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Roy M, Alix C, Burlaud-Gaillard J, Fouan D, Raoul W, Bouakaz A, Blanchard E, Lecomte T, Viaud-Massuard MC, Sasaki N, Serrière S, Escoffre JM. Delivery of Anticancer Drugs Using Microbubble-Assisted Ultrasound in a 3D Spheroid Model. Mol Pharm 2024; 21:831-844. [PMID: 38174896 DOI: 10.1021/acs.molpharmaceut.3c00921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Tumor spheroids are promising three-dimensional (3D) in vitro tumor models for the evaluation of drug delivery methods. The design of noninvasive and targeted drug methods is required to improve the intratumoral bioavailability of chemotherapeutic drugs and reduce their adverse off-target effects. Among such methods, microbubble-assisted ultrasound (MB-assisted US) is an innovative modality for noninvasive targeted drug delivery. The aim of the present study is to evaluate the efficacy of this US modality for the delivery of bleomycin, doxorubicin, and irinotecan in colorectal cancer (CRC) spheroids. MB-assisted US permeabilized the CRC spheroids to propidium iodide, which was used as a drug model without affecting their growth and viability. Histological analysis and electron microscopy revealed that MB-assisted US affected only the peripheral layer of the CRC spheroids. The acoustically mediated bleomycin delivery induced a significant decrease in CRC spheroid growth in comparison to spheroids treated with bleomycin alone. However, this US modality did not improve the therapeutic efficacy of doxorubicin and irinotecan on CRC spheroids. In conclusion, this study demonstrates that tumor spheroids are a relevant approach to evaluate the efficacy of MB-assisted US for the delivery of chemotherapeutics.
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Affiliation(s)
- Marie Roy
- UMR 1253, iBrain, Université de Tours, Inserm, 37032 Tours, France
| | - Corentin Alix
- UMR 1253, iBrain, Université de Tours, Inserm, 37032 Tours, France
| | - Julien Burlaud-Gaillard
- Inserm U1259, Université de Tours et CHRU de Tours & Plateforme IBiSA des Microscopies, PPF ASB, CHRU de Tours, 37032 Tours, France
| | - Damien Fouan
- UMR 1253, iBrain, Université de Tours, Inserm, 37032 Tours, France
| | - William Raoul
- Inserm UMR 1069, Nutrition Croissance et Cancer (N2C), Université de Tours, 37032 Tours, France
| | - Ayache Bouakaz
- UMR 1253, iBrain, Université de Tours, Inserm, 37032 Tours, France
| | - Emmanuelle Blanchard
- Inserm U1259, Université de Tours et CHRU de Tours & Plateforme IBiSA des Microscopies, PPF ASB, CHRU de Tours, 37032 Tours, France
| | - Thierry Lecomte
- Inserm UMR 1069, Nutrition Croissance et Cancer (N2C), Université de Tours, 37032 Tours, France
- Department of Hepato-Gastroenterology & Digestive Oncology, CHRU de Tours, 37000 Tours, France
| | | | - Noboru Sasaki
- Laboratory of Veterinary Internal Medicine, Department of Clinical Sciences, Faculty of Veterinary Medicine, Hokkaido University, 060-0818 Sapporo, Japan
| | - Sophie Serrière
- UMR 1253, iBrain, Université de Tours, Inserm, 37032 Tours, France
- Département d'Imagerie Préclinique, Plateforme Scientifique et Technique Analyse des Systèmes Biologiques, Université de Tours, 37032 Tours, France
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2
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Veronico V, Morelli S, Piscioneri A, Gristina R, Casiello M, Favia P, Armenise V, Fracassi F, De Bartolo L, Sardella E. Anticancer Effects of Plasma-Treated Water Solutions from Clinically Approved Infusion Liquids Supplemented with Organic Molecules. ACS OMEGA 2023; 8:33723-33736. [PMID: 37744835 PMCID: PMC10515361 DOI: 10.1021/acsomega.3c04061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/25/2023] [Indexed: 09/26/2023]
Abstract
Water solutions treated by cold atmospheric plasmas (CAPs) currently stand out in the field of cancer treatment as sources of exogenous blends of reactive oxygen and nitrogen species (RONS). It is well known that the balance of RONS inside both eukaryotic and prokaryotic cells is directly involved in physiological as well as pathological pathways. Also, organic molecules including phenols could exert promising anticancer effects, mostly attributed to their pro-oxidant ability in vitro and in vivo to generate RONS like O2-, H2O2, and a mixture of potentially cytotoxic compounds. By our vision of combining the efficacy of plasma-produced RONS and the use of organic molecules, we could synergistically attack cancer cells; yet, so far, this combination, to the best of our knowledge, has been completely unexplored. In this study, l-tyrosine, an amino acid with a phenolic side chain, is added to a physiological solution, often used in clinical practice (SIII) to be exposed to plasma. The efficacy of the gas plasma-oxidized SIII solution, containing tyrosine, was evaluated on four cancer cell lines selected from among tumors with poor prognosis (SHSY-5Y, MCF-7, HT-29, and SW-480). The aim was to induce tumor toxicity and trigger apoptosis pathways. The results clearly indicate that the plasma-treated water solution (PTWS) reduced cell viability and oxygen uptake due to an increase in intracellular ROS levels and activation of apoptosis pathways in all investigated cancer cells, which may be related to the activation of the mitochondrial-mediated and p-JNK/caspase-3 signaling pathways. This research offers improved knowledge about the physiological mechanisms underlying cancer treatment and a valid method to set up a prompt, adequate, and effective cancer treatment in the clinic.
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Affiliation(s)
- Valeria Veronico
- Department
of Chemistry, University of Bari Aldo Moro, via Orabona, 4, 70126 Bari, Italy
| | - Sabrina Morelli
- CNR-Institute
on Membrane Technology (CNR-ITM), Via Pietro Bucci Cubo, 17/C, 87036 Rende, CS, Italy
| | - Antonella Piscioneri
- CNR-Institute
on Membrane Technology (CNR-ITM), Via Pietro Bucci Cubo, 17/C, 87036 Rende, CS, Italy
| | - Roberto Gristina
- CNR-Institute
of Nanotechnology (CNR-NANOTEC), Via Amendola, 122/D, 70124 Bari, Italy
| | - Michele Casiello
- Department
of Chemistry, University of Bari Aldo Moro, via Orabona, 4, 70126 Bari, Italy
| | - Pietro Favia
- Department
of Chemistry, University of Bari Aldo Moro, via Orabona, 4, 70126 Bari, Italy
- CNR-Institute
of Nanotechnology (CNR-NANOTEC), Via Amendola, 122/D, 70124 Bari, Italy
| | - Vincenza Armenise
- Department
of Chemistry, University of Bari Aldo Moro, via Orabona, 4, 70126 Bari, Italy
| | - Francesco Fracassi
- Department
of Chemistry, University of Bari Aldo Moro, via Orabona, 4, 70126 Bari, Italy
- CNR-Institute
of Nanotechnology (CNR-NANOTEC), Via Amendola, 122/D, 70124 Bari, Italy
| | - Loredana De Bartolo
- CNR-Institute
on Membrane Technology (CNR-ITM), Via Pietro Bucci Cubo, 17/C, 87036 Rende, CS, Italy
| | - Eloisa Sardella
- CNR-Institute
of Nanotechnology (CNR-NANOTEC), Via Amendola, 122/D, 70124 Bari, Italy
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3
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Bekeschus S. Medical gas plasma technology: Roadmap on cancer treatment and immunotherapy. Redox Biol 2023; 65:102798. [PMID: 37556976 PMCID: PMC10433236 DOI: 10.1016/j.redox.2023.102798] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 08/11/2023] Open
Abstract
Despite continuous therapeutic progress, cancer remains an often fatal disease. In the early 2010s, first evidence in rodent models suggested promising antitumor action of gas plasma technology. Medical gas plasma is a partially ionized gas depositing multiple physico-chemical effectors onto tissues, especially reactive oxygen and nitrogen species (ROS/RNS). Today, an evergrowing body of experimental evidence suggests multifaceted roles of medical gas plasma-derived therapeutic ROS/RNS in targeting cancer alone or in combination with oncological treatment schemes such as ionizing radiation, chemotherapy, and immunotherapy. Intriguingly, gas plasma technology was recently unraveled to have an immunological dimension by inducing immunogenic cell death, which could ultimately promote existing cancer immunotherapies via in situ or autologous tumor vaccine schemes. Together with first clinical evidence reporting beneficial effects in cancer patients following gas plasma therapy, it is time to summarize the main concepts along with the chances and limitations of medical gas plasma onco-therapy from a biological, immunological, clinical, and technological point of view.
