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Duivenvoorden WC, Margel D, Subramony Gayathri V, Duceppe E, Yousef S, Naeim M, Khajehei M, Hopmans S, Popovic S, Ber Y, Heels-Ansdell D, Devereaux PJ, Pinthus JH. Follicle-Stimulating Hormone Exacerbates Cardiovascular Disease in the Presence of Low or Castrate Testosterone Levels. JACC Basic Transl Sci 2024; 9:364-379. [PMID: 38559622 PMCID: PMC10978407 DOI: 10.1016/j.jacbts.2023.10.010] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 04/04/2024]
Abstract
Low testosterone (T), common in aging men, associates with cardiovascular disease. We investigated whether follicle-stimulating hormone (FSH), which is affected by T, modulates the cardiovascular effects associated with low T or castration. FSHβ-/-:low-density lipoprotein receptor (LDLR)-/- mice, untreated or castrated (orchiectomy, gonadotropin-releasing hormone agonist or antagonist), demonstrated significantly less atherogenesis compared with similarly treated LDLR-/- mice, but not following FSH delivery. Smaller plaque burden in LDLR-/- mice receiving gonadotropin-releasing hormone antagonists vs agonists were nullified in FSHβ-/-:LDLR-/- mice. Atherosclerotic and necrotic plaque size and macrophage infiltration correlated with serum FSH/T. In patients with prostate cancer, FSH/T following androgen-deprivation therapy initiation predicted cardiovascular events. FSH facilitates cardiovascular disease when T is low or eliminated.
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Affiliation(s)
- Wilhelmina C.M. Duivenvoorden
- Department of Surgery, Division of Urology, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
- Research Institute of St. Joe’s Hamilton, Hamilton, Ontario, Canada
| | - David Margel
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Emmanuelle Duceppe
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Medicine, Centre Hospitalier de l'Universite de Montréal, Montréal, Québec, Canada
| | - Sadiya Yousef
- Research Institute of St. Joe’s Hamilton, Hamilton, Ontario, Canada
| | - Magda Naeim
- Research Institute of St. Joe’s Hamilton, Hamilton, Ontario, Canada
| | - Mohammad Khajehei
- Department of Surgery, Division of Urology, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Hopmans
- Department of Surgery, Division of Urology, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Snezana Popovic
- Department of Pathology and Molecular Medicine, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Yaara Ber
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Philip J. Devereaux
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Medicine, Centre Hospitalier de l'Universite de Montréal, Montréal, Québec, Canada
| | - Jehonathan H. Pinthus
- Department of Surgery, Division of Urology, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
- Research Institute of St. Joe’s Hamilton, Hamilton, Ontario, Canada
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Woldu SL, Gerald T, Margulis V, Halstuch D, Ber Y, Lifshitz K, Margel D, Lotan Y, Jia L. PD-L1 expression and BCG response in nonmuscle invasive bladder cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.545] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
545 Background: Intravesical bacillus Calmette Guerin (BCG) is the standard of care adjuvant therapy for high risk non-muscle invasive bladder cancer (NMIBC), yet many patients experience recurrence or disease progression. The mechanism of action of BCG is believed to be related to stimulation of immune surveillance. Relatedly, systemic immune checkpoint inhibition is currently being utilized in advanced bladder cancer and approved for BCG unresponsive NMIBC. We sought to determine the association between PD-L1 expression and BCG treatment. Methods: We identified 102 BCG-naïve patients with high grade (HG) NMIBC treated with BCG. All patients underwent initial transurethral resection (TUR) for pathologic diagnosis. Dako 22c3 assay was used to determine PD-L1 expression. Patients were defined as PD-L1 positive if the combined positive score (CPS) > 0. BCG unresponsiveness was defined by presence of high grade disease at 6 months following adequate BCG (one induction and maintenance cycle or two induction cycles) for pT1 or 12 months for CIS or presence of pT1 at 3 months following induction. HG relapse was defined as presence of any HG disease after being followed for 6 months after BCG. Results: The median follow-up time was 57 months. Median number of BCG maintenance cycles was 1, and 17 (16.7%) patients underwent immediate reinduction BCG. PD-L1 expression was observed 5.9% of pTa, 30.0% of pT1, and 3.6% of CIS. BCG unresponsiveness and HG relapse were observed in 32 (35.6%) and 29 (34.5%) patients, respectively. On univariate analysis, PD-L1 expression was inversely associated with BCG unresponsiveness (OR = 0.112; 95% CI 0.014-0.898) but not high grade relapse (OR = 0.296; 95% CI 0.061-1.440). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PD-L1 expression for BCG responsiveness were 22%, 97%, 93%, and 41%, respectively. The post-test probability of BCG responsiveness was 93% in patients positive for PD-L1 based on a positive likelihood ratio of 7.33 for PD-L1 expression. On multivariate regression, pT1 (OR = 0.159; 95% CI 0.045-0.600), CIS (OR = 0.247; 95% CI 0.071-0.857), and PD-L1 expression (OR = 15.625; 95% CI 1.779-142.857) were independently associated with BCG responsiveness. Conclusions: PD-L1 expression in HG NMIBC was low, and patients with PD-L1 expression at initial TUR were more likely to harbor invasive disease. Patients showing PD-L1 expression were more likely to demonstrate BCG responsiveness. These findings suggest a role of PD-L1 in the immune surveillance mechanism of BCG at initial pathologic diagnosis and may assist in predicting responses to BCG among patients with HG NMIBC. Further investigation is required to determine if additional immune checkpoint markers have strong correlation with BCG response, particularly among patients without PD-L1 expression.
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Affiliation(s)
| | - Thomas Gerald
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Yaara Ber
- Rabin Medical Center, Petah Tikva, Israel
| | | | | | - Yair Lotan
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Liwei Jia
- University of Texas Southwestern Medical Center, Dallas, TX
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Margel D, Bernstine H, Groshar D, Ber Y, Nezrit O, Segal N, Yakimov M, Baniel J, Domachevsky L. Diagnostic Performance of 68Ga Prostate-specific Membrane Antigen PET/MRI Compared with Multiparametric MRI for Detecting Clinically Significant Prostate Cancer. Radiology 2021; 301:379-386. [PMID: 34463555 DOI: 10.1148/radiol.2021204093] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Gallium 68 (68Ga) prostate-specific membrane antigen (PSMA) PET/MRI may improve detection of clinically significant prostate cancer (CSPC). Purpose To compare the sensitivity and specificity of 68Ga-PSMA PET/MRI with multiparametric MRI for detecting CSPC. Materials and Methods Men with prostate specific antigen levels of 2.5-20 ng/mL prospectively underwent 68Ga-PSMA PET/MRI, including multiparametric MRI sequences, between June 2019 and March 2020. Imaging was evaluated independently by two radiologists by using the Prostate Imaging Reporting and Data System (PI-RADS) version 2.1. Sensitivity and specificity for CSPC (International Society of Urological Pathology grade group ≥ 2) were compared for 68Ga-PSMA PET/MRI and multiparametric MRI by using the McNemar test. Decision curve analysis compared the net benefit of each imaging strategy. Results Ninety-nine men (median age, 67 years; interquartile range, 62-71 years) were included; 79% (78 of 99) underwent biopsy. CSPC was detected in 32% (25 of 78). For CSPC, specificity was higher for 68Ga-PSMA PET/MRI than multiparametric MRI (76% [95% CI: 62, 86] vs 49% [95% CI: 35, 63], respectively; P < .001). Sensitivity was similar (88% [95% CI: 69, 98] vs 92% [95% CI: 74, 99], respectively; P > .99). For PI-RADS 3 lesions, specificity was also higher for 68Ga-PSMA PET/MRI than for multiparametric MRI: 86% (95% CI: 73, 95) versus 59% (95% CI: 43, 74), respectively (P = .002). Decision curve analysis showed that biopsies targeted to PSMA uptake increased the net benefit of multiparametric MRI only among PI-RADS 3 lesions. The net benefit of targeted biopsy for a PI-RADS 3 lesion with PSMA uptake was higher across all threshold probabilities over 8%. The net benefit of targeted biopsy was similar for PI-RADS 4 and 5 lesions, regardless of PSMA uptake. Conclusions Gallium 68 prostate-specific membrane antigen PET/MRI improved specificity for clinically significant prostate cancer compared with multiparametric MRI, particularly in Prostate Imaging Reporting and Data System grade 3 lesions. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Williams and Estes in this issue.
