Efficacy of Transarterial Embolization with Arsenic Trioxide Oil Emulsion in a Rabbit VX2 Liver Tumor Model

Cerebral angiography using transauricular access in a rabbit model: a new technique

BACKGROUND

Cerebral angiography in a rabbit model is widely used in the field of interventional radiology. Conventionally, the femoral artery is used for cerebral angiography in radiology departments. However, angiographic studies require surgical cutdown of the femoral artery, which is technically difficult.

PURPOSE

To evaluate a new cerebral angiography technique involving a transauricular approach in a rabbit model.

MATERIAL AND METHODS

In each of 10 rabbits, central auricular arteries were punctured in the right or left ear with a 20-gauge i.v. catheter. A microcatheter (2.0 F) with a 0.016-inch guide wire was introduced through the i.v. catheter and advanced to the aortic arch. The microcatheter and guide wire were advanced selectively into cerebral arteries and angiography was performed.

RESULTS

Central auricular arteries were successfully punctured with 20-gauge i.v. catheters. After approaching the aortic arch, microcatheter tips and guide wires were advanced manually to cerebral arteries on both sides. Difficulties in selecting the carotid arteries were resolved by using a looping technique within the cardiac chamber. Microcatheter loops within the cardiac chamber disappeared or remained during artery superselection.

CONCLUSION

Transauricular cerebral angiography appears to be a feasible technique for brain or carotid intervention studies in rabbits. In addition, vertebral angiography using a transauricular approach is possible using the looping technique. Selection of carotid or vertebral arteries on each side was not difficult when the microcatheter and guide wire were looped within the cardiac chamber. The ear chosen for the initial puncture does not appear to be important.

Portal Vein Stenting Combined with 125I Particle Chain Implantation Followed by As2O3 in the Treatment of Hepatocellular Carcinoma with Portal Vein Tumour Thrombus

OBJECTIVE

To evaluate the feasibility and safety of portal vein stenting (PVS) combined with ¹²⁵I particle chain implantation and sequential arsenic trioxide (As₂O₃) for the treatment of hepatocellular carcinoma (HCC) with portal vein tumour thrombus (PVTT) by transcatheter arterial chemoembolization (TACE).

METHODS

From January 2015 to January 2018, the clinical data of 30 patients with HCC complicated by PVTT were retrospectively analysed (26 men and 4 women). The laboratory examinations, incidence of adverse events, cumulative survival rate, and stent patency were analysed for all enrolled patients.

RESULTS

The success rate of interventional treatment in all patients was 100%. The results of the laboratory tests before and 1 week after surgery showed that the mean concentrations of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) decreased from 50.9 U/L ± 25.8 to 41.8 U/L ± 21.6 (P < 0.001) and 57.6 U/L ± 19.9 to 44.2 U/L ± 26.1 (P < 0.001) and 57.6 U/L ± 19.9 to 44.2 U/L ± 26.1 (.

CONCLUSION

PVS combined with ¹²⁵I particle chain implantation followed by TACE with As₂O₃ is safe and feasible for patients with PVTT. The long-term efficacy of this treatment needs to be further studied.

Hepatic Arterial Chemoembolization With Arsenic Trioxide Eluting CalliSpheres Microspheres Versus Lipiodol Emulsion: Pharmacokinetics And Intratumoral Concentration In A Rabbit Liver Tumor Model

BACKGROUND

The objective of this study was to investigate the plasma pharmacokinetic profiles, intratumoral concentration and tissue distribution of arsenic trioxide (ATO) by drug-eluting beads (DEB)-transcatheter arterial chemoembolization (TACE) compared with conventional TACE (cTACE) in a rabbit liver tumor model.

METHODS

Sixty-four rabbits with VX2 liver tumor were established and randomly assigned to four groups equally. The calliSpheres microspheres (CSM)-ATO group received DEB-TACE treatment using ATO-loaded CSM; the cTACE-ATO group received cTACE treatment using ATO mixed with lipiodol; the CSM-normal control (NC) group received DEB-TACE treatment using blank CSM; the TAE-lipiodol group received cTACE treatment using saline mixed with lipiodol. ATO concentration in plasma, tumor and normal tissues, and liver and kidney function indexes were evaluated.

