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Carstam L, Vecchio TG, Lyczak M, Åberg H, Jakola AS, Jennische E, Lange S, Gatzinsky K. Antisecretory factor for treatment of peritumoral edema in glioblastoma patients. Acta Neurochir (Wien) 2025; 167:64. [PMID: 40056235 PMCID: PMC11890341 DOI: 10.1007/s00701-025-06481-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Accepted: 02/26/2025] [Indexed: 03/10/2025]
Abstract
PURPOSE Glioblastoma (GBM) is an aggressive brain tumor often accompanied by a vasogenic peritumoral edema, which contributes to symptoms both at diagnosis and during later stages of the disease. Previous studies have suggested effectiveness of the endogenous protein, Antisecretory Factor (AF), in reducing the intracranial pressure in cytotoxic brain edema after trauma. Interestingly, AF also seems to carry antineoplastic effects in experimental GBM models. This study investigated whether AF reduces peritumoral edema in GBM patients. As a secondary aim, we assessed potential effects on tumor progression by AF. METHODS Fifteen newly diagnosed GBM patients were treated for 7 days preoperatively with AF in addition to standard of care (SOC) treatment with corticosteroids. The change in edema volume was assessed volumetrically using T2/FLAIR weighted MRI and compared to a control group of 10 GBM patients receiving SOC only. RESULTS At baseline the mean tumor volume for the entire cohort was 35.7 cm3 with a mean edema of 62.2 cm3. There was no significant difference in edema volume change between the AF treated patients, who demonstrated a mean edema reduction of 7.1cm3 (95%CI -5.4-19.6), and the controls, 11.3cm3 (95%CI -0.8-23.5), p = 0.61. No difference was observed in tumor volume change between the two groups, p = 0.79. No adverse treatment effects were noted. CONCLUSION Treatment with AF in addition to SOC does not seem to reduce the peritumoral edema in GBM patients. The treatment was well tolerated. The lack of edema-reducing effect may be related to the different pathophysiological properties of vasogenic and cytotoxic edema.
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Affiliation(s)
- Louise Carstam
- Department of Neurosurgery, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden.
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, Sweden.
| | - Tomás Gómez Vecchio
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, Sweden
| | - Monika Lyczak
- Department of Neurology, Skaraborg Hospital, Skövde, Sweden
| | - Hanna Åberg
- Department of Neurology, Northern Älvsborg County Hospital, Trollhättan, Sweden
| | - Asgeir S Jakola
- Department of Neurosurgery, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, Sweden
| | - Eva Jennische
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, Sweden
| | - Stefan Lange
- Department of Clinical Microbiology, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, 405 30, Gothenburg, Sweden
| | - Kliment Gatzinsky
- Department of Neurosurgery, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, Sweden
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Vahrmeijer N, Kriel J, Harrington BM, van Staden ADP, Vlok AJ, Engelbrecht L, Du Toit A, Loos B. Antisecretory Factor 16 (AF16): A Promising Avenue for the Treatment of Traumatic Brain Injury-An In Vitro Model Approach. J Mol Neurosci 2024; 74:106. [PMID: 39505761 PMCID: PMC11541381 DOI: 10.1007/s12031-024-02268-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 09/16/2024] [Indexed: 11/08/2024]
Abstract
Traumatic brain injury (TBI) is caused by an external mechanical force to the head, resulting in abnormal brain functioning and clinical manifestations. Antisecretory factor (AF16) is a potential therapeutic agent for TBI treatment due to its ability to inhibit fluid secretion and decrease inflammation, intracranial pressure, and interstitial fluid build-up, key hallmarks presented in TBI. Here, we investigated the effect of AF16 in an in vitro model of neuronal injury, as well as its impact on key components of the autophagy pathway and mitochondrial dynamics. N2Awt cells were treated with AF16, injured using a scratch assay, and analysed using confocal microscopy, correlative light and electron microscopy (CLEM), flow cytometry, and western blotting. Our results reveal that AF16 enhances autophagy activity, regulates mitochondrial dynamics, and provides protection as early as 6 h post-injury. Fluorescently labelled AF16 was observed to localise to lysosomes and the autophagy compartment, suggesting a role for autophagy and mitochondrial quality control in conferring AF16-associated neuronal protection. This study concludes that AF16 has potential as a therapeutic agent for TBI treatment through is regulation of autophagy and mitochondrial dynamics.
