Disappearing large calcified thoracic disc herniation in a patient with thalassaemia

Regression of herniated disc fragments with subsequent improvement in clinical symptoms has been reported in the lumbar and cervical spine. Such regressions in the thoracic spine are extremely rare. We report a case of a 38-year-old patient with thalassaemia who had regression of a large calcified herniated thoracic disc causing cord compression, with subsequent herniation of a second calcified disc at a different level and discuss the possible aetiopathogenesis. This is the first such case reported in the thalassaemia population.

Pooled data analysis on anterior versus posterior approach for rheumatoid arthritis at the craniovertebral junction

OBJECT

Rheumatoid arthritis (RA) is one of the most debilitating autoimmune diseases affecting the craniovertebral junction (CVJ). Patients predominantly present with myelopathic symptoms and intractable neck pain. The surgical approach traditionally has been either a combined anterior and posterior approach or a posterior-only approach. In this article, the authors review pooled data from the literature and discuss the benefits of the two types of approaches.

METHODS

A search of the PubMed database was conducted using key words that describe spine deformities in RA and specific spinal interventions. The authors evaluated the neurological outcomes based on the Ranawat scale in both the groups through chi-square analysis. Multiple logistic regression was carried out to further examine for potential confounders. Any adverse sequalae resulting from either approach were also documented. Because all the procedures performed via a transoral approach in the analyzed articles also involved posterior fixation, for convenience of comparison, the combined procedures are referred to as "anterior approach" or "anterior-posterior" in the present study.

RESULTS

The search yielded 233 articles, of which 11 described anterior approaches and 14 evaluated posterior approaches. The statistical analysis showed that patients treated with a posterior approach fared better than those treated with an anterior (combined) approach. It was noted that those patients in whom the cervical subluxations were reducible on traction predominantly underwent posterior approaches.

CONCLUSIONS

CVJ instability is a serious complication of RA that requires surgical intervention. Although the anterior-posterior combined approach can provide direct decompression, it is associated with morbidity, and the analysis showed no statistically significant benefit to patients. In contrast, the posterior approach has been shown to provide statistically significant superiority with respect to stabilization and subsequent pannus reduction. Surgical approaches are undertaken based on the reducibility of subluxations with traction and the vector of compressive force. However, the choice of surgical approach should be based on the individual patient's pathology.

Abstract B39: Targeting cancer stem cells via inhibition of PI3K/AKT pathway alone and in combination with autophagy blockade

Background: Glioblastoma Multiforme (GBM) is the most aggressive form of malignant primary brain tumor. Despite an aggressive treatment regimen consisting of surgery, radiation and chemotherapy, individuals with GBM survive on average 15 months. A subset of glioblastoma cells, known as glioblastoma stem-like cells (GSCs), are chemotherapy and radiotherapy-resistent and are hypothesized to be responsible for tumor formation, maintenance, and recurrence. The PI3K/AKT pathway is overactive in GBM and has been shown to play an important role in cancer stem cell maintenance. Therefore we sought to determine the efficacy of drugs targeting the AKT pathway in multiple patient-derived GSC lines. In addition, we evaluated the cytotxicity of the most promising therapy on medulloblastoma and neuroblastoma stem cells.

Methods: GSC lines were generated from patient's tumors, propagated in neurosphere media and analyzed for stem cell markers by immunocytochemistry. Effect of growth factor receptor inhibitors (erlotinib, gefetinib, sunitinib), the intracellular PI3K/AKT pathway inhibitors (GDC-0941, OSU-03012, perifosine, NVP-BEZ235, KU-0063794 and everolimus) and autophagy inhibitor (chloroquine) on cell viability was determined with MTS assay. Caspase 3/7 activity was determined using CellEvent caspase reagent. The effect of the inhibitors on cell signaling pathways was evaluated by western blot analysis. Medulloblastoma and neuroblastoma stem cells were derived from Daoy and NB1691 cells respectively via propagation in neurosphere media.