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Affiliation(s)
- Sander Bekeschus
- ZIK plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Felix-Hausdorff-Str. 2, 17489, Greifswald, Germany; Clinic and Policlinic for Dermatology and Venerology, Rostock University Medical Center, Strempelstr. 13, 18057, Rostock, Germany.
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4
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Dai X, Wu J, Lu L, Chen Y. Current Status and Future Trends of Cold Atmospheric Plasma as an Oncotherapy. Biomol Ther (Seoul) 2023; 31:496-514. [PMID: 37641880 PMCID: PMC10468422 DOI: 10.4062/biomolther.2023.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 08/31/2023] Open
Abstract
Cold atmospheric plasma (CAP), a redox modulation tool, is capable of inhibiting a wide spectrum of cancers and has thus been proposed as an emerging onco-therapy. However, with incremental successes consecutively reported on the anticancer efficacy of CAP, no consensus has been made on the types of tumours sensitive to CAP due to the different intrinsic characteristics of the cells and the heterogeneous design of CAP devices and their parameter configurations. These factors have substantially hindered the clinical use of CAP as an oncotherapy. It is thus imperative to clarify the tumour types responsive to CAP, the experimental models available for CAP-associated investigations, CAP administration strategies and the mechanisms by which CAP exerts its anticancer effects with the aim of identifying important yet less studied areas to accelerate the process of translating CAP into clinical use and fostering the field of plasma oncology.
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Affiliation(s)
- Xiaofeng Dai
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China
| | - Jiale Wu
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Lianghui Lu
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Yuyu Chen
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
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5
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Canady J, Murthy SRK, Zhuang T, Gitelis S, Nissan A, Ly L, Jones OZ, Cheng X, Adileh M, Blank AT, Colman MW, Millikan K, O'Donoghue C, Stenson KM, Ohara K, Schtrechman G, Keidar M, Basadonna G. The First Cold Atmospheric Plasma Phase I Clinical Trial for the Treatment of Advanced Solid Tumors: A Novel Treatment Arm for Cancer. Cancers (Basel) 2023; 15:3688. [PMID: 37509349 PMCID: PMC10378184 DOI: 10.3390/cancers15143688] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Local regional recurrence (LRR) remains the primary cause of treatment failure in solid tumors despite advancements in cancer therapies. Canady Helios Cold Plasma (CHCP) is a novel Cold Atmospheric Plasma device that generates an Electromagnetic Field and Reactive Oxygen and Nitrogen Species to induce cancer cell death. In the first FDA-approved Phase I trial (March 2020-April 2021), 20 patients with stage IV or recurrent solid tumors underwent surgical resection combined with intra-operative CHCP treatment. Safety was the primary endpoint; secondary endpoints were non-LRR, survival, cancer cell death, and the preservation of surrounding healthy tissue. CHCP did not impact intraoperative physiological data (p > 0.05) or cause any related adverse events. Overall response rates at 26 months for R0 and R0 with microscopic positive margin (R0-MPM) patients were 69% (95% CI, 19-40%) and 100% (95% CI, 100-100.0%), respectively. Survival rates for R0 (n = 7), R0-MPM (n = 5), R1 (n = 6), and R2 (n = 2) patients at 28 months were 86%, 40%, 67%, and 0%, respectively. The cumulative overall survival rate was 24% at 31 months (n = 20, 95% CI, 5.3-100.0). CHCP treatment combined with surgery is safe, selective towards cancer, and demonstrates exceptional LRR control in R0 and R0-MPM patients. (Clinical Trials identifier: NCT04267575).
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Affiliation(s)
- Jerome Canady
- Department of Translational Research, Jerome Canady Research Institute for Advanced Biological and Technological Sciences, Takoma Park, MD 20912, USA
- Department of Mechanical and Aerospace Engineering, The George Washington University, Washington, DC 20052, USA
- Department of Surgery, University of Maryland, Capital Regional Medical Center, Largo, MD 21044, USA
| | - Saravana R K Murthy
- Department of Translational Research, Jerome Canady Research Institute for Advanced Biological and Technological Sciences, Takoma Park, MD 20912, USA
| | - Taisen Zhuang
- Department of Translational Research, Jerome Canady Research Institute for Advanced Biological and Technological Sciences, Takoma Park, MD 20912, USA
| | - Steven Gitelis
- Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Aviram Nissan
- Department of Surgical Oncology/General Surgery, Chaim Sheba Medical Center, Ramat Gan 52621, Israel
| | - Lawan Ly
- Department of Translational Research, Jerome Canady Research Institute for Advanced Biological and Technological Sciences, Takoma Park, MD 20912, USA
| | - Olivia Z Jones
- Department of Translational Research, Jerome Canady Research Institute for Advanced Biological and Technological Sciences, Takoma Park, MD 20912, USA
| | - Xiaoqian Cheng
- Department of Translational Research, Jerome Canady Research Institute for Advanced Biological and Technological Sciences, Takoma Park, MD 20912, USA
| | - Mohammad Adileh
- Department of Surgical Oncology/General Surgery, Chaim Sheba Medical Center, Ramat Gan 52621, Israel
| | - Alan T Blank
- Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Matthew W Colman
- Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Keith Millikan
- Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Cristina O'Donoghue
- Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Kerstin M Stenson
- Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Karen Ohara
- Department of Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Gal Schtrechman
- Department of Surgical Oncology/General Surgery, Chaim Sheba Medical Center, Ramat Gan 52621, Israel
| | - Michael Keidar
- Department of Mechanical and Aerospace Engineering, The George Washington University, Washington, DC 20052, USA
| | - Giacomo Basadonna
- Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA 01854, USA
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6
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de Caro A, Bellard E, Kolosnjaj-Tabi J, Golzio M, Rols MP. Gene Electrotransfer Efficiency in 2D and 3D Cancer Cell Models Using Different Electroporation Protocols: A Comparative Study. Pharmaceutics 2023; 15:pharmaceutics15031004. [PMID: 36986866 PMCID: PMC10053976 DOI: 10.3390/pharmaceutics15031004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
Electroporation, a method relying on a pulsed electric field to induce transient cell membrane permeabilization, can be used as a non-viral method to transfer genes in vitro and in vivo. Such transfer holds great promise for cancer treatment, as it can induce or replace missing or non-functioning genes. Yet, while efficient in vitro, gene-electrotherapy remains challenging in tumors. To assess the differences of gene electrotransfer in respect to applied pulses in multi-dimensional (2D, 3D) cellular organizations, we herein compared pulsed electric field protocols applicable to electrochemotherapy and gene electrotherapy and different "High Voltage-Low Voltage" pulses. Our results show that all protocols can result in efficient permeabilization of 2D- and 3D-grown cells. However, their efficiency for gene delivery varies. The gene-electrotherapy protocol is the most efficient in cell suspensions, with a transfection rate of about 50%. Conversely, despite homogenous permeabilization of the entire 3D structure, none of the tested protocols allowed gene delivery beyond the rims of multicellular spheroids. Taken together, our findings highlight the importance of electric field intensity and the occurrence of cell permeabilization, and underline the significance of pulses' duration, impacting plasmids' electrophoretic drag. The latter is sterically hindered in 3D structures and prevents the delivery of genes into spheroids' core.
