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Derby SJ, Dutton L, Strathdee KE, Stevenson K, Koessinger A, Jackson M, Tian Y, Yu W, Mclay K, Misquitta J, Alsharif S, Clarke CJ, Gilmour L, Thomason P, McGhee E, McGarrity-Cottrell CL, Vanderlinden A, Collis SJ, Rominyi O, Lemgruber L, Solecki G, Olson M, Winkler F, Carlin LM, Heiland DH, Inman GJ, Chalmers AJ, Norman JC, Carruthers R, Birch JL. Inhibition of ATR opposes glioblastoma invasion through disruption of cytoskeletal networks and integrin internalization via macropinocytosis. Neuro Oncol 2024; 26:625-639. [PMID: 37936324 PMCID: PMC10995506 DOI: 10.1093/neuonc/noad210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Glioblastomas have highly infiltrative growth patterns that contribute to recurrence and poor survival. Despite infiltration being a critical therapeutic target, no clinically useful therapies exist that counter glioblastoma invasion. Here, we report that inhibition of ataxia telangiectasia and Rad 3 related kinase (ATR) reduces invasion of glioblastoma cells through dysregulation of cytoskeletal networks and subsequent integrin trafficking. METHODS Glioblastoma motility and invasion were assessed in vitro and in vivo in response to ATR inhibition (ATRi) and ATR overexpression using time-lapse microscopy, two orthotopic glioblastoma models, and intravital imaging. Disruption to cytoskeleton networks and endocytic processing were investigated via high-throughput, super-resolution and intravital imaging. RESULTS High ATR expression was associated with significantly poorer survival in clinical datasets while histological, protein expression, and spatial transcriptomics using glioblastoma tumor specimens revealed higher ATR expression at infiltrative margins. Pharmacological inhibition with two different compounds and RNAi targeting of ATR opposed the invasion of glioblastoma, whereas overexpression of ATR drove migration. Subsequent investigation revealed that cytoskeletal dysregulation reduced macropinocytotic internalization of integrins at growth-cone-like structures, resulting in a tumor microtube retraction defect. The biological relevance and translational potential of these findings were confirmed using two orthotopic in vivo models of glioblastoma and intravital imaging. CONCLUSIONS We demonstrate a novel role for ATR in determining invasion in glioblastoma cells and propose that pharmacological targeting of ATR could have far-reaching clinical benefits beyond radiosensitization.
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Affiliation(s)
- Sarah J Derby
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Louise Dutton
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Karen E Strathdee
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Katrina Stevenson
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Anna Koessinger
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
- CRUK Scotland Institute, Glasgow, UK
| | - Mark Jackson
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Yuling Tian
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Wenxi Yu
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Kathy Mclay
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Josette Misquitta
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Sama Alsharif
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - Lesley Gilmour
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | | | | | - Aurelie Vanderlinden
- Department of Oncology and Metabolism, The University of Sheffield Medical School, Sheffield, UK
| | - Spencer J Collis
- Department of Oncology and Metabolism, The University of Sheffield Medical School, Sheffield, UK
| | - Ola Rominyi
- Department of Oncology and Metabolism, The University of Sheffield Medical School, Sheffield, UK
| | - Leandro Lemgruber
- Cellular Analysis Facility, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Gergely Solecki
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Olson
- Department of Chemistry and Biology, Ryeson University, Toronto, Ontario, Canada
| | - Frank Winkler
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Leo M Carlin
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
- CRUK Scotland Institute, Glasgow, UK
| | | | - Gareth J Inman
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
- CRUK Scotland Institute, Glasgow, UK
| | - Anthony J Chalmers
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Jim C Norman
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
- CRUK Scotland Institute, Glasgow, UK
| | - Ross Carruthers
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Joanna L Birch
- Wolfson Wohl Translational Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
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Jones CG, Vanderlinden A, Rominiyi O, Collis SJ. Development and Optimisation of Tumour Treating Fields (TTFields) Delivery within 3D Primary Glioma Stem Cell-like Models of Spatial Heterogeneity. Cancers (Basel) 2024; 16:863. [PMID: 38473223 DOI: 10.3390/cancers16050863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/08/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Glioblastoma is an aggressive, incurable brain cancer with poor five-year survival rates of around 13% despite multimodal treatment with surgery, DNA-damaging chemoradiotherapy and the recent addition of Tumour Treating Fields (TTFields). As such, there is an urgent need to improve our current understanding of cellular responses to TTFields using more clinically and surgically relevant models, which reflect the profound spatial heterogeneity within glioblastoma, and leverage these biological insights to inform the rational design of more effective therapeutic strategies incorporating TTFields. We have recently reported the use of preclinical TTFields using the inovitroTM system within 2D glioma stem-like cell (GSC) models and demonstrated significant cytotoxicity enhancement when co-applied with a range of therapeutically approved and preclinical DNA damage response inhibitors (DDRi) and chemoradiotherapy. Here we report the development and optimisation of preclinical TTFields delivery within more clinically relevant 3D scaffold-based primary GSC models of spatial heterogeneity, and highlight some initial enhancement of TTFields potency with temozolomide and clinically approved PARP inhibitors (PARPi). These studies, therefore, represent an important platform for further preclinical assessment of TTFields-based therapeutic strategies within clinically relevant 3D GSC models, aimed towards accelerating clinical trial implementation and the ultimate goal of improving the persistently dire survival rates for these patients.
