Chandrayee Ghosh’s research while affiliated with Stanford University and other places

Anaplastic thyroid cancer (ATC) is the most aggressive thyroid cancer. Despite advances in tissue culture techniques, a robust model for ATC spheroid culture is yet to be developed. In this study, we created an efficient and cost-effective 3D tumor spheroids culture system from human ATC cells and existing cell lines that better mimic patient tumors and that can enhance our understanding of in vivo treatment response. We found that patient-derived ATC cells and cell lines can readily form spheroids in culture with a unique morphology, size, and cytoskeletal organization. We observed both cohesive (dense and solid structures) and discohesive (irregularly shaped structures) spheroids within the same culture condition across different cell lines. BRAFWT ATC spheroids grew in a cohesive pattern, while BRAFV600E-mutant ATC spheroids had a discohesive organization. In the patient-derived BRAFV600E-mutant ATC spheroids, we observed both growth patterns, but mostly the discohesive type. Histologically, ATC spheroids had a similar morphology to the patient’s tumor through H&E staining and proliferation marker staining. Moreover, RNA sequencing analysis revealed that the gene expression profile of tumor cells derived from the spheroids closely matched parental patient tumor-derived cells in comparison to monolayer cultures. In addition, treatment response to combined BRAF and MEK inhibition in BRAFV600E-mutant ATC spheroids exhibited a similar sensitivity to the patient clinical response. Our study provides a robust and novel ex vivo spheroid model system that can be used in both established ATC cell lines and patient-derived tumor samples to better understand the biology of ATC and to test therapeutics. Supplementary Information The online version contains supplementary material available at 10.1186/s13046-024-03009-8.

Adrenocortical carcinoma is a rare malignancy with an annual worldwide incidence of 1-2 cases per 1 million and a 5-year survival rate of <60%. Although adrenocortical carcinoma is rare, such rare cancers account for approximately one third of patients diagnosed with cancer annually. In the past decade, there have been considerable advances in understanding the molecular basis of adrenocortical carcinoma. The genetic events associated with adrenocortical carcinoma in adults are distinct from those of paediatric cases, which are often associated with germline or somatic TP53 mutations and have a better prognosis. In adult primary adrenocortical carcinoma, the main somatic genetic alterations occur in genes that encode proteins involved in the WNT-β-catenin pathway, cell cycle and p53 apoptosis pathway, chromatin remodelling and telomere maintenance pathway, cAMP-protein kinase A (PKA) pathway or DNA transcription and RNA translation pathways. Recently, integrated molecular studies of adrenocortical carcinomas, which have characterized somatic mutations and the methylome as well as gene and microRNA expression profiles, have led to a molecular classification of these tumours that can predict prognosis and have helped to identify new therapeutic targets. In this Review, we summarize these recent translational research advances in adrenocortical carcinoma, which it is hoped could lead to improved patient diagnosis, treatment and outcome.

Disclosure: J. Han: None. Y. Yuan: None. J. Hu: None. C. Ghosh: None. E. Kebebew: None. Objective: The aim of the study was to evaluate the impact of successful parathyroidectomy on renal, skeletal and cardiovascular adverse events in patients with primary hyperparathyroidism (PHPT). Background: PHPT may be associated with renal, skeletal and cardiovascular diseases. In some but not all studies, successful parathyroidectomy has been reported to be associated with reduced risks of renal, skeletal or cardiovascular adverse events. To date, there has not been a comprehensive study with granular data looking at the impact of parathyroidectomy on all adverse events that have been associated with PHPT. Methods: A health system cohort study was performed in 3,048 patients with PHPT as defined by ICD10 or ICD9 codes who had successful parathyroidectomy defined by CPT codes (n=1,105) and no parathyroidectomy (n=1943). Comparison of cardiovascular (arrhythmias, myocardial infarction, congestive heart failure, cardiac admission, hypertension, diabetes mellitus), renal (kidney stone, end-stage renal disease requiring dialysis, GFR < 30 mL/min) and skeletal (all fractures, fragility fractures (hip/pelvis and spinal fractures), diagnosis of osteoporosis or osteopenia) adverse events by parathyroidectomy status (successful vs. no parathyroidectomy) in unmatched and basic matched analyses, and propensity score (PS) matched analysis at 10 years of follow up. Results: The mean age was higher in the no parathyroidectomy arm. The comorbidity score was higher (4.1 vs 3.6) in patients who did not have parathyroidectomy with higher rates of congestive heart failure and myocardial infarction at baseline. Patients who had parathyroidectomy had a lower rate of subsequent diagnosis of cardiovascular adverse events at 10 years of follow up (OR 0.57, p<0.001). There was also a lower odds of death at 10 years in those who had successful parathyroidectomy (OR 0.29, p<0.001). These differences were significant in the unmatched and basic matched analyses, but were not significant after PS matching. There was no significant difference in 10 years rates of any fractures , fragility fractures, or renal adverse events. The odds of diagnosis of osteoporosis or osteopenia at 10 years of follow up was significantly lower in patients who had successful parathyroidectomy in all 3 analyses (PS-matching: OR 0.507, p<0.001). Conclusions: Compared to patients who did not have parathyroidectomy for PHPT, patients who had successful parathyroidectomy have lower 10 years rates of osteoporosis/osteopenia diagnoses. Cardiovascular adverse events were lower in patients who had successful parathyroidectomy but this may be due to higher baseline comorbidities in those who did not have parathyroidectomy. Presentation: Friday, June 16, 2023

