Apoptotic and autophagic responses to Bcl-2 inhibition and photodamage

Among the cellular responses to photodamage initiated by photodynamic therapy (PDT) are autophagy and apoptosis. While autophagy is a reversible process that can be both a survival and a death pathway, apoptosis is irreversible, leading only to cell death. In this study, we followed the fate of mouse leukemia L1210 cells after photodamage to the endoplasmic reticulum (ER) using a porphycene photosensitizer, where Bcl-2 was among the PDT targets. In wild-type cells, we observed a rapid wave of autophagy, presumed to represent the recycling of some damaged organelles, followed by apoptosis. Using shRNA technology, we created a Bax knockdown line (L1210/Bax(-)). In the latter cell line, we found a marked decrease in apoptosis after photodamage or pharmacologic inactivation of Bcl-2 function, but this did not affect PDT efficacy. Loss of viability was associated with a highly-vacuolated morphology consistent with autophagic cell death. Previous studies indicated pro-survival attributes of autophagy after low-dose PDT, suggesting that autophagy may be responsible for the 'shoulder' on the dose-response curve. It appears that attempts at extensive recycling of damaged organelles are associated with cell death, and that this phenomenon is amplified when apoptosis is suppressed.

An augmented reality simulator for ultrasound guided needle placement training

Details are presented of a low cost augmented-reality system for the simulation of ultrasound guided needle insertion procedures (tissue biopsy, abscess drainage, nephrostomy etc.) for interventional radiology education and training. The system comprises physical elements; a mannequin, a mock ultrasound probe and a needle, and software elements; generating virtual ultrasound anatomy and allowing data collection. These two elements are linked by a pair of magnetic 3D position sensors. Virtual anatomic images are generated based on anatomic data derived from full body CT scans of live humans. Details of the novel aspects of this system are presented including; image generation, registration and calibration.

Strategies for the Management of SVC Stent Migration into the Right Atrium

PURPOSE

Stent migration into the right atrium is a potentially fatal complication of stenting in the venous system and is most likely to occur during the treatment of superior vena cava obstruction. Endovascular approaches that can salvage this hazardous situation are described and the keys to successful treatment are highlighted.

MATERIALS AND METHODS

Four different strategies are reviewed: (1) snaring the stent directly, (2) angioplasty balloon-assisted snaring of the stent, (3) guide wire-assisted snaring of the stent, and (4) superior vena cava-to-inferior vena cava bridging stent.

RESULTS

These techniques have been employed in the successful management of four cases. No short- or long-term complications as a result of these maneuvers have been identified. Additional treatment of the underlying disease was possible at the same time in each case.

CONCLUSION

We conclude that prompt management of right atrial stent migration is essential and can be successfully achieved by a variety of "bale-out" techniques which are within the technical range of most interventional radiologists.

Hemoperitoneum secondary to rupture of cystic artery pseudoaneurysm

BACKGROUND

Spontaneous hemoperitoneum of hepatobiliary origin is commonly due to hemorrhage from a liver tumor. It is rarely caused by spontaneous rupture of aneurysm in visceral arteries.

METHODS

We report an unusual case of hemoperitoneum caused by rupture of cystic artery pseudoaneurysm, and also outline the approach to its management through surgical and radiological methods.

RESULTS

In our patient, the pseudoanurysm was initially treated with percutaneous thrombin injection. However this method of treatment failed after initial success. The pseudoanurysm was finally obliterated successfully using microcoil embolization.

CONCLUSIONS

The mainstay of treatment of cystic artery pseudoaneurysm is cholecystectomy and ligation of the aneurysm. Recent publications showed success in using microcoil embolisation. In this case we also outline the use of percutaneous thrombin injection as a definitive treatment method and discuss its success or failure as a new method of treatment.

Initiation of apoptosis and autophagy by the Bcl-2 antagonist HA14-1

L1210 murine leukemia cells exposed to an LD(90) concentration of the Bcl-2/Bcl-x(L) antagonist HA14-1 rapidly undergo apoptosis but also develop numerous intracellular vacuoles with double membranes, exhibit enhanced labeling by monodansylcadaverine, and convert the cytosolic protein LC3-I to LC3-II. These are hallmarks of autophagy. Autophagic vacuoles develop rapidly, preceding the appearance of an apoptotic nuclear morphology and can be observed in both non-apoptotic and apoptotic cells. Inhibition of autophagy by the PI 3-kinase inhibitor wortmannin promoted apoptosis; conversely inhibition of caspase-3/7 with zDEVD-fmk promoted autophagy. Neither process was dependent on calcium translocation. These results indicate that pharmacological suppression of Bcl-2 function can mimic the induction of autophagy that can occur following the down-regulation of Bcl-2 expression by molecular approaches.

The role of autophagy in the death of L1210 leukemia cells initiated by the new antitumor agents, XK469 and SH80

