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Giovanni Vitale Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
Laboratory of Geriatric and Oncologic Neuroendocrinology Research, Istituto Auxologico Italiano IRCCS, Milan, Italy

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Alessandra Dicitore Laboratory of Geriatric and Oncologic Neuroendocrinology Research, Istituto Auxologico Italiano IRCCS, Milan, Italy

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Concetta Sciammarella Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy

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Sergio Di Molfetta Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy

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Manila Rubino Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, Milan, Italy

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Antongiulio Faggiano Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy

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Annamaria Colao Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy

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Somatostatin analogs have an important role in the medical therapy of neuroendocrine tumors (NETs). Octreotide and lanreotide, both somatostatin analogs binding with high affinity for the somatostatin receptor (SSTR)2, can control symptoms in functional NETs. In addition, these compounds, because of their antiproliferative effects, can stabilize growth of well-differentiated NETs. Pasireotide is a novel multireceptor-targeted somatostatin analog with high affinity for SSTR1, 2, 3, and 5. This review provides an overview of the state of the art of pasireotide in the treatment of NETs, with the aim of addressing clinical relevance and future perspectives for this molecule in the management of NETs.

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Giovanni Vitale Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Biosciences, Endocrinology Unit, University of Milan, Milan, Italy
Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Biosciences, Endocrinology Unit, University of Milan, Milan, Italy

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Germano Gaudenzi Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Biosciences, Endocrinology Unit, University of Milan, Milan, Italy

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Alessandra Dicitore Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Biosciences, Endocrinology Unit, University of Milan, Milan, Italy

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Franco Cotelli Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Biosciences, Endocrinology Unit, University of Milan, Milan, Italy

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Diego Ferone Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Biosciences, Endocrinology Unit, University of Milan, Milan, Italy

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Luca Persani Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Biosciences, Endocrinology Unit, University of Milan, Milan, Italy
Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Biosciences, Endocrinology Unit, University of Milan, Milan, Italy

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Tumor models have a relevant role in furthering our understanding of the biology of malignant disease and in preclinical cancer research. Only few models are available for neuroendocrine tumors (NETs), probably due to the rarity and heterogeneity of this group of neoplasms. This review provides insights into the current state-of-the-art of zebrafish as a model in cancer research, focusing on potential applications in NETs. Zebrafish has a complex circulatory system similar to that of mammals. A novel angiogenesis assay based on the injection of human NET cell lines (TT and DMS79 cells) into the subperidermal space of the zebrafish embryos has been developed. Proangiogenic factors locally released by the tumor graft affect the normal developmental pattern of the subintestinal vessels by stimulating the migration and growth of sprouting vessels toward the implant. In addition, a description of the striking homology between zebrafish and humans of molecular targets involved in tumor angiogenesis (somatostatin receptors, dopamine receptors, mammalian target of rapamycin), and currently used as targeted therapy of NETs, is reported.

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Germano Gaudenzi Istituto Auxologico Italiano, IRCCS, Laboratorio Sperimentale di Ricerche di Neuroendocrinologia Geriatrica ed Oncologica, Milan, Italy

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Silvia Carra Istituto Auxologico Italiano, IRCCS, Laboratorio Sperimentale di Ricerche Endocrino-Metaboliche, Milan, Italy

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Alessandra Dicitore Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy

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Maria Celeste Cantone Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy

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Luca Persani Istituto Auxologico Italiano, IRCCS, Laboratorio Sperimentale di Ricerche Endocrino-Metaboliche, Milan, Italy
Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy

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Giovanni Vitale Istituto Auxologico Italiano, IRCCS, Laboratorio Sperimentale di Ricerche di Neuroendocrinologia Geriatrica ed Oncologica, Milan, Italy
Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy

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Neuroendocrine tumors (NETs) are a class of rare and heterogeneous neoplasms that originate from the neuroendocrine system. In several cases, these neoplasms can release bioactive hormones leading to characteristic clinical syndromes and hormonal dysregulations with detrimental impact on the quality of life and survival of these patients. Only few animal models are currently available to investigate pathogenesis, progression and functional syndromes in NETs and to identify new therapeutic strategies. The tropical teleost zebrafish (Danio rerio) is a popular vertebrate model system that offers unique advantages for the study of several biological processes, ranging from embryonic development to human diseases such as cancer. In this review, we summarize recent advances on zebrafish models for NET preclinical research that take advantage of modern genetic and transplantable technologies. In the future, these tools may have a role in the treatment decision-making and tertiary prevention of NETs.

