1
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Zhang H, Luo YB, Wu W, Zhang L, Wang Z, Dai Z, Feng S, Cao H, Cheng Q, Liu Z. The molecular feature of macrophages in tumor immune microenvironment of glioma patients. Comput Struct Biotechnol J 2021; 19:4603-18. [PMID: 34471502 DOI: 10.1016/j.csbj.2021.08.019] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022] Open
Abstract
Background Gliomas are one of the most common types of primary tumors in central nervous system. Previous studies have found that macrophages actively participate in tumor growth. Methods Weighted gene co-expression network analysis was used to identify meaningful macrophage-related gene genes for clustering. Pamr, SVM, and neural network were applied for validating clustering results. Somatic mutation and methylation were used for defining the features of identified clusters. Differentially expressed genes (DEGs) between the stratified groups after performing elastic regression and principal component analyses were used for the construction of MScores. The expression of macrophage-specific genes were evaluated in tumor microenvironment based on single cell sequencing analysis. A total of 2365 samples from 15 glioma datasets and 5842 pan-cancer samples were used for external validation of MScore. Results Macrophages were identified to be negatively associated with the survival of glioma patients. Twenty-six macrophage-specific DEGs obtained by elastic regression and PCA were highly expressed in macrophages at single-cell level. The prognostic value of MScores in glioma was validated by the active proinflammatory and metabolic profile of infiltrating microenvironment and response to immunotherapies of samples with this signature. MScores managed to stratify patient survival probabilities in 15 external glioma datasets and pan-cancer datasets, which predicted worse survival outcome. Sequencing data and immunohistochemistry of Xiangya glioma cohort confirmed the prognostic value of MScores. A prognostic model based on MScores demonstrated high accuracy rate. Conclusion Our findings strongly support a modulatory role of macrophages, especially M2 macrophages in glioma progression and warrants further experimental studies.
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Key Words
- ACC, Adrenocortical carcinoma
- BBB, brain blood barrier
- BLCA, Bladder Urothelial Carcinoma
- BRCA, Breast invasive carcinoma
- CDF, cumulative distribution function
- CESC, Cervical squamous cell carcinoma and endocervical adenocarcinoma
- CGGA, Chinese Glioma Genome Atlas
- CHOL, Cholangiocarcinoma
- CNA, copy number alternations
- CNV, copy number variation
- COAD, Colon adenocarcinoma
- CSF-1, colony-stimulating factor-1
- DLBC, Lymphoid Neoplasm Diffuse Large B-cell Lymphoma
- DMP, differentially methylated position
- ESCA, Esophageal carcinoma
- GBM, glioblastoma
- GEO, Gene Expression Omnibus
- GO, gene ontology
- GSEA, gene set enrichment analysis
- GSVA, gene set variation analysis
- Glioma microenvironment
- HNSC, Head and Neck squamous cell carcinoma
- IGR, intergenic region
- IHC, immunohistochemistry
- IL, interleukin
- Immunotherapy
- KEGG, Kyoto Encyclopaedia of Genes and Genomes
- KICH, Kidney Chromophobe
- KIRC, Kidney renal clear cell carcinoma
- KIRP, Kidney renal papillary cell carcinoma
- LGG, low grade glioma
- LIHC, Liver hepatocellular carcinoma
- LUAD, Lung adenocarcinoma
- LUSC, Lung squamous cell carcinoma
- MMP-2, matrix metalloproteinase-2
- MT1, MMP membrane type 1 matrix metalloprotease
- Machine learning
- Macrophage
- OV, Ovarian serous cystadenocarcinoma
- PAAD, Pancreatic adenocarcinoma
- PAM, partition around medoids
- PCA, principal component analysis
- PCPG, Pheochromocytoma and Paraganglioma
- PRAD, Prostate adenocarcinoma
- Prognostic model
- READ, Rectum adenocarcinoma
- SARC, Sarcoma
- SKCM, Skin Cutaneous Melanoma
- SNP, single-nucleotide polymorphism
- SNV, single-nucleotide variant
- STAD, Stomach adenocarcinoma
- SVM, Support Vector Machines
- TAM, tumor associated macrophage
- TCGA, The Cancer Genome Atlas
- TGF-β, tumor growth factor-β
- THCA, Thyroid carcinoma
- THYM, Thymoma
- TIMP-2, tissue inhibitor of metalloproteinase-2
- TLR2, toll-like receptor 2
- TME, tumor microenvironment
- TNFα, tumor necrosis factor α
- TSS, transcription start site
- UCEC, Uterine Corpus Endometrial Carcinoma
- UCS, Uterine Carcinosarcoma
- WGCNA, weighted gene co-expression network analysis
- pamr, prediction analysis for microarrays
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Al-Kharboosh R, ReFaey K, Lara-Velazquez M, Grewal SS, Imitola J, Quiñones-Hinojosa A. Inflammatory Mediators in Glioma Microenvironment Play a Dual Role in Gliomagenesis and Mesenchymal Stem Cell Homing: Implication for Cellular Therapy. Mayo Clin Proc Innov Qual Outcomes 2020; 4:443-459. [PMID: 32793872 PMCID: PMC7411162 DOI: 10.1016/j.mayocpiqo.2020.04.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [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] [Indexed: 12/22/2022] Open
Abstract
Glioblastoma is the most aggressive malignant primary brain tumor, with a dismal prognosis and a devastating overall survival. Despite aggressive surgical resection and adjuvant treatment, average survival remains approximately 14.6 months. The brain tumor microenvironment is heterogeneous, comprising multiple populations of tumor, stromal, and immune cells. Tumor cells evade the immune system by suppressing several immune functions to enable survival. Gliomas release immunosuppressive and tumor-supportive soluble factors into the microenvironment, leading to accelerated cancer proliferation, invasion, and immune escape. Mesenchymal stem cells (MSCs) isolated from bone marrow, adipose tissue, or umbilical cord are a promising tool for cell-based therapies. One crucial mechanism mediating the therapeutic outcomes often seen in MSC application is their tropism to sites of injury. Furthermore, MSCs interact with host immune cells to regulate the inflammatory response, and data points to the possibility of using MSCs to achieve immunomodulation in solid tumors. Interleukin 1β, interleukin 6, tumor necrosis factor α, transforming growth factor β, and stromal cell-derived factor 1 are notably up-regulated in glioblastoma and dually promote immune and MSC trafficking. Mesenchymal stem cells have widely been regarded as hypoimmunogenic, enabling this cell-based administration across major histocompatibility barriers. In this review, we will highlight (1) the bidirectional communication of glioma cells and tumor-associated immune cells, (2) the inflammatory mediators enabling leukocytes and transplantable MSC migration, and (3) review preclinical and human clinical trials using MSCs as delivery vehicles. Mesenchymal stem cells possess innate abilities to migrate great distances, cross the blood-brain barrier, and communicate with surrounding cells, all of which make them desirable "Trojan horses" for brain cancer therapy.
