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Aebisher D, Woźnicki P, Czarnecka-Czapczyńska M, Dynarowicz K, Szliszka E, Kawczyk-Krupka A, Bartusik-Aebisher D. Molecular Determinants for Photodynamic Therapy Resistance and Improved Photosensitizer Delivery in Glioma. Int J Mol Sci 2024; 25:8708. [PMID: 39201395 PMCID: PMC11354549 DOI: 10.3390/ijms25168708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Gliomas account for 24% of all the primary brain and Central Nervous System (CNS) tumors. These tumors are diverse in cellular origin, genetic profile, and morphology but collectively have one of the most dismal prognoses of all cancers. Work is constantly underway to discover a new effective form of glioma therapy. Photodynamic therapy (PDT) may be one of them. It involves the local or systemic application of a photosensitive compound-a photosensitizer (PS)-which accumulates in the affected tissues. Photosensitizer molecules absorb light of the appropriate wavelength, initiating the activation processes leading to the formation of reactive oxygen species and the selective destruction of inappropriate cells. Research focusing on the effective use of PDT in glioma therapy is already underway with promising results. In our work, we provide detailed insights into the molecular changes in glioma after photodynamic therapy. We describe a number of molecules that may contribute to the resistance of glioma cells to PDT, such as the adenosine triphosphate (ATP)-binding cassette efflux transporter G2, glutathione, ferrochelatase, heme oxygenase, and hypoxia-inducible factor 1. We identify molecular targets that can be used to improve the photosensitizer delivery to glioma cells, such as the epithelial growth factor receptor, neuropilin-1, low-density lipoprotein receptor, and neuropeptide Y receptors. We note that PDT can increase the expression of some molecules that reduce the effectiveness of therapy, such as Vascular endothelial growth factor (VEGF), glutamate, and nitric oxide. However, the scientific literature lacks clear data on the effects of PDT on many of the molecules described, and the available reports are often contradictory. In our work, we highlight the gaps in this knowledge and point to directions for further research that may enhance the efficacy of PDT in the treatment of glioma.
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Affiliation(s)
- David Aebisher
- Department of Photomedicine and Physical Chemistry, Medical College of The Rzeszów University, 35-310 Rzeszów, Poland
| | - Paweł Woźnicki
- English Division Science Club, Medical College of The Rzeszów University, 35-310 Rzeszów, Poland;
| | - Magdalena Czarnecka-Czapczyńska
- Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Batorego 15 Street, 41-902 Bytom, Poland;
| | - Klaudia Dynarowicz
- Center for Innovative Research in Medical and Natural Sciences, Medical College of The University of Rzeszów, 35-310 Rzeszów, Poland;
| | - Ewelina Szliszka
- Department of Microbiology and Immunology, Medical University of Silesia, Poniatowskiego 15, 40-055 Katowice, Poland;
| | - Aleksandra Kawczyk-Krupka
- Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Batorego 15 Street, 41-902 Bytom, Poland;
| | - Dorota Bartusik-Aebisher
- Department of Biochemistry and General Chemistry, Medical College of The Rzeszów University, 35-310 Rzeszów, Poland;
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Johanssen VA, Ruan JL, Vince O, Thomas A, Peeters S, Soto MS, Buck J, Gray M, Stride E, Sibson NR. Targeted opening of the blood-brain barrier using VCAM-1 functionalised microbubbles and "whole brain" ultrasound. Theranostics 2024; 14:4076-4089. [PMID: 38994029 PMCID: PMC11234285 DOI: 10.7150/thno.93172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/26/2024] [Indexed: 07/13/2024] Open
Abstract
