Lung cancer samples preserved in liquid medium: One step beyond cytology

Lung cancer is one of the most common cancer types in men and women worldwide with a high mortality rate. World Health Organization (WHO) classification has accepted biopsy as the primary sample for lung cancer diagnosis, pathological classification and molecular testing for management of patients, yet, the use of alternative sampling procedures is highly encouraged. Bronchial cytological samples require a less invasive collection technique and may be suitable for pathological and molecular analysis and storage in liquid medium. Furthermore, the molecular analysis of bronchial cytological samples allows the detection of molecular biomarkers, which may be useful for the selection of molecular targeted therapies. Thus, the purpose of this review is to describe the usefulness of bronchial cytological samples preserved in liquid medium from lung cancer patients for pathological diagnosis and molecular investigation.Rui Manuel Reis and Adhemar Longatto-Filho have a Brazilian National Counsel of Technological and Scientific Development (CNPq) Produtivity scholarship.info:eu-repo/semantics/publishedVersio

Comprehensive molecular landscape of cetuximab resistance in head and neck cancer cell lines

Cetuximab is the sole anti-EGFR monoclonal antibody that is FDA approved to treat head and neck squamous cell carcinoma (HNSCC). However, no predictive biomarkers of cetuximab response are known for HNSCC. Herein, we address the molecular mechanisms underlying cetuximab resistance in an in vitro model. We established a cetuximab resistant model (FaDu), using increased cetuximab concentrations for more than eight months. The resistance and parental cells were evaluated for cell viability and functional assays. Protein expression was analyzed by Western blot and human cell surface panel by lyoplate. The mutational profile and copy number alterations (CNA) were analyzed using whole-exome sequencing (WES) and the NanoString platform. FaDu resistant clones exhibited at least two-fold higher IC50 compared to the parental cell line. WES showed relevant mutations in several cancer-related genes, and the comparative mRNA expression analysis showed 36 differentially expressed genes associated with EGFR tyrosine kinase inhibitors resistance, RAS, MAPK, and mTOR signaling. Importantly, we observed that overexpression of KRAS, RhoA, and CD44 was associated with cetuximab resistance. Protein analysis revealed EGFR phosphorylation inhibition and mTOR increase in resistant cells. Moreover, the resistant cell line demonstrated an aggressive phenotype with a significant increase in adhesion, the number of colonies, and migration rates. Overall, we identified several molecular alterations in the cetuximab resistant cell line that may constitute novel biomarkers of cetuximab response such as mTOR and RhoA overexpression. These findings indicate new strategies to overcome anti-EGFR resistance in HNSCC.This work was supported by Barretos Cancer Hospital and the Public Ministry of Labor Campinas (Research, Prevention, and Education of Occupational Cancer) in Campinas, Brazil, CAPESDFATD (88887.137283/2017-00). INFG is the recipient of a FAPESP Ph.D. fellowship (2017/22305-9)

