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  • Oxford University Press (OUP)  (13)
  • Berger, Michael  (13)
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  • Oxford University Press (OUP)  (13)
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  • 1
    In: Neuro-Oncology, Oxford University Press (OUP), Vol. 25, No. Supplement_1 ( 2023-06-12), p. i31-i31
    Abstract: Intrinsic brainstem tumors arising in pediatric, adolescent, and young adult patients comprise a spectrum of entities, predominantly diffuse midline gliomas (DMG) and IDH mutant astrocytomas. Accurate molecular diagnosis is essential for prognostication and optimal therapy. Therapeutic considerations include inclusion (in IDH mutant) or exclusion (in H3K27M) of adjuvant Temozolomide post radiotherapy and use of molecular targeted therapy (IDH inhibitors). Surgical biopsy, however, is associated with increased risk of permanent neurological deficits and may yield insufficient or non-diagnostic tissue. We hypothesized that minimally-invasive “liquid biopsy” of cerebrospinal fluid (CSF) could represent a superior diagnostic modality in this patient population, employing molecular analysis of cell free DNA (cfDNA). We analyzed 44 CSF samples from 38 unique patients for recurrent driver mutations in brainstem gliomas, including H3K27M, IDH1, and IDH2. MSK-IMPACT, a NY state-authorized hybridization capture-based next-generation panel DNA sequencing assay, was used for analysis. Samples without a detectable driver mutation by MSK-IMPACT testing were further subjected to gene targeted testing by droplet digital PCR. In all, 10/44 (22.7%) samples had mutations detected by MSK-IMPACT using standard calling criteria and 13 of the remaining 34 samples (38.2%) had supporting evidence of a mutation based on manual review. Further testing by ddPCR was performed on a subset of cases (based on DNA availability) which confirmed 7 of the previous low-level mutations and uncovered 4 additional mutations. Overall, 27/44 (61.4%) of cases had detectable evidence of a mutation, and of the 23 patients without a known tissue diagnosis, a driver in the CSF was identified for 47.8% of patients (11/23). Minimally-invasive analysis of CSF cfDNA in patients with intrinsic brainstem tumors has a high diagnostic yield and may obviate the need for tissue biopsy in a majority of patients. Testing with high sensitivity assays is valuable to maximize the rate of detection.
    Type of Medium: Online Resource
    ISSN: 1522-8517 , 1523-5866
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2094060-9
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  • 2
    In: Neuro-Oncology, Oxford University Press (OUP), Vol. 24, No. Supplement_1 ( 2022-06-03), p. i162-i162
    Abstract: PURPOSE: A subset of pediatric, adolescent and young adult (AYA) gliomas are located in the brainstem, eloquent locations, or present with diffuse/leptomeningeal disease, and are associated with high risk and low yield of biopsy. At the same time, accurate molecular diagnosis is necessary to direct optimal therapy. In such cases, analysis of cell free DNA (cfDNA) form cerebral spinal fluid (CSF) may represent a diagnostic alternative to biopsy. METHODS: We investigated the utility of CSF cfDNA sequencing through a stepwise approach, using clinically validated, targeted molecular assays. Testing was performed using a broad hybrid capture next generation sequencing assay (MSK-IMPACT) and subsequent targeted digital droplet PCR in a subset of cases. RESULTS: We analyzed 17 CSF samples from 17 pediatric (n=6) and AYA (n=11) glioma patients with primary or recurrent disease. Thirteen had tumors located within the brainstem, and four had leptomeningeal involvement. Somatic alterations were detected in 12/17 samples (71%). In 3/4 patients with leptomeningeal involvement, cfDNA testing revealed a BRAF fusion consistent with the diagnosis of diffuse leptomeningeal glioneuronal tumor (DLGNT). Among the 13 patients with brainstem involvement, four had somatic H3 K27M mutations, three had IDH mutations, and one had TP53 and ATRX mutations; five patients had no detectable mutations. CONCLUSION: In our analysis, we found that established glioma hotspot mutations were able to be detected within the CSF. We propose that in patients for whom tissue biopsy is high risk, not feasible, or tissue was nondiagnostic, CSF cfDNA sequencing has a substantial diagnostic yield and should be considered as a valuable novel diagnostic tool. Ongoing research is aiming to further increase the sensitivity of cfDNA testing, especially in patients with very low levels of CSF cfDNA.