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Affiliation(s)
- David Margel
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Hanna Bernstine
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - David Groshar
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Yaara Ber
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Orian Nezrit
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Niv Segal
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Maxim Yakimov
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Jack Baniel
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
| | - Liran Domachevsky
- From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.)
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Yerushalmi R, Bargil S, Ber Y, Ozlavo R, Sivan T, Rapson Y, Pomerantz A, Tsoref D, Sharon E, Caspi O, Grubsrein A, Margel D. 3,3-Diindolylmethane (DIM): a nutritional intervention and its impact on breast density in healthy BRCA carriers. A prospective clinical trial. Carcinogenesis 2021; 41:1395-1401. [PMID: 32458980 PMCID: PMC7566319 DOI: 10.1093/carcin/bgaa050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/10/2020] [Accepted: 05/23/2020] [Indexed: 12/21/2022] Open
Abstract
Women who carry the BRCA mutation are at high lifetime risk of breast cancer, but there is no consensus regarding an effective and safe chemoprevention strategy. A large body of evidence suggests that 3,3-diindolylmethane (DIM), a dimer of indole-3-carbinol found in cruciferous vegetables, can potentially prevent carcinogenesis and tumor development. The primary aim of this prospective single-arm study was to investigate the effect of DIM supplementation on breast density, a recognized predictive factor of breast cancer risk. Participants were 23 healthy female BRCA carriers (median age 47 years; 78% postmenopausal) who were treated with oral DIM 100 mg × 1/day for 1 year. The amount of fibroglandular tissue (FGT) and background parenchymal enhancement (BPE) on magnetic resonance imaging (MRI) performed before and after the intervention was scored by two independent expert radiologists using the Breast Imaging and Reporting Data System. The results showed a decrease in the average score for FGT amount from 2.8 ± 0.8 at the onset to 2.65 ± 0.84 after 1 year (P = 0.031), with no significant change in BPE (P = 0.429). A group of DIM-untreated age- and menopausal-status-matched women from the BRCA clinic did not show a significant change in FGT amount (P = 0.33) or BPE (P = 0.814) in a parallel year. Mean estradiol level decreased from 159 to 102 pmol/l (P = 0.01), and mean testosterone level decreased from 0.42 to 0.31 pmol/l (P = 0.007). Side effects were grade 1. In conclusion, 1 year’s supplementation with DIM 100 mg × 1/day in BRCA carriers was associated with a significant decline in FGT amount on MRI. Larger randomized studies are warranted to corroborate these findings.
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Affiliation(s)
- Rinat Yerushalmi
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Campus, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Bargil
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Campus, Petach Tikva, Israel
| | - Yaara Ber
- Division of Urology, Petach Tikva, Israel
| | | | | | - Yael Rapson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Imaging Department, Petach Tikva, Israel
| | - Adi Pomerantz
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Campus, Petach Tikva, Israel
| | - Daliah Tsoref
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Campus, Petach Tikva, Israel
| | - Eran Sharon
- Division of Surgery, Hospital for Women, Rabin Medical Center-Beilinson Campus, Petach Tikva, Israel
| | - Opher Caspi
- Davidoff Cancer Center, Rabin Medical Center-Beilinson Campus, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ahuvah Grubsrein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Imaging Department, Petach Tikva, Israel
| | - David Margel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Urology, Petach Tikva, Israel
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Lifshitz K, Ber Y, Margel D. Role of Metabolic Syndrome in Prostate Cancer Development. Eur Urol Focus 2021; 7:508-512. [PMID: 33994167 DOI: 10.1016/j.euf.2021.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/05/2021] [Accepted: 04/26/2021] [Indexed: 12/24/2022]
Abstract
Prostate cancer and metabolic syndrome are common among men in the Western world. As the population grows older and life expectancy increases, the rates of both diseases are expected to increase. We now recognize that metabolic syndrome and prostate cancer interact. Metabolic syndrome may be a risk factor for prostate cancer and may also worsen outcomes. At the same time, treatment for prostate cancer may exacerbate metabolic syndrome and cardiac disease. This mini-review summarizes current evidence and puts it into clinical prospective. PATIENT SUMMARY: Metabolic syndrome is now a global epidemic. It is characterized by obesity, insulin resistance, high blood pressure, and high blood lipids. There is a complex interaction between metabolic syndrome and the risk of prostate cancer, as treatment of one disease may affect the other.
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Affiliation(s)
| | - Yaara Ber
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel
| | - David Margel
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel; Division of Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Shenhar C, Degani H, Ber Y, Baniel J, Tamir S, Benjaminov O, Rosen P, Furman-Haran E, Margel D. Diffusion Is Directional: Innovative Diffusion Tensor Imaging to Improve Prostate Cancer Detection. Diagnostics (Basel) 2021; 11:diagnostics11030563. [PMID: 33804783 PMCID: PMC8003841 DOI: 10.3390/diagnostics11030563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022] Open
Abstract
In the prostate, water diffusion is faster when moving parallel to duct and gland walls than when moving perpendicular to them, but these data are not currently utilized in multiparametric magnetic resonance imaging (mpMRI) for prostate cancer (PCa) detection. Diffusion tensor imaging (DTI) can quantify the directional diffusion of water in tissue and is applied in brain and breast imaging. Our aim was to determine whether DTI may improve PCa detection. We scanned patients undergoing mpMRI for suspected PCa with a DTI sequence. We calculated diffusion metrics from DTI and diffusion weighted imaging (DWI) for suspected lesions and normal-appearing prostate tissue, using specialized software for DTI analysis, and compared predictive values for PCa in targeted biopsies, performed when clinically indicated. DTI scans were performed on 78 patients, 42 underwent biopsy and 16 were diagnosed with PCa. The median age was 62 (IQR 54.4–68.4), and PSA 4.8 (IQR 1.3–10.7) ng/mL. DTI metrics distinguished PCa lesions from normal tissue. The prime diffusion coefficient (λ1) was lower in both peripheral-zone (p < 0.0001) and central-gland (p < 0.0001) cancers, compared to normal tissue. DTI had higher negative and positive predictive values than mpMRI to predict PCa (positive predictive value (PPV) 77.8% (58.6–97.0%), negative predictive value (NPV) 91.7% (80.6–100%) vs. PPV 46.7% (28.8–64.5%), NPV 83.3% (62.3–100%)). We conclude from this pilot study that DTI combined with T2-weighted imaging may have the potential to improve PCa detection without requiring contrast injection.
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Affiliation(s)
- Chen Shenhar
- Department of Urology, Rabin Medical Center, 39 Ze’ev Jabotinsky St, Petah Tikva 4941492, Israel; (Y.B.); (J.B.); (D.M.)
