1
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Dillon M, Zielinski R, Worth J, Sanders M, Ibrahim O, Vedere T. An Unlikely Source of Iodine Uptake: A Bronchogenic Cyst Masquerading as Metastatic Thyroid Cancer. JCEM Case Rep 2024; 2:luae042. [PMID: 38495395 PMCID: PMC10943498 DOI: 10.1210/jcemcr/luae042] [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] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Indexed: 03/19/2024]
Abstract
Radioactive iodine therapy and posttreatment scanning are essential components of differentiated thyroid carcinoma treatment and detection of metastatic disease. False-positive results can be seen on an I-131 scan and are important for clinicians to be aware of. Here, we present a case of a 33-year-old female with follicular thyroid carcinoma who was noted to have an area of moderate uptake in the chest on a whole-body scan following remnant ablation with 30 mCi of I-131 (1.11GBq) concerning for a metastatic hilar lymph node. This was determined to be a mediastinal bronchogenic cyst on surgical pathology. It has been previously proposed that the expression of sodium iodide symporters in some bronchogenic cysts could be the mechanism by which iodine uptake is seen within them. We were able to demonstrate positive immunohistochemical staining for both sodium iodide symporter and the associated paired box gene 8 transcription factor in the cyst sample, which supports the proposed theory.
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Affiliation(s)
- Martha Dillon
- Primary Care Internal Medicine Residency, University of Connecticut Health Center: UConn Health, Farmington, CT 06030, USA
| | - Rachel Zielinski
- Primary Care Internal Medicine Residency, University of Connecticut Health Center: UConn Health, Farmington, CT 06030, USA
| | - Jennifer Worth
- Thoracic Surgery, Hartford Healthcare, Norwich, CT 06360, USA
| | - Melinda Sanders
- Pathology and Laboratory Medicine, University of Connecticut Health Center: UConn Health, Farmington, CT 06030, USA
| | - Omar Ibrahim
- Interventional Pulmonology, University of Connecticut Health Center: UConn Health, Farmington, CT 06030, USA
| | - Tarunya Vedere
- Endocrine Neoplasia, Endocrinology, University of Connecticut Health Center: UConn Health, Farmington, CT 06030, USA
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2
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Meyer CH, Bailey NM, Leslie SL, Thrasher K, Grady Z, Sanders M, Moore E, Nicely KW, Smith RN. Defining Ultra-Massive Transfusion through a Systematic Review. Am J Surg 2024; 228:192-198. [PMID: 38616968 PMCID: PMC11008908 DOI: 10.1016/j.amjsurg.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Background Despite the widespread use of ultra-massive transfusion (UMT) as an intervention for trauma patients in hemorrhagic shock, no standard definition exists. We performed a systematic review to determine a consensus definition for UMT. Methods A search was performed from 1979-2022. The authors screened studies defining UMT and associated outcomes as defined by our prespecified PICO questions. The PRISMA guidelines were used. Results 1662 articles met criteria for eligibility assessment, 17 for full-text review and eight for data extraction. Only two studies demonstrated a consensus definition of UMT, which used ≥20 units of red blood cell product within 24hrs. Parameters associated with increased mortality included lower blood pressure, lower pulse and lower Glasgow Coma Score at the time of presentation and a higher injury severity score and undergoing a resuscitative thoracotomy. Conclusions The absence of a consensus definition for UMT raises challenges from clinical, research and ethical perspectives. Based on our findings, the authors advocate for the feasibility of standardizing the definition of UMT as ≥20 units of red blood cell product within 24hrs.
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Affiliation(s)
- Courtney H Meyer
- Grady Health System, Atlanta, GA
- Emory University School of Medicine, Atlanta, GA
- Emory University Rollins School of Public Health, Atlanta, GA
| | | | - Sharon L Leslie
- Emory University Woodruff Health Sciences Center Library, Atlanta, GA
| | - Kenya Thrasher
- Grady Health System, Atlanta, GA
- Morehouse School of Medicine, Atlanta, GA
| | - Zach Grady
- Grady Health System, Atlanta, GA
- Emory University School of Medicine, Atlanta, GA
| | - M Sanders
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Erica Moore
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - K W Nicely
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Randi N Smith
- Grady Health System, Atlanta, GA
- Emory University School of Medicine, Atlanta, GA
- Emory University Rollins School of Public Health, Atlanta, GA
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3
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Kwon GJ, Jorgensen JR, Vedere TR, Sanders M, Nam G. Rare Primary Fallopian Tube Grade 2 Neuroendocrine Tumor: A Case Report With Review of Literature. Int J Gynecol Pathol 2023; 42:632-639. [PMID: 36867495 DOI: 10.1097/pgp.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Neuroendocrine neoplasms commonly arise from the gastrointestinal tract and lungs. Less commonly, they may occur in the gynecologic tract, typically within the ovary of a mature cystic teratoma. Primary neuroendocrine neoplasms of the fallopian tube are exceptionally rare and only a total of 11 cases have been reported in the literature. We describe the first case to our knowledge of a primary grade 2 neuroendocrine tumor of the fallopian tube in a 47-yr-old female. In this report, we describe the case's unique presentation, review the published literature on primary neuroendocrine neoplasms of the fallopian tube, discuss the treatment options, and speculate on their origin and histogenesis.
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4
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Eng J, Bucher E, Hu Z, Sanders M, Chakravarthy B, Gonzalez P, Pietenpol JA, Gibbs SL, Sears RC, Chin K. Robust biomarker discovery through multiplatform multiplex image analysis of breast cancer clinical cohorts. bioRxiv 2023:2023.01.31.525753. [PMID: 36778343 PMCID: PMC9915596 DOI: 10.1101/2023.01.31.525753] [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] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Spatial profiling of tissues promises to elucidate tumor-microenvironment interactions and enable development of spatial biomarkers to predict patient response to immunotherapy and other therapeutics. However, spatial biomarker discovery is often carried out on a single patient cohort or imaging technology, limiting statistical power and increasing the likelihood of technical artifacts. In order to analyze multiple patient cohorts profiled on different platforms, we developed methods for comparative data analysis from three disparate multiplex imaging technologies: 1) cyclic immunofluorescence data we generated from 102 breast cancer patients with clinical follow-up, in addition to publicly available 2) imaging mass cytometry and 3) multiplex ion-beam imaging data. We demonstrate similar single-cell phenotyping results across breast cancer patient cohorts imaged with these three technologies and identify cellular abundance and proximity-based biomarkers with prognostic value across platforms. In multiple platforms, we identified lymphocyte infiltration as independently associated with longer survival in triple negative and high-proliferation breast tumors. Then, a comparison of nine spatial analysis methods revealed robust spatial biomarkers. In estrogen receptor-positive disease, quiescent stromal cells close to tumor were more abundant in good prognosis tumors while tumor neighborhoods of mixed fibroblast phenotypes were enriched in poor prognosis tumors. In triple-negative breast cancer (TNBC), macrophage proximity to tumor and B cell proximity to T cells were greater in good prognosis tumors, while tumor neighborhoods of vimentin-positive fibroblasts were enriched in poor prognosis tumors. We also tested previously published spatial biomarkers in our ensemble cohort, reproducing the positive prognostic value of isolated lymphocytes and lymphocyte occupancy and failing to reproduce the prognostic value of tumor-immune mixing score in TNBC. In conclusion, we demonstrate assembly of larger clinical cohorts from diverse platforms to aid in prognostic spatial biomarker identification and validation.
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Affiliation(s)
- Jennifer Eng
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, 97239, USA
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Elmar Bucher
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Zhi Hu
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Melinda Sanders
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, 37232, USA, USA
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Bapsi Chakravarthy
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, 37232, USA, USA
| | - Paula Gonzalez
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, 37232, USA, USA
| | - Jennifer A. Pietenpol
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, 37232, USA, USA
- Department of Biochemistry, Vanderbilt University, Nashville, TN, 37232, USA
| | - Summer L. Gibbs
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Rosalie C. Sears
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Koei Chin
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, 97239, USA
- Center for Early Detection Advanced Research, Oregon Health and Science University, Portland, OR, 97239, USA
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5
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Taylor BC, Sun X, Balko J, Gonzalez-Ericsson P, Sanders M. Abstract PD2-06: Implications of Heterogeneity in Breast Tumor Cell MHC-I Expression on Immunity and Therapeutic Resistance. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd2-06] [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: 03/06/2023]
Abstract
Abstract
Background Immune checkpoint inhibitors (ICIs) targeting the PD-1/L1 axis are approved in early-stage treatment for triple-negative breast cancer (TNBC), but only a fraction of patients benefit. Tumor expressed antigens bound to major histocompatibility complex-I (MHC-I) are required for CD8-mediated tumoricidal activity, and thus, response to anti-PD-1/L1 targeted ICI. However, many breast tumors downregulate, or heterogeneously express, MHC-I, making them less susceptible to ICIs. Tumor cells downregulating MHC-I may be effectively targeted by natural killer (NK) cells due to ‘missing self’ signals. However, this heterogeneity in MHC-I expression is poorly modeled in most preclinical studies, limiting our understanding of how to overcome ICI resistance in the context of heterogeneous MHC-I expression, as is often observed clinically. Objective We aimed to 1) quantitatively delineate how intratumoral heterogeneity in MHC class I expression affects immune responses and immunotherapy outcomes in mouse models and 2) determine whether targeting inhibitory signals on NK cells can overcome ICI resistance in MHC-I heterogenous TNBC. Methods We performed quantitative immunofluorescence for MHC-I, CD8, CD56, and pan-cytokeratin on breast cancer tumors from diverse subtypes (n=314) to obtain single-cell-resolution MHC-I expression and spatial information of tumor and immune cells. Fluorescence intensity and spatial analysis were processed to output individual tumor/stromal cell MHC-I expression and the composition of the local tumor microenvironment. To determine the functional effect of MHC-I heterogeneity in vivo, we generated a CRISPR-guided B2m knockout (B2m-null) in a murine orthotopic model (EMT6). We then combined MHC-I-proficient and MHC-I-deficient isogenic lines at various ratios to model how populations of MHC-I loss affected the immune microenvironment. We also assessed a second, intrinsically heterogenous (MHC-I expression) TNBC model E0771. To evaluate changes in the microenvironment, we used flow cytometry and an immune NanoString panel to evaluate gene expression patterns in tumor cells and infiltrating immune cells. Results TNBC patients had the highest MHC-I expression level across tumor cells, but also the highest variability and probability of demonstrating bimodal MHC-I expression (consisting of high and low/absent cells within a single tumor). ER+ tumors were unimodally low. Using spatial analysis, we identified that heterogenous MHC-I tumors had significantly higher levels of infiltrating NK cells(Paired T-Test: p=0.03). In murine models, even 10% or less of MHC-I-null (B2m-null) EMT6 cells in the tumor injection resulted in acquisition of ICI resistance. Interestingly, heterogeneity in expression of MHC-I resulted in a substantial infiltration by NKG2A+ NK cells compared to MHC-I high or -low tumors (Student T-Test: p=.002). Activation of these infiltrating NK cells via anti-NKG2A and anti-PD-L1 combination treatment restored complete responses in heterogeneous EMT6 tumors, and significantly extended survival in both E0771 (Mantel-Cox: p< 0.0001) and EMT6 models (Mantel-Cox: < 0.0001). Additionally, anti-NKG2A and anti-PDL1 combination treatment improved complete response in the heterogenous MHC-I EMT6 model to 30% and in the parental EMT-6 tumors to 70%. Conclusion Combined therapy with anti-NKG2A (targeting NK cells) and anti-PD-L1 (targeting CD8+ T cells) can restore immunotherapy responses and overcome resistance due to lack of MHC-I expression in tumor cell subpopulations.
Citation Format: Brandie C. Taylor, Xiaopeng Sun, Justin Balko, Paula Gonzalez-Ericsson, Melinda Sanders. Implications of Heterogeneity in Breast Tumor Cell MHC-I Expression on Immunity and Therapeutic Resistance [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD2-06.
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Affiliation(s)
| | | | - Justin Balko
- 3Vanderbilt University Medical Center, Nashville, Tennessee
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Hanna A, Sun X, Sheng Q, Sanders M, Balko J. Abstract PD2-02: Longitudinal local and peripheral immunologic changes associated with checkpoint inhibition response in murine models of breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd2-02] [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: 03/06/2023]
Abstract
Abstract
Immune checkpoint inhibitors (ICI) have significantly enhanced patient survival in some cancer types but yield limited success in breast cancer. ICIs activate anti-tumor immunity by overriding the inhibition of tumor infiltrating lymphocytes (TILs). Clinical trials in triple negative breast cancer (TNBC) patients, who are more likely to harbor TILs within tumor stroma, have demonstrated increased progression-free survival (IMpassion130) and pathologic complete response (KEYNOTE-522) to ICI. Consequently, combinations of ICI and chemotherapy have been FDA-approved for metastatic TNBC. However, the therapeutic benefit of ICIs is highly heterogeneous among breast cancer patients; as such, we sought to model ICI response in vivo to evaluate therapeutic resistance and response heterogeneity, as well as ascertain predictive biomarkers for favorable outcomes to ICI in breast cancer. We used an immunocompetent EMT6 orthotopic mammary tumor model to investigate the efficacy of ICI (anti-PD-L1). Analysis of the primary tumor immune landscape was performed by flow cytometry and single-cell RNA sequencing. Matched longitudinal samples of the tumor microenvironment (collected by fine-needle aspiration) and peripheral blood (PBMC) from mice were profiled by bulk RNA and T-cell receptor (TCR) sequencing to identify systemic genomic alterations and T-cell expansion, respectively. Single-agent ICI robustly suppressed primary tumor growth (p =0.0046) and extended survival (p< 0.0001) beyond the control group in the EMT6 model. The addition of chemotherapy (paclitaxel and/or doxorubicin) demonstrated moderate therapeutic efficacy but failed to enhance ICI benefit. Phenotypic profiling of the tumor microenvironment (TME) revealed increased T cells, dendritic cells, and NK cells in anti-PD-L1 only and chemotherapy combination groups. Despite using a genetically identical tumor model and murine host, we found that PD-L1 blockade induced heterogeneous responses, similar to clinical outcomes in breast cancer patients, ranging from complete response to intrinsic resistance. Analysis of the primary tumor microenvironment showed upregulated signatures of cytotoxic T cell response and activation, specifically inflammatory interferon signaling (both prior to and post ICI administration) that corresponded to favorable response to anti-PD-L1 in individual mice. Longitudinal analysis of the peripheral blood identified modest changes among mice at baseline that progressively deviated by response type (non responders-vs-responder mice). Moreover, mice harbored enriched myeloid signatures and clonal T cell expansion during therapy corresponding to ICI resistance and response, respectively. Further investigations of matched peripheral blood and the primary tumor microenvironment signatures may identify systemic biomarkers and tumor antigen-specific T cell clones to accurately predict ICI response in patients and uncover mechanisms for sensitizing tumors refractory to ICI. In conclusion, we identify a heterogeneously ICI-responsive in vivo model that emulates TNBC patient response to combinatorial ICI approaches. We describe host-specific signatures, specifically myeloid cell responses, that correlate with differential responses to immunotherapy, which may serve as a basis for tracking immunotherapy response in peripheral blood from breast cancer patients.
Citation Format: Ann Hanna, Xiaopeng Sun, Quanhu Sheng, Melinda Sanders, Justin Balko. Longitudinal local and peripheral immunologic changes associated with checkpoint inhibition response in murine models of breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD2-02.
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Affiliation(s)
- Ann Hanna
- 1Vanderbilt University Medical Center
| | | | | | | | - Justin Balko
- 5Vanderbilt University Medical Center, Nashville, Tennessee
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7
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Eng JR, Bucher E, Hu Z, Sanders M, Chakravarthy B, Gibbs S, Chin K, Pietenpol J, Gray JW. Abstract 6149: Prognostic tumor microenvironment subtypes in triple-negative breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-6149] [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
Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer in which the tumor microenvironment (TME) is prognostic, with increased tumor-infiltrating lymphocytes predicting a good prognosis. Positive clinical trials of immune checkpoint inhibitors in TNBC further highlight the TME’s importance, but its single-cell composition and relationship to patient survival has not been well described. Therefore, we generated highly-multiplex cyclic immunofluorescence (CyCIF) data from 59 TNBC in tissue microarrays. Our CyCIF dataset served as a discovery cohort; the data included 35 protein markers and clinical outcomes for 18 patients. For a validation cohort, we analyzed 32 markers imaged with multiplex ion beam imaging (MIBI) in 38 TNBC patients (Keren et. al., Cell 2018). In the CyCIF cohort, we used markers’ single-cell mean intensity to generate a Umap manifold, which we clustered with the unsupervised Leiden algorithm. We annotated the resulting 28 cell types as epithelial, immune or stromal. In the MIBI cohort, we similarly clustered and annotated 21 cell types as epithelial, immune or stromal. Next, we clustered the patients based on the fraction of epithelial, immune or stromal cells in the tissue. In the CyCIF cohort, patients fell into three subtypes: epithelial-rich, stroma-rich and immune-rich. The patients in the epithelial-rich group had significantly shorter survival than the other two subtypes (log-rank p-value = 0.0008) and had shorter recurrence-free survival (log-rank p-value = 0.048). In the MIBI cohort, patients fell into the same three subtypes. As in the CyCIF cohort, the epithelial-rich patients had shorter survival than the other subtypes (log-rank p-value = 0.021), although there was no difference in recurrence-free survival (log-rank p-value = 0.47). Finally, we identified protein biomarkers with significantly different expression levels between the subtypes in one or both cohorts. The poor-prognosis, epithelial-rich subtype had higher CD31 expression in both cohorts, and in the CyCIF cohort, Glut1 was elevated, indicating a hypoxic, angiogenic TME. The immune infiltrate was primarily CD68+ macrophages and the stroma was activated, with higher levels of Ki67 in both cohorts. In contrast, the stroma-rich, good prognosis subtype had low immune infiltration, including fewer macrophages, low CD31 expression and a quiescent, non-proliferating stroma. Lastly, the good-prognosis, immune-rich subtype had high T and B cells levels, as well as markers of immune regulation, memory cells, and antigen presentation cells. In conclusion, we generated and analyzed a new multiplex CyCIF dataset with clinical annotation and confirmed our analytical findings in a second multiplex imaging dataset. We delineated three TME subtypes in TNBC with different outcomes, cell types and biomarker expression, potentially leading to better patient stratification and informing new drug targets.
Citation Format: Jennifer R. Eng, Elmar Bucher, Zhi Hu, Melinda Sanders, Bapsi Chakravarthy, Summer Gibbs, Koei Chin, Jennifer Pietenpol, Joe W. Gray. Prognostic tumor microenvironment subtypes in triple-negative breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6149.
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Affiliation(s)
| | - Elmar Bucher
- 1Oregon Health and Science University, Portland, OR
| | - Zhi Hu
- 1Oregon Health and Science University, Portland, OR
| | | | | | - Summer Gibbs
- 1Oregon Health and Science University, Portland, OR
| | - Koei Chin
- 1Oregon Health and Science University, Portland, OR
| | | | - Joe W. Gray
- 1Oregon Health and Science University, Portland, OR
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Christie M, Love C, Hanna I, Thomas G, Greenspon A, Chen S, Sanders M, Bauer C, Christopherson M, Balaji V, Skulsky S, Sohail M. Pre-clinical evaluation of a third generation absorbable antibacterial envelope. Europace 2022. [DOI: 10.1093/europace/euac053.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Medtronic
Background
An absorbable antibacterial envelope (TYRX), which stabilizes cardiac implantable electronic devices (CIEDs) was shown to significantly reduce infections in a large randomized controlled trial (WRAP-IT). A 3rd generation envelope (T3) is being developed to improve the implanter experience and enable smoother device insertion with a redesigned, multifilament mesh, an enhanced form factor, and identical polymer coating and antibiotic concentrations as the currently available 2nd generation envelope (T2).
