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Fovargue D, Fiorito M, Capilnasiu A, Nordsletten D, Lee J, Sinkus R. Towards noninvasive estimation of tumour pressure by utilising MR elastography and nonlinear biomechanical models: a simulation and phantom study. Sci Rep 2020; 10:5588. [PMID: 32221324 PMCID: PMC7101441 DOI: 10.1038/s41598-020-62367-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/11/2020] [Indexed: 01/22/2023] Open
Abstract
The solid and fluid pressures of tumours are often elevated relative to surrounding tissue. This increased pressure is known to correlate with decreased treatment efficacy and potentially with tumour aggressiveness and therefore, accurate noninvasive estimates of tumour pressure would be of great value. We present a proof-of-concept method to infer the total tumour pressure, that is the sum of the fluid and solid parts, by examining stiffness in the peritumoural tissue with MR elastography and utilising nonlinear biomechanical models. The pressure from the tumour deforms the surrounding tissue leading to changes in stiffness. Understanding and accounting for these biases in stiffness has the potential to enable estimation of total tumour pressure. Simulations are used to validate the method with varying pressure levels, tumour shape, tumour size, and noise levels. Results show excellent matching in low noise cases and still correlate well with higher noise. Percent error remains near or below 10% for higher pressures in all noise level cases. Reconstructed pressures were also calculated from experiments with a catheter balloon embedded in a plastisol phantom at multiple inflation levels. Here the reconstructed pressures generally match the increases in pressure measured during the experiments. Percent errors between average reconstructed and measured pressures at four inflation states are 17.9%, 52%, 23.2%, and 0.9%. Future work will apply this method to in vivo data, potentially providing an important biomarker for cancer diagnosis and treatment.
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Affiliation(s)
- Daniel Fovargue
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
| | - Marco Fiorito
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Adela Capilnasiu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - David Nordsletten
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Biomedical Engineering and Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jack Lee
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Ralph Sinkus
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- INSERM UMRS1148 - Laboratory for Vascular Translational Science, University Paris, Paris, France
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Böckelmann LC, Schumacher U. Targeting tumor interstitial fluid pressure: will it yield novel successful therapies for solid tumors? Expert Opin Ther Targets 2019; 23:1005-1014. [DOI: 10.1080/14728222.2019.1702974] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Lukas Clemens Böckelmann
- Institute of Anatomy and Experimental Morphology, Center for Experimental Medicine, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Udo Schumacher
- Institute of Anatomy and Experimental Morphology, Center for Experimental Medicine, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Baronzio G, Parmar G, Baronzio M. Overview of Methods for Overcoming Hindrance to Drug Delivery to Tumors, with Special Attention to Tumor Interstitial Fluid. Front Oncol 2015; 5:165. [PMID: 26258072 PMCID: PMC4512202 DOI: 10.3389/fonc.2015.00165] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/06/2015] [Indexed: 12/24/2022] Open
Abstract
Every drug used to treat cancer (chemotherapeutics, immunological, monoclonal antibodies, nanoparticles, radionuclides) must reach the targeted cells through the tumor environment at adequate concentrations, in order to exert their cell-killing effects. For any of these agents to reach the goal cells, they must overcome a number of impediments created by the tumor microenvironment (TME), beginning with tumor interstitial fluid pressure (TIFP), and a multifactorial increase in composition of the extracellular matrix (ECM). A primary modifier of TME is hypoxia, which increases the production of growth factors, such as vascular endothelial growth factor and platelet-derived growth factor. These growth factors released by both tumor cells and bone marrow recruited myeloid cells form abnormal vasculature characterized by vessels that are tortuous and more permeable. Increased leakiness combined with increased inflammatory byproducts accumulates fluid within the tumor mass (tumor interstitial fluid), ultimately creating an increased pressure (TIFP). Fibroblasts are also up-regulated by the TME, and deposit fibers that further augment the density of the ECM, thus, further worsening the TIFP. Increased TIFP with the ECM are the major obstacles to adequate drug delivery. By decreasing TIFP and ECM density, we can expect an associated rise in drug concentration within the tumor itself. In this overview, we will describe all the methods (drugs, nutraceuticals, and physical methods of treatment) able to lower TIFP and to modify ECM used for increasing drug concentration within the tumor tissue.
