A comparison of the response to hyperthermia of murine haemopoietic stem cells (CFU-S) and L1210 leukaemia cells: enhanced killing of leukaemic cells in presence of normal marrow cells

Heat shock proteins and Bcl-2 expression and function in relation to the differential hyperthermic sensitivity between leukemic and normal hematopoietic cells

A major problem in autologous stem cell transplantation is the occurrence of relapse by residual neoplastic cells from the graft. The selective toxicity of hyperthermia toward malignant hematopoietic progenitors compared with normal bone marrow cells has been utilized in purging protocols. The underlying mechanism for this selective toxicity has remained unclear. By using normal and leukemic cell line models, we searched for molecular mechanisms underlying this selective toxicity. We found that the differential heat sensitivity could not be explained by differences in the expression or inducibility of Hsp and also not by the overall chaperone capacity of the cells. Despite an apparent similarity in initial heat-induced damage, the leukemic cells underwent heat-induced apoptosis more readily than normal hematopoietic cells. The differences in apoptosis initiation were found at or upstream of cytochrome c release from the mitochondria. Sensitivity to staurosporine-induced apoptosis was similar in all cell lines tested, indicating that the apoptotic pathways were equally functional. The higher sensitivity to heat-induced apoptosis correlated with the level of Bcl-2 protein expression. Moreover, stable overexpression of Bcl-2 protected the most heat sensitive leukemic cells against heat-induced apoptosis. Our data indicate that leukemic cells have a specifically lower threshold for heat damage to initiate and execute apoptosis, which is due to an imbalance in the expression of the Bcl-2 family proteins in favor of the proapoptotic family members.

The development and magnitude of thermotolerance during chronic hyperthermia in murine bone marrow granulocyte-macrophage progenitors: I

Murine bone marrow granulocyte-macrophage progenitors (CFU-GM) are capable of developing thermotolerance during exposure to temperatures < 42.5 degrees C. Bone marrow from the tibia and femora was heated to 40-42 degrees C (i.e. chronic hyperthermia), and challenged immediately with 15 min at 44 degrees C at regular intervals during treatment (step-up heating). CFU-GM were heated and cultured in McCoy's 5A medium + 15% FBS (fetal bovine serum) and lung-conditioned medium (source of colony stimulating factor) in semisolid agar. The kinetics of thermotolerance development and decay, and the magnitude of the thermotolerance during chronic heating with temperatures of 40-41.5 degrees C were similar. Survival increased rapidly to a maxima by approximately 120 min of hyperthermia (temperatures of 40-41.5 degrees C) and thereafter decreased with a slope similar to the controls. Normalization for cell killing by chronic hyperthermia that occurred during "step-up' heating permitted analysis of thermotolerance in the surviving cells. The surviving fraction after 15 min at 44 degrees C, during incubation at 40, 41 and 41.5 degrees C increased from 0.13 to maxima of 0.56 +/- 0.04, 0.71 +/- 0.03 and 0.82 +/- 0.03 respectively, by 150 min and did not decrease for up to 480 min during chronic hyperthermia. The surviving fraction after 15 min at 44 degrees C during incubation at 42 degrees C increased more slowly than during incubations at 40-41.5 degrees C. The survival of thermotolerant cells after exposure to 15 min at 44 degrees C during 42 degrees C chronic hyperthermia was maximal at 0.87 +/- 0.08 by 120 min and then decreased after approximately 150 min of exposure to 42 degrees C. The thermotolerance ratios (TTR's) were 4.0, 5.4, 6.7 and 6.9 for temperatures of 40, 41, 41.5 and 42 degrees C respectively. The results suggest that chronic hyperthermia temperatures (i.e. 40-42 degrees C) induce rapid thermotolerance development in CFU-GM during the thermal exposure and protect this normal marrow progenitor during whole body hyperthermia or ex vivo purging of leukaemic cells.