- Correspondence: ; Tel.: +972-3-937-6558
| | - Hadassa Degani
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot 7610001, Israel;
| | - Yaara Ber
- Department of Urology, Rabin Medical Center, 39 Ze’ev Jabotinsky St, Petah Tikva 4941492, Israel; (Y.B.); (J.B.); (D.M.)
| | - Jack Baniel
- Department of Urology, Rabin Medical Center, 39 Ze’ev Jabotinsky St, Petah Tikva 4941492, Israel; (Y.B.); (J.B.); (D.M.)
| | - Shlomit Tamir
- Department of Imaging, Rabin Medical Center, 39 Ze’ev Jabotinsky St, Petah Tikva 4941492, Israel; (S.T.); (O.B.); (P.R.)
| | - Ofer Benjaminov
- Department of Imaging, Rabin Medical Center, 39 Ze’ev Jabotinsky St, Petah Tikva 4941492, Israel; (S.T.); (O.B.); (P.R.)
- Department of Imaging, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Philip Rosen
- Department of Imaging, Rabin Medical Center, 39 Ze’ev Jabotinsky St, Petah Tikva 4941492, Israel; (S.T.); (O.B.); (P.R.)
| | - Edna Furman-Haran
- Life Sciences Core Facilities, Weizmann Institute of Science, Rehovot 7610001, Israel;
| | - David Margel
- Department of Urology, Rabin Medical Center, 39 Ze’ev Jabotinsky St, Petah Tikva 4941492, Israel; (Y.B.); (J.B.); (D.M.)
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Segal N, Ber Y, Benjaminov O, Tamir S, Yakimov M, Kedar I, Rosenbaum E, Sela S, Ozalvo R, Shavit-Grievink L, Keder D, Baniel J, Margel D. Imaging-based prostate cancer screening among BRCA mutation carriers-results from the first round of screening. Ann Oncol 2020; 31:1545-1552. [PMID: 32958357 DOI: 10.1016/j.annonc.2020.06.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Male-carriers of BRCA1/2 gene mutations have an increased risk of prostate cancer (PCa) with a more aggressive phenotype. Current screening-guidelines suggest the use of prostate-specific antigen (PSA) only among BRCA2 carriers. Female carriers have extensive guidelines that include imaging. Our objective was to test the prevalence of PCa among BRCA carriers and examine screening strategies, using PSA and multiparametric magnetic resonance imaging (mpMRI). PATIENTS AND METHODS We recruited men aged 40-70 years with BRCA1/2 germline mutations and no prior history of prostate biopsy. All men underwent an initial round of screening which included PSA, and prostate mpMRI. PSA was considered elevated using an age-stratified threshold of ≥1 ng/ml for 40-50 years of age, ≥2 ng/ml for 50-60 years of age, and 2.5 ng/ml for 60-70 years of age. Men with elevated PSA and/or suspicious lesion on mpMRI were offered a prostate biopsy. PSA levels, MRI findings, PCa incidence, and tumor characteristics were evaluated. Decision curve analysis was used to compare screening strategies. RESULTS We recruited 188 men (108 BRCA1, 80 BRCA2), mean age 54 years (9.8). One hundred and ten (57%) had either elevated age-stratified PSA (75; 40%), a suspicious MRI lesion (67; 36%), or both (32; 17%). Of these, 92 (85%) agreed to perform a prostate biopsy. Sixteen (8.5%) were diagnosed with PCa; 44% of the tumors were classified as intermediate- or high-risk disease. mpMRI-based screening missed only one of the cancers (6%), while age-stratified PSA would have missed five (31%). Decision curve analysis showed that mpMRI screening, regardless of PSA, had the highest net benefit for PCa diagnosis, especially among men younger than 55 years of age. We found no difference in the risk of PCa between BRCA1 and BRCA2 (8.3% versus 8.7%, P = 0.91). Ninety percent had a Jewish founder mutation, thus the results cannot be generalized to all ethnic groups. CONCLUSIONS PCa is prevalent among BRCA carriers. Age may affect screening strategy for PCa in this population. Young carriers could benefit from initial MRI screening. BRCA carriers aged older than 55 years should use PSA and be referred to mpMRI if elevated. TRIAL REGISTRATION ClinicalTrial.gov ID: NCT02053805.
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Affiliation(s)
- N Segal
- Division of Urology, Rabin Medical Center, Petah-Tikva, Israel
| | - Y Ber
- Division of Urology, Rabin Medical Center, Petah-Tikva, Israel
| | - O Benjaminov
- Division of Imaging, Shaare Zedek Medical Center, Jerusalem, Israel
| | - S Tamir
- Department of Imaging, Rabin Medical Center, Petah-Tikva, Israel
| | - M Yakimov
- Department of Pathology, Rabin Medical Center, Petah-Tikva, Israel
| | - I Kedar
- The Raphael Recanati Genetic Institute, Rabin Medical Center, Petah-Tikva, Israel
| | - E Rosenbaum
- Davidoff Cancer Centre, Rabin Medical Center, Petach Tikva, Israel
| | - S Sela
- Division of Urology, Rabin Medical Center, Petah-Tikva, Israel
| | - R Ozalvo
- Division of Urology, Rabin Medical Center, Petah-Tikva, Israel
| | | | - D Keder
- Division of Urology, Rabin Medical Center, Petah-Tikva, Israel
| | - J Baniel
- Division of Urology, Rabin Medical Center, Petah-Tikva, Israel; Department of Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Margel
- Division of Urology, Rabin Medical Center, Petah-Tikva, Israel; Department of Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Margel D, Ber Y, Peer A, Shavit-Grievink L, Pinthus JH, Witberg G, Baniel J, Kedar D, Rosenbaum E. Cardiac biomarkers in patients with prostate cancer and cardiovascular disease receiving gonadotrophin releasing hormone agonist vs antagonist. Prostate Cancer Prostatic Dis 2020; 24:177-185. [PMID: 32737420 DOI: 10.1038/s41391-020-0264-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/12/2020] [Accepted: 07/24/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Gonadotrophin releasing hormone (GnRH) agonists and antagonists reduce testosterone levels for the treatment of advanced and metastatic prostate cancer. Androgen deprivation therapy (ADT) is associated with increased risk of cardiovascular (CV) events and CV disease (CVD), especially in patients with preexisting CVD treated with GnRH agonists. Here, we investigated the potential relationship between serum levels of the cardiac biomarkers N-terminal pro-B-type natriuretic peptide (NTproBNP), D-dimer, C-reactive protein (CRP), and high-sensitivity troponin (hsTn) and the risk of new CV events in prostate cancer patients with a history of CVD receiving a GnRH agonist or antagonist. METHODS Post-hoc analyses were performed of a phase II randomized study that prospectively assessed CV events in patients with prostate cancer and preexisting CVD, receiving GnRH agonist or antagonist. Cox proportional hazards models were used to determine whether the selected biomarkers had any predictive effect on CV events at baseline and across a 12-month treatment period. RESULTS Baseline and disease characteristics of the 80 patients who took part in the study were well balanced between treatment arms. Ischemic heart disease (66%) and myocardial infarction (37%) were the most common prior CVD and the majority (92%) of patients received CV medication. We found that high levels of NTproBNP (p = 0.008), and hsTn (p = 0.004) at baseline were associated with the development of new CV events in the GnRH agonist group but not in the antagonist. In addition, a nonsignificant trend was observed between higher levels of NTproBNP over time and the development of new CV events in the GnRH agonist group. CONCLUSIONS The use of cardiac biomarkers may be worthy of further study as tools in the prediction of CV risk in prostate cancer patients receiving ADT. Analysis was limited by the small sample size; larger studies are required to validate biomarker use to predict CV events among patients receiving ADT.
