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Wu S, Huisman BW, Rietveld MH, Rissmann R, Vermeer MH, van Poelgeest MIE, El Ghalbzouri A. The development of in vitro organotypic 3D vulvar models to study tumor-stroma interaction and drug efficacy. Cell Oncol (Dordr) 2024; 47:883-896. [PMID: 38057628 DOI: 10.1007/s13402-023-00902-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Vulvar squamous cell carcinoma (VSCC) is a rare disease with a poor prognosis. To date, there's no proper in vitro modeling system for VSCC to study its pathogenesis or for drug evaluation. METHODS We established healthy vulvar (HV)- and VSCC-like 3D full thickness models (FTMs) to observe the tumor-stroma interaction and their applicability for chemotherapeutic efficacy examination. VSCC-FTMs were developed by seeding VSCC tumor cell lines (A431 and HTB117) onto dermal matrices harboring two NF subtypes namely papillary fibroblasts (PFs) and reticular fibroblasts (RFs), or cancer-associated fibroblasts (CAFs) while HV-FTMs were constructed with primary keratinocytes and fibroblasts isolated from HV tissues. RESULTS HV-FTMs highly resembled HV tissues in terms of epidermal morphogenesis, basement membrane formation and collagen deposition. When the dermal compartment shifted from PFs to RFs or CAFs in VSCC-FTMs, tumor cells demonstrated more proliferation, EMT induction and stemness. In contrast to PFs, RFs started to lose their phenotype and express robust CAF-markers α-SMA and COL11A1 under tumor cell signaling induction, indicating a favored 'RF-to-CAF' transition in VSCC tumor microenvironment (TME). Additionally, chemotherapeutic treatment with carboplatin and paclitaxel resulted in a significant reduction in tumor-load and invasion in VSCC-FTMs. CONCLUSION We successfully developed in vitro 3D vulvar models mimicking both healthy and tumorous conditions which serve as a promising tool for vulvar drug screening programs. Moreover, healthy fibroblasts demonstrate heterogeneity in terms of CAF-activation in VSCC TME which brings insights in the future development of novel CAF-based therapeutic strategies in VSCC.
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Affiliation(s)
- Shidi Wu
- Department of Dermatology, Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands
| | - Bertine W Huisman
- Center for Human Drug Research, Leiden, 2333 CL, The Netherlands
- Department of Gynecology, Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands
| | - Marion H Rietveld
- Department of Dermatology, Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands
| | - Robert Rissmann
- Department of Dermatology, Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands
- Center for Human Drug Research, Leiden, 2333 CL, The Netherlands
- Leiden Academic Center for Drug Research, Leiden University, Leiden, 2333 CC, The Netherlands
| | - Maarten H Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands
| | - Mariette I E van Poelgeest
- Center for Human Drug Research, Leiden, 2333 CL, The Netherlands
- Department of Gynecology, Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands
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Loverro M, Bizzarri N, Capomacchia FM, Watrowski R, Querleu D, Gioè A, Naldini A, Santullo F, Foschi N, Fagotti A, Scambia G, Fanfani F. Indocyanine green fluorescence applied to gynecologic oncology: beyond sentinel lymph node. Int J Surg 2024; 110:3641-3653. [PMID: 38489558 PMCID: PMC11175818 DOI: 10.1097/js9.0000000000001318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 02/26/2024] [Indexed: 03/17/2024]
Abstract
Indocyanine green (ICG), a well-known molecule employed in medicine for over five decades, has emerged as a versatile dye widely embraced across various surgical disciplines. In gynecologic oncology, its prevalent use revolves around the detection of sentinel lymph nodes. However, the true potential of ICG extends beyond this singular application, owing to its pragmatic utility, cost-effectiveness, and safety profile. Furthermore, ICG has been introduced in the theranostic landscape, marking a significant juncture in the evolution of its clinical utility. This narrative review aims to describe the expanding horizons of ICG fluorescence in gynecologic oncology, beyond the sentinel lymph node biopsy. The manifold applications reported within this manuscript include: 1) lymphography; 2) angiography; 3) nerve visualization; 4) ICG-driven resections; and 5) theranostic. The extensive exploration across these numerous applications, some of which are still in the preclinical phase, serves as a hypothesis generator, aiming to stimulate the development of clinical studies capable of expanding the use of this drug in our field, enhancing the care of gynecological cancer patients.
