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Du Y, Li R, Fu D, Zhang B, Cui A, Shao Y, Lai Z, Chen R, Chen B, Wang Z, Zhang W, Chu L. Multi-omics technologies and molecular biomarkers in brain tumor-related epilepsy. CNS Neurosci Ther 2024; 30:e14717. [PMID: 38641945 PMCID: PMC11031674 DOI: 10.1111/cns.14717] [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] [Received: 11/17/2023] [Revised: 03/04/2024] [Accepted: 03/29/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Brain tumors are one of the leading causes of epilepsy, and brain tumor-related epilepsy (BTRE) is recognized as the major cause of intractable epilepsy, resulting in huge treatment cost and burden to patients, their families, and society. Although optimal treatment regimens are available, the majority of patients with BTRE show poor resolution of symptoms. BTRE has a very complex and multifactorial etiology, which includes several influencing factors such as genetic and molecular biomarkers. Advances in multi-omics technologies have enabled to elucidate the pathophysiological mechanisms and related biomarkers of BTRE. Here, we reviewed multi-omics technology-based research studies on BTRE published in the last few decades and discussed the present status, development, opportunities, challenges, and prospects in treating BTRE. METHODS First, we provided a general review of epilepsy, BTRE, and multi-omics techniques. Next, we described the specific multi-omics (including genomics, transcriptomics, epigenomics, proteomics, and metabolomics) techniques and related molecular biomarkers for BTRE. We then presented the associated pathogenetic mechanisms of BTRE. Finally, we discussed the development and application of novel omics techniques for diagnosing and treating BTRE. RESULTS Genomics studies have shown that the BRAF gene plays a role in BTRE development. Furthermore, the BRAF V600E variant was found to induce epileptogenesis in the neuronal cell lineage and tumorigenesis in the glial cell lineage. Several genomics studies have linked IDH variants with glioma-related epilepsy, and the overproduction of D2HG is considered to play a role in neuronal excitation that leads to seizure occurrence. The high expression level of Forkhead Box O4 (FOXO4) was associated with a reduced risk of epilepsy occurrence. In transcriptomics studies, VLGR1 was noted as a biomarker of epileptic onset in patients. Several miRNAs such as miR-128 and miRNA-196b participate in BTRE development. miR-128 might be negatively associated with the possibility of tumor-related epilepsy development. The lncRNA UBE2R2-AS1 inhibits the growth and invasion of glioma cells and promotes apoptosis. Quantitative proteomics has been used to determine dynamic changes of protein acetylation in epileptic and non-epileptic gliomas. In another proteomics study, a high expression of AQP-4 was detected in the brain of GBM patients with seizures. By using quantitative RT-PCR and immunohistochemistry assay, a study revealed that patients with astrocytomas and oligoastrocytomas showed high BCL2A1 expression and poor seizure control. By performing immunohistochemistry, several studies have reported the relationship between D2HG overproduction and seizure occurrence. Ki-67 overexpression in WHO grade II gliomas was found to be associated with poor postoperative seizure control. According to metabolomics research, the PI3K/AKT/mTOR pathway is associated with the development of glioma-related epileptogenesis. Another metabolomics study found that SV2A, P-gb, and CAD65/67 have the potential to function as biomarkers for BTRE. CONCLUSIONS Based on the synthesized information, this review provided new research perspectives and insights into the early diagnosis, etiological factors, and personalized treatment of BTRE.
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Affiliation(s)
- Yaoqiang Du
- Laboratory Medicine Center, Department of Transfusion MedicineZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouChina
- School of Basic Medical SciencesZhejiang Chinese Medical UniversityHangzhouChina
| | - Rusong Li
- The Second School of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Danqing Fu
- School of Basic Medical SciencesZhejiang Chinese Medical UniversityHangzhouChina
| | - Biqin Zhang
- Cancer Center, Department of HematologyZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouChina
| | - Ailin Cui
- Cancer Center, Department of Ultrasound MedicineZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouChina
| | - Yutian Shao
- Zhejiang BioAsia Life Science InstitutePinghuChina
| | - Zeyu Lai
- The Second School of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Rongrong Chen
- School of Clinical MedicineHangzhou Normal UniversityHangzhouChina
| | - Bingyu Chen
- Laboratory Medicine Center, Department of Transfusion MedicineZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouChina
| | - Zhen Wang
- Laboratory Medicine Center, Department of Transfusion MedicineZhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical CollegeHangzhouChina
| | - Wei Zhang
- The Second School of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Lisheng Chu
- School of Basic Medical SciencesZhejiang Chinese Medical UniversityHangzhouChina
- Department of PhysiologyZhejiang Chinese Medical UniversityHangzhouChina
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Salas-Gallardo GA, Lorea-Hernández JJ, Robles-Gómez ÁA, Del Campo CCM, Peña-Ortega F. Morphological differentiation of peritumoral brain zone microglia. PLoS One 2024; 19:e0297576. [PMID: 38451958 PMCID: PMC10919594 DOI: 10.1371/journal.pone.0297576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/08/2024] [Indexed: 03/09/2024] Open
Abstract
The Peritumoral Brain Zone (PBZ) contributes to Glioblastoma (GBM) relapse months after the resection of the original tumor, which is influenced by a variety of pathological factors. Among those, microglia are recognized as one of the main regulators of GBM progression and probably relapse. Although microglial morphology has been analyzed inside GBM and its immediate surroundings, it has not been objectively characterized throughout the PBZ. Thus, we aimed to perform a thorough characterization of microglial morphology in the PBZ and its likely differentiation not just from the tumor-associated microglia but from control tissue microglia. For this purpose, Sprague Dawley rats were intrastriatally implanted with C6 cells to induce a GBM formation. Gadolinium-based magnetic resonance imaging (MRI) was performed to locate the tumor and to define the PBZ (2 mm beyond the tumor border), thus delimitating the different regions of interest (ROIs: core tumoral zone and immediate interface; contralateral striatum as control). Brain slices were obtained and immunolabeled with the microglia marker Iba-1. Sixteen morphological parameters were measured for each cell, significative differences were found in all parameters when comparing the four ROIs. To determine if PBZ microglia could be morphologically differentiated from microglia in other ROIs, hierarchical clustering analysis was performed, revealing that microglia can be separated into four morphologically differentiated clusters, each of them mostly integrated by cells sampled in each ROI. Furthermore, a classifier based on linear discriminant analysis, including only three morphological parameters, categorized microglial cells across the studied ROIs and showed a gradual transition between them. The robustness of this classification was assessed through principal component analysis with the remaining 13 morphological parameters, corroborating the obtained results. Thus, in this study we provided objective and quantitative evidence that PBZ microglia represent a differentiable microglial morphotype that could contribute to the recurrence of GBM in this area.
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Affiliation(s)
- G. Anahí Salas-Gallardo
- Laboratorio de Células Neurales Troncales, CIACYT-Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, San Luis Potosí, México
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, México
| | - Jonathan-Julio Lorea-Hernández
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, México
| | - Ángel Abdiel Robles-Gómez
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, México
| | - Claudia Castillo-Martin Del Campo
- Laboratorio de Células Neurales Troncales, CIACYT-Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, San Luis Potosí, México
| | - Fernando Peña-Ortega
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, México
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3
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Gill BJA, Khan FA, Goldberg AR, Merricks EM, Wu X, Sosunov AA, Sudhakar TD, Dovas A, Lado W, Michalak AJ, Teoh JJ, Liou JY, Frankel WN, McKhann GM, Canoll P, Schevon CA. Single unit analysis and wide-field imaging reveal alterations in excitatory and inhibitory neurons in glioma. Brain 2022; 145:3666-3680. [PMID: 35552612 PMCID: PMC10202150 DOI: 10.1093/brain/awac168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 02/05/2022] [Accepted: 04/27/2022] [Indexed: 11/14/2022] Open
Abstract
While several studies have attributed the development of tumour-associated seizures to an excitatory-inhibitory imbalance, we have yet to resolve the spatiotemporal interplay between different types of neuron in glioma-infiltrated cortex. Herein, we combined methods for single unit analysis of microelectrode array recordings with wide-field optical mapping of Thy1-GCaMP pyramidal cells in an ex vivo acute slice model of diffusely infiltrating glioma. This enabled simultaneous tracking of individual neurons from both excitatory and inhibitory populations throughout seizure-like events. Moreover, our approach allowed for observation of how the crosstalk between these neurons varied spatially, as we recorded across an extended region of glioma-infiltrated cortex. In tumour-bearing slices, we observed marked alterations in single units classified as putative fast-spiking interneurons, including reduced firing, activity concentrated within excitatory bursts and deficits in local inhibition. These results were correlated with increases in overall excitability. Mechanistic perturbation of this system with the mTOR inhibitor AZD8055 revealed increased firing of putative fast-spiking interneurons and restoration of local inhibition, with concomitant decreases in overall excitability. Altogether, our findings suggest that diffusely infiltrating glioma affect the interplay between excitatory and inhibitory neuronal populations in a reversible manner, highlighting a prominent role for functional mechanisms linked to mTOR activation.
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Affiliation(s)
- Brian J A Gill
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Farhan A Khan
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Alexander R Goldberg
- Department of Pathology and Cell Biology, Irving Cancer Research Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Edward M Merricks
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Xiaoping Wu
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Alexander A Sosunov
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Tejaswi D Sudhakar
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Athanassios Dovas
- Department of Pathology and Cell Biology, Irving Cancer Research Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Wudu Lado
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Andrew J Michalak
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Jia Jie Teoh
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Jyun-you Liou
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Wayne N Frankel
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Genetics and Development, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Peter Canoll
- Department of Pathology and Cell Biology, Irving Cancer Research Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Catherine A Schevon
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
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Hills KE, Kostarelos K, Wykes RC. Converging Mechanisms of Epileptogenesis and Their Insight in Glioblastoma. Front Mol Neurosci 2022; 15:903115. [PMID: 35832394 PMCID: PMC9271928 DOI: 10.3389/fnmol.2022.903115] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/25/2022] [Indexed: 12/15/2022] Open
Abstract
Glioblastoma (GBM) is the most common and advanced form of primary malignant tumor occurring in the adult central nervous system, and it is frequently associated with epilepsy, a debilitating comorbidity. Seizures are observed both pre- and post-surgical resection, indicating that several pathophysiological mechanisms are shared but also prompting questions about how the process of epileptogenesis evolves throughout GBM progression. Molecular mutations commonly seen in primary GBM, i.e., in PTEN and p53, and their associated downstream effects are known to influence seizure likelihood. Similarly, various intratumoral mechanisms, such as GBM-induced blood-brain barrier breakdown and glioma-immune cell interactions within the tumor microenvironment are also cited as contributing to network hyperexcitability. Substantial alterations to peri-tumoral glutamate and chloride transporter expressions, as well as widespread dysregulation of GABAergic signaling are known to confer increased epileptogenicity and excitotoxicity. The abnormal characteristics of GBM alter neuronal network function to result in metabolically vulnerable and hyperexcitable peri-tumoral tissue, properties the tumor then exploits to favor its own growth even post-resection. It is evident that there is a complex, dynamic interplay between GBM and epilepsy that promotes the progression of both pathologies. This interaction is only more complicated by the concomitant presence of spreading depolarization (SD). The spontaneous, high-frequency nature of GBM-associated epileptiform activity and SD-associated direct current (DC) shifts require technologies capable of recording brain signals over a wide bandwidth, presenting major challenges for comprehensive electrophysiological investigations. This review will initially provide a detailed examination of the underlying mechanisms that promote network hyperexcitability in GBM. We will then discuss how an investigation of these pathologies from a network level, and utilization of novel electrophysiological tools, will yield a more-effective, clinically-relevant understanding of GBM-related epileptogenesis. Further to this, we will evaluate the clinical relevance of current preclinical research and consider how future therapeutic advancements may impact the bidirectional relationship between GBM, SDs, and seizures.
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Affiliation(s)
- Kate E. Hills
- Nanomedicine Lab, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Kostas Kostarelos
- Nanomedicine Lab, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Catalan Institute for Nanoscience and Nanotechnology (ICN2), Edifici ICN2, Campus UAB, Barcelona, Spain
| | - Robert C. Wykes
- Nanomedicine Lab, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- *Correspondence: Robert C. Wykes
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5
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Glioma facilitates the epileptic and tumor-suppressive gene expressions in the surrounding region. Sci Rep 2022; 12:6805. [PMID: 35474103 PMCID: PMC9042955 DOI: 10.1038/s41598-022-10753-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/13/2022] [Indexed: 11/29/2022] Open
Abstract
Patients with glioma often demonstrate epilepsy. We previously found burst discharges in the peritumoral area in patients with malignant brain tumors during biopsy. Therefore, we hypothesized that the peritumoral area may possess an epileptic focus and that biological alterations in the peritumoral area may cause epileptic symptoms in patients with glioma. To test our hypothesis, we developed a rat model of glioma and characterized it at the cellular and molecular levels. We first labeled rat C6 glioma cells with tdTomato, a red fluorescent protein (C6-tdTomato), and implanted them into the somatosensory cortex of VGAT-Venus rats, which specifically expressed Venus, a yellow fluorescent protein in GABAergic neurons. We observed that the density of GABAergic neurons was significantly decreased in the peritumoral area of rats with glioma compared with the contralateral healthy side. By using a combination technique of laser capture microdissection and RNA sequencing (LCM-seq) of paraformaldehyde-fixed brain sections, we demonstrated that 19 genes were differentially expressed in the peritumoral area and that five of them were associated with epilepsy and neurodevelopmental disorders. In addition, the canonical pathways actively altered in the peritumoral area were predicted to cause a reduction in GABAergic neurons. These results suggest that biological alterations in the peritumoral area may be a cause of glioma-related epilepsy.
