1
|
Wagner S, Ewald C, Freitag D, Herrmann KH, Koch A, Bauer J, Vogl TJ, Kemmling A, Gufler H. Radiomics and visual analysis for predicting success of transplantation of heterotopic glioblastoma in mice with MRI. J Neurooncol 2024; 169:257-267. [PMID: 38960965 PMCID: PMC11341603 DOI: 10.1007/s11060-024-04725-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/25/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Quantifying tumor growth and treatment response noninvasively poses a challenge to all experimental tumor models. The aim of our study was, to assess the value of quantitative and visual examination and radiomic feature analysis of high-resolution MR images of heterotopic glioblastoma xenografts in mice to determine tumor cell proliferation (TCP). METHODS Human glioblastoma cells were injected subcutaneously into both flanks of immunodeficient mice and followed up on a 3 T MR scanner. Volumes and signal intensities were calculated. Visual assessment of the internal tumor structure was based on a scoring system. Radiomic feature analysis was performed using MaZda software. The results were correlated with histopathology and immunochemistry. RESULTS 21 tumors in 14 animals were analyzed. The volumes of xenografts with high TCP (H-TCP) increased, whereas those with low TCP (L-TCP) or no TCP (N-TCP) continued to decrease over time (p < 0.05). A low intensity rim (rim sign) on unenhanced T1-weighted images provided the highest diagnostic accuracy at visual analysis for assessing H-TCP (p < 0.05). Applying radiomic feature analysis, wavelet transform parameters were best for distinguishing between H-TCP and L-TCP / N-TCP (p < 0.05). CONCLUSION Visual and radiomic feature analysis of the internal structure of heterotopically implanted glioblastomas provide reproducible and quantifiable results to predict the success of transplantation.
Collapse
Affiliation(s)
- Sabine Wagner
- Department of Neuroradiology, Marburg University Hospital - Philipps University, 35043, Marburg, Germany.
- Department of Neuroradiology, Institute for Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University, 07747, Jena, Germany.
| | - Christian Ewald
- Department of Neurosurgery, Brandenburg Medical School, Theodor Fontane, University Hospital Brandenburg/Havel, 14770, Brandenburg/Havel, Germany
| | - Diana Freitag
- Department of Neurosurgery, Section of Experimental Neurooncology, Jena University Hospital - Friedrich Schiller University, 07747, Jena, Germany
| | - Karl-Heinz Herrmann
- Medical Physics Group, Institute for Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University, 07743, Jena, Germany
| | - Arend Koch
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, and Berlin Institute of Health, Charité University Medicine, 10117, Berlin, Germany
| | - Johannes Bauer
- Department of Neurosurgery, Brandenburg Medical School, Theodor Fontane, University Hospital Brandenburg/Havel, 14770, Brandenburg/Havel, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Goethe University Hospital Frankfurt, 60590, Frankfurt Am Main, Germany
| | - André Kemmling
- Department of Neuroradiology, Marburg University Hospital - Philipps University, 35043, Marburg, Germany
| | - Hubert Gufler
- Department of Diagnostic and Interventional Radiology, Goethe University Hospital Frankfurt, 60590, Frankfurt Am Main, Germany
| |
Collapse
|
2
|
Kapteijn MY, Bakker N, Koekkoek JAF, Versteeg HH, Buijs JT. Venous Thromboembolism in Patients with Glioblastoma: Molecular Mechanisms and Clinical Implications. Thromb Haemost 2024. [PMID: 39168144 DOI: 10.1055/s-0044-1789592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Patients with glioblastoma are among the cancer patients with the highest risk of developing venous thromboembolism (VTE). Long-term thromboprophylaxis is not generally prescribed because of the increased susceptibility of glioblastoma patients to intracranial hemorrhage. This review provides an overview of the current clinical standard for glioblastoma patients, as well as the molecular and genetic background which underlies the high incidence of VTE. The two main procoagulant proteins involved in glioblastoma-related VTE, podoplanin and tissue factor, are described, in addition to the genetic aberrations that can be linked to a hypercoagulable state in glioblastoma. Furthermore, possible novel biomarkers and future treatment strategies are discussed, along with the potential of sequencing approaches toward personalized risk prediction for VTE. A glioblastoma-specific VTE risk stratification model may help identifying those patients in which the increased risk of bleeding due to extended anticoagulation is outweighed by the decreased risk of VTE.
Collapse
Affiliation(s)
- Maaike Y Kapteijn
- Division of Thrombosis and Hemostasis, Department of Medicine, Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Bakker
- Division of Thrombosis and Hemostasis, Department of Medicine, Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Henri H Versteeg
- Division of Thrombosis and Hemostasis, Department of Medicine, Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen T Buijs
- Division of Thrombosis and Hemostasis, Department of Medicine, Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
3
|
Meena D, Jha S. Autophagy in glioblastoma: A mechanistic perspective. Int J Cancer 2024; 155:605-617. [PMID: 38716809 DOI: 10.1002/ijc.34991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/28/2024] [Accepted: 04/12/2024] [Indexed: 06/20/2024]
Abstract
Glioblastoma (GBM) is one of the most lethal malignancies in humans. Even after surgical resection and aggressive radio- or chemotherapies, patients with GBM can survive for less than 14 months. Extreme inter-tumor and intra-tumor heterogeneity of GBM poses a challenge for resolving recalcitrant GBM pathophysiology. GBM tumor microenvironment (TME) exhibits diverse heterogeneity in cellular composition and processes contributing to tumor progression and therapeutic resistance. Autophagy is such a cellular process; that demonstrates a cell-specific and TME context-dependent role in GBM progression, leading to either the promotion or suppression of GBM progression. Autophagy can regulate GBM cell function directly via regulation of survival, migration, and invasion, or indirectly by affecting GBM TME composition such as immune cell population, tumor metabolism, and glioma stem cells. This review comprehensively investigates the role of autophagy in GBM pathophysiology.
Collapse
Affiliation(s)
- Durgesh Meena
- Department of Bioscience and Bioengineering, Indian Institute of Technology Jodhpur, Jodhpur, Rajasthan, India
| | - Sushmita Jha
- Department of Bioscience and Bioengineering, Indian Institute of Technology Jodhpur, Jodhpur, Rajasthan, India
| |
Collapse
|
4
|
Sadowski K, Jażdżewska A, Kozłowski J, Zacny A, Lorenc T, Olejarz W. Revolutionizing Glioblastoma Treatment: A Comprehensive Overview of Modern Therapeutic Approaches. Int J Mol Sci 2024; 25:5774. [PMID: 38891962 PMCID: PMC11172387 DOI: 10.3390/ijms25115774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 05/22/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Glioblastoma is the most common malignant primary brain tumor in the adult population, with an average survival of 12.1 to 14.6 months. The standard treatment, combining surgery, radiotherapy, and chemotherapy, is not as efficient as we would like. However, the current possibilities are no longer limited to the standard therapies due to rapid advancements in biotechnology. New methods enable a more precise approach by targeting individual cells and antigens to overcome cancer. For the treatment of glioblastoma, these are gamma knife therapy, proton beam therapy, tumor-treating fields, EGFR and VEGF inhibitors, multiple RTKs inhibitors, and PI3K pathway inhibitors. In addition, the increasing understanding of the role of the immune system in tumorigenesis and the ability to identify tumor-specific antigens helped to develop immunotherapies targeting GBM and immune cells, including CAR-T, CAR-NK cells, dendritic cells, and immune checkpoint inhibitors. Each of the described methods has its advantages and disadvantages and faces problems, such as the inefficient crossing of the blood-brain barrier, various neurological and systemic side effects, and the escape mechanism of the tumor. This work aims to present the current modern treatments of glioblastoma.
Collapse
Affiliation(s)
- Karol Sadowski
- The Department of Histology and Embryology, Medical University of Warsaw, Chalubinskiego 5, 02-004 Warsaw, Poland; (K.S.)
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, 02-091 Warsaw, Poland;
- Centre for Preclinical Research, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Adrianna Jażdżewska
- The Department of Anatomy and Neurobiology, Medical University of Gdansk, Dębinki 1, 80-211 Gdansk, Poland;
| | - Jan Kozłowski
- The Department of Histology and Embryology, Medical University of Warsaw, Chalubinskiego 5, 02-004 Warsaw, Poland; (K.S.)
| | - Aleksandra Zacny
- The Department of Histology and Embryology, Medical University of Warsaw, Chalubinskiego 5, 02-004 Warsaw, Poland; (K.S.)
| | - Tomasz Lorenc
- Department of Radiology I, The Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781 Warsaw, Poland
| | - Wioletta Olejarz
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, 02-091 Warsaw, Poland;
- Centre for Preclinical Research, Medical University of Warsaw, 02-091 Warsaw, Poland
| |
Collapse
|
5
|
Liu D, Zhu H, Cheng L, Li R, Ma X, Wang J, Wang J, Zhang S, Li Y, Shu K, Yu X, Li C. Hypoxia-induced galectin-8 maintains stemness in glioma stem cells via autophagy regulation. Neuro Oncol 2024; 26:872-888. [PMID: 38158714 PMCID: PMC11066898 DOI: 10.1093/neuonc/noad264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Glioma stem cells (GSCs) are the root cause of relapse and treatment resistance in glioblastoma (GBM). In GSCs, hypoxia in the microenvironment is known to facilitate the maintenance of stem cells, and evolutionally conserved autophagy regulates cell homeostasis to control cell population. The precise involvement of autophagy regulation in hypoxic conditions in maintaining the stemness of GSCs remains unclear. METHODS The association of autophagy regulation and hypoxia was first assessed by in silico analysis and validation in vitro. Glioma databases and clinical specimens were used to determine galectin-8 (Gal-8) expression in GSCs and human GBMs, and the regulation and function of Gal-8 in stemness maintenance were evaluated by genetic manipulation in vitro and in vivo. How autophagy was stimulated by Gal-8 under hypoxia was systematically investigated. RESULTS Hypoxia enhances autophagy in GSCs to facilitate self-renewal, and Gal-8 in the galectin family is specifically involved and expressed in GSCs within the hypoxic niche. Gal-8 is highly expressed in GBM and predicts poor survival in patients. Suppression of Gal-8 prevents tumor growth and prolongs survival in mouse models of GBM. Gal-8 binds to the Ragulator-Rag complex at the lysosome membrane and inactivates mTORC1, leading to the nuclear translocation of downstream TFEB and initiation of autophagic lysosomal biogenesis. Consequently, the survival and proliferative activity of GSCs are maintained. CONCLUSIONS Our findings reveal a novel Gal-8-mTOR-TFEB axis induced by hypoxia in the maintenance of GSC stemness via autophagy reinforcement, highlighting Gal-8 as a candidate for GSCs-targeted GBM therapy.
Collapse
Affiliation(s)
- Dan Liu
- Department of Medical Genetics, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongtao Zhu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lidong Cheng
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ran Li
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyu Ma
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junwen Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Suojun Zhang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingjie Li
- Department of Medical Genetics, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Shu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingjiang Yu
- Department of Histology and Embryology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuanzhou Li
- Department of Medical Genetics, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
6
|
Wang AF, Hsueh B, Choi BD, Gerstner ER, Dunn GP. Immunotherapy for Brain Tumors: Where We Have Been, and Where Do We Go From Here? Curr Treat Options Oncol 2024; 25:628-643. [PMID: 38649630 DOI: 10.1007/s11864-024-01200-9] [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] [Accepted: 03/18/2024] [Indexed: 04/25/2024]
Abstract
OPINION STATEMENT Immunotherapy for glioblastoma (GBM) remains an intensive area of investigation. Given the seismic impact of cancer immunotherapy across a range of malignancies, there is optimism that harnessing the power of immunity will influence GBM as well. However, despite several phase 3 studies, there are still no FDA-approved immunotherapies for GBM. Importantly, the field has learned a great deal from the randomized studies to date. Today, we are continuing to better understand the disease-specific features of the microenvironment in GBM-as well as the exploitable antigenic characteristic of the tumor cells themselves-that are informing the next generation of immune-based therapeutic strategies. The coming phase of next-generation immunotherapies is thus poised to bring us closer to treatments that will improve the lives of patients with GBM.
Collapse
Affiliation(s)
- Alexander F Wang
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Brian Hsueh
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Bryan D Choi
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Brain Tumor Immunology and Immunotherapy Program, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth R Gerstner
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Gavin P Dunn
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Brain Tumor Immunology and Immunotherapy Program, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
7
|
Sim Y, Choi SH, Lee N, Park YW, Ahn SS, Chang JH, Kim SH, Lee SK. Clinical, qualitative imaging biomarkers, and tumor oxygenation imaging biomarkers for differentiation of midline-located IDH wild-type glioblastomas and H3 K27-altered diffuse midline gliomas in adults. Eur J Radiol 2024; 173:111384. [PMID: 38422610 DOI: 10.1016/j.ejrad.2024.111384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/09/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To compare the clinical, qualitative and quantitative imaging phenotypes, including tumor oxygenation characteristics of midline-located IDH-wildtype glioblastomas (GBMs) and H3 K27-altered diffuse midline gliomas (DMGs) in adults. METHODS Preoperative MRI data of 55 adult patients with midline-located IDH-wildtype GBM or H3 K27-altered DMG (32 IDH-wildtype GBM and 23 H3 K27-altered DMG patients) were included. Qualitative imaging assessment was performed. Quantitative imaging assessment including the tumor volume, normalized cerebral blood volume, capillary transit time heterogeneity (CTH), oxygen extraction fraction (OEF), relative cerebral metabolic rate of oxygen values, and mean ADC value were performed from the tumor mask via automatic segmentation. Univariable and multivariable logistic analyses were performed. RESULTS On multivariable analysis, age (odds ratio [OR] = 0.92, P = 0.015), thalamus or medulla location (OR = 10.48, P = 0.013), presence of necrosis (OR = 0.15, P = 0.038), and OEF (OR = 0.01, P = 0.042) were independent predictors to differentiate H3 K27-altered DMG from midline-located IDH-wildtype GBM. The area under the curve, accuracy, sensitivity, and specificity of the multivariable model were 0.88 (95 % confidence interval: 0.77-0.95), 81.8 %, 82.6 %, and 81.3 %, respectively. CONCLUSIONS Along with younger age, tumor location, less frequent necrosis, and lower OEF may be useful imaging biomarkers to differentiate H3 K27-altered DMG from midline-located IDH-wildtype GBM. Tumor oxygenation imaging biomarkers may reflect the less hypoxic nature of H3 K27-altered DMG than IDH-wildtype GBM and may contribute to differentiation.
Collapse
Affiliation(s)
- Yongsik Sim
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Seo Hee Choi
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Narae Lee
- Department of Nuclear Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
| | - Yae Won Park
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Seung-Koo Lee
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
8
|
Saucedo-Mora L, Sanz MÁ, Montáns FJ, Benítez JM. A simple agent-based hybrid model to simulate the biophysics of glioblastoma multiforme cells and the concomitant evolution of the oxygen field. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 246:108046. [PMID: 38301393 DOI: 10.1016/j.cmpb.2024.108046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND AND OBJECTIVES Glioblastoma multiforme (GBM) is one of the most aggressive cancers of the central nervous system. It is characterized by a high mitotic activity and an infiltrative ability of the glioma cells, neovascularization and necrosis. GBM evolution entails the continuous interplay between heterogeneous cell populations, chemotaxis, and physical cues through different scales. In this work, an agent-based hybrid model is proposed to simulate the coupling of the multiscale biological events involved in the GBM invasion, specifically the individual and collective migration of GBM cells and the concurrent evolution of the oxygen field and phenotypic plasticity. An asset of the formulation is that it is conceptually and computationally simple but allows to reproduce the complexity and the progression of the GBM micro-environment at cell and tissue scales simultaneously. METHODS The migration is reproduced as the result of the interaction between every single cell and its micro-environment. The behavior of each individual cell is formulated through genotypic variables whereas the cell micro-environment is modeled in terms of the oxygen concentration and the cell density surrounding each cell. The collective behavior is formulated at a cellular scale through a flocking model. The phenotypic plasticity of the cells is induced by the micro-environment conditions, considering five phenotypes. RESULTS The model has been contrasted by benchmark problems and experimental tests showing the ability to reproduce different scenarios of glioma cell migration. In all cases, the individual and collective cell migration and the coupled evolution of both the oxygen field and phenotypic plasticity have been properly simulated. This simple formulation allows to mimic the formation of relevant hallmarks of glioblastoma multiforme, such as the necrotic cores, and to reproduce experimental evidences related to the mitotic activity in pseudopalisades. CONCLUSIONS In the collective migration, the survival of the clusters prevails at the expense of cell mitosis, regardless of the size of the groups, which delays the formation of necrotic foci and reduces the rate of oxygen consumption.
