1
|
Ando Y, Goggins M. ASO Author Reflections: Using a CA19-9 Tumor Marker Gene Test to Assess Outcome after Pancreatic Cancer Surgery. Ann Surg Oncol 2024; 31:2961-2962. [PMID: 38280960 DOI: 10.1245/s10434-024-14974-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/29/2024]
Affiliation(s)
- Yohei Ando
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Michael Goggins
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
- Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| |
Collapse
|
2
|
Ando Y, Dbouk M, Blackford AL, Yoshida T, Saba H, Abou Diwan E, Yoshida K, Sokoll L, Eshleman JR, Burkhart R, He J, Goggins M. Using a CA19-9 Tumor Marker Gene Test to Assess Outcome After Pancreatic Cancer Surgery. Ann Surg Oncol 2024; 31:2902-2912. [PMID: 38319515 DOI: 10.1245/s10434-024-14942-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/29/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Cancer antigen 19-9 (CA19-9) is widely used as a marker of pancreatic cancer tumor burden and response to therapy. Synthesis of CA19-9 and its circulating levels are determined by variants encoding the fucosyltransferases, FUT2 and FUT3. Individuals can be grouped into one of four functional FUT groups (FUT3-null, FUT-low, FUT-intermediate, FUT-high), each with its own CA19-9 reference range based on its predicted capacity to produce CA19-9. The authors hypothesized that a FUT variant-based CA19-9 tumor marker gene test could improve the prognostic performance of CA19-9. METHODS Preoperative and pre-treatment CA19-9 levels were measured, and FUT variants were determined in 449 patients who underwent surgery for pancreatic ductal adenocarcinoma (PDAC) at Johns Hopkins Hospital between 2010 and 2020, including 270 patients who underwent neoadjuvant therapy. Factors associated with recurrence-free and overall survival were determined in Cox proportional hazards models. RESULTS Higher preoperative CA19-9 levels were associated with recurrence and mortality for patients in the higher-FUT groups (FUT-intermediate, FUT-high for mortality, with adjustment for other prognostic factors; hazard ratio [HR], 1.34 and 1.58, respectively; P < 0.001), but not for those in the lower-FUT groups (FUT3-null, FUT-low). As a tumor marker, CA19-9 levels of 100 U/ml or lower after neoadjuvant therapy and normalization of CA19-9 based on FUT group were more sensitive but less specific predictors of evidence for a major pathologic response to therapy (little/no residual tumor) and of early recurrence (within 6 months). CONCLUSION Among patients undergoing pancreatic cancer resection, a CA19-9 tumor marker gene test modestly improved the prognostic performance of CA19-9.
Collapse
Affiliation(s)
- Yohei Ando
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mohamad Dbouk
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Amanda L Blackford
- Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Takeichi Yoshida
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Helena Saba
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Elizabeth Abou Diwan
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Kanako Yoshida
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Lori Sokoll
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - James R Eshleman
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Richard Burkhart
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jin He
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Michael Goggins
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
- Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| |
Collapse
|
3
|
Meghani K, Frydenlund N, Yu Y, Choy B, Meeks JJ. Spatial comparison of molecular features associated with resistance to pembrolizumab in BCG unresponsive bladder cancer. J Immunother Cancer 2024; 12:e008571. [PMID: 38631711 PMCID: PMC11029500 DOI: 10.1136/jitc-2023-008571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Intravenous immune checkpoint inhibition achieves a 40% 3-month response in BCG-unresponsive non-muscle invasive bladder cancer (NMIBC) with carcinoma in situ. Yet, only half of the early responders will continue to be disease-free by 12 months, and resistance mechanisms are poorly defined. We performed spatial profiling of BCG-unresponsive tumors from patients responsive or resistant to intravenous pembrolizumab treatment, analyzing samples both before initiating and 3 months post-intravenous pembrolizumab treatment. We analyzed 119 regions of interest, which included 59 pairs of epithelial and adjacent stromal segments across five patients: two responders and three non-responders. We demonstrate that BCG unresponsive tumors with an inflamed PanCK+ tumor area and an infiltrated stromal segment respond better to intravenous pembrolizumab. Furthermore, using segment-specific gene signatures generated from a cohort of BCG unresponsive NMIBC treated with intravesical BCG+pembrolizumab, we find that non-inflamed, immune-cold tumors that do not respond to intravenous pembrolizumab exhibit a favorable outcome to the combined application of BCG and pembrolizumab. For the first time, we have identified molecular features of tumors associated with response and resistance to intravenous pembrolizumab in BCG unresponsive NMIBCs. Further research with more patients and alternative checkpoint inhibitors is essential to validate our findings. We anticipate that using a transcriptomics signature like the one described here can help identify tumors with a higher possibility of responding to intravenous pembrolizumab.
Collapse
Affiliation(s)
- Khyati Meghani
- Departments of Urology, and Biochemistry and Molecular Genetics, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Noah Frydenlund
- Departments of Urology, and Biochemistry and Molecular Genetics, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yanni Yu
- Departments of Urology, and Biochemistry and Molecular Genetics, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bonnie Choy
- Department of Pathology, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joshua J Meeks
- Departments of Urology, and Biochemistry and Molecular Genetics, Feinberg School of Medicine, Chicago, Illinois, USA
- Jesse Brown VA Medical Center, Chicago, Illinois, USA
| |
Collapse
|
4
|
von Lersner A, Fernandes F, Ozawa PM, Jackson M, Masureel M, Ho H, Lima SM, Vagner T, Sung BH, Wehbe M, Franze K, Pua H, Wilson JT, Irish JM, Weaver AM, Di Vizio D, Zijlstra A. Multiparametric Single-Vesicle Flow Cytometry Resolves Extracellular Vesicle Heterogeneity and Reveals Selective Regulation of Biogenesis and Cargo Distribution. ACS Nano 2024; 18:10464-10484. [PMID: 38578701 PMCID: PMC11025123 DOI: 10.1021/acsnano.3c11561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/19/2024] [Accepted: 03/27/2024] [Indexed: 04/07/2024]
Abstract
Mammalian cells release a heterogeneous array of extracellular vesicles (EVs) that contribute to intercellular communication by means of the cargo that they carry. To resolve EV heterogeneity and determine if cargo is partitioned into select EV populations, we developed a method named "EV Fingerprinting" that discerns distinct vesicle populations using dimensional reduction of multiparametric data collected by quantitative single-EV flow cytometry. EV populations were found to be discernible by a combination of membrane order and EV size, both of which were obtained through multiparametric analysis of fluorescent features from the lipophilic dye Di-8-ANEPPS incorporated into the lipid bilayer. Molecular perturbation of EV secretion and biogenesis through respective ablation of the small GTPase Rab27a and overexpression of the EV-associated tetraspanin CD63 revealed distinct and selective alterations in EV populations, as well as cargo distribution. While Rab27a disproportionately affects all small EV populations with high membrane order, the overexpression of CD63 selectively increased the production of one small EV population of intermediate membrane order. Multiplexing experiments subsequently revealed that EV cargos have a distinct, nonrandom distribution with CD63 and CD81 selectively partitioning into smaller vs larger EVs, respectively. These studies not only present a method to probe EV biogenesis but also reveal how the selective partitioning of cargo contributes to EV heterogeneity.
Collapse
Affiliation(s)
- Ariana
K. von Lersner
- Program in
Cancer Biology, Vanderbilt University, Nashville, Tennessee 37232, United
States
| | - Fabiane Fernandes
- Department
of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
- Institute
of Applied Biosciences and Chemistry, Hogeschool
Arnhem en Nijmegen University of Applied Sciences, Nijmegen 6525 EM, Gelderland, Netherlands
| | - Patricia Midori
Murobushi Ozawa
- The
Center
for EV Research, Vanderbilt University, Nashville, Tennessee 37232, United States
- Department
of Cell and Developmental Biology, Vanderbilt
University School of Medicine, Nashville, Tennessee 37232, United States
| | - Marques Jackson
- Department
of Research Pathology, Genentech, San Francisco, California 94080, United States
| | - Matthieu Masureel
- Department
of Structural Biology, Genentech, San Francisco, California 94080, United States
| | - Hoangdung Ho
- Department
of Structural Biology, Genentech, San Francisco, California 94080, United States
| | - Sierra M. Lima
- Department
of Cell and Developmental Biology, Vanderbilt
University School of Medicine, Nashville, Tennessee 37232, United States
| | - Tatyana Vagner
- Department
of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, United States
| | - Bong Hwan Sung
- The
Center
for EV Research, Vanderbilt University, Nashville, Tennessee 37232, United States
- Department
of Cell and Developmental Biology, Vanderbilt
University School of Medicine, Nashville, Tennessee 37232, United States
| | - Mohamed Wehbe
- Department
of Chemical and Biomolecular Engineering, Vanderbilt University, Nashville, Tennessee 37232, United States
| | - Kai Franze
- Department
of Research Pathology, Genentech, San Francisco, California 94080, United States
- KNIME
GmbH, Konstanz 78467, Germany
| | - Heather Pua
- Department
of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
- The
Center
for EV Research, Vanderbilt University, Nashville, Tennessee 37232, United States
| | - John T. Wilson
- Program in
Cancer Biology, Vanderbilt University, Nashville, Tennessee 37232, United
States
- Department
of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
- The
Center
for EV Research, Vanderbilt University, Nashville, Tennessee 37232, United States
- Department
of Chemical and Biomolecular Engineering, Vanderbilt University, Nashville, Tennessee 37232, United States
| | - Jonathan M. Irish
- Program in
Cancer Biology, Vanderbilt University, Nashville, Tennessee 37232, United
States
- Department
of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
- Department
of Cell and Developmental Biology, Vanderbilt
University School of Medicine, Nashville, Tennessee 37232, United States
| | - Alissa M. Weaver
- Program in
Cancer Biology, Vanderbilt University, Nashville, Tennessee 37232, United
States
- Department
of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
- The
Center
for EV Research, Vanderbilt University, Nashville, Tennessee 37232, United States
- Department
of Cell and Developmental Biology, Vanderbilt
University School of Medicine, Nashville, Tennessee 37232, United States
| | - Dolores Di Vizio
- Department
of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, United States
| | - Andries Zijlstra
- Program in
Cancer Biology, Vanderbilt University, Nashville, Tennessee 37232, United
States
- Department
of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
- The
Center
for EV Research, Vanderbilt University, Nashville, Tennessee 37232, United States
- Department
of Research Pathology, Genentech, San Francisco, California 94080, United States
| |
Collapse
|
5
|
Bradley CJ, Owsley KM. Retirement behavior of cancer survivors: role of health insurance. J Cancer Surviv 2024; 18:499-508. [PMID: 36063307 DOI: 10.1007/s11764-022-01248-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Workers who rely on employment for health insurance may be unable to reduce work during and following treatment for a serious health condition, potentially harming their health in retirement. In this study, we examine the influence of retiree and employment-contingent insurance on the retirement and health of workers diagnosed with cancer. METHODS This longitudinal cohort study used 2000-2018 Health and Retirement Study data to examine changes in employment, weekly hours worked, and health status measures following a cancer diagnosis. We selected respondents who reported a new cancer diagnosis (n = 354) and a matched, non-cancer sample (n = 1770), restricting both samples to those employed and younger than age 63. RESULTS Following a cancer diagnosis, women with retiree health insurance were 18.6 percentage points less likely to work (95% CI: - 36.3 to - 1.0; p < 0.05) relative to women with employer health insurance, but no retiree insurance. Employed women with cancer but without employment-contingent health insurance increased weekly hours worked by 34% relative to similar non-cancer controls. Men and women with a cancer diagnosis and without employment-contingent health or retiree insurance were also less likely to work (p < 0.05). Among those who stopped working, respondents with cancer and employment-contingent health insurance reported better health status than respondents without employment-contingent health insurance. CONCLUSIONS Cancer survivors with employer and retiree health insurance leave the workforce earlier and report better health status when they stop working than those without equivalent insurance. IMPLICATIONS FOR CANCER SURVIVORS Policies to support health insurance outside of employment may allow cancer survivors to retire earlier and may have positive health benefits.
Collapse
Affiliation(s)
- Cathy J Bradley
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Comprehensive Cancer Center, 13001 East 17th Place, Mail Stop B119, Aurora, CO, 80045, USA
| | - Kelsey M Owsley
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA.
| |
Collapse
|
6
|
Walsh EA, Post K, Massad K, Horick N, Antoni MH, Penedo FJ, Safren SA, Partridge AH, Peppercorn J, Park ER, Temel JS, Greer JA, Jacobs JM. Identification of patient subgroups who benefit from a behavioral intervention to improve adjuvant endocrine therapy adherence: a randomized-controlled trial. Breast Cancer Res Treat 2024; 204:547-559. [PMID: 38231313 DOI: 10.1007/s10549-023-07228-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE Adjuvant endocrine therapy (AET) reduces breast cancer morbidity and mortality; however, adherence is suboptimal. Interventions exist, yet few have improved adherence. Patient characteristics may alter uptake of an intervention to boost adherence. We examined moderators of the effect of a virtual intervention (STRIDE; #NCT03837496) on AET adherence after breast cancer. METHODS At a large academic medical center, patients taking AET (N = 100; Mage = 56.1, 91% White) were randomized to receive STRIDE versus medication monitoring. All stored their medication in digital pill bottles (MEMS Caps) which captured objective adherence. Participants self-reported adherence (Medication Adherence Report Scale) at 12 weeks post-baseline. Moderators included age, anxiety, and depressive symptoms (Hospital Anxiety and Depression Scale), AET-related symptom distress (Breast Cancer Prevention Trial Symptom Scale), and AET-specific concerns (Beliefs about Medications Questionnaire). We used hierarchical linear modeling (time × condition × moderator) and multiple regression (condition × moderator) to test the interaction effects on adherence. RESULTS Age (B = 0.05, SE = 0.02, p = 0.003) and AET-related symptom distress (B = -0.04, SE = 0.02, p = 0.02) moderated condition effect on self-reported adherence while anxiety (B = -1.20, SE = 0.53, p = 0.03) and depressive symptoms (B = -1.65, SE = 0.65, p = 0.01) moderated objective adherence effects. AET-specific concerns approached significance (B = 0.91, SE = 0.57, p = 0.12). Participants who received STRIDE and were older or presented with lower anxiety and depressive symptoms or AET-related symptom distress exhibited improved adherence. Post hoc analyses revealed high correlations among most moderators. CONCLUSIONS A subgroup of patients who received STRIDE exhibited improvements in AET adherence. The interrelatedness of moderators suggests an underlying profile of patients with lower symptom burden who benefitted most from the intervention. STUDY REGISTRATION NCT03837496.
Collapse
Affiliation(s)
- Emily A Walsh
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL, 33146, USA.
| | - Kathryn Post
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Katina Massad
- University of Missouri School of Medicine, Columbia, MO, USA
| | - Nora Horick
- Massachusetts General Hospital, Boston, MA, USA
| | - Michael H Antoni
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL, 33146, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL, 33146, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL, 33146, USA
| | - Ann H Partridge
- Harvard Medical School, Boston, MA, USA
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Jeffrey Peppercorn
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elyse R Park
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jennifer S Temel
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Joseph A Greer
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jamie M Jacobs
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
7
|
Marquez J, Weldemariam MM, Dong J, Hayashi J, Kane MA, Serrero G. Effect of PTFGRN Expression on the Proteomic Profile of A431 Cells and Determination of the PTGFRN Interactome. ACS Omega 2024; 9:14381-14387. [PMID: 38559916 PMCID: PMC10975668 DOI: 10.1021/acsomega.4c00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 04/04/2024]
Abstract
Prostaglandin F2 receptor negative regulator (PTGFRN) is a transmembrane protein whose expression has been previously implicated in cancer metastasis. However, the exact molecular mechanisms by which PTGFRN influences cancer progression are still unknown. As such, our laboratory set out to investigate how PTGFRN knockdown affected the expression of other proteins. We also carried out coimmunoprecipitation experiments using a monoclonal anti-PTGFRN antibody. We employed mass spectrometry-based proteomics for both experiments to identify proteins that were associated with PTGFRN. Our data show that PTGFRN knockdown increased pathways related to innate immune responses and decreased pathways associated with the synthesis of metabolic precursors and protein processing, among others. Additionally, the coimmunoprecipitation experiments indicated that PTGFRN is associated with proteins involved in processing and metabolism, as well as VEGF signaling molecules. These results highlight the role of PTGFRN as a protein processing regulator, which may be influencing cancer progression.
Collapse
Affiliation(s)
- Jorge Marquez
- Department
of Pharmaceutical Sciences, University of
Maryland School of Pharmacy, Baltimore, Maryland 21201, United States of America
- Target
Discovery Division, A&G Pharmaceutical,
Inc., Columbia, Maryland 21045, United States of America
| | - Mehari M. Weldemariam
- Department
of Pharmaceutical Sciences, University of
Maryland School of Pharmacy, Baltimore, Maryland 21201, United States of America
| | - Jianping Dong
- Target
Discovery Division, A&G Pharmaceutical,
Inc., Columbia, Maryland 21045, United States of America
| | - Jun Hayashi
- Precision
Antibody Service, 9130
Red Branch Rd., Suite X Columbia, Maryland 21045, United States
| | - Maureen A. Kane
- Department
of Pharmaceutical Sciences, University of
Maryland School of Pharmacy, Baltimore, Maryland 21201, United States of America
| | - Ginette Serrero
- Target
Discovery Division, A&G Pharmaceutical,
Inc., Columbia, Maryland 21045, United States of America
| |
Collapse
|
8
|
Tieosapjaroen W, Chen E, Ritchwood T, Li C, Conklin JL, Babatunde AO, Ongkeko AM, Nwaozuru U, Tucker JD, Castillo Carandang NT, Ong JJ. Designathons in health research: a global systematic review. BMJ Glob Health 2024; 9:e013961. [PMID: 38453248 PMCID: PMC10921519 DOI: 10.1136/bmjgh-2023-013961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/16/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION A designathon is a three-stage participatory activity informed by design thinking. There is a growing literature on designathons in health. This study synthesised designathons' effectiveness and implementation-related factors to address health challenges. METHODS We searched Cochrane Library, Embase, PubMed, Scopus and the ClinicalTrials.gov registry for articles containing primary data on designathons for health from their dates of inception to 29 November 2022. We retrieved additional studies from citation searching and a complementary open call. We synthesised data on designathons' effectiveness (ie, engagement, outputs and implementation), required resources and implementation-related factors (ie, resources, facilitators, barriers, strengths and limitations). We assessed the risk of bias using a checklist adapted from Joanna Briggs Institute Critical Appraisal tools. RESULTS In total, 4973 citations were identified, and 42 studies were included. In total, 26 studies (62%) were from high-income countries. The median number of total participants was 49, divided into a median of 8 teams. The duration of the intensive collaboration phase ranged from 3 hours to 7 days. Common evaluation criteria were feasibility, innovation and impact. Idea and prototype outputs included mobile phone applications, educational programmes and medical devices. Interventions developed from a designathon was estimated to be highly cost-effective. The most common facilitators were interdisciplinary participants and high-quality mentorship. The most common barriers were suboptimal execution of the events, difficulties in balancing interdisciplinary participants across teams and limited support for participants along the process. There were limited data on required resources and further implementation of solutions after designathons. CONCLUSION Given designathons' adaptability in terms of budget, mode of delivery, type of output and involvement of diverse participants, including end users, designathons can be implemented in a wide range of contexts to address various health issues. PROSPERO REGISTRATION NUMBER CRD42023389685.
