Schrage, Y.M.
Citation
Schrage, Y. M. (2009, November 5). Towards new therapeutic strategies in chondrosarcoma. Retrieved from https://hdl.handle.net/1887/14327
Version: Corrected Publisher’s Version
License: Licence agreement concerning inclusion of doctoral thesis in the Institutional Repository of the University of Leiden
Downloaded from: https://hdl.handle.net/1887/14327
Note: To cite this publication please use the final published version (if applicable).
a role for celecoxib treatment?
Yvonne M. Schrage, Isidro Machado, Danielle Meijer, Inge Briaire-de Bruijn, Brendy E. van den Akker, Antonie H.M. Taminiau, Thomas Kalinski, Antonio Llombart-Bosch, Judith V.M.G. Bovée.
Submitted
Abstract
&KRQGURVDUFRPDVDUHUHVLVWDQWWRFRQYHQWLRQDOFKHPRDQGUDGLRWKHUDS\
$ VXEVHW RI FKRQGURVDUFRPDV DULVHV VHFRQGDULO\ LQ WKH EHQLJQ WXPRXU
V\QGURPHV (QFKRQGURPDWRVLV (& DQG 0XOWLSOH 2VWHRFKRQGURPDV 02 DQG SUHYHQWLRQ RI WXPRXU GHYHORSPHQW ZRXOG JUHDWO\ LPSURYH SURJQRVLV
:H WKHUHIRUH LQYHVWLJDWHG WKH HIIHFW RI VHOHFWLYH &2; LQKLELWLRQ RQ
chondrosarcoma growth.
&2; H[SUHVVLRQ ZDV VWXGLHG LQ FHQWUDO DQG SHULSKHUDO FDUWLODJLQRXV
WXPRXUV7KHHIIHFWRI&2;LQKLELWLRQZDVDVVHVVHGLQIRXUFKRQGURVDUFRPD
FHOOOLQHVXVLQJFHOHFR[LEDQG16WUHDWPHQW&2;DFWLYLW\SURVWDJODQGLQ
(23*(2(/,6$DQGFHOOYLDELOLW\ZHUHPHDVXUHG7KHSURSK\ODFWLFHIIHFW
RIFHOHFR[LERQFKRQGURVDUFRPDJURZWKin vivoZDVVWXGLHGGXULQJZHHNV
XVLQJD[HQRJUDIWPRGHORIFHOOOLQH&+LQLPPXQRLQFRPSHWHQWQXGH
mice.
+LJK &2; SURWHLQ H[SUHVVLRQ ZDV PDLQO\ IRXQG LQ VROLWDU\ SHULSKHUDO
chondrosarcoma and in enchondromatosis-related central chondrosarcoma, ZKLFK ZDV FRQÀUPHG E\ T3&5 $IWHU KRXUV RI FHOHFR[LE WUHDWPHQW D
VLJQLÀFDQWGHFUHDVHLQFHOOYLDELOLW\ZDVREVHUYHGLQWKUHHFKRQGURVDUFRPD
cell lines. In vivoFHOHFR[LELQLWLDOO\VORZHGWXPRXUJURZWKLQFKRQGURVDUFRPD
[HQRJUDIWVKRZHYHUDIWHUSURORQJHGWUHDWPHQWUHODSVHGWXPRXUJURZWKZDV
REVHUYHG7XPRXUYROXPHZDVQHJDWLYHO\DVVRFLDWHGZLWKFHOHFR[LEVHUXP
OHYHOVDQGVHHPHGVPDOOHULQWKHKLJKGRVHSURSK\ODFWLFWUHDWPHQWJURXS
:HFRQÀUPHGH[SUHVVLRQRI&2;LQRIFKRQGURVDUFRPDVDQG&2;
LQKLELWLRQE\FHOHFR[LEGLPLQLVKHGFHOOYLDELOLW\in vitro+RZHYHUWKHin vivoGDWDVXJJHVWQRUROHIRUFHOHFR[LELQWKHWUHDWPHQWRIDGXOWKLJKJUDGH
FKRQGURVDUFRPD7KHUROHRIKLJKGRVHSURSK\ODFWLFFHOHFR[LELQSUHYHQWLQJ
GHYHORSPHQW RI EHQLJQ DQG PDOLJQDQW FDUWLODJH WXPRXUV LQ (& DQG 02
patients deserves further investigation.
Introduction
&KRQGURVDUFRPDRIERQHLVDPDOLJQDQWFDUWLODJHIRUPLQJWXPRXUZKLFK
LVKLJKO\LQVHQVLWLYHWRFODVVLFDOFKHPRWKHUDSHXWLFVDQGUDGLDWLRQWKHUDS\
&KRQGURVDUFRPDV DUH KLVWRORJLFDOO\ GLYLGHG LQWR WKUHH JUDGHV ZKLFK LV
FXUUHQWO\WKHRQO\REMHFWLYHSUHGLFWRURIPHWDVWDVLV*UDGH,WXPRXUVUDUHO\
PHWDVWDVL]HZLWKD\HDUVXUYLYDOUDWHRIZKLOH\HDUVXUYLYDOIRU
JUDGH ,,, WXPRXUV GHFUHDVHV WR GXH WR PHWDVWDWLF GLVHDVH 0DUJLQDO
RU LQWUDODHVLRQDO H[FLVLRQ RI WXPRXUV FDQ UHVXOW LQ ORFDO UHFXUUHQFH ZLWK
increased histological grade2&XUUHQWO\VXUJLFDOUHPRYDORIWKHWXPRXULV
WKHRQO\RSWLRQIRUFXUDWLYHWUHDWPHQW7KHUHLVQRWUHDWPHQWZLWKFXUDWLYH
LQWHQWIRUSDWLHQWVZLWKPHWDVWDWLFGLVHDVHRULQRSHUDEOHWXPRXUV
7KHPDMRULW\RIFRQYHQWLRQDOFKRQGURVDUFRPDVDULVHLQWKHPHGXOODU
FDYLW\ RI ERQH DQG DUH GHVLJQDWHG DV SULPDU\ FHQWUDO FKRQGURVDUFRPDV3. )RU OHVV WKDQ RI FHQWUDO FKRQGURVDUFRPDV WKHUH LV FOLQLFDO HYLGHQFH
RI D SUHH[LVWLQJ EHQLJQ HQFKRQGURPD (QFKRQGURPDV RFFXU PRVWO\
DVVROLWDU\OHDVLRQVDOWKRXJKWKH\PD\RFFXUDVPXOWLSOHOHDVLRQVLQWKH
FRQWH[WRIHQFKRQGURPDWRVLV2OOLHUGLVHDVHZKLFKLVDUDUHQRQKHUHGLWDU\
V\QGURPH57KHULVNRIPDOLJQDQWSURJUHVVLRQLVLQFUHDVHGXSWRLQ
enchondromatosis patientsDVFRPSDUHGWRVROLWDU\HQFKRQGURPD
$W WKH VXUIDFH RI ERQH SHULSKHUDO FKRQGURVDUFRPDV DULVH VHFRQGDU\ WR
D SUHH[LVWLQJ RVWHRFKRQGURPD 0XOWLSOH RVWHRFKRQGURPDV 02 LV DQ
