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van den Berg J, Castricum KCM, Meel MH, Goedegebuure RSA, Lagerwaard FJ, Slotman BJ, Hulleman E, Thijssen VLJL. Development of transient radioresistance during fractionated irradiation in vitro. Radiother Oncol 2020; 148:107-114. [PMID: 32344261 DOI: 10.1016/j.radonc.2020.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/10/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE Effective combination treatments with fractionated radiotherapy rely on a proper understanding of the dynamic responses that occur during treatment. We explored the effect of clinical fractionated radiotherapy on the development and timing of radioresistance in tumor cells. METHODS AND MATERIALS Different colon (HT29/HCT116/COLO320/SW480/RKO) and high-grade astrocytoma (D384/U-251MG) cancer cell lines were treated for 6 weeks with daily fractions of 2 Gy, 5 days per week. Clonogenic survival was determined throughout the treatment period. In addition, the radiosensitivity of irradiated and non-irradiated was compared. Finally, the effect of different dose fractions on the development of radioresistance was determined. RESULTS All cell lines developed radioresistance within 2-3 weeks during fractionated radiotherapy. This was characterized by the occurrence of a steady state phase of clonogenic survival. In U-251MG cells this was accompanied by increased cell senescence and stemness. After recovering from six weeks of treatment, the radiosensitivity of fractionally irradiated and non-irradiated cells was similar. Including transient radioresistance, described as (α/β)-(d+1), as a factor in the classic LQ model resulted in a perfect fit with the experimental data observed during fractionated radiotherapy. This was confirmed when different dose fractions were applied. CONCLUSIONS Fractionated irradiation of cancer cells in vitro following clinical radiation schedules induces a reversible radioresistance response. This adaptive response can be included in the LQ model as a function of the dose fraction and the alpha/beta-ratio of a given cell line. These findings warrant further investigation of the mechanisms and clinical relevance of adaptive radioresistance.
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Affiliation(s)
- Jaap van den Berg
- Amsterdam UMC location VUmc, Department of Radiation Oncology, Cancer Center Amsterdam, The Netherlands
| | - Kitty C M Castricum
- Amsterdam UMC location VUmc, Department of Radiation Oncology, Cancer Center Amsterdam, The Netherlands
| | - Michaël H Meel
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ruben S A Goedegebuure
- Amsterdam UMC location VUmc, Department of Medical Oncology, Cancer Center Amsterdam, The Netherlands
| | - Frank J Lagerwaard
- Amsterdam UMC location VUmc, Department of Radiation Oncology, Cancer Center Amsterdam, The Netherlands
| | - Ben J Slotman
- Amsterdam UMC location VUmc, Department of Radiation Oncology, Cancer Center Amsterdam, The Netherlands
| | - Esther Hulleman
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Victor L J L Thijssen
- Amsterdam UMC location VUmc, Department of Radiation Oncology, Cancer Center Amsterdam, The Netherlands.