Results: GSC's expressed nestin, CD133, GFAP, musashi, BMi1, and SOX2. In addition, transplantation of GSC's into nude mice generated tumors. Of 11 GSC lines examined, all 11 demonstrated activation of the AKT pathway as indicated by robust phosphorylation of AKT (S473) and BAD (S136) and 10/11 demonstrated phosphorylation of mTOR (S2481). Growth factor receptor inhibition failed to induce significant reduction in cell viability. Intracellular inhibitors produced variable results except for dual PI3K/mTOR inhibitor NVB-BEZ235 (100nM) which consistantly induced approximately 50% reduction in cell viability. While the inhibition of autophagy with chloroquine significantly increased inhibitor induced cell death in some cell lines, combined PDK1 and autophagy inhibition induced robust caspase activity and significantly reduced viability in all six GSCs examined to an average of 6.1±2.7% viability compared to non-treated controls (100±1.9%). Similarly the combination significantly reduced both DAOY and NB1691 stem cell viability. In contrast the combination had no effect on primary neuronal cultures.

Conclusion: The AKT/PI3K pathway is overactive in GSCs and may contribute to stem cell maintenance as well as inhibition of apoptosis. Our data indicates that inhibiting autophagy concommitantly with PI3K/AKT pathway inhibition can potentiate their cytotoxic effect. Furthermore combined chloroquine and OSU-03012 resulted in a substantial decrease cell viability accross multiple GSC lines and in medulloblastoma and neuroblastoma stem cells suggesting that this combination may represent a potential adjuvant therapy these cancers.

Citation Format: Regina M. Graham, Andrew Middleton, Daniel A. Benito, Raisa Uddin, Baoyu Zhang, Winston Walters, Amade Bregy, Steven Vanni, Ricardo J. Komotar. Targeting cancer stem cells via inhibition of PI3K/AKT pathway alone and in combination with autophagy blockade. [abstract]. In: Proceedings of the AACR Special Conference: Targeting the PI3K-mTOR Network in Cancer; Sep 14-17, 2014; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(7 Suppl):Abstract nr B39.

Direct lateral retroperitoneal approach for the surgical treatment of lumbar discitis and osteomyelitis

OBJECT

The medical management of discitis and osteomyelitis with long-term antibiotic therapy and bracing usually results in eradicated infection. Surgical management is appropriate when medical management fails and in some cases with pyogenic deformity or neurological deficit. The success of surgery depends on adequate debridement of the necrotic infected disc and vertebral body, along with anterior column reconstruction and vertebral stabilization. Debridement is typically performed via an anterior retroperitoneal approach, which can necessitate mobilization of the great vessels for proper exposure. Mobilization can be technically difficult and lead to vascular injury. The purpose of this study was to evaluate an alternative technique for the surgical treatment of lumbar discitis and osteomyelitis using a direct lateral retroperitoneal approach, which allows for thorough debridement and anterior column reconstruction while avoiding the need to mobilize the great vessels.

METHODS

A retrospective chart analysis was performed for all patients who had presented with lumbar discitis and osteomyelitis and had undergone surgical management via the direct lateral retroperitoneal approach in the period from 2006 to 2013. Collected data included surgical blood loss, perioperative complications (wound infection, vascular injury, approach-related complications, and neurological injury), need for secondary procedures, microbiological and laboratory results, and efficacy of infection eradication. Imaging studies were reviewed as well.

RESULTS

Ten patients, 7 male and 3 female, underwent this procedure at the authors' institution in the defined period. Average blood loss was 272 ml (range 150-800 ml, with 800 ml in the only 2-level case). There were no vascular injuries. Average follow-up was 680 days, although 4 patients did not complete the follow-up beyond 6 months. Eight patients underwent immediate posterior pedicle screw instrumentation. Two patients did not undergo posterior instrumentation, and one of these developed a kyphotic deformity that required a secondary posterior procedure. Infection was eradicated in all patients according to a history, physical examination, imaging studies, and laboratory parameters (complete blood count, erythrocyte sedimentation rate, and C-reactive protein). One patient developed a painful neuroma at the iliac crest harvest site, and one patient had a retroperitoneal hematoma. Otherwise, there were no approach-related neurological injuries or complications. Neither was there any postoperative surgical site infection.

CONCLUSIONS

The direct lateral approach for the surgical treatment of lumbar discitis and osteomyelitis allows for thorough debridement and spinal reconstruction without the need to mobilize the great vessels. This technique effectively eradicated infection in all cases, with reasonable blood loss and no vascular injuries. This approach should be considered as an alternative to the open anterior approach. The authors recommend posterior instrumentation to prevent the development of kyphosis.