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6
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Abstract
Nervous system activity regulates development, homeostasis, and plasticity of the brain as well as other organs in the body. These mechanisms are subverted in cancer to propel malignant growth. In turn, cancers modulate neural structure and function to augment growth-promoting neural signaling in the tumor microenvironment. Approaching cancer biology from a neuroscience perspective will elucidate new therapeutic strategies for presently lethal forms of cancer. In this review, we highlight the neural signaling mechanisms recapitulated in primary brain tumors, brain metastases, and solid tumors throughout the body that regulate cancer progression. Expected final online publication date for the Annual Review of Neuroscience, Volume 45 is July 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Michael B Keough
- Department of Neurology and Neurological Sciences and Howard Hughes Medical Institute, Stanford University, Stanford, California, USA;
| | - Michelle Monje
- Department of Neurology and Neurological Sciences and Howard Hughes Medical Institute, Stanford University, Stanford, California, USA;
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7
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Wang Y, Deng K, Sun Y, Huang X, Dai Y, Chen W, Hu X, Jiang R. Preserved microstructural integrity of the corticospinal tract in patients with glioma-induced motor epilepsy: a study using mean apparent propagator magnetic resonance imaging. Quant Imaging Med Surg 2022; 12:1415-1427. [PMID: 35111635 DOI: 10.21037/qims-21-679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/08/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND To compare the microstructural integrity of the corticospinal tract (CST) between glioma patients with motor epilepsy and without epilepsy using mean apparent propagator magnetic resonance imaging (MAP-MRI). METHODS A total of 26 patients with glioma adjacent to the CST pathway (10 with motor epilepsy and 16 without epilepsy) and 13 matched healthy controls underwent brain structural and diffusion MRI. The morphological characteristics of the CST (tract volume, tract number, and average length) were extracted, and diffusion parameter values including mean squared displacement (MSD), q-space inverse variance (QIV), return-to-origin probability (RTOP), return-to-axis probabilities (RTAP), return-to-plane probabilities (RTPP), fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) along the CST were evaluated. The CST features were compared between healthy and affected sides and the relative CST features were compared across the three groups of participants. A receiver operating characteristic (ROC) curve was plotted to assess the performance of each relative CST characteristic for glioma-induced CST changes. RESULTS For patients without epilepsy, the tract number, tract volume, FA, RD, MSD, QIV, and RTAP changed significantly on the affected CST side compared with those on the healthy CST side (P=0.002, 0.002, 0.030 0.017, 0.039, 0.044, and 0.002, respectively). In contrast, for patients with motor epilepsy, no significant difference was found between the affected and healthy side in almost all CST features except RTPP (P=0.028). Compared with patients with motor epilepsy, the relative tract number, tract volume, AD, and RTAP were significantly lower (P=0.027, 0.018, 0.040, and 0.027, respectively) in patients without epilepsy, and their areas under the curve (AUCs) were 0.763, 0.781, 0.744, and 0.763, respectively. No significant difference was found between patients with motor epilepsy and matched healthy controls. CONCLUSIONS The MAP-MRI is a promising approach for evaluating CST changes. It provides additional information reflecting the microstructural complexity of the CST and demonstrates the preserved microstructural integrity of the CST in glioma patients with motor epilepsy.
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Affiliation(s)
- Yuhui Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Kaiji Deng
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yifan Sun
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xinming Huang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yihai Dai
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Weitao Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaomei Hu
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Rifeng Jiang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
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Sprugnoli G, Rossi S, Rotenberg A, Pascual-Leone A, El-Fakhri G, Golby AJ, Santarnecchi E. Personalised, image-guided, noninvasive brain stimulation in gliomas: Rationale, challenges and opportunities. EBioMedicine 2021; 70:103514. [PMID: 34391090 PMCID: PMC8365310 DOI: 10.1016/j.ebiom.2021.103514] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 11/22/2022] Open
Abstract
Malignant brain tumours are among the most aggressive human cancers, and despite intensive efforts made over the last decades, patients' survival has scarcely improved. Recently, high-grade gliomas (HGG) have been found to be electrically integrated with healthy brain tissue, a communication that facilitates tumour mitosis and invasion. This link to neuronal activity has provided new insights into HGG pathophysiology and opened prospects for therapeutic interventions based on electrical modulation of neural and synaptic activity in the proximity of tumour cells, which could potentially slow tumour growth. Noninvasive brain stimulation (NiBS), a group of techniques used in research and clinical settings to safely modulate brain activity and plasticity via electromagnetic or electrical stimulation, represents an appealing class of interventions to characterise and target the electrical properties of tumour-neuron interactions. Beyond neuronal activity, NiBS may also modulate function of a range of substrates and dynamics that locally interacts with HGG (e.g., vascular architecture, perfusion and blood-brain barrier permeability). Here we discuss emerging applications of NiBS in patients with brain tumours, covering potential mechanisms of action at both cellular, regional, network and whole-brain levels, also offering a conceptual roadmap for future research to prolong survival or promote wellbeing via personalised NiBS interventions.
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Affiliation(s)
- Giulia Sprugnoli
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Radiology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy; Image Guided Neurosurgery laboratory, Department of Neurosurgery and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Brain investigation and Neuromodulation Laboratory (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Unit, University of Siena, Siena, Italy
| | - Simone Rossi
- Brain investigation and Neuromodulation Laboratory (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Unit, University of Siena, Siena, Italy
| | - Alexander Rotenberg
- Department of Neurology and Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew Senior Life, Boston, MA, USA; Guttmann Brain Health Institute, Institut Guttmann, Universitat Autonoma, Barcelona, Spain
| | - Georges El-Fakhri
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexandra J Golby
- Image Guided Neurosurgery laboratory, Department of Neurosurgery and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Emiliano Santarnecchi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Wang YH, Huang TL, Chen X, Yu SX, Li W, Chen T, Li Y, Kuang YQ, Shu HF. Glioma-Derived TSP2 Promotes Excitatory Synapse Formation and Results in Hyperexcitability in the Peritumoral Cortex of Glioma. J Neuropathol Exp Neurol 2021; 80:137-149. [PMID: 33382873 DOI: 10.1093/jnen/nlaa149] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Seizures are common in patients with glioma, especially low-grade glioma (LGG). However, the epileptogenic mechanisms are poorly understood. Recent evidence has indicated that abnormal excitatory synaptogenesis plays an important role in epileptogenesis. The thrombospondin (TSP) family is a key regulator of synaptogenesis. Thus, this study aimed to elucidate the role of TSP2 in epileptogenesis in glioma-related epilepsy. The expression of TSP2 was increased in tumor tissue specimens from LGG patients, and this increase may have contributed to an increase in the density of spines and excitatory synapses in the peritumoral area. A glioma cell-implanted rat model was established by stereotactic implantation of wild-type TSP2-expressing, TSP2-overexpressing or TSP2-knockout C6 cells into the neocortex. Similarly, an increase in the density of excitatory synapses was also observed in the peritumoral area of the implanted tumor. In addition, epileptiform discharges occurred in the peritumoral cortex and were positively correlated with the TSP2 level in glioma tissues. Moreover, α2δ1/Rac1 signaling was enhanced in the peritumoral region, and treatment with the α2δ1 antagonist gabapentin inhibited epileptiform discharges in the peritumoral cortex. In conclusion, glioma-derived TSP2 promotes excitatory synapse formation, probably via the α2δ1/Rac1 signaling pathway, resulting in hyperexcitability in the peritumoral cortical networks, which may provide new insight into the epileptogenic mechanisms underlying glioma-related epilepsy.
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Affiliation(s)
- Yao-Hui Wang
- From the Department of Neurosurgery, General Hospital of Western Theater Command of PLA, Sichuan Province, China.,College of Medicine, Southwest Jiaotong University, Chengdu, China
| | - Tian-Lan Huang
- From the Department of Neurosurgery, General Hospital of Western Theater Command of PLA, Sichuan Province, China.,College of Medicine, Southwest Jiaotong University, Chengdu, China
| | - Xin Chen
- From the Department of Neurosurgery, General Hospital of Western Theater Command of PLA, Sichuan Province, China
| | - Si-Xun Yu
- From the Department of Neurosurgery, General Hospital of Western Theater Command of PLA, Sichuan Province, China
| | - Wei Li
- Central Lab, General Hospital of Western Theater Command of PLA, Sichuan Province, China
| | - Tao Chen
- From the Department of Neurosurgery, General Hospital of Western Theater Command of PLA, Sichuan Province, China
| | - Yang Li
- From the Department of Neurosurgery, General Hospital of Western Theater Command of PLA, Sichuan Province, China
| | - Yong-Qin Kuang
- From the Department of Neurosurgery, General Hospital of Western Theater Command of PLA, Sichuan Province, China
| | - Hai-Feng Shu
- From the Department of Neurosurgery, General Hospital of Western Theater Command of PLA, Sichuan Province, China.,College of Medicine, Southwest Jiaotong University, Chengdu, China
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10
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Lange F, Hörnschemeyer J, Kirschstein T. Glutamatergic Mechanisms in Glioblastoma and Tumor-Associated Epilepsy. Cells 2021; 10:cells10051226. [PMID: 34067762 PMCID: PMC8156732 DOI: 10.3390/cells10051226] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 12/21/2022] Open
Abstract
The progression of glioblastomas is associated with a variety of neurological impairments, such as tumor-related epileptic seizures. Seizures are not only a common comorbidity of glioblastoma but often an initial clinical symptom of this cancer entity. Both, glioblastoma and tumor-associated epilepsy are closely linked to one another through several pathophysiological mechanisms, with the neurotransmitter glutamate playing a key role. Glutamate interacts with its ionotropic and metabotropic receptors to promote both tumor progression and excitotoxicity. In this review, based on its physiological functions, our current understanding of glutamate receptors and glutamatergic signaling will be discussed in detail. Furthermore, preclinical models to study glutamatergic interactions between glioma cells and the tumor-surrounding microenvironment will be presented. Finally, current studies addressing glutamate receptors in glioma and tumor-related epilepsy will be highlighted and future approaches to interfere with the glutamatergic network are discussed.
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Affiliation(s)
- Falko Lange
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, 18057 Rostock, Germany;
- Center for Transdisciplinary Neurosciences Rostock, University of Rostock, 18147 Rostock, Germany
- Correspondence: (F.L.); (T.K.)
| | - Julia Hörnschemeyer
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, 18057 Rostock, Germany;
| | - Timo Kirschstein
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, 18057 Rostock, Germany;
- Center for Transdisciplinary Neurosciences Rostock, University of Rostock, 18147 Rostock, Germany
- Correspondence: (F.L.); (T.K.)
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11
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Ius T, Somma T, Baiano C, Guarracino I, Pauletto G, Nilo A, Maieron M, Palese F, Skrap M, Tomasino B. Risk Assessment by Pre-surgical Tractography in Left Hemisphere Low-Grade Gliomas. Front Neurol 2021; 12:648432. [PMID: 33679596 PMCID: PMC7928377 DOI: 10.3389/fneur.2021.648432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/25/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Tracking the white matter principal tracts is routinely typically included during the pre-surgery planning examinations and has revealed to limit functional resection of low-grade gliomas (LGGs) in eloquent areas. Objective: We examined the integrity of the Superior Longitudinal Fasciculus (SLF) and Inferior Fronto-Occipital Fasciculus (IFOF), both known to be part of the language-related network in patients with LGGs involving the temporo-insular cortex. In a comparative approach, we contrasted the main quantitative fiber tracking values in the tumoral (T) and healthy (H) hemispheres to test whether or not this ratio could discriminate amongst patients with different post-operative outcomes. Methods: Twenty-six patients with LGGs were included. We obtained quantitative fiber tracking values in the tumoral and healthy hemispheres and calculated the ratio (HIFOF–TIFOF)/HIFOF and the ratio (HSLF–TSLF)/HSLF on the number of streamlines. We analyzed how these values varied between patients with and without post-operative neurological outcomes and between patients with different post-operative Engel classes. Results: The ratio for both IFOF and SLF significantly differed between patient with and without post-operative neurological language deficits. No associations were found between white matter structural changes and post-operative seizure outcomes. Conclusions: Calculating the ratio on the number of streamlines and fractional anisotropy between the tumoral and the healthy hemispheres resulted to be a useful approach, which can prove to be useful during the pre-operative planning examination, as it gives a glimpse on the potential clinical outcomes in patients with LGGs involving the left temporo-insular cortex.
