Adrenal Tissue Samples Research Articles

FRI139 Identification Of Robust Aldosterone-Producing Adenomas-related Genes Using Adrenal Genome-wide Transcriptome Analysis

Abstract Disclosure: S. Lee: None. T. Lee: None. G. Yoo: None. J. Lim: None. Primary aldosteronism (PA), the most common cause of secondary hypertension, is caused by aldosterone overproduction in one or two adrenal glands. It carries a higher risk of cardiovascular disease and mortality compared to essential hypertension. In an effort to identify the underlying molecular mechanisms regarding aldosterone secretion and cell proliferation in aldosterone-producing adenomas (APA), genome-wide transcriptome analyses have been conducted; however, there are still some limitations that need to be addressed since a relatively small number of samples were analyzed at a single center in most studies. In this study, we performed integrative and systematic analysis using adrenal transcriptome datasets to verify candidate genes robustly associated with APA and obtain more generalized signatures involved in the pathophysiology of PA. Three mRNA datasets for adrenal tissues (GSE8514, GSE60042, and GSE64957) were obtained from the Gene Expression Omnibus Database. For the first two datasets, normal adrenal samples from patients with renal cell carcinoma and adrenal tissue samples adjacent to APA were included as controls, respectively. In GSE64957, zona glomerulosa (ZG) and zona fasciculata (ZF) samples were analyzed separately in the current study (GSE64957ZG and GSE64957ZF). Differentially expressed gene (DEG) investigation and comparative analysis were conducted using the limma method. The selection criteria for APA-related genes were as follows: those that are significantly dysregulated in more than three of the four datasets and show a consistent trend of up- or down-regulation in four datasets. 5,375 genes were present in all transcriptome datasets; for the GSE64957ZG, 57 DEGs were identified in the APA group, among which 14, 7, and 37 genes were also dysregulated in the APA group of GSE64957ZF, GSE8514, and GSE60042, respectively. All comparisons among four lists of DEGs exhibited significant enrichment results. The highest degree of overlap was shown in the DEG pair of GSE64957ZG-GSE60042. As a result, approximately 20 genes (12 upregulated and 12 downregulated DEGs), including CYP11B2, PCP4, and ATP2A3, were selected as the final APA-related genes. This study demonstrated several candidate genes that are strongly relevant to APA by examining whole genome disease-related signatures. Besides CYP11B2, it seems that alteration in PCP4 and ATP2A3 genes would be much more involved in the pathogenesis of PA, which warrants further investigation along with validation for the role of the remaining genes. Presentation: Friday, June 16, 2023

Detection of Sex Steroid Expressions in Benign Versus Malignant Adrenal Tumor Tissue Homogenates With Western Blot Analysis

Background: Adrenocortical cancer (ACC) is a rare tumor with poor prognosis. The prognostic value of sex steroid expressions in ACC, was firstly shown by our group with immunohistochemistry staining in paraffin embedded blocks (1). Aim: To detect the presence of sex steroid expressions in different types of adrenal fresh tissue samples by Western Blot method. Method: Adrenal fresh tissue samples were isolated from benign (patient 1: adrenal hemangioma, n: 1 intratumoral + 1 extratumoral tissue samples) and malignant tumors (patient 2: ACC, n: 4 intratumoral tissue samples). Expressions of estrogen receptor alpha (Erα), progesterone receptor A (PR), androgen receptor (AR) and aromatase proteins were investigated using Western Blot method in the tissue lysates obtained. Monoclonal antibodies that recognize a single determinant of the obtained denatured proteins with high affinity and specificity were used. GAPDH was used as control protein. After the primary antibody incubation, the incubation phase was started with the secondary antibody produced against the organism in which HRP (Horseradish Peroxidase) conjugated primary antibody was produced in order to visualize the primary antibody. ECL (Enhanced chemiluminescence) solution containing luminol, which is the substrate of the peroxidase enzyme contained in HRP conjugated to the secondary antibody, was used to enable the proteins to which the secondary antibody was bound to emit chemoluminescence. Finally, the densitometric densities of the bands obtained by chemiluminescence imaging were determined. Results: Expression of ER, AR, PR and aromatase was demonstrated in fresh tissue samples obtained from ACC, adrenal hemangioma and normal adrenal cortex. PR expression was higher in ACC lysates. ER and AR expressions were higher in hemangioma and normal adrenal cortex, respectively. Aromatase expression was also higher in adrenal hemangioma while similar in cancerous and normal adrenal tissue samples. Conclusions: We have demonstrated the dissimilarities between the expressions of sex steroid receptors and aromatase by using Western Blot method in fresh tissue samples obtained from different types of adrenal masses, including ACC. It would be possible to develop an in vitro experimental ACC model that can test the effect of sex steroid receptor ligands on tumor growth in order to clarify their role in adrenal tumorigenesis. Reference:1. Oguz SH, Sokmensuer C, Bayraktar M, Dagdelen S. Estrogen, progesterone, and androgen receptor expressions predict the prognosis for adrenocortical carcinoma. Endocrine Society’s Annual Meeting, 23–26 March 2019, New Orleans - USA. Journal of the Endocrine Society, Volume 3, Issue Supplement_1, April-May 2019, SUN-352.