Minimally Invasive Versus Open Lumbar Fusion: A Comparison of Blood Loss, Surgical Complications, and Hospital Course

BACKGROUND

Perioperative blood loss is a frequent concern in spine surgery and often necessitates the use of allogeneic transfusion. Minimally invasive technique (MIS) is an option that minimizes surgical trauma and therefore intra-operative bleeding. The purpose of this study is to evaluate the blood loss, surgical complications, and duration of inpatient hospitalization in patients undergoing open posterolateral lumbar fusion (PLF), open posterior lumbar interbody fusion (PLIF) with PLF, or MIS transforaminal lumbar interbody fusion (MIS TLIF).

METHODS

Operative reports and perioperative data of patients undergoing single-level, primary open PLF (n=41), open PLIF/PLF (n=42), and MIS TLIF (n=71) were retrospectively evaluated. Patient demographics, operative blood loss, use of transfusion products, complications, and length of stay were tabulated. Patient data was controlled for age, BMI, and gender for statistical analysis.

RESULTS

Patients undergoing open PLF and open PLIF/PLF respectively experienced a significantly higher blood loss (p<0.001), higher volume of blood transfusion (p<0.001), higher volume of cell saver transfusion (p<0.001), and more surgical complications (dural injury, wound infections, screw malposition) (p=0.02) than those undergoing MIS TLIF. There was no statistically significant difference in duration of hospital stay (p=0.11).

CONCLUSIONS

MIS TLIF provides interbody fusion with less intraoperative blood loss and subsequently a lower transfusion rate compared to open techniques, but this did not influence length of hospital stay. MIS TLIF is at least as safe as open techniques with respect to dural tear, wound infection, and screw placement.

LEVEL OF EVIDENCE

Level III, Therapeutic.

Abstract 5497: Targeting glioblastoma stem cells with withaferin A

Introduction. Glioblastoma multiforme (GBM) is the most common and aggressive form of primary brain cancer affecting 3 to 4 per 100,000 people annually in the United States. Despite aggressive therapy including surgical resection followed by both radiation and chemotherapy, overall survival remains dismal at approximately 14 months. Recent studies have determined that GBM's contain a small population of stem cells (GSCs), which promote tumor growth through unlimited self-renewal. Since GSCs are chemo- and radio-resistant and drive tumor regrowth following therapy, successful treatment depends on the elimination of these cells. Withaferin A (WA) is a bioactive compound derived from the plant Withonia somnifera which possesses anti-inflammatory and anti-cancer properties. Here we evaluated the effects of WA on patient derived GSCs.

Methods. With IRB approval, GSC lines were generated. GSCs were propagated in neurosphere media and examined for the stem cell markers CD133, nestin, musashi and BMi1 by immunocytochemistry and western blot analysis. Effect of WA on cell viability was determined using MTS assay. The effect of WA on cell survival and stress pathways was evaluated by western blot analysis.

Results. WA induced a significant decrease in cell viability at low micromolar concentrations. The IC50 for 3 patient derived GSC lines ranged between 0.96-1.78μM. WA induced ER stress and apoptosis in the GSCs as indicated by increased expression of ER stress markers grp78 and CHOP and increased levels of cleaved PARP. Furthermore, WA decreased survivin but increased phospho-ERK levels. However, inhibition of ERK activity with U0126 did not potentiate the effect of WA on cell death.

Conclusion. Ashwagandha has been used safely for medicinal purposes for centuries and pharmacokinetic studies in mice indicate that micromolar plasma concentrations of WA are obtainable. Our studies indicate that very low concentrations of WA induce ER stress and cell death in GSC lines. Targeting GSC with WA may increase patient survival by hindering GSC mediated tumor regrowth following surgery. Our data demonstrates the efficacy of WA and supports additional studies toward the use of WA as an adjuvant GBM therapy.

Citation Format: Baoyu Zhang, Branko Cuglievan, Nadia G. Myrthil, Steven Vanni, Ricardo J. Komotar, Regina M. Graham. Targeting glioblastoma stem cells with withaferin A. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5497. doi:10.1158/1538-7445.AM2014-5497

Abstract 2177: A novel role for sirtuins in modulating ER stress: implications for neuroblastoma therapy

Sirtuins (SIRTs) are NAD+ dependent deacetylases, which play an important role in cancer cell survival and resistance to chemotherapy. SIRT1, the most studied sirtuin, is overexpressed in many drug resistant cancers including neuroblastoma. SIRTs mediate cellular processes by deacetylating histone and non-histone proteins including those involved in the oxidative stress response, DNA repair and apoptosis. Here we define a novel role for Sirts in modulating the unfolded protein response (UPR) and cell survival following endoplasmic reticulum (ER) stress. Cellular stresses such as hypoxia, nutrient deprivation and chemotherapy can reduce the protein folding capacity of the ER leading to the accumulation of unfolded proteins which triggers activation of the UPR. The UPR is an adaptive mechanism that functions to restore ER and cellular homeostasis and as such plays a key role in cancer cell survival and tumor growth.