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Affiliation(s)
| | - Gurdev Parmar
- Integrated Health Clinic , Fort Langley, BC , Canada
| | - Miriam Baronzio
- Integrative Oncology Section, Medical Center Kines , Milan , Italy
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Zhadobov M, Alekseev SI, Le Dréan Y, Sauleau R, Fesenko EE. Millimeter waves as a source of selective heating of skin. Bioelectromagnetics 2015; 36:464-75. [DOI: 10.1002/bem.21929] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 06/09/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Maxim Zhadobov
- Institute of Electronics and Telecommunications of Rennes (IETR); UMR CNRS 6164; University of Rennes 1; Rennes France
| | - Stanislav I. Alekseev
- Institute of Cell Biophysics of Russian Academy of Sciences; Pushchino Moscow Region Russia
| | - Yves Le Dréan
- Institute for Research on Environmental and Occupational Health (IRSET); University of Rennes 1; Rennes France
| | - Ronan Sauleau
- Institute of Electronics and Telecommunications of Rennes (IETR); UMR CNRS 6164; University of Rennes 1; Rennes France
| | - Evgeny E. Fesenko
- Institute of Cell Biophysics of Russian Academy of Sciences; Pushchino Moscow Region Russia
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Poulin P, Chen YH, Ding X, Gould SE, Hop CE, Messick K, Oeh J, Liederer BM. Prediction of Drug Distribution in Subcutaneous Xenografts of Human Tumor Cell Lines and Healthy Tissues in Mouse: Application of the Tissue Composition-Based Model to Antineoplastic Drugs. J Pharm Sci 2015; 104:1508-21. [DOI: 10.1002/jps.24336] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 12/05/2014] [Accepted: 12/12/2014] [Indexed: 12/20/2022]
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Liu LJ, Brown SL, Ewing JR, Schlesinger M. Phenomenological model of interstitial fluid pressure in a solid tumor. PHYSICAL REVIEW. E, STATISTICAL, NONLINEAR, AND SOFT MATTER PHYSICS 2011; 84:021919. [PMID: 21929031 PMCID: PMC3533446 DOI: 10.1103/physreve.84.021919] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 06/04/2011] [Indexed: 05/15/2023]
Abstract
Tumor interstitial fluid pressure (TIFP) has the potential to predict tumor response to nonsurgical cancer treatments, including radiation therapy. At present the only quantitative measures available are of limited use, since they are invasive and yield only point measurements. We present the mathematical framework for a quantitative, noninvasive measure of TIFP. The model describes the distribution of interstitial fluid pressure in three distinct tumor regions: vascularized tumor rim, central tumor region, and normal tissue. A relationship between the TIFP and the fluid flow velocity at the periphery of a tumor is presented. This model suggests that a measure of fluid flow rate from a tumor into normal tissue reflects TIFP. We demonstrate that the acquisition of serial images of a tumor after the injection of a contrast agent can provide a noninvasive and potentially quantitative measure of TIFP.
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Affiliation(s)
- L. J. Liu
- Department of Physics, University of Windsor, Windsor, Ontario, Canada N9B 3P4
| | - S. L. Brown
- Henry Ford Hospital, Detroit, Michigan 48202-2689, USA
| | - J. R. Ewing
- Henry Ford Hospital, Detroit, Michigan 48202-2689, USA
| | - M. Schlesinger
- Department of Physics, University of Windsor, Windsor, Ontario, Canada N9B 3P4
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Bell LK, Ainsworth NL, Lee SH, Griffiths JR. MRI & MRS assessment of the role of the tumour microenvironment in response to therapy. NMR IN BIOMEDICINE 2011; 24:612-35. [PMID: 21567513 DOI: 10.1002/nbm.1720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 02/28/2011] [Accepted: 03/07/2011] [Indexed: 05/30/2023]
Abstract
MRI and MRS techniques are being applied to the characterisation of various aspects of the tumour microenvironment and to the assessment of tumour response to therapy. For example, kinetic parameters describing tumour blood vessel flow and permeability can be derived from dynamic contrast-enhanced MRI data and have been correlated with a positive tumour response to antivascular therapies. The ongoing development and validation of noninvasive, high-resolution anatomical/molecular MR techniques will equip us with the means to detect specific tumour biomarkers early on, and then to monitor the efficacy of cancer treatments efficiently and reliably, all within a clinically relevant time frame. Reliable tumour microenvironment imaging biomarkers will provide obvious advantages by enabling tumour-specific treatment tailoring and potentially improving patient outcome. However, for routine clinical application across many disease types, such imaging biomarkers must be quantitative, robust, reproducible, sufficiently sensitive and cost-effective. These characteristics are all difficult to achieve in practice, but image biomarker development and validation have been greatly facilitated by an increasing number of pertinent preclinical in vivo cancer models. Emphasis must now be placed on discovering whether the preclinical results translate into an improvement in patient care and, therefore, overall survival.
