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Juhász C, Mittal S. Molecular Imaging of Brain Tumor-Associated Epilepsy. Diagnostics (Basel) 2020; 10:diagnostics10121049. [PMID: 33291423 PMCID: PMC7762008 DOI: 10.3390/diagnostics10121049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022] Open
Abstract
Epilepsy is a common clinical manifestation and a source of significant morbidity in patients with brain tumors. Neuroimaging has a pivotal role in neuro-oncology practice, including tumor detection, differentiation, grading, treatment guidance, and posttreatment monitoring. In this review, we highlight studies demonstrating that imaging can also provide information about brain tumor-associated epileptogenicity and assist delineation of the peritumoral epileptic cortex to optimize postsurgical seizure outcome. Most studies focused on gliomas and glioneuronal tumors where positron emission tomography (PET) and advanced magnetic resonance imaging (MRI) techniques can detect metabolic and biochemical changes associated with altered amino acid transport and metabolism, neuroinflammation, and neurotransmitter abnormalities in and around epileptogenic tumors. PET imaging of amino acid uptake and metabolism as well as activated microglia can detect interictal or peri-ictal cortical increased uptake (as compared to non-epileptic cortex) associated with tumor-associated epilepsy. Metabolic tumor volumes may predict seizure outcome based on objective treatment response during glioma chemotherapy. Advanced MRI, especially glutamate imaging, can detect neurotransmitter changes around epileptogenic brain tumors. Recently, developed PET radiotracers targeting specific glutamate receptor types may also identify therapeutic targets for pharmacologic seizure control. Further studies with advanced multimodal imaging approaches may facilitate development of precision treatment strategies to control brain tumor-associated epilepsy.
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Affiliation(s)
- Csaba Juhász
- Departments of Pediatrics, Neurology, Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
- PET Center and Translational Imaging Laboratory, Barbara Ann Karmanos Cancer Institute, Detroit, MI 48201, USA
- Correspondence:
| | - Sandeep Mittal
- Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, USA;
- Carilion Clinic Neurosurgery, Roanoke, VA 24014, USA
- Fralin Biomedical Research Institute, Roanoke, VA 24016, USA
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Neal A, Moffat BA, Stein JM, Nanga RPR, Desmond P, Shinohara RT, Hariharan H, Glarin R, Drummond K, Morokoff A, Kwan P, Reddy R, O'Brien TJ, Davis KA. Glutamate weighted imaging contrast in gliomas with 7 Tesla magnetic resonance imaging. NEUROIMAGE-CLINICAL 2019; 22:101694. [PMID: 30822716 PMCID: PMC6396013 DOI: 10.1016/j.nicl.2019.101694] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 01/10/2019] [Accepted: 01/27/2019] [Indexed: 01/04/2023]
Abstract
Introduction Diffuse gliomas are incurable malignancies, which undergo inevitable progression and are associated with seizure in 50–90% of cases. Glutamate has the potential to be an important glioma biomarker of survival and local epileptogenicity if it can be accurately quantified noninvasively. Methods We applied the glutamate-weighted imaging method GluCEST (glutamate chemical exchange saturation transfer) and single voxel MRS (magnetic resonance spectroscopy) at 7 Telsa (7 T) to patients with gliomas. GluCEST contrast and MRS metabolite concentrations were quantified within the tumour region and peritumoural rim. Clinical variables of tumour aggressiveness (prior adjuvant therapy and previous radiological progression) and epilepsy (any prior seizures, seizure in last month and drug refractory epilepsy) were correlated with respective glutamate concentrations. Images were separated into post-hoc determined patterns and clinical variables were compared across patterns. Results Ten adult patients with a histo-molecular (n = 9) or radiological (n = 1) diagnosis of grade II-III diffuse glioma were recruited, 40.3 +/− 12.3 years. Increased tumour GluCEST contrast was associated with prior adjuvant therapy (p = .001), and increased peritumoural GluCEST contrast was associated with both recent seizures (p = .038) and drug refractory epilepsy (p = .029). We distinguished two unique GluCEST contrast patterns with distinct clinical and radiological features. MRS glutamate correlated with GluCEST contrast within the peritumoural voxel (R = 0.89, p = .003) and a positive trend existed in the tumour voxel (R = 0.65, p = .113). Conclusion This study supports the role of glutamate in diffuse glioma biology. It further implicates elevated peritumoural glutamate in epileptogenesis and altered tumour glutamate homeostasis in glioma aggressiveness. Given the ability to non-invasively visualise and quantify glutamate, our findings raise the prospect of 7 T GluCEST selecting patients for individualised therapies directed at the glutamate pathway. Larger studies with prospective follow-up are required. 7 T GluCEST glioma imaging is feasible, producing high quality quantifiable images. Increased peritumoural GluCEST contrast correlates with drug resistant epilepsy. Increased tumour GluCEST contrast is associated with prior adjuvant therapy. Two GluCEST patterns were identified with distinct clinico-radiological features. GluCEST contrast correlates with MRS glutamate in peritumoural regions.
