p<0.001). Liver fibrosis was not prognostic for NLS at KPE (HR = 1.00, p = 0.96) or follow-up (HR = 1.01, p = 0.29). CONCLUSIONS DR predicted NLS in different disease stages before transplantation while associating with serum bile acids after KPE.
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Affiliation(s)
- Iiris Nyholm
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Children and Adolescent Department, New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Pediatric Research Center, Children and Adolescent Department, New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nelli Sjöblom
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marjut Pihlajoki
- Pediatric Research Center, Children and Adolescent Department, New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maria Hukkinen
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Children and Adolescent Department, New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jouko Lohi
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Päivi Heikkilä
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Aino Mutka
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Timo Jahnukainen
- Department of Pediatric Nephrology and Transplantation, New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mark Davenport
- Department of Pediatric Surgery, King’s College Hospital, London, UK
| | - Markku Heikinheimo
- Pediatric Research Center, Children and Adolescent Department, New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, Missouri, USA
- Department of Pediatrics, Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Johanna Arola
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko P. Pakarinen
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Children and Adolescent Department, New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Pediatric Research Center, Children and Adolescent Department, New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
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Godbole N, Kyrönlahti A, Hukkinen M, Pihlajoki M, Heikinheimo M, Pakarinen MP. Bacterial translocation markers and toll-like receptors in biliary atresia following successful portoenterostomy. Acta Paediatr 2023; 112:2210-2217. [PMID: 37378619 DOI: 10.1111/apa.16893] [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: 02/27/2023] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 06/29/2023]
Abstract
AIM The gut-liver axis may contribute to pathophysiology of cholestatic liver disorders like biliary atresia (BA) by bacterial translocation (BT). Toll-like receptors (TLR) are pattern recognition receptors known to activate innate immunity and secretion of inflammatory cytokines. Herein, we examined BT-associated biomarkers and TLRs in relation to liver injury after successful portoenterostomy (SPE) in BA. METHODS Serum levels of lipopolysaccharide-binding protein (LBP), CD14, LAL, TNF-α, IL-6 and FABP2 along with liver expression of TLRs (TLR1, TLR4, TLR7 and TLR9), LBP and CD14 were measured during median 4.9 (1.7-10.6) years follow-up after SPE in 45 BA patients. RESULTS Serum LBP, CD14, TNF-α and IL-6 all increased after SPE whereas LAL and FABP-2 remained unchanged. Serum LBP correlated positively with CD14 and markers of hepatocyte injury and cholestasis, but not with Metavir fibrosis stage, transcriptional markers for fibrosis (ACTA2) or ductular reaction. Serum CD14 concentration was significantly higher in patients with portal hypertension than without. While liver expression of TLR4 and LBP remained low, TLR7 and TLR1 showed marked BA-specific increases, and TLR7 correlated with Metavir fibrosis stage and ACTA2. CONCLUSION BT does not seem to play a significant role in liver injury after SPE in our series of BA patients.
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Affiliation(s)
- Nimish Godbole
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group and Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Kyrönlahti
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maria Hukkinen
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group and Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marjut Pihlajoki
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markku Heikinheimo
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
- Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research, Tampere University, Tampere, Finland
| | - Mikko P Pakarinen
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group and Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Women's Health, Karolinska Institute, Stockholm, Sweden
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Nousiainen R, Eloranta K, Isoaho N, Cairo S, Wilson DB, Heikinheimo M, Pihlajoki M. UBE2C expression is elevated in hepatoblastoma and correlates with inferior patient survival. Front Genet 2023; 14:1170940. [PMID: 37377594 PMCID: PMC10291054 DOI: 10.3389/fgene.2023.1170940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Hepatoblastoma (HB) is the most common malignant liver tumor among children. To gain insight into the pathobiology of HB, we performed RNA sequence analysis on 5 patient-derived xenograft lines (HB-243, HB-279, HB-282, HB-284, HB-295) and 1 immortalized cell line (HUH6). Using cultured hepatocytes as a control, we found 2,868 genes that were differentially expressed in all of the HB lines on mRNA level. The most upregulated genes were ODAM, TRIM71, and IGDCC3, and the most downregulated were SAA1, SAA2, and NNMT. Protein-protein interaction analysis identified ubiquitination as a key pathway dysregulated in HB. UBE2C, encoding an E2 ubiquitin ligase often overexpressed in cancer cells, was markedly upregulated in 5 of the 6 HB cell lines. Validation studies confirmed UBE2C immunostaining in 20 of 25 HB tumor specimens versus 1 of 6 normal liver samples. The silencing of UBE2C in two HB cell models resulted in decreased cell viability. RNA sequencing analysis showed alterations in cell cycle regulation after UBE2C knockdown. UBE2C expression in HB correlated with inferior patient survival. We conclude that UBE2C may hold prognostic utility in HB and that the ubiquitin pathway is a potential therapeutic target in this tumor.
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Affiliation(s)
- Ruth Nousiainen
- Pediatric Research Center, Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Katja Eloranta
- Pediatric Research Center, Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Noora Isoaho
- Division of Micro and Nanosystems, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Stefano Cairo
- Champions Oncology, Hackensack, NJ, United States
- Istituto di Ricerca Pediatrica, Padova, Italy
- XenTech, Evry, France
| | - David B. Wilson
- Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO, United States
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO, United States
| | - Markku Heikinheimo
- Pediatric Research Center, Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO, United States
- Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Marjut Pihlajoki
- Pediatric Research Center, Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Nyholm I, Hukkinen M, Pihlajoki M, Davidson JR, Tyraskis A, Lohi J, Heikkilä P, Hänninen S, Andersson N, Eloranta K, Carpén O, Heikinheimo M, Davenport M, Pakarinen MP. Serum FGF19 predicts outcomes of Kasai portoenterostomy in biliary atresia. Hepatology 2023; 77:1263-1273. [PMID: 36692476 PMCID: PMC10026978 DOI: 10.1097/hep.0000000000000048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS Outcomes after Kasai portoenterostomy (KPE) for biliary atresia remain highly variable for unclear reasons. As reliable early biomarkers predicting KPE outcomes are lacking, we studied the prognostic value of FGF19. APPROACH AND RESULTS Serum and liver specimens, obtained from biliary atresia patients (N=87) at KPE or age-matched cholestatic controls (N=26) were included. Serum concentration of FGF19 and bile acids, liver mRNA expression of FGF19 , and key regulators of bile acid synthesis were related to KPE outcomes and liver histopathology. Immunohistochemistry and in situ hybridization were used for the localization of liver FGF19 expression. Serum levels (223 vs. 61 pg/mL, p <0.001) and liver mRNA expression of FGF19 were significantly increased in biliary atresia. Patients with unsuccessful KPE (419 vs. 145 pg/mL, p =0.047), and those subsequently underwent liver transplantation (410 vs. 99 pg/mL, p =0.007) had significantly increased serum, but not liver, FGF19, which localized mainly in hepatocytes. In Cox hazard modeling serum FGF19 <109 pg/mL predicted native liver survival (HR: 4.31, p <0.001) also among patients operated <60 days of age (HR: 8.77, p =0.004) or after successful KPE (HR: 6.76, p =0.01). Serum FGF19 correlated positively with increased serum primary bile acids ( R =0.41, p =0.004) and ductular reaction ( R =0.39, p =0.004). CONCLUSIONS Increased serum FGF19 at KPE predicted inferior long-term native liver survival in biliary atresia and was associated with unsuccessful KPE, elevated serum primary bile acids, and ductular reaction.
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Affiliation(s)
- Iiris Nyholm
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maria Hukkinen
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marjut Pihlajoki
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Joseph R. Davidson
- Department of Pediatric Surgery, GOS-UCL Institute of Child Health, London, UK
- Department of Pediatric Surgery, King’s College Hospital, London, UK
| | | | - Jouko Lohi
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Päivi Heikkilä
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Satu Hänninen
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Noora Andersson
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katja Eloranta
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Olli Carpén
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markku Heikinheimo
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, Missouri, USA
| | - Mark Davenport
- Department of Pediatric Surgery, King’s College Hospital, London, UK
| | - Mikko P. Pakarinen
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
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Eloranta K, Pihlajoki M, Liljeström E, Nousiainen R, Soini T, Lohi J, Cairo S, Wilson DB, Parkkila S, Heikinheimo M. SLC-0111, an inhibitor of carbonic anhydrase IX, attenuates hepatoblastoma cell viability and migration. Front Oncol 2023; 13:1118268. [PMID: 36776327 PMCID: PMC9909558 DOI: 10.3389/fonc.2023.1118268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/13/2023] [Indexed: 01/27/2023] Open
Abstract
Background In response to hypoxia, tumor cells undergo transcriptional reprogramming including upregulation of carbonic anhydrase (CA) IX, a metalloenzyme that maintains acid-base balance. CAIX overexpression has been shown to correlate with poor prognosis in various cancers, but the role of this CA isoform in hepatoblastoma (HB) has not been examined. Methods We surveyed the expression of CAIX in HB specimens and assessed the impact of SLC-0111, a CAIX inhibitor, on cultured HB cells in normoxic and hypoxic conditions. Results CAIX immunoreactivity was detected in 15 out of 21 archival pathology HB specimens. The CAIX-positive cells clustered in the middle of viable tumor tissue or next to necrotic areas. Tissue expression of CAIX mRNA was associated with metastasis and poor clinical outcome of HB. Hypoxia induced a striking upregulation of CAIX mRNA and protein in three HB cell models: the immortalized human HB cell line HUH6 and patient xenograft-derived lines HB-295 and HB-303. Administration of SLC-0111 abrogated the hypoxia-induced upregulation of CAIX and decreased HB cell viability, both in monolayer and spheroid cultures. In addition, SLC-0111 reduced HB cell motility in a wound healing assay. Transcriptomic changes triggered by SLC-0111 administration differed under normoxic vs. hypoxic conditions, although SLC-0111 elicited upregulation of several tumor suppressor genes under both conditions. Conclusion Hypoxia induces CAIX expression in HB cells, and the CAIX inhibitor SLC-0111 has in vitro activity against these malignant cells.
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Affiliation(s)
- Katja Eloranta
- Pediatric Research Center, Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Marjut Pihlajoki
- Pediatric Research Center, Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland,*Correspondence: Marjut Pihlajoki,
| | - Emmi Liljeström
- Pediatric Research Center, Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Ruth Nousiainen
- Pediatric Research Center, Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Tea Soini
- Pediatric Research Center, Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jouko Lohi
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Stefano Cairo
- Xentech, Evry, Evry, France,Istituto di Ricerca Pediatrica, Padova, Italy,Champions Oncology, Hackensack, NJ, United States
| | - David B. Wilson
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO, United States,Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO, United States
| | - Seppo Parkkila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,FICAN Mid, Tampere University, Tampere, Finland,Fimlab Ltd, Tampere University Hospital, Tampere, Finland
| | - Markku Heikinheimo
- Pediatric Research Center, Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland,Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO, United States,Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research, Tampere University, Tampere, Finland
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Angloher G, Dafinei I, Marco ND, Ferroni F, Fichtinger S, Filipponi A, Friedl M, Fuss A, Ge Z, Heikinheimo M, Huitu K, Maji R, Mancuso M, Pagnanini L, Petricca F, Pirro S, Pröbst F, Profeta G, Puiu A, Reindl F, Schäffner K, Schieck J, Schmiedmayer D, Schwertner C, Stahlberg M, Stendahl A, Wagner F, Yue S, Zema V, Zhu Y, Pandola L. Simulation-based design study for the passive shielding of the COSINUS dark matter experiment. Eur Phys J C Part Fields 2022; 82:248. [PMID: 35399983 PMCID: PMC8940824 DOI: 10.1140/epjc/s10052-022-10184-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
The COSINUS (Cryogenic Observatory for SIgnatures seen in Next-generation Underground Searches) experiment aims at the detection of dark matter-induced recoils in sodium iodide (NaI) crystals operated as scintillating cryogenic calorimeters. The detection of both scintillation light and phonons allows performing an event-by-event signal to background discrimination, thus enhancing the sensitivity of the experiment. The choice of using NaI crystals is motivated by the goal of probing the long-standing DAMA/LIBRA results using the same target material. The construction of the experimental facility is foreseen to start by 2021 at the INFN Gran Sasso National Laboratory (LNGS) in Italy. It consists of a cryostat housing the target crystals shielded from the external radioactivity by a water tank acting, at the same time, as an active veto against cosmic ray-induced events. Taking into account both environmental radioactivity and intrinsic contamination of materials used for cryostat, shielding and infrastructure, we performed a careful background budget estimation. The goal is to evaluate the number of events that could mimic or interfere with signal detection while optimising the geometry of the experimental setup. In this paper we present the results of the detailed Monte Carlo simulations we performed, together with the final design of the setup that minimises the residual amount of background particles reaching the detector volume.
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Affiliation(s)
- G. Angloher
- Max-Planck-Institut für Physik, 80805 Munich, Germany
| | | | - N. Di Marco
- Gran Sasso Science Institute, 67100 L’Aquila, Italy
- INFN-Laboratori Nazionali del Gran Sasso, 67010 Assergi, Italy
| | - F. Ferroni
- INFN-Sezione di Roma, 00185 Rome, Italy
- Gran Sasso Science Institute, 67100 L’Aquila, Italy
| | - S. Fichtinger
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, 1050 Vienna, Austria
| | - A. Filipponi
- INFN-Laboratori Nazionali del Gran Sasso, 67010 Assergi, Italy
- Dipartimento di Scienze Fisiche e Chimiche, Università degli Studi dell’Aquila, 67100 L’Aquila, Italy
| | - M. Friedl
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, 1050 Vienna, Austria
| | - A. Fuss
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, 1050 Vienna, Austria
- Atominstitut, Technische Universität Wien, 1020 Vienna, Austria
| | - Z. Ge
- SICCAS-Shanghai Institute of Ceramics, Shanghai, 200050 People’s Republic of China
| | | | - K. Huitu
- Helsinki Institute of Physics, 00560 Helsinki, Finland
| | - R. Maji
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, 1050 Vienna, Austria
- Atominstitut, Technische Universität Wien, 1020 Vienna, Austria
| | - M. Mancuso
- Max-Planck-Institut für Physik, 80805 Munich, Germany
| | - L. Pagnanini
- Gran Sasso Science Institute, 67100 L’Aquila, Italy
- INFN-Laboratori Nazionali del Gran Sasso, 67010 Assergi, Italy
| | - F. Petricca
- Max-Planck-Institut für Physik, 80805 Munich, Germany
| | - S. Pirro
- INFN-Laboratori Nazionali del Gran Sasso, 67010 Assergi, Italy
| | - F. Pröbst
- Max-Planck-Institut für Physik, 80805 Munich, Germany
| | - G. Profeta
- INFN-Laboratori Nazionali del Gran Sasso, 67010 Assergi, Italy
- Dipartimento di Scienze Fisiche e Chimiche, Università degli Studi dell’Aquila, 67100 L’Aquila, Italy
| | - A. Puiu
- Gran Sasso Science Institute, 67100 L’Aquila, Italy
- INFN-Laboratori Nazionali del Gran Sasso, 67010 Assergi, Italy
| | - F. Reindl
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, 1050 Vienna, Austria
- Atominstitut, Technische Universität Wien, 1020 Vienna, Austria
| | - K. Schäffner
- Max-Planck-Institut für Physik, 80805 Munich, Germany
| | - J. Schieck
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, 1050 Vienna, Austria
- Atominstitut, Technische Universität Wien, 1020 Vienna, Austria
| | - D. Schmiedmayer
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, 1050 Vienna, Austria
- Atominstitut, Technische Universität Wien, 1020 Vienna, Austria
| | - C. Schwertner
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, 1050 Vienna, Austria
- Atominstitut, Technische Universität Wien, 1020 Vienna, Austria
| | - M. Stahlberg
- Max-Planck-Institut für Physik, 80805 Munich, Germany
| | - A. Stendahl
- Helsinki Institute of Physics, 00560 Helsinki, Finland
| | - F. Wagner
- Institut für Hochenergiephysik der Österreichischen Akademie der Wissenschaften, 1050 Vienna, Austria
| | - S. Yue
- SICCAS-Shanghai Institute of Ceramics, Shanghai, 200050 People’s Republic of China
| | - V. Zema
- Max-Planck-Institut für Physik, 80805 Munich, Germany
| | - Y. Zhu
- SICCAS-Shanghai Institute of Ceramics, Shanghai, 200050 People’s Republic of China
| | | | - L. Pandola
- INFN-Laboratori Nazionali del Sud, 95125 Catania, Italy
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7
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Andersson N, Haltia UM, Färkkilä A, Wong SC, Eloranta K, Wilson DB, Unkila-Kallio L, Pihlajoki M, Kyrönlahti A, Heikinheimo M. Analysis of Non-Relapsed and Relapsed Adult Type Granulosa Cell Tumors Suggests Stable Transcriptomes during Tumor Progression. Curr Issues Mol Biol 2022; 44:686-698. [PMID: 35723333 PMCID: PMC8928977 DOI: 10.3390/cimb44020048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/17/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
Adult-type granulosa cell tumor (AGCT) is a rare ovarian malignancy characterized by slow growth and hormonal activity. The prognosis of AGCT is generally favorable, but one-third of patients with low-stage disease experience a late relapse, and over half of them die of AGCT. To identify markers that would distinguish patients at risk for relapse, we performed Lexogen QuantSeq 3′ mRNA sequencing on formalin-fixed paraffin-embedded, archival AGCT tissue samples tested positive for the pathognomonic Forkhead Box L2 (FOXL2) mutation. We compared the transcriptomic profiles of 14 non-relapsed archival primary AGCTs (follow-up time 17–26 years after diagnosis) with 13 relapsed primary AGCTs (follow-up time 1.7–18 years) and eight relapsed tumors (follow-up time 2.8–18.9 years). Non-relapsed and relapsed primary AGCTs had similar transcriptomic profiles. In relapsed tumors three genes were differentially expressed: plasmalemma vesicle associated protein (PLVAP) was upregulated (p = 0.01), whereas argininosuccinate synthase 1 (ASS1) (p = 0.01) and perilipin 4 (PLIN4) (p = 0.02) were downregulated. PLVAP upregulation was validated using tissue microarray RNA in situ hybridization. In our patient cohort with extremely long follow-up, we observed similar gene expression patterns in both primary AGCT groups, suggesting that relapse is not driven by transcriptomic changes. These results reinforce earlier findings that molecular markers do not predict AGCT behavior or risk of relapse.