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Annemiek Walenkamp
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Guillermo Crespo Department of Medical Oncology, Department of Medical Oncology, Department of Endocrine Oncology, Department of Cancer Research and Molecular Medicine, 2nd Department of Medicine, Department of Gastroenterology, Department of General Internal Medicine, Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Endocrine Oncology, UCL Cancer Institute, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands

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Felipe Fierro Maya Department of Medical Oncology, Department of Medical Oncology, Department of Endocrine Oncology, Department of Cancer Research and Molecular Medicine, 2nd Department of Medicine, Department of Gastroenterology, Department of General Internal Medicine, Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Endocrine Oncology, UCL Cancer Institute, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands

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Reidar Fossmark Department of Medical Oncology, Department of Medical Oncology, Department of Endocrine Oncology, Department of Cancer Research and Molecular Medicine, 2nd Department of Medicine, Department of Gastroenterology, Department of General Internal Medicine, Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Endocrine Oncology, UCL Cancer Institute, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands

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Peter Igaz Department of Medical Oncology, Department of Medical Oncology, Department of Endocrine Oncology, Department of Cancer Research and Molecular Medicine, 2nd Department of Medicine, Department of Gastroenterology, Department of General Internal Medicine, Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Endocrine Oncology, UCL Cancer Institute, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands

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Anja Rinke Department of Medical Oncology, Department of Medical Oncology, Department of Endocrine Oncology, Department of Cancer Research and Molecular Medicine, 2nd Department of Medicine, Department of Gastroenterology, Department of General Internal Medicine, Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Endocrine Oncology, UCL Cancer Institute, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands

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Gianluca Tamagno Department of Medical Oncology, Department of Medical Oncology, Department of Endocrine Oncology, Department of Cancer Research and Molecular Medicine, 2nd Department of Medicine, Department of Gastroenterology, Department of General Internal Medicine, Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Endocrine Oncology, UCL Cancer Institute, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands

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Giovanni Vitale Department of Medical Oncology, Department of Medical Oncology, Department of Endocrine Oncology, Department of Cancer Research and Molecular Medicine, 2nd Department of Medicine, Department of Gastroenterology, Department of General Internal Medicine, Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Endocrine Oncology, UCL Cancer Institute, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
Department of Medical Oncology, Department of Medical Oncology, Department of Endocrine Oncology, Department of Cancer Research and Molecular Medicine, 2nd Department of Medicine, Department of Gastroenterology, Department of General Internal Medicine, Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Endocrine Oncology, UCL Cancer Institute, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands

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Kjell Öberg Department of Medical Oncology, Department of Medical Oncology, Department of Endocrine Oncology, Department of Cancer Research and Molecular Medicine, 2nd Department of Medicine, Department of Gastroenterology, Department of General Internal Medicine, Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Endocrine Oncology, UCL Cancer Institute, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands

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Tim Meyer Department of Medical Oncology, Department of Medical Oncology, Department of Endocrine Oncology, Department of Cancer Research and Molecular Medicine, 2nd Department of Medicine, Department of Gastroenterology, Department of General Internal Medicine, Department of Clinical Sciences and Community Health (DISCCO), Laboratory of Endocrine and Metabolic Research, Department of Endocrine Oncology, UCL Cancer Institute, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands

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In the past few years, there have been advances in the treatment of neuroendocrine tumours (NETs) and improvements in our understanding of NET biology. However, the benefits to patients have been relatively modest and much remains yet to be done. The ‘Hallmarks of Cancer’, as defined by Hanahan and Weinberg, provide a conceptual framework for understanding the aberrations that underlie tumourigenesis and to help identify potential targets for therapy. In this study, our objective is to review the major molecular characteristics of NETs, based on the recently modified ‘Hallmarks of Cancer’, and highlight areas that require further research.

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Giovanni Vitale Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
Laboratory of Endocrine and Metabolic Research, Istituto Auxologico Italiano IRCCS, Milan, Italy

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Germano Gaudenzi Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy

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Luisa Circelli Department of Experimental Oncology, Laboratory of Molecular Biology and Viral Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, ‘Fondazione Pascale’ – IRCCS, Naples, Italy

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Marco F Manzoni Department of Endocrinology and Internal Medicine, Endocrine Tumors Unit, San Raffaele Hospital Vita-Salute San Raffaele University, Milan, Italy

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Andrea Bassi Department of Physics, Politecnico di Milano, Milan, Italy

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Niccolò Fioritti Department of Biosciences, University of Milan, Milan, Italy

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Antongiulio Faggiano Thyroid and Parathyroid Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori ‘Fondazione G. Pascale’ – IRCCS, Naples, Italy