Purpose
To compare drug elution profiles of T3 vs T2 and evaluate the efficacy of T3 against bacteria commonly known to be associated with CIED infections.
Methods
The T3 drug elution profile was assessed in vitro by evaluating the amount of each drug, minocycline and rifampin, released at a given timepoint using an accelerated dissolution method. For comparative analysis with T2, elution curve equivalency was based on similarity factor values (f2) of ≥50 per FDA guidance. An in vivo elution study was also conducted (per the Principles of Laboratory Animal Care [NIH Publication no. 85-23 revised 1985]) to ensure drug concentrations met the minimal inhibitory concentration (MIC) through 7 days. Substantial equivalence was defined as rifampin and minocycline concentrations above MIC at 2hr post-implant and sustained through 7 days. In a further animal model, 12 pockets were created in 6 rabbits, for CIED insertion with and without T3 envelopes, to evaluate efficacy against gram+ and gram- bacteria. At day 7, implant sites were evaluated for signs of infection via macroscopic observations and microbial recovery procedures. A Fisher’s Exact Test was used for comparisons.
Results
The T3 envelope showed a similar elution profile to T2 in vitro (Figure) with f2 >50 (range 76-84). In the in vivo assessment, the T3 envelope eluted both antibiotics above the MIC at 2hr post-implant with sustained elution through 7 days, consistent with historical T2 performance. Further bacterial challenge studies in vivo showed a statistically significant reduction (p<0.05) in infections with 0/6 infected pockets in the CIED + T3 group vs 6/6 infected pockets in the CIED only group consistent with T2 performance (Table).
Conclusion
The 3rd generation absorbable antibacterial envelope demonstrated equivalent pre-clinical performance compared to the 2nd generation envelope as antibiotic elution curves were equivalent, elution was sustained at concentrations above MIC for 7 days, and infection rates were significantly reduced compared to no envelope. These results suggest equivalent clinical performance could be expected with the newly designed envelope.
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Affiliation(s)
- M Christie
- 1Medtronic Inc., Melissa Christie, United States of America
| | - C Love
- The Johns Hopkins Hospital, Baltimore, United States of America
| | - I Hanna
- Brookwood Baptist Health Centers, Birmingham, United States of America
| | - G Thomas
- Weill Cornell Medical College, Pelham, United States of America
| | - A Greenspon
- Thomas Jefferson University Hospital, Elkins Park, United States of America
| | - S Chen
- 1Medtronic Inc., Melissa Christie, United States of America
| | - M Sanders
- 1Medtronic Inc., Melissa Christie, United States of America
| | - C Bauer
- 1Medtronic Inc., Melissa Christie, United States of America
| | | | - V Balaji
- 1Medtronic Inc., Melissa Christie, United States of America
| | - S Skulsky
- 1Medtronic Inc., Melissa Christie, United States of America
| | - M Sohail
- Baylor College of Medicine, Houston, United States of America
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9
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Axelrod ML, Wang Y, Xu Y, Sun X, Bejan CA, Gonzalez-Ericsson PI, Nunnery S, Bergman RE, Donaldson J, Guerrero-Zotano AL, Massa C, Seliger B, Sanders M, Mayer IA, Balko JM. Peripheral Blood Monocyte Abundance Predicts Outcomes in Patients with Breast Cancer. Cancer Res Commun 2022; 2:286-292. [PMID: 36304942 PMCID: PMC9604512 DOI: 10.1158/2767-9764.crc-22-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/02/2022] [Accepted: 04/21/2022] [Indexed: 04/27/2023]
Abstract
Biomarkers of response are needed in breast cancer to stratify patients to appropriate therapies and avoid unnecessary toxicity. We used peripheral blood gene expression and cell type abundance to identify biomarkers of response and recurrence in neoadjuvant chemotherapy treated breast cancer patients. We identified a signature of interferon and complement response that was higher in the blood of patients with pathologic complete response. This signature was preferentially expressed by monocytes in single cell RNA sequencing. Monocytes are routinely measured clinically, enabling examination of clinically measured monocytes in multiple independent cohorts. We found that peripheral monocytes were higher in patients with good outcomes in four cohorts of breast cancer patients. Blood gene expression and cell type abundance biomarkers may be useful for prognostication in breast cancer. Significance Biomarkers are needed in breast cancer to identify patients at risk for recurrence. Blood is an attractive site for biomarker identification due to the relative ease of longitudinal sampling. Our study suggests that blood-based gene expression and cell type abundance biomarkers may have clinical utility in breast cancer.
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Affiliation(s)
- Margaret L. Axelrod
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yu Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yaomin Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Xiaopeng Sun
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cosmin A. Bejan
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Sara Nunnery
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Riley E. Bergman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joshua Donaldson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Chiara Massa
- Institute of Medical Immunology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Barbara Seliger
- Institute of Medical Immunology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Melinda Sanders
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ingrid A. Mayer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Justin M. Balko
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
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10
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Hanna A, Sun X, Gonzalez-Ericsson P, Sanchez V, Sanders M, Balko J. 245 Host myeloid response to tumor and immunotherapy is associated with heterogeneity in outcomes to anti-PDL1. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundImmune checkpoint inhibitors (ICI) improve patient survival in some cancer types but yield limited success in breast cancer. Phase-III clinical trials in triple-negative breast cancer (TNBC) patients, who harbor extensive tumor-infiltrating lymphocytes, demonstrate increased progression-free survival (IMpassion130) and pathologic complete response (KEYNOTE-522). Consequently, combinations of ICI and chemotherapy have been FDA-approved for metastatic TNBC patients. However, the therapeutic benefit of ICI alone and the most efficacious chemotherapy combinations are poorly characterized. We sought to model ICI response in vivo to elucidate the mechanisms of immunotherapy efficacy in breast cancer and ascertain the therapeutic benefits of different chemotherapeutic combinations with ICI.MethodsUsing an immunocompetent EMT6 orthotopic mammary tumor model, we investigated the efficacy of single-agent immunotherapy and in combination with standard-of-care chemotherapy (paclitaxel [PAC] or doxorubicin [DOX]). We used single-cell RNA sequencing and bulk RNA and T-cell receptor (TCR) sequencingto assess the cellular landscape of the primary tumor in response to combinatorial therapeutic strategies and identify systemic genetic alterations and T-cell expansion, respectively.ResultsSingle-agent anti-PD-L1 robustly suppressed primary tumor growth (p =0.0046) and extended survival (p<0.0001) beyond the isotype control. Chemotherapy demonstrated moderate therapeutic efficacy without potentiating the benefit of single-agent anti-PD-L1. Interestingly, despite using a genetically identical murine tumor model/host, anti-PD-L1 induced heterogeneous responses, from complete response to intrinsic resistance. Longitudinal analysis of peripheral blood from heterogeneously responding mice uncovered myeloid cell recruitment signatures corresponding to transient responses ultimately converting to resistance. We identified specific clonal T cell expansion present only in responders. Single-cell transcriptomic profiling of the tumor microenvironment revealed increased T cells and natural killer cells and reduced regulatory T cells in the combination groups versus chemotherapy alone, although this did not translate into improved benefit. Gene-set enrichment analysis on infiltrating T cells identified a robust signature of cytotoxic T cell activation characterized by a significant enrichment in inflammatory pathways in both single-agent anti-PD-L1 and in combination with chemotherapy.ConclusionsWe identify a heterogeneously ICI-responsive in vivo model that emulates TNBC patient response to combinatorial ICI approaches. We describe single-agent ICI efficacy in upregulating cytotoxic immune cell infiltration and expansion within the primary tumor that diminishes tumor growth and enhances survival. Moreover, this study describes differential responses in a genetically similar host, which reflects heterogeneous patient response to ICI. Further characterization may identify systemic biomarkers and tumor antigen-specific T cell clones to accurately predict immunotherapy response in patients and uncover mechanisms for sensitizing refractory tumors to ICI
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Wescott E, Gonzalez-Ericcson P, Sanchez V, Sanders M, Balko J. 756 Identifying the role of B7-H4 as a suppressor of tumor infiltrating lymphocytes and a target for immunotherapy in breast cancer. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundImmune checkpoint inhibitors (ICI) have improved patient survival in some cancer types but yielded limited success in breast cancer. Combinations of ICI (αPD-L1/PD-1) and chemotherapy have been FDA-approved for metastatic TNBC patients, and potentially in the early breast cancer setting, but many patients remain non-responsive to ICI. B7-H4 is a B7 family ligand with proposed immunosuppressive functions being explored as a cancer immunotherapy target and may be associated with resistance to αPD-L1. We confirmed an inverse expression pattern between B7-H4 and PD-L1 in breast tumor cells, which has previously been noted by others. B7-H4 was expressed in immune-excluded tumors, while PD-L1 was expressed in immune-infiltrated tumors. Based on these findings, we hypothesized ectopic B7-H4 expression would induce αPD-L1 resistance through immune cell suppression in vivo.MethodsUsing an immunocompetent and αPD-L1-sensitive EMT6 orthotopic mammary cancer model, we induced ectopic expression of B7-H4 and performed animal survival studies to assess therapy response, and RNA analysis to assess changes to cell signaling among tumor infiltrating immune cells. Finally, we performed transcriptomic correlation analyses from the cancer cell line encyclopedia dataset to identify potential regulators of B7-H4 in breast cancer.ResultsIn the αPD-L1-sensitive EMT6 mammary cancer model, tumors with cell-surface B7-H4 expression were more resistant to immunotherapy. Additionally, tumor infiltrating immune cells had reduced immune activation signaling based on transcriptomic analysis. We also observed strong correlation with B7-H4 mRNA and epithelial cell markers, in contrast to gene expression markers of mesenchymal cells.ConclusionsOur data support the hypothesis that B7-H4 induces tumor resistance to αPD-L1 ICI through an immunosuppressive function. Additionally, the strong correlation of B7-H4 to epithelial cell markers suggests a potential regulatory mechanism of B7-H4 expression independent of PD-L1 regulation.
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Taylor B, Balko J, Sanders M, Gonzalez-Ericsson P, Sanchez V. 318 Enforced tumor specific MHC-I heterogeneity in triple negative breast cancer drives immunotherapy resistance. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundDespite the broad success of immune checkpoint inhibition (ICI e.g. anti-Programmed Death Ligand-1 [PD-L1]) in cancer treatment, tumor-intrinsic factors leading to intrinsic and acquired resistance are poorly understood. Tumor specific MHC-I expression is indispensable for anti-PD-1/L1 response as complete loss of MHC-I via B2M deletion results in inability of CD8+ T cells to recognize tumor-associated antigens. However, MHC-I is heterogeneously downregulated or lost in many tumor types. Tumor cell destruction can also occur through non-synaptic mechanisms, in a so-called ‘field effect’. Therefore, we modeled heterogeneous loss of MHC-I expression in breast cancer and experimentally evaluated how heterogeneous MHC-I loss affects response to anti-PD-L1 therapy.MethodsWe performed quantitative immunofluorescence for MHC-I and Pan-CK on breast cancer tumors (n=410). To determine the functional effect of MHC-I heterogeneity on anti-PD-L1 response, we used an immunocompetent EMT6 orthotopic mammary tumor model which ubiquitously expresses MHC-I at baseline. Using CRISPR/Cas9, we engineered EMT6 cells with B2m loci excision resulting in complete knockout of MHC-I on the cell surface. We then orthotopically implanted B2m-comtetent and B2m-KO cells at varying inoculum ratios (100:0, 90:10, 50:50, 10:90, 0:100) into syngeneic Balb/C mice and assessed immune responsiveness and efficacy of checkpoint inhibition. Additionally, to look at how loss of MHC-I affects the tumor microenvironment we will use the PanCancer Immune NanoString panel (n=770 genes) to evaluate gene expression patterns in tumor cells and infiltrating immune cells.ResultsIn patient samples, we identified high diversity in MHC-I expression across all clinical subtypes, with triple negative breast cancer (TNBC) having the highest MHC-I expression. Chemotherapy-treated tumors had higher MHC-I levels than untreated tumors. In mice when 10% of cells were B2m-KO, we observed a 50% reduction in complete eradication of EMT6 tumors with aPD-L1 treatment and reduced disease-stabilization and no complete responses when a 50% mixture of MHC-I deficient cells. An increasing percentage of B2m KO leads to worse outcomes overall and a decrease in infiltrating T cells.ConclusionsOur work suggests that there is an ICI-responsive phenotype that is driven by heterogeneity in MHC-I expression levels. As little as 10% of tumor specific MHC-I loss can lead to therapeutic resistance and a decrease in complete responders. This represents that early TNBC may be less responsive to single-agent PD-L1 due to specific percentages of MHC-I loss. MHC-I expression can influence therapy outcomes and potentially lead to novel observations of how to overcome lack of, or limited, MHC-I expression.
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Gonzalez-Ericsson PI, Wulfkhule JD, Gallagher RI, Sun X, Axelrod ML, Sheng Q, Luo N, Gomez H, Sanchez V, Sanders M, Pusztai L, Petricoin E, Blenman KRM, Balko JM. Tumor-Specific Major Histocompatibility-II Expression Predicts Benefit to Anti-PD-1/L1 Therapy in Patients With HER2-Negative Primary Breast Cancer. Clin Cancer Res 2021; 27:5299-5306. [PMID: 34315723 DOI: 10.1158/1078-0432.ccr-21-0607] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/15/2021] [Accepted: 07/15/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Immunotherapies targeting PD-1/L1 enhance pathologic complete response (pCR) rates when added to standard neoadjuvant chemotherapy (NAC) regimens in early-stage triple-negative, and possibly high-risk estrogen receptor-positive breast cancer. However, immunotherapy has been associated with significant toxicity, and most patients treated with NAC do not require immunotherapy to achieve pCR. Biomarkers discerning patients benefitting from the addition of immunotherapy from those who would achieve pCR to NAC alone are clearly needed. In this study, we tested the ability of MHC-II expression on tumor cells, to predict immunotherapy-specific benefit in the neoadjuvant breast cancer setting. PATIENTS AND METHODS This was a retrospective tissue-based analysis of 3 cohorts of patients with breast cancer: (i) primary nonimmunotherapy-treated breast cancers (n = 381), (ii) triple-negative breast cancers (TNBC) treated with durvalumab and standard NAC (n = 48), and (iii) HER2-negative patients treated with standard NAC (n = 87) or NAC and pembrolizumab (n = 66). RESULTS HLA-DR positivity on ≥5% of tumor cells, defined a priori, was observed in 10% and 15% of primary non-immunotherapy-treated hormone receptor-positive and triple-negative breast cancers, respectively. Quantitative assessment of MHC-II on tumor cells was predictive of durvalumab + NAC and pembrolizumab + NAC (ROC AUC, 0.71; P = 0.01 and AUC, 0.73; P = 0.001, respectively), but not NAC alone (AUC, 0.5; P = 0.99). CONCLUSIONS Tumor-specific MHC-II has a strong candidacy as a specific biomarker of anti-PD-1/L1 immunotherapy benefit when added to standard NAC in HER2-negative breast cancer. Combined with previous studies in melanoma, MHC-II has the potential to be a pan-cancer biomarker. Validation is warranted in existing and future phase II/III clinical trials in this setting.
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Affiliation(s)
- Paula I Gonzalez-Ericsson
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julia D Wulfkhule
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia
| | - Rosa I Gallagher
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia
| | - Xiaopeng Sun
- Program in Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Margaret L Axelrod
- Program in Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Quanhu Sheng
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Na Luo
- Anatomy and Histology, School of Medicine, Nankai University, Tianjin, China
| | - Henry Gomez
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Violeta Sanchez
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melinda Sanders
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lajos Pusztai
- Department of Internal Medicine Section of Medical Oncology and Yale Cancer Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Emanuel Petricoin
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia
| | - Kim R M Blenman
- Department of Internal Medicine Section of Medical Oncology and Yale Cancer Center, School of Medicine, Yale University, New Haven, Connecticut. .,Department of Computer Science, School of Engineering and Applied Science, Yale University, New Haven, Connecticut
| | - Justin M Balko
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee. .,Program in Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
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Oppezzo M, Tremmel J, Kapphahn K, Desai M, Baiocchi M, Sanders M, Prochaska J. Feasibility, preliminary efficacy, and accessibility of a twitter-based social support group vs Fitbit only to decrease sedentary behavior in women. Internet Interv 2021; 25:100426. [PMID: 34401385 PMCID: PMC8350596 DOI: 10.1016/j.invent.2021.100426] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/23/2021] [Accepted: 07/04/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Health behavior change interventions delivered by social media allow for real-time, dynamic interaction, peer social support, and experimenter-provided content. AIMS We tested the feasibility, acceptability, and preliminary efficacy of a novel Twitter-based walking break intervention with daily behavior change strategies and prompts for social support, combined with a Fitbit, vs. Fitbit alone. METHODS In a 2-group pilot, 45 sedentary women from a heart clinic were randomized to Twitter + Fitbit activity tracker (Tweet4Wellness, n = 23) or Fitbit-only (control, n = 22). All received a Fitbit and 13 weeks of tailored weekly step goals. Tweet4Wellness consisted of a private Twitter support group, with daily automated behavior change "tweets" informed by behavior change theory, and encouragement to communicate within the group. Feasibility outcomes included recruitment and enrollment numbers, implementation challenges, and number and type of help requests from participants throughout the study period. Preliminary efficacy outcomes provided by Fitbit data were sedentary minutes, number of hours with >250 steps, maximum sitting bout, weighted sedentary median bout length, total steps, intensity minutes (>3.0 METS), and ratio of time spent sitting-to-moving. Acceptability outcomes included level of Twitter participation within Tweet4Wellness, and Likert scale plus open-ended survey questions on enjoyment and perceived effectiveness of intervention components. Survey data on acceptability of the features of the intervention were collected at 13 weeks (end-of-treatment [EOT]) and 22 weeks (follow-up). RESULTS The study was feasible, with addressable implementation challenges. Tweet4Wellness participants changed significantly from baseline to EOT relative to control participants on number of active hours p = .018, total steps p = .028, and ratio of sitting-to-moving, p = .014. Only sitting-to-moving was significant at follow-up (p = .047). Among Tweet4Wellness participants, each tweet sent during treatment was associated with a 0.11 increase in active hours per day (p = .04) and a 292-step increase per day (p < .001). Tweet4Wellness participants averaged 54.8 (SD = 35.4) tweets, totaling 1304 tweets, and reported liking the accountability and peer support provided by the intervention. CONCLUSION A Twitter-delivered intervention for promoting physical activity among inactive women from a heart clinic was feasible, acceptable, and demonstrated preliminary efficacy in increasing daily active hours, daily total steps, and the ratio of sitting-to-moving from pre to post for the intervention compared with the control. Lessons learned from this pilot suggest that the next study should expand the recruitment pool, refine the intervention to increase group engagement, and select active hours, total steps, and ratio of sitting-to-movement as primary sedentary behavior measures.