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Affiliation(s)
- Alexia de Caro
- Institut de Pharmacologie et de Biologie Structurale du CNRS UMR 5089, 205, Route de Narbonne, 31077 Toulouse CEDEX, France
| | - Elisabeth Bellard
- Institut de Pharmacologie et de Biologie Structurale du CNRS UMR 5089, 205, Route de Narbonne, 31077 Toulouse CEDEX, France
| | - Jelena Kolosnjaj-Tabi
- Institut de Pharmacologie et de Biologie Structurale du CNRS UMR 5089, 205, Route de Narbonne, 31077 Toulouse CEDEX, France
| | - Muriel Golzio
- Institut de Pharmacologie et de Biologie Structurale du CNRS UMR 5089, 205, Route de Narbonne, 31077 Toulouse CEDEX, France
| | - Marie-Pierre Rols
- Institut de Pharmacologie et de Biologie Structurale du CNRS UMR 5089, 205, Route de Narbonne, 31077 Toulouse CEDEX, France
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7
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Yoshikawa N, Nakamura K, Kajiyama H. Current understanding of Plasma-activated solutions for potential cancer therapy. Free Radic Res 2023:1-12. [PMID: 36944223 DOI: 10.1080/10715762.2023.2193308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Cancer therapy consists of multidisciplinary treatment combining surgery, chemotherapy, radiotherapy, and immunotherapy. Despite the elucidation of cancer mechanisms by comprehensive genomic and epigenomic analyses and the development of molecular therapy, drug resistance and severe side effects have presented challenges to the long-awaited development of new therapies. With the rapid technological advances in the last decade, there are now reports concerning potential applications of non-equilibrium atmospheric pressure plasma (NEAPP) in cancer therapy. Two approaches have been tried: direct irradiation with NEAPP (direct plasma) and the administration of a liquid (e.g., culture medium, saline, Ringer's lactate) activated by NEAPP (plasma-activated solutions: PAS). Direct plasma is a unique treatment method in which various active species, charged ions, and photons are delivered to the affected area, but the direct plasma approach has physical limitations related to the device used, such as a limited depth of reach and limited irradiation area. PAS is a liquid that contains reactive oxygen species generated by PAS, and it has been confirmed to have antitumor activity that functions in the same manner as direct plasma. This review introduces recent studies of PAS and informs researchers about the potential of PAS for cancer therapy.Key Policy HighlightsPotential applications of plasma-activated solutions (PAS) in cancer therapy are described.Plasma-activated species generated in PAS, its effect on tumor cells, contribution to non-malignant immune cells, selectivity and safety are presented.The proposed anti-tumor mechanisms of PAS to date are described.Efficacy and safety evaluations of PAS have been studied in experimental animal models, but no human studies have been conducted.
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Affiliation(s)
- Nobuhisa Yoshikawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine
| | - Kae Nakamura
- Center for Low-Temperature Plasma Sciences, Nagoya University, Nagoya, Nagoya
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine
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8
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Miebach L, Mohamed H, Wende K, Miller V, Bekeschus S. Pancreatic Cancer Cells Undergo Immunogenic Cell Death upon Exposure to Gas Plasma-Oxidized Ringers Lactate. Cancers (Basel) 2023; 15:cancers15010319. [PMID: 36612315 PMCID: PMC9818580 DOI: 10.3390/cancers15010319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 01/05/2023] Open
Abstract
Survival rates among patients with pancreatic cancer, the most lethal gastrointestinal cancer, have not improved compared to other malignancies. Early tumor dissemination and a supportive, cancer-promoting tumor microenvironment (TME) limit therapeutic options and consequently impede tumor remission, outlining an acute need for effective treatments. Gas plasma-oxidized liquid treatment showed promising preclinical results in other gastrointestinal and gynecological tumors by targeting the tumor redox state. Here, carrier solutions are enriched with reactive oxygen (ROS) and nitrogen (RNS) species that can cause oxidative distress in tumor cells, leading to a broad range of anti-tumor effects. Unfortunately, clinical relevance is often limited, as many studies have forgone the use of medical-grade solutions. This study investigated the efficacy of gas plasma-oxidized Ringer's lactate (oxRilac), a physiological solution often used in clinical practice, on two pancreatic cancer cell lines to induce tumor toxicity and provoke immunogenicity. Tumor toxicity of the oxRilac solutions was further confirmed in three-dimensional tumor spheroids monitored over 72 h and in ovo using stereomicroscope imaging of excised GFP-expressing tumors. We demonstrated that cell death signaling was induced in a dose-dependent fashion in both cell lines and was paralleled by the increased surface expression of key markers of immunogenic cell death (ICD). Nuclear magnetic resonance (NMR) spectroscopy analysis suggested putative reaction pathways that may cause the non-ROS related effects. In summary, our study suggests gas plasma-deposited ROS in clinically relevant liquids as an additive option for treating pancreatic cancers via immune-stimulating and cytotoxic effects.
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Affiliation(s)
- Lea Miebach
- Department of General, Thoraxic, Vascular, and Visceral Surgery, Greifswald University Medical Center, 17489 Greifswald, Germany
- ZIK plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Felix-Hausdorff-Str. 2, 17489 Greifswald, Germany
| | - Hager Mohamed
- Emergex Vaccines Holding Limited, Doylestown, PA 18902, USA
- Department of Microbiology and Immunology, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA 19102, USA
| | - Kristian Wende
- ZIK plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Felix-Hausdorff-Str. 2, 17489 Greifswald, Germany
| | - Vandana Miller
- Department of Microbiology and Immunology, Institute for Molecular Medicine and Infectious Disease, Drexel University College of Medicine, Philadelphia, PA 19102, USA
| | - Sander Bekeschus
- ZIK plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Felix-Hausdorff-Str. 2, 17489 Greifswald, Germany
- Correspondence:
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9
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Yu H, Song X, Yang F, Wang J, Sun M, Liu G, Ahmad N, Zhou Y, Zhang Y, Shi G, Zhang R, Liu J, Jiang X, Fu P, Chen G, Li J, Zhuang J, Sun M. Combined effects of vitamin C and cold atmospheric plasma-conditioned media against glioblastoma via hydrogen peroxide. Free Radic Biol Med 2023; 194:1-11. [PMID: 36436726 DOI: 10.1016/j.freeradbiomed.2022.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
Glioblastoma is the most lethal intracranial malignant tumor, for which the five-year overall survival rate is approximately 5%. Here we explored the therapeutic combination of vitamin C and plasma-conditioned medium on glioblastoma cells in culture and as subcutaneous or intracranial xenografts in mice. The combination treatment reduced cell viability and proliferation while promoting apoptosis, and the effects were significantly stronger than with either treatment on its own. Similar results were obtained in the two xenograft models. Vitamin C appeared to upregulate aquaporin-3 and enhance the uptake of extracellular H2O2, while the combination treatment increased intracellular levels of reactive oxygen species including H2O2 and activated the JNK signaling pathway. The cytotoxic effects of the combination treatment were partially reversed by the specific JNK signaling inhibitor SP600125. Our results suggest that the combination of vitamin C and plasma-conditioned medium has therapeutic potential against glioblastoma, and they provide mechanistic insights that may help investigate this and other potential therapies in greater depth.
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Affiliation(s)
- Huidan Yu
- School of Life Sciences, Changchun University of Science and Technology, Changchun, 130022, China; Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China.
| | - Xueyan Song
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China.
| | - Fan Yang
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Jun Wang
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Mingjian Sun
- Measurement and Control Research Center Department of Control Science and Engineering, Harbin Institute of Technology, Harbin, 150001, China
| | - Guangxin Liu
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Nafees Ahmad
- Institute of Biomedical and Genetic Engineering, Islamabad, Pakistan
| | - Yuanshuai Zhou
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Yina Zhang
- Neurological Department, Helios-Amper Clinic, Dachau, Germany
| | - Guohua Shi
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Ruobing Zhang
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Jianping Liu
- Integrated Cardio Metabolic Centre, Karolinska Institute, Huddinge, Sweden
| | - Xiaobing Jiang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Fu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Chen
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jingmei Li
- School of Life Sciences, Changchun University of Science and Technology, Changchun, 130022, China.
| | - Jie Zhuang
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China.
| | - Minxuan Sun
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China.
