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Mueller LE, Issa PP, Hussein MH, Elshazli RM, Haidari M, Errami Y, Shama M, Fawzy MS, Kandil E, Toraih E. Clinical outcomes and tumor microenvironment response to radiofrequency ablation therapy: a systematic review and meta-analysis. Gland Surg 2024; 13:4-18. [PMID: 38323236 PMCID: PMC10839696 DOI: 10.21037/gs-22-555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 06/15/2023] [Indexed: 02/08/2024]
Abstract
Background Radiofrequency ablation (RFA) utilizes minimally invasive high-energy current to precisely ablate tumor cells. It has been utilized in many cancer types including thyroid, lung, and liver cancer. It has been shown to provide adequate ablative margins with minimal complications; however, incomplete RFA may lead to recurrence of tumor. The underlying cellular mechanism and behavior of ablated cancer tissue is poorly understood. Methods A systematic review was performed, searching EMBASE, Web of Science, PubMed, and Scopus for studies published up to March 2022 and reported following PRISMA guidelines. Collection was performed by two groups of investigators to avoid risk of bias. The Cochrane Collaboration's tool was used for assessing risk of bias. We identified human, in vivo, and in vitro research studies utilizing RFA for tumor tissues. We required that the studies included at least one of the following: complications, recurrence, or survival, and took interest to studies identifying cellular signaling pathway patterns after RFA. Descriptive statistical analysis was performed in 'R' software including mean and confidence interval. Results The most frequent cancers studied were liver and lung cancers accounting for 57.4% (N=995) and 15.4% (N=267), followed by esophageal (N=190) and breast cancer (N=134). The most common reported complications were bleeding (19%) and post-operative pain (14%). In our literature search, four independent studies showed upregulation and activation of the VEGF pathway following RFA, four showed upregulation and activation of the AKT pathway following RFA, three studies demonstrated involvement of matrix metalloproteinases, and four showed upregulation of c-Met protein following RFA. Conclusions In our review and meta-analysis, we identify several proteins and pathways of interest of which are important in wound healing, angiogenesis, and cellular growth and survival. These proteins and pathways of interest may implicate areas of research towards RFA resistance and cancer recurrence.
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Affiliation(s)
| | - Peter P. Issa
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | | | - Rami M. Elshazli
- Department of Biochemistry and Molecular Genetics, Faculty of Physical Therapy, Horus University-Egypt, New Damietta, Egypt
| | - Muhib Haidari
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Youssef Errami
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, USA
| | - Mohamed Shama
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, USA
| | - Manal S. Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
| | - Emad Kandil
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, USA
| | - Eman Toraih
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, USA
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Salvermoser L, Goldberg SN, Laville F, Markezana A, Stechele M, Ahmed M, Wildgruber M, Kazmierczak PM, Alunni-Fabbroni M, Galun E, Ricke J, Paldor M. Radiofrequency Ablation-Induced Tumor Growth Is Suppressed by MicroRNA-21 Inhibition in Murine Models of Intrahepatic Colorectal Carcinoma. J Vasc Interv Radiol 2023; 34:1785-1793.e2. [PMID: 37348786 DOI: 10.1016/j.jvir.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023] Open
Abstract
PURPOSE To investigate the role of microRNA-21 (miR21) in radiofrequency (RF) ablation-induced tumor growth and whether miR21 inhibition suppresses tumorigenesis. MATERIAL AND METHODS Standardized liver RF ablation was applied to 35 C57/BL6 mice. miR21 and target proteins pSTAT3, PDCD4, and PTEN were assayed 3 hours, 24 hours, and 3 days after ablation. Next, 53 Balb/c and 44 C57BL/6 mice received Antago-miR21 or scrambled Antago-nc control, followed by intrasplenic injection of 10,000 CT26 or MC38 colorectal tumor cells, respectively. Hepatic RF ablation or sham ablation was performed 24 hours later. Metastases were quantified and tumor microvascular density (MVD) and cellular proliferation were assessed at 14 or 21 days after the procedures, respectively. RESULTS RF ablation significantly increased miR21 levels in plasma and hepatic tissue at 3 and 24 hours as well as target proteins at 3 days after ablation (P < .05, all comparisons). RF ablation nearly doubled tumor growth (CT26, 2.0 SD ± 1.0 fold change [fc]; MC38, 1.9 SD ± 0.9 fc) and increased MVD (CT26, 1.9 SD ± 1.0 fc; MC38, 1.5 ± 0.5 fc) and cellular proliferation (CT26, 1.7 SD ± 0.7 fc; MC38, 1.4 SD ± 0.5 fc) compared with sham ablation (P < .05, all comparisons). RF ablation-induced tumor growth was suppressed when Antago-miR21 was administered (CT26, 1.0 SD ± 0.7 fc; MC38, 0.9 SD ± 0.4 fc) (P < .01, both comparisons). Likewise, Antago-miR21 decreased MVD (CT26, 1.0 SD ± 0.3 fc; MC38, 1.0 SD ± 0.2 fc) and cellular proliferation (CT26, 0.9 SD ± 0.3 fc; MC38, 0.8 SD ± 0.3 fc) compared with baseline (P < .05, all comparisons). CONCLUSIONS RF ablation upregulates protumorigenic miR21, which subsequently influences downstream tumor-promoting protein pathways. This effect can potentially be suppressed by specific inhibition of miR21, rendering this microRNA a pivotal and targetable driver of tumorigenesis after hepatic thermal ablation.
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Affiliation(s)
- Lukas Salvermoser
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
| | - S Nahum Goldberg
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Department of Radiology, the Laboratory for Minimally Invasive Tumor Therapies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts; Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Flinn Laville
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Aurelia Markezana
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Department of Radiology, the Laboratory for Minimally Invasive Tumor Therapies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Matthias Stechele
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Muneeb Ahmed
- Department of Radiology, the Laboratory for Minimally Invasive Tumor Therapies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Eithan Galun
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Mor Paldor
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Hendriks P, Rietbergen DDD, van Erkel AR, Coenraad MJ, Arntz MJ, Bennink RJ, Braat AE, Crobach ASLP, van Delden OM, van der Hulle T, Klümpen HJ, van der Meer RW, Nijsen JFW, van Rijswijk CSP, Roosen J, Ruijter BN, Smit F, Stam MK, Takkenberg RB, Tushuizen ME, van Velden FHP, de Geus-Oei LF, Burgmans MC. Study Protocol: Adjuvant Holmium-166 Radioembolization After Radiofrequency Ablation in Early-Stage Hepatocellular Carcinoma Patients-A Dose-Finding Study (HORA EST HCC Trial). Cardiovasc Intervent Radiol 2022; 45:1057-1063. [PMID: 35618860 PMCID: PMC9307549 DOI: 10.1007/s00270-022-03162-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 04/23/2022] [Indexed: 12/07/2022]
Abstract
PURPOSE To investigate the biodistribution of holmium-166 microspheres (166Ho-MS) when administered after radiofrequency ablation (RFA) of early-stage hepatocellular carcinoma (HCC). The aim is to establish a perfused liver administration dose that results in a tumoricidal dose of holmium-166 on the hyperaemic zone around the ablation necrosis (i.e. target volume). MATERIALS AND METHODS This is a multicentre, prospective, dose-escalation study in HCC patients with a solitary lesion 2-5 cm, or a maximum of 3 lesions of ≤ 3 cm each. The day after RFA patients undergo angiography and cone-beam CT (CBCT) with (super)selective infusion of technetium-99 m labelled microalbumin aggregates (99mTc-MAA). The perfused liver volume is segmented from the CBCT and 166Ho-MS is administered to this treatment volume 5-10 days later. The dose of holmium-166 is escalated in a maximum of 3 patient cohorts (60 Gy, 90 Gy and 120 Gy) until the endpoint is reached. SPECT/CT is used to determine the biodistribution of holmium-166. The endpoint is met when a dose of ≥ 120 Gy has been reached on the target volume in 9/10 patients of a cohort. Secondary endpoints include toxicity, local recurrence, disease-free and overall survival. DISCUSSION This study aims to find the optimal administration dose of adjuvant radioembolization with 166Ho-MS after RFA. Ultimately, the goal is to bring the efficacy of thermal ablation up to par with surgical resection for early-stage HCC patients. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT03437382.
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Affiliation(s)
- Pim Hendriks
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Daphne D D Rietbergen
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Arian R van Erkel
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Minneke J Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark J Arntz
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roel J Bennink
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Andries E Braat
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - A Stijn L P Crobach
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Otto M van Delden
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom van der Hulle
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Heinz-Josef Klümpen
- Department of Medical Oncology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Rutger W van der Meer
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - J Frank W Nijsen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carla S P van Rijswijk
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Joey Roosen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastian N Ruijter
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits Smit
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Mette K Stam
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - R Bart Takkenberg
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Maarten E Tushuizen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Floris H P van Velden
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Mark C Burgmans
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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Chen JLY, Pan CK, Lin YL, Tsai CY, Huang YS, Yang WC, Hsu FM, Kuo SH, Shieh MJ. Preclinical evaluation of PEGylated liposomal doxorubicin as an effective radiosensitizer in chemoradiotherapy for lung cancer. Strahlenther Onkol 2021; 197:1131-1142. [PMID: 34476531 DOI: 10.1007/s00066-021-01835-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 08/01/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Development of a safe and effective systemic chemotherapeutic agent for concurrent administration with definitive thoracic radiotherapy remains a major goal of lung cancer management. The synergistic effect of PEGylated liposomal doxorubicin and irradiation was evaluated in lung cancer cell lines both in vitro and in vivo. METHODS In vitro radiosensitization of A549 and LLC cell lines was evaluated by colony formation assay, γH2AX fluorescent staining and western blot assay, and annexin V staining. A radiosensitization study with healthy human lung-derived cell line BEAS-2B was performed for comparative purposes. In vivo radiosensitization was evaluated by tumor ectopic growth, cell survival, pharmacokinetics, and biodistribution analyses. Cleaved caspase‑3, the marker for apoptosis, was assessed immunohistochemically in A549 xenograft tumors. RESULTS Treatment with PEGylated liposomal doxorubicin decreased A549 and LLC cell proliferation in a dose-dependent manner. In vitro studies revealed comparable radiosensitizer advantages of PEGylated liposomal doxorubicin and free doxorubicin, showing equivalent DNA double-strand breaks according to γH2AX fluorescent staining and western blot assays, similar numbers of apoptotic cells in the annexin‑V staining assay, and moderately decreased clonogenic survival. In vivo studies demonstrated markedly slow ectopic tumor growth with prolonged survival following treatment with PEGylated liposomal doxorubicin plus irradiation in both A549 and LLC mouse models, suggesting that PEGylated liposomal doxorubicin is more effective as a radiosensitizer than free doxorubicin in vivo. Pharmacokinetics evaluation showed a longer half-life of approximately 40 h for PEGylated liposomal doxorubicin, confirming that the liposomal carrier achieved controlled release. Biodistribution evaluation of PEGylated liposomal doxorubicin confirmed high accumulation of doxorubicin in tumors, indicating the promising drug delivery attributes of PEGylated liposomal doxorubicin. Although free doxorubicin caused histopathologic myocarditis with the cardiac muscle fibers showing varying degrees of damage, PEGylated liposomal doxorubicin caused no such effects. The immunohistochemical expression of cleaved caspase-3-positive cells was greatest expressed in the irradiation and PEGylated liposomal doxorubicin combined treatment group, indicating prolonged tumoricidal effects. CONCLUSIONS Our study provides preclinical in vitro and in vivo evidence of the effectiveness of PEGylated liposomal doxorubicin as a radiosensitizer, supporting its potential clinical development as a component of chemoradiotherapy.
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Affiliation(s)
- Jenny Ling-Yu Chen
- Department of Radiology, National Taiwan University College of Medicine, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan
- Cancer Center, College of Medicine, National Taiwan University, No. 57, Lane 155, Section 3, Keelung Road, Taipei, Taiwan
| | - Chun-Kai Pan
- Department of Radiology, National Taiwan University College of Medicine, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan
- Department of Medical Research, National Taiwan University Hospital, No. 7, Chung-Shan South Road, 100, Taipei, Taiwan
| | - Yu-Li Lin
- Department of Medical Research, National Taiwan University Hospital, No. 7, Chung-Shan South Road, 100, Taipei, Taiwan.
| | - Ching-Yi Tsai
- Department of Medical Research, National Taiwan University Hospital, No. 7, Chung-Shan South Road, 100, Taipei, Taiwan
- Institute of Toxicology, National Taiwan University College of Medicine, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan
| | - Yu-Sen Huang
- Department of Radiology, National Taiwan University College of Medicine, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan
| | - Wen-Chi Yang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan
- Cancer Center, College of Medicine, National Taiwan University, No. 57, Lane 155, Section 3, Keelung Road, Taipei, Taiwan
| | - Feng-Ming Hsu
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan
- Cancer Center, College of Medicine, National Taiwan University, No. 57, Lane 155, Section 3, Keelung Road, Taipei, Taiwan
| | - Sung-Hsin Kuo
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan
- Cancer Center, College of Medicine, National Taiwan University, No. 57, Lane 155, Section 3, Keelung Road, Taipei, Taiwan
| | - Ming-Jium Shieh
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 1, Section 1, Jen-Ai Road, Taipei, Taiwan
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Markezana A, Goldberg SN, Kumar G, Zorde-Khvalevsky E, Gourevtich S, Rozenblum N, Galun E, Ahmed M. Incomplete thermal ablation of tumors promotes increased tumorigenesis. Int J Hyperthermia 2021; 38:263-272. [PMID: 33612046 DOI: 10.1080/02656736.2021.1887942] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE While systemic tumor-stimulating effects can occur following ablation of normal liver linked to the IL-6/HGF/VEGF cytokinetic pathway, the potential for tumor cells themselves to produce these unwanted effects is currently unknown. Here, we study whether partially treated tumors induce increased tumor growth post-radiofrequency thermal ablation (RFA). METHODS Tumor growth was measured in three immunocompetent, syngeneic tumor models following partial RFA of the target tumor (in subcutaneous CT26 and MC38 mouse colorectal adenocarcinoma, N = 14 each); and in a distant untreated tumor following partial RFA of target subcutaneous R3230 rat breast adenocarcinoma (N = 12). Tumor cell proliferation (ki-67) and microvascular density (CD34) was assessed. In R3230 tumors, in vivo mechanism of action was assessed following partial RFA by measuring IL-6, HGF, and VEGF expression (ELISA) and c-Met protein (Western blot). Finally, RFA was performed in R3230 tumors with adjuvant c-Met kinase inhibitor or VEGF receptor inhibitor (at 3 days post-RFA, N = 3/arm, total N = 12). RESULTS RFA stimulated tumor growth in vivo in residual, incompletely treated surrounding CT26 and MC38 tumor at 3-6 days (p < 0.01). In R3230, RFA increased tumor growth in distant tumor 7 days post treatment compared to controls (p < 0.001). For all models, Ki-67 and CD34 were elevated (p < 0.01, all comparisons). IL-6, HGF, and VEGF were also upregulated post incomplete tumor RFA (p < 0.01). These markers were suppressed to baseline levels with adjuvant c-MET kinase or VEGF receptor inhibition. CONCLUSION Incomplete RFA of a target tumor can sufficiently stimulate residual tumor cells to induce accelerated growth of distant tumors via the IL-6/c-Met/HGF pathway and VEGF production.