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Affiliation(s)
- Tamara Ius
- Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Cinzia Baiano
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Ilaria Guarracino
- Scientific Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) E. Medea, Pordenone, Italy
| | - Giada Pauletto
- Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Annacarmen Nilo
- Clinical Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Marta Maieron
- Medical Physics, Santa Maria della Misericordia University Hospital, Udine, Italy
| | | | - Miran Skrap
- Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Barbara Tomasino
- Scientific Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) E. Medea, Pordenone, Italy
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12
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Madadi A, Wolfart J, Lange F, Brehme H, Linnebacher M, Bräuer AU, Büttner A, Freiman T, Henker C, Einsle A, Rackow S, Köhling R, Kirschstein T, Müller S. Correlation between Kir4.1 expression and barium-sensitive currents in rat and human glioma cell lines. Neurosci Lett 2021; 741:135481. [PMID: 33161102 DOI: 10.1016/j.neulet.2020.135481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 01/29/2023]
Abstract
Gliomas are the most common primary brain tumors and often become apparent through symptomatic epileptic seizures. Glial cells express the inwardly rectifying K+ channel Kir4.1 playing a major role in K+ buffering, and are presumably involved in facilitating epileptic hyperexcitability. We therefore aimed to investigate the molecular and functional expression of Kir4.1 channels in cultured rat and human glioma cells. Quantitative PCR showed reduced expression of Kir4.1 in rat C6 and F98 cells as compared to control. In human U-87MG cells and in patient-derived low-passage glioblastoma cultures, Kir4.1 expression was also reduced as compared to autopsy controls. Testing Kir4.1 function using whole-cell patch-clamp experiments on rat C6 and two human low-passage glioblastoma cell lines (HROG38 and HROG05), we found a significantly depolarized resting membrane potential (RMP) in HROG05 (-29 ± 2 mV, n = 11) compared to C6 (-71 ± 1 mV, n = 12, P < 0.05) and HROG38 (-60 ± 2 mV, n = 12, P < 0.05). Sustained K+ inward or outward currents were sensitive to Ba2+ added to the bath solution in HROG38 and C6 cells, but not in HROG05 cells, consistent with RMP depolarization. While immunocytochemistry confirmed Kir4.1 in all three cell lines including HROG05, we found that aquaporin-4 and Kir5.1 were also significantly reduced suggesting that the Ba2+-sensitive K+ current is generally impaired in glioma tissue. In summary, we demonstrated that glioma cells differentially express functional inwardly rectifying K+ channels suggesting that impaired K+ buffering in cells lacking functional Ba2+-sensitive K+ currents may be a risk factor for increased excitability and thereby contribute to the differential epileptogenicity of gliomas.
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Affiliation(s)
- Annett Madadi
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Rostock, Germany
| | - Jakob Wolfart
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Rostock, Germany
| | - Falko Lange
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Rostock, Germany; Center of Transdisciplinary Neurosciences Rostock, (CTNR), Rostock University Medical Center, Germany
| | - Hannes Brehme
- Department of Neurology, Rostock University Medical Center, Germany
| | | | - Anja U Bräuer
- Research Group Anatomy, School for Medicine and Health Science, Carl von Ossietzky University Oldenburg, Oldenburg, Germany; Research Center for Neurosensory Science, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Andreas Büttner
- Institute of Forensic Medicine, Rostock University Medical Center, Germany
| | - Thomas Freiman
- Department of Neurosurgery, Rostock University Medical Center, Germany
| | - Christian Henker
- Department of Neurosurgery, Rostock University Medical Center, Germany
| | - Anne Einsle
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Rostock, Germany
| | - Simone Rackow
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Rostock, Germany
| | - Rüdiger Köhling
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Rostock, Germany; Center of Transdisciplinary Neurosciences Rostock, (CTNR), Rostock University Medical Center, Germany
| | - Timo Kirschstein
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Rostock, Germany; Center of Transdisciplinary Neurosciences Rostock, (CTNR), Rostock University Medical Center, Germany
| | - Steffen Müller
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Rostock, Germany.
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13
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Civita P, Valerio O, Naccarato AG, Gumbleton M, Pilkington GJ. Satellitosis, a Crosstalk between Neurons, Vascular Structures and Neoplastic Cells in Brain Tumours; Early Manifestation of Invasive Behaviour. Cancers (Basel) 2020; 12:E3720. [PMID: 33322379 PMCID: PMC7763100 DOI: 10.3390/cancers12123720] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 01/06/2023] Open
Abstract
The secondary structures of Scherer commonly known as perineuronal and perivascular satellitosis have been identified as a histopathological hallmark of diffuse, invasive, high-grade gliomas. They are recognised as perineuronal satellitosis when clusters of neoplastic glial cells surround neurons cell bodies and perivascular satellitosis when such tumour cells surround blood vessels infiltrating Virchow-Robin spaces. In this review, we provide an overview of emerging knowledge regarding how interactions between neurons and glioma cells can modulate tumour evolution and how neurons play a key role in glioma growth and progression, as well as the role of perivascular satellitosis into mechanisms of glioma cells spread. At the same time, we review the current knowledge about the role of perineuronal satellitosis and perivascular satellitosis within the tumour microenvironment (TME), in order to highlight critical knowledge gaps in research space.
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Affiliation(s)
- Prospero Civita
- Brain Tumour Research Centre, Institute of Biological and Biomedical Sciences (IBBS), School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2DT, UK
- School of Pharmacy and Pharmaceutical Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff CF10 3NB, UK;
| | - Ortenzi Valerio
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University Hospital, 56100 Pisa, Italy; (O.V.); (A.G.N.)
| | - Antonio Giuseppe Naccarato
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University Hospital, 56100 Pisa, Italy; (O.V.); (A.G.N.)
| | - Mark Gumbleton
- School of Pharmacy and Pharmaceutical Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff CF10 3NB, UK;
| | - Geoffrey J. Pilkington
- Brain Tumour Research Centre, Institute of Biological and Biomedical Sciences (IBBS), School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2DT, UK
- School of Pharmacy and Pharmaceutical Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff CF10 3NB, UK;
- Division of Neuroscience, Department of Basic and Clinical Neuroscience, Institute of Psychiatry & Neurology, King’s College London, London SE5 9RX, UK
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14
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Lange F, Hartung J, Liebelt C, Boisserée J, Resch T, Porath K, Hörnschemeyer MF, Reichart G, Sellmann T, Neubert V, Kriesen S, Hildebrandt G, Schültke E, Köhling R, Kirschstein T. Perampanel Add-on to Standard Radiochemotherapy in vivo Promotes Neuroprotection in a Rodent F98 Glioma Model. Front Neurosci 2020; 14:598266. [PMID: 33328869 PMCID: PMC7734300 DOI: 10.3389/fnins.2020.598266] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/10/2020] [Indexed: 01/02/2023] Open
Abstract
An abnormal glutamate signaling of glioblastoma may contribute to both tumor progression and the generation of glioma-associated epileptic seizures. We hypothesized that the AMPA receptor antagonist perampanel (PER) could attenuate tumor growth and epileptic events. F98 glioma cells, grown orthotopically in Fischer rats, were employed as a model of glioma to investigate the therapeutic efficiency of PER (15 mg/kg) as adjuvant to standard radiochemotherapy (RCT). The epileptiform phenotype was investigated by video-EEG analysis and field potential recordings. Effects on glioma progression were estimated by tumor size quantification, survival analysis and immunohistological staining. Our data revealed that orthotopically-growing F98 glioma promote an epileptiform phenotype in rats. RCT reduced the tumor size and prolonged the survival of the animals. The adjuvant administration of PER had no effect on tumor progression. The tumor-associated epileptic events were abolished by PER application or RCT respectively, to initial baseline levels. Remarkably, PER preserved the glutamatergic network activity on healthy peritumoral tissue in RCT-treated animals. F98 tumors are not only a robust model to investigate glioma progression, but also a viable model to simulate a glioma-associated epileptiform phenotype. Furthermore, our data indicate that PER acts as a potent anticonvulsant and may protect the tumor-surrounding tissue as adjuvant to RCT, but failed to attenuate tumor growth or promote animal survival.
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Affiliation(s)
- Falko Lange
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock, University of Rostock, Rostock, Germany
| | - Jens Hartung
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany
| | - Clara Liebelt
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany
| | - Julius Boisserée
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany
| | - Tobias Resch
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany
| | - Katrin Porath
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany
| | | | - Gesine Reichart
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany
| | - Tina Sellmann
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany
| | - Valentin Neubert
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany
| | - Stephan Kriesen
- Department of Radiotherapy and Radiation Oncology, Rostock University Medical Center, Rostock, Germany
| | - Guido Hildebrandt
- Department of Radiotherapy and Radiation Oncology, Rostock University Medical Center, Rostock, Germany
| | - Elisabeth Schültke
- Department of Radiotherapy and Radiation Oncology, Rostock University Medical Center, Rostock, Germany
| | - Rüdiger Köhling
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock, University of Rostock, Rostock, Germany
| | - Timo Kirschstein
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock, University of Rostock, Rostock, Germany
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15
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Bouckaert C, Germonpré C, Verhoeven J, Chong SA, Jacquin L, Mairet-Coello G, André VM, Leclercq K, Vanhove C, De Vos F, Van den Broecke C, Goethals I, Descamps B, Donche S, Carrette E, Wadman W, Boon P, Vonck K, Raedt R. Development of a Rat Model for Glioma-Related Epilepsy. Int J Mol Sci 2020; 21:E6999. [PMID: 32977526 PMCID: PMC7582710 DOI: 10.3390/ijms21196999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 12/13/2022] Open
Abstract
Seizures are common in patients with high-grade gliomas (30-60%) and approximately 15-30% of glioblastoma (GB) patients develop drug-resistant epilepsy. Reliable animal models are needed to develop adequate treatments for glioma-related epilepsy. Therefore, fifteen rats were inoculated with F98 GB cells (GB group) and four rats with vehicle only (control group) in the right entorhinal cortex. MRI was performed to visualize tumor presence. A subset of seven GB and two control rats were implanted with recording electrodes to determine the occurrence of epileptic seizures with video-EEG recording over multiple days. In a subset of rats, tumor size and expression of tumor markers were investigated with histology or mRNA in situ hybridization. Tumors were visible on MRI six days post-inoculation. Time-dependent changes in tumor morphology and size were visible on MRI. Epileptic seizures were detected in all GB rats monitored with video-EEG. Twenty-one days after inoculation, rats were euthanized based on signs of discomfort and pain. This study describes, for the first time, reproducible tumor growth and spontaneous seizures upon inoculation of F98 cells in the rat entorhinal cortex. The development of this new model of GB-related epilepsy may be valuable to design new therapies against tumor growth and associated epileptic seizures.
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Affiliation(s)
- Charlotte Bouckaert
- 4Brain, Department of Head and Skin, Ghent University, 9000 Ghent, East Flanders, Belgium; (C.B.); (C.G.); (E.C.); (W.W.); (P.B.); (K.V.)
| | - Charlotte Germonpré
- 4Brain, Department of Head and Skin, Ghent University, 9000 Ghent, East Flanders, Belgium; (C.B.); (C.G.); (E.C.); (W.W.); (P.B.); (K.V.)
| | - Jeroen Verhoeven
- Department of Pharmaceutical Analysis, Ghent University, 9000 Ghent, East Flanders, Belgium; (J.V.); (F.D.V.); (C.V.d.B.)
| | - Seon-Ah Chong
- Early Solutions, Neuroscience Therapeutic Area, UCB Pharma, 1420 Braine-l’Alleud, Brabant Wallon, Belgium; (S.-A.C.); (L.J.); (G.M.-C.); (V.M.A.); (K.L.)
| | - Lucas Jacquin
- Early Solutions, Neuroscience Therapeutic Area, UCB Pharma, 1420 Braine-l’Alleud, Brabant Wallon, Belgium; (S.-A.C.); (L.J.); (G.M.-C.); (V.M.A.); (K.L.)
| | - Georges Mairet-Coello
- Early Solutions, Neuroscience Therapeutic Area, UCB Pharma, 1420 Braine-l’Alleud, Brabant Wallon, Belgium; (S.-A.C.); (L.J.); (G.M.-C.); (V.M.A.); (K.L.)
| | - Véronique Marie André
- Early Solutions, Neuroscience Therapeutic Area, UCB Pharma, 1420 Braine-l’Alleud, Brabant Wallon, Belgium; (S.-A.C.); (L.J.); (G.M.-C.); (V.M.A.); (K.L.)
| | - Karine Leclercq
- Early Solutions, Neuroscience Therapeutic Area, UCB Pharma, 1420 Braine-l’Alleud, Brabant Wallon, Belgium; (S.-A.C.); (L.J.); (G.M.-C.); (V.M.A.); (K.L.)
| | - Christian Vanhove
- Department of Electronics and information systems, Ghent University Hospital, 9000 Ghent, East Flanders, Belgium; (C.V.); (B.D.)
| | - Filip De Vos
- Department of Pharmaceutical Analysis, Ghent University, 9000 Ghent, East Flanders, Belgium; (J.V.); (F.D.V.); (C.V.d.B.)
| | - Caroline Van den Broecke
- Department of Pharmaceutical Analysis, Ghent University, 9000 Ghent, East Flanders, Belgium; (J.V.); (F.D.V.); (C.V.d.B.)
| | - Ingeborg Goethals
- Department of Diagnostic Sciences, Ghent University Hospital, 9000 Ghent, East Flanders, Belgium; (I.G.); (S.D.)
| | - Benedicte Descamps
- Department of Electronics and information systems, Ghent University Hospital, 9000 Ghent, East Flanders, Belgium; (C.V.); (B.D.)
| | - Sam Donche
- Department of Diagnostic Sciences, Ghent University Hospital, 9000 Ghent, East Flanders, Belgium; (I.G.); (S.D.)
| | - Evelien Carrette
- 4Brain, Department of Head and Skin, Ghent University, 9000 Ghent, East Flanders, Belgium; (C.B.); (C.G.); (E.C.); (W.W.); (P.B.); (K.V.)
| | - Wytse Wadman
- 4Brain, Department of Head and Skin, Ghent University, 9000 Ghent, East Flanders, Belgium; (C.B.); (C.G.); (E.C.); (W.W.); (P.B.); (K.V.)
| | - Paul Boon
- 4Brain, Department of Head and Skin, Ghent University, 9000 Ghent, East Flanders, Belgium; (C.B.); (C.G.); (E.C.); (W.W.); (P.B.); (K.V.)
| | - Kristl Vonck
- 4Brain, Department of Head and Skin, Ghent University, 9000 Ghent, East Flanders, Belgium; (C.B.); (C.G.); (E.C.); (W.W.); (P.B.); (K.V.)
| | - Robrecht Raedt
- 4Brain, Department of Head and Skin, Ghent University, 9000 Ghent, East Flanders, Belgium; (C.B.); (C.G.); (E.C.); (W.W.); (P.B.); (K.V.)