Bioinformatic analysis of differentially expressed genes as prognostic markers in pheochromocytoma and paraganglioma tumors.

The pathogenesis of pheochromocytoma and paraganglioma (PCPG) catecholamine-producing tumors is exceedingly complicated. Here, we sought to identify important genes affecting the prognosis and survival rate of patients suffering from PCPG. We analyzed 95 samples obtained from two microarray data series, GSE19422 and GSE60459, from the Gene Expression Omnibus (GEO) repository. First, differentially expressed genes (DEGs) were identified by comparing 87 PCPG tumor samples and eight normal adrenal tissue samples using R language. The GEO2R tool and Venn diagram software were applied to the Database for Annotation, Visualization and Integrated Discovery (DAVID) to analyze Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways and Gene Ontology (GO). We further employed Cytoscape with the Molecular Complex Detection (MCODE) tool to make protein-protein interactions visible for the Search Tool for Retrieval of Interacting Genes (STRING). These procedures resulted in 30 candidate DEGs, which were subjected to Kaplan-Meier analysis and validated by Gene Expression Profiling Interactive Analysis (GEPIA) to determine their influence on overall survival rate. Finally, we identified ALDH3A2 and AKR1B1, two genes in the glycerolipid metabolism pathway, as being particularly enriched in PCPG tumors and correlated with T and B tumor-infiltrating immune cells. Our results suggest that these two DEGs are closely associated with the prognosis of malignant PCPG tumors.

Ghrelin as a potential molecular marker of adrenal carcinogenesis: In vivo and in vitro evidence.

Adrenal tumours belong to one of the most prevalent neoplasms. It is a heterogeneous group with different aetiology, clinical manifestation and prognosis. Its histopathologic diagnosis is difficult and identification of differentiation markers for tumorigenesis is extremely valuable for diagnosis. To assess ghrelin expression and the relationship among ghrelin, IGF2 and the clinicopathological characteristics of adrenal tumours. To investigate the influence of ghrelin on ACC cell line proliferation. Expression of ghrelin and IGF2 in a total of 84 adrenal tissue samples (30 adenoma, 12 hyperplasia, 8 myelolipoma, 20 pheochromocytoma, 7 carcinoma and 7 unchanged adrenal glands) were estimated. Every operated patient from whom samples were obtained underwent clinicopathological analysis. All the parameters were compared among the groups examined and correlations between these were estimated. H295R cell line was incubated with ghrelin to assess its effect on proliferation and migration rate. The highest ghrelin expression was observed in carcinoma samples and the lowest in the control group. Ghrelin expression was 21 times higher in carcinoma (P=.017) and 2.4 times higher in adenoma (P=.029) compared with controls. There were no statistically significant differences between myelolipoma (P=.093) and pheochromocytoma (P=.204) relative to the control. Ghrelin level was significantly higher in carcinoma compared to adenoma (P=.049) samples. A positive correlation between ghrelin and IGF2 expression was observed only in myelolipoma (P=.001). Ghrelin at concentrations of 1×10-6 mol/L and 1×10-8 mol/L significantly stimulated proliferation and migration rate in the H295R cell line. Ghrelin appears to be an essential factor in driving adrenal tumours development.