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10
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Combined In Vitro Toxicity and Immunogenicity of Cold Plasma and Pulsed Electric Fields. Biomedicines 2022; 10:biomedicines10123084. [PMID: 36551840 PMCID: PMC9775231 DOI: 10.3390/biomedicines10123084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/11/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022] Open
Abstract
In modern oncology, therapies are based on combining monotherapies to overcome treatment resistance and increase therapy precision. The application of microsecond-pulsed electric fields (PEF) is approved to enhance local chemotherapeutic drug uptake within combination electrochemotherapy regimens. Reactive oxygen species (ROS) have been implicated in anticancer effects, and cold physical plasma produces vast amounts of ROS, which have recently been shown to benefit head and neck cancer patients. PEF and cold plasma technology have been linked to immunogenic cell death (ICD) induction, a regulated cell death accompanied by sterile inflammation that promotes antitumor immunity. To this end, we investigated the combined effect of both treatments regarding their intracellular ROS accumulation, toxicity, ICD-related marker expression, and optimal exposure sequence in a leukemia model cell line. The combination treatment substantially increased ROS and intracellular glutathione levels, leading to additive cytotoxic effects accompanied by a significantly increased expression of ICD markers, such as the eat-me signal calreticulin (CRT). Preconditioned treatment with cold plasma followed by PEF exposure was the most potent treatment sequence. The results indicate additive effects of cold plasma and PEF, motivating further studies in skin and breast tumor models for the future improvement of ECT in such patients.
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11
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Yepez X, Illera AE, Baykara H, Keener K. Recent Advances and Potential Applications of Atmospheric Pressure Cold Plasma Technology for Sustainable Food Processing. Foods 2022; 11:foods11131833. [PMID: 35804648 PMCID: PMC9265751 DOI: 10.3390/foods11131833] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
In a circular economy, products, waste, and resources are kept in the system as long as possible. This review aims to highlight the importance of cold plasma technology as an alternative solution to some challenges in the food chain, such as the extensive energy demand and the hazardous chemicals used. Atmospheric cold plasma can provide a rich source of reactive gas species such as radicals, excited neutrals, ions, free electrons, and UV light that can be efficiently used for sterilization and decontamination, degrading toxins, and pesticides. Atmospheric cold plasma can also improve the utilization of materials in agriculture and food processing, as well as convert waste into resources. The use of atmospheric cold plasma technology is not without challenges. The wide range of reactive gas species leads to many questions about their safety, active life, and environmental impact. Additionally, the associated regulatory approval process requires significant data demonstrating its efficacy. Cold plasma generation requires a specific reliable system, process control monitoring, scalability, and worker safety protections.
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Affiliation(s)
- Ximena Yepez
- Escuela Superior Politécnica del Litoral, ESPOL, Facultad de Ingeniería Mecánica y Ciencias de la Producción, Campus Gustavo Galindo Km 30.5 Vía Perimetral, P.O. Box 09-01-5863, Guayaquil 090902, Ecuador;
- Correspondence:
| | - Alba E. Illera
- Faculty of Science, University of Burgos, Plaza Misael Bañuelos s/n, 09001 Burgos, Spain;
| | - Haci Baykara
- Escuela Superior Politécnica del Litoral, ESPOL, Facultad de Ingeniería Mecánica y Ciencias de la Producción, Campus Gustavo Galindo Km 30.5 Vía Perimetral, P.O. Box 09-01-5863, Guayaquil 090902, Ecuador;
- Escuela Superior Politécnica del Litoral, ESPOL, Center of Nanotechnology Research and Development (CIDNA), Campus Gustavo Galindo, Km 30.5 Vía Perimetral, P.O. Box 09-01-5863, Guayaquil 090902, Ecuador
| | - Kevin Keener
- College of Engineering and Physical Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada;
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12
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Raghavan S. How inclusive are cell lines in preclinical engineered cancer models? Dis Model Mech 2022; 15:275571. [PMID: 35642685 PMCID: PMC9187871 DOI: 10.1242/dmm.049520] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Diverse factors contribute to significant and dire disparities in cancer risk and treatment outcomes. To address this, there was a call for inclusion of sex as a biological variable, which resulted in more instances of careful inclusion of sex in preclinical studies of cancer. Another variable in cancer treatment is genetic ancestry. Although this is considered explicitly in clinical research, it is considerably neglected in preclinical studies. Preclinical research can use several 3D in vitro model systems, such as spheroids/organoids, xenografts, or other bioengineered systems that combine biomaterials and cellular material. Ultimately, the cellular base for all of these in vitro model systems is derived from human cell lines or patient samples, to investigate mechanisms of cancer and screen novel therapeutics, all of which aim to maximize successful outcomes in clinical trials. This in itself offers an opportunity to potentiate effective treatments for many groups of people, when diverse variables like genetic ancestry are consciously included into study design. This Perspective highlights the need for conscious inclusion of genetic ancestry in preclinical cancer tissue engineering, especially when it pertains to determining therapeutic outcomes. Summary: Genetic determinants, like ancestry, impact cancer risk and therapeutic outcomes. Hence, this is an important variable to consider at the very initial stages of biomedical research at the bench.
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Affiliation(s)
- Shreya Raghavan
- Department of Biomedical Engineering, Texas A&M University, 3120 TAMU, 5016 Emerging Technologies Building, College Station, TX 77843, USA
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13
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Cold Atmospheric Plasma, Platelet-Rich Plasma, and Nitric Oxide Synthesis Inhibitor: Effects Investigation on an Experimental Model on Rats. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The evolution of reconstructive methods for defects of the human body cannot yet replace the use of flap surgery. Research is still preoccupied with the ideal techniques for offering the best chances of survival of the flaps. In our study, we investigated the effects of cold atmospheric plasma (CAP), N-nitro-L-arginine methyl ester (L-NAME), and platelet-rich plasma (PRP) injectable solutions on flap survival using an in vivo model. Twenty-four Wistar rats (four groups) had the McFarlane flap raised and CAP, L-NAME, and PRP substances tested through a single dose subcutaneous injection. The control group had only a saline solution injected. To the best of our knowledge, this is the first study that evaluated a CAP activated solution through injection on flaps. The flap survival rate was determined by clinical examination (photography documented), hematology, thermography, and anatomopathological tests. The image digital analysis performed on the flaps showed that the necrosis area (control—49.64%) was significantly lower for the groups with the three investigated solutions: CAP (14.47%), L-NAME (18.2%), and PRP (23.85%). Thermography exploration revealed less ischemia than the control group on the CAP, L-NAME, and PRP groups as well. Anatomopathological data noted the best degree of angiogenesis on the CAP group, with similar findings on the L-NAME and PRP treated flaps. The blood work did not indicate infection or a strong inflammatory process in any of the subjects. Overall, the study shows that the CAP activated solution has a similar (better) impact on the necrosis rate (compared with other solutions with known effects) when injected on the modified dorsal rat skin flap, and on top of that it can be obtained fast, in unlimited quantities, non-invasively, and through a standardized process.
