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1.
Cell ; 182(5): 1341-1359.e19, 2020 09 03.
Article in English | MEDLINE | ID: mdl-32763154

ABSTRACT

Antitumoral immunity requires organized, spatially nuanced interactions between components of the immune tumor microenvironment (iTME). Understanding this coordinated behavior in effective versus ineffective tumor control will advance immunotherapies. We re-engineered co-detection by indexing (CODEX) for paraffin-embedded tissue microarrays, enabling simultaneous profiling of 140 tissue regions from 35 advanced-stage colorectal cancer (CRC) patients with 56 protein markers. We identified nine conserved, distinct cellular neighborhoods (CNs)-a collection of components characteristic of the CRC iTME. Enrichment of PD-1+CD4+ T cells only within a granulocyte CN positively correlated with survival in a high-risk patient subset. Coupling of tumor and immune CNs, fragmentation of T cell and macrophage CNs, and disruption of inter-CN communication was associated with inferior outcomes. This study provides a framework for interrogating how complex biological processes, such as antitumoral immunity, occur through concerted actions of cells and spatial domains.


Subject(s)
Colorectal Neoplasms/immunology , Colorectal Neoplasms/therapy , Neoplasm Invasiveness/immunology , B7-H1 Antigen/immunology , Biomarkers, Tumor/immunology , CD4-Positive T-Lymphocytes/immunology , Cell Line, Tumor , Female , Humans , Immunotherapy/methods , Male , Tumor Microenvironment/immunology
2.
Cell ; 174(4): 968-981.e15, 2018 08 09.
Article in English | MEDLINE | ID: mdl-30078711

ABSTRACT

A highly multiplexed cytometric imaging approach, termed co-detection by indexing (CODEX), is used here to create multiplexed datasets of normal and lupus (MRL/lpr) murine spleens. CODEX iteratively visualizes antibody binding events using DNA barcodes, fluorescent dNTP analogs, and an in situ polymerization-based indexing procedure. An algorithmic pipeline for single-cell antigen quantification in tightly packed tissues was developed and used to overlay well-known morphological features with de novo characterization of lymphoid tissue architecture at a single-cell and cellular neighborhood levels. We observed an unexpected, profound impact of the cellular neighborhood on the expression of protein receptors on immune cells. By comparing normal murine spleen to spleens from animals with systemic autoimmune disease (MRL/lpr), extensive and previously uncharacterized splenic cell-interaction dynamics in the healthy versus diseased state was observed. The fidelity of multiplexed spatial cytometry demonstrated here allows for quantitative systemic characterization of tissue architecture in normal and clinically aberrant samples.


Subject(s)
Antibodies/chemistry , Disease Models, Animal , Image Processing, Computer-Assisted/methods , Lupus Erythematosus, Systemic/pathology , Oligonucleotide Probes/chemistry , Spleen/pathology , Animals , Female , Male , Mass Spectrometry , Mice , Mice, Inbred MRL lpr
4.
Nat Methods ; 19(6): 759-769, 2022 06.
Article in English | MEDLINE | ID: mdl-35654951

ABSTRACT

Advances in multiplexed in situ imaging are revealing important insights in spatial biology. However, cell type identification remains a major challenge in imaging analysis, with most existing methods involving substantial manual assessment and subjective decisions for thousands of cells. We developed an unsupervised machine learning algorithm, CELESTA, which identifies the cell type of each cell, individually, using the cell's marker expression profile and, when needed, its spatial information. We demonstrate the performance of CELESTA on multiplexed immunofluorescence images of colorectal cancer and head and neck squamous cell carcinoma (HNSCC). Using the cell types identified by CELESTA, we identify tissue architecture associated with lymph node metastasis in HNSCC, and validate our findings in an independent cohort. By coupling our spatial analysis with single-cell RNA-sequencing data on proximal sections of the same specimens, we identify cell-cell crosstalk associated with lymph node metastasis, demonstrating the power of CELESTA to facilitate identification of clinically relevant interactions.