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Affiliation(s)
- Noora Andersson
- HUSLAB, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland;
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Tukholmankatu 8, 00290 Helsinki, Finland; (K.E.); (A.K.); (M.H.)
| | - Ulla-Maija Haltia
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland; (U.-M.H.); (A.F.); (L.U.-K.)
| | - Anniina Färkkilä
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland; (U.-M.H.); (A.F.); (L.U.-K.)
- Research Program for Systems Oncology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 8, 00290 Helsinki, Finland
| | | | - Katja Eloranta
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Tukholmankatu 8, 00290 Helsinki, Finland; (K.E.); (A.K.); (M.H.)
| | - David B. Wilson
- Department of Pediatrics, Washington University in St. Louis, 660 S Euclid Ave, St. Louis, MO 63110, USA;
- Department of Developmental Biology, Washington University School of Medicine, 660 S. Euclid Avenue Campus Box 8103, St. Louis, MO 63110, USA
| | - Leila Unkila-Kallio
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland; (U.-M.H.); (A.F.); (L.U.-K.)
| | - Marjut Pihlajoki
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Tukholmankatu 8, 00290 Helsinki, Finland; (K.E.); (A.K.); (M.H.)
- Correspondence:
| | - Antti Kyrönlahti
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Tukholmankatu 8, 00290 Helsinki, Finland; (K.E.); (A.K.); (M.H.)
| | - Markku Heikinheimo
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Tukholmankatu 8, 00290 Helsinki, Finland; (K.E.); (A.K.); (M.H.)
- Department of Pediatrics, Washington University in St. Louis, 660 S Euclid Ave, St. Louis, MO 63110, USA;
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8
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Passov A, Ilmakunnas M, Pihlajoki M, Hermunen K, Lempinen M, Helanterä I, Kailari V, Heikinheimo M, Andersson S, Pesonen E. Neutrophil gelatinase-associated lipocalin does not originate from the kidney during reperfusion in clinical renal transplantation. Intensive Care Med Exp 2021; 9:56. [PMID: 34807337 PMCID: PMC8608972 DOI: 10.1186/s40635-021-00422-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 11/11/2021] [Indexed: 11/12/2022] Open
Abstract
Background Acute Kidney Injury (AKI) is a common clinical complication. Plasma/serum neutrophil gelatinase-associated lipocalin (NGAL) has been proposed as a rapid marker of AKI. However, NGAL is not kidney-specific. It exists in three isoforms (monomeric, homo-dimeric and hetero-dimeric). Only the monomeric isoform is produced by renal tubular cells and plasma NGAL levels are confounded by the release of all NGAL isoforms from neutrophils. Our aim was to investigate whether NGAL is released into blood from injured renal tubules. Methods Kidney transplantation (n = 28) served as a clinical model of renal ischaemic injury. We used ELISA to measure NGAL concentrations at 2 minutes after kidney graft reperfusion in simultaneously taken samples of renal arterial and renal venous blood. Trans-renal gradients (venous–arterial) of NGAL were calculated. We performed Western blotting to distinguish between renal and non-renal NGAL isoforms. Liver-type fatty acid binding protein (LFABP) and heart-type fatty acid binding protein (HFABP) served as positive controls of proximal and distal tubular damage. Results Significant renal release of LFABP [trans-renal gradient 8.4 (1.7–30.0) ng/ml, p = 0.005] and HFABP [trans-renal gradient 3.7 (1.1–5.0) ng/ml, p = 0.003] at 2 minutes after renal graft reperfusion indicated proximal and distal tubular damage. NGAL concentrations were comparable in renal venous and renal arterial blood. Thus, there was no trans-renal gradient of NGAL. Western blotting revealed that the renal NGAL isoform represented only 6% of the total NGAL in renal venous blood. Conclusions Ischaemic proximal and distal tubular damage occurs in kidney transplantation without concomitant NGAL washout from the kidney graft into blood. Plasma/serum NGAL levels are confounded by the release of NGAL from neutrophils. Present results do not support the interpretation that increase in plasma NGAL is caused by release from the renal tubules.
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Affiliation(s)
- Arie Passov
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, PO BOX 266, 00029 HUS, Helsinki, Finland.
| | - Minna Ilmakunnas
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, 00029 HUS, Helsinki, Finland
| | - Marjut Pihlajoki
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, PO BOX 347, FIN 00029 HUS, Helsinki, Finland
| | - Kethe Hermunen
- Transplantation and Liver Surgery Clinic, Abdominal Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, 00029 HUS, Helsinki, Finland
| | - Marko Lempinen
- Transplantation and Liver Surgery Clinic, Abdominal Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, 00029 HUS, Helsinki, Finland
| | - Ilkka Helanterä
- Transplantation and Liver Surgery Clinic, Abdominal Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, 00029 HUS, Helsinki, Finland
| | - Villemikko Kailari
- Faculty of Medicine, University of Helsinki, PO BOX 63, 00014, Helsinki, Finland
| | - Markku Heikinheimo
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, PO BOX 347, FIN 00029 HUS, Helsinki, Finland.,Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, One Children's Place, St. Louis, MO, 63110, USA
| | - Sture Andersson
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, PO BOX 347, FIN 00029 HUS, Helsinki, Finland
| | - Eero Pesonen
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PO BOX 340, 00029 HUS, Helsinki, Finland
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9
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Pilsworth JA, Todeschini AL, Neilson SJ, Cochrane DR, Lai D, Anttonen M, Heikinheimo M, Huntsman DG, Veitia RA. FOXL2 in adult-type granulosa cell tumour of the ovary: oncogene or tumour suppressor gene? J Pathol 2021; 255:225-231. [PMID: 34338304 DOI: 10.1002/path.5771] [Citation(s) in RCA: 8] [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: 05/15/2021] [Revised: 07/13/2021] [Accepted: 07/28/2021] [Indexed: 12/19/2022]
Abstract
A recurrent mutation in FOXL2 (c.402C>G; p.C134W) is present in over 95% of adult-type granulosa cell tumours (AGCTs). In contrast, various loss-of-function mutations in FOXL2 lead to the development of blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES). BPES is characterised by an eyelid malformation often accompanied with primary ovarian insufficiency. Two recent studies suggest that FOXL2 C402G is a gain- or change-of-function mutation with altered DNA-binding specificity. Another study proposes that FOXL2 C402G is selectively targeted for degradation, inducing somatic haploinsufficiency, suggesting its role as a tumour suppressor. The latter study relies on data indicative of an FOXL2 allelic imbalance in AGCTs. Here we present RNA-seq data as genetic evidence that no real allelic imbalance is observed at the transcriptomic level in AGCTs. Additionally, there is no loss of protein expression in tumours harbouring the mutated allele. These data and other features of this mutation compared to other oncogenes and tumour suppressor genes argue strongly against FOXL2 being a tumour suppressor in this context. Given the likelihood that FOXL2 C402G is oncogenic, targeting the variant protein or its downstream consequences is the most viable path forward to identifying an effective treatment for this cancer. © 2021 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Jessica A Pilsworth
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada.,Department of Molecular Oncology, BC Cancer, Vancouver, Canada
| | - Anne-Laure Todeschini
- Université de Paris, Paris, France.,Université de Paris, CNRS, Institut Jacques Monod, Paris, France
| | | | - Dawn R Cochrane
- Department of Molecular Oncology, BC Cancer, Vancouver, Canada
| | - Daniel Lai
- Department of Molecular Oncology, BC Cancer, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Mikko Anttonen
- Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markku Heikinheimo
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - David G Huntsman
- Department of Molecular Oncology, BC Cancer, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Reiner A Veitia
- Université de Paris, Paris, France.,Université de Paris, CNRS, Institut Jacques Monod, Paris, France.,Université Paris-Saclay, Institut de Biologie F. Jacob, Commissariat à l'Energie Atomique, Fontenay aux Roses, France
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10
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Godbole N, Nyholm I, Hukkinen M, Davidson JR, Tyraskis A, Eloranta K, Andersson N, Lohi J, Heikkilä P, Kyrönlahti A, Pihlajoki M, Davenport M, Heikinheimo M, Pakarinen MP. Prognostic and Pathophysiologic Significance of IL-8 (CXCL8) in Biliary Atresia. J Clin Med 2021; 10:jcm10122705. [PMID: 34207442 PMCID: PMC8234515 DOI: 10.3390/jcm10122705] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 12/12/2022] Open
Abstract
Interleukin (IL)-8 (CXCL8), a chemokine involved in neutrophil recruitment, has been implicated in ductular reaction and liver fibrogenesis. We studied liver and serum IL-8 expression in a large biliary atresia (BA) cohort and explored its prognostic and pathophysiological potential. IL-8 expression was assessed in liver utilizing quantitative polymerase chain reaction (qPCR), immunohistochemistry and in situ hybridization and in serum using an enzyme-linked immunosorbent assay, among 115 BA patients, 10 disease controls and 68 normal controls. Results were correlated to portoenterostomy (PE) outcomes, biochemical and histological liver injury, transcriptional markers of fibrosis and cholangiocytes, and expression of other related cytokines. IL-8 was markedly overexpressed in liver and serum of BA patients at PE (n = 88) and in serum samples obtained during postoperative follow-up (n = 40). IL-8 expression in the liver was predominantly in cholangiocytes within areas of ductular reaction. Liver IL-8 mRNA expression correlated positively with its serum concentration, bile ductular proliferation, Metavir fibrosis stage, and transcriptional markers of activated myofibroblasts (ACTA2) and cholangiocytes (KRT19). Taken together, IL-8 may mediate liver injury in BA by promoting ductular reaction and associated liver fibrogenesis. Prognostic value of serum IL-8 to predict native liver survival was limited and confined to the postoperative period after PE.
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Affiliation(s)
- Nimish Godbole
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland; (N.G.); (I.N.); (M.H.); (K.E.); (N.A.); (A.K.); (M.P.); (M.H.)
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group and Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland
| | - Iiris Nyholm
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland; (N.G.); (I.N.); (M.H.); (K.E.); (N.A.); (A.K.); (M.P.); (M.H.)
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group and Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland
| | - Maria Hukkinen
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland; (N.G.); (I.N.); (M.H.); (K.E.); (N.A.); (A.K.); (M.P.); (M.H.)
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group and Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland
| | - Joseph R. Davidson
- Department of Pediatric Surgery, GOS-UCL Institute of Child Health, London WC1N 1EH, UK;
- Department of Pediatric Surgery, King’s College Hospital, London SE5 9RS, UK; (A.T.); (M.D.)
| | - Athanasios Tyraskis
- Department of Pediatric Surgery, King’s College Hospital, London SE5 9RS, UK; (A.T.); (M.D.)
| | - Katja Eloranta
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland; (N.G.); (I.N.); (M.H.); (K.E.); (N.A.); (A.K.); (M.P.); (M.H.)
| | - Noora Andersson
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland; (N.G.); (I.N.); (M.H.); (K.E.); (N.A.); (A.K.); (M.P.); (M.H.)
| | - Jouko Lohi
- Department of Pathology, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland; (J.L.); (P.H.)
| | - Päivi Heikkilä
- Department of Pathology, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland; (J.L.); (P.H.)
| | - Antti Kyrönlahti
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland; (N.G.); (I.N.); (M.H.); (K.E.); (N.A.); (A.K.); (M.P.); (M.H.)
| | - Marjut Pihlajoki
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland; (N.G.); (I.N.); (M.H.); (K.E.); (N.A.); (A.K.); (M.P.); (M.H.)
| | - Mark Davenport
- Department of Pediatric Surgery, King’s College Hospital, London SE5 9RS, UK; (A.T.); (M.D.)
| | - Markku Heikinheimo
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland; (N.G.); (I.N.); (M.H.); (K.E.); (N.A.); (A.K.); (M.P.); (M.H.)
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Mikko P. Pakarinen
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland; (N.G.); (I.N.); (M.H.); (K.E.); (N.A.); (A.K.); (M.P.); (M.H.)
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group and Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland
- Correspondence:
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11
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Kyrönlahti A, Godbole N, Akinrinade O, Soini T, Nyholm I, Andersson N, Hukkinen M, Lohi J, Wilson DB, Pihlajoki M, Pakarinen MP, Heikinheimo M. Evolving Up-regulation of Biliary Fibrosis-Related Extracellular Matrix Molecules After Successful Portoenterostomy. Hepatol Commun 2021; 5:1036-1050. [PMID: 34141988 PMCID: PMC8183171 DOI: 10.1002/hep4.1684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 12/16/2022] Open
Abstract
Successful portoenterostomy (SPE) improves the short-term outcome of patients with biliary atresia (BA) by relieving cholestasis and extending survival with native liver. Despite SPE, hepatic fibrosis progresses in most patients, leading to cirrhosis and a deterioration of liver function. The goal of this study was to characterize the effects of SPE on the BA liver transcriptome. We used messenger RNA sequencing to analyze global gene-expression patterns in liver biopsies obtained at the time of portoenterostomy (n = 13) and 1 year after SPE (n = 8). Biopsies from pediatric (n = 2) and adult (n = 2) organ donors and other neonatal cholestatic conditions (n = 5) served as controls. SPE was accompanied by attenuation of inflammation and concomitant up-regulation of key extracellular matrix (ECM) genes. Highly overexpressed genes promoting biliary fibrosis and bile duct integrity, such as integrin subunit beta 6 and previously unreported laminin subunit alpha 3, emerged as candidates to control liver fibrosis after SPE. At a cellular level, the relative abundance of activated hepatic stellate cells and liver macrophages decreased following SPE, whereas portal fibroblasts (PFs) and cholangiocytes persisted. Conclusion: The attenuation of inflammation following SPE coincides with emergence of an ECM molecular fingerprint, a set of profibrotic molecules mechanistically connected to biliary fibrosis. The persistence of activated PFs and cholangiocytes after SPE suggests a central role for these cell types in the progression of biliary fibrosis.