Collapse
Affiliation(s)
- Luis Saucedo-Mora
- E.T.S. de Ingeniería Aeronáutica y del Espacio, Universidad Politécnica de Madrid, Pza. Cardenal Cisneros 3, 28040, Madrid, Spain; Department of Materials, University of Oxford, Parks Road, Oxford, OX1 3PJ, UK; Department of Nuclear Science and Engineering, Massachusetts Institute of Technology, MA 02139, USA
| | - Miguel Ángel Sanz
- E.T.S. de Ingeniería Aeronáutica y del Espacio, Universidad Politécnica de Madrid, Pza. Cardenal Cisneros 3, 28040, Madrid, Spain
| | - Francisco Javier Montáns
- E.T.S. de Ingeniería Aeronáutica y del Espacio, Universidad Politécnica de Madrid, Pza. Cardenal Cisneros 3, 28040, Madrid, Spain; Department of Mechanical and Aerospace Engineering, Herbert Wertheim College of Engineering, University of Florida, FL 32611, USA
| | - José María Benítez
- E.T.S. de Ingeniería Aeronáutica y del Espacio, Universidad Politécnica de Madrid, Pza. Cardenal Cisneros 3, 28040, Madrid, Spain.
| |
Collapse
|
9
|
Fu Z, Chen Z, Ye J, Ji J, Ni W, Lin W, Lin H, Lu L, Zhu G, Xie Q, Yan F, Chen G, Liu F. Identifying PLAUR as a Pivotal Gene of Tumor Microenvironment and Regulating Mesenchymal Phenotype of Glioblastoma. Cancers (Basel) 2024; 16:840. [PMID: 38398231 PMCID: PMC10887327 DOI: 10.3390/cancers16040840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/04/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
The mesenchymal (MES) phenotype of glioblastoma (GBM) is the most aggressive and therapy-resistant subtype of GBM. The MES phenotype transition during tumor progression results from both tumor-intrinsic genetic alterations and tumor-extrinsic microenvironmental factors. In this study, we sought to identify genes that can modulate the MES phenotype via both mechanisms. By integrating weighted gene co-expression network analysis (WGCNA) and the differential expression analysis of hypoxia-immunosuppression-related genes, we identified the plasminogen activator, urokinase receptor (PLAUR) as the hub gene. Functional enrichment analysis and GSVA analysis demonstrated that PLAUR was associated with the MES phenotype of glioma and the hypoxia-immunosuppression-related microenvironmental components. Single-cell sequencing analysis revealed that PLAUR mediated the ligand-receptor interaction between tumor-associated macrophages (TAMs) and glioma cells. Functional experiments in vitro with cell lines or primary glioma cells and xenograft models using BALB/c nude mice confirmed the role of PLAUR in promoting the MES phenotype of GBM. Our findings indicate that PLAUR regulates both glioma cells and tumor cell-extrinsic factors that favor the MES phenotype and suggest that PLAUR might be a potential target for GBM therapy.
Collapse
Affiliation(s)
- Zaixiang Fu
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China; (Z.F.); (Z.C.); (J.Y.); (J.J.); (W.N.); (W.L.); (H.L.); (L.L.); (Q.X.); (F.Y.)
- Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou 310000, China
| | - Zihang Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China; (Z.F.); (Z.C.); (J.Y.); (J.J.); (W.N.); (W.L.); (H.L.); (L.L.); (Q.X.); (F.Y.)
- Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou 310000, China
| | - Jingya Ye
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China; (Z.F.); (Z.C.); (J.Y.); (J.J.); (W.N.); (W.L.); (H.L.); (L.L.); (Q.X.); (F.Y.)
- Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou 310000, China
| | - Jianxiong Ji
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China; (Z.F.); (Z.C.); (J.Y.); (J.J.); (W.N.); (W.L.); (H.L.); (L.L.); (Q.X.); (F.Y.)
- Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou 310000, China
| | - Weifang Ni
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China; (Z.F.); (Z.C.); (J.Y.); (J.J.); (W.N.); (W.L.); (H.L.); (L.L.); (Q.X.); (F.Y.)
- Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou 310000, China
| | - Weibo Lin
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China; (Z.F.); (Z.C.); (J.Y.); (J.J.); (W.N.); (W.L.); (H.L.); (L.L.); (Q.X.); (F.Y.)
- Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou 310000, China
| | - Haopu Lin
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China; (Z.F.); (Z.C.); (J.Y.); (J.J.); (W.N.); (W.L.); (H.L.); (L.L.); (Q.X.); (F.Y.)
- Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou 310000, China
| | - Liquan Lu
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China; (Z.F.); (Z.C.); (J.Y.); (J.J.); (W.N.); (W.L.); (H.L.); (L.L.); (Q.X.); (F.Y.)
- Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou 310000, China
| | - Ganggui Zhu
- Department of Lung Transplantation, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China;
| | - Qin Xie
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China; (Z.F.); (Z.C.); (J.Y.); (J.J.); (W.N.); (W.L.); (H.L.); (L.L.); (Q.X.); (F.Y.)
- Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou 310000, China
| | - Feng Yan
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China; (Z.F.); (Z.C.); (J.Y.); (J.J.); (W.N.); (W.L.); (H.L.); (L.L.); (Q.X.); (F.Y.)
- Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou 310000, China
| | - Gao Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China; (Z.F.); (Z.C.); (J.Y.); (J.J.); (W.N.); (W.L.); (H.L.); (L.L.); (Q.X.); (F.Y.)
- Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou 310000, China
| | - Fuyi Liu
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, China; (Z.F.); (Z.C.); (J.Y.); (J.J.); (W.N.); (W.L.); (H.L.); (L.L.); (Q.X.); (F.Y.)
- Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou 310000, China
| |
Collapse
|
10
|
Ahmed YB, Ababneh OE, Al-Khalili AA, Serhan A, Hatamleh Z, Ghammaz O, Alkhaldi M, Alomari S. Identification of Hypoxia Prognostic Signature in Glioblastoma Multiforme Based on Bulk and Single-Cell RNA-Seq. Cancers (Basel) 2024; 16:633. [PMID: 38339384 PMCID: PMC10854729 DOI: 10.3390/cancers16030633] [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: 12/20/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
Glioblastoma (GBM) represents a profoundly aggressive and heterogeneous brain neoplasm linked to a bleak prognosis. Hypoxia, a common feature in GBM, has been linked to tumor progression and therapy resistance. In this study, we aimed to identify hypoxia-related differentially expressed genes (DEGs) and construct a prognostic signature for GBM patients using multi-omics analysis. Patient cohorts were collected from publicly available databases, including the Gene Expression Omnibus (GEO), the Chinese Glioma Genome Atlas (CGGA), and The Cancer Genome Atlas-Glioblastoma Multiforme (TCGA-GBM), to facilitate a comprehensive analysis. Hypoxia-related genes (HRGs) were obtained from the Molecular Signatures Database (MSigDB). Differential expression analysis revealed 41 hypoxia-related DEGs in GBM patients. A consensus clustering approach, utilizing these DEGs' expression patterns, identified four distinct clusters, with cluster 1 showing significantly better overall survival. Machine learning techniques, including univariate Cox regression and LASSO regression, delineated a prognostic signature comprising six genes (ANXA1, CALD1, CP, IGFBP2, IGFBP5, and LOX). Multivariate Cox regression analysis substantiated the prognostic significance of a set of three optimal signature genes (CP, IGFBP2, and LOX). Using the hypoxia-related prognostic signature, patients were classified into high- and low-risk categories. Survival analysis demonstrated that the high-risk group exhibited inferior overall survival rates in comparison to the low-risk group. The prognostic signature showed good predictive performance, as indicated by the area under the curve (AUC) values for one-, three-, and five-year overall survival. Furthermore, functional enrichment analysis of the DEGs identified biological processes and pathways associated with hypoxia, providing insights into the underlying mechanisms of GBM. Delving into the tumor immune microenvironment, our analysis revealed correlations relating the hypoxia-related prognostic signature to the infiltration of immune cells in GBM. Overall, our study highlights the potential of a hypoxia-related prognostic signature as a valuable resource for forecasting the survival outcome of GBM patients. The multi-omics approach integrating bulk sequencing, single-cell analysis, and immune microenvironment assessment enhances our understanding of the intricate biology characterizing GBM, thereby potentially informing the tailored design of therapeutic interventions.
Collapse
Affiliation(s)
- Yaman B. Ahmed
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA;
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (O.E.A.); (A.A.A.-K.); (A.S.); (Z.H.); (O.G.); (M.A.)
| | - Obada E. Ababneh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (O.E.A.); (A.A.A.-K.); (A.S.); (Z.H.); (O.G.); (M.A.)
| | - Anas A. Al-Khalili
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (O.E.A.); (A.A.A.-K.); (A.S.); (Z.H.); (O.G.); (M.A.)
| | - Abdullah Serhan
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (O.E.A.); (A.A.A.-K.); (A.S.); (Z.H.); (O.G.); (M.A.)
| | - Zaid Hatamleh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (O.E.A.); (A.A.A.-K.); (A.S.); (Z.H.); (O.G.); (M.A.)
| | - Owais Ghammaz
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (O.E.A.); (A.A.A.-K.); (A.S.); (Z.H.); (O.G.); (M.A.)
| | - Mohammad Alkhaldi
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (O.E.A.); (A.A.A.-K.); (A.S.); (Z.H.); (O.G.); (M.A.)
| | - Safwan Alomari
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| |
Collapse
|
11
|
Pokorná M, Kútna V, Ovsepian SV, Matěj R, Černá M, O’Leary VB. Biomolecules to Biomarkers? U87MG Marker Evaluation on the Path towards Glioblastoma Multiforme Pathogenesis. Pharmaceutics 2024; 16:123. [PMID: 38258133 PMCID: PMC10818292 DOI: 10.3390/pharmaceutics16010123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
The heterogeneity of the glioma subtype glioblastoma multiforme (GBM) challenges effective neuropathological treatment. The reliance on in vitro studies and xenografted animal models to simulate human GBM has proven ineffective. Currently, a dearth of knowledge exists regarding the applicability of cell line biomolecules to the realm of GBM pathogenesis. Our study's objectives were to address this preclinical issue and assess prominin-1, ICAM-1, PARTICLE and GAS5 as potential GBM diagnostic targets. The methodologies included haemoxylin and eosin staining, immunofluorescence, in situ hybridization and quantitative PCR. The findings identified that morphology correlates with malignancy in GBM patient pathology. Immunofluorescence confocal microscopy revealed prominin-1 in pseudo-palisades adjacent to necrotic foci in both animal and human GBM. Evidence is presented for an ICAM-1 association with degenerating vasculature. Significantly elevated nuclear PARTICLE expression from in situ hybridization and quantitative PCR reflected its role as a tumor activator. GAS5 identified within necrotic GBM validated this potential prognostic biomolecule with extended survival. Here we present evidence for the stem cell marker prominin-1 and the chemotherapeutic target ICAM-1 in a glioma animal model and GBM pathology sections from patients that elicited alternative responses to adjuvant chemotherapy. This foremost study introduces the long non-coding RNA PARTICLE into the context of human GBM pathogenesis while substantiating the role of GAS5 as a tumor suppressor. The validation of GBM biomarkers from cellular models contributes to the advancement towards superior detection, therapeutic responders and the ultimate attainment of promising prognoses for this currently incurable brain cancer.
Collapse
Affiliation(s)
- Markéta Pokorná
- Department of Medical Genetics, Third Faculty of Medicine, Charles University, Ruská 87, Vinohrady, 10000 Prague, Czech Republic; (M.P.); (M.Č.)
| | - Viera Kútna
- Department of Experimental Neurobiology, National Institute of Mental Health, Topolová 748, 25067 Klecany, Czech Republic;
| | - Saak V. Ovsepian
- Faculty of Engineering and Science, University of Greenwich London, Chatham Maritime, Kent ME4 4TB, UK;
| | - Radoslav Matěj
- Department of Pathology, Third Faculty of Medicine, Charles University, Ruská 87, Vinohrady, 10000 Prague, Czech Republic;
- Department of Pathology, University Hospital Královské Vinohrady, Šrobárova 50, Vinohrady, 10000 Prague, Czech Republic
| | - Marie Černá
- Department of Medical Genetics, Third Faculty of Medicine, Charles University, Ruská 87, Vinohrady, 10000 Prague, Czech Republic; (M.P.); (M.Č.)
| | - Valerie Bríd O’Leary
- Department of Medical Genetics, Third Faculty of Medicine, Charles University, Ruská 87, Vinohrady, 10000 Prague, Czech Republic; (M.P.); (M.Č.)
| |
Collapse
|
12
|
Lorimer IAJ. Potential roles for efferocytosis in glioblastoma immune evasion. Neurooncol Adv 2024; 6:vdae012. [PMID: 38616895 PMCID: PMC11012614 DOI: 10.1093/noajnl/vdae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Glioblastoma is an aggressive and incurable brain cancer. This cancer establishes both local and systemic immunosuppression that creates a major obstacle to effective immunotherapies. Many studies point to tumor-resident myeloid cells (primarily microglia and macrophages) as key mediators of this immunosuppression. Myeloid cells exhibit a high level of plasticity with respect to their phenotype and are capable of both stimulating and repressing immune responses. How glioblastomas recruit myeloid cells and exploit them to avoid the immune system is an active area of research. Macrophages can acquire an immunosuppressive phenotype as a consequence of exposure to cytokines such as TGFB1 or IL4; in addition, macrophages can acquire an immunosuppressive phenotype as a consequence of the engulfment of apoptotic cells, a process referred to as efferocytosis. There is substantial evidence that glioblastoma cells are able to secrete cytokines and other factors that induce an immunosuppressive phenotype in macrophages and microglia. However, less is known about the contribution of efferocytosis to immunosuppression in glioblastoma. Here I review the literature in this area and discuss the potential of efferocytosis inhibition to improve glioblastoma response to immunotherapy.
Collapse
Affiliation(s)
- Ian A J Lorimer
- Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
13
|
Shinada M, Suzuki H, Hanyu M, Igarashi C, Matsumoto H, Takahashi M, Hihara F, Tachibana T, Sogawa C, Zhang MR, Higashi T, Sato H, Kurihara H, Yoshii Y, Doi Y. Trace Metal Impurities Effects on the Formation of [ 64Cu]Cu-diacetyl-bis( N4-methylthiosemicarbazone) ([ 64Cu]Cu-ATSM). Pharmaceuticals (Basel) 2023; 17:10. [PMID: 38275997 PMCID: PMC10821298 DOI: 10.3390/ph17010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
[64Cu]Cu-diacetyl-bis(N4-methylthiosemicarbazone) ([64Cu]Cu-ATSM) is a radioactive hypoxia-targeting therapeutic agent being investigated in clinical trials for malignant brain tumors. For the quality management of [64Cu]Cu-ATSM, understanding trace metal impurities' effects on the chelate formation of 64Cu and ATSM is important. In this study, we conducted coordination chemistry studies on metal-ATSM complexes. First, the effects of nonradioactive metal ions (Cu2+, Ni2+, Zn2+, and Fe2+) on the formation of [64Cu]Cu-ATSM were evaluated. When the amount of Cu2+ or Ni2+ added was 1.2 mol or 288 mol, equivalent to ATSM, the labeling yield of [64Cu]Cu-ATSM fell below 90%. Little effect was observed even when excess amounts of Zn2+ or Fe2+ were added to the ATSM. Second, these metals were reacted with ATSM, and chelate formation was measured using ultraviolet-visible (UV-Vis) absorption spectra. UV-Vis spectra showed a rapid formation of Cu2+ and the ATSM complex upon mixing. The rate of chelate formation by Ni2+ and ATSM was lower than that by Cu-ATSM. Zn2+ and Fe2+ showed much slower reactions with the ATSM than Ni2+. Trace amounts of Ni2+, Zn2+, and Fe2+ showed little effect on [64Cu]Cu-ATSM' quality, while the concentration of impurity Cu2+ must be controlled. These results can provide process management tools for radiopharmaceuticals.
