Molecularly based management of gliomas in clinical practice

Epilepsy-related brain tumors

Seizures are among the most common presentations of brain tumors. Several tumor types can cause seizures in varying rates; neuroglial tumors and the gliomas are the most common ones. Brain tumors are the second most common cause of focal intractable epilepsy in epilepsy surgery series, with the highest frequency being dysembryoplastic neuroepithelial tumors and gangliogliomas. Seizure management is an important part of the treatment of patients with brain tumors. This review discusses clinical features and management of seizures in patients with brain tumors, including, neuroglial tumors, gliomas, meningioma and metastases; with the help of recent literature data. Tumor-related seizures are focal seizures with or without secondary generalization. Seizures may occur either as initial symptom or during the course of the disease. Brain tumors related epilepsy tends to be resistant to antiepileptic drugs and treatment of tumor is main step also for the seizure treatment. Early surgery and extent of the tumor removal are important factors for achieving seizure freedom particularly in neuroglial tumors and low grade gliomas. During selection of the appropriate antiepileptic drug, the general approach to partial epilepsies can be followed. There are several factors influencing epileptogenesis in brain tumor-related epilepsy which also explains clinical heterogeneity of epilepsy among tumor types. Identification of molecular markers may guide future therapeutic approaches and further studies are needed to prove antitumor effects of different antiepileptic drugs.

A restricted signature of serum miRNAs distinguishes glioblastoma from lower grade gliomas

Background

Malignant gliomas are the most common primary brain tumors in adults and challenging cancers for diagnosis and treatment. They remain a disease for which non-invasive, diagnostic and/or prognostic novel biomarkers are highly desirable. Altered microRNA (miRNA) profiles have been observed in tumor tissues and biological fluids. To date only a small set of circulating/serum miRNA is found to be differentially expressed in brain tumors compared to normal controls.

Here a restricted signature of circulating/serum miRNA including miR-15b*,-23a, −99a, −125b, −133a, −150*, −197, −340, −497, −548b-5p and let-7c were investigated as potential non-invasive biomarkers in the diagnosis of glioma patients.

Methods

Serum and tissues miRNAs expression in patients with brain cancers (n = 30) and healthy controls (n = 15) were detected by quantitative real-time polymerase chain reaction (qRT-PCR). Relative expression was calculated using the comparative Ct method. Statistical significance (p ≤ 0,05) was determined using the Mann–Whitney rank sum and Fisher’s exact test. Diagnostic accuracy of miRNAs in distinguishing glioblastoma multiforme (GBM) from lower grade cancer was assessed by the Receiver Operating Characteristic (ROC) curve analysis.

To validate the role of the identified miRNAs in cancer a comprehensive literature search was conducted using PubMed, Web of Science (Core Collection) and Scopus databases.

Results

We observed a decrease of miR-497 and miR-125b serum levels depending on tumor stages with reduced level in GBM than lower grade tumors. The ROC curve analysis distinguishing GBM from lower grade cases yielded an area under the curve (AUC) of 0.87 (95 % confidence interval (CI) = 0.712–1) and of 0.75 (95 % CI = 0.533–0.967) for miR-497 and -125b, respectively. GBM patients are more likely to show a miR-497 and -125b down-regulation than the lower grade group (p = 0.002 and p = 0.024, respectively). These results were subsequently compared with evidence from 19 studies included in the final systematic review.

Conclusions

Although multiple biomarkers are currently leveraged in the clinic to detect specific cancer types, no such standard blood biomolecules are used as yet in gliomas. Our data suggest that serum miR-497 and -125b could be a novel diagnostic markers with good perspectives for future clinical applications in patients with glioma.

Increased expression of phosphatidylethanolamine-binding protein 4 (PEBP4) strongly associates with human gliomas grade

Abnormal expression of phosphatidylethanolamine-binding protein 4 (PEBP4) has been found in various types of malignancies. However, the PEBP4 expression in human gliomas is still unclear. In this study, we aim to compare the expression of PEBP4 in tumor samples derived from 58 patients with different grades of gliomas with that in 5 non-neoplastic brain samples and to investigate the clinical significance of PEBP4 expression in gliomas. The mRNA and protein expressions of PEBP4 were measured by real-time quantitative polymerase chain reaction and western blot, respectively. The intracellular expressions of PEBP4 in samples were examined by immunohistochemistry. The association between PEBP4 expression and the clinicopathologic characteristics of gliomas patients were analyzed. Our results demonstrated that the mRNA and protein levels of PEBP4 were upregulated in gliomas tissues, especially in high-grade (World Health Organization Grades III and IV) gliomas, when compared to normal control (p < 0.01). Immunohistochemical analysis indicated that PEBP4 was highly expressed in 82.4% (28/34) of high-grade gliomas, when compared to 41.7% (10/24) of high expression in low-grade gliomas and 20.0% (1/5) in non-neoplastic brain samples (p = 0.001). Multivariate Cox regression analysis revealed that increased PEBP4 expression was an independent prognostic factor for gliomas. Patients with low level of PEBP4 had longer survival time compared to those with high PEBP4 expression (p = 0.003). These data indicate a clinical significance of PEBP4 for predicting the tumor grade and the prognosis in patients with gliomas.