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Affiliation(s)
- David Margel
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yaara Ber
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Avivit Peer
- Department of Oncology, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Liat Shavit-Grievink
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel.,Davidoff Cancer Centre, Rabin Medical Center, Petach Tikva, Israel
| | - Jehonathan H Pinthus
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel
| | - Jack Baniel
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Kedar
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Eli Rosenbaum
- Davidoff Cancer Centre, Rabin Medical Center, Petach Tikva, Israel
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9
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Yerushalmi R, Bargil S, Ber Y, Ozalvo R, Sela S, Rapson Y, Pomerantz A, Tsoref D, Sharon E, Caspi O, Grubstein A, Margel D. 3,3'-Diindolylmethane (DIM): A nutritional intervention and its impact on breast density in healthy BRCA carriers compared to non-treated carriers—A prospective clinical trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1556] [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
1556 Background: Women who carry the BRCA mutation are at high lifetime risk of breast cancer, but there is no consensus regarding an effective and safe chemoprevention strategy. A large body of evidence suggests that 3,3-diindolylmethane (DIM), a dimer of indole-3-carbinol (I3C) found in cruciferous vegetables, can potentially prevent carcinogenesis and tumor development. The primary aim of this prospective study was to investigate the effect of DIM supplementation on breast density, a recognized predictive factor of breast-cancer risk. Methods: Participants were 23 healthy female BRCA carriers (median age 47 years; 78% postmenopausal) who were treated with oral DIM 100 mgx1/d for one year. The amount of fibroglandular tissue (FGT) and background parenchymal enhancement (BPE) on magnetic resonance imaging (MRI) performed before and after the intervention were scored by two independent expert radiologists using the Breast Imaging and Reporting Data System (BI-RADS). Each woman in the cohort was matched by age (within 3 years) and menopausal status to a woman attending the clinic who was not participating in the study and who underwent breast MRI in parallel year. Results: A decrease in the average score for FGT amount from 2.8±0.8 at onset to 2.65±0.842.8 after one year (p = 0.031), with no significant change in BPE (p = 0.429). A group of DIM-untreated age- and menopausal-status-matched clinic patients did not show a significant change in FGT amount (p = 0.33) or BPE (p = 0.814) in a parallel year. Mean estradiol level decreased from 159 to 102 pmol/L (p = 0.01), and mean testosterone level, from 0.42 to 0.31 pmol/L (p = 0.007). Side effects were grade 1. Conclusions: One year’s supplementation with DIM 100 mgX1/d in BRCA carriers was associated with a significant decline in FGT amount on MRI. Larger randomized studies are warranted to corroborate these findings. Clinical trial information: NCT02197000.
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Affiliation(s)
- Rinat Yerushalmi
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Sharon Bargil
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel
| | - Yaara Ber
- Rabin Medical Center, Petah Tikva, Israel
| | | | - Sivan Sela
- Rabin Medical Center, Petah Tikva, Israel
| | | | - Adi Pomerantz
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel
| | - Dalia Tsoref
- Gynecologic Oncology Division, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Opher Caspi
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel
| | - Ahuva Grubstein
- Department of Diagnostic Radiology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - David Margel
- Division of Urology, Rabin Medical Center, Petah Tikva, Israel
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10
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Affiliation(s)
- David Margel
- Division of Urology, Rabin Medical Center, Petah-Tikva, Israel; Department of Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yaara Ber
- Division of Urology, Rabin Medical Center, Petah-Tikva, Israel
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11
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Halstuch D, Ber Y, Margel D. Screening, Active Surveillance, and Treatment of Localized Prostate Cancer Among Carriers of Germline BRCA Mutations. Eur Urol Focus 2020; 6:212-214. [DOI: 10.1016/j.euf.2019.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/27/2019] [Accepted: 05/14/2019] [Indexed: 12/14/2022]
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12
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Witberg G, Lev E, Ber Y, Tabachnik T, Sela S, Belo I, Leshem-Lev D, Margel D. Vascular endothelium function among male carriers of BRCA 1&2 germline mutation. Oncotarget 2019; 10:5041-5051. [PMID: 31489114 PMCID: PMC6707947 DOI: 10.18632/oncotarget.27118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/29/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Breast cancer susceptibility genes 1&2 (BRCA1&2) mutations hinder DNA-repair. Germline mutations in these genes are known to cause cancer; however, they may have other consequences. In this study we evaluated for the first time, the effect of the BRCA mutations on the vascular endothelium of young healthy males. Results: The study included 82 participants (53 BRCA mutation positive-carriers and 29 negative-carriers). Subjects mean age was 40. There were no significant differences in the baseline characteristics of the two groups. BRCA-carriers had significantly higher levels of EPCs (fraction of CD34+/VEGF or CD133+/VEGF positive-cells) compared to non-carriers of the mutation (median 6.78[1.96,14.48]% vs. 1.46[0.65,6.18]%, p < 0.001, and median 7.17[1.70,16.69]% vs. 1.54[0.85,5.10]%, p < 0.001, respectively). This difference remained consistent after multivariate adjustment. We did not identify differences in endothelial function, endothelial damage markers and EPCs activity between the two groups. Methods: This was a prospective cohort study to test the association between BRCA status and possible endothelial alterations. The Study population included males, 18-50 years, with no cardiovascular morbidity, who were referred for BRCA screening. We tested the endothelial system by: Endothelial progenitor cells (EPC) production, endothelial function (EndoPAT2000), endothelial damage and related hormonal levels. We stratified the cohort by germline BRCA status and compared measurements between BRCA mutation positive- and negative-carriers. Conclusions: Male BRCA1&2 mutation positive-carriers had increased level of EPCs which may reflect a subclinical accumulative endothelial damage. These novel findings suggest that the effect of mutations in BRCA is not limited to increased cancer risk, but may affect the cardiovascular system.
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Lev
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,Department of Cardiology, Assuta Ashdod University Hospital, Ashdod, Israel.,Faculty of Medicine, Ben Gurion University, Be'er Sheva, Israel
| | - Yaara Ber
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Tzlil Tabachnik
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Sivan Sela
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Ira Belo
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Dorit Leshem-Lev
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Margel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Urology, Rabin Medical Center, Petach Tikva, Israel
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13
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Margel D, Peer A, Ber Y, Sela S, Shavit Grievink L, Tabachnik T, Witberg G, Baniel J, Kedar D, Duivenvoorden WCM, Rosenbaum E, Pinthus JH. Cardiovascular morbidity in a randomized trial comparing GnRH-agonist and antagonist among patients with advanced prostate cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5015 Background: Androgen-deprivation therapy (ADT) used in prostate-cancer may increase risk of cardiovascular disease (CVD). Limited preclinical and retrospective clinical data suggest that use of gonadotrophin-releasing hormone (GnRH)-antagonist may be associated with lower risk of CVD compared to GnRH-agonist. Methods: We conducted a randomized open-label study comparing the one year incidence of major cardiovascular and cerebrovascular event (MACCE) in prostate-cancer patients with pre-existing CVD commencing on GnRH-agonists or antagonists. Patients were followed every 3 months for the development of MACCE defined as either death, myocardial infarction (MI), cerebrovascular event (CVA), or percutaneous-coronary intervention (PCI). Serum levels of N-terminal pro-B-type natriuretic peptide (NTproBNP) were analyzed at baseline, 3, 6 and 12-months. Results: Eighty patients were enrolled (41 randomized to GnRH-antagonist, 39 to GnRH-agonist). Patients in both arms had similar age, baseline cardiovascular and prostate-cancer characteristics. During follow-up 15 patients developed a new cardiovascular event. Of these, nine patients developed MACCE (two deaths, one MI, two CVAs, and four PCI). Twenty percent (n = 8) of patients randomized to GnRH-agonists had a MACCE compared to 3% (n = 1) randomized to antagonists (log-rank p = 0.013). The absolute risk reduction for MACCE at 12 months using GnRH-antagonist was 18% (95%CI 5-31). Baseline levels of NTproBNP predicted events (AUC = 0.73 95%CI 0.54-0.91 p = 0.03) and increased over time only among patients with CV events. Conclusions: This is the first prospective study to test cardiovascular outcome among prostate-cancer patients receiving ADT. We demonstrated that in patients with pre-existing CVD, GnRH-antagonists was associated with development of fewer cardiovascular events compared to GnRH-agonists. Clinical trial information: NCT02475057.