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Affiliation(s)
- Callum G Jones
- Division of Clinical Medicine, University of Sheffield Medical School, Sheffield S10 2RX, UK
| | - Aurelie Vanderlinden
- Division of Clinical Medicine, University of Sheffield Medical School, Sheffield S10 2RX, UK
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ola Rominiyi
- Division of Clinical Medicine, University of Sheffield Medical School, Sheffield S10 2RX, UK
- Division of Neuroscience, University of Sheffield Medical School, Sheffield S10 2HQ, UK
- Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - Spencer J Collis
- Division of Clinical Medicine, University of Sheffield Medical School, Sheffield S10 2RX, UK
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Vanderlinden A, Jones CG, Myers KN, Rominiyi O, Collis SJ. DNA damage response inhibitors enhance tumour treating fields (TTFields) potency in glioma stem-like cells. Br J Cancer 2023; 129:1829-1840. [PMID: 37777579 PMCID: PMC10667536 DOI: 10.1038/s41416-023-02454-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND High-grade gliomas are primary brain cancers with unacceptably low and persistent survival rates of 10-16 months for WHO grade 4 gliomas over the last 40 years, despite surgical resection and DNA-damaging chemo-radiotherapy. More recently, tumour-treating fields therapy (TTFields) has demonstrated modest survival benefit and been clinically approved in several countries. TTFields is thought to mediate anti-cancer activity by primarily disrupting mitosis. However, recent data suggest that TTFields may also attenuate DNA damage repair and replication fork dynamics, providing a potential platform for therapeutic combinations incorporating standard-of-care treatments and targeted DNA damage response inhibitors (DDRi). METHODS We have used patient-derived, typically resistant, glioma stem-like cells (GSCs) in combination with the previously validated preclinical Inovitro™ TTFields system together with a number of therapeutic DDRi. RESULTS We show that TTFields robustly activates PARP- and ATR-mediated DNA repair (including PARylation and CHK1 phosphorylation, respectively), whilst combining TTFields with PARP1 or ATR inhibitor treatment leads to significantly reduced clonogenic survival. The potency of each of these strategies is further enhanced by radiation treatment, leading to increased amounts of DNA damage with profound delay in DNA damage resolution. CONCLUSION To our knowledge, our findings represent the first report of TTFields applied with clinically approved or in-trial DDRi in GSC models and provides a basis for translational studies toward multimodal DDRi/TTFields-based therapeutic strategies for patients with these currently incurable tumours.
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Affiliation(s)
- Aurelie Vanderlinden
- Division of Clinical Medicine, The University of Sheffield, School of Medicine and Population Health, Sheffield, S10 2RX, UK
| | - Callum G Jones
- Division of Clinical Medicine, The University of Sheffield, School of Medicine and Population Health, Sheffield, S10 2RX, UK
| | - Katie N Myers
- Division of Clinical Medicine, The University of Sheffield, School of Medicine and Population Health, Sheffield, S10 2RX, UK
| | - Ola Rominiyi
- Division of Clinical Medicine, The University of Sheffield, School of Medicine and Population Health, Sheffield, S10 2RX, UK.
- Division of Neuroscience, The University of Sheffield, School of Medicine and Population Health, Sheffield, S10 2RX, UK.