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Key Words
- 5-FC, 5-fluorocytosine
- AMSC, adipose tissue–derived mesenchymal stem cell
- BBB, blood-brain barrier
- BMSC, bone marrow–derived mesenchymal stem cell
- CED, convection-enhanced delivery
- DC, dendritic cell
- EGFRvIII, EGFR variant III
- GBM, glioblastoma
- GSC, glioma stem cell
- IFN, interferon
- IL, interleukin
- MDSC, myeloid-derived suppressor cell
- MHC, major histocompatibility complex
- MSC, mesenchymal stem cell
- NSC, neural stem cell
- TAM, tumor-associated macrophage
- TGF, transforming growth factor
- TNF, tumor necrosis factor
- UC-MSC, umbilical cord MSC
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Affiliation(s)
- Rawan Al-Kharboosh
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL.,Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences (Neuroscience Track), Regenerative Sciences Training Program, Mayo Clinic, Rochester, MN
| | - Karim ReFaey
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL
| | - Montserrat Lara-Velazquez
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL.,Plan of Combined Studies in Medicine (MD/PhD), National Autonomous University of Mexico, Mexico City
| | | | - Jaime Imitola
- Department of Neurology Research, Division of Multiple Sclerosis and Translational Neuroimmunology, UConn School of Medicine, Farmington, CT
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3
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Abstract
The extracellular matrix is engaged in an ever-evolving and elegant ballet of dynamic reciprocity that directly and bi-directionally regulates cell behavior. Homeostatic and pathophysiological changes in cell-matrix signaling cascades manifest as complex matrix phenotypes. Indeed, the extracellular matrix can be implicated in virtually every known human disease, thus, making it the most critical and dynamic "organ" in the human body. The overall goal of this Special Issue is to provide an accurate and inclusive functional definition that addresses the inherent complexity of matrix phenotypes. This goal is summarily achieved via a corpus of expertly written articles, reviews and original research, focused at answering this question empirically and fundamentally via state-of-the-art methods and research strategies.
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Key Words
- ADAM, a disintegrin and metalloproteinases
- AGE, advanced glycation end products
- Angiogenesis
- Cancer
- Collagen
- DDR1, discoidin domain receptor 1
- ECM, extracellular matrix
- EGF, epidermal growth factor
- EGFR, epidermal growth factor receptor
- EMILIN1, elastin microfibril interfacer 1
- EMILIN2, elastin microfibril interfacer 2
- EMT, epithelial-mesenchymal transition
- ERα, estrogen receptor α
- ERβ, estrogen receptor β
- GBM, glioblastoma
- HA, hyaluronan
- HAS2, hyaluronan synthase 2
- HAS2-AS1, HAS2 antisense 1
- HB-EGF, heparin binding EGF
- HMGA2, high-mobility group AT-Hook 2
- IBC, inflammatory breast cancer
- IGF-IR, insulin growth factor I receptor
- IR-A, insulin receptor A
- LEKTI, lympho-epithelial Kazal-type inhibitor
- LOX, lysyl oxidases
- LTBP, latent TGFβ-binding proteins
- MAGP, microfibril-associated glycoproteins
- MET, mesenchymal-epithelial transition
- MMP, matrix metalloproteinases
- Methodologies
- OB, osteoblast
- OI, osteogenesis imperfecta
- PARs, protease activated receptors
- PG, proteoglycans
- PLL, poly-l-lysine
- Proteoglycans
- ROS, reactive oxygen species
- RTK, receptor tyrosine kinase
- SLRP, small leucine rich proteoglycans
- SSR, solar-simulated radiation
- TGFβ, transforming growth factor β
- TNT, tunneling nanotubes
- UVR, ultraviolet radiation
- VEGF, vascular endothelial growth factor
- miR, microRNA
- tPA, tissue-type plasminogen activator
- uPA, urokinase-type plasminogen activator
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Affiliation(s)
- Renato V. Iozzo
- Department of Pathology, Anatomy and Cell Biology and the Cancer Cell Biology and Signaling Program, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Achilleas D. Theocharis
- Biochemistry, Biochemical Analysis and Matrix Pathobiology Research Group, Laboratory of Biochemistry, Department of Chemistry, University of Patras, Patras, Greece
| | - Thomas Neill
- Department of Pathology, Anatomy and Cell Biology and the Cancer Cell Biology and Signaling Program, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Nikos K. Karamanos
- Biochemistry, Biochemical Analysis and Matrix Pathobiology Research Group, Laboratory of Biochemistry, Department of Chemistry, University of Patras, Patras, Greece
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Zhang C, Zhang Z, Li F, Shen Z, Qiao Y, Li L, Liu S, Song M, Zhao X, Ren F, He Q, Yang B, Fan R, Zhang Y. Large-scale analysis reveals the specific clinical and immune features of B7-H3 in glioma. Oncoimmunology 2018; 7:e1461304. [PMID: 30377558 DOI: 10.1080/2162402x.2018.1461304] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/29/2018] [Accepted: 03/30/2018] [Indexed: 01/16/2023] Open
Abstract