Heat shock proteins, thermotolerance, and their relevance to clinical hyperthermia

Mammalian cells, when exposed to a non-lethal heat shock, have the ability to acquire a transient resistance to subsequent exposures at elevated temperatures, a phenomenon termed thermotolerance. The mechanism(s) for the development of thermotolerance is not well understood, but earlier experimental evidence suggests that protein synthesis may play a role in its manifestation. On the molecular level, heat shock activates a specific set of genes, so-called heat shock genes, and results in the preferential synthesis of heat shock proteins. The heat shock response, specifically the regulation, expression and functions of heat shock proteins, has been extensively studied in the past decades and has attracted the attention of a wide spectrum of investigators ranging from molecular and cell biologists to radiation and hyperthermia oncologists. There is much data supporting the hypothesis that heat shock proteins play important roles in modulating cellular responses to heat shock, and are involved in the development of thermotolerance. This review summarizes some current knowledge on thermotolerance and the functions of heat shock proteins, especially hsp70. The relationship between thermotolerance development and hsp70 synthesis in tumours and in normal tissues is examined. The possibility of using hsp70 as an indicator for thermotolerance is discussed.

Intrinsic thermal response, thermotolerance development and stepdown heating in murine bone marrow progenitor cells

Thermal response, thermotolerance development and stepdown heating (SDH) in the murine bone marrow granulocyte-macrophage (CFU-GM) progenitors were determined in vitro. Marrow was removed from femora and tibia, heated in McCoy's 5A medium plus 15% FBS and cultured in soft agar in the presence of three different sources of colony stimulating factor. D0's (+/- SE) for survival curves of CFU-GM heated in vitro were 147 +/- 13, 71 +/- 9, 37 +/- 2, 19 +/- 0.7, 11 +/- 1, and 4.3 +/- 0.3 min, for temperatures of 41.8, 42, 42.3, 42.5, 43 and 44 degrees C, respectively. Arrhenius analysis showed inactivation enthalpies of 812 +/- 9 KJoules/mole (193 +/- 2 Kcal/mole) above, and 2142 +/- 157 KJoules/mole (509 +/- 37 Kcal/mole) below, an inflection at 42.5 degrees C. Thermotolerance development was evident during prolonged hyperthermia exposure at temperatures below 42.5 degrees C (chronic hyperthermia) as a change in the slope of the survival curves after approximately 110 min of heating. Thermotolerance development at 37 degrees C after exposure to temperatures of 43 degrees C or greater (acute hyperthermia) was assessed by fractionated heat treatments consisting of an initial heat treatment (15 min at 44 degrees C) followed by incubation at 37 degrees C and challenge with 15 min or 25 min at 44 degrees C. Maximum thermotolerance occurred after 210 and 330 min at 37 degrees C, respectively. The half-time for maximum thermotolerance development was 36 min. Depending on the amount of heat damage and the maximum amount of thermotolerance development, the decay of thermotolerance was complete after approximately 48-72 h at 37 degrees C. An exposure of 10 min at 44 degrees C before incubation at 40 or 41 degrees C (stepdown heating) reduced the slope of the 40 or 41 degrees C survival curves by inhibiting thermotolerance development that would have otherwise occurred. D0's were 100 +/- 19 and 45 +/- 5 min for 40 and 41 degrees C incubation preceded by 10 min at 44 degrees C, respectively. These studies indicate that whole-body or regional hyperthermia protocols designed either to treat solid tumours or to purge leukemic stem cells from marrow ex vivo should avoid inadvertent temperature elevations to large volumes of marrow. Although, marrow progenitors are capable of thermotolerance development during exposure to temperatures up to 42.3 degrees C, results suggest that conditions of stepdown heating may prevent thermotolerance development.

Thermal sensitivity of the murine CFU-S-12: role of environmental cells

The hyperthermic sensitivity of the CFU-S-12 in bone marrow from normal and anaemic mice was determined. The terminal slope of the survival curves, demonstrated by the T0 values, does not significantly differ in the resting and active cycling stem cells. In the active cycling stem cells the initial shoulder region was less dominant compared with the resting stem cells. The difference in heat sensitivity between resting and active proliferating CFU-S-12 might be explained by a difference in the accumulation of damage before lethality becomes manifest. The difference in heat sensitivity appears to be independent of the environmental accessory cells, demonstrated by a similar hyperthermic effect of the purified stem cells from bone marrow and spleen and the stem cells in the total cell suspensions. Therefore the heat sensitivity of the haemopoietic stem cell is not mediated by a release of injurious substances from environmental heat-damaged cells. The heat treatment does not result in a selection of macroscopic detectable colonies 12 days after inoculation, as is demonstrated by the same morphology of the spleen colonies from the stem cells before and after the hyperthermic treatment.