DXWRVRPDO GRPLQDQW KHUHGLWDU\ GLVRUGHU ZKLFK RFFXUV LQ FKLOGUHQ DQG
\RXQJDGROHVFHQWV0DOLJQDQWSURJUHVVLRQRIKHUHGLWDU\RVWHRFKRQGURPDLV
VOLJKWO\PRUHIUHTXHQWWKDQLQVROLWDU\OHDVLRQVYV3UHYHQWLQJ
new tumour formation and malignant progression in enchondromatosis and PXOWLSOHRVWHRFKRQGURPDSDWLHQWVZRXOGJUHDWO\EHQHÀWWKHLUSURJQRVLV
,QFRORUHFWDOFDQFHUDSURWHFWLYHHIIHFWRISURVWDJODQGLQV\QWKHVLVLQKLELWRUV
DOVRNQRZQDVQRQVWHURLGDODQWLLQÁDPPDWRU\GUXJV16$,'VKDVEHHQ
VXJJHVWHG DJDLQVW GHYHORSPHQW DQG JURZWK RI WKH WXPRXUV &HOHFR[LE
DQGURIHFR[LEERWKVHOHFWLYH&2;LQKLELWRUVZHUHVKRZQWRUHGXFHWKH
QXPEHUDQGVL]HRIFRORUHFWDOSRO\SVLQWKHDGMXYDQWWUHDWPHQWRI)DPLOLDO
$GHQRPDWRXV3RO\SRVLV)$3SDWLHQWV. Also aspirin was found to have a chemopreventive effect on adenoma recurrence in patients in which a non- )$3UHODWHGDGHQRPDKDGEHHQUHPRYHG916$,'VEORFNDWWDFKPHQWVLWHV
IRUDUDFKLGRQLFDFLGRQWKH&2;HQ]\PHWKHUHE\LQKLELWLQJSURVWDJODQGLQ
production:KHUHDV&2;LVFRQVWLWXWLYHO\H[SUHVVHGXQGHUSK\VLRORJLF
FRQGLWLRQV&2;LVLQGXFHGE\F\WRNLQHVDQGIUHHUDGLFDOVPDNLQJLWD
VXLWDEOHWDUJHWIRUDQWLFDQFHUWKHUDS\
(QGR HW DO UHSRUWHG KLJK &2; H[SUHVVLRQ LQ D VXEVWDQWLDO DPRXQW RI
FKRQGURVDUFRPDVE\LPPXQRKLVWRFKHPLVWU\ZKLFKZDVDVVRFLDWHG
with high histological grade and poor prognosis+RZHYHU6XWWRQIRXQG
QR FRUUHODWLRQ RI &2; SURWHLQ H[SUHVVLRQ DQG KLVWRORJLFDO JUDGH LQ
FKRQGURVDUFRPDV JUDGH , WXPRXUV JUDGH ,, DQG JUDGH ,,,
ZKHUHDVHQFKRQGURPDVZHUHQHJDWLYH.
:H LQYHVWLJDWHG ZKHWKHU &2; LQKLELWLRQ
FRXOGSOD\DUROHLQHLWKHUWKHWUHDWPHQWRIKLJK
grade chondrosarcomas or the prevention of malignant progression of tumours associated ZLWK (QFKRQGURPDWRVLV RU 0XOWLSOH
Osteochondromas. Therefore we determined
&2; P51$ DQG SURWHLQ H[SUHVVLRQ LQ
patient material. We investigated the effects RI &2; LQKLELWLRQ RQ &2; SURWHLQ
H[SUHVVLRQ 3*(2 OHYHOV DQG FHOO YLDELOLW\
LQ KLJK JUDGH FKRQGURVDUFRPD FHOO OLQHV
in vitro. In addition, a chondrosarcoma [HQRJUDIW PRGHO RI LPPXQRLQFRPSHWHQW
QXGHPLFHZDVXVHGWRVWXG\WKHHIIHFWVRI
&2;LQKLELWLRQin vivo.
Material and methods
COX-2 expression in patient material of cartilaginous tumours
Conventional central and peripheral cartilaginous tumours were selected EDVHG RQ DFFHSWHG FOLQLFRSDWKRORJLFDO
and radiological criteria3 -X[WDFRUWLFDO
PHVHQFK\PDOGHGLIIHUHQWLDWHGDQGFOHDU
FHOO FKRQGURVDUFRPDV ZHUH H[FOXGHG ,Q
WRWDO IRUPDOLQÀ[HG SDUDIÀQHPEHGGHG
VSHFLPHQVIURPSDWLHQWV7DEOHDQG
IUHVKIUR]HQ PDWHULDO RI SDWLHQWV ZDV
VWXGLHG+LVWRORJLFDOJUDGLQJZDVSHUIRUPHG
DFFRUGLQJ WR (YDQV. All specimens were handled according to the ethical guidelines GHVFULEHG LQ ´&RGH IRU 3URSHU 6HFRQGDU\
8VH RI +XPDQ 7LVVXH LQ 7KH 1HWKHUODQGVµ
RIWKH'XWFK)HGHUDWLRQRI0HGLFDO6FLHQWLÀF
Societies.
&2; LPPXQRKLVWRFKHPLVWU\ 7DEOH
RI WXPRXU WLVVXH ZDV LQGHSHQGHQWO\
VHPLTXDQWLWDWLYHO\ VFRUHG IRU F\WRSODVPLF
VWDLQLQJDVGHVFULEHGSUHYLRXVO\, without knowledge of the clinicopathological data.
6FRUHVZHUHJLYHQIRULQWHQVLW\ ZHDN
PRGHUDWH VWURQJ DQG SHUFHQWDJH RI
SRVLWLYHFHOOV
DQG 7RDYRLGWXPRXUV
CentralPeripheral 6ROLWDU\(&TOTAL6ROLWDU\02TOTALOVERALL pospospospospospospos Benign3302025 Malignant9233 Grade I CS02073 Grade II CS5025 Grade III CS - -00 - - - - - -0 ALL (Benign +Malignant)27503722 Table 6.1 COX-2 protein expression in cartilaginous tumours
ZLWKVLQJOHSRVLWLYHFHOOVEHLQJ
regarded as positive a cut- RII OHYHO RI WRWDO VXP ZDV
applied.
51$ ZDV LVRODWHG IURP IUHVK
IUR]HQ WXPRXU WLVVXH RI
FHQWUDOWXPRXUVDVGHVFULEHG
SUHYLRXVO\. Growth plate VDPSOHV Q ZHUH XVHG DV
normal counterpart controls.
0HVVHQJHU 51$ H[SUHVVLRQ
of COX-2 was studied using TXDQWLWDWLYH 573&5 IRUZDUG
primer GAATCATTCACCA-
GGCAAATTG, reverse
primer TCTGTACTGCG- GGTGGAACA DV SUHYLRXVO\
GHVFULEHG. For normalisation
*(1250ZDVXVHG.