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Peterle GT, Maia LL, Trivilin LO, de Oliveira MM, Dos Santos JG, Mendes SO, Stur E, Agostini LP, Rocha LA, Moysés RA, Cury PM, Nunes FD, Louro ID, Dos Santos M, da Silva AMÁ. PAI-1, CAIX, and VEGFA expressions as prognosis markers in oral squamous cell carcinoma. J Oral Pathol Med 2018; 47:566-574. [PMID: 29693741 DOI: 10.1111/jop.12721] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND In oral squamous cell carcinoma (OSCC), the HIF-1 complex promotes the expression of genes involved in specific mechanisms of cell survival under hypoxic conditions, such as plasminogen activator inhibitor-1 (PAI-1), carbonic anhydrase 9 (CAIX), and vascular endothelial growth factor A (VEGFA). The study aimed to investigate the presence and prognostic value of PAI-1, CAIX, and VEGFA in OSCC. MATERIALS AND METHODS Immunohistochemistry was used to analyze the expressions of these proteins in 52 tumoral tissue samples of patients with OSCC, surgically treated and followed by a minimum of 24 months after surgery. The correlations between protein expressions and clinicopathological parameters and prognosis were analyzed. RESULTS Positive PAI-1 membrane expression was significantly associated with local disease relapse (P = .027). Multivariate analysis revealed that the positive PAI-1 membrane expression is an independent marker for local disease relapse, with approximately 14-fold increased risk when compared to negative expression (OR = 14.49; CI = 1.40-150.01, P = .025). Strong PAI-1 cytoplasmic expression was significantly associated with the less differentiation grade (P = .027). Strong CAIX membrane expression was significantly associated with local disease-free survival (P = .038). Positive CAIX cytoplasmic expression was significantly associated with lymph node affected (P = .025) and with disease-specific survival (P = .022). Multivariate analysis revealed that the positive CAIX cytoplasmic expression is an independent risk factor for disease-related death, increasing their risk approximately 3-fold when compared to negative expression (HR = 2.84; CI = 1.02-7.87, P = .045). Positive VEGFA cytoplasmic expression was significantly associated with less differentiation grade (P = .035). CONCLUSION Our results suggest a potential role for these expressions profiles as tumor prognostic markers in OSCC patients.
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Affiliation(s)
- Gabriela Tonini Peterle
- Programa de Pós-Graduação em Biotecnologia - RENORBIO, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Lucas Lima Maia
- Programa de Pós-Graduação em Biotecnologia - RENORBIO, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Leonardo Oliveira Trivilin
- Departamento de Medicina Veterinária, Universidade Federal do Espírito Santo, Campus Alegre, Alegre, ES, Brazil
| | - Mayara Mota de Oliveira
- Programa de Pós-Graduação em Biotecnologia - RENORBIO, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Joaquim Gasparini Dos Santos
- Programa de Pós-Graduação em Biotecnologia - RENORBIO, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Suzanny Oliveira Mendes
- Programa de Pós-Graduação em Biotecnologia - RENORBIO, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Elaine Stur
- Programa de Pós-Graduação em Biotecnologia - RENORBIO, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Lidiane Pignaton Agostini
- Programa de Pós-Graduação em Biotecnologia - RENORBIO, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Lília Alves Rocha
- Departamento de Patologia Bucal, Faculdade de Odontologia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Raquel Ajub Moysés
- Serviço de Cirurgia de Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Patrícia Maluf Cury
- Departamento de Medicina, Faculdade FACERES, São José do Rio Preto, SP, Brazil
| | - Fábio Daumas Nunes
- Departamento de Patologia Bucal, Faculdade de Odontologia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Iúri Drumond Louro
- Programa de Pós-Graduação em Biotecnologia - RENORBIO, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Marcelo Dos Santos
- Escola Multicampi de Ciências Médicas, Universidade Federal do Rio Grande do Norte, Caicó, RN, Brazil
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uPA/uPAR and SERPINE1 in head and neck cancer: role in tumor resistance, metastasis, prognosis and therapy. Oncotarget 2018; 7:57351-57366. [PMID: 27385000 PMCID: PMC5302994 DOI: 10.18632/oncotarget.10344] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/13/2016] [Indexed: 12/25/2022] Open
Abstract
There is strong evidence supporting the role of the plasminogen activator system in head and neck squamous cell carcinoma (HNSCC), particularly of its uPA (urokinase plasminogen activator) / uPAR (urokinase plasminogen activator receptor) and SERPINE1 components. Overexpression of uPA/uPAR and SERPINE1 enhances tumor cell migration and invasion and plays a key role in metastasis development, conferring poor prognosis. The apparent paradox of uPA/uPAR and its inhibitor SERPINE1 producing similar effects is solved by the identification of SERPINE1 activated signaling pathways independent of uPA inhibition. Both uPA/uPAR and SERPINE1 are directly linked to the induction of epithelial-to-mesenchymal transition, the acquisition of stem cell properties and resistance to antitumor agents. The aim of this review is to provide insight on the deregulation of these proteins in all these processes. We also summarize their potential value as prognostic biomarkers or potential drug targets in HNSCC patients. Concomitant overexpression of uPA/uPAR and SERPINE1 is associated with a higher risk of metastasis and could be used to identify patients that would benefit from an adjuvant treatment. In the future, the specific inhibitors of uPA/uPAR and SERPINE1, which are still under development, could be used to design new therapeutic strategies in HNSCCs.