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16
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Gonzalez Castro LN, Milligan TA. Seizures in patients with cancer. Cancer 2020; 126:1379-1389. [PMID: 31967671 DOI: 10.1002/cncr.32708] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/21/2019] [Accepted: 12/18/2019] [Indexed: 12/12/2022]
Abstract
Seizures are common in patients with cancer and either result from brain lesions, paraneoplastic syndromes, and complications of cancer treatment or are provoked by systemic illness (metabolic derangements, infections). Evaluation should include a tailored history, neurologic examination, laboratory studies, neuroimaging, and electroencephalogram. In unprovoked seizures, antiepileptic drug (AED) treatment is required, and a nonenzyme-inducing AED is preferred. Treatment of the underlying cancer with surgery, chemotherapy, and radiation therapy also can help reduce seizures. Benzodiazepines are useful in the treatment of both provoked seizures and breakthrough epileptic seizures and as first-line treatment for status epilepticus. Counseling for safety is an important component in the care of a patient with cancer who has seizures. Good seizure management can be challenging but significantly improves the quality of life during all phases of care, including end-of-life care.
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Affiliation(s)
- L Nicolas Gonzalez Castro
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tracey A Milligan
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
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17
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Mayer J, Kirschstein T, Resch T, Porath K, Krause BJ, Köhling R, Lange F. Perampanel attenuates epileptiform phenotype in C6 glioma. Neurosci Lett 2019; 715:134629. [PMID: 31734290 DOI: 10.1016/j.neulet.2019.134629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/30/2019] [Accepted: 11/12/2019] [Indexed: 02/07/2023]
Abstract
Epileptic seizures are frequent in patients with glioma, and anticonvulsive treatment is often indicated. Glioma cells release glutamate via the Xc- antiporter system, which appears to be a major pathomechanism of glioma-associated seizures and excitotoxicity. In addition, the proliferation and survival of the tumor cells are promoted. Therefore, anticonvulsants that attenuate glutamate-mediated receptor activation could be especially effective. In this study, we investigated the effects of AMPA receptor antagonist perampanel in rat C6 glioma model. In first pilot experiments, perampanel reduced glucose uptake but had no impact of extracellular glutamate level in vitro. To analyze the effects of perampanel in vivo, we injected C6 cells orthotopically into the neocortex of Wistar rats in order to establish a model of glioma-associated epilepsy. Spontaneous recurrent discharges in brain slices were abolished upon perfusion with the AMPA receptor blocker perampanel, supporting the major role of glutamatergic excitation. With respect to the tumor progression, no effect of perampanel on survival of the animals or on glioma size was determined. Our data demonstrate that perampanel inhibit epileptiform discharges in organotypic brain slices of glioma, but failed to attenuate tumor growth or promote animal survival.
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Affiliation(s)
- Johannes Mayer
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany; Psychology Department, University of California, Riverside, 900 University Avenue Riverside, CA, 92521, United States.
| | - Timo Kirschstein
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany; Center for Transdisciplinary Neurosciences Rostock, Rostock University Medical Center, Rostock, Germany.
| | - Tobias Resch
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany.
| | - Katrin Porath
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany.
| | - Bernd Joachim Krause
- Department of Nuclear Medicine, Rostock University Medical Center, Rostock, Germany; Center for Transdisciplinary Neurosciences Rostock, Rostock University Medical Center, Rostock, Germany.
| | - Rüdiger Köhling
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany; Center for Transdisciplinary Neurosciences Rostock, Rostock University Medical Center, Rostock, Germany.
| | - Falko Lange
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany; Center for Transdisciplinary Neurosciences Rostock, Rostock University Medical Center, Rostock, Germany.
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18
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Köhling R. Translational perspectives: Interneurones start seizures. J Physiol 2019; 597:5525-5526. [PMID: 31603536 DOI: 10.1113/jp278966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Rüdiger Köhling
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Rostock, Germany
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19
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Early glioma is associated with abnormal electrical events in cortical cultures. Med Biol Eng Comput 2019; 57:1645-1656. [PMID: 31079355 DOI: 10.1007/s11517-019-01980-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 04/04/2019] [Indexed: 10/26/2022]
Abstract
The prodromal stages of some neurological diseases have a distinct electrical profile which can potentially be leveraged for early diagnosis, predicting disease recurrence, monitoring of disease progression, and better understanding of the disease pathology. Gliomas are tumors that originate from glial cells present in the brain and spinal cord. Healthy glial cells support normal neuronal function and play an important role in modulating the regular electrical activity of neurons. However, gliomas can disrupt the normal electrical dynamics of the brain. Though experimental and clinical studies suggest that glioma and injury to glial cells disrupt electrical dynamics of the brain, whether these disruptions are present during the earliest stages of glioma and glial injury are unclear. The primary aim of this study is to investigate the effect of early in vitro glial pathology (glioma and glial injury in specific) on neuronal electrical activity. In particular, we investigated the effect of glial pathology on neural synchronization: an important phenomenon that underlies several central neurophysiological processes (ScienceDirect, 2018 ). We used two in vitro disease samples: (a) a sample in which cortical cultures were treated with anti-mitotic agents that deplete glial cells and (b) a glioma sample in which healthy cortical cells were cultured with CRL-2303 (an aggressive glioma cell line). Healthy cortical culture samples were used as controls. Cultures were established over a glass dish embedded with microelectrodes that permits simultaneous measurement of extracellular electrical activity from multiple sites of the culture. We observed that healthy cortical cultures produce spontaneous and synchronized oscillations which were attenuated in the absence of glial cells. The presence of glioma was associated with the emergence of two types of "abnormal electrical activity" each with distinct amplitude and frequency profile. Our results indicate that even early stages of glioma and glial injury are associated with distinct changes in neuronal electrical activity. Graphical abstract.
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20
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Rau A, Kellner E, Foit NA, Lützen N, Heiland DH, Schulze-Bonhage A, Reisert M, Kiselev VG, Prinz M, Urbach H, Mader I. Discrimination of epileptogenic lesions and perilesional white matter using diffusion tensor magnetic resonance imaging. Neuroradiol J 2019; 32:10-16. [PMID: 30461353 PMCID: PMC6327366 DOI: 10.1177/1971400918813991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to evaluate whether ganglioglioma (GGL), dysembryoplastic neuroepithelial tumour (DNET) and FCD (focal cortical dysplasia) are distinguishable through diffusion tensor imaging. Additionally, it was investigated whether the diffusion measures differed in the perilesional (pNAWM) and in the contralateral normal appearing white matter (cNAWM). Six GGLs, eight DNETs and seven FCDs were included in this study. Quantitative diffusion measures, that is, axial, radial and mean diffusivity and fractional anisotropy, were determined in the lesion identified on isotropic T2 or FLAIR-weighted images and in pNAWM and cNAWM, respectively. DNET differed from FCD in mean diffusivity, and GGL from FCD in radial diffusivity. Both types of glioneuronal tumours were different from pNAWM in fractional anisotropy and radial diffusivity. For identifying the tumour edges, threshold values for tumour-free tissue were investigated with receiver operating characteristic analyses: tumour could be separated from pNAWM at a threshold ≤ 0.32 (fractional anisotropy) or ≥ 0.56 (radial diffusivity) *10-3 mm2/s (area under the curve 0.995 and 0.990 respectively). While diffusion parameters of FCDs differed from cNAWM (radial diffusivity (*10-3 mm/s2): 0.74 ± 0.19 vs. 0.43 ± 0.05; corrected p-value < 0.001), the pNAWM could not be differentiated from the FCD.
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Affiliation(s)
- Alexander Rau
- Department of Neuroradiology, Medical
Centre – University of Freiburg, Faculty of Medicine, University of Freiburg,
Germany
| | - Elias Kellner
- Medical Physics, Department of
Radiology, Medical Centre – University of Freiburg, Faculty of Medicine, University
of Freiburg, Germany
| | - Niels A Foit
- Department of Neurosurgery, Medical
Centre – University of Freiburg, Faculty of Medicine, University of Freiburg,
Germany
| | - Niklas Lützen
- Department of Neuroradiology, Medical
Centre – University of Freiburg, Faculty of Medicine, University of Freiburg,
Germany
| | - Dieter H Heiland
- Department of Neurosurgery, Medical
Centre – University of Freiburg, Faculty of Medicine, University of Freiburg,
Germany
| | - Andreas Schulze-Bonhage
- Epilepsy Centre, Medical Centre –
University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Marco Reisert
- Medical Physics, Department of
Radiology, Medical Centre – University of Freiburg, Faculty of Medicine, University
of Freiburg, Germany
| | - Valerij G Kiselev
- Medical Physics, Department of
Radiology, Medical Centre – University of Freiburg, Faculty of Medicine, University
of Freiburg, Germany
| | - Marco Prinz
- Institute of Neuropathology, Medical
Centre – University of Freiburg, Faculty of Medicine, University of Freiburg,
Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical
Centre – University of Freiburg, Faculty of Medicine, University of Freiburg,
Germany
| | - Irina Mader
- Department of Neuroradiology, Medical
Centre – University of Freiburg, Faculty of Medicine, University of Freiburg,
Germany
- Department of Radiology, Schön-Klinik,
Vogtareuth, Germany
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21
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Mao XY, Tokay T, Zhou HH, Jin WL. Long-range and short-range tumor-stroma networks synergistically contribute to tumor-associated epilepsy. Oncotarget 2017; 7:33451-60. [PMID: 26967053 PMCID: PMC5078109 DOI: 10.18632/oncotarget.7962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/23/2016] [Indexed: 12/15/2022] Open
Abstract
Epileptic seizures are frequently caused by brain tumors. Traditional anti-epileptic treatments do not acquire satisfactory responses. Preoperative and postoperative seizures seriously influence the quality of life of patients. Thus, tumor-associated epilepsy (TAE) is an important subject of the current research. The delineation of the etiology of epileptogenesis in patients with primary brain tumor may help to find the novel and effective drug targets for treating this disease. In this review, we describe the current status of treatment of TAE. More importantly, we focus on the factors that are involved in the functional connectivity between tumors and stromal cells. We propose that there exist two modes, namely, long-range and short-range modes, which likely trigger neuronal hyperexcitation and subsequent epileptic seizures. The long-range mode is referred to as factors released by tumors including glutamate and GABA, binding to the corresponding receptor on the cellular membrane and causing neuronal hyperactivity, while the short-range mode is considered to involve direct intracellular communication between tumor cells and stromas. Gap junctions and tunneling nanotube network are involved in cellular interconnections. Future investigations focused on those two modes may find a potential novel therapeutic target for treating TAE.