Inhibition of COX-2 in chondrosarcoma in vitro Chondrosarcoma cell lines derived from chondrosarcoma JUDGH ,, 6: $PHULFDQ
7\SH &XOWXUH &ROOHFWLRQ
$7&& 0DQDVVDV 9$
JUDGH ,,, &+ and 2806 DQG D UHFXUUHQW
chondrosarcoma grade II in HQFKRQGURPDWRVLV & ZHUH FXOWXUHG LQ 530,
VXSSOHPHQWHG ZLWK
heat-inactivated foetal calf VHUXP *LEFR ,QYLWURJHQ
Life-Technologies, Scotland, 8. &HOO OLQH +7 $7&&
H[SUHVVLQJKLJK&2;OHYHOV
was used as a control. Cells were grown at 37ºC in a KXPLGLÀHG LQFXEDWRU ZLWK
DLU DQG &22. The FDUWLODJLQRXV SKHQRW\SH RI
the chondrosarcoma cell lines
AntigenCloneApplicManufac.OriginAgainstPositive controlPre- incubationSecondaryAntibody conc.AR COX-23*
,+& KXPDQ
1XFOLODE5DEELW+XPDQColorectal carcinoma
·EORFNLQJ solution*
$QWLUDEELW +53
Citrate COX-23*
,+& PRXVH
1XFOLODE5DEELW+XPDQColorectal carcinoma
·EORFNLQJ solution*
$QWLUDEELW envision*
Citrate .L0,%
,+& PRXVH
Dako0RXVH+XPDQ$Q\WXPRXUNoneAnti mouse ,J*+53Citrate Cleaved caspase-3 $VS
,+& PRXVH
Cell signalling5DEELW+XPDQBurkitt O\PSKRPDNone
$QWLUDEELW envision
Citrate
&' 3HFDP
,+& PRXVH
Santa Cruz5DEELW0RXVH$Q\·1*6
$QWLUDEELW envision
None COX-2IB
&D\PDQ chemicals
0RXVH+XPDQColorectal carcinoma
·QRQ IDWGU\PLONLQ 3%67ZHHQ
Anti mouse +53
QJ ml
7XEXOLQIB0RXVH+XPDQ$Q\
·QRQ IDWGU\PLONLQ 3%67ZHHQ Anti mouse +53 Table 6.2 Antibodies and protocols used for immunohistochemistry and immunoblotting. IRUKXPDQWLVVXHDQWLUDEELW+53ZDV XVHG,+&,PPXQRKLVWRFKHPLVWU\,%:HVWHUQEORW1*6QRUPDOJRDWVHUXP EORFNLQJVROXWLRQ07ULV00J&O7ZHHQ %6$DQGQRUPDOJRDWVHUXP$5DQWLJHQUHWULHYDO
ZDVFRQÀUPHGE\573&5VKRZLQJP51$H[SUHVVLRQRIcollagens I, 2B, 3, and 10; Aggrecan; and SOX9203URWHLQH[WUDFWLRQDQGLPPXQREORWWLQJZHUH
SHUIRUPHG DV GHVFULEHG SUHYLRXVO\ $ :67 FRORULPHWULF DVVD\ 5RFKH
'LDJQRVWLFV*PE+3HQ]EHUJ*HUPDQ\ZDVXVHGDVGHVFULEHGSUHYLRXVO\
WR PHDVXUH PHWDEROLF DFWLYLW\ UHSUHVHQWLQJ WKH DPRXQW RI YLDEOH FHOOV LQ
UHVSRQVH WR FHOHFR[LE 3À]HU 1< 86$ DQG 16 &D\PDQ FKHPLFDOV
$QQ$UERU0,86$ 3FKRQGURVDUFRPDFHOOV&+2806DQG
& DQG 3 +7 DQG 6: FHOOV ZHUH VHHGHG &HOHFR[LE DQG
16ZHUHGLOXWHGLQ'062$IWHUKRXUVLQFUHDVLQJFRQFHQWUDWLRQV
RIWKHGUXJVZHUHDGGHGDQGǍ0RU'062&ZDVQRW
LQFOXGHGLQWKH16DVVD\
)RUPHDVXULQJ3*(2OHYHOVFHOOVRI2806&+&DQG+7
ZHUHVHHGHGLQDZHOOVSODWHDWDGHQVLW\RI DQG6:DWD
GHQVLW\RI 7ZHQW\IRXUKRXUVDIWHUVHHGLQJFHOOVZHUHWUHDWHGZLWK
FHOHFR[LELQLQFUHDVLQJGRVDJHVDQGǍ0RUZLWK'062$IWHU
KRXUV3*(2FRQFHQWUDWLRQLQWKHPHGLXPZDVGHWHUPLQHGE\D3*(2- VSHFLÀFHQ]\PHOLQNHGLPPXQRDVVD\&D\PDQFKHPLFDOV$QQ$UERU0,
86$DFFRUGLQJWRWKHPDQXIDFWXUHU·VSURWRFROP51$ZDVH[WUDFWHGDQG
&<3$P51$OHYHOVZHUHGHWHUPLQHGWRDVVHVVDURPDWDVHDFWLYLW\20. Five SHUFHQWVHUXPVXSSOHPHQWDWLRQZDVXVHGIRUDOOH[SHULPHQWV
In vivo chondrosarcoma model
6L[W\ 6ZLVV PDOH QXGH PLFH &UO18,FR)R[QQX ,))$&5('2 /\RQ
)UDQFH ZHUH UDQGRPO\ DVVLJQHG WR RQH RI ÀYH JURXSV )LJXUH /RZ
GRVHV FRQWDLQHG SSP FHOHFR[LE KLJK GRVHV SSP 7KH VHOHFWLYH
&2; LQKLELWRU FHOHFR[LE &6 ZDV LQFRUSRUDWHG LQWR D PRGLÀHG
QXGH PRXVH GLHW $OWURPLQ *HVHOOVFKDIW IXU 7LHUHUQDKUXQJ PE+ /DJH
*HUPDQ\DQGLUUDGLDWHGWRDFFRPSOLVKVWHULOLW\0LFHZHUHDEOHWRIHHGDQG
GULQN DG OLELWXP $PRXQW RI IRRG FRQVXPHG ZDV PRQLWRUHG LQGLYLGXDOO\
3URSK\OD[LVZDVVWDUWHGGD\VSULRUWRLQRFXODWLRQDVVWHDG\VWDWHOHYHOV
RIFHOHFR[LEDUHUHDFKHGLQÀYHGD\VLQKXPDQV3À]HU$WZHHNDOOPLFH
ZHUHLQMHFWHGZLWK &+FHOOVVXEFXWDQHRXVO\RQWKHEDFN6LQFH
FKRQGURVDUFRPDV KDYH D UHODWLYHO\ VORZ JURZWK UDWH ZH ZDLWHG GD\V
IRUWKHWXPRXUVWRUHDFKDVL]HODUJHHQRXJKIRUH[WHUQDODQDO\VLVEHIRUH
WUHDWPHQW ZLWK FHOHFR[LE ZDV VWDUWHG 7UHDWPHQW ZDV SURORQJHG IRU
GD\V DIWHU ZKLFK WKH PLFH ZHUH VDFULÀFHG 7KH PLFH ZHUH ZHLJKWHG RQFH
a week. Calipers were used to measure the tumour volume in vivo using WKHIROORZLQJIRUPXODOHQJWK ZKLWK2%ORRGVDPSOHVREWDLQHGE\DRUWDO
SXQFWLRQDWWLPHRIVDFULÀFHZHUHDOORZHGWRFRDJXODWHDQGZHUHFHQWULIXJHG
IRUPLQXWHVDWUSPVXSHUQDWDQWVZHUHFROOHFWHGDQGVWRUHGDW
&XQWLO+3/&DQDO\VLV+3/&ZDVSHUIRUPHGE\&DVH%HO%RUJHUKRXW
%HOJLXPDVGHVFULEHGSUHYLRXVO\22.
