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Glioma-Specific Diffusion Signature in Diffusion Kurtosis Imaging. J Clin Med 2021; 10:jcm10112325. [PMID: 34073442 PMCID: PMC8199055 DOI: 10.3390/jcm10112325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose: This study aimed to assess the relationship between mean kurtosis (MK) and mean diffusivity (MD) values from whole-brain diffusion kurtosis imaging (DKI) parametric maps in preoperative magnetic resonance (MR) images from 2016 World Health Organization Classification of Tumors of the Central Nervous System integrated glioma groups. Methods: Seventy-seven patients with histopathologically confirmed treatment-naïve glioma were retrospectively assessed between 1 August 2013 and 30 October 2017. The area on scatter plots with a specific combination of MK and MD values, not occurring in the healthy brain, was labeled, and the corresponding voxels were visualized on the fluid-attenuated inversion recovery (FLAIR) images. Reversely, the labeled voxels were compared to those of the manually segmented tumor volume, and the Dice similarity coefficient was used to investigate their spatial overlap. Results: A specific combination of MK and MD values in whole-brain DKI maps, visualized on a two-dimensional scatter plot, exclusively occurs in glioma tissue including the perifocal infiltrative zone and is absent in tissue of the normal brain or from other intracranial compartments. Conclusions: A unique diffusion signature with a specific combination of MK and MD values from whole-brain DKI can identify diffuse glioma without any previous segmentation. This feature might influence artificial intelligence algorithms for automatic tumor segmentation and provide new aspects of tumor heterogeneity.
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Wang X, Li F, Wang D, Zeng Q. Diffusion kurtosis imaging combined with molecular markers as a comprehensive approach to predict overall survival in patients with gliomas. Eur J Radiol 2020; 128:108985. [PMID: 32361603 DOI: 10.1016/j.ejrad.2020.108985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/06/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to explore the usefulness of diffusion kurtosis imaging (DKI) and molecular markers in predicting the prognosis of glioma patients. METHOD Fifty-one patients with gliomas were examined by conventional MRI and DKI at 3.0 T before operation. The mean kurtosis (MK), mean diffusivity (MD), axial kurtosis (AK), and radial kurtosis (RK) values of tumors were measured and normalized to the contralateral normal-appearing white matter. The molecular markers of gliomas, including isocitrate dehydrogenase-1 (IDH1), α thalassemia/mental retardation syndrome x-linked (ATRX) and O6-methylguanine-DNA methyltransferase (MGMT), were immunohistochemically stained on the resected tumor tissues. Statistical methods, including the chi-square test, independent sample t-test, receiver operating characteristic curve analysis, Kaplan-Meier curve analysis, and Cox regression analysis were performed. RESULTS The patients with lower MK, AK, RK, and higher MD values showed significantly better prognosis (P < 0.001). Survival time was better in glioma patients with IDH1 mutation (P < 0.01), ATRX loss of expression (P < 0.05), and MGMT negative expression (P < 0.05). However, among the groups of gliomas with IDH1 wild type, ATRX retention and those with MGMT positive expression, the patients with lower MK showed better outcome (P < 0.01). Cox multivariate regression analysis demonstrated that MK, RK values and ATRX retention could be used as independent prognostic risk factors, and high MK values had the highest risk for prognosis (HR = 65.288). CONCLUSIONS Molecular markers and DKI parameters, especially MK values, can be used to effectively evaluate the prognosis of glioma patients.
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Affiliation(s)
- Xuan Wang
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Fuyan Li
- Department of Radiology, Shandong Medical Imaging Research Institute, Jinan, China
| | - Dawei Wang
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Qingshi Zeng
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China.
