TY  - THES
A1  - Vogg, Nora Johanna
T1  - Mass spectrometry-based quantification of steroids for the diagnostic workup of adrenal tumors
T1  - Massenspektrometrische Quantifizierung von Steroiden zur Diagnostik von Nebennierentumoren
N2  - Tumors of the adrenal gland belong to the most frequent neoplasms in humans with a prevalence of 3–10 % in adults. The aim of the diagnostic workup is the identification of potentially hormone-secreting and / or malignant tumors, because most of these tumors will require surgical resection. Malignant adrenocortical carcinomas (ACC) are very rare and associated with a poor prognosis in advanced stages, therefore, an early and accurate diagnosis is crucial.

Within this thesis, two liquid chromatography tandem mass spectrometry (LC-MS/MS) methods for the quantification of steroids in different biomaterials were developed to improve the diagnostic workup of adrenal tumors.

First, an LC-MS/MS method for the simultaneous quantification of cortisol and dexamethasone in serum samples after dexamethasone suppression test (DST) was developed, validated, and applied to 400 clinical samples. Newly established method-specific threshold concentrations for cortisol and dexamethasone increased DST specificity from 67.5 % to 92.4 % while preserving 100 % sensitivity.

Second, an LC-MS/MS method for the quantification of eleven urinary steroids was developed and validated to improve the differentiation between ACC and adrenocortical adenomas (ACA). A decision tree requiring only two steroids was trained for classification and tested based on 24 h urine samples from 268 patients with adrenal tumor. Malignancy was excluded with a negative predictive value of 100 % in an independent validation cohort of 84 samples of 24-h urine. A newly proposed simplified diagnostic workflow with urinary steroid profiling as first tier test could obviate additional adrenal-specific imaging in 42 of 64 patients with ACA.

The new DST method is already in clinical use at the University Hospital Würzburg, whereas the classification model based on urinary steroid profiling will require prospective validation in a larger cohort.
N2  - Nebennierentumoren gehören zu den häufigsten Neoplasmen beim Menschen und treten mit einer Prävalenz von 3–10 % bei Erwachsenen über 50 Jahren auf. Häufig wird die Raumforderung zufällig im Rahmen einer bildgebenden Untersuchung erkannt. Die meisten dieser sogenannten Inzidentalome sind gutartige und hormoninaktive Nebennierenrindenadenome (ACA), die keine therapeutische Intervention erfordern. Das Ziel der Nebennierentumor-Diagnostik ist die Abklärung potentieller Hormonaktivität und Malignität, denn diese Tumoren müssen zum Großteil operativ entfernt werden. Hormonaktive Tumoren können benigne oder maligne sein und sind durch die autonome Sekretion von Steroidhormonen charakterisiert. Maligne Nebennierenrindenkarzinome (ACC) sind sehr selten, aber aggressiv und mit einer schlechten Prognose im fortgeschrittenen Tumorstadium assoziiert. Da die therapeutischen Möglichkeiten für das ACC limitiert sind, ist eine schnelle und sichere Diagnostik erforderlich. Im Rahmen dieser Doktorarbeit wurden zwei Flüssigchromatographie-Tandemmassenspektrometrie (LC-MS/MS) Methoden zur Quantifizierung von Steroiden in Biomaterialien entwickelt, um damit die Diagnostik von Nebennierentumoren zu verbessern.
Der 1 mg-Dexamethason-Hemmtest (DST) ist ein häufig durchgeführter Screening-Test zur Untersuchung auf autonome Cortisolsekretion. Dabei wird die Supprimierbarkeit der Cortisolsekretion durch die orale Einnahme von Dexamethason überprüft. Eine LC-MS/MS Methode zur simultanen Quantifizierung von Cortisol und Dexamethason im Serum wurde entwickelt, validiert und zur Messung von 400 DST-Patientenproben genutzt. Durch methodenspezifische Schwellenwertkonzentrationen für Cortisol und Dexamethason konnte die klinische Testspezifität von 67.5 % auf 92.4 % bei unveränderter Sensitivität von 100.0 % erhöht werden.
Der zweite Teil dieser Arbeit befasst sich mit der Verbesserung der Unterscheidung von ACC und ACA. Dafür wurde eine LC-MS/MS Methode zur Quantifizierung von elf Steroiden im Urin entwickelt und validiert. Über die Messung von 24 h Sammelurinproben von 268 Nebennierenrindentumor-Patienten wurde ein Klassifikationsmodell, das auf nur zwei Steroiden basiert, trainiert und getestet. Sowohl die analytische Methode als auch das Klassifikationsmodell wurden hinsichtlich Robustheit und Zeiteffizienz optimiert, um sich möglichst gut in die klinische Routine implementieren zu lassen. Außerdem lag der Fokus auf einer einfachen, nachvollziehbaren und direkten Datenauswertung und -interpretation. Als ein Hauptergebnis konnte Malignität in einer unabhängigen Validierungskohorte von 84 Patienten mit einem negativen prädiktiven Wert von 100 % ausgeschlossen werden. Nach einem vereinfachten diagnostischen Schema mit der Urin-Steroid-Analytik als erstem Screening-Test könnte bei 42 von 64 Patienten mit ACA auf eine zusätzliche nebennierenspezifische Bildgebung verzichtet werden. Des Weiteren wurden erstmals Spontanurinproben als Surrogatmatrix für 24 h Sammelurin in der Validierungskohorte getestet. Dabei unterschied sich der positive prädiktive Wert der Spontanurine mit 86.7 % kaum von den 87.5 % der 24-h Sammelurine, während auch mit Spontanurin ein negativer prädiktiver Wert von 100 % erzielt werden konnte, was einen wichtigen Schritt in die Richtung einer vereinfachten Probensammlung darstellt.
Sowohl die simultane Quantifizierung von Cortisol und Dexamethason als auch die 24-h Urin-Steroid-Methode haben ihre Eignung für die klinische Routineanwendung bewiesen. Der Transfer der Urinmethode auf den deutlich einfacheren Spontanurin erfordert jedoch eine prospektive Validierung in einer größeren Patientenkohorte. Die neue DST-Methode wurde bereits im September 2021 in die klinische Routine am Universitätsklinikum Würzburg eingeführt.
KW  - Nebennierentumor
KW  - HPLC-MS
KW  - Steroide
KW  - adrenal incidentaloma
KW  - adrenocortical carcinoma
KW  - adrenocortical adenoma
KW  - dexamethasone suppression test
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-293438
N1  - A revised version of this manuscript has been published in Clinica Chimica Acta 2023
ER  - 
TY  - THES
A1  - Sbiera, Iuliu
T1  - Possible role of epithelial to mesenchymal transition and its associated FGF/FGFR pathway in adrenocortical carcinoma
T1  - Mögliche Rolle des epithelial-mesenchymalen Transition und des damit verbundenen FGF/FGFR-Signalwegs beim Nebennierenrindenkarzinom
N2  - Recent studies have hinted to an involvement of epithelial to mesenchymal transition, a mechanism often associated with metastasis in epithelial cancers, in adrenocortical carcinoma. In addition, the knowledge about the FGF/FGFR pathway in pathogenesis of the adrenal gland, a pathway often associated with the epithelial to mesenchymal transition, is sparse and fragmented. 
