Combined transarterial chemoembolization and arterial administration of Bletilla striata in treatment of liver tumor in rats

Screening of Bletilla striata, Bletilla ochracea, and Oreorchis foliosa differential metabolites based on metabolomics

As a representative medicinal plant in Orchidaceae, Bletilla striata plays a variety of pharmacological roles in the clinic. However, the emergence of counterfeit species affects the basic medicinal materials source identification process, of which Bletilla ochracea and Oreorchis foliosa of Orchidaceae are two representative species. For this study, 13 representative B. striata samples, 3 B. ochracea samples and 3 O. foliosa samples were selected for the systematic determination of polysaccharide yields and monosaccharide composition, and further detection of secondary metabolites by HPLC-MS. The results revealed that there was a significant difference in the yields of polysaccharides between B. striata and B. ochracea (P = 0.006). Although the polysaccharides of both species were composed of glucose and mannose, the molar ratio of the two monosaccharides was different suggested that the structures of the polysaccharide were different. The metabolomics results showed that there were no differences in the types of metabolites between B. striata and B. ochracea; however, there were differences in the content of these metabolites. Although there was no significant difference in the polysaccharide yields of B. striata and O. foliosa (P = 0.074) and the monosaccharide composition was the same (glucose and mannose), many different metabolites were screened out between them: 6 compounds such as C₃₆ H₃₄ O₁₁ existed only in B. striata, while substance C₃₉ H₅₄ O₂₂ was unique to O. foliosa. Therefore, based on the analysis of the polysaccharide content and monosaccharide composition, combined with phase metabolomics research, a preliminary distinction between B. striata, B. ochracea, and O. foliosa was achieved.

Recent advances and applications of microspheres and nanoparticles in transarterial chemoembolization for hepatocellular carcinoma

Transarterial chemoembolization (TACE) is a recommended treatment for patients suffering from intermediate and advanced hepatocellular carcinoma (HCC). As compared to the conventional TACE, drug-eluting bead TACE demonstrates several advantages in terms of survival, treatment response, and adverse effects. The selection of embolic agents is critical to the success of TACE. Many studies have been performed on the modification of the structure, size, homogeneity, biocompatibility, and biodegradability of embolic agents. Continuing efforts are focused on efficient loading of versatile chemotherapeutics, controlled sizes for sufficient occlusion, real-time detection intra- and post-procedure, and multimodality imaging-guided precise treatment. Here, we summarize recent advances and applications of microspheres and nanoparticles in TACE for HCC. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease.

Simultaneous Determination of Three Bioactive Constituents from Bletilla striata by UPLC-MS/MS and Application of the Technique to Pharmacokinetic Analyses

Bletilla striata has been widely used as a valuable hemostatic agent for thousands of years due to the high levels of bioactive constituents it contains. Here, we used a sensitive ultrahigh-performance liquid chromatography-tandem mass spectroscopy (UPLC-MS/MS) method for the simultaneous determination of three major active ingredients of the B. striata extract, namely, α-isobutylmalic acid, gymnoside I, and militarine in rat plasma. The three major active ingredients were determined using the multiple reaction monitoring (MRM) mode at m/z 189 ⟶ 129 for α-isobutylmalic acid, m/z 457.2 ⟶ 285.1 for gymnoside I, m/z 725.3 ⟶ 457.2 for militarine, and m/z 417.0 ⟶ 267.0 for the IS puerarin. All calibration curves showed good linearity (R² ≥ 0.999) over the concentration range with the lower limit of quantification between 0.015 and 0.029 μg/mL. The relative standard deviations of intraday and interday measurements were less than 15%, and the method was accurate within 93.3–100.4%. The extraction recovery was 92.65–100.98%, and no matrix effect was observed. The results indicated that after oral administration of B. striata in rats, the T_max of α-isobutylmalic acid was significantly longer than that of gymnoside I and militarine and the mean residence time and area under the curve of α-isobutylmalic acid and gymnoside I in rats were significantly higher than those of militarine. Moreover, the blood concentration-time curve of α-isobutylmalic acid showed double peaks, suggesting that α-isobutylmalic acid could exhibit the phenomenon of enterohepatic circulation or metabolic conversion. We also explored some of the pharmacokinetic characteristics of three ingredients from B. striata extract in vivo, and the data obtained may provide a basis for the further investigation of B. striata.