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Affiliation(s)
- Antti Kyrönlahti
- Pediatric Research CenterChildren's HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Nimish Godbole
- Pediatric Research CenterChildren's HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Oyediran Akinrinade
- Pediatric Research CenterChildren's HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Tea Soini
- Pediatric Research CenterChildren's HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland.,Center for Infectious MedicineDepartment of MedicineKarolinska InstitutetStockholmSweden
| | - Iiris Nyholm
- Pediatric Research CenterChildren's HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland.,Pediatric SurgeryPediatric Liver and Gut Research GroupChildren's HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Noora Andersson
- Pediatric Research CenterChildren's HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Maria Hukkinen
- Pediatric SurgeryPediatric Liver and Gut Research GroupChildren's HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Jouko Lohi
- Department of PathologyHelsinki University HospitalHelsinkiFinland
| | - David B Wilson
- Department of PediatricsSt. Louis Children's HospitalWashington University School of MedicineSt. LouisMOUSA
| | - Marjut Pihlajoki
- Pediatric Research CenterChildren's HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland.,Center for Infectious MedicineDepartment of MedicineKarolinska InstitutetStockholmSweden
| | - Mikko P Pakarinen
- Pediatric Research CenterChildren's HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland.,Pediatric SurgeryPediatric Liver and Gut Research GroupChildren's HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Markku Heikinheimo
- Pediatric Research CenterChildren's HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland.,Department of PediatricsSt. Louis Children's HospitalWashington University School of MedicineSt. LouisMOUSA
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12
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Sanaksenaho G, Mutanen A, Godbole N, Hukkinen M, Merras-Salmio L, Kivisaari R, Kyrönlahti A, Pihlajoki M, Lohi J, Heikinheimo M, Pakarinen MP. Compromised duodenal mucosal integrity in children with short bowel syndrome after adaptation to enteral autonomy. J Pediatr Surg 2021; 56:966-974. [PMID: 33131778 DOI: 10.1016/j.jpedsurg.2020.09.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/23/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intestinal adaptation has been extensively studied experimentally, but very limited data is available on human subjects. In this study we assessed intestinal adaption in humans with short bowel syndrome (SBS). METHODS We comparatively evaluated mucosal hyperplasia, inflammation, barrier function and nutrient transport using histology, immunohistochemistry and qPCR for selected 52 key genes in duodenal biopsies obtained from children with SBS after weaning off parenteral nutrition (n = 33), and matched controls without intestinal pathology (n = 12). Small bowel dilatation was assessed from contrast small bowel series. RESULTS Duodenal mucosa of SBS children showed increased histologic inflammation of lamina propria (p = 0.033) and mucosal mRNA expression of tumor necrosis factor (p = 0.027), transforming growth factor (TGF)-β2 (p = 0.006) and caveolin-1 (CAV1; p = 0.001). Villus height, crypt depth, enterocyte proliferation, apoptosis and expression of proliferation and nutrient transport genes remained unchanged. Pathologic small bowel dilatation reduced crypt depth (p = 0.045) and downregulated mRNA expression of interleukin (IL)-6 by three-fold (p = 0.008), while correlating negatively with IL6 (r = -0.609, p = 0.004). Loss of ileocecal valve (ICV) upregulated mRNA expression of toll-like receptor 4 (TLR4), TGF-β1, CAV1, several apoptosis regulating genes, and mRNA expression of zonulin (p < 0.05 for all). CONCLUSIONS Despite successful adaptation to enteral autonomy, duodenal mucosa of SBS children displayed histologic and molecular signs of abnormal inflammation and regulation of epithelial permeability, whereas no structural or molecular signs of adaptive hyperplasia or enhanced nutrient transport were observed. Excessive dilatation of the remaining small bowel paralleled impaired duodenal crypt homeostasis, while absence of ICV modified regulation of mucosal inflammation, regeneration and permeability. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Galina Sanaksenaho
- Division of Pediatric Surgery, Pediatric Liver and Gut Research Group, Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Annika Mutanen
- Division of Pediatric Surgery, Pediatric Liver and Gut Research Group, Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nimish Godbole
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maria Hukkinen
- Division of Pediatric Surgery, Pediatric Liver and Gut Research Group, Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura Merras-Salmio
- Department of Pediatric Gastroenterology, Pediatric Liver and Gut Research Group, Children's Hospital, Pediatric Research Centre, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Reetta Kivisaari
- HUS Medical Imaging Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Antti Kyrönlahti
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marjut Pihlajoki
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jouko Lohi
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markku Heikinheimo
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko P Pakarinen
- Division of Pediatric Surgery, Pediatric Liver and Gut Research Group, Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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13
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Eloranta K, Nousiainen R, Cairo S, Pakarinen MP, Wilson DB, Pihlajoki M, Heikinheimo M. Neuropilin-2 Is Associated With Increased Hepatoblastoma Cell Viability and Motility. Front Pediatr 2021; 9:660482. [PMID: 34239847 PMCID: PMC8257959 DOI: 10.3389/fped.2021.660482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/27/2021] [Indexed: 12/29/2022] Open
Abstract
The neuropilins NRP1 and NRP2 are multifunctional glycoproteins that have been implicated in several cancer-related processes including cell survival, migration, and invasion in various tumor types. Here, we examine the role of neuropilins in hepatoblastoma (HB), the most common pediatric liver malignancy. Using a combination of immunohistochemistry, RNA analysis and western blotting, we observed high level expression of NRP1 and NRP2 in 19 of 20 HB specimens and in a majority of human HB cell lines (HUH6 and five cell lines established from patient-derived xenografts) studied but not in normal hepatocytes. Silencing of NRP2 expression in HUH6 and HB-282 HB cells resulted in decreased cell viability, impaired cytoskeleton remodeling, and reduced cell motility, suggesting that NRP2 contributes to the malignant phenotype. We propose that neuropilins warrant further investigation as biomarkers of HB and potential therapeutic targets.
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Affiliation(s)
- Katja Eloranta
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Ruth Nousiainen
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Stefano Cairo
- XenTech, Evry, France.,Istituto di Ricerca Pediatrica, Padova, Italy
| | - Mikko P Pakarinen
- Pediatric Surgery, and Pediatric Liver and Gut Research Group, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - David B Wilson
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, United States.,Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO, United States
| | - Marjut Pihlajoki
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Markku Heikinheimo
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, United States
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14
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Eloranta K, Cairo S, Liljeström E, Soini T, Kyrönlahti A, Judde JG, Wilson DB, Heikinheimo M, Pihlajoki M. Chloroquine Triggers Cell Death and Inhibits PARPs in Cell Models of Aggressive Hepatoblastoma. Front Oncol 2020; 10:1138. [PMID: 32766148 PMCID: PMC7379510 DOI: 10.3389/fonc.2020.01138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/05/2020] [Indexed: 12/28/2022] Open
Abstract
Background: Hepatoblastoma (HB) is the most common pediatric liver malignancy. Despite advances in chemotherapeutic regimens and surgical techniques, the survival of patients with advanced HB remains poor, underscoring the need for new therapeutic approaches. Chloroquine (CQ), a drug used to treat malaria and rheumatologic diseases, has been shown to inhibit the growth and survival of various cancer types. We examined the antineoplastic activity of CQ in cell models of aggressive HB. Methods: Seven human HB cell models, all derived from chemoresistant tumors, were cultured as spheroids in the presence of relevant concentrations of CQ. Morphology, viability, and induction of apoptosis were assessed after 48 and 96 h of CQ treatment. Metabolomic analysis and RT-qPCR based Death Pathway Finder array were used to elucidate the molecular mechanisms underlying the CQ effect in a 2-dimensional cell culture format. Quantitative western blotting was performed to validate findings at the protein level. Results: CQ had a significant dose and time dependent effect on HB cell viability both in spheroids and in 2-dimensional cell cultures. Following CQ treatment HB spheroids exhibited increased caspase 3/7 activity indicating the induction of apoptotic cell death. Metabolomic profiling demonstrated significant decreases in the concentrations of NAD+ and aspartate in CQ treated cells. In further investigations, oxidation of NAD+ decreased as consequence of CQ treatment and NAD+/NADH balance shifted toward NADH. Aspartate supplementation rescued cells from CQ induced cell death. Additionally, downregulated expression of PARP1 and PARP2 was observed. Conclusions: CQ treatment inhibits cell survival in cell models of aggressive HB, presumably by perturbing NAD+ levels, impairing aspartate bioavailability, and inhibiting PARP expression. CQ thus holds potential as a new agent in the management of HB.
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Affiliation(s)
- Katja Eloranta
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Emmi Liljeström
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Tea Soini
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Department of Medicine, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Antti Kyrönlahti
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - David B Wilson
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, United States.,Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO, United States
| | - Markku Heikinheimo
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, United States
| | - Marjut Pihlajoki
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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15
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Crowgey EL, Soini T, Shah N, Pauniaho SL, Lahdenne P, Wilson DB, Heikinheimo M, Druley TE. Germline Sequencing Identifies Rare Variants in Finnish Subjects with Familial Germ Cell Tumors. Appl Clin Genet 2020; 13:127-137. [PMID: 32636668 PMCID: PMC7335280 DOI: 10.2147/tacg.s245093] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/19/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Pediatric germ cell tumors are rare, representing about 3% of childhood malignancies in children less than 15 years of age, presenting in neonates or adolescents with a greater incidence noted in older adolescents. Aberrations in primordial germ cell proliferation/differentiation can lead to a variety of neoplasms, including teratomas, embryonal carcinoma, choriocarcinoma, and yolk sac tumors. PATIENTS AND METHODS Three Finnish families with varying familial germ cell tumors were identified, and whole-genome sequencing was performed using an Illumina sequencing platform. In total, 22 unique subjects across the three families were sequenced. Family 1 proband (female) was affected by malignant ovarian teratoma, Family 2 proband (female) was affected by sacrococcygeal teratoma with yolk sac tumor in the setting of Cornelia de Lange syndrome, and Family 3 proband (male) was affected by malignant testicular teratoma. Rare variants were identified using an autosomal recessive or de novo model of inheritance. RESULTS For family 1 proband (female), an autosomal recessive or de novo model of inheritance identified variants of interest in the following genes: CD109, IKBKB, and CTNNA3, SUPT6H, MUC5AC, and FRG1. Family 2 proband (female) analysis identified gene variants of interest in the following genes: LONRF2, ANO7, HS6ST1, PRB2, and DNM2. Family 3 proband (male) analysis identified the following potential genes: CRIPAK, KRTAP5-7, and CACNA1B. CONCLUSION Leveraging deep pedigrees and next-generation sequencing, rare germline variants were identified that were enriched in three families from Finland with a history of familial germ cell tumors. The data presented support the importance of germline mutations when analyzing complex cancers with a low somatic mutation landscape.
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Affiliation(s)
- Erin L Crowgey
- Nemours Center for Cancer and Blood Disorders, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Tea Soini
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nidhi Shah
- Nemours Center for Cancer and Blood Disorders, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Satu-Liisa Pauniaho
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Tampere Center for Child Health Research, University of Tampere, Tampere University Hospital, Tampere, Finland
| | - Pekka Lahdenne
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - David B Wilson
- Department of Pediatrics, Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Markku Heikinheimo
- Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Pediatrics, Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Todd E Druley
- Department of Pediatrics, Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO, USA
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16
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Haltia UM, Pihlajoki M, Andersson N, Mäkinen L, Tapper J, Cervera A, Horlings HM, Turpeinen U, Anttonen M, Bützow R, Unkila-Kallio L, Carpén O, Wilson DB, Heikinheimo M, Färkkilä A. Functional Profiling of FSH and Estradiol in Ovarian Granulosa Cell Tumors. J Endocr Soc 2020; 4:bvaa034. [PMID: 32309755 PMCID: PMC7153750 DOI: 10.1210/jendso/bvaa034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/11/2020] [Indexed: 12/18/2022] Open
Abstract
Adult-type granulosa cell tumors (AGCTs) are sex-cord derived neoplasms with a propensity for late relapse. Hormonal modulators have been used empirically in the treatment of recurrent AGCT, albeit with limited success. To provide a more rigorous foundation for hormonal therapy in AGCT, we used a multimodal approach to characterize the expressions of key hormone biomarkers in 175 tumor specimens and 51 serum samples using RNA sequencing, immunohistochemistry, RNA in situ hybridization, quantitative PCR, and circulating biomarker analysis, and correlated these results with clinical data. We show that FSH receptor and estrogen receptor beta (ERβ) are highly expressed in the majority of AGCTs, whereas the expressions of estrogen receptor alpha (ERα) and G-protein coupled estrogen receptor 1 are less prominent. ERβ protein expression is further increased in recurrent tumors. Aromatase expression levels show high variability between tumors. None of the markers examined served as prognostic biomarkers for progression-free or overall survival. In functional experiments, we assessed the effects of FSH, estradiol (E2), and the aromatase inhibitor letrozole on AGCT cell viability using 2 in vitro models: KGN cells and primary cultures of AGCT cells. FSH increased cell viability in a subset of primary AGCT cells, whereas E2 had no effect on cell viability at physiological concentrations. Letrozole suppressed E2 production in AGCTs; however, it did not impact cell viability. We did not find preclinical evidence to support the clinical use of aromatase inhibitors in AGCT treatment, and thus randomized, prospective clinical studies are needed to clarify the role of hormonal treatments in AGCTs.
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Affiliation(s)
- Ulla-Maija Haltia
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Children's Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marjut Pihlajoki
- Children's Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Noora Andersson
- Children's Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lotta Mäkinen
- Children's Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Tapper
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Alejandra Cervera
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hugo M Horlings
- Department of Pathology, the Netherlands Cancer Institute, BE Amsterdam, the Netherlands
| | | | | | - Ralf Bützow
- Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leila Unkila-Kallio
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Olli Carpén
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - David B Wilson
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri 63110.,Department of Developmental Biology, Washington University School of Medicine, Saint Louis, Missouri 63110
| | - Markku Heikinheimo
- Children's Hospital and Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri 63110
| | - Anniina Färkkilä
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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17
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Tiusanen T, Hukkinen M, Leskinen O, Soini T, Kanerva JA, Jahnukainen T, Mäkisalo H, Heikinheimo M, Pakarinen MP. Incidence and long-term outcomes of surgically treated childhood hepatic malignancies in Finland. Acta Paediatr 2020; 109:404-414. [PMID: 31350767 DOI: 10.1111/apa.14952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/06/2019] [Accepted: 07/24/2019] [Indexed: 12/12/2022]
Abstract
AIM To analyse incidence, treatment and outcomes of paediatric liver malignancies in Finland during 1987-2017. METHODS Medical records and national cancer registry data of 47 children with liver malignancies were reviewed. Survival was calculated with the Kaplan-Meier method. RESULTS During follow-up, liver malignancy incidence remained stable at 1.1:106 . Altogether, 42 patients with hepatoblastoma (n = 24), hepatocellular carcinoma (n = 11) and undifferentiated embryonal sarcoma (n = 7) underwent surgery at median age 4.6 (interquartile range, 2.0-9.6) years and were followed up for 13 (7.0-19) years. Cumulative 5-year survival was 86% for hepatoblastoma, 41% for hepatocellular carcinoma and 67% for undifferentiated embryonal sarcoma. Five-year survival was decreased among hepatoblastoma patients aged ≥ 2.4 years (73% versus 100%, P = .040), with PRETreatment EXTent of disease IV (PRETEXT, 60% vs 100%, P = .004), and with recurrent disease (67% vs 88%, P = .029). Recurrent/residual disease associated with decreased 5-year survival in hepatocellular carcinoma (0% vs 83%, P = .028). Survival was similar among 19 transplanted and 23 resected patients. In total, 14 deaths occurred either for the underlying malignancy (n = 8), adverse effects of chemotherapy (n = 5) or unrelated reasons (n = 1). CONCLUSION Outcomes for PRETEXT I-III hepatoblastoma and un-metastasized hepatocellular carcinoma were encouraging. Adverse effects of chemotherapy significantly contributed to mortality.