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Affiliation(s)
- Xiao-Yuan Mao
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, P. R. China.,Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, P. R. China
| | - Tursonjan Tokay
- Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Astana, Republic of Kazakhstan
| | - Hong-Hao Zhou
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, P. R. China.,Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, P. R. China
| | - Wei-Lin Jin
- Institute of Nano Biomedicine and Engineering, Department of Instrument Science and Engineering, Key Laboratory for Thin Film and Microfabrication Technology of Ministry of Education, School of Electronic Information and Electronic Engineering, Shanghai Jiao Tong University, Shanghai, P. R. China.,National Center for Translational Medicine, Shanghai Jiao Tong University, Shanghai, P. R. China
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22
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Dong H, Zhou XW, Wang X, Yang Y, Luo JW, Liu YH, Mao Q. Complex role of connexin 43 in astrocytic tumors and possible promotion of glioma‑associated epileptic discharge (Review). Mol Med Rep 2017; 16:7890-7900. [PMID: 28983585 DOI: 10.3892/mmr.2017.7618] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 06/19/2017] [Indexed: 02/05/2023] Open
Abstract
Connexin (Cx)43 is a multifunction protein which forms gap junction channels and hemi‑channels. It also contains abundant binding domains which possess the ability to interact with certain Cx43‑associated proteins and therefore serve a fundamental role in various physiological and pathological functions. However, the understanding of the association between cancer and Cx43 along with Cx43‑gap junctions (GJ) remains unclear. All available data illustrate that Cx43 and its associated GJ serve important functions in cancers. The expression levels of Cx43 demonstrate a downward trend and an increase in the levels of malignancy, particularly in astrocytomas. The GJ intercellular communication activity in glioma cells can be adjusted via Cx43 phosphorylation and through the combination of Cx43 and its associated protein. Available evidence reveals Cx43 as a tumor‑inhibiting factor that suppresses glioma growth and proliferation. However, its mechanism is also regarded as complicated and ambiguous. Furthermore, it is apparent that Cx43‑GJ and the carboxyl tail may contribute to glioma growth and proliferation too. However, this valuable role could be weakened by its effects on migration and invasiveness. The detailed mechanism remains unclear and full of controversies. Cx43 can enhance the motor ability and invasiveness of astrocytic glioma cells. It is also able to influence glioma cells to detach from the tumor core to the peritumoral neocortex. This peritumoral region has recently been regarded as the basic focus of glioma‑associated seizure. Thus, Cx43 may take part in the onset and development of glioma‑associated epileptic discharge. In addition, change and increase of Cx43 expression in GJs has been observed in seizure perilesional tissue, which is associated with brain tumors. Cx43 or GJ/hemi‑channels exert enduring effects in the promotion of glioma‑associated epileptic release through direct mass effects and change of the tumor microenvironment. However, there are still a number of issues concerning this aspect that require further exploration. Cx43, as a potential treatment target against this incurable disease and its common symptom of epilepsy, requires further investigation.
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Affiliation(s)
- Hui Dong
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xing-Wang Zhou
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xiang Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yuan Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Jie-Wen Luo
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yan-Hui Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Qing Mao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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23
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Cha YJ, Kim DS, Lee SK, Kang HC, Kim SH. Long-term epilepsy-associated tumor in the amygdala of a 16-year-old boy: report of a rare case having intranuclear filaments. Brain Tumor Pathol 2017; 34:172-178. [PMID: 28799062 DOI: 10.1007/s10014-017-0294-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 08/04/2017] [Indexed: 11/30/2022]
Abstract
The term "long-term epilepsy-associated tumor (LEAT)" encompasses brain lesions associated with drug-resistant epilepsy over a long duration (≥2 years). Notably, some LEATs do not fit into any of the classifications of the World Health Organization (WHO). Herein, we report a LEAT that occurred in the left amygdala of a 16-year-old patient with intractable epilepsy. Histological examination of the resected amygdala revealed diffusely infiltrating tumor cells in the cortex. Perineuronal satellitosis and perivascular aggregation of tumor cells were apparent, along with mild nuclear enlargement and cytologic atypia. Tumor cells were positive for oligodendrocyte transcription factor 2 and neuronal markers including NeuN, neurofilaments, and synaptophysin, but were negative for CD34 and nestin. The most intriguing finding was intranuclear filaments, which appeared as rod- or needle-like shapes under high-power view. Ancillary ultrastructural analysis revealed thin filamentous intranuclear structures in tumor cells. Based on the glioneuronal nature of these cells as well as the infiltrative growth pattern, a diagnosis of LEAT was rendered that was deemed WHO grade I to II; however, the clinicopathological implications of the intranuclear inclusions remain unknown. The patient is currently alive and well without seizures.
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Affiliation(s)
- Yoon Jin Cha
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong-Seok Kim
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung-Koo Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hoon-Chul Kang
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Se Hoon Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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24
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Brain Tumor-Related Epilepsy: a Current Review of the Etiologic Basis and Diagnostic and Treatment Approaches. Curr Neurol Neurosci Rep 2017; 17:70. [DOI: 10.1007/s11910-017-0777-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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25
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Huang C, Chi XS, Hu X, Chen N, Zhou Q, Zhou D, Li JM. Predictors and mechanisms of epilepsy occurrence in cerebral gliomas: What to look for in clinicopathology. Exp Mol Pathol 2017; 102:115-122. [PMID: 28087392 DOI: 10.1016/j.yexmp.2017.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/02/2017] [Accepted: 01/06/2017] [Indexed: 02/05/2023]
Abstract
Gliomas, especially low-grade gliomas, are highly epileptogenic brain tumors. Histopathological information is valuable in evaluating the diagnosis and/or biologic behavior of various gliomas. Here we explored the clinical data and histopathological predictors of the occurrence of epilepsy in patients with gliomas. A retrospective study examined 310 consecutive patients who had undergone surgical treatment for gliomas in our institution from January 2013 to January 2015. Clinical data and pathological examination results were analyzed. Literatures regarding the predictors and etiology of glioma associated epileptic seizures in the period of 1995-2015 were also reviewed. A total of 234 (75.5%) astrocytic tumors and 76 (24.5%) oligodendrial tumors were included. At diagnosis, 33.6% of patients had epileptic seizures. Multivariate analysis revealed cortex involvement (OR=7.991, 95%CI=1.599-39.926), lower World Health Organization grade (OR=3.584, 95%CI=1.032-12.346) and topoisomerase II (TopoII) positivity (OR=0.943, 95%CI=0.903-0.982) were strong predictors for preoperative epileptic seizures. Gender, disease course, tumor classification, location or volume did not significantly affect epileptic seizure occurrence. Forty-three publications involved glioma-associated epilepsy were found in PubMed online database and key data were extracted and summarized. The present studies on glioma-related epilepsy are relatively limited and inconsistent. Low-grade gliomas, cortex involvement and TopoII positivity were independent predictors of a history of epileptic seizures at diagnosis. Further studies to examine the underlying mechanism of topoisomerase II as well as other molecules in epilepsy occurrence in brain gliomas are needed in the future.
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Affiliation(s)
- Cheng Huang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China; Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Xiao-Sa Chi
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Xin Hu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Ni Chen
- Department of Pathology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Qiao Zhou
- Department of Pathology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Jin-Mei Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China.
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26
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A versatile ex vivo technique for assaying tumor angiogenesis and microglia in the brain. Oncotarget 2016; 7:1838-53. [PMID: 26673818 PMCID: PMC4811501 DOI: 10.18632/oncotarget.6550] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 11/20/2015] [Indexed: 11/25/2022] Open
Abstract
Primary brain tumors are hallmarked for their destructive activity on the microenvironment and vasculature. However, solely few experimental techniques exist to access the tumor microenvironment under anatomical intact conditions with remaining cellular and extracellular composition. Here, we detail an ex vivo vascular glioma impact method (VOGIM) to investigate the influence of gliomas and chemotherapeutics on the tumor microenvironment and angiogenesis under conditions that closely resemble the in vivo situation. We generated organotypic brain slice cultures from rats and transgenic mice and implanted glioma cells expressing fluorescent reporter proteins. In the VOGIM, tumor-induced vessels presented the whole range of vascular pathologies and tumor zones as found in human primary brain tumor specimens. In contrast, non-transformed cells such as primary astrocytes do not alter the vessel architecture. Vascular characteristics with vessel branching, junctions and vessel meshes are quantitatively assessable as well as the peritumoral zone. In particular, the VOGIM resembles the brain tumor microenvironment with alterations of neurons, microglia and cell survival. Hence, this method allows live cell monitoring of virtually any fluorescence-reporter expressing cell. We further analyzed the vasculature and microglia under the influence of tumor cells and chemotherapeutics such as Temozolamide (Temodal/Temcad®). Noteworthy, temozolomide normalized vasculare junctions and branches as well as microglial distribution in tumor-implanted brains. Moreover, VOGIM can be facilitated for implementing the 3Rs in experimentations. In summary, the VOGIM represents a versatile and robust technique which allows the assessment of the brain tumor microenvironment with parameters such as angiogenesis, neuronal cell death and microglial activity at the morphological and quantitative level.
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27
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Zhou XW, Wang X, Yang Y, Luo JW, Dong H, Liu YH, Mao Q. Biomarkers related with seizure risk in glioma patients: A systematic review. Clin Neurol Neurosurg 2016; 151:113-119. [PMID: 27821299 DOI: 10.1016/j.clineuro.2016.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/03/2016] [Indexed: 02/05/2023]
Abstract
Increasing evidence indicates that genetic biomarkers play important roles in the development of glioma-associated seizures. Thus, we performed a systematic review to summarise biomarkers that are associated with seizures in glioma patients. An electronic literature search of public databases (PubMed, Embase and Medline) was performed using the keywords glioma, seizure and epilepsy. A totall of 26 eligible studies with 2224 cases were included in this systematic review of publications to 20 June, 2016. Genetic biomarkers such as isocitrate dehydrogenase 1 (IDH1) mutations, low expression of excitatory amino acid transporter 2 (EAAT2), high xCT expression, overexpression of adenosine kinase (ADK) and low expression of very large G-protein-coupled receptor-1 (VLGR1) are primarily involved in synaptic transmission, whereas BRAF mutations, epidermal growth factor receptor (EGFR) amplification, miR-196b expression and low ki-67 expression are associated with regulation of cell proliferation. However, there is limited evidence regarding the roles of RAD50 interactor 1 (RINT1) and olig2 in epileptogenesis among glioma patients. Glioma-related seizure was related to the dysfunction of tumor microenvironment. Our findings may provide new mechanistic insights into targeted therapy for glioma-related seizures and may result in the development of multi-target therapies.
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Affiliation(s)
- Xing-Wang Zhou
- Department of Neurosurgery, West China Hospital, Si Chuan University, Chengdu 610041, China
| | - Xiang Wang
- Department of Neurosurgery, West China Hospital, Si Chuan University, Chengdu 610041, China
| | - Yuan Yang
- Department of Neurosurgery, West China Hospital, Si Chuan University, Chengdu 610041, China
| | - Jie-Wen Luo
- Department of Neurosurgery, West China Hospital, Si Chuan University, Chengdu 610041, China
| | - Hui Dong
- Department of Neurosurgery, West China Hospital, Si Chuan University, Chengdu 610041, China
| | - Yan-Hui Liu
- Department of Neurosurgery, West China Hospital, Si Chuan University, Chengdu 610041, China
| | - Qing Mao
- Department of Neurosurgery, West China Hospital, Si Chuan University, Chengdu 610041, China.
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28
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MacKenzie G, O'Toole KK, Moss SJ, Maguire J. Compromised GABAergic inhibition contributes to tumor-associated epilepsy. Epilepsy Res 2016; 126:185-96. [PMID: 27513374 PMCID: PMC5308901 DOI: 10.1016/j.eplepsyres.2016.07.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/02/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Abstract
Glioblastoma Multiforme (GBM) is the most common form of primary brain tumor with 30-50% of patients presenting with epilepsy. These tumor-associated seizures are often resistant to traditional antiepileptic drug treatment and persist after tumor resection. This suggests that changes in the peritumoral tissue underpin epileptogenesis. It is known that glioma cells extrude pathological concentrations of glutamate which is thought to play a role in tumor progression and the development of epilepsy. Given that pathological concentrations of glutamate have been shown to dephosphorylate and downregulate the potassium chloride cotransporter KCC2, we hypothesized that glioma-induced alterations in KCC2 in the peritumoral region may play a role in tumor-associated epilepsy. Consistent with this hypothesis, we observe a decrease in total KCC2 expression and a dephosphorylation of KCC2 at residue Ser940 in a glioma model which exhibits hyperexcitability and the development of spontaneous seizures. To determine whether the reduction of KCC2 could potentially contribute to tumor-associated epilepsy, we generated mice with a focal knockdown of KCC2 by injecting AAV2-Cre-GFP into the cortex of floxed KCC2 mice. The AAV2-Cre-mediated knockdown of KCC2 was sufficient to induce the development of spontaneous seizures. Further, blocking NKCC1 with bumetanide to offset the loss of KCC2 reduced the seizure susceptibility in glioma-implanted mice. These findings support a mechanism of tumor-associated epilepsy involving downregulation of KCC2 in the peritumoral region leading to compromised GABAergic inhibition and suggest that modulating chloride homeostasis may be useful for seizure control.
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Affiliation(s)
- Georgina MacKenzie
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA 02111, United States
| | - Kate K O'Toole
- Training in Education and Critical Research Skills (TEACRS) Program, Tufts University School of Medicine, Boston, MA 02111, United States
| | - Stephen J Moss
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA 02111, United States
| | - Jamie Maguire
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA 02111, United States.
