ABSTRACT
CONTEXT: Cushing syndrome (CS) is associated with different hematological abnormalities. Nevertheless, conflicting data about erythropoiesis in CS have been reported. Furthermore, it is unclear whether CS sex and subtype-specific alterations in red blood cells (RBC) parameters are present. OBJECTIVE: To investigate sex and subtype-specific changes in RBC in patients with CS at initial diagnosis and after remission. DESIGN: Retrospective, monocentric study including 210 patients with CS (women, n = 162) matched 1:1 for sex and age to patients with pituitary microadenomas or adrenal incidentalomas (both hormonally inactive). RBC parameters were evaluated at initial diagnosis and after remission. RESULTS: Women with CS had higher hematocrit (median 42.2 vs 39.7%), hemoglobin (14.1 vs 13.4 g/dl) and mean corpuscular volume (MCV) (91.2 vs 87.9 fl) compared to the controls (all p < 0.0001). Women with Cushing disease (CD) showed higher hematocrit, RBC and hemoglobin levels than those with ectopic Cushing (ECS) (all p < 0.005). Men with CS had lower hematocrit (42.9 vs 44.7%), RBC count (4.8 vs 5.1n*106/µl) and hemoglobin (14.2 vs 15.4 g/dl), but higher MCV (90.8 vs 87.5 fl) than controls (all p < 0.05). In men with CS, no subtype-specific differences were identified. Three months after remission hemoglobin decreased in both sexes. CONCLUSION: CS is characterized by sexual and subtype-specific differences in RBC parameters. Compared to controls, women with CS showed higher hematocrit/hemoglobin levels, whereas men had lower hematocrit/hemoglobin, which further decreased directly after remission. Therefore, anemia should be considered as complication of CS in men. In women, differences in RBC parameters may help to differentiate CD from ECS.
Subject(s)
Adrenal Gland Neoplasms , Cushing Syndrome , Pituitary ACTH Hypersecretion , Male , Humans , Female , Erythropoiesis , Retrospective Studies , Hematocrit , HemoglobinsABSTRACT
Treatment options for adrenocortical carcinoma (ACC) are very limited. In other solid tumors, small vaccination trials targeting the anti-apoptotic molecule survivin suggested immunological and clinical benefit in selected patients. Therefore, we investigated whether survivin might be a suitable target for immunotherapy in ACC. Survivin mRNA and protein expression was assessed in adrenal tissue specimens [by real-time-PCR in 29 ACC, 24 adrenocortical adenomas (ACA) and 12 normal adrenal glands; by immunohistochemistry in 167 ACCs, 15 ACA, and 5 normal adrenal glands]. Expression was correlated with clinical outcome using Kaplan-Meier and Cox regression analyses. The anti-apoptotic role of survivin was investigated in the SW13 ACC cell line using survivin siRNA. The presence of spontaneous survivin specific T-cells in peripheral blood was assessed by FACS dextramere staining in 29 ACC patients in comparison to healthy controls. Survivin mRNA in ACC was significantly overexpressed when compared with ACA or normal adrenal glands. Immunohistochemistry confirmed survivin protein expression in 97% of the ACCs. In 83% of samples, staining was moderate or high and clinical outcome in this subgroup showed a trend towards poorer prognosis [hazard ratio for death 2.28 (95% CI 0.99-5.28); p=0.053]. Survivin knockdown in SW-13 cell significantly increased the rate of apoptosis. Finally, spontaneous survivin-reactive T cells were detectable in 3 of 29 ACC patients. In conclusion, our data suggest that survivin could play an important role in the anti-apoptotic mechanisms in ACC and provide first hints that targeting survivin might be an interesting new therapeutic approach in this rare disease.
Subject(s)
Adrenal Cortex Neoplasms/metabolism , Adrenal Cortex/metabolism , Adrenocortical Carcinoma/metabolism , Inhibitor of Apoptosis Proteins/metabolism , Neoplasm Proteins/metabolism , Adrenal Cortex/drug effects , Adrenal Cortex/pathology , Adrenal Cortex Neoplasms/diagnosis , Adrenal Cortex Neoplasms/drug therapy , Adrenal Cortex Neoplasms/pathology , Adrenocortical Adenoma/drug therapy , Adrenocortical Adenoma/metabolism , Adrenocortical Adenoma/physiopathology , Adrenocortical Carcinoma/diagnosis , Adrenocortical Carcinoma/drug therapy , Adrenocortical Carcinoma/pathology , Adult , Aged , Antineoplastic Agents/therapeutic use , Cell Line, Tumor , Cohort Studies , Female , Follow-Up Studies , Gene Expression Regulation, Neoplastic/drug effects , Humans , Inhibitor of Apoptosis Proteins/antagonists & inhibitors , Inhibitor of Apoptosis Proteins/genetics , Male , Middle Aged , Molecular Targeted Therapy , Neoplasm Proteins/antagonists & inhibitors , Neoplasm Proteins/genetics , Prognosis , RNA Interference , Survival Analysis , SurvivinABSTRACT
Dendritic cells (DCs) are the most potent antigen presenting cells in the human organism. Ever since the discovery of their function in the self/nonself discrimination, DCs have been seen as potential candidates for therapy in malignant tumors. With the exception of differentiated thyroid cancer, endocrine malignancies are rare tumors and apart from surgical intervention there is no truly established method for their treatment. Therefore, the prognosis of many endocrine carcinomas is still poor and new therapeutic options are needed. In the last decade, different immunotherapeutic approaches have shown promising results in other solid tumors. In recent studies, immunotherapy using DCs has been proven to be safe and effective to induce antitumor immune responses leading to tumor regression and even rejection of cancer in some cases. This review will summarize the latest progress in DCs based immunotherapy with special focus on the limited experience in endocrine malignancies. With regard to these tumors, it is of special interest which antigens could serve as potential target antigens for future trials. We also discuss what steps have to be taken to develop a better immunotherapy in endocrine tumors.