Suppression of Forkhead Box Protein O1 (FOXO1) Transcription Factor May Promote Adrenocortical Tumorigenesis.

Despite recent comprehensive genetic analyses, molecular evidence for a pathophysiological continuum linking benign adrenocortical adenoma (ACA) and highly aggressive adrenocortical carcinoma (ACC) is still elusive. Using human tumor samples and the established ACC cell line SW-13, this study investigated potential regulatory roles for FOXO transcription factors, in modulating adrenocortical tumorigenesis. Adrenocortical tumor specimens (20 ACAs, 10 ACCs, and 9 normal adrenal tissue samples) obtained from 30 patients were analyzed for ubiquitously expressed FOXO transcription factors, FOXO1 and FOXO3 using qRT-PCR and immunohistochemistry. The SW-13 ACC cells were used to study the phenotypic effects of FOXO regulation in vitro. While FOXO3 expression remained unchanged in ACCs, FOXO1 expression was found to be significantly downregulated in 19/20 ACAs and 9/10 ACCs (p<0.0001 and p<0.05, respectively), suggesting a global role for FOXO1 suppression in promoting and maintaining adrenocortical dedifferentiation. Silencing of FOXO1 in SW-13 cells resulted in significant loss of viability (p<0.001) mediated by apoptosis as determined by quantitative Annexin V immunofluorescence analysis (p<0.01). FOXO1 silencing also augmented the migratory behavior of SW-13 cells (p<0.0001), suggesting distinct roles for FOXO1 in promoting viability and controlled motility of adrenocortical cells.

Lipoprotein-Free Mitotane Exerts High Cytotoxic Activity in Adrenocortical Carcinoma.

Mitotane (o,p'-DDD), the only approved drug for advanced adrenocortical carcinoma (ACC), is a lipophilic agent that accumulates into circulating lipoprotein fractions and high-lipid-containing tissues. The aim of our study was to evaluate the in vivo and in vitro biological implication of serum lipoproteins on pharmacological action of mitotane. Distribution and concentration of mitotane were studied in plasma and adrenal tissue samples from mitotane-treated patients. The effect of lipoprotein-bound or lipoprotein-free (LP-F) mitotane was analyzed on proliferation and apoptosis of human adrenocortical H295R cells. A retrospective study of patients with ACC treated or not with statins was also performed. o,p'-DDD distribution among very low-density lipoprotein, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and LP-F fractions obtained after plasma ultracentrifugation of 23 of mitotane-treated patients was widely distributed in each subfraction. A positive correlation was observed between mitotane levels in plasma and in LDL, HDL, but also LP-F compartment. Intratumor o,p'-DDD concentrations in five ACC samples of mitotane-treated patients were found to be independent of cholesterol transporter expression, scavenger receptors, and LDL receptors. In vitro studies showed significant higher antiproliferative and proapoptotic effects and higher cell and mitochondrial uptake of mitotane when H295R cells were grown in LP-F medium. Finally, retrospective study of an ACC cohort of 26 mitotane-treated patients revealed that statin therapy was significantly associated with a higher rate of tumor control. Altogether, our in vitro and in vivo studies provided compelling evidence for a greater efficacy of LP-F mitotane. Patients with ACC may thus benefit from therapeutic strategies that aim to increase LP-F mitotane fraction.