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Affiliation(s)
- Toivo Tiusanen
- Pediatric Liver and Gut Research Group Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
- Pediatric Research Center Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Maria Hukkinen
- Pediatric Liver and Gut Research Group Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
- Pediatric Research Center Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
- Section of Pediatric Surgery Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Outi Leskinen
- HUS Medical Imaging Center Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Tea Soini
- Pediatric Research Center Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Jukka A. Kanerva
- Pediatric Research Center Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Timo Jahnukainen
- Pediatric Research Center Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
- Department of Pediatric Nephrology and Transplantation Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Heikki Mäkisalo
- Department of Liver and Transplantation Surgery University Hospital University of Helsinki Helsinki Finland
| | - Markku Heikinheimo
- Pediatric Research Center Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
- Department of Pediatrics Washington University St. Louis MO USA
| | - Mikko P. Pakarinen
- Pediatric Liver and Gut Research Group Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
- Pediatric Research Center Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
- Section of Pediatric Surgery Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
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18
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Sanaksenaho G, Mutanen A, Godbole N, Kyrönlahti A, Koivusalo A, Lohi J, Pihlajoki M, Heikinheimo M, Pakarinen MP. Parenteral Nutrition-Dependent Children With Short-Bowel Syndrome Lack Duodenal-Adaptive Hyperplasia but Show Molecular Signs of Altered Mucosal Function. JPEN J Parenter Enteral Nutr 2020; 44:1291-1300. [PMID: 31985858 DOI: 10.1002/jpen.1763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/30/2019] [Accepted: 12/04/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although adaptive mucosal growth of the remaining small intestine is an essential compensatory mechanism to bowel resection in experimental short-bowel syndrome (SBS), only scarce clinical data are available. We studied structural and molecular mechanisms of intestinal adaptation in children with SBS. METHODS Fourteen patients, who had been dependent on parenteral nutrition (PN) since neonatal period for a median (interquartile range)1.4 (0.7-6.5) years, were studied at the age of 1.5 (1.0-6.5) years. Median length of remaining small bowel was 33 (12-60) cm, and 6 patients had their ileocecal valve preserved. Six children without gastrointestinal disorders served as age-matched and gender-matched controls. All patients underwent duodenal biopsies. Mucosal microarchitecture, proliferation, apoptosis, inflammation, and epithelial-barrier function were addressed using histology, immunohistochemistry, and quantitative real-time polymerase chain reaction. RESULTS Villus height, crypt depth, enterocyte proliferation, and apoptosis were similar in patients and matched controls. Messenger RNA (mRNA) expression of numerous genes regulating gut epithelial-barrier function (TGFB2, CAV1, CLDN1, MUC2, and NLRC4) was significantly altered. Of various nutrient transporters studied, only expression of SLC2A1 encoding facilitative glucose transporter GLUT1 was increased among patients, whereas RNA expression of genes encoding sodium-dependent glucose, sterol, fatty-acid, and peptide transport remained unchanged. CONCLUSION Duodenal mucosal hyperplasia has a limited role in mediating physiological adaptation following intestinal resection among PN-dependent children with SBS. Further clinical studies addressing functional significance of the observed alterations in mucosal RNA expression are warranted.
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Affiliation(s)
- Galina Sanaksenaho
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Annika Mutanen
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nimish Godbole
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Kyrönlahti
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Koivusalo
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jouko Lohi
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marjut Pihlajoki
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markku Heikinheimo
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko P Pakarinen
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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19
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Crosley P, Agopsowicz K, Potts K, Noyce R, Pihlajoki M, Heikinheimo M, Färkkilä A, Evans D, Hitt M. Abstract NT-089: TRAIL-EXPRESSING ONCOLYTIC VACCINIA VIRUS COMBINED WITH SMALL-MOLECULE DRUG PAC1 IS A POTENTIALLY EFFECTIVE TREATMENT ALTERNATIVE FOR OVARIAN CANCERS. Clin Cancer Res 2019. [DOI: 10.1158/1557-3265.ovcasymp18-nt-089] [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: Procaspase activating compound-1 (PAC1) is a small-molecule drug shown in vitro to sequester inhibitory zinc ions from caspase-3. TNF-related apoptosis-inducing ligand (TRAIL) is a pro-apoptotic ligand that binds membrane-bound death receptors, triggering the extrinsic apoptotic pathway. Both agents display low toxicity in humans. Vaccinia virus (VACV) is a double-stranded DNA virus that has shown therapeutic efficacy in clinical trials and has an established safety profile in humans due to its use as the smallpox vaccine.
First-line standard of care for ovarian cancer is combination taxane and carboplatin, which has significant potential toxicity and 70% of women who receive it suffer relapse. Clinical trials involving TRAIL, both alone and combined with other drugs, have shown that while it is well-tolerated it is ineffective partly due to insufficient dosing at the tumour site.
In an effort to uncover a safer, more effective therapeutic for ovarian cancer we report here on the successful construction of a recombinant oncolytic vaccinia virus expressing TRAIL (VACVTRAIL). Secretion of TRAIL by VACV-infected cancer cells will result in localized administration of TRAIL at higher dosages and minimize potential side-effects. We posit that treatment with PAC1 and VACVTRAIL represents a potentially safe, effective treatment for ovarian cancers.
RESULTS: Testing in cell line models of granulosa cell tumour (GCT) have shown that recombinant human (rh)TRAIL is effective in combination with PAC1. Dose-response assays established that combination of PAC1 (20 μM) with rhTRAIL (10 ng/mL) dramatically reduced viability of cancer cells while being substantially less toxic to normal cells. Replication of those assays on patient-derived primary and recurrent GCT cells confirmed PAC1 combined with rhTRAIL was dramatically more cytotoxic than treatment with rhTRAIL or PAC1 alone.
To optimize delivery of TRAIL to tumour cells, we constructed a recombinant VACVTRAIL virus that secretes TRAIL in the range of 70–80 ng/mL. Dose-response curves showed VACVTRAIL to be strongly cytotoxic with an ED50 of 0.1 plaque forming unit (PFU) per cell. Comparing toxicity of VACVTRAIL to a non-TRAIL-expressing VACV established that secretion of TRAIL is the basis for VACVTRAIL superiority in killing GCT cells, and supernatant collected from infected cells is more effective at reducing cell viability when combined with PAC1 than is rhTRAIL combined with PAC1.
CONCLUSION: We have successfully constructed a TRAIL-expressing oncolytic VACV which produces effective levels of active TRAIL from infected cells. Results in vitro suggest combining PAC1 with oncolytic VACVTRAIL will allow localized delivery of TRAIL resulting in a safe, synergistic, self-amplifying therapy.
Citation Format: Powel Crosley, Kate Agopsowicz, Kyle Potts, Ryan Noyce, Marjut Pihlajoki, Markku Heikinheimo, Anniina Färkkilä, David Evans, Mary Hitt. TRAIL-EXPRESSING ONCOLYTIC VACCINIA VIRUS COMBINED WITH SMALL-MOLECULE DRUG PAC1 IS A POTENTIALLY EFFECTIVE TREATMENT ALTERNATIVE FOR OVARIAN CANCERS [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr NT-089.
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Affiliation(s)
| | | | | | - Ryan Noyce
- 2Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada
| | - Marjut Pihlajoki
- 3University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markku Heikinheimo
- 3University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anniina Färkkilä
- 3University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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20
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Haen SM, Heinonen M, Kauffold J, Heikinheimo M, Hoving LL, Soede NM, Peltoniemi OAT. GnRH-agonist deslorelin implant alters the progesterone release pattern during early pregnancy in gilts. Reprod Domest Anim 2019; 54:464-472. [PMID: 30431675 DOI: 10.1111/rda.13376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/04/2018] [Indexed: 11/27/2022]
Abstract
The aim of this study was to investigate the relationship of progesterone (P) and luteinizing hormone (LH) during recognition and establishment of pregnancy in the gilt. Therefore, the effects of eliminating episodic LH pulses on P patterns were determined during early pregnancy. To this end, a slow-release GnRH implant deslorelin was used for GnRH down-regulation. A group of gilts (GnRHa, n = 8) was implanted with the GnRH-agonist on Day 11 of pregnancy, while a control group (C, n = 5) was treated with a non-impregnated placebo implant. Blood was collected via a vena cava caudalis catheter at 10-min intervals for 8 hr on Day 16 and 21 of pregnancy. As expected, the GnRH implant reduced LH secretion (p < 0.01) and abolished LH pulses completely at Day 16 and Day 21 of pregnancy. On Day 16, there was no difference in P levels between the treatments. However, on Day 21, the GnRH-agonist treatment led to significantly increased P concentrations (p < 0.01) compared with the control gilts. Progesterone was secreted in a pulsatile manner in both treatment groups and no relationship between LH pulsatility and P pulsatility was observed. In conclusion, abolishment of LH pulsatility did not affect the pulsatile pattern of P secretion but led to an unexpected overall increase in P on Day 21 of pregnancy; this effect was delayed and occurred 10 days after commencing treatment with the GnRH depot agonist. The elevation of P on Day 21 of pregnancy in the GnRHa group suggests either a reduced negative feedback effect or an increased autocrine response by the corpora lutea.
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Affiliation(s)
- Silke M Haen
- Department of Production Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Saarentaus, Finland
| | - Mari Heinonen
- Department of Production Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Saarentaus, Finland
| | - Johannes Kauffold
- Clinic for Ruminants and Swine, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Markku Heikinheimo
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
| | - Lia L Hoving
- Adaptation Physiology Group, Department of Animal Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Nicoline M Soede
- Adaptation Physiology Group, Department of Animal Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Olli A T Peltoniemi
- Department of Production Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Saarentaus, Finland
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21
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Soini T, Eloranta K, Pihlajoki M, Kyrönlahti A, Akinrinade O, Andersson N, Lohi J, Pakarinen MP, Wilson DB, Heikinheimo M. Transcription factor GATA4 associates with mesenchymal-like gene expression in human hepatoblastoma cells. Tumour Biol 2018; 40:1010428318785498. [PMID: 30074440 DOI: 10.1177/1010428318785498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 12/21/2022] Open
Abstract
GATA4, a transcription factor crucial for early liver development, has been implicated in the pathophysiology of hepatoblastoma, an embryonal tumor of childhood. However, the molecular and phenotypic consequences of GATA4 expression in hepatoblastoma are not fully understood. We surveyed GATA4 expression in 24 hepatoblastomas using RNA in situ hybridization and immunohistochemistry. RNA interference was used to inhibit GATA4 in human HUH6 hepatoblastoma cells, and changes in cell migration were measured with wound healing and transwell assays. RNA microarray hybridization was performed on control and GATA4 knockdown HUH6 cells, and differentially expressed genes were validated by quantitative polymerase chain reaction or immunostaining. Plasmid transfection was used to overexpress GATA4 in primary human hepatocytes and ensuring changes in gene expression were measured by quantitative polymerase chain reaction. We found that GATA4 expression was high in most hepatoblastomas but weak or negligible in normal hepatocytes. GATA4 gene silencing impaired HUH6 cell migration. We identified 106 differentially expressed genes (72 downregulated, 34 upregulated) in knockdown versus control HUH6 cells. GATA4 silencing altered the expression of genes associated with cytoskeleton organization, cell-to-cell adhesion, and extracellular matrix dynamics (e.g. ADD3, AHNAK, DOCK8, RHOU, MSF, IGFBP1, COL4A2). These changes in gene expression reflected a more epithelial (less malignant) phenotype. Consistent with this notion, there was reduced F-actin stress fiber formation in knockdown HUH6 cells. Forced expression of GATA4 in primary human hepatocytes triggered opposite changes in the expression of genes identified by GATA4 silencing in HUH6 cells. In conclusion, GATA4 is highly expressed in most hepatoblastomas and correlates with a mesenchymal, migratory phenotype of hepatoblastoma cells.
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Affiliation(s)
- Tea Soini
- 1 Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katja Eloranta
- 1 Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marjut Pihlajoki
- 1 Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- 2 Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Antti Kyrönlahti
- 1 Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- 2 Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Oyediran Akinrinade
- 1 Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Noora Andersson
- 1 Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jouko Lohi
- 3 Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko P Pakarinen
- 1 Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- 4 Unit of Pediatric Surgery and Pediatric Liver and Gut Research Group, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - David B Wilson
- 2 Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- 5 Department of Developmental Biology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Markku Heikinheimo
- 1 Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- 2 Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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22
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Långström S, Koskenvuo M, Huttunen P, Lassila R, Taskinen M, Ranta S, Heikinheimo M, Mäkipernaa A. Haematopoietic Stem Cell Transplantation in Children Shifts the Coagulation System towards a Pro-Coagulant State. Thromb Haemost 2018; 118:1390-1396. [DOI: 10.1055/s-0038-1661394] [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: 10/28/2022]
Abstract
AbstractCoagulation system is disturbed by several mechanisms after allogeneic haematopoietic stem cell transplantation (HSCT). We evaluated the effect of HSCT on coagulation system by various conventional and investigational methods in 30 children and adolescents who received HSCT due to haematological malignancies. Pro-thrombin fragment 1 + 2, a specific measure of thrombin generation, and von Willebrand factor, a measure of endothelial activation, increased after conditioning treatment, and remained elevated until 3 months after HSCT (p < 0.05 for all comparisons to pre-conditioning treatment). D-dimer, a measure of fibrin turnover, was elevated from the second week onwards until 4 weeks after HSCT (p < 0.05). Endogenous thrombin potential was increased after conditioning, and at 2 weeks after HSCT (p < 0.05). Furthermore, the activities of acute phase reactants fibrinogen and coagulation factor VIII were increased (p < 0.05 for all comparisons to pre-conditioning treatment) from the first week onwards up to 3 weeks and 3 months after HSCT, respectively. Taken together, paediatric patients receiving HSCT demonstrate distinct and prolonged variations in the coagulation system towards a pro-coagulant state. This shift is of importance when estimating the risk of haemostatic and thrombotic complications in these children.
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Affiliation(s)
- Satu Långström
- Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Minna Koskenvuo
- Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Pasi Huttunen
- Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Riitta Lassila
- Unit for Coagulation Disorders, Department of Haematology, Comprehensive Care Center and Cancer Center, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Mervi Taskinen
- Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Susanna Ranta
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Markku Heikinheimo
- Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Anne Mäkipernaa
- Unit for Coagulation Disorders, Department of Haematology, Comprehensive Care Center and Cancer Center, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
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Soini T, Pihlajoki M, Andersson N, Lohi J, Huppert KA, Rudnick DA, Huppert SS, Wilson DB, Pakarinen MP, Heikinheimo M. Transcription factor GATA6: a novel marker and putative inducer of ductal metaplasia in biliary atresia. Am J Physiol Gastrointest Liver Physiol 2018; 314:G547-G558. [PMID: 29388792 PMCID: PMC6008062 DOI: 10.1152/ajpgi.00362.2017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Biliary atresia (BA), a neonatal liver disease, is characterized by obstruction of extrahepatic bile ducts with subsequent cholestasis, inflammation, and progressive liver fibrosis. To gain insights into the pathophysiology of BA, we focused attention on GATA6, a transcription factor implicated in biliary development. Early in fetal development GATA6 expression is evident in cholangiocytes and hepatocytes, but by late gestation it is extinguished in hepatocytes. Utilizing a unique set of BA liver samples collected before and after successful portoenterostomy (PE), we found that GATA6 expression is markedly upregulated in hepatocytes of patients with BA compared with healthy and cholestatic disease controls. This upregulation is recapitulated in two murine models simulating bile duct obstruction and intrahepatic bile ductule expansion. GATA6 expression in BA livers correlates with two established negative prognostic indicators (age at PE, degree of intrahepatic bile ductule expansion) and decreases after normalization of serum bilirubin by PE. GATA6 expression in BA livers correlates with expression of known regulators of cholangiocyte differentiation ( JAGGED1, HNF1β, and HNF6). These same genes are upregulated after enforced expression of GATA6 in human hepatocyte cell models. In conclusion, GATA6 is a novel marker and a putative driver of hepatocyte-cholangiocyte metaplasia in BA, and its expression in hepatocytes is downregulated after successful PE. NEW & NOTEWORTHY A pathological hallmark in the liver of patients with biliary atresia is ductular reaction, an expansion of new bile ductules that are thought to arise from conversion of mature hepatocytes. Here, we show that transcription factor GATA6 is a marker and potential driver of hepatocyte ductal metaplasia in biliary atresia. Hepatocyte GATA6 expression is elevated in biliary atresia, correlates with bile duct expansion, and decreases after successful portoenterostomy.