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Kleibeuker EA, Fokas E, Allen PD, Kersemans V, Griffioen AW, Beech J, Im JH, Smart SC, Castricum KC, van den Berg J, Schulkens IA, Hill SA, Harris AL, Slotman BJ, Verheul HM, Muschel RJ, Thijssen VL. Low dose angiostatic treatment counteracts radiotherapy-induced tumor perfusion and enhances the anti-tumor effect. Oncotarget 2016; 7:76613-76627. [PMID: 27780936 PMCID: PMC5363534 DOI: 10.18632/oncotarget.12814] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/13/2016] [Indexed: 12/15/2022] Open
Abstract
The extent of tumor oxygenation is an important factor contributing to the efficacy of radiation therapy (RTx). Interestingly, several preclinical studies have shown benefit of combining RTx with drugs that inhibit tumor blood vessel growth, i.e. angiostatic therapy. Recent findings show that proper scheduling of both treatment modalities allows dose reduction of angiostatic drugs without affecting therapeutic efficacy. We found that whilst low dose sunitinib (20 mg/kg/day) did not affect the growth of xenograft HT29 colon carcinoma tumors in nude mice, the combination with either single dose RTx (1x 5Gy) or fractionated RTx (5x 2Gy/week, up to 3 weeks) substantially hampered tumor growth compared to either RTx treatment alone. To better understand the interaction between RTx and low dose angiostatic therapy, we explored the effects of RTx on tumor angiogenesis and tissue perfusion. DCE-MRI analyses revealed that fractionated RTx resulted in enhanced perfusion after two weeks of treatment. This mainly occurred in the center of the tumor and was accompanied by increased tissue viability and decreased hypoxia. These effects were accompanied by increased expression of the pro-angiogenic growth factors VEGF and PlGF. DCE-MRI and contrast enhanced ultrasonography showed that the increase in perfusion and tissue viability was counteracted by low-dose sunitinib. Overall, these data give insight in the dynamics of tumor perfusion during conventional 2 Gy fractionated RTx and provide a rationale to combine low dose angiostatic drugs with RTx both in the palliative as well as in the curative setting.
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Affiliation(s)
- Esther A. Kleibeuker
- Department of Radiation Oncology, VU University Medical Centre, De Boelelaan, HV Amsterdam, The Netherlands
- Department of Medical Oncology, VU University Medical Centre, De Boelelaan, HV Amsterdam, The Netherlands
| | - Emmanouil Fokas
- Oxford Institute for Radiation Oncology and Biology, University of Oxford, Oxford, UK
| | - Philip D. Allen
- Oxford Institute for Radiation Oncology and Biology, University of Oxford, Oxford, UK
| | - Veerle Kersemans
- Oxford Institute for Radiation Oncology and Biology, University of Oxford, Oxford, UK
| | - Arjan W. Griffioen
- Department of Medical Oncology, VU University Medical Centre, De Boelelaan, HV Amsterdam, The Netherlands
| | - John Beech
- Oxford Institute for Radiation Oncology and Biology, University of Oxford, Oxford, UK
| | - Jaehong H. Im
- Oxford Institute for Radiation Oncology and Biology, University of Oxford, Oxford, UK
| | - Sean C. Smart
- Oxford Institute for Radiation Oncology and Biology, University of Oxford, Oxford, UK
| | - Kitty C. Castricum
- Department of Radiation Oncology, VU University Medical Centre, De Boelelaan, HV Amsterdam, The Netherlands
| | - Jaap van den Berg
- Department of Radiation Oncology, VU University Medical Centre, De Boelelaan, HV Amsterdam, The Netherlands
| | - Iris A. Schulkens
- Department of Radiation Oncology, VU University Medical Centre, De Boelelaan, HV Amsterdam, The Netherlands
| | - Sally A. Hill
- Oxford Institute for Radiation Oncology and Biology, University of Oxford, Oxford, UK
| | - Adrian L. Harris
- Department of Molecular Oncology, University of Oxford, Oxford, UK