    Type of Medium: Online Resource
    ISSN: 1522-8517 , 1523-5866
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2094060-9
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  • 3
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2015
    In:  Nucleic Acids Research Vol. 43, No. 17 ( 2015-09-30), p. 8215-8226
    In: Nucleic Acids Research, Oxford University Press (OUP), Vol. 43, No. 17 ( 2015-09-30), p. 8215-8226
    Type of Medium: Online Resource
    ISSN: 0305-1048 , 1362-4962
    RVK:
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2015
    detail.hit.zdb_id: 1472175-2
    SSG: 12
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  • 4
    In: JNCI: Journal of the National Cancer Institute, Oxford University Press (OUP), Vol. 113, No. 12 ( 2021-11-29), p. 1683-1692
    Abstract: The causative factors for the recent increase in early-onset colorectal cancer (EO-CRC) incidence are unknown. We sought to determine if early-onset disease is clinically or genomically distinct from average-onset colorectal cancer (AO-CRC). Methods Clinical, histopathologic, and genomic characteristics of EO-CRC patients (2014-2019), divided into age 35 years and younger and 36-49 years at diagnosis, were compared with AO-CRC (50 years and older). Patients with mismatch repair deficient tumors, CRC-related hereditary syndromes, and inflammatory bowel disease were excluded from all but the germline analysis. All statistical tests were 2-sided. Results In total, 759 patients with EO-CRC (35 years, n = 151; 36-49 years, n = 608) and AO-CRC (n = 687) were included. Left-sided tumors (35 years and younger = 80.8%; 36-49 years = 83.7%; AO = 63.9%; P  & lt; .001 for both comparisons), rectal bleeding (35 years and younger = 41.1%; 36-49 years = 41.0%; AO = 25.9%; P = .001 and P  & lt; .001, respectively), and abdominal pain (35 years and younger = 37.1%; 36-49 years = 34.0%; AO = 26.8%; P = .01 and P = .005, respectively) were more common in EO-CRC. Among microsatellite stable tumors, we found no differences in histopathologic tumor characteristics. Initially, differences in TP53 and Receptor Tyrosine Kinase signaling pathway (RTK-RAS)alterations were noted by age. However, on multivariate analysis including somatic gene analysis and tumor sidedness, no statistically significant differences at the gene or pathway level were demonstrated. Among advanced microsatellite stable CRCs, chemotherapy response and survival were equivalent by age cohorts. Pathogenic germline variants were identified in 23.3% of patients 35 years and younger vs 14.1% of AO-CRC (P = .01). Conclusions EO-CRCs are more commonly left-sided and present with rectal bleeding and abdominal pain but are otherwise clinically and genomically indistinguishable from AO-CRCs. Aggressive treatment regimens based solely on the age at CRC diagnosis are not warranted.
    Type of Medium: Online Resource
    ISSN: 0027-8874 , 1460-2105
    RVK:
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2992-0
    detail.hit.zdb_id: 1465951-7
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  • 5
    In: The Oncologist, Oxford University Press (OUP), Vol. 25, No. 8 ( 2020-08-01), p. e1158-e1169
    Abstract: Poly(ADP-ribose) polymerase inhibitors (PARPis) are U.S. Food and Drug Administration (FDA) approved for treatment of BRCA-mutated metastatic breast cancer. Furthermore, the BROCADE studies demonstrated benefit of adding an oral PARPi, veliparib, to carboplatin and paclitaxel in patients with metastatic breast cancer harboring BRCA mutation. Given multiple possible dosing schedules and the potential benefit of this regimen for patients with defective DNA repair beyond BRCA, we sought to find the recommended phase II dose (RP2D) and schedule of veliparib in combination with carboplatin in patients with advanced breast cancer, either triple-negative (TNBC) or hormone receptor (HR)-positive, human epidermal growth receptor 2 (HER2) negative with defective Fanconi anemia (FA) DNA-repair pathway based on FA triple staining immunofluorescence assay. Materials and Methods Patients received escalating doses of veliparib on a 7-, 14-, or 21-day schedule with carboplatin every 3 weeks. Patients underwent [18]fluoro-3′-deoxythymidine (18FLT) positron emission tomography (PET) imaging. Results Forty-four patients (39 TNBC, 5 HR positive/HER2 negative with a defective FA pathway) received a median of 5 cycles (range 1–36). Observed dose-limiting toxicities were grade (G) 4 thrombocytopenia (n = 4), G4 neutropenia (n = 1), and G3 akathisia (n = 1). Common grade 3–4 toxicities included thrombocytopenia, lymphopenia, neutropenia, anemia, and fatigue. Of the 43 patients evaluable for response, 18.6% achieved partial response and 48.8% had stable disease. Median progression-free survival was 18.3 weeks. RP2D of veliparib was established at 250 mg twice daily on days 1–21 along with carboplatin at area under the curve 5. Patients with partial response had a significant drop in maximum standard uptake value (SUVmax) of target lesions between baseline and early in cycle 1 based on 18FLT-PET (day 7–21; ptrend = .006). Conclusion The combination of continuous dosing of veliparib and every-3-week carboplatin demonstrated activity and an acceptable toxicity profile. Decrease in SUVmax on 18FLT-PET scan during the first cycle of this therapy can identify patients who are likely to have a response. Implications for Practice The BROCADE studies suggest that breast cancer patients with BRCA mutation benefit from addition of veliparib to carboplatin plus paclitaxel. This study demonstrates that a higher dose of veliparib is tolerable and active in combination with carboplatin alone. With growing interest in imaging-based early response assessment, the authors demonstrate that decrease in [18]fluoro-3′-deoxythymidine positron emission tomography (FLT-PET) SUVmax during cycle 1 of therapy is associated with response. Collectively, this study established a safety profile of veliparib and carboplatin in advanced breast cancer while also providing additional data on the potential for FLT-PET imaging modality in monitoring therapy response.
