VC-resist glioblastoma cell state: vessel co-option as a key driver of chemoradiation resistance

Glioblastoma (GBM) is a highly lethal type of cancer. GBM recurrence following chemoradiation is typically attributed to the regrowth of invasive and resistant cells. Therefore, there is a pressing need to gain a deeper understanding of the mechanisms underlying GBM resistance to chemoradiation and its ability to infiltrate. Using a combination of transcriptomic, proteomic, and phosphoproteomic analyses, longitudinal imaging, organotypic cultures, functional assays, animal studies, and clinical data analyses, we demonstrate that chemoradiation and brain vasculature induce cell transition to a functional state named VC-Resist (vessel co-opting and resistant cell state). This cell state is midway along the transcriptomic axis between proneural and mesenchymal GBM cells and is closer to the AC/MES1-like state. VC-Resist GBM cells are highly vessel co-opting, allowing significant infiltration into the surrounding brain tissue and homing to the perivascular niche, which in turn induces even more VC-Resist transition. The molecular and functional characteristics of this FGFR1-YAP1-dependent GBM cell state, including resistance to DNA damage, enrichment in the G2M phase, and induction of senescence/stemness pathways, contribute to its enhanced resistance to chemoradiation. These findings demonstrate how vessel co-option, perivascular niche, and GBM cell plasticity jointly drive resistance to therapy during GBM recurrence.

High-sensitive spatially resolved T cell receptor sequencing with SPTCR-seq

Spatial resolution of the T cell repertoire is essential for deciphering cancer-associated immune dysfunction. Current spatially resolved transcriptomic technologies are unable to directly annotate T cell receptors (TCR). We present spatially resolved T cell receptor sequencing (SPTCR-seq), which integrates optimized target enrichment and long-read sequencing for highly sensitive TCR sequencing. The SPTCR computational pipeline achieves yield and coverage per TCR comparable to alternative single-cell TCR technologies. Our comparison of PCR-based and SPTCR-seq methods underscores SPTCR-seq's superior ability to reconstruct the entire TCR architecture, including V, D, J regions and the complementarity-determining region 3 (CDR3). Employing SPTCR-seq, we assess local T cell diversity and clonal expansion across spatially discrete niches. Exploration of the reciprocal interaction of the tumor microenvironmental and T cells discloses the critical involvement of NK and B cells in T cell exhaustion. Integrating spatially resolved omics and TCR sequencing provides as a robust tool for exploring T cell dysfunction in cancers and beyond.

Sialic acid metabolism orchestrates transcellular connectivity and signaling in glioblastoma

BACKGROUND

In glioblastoma (GBM), the effects of altered glycocalyx are largely unexplored. The terminal moiety of cell coating glycans, sialic acid, is of paramount importance for cell-cell contacts. However, sialic acid turnover in gliomas and its impact on tumor networks remain unknown.

METHODS

We streamlined an experimental setup using organotypic human brain slice cultures as a framework for exploring brain glycobiology, including metabolic labeling of sialic acid moieties and quantification of glycocalyx changes. By live, 2-photon and high-resolution microscopy we have examined morphological and functional effects of altered sialic acid metabolism in GBM. By calcium imaging we investigated the effects of the altered glycocalyx on a functional level of GBM networks.

RESULTS

The visualization and quantitative analysis of newly synthesized sialic acids revealed a high rate of de novo sialylation in GBM cells. Sialyltrasferases and sialidases were highly expressed in GBM, indicating that significant turnover of sialic acids is involved in GBM pathology. Inhibition of either sialic acid biosynthesis or desialylation affected the pattern of tumor growth and lead to the alterations in the connectivity of glioblastoma cells network.

CONCLUSIONS

Our results indicate that sialic acid is essential for the establishment of GBM tumor and its cellular network. They highlight the importance of sialic acid for glioblastoma pathology and suggest that dynamics of sialylation have the potential to be targeted therapeutically.

Isolation and profiling of viable tumor cells from human ex vivo glioblastoma cultures through single-cell transcriptomics

Single-cell RNA-sequencing (scRNA-seq) is becoming a ubiquitous method in profiling the cellular transcriptomes of both malignant and non-malignant cells from the human brain. Here, we present a protocol to isolate viable tumor cells from human ex vivo glioblastoma cultures for single-cell transcriptomic analysis. We describe steps including surgical tissue collection, sectioning, culturing, primary tumor cells inoculation, growth tracking, fluorescence-based cell sorting, and population-enriched scRNA-seq. This comprehensive methodology empowers in-depth understanding of brain tumor biology at the single-cell level. For complete details on the use and execution of this protocol, please refer to Ravi et al.1.

18F-Fluorodeoxyglucose Positron Emission Tomography Parameters can Predict Long-Term Outcome Following Trimodality Treatment for Oesophageal Cancer

AIMS

¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸FDG-PET/CT) is routinely used for the pre-treatment staging of oesophageal or gastro-oesophageal junction cancers (EGEJC). The aim of this study was to identify objective ¹⁸FDG-PET/CT-derived parameters that can aid in predicting the patterns of recurrence and prognostication in patients with EGEJC.

PATIENTS AND METHODS

EGEJC patients referred for consideration of preoperative chemoradiation therapy were identified and clinicopathological data were collected. ¹⁸FDG-PET/CT imaging data were reviewed and correlated with treatment outcomes. Maximum standardised uptake value (SUV_max), metabolic tumour volume (MTV) and total lesion glycolysis were assessed and association with recurrence-free survival (RFS), locoregional recurrence-free survival (LR-RFS), oesophageal cancer-specific survival (ECSS) and overall survival were evaluated using receiver operating characteristic curves, as well as Cox regression and Kaplan-Meier models.

RESULTS

In total, 191 EGEJC patients completed trimodality treatment and 164 with ¹⁸FDG-PET/CT data were included in this analysis. At the time of analysis, 15 (9.1%), 70 (42.7%) and two (1.2%) patients were noted to have locoregional, distant and both locoregional and distant metastases, respectively. The median RFS was 30 months (9.6-50.4) and the 5-year RFS was 31.1%. The 5-year overall survival and ECSS were both noted to be 34.8%. Pre-treatment MTV₂₅ > 28.5 cm³ (P = 0.029), MTV₄₀ > 12.4 cm³ (P = 0.018) and MTV₅₀ > 10.2 cm³ (P = 0.005) predicted for worse LR-RFS, ECSS and overall survival for MTV definition of voxels ≥25%, 40% and 50% of SUV_max.

CONCLUSION

¹⁸FDG-PET/CT parameters MTV and total lesion glycolysis are useful prognostic tools to predict for LR-RFS, ECSS and overall survival in EGEJC. MTV had the highest accuracy in predicting clinical outcomes. The volume cut-off points we identified for different MTV thresholds predicted outcomes with significant accuracy and may potentially be used for decision making in clinical practice.