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Affiliation(s)
- Matteo Loverro
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS
| | | | - Rafał Watrowski
- Department of Gynecology and Obsterics, Helios Hospital Müllheim, Teaching Hospital of the University of Freiburg, 79379 Müllheim
- Faculty of Medicine, Medical Center - University of Freiburg, 79106 Freiburg, Germany
| | - Denis Querleu
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS
| | - Alessandro Gioè
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS
| | - Angelica Naldini
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS
| | - Francesco Santullo
- Operational Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli
| | - Nazario Foschi
- Urology Division, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Anna Fagotti
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS
- Università Cattolica del Sacro Cuore
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS
- Università Cattolica del Sacro Cuore
| | - Francesco Fanfani
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS
- Università Cattolica del Sacro Cuore
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Comprehensive Review of Fluorescence Applications in Gynecology. J Clin Med 2021; 10:jcm10194387. [PMID: 34640405 PMCID: PMC8509149 DOI: 10.3390/jcm10194387] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022] Open
Abstract
Since the introduction of indocyanine green (ICG) as a fluorophore in near-infrared imaging, fluorescence visualization has become an essential tool in many fields of surgery. In the field of gynecology, recent new applications have been proposed and found their place in clinical practice. Different applications in gynecology were investigated, subcategorized, and overviewed concerning surgical applications and available dyes. Specific applications in which fluorescence-guided surgery was implemented in gynecology are described in this manuscript—namely, sentinel node biopsy, mesometrium visualization, angiography of different organs, safety issues in pregnant women, ureters visualization, detection of peritoneal metastases, targeted fluorophores for cancer detection, fluorescent contamination hysterectomy, lymphography for lower limb lymphedema prevention, tumor margin detection, endometriosis, and metastases mapping. With evolving technology, further innovative research on the new applications of fluorescence visualization in cancer surgery may help to establish these techniques as standards of high-quality surgery in gynecology. However, more investigations are necessary in order to assess if these innovative tools can also be effective to improve patient outcomes and quality of life in different gynecologic malignancies.
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Zubor P, Wang Y, Liskova A, Samec M, Koklesova L, Dankova Z, Dørum A, Kajo K, Dvorska D, Lucansky V, Malicherova B, Kasubova I, Bujnak J, Mlyncek M, Dussan CA, Kubatka P, Büsselberg D, Golubnitschaja O. Cold Atmospheric Pressure Plasma (CAP) as a New Tool for the Management of Vulva Cancer and Vulvar Premalignant Lesions in Gynaecological Oncology. Int J Mol Sci 2020; 21:ijms21217988. [PMID: 33121141 PMCID: PMC7663780 DOI: 10.3390/ijms21217988] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 12/24/2022] Open
Abstract
Vulvar cancer (VC) is a specific form of malignancy accounting for 5–6% of all gynaecologic malignancies. Although VC occurs most commonly in women after 60 years of age, disease incidence has risen progressively in premenopausal women in recent decades. VC demonstrates particular features requiring well-adapted therapeutic approaches to avoid potential treatment-related complications. Significant improvements in disease-free survival and overall survival rates for patients diagnosed with post-stage I disease have been achieved by implementing a combination therapy consisting of radical surgical resection, systemic chemotherapy and/or radiotherapy. Achieving local control remains challenging. However, mostly due to specific anatomical conditions, the need for comprehensive surgical reconstruction and frequent post-operative healing complications. Novel therapeutic tools better adapted to VC particularities are essential for improving individual outcomes. To this end, cold atmospheric plasma (CAP) treatment is a promising option for VC, and is particularly appropriate for the local treatment of dysplastic lesions, early intraepithelial cancer, and invasive tumours. In addition, CAP also helps reduce inflammatory complications and improve wound healing. The application of CAP may realise either directly or indirectly utilising nanoparticle technologies. CAP has demonstrated remarkable treatment benefits for several malignant conditions, and has created new medical fields, such as “plasma medicine” and “plasma oncology”. This article highlights the benefits of CAP for the treatment of VC, VC pre-stages, and postsurgical wound complications. There has not yet been a published report of CAP on vulvar cancer cells, and so this review summarises the progress made in gynaecological oncology and in other cancers, and promotes an important, understudied area for future research. The paradigm shift from reactive to predictive, preventive and personalised medical approaches in overall VC management is also considered.