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29
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Neal A, Morokoff A, O'Brien TJ, Kwan P. Postoperative seizure control in patients with tumor-associated epilepsy. Epilepsia 2016; 57:1779-1788. [PMID: 27666131 DOI: 10.1111/epi.13562] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The patterns of postoperative seizure control and response to antiepileptic drugs (AEDs) in tumor-associated epilepsy (TAE) are poorly understood. We aim to document these characteristics in patients with supratentorial gliomas. METHODS This was a retrospective analysis of 186 patients with supratentorial gliomas. Seizure patterns were classified into four groups: A, no postoperative seizure; B, early postoperative seizure control within 6 months; C, fluctuating seizure control; and D, never seizure-free. Rates and duration of seizure freedom, subsequent seizure relapse, and response to AED were analyzed. RESULTS Among patients included, 49 (26.3%) had grade II, 28 (15.1%) had grade III, and 109 (58.6%) had grade IV glioma. Outcome pattern A was observed in 95 (51.1%), B in 22 (11.8%), C in 45 (24.2%), and D in 24 (12.9%). One hundred nineteen patients had at least one seizure and were classified as having TAE. Compared to pattern A, pattern B was predicted by histologic progression; pattern C by tumor grade, preoperative seizure, and histologic progression, and pattern D by preoperative seizure and gross total resection. Among patients with TAE, 57.5% of grade II, 68.2% of grade III, and 26.3% of grade IV experienced a period of 12-month seizure freedom. After first 12-month seizure remission, 39.1%, 60.0%, and 13.3% of grade II, III, and IV gliomas, respectively, experienced subsequent seizure; 22.6% of those with TAE reached terminal seizure freedom of at least 12 months on their first postoperative AED regimen, 6.5% on their second regimen, and 5.4% on subsequent regimens. SIGNIFICANCE Distinct patterns of postoperative seizure control exist in gliomas; they have specific risk factor profiles, and we hypothesize these correspond to unique pathogenic mechanisms. Twelve-month seizure freedom with subsequent relapse is frequent in grade II-III gliomas. Response to AEDs is markedly poorer than with non-TAE, highlighting the complex epileptogenicity of gliomas.
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Affiliation(s)
- Andrew Neal
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Andrew Morokoff
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia.,Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Terence John O'Brien
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Patrick Kwan
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
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30
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Neal A, Yuen T, Bjorksten AR, Kwan P, O'Brien TJ, Morokoff A. Peritumoural glutamate correlates with post-operative seizures in supratentorial gliomas. J Neurooncol 2016; 129:259-67. [PMID: 27311724 DOI: 10.1007/s11060-016-2169-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022]
Abstract
To examine the impact of glutamate on post-operative seizures and survival in a cohort of patients with grade II to IV supratentorial glioma. A retrospective analysis was performed on 216 patients who underwent surgery for supratentorial gliomas. Primary explanatory variables were peritumoural and/or tumoural glutamate concentrations, glutamate transporter expression (EAAT2 and SXC). Univariate and multivariate survival analysis was performed with primary outcomes of time to first post-operative seizure and overall survival. Subgroup analysis was performed in patients with de novo glioblastomas who received adjuvant chemoradiotherapy. 47 (21.8 %), 34 (15.8 %) and 135 (62.5 %) WHO grade II, III and IV gliomas respectively were followed for a median of 15.8 months. Following multivariate analysis, there was a non-significant association between higher peritumoural glutamate concentrations and time to first post-operative seizure (HR 2.07, CI 0.98-4.37, p = 0.06). In subgroup analysis of 81 glioblastoma patients who received adjunct chemoradiotherapy, peritumoural glutamate concentration was significantly associated with time to first post-operative seizure (HR 3.10, CI 1.20-7.97, p = 0.02). In both the overall cohort and subgroup analysis no glutamate cycle biomarkers were predictive of overall survival. Increased concentrations of peritumoural glutamate were significantly associated with shorter periods of post-operative seizure freedom in patients with de novo glioblastomas treated with adjuvant chemoradiotherapy. No glutamate cycle biomarkers were predictive of overall survival. These results suggest that therapies targeting glutamate may be beneficial in tumour associated epilepsy.
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Affiliation(s)
- Andrew Neal
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia.
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia.
| | - Tanya Yuen
- Department of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
| | - Andrew R Bjorksten
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, 3050, Parkville, VIC, Australia
| | - Patrick Kwan
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
| | - Terence J O'Brien
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
| | - Andrew Morokoff
- Department of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
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31
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Armstrong TS, Grant R, Gilbert MR, Lee JW, Norden AD. Epilepsy in glioma patients: mechanisms, management, and impact of anticonvulsant therapy. Neuro Oncol 2015; 18:779-89. [PMID: 26527735 DOI: 10.1093/neuonc/nov269] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 10/01/2015] [Indexed: 12/16/2022] Open
Abstract
Seizures are a well-recognized symptom of primary brain tumors, and anticonvulsant use is common. This paper provides an overview of epilepsy and the use of anticonvulsants in glioma patients. Overall incidence and mechanisms of epileptogenesis are reviewed. Factors to consider with the use of antiepileptic drugs (AEDs) including incidence during the disease trajectory and prophylaxis along with considerations in the selection of anticonvulsant use (ie, potential side effects, drug interactions, adverse effects, and impact on survival) are also reviewed. Finally, areas for future research and exploring the pathophysiology and use of AEDs in this population are also discussed.
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Affiliation(s)
- Terri S Armstrong
- Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.); Edinburgh Centre for Neuro-Oncology, Edinburgh, UK (R.G.); Neuro-Oncology Branch, National Cancer Institute and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland (M.R.G.); Division of EEG and Epilepsy, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (J.W.L.); Center for Neuro-Oncology, Dana-Farber Cancer Institute; Division of Cancer Neurology, Department of Neurology, Brigham and Women's Hospital; and Harvard Medical School, Boston, Massachusetts (A.D.N.)
| | - Robin Grant
- Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.); Edinburgh Centre for Neuro-Oncology, Edinburgh, UK (R.G.); Neuro-Oncology Branch, National Cancer Institute and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland (M.R.G.); Division of EEG and Epilepsy, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (J.W.L.); Center for Neuro-Oncology, Dana-Farber Cancer Institute; Division of Cancer Neurology, Department of Neurology, Brigham and Women's Hospital; and Harvard Medical School, Boston, Massachusetts (A.D.N.)
| | - Mark R Gilbert
- Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.); Edinburgh Centre for Neuro-Oncology, Edinburgh, UK (R.G.); Neuro-Oncology Branch, National Cancer Institute and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland (M.R.G.); Division of EEG and Epilepsy, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (J.W.L.); Center for Neuro-Oncology, Dana-Farber Cancer Institute; Division of Cancer Neurology, Department of Neurology, Brigham and Women's Hospital; and Harvard Medical School, Boston, Massachusetts (A.D.N.)
| | - Jong Woo Lee
- Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.); Edinburgh Centre for Neuro-Oncology, Edinburgh, UK (R.G.); Neuro-Oncology Branch, National Cancer Institute and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland (M.R.G.); Division of EEG and Epilepsy, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (J.W.L.); Center for Neuro-Oncology, Dana-Farber Cancer Institute; Division of Cancer Neurology, Department of Neurology, Brigham and Women's Hospital; and Harvard Medical School, Boston, Massachusetts (A.D.N.)
| | - Andrew D Norden
- Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.); Edinburgh Centre for Neuro-Oncology, Edinburgh, UK (R.G.); Neuro-Oncology Branch, National Cancer Institute and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland (M.R.G.); Division of EEG and Epilepsy, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts (J.W.L.); Center for Neuro-Oncology, Dana-Farber Cancer Institute; Division of Cancer Neurology, Department of Neurology, Brigham and Women's Hospital; and Harvard Medical School, Boston, Massachusetts (A.D.N.)
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Therapeutic potential of cyclooxygenase-3 inhibitors in the management of glioblastoma. J Neurooncol 2015; 126:271-8. [PMID: 26508095 DOI: 10.1007/s11060-015-1976-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/25/2015] [Indexed: 12/26/2022]
Abstract
In this study we investigated the expression of COX-1, COX-2 and COX-3 mRNA in C6 glioblastoma and normal brain tissues and the effects of acetaminophen, indomethacin or metamizole treatments on the development of C6 glioblastoma in relation with COX inhibition. Glioblastoma cells were inoculated intracerebrally into frontal lobe of adult male Wistar albino rats. 10 days after inoculation, rats were treated with 150 mg/kg acetaminophen, 10 mg/kg indomethacin or 150 mg/kg metamizole. The tumor size was measured histologically and total RNA was isolated from tumor or normal brain tissue and mRNA levels of COX isoforms were determined by qRT-PCR. Our results showed the presence of COX-1, COX-2 and COX-3 expressions in both C6 glioblastoma and normal brain tissues. In tumor tissues COX-3 expression was significantly higher than normal brain tissue (p < 0.05) while there was no significant difference in COX-1 and COX-2 expressions. Acetaminophen and indomethacin decreased the tumor size by 71 and 43 % by inhibiting COX-3 mRNA expression around 87 and 91 % respectively. For the first time our study proposes a possible relationship between COX-3 mRNA expression and C6 glioblastoma development. We also suggested that the inhibition of COX-3 enzyme may be responsible for decrease in tumor size in part, the mechanism by which acetaminophen and indomethacin decreased rat C6 glioblastoma growth. However, the molecular events responsible for COX-3 effects on tumor development are still unresolved as these drugs exert their anti-cancer effect via both COX-3 dependent and independent mechanisms.
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Gao X, Wang H, Cai S, Saadatzadeh MR, Hanenberg H, Pollok KE, Cohen-Gadol AA, Chen J. Phosphorylation of NMDA 2B at S1303 in human glioma peritumoral tissue: implications for glioma epileptogenesis. Neurosurg Focus 2015; 37:E17. [PMID: 25434386 DOI: 10.3171/2014.9.focus14485] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECT Peritumoral seizures are an early symptom of a glioma. To gain a better understanding of the molecular mechanism underlying tumor-induced epileptogenesis, the authors studied modulation of the N-methyl-d-aspartate (NMDA) receptor in peritumoral tissue. METHODS To study the possible etiology of peritumoral seizures, NMDA receptor expression, posttranslational modification, and function were analyzed in an orthotopic mouse model of human gliomas and primary patient glioma tissue in which the peritumoral border (tumor-brain interface) was preserved in a tissue block during surgery. RESULTS The authors found that the NMDA receptor containing the 2B subunit (NR2B), a predominantly extrasynaptic receptor, is highly phosphorylated at S1013 in the neurons located in the periglioma area of the mouse brain. NR2B is also highly phosphorylated at S1013 in the neurons located in the peritumoral area from human brain tissue containing a glioma. The phosphorylation of the extrasynaptic NMDA receptor increases its permeability for Ca(2+) influx and subsequently mediates neuronal overexcitation and seizure activity. CONCLUSIONS These data suggest that overexcitation of the extrasynaptic NMDA receptors in the peritumoral neurons may contribute to the development of peritumoral seizures and that the phosphorylated NR2B may be a therapeutic target for blocking primary brain tumor-induced peritumoral seizures.
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Affiliation(s)
- Xiang Gao
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine
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Gao X, Wang H, Pollok KE, Chen J, Cohen-Gadol AA. Activation of death-associated protein kinase in human peritumoral tissue: A potential therapeutic target. J Clin Neurosci 2015; 22:1655-60. [PMID: 26165472 DOI: 10.1016/j.jocn.2015.03.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/02/2015] [Indexed: 11/15/2022]
Abstract
To further understand the molecular mechanisms of N-methyl-D-aspartate receptor 2B (NR2B) phosphorylation and its contribution to glioma-related seizures, we investigated the expression of death-associated protein kinase-1 (DAPK1), which is a kinase known to phosphorylate NR2B at S1303 in glioma and peritumoral tissue. The molecular mechanisms leading to glioma-associated seizures are poorly understood. We recently discovered that NR2B is phosphorylated at S1303 in glioma peritumoral tissue. NR2B is an excitatory glutamate receptor, suggesting that glutamate released from glioma tumor cells may excite the neurons in the peritumoral tissue and contribute to glioma-associated epileptogenesis. DAPK1 levels were assessed in an intracranial mouse model of human glioma and in primary patient peritumoral and glioma tissues using immunohistochemistry. DAPK1 is highly expressed in the peritumoral region, but is poorly expressed in glioma tissues in both a mouse model of human glioma and in the primary patient glioma. In our previous report, we found that NR2B is also highly phosphorylated in the same region. Upregulation of DAPK1 in the peritumoral tissues suggests that DAPK1 can phosphorylate NR2B, increase its excitability, lead to glioma-induced seizures, and could potentially be an important therapeutic target. Furthermore, the xenograft model offers an opportunity to develop and test therapeutic approaches that can block DAPK1 activity in vivo.
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Affiliation(s)
- Xiang Gao
- Department of Neurological Surgery, Indiana University, 355 West 16th Street, Suite 5100, Indianapolis, IN 46202, USA; Stark Neuroscience Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Haiyan Wang
- Herman B. Wells Center for Pediatric Research, Riley Hospital for Children, Indiana University Health, Indianapolis, IN, USA; Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, USA; Simon Cancer Center, Indiana University, Indianapolis, IN, USA
| | - Karen E Pollok
- Herman B. Wells Center for Pediatric Research, Riley Hospital for Children, Indiana University Health, Indianapolis, IN, USA; Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, USA; Simon Cancer Center, Indiana University, Indianapolis, IN, USA
| | - Jinhui Chen
- Department of Neurological Surgery, Indiana University, 355 West 16th Street, Suite 5100, Indianapolis, IN 46202, USA; Stark Neuroscience Research Center, Indiana University School of Medicine, Indianapolis, IN, USA; Goodman Campbell Brain and Spine, Indianapolis, IN, USA
| | - Aaron A Cohen-Gadol
- Department of Neurological Surgery, Indiana University, 355 West 16th Street, Suite 5100, Indianapolis, IN 46202, USA; Simon Cancer Center, Indiana University, Indianapolis, IN, USA; Goodman Campbell Brain and Spine, Indianapolis, IN, USA.