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Affiliation(s)
- Aurelia Markezana
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - S Nahum Goldberg
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel.,Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.,Division of Image-guided Therapy and Interventional Oncology, Department of Radiology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Gaurav Kumar
- Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Elina Zorde-Khvalevsky
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Svetlana Gourevtich
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Nir Rozenblum
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Eithan Galun
- Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Muneeb Ahmed
- Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Molecularly targeted photothermal ablation improves tumor specificity and immune modulation in a rat model of hepatocellular carcinoma. Commun Biol 2020; 3:783. [PMID: 33335270 PMCID: PMC7746712 DOI: 10.1038/s42003-020-01522-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
Thermal ablation is a standard therapy for patients with hepatocellular carcinoma (HCC). Contemporary ablation devices are imperfect, as they lack tumor specificity. An ideal ablation modality would generate thermal energy only within tumoral tissue. Furthermore, as hyperthermia is known to influence tumor immunity, such a tumor-specific ablation modality may have the ability to favorably modulate the tumor immune landscape. Here we show a clinically relevant thermal ablation modality that generates tumor-specific hyperthermia, termed molecularly targeted photothermal ablation (MTPA), that is based upon the excellent localization of indocyanine green to HCC. In a syngeneic rat model, we demonstrate the tumor-specific hyperthermia generated by MTPA. We also show through spatial and transcriptomic profiling techniques that MTPA favorably modulates the intratumoral myeloid population towards tumor immunogenicity and diminishes the systemic release of oncogenic cytokines relative to conventional ablation modalities. Nina Muñoz et al. present a novel thermal ablation technique, termed molecularly targeted photothermal ablation (MTPA) that generates hyperthermia specifically within tumor tissue in a clinically-relevant rat model of liver cancer. They further show that MTPA modulates the intratumoral immune profile toward stronger tumor immunogenicity while reducing the release of oncogenic cytokines relative to conventional ablation techniques.
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Wu S, Zhang D, Yu J, Dou J, Li X, Mu M, Liang P. Chemotherapeutic Nanoparticle-Based Liposomes Enhance the Efficiency of Mild Microwave Ablation in Hepatocellular Carcinoma Therapy. Front Pharmacol 2020; 11:85. [PMID: 32174827 PMCID: PMC7054279 DOI: 10.3389/fphar.2020.00085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the third leading cause of death from cancer, and the 5-year overall survival (OS) rate for HCC remains unsatisfying worldwide. Microwave ablation (MWA) is a minimally invasive therapy that has made progress in treating HCC. However, HCC recurrence remains problematic. Therefore, combination therapy may offer better outcomes and enhance MWA efficiency through improved tumor control. We have developed doxorubicin-loaded liposomes (DNPs) as an efficient nanoplatform to enhance MWA of hepatocellular carcinoma even at the mild ablation condition. In this study, we demonstrated that the uptake of DNPs by HCC cells was increased 1.5-fold compared with that of free DOX. Enhanced synergism was observed in the combination of DNPs and MWA, which induced nearly 80% cell death. The combination of mild MWA and DNPs enhanced the ablation efficiency of HCC with significant inhibition of liver tumors and accounted for the longest survival rate among all groups. A much higher accumulation of the DNPs was observed in the transitional zone than in the ablation zone. No apparent systemic toxicity was observed for any of the treatments after 14 days. The present work demonstrates that DNPs combined with MWA could be a promising nanoparticle-based therapeutic approach for the treatment of hepatocellular carcinoma and shows potential for future clinical applications.
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Affiliation(s)
- Songsong Wu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Dongyun Zhang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jianping Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xin Li
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Mengjuan Mu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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Microwave ablation plus chemotherapy versus chemotherapy in advanced non-small cell lung cancer: a multicenter, randomized, controlled, phase III clinical trial. Eur Radiol 2020; 30:2692-2702. [PMID: 32020400 DOI: 10.1007/s00330-019-06613-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/27/2019] [Accepted: 12/09/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This prospective trial was performed to verify whether microwave ablation (MWA) in combination with chemotherapy could provide superior survival benefit compared with chemotherapy alone. MATERIALS AND METHODS From March 1, 2015, to June 20, 2017, treatment-naïve patients with pathologically verified advanced or recurrent non-small cell lung cancer (NSCLC) were randomly assigned to MWA plus chemotherapy group or chemotherapy group. The primary endpoint was progression-free survival (PFS), while the secondary endpoints included overall survival (OS), time to local progression (TTLP), and objective response rate (ORR). The complications and adverse events were also reported. RESULTS A total of 293 patients were randomly assigned into the two groups. One hundred forty-eight patients with 117 stage IV tumors were included in the MWA plus chemotherapy group. One hundred forty-five patients with 113 stage IV tumors were included in the chemotherapy group. The median follow-up period was 13.1 months and 12.4 months, respectively. Median PFS was 10.3 months (95% CI 8.0-13.0) in the MWA plus chemotherapy group and 4.9 months (95% CI 4.2-5.7) in the chemotherapy group (HR = 0.44, 95% CI 0.28-0.53; p < 0.0001). Median OS was not reached in the MWA plus chemotherapy group and 12.6 months (95% CI 10.6-14.6) in the chemotherapy group (HR = 0.38, 95% CI 0.27-0.53; p < 0.0001) using Kaplan-Meier analyses with log-rank test. The median TTLP was 24.5 months, and the ORR was 32% in both groups. The adverse event rate was not significantly different in the two groups. CONCLUSIONS In patients with advanced NSCLC, longer PFS and OS can be achieved with the treatment of combined MWA and chemotherapy than chemotherapy alone. KEY POINTS • Patients treated with MWA plus chemotherapy had superior PFS and OS over those treated with chemotherapy alone. • The ORR of patients treated with MWA plus chemotherapy was similar to that of those treated with chemotherapy alone. • Complications associated with MWA were common but tolerable and manageable.
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9
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Sharma A, Özayral S, Caserto JS, Ten Cate R, Anders NM, Barnett JD, Kandala SK, Henderson E, Stewart J, Liapi E, Rudek MA, Franken NAP, Oei AL, Korangath P, Bunz F, Ivkov R. Increased uptake of doxorubicin by cells undergoing heat stress does not explain its synergistic cytotoxicity with hyperthermia. Int J Hyperthermia 2020; 36:712-720. [PMID: 31345068 PMCID: PMC6934043 DOI: 10.1080/02656736.2019.1631494] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: A proposed mechanism for the enhanced effectiveness of hyperthermia and doxorubicin (Dox) combinations is increased intracellular Dox concentrations resulting from heat-induced cell stress. The purpose of this study was to determine whether specific varied Dox and heat combinations produce measurable effects greater than the additive combination, and whether these effects can be attributed to heat-induced increases in intracellular Dox concentrations. Methods: HCT116, HT29 and CT26 cells were exposed to Dox and water bath heating independently. A clonogenic survival assay was used to determine cell killing and intracellular Dox concentrations were measured in HCT116 cells with mass spectrometry. Cells were exposed to heating at 42 °C (60 min) and 0.5 μg/ml of Dox at varying intervals. Synergy was determined by curve-fitting and isobologram analysis. Results: All cell lines displayed synergistic effects of combined heating and Dox. A maximum synergistic effect was achieved with simultaneous cell exposure to Dox and heat. For exposures at 42 ° C, the synergistic effect was most pronounced at Dox concentrations <0.5 μg/ml. Increased intracellular concentrations of Dox in HCT116 cells caused by heat-stress did not generate a concomitant thermal enhancement. Conclusions: Simultaneous exposure of HCT116 cells to heating and Dox is more effective than sequential exposure. Heat-induced cell responses are accompanied by increased intracellular Dox concentrations; however, clonogenic survival data do not support this as the cause for synergistic cytotoxicity.
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Affiliation(s)
- Anirudh Sharma
- a Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Sanem Özayral
- a Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Julia S Caserto
- a Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Rosemarie Ten Cate
- b Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam , Amsterdam , Amsterdam , The Netherlands
| | - Nicole M Anders
- c Department of Oncology, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - James D Barnett
- a Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Sri Kamal Kandala
- a Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine , Baltimore , MD , USA.,d Department of Mechanical Engineering, Johns Hopkins University , Baltimore , MD , USA
| | - Elizabeth Henderson
- a Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Jacqueline Stewart
- a Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Eleni Liapi
- e Department of Radiology and Radiological Sciences, Johns Hopkins Hospital , Baltimore , MD , USA.,f Institute for Nanobiotechnology, Johns Hopkins University , Baltimore , MD , USA
| | - Michelle A Rudek
- c Department of Oncology, Johns Hopkins University School of Medicine , Baltimore , MD , USA.,g Department of Medicine, Johns Hopkins University , Baltimore , MD , USA.,h Division of Clinical Pharmacology, Johns Hopkins University , Baltimore , MD , USA
| | - Nicolaas A P Franken
- b Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam , Amsterdam , Amsterdam , The Netherlands
| | - Arlene L Oei
- a Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine , Baltimore , MD , USA.,b Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam , Amsterdam , Amsterdam , The Netherlands
| | - Preethi Korangath
- a Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Fred Bunz
- a Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine , Baltimore , MD , USA.,c Department of Oncology, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Robert Ivkov
- a Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine , Baltimore , MD , USA.,b Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam , Amsterdam , Amsterdam , The Netherlands.,d Department of Mechanical Engineering, Johns Hopkins University , Baltimore , MD , USA.,f Institute for Nanobiotechnology, Johns Hopkins University , Baltimore , MD , USA.,i Department of Materials Science and Engineering, Johns Hopkins University , Baltimore , MD , USA
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10
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Wei Z, Li Q, Ye X, Yang X, Huang G, Li W, Wang J, Han X. Microwave ablation or plus monochemotherapy in elderly advanced non-small-cell lung cancer patients. MINIM INVASIV THER 2019; 30:106-114. [PMID: 31621453 DOI: 10.1080/13645706.2019.1678173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the efficacy of microwave ablation (MWA) and MWA plus monochemotherapy in elderly patients with advanced non-small-cell lung cancer (NSCLC). MATERIAL AND METHODS Patients with advanced NSCLC aged ≥70 years were retrospectively enrolled. MWA was performed at the primary tumor site. The end points included progression-free survival (PFS), response to MWA and overall survival (OS). RESULTS Fifty-four patients were enrolled; of these, 36 received monochemotherapy. Complete ablation was achieved in 42 patients (77.8%). The median PFS and OS were 4.9 months and 21.8 months, respectively. Univariate analyses showed that female patients had superior PFS (31.9 months [95% confidence interval (CI): 0.8-63.0]) vs. 5.0 months in male patients (95% CI: 2.0-8.0), p = .002). Female sex was associated with better OS (not reached vs. 10.8 months, 95% CI: 9.3-12.3, p = .003). Moreover, patients with primary tumor size <3.5 cm had better OS than those with tumor size ≥3.5 cm (not reached vs. 10.9 months, 95% CI: 8.2-13.6, p = .006). Multivariate analyses showed that no characteristics were independent prognostic factors of PFS, but sex and primary tumor size were independent prognostic factors of OS. CONCLUSION MWA was effective in the treatment of elderly patients with advanced NSCLC.
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Affiliation(s)
- Zhigang Wei
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Qingyu Li
- Department of Hematology, Affiliated Hospital of Shandong Academy of Medical Sciences, Shandong First Medical University, Jinan, Shandong Province, China
| | - Xin Ye
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Xia Yang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Guanghui Huang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Wenhong Li
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Jiao Wang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Xiaoying Han
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
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11
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Zhou Q, Wang K, Dou J, Cao F, Liu F, Yuan H, Mu M, Xu J, Zhang D, Li X, Tian J, Yu J, Liang P. Theranostic liposomes as nanodelivered chemotherapeutics enhanced the microwave ablation of hepatocellular carcinoma. Nanomedicine (Lond) 2019; 14:2151-2167. [PMID: 31411535 DOI: 10.2217/nnm-2018-0424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: This study aimed to develop indocyanine green- and doxorubicin-loaded liposomes (DILPs) as theranostic nanoplatform for the detection of hepatocellular carcinoma (HCC) and as an efficient chemotherapeutic to enhance microwave ablation. Materials & methods: DILPs were synthesized and thoroughly characterized. Biocompatibility, tumor uptake and accumulation, and synergistic ablation-chemotherapeutic efficiency were systematically explored in them. In addition, human HCC surgical samples were used to test the affinity of DILPs for HCC. Results: The combination of microwave ablation and DILPs enhanced the ablation efficiency of HCC with apparent tumor inhibition. DILPs exhibited excellent diagnostic ability and could detect 2.5-mm HCC lesions via optoacoustic tomography imaging. DILPs had better affinity for human HCC surgical samples compared with normal liver tissue. Conclusion: Theranostic DILPs could serve as promising nanoparticles for treatment and management of HCC in the clinic.
