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1.
Acta Neuropathol ; 147(1): 11, 2024 01 06.
Article in English | MEDLINE | ID: mdl-38183430

ABSTRACT

Prognostic factors and standards of care for astrocytoma, isocitrate dehydrogenase (IDH)-mutant, CNS WHO grade 4, remain poorly defined. Here we sought to explore disease characteristics, prognostic markers, and outcome in patients with this newly defined tumor type. We determined molecular biomarkers and assembled clinical and outcome data in patients with IDH-mutant astrocytomas confirmed by central pathology review. Patients were identified in the German Glioma Network cohort study; additional cohorts of patients with CNS WHO grade 4 tumors were identified retrospectively at two sites. In total, 258 patients with IDH-mutant astrocytomas (114 CNS WHO grade 2, 73 CNS WHO grade 3, 71 CNS WHO grade 4) were studied. The median age at diagnosis was similar for all grades. Karnofsky performance status at diagnosis inversely correlated with CNS WHO grade (p < 0.001). Despite more intensive treatment upfront with higher grade, CNS WHO grade was strongly prognostic: median overall survival was not reached for grade 2 (median follow-up 10.4 years), 8.1 years (95% CI 5.4-10.8) for grade 3, and 4.7 years (95% CI 3.4-6.0) for grade 4. Among patients with CNS WHO grade 4 astrocytoma, median overall survival was 5.5 years (95% CI 4.3-6.7) without (n = 58) versus 1.8 years (95% CI 0-4.1) with (n = 12) homozygous CDKN2A deletion. Lower levels of global DNA methylation as detected by LINE-1 methylation analysis were strongly associated with CNS WHO grade 4 (p < 0.001) and poor outcome. MGMT promoter methylation status was not prognostic for overall survival. Histomolecular stratification based on CNS WHO grade, LINE-1 methylation level, and CDKN2A status revealed four subgroups of patients with significantly different outcomes. In conclusion, CNS WHO grade, global DNA methylation status, and CDKN2A homozygous deletion are prognostic in patients with IDH-mutant astrocytoma. Combination of these parameters allows for improved prediction of outcome. These data aid in designing upcoming trials using IDH inhibitors.


Subject(s)
Astrocytoma , Isocitrate Dehydrogenase , Humans , Astrocytoma/genetics , Astrocytoma/therapy , Cohort Studies , Homozygote , Isocitrate Dehydrogenase/genetics , Prognosis , Retrospective Studies , Sequence Deletion
2.
BMC Cancer ; 24(1): 82, 2024 Jan 15.
Article in English | MEDLINE | ID: mdl-38225589

ABSTRACT

BACKGROUND: Glioblastoma is the most common and most aggressive malignant primary brain tumor in adults. Glioblastoma cells synthesize and secrete large quantities of the excitatory neurotransmitter glutamate, driving epilepsy, neuronal death, tumor growth and invasion. Moreover, neuronal networks interconnect with glioblastoma cell networks through glutamatergic neuroglial synapses, activation of which induces oncogenic calcium oscillations that are propagated via gap junctions between tumor cells. The primary objective of this study is to explore the efficacy of brain-penetrating anti-glutamatergic drugs to standard chemoradiotherapy in patients with glioblastoma. METHODS/DESIGN: GLUGLIO is a 1:1 randomized phase Ib/II, parallel-group, open-label, multicenter trial of gabapentin, sulfasalazine, memantine and chemoradiotherapy (Arm A) versus chemoradiotherapy alone (Arm B) in patients with newly diagnosed glioblastoma. Planned accrual is 120 patients. The primary endpoint is progression-free survival at 6 months. Secondary endpoints include overall and seizure-free survival, quality of life of patients and caregivers, symptom burden and cognitive functioning. Glutamate levels will be assessed longitudinally by magnetic resonance spectroscopy. Other outcomes of interest include imaging response rate, neuronal hyperexcitability determined by longitudinal electroencephalography, Karnofsky performance status as a global measure of overall performance, anticonvulsant drug use and steroid use. Tumor tissue and blood will be collected for translational research. Subgroup survival analyses by baseline parameters include segregation by age, extent of resection, Karnofsky performance status, O6-methylguanine DNA methyltransferase (MGMT) promotor methylation status, steroid intake, presence or absence of seizures, tumor volume and glutamate levels determined by MR spectroscopy. The trial is currently recruiting in seven centers in Switzerland. TRIAL REGISTRATION: NCT05664464. Registered 23 December 2022.


