Current and promising treatment strategies in glioma

Folic acid-decorated astrocytes-derived exosomes enhanced the effect of temozolomide against glioma

A direct strategy to achieve specific treatments and reduce side effects is through cell type-specific drug delivery. Exosomes (Exos) can be modified with folic acid (FA) to prepare drug delivery systems targeting tumor cells that highly express FA receptors. This study aimed to produce an exo drug delivery system with FA decoration and temozolomide (TMZ) loading to improve the sustained TMZ release and targeting. We used DSPE-PEG2000-FA to modify exos derived from astrocyte U-87 to prepare FA-modified exos (Astro-exo-FA). TMZ was encapsulated into Astro-exo-FA or Astro-exo through electroporation to produce TMZ@Astro-exo and TMZ@Astro-exo-FA. In vitro drug release was examined using the dialysis bag method. Through cell experiments in vitro and mouse glioma models in vivo, the effect of TMZ@Astro-exo-FA on U-87 cells was determined. Exo properties were not affected by FA modification and TMZ loading. The drug release rate of TMZ@Astro-exo-FA was slower. TMZ@Astro-exo-FA uptake by U-87 cells was higher compared to TMZ@Astro-exo, indicating that TMZ@Astro-exo-FA has a stronger targeting toward U-87 cells. TMZ@Astro-exo-FA remarkably reduced U-87 cell proliferation, migration, and invasion compared with TMZ@Astro-exo and free TMZ. Treatment with TMZ@Astro-exo-FA reduced the side effects of TMZ (minimal change in body weight), prolonged survival, and inhibited tumor growth in mouse glioma models, and its efficacy was stronger than that of TMZ@Astro-exo and free TMZ. TMZ@Astro-exo-FA could enhance the effect of TMZ against glioma, providing novel ideas for drug targeting delivery and exploring exos as drug carriers against glioma.

Efficacy and Safety of Vaccines After Conventional Treatments for Survival of Gliomas: A Systematic Review and Meta-Analysis

Background

Malignant gliomas are known with poor prognosis and low rate of survival among brain tumors. Resection surgery is followed by chemotherapy and radiotherapy in treatment of gliomas which is known as the conventional treatment. However, this treatment method results in low survival rate. Vaccination has been suggested as a type of immunotherapy to increase survival rate of glioma patients. Different types of vaccines have been developed that are mainly classified in two groups including peptide vaccines and cell-based vaccines. However, there are still conflicts about which type of vaccines is more efficient for malignant glioma treatment.

Methods

Phase Ⅰ/Ⅱ clinical trials which compared the efficacy and safety of various vaccines with conventional treatments were searched in databases through November 2022. Overall survival (OS) rate, progression free survival (PFS), and OS duration were used for calculation of pooled risk ratio (RR). In addition, fatigue, headache, nausea, diarrhea, and flu-like syndrome were used for evaluating the safety of vaccines therapy in glioma patients.

Results

A total of twelve articles were included in the present meta-analysis. Comparison of OS rate between vaccinated groups and control groups who underwent only conventional treatments showed a significant increase in OS rate in vaccinated patients (I2 = 0%, RR = 11.17, 95% CI: 2.460-50.225). PFS rate was better in vaccinated glioma patients (I2 = 83%, RR = 2.87, 95% CI: 1.63-5.03). Assessment of safety demonstrated that skin reaction (I2 = 0.0%, RR = 3.654; 95% CI: 1.711-7.801, p-value = 0.0058) and flu-like syndrome were significantly more frequent adverse effects win vaccinated groups compared to the control group. Subgroup analysis also showed that vaccination leads to better OS duration in recurrent gliomas than primary gliomas, and in LGG than HGG (p-value = 0). On the other hand, personalized vaccines showed better OS duration than non-personalized vaccines (p-value = 0).

Conclusion

Vaccination is a type of immunotherapy which shows promising efficacy in treatment of malignant glioma patients in terms of OS, PFS and duration of survival. In addition, AFTV, peptide, and dendritic cell-based vaccines are among the most efficient vaccines for gliomas. Personalized vaccines also showed considerable efficacy for glioma treatments.

