Targeting loss of the Hippo signaling pathway in NF2-deficient papillary kidney cancers.

Papillary renal cell carcinomas (PRCC) are a histologically and genetically heterogeneous group of tumors that represent 15-20% of all kidney neoplasms and may require diverse therapeutic approaches. Alteration of the NF2 tumor suppressor gene, encoding a key regulator of the Hippo signaling pathway, is observed in 22.5% of PRCC. The Hippo signaling pathway controls cell proliferation by regulating the transcriptional activity of Yes-Associated Protein, YAP1. Loss of NF2 results in aberrant YAP1 activation. The Src family kinase member Yes also regulates YAP1 transcriptional activity. This study investigated the importance of YAP and Yes activity in three NF2-deficient PRCC cell lines. NF2-deficency correlated with increased expression of YAP1 transcriptional targets and siRNA-based knockdown of YAP1 and Yes1 downregulated this pathway and dramatically reduced cell viability. Dasatinib and saracatinib have potent inhibitory effects on Yes and treatment with either resulted in downregulation of YAP1 transcription targets, reduced cell viability, and G0-G1 cell cycle arrest. Xenograft models for NF2-deficient PRCC also demonstrated reduced tumor growth in response to dasatinib. Thus, inhibiting Yes and the subsequent transcriptional activity of YAP1 had a substantial anti-tumor cell effect both in vitro and in vivo and may provide a viable therapeutic approach for patients with NF2-deficient PRCC.

Description of a novel technique for suture ligation of the renal vessels during robotic nephrectomy.

Minimally invasive techniques are frequently used for surgical treatment of suspected malignant renal masses. We previously reported on our experience with robotic nephrectomy and the feasibility of performing suture ligation of the renal vessels using robotic needle drivers. We describe a novel technique for suture ligation of the renal vessels during robotic nephrectomy utilizing the robotic hook and a suture with loops at each end. Our technique for suture ligation of the renal vessels recapitulates the open technique without the need for exchanging the robotic working instruments for robotic needle drivers and without the need for endovascular staplers.