RESULTS

The CSM-ATO group exhibited lower plasma ATO concentrations at 10 minutes and 20 minutes post treatment compared with the cTACE-ATO group. Meanwhile, intratumoral ATO concentrations were higher in the CSM-ATO group compared with the cTACE-ATO group at 3-, 7- and 14-days post treatment. In normal liver tissue, heart and muscle tissues, ATO concentrations between the CSM-ATO and cTACE groups were similar at each time point; in kidney and lung tissues, ATO concentrations were lower in the CSM-ATO group at 1-day post treatment while they were similar at 3, 7 and 14 days post treatment. Also, liver or kidney function indexes were of no difference at each time point between CSM-ATO and cTACE-ATO groups.

CONCLUSION

Administration of ATO via DEB-TACE decreases systemic concentration while increasing intratumoral concentration of ATO without increasing liver or kidney toxicity compared with cTACE.

Arsenic trioxide reverses the chemoresistance in hepatocellular carcinoma: a targeted intervention of 14-3-3η/NF-κB feedback loop

Background

Multi-drug resistance (MDR) is one of the main obstacles for treatment of advanced/recurrent hepatocellular carcinoma (HCC). We have previously identified arsenic trioxide (ATO) as an effective metastasis/angiogenesis inhibitor in HCC. Here, we further found that MDR-HCC cells were more sensitive to ATO.

Methods

The MDR-HCC cells were used as experimental models. Biological functions were investigated using cell transfection, polymerase chain reaction, western blot, southwestern blot, immunostaining, immunoprecipitation plus atomic fluorescence spectrometry, and so on.

Results

The MDR-HCC cells underwent high oxidative stress condition, and employed adaptive mechanisms for them to survive; while ATO abolished such mechanisms via targeting the 14–3-3η/nuclear factor kappa B (NF-κB) feedback Loop. Briefly, in MDR cells, the increase of ROS activated NF-κB signaling, which transcriptionally activated 14–3-3η. Meanwhile, the activation of NF-κB can be constitutively maintained by 14–3-3η. As a NF-κB inhibitor, ATO transcriptionally inhibited the 14–3-3η mRNA level. Meanwhile, ATO was also validated to directly bind to 14–3-3η, enhancing the degradation of 14–3-3η protein in an ubiquitination-dependent manner. Knockdown of 14–3-3η reduced the ATO-induced reversal extents of drug resistance in MDR cells.

Conclusion

14–3-3η/NF-κB feedback loop plays an important role in maintaining the MDR phenotype in HCC. Moreover, via targeting such feedback loop, ATO could be considered as a potential molecular targeted agent for the treatment of HCC.

Electronic supplementary material

The online version of this article (10.1186/s13046-018-1005-y) contains supplementary material, which is available to authorized users.

Safety and effect on ablation size of hydrochloric acid-perfused radiofrequency ablation in animal livers

PURPOSE

Our objective was to determine the safety and ablation size of hydrochloric acid-perfused radiofrequency ablation (HCl-RFA) in liver tissues, prospectively using in vivo rabbit and ex vivo porcine liver models.

MATERIALS AND METHODS

The livers in 30 rabbits were treated in vivo with perfusions of normal saline (controls) and HCl concentrations of 5%, 10%, 15%, and 20%, during RFA at 103 °C and 30 W for 3 min. For each experimental setting, six ablations were created. Safety was assessed by comparing baseline weight and selected laboratory values with those at 2, 7, and 14 days' post-ablation, and by histopathological analysis. The livers in 25 pigs were treated ex vivo with the same five perfusions during RFA at 103 °C, at both 30 W and 60 W, for 30 min. Ablation diameters and volumes were measured by two examiners.

RESULTS

Rabbit weights and selected laboratory values did not differ significantly from baseline to 7 and 14 days' post-ablation, liver tissues outside the ablation zones were normal histologically, and adjacent organs showed no macroscopic damage. The mean ablation volumes in the porcine livers treated with HCl-RFA were all larger than those treated with normal saline perfusion during RFA (NS-RFA), at both 30 W and 60 W (p < 0.001). The largest ablation volume and transverse diameter were observed in the porcine livers during 10% HCl-RFA at 60 W, measuring 179.22 (SD = 24.79) cm³ and 6.84 (SD = 0.36) cm, respectively.