Abstract A11: Exome sequencing of FFPE material: An evaluation

Abstract Background: The current project aims to explore the possibility to use formalin fixed paraffin embedded (FFPE) samples for exome sequencing, which would open up a large collection of tissue samples for molecular studies. Usage of formalin is known to degrade and modify the DNA both during treatment and storage resulting in problems in downstream molecular analyses. The aim of the present study is to evaluate exome sequencing of FFPE samples by comparing data from FFPE normal tissue to corresponding snap frozen (SF) blood controls with focus on data output such as amount of data removed due to low sequencing quality, amount of data mapped to the genome, GC-content, and duplicate levels. Methods: In the current study we used the western Swedish biobank of neural tumors archived at the Sahlgrenska Hospital, Gothenburg. We performed exome sequencing of FFPE normal adrenal tissue samples and corresponding SF blood samples from five patients diagnosed with pheochromocytoma/paraganglioma. Two of the patients had known heterozygous germline mutations and were included to determine if these mutations could be found in both sample types. Libraries for SF samples were prepared according to protocol using Agilent Technologies SureSelect Human All Exon 50 Mb library prep kit. FFPE samples were prepared with slight modifications in the protocol, with additional PCR cycles used to increase amplification. 75 bp paired end reads were generated on Illumina HiScan SQ according to manufacturer's protocol (v.3). Results: Between 92-99% of the raw data were kept after removal of data due to low sequencing quality independent of sample type. For the SF samples 99-100% of the trimmed data mapped to the genome, the number for FFPE samples were slightly lower ranging from 87-98%. The GC content in the exome enriched DNA from FFPE and SF tissue were similar, ranging between 45-51%. Looking at the mapped data we found higher levels of duplicates in the FFPE samples compared to the SF samples, 19-78% vs. 5-15%. For one of the two patients with a known germline mutation the variant was detected at approximately the same frequency in both FFPE and SF sample (39% in FFPE vs. 44% in SF). For the other patient the variant were found at higher frequency in the FFPE sample compared to SF sample (80% vs. 50%). Conclusions: We saw no difference in amount data removed due to low sequencing quality between the five FFPE and SF samples evaluated in this study. Also, we saw only slightly lower mapping frequencies for the FFPE samples. The GC-content for both FFPE and SF samples were within the range of what's expected for exome sequencing data for libraries prepared with this kit and sequenced on Illumina HiScan SQ platform. Due to the additional PCR cycles used for FFPE samples we saw higher duplicate levels in these samples, suggesting that deeper sequencing is necessary for FFPE samples to get the same amount of unique reads as for the SF samples. A probable explanation to the higher allele frequency of the variant observed in the FFPE sample from one of the patients with a known germline mutation is the presence of contaminant tumor cells in the normal tissue sample, resulting in a shifted allele frequency. To conclude, SF samples are to prefer for exome sequencing. However, if SF material is not available FFPE tissue is a good alternative to increase the sample cohort when studying rare and complex diseases. Citation Format: Annica Wilzen, Heidi Ottesen, Anna Larsson, Bo Wangberg, Andreas Muth, Ola Nilsson, Frida Abel. Exome sequencing of FFPE material: An evaluation. [abstract]. In: Proceedings of the AACR Special Conference on Pediatric Cancer at the Crossroads: Translating Discovery into Improved Outcomes; Nov 3-6, 2013; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2013;74(20 Suppl):Abstract nr A11.

Metabolomic profile of the adrenal gland: from physiology to pathological conditions

In this study, we i) assessed the metabolic profile of the normal adrenal cortex and medulla of adult human subjects by means of (1)H-high-resolution magic-angle spinning nuclear magnetic resonance (HRMAS NMR) spectroscopy; ii) compared the biochemical profile of adenoma (Ad), adrenal cortical carcinoma (ACC), and pheochromocytoma (PCC) samples with that of healthy adrenal tissue samples; and iii) investigated the metabolic differences between ACCs and Ads as well as between ACCs and PCCs. Sixty-six tissue samples (13 adrenal cortical tissue, eight medullary tissue, 13 Ad, 12 ACC, and 20 PCC samples) were analyzed. Adrenaline and noradrenaline were undetectable in cortical samples representing the metabolic signature of the tissue derived from neural crest. Similarity between the metabolic profile of Ads and that of the normal adrenal cortex was shown. Inversely, ACC samples clearly made up a detached group exhibiting the typical stigmata of neoplastic tissue such as choline-containing compounds, biochemical markers of anaerobic processes, and increased glycolysis. Significantly higher levels of lactate, acetate, and total choline-containing compounds played a major role in the differentiation of ACCs from Ads. Moreover, the high fatty acid content of ACCs contributed to the cluster identification of ACCs. Of the 14 sporadic PCC samples, 12 exhibited predominant or exclusive noradrenaline secretion. The noradrenaline:adrenaline ratio was inverted in the normal medullary tissue samples. Multiple endocrine neoplasia type 2- and NF1-related PCC samples exhibited both adrenaline and noradrenaline secretion. In the von Hippel-Lindau disease-related PCC samples, only noradrenaline secretion was detected by HRMAS NMR spectroscopy. This study is one of the first applications of metabolomics to adrenal pathophysiology and it is the largest study to report HRMAS NMR data related to the adrenal cortex and adrenal cortical tumors.

