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Alfi O, Cohen M, Bar-On S, Hashimshony T, Levitt L, Raz Y, Blecher Y, Chaudhry MZ, Cicin-Sain L, Ben-El R, Oiknine-Djian E, Lahav T, Vorontsov O, Cohen A, Zakay-Rones Z, Daniel L, Berger M, Mandel-Gutfreund Y, Panet A, Wolf DG. Decidual-tissue-resident memory T cells protect against nonprimary human cytomegalovirus infection at the maternal-fetal interface. Cell Rep 2024; 43:113698. [PMID: 38265934 DOI: 10.1016/j.celrep.2024.113698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/14/2023] [Accepted: 01/05/2024] [Indexed: 01/26/2024] Open
Abstract
Congenital cytomegalovirus (cCMV) is the most common intrauterine infection, leading to infant neurodevelopmental disabilities. An improved knowledge of correlates of protection against cCMV is needed to guide prevention strategies. Here, we employ an ex vivo model of human CMV (HCMV) infection in decidual tissues of women with and without preconception immunity against CMV, recapitulating nonprimary vs. primary infection at the authentic maternofetal transmission site. We show that decidual tissues of women with preconception immunity against CMV exhibit intrinsic resistance to HCMV, mounting a rapid activation of tissue-resident memory CD8+ and CD4+ T cells upon HCMV reinfection. We further reveal the role of HCMV-specific decidual-tissue-resident CD8+ T cells in local protection against nonprimary HCMV infection. The findings could inform the development of a vaccine against cCMV and provide insights for further studies of the integrity of immune defense against HCMV and other pathogens at the human maternal-fetal interface.
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Affiliation(s)
- Or Alfi
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Department of Biochemistry, Institute for Medical Research Israel Canada, Faculty of Medicine, The Hebrew University, Jerusalem, Israel; Lautenberg Center for General and Tumor Immunology, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Mevaseret Cohen
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Department of Biochemistry, Institute for Medical Research Israel Canada, Faculty of Medicine, The Hebrew University, Jerusalem, Israel; Lautenberg Center for General and Tumor Immunology, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Shikma Bar-On
- Lis Maternity Hospital, Tel Aviv Souraski Medical Center, Tel Aviv, Israel; Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Hashimshony
- Faculty of Biology, Technion - Israel Institute of Technology, Haifa, Israel
| | - Lorinne Levitt
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Raz
- Lis Maternity Hospital, Tel Aviv Souraski Medical Center, Tel Aviv, Israel; Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Blecher
- Lis Maternity Hospital, Tel Aviv Souraski Medical Center, Tel Aviv, Israel; Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Zeeshan Chaudhry
- Department of Viral Immunology, Helmholtz Centre for Infection Research, Braunschweig, Germany; German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Braunschweig, Germany
| | - Luka Cicin-Sain
- Department of Viral Immunology, Helmholtz Centre for Infection Research, Braunschweig, Germany; German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Braunschweig, Germany; Centre for Individualised Infection Medicine (a joint venture of HZI and MHH), Hannover, Germany
| | - Rina Ben-El
- Faculty of Biology, Technion - Israel Institute of Technology, Haifa, Israel
| | - Esther Oiknine-Djian
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Lautenberg Center for General and Tumor Immunology, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Tamar Lahav
- Faculty of Biology, Technion - Israel Institute of Technology, Haifa, Israel
| | - Olesya Vorontsov
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Department of Biochemistry, Institute for Medical Research Israel Canada, Faculty of Medicine, The Hebrew University, Jerusalem, Israel; Lautenberg Center for General and Tumor Immunology, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Adiel Cohen
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zichria Zakay-Rones
- Department of Biochemistry, Institute for Medical Research Israel Canada, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Leonor Daniel
- Lautenberg Center for General and Tumor Immunology, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Michael Berger
- Lautenberg Center for General and Tumor Immunology, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | | | - Amos Panet
- Department of Biochemistry, Institute for Medical Research Israel Canada, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Dana G Wolf
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Lautenberg Center for General and Tumor Immunology, Faculty of Medicine, The Hebrew University, Jerusalem, Israel.
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Avraham S, Baruch Y, Schwartz A, Lavie A, Ignative A, Belov Y, Raz Y, Many A, Gamzu R, Yogev Y. The association between increased subjective sensation of fetal movements and pregnancy outcome-a prospective cohort and a retrospective comparative analysis. J Matern Fetal Neonatal Med 2023; 36:2184224. [PMID: 36860126 DOI: 10.1080/14767058.2023.2184224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To determine pregnancy outcomes in women with subjective sensation of increased fetal movements (IFM). METHODS A prospective cohort study of women after 20 weeks of gestation who were referred with subjective sensation of IFM (April 2018-April 2019) for assessment. Pregnancy outcome was compared to pregnancies with a normal sensation of fetal movements all through pregnancy who underwent obstetrical assessment at term (37-41 weeks of gestation) matched by maternal age and pre-pregnancy BMI in a 1:2 ratio. RESULTS Overall, out of 28,028 women referred to the maternity ward during the study period, 153 (0.54%) presented due to subjective sensation of IFM. The latter mainly occurred during the 3rd trimester (89.5%). Primiparity was significantly more prevalent in the study group (75.5% vs. 51.5%, p = .002). The study group had increased rates of operative vaginal deliveries and cesarean section (CS) due to non-reassuring fetal heart rate (15.1% vs. 8.7%, p = .048). Multivariate regression analysis showed that IFM was not associated with NRFHR affecting the mode of delivery (OR 1.1, CI 0.55 - 2.19), opposed to other variables such as primiparity (OR 11.08, CI 3.21-38.28) and induction of labor (OR 2.46, CI 1.18-5.15). There were no differences in the rates of meconium-stained amniotic fluid, 5 min Apgar score, birth weight, or rates of large/small for gestational-age newborns. CONCLUSION Subjective sensation of IFM is not associated with adverse pregnancy outcomes.
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Affiliation(s)
- Sarit Avraham
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Baruch
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Schwartz
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Lavie
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anna Ignative
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yekaterina Belov
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Raz
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Many
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronni Gamzu
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Michaan N, Wenkert A, Even-Sapir E, Kerzhner K, Rabin T, Safra T, Peleg-Hasson S, Baruch Y, Raz Y, Grisaru D, Laskov I. Prognostic significance of delayed complete metabolic response on PET/CT after primary chemoradiation treatment of cervical cancer. Int J Gynecol Cancer 2023; 33:1695-1701. [PMID: 37657818 DOI: 10.1136/ijgc-2023-004703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVE To investigate the prognostic significance of near-complete metabolic response on initial follow-up PET/CT after primary chemoradiation treatment of cervical cancer. METHODS Survival data were retrospectively compared between patients who had complete metabolic response on first follow-up PET/CT, 3 months after chemoradiation (group 1) with those who had near-complete metabolic response on first PET/CT and later showed complete metabolic response at subsequent PET/CT, 6 months or more after treatment (group 2). RESULTS Of the 108 patients included in the final analysis, 74 (68.5%) showed complete metabolic response on initial PET/CT, 3 months after treatment, and 34 patients (31.5%) showed complete metabolic response on subsequent PET/CT, 6 months after treatment. Tumor characteristics were comparable between groups. Group 1 had higher percent of stage 1 (12% vs 0%) and lower percent of stage 4 disease (3% vs 14%) than those of group 2. Group 2 patients had significantly fewer cases of recurrences and deaths than group 1 patients (6% vs 26%, p=0.018; 0% vs 20%, p=0.003, respectively), with comparable 3-year survival rates (group 1, 90% vs group 2, 100%, p=0.31). Twelve patients had progressive disease on first follow-up PET/CT; these patients had significantly worse overall survival compared with all other patients (log-rank test, p<0.001). Younger age and delayed complete metabolic response were associated with lower chance of recurrence and death on univariate analysis. On multivariate analysis, delayed complete metabolic response remained significantly associated with no recurrence HR=0.14 (95% CI 0.25 to 0.84), p=0.031. CONCLUSIONS Survival outcome of patients with cervical cancer who show residual 18F-fluorodeoxyglucose uptake on initial PET/CT after treatment, but reach complete metabolic response on follow-up PET/CT, is not inferior compared with survival of patients who show complete metabolic response on initial PET/CT 3 months after treatment. Watchful waiting with follow-up PET/CT seems a safe option for these patients.
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Affiliation(s)
- Nadav Michaan
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Atalia Wenkert
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Einat Even-Sapir
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Kosta Kerzhner
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tatiana Rabin
- Department of Radiation Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tamar Safra
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shira Peleg-Hasson
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yoav Baruch
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yael Raz
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dan Grisaru
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Laskov
- Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Hershkovitz G, Ochshorn Y, Michaan N, Fiszer E, Grisaru D, Raz Y. Knowledge is power? Cervical cancer prevention in female OB/GYNs compared to other female physicians. Front Public Health 2023; 11:1269393. [PMID: 37780452 PMCID: PMC10540616 DOI: 10.3389/fpubh.2023.1269393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Cervical cancer (CC) screening and prevention are crucial responsibilities of obstetrician-gynecologists (OB/GYNs). Our study aimed to investigate whether knowledge impacts OB/GYNs' (n = 42) adherence to CC prevention measures by comparing them to non-OB/GYN physicians (n = 80). An anonymous questionnaire collected demographic information, personal screening habits and evaluated their knowledge of CC prevention. Results revealed that OB/GYNs exhibited superior knowledge of CC risk factors and prevention compared to non-OB/GYNs. Of note, a lower percentage of OB/GYN residents correctly identified the recommended upper age limit for cervical screening and for HPV vaccination compared to attending OB/GYNs (50% vs. 83%, p = 0.04 and 11% vs. 50%, p = 0.01, respectively). Despite these findings, most physicians from both groups recommended HPV vaccination. Cervical screening rates were similar between OB/GYNs and non-OB/GYNs (75% vs. 83%, p = 0.3). Half of OB/GYNs initiated their own cervical screening, similar to non-OB/GYNs. Interestingly, residents had higher HPV vaccination rates compared to attending physicians, irrespective of specialty (OB/GYNs - 38.89% vs. 4.76%, p = 0.0149; non-OB/GYNs - 51.06% vs. 15.38%, p = 0.0028). In conclusion, contrary to the assumption that physicians prioritize personal well-being, our study reveals the opposite. While skilled in guiding patients through CC screening and prevention, female OB/GYNs often neglect their own health. OB/GYNs must also be educated and supported in safeguarding their health, setting an essential example for patients.
