Publications by authors named "Roderick Clifton Bligh"

The association between RET and multiple endocrine neoplasia type 2 was established in 1993 and remains one of the very few oncogenes for which distinct phenotypes (medullary thyroid cancer or phaeochromocytoma) are associated with the same hot-spot variants occurring either in germline or somatic DNA. Somatic RET fusion events have also been described in several cancers, including papillary thyroid cancer, non-small cell lung cancer, breast cancer, salivary gland cancer and pancreatic cancer. Highly selective RET inhibitors have improved outcomes in RET-altered cancers and have been well tolerated.

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The orphan nuclear receptor Nr4a1 has complex biological functions and has been implicated in numerous diseases, including cardiovascular disease. While protective in atherosclerosis and myocardial ischemia, Nr4a1 has been shown to cause cardiac fibrosis in non-ischemic adverse remodeling of the heart. However, mechanisms underlying these actions are still poorly understood.

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Liquid biopsies are a minimally invasive approach to obtain biomarkers including cell free DNA (cfDNA) from peripheral blood. Our study evaluated the utility of cfDNA in advanced thyroid cancers. Patients aged >18 years with metastatic medullary thyroid cancer (MTC), poorly differentiated thyroid cancer (PDTC), or anaplastic thyroid cancer (ATC) were enrolled in this prospective study between 2020 and 2024.

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Current therapeutic approaches for osteoporosis predominantly involve antiresorptive agents, but the emergence of bone anabolic therapy, such as romosozumab, presents a promising alternative. Romosozumab, a monoclonal antibody targeting sclerostin, exhibits both bone anabolic and antiresorptive effects, offering the potential to enhance bone mineral density and mitigate fracture risk. Evidence from several studies demonstrating the efficacy of romosozumab is now established in improving bone mineral density and reducing fracture rates in postmenopausal women and men.

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  • Accelerated bone loss is common in the first 2-3 years after traumatic spinal cord injury (TSCI), especially in the distal femur and proximal tibia, with limited studies focused on treating this condition.
  • A study conducted from 2018 to 2023 involved two groups: an 'acute interventional cohort' receiving zoledronic acid (ZOL) and a 'chronic non-interventional cohort' not receiving treatment, both monitored for bone mineral density (BMD) over time.
  • Results showed that the acute group, despite receiving ZOL, experienced significant BMD decline at 12 and 48 months, indicating that this treatment did not effectively prevent bone loss, highlighting the need for further research on
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  • The study explores the use of an online clinical support tool designed to minimize judgment variability, or "noise," in prescribing radioactive iodine (RAI) for patients with differentiated thyroid cancer (DTC).
  • It involved applying the tool to 103 patients treated from 2021-2022 and comparing it to 393 patients treated from 2017-2021, showing significant reductions in RAI dosages for intermediate and high-risk patients.
  • The results indicate that the tool effectively reduces variability in treatment decisions without increasing recurrence rates, suggesting it's a beneficial resource for clinical practice in DTC management.
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Phaeochromocytomas (PC) and paragangliomas (PG) are neural crest cancers with high heritability. Recent advances in molecular profiling, including multi-omics and single cell genomics has identified up to seven distinct molecular subtypes. These subtypes are defined by mutations involving hypoxia-inducible factors (HIFs), Krebs cycle, kinase and WNT signalling, but are also defined by chromaffin differentiation states.

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  • The ROLEX-DUO study is a randomized controlled trial aimed at understanding if high-intensity resistance and impact exercise combined with romosozumab can improve bone density and muscle outcomes in postmenopausal women with osteoporosis/osteopenia.
  • The trial involves 102 participants who will be divided into three groups: one receiving romosozumab with supervised high-intensity exercise, another receiving romosozumab with low-intensity exercise, and a third group getting a placebo with low-intensity exercise.
  • Key outcomes to be measured include changes in lumbar spine bone mineral density and performance on a sit-to-stand test, along with various secondary health indicators related to bone health and quality of life over an 8-month period
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Phaeochromocytomas and paragangliomas (PPGL) are rare neuroendocrine tumours that arise not only in adulthood but also in childhood and adolescence. Up to 70-80% of childhood PPGL are hereditary, accounting for a higher incidence of metastatic and/or multifocal PPGL in paediatric patients than in adult patients. Key differences in the tumour biology and management, together with rare disease incidence and therapeutic challenges in paediatric compared with adult patients, mandate close expert cross-disciplinary teamwork.

