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Abstract
BACKGROUND Corticosteroids are commonly used in the management of primary central nervous system (CNS) tumors and CNS metastases to treat cancer- and treatment-related cerebral edema and improve neurologic function. However, they are also associated with significant morbidity and mortality, given their wide range of adverse effects. PURPOSE OF REVIEW To review the mechanism of action, pharmacology, and toxicity profile of corticosteroids and to critically appraise the evidence that supports their use in neuro-oncologic practice based on the latest scientific and clinical data. RECENT FINDINGS Recent data suggest that corticosteroids may negatively impact survival in glioma patients. In addition, corticosteroids should be incorporated as a standard criterion to assess a patient's clinical and radiographic response to treatment. Corticosteroids should be used judiciously in neuro-oncologic patients, given the potential deleterious effects on clinical outcome and patient survival. Anti-angiogenic agents, which lack these adverse effects, may be a reasonable alternative to corticosteroids.
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Affiliation(s)
- K Ina Ly
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
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Kotsarini C, Griffiths PD, Wilkinson ID, Hoggard N. A systematic review of the literature on the effects of dexamethasone on the brain from in vivo human-based studies: implications for physiological brain imaging of patients with intracranial tumors. Neurosurgery 2011; 67:1799-815; discussion 1815. [PMID: 21107211 DOI: 10.1227/neu.0b013e3181fa775b] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Among glucocorticoids, dexamethasone is most widely used for treatment of cerebral edema because of its long biological half-life and its low mineralocorticoid activity (sodium retaining). OBJECTIVE A systematic review of the literature on the effects of dexamethasone on the brain from in vivo studies in humans. METHODS A MEDLINE database search (via the PubMed interface) and an EMBASE database search (via the Dialog interface) of the past 35 years was performed. Every article relating to human use reported in English was included. In addition, references of all eligible articles were searched to identify other possible sources. RESULTS Twenty-four articles matched the eligibility criteria. There were disparate methodologies and conflicting results, although they tended to indicate a decrease in blood-tumor barrier permeability, decreased tumoral perfusion, decreased tumoral diffusivity, and the possibility of decreased perfusion in contralateral normal-appearing brain tissue. CONCLUSION Treatment with dexamethasone may alter imaging parameters from cerebral perfusion studies used in the management of brain tumors. In adequately powered studies, it may be possible to assess the longer term effects of dexamethasone on normal brain tissue to help optimize use with longer term survivors that are emerging as improvements in glioma treatment are made.
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Affiliation(s)
- Christina Kotsarini
- Academic Unit of Radiology, University of Sheffield, and Royal Hallamshire Hospital, Sheffield, United Kingdom
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Zhu L, Maruvada R, Sapirstein A, Malik KU, Peters-Golden M, Kim KS. Arachidonic acid metabolism regulates Escherichia coli penetration of the blood-brain barrier. Infect Immun 2010; 78:4302-10. [PMID: 20696828 PMCID: PMC2950368 DOI: 10.1128/iai.00624-10] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 07/09/2010] [Accepted: 07/30/2010] [Indexed: 01/29/2023] Open
Abstract
Escherichia coli K1 meningitis occurs following penetration of the blood-brain barrier, but the underlying mechanisms involved in E. coli penetration of the blood-brain barrier remain incompletely understood. We have previously shown that host cytosolic phospholipase A(2)α (cPLA(2)α) contributes to E. coli invasion of human brain microvascular endothelial cells (HBMEC), which constitute the blood-brain barrier, but the underlying mechanisms remain unclear. cPLA(2)α selectively liberates arachidonic acid from membrane phospholipids. Here, we provide the first direct evidence that host 5-lipoxygenase and lipoxygenase products of arachidonic acid, cysteinyl leukotrienes (LTs), contribute to E. coli K1 invasion of HBMEC and penetration into the brain, and their contributions involve protein kinase C alpha (PKCα). These findings demonstrate that arachidonic acid metabolism regulates E. coli penetration of the blood-brain barrier, and studies are needed to further elucidate the mechanisms involved with metabolic products of arachidonic acid for their contribution to E. coli invasion of the blood-brain barrier.