	We assessed, in a large number of normal, benign and malignant adrenocortical tissues (a total of 181 different samples), the expression of canonical and novel epithelial and mesenchymal markers and compared it with their expression in typical epithelial and mesenchymal tissues.  In addition, we also quantified the expression of most members of the FGF/FGFR pathway in adrenocortical tissues and compared it against well-studied epithelial and mesenchymal tissues as well as between malignant and not malignant adrenocortical tissues, in order to assess the possible connection to epithelial to mesenchymal transition and find possible drug targets. Surprisingly, both normal and neoplastic adrenocortical tissues lacked expression of epithelial markers (e.g. E-Cadhering or EpCAM) but strongly expressed mesenchymal markers (e.g. N-Cadherin or SLUG), suggesting a higher similarity of adrenocortical tissues to mesenchymal compared to epithelial tissues, reminiscent of the adrenocortical origin from the intermediate mesoderm. Despite their ubiquitous expression in all adrenocortical tissues, mesenchymal markers had a variable expression in adrenocortical carcinoma, associating either directly or inversely with different clinical markers of tumor aggressiveness.  Lymph node infiltration was associated with high expression of SLUG (p = 0.04), and at the same time low expression of N-cadherin (p = 0.001), and the same pattern was observed for venous infiltration of tumoral tissue, Weiss score of tumor malignancy or Ki67 proliferation marker. In malignant compared to benign adrenal tumors, we found significant differences in the expression of 16 out of the 94 studied FGF receptor pathway related genes. Genes involved in tissue differentiation and metastatic spread through epithelial to mesenchymal transition were most strongly altered. The therapeutically targetable FGF receptors 1 and 4 were upregulated 4.6- and 6-fold, respectively, in malignant compared to benign adrenocortical tumors, which was confirmed by using two different quantification methods in both frozen and paraffin embedded tissue material. High expression of FGFR1 and 4 was significantly associated with worse patient prognosis (High FGFR1 expression was associated with a shorter overall patient survival of 84 vs 148 months (HR=1.8, 95% CI: 1.01-3.25) as well as a shorter resection free survival of 25 vs 75 months ((HR=2.93, 95% CI: 1.25-6.84), while high FGFR4 was associated with a much shorter overall survival of 50 vs 155 months (HR=2.44, 95% CI: 1.41-4.22).
	 In conclusion, epithelial to mesenchymal transition does not seem to play a role in adrenocortical carcinoma tumor progression, and the FGF/FGFR pathway, even if it is probably not related to EMT, is nonetheless associated with tumor aggressiveness. Furthermore, quantification of FGF receptors may enable a stratification of adrenocortical carcinoma for the use of FGFR inhibitors in future clinical trials.
N2  - Jüngste Studien weisen auf eine Beteiligung der epithelial-mesenchymalen Transition, ein Mechanismus der oft mit Metastasen bei Epithelkarzinomen assoziiert ist, beim Nebennierenrindenkarzinom hin. Darüber hinaus gibt es kaum Kenntnisse über die Rolle des FGF/FGFR-Signalweges in der Pathogenese der Nebenniere, ein Signalweg, der oft mit der epithelial-mesenchymalen Transition in Verbindung gebracht wird.
	 Wir haben hier an einer großen Anzahl von normalen, gutartigen und bösartigen Nebennierenrindengewebeproben (insgesamt 181 Proben) die Expression von kanonischen und anderen epithelialen und mesenchymalen Markern untersucht und mit ihrer Expression in typischen epithelialen und mesenchymalen Geweben verglichen. Darüber hinaus, haben wir auch die Expression der meisten Mitglieder des FGF/FGFR-Signalwegs in Nebennierenrindengeweben quantifiziert und mit gut definierten epithelialen und mesenchymalen Geweben verglichen sowie zwischen bösartigen und nicht bösartigen Nebennierenrindengeweben, um die mögliche Verbindung zu epithelialer-mesenchymaler Transition zu finden und mögliche therapeutische Ziele zu identifizieren. Überraschenderweise konnte weder in normalem noch in neoplastischem Nebennierenrindengewebe die Expression von epithelialen Markern (z. B. E-Cadherin oder EpCAM) nachgewiesen werden. In beiden Geweben wurde aber eine starke Expression mesenchymaler Marker (z. B. N-Cadherin oder SLUG) gefunden, was auf eine größere Ähnlichkeit von Nebennierenrindengeweben zu mesenchymalen im Vergleich zu epithelialen Geweben hindeutet. Dies könnte mit der Entwicklung des Nebennierenrinden-gewebes aus dem intermediären Mesoderm erklärt werden. Trotz ihrer ubiquitären Expression in allen Nebennierenrindengeweben, hatten mesenchymale Marker eine variable Expression in Nebennierenrindenkarzinomen, die entweder direkt oder indirekt mit verschiedenen klinischen Markern der Tumoraggressivität assoziiert waren. Die Lymphknoteninfiltration war mit einer hohen Expression von SLUG (p = 0,04) und einer niedrigen Expression von N-Cadherin (p = 0,001) verbunden. Das gleiche Muster wurde für die venöse Infiltration von Tumorgewebe, dem Weiss-Score oder dem Ki67-Proliferationsmarker beobachtet. Signifikante Unterschiede in der Expression von 16 der 94 untersuchten Gene, die mit dem FGF-Rezeptorsignalweg in Verbindung stehen, wurden beim Vergleich von bösartigen und gutartigen Nebennierentumoren gefunden. Gene, die an der Gewebedifferenzierung und Metastasierung durch epithelial-mesenchymale Transition beteiligt sind, waren dabei am stärksten verändert. Die therapeutisch relevante FGF-Rezeptoren 1 und 4 waren bei malignen im Vergleich zu gutartigen Nebennierenrindentumoren 4,6- bzw. 6,0-fach hochreguliert. Dies wurde durch Verwendung zweier unabhängiger Quantifizierungsmethoden sowohl in gefrorenem als auch in paraffineingebettetem Gewebematerial bestätigt. Eine hohe Expression von FGFR1 und 4 war signifikant mit einer schlechteren Prognose verbunden. Eine hohe FGFR1-Expression war mit einem kürzeren Gesamtüberleben der Patienten von 84 vs. 148 Monaten (HR = 1,8; 95%CI: 1,01-3,25) sowie einem kürzeren resektions-freien Überleben von 25 vs. 75 Monaten (HR = 2,93; 95%CI: 1,25-6,84) verbunden, während eine höhere FGFR4-Expression mit einem viel kürzeren Gesamtüberleben von 50 vs. 155 Monaten assoziiert war (HR = 2,44; 95%CI: 1,41-4.22)). 