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Hempel JM, Brendle C, Bender B, Bier G, Kraus MS, Skardelly M, Richter H, Eckert F, Schittenhelm J, Ernemann U, Klose U. Diffusion kurtosis imaging histogram parameter metrics predicting survival in integrated molecular subtypes of diffuse glioma: An observational cohort study. Eur J Radiol 2019; 112:144-152. [PMID: 30777204 DOI: 10.1016/j.ejrad.2019.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/22/2018] [Accepted: 01/14/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE The aim of the study was to assess the predictive value of preoperatively assessed diffusion kurtosis imaging (DKI) metrics as prognostic factors in the 2016 World Health Organization Classification of Tumors of the Central Nervous System integrated glioma groups. MATERIAL AND METHODS Seventy-seven patients with histopathologically confirmed treatment-naïve glioma were retrospectively assessed between 08/2013 and 10/2017 using mean kurtosis (MK) and mean diffusivity (MD) histogram parameters from DKI, overall and progression-free survival, and relevant prognostic molecular data (isocitrate dehydrogenase, [IDH]; alpha-thalassemia/mental retardation syndrome X-linked, [ATRX]; chromosome 1p/19q loss of heterozygosity). Receiver operating characteristic (ROC) analysis was performed on metric variables to determine the optimal cutoff-values. The Kaplan-Meier method was used to assess univariate survival data. A multivariate Cox proportional hazards model was performed on significant results from the univariate analysis. RESULTS There were significant differences in overall and progression-free survival between patient age (p = 0.001), resection statuses (p = 0.002), WHO glioma grades (p < 0.0001), and integrated molecular profiles (p < 0.0001). Survival was significantly better in patients with lower MK and higher MD values globally (p = 0.009), in gliomas without chromosome 1p/19q LOH (p < 0.0001), and those with retained ATRX expression (p = 0.008). CONCLUSIONS Patient age and MK from DKI from DKI are relevant factors for preoperatively predicting overall and progression-free survival. Regarding the molecular subgroups, they seem to be predictive in gliomas with ATRX retention, representing a feature of IDH wild-type gliomas.
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Affiliation(s)
- Johann-Martin Hempel
- Department of Neuroradiology, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany; Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany.
| | - Cornelia Brendle
- Department of Neuroradiology, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany; Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Benjamin Bender
- Department of Neuroradiology, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany; Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Georg Bier
- Department of Neuroradiology, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany; Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Mareen Sarah Kraus
- Department of Neuroradiology, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Marco Skardelly
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany; Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany; Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Hardy Richter
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
| | - Franziska Eckert
- Department of Radiation Oncology, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany; Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Jens Schittenhelm
- Institute of Neuropathology, Department of Pathology and Neuropathology, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany; Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Ulrike Ernemann
- Department of Neuroradiology, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany; Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Uwe Klose
- Department of Neuroradiology, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
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Rao AA, Mehta K, Gahoi N, Srivastava S. Application of 2D-DIGE and iTRAQ Workflows to Analyze CSF in Gliomas. Methods Mol Biol 2019; 2044:81-110. [PMID: 31432408 DOI: 10.1007/978-1-4939-9706-0_6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Proteomics is an indispensable tool for disease biomarker discovery. It is widely used for the analysis of biological fluids such as cerebrospinal fluid (CSF), blood, and saliva, which further aids in our understanding of disease incidence and progression. CSF is often the biospecimen of choice in case of intracranial tumors, as rapid changes in the tumor microenvironment can be easily assessed due to its close proximity to the brain. On the contrary studies comprising of serum or plasma samples do not truly reflect the underlying molecular alterations due to the presence of protective blood-brain barrier. We have described in here the detailed workflows for two advanced proteomics techniques, namely, 2D-DIGE (two-dimensional difference in-gel electrophoresis) and iTRAQ (isobaric tag for relative and absolute quantitation), for CSF analysis. Both of these techniques are very sensitive and widely used for quantitative proteomics analysis.
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Affiliation(s)
- Aishwarya A Rao
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, India
| | - Kanika Mehta
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, India
| | - Nikita Gahoi
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, India
- Centre for Research in Nanotechnology and Sciences, Indian Institute of Technology Bombay, Mumbai, India
| | - Sanjeeva Srivastava
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, India.
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Khatua S, Mangum R, Bertrand KC, Zaky W, McCall D, Mack SC. Pediatric ependymoma: current treatment and newer therapeutic insights. Future Oncol 2018; 14:3175-3186. [PMID: 30418040 DOI: 10.2217/fon-2018-0502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Advances in genomic, transcriptomic and epigenomic profiling now identifies pediatric ependymoma as a defined biological entity. Molecular interrogation has segregated these tumors into distinct biological subtypes based on anatomical location, age and clinical outcome, which now defines the need to tailor therapy even for histologically similar tumors. These findings now provide reasons for a paradigm shift in therapy, which should profile future clinical trials focused on targeted therapeutic strategies and risk-based treatment. The need to diagnose and differentiate the aggressive variants, which include the posterior fossa group A and the supratentorial RELA fusion subtypes, is imperative to escalate therapy and improve survival.