Chemical Constituents, Pharmacologic Properties, and Clinical Applications of Bletilla striata

Bletilla striata is a plant from the Orchidaceae family that has been employed as a traditional Chinese medicine (TCM) for thousands of years in China. Here, we briefly review the published studies of the last 30 years that were related to chemical constituents, pharmacologic activities, and clinical applications of B. striata. Approximately 158 compounds have been extracted from B. striata tubers with clarified molecular structures that were classified as glucosides, bibenzyls, phenanthrenes, quinones, biphenanthrenes, dihydrophenanthrenes, anthocyanins, steroids, triterpenoids, and phenolic acids. These chemicals support the pharmacological properties of hemostasis and wound healing, and also exhibit anti-oxidation, anti-cancer, anti-viral, and anti-bacterial activities. Additionally, various clinical trials conducted on B. striata have demonstrated its marked activities as an embolizing and mucosa-protective agent, and its application for use in novel biomaterials, quality control, and toxicology. It also has been widely used as a constituent of many preparations in TCM formulations, but because there are insufficient studies on its clinical properties, its efficacy and safety cannot be established from a scientific point of view. We hope that this review will provide reference for further research and development of this unique plant.

Factors impacting technical success rate of image-guided intra-arterial therapy in rat orthotopic liver tumor model

Transcatheter hepatic arterial chemoembolization (TACE) is the current standard of care for intermediate stage hepatocellular carcinoma (HCC) patients. To study the effects of TACE in the tumor immune microenvironment, an immunocompetent rat model is required. The purpose of this study was to determine factors influencing technical success during hepatic arterial catheterization in immunocompetent orthotopic rat liver models. To this end, 91 Sprague-Dawley and eighty-three F344 rats underwent transcatheter hepatic arterial embolization using a transcarotid approach and were divided into a non-tumor-bearing (n = 41) and tumor-bearing (n = 133) groups. Vascular diameters of the hepatic arterial branches were evaluated from angiographic images. Catheterization of the proper hepatic artery (PHA) was achieved in 92% of the tumor-bearing and 68.3% of the non-tumor-bearing rats. We found a strong positive association between the diameter of the PHA and animals' body weight in both groups (P < 0.005), independently of the rat's strain. Results of the logistic regression model predicting a successful catheter placement into the PHA according to the animal's weight indicate that successful PHA catheterization is likely to be achieved in tumor-bearing animals weighing ≥ 250 g and > 308 g in non-tumor-bearing rats, with a sensitivity and specificity of 91.3% and 100.0% and 96.4% and 92.3%, respectively. In conclusion, animal's body weight at the time of catheterization is the principal determinant of technical success for transcatheter arterial embolization. Familiarity with these technical factors during animal selection will improve TACE technical success rates.

Embolic effects of Bletilla striata microspheres in renal artery and transplanted VX2 liver tumor model in rabbits

OBJECTIVES

To evaluate the characteristics of Bletilla striata microspheres (BSMs) and its effects as an embolic agent in a rabbit model.

METHODS

BSMs were prepared with an emulsification-cool condensation-chemical cross-linking method. The characteristics of BSMs in vitro were observed. Embolization experiments were performed in renal artery of rabbit and in a rabbit liver VX2 carcinoma model. Seventy-two New Zealand rabbits were divided into 2 groups, and the right renal artery was embolized with BSMs (200 μm in diameter) in the experimental group and with polyvinyl alcohol (PVA) of the same size in the control group. The pathological findings were examined with hematoxylin-eosin and Masson stainings. Liver and renal functions were tested before and after embolization. VX2 tumor was transplanted in 15 New Zealand rabbits, which were randomly divided into 3 groups (n=5). Group A were treated with saline, group B with a mixture of doxorubicin and lipiodol, and group C with hepatic arterial infusion of BSMs (200 μm in diameter). Tumor growth rate was evaluated by magnetic resonance imaging scan. Apoptosis-related factors (bax, bcl-2) and tumor vascular endothelial cell growth factor (VEGF) were evaluated through immunohistochemical staining.