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Affiliation(s)
- Andrew Neal
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Australia.
| | - Bradford A Moffat
- Melbourne Node of the National Imaging Facility, Department of Radiology, University of Melbourne, Australia
| | - Joel M Stein
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Ravi Prakash Reddy Nanga
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Patricia Desmond
- Department of Radiology, Royal Melbourne Hospital, Australia; Department of Radiology and Medicine, University of Melbourne, Australia
| | - Russell T Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, PA, United States
| | - Hari Hariharan
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca Glarin
- Department of Radiology, Royal Melbourne Hospital, Australia; Department of Radiology and Medicine, University of Melbourne, Australia
| | - Katharine Drummond
- Department of Neurosurgery, Royal Melbourne Hospital, Australia; Department of Surgery, University of Melbourne, Australia; Melbourne Brain Centre, The Royal Melbourne Hospital, Australia
| | - Andrew Morokoff
- Department of Neurosurgery, Royal Melbourne Hospital, Australia; Department of Surgery, University of Melbourne, Australia
| | - Patrick Kwan
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Australia; Department of Neuroscience, Central Clinical School, Monash University, Australia; Department of Neurology, The Alfred Hospital Monash University, Australia
| | - Ravinder Reddy
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Terence J O'Brien
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Australia; Department of Neuroscience, Central Clinical School, Monash University, Australia; Department of Neurology, The Alfred Hospital Monash University, Australia
| | - Kathryn A Davis
- Penn Epilepsy Center, Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
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Nasr B, Chatterton R, Yong JHM, Jamshidi P, D'Abaco GM, Bjorksten AR, Kavehei O, Chana G, Dottori M, Skafidas E. Self-Organized Nanostructure Modified Microelectrode for Sensitive Electrochemical Glutamate Detection in Stem Cells-Derived Brain Organoids. BIOSENSORS 2018; 8:E14. [PMID: 29401739 PMCID: PMC5872062 DOI: 10.3390/bios8010014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 02/05/2023]
Abstract
Neurons release neurotransmitters such as glutamate to communicate with each other and to coordinate brain functioning. As increased glutamate release is indicative of neuronal maturation and activity, a system that can measure glutamate levels over time within the same tissue and/or culture system is highly advantageous for neurodevelopmental investigation. To address such challenges, we develop for the first time a convenient method to realize functionalized borosilicate glass capillaries with nanostructured texture as an electrochemical biosensor to detect glutamate release from cerebral organoids generated from human embryonic stem cells (hESC) that mimic various brain regions. The biosensor shows a clear catalytic activity toward the oxidation of glutamate with a sensitivity of 93 ± 9.5 nA·µM-1·cm-2. It was found that the enzyme-modified microelectrodes can detect glutamate in a wide linear range from 5 µM to 0.5 mM with a limit of detection (LOD) down to 5.6 ± 0.2 µM. Measurements were performed within the organoids at different time points and consistent results were obtained. This data demonstrates the reliability of the biosensor as well as its usefulness in measuring glutamate levels across time within the same culture system.
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Affiliation(s)
- Babak Nasr
- Centre for Neural Engineering, The University of Melbourne, Melbourne, VIC 3053, Australia.
- The Department of Electrical and Electronic Engineering, The University of Melbourne, Melbourne, VIC 3010, Australia.
- ARC Centre of Excellence for Integrative Brain Function, The University of Melbourne, Melbourne, VIC 3010, Australia.
| | - Rachael Chatterton
- Centre for Neural Engineering, The University of Melbourne, Melbourne, VIC 3053, Australia.
| | - Jason Hsien Ming Yong
- Centre for Neural Engineering, The University of Melbourne, Melbourne, VIC 3053, Australia.
- The Department of Electrical and Electronic Engineering, The University of Melbourne, Melbourne, VIC 3010, Australia.
| | - Pegah Jamshidi
- Centre for Neural Engineering, The University of Melbourne, Melbourne, VIC 3053, Australia.
| | - Giovanna Marisa D'Abaco
- The Department of Biomedical Engineering, The University of Melbourne, Melbourne, VIC 3010, Australia.
| | - Andrew Robin Bjorksten
- The Department of Anaesthesia & Pain Management, Royal Melbourne Hospital, Parkville, VIC 3050, Australia.
| | - Omid Kavehei
- Faculty of Engineering and Information Technology, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Gursharan Chana
- Centre for Neural Engineering, The University of Melbourne, Melbourne, VIC 3053, Australia.