Collapse
Affiliation(s)
- Mitsuhiro Shinada
- Faculty of Science, Toho University, Funabashi 274-8510, Japan; (M.T.); (T.T.); (Y.D.)
- Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan; (H.S.); (M.H.); (C.I.); (H.M.); (F.H.); (C.S.); (M.-R.Z.); (T.H.)
- Kanagawa Cancer Center, Kanagawa 241-8515, Japan; (H.S.); (H.K.)
| | - Hisashi Suzuki
- Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan; (H.S.); (M.H.); (C.I.); (H.M.); (F.H.); (C.S.); (M.-R.Z.); (T.H.)
| | - Masayuki Hanyu
- Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan; (H.S.); (M.H.); (C.I.); (H.M.); (F.H.); (C.S.); (M.-R.Z.); (T.H.)
| | - Chika Igarashi
- Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan; (H.S.); (M.H.); (C.I.); (H.M.); (F.H.); (C.S.); (M.-R.Z.); (T.H.)
- Kanagawa Cancer Center, Kanagawa 241-8515, Japan; (H.S.); (H.K.)
| | - Hiroki Matsumoto
- Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan; (H.S.); (M.H.); (C.I.); (H.M.); (F.H.); (C.S.); (M.-R.Z.); (T.H.)
- Kanagawa Cancer Center, Kanagawa 241-8515, Japan; (H.S.); (H.K.)
| | - Masashi Takahashi
- Faculty of Science, Toho University, Funabashi 274-8510, Japan; (M.T.); (T.T.); (Y.D.)
- Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan; (H.S.); (M.H.); (C.I.); (H.M.); (F.H.); (C.S.); (M.-R.Z.); (T.H.)
| | - Fukiko Hihara
- Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan; (H.S.); (M.H.); (C.I.); (H.M.); (F.H.); (C.S.); (M.-R.Z.); (T.H.)
| | - Tomoko Tachibana
- Faculty of Science, Toho University, Funabashi 274-8510, Japan; (M.T.); (T.T.); (Y.D.)
- Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan; (H.S.); (M.H.); (C.I.); (H.M.); (F.H.); (C.S.); (M.-R.Z.); (T.H.)
| | - Chizuru Sogawa
- Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan; (H.S.); (M.H.); (C.I.); (H.M.); (F.H.); (C.S.); (M.-R.Z.); (T.H.)
| | - Ming-Rong Zhang
- Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan; (H.S.); (M.H.); (C.I.); (H.M.); (F.H.); (C.S.); (M.-R.Z.); (T.H.)
| | - Tatsuya Higashi
- Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan; (H.S.); (M.H.); (C.I.); (H.M.); (F.H.); (C.S.); (M.-R.Z.); (T.H.)
| | - Hidemitsu Sato
- Kanagawa Cancer Center, Kanagawa 241-8515, Japan; (H.S.); (H.K.)
| | - Hiroaki Kurihara
- Kanagawa Cancer Center, Kanagawa 241-8515, Japan; (H.S.); (H.K.)
| | - Yukie Yoshii
- Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan; (H.S.); (M.H.); (C.I.); (H.M.); (F.H.); (C.S.); (M.-R.Z.); (T.H.)
- Kanagawa Cancer Center, Kanagawa 241-8515, Japan; (H.S.); (H.K.)
| | - Yoshihiro Doi
- Faculty of Science, Toho University, Funabashi 274-8510, Japan; (M.T.); (T.T.); (Y.D.)
| |
Collapse
|
14
|
Slika H, Karimov Z, Alimonti P, Abou-Mrad T, De Fazio E, Alomari S, Tyler B. Preclinical Models and Technologies in Glioblastoma Research: Evolution, Current State, and Future Avenues. Int J Mol Sci 2023; 24:16316. [PMID: 38003507 PMCID: PMC10671665 DOI: 10.3390/ijms242216316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Glioblastoma is the most common malignant primary central nervous system tumor and one of the most debilitating cancers. The prognosis of patients with glioblastoma remains poor, and the management of this tumor, both in its primary and recurrent forms, remains suboptimal. Despite the tremendous efforts that are being put forward by the research community to discover novel efficacious therapeutic agents and modalities, no major paradigm shifts have been established in the field in the last decade. However, this does not mirror the abundance of relevant findings and discoveries made in preclinical glioblastoma research. Hence, developing and utilizing appropriate preclinical models that faithfully recapitulate the characteristics and behavior of human glioblastoma is of utmost importance. Herein, we offer a holistic picture of the evolution of preclinical models of glioblastoma. We further elaborate on the commonly used in vitro and vivo models, delving into their development, favorable characteristics, shortcomings, and areas of potential improvement, which aids researchers in designing future experiments and utilizing the most suitable models. Additionally, this review explores progress in the fields of humanized and immunotolerant mouse models, genetically engineered animal models, 3D in vitro models, and microfluidics and highlights promising avenues for the future of preclinical glioblastoma research.
Collapse
Affiliation(s)
- Hasan Slika
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (H.S.); (Z.K.); (S.A.)
| | - Ziya Karimov
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (H.S.); (Z.K.); (S.A.)
- Faculty of Medicine, Ege University, 35100 Izmir, Turkey
| | - Paolo Alimonti
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (P.A.); (E.D.F.)
| | - Tatiana Abou-Mrad
- Faculty of Medicine, American University of Beirut, Beirut P.O. Box 11-0236, Lebanon;
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Emerson De Fazio
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy; (P.A.); (E.D.F.)
| | - Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (H.S.); (Z.K.); (S.A.)
| | - Betty Tyler
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (H.S.); (Z.K.); (S.A.)
| |
Collapse
|
15
|
Srivastava R, Dodda M, Zou H, Li X, Hu B. Tumor Niches: Perspectives for Targeted Therapies in Glioblastoma. Antioxid Redox Signal 2023; 39:904-922. [PMID: 37166370 PMCID: PMC10654996 DOI: 10.1089/ars.2022.0187] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 05/12/2023]
Abstract
Significance: Glioblastoma (GBM), the most common and lethal primary brain tumor with a median survival rate of only 15 months and a 5-year survival rate of only 6.8%, remains largely incurable despite the intensive multimodal treatment of surgical resection and radiochemotherapy. Developing effective new therapies is an unmet need for patients with GBM. Recent Advances: Targeted therapies, such as antiangiogenesis therapy and immunotherapy, show great promise in treating GBM based upon increasing knowledge about brain tumor biology. Single-cell transcriptomics reveals the plasticity, heterogeneity, and dynamics of tumor cells during GBM development and progression. Critical Issues: While antiangiogenesis therapy and immunotherapy have been highly effective in some types of cancer, the disappointing results from clinical trials represent continued challenges in applying these treatments to GBM. Molecular and cellular heterogeneity of GBM is developed temporally and spatially, which profoundly contributes to therapeutic resistance and tumor recurrence. Future Directions: Deciphering mechanisms of tumor heterogeneity and mapping tumor niche trajectories and functions will provide a foundation for the development of more effective therapies for GBM patients. In this review, we discuss five different tumor niches and the intercellular and intracellular communications among these niches, including the perivascular, hypoxic, invasive, immunosuppressive, and glioma-stem cell niches. We also highlight the cellular and molecular biology of these niches and discuss potential strategies to target these tumor niches for GBM therapy. Antioxid. Redox Signal. 39, 904-922.
Collapse
Affiliation(s)
- Rashmi Srivastava
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- John G. Rangos Sr. Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Meghana Dodda
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- John G. Rangos Sr. Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Han Zou
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- John G. Rangos Sr. Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Xuejun Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Changsha, China
| | - Baoli Hu
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- John G. Rangos Sr. Research Center, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Cancer Biology Program, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
16
|
Li D, Ren T, Wang X, Xiao Z, Sun G, Zhang N, Zhao L, Zhong R. Development and in vitro evaluation of carmustine delivery platform: A hypoxia-sensitive anti-drug resistant nanomicelle with BBB penetrating ability. Biomed Pharmacother 2023; 167:115631. [PMID: 37804814 DOI: 10.1016/j.biopha.2023.115631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/09/2023] Open
Abstract
Glioma is extremely difficult to be completely excised by surgery due to its invasive nature. Thus, chemotherapy still is the mainstay in the treatment of glioma after surgery. However, the natural blood-brain barrier (BBB) greatly restricts the penetration of chemotherapeutic agents into the central nervous system. As a front-line anti-glioma agent in clinical, carmustine (BCNU) exerts antitumor effect by inducing DNA damage at the O6 position of guanine. However, the therapeutic effect of BCNU was largely decreased because of the drug resistance mediated by O6-alkylguanine-DNA alkyltransferase (AGT) and insufficient local drug concentrations. To overcome these obstacles, we synthesized a BCNU-loaded hypoxia-responsive nano-micelle with BBB penetrating capacity and AGT inhibitory activity, named as T80-HA-AZO-BG/BCNU NPs. In this nano-system, Tween 80 (T80) serves as a functional coating on the surface of the micelle, promoting transportation across the BBB. Hyaluronic acid (HA) with active tumor-targeting capability was linked with the hydrophobic O6-benzylguanine (BG) analog via a hypoxia-sensitive azo bond. Under hypoxic tumor microenvironment, the azo bond selectively breaks to release O6-BG as AGT inhibitor and BCNU as DNA alkylating agent. The synthesized T80-HA-AZO-BG/BCNU NPs showed good stability, favorable biocompatibility and hypoxia-responsive drug-releasing ability. T80 modification improved the transportation of the micelle across an in vitro BBB model. Moreover, T80-HA-AZO-BG/BCNU NPs exhibited significantly enhanced cytotoxicity against glioma cell lines with high AGT expression compared with traditional combined medication of BCNU plus O6-BG. We expect that the tumor-targeting nano-micelle designed for chloroethylnitrosourea will provide new tools for the development of effective glioma therapy.
Collapse
Affiliation(s)
- Duo Li
- Beijing Key Laboratory of Environmental & Viral Oncology, Faculty of Environment & Life, Beijing University of Technology, Beijing 100124, China
| | - Ting Ren
- Beijing Key Laboratory of Environmental & Viral Oncology, Faculty of Environment & Life, Beijing University of Technology, Beijing 100124, China
| | - Xiaoli Wang
- Beijing Key Laboratory of Environmental & Viral Oncology, Faculty of Environment & Life, Beijing University of Technology, Beijing 100124, China
| | - Zhixuan Xiao
- Beijing Key Laboratory of Environmental & Viral Oncology, Faculty of Environment & Life, Beijing University of Technology, Beijing 100124, China
| | - Guohui Sun
- Beijing Key Laboratory of Environmental & Viral Oncology, Faculty of Environment & Life, Beijing University of Technology, Beijing 100124, China
| | - Na Zhang
- Beijing Key Laboratory of Environmental & Viral Oncology, Faculty of Environment & Life, Beijing University of Technology, Beijing 100124, China
| | - Lijiao Zhao
- Beijing Key Laboratory of Environmental & Viral Oncology, Faculty of Environment & Life, Beijing University of Technology, Beijing 100124, China.
| | - Rugang Zhong
- Beijing Key Laboratory of Environmental & Viral Oncology, Faculty of Environment & Life, Beijing University of Technology, Beijing 100124, China
| |
Collapse
|
17
|
Wirsching HG, Felsberg J, Prummer M, Moisoiu V, Lourman R, Hertler C, Antonios M, Cimino PJ, Roth P, Gorlia T, Prins RM, Cloughesy T, Wen PY, Holland EC, Reifenberger G, Weller M. Spatial immune profiling of glioblastoma identifies an inflammatory, perivascular phenotype associated with longer survival. Acta Neuropathol 2023; 146:647-649. [PMID: 37573572 PMCID: PMC10499942 DOI: 10.1007/s00401-023-02617-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Hans-Georg Wirsching
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, CH-8091, Zurich, Switzerland.
| | - Jörg Felsberg
- Institute of Neuropathology, Medical Faculty, Heinrich Heine University and University Hospital Düsseldorf, Düsseldorf, Germany
| | - Michael Prummer
- NEXUS Personalized Health Technologies and Swiss Institute of Bioinformatics, ETH Zurich, Zurich, Switzerland
| | - Vlad Moisoiu
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, CH-8091, Zurich, Switzerland
| | - Roxanne Lourman
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, CH-8091, Zurich, Switzerland
| | - Caroline Hertler
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Michelle Antonios
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, CH-8091, Zurich, Switzerland
| | - Patrick J Cimino
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Patrick Roth
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, CH-8091, Zurich, Switzerland
| | - Thierry Gorlia
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Robert M Prins
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Timothy Cloughesy
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Eric C Holland
- Human Biology Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Guido Reifenberger
- Institute of Neuropathology, Medical Faculty, Heinrich Heine University and University Hospital Düsseldorf, Düsseldorf, Germany
- Partner Site Essen/Düsseldorf, German Cancer Consortium (DKTK), Düsseldorf, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, CH-8091, Zurich, Switzerland
| |
Collapse
|
18
|
Tora MS, Neill SG, Lakhina Y, Assed H, Zhang M, Nagarajan PP, Federici T, Gutierrez J, Hoang KB, Du Y, Lei K, Boulis NM. Tumor microenvironment in a minipig model of spinal cord glioma. J Transl Med 2023; 21:667. [PMID: 37752585 PMCID: PMC10523785 DOI: 10.1186/s12967-023-04531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Spinal cord glioma (SCG) is considered an orphan disease that lacks effective treatment options with margins that are surgically inaccessible and an overall paucity of literature on the topic. The tumor microenvironment is a critical factor to consider in treatment and modeling design, especially with respect to the unresectable tumor edge. Recently, our group developed a high-grade spinal cord glioma (SCG) model in Göttingen minipigs. METHODS Immunofluorescence and ELISA were performed to explore the microenvironmental features and inflammation cytokines in this minipig SCG model. Protein carbonyl assay and GSH/GSSG assay were analyzed in the core and edge lesions in the minipig SCG model. The primary core and edge cells proliferation rate were shown in vitro, and the xenograft model in vivo. RESULTS We identified an elevated Ki-67 proliferative index, vascular and pericyte markers, CD31 and desmin in the tumor edge as compared to the tumor core. In addition, we found that the tumor edge demonstrated increased pro-inflammatory and gliomagenic cytokines including TNF-α, IL-1β, and IL-6. Furthermore, the mediation of oxidative stress is upregulated in the tumor edge. Hypoxic markers had statistically significant increased staining in the tumor core, but were notably still present in the tumor edge. The edge cells cultures derived from SCG biopsy also demonstrated an increased proliferative rate compared to core cell cultures in a xenotransplantation model. CONCLUSIONS Our study demonstrates heterogeneity in microenvironmental features in our minipig model of high-grade SCG, with a phenotype at the edge showing increased oxidative stress, proliferation, inflammatory cytokines, neovascularization, and decreased but present staining for hypoxic markers. These findings support the utility of this model as a means for investigating therapeutic approaches targeting the more aggressive and surgically unresectable tumor border.