Subject(s)
Head and Neck Neoplasms , Cohort Studies , Humans , Lymphatic Metastasis , Squamous Cell Carcinoma of Head and Neck
5.
Eur J Immunol ; 51(5): 1262-1277, 2021 05.
Article in English | MEDLINE | ID: mdl-33548142

ABSTRACT

Multiparameter tissue imaging enables analysis of cell-cell interactions in situ, the cellular basis for tissue structure, and novel cell types that are spatially restricted, giving clues to biological mechanisms behind tissue homeostasis and disease. Here, we streamlined and simplified the multiplexed imaging method CO-Detection by indEXing (CODEX) by validating 58 unique oligonucleotide barcodes that can be conjugated to antibodies. We showed that barcoded antibodies retained their specificity for staining cognate targets in human tissue. Antibodies were visualized one at a time by adding a fluorescently labeled oligonucleotide complementary to oligonucleotide barcode, imaging, stripping, and repeating this cycle. With this we developed a panel of 46 antibodies that was used to stain five human lymphoid tissues: three tonsils, a spleen, and a LN. To analyze the data produced, an image processing and analysis pipeline was developed that enabled single-cell analysis on the data, including unsupervised clustering, that revealed 31 cell types across all tissues. We compared cell-type compositions within and directly surrounding follicles from the different lymphoid organs and evaluated cell-cell density correlations. This sequential oligonucleotide exchange technique enables a facile imaging of tissues that leverages pre-existing imaging infrastructure to decrease the barriers to broad use of multiplexed imaging.


Subject(s)
Antibodies , Histocytochemistry/methods , Molecular Imaging/methods , Oligonucleotides , Cell Communication , Cell Count , Humans , In Situ Hybridization/methods , Lymphoid Tissue , Organ Specificity , Reproducibility of Results , Sensitivity and Specificity , Single-Cell Analysis/methods
6.
Nat Methods ; 13(6): 493-6, 2016 06.
Article in English | MEDLINE | ID: mdl-27183440

ABSTRACT

Accurate identification of cell subsets in complex populations is key to discovering novelty in multidimensional single-cell experiments. We present X-shift (http://web.stanford.edu/~samusik/vortex/), an algorithm that processes data sets using fast k-nearest-neighbor estimation of cell event density and arranges populations by marker-based classification. X-shift enables automated cell-subset clustering and access to biological insights that 'prior knowledge' might prevent the researcher from discovering.


Subject(s)
Image Interpretation, Computer-Assisted/methods , Pattern Recognition, Automated/methods , Single-Cell Analysis/methods , Algorithms , Animals , Bone Marrow Cells/cytology , Cluster Analysis , Image Enhancement , Male , Mice, Inbred C57BL , Sensitivity and Specificity
7.
Bioinformatics ; 34(23): 4131-4133, 2018 12 01.
Article in English | MEDLINE | ID: mdl-29850785

ABSTRACT

Motivation: High-parameter single-cell technologies can reveal novel cell populations of interest, but studying or validating these populations using lower-parameter methods remains challenging. Results: Here, we present GateFinder, an algorithm that enriches high-dimensional cell types with simple, stepwise polygon gates requiring only two markers at a time. A series of case studies of complex cell types illustrates how simplified enrichment strategies can enable more efficient assays, reveal novel biomarkers and clarify underlying biology. Availability and implementation: The GateFinder algorithm is implemented as a free and open-source package for BioConductor: https://nalab.stanford.edu/gatefinder. Supplementary information: Supplementary data are available at Bioinformatics online.


Subject(s)
Algorithms , Biomarkers/analysis , Flow Cytometry , Software
8.
PLoS Comput Biol ; 13(12): e1005875, 2017 12.
Article in English | MEDLINE | ID: mdl-29281633

ABSTRACT

Mass cytometry (CyTOF) has greatly expanded the capability of cytometry. It is now easy to generate multiple CyTOF samples in a single study, with each sample containing single-cell measurement on 50 markers for more than hundreds of thousands of cells. Current methods do not adequately address the issues concerning combining multiple samples for subpopulation discovery, and these issues can be quickly and dramatically amplified with increasing number of samples. To overcome this limitation, we developed Partition-Assisted Clustering and Multiple Alignments of Networks (PAC-MAN) for the fast automatic identification of cell populations in CyTOF data closely matching that of expert manual-discovery, and for alignments between subpopulations across samples to define dataset-level cellular states. PAC-MAN is computationally efficient, allowing the management of very large CyTOF datasets, which are increasingly common in clinical studies and cancer studies that monitor various tissue samples for each subject.