To induce ER stress we exposed neuroblastoma cell lines NB1691, SK-N-BE2 and SH-SY5Y to the glucose analog, 2-deoxy-D-glucose (2-DG). In addition to inhibiting glycolysis, 2-DG has been shown to activate the UPR by interfering with N-linked glycosylation and proper protein folding. 2-DG (2mM) induced the UPR markers grp78, grp94 and CHOP as determined by western blot analysis. Treatment of neuroblastoma cell lines with the SIRT inhibitor, sirtinol (50μM), blocked the induction of grp78 by 2-DG, attenuated grp94 and increased CHOP. Recently it has been shown that activation of SIRT1 and AMP-activated protein kinase (AMPK) exerts similar effects and may regulate the activity of each other. AMPK can increase the transcription of the NAD+ biosynthetic enzyme Nampt, which in turn increases the NAD+/NADH ratio We found that 2-DG induced rapid activation of AMPK, as indicated by robust induction of phospho-ACC (serine 79) and inhibition of AMPK with compound C prevented grp78 induction by 2-DG. To determine if this effect of SIRT inhibition on grp78 induction was unique to 2-DG, we also treated neuroblastoma cells with the ER stressors velcade (bortezomib) and the endoplasmic reticulum Ca2+-ATPase inhibitor, thapsigargin. Inhibiting SIRTs significantly decreased the induction of grp78 and enhanced CHOP levels. Furthermore, sirtinol significantly increased 2-DG, velcade, and thapsigargin induced cell death as determined by MTS assay.

The UPR promotes cancer cell survival in response to cellular stressors including chemotherapy. Therapeutic targeting of the UPR is a novel anti-cancer approach. Inhibiting the activity of SIRTs modulates the UPR in neuroblastoma and represents an innovative way to enhance the effect of chemotherapy in a cancer with minimal survival.

Citation Format: Regina M. Graham, Jayanti Singh, Keith A. Webster, Steven Vanni. A novel role for sirtuins in modulating ER stress: implications for neuroblastoma therapy. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2177. doi:10.1158/1538-7445.AM2013-2177

A closer look into G protein coupled receptor activation: X-ray crystallography and long-scale molecular dynamics simulations

G protein coupled receptors (GPCRs) are a large eukaryotic protein family of transmembrane receptors that react to a signal coming from the extracellular environment to generate an intracellular response through the activation of a signal transduction pathway mediated by a heterotrimeric G protein. Their diversity, dictated by the multiplicity of stimuli to which they respond and by the variety of intracellular signalling pathways they activate, make them one of the most prominent families of validated pharmacological targets in biomedicine. In recent years, major breakthroughs in structure determination of GPCRs have given new stimuli to the exploration of the biology of these proteins, providing a structural basis to understand the molecular origin of GPCR mechanisms of action. Based on the information coming from these structural studies, a number of recent in silico investigations used molecular dynamics (MD) simulations to contribute to our knowledge of GPCRs. In this review, we will focus on investigations that, taking advantage of the tremendous progress in both hardware and software, made testable hypotheses that have been validated by subsequent structural studies. These stateof- the-art molecular simulations highlight the potential of microsecond MD simulations as a valuable tool in GPCR structural biology and biophysics.

Motor nerve injuries following the minimally invasive lateral transpsoas approach

OBJECT

The aim of this study was to determine the incidence of motor nerve injuries during the minimally invasive lateral interbody fusion procedure at a single academic medical center.

METHODS

A retrospective chart review of 118 patients who had undergone lateral interbody fusion was performed. Both inpatient and outpatient records were examined to identify any new postoperative motor weakness in the lower extremities and abdominal wall musculature that was attributable to the operative procedure.