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Annamaria Colao Department of Clinical Medicine and Surgery, Section of Endocrinology, ‘Federico II’ University of Naples, Naples, Italy

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on behalf of NIKE Group Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy

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Medullary thyroid carcinoma is a neuroendocrine tumour originating from parafollicular C cells accounting for 5–10% of thyroid cancers. Increased understanding of disease-specific molecular targets of therapy has led to the regulatory approval of two drugs (vandetanib and cabozantinib) for the treatment of medullary thyroid carcinoma. These drugs increase progression-free survival; however, they are often poorly tolerated and most treatment responses are transient. Animal models are indispensable tools for investigating the pathogenesis, mechanisms for tumour invasion and metastasis and new therapeutic approaches for cancer. Unfortunately, only few models are available for medullary thyroid carcinoma. This review provides an overview of the state of the art of animal models in medullary thyroid carcinoma and highlights future developments in this field, with the aim of addressing salient features and clinical relevance.

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Chiara Alessandra Cella Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS, Milan, Italy
Department of Molecular and Translational Medicine, Division of Biology and Genetics, University of Brescia, Brescia, Italy

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Riccardo Cazzoli Department of Experimental Oncology, European Institute of Oncology, IEO, IRCCS, Milan, Italy
Metal Targeted Therapy & Immunology lab, Childrens’ cancer institute, Sydney, NSW, Australia

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Nicola Fazio Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS, Milan, Italy

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Giuseppina De Petro Department of Molecular and Translational Medicine, Division of Biology and Genetics, University of Brescia, Brescia, Italy

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Germano Gaudenzi Laboratory of Geriatric and Oncologic Neuroendocrinology Research, IRCCS, Istituto Auxologico Italiano, Milan, Italy

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Silvia Carra Laboratory of Endocrine and Metabolic Research, IRCCS, Istituto Auxologico Italiano, Milan, Italy

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Mauro Romanenghi Department of Experimental Oncology, European Institute of Oncology, IEO, IRCCS, Milan, Italy

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Francesca Spada Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS, Milan, Italy

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Ilaria Grossi Department of Molecular and Translational Medicine, Division of Biology and Genetics, University of Brescia, Brescia, Italy

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Isabella Pallavicini Department of Experimental Oncology, European Institute of Oncology, IEO, IRCCS, Milan, Italy

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Saverio Minucci Department of Experimental Oncology, European Institute of Oncology, IEO, IRCCS, Milan, Italy
Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

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Giovanni Vitale Laboratory of Geriatric and Oncologic Neuroendocrinology Research, IRCCS, Istituto Auxologico Italiano, Milan, Italy
Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy

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Neuroendocrine tumors (NETs) are highly vascularized malignancies in which angiogenesis may entail cell proliferation and survival. Among the emerging compounds with antivascular properties, cabozantinib (CAB) appeared promising. We analyzed the antitumor activity of CAB against NETs utilizing in vitro and in vivo models. For cell cultures, we used BON-1, NCI-H727 and NCI-H720 cell lines. Cell viability was assessed by manual count coupled with quantification of cell death, performed through fluorescence-activated cell sorting analysis as propidium iodide exclusion assay. In addition, we investigated the modulation of the antiapoptotic myeloid cell leukemia 1 protein under CAB exposure, as a putative adaptive pro-survival mechanism, and compared the responses with sunitinib. The activity of CAB was also tested in mouse and zebrafish xenograft tumor models. Cabozantinib showed a dose-dependent and time-dependent effect on cell viability and proliferation in human NET cultures, besides a halting of cell cycle progression for endoduplication, never reported for other tyrosine kinase inhibitors. In a transplantable zebrafish model, CAB drastically inhibited NET-induced angiogenesis and migration of implanted cells through the embryo body. CAB showed encouraging activity in NETs, both in vitro and in vivo models. On this basis, we envisage future research to further investigate along these promising lines.