Metastatic tumours in the brain now represent one of the leading causes of death from cancer. Current treatments are largely ineffective owing to the combination of late diagnosis and poor delivery of therapies across the blood-brain barrier (BBB). Conjugating magnetic resonance imaging (MRI) contrast agents with a monoclonal antibody for VCAM-1 (anti-VCAM1) has been shown to enable detection of micrometastases, two to three orders of magnitude smaller in volume than those currently detectable clinically. The aim of this study was to exploit this targeting approach to enable localised and temporary BBB opening at the site of early-stage metastases using functionalised microbubbles and ultrasound. Methods: Microbubbles functionalised with anti-VCAM1 were synthesised and shown to bind to VCAM-1-expressing cells in vitro. Experiments were then conducted in vivo in a unilateral breast cancer brain metastasis mouse model using Gadolinium-DTPA (Gd-DTPA) enhanced MRI to detect BBB opening. Following injection of Gd-DTPA and targeted microbubbles, the whole brain volume was simultaneously exposed to ultrasound (0.5 MHz, 10% duty cycle, 0.7 MPa peak negative pressure, 2 min treatment time). T1-weighted MRI was then performed to identify BBB opening, followed by histological confirmation via immunoglobulin G (IgG) immunohistochemistry. Results: In mice treated with targeted microbubbles and ultrasound, statistically significantly greater extravasation of Gd-DTPA and IgG was observed in the left tumour-bearing hemisphere compared to the right hemisphere 5 min after treatment. No acute adverse effects were observed. There was no investigation of longer term bioeffects owing to the nature of the study. Conclusion: The results demonstrate the feasibility of using targeted microbubbles in combination with low intensity ultrasound to localise opening of the BBB to metastatic sites in the brain. This approach has potential application in the treatment of metastatic tumours whose location cannot be established a priori with conventional imaging methods.
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Affiliation(s)
| | - Jia-Ling Ruan
- Department of Oncology, University of Oxford, Oxford, UK
| | - Oliver Vince
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, UK
| | - Alec Thomas
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, UK
| | - Sarah Peeters
- Department of Oncology, University of Oxford, Oxford, UK
| | | | - Jessica Buck
- Department of Oncology, University of Oxford, Oxford, UK
| | - Michael Gray
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, UK
| | - Eleanor Stride
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Research, University of Oxford, UK
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3
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Melemenidis S, Knight JC, Kersemans V, Perez-Balderas F, Zarghami N, Soto MS, Cornelissen B, Muschel RJ, Sibson NR. In Vivo PET Detection of Lung Micrometastasis in Mice by Targeting Endothelial VCAM-1 Using a Dual-Contrast PET/MRI Probe. Int J Mol Sci 2024; 25:7160. [PMID: 39000268 PMCID: PMC11241628 DOI: 10.3390/ijms25137160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/21/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Current clinical diagnostic imaging methods for lung metastases are sensitive only to large tumours (1-2 mm cross-sectional diameter), and early detection can dramatically improve treatment. We have previously demonstrated that an antibody-targeted MRI contrast agent based on microparticles of iron oxide (MPIO; 1 μm diameter) enables the imaging of endothelial vascular cell adhesion molecule-1 (VCAM-1). Using a mouse model of lung metastasis, upregulation of endothelial VCAM-1 expression was demonstrated in micrometastasis-associated vessels but not in normal lung tissue, and binding of VCAM-MPIO to these vessels was evident histologically. Owing to the lack of proton MRI signals in the lungs, we modified the VCAM-MPIO to include zirconium-89 (89Zr, t1/2 = 78.4 h) in order to allow the in vivo detection of lung metastases by positron emission tomography (PET). Using this new agent (89Zr-DFO-VCAM-MPIO), it was possible to detect the presence of micrometastases within the lung in vivo from ca. 140 μm in diameter. Histological analysis combined with autoradiography confirmed the specific binding of the agent to the VCAM-1 expressing vasculature at the sites of pulmonary micrometastases. By retaining the original VCAM-MPIO as the basis for this new molecular contrast agent, we have created a dual-modality (PET/MRI) agent for the concurrent detection of lung and brain micrometastases.