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Affiliation(s)
- M.A. Oppezzo
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, United States of America,Corresponding author at: Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA, United States of America.
| | - J.A. Tremmel
- Interventional Cardiology, Women's Heart Health at Stanford, Stanford, CA, United States of America
| | - K. Kapphahn
- Quantitative Science Unit, Stanford University School of Medicine, Stanford, CA, United States of America
| | - M. Desai
- Quantitative Science Unit, Stanford University School of Medicine, Stanford, CA, United States of America
| | - M. Baiocchi
- Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States of America
| | - M. Sanders
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America
| | - J.J. Prochaska
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, United States of America
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Sanders M, Ida K, Yoshinuma M, Suzuki C, Yoshimura Y, Seki R, Emoto M, Yoshida M, Kobayashi T. Analysis of the Motional Stark Effect (MSE) diagnostic to measure the rotational transform and current profile in the Large Helical Device. Rev Sci Instrum 2021; 92:053503. [PMID: 34243309 DOI: 10.1063/5.0018859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 04/07/2021] [Indexed: 06/13/2023]
Abstract
The analysis method of the Motional Stark Effect (MSE) diagnostic to measure the rotational transform and current profiles in the Large Helical Device has been improved. This was done by using the Variational Moments Equilibrium Code to calculate an equilibrium database for various pressure profiles and current profiles. This method looks for the radial profile of the rotational transform in the equilibrium database that gives the best fit to the polarization angle profiles measured with the MSE diagnostic. This analysis improves the measurements of rotational transform, especially near the magnetic axis, where the sensitivity of the polarization angle measurements becomes low and the uncertainty due to error in the estimation of the Pfirsch-Schlüter current becomes large. The radial profiles of the rotational transform and current profiles for Electron Cyclotron Current Drive and Neutral Beam Current Drive are obtained in the new analysis method with a sufficiently high accuracy to discuss the discrepancy of the current density profiles between the measurements and the calculations.
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Affiliation(s)
- M Sanders
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven 5600 MB, The Netherlands
| | - K Ida
- National Institute for Fusion Science, National Institutes of Natural Sciences, Toki, Gifu 509-5292, Japan
| | - M Yoshinuma
- National Institute for Fusion Science, National Institutes of Natural Sciences, Toki, Gifu 509-5292, Japan
| | - C Suzuki
- National Institute for Fusion Science, National Institutes of Natural Sciences, Toki, Gifu 509-5292, Japan
| | - Y Yoshimura
- National Institute for Fusion Science, National Institutes of Natural Sciences, Toki, Gifu 509-5292, Japan
| | - R Seki
- National Institute for Fusion Science, National Institutes of Natural Sciences, Toki, Gifu 509-5292, Japan
| | - M Emoto
- National Institute for Fusion Science, National Institutes of Natural Sciences, Toki, Gifu 509-5292, Japan
| | - M Yoshida
- National Institute for Fusion Science, National Institutes of Natural Sciences, Toki, Gifu 509-5292, Japan
| | - T Kobayashi
- National Institute for Fusion Science, National Institutes of Natural Sciences, Toki, Gifu 509-5292, Japan
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Ericsson PIG, Balko JM, Sanchez V, Sanders M. Abstract PS4-19: Evaluation of tumor-specific MHC-II expression as a biomarker. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps4-19] [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
Recently MHC-II protein expression levels in breast cancer tumor cells were shown to predict response to the PD-1 inhibitor pembrolizumab on a neoadjuvant clinical trial for ER+ and TNBC (ISPY-2). To better understand this biomarker and avoid post-market issues, we aimed to investigate possible pitfalls of MHC-II/HLA-DR quantification, prevalence of HLA-DR expression in breast cancer (BC) cells and its association with clinical data in a cohort of 372 BC patents. We assessed tumor and non-tumor HLA-DR expression by multiplex fluorescence immunohistochemistry on 8 TMAs containing 372 surgical BC samples, comprised of 239 ER+ and 123 TNBCs. Patient characteristics are shown in table 1. PanCK was used to define the tumor area and HLA-DR quantification was performed by training an object classifier on QuPath. Upon visual examination, 23 samples showed patchy panCK expression. We excluded normal breast epithelium and in situ components, which showed varying degrees of HLA-DR. 44.4% of breast cancers expressed HLA-DR, with 8.3% showing high tumor expression (HLA-DRHI; ≥20% of tumor cells). TNBC showed higher prevalence of HLA-DRHI cases (35% HLADR+, 14.6% HLA-DRHI, mean tumor HLA-DR expression (% of tumor cells) 10.3%, range 0-84%) than ER+ BC (51% HLADR+, 5.4% HLA-DRHI, mean 7.4%, range 0-66.5%). In some cases, HLA-DR and panCK expression were mutually exclusive. In other cases the lack of panCK expression highlighted the presence of stromal cells within the tumor area that were not evident on H&E. Tumoral MHC-II expression correlated with the presence of TILs for ER+ BC (r=0.18, p=0.0158) and TNBC (r=0.20, p= 0.0450), specifically CD3 (r=0.49 p<0.0001) and CD4 (r=0.48 p<0.0001), and to a lesser extent CD8 (r=0.28, p= 0.013) in a subset of TNBCs on which these stains where performed (n=81). We found no correlation between tumoral MHC-II expression and clinical characteristics (ER and PR within ER+ BC, age, presence of lymph node metastasis, stage, neoadjuvant treatment) in ER+ or TNBC. High tumor HLA-DR expression correlated with poorer recurrence-free survival (RFS) in ER+ BC (p=0.038) but showed no correlation in TNBC. Cox proportional hazard model including clinical data determined that only stage was an independent predictor of survival in ER+. Non-tumoral HLA-DR expression was associated with better RFS (p=0.007) and overall survival (p=0.01) in TNBC; however, only stage was an independent predictor in multivariant analyses. Tumor MHC-II expression in BC has been reported to range from 22% to 48.5% in TNBC or unselected BC, and high tumoral MHC-II expression was reported to be 6.9% in unselected BC and 36.3% in TNBC. Specific rates of HLA-DR expression in ER+ breast cancer have not been extensively investigated. Here we report a similar overall prevalence, but lower number of tumors presenting high HLA-DR expression and an association with poorer survival in ER+ BC. HLA-DR IHC is a robust assay that can be easily used to identify MCH-II high expressing tumors and scoring percentage of tumoral cells should be more reproducible than PD-L1 scoring on immune cells when assessed by a trained pathologist.
Table 1: Patient characteristicsTNBCER+Total number of cases239123Median age48,563Treatmenttreatment naïve26%45%neoadjuvant chemotherapy74%4%pre-surgical letrozole-51%Positive lymph node58%14%StageI27%82%II20%27%III67%8%IV0%1%
Citation Format: Paula Ines Gonzalez Ericsson, Justin M Balko, Violeta Sanchez, Melinda Sanders. Evaluation of tumor-specific MHC-II expression as a biomarker [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS4-19.
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Peszka J, Michelle S, Collins BT, Abu-Halimeh N, Quattom M, Henderson M, Sanders M, Critton J, Moore B, Mastin DF. 0180 Sleep, Sleepiness, and Sleep Hygiene Related to Nomophobia (No Mobile Phone Phobia). Sleep 2020. [DOI: 10.1093/sleep/zsaa056.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Previously, active phone use at bedtime has been implicated in disrupted sleep and related complaints. To improve sleep, a recommendation following such findings is limiting phone use before and during bedtime. However, for those with the characteristic of “nomophobia”, fear of being out of mobile phone contact, this recommendation could exacerbate anxiety at and around bedtime and disrupt, rather than improve, sleep. In 2012, an estimated 77% of 18-24-year-olds could be identified as nomophobic. Because of the prevalence of nomophobia and its possible interaction with sleep, we explored the existence of nomophobia in a college-age population and its relationship to sleep, sleepiness, and sleep hygiene behaviors.
Methods
327 university students (age: M=19.7 years, SD=3.78) recruited from introductory psychology courses and campus newsletters were given extra credit or a chance to win $25 gift cards for participation. Participants completed demographic information, the Nomophobia Questionnaire (NMP-Q), the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index, questions regarding associated features of inadequate sleep hygiene, and the Sleep Hygiene Index. Additional sleep hygiene questions assessed frequency of active and passive technology use during sleep time.
Results
89.4% of the participants had moderate or severe nomophobia. Greater nomophobia was significantly related to greater daytime sleepiness (ESS) (r(293)=.150, p<.05), associated features of poor sleep (daytime sleepiness: r(297)=.097, p<.05, and avolition: r(297)=.100, p<.05), more maladaptive sleep hygiene behaviors including active technology use during sleep time (r(298)=.249, p<.05), long daytime naps, inconsistent wake and bed times, using bed for non-sleep purposes, uncomfortable bed, and bedtime cognitive rumination (r’s=0.097 to 0.182).
Conclusion
Most participants experienced moderate to severe nomophobia with greater nomophobia associated with greater sleepiness, avolition, and poorer sleep hygiene. Nomophobia is likely to be an important consideration when treating sleep disorders and/or making any sleep hygiene recommendations.
Support
Hendrix College Charles Brewer Fund for Psychology
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Affiliation(s)
| | - S Michelle
- University of Arkansas at Little Rock, Little Rock, AR
| | - B T Collins
- University of Arkansas at Little Rock, Little Rock, AR
| | - N Abu-Halimeh
- University of Arkansas at Little Rock, Little Rock, AR
| | - M Quattom
- University of Arkansas at Little Rock, Little Rock, AR
| | - M Henderson
- University of Arkansas at Little Rock, Little Rock, AR
| | - M Sanders
- University of Arkansas at Little Rock, Little Rock, AR
| | - J Critton
- University of Arkansas at Little Rock, Little Rock, AR
| | - B Moore
- University of Arkansas at Little Rock, Little Rock, AR
| | - D F Mastin
- University of Arkansas at Little Rock, Little Rock, AR
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Mastin D, Abu-Halimeh N, Collins BT, Critton J, Henderson M, Michelle S, Quattom M, Sanders M, Moore B, Peszka J. 0194 Bedtime Technology Use and New Questions for the Sleep Hygiene Index. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.192] [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: 11/15/2022] Open
Abstract
Abstract
Introduction
We examined the relationship between bedtime active and passive social technology use (self and bedpartner) and daytime sleepiness/sleep. We generated questions to differentiate participants with and without bedpartners and updated passive personal, active bedpartner, and passive bedpartner social technology questions of the Sleep Hygiene Index.
Methods
327 students (age: M=19.7 years, SD=3.78) recruited through psychology courses and campus newsletters received extra credit or chances to win $25 gift cards. Participants completed demographic information, the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index, questions regarding associated features of inadequate sleep hygiene, and the Sleep Hygiene Index. Five questions assessed active and passive social technology use, presence of a bedpartner, and awareness of bedpartner active and passive social technology use during sleep time.
Results
61.8% and 62.7% of students reported frequently or always using active and passive bedtime social technology, respectively; and 23.5% and 29.1% reported noticing a partner’s active or passive use. More frequent active technology use was significantly related to greater daytime sleepiness (ESS) (r(305)=.193, p<.05), sleep disturbances (PSQI-global: r(302)=.120, p<.05), and associated features of inadequate sleep hygiene (daytime sleepiness, worry about sleep, mood disturbance, avolition, and reduced cognition (r(306)=.212, p<.05)). Neither passive use nor passive or active partner use was significantly related to any sleep/sleepiness variables.
Conclusion
We continue to find students are frequent users of bedtime social technology which is related to daytime sleepiness, disrupted sleep, and related complaints. Passive and partner active/passive bedtime technology use may not have a significant impact on daytime sleepiness. It is possible younger participants are not good judges of passive or partner technology use or this younger population is resilient to these disruptions.
Support
none
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Affiliation(s)
- D Mastin
- University of Arkansas Little Rock, Little Rock, AR
| | | | - B T Collins
- University of Arkansas Little Rock, Little Rock, AR
| | - J Critton
- University of Arkansas Little Rock, Little Rock, AR
| | - M Henderson
- University of Arkansas Little Rock, Little Rock, AR
| | - S Michelle
- University of Arkansas Little Rock, Little Rock, AR
| | - M Quattom
- University of Arkansas Little Rock, Little Rock, AR
| | - M Sanders
- University of Arkansas Little Rock, Little Rock, AR
| | - B Moore
- University of Arkansas Little Rock, Little Rock, AR
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Gonzalez-Ericsson PI, Stovgaard ES, Sua LF, Reisenbichler E, Kos Z, Carter JM, Michiels S, Le Quesne J, Nielsen TO, Laenkholm AV, Fox SB, Adam J, Bartlett JM, Rimm DL, Quinn C, Peeters D, Dieci MV, Vincent-Salomon A, Cree I, Hida AI, Balko JM, Haynes HR, Frahm I, Acosta-Haab G, Balancin M, Bellolio E, Yang W, Kirtani P, Sugie T, Ehinger A, Castaneda CA, Kok M, McArthur H, Siziopikou K, Badve S, Fineberg S, Gown A, Viale G, Schnitt SJ, Pruneri G, Penault-Llorca F, Hewitt S, Thompson EA, Allison KH, Symmans WF, Bellizzi AM, Brogi E, Moore DA, Larsimont D, Dillon DA, Lazar A, Lien H, Goetz MP, Broeckx G, El Bairi K, Harbeck N, Cimino-Mathews A, Sotiriou C, Adams S, Liu SW, Loibl S, Chen IC, Lakhani SR, Juco JW, Denkert C, Blackley EF, Demaria S, Leon-Ferre R, Gluz O, Zardavas D, Emancipator K, Ely S, Loi S, Salgado R, Sanders M. The path to a better biomarker: application of a risk management framework for the implementation of PD-L1 and TILs as immuno-oncology biomarkers in breast cancer clinical trials and daily practice. J Pathol 2020; 250:667-684. [PMID: 32129476 DOI: 10.1002/path.5406] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/18/2020] [Indexed: 02/05/2023]
Abstract
Immune checkpoint inhibitor therapies targeting PD-1/PD-L1 are now the standard of care in oncology across several hematologic and solid tumor types, including triple negative breast cancer (TNBC). Patients with metastatic or locally advanced TNBC with PD-L1 expression on immune cells occupying ≥1% of tumor area demonstrated survival benefit with the addition of atezolizumab to nab-paclitaxel. However, concerns regarding variability between immunohistochemical PD-L1 assay performance and inter-reader reproducibility have been raised. High tumor-infiltrating lymphocytes (TILs) have also been associated with response to PD-1/PD-L1 inhibitors in patients with breast cancer (BC). TILs can be easily assessed on hematoxylin and eosin-stained slides and have shown reliable inter-reader reproducibility. As an established prognostic factor in early stage TNBC, TILs are soon anticipated to be reported in daily practice in many pathology laboratories worldwide. Because TILs and PD-L1 are parts of an immunological spectrum in BC, we propose the systematic implementation of combined PD-L1 and TIL analyses as a more comprehensive immuno-oncological biomarker for patient selection for PD-1/PD-L1 inhibition-based therapy in patients with BC. Although practical and regulatory considerations differ by jurisdiction, the pathology community has the responsibility to patients to implement assays that lead to optimal patient selection. We propose herewith a risk-management framework that may help mitigate the risks of suboptimal patient selection for immuno-therapeutic approaches in clinical trials and daily practice based on combined TILs/PD-L1 assessment in BC. © 2020 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Elisabeth S Stovgaard
- Department of Pathology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Luz F Sua
- Department of Pathology and Laboratory Medicine, Fundación Valle del Lili, and Faculty of Health Sciences, Universidad ICESI, Cali, Colombia
| | | | - Zuzana Kos
- Department of Pathology, BC Cancer Agency, Vancouver, Canada
| | - Jodi M Carter
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Stefan Michiels
- Biostatistics and Epidemiology Service, Centre de Recherche en Epidémiologie et Santé des Populations, Gustave Roussy, Université Paris-Sud, Villejuif, France
| | - John Le Quesne
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
- MRC Toxicology Unit, University of Cambridge, Leicester, UK
| | - Torsten O Nielsen
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | | | - Stephen B Fox
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Julien Adam
- Department of Pathology, Gustave Roussy, Grand Paris, France
| | - John Ms Bartlett
- Ontario Institute for Cancer Research, Toronto, Canada
- Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Edinburgh, UK
| | - David L Rimm
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Cecily Quinn
- Department of Pathology, St Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Dieter Peeters
- HistoGeneX NV, Antwerp, Belgium
- AZ Sint-Maarten Hospital, Mechelen, Belgium
| | - Maria V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | | | - Ian Cree
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Akira I Hida
- Department of Pathology, Matsuyama Shimin Hospital, Matsuyama, Japan
| | - Justin M Balko
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harry R Haynes
- Department of Cellular Pathology, North Bristol NHS Trust, Bristol, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Isabel Frahm
- Department of Pathology, Sanatorio Mater Dei, Buenos Aires, Argentina
| | - Gabriela Acosta-Haab
- Department of Pathology, Hospital de Oncología Maria Curie, Buenos Aires, Argentina
| | - Marcelo Balancin
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Enrique Bellolio
- Department of Pathology, Universidad de La Frontera, Temuco, Chile
| | - Wentao Yang
- Department of Pathology, Fudan University Shanghai Cancer Centre, Shanghai, PR China
| | - Pawan Kirtani
- Department of Histopathology, Manipal Hospitals Dwarka, New Delhi, India
| | - Tomoharu Sugie
- Breast Surgery, Kansai Medical University Hospital, Hirakata, Japan
| | - Anna Ehinger
- Department of Clinical Genetics and Pathology, Skane University Hospital, Lund University, Lund, Sweden
| | - Carlos A Castaneda
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Marleen Kok
- Divisions of Medical Oncology, Tumor Biology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Heather McArthur
- Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kalliopi Siziopikou
- Department of Pathology, Breast Pathology Section, Northwestern University, Chicago, IL, USA
| | - Sunil Badve
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN, USA
| | - Susan Fineberg
- Department of Pathology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Allen Gown
- PhenoPath Laboratories, Seattle, WA, USA
| | - Giuseppe Viale
- Department of Pathology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
- University of Milan, Milan, Italy
| | - Stuart J Schnitt
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Giancarlo Pruneri
- University of Milan, Milan, Italy
- Department of Pathology, IRCCS Fondazione Instituto Nazionale Tumori, Milan, Italy
| | - Frederique Penault-Llorca
- Department of Biology and Pathology, Centre Jean Perrin, Clermont Ferrand, France
- UMR INSERM 1240, Université Clermont Auvergne, Clermont Ferrand, France
| | - Stephen Hewitt
- Experimental Pathology Laboratory, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | - William F Symmans
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew M Bellizzi
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David A Moore
- CRUK Lung Cancer Centre of Excellence, UCL Cancer Institute, and Department of Cellular Pathology, UCLH, London, UK
| | - Denis Larsimont
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Deborah A Dillon
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alexander Lazar
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Huangchun Lien
- Graduate Institute of Pathology, National Taiwan University, Taipei, Taiwan
| | | | - Glenn Broeckx
- Department of Pathology, University Hospital Antwerp, Edegem, Belgium
| | - Khalid El Bairi
- Cancer Biomarkers Working Group, Faculty of Medicine and Pharmacy, Mohamed Ist University, Oujda, Morocco
| | - Nadia Harbeck
- Breast Center, Department of OB&GYN and CCC (LMU), University of Munich, Munich, Germany
| | - Ashley Cimino-Mathews
- Department of Pathology and Oncology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Christos Sotiriou
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Sylvia Adams
- Perlmutter Cancer Center, New York University Medical School, New York, NY, USA
| | | | | | - I-Chun Chen
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Sunil R Lakhani
- The University of Queensland, Centre for Clinical Research, and Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Jonathan W Juco
- Translational Medicine, Merck & Co, Inc, Kenilworth, NJ, USA
| | - Carsten Denkert
- Institute of Pathology, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg and Philipps-Universität Marburg, Marburg, Germany
| | - Elizabeth F Blackley
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sandra Demaria
- Department of Radiation Oncology, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Oleg Gluz
- Johanniter GmbH - Evangelisches Krankenhaus Bethesda Mönchengladbach, West German Study Group, Mönchengladbach, Germany
| | | | | | - Scott Ely
- Translational Medicine, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Sherene Loi
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Roberto Salgado
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
| | - Melinda Sanders
- Breast Cancer Research Program, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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Dieci MV, Conte P, Bisagni G, Brandes AA, Frassoldati A, Cavanna L, Musolino A, Giotta F, Rimanti A, Garrone O, Bertone E, Cagossi K, Sarti S, Ferro A, Piacentini F, Maiorana A, Orvieto E, Sanders M, Miglietta F, Balduzzi S, D'Amico R, Guarneri V. Association of tumor-infiltrating lymphocytes with distant disease-free survival in the ShortHER randomized adjuvant trial for patients with early HER2+ breast cancer. Ann Oncol 2020; 30:418-423. [PMID: 30657852 PMCID: PMC6442655 DOI: 10.1093/annonc/mdz007] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is the need to identify new prognostic markers to refine risk stratification for HER2-positive early breast cancer patients. The aim of this study was to evaluate the association of tumor-infiltrating lymphocytes (TILs) with distant disease-free survival (DDFS) in patients with HER2-positive early breast cancer enrolled in the ShortHER adjuvant trial which compared 9 weeks versus 1-year trastuzumab in addition to chemotherapy, and to test the interaction between TILs and treatment arm. PATIENTS AND METHODS Stromal TILs were assessed for 866 cases on centralized hematoxylin and eosin-stained tumor slides. The association of TILs as 10% increments with DDFS was assessed with Cox models. Kaplan-Meier curves were estimated for patients with TILs ≥20% and TILs <20%. Median follow-up was 6.1 years. RESULTS Median TILs was 5% (Q1-Q3 1%-15%). Increased TILs were independently associated with better DDFS in multivariable model [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.59-0.89, P = 0.006, for each 10% TILs increment]. Five years DDFS rates were 91.1% for patients with TILs <20% and 95.7% for patients with TILs ≥20% (P = 0.025). The association between 10% TILs increments and DDFS was significant for patients randomized to 9 weeks of trastuzumab (HR 0.60, 95% CI 0.41-0.88) but not for patients treated with 1 year of trastuzumab (HR 0.89, 95% CI 0.71-1.12; test for interaction P = 0.088). For patients with TILs <20%, the HR for the comparison between the short versus the long arm was 1.75 (95% CI 1.09-2.80, P=0.021); whereas, for patients with TILs ≥20% the HR for the comparison of short versus long arm was 0.23 (95% CI 0.05-1.09, P = 0.064), resulting in a significant interaction (P = 0.015). CONCLUSIONS TILs are an independent prognostic factor for HER2-positive early breast cancer patients treated with adjuvant chemotherapy and trastuzumab and may refine the ability to identify patients at low risk of relapse eligible for de-escalated adjuvant therapy.