Subject(s)
Single-Cell Analysis/statistics & numerical data , Animals , Biomarkers/analysis , Cluster Analysis , Computational Biology , Computer Simulation , Data Interpretation, Statistical , Databases, Factual , Flow Cytometry/statistics & numerical data , Gene Expression , Humans , Mice
9.
Nature ; 464(7286): 243-9, 2010 Mar 11.
Article in English | MEDLINE | ID: mdl-20190736

ABSTRACT

Endocytosis is a complex process fulfilling many cellular and developmental functions. Understanding how it is regulated and integrated with other cellular processes requires a comprehensive analysis of its molecular constituents and general design principles. Here, we developed a new strategy to phenotypically profile the human genome with respect to transferrin (TF) and epidermal growth factor (EGF) endocytosis by combining RNA interference, automated high-resolution confocal microscopy, quantitative multiparametric image analysis and high-performance computing. We identified several novel components of endocytic trafficking, including genes implicated in human diseases. We found that signalling pathways such as Wnt, integrin/cell adhesion, transforming growth factor (TGF)-beta and Notch regulate the endocytic system, and identified new genes involved in cargo sorting to a subset of signalling endosomes. A systems analysis by Bayesian networks further showed that the number, size, concentration of cargo and intracellular position of endosomes are not determined randomly but are subject to specific regulation, thus uncovering novel properties of the endocytic system.


Subject(s)
Endocytosis/physiology , Gene Expression Profiling/methods , Image Processing, Computer-Assisted , Computing Methodologies , Endosomes/metabolism , Epidermal Growth Factor/metabolism , Genome-Wide Association Study , Humans , Metabolic Networks and Pathways/physiology , Microscopy, Confocal , Phenotype , Protein Transport/physiology , RNA Interference , Signal Transduction/physiology , Transferrin/metabolism
10.
Proc Natl Acad Sci U S A ; 109(29): 11836-41, 2012 Jul 17.
Article in English | MEDLINE | ID: mdl-22753484

ABSTRACT

The expansion of the neocortex during mammalian brain evolution results primarily from an increase in neural progenitor cell divisions in its two principal germinal zones during development, the ventricular zone (VZ) and the subventricular zone (SVZ). Using mRNA sequencing, we analyzed the transcriptomes of fetal human and embryonic mouse VZ, SVZ, and cortical plate. In mouse, the transcriptome of the SVZ was more similar to that of the cortical plate than that of the VZ, whereas in human the opposite was the case, with the inner and outer SVZ being highly related to each other despite their cytoarchitectonic differences. We describe sets of genes that are up- or down-regulated in each germinal zone. These data suggest that cell adhesion and cell-extracellular matrix interactions promote the proliferation and self-renewal of neural progenitors in the developing human neocortex. Notably, relevant extracellular matrix-associated genes include distinct sets of collagens, laminins, proteoglycans, and integrins, along with specific sets of growth factors and morphogens. Our data establish a basis for identifying novel cell-type markers and open up avenues to unravel the molecular basis of neocortex expansion during evolution.


Subject(s)
Biological Evolution , Extracellular Matrix Proteins/metabolism , Gene Expression Regulation, Developmental/genetics , Neocortex/growth & development , Neocortex/metabolism , Stem Cells/cytology , Transcriptome/genetics , Analysis of Variance , Animals , Cell Adhesion/physiology , Cluster Analysis , DNA Primers/genetics , Fetus/metabolism , Gene Expression Profiling , Humans , Immunohistochemistry , Laser Capture Microdissection , Mice , Polymerase Chain Reaction , Principal Component Analysis , RNA, Messenger/genetics , Sequence Analysis, RNA
11.
Nat Protoc ; 16(8): 3802-3835, 2021 08.
Article in English | MEDLINE | ID: mdl-34215862