7KHH[FLVHGWXPRXUVZHUHÀ[HGLQIRUPDOLQIRUKRXUVDQGHPEHGGHG
LQSDUDIÀQ7RVWXG\SRVVLEOHWR[LFLW\RIFHOHFR[LEWLVVXHRIWKHKHDUWOXQJV
OLYHUDQGNLGQH\ZHUHWDNHQDWDXWRSV\IRUKLVWRORJLFDODQDO\VLV;HQRJUDIWHG
WXPRXUVZHUHDQDO\VHGE\+ (7ROXLGLQHEOXHDQGLPPXKLVWRFKHPLVWU\
IRU&2;.LFOHDYHGFDVSDVHDQG&'7DEOH&2;VWDLQLQJ
ZDVVFRUHGDVQHJDWLYHYHU\ZHDNRUSRVLWLYH.LDQGFOHDYHGFDVSDVH
VWDLQLQJ ZHUH GLJLWDOO\ VFRUHG XVLQJ FRQIRFDO PLFURVFRS\ 1XDQFH
&DPEULGJH UHVHDUFK DQG ,QVWUXPHQWDWLRQ ,QF :REXUQ 0$ 86$ $
minimum of 2000 cells were counted and the percentage of positive cells ZDV DXWRPDWLFDOO\ FDOFXODWHG ,PDJH- 9 :D\QH 5DVEDQG 1DWLRQDO
,QVWLWXWHV RI +HDOWK 86$ WR DVVHVV PLFURYHVVHO GHQVLW\ &'SRVLWLYH
YHVVHOVZHUHFRXQWHGLQKLJKSRZHUÀHOGVSHUWXPRXU$QLQGHSHQGHQW
H[SHULPHQWZDVSHUIRUPHGXVLQJJUDGH,,FKRQGURVDUFRPD[HQRJUDIWPRGHO
ZLWKKLJKFHOHFR[LESURSK\OD[LVQ DQGWUHDWPHQWQ JURXS
Statistics
&RPSDULVRQ EHWZHHQ JURXSV ZDV SHUIRUPHG XVLQJ 3HDUVRQ &KL6TXDUH
LPPXQRKLVWRFKHPLVWU\ DQG 6WXGHQWV·V WWHVW 573&5 3 YDOXHV
ZHUHFRQVLGHUHGVLJQLÀFDQW
Results
Higher COX-2 expression in chondrosarcoma and in enchondromatosis.
,Q WRWDO LQ RI WKH FKRQGURVDUFRPDV WXPRXU FHOOV GHPRQVWUDWHG
F\WRSODVPLF &2; SURWHLQ H[SUHVVLRQ )LJXUH $ 0DOLJQDQW WXPRXUV
ZHUH PRUH RIWHQ SRVLWLYH IRU &2; WKDQ EHQLJQ WXPRXUV YV
S IRUFHQWUDODQGYVS IRUSHULSKHUDO3HDUVRQ&KL
6TXDUH ,Q WKH JURXS RI FHQWUDO FKRQGURVDUFRPDV SRVLWLYLW\ ZDV PDLQO\
VHHQ LQ HQFKRQGURPDWRVLVUHODWHG FKRQGURVDUFRPDV ZKHUHDV
SHULSKHUDO VROLWDU\ WXPRXUV ZHUH PRUH RIWHQ SRVLWLYH WKDQ 02
UHODWHGFKRQGURVDUFRPDV5HVXOWVDUHVXPPDULVHGLQWDEOH
$OVRDWP51$OHYHOHQFKRQGURPDWRVLVUHODWHGWXPRXUVWHQGWRVKRZKLJKHU
&2; H[SUHVVLRQ DV FRPSDUHG WR VROLWDU\ WXPRXUV S 6WXGHQW·V
WWHVW )LJXUH % +RZHYHU QR GLIIHUHQFH LQ &2; P51$ H[SUHVVLRQ
EHWZHHQEHQLJQQ DQGPDOLJQDQWWXPRXUVQ ZDVIRXQG6WXGHQW·V
WWHVWS QRWVKRZQ
Figure 6.16L[W\LPPXQRLQFRP- SHWHQWQXGHPLFHZHUHUDQGRPO\
DVVLJQHGWRHLWKHUSURSK\ODFWLFORZ
GRVHFHOHFR[LE3/;BORZSURSK\ODF- WLFKLJKGRVHFHOHFR[LE3/;BKLJK
WUHDWPHQWORZGRVHFHOHFR[LE750B ORZWUHDWPHQWKLJKGRVHFHOHFR[LE
3/;BKLJKRUFRQWUROJURXS&RQ- WURO
COX-2 inhibitors decrease proliferation of chondrosarcomas in vitro
$OOIRXUFKRQGURVDUFRPDFHOOOLQHVGHPRQVWUDWHG&2;SURWHLQH[SUHVVLRQ
LQYDULDEOHOHYHOV)LJXUH$$IWHUKRXUVRIǍ0FHOHFR[LEWUHDWPHQW
DGHFUHDVHLQFHOOYLDELOLW\ZDVREVHUYHGFRPSDUDEOHWR+7LQWKHWKUHH
FHOOOLQHVWKDWZHUHGHULYHGIURPVROLWDU\WXPRXUV)LJXUH%)RU2806
DGHFUHDVHLQFHOOYLDELOLW\ZDVREVHUYHGDOUHDG\DWǍ0FHOHFR[LE&
GLGQRWUHVSRQGWRFHOHFR[LE)LJXUH%QRWHYHQZKHQWUHDWPHQWZDV
SURORQJHGIRUKRXUVGDWDQRWVKRZQ(IIHFWVRI16ZHUHPRUHVXEWOH
)LJXUH&
Response to celecoxib is independent of COX-2 activity
%\3*(2(/,6$ZHVKRZHGWKDWLQ&+2806DQG&WKH&2;
HQ]\PHV DUH DFWLYH DQG WKDW D GRVH RI Ǎ0 FHOHFR[LE ZDV HQRXJK WR
VLJQLÀFDQWO\GHFUHDVH3*(2OHYHOV)LJXUH'5HPDUNDEO\ZHZHUHQRW
DEOHWRGHWHFW&2;DFWLYLW\LQ+7DQG6:ZKLFKERWKUHVSRQGHG
ZHOOWRFHOHFR[LEWUHDWPHQW5HODWLYH&<3$P51$OHYHOVZHUHGHFUHDVHG
WZRIROG XSRQ FHOHFR[LE WUHDWPHQW LQ 6: ZKHUHDV LQ &+ DQG
&&<3$OHYHOVZHUHLQFUHDVHGWZRIROGGDWDQRWVKRZQ
Figure 6.2 $ &\WRSODVPLF &2; H[- pression in central chondrosarcoma JUDGH,%&2;P51$ZDVKLJKHUH[- pressed in central cartilaginous tumours FRPSDUHG WR JURZWK SODWH *3 VDPSOHV
and tumours related to enchondroma- WRVLV (& VKRZHG KLJKHU H[SUHVVLRQ RI
&2;WKDQVROLWDU\WXPRXUV