Lactate dehydrogenases promote glioblastoma growth and invasion via a metabolic symbiosis

Lactate is a central metabolite in brain physiology but also contributes to tumor development. Glioblastoma (GB) is the most common and malignant primary brain tumor in adults, recognized by angiogenic and invasive growth, in addition to its altered metabolism. We show herein that lactate fuels GB anaplerosis by replenishing the tricarboxylic acid (TCA) cycle in absence of glucose. Lactate dehydrogenases (LDHA and LDHB), which we found spatially expressed in GB tissues, catalyze the interconversion of pyruvate and lactate. However, ablation of both LDH isoforms, but not only one, led to a reduction in tumor growth and an increase in mouse survival. Comparative transcriptomics and metabolomics revealed metabolic rewiring involving high oxidative phosphorylation (OXPHOS) in the LDHA/B KO group which sensitized tumors to cranial irradiation, thus improving mouse survival. When mice were treated with the antiepileptic drug stiripentol, which targets LDH activity, tumor growth decreased. Our findings unveil the complex metabolic network in which both LDHA and LDHB are integrated and show that the combined inhibition of LDHA and LDHB strongly sensitizes GB to therapy.

P10.24.A A personalized BRAF mutant glioblastoma with Human2Humanex-vivo cortical cultures

Background

Glioblastoma is among the most common primary malignancy with a poor medium survival post-diagnosis. The incredible heterogeneity of glioblastoma highlights its incurable nature. Methods to overcome difficulties leaded by glioblastoma heterogeneity remain to be explored. Here we present our Human2Human personalized autografted BRAF(V600E) mutant glioblastoma model, focusing on the idea of precision. This model, with an inoculation of self-derived glioblastoma cells, can imitate the tumor growth, invasion, metabolism and microenvironmental crosstalk within its “native” microenvironment and allows us to investigate the influence of different chemotherapies on the immunosuppressive tumor microenvironment from each specific individual glioblastoma patient.

Material and Methods

Non-neoplastic cortical tissue was obtained from a BRAF(V600E) mutant glioblastoma patient during surgical operation. Tissue was sectioned and inoculated with autografted glioblastoma cells in order to establish the ex-vivo Human2Human personalized brain slice model. Slice viability and tumor growth were monitored throughout the culture period, with and without day-wise refreshed treatments of clinically proved BRAF/MEK inhibitors. Sections were fixed and stained post cultivation. Pathway proteins p-ERK, p-Akt based on BRAF signaling along with markers (TMEM119, Iba-1, CD3, CD68, GFAP and NeuN) for major cell types in the environment were stained. Single Nuclei RNA Sequencing and Spatially Resolved Transcriptomics were applied.

Results

Tumor growth quantification over the culture period revealed different tumor reaction and tolerance towards various chemotherapies. The combination of Vemurafenib + Trametinib exhibited more efficient therapy response in comparison with either Dabrafenib + Trametinib or Encorafenib + Trametinib. Immunofluorescence and immunohistochemistry based quantification referring to neurons (NeuN), astrocytes (GFAP) and microglia/macrophage cells (Iba-1) suggested no toxic effects of the drug combinations on the tumor microenvironment. BRAF pathway proteins and immune cells showed various activation patterns upon different treatment combinations on an immunofluorescence base. Single Nuclei RNA Sequencing revealed the mesenchymal differentiation of BRAF mutant glioblastoma cells. Spatially Resolved Transcriptomics characterized tumor recurrence and suggested the therapy response accurately and visually.

Conclusion

The combination of Vemurafenib + Trametinib shows strategy to this specific BRAF mutant glioblastoma patient. And therefore, this Human2Human personalized model has a potential to provide in-depth information of the spatio-temporal tumor differentiation ex-vivo, correct inter-patient bias, and model therapy response in a very short time frame to provide drug testing results for clinical decision making.

P12.14.A The role of onco-metabolite (R2hydroxyglutarate) in the IDH mutant glioblastoma microenvironment

Background

Recently, we found that the reactive astrocytes in the IDH wild type glioblastoma contribute to anti-tumor immunity and support pro-oncogenic signaling. Here, we characterized the transcriptomic signature of IDH1/2-mutant glioma associated astrocytes and determined a unique inflammatory transformation, profoundly different to astrocytes in IDH wildtype glioma patients due to an onco-metabolite R-2-hydroxyglutarate using Next generation sequencing and human ex-vivo slice model.

Material and Methods

We purified and transcriptionally profiled astrocytes from 9 patients with confirmed IDH1-R132H mutation, by means of RNA-sequencing and the data were analyzed using the established pipelines. We also used spatial transcriptomics to evidently show the spatial distribution of astrocytes in IDH-mutated/wildtype glioma samples. We validated our findings using human organotypic slice model inoculated with IDH-mutant cell line or treated with oncometabolite 2-hydroxy glutarate. Additionally, LC-MS was further used to give us a chart of neurotransmitters due to altered microenvironment.

Results

Our results from RNA sequencing showed a transcriptional transformation of reactive astrocytes within the microenvironment of IDH-mutated tumors compared to wildtype glioma by means of RNA-sequencing of purified astrocytes. And, using our established human neocortical GBM model inoculated with IDH mutant tumor and R-2HG treatment, we showed that we were able to activate inflammatory transcriptional programs in astrocytes, mediated by the presence of microglia. Further, by spatially mapping the transcriptomic profiles of purified microglia, we were able to confirm that microglia also demonstrate inflammatory activation in IDH mutated glioma. This inflammatory astrocyte transformation is associated with a loss of neurotransmitter homeostasis (disrupted levels of glutamate) in the treated sections, as has been previously reported in IDH mutated tumors. Additionally, R-H2G increased neuronal spiking rate in, pointing to potential excitotoxicity.

Conclusion

Our work provides a crucial contribution towards understanding the role of R-2HG in the IDH mutant glioma microenvironment and sheds light on the significant microenvironmental differences to IDH wild-type glioma.

Spatially resolved multi-omics deciphers bidirectional tumor-host interdependence in glioblastoma

Glioblastomas are malignant tumors of the central nervous system hallmarked by subclonal diversity and dynamic adaptation amid developmental hierarchies. The source of dynamic reorganization within the spatial context of these tumors remains elusive. Here, we characterized glioblastomas by spatially resolved transcriptomics, metabolomics, and proteomics. By deciphering regionally shared transcriptional programs across patients, we infer that glioblastoma is organized by spatial segregation of lineage states and adapts to inflammatory and/or metabolic stimuli, reminiscent of the reactive transformation in mature astrocytes. Integration of metabolic imaging and imaging mass cytometry uncovered locoregional tumor-host interdependence, resulting in spatially exclusive adaptive transcriptional programs. Inferring copy-number alterations emphasizes a spatially cohesive organization of subclones associated with reactive transcriptional programs, confirming that environmental stress gives rise to selection pressure. A model of glioblastoma stem cells implanted into human and rodent neocortical tissue mimicking various environments confirmed that transcriptional states originate from dynamic adaptation to various environments.

Does Loosening the Inclusion Criteria of the CROSS Trial Impact Outcomes in the Curative-Intent Trimodality Treatment of Oesophageal and Gastroesophageal Cancer Patients?

AIM

To determine the efficacy of preoperative chemoradiotherapy as per the CROSS protocol for oesophageal/gastroesophageal junction cancer (OEGEJC), when expanded to patients outside of the inclusion/exclusion criteria defined in the original clinical trial.