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Affiliation(s)
- Tea Soini
- 1Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marjut Pihlajoki
- 1Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland,2Department of Pediatrics, Saint Louis Children’s Hospital, Washington University School of Medicine, Saint Louis, Missouri
| | - Noora Andersson
- 1Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jouko Lohi
- 3Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kari A. Huppert
- 4Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Research Foundation and the University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David A. Rudnick
- 2Department of Pediatrics, Saint Louis Children’s Hospital, Washington University School of Medicine, Saint Louis, Missouri,5Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stacey S. Huppert
- 4Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Research Foundation and the University of Cincinnati College of Medicine, Cincinnati, Ohio,5Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David B. Wilson
- 2Department of Pediatrics, Saint Louis Children’s Hospital, Washington University School of Medicine, Saint Louis, Missouri,6Department of Developmental Biology, Washington University School of Medicine, Saint Louis, Missouri
| | - Mikko P. Pakarinen
- 1Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland,7Pediatric Surgery and Pediatric Liver and Gut Research Group, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markku Heikinheimo
- 1Pediatric Research Center, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland,2Department of Pediatrics, Saint Louis Children’s Hospital, Washington University School of Medicine, Saint Louis, Missouri
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24
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Hyytiäinen S, Wartiovaara-Kautto U, Ulander VM, Kaaja R, Heikinheimo M, Petäjä J. The procoagulant effects of factor V Leiden may be balanced against decreased levels of factor V and do not reflect in vivo thrombin formation in newborns. Thromb Haemost 2017; 95:434-40. [PMID: 16525570 DOI: 10.1160/th05-05-0375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryThrombin regulation in newborns remains incompletely understood.We studied tissue factor-initiated thrombin formation in cord plasma in vitro, and the effects of Factor VLeiden (FVL) heterozygosity on thrombin regulation both in vitro and in vivo in newborns. Pregnant women with known thrombophilia (n=27) were enrolled in the study. Cord blood and venous blood at the age of 14 days were collected from 11 FVL heterozygous newborns (FVL-positive) and from 16 FVL-negative newborns. Prothrombin fragment F1+2 and coagulation factors were measured. Tissue factor-initiated thrombin formation was studied in cord platelet-poor plasma (PPP) of FVL-negative and -positive newborns, and in both PPP and platelet-rich plasma (PRP) of healthy controls. The endogenous thrombin potential (ETP) in cord PPP or PRP was ∼60% of that in adult plasma, while thrombin formation started ∼55% and ∼40% earlier in cord PPP and PRP, respectively. Further, in FVL-positive newborns thrombin formation started significantly earlier than in FVL-negative newborns. Exogenous activated protein C (APC) decreased ETP significantly more in cord than in adult PRP. In FVL-negative cord plasma 5nM APC decreased ETP by 17.4±3.5% (mean±SEM) compared with only 3.5±3.8% in FVL-positive cord plasma (p=0.01). FVL-positive newborns showed similar levels of F1+2 but significantly decreased levels of factor V compared with FVL negative newborns both in cord plasma (FV 0.82±0.07 U/ml vs. 0.98±0.05 U/ml, p=0.03) and at the age of two weeks (FV 1.15±0.04 U/ml vs. 1.32±0.05 U/ml, p=0.03). In conclusion, newborn plasma showed more rapid thrombin formation and enhanced sensitivity to APC compared with adult plasma. FVL conveyed APC resistance and a procoagulant effect in newborn plasma. Lack of elevated F1+2 levels in FVL-positive infants, however, suggested the existence of balancing mechanisms; one could be the observed lower level of factor V in FVL heterozygous newborns.
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Wartiovaara-Kautto U, Andersson S, Heikinheimo M, Petäjä J, Långström S. Exchange transfusion activates coagulation and alters the coagulation profile in newborn infants. Thromb Haemost 2017. [DOI: 10.1160/th06-03-0182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryExchange transfusion (ET) with adult blood is a standard procedure for neonates with severe hyperbilirubinemia. How ET affects newborn coagulation system remains, however, largely unknown. Thus, we prospectively evaluated the effect of ET on thrombin formation and coagulation profile in 18 newborns (22 ETs). Prothrombin fragment F1+2 and thrombin-antithrombin complexes increased considerably during ET while platelets were significantly reduced. Protein C increased less (p<0.001) and factorVIIIc more (p<0.001) than expected based on their levels in the infused blood. Further, in vitro thrombin generation initiated by5 pM tissue factor was analysed. Before the first ET, newborn endogenous thrombin potential (ETP) and thrombin peak remained at ≈60% of adult control plasma levels, but the lag time to thrombin burst in newborn plasma was ≈45% shorter than the lag time in adult plasma. At the end of the first ET, the thrombin burst still started ≈35% earlier in newborn than adult plasma, whereas ETP and thrombin peak were increased to >90% of adult levels. ETP and peak remained elevated at adult levels until the beginning of the second ET. APC-induced reductions in newborn ETP remained unaltered throughout the first ET. The reductions of ETP by APC were less pronounced in newborn than adult plasma (p<0.0001).We conclude that ET is associated with multiple procoagulant changes and increased in vivo thrombin formation. This ET-induced procoagulant challenge may be of clinical significance in sick newborns already prone to bleeding and thrombotic complications.
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Rautiainen P, Mildh L, Peltola K, Wartiovaara-Kautto U, Petäjä J, Långström S, Heikinheimo M. Thrombin regulation in neonates undergoing cardiopulmonary bypass. Thromb Haemost 2017; 99:791-2. [DOI: 10.1160/th07-11-0657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rautiainen P, Mildh L, Peltola K, Wartiovaara-Kautto U, Heikinheimo M, Petäjä J, Långström S. Fresh frozen plasma does not reduce in vivo thrombin formation after neonatal cardiopulmonary bypass surgery. Thromb Haemost 2017. [DOI: 10.1160/th08-05-0340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Adult-type granulosa cell tumor is a clinically and molecularly unique subtype of ovarian cancer. These tumors originate from the sex cord stromal cells of the ovary and represent 3-5% of all ovarian cancers. The majority of adult-type granulosa cell tumors are diagnosed at an early stage with an indolent prognosis. Surgery is the cornerstone for the treatment of both primary and relapsed tumor, while chemotherapy is applied only for advanced or non-resectable cases. Tumor stage is the only factor consistently associated with prognosis. However, every third of the patients relapse, typically in 4-7 years from diagnosis, leading to death in 50% of these patients. Anti-Müllerian Hormone and inhibin B are currently the most accurate circulating biomarkers. Adult-type granulosa cell tumors are molecularly characterized by a pathognomonic somatic missense point mutation 402C->G (C134W) in the transcription factor FOXL2. The FOXL2 402C->G mutation leads to increased proliferation and survival of granulosa cells, and promotes hormonal changes. Histological diagnosis of adult-type granulosa cell tumor is challenging, therefore testing for the FOXL2 mutation is crucial for differential diagnosis. Large international collaborations utilizing molecularly defined cohorts are essential to improve and validate new treatment strategies for patients with high-risk or relapsed adult-type granulosa cell tumor. Key Messages: Adult-type granulosa cell tumor is a unique ovarian cancer with an indolent, albeit unpredictable disease course. Adult-type granulosa cell tumors harbor a pathognomonic somatic missense mutation in transcription factor FOXL2. The key challenges in the treatment of patients with adult-type granulosa cell tumor lie in the identification and management of patients with high-risk or relapsed disease.
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Affiliation(s)
- Anniina Färkkilä
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.,b Children's Hospital , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Ulla-Maija Haltia
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.,b Children's Hospital , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Johanna Tapper
- a Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Melissa K McConechy
- c Department of Human Genetics , Research Institute of the McGill University Health Centre, McGill University , Montreal , Canada
| | - David G Huntsman
- d Department of Pathology and Laboratory Medicine , University of British Columbia , Vancouver , Canada.,e Department of Molecular Oncology , British Columbia Cancer Agency , Vancouver , Canada
| | - Markku Heikinheimo
- b Children's Hospital , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.,f Department of Pediatrics , Washington University School of Medicine, St. Louis Children's Hospital , St. Louis , MO , USA
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Penny GM, Cochran RB, Pihlajoki M, Kyrönlahti A, Schrade A, Häkkinen M, Toppari J, Heikinheimo M, Wilson DB. Probing GATA factor function in mouse Leydig cells via testicular injection of adenoviral vectors. Reproduction 2017; 154:455-467. [PMID: 28710293 DOI: 10.1530/rep-17-0311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/09/2017] [Accepted: 07/14/2017] [Indexed: 12/21/2022]
Abstract
Testicular Leydig cells produce androgens essential for proper male reproductive development and fertility. Here, we describe a new Leydig cell ablation model based on Cre/Lox recombination of mouse Gata4 and Gata6, two genes implicated in the transcriptional regulation of steroidogenesis. The testicular interstitium of adult Gata4flox/flox ; Gata6flox/flox mice was injected with adenoviral vectors encoding Cre + GFP (Ad-Cre-IRES-GFP) or GFP alone (Ad-GFP). The vectors efficiently and selectively transduced Leydig cells, as evidenced by GFP reporter expression. Three days after Ad-Cre-IRES-GFP injection, expression of androgen biosynthetic genes (Hsd3b1, Cyp17a1 and Hsd17b3) was reduced, whereas expression of another Leydig cell marker, Insl3, was unchanged. Six days after Ad-Cre-IRES-GFP treatment, the testicular interstitium was devoid of Leydig cells, and there was a concomitant loss of all Leydig cell markers. Chromatin condensation, nuclear fragmentation, mitochondrial swelling, and other ultrastructural changes were evident in the degenerating Leydig cells. Liquid chromatography-tandem mass spectrometry demonstrated reduced levels of androstenedione and testosterone in testes from mice injected with Ad-Cre-IRES-GFP. Late effects of treatment included testicular atrophy, infertility and the accumulation of lymphoid cells in the testicular interstitium. We conclude that adenoviral-mediated gene delivery is an expeditious way to probe Leydig cell function in vivo Our findings reinforce the notion that GATA factors are key regulators of steroidogenesis and testicular somatic cell survival.Free Finnish abstract: A Finnish translation of this abstract is freely available at http://www.reproduction-online.org/content/154/4/455/suppl/DC2.
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Affiliation(s)
- Gervette M Penny
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Rebecca B Cochran
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Marjut Pihlajoki
- Children's HospitalUniversity of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Kyrönlahti
- Children's HospitalUniversity of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anja Schrade
- Children's HospitalUniversity of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Merja Häkkinen
- University of Eastern FinlandSchool of Pharmacy, Kuopio, Finland
| | - Jorma Toppari
- Department of PhysiologyInstitute of Biomedicine, University of Turku and Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Markku Heikinheimo
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA.,Children's HospitalUniversity of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - David B Wilson
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA .,Department of Developmental BiologyWashington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA
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Crosley P, Agopsowicz K, Pihlajoki M, Heikinheimo M, Färkkilä A, Hitt M. Abstract NTOC-086: PAC–1 COMBINATION WITH TRAIL ENHANCES APOPTOSIS IN CELL–LINE AND PRIMARY CULTURED ADULT GRANULOSA CELL TUMOUR CELLS. Clin Cancer Res 2017. [DOI: 10.1158/1557-3265.ovcasymp16-ntoc-086] [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: Granulosa cell tumour (GCT) constitutes ~5% of ovarian neoplasms. Surgery remains the primary treatment modality due to a generally poor response to chemotherapy in GCT patients.
Procaspase activating compound-1 (PAC1) is a small-molecule drug shown in vitro to sequester inhibitory zinc ions from the Caspase-3 (CASP3) zymogen allowing CASP3 to automature and execute apoptosis. PAC1 has demonstrated safety and efficacy in vivo against several cancers and is currently in Phase I trials for advanced malignancies.
TNF-related apoptosis-inducing ligand (TRAIL) is a pro-apoptosis ligand that can bind membrane-bound death receptors. This binding triggers the extrinsic apoptotic pathway resulting in activation of CASP3 to execute its proteolytic role and programmed cell death. TRAIL has been found to induce apoptosis selectively in cancer cells in vitro and in vivo, and has been well tolerated in human patients.
We hypothesise that combining PAC1 activation of CASP3 with induction of apoptotic signaling by exogenous TRAIL will significantly heighten biologic effect, reduction of disease, and that these effects will be obtained at doses lower than those required by either agent alone.
Here we report on in vitro experiments in support of this hypothesis, suggesting that combining PAC1 with TRAIL may be effective therapy for treatment of GCT.
METHODS: The GCT cell line KGN was treated in vitro with a 6-log range of PAC1 concentration for 48 hours to establish a dose-response curve (using a real-time cell analyzer, RTCA). In parallel, KGN cells were treated with a 6-log range of TRAIL concentration to establish its dose-response curve. Calculated EC50 values were then used for both PAC1 (20 μM) and TRAIL (10 ng/mL) to evaluate the biologic response of simultaneous treatment with PAC1 and TRAIL, and TRAIL delayed 24 hours after PAC1 treatment (using resazurin viability assay and RTCA). Separately, cells from fresh primary and recurrent tumour samples were cultured in vitro for 5 days, then treated with PAC1 (20 μM), TRAIL (10 ng/mL), or the combination, and finally assayed for viability and caspase 3/7 activity 48 and 72 hours later.
RESULTS: Dose-response assays indicate treatment with PAC1 strongly reduces viability of KGN cells compared to untreated control (p<0.05) in a dose-dependent manner and treatment with PAC1 alone significantly reduced viability compared to untreated control (p<0.05). Similar assays with TRAIL only reduced viability of KGN cells at the highest concentration tested (1 µg/mL). The assays also suggest a ~24 hour delay in PAC1 reduction of GCT viability while TRAIL appears to display a time-limited response. Combination treatment was assessed using calculated EC50 concentrations for both PAC1 (20 µM) and TRAIL (10 ng/mL). Assays for both KGN and patient-derived primary GCT cells tested each drug alone, both drugs applied concurrently and TRAIL applied 24 hours after PAC1. Combination of PAC1 with TRAIL was dramatically more cytotoxic than TRAIL or PAC1 treatment alone (p<0.05)
CONCLUSION: Combining CASP3 activator PAC1 with apoptosis-inducing agents may be an effective strategy for treatment of GCT and warrants preclinical assessment.
Citation Format: Powel Crosley; Kate Agopsowicz; Marjut Pihlajoki; Markku Heikinheimo; Anniina Färkkilä; Mary Hitt. PAC–1 COMBINATION WITH TRAIL ENHANCES APOPTOSIS IN CELL–LINE AND PRIMARY CULTURED ADULT GRANULOSA CELL TUMOUR CELLS [abstract]. In: Proceedings of the 11th Biennial Ovarian Cancer Research Symposium; Sep 12-13, 2016; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(11 Suppl):Abstract nr NTOC-086.
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Affiliation(s)
- Powel Crosley
- 1Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Kate Agopsowicz
- 1Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Marjut Pihlajoki
- 2University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markku Heikinheimo
- 2University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anniina Färkkilä
- 2University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mary Hitt
- 1Department of Oncology, University of Alberta, Edmonton, AB, Canada
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31
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Soini T, Pihlajoki M, Kyrönlahti A, Andersson LC, Wilson DB, Heikinheimo M. Downregulation of transcription factor GATA4 sensitizes human hepatoblastoma cells to doxorubicin-induced apoptosis. Tumour Biol 2017; 39:1010428317695016. [PMID: 28349834 DOI: 10.1177/1010428317695016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Hepatoblastoma, the most common type of pediatric liver cancer, is treated with a combination of surgery and chemotherapy. An essential drug in the treatment of hepatoblastoma is doxorubicin, which in high doses is cardiotoxic. This adverse effect is due to downregulation of cardiac expression of transcription factor GATA4, leading in turn to diminished levels of anti-apoptotic BCL2 (B-cell lymphoma 2) protein family members. GATA4 is also expressed in early fetal liver, but absent from normal postnatal hepatocytes. However, GATA4 is highly expressed in hepatoblastoma tissue. In this study, we assessed the role of GATA4 in doxorubicin-induced apoptosis of hepatoblastoma cells. Herein, we demonstrate that doxorubicin decreases GATA4 expression and alters the expression pattern of BCL2 family members, most profoundly that of BCL2 and BAK, in the HUH6 hepatoblastoma cell line. Silencing of GATA4 by siRNA prior to doxorubicin treatment sensitizes HUH6 cells to the apoptotic effect of this drug by further shifting the balance of BCL2 family members to the pro-apoptotic direction. Specifically, expression levels of anti-apoptotic BCL2 were decreased and pro-apoptotic BID were increased after GATA4 silencing. On the whole, our results indicate that since high endogenous levels of transcription factor GATA4 likely protect hepatoblastoma cells from doxorubicin-induced apoptosis, these cells can be rendered more sensitive to the drug by downregulation of GATA4.
