Survivin gene levels in the peripheral blood of patients with gastric cancer independently predict survival

<p>Abstract</p> <p>Background</p> <p>The detection of circulating tumor cells (CTC) is considered a promising tool for improving risk stratification in patients with solid tumors. We investigated on whether the expression of CTC related genes adds any prognostic power to the TNM staging system in patients with gastric carcinoma.</p> <p>Methods</p> <p>Seventy patients with TNM stage I to IV gastric carcinoma were retrospectively enrolled. Peripheral blood samples were tested by means of quantitative real time PCR (qrtPCR) for the expression of four CTC related genes: carcinoembryonic antigen (CEA), cytokeratin-19 (CK19), vascular endothelial growth factor (VEGF) and Survivin (BIRC5).</p> <p>Results</p> <p>Gene expression of Survivin, CK19, CEA and VEGF was higher than in normal controls in 98.6%, 97.1%, 42.9% and 38.6% of cases, respectively, suggesting a potential diagnostic value of both Survivin and CK19. At multivariable survival analysis, TNM staging and Survivin mRNA levels were retained as independent prognostic factors, demonstrating that Survivin expression in the peripheral blood adds prognostic information to the TNM system. In contrast with previously published data, the transcript abundance of CEA, CK19 and VEGF was not associated with patients' clinical outcome.</p> <p>Conclusions</p> <p>Gene expression levels of Survivin add significant prognostic value to the current TNM staging system. The validation of these findings in larger prospective and multicentric series might lead to the implementation of this biomarker in the routine clinical setting in order to optimize risk stratification and ultimately personalize the therapeutic management of these patients.</p

Synergistic antitumour activity of RAF265 and ZSTK474 on human TT medullary thyroid cancer cells

Medullary thyroid cancer (MTC) is an aggressive malignancy responsible for up to 14% of all thyroid cancer-related deaths. It is characterized by point mutations in the rearranged during transfection (RET) proto-oncogene. The activated RET kinase is known to signal via extracellular signal regulated kinase (ERK) and phosphoinositide 3-kinase (PI3K), leading to enhanced proliferation and resistance to apoptosis. In the present work, we have investigated the effect of two serine/threonine-protein kinase B-Raf (BRAF) inhibitors (RAF265 and SB590885), and a PI3K inhibitor (ZSTK474), on RET-mediated signalling and proliferation in a MTC cell line (TT cells) harbouring the RETC634W activating mutation. The effects of the inhibitors on VEGFR2, PI3K/Akt and mitogen-activated protein kinases signalling pathways, cell cycle, apoptosis and calcitonin production were also investigated. Only the RAF265+ ZSTK474 combination synergistically reduced the viability of treated cells. We observed a strong decrease in phosphorylated VEGFR2 for RAF265+ ZSTK474 and a signal reduction in activated Akt for ZSTK474. The activated ERK signal also decreased after RAF265 and RAF265+ ZSTK474 treatments. Alone and in combination with ZSTK474, RAF265 induced a sustained increase in necrosis. Only RAF265, alone and combined with ZSTK474, prompted a significant drop in calcitonin production. Combination therapy using RAF265 and ZSTK47 proved effective in MTC, demonstrating a cytotoxic effect. As the two inhibitors have been successfully tested individually in clinical trials on other human cancers, our preclinical data support the feasibility of their combined use in aggressive MTC