| | - Ben J. Slotman
- Department of Radiation Oncology, VU University Medical Centre, De Boelelaan, HV Amsterdam, The Netherlands
| | - Henk M. Verheul
- Department of Medical Oncology, VU University Medical Centre, De Boelelaan, HV Amsterdam, The Netherlands
| | - Ruth J. Muschel
- Oxford Institute for Radiation Oncology and Biology, University of Oxford, Oxford, UK
| | - Victor L. Thijssen
- Department of Radiation Oncology, VU University Medical Centre, De Boelelaan, HV Amsterdam, The Netherlands
- Department of Medical Oncology, VU University Medical Centre, De Boelelaan, HV Amsterdam, The Netherlands
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Nakajima EC, Laymon C, Oborski M, Hou W, Wang L, Grandis JR, Ferris RL, Mountz JM, Van Houten B. Quantifying metabolic heterogeneity in head and neck tumors in real time: 2-DG uptake is highest in hypoxic tumor regions. PLoS One 2014; 9:e102452. [PMID: 25127378 PMCID: PMC4134191 DOI: 10.1371/journal.pone.0102452] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 06/02/2014] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Intratumoral metabolic heterogeneity may increase the likelihood of treatment failure due to the presence of a subset of resistant tumor cells. Using a head and neck squamous cell carcinoma (HNSCC) xenograft model and a real-time fluorescence imaging approach, we tested the hypothesis that tumors are metabolically heterogeneous, and that tumor hypoxia alters patterns of glucose uptake within the tumor. EXPERIMENTAL DESIGN Cal33 cells were grown as xenograft tumors (n = 16) in nude mice after identification of this cell line's metabolic response to hypoxia. Tumor uptake of fluorescent markers identifying hypoxia, glucose import, or vascularity was imaged simultaneously using fluorescent molecular tomography. The variability of intratumoral 2-deoxyglucose (IR800-2-DG) concentration was used to assess tumor metabolic heterogeneity, which was further investigated using immunohistochemistry for expression of key metabolic enzymes. HNSCC tumors in patients were assessed for intratumoral variability of (18)F-fluorodeoxyglucose ((18)F-FDG) uptake in clinical PET scans. RESULTS IR800-2-DG uptake in hypoxic regions of Cal33 tumors was 2.04 times higher compared to the whole tumor (p = 0.0001). IR800-2-DG uptake in tumors containing hypoxic regions was more heterogeneous as compared to tumors lacking a hypoxic signal. Immunohistochemistry staining for HIF-1α, carbonic anhydrase 9, and ATP synthase subunit 5β confirmed xenograft metabolic heterogeneity. We detected heterogeneous (18)F-FDG uptake within patient HNSCC tumors, and the degree of heterogeneity varied amongst tumors. CONCLUSION Hypoxia is associated with increased intratumoral metabolic heterogeneity. (18)F-FDG PET scans may be used to stratify patients according to the metabolic heterogeneity within their tumors, which could be an indicator of prognosis.
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Affiliation(s)
- Erica C. Nakajima
- Physician Scientist Training Program, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Howard Hughes Medical Fellow, Howard Hughes Medical Institute, Bethesda, Maryland, United States of America
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Charles Laymon
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Matthew Oborski
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Weizhou Hou
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Lin Wang
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Jennifer R. Grandis
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Robert L. Ferris
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - James M. Mountz
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Bennett Van Houten
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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