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Affiliation(s)
- Soumen Khatua
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ross Mangum
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.,Department of Pediatric Hematology & Oncology, Texas Children's Cancer & Hematology Centers, Houston, TX 77030, USA
| | - Kelsey C Bertrand
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.,Department of Pediatric Hematology & Oncology, Texas Children's Cancer & Hematology Centers, Houston, TX 77030, USA
| | - Wafik Zaky
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - David McCall
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Stephen C Mack
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.,Department of Pediatric Hematology & Oncology, Texas Children's Cancer & Hematology Centers, Houston, TX 77030, USA
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Pavon LF, Sibov TT, de Souza AV, da Cruz EF, Malheiros SMF, Cabral FR, de Souza JG, Boufleur P, de Oliveira DM, de Toledo SRC, Marti LC, Malheiros JM, Paiva FF, Tannús A, de Oliveira SM, Chudzinski-Tavassi AM, de Paiva Neto MA, Cavalheiro S. Tropism of mesenchymal stem cell toward CD133 + stem cell of glioblastoma in vitro and promote tumor proliferation in vivo. Stem Cell Res Ther 2018; 9:310. [PMID: 30413179 PMCID: PMC6234773 DOI: 10.1186/s13287-018-1049-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 09/11/2018] [Accepted: 10/16/2018] [Indexed: 02/07/2023] Open
Abstract
Background Previous studies have demonstrated remarkable tropism of mesenchymal stem cells (MSCs) toward malignant gliomas, making these cells a potential vehicle for delivery of therapeutic agents to disseminated glioblastoma (GBM) cells. However, the potential contribution of MSCs to tumor progression is a matter of concern. It has been suggested that CD133+ GBM stem cells secrete a variety of chemokines, including monocytes chemoattractant protein-1 (MCP-1/CCL2) and stromal cell-derived factor-1(SDF-1/CXCL12), which could act in this tropism. However, the role in the modulation of this tropism of the subpopulation of CD133+ cells, which initiate GBM and the mechanisms underlying the tropism of MSCs to CD133+ GBM cells and their effects on tumor development, remains poorly defined. Methods/results We found that isolated and cultured MSCs (human umbilical cord blood MSCs) express CCR2 and CXCR4, the respective receptors for MCP-1/CCL2 and SDF-1/CXCL12, and demonstrated, in vitro, that MCP-1/CCL2 and SDF-1/CXC12, secreted by CD133+ GBM cells from primary cell cultures, induce the migration of MSCs. In addition, we confirmed that after in vivo GBM tumor establishment, by stereotaxic implantation of the CD133+ GBM cells labeled with Qdots (705 nm), MSCs labeled with multimodal iron oxide nanoparticles (MION) conjugated to rhodamine-B (Rh-B) (MION-Rh), infused by caudal vein, were able to cross the blood-brain barrier of the animal and migrate to the tumor region. Evaluation GBM tumors histology showed that groups that received MSC demonstrated tumor development, glial invasiveness, and detection of a high number of cycling cells. Conclusions Therefore, in this study, we validated the chemotactic effect of MCP-1/CCL2 and SDF-1/CXCL12 in mediating the migration of MSCs toward CD133+ GBM cells. However, we observed that, after infiltrating the tumor, MSCs promote tumor growth in vivo probably by release of exosomes. Thus, the use of these cells as a therapeutic carrier strategy to target GBM cells must be approached with caution.
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Affiliation(s)
- Lorena Favaro Pavon
- Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil. .,Laboratory of Cellular and Molecular Neurosurgery, Federal University of São Paulo, Rua Napoleão de Barros, n. 626 -Vila Clementino, São Paulo, SP, 04024-002, Brazil.
