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Wu H, Yang L, Liu H, Zhou D, Chen D, Zheng X, Yang H, Li C, Chang J, Wu A, Wang Z, Ren N, Lv S, Liu Y, Jia M, Lu J, Liu H, Sun G, Liu Z, Liu J, Chen L. Exploring the efficacy of tumor electric field therapy against glioblastoma: An in vivo and in vitro study. CNS Neurosci Ther 2021; 27:1587-1604. [PMID: 34710276 PMCID: PMC8611775 DOI: 10.1111/cns.13750] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS Tumor electric fields therapy (TTFields) is emerging as a novel anti-cancer physiotherapy. Despite recent breakthroughs of TTFields in glioma treatment, the average survival time for glioblastoma patients with TTFields is <2 years, even when used in conjugation with traditional anti-cancer therapies. To optimize TTFields-afforded efficacy against glioblastoma, we investigated the cancer cell-killing effects of various TTFields paradigms using in vitro and in vivo models of glioblastoma. METHODS For in vitro studies, the U251 glioma cell line or primary cell cultures prepared from 20 glioblastoma patients were treated with the tumor electric field treatment (TEFT) system. Cell number, volume, and proliferation were measured after TEFT at different frequencies (100, 150, 180, 200, or 220 kHz), durations (24, 48, or 72 h), field strengths (1.0, 1.5, or 2.2V/cm), and output modes (fixed or random sequence output). A transwell system was used to evaluate the influence of TEFT on the invasiveness of primary glioblastoma cells. For in vivo studies, the therapeutic effect and safety profiles of random sequence electric field therapy in glioblastoma-transplanted rats were assessed by calculating tumor size and survival time and evaluating peripheral immunobiological and blood parameters, respectively. RESULTS In the in vitro settings, TEFT was robustly effective in suppressing cell proliferation of both the U251 glioma cell line and primary glioblastoma cell cultures. The anti-proliferation effects of TEFT were frequency- and "dose" (field strength and duration)-dependent, and contingent on the field sequence output mode, with the random sequence mode (TEFT-R) being more effective than the fixed sequence mode (TEFT-F). Genetic tests were performed in 11 of 20 primary glioblastoma cultures, and 6 different genetic traits were identified them. However, TEFT exhibited comparable anti-proliferation effects in all primary cultures regardless of their genetic traits. TEFT also inhibited the invasiveness of primary glioblastoma cells in transwell experiments. In the in vivo rat model of glioblastoma brain transplantation, treatment with TEFT-F or TEFT-R at frequency of 200 kHz and field strength of 2.2V/cm for 14 days significantly reduced tumor volume by 42.63% (TEFT-F vs. control, p = 0.0002) and 63.60% (TEFT-R vs. control, p < 0.0001), and prolonged animal survival time by 30.15% (TEFT-F vs. control, p = 0.0415) and 69.85% (TEFT-R vs. control, p = 0.0064), respectively. The tumor-bearing rats appeared to be well tolerable to TEFT therapies, showing only moderate increases in blood levels of creatine and red blood cells. Adverse skin reactions were common for TEFT-treated rats; however, skin reactions were curable by local treatment. CONCLUSION Tumor electric field treatment at optimal frequency, strength, and output mode markedly inhibits the cell viability, proliferation, and invasiveness of primary glioblastoma cells in vitro independent of different genetic traits of the cells. Moreover, a random sequence electric field output confers considerable anti-cancer effects against glioblastoma in vivo. Thus, TTFields are a promising physiotherapy for glioblastoma and warrants further investigation.
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Affiliation(s)
- Hao Wu
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, China.,Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lin Yang
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hanjie Liu
- Beijing Neurosurgical Institute; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dan Zhou
- Hunan An Tai Kang Cheng Biotechnology Co., Ltd, Changsha, China
| | - Dikang Chen
- Hunan An Tai Kang Cheng Biotechnology Co., Ltd, Changsha, China
| | - Xiaoque Zheng
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hui Yang
- Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Chong Li
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Jiusheng Chang
- Hunan An Tai Kang Cheng Biotechnology Co., Ltd, Changsha, China
| | - Anhua Wu
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, China
| | - Zhifei Wang
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Nianjun Ren
- Department of Neurosurgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Shengqing Lv
- Department of Neurosurgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yuyang Liu
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Muyuan Jia
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jian Lu
- Hunan An Tai Kang Cheng Biotechnology Co., Ltd, Changsha, China
| | - Hongyu Liu
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Guochen Sun
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhixiong Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Jialin Liu
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ling Chen
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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