    Type of Medium: Online Resource
    ISSN: 1083-7159 , 1549-490X
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2023829-0
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  • 6
    In: Neuro-Oncology, Oxford University Press (OUP), Vol. 23, No. Supplement_1 ( 2021-06-01), p. i51-i51
    Abstract: Pediatric central nervous system tumors remain a leading cause of cancer-related death in children and adolescents. Safe sampling of tumor tissue for diagnostic purposes may be challenging. Subclinical detection of disease prior to clinical or imaging progression may provide opportunity for earlier intervention and ultimately improve overall survival. Additionally, our understanding of molecular evolution in response to therapy remains limited, given the rarity of serial sampling of tumor tissue. Methods We report our experience with minimally invasive molecular diagnostics using a validated next generation sequencing assay for sequencing of cerebrospinal fluid (CSF) cell-free DNA (cfDNA) obtained at the time of surgery, by intraventricular catheter or lumbar puncture. All CSF samples were collected as part of clinical care, and results reported to both clinicians and patients/families. Results We analyzed 64 CSF samples from 45 pediatric and adolescent and young adult (AYA) patients (pediatric=25; AYA=20) with primary and recurrent brain tumors across 12 histopathological subtypes including high-grade glioma (n=10), medulloblastoma (n=10), pineoblastoma (n=5), low grade glioma (n=4), diffuse leptomeningeal glioneuronal tumor (DLGNT) (n=4), metastatic retinoblastoma (n=4), ependymoma (n=3), and other (n=5). Somatic alterations were detected in 28/64 samples (44.4%) and in at least one sample per unique patient in 22/45 patients (48.8%). CSF cfDNA positivity was strongly associated with the presence of disseminated disease at the time of collection (86.3%). No association was seen between CSF cfDNA positivity and the timing of CSF collection during the patient’s disease course. Conclusion We identified four general categories where CSF cfDNA testing provided additional relevant diagnostic, prognostic, and/or therapeutic information, impacting clinical assessment and decision making: 1) diagnosis; 2) identification of actionable alterations; 3) track response to therapy; and 4) monitoring tumor evolution. Our findings support broader implementation of clinical CSF cfDNA testing in this population that may improve care.
    Type of Medium: Online Resource
    ISSN: 1522-8517 , 1523-5866
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2094060-9
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  • 7
    In: American Journal of Clinical Pathology, Oxford University Press (OUP), Vol. 145, No. 4 ( 2016-04), p. 459-466
    Type of Medium: Online Resource
    ISSN: 0002-9173 , 1943-7722
    RVK:
    RVK:
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2016
    detail.hit.zdb_id: 2039921-2
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  • 8
    In: Inflammatory Bowel Diseases, Oxford University Press (OUP), Vol. 16, No. 11 ( 2010-11), p. 1882-1890
    Type of Medium: Online Resource
    ISSN: 1078-0998
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2010
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  • 9
    In: Neuro-Oncology Advances, Oxford University Press (OUP), Vol. 1, No. Supplement_1 ( 2019-08-12), p. i32-i33
    Abstract: INTRODUCTION: Laser interstitial thermal therapy (LITT) is a novel, minimally-invasive adjuvant therapy that is well-suited for intracranial tumors in deep or critical areas, recurrences failing standard therapy, and poor open-surgical candidates. To better characterize safety and clinical outcomes, we present the largest single-institutional experience with LITT for recurrent brain metastases. METHODS: All patients undergoing LITT for single recurrent brain metastases from 2013–2018 at the University of Miami were included in this study. Primary outcomes included extent of ablation (EOA), time-to-recurrence (TTR), and overall survival (OS). Secondary endpoints include neurologic status and complication rate. Kaplan-Meier survival analysis was performed to quantify TTR and OS, compare outcomes by primary tumor of origin, and identify potential predictors of TTR and OS. RESULTS: Thirty-six patients underwent 44 LITT procedures; all had undergone prior treatment with stereotactic radiosurgery (SRS). Mean age was 56.8 years and 83.3% were female. Average pretreatment tumor volume was 6.6cm3. Patients were treated with a mean ablation dose of 12.4W (9.8-14W), achieving a median EOA of 100% (range 55–100%). At median follow-up of 11.6 months (IQR 4.6–19.1 months), 34 of 44 (87.3%) cases had tumor control on radiographic imaging and 22 of 36 (61.1%) of patients remain alive. Median TTR was 55.9 months; median OS was 25.5 months. Neither TTR nor OR differed significantly by primary tumor of origin (P & gt;.05). EOA & gt;88% predicted longer TTR (P=.01) Neurologic status was stable or improved in all surviving patients. No major complications occurred (0% rate). CONCLUSIONS: Our institutional experience demonstrates LITT is safe for intracranial metastases resistant to SRS and offers several advantages over open surgical treatment. TTR and OS were not associated with primary tumor of origin. A threshold EOA & gt;88% predicted longer TTR. Randomized studies are needed to evaluate the role of LITT as a treatment adjunct.