| | - Tatiana Tais Sibov
- Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Jean Gabriel de Souza
- Laboratory of Molecular Biology, Butantan Institute, São Paulo, Brazil.,Centre of Excellence in New Target Discovery (CENTD), Butantan Institute, São Paulo, Brazil
| | - Pamela Boufleur
- Laboratory of Molecular Biology, Butantan Institute, São Paulo, Brazil.,Centre of Excellence in New Target Discovery (CENTD), Butantan Institute, São Paulo, Brazil
| | | | - Silvia Regina Caminada de Toledo
- Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), Federal University of São Paulo, São Paulo, Brazil
| | - Luciana C Marti
- Experimental Research Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Fernando F Paiva
- São Carlos Institute of Physics, São Paulo University, São Carlos, Brazil
| | - Alberto Tannús
- São Carlos Institute of Physics, São Paulo University, São Carlos, Brazil
| | | | - Ana Marisa Chudzinski-Tavassi
- Laboratory of Molecular Biology, Butantan Institute, São Paulo, Brazil.,Centre of Excellence in New Target Discovery (CENTD), Butantan Institute, São Paulo, Brazil
| | | | - Sérgio Cavalheiro
- Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
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Abstract
Recent advances in molecular pathology have reshaped the practice of brain tumor diagnostics. The classification of gliomas has been restructured with the discovery of isocitrate dehydrogenase (IDH) 1/2 mutations in the vast majority of lower grade infiltrating gliomas and secondary glioblastomas (GBM), with IDH-mutant astrocytomas further characterized by TP53 and ATRX mutations. Whole-arm 1p/19q codeletion in conjunction with IDH mutations now define oligodendrogliomas, which are also enriched for CIC, FUBP1, PI3K, NOTCH1, and TERT-p mutations. IDH-wild-type (wt) infiltrating astrocytomas are mostly primary GBMs and are characterized by EGFR, PTEN, TP53, NF1, RB1, PDGFRA, and CDKN2A/B alterations, TERT-p mutations, and characteristic copy number alterations including gains of chromosome 7 and losses of 10. Other clinically and genetically distinct infiltrating astrocytomas include the aggressive H3K27M-mutant midline gliomas, and smaller subsets that occur in the setting of NF1 or have BRAF V600E mutations. Low-grade pediatric gliomas are both genetically and biologically distinct from their adult counterparts and often harbor a single driver event often involving BRAF, FGFR1, or MYB/MYBL1 genes. Large scale genomic and epigenomic analyses have identified distinct subgroups of ependymomas tightly linked to tumor location and clinical behavior. The diagnosis of embryonal neoplasms also integrates molecular testing: (I) 4 molecularly defined, biologically distinct subtypes of medulloblastomas are now recognized; (II) 3 histologic entities have now been reclassified under a diagnosis of "embryonal tumor with multilayered rosettes (ETMR), C19MC-altered"; and (III) atypical teratoid/rhabdoid tumors (AT/RT) now require SMARCB1 (INI1) or SMARCA4 (BRG1) alterations for their diagnosis. We discuss the practical use of contemporary biomarkers for an integrative diagnosis of central nervous system neoplasia.
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Roos A, Ding Z, Loftus JC, Tran NL. Molecular and Microenvironmental Determinants of Glioma Stem-Like Cell Survival and Invasion. Front Oncol 2017; 7:120. [PMID: 28670569 PMCID: PMC5472661 DOI: 10.3389/fonc.2017.00120] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/24/2017] [Indexed: 12/22/2022] Open
Abstract
Glioblastoma multiforme (GBM) is the most frequent primary brain tumor in adults with a 5-year survival rate of 5% despite intensive research efforts. The poor prognosis is due, in part, to aggressive invasion into the surrounding brain parenchyma. Invasion is a complex process mediated by cell-intrinsic pathways, extrinsic microenvironmental cues, and biophysical cues from the peritumoral stromal matrix. Recent data have attributed GBM invasion to the glioma stem-like cell (GSC) subpopulation. GSCs are slowly dividing, highly invasive, therapy resistant, and are considered to give rise to tumor recurrence. GSCs are localized in a heterogeneous cellular niche, and cross talk between stromal cells and GSCs cultivates a fertile environment that promotes GSC invasion. Pro-migratory soluble factors from endothelial cells, astrocytes, macrophages, microglia, and non-stem-like tumor cells can stimulate peritumoral invasion of GSCs. Therefore, therapeutic efforts designed to target the invasive GSCs may enhance patient survival. In this review, we summarize the current understanding of extrinsic pathways and major stromal and immune players facilitating GSC maintenance and survival.
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Affiliation(s)
- Alison Roos
- Departments of Cancer Biology and Neurosurgery, Mayo Clinic Arizona, Scottsdale, AZ, United States
| | - Zonghui Ding
- Department of Biochemistry and Molecular Biology, Mayo Clinic Arizona, Scottsdale, AZ, United States
| | - Joseph C Loftus
- Department of Biochemistry and Molecular Biology, Mayo Clinic Arizona, Scottsdale, AZ, United States
| | - Nhan L Tran
- Departments of Cancer Biology and Neurosurgery, Mayo Clinic Arizona, Scottsdale, AZ, United States
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