MATERIALS AND METHODS

Data were collected retrospectively on 229 OEGEJC patients referred for curative-intent preoperative chemoradiotherapy. Outcomes including pathological complete response (pCR), overall survival (OS), cancer-specific survival and recurrence-free survival (RFS) of patients who met CROSS inclusion criteria (MIC) versus those who failed to meet criteria (FMIC) were determined.

RESULTS

In total, 42.8% of patients MIC, whereas 57.2% FMIC; 16.6% of patients did not complete definitive surgery. The MIC cohort had higher rates of pCR, when compared with the FMIC cohort (33.3% versus 20.6%, P = 0.039). The MIC cohort had a better RFS, cancer-specific survival and OS compared with the FMIC cohort (P = 0.006, P = 0.004 and P = 0.009, respectively). Age >75 years and pretreatment weight loss >10% were not associated with a poorer RFS (P = 0.541 and 0.458, respectively). Compared with stage I-III patients, stage IVa was associated with a poorer RFS (hazard ratio (HR) = 2.158; 95% confidence interval (CI) = 1.339-3.480, P = 0.001). Tumours >8 cm in length or >5 cm in width had a trend towards worse RFS (HR = 2.060; 95% CI = 0.993-4.274, P = 0.052).

CONCLUSION

Our study showed that the robust requirements of the CROSS trial may limit treatment for patients with potentially curable OEGEJC and can be adapted to include patients with a good performance status who are older than 75 years or have >10% pretreatment weight loss. However, the inclusion of patients with celiac nodal metastases or tumours >8 cm in length or >5 cm in width may be associated with poor outcomes.

Modification of epoxy binder with multi walled carbon nanotubes in hybrid fiber systems used for retrofitting of concrete structures: evaluation of strength characteristics

The rapid development in infrastructural facilities necessitates an efficient approach for the repair and retrofitting of concrete structures and, confinement method using fiber reinforced polymer is a promising one. The commonly used carbon and glass fibers for confinement poses environmental and performance issues. The present study addresses these two major aspects by considering natural fibers along with modification of epoxy binder to impart ductile behavior ie., to investigate the effectiveness of multiwalled carbon nanotubes (MWCNT) incorporated synthetic and natural fiber reinforced polymer (FRP) systems as the external confinement. MWCNT is incorporated in 0.5-1.5wt.% in epoxy nano and epoxy multiscale and there is significant enhancement in tensile and fracture properties of the composites up to 1wt.%, beyond which it declined due to agglomeration. Various strength tests were performed with sisal, basalt, carbon and hybrid sisal-basalt FRP systems with different FRP layer thickness on plain concrete cylinders. From the test results it is outlined that external confinement with MWCNT incorporated FRP improved the axial load-carrying capacity, energy absorption and ductility of concrete with respect to that of control specimens. Compared with unconfined specimens, those strengthened with MWCNT modified hybrid FRP wraps containing sisal and basalt fibers recorded increments of 114% and 87% in their load-carrying capacity and energy absorption, due to the intrinsic rigidity of hybrid fibers and epoxy modification. Furthermore, the outcomes indicate that MWCNT incorporated hybrid sisal-basalt FRP confined specimens exhibited superior properties and the low strength of natural FRP confinement compared to artificial FRP can be improved by epoxy modification. The outer jacketing resisted abrupt and catastrophic failure to a great extent.

TAMI-49. JAK STAT INHIBITION REVERSES MYELOID CELL INDUCED ANTI TUMOR IMMUNITY IN T CELLS

BACKGROUND

Many central questions about the immunosuppressive microenvironment in glioblastoma (GBM) remain unanswered, particularly the interaction with lymphoid and myeloid populations. Here, we combined single-cell (scRNA) and spatial transcriptomics (stRNA) to comprehensively characterize the immune interaction with GBM.

MATERIAL AND METHODS

We performed scRNA-Seq of 50k CD45+ cells (8 patients) and inferred transcriptional programs and fate decisions in T cells. A novel algorithm (Nearest functionally connected neighbor) was used to predict interacting cells, further validated using spatial transcriptomics and immunofluorescence. Our findings were validated in our human neocortical glioblastoma model with autografted T cells.

RESULTS

Integration of st/scRNA-seq revealed a transcriptional shift of T cells towards exhaustion/hypoxia induced dysfunction. Pseudo-time analysis revealed increased Interleukin 10 (IL10) response during the Tcell transformation from the effector to the exhausted state. Using NFCN we identified a subset of HMOX1+ myeloid cells (STAT/HMOX axis), responsible for this IL10 release. Computational findings were validated using our human neocortical glioblastoma model with autografted T cells, where IL10R-inhibition/myeloid cell depletion prevented T cell exhaustion/dysfunction (p < 0.01) . In order to target the STAT3/HMOX1 axis we used a JAK/STAT inhibitor in our model which showed a drastic reduction of IL10 release (p< 0.02) and concordant activation of T cells. Clinically, one patient treated with a JAK/STAT-inhibitor in a neoadjuvant setting, 4 weeks prior to the recurrent GBM surgery, led to a significant increase (p< 0.001) in effector T cell population.

CONCLUSION

Our findings suggest that targeting the myeloid compartment of GBM provides an opportunity to convert a “cold” into “hot” immune environment which might be helpful to improve all T cell based therapies in the future.

TMOD-17. A NOVEL GLIOBLASTOMA INVASION MODEL USING HUMAN BRAIN SLICE CULTURES

OBJECTIVE

Glioblastoma (GBM) is among the most common of malignant brain tumours, with a median post-surgical survival of less than one year. Over the past several decades, therapies that appeared promising in mice models have failed during clinical trials due to the differences encountered during translation of research from model organisms to humans. To partially mitigate these difficulties in translation, we present a human cortical organotypic culture based GBM model, which allows us to manipulate individual components of the tumour environment in order to investigate the influence of different cell types in the immunosuppressive tumour microenvironment.

METHODS

Human neocortical tissue (at least 2 cm away from the tumour core) or entry cortex from epilepsy surgery guided by intraoperative neuro navigation, was cultured for up to 14 days post resection using an optimized medium. The cultured tissue was further injected with patient derived human GBM cells to create an ex vivo human model of glioblastoma model. The role of astrocytes in the tumour microenvironment was studied using microglia loss of function model.

RESULTS

Our established human neo-cortical slice model can recapitulate an in-vivo characteristics of glioblastoma from functional and imaging aspect. Our data corroborate differences between astrocytes in human and murine models in different reactive states, shows that the glioblastoma microenvironment can be difficult to be accurately modelled using murine models. Results from our human microglia depletion model, provided ample evidence that complex interaction of astrocytes and microglia cells, promotes an immunosuppressive environment in Glioblastoma by releasing high concentration of IL10 and TGFbeta (p< 0.001).

CONCLUSION

Our model therefore has potential applications to the fields of neuroscience, neuro-oncology, and pharmacotherapy.