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Affiliation(s)
- Qunfang Zhou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, PR China.,Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, PR China
| | - Kun Wang
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, PR China
| | - Jianping Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, PR China
| | - Feng Cao
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, PR China
| | - Fengyong Liu
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, PR China
| | - Hongjun Yuan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, PR China
| | - Mengjuan Mu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, PR China
| | - Jinshun Xu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, PR China
| | - Dongyun Zhang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, PR China
| | - Xin Li
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, PR China
| | - Jie Tian
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, PR China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, PR China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, PR China
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12
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Degrauwe N, Hocquelet A, Digklia A, Schaefer N, Denys A, Duran R. Theranostics in Interventional Oncology: Versatile Carriers for Diagnosis and Targeted Image-Guided Minimally Invasive Procedures. Front Pharmacol 2019; 10:450. [PMID: 31143114 PMCID: PMC6521126 DOI: 10.3389/fphar.2019.00450] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/08/2019] [Indexed: 12/12/2022] Open
Abstract
We are continuously progressing in our understanding of cancer and other diseases and learned how they can be heterogeneous among patients. Therefore, there is an increasing need for accurate characterization of diseases at the molecular level. In parallel, medical imaging and image-guided therapies are rapidly developing fields with new interventions and procedures entering constantly in clinical practice. Theranostics, a relatively new branch of medicine, refers to procedures combining diagnosis and treatment, often based on patient and disease-specific features or molecular markers. Interventional oncology which is at the convergence point of diagnosis and treatment employs several methods related to theranostics to provide minimally invasive procedures tailored to the patient characteristics. The aim is to develop more personalized procedures able to identify cancer cells, selectively reach and treat them, and to assess drug delivery and uptake in real-time in order to perform adjustments in the treatment being delivered based on obtained procedure feedback and ultimately predict response. Here, we review several interventional oncology procedures referring to the field of theranostics, and describe innovative methods that are under development as well as future directions in the field.
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Affiliation(s)
- Nils Degrauwe
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Arnaud Hocquelet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonia Digklia
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alban Denys
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rafael Duran
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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13
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Cao F, Wan C, Xie L, Qi H, Shen L, Chen S, Song Z, Fan W. Localized RNA interference therapy to eliminate residual lung cancer after incomplete microwave ablation. Thorac Cancer 2019; 10:1369-1377. [PMID: 31017731 PMCID: PMC6558495 DOI: 10.1111/1759-7714.13079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 12/25/2022] Open
Abstract
Background This study evaluated the safety and efficacy of localized injection of polyethylene glycol (PEG)‐hyperbranched polyethyleneimine (PEI)‐EGFR‐small interfering RNA (siRNA) nanocomposites as a treatment for residual lung cancer after incomplete microwave ablation (MWA). Methods Human lung cancer cell lines with high and low EGFR expression were selected for the study. The effects of PEG‐PEI‐EGFR‐siRNA nanocomposite transfection on the proliferation, migration, and apoptosis of lung cancer cells were verified. Sixteen healthy ICR mice were injected into the lung to test the biological safety of the nanocomposites. In addition, 24 subcutaneous xenograft BALB/C nude mice with high EGFR expression were separated into four groups and then treated with an intratumoral injection of PEG‐PEI‐EGFR‐siRNA, PEG‐PEI‐normal control (NC)‐siRNA, PEG‐PEI‐EGFR‐siRNA after MWA, or PEG‐PEI‐NC‐siRNA after MWA. Tumor growth, pathological changes, and EGFR expression in each group were observed. Results PEG‐PEI‐EGFR‐siRNA nanocomposites were transfected to HCC 827 cells showing high EGFR expression and to H23 cells showing low EGFR expression. In HCC827 cells, downregulation of EGFR gene expression reduced cell proliferation, invasion, and migration, whereas cell apoptosis increased. In contrast, in H23 cells, no significant differences in those parameters were detected. No acute toxicity occurred in the ICR mice during the biosafety test. Localized injection of PEG‐PEI‐EGFR‐siRNA nanocomposites significantly inhibited the growth of human lung xenografts in mice and the growth of residual tumors after MWA. Conclusion PEG‐PEI‐EGFR‐siRNA nanocomposites may be a supplemental therapy strategy to treat residual lung cancer after incomplete MWA.
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Affiliation(s)
- Fei Cao
- Department of Minimally Invasive Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chao Wan
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Lin Xie
- Department of Minimally Invasive Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Han Qi
- Department of Minimally Invasive Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Lujun Shen
- Department of Minimally Invasive Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shuanggang Chen
- Department of Minimally Invasive Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ze Song
- Department of Oncology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Weijun Fan
- Department of Minimally Invasive Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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14
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The Accumulation and Effects of Liposomal Doxorubicin in Tissues Treated by Radiofrequency Ablation and Irreversible Electroporation in Liver: In Vivo Experimental Study on Porcine Models. Cardiovasc Intervent Radiol 2019; 42:751-762. [DOI: 10.1007/s00270-019-02175-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/31/2019] [Indexed: 12/18/2022]
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15
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Gao J, Wang J, Jin Y, Zhang F, Yang X. Intratumoral radiofrequency hyperthermia-enhanced chemotherapy of liposomal doxorubicin on hepatocellular carcinoma. Am J Transl Res 2018; 10:3619-3627. [PMID: 30662613 PMCID: PMC6291704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/29/2018] [Indexed: 06/09/2023]
Abstract
PURPOSE To investigate the possibility of using radiofrequency hyperthermia (RFH) to enhance intratumoral therapeutic effect of liposomal doxorubicin on hepatocellular carcinoma (HCC) via an interventional molecular imaging approach. MATERIALS AND METHODS For both in-vitro confirmation and in-vivo validation, Luciferase/mCherry-labeled human HCC cells (HepG2) and mice subcutaneous hepatic cancer xenografts were treated by: (i) combination therapy of liposomal doxorubicin plus RFH at 42°C; (ii) liposomal doxorubicin alone; (iii) RFH at 42°C alone; (iv) phosphate buffered saline (PBS) as a control. For in-vitro confirmation, MTS assay, confocal microscopy, optical imaging and flow cytometry were used to evaluate and compare cell viabilities and apoptosis among different treatment groups. For in vivo validation, liposomal doxorubicin was directly injected into the tumor and RFH was performed subsequently under ultrasound imaging guidance. Changes of tumor sizes were quantified using ultrasound imaging and bioluminescence signal intensities after treatments were measured by optical imaging over 14 days, which were correlated with subsequent histology analysis. RESULTS Of in vitro experiments, MTS assay demonstrated the lowest cell proliferation in combination therapy group compared with the other three groups (25.0 ± 5.6% vs 49.7 ± 5.2% vs 94.2 ± 3.9% vs 100%, respectively, P < 0.001). Flow cytometry showed the highest percentage of early apoptotic HepG2 cells in combination therapy compared to the other three groups (37.9 ± 3.2% vs 32.2 ± 1.7% vs 2.9 ± 1.7% vs 1.8 ± 0.7%, respectively, P < 0.001). Of in vivo experiments, optical imaging demonstrated a significantly decreased bioluminescence signal intensities in the combination therapy group, compared with the other three groups (0.53 ± 0.10 VS 1.4 ± 0.5 VS 2.8 ± 0.8 VS 3.0 ± 0.3, P < 0.05). Ultrasound images showed the smallest tumor volumes of the combination therapy group, in comparison to other control groups (0.7 ± 0.1 VS 1.8 ± 0.4 VS 3.0 ± 0.8 VS 3.3 ± 0.3, P < 0.05). Both histologic correlation confirmed imaging findings. CONCLUSION RFH can enhance intratumoral therapy with liposomal doxorubicin for HCC, which is effectively monitored by ultrasound imaging and optical imaging techniques. This concept may provide new avenues for eradicating the residual tumor cells when combining RFA with interventional molecular imaging guided direct intratumoral chemotherapy of HCC.
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Affiliation(s)
- Jun Gao
- Image-Guided Bio-Molecular Intervention Research and Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington School of MedicineSeattle 98109, WA, USA
- Department of Hepatobiliary Surgery, Beijing Chao-Yang Hospital Affiliated with Capital Medical UniversityNo. 5 Jingyuan Street, Beijing 100043, China
| | - Jianfeng Wang
- Image-Guided Bio-Molecular Intervention Research and Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington School of MedicineSeattle 98109, WA, USA
- Department of Hepatobiliary Surgery, Beijing Chao-Yang Hospital Affiliated with Capital Medical UniversityNo. 5 Jingyuan Street, Beijing 100043, China
| | - Yin Jin
- Image-Guided Bio-Molecular Intervention Research and Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington School of MedicineSeattle 98109, WA, USA
| | - Feng Zhang
- Image-Guided Bio-Molecular Intervention Research and Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington School of MedicineSeattle 98109, WA, USA
| | - Xiaoming Yang
- Image-Guided Bio-Molecular Intervention Research and Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington School of MedicineSeattle 98109, WA, USA
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16
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Han L, Guo K, Gu F, Zhang YF, Li K, Mu XX, Liu HJ, Zhou XD, Luo W. Effects of silibinin-loaded thermosensitive liposome-microbubble complex on inhibiting rabbit liver VX2 tumors in sub-hyperthermia fields. Exp Ther Med 2018; 15:1233-1240. [PMID: 29434709 PMCID: PMC5774404 DOI: 10.3892/etm.2017.5566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 09/01/2017] [Indexed: 11/05/2022] Open
Abstract
In the present study, the effects of silibinin-loaded thermosensitive liposome-microbubble complex (STLMC) on rabbit liver VX2 tumors in sub-hyperthermia fields were investigated using two-dimensional ultrasonography (2D US), contrast-enhanced US (CEUS), hematoxylin and eosin (H&E) staining, immunohistochemistry and ultrastructure observation. 50 rabbits with VX2 liver tumors were divided into five groups: Sub-hyperthermia microwave ablation group (SHM), STLMC injection group (STLMC), SHM ablation plus STLMC injection group (SHM + STLMC), microbubble injection group and blank control group without any treatment. Rabbits in each group were examined using 2D US and CEUS in order to evaluate the tumor volume and diameter before treatment and at day 7 and 21 after treatment. Morphology, expression of CD163 and CD206, and ultrastructure of the tumors were assessed. The average post-treatment volume of tumors in group SHM + STLMC was 1.17±0.88 cm3 at day 7 and 2.15±0.96 cm3 at day 21, which was significantly decreased compared with all other groups (P<0.05). H&E staining indicated that the number of disordered macrophages in the SHM + STLMC group significantly increased compared with the other groups (P<0.05). Immunohistochemical results demonstrated that in the SHM + STLMC, the expression of CD163 and CD206 significantly decreased compared with all other groups (P<0.05). These results suggested that STLMC has a potential function in preventing tumor growth, which may be due to its inhibitory effect on tumor-associated macrophages in the tumor microenvironment.
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Affiliation(s)
- Lu Han
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Kai Guo
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Fen Gu
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Yun-Fei Zhang
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Ke Li
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Xi-Xi Mu
- Department of General Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Hai-Jing Liu
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Xiao-Dong Zhou
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Wen Luo
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
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Zhou Q, Wu S, Gong N, Li X, Dou J, Mu M, Yu X, Yu J, Liang P. Liposomes loading sodium chloride as effective thermo-seeds for microwave ablation of hepatocellular carcinoma. NANOSCALE 2017; 9:11068-11076. [PMID: 28741635 DOI: 10.1039/c7nr02955a] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Microwave ablation (MWA) is a promising minimally invasive therapy that has been widely used to treat hepatocellular carcinoma (HCC). However, the efficiency of MWA in treating HCC is evidently limited by the incomplete ablation of large tumors and tumors in high-risk locations. Here, we report the value of using liposomes packed with sodium chloride (NaCl-LPs) as effective thermo-seeds for MWA of HCC. The prepared liposomes exhibited excellent heat conversion ability by showing a more rapid temperature increase than free NaCl medium, blank liposomes or water under microwave irradiation. The high efficiency of this new microwave sensitization strategy was fully demonstrated in vitro in subcutaneous and orthotopic tumors. The results showed that MWA combined with NaCl-LPs clearly enhanced the ablation efficiency, leading to apparent tumor inhibition and low recurrence. What's more, we verified the susceptibility of NaCl-LPs on orthotopic tumors. Based on the unique properties of NaCl-LPs, sublethal MWA was used to mimic the transitional zone, and large-scale necrosis was observed in tumors combined with NaCl-LPs. In addition, HE staining and blood hematology analysis revealed no noticeable toxicity of NaCl-LPs in vivo, which confirmed that NaCl-LPs possessed good biocompatibility. CONCLUSION The effective nanoparticles could play a valuable role in enhancing the thermo-sensitizing effect of MWA for achieving better therapeutic efficacy.