Background: B7-H3 is an immune checkpoint member that belongs to B7-CD28 families and plays a vital role in the inhibition of T-cell function. Importantly, B7-H3 is widely overexpressed on solid tumors, making it become an attractive target for cancer immunotherapy. To clarify the expression panel of B7-H3 in glioma, we explored the clinical and immune features of B7-H3 expression in a large-scale study. Methods and patients: Totally, 1323 glioma samples from Chinese Glioma Genome Atlas (CGGA) dataset, including 325 RNAseq data and 301 mRNA microarray data, and The Cancer Genome Atlas (TCGA) dataset, including 697 RNAseq data, were gathered into our research. The statistical analysis and graphical work were mainly realized by R language. Results: B7-H3 expression was found positively correlated with the grade of malignancy, which might be caused by hypomethylation. The expression level of B7-H3 was consistently up-regulated in IDH wild-type glioma and highly enriched in mesenchymal subtype. GSEA analysis suggested that B7-H3 related genes were more involved in immune response and angiogenesis in glioma. Moreover, B7-H3 showed a consistent positive relationship with stromal and immune cell populations. Further analysis confirmed that B7-H3 played an important role in T-cell-mediated immunity, especially in T-cell-mediated immune response to tumor cell. Circos plots revealed that B7-H3 was tightly associated with most B7 members and other immune checkpoints. Univariate and multivariate cox analysis demonstrated that B7-H3 was an independent prognosticator for glioma patients. Conclusion: B7-H3 represents the malignant phenotype of glioma and independently predicted worse prognosis in glioma patients. Moreover, B7-H3 collaborating with other checkpoint members may contribute to the dysfunctional phenotype of T cell. These findings will be helpful for further optimizing immunotherapies for glioma.
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Affiliation(s)
- Chaoqi Zhang
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China.,Cancer center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Zhen Zhang
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Feng Li
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Zhibo Shen
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China.,Cancer center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Yamin Qiao
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Lifeng Li
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China.,Cancer center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Shasha Liu
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China.,Cancer center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Mengjia Song
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China.,Cancer center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Xuan Zhao
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Feifei Ren
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China.,School of Life Sciences, Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Qianyi He
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Bo Yang
- Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Ruitai Fan
- Department of Radiation Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Yi Zhang
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China.,Cancer center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China.,School of Life Sciences, Zhengzhou University, Zhengzhou, Henan, 450052, China.,Henan Key Laboratory for Tumor Immunology and Biotherapy, Zhengzhou, Henan 450052, China
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5
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Kong Z, Yan C, Zhu R, Wang J, Wang Y, Wang Y, Wang R, Feng F, Ma W. Imaging biomarkers guided anti-angiogenic therapy for malignant gliomas. Neuroimage Clin 2018; 20:51-60. [PMID: 30069427 PMCID: PMC6067083 DOI: 10.1016/j.nicl.2018.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 12/24/2022]
Abstract
Antiangiogenic therapy is a universal approach to the treatment of malignant gliomas but fails to prolong the overall survival of newly diagnosed or recurrent glioblastoma patients. Imaging biomarkers are quantitative imaging parameters capable of objectively describing biological processes, pathological changes and treatment responses in some situations and have been utilized for outcome predictions of malignant gliomas in anti-angiogenic therapy. Advanced magnetic resonance imaging techniques (including perfusion-weighted imaging and diffusion-weighted imaging), positron emission computed tomography and magnetic resonance spectroscopy are imaging techniques that can be used to acquire imaging biomarkers, including the relative cerebral blood volume (rCBV), Ktrans, and the apparent diffusion coefficient (ADC). Imaging indicators for a better prognosis when treating malignant gliomas with antiangiogenic therapy include the following: a lower pre- or post-treatment rCBV, less change in rCBV during treatment, a lower pre-treatment Ktrans, a higher vascular normalization index during treatment, less change in arterio-venous overlap during treatment, lower pre-treatment ADC values for the lower peak, smaller ADC volume changes during treatment, and metabolic changes in glucose and phenylalanine. The investigation and utilization of these imaging markers may confront challenges, but may also promote further development of anti-angiogenic therapy. Despite considerable evidence, future prospective studies are critically needed to consolidate the current data and identify novel biomarkers. Anti-angiogenic therapy only benefits specific populations of glioma patients. Advanced imaging techniques can produce quantitative imaging biomarkers. Physiological and metabolic parameter can predict outcome for anti-angiogenic therapy. Larger prospective studies are needed to provide further evidence.