ARPC5 acts as a potential prognostic biomarker that is associated with cell proliferation, migration and immune infiltrate in gliomas

BACKGROUND

Gliomas are the most common malignant brain tumors, with powerful invasiveness and an undesirable prognosis. Actin related protein 2/3 complex subunit 5 (ARPC5) encodes a component of the Arp2/3 protein complex, which plays a significant role in regulating the actin cytoskeleton. However, the prognostic values and biological functions of ARPC5 in gliomas remain unclear.

METHODS

Based on the TCGA, GEO, HPA, and UALCAN database, we determined the expression of ARPC5 in glioma. The results were verified by immunohistochemistry and Western blot analysis of glioma samples. Moreover, Kaplan-Meier curves, ROC curves, Cox regression analyses, and prognostic nomograms were used to observe the correlation between the ARPC5 expression and the prognosis of glioma patients. GO and KEGG enrichment analyses were conducted to identify immune-related pathways involved with the differential expression of ARPC5. Subsequently, the TCGA database was used to estimate the relationship between ARPC5 expression and immunity-related indexes, such as immune scores, infiltrating immune cells, and TMB. The TCIA database was used to assess the correlation between ARPC5 with immunotherapy. The association between ARPC5 and T cells marker CD3 was also evaluated through immunohistochemistry methods. The correlation between ARPC5 and T cell, as well as the prognosis of patients, was also evaluated using immunological methods. Moreover, the effect of ARPC5 on the biological characteristics of LN229 and U251 cells was determined by MTT, clone formation, and transwell migration assay.

RESULTS

The high degree of ARPC5 was correlated with worse prognosis and unfavorable clinical characteristics of glioma patients. In the analysis of GO and KEGG, it is shown that ARPC5 was strongly correlated with multiple immune-related signaling pathways. The single-cell analysis revealed that ARPC5 expression was increased in astrocytes, monocytes and T cells. In addition, ARPC5 expression was strongly associated with immune scores, infiltrating immune cells, TMB, MSI, immune biomarkers, and immunotherapy. In experimental analysis, we found that ARPC5 was significantly overexpressed in gliomas and closely correlated with patient prognosis and CD3 expression. Functionally, the knockout of ARPC5 significantly reduced the proliferation and invasion of LN229 and U251 cells.

CONCLUSIONS

Our study revealed that the high expression level of ARPC5 may serve as a promising prognostic biomarker and be associated with tumor immunity in glioma.

Targeting Heat Shock Proteins in Malignant Brain Tumors: From Basic Research to Clinical Trials

Heat shock proteins (HSPs) are conservative and ubiquitous proteins that are expressed both in prokaryotic and eukaryotic organisms and play an important role in cellular homeostasis, including the regulation of proteostasis, apoptosis, autophagy, maintenance of signal pathways, protection from various stresses (e.g., hypoxia, ionizing radiation, etc.). Therefore, HSPs are highly expressed in tumor cells, including malignant brain tumors, where they also associate with cancer cell invasion, metastasis, and resistance to radiochemotherapy. In the current review, we aimed to assess the diagnostic and prognostic values of HSPs expression in CNS malignancies as well as the novel treatment approaches to modulate the chaperone levels through the application of inhibitors (as monotherapy or in combination with other treatment modalities). Indeed, for several proteins (i.e., HSP10, HSPB1, DNAJC10, HSPA7, HSP90), a direct correlation between the protein level expression and poor overall survival prognosis for patients was demonstrated that provides a possibility to employ them as prognostic markers in neuro-oncology. Although small molecular inhibitors for HSPs, particularly for HSP27, HSP70, and HSP90 families, were studied in various solid and hematological malignancies demonstrating therapeutic potential, still their potential was not yet fully explored in CNS tumors. Some newly synthesized agents (e.g., HSP40/DNAJ inhibitors) have not yet been evaluated in GBM. Nevertheless, reported preclinical studies provide evidence and rationale for the application of HSPs inhibitors for targeting brain tumors.