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Affiliation(s)
- Stavros Melemenidis
- Department of Radiation Oncology, Stanford School of Medicine, Cancer Institute, Stanford University, Stanford, CA 94305, USA;
| | - James C. Knight
- School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - Veerle Kersemans
- Clinical Nuclear Medicine Imaging, Siemens Healthineers, 2595 BN The Hague, The Netherlands;
| | | | - Niloufar Zarghami
- Department of Oncology, University of Oxford, Oxford OX3 7DQ, UK; (N.Z.); (R.J.M.)
| | - Manuel Sarmiento Soto
- Department of Biochemistry and Molecular Biology, University of Seville, 41004 Seville, Spain;
| | - Bart Cornelissen
- Department of Nuclear Medicine, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Ruth J. Muschel
- Department of Oncology, University of Oxford, Oxford OX3 7DQ, UK; (N.Z.); (R.J.M.)
| | - Nicola R. Sibson
- Department of Oncology, University of Oxford, Oxford OX3 7DQ, UK; (N.Z.); (R.J.M.)
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4
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Song L, Gao Y, Wang Z, Shi Y. Serum Levels of Intercellular Adhesion Molecule 1 and Vascular Cell Adhesion Molecule 1 as Biomarkers to Predict Radiotherapy Sensitivity in Cervical Cancer. Geburtshilfe Frauenheilkd 2024; 84:370-377. [PMID: 38618575 PMCID: PMC11006555 DOI: 10.1055/a-2275-0717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/22/2024] [Indexed: 04/16/2024] Open
Abstract
Background Cervical cancer is a significant global health burden, and individualized treatment approaches are necessary due to its heterogeneity. Radiotherapy is a common treatment modality; however, the response varies among patients. The identification of reliable biomarkers to predict radiotherapy sensitivity is crucial. Methods A cohort of 189 patients with stage IB2-IVA cervical cancer, treated with radiotherapy alone or concurrent chemoradiotherapy, was included. Serum samples were collected before treatment, and intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) concentrations were determined. Patients were categorized into radiotherapy-sensitive (RS) and radiotherapy-resistant (RR) groups based on treatment response. Clinicopathological characteristics and survival rates were analyzed. Results The analysis of clinicopathological characteristics showed that age, family history of cervical cancer and post-menopausal status did not significantly differ between RS and RR groups. Tumor size demonstrated a borderline significant association with radiotherapy response, while differentiation degree was significantly associated. Serum ICAM-1 and VCAM-1 concentrations were significantly higher in the RR group compared to the RS group. Combined detection of ICAM-1 and VCAM-1 improved the predictive ability for radiotherapy sensitivity. Higher serum ICAM-1 and VCAM-1 levels were observed in patients with lower tumor differentiation. Five-year overall survival rates differed significantly between patients with high and low ICAM-1 and VCAM-1 levels. Conclusion Serum ICAM-1 and VCAM-1 levels show potential as predictive biomarkers for radiotherapy sensitivity in cervical cancer.
