The Journal of pathology
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The Journal of pathology · Jan 2014
ReviewPathology is a necessary and informative tool in oncology clinical trials.
Clinical trials are essential for the improvement of cancer care. The complexity of modern cancer care and research require careful design, for which input from all disciplines is necessary. ⋯ In the current review all these aspects are discussed, with examples from colorectal cancer trials. We describe critical issues in biomarker evaluation and development and emphasize the importance of the role of the pathologist in quality control of cancer treatment.
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The Journal of pathology · Jan 2014
ReviewUsing the molecular classification of glioblastoma to inform personalized treatment.
Glioblastoma is the most common and most aggressive diffuse glioma, associated with short survival and uniformly fatal outcome, irrespective of treatment. It is characterized by morphological, genetic and gene-expression heterogeneity. The current standard of treatment is maximal surgical resection, followed by radiation, with concurrent and adjuvant chemotherapy. ⋯ Following recurrence, glioblastoma is quickly fatal in the majority of cases. Recent genetic molecular advances have contributed to a better understanding of glioblastoma pathophysiology and disease stratification. In this paper we review basic glioblastoma pathophysiology, with emphasis on clinically relevant genetic molecular alterations and potential targets for further drug development.
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The Journal of pathology · Jan 2014
ReviewImplications of intratumour heterogeneity for treatment stratification.
Despite advances in the diagnosis and treatment of cancer, the majority of advanced metastatic solid tumours remain incurable. Differential gene expression, somatic mutational status, tumour-specific genetic signatures and micro-environmental selection pressures within individual tumours have implications for the success of predictive assays to guide therapeutic intervention. ⋯ We highlight areas of research that could be improved in order to better stratify patient treatment. We also discuss the predictive potential of patient-derived models of tumour response, including xenograft and cell line-based systems within the context of intratumour heterogeneity.
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The Journal of pathology · Jan 2014
Defective control of vitamin D receptor-mediated epithelial STAT1 signalling predisposes to severe respiratory syncytial virus bronchiolitis.
Respiratory syncytial virus (RSV) infection causes bronchiolitis in infants with seasonal frequency, for which vitamin D deficiency and a well-described polymorphism in the vitamin D receptor (VDR) FokI are important risk factors. Recent studies suggest that vitamin D regulates immune pathways in airway epithelial cells during RSV infection. It is not understood why the VDR FokI polymorphism predisposes to severe RSV bronchiolitis. ⋯ However, while NFκB control by vitamin D remained intact, both RSV-induced phosphorylation of STAT1 and expression of its downstream targets, IRF1 and IRF7, escaped vitamin D control in FokI epithelial cells. The poor capacity of vitamin D to regulate IRF1 in FokI VDR-expressing cells was recapitulated using blood samples from normal and FokI VDR-genotyped healthy donors. Hence, we provide mechanistic insight that the FokI VDR polymorphism renders STAT1-mediated antiviral immune reactions to RSV infection non-responsive to vitamin D control, resulting in enhanced immunopathology and exacerbated RSV bronchiolitis.