CONCLUSIONS

Based on our experiments, HCl-RFA in the liver appears to be as safe as NS-RFA while also resulting in larger ablation zones.

Arsenic trioxide combined with transarterial chemoembolization for primary liver cancer: A meta-analysis

BACKGROUND AND AIM

The benefit of combination therapy of arsenic trioxide (As₂ O₃ ) and transarterial chemoembolization (TACE) is debated. This meta-analysis was conducted to determine whether As₂ O₃ &TACE therapy achieves better therapeutic effects compared with TACE alone for primary liver cancer.

METHODS

A systematic search of both English and Chinese databases was conducted for randomized controlled trials. The main outcomes were therapeutic responses, survival rates, improvement in quality of life, and adverse events. All data analyses in this study were carried out using Review Manager software and STATA software.

RESULTS

Eighteen randomized controlled trials involving 1412 participants were included. The pooled objective response rate was significantly higher in the As₂ O₃ &TACE group compared with the TACE group (relative risk [RR] 1.36, 95% confidence interval [CI] 1.16-1.58, P < 0.0001), and the pooled clinical benefit rate was also significantly higher (RR 1.18, 95% CI 1.08-1.29, P = 0.0002). A higher pooled result was obtained from the combination group for 1-year survival rate (RR 1.37, 95% CI 1.23-1.53, P < 0.00001). As₂ O₃ &TACE therapy was not superior to TACE alone for improvement in quality of life (RR 1.15, 95% CI 0.98-1.36, P = 0.09). There was no significant difference in the risk of adverse effects. When a subgroup analysis was performed, both administration methods of As₂ O₃ (intravenous or arterial) were effective for all evaluating indicators except the improvement in quality of life.

CONCLUSIONS

Adjuvant As₂ O₃ therapy combined with TACE achieves better therapeutic effects compared with TACE alone. Both the intravenous administration of As₂ O₃ and the arterial administration of As₂ O₃ were good options for clinical practice.

Effects of arsenic trioxide on the expression of ezrin in hepatocellular carcinoma

The aim of the study was to investigate the effects of arsenic trioxide (As2O3) treatment on the expression of ezrin and serum alpha-fetoprotein (AFP) levels in hepatocellular carcinoma (HCC).A total of 24 patients (20 males and 4 females) with resectable HCC were treated with venous injection of As2O3 for 14 days (10 mg/d) before surgery. The ezrin expression and serum AFP levels were assessed before and after treatment, respectively.The serum AFP levels were 325.5 ng/L before treatment and 278.6 ng/L after treatment, with statistical significant difference (Z = -2.360, P < .05). The expression of ezrin was negative, weak positive, and strong positive in 11, 7, and 6 cases, respectively, before As2O3 treatment, and 17, 5, 2 cases respectively after the treatment. The difference between the 2 groups was statistically significant (χ = 5.619, P < .05). Also, the results showed that there was a significant correlation between the high serum AFP level (AFP ≥ 500 ng/L) and high expression of ezrin (χ = 8.080, P < .05).As2O3 treatment can significantly downregulate the expression of ezrin in HCC.

Arsenic trioxide intravenous infusion combined with transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with pulmonary metastasis: Long-term outcome analysis

OBJECTIVE

To evaluate the safety, clinical efficacy, and long-term outcome of arsenic trioxide (As₂ O₃ ) intravenous infusion for pulmonary metastases in patients with HCC.

MATERIALS AND METHODS

Sixty consecutive patients who were diagnosed with advanced hepatocellular carcinoma (HCC) with pulmonary metastasis were randomized 1:1 into the treatment and control groups. Treatment group underwent transcatheter arterial chemoembolization (TACE) for the primary liver tumor and then underwent As₂ O₃ treatment, whereas control group underwent TACE alone. The treatment group underwent a continuous 5-h intravenous infusion of 10 mg/day As₂ O₃ . The course of As₂ O₃ treatment was initiated 3-5 days after TACE (to allow liver and gastrointestinal function to recover) and continued for 14 consecutive days. All patients in the treatment group underwent at least four treatment courses. Response to treatment was evaluated after four treatment courses.

