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Is current therapy of malignant gliomas beneficial for patients? Proteomics evidence of shifts in glioma cells expression patterns under clinically relevant treatment conditions.

The most common human brain tumours - gliomas - have poor prognosis with and without treatment. The current therapy conditions act sub-lethally and cannot effectively suppress the proliferation of glioma cells. Here we show differential protein expression patterns in surviving human malignant U87-MG glioma cells under clinically relevant chemo/radiotherapy. In parallel experiments, the cells underwent either irradiation (2 Gy, 200 KV X-ray) or chemotreatment with 30 microg/mL of temozolomide in the cultivation medium or combined chemo/radiation treatment. The cell cultures were treated during 5 days from day 4 until day 9 of growth. Modulated expression patterns of vimentin and RhoA GTPase indicate a potentially increasing grade of malignancy in treated cell fractions correlating well with extremely aggressive tumour phenotypes observed clinically at recidivation of treated malignant gliomas.

Antineoplastic Agents, Alkylating↗

Bradykinin induces hyperpolarizations in rat glioma cells and in neuroblastoma X glioma hybrid cells.

The effect of the nonapeptide bradykinin on the membrane potential of permanent cell lines from neural origin was studied. A hyperpolarizing response of 10-30 s duration was produced when bradykinin was iontophoretically applied onto polyploid rat glioma cells (clone C6-4-2). Starting from the resting membrane potential the peak value of the hyperpolarizing response was reached within 0.5-1.5 s. Then the potential returned more slowly to the original value. The hyperpolarization was associated with an approximately 50% decrease in membrane resistance. Neither Na+ nor Cl- seemed to be important for the hyperpolarizing response, since bradykinin elicited similar hyperpolarizations in cells exposed to media in which Na+ or Cl- were replaced by choline or isethionate, respectively. Ca2+ fluxes are unlikely to be involved, since the addition of D600 did not affect the hyperpolarizations induced by bradykinin. However, a 10-fold increase in the concentration of K+ in the medium reduced the amplitude of the hyperpolarization by 40 mV. Thus, the hyperpolarization induced by bradykinin is associated with decrease in membrane resistance which is likely to be caused by an increased K+-conductance. The glioma cells showed a desensitization upon repeated application of bradykinin. However, the sensitivity of the cells to bradykinin was restored after 3-8 min of incubation in the absence of bradykinin. Since an antagonist of bradykinin is not known, the specificity of the action of bradykinin is difficult to assess. Nevertheless, the hyperpolarizing response to bradykinin appears to be specific insofar as other peptides, i.e. lutoliberin, thyroliberin, neurotensin, substance P and apamin, exerted no effect on the membrane potential of the glioma cells. Bradykinin-elicited hyperpolarizations with characteristics similar to those described above could also be demonstrated in neuroblastoma X glioma hybrid cells, but not in multinucleated fibroblast cells.

Animals↗

Spontaneous regression of experimental gliomas--an immunohistochemical and MRI study of the C6 glioma spheroid implantation model.

OBJECTIVE: The orthotopic C6 glioma spheroid implantation model has been used to examine factors of neoangiogenesis, growth factor release, and protease expression as well the effect of antitumor agents. The present study systematically investigates the long-term course of orthotopically implanted C6 spheroid gliomas. METHODS: Reaggregated C6 spheroid tumors were implanted into the forebrain of 48 male Sprague-Dawley rats (32 immunocompetent, 16 thymectomized). The animals were examined by MRI at postoperative day (POD) 7, 14, 21, 28, 32, 45, 60, and 70. The MRI protocol included a T2-w and T1-w SE sequence before and after application of contrast medium and a CISS 3D sequence for volumetry. A total of six animals were selected after each MR exam from both groups and sacrificed for HE light microscopy and CD8+ T-lymphocyte, ED1+ macrophage, CD31+ endothelial cell immunohistochemistry. RESULTS: The tumors progressed to reach a maximum volume on day 28: 0.23 +/- 0.05 ml in the thymectomized and 0.16 +/- 0.021 ml in the immunocompetent group. Tumors then consistently regressed to vanish completely by POD 70. The influx of cytotoxic CD8+ T-lymphocytes correlated with tumor progression and the tumors reached a larger size in the thymectomized group. However, the time course of tumor regression was the same for both groups. CONCLUSION: The present data suggest that the orthotopic C6 glioma implanted into Sprague-Dawley rats will progress within a time span of approximately 4 weeks and can then retrogress again spontaneously. This finding has to be taken into account when deciding on a study protocol and the appropriate animal model. The C6 glioma model may be suitable to study the cell biological steps involved in the phenomenon of spontaneous tumor regression.