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Affiliation(s)
- Gal Hershkovitz
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yifat Ochshorn
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Michaan
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elisheva Fiszer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Anesthesiology, Pain and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dan Grisaru
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Raz
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hershkovitz G, Raz Y, Goldinger I, Many A, Hiersch L, Eli R. Severe Intrahepatic Cholestasis of Pregnancy-Potential Mechanism by Which Fetuses Are Protected from the Hazardous Effect of Bile Acids. J Clin Med 2023; 12:jcm12020616. [PMID: 36675545 PMCID: PMC9860676 DOI: 10.3390/jcm12020616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/15/2023] Open
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is characterized by elevated total bile acids (TBA). Although elevated maternal TBA is a major risk factors for fetal morbidity and mortality, it is unclear why some fetuses are more prone to the hazardous effect of bile acids (BA) over the others. It is unclear whether fetuses are protected by placental BA uptake, or it is the fetal BA metabolism that reduces fetal BA as compared to maternal levels. Therefore, we aimed to compared TBA levels in the umbilical vein and artery to maternal TBA in women with ICP. The study included 18 women who had TBA > 40 μmol/L and their 23 fetuses. We found that the TBA level in umbilical vein was significantly lower compared to maternal TBA level. The TBA levels in umbilical vein and umbilical artery were similar. No fetus had a serious neonatal complication. Importantly, since TBA level remains low even though maternal TBA level is high the fetuses are protected from the hazardous effects of maternal BA. Our findings suggest that there is no effective metabolism of BA in the fetus and the main decrease in TBA in the fetus is related to placental BA uptake.
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Affiliation(s)
- Gal Hershkovitz
- Department of Obstetrics and Gynecology, Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Yael Raz
- Department of Obstetrics and Gynecology, Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Ilana Goldinger
- Department of Clinical Biochemistry Laboratory, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Ariel Many
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Bark, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 51544, Israel
| | - Liran Hiersch
- Department of Obstetrics and Gynecology, Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Rimon Eli
- Department of Obstetrics and Gynecology, Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Correspondence:
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Deshet-Unger N, Horn G, Rawet-Slobodkin M, Waks T, Laskov I, Michaan N, Raz Y, Bar V, Zundelevich A, Aharon S, Turovsky L, Mallel G, Salpeter S, Neev G, Hollander KS, Katz BZ, Grisaru D, Globerson Levin A. Comparing Intraperitoneal and Intravenous Personalized ErbB2CAR-T for the Treatment of Epithelial Ovarian Cancer. Biomedicines 2022; 10:biomedicines10092216. [PMID: 36140319 PMCID: PMC9496506 DOI: 10.3390/biomedicines10092216] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022] Open
Abstract
High-grade serous ovarian carcinoma (HGSOC) is the most common type of epithelial ovarian cancer. The majority of cases are diagnosed at advanced stages, when intraperitoneal (IP) spread has already occurred. Despite significant surgical and chemotherapeutic advances in HGSOC treatment over the past decades, survival rates with HGSOC have only modestly improved. Chimeric antigen receptor (CAR)-T cells enable T cells to directly bind to tumor-associated antigens in a major histocompatibility complex-independent manner, thereby inducing tumor rejection. While CAR-T cell therapy shows great promise in hematological malignancies, its use in solid tumors is limited. Therefore, innovative approaches are needed to increase the specificity of CAR-modified T cells against solid tumors. The aim of this study was to assess the efficacy and safety of intraperitoneal (IP) versus intravenous (IV) CAR-T cell therapy in the treatment of HGSOC. We constructed a CAR that targets the ErbB2/HER2 protein (ErbB2CAR), which is overexpressed in HGSOC, and evaluated the functionality of ErbB2CAR on ovarian cancer cell lines (OVCAR8, SKOV3, and NAR). Our findings show that an IP injection of ErbB2CAR-T cells to tumor-bearing mice led to disease remission and increased survival compared to the IV route. Moreover, we found that IP-injected ErbB2CART cells circulate to a lesser extent, making them safer for non-tumor tissues than IV-injected cells. Further supporting our findings, we show that the effect of ErbB2CAR-T cells on primary HGSOC tumors is correlated with ErbB2 expression. Together, these data demonstrate the advantages of an IP administration of CAR-T cells over IV administration, offering not only a safer strategy but also the potential for counteracting the effect of ErbB2CAR in HGSOC. Significance: IP-injected ErbB2CAR-T cells led to disease remission and increased survival compared to the IV route. These findings demonstrate the advantages of IP administration, offering a safe treatment strategy with the potential for counteracting the effect of ErbB2CAR in HGSOC.
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Affiliation(s)
- Naamit Deshet-Unger
- Immunology and Advanced CAR-T Therapy, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
| | - Galit Horn
- Immunology and Advanced CAR-T Therapy, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
| | - Moran Rawet-Slobodkin
- Immunology and Advanced CAR-T Therapy, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
| | - Tova Waks
- Immunology and Advanced CAR-T Therapy, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
- Department of Immunology, The Weizmann Institute, Rehovot 7610001, Israel
| | - Ido Laskov
- Department of Gynecologic Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Nadav Michaan
- Department of Gynecologic Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Yael Raz
- Department of Gynecologic Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Vered Bar
- cResponce Company, Rehovot 7670102, Israel
| | | | | | | | | | | | - Guy Neev
- cResponce Company, Rehovot 7670102, Israel
| | - Kenneth Samuel Hollander
- Immunology and Advanced CAR-T Therapy, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
| | - Ben-Zion Katz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
- The Hematology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6997801, Israel
| | - Dan Grisaru
- Department of Gynecologic Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Anat Globerson Levin
- Immunology and Advanced CAR-T Therapy, Tel-Aviv Sourasky Medical Center, Tel-Aviv 6423906, Israel
- Dotan Center for Advanced Therapies, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv 6423906, Israel
- Correspondence: ; Tel.: +972-3-6972503
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Shachar E, Raz Y, Hasson SP, Levy B, Adar L, Honig Z, Mischan N, Laskov I, Grisaru D, Wolf I, Safra T. 543P Can we predict the long and short-term survivors with advanced ovarian cancer? Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.671] [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: 11/01/2022] Open
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Laskov I, Deshet-Unger N, Waks T, Michaan N, Raz Y, Katz BZ, Grisaru D, Levin AG. Intra-peritoneal CAR-T cell therapy shows promising results in a murine model of epithelial ovarian cancer (313). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01536-0] [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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Wu J, Raz Y, Recouvreux MS, Diniz MA, Lester J, Karlan BY, Walts AE, Gertych A, Orsulic S. Focal Serous Tubal Intra-Epithelial Carcinoma Lesions Are Associated With Global Changes in the Fallopian Tube Epithelia and Stroma. Front Oncol 2022; 12:853755. [PMID: 35387127 PMCID: PMC8977528 DOI: 10.3389/fonc.2022.853755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/13/2022] [Accepted: 02/22/2022] [Indexed: 01/19/2023] Open
Abstract
Objective Serous tubal intra-epithelial carcinoma (STIC) lesions are thought to be precursors to high-grade serous ovarian cancer (HGSOC), but HGSOC is not always accompanied by STIC. Our study was designed to determine if there are global visual and subvisual microenvironmental differences between fallopian tubes with and without STIC lesions. Methods Computational image analyses were used to identify potential morphometric and topologic differences in stromal and epithelial cells in samples from three age-matched groups of fallopian tubes. The Benign group comprised normal fallopian tubes from women with benign conditions while the STIC and NoSTIC groups consisted of fallopian tubes from women with HGSOC, with and without STIC lesions, respectively. For the morphometric feature extraction and analysis of the stromal architecture, the image tiles in the STIC group were further divided into the stroma away from the STIC (AwaySTIC) and the stroma near the STIC (NearSTIC). QuPath software was used to identify and quantitate secretory and ciliated epithelial cells. A secretory cell expansion (SCE) or a ciliated cell expansion (CCE) was defined as a monolayered contiguous run of >10 secretory or ciliated cells uninterrupted by the other cell type. Results Image analyses of the tubal stroma revealed gradual architectural differences from the Benign to NoSTIC to AwaySTIC to NearSTIC groups. In the epithelial topology analysis, the relative number of SCE and the average number of cells within SCE were higher in the STIC group than in the Benign and NoSTIC groups. In addition, aging was associated with an increased relative number of SCE and a decreased relative number of CCE. ROC analysis determined that an average of 15 cells within SCE was the optimal cutoff value indicating the presence of a STIC lesion in the tubal epithelium. Conclusions Our findings suggest that global stromal alterations and age-associated reorganization of tubal secretory and ciliated cells are associated with STIC lesions. Further studies will need to determine if these alterations precede STIC lesions and provide permissible conditions for the formation of STIC.
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Affiliation(s)
- Jingni Wu
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Yael Raz
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Maria Sol Recouvreux
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Márcio Augusto Diniz
- Biostatistics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Jenny Lester
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Beth Y. Karlan
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ann E. Walts
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Arkadiusz Gertych
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
| | - Sandra Orsulic
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, United States,Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, United States,*Correspondence: Sandra Orsulic,
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10
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Shani O, Raz Y, Monteran L, Scharff Y, Levi-Galibov O, Megides O, Shacham H, Cohen N, Silverbush D, Avivi C, Sharan R, Madi A, Scherz-Shouval R, Barshack I, Tsarfaty I, Erez N. Evolution of fibroblasts in the lung metastatic microenvironment is driven by stage-specific transcriptional plasticity. eLife 2021; 10:e60745. [PMID: 34169837 PMCID: PMC8257251 DOI: 10.7554/elife.60745] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 07/06/2020] [Accepted: 06/24/2021] [Indexed: 12/21/2022] Open
Abstract
Mortality from breast cancer is almost exclusively a result of tumor metastasis, and lungs are one of the main metastatic sites. Cancer-associated fibroblasts are prominent players in the microenvironment of breast cancer. However, their role in the metastatic niche is largely unknown. In this study, we profiled the transcriptional co-evolution of lung fibroblasts isolated from transgenic mice at defined stage-specific time points of metastases formation. Employing multiple knowledge-based platforms of data analysis provided powerful insights on functional and temporal regulation of the transcriptome of fibroblasts. We demonstrate that fibroblasts in lung metastases are transcriptionally dynamic and plastic, and reveal stage-specific gene signatures that imply functional tasks, including extracellular matrix remodeling, stress response, and shaping the inflammatory microenvironment. Furthermore, we identified Myc as a central regulator of fibroblast rewiring and found that stromal upregulation of Myc transcriptional networks is associated with disease progression in human breast cancer.