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Affiliation(s)
- M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - P Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova.
| | - G Bisagni
- Oncology Unit, Department of Oncology and Advanced Technologies, Azienda USL-IRCCS, Reggio Emilia
| | - A A Brandes
- Medical Oncology, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna
| | - A Frassoldati
- Clinical Oncology, Department of Morphology, Surgery and Experimental Medicine, S Anna University Hospital, Ferrara
| | - L Cavanna
- Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza
| | - A Musolino
- Medical Oncology Unit, University Hospital of Parma, Piacenza
| | - F Giotta
- Division of Medical Oncology, IRCCS, Istituto Tumori "Giovanni Paolo II", Bari
| | - A Rimanti
- Medical Oncology, Azienda Ospedaliera di Mantova, Mantova
| | - O Garrone
- Medical Oncology, A.O. S. Croce and Carle Teaching Hospital, Cuneo
| | - E Bertone
- Medical Oncology, S. Anna Hospital, Torino
| | - K Cagossi
- Breast Unit Ausl Modena, Ramazzini Hospital, Carpi
| | - S Sarti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola
| | - A Ferro
- Rete Clinica Senologica - Oncologia Medica S. Chiara, Trento
| | - F Piacentini
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena; Azienda Ospedaliero-Universitaria di Modena, Modena
| | - A Maiorana
- Department of Diagnostic, Clinical Medicine and Public Health, University Hospital of Modena, Modena
| | - E Orvieto
- Pathology Unit, Ulss 5 Polesana, Rovigo, Italy
| | - M Sanders
- Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, USA
| | - F Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova
| | - S Balduzzi
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Italy
| | - R D'Amico
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Italy
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
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Wang H, Correa H, Sanders M, Neblett WW, Liang J. Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features in Children: An Institutional Experience and Literature Review. Pediatr Dev Pathol 2020; 23:121-126. [PMID: 31483741 DOI: 10.1177/1093526619866584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 01/19/2023]
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) in children has a distinctive set of clinicopathologic features and molecular signature compared to their adult counterparts. The recent recommendation to reclassify encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) without invasion as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is based on evidence derived almost exclusively from studies in adults. Clinicopathologic studies restricted to pediatric NIFTP are limited. METHODS We retrospectively analyzed all pediatric PTC and NIFTP diagnosed and treated in our institution from 1999 to 2016 (n = 31). RESULTS Using recently published consensus diagnostic criteria, we identified 3 NIFTP and 2 infiltrative follicular variants of papillary thyroid carcinoma (FVPTC) among 31 cases. Two of the NIFTP cases were initially diagnosed as EFVPTC. All 3 patients with NIFTP had unifocal tumors of lower American Joint Committee on Cancer (AJCC) classification (T2 or lower) and were free of lymph node or distant metastasis. Total (n = 1) or completion (n = 2) thyroidectomy was performed in all cases, and only 1 NIFTP patient received subsequent radioablative therapy. No residual or recurrent disease has been observed during follow-up (15-138 months) in patients with NIFTP. CONCLUSIONS Our experience with NIFTP in children is similar to outcomes reported in adult studies, suggesting that pediatric NIFTP behave indolently as evidenced by the absence of local recurrence in our cohort.
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Affiliation(s)
- Huiying Wang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hernan Correa
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melinda Sanders
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wallace W Neblett
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jiancong Liang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
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Lee KM, Guerrero-Zotano A, Hanker A, Servetto A, Sudhan D, Formisano L, Jansen V, González-Ericsson P, Sanders M, Stricker T, Cantley L, Arteaga C. Abstract GS6-06: A neoadjuvant trial with letrozole identifies PRR11 in the 17q23 amplicon as a mechanism of resistance to endocrine therapy in ER-positive breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-gs6-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Although the 17q23 amplicon has been associated with luminal B breast cancer (BC) and high risk of recurrence, a specific gene or genes in this region that would be causal to endocrine resistance have not yet been uncovered. We performed whole transcriptome analysis on RNA extracted from 58 estrogen receptor (ER)+ BCs treated with neoadjuvant letrozole for median 7.2 months. PRR11 (Proline rich 11), located in 17q23, was upregulated in non-responding tumors as defined by relapse after a median follow up of 5 years and/or a preoperative endocrine prognostic index (PEPI) ≥4. Differential gene expression analysis between tumors expressing low vs high PRR11 mRNA showed that BC signatures associated with proliferation, IGF-1 and PI3K signaling were enriched in tumors with high PRR11 expression.
Rate of PRR11 amplification is 15.2% in the Metastatic Breast Cancer project, but 9.5% and 9.4% in METABRIC and The Cancer Genome Atlas (TCGA), respectively. Gene Set Enrichment Analysis revealed an enrichment of hallmark gene sets associated with proliferation in PRR11-amplified ER+ BCs in METABRIC and TCGA. Integrated analysis of gene expression with on-treatment Ki67 levels from three independent studies with operable ER+ BCs treated with neoadjuvant aromatase inhibitor (ACOSOG-Z1031, NCT00651976, Llombart-Cussac et al.) showed that PRR11 was the only gene in 17q23 with a significant correlation with a high Ki67 levels across all studies.
PRR11 knockdown inhibited E2-independent growth of HCC1428 LTED (long-term estrogen deprived) and MCF7 LTED cells in culture and MCF7 xenografts. PRR11 siRNA also inhibited growth of fulvestrant-resistant and tamoxifen-resistant MCF7 cells. Conversely, PRR11 transduction induced MDA-MB-134VI cell growth under estrogen-depleted conditions. Using a PCR array with 84-cell cycle genes, we identified SKP2, CDKN1A, CCNB2, CCNA2, CKS2 and CCNB1 as genes downregulated by PRR11 knockdown. Except for SKP2 and CDKN1A, expression of all those genes was elevated in PRR11-amplifiedER+ BCs in TCGA and METABRIC.
Suggesting a link to activation of PI3K signaling, we found the proline-rich motif of PRR11 associates with the SH3 domain of the p85 regulatory subunit of PI3K. We hypothesized that this association suppresses p85 homodimer formation, thus facilitating binding of PI3Kα (p110α)-p85 dimers to IRS1, retention of p110α at the plasma membrane and, hence, activation of PI3K/AKT. To test this, we co-transfected HEK293T cells with HA-p85 and FLAG-p85. Forced expression of PRR11 reduced HA-p85 and FLAG-p85 homodimers as shown by HA and FLAG pulldowns followed by FLAG and HA immunoblots, respectively. PRR11 overexpression enhanced insulin-stimulated association of IRS1 to p110α and activation of AKT. PRR11 knockdown reduced insulin/IGF-1/2-stimulated p-AKT. In METABRIC and TCGA, PRR11 amplification and PIK3CA mutations are exclusive of each other, suggesting these alterations would be functionally linked with the same pathway.
Connectivity map analysis with the list of genes significantly overexpressed in ER+/PRR11-amplified BCs predicted PI3K inhibitors as perturbations that suppress such gene list. In the MGH/Sanger dataset, PRR11-amplified BC cell lines displayed significantly higher sensitivity to the pan-PI3K inhibitor pictilisib compared to cell lines without PRR11 amplification. Finally, inhibition of PI3Kα by siRNA or alpelisib abrogated E2-independent growth and insulin-stimulated growth of PRR11-transduced MDA-MB-134VI and MCF10A cells, respectively, suggesting p110α is required for the growth promoting effects of PRR11.
These data suggest that 1) PRR11 is a mediator of resistance to antiestrogens via amplification of PI3K/AKT signaling, and 2) PI3Kα is a potential therapeutic target in ER+ BCs harboring PRR11 amplification.
Citation Format: Kyung-min Lee, Angel Guerrero-Zotano, Ariella Hanker, Alberto Servetto, Dhivya Sudhan, Luigi Formisano, Valerie Jansen, Paula González-Ericsson, Melinda Sanders, Thomas Stricker, Lewis Cantley, Carlos Arteaga. A neoadjuvant trial with letrozole identifies PRR11 in the 17q23 amplicon as a mechanism of resistance to endocrine therapy in ER-positive breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr GS6-06.
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Kodali D, Sanders M, Dowsett RJ, Spiro J, Hegde UP. High-risk human papilloma virus testing in oropharyngeal squamous cell carcinoma at a university-based cancer center: A quality improvement project. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.21] [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: 11/20/2022] Open
Abstract
21 Background: Although traditionally linked to smoking and alcohol, high-risk (HR) human papilloma virus (HPV) associated head and neck cancers are becoming increasingly common in non-smokers. HR HPV causes approx. 70% of all oropharyngeal squamous cell carcinomas (OPSCC) and they have better outcomes when compared with smoking associated OPSCC. An accurate HPV assessment in OPSCC is important due to its relevance in treatment and follow up. This Quality Improvement project was designed to evaluate frequency of HPV testing with p16 immunochemistry (IHC) staining in patients with OPSCC at a University-based cancer center. Methods: All cases diagnosed with OPSCC or those with high suspicion for OPSCC between 2008 and 2017 were obtained from Department of Pathology. Patients with biopsies from sites other than oropharynx as well as those with biopsies performed at outside hospitals were excluded. All pathology reports were reviewed to identifyfrequency of p16 IHC staining. Results: A list of 127 cases was obtained from Pathology. Of these, 26 non-OPSCC and external hospital slides were excluded, making sample size (n) 101. HR HPV testing by p16 IHC staining was performed in 42 of 101 patients (41.5%) and not performed in 59 (58.5%). 38 of 42 patients tested were positive for HR HPV (90.5%). There was an overall upward trend in the frequency of HPV testing over the 10 years. Conclusions: HR HPV testing was done only in 41.5% of eligible patients suggesting a deficiency in testing for this biomarker. Various causes for this lack of testing were identified, most common one being inadequacy of tissue specimen. 90.5% of eligible patients tested were positive for HR-HPV, highlighting the strong association between HPV and OPSCC. Based on importance of testing HR HPV in OPSCC and need for aligning with American Society of Clinical Pathology guidelines, corrective actions were proposed by meeting with pathologists and otolaryngologists.
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Affiliation(s)
| | | | | | - Jeffrey Spiro
- University of Connecticut Health Center, Farmington, CT
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Ares ED, Seville E, Hesford W, Venkateswaran R, Pate B, Exton P, Sinstadt N, Sanders M, Rabbett K, Sheardown A. The wythenshawe hybrid circuit: a novel technique for lung transplantation. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sanders M, Servaas S, Slagt C. Accuracy and precision of non-invasive cardiac output monitoring by electrical cardiometry: a systematic review and meta-analysis. J Clin Monit Comput 2019; 34:433-460. [PMID: 31175501 PMCID: PMC7205855 DOI: 10.1007/s10877-019-00330-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 03/11/2019] [Accepted: 05/29/2019] [Indexed: 12/14/2022]
Abstract
Cardiac output monitoring is used in critically ill and high-risk surgical patients. Intermittent pulmonary artery thermodilution and transpulmonary thermodilution, considered the gold standard, are invasive and linked to complications. Therefore, many non-invasive cardiac output devices have been developed and studied. One of those is electrical cardiometry. The results of validation studies are conflicting, which emphasize the need for definitive validation of accuracy and precision. We performed a database search of PubMed, Embase, Web of Science and the Cochrane Library of Clinical Trials to identify studies comparing cardiac output measurement by electrical cardiometry and a reference method. Pooled bias, limits of agreement (LoA) and mean percentage error (MPE) were calculated using a random-effects model. A pooled MPE of less than 30% was considered clinically acceptable. A total of 13 studies in adults (620 patients) and 11 studies in pediatrics (603 patients) were included. For adults, pooled bias was 0.03 L min-1 [95% CI - 0.23; 0.29], LoA - 2.78 to 2.84 L min-1 and MPE 48.0%. For pediatrics, pooled bias was - 0.02 L min-1 [95% CI - 0.09; 0.05], LoA - 1.22 to 1.18 L min-1 and MPE 42.0%. Inter-study heterogeneity was high for both adults (I2 = 93%, p < 0.0001) and pediatrics (I2 = 86%, p < 0.0001). Despite the low bias for both adults and pediatrics, the MPE was not clinically acceptable. Electrical cardiometry cannot replace thermodilution and transthoracic echocardiography for the measurement of absolute cardiac output values. Future research should explore it's clinical use and indications.
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Affiliation(s)
- M Sanders
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - S Servaas
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - C Slagt
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands.
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Abstract
Multiple opioids are known to trigger mast cell degranulation. We report the case of a neonate with blistering skin lesions at birth who died of multi-organ failure after administration of morphine. Given the excessive histamine release and potential complications associated with morphine administration, alternative opioids and adjuvants should be considered in infants presenting with evidence of bullous or infiltrative skin lesions until mastocytosis is ruled out.
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Affiliation(s)
- Aamir Hussain
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Melinda Sanders
- Department of Pathology, University of Connecticut, Farmington, Connecticut
| | - Clare Riotte
- Department of Pediatrics, Division of Pain and Palliative Medicine, University of Connecticut, Farmington, Connecticut
| | - Naveed Hussain
- Department of Pediatrics, Division of Neonatology, University of Connecticut, Farmington, Connecticut
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Yang JLX, Zhang Y, Feng WW, Tang H, Shao J, Wang NR, Wang H, Sun J, Luo Y, Lyu LQ, Yan SQ, Zhao DM, Mu LJ, Yan DM, Wang H, Gao XT, He MF, Yang J, Fu M, Sanders M, Haslam D. [Practice of parenting and related factors on children aged 0-5 in the urban areas of China]. Zhonghua Liu Xing Bing Xue Za Zhi 2019; 40:422-426. [PMID: 31006202 DOI: 10.3760/cma.j.issn.0254-6450.2019.04.010] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objective: To characterize the relations between the practice of parenting and associated factors on children (0-5 years old) in urban areas of China, in order to provide evidence for promoting the early development of children and to provide positive guidance and service programs on parenting. Methods: A total of 4 515 parents from 15 cities (14 provinces) were surveyed with a self-administered questionnaire. Parenting and Family Adjustment Scales (PAFAS) was used, including parameters as: consistency and coercive parenting, positive encouragement, parent-child relationship and parental emotion adjustment, family relationship and parental teamwork aspects, etc. Both single factor analysis and multiple linear regression were used to examine the associations between parenting practice, individual, parental and family factors. Results: The mean score of PAFAS was 21.00 (15.00-28.00), associated with factors as children's age, only-child family, premature delivery, father's education level, confidence on parenting, problems regarding the parental mood, annual family income, family structure and behavior on seeking professional help, etc. Results showed that there were big differences on the practice of parenting in China and influenced by variety of factors. Conclusions: The general situation of parenting was well, in the urban areas of China. The practice of parenting was associated with a series of individual, parental and family factors. Programs on improving the parenting skills and promoting the early development of children, should be highlighted.