	Zusammenfassend lässt sich sagen, dass der Mechanismus der epithelial-mesenchymalen Transition keine Rolle bei der Tumorprogression des Nebennierenrindenkarzinoms zu spielen schein. Es konnte außerdem gezeigt werden, dass der FGF/FGFR-Signalweg, auch wenn er wahrscheinlich nicht mit der EMT zusammenhängt, mit der Aggressivität der Tumoren assoziiert. Die Untersuchung der Expression der FGF-Rezeptoren könnte für die Stratifizierung des Nebennierenrindenkarzinoms, zwecks Verwendung von FGFR-Inhibitoren in zukünftigen klinischen Studien, benutzt werden.
KW  - Nebennierenrindenkrebs
KW  - Fibroblastenwachstumsfaktor
KW  - adrenocortical carcinoma
KW  - epithelial to mesenchymal transition
KW  - fibroblast growth factors
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-277454
ER  - 
TY  - JOUR
A1  - Salman Haider, Malik
A1  - Schreiner, Jochen
A1  - Kendl, Sabine
A1  - Kroiss, Matthias
A1  - Luxenhofer, Robert
T1  - A Micellar Mitotane Formulation with High Drug-Loading and Solubility: Physico-Chemical Characterization and Cytotoxicity Studies in 2D and 3D In Vitro Tumor Models
JF  - Macromolecular Bioscience
N2  - Adrenocortical carcinoma (ACC) is a rare tumor and prognosis is overall poor but heterogeneous. Mitotane (MT) has been used for treatment of ACC for decades, either alone or in combination with cytotoxic chemotherapy. Even at doses up to 6 g per day, more than half of the patients do not achieve targeted plasma concentration (14–20 mg L\(^{-1}\)) even after many months of treatment due to low water solubility, bioavailability, and unfavorable pharmacokinetic profile. Here a novel MT nanoformulation with very high MT concentrations in physiological aqueous media is reported. The MT‐loaded nanoformulations are characterized by Fourier transform infrared spectroscopy, differential scanning calorimetry, and powder X‐ray diffraction which confirms the amorphous nature of the drug. The polymer itself does not show any cytotoxicity in adrenal and liver cell lines. By using the ACC model cell line NCI‐H295 both in monolayers and tumor cell spheroids, micellar MT is demonstrated to exhibit comparable efficacy to its ethanol solution. It is postulated that this formulation will be suitable for i.v. application and rapid attainment of therapeutic plasma concentrations. In conclusion, the micellar formulation is considered a promising tool to alleviate major drawbacks of current MT treatment while retaining bioactivity toward ACC in vitro.
KW  - adrenocortical carcinoma
KW  - amphiphilic block copolymer
KW  - NCI-H295R
KW  - poly(2-oxazoline)
KW  - solubility enhancement
Y1  - 2019
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-206224
VL  - 20
IS  - 1
ER  - 
TY  - JOUR
A1  - Oreglia, Maurine
A1  - Sbiera, Silviu
A1  - Fassnacht, Martin
A1  - Guyon, Laurent
A1  - Denis, Josiane
A1  - Cristante, Justine
A1  - Chabre, Olivier
A1  - Cherradi, Nadia
T1  - Early postoperative circulating miR-483-5p is a prognosis marker for adrenocortical cancer
JF  - Cancers
N2  - We have previously identified serum miR-483-5p as a preoperative diagnosis and prognosis biomarker for adrenocortical cancer (ACC). Here, we aimed to determine whether circulating miR-483-5p levels measured 3 months post-operatively distinguished patients with good prognosis (no recurrence for at least 3 years; NR3yrs) from patients with poor prognosis (recurrence or death within 3 years after surgery; R < 3yrs). We conducted a single-center retrospective analysis using sera from 48 patients with ACC that were initially non-metastatic and treated by surgery. Sera sampled within 3 months after surgery were available in 26 patients. MiR-483-5p absolute circulating levels were measured using quantitative PCR. Thirteen patients showed a recurrence before 3 years (=R < 3yrs). Thirteen patients showed no recurrence within 3 years, including 11 patients with a follow-up longer than 3 years (=NR3yrs). Serum miR-483-5p levels were higher in R < 3yrs than in NR3yrs: 1,541,990 ± 428,377 copies/mL vs. 388,457 ± 62,169 copies/mL (p = 0.002). Receiver operating characteristic analysis showed that a value of 752,898 copies/mL distinguished R < 3yrs from NR3yrs with 61.5% sensitivity (CI 31.6–86.1) and 100% specificity (CI 71.5–100) with an area under the curve of 0.853. Patients with a value below this threshold had a significantly longer recurrence-free and overall survival. In multivariate analysis, miR-483-5p provided the single best prognostic value for recurrence-free survival (RFS) (hazard ratio (HR) for recurrence 5.98, p < 0.011) but not for overall survival. Our study suggests that serum miR-483-5p is a potent early post-operative biomarker for ACC prognosis that might be a better predictor of RFS than currently used markers.
KW  - adrenocortical carcinoma
KW  - biomarker
KW  - circulating microRNA
KW  - miR-483-5p
KW  - early prognosis
KW  - recurrence
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-203227
SN  - 2072-6694
VL  - 12
IS  - 3
ER  - 
TY  - JOUR
A1  - Michalski, Kerstin
A1  - Schlötelburg, Wiebke
A1  - Hartrampf, Philipp E.
A1  - Kosmala, Aleksander
A1  - Buck, Andreas K.
A1  - Hahner, Stefanie
A1  - Schirbel, Andreas
T1  - Radiopharmaceuticals for treatment of adrenocortical carcinoma
JF  - Pharmaceuticals
N2  - Adrenocortical carcinoma (ACC) represents a rare tumor entity with limited treatment options and usually rapid tumor progression in case of metastatic disease. As further treatment options are needed and ACC metastases are sensitive to external beam radiation, novel theranostic approaches could complement established therapeutic concepts. Recent developments focus on targeting adrenal cortex-specific enzymes like the theranostic twin [\(^{123/131}\)I]IMAZA that shows a good image quality and a promising therapeutic effect in selected patients. But other established molecular targets in nuclear medicine such as the C-X-C motif chemokine receptor 4 (CXCR4) could possibly enhance the therapeutic regimen as well in a subgroup of patients. The aims of this review are to give an overview of innovative radiopharmaceuticals for the treatment of ACC and to present the different molecular targets, as well as to show future perspectives for further developments since a radiopharmaceutical with a broad application range is still warranted.