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK.
| | - Spencer J Collis
- Division of Clinical Medicine, The University of Sheffield, School of Medicine and Population Health, Sheffield, S10 2RX, UK.
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Vanderlinden A, Rominiyi O, Collis S, Jones C, Myers K, McGarrity - Cottrell C. DNAR-12. COMBINING TUMOUR TREATING FIELDS WITH THERAPEUTIC DNA DAMAGE RESPONSE INHIBITORS TO INCREASE POTENCY IN HIGH-GRADE GLIOBLASTOMAS USING CLINICALLY RELEVANT EX-VIVO GLIOMA STEM CELL MODELS. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
High-grade gliomas are the most common and aggressive type of primary brain cancer. Despite maximal surgical resection, followed by chemotherapy and radiotherapy, overall survival for patients remains between 10-16 months, with limited improvement in survival rates over the last 40 years. This highlights an urgent unmet clinical need to develop more effective therapeutic interventions for these devastating tumours.Tumour-Treating Fields (TTFields), which deliver low-intensity (1–3V/cm) intermediate-frequency (100–300kHz) alternating electric fields to localised tumour sites, represents an exciting new clinically-approved fourth modality for the treatment of high-grade gliomas, with randomised clinical trial evidence supporting improved overall survival (20.9 vs 16.0 months). Whilst TTFields are primarily thought to mediate their anti-cancer effects by disrupting mitotic tubulin dimer alignment leading to abnormal chromosomal segregation and mitotic cell death, recent data suggests that TTFields may also attenuate DNA damage repair efficiency and replication fork dynamics. We therefore hypothesised that combining TTFields with therapeutic DNA damage response inhibitors (DDRi), to develop next generation multimodal therapy regimes, would enhance TTFields potency in glioma cells either alone, or in combination with current standard-of-care chemoradiotherapy. To assess this, we employed clinically-relevant patient-derived primary glioma stem cell (GSC) models that represent both inter-patient and intra-tumoural heterogeneity, including unique ex-vivo models of post-surgical residual disease. We show that combining TTFields with radiation and clinically approved PARP inhibitor therapy leads to significantly increased amounts of DNA damage with concurrent decreased clonogenic survival in GSCs. Furthermore, we have shown similar impressive potency when TTFields treatments are combined with ATR inhibitors that are currently being assessed in various global clinical trials for other cancers. Overall, these exciting findings support further assessment of TTFields and DDRi combinations to underpin future clinical trials combining TTFields with clinically approved DDRi to improve outcomes for patients with currently incurable high-grade gliomas.
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Affiliation(s)
| | - Ola Rominiyi
- University of Sheffield , Sheffield, England , United Kingdom
| | - Spencer Collis
- University of Sheffield , Sheffield, England , United Kingdom
| | - Callum Jones
- University of Sheffield , Sheffield , United Kingdom
| | - Katie Myers
- University of Sheffield , Sheffield, England , United Kingdom
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Rominiyi O, Vanderlinden A, Myers K, Gomez-Roman N, Dar D, Bagga V, Jellinek DA, Chalmers AJ, Carroll TA, Al-Tamimi Y, Collis SJ. O2: TOWARDS A LIVING BIOBANK OF SURGICALLY-RELEVANT 3-DIMENSIONAL GLIOBLASTOMA STEM CELL MODELS TO EVALUATE NOVEL THERAPEUTICS AND INTERROGATE INTRATUMOURAL HETEROGENEITY. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Glioblastoma is the most common cancer arising within the brain. Despite surgery, followed by DNA-damaging chemoradiotherapy, average survival remains between 12-15 months. Unacceptable survival rates underline the need to develop preclinical research models which recapitulate features underpinning therapeutic resistance in patients, such as intratumoural heterogeneity and treatment resistant glioblastoma stem cell (GSC) subpopulations which demonstrate elevated DNA damage response (DDR) activity.
Method
Tumour specimens from patients were used to generate 2D and 3D scaffold-based GSC models, with a range of preclinical survival and molecular assays used to interrogate cancer biology and assess therapeutic responses.