Telomerase activity in benign and malignant adrenal tumors.

Histological analysis of surgically removed adrenal masses often fails to differentiate between benign and malignant tumors. In normal cells, the telomeric ends of the chromosomes are shortened with each cell division, leading to chromosome destabilization and cellular senescence after a critical number of cell cycles. In tumor cells, telomere shortening is prevented by a specific DNA polymerase, called telomerase. In an effort to clarify the role of telomerase in the pathogenesis of adrenal tumors, and to test whether its activity could serve as marker of malignancy, we measured telomerase activity in 41 human adrenal tissue samples that were classified both by the clinical course and by histological examination. Telomerase activity was determined by TRAP ELISA and expressed as high (>50% of positive control telomerase activity), medium (31-50%), low (11-30%), very low (< or = 10%), or absent (0%). The 8 normal adrenal tissue samples showed very low levels of telomerase activity. Mean telomerase activity also very low in 3/3 incidentalomas, 6/6 Cushing adenomas, 6/6 Conn adenomas, 7/7 adrenocortical carcinomas, 8/8 benign pheochromocytomas, and 2/3 malignant pheochromocytomas. In contrast, one malignant pheochromocytoma showed high telomerase activity. These data indicate that telomerase activity may not be a suitable marker for malignancy in the adrenal gland. Our results also challenge the current dogma of close correlation between cell dedifferentiation and telomerase activity.

BMP dependent effects on adrenal tumorigenesis and function

Members of the TGFβ family of ligands – including bone morphogenic proteins (BMPs) – have been demonstrated to profoundly impact tumorigenesis in a variety of tumor entities. As for the adrenal cortex, BMP6 has been implicated as an important modulator of aldosterone secretion. To screen for alterations of TGFß dependent pathways in adrenal tumorigenesis we performed gene profiling experiments. By comparing human adrenal carcinoma (ACC) against normal adrenal tissue samples (Co) we detected a down-regulation of various BMPs (e.g. BMP2 and BMP5) which was further validated by Real Time analysis (BMP5, ACC vs. Co 6.1±1.4% vs. 100±29.7%, p<0.01; BMP2, ACC vs. Co 35.1±1.2% vs. 100±17%, p<0.01). As similar expression pattern with loss of BMP5 expression was evident in NCIh295 cells, this cell line was used as an in vitro model to assess potential impact of BMP dependent pathways. Incubation with recombinant hBMP5 induced phosphorylation of SMAD 1/5/8 and subsequent increase of ID protein expression levels in a dose dependent manner, while co-incubation with the physiological BMP antagonist Noggin neutralized these effects. Thus, these findings demonstrated the integrity of the pathway in NCIh295 cells. Notably, BMP5 treatment resulted in a decrease in cellular viability (68.3±1.1% vs. 100±2.7%, p<0.01) but increase in the expression levels of steroidogenic enzymes such as StAR (225±9.6% vs. 100±2.3%, p<0.01) and SCC (460.3±58.8% vs. 100±0.53%, p<0.01). The BMP5 dependent reduced viability was accompanied by concomitant changes in the cell cycle possibly through an increased rate in apoptosis. Taken together, we demonstrate that loss of BMP expression is a common finding in ACC. Moreover, we provide first evidence that BMP dependent pathways might be involved in modulation of the malignant phenotype of adrenocortical cancer.