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Affiliation(s)
- J L X Yang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing 100081, China
| | - Y Zhang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing 100081, China
| | - W W Feng
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing 100081, China
| | - H Tang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing 100081, China
| | - J Shao
- Zhejiang University School of Medicine Affiliated Children's Hospital, Hangzhou 310003, China
| | - N R Wang
- Chongqing Maternal and Child Health Hospital, Chongqing 400013, China
| | - H Wang
- Maternal and Child Health Hospital of Sichuan Province, Chengdu 610031, China
| | - J Sun
- Dalian Maternal and Child Health Hospital of Liaoning Province, Dalian 116033, China
| | - Y Luo
- Guiyang Maternal and Child Health Hospital, Guiyang 550003, China
| | - L Q Lyu
- Ningbo Women and Children's Hospital of Zhejiang Province, Ningbo 315000, China
| | - S Q Yan
- Ma'anshan Maternal and Child Health Hospital of Anhui Province, Ma'anshan 243011, China
| | - D M Zhao
- Qilu Children's Hospital of Shandong University, Jinan 250022, China
| | - L J Mu
- Fangshan District Maternal and Child Health Hospital of Beijing, Beijing 102488, China
| | - D M Yan
- Lianyungang Maternal and Child Health Hospital of Jiangsu Province, Lianyungang 222000, China
| | - H Wang
- Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, China
| | - X T Gao
- Northwest Women and Children's Hospital, Xi'an710061, China
| | - M F He
- Maternal and Child Health Hospital Hunan Province, Changsha 410008, China
| | - J Yang
- Qinhuangdao Maternal and Child Health Hospital of Hebei Province, Qinhuangdao 066001, China
| | - M Fu
- Maternal and Child Health Hospital of Guangdong Province, Guangzhou 510010, China
| | - M Sanders
- The University of Queensland, Australia, Queensland 4072, Australia
| | - D Haslam
- The University of Queensland, Australia, Queensland 4072, Australia
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Bhola NE, Jansen VM, Bafna S, Giltnane JM, Balko JM, Estrada MV, Meszoely I, Mayer I, Abramson V, Ye F, Sanders M, Dugger TC, Allen EV, Arteaga CL. Correction: Kinome-wide Functional Screen Identifies Role of PLK1 in Hormone-Independent, ER-Positive Breast Cancer. Cancer Res 2019; 79:876. [PMID: 30770371 DOI: 10.1158/0008-5472.can-18-4088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Formisano L, Stauffer KM, Young CD, Bhola NE, Guerrero-Zotano AL, Jansen VM, Estrada MM, Hutchinson KE, Giltnane JM, Schwarz LJ, Lu Y, Balko JM, Deas O, Cairo S, Judde JG, Mayer IA, Sanders M, Dugger TC, Bianco R, Stricker T, Arteaga CL. Correction: Association of FGFR1 with ERα Maintains Ligand-Independent ER Transcription and Mediates Resistance to Estrogen Deprivation in ER+ Breast Cancer. Clin Cancer Res 2019; 25:1433. [DOI: 10.1158/1078-0432.ccr-18-4268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Scheie A, Dasgupta S, Sanders M, Sakai A, Matsumoto Y, Prisk TR, Nakatsuji S, Cava RJ, Broholm C. Homogeneous reduced moment in a gapful scalar chiral kagome antiferromagnet. Phys Rev B 2019; 100:10.1103/physrevb.100.024414. [PMID: 38617197 PMCID: PMC11015473 DOI: 10.1103/physrevb.100.024414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
We present a quantitative experimental investigation of the scalar chiral magnetic order with in Nd3Sb3Mg2O14. Static magnetization reveals a net ferromagnetic ground state, and inelastic neutron scattering from the hyperfine coupled nuclear spin reveals a local ordered moment of 1.76(6) μ B , just 61(2)% of the saturated moment size. The experiments exclude static disorder as the source of the reduced moment. A 38(1) μ eV gap in the magnetic excitation spectrum inferred from heat capacity rules out thermal fluctuations and suggests a multipolar explanation for the moment reduction. We compare Nd3Sb3Mg2O14 to Nd pyrochlores and show that Nd2Zr2O7 is in a spin fragmented state using nuclear Schottky heat capacity.
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Affiliation(s)
- A Scheie
- Institute for Quantum Matter and Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Maryland 21218
| | - S Dasgupta
- Institute for Quantum Matter and Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Maryland 21218
| | - M Sanders
- Department of Chemistry, Princeton University, Princeton, New Jersey 08544
| | - A Sakai
- Institute for Solid State Physics, University of Tokyo, Kashiwa, Chiba 277-8581, Japan
| | - Y Matsumoto
- Institute for Solid State Physics, University of Tokyo, Kashiwa, Chiba 277-8581, Japan
| | - T R Prisk
- NIST Center for Neutron Research, National Institute of Standards and Technology, Gaithersburg, Maryland 20899
| | - S Nakatsuji
- Institute for Solid State Physics, University of Tokyo, Kashiwa, Chiba 277-8581, Japan
| | - R J Cava
- Department of Chemistry, Princeton University, Princeton, New Jersey 08544
| | - C Broholm
- Institute for Quantum Matter and Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Maryland 21218
- NIST Center for Neutron Research, National Institute of Standards and Technology, Gaithersburg, Maryland 20899
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, Maryland 21218
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31
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Graham KL, Byosiere SE, Feng LC, Sanders M, Bennett PC, Caruso K, McCowan CI, White A. A forced-choice preferential looking task for the assessment of vision in dogs: pilot study. J Small Anim Pract 2018; 60:340-347. [PMID: 30474235 DOI: 10.1111/jsap.12965] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/24/2018] [Accepted: 10/17/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To describe preliminary use of a forced-choice preferential looking task for the clinical assessment of vision in dogs. MATERIALS AND METHODS The vision of 18 pet dogs was investigated in two separate studies using a forced-choice preferential looking task: multiple observers watched eye, head and body movements on video recordings to identify cues suggesting when a dog had seen the feature of interest. Human observer reliability was determined using eight dogs and computer-generated stimuli. Visual acuity was assessed using computer-generated grating stimuli: in real-time, an observer watched each dog's eye movement patterns and behaviour to decide whether each grating was seen. Stimuli were presented in a step-wise manner and were controlled by the observer. Acuity was estimated as the highest spatial frequency the dog was determined to have seen. RESULTS Median estimated visual acuity was better at 1 m compared to that at 3 m. Average test time was longer at a 3-m distance than at 1 m. Inter- and intra-observer reliability was better from 1 m than from 3 m. CLINICAL SIGNIFICANCE Preliminary use of a forced-choice preferential looking task for measurement of visual acuity in dogs has potential use as a clinical tool for the assessment of vision in dogs.
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Affiliation(s)
- K L Graham
- Clinical Ophthalmology and Eye Health, Sydney Medical School, University of Sydney, Sydney, New South Wales 2000, Australia
| | - S-E Byosiere
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria 3083, Australia
| | - L C Feng
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria 3083, Australia
| | - M Sanders
- Animal Eye Care, Melbourne, Victoria 3145, Australia
| | - P C Bennett
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria 3083, Australia
| | - K Caruso
- Eye Clinic for Animals, Sydney, New South Wales 2065, Australia
| | - C I McCowan
- University of Melbourne Veterinary Hospital, University of Melbourne, Melbourne, Victoria 3030, Australia.,Department of Economic Development, Jobs, Transport and Resources, Melbourne, Victoria 3000, Australia
| | - A White
- Clinical Ophthalmology and Eye Health, Sydney Medical School, University of Sydney, Sydney, New South Wales 2000, Australia.,Centre for Vision Research, Westmead Institute for Medical Research, Westmead, New South Wales 2145, Australia
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32
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Dieci M, Conte P, Bisagni G, Brandes A, Frassoldati A, Cavanna L, Musolino A, Giotta F, Rimanti A, Garrone O, Bertone E, Cagossi K, Sarti S, Ferro A, Omarini C, Maiorana A, Orvieto E, Sanders M, D'Amico R, Guarneri V. Tumor-infiltrating lymphocytes (TILs) as an independent prognostic factor for early HER2+ breast cancer patients treated with adjuvant chemotherapy and trastuzumab in the randomized shortHER trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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33
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Sudhan DR, Schwarz LJ, Guerrero-Zotano A, Formisano L, Nixon MJ, Croessmann S, González Ericsson PI, Sanders M, Balko JM, Avogadri-Connors F, Cutler RE, Lalani AS, Bryce R, Auerbach A, Arteaga CL. Extended Adjuvant Therapy with Neratinib Plus Fulvestrant Blocks ER/HER2 Crosstalk and Maintains Complete Responses of ER +/HER2 + Breast Cancers: Implications to the ExteNET Trial. Clin Cancer Res 2018; 25:771-783. [PMID: 30274983 DOI: 10.1158/1078-0432.ccr-18-1131] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/09/2018] [Accepted: 09/26/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE The phase III ExteNET trial showed improved invasive disease-free survival in patients with HER2+ breast cancer treated with neratinib versus placebo after trastuzumab-based adjuvant therapy. The benefit from neratinib appeared to be greater in patients with ER+/HER2+ tumors. We thus sought to discover mechanisms that may explain the benefit from extended adjuvant therapy with neratinib.Experimental Design: Mice with established ER+/HER2+ MDA-MB-361 tumors were treated with paclitaxel plus trastuzumab ± pertuzumab for 4 weeks, and then randomized to fulvestrant ± neratinib treatment. The benefit from neratinib was evaluated by performing gene expression analysis for 196 ER targets, ER transcriptional reporter assays, and cell-cycle analyses. RESULTS Mice receiving "extended adjuvant" therapy with fulvestrant/neratinib maintained a complete response, whereas those treated with fulvestrant relapsed rapidly. In three ER+/HER2+ cell lines (MDA-MB-361, BT-474, UACC-893) but not in ER+/HER2- MCF7 cells, treatment with neratinib induced ER reporter transcriptional activity, whereas treatment with fulvestrant resulted in increased HER2 and EGFR phosphorylation, suggesting compensatory reciprocal crosstalk between the ER and ERBB RTK pathways. ER transcriptional reporter assays, gene expression, and immunoblot analyses showed that treatment with neratinib/fulvestrant, but not fulvestrant, potently inhibited growth and downregulated ER reporter activity, P-AKT, P-ERK, and cyclin D1 levels. Finally, similar to neratinib, genetic and pharmacologic inactivation of cyclin D1 enhanced fulvestrant action against ER+/HER2+ breast cancer cells. CONCLUSIONS These data suggest that ER blockade leads to reactivation of ERBB RTKs and thus extended ERBB blockade is necessary to achieve durable clinical outcomes in patients with ER+/HER2+ breast cancer.
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Affiliation(s)
- Dhivya R Sudhan
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Luis J Schwarz
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Oncosalud-AUNA, Lima, Peru
| | - Angel Guerrero-Zotano
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Luigi Formisano
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mellissa J Nixon
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah Croessmann
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paula I González Ericsson
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melinda Sanders
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Pathology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Justin M Balko
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Cancer Biology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | | | | | - Carlos L Arteaga
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee. .,Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Cancer Biology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, Texas
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34
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Kodack DP, Askoxylakis V, Ferraro GB, Sheng Q, Badeaux M, Goel S, Qi X, Shankaraiah R, Cao ZA, Ramjiawan RR, Bezwada D, Patel B, Song Y, Costa C, Naxerova K, Wong CSF, Kloepper J, Das R, Tam A, Tanboon J, Duda DG, Miller CR, Siegel MB, Anders CK, Sanders M, Estrada MV, Schlegel R, Arteaga CL, Brachtel E, Huang A, Fukumura D, Engelman JA, Jain RK. The brain microenvironment mediates resistance in luminal breast cancer to PI3K inhibition through HER3 activation. Sci Transl Med 2018; 9:9/391/eaal4682. [PMID: 28539475 DOI: 10.1126/scitranslmed.aal4682] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 05/02/2017] [Indexed: 12/16/2022]
Abstract
Although targeted therapies are often effective systemically, they fail to adequately control brain metastases. In preclinical models of breast cancer that faithfully recapitulate the disparate clinical responses in these microenvironments, we observed that brain metastases evade phosphatidylinositide 3-kinase (PI3K) inhibition despite drug accumulation in the brain lesions. In comparison to extracranial disease, we observed increased HER3 expression and phosphorylation in brain lesions. HER3 blockade overcame the resistance of HER2-amplified and/or PIK3CA-mutant breast cancer brain metastases to PI3K inhibitors, resulting in marked tumor growth delay and improvement in mouse survival. These data provide a mechanistic basis for therapeutic resistance in the brain microenvironment and identify translatable treatment strategies for HER2-amplified and/or PIK3CA-mutant breast cancer brain metastases.
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Affiliation(s)
- David P Kodack
- Edwin L. Steele Laboratory, Department of Radiation Oncology, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA 02114, USA
| | - Vasileios Askoxylakis
- Edwin L. Steele Laboratory, Department of Radiation Oncology, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA 02114, USA
| | - Gino B Ferraro
- Edwin L. Steele Laboratory, Department of Radiation Oncology, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA 02114, USA
| | - Qing Sheng
- Oncology Translational Medicine, Novartis Institute for Biomedical Research, Cambridge, MA 02139, USA
| | - Mark Badeaux
- Edwin L. Steele Laboratory, Department of Radiation Oncology, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA 02114, USA
| | - Shom Goel
- Edwin L. Steele Laboratory, Department of Radiation Oncology, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA 02114, USA
| | - Xiaolong Qi
- Edwin L. Steele Laboratory, Department of Radiation Oncology, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA 02114, USA
| | - Ram Shankaraiah
- Edwin L. Steele Laboratory, Department of Radiation Oncology, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA 02114, USA
| | - Z Alexander Cao
- Oncology Translational Medicine, Novartis Institute for Biomedical Research, Cambridge, MA 02139, USA
| | - Rakesh R Ramjiawan
- Edwin L. Steele Laboratory, Department of Radiation Oncology, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA 02114, USA
| | - Divya Bezwada
- Edwin L. Steele Laboratory, Department of Radiation Oncology, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA 02114, USA
| | - Bhushankumar Patel
- Edwin L. Steele Laboratory, Department of Radiation Oncology, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA 02114, USA
| | - Yongchul Song
- Department of Medicine, MGH Cancer Center and HMS, Boston, MA 02129, USA
| | - Carlotta Costa
- Department of Medicine, MGH Cancer Center and HMS, Boston, MA 02129, USA
| | - Kamila Naxerova
- Edwin L. Steele Laboratory, Department of Radiation Oncology, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA 02114, USA
| | - Christina S F Wong
- Edwin L. Steele Laboratory, Department of Radiation Oncology, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA 02114, USA
| | - Jonas Kloepper
- Edwin L. Steele Laboratory, Department of Radiation Oncology, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA 02114, USA
| | - Rita Das
- Oncology Translational Medicine, Novartis Institute for Biomedical Research, Cambridge, MA 02139, USA
| | - Angela Tam
- Oncology Translational Medicine, Novartis Institute for Biomedical Research, Cambridge, MA 02139, USA
| | | | - Dan G Duda
- Edwin L. Steele Laboratory, Department of Radiation Oncology, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA 02114, USA
| | - C Ryan Miller
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Marni B Siegel
- Department of Genetics, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Carey K Anders
- Division of Hematology Oncology, Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Melinda Sanders
- Department of Pathology, Microbiology, and Immunology, Vanderbilt-Ingram Cancer Center, Nashville, TN 37203, USA
| | - Monica V Estrada
- Breast Cancer Research Program, Vanderbilt-Ingram Cancer Center, Nashville, TN 37203, USA
| | - Robert Schlegel
- Oncology Translational Medicine, Novartis Institute for Biomedical Research, Cambridge, MA 02139, USA
| | - Carlos L Arteaga
- Departments of Medicine and Cancer Biology, Vanderbilt-Ingram Cancer Center, Nashville, TN 37203, USA
| | - Elena Brachtel
- Department of Pathology, MGH and HMS, Boston, MA 02114, USA
| | - Alan Huang
- Oncology Translational Medicine, Novartis Institute for Biomedical Research, Cambridge, MA 02139, USA
| | - Dai Fukumura
- Edwin L. Steele Laboratory, Department of Radiation Oncology, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA 02114, USA
| | - Jeffrey A Engelman
- Department of Medicine, MGH Cancer Center and HMS, Boston, MA 02129, USA.
| | - Rakesh K Jain
- Edwin L. Steele Laboratory, Department of Radiation Oncology, Massachusetts General Hospital (MGH) and Harvard Medical School (HMS), Boston, MA 02114, USA.
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35
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Sanders M, Guitan J, Pead M, Grierson J. Comparison of anatomical tibial plateau angle versus observer measurement from lateral radiographs in dogs. Vet Comp Orthop Traumatol 2018. [DOI: 10.1055/s-0038-1632956] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryThis study was conducted to compare the anatomical tibial plateau angle (TPA) with that measured by observers from a lateral radiograph of the limb, the hypothesis being that there would not be any statistically significant differences between the observer measured TPA and the true anatomical TPA. Twelve pelvic limbs from skeletally mature greyhound cadavers, without any clinical or radiographic evidence of stifle pathology, were used in this study. The radiographs were taken of each limb in a lateral position with the primary beam centered over the tibial eminences and collimated to include the stifle and tarso-crural joints. For subsequent radiographs, Kirschner wires were inserted to enable identification of the tibial plateau. The TPA was then measured, by three observers, from the plain radiographs and by one observer from the marked radiographs. The mean observer TPA was 24.4° (range 17–30°) and the mean anatomical TPA was 23.8° (range 15–31°). The mean and median discrepancy between the anatomical TPA and the observer TPA was negative and very small (− 0.64° and 0°). The magnitude of the discrepancy between individual measurements made by the observers tended to overestimate small angles and underestimate the large ones, and this trend is statistically significant. These results suggest that the measurements made by observers accurately represent the anatomical slope of the tibial plateau. Therefore, observer TPA is suitable for the planning and assessment of TPLO procedures. However, as the anatomical TPA moves away from a median angle (23.25°) the magnitude of error in the measurement increases.
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36
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Formisano L, Lu Y, Jansen VM, Bauer JA, Hanker A, Gonzalez Ericsson P, Lee KM, Nixon MJ, Guerrero-Zotano AL, Schwarz LJ, Sanders M, Sudhan D, Dugger TC, Cruz MR, Behdad A, Cristofanilli M, Bardia A, O'Shaughnessy J, Mayer IA, Arteaga CL. Abstract GS6-05: Gain-of-function kinase library screen identifies FGFR1 amplification as a mechanism of resistance to antiestrogens and CDK4/6 inhibitors in ER+ breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-gs6-05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: CDK4/6 inhibitors have been approved in combination with endocrine therapy for treatment of ER+ metastatic breast cancer. The goal of this study was to discover mechanisms of resistance to ER antagonists alone and in combination with CDK4/6 inhibitors.
Results: To achieve this goal, we used lentiviral vectors to individually express 559 human kinase open reading frames (ORFs) in ER+ MCF7 human breast cancer cells treated with fulvestrant ± the CDK4/6 inhibitor ribociclib. In MCF7 cells treated with fulvestrant alone or with ribociclib, we identified 15 and 17 kinases associated with resistance, respectively. Ten of these kinases overlapped in both groups. In a secondary screen, MCF7 cells were stably transduced with V5-tagged lentiviruses expressing the positive 'hits' for treatment with fulvestrant/ribociclib. Five of 17 kinases (FGFR1, FRK, HCK, FGR, CRKL) were confirmed to induce resistance to fulvestrant/palbociclib and fulvestrant/ribociblib. Survey of TCGA for copy number alterations and/or expression of these 5 genes showed only FGFR1 to be amplified/overexpressed in ˜15% of ER+ breast cancers. Experiments in vitro showed that ER+/FGFR1-amplified (amp) MDA-134, CAMA-1 and HCC1500 human breast cancer cells and MCF7 cells stably transduced with FGFR1 were relatively resistant to estrogen deprivation, fulvestrant and fulvestrant/palbociclib compared to non-FGFR1 amp MCF7 cells. This resistance was abrogated by treatment with the FGFR tyrosine kinase inhibitor (TKI) lucitanib. Treatment with fulvestrant or palbociclib alone modestly delayed growth of ER+/FGFR1-amp breast cancer patient-derived xenografts (PDX) established in nude mice. However, addition of the FGFR TKI erdafitinib to fulvestrant/palbociclib resulted in marked PDX regression in all mice without associated toxicity and a complete cell cycle arrest measured by Ki67. Treatment of FGFR-amp cells with FGF-2 strongly induced CCND1 (cyclin D1) expression. Downregulation of CCND1 with CCND1 RNAi oligonucleotides restored sensitivity of FGFR1-amp cells to fulvestrant/palbociclib, thus phenocopying the effect of FGFR TKIs. Conversely, overexpression of CCND1 in MCF7 cells induced resistance to estrogen deprivation and to fulvestrant ± palbociclib. Finally, we examined next gen sequencing of cell free tumor DNA by Guardant360 in 34 patients before and after progression on CDK4/6 inhibitor. In 10/34 (29%) post-progression specimens, we detected alterations in the FGFR pathway: FGFR1 amplification (n=7), FGFR1 N546K (n=1), FGFR2 N549K (n=1), and FGFR2 V395D (n=1) activating mutations.