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Affiliation(s)
- Nicola Vahrmeijer
- Department of Physiological Sciences, Stellenbosch University, Merriman Avenue, Mike de Vries Building, Stellenbosch, 7600, South Africa
| | - Jurgen Kriel
- Central Analytical Facilities, Stellenbosch University, Tygerberg Medical Campus, Clinical Building, 7Th Floor, Room 7063, Stellenbosch, South Africa
| | - Bradley M Harrington
- Department of Neurosurgery, Tygerberg University Hospital, Tygerberg, Cape Town, South Africa
| | - Anton Du Preez van Staden
- Division Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adriaan Johannes Vlok
- Department of Neurosurgery, Tygerberg University Hospital, Tygerberg, Cape Town, South Africa
| | - Lize Engelbrecht
- Central Analytical Facilities, Stellenbosch University, Merriman Avenue, Mike de Vries Building, Stellenbosch, 7600, South Africa
| | - Andre Du Toit
- Department of Physiological Sciences, Stellenbosch University, Merriman Avenue, Mike de Vries Building, Stellenbosch, 7600, South Africa
| | - Ben Loos
- Department of Physiological Sciences, Stellenbosch University, Merriman Avenue, Mike de Vries Building, Stellenbosch, 7600, South Africa.
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Kopecky J, Pérez JE, Eriksson H, Visse E, Siesjö P, Darabi A. Intratumoral administration of the antisecretory peptide AF16 cures murine gliomas and modulates macrophage functions. Sci Rep 2022; 12:4609. [PMID: 35301393 PMCID: PMC8930985 DOI: 10.1038/s41598-022-08618-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/09/2022] [Indexed: 11/09/2022] Open
Abstract
Glioblastoma has remained the deadliest primary brain tumor while its current therapy offers only modest survival prolongation. Immunotherapy has failed to record notable benefits in routine glioblastoma treatment. Conventionally, immunotherapy relies on T cells as tumor-killing agents; however, T cells are outnumbered by macrophages in glioblastoma microenvironment. In this study, we explore the effect of AF16, a peptide from the endogenous antisecretory factor protein, on the survival of glioma-bearing mice, the tumor size, and characteristics of the tumor microenvironment with specific focus on macrophages. We elucidate the effect of AF16 on the inflammation-related secretome of human and murine macrophages, as well as human glioblastoma cells. In our results, AF16 alone and in combination with temozolomide leads to cure in immunocompetent mice with orthotopic GL261 gliomas, as well as prolonged survival in immunocompromised mice. We recorded decreased tumor size and changes in infiltration of macrophages and T cells in the murine glioma microenvironment. Human and murine macrophages increased expression of proinflammatory markers in response to AF16 treatment and the same effect was seen in human primary glioblastoma cells. In summary, we present AF16 as an immunomodulatory factor stimulating pro-inflammatory macrophages with a potential to be implemented in glioblastoma treatment protocols.
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Affiliation(s)
- Jan Kopecky
- Glioma Immunotherapy Group, Division of Neurosurgery, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Barngatan 4, 221 85, Lund, Sweden.