Animals↗

Multidrug resistance-associated protein MRP1 expression in human gliomas: chemosensitization to vincristine and etoposide by indomethacin in human glioma cell lines overexpressing MRP1.

The 190 kDa multidrug resistance protein MRP1 is likely to be involved in the multidrug resistance phenotype of human gliomas. MRP1 expression was evaluated in surgical tumor samples from 17 patients with gliomas. In addition, the impact of the MRP's inhibitor, indomethacin, on the chemosensitivity to etoposide (VP16) and vincristine (VCR) of two glioblastoma cell lines expressing MRP1 (GL15 and 8MG) was investigated. When evaluated in tumor samples, MRP1 expression was observed in all of them with more than 90% of stained tumor cells in 14/15 high-grade gliomas. MRP1 was also strongly expressed at the membrane of the vascular endothelial cells in the same 14 tumor samples, suggesting that the permeability to anticancer drugs could be also limited across brain tumor vessels. At concentrations comprised between 5 and 50 microM, indomethacin significantly increased the cytotoxic effect of etoposide in both cell lines but it was more efficient in increasing the cytotoxicity of VCR on GL15 cells, as compared with 8MG cells. These results suggest that the association of indomethacin to VCR or etoposide could be of interest in the clinical management of gliomas.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

Vascular apoptosis and involution in gliomas precede neovascularization: a novel concept for glioma growth and angiogenesis.

Vascular changes in gliomas were analyzed by implanting fluorescent-labeled glioma 261 cells in the brains of 28 mice. Seven animals were killed each week for 4 weeks. We investigated the expression of angiopoietin-2 (Ang-2) by in situ hybridization and compared it with the distribution of apoptotic cells identified by DNA strand breaks (using the terminal deoxynucleotidyl transferase-mediated biotinylated deoxyuridine triphosphate nick end labeling [TUNEL] method) and transmission electron microscopy (TEM). As early as 1 week after implantation, tumor cells accumulated around vessels, which expressed Ang-2 and were TUNEL negative. TEM showed tumor cells adjacent to the vascular cells "lifting up" the normal astrocytic feet processes away from the endothelial cells and disrupting normal pericytic cuffing. After 2 weeks the number of perivascular glioma cells had increased. No increase in the number of blood vessels was detected at this time. Vascular cells remained positive for Ang-2 and rare ones were TUNEL positive. TEM showed closely packed proliferating perivascular tumor cells. After 3 weeks, there was vascular involution with scant zones of tumor necrosis. Ang-2 was still detected in vascular cells, but now numerous vascular cells were TUNEL positive. In addition, TEM showed apoptotic vascular cells. After 4 weeks, there were extensive areas of tumor necrosis with pseudopalisading and adjacent angiogenesis. Ang-2 was detected in vascular cells at the edge of the tumors in the invaded brain and in vessels surrounded by tumor cells. At both 3 and 4 weeks, most of the TUNEL-positive tumor cells lacked morphological features characteristic of apoptosis and displayed features consistent with necrotic cell death as determined by TEM. Only rare tumor cells appeared truly apoptotic. In contrast, the TUNEL-positive endothelial cells and pericytes were round and shrunken, with condensed nuclear chromatin by TEM, suggesting that vascular cells were undergoing an apoptotic cell death. These results suggest that vascular cell apoptosis and involution preceded tumor necrosis and that angiogenesis is a later event in tumor progression in experimental gliomas. Moreover, Ang-2 is detected prior to the onset of apoptosis in vascular cells and could be linked to vascular involution.