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Affiliation(s)
- Ophir Shani
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - Yael Raz
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Lea Monteran
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - Ye'ela Scharff
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - Oshrat Levi-Galibov
- Department of Biomolecular Sciences, The Weizmann Institute of ScienceRehovotIsrael
| | - Or Megides
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - Hila Shacham
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - Noam Cohen
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - Dana Silverbush
- Blavatnik School of Computer Sciences, Faculty of Exact Sciences, Tel Aviv UniversityTel AvivIsrael
| | - Camilla Avivi
- Department of Pathology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - Roded Sharan
- Blavatnik School of Computer Sciences, Faculty of Exact Sciences, Tel Aviv UniversityTel AvivIsrael
| | - Asaf Madi
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - Ruth Scherz-Shouval
- Department of Biomolecular Sciences, The Weizmann Institute of ScienceRehovotIsrael
| | - Iris Barshack
- Department of Pathology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - Ilan Tsarfaty
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - Neta Erez
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
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11
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Shani O, Vorobyov T, Monteran L, Lavie D, Cohen N, Raz Y, Tsarfaty G, Avivi C, Barshack I, Erez N. Fibroblast-Derived IL33 Facilitates Breast Cancer Metastasis by Modifying the Immune Microenvironment and Driving Type 2 Immunity. Cancer Res 2020; 80:5317-5329. [PMID: 33023944 DOI: 10.1158/0008-5472.can-20-2116] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/26/2020] [Accepted: 09/29/2020] [Indexed: 12/21/2022]
Abstract
Lungs are one of the main sites of breast cancer metastasis. The metastatic microenvironment is essential to facilitate growth of disseminated tumor cells. Cancer-associated fibroblasts (CAF) are prominent players in the microenvironment of breast cancer. However, their role in the formation of a permissive metastatic niche is unresolved. Here we show that IL33 is upregulated in metastases-associated fibroblasts in mouse models of spontaneous breast cancer metastasis and in patients with breast cancer with lung metastasis. Upregulation of IL33 instigated type 2 inflammation in the metastatic microenvironment and mediated recruitment of eosinophils, neutrophils, and inflammatory monocytes to lung metastases. Importantly, targeting of IL33 in vivo resulted in inhibition of lung metastasis and significant attenuation of immune cell recruitment and type 2 immunity. These findings demonstrate a key function of IL33 in facilitating lung metastatic relapse by modulating the immune microenvironment. Our study shows a novel interaction axis between CAF and immune cells and reveals the central role of CAF in establishing a hospitable inflammatory niche in lung metastasis. SIGNIFICANCE: This study elucidates a novel role for fibroblast-derived IL33 in facilitating breast cancer lung metastasis by modifying the immune microenvironment at the metastatic niche toward type 2 inflammation.
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Affiliation(s)
- Ophir Shani
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tatiana Vorobyov
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lea Monteran
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dor Lavie
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Cohen
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Raz
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galia Tsarfaty
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Camila Avivi
- Department of Pathology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Barshack
- Department of Pathology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Neta Erez
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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12
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Hershkovitz G, Ochshorn Y, Raz Y, Michaan N, Laskov I, Fiszer E, Grisaru D. Knowledge is power? Pap smear habits of female OB/GYNs compared to other female physicians. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.659] [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: 10/23/2022]
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13
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Tzur Y, Samueloff O, Raz Y, Bar-On S, Laskov I, Tzur T. Conception rates after medical versus surgical evacuation of early miscarriage. Fertil Steril 2020; 115:118-124. [PMID: 32811672 DOI: 10.1016/j.fertnstert.2020.07.016] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/02/2020] [Accepted: 07/10/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare short-term fertility rates after medical and surgical management of early miscarriage. DESIGN Observational cohort study. SETTING Academic tertiary-care medical center. PATIENT(S) A total of 203 patients were enrolled between June 2017 and May 2018, comprising 106 surgical evacuations and 97 medical evacuations. INTERVENTION(S) Either surgical or medical evacuation of the uterine cavity. MAIN OUTCOME MEASURE(S) Conception rates 6 months after miscarriage. RESULT(S) Conception rates 6 months after miscarriage among women who had attempted to become pregnant were similar between the medically and surgically evacuated groups (68.0% vs. 65.1%). There were no significant differences in background characteristics between the groups, apart from younger age and earlier gestational age among the medically treated group. There was no difference in the proportion of women using assisted reproductive technologies between the medically and surgically managed groups (15.5% vs. 12.6%, respectively). The median time-to-conception was 4 ± 2 months in both groups. Cumulative pregnancy rate 12 months after pregnancy loss, live birth rate, and repeat miscarriage rate also were similar between groups. CONCLUSION(S) Modality of uterine evacuation after early miscarriage does not affect short-term fertility outcomes.
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Affiliation(s)
- Yossi Tzur
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Ofri Samueloff
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Raz
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Shikma Bar-On
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Laskov
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tamar Tzur
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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14
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Hu Y, Taylor-Harding B, Raz Y, Haro M, Recouvreux MS, Taylan E, Lester J, Millstein J, Walts AE, Karlan BY, Orsulic S. Are Epithelial Ovarian Cancers of the Mesenchymal Subtype Actually Intraperitoneal Metastases to the Ovary? Front Cell Dev Biol 2020; 8:647. [PMID: 32766252 PMCID: PMC7380132 DOI: 10.3389/fcell.2020.00647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/29/2020] [Indexed: 12/12/2022] Open
Abstract
Primary ovarian high-grade serous carcinoma (HGSC) has been classified into 4 molecular subtypes: Immunoreactive, Proliferative, Differentiated, and Mesenchymal (Mes), of which the Mes subtype (Mes-HGSC) is associated with the worst clinical outcomes. We propose that Mes-HGSC comprise clusters of cancer and associated stromal cells that detached from tumors in the upper abdomen/omentum and disseminated in the peritoneal cavity, including to the ovary. Using comparative analyses of multiple transcriptomic data sets, we provide the following evidence that the phenotype of Mes-HGSC matches the phenotype of tumors in the upper abdomen/omentum: (1) irrespective of the primary ovarian HGSC molecular subtype, matched upper abdominal/omental metastases were typically of the Mes subtype, (2) the Mes subtype was present at the ovarian site only in patients with concurrent upper abdominal/omental metastases and not in those with HGSC confined to the ovary, and (3) ovarian Mes-HGSC had an expression profile characteristic of stromal cells in the upper abdominal/omental metastases. We suggest that ovarian Mes-HGSC signifies advanced intraperitoneal tumor dissemination to the ovary rather than a subtype of primary ovarian HGSC. This is consistent with the presence of upper abdominal/omental disease, suboptimal debulking, and worst survival previously reported in patients with ovarian Mes-HGSC compared to other molecular subtypes.
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Affiliation(s)
- Ye Hu
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Barbie Taylor-Harding
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Yael Raz
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Marcela Haro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Maria Sol Recouvreux
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Enes Taylan
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Jenny Lester
- Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Joshua Millstein
- Division of Biostatistics, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Ann E Walts
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Beth Y Karlan
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sandra Orsulic
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, United States
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15
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Bi H, Hojo K, Watanabe M, Yee C, Maski K, Saba S, Graff-Radford J, Machulda MM, St Louis EK, Humes IS, Flanagan EP, Nicolau S, Jones DT, Patterson MC, Kotagal S, Raz Y, Niu Z, Li J, Klein CJ. Expanded genetic insight and clinical experience of DNMT1-complex disorder. Neurol Genet 2020; 6:e456. [PMID: 32754641 PMCID: PMC7357420 DOI: 10.1212/nxg.0000000000000456] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/30/2020] [Indexed: 11/16/2022]
Abstract
Objective To report novel causal mutations, expanded clinical phenotypes, and clinical management of DNA methyltransferase 1 (DNMT1)-complex disorder. Methods Neurophysiologic testing, imaging, and genetic findings were summarized in clinical context for 5 cases with DNMT1-complex disorder. Results We identified 2 novel DNMT1 mutations (p.E510K and p.P1546A) by whole-exome sequencing (WES). Case 1 (p.E510K) presented with childhood ataxia, treatment-refractory seizures, and rapid cognitive decline in his 50s. Case 2 also had childhood onset and presented with seizures, language regression, hearing loss, narcolepsy with cataplexy symptoms, optic atrophy, sensory neuropathy, and hypogammaglobulinemia requiring IV immunoglobulin. Case 2 (p.P1546A) was identified with a de novo and the first mutation residing outside the targeting sequence domain. Case 3 (p.A570V) had paralytic asymmetric onset attacks triggered by emotionality and lasting sometimes for weeks. Neuropsychological testing showed executive dysfunction localizing to frontosubcortical and frontoparietal structures. He gradually developed left predominant brain atrophy. MRI showed T2 hyperintense lesions that enhanced on T1 postgadolinium images, and brain PET showed hypometabolism in atrophied regions. Case 4 (p.T497P) underwent left cochlear implant, resulting in significant hearing improvements at all tested frequencies (250–6,000 Hz). Case 5 (p.Y511H) had profound gait ataxia with posterior column atrophy of the spinal cord and abnormal evoked potentials primarily affecting the fasciculus gracilis. Conclusions Broader application of WES further expands genotype-phenotype correlations of DNMT1-complex disorder. Two mutations are identified with early childhood onsets. The expanded new phenotypes include asymmetric brain hemiatrophy with parenchymal gadolinium enhancement, spinal cord atrophy, prolonged cataplectic spells, and hypogammaglobulinemia. Hearing loss treatment by cochlear implantation is helpful and should be considered.