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Kirschstein T, Köhling R. Animal models of tumour-associated epilepsy. J Neurosci Methods 2015; 260:109-17. [PMID: 26092434 DOI: 10.1016/j.jneumeth.2015.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 01/26/2023]
Abstract
Brain tumours cause a sizeable proportion of epilepsies in adulthood, and actually can be etiologically responsible also for childhood epilepsies. Conversely, seizures are often first clinical signs of a brain tumour. Nevertheless, several issues of brain-tumour associated seizures and epilepsies are far from understood, or clarified regarding clinical consensus. These include both the specific mechanisms of epileptogenesis related to different tumour types, the possible relationship between malignancy and seizure emergence, the interaction between tumour mass and surrounding neuronal networks, and - not least - the best treatment options depending on different tumour types. To investigate these issues, experimental models of tumour-induced epilepsies are necessary. This review concentrates on the description of currently used models, focusing on methodological aspects. It highlights advantages and shortcomings of these models, and identifies future experimental challenges.
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Affiliation(s)
- Timo Kirschstein
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Gertrudenstrasse 9, 18057 Rostock, Germany
| | - Rüdiger Köhling
- Oscar-Langendorff-Institute of Physiology, Rostock University Medical Center, Gertrudenstrasse 9, 18057 Rostock, Germany.
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Di Angelantonio S, Murana E, Cocco S, Scala F, Bertollini C, Molinari MG, Lauro C, Bregestovski P, Limatola C, Ragozzino D. A role for intracellular zinc in glioma alteration of neuronal chloride equilibrium. Cell Death Dis 2014; 5:e1501. [PMID: 25356870 PMCID: PMC4237258 DOI: 10.1038/cddis.2014.437] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 09/04/2014] [Accepted: 09/09/2014] [Indexed: 11/16/2022]
Abstract
Glioma patients commonly suffer from epileptic seizures. However, the mechanisms of glioma-associated epilepsy are far to be completely understood. Using glioma-neurons co-cultures, we found that tumor cells are able to deeply influence neuronal chloride homeostasis, by depolarizing the reversal potential of γ-aminobutyric acid (GABA)-evoked currents (EGABA). EGABA depolarizing shift is due to zinc-dependent reduction of neuronal KCC2 activity and requires glutamate release from glioma cells. Consistently, intracellular zinc loading rapidly depolarizes EGABA in mouse hippocampal neurons, through the Src/Trk pathway and this effect is promptly reverted upon zinc chelation. This study provides a possible molecular mechanism linking glioma invasion to excitation/inhibition imbalance and epileptic seizures, through the zinc-mediated disruption of neuronal chloride homeostasis.
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Affiliation(s)
- S Di Angelantonio
- Istituto Pasteur-Fondazione Cenci Bolognetti, Department of Physiology and Pharmacology, Sapienza University of Rome, Piazzale Aldo Piazzale Aldo Moro 5, Roma 00185, Italy
- Center for Life Nano Science@Sapienza, Istituto Italiano di Tecnologia, Viale Regina Elena 291, Roma 00161, Italy
| | - E Murana
- Istituto Pasteur-Fondazione Cenci Bolognetti, Department of Physiology and Pharmacology, Sapienza University of Rome, Piazzale Aldo Piazzale Aldo Moro 5, Roma 00185, Italy
| | - S Cocco
- Istituto Pasteur-Fondazione Cenci Bolognetti, Department of Physiology and Pharmacology, Sapienza University of Rome, Piazzale Aldo Piazzale Aldo Moro 5, Roma 00185, Italy
| | - F Scala
- Istituto Pasteur-Fondazione Cenci Bolognetti, Department of Physiology and Pharmacology, Sapienza University of Rome, Piazzale Aldo Piazzale Aldo Moro 5, Roma 00185, Italy
| | - C Bertollini
- Istituto Pasteur-Fondazione Cenci Bolognetti, Department of Physiology and Pharmacology, Sapienza University of Rome, Piazzale Aldo Piazzale Aldo Moro 5, Roma 00185, Italy
| | - M G Molinari
- Istituto Pasteur-Fondazione Cenci Bolognetti, Department of Physiology and Pharmacology, Sapienza University of Rome, Piazzale Aldo Piazzale Aldo Moro 5, Roma 00185, Italy
| | - C Lauro
- Istituto Pasteur-Fondazione Cenci Bolognetti, Department of Physiology and Pharmacology, Sapienza University of Rome, Piazzale Aldo Piazzale Aldo Moro 5, Roma 00185, Italy
| | - P Bregestovski
- INSERM URM 1106, Aix-Marseille University, Brain Dynamics Institute, Marseille, France
| | - C Limatola
- Istituto Pasteur-Fondazione Cenci Bolognetti, Department of Physiology and Pharmacology, Sapienza University of Rome, Piazzale Aldo Piazzale Aldo Moro 5, Roma 00185, Italy
- IRCCS Neuromed, Via Atinese, Pozzilli, Italy
| | - D Ragozzino
- Istituto Pasteur-Fondazione Cenci Bolognetti, Department of Physiology and Pharmacology, Sapienza University of Rome, Piazzale Aldo Piazzale Aldo Moro 5, Roma 00185, Italy
- IRCCS Neuromed, Via Atinese, Pozzilli, Italy
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Koekkoek JAF, Dirven L, Reijneveld JC, Postma TJ, Grant R, Pace A, Oberndorfer S, Heimans JJ, Taphoorn MJB. Epilepsy in the end of life phase of brain tumor patients: a systematic review. Neurooncol Pract 2014; 1:134-140. [PMID: 31386028 DOI: 10.1093/nop/npu018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Indexed: 12/13/2022] Open
Abstract
Epileptic seizures are common in patients with primary or secondary malignant brain tumor. However, current knowledge on the occurrence of seizures during the end of life (EOL) phase of brain tumor patients is limited. Because symptom management with preservation of quality of life is of major importance for patients with a malignant brain tumor, particularly in the EOL, it is necessary to gain a deeper understanding of seizures and their management during this phase. We performed a systematic review of literature related to epilepsy in the EOL phase of brain tumor patients, based on the electronic resources PubMed, Embase, and Cinahl. The search yielded 442 unique records, of which 11 articles were eligible for further analysis after applying predefined inclusion criteria. Seizures occur relatively frequently in the EOL phase, particularly in patients with high-grade glioma. However, seizure management is often hampered by swallowing difficulties and impaired consciousness. Treatment decisions are largely dependent on expert opinion because a standardized approach for treating seizures in the terminal stage of brain tumor patients is still lacking.
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Affiliation(s)
- Johan A F Koekkoek
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
| | - Linda Dirven
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
| | - Jaap C Reijneveld
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
| | - Tjeerd J Postma
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
| | - Robin Grant
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
| | - Andrea Pace
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
| | - Stefan Oberndorfer
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
| | - Jan J Heimans
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
| | - Martin J B Taphoorn
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands (J.A.F.K., L.D., J.C.R., T.J.P., J.J.H., M.J.B.T.); Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (J.A.F.K., M.J.B.T.); Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland (R.G.); Neuro-Oncology Unit, Regina Elena Cancer Institute, Rome, Italy (A.P.); Department of Neurology, Landesklinikum St. Pölten, Sankt Pölten, Austria (S.O.)
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Petit LF, Jalabert M, Buhler E, Malvache A, Peret A, Chauvin Y, Watrin F, Represa A, Manent JB. Normotopic cortex is the major contributor to epilepsy in experimental double cortex. Ann Neurol 2014; 76:428-42. [PMID: 25074818 DOI: 10.1002/ana.24237] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 07/08/2014] [Accepted: 07/21/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Subcortical band heterotopia (SBH) is a cortical malformation formed when neocortical neurons prematurely stop their migration in the white matter, forming a heterotopic band below the normotopic cortex, and is generally associated with intractable epilepsy. Although it is clear that the band heterotopia and the overlying cortex both contribute to creating an abnormal circuit prone to generate epileptic discharges, it is less understood which part of this circuitry is the most critical. Here, we sought to identify the origin of epileptiform activity in a targeted genetic model of SBH in rats. METHODS Rats with SBH (Dcx-KD rats) were generated by knocking down the Dcx gene using shRNA vectors transfected into neocortical progenitors of rat embryos. Origin, spatial extent, and laminar profile of bicuculline-induced interictal-like activity on neocortical slices were analyzed by using extracellular recordings from 60-channel microelectrode arrays. Susceptibility to pentylenetetrazole-induced seizures was assessed by electrocorticography in head-restrained nonanesthetized rats. RESULTS We show that the band heterotopia does not constitute a primary origin for interictal-like epileptiform activity in vitro and is dispensable for generating induced seizures in vivo. Furthermore, we report that most interictal-like discharges originating in the overlying cortex secondarily propagate to the band heterotopia. Importantly, we found that in vivo suppression of neuronal excitability in SBH does not alter the higher propensity of Dcx-KD rats to display seizures. INTERPRETATION These results suggest a major role of the normotopic cortex over the band heterotopia in generating interictal epileptiform activity and seizures in brains with SBH.
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Affiliation(s)
- Ludovic Franck Petit
- Institut de Neurobiologie de la Méditerranée/Institut National de la Santé et de la Recherche Médicale U901, Marseille, France; Aix-Marseille University, Marseille, France
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Liubinas SV, O'Brien TJ, Moffat BM, Drummond KJ, Morokoff AP, Kaye AH. Tumour associated epilepsy and glutamate excitotoxicity in patients with gliomas. J Clin Neurosci 2014; 21:899-908. [PMID: 24746886 DOI: 10.1016/j.jocn.2014.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 02/22/2014] [Indexed: 02/04/2023]
Abstract
Tumour associated epilepsy (TAE) is common, debilitating and often not successfully controlled by surgical resection of the tumour and administration of multiple anti-epileptic drugs. It represents a cause of significant lost quality of life in an incurable disease and is therefore an important subject for ongoing research. The pathogenesis of TAE is likely to be multifactorial and involve, on the microscopic level, the interaction of genetic factors, changes in the peritumoural microenvironment, alterations in synaptic neurotransmitter release and re-uptake, and the excitotoxic effects of glutamate. On a macroscopic level, the occurrence of TAE is likely to be influenced by tumour size, location and interaction with environmental factors. The optimal treatment of TAE requires a multi-disciplinary approach with input from neurosurgeons, neurologists, radiologists, pathologists and basic scientists. This article reviews the current literature regarding the incidence, treatment, and aetiology of TAE.
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Affiliation(s)
- Simon V Liubinas
- Department of Neurosurgery, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia; Department of Surgery (RMH/WH), The University of Melbourne, Parkville, VIC, Australia.
| | - Terence J O'Brien
- Department of Medicine (RMH/WH), The University of Melbourne, Parkville, VIC, Australia
| | - Bradford M Moffat
- Department of Radiology (RMH/WH), The University of Melbourne, Parkville, VIC, Australia
| | - Katharine J Drummond
- Department of Neurosurgery, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia; Department of Surgery (RMH/WH), The University of Melbourne, Parkville, VIC, Australia
| | - Andrew P Morokoff
- Department of Neurosurgery, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia; Department of Surgery (RMH/WH), The University of Melbourne, Parkville, VIC, Australia
| | - Andrew H Kaye
- Department of Neurosurgery, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia; Department of Surgery (RMH/WH), The University of Melbourne, Parkville, VIC, Australia
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Pallud J, Capelle L, Huberfeld G. Tumoral epileptogenicity: How does it happen? Epilepsia 2013; 54 Suppl 9:30-4. [DOI: 10.1111/epi.12440] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Johan Pallud
- Neurosurgery Unit; Sainte-Anne Hospital; Paris France
- Paris Descartes University; Paris France
| | - Laurent Capelle
- Neurosurgery Unit; Pitie-Salpetriere University Hospital; Assistance Publique - Hopitaux de Paris (AP-HP); Paris France
| | - Gilles Huberfeld
- Neurophysiology Department; Pitie-Salpetriere University Hospital; Assistance Publique - Hopitaux de Paris (AP-HP); Paris France
- Brain & Spine Institute; INSERM UMRS975; CNRS UMR7225; Pierre and Marie Curie University (UPMC); Paris France
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Ius T, Pauletto G, Isola M, Gregoraci G, Budai R, Lettieri C, Eleopra R, Fadiga L, Skrap M. Surgery for insular low-grade glioma: predictors of postoperative seizure outcome. J Neurosurg 2013; 120:12-23. [PMID: 24236654 DOI: 10.3171/2013.9.jns13728] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Although a number of recent studies on the surgical treatment of insular low-grade glioma (LGG) have demonstrated that aggressive resection leads to increased overall patient survival and decreased malignant progression, less attention has been given to the results with respect to tumor-related epilepsy. The aim of this investigation was to evaluate the impact of volumetric, histological, and intraoperative neurophysiological factors on seizure outcome in patients with insular LGG. METHODS The authors evaluated predictors of seizure outcome with special emphasis on both the extent of tumor resection (EOR) and the tumor's infiltrative pattern quantified by computing the difference between the preoperative T2- and T1-weighted MR images (ΔVT2T1) in 52 patients with preoperative drug-resistant epilepsy. RESULTS The 12-month postoperative seizure outcome (Engel class) was as follows: seizure free (Class I), 67.31%; rare seizures (Class II), 7.69%; meaningful seizure improvement (Class III), 15.38%; and no improvement or worsening (Class IV), 9.62%. Poor seizure control was more common in patients with a longer preoperative seizure history (p < 0.002) and higher frequency of seizures (p = 0.008). Better seizure control was achieved in cases with EOR ≥ 90% (p < 0.001) and ΔVT2T1 < 30 cm(3) (p < 0.001). In the final model, ΔVT2T1 proved to be the strongest independent predictor of seizure outcome in insular LGG patients (p < 0.0001). CONCLUSIONS No or little postoperative seizure improvement occurs mainly in cases with a prevalent infiltrative tumor growth pattern, expressed by high ΔVT2T1 values, which consequently reflects a smaller EOR.