Prognostic Impact of miR-224 and RAS Mutations in Medullary Thyroid Carcinoma

Little is known about the function of microRNA-224 (miR-224) in medullary thyroid cancer (MTC). This study investigated the role of miR-224 expression in MTC and correlated it with mutation status in sporadic MTCs. A consecutive series of 134 MTCs were considered. Patients had a sporadic form in 80% of cases (107/134). In this group, REarranged during transfection (RET) and rat sarcoma (RAS) mutation status were assessed by direct sequencing in the tumor tissues. Quantitative real-time polymerase chain reaction was used to quantify mature hsa-miR-224 in tumor tissue. RAS (10/107 cases, 9%) and RET (39/107 cases, 36%) mutations were mutually exclusive in sporadic cases. miR-224 expression was significantly downregulated in patients with the following: high calcitonin levels at diagnosis (p=0.03, r=−0.3); advanced stage (p=0.001); persistent disease (p=0.001); progressive disease (p=0.002); and disease-related death (p=0.0001). We found a significant positive correlation between miR-224 expression and somatic RAS mutations (p=0.007). Patients whose MTCs had a low miR-224 expression tended to have a shorter overall survival (log-rank test p=0.005). On multivariate analysis, miR-224 represented an independent prognostic marker. Our data indicate that miR-224 is upregulated in RAS-mutated MTCs and in patients with a better prognosis and could represent an independent prognostic marker in MTC patients

Frequency and significance of Ras, Tert promoter, and Braf mutations in cytologically indeterminate thyroid nodules: A monocentric case series at a tertiary-level Endocrinology unit

PurposeThe management of thyroid nodules of indeterminate cytology is controversial. Our study aimed to establish the frequency and significance of H-,K-,N-RAS, TERT promoter, and BRAF gene mutations in thyroid nodes of indeterminate cytology and to assess their potential usefulness in clinical practice.MethodsH-,K-,N-RAS, TERT promoter and BRAF gene mutations were examined in a series of 199 consecutive nodes of indeterminate cytology referred for surgical excision.Results69/199 (35%) were malignant on histopathological review. RAS mutations were detected in 36/199 (18%), and 19/36 cases (53%) were malignant on histological diagnosis. TERT promoter mutations were detected in 7/199 (4%) nodules, which were all malignant lesions. BRAF mutations were detected in 15/199 (8%), and a BRAF K601E mutation was identified in 2 follicular adenomas and 1 noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Altogether, this panel was able to identify 48% of the malignant lesions, achieving a specificity, positive predictive value, and negative predictive value for malignancy of 85, 62, and 75%, respectively.ConclusionThe residual malignancy risk in mutation-negative nodes is 25%. These nodes still need to be resected, but mutation analysis could help to orient the appropriate surgical strategy

A constitutive active MAPK/ERK pathway due to BRAFV600E positively regulates AHR pathway in PTC

The aryl hydrocarbon receptor (AHR) is a ligand-activated transcription factor mediating the toxicity and tumor-promoting properties of dioxin. AHR has been reported to be overexpressed and constitutively active in a variety of solid tumors, but few data are currently available concerning its role in thyroid cancer. In this study we quantitatively explored a series of 51 paired-normal and papillary thyroid carcinoma (PTC) tissues for AHR-related genes. We identified an increased AHR expression/activity in PTC, independently from its nuclear dimerization partner and repressor but strictly related to a constitutive active MAPK/ERK pathway. The AHR up-regulation followed by an increased expression of AHR target genes was confirmed by a meta-analysis of published microarray data, suggesting a ligand-independent active AHR pathway in PTC. In-vitro studies using a PTC-derived cell line (BCPAP) and HEK293 cells showed that BRAF(V600E) may directly modulate AHR localization, induce AHR expression and activity in an exogenous ligand-independent manner. The AHR pathway might represent a potential novel therapeutic target for PTC in the clinical practice