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Affiliation(s)
| | | | - Yaara Ber
- Rabin Medical Center, Petah Tikva, Israel
| | - Sivan Sela
- Rabin Medical Center, Petah Tikva, Israel
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14
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Margel D, Ber Y, Baniel J. Re: Optimizing Patient's Selection for Prostate Biopsy: A Single Institution Experience with Multi-parametric MRI and the 4Kscore Test for the Detection of Aggressive Prostate Cancer. Eur Urol 2019; 76:535-536. [PMID: 31056230 DOI: 10.1016/j.eururo.2019.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/17/2019] [Indexed: 11/19/2022]
Affiliation(s)
- David Margel
- Department of Urology, Rabin Medical Center, Petah-Tikva, Israel
| | - Yaara Ber
- Department of Urology, Rabin Medical Center, Petah-Tikva, Israel
| | - Jack Baniel
- Department of Urology, Rabin Medical Center, Petah-Tikva, Israel.
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15
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Halstuch D, Baniel J, Lifshitz D, Sela S, Ber Y, Margel D. Characterizing the learning curve of MRI-US fusion prostate biopsies. Prostate Cancer Prostatic Dis 2019; 22:546-551. [PMID: 30842585 DOI: 10.1038/s41391-019-0137-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/27/2019] [Accepted: 02/04/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND MRI-US fusion prostate biopsies are becoming a common procedure to diagnose prostate cancer. There is a paucity of information regarding the learning curve for fusion biopsies. We aim to study the amount of experience needed to be both accurate and time-efficient in this procedure. METHODS We prospectively collected data on all MRI-US fusion biopsies performed from April 2014 to August 2017. We used two parameters to define the learning curve. Process Measurement (efficiency) was measured by time from the beginning of anesthesia to end of procedure. Outcome Measurement (accuracy) was measured by cancer detection rate for PI-RAD 3 lesions. The end of the learning curve was defined graphically and mathematically. We performed a separate analysis for transrectal and transperineal biopsies. RESULTS We completed 779 fusion biopsies (523 transrectal, 256 transperineal). Patients median age was 66 years (IQR 61-70) and median PSA 6.95 ng/ml (IQR 4.2-10.6). Prostate cancer was diagnosed in 385 (49%). Process Measurement-Procedure time decreased from 45 min in the first transrectal fusion biopsy to 15 min after 109 biopsies and remained stable (p < 0.0001). Time decreased from 55 min in the first transperineal biopsy to 18 min after 124 biopsies (p < 0.0001). Outcome Measurement-In transrectal fusion-biopsies detection rate for PI-RADS 3 lesions increased from 35 to 50% after 104 biopsies. In transperineal fusion-biopsies, detection rate increased from 40 to 55% after 119 cases for PI-RADS 3 lesions. CONCLUSIONS We measured the learning curve of fusion biopsies graphically and mathematically. We demonstrated that proficiency occurs after 110 transrectal and 125 transperineal fusion-biopsies.
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Affiliation(s)
- Daniel Halstuch
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel.
| | - Jack Baniel
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel.,Division of Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Urology clinic, Ramat Aviv Medical Center, Tel-Aviv, Israel
| | - David Lifshitz
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel.,Division of Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sivan Sela
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel
| | - Yaara Ber
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel
| | - David Margel
- Department of Urology, Rabin Medical Center, Petah Tikva, Israel.,Division of Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Urology clinic, Ramat Aviv Medical Center, Tel-Aviv, Israel
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16
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Halstuch D, Sela S, Ber Y, Kedar D, Baniel J, Margel D. Active surveillance for low risk prostate cancer among men with high risk genetic predisposition. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/s1569-9056(19)31252-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Shiloh R, Gilad Y, Ber Y, Eisenstein M, Aweida D, Bialik S, Cohen S, Kimchi A. Non-canonical activation of DAPK2 by AMPK constitutes a new pathway linking metabolic stress to autophagy. Nat Commun 2018; 9:1759. [PMID: 29717115 PMCID: PMC5931534 DOI: 10.1038/s41467-018-03907-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/21/2018] [Indexed: 12/21/2022] Open
Abstract
Autophagy is an intracellular degradation process essential for adaptation to metabolic stress. DAPK2 is a calmodulin-regulated protein kinase, which has been implicated in autophagy regulation, though the mechanism is unclear. Here, we show that the central metabolic sensor, AMPK, phosphorylates DAPK2 at a critical site in the protein structure, between the catalytic and the calmodulin-binding domains. This phosphorylation activates DAPK2 by functionally mimicking calmodulin binding and mitigating an inhibitory autophosphorylation, providing a novel, alternative mechanism for DAPK2 activation during metabolic stress. In addition, we show that DAPK2 phosphorylates the core autophagic machinery protein, Beclin-1, leading to dissociation of its inhibitor, Bcl-XL. Importantly, phosphorylation of DAPK2 by AMPK enhances DAPK2’s ability to phosphorylate Beclin-1, and depletion of DAPK2 reduces autophagy in response to AMPK activation. Our study reveals a unique calmodulin-independent mechanism for DAPK2 activation, critical to its function as a novel downstream effector of AMPK in autophagy. DAPK2 is a calmodulin-regulated protein kinase implicated in autophagy regulation, but how physiological stress leads to its activation is yet unknown. Here, the authors show that the central metabolic sensor AMPK phosphorylates DAPK2 to promote autophagy in a calmodulin-independent mechanism.
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Affiliation(s)
- Ruth Shiloh
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, 76100, Israel
| | - Yuval Gilad
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, 76100, Israel
| | - Yaara Ber
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, 76100, Israel
| | - Miriam Eisenstein
- Department of Chemical Research Support, Weizmann Institute of Science, Rehovot, 76100, Israel
| | - Dina Aweida
- Faculty of Biology, Technion Israel Institute of Technology, Haifa, 32000, Israel
| | - Shani Bialik
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, 76100, Israel
| | - Shenhav Cohen
- Faculty of Biology, Technion Israel Institute of Technology, Haifa, 32000, Israel
| | - Adi Kimchi
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, 76100, Israel.