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Affiliation(s)
- Leanne K Bell
- Cancer Research UK, Cambridge Research Institute, Li Ka Shing Centre, Cambridge, UK.
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McSheehy PMJ, Weidensteiner C, Cannet C, Ferretti S, Laurent D, Ruetz S, Stumm M, Allegrini PR. Quantified tumor t1 is a generic early-response imaging biomarker for chemotherapy reflecting cell viability. Clin Cancer Res 2009; 16:212-25. [PMID: 20008843 DOI: 10.1158/1078-0432.ccr-09-0686] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Identification of a generic response biomarker by comparison of chemotherapeutics with different action mechanisms on several noninvasive biomarkers in experimental tumor models. EXPERIMENTAL DESIGN The spin-lattice relaxation time of water protons (T(1)) was quantified using an inversion recovery-TrueFISP magnetic resonance imaging method in eight different experimental tumor models before and after treatment at several different time points with five different chemotherapeutics. Effects on T(1) were compared with other minimally invasive biomarkers including vascular parameters, apparent diffusion coefficient, and interstitial fluid pressure, and were correlated with efficacy at the endpoint and histologic parameters. RESULTS In all cases, successful chemotherapy significantly lowered tumor T(1) compared with vehicle and the fractional change in T(1) (DeltaT(1)) correlated with the eventual change in tumor size (range: r(2) = 0.21, P < 0.05 to r(2) = 0.73, P < 0.0001), except for models specifically resistant to that drug. In RIF-1 tumors, interstitial fluid pressure was decreased, but apparent diffusion coefficient and permeability increased in response to the microtubule stabilizer patupilone and 5-fluorouracil. Although DeltaT(1) was small (maximum of -20%), the variability was very low (5%) compared with other magnetic resonance imaging methods (24-48%). Analyses ex vivo showed unchanged necrosis, increased apoptosis, and decreased %Ki67 and total choline, but only Ki67 and choline correlated with DeltaT(1). Correlation of Ki67 and DeltaT(1) were observed in other models using patupilone, paclitaxel, a VEGF-R inhibitor, and the mammalian target of rapamycin inhibitor everolimus. CONCLUSIONS These results suggest that a decrease in tumor T(1) reflects hypocellularity and is a generic marker of response. The speed and robustness of the method should facilitate its use in clinical trials.
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Affiliation(s)
- Paul M J McSheehy
- Oncology Research and Global Imaging Group, Novartis Institutes for Biomedical Research, Basel, Switzerland.
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Gade TPF, Buchanan IM, Motley MW, Mazaheri Y, Spees WM, Koutcher JA. Imaging intratumoral convection: pressure-dependent enhancement in chemotherapeutic delivery to solid tumors. Clin Cancer Res 2009; 15:247-55. [PMID: 19118052 DOI: 10.1158/1078-0432.ccr-08-0611] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Low-molecular weight (LMW) chemotherapeutics are believed to reach tumors through diffusion across capillary beds as well as membrane transporters. Unexpectedly, the delivery of these agents seems to be augmented by reductions in tumor interstitial fluid pressure, an effect typically associated with high-molecular weight molecules that reach tumors principally through convection. We investigated the hypothesis that improved intratumoral convection can alter tumor metabolism and enhance the delivery of a LMW chemotherapeutic agent to solid tumors. EXPERIMENTAL DESIGN For this purpose, we applied 31P/19F magnetic resonance spectroscopy (MRS) and magnetic resonance spectroscopic imaging (MRSI) to examine the influence of type I collagenase on tumor bioenergetics and the delivery of 5-fluorouracil (5FU) to HT29 human colorectal tumors grown s.c. in mice. RESULTS Collagenase effected a 34% reduction in tumor interstitial fluid pressure with an attendant disintegration of intratumoral collagen. Neither mice-administered collagenase nor controls receiving PBS showed changes in (31)phosphorus MRS-measured tumor bioenergetics; however, a time-dependent increase in the content of extracellular inorganic phosphate (Pi(e)) was observed in tumors of collagenase-treated animals. (31)Phosphorus MRSI showed that this increase underscored a more homogeneous distribution of Pi(e) in tumors of experimental mice. (19)Fluorine MRS showed that these changes were associated with a 50% increase in 5FU uptake in tumors of experimental versus control animals; however, this increase resulted in an increase in 5FU catabolites rather than fluoronucleotide intermediates that are required for subsequent cytotoxicity. CONCLUSIONS These data indicate that the modulation of convective flow within tumors can improve the delivery of (LMW) chemotherapeutics and show the potential role for noninvasive imaging of this process in vivo.