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Peter M van Koetsveld Division of Endocrinology, Department of Pathology, Dipartimento di Scienze Mediche, IRCCS Istituto Auxologico Italiano, Department of Pathology, Department of Internal Medicine, Erasmus Medical Center, Erasmus MC, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

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Giovanni Vitale Division of Endocrinology, Department of Pathology, Dipartimento di Scienze Mediche, IRCCS Istituto Auxologico Italiano, Department of Pathology, Department of Internal Medicine, Erasmus Medical Center, Erasmus MC, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands
Division of Endocrinology, Department of Pathology, Dipartimento di Scienze Mediche, IRCCS Istituto Auxologico Italiano, Department of Pathology, Department of Internal Medicine, Erasmus Medical Center, Erasmus MC, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands
Division of Endocrinology, Department of Pathology, Dipartimento di Scienze Mediche, IRCCS Istituto Auxologico Italiano, Department of Pathology, Department of Internal Medicine, Erasmus Medical Center, Erasmus MC, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

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Richard A Feelders Division of Endocrinology, Department of Pathology, Dipartimento di Scienze Mediche, IRCCS Istituto Auxologico Italiano, Department of Pathology, Department of Internal Medicine, Erasmus Medical Center, Erasmus MC, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

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Marlijn Waaijers Division of Endocrinology, Department of Pathology, Dipartimento di Scienze Mediche, IRCCS Istituto Auxologico Italiano, Department of Pathology, Department of Internal Medicine, Erasmus Medical Center, Erasmus MC, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

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Diana M Sprij-Mooij Division of Endocrinology, Department of Pathology, Dipartimento di Scienze Mediche, IRCCS Istituto Auxologico Italiano, Department of Pathology, Department of Internal Medicine, Erasmus Medical Center, Erasmus MC, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

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Ronald R de Krijger Division of Endocrinology, Department of Pathology, Dipartimento di Scienze Mediche, IRCCS Istituto Auxologico Italiano, Department of Pathology, Department of Internal Medicine, Erasmus Medical Center, Erasmus MC, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

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Ernst-Jan M Speel Division of Endocrinology, Department of Pathology, Dipartimento di Scienze Mediche, IRCCS Istituto Auxologico Italiano, Department of Pathology, Department of Internal Medicine, Erasmus Medical Center, Erasmus MC, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

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Johannes Hofland Division of Endocrinology, Department of Pathology, Dipartimento di Scienze Mediche, IRCCS Istituto Auxologico Italiano, Department of Pathology, Department of Internal Medicine, Erasmus Medical Center, Erasmus MC, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

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Steven W J Lamberts Division of Endocrinology, Department of Pathology, Dipartimento di Scienze Mediche, IRCCS Istituto Auxologico Italiano, Department of Pathology, Department of Internal Medicine, Erasmus Medical Center, Erasmus MC, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

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Wouter W de Herder Division of Endocrinology, Department of Pathology, Dipartimento di Scienze Mediche, IRCCS Istituto Auxologico Italiano, Department of Pathology, Department of Internal Medicine, Erasmus Medical Center, Erasmus MC, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

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Leo J Hofland Division of Endocrinology, Department of Pathology, Dipartimento di Scienze Mediche, IRCCS Istituto Auxologico Italiano, Department of Pathology, Department of Internal Medicine, Erasmus Medical Center, Erasmus MC, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

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Adrenocortical carcinoma (ACC) is an aggressive tumor with very poor prognosis. Novel medical treatment opportunities are required. We investigated the effects of interferon-β (IFN-β), alone or in combination with mitotane, on cell growth and cortisol secretion in primary cultures of 13 human ACCs, three adrenal hyperplasias, three adrenal adenomas, and in two ACC cell lines. Moreover, the interrelationship between the effects of IGF2 and IFN-β was evaluated. Mitotane inhibited cell total DNA content/well (representing cell number) in 7/11 (IC50: 38±9.2 μM) and cortisol secretion in 5/5 ACC cultures (IC50: 4.5±0.1 μM). IFN-β reduced cell number in 10/11 (IC50: 83±18 IU/ml) and cortisol secretion in 5/5 ACC cultures (IC50: 7.3±1.5 IU/ml). The effect of IFN-β on cell number included the induction of apoptosis. IFN-β strongly inhibited mRNA expression of STAR, CYP11A1, CYP17A1, and CYP11B1. Mitotane and IFN-β induced an additive inhibitory effect on cell number and cortisol secretion. IGF2 (10 nM) inhibited apoptosis and increased cell number and cortisol secretion. These effects were counteracted by IFN-β treatment. Finally, IFN-β inhibited IGF2 secretion and mRNA expression. In conclusion, IFN-β is a potent inhibitor of ACC cell growth in human primary ACC cultures, partially mediated by an inhibition of the effects of IGF2, as well as its production. The increased sensitivity of ACC cells to mitotane induced by treatment with IFN-β may open the opportunity for combined treatment regimens with lower mitotane doses. The inhibition of the expression of steroidogenic enzymes by IFN-β is a novel mechanism that may explain its inhibitory effect on cortisol production.

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