Collapse
Affiliation(s)
- Muhibullah S Tora
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Stewart G Neill
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Yuliya Lakhina
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Hemza Assed
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Michelle Zhang
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Purva P Nagarajan
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Thais Federici
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Juanmarco Gutierrez
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Kimberly B Hoang
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Yuhong Du
- Department of Pharmacology and Chemical Biology, Emory Chemical Biology Discovery Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Kecheng Lei
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
| | - Nicholas M Boulis
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
| |
Collapse
|
19
|
Seystahl K, Martinez-Majander N, Salerno A, Beyeler M, Erdur H, Marto JP, Hametner C, Zedde M, Pezzini A, Leker R, Altersberger V, Costamagna G, Serôdio M, Migliaccio L, Pascarella R, Zini A, Mannismäki L, Béjot Y, Jung S, Gensicke H, Padjen V, Ringleb PA, Nolte C, Heldner MR, Michel P, Engelter ST, Curtze S, Weller M, Wegener S. IV Thrombolysis With or Without Endovascular Treatment for Suspected Ischemic Stroke in Patients With Intracranial Tumors. Neurology 2023; 101:e1241-e1255. [PMID: 37463747 PMCID: PMC10516283 DOI: 10.1212/wnl.0000000000207624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/19/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES IV thrombolysis (IVT) for suspected ischemic stroke in patients with intracranial neoplasms is off-label. However, data on risks of intracranial hemorrhage (ICH) are scarce. METHODS In a multicenter registry-based analysis within the European Thrombolysis in Ischemic Stroke Patients (TRISP) collaboration, we assessed frequencies of symptomatic and fatal ICH after IVT for suspected ischemic stroke in patients with intracranial tumors by descriptive statistics and analyzed associations with clinical and imaging characteristics by binary logistic regression. Definition of symptomatic ICH was based on the clinical criteria of the European Cooperative Acute Stroke-II trial including hemorrhage at any site in cranial imaging and concurrent clinical deterioration. RESULTS Screening data of 21,289 patients from 14 centers, we identified 105 patients receiving IVT; among them were 29 patients (28%) with additional endovascular treatment, with suspected, that is, imaging-based, or histologically confirmed diagnosis of intracranial tumors. Among 104 patients with CT or MRI after IVT available, symptomatic and fatal ICH were observed in 9 and 4 patients (9% and 4%, respectively). Among 82 patients with suspected or confirmed meningioma, symptomatic and fatal ICH occurred in 6 and 3 patients (7% and 4%), respectively. In 18 patients with intra-axial suspected or confirmed primary or secondary brain tumors, there was 1 symptomatic nonfatal ICH (6%). Of 4 patients with tumors of the pituitary region, 2 patients (50%) had symptomatic ICH including 1 fatal ICH (25%). Tumor size was not associated with the occurrence of symptomatic ICH (odds ratio 2.8, 95% CI 0.3-24.8, p = 0.34). DISCUSSION In our dataset from routine clinical care, we provide insights on the safety of IVT for suspected ischemic stroke in patients with intracranial tumors, a population that is commonly withheld thrombolysis in clinical practice and prospective trials. Except for a potential high risk of symptomatic ICH after IVT in patients with tumors of the pituitary region, frequencies of symptomatic ICH in patients with intracranial tumors in our cohort seem to be in the upper range of rates observed in previous studies within the TRISP cooperation. These results may guide individual treatment decisions in patients with acute stroke and intracranial tumors with potential benefit of IVT.
Collapse
Affiliation(s)
- Katharina Seystahl
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland.
| | - Nicolas Martinez-Majander
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Alexander Salerno
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Morin Beyeler
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Hebun Erdur
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - João Pedro Marto
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Christian Hametner
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Marialuisa Zedde
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Alessandro Pezzini
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Ronen Leker
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Valerian Altersberger
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Gianluca Costamagna
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Miguel Serôdio
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Ludovica Migliaccio
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Rosario Pascarella
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Andrea Zini
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Laura Mannismäki
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Yannick Béjot
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Simon Jung
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Henrik Gensicke
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Visnja Padjen
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Peter A Ringleb
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Christian Nolte
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Mirjam R Heldner
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Patrik Michel
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Stefan T Engelter
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Sami Curtze
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Michael Weller
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| | - Susanne Wegener
- From the Department of Neurology (K.S., M.W., S.W.), Clinical Neuroscience Center, University Hospital and University of Zurich, Switzerland; Department of Neurology (N.M.-M., L. Mannismäki, S.C.), University of Helsinki and Helsinki University Hospital, Finland; Stroke Center (A.S., G.C., P.M.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; Department of Neurology (M.B., S.J., M.R.H.), Inselspital, Bern University Hospital and University of Bern; Graduate School for Health Sciences (M.B.), University of Bern, Switzerland; Department of Neurology (H.E., C.N.), Charité-Universitaetsmedizin Berlin; Center for Stroke Research (CSB) (H.E., C.N.), Berlin; and Berlin Institute of Health (BIH) (H.E., C.N.), Germany; Department of Neurology (J.P.M., M.S.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal; Department of Neurology (C.H., P.A.R.), University Hospital Heidelberg, Germany; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Neurology Unit, ASST Spedali Civili, Italy; Department of Neurology (R.L.), Hebrew University Hadassah Medical Center, Jerusalem, Israel; Stroke Center and Department of Neurology (V.A., H.G., S.T.E.), University Hospital Basel and University of Basel, Switzerland; IRCCS Istituto Delle Scienze Neurologiche Di Bologna (L. Migliaccio, A.Z.), Department of Neurology and Stroke Center, Maggiore Hospital, Bologna; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria Locale di Reggio Emilia, Italy; Department of Neurology (Y.B.), University Hospital Dijon, France; Neurology Clinic (V.P.), University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia; Department of Neurology and Neurorehabilitation (S.T.E.), Center for Medicine of Aging and Rehabilitation, University of Basel and University, Felix Platter Hospital, Switzerland
| |
Collapse
|
20
|
Furuta T, Negoto T, Miyoshi H, Moritsubo M, Nakamura H, Morioka M, Akiba J, Ohshima K, Sugita Y. Intratumoral thrombosis as a histological biomarker for predicting epidermal growth factor receptor alteration and poor prognosis in patients with glioblastomas. J Neurooncol 2023; 164:633-641. [PMID: 37710025 DOI: 10.1007/s11060-023-04447-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE Intratumoral thrombosis is a specific finding in glioblastomas and considered the origin of palisading necrosis. Its distribution and contribution to the glioblastoma pathophysiology and systemic thrombosis are obscure, although deep vein thrombosis is a common complication in glioblastoma cases. METHODS Clinicopathological and genetic analyses were performed on 97 glioblastoma tissue specimens to elucidate the role of thrombotic events and associated molecular abnormalities. RESULTS Morphologically, intratumoral thrombosis was observed more frequently in vessels composed of single-layered CD34-positive endothelium and/or αSMA-positive pericytes in the tumor periphery, compared to microvascular proliferation with multi-channeled and pericyte-proliferating vessels in the tumor center. Intratumoral thrombosis was significantly correlated with the female sex, high preoperative D-dimer levels, and epidermal growth factor receptor (EGFR) amplification. The presence of one or more thrombi in 20 high-power fields was a predictive marker of EGFR amplification, with a sensitivity of 81.5% and specificity of 52.6%. RNA sequencing demonstrated that the group with many thrombi had higher EGFR gene expression levels than the group with few thrombi. The tumor cells invading along the vessels in the tumor periphery were positive for wild-type EGFR but negative for EGFRvIII, whereas the cells around the microvascular proliferation (MVP) in the tumor center were positive for both wild-type EGFR and EGFRvIII. Intratumoral thrombosis is an independent poor prognostic factor. CONCLUSIONS Aberrant but exquisitely regulated EGFR can induce thrombosis in non-MVP vessels in the tumor invasion area and then promote palisading necrosis, followed by hypoxia, abnormal angiogenesis, and further tumor cell invasion.
Collapse
Affiliation(s)
- Takuya Furuta
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan.
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan.
- Department of Pathology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Tetsuya Negoto
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Hiroaki Miyoshi
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Mayuko Moritsubo
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Hideo Nakamura
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Jun Akiba
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Yasuo Sugita
- Department of Neuropathology, St. Mary's Hospital, Kurume, Japan
| |
Collapse
|
21
|
Dzhalilova DS, Zolotova NA, Mkhitarov VA, Kosyreva AM, Tsvetkov IS, Khalansky AS, Alekseeva AI, Fatkhudinov TH, Makarova OV. Morphological and molecular-biological features of glioblastoma progression in tolerant and susceptible to hypoxia Wistar rats. Sci Rep 2023; 13:12694. [PMID: 37542119 PMCID: PMC10403616 DOI: 10.1038/s41598-023-39914-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/02/2023] [Indexed: 08/06/2023] Open
Abstract
Hypoxia is a major pathogenetic factor in many cancers. Individual resistance to suboptimal oxygen availability is subject to broad variation and its possible role in tumorigenesis remains underexplored. This study aimed at specific characterization of glioblastoma progression in male tolerant and susceptible to hypoxia Wistar rats. Hypoxia resistance was assessed by gasping time measurement in an 11,500 m altitude-equivalent hypobaric decompression chamber. Based on the outcome, the animals were assigned to three groups termed 'tolerant to hypoxia' (n = 13), 'normal', and 'susceptible to hypoxia' (n = 24). The 'normal' group was excluded from subsequent experiments. One month later, the animals underwent inoculation with rat glioblastoma 101.8 followed by monitoring of survival, body weight dynamics and neurological symptoms. The animals were sacrificed on post-inoculation days 11 (subgroup 1) and 15 (subgroup 2). Relative vessels number, necrosis areas and Ki-67 index were assessed microscopically; tumor volumes were determined by 3D reconstruction from histological images; serum levels of HIF-1α, IL-1β, and TNFα were determined by ELISA. None of the tolerant to hypoxia animals died of the disease during observation period, cf. 85% survival on day 11 and 55% survival on day 15 in the susceptible group. On day 11, proliferative activity of the tumors in the tolerant animals was higher compared with the susceptible group. On day 15, proliferative activity, necrosis area and volume of the tumors in the tolerant to hypoxia animals were higher compared with the susceptible group. ELISA revealed no dynamics in TNFα levels, elevated levels of IL-1β in the susceptible animals on day 15 in comparison with day 11 and tolerant ones. Moreover, there were elevated levels of HIF-1α in the tolerant animals on day 15 in comparison with day 11. Thus, the proliferative activity of glioblastoma cells and the content of HIF-1α were higher in tolerant to hypoxia rats, but the mortality associated with the tumor process and IL-1β level in them were lower than in susceptible animals. Specific features of glioblastoma 101.8 progression in tolerant and susceptible to hypoxia rats, including survival, tumor growth rates and IL-1β level, can become the basis of new personalized approaches for cancer diseases treatment in accordance to individual hypoxia resistance.
Collapse
Affiliation(s)
- D Sh Dzhalilova
- Avtsyn Research Institute of Human Morphology of Federal State Budgetary Scientific Institution "Petrovsky National Research Centre of Surgery", 3 Tsyurupy Street, Moscow, Russia, 117418.
| | - N A Zolotova
- Avtsyn Research Institute of Human Morphology of Federal State Budgetary Scientific Institution "Petrovsky National Research Centre of Surgery", 3 Tsyurupy Street, Moscow, Russia, 117418
| | - V A Mkhitarov
- Avtsyn Research Institute of Human Morphology of Federal State Budgetary Scientific Institution "Petrovsky National Research Centre of Surgery", 3 Tsyurupy Street, Moscow, Russia, 117418
| | - A M Kosyreva
- Avtsyn Research Institute of Human Morphology of Federal State Budgetary Scientific Institution "Petrovsky National Research Centre of Surgery", 3 Tsyurupy Street, Moscow, Russia, 117418
- Research Institute of Molecular and Cellular Medicine, RUDN University, 6 Miklukho-Maklaya St, Moscow, Russia, 117198
| | - I S Tsvetkov
- Avtsyn Research Institute of Human Morphology of Federal State Budgetary Scientific Institution "Petrovsky National Research Centre of Surgery", 3 Tsyurupy Street, Moscow, Russia, 117418
| | - A S Khalansky
- Avtsyn Research Institute of Human Morphology of Federal State Budgetary Scientific Institution "Petrovsky National Research Centre of Surgery", 3 Tsyurupy Street, Moscow, Russia, 117418
| | - A I Alekseeva
- Avtsyn Research Institute of Human Morphology of Federal State Budgetary Scientific Institution "Petrovsky National Research Centre of Surgery", 3 Tsyurupy Street, Moscow, Russia, 117418
| | - T H Fatkhudinov
- Avtsyn Research Institute of Human Morphology of Federal State Budgetary Scientific Institution "Petrovsky National Research Centre of Surgery", 3 Tsyurupy Street, Moscow, Russia, 117418
- Research Institute of Molecular and Cellular Medicine, RUDN University, 6 Miklukho-Maklaya St, Moscow, Russia, 117198
| | - O V Makarova
- Avtsyn Research Institute of Human Morphology of Federal State Budgetary Scientific Institution "Petrovsky National Research Centre of Surgery", 3 Tsyurupy Street, Moscow, Russia, 117418
| |
Collapse
|
22
|
Dreyer CA, VanderVorst K, Natwick D, Bell G, Sood P, Hernandez M, Angelastro JM, Collins SR, Carraway KL. A complex of Wnt/planar cell polarity signaling components Vangl1 and Fzd7 drives glioblastoma multiforme malignant properties. Cancer Lett 2023; 567:216280. [PMID: 37336284 PMCID: PMC10582999 DOI: 10.1016/j.canlet.2023.216280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023]
Abstract
Targeting common oncogenic drivers of glioblastoma multiforme (GBM) in patients has remained largely ineffective, raising the possibility that alternative pathways may contribute to tumor aggressiveness. Here we demonstrate that Vangl1 and Fzd7, components of the non-canonical Wnt planar cell polarity (Wnt/PCP) signaling pathway, promote GBM malignancy by driving cellular proliferation, migration, and invasiveness, and engage Rho GTPases to promote cytoskeletal rearrangements and actin dynamics in migrating GBM cells. Mechanistically, we uncover the existence of a novel Vangl1/Fzd7 complex at the leading edge of migrating GBM cells and propose that this complex is critical for the recruitment of downstream effectors to promote tumor progression. Moreover, we observe that depletion of FZD7 results in a striking suppression of tumor growth and latency and extends overall survival in an intracranial mouse xenograft model. Our observations support a novel mechanism by which Wnt/PCP components Vangl1 and Fzd7 form a complex at the leading edge of migratory GBM cells to engage downstream effectors that promote actin cytoskeletal rearrangements dynamics. Our findings suggest that interference with Wnt/PCP pathway function may offer a novel therapeutic strategy for patients diagnosed with GBM.
Collapse
Affiliation(s)
- Courtney A Dreyer
- Department of Biochemistry and Molecular Medicine and University of California Davis Comprehensive Cancer Center, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Kacey VanderVorst
- Department of Biochemistry and Molecular Medicine and University of California Davis Comprehensive Cancer Center, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Dean Natwick
- Department of Microbiology and Molecular Genetics, University of California Davis, Davis, CA, USA
| | - George Bell
- Department of Microbiology and Molecular Genetics, University of California Davis, Davis, CA, USA
| | - Prachi Sood
- Department of Biochemistry and Molecular Medicine and University of California Davis Comprehensive Cancer Center, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Maria Hernandez
- Department of Biochemistry and Molecular Medicine and University of California Davis Comprehensive Cancer Center, University of California Davis School of Medicine, Sacramento, CA, USA
| | - James M Angelastro
- Department of Molecular Biosciences, University of California Davis School of Veterinary Medicine, Davis, CA, USA
| | - Sean R Collins
- Department of Microbiology and Molecular Genetics, University of California Davis, Davis, CA, USA
| | - Kermit L Carraway
- Department of Biochemistry and Molecular Medicine and University of California Davis Comprehensive Cancer Center, University of California Davis School of Medicine, Sacramento, CA, USA.
| |
Collapse
|
23
|
Wang X, Sun Y, Zhang DY, Ming GL, Song H. Glioblastoma modeling with 3D organoids: progress and challenges. OXFORD OPEN NEUROSCIENCE 2023; 2:kvad008. [PMID: 38596241 PMCID: PMC10913843 DOI: 10.1093/oons/kvad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Glioblastoma (GBM) is the most aggressive adult primary brain tumor with nearly universal treatment resistance and recurrence. The mainstay of therapy remains maximal safe surgical resection followed by concurrent radiation therapy and temozolomide chemotherapy. Despite intensive investigation, alternative treatment options, such as immunotherapy or targeted molecular therapy, have yielded limited success to achieve long-term remission. This difficulty is partly due to the lack of pre-clinical models that fully recapitulate the intratumoral and intertumoral heterogeneity of GBM and the complex tumor microenvironment. Recently, GBM 3D organoids originating from resected patient tumors, genetic manipulation of induced pluripotent stem cell (iPSC)-derived brain organoids and bio-printing or fusion with non-malignant tissues have emerged as novel culture systems to portray the biology of GBM. Here, we highlight several methodologies for generating GBM organoids and discuss insights gained using such organoid models compared to classic modeling approaches using cell lines and xenografts. We also outline limitations of current GBM 3D organoids, most notably the difficulty retaining the tumor microenvironment, and discuss current efforts for improvements. Finally, we propose potential applications of organoid models for a deeper mechanistic understanding of GBM and therapeutic development.