Celecoxib initially slows tumour growth in chondrosarcoma xenografts During the in vivo VWXG\DOOPLFHKDGFRPSDUDEOHERG\ZHLJKWVDQGDPRXQWV
RIIRRGDGPLQLVWHUHG$6L[PLFHGLHGGXULQJWKHH[SHULPHQWVERWKLQ
WKHFHOHFR[LEDQGWKHFRQWUROJURXSV6HUXPOHYHOVRIFHOHFR[LEFRUUHVSRQGHG
WRWKHGRVHRIFHOHFR[LEDGPLQLVWHUHGDOWKRXJKOHYHOVZHUHYDULDEOH)LJXUH
%7XPRXUVL]HZDVQHJDWLYHO\FRUUHODWHGWRFHOHFR[LEVHUXPOHYHOV
U )LJXUH&$WZHHNVWKHWXPRXUYROXPHVHHPHGVPDOOHULQ
WKH JURXSV UHFHLYLQJ FHOHFR[LE SURSK\OD[LV ZKLFK ZDV VLJQLÀFDQW IRU WKH
KLJK GRVH DV FRPSDUHG WR WKH FRQWURO JURXS 6WXGHQW·V WWHVW S
ORZGRVHDQGS KLJKGRVHUHVSHFWLYHO\)LJXUH'+LVWRORJLFDO
HYDOXDWLRQRIWKHKHDUWOXQJVOLYHUVSOHHQDQGNLGQH\VRIWKHPLFHGLGQRW
UHYHDODQ\VLJQVRIWR[LFLW\
Relapse of tumour growth in xenografts after prolonged treatment
$W ZHHN D UHODSVH ZDV REVHUYHG PRVW FOHDUO\ LQ WKH ORZ FHOHFR[LE
SURSK\OD[LV DQG WUHDWPHQW JURXSV $W WKH HQG RI WKH H[SHULPHQW ZHHN
RQO\WKHKLJKSURSK\OD[LVJURXSVKRZHGVPDOOHUWXPRXUYROXPHVWKDQ
WKHFRQWUROJURXS)LJXUH(+RZHYHUGXHWRODUJHYDULDWLRQLQWXPRXU
volume within the groups, statistical calculations are not meaningful. The JURZWKFXUYHVRIWKHWXPRXUVVKRZHGWKDWDWZHHNWKHWXPRXUVVWDUWHG
WRJURZHYHQIDVWHUWKDQWKHFRQWUROJURXS)LJXUH)7KLVZDVH[DFWO\
WKH WLPH SRLQW DW ZKLFK WKH JURZWK FXUYHV RI WKH PLFH ÁDWWHQHG )LJXUH
Figure 6.3$&2;SURWHLQH[SUHVVLRQLQFHOOOLQHV%GHFUHDVHGYLDELOLW\6:2806
DQG&+XSRQǍ0FHOHFR[LEWUHDWPHQW&16KDVDPRGHUDWHHIIHFWG&2;DF- WLYLW\LVDEVHQWLQ6:DQGGHFUHDVHGXSRQǍ0FHOHFR[LEWUHDWPHQWLQ2806&+
DQG&
$ VXJJHVWLQJ WKH HQG RI SXEHUW\ 7KH LQGHSHQGHQW H[SHULPHQWV LQ
ZKLFKKLJKFHOHFR[LEGRVHVZHUHXVHGVKRZHGVLPLODUUHVXOWVIRUWKHJUDGH
,,FKRQGURVDUFRPD[HQRJUDIWPRGHOGDWDQRWVKRZQ Evaluation of tumour tissue
7XPRXUVZHUHKLJKO\FHOOXODUZLWKOLPLWHGF\WRQXFOHDUDW\SLDDQGDOLPLWHG
DPRXQW RI H[WUDFHOOXODU PDWUL[ )LJXUH $ 7ROXLGLQHEOXH VWDLQLQJ
FRQÀUPHG WKH GHSRVLWLRQ RI SURWHRJO\FDQV )LJXUH % :KHUHDV LQ DOO
FHOHFR[LEWUHDWHGJURXSV&2;VWDLQLQJZDVDEVHQWRUYHU\ZHDN)LJXUH
&VWURQJ&2;H[SUHVVLRQZDVREVHUYHGLQRIWKHFRQWUROWXPRXUV
Figure 6.4$0LFHERG\ZHLJKWLQFUHDVHVWLOOZHHN%&HOHFR[LEEORRGOHYHOVFRUUHVSRQG
WRFHOHFR[LEGRVH&WXPRXUYROXPHLVQHJDWLYHO\FRUUHODWHGZLWKFHOHFR[LEVHUXPOHYHOV
U '/RZHUWXPRXUYROXPHLQSURSK\OD[LVJURXSDWZHHN(WXPRXUVH[SRVHGWR
ORZGRVHFHOHFR[LEDUHODUJHUWKDQFRQWUROVDWZHHNDOWKRXJKYDULDWLRQZLWKLQWKHJURXSV
LVFRQVLGHUDEOH)2YHUDOOJURZWKFXUYHRIWKHWXPRXUVVKRZLQJUHODSVHDWZHHNIRUWKRVH
H[SRVHGWRORZGRVHFHOHFR[LE VLJQLÀFDQWO\GLIIHUHQWIURPFRQWUROV
)LJXUH'3UROLIHUDWLRQZDVVHHQLQDOOJURXSV)LJXUH(ZLWKKLJKHU
.LH[SUHVVLRQLQWKHWUHDWHGWXPRXUVDWZHHN6WXGHQW·VWWHVWORZGRVH
S DQGKLJKGRVHS $VWHULVNVÀJXUH)&OHDYHGFDVSDVH
H[SUHVVLRQ ZDV ORZ PHDQ UDQJH DV ZDV PLFURYHVVHO
GHQVLW\PHDQSHUKSIUDQJHSHUKSIDQGQRGLIIHUHQFHV
EHWZHHQJURXSVZHUHIRXQG)LJXUHV*+
Discussion
Since there is nothing to offer with curative intent to patients with PHWDVWDWLFRULQRSHUDEOHFKRQGURVDUFRPDWKHUHLVDGHVSHUDWHQHHGIRUQHZ
therapeutic options. Furthermore, the prevention of development of new WXPRXUV DQG HVSHFLDOO\ RI PDOLJQDQW WUDQVIRUPDWLRQ RI EHQLJQ SUHFXUVRU
leasions in patients with enchondromatosis and multiple osteochondromas ZRXOGJUHDWO\LPSURYHWKHSURJQRVLVRIWKHVHFKLOGUHQDQG\RXQJDGXOWV,Q
WKLVVWXG\ZHLQYHVWLJDWHGWKHSRWHQWLDORIVHOHFWLYH&2;LQKLELWLRQIRUWKH
treatment of chondrosarcoma.