Result
We have developed a ‘living biobank’ of 20+ ex-vivo GSC models which reflect key clinicopathological diversity. These models include residual disease models based on careful macrodissection of rare en-blocpartial lobectomy specimens to liberate parallel GSC lines from the tumour core and adjacent infiltrated brain, to represent cells typically left behind after surgery. Therapeutic strategies targeting fundamental DDR processes demonstrate preclinical efficacy, for example dual inhibition of ATR and the FA DNA damage repair pathways elicits profound radiosensitisation (sensitiser enhancement ratio of 3.23 (3.03-3.49, 95%-CI)) with evidence of delayed DNA damage repair on single-cell gel electrophoresis. Finally, characterisation of our surgically-relevant resected and residual models reveals numerous divergent properties including elevated stem cell marker expression in residual models (p=0.0021), which may partially explain treatment resistance in disease left behind after surgery.
Conclusion
Our living biobank represents a useful resource for preclinical glioblastoma research and demonstrates the value of partnership between surgeons and laboratory-based scientists.
Take-home message
Our living biobank represents a useful resource for preclinical glioblastoma research and demonstrates the value of partnership between surgeons and laboratory-based scientists.
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Affiliation(s)
- O Rominiyi
- Academic Unit of Molecular Oncology, Department of Oncology & Metabolism, University of Sheffield
- Neuro-oncology Group, Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust
| | - A Vanderlinden
- Academic Unit of Molecular Oncology, Department of Oncology & Metabolism, University of Sheffield
| | - K Myers
- Academic Unit of Molecular Oncology, Department of Oncology & Metabolism, University of Sheffield
| | - N Gomez-Roman
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow
| | - D Dar
- Academic Unit of Molecular Oncology, Department of Oncology & Metabolism, University of Sheffield
| | - V Bagga
- Neuro-oncology Group, Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust
| | - DA Jellinek
- Neuro-oncology Group, Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust
| | - AJ Chalmers
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow
| | - TA Carroll
- Neuro-oncology Group, Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust
| | - Y Al-Tamimi
- Neuro-oncology Group, Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust
| | - SJ Collis
- Academic Unit of Molecular Oncology, Department of Oncology & Metabolism, University of Sheffield
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Carmell N, Rominiyi O, Myers KN, McGarrity-Cottrell C, Vanderlinden A, Lad N, Perroux-David E, El-Khamisy SF, Fernando M, Finegan KG, Brown S, Collis SJ. Identification and Validation of ERK5 as a DNA Damage Modulating Drug Target in Glioblastoma. Cancers (Basel) 2021; 13:cancers13050944. [PMID: 33668183 PMCID: PMC7956595 DOI: 10.3390/cancers13050944] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Glioblastomas are high-grade brain tumours and are the most common form of malignancy arising in the brain. Patient survival has improved little over the last 40 years, highlighting an urgent unmet need for more effective treatments for these tumours. Current standard-of-care treatment involves surgical removal of as much of the tumour as possible followed by a course of chemo-/radiotherapy. The main chemotherapeutic drug used is called temozolomide, however even with this treatment regimen, the average patient survival following diagnosis is around 15 months. We have identified a protein called ERK5 which is present at higher levels in these high-grade brain tumours compared to normal brain tissue, and which is also associated with resistance to temozolomide and poor patient survival. Additionally, we show that targeting ERK5 in brain tumour cells can improve the effectiveness of temozolomide in killing these tumour cells and offers potential much-needed future clinical benefit to patients diagnosed with glioblastoma. Abstract Brain tumours kill more children and adults under 40 than any other cancer, with approximately half of primary brain tumours being diagnosed as high-grade malignancies known as glioblastomas. Despite de-bulking surgery combined with chemo-/radiotherapy regimens, the mean survival for these patients is only around 15 months, with less than 10% surviving over 5 years. This dismal prognosis highlights the urgent need to develop novel agents to improve the treatment of these tumours. To address this need, we carried out a human kinome siRNA screen to identify potential drug targets that augment the effectiveness of temozolomide (TMZ)—the standard-of-care chemotherapeutic agent used to treat glioblastoma. From this we identified ERK5/MAPK7, which we subsequently validated using a range of siRNA and small molecule inhibitors within a panel of glioma cells. Mechanistically, we find that ERK5 promotes efficient repair of TMZ-induced DNA lesions to confer cell survival and clonogenic capacity. Finally, using several glioblastoma patient cohorts we provide target validation data for ERK5 as a novel drug target, revealing that heightened ERK5 expression at both the mRNA and protein level is associated with increased tumour grade and poorer patient survival. Collectively, these findings provide a foundation to develop clinically effective ERK5 targeting strategies in glioblastomas and establish much-needed enhancement of the therapeutic repertoire used to treat this currently incurable disease.