Analysis of numerical chromosomal aberrations in adrenal cortical neoplasms by fluorescence in situ hybridization.

We identified numerical chromosomal aberrations in adrenal cortical neoplasms using interphase fluorescence in situ hybridization (FISH) and correlated these aberrations with DNA ploidy and endocrine dysfunction. Our study included 25 adenomas and 2 carcinomas associated with primary aldosteronism or Cushing's syndrome. Eight normal adrenal tissue samples served as controls. Isolated nuclei from frozen samples were used for FISH and formalin fixed, paraffin embedded tissues from the same materials were analyzed by flow cytometry for DNA ploidy. For FISH we used centromere specific probes for chromosomes 3, 7, 8, 11 and 12. None of the normal adrenal tissues had any numerical chromosomal aberrations in any chromosome analyzed or any abnormal findings on DNA ploidy analysis. Tetrasomy of chromosomes 3, 7, 8, 11 and 12 was detected in 8, 13, 14, 11 and 12 of the 17 adenomas associated with primary aldosteronism, and in 2, 0, 0, 0 and 0 of the 8 associated with Cushing's syndrome, respectively. DNA flow cytometry revealed tetraploidy in 11 of the 17 cases of primary aldosteronism and in 1 of the 8 of Cushing's syndrome. Five diploid adenomas associated with primary aldosteronism also showed tetrasomy in 2 or more chromosomes. One of the 2 carcinomas showed aneuploidy and aneusomy of chromosomes 8, 11 and 12 but the other showed no abnormal peaks on DNA histography and no numerical chromosomal aberrations. All chromosomes analyzed in adenomas associated with primary aldosteronism frequently showed tetrasomy, whereas few chromosomal abnormalities were detected in adenomas associated with Cushing's syndrome. Our results indicate that DNA tetraploidy is common in adrenal cortical adenomas associated with primary aldosteronism. Interphase FISH strongly supported flow cytometry findings and could provide further information on individual chromosomes.

Mutation and methylation analysis of TP53 in adrenal carcinogenesis

Aim To investigate the role of coding region mutation and promoter hypermethylation of TP53 in adrenocortical cancer formation. Methods Twenty sporadic adrenocortical cancers (ACCs) and five normal adrenal tissue samples were available for analysis. Coding region mutation of TP53 in 20 ACCs was examined by polymerase chain amplification using intronic primers for exons 2–11 and direct sequencing of the product. In 10 ACCs and five normal adrenal tissue specimens, methylation of the 16 CpG sites within the TP53 promoter was examined using bisulphite methylation sequencing. Results Coding region mutation in TP53 was demonstrated in 5 of 20 ACCs. There were four mis-sense mutations and one frameshift mutation. Four of 5 patients with a TP53 mutation had metastases at diagnosis or detected soon thereafter and 3 of 4 died of disease within 12 months of surgical resection. No methylation was seen in the TP53 promoter in 10 ACC and the five normal adrenal tissues examined. Conclusion Coding region mutation in TP53 occurs in 25% of ACCs with a trend toward a poorer prognosis. Promoter methylation of TP53 is not present in ACC as a mechanism for tumour suppressor gene (TSG) inactivation and, therefore, other genes in the 17p13 region are implicated in adrenal carcinogenesis.

Analysis Of Numerical Chromosomal Aberrations In Adrenal Cortical Neoplasms By Fluorescence In Situ Hybridization