ABSTRACT

Advances in multiplexed imaging technologies have drastically improved our ability to characterize healthy and diseased tissues at the single-cell level. Co-detection by indexing (CODEX) relies on DNA-conjugated antibodies and the cyclic addition and removal of complementary fluorescently labeled DNA probes and has been used so far to simultaneously visualize up to 60 markers in situ. CODEX enables a deep view into the single-cell spatial relationships in tissues and is intended to spur discovery in developmental biology, disease and therapeutic design. Herein, we provide optimized protocols for conjugating purified antibodies to DNA oligonucleotides, validating the conjugation by CODEX staining and executing the CODEX multicycle imaging procedure for both formalin-fixed, paraffin-embedded (FFPE) and fresh-frozen tissues. In addition, we describe basic image processing and data analysis procedures. We apply this approach to an FFPE human tonsil multicycle experiment. The hands-on experimental time for antibody conjugation is ~4.5 h, validation of DNA-conjugated antibodies with CODEX staining takes ~6.5 h and preparation for a CODEX multicycle experiment takes ~8 h. The multicycle imaging and data analysis time depends on the tissue size, number of markers in the panel and computational complexity.


Subject(s)
Antibodies/chemistry , DNA/chemistry , Single-Cell Analysis/methods , Animals , Biomarkers , Diagnostic Imaging , Haplorhini , Humans , Image Processing, Computer-Assisted , Mice , Paraffin Embedding , Reproducibility of Results , Tissue Fixation/methods
12.
Cytometry B Clin Cytom ; 98(2): 131-145, 2020 03.
Article in English | MEDLINE | ID: mdl-31917512

ABSTRACT

BACKGROUND: We sought to enhance the cytometric analysis of myelodysplastic syndromes (MDS) by performing a pilot study of a single cell mass cytometry (MCM) assay to more comprehensively analyze patterns of surface marker expression in patients with MDS. METHODS: Twenty-three MDS and five healthy donor bone marrow samples were studied using a 34-parameter mass cytometry panel utilizing barcoding and internal reference standards. The resulting data were analyzed by both traditional gating and high-dimensional clustering. RESULTS: This high-dimensional assay provided three major benefits relative to traditional cytometry approaches: First, MCM enabled detection of aberrant surface maker at high resolution, detecting aberrancies in 27/31 surface markers, encompassing almost every previously reported MDS surface marker aberrancy. Additionally, three previously unrecognized aberrancies in MDS were detected in multiple samples at least one developmental stage: increased CD321 and CD99; and decreased CD47. Second, analysis of the stem and progenitor cell compartment (HSPCs), demonstrated aberrant expression in 21 of the 23 MDS samples, which were not detected in three samples from patients with idiopathic cytopenia of undetermined significance. These immunophenotypically abnormal HSPCs were also the single most significant distinguishing feature between clinical risk groups. Third, unsupervised clustering of high-parameter MCM data allowed identification of abnormal differentiation patterns associated with immunophenotypically aberrant myeloid cells similar to myeloid derived suppressor cells. CONCLUSIONS: These results demonstrate that high-parameter cytometry methods that enable simultaneous analysis of all bone marrow cell types could enhance the diagnostic utility of immunophenotypic analysis in MDS.


Subject(s)
Flow Cytometry/methods , Myelodysplastic Syndromes/diagnosis , Stem Cells/pathology , Stem Cells/physiology , Biopsy, Needle , Bone Marrow/pathology , Bone Marrow Cells/immunology , Bone Marrow Cells/pathology , Bone Marrow Cells/physiology , Cell Differentiation , Humans , Immunophenotyping/methods , Myelodysplastic Syndromes/pathology , Myelodysplastic Syndromes/physiopathology , Phenotype , Pilot Projects
13.
Commun Biol ; 3(1): 213, 2020 05 07.
Article in English | MEDLINE | ID: mdl-32382044

ABSTRACT

Single-cell omics provide insight into cellular heterogeneity and function. Recent technological advances have accelerated single-cell analyses, but workflows remain expensive and complex. We present a method enabling simultaneous, ultra-high throughput single-cell barcoding of millions of cells for targeted analysis of proteins and RNAs. Quantum barcoding (QBC) avoids isolation of single cells by building cell-specific oligo barcodes dynamically within each cell. With minimal instrumentation (four 96-well plates and a multichannel pipette), cell-specific codes are added to each tagged molecule within cells through sequential rounds of classical split-pool synthesis. Here we show the utility of this technology in mouse and human model systems for as many as 50 antibodies to targeted proteins and, separately, >70 targeted RNA regions. We demonstrate that this method can be applied to multi-modal protein and RNA analyses. It can be scaled by expansion of the split-pool process and effectively renders sequencing instruments as versatile multi-parameter flow cytometers.