Angiopoietin-2↗

Fatty acid induced glioma cell growth is mediated by the acyl-CoA synthetase 5 gene located on chromosome 10q25.1-q25.2, a region frequently deleted in malignant gliomas.

Acyl-CoA synthetase (ACS) ligates fatty acid and CoA to produce acyl-CoA, an essential molecule in fatty acid metabolism and cell proliferation. ACS5 is a recently characterized ACS isozyme highly expressed in proliferating 3T3-L1 cells. Molecular characterization of the human ACS5 gene revealed that the gene is located on chromosome 10q25.1-q25.2, spans approximately 46 kb, comprises 21 exons and 22 introns, and encodes a 683 amino acid protein. Two major ACS5 transcripts of 2.5- and 3.7-kb are distributed in a wide range of tissues with the highest expression in uterus and spleen. Markedly increased levels of ACS5 transcripts were detected in a glioma line, A172 cells, and primary gliomas of grade IV malignancy, while ACS5 expression was found to be low in normal brain. Immunohistochemical analysis also revealed strong immunostaining with an anti-ACS5 antibody in glioblastomas. U87MG glioma cells infected with an adenovirus encoding ACS5 displayed induced cell growth on exposure to palmitate. Consistent with the induction of cell growth, the virus infected cells displayed induced uptake of palmitate. These results demonstrate a novel fatty acid-induced glioma cell growth mediated by ACS5.

Adenoviridae↗

Diffusion MR imaging in glioma: does it have any role in the pre-operation determination of grading of glioma?

AIM: To investigate the role of the diffusion MR weighted sequence in the pre-operative grading of gliomas, and its application in defining the different components of these tumours. MATERIALS AND METHODS: Seventeen patients with gliomas (eight high grade, nine low grade) had diffusion weighted imaging. Apparent diffusion coefficients (ADCs) of different components of tumours were measured. RESULTS: ADC of the cystic portion of the tumour was significantly higher than ADCs of the enhanced tumour, non-enhanced tumour and perifocal oedema (P < 0.01). No significant difference in ADC values between low grade and high grade glioma (P > 0.7) was found nor was there any difference between oligoglioma and non-oligoglioma (P > 0.29). CONCLUSION: ADC value was useful to differentiate the cystic from the solid components of the tumours. However, it was not useful in pre-operative grading of glioma.

Adolescent↗

Therapeutic effects of sodium butyrate on glioma cells in vitro and in the rat C6 glioma model.

OBJECTIVE: Preliminary in vitro studies have indicated that sodium butyrate inhibits the proliferation of cultured glioma cells and induces cellular differentiation, making it potentially useful as a therapeutic agent for patients with glioblastoma multiforme. The purpose of this study was to expand on the preliminary research by investigating the effects of sodium butyrate on multiple cell lines, explanted cells from glioblastoma tumor specimens, and in vivo in the rat C6 glioma brain tumor model. METHODS: Four malignant glioma cell lines (A-172, T98G, U118MG, and C6) and two primary cell cultures derived from human glioblastoma tumor specimens were treated with 2 mmol/L sodium butyrate for up to 72 hours. Sodium butyrate-induced effects on cell morphology, proliferation, cell cycle distribution, migration, glial fibrillary acidic protein staining, and S100beta protein content were determined. For in vivo studies, a total of 64 male Wistar-Furth rats underwent operations to implant C6 glioma cells stereotactically or were used as controls. The rats were treated with escalating doses of sodium butyrate by microinfusion with Alzet minipumps (Durect Corp., Cupertino, CA). RESULTS: Sodium butyrate treatment in vitro produced changes in morphology and glial fibrillary acidic protein expression indicative of cellular differentiation. In cell lines and explanted cells, sodium butyrate consistently inhibited glioblastoma cell proliferation (to 51 +/- 6% that of controls) and migration (to 46 +/- 17%). Intratumoral infusion of 40 mmol/L sodium butyrate prolonged the survival of Wistar-Furth rats with intracerebral C6 tumors (P = 0.013) without detectable toxicity. CONCLUSION: These data support further consideration of direct interstitial infusion of sodium butyrate in a Phase I clinical study for patients with recurrent glioblastoma multiforme.