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Affiliation(s)
- Longkun Zhu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 North Wolfe St., Room 3157, Baltimore, Maryland 21287, Department of Anesthesiology and Critical Care Medicine, 600 North Wolfe Street, Meyer 297-A, Baltimore, Maryland 21287, Department of Pharmacology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee 38163, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 6301 MSRB III, 1150 W. Medical Center Drive, Ann Arbor, Michigan 48109
| | - Ravi Maruvada
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 North Wolfe St., Room 3157, Baltimore, Maryland 21287, Department of Anesthesiology and Critical Care Medicine, 600 North Wolfe Street, Meyer 297-A, Baltimore, Maryland 21287, Department of Pharmacology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee 38163, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 6301 MSRB III, 1150 W. Medical Center Drive, Ann Arbor, Michigan 48109
| | - Adam Sapirstein
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 North Wolfe St., Room 3157, Baltimore, Maryland 21287, Department of Anesthesiology and Critical Care Medicine, 600 North Wolfe Street, Meyer 297-A, Baltimore, Maryland 21287, Department of Pharmacology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee 38163, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 6301 MSRB III, 1150 W. Medical Center Drive, Ann Arbor, Michigan 48109
| | - Kafait U. Malik
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 North Wolfe St., Room 3157, Baltimore, Maryland 21287, Department of Anesthesiology and Critical Care Medicine, 600 North Wolfe Street, Meyer 297-A, Baltimore, Maryland 21287, Department of Pharmacology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee 38163, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 6301 MSRB III, 1150 W. Medical Center Drive, Ann Arbor, Michigan 48109
| | - Marc Peters-Golden
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 North Wolfe St., Room 3157, Baltimore, Maryland 21287, Department of Anesthesiology and Critical Care Medicine, 600 North Wolfe Street, Meyer 297-A, Baltimore, Maryland 21287, Department of Pharmacology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee 38163, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 6301 MSRB III, 1150 W. Medical Center Drive, Ann Arbor, Michigan 48109
| | - Kwang Sik Kim
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 North Wolfe St., Room 3157, Baltimore, Maryland 21287, Department of Anesthesiology and Critical Care Medicine, 600 North Wolfe Street, Meyer 297-A, Baltimore, Maryland 21287, Department of Pharmacology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee 38163, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 6301 MSRB III, 1150 W. Medical Center Drive, Ann Arbor, Michigan 48109
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Whittle IR, Ironside JW, Piper IR, Miller JD. Neuropathological and neurophysiological effects of interstitial white matter autologous and non-autologous protein containing solutions: further evidence for a glioma derived permeability factor. Acta Neurochir (Wien) 1993; 120:164-74. [PMID: 8460570 DOI: 10.1007/bf02112037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The feline infusion model of brain edema was used to evaluate the pathophysiological effects of 0.6 ml infusions of autologous serum protein (66%), human serum protein (66%), human glioma cyst fluid and a tissue culture medium (TCM) on the structure and function of the forebrain white matter. These infusions increased local white matter water content by between 10.8 and 12.5 ml/100 g brain and were associated with moderate increases in ICP and CSF outflow resistance and a significant decrease in lumped craniospinal compliance. Cortical somatosensory potentials, motor evoked potentials, EEG and local cerebral blood flow (rCBF) at normocapnia were generally unchanged by the various infusions. All infusates except the 66% autologous serum protein infusion impaired rCBF CO2 reactivity. Histologically all infusates caused marked extracellular edema. The autologous serum protein infusion caused no additional histological changes whereas the glioma cyst infusates caused profound endothelial and astrocytic swelling, focal endothelial necrosis, basement membrane disruption, perivascular microglial reaction and pavementation and perivascular migration of polymorphonuclear leukocytes. Similar but less marked changes were seen after infusion of human serum protein whilst the TCM produced only minimal changes. The intensity and extent of Evans Blue extravasation into the forebrain white matter was greatest with glioma cyst infusates and with all infusions reflected the extent to microvascular changes. These studies show that products derived from gliomas cause additional damage to the blood-brain-barrier than that caused by non-autologous serum proteins. These results add further support for the existence of glioma derived permeability factors (GDPF), but suggest neither serum proteins nor glioma derived compounds in the white matter interstitium significantly influence local electrophysiological function. Some limitations of the infusion edema model when using non-autologous infusions and difficulties quantitating brain dysfunction are emphasised.
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Affiliation(s)
- I R Whittle
- University Department of Clinical Neurosciences, Western General Hospital, Edinburgh, Scotland, U.K
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