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Key Words
- 18F-FDOPA, 3,4-dihydroxy-6-[18F]-fluoro-l-phenylalanine
- 18F-FLT, [18F]-fluoro-3-deoxy-3-L-fluorothymidine
- ADC, apparent diffusion coefficient
- AVOL, arterio-venous overlap
- Anti-angiogenic
- BBB, blood brain barrier
- Biomarkers
- CBF, cerebral blood flow
- CBV, cerebral blood volume
- CNS, central nervous system
- CT, computed tomography
- D-2HG, D-2-hydroxypentanedioic acid
- DCE-MRI, dynamic contrast-enhanced magnetic resonance imaging
- DSC-MRI, dynamic susceptibility contrast magnetic resonance imaging
- DWI, diffusion-weighted imaging
- FDG, fluorodeoxyglucose
- FLAIR, fluid-attenuated inversion recovery
- FSE pcASL, fast spin echo pseudocontinuous artery spin labeling
- GBM, glioblastoma
- Glioma
- Imaging
- Ktrans, volume transfer constant between blood plasma and extravascular extracellular space
- MRI, magnetic resonance imaging
- MRS, magnetic resonance spectroscopy
- OS, overall survival
- PET, positron emission computed tomography
- PFS, progression-free survival
- PWI, perfusion-weighted imaging
- RANO, Response Assessment in Neuro-Oncology
- ROI, region of interest
- RSI, restriction spectrum imaging
- SUV, standardized uptake value
- TMZ, temozolomide
- Therapy
- VAI, vessel architectural imaging
- VEGF-A, vascular endothelial growth factor A
- VNI, vascular normalization index.
- fDMs, functional diffusion maps
- nGBM, newly diagnosed glioblastoma
- rCBF, relative cerebral blood flow
- rCBV, relative cerebral blood volume
- rGBM, recurrent glioblastoma
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Affiliation(s)
- Ziren Kong
- Department of Neurosurgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Chengrui Yan
- Department of Neurosurgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China; Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China
| | - Ruizhe Zhu
- Department of Neurosurgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Jiaru Wang
- Department of Neurosurgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Yaning Wang
- Department of Neurosurgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Yu Wang
- Department of Neurosurgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
| | - Renzhi Wang
- Department of Neurosurgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
| | - Feng Feng
- Department of Radiology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China..
| | - Wenbin Ma
- Department of Neurosurgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
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6
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Fan Q, Aksoy O, Wong RA, Ilkhanizadeh S, Novotny CJ, Gustafson WC, Truong AYQ, Cayanan G, Simonds EF, Haas-Kogan D, Phillips JJ, Nicolaides T, Okaniwa M, Shokat KM, Weiss WA. A Kinase Inhibitor Targeted to mTORC1 Drives Regression in Glioblastoma. Cancer Cell 2017; 31:424-435. [PMID: 28292440 PMCID: PMC5386178 DOI: 10.1016/j.ccell.2017.01.014] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 08/19/2016] [Accepted: 01/26/2017] [Indexed: 11/28/2022]
Abstract
Although signaling from phosphatidylinositol 3-kinase (PI3K) and AKT to mechanistic target of rapamycin (mTOR) is prominently dysregulated in high-grade glial brain tumors, blockade of PI3K or AKT minimally affects downstream mTOR activity in glioma. Allosteric mTOR inhibitors, such as rapamycin, incompletely block mTORC1 compared with mTOR kinase inhibitors (TORKi). Here, we compared RapaLink-1, a TORKi linked to rapamycin, with earlier-generation mTOR inhibitors. Compared with rapamycin and Rapalink-1, TORKi showed poor durability. RapaLink-1 associated with FKBP12, an abundant mTOR-interacting protein, enabling accumulation of RapaLink-1. RapaLink-1 showed better efficacy than rapamycin or TORKi, potently blocking cancer-derived, activating mutants of mTOR. Our study re-establishes mTOR as a central target in glioma and traces the failure of existing drugs to incomplete/nondurable inhibition of mTORC1.
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Affiliation(s)
- QiWen Fan
- Department of Neurology, University of California, San Francisco, CA 94158, USA; Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94158, USA
| | - Ozlem Aksoy
- Department of Neurology, University of California, San Francisco, CA 94158, USA; Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94158, USA
| | - Robyn A Wong
- Department of Neurology, University of California, San Francisco, CA 94158, USA; Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94158, USA
| | - Shirin Ilkhanizadeh
- Department of Neurology, University of California, San Francisco, CA 94158, USA; Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94158, USA
| | - Chris J Novotny
- Howard Hughes Medical Institute, Department of Cellular and Molecular Pharmacology, University of California, San Francisco, CA 94158, USA
| | - William C Gustafson
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94158, USA; Department of Pediatrics, University of California, San Francisco, CA 94158, USA
| | - Albert Yi-Que Truong
- Department of Pediatrics, University of California, San Francisco, CA 94158, USA; Department of Neurological Surgery, University of California, San Francisco, CA 94158, USA
| | - Geraldine Cayanan
- Department of Neurology, University of California, San Francisco, CA 94158, USA; Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94158, USA
| | - Erin F Simonds
- Department of Neurology, University of California, San Francisco, CA 94158, USA; Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94158, USA
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Joanna J Phillips
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94158, USA; Department of Neurological Surgery, University of California, San Francisco, CA 94158, USA
| | - Theodore Nicolaides
- Department of Pediatrics, University of California, San Francisco, CA 94158, USA; Department of Neurological Surgery, University of California, San Francisco, CA 94158, USA
| | - Masanori Okaniwa
- Howard Hughes Medical Institute, Department of Cellular and Molecular Pharmacology, University of California, San Francisco, CA 94158, USA
| | - Kevan M Shokat
- Howard Hughes Medical Institute, Department of Cellular and Molecular Pharmacology, University of California, San Francisco, CA 94158, USA
| | - William A Weiss
- Department of Neurology, University of California, San Francisco, CA 94158, USA; Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94158, USA; Department of Pediatrics, University of California, San Francisco, CA 94158, USA; Department of Neurological Surgery, University of California, San Francisco, CA 94158, USA.