Collapse
Affiliation(s)
- Warittha Tieosapjaroen
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth Chen
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tiarney Ritchwood
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | - Chunyan Li
- Tokyo College, The University of Tokyo, Tokyo, Japan
| | - Jamie L Conklin
- Health Sciences Library, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Arturo M Ongkeko
- National Institutes of Health, University of the Philippines Manila, Manila, The Philippines
- Foundation for the Advancement of Clinical Epidemiology Inc, Manila, The Philippines
| | - Ucheoma Nwaozuru
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Nina T Castillo Carandang
- Foundation for the Advancement of Clinical Epidemiology Inc, Manila, The Philippines
- Department of Clinical Epidemiology, University of the Philippines Manila, Manila, The Philippines
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
9
|
Xiong S, Humble S, Barnette A, Brandt H, Thompson V, Klesges LM, Silver MI. Associations of geographic-based socioeconomic factors and HPV vaccination among male and female children in five US states. BMC Public Health 2024; 24:702. [PMID: 38443823 PMCID: PMC10916280 DOI: 10.1186/s12889-024-18206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/24/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND We assessed whether five geographic-based socioeconomic factors (medically underserved area (MUA); healthcare provider shortage area (HPSA); persistent poverty; persistent child poverty; and social vulnerability index (SVI)) were associated with the odds of HPV vaccination initiation, series completion, and parental vaccine hesitancy, and whether the observed relationships varied by gender of the child. METHODS An online panel service, administered through Qualtrics®, was used to recruit parents of adolescents 9-17 years of age to complete a one-time survey in 2021. Coverage of the panel included five US states: Arkansas, Mississippi, Missouri, Tennessee, and Southern Illinois. Generalized estimating equation (GEE) models were used to assess population-level associations between five geographic-based socioeconomic factors (MUA; HPSA; persistent poverty; persistent child poverty; and SVI) and three HPV vaccination outcomes (initiation, series completion, and hesitancy). All GEE models were adjusted for age of child and clustering at the state level. RESULTS Analyses were conducted using responses from 926 parents about their oldest child in the target age range (9-17 years). The analytic sample consisted of 471 male children and 438 female children across the five states. In adjusted GEE models, persistent child poverty and HPSA were negatively associated with HPV vaccination initiation and series completion among female children, respectively. Among male children, high social vulnerability was negatively associated with HPV vaccine series completion. Additionally, persistent poverty and high social vulnerability were negatively associated with HPV vaccine hesitancy in male children. CONCLUSIONS The results of this cross-sectional study suggest that geographic-based socioeconomic factors, particularly, HPSA, persistent poverty, and SVI, should be considered when implementing efforts to increase HPV vaccine coverage for adolescents. The approaches to targeting these geographic factors should also be evaluated in future studies to determine if they need to be tailored for male and female children.
Collapse
Affiliation(s)
- Serena Xiong
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St SE, Suite 166, 55414, Minneapolis, MN, USA.
| | - Sarah Humble
- Department of Surgery, Washington University School of Medicine, 600 S Taylor Avenue, 63110, St. Louis, MO, USA
| | - Alan Barnette
- Saint Francis Medical Center, 211 St. Francis Drive, 63703, Cape Girardeau, MO, USA
| | - Heather Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, 262 Danny Thomas Place, 38105-3678, Memphis, TN, USA
| | - Vetta Thompson
- Barnes-Jewish Hospital, Alvin J. Siteman Cancer Center, Washington University School of Medicine, 63110, St. Louis, MO, USA
- Department of Medicine and Pediatrics, Washington University School of Medicine, Washington University in St. Louis, 63110, St. Louis, MO, USA
| | - Lisa M Klesges
- Department of Surgery, Washington University School of Medicine, 600 S Taylor Avenue, 63110, St. Louis, MO, USA
| | - Michelle I Silver
- Department of Surgery, Washington University School of Medicine, 600 S Taylor Avenue, 63110, St. Louis, MO, USA
| |
Collapse
|
10
|
Kessler LG, Comstock B, Aiello Bowles EJ, Mou J, Nash MG, Bravo P, Fleckenstein LE, Pflugeisen C, Gao H, Winer RL, Ornelas IJ, Smith C, Neslund-Dudas C, Shetty P. Protocol to measure validity and reliability of colorectal, breast, cervical and lung cancer screening questions from the 2021 National Health Interview Survey: Methodology and design. PLoS One 2024; 19:e0297773. [PMID: 38437207 PMCID: PMC10911603 DOI: 10.1371/journal.pone.0297773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 03/06/2024] Open
Abstract
Previous studies demonstrate that self-reports of mammography screening for breast cancer and colonoscopy screening for colorectal cancer demonstrate concordance, based on adherence to screening guidelines, with electronic medical records (EMRs) in over 90% of those interviewed, as well as high sensitivity and specificity, and can be used for monitoring our Healthy People goals. However, for screening tests for cervical and lung cancers, and for various sub-populations, concordance between self-report and EMRs has been noticeably lower with poor sensitivity or specificity. This study aims to test the validity and reliability of lung, colorectal, cervical, and breast cancer screening questions from the 2021 and 2022 National Health Interview Survey (NHIS). We present the protocol for a study designed to measure the validity and reliability of the NHIS cancer screening questions compared to EMRs from four US-based healthcare systems. We planned a randomized trial of a phone- vs web-based survey with NHIS questions that were previously revised based on extensive cognitive interviewing. Our planned sample size will be 1576 validity interviews, and 1260 interviews randomly assigned at 1 or 3 months after the initial interview. We are enrolling people eligible for cancer screening based on age, sex, and smoking history per US Preventive Services Task Force recommendations. We will evaluate question validity using concordance, sensitivity, specificity, positive predictive value, negative predictive value, and report-to-records ratio. We further are randomizing participants to complete a second survey 1 vs 3 months later to assess question reliability. We suggest that typical measures of concordance may need to be reconsidered in evaluating cancer screening questions.
Collapse
Affiliation(s)
- Larry G. Kessler
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Bryan Comstock
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Erin J. Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America
| | - Jin Mou
- Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington, United State of America
| | - Michael G. Nash
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Perla Bravo
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Lynn E. Fleckenstein
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America
| | - Chaya Pflugeisen
- Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington, United State of America
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America
| | - Rachel L. Winer
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - India J. Ornelas
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Cynthia Smith
- Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington, United State of America
| | - Chris Neslund-Dudas
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, United States of America
| | - Punith Shetty
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, United States of America
| |
Collapse
|
11
|
Eckhoff AM, Kanu E, Fletcher A, Bao M, Aushev VN, Spickard E, Nussbaum DP, Allen PJ. Initial Report: Personalized Circulating Tumor DNA and Survival in Patients with Resectable Pancreatic Cancer. Ann Surg Oncol 2024; 31:1444-1446. [PMID: 38170407 DOI: 10.1245/s10434-023-14751-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/25/2023] [Indexed: 01/05/2024]
Abstract
ABSTRACT: BACKGROUND: Pancreatic adenocarcinoma (PDAC) is highly lethal with up to 80% of resected patients experiencing disease recurrence within 2 years (Watanabe, Nakamura, Kimura et al in Int J Mol Sci 23(19):11521, 2022). Cross-sectional imaging and serum tumor markers are used for monitoring post-operative recurrence; however, both have significant limitations (Edland, Tjensvoll, Oltedal et al in Mol Oncol 17:1857-1870, 2023). Circulating tumor DNA (ctDNA) has emerged as a valuable prognostic tool to measure molecular residual disease (MRD) and predict recurrence in solid tumors (Watanabe, Nakamura, Kimura et al in Int J Mol Sci 23(19):11521, 2022). In this study, we evaluated the feasibility of a personalized, tumor-informed ctDNA assay to detect recurrence prior to standard surveillance tools in patients with PDAC. PATIENTS AND METHODS: After Institutional Review Board (IRB) approval (Pro00106870), we assessed serial ctDNA measurements (n = 177) from 35 patients with resectable PDAC treated by either upfront resection or neoadjuvant chemotherapy. Plasma samples (median 4 ml, interquartile range 0.6-5.9 ml) were isolated from blood collected in EDTA tubes and banked at diagnosis, during neoadjuvant therapy if applicable, on the day of surgery, and every 2-3 months postoperatively. A tumor-informed assay (Signatera™, Natera, Inc.) that tracks up to 16 individual-specific, somatic single nucleotide variants in the corresponding patient's plasma samples were used for ctDNA detection. Survival was calculated using Kaplan-Meier curves, and significance was determined with the log-rank test. RESULTS: Personalized ctDNA assays were successfully designed for all patients (with 32/35 patients having 16-plex assays). Median follow-up from initial treatment was 13 months (range 1-26 months; Table 1). ctDNA-positivity at any time point was observed in 40% (14/35) of patients. During the follow-up period, 18 patients (51%) developed radiographic evidence of recurrence after a median of 9 months of follow-up (range 1-26 months). At the time of radiographic recurrence, 50% (9/18) of patients were ctDNA-positive. During the immediate postoperative period (up to 9 weeks post-surgery), RFS and OS were significantly inferior in patients who were ctDNA-positive versus ctDNA-negative (RFS 97 versus 297 days, p < 0.001; OS 110 versus 381 days, p < 0.001; Fig. 1). Table 1 Cohort demographics (N = 35); patient demographics, tumor characteristics, and survival Gender (%) Female 17 (49%) Male 18 (51%) Median age (IQR) 70 years (65-75 years) Neoadjuvant treatment (%) 11 (31%) Median sample plasma volume (IQR) 4.0 mL (0.6-5.9 mL) Median follow-up (range) 13 months (1-26 months) Median initial CA 19-9 in U/mL (IQR) 56 (18-160) Median tumor size in cm (IQR) 2.5 (1.8-3.3) Median number of positive lymph nodes (IQR) 1 (0-3) Median recurrence-free survival 9.4 months Median overall survival N/A (not reached) Fig. 1 a Overview plot showing longitudinal ctDNA status, treatment regimen, and clinical outcomes for each patient (N = 35); median follow-up from the start of the neoadjuvant therapy/surgery was 13 months (range 1-26 months); ctDNA at any time point was 40% (14/35); out of the 35 patients, 18 (51%) developed radiographic evidence of recurrence (median RFS: 9 months), and of these 18 patients with clinical recurrence, 9 (50%) were ctDNA-positive and the remaining ctDNA-negative; notably, all ctDNA-negative patients with recurrence had suboptimal plasma volume available for ctDNA analysis; b, c Kaplan-Meier estimates representing the association of ctDNA status with (b) RFS and (c) OS, at MRD time point (9 weeks post-surgery) DISCUSSION: Our study demonstrates the feasibility of tumor-informed ctDNA-based MRD testing in resectable PDAC and shows that MRD detected by ctDNA within the immediate postoperative period portends a dismal prognosis. This information is valuable for both patients and clinicians in setting prognostic expectations.
Collapse
Affiliation(s)
| | - Elishama Kanu
- Department of Surgery, Duke University, Durham, NC, USA
| | | | - Matthew Bao
- Department of Surgery, Duke University, Durham, NC, USA
| | | | | | | | - Peter J Allen
- Department of Surgery, Duke University, Durham, NC, USA.
| |
Collapse
|
12
|
Walsh EA, Walsh LE, Hernand M, Horick N, Antoni MH, Temel JS, Greer JA, Jacobs JM. Concurrent factors associated with adherence to adjuvant endocrine therapy among women with non-metastatic breast cancer. J Cancer Surviv 2024:10.1007/s11764-024-01556-9. [PMID: 38401012 DOI: 10.1007/s11764-024-01556-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/18/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE Adjuvant endocrine therapy (AET) reduces breast cancer morbidity and mortality, yet women often report suboptimal adherence. Though correlates of AET adherence are well-documented, few studies examine the relative importance of multi-level factors associated with adherence. The aim of this study was to identify factors most strongly associated with AET adherence in women with breast cancer. METHODS Between 10/2019 and 6/2021, women (N = 100) with non-metastatic, hormone receptor-positive breast cancer, taking AET who reported AET-related distress enrolled into a clinical trial. Participants completed baseline measures, including the Medication Adherence Rating Scale-5, sociodemographics, and validated measures of anxiety, depression, medication-taking self-efficacy, social support, and treatment satisfaction. We created a latent factor and tested associations between sociodemographic, medical, and psychosocial characteristics and adherence. Associated predictors (p < .10) were entered into a structural model, which was corroborated via multivariate regression modeling. RESULTS A four-indicator latent adherence factor demonstrated good model fit. Participants (Mage = 56.1 years, 91% White) who were unemployed (B = 0.27, SE = 0.13, p = .046) and reported greater treatment convenience (B = 0.01, SE = 0.01, p = .046) reported greater adherence. Scores of participants who reported greater medication-taking self-efficacy (p = .097) and social support (p = .062) approached better adherence. Greater medication-taking self-efficacy (B = 0.08, SE = 0.02, p < .001) and being unemployed (B = 0.28, SE = .14, p = .042) were most strongly associated with greater adherence, independent of other predictors. Multivariate modeling confirmed similar findings. CONCLUSIONS Medication-taking self-efficacy and employment status were associated with AET adherence above other related factors. IMPLICATIONS FOR CANCER SURVIVORS Enhancing patients' confidence in their ability to take AET for breast cancer may represent an important intervention target to boost adherence.
Collapse
Affiliation(s)
- Emily A Walsh
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL, 33146, USA.
| | - Leah E Walsh
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Max Hernand
- Massachusetts General Hospital, Boston, MA, USA
| | - Nora Horick
- Massachusetts General Hospital, Boston, MA, USA
| | - Michael H Antoni
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL, 33146, USA
| | - Jennifer S Temel
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Joseph A Greer
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jamie M Jacobs
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
13
|
Chen KM, Sun YW, Hu J, Balogh K, Gowda K, Aliaga C, Sun D, Christensen N, Amin S, El-Bayoumy K. Gender Difference in DNA Damage Induced by the Environmental Carcinogen Dibenzo[ def,p]chrysene Individually and in Combination with Mouse Papillomavirus Infection in the Mouse Oral Cavity. ACS Omega 2024; 9:8434-8438. [PMID: 38405470 PMCID: PMC10882652 DOI: 10.1021/acsomega.3c09611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/27/2024]
Abstract
Tobacco smoking and human papillomavirus infection are established etiological agents in the development of head and neck squamous cell carcinoma (HNSCC). The incidence and mortality of HNSCC are higher in men than women. To provide biochemical basis for sex differences, we tested the hypothesis that carcinogen treatment using dibenzo[def,p]chrysene, which is an environmental pollutant and tobacco smoke constituent, in the absence or presence of the mouse papillomavirus infection results in significantly higher levels of DNA damage in the oral cavity in male than in female mice. However, the results of the present investigation do not support our hypothesis since we found that females were more susceptible to carcinogen-induced covalent DNA damage than males independent of the viral infection. Since DNA damage represents only a single-step in the carcinogenesis process, additional factors may contribute to sex differences in humans.
Collapse
Affiliation(s)
- Kun-Ming Chen
- Department
of Biochemistry & Molecular Biology, Penn State College of Medicine, Hershey, Pennsylvania 17033-2360, United States
| | - Yuan-Wan Sun
- Department
of Biochemistry & Molecular Biology, Penn State College of Medicine, Hershey, Pennsylvania 17033-2360, United States
| | - Jiafen Hu
- The
Jake Gittlen Laboratories for Cancer Research, Penn State College of Medicine, Hershey, Pennsylvania 17033-2360, United States
- Department
of Pathology, Penn State College of Medicine, Hershey, Pennsylvania 17033-2360, United
States
| | - Karla Balogh
- The
Jake Gittlen Laboratories for Cancer Research, Penn State College of Medicine, Hershey, Pennsylvania 17033-2360, United States
| | - Krishne Gowda
- Department
of Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania 17033-2360, United
States
| | - Cesar Aliaga
- Department
of Biochemistry & Molecular Biology, Penn State College of Medicine, Hershey, Pennsylvania 17033-2360, United States
| | - Dongxiao Sun
- Department
of Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania 17033-2360, United
States
| | - Neil Christensen
- The
Jake Gittlen Laboratories for Cancer Research, Penn State College of Medicine, Hershey, Pennsylvania 17033-2360, United States
- Department
of Pathology, Penn State College of Medicine, Hershey, Pennsylvania 17033-2360, United
States
| | - Shantu Amin
- Department
of Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania 17033-2360, United
States
| | - Karam El-Bayoumy
- Department
of Biochemistry & Molecular Biology, Penn State College of Medicine, Hershey, Pennsylvania 17033-2360, United States
| |
Collapse
|
14
|
Adashek JJ, Pandya C, Maragakis NJ, De P, Cohen PR, Kato S, Kurzrock R. Neuregulin-1 and ALS19 (ERBB4): at the crossroads of amyotrophic lateral sclerosis and cancer. BMC Med 2024; 22:74. [PMID: 38369520 PMCID: PMC10875826 DOI: 10.1186/s12916-024-03293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/12/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Neuregulin-1 (NRG1) is implicated in both cancer and neurologic diseases such as amyotrophic lateral sclerosis (ALS); however, to date, there has been little cross-field discussion between neurology and oncology in regard to these genes and their functions. MAIN BODY Approximately 0.15-0.5% of cancers harbor NRG1 fusions that upregulate NRG1 activity and hence that of the cognate ERBB3/ERBB4 (HER3/HER4) receptors; abrogating this activity with small molecule inhibitors/antibodies shows preliminary tissue-agnostic anti-cancer activity. Notably, ERBB/HER pharmacologic suppression is devoid of neurologic toxicity. Even so, in ALS, attenuated ERBB4/HER4 receptor activity (due to loss-of-function germline mutations or other mechanisms in sporadic disease) is implicated; indeed, ERBB4/HER4 is designated ALS19. Further, secreted-type NRG1 isoforms may be upregulated (perhaps via a feedback loop) and could contribute to ALS pathogenesis through aberrant glial cell stimulation via enhanced activity of other (e.g., ERBB1-3/HER1-3) receptors and downstream pathways. Hence, pan-ERBB inhibitors, already in use for cancer, may be agents worthy of testing in ALS. CONCLUSION Common signaling cascades between cancer and ALS may represent novel therapeutic targets for both diseases.
Collapse
Affiliation(s)
- Jacob J Adashek
- Department of Oncology, The Johns Hopkins Hospital, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
| | - Chinmayi Pandya
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA, USA
| | | | - Pradip De
- Cancer Genomics, Avera Cancer Institute, Sioux Falls, SD, USA
| | - Philip R Cohen
- Department of Dermatology, Davis Medical Center, University of California, Sacramento, CA, USA
- Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
| | - Shumei Kato
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA, USA
| | - Razelle Kurzrock
- WIN Consortium, Paris, France.