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18
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Margel D, Ber Y, Sela S, Tabachnik T, Belo I, Tamir S, Benjaminov O, Baniel J. PD23-08 CHARACTERIZING THE LEARNING CURVE OF MRI-US FUSION PROSTATE BIOPSIES. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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19
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Margel D, Pe'er A, Ber Y, Shaparberg M, Sela S, Ozalvo R, Tabachnik T, Duivenvoorden W, Pinthus J, Baniel J. MP52-17 CARDIOVASCULAR EVENTS AND BIOMARKERS IN A RANDOMIZED TRIAL COMPARING LHRH AGONIST AND ANTAGONIST AMONG PATIENTS WITH ADVANCED PROSTATE CANCER. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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20
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Chaparro M, Verreth A, Lobaton T, Gravito-Soares E, Julsgaard M, Savarino E, Magro F, Biron AI, Lopez-Serrano P, Casanova MJ, Gompertz M, Vitor S, Arroyo M, Pugliese D, Zabana Y, Vicente R, Aguas M, Shitrit BGA, Gutierrez A, Doherty GA, Fernandez-Salazar L, Cadilla MJ, Huguet JM, OʼToole A, Stasi E, Marcos MN, Villoria A, Karmiris K, Rahier JF, Rodriguez C, Palomares DLM, Fiorino G, Benitez JM, Principi M, Naftali T, Taxonera C, Mantzaris G, Sebkova L, Iade B, Lissner D, Bradley FI, Roman LSA, Marin-Jimenez I, Merino O, Sierra M, Van Domselaar M, Caprioli F, Guerra I, Peixe P, Piqueras M, Rodriguez-Lago I, Ber Y, van Hoeve K, Torres P, Gravito-Soares M, Rudbeck-Resdal D, Bartolo O, Peixoto A, Martin G, Armuzzi A, Garre A, Donday MG, de Carpi MFJ, Gisbert JP. Long-Term Safety of In Utero Exposure to Anti-TNFα Drugs for the Treatment of Inflammatory Bowel Disease: Results from the Multicenter European TEDDY Study. Am J Gastroenterol 2018; 113:396-403. [PMID: 29460920 DOI: 10.1038/ajg.2017.501] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 11/26/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The long-term safety of exposure to anti-tumor necrosis factor (anti-TNFα) drugs during pregnancy has received little attention. We aimed to compare the relative risk of severe infections in children of mothers with inflammatory bowel disease (IBD) who were exposed to anti-TNFα drugs in utero with that of children who were not exposed to the drugs. METHODS Retrospective multicenter cohort study. Exposed cohort: children from mothers with IBD receiving anti-TNFα medication (with or without thiopurines) at any time during pregnancy or during the 3 months before conception. Non-exposed cohort: children from mothers with IBD not treated with anti-TNFα agents or thiopurines at any time during pregnancy or the 3 months before conception. The cumulative incidence of severe infections after birth was estimated using Kaplan-Meier curves, which were compared using the log-rank test. Cox-regression analysis was performed to identify potential predictive factors for severe infections in the offspring. RESULTS The study population comprised 841 children, of whom 388 (46%) had been exposed to anti-TNFα agents. Median follow-up after delivery was 47 months in the exposed group and 68 months in the non-exposed group. Both univariate and multivariate analysis showed the incidence rate of severe infections to be similar in non-exposed and exposed children (1.6% vs. 2.8% per person-year, hazard ratio 1.2 (95% confidence interval 0.8-1.8)). In the multivariate analysis, preterm delivery was the only variable associated with a higher risk of severe infection (2.5% (1.5-4.3)). CONCLUSIONS In utero exposure to anti-TNFα drugs does not seem to be associated with increased short-term or long-term risk of severe infections in children.
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Affiliation(s)
- M Chaparro
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - A Verreth
- Department of Gastroenterology and Department of Pediatric Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - T Lobaton
- Hospital Universitari Germans Trias i Pujol and CIBEREHD, Badalona, Spain
| | | | - M Julsgaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - F Magro
- Centro Hospitalar São João, Porto, Portugal
| | - Avni I Biron
- Gastroenterology Devision, Rabin Medical Center, Petach Tikva, Israel
| | | | - M J Casanova
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - M Gompertz
- Hospital Clinic and CIBEREHD, Barcelona, Spain
| | - S Vitor
- Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - M Arroyo
- Hospital Clinico Universitario Lozano Blesa, IIS Aragon, CIBEREHD, Zaragoza, Spain
| | - D Pugliese
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Roma, Italy
| | - Y Zabana
- Hospital Universitari Mutua de Terrassa and CIBEREHD, Terrassa, Spain
| | - R Vicente
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - M Aguas
- Hospital Universitario La Fe and CIBEREHD, Valencia, Spain
| | | | - A Gutierrez
- Hospital General Universitario de Alicante and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Alicante, Spain
| | - G A Doherty
- St. Vincents University Hospital, Dublin, Ireland
| | | | | | - J M Huguet
- Hospital General Universitario de Valencia, Valencia, Spain
| | | | - E Stasi
- IRCCS Saverio de Bellis, Castellana Grotte, Italy
| | | | - A Villoria
- Hospital Universitari Parc Taulí.Institut d'Investigació i Innovació Parc Taulí. Departament de Medicina, Universitat Autònoma de Barcelona.CIBERehd, Instituto de Salud Carlos III, Sabadell, Spain
| | - K Karmiris
- Venizeleio General Hospital, Heraklion, Greece
| | | | - C Rodriguez
- Complejo Universitario de Navarra, Pamplona, Spain
| | | | - G Fiorino
- IBD Center, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy and Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - J M Benitez
- Hospital Universitario Reina Sofia and IMIBIC, Córdoba, Spain
| | - M Principi
- Azienda Policlinico Ospedaliero-Universitaria di Bari, Bari, Italy
| | - T Naftali
- Meir Hospital Kfar saba Tel Aviv University, Tel Aviv, Israel
| | - C Taxonera
- Hospital Clínico San Carlos and IdISSC, Madrid, Spain
| | - G Mantzaris
- Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens, Greece
| | - L Sebkova
- Azienda Ospedaliera "Pugliese-Ciaccio", Catanzaro, Italy
| | - B Iade
- Hospital de Clinicas, Montevideo, Uruguay
| | - D Lissner
- Universitatsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | | | | | - I Marin-Jimenez
- Hospital General Universitario Gregorio Marañón and IiSGM, Madrid, Spain
| | - O Merino
- Hospital Universitario de Cruces, Baracaldo, Spain
| | - M Sierra
- Complejo Universitario de León, León, Spain
| | | | - F Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano AND Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - I Guerra
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - P Peixe
- Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - M Piqueras
- Consorci Sanitari de Terrasa, Terrasa, Spain
| | | | - Y Ber
- Hospital San Jorge, Huesca, Spain
| | - K van Hoeve
- Department of Paediatrics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - P Torres
- Hospital Universitari Germans Trias i Pujol and CIBEREHD, Badalona, Spain
| | | | - D Rudbeck-Resdal
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - A Peixoto
- Centro Hospitalar São João, Porto, Portugal
| | - G Martin
- Gastroenterology Devision, Rabin Medical Center, Petach Tikva, Israel
| | - A Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Roma, Italy
| | - A Garre
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - M G Donday
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | | | - J P Gisbert
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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Halstuch D, Baniel J, Lifshitz D, Sela S, Ber Y, Margel D. Assessment of Needle Tip Deflection During Transrectal Guided Prostate Biopsy: Implications for Targeted Biopsies. J Endourol 2018; 32:252-256. [PMID: 29284293 DOI: 10.1089/end.2017.0694] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To measure needle tip deflection during transrectal ultrasound (TRUS) prostate biopsy and evaluate predictors for needle tip deflection. MATERIALS AND METHODS Analysis of 568 prostate biopsies obtained from 51 consecutive patients who underwent a standard 12-core TRUS guided prostate biopsy. TRUS guided prostate biopsies were performed using BK flex500, with a side-fire biplane probe. Each biopsy core image was captured and clinical data were recorded prospectively. The angle between the expected trajectory of the needle and actual needle course was measured using the longitudinal view of the captured image. The distance between expected and actual needle tip was calculated. We measured median and interquartile needle tip deflection rate stratified by side and location (apex, midgland, base). Univariable and multivariable linear regressions analysis were performed. RESULTS The overall median needle tip deflection was 1.77 mm (IQR 1.35-2.47). Location did not significantly alter needle deflection measurements. On multivariable linear regression analysis, higher prostate volume (B = 0.007 95%, CI 0.004, 0.011; p < 0.001) and the right sided biopsy (B = 0.191 95%, CI 0.047, 0.336; p = 0.010) emerged as predictors of higher needle tip deflection. CONCLUSIONS To the best of our knowledge this is the first study to measure needle tip deflection during TRUS guided prostate biopsies. We demonstrated that larger prostate size and biopsy side may affect the accuracy of biopsies. These results may have clinical implication to those performing targeted biopsies.