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC 3050, Australia.
| | - Mirella Dottori
- Centre for Neural Engineering, The University of Melbourne, Melbourne, VIC 3053, Australia.
- The Department of Electrical and Electronic Engineering, The University of Melbourne, Melbourne, VIC 3010, Australia.
- Illawarra Health and Medical Research Institute, Centre for Molecular and Medical Bioscience, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Efstratios Skafidas
- Centre for Neural Engineering, The University of Melbourne, Melbourne, VIC 3053, Australia.
- The Department of Electrical and Electronic Engineering, The University of Melbourne, Melbourne, VIC 3010, Australia.
- ARC Centre of Excellence for Integrative Brain Function, The University of Melbourne, Melbourne, VIC 3010, Australia.
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Neal A, Kwan P, O'Brien TJ, Buckland ME, Gonzales M, Morokoff A. IDH1 and IDH2 mutations in postoperative diffuse glioma-associated epilepsy. Epilepsy Behav 2018; 78:30-36. [PMID: 29172136 DOI: 10.1016/j.yebeh.2017.10.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/10/2017] [Accepted: 10/22/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Isocitrate dehydrogenase 1 and 2 mutations (IDH1/2) have an established association with preoperative seizures in patients with grades II-IV diffuse gliomas. Here, we examined if IDH1/2 mutations are a biomarker of postoperative seizure frequency. METHODS This was a retrospective study. Patients with grades II-IV supratentorial diffuse glioma, immunohistochemistry results of IDH1-R132H, and antiepileptic drug (AED) prescribed postoperatively were included. The primary outcome was seizure frequency over the first 12 postoperative months: Group A - postoperative seizure freedom; Group B - 1-11 seizures over 12months (less than one seizure per month); and Group C - greater than one seizure per month. Rates of IDH1-R132H mutation were compared between the three outcome groups in univariate and multivariate analyses. Subgroup analysis was performed in 64 patients with IDH1/2 pyrosequencing data. RESULTS One hundred cases were included in the analysis: 30.0% grade II, 20.0% grade III, and 50.0% grade IV gliomas. Group B patients averaged 1 seizure over 12months, compared with 2 seizures per month in Group C. Isocitrate dehydrogense 1-R132H mutation was present in 29.3% (17/58) of Group A, 18.2% (14/22) of Group B, and 70.0% (14/20) of Group C patients (p=0.001). On multivariate analysis, after controlling for preoperative seizure, grade, and temporal tumor location, IDH1-R132H was associated with Group C when compared with both Group A (RR 4.75, p=0.032) and Group B (RR 9.70, p=0.012). In the subgroup with IDH1/2 molecular data, an IDH1/2 mutation was present in 64.7% (22/34) of Group A, 28.6% (4/14) of Group C, and 87.5% (14/16) of Group C patients (p=0.004). SIGNIFICANCE In patients with supratentorial diffuse gliomas, IDH1-R132H mutations are associated with a more severe phenotype of postoperative epilepsy. These findings support further research into IDH mutations, and the potential for an antiepileptic therapeutic effect of their inhibitors, in patients with glioma-associated epilepsy.
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Affiliation(s)
- Andrew Neal
- Department of Medicine, The University of Melbourne, Parkville, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Australia.
| | - Patrick Kwan
- Department of Medicine, The University of Melbourne, Parkville, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
| | - Terence John O'Brien
- Department of Medicine, The University of Melbourne, Parkville, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
| | - Michael E Buckland
- Department of Neuropathology, Royal Prince Alfred Hospital, NSW, Australia; Brain & Mind Centre, University of Sydney, NSW, Australia
| | - Michael Gonzales
- Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Australia
| | - Andrew Morokoff
- Department of Surgery, The University of Melbourne, Parkville, Australia; Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Australia
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Aripiprazole and Riluzole treatment alters behavior and neurometabolites in young ADHD rats: a longitudinal 1H-NMR spectroscopy study at 11.7T. Transl Psychiatry 2017; 7:e1189. [PMID: 28763063 PMCID: PMC5611734 DOI: 10.1038/tp.2017.167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/20/2017] [Accepted: 05/30/2017] [Indexed: 01/13/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD), Tourette syndrome (TS) as well as obsessive compulsive disorder (OCD) are co-occurring neurodevelopmental diseases that share alterations of frontocortical neurometabolites. In this longitudinal study we investigated the behavioral and neurochemical effects of aripiprazole and riluzole treatment in juvenile spontaneously hypertensive rats (SHR), a model for ADHD. For neurochemical analysis we employed in vivo magnetic resonance spectroscopy (MRS). Spectra from voxels located at the central striatum and prefrontal cortex were acquired postnatally from day 35 to 50. In the SHR strain only, treatments reduced repetitive grooming and climbing behavior. The absolute quantification of cerebral metabolites in vivo using localized 1H-MRS at 11.7T showed significant alterations in SHR rats compared to controls (including glutamine, aspartate and total NAA). In addition, drug treatment reduced the majority of the detected metabolites (glutamate and glutamine) in the SHR brain. Our results indicate that the drug treatments might influence the hypothesized 'hyperactive' state of the cortico-striatal-thalamo-cortical circuitries of the SHR strain. Furthermore, we could show that behavioral changes correlate with brain region-specific alterations in neurometabolite levels in vivo. These findings should serve as reference for animal studies and for the analysis of neurometabolites in selected human brain regions to further define neurochemical alterations in neuropsychiatric diseases.