The phenoxypropionic acid derivative 2-{4-[(7-chloro-2-quinoxalinyl)oxy]phenoxy}propionic acid (XK469) and an analogue termed 2-{4-[(7-bromo-2-quinalinyl)oxy]phenoxy}propionic acid (SH80) can eradicate malignant cell types resistant to many common antitumor agents. Colony formation assays indicated that a 24 h exposure of L1210 cells to XK469 or SH80 inhibited clonogenic growth with CI(90) values of 10 and 13 micromol/L, respectively. This effect was associated with G(2)-M arrest and the absence of any detectable markers of apoptosis (i.e., plasma membrane blebbing, procaspase 3 activation, loss of mitochondrial membrane potential, and formation of condensed chromatin). Drug-treated cells increased in size and eventually exhibited the characteristics of autophagy (i.e., appearance of autophagosomes and conversion of microtubule-associated protein light chain 3-I to 3-II). The absence of apoptosis was not related to an inhibition of the apoptotic program. Cultures treated with XK469 or SH80 readily underwent apoptosis upon exposure to the Bcl-2/Bcl-x(L) antagonist ethyl 2-amino-6-bromo-4-(1-cyano-2-ethoxy-2-oxoethyl)-4H-chromene-3-carboxylate. Continued incubation of drug-treated cells led to a reciprocal loss of large autophagic cells and the appearance of smaller cells that could not be stained with Höechst dye HO33342, had a chaotic morphology, were trypan blue-permeable, and lacked mitochondrial membrane potential. L1210 cells cotreated with the phosphatidylinositol-3-kinase inhibitor wortmannin, or having reduced Atg7 protein content, underwent G(2)-M arrest, but not autophagy, following XK469 treatment. Hence, the therapeutic actions of XK469/SH80 with L1210 cultures reflect both the initiation of a cell cycle arrest as well as the initiation of autophagy.

Initiation of apoptosis and autophagy by photodynamic therapy

BACKGROUND AND OBJECTIVES

This study was designed to examine modes of cell death after photodynamic therapy (PDT).

STUDY DESIGN

Murine leukemia L1210 cells and human prostate Bax-deficient DU145 cells were examined after PDT-induced photodamage to the endoplasmic reticulum (ER). Phase contrast, fluorescence and electron microscopy were used to identify changes in cellular morphology, chromatin condensation, loss of mitochondrial membrane potential, and formation of phagolysosomes. Western blots were used to assess the processing of LC3-I to LC3-II, a marker for autophagy. Inhibitors of apoptosis and/or autophagy were used to delineate the contributions of the two pathways to the effects of PDT.

RESULTS

Both apoptosis and autophagy occurred in L1210 after ER photodamage with the latter predominating after 24 hours. In DU145 cells, PDT conditions causing comparable cytotoxicity only initiated autophagy. PI3-kinase inhibitors suppressed autophagy in both cell lines as indicated by inhibition of vacuolization and LC3 processing.

CONCLUSIONS

Both autophagy and apoptosis were observed in L1210 cells following ER photodamage. In the Bax-deficient DU145 cell line only autophagy was observed. Current information suggests that autophagy can function as either a survival or death pathway. We propose that in the context of PDT, this may also be true.

Endovascular treatment of visceral aneurysms associated with pancreatitis and a suggested classification with therapeutic implications

PURPOSE

To describe a 10-year experience of endovascular and percutaneous treatment of aneurysms and pseudoaneurysms complicating pancreatitis, and to analyze this experience and propose a classification based on computed tomography (CT) and angiographic findings that has therapeutic implications. This may reduce the rate of recurrent bleeding after surgery or endovascular treatment.

MATERIALS AND METHODS

Twenty-three patients with aneurysms or pseudoaneurysms associated with acute pancreatitis were treated by endovascular or percutaneous methods. All underwent CT and angiography. The early development of a simple classification based on the CT and angiographic findings was used to guide treatment decisions. In accordance with this classification, 19 patients were treated by primary coil embolization and four were treated by primary percutaneous thrombin injection.

RESULTS

Among the 19 patients treated by primary coil embolization, there were two early recurrences of the pseudoaneurysm. All four patients treated by percutaneous thrombin injection exhibited late recurrences and were successfully treated by percutaneous thrombin injections. Twenty-one patients (91.3%) were alive at 6 months.

CONCLUSIONS

Endovascular and percutaneous treatment of aneurysms and pseudoaneurysms complicating pancreatitis is safe and effective and is associated with good outcomes, but careful follow-up is necessary. The decision of which treatment option is most appropriate can be made in accordance with a classification based on CT and angiographic appearance.

Death pathways associated with photodynamic therapy

When the mitochondria and/or the endoplasmic reticulum were targeted by photodynamic therapy, photodamage to the anti-apoptotic protein Bcl-2 was observed. This led to an apoptotic outcome if that death pathway was available. Lysosomal photodamage ultimately resulted in activation of the pro-apoptotic protein Bid, also leading to apoptosis. Photodamage to the plasma membrane was associated with migration of sensitizers to the cytosol and procaspase photodamage, with apoptosis impaired. Where apoptosis was unavailable because of lack of necessary components of the program, an autophagic outcome has been observed. It is also clear that autophagy can occur along with apoptosis as a PDT response, and may play a role in immunologic responses to photodamaged tumor cells.

Initiation of apoptosis and autophagy by photodynamic therapy

This study was designed to examine modes of cell death after photodynamic therapy (PDT). Murine leukemia L1210 cells and human prostate Bax-deficient DU-145 cells were examined after PDT-induced photodamage to the endoplasmic reticulum (ER). Previous studies indicated that this treatment resulted in a substantial loss of Bcl-2 function. Both apoptosis and autophagy occurred in L1210 cells after ER photodamage with the latter predominating after 24 hr. These processes were characterized by altered cellular morphology, chromatin condensation, loss of mitochondrial membrane potential and formation of vacuoles containing cytosolic components. Western blots demonstrated processing of LC3-I to LC3-II, a marker for autophagy. In DU145 cells, PDT initiated only autophagy. Phosphatidylinositol (PI) 3-kinase inhibitors suppressed autophagy in both cell lines as indicated by inhibition of vacuolization and LC3 processing. Inhibitors of apoptosis and/or autophagy were then used to delineate the contributions of the two pathways to the effects of PDT. Given the ability of autophagy to upregulate MHC-11 peptide presentation, autophagy may play a role in the ability of photodynamic therapy to stimulate immunologic recognition of target cells.