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7
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Chaumeil MM, Radoul M, Najac C, Eriksson P, Viswanath P, Blough MD, Chesnelong C, Luchman HA, Cairncross JG, Ronen SM. Hyperpolarized (13)C MR imaging detects no lactate production in mutant IDH1 gliomas: Implications for diagnosis and response monitoring. Neuroimage Clin 2016; 12:180-9. [PMID: 27437179 PMCID: PMC4939422 DOI: 10.1016/j.nicl.2016.06.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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: 05/26/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 10/26/2022]
Abstract
Metabolic imaging of brain tumors using (13)C Magnetic Resonance Spectroscopy (MRS) of hyperpolarized [1-(13)C] pyruvate is a promising neuroimaging strategy which, after a decade of preclinical success in glioblastoma (GBM) models, is now entering clinical trials in multiple centers. Typically, the presence of GBM has been associated with elevated hyperpolarized [1-(13)C] lactate produced from [1-(13)C] pyruvate, and response to therapy has been associated with a drop in hyperpolarized [1-(13)C] lactate. However, to date, lower grade gliomas had not been investigated using this approach. The most prevalent mutation in lower grade gliomas is the isocitrate dehydrogenase 1 (IDH1) mutation, which, in addition to initiating tumor development, also induces metabolic reprogramming. In particular, mutant IDH1 gliomas are associated with low levels of lactate dehydrogenase A (LDHA) and monocarboxylate transporters 1 and 4 (MCT1, MCT4), three proteins involved in pyruvate metabolism to lactate. We therefore investigated the potential of (13)C MRS of hyperpolarized [1-(13)C] pyruvate for detection of mutant IDH1 gliomas and for monitoring of their therapeutic response. We studied patient-derived mutant IDH1 glioma cells that underexpress LDHA, MCT1 and MCT4, and wild-type IDH1 GBM cells that express high levels of these proteins. Mutant IDH1 cells and tumors produced significantly less hyperpolarized [1-(13)C] lactate compared to GBM, consistent with their metabolic reprogramming. Furthermore, hyperpolarized [1-(13)C] lactate production was not affected by chemotherapeutic treatment with temozolomide (TMZ) in mutant IDH1 tumors, in contrast to previous reports in GBM. Our results demonstrate the unusual metabolic imaging profile of mutant IDH1 gliomas, which, when combined with other clinically available imaging methods, could be used to detect the presence of the IDH1 mutation in vivo.
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Key Words
- 2-HG, 2-hydroxyglutarate
- AIF, arterial input function
- AUC, area under the curve
- DNP, dynamic nuclear polarization
- DNP-MR, dynamic nuclear polarization magnetic resonance
- EGF, epidermal growth factor
- EGFR, epidermal growth factor receptor
- FA, flip angle
- FGF, fibroblast growth factor
- FLAIR, fluid attenuated inversion recovery
- FOV, field of view
- GBM, glioblastoma
- Glioma
- Hyperpolarized 13C Magnetic Resonance Spectroscopy (MRS)
- IDH1, isocitrate dehydrogenase 1
- Isocitrate dehydrogenase 1 (IDH1) mutation
- LDHA, lactate dehydrogenase A
- MCT1, monocarboxylate transporter 1
- MCT4, monocarboxylate transporter 4
- MR, magnetic resonance
- MRI, magnetic resonance imaging
- MRS, magnetic resonance spectroscopic imaging
- MRS, magnetic resonance spectroscopy
- Metabolic reprogramming
- NA, number of averages
- NT, number of transients
- PBS, phosphate-buffer saline
- PDGF, platelet-derived growth factor
- PET, positron emission tomography
- PI3K, phosphoinositide 3-kinase
- PTEN, phosphatase and tensin homolog
- RB1, retinoblastoma protein 1
- SLC16A1, solute carrier family 16 member 1
- SLC16A3, solute carrier family 16 member 3
- SNR, signal-to-noise ratio
- SW, spectral width
- TCGA, The Cancer Genome Atlas
- TE, echo time
- TMZ, temozolomide
- TP53, tumor protein p53
- TR, repetition time
- Tacq, acquisition time
- VOI, voxel of interest
- mTOR, mammalian target of rapamycin
- α-KG, α-ketoglutarate
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Affiliation(s)
- Myriam M. Chaumeil
- Department of Radiology and Biomedical Imaging, Mission Bay Campus, 1700 4th Street, Byers Hall, University of California, 94158 San Francisco, CA, United States
| | - Marina Radoul
- Department of Radiology and Biomedical Imaging, Mission Bay Campus, 1700 4th Street, Byers Hall, University of California, 94158 San Francisco, CA, United States
| | - Chloé Najac
- Department of Radiology and Biomedical Imaging, Mission Bay Campus, 1700 4th Street, Byers Hall, University of California, 94158 San Francisco, CA, United States
| | - Pia Eriksson
- Department of Radiology and Biomedical Imaging, Mission Bay Campus, 1700 4th Street, Byers Hall, University of California, 94158 San Francisco, CA, United States
| | - Pavithra Viswanath
- Department of Radiology and Biomedical Imaging, Mission Bay Campus, 1700 4th Street, Byers Hall, University of California, 94158 San Francisco, CA, United States
| | - Michael D. Blough
- Department of Clinical Neurosciences, Foothills Hospital, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
| | - Charles Chesnelong
- Department of Clinical Neurosciences, Foothills Hospital, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
| | - H. Artee Luchman
- Department of Clinical Neurosciences, Foothills Hospital, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
| | - J. Gregory Cairncross