Subject(s)
Antibodies/analysis , High-Throughput Nucleotide Sequencing/methods , Proteins/analysis , RNA/analysis , Single-Cell Analysis/methods , Animals , Humans , Mice , Mice, Inbred C57BL
15.
Nat Biotechnol ; 37(3): 259-266, 2019 03.
Article in English | MEDLINE | ID: mdl-30742126

ABSTRACT

Selective differentiation of naive T cells into multipotent T cells is of great interest clinically for the generation of cell-based cancer immunotherapies. Cellular differentiation depends crucially on division state and time. Here we adapt a dye dilution assay for tracking cell proliferative history through mass cytometry and uncouple division, time and regulatory protein expression in single naive human T cells during their activation and expansion in a complex ex vivo milieu. Using 23 markers, we defined groups of proteins controlled predominantly by division state or time and found that undivided cells account for the majority of phenotypic diversity. We next built a map of cell state changes during naive T-cell expansion. By examining cell signaling on this map, we rationally selected ibrutinib, a BTK and ITK inhibitor, and administered it before T cell activation to direct differentiation toward a T stem cell memory (TSCM)-like phenotype. This method for tracing cell fate across division states and time can be broadly applied for directing cellular differentiation.


Subject(s)
Cell Differentiation/genetics , Cell Proliferation/genetics , Lymphocyte Activation/genetics , Multipotent Stem Cells/cytology , Cell Tracking/methods , Humans , Single-Cell Analysis/methods , T-Lymphocytes/cytology
16.
Nat Cell Biol ; 20(8): 990, 2018 08.
Article in English | MEDLINE | ID: mdl-29507406

ABSTRACT

In the version of this Article originally published, the name of author Andrew Tri Van Ho was coded wrongly, resulting in it being incorrect when exported to citation databases. This has been corrected, though no visible changes will be apparent.

17.
Nat Neurosci ; 21(4): 541-551, 2018 04.
Article in English | MEDLINE | ID: mdl-29507414

ABSTRACT

Neuroinflammation and neurodegeneration may represent two poles of brain pathology. Brain myeloid cells, particularly microglia, play key roles in these conditions. We employed single-cell mass cytometry (CyTOF) to compare myeloid cell populations in the experimental autoimmune encephalomyelitis (EAE) model of multiple sclerosis, the R6/2 model of Huntington's disease (HD) and the mutant superoxide dismutase 1 (mSOD1) model of amyotrophic lateral sclerosis (ALS). We identified three myeloid cell populations exclusive to the CNS and present in each disease model. Blood-derived monocytes comprised five populations and migrated to the brain in EAE, but not in HD and ALS models. Single-cell analysis resolved differences in signaling and cytokine production within similar myeloid populations in EAE compared to HD and ALS models. Moreover, these analyses highlighted α5 integrin on myeloid cells as a potential therapeutic target for neuroinflammation. Together, these findings illustrate how neuropathology may differ between inflammatory and degenerative brain disease.


Subject(s)
Amyotrophic Lateral Sclerosis/pathology , Brain/pathology , Cytokines/metabolism , Encephalomyelitis, Autoimmune, Experimental/pathology , Huntington Disease/pathology , Intracellular Signaling Peptides and Proteins/metabolism , Myeloid Cells/pathology , Animals , CREB-Binding Protein/metabolism , CX3C Chemokine Receptor 1/genetics , CX3C Chemokine Receptor 1/metabolism , Disease Models, Animal , Huntingtin Protein/genetics , Huntington Disease/genetics , Luminescent Proteins/genetics , Luminescent Proteins/metabolism , Mice , Mice, Inbred C57BL , Mice, Mutant Strains , Mice, Transgenic , Monocytes , Mutation/genetics , Myeloid Cells/metabolism , Single-Cell Analysis/methods , Superoxide Dismutase-1/genetics
18.
Nat Med ; 24(4): 474-483, 2018 05.
Article in English | MEDLINE | ID: mdl-29505032