KW  - adrenocortical carcinoma
KW  - theranostics
KW  - endoradiotherapy
KW  - IMAZA
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-355901
SN  - 1424-8247
VL  - 17
IS  - 1
ER  - 
TY  - JOUR
A1  - Marquardt, André
A1  - Landwehr, Laura-Sophie
A1  - Ronchi, Cristina L.
A1  - di Dalmazi, Guido
A1  - Riester, Anna
A1  - Kollmannsberger, Philip
A1  - Altieri, Barbara
A1  - Fassnacht, Martin
A1  - Sbiera, Silviu
T1  - Identifying New Potential Biomarkers in Adrenocortical Tumors Based on mRNA Expression Data Using Machine Learning
JF  - Cancers
N2  - Simple Summary
Using a visual-based clustering method on the TCGA RNA sequencing data of a large adrenocortical carcinoma (ACC) cohort, we were able to classify these tumors in two distinct clusters largely overlapping with previously identified ones. As previously shown, the identified clusters also correlated with patient survival. Applying the visual clustering method to a second dataset also including benign adrenocortical samples additionally revealed that one of the ACC clusters is more closely located to the benign samples, providing a possible explanation for the better survival of this ACC cluster. Furthermore, the subsequent use of machine learning identified new possible biomarker genes with prognostic potential for this rare disease, that are significantly differentially expressed in the different survival clusters and should be further evaluated.

Abstract
Adrenocortical carcinoma (ACC) is a rare disease, associated with poor survival. Several “multiple-omics” studies characterizing ACC on a molecular level identified two different clusters correlating with patient survival (C1A and C1B). We here used the publicly available transcriptome data from the TCGA-ACC dataset (n = 79), applying machine learning (ML) methods to classify the ACC based on expression pattern in an unbiased manner. UMAP (uniform manifold approximation and projection)-based clustering resulted in two distinct groups, ACC-UMAP1 and ACC-UMAP2, that largely overlap with clusters C1B and C1A, respectively. However, subsequent use of random-forest-based learning revealed a set of new possible marker genes showing significant differential expression in the described clusters (e.g., SOAT1, EIF2A1). For validation purposes, we used a secondary dataset based on a previous study from our group, consisting of 4 normal adrenal glands and 52 benign and 7 malignant tumor samples. The results largely confirmed those obtained for the TCGA-ACC cohort. In addition, the ENSAT dataset showed a correlation between benign adrenocortical tumors and the good prognosis ACC cluster ACC-UMAP1/C1B. In conclusion, the use of ML approaches re-identified and redefined known prognostic ACC subgroups. On the other hand, the subsequent use of random-forest-based learning identified new possible prognostic marker genes for ACC.
KW  - adrenocortical carcinoma
KW  - in silico analysis
KW  - machine learning
KW  - bioinformatic clustering
KW  - biomarker prediction
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-246245
SN  - 2072-6694
VL  - 13
IS  - 18
ER  - 
TY  - THES
A1  - Liang, Raimunde
T1  - Identification of new drug targets in adrenocortical carcinoma through targeted mRNA analysis
T1  - Identifikation neuer Drug Targets im Nebennierenrindenkarzinom durch gezielte mRNA-Analyse
N2  - Adrenocortical carcinomas (ACC) are aggressive tumors associated with a heterogeneous but generally poor prognosis and limited treatment options for advanced stages. Despite promising molecular insights and improved understanding of ACC biology, efficient targeted therapies have not been identified yet. Thus, this study aims to identify potential new drug targets for a future personalized therapeutic approach.
RNA was isolated from 104 formalin-fixed paraffin-embedded tumor samples from ACC patients, 40 of those 104 cases proved to be suitable for further mRNA analyses according to the quality check of the extracted RNA. Gene expression of 84 known cancer drug targets was evaluated by quantitative real-time PCR using 5 normal adrenal glands as reference. Protein expression was investigated for selected candidate drug targets by immunohistochemistry in 104 ACC samples, 11 adenomas and 6 normal adrenal glands. Efficacy of an available inhibitor of the most promising candidate was tested by functional in vitro experiments in two ACC cell lines (NCI-H295R and MUC1) alone or in combination with other drugs.
Most frequently overexpressed genes were TOP2A, IGF2, CDK1, CDK4, PLK4 and PLK1. Nuclear immunostaining of CDK1, CDK4 and PLK1 significantly correlated with the respective mRNA expression. CDK4 was chosen as the most promising candidate for functional validation as it is actionable by FDA-approved CDK4/6 inhibitors. ACC samples with copy number gains at CDK4 locus presented significantly higher CDK4 expression levels. The CDK4/6 inhibitor palbociclib showed a concentration- and time- dependent reduction of cell viability in vitro, which was more pronounced in NCI-H295R than in MUC1 cells. This was in line with higher CDK4 expression at western blot analysis in NCI-H295R cells. Furthermore, palbociclib was applied in combination with dual IGFR/IR inhibitor linsitinib showing a synergistic effect on reducing cell viability. In conclusion, this proof-of-principle study confirmed RNA profiling to be useful to discover potential drug targets. Detected drug targets are suitable to be investigated by immunohistochemistry in the clinical setting. Moreover, CDK4/6 inhibitors are promising candidates for treatment of a subset of patients with tumors presenting CDK4 copy number gains and/or overexpression, while linsitinib might be an interesting combination partner in patients with both IGF2 and IGF1R overexpression.
These results are intended as a basis for a validation study in a prospective cohort, further evaluation in vivo in suitable mouse models or testing in patients with ACC in clinical trials are needed and might improve the future management of patients with ACC in terms of precision medicine.
N2  - Nebennierenrindenkarzinome (ACC) sind aggressive Tumore, die mit einer heterogenen, aber insgesamt ungünstigen Prognose sowie limitierten therapeutischen Optionen für fortgeschrittene Stadien assoziiert sind. Trotz hoffnungsvoll stimmenden molekularen Einblicken und verbessertem Verständnis für die Biologie des ACC wurden bisher keine effektiven Targeted Therapies (zielgerichtete Therapien) identifiziert. Daher strebt diese Studie die Identifikation potentieller neuer Drug Targets (Arzneimittelzielpunkte) im Rahmen einer zukünftigen personalisierten Therapie an.
RNA wurde von 104 formalinfixierten und paraffineingebetteten Tumorproben von ACC Patienten isoliert, 40 der 104 Fälle zeigten sich nach der Qualitätsprüfung der extrahierten RNA geeignet für weiterführende mRNA-Analysen. Genexpression von 84 bekannten Karzinom-Drug Targets wurden durch quantitative Real-Time PCR unter Nutzung von 5 normalen Nebennieren als Referenz evaluiert. Proteinexpression wurde in selektierten Kandidaten-Drug Targets durch Immunhistochemie in 104 ACC-Proben, 11 Adenomen und 6 normalen Nebennieren untersucht. Das Potential eines verfügbaren Inhibitors gegen das vielversprechendste Kandidatengen wurde in funktionalen in vitro Experimenten mit zwei ACC-Zelllinien (NCI-H295R und MUC1) allein und in Kombination mit einem anderen Medikament getestet.