Conclusions: These data suggest aberrant FGFR signaling is a mechanism of resistance to anti-ER therapies ± CDK4/6 inhibitors. We posit overexpression of cyclin D1 induced by both FGFR signaling and ER transcription plays a role in drug resistance. Based on these findings we propose ER+/FGFR1 amplified breast cancers are endocrine resistant and should be candidates for treatment with combinations of ER and FGFR antagonists. Accordingly, we have initiated a phase Ib trial of fulvestrant, palbociclib and erdafitinib in patients with antiestrogen resistant ER+/HER2-negative breast cancer with FGFR1-4 amplification.
Citation Format: Formisano L, Lu Y, Jansen VM, Bauer JA, Hanker A, Gonzalez Ericsson P, Lee K-M, Nixon MJ, Guerrero-Zotano AL, Schwarz LJ, Sanders M, Sudhan D, Dugger TC, Cruz MR, Behdad A, Cristofanilli M, Bardia A, O'Shaughnessy J, Mayer IA, Arteaga CL. Gain-of-function kinase library screen identifies FGFR1 amplification as a mechanism of resistance to antiestrogens and CDK4/6 inhibitors in ER+ breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr GS6-05.
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Affiliation(s)
- L Formisano
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - Y Lu
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - VM Jansen
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - JA Bauer
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - A Hanker
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - P Gonzalez Ericsson
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - K-M Lee
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - MJ Nixon
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - AL Guerrero-Zotano
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - LJ Schwarz
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - M Sanders
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - D Sudhan
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - TC Dugger
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - MR Cruz
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - A Behdad
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - M Cristofanilli
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - A Bardia
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - J O'Shaughnessy
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - IA Mayer
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
| | - CL Arteaga
- Vanderbilt Medical Center; Robert H Lurie Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; Baylor University Medical Center
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Balko JM, Johnson DB, Wang DY, Ericsson-Gonzalez P, Nixon M, Salgado R, Sanchez V, Schreeder D, Kim JY, Bordeaux J, Sanders M, Davis RS. MHC-II expression to drive a unique pattern of adaptive resistance to antitumor immunity through receptor checkpoint engagement. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.5_suppl.180] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
180 Background: Anti-PD-1 therapy is effective in many cancers, but tumor-intrinsic factors governing response and resistance are largely unknown. MHC-II (HLA-DR) expression on tumor cells can predict response to anti-PD-1. Thus, we sought to determine the molecular features of MHC-II+ tumors in the evolution of anti-PD-1 response. Methods: We performed RNA-seq on 58 anti-PD-1 treated melanoma and lung tumors, including a subset of matched specimens prior to treatment and at acquired resistance. We performed immunohistochemistry (IHC) for immunologic markers, including HLA-DR on tumor cells. In triple-negative breast cancers (TNBC; n = 103), we performed IHC and/or quantitative immunofluorescence (QIF) for LAG3, PD-L1, CD4, CD8, Fc-receptor-like 6 (FCRL6), and granzyme B (GZMB). QIF images were assessed by Automated Quantitative Analysis (AQUA). To determine the functional effect of MHC-II on tumor cells, we generated isogenic MHC-II+ mouse tumors and assessed immune responsiveness and efficacy of checkpoint inhibition. Results: We identified unique inflammatory signatures in HLA-DR+ tumors, correlating with enhanced pre-treatment CD4+ and CD8+ tumor-infiltrating lymphocytes (TILs) and response to anti-PD-1. LAG3+ and FCRL6+ TILs were enriched in HLA-DR+ tumors. LAG3 and FCRL6, known inhibitory receptors which bind MHC-II, were elevated at anti-PD-1 resistance. Similarly, in > 100 TNBCs, HLA-DR+ tumor cells associated with increased CD4+ and CD8+ TILs and enhanced LAG3+ and FCRL6+ TILs. Further, presence of MHC-II-suppressing (LAG3+/FCRL6+) TILs associated with decreased GZMB+ CD8+ T cells, suggesting suppressed cytotoxicity. In mice, enforced expression of MHC-II on tumor cells enhanced CD4-enhanced anti-tumor immunity but was thwarted by LAG3+ TIL recruitment. Combined anti-LAG3 and anti-PD-1 therapy was selectively effective in MHC-II+ tumors. Conclusions: MHC-II+ tumors are immunologically active and may circumvent anti-tumor immunity by targeting MHC-II antigen presentation via recruitment of MHC-II-suppressing TILs. MHC-II expression may be useful to stratify patients to anti-PD-1/anti-LAG3 and eventually, anti-PD-1/anti-FCRL6 combinations.
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Affiliation(s)
| | | | | | | | | | - Roberto Salgado
- Breast Cancer Translational Research Laboratory/Breast International Group, Institut Jules Bordet, Brussels, Belgium
| | | | | | - Ju Young Kim
- Navigate BioPharma Services, Inc., a Novartis subsidiary, Carlsbad, CA
| | - Jennifer Bordeaux
- Navigate BioPharma Services, Inc., a Novartis subsidiary, Carlsbad, CA
| | | | - Randall S. Davis
- University of Alabama at Birmingham, Division of Hematology and Oncology, Birmingham, AL
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Sanders M, Bruin R, Tran C. Technologie des chambres d’inhalation à valve : efficacité à faible débit (nourrissons). Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hendry S, Salgado R, Gevaert T, Russell PA, John T, Thapa B, Christie M, van de Vijver K, Estrada MV, Gonzalez-Ericsson PI, Sanders M, Solomon B, Solinas C, Van den Eynden GGGM, Allory Y, Preusser M, Hainfellner J, Pruneri G, Vingiani A, Demaria S, Symmans F, Nuciforo P, Comerma L, Thompson EA, Lakhani S, Kim SR, Schnitt S, Colpaert C, Sotiriou C, Scherer SJ, Ignatiadis M, Badve S, Pierce RH, Viale G, Sirtaine N, Penault-Llorca F, Sugie T, Fineberg S, Paik S, Srinivasan A, Richardson A, Wang Y, Chmielik E, Brock J, Johnson DB, Balko J, Wienert S, Bossuyt V, Michiels S, Ternes N, Burchardi N, Luen SJ, Savas P, Klauschen F, Watson PH, Nelson BH, Criscitiello C, O’Toole S, Larsimont D, de Wind R, Curigliano G, André F, Lacroix-Triki M, van de Vijver M, Rojo F, Floris G, Bedri S, Sparano J, Rimm D, Nielsen T, Kos Z, Hewitt S, Singh B, Farshid G, Loibl S, Allison KH, Tung N, Adams S, Willard-Gallo K, Horlings HM, Gandhi L, Moreira A, Hirsch F, Dieci MV, Urbanowicz M, Brcic I, Korski K, Gaire F, Koeppen H, Lo A, Giltnane J, Ziai J, Rebelatto MC, Steele KE, Zha J, Emancipator K, Juco JW, Denkert C, Reis-Filho J, Loi S, Fox SB. Assessing Tumor-Infiltrating Lymphocytes in Solid Tumors: A Practical Review for Pathologists and Proposal for a Standardized Method from the International Immuno-Oncology Biomarkers Working Group: Part 2: TILs in Melanoma, Gastrointestinal Tract Carcinomas, Non-Small Cell Lung Carcinoma and Mesothelioma, Endometrial and Ovarian Carcinomas, Squamous Cell Carcinoma of the Head and Neck, Genitourinary Carcinomas, and Primary Brain Tumors. Adv Anat Pathol 2017; 24:311-335. [PMID: 28777143 PMCID: PMC5638696 DOI: 10.1097/pap.0000000000000161] [Citation(s) in RCA: 452] [Impact Index Per Article: 64.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Assessment of the immune response to tumors is growing in importance as the prognostic implications of this response are increasingly recognized, and as immunotherapies are evaluated and implemented in different tumor types. However, many different approaches can be used to assess and describe the immune response, which limits efforts at implementation as a routine clinical biomarker. In part 1 of this review, we have proposed a standardized methodology to assess tumor-infiltrating lymphocytes (TILs) in solid tumors, based on the International Immuno-Oncology Biomarkers Working Group guidelines for invasive breast carcinoma. In part 2 of this review, we discuss the available evidence for the prognostic and predictive value of TILs in common solid tumors, including carcinomas of the lung, gastrointestinal tract, genitourinary system, gynecologic system, and head and neck, as well as primary brain tumors, mesothelioma and melanoma. The particularities and different emphases in TIL assessment in different tumor types are discussed. The standardized methodology we propose can be adapted to different tumor types and may be used as a standard against which other approaches can be compared. Standardization of TIL assessment will help clinicians, researchers and pathologists to conclusively evaluate the utility of this simple biomarker in the current era of immunotherapy.
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Affiliation(s)
- Shona Hendry
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Roberto Salgado
- Breast Cancer Translational Research Laboratory/Breast International Group, Institut Jules Bordet, Brussels, Belgium
- Department of Pathology and TCRU, GZA, Antwerp, Belgium
| | - Thomas Gevaert
- Department of Development and Regeneration, Laboratory of Experimental Urology, KU Leuven, Leuven, Belgium
- Department of Pathology, AZ Klina, Brasschaat, Belgium
| | - Prudence A. Russell
- Department of Anatomical Pathology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
- Department of Pathology, University of Melbourne, Parkville, Australia
| | - Tom John
- Department of Medical Oncology, Austin Health, Heidelberg, Australia
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
- School of Cancer Medicine, La Trobe University, Bundoora, Australia
| | - Bibhusal Thapa
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
- Department of Medicine, University of Melbourne, Parkville, Australia
| | - Michael Christie
- Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Australia
| | - Koen van de Vijver
- Divisions of Diagnostic Oncology & Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - M. Valeria Estrada
- Department of Pathology, School of Medicine, University of California, San Diego, USA
| | | | - Melinda Sanders
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, USA
| | - Benjamin Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Cinzia Solinas
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Gert GGM Van den Eynden
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
- Department of Pathology, GZA Ziekenhuizen, Antwerp, Belgium
| | - Yves Allory
- Université Paris-Est, Créteil, France
- INSERM, UMR 955, Créteil, France
- Département de pathologie, APHP, Hôpital Henri-Mondor, Créteil, France
| | - Matthias Preusser
- Department of Medicine, Clinical Division of Oncology, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Johannes Hainfellner
- Institute of Neurology, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Giancarlo Pruneri
- European Institute of Oncology, Milan, Italy
- University of Milan, School of Medicine, Milan, Italy
| | - Andrea Vingiani
- European Institute of Oncology, Milan, Italy
- University of Milan, School of Medicine, Milan, Italy
| | - Sandra Demaria
- New York University Medical School, New York, USA
- Perlmutter Cancer Center, New York, USA
| | - Fraser Symmans
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, USA
| | - Paolo Nuciforo
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Laura Comerma
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | | | - Sunil Lakhani
- Centre for Clinical Research and School of Medicine, The University of Queensland, Brisbane, Australia
- Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Seong-Rim Kim
- National Surgical Adjuvant Breast and Bowel Project Operations Center/NRG Oncology, Pittsburgh, Pennsylvania
| | - Stuart Schnitt
- Cancer Research Institute and Department of Pathology, Beth Israel Deaconess Cancer Center, Boston, USA
- Harvard Medical School, Boston, USA
| | - Cecile Colpaert
- Department of Pathology, GZA Ziekenhuizen, Sint-Augustinus, Wilrijk, Belgium
| | - Christos Sotiriou
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Stefan J. Scherer
- Academic Medical Innovation, Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - Michail Ignatiadis
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Sunil Badve
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, USA
| | - Robert H. Pierce
- Cancer Immunotherapy Trials Network, Central Laboratory and Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Giuseppe Viale
- Department of Pathology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy
| | - Nicolas Sirtaine
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Frederique Penault-Llorca
- Department of Surgical Pathology and Biopathology, Jean Perrin Comprehensive Cancer Centre, Clermont-Ferrand, France
- University of Auvergne UMR1240, Clermont-Ferrand, France
| | - Tomohagu Sugie
- Department of Surgery, Kansai Medical School, Hirakata, Japan
| | - Susan Fineberg
- Montefiore Medical Center, Bronx, New York, USA
- The Albert Einstein College of Medicine, Bronx, New York, USA
| | - Soonmyung Paik
- National Surgical Adjuvant Breast and Bowel Project Operations Center/NRG Oncology, Pittsburgh, Pennsylvania
- Severance Biomedical Science Institute and Department of Medical Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ashok Srinivasan
- National Surgical Adjuvant Breast and Bowel Project Operations Center/NRG Oncology, Pittsburgh, Pennsylvania
| | - Andrea Richardson
- Harvard Medical School, Boston, USA
- Department of Pathology, Brigham and Women’s Hospital, Boston, USA
- Department of Cancer Biology, Dana Farber Cancer Institute, Boston, USA
| | - Yihong Wang
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Providence, USA
- Warren Alpert Medical School of Brown University, Providence, USA
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Memorial Cancer Center, Gliwice, Poland
- Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Jane Brock
- Harvard Medical School, Boston, USA
- Department of Pathology, Brigham and Women’s Hospital, Boston, USA
| | - Douglas B. Johnson
- Department of Medicine, Vanderbilt University Medical Centre, Nashville, USA
- Vanderbilt Ingram Cancer Center, Nashville, USA
| | - Justin Balko
- Department of Medicine, Vanderbilt University Medical Centre, Nashville, USA
- Vanderbilt Ingram Cancer Center, Nashville, USA
| | - Stephan Wienert
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany
- VMscope GmbH, Berlin, Germany
| | - Veerle Bossuyt
- Department of Pathology, Yale University School of Medicine, New Haven, USA
| | - Stefan Michiels
- Service de Biostatistique et d’Epidémiologie, Gustave Roussy, CESP, Inserm U1018, Université-Paris Sud, Université Paris-Saclay, Villejuif, France
| | - Nils Ternes
- Service de Biostatistique et d’Epidémiologie, Gustave Roussy, CESP, Inserm U1018, Université-Paris Sud, Université Paris-Saclay, Villejuif, France
| | | | - Stephen J. Luen
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Peter Savas
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Peter H. Watson
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Trev & Joyce Deeley Research Centre, British Columbia Cancer Agency, Victoria, British Columbia, Canada
| | - Brad H. Nelson
- Trev & Joyce Deeley Research Centre, British Columbia Cancer Agency, Victoria, British Columbia, Canada
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, Canada
- Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sandra O’Toole
- The Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, Australia
- Australian Clinical Labs, Bella Vista, Australia
| | - Denis Larsimont
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Roland de Wind
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Fabrice André
- INSERM Unit U981, and Department of Medical Oncology, Gustave Roussy, Villejuif, France
- Faculté de Médecine, Université Paris Sud, Kremlin-Bicêtre, France
| | - Magali Lacroix-Triki
- INSERM Unit U981, and Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Mark van de Vijver
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Federico Rojo
- Pathology Department, IIS-Fundacion Jimenez Diaz, UAM, Madrid, Spain
| | - Giuseppe Floris
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - Shahinaz Bedri
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Joseph Sparano
- Department of Oncology, Montefiore Medical Centre, Albert Einstein College of Medicine, Bronx, USA
| | - David Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, USA
| | - Torsten Nielsen
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Zuzana Kos
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada
| | - Stephen Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baljit Singh
- Department of Pathology, New York University Langone Medical Centre, New York, USA
| | - Gelareh Farshid
- Directorate of Surgical Pathology, SA Pathology, Adelaide, Australia
- Discipline of Medicine, Adelaide University, Adelaide, Australia
| | | | | | - Nadine Tung
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, USA
| | - Sylvia Adams
- New York University Medical School, New York, USA
- Perlmutter Cancer Center, New York, USA
| | - Karen Willard-Gallo
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Hugo M. Horlings
- Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Leena Gandhi
- Perlmutter Cancer Center, New York, USA
- Dana-Farber Cancer Institute, Boston, USA
| | - Andre Moreira
- Pulmonary Pathology, New York University Center for Biospecimen Research and Development, New York University, New York, USA
| | - Fred Hirsch
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
- Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Maria Urbanowicz
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Iva Brcic
- Institute of Pathology, Medical University of Graz, Austria
| | - Konstanty Korski
- Pathology and Tissue Analytics, Roche Innovation Centre Munich, Penzberg, Germany
| | - Fabien Gaire
- Pathology and Tissue Analytics, Roche Innovation Centre Munich, Penzberg, Germany
| | - Hartmut Koeppen
- Research Pathology, Genentech Inc., South San Francisco, USA
| | - Amy Lo
- Research Pathology, Genentech Inc., South San Francisco, USA
- Department of Pathology, Stanford University, Palo Alto, USA
| | | | - James Ziai
- Research Pathology, Genentech Inc., South San Francisco, USA
| | | | | | - Jiping Zha
- Translational Sciences, MedImmune, Gaithersberg, USA
| | | | | | - Carsten Denkert
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jorge Reis-Filho
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Sherene Loi
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Stephen B. Fox
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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Thomas K, Sanders M, Rogers M, Reynolds T. Impact of Adding Resistance Training to a Clinical Weight Management Program. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.255] [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: 10/19/2022]
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Hendry S, Salgado R, Gevaert T, Russell PA, John T, Thapa B, Christie M, van de Vijver K, Estrada MV, Gonzalez-Ericsson PI, Sanders M, Solomon B, Solinas C, Van den Eynden GGGM, Allory Y, Preusser M, Hainfellner J, Pruneri G, Vingiani A, Demaria S, Symmans F, Nuciforo P, Comerma L, Thompson EA, Lakhani S, Kim SR, Schnitt S, Colpaert C, Sotiriou C, Scherer SJ, Ignatiadis M, Badve S, Pierce RH, Viale G, Sirtaine N, Penault-Llorca F, Sugie T, Fineberg S, Paik S, Srinivasan A, Richardson A, Wang Y, Chmielik E, Brock J, Johnson DB, Balko J, Wienert S, Bossuyt V, Michiels S, Ternes N, Burchardi N, Luen SJ, Savas P, Klauschen F, Watson PH, Nelson BH, Criscitiello C, O’Toole S, Larsimont D, de Wind R, Curigliano G, André F, Lacroix-Triki M, van de Vijver M, Rojo F, Floris G, Bedri S, Sparano J, Rimm D, Nielsen T, Kos Z, Hewitt S, Singh B, Farshid G, Loibl S, Allison KH, Tung N, Adams S, Willard-Gallo K, Horlings HM, Gandhi L, Moreira A, Hirsch F, Dieci MV, Urbanowicz M, Brcic I, Korski K, Gaire F, Koeppen H, Lo A, Giltnane J, Ziai J, Rebelatto MC, Steele KE, Zha J, Emancipator K, Juco JW, Denkert C, Reis-Filho J, Loi S, Fox SB. Assessing Tumor-infiltrating Lymphocytes in Solid Tumors: A Practical Review for Pathologists and Proposal for a Standardized Method From the International Immunooncology Biomarkers Working Group: Part 1: Assessing the Host Immune Response, TILs in Invasive Breast Carcinoma and Ductal Carcinoma In Situ, Metastatic Tumor Deposits and Areas for Further Research. Adv Anat Pathol 2017; 24:235-251. [PMID: 28777142 PMCID: PMC5564448 DOI: 10.1097/pap.0000000000000162] [Citation(s) in RCA: 423] [Impact Index Per Article: 60.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Assessment of tumor-infiltrating lymphocytes (TILs) in histopathologic specimens can provide important prognostic information in diverse solid tumor types, and may also be of value in predicting response to treatments. However, implementation as a routine clinical biomarker has not yet been achieved. As successful use of immune checkpoint inhibitors and other forms of immunotherapy become a clinical reality, the need for widely applicable, accessible, and reliable immunooncology biomarkers is clear. In part 1 of this review we briefly discuss the host immune response to tumors and different approaches to TIL assessment. We propose a standardized methodology to assess TILs in solid tumors on hematoxylin and eosin sections, in both primary and metastatic settings, based on the International Immuno-Oncology Biomarker Working Group guidelines for TIL assessment in invasive breast carcinoma. A review of the literature regarding the value of TIL assessment in different solid tumor types follows in part 2. The method we propose is reproducible, affordable, easily applied, and has demonstrated prognostic and predictive significance in invasive breast carcinoma. This standardized methodology may be used as a reference against which other methods are compared, and should be evaluated for clinical validity and utility. Standardization of TIL assessment will help to improve consistency and reproducibility in this field, enrich both the quality and quantity of comparable evidence, and help to thoroughly evaluate the utility of TILs assessment in this era of immunotherapy.