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Affiliation(s)
- Hongyan Bi
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - Kaori Hojo
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - Masashi Watanabe
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - Christina Yee
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - Kiran Maski
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - Sadaf Saba
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - Jonathan Graff-Radford
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - Mary M Machulda
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - Erik K St Louis
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - Ilona Spitsyna Humes
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - Eoin P Flanagan
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - Stefan Nicolau
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - David T Jones
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - Marc C Patterson
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - Suresh Kotagal
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - Yael Raz
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - Zhiyv Niu
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - Jun Li
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
| | - Christopher J Klein
- Department of Neurology (H.B., J.G.-R., E.K.S.L., E.P.F., S.N., D.T.J., M.C.P., S.K., C.J.K.), Mayo Clinic, Rochester, MN; Department of Neurology (H.B.), Beijing Friendship Hospital, China; Division of Neuropsychiatry (K.H.), Harima Sanatorium, Hyogo, Japan; Department of Neurology (M.W.), Ehime Prefectural Central Hospital, Matsuyama, Japan; Harvard Medical School (C.Y., K.M.), Boston Children's Hospital, MA; Center for Molecular Medicine and Genetics (S.S.), School of Medicine, Wayne State University, Detroit, MI; Department of Psychology (M.M.M.), Mayo Clinic, Rochester, MN; Atrium Health (I.S.H.), Neurosciences Institute, Concord, NC; Deapartment of Head and Neck Surgery (Y.R.), Oregon Health and Science University, Portland; Department of Laboratory Medicine and Pathology (Z.N., C.J.K.), Mayo Clinic, Rochester, MN; and Department of Neurology and Translational Neuroscience Initiative (J.L.), School of Medicine. Wayne State University, Detroit, MI
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Funamoto M, Moonsamy P, Ong C, Li S, Mohan N, Osho A, Cudemus G, Raz Y, Astor T, Villavicencio M. "Awake" Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplant. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.853] [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: 10/24/2022] Open
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Laskov I, Grisaru D, Deutsch V, Fargo N, Raz Y, Mishaan N. Evaluation of the hypercoagulable state of gynecologic cancer patients by thromboelastography: a prospective pilot study and a review of the literature. EUR J GYNAECOL ONCOL 2019. [DOI: 10.12892/ejgo5003.2019] [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]
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Shayman CS, Ha YM, Raz Y, Hullar TE. Geographic Disparities in US Veterans' Access to Cochlear Implant Care Within the Veterans Health Administration System. JAMA Otolaryngol Head Neck Surg 2019; 145:889-896. [PMID: 31369048 DOI: 10.1001/jamaoto.2019.1918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Veterans are at high risk for developing sensorineural hearing loss leading to cochlear implant (CI) candidacy; however, the ability to care for these patients is limited by the number and location of Veterans Health Administration (VHA) facilities that provide specialized CI services. Objective To investigate geographic disparities in access to CI care within the VHA system for US veterans. Design, Setting, and Participants An analysis of census tract-level data including US veterans was conducted using the nationwide American Community Survey data collected by the US Census Bureau from January to December 2016, which were accessed in 2017. Main Outcomes and Measures Maps showing the geographic variability in need for specialized CI services, estimated as a function of the number of veterans and the distance to the nearest established VHA-based CI surgical or audiologic facilities. Results A total of 19.9 million veterans within the continental United States resided at a median distance of 80 miles (interquartile range [IQR], 30.1-140.9 miles; mean [SD], 1002 [465.8] miles) from the nearest VHA facility offering CI care; of these, 3.98 million (20.0%) resided more than 160.7 miles from the nearest VHA facility. When considering only comprehensive facilities offering both surgical and audiologic care, the median distance was 101.3 miles (IQR, 39.4-178.7 miles; mean [SD], 126.0 [448.4] miles), but 20.0% of veterans had to travel more than 201.0 miles to a VHA facility. Veterans residing in urban areas (74.0%) lived a median distance of 61.2 miles (IQR, 23.7-121.3 miles; mean [SD], 83.8 [477.1] miles) from the nearest VHA facility, with 2.9 million (20.0%) living the farthest at 140.7 miles. Veterans residing in rural areas (26.0%) lived a median distance of 119.8 miles (IQR, 79.0-182.4 miles; mean [SD], 146.9 [431.0] miles) from their nearest VHA facility, with 1.04 million (20.0%) living more than 206.2 miles from the nearest VHA facility. Conclusions and Relevance This study's findings suggest that large disparities exist in the distance to the nearest VHA-based CI facilities. Veterans face considerable geographic barriers to obtaining VHA-based CI care in many parts of the country, including some large metropolitan areas. Those requiring only audiologic services face similar geographic barriers as those requiring surgery. Thoughtful placement of new facilities, along with upcoming advances in remote programming of implants, may help ensure appropriate care for this high-risk population.
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Affiliation(s)
- Corey S Shayman
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Yi-Min Ha
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Yael Raz
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland.,Operative Care Division, Veterans Health Administration Portland Health Care System, Portland, Oregon
| | - Timothy E Hullar
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland.,Operative Care Division, Veterans Health Administration Portland Health Care System, Portland, Oregon.,Department of Neurology, Oregon Health & Science University, Portland
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19
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Ershaid N, Sharon Y, Doron H, Raz Y, Shani O, Cohen N, Monteran L, Leider-Trejo L, Ben-Shmuel A, Yassin M, Gerlic M, Ben-Baruch A, Pasmanik-Chor M, Apte R, Erez N. NLRP3 inflammasome in fibroblasts links tissue damage with inflammation in breast cancer progression and metastasis. Nat Commun 2019; 10:4375. [PMID: 31558756 PMCID: PMC6763472 DOI: 10.1038/s41467-019-12370-8] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 09/02/2019] [Indexed: 02/07/2023] Open
Abstract
Cancer-Associated Fibroblasts (CAFs) were shown to orchestrate tumour-promoting inflammation in multiple malignancies, including breast cancer. However, the molecular pathways that govern the inflammatory role of CAFs are poorly characterised. In this study we found that fibroblasts sense damage-associated molecular patterns (DAMPs), and in response activate the NLRP3 inflammasome pathway, resulting in instigation of pro-inflammatory signalling and secretion of IL-1β. This upregulation was evident in CAFs in mouse and in human breast carcinomas. Moreover, CAF-derived inflammasome signalling facilitated tumour growth and metastasis, which was attenuated when NLRP3 or IL-1β were specifically ablated. Functionally, CAF-derived inflammasome promoted tumour progression and metastasis by modulating the tumour microenvironment towards an immune suppressive milieu and by upregulating the expression of adhesion molecules on endothelial cells. Our findings elucidate a mechanism by which CAFs promote breast cancer progression and metastasis, by linking the physiological tissue damage response of fibroblasts with tumour-promoting inflammation.
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Affiliation(s)
- Nour Ershaid
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoray Sharon
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hila Doron
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Raz
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ophir Shani
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Cohen
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lea Monteran
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonor Leider-Trejo
- Department of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Amir Ben-Shmuel
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Muhammad Yassin
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Motti Gerlic
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adit Ben-Baruch
- Department of Cell Research and Immunology, Tel Aviv University, Tel Aviv, Israel
| | - Metsada Pasmanik-Chor
- Bioinformatics Unit, George S. Wise Faculty of Life Science, Tel Aviv University, Tel Aviv, Israel
| | - Roni Apte
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Neta Erez
- Department of Pathology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Raz Y, Trabert B, Taylor-Harding B, Karlan B, Orsulic S. Distinct early changes in the fallopian tubes of mutation carriers. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.194] [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: 10/26/2022]
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21
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Ovadia C, Seed PT, Sklavounos A, Geenes V, Di Ilio C, Chambers J, Kohari K, Bacq Y, Bozkurt N, Brun-Furrer R, Bull L, Estiú MC, Grymowicz M, Gunaydin B, Hague WM, Haslinger C, Hu Y, Kawakita T, Kebapcilar AG, Kebapcilar L, Kondrackienė J, Koster MPH, Kowalska-Kańka A, Kupčinskas L, Lee RH, Locatelli A, Macias RIR, Marschall HU, Oudijk MA, Raz Y, Rimon E, Shan D, Shao Y, Tribe R, Tripodi V, Yayla Abide C, Yenidede I, Thornton JG, Chappell LC, Williamson C. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet 2019; 393:899-909. [PMID: 30773280 PMCID: PMC6396441 DOI: 10.1016/s0140-6736(18)31877-4] [Citation(s) in RCA: 248] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Intrahepatic cholestasis of pregnancy is associated with adverse perinatal outcomes, but the association with the concentration of specific biochemical markers is unclear. We aimed to quantify the adverse perinatal effects of intrahepatic cholestasis of pregnancy in women with increased serum bile acid concentrations and determine whether elevated bile acid concentrations were associated with the risk of stillbirth and preterm birth. METHODS We did a systematic review by searching PubMed, Web of Science, and Embase databases for studies published from database inception to June 1, 2018, reporting perinatal outcomes for women with intrahepatic cholestasis of pregnancy when serum bile acid concentrations were available. Inclusion criteria were studies defining intrahepatic cholestasis of pregnancy based upon pruritus and elevated serum bile acid concentrations, with or without raised liver aminotransferase concentrations. Eligible studies were case-control, cohort, and population-based studies, and randomised controlled trials, with at least 30 participants, and that reported bile acid concentrations and perinatal outcomes. Studies at potential higher risk of reporter bias were excluded, including case reports, studies not comprising cohorts, or successive cases seen in a unit; we also excluded studies with high risk of bias from groups selected (eg, a subgroup of babies with poor outcomes were explicitly excluded), conference abstracts, and Letters to the Editor without clear peer review. We also included unpublished data from two UK hospitals. We did a random effects meta-analysis to determine risk of adverse perinatal outcomes. Aggregate data for maternal and perinatal outcomes were extracted from case-control studies, and individual patient data (IPD) were requested from study authors for all types of study (as no control group was required for the IPD analysis) to assess associations between biochemical markers and adverse outcomes using logistic and stepwise logistic regression. This study is registered with PROSPERO, number CRD42017069134. FINDINGS We assessed 109 full-text articles, of which 23 studies were eligible for the aggregate data meta-analysis (5557 intrahepatic cholestasis of pregnancy cases and 165 136 controls), and 27 provided IPD (5269 intrahepatic cholestasis of pregnancy cases). Stillbirth occurred in 45 (0·83%) of 4936 intrahepatic cholestasis of pregnancy cases and 519 (0·32%) of 163 947 control pregnancies (odds ratio [OR] 1·46 [95% CI 0·73-2·89]; I2=59·8%). In singleton pregnancies, stillbirth was associated with maximum total bile acid concentration (area under the receiver operating characteristic curve [ROC AUC]) 0·83 [95% CI 0·74-0·92]), but not alanine aminotransferase (ROC AUC 0·46 [0·35-0·57]). For singleton pregnancies, the prevalence of stillbirth was three (0·13%; 95% CI 0·02-0·38) of 2310 intrahepatic cholestasis of pregnancy cases in women with serum total bile acids of less than 40 μmol/L versus four (0·28%; 0·08-0·72) of 1412 cases with total bile acids of 40-99 μmol/L (hazard ratio [HR] 2·35 [95% CI 0·52-10·50]; p=0·26), and versus 18 (3·44%; 2·05-5·37) of 524 cases for bile acids of 100 μmol/L or more (HR 30·50 [8·83-105·30]; p<0·0001). INTERPRETATION The risk of stillbirth is increased in women with intrahepatic cholestasis of pregnancy and singleton pregnancies when serum bile acids concentrations are of 100 μmol/L or more. Because most women with intrahepatic cholestasis of pregnancy have bile acids below this concentration, they can probably be reassured that the risk of stillbirth is similar to that of pregnant women in the general population, provided repeat bile acid testing is done until delivery. FUNDING Tommy's, ICP Support, UK National Institute of Health Research, Wellcome Trust, and Genesis Research Trust.