Collapse
Affiliation(s)
- Xin Wang
- Department of Neuroscience and Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yusha Sun
- Neuroscience Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Daniel Y Zhang
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Guo-li Ming
- Department of Neuroscience and Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Institute for Regenerative Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hongjun Song
- Department of Neuroscience and Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Institute for Regenerative Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- The Epigenetics Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- GBM Translational Center of Excellence, Abramson Cancer Center, University of Pennsylvania Philadelphia, PA 19104, USA
| |
Collapse
|
24
|
Rodriguez SMB, Kamel A, Ciubotaru GV, Onose G, Sevastre AS, Sfredel V, Danoiu S, Dricu A, Tataranu LG. An Overview of EGFR Mechanisms and Their Implications in Targeted Therapies for Glioblastoma. Int J Mol Sci 2023; 24:11110. [PMID: 37446288 DOI: 10.3390/ijms241311110] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Despite all of the progress in understanding its molecular biology and pathogenesis, glioblastoma (GBM) is one of the most aggressive types of cancers, and without an efficient treatment modality at the moment, it remains largely incurable. Nowadays, one of the most frequently studied molecules with important implications in the pathogenesis of the classical subtype of GBM is the epidermal growth factor receptor (EGFR). Although many clinical trials aiming to study EGFR targeted therapies have been performed, none of them have reported promising clinical results when used in glioma patients. The resistance of GBM to these therapies was proven to be both acquired and innate, and it seems to be influenced by a cumulus of factors such as ineffective blood-brain barrier penetration, mutations, heterogeneity and compensatory signaling pathways. Recently, it was shown that EGFR possesses kinase-independent (KID) pro-survival functions in cancer cells. It seems imperative to understand how the EGFR signaling pathways function and how they interconnect with other pathways. Furthermore, it is important to identify the mechanisms of drug resistance and to develop better tailored therapeutic agents.
Collapse
Affiliation(s)
- Silvia Mara Baez Rodriguez
- Neurosurgical Department, Clinical Emergency Hospital "Bagdasar-Arseni", Soseaua Berceni 12, 041915 Bucharest, Romania
| | - Amira Kamel
- Neurosurgical Department, Clinical Emergency Hospital "Bagdasar-Arseni", Soseaua Berceni 12, 041915 Bucharest, Romania
| | - Gheorghe Vasile Ciubotaru
- Neurosurgical Department, Clinical Emergency Hospital "Bagdasar-Arseni", Soseaua Berceni 12, 041915 Bucharest, Romania
| | - Gelu Onose
- Neuromuscular Rehabilitation Department, Clinical Emergency Hospital "Bagdasar-Arseni", Soseaua Berceni 12, 041915 Bucharest, Romania
| | - Ani-Simona Sevastre
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Medicine and Pharmacy of Craiova, Str. Petru Rares nr. 2-4, 710204 Craiova, Romania
| | - Veronica Sfredel
- Department of Physiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Str. Petru Rares nr. 2-4, 710204 Craiova, Romania
| | - Suzana Danoiu
- Department of Physiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Str. Petru Rares nr. 2-4, 710204 Craiova, Romania
| | - Anica Dricu
- Department of Biochemistry, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Str. Petru Rares nr. 2-4, 710204 Craiova, Romania
| | - Ligia Gabriela Tataranu
- Neurosurgical Department, Clinical Emergency Hospital "Bagdasar-Arseni", Soseaua Berceni 12, 041915 Bucharest, Romania
- Department of Neurosurgery, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 020022 Bucharest, Romania
| |
Collapse
|
25
|
Castillo SP, Galvez-Cancino F, Liu J, Pollard SM, Quezada SA, Yuan Y. The tumour ecology of quiescence: Niches across scales of complexity. Semin Cancer Biol 2023; 92:139-149. [PMID: 37037400 DOI: 10.1016/j.semcancer.2023.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/06/2023] [Accepted: 04/08/2023] [Indexed: 04/12/2023]
Abstract
Quiescence is a state of cell cycle arrest, allowing cancer cells to evade anti-proliferative cancer therapies. Quiescent cancer stem cells are thought to be responsible for treatment resistance in glioblastoma, an aggressive brain cancer with poor patient outcomes. However, the regulation of quiescence in glioblastoma cells involves a myriad of intrinsic and extrinsic mechanisms that are not fully understood. In this review, we synthesise the literature on quiescence regulatory mechanisms in the context of glioblastoma and propose an ecological perspective to stemness-like phenotypes anchored to the contemporary concepts of niche theory. From this perspective, the cell cycle regulation is multiscale and multidimensional, where the niche dimensions extend to extrinsic variables in the tumour microenvironment that shape cell fate. Within this conceptual framework and powered by ecological niche modelling, the discovery of microenvironmental variables related to hypoxia and mechanosignalling that modulate proliferative plasticity and intratumor immune activity may open new avenues for therapeutic targeting of emerging biological vulnerabilities in glioblastoma.
Collapse
Affiliation(s)
- Simon P Castillo
- Centre for Evolution and Cancer & Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK
| | - Felipe Galvez-Cancino
- Immune Regulation and Tumor Immunotherapy Group, Cancer Immunology Unit, Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Jiali Liu
- Immune Regulation and Tumor Immunotherapy Group, Cancer Immunology Unit, Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Steven M Pollard
- Centre for Regenerative Medicine and Cancer Research UK Scotland Centre, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh EH16 4UU, UK
| | - Sergio A Quezada
- Immune Regulation and Tumor Immunotherapy Group, Cancer Immunology Unit, Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Yinyin Yuan
- Centre for Evolution and Cancer & Division of Molecular Pathology, The Institute of Cancer Research, London SM2 5NG, UK.
| |
Collapse
|
26
|
Allgood JE, Roe A, Sparks BB, Castillo M, Cruz A, Brooks AE, Brooks BD. The Correlation of Sleep Disturbance and Location of Glioma Tumors: A Narrative Review. J Clin Med 2023; 12:4058. [PMID: 37373751 DOI: 10.3390/jcm12124058] [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: 05/01/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Sleep disturbance can occur when sleep centers of the brain, regions that are responsible for coordinating and generating healthy amounts of sleep, are disrupted by glioma growth or surgical resection. Several disorders cause disruptions to the average duration, quality, or patterns of sleep, resulting in sleep disturbance. It is unknown whether specific sleep disorders can be reliably correlated with glioma growth, but there are sufficient numbers of case reports to suggest that a connection is possible. In this manuscript, these case reports and retrospective chart reviews are considered in the context of the current primary literature on sleep disturbance and glioma diagnosis to identify a new and useful connection which warrants further systematic and scientific examination in preclinical animal models. Confirmation of the relationship between disruption of the sleep centers in the brain and glioma location could have significant implications for diagnostics, treatment, monitoring of metastasis/recurrence, and end-of-life considerations.
Collapse
Affiliation(s)
- JuliAnne E Allgood
- Department of Neuroscience, University of Wyoming, Laramie, WY 82071, USA
| | - Avery Roe
- College of Osteopathic Medicine, Rocky Vista University, Greenwood Village, CO 80112, USA
| | - Bridger B Sparks
- Department of Neuroscience, University of Wyoming, Laramie, WY 82071, USA
| | - Mercedes Castillo
- College of Osteopathic Medicine, Rocky Vista University, Greenwood Village, CO 80112, USA
| | - Angel Cruz
- College of Osteopathic Medicine, Rocky Vista University, Greenwood Village, CO 80112, USA
| | - Amanda E Brooks
- College of Osteopathic Medicine, Rocky Vista University, Greenwood Village, CO 80112, USA
| | - Benjamin D Brooks
- College of Osteopathic Medicine, Rocky Vista University, Greenwood Village, CO 80112, USA
| |
Collapse
|
27
|
Athni Hiremath S, Surulescu C. Data driven modeling of pseudopalisade pattern formation. J Math Biol 2023; 87:4. [PMID: 37300719 DOI: 10.1007/s00285-023-01933-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 02/19/2023] [Accepted: 04/29/2023] [Indexed: 06/12/2023]
Abstract
Pseudopalisading is an interesting phenomenon where cancer cells arrange themselves to form a dense garland-like pattern. Unlike the palisade structure, a similar type of pattern first observed in schwannomas by pathologist J.J. Verocay (Wippold et al. in AJNR Am J Neuroradiol 27(10):2037-2041, 2006), pseudopalisades are less organized and associated with a necrotic region at their core. These structures are mainly found in glioblastoma (GBM), a grade IV brain tumor, and provide a way to assess the aggressiveness of the tumor. Identification of the exact bio-mechanism responsible for the formation of pseudopalisades is a difficult task, mainly because pseudopalisades seem to be a consequence of complex nonlinear dynamics within the tumor. In this paper we propose a data-driven methodology to gain insight into the formation of different types of pseudopalisade structures. To this end, we start from a state of the art macroscopic model for the dynamics of GBM, that is coupled with the dynamics of extracellular pH, and formulate a terminal value optimal control problem. Thus, given a specific, observed pseudopalisade pattern, we determine the evolution of parameters (bio-mechanisms) that are responsible for its emergence. Random histological images exhibiting pseudopalisade-like structures are chosen to serve as target pattern. Having identified the optimal model parameters that generate the specified target pattern, we then formulate two different types of pattern counteracting ansatzes in order to determine possible ways to impair or obstruct the process of pseudopalisade formation. This provides the basis for designing active or live control of malignant GBM. Furthermore, we also provide a simple, yet insightful, mechanism to synthesize new pseudopalisade patterns by linearly combining the optimal model parameters responsible for generating different known target patterns. This particularly provides a hint that complex pseudopalisade patterns could be synthesized by a linear combination of parameters responsible for generating simple patterns. Going even further, we ask ourselves if complex therapy approaches can be conceived, such that some linear combination thereof is able to reverse or disrupt simple pseudopalisade patterns; this is investigated with the help of numerical simulations.
Collapse
Affiliation(s)
- Sandesh Athni Hiremath
- Mechanical and Process Engineering, TU Kaiserslautern, Gottlieb-Daimler-Straße 42, 67663, Kaiserslautern, Rhineland-Palatinate, Germany.
| | - Christina Surulescu
- Felix-Klein-Zentrum für Mathematik, TU Kaiserslautern, Paul-Ehrlich-Str. 31, 67663, Kaiserslautern, Rhineland-Palatinate, Germany
| |
Collapse
|
28
|
Gillette JS, Wang EJ, Dowd RS, Toms SA. Barriers to overcoming immunotherapy resistance in glioblastoma. Front Med (Lausanne) 2023; 10:1175507. [PMID: 37275361 PMCID: PMC10232794 DOI: 10.3389/fmed.2023.1175507] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/12/2023] [Indexed: 06/07/2023] Open
Abstract
Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor, known for its poor prognosis and high recurrence rate. Current standard of care includes surgical resection followed by combined radiotherapy and chemotherapy. Although immunotherapies have yielded promising results in hematological malignancies, their successful application in GBM remains limited due to a host of immunosuppressive factors unique to GBM. As a result of these roadblocks, research efforts have focused on utilizing combinatorial immunotherapies that target networks of immune processes in GBM with promising results in both preclinical and clinical trials, although limitations in overcoming the immunosuppressive factors within GBM remain. In this review, we aim to discuss the intrinsic and adaptive immune resistance unique to GBM and to summarize the current evidence and outcomes of engineered and non-engineered treatments targeted at overcoming GBM resistance to immunotherapy. Additionally, we aim to highlight the most promising strategies of targeted GBM immunotherapy combinatorial treatments and the insights that may directly improve the current patient prognosis and clinical care.
Collapse
|
29
|
Knebel Doeberitz NV, Kroh F, Breitling J, König L, Maksimovic S, Graß S, Adeberg S, Scherer M, Unterberg A, Bendszus M, Wick W, Bachert P, Debus J, Ladd ME, Schlemmer HP, Korzowski A, Goerke S, Paech D. CEST Imaging of the APT and ssMT predict the overall survival of patients with glioma at the first follow-up after completion of radiotherapy at 3T. Radiother Oncol 2023; 184:109694. [PMID: 37150450 DOI: 10.1016/j.radonc.2023.109694] [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: 02/01/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND AND PURPOSE Outcome prediction of patients with glioma early after the completion of radiotherapy represents a major clinical challenge. Previously, the prognostic value of chemical exchange saturation transfer (CEST) imaging has been demonstrated in patients with newly diagnosed glioma. The objective of this study was to assess the potential of amide proton transfer (APT)-, relayed nuclear Overhauser effect (rNOE)- and semi-solid magnetization transfer (ssMT)-imaging according to Zhou et al. (APTwasym), Goerke et al. (MTRRexAPT, MTRRexNOE and MTRRexMT) and Mehrabian et al. (PeakAreaAPT, PeakAreaNOE and MTconst) for the prognostication of the overall survival (OS) of patients with glioma at the first follow-up after the completion of radiotherapy. MATERIALS AND METHODS 49 of 72 participants with diffuse glioma, who underwent CEST MRI at 3T between July 2018 and December 2021 4 to 6 weeks after the completion of radiotherapy, were analyzed. Contrast-enhancing tumor (CE) and whole tumor (WT) volumes were segmented on T2w-FLAIR and contrast-enhanced T1w images. Kaplan-Meier analysis and logrank-test were used for statistical analyses. RESULTS APTw imaging demonstrated the strongest association with OS (HR=4.66, p<0.001). The MTconst (HR=2.54, p=0.044) was associated with the OS of participants with residual contrast-enhancing glioma tissue, whilst the MTRRexAPT (HR=2.44, p=0.056) showed a trend in this sub-cohort. The MTRRexNOE, MTRRexMT and PeakAreaNOE were not associated with survival. CONCLUSION Imaging of the APT and ssMT at the first follow-up 4 to 6 weeks after the completion of radiotherapy at 3T were associated with the overall survival of patients with glioma.
Collapse
Affiliation(s)
| | - Florian Kroh
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Johannes Breitling
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Srdjan Maksimovic
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Svenja Graß
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Moritz Scherer
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Peter Bachert
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Mark E Ladd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Andreas Korzowski
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Steffen Goerke
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Paech
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Neuroradiology, University Hospital Bonn, Bonn, Germany.
| |
Collapse
|
30
|
Pawlowski KD, Duffy JT, Babak MV, Balyasnikova IV. Modeling glioblastoma complexity with organoids for personalized treatments. Trends Mol Med 2023; 29:282-296. [PMID: 36805210 PMCID: PMC11101135 DOI: 10.1016/j.molmed.2023.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/23/2022] [Accepted: 01/12/2023] [Indexed: 02/17/2023]
Abstract
Glioblastoma (GBM) remains a fatal diagnosis despite the current standard of care of maximal surgical resection, radiation, and temozolomide (TMZ) therapy. One aspect that impedes drug development is the lack of an appropriate model representative of the complexity of patient tumors. Brain organoids derived from cell culture techniques provide a robust, easily manipulatable, and high-throughput model for GBM. In this review, we highlight recent progress in developing GBM organoids (GBOs) with a focus on generating the GBM microenvironment (i.e., stem cells, vasculature, and immune cells) recapitulating human disease. Finally, we also discuss the use of organoids as a screening tool in drug development for GBM.