Effect of a hyperthermic treatment on the pluripotent haemopoietic stem cell in normal and anaemic mice

Up to now, the hyperthermic sensitivity of pluripotent haemopoietic stem cells is unknown, and the few existing data from reports in the literature are conflicting. There are two main drawbacks in the set-up of those studies: (1) only CFU-S day 9 results were presented, whereas it is questionable if this assay gives a true reflection of the pluripotent stem cell, and (2) no attention has been paid to heat effects on the seeding efficiency, i.e. the amount of stem cells which will lodge in the spleen. The present study focused on the procedural differences and compared the results of a hyperthermic treatment (60 min, 42 degrees C) on the stem cells, assayed with the CFU-S day 9 and the CFU-S day 12 method, using the following three stem cell suspensions, all differing in their proliferative activity: bone marrow from normal mice and bone marrow and spleen cells from anaemic mice. Furthermore, we investigated the seeding efficiency before and after heat treatment. Resting stem cells, assayed with the CFU-S day 12 method, turned out to be resistant to hyperthermia as compared with the active cycling stem cells, while with the CFU-S day 9 assay the stem showed the same thermosensitivity in the two bone marrow suspensions. The active cycling stem cells do not significantly differ in thermosensitivity, in CFU-S day 9 and day 12 assays, although there is a difference between bone marrow and spleen. Hyperthermia appears to influence the seeding efficiency for spleen CFU-S; an increase of 1.73 was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Heat sensitivity, thermotolerance and protein synthesis of granulocyte and macrophage progenitors from mice and from long-term bone marrow cultures

Ex-vivo purging of leukaemic cells by single or fractionated heating during bone marrow transplantation for acute myeloid or lymphoblastic leukaemias may be possible since many leukaemic cells may be more sensitive to killing by heat than normal bone marrow colony-forming unit-granulocyte and macrophage (CFU-GM). In these studies we have compared heat response, thermotolerance response and heat shock protein (HSP) synthesis of bone marrow progenitors from intact mice or bone marrow obtained from 37 degrees C or 33 degrees C long-term bone marrow cultures (LTBMCs). Such studies were done to examine whether CFU-GM responses to heat are influenced by in vitro growth conditions. In terms of heat response CFU-GM progenitors from LTBMCs showed increased heat sensitivity when compared to CFU-GM from mice, with CFU-GM from 33 degrees C cultures being more heat-sensitive than those from 37 degrees C cultures. The kinetics of thermotolerance development and decay in CFU-GM were similar from all three systems. Thermotolerance was maximum at 3-9 h, began to decay by 24 h and was absent by 48 h from cells obtained from mice and LTBMCs grown at 37 degrees C. However, CFU-GM from 33 degrees C LTBMCs showed a delay in decay of thermotolerance. The kinetics of the development and decay of thermotolerance remained as above and was independent of incubation conditions whether bone marrow was left in situ or incubated in vitro in medium containing various colony-stimulating factors (CSF) or medium containing no CSF. The synthesis of HSPs was measured by one- and two-dimensional gel electrophoresis. Synthesis of HSP-70 kd was detected following a triggering dose of heat at 0-3 h for bone marrow heated in vivo and 0-6 h for bone marrow from LTBMCs. These studies indicate that CFU-GM heat and thermotolerance response was influenced by the temperature at which the cultures were maintained but not by other differences present in their microenvironment.