Die am häufigsten überexprimierten Gene stellten TOP2A, IGF2, CDK1, CDK4, PLK4 und PLK1 dar. Die immunhistologische Kernfärbung für CDK1, CDK4 und PLK1 korrelierten signifikant mit der jeweiligen mRNA-Expression. CDK4 wurde als erfolgversprechendster Kandidat für weitere funktionale Validierung ausgewählt, da es durch FDA-genehmigte CDK4/6-Inhibitoren angreifbar ist. ACC-Proben mit Copy Number Gains des CDK4 Genlocus zeigten signifikant höhere CDK4 Expressionslevel. Der CDK4/6-Inhibitor Palbociclib wies eine zeit- und konzentrationsabhängige Reduktion der Zellviabilität in vitro auf, welche ausgeprägter in NCI-H295R- als in MUC1-Zellen war. Dies war in Einklang mit stärkerer CDK4 Expression in den NCI-H295R-Zellen in der Western Blot Analyse. Weiterhin wurde Palbociclib in Kombination mit dem dualen IGFR/IR-Inhibitor Linsitinib eingesetzt, dies zeigte einen synergistischen Effekt auf die Reduktion der Zellviabilität. 
Zusammenfassend bestätigte diese Proof-of-Principle den Nutzen von RNA Profiling zur Erfassung potentieller Drug Targets. Die ermittelten Drug Targets sind geeignet für immunhistochemische Untersuchungen im klinischen Setting. Darüber hinaus sind CDK4/6-Inhibitoren vielversprechende Kandidaten für die Behandlung einer Teilgruppe von Patienten mit Tumoren, die CDK4-Copy Number Gains und/oder -Überexpression aufweisen, während Linsitinib ein interessanter Kombinationspartner in Patienten mit sowohl IGF2- wie auch IGF1R-Überexpression darstellen könnte. 
Diese Resultate sollen als Basis für eine Validationsstudie in einer prospektiven Kohorte dienen, weitere Evaluation in vivo in geeigneten Mausmodellen oder Untersuchung in ACC-Patienten in klinischen Studien sind erforderlich und könnten das zukünftige Management von ACC-Patienten verbessern im Rahmen der Präzisionsmedizin.
KW  - Adrenokortikales Karzinom
KW  - CDK4 Inhibitor
KW  - Präzisionsmedizin
KW  - gezielte Therapie
KW  - Palbociclib
KW  - adrenocortical carcinoma
KW  - precision medicine
KW  - CDK4 inhibitor
KW  - ACC
KW  - targeted therapy
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235545
ER  - 
TY  - JOUR
A1  - Lacombe, Amanda Meneses Ferreira
A1  - Soares, Iberê Cauduro
A1  - Mariani, Beatriz Marinho de Paula
A1  - Nishi, Mirian Yumie
A1  - Bezerra-Neto, João Evangelista
A1  - Charchar, Helaine da Silva
A1  - Brondani, Vania Balderrama
A1  - Tanno, Fabio
A1  - Srougi, Victor
A1  - Chambo, José Luiz
A1  - Costa de Freitas, Ricardo Miguel
A1  - Mendonca, Berenice Bilharinho
A1  - Hoff, Ana O.
A1  - Almeida, Madson Q.
A1  - Weigand, Isabel
A1  - Kroiss, Matthias
A1  - Zerbini, Maria Claudia Nogueira
A1  - Fragoso, Maria Candida Barisson Villares
T1  - Sterol O-acyl transferase 1 as a prognostic marker of adrenocortical carcinoma
JF  - Cancers
N2  - Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with an unfavorable prognosis. Despite the poor prognosis in the majority of patients, no improvements in treatment strategies have been achieved. Therefore, the discovery of new prognostic biomarkers is of enormous interest. Sterol-O-acyl transferase 1 (SOAT1) is involved in cholesterol esterification and lipid droplet formation. Recently, it was demonstrated that SOAT1 inhibition leads to impaired steroidogenesis and cell viability in ACC. To date, no studies have addressed the impact of SOAT1 expression on ACC prognosis and clinical outcomes. We evaluated SOAT1 expression by quantitative real-time polymerase chain reaction and immunohistochemistry in a tissue microarray of 112 ACCs (Weiss score ≥ 3) from adults treated in a single tertiary center in Brazil. Two independent pathologists evaluated the immunohistochemistry results through a semiquantitative approach (0–4). We aimed to evaluate the correlation between SOAT1 expression and clinical, biochemical and anatomopathological parameters, recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS). SOAT1 protein expression was heterogeneous in this cohort, 37.5% of the ACCs demonstrated a strong SOAT1 protein expression (score > 2), while 62.5% demonstrated a weak or absent protein expression (score ≤ 2). Strong SOAT1 protein expression correlated with features of high aggressiveness in ACC, such as excessive tumor cortisol secretion (p = 0.01), an advanced disease stage [European Network for the Study of Adrenal Tumors (ENSAT) staging system 3 and 4 (p = 0.011)] and a high Ki67 index (p = 0.002). In multivariate analysis, strong SOAT1 protein expression was an independent predictor of a reduced OS (hazard ratio (HR) 2.15, confidence interval (CI) 95% 1.26–3.66; p = 0.005) in all patients (n = 112), and a reduced RFS (HR 2.1, CI 95% 1.09–4.06; p = 0.027) in patients with localized disease at diagnosis (n = 83). Our findings demonstrated that SOAT1 protein expression has prognostic value in ACC and reinforced the importance of investigating SOAT1 as a possible therapeutic target for patients with ACC.
KW  - adrenocortical carcinoma
KW  - prognostic factors
KW  - SOAT1
KW  - target therapies
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-200857
SN  - 2072-6694
VL  - 12
IS  - 1
ER  - 
TY  - JOUR
A1  - Kimpel, Otilia
A1  - Bedrose, Sara
A1  - Megerle, Felix
A1  - Berruti, Alfredo
A1  - Terzolo, Massimo
A1  - Kroiss, Matthias
A1  - Mai, Knut
A1  - Dekkers, Olaf M.
A1  - Habra, Mouhammed Amir
A1  - Fassnacht, Martin
T1  - Adjuvant platinum-based chemotherapy in radically resected adrenocortical carcinoma: a cohort study
JF  - British Journal of Cancer
N2  - Background
After radical resection, patients with adrenocortical carcinoma (ACC) frequently experience recurrence and, therefore, effective adjuvant treatment is urgently needed. The aim of the study was to investigate the role of adjuvant platinum-based therapy.