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Affiliation(s)
- Qunfang Zhou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
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Ueki A, Okuma T, Hamamoto S, Miki Y. Therapeutic Effects of CT-guided Radiofrequency Ablation with Concurrent Platinum-Doublet Chemotherapy in a Rabbit VX2 Lung Tumor Model. Radiology 2017; 283:391-398. [DOI: 10.1148/radiol.2016160414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ai Ueki
- From the Department of Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Tomohisa Okuma
- From the Department of Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Shinichi Hamamoto
- From the Department of Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Yukio Miki
- From the Department of Radiology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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Andriyanov AV, Portnoy E, Koren E, Inesa S, Eyal S, Goldberg SN, Barenholz Y. Therapeutic efficacy of combined PEGylated liposomal doxorubicin and radiofrequency ablation: Comparing single and combined therapy in young and old mice. J Control Release 2017; 257:2-9. [PMID: 28215670 DOI: 10.1016/j.jconrel.2017.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/13/2017] [Accepted: 02/16/2017] [Indexed: 12/27/2022]
Abstract
Antitumor therapy in the elderly is particularly challenging due to multiple, often chronic diseases, poly-therapy, and age-related physiological changes that affect drug efficacy and safety. Furthermore, tumors may become more aggressive and drug-resistant with advanced age, leading to poor patient prognosis. In this study, we evaluated in mice bearing medulloblastoma xenografts the effect of age on tumor progression and tumor therapy. We focused on therapeutic efficacy of two treatment modalities alone radiofrequency ablation therapy (RFA), PEGylated liposomal doxorubicin (PLD) equivalent to Doxil, and their combination. We demonstrated that tumor growth rate was higher and survival was lower in old versus young mice (p<0.05). Likewise, tumors in old mice were less susceptible to either PLD or RFA monotherapy. However, combined therapy of PLD and RFA succeeded to eliminate the age-related differences in anti-cancer treatment efficacy (p>0.05) by the two monotherapies. The results on PLD therapy are supported by preferable PEGylated nano-liposomes accumulation in tumors of young mice compared to old mice, as determined by near-infrared imaging with indocyanine green (ICG)-labeled PEGylated nano-liposomes. Taken together, our findings suggest that age effects on tumor progression and tumor monotherapy outcome may potentially be related to changes in tumor microenvironment, and that these changes can be overcome by RFA as this technique abolishes these differences and significantly improves success of PLD treatment.
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Affiliation(s)
- Alexander V Andriyanov
- Department of Biochemistry, Institute for Medical Research Israel-Canada, Hebrew University -Hadassah Medical School, P.O.B. 12272, Jerusalem 91120, Israel
| | - Emma Portnoy
- Department of Biochemistry, Institute for Medical Research Israel-Canada, Hebrew University -Hadassah Medical School, P.O.B. 12272, Jerusalem 91120, Israel
| | - Erez Koren
- Department of Biochemistry, Institute for Medical Research Israel-Canada, Hebrew University -Hadassah Medical School, P.O.B. 12272, Jerusalem 91120, Israel
| | - Semenenko Inesa
- Institute for Drug Research, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Sara Eyal
- Institute for Drug Research, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - S Nahum Goldberg
- Radiology Department, Hadassah Hebrew University Medical Center, Ein Karem, Jerusalem, Israel
| | - Yechezkel Barenholz
- Department of Biochemistry, Institute for Medical Research Israel-Canada, Hebrew University -Hadassah Medical School, P.O.B. 12272, Jerusalem 91120, Israel.
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Liu K, Hao M, Ouyang Y, Zheng J, Chen D. CD133 + cancer stem cells promoted by VEGF accelerate the recurrence of hepatocellular carcinoma. Sci Rep 2017; 7:41499. [PMID: 28134312 PMCID: PMC5278354 DOI: 10.1038/srep41499] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/21/2016] [Indexed: 12/12/2022] Open
Abstract
The role of cancer stem cells (CSCs) in inducing the recurrence of hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) remains unclear. Here, we found that a dramatic increase in plasma vascular endothelial growth factor (VEGF) and an induction of local CD133+ CSCs are associated with early HCC recurrence, suggesting that VEGF expression and tumour stemness contribute to the relapse. In vitro studies demonstrated that VEGF, via activation of VEGFR2, increased the number of CD133+ CSCs and enhanced their capacity for self-renewal by inducing the expression of Nanog. In vivo studies further demonstrated that VEGF-treated CD133+ CSCs formed tumours larger than those developing from unstimulated cells and VEGF pre-treatment increased the tumorigenic cell frequency of primary HCC cells dependently on the presence of Nanog and VEGFR2. In HCC tissue derived from patients with early recurrence, almost all CD133+ cells were Nanog and p-VEGFR2 positive, suggesting that activation of VEGFR2 is critical for RFA-induced tumour stemness in HCC. In summary, RFA-induced VEGF promotes tumour stemness and accelerates tumourigenesis in HCC in a manner dependent on Nanog and VEGFR2, which is valuable for the prediction of HCC recurrence after RFA and the development of novel therapeutics.
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Affiliation(s)
- Kai Liu
- Capital Medical University affiliated Beijing You An Hospital, Beijing, 100069, China.,Beijing Institute of Hepatology, Beijing, 100069, China
| | - Meijun Hao
- Capital Medical University affiliated Beijing You An Hospital, Beijing, 100069, China
| | - Yabo Ouyang
- Capital Medical University affiliated Beijing You An Hospital, Beijing, 100069, China.,Beijing Institute of Hepatology, Beijing, 100069, China
| | - Jiasheng Zheng
- Capital Medical University affiliated Beijing You An Hospital, Beijing, 100069, China
| | - Dexi Chen
- Capital Medical University affiliated Beijing You An Hospital, Beijing, 100069, China.,Beijing Institute of Hepatology, Beijing, 100069, China.,Organ Transplantation Center, the Affiliated Hospital of Qingdao University, Qingdao City, Shandong Province, 266003, China
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Zhou L, Zhang M, Fu Q, Li J, Sun H. Targeted near infrared hyperthermia combined with immune stimulation for optimized therapeutic efficacy in thyroid cancer treatment. Oncotarget 2017; 7:6878-90. [PMID: 26769848 PMCID: PMC4872755 DOI: 10.18632/oncotarget.6901] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 12/29/2015] [Indexed: 01/08/2023] Open
Abstract
Treatment of thyroid cancer has incurred much focus because of its high prevalency. As a new strategy treating thyroid cancer, hyperthermia takes several advantages compared with surgery or chemotherapy, including minimal invasion, low systematic toxicity and the ability to enhance the immunogenicity of cancer cells with the expression Hsp70 which serves as Toll-like receptors-4 (TLR-4 agonist). However, Hsp70 as a molecular chaperone can protect cells from heat induced apoptosis and therefore compromise the tumor killing effect of hyperthermia. In this study, to solve this problem, a combined hyperthermia therapy was employed to treat thyroid cancer. We prepared a probe with the tumor targeting agent AG to monitor thyroid tumor issue and generate heat to kill tumor cells in vivo. At the same time Quercetin (inhibitor of HSP70) and lipopolysaccharide (LPS) (agonist of TLR-4) were used for the combined hyperthermia therapy. The results showed that compared with free IR820, AG modification facilitated much enhanced cellular uptake and greatly pronounced tumor targeting ability. The combined therapy exhibited the most remarkable tumor inhibition compared with the single treatments both in vitro and in vivo. These findings verified that the new therapeutic combination could significantly improve the effect of hyperthermia and shed light on a novel clinical strategy in thyroid cancer treatment.
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Affiliation(s)
- Le Zhou
- Department of Thyroid Surgery, China-Japan Union Hospital, Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun 130033, China
| | - Mengchao Zhang
- Radiology Department, China-Japan Union Hospital, Jilin University, Changchun 130033, China
| | - Qingfeng Fu
- Department of Thyroid Surgery, China-Japan Union Hospital, Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun 130033, China
| | - Jingting Li
- Department of Thyroid Surgery, China-Japan Union Hospital, Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun 130033, China
| | - Hui Sun
- Department of Thyroid Surgery, China-Japan Union Hospital, Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun 130033, China
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Xu J, Chen Y, Deng L, Liu J, Cao Y, Li P, Ran H, Zheng Y, Wang Z. Microwave-activated nanodroplet vaporization for highly efficient tumor ablation with real-time monitoring performance. Biomaterials 2016; 106:264-75. [DOI: 10.1016/j.biomaterials.2016.08.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 12/31/2022]
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Xu J, Cao Y, Xu C, Cheng X, You Y, Yao Y, Liu J, Wang Z, Li P, Lu M. Combination of microbubbles and diagnostic ultrasound at a high mechanical index for the synergistic microwave ablation of tumours. Int J Hyperthermia 2016; 33:318-326. [PMID: 27764970 DOI: 10.1080/02656736.2016.1239843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To determine whether combining microbubbles (MBs) with diagnostic ultrasound (US) at a high mechanical index (MI) could enhance the microwave (MW) ablation of tumours. MATERIALS AND METHODS Five therapeutic MW adjuvant protocols were studied: MW, MW + US, MW + US + MB, MW + US + NS (saline) and MW + MB. In 30 normal rabbit livers, the synergistic effects were evaluated via temperature, necrosis volume and histology. In 90 VX2 rabbit hepatic tumours, residual cells in the peripheral ablated tumours were examined via immunohistochemical assay and tumour growth. Additional 40 VX2 hepatic tumours were evaluated for ablation safety via blood assay and weight and for survival to 105 days. Results were compared using analysis of variance. RESULTS Compared with the other protocols, the ablation volumes in normal rabbit livers were significantly larger using the MW + US + MB protocol (p < .001). The histological examination was consistent with more efficient ablation in that protocol. In detecting residual cells, the apoptotic index was higher, the proliferating index was lower (p < .05), tumour growth was significantly smaller (p < .001), and the rabbits of the MW + US + MB T-Group survived longer (p < .05) than those of the other groups. Additionally, no damage to the liver function or blood cells was found in any of the protocols after ablation (p < .05). CONCLUSIONS MBs in combination with diagnostic US at a high MI showed potential synergy in the MW ablation of tumours in rabbits.
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Affiliation(s)
- Jinshun Xu
- a Chongqing Key Laboratory of Ultrasound Molecular Imaging , Second Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Yang Cao
- a Chongqing Key Laboratory of Ultrasound Molecular Imaging , Second Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Chunyan Xu
- a Chongqing Key Laboratory of Ultrasound Molecular Imaging , Second Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Xueqing Cheng
- b Department of Radiology , Central Hospital of Enshi Autonomous Prefecture , Hubei , China
| | - Yufeng You
- c Department of Ultrasound , Sichuan Provincial Cancer Hospital , Sichuan , China
| | - Yuanzhi Yao
- a Chongqing Key Laboratory of Ultrasound Molecular Imaging , Second Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Jianxin Liu
- a Chongqing Key Laboratory of Ultrasound Molecular Imaging , Second Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Zhigang Wang
- a Chongqing Key Laboratory of Ultrasound Molecular Imaging , Second Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Pan Li
- a Chongqing Key Laboratory of Ultrasound Molecular Imaging , Second Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Min Lu
- d Department of Ultrasound , Second Affiliated Hospital of Chongqing Medical University , Chongqing , China
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Moussa M, Goldberg SN, Kumar G, Levchenko T, Torchilin V, Ahmed M. Effect of thermal dose on heat shock protein expression after radio-frequency ablation with and without adjuvant nanoparticle chemotherapies. Int J Hyperthermia 2016; 32:829-841. [PMID: 27600101 DOI: 10.3109/02656736.2016.1164904] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the effect of different radio-frequency ablation (RFA) thermal doses on coagulation and heat shock protein (HSP) response with and without adjuvant nanotherapies. MATERIALS AND METHODS First, Fischer rats were assigned to nine different thermal doses of hepatic RFA (50-90 °C, 2-20 min, three per group) or no treatment (n = 3). Next, five of these RF thermal doses were combined with liposomal-doxorubicin (Lipo-Dox, 1 mg intravenously) in R3230 breast tumours, or no tumour treatment (five per group). Finally, RFA/Lipo-Dox was given without and with an Hsp70 inhibitor, micellar quercetin (Mic-Qu, 0.3 mg intravenously) for two different RFA doses with similar coagulation but differing peri-ablational Hsp70 (RFA/Lipo-Dox at 70 °C × 5 min and 90 °C × 2 min, single tumours, five per group). All animals were sacrificed 24 h post-RFA and gross tissue coagulation and Hsp70 (maximum rim thickness and % cell positivity) were correlated to thermal dose including cumulative equivalent minutes at 43 °C (CEM43). RESULTS Incremental increases in thermal dose (CEM43) correlated to increasing liver tissue coagulation (R2 = 0.7), but not with peri-ablational Hsp70 expression (R2 = 0.14). Similarly, increasing thermal dose correlated to increasing R3230 tumour coagulation for RF alone and RFA/Lipo-Dox (R2 = 0.7 for both). The addition of Lipo-Dox better correlated to increasing Hsp70 expression compared to RFA alone (RFA: R2 = 0.4, RFA/Lipo-Dox: R2 = 0.7). Finally, addition of Mic-Qu to two thermal doses combined with Lipo-Dox resulted in greater tumour coagulation (p < 0.0003) for RFA at 90 °C × 2 min (i.e. greater baseline Hsp70 expression) than an RFA dose that produced similar coagulation but less HSP expression (p < 0.0004). CONCLUSION Adjuvant intravenous Lipo-Dox increases peri-ablational Hsp70 expression in a thermally dependent manner. Such expression can be exploited to produce greater tumour destruction when adding a second adjuvant nanodrug (Mic-Qu) to suppress peri-ablational HSP expression.