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Affiliation(s)
- Daniel Halstuch
- 1 Division of Urology, Rabin Medical Center , Petah-Tikva, Israel .,2 Division of Surgery, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Jack Baniel
- 1 Division of Urology, Rabin Medical Center , Petah-Tikva, Israel .,2 Division of Surgery, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - David Lifshitz
- 1 Division of Urology, Rabin Medical Center , Petah-Tikva, Israel .,2 Division of Surgery, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Sivan Sela
- 1 Division of Urology, Rabin Medical Center , Petah-Tikva, Israel
| | - Yaara Ber
- 1 Division of Urology, Rabin Medical Center , Petah-Tikva, Israel
| | - David Margel
- 1 Division of Urology, Rabin Medical Center , Petah-Tikva, Israel .,2 Division of Surgery, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
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22
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Goldberg H, Grievink LS, Mano R, Ber Y, Ozalbo R, Tuval S, Baniel J, Margel D. Lower Urinary Tract Symptoms and Benign Prostate Hyperplasia Features Among Male BRCA Mutation Carriers. Urology 2017; 108:71-75. [PMID: 28577930 DOI: 10.1016/j.urology.2017.05.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/08/2017] [Accepted: 05/10/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To analyze lower urinary tract symptoms and benign prostate hyperplasia features among male BRCA1 and 2 carriers and an age-matched control group. METHODS Male BRCA carriers and noncarriers aged 40-70 years were enrolled in our cross-sectional study. Relevant clinical data were collected, and patients filled the International Prostate Symptom Score. Patients also underwent prostate-specific antigen (PSA) blood testing, digital rectal examination, uroflowmetry, and post-void residual ultrasound examination. As part of their routine follow-up, BRCA carriers underwent prostate magnetic resonance imaging. RESULTS Overall, 87 carriers and 30 noncarriers were enrolled. The median age, mean body mass index, and comorbidities in both groups were similar. Maximal flow (QMAX) was higher in the noncarrier group (16.9 mL/s vs 12 mL/s, P = .01). Mean prostate volume among all BRCA carriers was 38.8 cc (19.7), but BRCA1 patients had larger glands with higher mean PSA and PSA density than BRCA2 patients (41.8 cc vs 33.1 cc, P = .047, 1.84 ng/mL vs 1.07 ng/mL, P = .006, and .044 vs .032, P = .042, respectively). Multivariate analysis demonstrated age being the sole significant predictor of PSA density in BRCA2 patients. CONCLUSION Male carrying BRCA mutations have significantly lower QMAX than healthy men. BRCA1 patients have on average larger prostate glands and higher PSA than BRCA2 patients. Further research is required to decipher the association of lower urinary tract symptoms or benign prostate hyperplasia with BRCA carriers.
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Affiliation(s)
- Hanan Goldberg
- Institute of Urology, Rabin Medical Center, Petah Tikva; and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Liat Shavit Grievink
- Institute of Urology, Rabin Medical Center, Petah Tikva; and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Mano
- Institute of Urology, Rabin Medical Center, Petah Tikva; and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaara Ber
- Institute of Urology, Rabin Medical Center, Petah Tikva; and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rachely Ozalbo
- Institute of Urology, Rabin Medical Center, Petah Tikva; and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sivan Tuval
- Institute of Urology, Rabin Medical Center, Petah Tikva; and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jack Baniel
- Institute of Urology, Rabin Medical Center, Petah Tikva; and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Margel
- Institute of Urology, Rabin Medical Center, Petah Tikva; and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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23
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Margel D, Peer A, Ber Y, Shaparberg M, Sela S, Ozalvo R, Baniel J, Duivenvoorden W, Pinthus J. MP57-13 EARLY CARDIoVASCULAR MORBIDITY IN A PILOT PROSPECTIVE RANDOMIZED TRIAL COMPARING LHRH AGONIST AND ANTAGONIST AMONG PATIENTS WITH ADVANCED PROSTATE CANCER. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ber Y, Shiloh R, Gilad Y, Degani N, Bialik S, Kimchi A. DAPK2 is a novel regulator of mTORC1 activity and autophagy. Cell Death Differ 2014; 22:465-75. [PMID: 25361081 PMCID: PMC4326577 DOI: 10.1038/cdd.2014.177] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 08/19/2014] [Accepted: 08/21/2014] [Indexed: 12/15/2022] Open
Abstract
Autophagy is a tightly regulated catabolic process, which is upregulated in cells in response to many different stress signals. Inhibition of mammalian target of rapmaycin complex 1 (mTORC1) is a crucial step in induction of autophagy, yet the mechanisms regulating the fine tuning of its activity are not fully understood. Here we show that death-associated protein kinase 2 (DAPK2), a Ca(2+)-regulated serine/threonine kinase, directly interacts with and phosphorylates mTORC1, and has a part in suppressing mTOR activity to promote autophagy induction. DAPK2 knockdown reduced autophagy triggered either by amino acid deprivation or by increases in intracellular Ca(2+) levels. At the molecular level, DAPK2 depletion interfered with mTORC1 inhibition caused by these two stresses, as reflected by the phosphorylation status of mTORC1 substrates, ULK1 (unc-51-like kinase 1), p70 ribosomal S6 kinase and eukaryotic initiation factor 4E-binding protein 1. An increase in mTORC1 kinase activity was also apparent in unstressed cells that were depleted of DAPK2. Immunoprecipitated mTORC1 from DAPK2-depleted cells showed increased kinase activity in vitro, an indication that DAPK2 regulation of mTORC1 is inherent to the complex itself. Indeed, we found that DAPK2 associates with components of mTORC1, as demonstrated by co-immunoprecipitation with mTOR and its complex partners, raptor (regulatory-associated protein of mTOR) and ULK1. DAPK2 was also able to interact directly with raptor, as shown by recombinant protein-binding assay. Finally, DAPK2 was shown to phosphorylate raptor in vitro. This phosphorylation was mapped to Ser721, a site located within a highly phosphorylated region of raptor that has previously been shown to regulate mTORC1 activity. Thus, DAPK2 is a novel kinase of mTORC1 and is a potential new member of this multiprotein complex, modulating mTORC1 activity and autophagy levels under stress and steady-state conditions.