PROGNOSTIC SIGNIFICANCE OF TERT PROMOTER AND BRAF MUTATIONS IN TIR-4 AND TIR-5 THYROID CYTOLOGY

Objective: Follicular-derived thyroid cancers generally have a good prognosis, but in a minority of cases, they have an aggressive behavior and develop distant metastases, with an increase in the associated mortality. None of the prognostic markers currently available prior to surgery can identify such cases. Methods: TERT promoter and BRAF gene mutations were examined in a series of 436 consecutive TIR-4 and TIR-5 nodes referred for surgery. Follow-up (median: 59 months, range: 7-293 months) was available for 384/423 patients with malignant nodes. Results: TERT promoter and BRAF mutations were detected in 20/436 (4.6%) and 257/434 thyroid nodules (59.2%), respectively. At the end of the follow-up, 318/384 patients (82.8%) had an excellent outcome, 48/384 (12.5%) had indeterminate response or biochemical persistence, 18/384 (4.7%) had a structural persistence or died from thyroid cancer. TERT promoter mutations correlated with older age (P < 0.0001), larger tumor size (P = 0.0002), oxyntic and aggressive PTC variants (P = 0.01), higher tumor stages (P < 0.0001), distant metastases (<0.0001) and disease outcome (P < 0.0001). At multivariate analysis, TERT promoter mutation was not an independent predictor of disease outcome. TERT promoter mutation- (OR: 40.58; 95% CI: 3.06-539.04), and N1b lymph node metastases (OR: 40.16, 95% CI: 3.48-463.04) were independent predictors of distant metastases. BRAF mutation did not predict the outcome, and it correlated with a lower incidence of distant metastases (P = 0.0201). Conclusions: TERT promoter mutation proved an independent predictor of distant metastases, giving clinicians the chance to identify many of the patients who warranted more aggressive initial treatment and closer follow-up

Validation of miRNAs as diagnostic and prognostic biomarkers, and possible therapeutic targets in medullary thyroid cancers

IntroductionMedullary thyroid cancer (MTC) is a rare type of neuroendocrine tumor that produces a hormone called calcitonin (CT). Thyroidectomy is the preferred treatment for MTC, as chemotherapy has been shown to have limited effectiveness. Targeted therapy approaches are currently being used for patients with advanced, metastatic MTC. Several studies have identified microRNAs, including miR-21, as playing a role in the development of MTC. Programmed cell death 4 (PDCD4) is a tumor suppressor gene that is an important target of miR-21. Our previous research has shown that high levels of miR-21 are associated with low PDCD4 nuclear scores and high CT levels. The aim of this study was to investigate the potential of this pathway as a novel therapeutic target for MTC.MethodsWe used a specific process to silence miR-21 in two human MTC cell lines. We studied the effect of this anti-miRNA process alone and in combination with cabozantinib and vandetanib, two drugs used in targeted therapy for MTC. We analyzed the effect of miR-21 silencing on cell viability, PDCD4 and CT expression, phosphorylation pathways, cell migration, cell cycle, and apoptosis.ResultsSilencing miR-21 alone resulted in a reduction of cell viability and an increase in PDCD4 levels at both mRNA and protein levels. It also led to a reduction in CT expression at both mRNA and secretion levels. When combined with cabozantinib and vandetanib, miR-21 silencing did not affect cell cycle or migration but was able to enhance apoptosis.ConclusionSilencing miR-21, although not showing synergistic activity with TKIs (tyrosine kinase inhibitors), represents a potential alternative worth exploring as a therapeutic target for MTC

Circulating miR-146a predicts glucocorticoid response in thyroid eye disease

Objective: Thyroid eye disease (TED) is an immune-mediated disorder of the eye. Intravenous glucocorticoid (GC) is the first-line treatment for patients with active moderate-to-severe TED. However, the response rate is between 5 0% and 80%. There are still no simple and reliable markers of responsiveness to G C therapy. We aimed to explore the possible role of miR-146a and miR-21 as predictors of responsiveness to GC treatment in TED. Methods: We carried out a prospective longitudinal study on 30 consecutive adult patients with active moderate-to-severe TED and eligible for GC therapy. All patients received the standard GC treatment with methylprednisolone iv. In cases of progressive worsening of Gorman Score for diplopia or with duction restrict ion <30° in at least two consecutive controls, patients also underwent orbital radiotherapy. Response to GC treatment was defined as a decrease of two or more points in the clinical activity score (CAS) or CAS <4/10 at 24 weeks. Circulating miRNAs were extract ed from patients’ serum and quantified by real-time PCR. Results: Twenty-three (77%) patients responded to GC. Thyroid surgery, higher CAS, greater proptosis and higher pre-treatment circulating levels of miR-146a emerged as predictive factors of responsiveness to GC. A ROC analysis revealed that miR-146a could predict responsiveness to GC with a positive predictive value of 100%. Conclusion: This is the first study investigating the role of pre-treatment circulating miR-21 and miR-146a to predict responsiveness to GC in TED. miR-146a emerged as a simple, objective, new marker of GC sensitivity that could be used to avoid ineffective administration of GC therapy to TED patients