RESULTS

The characteristics of BSMs in vitro were in full compliance with the requirements for use in interventional procedures. In the renal artery embolization experiment, after BSMs intervention, it was more difficult to form collateral circulation than that with PVAs, and the kidney manifested atrophy and calcification. There were no significant difference of liver and renal functions in rabbits between groups. In the liver VX2 carcinoma embolization experiment, compared with group A, the growth rate of VX2 liver tumor and Bcl-2 levels was reduced, while apoptosis index, Bax, and VEGF were increased in group B (P<0.05). There were no significant difference between groups B and C (P>0.05).

CONCLUSIONS

The characteristics of BSMs in vitro and in vivo meet the requirements for its use as an embolic agent in interventional approaches.

Combination of intra-arterial therapies and sorafenib: is there a clinical benefit?

Intra-arterial therapies (IATs) play a major role in the treatment of patients with unresectable hepatocellular carcinoma. Over the last three decades, multiple loco-regional approaches such as transarterial chemoembolization or radioembolization were shown to effectively achieve local tumor control, offering significant survival benefits for selected patients with intermediate to advanced-stage disease (Barcelona Clinic Liver Cancer stage B and C). These therapies provide a dual benefit of safely delivering a highly cytotoxic payload directly to the tumor while reducing systemic toxicity. This capability maintained the advantage of IATs over conventional systemic chemotherapy. The introduction of sorafenib as a systemically applicable drug, the first of its kind to provide survival benefits by means of oral monotherapy, contributed to a paradigm change. The idea of combining this novel agent with IATs seemed intriguing, and a variety of national and international clinical trials were initiated to explore the potential benefits of this exciting new option. A plethora of preliminary data has been made available throughout the last 5 years, and the interpretation of the inhomogeneously designed protocols proved difficult. In this review, we will provide a brief state-of-the-art update on the most frequently used intra-arterial modalities and discuss the molecular mechanism, potential biomarkers as well as the safety profile of sorafenib. Furthermore, we will discuss the role of the sequence of administration in combined therapies. Finally, this review will examine the evidence for clinical outcomes for the combination of different IATs with sorafenib.

Combined radiofrequency ablation and ethanol injection with a multipronged needle for the treatment of medium and large hepatocellular carcinoma

OBJECTIVE

To evaluate the efficacy and safety of combined radiofrequency ablation (RFA) and ethanol injection with a multipronged needle in the treatment of medium (3.1-5.0 cm) and large (5.1-7.0 cm) hepatocellular carcinoma (HCC).

METHODS

A total of 65 patients with 67 HCC nodules were enrolled in this prospective study. All of them received the treatment of combined RFA and multipronged ethanol injection percutaneously.

RESULTS

The average volume of injected ethanol was 14.4 ± 4.1 ml (range, 9-30 ml). The average number of RFA electrode insertions was 1.7 ± 0.8 (range, 1-4). The rate of initial local complete response (CR) was 94.0 % (63/67). After additional treatment, technical success was achieved in all HCC nodules. There were no treatment-related deaths, and major complications were observed in 3 (4.6%) patients. After a mean follow-up of 20.0 ± 7.6 months, local tumour progression was observed in 10 (10/67, 14.9%) tumours, whereas distant recurrence developed in 32 (32/65, 49.2%) patients. The 1-year and 2-year survival rates were 93.1% and 88.1%, respectively.

CONCLUSION

The combination of RFA and multipronged ethanol injection in the treatment of medium and large HCC is safe and effective with a high rate of local tumour control.

KEY POINTS

• Combined radiofrequency ablation and multipronged ethanol injection is a new therapeutic strategy • Treatment is safe and effective for medium and large hepatocellular carcinoma (HCC) • A multipronged needle allows for a homogeneous ethanol distribution.

Safety evaluation of intracameral and subconjunctival injection of a novel mucoadhesive polysaccharide isolated from Bletilla striata in rabbit eye

PURPOSE

To evaluate the safety of intracameral and subconjunctival injection of a novel mucoadhesive polysaccharide isolated from Bletilla striata in rabbit eye.