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Anaplastic thyroid cancer (ATC), a rare and highly aggressive malignancy, is characterized by an exceptionally poor prognosis, where the majority of patients present with extensive local invasion and/or distant metastases. 20-30% of ATCs harbor the BRAF-V600E mutation. Neoadjuvant BRAF-targeted therapy may have the potential to downstage and facilitate surgical resection for patients with locally advanced and unresectable primary tumors with BRAF mutation and may convey a survival advantage in those with metastatic disease.

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Phaeochromocytomas and paragangliomas (collectively termed PPGL) are rare yet highly heritable neuroendocrine tumours, with over one-third of cases associated with germline pathogenic variants (PVs) in numerous genes. PVs in the succinate dehydrogenase subunit-A gene (SDHA) were initially implicated in hereditary PPGL in 2010, and SDHA has since become an important susceptibility gene accounting for up to 2.8% of cases.

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  • Several small genetic studies on atypical femur fractures (AFF) have been conducted, but results lacked replication; this study uses whole exome sequencing to analyze genetic factors in a larger sample of 139 European AFF cases and 196 controls.
  • The analysis identified suggestive associations with genes like PLOD2, XRN2, and SORD, although not statistically significant; replication studies showed varying consistency across populations.
  • Findings suggest that genetic factors influencing AFFs differ among individuals and highlight the need for larger studies to further understand the genetic basis of AFF.*
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Despite well-defined criteria for radiographic diagnosis of atypical femur fractures (AFFs), missed and delayed diagnosis is common. An AFF diagnostic software could provide timely AFF detection to prevent progression of incomplete or development of contralateral AFFs. In this study, we investigated the ability for an artificial intelligence (AI)-based application, using deep learning models (DLMs), particularly convolutional neural networks (CNNs), to detect AFFs from femoral radiographs.

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In this review, we explore the underlying molecular biology of medullary thyroid carcinoma (MTC) and its interplay with the host immune system. MTC is consistently driven by a small number of specific pathogenic variants, beyond which few additional genetic events are required for tumorigenesis. This explains the exceedingly low tumour mutational burden seen in most MTC, in contrast to other cancers.

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  • Hereditary mutant pheochromocytomas (PC) and paragangliomas (PG) are rare tumors that tend to metastasize unpredictably, prompting a study to better understand their genomic characteristics.
  • A multi-omic analysis of 94 tumors from 79 patients revealed distinct molecular profiles based on whether the tumors originated from sympathetic or parasympathetic cells, with specific alterations linked to metastatic behavior.
  • The study also identified high mutation loads, unusual genomic features, and mechanisms of resistance to DNA alkylating chemotherapies, enhancing the comprehension of these complex neuroendocrine tumors and their treatment responses.
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Papillary thyroid cancer (PTC) and lymphocytic thyroiditis (LT) co-occur with a prevalence of about 30%. PTC harboring (PTC-) confers a worse prognosis, but it is unclear if LT alters prognostic features and recurrence of PTC. We compared the prevalence of PTC- with and without LT.

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Unlabelled: In severe osteoporosis, the optimal approach for sequential treatment between denosumab and romosozumab is unclear. We utilised a novel overlapping strategy in three patients with very-high fracture risk despite long-term denosumab which led to greater bone density improvements than previously reported with standard approaches. Larger confirmatory prospective studies are needed.

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  • RET mutations are found in 60% of medullary thyroid cancer cases and the drug selpercatinib shows significant effectiveness against it compared to older treatments.
  • A 22-year-old woman with metastatic medullary thyroid cancer improved with selpercatinib, but later developed lung nodules diagnosed as Langerhans cell histiocytosis, which had a rare BRAF mutation.
  • The authors suggest that the use of RET inhibitors like selpercatinib might cause dormant BRAF mutations to activate, leading to new cancers due to changes in the MAPK signaling pathway.
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  • Activating RET alterations have been found in various solid tumors, including pheochromocytoma, which can occur sporadically or in familial cases linked to MEN2 syndromes.
  • Selpercatinib, a potent RET kinase inhibitor, showed significant anti-tumor effects in the LIBRETTO-001 study, specifically in six pheochromocytoma patients treated with it.
  • Out of these patients, four experienced a partial or complete response while two had stable disease, indicating that selpercatinib is a promising therapy for RET-mutant pheochromocytoma.
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  • The study investigates the CHEK2 gene, known for its association with breast cancer, to see if it plays a role in pituitary adenomas (PAs) among patients.
  • Researchers analyzed 165 individuals with PAs using genetic sequencing, finding that 3% had rare and potentially harmful CHEK2 variants, indicating a possible link to pituitary tumor development.
  • The findings suggest that CHEK2 variants could be a significant risk factor for PAs, especially since these tumors are common and often don't follow typical family history patterns.
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