Subject(s)
Brain Neoplasms , Glioblastoma , Adult , Humans , Brain Neoplasms/drug therapy , Brain Neoplasms/genetics , Chemoradiotherapy , Clinical Trials, Phase I as Topic , Clinical Trials, Phase II as Topic , Drug Repositioning , Glioblastoma/drug therapy , Glioblastoma/genetics , Glutamates , Multicenter Studies as Topic , Quality of Life , Randomized Controlled Trials as Topic , Steroids/therapeutic use
3.
J Struct Biol ; 215(1): 107924, 2023 03.
Article in English | MEDLINE | ID: mdl-36462717

ABSTRACT

Structural and functional characterization of proteins as well as the design of targeted drugs heavily rely on recombinant protein expression and purification. The polyhistidine-tag (His-tag) is among the most prominent examples of affinity tags used for the isolation of recombinant proteins from their expression hosts. Short peptide tags are commonly considered not to interfere with the structure of the tagged protein and tag removal is frequently neglected. This study demonstrates the formation of higher-order oligomers based on the example of two His-tagged membrane proteins, the dimeric arginine-agmatine antiporter AdiC and the pentameric light-driven proton pump proteorhodopsin. Size exclusion chromatography revealed the formation of tetrameric AdiC and decameric as well as pentadecameric proteorhodopsin through specific interactions between their His-tags. In addition, single particle cryo-electron microscopy (cryo-EM) allowed structural insights into the three-dimensional arrangement of the higher-order oligomers and the underlying His-tag-mediated interactions. These results reinforce the importance of considering the length and removal of affinity purification tags and illustrate how neglect can lead to potential interference with downstream biophysical or biochemical characterization of the target protein.


Subject(s)
Membrane Proteins , Cryoelectron Microscopy , Recombinant Proteins , Chromatography, Affinity/methods , Chromatography, Gel
4.
Curr Opin Neurol ; 36(5): 427-431, 2023 10 01.
Article in English | MEDLINE | ID: mdl-37639489

ABSTRACT

PURPOSE OF REVIEW: This review highlights recent knowledge on the diagnosis and treatment of immune checkpoint inhibitor-induced neurological side effects (irNAE) focussing on the neuromuscular system. RECENT FINDINGS: irNAEs mainly resemble sporadic neuromuscular autoimmune diseases and paraneoplastic neurological syndromes. However, neurological symptoms may be unspecific (muscle weakness, fatigue) in the oncological setting and carry the risk of misdiagnosis and delayed therapeutic intervention. The role of disease-specific neuromuscular autoantibodies in the diagnosis is controversial as preexisting autoantibodies may otherwise be present before immune checkpoint inhibitor (ICI) treatment without clinical symptoms and may not develop in case of irNAE manifestation. A new necrotising form of myositis (irMyositis) has been described presenting with facial weakness and ptosis mimicking myasthenia gravis. It comes along with a high rate of severe myocarditis accounting for a triad overlap syndrome (myasthenia/myositis/myocarditis). The role of modern biologicals in the treatment of irNAEs has to be determined. SUMMARY: irNAEs are rare but carry the risk of permanent morbidity and mortality. Early suspicion and diagnosis are key to prevent neurological sequelae. Beyond interruption of ICI administration, treatment corresponds to sporadic autoimmune diseases. The myasthenia/myositis/myocarditis overlap syndrome deserves special attention as it carries the highest risk of mortality. The role of neurotoxic pretreatment regimens, preexisting subclinical neurological autoimmune diseases and the risk of ICI-re-challenge after irNAEs has to be further investigated.