We identified numerical chromosomal aberrations in adrenal cortical neoplasms using interphase fluorescence in situ hybridization (FISH) and correlated these aberrations with DNA ploidy and endocrine dysfunction. Our study included 25 adenomas and 2 carcinomas associated with primary aldosteronism or Cushing's syndrome. Eight normal adrenal tissue samples served as controls. Isolated nuclei from frozen samples were used for FISH and formalin fixed, paraffin embedded tissues from the same materials were analyzed by flow cytometry for DNA ploidy. For FISH we used centromere specific probes for chromosomes 3, 7, 8, 11 and 12. None of the normal adrenal tissues had any numerical chromosomal aberrations in any chromosome analyzed or any abnormal findings on DNA ploidy analysis. Tetrasomy of chromosomes 3, 7, 8, 11 and 12 was detected in 8, 13, 14, 11 and 12 of the 17 adenomas associated with primary aldosteronism, and in 2, 0, 0, 0 and 0 of the 8 associated with Cushing's syndrome, respectively. DNA flow cytometry revealed tetraploidy in 11 of the 17 cases of primary aldosteronism and in 1 of the 8 of Cushing's syndrome. Five diploid adenomas associated with primary aldosteronism also showed tetrasomy in 2 or more chromosomes. One of the 2 carcinomas showed aneuploidy and aneusomy of chromosomes 8, 11 and 12 but the other showed no abnormal peaks on DNA histography and no numerical chromosomal aberrations. All chromosomes analyzed in adenomas associated with primary aldosteronism frequently showed tetrasomy, whereas few chromosomal abnormalities were detected in adenomas associated with Cushing's syndrome. Our results indicate that DNA tetraploidy is common in adrenal cortical adenomas associated with primary aldosteronism. Interphase FISH strongly supported flow cytometry findings and could provide further information on individual chromosomes.

Adrenocortical Carcinoma: Clinical, Morphologic, and Molecular Characterization

PURPOSE: To define multimolecular phenotypes of adrenocortical carcinoma (ACC) and to correlate outcome with morphologic and molecular parameters. PATIENTS AND METHODS: Clinical data were analyzed for 124 patients, histopathologic slides for 67 primary tumors, and tissue specimens for 74 patients (38 primary and 36 metastatic tumors) with ACC and for 38 normal adrenal tissue samples. Molecular expression profiles were investigated by immunohistochemistry. The prognostic significance of 12 gross and histologic parameters in 67 primary ACCs was evaluated. Morphologic and protein expression patterns were correlated with disease-specific survival (DSS). Univariate influence of prognostic factors on DSS was analyzed by log-rank test and multivariate analysis by Cox regression. RESULTS: The median follow-up period was 4.7 years. Significant predictors of DSS included distant metastasis at time of initial presentation; venous, capsular, and adjacent organ invasion; tumor necrosis, mitotic rate, atypical mitosis, and mdm-2 overexpression. Five-year DSS by number (one to six) of adverse histologic parameters was as follows: one to two, 84%; three to four, 37%; more than four, 9% (P = .005).The phenotype Ki-67(−)p53(−)mdm-2(+)cyclinD1(−)Bcl-2(−)p21(−)p27(+) was observed in 83% of normal and 3% of malignant adrenal tissue (P = .01). Molecular phenotypic expression was more heterogeneous in malignant than in normal (10 v five phenotypes) adrenal tissue. CONCLUSION: Meticulous morphologic evaluation, mitotic count, and tumor stage are essential in determining prognosis for patients with ACC. Multimolecular phenotyping demonstrates that the molecular complexity and heterogeneity of these neoplasms are such that targeted therapy needs to be patient specific.

Adrenocortical carcinoma: clinical, morphologic, and molecular characterization.

To define multimolecular phenotypes of adrenocortical carcinoma (ACC) and to correlate outcome with morphologic and molecular parameters. Clinical data were analyzed for 124 patients, histopathologic slides for 67 primary tumors, and tissue specimens for 74 patients (38 primary and 36 metastatic tumors) with ACC and for 38 normal adrenal tissue samples. Molecular expression profiles were investigated by immunohistochemistry. The prognostic significance of 12 gross and histologic parameters in 67 primary ACCs was evaluated. Morphologic and protein expression patterns were correlated with disease-specific survival (DSS). Univariate influence of prognostic factors on DSS was analyzed by log-rank test and multivariate analysis by Cox regression. The median follow-up period was 4.7 years. Significant predictors of DSS included distant metastasis at time of initial presentation; venous, capsular, and adjacent organ invasion; tumor necrosis, mitotic rate, atypical mitosis, and mdm-2 overexpression. Five-year DSS by number (one to six) of adverse histologic parameters was as follows: one to two, 84%; three to four, 37%; more than four, 9% (P =.005). The phenotype Ki-67(-)p53(-)mdm-2(+)cyclinD1(-)Bcl-2(-)p21(-)p27(+) was observed in 83% of normal and 3% of malignant adrenal tissue (P =.01). Molecular phenotypic expression was more heterogeneous in malignant than in normal (10 v five phenotypes) adrenal tissue. Meticulous morphologic evaluation, mitotic count, and tumor stage are essential in determining prognosis for patients with ACC. Multimolecular phenotyping demonstrates that the molecular complexity and heterogeneity of these neoplasms are such that targeted therapy needs to be patient specific.