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Affiliation(s)
- Natasha Carmell
- Weston Park Cancer Centre, Department of Oncology & Metabolism, The University of Sheffield Medical School, Sheffield S10 2SJ, UK; (N.C.); (O.R.); (K.N.M.); (C.M.-C.); (A.V.); (N.L.); (E.P.-D.)
| | - Ola Rominiyi
- Weston Park Cancer Centre, Department of Oncology & Metabolism, The University of Sheffield Medical School, Sheffield S10 2SJ, UK; (N.C.); (O.R.); (K.N.M.); (C.M.-C.); (A.V.); (N.L.); (E.P.-D.)
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - Katie N. Myers
- Weston Park Cancer Centre, Department of Oncology & Metabolism, The University of Sheffield Medical School, Sheffield S10 2SJ, UK; (N.C.); (O.R.); (K.N.M.); (C.M.-C.); (A.V.); (N.L.); (E.P.-D.)
| | - Connor McGarrity-Cottrell
- Weston Park Cancer Centre, Department of Oncology & Metabolism, The University of Sheffield Medical School, Sheffield S10 2SJ, UK; (N.C.); (O.R.); (K.N.M.); (C.M.-C.); (A.V.); (N.L.); (E.P.-D.)
| | - Aurelie Vanderlinden
- Weston Park Cancer Centre, Department of Oncology & Metabolism, The University of Sheffield Medical School, Sheffield S10 2SJ, UK; (N.C.); (O.R.); (K.N.M.); (C.M.-C.); (A.V.); (N.L.); (E.P.-D.)
| | - Nikita Lad
- Weston Park Cancer Centre, Department of Oncology & Metabolism, The University of Sheffield Medical School, Sheffield S10 2SJ, UK; (N.C.); (O.R.); (K.N.M.); (C.M.-C.); (A.V.); (N.L.); (E.P.-D.)
| | - Eva Perroux-David
- Weston Park Cancer Centre, Department of Oncology & Metabolism, The University of Sheffield Medical School, Sheffield S10 2SJ, UK; (N.C.); (O.R.); (K.N.M.); (C.M.-C.); (A.V.); (N.L.); (E.P.-D.)
| | - Sherif F. El-Khamisy
- Sheffield Institute for Nucleic Acids (SInFoNiA) and the Healthy Lifespan Institute, University of Sheffield, Sheffield S10 2TN, UK;
- Institute of Cancer Therapeutics, University of Bradford, Bradford BD7 1DP, UK
| | - Malee Fernando
- Department of Histopathology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2TN, UK;
| | - Katherine G. Finegan
- Faculty of Biology Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
| | - Stephen Brown
- Department of Biomedical Science, The Sheffield RNAi Screening Facility, The University of Sheffield, Sheffield S10 2TN, UK;
| | - Spencer J. Collis
- Weston Park Cancer Centre, Department of Oncology & Metabolism, The University of Sheffield Medical School, Sheffield S10 2SJ, UK; (N.C.); (O.R.); (K.N.M.); (C.M.-C.); (A.V.); (N.L.); (E.P.-D.)
- Sheffield Institute for Nucleic Acids (SInFoNiA) and the Healthy Lifespan Institute, University of Sheffield, Sheffield S10 2TN, UK;
- Correspondence: ; Tel.: +44-(0)114-215-9043
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Rominiyi O, Vanderlinden A, Clenton SJ, Bridgewater C, Al-Tamimi Y, Collis SJ. Tumour treating fields therapy for glioblastoma: current advances and future directions. Br J Cancer 2021; 124:697-709. [PMID: 33144698 PMCID: PMC7884384 DOI: 10.1038/s41416-020-01136-5] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/16/2020] [Accepted: 10/05/2020] [Indexed: 12/13/2022] Open
Abstract
Glioblastoma multiforme (GBM) is the most common primary brain tumour in adults and continues to portend poor survival, despite multimodal treatment using surgery and chemoradiotherapy. The addition of tumour-treating fields (TTFields)-an approach in which alternating electrical fields exert biophysical force on charged and polarisable molecules known as dipoles-to standard therapy, has been shown to extend survival for patients with newly diagnosed GBM, recurrent GBM and mesothelioma, leading to the clinical approval of this approach by the FDA. TTFields represent a non-invasive anticancer modality consisting of low-intensity (1-3 V/cm), intermediate-frequency (100-300 kHz), alternating electric fields delivered via cutaneous transducer arrays configured to provide optimal tumour-site coverage. Although TTFields were initially demonstrated to inhibit cancer cell proliferation by interfering with mitotic apparatus, it is becoming increasingly clear that TTFields show a broad mechanism of action by disrupting a multitude of biological processes, including DNA repair, cell permeability and immunological responses, to elicit therapeutic effects. This review describes advances in our current understanding of the mechanisms by which TTFields mediate anticancer effects. Additionally, we summarise the landscape of TTFields clinical trials across various cancers and consider how emerging preclinical data might inform future clinical applications for TTFields.