- MCW Cancer Center, Milwaukee, WI, USA.
- University of Nebraska, Omaha, NE, USA.
| |
Collapse
|
15
|
Williams RM, Whealan J, Taylor KL, Adams-Campbell L, Miller KE, Foley K, Luta G, Brandt H, Glassmeyer K, Sangraula A, Yee P, Camidge K, Blumenthal J, Modi S, Kratz H. Multilevel approaches to address disparities in lung cancer screening: a study protocol. Implement Sci Commun 2024; 5:15. [PMID: 38365820 PMCID: PMC10870584 DOI: 10.1186/s43058-024-00553-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/01/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Low-dose computed tomography (lung cancer screening) can reduce lung cancer-specific mortality by 20-24%. Based on this evidence, the United States Preventive Services Task Force recommends annual lung cancer screening for asymptomatic high-risk individuals. Despite this recommendation, utilization is low (3-20%). Lung cancer screening may be particularly beneficial for African American patients because they are more likely to have advanced disease, lower survival, and lower screening rates compared to White individuals. Evidence points to multilevel approaches that simultaneously address multiple determinants to increase screening rates and decrease lung cancer burden in minoritized populations. This study will test the effects of provider- and patient-level strategies for promoting equitable lung cancer screening utilization. METHODS Guided by the Health Disparities Research Framework and the Practical, Robust Implementation and Sustainability Model, we will conduct a quasi-experimental study with four primary care clinics within a large health system (MedStar Health). Individuals eligible for lung cancer screening, defined as 50-80 years old, ≥ 20 pack-years, currently smoking, or quit < 15 years, no history of lung cancer, who have an appointment scheduled with their provider, and who are non-adherent to screening will be identified via the EHR, contacted, and enrolled (N = 184 for implementation clinics, N = 184 for comparison clinics; total N = 368). Provider participants will include those practicing at the partner clinics (N = 26). To increase provider-prompted discussions about lung screening, an electronic health record (EHR) clinician reminder will be sent to providers prior to scheduled visits with the screening-eligible participants. To increase patient-level knowledge and patient activation about screening, an inreach specialist will conduct a pre-visit phone-based educational session with participants. Patient participants will be assessed at baseline and 1-week post-visit to measure provider-patient discussion, screening intentions, and knowledge. Screening referrals and screening completion rates will be assessed via the EHR at 6 months. We will use mixed methods and multilevel assessments of patients and providers to evaluate the implementation outcomes (adoption, feasibility, acceptability, and fidelity). DISCUSSION The study will inform future work designed to measure the independent and overlapping contributions of the multilevel implementation strategies to advance equity in lung screening rates. TRIAL REGISTRATION ClinicalTrials.gov, NCT04675476. Registered December 19, 2020.
Collapse
Affiliation(s)
- Randi M Williams
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA.
| | - Julia Whealan
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Kathryn L Taylor
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Lucile Adams-Campbell
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | | | - Kristie Foley
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Heather Brandt
- Epidemiology and Cancer Control Department, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Katharine Glassmeyer
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Anu Sangraula
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Peyton Yee
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Kaylin Camidge
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | | | | | - Heather Kratz
- The Catholic University of America, Washington, DC, USA
| |
Collapse
|
16
|
Jacobo Jacobo M, Donnella HJ, Sobti S, Kaushik S, Goga A, Bandyopadhyay S. An inflamed tumor cell subpopulation promotes chemotherapy resistance in triple negative breast cancer. Sci Rep 2024; 14:3694. [PMID: 38355954 PMCID: PMC10866903 DOI: 10.1038/s41598-024-53999-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/07/2024] [Indexed: 02/16/2024] Open
Abstract
Individual cancers are composed of heterogeneous tumor cells with distinct phenotypes and genotypes, with triple negative breast cancers (TNBC) demonstrating the most heterogeneity among breast cancer types. Variability in transcriptional phenotypes could meaningfully limit the efficacy of monotherapies and fuel drug resistance, although to an unknown extent. To determine if transcriptional differences between tumor cells lead to differential drug responses we performed single cell RNA-seq on cell line and PDX models of breast cancer revealing cell subpopulations in states associated with resistance to standard-of-care therapies. We found that TNBC models contained a subpopulation in an inflamed cellular state, often also present in human breast cancer samples. Inflamed cells display evidence of heightened cGAS/STING signaling which we demonstrate is sufficient to cause tumor cell resistance to chemotherapy. Accordingly, inflamed cells were enriched in human tumors taken after neoadjuvant chemotherapy and associated with early recurrence, highlighting the potential for diverse tumor cell states to promote drug resistance.
Collapse
Affiliation(s)
- Mauricio Jacobo Jacobo
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Hayley J Donnella
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Sushil Sobti
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Swati Kaushik
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Andrei Goga
- Department of Cell & Tissue Biology, University of California San Francisco, San Francisco, CA, 94143, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Sourav Bandyopadhyay
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, CA, 94143, USA.
| |
Collapse
|
17
|
Gu D, Rafferty H, Vijayaraghavan M. Factors Associated with Smoking Cessation and the Receipt of Cessation Services in a Public, Safety-Net Primary Care System. J Gen Intern Med 2024:10.1007/s11606-024-08664-3. [PMID: 38332442 DOI: 10.1007/s11606-024-08664-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Prevalence of smoking is high among patients receiving care in safety-net settings, and there is a need to better understand patient factors associated with smoking cessation and receipt of cessation services. OBJECTIVE To identify patient factors associated with smoking cessation attempts and receipt of cessation counseling and pharmacotherapy in a large safety-net health system. DESIGN We conducted a retrospective cohort analysis using EHR data in a safety-net system in San Francisco, CA. PARTICIPANTS We included 7384 adult current smokers who had at least three unique primary care encounters with documented smoking status between August 2019 and April 2022. MAIN MEASURES We assessed four outcomes using multivariate generalized estimating equation models: (1) any cessation attempt, indicating a transition in smoking status from "current smoker" to "former smoker"; (2) sustained cessation, defined as transition in smoking status from current smoker to former smokers for two or more consecutive visits; (3) receipt of smoking cessation counseling from healthcare providers; and (4) receipt of pharmacotherapy. KEY RESULTS Of 7384 current adult smokers, 17.6% had made any cessation attempt, and of those 66.5% had sustained cessation. Most patients (81.1%) received counseling and 41.8% received pharmacotherapy. Factors associated with lower odds of any cessation attempt included being aged 45-64, non-Hispanic black, and experiencing homelessness. The factor associated with lower odds of sustained cessation was being male. Factors associated with lower odds of receiving counseling were being insured by Medicaid or being uninsured. Factors associated with lower odds of receiving pharmacotherapy included speaking languages other than English, being male, and identifying as racial and ethnic minorities. CONCLUSIONS Health system interventions could close the gap in access to smoking cessation services for unhoused and racial/ethnic minority patients in safety-net settings, thereby increasing cessation among these populations.
Collapse
Affiliation(s)
- Dian Gu
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA, USA.
- Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA.
| | - Henry Rafferty
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Maya Vijayaraghavan
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA, USA
- San Francisco Department of Public Health, San Francisco, CA, USA
| |
Collapse
|
18
|
Vu M, Zhu Y, Trinh DD, Hong YR, Suk R. Awareness and Knowledge of HPV and HPV Vaccine among Asian American Adults by Origin Group: a 2014-2019 Population-Based Analysis. J Gen Intern Med 2024; 39:342-344. [PMID: 37884834 PMCID: PMC10853116 DOI: 10.1007/s11606-023-08485-w] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Milkie Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yenan Zhu
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Duy D Trinh
- Niehaus Center for Globalization and Governance, Princeton University, Princeton, NJ, USA
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
- UF Health Cancer Center, Gainesville, FL, USA
| | - Ryan Suk
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
| |
Collapse
|
19
|
Hammerback K, Strait M, Kohn MJ, Garcia C, Harris JR, Hannon PA. Exploring the Impact of the COVID-19 Pandemic on Employees' Workplace Health Promotion Preferences. Am J Health Promot 2024; 38:238-241. [PMID: 37349879 PMCID: PMC10291210 DOI: 10.1177/08901171231185765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
PURPOSE The COVID-19 pandemic has led to profound changes in the workplace as well as increases in stress, missed preventive care, and other health concerns. There is limited research since the onset of the pandemic on employees' primary health concerns and their willingness to engage with workplace health promotion (WHP) programs to address these needs. We conducted this survey about employees' current health priorities as a first step to exploring whether WHP programs need to evolve to be responsive to employees' needs at this stage of the pandemic. DESIGN National cross-sectional survey. SETTING United States, April 29-May 5, 2022. SUBJECTS 2053 Americans employed part or full time. MEASURES 17-item online survey assessing demographics, health priorities, and impact of the pandemic on health. ANALYSIS Descriptive statistics, SPSS Version 19. RESULTS Employees' most common health concerns included work/life balance and stress (each cited by 55%). Nearly half (46%) said their health or well-being was affected by the pandemic; within this group, the most common concerns were stress (66%), anxiety (61%), sleep (49%), and depression (48%). Almost all (94%) indicated they would be open to receiving support from their employers. CONCLUSION This research is a first step in learning about employees' current health priorities and how they may have changed. WHP researchers and practitioners can determine how their programs align with current priorities. Our future research will explore employees' preferences, heath behaviors, and their current workplace environments in more depth.
Collapse
Affiliation(s)
- Kristen Hammerback
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Michelle Strait
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Marlana J. Kohn
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Cinthya Garcia
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Jeffrey R. Harris
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Peggy A. Hannon
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
20
|
Fiveash JB, Ye X, Peerboom DM, Mikkelsen T, Chowdhary S, Rosenfeld M, Lesser GJ, Fisher J, Desideri S, Grossman S, Leopold L, Nabors LB. Clinical trials of R-(-)-gossypol (AT-101) in newly diagnosed and recurrent glioblastoma: NABTT 0602 and NABTT 0702. PLoS One 2024; 19:e0291128. [PMID: 38285688 PMCID: PMC10824421 DOI: 10.1371/journal.pone.0291128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 08/21/2023] [Indexed: 01/31/2024] Open
Abstract
PURPOSE AT-101 is an oral bcl-2 family protein inhibitor (Bcl-2, Bcl-XL, Mcl-1, Bcl-W) and potent inducer of proapoptotic proteins. A prior study of the parent compound, racemic gossypol, demonstrated objective and durable responses in patients with malignant glioma. AT-101 has demonstrated synergy with radiation in animal models. The objectives of trial NABTT 0602 were to determine the MTD of AT-101 concurrent with temozolomide (TMZ) and radiation therapy (RT) (Arm I) and to determine the MTD of AT-101 when given with adjuvant TMZ after completion of standard chemoradiation (Arm 2). Separately in trial NABTT 0702, the survival and response rates of single agent AT-101 were evaluated in patients with recurrent glioblastoma. METHODS In NABTT 0602 Phase I, a 3+3 design was used to define MTDs after maximal safe resection, patients with newly diagnosed glioblastoma received standard concurrent RT (60 Gy) and TMZ 75 mg/m2/day followed by adjuvant TMZ 150-200 mg/m2 days 1-5 in 28-day cycles (Stupp regimen). In Arm I, AT-101 was administered M-F during the six weeks of RT beginning 20 mg qd. In Arm 2, concurrent with each adjuvant cycle of TMZ, AT-101 was administered at a starting dose of 20 mg, days 1-21 followed by 7-day break for a maximum of 6 cycles. The PK blood samples were collected in the first three patients in each cohort of arm 1. In NABTT 0702 patients with recurrent glioblastoma received 20 mg p.o. per day for 21 of 28 days in repeated cycles to assess overall survival (OS). RESULTS A total of sixteen patients were enrolled on the two study arms of NABTT 0602. In Arm 1 AT-101 was escalated from 20 to 30 mg where one of six patients experienced DLT (grade 3 GI ulcer). On Arm 2 one patient treated at 20 mg experienced DLT (grade 3 ileus, nausea and diarrhea). The cohort was expanded to include seven patients without observation of DLT. PK results were consistent with drug levels from non-CNS studies. At study closure six patients are still alive. The median survival times for Arm I and Arm II are 15.2 months and 18.2 months, respectively. In NABTT 0702 fifty-six patients were enrolled and forty-three were eligible for imaging response. Sixteen patients (29%) had stable disease as best response and one partial response was observed. The median OS with single agent AT-101 was 5.7 months (95%CI: 3.8-7.6 months) for patients with rGBM. CONCLUSIONS AT-101 can be safely administered with radiation therapy and TMZ in patients with newly diagnosed glioblastoma without toxicity unique to patients with CNS tumors. Because of toxicity observed in non-CNS AT-101 clinical trials, further dose-escalation was not attempted. The recommended dose for future studies that utilize continual AT-101 exposure is 20 mg days M-F concurrent with RT/TMZ and 20 mg days 1-21 for each 28-day cycle of TMZ. AT-101 has limited activity as a single agent in unselected patients with recurrent glioblastoma. Future trials should attempt to better understand resistance mechanisms and consider combination therapy.
Collapse
Affiliation(s)
- John B. Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Xiaobu Ye
- Departments of Neurosurgery and Oncology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - David M. Peerboom
- Cleveland Clinic Brain Tumor and Neuro-Oncology Center, Cleveland, Ohio, United States of America
| | - Tom Mikkelsen
- Henry Ford Hospital Hermelin Brain Center, Michigan, Indiana, United States of America
| | | | - Myrna Rosenfeld
- University of Pennsylvania Department of Neurology, Philadelphia, Pennsylvania, United States of America
| | - Glenn J. Lesser
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Joy Fisher
- Departments of Neurosurgery and Oncology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Serena Desideri
- Departments of Neurosurgery and Oncology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Stuart Grossman
- Departments of Neurosurgery and Oncology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Lance Leopold
- Incyte, Wilmington, Delaware, United States of America
| | - Louis B. Nabors
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| |
Collapse
|
21
|
Qian J, Wang Q, Xiao L, Xiong W, Xian M, Su P, Yang M, Zhang C, Li Y, Zhong L, Ganguly S, Zu Y, Yi Q. Development of therapeutic monoclonal antibodies against DKK1 peptide-HLA-A2 complex to treat human cancers. J Immunother Cancer 2024; 12:e008145. [PMID: 38267222 PMCID: PMC10824003 DOI: 10.1136/jitc-2023-008145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Targeted immunotherapy with monoclonal antibodies (mAbs) is an effective and safe method for the treatment of malignancies. Development of mAbs with improved cytotoxicity, targeting new and known tumor-associated antigens, therefore continues to be an active research area. We reported that Dickkopf-1 (DKK1) is a good target for immunotherapy of human cancers based on its wide expression in different cancers but not in normal tissues. As DKK1 is a secreted protein, mAbs binding directly to DKK1 have limited effects on cancer cells in vivo. METHODS The specificity and antibody-binding capacity of DKK1-A2 mAbs were determined using indirect ELISA, confocal imaging, QIFIKIT antibody-binding capacity and cell surface binding assays. The affinity of mAbs was determined using a surface plasmon resonance biosensor. A flow cytometry-based cell death was performed to detect tumor cell apoptosis. Antibody-dependent cellular cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC) assays were used to evaluate the ability of DKK1-A2 mAbs to mediate ADCC and CDC activities against tumor cells in vitro. Flow cytometry data were collected with an FACSymphony A3 cell analyzer and analyzed with FlowJo V.10.1 software. Human cancer xenograft mouse models were used to determine the in vivo therapeutic efficacy and the potential safety and toxicity of DKK1-A2 mAbs. In situ TUNEL assay was performed to detect apoptosis in tumors and mouse organs. RESULTS We generated novel DKK1-A2 mAbs that recognize the DKK1 P20 peptide presented by human HLA-A*0201 (HLA-A2) molecules (DKK1-A2 complexes) that are naturally expressed by HLA-A2+DKK1+ cancer cells. These mAbs directly induced apoptosis in HLA-A2+DKK1+ hematologic and solid cancer cells by activating the caspase-9 cascade, effectively lysed the cancer cells in vitro by mediating CDC and ADCC and were therapeutic against established cancers in their xenograft mouse models. As DKK1 is not detected in most human tissues, DKK1-A2 mAbs neither bound to or killed HLA-A2+ blood cells in vitro nor caused tissue damage in tumor-free or tumor-bearing HLA-A2-transgenic mice. CONCLUSION Our study suggests that DKK1-A2 mAbs may be a promising therapeutic agent to treat human cancers.
Collapse
Affiliation(s)
- Jianfei Qian
- Center for Translational Research in Hematological Malignancies, Houston Methodist Neal Cancer Center/Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Qiang Wang
- Center for Translational Research in Hematological Malignancies, Houston Methodist Neal Cancer Center/Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Liuling Xiao
- Center for Translational Research in Hematological Malignancies, Houston Methodist Neal Cancer Center/Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Wei Xiong
- Center for Translational Research in Hematological Malignancies, Houston Methodist Neal Cancer Center/Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Miao Xian
- Center for Translational Research in Hematological Malignancies, Houston Methodist Neal Cancer Center/Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Pan Su
- Center for Translational Research in Hematological Malignancies, Houston Methodist Neal Cancer Center/Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Maojie Yang
- Center for Translational Research in Hematological Malignancies, Houston Methodist Neal Cancer Center/Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Chuanchao Zhang
- Center for Translational Research in Hematological Malignancies, Houston Methodist Neal Cancer Center/Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Yabo Li
- Center for Translational Research in Hematological Malignancies, Houston Methodist Neal Cancer Center/Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Ling Zhong
- Center for Translational Research in Hematological Malignancies, Houston Methodist Neal Cancer Center/Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Siddhartha Ganguly
- Houston Methodist Neal Cancer Center, Houston Methodist Research Institute, Houston, TX, USA
| | - Youli Zu
- Department of Pathology and Genomic Medicine, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Qing Yi
- Center for Translational Research in Hematological Malignancies, Houston Methodist Neal Cancer Center/Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
| |
Collapse
|
22
|
Wipfli H, Arinaitwe J, Goma F, Atuyambe L, Guwatudde D, Phiri MM, Rutebemberwa E, Wabwire-Mangen F, Zulu R, Zyambo C, Guy K, Kusolo R, Mukupa M, Musasizi E, Tucker JS. A phone-based tobacco use cessation program for people living with HIV in Uganda and Zambia: study protocol for a randomized controlled trial. Addict Sci Clin Pract 2024; 19:6. [PMID: 38243301 PMCID: PMC10797805 DOI: 10.1186/s13722-024-00438-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Nicotine replacement therapy (NRT) and short messaging service (SMS)-based tobacco cessation interventions have demonstrated effectiveness in reducing tobacco use in many populations, but evidence is needed on which tailored treatments are most efficacious in meeting the complex medical and psychosocial factors confronting people living with HIV (PLWH) in sub-Saharan Africa (SSA). This paper describes the protocol of a study to test the efficacy of both NRT and a tailored SMS-based tobacco use cessation intervention among PLWH in Uganda and Zambia. METHODS In a randomized controlled trial, 800 adult PLWH who use tobacco will be recruited by health care professionals at HIV treatment centers where they are receiving care. Participants will be randomized to one of the four study arms: (1) standard of care [SOC; brief clinician advice to quit combined with HIV education and information aimed at encouraging HIV treatment adherence (with no mention of tobacco) delivered via text messages]; (2) SOC + 12 weeks of NRT; (3) SOC + 6 weeks of SMS text messages to support quitting tobacco use (SMS); or (4) SOC + NRT + SMS. Participants will receive a cell phone and solar panel with power bank for charging the phone. The main outcome is cessation of tobacco use by study participants verified by urinary cotinine (< 15 ng/mL) at 6 months post-enrollment. As a secondary tobacco use outcome, we will measure 7-day point-prevalence abstinence (7 consecutive days of no tobacco use) measured by self-report and biochemically-verified at 4 weeks, 8 weeks, and 3 months post enrollment. DISCUSSION Our study will provide insight into the efficacy, feasibility and applicability of delivering tobacco cessation interventions through health care professionals combined with tailored tobacco cessation SMS text messaging in two countries with different tobacco use patterns, policy environments, and health care resources and provide needed information to providers and policymakers looking for cost-effective tobacco cessation interventions. The previously tested SMS-platform to be used in our study is uniquely positioned to be scaled in low- and middle-income countries worldwide, in which case evidence of even modest success in reducing the prevalence of tobacco consumption among PLWH could confer enormous health and economic benefits. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT05487807. Registered August 4, 2022, https://clinicaltrials.gov/ct2/show/record/NCT05487807.