Analisi delle Cellule Tumorali Circolanti nel carcinoma gastrico e nelle metastasi epatiche da cancro del colon-retto: ruolo di Survivin e CD133 come fattori prognostici.

Background At present the only prognostic system routinely employed for the management of gastric cancer patients is the TNM staging classification, that identifies broad risk categories with a significant prognostic variability within each stage, which makes TNM a suboptimal predictive tool on the single patient basis. Only 10-20% of patients with liver metastases from colorectal cancer is resectable with radical intent and 60-70% will develop a relapse despite apparently curative surgery. Both these classes of patients therefore would benefit from additional treatments after surgery such as adjuvant chemotherapy. We need new prognostic factors that can identify patients at high risk to be submitted to treatment. Aim of the study To study circulating tumor cells by gene profiling the peripheral blood in order to identify prognostic biomarkers that add independent prognostic power to the conventional staging systems. This might allow for a better stratification of patients’ risk and thus a better therapeutic management of gastric cancer and metastatic colorectal cancer patients, especially in the adjuvant setting. Patients, materials and methods 70 patients, affected with gastric adenocarcinoma at different TNM stages of disease who underwent radical surgery and 50 patients undergoing liver resection for metastases from colorectal cancer (stage IV) were enrolled in the study. Immediately before surgery, a sample of peripheral blood was withdrawn from each patient. For each sample, RNA was extracted and utilized for quantitative real time PCR evaluation of the expression of the following genes: CK19, CEA, VEGF, and Survivin for gastric cancer patients; CK19, CK20, CEA, VEGF, EGFR, CD133 and Survivin for colorectal liver metastases patients. Univariate and multivariate survival analysis was performed to investigate on the prognostic role of these biomarkers. Results After stepwise variable selection, Cox multivariate analysis of survival showed a significant association between overall survival and both TNM stage ad Survivin gene expression levels in peripheral blood of gastric cancer patients, while multivariate analysis confirmed the statistically significant association between both the radical resection and the transcriptional levels of CD133 and overall survival in colorectal liver metastases patients. In addition, Survivin transcriptional levels were higher in patients with gastric cancer as compared to the calibrator reference (obtained from the peripheral blood of healthy donors) in 98.6% of cases; analogously, CK19 was upregulated in 97.1% of cases. These findings support the hypothesis that the peripheral blood gene profile might be utilized also as a diagnostic marker in gastric cancer. Concluding remarks The positive findings of this pilot study are the basis for larger prospective studies in larger groups of gastric cancer and colorectal liver metastases patients, aimed to validate the prognostic power of Survivin and CD33 expression in peripheral blood of these two groups, respectively. Moreover it would be interesting to further explore also the potential diagnostic value of the peripheral blood gene profile in gastric cancer.Presupposti dello studio Attualmente l'unico sistema prognostico utilizzato in clinica per i pazienti con cancro gastrico è la stadiazione TNM, che crea classi di rischio con prognosi significativamente diversa, ma con un’alta variabilità del rischio all’interno delle singole classi, risultando così uno strumento prognostico non ottimale a livello di singolo paziente. Solo il 10-20% dei pazienti con metastasi epatiche da carcinoma del colon-retto (CRC) risulta resecabile con intento radicale e di questi il 60-70% svilupperà una recidiva nonostante