:H GHPRQVWUDWHG H[SUHVVLRQ RI &2; LQ D VXEVHW RI HQFKRQGURPDV
RVWHRFKRQGURPDV DQG FHQWUDO DQG SHULSKHUDO FKRQGURVDUFRPDV FRQÀUPLQJ SXEOLVKHG UHVXOWV ,QWHUHVWLQJO\ &2;
SURWHLQ DQG P51$ H[SUHVVLRQ ZDV PDLQO\ IRXQG LQ HQFKRQGURPDWRVLV
UHODWHGWXPRXUVZKHUHDVFRUUHODWLRQZLWKKLVWRORJLFDOJUDGHFRXOGQRWEH
FRQÀUPHG
&KRQGURVDUFRPDFHOOYLDELOLW\GHFUHDVHGDIWHUDGPLQLVWUDWLRQRIKLJKVXSHU
SK\VLRORJLFOHYHOVRIFHOHFR[LEDQG16ZKLOHDSK\VLRORJLFGRVDJHRI
FHOHFR[LEZDVDEOHWRDEROLVKPRVW&2;DFWLYLW\LQWKUHHFHOOOLQHV'HVSLWH
WKHODFNRI&2;DFWLYLW\LQ6:DGHFUHDVHLQFHOOYLDELOLW\ZDVIRXQG
LQUHVSRQVHWRFHOHFR[LEZKLFKVXJJHVWVD&2;LQGHSHQGHQWPHFKDQLVP
ZKLFKZDVSUHYLRXVO\VXJJHVWHGIRUFRORUHFWDOFDQFHUUHYLHZHGE\*URVFKHW
al.23,QEUHDVWFDQFHU&2;LQKLELWRUVZHUHIRXQGWRVXSSUHVVDURPDWDVH
DFWLYLW\LQERWKD3*(2 dependent and independent manner, and Cleton- -DQVHQ HW DO VKRZHG WKDW FKRQGURVDUFRPD JURZWK FRXOG EH LQKLELWHG E\
DURPDWDVHLQKLELWRUVin vitro207KHGHFUHDVHLQ&<3$DFWLYLW\LQ6:
GXULQJ FHOHFR[LE WUHDWPHQW VXJJHVWV WKDW WKLV JURZWK LQKLELWRU\ HIIHFW LV
H[HUWHGYLDWKHLQKLELWLRQRIDURPDWDVH
6LQFHWKUHHRIIRXUFKRQGURVDUFRPDFHOOOLQHVUHVSRQGHGWRFHOHFR[LEin vitro, ZHDOVRWHVWHGFHOHFR[LELQFKRQGURVDUFRPD[HQRJUDIWV&HOHFR[LEWUHDWPHQW
ZDVLQLWLDOO\HIIHFWLYHLQVORZLQJWKHJURZWKUDWHRIFKRQGURVDUFRPD0RUHRYHU
WXPRXUVL]HZDVLQYHUVHO\FRUUHODWHGZLWKFHOHFR[LEVHUXPOHYHOVPHDVXUHG
DWWKHHQGRIWKHH[SHULPHQW+RZHYHUDUHODSVHZDVREVHUYHGLQZHHN
ZKLFKZDVHVSHFLDOO\SURPLQHQWLQWKHPLFHUHFHLYLQJORZGRVHFHOHFR[LE
In addition, the treated tumours showed an increased proliferation rate.
,QWHUHVWLQJO\DWZHHNWKHJURZWKFXUYHRIWKHPLFHÁDWWHQHGVXJJHVWLQJ
WKHHQGRISXEHUW\ZKLFKVXJJHVWVKRUPRQDOLQÁXHQFHVRQWXPRXUJURZWK
+HUHWKLVHIIHFWFDQQRWEHDWWULEXWHGWRHVWURJHQVVLQFH&+LVHVWURJHQ
receptor negative.
2QHRIWKHPHFKDQLVPVRIWXPRXULQKLELWLRQRIFHOHFR[LELVWKRXJKWWREHWKH
LQKLELWLRQRIDQJLRJHQHVLV7KHUHODSVHDWZHHNPLJKWUHÁHFWDWLPHSRLQW
ZKHUHFHOHFR[LEFDQQRORQJHULQKLELWDQJLRJHQHVLVDOORZLQJYHVVHOLQJURZWK
$W VDFULÀFH QR GLIIHUHQFHV LQ PLFURYHVVHO GHQVLW\ ZHUH IRXQG VXJJHVWLQJ
WKDW HLWKHU GLIIHUHQFHV LQ PLFURYHVVHO GHQVLW\ DUH FRPSOHWHO\ RYHUFRPH RU
D GLIIHUHQW PHFKDQLVP ZDV UHVSRQVLEOH IRU WKH LQLWLDO GHFUHDVHG WXPRXU
JURZWK8QIRUWXQDWHO\ZHZHUHQRWDEOHWRVWXG\WXPRXUFKDUDFWHULVWLFVRU
EORRGSDUDPHWHUVGXULQJWKHH[SHULPHQW
,Q DQDORJ\ WR WKH SUHYHQWLRQ RI QHZ DGHQRPD IRUPDWLRQ LQ IDPLOLDO
DGHQRPDWRXV SRO\SRVLV SUHYHQWLRQ RI GHYHORSPHQW DQG PDOLJQDQW
transformation of enchondromas and osteochondromas in patients with HQFKRQGURPDWRVLV DQG PXOWLSOH RVWHRFKRQGURPDV PLJKW EH EHQHÀFLDO
$OWKRXJKZHVKRZHG&2;H[SUHVVLRQWREHKLJKHULQHQFKRQGURPDWRVLV
UHODWHG WXPRXUV FRPSDUHG WR VROLWDU\ WXPRXUV WKH HQFKRQGURPDWRVLV
GHULYHGFHOOOLQH&GLGQRWUHVSRQGWRFHOHFR[LEWUHDWPHQWin vitro. In YLYRDJURZWKLQKLELWLQJHIIHFWZDVVKRZQLQWKHÀUVWZHHNVRIWKHVWXG\LQ
WKHSUHSXEHUWDOPLFHZKLFKZDVDEROLVKHGDWWKHPRPHQWWKHPLFHUHDFKHG
DGXOWKRRG7KLVPLJKWVXJJHVWWKDWFHOHFR[LELVPRUHHIIHFWLYHLQSUHSXEHUWDO
SDWLHQWV0RUHRYHUWKHUHZDVDWUHQGIRUKLJKGRVHSURSK\ODFWLFFHOHFR[LE
WUHDWPHQWWRKDYHVPDOOHUWXPRXUVDWWKHHQGRIWKHVWXG\+RZHYHUWKH
KLJKGRVHSURSK\OD[LVJURXSVKRZHGDKLJKHUSUROLIHUDWLRQUDWHDVFRPSDUHG
to the control. Thus, our results are not conclusive on whether the paediatric population of multiple osteochondromas and enchondromatosis patients PLJKW EHQHÀW IURP FHOHFR[LE WUHDWPHQW DQG IXUWKHU VWXGLHV VKRXOG EH
SHUIRUPHG,QDGGLWLRQLWVKRXOGEHQRWHGWKDWRXUPRGHOLVVXERSWLPDOWR
VWXG\WKHHIIHFWRIFHOHFR[LERQSUHYHQWLRQRIPDOLJQDQWWUDQVIRUPDWLRQVLQFH