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14
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Cold Physical Plasma in Cancer Therapy: Mechanisms, Signaling, and Immunity. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:9916796. [PMID: 35284036 PMCID: PMC8906949 DOI: 10.1155/2021/9916796] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 11/26/2021] [Indexed: 12/11/2022]
Abstract
Despite recent advances in therapy, cancer still is a devastating and life-threatening disease, motivating novel research lines in oncology. Cold physical plasma, a partially ionized gas, is a new modality in cancer research. Physical plasma produces various physicochemical factors, primarily reactive oxygen and nitrogen species (ROS/RNS), causing cancer cell death when supplied at supraphysiological concentrations. This review outlines the biomedical consequences of plasma treatment in experimental cancer therapy, including cell death modalities. It also summarizes current knowledge on intracellular signaling pathways triggered by plasma treatment to induce cancer cell death. Besides the inactivation of tumor cells, an equally important aspect is the inflammatory context in which cell death occurs to suppress or promote the responses of immune cells. This is mainly governed by the release of damage-associated molecular patterns (DAMPs) to provoke immunogenic cancer cell death (ICD) that, in turn, activates cells of the innate immune system to promote adaptive antitumor immunity. The pivotal role of the immune system in cancer treatment, in general, is highlighted by many clinical trials and success stories on using checkpoint immunotherapy. Hence, the potential of plasma treatment to induce ICD in tumor cells to promote immunity targeting cancer lesions systemically is also discussed.
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15
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Freund E, Bekeschus S. Gas Plasma-Oxidized Liquids for Cancer Treatment: Preclinical Relevance, Immuno-Oncology, and Clinical Obstacles. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2021. [DOI: 10.1109/trpms.2020.3029982] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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16
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Gouarderes S, Marches A, Vicendo P, Fourquaux I, Simon M, Merbahi N, Gibot L. Cold helium plasma jet does not stimulate collagen remodeling in a 3D human dermal substitute. Bioelectrochemistry 2021; 143:107985. [PMID: 34735915 DOI: 10.1016/j.bioelechem.2021.107985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/03/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022]
Abstract
Cold Atmospheric Plasma (CAP) is an emerging physical approach displaying encouraging antitumor and wound healing effects both in vitro and in vivo. In this study, we assessed the potential of direct CAP to remodel skin collagens using an original tissue-engineered human dermal substitute model rich in endogenous extracellular matrix (ECM) covered with 600 µl of culture medium and treated with CAP for 30 and 120 s. Our results indicated that Reactive Oxygen and Nitrogen Species (RONS) such as H2O2, NO3- and NO2- were produced in the medium during treatment. It appeared that in the CAP-treated dermal substitutes 1) cell viability was not altered, 2) pro-collagen I secretion was not modified over 48 h of culture after treatment, 3) global activity of matrix metalloproteinases MMPs was not modulated over 48 h after treatment, and 4) no change in hydroxyproline content was observed over 5 days after treatment. In order to confirm the efficiency of our device, we showed that the plasma-activated culture medium induced cell apoptosis and growth delay using a 3D human tumor spheroid model. In conclusion, no effect of direct CAP treatment was monitored on dermal ECM production and degradation, indicating that CAP does not stimulate collagen remodeling at the tissue scale.
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Affiliation(s)
- Sara Gouarderes
- Laboratoire des IMRCP, CNRS UMR 5623, Université Toulouse III - Paul Sabatier, France
| | - Aurélie Marches
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse University, CNRS, Inserm, Toulouse III - Paul Sabatier University, Toulouse, France; Laplace UMR CNRS 5213, Université Toulouse III - Paul Sabatier, France
| | - Patricia Vicendo
- Laboratoire des IMRCP, CNRS UMR 5623, Université Toulouse III - Paul Sabatier, France
| | - Isabelle Fourquaux
- Centre de Microscopie Électronique Appliquée à la Biologie, CMEAB, 133 route de Narbonne, 31062 Toulouse, France
| | - Michel Simon
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse University, CNRS, Inserm, Toulouse III - Paul Sabatier University, Toulouse, France
| | - Nofel Merbahi
- Laplace UMR CNRS 5213, Université Toulouse III - Paul Sabatier, France.
| | - Laure Gibot
- Laboratoire des IMRCP, CNRS UMR 5623, Université Toulouse III - Paul Sabatier, France.
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17
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Electroporation of suspension cell lines - A proposed assay set for optimizations. Bioelectrochemistry 2021; 142:107891. [PMID: 34425391 DOI: 10.1016/j.bioelechem.2021.107891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/03/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022]
Abstract
To make in vitro single cell electroporation protocols more comparable between various cancer types and groups, we propose a set of assays to test a range of electric field strengths at the start of any new project to determine the optimal electric field strength for a given cell line. While testing a range of electric field strengths, we kept the other ESOPE parameters constant (8 pulses, 100 µs pulse duration, 1 Hz pulse frequency). Basic assays were employed to measure short-term viability, effectiveness of treatment, metabolic activity, and recovery potential post-treatment to determine the optimal field strength for a particular cell line. Six cancer cell lines were tested, three of human (A549, A375 and Pan02) and three murine (LLC, B16F10 and MIA-PACA2). Our findings demonstrate that the optimal electroporation setting while keeping with all other ESOPE parameters are 800 V/cm for A549 and Pan02, 700 V/cm for A375, Mia-PACA2, and B16F10, and 1300 V/cm for LLC. Having an agreed upon set of assays to determine each cell lines optimal electric field strength should allow an improve translation of findings between cell lines for in vitro work from various groups and potentially improve translation into the clinic.
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18
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Carr L, Golzio M, Orlacchio R, Alberola G, Kolosnjaj-Tabi J, Leveque P, Arnaud-Cormos D, Rols MP. A nanosecond pulsed electric field (nsPEF) can affect membrane permeabilization and cellular viability in a 3D spheroids tumor model. Bioelectrochemistry 2021; 141:107839. [PMID: 34020398 DOI: 10.1016/j.bioelechem.2021.107839] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 12/01/2022]
Abstract
Three-dimensional (3D) cellular models represent more realistically the complexity of in vivo tumors compared to 2D cultures. While 3D models were largely used in classical electroporation, the effects of nanosecond pulsed electric field (nsPEF) have been poorly investigated. In this study, we evaluated the biological effects induced by nsPEF on spheroid tumor model derived from the HCT-116 human colorectal carcinoma cell line. By varying the number of pulses (from 1 to 500) and the polarity (unipolar and bipolar), the response of nsPEF exposure (10 ns duration, 50 kV/cm) was assessed either immediately after the application of the pulses or over a period lasting up to 6 days. Membrane permeabilization and cellular death occurred following the application of at least 100 pulses. The extent of the response increased with the number of pulses, with a significant decrease of viability, 24 h post-exposure, when 250 and 500 pulses were applied. The effects were highly reduced when an equivalent number of bipolar pulses were delivered. This reduction was eliminated when a 100 ns interphase interval was introduced into the bipolar pulses. Altogether, our results show that nsPEF effects, previously observed at the single cell level, also occur in more realistic 3D tumor spheroids models.
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Affiliation(s)
- Lynn Carr
- Univ. Limoges, CNRS, XLIM, UMR 7252, F-87000 Limoges, France; School of Electronic Engineering, Bangor University, Bangor, UK
| | - Muriel Golzio
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, 31077 Toulouse, France
| | - Rosa Orlacchio
- Univ. Limoges, CNRS, XLIM, UMR 7252, F-87000 Limoges, France
| | - Geraldine Alberola
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, 31077 Toulouse, France
| | - Jelena Kolosnjaj-Tabi
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, 31077 Toulouse, France
| | | | - Delia Arnaud-Cormos
- Univ. Limoges, CNRS, XLIM, UMR 7252, F-87000 Limoges, France; Institut Universitaire de France (IUF), 75005 Paris, France.
| | - Marie-Pierre Rols
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, 31077 Toulouse, France.