Animals↗

Transfection-induced tumor necrosis factor-alpha increases the susceptibility of human glioma cells to lysis by lymphokine-activated killer cells: continuous expression of intercellular adhesion molecule-1 on the glioma cells.

To develop more effective adoptive immunotherapy, we transfected the human tumor necrosis factor-alpha (TNF-alpha) gene into human glioma cells (U251-SP), which were used as target cells. TNF-alpha is known to increase both the expression of intercellular adhesion molecule-1 (ICAM-1) on the surface of glioma cells and the susceptibility of glioma cells to lymphokine-activated killer (LAK) cell cytolysis. We compared the expression of ICAM-1 induced by TNF-alpha generated by the TNF-alpha gene-transfected cells with that induced by exogenously added TNF-alpha. When the TNF-alpha gene was transfected into U251-SP cells, the expression of ICAM-1 was detected on the cell surface from 3 days after the transfection and continued until at least 9 days. In contrast, it was expressed only transiently in the case of exogenously added TNF-alpha. Also, the cytolytic activity of LAK cells induced by transfection-induced TNF-alpha was significantly stronger than that induced by exogenously added TNF-alpha. The increased susceptibility was quenched by anti-ICAM-1 monoclonal antibody. These data indicated that continuous expression of ICAM-1 induced by TNF-alpha gene transfection of glioma cells resulted in higher cytolytic activity of LAK cells.

Antibodies, Monoclonal↗

Different aetiology of familial low-grade and high-grade glioma? A nationwide cohort study of familial glioma.

An increased risk for first-degree relatives (FDR) of glioma patients has previously been observed. The novel objective of this study was to investigate differences in familial risk among FDR of low-grade glioma (LGG) and high-grade glioma (HGG) cases, respectively. Two cohorts were constructed, one from 15,321 FDR of LGG cases and the other from 26,635 FDR of HGG cases calculating standardised incidence ratios (SIR). The risk for LGG among FDR of LGG cases was significantly increased, SIR 3.65 (95% CI 2.31-5.47). The risk was even higher in the cohort of siblings, SIR 7.00 (95% CI 3.35-12.87), and especially in the younger siblings (<40 years), SIR 9.01 (95% CI 4.31-16.57). When calculating the risk for HGG in the LGG cohort and the risk for HGG in the HGG cohort, there was a generally twofold increased risk, but no trends of increased risk in relatives of younger probands. Two different methods calculating familial risk displayed similar results. LGG families apparently have features manifesting a distinct pedigree pattern with sibpairs affected at a young age. These families could provide new insights into the aetiology of glioma.

Adolescent↗

Dietary calcium consumption and astrocytic glioma: the San Francisco Bay Area Adult Glioma Study, 1991-1995.

Previous studies suggest an association between calcium consumption and glioma risk. In the present study, we compare consumption of calcium and other dairy components and foods (cholesterol, fat, protein, calories, milk, and cheese) of 337 astrocytic glioma case patients with 450 controls from the San Francisco Bay Area Adult Glioma Study, 1991-1995. We use unconditional logistic regression models to estimate odds ratios (ORs) by gender controlling for age, education, and income. A statistically significant inverse association [p (trend) = 0.05] was observed for dietary calcium intake for women only [OR = 0.49, 95% confidence interval (CI) = 0.24-1.03 for highest vs. lowest quartile of consumption]. In addition, we observed elevated ORs for highest vs. lowest quartiles of cholesterol intake among women and men (OR = 2.07, 95% CI = 1.00-4.28 and OR = 1.75, 95% CI = 0.92-3.31, respectively). Calcium may exert a protective effect through its known roles in apoptosis, DNA repair, and inhibition of parathyroid hormone production. Recent evidence suggests that parathyroid hormone may influence growth and dedifferentiation of astrocytoma cells. Finally, circulating estradiol might directly stimulate intestinal absorption of calcium and may therefore explain why the inverse association of calcium intake and glioma is confined to women.

Adult↗

The pyruvate kinase isoenzyme shift in human gliomas: a potential marker in the treatment of gliomas.