Wnt/?-catenin signaling pathway in childhood adrenocortical tumors

Introdução: Em crianças das regiões Sul e Sudeste do Brasil há uma incidência elevada de tumores adrenocorticais (TAC). Anormalidades da ?-catenina tem sido encontradas em TAC em adultos e sugerem a ativação da via Wnt/ -catenina nestes tumores. No entanto, não há estudos avaliando o papel desta via em casuísticas de TAC pediátricos. Objetivos: Avaliar o papel da via Wnt/catenina e mutações do gene CTNNB1 na tumorigênese adrenocortical pediátrica. Indivíduos, Material e Métodos: Foram avaliados 62 pacientes pediátricos com TAC oriundos de dois centros de referência. Controles: córtex adrenal de indivíduos jovens com morte acidental. Avaliou-se a presença de mutação nos genes TP53 e CTNNB1. A expressão de genes da via Wnt (CTNNB1, o ligante WNT4, os inibidores SFRP1, DKK3 e AXIN1, o fator de transcrição TCF7 e os genes-alvo MYC e WISP2) foi avaliada por qPCR, utilizando-se o método de 2-Ct. Adicionalmente, a expressão de proteínas da via Wnt/-catenina e P53 foi avaliada por imunoistoquímica. Avaliou-se a relação entre possíveis anormalidades moleculares com o fenótipo clínico e o desfecho. Resultados: A sobrevida geral foi maior em pacientes menores que 5 anos de idade (p<0.0001) e em pacientes com estágios tumorais menos avançados (p<0.0001). A mutação P53 p.R337H foi encontrada em 87% dos pacientes e não se associou com características clinicopatológicas ou desfecho. Mutações do gene CTNNB1 foram encontradas em 4/62 (6%) TAC, todos carreadores da mutação P53 p.R337H. Houve associação entre óbito e presença de mutações do gene CTNNB1 (p=0,02). Acúmulo difuso da -catenina foi observado em 71% dos TAC, a maioria sem mutações do CTNNB1. Comparados a adrenais normais, os TAC apresentaram aumento da expressão do RNAm de CTNNB1 (p=0.008) e diminuição da expressão de genes inibidores da via Wnt: DKK3 (p<0.0001), SFRP1 (p=0.05) e AXIN1 (p=0.04). Com relação aos genes-alvo da via Wnt/-catenina, TAC apresentaram expressão aumentada de WISP2 e baixa expressão de MYC. Maior sobrevida geral foi associada à expressão baixa de SFRP1 (p=0.01), WNT4 (p=0.004) e TCF7 (p<0.01). Conclusões: Em TAC pediátricos, mutações somáticas ativadoras do gene CTNNB1 são pouco freqüentes e parecem estar associadas à maior ocorrência de óbito. Mesmo na ausência de mutações do gene CTNNB1, estes tumores apresentaram acúmulo de -catenina e do gene-alvo WISP2 e expressão reduzida de inibidores da via Wnt (DKK3, SFRP1 e AXIN1). Estes dados demonstram evidências de anormalidades na via Wnt/-catenina em TAC pediátricos, mesmo na ausência de mutações do gene CTNNB1. É provável que outros eventos genéticos afetando a via Wnt/-catenina estejam envolvidos na tumorigênese adrenocortical pediátricaContext: CTNNB1 mutations and activation of Wnt/-catenin pathway are frequent in adult adrenocortical tumors (ACTs) but data on childhood ACTs are lacking. Objective: To investigate Wnt/-catenin pathway abnormalities and CTNNB1 mutations in childhood ACTs. Patients and Methods: Clinicopathological findings and outcome of 62 childhood ACTs patients were analyzed regarding to CTNNB1/ -catenin mutations and to the expression of Wnt-related genes (CTNNB1, a Wnt ligand: WNT4, Wnt inhibitors: SFRP1, DKK3 and AXIN1, a transcription factor: TCF7, and target genes: MYC and WISP2) by qPCR and immunohistochemistry. Results: Overall survival (OS) was higher in patients younger than 5 years (p<0.0001) and associated with less advanced tumoral stage (p<0.0001). The p.R337H P53 mutation, found in 87% of the patients, was not associated with clinicopathological findings or outcome. CTNNB1 activating mutations were found in only 4/62 ACTs (6%), all of them harboring TP53 mutation. There was association between the presence of CTNNB1 mutation and death (p=0.02). Diffuse -catenin accumulation was found in 71% of ACTs, most of them without CTNNB1 mutation. CTNNB1 mutated ACTs presented weak/moderate -catenin accumulation. Compared to normal adrenals, ACTs presented increased expression of CTNNB1 (p=0.008) and underexpression of Wnt inhibitor genes: DKK3 (p<0.0001), SFRP1 (p=0.05) and AXIN1 (p=0.04). With regards to Wnt/-catenin target genes, ACTs presented lower expression of MYC but increased expression of WISP2. Higher overall survival was associated with underexpression of SFRP1 (p=0.01), WNT4 (p=0.004) and TCF7 (p<0.01). Conclusions: In childhood ACTs, CTNNB1 mutations are rare and appear to be associated with poor prognosis. Regardless of CTNNB1 mutations, these tumors presented reduced expression of Wnt inhibitor genes (DKK3, SFRP1 and AXIN1) and increased expression of CTNNB1 and a target gene, WISP2. Thus, besides CTNNB1 mutations, additional genetic events affecting the Wnt/-catenin pathway may be involved in childhood adrenocortical tumorigenesis