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Affiliation(s)
- Tea Soini
- 1 Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marjut Pihlajoki
- 1 Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,2 Department of Pediatrics, School of Medicine, Washington University in St. Louis and St. Louis Children's Hospital, St. Louis, MO, USA
| | - Antti Kyrönlahti
- 1 Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,2 Department of Pediatrics, School of Medicine, Washington University in St. Louis and St. Louis Children's Hospital, St. Louis, MO, USA
| | - Leif C Andersson
- 3 Department of Pathology, University of Helsinki and HUSLAB, Helsinki, Finland
| | - David B Wilson
- 2 Department of Pediatrics, School of Medicine, Washington University in St. Louis and St. Louis Children's Hospital, St. Louis, MO, USA.,4 Department of Developmental Biology, School of Medicine, Washington University in St. Louis and St. Louis Children's Hospital, St. Louis, MO, USA
| | - Markku Heikinheimo
- 1 Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,2 Department of Pediatrics, School of Medicine, Washington University in St. Louis and St. Louis Children's Hospital, St. Louis, MO, USA
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32
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Dörner J, Martinez Rodriguez V, Ziegler R, Röhrig T, Cochran RS, Götz RM, Levin MD, Pihlajoki M, Heikinheimo M, Wilson DB. GLI1 + progenitor cells in the adrenal capsule of the adult mouse give rise to heterotopic gonadal-like tissue. Mol Cell Endocrinol 2017; 441:164-175. [PMID: 27585489 PMCID: PMC5235954 DOI: 10.1016/j.mce.2016.08.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/26/2016] [Accepted: 08/28/2016] [Indexed: 01/20/2023]
Abstract
As certain strains of mice age, hyperplastic lesions resembling gonadal tissue accumulate beneath the adrenal capsule. Gonadectomy (GDX) accelerates this heterotopic differentiation, resulting in the formation of wedge-shaped adrenocortical neoplasms that produce sex steroids. Stem/progenitor cells that reside in the adrenal capsule and retain properties of the adrenogonadal primordium are thought to be the source of this heterotopic tissue. Here, we demonstrate that GLI1+ progenitors in the adrenal capsule give rise to gonadal-like cells that accumulate in the subcapsular region. A tamoxifen-inducible Cre driver (Gli1-creERT2) and two reporters (R26R-lacZ, R26R-confetti) were used to track the fate of GLI1+ cells in the adrenal glands of B6D2F2 mice, a strain that develops both GDX-induced adrenocortical neoplasms and age-dependent subcapsular cell hyperplasia. In gonadectomized B6D2F2 mice GLI1+ progenitors contributed to long-lived adrenal capsule cells and to adrenocortical neoplasms that expressed Gata4 and Foxl2, two prototypical gonadal markers. Pdgfra, a gene expressed in adrenocortical stromal cells, was upregulated in the GDX-induced neoplasms. In aged non-gonadectomized B6D2F2 mice GLI1+ progenitors gave rise to patches of subcapsular cell hyperplasia. Treatment with GANT61, a small-molecule GLI antagonist, attenuated the upregulation of gonadal-like markers (Gata4, Amhr2, Foxl2) in response to GDX. These findings support the premise that GLI1+ progenitor cells in the adrenal capsule of the adult mouse give rise to heterotopic tissue.
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Affiliation(s)
- Julia Dörner
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110 USA; Hochschule Mannheim - University of Applied Sciences, 68163 Mannheim, Germany
| | - Verena Martinez Rodriguez
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110 USA; Hochschule Mannheim - University of Applied Sciences, 68163 Mannheim, Germany
| | - Ricarda Ziegler
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110 USA; Hochschule Mannheim - University of Applied Sciences, 68163 Mannheim, Germany
| | - Theresa Röhrig
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110 USA; Hochschule Mannheim - University of Applied Sciences, 68163 Mannheim, Germany
| | - Rebecca S Cochran
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110 USA
| | - Ronni M Götz
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110 USA; Hochschule Mannheim - University of Applied Sciences, 68163 Mannheim, Germany
| | - Mark D Levin
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110 USA
| | - Marjut Pihlajoki
- University of Helsinki and Helsinki University Central Hospital, Children's Hospital, 00290 Helsinki, Finland
| | - Markku Heikinheimo
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110 USA; University of Helsinki and Helsinki University Central Hospital, Children's Hospital, 00290 Helsinki, Finland
| | - David B Wilson
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110 USA; Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO 63110 USA.
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33
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Haltia UM, Andersson N, Yadav B, Färkkilä A, Kulesskiy E, Kankainen M, Tang J, Bützow R, Riska A, Leminen A, Heikinheimo M, Kallioniemi O, Unkila-Kallio L, Wennerberg K, Aittokallio T, Anttonen M. Systematic drug sensitivity testing reveals synergistic growth inhibition by dasatinib or mTOR inhibitors with paclitaxel in ovarian granulosa cell tumor cells. Gynecol Oncol 2017; 144:621-630. [PMID: 28104295 DOI: 10.1016/j.ygyno.2016.12.016] [Citation(s) in RCA: 24] [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: 10/26/2016] [Revised: 12/18/2016] [Accepted: 12/19/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Resistance to standard chemotherapy poses a major clinical problem in the treatment of ovarian cancer patients. Adult-type granulosa cell tumor (AGCT) is a unique ovarian cancer subtype for which efficient treatment options are lacking in advanced disease. To this end, systematic drug response and transcriptomics profiling were performed to uncover new therapy options for AGCTs. METHODS The responses of three primary and four recurrent AGCTs to 230 anticancer compounds were screened in vitro using a systematic drug sensitivity and resistance testing (DSRT) platform, coupled with mRNA sequencing. The responses of the AGCTs were compared with those of human granulosa luteal cells and bone marrow mononuclear cells. RESULTS Patient-derived AGCT cells showed selective sensitivity to the Src family tyrosine kinase inhibitor dasatinib. A combination of either dasatinib or an mTOR-inhibitor everolimus with paclitaxel resulted in synergistic inhibition of AGCT cell viability. The key kinase targets of dasatinib and members of the mTOR pathway were constantly expressed at mRNA and protein levels, indicating multikinase signal addictions in the AGCT cells. Transcriptomic characterization of the tumors revealed no known oncogenic mutations, suggesting that the drug sensitivity of AGCTs was rather conveyed by selective target expression. CONCLUSIONS We used a systematic functional approach to reveal novel treatment options for a unique gynecological cancer. The selective synergy found between taxanes and dasatinib or mTOR inhibitors warrants further clinical investigations of these combinations in relapsed or aggressive AGCTs and demonstrate that high-throughput drug screening and molecular profiling can provide an effective approach to uncover new therapy options.
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Affiliation(s)
- Ulla-Maija Haltia
- Children's Hospital, University of Helsinki and Helsinki University Hospital, PO Box 20, 00014 University of Helsinki, Finland; Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO Box 140, 00290 Helsinki, Finland
| | - Noora Andersson
- Children's Hospital, University of Helsinki and Helsinki University Hospital, PO Box 20, 00014 University of Helsinki, Finland
| | - Bhagwan Yadav
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, PO Box 20, 00014 Helsinki, Finland
| | - Anniina Färkkilä
- Children's Hospital, University of Helsinki and Helsinki University Hospital, PO Box 20, 00014 University of Helsinki, Finland; Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO Box 140, 00290 Helsinki, Finland.
| | - Evgeny Kulesskiy
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, PO Box 20, 00014 Helsinki, Finland
| | - Matti Kankainen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, PO Box 20, 00014 Helsinki, Finland
| | - Jing Tang
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, PO Box 20, 00014 Helsinki, Finland
| | - Ralf Bützow
- Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, PO Box 400, 00290 Helsinki, Finland
| | - Annika Riska
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO Box 140, 00290 Helsinki, Finland
| | - Arto Leminen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO Box 140, 00290 Helsinki, Finland
| | - Markku Heikinheimo
- Children's Hospital, University of Helsinki and Helsinki University Hospital, PO Box 20, 00014 University of Helsinki, Finland; Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO 63110, USA
| | - Olli Kallioniemi
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, PO Box 20, 00014 Helsinki, Finland
| | - Leila Unkila-Kallio
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO Box 140, 00290 Helsinki, Finland
| | - Krister Wennerberg
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, PO Box 20, 00014 Helsinki, Finland
| | - Tero Aittokallio
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, PO Box 20, 00014 Helsinki, Finland; Department of Mathematics and Statistics, University of Turku, 20014 Turku, Finland
| | - Mikko Anttonen
- Clinical Chemistry and Hematology, University of Helsinki and HUSLAB, Helsinki University Hospital, PO Box 400, 00290 Helsinki, Finland
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Zaby K, McConechy MK, Färkkilä A, Horlings HM, Talhouk A, Unkila-Kallio L, van Meurs HS, Yang W, Rozenberg N, Andersson N, Bryk S, Bützow R, Halfwerk JBG, Hooijer GKJ, van de Vijver MJ, Buist MR, Kenter GG, Brucker SY, Kraemer B, Staebler A, Bleeker MCG, Heikinheimo M, Gilks CB, Anttonen M, Huntsman DG, Kommoss S. Adulte Granulosazelltumoren: FOXL2-Mutation als Grundlage zur Bereinigung bisheriger Studienkollektive und kritischen Analyse derzeitiger Behandlungskonzepte. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bryk S, Färkkilä A, Bützow R, Leminen A, Tapper J, Heikinheimo M, Unkila-Kallio L, Riska A. Characteristics and outcome of recurrence in molecularly defined adult-type ovarian granulosa cell tumors. Gynecol Oncol 2016; 143:571-577. [PMID: 27729108 DOI: 10.1016/j.ygyno.2016.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 09/28/2016] [Accepted: 10/01/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Adult-type ovarian granulosa cell tumors (AGCTs) have an unpredictable tendency to relapse. In a carefully validated patient cohort, we evaluated the prognostic factors related to AGCT recurrence. METHODS We identified all patients diagnosed with AGCT during 1956-2014 in Helsinki University Hospital, with a minimum follow-up of one year (n=240). After a histological review supplemented with FOXL2 (402C-G) mutation status analysis, we analyzed the clinical data for association with relapse. RESULTS The final cohort included 164 (68%) molecularly defined AGCTs (MD-AGCTs). The majority of the women were postmenopausal (63%), and 92% of tumors were stage I. The median follow-up time was 15.5years. Fifty-two (32%) patients developed tumor recurrence, of whom 55% had successive recurrences. Multiple-site recurrences were common, and nearly half of the recurrences were asymptomatic. The median time to the first relapse was 7.4years, and 75% of relapses occurred within ten years after primary diagnosis. The median disease-free survival was 11.3years. Premenopausal status at initial diagnosis, FIGO stage Ic versus Ia, and tumor rupture associated with relapse. However, tumor rupture was the only independent predictive factor. Of the relapsed patients, 48% died of AGCT in a median time of 15.3years. CONCLUSION Tumor rupture is the strongest predictive factor for recurrence, and these patients might benefit from a more aggressive initial treatment approach. AGCT requires active follow up for 10 to 15years after primary diagnosis, since recurrences may develop late, asymptomatically and in multiple anatomical locations.
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Affiliation(s)
- Saara Bryk
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland; Children's Hospital, University of Helsinki and Helsinki University Hospital, Finland.
| | - Anniina Färkkilä
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland; Children's Hospital, University of Helsinki and Helsinki University Hospital, Finland
| | - Ralf Bützow
- Pathology and HUSLAB, University of Helsinki and Helsinki University Hospital, Finland
| | - Arto Leminen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland
| | - Johanna Tapper
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland
| | - Markku Heikinheimo
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Finland; Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO, United States
| | - Leila Unkila-Kallio
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland
| | - Annika Riska
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland
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McConechy MK, Färkkilä A, Horlings HM, Talhouk A, Unkila-Kallio L, van Meurs HS, Yang W, Rozenberg N, Andersson N, Zaby K, Bryk S, Bützow R, Halfwerk JBG, Hooijer GKJ, van de Vijver MJ, Buist MR, Kenter GG, Brucker SY, Krämer B, Staebler A, Bleeker MCG, Heikinheimo M, Kommoss S, Blake Gilks C, Anttonen M, Huntsman DG. Molecularly Defined Adult Granulosa Cell Tumor of the Ovary: The Clinical Phenotype. J Natl Cancer Inst 2016; 108:djw134. [PMID: 27297428 DOI: 10.1093/jnci/djw134] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/18/2016] [Indexed: 12/11/2022] Open
Abstract
The histopathologic features of adult granulosa cell tumors (AGCTs) are relatively nonspecific, resulting in misdiagnosis of other cancers as AGCT, a problem that has not been well characterized. FOXL2 mutation testing was used to stratify 336 AGCTs from three European centers into three categories: 1) FOXL2 mutant molecularly defined AGCT (MD-AGCT) (n = 256 of 336), 2) FOXL2 wild-type AGCT (n = 17 of 336), 3) misdiagnosed other tumor types (n = 63 of 336). All statistical tests were two-sided. The overall and disease-specific survival of the misdiagnosed cases was lower than in the MD-AGCTs (P < .001). The misdiagnosed cases accounted for 71.9% of disease-specific deaths within five years. In the population-based cohort, overall survival of MD-AGCT patients was not different from age-matched, population-based controls. Even though 35.2% of all the MD-AGCT patients in our study experienced a relapse, AGCT is usually an indolent disease. The historical, premolecular data underpinning our clinical understanding of AGCT was likely skewed by inclusion of misdiagnosed cases, and future management strategies should reflect the potential for surgical cure and long survival even after relapse.
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Affiliation(s)
- Melissa K McConechy
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Anniina Färkkilä
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Hugo M Horlings
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Aline Talhouk
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Leila Unkila-Kallio
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Hannah S van Meurs
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Winnie Yang
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Nirit Rozenberg
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Noora Andersson
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Katharina Zaby
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Saara Bryk
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Ralf Bützow
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Johannes B G Halfwerk
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Gerrit K J Hooijer
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Marc J van de Vijver
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Marrije R Buist
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Gemma G Kenter
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Sara Y Brucker
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Bernhard Krämer
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Annette Staebler
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Maaike C G Bleeker
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Markku Heikinheimo
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Stefan Kommoss
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - C Blake Gilks
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - Mikko Anttonen
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
| | - David G Huntsman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital and BC Cancer Agency, Vancouver, Canada (MKM, HMH, AT, WY, NR, CBG, DGH); Biomedicum Helsinki, University of Helsinki, Helsinki, Finland (AF, LUK, SB, MA); Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland (AF, LUK, SB, MA); Centre of Gynaecologic Oncology Amsterdam (HSvM, MRB, GGK) and Department of Pathology (JBGH, GKJH, MJvdV, MCGB), Academic Medical Center, Amsterdam, the Netherlands; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (NA, MH); Department of Obstetrics and Gynaecology, Tübingen University Hospital, Department of Women's Health, Tübingen, Germany (KZ, SYB, BK, SK); Department of Pathology (RB) and Department of Clinical Chemistry and Hematology (MA), Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland; Institute of Pathology, Tübingen University Hospital, Tübingen, Germany (AS); Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO (MH); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (DGH); Department of Human Genetics, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada (MKM)
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Schrade A, Kyrönlahti A, Akinrinade O, Pihlajoki M, Fischer S, Rodriguez VM, Otte K, Velagapudi V, Toppari J, Wilson DB, Heikinheimo M. GATA4 Regulates Blood-Testis Barrier Function and Lactate Metabolism in Mouse Sertoli Cells. Endocrinology 2016; 157:2416-31. [PMID: 26974005 PMCID: PMC4891789 DOI: 10.1210/en.2015-1927] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Conditional deletion of Gata4 in Sertoli cells (SCs) of adult mice has been shown to increase permeability of the blood-testis barrier (BTB) and disrupt spermatogenesis. To gain insight into the molecular underpinnings of these phenotypic abnormalities, we assessed the impact of Gata4 gene silencing in cell culture models. Microarray hybridization identified genes dysregulated by siRNA-mediated inhibition of Gata4 in TM4 cells, an immortalized mouse SC line. Differentially expressed genes were validated by quantitative RT-PCR analysis of primary cultures of Gata4(flox/flox) mouse SCs that had been subjected to cre-mediated recombination in vitro. Depletion of GATA4 in TM4 cells and primary SCs was associated with altered expression of genes involved in key facets of BTB maintenance, including tight/adherens junction formation (Tjp1, Cldn12, Vcl, Tnc, Csk) and extracellular matrix reorganization (Lamc1, Col4a1, Col4a5, Mmp10, Mmp23, Timp2). Western blotting and immunocytochemistry demonstrated reduced levels of tight junction protein-1, a prototypical tight junction protein, in GATA4-depleted cells. These changes were accompanied by a loss of morphologically recognizable junctional complexes and a decline in epithelial membrane resistance. Furthermore, Gata4 gene silencing was associated with altered expression of Hk1, Gpi1, Pfkp, Pgam1, Gls2, Pdk3, Pkd4, and Ldhb, genes regulating the production of lactate, a key nutrient that SCs provide to developing germ cells. Comprehensive metabolomic profiling demonstrated impaired lactate production in GATA4-deficient SCs. We conclude that GATA4 plays a pivotal role in the regulation of BTB function and lactate metabolism in mouse SCs.