ABSTRACT

Insight into the cancer cell populations that are responsible for relapsed disease is needed to improve outcomes. Here we report a single-cell-based study of B cell precursor acute lymphoblastic leukemia at diagnosis that reveals hidden developmentally dependent cell signaling states that are uniquely associated with relapse. By using mass cytometry we simultaneously quantified 35 proteins involved in B cell development in 60 primary diagnostic samples. Each leukemia cell was then matched to its nearest healthy B cell population by a developmental classifier that operated at the single-cell level. Machine learning identified six features of expanded leukemic populations that were sufficient to predict patient relapse at diagnosis. These features implicated the pro-BII subpopulation of B cells with activated mTOR signaling, and the pre-BI subpopulation of B cells with activated and unresponsive pre-B cell receptor signaling, to be associated with relapse. This model, termed 'developmentally dependent predictor of relapse' (DDPR), significantly improves currently established risk stratification methods. DDPR features exist at diagnosis and persist at relapse. By leveraging a data-driven approach, we demonstrate the predictive value of single-cell 'omics' for patient stratification in a translational setting and provide a framework for its application to human cancer.


Subject(s)
Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/classification , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Single-Cell Analysis , Adult , B-Lymphocytes/pathology , Female , Humans , Male , Middle Aged , Phenotype , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/pathology , Recurrence , Risk Assessment , Signal Transduction , Survival Analysis , TOR Serine-Threonine Kinases/metabolism , Young Adult
19.
Science ; 361(6400)2018 07 27.
Article in English | MEDLINE | ID: mdl-29930089

ABSTRACT

Retrieving high-content gene-expression information while retaining three-dimensional (3D) positional anatomy at cellular resolution has been difficult, limiting integrative understanding of structure and function in complex biological tissues. We developed and applied a technology for 3D intact-tissue RNA sequencing, termed STARmap (spatially-resolved transcript amplicon readout mapping), which integrates hydrogel-tissue chemistry, targeted signal amplification, and in situ sequencing. The capabilities of STARmap were tested by mapping 160 to 1020 genes simultaneously in sections of mouse brain at single-cell resolution with high efficiency, accuracy, and reproducibility. Moving to thick tissue blocks, we observed a molecularly defined gradient distribution of excitatory-neuron subtypes across cubic millimeter-scale volumes (>30,000 cells) and a short-range 3D self-clustering in many inhibitory-neuron subtypes that could be identified and described with 3D STARmap.


Subject(s)
Imaging, Three-Dimensional , Neurons/metabolism , Sequence Analysis, RNA/methods , Single-Cell Analysis/methods , Transcription, Genetic , Transcriptome , Animals , Chromosome Mapping , Frontal Lobe/cytology , Frontal Lobe/metabolism , Male , Mice , Mice, Inbred C57BL , Molecular Imaging , Somatosensory Cortex/cytology , Somatosensory Cortex/metabolism , Visual Cortex/cytology , Visual Cortex/metabolism
20.
Cell Rep ; 22(7): 1875-1888, 2018 02 13.
Article in English | MEDLINE | ID: mdl-29444438

ABSTRACT

We have performed an in-depth single-cell phenotypic characterization of high-grade serous ovarian cancer (HGSOC) by multiparametric mass cytometry (CyTOF). Using a CyTOF antibody panel to interrogate features of HGSOC biology, combined with unsupervised computational analysis, we identified noteworthy cell types co-occurring across the tumors. In addition to a dominant cell subset, each tumor harbored rarer cell phenotypes. One such group co-expressed E-cadherin and vimentin (EV), suggesting their potential role in epithelial mesenchymal transition, which was substantiated by pairwise correlation analyses. Furthermore, tumors from patients with poorer outcome had an increased frequency of another rare cell type that co-expressed vimentin, HE4, and cMyc. These poorer-outcome tumors also populated more cell phenotypes, as quantified by Simpson's diversity index. Thus, despite the recognized genomic complexity of the disease, the specific cell phenotypes uncovered here offer a focus for therapeutic intervention and disease monitoring.


Subject(s)
Flow Cytometry/methods , Aged , Aged, 80 and over , Antibodies, Neoplasm/metabolism , Carboplatin/pharmacology , Cell Line, Tumor , Cluster Analysis , Cystadenocarcinoma, Serous/metabolism , Cystadenocarcinoma, Serous/pathology , Drug Resistance, Neoplasm/drug effects , Female , Humans , Middle Aged , Neoplasm Proteins/metabolism , Neoplasm Recurrence, Local/pathology , Ovarian Neoplasms/metabolism , Ovarian Neoplasms/pathology , Phenotype , Prognosis
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