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Gallez B. The Role of Imaging Biomarkers to Guide Pharmacological Interventions Targeting Tumor Hypoxia. Front Pharmacol 2022; 13:853568. [PMID: 35910347 PMCID: PMC9335493 DOI: 10.3389/fphar.2022.853568] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/23/2022] [Indexed: 12/12/2022] Open
Abstract
Hypoxia is a common feature of solid tumors that contributes to angiogenesis, invasiveness, metastasis, altered metabolism and genomic instability. As hypoxia is a major actor in tumor progression and resistance to radiotherapy, chemotherapy and immunotherapy, multiple approaches have emerged to target tumor hypoxia. It includes among others pharmacological interventions designed to alleviate tumor hypoxia at the time of radiation therapy, prodrugs that are selectively activated in hypoxic cells or inhibitors of molecular targets involved in hypoxic cell survival (i.e., hypoxia inducible factors HIFs, PI3K/AKT/mTOR pathway, unfolded protein response). While numerous strategies were successful in pre-clinical models, their translation in the clinical practice has been disappointing so far. This therapeutic failure often results from the absence of appropriate stratification of patients that could benefit from targeted interventions. Companion diagnostics may help at different levels of the research and development, and in matching a patient to a specific intervention targeting hypoxia. In this review, we discuss the relative merits of the existing hypoxia biomarkers, their current status and the challenges for their future validation as companion diagnostics adapted to the nature of the intervention.
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Hou H, Khan N, Gohain S, Eskey CJ, Moodie KL, Maurer KJ, Swartz HM, Kuppusamy P. Dynamic EPR Oximetry of Changes in Intracerebral Oxygen Tension During Induced Thromboembolism. Cell Biochem Biophys 2017; 75:285-294. [PMID: 28434138 DOI: 10.1007/s12013-017-0798-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/12/2017] [Indexed: 12/19/2022]
Abstract
Cerebral tissue oxygenation (oxygen tension, pO2) is a critical parameter that is closely linked to brain metabolism, function, and pathophysiology. In this work, we have used electron paramagnetic resonance oximetry with a deep-tissue multi-site oxygen-sensing probe, called implantable resonator, to monitor temporal changes in cerebral pO2 simultaneously at four sites in a rabbit model of ischemic stroke induced by embolic clot. The pO2 values in healthy brain were not significantly different among the four sites measured over a period of 4 weeks. During exposure to 15% O2 (hypoxia), a sudden and significant decrease in pO2 was observed in all four sites. On the other hand, brief exposure to breathing carbogen gas (95% O2 + 5% CO2) showed a significant increase in the cerebral pO2 from baseline value. During ischemic stroke, induced by embolic clot in the left brain, a significant decline in the pO2 of the left cortex (ischemic core) was observed without any change in the contralateral sites. While the pO2 in the non-infarct regions returned to baseline at 24-h post-stroke, pO2 in the infarct core was consistently lower compared to the baseline and other regions of the brain. The results demonstrated that electron paramagnetic resonance oximetry with the implantable resonator can repeatedly and simultaneously report temporal changes in cerebral pO2 at multiple sites. This oximetry approach can be used to develop interventions to rescue hypoxic/ischemic tissue by modulating cerebral pO2 during hypoxic and stroke injury.
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Affiliation(s)
- Huagang Hou
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Nadeem Khan
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Sangeeta Gohain
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Clifford J Eskey
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Karen L Moodie
- Center for Comparative Medicine and Research, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Kirk J Maurer
- Center for Comparative Medicine and Research, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Harold M Swartz
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Periannan Kuppusamy
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA.
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Lang MJ, Kelly JJ, Sutherland GR. A Moveable 3-Tesla Intraoperative Magnetic Resonance Imaging System. Oper Neurosurg (Hagerstown) 2011; 68:168-79. [DOI: 10.1227/neu.0b013e3182045803] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Based on success with a prototype 1.5T intraoperative magnetic resonance imaging (iMRI) system and the desire for increased signal-to-noise ratio, along with its relationship to image quality and advanced applications, a 3.0T system that uses the same novel moveable magnet configuration was developed.
OBJECTIVE:
To assess clinical applicability by prospectively applying the higher-field system to a neurosurgical cohort.
METHODS:
Upgrading to 3.0T required substantial modification of an existing iMRI-equipped operating room. The 1.5T magnet was replaced with a ceiling-mounted, moveable 3.0T magnet with a 70-cm working aperture. Local radiofrequency shielding was replaced with whole-room shielding. A new hydraulic operating table, high-performance gradients, and advanced image processing software were also installed. The new system was used as an adjunct to standard neurosurgical practice.
RESULTS:
The iMRI system upgrade required 6 months. Since completion, the 3.0T iMRI system has successfully guided neurosurgery in 120 patients without system failure in a patient-focused environment. Intraoperative image quality was superior to that obtained at 1.5T and enabled intraoperative acquisition of advanced imaging sequences, including tractography. Intraoperative imaging was found to modify surgery in a substantial number of patients.