- Department of Clinical Neurosciences, Foothills Hospital, 1403 29 St NW, Calgary, AB T2N 2T9, Canada
| | - Sabrina M. Ronen
- Department of Radiology and Biomedical Imaging, Mission Bay Campus, 1700 4th Street, Byers Hall, University of California, 94158 San Francisco, CA, United States
- Brain Tumor Research Center, Helen Diller Family Cancer Research Building, 1450 3rd Street, University of California, 94158 San Francisco, CA, United States
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8
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Zhang Y, Ni S, Huang B, Wang L, Zhang X, Li X, Wang H, Liu S, Hao A, Li X. Overexpression of SCLIP promotes growth and motility in glioblastoma cells. Cancer Biol Ther 2015; 16:97-105. [PMID: 25511414 DOI: 10.4161/15384047.2014.987037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
SCLIP, a microtubule-destabilizing phosphoprotein, is known to be involved in the development of the central nervous system (CNS). It has been well established that there are notable parallels between normal development and tumorigenesis, especially in glioma. However, no studies have examined the significance of SCLIP in gliomagenesis. To address this, we investigated the expression of SCLIP and its roles in the development of gliomas. Notably, we found that SCLIP was highly expressed in various grades of glioma samples, as compared with normal brain tissues. Overexpression of SCLIP dramatically stimulated tumor cell migration and invasion as well as proliferation and downregulation of SCLIP showed opposite effects, establishing an important oncogenic role for this gene. Furthermore, we revealed that STAT3 was required to maintain SCLIP stability, suggesting that overexpression of STAT3 may be a critical step to facilitate microtubule dynamics and subsequently promotes migration and invasion of glioma cells. Taken together, our findings demonstrate that SCLIP plays an important role in glioma pathology, and may represent a novel therapeutic strategy against human glioma.
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Key Words
- BrdU, Bromodeoxyuridine
- CHX, cycloheximide
- ELISA, enzyme-linked immunosorbent assay
- GBM, glioblastoma
- HRP, horseradish peroxidase
- IHC, immunohistochemical
- MTT, 3-[4,5-dimethylthiazol-2-yl] -2,5-diphenyl-tetrazolium bromide
- RT-PCR, reversed transcription polymerase chain reaction
- SCLIP
- SCLIP, SCG10 (superior cervical ganglia protein 10)-like protein Op18, Oncoprotein 18
- STAT3
- WHO, World Health Organization
- glioma
- growth
- motility
- progression
- tumorigenesis
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Affiliation(s)
- Yanmin Zhang
- a Key Laboratory of the Ministry of Education for Experimental Teratology; Department of Histology and Embryology ; Shandong University School of Medicine ; Jinan , China
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9
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Suryadevara CM, Gedeon PC, Sanchez-Perez L, Verla T, Alvarez-Breckenridge C, Choi BD, Fecci PE, Sampson JH. Are BiTEs the "missing link" in cancer therapy? Oncoimmunology 2015; 4:e1008339. [PMID: 26155413 DOI: 10.1080/2162402x.2015.1008339] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
Conventional treatment for cancer routinely includes surgical resection and some combination of chemotherapy and radiation. These approaches are frequently accompanied by unintended and highly toxic collateral damage to healthy tissues, which are offset by only marginal prognostic improvements in patients with advanced cancers. This unfortunate balance has driven the development of novel therapies that aim to target tumors both safely and efficiently. Over the past decade, mounting evidence has supported the therapeutic utility of T-cell-centered cancer immunotherapy, which, in its various iterations, has been shown capable of eliciting highly precise and robust antitumor responses both in animal models and human trials. The identification of tumor-specific targets has further fueled a growing interest in T-cell therapies given their potential to circumvent the non-specific nature of traditional treatments. Of the several strategies geared toward achieving T-cell recognition of tumor, bispecific antibodies (bsAbs) represent a novel class of biologics that have garnered enthusiasm in recent years due to their versatility, specificity, safety, cost, and ease of production. Bispecific T-cell Engagers (BiTEs) are a subclass of bsAbs that are specific for CD3 on one arm and a tumor antigen on the second. As such, BiTEs function by recruiting and activating polyclonal populations of T-cells at tumor sites, and do so without the need for co-stimulation or conventional MHC recognition. Blinatumomab, a well-characterized BiTE, has emerged as a promising recombinant bscCD19×CD3 construct that has demonstrated remarkable antitumor activity in patients with B-cell malignancies. This clinical success has resulted in the rapid extension of BiTE technology against a greater repertoire of tumor antigens and the recent US Food and Drug Administration's (FDA) accelerated approval of blinatumomab for the treatment of a rare form of acute lymphoblastic leukemia (ALL). In this review, we dissect the role of T-cell therapeutics in the new era of cancer immunotherapy, appraise the value of CAR T-cells in the context of solid tumors, and discuss why the BiTE platform may rescue several of the apparent deficits and shortcomings of competing immunotherapies to support its widespread clinical application.