Collapse
Affiliation(s)
- Kristen D Pawlowski
- Rush Medical College, Rush University Medical Center, Chicago, IL 60612, USA; Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Joseph T Duffy
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Maria V Babak
- Drug Discovery Lab, Department of Chemistry, City University of Hong Kong, 83 Tat Chee Avenue, Hong Kong, SAR 999077, People's Republic of China.
| | - Irina V Balyasnikova
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
| |
Collapse
|
31
|
Aymeric A, Louis-Marie T, Gabrielle C, Vincent J, Benoit M, Romuald S, Evelyne E, Luc B, Vincent R, Jimmy V, Christophe J, Emmanuel M, Leslie L, Bertrand M, Pierre-Jean LR, Andres C, Antoine P, Valérie R, Karima M, Audrey R, Philippe M, Dominique FB, Guillaume G, Kaissar F, Johan P, Ilyess Z. Natural history of spinal cord metastasis from brain glioblastomas. J Neurooncol 2023; 162:373-382. [PMID: 36991306 DOI: 10.1007/s11060-023-04298-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/13/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Spinal cord metastasis arising from an intracranial glioblastoma is a rare and late event during the natural course of the disease. These pathological entities remain poorly characterized. This study aimed to identify and investigate the timeline, clinical and imaging findings, and prognostic factors of spinal cord metastasis from a glioblastoma. METHODS Consecutive histopathological cases of spinal cord metastasis from glioblastomas in adults entered in the French nationwide database between January 2004 and 2016 were screened. RESULTS Overall, 14 adult patients with a brain glioblastoma (median age 55.2 years) and harboring a spinal cord metastasis were included. The median overall survival as 16.0 months (range, 9.8-22.2). The median spinal cord Metastasis Free Survival (time interval between the glioblastoma diagnosis and the spinal cord metastasis diagnosis) was 13.6 months (range, 0.0-27.9). The occurrence of a spinal cord metastasis diagnosis greatly impacted neurological status: 57.2% of patients were not ambulatory, which contributed to dramatically decreased Karnofsky Performance Status (KPS) scores (12/14, 85.7% with a KPS score ≤ 70). The median overall survival following spinal cord metastasis was 3.3 months (range, 1.3-5.3). Patients with a cerebral ventricle effraction during the initial brain surgery had a shorter spinal cord Metastasis Free Survival (6.6 vs 18.3 months, p = 0.023). Out of the 14 patients, eleven (78.6%) had a brain IDH-wildtype glioblastoma. CONCLUSIONS Spinal cord metastasis from a brain IDH-wildtype glioblastoma has a poor prognosis. Spinal MRI can be proposed during the follow-up of glioblastoma patients especially those who have benefited from cerebral surgical resection with opening of the cerebral ventricles.
Collapse
Affiliation(s)
- Amelot Aymeric
- Department of Neurosurgery, CHRU de Tours, Tours, France.
- Service de Neurochirurgie, CHRU Bretonneau, 2 Boulevard Tonnellé, Tours Cedex 9, 37044, Tours, France.
| | - Terrier Louis-Marie
- Department of Neurosurgery, Clairval Private Hospital, Ramsay Generale de Sante, Marseille, France
| | - Cognacq Gabrielle
- University of Oxford, John Radcliffe HospitalHeadley Way, Headington, Oxford, OX3 9DU, Oxfordshire, United Kingdom
| | - Jecko Vincent
- Department of Neurosurgery A, CHU Pellegrin, Bordeaux, France
| | | | - Seizeur Romuald
- Department of Neurosurgery, CHU de La Cavale Blanche, Brest, France
| | - Emery Evelyne
- Department of Neurosurgery, CHU de Caen, Caen, France
| | - Bauchet Luc
- Department of Neurosurgery, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France
| | | | - Voirin Jimmy
- Department of Neurosurgery, Pasteur Hospital, HCC, Colmar, France
| | | | | | - Lemnos Leslie
- Department of Neurosurgery, CHU Dupuytren, Limoges, France
| | - Mathon Bertrand
- Department of Neurosurgery, CHU Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | | | - Coca Andres
- Department of Neurosurgery, CHU Strasbourg, Strasbourg, France
| | - Petit Antoine
- Department of Neurosurgery, CHU Jean-Minjoz, Besançon, France
| | - Rigau Valérie
- Department of Neuropathology, CHU Gui de Chauliac, Montpellier, France
| | - Mokhtari Karima
- Department of Neuropathology, Pitié-Salpêtrière, AP-HP, Paris, France
| | | | - Metellus Philippe
- Department of Neurosurgery, Clairval Private Hospital, Ramsay Generale de Sante, Marseille, France
| | | | | | - Farah Kaissar
- Department of Neurosurgery, CHU La Timone, Marseille, France
| | - Pallud Johan
- Department of Neurosurgery, GHU-Paris Psychiatrie Et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | | |
Collapse
|
32
|
Slavkova KP, Patel SH, Cacini Z, Kazerouni AS, Gardner AL, Yankeelov TE, Hormuth DA. Mathematical modelling of the dynamics of image-informed tumor habitats in a murine model of glioma. Sci Rep 2023; 13:2916. [PMID: 36804605 PMCID: PMC9941120 DOI: 10.1038/s41598-023-30010-6] [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: 09/13/2022] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
Tumors exhibit high molecular, phenotypic, and physiological heterogeneity. In this effort, we employ quantitative magnetic resonance imaging (MRI) data to capture this heterogeneity through imaging-based subregions or "habitats" in a murine model of glioma. We then demonstrate the ability to model and predict the growth of the habitats using coupled ordinary differential equations (ODEs) in the presence and absence of radiotherapy. Female Wistar rats (N = 21) were inoculated intracranially with 106 C6 glioma cells, a subset of which received 20 Gy (N = 5) or 40 Gy (N = 8) of radiation. All rats underwent diffusion-weighted and dynamic contrast-enhanced MRI at up to seven time points. All MRI data at each visit were subsequently clustered using k-means to identify physiological tumor habitats. A family of four models consisting of three coupled ODEs were developed and calibrated to the habitat time series of control and treated rats and evaluated for predictive capability. The Akaike Information Criterion was used for model selection, and the normalized sum-of-square-error (SSE) was used to evaluate goodness-of-fit in model calibration and prediction. Three tumor habitats with significantly different imaging data characteristics (p < 0.05) were identified: high-vascularity high-cellularity, low-vascularity high-cellularity, and low-vascularity low-cellularity. Model selection resulted in a five-parameter model whose predictions of habitat dynamics yielded SSEs that were similar to the SSEs from the calibrated model. It is thus feasible to mathematically describe habitat dynamics in a preclinical model of glioma using biology-based ODEs, showing promise for forecasting heterogeneous tumor behavior.
Collapse
Affiliation(s)
- Kalina P. Slavkova
- grid.89336.370000 0004 1936 9924Department of Physics, The University of Texas at Austin, Austin, TX USA
| | - Sahil H. Patel
- grid.67105.350000 0001 2164 3847 Department of Computer Science, Case Western Reserve University, Cleveland, OH USA
| | - Zachary Cacini
- grid.35403.310000 0004 1936 9991 Department of Bioengineering, University of Illinois, Urbana-Champaign, IL USA
| | - Anum S. Kazerouni
- grid.34477.330000000122986657Department of Radiology, The University of Washington, Seattle, WA USA
| | - Andrea L. Gardner
- grid.89336.370000 0004 1936 9924Department of Biomedical Engineering, The University of Texas at Austin, Austin, USA
| | - Thomas E. Yankeelov
- grid.89336.370000 0004 1936 9924Department of Biomedical Engineering, The University of Texas at Austin, Austin, USA ,grid.89336.370000 0004 1936 9924Department of Diagnostic Medicine, The University of Texas at Austin, Austin, TX USA ,grid.89336.370000 0004 1936 9924Department of Oncology, The University of Texas at Austin, Austin, TX USA ,grid.89336.370000 0004 1936 9924The Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, 201 E 24th Street, Austin, TX 78712 USA ,grid.89336.370000 0004 1936 9924Livestrong Cancer Institutes, The University of Texas at Austin, Austin, TX USA ,grid.240145.60000 0001 2291 4776Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - David A. Hormuth
- grid.89336.370000 0004 1936 9924The Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, 201 E 24th Street, Austin, TX 78712 USA ,grid.89336.370000 0004 1936 9924Livestrong Cancer Institutes, The University of Texas at Austin, Austin, TX USA
| |
Collapse
|
33
|
Forecasting Molecular Features in IDH-Wildtype Gliomas: The State of the Art of Radiomics Applied to Neurosurgery. Cancers (Basel) 2023; 15:cancers15030940. [PMID: 36765898 PMCID: PMC9913449 DOI: 10.3390/cancers15030940] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The fifth edition of the WHO Classification of Tumors of the Central Nervous System (CNS), published in 2021, marks a step forward the future diagnostic approach to these neoplasms. Alongside this, radiomics has experienced rapid evolution over the last several years, allowing us to correlate tumor imaging heterogeneity with a wide range of tumor molecular and subcellular features. Radiomics is a translational field focused on decoding conventional imaging data to extrapolate the molecular and prognostic features of tumors such as gliomas. We herein analyze the state-of-the-art of radiomics applied to glioblastoma, with the goal to estimate its current clinical impact and potential perspectives in relation to well-rounded patient management, including the end-of-life stage. METHODS A literature review was performed on the PubMed, MEDLINE and Scopus databases using the following search items: "radiomics and glioma", "radiomics and glioblastoma", "radiomics and glioma and IDH", "radiomics and glioma and TERT promoter", "radiomics and glioma and EGFR", "radiomics and glioma and chromosome". RESULTS A total of 719 articles were screened. Further quantitative and qualitative analysis allowed us to finally include 11 papers. This analysis shows that radiomics is rapidly evolving towards a reliable tool. CONCLUSIONS Further studies are necessary to adjust radiomics' potential to the newest molecular requirements pointed out by the 2021 WHO classification of CNS tumors. At a glance, its application in the clinical routine could be beneficial to achieve a timely diagnosis, especially for those patients not eligible for surgery and/or adjuvant therapies but still deserving palliative and supportive care.
Collapse
|
34
|
Giambra M, Di Cristofori A, Valtorta S, Manfrellotti R, Bigiogera V, Basso G, Moresco RM, Giussani C, Bentivegna A. The peritumoral brain zone in glioblastoma: where we are and where we are going. J Neurosci Res 2023; 101:199-216. [PMID: 36300592 PMCID: PMC10091804 DOI: 10.1002/jnr.25134] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/01/2022] [Accepted: 10/01/2022] [Indexed: 12/13/2022]
Abstract
Glioblastoma (GBM) is the most aggressive and invasive primary brain tumor. Current therapies are not curative, and patients' outcomes remain poor with an overall survival of 20.9 months after surgery. The typical growing pattern of GBM develops by infiltrating the surrounding apparent normal brain tissue within which the recurrence is expected to appear in the majority of cases. Thus, in the last decades, an increased interest has developed to investigate the cellular and molecular interactions between GBM and the peritumoral brain zone (PBZ) bordering the tumor tissue. The aim of this review is to provide up-to-date knowledge about the oncogenic properties of the PBZ to highlight possible druggable targets for more effective treatment of GBM by limiting the formation of recurrence, which is almost inevitable in the majority of patients. Starting from the description of the cellular components, passing through the illustration of the molecular profiles, we finally focused on more clinical aspects, represented by imaging and radiological details. The complete picture that emerges from this review could provide new input for future investigations aimed at identifying new effective strategies to eradicate this still incurable tumor.
Collapse
Affiliation(s)
- Martina Giambra
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,PhD Program in Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Andrea Di Cristofori
- PhD Program in Neuroscience, University of Milano-Bicocca, Monza, Italy.,Division of Neurosurgery, Azienda Socio Sanitaria Territoriale - Monza, Ospedale San Gerardo, Monza, Italy
| | - Silvia Valtorta
- Department of Nuclear Medicine, San Raffaele Scientific Institute, IRCCS, Milan, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Segrate, Italy.,NBFC, National Biodiversity Future Center, 90133, Palermo, Italy
| | - Roberto Manfrellotti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Division of Neurosurgery, Azienda Socio Sanitaria Territoriale - Monza, Ospedale San Gerardo, Monza, Italy
| | - Vittorio Bigiogera
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Gianpaolo Basso
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Rosa Maria Moresco
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Department of Nuclear Medicine, San Raffaele Scientific Institute, IRCCS, Milan, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Segrate, Italy
| | - Carlo Giussani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Division of Neurosurgery, Azienda Socio Sanitaria Territoriale - Monza, Ospedale San Gerardo, Monza, Italy
| | - Angela Bentivegna
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| |
Collapse
|
35
|
Changes in the histopathology and in the proteins related to the MAPK pathway in the brains of rats exposed to pre and postnatal radiofrequency radiation over four generations. J Chem Neuroanat 2022; 126:102187. [DOI: 10.1016/j.jchemneu.2022.102187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022]
|
36
|
Lam KHB, Faust K, Yin R, Fiala C, Diamandis P. The Brain Protein Atlas: A conglomerate of proteomics datasets of human neural tissue. Proteomics 2022; 22:e2200127. [PMID: 35971647 DOI: 10.1002/pmic.202200127] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/09/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022]
Abstract
The human brain represents one of the most complex biological structures with significant spatiotemporal molecular plasticity occurring through early development, learning, aging, and disease. While much progress has been made in mapping its transcriptional architecture, more downstream phenotypic readouts are relatively scarce due to limitations with tissue heterogeneity and accessibility, as well as an inability to amplify protein species prior to global -OMICS analysis. To address some of these barriers, our group has recently focused on using mass-spectrometry workflows compatible with small amounts of formalin-fixed paraffin-embedded tissue samples. This has enabled exploration into spatiotemporal proteomic signatures of the brain and disease across otherwise inaccessible neurodevelopmental timepoints and anatomical niches. Given the similar theme and approaches, we introduce an integrated online portal, "The Brain Protein Atlas (BPA)" (www.brainproteinatlas.org), representing a public resource that allows users to access and explore these amalgamated datasets. Specifically, this portal contains a growing set of peer-reviewed mass-spectrometry-based proteomic datasets, including spatiotemporal profiles of human cerebral development, diffuse gliomas, clinically aggressive meningiomas, and a detailed anatomic atlas of glioblastoma. One barrier to entry in mass spectrometry-based proteomics data analysis is the steep learning curve required to extract biologically relevant data. BPA, therefore, includes several built-in analytical tools to generate relevant plots (e.g., volcano plots, heatmaps, boxplots, and scatter plots) and evaluate the spatiotemporal patterns of proteins of interest. Future iterations aim to expand available datasets, including those generated by the community at large, and analytical tools for exploration. Ultimately, BPA aims to improve knowledge dissemination of proteomic information across the neuroscience community in hopes of accelerating the biological understanding of the brain and various maladies.