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Affiliation(s)
- Caroline Ovadia
- Department of Women and Children's Health, King's College London, London, UK
| | - Paul T Seed
- Department of Women and Children's Health, King's College London, London, UK
| | | | - Victoria Geenes
- Department of Women and Children's Health, King's College London, London, UK
| | - Chiara Di Ilio
- Department of Women and Children's Health, King's College London, London, UK
| | - Jenny Chambers
- Department of Women and Children's Health, King's College London, London, UK; Women's Health Research Centre, Imperial College London, London, UK
| | - Katherine Kohari
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Yannick Bacq
- Department of Hepatology and Gastroenterology, University Hospital of Tours, Tours, France
| | - Nuray Bozkurt
- Department of Obstetrics and Gynecology, Gazi University School of Medicine, Ankara, Turkey
| | - Romana Brun-Furrer
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - Laura Bull
- Department of Medicine and Institute for Human Genetics, University of California, San Francisco, CA, USA
| | - Maria C Estiú
- Ramón Sardá Mother's and Children's Hospital, Buenos Aires, Argentina
| | - Monika Grymowicz
- Department of Gynecological Endocrinology, Warsaw Medical University, Warsaw, Poland
| | - Berrin Gunaydin
- Department of Anesthesiology and Reanimation, Gazi University School of Medicine, Ankara, Turkey
| | - William M Hague
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | | | - Yayi Hu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tetsuya Kawakita
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ayse G Kebapcilar
- Department of Gynecology and Obstetrics, Selcuk University, Konya, Turkey
| | | | - Jūratė Kondrackienė
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Maria P H Koster
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, Netherlands
| | - Aneta Kowalska-Kańka
- Obstetrics and Gynaecology Clinic, Institute of Mother and Child, Warsaw, Poland
| | - Limas Kupčinskas
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Richard H Lee
- Obstetrics and Gynecology, Keck School of Medicine University of Southern California, Los Angeles, CA, USA
| | - Anna Locatelli
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy
| | - Rocio I R Macias
- National Institute for the Study of Liver and Gastrointestinal Diseases, Institute of Biomedical Research of Salamanca, University of Salamanca, Salamanca, Spain
| | - Hanns-Ulrich Marschall
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Martijn A Oudijk
- Department of Obstetrics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Yael Raz
- Department of Obstetrics and Gynecology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Eli Rimon
- Department of Obstetrics and Gynecology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Dan Shan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yong Shao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rachel Tribe
- Department of Women and Children's Health, King's College London, London, UK
| | - Valeria Tripodi
- School of Pharmacy and Biochemistry, University of Buenos Aires, Buenos Aires, Argentina
| | - Cigdem Yayla Abide
- Clinic of Obstetrics and Gynecology, Zeynep Kamil Women and Children's Health Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ilter Yenidede
- Clinic of Obstetrics and Gynecology, Zeynep Kamil Women and Children's Health Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Jim G Thornton
- Division of Child Health, Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK
| | - Lucy C Chappell
- Department of Women and Children's Health, King's College London, London, UK
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Raz Y, Keinan-Boker L, Goren S, Soen-Grisaru G, Cohen D, Grisaru D. The effect of age at immigration on cervical cancer incidence: a population-based cohort study of 1 486 438 Israeli women. Int J Gynecol Cancer 2019; 29:492-496. [PMID: 30833437 DOI: 10.1136/ijgc-2018-000053] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To clarify the effect of mass migration from a high-risk area (former Soviet Union) to a low-risk area (Israel) on cervical cancer incidence and mortality in Israel and the modifying effect of age at immigration. METHODS All women who immigrated to Israel from the former Soviet Union between January 1, 1990 and December 31, 2000 (N=345 202) and all Jewish Israeli-born women who were 0-80 years old on January 1, 1990 (N=1 141 236) were included. Follow-up ended at December 31, 2010 or date of death or date of cervical cancer diagnosis, whatever occurred earlier. Crossing data from the computerized population registry of the Ministry of Interior, the Israel National Cancer Registry and the Central Bureau of Statistics, cervical cancer incidence and mortality and adjusted hazard ratios (aHR) with 95% confidence intervals (95% CI) were calculated. RESULTS 1595 new cases (crude incidence rate 29.71: 100 000 person years) of cervical cancer were diagnosed in immigrants as compared with 6159 cases (crude incidence rate 27.21: 100 000 person years) diagnosed in Israel-born Jewish women. Immigration at an age older than 12 years was hazardous (aHR 1.27, 95% CI 1.19 to 1.35; P<0.001) while immigration at a younger age was protective (aHR 0.62, 95% CI 0.51 to 0.75; P<0.001) for cervical cancer incidence compared with native Israeli women. Cervical cancer mortality was also significantly higher in immigrants compared with Israel-born women with incidence density rates of 1.15 and 0.35 per 100 person years, respectively (P<0.0001). CONCLUSIONS Factors related to the acquired causes of the disease at the country of origin are probably at the root of the low incidence of cervical cancer in Israel. Adult immigrants from the former Soviet Union should be managed as a high-risk group.
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Affiliation(s)
- Yael Raz
- 'Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Ministry of Health, Gertner Institute, Sheba Medical Center, Ramat Gan, Israel.,School of Public Health, University of Haifa, Haifa, Israel
| | - Sophy Goren
- Stanley Steyer Institute for Cancer Epidemiology and Research, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galia Soen-Grisaru
- Pediatrics Infectious Diseases Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Daniel Cohen
- Stanley Steyer Institute for Cancer Epidemiology and Research, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Grisaru
- 'Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Raz Y, Cohen N, Shani O, Bell RE, Novitskiy SV, Abramovitz L, Levy C, Milyavsky M, Leider-Trejo L, Moses HL, Grisaru D, Erez N. Bone marrow-derived fibroblasts are a functionally distinct stromal cell population in breast cancer. J Exp Med 2018; 215:3075-3093. [PMID: 30470719 PMCID: PMC6279405 DOI: 10.1084/jem.20180818] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/05/2018] [Accepted: 10/23/2018] [Indexed: 12/21/2022] Open
Abstract
Raz et al. demonstrate that the expression of PDGFRα distinguishes two functional CAF populations in breast tumors and lung metastases and identify a subpopulation of CAFs that are specifically recruited to the tumor microenvironment from mesenchymal stromal cells in the BM. Cancer-associated fibroblasts (CAFs) are highly prominent in breast tumors, but their functional heterogeneity and origin are still largely unresolved. We report that bone marrow (BM)–derived mesenchymal stromal cells (MSCs) are recruited to primary breast tumors and to lung metastases and differentiate to a distinct subpopulation of CAFs. We show that BM-derived CAFs are functionally important for tumor growth and enhance angiogenesis via up-regulation of Clusterin. Using newly generated transgenic mice and adoptive BM transplantations, we demonstrate that BM-derived fibroblasts are a substantial source of CAFs in the tumor microenvironment. Unlike resident CAFs, BM-derived CAFs do not express PDGFRα, and their recruitment resulted in a decrease in the percentage of PDGFRα-expressing CAFs. Strikingly, decrease in PDGFRα in breast cancer patients was associated with worse prognosis, suggesting that BM-derived CAFs may have deleterious effects on survival. Therefore, PDGFRα expression distinguishes two functionally unique CAF populations in breast tumors and metastases and may have important implications for patient stratification and precision therapeutics.