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Key Words
- ACT, adoptive cell therapy
- AICD, activation induced cell death
- ALL, acute lymphoblastic leukemia
- APC, antigen presenting cell
- BiTE, bispecific T-cell engager
- BsAb, bispecific antibody
- CAR, chimeric antigen receptors
- CHO, chinese hamster ovary
- CML, chronic myeloid leukemia
- GBM, glioblastoma
- MAb, monoclonal antibody
- MHC, major histocompatibility complex
- OS, overall survival
- ScFv, single chain variable fragment
- T lymphocytes
- TAA, tumor associated antigens
- TCR, T-cell receptor
- TIL, tumor infiltrating lymphocytes
- TREG, regulatory T-cells
- TSA, tumor specific antigens
- VV, vaccinia virus
- bispecific antibodies
- immunotherapy
- malignancies
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Affiliation(s)
- Carter M Suryadevara
- Duke Brain Tumor Immunotherapy Program; Division of Neurosurgery; Department of Surgery; Duke University Medical Center ; Durham, NC, USA ; Department of Pathology; Duke University Medical Center ; Durham, NC, USA ; The Preston Robert Tisch Brain Tumor Center; Duke University Medical Center ; Durham, NC, USA
| | - Patrick C Gedeon
- Duke Brain Tumor Immunotherapy Program; Division of Neurosurgery; Department of Surgery; Duke University Medical Center ; Durham, NC, USA ; The Preston Robert Tisch Brain Tumor Center; Duke University Medical Center ; Durham, NC, USA ; Department of Biomedical Engineering; Duke University ; Durham, NC, USA
| | - Luis Sanchez-Perez
- Duke Brain Tumor Immunotherapy Program; Division of Neurosurgery; Department of Surgery; Duke University Medical Center ; Durham, NC, USA ; The Preston Robert Tisch Brain Tumor Center; Duke University Medical Center ; Durham, NC, USA
| | - Terence Verla
- Duke Brain Tumor Immunotherapy Program; Division of Neurosurgery; Department of Surgery; Duke University Medical Center ; Durham, NC, USA ; The Preston Robert Tisch Brain Tumor Center; Duke University Medical Center ; Durham, NC, USA
| | | | - Bryan D Choi
- Department of Neurosurgery; Massachusetts General Hospital and Harvard Medical School ; Boston, MA, USA
| | - Peter E Fecci
- Duke Brain Tumor Immunotherapy Program; Division of Neurosurgery; Department of Surgery; Duke University Medical Center ; Durham, NC, USA ; The Preston Robert Tisch Brain Tumor Center; Duke University Medical Center ; Durham, NC, USA
| | - John H Sampson
- Duke Brain Tumor Immunotherapy Program; Division of Neurosurgery; Department of Surgery; Duke University Medical Center ; Durham, NC, USA ; Department of Pathology; Duke University Medical Center ; Durham, NC, USA ; The Preston Robert Tisch Brain Tumor Center; Duke University Medical Center ; Durham, NC, USA ; Department of Biomedical Engineering; Duke University ; Durham, NC, USA
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10
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Hong CS, Ho W, Zhang C, Yang C, Elder JB, Zhuang Z. LB100, a small molecule inhibitor of PP2A with potent chemo- and radio-sensitizing potential. Cancer Biol Ther 2015; 16:821-33. [PMID: 25897893 DOI: 10.1080/15384047.2015.1040961] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Protein phosphatase 2A (PP2A) is a serine/threonine phosphatase that plays a significant role in mitotic progression and cellular responses to DNA damage. While traditionally viewed as a tumor suppressor, inhibition of PP2A has recently come to attention as a novel therapeutic means of driving senescent cancer cells into mitosis and promoting cell death via mitotic catastrophe. These findings have been corroborated in numerous studies utilizing naturally produced compounds that selectively inhibit PP2A. To overcome the known human toxicities associated with these compounds, a water-soluble small molecule inhibitor, LB100, was recently developed to competitively inhibit the PP2A protein. This review summarizes the pre-clinical studies to date that have demonstrated the anti-cancer activity of LB100 via its chemo- and radio-sensitizing properties. These studies demonstrate the tremendous therapeutic potential of LB100 in a variety of cancer types. The results of an ongoing phase 1 trial are eagerly anticipated.
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Key Words
- ABC, ATP-binding cassette.