ZHXVHGKLJKJUDGHFKRQGURVDUFRPD[HQRJUDIWV8QIRUWXQDWHO\WKHUHLVQR
VXLWDEOHin vivo model for enchondromatosis or multiple osteochondromas, DQG[HQRJUDIWVIURPORZJUDGHFKRQGURVDUFRPDVDUHGLIÀFXOWWRREWDLQ
'XULQJ ORQJWHUP FOLQLFDO WULDOV &2; LQKLELWRUV ZHUH VKRZQ WR KDYH
FDUGLRYDVFXODUVLGHHIIHFWV&HOHFR[LEWULDOVZHUHGLVFRQWLQXDWHGHDUOLHU25 and URIHFR[LEZDVZLWKGUDZQE\WKH)'$+RZHYHUFKLOGUHQDQGDGROHVFHQWV
DUHDWORZULVNRIFDUGLRYDVFXODUGLVHDVHZKLFKUHQGHUVWKHXVHRIFHOHFR[LE
UHODWLYHO\VDIH$FFRUGLQJO\FHOHFR[LELVSUHVFULEHGWRMXYHQLOHUKHXPDWRLG
DUWKULWLV SDWLHQWV IURP WKH DJH RI \HDUV UHYLHZHG LQ )UDPSWRQ HW DO27
1H[WWRLWVSRWHQWLDODQWLWXPRXUHIIHFWFHOHFR[LEVDQDOJHWLFHIIHFWZLOOEH
EHQHÀFLDOIRUPXOWLSOHRVWHRFKRQGURPDVDQGHQFKRQGURPDWRVLVSDWLHQWV
left page Figure 6.5$+ (VWDLQLQJRIWKH&+[HQRJUDIW%7ROXLGLQHEOXHVWDLQLQJ
FRQÀUPHGSURWHRJO\FDQFRQWHQW&$EVHQWRUYHU\ZHDN&2;VWDLQLQJLQWUHDWHGWXPRXUV
'VWURQJ&2;VWDLQLQJLQRIWKHFRQWUROV()+LJKHUSUROLIHUDWLRQUDWH.LLQWKH
FHOHFR[LEWUHDWHGWXPRXUV*&DVSDVHPHGLDWHGDSRSWRVLVLVOLPLWHG+0LFURYHVVHOV
GHWHFWHGE\&'
,QFRQFOXVLRQZHFRQÀUPHGH[SUHVVLRQRI&2;LQRIFKRQGURVDUFRPDV
DQG &2; LQKLELWLRQ GLPLQLVKHG FHOO YLDELOLW\ in vitro, although this ZDV LQGHSHQGHQW RI &2; DFWLYLW\ +RZHYHU XVLQJ D JUDGH ,, DQG ,,,
FKRQGURVDUFRPD [HQRJUDIW PRGHO ZH REVHUYHG D VZLWFK IURP WXPRXU
LQKLELWRU\ WR WXPRXU SURPRWLQJ HIIHFWV ZKHQ PLFH UHDFKHG DGXOWKRRG
VXJJHVWLQJWKDWHYHQWKRXJKWXPRXUYROXPHZDVQHJDWLYHO\DVVRFLDWHGZLWK
FHOHFR[LEVHUXPOHYHOVWKHUHLVQRUROHIRUFHOHFR[LELQWKHWUHDWPHQWRIDGXOW
KLJKJUDGH FKRQGURVDUFRPD 7KH UROH RI KLJKGRVH SURSK\ODFWLF FHOHFR[LE
LQ SUHYHQWLQJ GHYHORSPHQW RI EHQLJQ DQG PDOLJQDQW FDUWLODJH WXPRXUV LQ
SUHSXEHUWDO(&DQG02SDWLHQWVGHVHUYHVIXUWKHULQYHVWLJDWLRQ
Acknowledgements
7KHDXWKRUVOLNHWRWKDQN3-..XSSHQ'HSDUWPHQWRI6XUJHU\/80&
7KH1HWKHUODQGV3&:+RJHQGRRUQ'HSDUWPHQWRI3DWKRORJ\/80&7KH
1HWKHUODQGV0.DUSHULHQ'HSDUWPHQWRI7LVVXH5HJHQHUDWLRQ8QLYHUVLW\
RI7ZHQWH7KH1HWKHUODQGVDQG&(3$VVHOEHUJV'HSDUWPHQWRI6XUJHU\
/80& 7KH 1HWKHUODQGV IRU IUXLWIXO GLVFXVVLRQ DQG ) 3ULQV $ YDQ GHU
:DODQG3:LMHUV.RVWHUIRUH[FHOOHQWWHFKQLFDODVVLVWDQFH
*UDQWVXSSRUW1HWKHUODQGV2UJDQLVDWLRQIRU6FLHQWLÀF5HVHDUFK>
<06 DQG WR -90*%@ 7KLV VWXG\ ZDV SHUIRUPHG
ZLWKLQ WKH FRQWH[W RI WKH (XUR%R1H7 FRQVRUWLXP >@ D (XURSHDQ
&RPPLVVLRQJUDQWHG1HWZRUNRI([FHOOHQFHIRUVWXG\LQJWKHSDWKRORJ\DQG
JHQHWLFVRIERQHWXPRXUV
Reference List
(YDQV+/$\DOD$*5RPVGDKO003URJQRVWLFIDFWRUVLQFKRQGURVDUFRPD
RI ERQH $ FOLQLFRSDWKRORJLF DQDO\VLV ZLWK HPSKDVLV RQ KLVWRORJLF JUDGLQJ
Cancer
%ULHQ(:0LUUD-0/XFN-9-U%HQLJQDQGPDOLJQDQWFDUWLODJHWXPRXUV
RIERQHDQGMRLQWWKHLUDQDWRPLFDQGWKHRUHWLFDOEDVLVZLWKDQHPSKDVLVRQ
UDGLRORJ\SDWKRORJ\DQGFOLQLFDOELRORJ\,,-X[WDFRUWLFDOFDUWLODJHWXPRXUV
Skeletal Radiol
%HUWRQL)%DFFKLQL3+RJHQGRRUQ3&:&KRQGURVDUFRPD,Q)OHWFKHU&'0
8QQL .. 0HUWHQV ) HGLWRUV :RUOG +HDOWK 2UJDQLVDWLRQ FODVVLÀFDWLRQ RI
WXPRXUV 3DWKRORJ\ DQG JHQHWLFV RI WXPRXUV RI VRIW WLVVXH DQG ERQH/\RQ
,$5&3UHVVS
/XFDV'5%ULGJH-$&KRQGURPDVHQFKRQGURPDSHULRVWHDOFKRQGURPDDQG
HQFKRQGURPDWRVLV ,Q )OHWFKHU &'0 8QQL .. 0HUWHQV ) HGLWRUV :RUOG
+HDOWK 2UJDQL]DWLRQ FODVVLÀFDWLRQ RI WXPRXUV 3DWKRORJ\ DQG JHQHWLFV RI
WXPRXUVRIVRIWWLVVXHDQGERQH/\RQ,$5&3UHVVS
2OOLHU0'\VFKRQGURSODVLHLyon Med
6FKZDUW] +6 =LPPHUPDQ 1% 6LPRQ 0$ :UREOH 55 0LOODU ($ %RQÀJOLR
0 7KH PDOLJQDQW SRWHQWLDO RI HQFKRQGURPDWRVLV J Bone Joint Surg Am
6WHLQEDFK*/\QFK303KLOOLSV5.:DOODFH0++DZN(*RUGRQ*%HWDO
7KHHIIHFWRIFHOHFR[LEDF\FORR[\JHQDVHLQKLELWRULQIDPLOLDODGHQRPDWRXV
SRO\SRVLVN Engl J Med