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Affiliation(s)
- Yael Raz
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Noam Cohen
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ophir Shani
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rachel E Bell
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sergey V Novitskiy
- Department of Cancer Biology, Vanderbilt University School of Medicine and Vanderbilt-Ingram Comprehensive Cancer Center, Nashville, TN
| | - Lilach Abramovitz
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carmit Levy
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Milyavsky
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonor Leider-Trejo
- Department of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Harold L Moses
- Department of Cancer Biology, Vanderbilt University School of Medicine and Vanderbilt-Ingram Comprehensive Cancer Center, Nashville, TN
| | - Dan Grisaru
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Neta Erez
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Milyavsky M, Biechonski S, Olender L, Zipin-Roitman A, Yassin M, Aqaqe N, Marcu-Malina V, Rall M, Wiesmuller L, Beider K, Raz Y, Grisaru D, Nagler A. ¬¬Attenuated DNA Damage Responses and Increased Apoptosis Characterize Human Hematopoietic Stem Cells Exposed to Irradiation. Exp Hematol 2018. [DOI: 10.1016/j.exphem.2018.06.097] [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: 10/28/2022]
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Axtell A, Fiedler A, Heng E, Melnitchouk S, D'Alessandro D, Tolis G, Astor T, Raz Y, Neuringer I, Villavicencio M. Rates of Primary Graft Dysfunction and Overall Survival Are Not Affected by the Laterality of the First Implanted Lung in Bilateral Lung Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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26
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Fiedler A, Axtell A, Heng E, Osho A, Melnitchouk S, D'Alessandro D, Tolis G, Astor T, Raz Y, Neuringer I, Villavicencio M. Low Partial Pressures of Oxygen in Circulatory Death Donors is Associated with Decreased Survival in Lung Transplant Recipients. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.321] [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] Open
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Villavicencio M, Axtell A, Fiedler A, Heng E, Raz Y, Neuringer I, Melnitchouk S, Tolis G, D'Alessandro D, Astor T. Impact of Carbon Dioxide Tension on Survival After Lung Transplantation for Pulmonary Fibrosis. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Abstract
Objective Evaluate if electrode design affects hearing preservation (HP) following cochlear implantation (CI) with full-length electrodes. Study Design Case series with chart review. Setting Tertiary referral academic center. Subjects and Methods Forty-five adults with low-frequency hearing (≤85 dB at 250 and 500 Hz) who underwent unilateral CI with full-length electrode arrays made by 1 manufacturer were included. HP was calculated with (1) mean low-frequency pure-tone average (LFPTA) at 250 and 500 Hz (MEAN method), (2) a percentile method across the audiometric frequency spectrum generating an S-value (HEARRING method), and (3) functional if hearing remained ≤85 dB at 250 and 500 Hz. Audiometric testing was performed approximately 1 month and 1 year postoperatively, yielding short-term and long-term results, respectively. Results Of 45 patients who underwent CI, 46.7% received lateral wall (LW) and 53.3% received perimodiolar (PM) electrodes. At short-term follow-up, LW electrodes were associated with significantly better HP than PM (LFPTA method: 27.7 vs 39.3 dB, P < .05; S-value method: 48.2 vs 21.8%, P < .05). In multivariate regression of short-term outcomes, LW electrode use was a significant predictor of better HP ( P < .05). At long-term follow-up, electrode type was not associated with HP. Younger patient age was the only significant predictor of long-term HP on multivariate analysis ( P < .05). Conclusion The LW electrode is associated with short-term HP, suggesting its design is favorable for limiting trauma to the cochlea during and directly following CI. Other factors, including age, are relevant for maintaining HP over the long term. The data support further investigation into what modifiable factors may promote long-term HP.
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Affiliation(s)
- Leila J Mady
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Daniel C Sukato
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jenifer Fruit
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Catherine Palmer
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,2 Department of Communication Science and Disorders, University of Pittsburgh, Pennsylvania, USA
| | - Yael Raz
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,3 Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Barry E Hirsch
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,2 Department of Communication Science and Disorders, University of Pittsburgh, Pennsylvania, USA
| | - Andrew A McCall
- 1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Cohen N, Shani O, Raz Y, Sharon Y, Hoffman D, Abramovitz L, Erez N. Fibroblasts drive an immunosuppressive and growth-promoting microenvironment in breast cancer via secretion of Chitinase 3-like 1. Oncogene 2017; 36:4457-4468. [PMID: 28368410 PMCID: PMC5507301 DOI: 10.1038/onc.2017.65] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [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: 12/13/2016] [Revised: 02/02/2017] [Accepted: 02/05/2017] [Indexed: 12/11/2022]
Abstract
Cancer-Associated Fibroblasts (CAFs) are the most prominent stromal cell type in breast tumors. CAFs promote tumor growth and metastasis by multiple mechanisms, including by mediating tumor-promoting inflammation. Immune modulation in the tumor microenvironment plays a central role in determining disease outcome. However, the functional interactions of CAFs with immune cells are largely unknown. Here we report a novel signaling axis between fibroblasts, cancer cells and immune cells in breast tumors that drives an immunosuppressive microenvironment, mediated by CAF-derived Chi3L1. We demonstrate that Chi3L1 is highly upregulated in CAFs isolated from mammary tumors and pulmonary metastases of transgenic mice, and in the stroma of human breast carcinomas. Genetic ablation of Chi3L1 in fibroblasts in vivo attenuated tumor growth, macrophage recruitment and reprogramming to an M2-like phenotype, enhanced tumor infiltration by CD8+ and CD4+ T cells and promoted a Th1 phenotype. These results indicate that CAF-derived Chi3L1 promotes tumor growth and shifts the balance of the immune milieu towards type 2 immunity. Taken together, our findings implicate fibroblast-derived Chi3L1 as a novel key player in the complex reciprocal interactions of stromal cells that facilitate tumor progression and metastasis, and suggest that targeting Chi3L1 may be clinically beneficial in breast cancer.
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Affiliation(s)
- N Cohen
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Shani
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Raz
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Y Sharon
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Hoffman
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Abramovitz
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Erez
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
BACKGROUND This study was conducted to determine the incidence of and risk factors associated with the development of radiographic mastoid and middle ear effusions (ME/MEE) in ICU patients. METHODS Head computed tomography or magnetic resonance images of 300 subjects admitted to the University of Pittsburgh Medical Center neurologic ICU from April 2013 through April 2014 were retrospectively reviewed. Images were reviewed for absent, partial, or complete opacification of the mastoid air cells and middle ear space. Exclusion criteria were temporal bone or facial fractures, transmastoid surgery, prior sinus or skull base surgery, history of sinonasal malignancy, ICU admission < 3 days or inadequate imaging. RESULTS At the time of admission, 3.7% of subjects had radiographic evidence of ME/MEE; 10.3% (n = 31) of subjects subsequently developed new or worsening ME/MEE during their ICU stay. ME/MEE was a late finding and was found to be most prevalent in subjects with a prolonged stay (P < .001). Variables associated with ME/MEE included younger age, the use of antibiotics, and development of radiographic sinus opacification. The proportion of subjects with ME/MEE was significantly higher in the presence of an endotracheal tube (22.7% vs 0.6%, P < .001) or a nasogastric tube (21.4% vs 0.6%, P < .001). CONCLUSIONS Radiographic ME/MEE was identified in 10.3% of ICU subjects and should be considered especially in patients with prolonged stay, presence of an endotracheal tube or nasogastric tube, and concomitant sinusitis. ME/MEE is a potential source of fever and sensory impairment that may contribute to delirium and perceived depressed consciousness in ICU patients.
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Affiliation(s)
- Phillip Huyett
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yael Raz
- Department of Otolaryngology-Head and Neck Surgery, Veteran's Affairs Hospital Pittsburgh, Pittsburgh, Pennsylvania
| | - Barry E Hirsch
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew A McCall
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Biechonski S, Gourevich D, Rall M, Aqaqe N, Yassin M, Zipin-Roitman A, Trakhtenbrot L, Olender L, Raz Y, Jaffa AJ, Grisaru D, Wiesmuller L, Elad D, Milyavsky M. Quercetin alters the DNA damage response in human hematopoietic stem and progenitor cellsviaTopoII- and PI3K-dependent mechanisms synergizing in leukemogenic rearrangements. Int J Cancer 2016; 140:864-876. [DOI: 10.1002/ijc.30497] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/01/2016] [Accepted: 10/13/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Shahar Biechonski
- Department of Pathology, Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Dana Gourevich
- Department of Pathology, Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
- Department of Biomedical Engineering, Faculty of Engineering; Tel Aviv University; Tel Aviv Israel
| | - Melanie Rall
- Department of Obstetrics and Gynecology; Gynecological Oncology, University of Ulm; Ulm Germany
| | - Nasma Aqaqe
- Department of Pathology, Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Muhammad Yassin
- Department of Pathology, Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Adi Zipin-Roitman
- Department of Pathology, Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | | | - Leonid Olender
- Department of Pathology, Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Yael Raz
- Department of Pathology, Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
- Department of Obstetrics and Gynecology; Gynecologic Oncology Division, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center; Tel-Aviv Israel
| | - Ariel J. Jaffa
- Ultrasound Unit in Obstetrics and Gynecology; Lis Maternity Hospital, Tel Aviv Sourasky Medical Center; Tel-Aviv Israel
- Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Dan Grisaru
- Department of Obstetrics and Gynecology; Gynecologic Oncology Division, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center; Tel-Aviv Israel
- Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Lisa Wiesmuller
- Department of Obstetrics and Gynecology; Gynecological Oncology, University of Ulm; Ulm Germany
| | - David Elad
- Department of Biomedical Engineering, Faculty of Engineering; Tel Aviv University; Tel Aviv Israel
| | - Michael Milyavsky
- Department of Pathology, Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
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Sharon Y, Ershaid N, Raz Y, Cohen N, Pasmanik-Chor M, Geiger T, Erez N. Abstract IA14: Breaking bad: Cancer-associated fibroblasts are reprogrammed from growth inhibitory to pro-inflammatory and tumor promoting in breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.tme16-ia14] [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
Breast tumors are characterized by an extensive desmoplastic stroma, abundantly populated by fibroblasts. We previously demonstrated that Cancer-Associated Fibroblasts (CAFs) orchestrate tumor-enhancing inflammation in multiple mouse and human malignancies, including breast cancer. Although breast cancer is one of the major tumor types where CAFs were shown to be tumor promoting, there is no detailed analysis of the dynamic changes in CAFs characteristics and function in correlation with tumor progression. We therefore set out to characterize the dynamic changes in CAFs during progression of mammary carcinogenesis, in a transgenic mouse model of human breast cancer. We profiled the transcriptome of fibroblasts isolated from normal mammary glands, or from mammary glands of transgenic mice at defined tumorigenic stages. Data analysis revealed unique CAF gene signatures that correspond to distinct tumor stages, with only partial overlap between the stages, suggesting co-evolution of the microenvironment with tumorigenic progression. Interestingly, the gene signature of fibroblasts isolated from hyperplastic lesions is inverse to that in CAFs from neoplastic stages, and has a growth inhibitory phenotype, while CAFs from mammary tumors express pro-inflammatory and tumor promoting gene signatures. Moreover, we functionally demonstrate that CAFs isolated from late carcinoma express a gene signature that links tissue damage with tumor-promoting inflammation. To identify tumor-secreted factors capable of reprogramming normal mammary fibroblasts to pro-inflammatory CAFs, we performed a proteomic screen of breast cancer cells secretome, and identified Osteopontin (OPN). Knockdown of OPN in tumor cells in vivo resulted in attenuated stromal activation, reduced immune cell recruitment and inhibition of tumor growth. Taken together, our findings reveal reciprocal crosstalk between fibroblasts and cancer cells which drives CAF reprogramming, to facilitate tumor progression in breast cancer.