Survival and characteristics of murine leukaemic and normal stem cells after hyperthermia: a murine model for human bone marrow purging

The effect of hyperthermia in vitro on the survival and leukaemogenic effectiveness of WEHI 3-B cells and on the survival and transplantation efficiency of bone marrow cells was compared in a murine model system. Normal murine clonogenic haemopoietic cells (day 9 CFU-S and CFU-GM) proved to be significantly less sensitive to 42.5 degrees C hyperthermia (Do values: 54.3 and 41.1 min, respectively) than leukaemic clonogenic cells (CFU-L) derived from suspension culture or from bone marrow of leukaemic mice (Do: 17.8 min). Exposure for 120 min to 42.5 degrees C reduced the surviving fraction of CFU-L to 0.002 and that of CFU-S to 0.2. If comparable graft sizes were transplanted from normal or heat exposed bone marrow, 60-day survival of supralethally irradiated mice was similar. Surviving WEHI 3-B cells were capable of inducing leukaemia in vivo. The two log difference in the surviving fraction of CFU-L and CFU-S after 120 min exposure to 42.5 degrees C suggests that hyperthermia ex vivo may be a suitable purging method for autologous bone marrow transplantation.

Influence of limb restraint on the thermal response of bone marrow CFU-GM heated in situ

The method used to restrain anaesthetized (sodium pentobarbital) mice for in situ heating of tibial marrow affects the survival response of CFU-GM. Three methods of limb restraint, in addition to ischaemia induced by tourniquet, were examined for their relative effect on the thermal response of CFU-GM. The three methods of restraint were to secure only the toes with suture material to a submersion post in the water bath, to tape the foot, or to tape the leg. Temperatures in the lumen of the tibia were measured with a 100 micron (tip diameter) microthermocouple during representative experimental conditions. After heating in situ, bone marrow was extruded and CFU-GM cultured in standard soft agar conditions in lung-conditioned medium. The most restrictive restraining method, i.e. taping the leg, produced the greatest thermal response among the three restraining methods examined. The D0 (+/- 95% CI) of the 42 degrees C survival curve for CFU-GM was 22 +/- 4, 46 +/- 8, or 94 +/- 53 min for restraint of leg, foot, or toes, respectively. Survival reached a plateau by 100 min of heating indicative of the development of thermotolerance. The D0 of the 44 degrees C survival curve was 3 +/- 1, 6 +/- 2 and 16 +/- 6 min for restraint of leg, foot, or toes respectively. Ischaemia produced the most pronounced effect on the thermal response of tibial CFU-GM with D0 values of 2 +/- 1 or 3.6 +/- 1.5 min after exposure to 44 degrees C or 42 degrees C, respectively. The method of limb restraint affects the thermal sensitivity of CFU-GM most probably by blood flow obstruction and resultant pH decrease. Thus, precautions must be taken to ensure that limb restriction does not introduce artifacts in the hyperthermia response of normal tissues or tumours during heating in situ.

Enhancement of murine bone marrow ablation by combining whole body hyperthermia with total body irradiation and cyclophosphamide

Bone marrow ablation using combined whole body hyperthermia (WBH), total body irradiation (TBI), and cyclophosphamide (Cy) was investigated in C3H f/Sed mice to demonstrate cytotoxic synergism between the three modalities. TBI was given on day 0. WBH treatment was for 1 hr at 41.8 degrees C, given in daily sessions for 1, 2 or 3 modalities. TBI was given on day 0. WBH treatment was for 1 hr at 41.8 degrees C, given in daily sessions for 1, 2 or 3 consecutive days following TBI. Total cyclophosphamide doses were 160 and 240 mg/kg given in 2 daily injections on days 1 and 2 following TBI. Polymorphonuclear leukocyte and lymphocyte numbers were determined by differential cell counts. The total peripheral blood cell counts were also determined. WBH alone, given in daily sessions for 3 days, did not reduce the total peripheral blood cell counts. However, when WBH was added to TBI (6.3 Gy) peripheral blood cellularity was reduced on day 2, but no significant heat/radiosensitization was evident after day 2. WBH (3 daily sessions) significantly reduced the peripheral blood cellularity and resulted in bone marrow ablation when it was combined with TBI and Cy. CY (160-240 mg/kg) combined with TBI (5.4 Gy) resulted in bone marrow ablation and subsequent death in 14-22% of mice treated; 60-100% of mice died from bone marrow ablation when WBH was added to TBI (5.4 Gy) and Cy (160-240 mg/kg). Femoral and vertebral tissue sections showed total loss of progenitor cells when WBH, TBI (5.4 Gy), and Cy (240 mg/kg) were combined whereas lessor treatment was associated with histologically verified reconstitution of progenitor cells inside the marrow cavities. These studies indicate that bone marrow ablation can be achieved when using WBH in combination with lower doses of TBI and Cy.