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Affiliation(s)
- Anja Schrade
- Children's Hospital (A.S., A.K., O.A., M.P., M.H.), University of Helsinki and Helsinki University Central Hospital, Helsinki 00014, Finland; Institute of Applied Biotechnology (S.F., K.O.), University of Applied Sciences Biberach, Biberach 88400, Germany; Metabolomics Unit (V.V.), Institute for Molecular Medicine Finland, University of Helsinki 00014, Helsinki, Finland; Departments of Physiology and Pediatrics (J.T.), University of Turku and Turku University Hospital, Turku 20520, Finland; and Departments of Pediatrics (A.S., V.M.R., D.B.W., M.H.) and Developmental Biology (D.B.W.), Washington University, St Louis, Missouri 63110
| | - Antti Kyrönlahti
- Children's Hospital (A.S., A.K., O.A., M.P., M.H.), University of Helsinki and Helsinki University Central Hospital, Helsinki 00014, Finland; Institute of Applied Biotechnology (S.F., K.O.), University of Applied Sciences Biberach, Biberach 88400, Germany; Metabolomics Unit (V.V.), Institute for Molecular Medicine Finland, University of Helsinki 00014, Helsinki, Finland; Departments of Physiology and Pediatrics (J.T.), University of Turku and Turku University Hospital, Turku 20520, Finland; and Departments of Pediatrics (A.S., V.M.R., D.B.W., M.H.) and Developmental Biology (D.B.W.), Washington University, St Louis, Missouri 63110
| | - Oyediran Akinrinade
- Children's Hospital (A.S., A.K., O.A., M.P., M.H.), University of Helsinki and Helsinki University Central Hospital, Helsinki 00014, Finland; Institute of Applied Biotechnology (S.F., K.O.), University of Applied Sciences Biberach, Biberach 88400, Germany; Metabolomics Unit (V.V.), Institute for Molecular Medicine Finland, University of Helsinki 00014, Helsinki, Finland; Departments of Physiology and Pediatrics (J.T.), University of Turku and Turku University Hospital, Turku 20520, Finland; and Departments of Pediatrics (A.S., V.M.R., D.B.W., M.H.) and Developmental Biology (D.B.W.), Washington University, St Louis, Missouri 63110
| | - Marjut Pihlajoki
- Children's Hospital (A.S., A.K., O.A., M.P., M.H.), University of Helsinki and Helsinki University Central Hospital, Helsinki 00014, Finland; Institute of Applied Biotechnology (S.F., K.O.), University of Applied Sciences Biberach, Biberach 88400, Germany; Metabolomics Unit (V.V.), Institute for Molecular Medicine Finland, University of Helsinki 00014, Helsinki, Finland; Departments of Physiology and Pediatrics (J.T.), University of Turku and Turku University Hospital, Turku 20520, Finland; and Departments of Pediatrics (A.S., V.M.R., D.B.W., M.H.) and Developmental Biology (D.B.W.), Washington University, St Louis, Missouri 63110
| | - Simon Fischer
- Children's Hospital (A.S., A.K., O.A., M.P., M.H.), University of Helsinki and Helsinki University Central Hospital, Helsinki 00014, Finland; Institute of Applied Biotechnology (S.F., K.O.), University of Applied Sciences Biberach, Biberach 88400, Germany; Metabolomics Unit (V.V.), Institute for Molecular Medicine Finland, University of Helsinki 00014, Helsinki, Finland; Departments of Physiology and Pediatrics (J.T.), University of Turku and Turku University Hospital, Turku 20520, Finland; and Departments of Pediatrics (A.S., V.M.R., D.B.W., M.H.) and Developmental Biology (D.B.W.), Washington University, St Louis, Missouri 63110
| | - Verena Martinez Rodriguez
- Children's Hospital (A.S., A.K., O.A., M.P., M.H.), University of Helsinki and Helsinki University Central Hospital, Helsinki 00014, Finland; Institute of Applied Biotechnology (S.F., K.O.), University of Applied Sciences Biberach, Biberach 88400, Germany; Metabolomics Unit (V.V.), Institute for Molecular Medicine Finland, University of Helsinki 00014, Helsinki, Finland; Departments of Physiology and Pediatrics (J.T.), University of Turku and Turku University Hospital, Turku 20520, Finland; and Departments of Pediatrics (A.S., V.M.R., D.B.W., M.H.) and Developmental Biology (D.B.W.), Washington University, St Louis, Missouri 63110
| | - Kerstin Otte
- Children's Hospital (A.S., A.K., O.A., M.P., M.H.), University of Helsinki and Helsinki University Central Hospital, Helsinki 00014, Finland; Institute of Applied Biotechnology (S.F., K.O.), University of Applied Sciences Biberach, Biberach 88400, Germany; Metabolomics Unit (V.V.), Institute for Molecular Medicine Finland, University of Helsinki 00014, Helsinki, Finland; Departments of Physiology and Pediatrics (J.T.), University of Turku and Turku University Hospital, Turku 20520, Finland; and Departments of Pediatrics (A.S., V.M.R., D.B.W., M.H.) and Developmental Biology (D.B.W.), Washington University, St Louis, Missouri 63110
| | - Vidya Velagapudi
- Children's Hospital (A.S., A.K., O.A., M.P., M.H.), University of Helsinki and Helsinki University Central Hospital, Helsinki 00014, Finland; Institute of Applied Biotechnology (S.F., K.O.), University of Applied Sciences Biberach, Biberach 88400, Germany; Metabolomics Unit (V.V.), Institute for Molecular Medicine Finland, University of Helsinki 00014, Helsinki, Finland; Departments of Physiology and Pediatrics (J.T.), University of Turku and Turku University Hospital, Turku 20520, Finland; and Departments of Pediatrics (A.S., V.M.R., D.B.W., M.H.) and Developmental Biology (D.B.W.), Washington University, St Louis, Missouri 63110
| | - Jorma Toppari
- Children's Hospital (A.S., A.K., O.A., M.P., M.H.), University of Helsinki and Helsinki University Central Hospital, Helsinki 00014, Finland; Institute of Applied Biotechnology (S.F., K.O.), University of Applied Sciences Biberach, Biberach 88400, Germany; Metabolomics Unit (V.V.), Institute for Molecular Medicine Finland, University of Helsinki 00014, Helsinki, Finland; Departments of Physiology and Pediatrics (J.T.), University of Turku and Turku University Hospital, Turku 20520, Finland; and Departments of Pediatrics (A.S., V.M.R., D.B.W., M.H.) and Developmental Biology (D.B.W.), Washington University, St Louis, Missouri 63110
| | - David B Wilson
- Children's Hospital (A.S., A.K., O.A., M.P., M.H.), University of Helsinki and Helsinki University Central Hospital, Helsinki 00014, Finland; Institute of Applied Biotechnology (S.F., K.O.), University of Applied Sciences Biberach, Biberach 88400, Germany; Metabolomics Unit (V.V.), Institute for Molecular Medicine Finland, University of Helsinki 00014, Helsinki, Finland; Departments of Physiology and Pediatrics (J.T.), University of Turku and Turku University Hospital, Turku 20520, Finland; and Departments of Pediatrics (A.S., V.M.R., D.B.W., M.H.) and Developmental Biology (D.B.W.), Washington University, St Louis, Missouri 63110
| | - Markku Heikinheimo
- Children's Hospital (A.S., A.K., O.A., M.P., M.H.), University of Helsinki and Helsinki University Central Hospital, Helsinki 00014, Finland; Institute of Applied Biotechnology (S.F., K.O.), University of Applied Sciences Biberach, Biberach 88400, Germany; Metabolomics Unit (V.V.), Institute for Molecular Medicine Finland, University of Helsinki 00014, Helsinki, Finland; Departments of Physiology and Pediatrics (J.T.), University of Turku and Turku University Hospital, Turku 20520, Finland; and Departments of Pediatrics (A.S., V.M.R., D.B.W., M.H.) and Developmental Biology (D.B.W.), Washington University, St Louis, Missouri 63110
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Abstract
GATA transcription factors are structurally-related zinc finger proteins that recognize the consensus DNA sequence WGATAA (the GATA motif), an essential cis-acting element in the promoters and enhancers of many genes. These transcription factors regulate cell fate specification and differentiation in a wide array of tissues. As demonstrated by genetic analyses of mice and humans, GATA factors play pivotal roles in the development, homeostasis, and function of several endocrine organs including the adrenal cortex, ovary, pancreas, parathyroid, pituitary, and testis. Additionally, GATA factors have been shown to be mutated, overexpressed, or underexpressed in a variety of endocrine tumors (e.g., adrenocortical neoplasms, parathyroid tumors, pituitary adenomas, and sex cord stromal tumors). Emerging evidence suggests that GATA factors play a direct role in the initiation, proliferation, or propagation of certain endocrine tumors via modulation of key developmental signaling pathways implicated in oncogenesis, such as the WNT/β-catenin and TGFβ pathways. Altered expression or function of GATA factors can also affect the metabolism, ploidy, and invasiveness of tumor cells. This article provides an overview of the role of GATA factors in endocrine neoplasms. Relevant animal models are highlighted.
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Affiliation(s)
- Marjut Pihlajoki
- Children's Hospital, Helsinki University Central Hospital, University of Helsinki, 00290 Helsinki, Finland
| | - Anniina Färkkilä
- Children's Hospital, Helsinki University Central Hospital, University of Helsinki, 00290 Helsinki, Finland; Department of Obstetrics and Gynecology, Helsinki University Central Hospital, University of Helsinki, 00290 Helsinki, Finland
| | - Tea Soini
- Children's Hospital, Helsinki University Central Hospital, University of Helsinki, 00290 Helsinki, Finland
| | - Markku Heikinheimo
- Children's Hospital, Helsinki University Central Hospital, University of Helsinki, 00290 Helsinki, Finland; Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - David B Wilson
- Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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39
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Röhrig T, Pihlajoki M, Ziegler R, Cochran RS, Schrade A, Schillebeeckx M, Mitra RD, Heikinheimo M, Wilson DB. Toying with fate: Redirecting the differentiation of adrenocortical progenitor cells into gonadal-like tissue. Mol Cell Endocrinol 2015; 408:165-77. [PMID: 25498963 PMCID: PMC4417465 DOI: 10.1016/j.mce.2014.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 09/29/2014] [Revised: 11/30/2014] [Accepted: 12/01/2014] [Indexed: 01/07/2023]
Abstract
Cell fate decisions are integral to zonation and remodeling of the adrenal cortex. Animal models exhibiting ectopic differentiation of gonadal-like cells in the adrenal cortex can shed light on the molecular mechanisms regulating steroidogenic cell fate. In one such model, prepubertal gonadectomy (GDX) of mice triggers the formation of adrenocortical neoplasms that resemble luteinized ovarian stroma. Transcriptomic analysis and genome-wide DNA methylation mapping have identified genetic and epigenetic markers of GDX-induced adrenocortical neoplasia. Members of the GATA transcription factor family have emerged as key regulators of cell fate in this model. Expression of Gata4 is pivotal for the accumulation of gonadal-like cells in the adrenal glands of gonadectomized mice, whereas expression of Gata6 limits the spontaneous and GDX-induced differentiation of gonadal-like cells in the adrenal cortex. Additionally, Gata6 is essential for proper development of the adrenal X-zone, a layer analogous to the fetal zone of the human adrenal cortex. The relevance of these observations to developmental signaling pathways in the adrenal cortex, to other animal models of altered adrenocortical cell fate, and to human diseases is discussed.
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Affiliation(s)
- Theresa Röhrig
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Hochschule Mannheim - University of Applied Sciences, Mannheim 68163, Germany
| | - Marjut Pihlajoki
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki 00290, Finland
| | - Ricarda Ziegler
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Hochschule Mannheim - University of Applied Sciences, Mannheim 68163, Germany
| | - Rebecca S Cochran
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA
| | - Anja Schrade
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki 00290, Finland
| | - Maximiliaan Schillebeeckx
- Department of Genetics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA
| | - Robi D Mitra
- Department of Genetics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA
| | - Markku Heikinheimo
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki 00290, Finland
| | - David B Wilson
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Department of Developmental Biology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA.
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Affiliation(s)
- Markku Heikinheimo
- Departments of Pediatrics and Developmental Biology (M.H., D.B.W.), Washington University School of Medicine and St Louis Children's Hospital, St Louis, Missouri 63110; and Children's Hospital (M.H., M.P., A.S., A.K.), University of Helsinki and Helsinki Central Hospital, 00290 Helsinki, Finland
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Schrade A, Kyrönlahti A, Akinrinade O, Pihlajoki M, Häkkinen M, Fischer S, Alastalo TP, Velagapudi V, Toppari J, Wilson DB, Heikinheimo M. GATA4 is a key regulator of steroidogenesis and glycolysis in mouse Leydig cells. Endocrinology 2015; 156:1860-72. [PMID: 25668067 PMCID: PMC4398762 DOI: 10.1210/en.2014-1931] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Transcription factor GATA4 is expressed in somatic cells of the mammalian testis. Gene targeting studies in mice have shown that GATA4 is essential for proper differentiation and function of Sertoli cells. The role of GATA4 in Leydig cell development, however, remains controversial, because targeted mutagenesis experiments in mice have not shown a consistent phenotype, possibly due to context-dependent effects or compensatory responses. We therefore undertook a reductionist approach to study the function of GATA4 in Leydig cells. Using microarray analysis and quantitative RT-PCR, we identified a set of genes that are down-regulated or up-regulated after small interfering RNA (siRNA)-mediated silencing of Gata4 in the murine Leydig tumor cell line mLTC-1. These same genes were dysregulated when primary cultures of Gata4(flox/flox) adult Leydig cells were subjected to adenovirus-mediated cre-lox recombination in vitro. Among the down-regulated genes were enzymes of the androgen biosynthetic pathway (Cyp11a1, Hsd3b1, Cyp17a1, and Srd5a). Silencing of Gata4 expression in mLTC-1 cells was accompanied by reduced production of sex steroid precursors, as documented by mass spectrometric analysis. Comprehensive metabolomic analysis of GATA4-deficient mLTC-1 cells showed alteration of other metabolic pathways, notably glycolysis. GATA4-depleted mLTC-1 cells had reduced expression of glycolytic genes (Hk1, Gpi1, Pfkp, and Pgam1), lower intracellular levels of ATP, and increased extracellular levels of glucose. Our findings suggest that GATA4 plays a pivotal role in Leydig cell function and provide novel insights into metabolic regulation in this cell type.
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Affiliation(s)
- Anja Schrade
- Children's Hospital (A.S., A.K., O.A., M.P., T.-P.A., M.H.), University of Helsinki, Helsinki 00014, Finland; Institute of Biomedicine (O.A.), University of Helsinki, Helsinki 00014, Finland; School of Pharmacy (M.H.), University of Eastern Finland, Kuopio 70211, Finland; Institute of Applied Biotechnology (S.F.), University of Applied Sciences Biberach, Biberach 88400, Germany; Metabolomics Unit (V.V.), Institute for Molecular Medicine Finland, University of Helsinki 00014, Helsinki, Finland; Departments of Physiology and Pediatrics (J.T.), University of Turku, Turku 20520, Finland; and Departments of Pediatrics (A.S., M.P., D.B.W., M.H.) and Developmental Biology (D.B.W.), Washington University in St. Louis, St. Louis, Missouri 63110
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42
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Färkkilä A, Koskela S, Bryk S, Alfthan H, Bützow R, Leminen A, Puistola U, Tapanainen JS, Heikinheimo M, Anttonen M, Unkila-Kallio L. The clinical utility of serum anti-Müllerian hormone in the follow-up of ovarian adult-type granulosa cell tumors--A comparative study with inhibin B. Int J Cancer 2015; 137:1661-71. [PMID: 25808251 DOI: 10.1002/ijc.29532] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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: 11/20/2014] [Accepted: 03/09/2015] [Indexed: 11/10/2022]
Abstract
Ovarian adult-type granulosa cell tumors (AGCTs) require prolonged follow-up, but evidence regarding the optimal follow-up marker is lacking. The objective of our study was to validate the clinical usefulness of serum anti-Müllerian hormone (AMH) and the current marker inhibin B as single and combined markers of AGCTs. We conducted a longitudinal, partially prospective cohort study of 123 premenopausal and postmenopausal AGCT patients with a median follow-up time of 10.5 years (range 0.3-50.0 years). Serum AMH and inhibin B levels were measured from 560 pretreatment and follow-up serum samples by using immunoenzymometric assays. We found that serum AMH and inhibin B levels were significantly elevated in patients with primary or recurrent AGCTs. The levels of both markers positively correlated to tumor size (p < 0.05). AMH and inhibin B performed similarly in receiving operator characteristic analyses; area under the curve (AUC) values were 0.92 [95% confidence interval (CI) 0.88-0.95] for AMH, and 0.94 (95% CI 0.90-0.96) for inhibin B. AMH was highly sensitive (92%) and specific (81%) in detecting a macroscopic AGCT. However, in AUC comparison analyses, the combination of the markers was superior to inhibin B alone. In conclusion, serum AMH is a sensitive and specific marker of AGCT, and either AMH or inhibin B can be monitored during follow-up. However, combining AMH and inhibin B in AGCT patient follow-up improves the detection of recurrent disease.