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19
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Shaw P, Kumar N, Privat-Maldonado A, Smits E, Bogaerts A. Cold Atmospheric Plasma Increases Temozolomide Sensitivity of Three-Dimensional Glioblastoma Spheroids via Oxidative Stress-Mediated DNA Damage. Cancers (Basel) 2021; 13:cancers13081780. [PMID: 33917880 PMCID: PMC8068248 DOI: 10.3390/cancers13081780] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 12/31/2022] Open
Abstract
Simple Summary Cold atmospheric plasma (CAP) is gaining increasing interest for cancer treatment, for a wide range of cancer types. The studies performed with CAP as a standalone treatment modality serve as evidence that it can also be a suitable candidate for combination therapy. Temozolomide (TMZ) is used as the gold standard drug for glioblastoma treatment, one of the most aggressive malignant brain tumors in adults that remains incurable despite treatment advances. In this study, we explore whether CAP, a cocktail of reactive oxygen and nitrogen species, can amplify the cytotoxic effect on both TMZ-sensitive and TMZ-resistant glioblastoma multiforme (GBM) in three-dimensional tumor-like tissues through inhibiting the glutathione (GSH)/ glutathione peroxidase 4 (GPX4) antioxidant machinery, which can further lead to DNA damage. Abstract Glioblastoma multiforme (GBM) is the most frequent and aggressive primary malignant brain tumor in adults. Current standard radiotherapy and adjuvant chemotherapy with the alkylating agent temozolomide (TMZ) yield poor clinical outcome. This is due to the stem-like properties of tumor cells and genetic abnormalities in GBM, which contribute to resistance to TMZ and progression. In this study, we used cold atmospheric plasma (CAP) to enhance the sensitivity to TMZ through inhibition of antioxidant signaling (linked to TMZ resistance). We demonstrate that CAP indeed enhances the cytotoxicity of TMZ by targeting the antioxidant specific glutathione (GSH)/glutathione peroxidase 4 (GPX4) signaling. We optimized the threshold concentration of TMZ on five different GBM cell lines (U251, LN18, LN229, U87-MG and T98G). We combined TMZ with CAP and tested it on both TMZ-sensitive (U251, LN18 and LN229) and TMZ-resistant (U87-MG and T98G) cell lines using two-dimensional cell cultures. Subsequently, we used a three-dimensional spheroid model for the U251 (TMZ-sensitive) and U87-MG and T98G (TMZ-resistant) cells. The sensitivity of TMZ was enhanced, i.e., higher cytotoxicity and spheroid shrinkage was obtained when TMZ and CAP were administered together. We attribute the anticancer properties to the release of intracellular reactive oxygen species, through inhibiting the GSH/GPX4 antioxidant machinery, which can lead to DNA damage. Overall, our findings suggest that the combination of CAP with TMZ is a promising combination therapy to enhance the efficacy of TMZ towards the treatment of GBM spheroids.
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Affiliation(s)
- Priyanka Shaw
- Research Group PLASMANT, Department of Chemistry, University of Antwerp, 2610 Antwerp, Belgium
- Solid Tumor Immunology Group, Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, 2610 Antwerp, Belgium
| | - Naresh Kumar
- Research Group PLASMANT, Department of Chemistry, University of Antwerp, 2610 Antwerp, Belgium
- National Institute of Pharmaceutical Education and Research, Guwahati, Guwahati 781125, Assam, India
| | - Angela Privat-Maldonado
- Research Group PLASMANT, Department of Chemistry, University of Antwerp, 2610 Antwerp, Belgium
- Solid Tumor Immunology Group, Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, 2610 Antwerp, Belgium
| | - Evelien Smits
- Solid Tumor Immunology Group, Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, 2610 Antwerp, Belgium
| | - Annemie Bogaerts
- Research Group PLASMANT, Department of Chemistry, University of Antwerp, 2610 Antwerp, Belgium
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20
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Mateu-Sanz M, Tornín J, Ginebra MP, Canal C. Cold Atmospheric Plasma: A New Strategy Based Primarily on Oxidative Stress for Osteosarcoma Therapy. J Clin Med 2021; 10:893. [PMID: 33672274 PMCID: PMC7926371 DOI: 10.3390/jcm10040893] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 12/12/2022] Open
Abstract
Osteosarcoma is the most common primary bone tumor, and its first line of treatment presents a high failure rate. The 5-year survival for children and teenagers with osteosarcoma is 70% (if diagnosed before it has metastasized) or 20% (if spread at the time of diagnosis), stressing the need for novel therapies. Recently, cold atmospheric plasmas (ionized gases consisting of UV-Vis radiation, electromagnetic fields and a great variety of reactive species) and plasma-treated liquids have been shown to have the potential to selectively eliminate cancer cells in different tumors through an oxidative stress-dependent mechanism. In this work, we review the current state of the art in cold plasma therapy for osteosarcoma. Specifically, we emphasize the mechanisms unveiled thus far regarding the action of plasmas on osteosarcoma. Finally, we review current and potential future approaches, emphasizing the most critical challenges for the development of osteosarcoma therapies based on this emerging technique.
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Affiliation(s)
- Miguel Mateu-Sanz
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Engineering, Escola d’Enginyeria Barcelona Est (EEBE), Universitat Politècnica de Catalunya (UPC), 08930 Barcelona, Spain; (M.M.-S.); (J.T.); (M.-P.G.)
- Barcelona Research Center in Multiscale Science and Engineering, UPC, 08930 Barcelona, Spain
- Research Centre for Biomedical Engineering (CREB), UPC, 08034 Barcelona, Spain
| | - Juan Tornín
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Engineering, Escola d’Enginyeria Barcelona Est (EEBE), Universitat Politècnica de Catalunya (UPC), 08930 Barcelona, Spain; (M.M.-S.); (J.T.); (M.-P.G.)
- Barcelona Research Center in Multiscale Science and Engineering, UPC, 08930 Barcelona, Spain
- Research Centre for Biomedical Engineering (CREB), UPC, 08034 Barcelona, Spain
| | - Maria-Pau Ginebra
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Engineering, Escola d’Enginyeria Barcelona Est (EEBE), Universitat Politècnica de Catalunya (UPC), 08930 Barcelona, Spain; (M.M.-S.); (J.T.); (M.-P.G.)
- Barcelona Research Center in Multiscale Science and Engineering, UPC, 08930 Barcelona, Spain
- Research Centre for Biomedical Engineering (CREB), UPC, 08034 Barcelona, Spain
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), 08034 Barcelona, Spain
| | - Cristina Canal
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Engineering, Escola d’Enginyeria Barcelona Est (EEBE), Universitat Politècnica de Catalunya (UPC), 08930 Barcelona, Spain; (M.M.-S.); (J.T.); (M.-P.G.)
- Barcelona Research Center in Multiscale Science and Engineering, UPC, 08930 Barcelona, Spain
- Research Centre for Biomedical Engineering (CREB), UPC, 08034 Barcelona, Spain
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21
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Los A, Ziuzina D, Van Cleynenbreugel R, Boehm D, Bourke P. Assessing the Biological Safety of Atmospheric Cold Plasma Treated Wheat Using Cell and Insect Models. Foods 2020; 9:foods9070898. [PMID: 32650404 PMCID: PMC7404979 DOI: 10.3390/foods9070898] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 12/20/2022] Open
Abstract
Atmospheric cold plasma (ACP) is under investigation for an extensive range of biocontrol applications in food biosystems. However, the development of a novel intervention technology requires a thorough evaluation of the potential for negative effects and the implications for the human and animal food chains’ safety. The evaluations were performed using a contained, high-voltage, dielectric barrier discharge plasma system. The cytotoxicity of two types of food models—a liquid model (wheat model medium (WMM)) vs. a solid model (wheat grain extract (WGE)) was compared in vitro using the mammalian cell line CHO-K1. The residual toxicity of ACP treatment of grains for food purposes was assessed using the invertebrate model Tribolium castaneum, by feeding the beetles with flour produced from ACP-treated wheat grains. The cytotoxic effects and changes in the chemistry of the ACP-treated samples were more pronounced in samples treated in a liquid form as opposed to actual wheat grains. The feeding trial using T. castaneum demonstrated no negative impacts on the survivability or weight profiles of insects. Investigations into the interactions of plasma-generated species with secondary metabolites in the food matrices are necessary to ensure the safety of plasma for food applications.
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Affiliation(s)
- Agata Los
- Environmental Sustainability and Health Institute, Technological University Dublin, Dublin 7, Ireland; (A.L.); (D.Z.); (R.V.C.); (D.B.)
| | - Dana Ziuzina
- Environmental Sustainability and Health Institute, Technological University Dublin, Dublin 7, Ireland; (A.L.); (D.Z.); (R.V.C.); (D.B.)
| | - Robin Van Cleynenbreugel
- Environmental Sustainability and Health Institute, Technological University Dublin, Dublin 7, Ireland; (A.L.); (D.Z.); (R.V.C.); (D.B.)