Differential sensitivity to hyperthermia of mouse normal haemopoietic stem cells related to proliferation activity and organ source

Thermosensitivity of haemopoietic stem cells was studied in relation to the organ source and the proliferative state of the cells. Heat treatment was carried out at 41, 42, 43, 44 and 45 degrees C until about 1 per cent survival was reached. Treatments at 42 degrees C and below appear to be critical in revealing thermosensitivity differences between haemopoietic stem cells, characterized by the time T(o) at a given temperature to induce a lethal event. At these temperatures, foetal liver CFU-S (about 35 per cent in S phase) were more thermosensitive than steady-state bone marrow and spleen CFU-S (less than 10 per cent in S). We consider that these thermosensitivity differences cannot be attributed exclusively to differences in proliferation rates of the CFU-S, since exponentially-proliferating marrow CFU-S (48 per cent in S) does not significantly differ in sensitivity compared with steady-state CFU-S, while regenerating spleen CFU-S does (34 per cent in S). An Arrhenius analysis of heat survival curves of the different CFU-S allowed us to estimate only one activation energy (Ea) in the inactivation process of foetal liver and regenerating spleen CFU-S, and two Ea in the case of steady-state marrow and spleen CFU-S and regenerating marrow CFU-S.

Normal cells and malignant cells transfected with the HRas oncogene have the same heat sensitivity in culture

Mouse embryo cells (C3H 10T1/2) were transfected with a plasmid (pAL8A) containing the HRas oncogene and neomycin resistance gene. Five transfected cell clones were isolated and established as cell lines, and these showed neomycin resistance. Two of these cell lines expressed a normal morphology while three showed a transformed morphology. Four of the cell lines produced tumours in nude mice. Flow cytometry measurements showed that exponentially growing cell cultures of the five transfected cell lines had the same cell cycle distribution as the normal parental cell line. The sensitivity to hyperthermia of the five transfected cell lines was the same as that of the normal cell line for temperatures ranging from 42.0 to 45.0 degrees C. Thus in these studies we found no difference in the thermal sensitivity of normal and malignant cells transfected by the Hras oncogene.

Thermal sensitivity of haemopoietic and stromal progenitor cells in different proliferative states

Stromal progenitor cells (CFU-F) in normal mouse bone marrow were more sensitive to heat at 43 degrees C than haemopoietic progenitor cells (CFU-S and GM-CFC) by a factor of approximately 1.2. In marrow regenerating after 4.5 Gy X-rays, the changes in sensitivity were by less than a factor of 1.4 and the sensitivity of CFU-F changed slightly to become intermediate between that of CFU-S and GM-CFC. A comparison of sensitivities reported in the literature revealed an inexplicable large variation of up to a factor of 6 in the thermal sensitivities of CFU-S and GM-CFC.

Potentiation of differential hyperthermic sensitivity of AKR leukemia and normal bone marrow cells by lidocaine or thiopental

Previous work has utilized spleen colony formation to evaluate the fractional survival of AKR leukemia and normal bone marrow cells after in vitro heat exposure. An inherently greater sensitivity of neoplastic cells to thermal killing, as compared to normal syngeneic stem cells, has been established both at 41.8 degrees C and 42.5 degrees C. Normal bone marrow colony-forming units were assayed in lethally irradiated (750 cGy) mice. Leukemic colony-forming units were assayed in nonirradiated mice. Using this methodology, the authors demonstrated that the differential effect of hyperthermia on AKR murine leukemia and AKR bone marrow cells can be further enhanced by the addition of lidocaine or thiopental to incubation mixtures. These findings may have application to autologous bone marrow transplantation in humans.