Citation Format: Yoray Sharon, Nour Ershaid, Yael Raz, Noam Cohen, Metsada Pasmanik-Chor, Tamar Geiger, Neta Erez. Breaking bad: Cancer-associated fibroblasts are reprogrammed from growth inhibitory to pro-inflammatory and tumor promoting in breast cancer. [abstract]. In: Proceedings of the AACR Special Conference: Function of Tumor Microenvironment in Cancer Progression; 2016 Jan 7–10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2016;76(15 Suppl):Abstract nr IA14.
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Affiliation(s)
| | | | - Yael Raz
- Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Neta Erez
- Tel Aviv University, Tel Aviv, Israel
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Raz Y, Cohen N, Grisaru D, Erez N. Bone marrow–derived fibroblasts are a functionally distinct stromal cell population in breast cancer and lung metastases. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.437] [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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Affiliation(s)
- Yael Raz
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Rimon
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Raz Y, Grisaru D, Boker-Keinan L, Cohen D, Goren S. Cervical cancer epidemiology in former Soviet Union immigrants to Israel: A step towards solving the enigma. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.356] [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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Sharon Y, Raz Y, Cohen N, Ben-Shmuel A, Schwartz H, Geiger T, Erez N. Tumor-derived osteopontin reprograms normal mammary fibroblasts to promote inflammation and tumor growth in breast cancer. Cancer Res 2015; 75:963-73. [PMID: 25600648 DOI: 10.1158/0008-5472.can-14-1990] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [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
Breast tumors are characterized by an extensive desmoplastic stroma, abundantly populated by fibroblasts. Cancer-associated fibroblasts (CAF) support tumorigenesis by stimulating angiogenesis, cancer cell proliferation, and invasion. CAF also orchestrate tumor-promoting inflammation in multiple tumor types, including breast cancer. However, the mechanisms through which normal tissue fibroblasts are reprogrammed to tumor-promoting CAFs are mainly obscure. Here, we show that mammary fibroblasts can be educated by breast cancer cells to become activated to a proinflammatory state that supports malignant progression. Proteomic analysis of breast cancer cell-secreted factors identified the secreted proinflammatory mediator osteopontin, which has been implicated in inflammation, tumor progression, and metastasis. Osteopontin was highly secreted by mouse and human breast cancer cells, and tumor cell-secreted osteopontin activated a CAF phenotypes in normal mammary fibroblasts in vitro and in vivo. Osteopontin was sufficient to induce fibroblast reprogramming and neutralizing antibodies against osteopontin-blocked fibroblast activation induced by tumor cells. The ability of secreted osteopontin to activate mammary fibroblasts relied upon its known receptors CD44 and αVβ3 integrin. Strikingly, osteopontin silencing in tumor cells in vivo attenuated stromal activation and inhibited tumor growth. Our findings establish a critical functional role for paracrine signaling by tumor-derived osteopontin in reprograming normal fibroblasts into tumor-promoting CAFs.
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Affiliation(s)
- Yoray Sharon
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Raz
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Department of Obstetrics and Gynecology, LIS Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Noam Cohen
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Ben-Shmuel
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hila Schwartz
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Geiger
- Department of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Neta Erez
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Uzefovsky F, Shalev I, Israel S, Edelman S, Raz Y, Mankuta D, Knafo-Noam A, Ebstein RP. Oxytocin receptor and vasopressin receptor 1a genes are respectively associated with emotional and cognitive empathy. Horm Behav 2015; 67:60-5. [PMID: 25476609 DOI: 10.1016/j.yhbeh.2014.11.007] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/28/2014] [Accepted: 11/08/2014] [Indexed: 01/10/2023]
Abstract
Empathy is the ability to recognize and share in the emotions of others. It can be considered a multifaceted concept with cognitive and emotional aspects. Little is known regarding the underlying neurochemistry of empathy and in the current study we used a neurogenetic approach to explore possible brain neurotransmitter pathways contributing to cognitive and emotional empathy. Both the oxytocin receptor (OXTR) and the arginine vasopressin receptor 1a (AVPR1a) genes contribute to social cognition in both animals and humans and hence are prominent candidates for contributing to empathy. The following research examined the associations between polymorphisms in these two genes and individual differences in emotional and cognitive empathy in a sample of 367 young adults. Intriguingly, we found that emotional empathy was associated solely with OXTR, whereas cognitive empathy was associated solely with AVPR1a. Moreover, no interaction was observed between the two genes and measures of empathy. The current findings contribute to our understanding of the distinct neurogenetic pathways involved in cognitive and emotional empathy and underscore the pervasive role of both oxytocin and vasopressin in modulating human emotions.
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Affiliation(s)
- F Uzefovsky
- Psychology Department, Hebrew University, Jerusalem 91501, Israel; Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
| | - I Shalev
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - S Israel
- Psychology Department, Hebrew University, Jerusalem 91501, Israel
| | - S Edelman
- Psychology Department, Hebrew University, Jerusalem 91501, Israel
| | - Y Raz
- Neurobiology, Hebrew University, Jerusalem, Israel
| | - D Mankuta
- Hadassah Medical Organization, Department of Labor and Delivery, Jerusalem, Israel
| | - A Knafo-Noam
- Psychology Department, Hebrew University, Jerusalem 91501, Israel
| | - R P Ebstein
- Psychology Department, National University of Singapore, Singapore
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McCall AA, Hobson CE, Moy JD, Byers KE, Raz Y, Hirsch BE. Response to “Management and Outcomes in Patients Affected by Malignant Otitis Externa”. Otolaryngol Head Neck Surg 2014; 151:890-1. [DOI: 10.1177/0194599814551534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hobson CE, Moy JD, Byers KE, Raz Y, Hirsch BE, McCall AA. Malignant Otitis Externa. Otolaryngol Head Neck Surg 2014; 151:112-6. [DOI: 10.1177/0194599814528301] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 02/26/2014] [Indexed: 11/15/2022]
Abstract
Objective Malignant otitis externa (MOE) is an invasive infection of the temporal bone that is classically caused by Pseudomonas aeruginosa. Increasingly, however, nonpseudomonal cases are being reported. The goal of this study was to evaluate and compare the clinical presentation and outcomes of cases of MOE caused by Pseudomonas versus non- Pseudomonas organisms. Study Design Retrospective case series with chart review. Setting Tertiary care institution. Subjects and Methods Adult patients with diagnoses of MOE between 1995 and 2012 were identified. Charts were reviewed for history, clinical presentation, laboratory data, treatment, and outcomes. Results Twenty patients diagnosed with and treated for MOE at the University of Pittsburgh Medical Center between 1995 and 2012 were identified. Nine patients (45%) had cultures that grew P aeruginosa. Three patients (15%) had cultures that grew methicillin-resistant Staphylococcus aureus (MRSA). Signs and symptoms at presentation were similar across groups. However, all of the patients with Pseudomonas had diabetes, compared with 33% of MRSA-infected patients ( P = .046) and 55% of all non- Pseudomonas-infected patients ( P = .04). Patients infected with MRSA were treated for an average total of 4.7 more weeks of antibiotic therapy than Pseudomonas-infected patients ( P = .10). Overall, patients with non- Pseudomonas infections were treated for a total of 2.4 more weeks than Pseudomonas-infected patients ( P = .25). Conclusions A high index of suspicion for nonpseudomonal organisms should be maintained in patients with signs and symptoms of MOE, especially in those without diabetes. MRSA is an increasingly implicated organism in MOE.
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Affiliation(s)
- Candace E. Hobson
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jennifer D. Moy
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Karin E. Byers
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Yael Raz
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Barry E. Hirsch
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andrew A. McCall
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Uzefovsky F, Shalev I, Israel S, Edelman S, Raz Y, Perach-Barzilay N, Mankuta D, Shamay-Tsoory SG, Knafo A, Ebstein RP. The Dopamine D4 receptor gene shows a gender-sensitive association with cognitive empathy: Evidence from two independent samples. Emotion 2014; 14:712-21. [DOI: 10.1037/a0036555] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Objective (1) Determine whether tuning fork material (aluminum vs stainless steel) affects Rinne testing in the clinical assessment of conductive hearing loss (CHL). (2) Determine the relative acoustic and mechanical outputs of 512-Hz tuning forks made of aluminum and stainless steel. Study Design Prospective, observational. Setting Outpatient otology clinic. Subjects and Methods Fifty subjects presenting May 2011 to May 2012 with negative or equivocal Rinne in at least 1 ear and same-day audiometry. Rinne test results using aluminum and steel forks were compared and correlated with the audiometric air-bone gap. Bench top measurements using sound-level meter, microphone, and artificial mastoid. Results Patients with CHL were more likely to produce a negative Rinne test with a steel fork than with an aluminum fork. Logistic regression revealed that the probability of a negative Rinne reached 50% at a 19 dB air-bone gap for stainless steel versus 27 dB with aluminum. Bench top testing revealed that steel forks demonstrate, in effect, more comparable air and bone conduction efficiencies while aluminum forks have relatively lower bone conduction efficiency. Conclusion We have found that steel tuning forks can detect a lesser air-bone gap compared to aluminum tuning forks. This is substantiated by observations of clear differences in the relative acoustic versus mechanical outputs of steel and aluminum forks, reflecting underlying inevitable differences in acoustic versus mechanical impedances of these devices, and thus efficiency of coupling sound/vibratory energy to the auditory system. These findings have clinical implications for using tuning forks to determine candidacy for stapes surgery.