TAMI-72. DIVERSITY OF CELLULAR COMMUNICATION IN GLIOBLASTOMA

OBJECTIVE

Owing to recent advances in understanding of the active functional states exhibited within glioblastoma (GBM), intra-tumoral cellular signaling has moved into focus of neuro-oncology. In this study, we aim to explore the diversity of transcellular signaling and investigate correlations between transcriptional dynamics and functional signaling.

METHODS

Electrophysiological characterization of GBM was carried out using planar microelectrodes and Ca2+ imaging, in both 2D cell culture as well as in our novel human cortical GBM model. Exposure to physiologically relevant conditions present within the tumor was carried out to identify specific signaling cells of interest and capture the signaling diversity in response to environmental conditions. Transcriptional dynamics and plasticity were examined by means of scRNA-sequencing with CRISPR based perturbation, spatial transcriptomics and deep long-read RNA-sequencing.

RESULTS

Electrophysiological profiles of multiple primary GBM cell lines revealed characteristics of scale-free networks (R2=0.875), confirmed in both 2D culture as well as a human neocortical GBM model. When GBM was cultured in a “in-vivo” like environment, basal activity was significantly higher (50%, p=0.01). Cellular signaling was directly correlated to changes in the environment, like hypoxia or glutamatergic activation, and total inhibition of electrical signaling required the usage of synaptic inhibitors. Using single-cell RNA sequencing and proteomics, several synaptogenesis related genes were identified to play a crucial role in the lineage states present in GBM. CRISPR based perturbation of these genes resulted in alterations in cellular morphology and decreased cellular connectivity (p< 0.01), with loss of scale free features (R2=0.35), and transcriptomic loss of developmental lineages (FDR< 0.01), leading to significant inhibition of GBM stress response.

CONCLUSION

Our findings highlight the role of electrical signaling in glioblastoma. Cellular stressors induce intercellular signaling, leading to transcriptional adaptation suggesting that there exists a highly complex and powerful mechanism for dynamic transcriptional state adaptation.

IMMU-28. DECONVOLUTION OF SPATIALLY RESOLVED T CELL RECEPTOR PROFILING (SPTCR-seq) UNCOVERED REGIONAL ANTI-TUMOR IMMUNITY IN GLIOBLASTOMA

The diversity to T cell responses and clonality in spatially heterogeneous glioblastoma is of paramount importance to explore underlying mechanisms of anti-tumor immunity. Spatial transcriptomics, a novel technology to map the transcriptional architecture, is technically limited to discover T cell receptor (TCR) sequences as the 3' approach lacks sufficient coverage. Here, we established SPTCR-seq, a method to capture TCR sequences followed by long-read sequencing to enable full-length TCR reconstruction. We performed 10X Visium spatial transcriptomics on 9 primary and recurrent glioblastoma with both 3’-sequencing and SPTCR-seq. For SPTCR-seq, we target enriched T cell receptor sequences by capturing by hybridization followed by Oxford-Nanopore long-read sequencing. The on-target rate was above 80% for captured TCR genes and spatial barcode was successfully aligned in more than 60%. IgBlast and MixCR were used to reconstruct the TCR and map T cell clonality. Within our recent developed spatial transcriptomic analysis framework (SPATA2), we build a novel toolbox, SPATA-Immunology, which enables integration of stRNA-sequencing data and spatially resolved TCR sequencing. Our data showed that clonal evolution of T cells is limited to regional areas underpinned by significant spatial autocorrelation coefficient (0.6-0.95, padj< 0.001). In the surrounding tumor cell spots, the recently described transcriptional program “reactive immune” (RI), was significantly enriched. Using spotlight, a computational approach to project scRNA-sequencing into the spatial space, we found a local enrichment of CD163 positive macrophages exclusively in areas of large T cell clonality. Imaging mass cytometry of a consecutive section confirmed the spatial confluence of T-cell infiltration and CD163-positive macrophages. Through DeepTCR we uncovered potential epitopes which correlate with T cell clonality and might help to discover novel targets for CART therapy. Spatial profiling of TCR sequences through SPTCR-seq is a powerful tool to investigate anti-tumor immunity in glioblastoma and allows to discover general and personalized targets for immunotherapy.

TAMI-63. INHIBITION OF LINEAGE STATES WITHIN GBM OVERCOMES CHEMO-RESISTANCE

OBJECTIVE

Novel insights into the developmental trajectory exhibited by glioblastoma (GBM) have shown that it has the capability to respond to its microenvironment by clonal selection of specific transcriptional phenotypes. Using the same mechanisms, malignant GBM develop intrinsic mechanisms to resist chemotherapeutic treatments. In this study, we determine the role of the metabotropic glutamate receptor 3 (mGluR3) in chemoresistance and show that inhibition of mGluR3 leads to significant loss of tumor growth volume when concomitantly treated with Temozolomide.

METHODS

Transcriptomic analysis was carried out post mGlur3 receptor inhibition using LY341495 (100nM), to study loss of transcriptional programs. Morphological and cellular kinetic analysis was carried out post inhibition, to determine apoptosis/necrosis rate, when combined with Temozolomide. The efficacy of the treatment within a human like environment was assessed using our novel human cortical GBM model.

RESULTS

We present transcriptional and morphological evidence that mGluR3 inhibition using LY341495 leads to loss of both lineage (FDR< 0.01) and reactive (FDR< 0.01) transcription programs. This leads to a loss of ability to evade cytotoxicity when combined with Temozolomide treatment, validated using kinetic apoptosis (p< 0.01). When our cortical GBM model was used to study the effect of treatment within the appropriate microenvironment, we see that the combination therapy leads to a significant reduction in tumor growth (p< 0.01) over the course of 10 days.

CONCLUSION

Through the integration of diversified molecular-biological analyses, we illustrate a new picture of how glutamate signaling via mGluR3 interacts with phenotypical GBM transcriptional programs to evade effective therapy, the inhibition of which leads to loss of chemo-resistance.

TAMI-64. IMMUNE ENVIRONMENT SHAPES GLIOBLASTOMA HETEROGENEITY IN TIME AND SPACE

Glioblastomas are embedded into an immunosuppressive microenvironment resulting in limited success of immunotherapies. Although, we and others observed defined myeloid-tumor crosslinks reducing T cell homing and activation, the spatial context of these interactions remained unexplored. Here, we provide evidence, that local T cell infiltration results in a defined activation of myeloid cells causing transcriptional reprogramming of tumor cells reminiscent of reactive transformation in mature astrocytes. Through integration of spatially resolved transcriptomics and imaging mass cytometry (n=18, 39 protein glioma panel) we mapped defined transcriptional responses in areas of high or low T cell infiltration respectively. Functional analysis revealed that areas of large T cell infiltration are enriched for glial (CHI3L1, GFAP and VIM) and inflammatory genes (HLA-DRA, C3, CCL4, CCL3). We found that marker genes of common reactive states in mature astrocytes significantly overlap with the reactive immune program of glioblastoma cells (f-score 0.76, p=2.2e-10). Increased numbers of CD163+ cells were found in surrounding areas of T cell infiltration and spatially linked to defined immunosuppressive release of IL10, recently reported as a major driver of T cell exhaustion. To support our findings, we injected a primary glioblastoma cell line into cortex slices of three different human and rodent donors. After 7 days of tumor growth, we performed scRNA-sequencing of FACS-sorted tumor cells and baseline cell culture cells. Compared to baseline, we found cells of all reported transcriptional states, confirming the dynamic adaptation of cells within a neural environment. In elderly donors, a significant accumulation of reactive immune programs (ANOVA p< 0.001) was observed. Immunostainings confirmed an increased myeloid cell activation in these donors. Our data suggest that inflammatory stimuli in the glioblastoma microenvironment cause transcriptional reprogramming in glioblastoma similar to inflammatory transformation of reactive astrocytes. The spatial exclusivity of these programs highlights the value of a spatial perspective on heterogeneity.