Subject(s)
Drug-Related Side Effects and Adverse Reactions , Myasthenia Gravis , Myocarditis , Myositis , Humans , Immune Checkpoint Inhibitors/adverse effects , Peripheral Nervous System , Myasthenia Gravis/chemically induced , Myasthenia Gravis/drug therapy , Myositis/chemically induced , Myositis/drug therapy , Autoantibodies
5.
Invest New Drugs ; 41(2): 267-275, 2023 04.
Article in English | MEDLINE | ID: mdl-36792805

ABSTRACT

PURPOSE: Lisavanbulin (BAL101553) is the prodrug of avanbulin (BAL27862), a microtubule-destabilizing agent. The goal of this study (NCT02895360) was to characterize the safety, tolerability and antitumor activity of lisavanbulin administered as a 48-hour intravenous (IV) infusion at the recommended Phase 2 dose (RP2D) of 70 mg/m2. Results from the Phase 1 dose-escalation portion of the study identifying the RP2D have been previously reported. Here, we present the findings from the Phase 2a portion of this study. Methods. This multi-center, open-label study included patients with ovarian, fallopian-tube, or primary peritoneal cancer that was either platinum-resistant or refractory (11 patients), or with first recurrence of glioblastoma (12 patients). Lisavanbulin was administered as a 48-hour IV infusion on Days 1, 8, and 15 of a 28-day cycle. Results. Lisavanbulin was well tolerated in both patient cohorts. Thirteen patients (56.5%) developed 49 adverse events assessed as related to study treatment. The majority were mild or moderate; four were grade 3/4. Sixteen SAEs were reported in nine patients (39.1%), with none considered related to study treatment. No AEs led to permanent treatment discontinuation. Three patients in the ovarian cancer cohort had stable disease with lesion size reductions after two cycles of treatment; in the glioblastoma cohort, one patient showed partial response with a > 90% glioblastoma area reduction as best response, and one patient had stable disease after eight cycles of treatment. Conclusion. This study demonstrated a favorable safety and tolerability profile of 48-hour continuous IV infusion of lisavanbulin in patients with solid extracranial tumors or glioblastoma. Clinicaltrials.gov registration: NCT02895360.


Subject(s)
Glioblastoma , Ovarian Neoplasms , Humans , Female , Neoplasm Recurrence, Local/drug therapy , Ovarian Neoplasms/drug therapy , Ovarian Neoplasms/pathology
6.
Acta Neuropathol ; 146(2): 173-190, 2023 08.
Article in English | MEDLINE | ID: mdl-37368072

ABSTRACT

Meningiomas are the most common primary intracranial tumors. Although most symptomatic cases can be managed by surgery and/or radiotherapy, a relevant number of patients experience an unfavorable clinical course and additional treatment options are needed. As meningiomas are often perfused by dural branches of the external carotid artery, which is located outside the blood-brain barrier, they might be an accessible target for immunotherapy. However, the landscape of naturally presented tumor antigens in meningioma is unknown. We here provide a T-cell antigen atlas for meningioma by in-depth profiling of the naturally presented immunopeptidome using LC-MS/MS. Candidate target antigens were selected based on a comparative approach using an extensive immunopeptidome data set of normal tissues. Meningioma-exclusive antigens for HLA class I and II are described here for the first time. Top-ranking targets were further functionally characterized by showing their immunogenicity through in vitro T-cell priming assays. Thus, we provide an atlas of meningioma T-cell antigens which will be publicly available for further research. In addition, we have identified novel actionable targets that warrant further investigation as an immunotherapy option for meningioma.


Subject(s)
Meningeal Neoplasms , Meningioma , Humans , Meningioma/therapy , Chromatography, Liquid , Tandem Mass Spectrometry , Immunotherapy , T-Lymphocytes , Meningeal Neoplasms/therapy
7.
Epilepsia ; 63(10): e138-e143, 2022 10.
Article in English | MEDLINE | ID: mdl-35892318

ABSTRACT

Seizures in patients with brain metastases have an impact on morbidity and quality of life. The influence of tumor growth on the risk of seizures in these patients is not well defined. In this cohort study, we evaluated adult patients from the University Hospital of Zurich following resection of brain metastases from solid tumors, with or without preoperative seizures, at 3, 6, 9, and 12 months postoperatively. Brain magnetic resonance imaging was assessed for tumor progression using the Response Assessment in Neuro-Oncology criteria. The quarterly risk of unprovoked seizures was modeled with mixed effects logistic regression. We analyzed 444 time frames in 220 patients. Progression of brain metastases was independently associated with seizures during the respective quarterly follow-up period (odds ratio = 3.9, 95% confidence interval = 1.3-11.3, p = .014). Complete resection of brain metastases was associated with a lower risk of seizures (odds ratio = .2, 95% confidence interval = .04-.7, p = .015). Postoperative progression of brain metastases quadrupled the risk of seizures; therefore, vigorous follow-up may be useful to identify tumor progression and gauge the risk of seizures. The identification of patients at high seizure risk may have implications for treatment decisions and influence aspects of daily life. Breakthrough seizures may indicate brain metastases progression.