CONCLUSION:
Implementation of an iMRI system based on a moveable 3.0T magnet is feasible. From clinical experience with 120 patients, iMRI at 3.0T is safe, reliable, and capable of directing image-guided surgery with exceptional image quality.
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Affiliation(s)
- Michael J. Lang
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - John J. Kelly
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Garnette R. Sutherland
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Baudelet C, Gallez B. Effect of anesthesia on the signal intensity in tumors using BOLD-MRI: Comparison with flow measurements by Laser Doppler flowmetry and oxygen measurements by luminescence-based probes. Magn Reson Imaging 2004; 22:905-12. [PMID: 15288130 DOI: 10.1016/j.mri.2004.02.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2003] [Accepted: 02/03/2004] [Indexed: 11/26/2022]
Abstract
BOLD-contrast functional magnetic resonance imaging (MRI) was used to assess the evolution of tumor oxygenation and blood flow after administration of four different anesthetics: pentobarbital (60 mg/kg), ketamine/xylazine (80/8 mg/kg), fentanyl/droperidol (0.078/3.9 mg/kg), and isoflurane (1.5%). Gradient echo sequences were carried out at 4.7 Tesla in a TLT tumor model implanted in the muscle of NMRI mice. In parallel experiments, tumor blood flow and tumor pO2 were measured using the OxyLite/OxyFlo probe system. A comparison was made with the changes occurring in the skeletal muscle (host tissue). The signal intensity was dramatically decreased in tumors after administration of anesthetics, except isoflurane. These results correlated well with measurements of oxygenation and blood perfusion. Isoflurane produced constant muscle pO2 and blood perfusion although large transient fluctuations in pO2 and blood flow were reported in some tumors. Our results emphasize the need for careful monitoring of the effects of anesthesia when trying to identify new therapeutic approaches that are aimed at modulating tumor hemodynamics.
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Affiliation(s)
- Christine Baudelet
- Laboratory of Medicinal Chemistry and Radiopharmacy, Université Catholique de Louvain, Brussels, Belgium
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Abstract
The spatial heterogeneity of the oxygen tension (pO(2)) in human and experimental tumours has been studied extensively, whereas studies of the temporal heterogeneity in pO(2) are sparse. In the work reported here, pO(2) was measured continuously over periods of at least 60 min in A-07 human melanoma xenografts by using the OxyLite fibre-optic oxygen-sensing device. The main purpose of the work was to establish the usefulness of the OxyLite system in measuring the temporal heterogeneity in pO(2) in tissues and to characterise the fluctuations in tissue pO(2) in A-07 tumours. The OxyLite device was found to be suitable for studies of the temporal heterogeneity in pO(2) in tumours. However, potential pitfalls were identified, and reliable pO(2) measurements require that precautions are taken to avoid these pitfalls, that is, erroneous pO(2) readings caused by tissue trauma induced by the probe, probe movements induced by reflex actions of the host mouse and occasional probe drift. Significant fluctuations in pO(2) were detected in the majority of the 70 tumour regions subjected to measurement. The fluctuations in different regions of the same tumour were in general temporally independent, implying that they were caused primarily by redistribution of the tumour perfusion rather than fluctuations in global perfusion. Fourier analysis of the pO(2) traces showed that the pO(2) usually fluctuated at frequencies lower than 1.5-2.0 mHz, corresponding to less than 0.1 cycle min(-1). Haemodynamic effects may cause pO(2) fluctuations in this frequency range, and hence, the redistribution of the perfusion could have been caused by morphological abnormalities of the tumour microvasculature. Moreover, acute hypoxia, that is, pO(2) fluctuations around 10 or 5 mmHg, was detected in 20 of 70 regions, that is, 29% (10 mmHg), or 27 of 70 regions, that is, 39% (5 mmHg). The median fraction of the time these regions were acutely hypoxic was 73% (10 mmHg) or 53% (5 mmHg). Consequently, if A-07 tumours are adequate models of tumours in man, acute hypoxia may be a commonly occurring phenomenon in neoplastic tissues, and hence, acute hypoxia is likely to cause resistance to radiation therapy and promote tumour aggressiveness.
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Affiliation(s)
- K G Brurberg
- Group of Radiation Biology and Tumor Physiology, Department of Biophysics and Centre for Research and Training in Radiation Therapy, The Norwegian Radium Hospital, Montebello, N-0310 Oslo, Norway
| | - B A Graff
- Group of Radiation Biology and Tumor Physiology, Department of Biophysics and Centre for Research and Training in Radiation Therapy, The Norwegian Radium Hospital, Montebello, N-0310 Oslo, Norway
| | - E K Rofstad
- Group of Radiation Biology and Tumor Physiology, Department of Biophysics and Centre for Research and Training in Radiation Therapy, The Norwegian Radium Hospital, Montebello, N-0310 Oslo, Norway
- Department of Biophysics, Institute for Cancer Research, The Norwegian Radium Hospital, Montebello, N-0310 Oslo, Norway. E-mail:
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