TAMI-39. INTEGRATION OF SPATIALLY RESOLVED TRANSCRIPTOMICS AND METABOLOMICS UNCOVERS HYPOXIA-DRIVEN ACCUMULATION OF GENOMIC INSTABILITIES IN HUMAN GLIOMA

High-dimensional technologies have provided insights into transcriptional heterogeneity and dynamic plasticity which are hallmarks of brain tumors. Although scRNA-seq recovers the diversity of transcriptional states, their spatial context within the neuronal environment has remained unexplored. Here, we integrated spatially resolved transcriptomics and metabolomics to characterize the glioma landscape at multiple molecular levels. We integrated spatial transcriptomics (10X Visium, n= 28) and metabolomics (MALDI, n= 6) from primary and recurrent glioblastoma patients. Unsupervised cluster analysis and pattern recognition uncovered 5 spatially distinct transcriptional programs, shared across patients. These included three cell-specific developmental stages largely reflecting those that are part of recently suggested models. By integrating metabolome data, we identified an additional program encompassing reactive responses to hypoxia. Areas of hypoxic response were negatively correlated with proliferation (R2= -0.34, p< 0.001) and significantly enriched for gene expression signatures from the S-phase (p< 0.001). Modeling of transient spatial gradients using vector field predictions showed opposing vector directions of hypoxia response and migratory capacity, underpinning the “go-or-growth” theory, where cells either proliferate or migrate. Inferred copy-number alterations (CNA) revealed a significant increase in genomic instability, highly correlated to hypoxia response (R2= 0.78, p< 0.001). Near necrotic areas, we observed a significant accumulation of CNAs while proliferation was inhibited, and cells remained in the S-phase. We validated this hypothesis of hypoxia-driven accumulation of CNAs by chronic hypoxia cultures of primary patient-derived cell lines. A gain of chromosomal instability after long-term hypoxia was observed, suggesting that hypoxic areas in glioblastoma function as bioreactors for genomic instability. Our findings elucidate the evolution of resistant subclones in glioblastoma. They provide novel insights into the dynamic regulation and interaction between host and tumor and cast a new light on hypoxic and necrotic areas, which may represent the source of the heterogeneous and resistant nature of glioblastomas.

Transcriptional characterization of the glial response due to chronic neural implantation of flexible microprobes

Long term implantation of (micro-)probes into neural tissue causes unique and disruptive responses. In this study, we investigate the transcriptional trajectory of glial cells responding to chronic implantation of 380 μm flexible micro-probes for up to 18 weeks. Transcriptomic analysis shows a rapid activation of microglial cells and a strong reactive astrocytic polarization, both of which are lost over the chronic of the implant duration. Animals that were implanted for 18 weeks show a transcriptional profile similar to non-implanted controls, with increased expression of genes associated with wound healing and angiogenesis, which raises hope of a normalization of the neuropil to the pre-injury state when using flexible probes. Nevertheless, our data shows that a subset of genes upregulated after 18 weeks belong to the family of immediate early genes, which indicates that structural and functional remodeling is not complete at this time point. Our results confirm and extend previous work on the molecular changes resulting from the presence of neural probes and provide a rational basis for developing interventional strategies to control them.

Meclofenamate causes loss of cellular tethering and decoupling of functional networks in glioblastoma

BACKGROUND

Glioblastoma cells assemble to a syncytial communicating network based on tumor microtubes (TMs) as ultra-long membrane protrusions. The relationship between network architecture and transcriptional profile remains poorly investigated. Drugs that interfere with this syncytial connectivity such as meclofenamate (MFA) may be highly attractive for glioblastoma therapy.

METHODS

In a human neocortical slice model using glioblastoma cell populations of different transcriptional signatures, three-dimensional tumor networks were reconstructed, and TM-based intercellular connectivity was mapped on the basis of two-photon imaging data. MFA was used to modulate morphological and functional connectivity; downstream effects of MFA treatment were investigated by RNA sequencing and fluorescence-activated cell sorting (FACS) analysis.

RESULTS

TM-based network morphology strongly differed between the transcriptional cellular subtypes of glioblastoma and was dependent on axon guidance molecule expression. MFA revealed both a functional and morphological demolishment of glioblastoma network architectures which was reflected by a reduction of TM-mediated intercellular cytosolic traffic as well as a breakdown of TM length. RNA sequencing confirmed a downregulation of NCAM and axon guidance molecule signaling upon MFA treatment. Loss of glioblastoma communicating networks was accompanied by a failure in the upregulation of genes that are required for DNA repair in response to temozolomide (TMZ) treatment and culminated in profound treatment response to TMZ-mediated toxicity.

CONCLUSION

The capacity of TM formation reflects transcriptional cellular heterogeneity. MFA effectively demolishes functional and morphological TM-based syncytial network architectures. These findings might pave the way to a clinical implementation of MFA as a TM-targeted therapeutic approach.

OS06.9A Diversity of cellular communication in glioblastoma

BACKGROUND

Owing to recent advances in understanding of the active functional states exhibited within glioblastoma (GBM), intra-tumoral cellular signaling has moved into focus of neuro-oncological research. In our study, we aim to explore the diversity of transcellular signaling and investigate correlations to transcriptional dynamics and cellular behavior.

MATERIAL AND METHODS

Electrophysiological mapping of primary GBM cultures was performed by planar microelectrodes, in conjunction with calcium imaging in a human neocortical section based GBM model. Exposure to conditions that are physiologically present within the tumor was carried out to identify specific signaling cells of interest and signaling diversity presented as response to specific environmental conditions. Transcriptional dynamics and plasticity were examined by means of scRNA-sequencing with CRISPR based perturbation, spatial transcriptomics and deep long-read RNA-sequencing.

RESULTS

Electrophysiological profiles of primary GBM cell lines revealed highly variable network activity. Despite these different characteristics, all profiled primary cell-lines exhibited characteristics of scale-free networks, confirmed in a human neocortical GBM model. When the GBM was allowed to grow in “in-vivo” like environment, basal activity was significantly increased, owing to interactions with elements within the neural environment. Cellular signaling was directly correlated to changes in the environment, like hypoxia or glutamatergic activation, and total inhibition of electrical signaling was achieved only with a combination of both gap junction and synaptic inhibitors. Using single-cell sequencing and proteomics, we identified several genes related to synaptogenesis that plays a crucial role in network formation and consequently transcellular signaling. CRISPR based perturbation of these genes resulted in alterations in cellular morphology and decreased cellular connectivity, with electrical signaling being significantly attenuated. Single-cell sequencing of perturbed tumor cells in the GBM model revealed a loss of developmental lineages and significant reduction of cellular stress response state.