RESULTS

In the period from 2007 to 2011 the lateral interbody fusion procedure was attempted on 201 lumbar intervertebral disc levels. No femoral nerve injuries occurred at any disc level other than the L4-5 disc space. Among procedures involving the L4-5 level there were 2 femoral nerve injuries, corresponding to a 4.8% injury risk at this level as compared with a 0% injury risk at other lumbar spine levels. Five patients (4.2%) had postoperative abdominal flank bulge attributable to injury to the abdominal wall motor innervation.

CONCLUSIONS

The overall incidence of femoral nerve injury after the lateral transpsoas approach was 1.7%; however, the level-specific incidence was 4.8% for procedures performed at the L4-5 disc space. Approximately 4% of patients had postoperative abdominal flank bulge. Surgeons will be able to minimize these motor nerve injuries through judicious use of the procedure at the L4-5 level and careful attention to the T-11 and T-12 motor nerves during exposure and closure of the abdominal wall.

Occiput to thoracic fusion after surgical resection of desmoid tumor

BACKGROUND

Desmoid tumors are rare clinical entities that cause significant morbidity based on their locally aggressive nature. Complete resection with wide margins is the standard of care; however, when arising in the neck, resection is limited due to proximity of the lesion to critical structures.

CASE DESCRIPTION

We describe a complete resection of a desmoid tumor requiring extensive resection of cervical extensor musculature. We were able to achieve a total resection of a cervical desmoid tumor with no evidence of recurrence at follow-up.

CONCLUSIONS

Complete resection of desmoid tumors is the standard of care. In this case, we felt that complete resection would lead to iatrogenic instability; therefore, an occiput to thoracic fusion was performed at the time of the resection.

Comparison of two prognostic models for acute pulmonary embolism: clinical vs. right ventricular dysfunction-guided approach

BACKGROUND

Recently, some prognostic models for acute pulmonary embolism (PE) have been proposed. We investigated whether the Pulmonary Embolism Severity Index (PESI) and the European Society of Cardiology (ESC) prognostic approaches result in different prognoses.

METHODS

Consecutive adult patients with acute PE were included. According to the ESC guidelines, high-risk patients were identified by the presence of shock/hypotension, intermediate-risk patients by elevated troponin I or right ventricular dysfunction as assessed by echocardiography, and low-risk patients by the absence of any of the above. In the PESI model, 11 clinical variables, easily accessible at the bedside, were used to generate three risk classes. The main outcomes were all-cause and PE-related in-hospital mortality.

RESULTS

Forty-one patients (8%, 95% confidence interval [CI] 5.8-10.8) of 510 died. According to the ESC model, 40% were at low risk of short-term mortality, 54% at intermediate risk, and 6% at high risk. The distribution according to the PESI model was 31% (P < 0.05 vs. ESC), 49% and 20% (P < 0.05 vs. ESC), respectively. Mortality increased through the risk classes (P < 0.01), without significant differences between the models. The ESC model identified with higher accuracy than the PESI model both high-risk and low-risk patients (P < 0.05 for both). When patients with shock/hypotension were excluded, the PESI model stratified patients into classes with increasing PE-related mortality (0.7%, 4.3%, and 11.6%, P < 0.05). Troponin I and right ventricular dysfunction added incremental prognostic value to the PESI model, particularly in normotensive patients at intermediate risk.

CONCLUSIONS

The ESC model showed higher accuracy than the PESI model in identifying high-risk and low-risk patients. In normotensive patients, the PESI model could guide clinical management as well as troponin I and echocardiography testing.

A Prospective, Randomized Trial Comparing Expansile Cervical Laminoplasty and Cervical Laminectomy and Fusion for Multilevel Cervical Myelopathy

BACKGROUND:

Controversy exists as to the best posterior operative procedure to treat multilevel compressive cervical spondylotic myelopathy.

OBJECTIVE:

To determine clinical, radiological, and patient satisfaction outcomes between expansile cervical laminoplasty (ECL) and cervical laminectomy and fusion (CLF).

METHODS:

We performed a prospective, randomized study of ECL vs CLF in patients suffering from cervical spondylotic myelopathy. End points included the Short Form-36, Neck Disability Index, Visual Analog Scale, modified Japanese Orthopedic Association score, Nurick score, and radiographic measures.