Collapse
Affiliation(s)
- K H Brian Lam
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada.,Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, United States of America
| | - Kevin Faust
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Richard Yin
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Clare Fiala
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Phedias Diamandis
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada.,Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
37
|
The diagnostic and prognostic potential of the EGFR/MUC4/MMP9 axis in glioma patients. Sci Rep 2022; 12:19868. [PMID: 36400876 PMCID: PMC9674618 DOI: 10.1038/s41598-022-24099-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022] Open
Abstract
Glioblastoma is the most aggressive form of brain cancer, presenting poor prognosis despite current advances in treatment. There is therefore an urgent need for novel biomarkers and therapeutic targets. Interactions between mucin 4 (MUC4) and the epidermal growth factor receptor (EGFR) are involved in carcinogenesis, and may lead to matrix metalloproteinase-9 (MMP9) overexpression, exacerbating cancer cell invasiveness. In this study, the role of MUC4, MMP9, and EGFR in the progression and clinical outcome of glioma patients was investigated. Immunohistochemistry (IHC) and immunofluorescence (IF) in fixed tissue samples of glioma patients were used to evaluate the expression and localization of EGFR, MMP9, and MUC4. Kaplan-Meier survival analysis was also performed to test the prognostic utility of the proteins for glioma patients. The protein levels were assessed with enzyme-linked immunosorbent assay (ELISA) in serum of glioma patients, to further investigate their potential as non-invasive serum biomarkers. We demonstrated that MUC4 and MMP9 are both significantly upregulated during glioma progression. Moreover, MUC4 is co-expressed with MMP9 and EGFR in the proliferative microvasculature of glioblastoma, suggesting a potential role for MUC4 in microvascular proliferation and angiogenesis. The combined high expression of MUC4/MMP9, and MUC4/MMP9/EGFR was associated with poor overall survival (OS). Finally, MMP9 mean protein level was significantly higher in the serum of glioblastoma compared with grade III glioma patients, whereas MUC4 mean protein level was minimally elevated in higher glioma grades (III and IV) compared with control. Our results suggest that MUC4, along with MMP9, might account for glioblastoma progression, representing potential therapeutic targets, and suggesting the 'MUC4/MMP9/EGFR axis' may play a vital role in glioblastoma diagnostics.
Collapse
|
38
|
Chung H, Seo H, Choi SH, Park CK, Kim TM, Park SH, Won JK, Lee JH, Lee ST, Lee JY, Hwang I, Kang KM, Yun TJ. Cluster Analysis of DSC MRI, Dynamic Contrast-Enhanced MRI, and DWI Parameters Associated with Prognosis in Patients with Glioblastoma after Removal of the Contrast-Enhancing Component: A Preliminary Study. AJNR Am J Neuroradiol 2022; 43:1559-1566. [PMID: 36175084 PMCID: PMC9731243 DOI: 10.3174/ajnr.a7655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/21/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE No report has been published on the use of DSC MR imaging, DCE MR imaging, and DWI parameters in combination to create a prognostic prediction model in glioblastoma patients. The aim of this study was to develop a machine learning-based model to find preoperative multiparametric MR imaging parameters associated with prognosis in patients with glioblastoma. Normalized CBV, volume transfer constant, and ADC of the nonenhancing T2 high-signal-intensity lesions were evaluated using K-means clustering. MATERIALS AND METHODS A total of 142 patients with glioblastoma who underwent preoperative MR imaging and total resection were included in this retrospective study. From the normalized CBV, volume transfer constant, and ADC maps, the parametric data were sorted using the K-means clustering method. Patients were divided into training and test sets (ratio, 1:1), and the optimal number of clusters was determined using receiver operating characteristic analysis. Kaplan-Meier survival analysis and log-rank tests were performed to identify potential parametric predictors. A multivariate Cox proportional hazard model was conducted to adjust for clinical predictors. RESULTS The nonenhancing T2 high-signal-intensity lesions were divided into 6 clusters. The cluster (class 4) with the relatively low normalized CBV and volume transfer constant value and the lowest ADC values was most associated with predicting glioblastoma prognosis. The optimal cutoff of the class 4 volume fraction of nonenhancing T2 high-signal-intensity lesions predicting 1-year progression-free survival was 9.70%, below which the cutoff was associated with longer progression-free survival. Two Kaplan-Meier curves based on the cutoff value showed a statistically significant difference (P = .037). When we adjusted for all clinical predictors, the cluster with the relatively low normalized CBV and volume transfer constant values and the lowest ADC value was an independent prognostic marker (hazard ratio, 3.04; P = .048). The multivariate Cox proportional hazard model showed a concordance index of 0.699 for progression-free survival. CONCLUSIONS Our model showed that nonenhancing T2 high-signal-intensity lesions with the relatively low normalized CBV, low volume transfer constant values, and the lowest ADC values could serve as useful prognostic imaging markers for predicting survival outcomes in patients with glioblastoma.
Collapse
Affiliation(s)
- H Chung
- From the Seoul National University College of Medicine (H.C., H.S.), Seoul, Korea
| | - H Seo
- From the Seoul National University College of Medicine (H.C., H.S.), Seoul, Korea
| | - S H Choi
- Department of Radiology (S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Center for Nanoparticle Research (S.H.C.), Institute for Basic Science, Seoul, Korea
- School of Chemical and Biological Engineering (S.H.C.), Seoul National University, Seoul, Korea
| | - C-K Park
- Department of Neurosurgery (C.-K.P.), Internal Medicine
| | - T M Kim
- Cancer Research Institute (T.M.K.)
| | - S-H Park
- Departments of Pathology (S.-H.P., J.K.W.), Radiation Oncology
| | - J K Won
- Departments of Pathology (S.-H.P., J.K.W.), Radiation Oncology
| | - J H Lee
- Cancer Research Institute (J.H.L.)
| | - S-T Lee
- Neurology (S.-T.L.), Seoul National University Hospital, Seoul, Korea
| | - J Y Lee
- Department of Radiology (S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - I Hwang
- Department of Radiology (S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - K M Kang
- Department of Radiology (S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - T J Yun
- Department of Radiology (S.H.C., J.Y.L., I.H., K.M.K., T.J.Y.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
39
|
Precise gliomas therapy: Hypoxia-activated prodrugs sensitized by nano-photosensitizers. Biomaterials 2022; 289:121770. [DOI: 10.1016/j.biomaterials.2022.121770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 11/18/2022]
|
40
|
Rocha JD, Uribe D, Delgado J, Niechi I, Alarcón S, Erices JI, Melo R, Fernández-Gajardo R, Salazar-Onfray F, San Martín R, Quezada Monrás C. A 2B Adenosine Receptor Enhances Chemoresistance of Glioblastoma Stem-Like Cells under Hypoxia: New Insights into MRP3 Transporter Function. Int J Mol Sci 2022; 23:ijms23169022. [PMID: 36012307 PMCID: PMC9409164 DOI: 10.3390/ijms23169022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/24/2022] Open
Abstract
Glioblastoma is the most common and aggressive primary brain tumor, characterized by its high chemoresistance and the presence of a cell subpopulation that persists under hypoxic niches, called glioblastoma stem-like cells (GSCs). The chemoresistance of GSCs is mediated in part by adenosine signaling and ABC transporters, which extrude drugs outside the cell, such as the multidrug resistance-associated proteins (MRPs) subfamily. Adenosine promotes MRP1-dependent chemoresistance under normoxia. However, adenosine/MRPs-dependent chemoresistance under hypoxia has not been studied until now. Transcript and protein levels were determined by RT-qPCR and Western blot, respectively. MRP extrusion capacity was determined by intracellular 5 (6)-Carboxyfluorescein diacetate (CFDA) accumulation. Cell viability was measured by MTS assays. Cell cycle and apoptosis were determined by flow cytometry. Here, we show for the first time that MRP3 expression is induced under hypoxia through the A2B adenosine receptor. Hypoxia enhances MRP-dependent extrusion capacity and the chemoresistance of GSCs. Meanwhile, MRP3 knockdown decreases GSC viability under hypoxia. Downregulation of the A2B receptor decreases MRP3 expression and chemosensibilizes GSCs treated with teniposide under hypoxia. These data suggest that hypoxia-dependent activation of A2B adenosine receptor promotes survival of GSCs through MRP3 induction.
Collapse
Affiliation(s)
- José-Dellis Rocha
- Instituto de Bioquímica y Microbiología, Facultad de Ciencias, Universidad Austral de Chile, Valdivia 5110566, Chile
| | - Daniel Uribe
- Instituto de Bioquímica y Microbiología, Facultad de Ciencias, Universidad Austral de Chile, Valdivia 5110566, Chile
| | - Javiera Delgado
- Instituto de Bioquímica y Microbiología, Facultad de Ciencias, Universidad Austral de Chile, Valdivia 5110566, Chile
| | - Ignacio Niechi
- Instituto de Bioquímica y Microbiología, Facultad de Ciencias, Universidad Austral de Chile, Valdivia 5110566, Chile
- Millennium Institute on Immunology and Immunotherapy, Universidad Austral de Chile, Valdivia 5090000, Chile
| | - Sebastián Alarcón
- Instituto de Bioquímica y Microbiología, Facultad de Ciencias, Universidad Austral de Chile, Valdivia 5110566, Chile
| | - José Ignacio Erices
- Instituto de Bioquímica y Microbiología, Facultad de Ciencias, Universidad Austral de Chile, Valdivia 5110566, Chile
- Millennium Institute on Immunology and Immunotherapy, Universidad Austral de Chile, Valdivia 5090000, Chile
| | - Rómulo Melo
- Servicio de Neurocirugía, Instituto de Neurocirugía Dr. Asenjo, Santiago 7500691, Chile
| | | | - Flavio Salazar-Onfray
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago 7500691, Chile
- Millennium Institute on Immunology and Immunotherapy, Facultad de Medicina, Universidad de Chile, Santiago 7500691, Chile
| | - Rody San Martín
- Instituto de Bioquímica y Microbiología, Facultad de Ciencias, Universidad Austral de Chile, Valdivia 5110566, Chile
| | - Claudia Quezada Monrás
- Instituto de Bioquímica y Microbiología, Facultad de Ciencias, Universidad Austral de Chile, Valdivia 5110566, Chile
- Millennium Institute on Immunology and Immunotherapy, Universidad Austral de Chile, Valdivia 5090000, Chile
- Correspondence: ; Tel.: +56-63-2221332
| |
Collapse
|
41
|
Hypoxia-induced HMGB1 promotes glioma stem cells self-renewal and tumorigenicity via RAGE. iScience 2022; 25:104872. [PMID: 36034219 PMCID: PMC9399482 DOI: 10.1016/j.isci.2022.104872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/10/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Glioma stem cells (GSCs) in the hypoxic niches contribute to tumor initiation, progression, and recurrence in glioblastoma (GBM). Hypoxia induces release of high-mobility group box 1 (HMGB1) from tumor cells, promoting the development of tumor. Here, we report that HMGB1 is overexpressed in human GBM specimens. Hypoxia promotes the expression and secretion of HMGB1 in GSCs. Furthermore, silencing HMGB1 results in the loss of stem cell markers and a reduction in self-renewal ability of GSCs. Additionally, HMGB1 knockdown inhibits the activation of RAGE-dependent ERK1/2 signaling pathway and arrests the cell cycle in GSCs. Consistently, FPS-ZM1, an inhibitor of RAGE, downregulates HMGB1 expression and the phosphorylation of ERK1/2, leading to a reduction in the proliferation of GSCs. In xenograft mice of GBM, HMGB1 knockdown inhibits tumor growth and promotes mouse survival. Collectively, these findings uncover a vital function for HMGB1 in regulating GSC self-renewal potential and tumorigenicity. Glioma stem cells overexpress HMGB1 in human glioblastoma Hypoxia induces the upregulation and release of HMGB1 in glioma stem cells HMGB1 promotes the self-renewal of glioma stem cells via RAGE Targeting HMGB1 inhibits the tumorigenesis of glioma stem cells
Collapse
|
42
|
Park S, Avera AD, Kim Y. BIOMANUFACTURING OF GLIOBLASTOMA ORGANOIDS EXHIBITING HIERARCHICAL AND SPATIALLY ORGANIZED TUMOR MICROENVIRONMENT VIA TRANSDIFFERENTIATION. Biotechnol Bioeng 2022; 119:3252-3274. [DOI: 10.1002/bit.28191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Seungjo Park
- Department of Chemical and Biological EngineeringThe University of AlabamaTuscaloosaAlabama
| | - Alexandra D. Avera
- Department of Chemical and Biological EngineeringThe University of AlabamaTuscaloosaAlabama
| | - Yonghyun Kim
- Department of Chemical and Biological EngineeringThe University of AlabamaTuscaloosaAlabama
| |
Collapse
|
43
|
Zhang T, Guo R, Li Y, Zhao Y, Li Y, Liang ZP. T 2 ' mapping of the brain from water-unsuppressed 1 H-MRSI and turbo spin-echo data. Magn Reson Med 2022; 88:2198-2207. [PMID: 35844075 DOI: 10.1002/mrm.29386] [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: 01/03/2022] [Revised: 06/14/2022] [Accepted: 06/22/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE To obtain high-quality T 2 ' $$ {\mathrm{T}}_2^{\prime } $$ maps of brain tissues from water-unsuppressed magnetic resonance spectroscopic imaging (MRSI) and turbo spin-echo (TSE) data. METHODS T 2 ' $$ {\mathrm{T}}_2^{\prime } $$ mapping can be achieved using T 2 * $$ {\mathrm{T}}_2^{\ast } $$ mapping from water-unsuppressed MRSI data and T 2 $$ {\mathrm{T}}_2 $$ mapping from TSE data. However, T 2 * $$ {\mathrm{T}}_2^{\ast } $$ mapping often suffers from signal dephasing and distortions caused by B 0 $$ {\mathrm{B}}_0 $$ field inhomogeneity; T 2 $$ {\mathrm{T}}_2 $$ measurements may be biased due to system imperfections, especially for T 2 $$ {\mathrm{T}}_2 $$ -weighted image with small number of TEs. In this work, we corrected the B 0 $$ {\mathrm{B}}_0 $$ field inhomogeneity effect on T 2 * $$ {\mathrm{T}}_2^{\ast } $$ mapping using a subspace model-based method, incorporating pre-learned spectral basis functions of the water signals. T 2 $$ {\mathrm{T}}_2 $$ estimation bias was corrected using a TE-adjustment method, which modeled the deviation between measured and reference T 2 $$ {\mathrm{T}}_2 $$ decays as TE shifts. RESULTS In vivo experiments were performed to evaluate the performance of the proposed method. High-quality T 2 * $$ {\mathrm{T}}_2^{\ast } $$ maps were obtained in the presence of large field inhomogeneity in the prefrontal cortex. Bias in T 2 $$ {\mathrm{T}}_2 $$ measurements obtained from TSE data was effectively reduced. Based on the T 2 * $$ {\mathrm{T}}_2^{\ast } $$ and T 2 $$ {\mathrm{T}}_2 $$ measurements produced by the proposed method, high-quality T 2 ' $$ {\mathrm{T}}_2^{\prime } $$ maps were obtained, along with neurometabolite maps, from MRSI and TSE data that were acquired in about 9 min. The results obtained from acute stroke and glioma patients demonstrated the feasibility of the proposed method in the clinical setting. CONCLUSIONS High-quality T 2 ' $$ {\mathrm{T}}_2^{\prime } $$ maps can be obtained from water-unsuppressed 1 H-MRSI and TSE data using the proposed method. With further development, this method may lay a foundation for simultaneously imaging oxygenation and neurometabolic alterations of brain disorders.
Collapse
Affiliation(s)
- Tianxiao Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Guo
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Yudu Li
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Yibo Zhao
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Yao Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi-Pei Liang
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| |
Collapse
|
44
|
Barajas RF, Ambady P, Link J, Krohn KA, Raslan A, Mallak N, Woltjer R, Muldoon L, Neuwelt EA. [ 18F]-fluoromisonidazole (FMISO) PET/MRI hypoxic fraction distinguishes neuroinflammatory pseudoprogression from recurrent glioblastoma in patients treated with pembrolizumab. Neurooncol Pract 2022; 9:246-250. [PMID: 35601969 PMCID: PMC9113243 DOI: 10.1093/nop/npac021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Response assessment after immunotherapy remains a major challenge in glioblastoma due to an expected increased incidence of pseudoprogression. Gadolinium-enhanced magnetic resonance imaging (MRI) is the standard for monitoring therapeutic response, however, is markedly limited in characterizing pseudoprogression. Given that hypoxia is an important defining feature of glioblastoma regrowth, we hypothesized that [18F]-fluoromisonidazole (FMISO) positron emission tomography (PET) could provide an additional physiological measure for the diagnosis of immunotherapeutic failure. Six patients with newly diagnosed glioblastoma who had previously received maximal safe resection followed by Stupp protocol CRT concurrent with pembrolizumab immunotherapy were recruited for FMISO PET and Gd-MRI at the time of presumed progression. The hypoxic fraction was defined as the ratio of hypoxic volume to T1-weighted gadolinium-enhancing volume. Four patients diagnosed with pseudoprogression demonstrated a mean hypoxic fraction of 9.8 ± 10%. Two with recurrent tumor demonstrated a mean hypoxic fraction of 131 ± 66%. Our results, supported by histopathology, suggest that the noninvasive assessment of hypoxic fraction by FMISO PET/MRI is clinically feasible and may serve as a biologically specific metric of therapeutic failure.