Collapse
Affiliation(s)
- Heather Wipfli
- Keck School of Medicine, Department of Preventative Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90033, USA.
| | - Jim Arinaitwe
- School of Public Health, Makerere University, Centre for Tobacco Control in Africa, Kampala, Uganda
| | - Fastone Goma
- School of Medicine, University of Zambia, Centre For Primary Care Research, Lusaka, Zambia
| | - Lynn Atuyambe
- School of Public Health, Department of Community Health and Behavioural Sciences, Makerere University, Kampala, Uganda
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Masauso Moses Phiri
- School of Medicine, University of Zambia, Centre For Primary Care Research, Lusaka, Zambia
- School of Medicine, Department of Pathology and Microbiology, University of Zambia, Lusaka, Zambia
| | - Elizeus Rutebemberwa
- School of Public Health, Department of Health Policy, Makerere University, Planning, and Management, Kampala, Uganda
| | - Fred Wabwire-Mangen
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Richard Zulu
- School of Medicine, University of Zambia, Centre For Primary Care Research, Lusaka, Zambia
| | - Cosmas Zyambo
- School of Public Health, Department of Community and Family Medicine, University of Zambia, Lusaka, Zambia
| | - Kyra Guy
- Keck School of Medicine, Department of Preventative Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90033, USA
| | - Ronald Kusolo
- School of Public Health, Makerere University, Centre for Tobacco Control in Africa, Kampala, Uganda
| | - Musawa Mukupa
- School of Medicine, University of Zambia, Centre For Primary Care Research, Lusaka, Zambia
| | - Ezekiel Musasizi
- School of Public Health, Makerere University, Centre for Tobacco Control in Africa, Kampala, Uganda
| | | |
Collapse
|
23
|
Craig DW, Walker TJ, Cuccaro P, Sharma SV, Heredia NI, Robertson MC, Fernandez ME. Using the R = MC 2 heuristic to understand barriers to and facilitators of implementing school-based physical activity opportunities: a qualitative study. BMC Public Health 2024; 24:207. [PMID: 38233842 PMCID: PMC10792959 DOI: 10.1186/s12889-024-17744-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 01/11/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Schools are a key setting for supporting youth physical activity, given their broad reach and diverse student populations. Organizational readiness is a precursor to the successful implementation of school-based physical activity opportunities. The R = MC2 heuristic (Readiness = Motivation x Innovation-Specific Capacity x General Capacity) describes readiness as a function of an organization's motivation and capacity to implement an innovation and can be applied to better understand the implementation process. The purpose of this study was to explore the barriers to and facilitators of implementing school-based physical activity opportunities in the context of organizational readiness. METHODS We analyzed interview data from 15 elementary school staff (principals, assistant principals, physical education teachers, and classroom teachers) from a school district in Texas. We focused on factors related to adopting, implementing, and sustaining a variety of school-based physical activity opportunities. We used the Framework Method to guide the analysis and coded data using deductive (informed by the R = MC2 heuristic) and inductive approaches. Themes were generated using the frequency, depth, and richness of participant responses. RESULTS Four themes emerged from the data: (1) implementation is aided by the presence of internal and external relationships; (2) physical activity opportunities compete with other school priorities; (3) seeing the benefits of physical activity opportunities motivates school staff toward implementation; and (4) staff buy-in is critical to the implementation process. Themes 1-3 aligned with subcomponents of the R = MC2 heuristic (intra- and inter-organizational relationships, priority, and observability), whereas Theme 4 (staff buy-in) related to multiple subcomponents within the Motivation component but was ultimately viewed as a distinct construct. CONCLUSION Our results highlight and explain how key readiness constructs impact the implementation of school-based physical activity opportunities. They also highlight the importance of obtaining staff buy-in when implementing in the school setting. This information is critical to developing readiness-building strategies that help schools improve their capacity to deliver physical activity opportunities effectively. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Derek W Craig
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA.
| | - Timothy J Walker
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Paula Cuccaro
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Shreela V Sharma
- Department of Epidemiology, Human Genetics, & Environmental Sciences, Center for Health Equity, Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Natalia I Heredia
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Michael C Robertson
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
- Department of Family and Preventive Medicine, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Maria E Fernandez
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| |
Collapse
|
24
|
Padamsee TJ, Bijou C, Swinehart-Hord P, Hils M, Muraveva A, Meadows RJ, Shane-Carson K, Yee LD, Wills CE, Paskett ED. Risk-management decision-making data from a community-based sample of racially diverse women at high risk of breast cancer: rationale, methods, and sample characteristics of the Daughter Sister Mother Project survey. Breast Cancer Res 2024; 26:8. [PMID: 38212792 PMCID: PMC10785448 DOI: 10.1186/s13058-023-01753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND To understand the dynamics that limit use of risk-management options by women at high risk of breast cancer, there is a critical need for research that focuses on patient perspectives. Prior research has left important gaps: exclusion of high-risk women not in risk-related clinical care, exclusion of non-white populations, and lack of attention to the decision-making processes that underlie risk-management choices. Our objective was to create a more inclusive dataset to facilitate research to address disparities related to decision making for breast cancer risk management. METHODS The Daughter Sister Mother Project survey collects comprehensive information about the experiences of women at high risk of breast cancer. We collected novel measures of feelings about and reactions to cancer screenings; knowledge, barriers, and facilitators of risk-management options; beliefs related to cancer risk and risk management; and involvement with loved ones who had cancer. Eligible individuals were non-Hispanic white and non-Hispanic Black adult women who self-identified as having high risk of breast cancer and had no personal history of cancer. Between October 2018 and August 2019, 1053 respondents completed the online survey. Of these, 717 were confirmed through risk prediction modeling to have a lifetime breast cancer risk of ≥ 20%. Sociodemographic characteristics of this sample were compared to those of nationally representative samples of the US population: the 2019 Health Information National Trends Survey and the Pew Research Center report: Jewish Americans in 2020. RESULTS The sample of 717 women at objectively high risk of breast cancer was largely (95%) recruited from non-clinical sources. Of these respondents, only 31% had seen a genetic counselor, 34% had had genetic testing specific to breast cancer risk, and 35% had seen at least one breast or cancer care specialist. The sample includes 35% Black respondents and 8% with Ashkenazi Jewish ancestry. Although encompassing a substantial range of ages, incomes, and education levels, respondents are overall somewhat younger, higher-income, and more educated than the US population as a whole. CONCLUSIONS The DSM dataset offers comprehensive data from a community-based, diverse sample of women at high risk of breast cancer. The dataset includes substantial proportions of Black and Ashkenazi Jewish women and women who are not already in clinical care related to their breast cancer risk. This sample will facilitate future studies of risk-management behaviors among women who are and are not receiving high-risk care, and of variations in risk-management experiences across race and ethnicity.
Collapse
Affiliation(s)
- Tasleem J Padamsee
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA.
| | - Christina Bijou
- Department of Sociology, The Ohio State University, Columbus, OH, USA
| | - Paige Swinehart-Hord
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA
| | - Megan Hils
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 280F Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA
| | - Anna Muraveva
- Government Resources Center, The Ohio State University, Columbus, OH, USA
| | - Rachel J Meadows
- Center for Epidemiology and Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | | | - Lisa D Yee
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Celia E Wills
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Electra D Paskett
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
25
|
Shareef F, Bharti B, Garcia-Bigley F, Hernandez M, Nodora J, Liu J, Ramers C, Nery JD, Marquez J, Moyano K, Rojas S, Arredondo E, Gupta S. Abnormal Colorectal Cancer Test Follow-Up: A Quality Improvement Initiative at a Federally Qualified Health Center. J Prim Care Community Health 2024; 15:21501319241242571. [PMID: 38554066 PMCID: PMC10981848 DOI: 10.1177/21501319241242571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 04/01/2024] Open
Abstract
INTRODUCTION/OBJECTIVES Colonoscopy completion rates after an abnormal fecal immunochemical test (FIT) are suboptimal, resulting in missed opportunities for early detection and prevention of colorectal cancer. Patient navigation and structured follow-up may improve colonoscopy completion, but implementation of these strategies is not widespread. METHODS We conducted a quality improvement study using a Plan-Do-Study-Act (PDSA) Model to increase colonoscopy completion after abnormal FIT in a large federally qualified health center serving a diverse and low-income population. Intervention components included patient navigation, and a checklist to promote completion of key steps required for abnormal FIT follow-up. Primary outcome was proportion of patients achieving colonoscopy completion within 6 months of abnormal FIT, assessed at baseline for 156 patients pre-intervention, and compared to 208 patients during the intervention period from April 2017 to December 2019. Drop offs at each step in the follow-up process were assessed. RESULTS Colonoscopy completion improved from 21% among 156 patients with abnormal FIT pre-intervention, to 38% among 208 patients with abnormal FIT during the intervention (P < .001; absolute increase: 17%, 95% CI: 6.9%-25.2%). Among the 130 non-completers during the intervention period, lack of completion was attributable to absence of colonoscopy referral for 7.7%; inability to schedule a pre-colonoscopy specialist visit for 71.5%; failure to complete a pre-colonoscopy visit for 2.3%; the absence of colonoscopy scheduling for 9.2%; failure to show for a scheduled colonoscopy for 9.2%. CONCLUSIONS Patient navigation and structured follow-up appear to improve colonoscopy completion after abnormal FIT. Additional strategies are needed to achieve optimal rates of completion.
Collapse
Affiliation(s)
- Faizah Shareef
- University of California San Diego (Internal Medicine), La Jolla, CA, USA
| | - Balambal Bharti
- University of California San Diego (Internal Medicine), La Jolla, CA, USA
| | | | | | - Jesse Nodora
- University of California San Diego (Radiation Medicine), La Jolla, CA, USA
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Jie Liu
- Shang Consulting LLC, San Diego CA, USA
| | - Christian Ramers
- Family Health Centers of San Diego (Graduate Medical Education), San Diego, CA, USA
| | | | | | - Karina Moyano
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | | | | | - Samir Gupta
- University of California San Diego (Internal Medicine), La Jolla, CA, USA
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| |
Collapse
|
26
|
Salameh ZS, Aycock KN, Alinezhadbalalami N, Imran KM, McKillop IH, Allen IC, Davalos RV. Harnessing the Electrochemical Effects of Electroporation-Based Therapies to Enhance Anti-tumor Immune Responses. Ann Biomed Eng 2024; 52:48-56. [PMID: 37989902 PMCID: PMC10781785 DOI: 10.1007/s10439-023-03403-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/31/2023] [Indexed: 11/23/2023]
Abstract
This study introduces a new method of targeting acidosis (low pH) within the tumor microenvironment (TME) through the use of cathodic electrochemical reactions (CER). Low pH is oncogenic by supporting immunosuppression. Electrochemical reactions create local pH effects when a current passes through an electrolytic substrate such as biological tissue. Electrolysis has been used with electroporation (destabilization of the lipid bilayer via an applied electric potential) to increase cell death areas. However, the regulated increase of pH through only the cathode electrode has been ignored as a possible method to alleviate TME acidosis, which could provide substantial immunotherapeutic benefits. Here, we show through ex vivo modeling that CERs can intentionally elevate pH to an anti-tumor level and that increased alkalinity promotes activation of naïve macrophages. This study shows the potential of CERs to improve acidity within the TME and that it has the potential to be paired with existing electric field-based cancer therapies or as a stand-alone therapy.
Collapse
Affiliation(s)
- Zaid S Salameh
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 325 Stanger St, Blacksburg, VA, 24061, USA
| | - Kenneth N Aycock
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 325 Stanger St, Blacksburg, VA, 24061, USA
| | - Nastaran Alinezhadbalalami
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 325 Stanger St, Blacksburg, VA, 24061, USA
| | - Khan Mohammad Imran
- Department of Biomedical Sciences and Pathobiology, VA-MD College of Veterinary Medicine, Virginia Tech, 205 Duck Pond Drive, Blacksburg, VA, 24061, USA
| | - Iain H McKillop
- Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Irving C Allen
- Department of Biomedical Sciences and Pathobiology, VA-MD College of Veterinary Medicine, Virginia Tech, 205 Duck Pond Drive, Blacksburg, VA, 24061, USA
| | - Rafael V Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 325 Stanger St, Blacksburg, VA, 24061, USA.
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech - Emory, 313 Ferst Dr, Atlanta, GA, 30308, USA.
| |
Collapse
|
27
|
Osaghae I, Chido-Amajuoyi OG, Talluri R, Shete S. Prevalence, reasons for use, perceived benefits, and awareness of health risks of cannabis use among cancer survivors - implications for policy and interventions. J Cancer Surviv 2023:10.1007/s11764-023-01526-7. [PMID: 38158514 DOI: 10.1007/s11764-023-01526-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND There is increasing discourse on the use of cannabis as a palliative for cancer/cancer-treatment-related symptoms. We described the prevalent reasons for use, perceived benefits, and awareness of health risks from cannabis use for cancer management among cancer survivors. METHODS Cross-sectional survey of adult (≥ 18 years) cancer survivors from 41 US states receiving treatment at a comprehensive cancer center. RESULTS Of 1,886 cancer survivors included, 17.4% were current users, 30.5% were former users, and 52.2% were never users of cannabis. Among survivors who currently or formerly used cannabis after their cancer diagnosis (n = 510), the reasons for cannabis use in cancer management were; sleep disturbance (60%), pain (51%), stress (44%), nausea (34%), and mood disorder/depression (32%). Also, about a fifth (91/510) of survivors used cannabis to treat their cancer. Across the different symptoms assessed, over half of the survivors who reported a reason for using cannabis currently or after their cancer diagnosis perceived that cannabis was helpful to a great extent in improving their symptoms. However, of the 167 survivors who reported awareness of potential health risks from cannabis use, the awareness of adverse health risks associated with cannabis use was low: suicidal thoughts (5%), intense nausea and vomiting (6%), depression (11%), anxiety (14%), breathing problems (31%), and interaction with cancer drugs (35%). CONCLUSION Prevalence of cannabis use among survivors was notable, with most reporting a great degree of symptomatic improvement for the specified reason for use. However, only a few were aware of the health risks of cannabis use during cancer management. IMPLICATIONS FOR CANCER SURVIVORS With more cancer survivors using cannabis as a palliative in managing their cancer-related symptoms, future guidelines and policies on cannabis use in cancer management should incorporate cannabis-based interventions to minimize the inadvertent harm from cannabis use during cancer treatment among survivors.
Collapse
Affiliation(s)
- Ikponmwosa Osaghae
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Rajesh Talluri
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, 1400 Pressler Dr., FCT4.6002, Houston, TX, 77030, USA.
| |
Collapse
|
28
|
Williams NO, Quiroga D, Johnson C, Brufsky A, Chambers M, Bhattacharya S, Patterson M, Sardesai SD, Stover D, Lustberg M, Noonan AM, Cherian M, Bystry DM, Hill KL, Chen M, Phelps MA, Grever M, Stephens JA, Ramaswamy B, Carson WE, Wesolowski R. Phase Ib study of HSP90 inhibitor, onalespib (AT13387), in combination with paclitaxel in patients with advanced triple-negative breast cancer. Ther Adv Med Oncol 2023; 15:17588359231217976. [PMID: 38152697 PMCID: PMC10752118 DOI: 10.1177/17588359231217976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/15/2023] [Indexed: 12/29/2023] Open
Abstract
Background Heat shock protein 90 (HSP90) is a molecular chaperone required for stabilization of client proteins over-activated in triple-negative breast cancer (TNBC). Over-expression of HSP90 client proteins has been implicated in paclitaxel resistance. Onalespib (AT13387) is a potent inhibitor of HSP90 that could improve paclitaxel efficacy when administered in combination. Design This phase Ib trial administered onalespib with paclitaxel in patients with advanced TNBC to assess safety and establish a recommended phase II dose (RP2D). Objectives The primary objectives were determining the dose-limiting toxicities and maximum tolerated dose of combination therapy. Secondary objectives included pharmacokinetic (PK) analysis and determination of overall response rate (ORR), duration of response (DOR), and progression-free survival (PFS). Methods Patients with advanced TNBC were treated with standard dose intravenous paclitaxel in combination with intravenous onalespib at doses ranging from 120 to 260 mg/m2 administered on days 1, 8, and 15 of a 28-day cycle using a standard 3 + 3 design. A total of 15 patients were enrolled to dose expansion cohort at RP2D to confirm safety profile. Results Thirty-one patients were enrolled in the study, of which over 90% had received prior taxane therapy. Paclitaxel was given for metastatic disease in 23% of patients. Adverse events (AEs) included anemia (grade 3: 20%), lymphopenia (grade 3: 17%), and neutropenia (grade 3: 33%, grade 4: 4%). The most frequent grade ⩾3 non-hematologic AE was diarrhea (7%). The established RP2D was 260 mg/m2 onalespib when given with paclitaxel at 80 mg/m2. PK analysis revealed a modest drug interaction profile for onalespib in the combination regimen. ORR was 20%. Three patients achieved complete responses, all of whom had received prior taxane therapy. Median DOR was 5.6 months; median PFS was 2.9 months. Conclusion Combination treatment with onalespib and paclitaxel had an acceptable toxicity profile and RP2D was determined to be 260 mg/m2 of onalespib. Combination therapy showed antitumor activity in patients with advanced TNBC. Trial registration Onalespib and paclitaxel in treating patients with advanced TNBC https://clinicaltrials.gov/ct2/show/NCT02474173.