Subject(s)
Brain Neoplasms , Quality of Life , Adult , Brain Neoplasms/complications , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/surgery , Cohort Studies , Humans , Retrospective Studies , Seizures/complications , Treatment Outcome
8.
Eur J Neurol ; 29(8): 2386-2397, 2022 08.
Article in English | MEDLINE | ID: mdl-35545894

ABSTRACT

BACKGROUND AND PURPOSE: Venous thromboembolic events (VTEs) are a major complication in cancer patients, and therefore, also in brain cancer patients, anticoagulants are considered appropriate in the treatment of VTEs. METHODS: Frequency, risk factors, and treatment of VTEs, as well as associated complications, were assessed in a population-based cohort of glioblastoma patients in the Canton of Zurich, Switzerland. Correlations between clinical data and survival were retrospectively analyzed using the log-rank test and Cox regression models. RESULTS: Four hundred fourteen glioblastoma patients with isocitrate dehydrogenase wild-type status were identified. VTEs were documented in 65 patients (15.7%). Median time from tumor diagnosis to the occurrence of a VTE was 1.8 months, and 27 patients were diagnosed with VTEs postoperatively (within 35 days; 42.2%). History of a prior VTE was more common in patients who developed VTEs than in those who did not (p = 0.004). Bevacizumab treatment at any time during the disease course was not associated with occurrence of VTEs (p = 0.593). Most patients with VTEs (n = 61, 93.8%) were treated with therapeutic anticoagulation. Complications occurred in 14 patients (23.0%), mainly intracranial hemorrhages (n = 7, 11.5%). Overall survival did not differ between patients diagnosed with VTEs and those who had no VTE (p = 0.139). Tumor progression was the major cause of death (n = 283, 90.7%), and only three patients (1.0%) died in association with acute VTEs. CONCLUSIONS: Venous thromboembolic events occurred early in the disease course, suggesting that the implementation of primary venous thromboembolism prophylaxis during first-line chemoradiotherapy could be explored in a randomized setting.


Subject(s)
Glioblastoma , Venous Thromboembolism , Venous Thrombosis , Anticoagulants/therapeutic use , Glioblastoma/complications , Glioblastoma/epidemiology , Humans , Incidence , Retrospective Studies , Risk Factors , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control , Venous Thrombosis/drug therapy
9.
Brain ; 144(11): 3322-3327, 2021 12 16.
Article in English | MEDLINE | ID: mdl-33974079

ABSTRACT

Pro-tumorigenic electrochemical synapses between neurons and brain tumour cells in preclinical studies suggest unfavourable effects of epilepsy on patient survival. We investigated associations of epilepsy and survival in three cohorts of brain tumour patients (meningioma, glioblastoma and brain metastases). Cohorts were segregated into three groups for comparative analyses: (i) no epilepsy; (ii) epilepsy without status epilepticus; and (iii) status epilepticus. Status epilepticus was considered a surrogate of extensive neuronal hyperexcitability. The main outcome was progression-free survival (meningioma) and overall survival (glioblastoma and brain metastases), adjusted for established prognostic factors and onset of epilepsy by time-dependent multivariate Cox modelling. The primary analysis population comprised 1792 patients (742 meningioma, 249 glioblastoma, 801 brain metastases). Epilepsy was associated with favourable prognostic factors. However, on multivariate analyses, status epilepticus was associated with inferior overall survival of patients with glioblastoma [status epilepticus versus no epilepsy multivariate hazard ratio (HR) 3.72, confidence interval (CI) 1.78-7.76, P < 0.001] and brain metastases (status epilepticus versus no epilepsy HR 2.30, CI 1.10-4.79, P = 0.026). Among brain metastases patients, but not among patients with meningioma or glioblastoma, epilepsy was similarly associated with inferior overall survival (epilepsy versus no epilepsy HR 2.16, CI 1.60-2.93, P < 0.001). We conclude that epilepsy may convey inferior survival of patients with malignant brain tumours.