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Affiliation(s)
- Y Ber
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 76100, Israel
| | - R Shiloh
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Y Gilad
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 76100, Israel
| | - N Degani
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 76100, Israel
| | - S Bialik
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 76100, Israel
| | - A Kimchi
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 76100, Israel
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Gilad Y, Shiloh R, Ber Y, Bialik S, Kimchi A. Discovering protein-protein interactions within the programmed cell death network using a protein-fragment complementation screen. Cell Rep 2014; 8:909-21. [PMID: 25066129 DOI: 10.1016/j.celrep.2014.06.049] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/08/2014] [Accepted: 06/25/2014] [Indexed: 12/22/2022] Open
Abstract
Apoptosis and autophagy are distinct biological processes, each driven by a different set of protein-protein interactions, with significant crosstalk via direct interactions among apoptotic and autophagic proteins. To measure the global profile of these interactions, we adapted the Gaussia luciferase protein-fragment complementation assay (GLuc PCA), which monitors binding between proteins fused to complementary fragments of a luciferase reporter. A library encompassing 63 apoptotic and autophagic proteins was constructed for the analysis of ∼3,600 protein-pair combinations. This generated a detailed landscape of the apoptotic and autophagic modules and points of interface between them, identifying 46 previously unknown interactions. One of these interactions, between DAPK2, a Ser/Thr kinase that promotes autophagy, and 14-3-3τ, was further investigated. We mapped the region responsible for 14-3-3τ binding and proved that this interaction inhibits DAPK2 dimerization and activity. This proof of concept underscores the power of the GLuc PCA platform for the discovery of biochemical pathways within the cell death network.
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Affiliation(s)
- Yuval Gilad
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Ruth Shiloh
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Yaara Ber
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Shani Bialik
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 76100, Israel
| | - Adi Kimchi
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot 76100, Israel.
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26
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Nunes T, Etchevers MJ, Domènech E, García-Sánchez V, Ber Y, Peñalva M, Merino O, Nos P, Garcia-Planella E, Casbas AG, Esteve M, Taxonera Samsó C, Montoro Huguet M, Gisbert JP, Martín Arranz MD, García-Sepulcre MF, Barreiro-de Acosta M, Beltrán B, Alcaide Suárez N, Saro Gismera C, Cabriada JL, Cañas-Ventura A, Gomollón F, Panés J. Smoking does influence disease behaviour and impacts the need for therapy in Crohn's disease in the biologic era. Aliment Pharmacol Ther 2013; 38:752-60. [PMID: 23980933 DOI: 10.1111/apt.12440] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/14/2013] [Accepted: 07/13/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recently, the notion that smoking may adversely affect Crohn's disease (CD) outcomes has been challenged by the suggestion that the widespread use of immunosuppressants and anti-TNF drugs might offset the adverse effects of tobacco. AIM To reassess the influence of tobacco smoking on disease phenotype and complications on a time-dependent analysis, taking into account the different therapeutic interventions. METHODS We designed a retrospective cohort study of 3224 patients with Crohn's disease. The data were collected from the Spanish national inflammatory bowel disease registry (ENEIDA), including information regarding demographics, clinical characteristics, disease complications, therapeutic interventions and smoking status. Patients were classified as nonsmokers, smokers and former smokers, according to their present and past smoking habits. RESULTS In the univariate analysis, smokers had more strictures (22.6% vs. 19.3%, P < 0.05) and less colonic involvement (7.2% vs. 10.9%, P < 0.05), and were more frequently under treatment with steroids (91.6% vs. 85.8%, P < 0.05), immunosuppressants (73.5% vs. 63.6% P < 0.05) or anti-TNF drugs (31.4% vs. 25.1%, P < 0.05) than nonsmokers. In the time-dependent multivariate analysis, smokers were found to have a significantly decreased survival free of stricturing disease (HR: 1.5, CI 95% 1.18-1.90) or perianal complications (HR: 1.50, CI 95% 1.01-1.46), and had a higher risk for requiring thiopurine therapy (HR: 1.20, CI 95% 1.05-1.30). CONCLUSION These results suggest that, despite the widespread use of immunosuppressants and anti-TNF drugs, smokers with Crohn's disease still have a more severe disease course, with increased therapeutic requirements when compared with nonsmokers.
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Affiliation(s)
- T Nunes
- Hospital Clınic, Barcelona, Spain
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Paz A, Brownstein Z, Ber Y, Bialik S, David E, Sagir D, Ulitsky I, Elkon R, Kimchi A, Avraham KB, Shiloh Y, Shamir R. SPIKE: a database of highly curated human signaling pathways. Nucleic Acids Res 2010; 39:D793-9. [PMID: 21097778 PMCID: PMC3014840 DOI: 10.1093/nar/gkq1167] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The rapid accumulation of knowledge on biological signaling pathways and their regulatory mechanisms has highlighted the need for specific repositories that can store, organize and allow retrieval of pathway information in a way that will be useful for the research community. SPIKE (Signaling Pathways Integrated Knowledge Engine; http://www.cs.tau.ac.il/&~spike/) is a database for achieving this goal, containing highly curated interactions for particular human pathways, along with literature-referenced information on the nature of each interaction. To make database population and pathway comprehension straightforward, a simple yet informative data model is used, and pathways are laid out as maps that reflect the curator’s understanding and make the utilization of the pathways easy. The database currently focuses primarily on pathways describing DNA damage response, cell cycle, programmed cell death and hearing related pathways. Pathways are regularly updated, and additional pathways are gradually added. The complete database and the individual maps are freely exportable in several formats. The database is accompanied by a stand-alone software tool for analysis and dynamic visualization of pathways.
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Affiliation(s)
- Arnon Paz
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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28
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Bialik S, Zalckvar E, Ber Y, Rubinstein AD, Kimchi A. Systems biology analysis of programmed cell death. Trends Biochem Sci 2010; 35:556-64. [PMID: 20537543 DOI: 10.1016/j.tibs.2010.04.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Revised: 04/21/2010] [Accepted: 04/23/2010] [Indexed: 11/30/2022]
Abstract
Systems biology, a combined computational and experimental approach to analyzing complex biological systems, has recently been applied to understanding the pathways that regulate programmed cell death. This approach has become especially crucial because recent advances have resulted in an expanded view of the network, to include not just a single death module (apoptosis) but multiple death programs, including programmed necrosis and autophagic cell death. Current research directions in the systems biology field range from quantitative analysis of subprocesses of individual death pathways to the study of interconnectivity among the various death modules of the larger network. These initial studies have provided great advances in our understanding of programmed cell death and have important clinical implications for drug target research.
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Affiliation(s)
- Shani Bialik
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel 76100
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29
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Vinker S, Mankuta D, Yischak B, Ber Y, Nachtigal D, Biran Y. [Medical records audit in primary care clinics of the Israel Navy]. Harefuah 1996; 131:477-9, 535. [PMID: 9043157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The primary care clinics of the Israeli Defense Forces are similar to those of the civilian health system, yet some characteristics are unique: Soldiers are a young, healthy population; their physicians are either serving in the reserves for short periods, or are primary care physicians of the regular army; and during military service the soldier is usually treated in several different primary care clinics. A detailed medical record facilitates communication between the various primary care physicians. As part of a 2-year quality assurance project all naval clinics in Israel were surveyed at 6-month intervals. From the clinic records, 685 encounters involving the 7 most common problems were randomly chosen. We evaluated the quality of the medical records of these encounters scoring them according to subjective, objective assessment and therapeutic and evaluative plan (SOAP) Each record was evaluated by 2 physicians and scored from 0 to 100, using fixed criteria. The score for the therapeutic and evaluative plan was significantly higher than that of the other parts of the medical record (80% vs. 55-59%, p < 0.001). The score of the primary care physicians was significantly higher than that of physicians of the reserves (73% vs. 63%, p < 0.001). Encounters involving upper respiratory tract infections and abdominal pain scored higher than those involving other common problems. The medical recording process has a fundamental role in medical care. Our findings suggest that the subjective, objective and assessment parts of naval medical records need improvement. Further studies might help improve the quality of primary medical care.
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Affiliation(s)
- S Vinker
- Defence Forces Medical Corps, IDF Navy
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