CONCLUSION

Our findings highlight the role of electrical signaling in glioblastoma. Cellular stressors induce intercellular signaling, leading to transcriptional adaptation suggesting that there exists a highly complex and powerful mechanism for dynamic transcriptional state adaptation.

Inhibition of metabotropic glutamate receptor III facilitates sensitization to alkylating chemotherapeutics in glioblastoma

Glioblastoma (GBM), the most malignant tumor of the central nervous system, is marked by its dynamic response to microenvironmental niches. In particular, this cellular plasticity contributes to the development of an immediate resistance during tumor treatment. Novel insights into the developmental trajectory exhibited by GBM show a strong capability to respond to its microenvironment by clonal selection of specific phenotypes. Using the same mechanisms, malignant GBM do develop intrinsic mechanisms to resist chemotherapeutic treatments. This resistance was reported to be sustained by the paracrine and autocrine glutamate signaling via ionotropic and metabotropic receptors. However, the extent to which glutamatergic signaling modulates the chemoresistance and transcriptional profile of the GBM remains unexplored. In this study we aimed to map the manifold effects of glutamate signaling in GBM as the basis to further discover the regulatory role and interactions of specific receptors, within the GBM microenvironment. Our work provides insights into glutamate release dynamics, representing its importance for GBM growth, viability, and migration. Based on newly published multi-omic datasets, we explored the and characterized the functions of different ionotropic and metabotropic glutamate receptors, of which the metabotropic receptor 3 (GRM3) is highlighted through its modulatory role in maintaining the ability of GBM cells to evade standard alkylating chemotherapeutics. We addressed the clinical relevance of GRM3 receptor expression in GBM and provide a proof of concept where we manipulate intrinsic mechanisms of chemoresistance, driving GBM towards chemo-sensitization through GRM3 receptor inhibition. Finally, we validated our findings in our novel human organotypic section-based tumor model, where GBM growth and proliferation was significantly reduced when GRM3 inhibition was combined with temozolomide application. Our findings present a new picture of how glutamate signaling via mGluR3 interacts with the phenotypical GBM transcriptional programs in light of recently published GBM cell-state discoveries.

CNS infection with a history of recurrent epistaxis: Streptococcal meningitis as a first presentation of juvenile nasopharyngeal angiofibroma

An adolescent male with a history of recurrent epistaxis presented with headache and vomiting. Investigations revealed concurrent meningitis as well as the presence of a subarachnoid haemorrhage. Subsequent imaging identified a Juvenile Nasopharyngeal Angiofibroma; a rare but important cause of meningitis that should be considered in the young adult population.

TAMI-53. THE ONCOMETABOLITE D-2HG INDUCE INFLAMMATORY ASTROGLIOSIS CAUSING NEUROTOXICITY AND SEIZURES IN IDH MUTATED GLIOMA

The role of tumor-associated astrocytes in the microenvironment of glioma has long been underestimated but is moving into the focus of current research. We explored the role of reactive astrocytes in IDH-mutated glioma using RNA-sequencing of purified astrocytes and microglia and single-nucleus RNA-sequencing of infiltrating tumor regions. Mapping of the transcriptional phenotype of astrocytes along developmental and reactive trajectories revealed an inflammatory transformation of IDH-mutated associated astrocytes. The major proportion of astrocytes is marked by complement-activation similar to findings in neuroinflammatory diseases. A human neocortical slices model with injected IDH-mutated patient-derived cells or D-2HG treatment (+/- microglia depletion) was used to map shared and unique transcriptional adaptation in astrocytes promoted by either tumor cells or metabolic alteration. High-dimensional electrophysiological profiling was used to investigate alterations in neural response to tumor-induced microenvironmental transformation. We showed that 2HG alone promote the inflammatory pattern of astrocytes, which causes neurotoxicity and seizures in our neocortical slice model. Depletion of microglia rescued the neurotoxicity suggesting that microglia predominantly drive inflammatory astrogliosis as a response to metabolic alteration the tumor environment. We showed that neurotoxic astrogliosis induced by the oncometabolite D-2HG via distinct microglia activation promote the evolution of frequently observed seizures in IDH-mutated glioma patients.

EXTH-56. DISRUPTION OF FUNCTIONAL NETWORKS IN GLIOBLASTOMA TO OVERCOME THERAPY RESISTANCE

Neurobeachin plays a crucial role when it comes to the formation, maturation, and differentiation of functional synapses, within the central nervous system (CNS). Glioblastoma has cellular compartments that have been shown to form functional synapses, integrating themselves to existing neuronal networks. We present evidence that GBM cells form electrophysiologically active networks, mediated by both electrical and chemical synapses during their growth. These networks carry information about changes in the tumor microenvironment, similar to those observed in neuronal networks. We present data about signature signaling patterns, dependent on stimuli, leading to transcriptional changes. These patterns are conducted through the network by means of electrical/chemical synapses, mediated by Neurobeachin. When the tumor network was acutely treated with a signaling inhibitor, Meclofenamate, functional synapses were altered, leading to an abolishment of electrical signaling, resulting in loss of biological organization. These results were validated in both extracellular electrophysiological recordings and Ca2+ imaging experiments. The formation of these functional networks plays a vital role in the resistance to alkylating agents or harsh metabolic imbalances, which was completely lost when the network was disrupted. Acute downregulation of Neurobeachin expression causes electrophysiological disruption of the GBM network, leading to loss of connectivity, terminally resulting in cell apoptosis/necrosis, transcriptionally validated by means of RNA-seq. This combined therapeutic approach could lead to potential alternative therapy, where the basic biological functionality of the GBM is targeted.

IMMU-34. LANDSCAPE OF GLIOBLASTOMA-ASSOCIATED IMMUNITY BY INTEGRATION OF scRNA-SEQ AND SPATIAL TRANSCRIPTOMICS

The diversity of molecular states and cellular plasticity of immune cells within the glioblastoma (GBM) environment remain poorly investigated. Here, we conduct deep transcriptional profiling of lymphoid and myeloid cell populations by scRNA-sequencing, map potential cellular interactions and cytokine responses that lead to the dysfunctional and exhausted phenotype of T cells. We identified Interleukin 10 (IL-10) response during T cell activation, which lead to a dysfunctional state of T cells. By the use of a novel method: The nearest functionally connected neighbor (NFCN), an in-silico model to explore cell-cell interaction, the dysfunctional/exhausted phenotype was found to be driven by subset of myeloid cells defined by high expression of HMOX1. By using spatial transcriptomic RNA-sequencing, we identified a correlation between T cell exhaustion and colocalized mesenchymal gene expression. We found that HMOX1 expressing myeloid cells occupying regions marked by T cell exhaustion. Using a human neocortical slice model with myeloid cell depletion we confirmed the functional interaction of myeloid and lymphoid cell leading to the dysfunctional state of T cells. A comprehensive understanding of cellular states and plasticity of lymphoid cells in GBM aids in providing successful immunotherapeutic approaches.