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Affiliation(s)
- Marwan Moussa
- a Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology , Beth Israel Deaconess Medical Center/Harvard Medical School , Boston , Massachusetts , USA
| | - S Nahum Goldberg
- a Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology , Beth Israel Deaconess Medical Center/Harvard Medical School , Boston , Massachusetts , USA.,b Division of Image-Guided Therapy and Interventional Oncology, Department of Radiology , Hadassah Hebrew University Medical Center , Jerusalem , Israel
| | - Gaurav Kumar
- a Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology , Beth Israel Deaconess Medical Center/Harvard Medical School , Boston , Massachusetts , USA
| | - Tatyana Levchenko
- c Department of Pharmaceutical Sciences and Center for Pharmaceutical Biotechnology and Nanomedicine , Northeastern University , Boston , Massachusetts , USA
| | - Vladimir Torchilin
- c Department of Pharmaceutical Sciences and Center for Pharmaceutical Biotechnology and Nanomedicine , Northeastern University , Boston , Massachusetts , USA
| | - Muneeb Ahmed
- a Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology , Beth Israel Deaconess Medical Center/Harvard Medical School , Boston , Massachusetts , USA
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A review of radiofrequency ablation: Large target tissue necrosis and mathematical modelling. Phys Med 2016; 32:961-71. [PMID: 27461969 DOI: 10.1016/j.ejmp.2016.07.092] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 06/06/2016] [Accepted: 07/18/2016] [Indexed: 12/15/2022] Open
Abstract
Radiofrequency ablation (RFA) is an effective clinical method for tumour ablation with minimum intrusiveness. However, the use of RFA is mostly restricted to small tumours, especially those <3cm in diameter. This paper discusses the state-of-the-art of RFA, drawn from experimental and clinical results, for large tumours (i.e. ⩾3cm in diameter). In particular, the paper analyses clinical results related to target tissue necrosis (TTN) and mathematical modelling of the RFA procedure to understand the mechanism whereby the TTN is limited to under 3cm with RFA. This paper also discusses a strategy of controlling of the temperature of target tissue in the RFA procedure with the state-of-art device, which has the potential to increase the size of TTN. This paper ends with a discussion of some future ideas to solve the so-called 3-cm problem with RFA.
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Hepatic radiofrequency ablation: markedly reduced systemic effects by modulating periablational inflammation via cyclooxygenase-2 inhibition. Eur Radiol 2016; 27:1238-1247. [DOI: 10.1007/s00330-016-4405-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 05/03/2016] [Accepted: 05/12/2016] [Indexed: 12/16/2022]
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Yang W, Cui M, Lee J, Gong W, Wang S, Fu J, Wu G, Yan K. Heat shock protein inhibitor, quercetin, as a novel adjuvant agent to improve radiofrequency ablation-induced tumor destruction and its molecular mechanism. Chin J Cancer Res 2016; 28:19-28. [PMID: 27041924 DOI: 10.3978/j.issn.1000-9604.2016.02.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We investigated the effect of a small molecular inhibitor of heat shock protein (HSP), quercetin, on tumor radiofrequency (RF) ablation, and explored the underlying molecular mechanisms. METHODS In in vivo study, rats with R3230 breast adenocarcinoma were sacrificed 24 h post-treatment and gross coagulation areas were compared, and next, randomized into four treatment arms (control, quercetin alone, RF alone, and combination) for Kaplan-Meier analysis of defined endpoint survival. Then the distribution and expression levels of heat shock protein 70 (HSP70), cleaved caspase-3 and heat shock factor 1 (HSF1) were analyzed after different treatments. In in vitro study, we used quercetin to promote SK-HEP-1 (hepatic) and MCF-7 (breast) cancer cell apoptosis in heat shock cell model, and siRNA was used to block c-Jun and to explore the role of activating protein-1 (AP-1) signaling pathways. RESULTS We found the effects of quercetin plus RFA resulted in increase on the tumor destruction/endpoint survival (26.5±3.4 d) in vivo, compared with RF alone (17.6±2.5 d) and quercetin alone (15.7±3.1 d). Most importantly, quercetin-induced cancer cell death required the presence of HSF1 in animal model. Furthermore, quercetin directly down-regulated expression of HSF1 in vitro, which our findings have revealed, required the activation of AP-1 signaling pathways by loss-of-function analysis using siRNA mediated targeting of c-Jun. CONCLUSIONS These results indicated a protective role of quercetin in tumor ablation and highlighted a novel mechanism involving HSP70 with HSF1 pathway in thermal ablation of solid tumors.
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Affiliation(s)
- Wei Yang
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China ; 4 Department of Cardiovascular and Neurovascular, Guangzhou Medical University, Guangzhou 510182, China ; 5 Department of Oncology, The first Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Ming Cui
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China ; 4 Department of Cardiovascular and Neurovascular, Guangzhou Medical University, Guangzhou 510182, China ; 5 Department of Oncology, The first Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Jungchieh Lee
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China ; 4 Department of Cardiovascular and Neurovascular, Guangzhou Medical University, Guangzhou 510182, China ; 5 Department of Oncology, The first Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Wei Gong
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China ; 4 Department of Cardiovascular and Neurovascular, Guangzhou Medical University, Guangzhou 510182, China ; 5 Department of Oncology, The first Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Song Wang
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China ; 4 Department of Cardiovascular and Neurovascular, Guangzhou Medical University, Guangzhou 510182, China ; 5 Department of Oncology, The first Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Jingjing Fu
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China ; 4 Department of Cardiovascular and Neurovascular, Guangzhou Medical University, Guangzhou 510182, China ; 5 Department of Oncology, The first Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Gongxiong Wu
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China ; 4 Department of Cardiovascular and Neurovascular, Guangzhou Medical University, Guangzhou 510182, China ; 5 Department of Oncology, The first Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Kun Yan
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China ; 4 Department of Cardiovascular and Neurovascular, Guangzhou Medical University, Guangzhou 510182, China ; 5 Department of Oncology, The first Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
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Ahmed M, Kumar G, Moussa M, Wang Y, Rozenblum N, Galun E, Goldberg SN. Hepatic Radiofrequency Ablation-induced Stimulation of Distant Tumor Growth Is Suppressed by c-Met Inhibition. Radiology 2016; 279:103-17. [PMID: 26418615 PMCID: PMC4819900 DOI: 10.1148/radiol.2015150080] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To elucidate how hepatic radiofrequency (RF) ablation affects distant extrahepatic tumor growth by means of two key molecular pathways. MATERIALS AND METHODS Rats were used in this institutional animal care and use committee-approved study. First, the effect of hepatic RF ablation on distant subcutaneous in situ R3230 and MATBIII breast tumors was evaluated. Animals were randomly assigned to standardized RF ablation, sham procedure, or no treatment. Tumor growth rate was measured for 3½ to 7 days. Then, tissue was harvested for Ki-67 proliferative indexes and CD34 microvascular density. Second, hepatic RF ablation was performed for hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), and c-Met receptor expression measurement in periablational rim, serum, and distant tumor 24 hours to 7 days after ablation. Third, hepatic RF ablation was combined with either a c-Met inhibitor (PHA-665752) or VEGF receptor inhibitor (semaxanib) and compared with sham or drug alone arms to assess distant tumor growth and growth factor levels. Finally, hepatic RF ablation was performed in rats with c-Met-negative R3230 tumors for comparison with the native c-Met-positive line. Tumor size and immunohistochemical quantification at day 0 and at sacrifice were compared with analysis of variance and the two-tailed Student t test. Tumor growth curves before and after treatment were analyzed with linear regression analysis to determine mean slopes of pre- and posttreatment growth curves on a per-tumor basis and were compared with analysis of variance and paired two-tailed t tests. RESULTS After RF ablation of normal liver, distant R3230 tumors were substantially larger at 7 days compared with tumors treated with the sham procedure and untreated tumors, with higher growth rates and tumor cell proliferation. Similar findings were observed in MATBIII tumors. Hepatic RF ablation predominantly increased periablational and serum HGF and downstream distant tumor VEGF levels. Compared with RF ablation alone, RF ablation combined with adjuvant PHA-665752 or semaxanib reduced distant tumor growth, proliferation, and microvascular density. For c-Met-negative tumors, hepatic RF ablation did not increase distant tumor growth, proliferation, or microvascular density compared with sham treatment. CONCLUSION RF ablation of normal liver can stimulate distant subcutaneous tumor growth mediated by HGF/c-Met pathway and VEGF activation. This effect was not observed in c-Met-negative tumors and can be blocked with adjuvant c-Met and VEGF inhibitors.
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Affiliation(s)
- Muneeb Ahmed
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, WCC 308-B, Boston, MA 02215 (M.A., G.K., M.M., Y.W., S.N.G.); and Goldyne Savad Institute of Gene Therapy (N.R., E.G.) and Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Gaurav Kumar
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, WCC 308-B, Boston, MA 02215 (M.A., G.K., M.M., Y.W., S.N.G.); and Goldyne Savad Institute of Gene Therapy (N.R., E.G.) and Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Marwan Moussa
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, WCC 308-B, Boston, MA 02215 (M.A., G.K., M.M., Y.W., S.N.G.); and Goldyne Savad Institute of Gene Therapy (N.R., E.G.) and Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Yuanguo Wang
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, WCC 308-B, Boston, MA 02215 (M.A., G.K., M.M., Y.W., S.N.G.); and Goldyne Savad Institute of Gene Therapy (N.R., E.G.) and Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Nir Rozenblum
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, WCC 308-B, Boston, MA 02215 (M.A., G.K., M.M., Y.W., S.N.G.); and Goldyne Savad Institute of Gene Therapy (N.R., E.G.) and Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Eithan Galun
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, WCC 308-B, Boston, MA 02215 (M.A., G.K., M.M., Y.W., S.N.G.); and Goldyne Savad Institute of Gene Therapy (N.R., E.G.) and Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - S. Nahum Goldberg
- From the Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd, WCC 308-B, Boston, MA 02215 (M.A., G.K., M.M., Y.W., S.N.G.); and Goldyne Savad Institute of Gene Therapy (N.R., E.G.) and Division of Image-guided Therapy and Interventional Oncology, Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel
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Thermal Ablative Therapies and Immune Checkpoint Modulation: Can Locoregional Approaches Effect a Systemic Response? Gastroenterol Res Pract 2016; 2016:9251375. [PMID: 27051417 PMCID: PMC4802022 DOI: 10.1155/2016/9251375] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 02/16/2016] [Indexed: 02/08/2023] Open
Abstract
Percutaneous image-guided ablation is an increasingly common treatment for a multitude of solid organ malignancies. While historically these techniques have been restricted to the management of small, unresectable tumors, there is an expanding appreciation for the systemic effects these locoregional interventions can cause. In this review, we summarize the mechanisms of action for the most common thermal ablation modalities and highlight the key advances in knowledge regarding the interactions between thermal ablation and the immune system.
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Wang S, Mei XG, Goldberg SN, Ahmed M, Lee JC, Gong W, Han HB, Yan K, Yang W. Does Thermosensitive Liposomal Vinorelbine Improve End-Point Survival after Percutaneous Radiofrequency Ablation of Liver Tumors in a Mouse Model? Radiology 2016; 279:762-72. [PMID: 26785043 DOI: 10.1148/radiol.2015150787] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose To investigate the role of thermosensitive liposome-encapsulated vinorelbine (Thermo-Vin) in combined radiofrequency (RF) ablation of liver tumors. Materials and Methods Approval from the institutional animal care and use committee was obtained before this study. First, the anticancer efficacy of Thermo-Vin was assessed in vitro (H22 cells) for 72 hours at 37°C or 42°C. Next, 203 H22 liver adenocarcinomas were implanted in 191 mice for in vivo study. Tumors were randomized into seven groups: (a) no treatment, (b) treatment with RF ablation alone, (c) treatment with RF ablation followed by free vinorelbine (Free-Vin) at 30 minutes, (d) treatment with RF ablation followed by empty liposomes (Empty-Lip+RF), (e) treatment with RF ablation followed by Thermo-Vin (5 mg/kg), (f) treatment with RF ablation followed by Thermo-Vin (10 mg/kg), and (g) treatment with RF ablation followed by Thermo-Vin (20 mg/kg). Tumor destruction areas and pathologic changes were compared for different groups at 24 and 72 hours after treatment. Kaplan-Meier analysis was used to compare end-point survival (tumor < 30 mm in diameter). Additionally, the effect of initial tumor size on long-term outcome was analyzed. Results In vitro, both Free-Vin and Thermo-Vin dramatically inhibited H22 cell viability at 24 hours. Likewise, in vivo, 10 mg/kg Thermo-Vin+RF ablation increased tumor destruction compared with RF ablation (P = .001). Intratumoral vinorelbine accumulation with Thermo-Vin+RF increased 15-fold compared with Free-Vin alone. Thermo-Vin substantially increased apoptosis at the coagulation margin and suppressed cellular proliferation in the residual tumor (P < .001). The Thermo-Vin+RF study arm also had better survival than the arm treated with RF ablation alone (mean, 37.6 days ± 20.1 vs 23.4 days ± 5.0; P = .001), the arm treated with Free-Vin+RF (23.3 days ± 1.2, P = .002), or the arm treated with Empty-Lip+RF (20.8 days ± 0.4, P < .001) in animals with medium-sized (10-12-mm) tumors. No significant difference in end-point survival was noted in the treatment arms with large or small tumors. Conclusion Thermo-Vin can effectively increase tumor destruction and improve animal survival. End-point survival is most affected in animals with medium-sized tumors, suggesting that combination therapy should be tailored to tumor size and the expected volume of ablation of the device used. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Song Wang
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound (S.W., J.C.L., K.Y., W.Y.) and Department of Biobank (H.B.H.), Peking University Cancer Hospital and Institute, 52 Fucheng Rd, Haidian District, Beijing 100142, China; State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China (X.G.M., W.G.); Division of Image-guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.); and Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.N.G., M.A.)
| | - Xing-Guo Mei
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound (S.W., J.C.L., K.Y., W.Y.) and Department of Biobank (H.B.H.), Peking University Cancer Hospital and Institute, 52 Fucheng Rd, Haidian District, Beijing 100142, China; State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China (X.G.M., W.G.); Division of Image-guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.); and Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.N.G., M.A.)