The sensitivity to hyperthermia of human granulocyte/macrophage progenitor cells (CFU-GM) derived from blood or marrow of normal subjects and patients with chronic granulocytic leukaemia

To compare the relative heat sensitivities of human normal and neoplastic cells of the same tissue type, a study was carried out of the relative sensitivities to heat of granulocyte/macrophage progenitor cells (CFU-GM) derived from the peripheral blood and bone marrow of normal subjects and patients with chronic granulocytic leukaemia (CGL). Nucleated haemopoietic cells were incubated at temperatures in the range 41.5 degrees C to 44.0 degrees C for various periods before culture in agar. The results of these experiments showed that CFU-GM from normal blood were consistently less sensitive to damage by heat than normal marrow CFU-GM. There was no comparable difference in the relative heat sensitivities of CFU-GM from blood and marrow of patients with CGL and no significant difference between the heat sensitivities of CFU-GM derived from marrow from normal individuals and patients with CGL. The observed difference in heat sensitivity of CFU-GM from normal blood and marrow accords with other data suggesting that the two progenitor cell compartments are distinct: the blood CFU-GM may represent a more primitive population of committed progenitor cells. In CGL, CFU-GM in the blood may much more closely resemble those in the marrow. The data provide no support for the hypothesis that malignant cells differ intrinsically from their normal counterparts in respect of sensitivity to damage by hyperthermia.

Temporal response of murine bone marrow to local hyperthermia

Hemopoietic insufficiency resulting from single or multiple agents used in cancer therapy often becomes a dose limiting toxicity. Since hyperthermia is finding increased clinical application with whole body or extended field treatments for a variety of neoplastic diseases, we wished to examine its potential effects on normal bone marrow. One hind leg of anesthetized mice received up to one hour water bath heating to 41-44 degrees C. With temperatures of 42 degrees C or greater, there was a dose and heating time dependent initial depletion of both CFU-S and CFU-GM that was not appreciably affected by migration of stem cells to or from the heated field. CFU-S and CFU-GM returned to normal values by 2 to 3 weeks after 1 hour heating to 42 degrees C. However, at 43 degrees or 44 degrees C for 1 hour, CFU-GM only transiently returned to normal, falling to 55% and 33% of control respectively by 3 months. Total nucleated cell counts reflected a similar dose and time dependent depletion and repopulation. Finally, bone marrow differential counts from heated marrow suggested that equivalent repopulation along each differentiation pathway occurred during recovery after thermal injury. These data indicate that temperatures greater than 42 degrees C for one hour caused a long term delay in hemopoietic repopulation, which may contribute to a significant toxicity when hyperthermia is used in combination with chemotherapeutic drugs or local irradiation incorporating the same treatment field.

Sensitivity of normal mouse marrow and RIF-1 tumour to hyperthermia combined with cyclophosphamide or BCNU: a lack of therapeutic gain

The effect of simultaneous whole-body heat (45 min 41 degrees C) on cyclophosphamide (CTX) and BCNU toxicity to normal mouse marrow stem cells and to the RIF-1 tumour in C3H/He mice has been studied. Marrow stem-cell survival was assayed by the spleen-colony technique at both 2 and 24 h after treatment, and also by following peripheral WBC count during the weeks after treatment. Heat potentiation of CTX toxicity to marrow stem cells was similar at both times and 24 h after treatment heat was dose-modifying with a DMF of 2.0. The heat potentiation of BCNU toxicity to stem cells was much greater at 24 h than at 2 h, and at 24 h had a DMF of 2.1. Peripheral WBC counts supported the results from 24 h assay for both drugs. RIF-1 tumour response was assayed by clonogenic cell survival measured 24 h after treatment, and by growth delay. For clonogenic tumour-cell survival after CTX, heated and unheated curves were parallel at doses above 75 mg/kg, yielding DMFs varying between 1.9 and 1.4 according to dose. DMFs for BCNU were also dose-dependent, lying between 2.0 and 1.6, the RIF-1 tumour being much less sensitive to BCNU than to CTX. Growth-delay data agreed with clonogenic cell survival. Therapeutic ratios for the combination of heat with CTX or BCNU fell in the range 0.91--0.69, according to dose, i.e. no gain or even therapeutic loss under the conditions of this study.