METHODS

One hundred microliters (100 μL) of Bletilla striata polysaccharide (BsP) at concentrations of 10, 40, and 80 mg/mL was intracamerally or subconjunctivally injected into rabbit eyes. Phosphate-buffered saline and 10 mg/mL hyaluronic acid solution were also injected as controls. BsP safety was evaluated via clinical follow-up and histological analysis. The dead corneal endothelial cells were observed by vital staining with alizarin red and trypan blue at 14 days after intracameral injection. Finally, in the intracameral injection study, scanning electron microscopy was performed for evaluation of the structure of the corneal endothelium and anterior lens capsules.

RESULTS

Subconjunctival injection of 10 mg/mL BsP does not cause pathological changes or an inflammatory response. Concentration greater than 10 mg/mL of BsP (40 or 80 mg/mL) leaded to a slight inflammatory response, but the rabbits recovered well in 3 days. The pathological observation further confirmed the safety of subconjunctival injection of BsP, and subconjunctival injection of 80 mg/mL BsP caused no lesion of the ocular tissues. Intracameral injection of 80 mg/mL of BsP did not cause a significant inflammatory reaction, and an even lower inflammatory response was observed in rabbits intracamerally injected with 40 or 10 mg/mL BsP. All rabbits intracamerally injected with BsP recovered within 7-14 days. BsP had little effect on the blood-aqueous barrier's integrity when the concentration was 10 mg/mL; at 40 or 80 mg/mL, a mild effect was observed, and the rabbits recovered in 1-3 days. Intracameral BsP injected at a concentration of 80 mg/mL had a negative impact on the corneal endothelium and lens, but concentrations of 40 or 10 mg/mL could be injected safely.

CONCLUSIONS

BsP injection into the subconjunctival space and anterior chamber in rabbits at low concentrations (such as 10 mg/mL) did not have adverse effects.

Partial splenic embolization using Bletilla striata particles for hypersplenism in cirrhosis: a prospective study

The article evaluates the long-term follow-up results of PSE using Bletilla striata (BS) particles for hypersplenism in cirrhosis, as compared to PSE using gelfoam particles. Fifty-nine patients with cirrhosis-induced hypersplenism were treated with PSE. The patients were randomly assigned into two groups: gelfoam group, which includes 32 patients using gelfoam particles as the embolic material, and BS group, which includes 27 patients using BS particles. The peripheral blood cell counts and parameters for complications associated with PSE were measured during the follow-up. The mean values of leukocyte and thrombocyte, but not hemoglobin, were significantly increased after PSE (p < 0.01) in both groups. The values of leukocyte and thrombocyte during the long-term follow-up were significantly improved in BS group than that in gelfoam group (both p < 0.01). The frequency of bleeding episodes from esophageal varices in both groups was significantly reduced after PSE (both p < 0.01), but the post-PSE bleeding episodes showed no remarkable differences between the two groups (p = 0.084). Post-embolization syndrome consisted mainly of fever, nausea and vomiting, and abdominal pain in the two groups. The incidence of grade II to III abdominal pain in BS group (82.8%, 27/33) was significantly higher than in gelfoam group (57.9%, 33/57) (p = 0.020). The mean survival time was 61.5 ± 9.1 (median 60, 1-157) months in gelfoam group and 63.4 ± 9.9 (median 52, 0-161) months in BS group, which showed no significant difference (p = 0.930). In conclusion, BS particles could be used as the embolic material in PSE. Compared to gelfoam used in PSE, BS can achieve even better efficacy in alleviating hypersplenism. It provides a long-term effect on the hematological parameters, bleeding from esophageal varices and good palliation, and improved clinical status contributing to symptomatic control.

Novel mucoadhesive polysaccharide isolated from Bletilla striata improves the intraocular penetration and efficacy of levofloxacin in the topical treatment of experimental bacterial keratitis

OBJECTIVES

The objective of the present study was to evaluate a novel mucoadhesive polymer extracted from Bletilla striata for ocular delivery of 0.5% levofloxacin in rabbits, and to determine its improved efficacy against experimental keratitis.