| | - S Nahum Goldberg
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound (S.W., J.C.L., K.Y., W.Y.) and Department of Biobank (H.B.H.), Peking University Cancer Hospital and Institute, 52 Fucheng Rd, Haidian District, Beijing 100142, China; State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China (X.G.M., W.G.); Division of Image-guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.); and Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.N.G., M.A.)
| | - Muneeb Ahmed
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound (S.W., J.C.L., K.Y., W.Y.) and Department of Biobank (H.B.H.), Peking University Cancer Hospital and Institute, 52 Fucheng Rd, Haidian District, Beijing 100142, China; State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China (X.G.M., W.G.); Division of Image-guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.); and Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.N.G., M.A.)
| | - Jung-Chieh Lee
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound (S.W., J.C.L., K.Y., W.Y.) and Department of Biobank (H.B.H.), Peking University Cancer Hospital and Institute, 52 Fucheng Rd, Haidian District, Beijing 100142, China; State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China (X.G.M., W.G.); Division of Image-guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.); and Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.N.G., M.A.)
| | - Wei Gong
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound (S.W., J.C.L., K.Y., W.Y.) and Department of Biobank (H.B.H.), Peking University Cancer Hospital and Institute, 52 Fucheng Rd, Haidian District, Beijing 100142, China; State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China (X.G.M., W.G.); Division of Image-guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.); and Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.N.G., M.A.)
| | - Hai-Bo Han
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound (S.W., J.C.L., K.Y., W.Y.) and Department of Biobank (H.B.H.), Peking University Cancer Hospital and Institute, 52 Fucheng Rd, Haidian District, Beijing 100142, China; State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China (X.G.M., W.G.); Division of Image-guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.); and Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.N.G., M.A.)
| | - Kun Yan
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound (S.W., J.C.L., K.Y., W.Y.) and Department of Biobank (H.B.H.), Peking University Cancer Hospital and Institute, 52 Fucheng Rd, Haidian District, Beijing 100142, China; State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China (X.G.M., W.G.); Division of Image-guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.); and Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.N.G., M.A.)
| | - Wei Yang
- From the Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Ultrasound (S.W., J.C.L., K.Y., W.Y.) and Department of Biobank (H.B.H.), Peking University Cancer Hospital and Institute, 52 Fucheng Rd, Haidian District, Beijing 100142, China; State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China (X.G.M., W.G.); Division of Image-guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel (S.N.G.); and Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.N.G., M.A.)
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Parry TL, Hayward R. Exercise training does not affect anthracycline antitumor efficacy while attenuating cardiac dysfunction. Am J Physiol Regul Integr Comp Physiol 2015; 309:R675-83. [PMID: 26246505 DOI: 10.1152/ajpregu.00185.2015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 08/03/2015] [Indexed: 11/22/2022]
Abstract
Highly effective anthracyclines, like doxorubicin (DOX), have limited clinical use due to protracted cardiotoxic effects. While exercise is known to be cardioprotective, it is unclear whether exercise compromises chemotherapy treatment efficacy. To determine the effect of exercise training on DOX antitumor efficacy as well as DOX-induced cardiotoxicity, female Fisher 344 rats were randomly assigned to sedentary + saline (SED+SAL), SED+DOX, wheel run exercise training + SAL (WR+SAL), or WR+DOX. On week 11, animals were inoculated with 1×10(6) MatBIII tumor cells. Once tumors reached ∼1 cm in diameter, animals were treated with 12 mg/kg of DOX or SAL. Animals were killed 1, 3, or 5 days following treatment. Tumor growth and cardiac function were measured at each interval. DOX accumulation and multidrug resistance protein (MRP) expression were quantified in tumor and heart tissue. No significant difference (P > 0.05) existed between DOX-treated SED and WR groups for tumor measurements. Exercise preserved cardiac function up to 5 days following DOX treatment. Exercise reduced ventricular DOX accumulation and upregulated ventricular MPR1 and MPR2. In contrast, no differences were observed in DOX accumulation or MRP expression in tumors of SED and WR animals. Endurance exercise had no effect on DOX antitumor efficacy as evidenced by a definitive DOX-induced reduction in tumor growth in both the SED and WR groups. Although exercise did not affect the antitumor efficacy of DOX, it still provided protection against cardiac dysfunction. These effects may be mediated by the degree of DOX tissue accumulation secondary to the regulation of MRP expression.
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Affiliation(s)
- Traci L Parry
- School of Sport and Exercise Science, University of Northern Colorado, Greeley, Colorado; and Rocky Mountain Cancer Rehabilitation Institute, University of Northern Colorado, Greeley, Colorado
| | - Reid Hayward
- School of Sport and Exercise Science, University of Northern Colorado, Greeley, Colorado; and Rocky Mountain Cancer Rehabilitation Institute, University of Northern Colorado, Greeley, Colorado
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Rozenblum N, Zeira E, Bulvik B, Gourevitch S, Yotvat H, Galun E, Goldberg SN. Radiofrequency Ablation: Inflammatory Changes in the Periablative Zone Can Induce Global Organ Effects, including Liver Regeneration. Radiology 2015; 276:416-25. [DOI: 10.1148/radiol.15141918] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Ahmed M, Kumar G, Navarro G, Wang Y, Gourevitch S, Moussa MH, Rozenblum N, Levchenko T, Galun E, Torchilin VP, Goldberg SN. Systemic siRNA Nanoparticle-Based Drugs Combined with Radiofrequency Ablation for Cancer Therapy. PLoS One 2015; 10:e0128910. [PMID: 26154425 PMCID: PMC4495977 DOI: 10.1371/journal.pone.0128910] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/01/2015] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Radiofrequency thermal ablation (RFA) of hepatic and renal tumors can be accompanied by non-desired tumorigenesis in residual, untreated tumor. Here, we studied the use of micelle-encapsulated siRNA to suppress IL-6-mediated local and systemic secondary effects of RFA. METHODS We compared standardized hepatic or renal RFA (laparotomy, 1 cm active tip at 70 ± 2 °C for 5 min) and sham procedures without and with administration of 150 nm micelle-like nanoparticle (MNP) anti-IL6 siRNA (DOPE-PEI conjugates, single IP dose 15 min post-RFA, C57Bl mouse:3.5 ug/100ml, Fisher 344 rat: 20 ug/200 ul), RFA/scrambled siRNA, and RFA/empty MNPs. Outcome measures included: local periablational cellular infiltration (α-SMA+ stellate cells), regional hepatocyte proliferation, serum/tissue IL-6 and VEGF levels at 6-72 hr, and distant tumor growth, tumor proliferation (Ki-67) and microvascular density (MVD, CD34) in subcutaneous R3230 and MATBIII breast adenocarcinoma models at 7 days. RESULTS For liver RFA, adjuvant MNP anti-IL6 siRNA reduced RFA-induced increases in tissue IL-6 levels, α-SMA+ stellate cell infiltration, and regional hepatocyte proliferation to baseline (p < 0.04, all comparisons). Moreover, adjuvant MNP anti-IL6- siRNA suppressed increased distant tumor growth and Ki-67 observed in R3230 and MATBIII tumors post hepatic RFA (p<0.01). Anti-IL6 siRNA also reduced RFA-induced elevation in VEGF and tumor MVD (p < 0.01). Likewise, renal RFA-induced increases in serum IL-6 levels and distant R3230 tumor growth was suppressed with anti-IL6 siRNA (p < 0.01). CONCLUSIONS Adjuvant nanoparticle-encapsulated siRNA against IL-6 can be used to modulate local and regional effects of hepatic RFA to block potential unwanted pro-oncogenic effects of hepatic or renal RFA on distant tumor.
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Affiliation(s)
- Muneeb Ahmed
- Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd.–WCC-308B, Boston, Massachusetts, 02215, United States of America
- * E-mail:
| | - Gaurav Kumar
- Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd.–WCC-308B, Boston, Massachusetts, 02215, United States of America
| | - Gemma Navarro
- Department of Pharmaceutical Sciences and Center for Pharmaceutical Biotechnology and Nanomedicine, Northeastern University, 140 The Fenway, Boston, Massachusetts, 02115, United States of America
| | - Yuanguo Wang
- Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd.–WCC-308B, Boston, Massachusetts, 02215, United States of America
| | - Svetlana Gourevitch
- The Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Medical Center, Kiryat Hadassah POB 12000, Jerusalem, 91120, Israel
| | - Marwan H. Moussa
- Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd.–WCC-308B, Boston, Massachusetts, 02215, United States of America
| | - Nir Rozenblum
- The Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Medical Center, Kiryat Hadassah POB 12000, Jerusalem, 91120, Israel
| | - Tatyana Levchenko
- Department of Pharmaceutical Sciences and Center for Pharmaceutical Biotechnology and Nanomedicine, Northeastern University, 140 The Fenway, Boston, Massachusetts, 02115, United States of America
| | - Eithan Galun
- The Goldyne Savad Institute of Gene Therapy, Hadassah Hebrew University Medical Center, Kiryat Hadassah POB 12000, Jerusalem, 91120, Israel
| | - Vladimir P. Torchilin
- Department of Pharmaceutical Sciences and Center for Pharmaceutical Biotechnology and Nanomedicine, Northeastern University, 140 The Fenway, Boston, Massachusetts, 02115, United States of America
| | - S. Nahum Goldberg
- Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 1 Deaconess Rd.–WCC-308B, Boston, Massachusetts, 02215, United States of America
- Division of Image-guided Therapy and Interventional Oncology, Department of Radiology, Hadassah Hebrew University Medical Center, Kiryat Hadassah POB 12000, Jerusalem, 91120, Israel
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Hohenforst-Schmidt W, Zarogoulidis P, Stopek J, Vogl T, Hübner F, Turner JF, Browning R, Zarogoulidis K, Drevelegas A, Drevelegas K, Darwiche K, Freitag L, Rittger H. DDMC-p53 gene therapy with or without cisplatin and microwave ablation. Onco Targets Ther 2015; 8:1165-73. [PMID: 26056480 PMCID: PMC4446017 DOI: 10.2147/ott.s83794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Lung cancer remains the leading cause of death in cancer patients. Severe treatment side effects and late stage of disease at diagnosis continue to be an issue. We investigated whether local treatment using 2-diethylaminoethyl-dextran methyl methacrylate copolymer with p53 (DDMC-p53) with or without cisplatin and/or microwave ablation enhances disease control in BALBC mice. We used a Lewis lung carcinoma cell line to inoculate 140 BALBC mice, which were divided into the following seven groups; control, cisplatin, microwave ablation, DDMC-p53, DDMC-p53 plus cisplatin, DDMC-p53 plus microwave, and DDMC-p53 plus cisplatin plus microwave. Microwave ablation energy was administered at 20 W for 10 minutes. Cisplatin was administered as 1 mL/mg and the DDMC-p53 complex delivered was 0.5 mL. Increased toxicity was observed in the group receiving DDMC-p53 plus cisplatin plus microwave followed by the group receiving DDMC-p53 plus cisplatin. Infection after repeated treatment administration was a major issue. We conclude that a combination of gene therapy using DDMC-p53 with or without cisplatin and microwave is an alternative method for local disease control. However, more experiments are required in a larger model to identify the appropriate dosage profile.
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Affiliation(s)
| | - Paul Zarogoulidis
- Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Thomas Vogl
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany
| | - Frank Hübner
- II Medical Clinic, Coburg Hospital, University of Wuerzburg, Coburg, Germany
| | - J Francis Turner
- Division of Interventional Pulmonology, Western Regional Medical Center, Goodyear, AZ ; Medical Oncology, Cancer Treatment Centers of America, Western Regional Medical Center, Goodyear, AZ
| | - Robert Browning
- Pulmonary and Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, MD, USA
| | - Konstantinos Zarogoulidis
- Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonis Drevelegas
- Radiology Department, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | - Kaid Darwiche
- Department of interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Essen, Germany
| | - Lutz Freitag
- Department of interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Essen, Germany
| | - Harald Rittger
- Medical Clinic I, 'Fuerth Hospital, University of Erlangen, Erlangen, Germany
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Zhang S, Hu Y, Huang Y, Xu H, Wu G, Dai H. Heat shock protein 27 promotes cell proliferation through activator protein-1 in lung cancer. Oncol Lett 2015; 9:2572-2576. [PMID: 26137108 DOI: 10.3892/ol.2015.3073] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 03/05/2015] [Indexed: 12/21/2022] Open
Abstract
Heat shock protein 27 (HSP27) is an important regulator involved in the development of lung cancer. However, limited evidence exists concerning the underlying molecular mechanisms of its action. The results of the present study revealed that HSP27 was highly expressed in the lung cancer tissues of mice. In an in vitro model, the overexpression of HSP27 promoted cell proliferation, while HSP27 knockdown inhibited cell proliferation. HSP27 promoted cell proliferation in vitro by directly upregulating the expression of HSP27 target genes, which required the activation of the activator protein-1 (AP-1) signaling pathway. This was evaluated by the phosphorylation status of an important pathway component, c-Jun in lung cancer tissue and cells. These results suggested that HSP27 has a promotional role in lung cancer, and therefore indicated a novel mechanism involving lung cancer cell proliferation, which may underlie poor responses to therapy. Therefore, HSP27 may be a suitable therapeutic target for the treatment of lung cancer.