In primary human brain tumours a shift occurs in the synthesis of isoenzymes of pyruvate kinase from the M towards the K-type. In astrocytomas, oligodendrogliomas and glioblastomas, which were localised in the cerebral hemispheres of adult patients over 20 years of age, the shift correlated well with histological grading and growth rate as observed in postoperative survival. Gliomas of adults, localised in midline structures, as well as childrens gliomas were characterised too by a strong shift from M towards the K type. However, in these tumours, less correlation with histological grading and growth rate was found. The isoenzyme shift can be rapidly demonstrated with an alanine inhibition test. The application of this assay may have a diagnostic value during operation for gliomas in grading of malignancy in adults as well as demarcation of the resection of gliomas in all age groups. The test can be performed within 10-15 min and can thus fit easily into a surgical procedure. A case report is presented for illustration.

Adolescent↗

Proposal of a clinico-histological "glioma score" as a prognostic index in high-grade glioma patients. Preliminary observations in a series of 80 cases.

BACKGROUND: Despite of several multimodal treatments, malignant gliomas still have a poor outcome. In order to identify subgroups of patients with different prognosis, we propose a clinical and histological score (GS). METHODS: Eighty consecutive patients operated on for a high-grade glioma and treated with adjuvant therapy entered the study. In relation to age at diagnosis, preoperative Karnofsky Performance Status (KPS), and MIB-1 index, patients have been splitted in 4 groups (GS 0-III). RESULTS: The overall mean survival of the entire cohort was 18.2 months (median 12). Patients with GS 0 have a mean survival rate of 30.0 months, with GS I 23.1 months, with GS II 12.1 months, and with GS III 9.0 months (p=0.0001). Moreover, mean survival with a KPS = or >70 was 29.0 in GS 0, 26.0 in GS I, 10.0 in GS II, and 0 in GS III patients (p<0.0001). CONCLUSIONS: On the basis of these preliminary observations, we discuss the utility of our "glioma score" as a prognostic indicator for patients operated on for cerebral malignant gliomas and treated postoperatively with adjuvant therapy.

Adult↗

Glioma tumourgenicity is decreased by iNOS knockout: experimental studies using the C6 striatal implantation glioma model.

Nitric oxide synthase (NOS) has recently been shown to be an important pathophysiological regulator in experimental implantation glioma since manipulation of NOS can significantly alter tumoural blood flow and inhibit tumour growth. In this study we investigated the role of iNOS (inducible NOS) in glioma tumourogenisis using the rodent C6 striatal implantation model. We produced genetically engineered C6 clones that do not express iNOS activity even after stimulation with a mixture of lipopolysaccaride (LPS) and tumour necrosis factor (TNF)-alpha. These iNOS knockout cells showed a similar growth rate to control cells in vivo at 5 days. We then performed an in vivo implantation glioma study using either the iNOS knockout clone or two genetically engineered control C6 clones. There was a significant reduction (p < 0.01) of tumour mass with the iNOS knockout clone 28 days after the implantation. Immunocytochemistry indicated infiltrates of CD3 positive T cells and macrophages in the controls and the iNOS knockout group. These studies indicate that iNOS expression by tumour parenchymal cells is a critical factor for tumour growth with this model. The mechanisms that cause failure of tumour growth need clarification prior to considering that specific iNOS inhibitors might be candidates for adjuvant treatment of malignant glioma.

Animals↗

Flavopiridol inhibits the growth of GL261 gliomas in vivo: implications for malignant glioma therapy.

The mechanism of action of many chemotherapeutic agents targets the cell cycle. Recently, we demonstrated cytotoxic and other anti-tumor effects of flavopiridol, the first synthetic cyclin dependent kinase (CDK) inhibitor to enter clinical trials, on the murine GL261 glioma cell line in vitro (Newcomb et al., Cell Cycle 2003; 2:243). Given that flavopiridol has demonstrated anti-tumor activity in several human xenograft models, we wanted to evaluate it for anti-glioma activity in vivo in our established subcutaneous and intracranial GL261 experimental tumor models. In particular, the intracranial animal model recapitulates many of the histopathological and biological features of human high-grade glioma including both necrosis with pseudopalisading and invasion of the brain adjacent to tumor. Here we tested the activity of flavopiridol against tumors formed by GL261 cells, first as subcutaneous implants, and then in the intracranial model. We demonstrate efficacy of flavopiridol as a single modality treatment in delaying tumor growth in both animal models. We hypothesize that flavopiridol treatment induced tumor growth delay by two possible mechanisms involving growth arrest combined with recruitment of tumor cells to S-phase. Based on our findings, flavopiridol should be considered as a treatment approach for patients with high-grade glioma.