| | - Julio Enríquez Pérez
- Glioma Immunotherapy Group, Division of Neurosurgery, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Barngatan 4, 221 85, Lund, Sweden
| | - Håkan Eriksson
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Edward Visse
- Glioma Immunotherapy Group, Division of Neurosurgery, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Barngatan 4, 221 85, Lund, Sweden
| | - Peter Siesjö
- Glioma Immunotherapy Group, Division of Neurosurgery, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Barngatan 4, 221 85, Lund, Sweden.,Section of Neurosurgery, Department of Clinical Sciences Lund, Skåne University Hospital, Lund, Sweden
| | - Anna Darabi
- Glioma Immunotherapy Group, Division of Neurosurgery, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Barngatan 4, 221 85, Lund, Sweden
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Upregulation of the endogenous peptide antisecretory factor enhances hippocampal long-term potentiation and promotes learning in wistar rats. Neuroscience 2022; 490:120-130. [PMID: 35276306 DOI: 10.1016/j.neuroscience.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/01/2022] [Accepted: 03/03/2022] [Indexed: 01/18/2023]
Abstract
Antisecretory Factor (AF) is an endogenous peptide known for its powerful antisecretory and anti-inflammatory properties. We have previously shown that AF also acts as a neuromodulator of GABAergic synaptic transmission in rat hippocampus in a way that results in disinhibition of CA1 pyramidal neurons. Disinhibition is expected to facilitate the induction of long-term potentiation (LTP), and LTP is known to play a crucial role in learning and memory acquisition. In the present study we investigated the effect of AF on LTP in CA3-CA1 synapses in rat hippocampus. In addition, endogenous AF plasma activity was upregulated by feeding the rats with specially processed cereals (SPC) and spatial learning and memory was studied in the Morris Water Maze (MWM). We found that LTP was significantly enhanced in the presence of AF, both when added exogenously in vitro as well as when upregulated endogenously by SPC-feeding. In the presence of the GABAA-receptor antagonist picrotoxin (PTX) there was however no significant enhancement of LTP. Moreover, rats fed with SPC demonstrated enhanced spatial learning and short-term memory, compared with control animals. These results show that the disinhibition of GABAergic transmission in the hippocampus by the endogenous peptide AF enhances LTP as well as spatial learning and memory.
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Gatzinsky K, Johansson E, Jennische E, Oshalim M, Lange S. Elevated intracranial pressure after head trauma can be suppressed by antisecretory factor-a pilot study. Acta Neurochir (Wien) 2020; 162:1629-1637. [PMID: 32445122 PMCID: PMC7295841 DOI: 10.1007/s00701-020-04407-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/10/2020] [Indexed: 01/15/2023]
Abstract
Background Control of intracranial pressure (ICP) is a key element in neurointensive care for directing treatment decisions in patients with severe traumatic brain injury (TBI). The anti-inflammatory protein antisecretory factor (AF) has been demonstrated to reduce experimentally induced high ICP in animal models. This report describes the first steps to investigate the uptake, safety, and influence of AF for reduction of elevated ICP in patients with TBI in a clinical setting. Method Four patients with severe TBI (Glasgow Coma Scale < 9) that required neurointensive care with ICP monitoring due to signs of refractory intracranial hypertension were investigated. One hundred milliliters of Salovum®, a commercially available egg yolk powder with high contents of AF peptides, was administrated either via nasogastric (patients 1 and 2) or rectal tube (patients 2, 3, and 4) every 8 h for 2 to 3 days as a supplement to the conventional neurointensive care. ICP was registered continuously. Plasma levels of AF were measured by enzyme-linked immunosorbent assay (ELISA) to confirm that Salovum® was absorbed appropriately into the bloodstream. Results In the first two patients, we observed that when delivered by the nasogastric route, there was an accumulation of the Salovum® solution in the stomach with difficulties to control ICP due to impaired gastric emptying. Therefore, we tested to administer Salovum® rectally. In the third and fourth patients, who both showed radiological signs of extensive brain edema, ICP could be controlled during the course of rectal administration of Salovum®. The ICP reduction was statistically significant and was accompanied by an increase in blood levels of AF. No adverse events that could be attributed to AF treatment or the rectal approach for Salovum® administration were observed. Conclusions The outcomes suggest that AF can act as a suppressor of high ICP induced by traumatic brain edema. Use of AF may offer a new therapeutic option for targeting cerebral edema in clinical practice.