Methods
In this retrospective multicentre cohort study, we identified patients treated with adjuvant platinum-based chemotherapy after radical resection and compared them with patients without adjuvant chemotherapy. Recurrence-free and overall survival (RFS/OS) were investigated in a matched group analysis and by applying a propensity score matching using the full control cohort (n = 268). For both approaches, we accounted for immortal time bias.
Results
Of the 31 patients in the platinum cohort (R0 n = 25, RX n = 4, R1 n = 2; ENSAT Stage II n = 11, III n = 16, IV n = 4, median Ki67 30%, mitotane n = 28), 14 experienced recurrence compared to 29 of 31 matched controls (median RFS after the landmark at 3 months 17.3 vs. 7.3 months; adjusted HR 0.19 (95% CI 0.09-0.42; P < 0.001). Using propensity score matching, the HR for RFS was 0.45 (0.29-0.89, P = 0.021) and for OS 0.25 (0.09-0.69; P = 0.007).
Conclusions
Our study provides the first evidence that adjuvant platinum-based chemotherapy may be associated with prolonged recurrence-free and overall survival in patients with ACC and a very high risk for recurrence.
KW  - adjuvant platinum-based chemotherapy
KW  - adrenocortical carcinoma
KW  - radical resection
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-273000
SN  - 1532-1827
VL  - 125
IS  - 9
ER  - 
TY  - JOUR
A1  - Hendricks, Anne
A1  - Müller, Sophie
A1  - Fassnacht, Martin
A1  - Germer, Christoph-Thomas
A1  - Wiegering, Verena A.
A1  - Wiegering, Armin
A1  - Reibetanz, Joachim
T1  - Impact of lymphadenectomy on the oncologic outcome of patients with adrenocortical carcinoma — a systematic review and meta-analysis
JF  - Cancers
N2  - (1) Background: Locoregional lymphadenectomy (LND) in adrenocortical carcinoma (ACC) may impact oncological outcome, but the findings from individual studies are conflicting. The aim of this systematic review and meta-analysis was to determine the oncological value of LND in ACC by summarizing the available literature. (2) Methods: A systematic search on studies published until December 2020 was performed according to the PRISMA statement. The primary outcome was the impact of lymphadenectomy on overall survival (OS). Two separate meta-analyses were performed for studies including patients with localized ACC (stage I–III) and those including all tumor stages (I–IV). Secondary endpoints included postoperative mortality and length of hospital stay (LOS). (3) Results: 11 publications were identified for inclusion. All studies were retrospective studies, published between 2001–2020, and 5 were included in the meta-analysis. Three studies (N = 807 patients) reported the impact of LND on disease-specific survival in patients with stage I–III ACC and revealed a survival benefit of LND (hazard ratio (HR) = 0.42, 95% confidence interval (95% CI): 0.26–0.68). Based on results of studies including patients with ACC stage I–IV (2 studies, N = 3934 patients), LND was not associated with a survival benefit (HR = 1.00, 95% CI: 0.70–1.42). None of the included studies showed an association between LND and postoperative mortality or LOS. (4) Conclusion: Locoregional lymphadenectomy seems to offer an oncologic benefit in patients undergoing curative-intended surgery for localized ACC (stage I–III).
KW  - adrenocortical carcinoma
KW  - adrenal cancer
KW  - lymphadenectomy
KW  - lymph node dissection
KW  - LND
KW  - LNE
KW  - review
KW  - meta-analysis
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-254798
SN  - 2072-6694
VL  - 14
IS  - 2
ER  - 
TY  - JOUR
A1  - Heinze, Britta
A1  - Schirbel, Andreas
A1  - Nannen, Lukas
A1  - Michelmann, David
A1  - Hartrampf, Philipp E.
A1  - Bluemel, Christina
A1  - Schneider, Magdalena
A1  - Herrmann, Ken
A1  - Haenscheid, Heribert
A1  - Fassnacht, Martin
A1  - Buck, Andreas K.
A1  - Hahner, Stefanie
T1  - Novel CYP11B-ligand [\(^{123/131}\)I]IMAZA as promising theranostic tool for adrenocortical tumors: comprehensive preclinical characterization and first clinical experience
JF  - European Journal of Nuclear Medicine and Molecular Imaging
N2  - Purpose
Adrenal tumors represent a diagnostic and therapeutic challenge. Promising results have been obtained through targeting the cytochrome P450 enzymes CYP11B1 and CYP11B2 for molecular imaging, and [\(^{123/131}\)I]iodometomidate ([\(^{123/131}\)I]IMTO) has even been successfully introduced as a theranostic agent. As this radiopharmaceutical shows rapid metabolic inactivation, we aimed at developing new improved tracers.
Methods
Several IMTO derivatives were newly designed by replacing the unstable methyl ester by different carboxylic esters or amides. The inhibition of aldosterone and cortisol synthesis was tested in different adrenocortical cell lines. The corresponding radiolabeled compounds were assessed regarding their stability, in vitro cell uptake, in vivo biodistribution in mice, and their binding specificity to cryosections of human adrenocortical and non-adrenocortical tissue. Furthermore, a first investigation was performed in patients with known metastatic adrenal cancer using both [\(^{123}\)I]IMTO and the most promising compound (R)-1-[1-(4-[\(^{123/}\)I]iodophenyl)ethyl]-1H-imidazole-5-carboxylic acid azetidinylamide ([\(^{123}\)I]IMAZA) for scintigraphy. Subsequently, a first endoradiotherapy with [\(^{131}\)I]IMAZA in one of these patients was performed.
Results
We identified three analogues to IMTO with high-affinity binding to the target enzymes and comparable or higher metabolic stability and very high and specific accumulation in adrenocortical cells in vitro and in vivo. Labeled IMAZA exhibited superior pharmacokinetic and imaging properties compared to IMTO in mice and 3 patients, too. An endoradiotherapy with [\(^{131}\)I]IMAZA induced a 21-month progression-free interval in a patient with rapidly progressing ACC prior this therapy.
Conclusion
We developed the new radiopharmaceutical [\(^{123/131}\)I]IMAZA with superior properties compared to the reference compound IMTO and promising first experiences in humans.