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Affiliation(s)
- Sai Zhang
- Department of Thoracic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Yangmin Hu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Yuwen Huang
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Huimin Xu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Gongxiong Wu
- Research Division, Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA
| | - Haibin Dai
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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Hohenforst-Schmidt W, Zarogoulidis P, Stopek J, Kosmidis E, Vogl T, Linsmeier B, Tsakiridis K, Lampaki S, Lazaridis G, Mpakas A, Browning R, Papaiwannou A, Drevelegas A, Baka S, Karavasilis V, Mpoukovinas I, Turner JF, Zarogoulidis K, Brachmann J. Enhancement of Intratumoral Chemotherapy with Cisplatin with or without Microwave Ablation and Lipiodol. Future Concept for Local Treatment in Lung Cancer. J Cancer 2015; 6:218-26. [PMID: 25663938 PMCID: PMC4317756 DOI: 10.7150/jca.10970] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 12/13/2014] [Indexed: 02/06/2023] Open
Abstract
Novel therapies for lung cancer are being explored nowadays with local therapies being the tip of the arrow. Intratumoral chemotherapy administration and local microwave ablation have been investigated in several studies. It has been previously proposed that lipiodol has the ability to modify the microenvironment matrix. In our current study we investigated this theory in BALBC mice. In total 160 BALBC mice were divided in eight groups: a) control, b) cisplatin, c) microwave, d) microwave and lipiodol, e) cisplatin and lipiodol, f) microwave and cisplatin, g) lipiodol and h) lipiodol, cisplatin and microwave. Lewis lung carcinoma cell lines (106) were injected into the right back leg of each mouse. After the 8th day, when the tumor volume was about 100mm3 the therapy application was initiated, once per week for four weeks. Magnetic resonance imaging was performed for each tumor when a mouse died or when sacrificed if they were still alive by the end of the experiment (8-Canal multifunctional spool; NORAS MRI products, Gmbh, Germany). Imaging and survival revealed efficient tumor apoptosis for the groups b,c,d,e and f. However; severe toxicity was observed in group h and no follow up was available for this group after the second week of therapy administration. Lipiodol in its current form does assist in a more efficient way the distribution of cisplatin, as the microwave apoptotic effect. Future modification of lipiodol might provide a more efficient method of therapy enhancement. Combination of drug and microwave ablation is possible and has an efficient apoptotic effect.
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Affiliation(s)
| | - Paul Zarogoulidis
- 2. Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Thomas Vogl
- 5. Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany
| | - Bernd Linsmeier
- 6. Department of Thoracic Surgery, Medinos Clinic Sonneberg, Sonnerberg, Germany
| | - Kosmas Tsakiridis
- 7. Department of Thoracic Surgery,"Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece
| | - Sofia Lampaki
- 2. Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Lazaridis
- 8. Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Mpakas
- 7. Department of Thoracic Surgery,"Saint Luke" Private Hospital, Panorama, Thessaloniki, Greece
| | - Robert Browning
- 9. Pulmonary & Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, U.S.A
| | - Antonis Papaiwannou
- 2. Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonis Drevelegas
- 10. Radiology Department, "Interbalkan European Medical Center", Τhessaloniki. Greece
| | - Sofia Baka
- 11. Oncology Department, "Interbalkan European Medical Center", Τhessaloniki. Greece
| | - Vasilis Karavasilis
- 8. Oncology Department, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - J Francis Turner
- 13. Division of Interventional Pulmonology & 2 Medical Oncology, Cancer Treatment Centers of America, Western Regional Medical Center, Goodyear, AZ
| | - Konstantinos Zarogoulidis
- 2. Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Johannes Brachmann
- 1. II Medical Clinic, "Coburg" Hospital, University of Wuerzburg, Coburg, Germany
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Microwave ablation plus chemotherapy improved progression-free survival of advanced non-small cell lung cancer compared to chemotherapy alone. Med Oncol 2015; 32:464. [PMID: 25572816 DOI: 10.1007/s12032-014-0464-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/16/2014] [Indexed: 01/13/2023]
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Radiofrequency ablation-induced upregulation of hypoxia-inducible factor-1α can be suppressed with adjuvant bortezomib or liposomal chemotherapy. J Vasc Interv Radiol 2014; 25:1972-82. [PMID: 25439675 DOI: 10.1016/j.jvir.2014.08.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To characterize upregulation of hypoxia-inducible factor (HIF)-1α after radiofrequency (RF) ablation and the influence of an adjuvant HIF-1α inhibitor (bortezomib) and nanodrugs on modulating RF ablation-upregulated hypoxic pathways. MATERIALS AND METHODS Fisher 344 rats (n = 68) were used. First, RF ablation-induced periablational HIF-1α expression was evaluated in normal liver or subcutaneous R3230 tumors (14-16 mm). Next, the effect of varying RF ablation thermal dose (varying tip temperature 50°C-90°C for 2-20 minutes) on HIF-1α expression was studied in R3230 tumors. Third, RF ablation was performed in R3230 tumors without or with an adjuvant HIF-1α inhibitor, bortezomib (single intraperitoneal dose 0.1 mg/kg). Finally, the combination RF ablation and intravenous liposomal chemotherapeutics with known increases in periablational cellular cytotoxicity (doxorubicin, paclitaxel, and quercetin) was assessed for effect on periablational HIF-1α. Outcome measures included immunohistochemistry of HIF-1α and heat shock protein 70 (marker of nonlethal thermal injury). RESULTS RF ablation increased periablational HIF-1α in both normal liver and R3230 tumor, peaking at 24-72 hours. Tumor RF ablation had similar HIF-1α rim thickness but significantly greater percent cell positivity compared with hepatic RF ablation (P < .001). HIF-1α after ablation was the same regardless of thermal dose. Bortezomib suppressed HIF-1α (rim thickness, 68.7 µm ± 21.5 vs 210.3 µm ± 85.1 for RF ablation alone; P < .02) and increased ablation size (11.0 mm ± 1.5 vs 7.7 mm ± 0.6 for RF ablation alone; P < .002). Finally, all three nanodrugs suppressed RF ablation-induced HIF-1α (ie, rim thickness and cell positivity; P < .02 for all comparisons), with liposomal doxorubicin suppressing HIF-1α the most (P < .03). CONCLUSIONS RF ablation upregulates HIF-1α in normal liver and tumor in a temperature-independent manner. This progrowth, hypoxia pathway can be successfully suppressed with an adjuvant HIF-1α-specific inhibitor, bortezomib, or non-HIF-1α-specific liposomal chemotherapy.
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Image-guided interventional therapy for cancer with radiotherapeutic nanoparticles. Adv Drug Deliv Rev 2014; 76:39-59. [PMID: 25016083 DOI: 10.1016/j.addr.2014.07.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/09/2014] [Accepted: 07/01/2014] [Indexed: 12/18/2022]
Abstract
One of the major limitations of current cancer therapy is the inability to deliver tumoricidal agents throughout the entire tumor mass using traditional intravenous administration. Nanoparticles carrying beta-emitting therapeutic radionuclides that are delivered using advanced image-guidance have significant potential to improve solid tumor therapy. The use of image-guidance in combination with nanoparticle carriers can improve the delivery of localized radiation to tumors. Nanoparticles labeled with certain beta-emitting radionuclides are intrinsically theranostic agents that can provide information regarding distribution and regional dosimetry within the tumor and the body. Image-guided thermal therapy results in increased uptake of intravenous nanoparticles within tumors, improving therapy. In addition, nanoparticles are ideal carriers for direct intratumoral infusion of beta-emitting radionuclides by convection enhanced delivery, permitting the delivery of localized therapeutic radiation without the requirement of the radionuclide exiting from the nanoparticle. With this approach, very high doses of radiation can be delivered to solid tumors while sparing normal organs. Recent technological developments in image-guidance, convection enhanced delivery and newly developed nanoparticles carrying beta-emitting radionuclides will be reviewed. Examples will be shown describing how this new approach has promise for the treatment of brain, head and neck, and other types of solid tumors.
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Nanodrug-enhanced radiofrequency tumor ablation: effect of micellar or liposomal carrier on drug delivery and treatment efficacy. PLoS One 2014; 9:e102727. [PMID: 25133740 PMCID: PMC4136708 DOI: 10.1371/journal.pone.0102727] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/21/2014] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To determine the effect of different drug-loaded nanocarriers (micelles and liposomes) on delivery and treatment efficacy for radiofrequency ablation (RFA) combined with nanodrugs. MATERIALS/METHODS Fischer 344 rats were used (n = 196). First, single subcutaneous R3230 tumors or normal liver underwent RFA followed by immediate administration of i.v. fluorescent beads (20, 100, and 500 nm), with fluorescent intensity measured at 4-24 hr. Next, to study carrier type on drug efficiency, RFA was combined with micellar (20 nm) or liposomal (100 nm) preparations of doxorubicin (Dox; targeting HIF-1α) or quercetin (Qu; targeting HSP70). Animals received RFA alone, RFA with Lipo-Dox or Mic-Dox (1 mg i.v., 15 min post-RFA), and RFA with Lipo-Qu or Mic-Qu given 24 hr pre- or 15 min post-RFA (0.3 mg i.v.). Tumor coagulation and HIF-1α or HSP70 expression were assessed 24 hr post-RFA. Third, the effect of RFA combined with i.v. Lipo-Dox, Mic-Dox, Lipo-Qu, or Mic-Qu (15 min post-RFA) compared to RFA alone on tumor growth and animal endpoint survival was evaluated. Finally, drug uptake was compared between RFA/Lipo-Dox and RFA/Mic-Dox at 4-72 hr. RESULTS Smaller 20 nm beads had greater deposition and deeper tissue penetration in both tumor (100 nm/500 nm) and liver (100 nm) (p<0.05). Mic-Dox and Mic-Qu suppressed periablational HIF-1α or HSP70 rim thickness more than liposomal preparations (p<0.05). RFA/Mic-Dox had greater early (4 hr) intratumoral doxorubicin, but RFA/Lipo-Dox had progressively higher intratumoral doxorubicin at 24-72 hr post-RFA (p<0.04). No difference in tumor growth and survival was seen between RFA/Lipo-Qu and RFA/Mic-Qu. Yet, RFA/Lipo-Dox led to greater animal endpoint survival compared to RFA/Mic-Dox (p<0.03). CONCLUSION With RF ablation, smaller particle micelles have superior penetration and more effective local molecular modulation. However, larger long-circulating liposomal carriers can result in greater intratumoral drug accumulation over time and reduced tumor growth. Accordingly, different carriers provide specific advantages, which should be considered when formulating optimal combination therapies.
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Li S, He N, Li W, Wu PH. Debulking treatment with CT-guided percutaneous radiofrequency ablation and hepatic artery infusion of floxuridine improves survival of patients with unresectable pulmonary and hepatic metastases of colorectal cancer. CHINESE JOURNAL OF CANCER 2014; 33:295-305. [PMID: 24823993 PMCID: PMC4059867 DOI: 10.5732/cjc.013.10191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The survival of most patients with both unresectable hepatic and pulmonary metastases of colorectal cancer is poor. In this retrospective study, we investigated the efficacy of computed tomography (CT)-guided radiofrequency ablation (RFA) and systemic chemotherapy plus hepatic artery infusion of floxuridine (HAI-FUDR). Sixty-one patients were selected from 1,136 patients with pulmonary and hepatic metastases from colorectal cancer. Patients were treated with RFA and systemic chemotherapy plus HAI-FUDR (ablation group, n = 39) or systemic chemotherapy plus HAI-FUDR (FUDR group, n = 22). Patients in the two groups were matched by sex, age, number of metastases, and calendar year of RFA or FUDR. Survival data were evaluated by using univariate and multivariate analyses. Clinical characteristics were comparable between the two groups. All patients in the ablation group underwent RFA and chemotherapy. Median follow-up was 56.8 months. The 1-, 3-, and 5-year overall survival (OS) rates were 97%, 64%, and 37%, respectively, for the ablation group, and 82%, 32%, and 19%, respectively, for the FUDR group. The 1-, 3-, and 5-year survival rates after metastasis were 97%, 49%, and 26% for the ablation group, and 72%, 24%, and 24% for the FUDR group, respectively. The median OS times were 45 and 25 months for the ablation and FUDR groups, respectively. In the multivariate analysis, treatment allocation was a favorable independent prognostic factor for OS (P = 0.001) and survival after metastasis (P = 0.009). These data suggest that the addition of RFA to systemic chemotherapy plus HAI-FUDR improves the survival of patients with both unresectable hepatic and pulmonary metastases from colorectal cancer.
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Affiliation(s)
- Sheng Li
- Department of Medical Imaging & Interventional Radiology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China.
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Therapeutic efficacy of combining pegylated liposomal doxorubicin and radiofrequency (RF) ablation: comparison between slow-drug-releasing, non-thermosensitive and fast-drug-releasing, thermosensitive nano-liposomes. PLoS One 2014; 9:e92555. [PMID: 24786533 PMCID: PMC4006748 DOI: 10.1371/journal.pone.0092555] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 02/25/2014] [Indexed: 11/19/2022] Open
Abstract
AIMS To determine how the accumulation of drug in mice bearing an extra-hepatic tumor and its therapeutic efficacy are affected by the type of PEGylated liposomal doxorubicin used, treatment modality, and rate of drug release from the liposomes, when combined with radiofrequency (RF) ablation. MATERIALS AND METHODS Two nano-drugs, both long-circulating PEGylated doxorubicin liposomes, were formulated: (1) PEGylated doxorubicin in thermosensitive liposomes (PLDTS), having a burst-type fast drug release above the liposomes' solid ordered to liquid disordered phase transition (at 42°C), and (2) non-thermosensitive PEGylated doxorubicin liposomes (PLDs), having a slow and continuous drug release. Both were administered intravenously at 8 mg/kg doxorubicin dose to tumor-bearing mice. Animals were divided into 6 groups: no treatment, PLD, RF, RF+PLD, PLDTS, and PLDTS+RF, for intra-tumor doxorubicin deposition at 1, 24, and 72 h post-injection (in total 41, mice), and 31 mice were used for randomized survival studies. RESULTS Non-thermosensitive PLD combined with RF had the least tumor growth and the best end-point survival, better than PLDTS+RF (p<0.005) or all individual therapies (p<0.001). Although at 1 h post-treatment the greatest amount of intra-tumoral doxorubicin was seen following PLDTS+RF (p<0.05), by 24 and 72 h the greatest doxorubicin amount was seen for PLD+RF (p<0.05); in this group the tumor also has the longest exposure to doxorubicin. CONCLUSION Optimizing therapeutic efficacy of PLD requires a better understanding of the relationship between the effect of RF on tumor microenvironment and liposome drug release profile. If drug release is too fast, the benefit of changing the microenvironment by RF on tumor drug localization and therapeutic efficacy may be much smaller than for PLDs having slow and temperature-independent drug release. Thus the much longer circulation time of doxorubicin from PLD than from PLDTS may be beneficial in many therapeutic instances, especially in extra-hepatic tumors.