Background: Anaplastic thyroid cancer (ATC) is uniformly lethal. BRAFV600E mutation is present in up to 45% of patients with ATC. Targeted therapy with combined BRAF and MEK inhibition in BRAFV600E-mutant ATC can be effective, but acquired resistance is common because this combination targets the same pathway. Drug matrix screening, in BRAFV600E ATC cells, of highly active compounds in combination with BRAF inhibition showed multitargeting tyrosine kinase inhibitors (MTKIs) had the highest synergistic/additive activity. Thus, we hypothesized that the combination of BRAFV600E inhibition and an MTKI is more effective than a single drug or combined BRAF and MEK inhibition in BRAFV600E-mutant ATC. We evaluated the effect of BRAFV600E inhibitors in combination with the MTKI axitinib and its mechanism(s) of action. Methods: We evaluated the effects of BRAFV600E inhibitors and axitinib alone and in combination in in vitro and in vivo models of BRAFV600E-mutant and wildtype ATC. Results: The combination of axitinib and BRAFV600E inhibitors (dabrafenib and PLX4720) showed an additive effect on inhibiting cell proliferation based on the Chou-Talalay algorithm in BRAFV600E-mutant ATC cell lines. This combination also significantly inhibited cell invasion and migration (P < 0.001) compared with the control. Dabrafenib and PLX4720 arrested ATC cells in the G0/G1 phase. Axitinib arrested ATC cells in the G2/M phase by decreasing phosphorylation of aurora kinase B (Thr232) and histone H3 (Ser10) proteins and by upregulating the c-JUN signaling pathway. The combination of BRAF inhibition and axitinib significantly inhibited tumor growth and was associated with improved survival in an orthotopic ATC model. Conclusions: The novel combination of axitinib and BRAFV600E inhibition enhanced anticancer activity in in vitro and in vivo models of BRAFV600E-mutant ATC. This combination may have clinical utility in BRAFV600E-mutant ATC that is refractory to current standard therapy, namely combined BRAF and MEK inhibition.

Background: Anaplastic thyroid cancer (ATC) is the most aggressive thyroid cancer. Despite advances in tissue culture techniques, a robust model for thyroid cancer spheroid culture is yet to be developed. Here, we described a protocol to generate tumor spheroids from human ATC cells and excising cell lines. Methods: Using four established ATC cell lines (8505C, SW1736, C643 and THJ-16T) and one clinical tumor sample derived ATC cells, we created an efficient and cost-effective 3D culture system that can enhance our understanding of ex vivo treatment response. Results: We found that all four cell lines can readily form spheroids in culture with unique morphology, size, and cytoskeletal organization. We observed both cohesive (dense and solid structures) and dis-cohesive (irregularly shaped structures) spheroids within the same culture condition across different cell lines. BRAFWT ATC spheroids grew in a cohesive pattern, while BRAFV600E- mutant ATC spheroids show dis-cohesive organization. In the patient-derived spheroids (BRAFV600E- mutant ATC), we observed both growth patterns with mostly the dis-cohesive type. Phase-contrast images taken over time suggest that the cohesive ATC spheroids seem to be clonally derived, allowing the study of tumor heterogeneity. Furthermore, the ATC spheroids we established can maintain the 3D structures in the culture medium. Conclusion: Our study describes the development of a robust spheroid system from established ATC cell lines and freshly acquired patient tumor samples. We show that combining 3D culture with traditional 2D methods provides a complementary and powerful approach to the future drug screening and mechanism studies in the ATC. Citation Format: Jiangnan Hu, Chandrayee Ghosh, Electron Kebebew. Generation and maintenance of anaplastic thyroid cancer spheroids from human cancer cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 176.