Collapse
Affiliation(s)
- Nicole O. Williams
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Dionisia Quiroga
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Courtney Johnson
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Adam Brufsky
- University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, USA
| | - Mara Chambers
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
| | | | - Maria Patterson
- Stefanie Spielman Comprehensive Breast Center, The Ohio State University, Columbus, OH, USA
| | - Sagar D. Sardesai
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Daniel Stover
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Maryam Lustberg
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Anne M. Noonan
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mathew Cherian
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Darlene M. Bystry
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Kasey L. Hill
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Min Chen
- The Ohio State University College of Pharmacy, Columbus, OH, USA
| | - Mitch A. Phelps
- The Ohio State University – Arthur G. James Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Pharmacy, Columbus, OH, USA
| | - Michael Grever
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Julie A. Stephens
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - William E. Carson
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, 1800 Cannon Drive, 1310D Lincoln Tower, Columbus, OH 43210, USA
| |
Collapse
|
29
|
Henry C, Kruell JA, Wilson RM, Chang CF, Woo CM, Koehler AN. A Versatile Isocyanate-Mediated Strategy for Appending Chemical Tags onto Drug-Like Small Molecules. Bioconjug Chem 2023; 34:2181-2186. [PMID: 38052453 PMCID: PMC10739574 DOI: 10.1021/acs.bioconjchem.3c00352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/09/2023] [Accepted: 10/23/2023] [Indexed: 12/07/2023]
Abstract
Target identification studies are a major hurdle in probe and drug discovery pipelines due to the need to chemically modify small molecules of interest, which can be time intensive and have low throughput. Here, we describe a versatile and scalable method for attaching chemical moieties to a small molecule, isocyanate-mediated chemical tagging (IMCT). By preparation of a template resin with an isocyanate capture group and a cleavable linker, nucleophilic groups on small molecules can be modified with an enforced one-to-one stoichiometry. We demonstrate a small molecule substrate scope that includes primary and secondary amines, thiols, phenols, benzyl alcohols, and primary alcohols. Cheminformatic analyses predict that IMCT is reactive with more than 25% of lead-like compounds in publicly available databases. To demonstrate that the method can produce biologically active molecules, we generated FKBP12 photoaffinity labeling (PAL) compounds with a wide range of affinities and showed that purified and crude cleavage products can bind to and label FKBP12. This method could be used to rapidly modify small molecules for many applications, including the synthesis of PAL probes, fluorescence polarization probes, pull-down probes, and degraders.
Collapse
Affiliation(s)
- Catherine
C. Henry
- David
H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, United States
- MIT
Center for Precision Cancer Medicine, Massachusetts
Institute of Technology, Cambridge, Massachusetts 02142, United States
- Broad
Institute of MIT and Harvard, Cambridge, Massachusetts 02142, United States
- Department
of Biological Engineering, Massachusetts
Institute of Technology, Cambridge, Massachusetts 02142, United States
| | - Jasmin A. Kruell
- David
H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, United States
- MIT
Center for Precision Cancer Medicine, Massachusetts
Institute of Technology, Cambridge, Massachusetts 02142, United States
- Broad
Institute of MIT and Harvard, Cambridge, Massachusetts 02142, United States
| | - Robert M. Wilson
- David
H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, United States
- MIT
Center for Precision Cancer Medicine, Massachusetts
Institute of Technology, Cambridge, Massachusetts 02142, United States
- Broad
Institute of MIT and Harvard, Cambridge, Massachusetts 02142, United States
- Department
of Biological Engineering, Massachusetts
Institute of Technology, Cambridge, Massachusetts 02142, United States
| | - Chia-Fu Chang
- Chemistry
and Chemical Biology, Harvard University, Cambridge, Massachusetts 02138, United States
| | - Christina M. Woo
- Chemistry
and Chemical Biology, Harvard University, Cambridge, Massachusetts 02138, United States
| | - Angela N. Koehler
- David
H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, United States
- MIT
Center for Precision Cancer Medicine, Massachusetts
Institute of Technology, Cambridge, Massachusetts 02142, United States
- Broad
Institute of MIT and Harvard, Cambridge, Massachusetts 02142, United States
- Department
of Biological Engineering, Massachusetts
Institute of Technology, Cambridge, Massachusetts 02142, United States
| |
Collapse
|
30
|
Kaku K, Ravindra MP, Tong N, Choudhary S, Li X, Yu J, Karim M, Brzezinski M, O’Connor C, Hou Z, Matherly LH, Gangjee A. Discovery of Tumor-Targeted 6-Methyl Substituted Pemetrexed and Related Antifolates with Selective Loss of RFC Transport. ACS Med Chem Lett 2023; 14:1682-1691. [PMID: 38116433 PMCID: PMC10726441 DOI: 10.1021/acsmedchemlett.3c00326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 12/21/2023] Open
Abstract
Pemetrexed and related 5-substituted pyrrolo[2,3-d]pyrimidine antifolates are substrates for the ubiquitously expressed reduced folate carrier (RFC), and the proton-coupled folate transporter (PCFT) and folate receptors (FRs) which are more tumor-selective. A long-standing goal has been to discover tumor-targeted therapeutics that draw from one-carbon metabolic vulnerabilities of cancer cells and are selective for transport by FRs and PCFT over RFC. We discovered that a methyl group at the 6-position of the pyrrole ring in the bicyclic scaffold of 5-substituted 2-amino-4-oxo-pyrrolo[2,3-d]pyrimidine antifolates 1-4 (including pemetrexed) abolished transport by RFC with modest impacts on FRs or PCFT. From molecular modeling, loss of RFC transport involves steric repulsion in the scaffold binding site due to the 6-methyl moiety. 6-Methyl substitution preserved antiproliferative activities toward human tumor cells (KB, IGROV3) with selectivity over IOSE 7576 normal ovary cells and inhibition of de novo purine biosynthesis. Thus, adding a 6-methyl moiety to 5-substituted pyrrolo[2,3-d]pyrimidine antifolates affords tumor transport selectivity while preserving antitumor efficacy.
Collapse
Affiliation(s)
- Krishna Kaku
- Division
of Medicinal Chemistry, Graduate School of Pharmaceutical Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, Pennsylvania 15282, United States
| | - Manasa P. Ravindra
- Division
of Medicinal Chemistry, Graduate School of Pharmaceutical Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, Pennsylvania 15282, United States
| | - Nian Tong
- Division
of Medicinal Chemistry, Graduate School of Pharmaceutical Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, Pennsylvania 15282, United States
| | - Shruti Choudhary
- Division
of Medicinal Chemistry, Graduate School of Pharmaceutical Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, Pennsylvania 15282, United States
| | - Xinxin Li
- Division
of Medicinal Chemistry, Graduate School of Pharmaceutical Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, Pennsylvania 15282, United States
| | - Jianming Yu
- Division
of Medicinal Chemistry, Graduate School of Pharmaceutical Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, Pennsylvania 15282, United States
| | - Mohammad Karim
- Division
of Medicinal Chemistry, Graduate School of Pharmaceutical Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, Pennsylvania 15282, United States
| | - Madelyn Brzezinski
- Department
of Oncology, Wayne State University School
of Medicine, Detroit, Michigan 48201, United States
| | - Carrie O’Connor
- Department
of Oncology, Wayne State University School
of Medicine, Detroit, Michigan 48201, United States
| | - Zhanjun Hou
- Molecular
Therapeutics Program, Barbara Ann Karmanos
Cancer Institute, 4100 John R, Detroit, Michigan 48201, United States
- Department
of Oncology, Wayne State University School
of Medicine, Detroit, Michigan 48201, United States
| | - Larry H. Matherly
- Molecular
Therapeutics Program, Barbara Ann Karmanos
Cancer Institute, 4100 John R, Detroit, Michigan 48201, United States
- Department
of Oncology, Wayne State University School
of Medicine, Detroit, Michigan 48201, United States
- Department
of Pharmacology, Wayne State University
School of Medicine, Detroit, Michigan 48201, United States
| | - Aleem Gangjee
- Division
of Medicinal Chemistry, Graduate School of Pharmaceutical Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, Pennsylvania 15282, United States
| |
Collapse
|
31
|
Yousaf I, Hannon WW, Donohue RC, Pfaller CK, Yadav K, Dikdan RJ, Tyagi S, Schroeder DC, Shieh WJ, Rota PA, Feder AF, Cattaneo R. Brain tropism acquisition: The spatial dynamics and evolution of a measles virus collective infectious unit that drove lethal subacute sclerosing panencephalitis. PLoS Pathog 2023; 19:e1011817. [PMID: 38127684 PMCID: PMC10735034 DOI: 10.1371/journal.ppat.1011817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023] Open
Abstract
It is increasingly appreciated that pathogens can spread as infectious units constituted by multiple, genetically diverse genomes, also called collective infectious units or genome collectives. However, genetic characterization of the spatial dynamics of collective infectious units in animal hosts is demanding, and it is rarely feasible in humans. Measles virus (MeV), whose spread in lymphatic tissues and airway epithelia relies on collective infectious units, can, in rare cases, cause subacute sclerosing panencephalitis (SSPE), a lethal human brain disease. In different SSPE cases, MeV acquisition of brain tropism has been attributed to mutations affecting either the fusion or the matrix protein, or both, but the overarching mechanism driving brain adaptation is not understood. Here we analyzed MeV RNA from several spatially distinct brain regions of an individual who succumbed to SSPE. Surprisingly, we identified two major MeV genome subpopulations present at variable frequencies in all 15 brain specimens examined. Both genome types accumulated mutations like those shown to favor receptor-independent cell-cell spread in other SSPE cases. Most infected cells carried both genome types, suggesting the possibility of genetic complementation. We cannot definitively chart the history of the spread of this virus in the brain, but several observations suggest that mutant genomes generated in the frontal cortex moved outwards as a collective and diversified. During diversification, mutations affecting the cytoplasmic tails of both viral envelope proteins emerged and fluctuated in frequency across genetic backgrounds, suggesting convergent and potentially frequency-dependent evolution for modulation of fusogenicity. We propose that a collective infectious unit drove MeV pathogenesis in this brain. Re-examination of published data suggests that similar processes may have occurred in other SSPE cases. Our studies provide a primer for analyses of the evolution of collective infectious units of other pathogens that cause lethal disease in humans.
Collapse
Affiliation(s)
- Iris Yousaf
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, United States of America
| | - William W. Hannon
- Basic Sciences and Computational Biology, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
- Molecular and Cellular Biology Graduate Program, University of Washington, Seattle, Washington, United States of America
| | - Ryan C. Donohue
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, United States of America
| | - Christian K. Pfaller
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, United States of America
| | - Kalpana Yadav
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ryan J. Dikdan
- Public Health Research Institute, Rutgers University, Newark, New Jersey, United States of America
| | - Sanjay Tyagi
- Public Health Research Institute, Rutgers University, Newark, New Jersey, United States of America
| | - Declan C. Schroeder
- Department of Veterinary Population Medicine, University of Minnesota, St Paul, Minnesota, United States of America
| | - Wun-Ju Shieh
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Center for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Paul A. Rota
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Center for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Alison F. Feder
- Genome Sciences, University of Washington, Seattle, Washington, United States of America
- Public Health Sciences and Computational Biology, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Roberto Cattaneo
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, United States of America
| |
Collapse
|
32
|
Farley C, Bassett R, Meric-Bernstam F, Bedrosian I, Caudle A, DeSnyder S, Hunt K, Kuerer H, Singh P, Sun S, Tamirisa N, Teshome M, Hwang RF. To Dissect or Not to Dissect: Can We Predict the Presence of Four or More Axillary Lymph Node Metastases in Postmenopausal Women with Clinically Node-Negative Breast Cancer? Ann Surg Oncol 2023; 30:8327-8334. [PMID: 37670121 DOI: 10.1245/s10434-023-14245-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/17/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Axillary lymph node (ALN) involvement is important for prognosis and guidance of multidisciplinary treatment of breast cancer patients. This study sought to identify preoperative clinicopathologic factors predictive of four or more pathologically positive ALNs in patients with cN0 disease and to develop a predictive nomogram to inform therapy recommendations. METHODS Using an institutional prospective database, the study identified postmenopausal women with cN0 invasive breast cancer undergoing upfront sentinel lymph node biopsy (SLNB) with or without completion ALND (cALND) between 1993 and 2007. Logistic regression analyses identified factors predictive of four or more positive nodes in the cN0 population and patients with one, two, or more SLNs. RESULTS The study identified 2532 postmenopausal women, 615 (24.3%) of whom underwent cALND. In the univariate analysis, tumor size, lymphovascular (LVI), histology, estrogen receptor (ER)-positive status, and multifocality/multicentricity were predictive of four or more positive nodes (n = 63; p < 0.05), and all except ER status were significant in the multivariate analysis. Of the 2532 patients, 1263 (49.2%) had hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative disease, and 30 (2.4%) were found to have four or more positive nodes. Of the 130 patients with exactly one positive SLN who underwent cALND (n = 130, 5.4%), 7 had four or more positive nodes, with grade as the only predictive factor (p = 0.01). Of the 33 patients with two or more positive SLNs who underwent cALND, 9 (27.3%) had four or more positive nodes after cALND, but no factors were predictive in this subset. CONCLUSION Postmenopausal women with early-stage cN0 HR-positive, HER2-negative breast cancer with a single positive SLN had a very low risk (5%) of having four or more positive nodes on final pathology. With such a low risk of N2 disease, limited staging with SLNB may be sufficient to guide therapy decisions for this subset of patients.
Collapse
Affiliation(s)
- Clara Farley
- Department of Surgical Oncology, Emory University Hospital, Atlanta, GA, USA
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roland Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Funda Meric-Bernstam
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Isabelle Bedrosian
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abigail Caudle
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly Hunt
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henry Kuerer
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Puneet Singh
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susie Sun
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nina Tamirisa
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mediget Teshome
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rosa F Hwang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
33
|
Adams A, Heinert S, Sanchez L, Karasz A, Ramos ME, Sarkar S, Rapkin B, In H. A qualitative analysis of patients' experiences with an emergency department diagnosis of gastrointestinal cancer. Acad Emerg Med 2023; 30:1201-1209. [PMID: 37641573 DOI: 10.1111/acem.14797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES Optimally, cancer is diagnosed through periodic screening or detection of early symptoms in primary care settings. However, an estimated 23%-52% of gastrointestinal (GI) cancers are diagnosed in the emergency department (ED). Cancer diagnosed in the ED has been associated with worse clinical and patient-reported outcomes even after adjustment for cancer stage. We sought to explore patients' accounts of patient and health care system factors related to their diagnosis in the ED and their lived experience of receiving a diagnosis in this setting. METHODS Patients with an ED visit during or within 30 days of their GI cancer diagnosis at an urban academic hospital serving a largely disadvantaged population were recruited. Interviews were coded in NVivo 12 and analyzed using a thematic analysis approach. RESULTS Patient-reported factors associated with their experiences included denial and avoidance of symptoms, mistrust of the health system, and lack of cancer screening knowledge. Health care system factors included misdiagnosis and delayed access to specialty care or tests. Experiences receiving a cancer diagnosis in the ED were overwhelmingly negative. CONCLUSIONS This study highlights the unmet needs in identifying and diagnosing patients who ultimately present to the ED for evaluation and eventual diagnosis of cancer. Our results shed light on several modifiable factors, including the need for increased public awareness of the asymptomatic nature of cancer and the importance of cancer screening. Additionally, health care systems modifications beyond the ED are needed to improve access to timely care when symptoms arise.
Collapse
Affiliation(s)
- Alexandra Adams
- Division of Surgical Oncology, Rutgers Cancer Institute, New Brunswick, New Jersey, USA
| | - Sara Heinert
- Department of Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Lauren Sanchez
- Albert Einstein College of Medicine, New York, New York, USA
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Alison Karasz
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Maria Elena Ramos
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Srawani Sarkar
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Bruce Rapkin
- Albert Einstein College of Medicine, New York, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York, USA
| | - Haejin In
- Division of Surgical Oncology, Rutgers Cancer Institute, New Brunswick, New Jersey, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York, USA
- Department of Health, Behavior and Policy, Rutgers University, Piscataway, New Jersey, USA
| |
Collapse
|
34
|
Levy DT, Cadham CJ, Yuan Z, Li Y, Gravely S, Cummings KM. Comparison of smoking prevalence in Canada before and after nicotine vaping product access using the SimSmoke model. Can J Public Health 2023; 114:992-1005. [PMID: 37540451 PMCID: PMC10661672 DOI: 10.17269/s41997-023-00792-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/29/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES The public health impact of nicotine vaping products (NVPs) is subject to complex transitions between NVP and cigarette use. To circumvent the data limitations and parameter instability challenges in modeling transitions, we indirectly estimate NVPs' impact on smoking prevalence and resulting smoking-attributable deaths using the SimSmoke simulation model. METHODS Canada SimSmoke uses age- and sex-specific data on Canadian population, smoking prevalence and tobacco control policies. The model incorporates the impact of cigarette-oriented policies on smoking prevalence but not the explicit contribution of NVPs. The model was calibrated from 1999 to 2012, thereby projecting smoking prevalence before NVPs were widely used in Canada. The NVP impact on smoking prevalence is inferred by comparing projected 2012-2020 smoking trends absent NVPs to corresponding trends from two Canadian national surveys. We further distinguish impacts before and after NVPs became regulated in 2018 and more available. RESULTS Comparing 2012-2020 survey data of post-NVP to SimSmoke projected smoking prevalence trends, one survey indicated an NVP-related relative reduction of 15% (15%) for males (females) age 15+, but 32% (52%) for those ages 15-24. The other survey indicated a 14% (19%) NVP-related smoking reduction for ages 18+, but 42% (53%) for persons ages 18-24. Much of the gain occurred since Canada relaxed NVP restrictions. NVP-related 2012-2020 smoking reductions yielded 100,000 smoking-attributable deaths averted from 2012 to 2060. CONCLUSION Smoking prevalence in Canada, especially among younger adults, declined more rapidly once NVPs became readily available. The emergence of NVPs into the Canadian marketplace has not slowed the decline in smoking.