Collapse
Affiliation(s)
- Ramon F Barajas
- Department of Radiology, Neuroradiology Section, Oregon Health & Science University, Portland Oregon, USA
- Knight Cancer Institute Translational Oncology Program, Oregon Health & Science University, Portland, Oregon, USA
| | - Prakash Ambady
- Neuro-Oncology and Blood-Brain Barrier Program, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeanne Link
- Center for Radiochemistry Research, Oregon Health & Science University, Portland, Oregon, USA
| | - Kenneth A Krohn
- Center for Radiochemistry Research, Oregon Health & Science University, Portland, Oregon, USA
| | - Ahmed Raslan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Nadine Mallak
- Advanced Imaging Research Center, Oregon Health & Science University, Portland Oregon, USA
| | - Randy Woltjer
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
| | - Leslie Muldoon
- Neuro-Oncology and Blood-Brain Barrier Program, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Edward A Neuwelt
- Neuro-Oncology and Blood-Brain Barrier Program, Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
- Office of Research and Development, Portland Veterans Affairs Medical Center, Portland, Oregon, USA
| |
Collapse
|
45
|
Identification and quantitative structure–activity relationship assessment of trace chemical impurities contained in the therapeutic formulation of [64Cu]Cu-ATSM. Nucl Med Biol 2022; 108-109:10-15. [DOI: 10.1016/j.nucmedbio.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 11/22/2022]
|
46
|
Rodriguez SMB, Staicu GA, Sevastre AS, Baloi C, Ciubotaru V, Dricu A, Tataranu LG. Glioblastoma Stem Cells-Useful Tools in the Battle against Cancer. Int J Mol Sci 2022; 23:ijms23094602. [PMID: 35562993 PMCID: PMC9100635 DOI: 10.3390/ijms23094602] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 02/01/2023] Open
Abstract
Glioblastoma stem cells (GSCs) are cells with a self-renewal ability and capacity to initiate tumors upon serial transplantation that have been linked to tumor cell heterogeneity. Most standard treatments fail to completely eradicate GSCs, causing the recurrence of the disease. GSCs could represent one reason for the low efficacy of cancer therapy and for the short relapse time. Nonetheless, experimental data suggest that the presence of therapy-resistant GSCs could explain tumor recurrence. Therefore, to effectively target GSCs, a comprehensive understanding of their biology and the survival and developing mechanisms during treatment is mandatory. This review provides an overview of the molecular features, microenvironment, detection, and targeting strategies of GSCs, an essential information required for an efficient therapy. Despite the outstanding results in oncology, researchers are still developing novel strategies, of which one could be targeting the GSCs present in the hypoxic regions and invasive edge of the glioblastoma.
Collapse
Affiliation(s)
- Silvia Mara Baez Rodriguez
- Neurosurgical Department, Clinical Hospital “Bagdasar-Arseni”, 041915 Bucharest, Romania; (S.M.B.R.); (V.C.); (L.G.T.)
| | - Georgiana-Adeline Staicu
- Department of Biochemistry, Faculty of Medicine, University of Medicine and Pharmacy, 200349 Craiova, Romania; (G.-A.S.); (C.B.)
| | - Ani-Simona Sevastre
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Medicine and Pharmacy, 200349 Craiova, Romania;
| | - Carina Baloi
- Department of Biochemistry, Faculty of Medicine, University of Medicine and Pharmacy, 200349 Craiova, Romania; (G.-A.S.); (C.B.)
| | - Vasile Ciubotaru
- Neurosurgical Department, Clinical Hospital “Bagdasar-Arseni”, 041915 Bucharest, Romania; (S.M.B.R.); (V.C.); (L.G.T.)
| | - Anica Dricu
- Department of Biochemistry, Faculty of Medicine, University of Medicine and Pharmacy, 200349 Craiova, Romania; (G.-A.S.); (C.B.)
- Correspondence:
| | - Ligia Gabriela Tataranu
- Neurosurgical Department, Clinical Hospital “Bagdasar-Arseni”, 041915 Bucharest, Romania; (S.M.B.R.); (V.C.); (L.G.T.)
- Department 6—Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| |
Collapse
|
47
|
Burgess ER, Crake RLI, Phillips E, Morrin HR, Royds JA, Slatter TL, Wiggins GAR, Vissers MCM, Robinson BA, Dachs GU. Increased Ascorbate Content of Glioblastoma Is Associated With a Suppressed Hypoxic Response and Improved Patient Survival. Front Oncol 2022; 12:829524. [PMID: 35419292 PMCID: PMC8995498 DOI: 10.3389/fonc.2022.829524] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/23/2022] [Indexed: 12/13/2022] Open
Abstract
Glioblastoma multiforme is a challenging disease with limited treatment options and poor survival. Glioblastoma tumours are characterised by hypoxia that activates the hypoxia inducible factor (HIF) pathway and controls a myriad of genes that drive cancer progression. HIF transcription factors are regulated at the post-translation level via HIF-hydroxylases. These hydroxylases require oxygen and 2-oxoglutarate as substrates, and ferrous iron and ascorbate as cofactors. In this retrospective observational study, we aimed to determine whether ascorbate played a role in the hypoxic response of glioblastoma, and whether this affected patient outcome. We measured the ascorbate content and members of the HIF-pathway of clinical glioblastoma samples, and assessed their association with clinicopathological features and patient survival. In 37 samples (37 patients), median ascorbate content was 7.6 μg ascorbate/100 mg tissue, range 0.8 – 20.4 μg ascorbate/100 mg tissue. In tumours with above median ascorbate content, HIF-pathway activity as a whole was significantly suppressed (p = 0.005), and several members of the pathway showed decreased expression (carbonic anhydrase-9 and glucose transporter-1, both p < 0.01). Patients with either lower tumour HIF-pathway activity or higher tumour ascorbate content survived significantly longer than patients with higher HIF-pathway or lower ascorbate levels (p = 0.011, p = 0.043, respectively). Median survival for the low HIF-pathway score group was 362 days compared to 203 days for the high HIF-pathway score group, and median survival for the above median ascorbate group was 390 days, compared to the below median ascorbate group with 219 days. The apparent survival advantage associated with higher tumour ascorbate was more prominent for the first 8 months following surgery. These associations are promising, suggesting an important role for ascorbate-regulated HIF-pathway activity in glioblastoma that may impact on patient survival.
Collapse
Affiliation(s)
- Eleanor R Burgess
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, New Zealand
| | - Rebekah L I Crake
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, New Zealand.,Metastasis Research Laboratory, GIGA-Cancer, University of Liège, Liege, Belgium
| | - Elisabeth Phillips
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, New Zealand
| | - Helen R Morrin
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, New Zealand.,Cancer Society Tissue Bank, University of Otago Christchurch, Christchurch, New Zealand
| | - Janice A Royds
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Tania L Slatter
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - George A R Wiggins
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, New Zealand
| | - Margreet C M Vissers
- Centre for Free Radical Research, Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, New Zealand
| | - Bridget A Robinson
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, New Zealand.,Canterbury Regional Cancer and Haematology Service, Canterbury District Health Board, and Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Gabi U Dachs
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, New Zealand
| |
Collapse
|
48
|
Bobholz SA, Lowman AK, Brehler M, Kyereme F, Duenweg SR, Sherman J, McGarry SD, Cochran EJ, Connelly J, Mueller WM, Agarwal M, Banerjee A, LaViolette PS. Radio-Pathomic Maps of Cell Density Identify Brain Tumor Invasion beyond Traditional MRI-Defined Margins. AJNR Am J Neuroradiol 2022; 43:682-688. [PMID: 35422419 PMCID: PMC9089258 DOI: 10.3174/ajnr.a7477] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/07/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Currently, contrast-enhancing margins on T1WI are used to guide treatment of gliomas, yet tumor invasion beyond the contrast-enhancing region is a known confounding factor. Therefore, this study used postmortem tissue samples aligned with clinically acquired MRIs to quantify the relationship between intensity values and cellularity as well as to develop a radio-pathomic model to predict cellularity using MR imaging data. MATERIALS AND METHODS This single-institution study used 93 samples collected at postmortem examination from 44 patients with brain cancer. Tissue samples were processed, stained with H&E, and digitized for nuclei segmentation and cell density calculation. Pre- and postgadolinium contrast T1WI, T2 FLAIR, and ADC images were collected from each patient's final acquisition before death. In-house software was used to align tissue samples to the FLAIR image via manually defined control points. Mixed-effects models were used to assess the relationship between single-image intensity and cellularity for each image. An ensemble learner was trained to predict cellularity using 5 × 5 voxel tiles from each image, with a two-thirds to one-third train-test split for validation. RESULTS Single-image analyses found subtle associations between image intensity and cellularity, with a less pronounced relationship in patients with glioblastoma. The radio-pathomic model accurately predicted cellularity in the test set (root mean squared error = 1015 cells/mm2) and identified regions of hypercellularity beyond the contrast-enhancing region. CONCLUSIONS A radio-pathomic model for cellularity trained with tissue samples acquired at postmortem examination is able to identify regions of hypercellular tumor beyond traditional imaging signatures.
Collapse
Affiliation(s)
- S A Bobholz
- From the Departments of Biophysics (S.A.B., S.R.D., J.S., S.D.M.)
| | | | - M Brehler
- Radiology (A.L., M.B., M.A., P.S.L.)
| | | | - S R Duenweg
- From the Departments of Biophysics (S.A.B., S.R.D., J.S., S.D.M.)
| | - J Sherman
- From the Departments of Biophysics (S.A.B., S.R.D., J.S., S.D.M.)
| | - S D McGarry
- From the Departments of Biophysics (S.A.B., S.R.D., J.S., S.D.M.)
| | | | | | | | - M Agarwal
- Radiology (A.L., M.B., M.A., P.S.L.)
| | | | - P S LaViolette
- Radiology (A.L., M.B., M.A., P.S.L.)
- Biomedical Engineering (P.S.L.), Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
49
|
Ayensa-Jiménez J, Doweidar MH, Sanz-Herrera JA, Doblare M. Understanding glioblastoma invasion using physically-guided neural networks with internal variables. PLoS Comput Biol 2022; 18:e1010019. [PMID: 35377875 PMCID: PMC9009781 DOI: 10.1371/journal.pcbi.1010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 04/14/2022] [Accepted: 03/15/2022] [Indexed: 11/18/2022] Open
Abstract
Microfluidic capacities for both recreating and monitoring cell cultures have opened the door to the use of Data Science and Machine Learning tools for understanding and simulating tumor evolution under controlled conditions. In this work, we show how these techniques could be applied to study Glioblastoma, the deadliest and most frequent primary brain tumor. In particular, we study Glioblastoma invasion using the recent concept of Physically-Guided Neural Networks with Internal Variables (PGNNIV), able to combine data obtained from microfluidic devices and some physical knowledge governing the tumor evolution. The physics is introduced in the network structure by means of a nonlinear advection-diffusion-reaction partial differential equation that models the Glioblastoma evolution. On the other hand, multilayer perceptrons combined with a nodal deconvolution technique are used for learning the go or grow metabolic behavior which characterises the Glioblastoma invasion. The PGNNIV is here trained using synthetic data obtained from in silico tests created under different oxygenation conditions, using a previously validated model. The unravelling capacity of PGNNIV enables discovering complex metabolic processes in a non-parametric way, thus giving explanatory capacity to the networks, and, as a consequence, surpassing the predictive power of any parametric approach and for any kind of stimulus. Besides, the possibility of working, for a particular tumor, with different boundary and initial conditions, permits the use of PGNNIV for defining virtual therapies and for drug design, thus making the first steps towards in silico personalised medicine. In this work, we apply Physically-Guided Neural Networks with Internal Variables (PGNNIV) to the understanding of the Glioblastoma evolution process. We explain the metabolic changes between the proliferative and migrative activity of Glioblastoma cell cultures by using the go or grow activation functions as a pair of internal variables, whose dependence on the oxygen level is unravelled by some building blocks of the whole PGNNIV. Due to its model-free nature, our method is able to identify different classical mechanistic approaches and to outperform cell culture evolution predictions, as we demonstrate in the paper. Unlike Biologically-Informed Neural Networks we can assimilate data obtained from different boundary conditions and under different external stimuli to simulate the tumor progression under arbitrary conditions. We demonstrate this ability by comparing the predictions with different boundary conditions, resulting in different oxygenation conditions. This flexibility enables the use of our proposed method for personalised medical purposes, as the cell culture metabolic information, for a particular tumor, is encapsulated in a sub-network and may be used for arbitrary in silico tests.
Collapse
Affiliation(s)
- Jacobo Ayensa-Jiménez
- Mechanical Engineering Department, School of Engineering and Architecture, University of Zaragoza, Spain
- Aragón Institute of Engineering Research (I3A), University of Zaragoza, Spain
- Aragón Institute of Health Research (IIS Aragón), Spain
| | - Mohamed H. Doweidar
- Mechanical Engineering Department, School of Engineering and Architecture, University of Zaragoza, Spain
- Aragón Institute of Engineering Research (I3A), University of Zaragoza, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBERBBN), Spain
| | - Jose A. Sanz-Herrera
- Mechanical Engineering Department, School of Engineering, University of Sevilla, Spain
| | - Manuel Doblare
- Mechanical Engineering Department, School of Engineering and Architecture, University of Zaragoza, Spain
- Aragón Institute of Engineering Research (I3A), University of Zaragoza, Spain
- Aragón Institute of Health Research (IIS Aragón), Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBERBBN), Spain
- * E-mail:
| |
Collapse
|
50
|
Markwell SM, Ross JL, Olson CL, Brat DJ. Necrotic reshaping of the glioma microenvironment drives disease progression. Acta Neuropathol 2022; 143:291-310. [PMID: 35039931 DOI: 10.1007/s00401-021-02401-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/13/2022]
Abstract
Glioblastoma is the most common primary brain tumor and has a dismal prognosis. The development of central necrosis represents a tipping point in the evolution of these tumors that foreshadows aggressive expansion, swiftly leading to mortality. The onset of necrosis, severe hypoxia and associated radial glioma expansion correlates with dramatic tumor microenvironment (TME) alterations that accelerate tumor growth. In the past, most have concluded that hypoxia and necrosis must arise due to "cancer outgrowing its blood supply" when rapid tumor growth outpaces metabolic supply, leading to diffusion-limited hypoxia. However, growing evidence suggests that microscopic intravascular thrombosis driven by the neoplastic overexpression of pro-coagulants attenuates glioma blood supply (perfusion-limited hypoxia), leading to TME restructuring that includes breakdown of the blood-brain barrier, immunosuppressive immune cell accumulation, microvascular hyperproliferation, glioma stem cell enrichment and tumor cell migration outward. Cumulatively, these adaptations result in rapid tumor expansion, resistance to therapeutic interventions and clinical progression. To inform future translational investigations, the complex interplay among environmental cues and myriad cell types that contribute to this aggressive phenotype requires better understanding. This review focuses on contributions from intratumoral thrombosis, the effects of hypoxia and necrosis, the adaptive and innate immune responses, and the current state of targeted therapeutic interventions.
Collapse
Affiliation(s)
- Steven M Markwell
- Department of Pathology, Northwestern Medicine Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave. Ward 3-140, Chicago, IL, USA
| | - James L Ross
- Department of Microbiology and Immunology, Emory University, Atlanta, GA, USA
| | - Cheryl L Olson
- Department of Pathology, Northwestern Medicine Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave. Ward 3-140, Chicago, IL, USA
| | - Daniel J Brat
- Department of Pathology, Northwestern Medicine Malnati Brain Tumor Institute of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave. Ward 3-140, Chicago, IL, USA.
| |
Collapse
|