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Goldberg SN. Science to practice: why debate the role of Dbait for improving tumor ablation? Radiology 2014; 270:635-7. [PMID: 24568699 DOI: 10.1148/radiol.13132824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this basic research study, Devun et al report an interesting set of experimental studies that document that adjuvant administration of Dbait, a DNA repair inhibitor, can be used to increase cytotoxicity of hyperthermia in in vitro cell lines and the effectiveness of tumor ablation from a given radiofrequency ablation application, including increased animal survival. The key novelty of this study lies in the use of this agent to take advantage of the ability of radiofrequency ablation to, at least temporarily, damage DNA. As such, the work has practical application and follows the line of study combining tumor ablation (and especially, the lower-dose reversible hyperthermia that surrounds a coagulated zone) with mechanism-based agents targeted to potentially reversible processes.
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Affiliation(s)
- S Nahum Goldberg
- Image-guided Therapy and Interventional Oncology Unit, Department of Radiology Hadassah Hebrew University Medical Center Ein Karem Jerusalem, Israel Minimally Invasive Tumor Therapy Laboratory Section of Interventional Radiology Department of Radiology Beth Israel Deaconess Medical Center/Harvard Medical School 330 Brookline Ave Boston, MA 02215
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Thompson SM, Callstrom MR, Butters KA, Knudsen B, Grande JP, Roberts LR, Woodrum DA. Heat stress induced cell death mechanisms in hepatocytes and hepatocellular carcinoma: in vitro and in vivo study. Lasers Surg Med 2014; 46:290-301. [PMID: 24643941 DOI: 10.1002/lsm.22231] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2014] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVE The aims of the present study were to investigate the thermal-dose dependent effect of heat stress on hepatocyte and HCC cell death mechanisms using clinically relevant experimental heat stress conditions in vitro and to investigate apoptotic cell death induced by laser thermal ablation in vivo. STUDY DESIGN/MATERIALS AND METHODS Institutional Animal Care and Use Committee approved all studies. Hepatocyte and HCC cell lines were heat stressed from 37 to 60°C for 2 or 10 minutes and assessed for viability, cytotoxicity and caspase-3/7 activity at 6 and/or 24 hours post-treatment (N = 3). Viability experiments were repeated with the RIPK1 inhibitor Necrostatin-1 to block necroptosis (N = 3). Rats with orthotopic HCC tumors stably expressing luciferase (N1S1luc2) were randomized to US-guided laser ablation (3W-45s for an intentional partial ablation; N = 6) or sham (N = 6) and followed by post-ablation caspase-3/7 bioluminescence imaging at 6 and 24 hours and cleaved caspase-3 immunostaining. P < 0.05 was considered statistically significant. RESULTS Heat-stress induced apoptosis and necrosis in hepatocytes and HCC cells in a thermal dose and cell-type dependent manner. Inhibition of RIPIK1-mediated necroptosis induced a significant, differential increase in HCC cell viability under physiologic and hyperthermic heat stress (P < 0.001). Intentional partial laser thermal ablation induced a significant increase in caspase-3/7 activity in the laser versus sham ablation groups at both 6 hours (10.1-fold, P < 0.01) and 24 hours (16.7-fold, P < 0.02). Immunohistochemistry confirmed increased cleaved caspase-3 staining at the tumor ablation margin 24 hours post-ablation. CONCLUSIONS Both regulated and non-regulated cell death mechanisms mediate heat stress-induced HCC cell killing and vary between hepatocytes and HCC subtypes. Apoptosis is a significant mechanism of cell death at the HCC tumor ablation margin.
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Affiliation(s)
- Scott M Thompson
- Medical Scientist Training Program, Mayo Clinic, Rochester, Minnesota
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Abstract
Minimally invasive thermal ablation of tumours has become common since the advent of modern imaging. From the ablation of small, unresectable tumours to experimental therapies, percutaneous radiofrequency ablation, microwave ablation, cryoablation and irreversible electroporation have an increasing role in the treatment of solid neoplasms. This Opinion article examines the mechanisms of tumour cell death that are induced by the most common thermoablative techniques and discusses the rapidly developing areas of research in the field, including combinatorial ablation and immunotherapy, synergy with conventional chemotherapy and radiation, and the development of a new ablation modality in irreversible electroporation.
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Affiliation(s)
- Katrina F Chu
- The Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy Street, Providence, Rhode Island 02903, USA
| | - Damian E Dupuy
- The Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy Street, Providence, Rhode Island 02903, USA
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Molecular bioluminescence imaging as a noninvasive tool for monitoring tumor growth and therapeutic response to MRI-guided laser ablation in a rat model of hepatocellular carcinoma. Invest Radiol 2014; 48:413-21. [PMID: 23262791 DOI: 10.1097/rli.0b013e31827a4a3f] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The objective of this study was to quantitatively compare tumor imaging by magnetic resonance imaging (MRI) and molecular bioluminescence imaging (BLI) and test the feasibility of monitoring the effect of MRI-guided laser ablation on tumor viability by 2-dimensional BLI and 3-dimensional diffuse luminescence tomography (3D DLIT) in an orthotopic rat model of hepatocellular carcinoma. MATERIALS AND METHODS This study was approved by the animal care committee. Rats underwent injection of N1S1 cells stably transfected with an empty vector (n = 3) or a heat shock element luciferase reporter (HSE-luc; n = 4) into the liver. All rats underwent MRI to assess tumor establishment and volume and 2-dimensional BLI to assess tumor luminescence at day 7 with subsequent MRI and 2D BLI and 3D DLIT in select animals at days 14 and 21. Magnetic resonance imaging-guided laser ablation of the tumor was performed with preablation and postablation 2D BLI and/or 3D DLIT (n = 2). The tumors underwent histopathologic analysis to assess tumor viability. RESULTS The MRI scans demonstrated hyperintense T2-weighted lesions at 3 of 3 and 4 of 4 sites in the empty vector and HSE-luc rats, respectively. Two-dimensional BLI quantitation demonstrated 23.0-fold higher radiance in the HSE-luc group compared with the empty vector group at day 7 (P < 0.01) and a significant correlation with tumor volume by MRI (r = 0.86; P < 0.03). Tumor dimensions by 3D DLIT and MRI demonstrated good agreement. Three-dimensional DLIT quantitation demonstrated better agreement with the percentage of nonviable tumor by histopathology than did 2D BLI quantitation after the MRI-guided laser ablation. CONCLUSIONS Bioluminescence imaging is feasible as a noninvasive, quantitative tool for monitoring tumor growth and therapeutic response to thermal ablation in a rat model of hepatocellular carcinoma.
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Moussa M, Goldberg SN, Tasawwar B, Sawant RR, Levchenko T, Kumar G, Torchilin VP, Ahmed M. Adjuvant liposomal doxorubicin markedly affects radiofrequency ablation-induced effects on periablational microvasculature. J Vasc Interv Radiol 2013; 24:1021-33. [PMID: 23664809 DOI: 10.1016/j.jvir.2013.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/05/2013] [Accepted: 03/06/2013] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate the effects of radiofrequency (RF) ablation without and with adjuvant intravenous (IV) liposomal doxorubicin (Doxil) on microvessel morphology and patency and intratumoral drug delivery and retention. MATERIALS AND METHODS There were 133 tumors/animals used in this experiment. First, single subcutaneous tumors (R3230 in Fischer rats and 786-0 in nude mice) were randomly assigned to receive RF ablation alone or no treatment and sacrificed 0-72 hours after treatment. Next, combined RF ablation and liposomal doxorubicin (1 mg given 15 min after RF ablation) was studied in R3230 tumors at 0-72 hours after treatment. Histopathologic assessment, including immunohistochemical staining for cleaved caspase-3, heat-shock protein 70, and CD34, was performed to assess morphologic vessel appearance, vessel diameter, and microvascular density. Subsequently, tumors were randomly assigned to receive RF ablation alone, RF ablation and liposomal doxorubicin, or no treatment (control tumors), followed by IV fluorescent-labeled liposomes (a surrogate marker) given 0-24 hours after RF ablation to permit qualitative assessment. RESULTS RF ablation alone resulted in enlarged and dysmorphic vessels from 0-4 hours, peaking at 12-24 hours after RF ablation, occurring preferentially closer to the electrode. The addition of doxorubicin resulted in earlier vessel contraction (mean vessel area, 47,539 μm(2)±9,544 vs 1,854 μm(2)±458 for RF ablation alone at 15 min; P<.05). Combined RF ablation and liposomal doxorubicin produced similar fluorescence 1 hour after treatment (40.88 AU/μm(2)±33.53 vs 22.1 AU/μm(2)±13.19; P = .14) but significantly less fluorescence at 4 hours (24.3 AU/μm(2)±3.65 vs 2.8 AU/μm(2)±3.14; P<.002) compared with RF ablation alone denoting earlier reduction in microvascular patency. CONCLUSIONS RF ablation induces morphologic changes to vessels within the ablation zone lasting 12-24 hours after treatment. The addition of liposomal doxorubicin causes early vessel contraction and a reduction in periablational microvascular patency. Such changes would likely need to be considered when determining optimal drug administration and imaging paradigms.
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Affiliation(s)
- Marwan Moussa
- Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, USA
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Ta T, Porter TM. Thermosensitive liposomes for localized delivery and triggered release of chemotherapy. J Control Release 2013; 169:112-25. [PMID: 23583706 DOI: 10.1016/j.jconrel.2013.03.036] [Citation(s) in RCA: 230] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 03/29/2013] [Accepted: 03/30/2013] [Indexed: 01/07/2023]
Abstract
Liposomes are a promising class of nanomedicine with the potential to provide site-specific chemotherapy, thus improving the quality of cancer patient care. First-generation liposomes have emerged as one of the first nanomedicines used clinically for localized delivery of chemotherapy. Second-generation liposomes, i.e. stimuli-responsive liposomes, have the potential to not only provide site-specific chemotherapy, but also triggered drug release and thus greater spatial and temporal control of therapy. Temperature-sensitive liposomes are an especially attractive option, as tumors can be heated in a controlled and predictable manner with external energy sources. Traditional thermosensitive liposomes are composed of lipids that undergo a gel-to-liquid phase transition at several degrees above physiological temperature. More recently, temperature-sensitization of liposomes has been demonstrated with the use of lysolipids and synthetic temperature-sensitive polymers. The design, drug release behavior, and clinical potential of various temperature-sensitive liposomes, as well as the various heating modalities used to trigger release, are discussed in this review.
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Affiliation(s)
- Terence Ta
- Department of Biomedical Engineering, Boston University, 44 Cummington St., Room 403, Boston, USA.
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Dewhirst MW, Landon CD, Hofmann CL, Stauffer PR. Novel approaches to treatment of hepatocellular carcinoma and hepatic metastases using thermal ablation and thermosensitive liposomes. Surg Oncol Clin N Am 2013; 22:545-61. [PMID: 23622079 DOI: 10.1016/j.soc.2013.02.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Because of the limitations of surgical resection, thermal ablation is commonly used for the treatment of hepatocellular carcinoma and liver metastases. Current methods of ablation can result in marginal recurrences of larger lesions and in tumors located near large vessels. This review presents a novel approach for extending treatment out to the margins where temperatures do not provide complete treatment with ablation alone, by combining thermal ablation with drug-loaded thermosensitive liposomes. A history of the development of thermosensitive liposomes is presented. Clinical trials have shown that the combination of radiofrequency ablation and doxorubicin-loaded thermosensitive liposomes is a promising treatment.
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Affiliation(s)
- Mark W Dewhirst
- Radiation Oncology Department, Duke University Medical Center, Durham, NC 27710, USA.
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Cheng JW, Lv Y. New progress of non-surgical treatments for hepatocellular carcinoma. Med Oncol 2013; 30:381. [PMID: 23292867 DOI: 10.1007/s12032-012-0381-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 12/11/2012] [Indexed: 02/07/2023]
Abstract
Many non-surgical treatments of hepatocellular carcinoma (HCC) have significantly improved in the last few decades and have shown survival benefits for selected patients with HCC. Today ablation can improve survival in individuals diagnosed in early HCC and even offer a curative treatment in selected candidates. Patients with intermediate-stage HCC benefit from transarterial chemoembolization (TACE). Drug-eluting bead transarterial chemoembolization (DEB-TACE) has shown a better combined ischemic and cytotoxic effect locally and less system toxicity when compared with conventional TACE. Those diagnosed at advanced stage benefit from sorafenib. In addition to TACE and sorafenib which could improve survival for selected patients, three-dimensional conformal radiotherapy treatment (3-DCRT), selection internal radiation therapy and systemic chemotherapy have also shown anti-tumor activity in the treatment of advanced HCC, but their survival benefit have not been proven. The limited effects of single therapy suggested that the combination would enhance the overall treatment effect. Other potential non-surgical therapies like gene therapy and immunotherapy are still in testing phases, except for some small-scale clinical trials which have been reported to show some beneficial effect. Here, we review the current non-surgical treatments in HCC and the new advances in this field.
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Affiliation(s)
- Ji-Wen Cheng
- Department of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, 76 Yanta West Road, Xi'an 710061, People's Republic of China.
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