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Affiliation(s)
- Kliment Gatzinsky
- Department of Neurosurgery, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden.
| | - Ewa Johansson
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Jennische
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Merna Oshalim
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stefan Lange
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Zaman S, Aamir K, Hanson LÅ, Lange S. High doses of Antisecretory Factor stop diarrhea fast without recurrence for six weeks post treatment. Int J Infect Dis 2018; 71:48-52. [DOI: 10.1016/j.ijid.2018.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/18/2018] [Accepted: 03/25/2018] [Indexed: 11/30/2022] Open
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Antisecretory Factor Modulates GABA A Receptor Activity in Neurons. J Mol Neurosci 2018; 64:312-320. [PMID: 29308551 DOI: 10.1007/s12031-017-1024-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Abstract
The antisecretory factor is an endogenous protein found in all mammalian tissues investigated so far. It acts by counteracting intestinal hypersecretion and various forms of inflammation, but the detailed mechanism of antisecretory factor (AF) action is unknown. We tested neuronal GABAA receptors by means of AF-16, a potent AF peptide derived from amino acids 36-51 from the NH2 part of AF. Cultured rat cerebellar granule cells were used, and the effects on the GABA-mediated chloride currents were determined by whole-cell patch clamp. Both the neurotransmitter GABA and AF-16 were added by perfusion of the experimental system. A 3-min AF-16 preincubation was more efficacious than 30 s in significantly elevating the rapidly desensitizing GABA-activated chloride current. No effect was found on the tonic, slowly desensitizing current. The GABA-activated current increase by AF-16 demonstrated a low k of 41 pM with a maximal increase of 37% persisting for some minutes after AF washout, independent from GABA concentration. This indicates an effect on the maximal stimulation (E%Max) excluding an altered affinity between GABA and its receptor. An immunocytochemical fluorescence approach with anti γ2 subunit antibodies demonstrated an increased expression of GABAA receptors. Thus, both the electrophysiological and the immunofluorescence approach indicate an increased appearance of GABAA receptors on the neuronal membrane. The rationale of the experiments was to test the effect of AF on a defined neuronal population of GABAA receptors. The implications of the results on the impact of AF on the enteric nervous system or on brain function are discussed.
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Clausen F, Hansson HA, Raud J, Marklund N. Intranasal Administration of the Antisecretory Peptide AF-16 Reduces Edema and Improves Cognitive Function Following Diffuse Traumatic Brain Injury in the Rat. Front Neurol 2017; 8:39. [PMID: 28261150 PMCID: PMC5306199 DOI: 10.3389/fneur.2017.00039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/27/2017] [Indexed: 12/19/2022] Open
Abstract
A synthetic peptide with antisecretory activity, antisecretory factor (AF)-16, improves injury-related deficits in water and ion transport and decreases intracranial pressure after experimental cold lesion injury and encephalitis although its role in traumatic brain injury (TBI) is unknown. AF-16 or an inactive reference peptide was administrated intranasally 30 min following midline fluid percussion injury (mFPI; n = 52), a model of diffuse mild-moderate TBI in rats. Sham-injured (n = 14) or naïve (n = 24) animals were used as controls. The rats survived for either 48 h or 15 days post-injury. At 48 h, the animals were tested in the Morris water maze (MWM) for memory function and their brains analyzed for cerebral edema. Here, mFPI-induced brain edema compared to sham or naïve controls that was significantly reduced by AF-16 treatment (p < 0.05) although MWM performance was not altered. In the 15-day survival groups, the MWM learning and memory abilities as well as histological changes were analyzed. AF-16-treated brain-injured animals shortened both MWM latency and swim path in the learning trials (p < 0.05) and improved probe trial performance compared to brain-injured controls treated with the inactive reference peptide. A modest decrease by AF-16 on TBI-induced changes in hippocampal glial acidic fibrillary protein (GFAP) staining (p = 0.11) was observed. AF-16 treatment did not alter any other immunohistochemical analyses (degenerating neurons, beta-amyloid precursor protein (β-APP), and Olig2). In conclusion, intranasal AF-16-attenuated brain edema and enhanced visuospatial learning and memory following diffuse TBI in the rat. Intranasal administration early post-injury of a promising neuroprotective substance offers a novel treatment approach for TBI.
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Affiliation(s)
- Fredrik Clausen
- Unit for Neurosurgery, Department of Neuroscience, Uppsala University , Uppsala , Sweden
| | - Hans-Arne Hansson
- Institute of Biomedicine, University of Gothenburg , Göteborg , Sweden
| | - Johan Raud
- Lantmännen AS Faktor AB , Stockholm , Sweden
| | - Niklas Marklund
- Unit for Neurosurgery, Department of Neuroscience, Uppsala University , Uppsala , Sweden
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