Subject(s)
Brain Neoplasms/complications , Brain Neoplasms/mortality , Epilepsy/etiology , Cohort Studies , Female , Glioblastoma/complications , Glioblastoma/mortality , Humans , Male , Meningeal Neoplasms/complications , Meningeal Neoplasms/mortality , Meningioma/complications , Meningioma/mortality , Prognosis , Progression-Free Survival
10.
Birth ; 48(4): 574-582, 2021 12.
Article in English | MEDLINE | ID: mdl-34219255

ABSTRACT

BACKGROUND: Obstetric induction procedures are expensive, and little is known of the specific difference in cost between inpatient and outpatient protocols for these procedures. OBJECTIVE: The objective of this study was to examine the difference in health care costs, maternal and neonatal morbidity, and cesarean birth rates for inpatient versus outpatient Foley induction protocols. MATERIAL AND METHODS: We conducted a retrospective study using deliveries from 2013 to 2015 that received an outpatient or inpatient Foley catheter induction. Inductions were matched by race, parity, and maternal age. We used univariate and multivariate logistic regression to test the association between type of induction, length of stay, and cost. Maternal and neonatal factors and cesarean rates were also considered. RESULTS: A total of 163 outpatient Foley inductions were matched 1:1 to inpatient inductions. Outpatient inductions were more likely to have a shorter length of hospitalization from admission to discharge (a 7.17-hour difference, 95% CI, 71.00, 77.59) and lower costs of hospitalization ($408 per patient, 95% CI, 4305, 4714). In the univariate analysis, there was no difference in rate of cesarean birth (OR 0.95, 95% CI, 0.61, 1.48). However, in the multivariate analysis, there was a decreased rate of cesarean for outpatient inductions (OR 0.5, 95% CI, 0.26, 0.97). CONCLUSIONS: Outpatient Foley catheter induction appears to be a safe, cost-effective method for induction of labor. Generating protocols allowing patients to receive quality care in an outpatient setting is increasingly important in current health care environments.


Subject(s)
Cervical Ripening , Labor, Induced , Catheters , Cost-Benefit Analysis , Female , Humans , Infant, Newborn , Outpatients , Pregnancy , Retrospective Studies
11.
Blood ; 132(26): 2744-2753, 2018 12 27.
Article in English | MEDLINE | ID: mdl-30249786

ABSTRACT

To address the role of chronic antigenic stimulation in primary central nervous system lymphoma (PCNSL), we searched for autoantigens and identified sterile α-motif domain containing protein 14 (SAMD14) and neural tissue-specific F-actin binding protein I (neurabin-I) as autoantigenic targets of the B-cell receptors (BCRs) from 8/12 PCNSLs. In the respective cases, SAMD14 and neurabin-I were atypically hyper-N-glycosylated (SAMD14 at ASN339 and neurabin-I at ASN1277), explaining their autoimmunogenicity. SAMD14 and neurabin-I induced BCR pathway activation and proliferation of aggressive lymphoma cell lines transfected with SAMD14- and neurabin-I-reactive BCRs. Moreover, the BCR binding epitope of neurabin-I conjugated to truncated Pseudomonas exotoxin-killed lymphoma cells expressing the respective BCRs. These results support the role of chronic antigenic stimulation by posttranslationally modified central nervous system (CNS) driver autoantigens in the pathogenesis of PCNSL, serve as an explanation for their CNS tropism, and provide the basis for a novel specific treatment approach.


Subject(s)
Antigens, Neoplasm/immunology , Autoantigens/immunology , Central Nervous System Neoplasms/immunology , Lymphoma, Large B-Cell, Diffuse/immunology , Microfilament Proteins/immunology , Neoplasm Proteins/immunology , Nerve Tissue Proteins/immunology , Repressor Proteins/immunology , Antigens, Neoplasm/genetics , Autoantigens/genetics , Cell Line, Tumor , Central Nervous System Neoplasms/genetics , Central Nervous System Neoplasms/pathology , Central Nervous System Neoplasms/therapy , Glycosylation , HEK293 Cells , Humans , Lymphoma, Large B-Cell, Diffuse/genetics , Lymphoma, Large B-Cell, Diffuse/pathology , Lymphoma, Large B-Cell, Diffuse/therapy , Microfilament Proteins/genetics , Neoplasm Proteins/genetics , Nerve Tissue Proteins/genetics , Repressor Proteins/genetics
12.
J Neurooncol ; 147(3): 663-669, 2020 May.
Article in English | MEDLINE | ID: mdl-32232622