Wnt/?-catenin signaling pathway in childhood adrenocortical tumors

Introdução: Em crianças das regiões Sul e Sudeste do Brasil há uma incidência elevada de tumores adrenocorticais (TAC). Anormalidades da ?-catenina tem sido encontradas em TAC em adultos e sugerem a ativação da via Wnt/ -catenina nestes tumores. No entanto, não há estudos avaliando o papel desta via em casuísticas de TAC pediátricos. Objetivos: Avaliar o papel da via Wnt/catenina e mutações do gene CTNNB1 na tumorigênese adrenocortical pediátrica. Indivíduos, Material e Métodos: Foram avaliados 62 pacientes pediátricos com TAC oriundos de dois centros de referência. Controles: córtex adrenal de indivíduos jovens com morte acidental. Avaliou-se a presença de mutação nos genes TP53 e CTNNB1. A expressão de genes da via Wnt (CTNNB1, o ligante WNT4, os inibidores SFRP1, DKK3 e AXIN1, o fator de transcrição TCF7 e os genes-alvo MYC e WISP2) foi avaliada por qPCR, utilizando-se o método de 2-Ct. Adicionalmente, a expressão de proteínas da via Wnt/-catenina e P53 foi avaliada por imunoistoquímica. Avaliou-se a relação entre possíveis anormalidades moleculares com o fenótipo clínico e o desfecho. Resultados: A sobrevida geral foi maior em pacientes menores que 5 anos de idade (p<0.0001) e em pacientes com estágios tumorais menos avançados (p<0.0001). A mutação P53 p.R337H foi encontrada em 87% dos pacientes e não se associou com características clinicopatológicas ou desfecho. Mutações do gene CTNNB1 foram encontradas em 4/62 (6%) TAC, todos carreadores da mutação P53 p.R337H. Houve associação entre óbito e presença de mutações do gene CTNNB1 (p=0,02). Acúmulo difuso da -catenina foi observado em 71% dos TAC, a maioria sem mutações do CTNNB1. Comparados a adrenais normais, os TAC apresentaram aumento da expressão do RNAm de CTNNB1 (p=0.008) e diminuição da expressão de genes inibidores da via Wnt: DKK3 (p<0.0001), SFRP1 (p=0.05) e AXIN1 (p=0.04). Com relação aos genes-alvo da via Wnt/-catenina, TAC apresentaram expressão aumentada de WISP2 e baixa expressão de MYC. Maior sobrevida geral foi associada à expressão baixa de SFRP1 (p=0.01), WNT4 (p=0.004) e TCF7 (p<0.01). Conclusões: Em TAC pediátricos, mutações somáticas ativadoras do gene CTNNB1 são pouco freqüentes e parecem estar associadas à maior ocorrência de óbito. Mesmo na ausência de mutações do gene CTNNB1, estes tumores apresentaram acúmulo de -catenina e do gene-alvo WISP2 e expressão reduzida de inibidores da via Wnt (DKK3, SFRP1 e AXIN1). Estes dados demonstram evidências de anormalidades na via Wnt/-catenina em TAC pediátricos, mesmo na ausência de mutações do gene CTNNB1. É provável que outros eventos genéticos afetando a via Wnt/-catenina estejam envolvidos na tumorigênese adrenocortical pediátricaContext: CTNNB1 mutations and activation of Wnt/-catenin pathway are frequent in adult adrenocortical tumors (ACTs) but data on childhood ACTs are lacking. Objective: To investigate Wnt/-catenin pathway abnormalities and CTNNB1 mutations in childhood ACTs. Patients and Methods: Clinicopathological findings and outcome of 62 childhood ACTs patients were analyzed regarding to CTNNB1/ -catenin mutations and to the expression of Wnt-related genes (CTNNB1, a Wnt ligand: WNT4, Wnt inhibitors: SFRP1, DKK3 and AXIN1, a transcription factor: TCF7, and target genes: MYC and WISP2) by qPCR and immunohistochemistry. Results: Overall survival (OS) was higher in patients younger than 5 years (p<0.0001) and associated with less advanced tumoral stage (p<0.0001). The p.R337H P53 mutation, found in 87% of the patients, was not associated with clinicopathological findings or outcome. CTNNB1 activating mutations were found in only 4/62 ACTs (6%), all of them harboring TP53 mutation. There was association between the presence of CTNNB1 mutation and death (p=0.02). Diffuse -catenin accumulation was found in 71% of ACTs, most of them without CTNNB1 mutation. CTNNB1 mutated ACTs presented weak/moderate -catenin accumulation. Compared to normal adrenals, ACTs presented increased expression of CTNNB1 (p=0.008) and underexpression of Wnt inhibitor genes: DKK3 (p<0.0001), SFRP1 (p=0.05) and AXIN1 (p=0.04). With regards to Wnt/-catenin target genes, ACTs presented lower expression of MYC but increased expression of WISP2. Higher overall survival was associated with underexpression of SFRP1 (p=0.01), WNT4 (p=0.004) and TCF7 (p<0.01). Conclusions: In childhood ACTs, CTNNB1 mutations are rare and appear to be associated with poor prognosis. Regardless of CTNNB1 mutations, these tumors presented reduced expression of Wnt inhibitor genes (DKK3, SFRP1 and AXIN1) and increased expression of CTNNB1 and a target gene, WISP2. Thus, besides CTNNB1 mutations, additional genetic events affecting the Wnt/-catenin pathway may be involved in childhood adrenocortical tumorigenesis

Liquid Biopsy for Lung Cancer: Up-to-Date and Perspectives for Screening Programs