METHODS

B. striata polysaccharide (BsP) was subjected to cell cytotoxicity and ferning tests. The pharmacokinetics and bioavailability of topically applied 0.5% levofloxacin-BsP eye drops was investigated and compared with 0.5% levofloxacin eye drops (Cravit). Experimental Staphylococcus aureus keratitis was induced and treated with levofloxacin or levofloxacin-BsP eye drops.

KEY FINDINGS

BsP markedly increased the proliferative capacity of a human corneal epithelial [corrected] cell line. The ferning test showed that BsP exhibited optimal performance as a tear fluid. The polysaccharides significantly increased intra-aqueous penetration and corneal accumulation in rabbits. Treatment with levofloxacin-BsP reduced the number of organisms more significantly than eye drops containing levofloxacin alone.

CONCLUSIONS

BsP appears to be a promising candidate as a vehicle for topical ophthalmic drug delivery, especially for antibiotics.

Targeting delivery oligonucleotide into macrophages by cationic polysaccharide from Bletilla striata successfully inhibited the expression of TNF-alpha

Competent vehicles based on natural biopolymers are highly demanded in the practice of gene-assisted cell therapy. In this study, a novel gene carrier was developed based on a bioactive glucomannan that was a polysaccharide isolated from an herb Bletilla striata (BSP) and modified with N, N'-carbonyldiimidazole (CDI)/ethylenediamine in order to acquire nucleic acid binding affinity. Particle size observation and electrophoretic mobility tests indicated that the cationized BSP (cBSP) could efficiently combine DNA to form nano-scaled compact and stable complexes and promote the transfection of oligodeoxynucleotide (ODN). Specifically, cBSP exhibited significantly high affinity to macrophages, as evidenced by transfection examination on multiple cell types and competitive test with mannose/glucomannan. In addition, the efficacy of the delivered ODN by cBSP was evaluated by the quantification of gene expression and a dramatic enhancement in suppressing target gene expression was observed. All the findings suggested the possible existence of interaction between cBSP ligand and receptor on macrophage surface. In this way, the ubiquitous mannose receptors and beta-glucan receptors on macrophage could recognize the mannose and beta-glucose residues in BSP framework, thus further mediated the oriented ODN delivery. We expect cBSP to be capable of conveying antisense nucleotides (e.g., oligodeoxynucleotide and small interference RNA) for the practical anti-inflammatory therapy.

Chinese herb related molecules of cancer-cell-apoptosis: a minireview of progress between Kanglaite injection and related genes

Many kinds of Chinese herb had been confirmed to have the character of anti-tumor, clinical reports about anti-tumor effects of Chinese herb had also been found in recent years, but most of the reports were focused on the clinical treatment of effectiveness for Chinese herb, on the other hand, review about Chinese herbal related with molecules on cancer-cell-apoptosis was seldom, many scientists could not believe such kinds of clinical describes about anti-tumor effects for Chinese herb, because these describes were lack of molecular biology evidence. Kanglaite(KLT) injection is an anti-tumor new drug which extracts from Chinese medicine-coix seed with modern advanced pharmaceutical technology, it is also a new biphase extended-spectrum anticancer medicine, the food and drug administration(FDA) of United States also approved a phase II trial of KLT to test its efficacy in treating non-small-cell lung cancer. Some studies show it could inhibit some anti-apoptotic gene and activate some pro-apoptotic gene, its injection solution is one of the new anticancer medicine that can significantly inhibit a various kinds of tumor cells, so it has become the core of research that how to further explore KLT injection to promote tumor cell apoptosis by impacting on related genes. In this review, the relationship between KLT and some tumor cell apoptosis molecules had been discussed and reviewed generally.

Preventive effect of regional radiotherapy with phosphorus-32 glass microspheres in hepatocellular carcinoma recurrence after hepatectomy

AIM

To evaluate the preventive effects of phosphorus-32 glass microspheres (P32-GMS) in the recurrence of massive hepatocellular carcinomas (HCCs) after tumor resection.

