Immunohistochemical evaluation of biomarkers with predictive role in acromegaly: a literature review

Abstract

Acromegaly is a rare endocrine disorder, which despite the recent advances in diagnosis and management, remains a significant burden in terms of morbidity and mortality for patients because of the frequent aggressive evolution and lack of response to available first-line pharmacological therapy. A switch from the classical “trial and error” management to a personalized therapy approach has been proposed through early identification of biomarkers that could predict treatment response and biological behavior. Several such molecular markers have been extensively studied through immunohistochemistry (IHC), among them the somatostatin receptors type 2 (SSTR-2) and type 5 (SSTR-5), which are known to correlate with response to somatostatin analogues treatment, the SSTR-2 negative tumors usually being resistant to first-generation analogues, while SSTR-5 potentially being a predictive marker for the novel agent, Pasireotide. Based on cytokeratin (CK) immunostaining pattern, somatotropinomas have been classified into densely granulated adenomas (DGAs), which present a milder evolution and favorable outcomes after therapy, and sparsely granulated adenomas (SGAs), known to be more aggressive and frequently resistant to first-line treatment options. Other novel markers, such as the E-cadherin cell-adhesion protein, the aryl hydrocarbon receptor-interacting protein (AIP), the cytoskeleton molecule filamin A (FLNA) and the Ki-67 nuclear antigen have also been the highlight of IHC studies on growth hormone (GH)-producing tumors, with promising results regarding their predictive roles for the outcome of acromegalic patients. In this review, we aimed to summarize the current knowledge on the role of IHC for acromegaly, highlighting the most important biomarkers that could offer valuable information for predicting treatment response, biological behavior, and prognosis.

Predictors of morphofunctional features of somatotrophic tumors and of the effectiveness of treatment with first-generation somatostatin receptor ligands

“…ПСО, отличающиеся гипоинтенсивным сигналом, проявляют хорошую чувствительность к АС1, тогда как гиперинтенсивный сигнал при РСО указывает на слабую чувствительность к АС1 и хороший ответ на АС2. Избыточное присутствие ФТ, низкая экспрессия Е-кадгерина и высокая экспрессия Ki-67 также указывают на предпочтительное использование АС2 [43,44]. Дальнейшее накопление клинических, радиологических и морфологических данных позволит оценить диагностическую значимость предложенных пороговых значений ОИОС для дифференциальной диагностики ПСО и РСО и оптимизации МТ.…”