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Affiliation(s)
- Pavol Zubor
- Department of Gynaecological Oncology, The Norwegian Radium Hospital, Oslo University Hospital, 0379 Oslo, Norway; (Y.W.); (A.D.)
- OBGY Health & Care, Ltd., 010 01 Zilina, Slovakia
- Correspondence: or
| | - Yun Wang
- Department of Gynaecological Oncology, The Norwegian Radium Hospital, Oslo University Hospital, 0379 Oslo, Norway; (Y.W.); (A.D.)
| | - Alena Liskova
- Department of Medical Biology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia; (A.L.); (M.S.); (L.K.); (P.K.)
| | - Marek Samec
- Department of Medical Biology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia; (A.L.); (M.S.); (L.K.); (P.K.)
| | - Lenka Koklesova
- Department of Medical Biology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia; (A.L.); (M.S.); (L.K.); (P.K.)
| | - Zuzana Dankova
- Biomedical Centre Martin, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia; (Z.D.); (D.D.); (V.L.); (B.M.); (I.K.)
| | - Anne Dørum
- Department of Gynaecological Oncology, The Norwegian Radium Hospital, Oslo University Hospital, 0379 Oslo, Norway; (Y.W.); (A.D.)
| | - Karol Kajo
- Department of Pathology, St. Elizabeth Cancer Institute Hospital, 81250 Bratislava, Slovakia;
| | - Dana Dvorska
- Biomedical Centre Martin, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia; (Z.D.); (D.D.); (V.L.); (B.M.); (I.K.)
| | - Vincent Lucansky
- Biomedical Centre Martin, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia; (Z.D.); (D.D.); (V.L.); (B.M.); (I.K.)
| | - Bibiana Malicherova
- Biomedical Centre Martin, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia; (Z.D.); (D.D.); (V.L.); (B.M.); (I.K.)
| | - Ivana Kasubova
- Biomedical Centre Martin, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia; (Z.D.); (D.D.); (V.L.); (B.M.); (I.K.)
| | - Jan Bujnak
- Department of Obstetrics and Gynaecology, Kukuras Michalovce Hospital, 07101 Michalovce, Slovakia;
| | - Milos Mlyncek
- Department of Obstetrics and Gynaecology, Faculty Hospital Nitra, Constantine the Philosopher University, 949 01 Nitra, Slovakia;
| | - Carlos Alberto Dussan
- Department of Surgery, Orthopaedics and Oncology, University Hospital Linköping, 581 85 Linköping, Sweden;
| | - Peter Kubatka
- Department of Medical Biology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 03601 Martin, Slovakia; (A.L.); (M.S.); (L.K.); (P.K.)
| | - Dietrich Büsselberg
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, P.O. Box 24144 Doha, Qatar;
| | - Olga Golubnitschaja
- Predictive, Preventive Personalised (3P) Medicine, Department of Radiation Oncology, Rheinische Friedrich-Wilhelms-Universität Bonn, 53105 Bonn, Germany;
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