ABSTRACT

PURPOSE: Gliomas are primary brain tumors with a life-limiting course of disease, and the last weeks of life are often characterized by neurological deficits that affect communication and personality. End-of-life treatment in this patient group therefore requires specific approaches. To date, little data is available on patients' and caregivers' needs and experiences in the last phase of the disease. METHODS: In this observational study, relatives of patients treated at the University Hospital Zurich, Switzerland and deceased 2015-2017 due to glioma progression were contacted to complete a structured questionnaire assessing caregivers experience within the last weeks of the disease. RESULTS: The survey was sent to 120 relatives of deceased patients with a glioma (WHO grades II-IV) (median patient age: 62 years; 73.8% male). Forty-three questionnaires were returned (37.7%). Approximately half of the patients were taken care of at home in the last 4 weeks of the disease, mainly with the assistance of in-home nursing care, of which eventually 14 patients (63.6%) died at home. While caregivers reported high satisfaction with medical and nursing care, psychological support was rated average to poor on a 10-point scale. Free comment fields were used widely, revealing open questions and needs of the relatives. CONCLUSIONS: This study illustrates the need for a more patient-centered end-of-life care including higher psychological support mechanisms, and a higher inclusion and consideration of relatives and caregivers into the care focus. Earlier discussion of end-of-life preferences could prevent hospitalizations in the last phase of life and could improve patients' and caregivers' quality of life.


Subject(s)
Brain Neoplasms , Caregivers/psychology , Glioma , Terminal Care/psychology , Adult , Aged , Aged, 80 and over , Brain Neoplasms/psychology , Brain Neoplasms/therapy , Female , Glioma/psychology , Glioma/therapy , Humans , Male , Middle Aged , Palliative Care/psychology , Surveys and Questionnaires , Young Adult
13.
Qual Life Res ; 29(7): 1801-1808, 2020 Jul.
Article in English | MEDLINE | ID: mdl-32128657

ABSTRACT

PURPOSE: Long-term impairment of quality of life (QoL) occurs in a subset of meningioma patients, even after curative surgical resection. We sought to explore socioeconomic burden of meningioma surgery and associations with post-operative QoL to identify patients at risk for inferior outcome. METHODS: All patients with histological diagnosis of an intracranial meningioma treated at a single institution 2000-2013 were screened for inclusion in this cross-sectional survey study. Surveys comprised tools to assess socioeconomic status including social deprivation, QoL and symptom burden. Multivariate binary regression models controlling for established prognostic factors were applied to explore associations of socioeconomics with QoL 1 year after surgery. RESULTS: Completed surveys were returned by 249 patients. The median age at diagnosis was 56 years (SD ± 12), 185 patients (74%) were female and 219 (88%) had World Health Organization grade I meningiomas. One year after surgery, there was a 20% decrease in the number of patients working (p < 0.001), 22% of full-time working patients transitioned to part-time work (p < 0.001) and more patients depended on professional care (14% versus 4%, p < 0.001). Patients reported improved QoL, including improved global health (effect: 21%, 95% confidence interval [1] 15-26%), headaches (effect: 19%, CI 13-24%) and seizures (effect: 12%, CI 8-17%). On multivariable analyses, QoL after meningioma surgery was associated with preoperative employment status (odds ratio [OR] 0.41, 95% CI 0.17-0.98) and subjective work ability (OR 0.37, 95% CI 0.15-0.92). CONCLUSION: In a subset of meningioma patients, there is marked socioeconomic burden, which may be associated with inferior patient-reported outcome.