METHODS

Twenty-nine patients with massive HCCs received local P32-GMS implantation after liver tumors were removed, while the other 38 patients with massive HCCs were not treated with P32-GMS after hepatectomies. The radioactivity of the blood, urine and liver were examined. The complications, HCC recurrence and overall survival rates in the patients were analyzed.

RESULTS

P32-GMS implanted in the liver did not cause systemic absorption of P32. There were no significant differences of postoperative complications between the patients with and without P32-GMS treatment. The short-term (six months and 1 year) and long-term (2, 3 and over 3 years) recurrence rates in patients who received P32-GMS radiotherapy were significantly decreased, and the overall survival rates in this group were significantly improved.

CONCLUSION

P32-GMS implantation in the liver can significantly decrease the postoperative recurrence and improve the overall survival in HCCs patients after hepatectomy. This therapy may provide an innovative method in prevention of HCC recurrence after operation.

Catheterization of the hepatic artery via the left common carotid artery in rats

The commonly used approach for rat hepatic artery catheterization is via the gastroduodenal artery, which is ligated after the procedure. A new method of rat hepatic artery catheterization via the left common carotid artery (LCCA) is described. The LCCA is repaired after catheterization. The catheterization procedures included the following: (1) opening the rat's abdominal cavity and exposing the portion of abdominal aorta at the level of the celiac trunk; (2) separating and exposing the LCCA; inserting a microguidewire and microcatheter set into the LCCA via an incision; after placement into the descending aorta, the microguidewire and microcatheter are maneuvered into the hepatic artery under direct vision; (3) after transcatheter therapy, the catheter is withdrawn and the incision at the LCCA is repaired. This technique was employed on 60 male Sprague-Dawley rats with diethylnitrosamine-induced liver cancer, using a 3F microguidewire and microcatheter set. Selective hepatic artery catheterization was successfully performed in 57 rats. One rat died during the operation and five rats died within 7 days after the procedure. It is envisaged that as experience increases, the catheterization success rate will increase and the death rate will decrease. A new approach for selective hepatic artery catheterization via the LCCA in rats is introduced, which makes repeat catheterization of this artery possible and allows large embolization particles to be delivered by using a 3F catheter.

Liver Metastases in Rats: Chemoembolization Combined with Interstitial Laser Ablation for Treatment

PURPOSE

To assess the effect of transcatheter arterial chemoembolization (TACE) combined with laser-induced thermotherapy (LITT) for treatment of liver metastases in an animal model.

MATERIALS AND METHODS

All experiments were approved by the German government and the institutional animal research review board. After subcapsular liver implantation of colorectal cancer cells in 30 WAG rats (on day 0), the animals were randomly assigned to three interventional treatment groups. In the 10 rats in group A, TACE was performed: Fourteen days after cancer cell implantation and within 20 minutes after laparotomy and retrograde placement of a microcatheter into the gastroduodenal artery, these rats were injected with mitomycin (0.1 mg), iodized oil (0.1 mL), and degradable starch microspheres (5.0 mg). In the 10 rats in group B, LITT was performed: Also on day 14, the tumors in these animals were exposed to Nd:YAG laser light of 1064 nm at 2 W for 5 minutes. In the 10 rats in group C, combined treatment was administered: TACE was performed on day 14, and LITT was performed on day 21. Tumor volumes were measured before (on day 13) and after (on day 28) treatment with magnetic resonance (MR) imaging, and the mean tumor growth ratio (day 13 tumor volume divided by day 28 tumor volume) was calculated.

RESULTS

The mean tumor volumes measured before and after the treatments were, respectively, 0.11 and 0.60 cm(3) in group A, 0.11 and 0.68 cm(3) in group B, and 0.11 and 0.35 cm(3) in group C. The mean tumor growth ratio was 5.42 in group A, 6.14 in group B, and 3.15 in group C. According to Bonferroni test results, compared with the rats in groups A and B (controls), the group C rats had significantly inhibited tumor growth (P < .01 for both comparisons).

CONCLUSION

Use of combined TACE-LITT treatment, compared with the use of TACE or LITT alone, significantly inhibits tumor growth.