Collapse
Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
| | - Christopher J Cadham
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Science, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
35
|
Levi H, Carmi S, Rosset S, Yerushalmi R, Zick A, Yablonski-Peretz T, Wang Q, Bolla MK, Dennis J, Michailidou K, Lush M, Ahearn T, Andrulis IL, Anton-Culver H, Antoniou AC, Arndt V, Augustinsson A, Auvinen P, Beane Freeman L, Beckmann M, Behrens S, Bermisheva M, Bodelon C, Bogdanova NV, Bojesen SE, Brenner H, Byers H, Camp N, Castelao J, Chang-Claude J, Chirlaque MD, Chung W, Clarke C, Collee MJ, Colonna S, Couch F, Cox A, Cross SS, Czene K, Daly M, Devilee P, Dork T, Dossus L, Eccles DM, Eliassen AH, Eriksson M, Evans G, Fasching P, Fletcher O, Flyger H, Fritschi L, Gabrielson M, Gago-Dominguez M, García-Closas M, Garcia-Saenz JA, Genkinger J, Giles GG, Goldberg M, Guénel P, Hall P, Hamann U, He W, Hillemanns P, Hollestelle A, Hoppe R, Hopper J, Jakovchevska S, Jakubowska A, Jernström H, John E, Johnson N, Jones M, Vijai J, Kaaks R, Khusnutdinova E, Kitahara C, Koutros S, Kristensen V, Kurian AW, Lacey J, Lambrechts D, Le Marchand L, Lejbkowicz F, Lindblom A, Loibl S, Lori A, Lubinski J, Mannermaa A, Manoochehri M, Mavroudis D, Menon U, Mulligan A, Murphy R, Nevelsteen I, Newman WG, Obi N, O'Brien K, Offit K, Olshan A, Plaseska-Karanfilska D, Olson J, Panico S, Park-Simon TW, Patel A, Peterlongo P, Rack B, Radice P, Rennert G, Rhenius V, Romero A, Saloustros E, Sandler D, Schmidt MK, Schwentner L, Shah M, Sharma P, Simard J, Southey M, Stone J, Tapper WJ, Taylor J, Teras L, Toland AE, Troester M, Truong T, van der Kolk LE, Weinberg C, Wendt C, Yang XR, Zheng W, Ziogas A, Dunning AM, Pharoah P, Easton DF, Ben-Sachar S, Elefant N, Shamir R, Elkon R. Evaluation of European-based polygenic risk score for breast cancer in Ashkenazi Jewish women in Israel. J Med Genet 2023; 60:1186-1197. [PMID: 37451831 PMCID: PMC10715538 DOI: 10.1136/jmg-2023-109185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Polygenic risk score (PRS), calculated based on genome-wide association studies (GWASs), can improve breast cancer (BC) risk assessment. To date, most BC GWASs have been performed in individuals of European (EUR) ancestry, and the generalisation of EUR-based PRS to other populations is a major challenge. In this study, we examined the performance of EUR-based BC PRS models in Ashkenazi Jewish (AJ) women. METHODS We generated PRSs based on data on EUR women from the Breast Cancer Association Consortium (BCAC). We tested the performance of the PRSs in a cohort of 2161 AJ women from Israel (1437 cases and 724 controls) from BCAC (BCAC cohort from Israel (BCAC-IL)). In addition, we tested the performance of these EUR-based BC PRSs, as well as the established 313-SNP EUR BC PRS, in an independent cohort of 181 AJ women from Hadassah Medical Center (HMC) in Israel. RESULTS In the BCAC-IL cohort, the highest OR per 1 SD was 1.56 (±0.09). The OR for AJ women at the top 10% of the PRS distribution compared with the middle quintile was 2.10 (±0.24). In the HMC cohort, the OR per 1 SD of the EUR-based PRS that performed best in the BCAC-IL cohort was 1.58±0.27. The OR per 1 SD of the commonly used 313-SNP BC PRS was 1.64 (±0.28). CONCLUSIONS Extant EUR GWAS data can be used for generating PRSs that identify AJ women with markedly elevated risk of BC and therefore hold promise for improving BC risk assessment in AJ women.
Collapse
Grants
- R01 CA176785 NCI NIH HHS
- NU58DP006344 NCCDPHP CDC HHS
- R37 CA070867 NCI NIH HHS
- HHSN261201800015I NCI NIH HHS
- R01 CA064277 NCI NIH HHS
- P50 CA116201 NCI NIH HHS
- G1000143 Medical Research Council
- P30 CA062203 NCI NIH HHS
- HHSN261201800015C NCI NIH HHS
- R01 CA047305 NCI NIH HHS
- HHSN261201800009I NCI NIH HHS
- R01 CA163353 NCI NIH HHS
- UM1 CA164917 NCI NIH HHS
- U01 CA199277 NCI NIH HHS
- U01 CA179715 NCI NIH HHS
- HHSN261201800032C NCI NIH HHS
- U54 CA156733 NCI NIH HHS
- HHSN261201800009C NCI NIH HHS
- Z01 CP010119 Intramural NIH HHS
- UM1 CA164973 NCI NIH HHS
- P01 CA087969 NCI NIH HHS
- UM1 CA164920 NCI NIH HHS
- NU58DP006320 CDC HHS
- UM1 CA176726 NCI NIH HHS
- R01 CA092447 NCI NIH HHS
- Z01 ES049030 Intramural NIH HHS
- R01 CA058860 NCI NIH HHS
- K07 CA092044 NCI NIH HHS
- HHSN261201800016C NCI NIH HHS
- P50 CA058223 NCI NIH HHS
- R01 CA100374 NCI NIH HHS
- P30 CA008748 NCI NIH HHS
- R01 CA128978 NCI NIH HHS
- R01 CA047147 NCI NIH HHS
- U19 CA148537 NCI NIH HHS
- R01 CA116167 NCI NIH HHS
- R01 CA148667 NCI NIH HHS
- R01 CA063464 NCI NIH HHS
- HHSN261201800016I NCI NIH HHS
- UM1 CA186107 NCI NIH HHS
- P30 CA023100 NCI NIH HHS
- U01 CA063464 NCI NIH HHS
- R01 CA077398 NCI NIH HHS
- R01 CA054281 NCI NIH HHS
- R01 CA132839 NCI NIH HHS
- P30 CA068485 NCI NIH HHS
- U01 CA058860 NCI NIH HHS
- U01 CA164920 NCI NIH HHS
- R35 CA253187 NCI NIH HHS
- 14136 Cancer Research UK
- U19 CA148112 NCI NIH HHS
- HHSN261201800032I NCI NIH HHS
- U01 CA098758 NCI NIH HHS
- Z01 ES044005 Intramural NIH HHS
- U19 CA148065 NCI NIH HHS
- P30 CA033572 NCI NIH HHS
- R01 CA069664 NCI NIH HHS
- Wellcome Trust
- 001 World Health Organization
- Z01 ES049033 Intramural NIH HHS
- R01 CA192393 NCI NIH HHS
- U01 CA164973 NCI NIH HHS
- R37 CA054281 NCI NIH HHS
- Consellería de Industria Programa Sectorial de Investigación Aplicada
- Statistics Netherlands
- South Eastern Norway Health Authority
- Lower Saxonian Cancer Society
- Lise Boserup Fund
- Heidelberger Zentrum für Personalisierte Onkologie Deutsches Krebsforschungszentrum In Der Helmholtz-Gemeinschaft
- Lon V. Smith Foundation
- Scottish Funding Council
- Komen Foundation
- Claudia von Schilling Foundation for Breast Cancer Research
- Russian Foundation for Basic Research
- Ligue Contre le Cancer
- Sigrid Juselius Foundation
- Kuopion Yliopistollinen Sairaala
- Sheffield Experimental Cancer Medicine Centre
- Stockholm läns landsting
- Department of Health and Human Services (USA)
- Department of Defence (USA)
- Stichting Tegen Kanker
- David F. and Margaret T. Grohne Family Foundation
- Sundhed og Sygdom, Det Frie Forskningsråd
- Stavros Niarchos Foundation
- Post-Cancer GWAS initiative
- Institute of the Ruhr University Bochum
- Instituto de Salud Carlos III
- Institute of Cancer Research
- Public Health Institute
- Fondation du cancer du sein du Québec
- Institut National de la Santé et de la Recherche Médicale
- Pink Ribbon
- Institute for Prevention and Occupational Medicine
- K.G. Jebsen Centre for Breast Cancer Research
- Research Centre for Genetic Engineering and Biotechnology
- Center of Excellence (Finland)
- Robert and Kate Niehaus Clinical Cancer Genetics Initiative
- Rudolf Bartling Foundation
- Center for Disease Control and Prevention (USA)
- Karolinska Institutet
- Norges Forskningsråd
- Robert Bosch Stiftung
- Intramural Research Funds of the National Cancer Institute (USA)
- Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, ISCIII RETIC
- Intramural Research Program of the Division of Cancer Epidemiology and Genetics
- Centre International de Recherche sur le Cancer
- Queensland Cancer Fund
- Red Temática de Investigación Cooperativa en Cáncer
- Intramural Research Program of the National Institutes of Health
- National Health Service (UK)
- Ministerie van Volksgezondheid, Welzijn en Sport
- National cancer institute (USA)
- KWF Kankerbestrijding
- Märit and Hans Rausings Initiative Against Breast Cancer
- Associazione Italiana per la Ricerca sul Cancro
- Fundación Científica Asociación Española Contra el Cáncer
- ERC advanced grant
- Australian National Health and Medical Research Council
- Agence Nationale de la Recherche
- Dutch Prevention Funds,
- Agence Nationale de Sécurité Sanitaire de l'Alimentation, de l'Environnement et du Travail
- American Cancer Society
- Dutch Zorg Onderzoek
- Alexander von Humboldt-Stiftung
- Ministerio de Economia y Competitividad (Spain)
- Ministère du Développement Économique, de l’Innovation et de l’Exportation
- Susan G. Komen for the Cure
- Minister of Science and Higher Education
- Medical Research Council UK
- Ministry of Science and Higher Education of the Russian Federation
- Ministry of Science and Higher Education (Sweden)
- Against Breast Cancer
- Mutuelle Générale de l’Education Nationale
- Academy of Finland
- Deutsche Krebshilfe e.V.
- Dietmar-Hopp Foundation,
- Division of Cancer Prevention, National Cancer Institute
- Deutsche Krebshilfe
- World Cancer Research Fund
- Genome Québec
- National Cancer Institute’s Surveillance, Epidemiology and End Results Program
- Breast Cancer Campaign
- National Cancer Research Network
- Berta Kamprad Foundation FBKS
- Bert von Kantzows foundation
- Biomedical Research Centre at Guy’s and St Thomas
- Genome Canada
- Freistaat Sachsen
- Biobanking and Biomolecular Resources Research Infrastructure
- Friends of Hannover Medical School
- Breast Cancer Research Foundation
- California Department of Public Health
- Government of Russian Federation
- Deutsche Forschungsgemeinschaft
- National Institute for Health and Care Research
- National Health and Medical Research Council (Australia)
- German Federal Ministry of Research and Education
- National Institute of Environmental Health Sciences
- Breast Cancer Now
- Seventh Framework Programme
- Transcan
- Centrum för idrottsforskning
- UK National Institute for Health Research Biomedical Research Centre
- University of Crete
- National Breast Cancer Foundation (Finland)
- European Regional Development Fund
- National Breast Cancer Foundation (Australia)
- United States Army Medical Research and Materiel Command
- EU Horizon 2020 Research and Innovation Programme
- Directorate-General XII, Science, Research, and Development
- Baden Württemberg Ministry of Science, Research and Arts
- VicHealth
- Fondo de Investigación Sanitario
- Victorian Breast Cancer Research Consortium.
- Finnish Cancer Foundation
- University of Southern California San Francisco
- Fomento de la Investigación Clínica Independiente
- the Cancer Biology Research Center (CBRC), Djerassi Oncology Center
- Bundesministerium für Bildung und Forschung
- Cancerfonden
- Tel Aviv University Center for AI and Data Science
- University of Oulu
- National Breast Cancer Foundation (JS)
- Safra Center for Bioinformatics
- Fondation de France, Institut National du Cancer
- Israeli Science Foundation
- University of Utah
- National Cancer Center Research and Development Fund (Japan)
- Chief Scientist Office, Scottish Government Health and Social Care Directorate
- Oak Foundation
- Health Research Fund (FIS)
- Ontario Familial Breast Cancer Registry
- New South Wales Cancer Council
- North Carolina University Cancer Research Fund
- Kreftforeningen
- Northern California Breast Cancer Family Registry
- Institut Gustave Roussy
- Huntsman Cancer Institute, University of Utah
- Ovarian Cancer Research Fund
- NIHR Oxford Biomedical Research Centre
- Hellenic Health Foundation
- Oulun Yliopistollinen Sairaala
- Helmholtz Society
- Herlev and Gentofte Hospital
- PSRSIIRI-701
- Helsinki University Hospital Research Fund
- Cancer Council Victoria
- National Research Council (Italy)
- Cancer Council Tasmania
- Cancer Council Western Australia
- Hamburger Krebsgesellschaft
- Gustav V Jubilee foundation
- National Program of Cancer Registries
- Canadian Cancer Society
- Cancer Council South Australia
- Canadian Institutes of Health Research
- Cancer Council NSW
- Guy's & St. Thomas' NHS Foundation Trust
- Netherlands Organisation of Scientific Research
- Cancer Institute NSW
- National Institutes of Health (USA)
- National Research Foundation of Korea
- Syöpäsäätiö
- Cancer Foundation of Western Australia
- Netherlands Cancer Registry (NKR),
- Cancer Fund of North Savo
Collapse
Affiliation(s)
- Hagai Levi
- The Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel
- Department of Human Molecular Genetics and Biochemistry, Tel Aviv University, Tel Aviv, Israel
| | - Shai Carmi
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Saharon Rosset
- Department of Statistics and Operations Research, Tel Aviv University, Tel Aviv, Israel
| | - Rinat Yerushalmi
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviad Zick
- Department of oncology, Hadassah Medical Center, Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tamar Yablonski-Peretz
- Department of oncology, Hadassah Medical Center, Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Qin Wang
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Manjeet K Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kyriaki Michailidou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Biostatistics Unit, The Cyprus Institute of Neurology & Genetics, Nicosia, Cyprus
| | - Michael Lush
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thomas Ahearn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Irene L Andrulis
- Fred A. Litwin Center for Cancer Genetics, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Hoda Anton-Culver
- Department of Medicine, Genetic Epidemiology Research Institute, University of California Irvine, Irvine, CA, USA
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annelie Augustinsson
- Oncology, Department of Clinical Sciences in Lund, Lund University, Lund, Sweden
| | - Päivi Auvinen
- Translational Cancer Research Area, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Oncology, University of Eastern Finland, Kuopio, Finland
- Department of Oncology, Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Laura Beane Freeman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthias Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marina Bermisheva
- Institute of Biochemistry and Genetics, Ufa Federal Research Centre of the Russian Academy of Sciences, Ufa, Russia
| | - Clara Bodelon
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | - Natalia V Bogdanova
- Department of Radiation Oncology, Hannover Medical School, Hannover, Germany
- Gynaecology Research Unit, Hannover Medical School, Hamburg, Germany
- N.N. Alexandrov Research Institute of Oncology and Medical Radiology, Minsk, Belarus
| | - Stig E Bojesen
- Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Helen Byers
- North West Genomics Laboratory Hub, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Nicola Camp
- Department of Internal Medicine and Huntsman Cancer Institute, University of Utah, Salt lake city, UT, USA
| | - Jose Castelao
- Oncology and Genetics Unit, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Xerencia de Xestion Integrada de Vigo-SERGAS, Vigo, Spain
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Cancer Epidemiology Group, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Wendy Chung
- Departments of Pediatrics and Medicine, Columbia University, New York, NY, USA
| | - Christine Clarke
- Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Margriet J Collee
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, Netherlands
| | - Sarah Colonna
- Department of Internal Medicine and Huntsman Cancer Institute, University of Utah, Salt lake city, UT, USA
| | - Fergus Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Angela Cox
- Department of Oncology and Metabolism, Sheffield Institute for Nucleic Acids (SInFoNiA), University of Sheffield, Sheffield, UK
| | - Simon S Cross
- Academic Unit of Pathology, Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mary Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Peter Devilee
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
- Department of Human Genetics, Leiden University Medical, Leiden, Netherlands
| | - Thilo Dork
- Gynaecology Research Unit, Hannover Medical School, Hamburg, Germany
| | - Laure Dossus
- Nutrition and Metabolism Section, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Diana M Eccles
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gareth Evans
- North West Genomics Laboratory Hub, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Peter Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Olivia Fletcher
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Henrik Flyger
- Department of Breast Surgery, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Lin Fritschi
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Marike Gabrielson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Manuela Gago-Dominguez
- Genomic Medicine Group, International Cancer Genetics and Epidemiology Group, Fundación Pública Galega de Medicina Xenómica, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Montserrat García-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Jeanine Genkinger
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York, New York, USA
| | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Mark Goldberg
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University, Montreal, QU, Canada
| | - Pascal Guénel
- Team 'Exposome and Heredity', CESP, Gustave Roussy, INSERM, University Paris-Saclay, UVSQ, Villejuif, France
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wei He
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Hillemanns
- Gynaecology Research Unit, Hannover Medical School, Hamburg, Germany
| | | | - Reiner Hoppe
- Dr Margarete Fischer Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tubingen, Germany
| | - John Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Simona Jakovchevska
- Research Centre for Genetic Engineering and Biotechnology 'Georgi D. Efremov', Skopje, North Macedonia
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
- Independent Laboratory of Molecular Biology and Genetic Diagnostics, Pomeranian Medical University, Szczecin, Poland
| | - Helena Jernström
- Oncology, Department of Clinical Sciences in Lund, Lund University, Lund, Sweden
| | - Esther John
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Division of Oncology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Nichola Johnson
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Michael Jones
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, UK
| | - Joseph Vijai
- Clinical Genetics Research Lab, Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elza Khusnutdinova
- Institute of Biochemistry and Genetics, Ufa Federal Research Centre of the Russian Academy of Sciences, Ufa, Russia
- Department of Genetics and Fundamental Medicine, Bashkir State University, Ufa, Russia
| | - Cari Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Stella Koutros
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Vessela Kristensen
- Institute of Clinical Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medical Genetics, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Allison W Kurian
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Division of Oncology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - James Lacey
- Department of Computational and Quantitative Medicine, City of Hope, Duarte, CA, USA
- City of Hope Comprehensive Cancer Center, City of Hope, Duarte, CA, USA
| | - Diether Lambrechts
- Laboratory for Translational Genetics, Department of Human Genetics, KU Leuven, Leuven, Belgium
- VIB Center for Cancer Biology, VIB, Leuven, Belgium
| | - Loic Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Flavio Lejbkowicz
- Clalit National Cancer Control Center, Carmel Medical Center and Technion Faculty of Medicine, Haifa, Israel
| | - Annika Lindblom
- Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | | | - Adriana Lori
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | - Jan Lubinski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Arto Mannermaa
- Translational Cancer Research Area, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Pathology and Forensic Medicine, University of Eastern Finland, Kuopio, Finland
- Biobank of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - Mehdi Manoochehri
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dimitrios Mavroudis
- Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Greece
| | - Usha Menon
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College, London, UK
| | - AnnaMarie Mulligan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Rachel Murphy
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Cancer Control Research, BC Cancer Agency, Vancouver, BC, Canada
| | - Ines Nevelsteen
- Leuven Multidisciplinary Breast Center, Department of Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - William G Newman
- North West Genomics Laboratory Hub, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Nadia Obi
- Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katie O'Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Ken Offit
- Clinical Genetics Research Lab, Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Olshan
- Department of Epidemiology, Gillings School of Global Public Health and UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Janet Olson
- Department of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Salvatore Panico
- Dipertimento Di Medicina Clinca e Chirurgia, Federico II University, Naples, Italy
| | | | - Alpa Patel
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | - Paolo Peterlongo
- Genome Diagnostics Program, IFOM ETS - the AIRC Institute of Molecular Oncology, Milan, Italy
| | - Brigitte Rack
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Paolo Radice
- Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Gad Rennert
- Clalit National Cancer Control Center, Carmel Medical Center and Technion Faculty of Medicine, Haifa, Israel
| | - Valerie Rhenius
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Atocha Romero
- Laboratorio de Oncología Molecular, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Dale Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Marjanka K Schmidt
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, Netherlands
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
| | - Lukas Schwentner
- Department of Gynaecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Mitul Shah
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Priyanka Sharma
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, Westwood, KS, USA
| | - Jacques Simard
- Genomics Center, Molecular Medicine, Université Laval, Quebec, Quebec, Canada
| | - Melissa Southey
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Department of Clinical Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Stone
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Genetic Epidemiology Group, School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - William J Tapper
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jack Taylor
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
- Epigenetic and Stem Cell Biology Laboratory, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Lauren Teras
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | - Amanda E Toland
- Department of Cancer Biology and Genetics, The Ohio State University, Columbus, OH, USA
| | - Melissa Troester
- Department of Epidemiology, Gillings School of Global Public Health and UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thérèse Truong
- Team 'Exposome and Heredity', CESP, Gustave Roussy, INSERM, University Paris-Saclay, UVSQ, Villejuif, France
| | | | - Clarice Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Camilla Wendt
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Xiaohong Rose Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Argyrios Ziogas
- Department of Medicine, Genetic Epidemiology Research Institute, University of California Irvine, Irvine, CA, USA
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Paul Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, West Hollywood, CA, USA
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Shay Ben-Sachar
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
| | - Naama Elefant
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
- Department of Genetics, Hadassah Medical Center, Jerusalem, Israel
| | - Ron Shamir
- The Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel
| | - Ran Elkon
- Department of Human Molecular Genetics and Biochemistry, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
36
|
Nawas AF, Solmonson A, Gao B, DeBerardinis RJ, Minna JD, Conacci-Sorrell M, Mendelson CR. IL-1β mediates the induction of immune checkpoint regulators IDO1 and PD-L1 in lung adenocarcinoma cells. Cell Commun Signal 2023; 21:331. [PMID: 37985999 PMCID: PMC10658741 DOI: 10.1186/s12964-023-01348-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/02/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Inflammation plays a significant role in various cancers, including lung cancer, where the inflammatory cytokine IL-1β is often elevated in the tumor microenvironment. Patients with lung adenocarcinoma show higher levels of serum IL-1β compared to healthy individual. Moreover, IL-1β blockade reduces the incidence and mortality of lung cancer. Our prior studies revealed that alveolar type-II cells, the precursors for lung adenocarcinoma, display an induction in the expression of the enzyme tryptophan 2,3-dioxygenase (TDO2) during normal lung development. This induction of TDO2 coincides with an increase in IL-1β levels and is likely caused by IL-1β. Given that cancer cells can co-opt developmentally regulated pathways, we hypothesized that IL-1β may exert its pro-tumoral function by stimulating TDO2 and indoleamine 2, 3-dioxygenase-1 (IDO1), parallel enzymes involved in the conversion of tryptophan (Trp) into the immune-suppressive oncometabolite kynurenine (Kyn). Our goal was to determine whether IL-1β is a common upstream regulator of immune checkpoint regulators. METHODS To determine whether IL-1β regulates IDO1, TDO2, PD-L1, and PD-L2, we measured mRNA and protein levels in lung adenocarcinoma cells lines (A549, H1792, H1838, H2347, H2228, HCC364 and HCC827) grown in 2D or 3D and in immortalized normal lung epithelial cells (HBEC3-KT and HSAEC1-KT). To determine the importance of the NFκB pathway in mediating IL-1β -regulated cellular effects, we used siRNA to knockdown RelA/p65 in IL-1β treated cells. The levels of Trp and Kyn in the IL-1β-treated cells and media were measured by mass spectrometry. RESULTS Upon IL-1β stimulation, lung adenocarcinoma cells exhibited significant increases in IDO1 mRNA and protein levels, a response that depended on the NFκB pathway. Interestingly, this induction was more pronounced in 3D spheroid cultures compared to monolayer cultures and was not observed in normal immortalized lung epithelial cells. Furthermore, the conversion of Trp to Kyn increased in cells exposed to IL-1β, aligning with the heightened IDO1 expression. Remarkably, IL-1β also upregulated the expression of programmed death ligand-1 (PD-L1) and PD-L2 in multiple cell lines, indicating that IL-1β triggers parallel immune-suppressive mechanisms in lung adenocarcinoma cells. CONCLUSIONS Our studies demonstrate that lung adenocarcinoma cells, but not normal immortalized lung epithelial cells, respond to IL-1β signaling by inducing the expression of parallel immune checkpoint proteins that have the potential to promote immune evasion. Video Abstract.