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Buckingham SC, Robel S. Glutamate and tumor-associated epilepsy: glial cell dysfunction in the peritumoral environment. Neurochem Int 2013; 63:696-701. [PMID: 23385090 DOI: 10.1016/j.neuint.2013.01.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 11/30/2012] [Accepted: 01/27/2013] [Indexed: 01/22/2023]
Abstract
Seizures are a serious and debilitating co-morbidity of primary brain tumors that affect most patients, yet their etiology is poorly understood. In many CNS pathologies, including epilepsy and brain injury, high levels of extracellular glutamate have been implicated in seizure generation. It has been shown that gliomas release neurotoxic levels of glutamate through their high expression of system xc-. More recently it was shown that the surrounding peritumoral cortex is spontaneously hyperexcitable. In this review, we discuss how gliomas induce changes in the surrounding environment that may further contribute to elevated extracellular glutamate and tumor-associated seizures. Peritumoral astrocytes become reactive and lose their ability to remove glutamate, while microglia, in response to signals from glioma cells, may release glutamate. In addition, gliomas increase blood brain barrier permeability, allowing seizure-inducing serum components, including glutamate, into the peritumoral region. These factors, working together or alone, may influence the frequency and severity of tumor-associated epilepsy.
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Affiliation(s)
- Susan C Buckingham
- Department of Neurobiology, Center for Glial Biology in Medicine, University of Alabama at Birmingham, 1719 6th Avenue South, Birmingham, AL 35294, USA.
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Hiraishi T, Kitaura H, Oishi M, Fukuda M, Kameyama S, Takahashi H, Kakita A, Fujii Y. Significance of horizontal propagation of synchronized activities in human epileptic neocortex investigated by optical imaging and immunohistological study. Epilepsy Res 2012. [PMID: 23200433 DOI: 10.1016/j.eplepsyres.2012.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
To characterize the physiological condition of human epileptic neocortex, we employed flavoprotein fluorescence imaging (FFI), an optical imaging method which detects intrinsic signals accompanying neural activation, and immunohistologically studied human cortical specimens. The experimented materials were cortical tissues surrounding various intracerebral lesions obtained from 5 patients with epilepsy (epileptic patients: EPs) and 5 without epilepsy (non-epileptic patients: NEPs). These tissues were immersed in oxygenated artificial cerebrospinal fluid immediately after removal in the operating room. Signal changes of FFI in the cortical layers subjected to electrical stimulation were observed under bicuculline methiodide perfusion. Immunohistological staining for parvalbumin (PV), calbindin, and calretinin were performed on the same specimens to evaluate expressions of calcium-binding protein positive cells. The FFI study showed the characteristic cortical propagation pattern of elicited activities horizontally along the cortical layers in EPs but not in NEPs. The propagated area with more than 0.5% signal changes was significantly larger in EPs than in NEPs (p=0.008). Only the expression of PV positive neurons was significantly lower in EPs than in NEPs (p=0.006). The propagated area on FFI and the decrease in PV positive neurons correlated significantly (R=-0.78, p=0.04). The present study visualized the unique horizontal propagation of signal changes on FFI and demonstrated a correlation of this propagation with immunohistological decreases in PV positive neurons in human epileptic cortex. Further investigations may elucidate the mechanism of hyper-excitability and hyper-synchronization in epileptic cortical tissue itself.
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Affiliation(s)
- Tetsuya Hiraishi
- Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata, Japan.
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Prakash O, Lukiw WJ, Peruzzi F, Reiss K, Musto AE. Gliomas and seizures. Med Hypotheses 2012; 79:622-6. [PMID: 22959996 DOI: 10.1016/j.mehy.2012.07.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 07/28/2012] [Indexed: 10/27/2022]
Abstract
Glial neoplasms account for nearly 50% of all adult primary brain tumors. They originate from glial cells in the brain and/or spinal cord and include low-grade diffuse astrocytomas, anaplastic-astrocytomas, and glioblastomas. Of all brain tumors, glioblastoma multiforme (GBM) is the most aggressive and is characterized by rapid glial cell growth, resistance to radio- and chemo- therapies, and relentless infiltration and spreading throughout the central nervous system (CNS). In glioblastomas, primary tumor growth and CNS invasion are associated with the activation of complex structural molecular and metabolic changes within the tumor tissue, which profoundly affect the surrounding neuronal networks and may in part explain induction of epilepsy. In fact, epileptic seizures are very common among patients with glial tumors, reaching nearly 50% in glioblastoma patients and almost 90% in low-grade astrocytomas. The overall hypothesis presented here discusses the possibility that the aberrant tumor cell metabolism may act directly on neuronal network, and this leads to seizure susceptibility. Further invasion and growth of the malignant glial cells exacerbate this initial pathologic state which promotes recurrent seizures (epileptogenesis).
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Affiliation(s)
- O Prakash
- LSUHSC - Cancer Center, Neurosurgery Department and Neuroscience Center of Excellence, 2020 Gravier St., New Orleans, LA 70112, USA
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Abstract
The term long-term epilepsy associated tumor (LEAT) encompasses lesions identified in patients investigated for long histories (often 2 years or more) of drug-resistant epilepsy. They are generally slowly growing, low grade, cortically based tumors, more often arising in younger age groups and in many cases exhibit neuronal in addition to glial differentiation. Gangliogliomas and dysembryoplastic neuroepithelial tumors predominate in this group. LEATs are further united by cyto-architectural changes that may be present in the adjacent cortex which have some similarities to developmental focal cortical dysplasias (FCD); these are now grouped as FCD type IIIb in the updated International League Against Epilepsy (ILAE) classification. In the majority of cases, surgical treatments are beneficial from both perspectives of managing the seizures and the tumor. However, in a minority, seizures may recur, tumors may show regrowth or recurrence, and rarely undergo anaplastic progression. Predicting and identifying tumors likely to behave less favorably are key objectives of the neuropathologist. With immunohistochemistry and modern molecular pathology, it is becoming increasingly possible to refine diagnostic groups. Despite this, some LEATs remain difficult to classify, particularly tumors with "non-specific" or diffuse growth patterns. Modification of LEAT classification is inevitable with the goal of unifying terminological criteria applied between centers for accurate clinico-pathological-molecular correlative data to emerge. Finally, establishing the epileptogenic components of LEAT, either within the lesion or perilesional cortex, will elucidate the cellular mechanisms of epileptogenesis, which in turn will guide optimal surgical management of these lesions.
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Affiliation(s)
- Maria Thom
- Department of Clinical and Experimental Epilepsy, UCL, Institute of Neurology, Queen Square, London, UK.
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Campbell SL, Buckingham SC, Sontheimer H. Human glioma cells induce hyperexcitability in cortical networks. Epilepsia 2012; 53:1360-70. [PMID: 22709330 DOI: 10.1111/j.1528-1167.2012.03557.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Patients with gliomas frequently present with seizures, but the factors associated with seizure development are still poorly understood. In this study, we assessed peritumoral synaptic network activity in a glioma animal model and tested the contribution of aberrant glutamate release from gliomas on glioma-associated epileptic network activity. METHODS In vitro brain slices were made from glioma-implanted mice. Using extracellular field recordings, we analyzed peritumoral epileptiform activity induced by Mg(2+)-free medium in slices from tumor-bearing animals and sham-operated controls. We assessed the effect of sulfasalazine (SAS), a blocker of system and glutamate release, on spontaneous and evoked activity in tumor-associated slices. KEY FINDINGS Tumor-associated cortical networks were hyperexcitable. The onset latency of Mg(2+)-free-induced epileptiform activity was significantly shorter in tumor-bearing slices, and the incidence of Mg(2+)-free-induced ictal-like events was higher. Block of glutamate release from system decreased the response area of evoked activity and completely blocked Mg(2+)-free-induced ictal-like, but not interictal-like events. SIGNIFICANCE Control of seizures in patients with gliomas is an essential component of clinical management; therefore, understanding the origin of seizures is vital. This work provides evidence that peritumoral synaptic network activity is disrupted by tumor masses resulting in network excitability. We show that blocking glutamate release via system with SAS, a drug already approved by the U.S. Food and Drug Administration (FDA), can inhibit Mg(2+)-free-induced ictal-like epileptiform events similar to other chemicals used to decrease seizure activity. We, therefore, suggest that further studies should consider SAS a promising agent to aid in the treatment of seizures associated with gliomas.
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Affiliation(s)
- Susan L Campbell
- Department of Neurobiology, Center for Glial Biology in Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA
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de Groot M, Reijneveld JC, Aronica E, Heimans JJ. Epilepsy in patients with a brain tumour: focal epilepsy requires focused treatment. Brain 2011; 135:1002-16. [PMID: 22171351 DOI: 10.1093/brain/awr310] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Brain tumours frequently cause epileptic seizures. Medical antiepileptic treatment is often met with limited success. Pharmacoresistance, drug interactions and adverse events are common problems during treatment with antiepileptic drugs. The unpredictability of epileptic seizures and the treatment-related problems deeply affect the quality of life of patients with a brain tumour. In this review, we focus on both clinical and basic aspects of possible mechanisms in epileptogenesis in patients with a brain tumour. We provide an overview of the factors that are involved in epileptogenesis, starting focally at the tumour and the peritumoral tissue and eventually extending to alterations in functional connectivity throughout the brain. We correlate this knowledge to the known mechanisms of antiepileptic drugs. We conclude that the underlying mechanisms of epileptogenesis in patients with a brain tumour are poorly understood. The currently available antiepileptic drugs have little to no influence on the known epileptogenic mechanisms that could contribute to the poor efficacy. Better understanding of focal changes that are involved in epileptogenesis may provide new tools for optimal treatment of both the seizures and the underlying tumour. In our opinion, therapy for every patient with a brain tumour suffering from epilepsy should first and foremost aim at eliminating the tumour as well as the epileptic focus through resection combined with postoperative treatment, and only if this strategy does not result in adequate seizure control should medical antiepileptic treatment be intensified. If this strategy, however, results in sustained seizure freedom, tapering of antiepileptic drugs should be considered in the long term.
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Affiliation(s)
- Marjolein de Groot
- Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
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Vercueil L. Brain tumor epilepsy: A reappraisal and six remaining issues to be debated. Rev Neurol (Paris) 2011; 167:751-61. [PMID: 21890158 DOI: 10.1016/j.neurol.2011.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 08/08/2011] [Indexed: 12/28/2022]
Affiliation(s)
- L Vercueil
- INSERM U836, EFSN, Psychiatry and Neurology Pole, Grenoble Institut of Neurosciences, CHU Grenoble, Grenoble cedex 9, France.
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Glutamate release by primary brain tumors induces epileptic activity. Nat Med 2011; 17:1269-74. [PMID: 21909104 PMCID: PMC3192231 DOI: 10.1038/nm.2453] [Citation(s) in RCA: 345] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 07/27/2011] [Indexed: 11/08/2022]
Abstract
Epileptic seizures are a common and poorly understood comorbidity for individuals with primary brain tumors. To investigate peritumoral seizure etiology, we implanted human-derived glioma cells into severe combined immunodeficient mice. Within 14-18 d, glioma-bearing mice developed spontaneous and recurring abnormal electroencephalogram events consistent with progressive epileptic activity. Acute brain slices from these mice showed marked glutamate release from the tumor mediated by the system x(c)(-) cystine-glutamate transporter (encoded by Slc7a11). Biophysical and optical recordings showed glutamatergic epileptiform hyperexcitability that spread into adjacent brain tissue. We inhibited glutamate release from the tumor and the ensuing hyperexcitability by sulfasalazine (SAS), a US Food and Drug Administration-approved drug that blocks system x(c)(-). We found that acute administration of SAS at concentrations equivalent to those used to treat Crohn's disease in humans reduced epileptic event frequency in tumor-bearing mice compared with untreated controls. SAS should be considered as an adjuvant treatment to ameliorate peritumoral seizures associated with glioma in humans.
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