KW  - CYP11B enzymes
KW  - adrenal incidentaloma
KW  - adrenocortical carcinoma
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265606
SN  - 1619-7089
VL  - 49
IS  - 1
ER  - 
TY  - JOUR
A1  - Fuss, Carmina Teresa
A1  - Other, Katharina
A1  - Heinze, Britta
A1  - Landwehr, Laura-Sophie
A1  - Wiegering, Armin
A1  - Kalogirou, Charis
A1  - Hahner, Stefanie
A1  - Fassnacht, Martin
T1  - Expression of the chemokine receptor CCR7 in the normal adrenal gland and adrenal tumors and its correlation with clinical outcome in adrenocortical carcinoma
JF  - Cancers
N2  - Background: The chemokine receptor CCR7 is crucial for an intact immune function, but its expression is also associated with clinical outcome in several malignancies. No data exist on the expression of CCR7 in adrenocortical tumors. Methods: CCR7 expression was investigated by qRT-PCR and immunohistochemistry in 4 normal adrenal glands, 59 adrenocortical adenomas, and 181 adrenocortical carcinoma (ACC) samples. Results: CCR7 is highly expressed in the outer adrenocortical zones and medulla. Aldosterone-producing adenomas showed lower CCR7 protein levels (H-score 1.3 ± 1.0) compared to non-functioning (2.4 ± 0.5) and cortisol-producing adenomas (2.3 ± 0.6), whereas protein expression was variable in ACC (1.8 ± 0.8). In ACC, CCR7 protein expression was significantly higher in lymph node metastases (2.5 ± 0.5) compared to primary tumors (1.8±0.8) or distant metastases (2.0 ± 0.4; p < 0.01). mRNA levels of CCR7 were not significantly different between ACCs, normal adrenals, and adrenocortical adenomas. In contrast to other tumor entities, neither CCR7 protein nor mRNA expression significantly impacted patients' survival. Conclusion: We show that CCR7 is expressed on mRNA and protein level across normal adrenals, benign adrenocortical tumors, as well as ACCs. Given that CCR7 did not influence survival in ACC, it is probably not involved in tumor progression, but it could play a role in adrenocortical homeostasis.
KW  - CCR7
KW  - chemokine receptor
KW  - adrenocortical carcinoma
KW  - adrenal tumors
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-250112
SN  - 2072-6694
VL  - 13
IS  - 22
ER  - 
TY  - JOUR
A1  - Doghman-Bouguerra, Mabrouka
A1  - Finetti, Pascal
A1  - Durand, Nelly
A1  - Parise, Ivy Zortéa S.
A1  - Sbiera, Silviu
A1  - Cantini, Giulia
A1  - Canu, Letizia
A1  - Hescot, Ségolène
A1  - Figueiredo, Mirna M. O.
A1  - Komechen, Heloisa
A1  - Sbiera, Iuliu
A1  - Nesi, Gabriella
A1  - Paci, Angelo
A1  - Al Ghuzlan, Abir
A1  - Birnbaum, Daniel
A1  - Baudin, Eric
A1  - Luconi, Michaela
A1  - Fassnacht, Martin
A1  - Figueiredo, Bonald C.
A1  - Bertucci, François
A1  - Lalli, Enzo
T1  - Cancer-testis antigen FATE1 expression in adrenocortical tumors is associated with a pervasive autoimmune response and is a marker of malignancy in adult, but not children, ACC
JF  - Cancers
N2  - The SF-1 transcription factor target gene FATE1 encodes a cancer-testis antigen that has an important role in regulating apoptosis and response to chemotherapy in adrenocortical carcinoma (ACC) cells. Autoantibodies directed against FATE1 were previously detected in patients with hepatocellular carcinoma. In this study, we investigated the prevalence of circulating anti-FATE1 antibodies in pediatric and adult patients with adrenocortical tumors using three different methods (immunofluorescence, ELISA and Western blot). Our results show that a pervasive anti-FATE1 immune response is present in those patients. Furthermore, FATE1 expression is a robust prognostic indicator in adult patients with ACC and is associated with increased steroidogenic and decreased immune response gene expression. These data can open perspectives for novel strategies in ACC immunotherapy.
KW  - adrenocortical carcinoma
KW  - cancer-testis antigens
KW  - autoantibodies
KW  - immune response
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-203211
SN  - 2072-6694
VL  - 12
IS  - 3
ER  - 
TY  - JOUR
A1  - Chifu, Irina
A1  - Heinze, Britta
A1  - Fuss, Carmina T.
A1  - Lang, Katharina
A1  - Kroiss, Matthias
A1  - Kircher, Stefan
A1  - Ronchi, Cristina L.
A1  - Altieri, Barbara
A1  - Schirbel, Andreas
A1  - Fassnacht, Martin
A1  - Hahner, Stefanie
T1  - Impact of the Chemokine Receptors CXCR4 and CXCR7 on Clinical Outcome in Adrenocortical Carcinoma
JF  - Frontiers in Endocrinology
N2  - Chemokine receptors have a negative impact on tumor progression in several human cancers and have therefore been of interest for molecular imaging and targeted therapy. However, their clinical and prognostic significance in adrenocortical carcinoma (ACC) is unknown. The aim of this study was to evaluate the chemokine receptor profile in ACC and to analyse its association with clinicopathological characteristics and clinical outcome. A chemokine receptor profile was initially evaluated by quantitative PCR in 4 normal adrenals, 18 ACC samples and human ACC cell line NCI-H295. High expression of CXCR4 and CXCR7 in both healthy and malignant adrenal tissue and ACC cells was confirmed. In the next step, we analyzed the expression and cellular localization of CXCR4 and CXCR7 in ACC by immunohistochemistry in 187 and 84 samples, respectively. These results were correlated with clinicopathological parameters and survival outcome. We detected strong membrane expression of CXCR4 and CXCR7 in 50% of ACC samples. Strong cytoplasmic CXCR4 staining was more frequent among samples derived from metastases compared to primaries (p=0.01) and local recurrences (p=0.04). CXCR4 membrane staining positively correlated with proliferation index Ki67 (r=0.17, p=0.028). CXCR7 membrane staining negatively correlated with Ki67 (r=−0.254, p=0.03) but positively with tumor size (r=0.3, p=0.02). No differences in progression-free or overall survival were observed between patients with strong and weak staining intensities for CXCR4 or CXCR7. Taken together, high expression of CXCR4 and CXCR7 in both local tumors and metastases suggests that some ACC patients might benefit from CXCR4/CXCR7-targeted therapy.
KW  - chemokine receptor
KW  - prognosis
KW  - adrenocortical carcinoma
KW  - CXCR4
KW  - CXCR7
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-216494
SN  - 1664-2392
VL  - 11
ER  - 
TY  - JOUR
A1  - Buck, Andreas K.
A1  - Serfling, Sebastian E.
A1  - Lindner, Thomas
A1  - Hänscheid, Heribert
A1  - Schirbel, Andreas
A1  - Hahner, Stefanie
A1  - Fassnacht, Martin
A1  - Einsele, Hermann
A1  - Werner, Rudolf A.