Molecular analysis of CDKN1C and TP53 in sporadic adrenal tumors.

To evaluate the roles of the CDKN1C (P57KIP2) gene, which encodes for the cyclin-dependent kinase inhibitor CDNC, and the TP53 tumor suppressor gene in adrenal tumorigenesis, as a means of investigating the molecular basis of sporadic adrenal tumors, which is unknown. Screening for the presence CDKN1C and TP53 mutations and analyzing the expression pattern of CDNC, P53 and its downstream effector CDN1 (P21WAF1/CIP1) in a series of 79 sporadic adrenal tumors. Single-strand conformation polymorphism and sequencing were used for mutation analysis of CDKN1C and TP53 in blood and adrenal tissue samples. In a subgroup of 48 tissues, CDKN1C expression was evaluated by RT-PCR and immunohistochemistry. Immunohistochemical analysis of P53 and CDN1 was performed. No somatic mutations of CDKN1C were found in the tumors analyzed, in spite of low/absent CDNC expression in adrenocortical adenomas and carcinomas. Mutations in the TP53 gene were present in 70% of adrenocortical carcinomas, associated with abnormal P53 and CDN1 expression, but not in benign neoplasms. In the normal adrenal cortex, CDNC expression was strictly nuclear and confined to the cortical zone (i.e. zona glomerulosa and reticularis), with no staining in the medulla. Mutations in the TP53 gene are frequent in adrenocortical carcinomas and might be used as a marker of malignancy. In the normal adrenal cortex, the zone-specific pattern of expression of CDNC suggests a role in adrenal differentiation.

In vivo activity of tyrosine hydroxylase in rat adrenal glands following administration of quinpirole and dopamine

Using adrenal dopamine as indicator we have previously obtained evidence that quinpirole and several other agonists on dopamine D 2-like receptors acutely stimulate the synthesis of adrenal catecholamines. In the present study we measured the effect of quinpirole and dopamine on the hydroxylation of tyrosine in the adrenals, using the method of DOPA (3,4-dihydroxyphenylalanine) accumulation following the administration of the inhibitor of aromatic l-amino acid decarboxylase NSD 1015 (3-hydroxybenzylhydrazyne). In view of the large amounts of catecholamines in the adrenal tissue samples, this necessitated a modification of the method for analysing DOPA. Both quinpirole and dopamine significantly enhanced the rate of DOPA accumulation in the adrenals, indicating stimulation of adrenal tyrosine hydroxylase. The effect of dopamine was blocked by domperidone, a dopamine D 2 receptor antagonist that penetrates poorly into the central nervous system. Thus the effect of dopamine, which itself penetrates poorly into the central nervous system, was presumably mediated peripherally. Similarly epinine, i.e. the N-methyl derivative of dopamine, appeared to enhance adrenal catecholamine synthesis, as indicated by an elevated adrenal dopamine level. The data support the view that stimulation of peripherally located dopamine D 2-like receptors can enhance the rate of adrenal catecholamine synthesis by stimulating the activity of tyrosine hydroxylase.

Estimating the actual effect of persistent DDT and its metabolites on the function of the adrenal cortex in human organism

Gas chromatography with ECD detection was used to determine the adrenal levels of DDT and its metabolites DDD and DDE. Adrenal concentrations of progesterone, cortisol and corticosterone were measured by the RIA radioimmunological method. Adrenal tissue samples were taken from 60 subjects during post‐mortem examination. The results were interpreted statistically. Statistical significance was determined by Student's t‐test at p = 0.05, and the correlation coefficients were calculated numerically.