- Faculty of Engineering Technology, Katholieke University Leuven, 9000 Ghent, Belgium
| | - Daniela Boehm
- Environmental Sustainability and Health Institute, Technological University Dublin, Dublin 7, Ireland; (A.L.); (D.Z.); (R.V.C.); (D.B.)
| | - Paula Bourke
- Environmental Sustainability and Health Institute, Technological University Dublin, Dublin 7, Ireland; (A.L.); (D.Z.); (R.V.C.); (D.B.)
- Plasma Research Group, School of Biosystems and Food Engineering, University College Dublin, Dublin 4, Ireland
- School of Biological Sciences, Institute for Global Food Security, Queens University Belfast, Belfast BT9 5DL, UK
- Correspondence:
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22
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Combination Treatment with Cold Physical Plasma and Pulsed Electric Fields Augments ROS Production and Cytotoxicity in Lymphoma. Cancers (Basel) 2020; 12:cancers12040845. [PMID: 32244543 PMCID: PMC7226014 DOI: 10.3390/cancers12040845] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/28/2020] [Accepted: 03/28/2020] [Indexed: 02/08/2023] Open
Abstract
New approaches in oncotherapy rely on the combination of different treatments to enhance the efficacy of established monotherapies. Pulsed electric fields (PEFs) are an established method (electrochemotherapy) for enhancing cellular drug uptake while cold physical plasma is an emerging and promising anticancer technology. This study aimed to combine both technologies to elucidate their cytotoxic potential as well as the underlying mechanisms of the effects observed. An electric field generator (0.9–1.0 kV/cm and 100-μs pulse duration) and an atmospheric pressure argon plasma jet were employed for the treatment of lymphoma cell lines as a model system. PEF but not plasma treatment induced cell membrane permeabilization. Additive cytotoxicity was observed for the metabolic activity and viability of the cells while the sequence of treatment in the combination played only a minor role. Intriguingly, a parallel combination was more effective compared to a 15-min pause between both treatment regimens. A combination effect was also found for lipid peroxidation; however, none could be observed in the cytosolic and mitochondrial reactive oxygen species (ROS) production. The supplementation with either antioxidant, a pan-caspase-inhibitor or a ferroptosis inhibitor, all partially rescued lymphoma cells from terminal cell death, which contributes to the mechanistic understanding of this combination treatment.
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23
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Griseti E, Merbahi N, Golzio M. Anti-Cancer Potential of Two Plasma-Activated Liquids: Implication of Long-Lived Reactive Oxygen and Nitrogen Species. Cancers (Basel) 2020; 12:E721. [PMID: 32204401 PMCID: PMC7140060 DOI: 10.3390/cancers12030721] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 12/23/2022] Open
Abstract
Cold atmospheric plasma-exposed culture medium may efficiently kill cancer cells in vitro. Due to the complexity of the medium obtained after plasma exposure, less complex physiological liquids, such as saline solutions and saline buffers, are gathering momentum. Among the plethora of reactive oxygen and nitrogen species (RONS) that are produced in these plasma-activated liquids, hydrogen peroxide, nitrite and nitrate appear to be mainly responsible for cytotoxic and genotoxic effects. Here, we evaluated the anti-cancer potential of plasma-activated phosphate-buffered saline (P-A PBS) and sodium chloride 0.9% (P-A NaCl), using a three-dimensional tumor model. Two epithelial cancer cell lines were used to evaluate cellular effects of either P-A PBS or P-A NaCl. Human colorectal cancer cells HCT 116 and human ovarian carcinoma, SKOV-3 were used to investigate the manner by which different cell types respond to different plasma-activated liquids treatments. Our investigations indicate that P-A PBS is more efficient than P-A NaCl mainly because RONS are produced in larger quantities. Indeed, we show that the cytotoxicity of these liquids directly correlates with the concentration of hydrogen peroxide and nitrite. Moreover, P-A PBS induced a faster-occurring and more pronounced cell death, which arose within deeper layers of the 3D multicellular spheroid models.
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Affiliation(s)
- Elena Griseti
- CNRS UMR 5089, Institut de Pharmacologie et de Biologie Structurale, IPBS, 205 Route de Narbonne, 31077 Toulouse, France;
- CNRS UMR 5213, Laboratoire des Plasmas et Conversion d’Énergie, Université Toulouse III- Paul Sabatier, LAPLACE, 118 Route de Narbonne-Bât, 3R3-31062 Toulouse, France
| | - Nofel Merbahi
- CNRS UMR 5213, Laboratoire des Plasmas et Conversion d’Énergie, Université Toulouse III- Paul Sabatier, LAPLACE, 118 Route de Narbonne-Bât, 3R3-31062 Toulouse, France
| | - Muriel Golzio
- CNRS UMR 5089, Institut de Pharmacologie et de Biologie Structurale, IPBS, 205 Route de Narbonne, 31077 Toulouse, France;
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Mateu-Sanz M, Tornín J, Brulin B, Khlyustova A, Ginebra MP, Layrolle P, Canal C. Cold Plasma-Treated Ringer's Saline: A Weapon to Target Osteosarcoma. Cancers (Basel) 2020; 12:cancers12010227. [PMID: 31963398 PMCID: PMC7017095 DOI: 10.3390/cancers12010227] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/10/2020] [Accepted: 01/14/2020] [Indexed: 12/22/2022] Open
Abstract
Osteosarcoma (OS) is the main primary bone cancer, presenting poor prognosis and difficult treatment. An innovative therapy may be found in cold plasmas, which show anti-cancer effects related to the generation of reactive oxygen and nitrogen species in liquids. In vitro models are based on the effects of plasma-treated culture media on cell cultures. However, effects of plasma-activated saline solutions with clinical application have not yet been explored in OS. The aim of this study is to obtain mechanistic insights on the action of plasma-activated Ringer’s saline (PAR) for OS therapy in cell and organotypic cultures. To that aim, cold atmospheric plasma jets were used to obtain PAR, which produced cytotoxic effects in human OS cells (SaOS-2, MG-63, and U2-OS), related to the increasing concentration of reactive oxygen and nitrogen species generated. Proof of selectivity was found in the sustained viability of hBM-MSCs with the same treatments. Organotypic cultures of murine OS confirmed the time-dependent cytotoxicity observed in 2D. Histological analysis showed a decrease in proliferating cells (lower Ki-67 expression). It is shown that the selectivity of PAR is highly dependent on the concentrations of reactive species, being the differential intracellular reactive oxygen species increase and DNA damage between OS cells and hBM-MSCs key mediators for cell apoptosis.
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Affiliation(s)
- Miguel Mateu-Sanz
- Biomaterials, Biomechanics and Tissue Engineering Group, Department Materials Science and Metallurgy, Technical University of Catalonia (UPC), Escola d’Enginyeria Barcelona Est (EEBE), c/Eduard Maristany 14, 08019 Barcelona, Spain; (M.M.-S.); (J.T.); (A.K.); (M.-P.G.)
- Barcelona Research Center in Multiscale Science and Engineering, UPC, 08019 Barcelona, Spain
- Research Centre for Biomedical Engineering (CREB), UPC, 08019 Barcelona, Spain
| | - Juan Tornín
- Biomaterials, Biomechanics and Tissue Engineering Group, Department Materials Science and Metallurgy, Technical University of Catalonia (UPC), Escola d’Enginyeria Barcelona Est (EEBE), c/Eduard Maristany 14, 08019 Barcelona, Spain; (M.M.-S.); (J.T.); (A.K.); (M.-P.G.)