Skin Toxicity in Early Breast Cancer Patients Treated with Field-In-Field Breast Intensity-Modulated Radiotherapy versus Helical Inverse Breast Intensity-Modulated Radiotherapy: Results of a Phase III Randomised Controlled Trial

AIMS

Skin toxicity is a common adverse effect of breast radiotherapy. We investigated whether inverse-planned intensity-modulated radiotherapy (IMRT) would reduce the incidence of skin toxicity compared with forward field-in-field breast IMRT (FiF-IMRT) in early stage breast cancer.

MATERIALS AND METHODS

This phase III randomised controlled trial compared whole-breast irradiation with either FiF-IMRT or helical tomotherapy IMRT (HT-IMRT), with skin toxicity as the primary end point. Patients received 50 Gy in 25 fractions and were assessed to compare skin toxicity between treatment arms.

RESULTS

In total, 177 patients were available for assessment and the median follow-up was 73.1 months. Inverse IMRT achieved more homogeneous coverage than FiF-IMRT; erythema and moist desquamation were higher with FiF-IMRT compared with HT-IMRT (61% versus 34%; P < 0.001; 33% versus 11%; P < 0.001, respectively). Multivariate analysis showed large breast volume, FiF-IMRT and chemotherapy were independent factors associated with worse acute toxicity. There was no difference between treatment arms in the incidence of late toxicities. The 5-year recurrence-free survival was 96.3% for both FiF-IMRT and HT-IMRT and the 5-year overall survival was 96.3% for FiF-IMRT and 97.4% for HT-IMRT.

CONCLUSIONS

Our study showed significant reduction in acute skin toxicity using HT-IMRT compared with FiF-IMRT, without significant reduction in late skin toxicities. On the basis of these findings, inverse-planned IMRT could be used in routine practice for whole-breast irradiation with careful plan optimisation to achieve the required dose constraints for organs at risk.

Human organotypic brain slice culture: a novel framework for environmental research in neuro-oncology

When it comes to the human brain, models that closely mimic in vivo conditions are lacking. Living neuronal tissue is the closest representation of the in vivo human brain outside of a living person. Here, we present a method that can be used to maintain therapeutically resected healthy neuronal tissue for prolonged periods without any discernible changes in tissue vitality, evidenced by immunohistochemistry, genetic expression, and electrophysiology. This method was then used to assess glioblastoma (GBM) progression in its natural environment by microinjection of patient-derived tumor cells into cultured sections. The result closely resembles the pattern of de novo tumor growth and invasion, drug therapy response, and cytokine environment. Reactive transformation of astrocytes, as an example of the cellular nonmalignant tumor environment, can be accurately simulated with transcriptional differences similar to those of astrocytes isolated from acute GBM specimens. In a nutshell, we present a simple method to study GBM in its physiological environment, from which valuable insights can be gained. This technique can lead to further advancements in neuroscience, neuro-oncology, and pharmacotherapy.

Quantitative synchrotron X-ray tomography of the material-tissue interface in rat cortex implanted with neural probes

Neural probes provide many options for neuroscientific research and medical purposes. However, these implantable micro devices are not functionally stable over time due to host-probe interactions. Thus, reliable high-resolution characterization methods are required to understand local tissue changes upon implantation. In this work, synchrotron X-ray tomography is employed for the first time to image the interface between brain tissue and an implanted neural probe, showing that this 3D imaging method is capable of resolving probe and surrounding tissue at a resolution of about 1 micrometer. Unstained tissue provides sufficient contrast to identify electrode sites on the probe, cells, and blood vessels within tomograms. Exemplarily, we show that it is possible to quantify characteristics of the interaction region between probe and tissue, like the blood supply system. Our first-time study demonstrates a way for simultaneous 3D investigation of brain tissue with implanted probe, providing information beyond what was hitherto possible.

When the Ostrich-Algorithm Fails: Blanking Method Affects Spike Train Statistics

Modern electroceuticals are bound to employ the usage of electrical high frequency (130-180 Hz) stimulation carried out under closed loop control, most prominent in the case of movement disorders. However, particular challenges are faced when electrical recordings of neuronal tissue are carried out during high frequency electrical stimulation, both in-vivo and in-vitro. This stimulation produces undesired artifacts and can render the recorded signal only partially useful. The extent of these artifacts is often reduced by temporarily grounding the recording input during stimulation pulses. In the following study, we quantify the effects of this method, "blanking," on the spike count and spike train statistics. Starting from a theoretical standpoint, we calculate a loss in the absolute number of action potentials, depending on: width of the blanking window, frequency of stimulation, and intrinsic neuronal activity. These calculations were then corroborated by actual high signal to noise ratio (SNR) single cell recordings. We state that, for clinically relevant frequencies of 130 Hz (used for movement disorders) and realistic blanking windows of 2 ms, up to 27% of actual existing spikes are lost. We strongly advice cautioned use of the blanking method when spike rate quantification is attempted.

Impact statement

Blanking (artifact removal by temporarily grounding input), depending on recording parameters, can lead to significant spike loss. Very careful use of blanking circuits is advised.

Kinetics of Pulmonary Leukocyte Sequestration in Man during Hemodialysis with Different Membrane-Types

Although it has been suggested that pulmonary sequestration of leukocytes could account for membrane-dependent white blood cell depletion in HD, direct evidence in patients is still lacking. Therefore a study was initiated to test whether and how leukocytes distribute in the lung circulation during HD with different membranes. Thirteen patients suffering from chronic renal failure underwent lung scintigraphy during HD with cuprophane (n = 3), hemophane (n = 8) and polysulfone (n = 2) lowflux capillary dialyzers. Isolated autologous leukocytes were labelled with 99m-Technetium and reinfused before starting HD. Distribution of leukocyte related activity was registered by lung scintigraphy. In comparison to normal lung scintigraphy performed without HD, an impressive redistribution peak was demonstrated 10-20 min after the start of HD with cuprophane and also to a lesser extent with hemophane. When HD was performed with polysulfone the decrease in activity was delayed but no real redistribution was obtained.

In accordance with other phenomena, such as peripheral leukopenia and changes in granulocyte oxidative metabolism, pulmonary sequestration of leukocytes takes place in man in the initial phase of HD and appears to be strongly dependent on the type of membrane. (Int J Artif Organs 1990; 13: 729-36)

Anschluß und On-line-Betrieb eines Szintiscanners an einem Digitalrechner

Das Betriebssystem BSC 1 steuert sowohl die Übernahme der Scanner-Informationen und die Eingaben vom Teletype als auch die verschiedenen Wiedergabemöglichkeiten eines Szintigramms. Bei der Aufnahme werden zunächst Patientennamen und verschiedene Scan-Parameter eingegeben. Vor Beginn des übemahmeprogramms errechnet das Programm Größen für eine möglichst optimale Ausnutzung des Speichers. Nach der Scan-Aufnahme werden Parameter für die Wiedergabeprogramme bestimmt. Danach geht der Rechner in die Warteschleife, in der er auf Wiedergabekommandos wartet. Das Betriebssystem enthält weiter Programmteile, mit denen der Inhalt des Datenspeichers als Lochstreifen ausgegeben, ein solcher Lochstreifen wieder eingelesen werden kann und Möglichkeiten zur zusätzlichen Beschriftung der Sichtgerätausgaben.