l’intervento potenzialmente curativo. Entrambe queste classi di pazienti necessitano di trattamenti aggiuntivi alla chirurgia come la chemioterapia adiuvante. Sono quindi necessari fattori prognostici nuovi, che permettano di individuare i pazienti ad alto rischio da indirizzare alla terapia. Scopo dello studio Studiare le cellule tumorali circolanti, attraverso il profilo di espressione genica nel sangue periferico, per individuare fattori prognostici indipendenti, in modo da rendere migliore la stratificazione del rischio e di conseguenza la cura dei pazienti con adenocarcinoma gastrico e con metastasi epatiche da carcinoma del colon-retto, con particolare riguardo alla selezione dei pazienti da trattare con terapia adiuvante. Pazienti, materiali e metodi Nello studio sono stati inclusi 70 pazienti con adenocarcinoma gastrico in diverso stadio TNM sottoposti a gastrectomia con intento radicale e 50 pazienti con metastasi epatiche da CRC sottoposti a chirurgia. Prima dell’intervento chirurgico, a ogni paziente è stato eseguito un prelievo di sangue venoso periferico, se ne è estratto l’RNA totale ed il corrispondente cDNA è stato utilizzato per l’analisi di espressione genica mediante PCR quantitativa. Per i pazienti con carcinoma gastrico sono stati valutati i geni CK19, CEA, VEGF, Survivin; per i pazienti con metastasi epatiche da CRC sono stati valutati i geni CK19, CK20, CEA, VEGF, EGFR, CD133 e Survivin. Per valutare il ruolo prognostico di ogni marcatore sono state effettuate le analisi di sopravvivenza uni- e multivariata. Risultati All’analisi multivariata secondo Cox della sopravvivenza globale, dopo selezione stepwise, sono risultati fattori prognostici indipendenti per i pazienti con cancro gastrico la stadiazione TNM e l’espressione del gene codificante per Survivin, mentre per i pazienti con CRC metastatico sono risultati fattori prognostici indipendenti la radicalità dell’intervento e l’espressione di CD133 nel sangue periferico. Inoltre Survivin era maggiormente espressa nei pazienti con carcinoma gastrico rispetto al calibratore (ottenuto dal sangue di donatori sani) nel 98.6% dei casi; analogamente CK19 era maggiormente espressa nel 97.1% dei casi. Questi dati supportano la possibilità dell’utilizzo dell’espressione genica nel sangue periferico anche come marcatore diagnostico del carcinoma gastrico. Conclusioni I risultati positivi di queste analisi costituiscono la base per la conduzione di più ampi studi prospettici nelle due patologie considerate, al fine di poter validare il valore prognostico dell’espressione di Survivin e CD133 nel sangue periferico dei pazienti rispettivamente con carcinoma gastrico e con CRC metastatico. Sarebbe inoltre di sicuro interesse confermare il significato diagnostico del profilo genico del sangue periferico nel cancro gastrico

Tumor necrosis factor (TNF) biology and cell death

Tumor necrosis factor (TNF) was the first cytokine to be used in humans for cancer therapy. However, its role in the treatment of cancer patients is debated. Most uncertainties in this field stem from the knowledge that the pathways directly activated or indirectly affected upon TNF engagement with its receptors can ultimately lead to very different outcomes in terms of cell survival. In this article, we summarize the fundamental molecular biology aspects of this cytokine. Such a basis is a prerequisite to critically approach the sometimes conflicting preclinical and clinical findings regarding the relationship between TNF, tumor biology and anticancer therapy. Although the last decade has witnessed remarkable advances in this field, we still do not know in detail how cells choose between life and death after TNF stimulation. Understanding this mechanism will not only shed new light on the physiological significance of TNF-driven programmed cell death but also help investigators maximize the anticancer potential of this cytokine