- Barcelona Research Center in Multiscale Science and Engineering, UPC, 08019 Barcelona, Spain
- Research Centre for Biomedical Engineering (CREB), UPC, 08019 Barcelona, Spain
| | - Bénédicte Brulin
- Inserm, UMR 1238, PHY-OS, Laboratory of Bone Sarcomas and Remodeling of Calcified Tissues, Faculty of Medicine, University of Nantes, 44035 Nantes, France; (B.B.); (P.L.)
| | - Anna Khlyustova
- Biomaterials, Biomechanics and Tissue Engineering Group, Department Materials Science and Metallurgy, Technical University of Catalonia (UPC), Escola d’Enginyeria Barcelona Est (EEBE), c/Eduard Maristany 14, 08019 Barcelona, Spain; (M.M.-S.); (J.T.); (A.K.); (M.-P.G.)
- Barcelona Research Center in Multiscale Science and Engineering, UPC, 08019 Barcelona, Spain
- Research Centre for Biomedical Engineering (CREB), UPC, 08019 Barcelona, Spain
| | - Maria-Pau Ginebra
- Biomaterials, Biomechanics and Tissue Engineering Group, Department Materials Science and Metallurgy, Technical University of Catalonia (UPC), Escola d’Enginyeria Barcelona Est (EEBE), c/Eduard Maristany 14, 08019 Barcelona, Spain; (M.M.-S.); (J.T.); (A.K.); (M.-P.G.)
- Barcelona Research Center in Multiscale Science and Engineering, UPC, 08019 Barcelona, Spain
- Research Centre for Biomedical Engineering (CREB), UPC, 08019 Barcelona, Spain
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), c/Baldiri i Reixach 10-12, 08028 Barcelona, Spain
| | - Pierre Layrolle
- Inserm, UMR 1238, PHY-OS, Laboratory of Bone Sarcomas and Remodeling of Calcified Tissues, Faculty of Medicine, University of Nantes, 44035 Nantes, France; (B.B.); (P.L.)
| | - Cristina Canal
- Biomaterials, Biomechanics and Tissue Engineering Group, Department Materials Science and Metallurgy, Technical University of Catalonia (UPC), Escola d’Enginyeria Barcelona Est (EEBE), c/Eduard Maristany 14, 08019 Barcelona, Spain; (M.M.-S.); (J.T.); (A.K.); (M.-P.G.)
- Barcelona Research Center in Multiscale Science and Engineering, UPC, 08019 Barcelona, Spain
- Research Centre for Biomedical Engineering (CREB), UPC, 08019 Barcelona, Spain
- Correspondence:
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25
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Giteru SG, Cridge B, Oey I, Ali A, Altermann E. In-vitro degradation and toxicological assessment of pulsed electric fields crosslinked zein-chitosan-poly(vinyl alcohol) biopolymeric films. Food Chem Toxicol 2020; 135:111048. [DOI: 10.1016/j.fct.2019.111048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/02/2019] [Accepted: 12/06/2019] [Indexed: 12/12/2022]
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26
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Gibot L, Kolosnjaj-Tabi J, Bellard E, Chretiennot T, Saurin Q, Catrain A, Golzio M, Vézinet R, Rols MP. Evaluations of Acute and Sub-Acute Biological Effects of Narrowband and Moderate-Band High Power Electromagnetic Waves on Cellular Spheroids. Sci Rep 2019; 9:15324. [PMID: 31653929 PMCID: PMC6814744 DOI: 10.1038/s41598-019-51686-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/23/2019] [Indexed: 12/16/2022] Open
Abstract
High power electromagnetic signals can disrupt the functioning of electronic devices. As electromagnetism plays a role in cells homeostasis, such electromagnetic signals could potentially also alter some physiological processes. Herein we report on distinct biological parameters assessment after cellular spheroids exposure to high power electromagnetic signals, such as the ones used for defense applications. Signals effects were assessed in tumor cells spheroids and in normal human dermal fibroblasts spheroids, where macroscopic aspect, growth, plasma membrane integrity, induction of apoptosis, ATP content, and mitochondrial potential were investigated after spheroids exposure to high power electromagnetic signals. No significant effects were observed, indicating that 1.5 GHz narrowband electromagnetic fields with incident amplitude level of 40 kV/m, and 150 MHz moderate-band electric fields with an amplitude of 72.5 to approximately 200 kV/m, do not cause any significant alterations of assessed parameters.
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Affiliation(s)
- Laure Gibot
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, Toulouse, France
| | - Jelena Kolosnjaj-Tabi
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, Toulouse, France
| | - Elisabeth Bellard
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, Toulouse, France
| | | | | | | | - Muriel Golzio
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, Toulouse, France
| | | | - Marie-Pierre Rols
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, Toulouse, France.
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de Macedo MP, de Melo FM, Ribeiro JDS, de Mello CAL, de Souza Begnami MDF, Soares FA, Carraro DM, da Cunha IW. RAS mutations vary between lesions in synchronous primary colorectal cancer: testing only one lesion is not sufficient to guide anti-EGFR treatment decisions. Oncoscience 2015; 2:125-30. [PMID: 25859555 PMCID: PMC4381705 DOI: 10.18632/oncoscience.118] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/06/2015] [Indexed: 02/07/2023] Open
Abstract
Introduction Mutations in KRAS and NRAS genes are negative predictors of anti-EGFR therapies response in metastatic colorectal cancer. There are few reports on RAS testing in synchronous primary colorectal cancer (SP-CRC) and a lack of recommendations on which tissue should be tested for the mutation in this disease. This study analyzed the RAS status of both lesions in SP-CRC patients and in their metastasis. Materials and methods DNA was obtained from formalin-fixed-paraffin-embedded tissue, and mutations were analyzed by pyrosequencing. Results RAS status was heterogeneous in 6 (75%) of 8 SP-CRC patients between primary lesions. Five showed heterogeneity regarding RAS mutational status, and from these, four presented with metastasis: 3 cases (75%) had WT metastatic tissue, and 1 case (25%) had mutated metastatic tissue. One patient showed divergence regarding RAS mutation type. Discussion RAS mutations vary significantly between SP-CRC lesions, and the status of the metastasis is unpredictable. Testing for RAS mutations in only 1 of the primary lesions can misguide clinical decisions and hind the predictive potential of anti-EGFR treatment. A more appropriate approach in metastatic SP-CRC is to test the metastatic tissue or both primary lesions for providing more accurate mutation scenery and support more assertive clinical decisions.
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Affiliation(s)
- Mariana Petaccia de Macedo
- Department of Molecular Diagnosis, Anatomic Pathology Department, AC Camargo Cancer Center, São Paulo, Brazil ; Laboratory of Investigative Pathology, CIPE / AC Camargo Cancer Center, São Paulo, Brazil
| | - Fernanda Machado de Melo
- Department of Molecular Diagnosis, Anatomic Pathology Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - Júlia da Silva Ribeiro
- Department of Molecular Diagnosis, Anatomic Pathology Department, AC Camargo Cancer Center, São Paulo, Brazil
| | | | - Maria Dirlei Ferreira de Souza Begnami
- Department of Molecular Diagnosis, Anatomic Pathology Department, AC Camargo Cancer Center, São Paulo, Brazil ; Laboratory of Investigative Pathology, CIPE / AC Camargo Cancer Center, São Paulo, Brazil
| | - Fernando Augusto Soares
- Department of Molecular Diagnosis, Anatomic Pathology Department, AC Camargo Cancer Center, São Paulo, Brazil ; Laboratory of Investigative Pathology, CIPE / AC Camargo Cancer Center, São Paulo, Brazil
| | - Dirce Maria Carraro
- Department of Molecular Diagnosis, Anatomic Pathology Department, AC Camargo Cancer Center, São Paulo, Brazil ; Laboratory of Genomics and Molecular Biology, CIPE / AC Camargo Cancer Center, São Paulo, Brazil
| | - Isabela Werneck da Cunha
- Department of Molecular Diagnosis, Anatomic Pathology Department, AC Camargo Cancer Center, São Paulo, Brazil ; Laboratory of Investigative Pathology, CIPE / AC Camargo Cancer Center, São Paulo, Brazil
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