9DQ6WRON56WRQHU*+D\WRQ:/&KDQ.'H<RXQJ%.UHVW\/HWDO3KDVH
,WULDORIH[LVXOLQGVXOLQGDFVXOIRQH)*1DVDFKHPRSUHYHQWLYHDJHQWLQ
SDWLHQWVZLWKIDPLOLDODGHQRPDWRXVSRO\SRVLVClin Cancer Res
%DURQ -$ &ROH %) 6DQGOHU 56 +DLOH 5: $KQHQ ' %UHVDOLHU 5 HW DO $
randomized trial of aspirin to prevent colorectal adenomas. N Engl J Med
6PLWK :/ 0DUQHWW /- 'H:LWW '/ 3URVWDJODQGLQ DQG WKURPER[DQH
ELRV\QWKHVLVPharmacol Ther
(QGR00DWVXPXUD7<DPDJXFKL7<DPDJXFKL80RULPRWR<1DNDWDQL
)HWDO&\FORR[\JHQDVHRYHUH[SUHVVLRQDVVRFLDWHGZLWKDSRRUSURJQRVLVLQ
chondrosarcomas. Hum Pathol
6XWWRQ.0:ULJKW0)RQGUHQ*7RZOH&$0DQNLQ+-&\FORR[\JHQDVH
H[SUHVVLRQLQFKRQGURVDUFRPDOncology
%RYpH-90*&OHWRQ-DQVHQ$0.XLSHUV'LMNVKRRUQ19DQGHQ%URHN/-&0
7DPLQLDX$+0&RUQHOLVVH&-HWDO/RVVRIKHWHUR]\JRVLW\DQG'1$SORLG\
point to a diverging genetic mechanism in the origin of peripheral and central chondrosarcoma. Genes Chrom Cancer
%DHOGH+-&OHWRQ-DQVHQ$0YDQ%HHUHQGRQN+1DPED0%RYpH-90*
+RJHQGRRUQ3&:+LJKTXDOLW\51$LVRODWLRQIURPWXPRXUVZLWKORZFHOOXODULW\
DQGKLJKH[WUDFHOOXODUPDWUL[FRPSRQHQWIRUF'1$PLFURDUUD\VDSSOLFDWLRQWR
chondrosarcoma. J Clin Pathol
+DPHHWPDQ/5R]HPDQ/%/RPEDHUWV02RVWLQJ-7DPLQLDX$+0&OHWRQ
-DQVHQ$0HWDO3HULSKHUDOFKRQGURVDUFRPDSURJUHVVLRQLVDFFRPSDQLHGE\
GHFUHDVHG,QGLDQ+HGJHKRJ,++VLJQDOOLQJJ Pathol
9DQGHVRPSHOH - 'H 3UHWHU . 3DWW\Q ) 3RSSH % 9DQ 5R\ 1 'H 3DHSH
$ HW DO $FFXUDWH QRUPDOL]DWLRQ RI UHDOWLPH TXDQWLWDWLYH 573&5 GDWD
E\ JHRPHWULF DYHUDJLQJ RI PXOWLSOH LQWHUQDO FRQWURO JHQHV Genome Biol
UHVHDUFK
*LO%HQVR 5 /RSH]*LQHV & /RSH]*XHUUHUR -$ &DUGD & &DOODJKDQ 5&
1DYDUUR6HWDO(VWDEOLVKPHQWDQGFKDUDFWHUL]DWLRQRIDFRQWLQXRXVKXPDQ
FKRQGURVDUFRPDFHOOOLQHFKFRPSDUDWLYHKLVWRORJLFDQGJHQHWLFVWXGLHV
with its tumour of origin. Lab Invest
.XQLVDGD70L\D]DNL00LKDUD.*DR&.DZDL$,QRXH+HWDO$QHZ
KXPDQ FKRQGURVDUFRPD FHOO OLQH 2806 WKDW PDLQWDLQV FKRQGURF\WLF
differentiation. Int J Cancer
.DOLQVNL 7 .UXHJHU 6 3HO] $) :LHDFNHU 3 +DUWLJ 5 5RSNH 0 HW DO
(VWDEOLVKPHQWDQGFKDUDFWHUL]DWLRQRIWKHSHUPDQHQWKXPDQFHOOOLQH&
GHULYHGIURPDVHFRQGDU\FKRQGURVDUFRPDLQ2OOLHU·VGLVHDVHVirchows Arch
&OHWRQ-DQVHQ$0YDQ%HHUHQGRQN+0%DHOGH+-%RYpH-90*.DUSHULHQ
0+RJHQGRRUQ3&:(VWURJHQVLJQDOOLQJLVDFWLYHLQFDUWLODJLQRXVWXPRXUV
LPSOLFDWLRQVIRUDQWLHVWURJHQWKHUDS\DVWUHDWPHQWRSWLRQRIPHWDVWDVL]HGRU
LUUHVHFWDEOHFKRQGURVDUFRPDClin Cancer Res
6FKUDJH <0 %ULDLUHGH %UXLMQ ,+ GH 0LUDQGD 1)&& YDQ 2RVWHUZLMN -
7DPLQLDX $+0 YDQ :H]HO 7 HW DO .LQRPH SURÀOLQJ RI FKRQGURVDUFRPD
UHYHDOV 6UFSDWKZD\ DFWLYLW\ DQG GDVDWLQLE DV RSWLRQ IRU WUHDWPHQW Cancer Res
GH+HHU+36DQGHO0+*XHUWHQV*GH%*.RXGLMV001DJHONHUNH-)HWDO
&HOHFR[LELQKLELWVJURZWKRIWXPRXUVLQDV\QJHQHLFUDWOLYHUPHWDVWDVHVPRGHO
for colorectal cancer. Cancer Chemother Pharmacol
*URVFK 6 0DLHU 7- 6FKLIIPDQQ 6 *HLVVOLQJHU * &\FORR[\JHQDVH &2;
LQGHSHQGHQWDQWLFDUFLQRJHQLFHIIHFWVRIVHOHFWLYH&2;LQKLELWRUVJ Natl
Cancer Inst
6X%'LD]&UX](6/DQGLQL6%UXHJJHPHLHU5:6XSSUHVVLRQRIDURPDWDVH
LQKXPDQEUHDVWFHOOVE\DF\FORR[\JHQDVHLQKLELWRUDQGLWVDQDORJLQYROYHV
PXOWLSOH PHFKDQLVPV LQGHSHQGHQW RI F\FORR[\JHQDVH LQKLELWLRQ Steroids
6RORPRQ 6' 0F0XUUD\ -- 3IHIIHU 0$ :LWWHV - )RZOHU 5 )LQQ 3 HW DO
&DUGLRYDVFXODUULVNDVVRFLDWHGZLWKFHOHFR[LELQDFOLQLFDOWULDOIRUFRORUHFWDO
adenoma prevention. N Engl J Med
%UHVDOLHU566DQGOHU564XDQ+%RORJQHVH-$2[HQLXV%+RUJDQ.HW
DO&DUGLRYDVFXODUHYHQWVDVVRFLDWHGZLWKURIHFR[LELQDFRORUHFWDODGHQRPD
chemoprevention trial. N Engl J Med
)UDPSWRQ-(.HDWLQJ*0&HOHFR[LEDUHYLHZRILWVXVHLQWKHPDQDJHPHQW
of arthritis and acute pain. Drugs