Subject(s)
Meningioma/epidemiology , Meningioma/psychology , Quality of Life/psychology , Socioeconomic Factors , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Retrospective Studies , Surveys and Questionnaires
14.
J Neurooncol ; 145(2): 339-347, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31571112

ABSTRACT

PURPOSE: Overweight may be associated with favorable outcome whereas tumor cachexia may be associated with worse outcome in patients with metastatic cancer. Here we evaluate the association of abnormal body mass index and weight change with outcome in patients with brain metastasis. METHODS: Patients with a diagnosis of brain metastasis treated at the University Hospital Zurich (n = 703) were assessed for associations of body mass index, weight change, comorbidities and survival. RESULTS: Compared with patients with normal body mass index of 18.5-24.9 kg/m2 and a median overall survival of 9 months (95% confidence interval 7.5-10.5), overall survival was inferior in patients with body mass index < 18.5 kg/m2 (overall survival 6 months, 95% confidence interval 1.6-10.3, p = 0.04), but superior in patients with body mass index > 25 kg/m2 (overall survival 13 months, 95% confidence interval 11.0-15.0; p = 0.033). We report a median relative weight loss of 5% within the first 6 months of diagnosis of brain metastasis (95% confidence interval 3.3-6.5), and reduction exceeding the median was associated with an unfavorable outcome (weight loss < 5% 22.0 months, 95% confidence interval 19.2-24.8; weight loss > 5% 14.0 months, 95% confidence interval 11.9-16.). CONCLUSION: High body mass index is associated with better, and underweight with worse outcome in patients with brain metastasis. Conversely, weight loss above median may predict poor outcome. Future studies need to address whether vigorous treatment of tumor cachexia, e.g. by specific nutrition management, might improve outcome of patients with brain metastasis. In contrast, regimens associated with weight loss such as ketogenic diet may be detrimental.


Subject(s)
Brain Neoplasms , Thinness/complications , Weight Loss , Adult , Aged , Aged, 80 and over , Body Mass Index , Brain Neoplasms/complications , Brain Neoplasms/diagnosis , Brain Neoplasms/secondary , Female , Humans , Male , Middle Aged , Overweight/complications , Young Adult
15.
Environ Sci Technol ; 53(6): 3037-3047, 2019 03 19.
Article in English | MEDLINE | ID: mdl-30794395

ABSTRACT

The effects of photochemical aging on exhaust emissions from two light-duty vehicles with gasoline direct injection (GDI) engines equipped with and without catalyzed gasoline particle filters (GPFs) were investigated using a mobile environmental chamber. Both vehicles with and without the GPFs were exercised over the LA92 drive cycle using a chassis dynamometer. Diluted exhaust emissions from the entire LA92 cycle were introduced to the mobile chamber and subsequently photochemically reacted. It was found that the addition of catalyzed GPFs will significantly reduce tailpipe particulate emissions and also provide benefits in gaseous emissions, including nonmethane hydrocarbons (NMHC). Tailpipe emissions composition showed important changes with the use of GPFs by practically eliminating black carbon and increasing the fractional contribution of organic mass. Production of secondary organic aerosol (SOA) was reduced with GPF addition, but was also dependent on engine design which determined the amount of SOA precursors at the tailpipe. Our findings indicate that SOA production from GDI vehicles will be reduced with the application of catalyzed GPFs through the mitigation of reactive hydrocarbon precursors.


Subject(s)
Gasoline , Vehicle Emissions , Aerosols , Catalysis , Motor Vehicles , Soot
16.
J Neurochem ; 144(6): 780-790, 2018 03.
Article in English | MEDLINE | ID: mdl-29480969

ABSTRACT

O6 -methylguanine DNA methyltransferase (MGMT) promoter methylation is a predictive biomarker for benefit from alkylating chemotherapy, specifically temozolomide (TMZ), in glioblastoma, the most common malignant intrinsic brain tumor. Glioma-initiating cells (GIC) with stem-like properties have been associated with resistance to therapy and progression. We assessed the levels of MGMT mRNA and MGMT protein by real-time PCR and immunoblot and evaluated the impact of MGMT on TMZ sensitivity in clonogenicity assays in GIC sphere cultures (S) or differentiated adherent monolayer cultures (M). Nuclear factor kappa B (NF-κB) signaling was assessed by reporter assay and immunoblot. Compared to M cells, S cells expressed higher levels of MGMT. Differentiation of GIC induced by S-to-M transition resulted in a gradual loss of MGMT expression and increased TMZ sensitivity. This transcriptional regulation of MGMT was restricted to cell lines without MGMT promoter methylation and was not coupled to any specific neurobasal (NB) stem cell medium supplement or loss of cell adhesion. Expression levels of p50/p65 subunits of NF-κB, a transcriptional regulator of MGMT, were increased in S cells. Inhibition of NF-κB by the small molecule inhibitor, BAY 11-7082, or siRNA-mediated gene silencing, reduced MGMT levels. In summary, alkylator resistance of S cells is mainly promoted by over-expression of MGMT which results from increased activity of the NF-κB pathway in this cell culture model of glioma stem-like cells. Read the Editorial Highlight for this article on page 688.