Purpose: Anaplastic thyroid cancer (ATC) is one of the most aggressive human cancers, with a median survival time of 6 months and with no current curative treatment. We have used quantitative high-throughput screening (qHTS) of clinically approved or investigational agents to identify candidate compounds for ATC therapy. As monotherapy for most cancers is not effective, we used combination drug matrix screening of highly active compounds from our single agent qHTS to identify compound combinations that may show synergistic effect. In this study, we evaluated the anticancer activity of nitazoxanide and auranofin combination treatment and its mechanism of action and biomarkers of treatment response in in vitro and in vivo models of ATC. Experimental Design: We used four (8505C, C643, SW1736, THJ16T) ATC cell lines in in vitro and in vivo ATC models to evaluate the safety and efficacy of this combination treatment compared to single agent and vehicle control. Results: Combination nitazoxanide and auranofin treatment synergistically inhibited cellular proliferation (p<0.001) and inhibited colony formation and migration (p<0.001) in ATC cell lines. We observed cellular oxidative stress with significant increase in ROS levels in the combination treatment group (p<0.001). Nitazoxanide treatment alone and in combination with auranofin caused G1/G0 arrest in cell cycle, induced autophagy (increased LC3BII expression) and later apoptosis. Auranofin treatment alone and in combination with nitazoxanide induced ferroptosis (decreased GPX4 expression and intracellular GSH/GSSG ratios). RNA-Seq analysis, to identify biomarkers of response, showed >7-fold increase in HMOX-1 (heme oxygenase 1) with combination treatment which was validated by western blot. Combination treatment significantly inhibited tumor growth as compared to single agents (p<0.01) and had no significant treatment-related toxicity in vivo. Analysis of tumor samples showed significantly increased LC3BII expression by immunohistochemistry and reduced GPX4 mRNA expression (p<0.0001) with combination treatment compared to control in vivo. Conclusions: Combination nitazoxanide and auranofin treatment has synergistic anticancer activity in both in vitro and in vivo ATC models. The synergistic activity of the combination is due to enhanced G1/G0 arrest, greater activation of autophagy, apoptosis and ferroptosis than single drug treatment. LC3BII, HMOX-1 and GPX4 levels could be useful biomarkers of treatment response to combination nitazoxanide and auranofin. Citation Format: Chandrayee Ghosh, Viswanath Gunda, Jiangnan Hu, Lisa Zhang, Ya-Qin Zhang, Min Shen, Electron Kebebew. Combination nitazoxanide and auranofin treatment has synergistic anticancer activity in anaplastic thyroid cancer and act by enhanced activation of multiple cell death pathways. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5505.

Background: Genetic testing for germline pheochromocytoma and paraganglioma susceptibility genes is associated with improved patient management. However, data are currently sparse on the probability of a positive testing result based on an individual's clinical presentation. This study evaluates clinical characteristics for association with testing positive for known pheochromocytoma and paraganglioma susceptibility genes. Methods: This retrospective analysis examined 111 patients with a diagnosis of pheochromocytoma and paraganglioma who underwent genetic testing. Logistic regression and receiver operating characteristic analyses were performed to identify factors associated with a positive genetic testing result. Probabilities were then calculated for combinations of significant factors to determine the likelihood of a positive test result in each group. Results: Of 32 patients with a family history of pheochromocytoma and paraganglioma, 31 (97%) had a germline mutation detected. Of 79 patients without a family history, 24 (30%) had a pathogenic germline mutation detected. In multivariate analysis, a positive family history, aged ≤47 years, and tumor size ≤2.9 cm were independent factors associated with a positive genetic testing result. Patients meeting all 3 criteria had a 100% probability compared with 13% in those without any of the criteria. In addition to a positive family history, having either aged ≤47 years or tumor size ≤2.9 cm resulted in a 90% and 100% probability of a positive result, respectively. In the absence of a family history, the probability in patients who were aged ≤47 years and had a tumor size ≤2.9 cm was 60%. Conclusion: In addition to a family history of pheochromocytoma and paraganglioma, aged ≤47 years, and tumor size ≤2.9 cm are associated with a higher probability of testing positive for a pheochromocytoma and paraganglioma susceptibility gene mutation. Patients meeting all 3 criteria have a 100% probability of a positive genetic testing result.

The aim of this study is to determine the accuracy of adrenal vein sampling (AVS) with and without adrenocorticotropic hormone (ACTH) stimulation to distinguish between unilateral and bilateral primary hyperaldosteronism (PA). Retrospective analysis of a prospective database from a referral center between 1984 and 2009, 76 patients had simultaneous cannulation of bilateral adrenal veins and AVS with and without ACTH stimulation. All patients had adrenalectomies. The selectivity index (SI, cut-off value ≥2) was used for confirmation of successful cannulation of the adrenal vein. The lateralization index (LI, cut-off value >2 and >4) was used for distinguishing between unilateral and bilateral PA. The SI ratio was higher with ACTH stimulation compared to without for the right adrenal vein (p = 0.027). The LI >2 ratio was higher with ACTH stimulation compared to without (p = 0.007). For the LI >4 ratio, there was no difference between with and without ACTH stimulation (p = 0.239). However, for a LI >4, 7 patients (9.2%) were not lateralized with ACTH stimulation, but they did lateralize without ACTH stimulation. AVS with ACTH stimulation is associated with a higher SI ratio compared to AVS without ACTH stimulation. However, when using LI >4 for AVS, samples without ACTH stimulation should also be included to detect a subset of patients with unilateral disease that are not detected with ACTH stimulation.