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Affiliation(s)
- Terence P F Gade
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Gulliksrud K, Brurberg KG, Rofstad EK. Dynamic contrast-enhanced magnetic resonance imaging of tumor interstitial fluid pressure. Radiother Oncol 2009; 91:107-13. [DOI: 10.1016/j.radonc.2008.08.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 06/23/2008] [Accepted: 08/18/2008] [Indexed: 10/21/2022]
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Hassid Y, Furman-Haran E, Margalit R, Eilam R, Degani H. Noninvasive magnetic resonance imaging of transport and interstitial fluid pressure in ectopic human lung tumors. Cancer Res 2006; 66:4159-66. [PMID: 16618737 DOI: 10.1158/0008-5472.can-05-3289] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tumor response to blood borne drugs is critically dependent on the efficiency of vascular delivery and transcapillary transfer. However, increased tumor interstitial fluid pressure (IFP) forms a barrier to transcapillary transfer, leading to resistance to drug delivery. We present here a new, noninvasive method which estimates IFP and its spatial distribution in vivo using contrast-enhanced magnetic resonance imaging (MRI). This method was tested in ectopic human non-small-cell lung cancer which exhibited a high IFP of approximately 28 mm Hg and, for comparison, in orthotopic MCF7 human breast tumors which exhibited a lower IFP of approximately 14 mm Hg, both implanted in nude mice. The MRI protocol consisted of slow infusion of the contrast agent [gadolinium-diethylenetriaminepentaacetic acid (GdDTPA)] into the blood for approximately 2 hours, sequential acquisition of images before and during the infusion, and measurements of T1 relaxation rates before infusion and after blood and tumor GdDTPA concentration reached a steady state. Image analysis yielded parametric images of steady-state tissue GdDTPA concentration with high values of this concentration outside the tumor boundaries, approximately 1 mmol/L, declining in the tumor periphery to approximately 0.5 mmol/L, and then steeply decreasing to low or null values. The distribution of steady-state tissue GdDTPA concentration reflected the distribution of IFP, showing an increase from the rim inward, with a high IFP plateau inside the tumor. The changes outside the borders of the tumors with high IFP were indicative of convective transport through the interstitium. This work presents a noninvasive method for assessing the spatial distribution of tumor IFP and mapping barriers to drug delivery and transport.
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Affiliation(s)
- Yaron Hassid
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot, Israel
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Dzik-Jurasz ASK, Leach MO, Rowland IJ. Investigation of microenvironmental factors influencing the longitudinal relaxation times of drugs and other compounds. Magn Reson Imaging 2004; 22:973-82. [PMID: 15288138 DOI: 10.1016/j.mri.2004.01.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2003] [Accepted: 01/30/2004] [Indexed: 11/20/2022]
Abstract
The aim of this study was to investigate the microenvironmental factors likely to influence the longitudinal relaxation time of MR visible drugs or compounds in vivo at 1.5 T. The relative influence that viscosity, albumin and paramagnetic contrast agent concentrations have on the observed longitudinal relaxation times of three 19F MR detectable drugs and compounds have been investigated. Our data show that for 5-fluorouracil, flucloxacillin and tetrafluorosuccinic acid-containing phantoms, the presence of albumin at normal physiological concentrations will have relaxation effects of the same order of magnitude as that of a commonly clinically administered contrast agent, gadolinium diethylenetriamine pentaacetic acid. The contribution of viscosity is shown, in the examples studied here, to be of minor importance, contributing less than 6.5% to the observed relaxation effects. It is also demonstrated that in the presence of competitive binding of other ligands for common binding sites on albumin, the 19F longitudinal relaxation time of 5-fluorouracil can increase by up to 340% from its value in the absence of the competing ligand. The relevance of the findings to in vivo studies is discussed.
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Affiliation(s)
- A S K Dzik-Jurasz
- Cancer Research UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research, Sutton, Surrey, SM2 5PT.
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