Collapse
Affiliation(s)
- Afshan Fathima Nawas
- Department of Biochemistry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Ashley Solmonson
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Boning Gao
- Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
- Departments of Internal Medicine and Pharmacology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Ralph J DeBerardinis
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
- Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - John D Minna
- Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
- Departments of Internal Medicine and Pharmacology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Maralice Conacci-Sorrell
- Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
- Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
| | - Carole R Mendelson
- Department of Biochemistry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
- Department of Obstetrics and Gynecology and North Texas March of Dimes Birth Defects Center, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| |
Collapse
|
37
|
Dow LF, Case AM, Paustian MP, Pinkerton BR, Simeon P, Trippier PC. The evolution of small molecule enzyme activators. RSC Med Chem 2023; 14:2206-2230. [PMID: 37974956 PMCID: PMC10650962 DOI: 10.1039/d3md00399j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/20/2023] [Indexed: 11/19/2023] Open
Abstract
There is a myriad of enzymes within the body responsible for maintaining homeostasis by providing the means to convert substrates to products as and when required. Physiological enzymes are tightly controlled by many signaling pathways and their products subsequently control other pathways. Traditionally, most drug discovery efforts focus on identifying enzyme inhibitors, due to upregulation being prevalent in many diseases and the existence of endogenous substrates that can be modified to afford inhibitor compounds. As enzyme downregulation and reduction of endogenous activators are observed in multiple diseases, the identification of small molecules with the ability to activate enzymes has recently entered the medicinal chemistry toolbox to afford chemical probes and potential therapeutics as an alternative means to intervene in diseases. In this review we highlight the progress made in the identification and advancement of non-kinase enzyme activators and their potential in treating various disease states.
Collapse
Affiliation(s)
- Louise F Dow
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center Omaha NE 68106 USA
| | - Alfie M Case
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center Omaha NE 68106 USA
| | - Megan P Paustian
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center Omaha NE 68106 USA
| | - Braeden R Pinkerton
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center Omaha NE 68106 USA
| | - Princess Simeon
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center Omaha NE 68106 USA
| | - Paul C Trippier
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center Omaha NE 68106 USA
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center Omaha NE 68106 USA
- UNMC Center for Drug Discovery, University of Nebraska Medical Center Omaha NE 68106 USA
| |
Collapse
|
38
|
Carpenter MA, Temiz NA, Ibrahim MA, Jarvis MC, Brown MR, Argyris PP, Brown WL, Starrett GJ, Yee D, Harris RS. Mutational impact of APOBEC3A and APOBEC3B in a human cell line and comparisons to breast cancer. PLoS Genet 2023; 19:e1011043. [PMID: 38033156 PMCID: PMC10715669 DOI: 10.1371/journal.pgen.1011043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/12/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
A prominent source of mutation in cancer is single-stranded DNA cytosine deamination by cellular APOBEC3 enzymes, which results in signature C-to-T and C-to-G mutations in TCA and TCT motifs. Although multiple enzymes have been implicated, reports conflict and it is unclear which protein(s) are responsible. Here we report the development of a selectable system to quantify genome mutation and demonstrate its utility by comparing the mutagenic activities of three leading candidates-APOBEC3A, APOBEC3B, and APOBEC3H. The human cell line, HAP1, is engineered to express the thymidine kinase (TK) gene of HSV-1, which confers sensitivity to ganciclovir. Expression of APOBEC3A and APOBEC3B, but not catalytic mutant controls or APOBEC3H, triggers increased frequencies of TK mutation and similar TC-biased cytosine mutation profiles in the selectable TK reporter gene. Whole genome sequences from independent clones enabled an analysis of thousands of single base substitution mutations and extraction of local sequence preferences with APOBEC3A preferring YTCW motifs 70% of the time and APOBEC3B 50% of the time (Y = C/T; W = A/T). Signature comparisons with breast tumor whole genome sequences indicate that most malignancies manifest intermediate percentages of APOBEC3 signature mutations in YTCW motifs, mostly between 50 and 70%, suggesting that both enzymes contribute in a combinatorial manner to the overall mutation landscape. Although the vast majority of APOBEC3A- and APOBEC3B-induced single base substitution mutations occur outside of predicted chromosomal DNA hairpin structures, whole genome sequence analyses and supporting biochemical studies also indicate that both enzymes are capable of deaminating the single-stranded loop regions of DNA hairpins at elevated rates. These studies combine to help resolve a long-standing etiologic debate on the source of APOBEC3 signature mutations in cancer and indicate that future diagnostic and therapeutic efforts should focus on both APOBEC3A and APOBEC3B.
Collapse
Affiliation(s)
- Michael A. Carpenter
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, Minnesota, United States of America
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
- Howard Hughes Medical Institute, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Biochemistry and Structural Biology, University of Texas Health San Antonio, San Antonio, Texas, United States of America
- Howard Hughes Medical Institute, University of Texas Health San Antonio, San Antonio, Texas, United States of America
| | - Nuri A. Temiz
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Mahmoud A. Ibrahim
- Department of Biochemistry and Structural Biology, University of Texas Health San Antonio, San Antonio, Texas, United States of America
| | - Matthew C. Jarvis
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, Minnesota, United States of America
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Margaret R. Brown
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, Minnesota, United States of America
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Prokopios P. Argyris
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, Minnesota, United States of America
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
- Howard Hughes Medical Institute, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - William L. Brown
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, Minnesota, United States of America
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Gabriel J. Starrett
- Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland, United States of America
| | - Douglas Yee
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Reuben S. Harris
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, Minnesota, United States of America
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
- Howard Hughes Medical Institute, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Biochemistry and Structural Biology, University of Texas Health San Antonio, San Antonio, Texas, United States of America
- Howard Hughes Medical Institute, University of Texas Health San Antonio, San Antonio, Texas, United States of America
| |
Collapse
|
39
|
Clelland EN, Rothschild HT, Patterson A, Molina-Vega J, Kaur M, Symmans WF, Schwartz CJ, Chien AJ, Benz CC, Mukhtar RA. Quantifying hormone receptor status in lobular breast cancer in an institutional series: the relationship between estrogen and progesterone receptor status and outcomes. Breast Cancer Res Treat 2023; 202:367-375. [PMID: 37500962 PMCID: PMC10505592 DOI: 10.1007/s10549-023-07059-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Recent guidelines defined a new reporting category of ER-low-positive breast cancer based on immunohistochemistry (IHC). While low positivity of either hormone receptor is uncommon in invasive lobular carcinoma (ILC), we sought to investigate whether relatively low hormone receptor positivity was associated with tumor characteristics and patient outcomes in a single institutional cohort. METHODS We searched an institutional database for cases of stage I-III ILC with available IHC reports. Based on prior published categories in ILC, ER was classified as low, medium, or high as defined by ER staining of 10-69%, 70-89%, and ≥ 90% respectively. PR low and high tumors were defined by < 20%, or ≥ 20% staining respectively. We used chi-squared tests, t-tests, and Cox proportional hazards models to evaluate associations between ER/PR categories and tumor characteristics or disease-free survival (DFS). RESULTS The cohort consisted of 707 ILC cases, with 11% of cases categorized as ER low, 15.1% as medium, and 73.8% as high. The majority (67.6%) were PR high. Patients with ER low/medium expression were significantly younger, and more likely to also have PR low and/or HER2 positive tumors compared to those that were ER high. In a Cox proportional hazards model adjusting for age, stage, grade, pleomorphic histology, and treatment, ER category was not prognostic for DFS, but PR negative and PR low status each had significantly worse DFS compared to PR high status (HR 3.5, 95% CI 1.8-6.7, p < 0.001; and HR 2.0, 95% CI 1.1-3.5, p = 0.015, respectively). CONCLUSION These findings highlight the relevance of quantifying ER and PR within ILC.
Collapse
Affiliation(s)
- Elle N Clelland
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Harriet T Rothschild
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Anne Patterson
- Department of Surgery, University of California, 1825 4th Street, 3rd Floor, Box 1710, San Francisco, CA, 94143, USA
| | - Julissa Molina-Vega
- Department of Surgery, University of California, 1825 4th Street, 3rd Floor, Box 1710, San Francisco, CA, 94143, USA
| | - Mandeep Kaur
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - W Fraser Symmans
- Department of Pathology, MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher J Schwartz
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - A Jo Chien
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Christopher C Benz
- Cancer & Developmental Therapeutics Program, Buck Institute for Research on Aging, Novato, USA
| | - Rita A Mukhtar
- Department of Surgery, University of California, 1825 4th Street, 3rd Floor, Box 1710, San Francisco, CA, 94143, USA.
| |
Collapse
|
40
|
Franco I, Alshalalfa M, Hernandez A, Mahal BA, Nguyen T, Wang L, Punglia R, Swami N, Goel N. Genomic Characterization of Aggressive Breast Cancer in Younger Women. Ann Surg Oncol 2023; 30:7569-7578. [PMID: 37550448 DOI: 10.1245/s10434-023-14080-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Although breast cancer (BC) risk increases with age, BC in younger women is more aggressive with higher mortality compared with older women. We characterize the genomic landscape of BCs in younger women. METHODS Clinicopathologic, molecular, and genomic differences across age groups (< 40 years, 40-60 years, > 60 years) in female BC patients were investigated in two large cohorts [AACR-GENIE8.1 (n = 11,594) and METABRIC (n = 2509)]. Cox-proportional regression analyzed the prognostic impact of age groups for disease-specific survival (DSS) and recurrence-free survival (RFS) in METABRIC and progression-free survival (PFS) in GENIE cohorts. Chi-squared test was used to assess statistical associations between genomic alterations and age groups. RESULTS Survival analysis showed that women < 40 years had shorter DSS [hazard ratio (HR): 1.52, p = 0.005], RFS (HR: 1.4, p = 0.006), and PFS (HR: 1.82, p = 0.0003) compared with women 40-60 years, and shorter RFS (HR: 1.5, p = 0.001) and PFS (HR: 2.95, p < 0.0001) compared with women > 60 years. Molecular subtypes in the METABRIC cohort showed women < 40 years were enriched with basal, and HER2+ subtypes, and less enriched with luminal A and B subtype (p < 0.0001). Characterization of genomic alterations in both cohorts demonstrated that BCs in women < 40 years were more enriched with TP53 mutations (FDR < 0.0001), BRCA1 mutations (FDR = 0.01), ERBB2 amplifications (FDR < 0.001), CDK12 amplifications (FDR < 0.001), and PPM1D amplifications (FDR < 0.001). In contrast, BCs in older women (> 60 years) were more enriched with PIK3CA, KMT2C, and CDH1 mutations (FDR < 0.0001). CONCLUSIONS BCs in young women are associated with shorter survival and more aggressive genomic features, including mutations in TP53 and BRCA1, and amplifications in ERBB2 and CDK12. These findings have the potential to impact clinical trial design and treatment.
Collapse
Affiliation(s)
- Idalid Franco
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mohammed Alshalalfa
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alexandra Hernandez
- Department of Surgical Oncology, Department of Surgery, University of Miami, Miami, FL, USA
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tiffany Nguyen
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lora Wang
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rinaa Punglia
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nishwant Swami
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Neha Goel
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
- Department of Surgical Oncology, Department of Surgery, University of Miami, Miami, FL, USA.
| |
Collapse
|
41
|
Mendoza-Graf A, MacCarthy S, Collins R, Wagner L, Dubowitz T. Exploring differences in perceptions of gentrification, neighborhood satisfaction, social cohesion, and health among residents of two predominantly African American Pittsburgh neighborhoods (n = 60). BMC Public Health 2023; 23:2137. [PMID: 37915015 PMCID: PMC10621185 DOI: 10.1186/s12889-023-16970-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Gentrification often leads to changes in the social and physical environment of neighborhoods, which social capital theory has found are connected to aspects of resident health and wellbeing. A growing body of literature has explored the impact of gentrification on health and wellbeing of residents. The goal of this study is to qualitatively explore the ways in which gentrification may have impacted perceptions of neighborhood satisfaction, social cohesion, and health of neighborhood residents (n = 60) from two predominantly Black neighborhoods in Pittsburgh, Pennsylvania, one of which experienced Black gentrification during the study's time period. This analysis is unique in its ability to capture experiences of residents who remained in their neighborhood throughout the course of the study, as well as those who moved away from their neighborhood. METHODS Participants were randomly selected from a larger cohort enrolled in a quasi-experimental study and categorized by whether they lived in a census tract that gentrified, whether they owned or rented their home, and whether they moved from the neighborhood or remained in the same place of residence between 2011 and 2018. Phone interviews lasting approximately 30 min were conducted with participants and were audio recorded and transcribed verbatim. Participants were provided a $40 gift card for their time. Interview data were analyzed using a directed content approach, and Cohen's Kappa was obtained (k = 0.924) to signal good inter-rater reliability. RESULTS Results showed renters in gentrified census tracts overwhelmingly viewed gentrification trends as a negative change compared to homeowners. Overall, participants from gentrified census tracts reported being relatively satisfied with their neighborhood, though some suggested there were fewer resources in the neighborhood over time; felt their social cohesion had deteriorated over time; and more commonly reflected negative health changes over time. CONCLUSIONS These findings suggest that while gentrification can bring much needed improvements to neighborhoods, it can also bring other disruptive changes that affect the health and wellbeing of existing residents.
Collapse
Affiliation(s)
| | - Sarah MacCarthy
- Department of Health Behavior, University of Alabama School of Public Health, 227 Ryals Public Health Building, 1665 University Boulevard, Birmingham, Alabama, 35233, England
| | - Rebecca Collins
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - La'Vette Wagner
- RAND Corporation, Pittsburgh Office, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Tamara Dubowitz
- RAND Corporation, Pittsburgh Office, 1776 Main Street, Santa Monica, CA, 90407, USA
| |
Collapse
|
42
|
Hoang Trinh TK, Catalano C, Guo Y. Fabrication of membrane proteins in the form of native cell membrane nanoparticles using novel membrane active polymers. Nanoscale Adv 2023; 5:5932-5940. [PMID: 37881706 PMCID: PMC10597567 DOI: 10.1039/d3na00381g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/04/2023] [Indexed: 10/27/2023]
Abstract
Membrane proteins are a widespread class of bio-macromolecules responsible for numerous vital biological processes and serve as therapeutic targets for a vast array of contemporary medications. For membrane protein isolation and purification, detergents have historically been used. Despite this, detergents frequently result in protein instability. Consequently, their application was limited. Recent detergent-free approaches have been invented. Among these, styrene-maleic acid lipid particle (SMALP), diisobutylene-maleic acid lipid particle (DIBMALP), and native cell membrane nanoparticle (NCMN) systems are the most prevalent. The NCMN system intends to create a library of membrane-active polymers suitable for high-resolution structure determination of membrane protein. Design, synthesis, characterization, and comparative application evaluations of three novel classes of NCMN polymers, NCMNP13-x, NCMNP21-x, and NCMNP21b-x, are presented in this article. Although each NCMN polymer can solubilize distinct model membrane proteins and retain native lipids in NCMN particles, only the NCMNP21b-x family produces lipid-protein particles with ideal buffer compatibility and high homogeneity suitable for single-particle cryo-EM analysis. NCMNP21b-x polymers that generate high-quality NCMN particles are particularly desirable for membrane protein structural biology.