Lung cancer is the deadliest cancer worldwide. Tissue biopsy is currently employed for the diagnosis and molecular stratification of lung cancer. Liquid biopsy is a minimally invasive approach to determine biomarkers from body fluids, such as blood, urine, sputum, and saliva. Tumor cells release cfDNA, ctDNA, exosomes, miRNAs, circRNAs, CTCs, and DNA methylated fragments, among others, which can be successfully used as biomarkers for diagnosis, prognosis, and prediction of treatment response. Predictive biomarkers are well-established for managing lung cancer, and liquid biopsy options have emerged in the last few years. Currently, detecting EGFR p.(Tyr790Met) mutation in plasma samples from lung cancer patients has been used for predicting response and monitoring tyrosine kinase inhibitors (TKi)-treated patients with lung cancer. In addition, many efforts continue to bring more sensitive technologies to improve the detection of clinically relevant biomarkers for lung cancer. Moreover, liquid biopsy can dramatically decrease the turnaround time for laboratory reports, accelerating the beginning of treatment and improving the overall survival of lung cancer patients. Herein, we summarized all available and emerging approaches of liquid biopsy—techniques, molecules, and sample type—for lung cancer

Lack of KBTBD4 mutations in molecularly classified Brazilian medulloblastomas

Medulloblastoma is the most frequent malignant brain tumor in children, representing 20% of all childhood brain tumors. Currently, medulloblastomas are molecularly classified in 4 subgroups that are associated with distinctive clinicopathological features. KBTBD4 mutations were recently described in a subset of MBGRP3 and MBGRP4 medulloblastomas subgroups. However, no other studies reported KBTBD4 mutations in medulloblastomas. Thus, our aim was to investigate KBTBD4 mutations in a Brazilian series of medulloblastoma. We evaluated 128 medulloblastoma patients molecularly classified from 4 Brazilian reference centers. DNA from formalin-fixed, paraffin-embedded samples was screened for KBTBD4 hotspot mutations by Sanger sequencing. Most of the patients were male, average age was 16.5 years old and average overall survival was 55.9 months. The predominant histological subtype was the classic subtype, followed by nodular/desmoplastic, and the predominant medulloblastoma molecular subtype was the MBSHH subgroup (46%), followed by MBGRP3 and MBGRP4 (19%/each), and MBWNT (16%). Among the 128 samples, 111 were successfully sequenced. No KBTBD4 mutations were identified in 111 samples. Our findings suggest that KBTBD4 mutations are uncommon in Brazilian MBGRP3 and MBGRP4 medulloblastomas subgroups. Further studies in a larger series of MBGRP3 and MBGRP4 medulloblastomas are warranted to better assess role of KBTBD4 mutations.We thank Barretos Cancer Hospital and FINEP for partially funding the present study. Leticia Ferro Leal is supported by Public Ministry of Labor Campinas (Research, Prevention and Education of Occupational Cancer) in Campinas, Brazil. Rui Manuel Reis is sponsored by the National Council for Scientific and Technological Development (CNPq, Brazil)

IGF2 and IGF1R in pediatric adrenocortical tumors: roles in metastasis and steroidogenesis

Deregulation of the IGF system observed in human tumors indicates a role in malignant cell transformation and in tumor cell proliferation. Although overexpression of the IGF2 and IGF1R genes was described in adrenocortical tumors (ACTs), few studies reported their profiles in pediatric ACTs. In this study, the IGF2 and IGF1R expression was evaluated by RT-qPCR according to the patient’s clinical/pathological features in 60 pediatric ACT samples, and IGF1R protein was investigated in 45 samples by immunohistochemistry (IHC). Whole transcriptome and functional assays were conducted after IGF1R inhibition with OSI-906 in NCI-H295A cell line. Significant IGF2 overexpression was found in tumor samples when compared with non-neoplastic samples (P1μM) showed limited reduction of cell viability, suggesting that OSI-906 alone could not be a suitable therapy to abolish carcinoma cell growth.236481493CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPSem informação2010/07020-

Supplemental Material - Implementation of an Integrated Lung Cancer Prevention and Screening Program Using a Mobile Computed Tomography (CT) Unit in Brazil

Supplemental Material for Implementation of an Integrated Lung Cancer Prevention and Screening Program Using a Mobile Computed Tomography (CT) Unit in Brazil by Rodrigo Sampaio Chiarantano, Fabiana Lima Vazquez, Alexander Franco, Larissa Cristina Ferreira, Maraísa Cristina da Costa, Thais Talarico, Ângela Neves Oliveira, José Elias Miziara, Edmundo Carvalho Mauad, Eduardo Caetano da Silva, Luis Marcelo Ventur, Raphael Haikel Junior, Letícia Ferro Leal, and Rui Manuel Reis in Cancer Control</p