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Neal A, Yuen T, Bjorksten AR, Kwan P, O'Brien TJ, Morokoff A. Peritumoural glutamate correlates with post-operative seizures in supratentorial gliomas. J Neurooncol 2016; 129:259-67. [PMID: 27311724 DOI: 10.1007/s11060-016-2169-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022]
Abstract
To examine the impact of glutamate on post-operative seizures and survival in a cohort of patients with grade II to IV supratentorial glioma. A retrospective analysis was performed on 216 patients who underwent surgery for supratentorial gliomas. Primary explanatory variables were peritumoural and/or tumoural glutamate concentrations, glutamate transporter expression (EAAT2 and SXC). Univariate and multivariate survival analysis was performed with primary outcomes of time to first post-operative seizure and overall survival. Subgroup analysis was performed in patients with de novo glioblastomas who received adjuvant chemoradiotherapy. 47 (21.8 %), 34 (15.8 %) and 135 (62.5 %) WHO grade II, III and IV gliomas respectively were followed for a median of 15.8 months. Following multivariate analysis, there was a non-significant association between higher peritumoural glutamate concentrations and time to first post-operative seizure (HR 2.07, CI 0.98-4.37, p = 0.06). In subgroup analysis of 81 glioblastoma patients who received adjunct chemoradiotherapy, peritumoural glutamate concentration was significantly associated with time to first post-operative seizure (HR 3.10, CI 1.20-7.97, p = 0.02). In both the overall cohort and subgroup analysis no glutamate cycle biomarkers were predictive of overall survival. Increased concentrations of peritumoural glutamate were significantly associated with shorter periods of post-operative seizure freedom in patients with de novo glioblastomas treated with adjuvant chemoradiotherapy. No glutamate cycle biomarkers were predictive of overall survival. These results suggest that therapies targeting glutamate may be beneficial in tumour associated epilepsy.
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Affiliation(s)
- Andrew Neal
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia.
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia.
| | - Tanya Yuen
- Department of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
| | - Andrew R Bjorksten
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, 3050, Parkville, VIC, Australia
| | - Patrick Kwan
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
| | - Terence J O'Brien
- Department of Neurology, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
| | - Andrew Morokoff
- Department of Neurosurgery, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, 3050, Parkville, VIC, Australia
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Abstract
By histological, morphological criteria, and malignancy, brain tumors are classified by WHO into grades I (most benign) to IV (highly malignant), and gliomas are the most frequently occurring class throughout the grades. Similar to peripheral tumors, the growth of glia-derived tumor cells largely depends on glutamine (Gln), which is vividly taken up by the cells, using mostly ASCT2 and SN1 as Gln carriers. Tumor growth-promoting effects of Gln are associated with its phosphate-activated glutaminase (GA) (specifically KGA)-mediated degradation to glutamate (Glu) and/or with its entry to the energy- and intermediate metabolite-generating pathways related to the tricarboxylic acid cycle. However, a subclass of liver-type GA are absent in glioma cells, a circumstance which allows phenotype manipulations upon their transfection to the cells. Gln-derived Glu plays a major role in promoting tumor proliferation and invasion. Glu is relatively inefficiently recycled to Gln and readily leaves the cells by exchange with the extracellular pool of the glutathione (GSH) precursor Cys mediated by xc- transporter. This results in (a) cell invasion-fostering interaction of Glu with ionotropic Glu receptors in the surrounding tissue, (b) intracellular accumulation of GSH which increases tumor resistance to radio- and chemotherapy.
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Affiliation(s)
- Monika Szeliga
- Department of Neurotoxicology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Pawińskiego St. 5, 02-106, Warsaw, Poland.
| | - Jan Albrecht
- Department of Neurotoxicology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Pawińskiego St. 5, 02-106, Warsaw, Poland
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