Subject(s)
Antineoplastic Agents, Alkylating/pharmacology , Brain Neoplasms/drug therapy , Brain Neoplasms/metabolism , Drug Resistance, Neoplasm , Glioblastoma/drug therapy , Glioblastoma/metabolism , O(6)-Methylguanine-DNA Methyltransferase/metabolism , Temozolomide/pharmacology , Cell Line, Tumor , Gene Expression Regulation, Neoplastic , Humans , NF-kappa B/metabolism , RNA, Messenger/metabolism
18.
Acta Neuropathol ; 135(6): 923-938, 2018 06.
Article in English | MEDLINE | ID: mdl-29557506

ABSTRACT

Glioblastoma is the most frequent malignant primary brain tumor. In a hierarchical tumor model, glioblastoma stem-like cells (GSC) play a major role in tumor initiation and maintenance as well as in therapy resistance and recurrence. Thus, targeting this cellular subset may be key to effective immunotherapy. Here, we present a mass spectrometry-based analysis of HLA-presented peptidomes of GSC and glioblastoma patient specimens. Based on the analysis of patient samples (n = 9) and GSC (n = 3), we performed comparative HLA peptidome profiling against a dataset of normal human tissues. Using this immunopeptidome-centric approach we could clearly delineate a subset of naturally presented, GSC-associated HLA ligands, which might serve as highly specific targets for T cell-based immunotherapy. In total, we identified 17 antigens represented by 41 different HLA ligands showing natural and exclusive presentation both on GSC and patient samples. Importantly, in vitro immunogenicity and antigen-specific target cell killing assays suggest these peptides to be epitopes of functional CD8+ T cell responses, thus rendering them prime candidates for antigen-specific immunotherapy of glioblastoma.


Subject(s)
Brain Neoplasms/metabolism , Glioblastoma/metabolism , HLA Antigens/metabolism , Neoplastic Stem Cells/metabolism , Adult , Aged , Aged, 80 and over , Brain/metabolism , Brain/pathology , Brain Neoplasms/genetics , Brain Neoplasms/pathology , Brain Neoplasms/therapy , CD8-Positive T-Lymphocytes/metabolism , Cell Line, Tumor , Child , Cohort Studies , Female , Glioblastoma/genetics , Glioblastoma/pathology , Glioblastoma/therapy , Humans , Immunotherapy/methods , Isocitrate Dehydrogenase/genetics , Ligands , Male , Middle Aged
20.
Environ Sci Technol ; 52(5): 3275-3284, 2018 03 06.
Article in English | MEDLINE | ID: mdl-29446927

ABSTRACT

We assessed the gaseous, particulate, and genotoxic pollutants from two current technology gasoline direct injection vehicles when tested in their original configuration and with a catalyzed gasoline particulate filter (GPF). Testing was conducted over the LA92 and US06 Supplemental Federal Test Procedure (US06) driving cycles on typical California E10 fuel. The use of a GPF did not show any fuel economy and carbon dioxide (CO2) emission penalties, while the emissions of total hydrocarbons (THC), carbon monoxide (CO), and nitrogen oxides (NOx) were generally reduced. Our results showed dramatic reductions in particulate matter (PM) mass, black carbon, and total and solid particle number emissions with the use of GPFs for both vehicles over the LA92 and US06 cycles. Particle size distributions were primarily bimodal in nature, with accumulation mode particles dominating the distribution profile and their concentrations being higher during the cold-start period of the cycle. Polycyclic aromatic hydrocarbons (PAHs) and nitrated PAHs were quantified in both the vapor and particle phases of the PM, with the GPF-equipped vehicles practically eliminating most of these species in the exhaust. For the stock vehicles, 2-3 ring compounds and heavier 5-6 ring compounds were observed in the PM, whereas the vapor phase was dominated mostly by 2-3 ring aromatic compounds.


Subject(s)
Air Pollutants , Polycyclic Aromatic Hydrocarbons , California , Gasoline , Particulate Matter , Vehicle Emissions
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