T1  - CXCR4-targeted theranostics in oncology
JF  - European Journal of Nuclear Medicine and Molecular Imaging
N2  - A growing body of literature reports on the upregulation of C-X-C motif chemokine receptor 4 (CXCR4) in a variety of cancer entities, rendering this receptor as suitable target for molecular imaging and endoradiotherapy in a theranostic setting. For instance, the CXCR4-targeting positron emission tomography (PET) agent [\(^{68}\)Ga]PentixaFor has been proven useful for a comprehensive assessment of the current status quo of solid tumors, including adrenocortical carcinoma or small-cell lung cancer. In addition, [\(^{68}\)Ga]PentixaFor has also provided an excellent readout for hematological malignancies, such as multiple myeloma, marginal zone lymphoma, or mantle cell lymphoma. PET-based quantification of the CXCR4 capacities in vivo allows for selecting candidates that would be suitable for treatment using the theranostic equivalent [\(^{177}\)Lu]/[\(^{90}\)Y]PentixaTher. This CXCR4-directed theranostic concept has been used as a conditioning regimen prior to hematopoietic stem cell transplantation and to achieve sufficient anti-lymphoma/-tumor activity in particular for malignant tissues that are highly sensitive to radiation, such as the hematological system. Increasing the safety margin, pretherapeutic dosimetry is routinely performed to determine the optimal activity to enhance therapeutic efficacy and to reduce off-target adverse events. The present review will provide an overview of current applications for CXCR4-directed molecular imaging and will introduce the CXCR4-targeted theranostic concept for advanced hematological malignancies.
KW  - CXCR4
KW  - theranostics
KW  - C-X-C motif chemokine receptor 4
KW  - [68Ga]PentixaFor
KW  - [177Lu]PentixaTher
KW  - [90Y]PentixaTher
KW  - endoradiotherapy
KW  - adrenocortical carcinoma
KW  - multiple myeloma
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324545
VL  - 49
IS  - 12
ER  - 
TY  - JOUR
A1  - Bothou, Christina
A1  - Sharma, Ashish
A1  - Oo, Adrian
A1  - Kim, Baek
A1  - Perge, Pal
A1  - Igaz, Peter
A1  - Ronchi, Cristina L.
A1  - Shapiro, Igor
A1  - Hantel, Constanze
T1  - Novel insights into the molecular regulation of ribonucleotide reductase in adrenocortical carcinoma treatment
JF  - Cancers
N2  - Current systemic treatment options for patients with adrenocortical carcinomas (ACCs) are far from being satisfactory. DNA damage/repair mechanisms, which involve, e.g., ataxia-telangiectasia-mutated (ATM) and ataxia-telangiectasia/Rad3-related (ATR) protein signaling or ribonucleotide reductase subunits M1/M2 (RRM1/RRM2)-encoded ribonucleotide reductase (RNR) activation, commonly contribute to drug resistance. Moreover, the regulation of RRM2b, the p53-induced alternative to RRM2, is of unclear importance for ACC. Upon extensive drug screening, including a large panel of chemotherapies and molecular targeted inhibitors, we provide strong evidence for the anti-tumoral efficacy of combined gemcitabine (G) and cisplatin (C) treatment against the adrenocortical cell lines NCI-H295R and MUC-1. However, accompanying induction of RRM1, RRM2, and RRM2b expression also indicated developing G resistance, a frequent side effect in clinical patient care. Interestingly, this effect was partially reversed upon addition of C. We confirmed our findings for RRM2 protein, RNR-dependent dATP levels, and modulations of related ATM/ATR signaling. Finally, we screened for complementing inhibitors of the DNA damage/repair system targeting RNR, Wee1, CHK1/2, ATR, and ATM. Notably, the combination of G, C, and the dual RRM1/RRM2 inhibitor COH29 resulted in previously unreached total cell killing. In summary, we provide evidence that RNR-modulating therapies might represent a new therapeutic option for ACC.
KW  - adrenocortical carcinoma
KW  - adrenocortical cell line
KW  - RRM2
KW  - RNR
KW  - COH29
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-245132
SN  - 2072-6694
VL  - 13
IS  - 16
ER  - 
TY  - JOUR
A1  - Altieri, Barbara
A1  - Sbiera, Silviu
A1  - Herterich, Sabine
A1  - De Francia, Silvia
A1  - Della Casa, Silvia
A1  - Calabrese, Anna
A1  - Pontecorvi, Alfredo
A1  - Quinkler, Marcus
A1  - Kienitz, Tina
A1  - Mannelli, Massimo
A1  - Canu, Letizia
A1  - Angelousi, Anna
A1  - Chortis, Vasileios
A1  - Kroiss, Matthias
A1  - Terzolo, Massimo
A1  - Fassnacht, Martin
A1  - Ronchi, Cristina L.
T1  - Effects of Germline CYP2W1*6 and CYP2B6*6 Single Nucleotide Polymorphisms on Mitotane Treatment in Adrenocortical Carcinoma: A Multicenter ENSAT Study
JF  - Cancers
N2  - Mitotane is the only approved drug for advanced adrenocortical carcinoma (ACC) and no biomarkers are available to predict attainment of therapeutic plasma concentrations and clinical response. Aim of the study was to evaluate the suitability of cytochrome P450(CYP)2W1 and CYP2B6 single nucleotide polymorphisms (SNPs) as biomarkers. A multicenter cohort study including 182 ACC patients (F/M = 121/61) treated with mitotane monotherapy after radical resection (group A, n = 103) or in not completely resectable, recurrent or advanced disease (group B, n = 79) was performed. CYP2W1*2, CYP2W1*6, CYP2B6*6 and CYP2B6 rs4803419 were genotyped in germline DNA. Mitotane blood levels were measured regularly. Response to therapy was evaluated as time to progression (TTP) and disease control rate (DCR). Among investigated SNPs, CYP2W1*6 and CYP2B6*6 correlated with mitotane treatment only in group B. Patients with CYP2W1*6 (n = 21) achieved less frequently therapeutic mitotane levels (>14 mg/L) than those with wild type (WT) allele (76.2% vs 51.7%, p = 0.051) and experienced shorter TTP (HR = 2.10, p = 0.019) and lower DCR (chi-square = 6.948, p = 0.008). By contrast, 55% of patients with CYP2B6*6 vs. 28.2% WT (p = 0.016) achieved therapeutic range. Combined, a higher rate of patients with CYP2W1*6WT+CYP2B6*6 (60.6%) achieved mitotane therapeutic range (p = 0.034). In not completely resectable, recurrent or advanced ACC, CYP2W1*6 SNP was associated with a reduced probability to reach mitotane therapeutic range and lower response rates, whereas CYP2B6*6 correlated with higher mitotane levels. The association of these SNPs may predict individual response to mitotane.
KW  - adrenocortical carcinoma
KW  - mitotane
KW  - CYP2W1
KW  - CYP2B6
KW  - SNP
KW  - biomarker
KW  - predictive marker
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-200565
SN  - 2072-6694
VL  - 12
IS  - 2
ER  -