Anschluß und On-line-Betrieb eines Szintiscanners an einem Digitalrechner

Zur möglichst vollständigen Übernahme und Speicherung der bei der Aufnahme eines Szintigramms gewinnbaren Basis-Informationen wird ein Digitalrechner eingesetzt. Die Anlage besteht aus einem Picker Magnascanner und einem Rechner PDP 8/S als Grundeinheiten und einem Fernschreiber, einem Sichtgerät und einem x-y-Schreiber als Ausgabeeinheiten. Interface-Elektroniken dienen dazu, die Scanner-Informationen in den Rechner zu übernehmen und die Ausgabegeräte softwaremäßig vom Rechner her zu steuern. Das “Übernahme-Interface enthält ein eigenes Zählregister, Dadurch und durch die Bedienung des Interface über den Programm-Interrupt wurde erreicht, daß der Rechner während der Szintigramm-Aufnahme nur einen kleinen Prozentsatz der Zeit beansprucht wird und in der übrigen Zeit für die Auswertung der Datenmatrix oder für die Bedienung weiterer Geräte zur Verfügung steht.

Anschluß und On-line-Betrieb eines Szintiscanners an einem Digitalrechner

Das Betriebssystem enthält 2 Arten von Wiedergabeprogrammen: Wiedergaben am Sichtgerät und Druckausgaben. Beide werden durch ein Codewort vom Teletype aus aufgerufen.

Bei dem Programm SSWE werden auf dem Sichtgerät alle Werte dargestellt, die über einer bestimmten Schwelle liegen. Diese Schwelle wird bei diesem Programm mit der Hand eingestellt, während sie bei dem Programm SASW automatisch angehoben wird und so einen Bilderzyklus liefert. Weitere Programme zeichnen die Höhenschichtlinien und liefern eine perspektivische Darstellung des Aktivitätsgebirges.

Bei den Druckausgaben liefert das Programm FSWE eine Schwellendarstellung, während das Programm FVZE eine Darstellung der verschiedenen Niveaus mit verschiedenen Druckzeichen ausgibt. Ein ähnliches Programm ergibt eine Darstellung in mehrfachen Niveaugruppen. Außerdem ist in dem Betriebssystem noch ein Programm zur Druckausgabe von Höhenschichtlinien enthalten.

Rezeptorszintigraphie mit 111In-Pentetreotid beiendokrinen gastroenteropankreatischenTumoren

Die Rezeptorszintigraphie mit 111In-Pentetreotid ist ein komplementäres bildgebendesVerfahren mit einer Sensitivität von 88%, um bei Patienten mitklinischen und biochemischen Symptomen eines endokrinen Tumors desGastrointestinaltraktes oder des Pankreas den Primärtumor und dessen Metastasen zu lokalisieren. Als Ganzkörperszintigraphie erfaßt sie jede Körperregionund stellt auch kleine Tumoren dar, die mit den übrigen bildgebendenVerfahren nicht oder nur schwer zu entdecken sind. Bei 104 Patienten mit GEP-Tumoren oder nach operativer Entfernung eines solchen Tumors erwiessich die Rezeptorszintigraphie als dem Ultraschall und der Computertomographie bei 34% in der Aussagekraftüberlegen, bei 52% als gleich und bei 14%als unterlegen.

Guideline for in vivo- and in vitro procedures for thyroid diseases (version 2)

The version 2 of the guideline for diagnostic standards of thyroid disorders is an update of the guideline published in 1999 and describes standards of in vitro and in vivo procedures. The following statements are modified: In vitro procedures: When measurement of the TSH-receptor antibodies is indicated, the guideline recommends the use of a second generation assay (recombinant human TSH-receptor as antigen). The functional assay sensitivity for the measurement of thyroglobulin should reach a value ≤1 ng/ml. Moleculargenetic tests (RET proto-oncogen) are indicated in patients with a newly diagnosed medullary thyroid cancer and in the relatives of patients with hereditary medullary thyroid cancer. In vivo procedures: The sonographic examination should use a probe with a frequency of at least 7.5 MHz. Indications for the thyroid scintigraphy: nodule size ≥1 cm in diameter, autonomous goitre/nodule with clinical or subclinical hyperthyroidism, necessity of a differentiation between Graves’ disease and chronic lymphocytic thyroiditis, therapy control after a definitive treatment and – in individual cases – the follow-up of untreated autonomous nodules.

Früherkennung der thyreoidalen Autonomie durch Kombination von quantitativer Szintigrammauswertung mit einem Äquivalent des freien T4

Autonomes Schilddrüsengewebe (AFTT) fanden wir im Endemiegebiet bei eumetabolen Menschen sowohl in der umschriebenen (sog. autonomes Adenom) als auch in der disseminierten Form gleich häufig und in gleicher Ausprägung vor wie nach dem 40. Lebensjahr. Es ist im Endemiegebiet die häufigste Voraussetzung einer ungezügelten Hormonproduktion, die durch - meist iatrogene - Jodzufuhr ausgelöst wird. Die Verdachtsdiagnose der thyreoidalen Autonomie kann mit einer Treffsicherheit von etwa 80% schon bei euthyreoten Menschen durch gemeinsame Betrachtung des freien Thyroxin-Äquivalents (FTE) und eines durch quantitative Auswertung des Technetiumszintigrammes erhaltenen äquivalents der Jodidclearance (TcTU) gestellt werden. Der Suppressionstest liefert dann nicht nur qualitativ den Nachweis der fehlenden Regelbarkeit, sondern ermöglicht in der protrahiert-fraktionierten Form auch eine Abschätzung des Volumens autonomen Gewebes, denn der TcTU nach Suppression korreliert linear mit dem Volumen autonomen Gewebes. Da nach Jodzufuhr das FTE dem Volumen autonomen Gewebes proportional ansteigt, erscheint auch im Sinne einer groben Faustregel eine Prognose der thyreoidalen Autonomie möglich: oberhalb eines „kritischen‟ Volumens autonomen Gewebes wird mit an Sicherheit grenzender Wahrscheinlichkeit eine ausreichende Jodzufuhr genügender Dauer eine Hyperthyreose auslösen. Eine prospektive Studie an euthyreoten Patienten im Alter unter 50 Jahren mit unterschiedlichen Mengen autonomen Schilddrüsengewebes ergab, daß die Jodsalzprophylaxe in dieser Altersgruppe keine klinisch manifeste Hyperthyreose auslöst, wenn die tägliche zusätzliche Jodaufnahme 100 μg nicht übersteigt.

Microfluidic drive for flexible brain implants

Flexible polyimide probes, used for neuronal signal acquisition, are thought to reduce signal deteriorating gliosis, improving the quality of recordings in brain machine interfacing applications. These probes suffer from the disadvantage that they cannot penetrate brain tissue on their own, owing to their limited stiffness and low buckling forces. A microfluidic device as an external micro-drive which aids in the insertion of flexible polyimide neural probes in 0.6% Agarose gel is presented here.