RESULT

In treatment group, two patients had a complete response (CR), six had a partial response (PR), 10 had stable disease (SD), and 12 had progressive disease. A clinically effective rate (CR + PR) was achieved in 26.7%, and the clinical benefit rate (CR + PR + SD) was 60%. In the control group, no patients had a CR or PR, five had SD, and 25 had progressive disease. The clinically effective rate was 0%, and the clinical benefit rate was 16.7%. The overall 1-year survival was 56.7% in treatment group and 36.7% in control group. The overall 2-year survival was 16.7% in treatment group and 3.3% in control group.

CONCLUSION

Transcatheter arterial chemoembolization plus an intravenous infusion of As₂ O₃ effectively controlled pulmonary metastasis and prolonged overall survival in patients with HCC compared with TACE alone.

Anticancer effect of arsenic trioxide on cholangiocarcinoma: in vitro experiments and in vivo xenograft mouse model

The purpose of our study was to investigate anticancer activity of arsenic trioxide (As2O3) on cholangiocarcinoma through in vitro and in vivo experiments using human cholangiocarcinoma cancer cells (CC-t6 cells) and a nude mouse model. The effect of As2O3 on CC-t6 cell survival was determined in vitro using MTT assay. Analysis of cell cycle phase distribution and quantification of apoptosis/necrosis, which were achieved by flow cytometry, were performed in order to understand the mechanism of As2O3. In vivo experiment was performed to assess the effectiveness of local injection of As2O3 on tumor inhibition by comparing the following three groups each consisting of five nude mouse xenograft models: high dose As2O3 (5 mg/kg), low dose As2O3 (1 mg/kg), and saline. In MTT assay, As2O3 inhibited the growth of CC-t6 cells more effectively than cisplatin or adriamycin at concentrations between 1 and 100 μM for most time points between 24 and 72 h (p < 0.05). With increased concentration of As2O3, there was dose-dependent increase in G 0/G 1 phase and dose-dependent decrease in S phase. As2O3-mediated inhibition of cell viability was achieved via induction of apoptosis and necrosis in a dose-dependent manner. Injection of As2O3 into CC-t6-induced tumors in nude mice inhibited the growth of subcutaneous tumor xenografts. As2O3 treatment dose-dependently inhibited the proliferation of CC-t6 cells via G 0/G 1 phase arrest and retarded tumor growth in nude mice, suggesting that As2O3 may be effective in the treatment of cholangiocarcinoma.

Comparison between transauricular and transfemoral arterial access for hepatic artery angiography in a rabbit model

PURPOSE

To evaluate the feasibility of transauricular arterial access and compare the procedure time needed for hepatic artery angiography via transfemoral versus transauricular arterial access in a rabbit model.

MATERIALS AND METHODS

This study was approved by the research animal care and use committee. Twenty rabbits were divided into transfemoral (n = 10) and transauricular access groups (n = 10). The procedure consisted of shaving the hair, obtaining intraarterial access, performing hepatic artery angiography, and repairing the access site. A Mann-Whitney U test was used to compare the two groups in terms of the total procedure time and the time needed for each step.

RESULTS

Hepatic artery angiography was technically feasible in all animals in both groups. The time required for shaving was 55 seconds ± 9.9 in the transfemoral access group; shaving was unnecessary in the transauricular access group. The times needed to obtain intraarterial access, perform hepatic artery angiography, repair the access site, and perform the entire procedure in the transfemoral and transauricular access groups were as follows: 503.3 s ± 211.8 and 97 s ± 83.3 (P < .001), 229.6 s ± 90 and 310.7 s ± 211 (P = .705), 305.5 s ± 80.6 and 90 s ± 0 (P < .001), and 1,038 s ± 265.9 and 497.7 s ± 256.9 (P = 0.001), respectively.

CONCLUSIONS

Hepatic artery angiography is technically feasible via transauricular arterial access. The major advantages of transauricular arterial access versus transfemoral arterial access include a procedure time reduced by the omission of shaving and surgical cutdown.