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Affiliation(s)
- Cheryl A. MacKechnie
- Banner Medical Group, Banner Good Samaritan Medical Center, Phoenix, Arizona, USA
| | - Jesse J. Greenberg
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard C. Gerkin
- School of Life Sciences, Arizona State University, Phoenix, Arizona, USA
| | - Andrew A. McCall
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Barry E. Hirsch
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John D. Durrant
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yael Raz
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Hobson CE, Moy J, Byers K, Raz Y, Hirsch BE, McCall AA. Malignant Otitis Externa: An Evolving Disease. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813496044a269] [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: 11/16/2022]
Abstract
Objectives: 1) Compare the clinical presentations and outcomes of patients with MOE caused by Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). 2) Recognize the evolving trend of atypical and drug-resistant organisms causing malignant otitis externa (MOE). Methods: A retrospective review of disease course and outcome was performed of patients diagnosed with MOE at a tertiary referral center between 1995 and 2012. Results: Forty-four patients with a diagnosis of MOE were identified. Eighteen patients were excluded due to insufficient or inconsistent clinical data, leaving 26 patients for analysis. Forty-six percent of patient cultures grew Pseudomonas and 12% grew MRSA. All patients infected with Pseudomonas had diabetes mellitus, compared to 33% of MRSA-infected patients ( P < 0.05). Twenty-five percent of Pseudomonas-infected patients presented with at least one cranial nerve palsy, as compared to none of the MRSA-infected patients (ns). Duration of therapy for Pseudomonas-infected patients lasted an average of 7.2 weeks, while MRSA-infected patients lasted 10 weeks (ns). Excluding failed initial treatment courses, the average treatment durations were 5.0 and 7.7 weeks for Pseudomonas and MRSA infections, respectively. Other atypical pathogenic organisms isolated in culture include Candida, Aspergillus, and Enterococcus species. Conclusions: Increasingly, MOE is being caused by organisms other than Pseudomonas, including MRSA. Empiric treatment, without culture, can lead to delays in definitive therapy. A high index of suspicion for atypical or drug resistant organisms should be maintained in MOE patients who are not diabetic. Culture directed therapy for treatment of MOE is paramount.
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Raz Y, Erez N. An inflammatory vicious cycle: Fibroblasts and immune cell recruitment in cancer. Exp Cell Res 2013; 319:1596-603. [PMID: 23567181 DOI: 10.1016/j.yexcr.2013.03.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/12/2013] [Accepted: 03/16/2013] [Indexed: 01/07/2023]
Abstract
Cancer-associated fibroblasts (CAFs) have been established as a key component of the crosstalk between tumor cells and their microenvironment. The ability of CAFs to orchestrate tumor-promoting inflammation is central to their role in facilitating tumor growth, invasion, and metastasis. Here we review pathways by which CAFs and their soluble mediators provide multiple complex signals that modulate the recruitment, functional activation status, and retention of immune cells in the tumor microenvironment.
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Affiliation(s)
- Yael Raz
- Lis Maternity Hospital, Tel Aviv Sorasky Medical Center, affiliated to Sackler School of Medicine, Tel Aviv, Israel; Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel-Aviv 69978, Israel
| | - Neta Erez
- Department of Pathology, Sackler School of Medicine, Tel Aviv University, Tel-Aviv 69978, Israel.
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Sharon Y, Raz Y, Alon L, Erez N. Abstract B103: Proinflammatory signaling by cancer-associated fibroblasts co-evolves during mammary carcinogenesis. Cancer Res 2013. [DOI: 10.1158/1538-7445.tim2013-b103] [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
Cancer-associated fibroblasts (CAFs) support tumorigenesis by stimulating angiogenesis, cancer cell proliferation, and invasion. We demonstrated that CAFs also mediate tumor-enhancing inflammation: CAFs isolated from pre-neoplastic and tumor tissue expressed a pro-inflammatory gene signature and functioned to recruit macrophages and enhance tumor angiogenesis in a mouse model of squamous carcinoma. Moreover, we demonstrated that pro-inflammatory signaling by CAFs is operative also in mouse and human breast carcinogenesis. Although breast cancer is one of the major tumor types where CAFs were shown to be tumor promoting, there is no detailed analysis of CAF characteristics and function in correlation with tumor progression. We therefore set out to characterize the dynamic changes in CAFs during progression of mammary carcinogenesis, in a transgenic mouse model of human breast cancer, the MMTV-PyMT mice. We show that normal mammary fibroblasts can be “educated” by mammary carcinoma cells to become activated, pro-inflammatory CAFs. Furthermore, transcriptome profiling of fibroblasts isolated from normal mammary glands, or from mammary glands of transgenic mice at defined tumorigenic stages (hyperplasia, early carcinoma, invasive adenocarcinoma) revealed distinct CAF gene expression signatures that correspond to different tumor stages, with only partial overlap between the stages, suggesting co-evolution of the microenvironment with tumorigenic progression. Interestingly, the gene signature of fibroblasts isolated from hyperplastic lesions is inverse to that in CAFs from neoplastic stages, and has a putative growth inhibitory phenotype, while CAFs from early and late carcinoma express pro-inflammatory and tumor promoting gene signatures. Elucidating the molecular mechanisms by which CAFs mediate cancer-related inflammation in breast cancer will greatly increase our understanding of stromal pathways that contribute to tumorigenesis, in an effort to identify novel stromal molecular targets for combinatorial therapeutic approaches to combat breast cancer progression.
Citation Format: Yoray Sharon, Yael Raz1,2, Lina Alon, Neta Erez. Proinflammatory signaling by cancer-associated fibroblasts co-evolves during mammary carcinogenesis. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Invasion and Metastasis; Jan 20-23, 2013; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2013;73(3 Suppl):Abstract nr B103.
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Affiliation(s)
- Yoray Sharon
- 1Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel,
| | - Yael Raz
- 1Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel,
- 2LIS Maternity Hospital, Tel Aviv Sourasky Medical Center. Tel-Aviv, Israel
| | - Lina Alon
- 1Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel,
| | - Neta Erez
- 1Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel,
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Grisaru D, Raz Y, Shtabsky A. A peculiar presentation: for 2 women, a rare infection preceded a more urgent diagnosis. Am J Obstet Gynecol 2012; 207:342.e1-2. [PMID: 22704763 DOI: 10.1016/j.ajog.2012.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 03/21/2012] [Accepted: 05/26/2012] [Indexed: 11/19/2022]
Affiliation(s)
- Dan Grisaru
- Departments of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Greenberg JJ, Raz Y, MacKechnie CA, McCall AA, Hirsch BE, Gerkin RC, Durrant JD. Rinne Revisited: Steel versus Aluminum Tuning Forks. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812451438a177] [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: 11/17/2022]
Abstract
Objective: 1) Determine whether tuning fork material (aluminum vs stainless steel) affects Rinne testing in the clinical assessment of conductive hearing loss (CHL). 2) Determine the acoustic and mechanical impedance properties of 512 Hz tuning forks made of aluminum and stainless steel. Method: Prospective, randomized observational study of 38 subjects presenting to outpatient clinic May 2011 through February 2012 with negative or equivocal Rinne and same-day audiogram. Laboratory tuning fork impedance measurements were obtained using sound-level meter and artificial mastoid (simulating air and bone conduction). Outcome: Sensitivity of negative Rinne in predicting air-bone gap at 500 Hz. Results: Patients with CHL were more likely to produce a negative Rinne test with a steel fork than with an aluminum fork. Logistic regression revealed that the probability of a negative Rinne reached 50% at 20.3 (±2.5) dB air-bone gap for stainless steel versus 27.5 (±2.6) dB with aluminum. In a supporting laboratory study, steel forks exhibited comparable air and bone conduction efficiencies while aluminum forks favored air conduction. This results in a larger CHL being required to overcome aluminum forks’ increased air conduction efficiency before producing a negative Rinne. Conclusion: We have found steel tuning forks are more sensitive in detecting the presence of an air-bone gap. This is substantiated by significant differences in the relative acoustic versus mechanical impedances of steel and aluminum forks. These findings have clinical implications for using tuning forks to determine candidacy for stapes surgery.
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Wetmore SJ, Eibling DE, Goebel JA, Gottshall KR, Hoffer ME, Magnusson M, Raz Y. Challenges and opportunities in managing the dizzy older adult. Otolaryngol Head Neck Surg 2011; 144:651-6. [PMID: 21493351 DOI: 10.1177/0194599810397493] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Balance disorders are common in elderly people, not only resulting in distressing sensations but also leading to reduced activity levels and quality of life. It has been estimated that 30% of elderly patients experience a balance disorder. Managing these disorders is a substantial challenge for patients and their caregivers and physicians. Moreover, abnormalities in balance are associated with falls, a major cause of morbidity and mortality for elderly people. Management is complicated by the inherent difficulties in assessing the generic complaint of dizziness, as well as the likelihood of multiple, often nonvestibular causes. The authors of this mini-seminar review both vestibular and nonvestibular causes of balance disorders in elderly people, emphasizing practical therapeutic maneuvers that can be used.
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Affiliation(s)
- Stephen J Wetmore
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia 26506-9200, USA.
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Treister R, Pud D, Ebstein RP, Laiba E, Raz Y, Gershon E, Haddad M, Eisenberg E. Association Between Polymorphisms in Serotonin and Dopamine-Related Genes and Endogenous Pain Modulation. The Journal of Pain 2011; 12:875-83. [DOI: 10.1016/j.jpain.2011.02.348] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 01/17/2011] [Accepted: 02/07/2011] [Indexed: 12/16/2022]
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Almog B, Wagman I, Bibi G, Raz Y, Azem F, Groutz A, Barkan G, Holzer H, Amit A, Tulandi T, Levin I. Effects of salpingectomy on ovarian response in controlled ovarian hyperstimulation for in vitro fertilization: a reappraisal. Fertil Steril 2011; 95:2474-6. [DOI: 10.1016/j.fertnstert.2011.03.032] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 03/03/2011] [Accepted: 03/09/2011] [Indexed: 11/27/2022]
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Wetmore S, Eibling D, Raz Y, Hoffer M, Goebel J. Challenges/Opportunities in Managing the Dizzy Older Adult. Otolaryngol Head Neck Surg 2010. [DOI: 10.1016/j.otohns.2010.06.675] [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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