- APC, adenomatous polyposis coli
- ARPP19, cyclic AMP-regulated phosphoprotein 19
- ATM, ataxia-telangiectasia mutated
- CIP2A, cancerous inhibitor of PP2A
- CNTF, ciliary neurotrophic factor
- DISC, death-inducing signaling complex
- DVL, dishevelled
- ENSA, α-endosulphine
- GBM, glioblastoma
- GFAP, glial fibrillary acidic protein
- HCC, hepatocellular carcinoma
- HDACs, histone deacetylase complexes
- HIF-1a, hypoxia-inducible factor-1a
- HRR, homologous recombination repair
- MDM2, mouse double minute 2 homolog
- MRI, magnetic resonance imaging
- NPC, nasopharyngeal carcinoma
- PP2A, protein phosphatase 2A
- Plk1, polo-like kinase 1
- TCTP, translationally-controlled tumor protein
- TMZ, temozolomide
- TRAIL, TNF-related apoptosis-inducing ligand
- VEGF, vascular endothelial growth factor
- cell cycle
- chemosensitization
- mitotic catastrophe
- protein phosphatase 2A
- radiosensitizationreview
- small molecule inhibitor
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Affiliation(s)
- Christopher S Hong
- a The Ohio State University Wexner Medical Center ; Department of Neurological Surgery ; Columbus , OH USA
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11
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Rahbar A, Peredo I, Solberg NW, Taher C, Dzabic M, Xu X, Skarman P, Fornara O, Tammik C, Yaiw K, Wilhelmi V, Assinger A, Stragliotto G, Söderberg-Naucler C. Discordant humoral and cellular immune responses to Cytomegalovirus (CMV) in glioblastoma patients whose tumors are positive for CMV. Oncoimmunology 2015; 4:e982391. [PMID: 25949880 DOI: 10.4161/2162402x.2014.982391] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 10/28/2014] [Indexed: 01/22/2023] Open
Abstract
Background. Glioblastoma (GBM) is the most common malignant brain tumor in adults and is nearly always fatal. Emerging evidence suggests that human Cytomegalovirus (HCMV) is present in 90-100% of GBMs and that add-on antiviral treatment for HCMV show promise to improve survival. Methods. In a randomized, placebo-controlled trial of valganciclovir in 42 GBM patients, blood samples were collected for analyses of HCMV DNA, RNA, reactivity against HCMV peptides, IgG, and IgM at baseline and at 3, 12, and 24 weeks of treatment. Results. All 42 tumors were positive for HCMV protein. All patients examined had at least one blood sample positive for HCMV DNA, 63% were HCMV RNA positive, and 21% were IgM positive. However, 29% of GBM patients were IgG negative for HCMV. Five of these samples were positive in an enzyme-linked immunosorbent assay (ELISA) that used antigens derived from a clinical isolate. Blood T cells from 11 of 13 (85%) HCMV IgG-negative GBM patients reacted against HCMV peptides. Valganciclovir did not affect IgG titers, DNA, or RNA levels of the HCMV immediate early (HCMV IE) gene in blood. Conclusion. In GBM patients, HCMV activity is higher than in healthy controls and serology is a poor test to define previous or active HCMV infection in these patients.
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Key Words
- ELISA, enzyme-linked immunosorbent assay
- FACS, flow cytometry analyses
- FITC, fluorescein isothiocyanate
- GBM, glioblastoma
- HCMV IE, human Cytomegalovirus-immediate early
- HCMV, human Cytomegalovirus
- HIV, human immunodeficiency virus
- HSV, herpes simplex virus
- PBMC, Peripheral blood mononuclear cells
- PBS, Phosphate buffered saline
- PCR, polymerase chain reaction
- SEB, staphylococcal snterotoxin B
- VIGAS study, Efficacy and Safety of Valcyte® as an Add-on Therapy in Patients with Malignant Glioblastoma and cytomegalovirus infection
- Valcyte
- cytomegalovirus
- glioblastoma
- peptides stimulation
- serology
- valganciclovir
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Affiliation(s)
- Afsar Rahbar
- Department of Medicine; Solna; Center for Molecular Medicine; Karolinska Institute ; Stockholm, Sweden
| | - Inti Peredo
- Departments of Neurosurgery; Karolinska University Hospital ; Stockholm, Sweden
| | - Nina Wolmer Solberg
- Department of Medicine; Solna; Center for Molecular Medicine; Karolinska Institute ; Stockholm, Sweden
| | - Chato Taher
- Department of Medicine; Solna; Center for Molecular Medicine; Karolinska Institute ; Stockholm, Sweden
| | - Mensur Dzabic
- Department of Medicine; Solna; Center for Molecular Medicine; Karolinska Institute ; Stockholm, Sweden
| | - Xinling Xu
- Department of Medicine; Solna; Center for Molecular Medicine; Karolinska Institute ; Stockholm, Sweden
| | - Petra Skarman
- Department of Medicine; Solna; Center for Molecular Medicine; Karolinska Institute ; Stockholm, Sweden
| | - Olesja Fornara
- Department of Medicine; Solna; Center for Molecular Medicine; Karolinska Institute ; Stockholm, Sweden
| | - Charlotte Tammik
- Department of Medicine; Solna; Center for Molecular Medicine; Karolinska Institute ; Stockholm, Sweden
| | - Koon Yaiw
- Department of Medicine; Solna; Center for Molecular Medicine; Karolinska Institute ; Stockholm, Sweden
| | - Vanessa Wilhelmi
- Department of Medicine; Solna; Center for Molecular Medicine; Karolinska Institute ; Stockholm, Sweden
| | - Alice Assinger
- Department of Medicine; Solna; Center for Molecular Medicine; Karolinska Institute ; Stockholm, Sweden
| | | | - Cecilia Söderberg-Naucler
- Department of Medicine; Solna; Center for Molecular Medicine; Karolinska Institute ; Stockholm, Sweden
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