RESULTS:

A survey of academic North American spine surgeons (n = 30) demonstrated that CLF is the most commonly used (70%) posterior procedure to treat multilevel spondylotic cervical myelopathy. A total of 16 patients were randomized: 7 to CLF and 9 to ECL. Both groups showed improvements in their Nurick grade and Japanese Orthopedic Association score postoperatively, but only the improvement in the Nurick grade for the ECL group was statistically significant (P &lt; .05). The cervical range of motion between C2 and C7 was reduced by 75% in the CLF group and by only 20% in the ECL group in a comparison of preoperative and postoperative range of motion. The overall increase in canal area was significantly (P &lt; .001) greater in the CLF group, but there was a suggestion that the adjacent level was more narrowed in the CLF group in as little as 1 year postoperatively.

CONCLUSION:

In many respects, ECL compares favorably to CLF. Although the patient numbers were small, there were significant improvements in pain measures in the ECL group while still maintaining range of motion. Restoration of spinal canal area was superior in the CLF group.

Abstract 4335: Low dose 2 deoxy glucose induces ER stress and neuroblastoma cell death

Introduction. The prognosis for relapsed neuroblastoma (NB) is extremely poor. While standard therapies can produce brief periods of remission, many NB patients will eventually die due to recurrent disease. Therefore novel approaches are urgently needed for the treatment of NB. Cancer cells are characterized by increased rates of aerobic glycolysis, which correlate with increased tumor aggressiveness and a poor prognosis. 2-deoxy-D-glucose (2-DG) is a glucose analogue which blocks glycolysis and has recently been investigated in a phase I trial for advanced solid tumors. Here we examine the potential of 2-DG for neuroblastoma treatment.

Methods. The effect of 2-DG was evaluated in a panel of neuroblastoma cell lines: N-Myc amplified: NB1691, SMS-KCNR, SK-N-BE2, and non N-Myc amplified: SK-N-SH, SH-SY5Y, and SVBM15, a newly developed cell line derived from a bone marrow aspirate of a stage IV relapsed NB patient. The effects of 2-DG were evaluated by MTS assay and LDH release. ATP levels were evaluated using an ATP colorimetric assay. Western blot analysis was used to determine protein levels of ER stress proteins and AKT.

Results. To determine the effective dose (ED50) of 2-DG, we exposed NB cells to 0.1-8mM 2-DG for 72 hours and measured cell viability. The ED50 was found to be close to 2mM for most cell lines examined; SH-SY5Y: 1.86mM, SK-N-SH: 2.23mM, SVBM15: 2.4mM, SK-N-BE2: 1.87mM, SMSKNR: 1.98mM, and NB1691: 5.44mM. LDH analysis of SH-SY5Y and SK-N-BE2 cells indicated that this effect was primarily due to cell death and not cell cycle inhibition. Inhibiting glycolysis with 2mM 2-DG reduced ATP levels by ∼30% at 24 hours (SK-N-BE2: 70±6.3% and SH-SY5Y: 64±4.4% of non-treated controls). Examination of cell signaling pathways induced by 2-DG in SH-SY5Y and SK-N-BE2 cells revealed a dose-dependent induction of AKT and ER stress associated proteins; GRP94, GRP78, and GADD153. To determine if inhibiting GRP94 or AKT would potentiate 2-DG induced cell death, cells were exposed to 2mM 2-DG with 17-AAG (500nM), an inhibitor of GRP94, or AKT inhibitor × (10uM). Inhibiting the activity of both GRP94 and AKT further reduced viability by an additional ∼50% over 2-DG alone in SH-SY5Y cells (2-DG: 45±1.4%; 17-AAG: 62±1.6%; 2-DG+17-AAG: 25±0.61%; AKT X: 49±1.8%; 2-DG+AKT X: 23±1.93%) and SK-N-BE2 cells (2-DG: 41±3.3%; 17-AAG: 85±2.0%; 2-DG+17-AAG: 24±0.43%; AKT X: 75±7.3%; 2-DG+AKT X: 22±1.2%).

Conclusions. These results demonstrate that clinically achievable levels of 2-DG reduce ATP concentrations and induce significant loss of NB cell viability. Furthermore, inhibiting cell survival signaling pathways activated by 2-DG exposure can increase the effectiveness of 2-DG treatment. Targeting NB cell metabolism is a novel approach to NB treatment, and when combined with additional chemotherapeutic agents, may be an effective treatment for NB.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4335. doi:10.1158/1538-7445.AM2011-4335