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Affiliation(s)
- Anniina Färkkilä
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Department of Pediatrics, University of Helsinki, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Sanna Koskela
- Department of Obstetrics and Gynecology, University of Oulu, Oulu University Hospital and Medical Research Center Oulu, Oulu, Finland
| | - Saara Bryk
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Henrik Alfthan
- Department of Clinical Chemistry, University of Helsinki and HUSlab, Helsinki University Central Hospital, Helsinki, Finland
| | - Ralf Bützow
- Department of Pathology, University of Helsinki and HUSlab, Helsinki University Central Hospital, Helsinki, Finland
| | - Arto Leminen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Ulla Puistola
- Department of Obstetrics and Gynecology, University of Oulu, Oulu University Hospital and Medical Research Center Oulu, Oulu, Finland
| | - Juha S Tapanainen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Department of Obstetrics and Gynecology, University of Oulu, Oulu University Hospital and Medical Research Center Oulu, Oulu, Finland
| | - Markku Heikinheimo
- Department of Pediatrics, University of Helsinki, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO
| | - Mikko Anttonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Leila Unkila-Kallio
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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Schillebeeckx M, Pihlajoki M, Gretzinger E, Yang W, Thol F, Hiller T, Löbs AK, Röhrig T, Schrade A, Cochran R, Jay PY, Heikinheimo M, Mitra RD, Wilson DB. Novel markers of gonadectomy-induced adrenocortical neoplasia in the mouse and ferret. Mol Cell Endocrinol 2015; 399:122-30. [PMID: 25289806 PMCID: PMC4262703 DOI: 10.1016/j.mce.2014.09.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 01/21/2014] [Revised: 07/18/2014] [Accepted: 09/29/2014] [Indexed: 12/25/2022]
Abstract
Gonadectomy (GDX) induces sex steroid-producing adrenocortical tumors in certain mouse strains and in the domestic ferret. Transcriptome analysis and DNA methylation mapping were used to identify novel genetic and epigenetic markers of GDX-induced adrenocortical neoplasia in female DBA/2J mice. Markers were validated using a combination of laser capture microdissection, quantitative RT-PCR, in situ hybridization, and immunohistochemistry. Microarray expression profiling of whole adrenal mRNA from ovariectomized vs. intact mice demonstrated selective upregulation of gonadal-like genes including Spinlw1 and Insl3 in GDX-induced adrenocortical tumors of the mouse. A complementary candidate gene approach identified Foxl2 as another gonadal-like marker expressed in GDX-induced neoplasms of the mouse and ferret. That both "male-specific" (Spinlw1) and "female-specific" (Foxl2) markers were identified is noteworthy and implies that the neoplasms exhibit mixed characteristics of male and female gonadal somatic cells. Genome-wide methylation analysis showed that two genes with hypomethylated promoters, Igfbp6 and Foxs1, are upregulated in GDX-induced adrenocortical neoplasms. These new genetic and epigenetic markers may prove useful for studies of steroidogenic cell development and for diagnostic testing.
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Affiliation(s)
- Maximiliaan Schillebeeckx
- Department of Genetics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA
| | - Marjut Pihlajoki
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki 00290, Finland
| | - Elisabeth Gretzinger
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Hochschule Mannheim, University of Applied Sciences, Mannheim 68163, Germany
| | - Wei Yang
- Department of Genetics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA
| | - Franziska Thol
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Hochschule Mannheim, University of Applied Sciences, Mannheim 68163, Germany
| | - Theresa Hiller
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Hochschule Mannheim, University of Applied Sciences, Mannheim 68163, Germany
| | - Ann-Kathrin Löbs
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Hochschule Mannheim, University of Applied Sciences, Mannheim 68163, Germany
| | - Theresa Röhrig
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Hochschule Mannheim, University of Applied Sciences, Mannheim 68163, Germany
| | - Anja Schrade
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki 00290, Finland
| | - Rebecca Cochran
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA
| | - Patrick Y Jay
- Department of Genetics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA
| | - Markku Heikinheimo
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki 00290, Finland
| | - Robi D Mitra
- Department of Genetics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA
| | - David B Wilson
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA; Department of Developmental Biology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA.
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Abstract
The adrenal cortex is divided into concentric zones. In humans the major cortical zones are the zona glomerulosa, zona fasciculata, and zona reticularis. The adrenal cortex is a dynamic organ in which senescent cells are replaced by newly differentiated ones. This constant renewal facilitates organ remodeling in response to physiological demand for steroids. Cortical zones can reversibly expand, contract, or alter their biochemical profiles to accommodate needs. Pools of stem/progenitor cells in the adrenal capsule, subcapsular region, and juxtamedullary region can differentiate to repopulate or expand zones. Some of these pools appear to be activated only during specific developmental windows or in response to extreme physiological demand. Senescent cells can also be replenished through direct lineage conversion; for example, cells in the zona glomerulosa can transform into cells of the zona fasciculata. Adrenocortical cell differentiation, renewal, and function are regulated by a variety of endocrine/paracrine factors including adrenocorticotropin, angiotensin II, insulin-related growth hormones, luteinizing hormone, activin, and inhibin. Additionally, zonation and regeneration of the adrenal cortex are controlled by developmental signaling pathways, such as the sonic hedgehog, delta-like homolog 1, fibroblast growth factor, and WNT/β-catenin pathways. The mechanisms involved in adrenocortical remodeling are complex and redundant so as to fulfill the offsetting goals of organ homeostasis and stress adaptation.
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Affiliation(s)
- Marjut Pihlajoki
- Helsinki University Central Hospital, Children’s Hospital, University of Helsinki, Helsinki, Finland
| | - Julia Dörner
- Hochschule Mannheim – University of Applied Sciences, Mannheim, Germany
- St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Rebecca S. Cochran
- St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Markku Heikinheimo
- Helsinki University Central Hospital, Children’s Hospital, University of Helsinki, Helsinki, Finland
- St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - David B. Wilson
- St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO, USA
- *Correspondence: David B. Wilson, Washington University School of Medicine, Box 8208, 660 South Euclid Avenue, St. Louis, MO 63110, USA e-mail:
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Andersson N, Anttonen M, Färkkilä A, Pihlajoki M, Bützow R, Unkila-Kallio L, Heikinheimo M. Sensitivity of human granulosa cell tumor cells to epidermal growth factor receptor inhibition. J Mol Endocrinol 2014; 52:223-34. [PMID: 24463098 DOI: 10.1530/jme-13-0286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Epidermal growth factor receptor (EGFR) is implicated in the progression of many human cancers, but its significance in ovarian granulosa cell tumor (GCT) pathobiology remains poorly understood. We assessed the EGFR gene copy number, surveyed the mRNA and protein expression patterns of EGFR in 90 adult GCTs, and assessed the in vitro sensitivity of GCT cells to EGFR inhibition. Low-level amplification of EGFR gene was observed in five GCTs and high-level amplification in one sample. EGFR mRNA was robustly expressed in GCTs. Most tumors expressed both unphosphorylated and phosphorylated EGFR protein, but the protein expression did not correlate with clinical parameters, including the risk of recurrence. Small-molecule EGFR inhibitors reduced the EGF-induced activation of EGFR and its downstream signaling molecules at nanomolar doses, but cell viability was reduced, and caspase-3/7 was activated in GCT cells only at micromolar doses. Based on the present results, EGFR is active and abundantly expressed in the majority of GCTs, but probably has only minor contribution to GCT cell growth. Given the high doses of EGFR inhibitors required to reduce GCT cell viability in vitro, they are not likely to be effective for GCT treatment as single agents; they should rather be tested as part of combination therapies for these malignancies.
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Affiliation(s)
- Noora Andersson
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, PO Box 20, 00014 University of Helsinki, Finland Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, PO Box 140, 00290 Helsinki, Finland Department of Pathology, Helsinki University Central Hospital, University of Helsinki and HUSlab, Haartmaninkatu 3, 00290 Helsinki, Finland Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri 63110, USA
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Färkkilä A, Andersson N, Bützow R, Leminen A, Heikinheimo M, Anttonen M, Unkila-Kallio L. HER2 and GATA4 are new prognostic factors for early-stage ovarian granulosa cell tumor-a long-term follow-up study. Cancer Med 2014; 3:526-36. [PMID: 24687970 PMCID: PMC4101743 DOI: 10.1002/cam4.230] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/10/2014] [Accepted: 02/14/2014] [Indexed: 12/11/2022] Open
Abstract
Granulosa cell tumors (GCTs) carry a risk of recurrence also at an early stage, but reliable prognostic factors are lacking. We assessed clinicopathological prognostic factors and the prognostic roles of the human epidermal growth factor receptors (HER 2–4) and the transcription factor GATA4 in GCTs. We conducted a long-term follow-up study of 80 GCT patients with a mean follow-up time of 16.8 years. A tumor-tissue microarray was immunohistochemically stained for HER2–4 and GATA4. Expression of HER2–4 mRNA was studied by means of real time polymerase chain reaction and HER2 gene amplification was analyzed by means of silver in situ hybridization. The results were correlated to clinical data on recurrences and survival. We found that GCTs have an indolent prognosis, with 5-year disease-specific survival (DSS) being 97.5%. Tumor recurrence was detected in 24% of the patients at a median of 7.0 years (range 2.6–18 years) after diagnosis. Tumor stage was not prognostic of disease-free survival (DFS). Of the molecular prognostic factors, high-level expression of HER2, and GATA4, and high nuclear atypia were prognostic of shorter DFS. In multivariate analyses, high-level coexpression of HER2 and GATA4 independently predicted DFS (hazard ratio [HR] 8.75, 95% CI 2.20–39.48, P = 0.002). High-level expression of GATA4 also predicted shorter DSS (HR 3.96, 95% CI 1.45–12.57, P = 0.006). In multivariate analyses, however, tumor stage (II–III) and nuclear atypia were independent prognostic factors of DSS. In conclusion HER2 and GATA4 are new molecular prognostic markers of GCT recurrence, which could be utilized to optimize the management and follow-up of patients with early-stage GCTs.
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Affiliation(s)
- Anniina Färkkilä
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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Ylitalo P, Pitkänen OM, Lauerma K, Holmström M, Rahkonen O, Heikinheimo M, Sairanen H, Jokinen E. Late gadolinium enhancement (LGE) progresses with right ventricle volume in children after repair of tetralogy of fallot. Int J Cardiol Heart Vessel 2014; 3:15-20. [PMID: 29450164 PMCID: PMC5801263 DOI: 10.1016/j.ijchv.2014.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 01/31/2014] [Indexed: 11/17/2022]
Abstract
Background Fibrosis after myocardial damage can be determined by cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE). We studied whether ventricular LGE is visible in the ventricles of pediatric and adolescent TOF (tetralogy of Fallot) patients by measuring LGE and investigating whether fibrosis correlated with right ventricular volume, pulmonary regurgitation, N-terminal pro-brain natriuretic peptide (NT-proBNP) or the aminoterminal propeptide of type III procollagen (PIIINP). We also studied if the patient's age, post-operative follow-up time or surgical history would affect LGE. Methods A total of 40 pediatric patients who had undergone TOF repair and 43 healthy age and gender matched controls underwent a CMR study, whereby LGE was scored in the right (RV) and the left ventricle. To exclude the possible iatrogenic scarring we calculated the LGE score by excluding the right ventricular outflow tract and VSD patch region. Results All patients had RV LGE and in 39 of 40 it was seen also outside the surgically affected areas. The amount of LGE correlated positively with the RV end-diastolic volume (r = 0.44, P = 0.0045), pulmonary regurgitation (r = 0.40, P = 0.013), and with NT-proBNP. The presence of LGE also depended on post-operative follow-up time (r = 0.53, P = 0.006). PIIINP levels of TOF patients were significantly higher than in the control subjects but it did not correlate with LGE or with any of the studied clinical markers. Conclusions LGE is present globally in the right ventricular muscle in children and adolescents with TOF. The longer the follow-up time the more common was the LGE in the right ventricle.
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Affiliation(s)
- Pekka Ylitalo
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Olli M. Pitkänen
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Kirsi Lauerma
- Helsinki Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Miia Holmström
- Helsinki Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Otto Rahkonen
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Markku Heikinheimo
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Heikki Sairanen
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Eero Jokinen
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Corresponding author at: Children's Hospital, University of Helsinki Stenbäckinkatu 11, PL 281, 00029 HUS, Finland. Tel.: + 358 50 4270301; fax: + 358 9 47175306Corresponding author at: Children's HospitalUniversity of Helsinki Stenbäckinkatu 11PL 281, 00029 HUSTel.: + 358 50 4270301; fax: + 358 9 47175306Finland
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Lohi O, Jahnukainen K, Huttunen P, Taskinen M, Taskinen S, Pakarinen M, Koivusalo A, Rintala R, Kanerva J, Grönroos M, Heikinheimo M, Vettenranta K. [Solid tumors in children]. Duodecim 2014; 130:2050-2059. [PMID: 25558602] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A quarter of cancers diagnosed in those under 18 years of age are leukemias, another quarter being tumors of the central nervous system. The remaining cancers are solid tumors occurring elswehere in the body, most commonly lymphomas, soft tissue and bone sarcomas, neuroblastomas and Wilms tumors. In almost all cases, the treatment of these solid tumors consists of combinations of surgery, cytotoxic drugs and radiotherapy. Although the prognoses have improved, they exhibit variation even within tumor groups. New targeted therapies are being developed, but for the time being they do not have any significant role.
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49
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Affiliation(s)
- Marjut Pihlajoki
- Box 8208, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Missouri 63110.
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50
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Parviainen H, Schrade A, Kiiveri S, Prunskaite-Hyyryläinen R, Haglund C, Vainio S, Wilson DB, Arola J, Heikinheimo M. Expression of Wnt and TGF-β pathway components and key adrenal transcription factors in adrenocortical tumors: association to carcinoma aggressiveness. Pathol Res Pract 2013; 209:503-9. [PMID: 23866946 DOI: 10.1016/j.prp.2013.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 05/02/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
Abstract
Factors controlling benign and malignant adrenocortical tumorigenesis are largely unknown, but several mouse models suggest an important role for inhibin-alpha (INHA). To show that findings in the mouse are relevant to human tumors and clinical outcome, we investigated the expression of signaling proteins and transcription factors involved in the regulation of INHA in human tumor samples⋅ Thirty-one adrenocortical tumor samples, including 13 adrenocortical carcinomas (ACCs), were categorized according to Weiss score, hormonal profile, and patient survival data and analyzed using immunohistochemistry and RT-PCR. Expression of the TGF-β signaling mediator SMAD3 varied inversely with Weiss score, so that SMAD3 expression was lowest in the most malignant tumors. By contrast, SMAD2 expression was upregulated in most malignant tumors. Wnt pathway co-receptors LRP5 and LRP6 were predominantly expressed in benign adrenocortical tumors. In ACCs, expression of transcription factors GATA-6 and SF-1 correlated with that of their target gene INHA. Moreover, the diminished expression of GATA-6 and SF-1 in ACCs correlated with poor outcome. We conclude that the factors driving INHA expression are reduced in ACCs with poor outcome, implicating a role for INHA as a tumor suppressor in humans.
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Affiliation(s)
- Helka Parviainen
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Finland
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