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Affiliation(s)
- Shona Hendry
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Roberto Salgado
- Breast Cancer Translational Research Laboratory/Breast International Group, Institut Jules Bordet, Brussels, Belgium,Department of Pathology and TCRU, GZA, Antwerp, Belgium
| | - Thomas Gevaert
- Department of Development and Regeneration, Laboratory of Experimental Urology, KU Leuven, Leuven, Belgium,Department of Pathology, AZ Klina, Brasschaat, Belgium
| | - Prudence A. Russell
- Department of Anatomical Pathology, St Vincent’s Hospital Melbourne, Fitzroy, Australia,Department of Pathology, University of Melbourne, Parkville, Australia
| | - Tom John
- Department of Medical Oncology, Austin Health, Heidelberg, Australia,Olivia Newton-John Cancer Research Institute, Heidelberg, Australia,School of Cancer Medicine, La Trobe University, Bundoora, Australia
| | - Bibhusal Thapa
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia,Department of Medicine, University of Melbourne, Parkville, Australia
| | - Michael Christie
- Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Australia
| | - Koen van de Vijver
- Divisions of Diagnostic Oncology & Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - M. Valeria Estrada
- Department of Pathology, School of Medicine, University of California, San Diego, USA
| | | | - Melinda Sanders
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, USA
| | - Benjamin Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Cinzia Solinas
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Gert GGM Van den Eynden
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium,Department of Pathology, GZA Ziekenhuizen, Antwerp, Belgium
| | - Yves Allory
- Université Paris-Est, Créteil, France,INSERM, UMR 955, Créteil, France,Département de pathologie, APHP, Hôpital Henri-Mondor, Créteil, France
| | - Matthias Preusser
- Department of Medicine, Clinical Division of Oncology, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Johannes Hainfellner
- Institute of Neurology, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Giancarlo Pruneri
- European Institute of Oncology, Milan, Italy,University of Milan, School of Medicine, Milan, Italy
| | - Andrea Vingiani
- European Institute of Oncology, Milan, Italy,University of Milan, School of Medicine, Milan, Italy
| | - Sandra Demaria
- New York University Medical School, New York, USA,Perlmutter Cancer Center, New York, USA
| | - Fraser Symmans
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, USA
| | - Paolo Nuciforo
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Laura Comerma
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | | | - Sunil Lakhani
- Centre for Clinical Research and School of Medicine, The University of Queensland, Brisbane, Australia,Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Seong-Rim Kim
- National Surgical Adjuvant Breast and Bowel Project Operations Center/NRG Oncology, Pittsburgh, Pennsylvania
| | - Stuart Schnitt
- Cancer Research Institute and Department of Pathology, Beth Israel Deaconess Cancer Center, Boston, USA,Harvard Medical School, Boston, USA
| | - Cecile Colpaert
- Department of Pathology, GZA Ziekenhuizen, Sint-Augustinus, Wilrijk, Belgium
| | - Christos Sotiriou
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Stefan J. Scherer
- Academic Medical Innovation, Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - Michail Ignatiadis
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Sunil Badve
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, USA
| | - Robert H. Pierce
- Cancer Immunotherapy Trials Network, Central Laboratory and Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Giuseppe Viale
- Department of Pathology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy
| | - Nicolas Sirtaine
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Frederique Penault-Llorca
- Department of Surgical Pathology and Biopathology, Jean Perrin Comprehensive Cancer Centre, Clermont-Ferrand, France,University of Auvergne UMR1240, Clermont-Ferrand, France
| | - Tomohagu Sugie
- Department of Surgery, Kansai Medical School, Hirakata, Japan
| | - Susan Fineberg
- Montefiore Medical Center, Bronx, New York, USA,The Albert Einstein College of Medicine, Bronx, New York, USA
| | - Soonmyung Paik
- National Surgical Adjuvant Breast and Bowel Project Operations Center/NRG Oncology, Pittsburgh, Pennsylvania,Severance Biomedical Science Institute and Department of Medical Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ashok Srinivasan
- National Surgical Adjuvant Breast and Bowel Project Operations Center/NRG Oncology, Pittsburgh, Pennsylvania
| | - Andrea Richardson
- Harvard Medical School, Boston, USA,Department of Pathology, Brigham and Women’s Hospital, Boston, USA,Department of Cancer Biology, Dana Farber Cancer Institute, Boston, USA
| | - Yihong Wang
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Providence, USA,Warren Alpert Medical School of Brown University, Providence, USA
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Memorial Cancer Center, Gliwice, Poland,Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Jane Brock
- Harvard Medical School, Boston, USA,Department of Pathology, Brigham and Women’s Hospital, Boston, USA
| | - Douglas B. Johnson
- Department of Medicine, Vanderbilt University Medical Centre, Nashville, USA,Vanderbilt Ingram Cancer Center, Nashville, USA
| | - Justin Balko
- Department of Medicine, Vanderbilt University Medical Centre, Nashville, USA,Vanderbilt Ingram Cancer Center, Nashville, USA
| | - Stephan Wienert
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany,VMscope GmbH, Berlin, Germany
| | - Veerle Bossuyt
- Department of Pathology, Yale University School of Medicine, New Haven, USA
| | - Stefan Michiels
- Service de Biostatistique et d’Epidémiologie, Gustave Roussy, CESP, Inserm U1018, Université-Paris Sud, Université Paris-Saclay, Villejuif, France
| | - Nils Ternes
- Service de Biostatistique et d’Epidémiologie, Gustave Roussy, CESP, Inserm U1018, Université-Paris Sud, Université Paris-Saclay, Villejuif, France
| | | | - Stephen J. Luen
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Peter Savas
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Peter H. Watson
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada,Trev & Joyce Deeley Research Centre, British Columbia Cancer Agency, Victoria, British Columbia, Canada
| | - Brad H. Nelson
- Trev & Joyce Deeley Research Centre, British Columbia Cancer Agency, Victoria, British Columbia, Canada,Department of Biochemistry and Microbiology, University of Victoria, Victoria, Canada,Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sandra O’Toole
- The Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, Australia,Australian Clinical Labs, Bella Vista, Australia
| | - Denis Larsimont
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Roland de Wind
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Fabrice André
- INSERM Unit U981, and Department of Medical Oncology, Gustave Roussy, Villejuif, France,Faculté de Médecine, Université Paris Sud, Kremlin-Bicêtre, France
| | - Magali Lacroix-Triki
- INSERM Unit U981, and Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Mark van de Vijver
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Federico Rojo
- Pathology Department, IIS-Fundacion Jimenez Diaz, UAM, Madrid, Spain
| | - Giuseppe Floris
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - Shahinaz Bedri
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Joseph Sparano
- Department of Oncology, Montefiore Medical Centre, Albert Einstein College of Medicine, Bronx, USA
| | - David Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, USA
| | - Torsten Nielsen
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Zuzana Kos
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada
| | - Stephen Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baljit Singh
- Department of Pathology, New York University Langone Medical Centre, New York, USA
| | - Gelareh Farshid
- Directorate of Surgical Pathology, SA Pathology, Adelaide, Australia,Discipline of Medicine, Adelaide University, Adelaide, Australia
| | | | | | - Nadine Tung
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, USA
| | - Sylvia Adams
- New York University Medical School, New York, USA,Perlmutter Cancer Center, New York, USA
| | - Karen Willard-Gallo
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Hugo M. Horlings
- Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Leena Gandhi
- Perlmutter Cancer Center, New York, USA,Dana-Farber Cancer Institute, Boston, USA
| | - Andre Moreira
- Pulmonary Pathology, New York University Center for Biospecimen Research and Development, New York University, New York, USA
| | - Fred Hirsch
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy,Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Maria Urbanowicz
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Iva Brcic
- Institute of Pathology, Medical University of Graz, Austria
| | - Konstanty Korski
- Pathology and Tissue Analytics, Roche Innovation Centre Munich, Penzberg, Germany
| | - Fabien Gaire
- Pathology and Tissue Analytics, Roche Innovation Centre Munich, Penzberg, Germany
| | - Hartmut Koeppen
- Research Pathology, Genentech Inc., South San Francisco, USA
| | - Amy Lo
- Research Pathology, Genentech Inc., South San Francisco, USA,Department of Pathology, Stanford University, Palo Alto, USA
| | | | - James Ziai
- Research Pathology, Genentech Inc., South San Francisco, USA
| | | | | | - Jiping Zha
- Translational Sciences, MedImmune, Gaithersberg, USA
| | | | | | - Carsten Denkert
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jorge Reis-Filho
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Sherene Loi
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Stephen B. Fox
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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Formisano L, Stauffer KM, Young CD, Bhola NE, Guerrero-Zotano AL, Jansen VM, Estrada MM, Hutchinson KE, Giltnane JM, Schwarz LJ, Lu Y, Balko JM, Deas O, Cairo S, Judde JG, Mayer IA, Sanders M, Dugger TC, Bianco R, Stricker T, Arteaga CL. Association of FGFR1 with ERα Maintains Ligand-Independent ER Transcription and Mediates Resistance to Estrogen Deprivation in ER + Breast Cancer. Clin Cancer Res 2017; 23:6138-6150. [PMID: 28751448 DOI: 10.1158/1078-0432.ccr-17-1232] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/12/2017] [Accepted: 07/19/2017] [Indexed: 01/03/2023]
Abstract
Purpose:FGFR1 amplification occurs in approximately 15% of estrogen receptor-positive (ER+) human breast cancers. We investigated mechanisms by which FGFR1 amplification confers antiestrogen resistance to ER+ breast cancer.Experimental Design: ER+ tumors from patients treated with letrozole before surgery were subjected to Ki67 IHC, FGFR1 FISH, and RNA sequencing (RNA-seq). ER+/FGFR1-amplified breast cancer cells, and patient-derived xenografts (PDX) were treated with FGFR1 siRNA or the FGFR tyrosine kinase inhibitor lucitanib. Endpoints were cell/xenograft growth, FGFR1/ERα association by coimmunoprecipitation and proximity ligation, ER genomic activity by ChIP sequencing, and gene expression by RT-PCR.Results: ER+/FGFR1-amplified tumors in patients treated with letrozole maintained cell proliferation (Ki67). Estrogen deprivation increased total and nuclear FGFR1 and FGF ligands expression in ER+/FGFR1-amplified primary tumors and breast cancer cells. In estrogen-free conditions, FGFR1 associated with ERα in tumor cell nuclei and regulated the transcription of ER-dependent genes. This association was inhibited by a kinase-dead FGFR1 mutant and by treatment with lucitanib. ChIP-seq analysis of estrogen-deprived ER+/FGFR1-amplified cells showed binding of FGFR1 and ERα to DNA. Treatment with fulvestrant and/or lucitanib reduced FGFR1 and ERα binding to DNA. RNA-seq data from FGFR1-amplified patients' tumors treated with letrozole showed enrichment of estrogen response and E2F target genes. Finally, growth of ER+/FGFR1-amplified cells and PDXs was more potently inhibited by fulvestrant and lucitanib combined than each drug alone.Conclusions: These data suggest the ERα pathway remains active in estrogen-deprived ER+/FGFR1-amplified breast cancers. Therefore, these tumors are endocrine resistant and should be candidates for treatment with combinations of ER and FGFR antagonists. Clin Cancer Res; 23(20); 6138-50. ©2017 AACR.
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Affiliation(s)
- Luigi Formisano
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Clinical Medicine, University of Naples Federico II, Naples, Italy
| | - Kimberly M Stauffer
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christian D Young
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Neil E Bhola
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Valerie M Jansen
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mónica M Estrada
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Jennifer M Giltnane
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Luis J Schwarz
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yao Lu
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Justin M Balko
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Stefano Cairo
- XenTech, Evry, France.,LTTA Center, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | | | - Ingrid A Mayer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melinda Sanders
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee.,Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Teresa C Dugger
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roberto Bianco
- Department of Clinical Medicine, University of Naples Federico II, Naples, Italy
| | - Thomas Stricker
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee. .,Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carlos L Arteaga
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. .,Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, Tennessee
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Ferraro GB, Kodack DP, Askoxylakis V, Sheng Q, Badeaux M, Goel S, Qi X, Shankaraiah R, Cao AZ, Ramjiawan RR, Bezwada D, Patel B, Song Y, Costa C, Naxerova K, Wong C, Kloepper J, Das R, Tam A, Tanboon J, Duda DG, Miller RC, Siegel MB, Anders CK, Sanders M, Estrada VM, Schlegel R, Arteaga CL, Brachtel E, Huang A, Fukumura D, Engelman JA, Jain RK. Abstract 5008: The brain microenvironment mediates resistance in luminal breast cancer to PI3K inhibition through HER3 activation. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5008] [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
Brain metastases represent a devastating progression of luminal breast cancer. While targeted therapies are often effective systemically, they fail to adequately control brain metastases. In preclinical models that faithfully recapitulate the disparate clinical responses in these microenvironments, we observed that brain metastases evade PI3K inhibition despite efficient drug delivery. In comparison to extracranial disease, there is increased HER3 expression and phosphorylation in the brain lesions. HER3 blockade overcomes the resistance of both HER2-amplified and/or PIK3CA-mutant breast cancer brain metastases to PI3K inhibitors, leading to striking tumor growth delay and significant improvement of mouse survival. Collectively, these data provide a mechanistic basis underlying therapeutic resistance in the brain microenvironment and identify rapidly translatable treatment strategiesfor HER2-amplified and/or PIK3CA-mutant breast cancer brain metastases.
Citation Format: Gino B. Ferraro, David P. Kodack, Vasileios Askoxylakis, Qing Sheng, Mark Badeaux, Shom Goel, Xiaolong Qi, Ram Shankaraiah, Alexander Z. Cao, Rakesh R. Ramjiawan, Divya Bezwada, Bhushankumar Patel, Youngchul Song, Carlotta Costa, Kamila Naxerova, Christina Wong, Jonas Kloepper, Rita Das, Angela Tam, Jantima Tanboon, Dan G. Duda, Ryan C. Miller, Marni B. Siegel, Carey K. Anders, Melinda Sanders, Valeria M. Estrada, Robert Schlegel, Carlos L. Arteaga, Elena Brachtel, Alan Huang, Dai Fukumura, Jeffrey A. Engelman, Rakesh K. Jain. The brain microenvironment mediates resistance in luminal breast cancer to PI3K inhibition through HER3 activation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5008. doi:10.1158/1538-7445.AM2017-5008
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Affiliation(s)
- Gino B. Ferraro
- 1Massachusetts General Hospital / Harvard Medical School, Boston, MA
| | - David P. Kodack
- 1Massachusetts General Hospital / Harvard Medical School, Boston, MA
| | | | | | - Mark Badeaux
- 1Massachusetts General Hospital / Harvard Medical School, Boston, MA
| | - Shom Goel
- 3Massachusetts General Hospital / Harvard Medical School / Dana Farber Cancer Institute, Boston, MA
| | - Xiaolong Qi
- 1Massachusetts General Hospital / Harvard Medical School, Boston, MA
| | - Ram Shankaraiah
- 1Massachusetts General Hospital / Harvard Medical School, Boston, MA
| | | | | | - Divya Bezwada
- 1Massachusetts General Hospital / Harvard Medical School, Boston, MA
| | | | - Youngchul Song
- 1Massachusetts General Hospital / Harvard Medical School, Boston, MA
| | - Carlotta Costa
- 1Massachusetts General Hospital / Harvard Medical School, Boston, MA
| | - Kamila Naxerova
- 1Massachusetts General Hospital / Harvard Medical School, Boston, MA
| | - Christina Wong
- 1Massachusetts General Hospital / Harvard Medical School, Boston, MA
| | - Jonas Kloepper
- 1Massachusetts General Hospital / Harvard Medical School, Boston, MA
| | | | | | - Jantima Tanboon
- 1Massachusetts General Hospital / Harvard Medical School, Boston, MA
| | - Dan G. Duda
- 1Massachusetts General Hospital / Harvard Medical School, Boston, MA
| | - Ryan C. Miller
- 4Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Marni B. Siegel
- 4Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Carey K. Anders
- 4Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | | | | | | | - Elena Brachtel
- 1Massachusetts General Hospital / Harvard Medical School, Boston, MA
| | | | - Dai Fukumura
- 1Massachusetts General Hospital / Harvard Medical School, Boston, MA
| | | | - Rakesh K. Jain
- 1Massachusetts General Hospital / Harvard Medical School, Boston, MA
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Lee KM, Giltnane J, Balko J, Schwarz L, Guerrero A, Hutchinson K, Hicks M, Sanchez V, Sanders M, Lee T, Olejniczak E, Fesik S, Arteaga C. Abstract 3890: Mitochondrial MCL1 maintains triple negative breast cancer stem cells and contributes to chemotherapy resistance. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-3890] [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
Cytotoxic chemotherapy is the standard of care for patients with triple negative breast cancer (TNBC). Most patients with advanced TNBC progress after chemotherapy and die from metastatic disease. MCL1 is an anti-apoptotic Bcl-2 family member known to sequester and inactivate pro-apoptotic Bcl-2 family proteins and, thus, contribute to chemotherapy resistance. We previously reported that ~45% of residual TNBCs that remain in the breast after neoadjuvant chemotherapy harbor MCL1 amplification, suggesting a causal role for MCL1 in drug resistance. A recent report (Goodwin et al. 2015) suggested that siRNA-mediated ablation of MCL1 does not induce apoptosis in claudin-low TNBC cells with a cancer stem cell (CSC) gene expression signature. CSCs comprise a rare population of cells with tumor-initiating properties and refractoriness to chemotherapy. In this study, we showed that MCL1 expression is elevated in claudin-low TNBC SUM159PT and MDA436 CSCs as measured by ALDH+ by flow cytometry and ability to form mammospheres. RNA interference of MCL1 in SUM159PT cells reduced CSCs and attenuated tumor formation in vivo. Mitochondrial oxidative phosphorylation (mtOXPHOS) plays a crucial role in maintenance of CSCs. MCL1 has been shown to localize in the mitochondrial matrix and contribute to mitochondrial respiration. Thus, we hypothesized that MCL1 contributes to enrichment of TNBC CSCs and chemotherapy resistance via mitochondrial regulation. Stable transfection and overexpression of MCL1 in MDA468 cells increased oxygen consumption ratio, mitochondrial membrane potential, and production of reactive oxygen species (ROS), all features of activated mtOXPHOS. Conversely, RNAi-mediated ablation of MCL1 in SUM159PT and MDA436 cells repressed these markers of activated mtOXPHOS. A mutant of MCL1 lacking its mitochondrial target sequences (MTS) was unable to localize in mitochondria and, when transfected into MDA468 cells, reduced the CD44high/CD24low fraction and mammosphere formation. We next tested VU0659158, a BH3 mimetic in development at Vanderbilt that disrupts MCL1 interactions with BH3 domain-containing proteins, such as BID, BIM, NOXA and PUMA. Treatment of SUM159PT cells with VU0659158 increased caspase activity but did not attenuate mammosphere formation. Analysis of mRNA expression in TCGA revealed that genes induced by mtOXPHOS involved in the hypoxia pathway are significantly up-regulated in MCL1 amplified breast cancers. Finally, pharmacological inhibition of HIF-1α, a key regulator of hypoxia, with digoxin decreased CSCs and attenuated tumor formation in vivo. These data suggest that 1) MCL1 confers resistance to chemotherapy by expanding CSCs via mtOXPHOS independent of its BH3 domain-mediated, anti-apoptotic function, and 2) targeting mitochondrial respiration and the hypoxia pathway may delay or reverse chemotherapy resistance in MCL1 amplified TNBC.