Collapse
Affiliation(s)
- Thi Kim Hoang Trinh
- Department of Medicinal Chemistry, School of Pharmacy, Virginia Commonwealth University Richmond VA 23298 USA
- Institute for Structural Biology, Drug Discovery and Development, School of Pharmacy, Virginia Commonwealth University Richmond VA 23219 USA
| | - Claudio Catalano
- Department of Medicinal Chemistry, School of Pharmacy, Virginia Commonwealth University Richmond VA 23298 USA
- Institute for Structural Biology, Drug Discovery and Development, School of Pharmacy, Virginia Commonwealth University Richmond VA 23219 USA
| | - Youzhong Guo
- Department of Medicinal Chemistry, School of Pharmacy, Virginia Commonwealth University Richmond VA 23298 USA
- Institute for Structural Biology, Drug Discovery and Development, School of Pharmacy, Virginia Commonwealth University Richmond VA 23219 USA
| |
Collapse
|
43
|
Fix BV, Wackowski OA, Sharma A, Diaz D, Bansal-Travers M, Cummings KM, Rees VW, Hatsukami DK, O'Connor RJ. Perceived Truthfulness of Reduced Lung Cancer Risk Advertising Claims Influences Consumers' Intention to try and to Purchase Snus. Tob Use Insights 2023; 16:1179173X231206042. [PMID: 37842177 PMCID: PMC10576425 DOI: 10.1177/1179173x231206042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
Abstract
The objective of the current study was to evaluate the impact of a reduced risk claim about lung cancer, presented in various formats, on smokers' and non-smokers' interest in trying Camel Snus and intention to purchase Camel Snus. We varied claim formats by varying advertising messages for Camel Snus in 4 ways (1) text only; (2) bar chart; (3) text/testimonial; and (4) bar chart/testimonial. 3001 participants were recruited from a web-based consumer specialty panel via an email invitation. In 2015, a second study was conducted, using similar methods, where 3001 additional participants were recruited. Overall, controlling for other factors, the presence of an MRTP claim was not significantly related to interest in trying snus [X2 (4) = 8.567, P = .073], or purchase intentions [X2 (4) = 1.148, P = .887]. Relative to a control ad where no explicit health risk claim was made, the Graphic + testimonial [OR = 1.29] or Text only [OR = 1.41] claims did significantly increase interest in trying Camel Snus. However, the adverting format did not impact interest in purchasing Camel Snus. While current smokeless tobacco users (95%) and smokers (59%) expressed interest in trying Camel Snus, non-tobacco users (7%) showed low interest in trying or purchasing Camel Snus (P < .001). Interest in trying Camel Snus was stronger in younger smokers compared to older smokers. Among current smokers, worry about lung cancer (the key focus of the reduced risk claim) was not associated with interest in trying Camel Snus or with purchase intention [OR = .91, 95% CI: .72, 1.14] or intention to purchase snus [OR = 1.07, 95% CI: .86, 1.32]. Future research should evaluate how claim and messaging formats influence perceived truthfulness and whether this effect differs among sub-groups of consumers, such as adolescents, those with tobacco-related disease, and former smokers. It will also be helpful to understand whether perceptions of ad truthfulness result in changes in product use patterns over time. In sum, giving people truthful, credible information about relative product risks, such as through authorized MRTP claims, is important, but such information is likely insufficient to get smokers to switch.
Collapse
Affiliation(s)
- Brian V Fix
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Olivia A Wackowski
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Akshika Sharma
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Destiny Diaz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Vaughan W Rees
- Center for Global Tobacco Control, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| |
Collapse
|
44
|
Cruz G, Ramos-Cartagena JM, Torres-Russe JL, Colón-López V, Ortiz-Ortiz KJ, Pericchi L, Deshmukh AA, Ortiz AP. Barriers and facilitators to anal cancer screening among people living with HIV in Puerto Rico. BMC Public Health 2023; 23:1940. [PMID: 37803344 PMCID: PMC10559598 DOI: 10.1186/s12889-023-16847-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Anal cancer (AC) disproportionally affects people living with HIV (PLWH). Although there are no consensus-based AC screening guidelines, experts recommend anal pap as a primary screening tool in settings where high-resolution anoscopy (HRA) is available. We aimed to assess barriers and facilitators to anal cancer screening in a sample of Hispanic PLWH in Puerto Rico. METHODS To assess their knowledge and attitudes, we conducted a cross-sectional survey from 2020-2021 among PLWH in Puerto Rico (n = 212). Data was collected through a telephone interview that assessed information on sociodemographics, knowledge, and attitudes about AC, and the history of AC screening. The chi-square test, Fisher exact test, and logistic regression models were used to assess factors associated with screening uptake. RESULTS Anal Pap and HRA awareness were 60.4% and 30.7%, respectively. Anal Pap and HRA uptake was 51.5% and 19.3%, respectively. The most common barriers for anal Pap and HRA were lack of knowledge about the test and lack of physician recommendation. MSM were more likely to have heard of anal Pap (OR: 2.15, 95% CI:1.30-3.54) than MSW. MSM (OR: 3.04, 95% CI: 1.79-5.19) and women (OR: 3.00, 95% CI: 1.72-5.20) were also more likely to have undergone anal Pap. Similarly, individuals with a history of genital warts were more likely to have heard of anal Pap and HRA and have undergone anal Pap and HRA. Awareness of where to go for concerns about anal health was positively associated with having received anal Pap and HRA. CONCLUSIONS With emerging evidence on the effectiveness of screening and treatment for anal cancer, several organizations are steering toward generating consensus-based anal cancer screening recommendations. Our study provides foundational data on barriers and facilitators to anal cancer screening in Puerto Rico that will be critical to informing screening implementation in this US territory.
Collapse
Affiliation(s)
- Gabriela Cruz
- College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Jeslie M Ramos-Cartagena
- Medical Science Campus, University of Puerto Rico/MD Anderson Cancer Center Partnership for Excellence in Cancer Research, PO BOX 365067, San Juan, 00936-5067, Puerto Rico
| | - José L Torres-Russe
- University of Puerto Rico Comprehensive Cancer Center, PO Box 363027, San Juan, 00936-3027, Puerto Rico
| | - Vivian Colón-López
- University of Puerto Rico Comprehensive Cancer Center, PO Box 363027, San Juan, 00936-3027, Puerto Rico
| | - Karen J Ortiz-Ortiz
- University of Puerto Rico Comprehensive Cancer Center, PO Box 363027, San Juan, 00936-3027, Puerto Rico
- Puerto Rico Central Cancer Registry, San Juan, Puerto Rico
| | - Luis Pericchi
- Department of Mathematics, University of Puerto Rico, Rio Piedras Campus, Medical Science Campus, PO BOX 365067, San Juan, 00936-5067, Puerto Rico
| | - Ashish A Deshmukh
- Medical University of South Carolina, 68 President St, BE 103, Charleston, SC, 29425, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Ana Patricia Ortiz
- University of Puerto Rico Comprehensive Cancer Center, PO Box 363027, San Juan, 00936-3027, Puerto Rico.
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
| |
Collapse
|
45
|
Rothman J, Roudik M, Zeng C, Ssebyala S, Pinheiro LC. Diabetes and Cancer Co-management Education: Leveraging the Patient Activated Learning System (PALS) for Patients with Breast Cancer. J Cancer Educ 2023; 38:1557-1561. [PMID: 37099118 PMCID: PMC10132441 DOI: 10.1007/s13187-023-02298-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 06/19/2023]
Abstract
More than 70% of cancer patients have one or more comorbid conditions, and diabetes is one of the most common and burdensome comorbidities. However, existing patient-centered education materials often fail to acknowledge how to co-manage cancer and diabetes, leaving patients feeling overwhelmed and searching for guidance. Our team sought to fill this knowledge gap by using the Patient Activated Learning System (PALS), a patient-centered, publicly available platform, to generate patient-centered education materials about co-managing diabetes and cancer. Using insights from 15 patient interview transcripts, we developed eight reusable knowledge objects (RKOs) for a variety of common questions that patients have about co-managing diabetes and cancer. The RKOs were written in collaboration with researchers and clinicians and then peer reviewed by experts. The eight evidence-based RKOs have the potential to equip patients with the knowledge to support cancer and diabetes co-management. There are no existing patient-centered educational resources to help patients manage their diabetes during cancer treatments. We filled this gap by using the Patient Activated Learning System (PALS) to generate evidence-based, patient-facing educational information that was written by researchers and clinicians and peer reviewed by experts. This educational content will support cancer and diabetes co-management for patients.
Collapse
Affiliation(s)
| | | | - Caroline Zeng
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, Box 331, 420 East 70th Street, New York, NY, 10021, USA
| | | | - Laura C Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, Box 331, 420 East 70th Street, New York, NY, 10021, USA.
- Division of Epidemiology, Department of Population Health Science, Weill Cornell Medicine, New York, NY, USA.
| |
Collapse
|
46
|
Ohde JW, Warner DO, Egginton JS, Hagedorn HJ. Stakeholder perceptions of using "opt-out" for tobacco use treatment in a cancer care setting: a qualitative evaluation of patients, providers, and desk staff. Implement Sci Commun 2023; 4:117. [PMID: 37730738 PMCID: PMC10510286 DOI: 10.1186/s43058-023-00493-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 08/28/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Continued tobacco use in cancer patients increases the risk of cancer treatment failure and decreases survival. However, currently, most cancer patients do not receive evidence-based tobacco treatment. A recently proposed "opt-out" approach would automatically refer all cancer patients who use tobacco to tobacco treatment, but its acceptability to cancer patients and providers is unknown. We aimed to understand stakeholder beliefs, concerns, and receptivity to using the "opt-out" approach for tobacco treatment referrals in a cancer care setting. METHODS Semi-structured interviews were conducted with oncology patients, providers, and desk staff. The sample size was determined when theoretical saturation was reached. Given the differences among participant roles, separate interview guides were developed. Transcripts were analyzed using standard coding techniques for qualitative data using the Consolidated Framework for Implementation Research (CFIR) codebook. Emergent codes were added to the codebook to account for themes not represented by a CFIR domain. Coded transcripts were then entered into the qualitative analysis software NVivo to generate code reports for CFIR domains and emergent codes for each stakeholder group. Data were presented by stakeholder group and subcategorized by CFIR domains and emergent codes when appropriate. RESULTS A total of 21 providers, 19 patients, and 6 desk staff were interviewed. Overall acceptance of the "opt out" approach was high among all groups. Providers overwhelmingly approved of the approach as it requires little effort from them to operate and saves clinical time. Desk staff supported the opt-out system and believed there are clinical benefits to patients receiving information about tobacco treatment. Many patients expressed support for using an opt-out approach as many smokers need assistance but may not directly ask for it. Patients also thought that providers emphasizing the benefits of stopping tobacco use to cancer treatment and survival would be an important factor motivating them to attend treatment. CONCLUSIONS While providers appreciated that the system required little effort on their part, patients clearly indicated that promotion of tobacco cessation treatment by their provider would be vital to enhance willingness to engage with treatment. Future implementation efforts of opt-out systems will require implementation strategies that promote provider engagement with their patients around smoking cessation while continuing to limit burden on providers.
Collapse
Affiliation(s)
- Joshua W Ohde
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA.
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jason S Egginton
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Hildi J Hagedorn
- Center for Care Delivery & Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| |
Collapse
|
47
|
Rosenthal GE, McClain DA, High KP, Easterling D, Sharkey A, Wagenknecht LE, O’Byrne C, Woodside R, Houston TK. The Academic Learning Health System: A Framework for Integrating the Multiple Missions of Academic Medical Centers. Acad Med 2023; 98:1002-1007. [PMID: 37099650 PMCID: PMC10453356 DOI: 10.1097/acm.0000000000005259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The learning health system (LHS) has emerged over the past 15 years as a concept for improving health care delivery. Core aspects of the LHS concept include: promoting improved patient care through organizational learning, innovation, and continuous quality improvement; identifying, critically assessing, and translating knowledge and evidence into improved practices; building new knowledge and evidence around how to improve health care and health outcomes; analyzing clinical data to support learning, knowledge generation, and improved patient care; and engaging clinicians, patients, and other stakeholders in processes of learning, knowledge generation, and translation. However, the literature has paid less attention to how these LHS aspects may integrate with the multiple missions of academic medical centers (AMCs). The authors define an academic learning health system (aLHS) as an LHS built around a robust academic community and central academic mission, and they propose 6 features that emphasize how an aLHS differs from an LHS. An aLHS capitalizes on embedded academic expertise in health system sciences; engages the full spectrum of translational investigation from mechanistic basic sciences to population health; builds pipelines of experts in LHS sciences and clinicians with fluency in practicing in an LHS; applies core LHS principles to the development of curricula and clinical rotations for medical students, housestaff, and other learners; disseminates knowledge more broadly to advance the evidence for clinical practice and health systems science methods; and addresses social determinants of health, creating community partnerships to mitigate disparities and improve health equity. As AMCs evolve, the authors expect that additional differentiating features and ways to operationalize the aLHS will be identified and hope this article stimulates further discussion around the intersection of the LHS concept and AMCs.
Collapse
Affiliation(s)
- Gary E. Rosenthal
- G.E. Rosenthal is professor and chair, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Donald A. McClain
- D.A. McClain is professor, Department of Internal Medicine, Section on Endocrinology and Metabolism, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kevin P. High
- K.P. High is professor, Department of Internal Medicine, and president, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Douglas Easterling
- D. Easterling is professor, Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Angela Sharkey
- A. Sharkey is professor, Department of Pediatrics, and senior associate dean for undergraduate medical education, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lynne E. Wagenknecht
- L.E. Wagenknecht is professor and chair, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Christopher O’Byrne
- C. O’Byrne is vice president and associate dean, Research Administration and Operations, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Rachel Woodside
- R. Woodside is director, Research Strategy and Operations, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Thomas K. Houston
- T.K. Houston is professor and vice chair for learning health systems, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
48
|
Jain B, Bajaj SS, Patel TA, Vapiwala N, Lam MB, Mahal BA, Muralidhar V, Amen TB, Nguyen PL, Sanford NN, Dee EC. ASO Author Reflections: Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders. Ann Surg Oncol 2023; 30:5506-5508. [PMID: 37120487 DOI: 10.1245/s10434-023-13560-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Miranda B Lam
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Brandon A Mahal
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Vinayak Muralidhar
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Kaiser Permanente Northwest, Portland, OR, USA
| | - Troy B Amen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Nina N Sanford
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA.
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
49
|
Levy DT, Liber AC, Cadham C, Sanchez-Romero LM, Hyland A, Cummings M, Douglas C, Meza R, Henriksen L. Follow the money: a closer look at US tobacco industry marketing expenditures. Tob Control 2023; 32:575-582. [PMID: 35074930 PMCID: PMC9346571 DOI: 10.1136/tobaccocontrol-2021-056971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/12/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION While much of the concern with tobacco industry marketing has focused on direct media advertising, a less explored form of marketing strategy is to discount prices. Price discounting is important because it keeps the purchase price low and can undermine the impact of tax increases. METHODS We examine annual US marketing expenditures from 1975 to 2019 by the largest cigarette and smokeless tobacco companies as reported to the Federal Trade Commission. We consider three categories: direct advertising, promotional allowances and price discounting. In addition to considering trends in these expenditures, we examine how price discounting expenditures relate to changes in product prices and excise taxes. RESULTS US direct advertising expenditures for cigarettes fell from 80% of total industry marketing expenditures in 1975 to less than 3% in 2019, while falling from 39% in 1985 to 6% in 2019 for smokeless tobacco. Price discounting expenditures for cigarettes became prominent after the Master Settlement Agreement and related tax increases in 2002. By 2019, 87% of cigarette marketing expenditures were for price discounts and 7% for promotional allowances. Smokeless marketing expenditures were similar: 72% for price promotions and 13% for promotional allowances. Price discounting increased with prices and taxes until reaching their currently high levels. CONCLUSIONS Between 1975 and 2019, direct advertising dramatically fell while price discounting and promotional expenditures increased. Local, state and federal policies are needed that apply non-tax mechanisms to increase tobacco prices and restrict industry contracts to offset industry marketing strategies. Further study is needed to better understand industry decisions about marketing expenditures.
Collapse
Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Alex C Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Christopher Cadham
- Department of Health Management and Policy, University of Michigan School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Andrew Hyland
- Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Michael Cummings
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cliff Douglas
- Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Rafael Meza
- Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
50
|
Rutherford DV, Medley S, Henderson NC, Gersch CL, Vandenberg TA, Albain KS, Dakhil SR, Tirumali NR, Gralow JR, Hortobagyi GN, Pusztai L, Mehta RS, Hayes DF, Kidwell KM, Henry NL, Barlow WE, Rae JM, Hertz DL. Effects of CYP3A4 and CYP2C9 genotype on systemic anastrozole and fulvestrant concentrations in SWOG S0226. Pharmacogenomics 2023; 24:665-673. [PMID: 37615099 PMCID: PMC10565537 DOI: 10.2217/pgs-2023-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023] Open
Abstract
Objective & methods: This study tested associations of genotype-predicted activity of CYP3A4, other pharmacogenes, SLC28A7 (rs11648166) and ALPPL2 (rs28845026) with systemic concentrations of the endocrine therapies anastrozole and fulvestrant in SWOG S0226 trial participants. Results: Participants in the anastrozole-only arm with low CYP3A4 activity (i.e. CYP3A4*22 carriers) had higher systemic anastrozole concentrations than patients with high CYP3A4 activity (β-coefficient = 10.03; 95% CI: 1.42, 18.6; p = 0.025). In an exploratory analysis, participants with low CYP2C9 activity had lower anastrozole concentrations and higher fulvestrant concentrations than participants with high CYP2C9 activity. Conclusion: Inherited genetic variation in CYP3A4 and CYP2C9 may affect concentrations of endocrine therapy and may be useful to personalize dosing and improve treatment outcomes.
Collapse
Affiliation(s)
- Delaney V Rutherford
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Sarah Medley
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Nicholas C Henderson
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Christina L Gersch
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Ted A Vandenberg
- Western University/Canadian Cancer Trials Group, London, ON, N5X 3K8, Canada
| | - Kathy S Albain
- Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153, USA
| | | | | | - Julie R Gralow
- American Society of Clinical Oncology, Alexandria, 22314, Virginia
| | | | | | - Rita S Mehta
- University of California Irvine Medical Center, Chao Family Comprehensive Cancer Center, Orange, CA 92868, USA
| | - Daniel F Hayes
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - N Lynn Henry
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | | | - James M Rae
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USA
| |
Collapse
|