    Type of Medium: Online Resource
    ISSN: 2632-2498
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 3009682-0
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  • 10
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2022
    In:  Nephrology Dialysis Transplantation Vol. 37, No. Supplement_3 ( 2022-05-03)
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 37, No. Supplement_3 ( 2022-05-03)
    Abstract: Obesity, a widespread condition with an ever-increasing prevalence, imposes a great medical concern since it serves as a risk factor for a wide range of conditions, including the development of chronic kidney disease (CKD). Lipid accumulation and impaired fatty acid β-oxidation in the renal proximal tubular cells (RPTCs) as well as an overall mitochondrial dysfunction have been shown to induce kidney injury, inflammation and fibrosis, leading to the development of CKD. However, the molecular mechanisms linking mitochondrial dysfunction in RPTCs to obesity-induced CKD are not fully understood and require further examination. Adenine nucleotide translocases (ANTs), which transport ADP and ATP through the mitochondrial inner membrane, play an essential role in energy metabolism of eukaryotic cells. ANT2 (Slc25a5) mediates fatty acid-induced uncoupled respiration, and its complete deletion is embryonic lethal. Here we explore its specific role in RPTCs in the development of obesity-induced CKD. METHOD ANT2 protein levels were measured using western blot and immunohistochemistry analyses. RPTC-ANT2-/- animals were generated using the Cre/loxP system. The null mice and their wild-type littermate controls were fed with either a high-fat diet (HFD) or a standard diet (STD) for 24 weeks. Kidney function and lipid content were assessed by biochemical analysis. Histological techniques were used to visualize the morphological changes in the kidney as well as fibrogenesis. Kidney injury and inflammatory markers were measured via qPCR and ELISAs. Mitochondrial function was tested in primary mouse RPTCs extracted from the null and WT animals by measuring oxygen consumption rate via Seahorse as well as reactive oxygen species (ROS) production by DCFDA staining. RESULTS As evident from the double-stained immunofluorescence staining of mouse kidney, high levels of ANT2 were found in RPTCs. Interestingly, its protein expression was downregulated in HFD-fed WT mice. Nullification of ANT2 specifically in RPTCs prevented the obesity-induced kidney dysfunction as reflected by lowered albumin-to-creatinine ratio. This was associated with the improved renal morphology in HFD-fed RPTC-ANT2-/- mice, evident by the reduction in obesity-related increased glomerular and Bowman's space areas and mesangial expansion. Compared with their littermate controls, obese RPTC-ANT2-/- mice showed reduced renal KIM-1 and NGAL protein levels and downregulation in the expression levels of Mcp1 and Lcn2, markers of renal injury and inflammation, respectively. The null mice were also protected from obesity-induced fibrosis, measured by trichrome staining, as well as accumulation of triglycerides and cholesterol in the kidney. In addition, preserved mitochondrial function was found in primary mouse RPTCs lacking ANT2, measured by increased spare respiratory capacity and decreased ROS production. Lastly, downregulated Hif1α gene and protein expression levels were found in RPTCs and kidney tissue lacking ANT2. CONCLUSION Our findings introduce ANT2 in the RPTCs as a key player in the development of obesity-induced CKD. Deletion of RPTC-ANT2 protects the kidney from the deleterious effects of lipotoxicity. Therefore, targeted manipulation of renal mitochondrial metabolism, particularly via inhibiting ANT2, may represent a novel approach for the treatment of obesity-induced CKD.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 1465709-0
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