Citation Format: Kyung-min Lee, Jennifer Giltnane, Justin Balko, Luis Schwarz, Angel Guerrero, Katie Hutchinson, Mellissa Hicks, Violeta Sanchez, Melinda Sanders, Taekyu Lee, Edward Olejniczak, Stephen Fesik, Carlos Arteaga. Mitochondrial MCL1 maintains triple negative breast cancer stem cells and contributes to chemotherapy resistance [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3890. doi:10.1158/1538-7445.AM2017-3890
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Dumetz F, Imamura H, Sanders M, Seblova V, Myskova J, Pescher P, Vanaerschot M, Meehan CJ, Cuypers B, De Muylder G, Späth GF, Bussotti G, Vermeesch JR, Berriman M, Cotton JA, Volf P, Dujardin JC, Domagalska MA. Modulation of Aneuploidy in Leishmania donovani during Adaptation to Different In Vitro and In Vivo Environments and Its Impact on Gene Expression. mBio 2017; 8:e00599-17. [PMID: 28536289 PMCID: PMC5442457 DOI: 10.1128/mbio.00599-17] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/01/2017] [Indexed: 12/23/2022] Open
Abstract
Aneuploidy is usually deleterious in multicellular organisms but appears to be tolerated and potentially beneficial in unicellular organisms, including pathogens. Leishmania, a major protozoan parasite, is emerging as a new model for aneuploidy, since in vitro-cultivated strains are highly aneuploid, with interstrain diversity and intrastrain mosaicism. The alternation of two life stages in different environments (extracellular promastigotes and intracellular amastigotes) offers a unique opportunity to study the impact of environment on aneuploidy and gene expression. We sequenced the whole genomes and transcriptomes of Leishmania donovani strains throughout their adaptation to in vivo conditions mimicking natural vertebrate and invertebrate host environments. The nucleotide sequences were almost unchanged within a strain, in contrast to highly variable aneuploidy. Although high in promastigotes in vitro, aneuploidy dropped significantly in hamster amastigotes, in a progressive and strain-specific manner, accompanied by the emergence of new polysomies. After a passage through a sand fly, smaller yet consistent karyotype changes were detected. Changes in chromosome copy numbers were correlated with the corresponding transcript levels, but additional aneuploidy-independent regulation of gene expression was observed. This affected stage-specific gene expression, downregulation of the entire chromosome 31, and upregulation of gene arrays on chromosomes 5 and 8. Aneuploidy changes in Leishmania are probably adaptive and exploited to modulate the dosage and expression of specific genes; they are well tolerated, but additional mechanisms may exist to regulate the transcript levels of other genes located on aneuploid chromosomes. Our model should allow studies of the impact of aneuploidy on molecular adaptations and cellular fitness.IMPORTANCE Aneuploidy is usually detrimental in multicellular organisms, but in several microorganisms, it can be tolerated and even beneficial. Leishmania-a protozoan parasite that kills more than 30,000 people each year-is emerging as a new model for aneuploidy studies, as unexpectedly high levels of aneuploidy are found in clinical isolates. Leishmania lacks classical regulation of transcription at initiation through promoters, so aneuploidy could represent a major adaptive strategy of this parasite to modulate gene dosage in response to stressful environments. For the first time, we document the dynamics of aneuploidy throughout the life cycle of the parasite, in vitro and in vivo We show its adaptive impact on transcription and its interaction with regulation. Besides offering a new model for aneuploidy studies, we show that further genomic studies should be done directly in clinical samples without parasite isolation and that adequate methods should be developed for this.
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Affiliation(s)
- F Dumetz
- Molecular Parasitology, Institute of Tropical Medicine, Antwerp, Belgium
| | - H Imamura
- Molecular Parasitology, Institute of Tropical Medicine, Antwerp, Belgium
| | - M Sanders
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - V Seblova
- Charles University, Prague, Czech Republic
| | - J Myskova
- Charles University, Prague, Czech Republic
| | - P Pescher
- Unité de Parasitologie Moléculaire et Signalisation, INSERM U1201, Institut Pasteur, Paris, France
| | - M Vanaerschot
- Molecular Parasitology, Institute of Tropical Medicine, Antwerp, Belgium
| | - C J Meehan
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - B Cuypers
- Molecular Parasitology, Institute of Tropical Medicine, Antwerp, Belgium
- Advanced Database Research and Modelling (ADReM), Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium
| | - G De Muylder
- Molecular Parasitology, Institute of Tropical Medicine, Antwerp, Belgium
| | - G F Späth
- Unité de Parasitologie Moléculaire et Signalisation, INSERM U1201, Institut Pasteur, Paris, France
| | - G Bussotti
- Unité de Parasitologie Moléculaire et Signalisation, INSERM U1201, Institut Pasteur, Paris, France
| | - J R Vermeesch
- Molecular Cytogenetics and Genome Research, Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - M Berriman
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - J A Cotton
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - P Volf
- Charles University, Prague, Czech Republic
| | - J C Dujardin
- Molecular Parasitology, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - M A Domagalska
- Molecular Parasitology, Institute of Tropical Medicine, Antwerp, Belgium
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Keller RA, Hood B, Wang G, Oliver J, Sanders M, Wang X, Khoury A, Campbell WA, Conrads T, Maxwell GL. 979: Identification of proteomic changes associated with placenta accreta. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Heng YJ, Lester SC, Tse GM, Factor RE, Allison KH, Collins LC, Chen YY, Jensen KC, Johnson NB, Jeong JC, Punjabi R, Shin SJ, Singh K, Krings G, Eberhard DA, Tan PH, Korski K, Waldman FM, Gutman DA, Sanders M, Reis-Filho JS, Flanagan SR, Gendoo DM, Chen GM, Haibe-Kains B, Ciriello G, Hoadley KA, Perou CM, Beck AH. The molecular basis of breast cancer pathological phenotypes. J Pathol 2016; 241:375-391. [PMID: 27861902 DOI: 10.1002/path.4847] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [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: 04/25/2016] [Revised: 10/21/2016] [Accepted: 11/01/2016] [Indexed: 12/21/2022]
Abstract
The histopathological evaluation of morphological features in breast tumours provides prognostic information to guide therapy. Adjunct molecular analyses provide further diagnostic, prognostic and predictive information. However, there is limited knowledge of the molecular basis of morphological phenotypes in invasive breast cancer. This study integrated genomic, transcriptomic and protein data to provide a comprehensive molecular profiling of morphological features in breast cancer. Fifteen pathologists assessed 850 invasive breast cancer cases from The Cancer Genome Atlas (TCGA). Morphological features were significantly associated with genomic alteration, DNA methylation subtype, PAM50 and microRNA subtypes, proliferation scores, gene expression and/or reverse-phase protein assay subtype. Marked nuclear pleomorphism, necrosis, inflammation and a high mitotic count were associated with the basal-like subtype, and had a similar molecular basis. Omics-based signatures were constructed to predict morphological features. The association of morphology transcriptome signatures with overall survival in oestrogen receptor (ER)-positive and ER-negative breast cancer was first assessed by use of the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) dataset; signatures that remained prognostic in the METABRIC multivariate analysis were further evaluated in five additional datasets. The transcriptomic signature of poorly differentiated epithelial tubules was prognostic in ER-positive breast cancer. No signature was prognostic in ER-negative breast cancer. This study provided new insights into the molecular basis of breast cancer morphological phenotypes. The integration of morphological with molecular data has the potential to refine breast cancer classification, predict response to therapy, enhance our understanding of breast cancer biology, and improve clinical management. This work is publicly accessible at www.dx.ai/tcga_breast. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Yujing J Heng
- Cancer Research Institute, Beth Israel Deaconess Cancer Center, Boston, MA, USA.,Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Susan C Lester
- Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Gary Mk Tse
- Department of Anatomical & Cellular Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Rachel E Factor
- Department of Pathology, School of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Kimberly H Allison
- Department of Pathology, School of Medicine, Stanford Medical Center, Stanford University, Stanford, CA, USA
| | - Laura C Collins
- Cancer Research Institute, Beth Israel Deaconess Cancer Center, Boston, MA, USA.,Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Yunn-Yi Chen
- Department of Pathology, School of Medicine, University of California, San Francisco, CA, USA
| | - Kristin C Jensen
- Department of Pathology, School of Medicine, Stanford Medical Center, Stanford University, Stanford, CA, USA.,VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Nicole B Johnson
- Cancer Research Institute, Beth Israel Deaconess Cancer Center, Boston, MA, USA.,Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jong Cheol Jeong
- Cancer Research Institute, Beth Israel Deaconess Cancer Center, Boston, MA, USA.,Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rahi Punjabi
- Cancer Research Institute, Beth Israel Deaconess Cancer Center, Boston, MA, USA.,Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sandra J Shin
- Department of Pathology & Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Kamaljeet Singh
- Department of Pathology & Laboratory Medicine, Brown University, Providence, RI, USA
| | - Gregor Krings
- Department of Pathology, School of Medicine, University of California, San Francisco, CA, USA
| | - David A Eberhard
- Department of Pathology & Laboratory Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Puay Hoon Tan
- Department of Pathology, Singapore General Hospital, Singapore
| | - Konstanty Korski
- Department of Pathology, Greater Poland Cancer Centre, Poznan, Poland
| | - Frederic M Waldman
- Department of Laboratory Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - David A Gutman
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Melinda Sanders
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, TN, USA
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sydney R Flanagan
- Cancer Research Institute, Beth Israel Deaconess Cancer Center, Boston, MA, USA.,Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Deena Ma Gendoo
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Departments of Medical Biophysics and Computer Science, University of Toronto, Toronto, ON, Canada
| | - Gregory M Chen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Benjamin Haibe-Kains
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Departments of Medical Biophysics and Computer Science, University of Toronto, Toronto, ON, Canada
| | - Giovanni Ciriello
- Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland
| | - Katherine A Hoadley
- Department of Genetics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Charles M Perou
- Department of Pathology & Laboratory Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.,Department of Genetics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Andrew H Beck
- Cancer Research Institute, Beth Israel Deaconess Cancer Center, Boston, MA, USA.,Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Sai J, Owens P, Novitskiy SV, Hawkins OE, Vilgelm AE, Yang J, Sobolik T, Lavender N, Johnson AC, McClain C, Ayers GD, Kelley MC, Sanders M, Mayer IA, Moses HL, Boothby M, Richmond A. PI3K Inhibition Reduces Mammary Tumor Growth and Facilitates Antitumor Immunity and Anti-PD1 Responses. Clin Cancer Res 2016; 23:3371-3384. [PMID: 28003307 DOI: 10.1158/1078-0432.ccr-16-2142] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/23/2016] [Accepted: 12/14/2016] [Indexed: 12/13/2022]
Abstract
Purpose: Metastatic breast cancers continue to elude current therapeutic strategies, including those utilizing PI3K inhibitors. Given the prominent role of PI3Kα,β in tumor growth and PI3Kγ,δ in immune cell function, we sought to determine whether PI3K inhibition altered antitumor immunity.Experimental Design: The effect of PI3K inhibition on tumor growth, metastasis, and antitumor immune response was characterized in mouse models utilizing orthotopic implants of 4T1 or PyMT mammary tumors into syngeneic or PI3Kγ-null mice, and patient-derived breast cancer xenografts in humanized mice. Tumor-infiltrating leukocytes were characterized by IHC and FACS analysis in BKM120 (30 mg/kg, every day) or vehicle-treated mice and PI3Kγnull versus PI3KγWT mice. On the basis of the finding that PI3K inhibition resulted in a more inflammatory tumor leukocyte infiltrate, the therapeutic efficacy of BKM120 (30 mg/kg, every day) and anti-PD1 (100 μg, twice weekly) was evaluated in PyMT tumor-bearing mice.Results: Our findings show that PI3K activity facilitates tumor growth and surprisingly restrains tumor immune surveillance. These activities could be partially suppressed by BKM120 or by genetic deletion of PI3Kγ in the host. The antitumor effect of PI3Kγ loss in host, but not tumor, was partially reversed by CD8+ T-cell depletion. Treatment with therapeutic doses of both BKM120 and antibody to PD-1 resulted in consistent inhibition of tumor growth compared with either agent alone.Conclusions: PI3K inhibition slows tumor growth, enhances antitumor immunity, and heightens susceptibility to immune checkpoint inhibitors. We propose that combining PI3K inhibition with anti-PD1 may be a viable therapeutic approach for triple-negative breast cancer. Clin Cancer Res; 23(13); 3371-84. ©2016 AACR.
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Affiliation(s)
- Jiqing Sai
- Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, Tennessee.,Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee
| | - Philip Owens
- Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, Tennessee.,Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee
| | | | - Oriana E Hawkins
- Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, Tennessee.,Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee
| | - Anna E Vilgelm
- Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, Tennessee.,Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee
| | - Jinming Yang
- Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, Tennessee.,Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee
| | - Tammy Sobolik
- Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, Tennessee.,Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee
| | - Nicole Lavender
- Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, Tennessee.,Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee
| | - Andrew C Johnson
- Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, Tennessee.,Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee
| | - Colt McClain
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, Tennessee
| | - Gregory D Ayers
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Mark C Kelley
- Department of Surgical Oncology, Vanderbilt University, Nashville, Tennessee
| | - Melinda Sanders
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, Tennessee
| | - Ingrid A Mayer
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Harold L Moses
- Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee
| | - Mark Boothby
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, Tennessee
| | - Ann Richmond
- Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, Tennessee. .,Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee
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Nandy S, Sanders M, Zhu Q. Classification and analysis of human ovarian tissue using full field optical coherence tomography. Biomed Opt Express 2016; 7:5182-5187. [PMID: 28018734 PMCID: PMC5175561 DOI: 10.1364/boe.7.005182] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/09/2016] [Accepted: 11/09/2016] [Indexed: 05/26/2023]
Abstract
In this study, a full field optical coherence tomography (FFOCT) system was used to analyze and classify normal and malignant human ovarian tissue. 14 ovarian tissue samples (7 normal, 7 malignant) were imaged with the FFOCT system and five features were extracted by analyzing the normalized image histogram from 56 FFOCT images, based on the differences in the morphology of the normal and malignant tissue samples. A generalized linear model (GLM) classifier was trained using 36 images, and sensitivity of 95.3% and specificity of 91.1% was obtained. 20 images were used to test the model, and a sensitivity of 91.6% and specificity of 87.7% was obtained.
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Affiliation(s)
- Sreyankar Nandy
- Department of Biomedical Engineering, Washington University in St. Louis, USA
| | - Melinda Sanders
- University of Connecticut Health Center, Division of Pathology, USA
| | - Quing Zhu
- Department of Biomedical Engineering, Washington University in St. Louis, USA
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Nandy S, Mostafa A, Kumavor PD, Sanders M, Brewer M, Zhu Q. Characterizing optical properties and spatial heterogeneity of human ovarian tissue using spatial frequency domain imaging. J Biomed Opt 2016; 21:101402. [PMID: 26822943 PMCID: PMC4728740 DOI: 10.1117/1.jbo.21.10.101402] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 12/17/2015] [Indexed: 05/15/2023]
Abstract
A spatial frequency domain imaging (SFDI) system was developed for characterizing ex vivo human ovarian tissue using wide-field absorption and scattering properties and their spatial heterogeneities. Based on the observed differences between absorption and scattering images of different ovarian tissue groups, six parameters were quantitatively extracted. These are the mean absorption and scattering, spatial heterogeneities of both absorption and scattering maps measured by a standard deviation, and a fitting error of a Gaussian model fitted to normalized mean Radon transform of the absorption and scattering maps. A logistic regression model was used for classification of malignant and normal ovarian tissues. A sensitivity of 95%, specificity of 100%, and area under the curve of 0.98 were obtained using six parameters extracted from the SFDI images. The preliminary results demonstrate the diagnostic potential of the SFDI method for quantitative characterization of wide-field optical properties and the spatial distribution heterogeneity of human ovarian tissue. SFDI could be an extremely robust and valuable tool for evaluation of the ovary and detection of neoplastic changes of ovarian cancer.
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Affiliation(s)
- Sreyankar Nandy
- University of Connecticut, Biomedical Engineering Department, 371 Fairfield Way, U-4157, Storrs, Connecticut 06269-4157, United States
| | - Atahar Mostafa
- University of Connecticut, Department of Electrical and Computer Engineering, 371 Fairfield Way, U-4157, Storrs, Connecticut 06269-4157, United States
| | - Patrick D Kumavor
- University of Connecticut, Biomedical Engineering Department, 371 Fairfield Way, U-4157, Storrs, Connecticut 06269-4157, United States
| | - Melinda Sanders
- University of Connecticut Health Center, Pathology Department, Farmington, Connecticut 06030, United States
| | - Molly Brewer
- University of Connecticut Health Center, Division of Gynecologic Oncology, Farmington, Connecticut 06030, United States
| | - Quing Zhu
- University of Connecticut, Biomedical Engineering Department, 371 Fairfield Way, U-4157, Storrs, Connecticut 06269-4157, United States
- University of Connecticut, Department of Electrical and Computer Engineering, 371 Fairfield Way, U-4157, Storrs, Connecticut 06269-4157, United States
- Address all correspondence to: Quing Zhu, E-mail:
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