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Affiliation(s)
- Ola Rominiyi
- Weston Park Cancer Centre, Department of Oncology & Metabolism, The University of Sheffield Medical School, Sheffield, UK.
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - Aurelie Vanderlinden
- Weston Park Cancer Centre, Department of Oncology & Metabolism, The University of Sheffield Medical School, Sheffield, UK
| | - Susan Jane Clenton
- Department of Clinical Oncology, Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Caroline Bridgewater
- Department of Clinical Oncology, Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Yahia Al-Tamimi
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Spencer James Collis
- Weston Park Cancer Centre, Department of Oncology & Metabolism, The University of Sheffield Medical School, Sheffield, UK.
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Rominiyi O, Myers K, Vanderlinden A, Dar D, Bagga V, Gomez-Roman N, Jellinek D, Carroll T, Chalmers A, Al-Tamimi Y, Collis S. TMOD-39. EX-VIVO 3-DIMENSIONAL MODELS OF POST-SURGICAL RESIDUAL DISEASE IN HUMAN GLIOBLASTOMA. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Translation of novel therapies for glioblastoma from laboratory to clinical trials has relied heavily on cells derived from within patient tumours. However, it is clear from over 40 years of limited improvement in survival rates, that the traditional paradigm of 2-dimensional in-vitro studies using these cells followed by implantation into mouse models poorly predicts the treatment response of glioblastoma cells left behind after surgery in patients. Additionally, recent increases in the number of new therapies requiring pre-clinical evaluation emphasise a need to apply disease models that faithfully and efficiently reproduce biological features of post-surgical residual glioblastoma in patients. Dependent on the anatomical considerations of individual cases, surgical resection occasionally provides an en-bloc specimen (e.g. partial lobectomy), which includes portions of infiltrated brain that would not otherwise be resected. Such specimens provide crucial material to model and understand residual (typically left behind) disease in glioblastoma. Using such specimens, we have developed a pragmatic methodology to liberate glioblastoma stem cells (GSC) from the tumour core and adjacent infiltrated brain to model resected and residual disease, respectively. Imperative considerations include careful patient selection and intraoperative clinical-academic collaboration, with immediate ex-vivo hemi-section and processing of suitable specimens. Initial biological characterisation of our resected and residual models reveals numerous divergent properties including morphological differences and elevated stem cell marker expression in residual models (p=0.0021). Importantly, although GSC within recently derived 2-dimensional residual disease models are frequently too migratory to reliably form discrete colonies, we are able to perform robust clonogenic survival studies using the same GSC within a novel customised 3-dimensional scaffold-based architecture (3.4-fold greater clonogenic potential, p=0.0010). In conclusion, we believe that our models provide a biologically relevant and cost-effective tool to investigate the nuances of residual glioblastoma and assess the potential of therapies to tackle disease normally left behind following surgery in patients.
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Affiliation(s)
- Ola Rominiyi
- The University of Sheffield, Sheffield, England, United Kingdom
| | - Katie Myers
- The University of Sheffield, Sheffield, England, United Kingdom
| | | | - Dawoud Dar
- The University of Sheffield, Sheffield, England, United Kingdom
| | - Veejay Bagga
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England, United Kingdom
| | | | - David Jellinek
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England, United Kingdom
| | - Thomas Carroll
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England, United Kingdom
| | | | - Yahia Al-Tamimi
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England, United Kingdom
| | - Spencer Collis
- The University of Sheffield, Sheffield, England, United Kingdom
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