Animals↗

[Total removal of hypothalamic glioma 15 years after irradiation of right optic glioma].

Hypothalamic glioma was found in a 17 year old male patient 15 years after irradiation of right optic glioma. It was totally removed by surgery. He was first admitted to Ryukyu University Hospital at the age of 1 year and 11 months, with right exophthalmos and visual disturbance. Diagnosis was anterior type of right optic glioma. This was treated by irradiation (47 Gy). Follow-up CT scans revealed no regrowth in intraorbital and intracranial regions. At the age of 17 years, CT scan and MRI showed an enhanced mass in the hypothalamus above the suprasellar cistern. Total removal was performed by bifrontal interhemispheric trans-lamina terminalis approach. Histological diagnosis was pilocytic astrocytoma. Postoperatively, consciousness remained disturbed for 3 weeks because of infarction in the bilateral medial nucleus of the thalamus. Radical excision of hypothalamic glioma was reviewed in the literature. We concluded that such excision has a potentially good outcome, and should be attempted when circumstances indicate its feasibility.

Adolescent↗

Tumor spread in unilateral optic glioma. Study report No. 2. North American Study Group for Optic Glioma.

We describe 106 cases with unilateral optic nerve gliomas confined initially to the orbit. Thirty-four have been observed without biopsy or excision, 28 had a biopsy and 44 had complete excision of the glioma. Data on these cases were collected from 21 academic centers and comprise the second report by a recently formed study group. Some of the cases have been previously reported, but the present study extends their follow-up. The cases have been analyzed with regard to the certainty of diagnosis, the basis for unilaterality, the type of excision, duration of follow-up and growth of the tumor. We addressed three related questions. Can even the most sophisticated neuroimaging and histological techniques reliably detect the cranial extent of an optic glioma? Is the tumor often enough unifocal in one nerve so that excision has a reasonable chance to effect a cure? What percentage of untreated unilateral optic gliomas eventually spread to the chiasm? While this is an ongoing study, data collected to date seem to indicate that most tumors are unicentric and that only infrequently do they invade the chiasm (4 of 106 cases).

Adolescent↗

EphA2 as a glioma-associated antigen: a novel target for glioma vaccines.

EphA2 is a receptor tyrosine kinase and is frequently overexpressed in a wide array of advanced cancers. We demonstrate in the current study that the EphA2 protein is restrictedly expressed in primary glioblastoma multiforme and anaplastic astrocytoma tissues in comparison to normal brain tissues. To evaluate the possibility of targeting EphA2 in glioma vaccine strategies, we stimulated human leukocyte antigen (HLA) A2+ peripheral blood mononuclear cells (PBMCs) obtained from healthy donors and glioma patients with autologous dendritic cells (DCs) loaded with synthetic EphA2883-891 peptide (TLADFDPRV), which has previously been reported to induce interferon-gamma in HLA-A2+ PBMCs. Stimulated PBMCs demonstrated antigen-specific cytotoxic T lymphocyte (CTL) responses as detected by specific lysis of T2 cells loaded with the EphA2883 peptide as well as HLA-A2+ glioma cells, SNB19 and U251, that express EphA2. Furthermore, in vivo immunization of HLA-A2 transgenic HHD mice with the EphA2883-891 peptide resulted in the development of an epitope-specific CTL response in splenocytes, despite the fact that EphA2883-891 is an autoantigen in these mice. Taken together, these data suggest that EphA2883-891 may be an attractive antigen epitope for molecularly targeted glioma vaccines.

Animals↗