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Affiliation(s)
- Lina Song
- Department of Radiation Therapy, Cangzhou Central Hospital, Cangzhou, China
| | - Yali Gao
- Department of Radiation Therapy, Cangzhou Central Hospital, Cangzhou, China
| | - Zhicong Wang
- Department of Radiation Therapy, Cangzhou Central Hospital, Cangzhou, China
| | - Yufeng Shi
- Department of Radiation Therapy, Cangzhou Central Hospital, Cangzhou, China
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5
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Cao Z, Liu X, Zhang W, Zhang K, Pan L, Zhu M, Qin H, Zou C, Wang W, Zhang C, He Y, Lin W, Zhang Y, Han D, Li M, Gu J. Biomimetic Macrophage Membrane-Camouflaged Nanoparticles Induce Ferroptosis by Promoting Mitochondrial Damage in Glioblastoma. ACS NANO 2023; 17:23746-23760. [PMID: 37991252 PMCID: PMC10722604 DOI: 10.1021/acsnano.3c07555] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 11/23/2023]
Abstract
The increasing understanding of ferroptosis has indicated its role and therapeutic potential in cancer; however, this knowledge has yet to be translated into effective therapies. Glioblastoma (GBM) patients face a bleak prognosis and encounter challenges due to the limited treatment options available. In this study, we conducted a genome-wide CRISPR-Cas9 screening in the presence of a ferroptosis inducer (RSL3) to identify the key driver genes involved in ferroptosis. We identified ALOX15, a key lipoxygenase (LOX), as an essential driver of ferroptosis. Small activating RNA (saRNA) was used to mediate the expression of ALOX15 promoted ferroptosis in GBM cells. We then coated saALOX15-loaded mesoporous polydopamine (MPDA) with Angiopep-2-modified macrophage membranes (MMs) to reduce the clearance by the mononuclear phagocyte system (MPS) and increase the ability of the complex to cross the blood-brain barrier (BBB) during specific targeted therapy of orthotopic GBM. These generated hybrid nanoparticles (NPs) induced ferroptosis by mediating mitochondrial dysfunction and rendering mitochondrial morphology abnormal. In vivo, the modified MM enabled the NPs to target GBM cells, exert a marked inhibitory effect on GBM progression, and promote GBM radiosensitivity. Our results reveal ALOX15 to be a promising therapeutic target in GBM and suggest a biomimetic strategy that depends on the biological properties of MMs to enhance the in vivo performance of NPs for treating GBM.
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Affiliation(s)
- Zhengcong Cao
- State
Key Laboratory of Cancer Biology, Biotechnology Center, School of
Pharmacy, The Fourth Military Medical University, Xi’an 710032, China
| | - Xiao Liu
- Department
of Neurosurgery, Xijing Hospital, Xi’an 710032, China
| | - Wangqian Zhang
- State
Key Laboratory of Cancer Biology, Biotechnology Center, School of
Pharmacy, The Fourth Military Medical University, Xi’an 710032, China
| | - Keying Zhang
- Department
of Urology, Xijing Hospital, Xi’an 710032, China
| | - Luxiang Pan
- State
Key Laboratory of Cancer Biology, Biotechnology Center, School of
Pharmacy, The Fourth Military Medical University, Xi’an 710032, China
| | - Maorong Zhu
- State
Key Laboratory of Cancer Biology, Biotechnology Center, School of
Pharmacy, The Fourth Military Medical University, Xi’an 710032, China
| | - Haozhe Qin
- State
Key Laboratory of Cancer Biology, Biotechnology Center, School of
Pharmacy, The Fourth Military Medical University, Xi’an 710032, China
| | - Cheng Zou
- State
Key Laboratory of Cancer Biology, Biotechnology Center, School of
Pharmacy, The Fourth Military Medical University, Xi’an 710032, China
| | - Weizhong Wang
- Department
of Neurosurgery, Xijing Hospital, Xi’an 710032, China
| | - Cong Zhang
- Department
of Radiation Oncology, Xijing Hospital, Xi’an 710032, China
| | - Yalong He
- Department
of Neurosurgery, Xijing Hospital, Xi’an 710032, China
| | - Wei Lin
- Department
of Neurosurgery, Xijing Hospital, Xi’an 710032, China
| | - Yingqi Zhang
- State
Key Laboratory of Cancer Biology, Biotechnology Center, School of
Pharmacy, The Fourth Military Medical University, Xi’an 710032, China
| | - Donghui Han
- Department
of Urology, Xijing Hospital, Xi’an 710032, China
| | - Meng Li
- State
Key Laboratory of Cancer Biology, Biotechnology Center, School of
Pharmacy, The Fourth Military Medical University, Xi’an 710032, China
| | - Jintao Gu
- State
Key Laboratory of Cancer Biology, Biotechnology Center, School of
Pharmacy, The Fourth Military Medical University, Xi’an 710032, China
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6
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McDonald B, Barth K, Schmidt MHH. The origin of brain malignancies at the blood-brain barrier. Cell Mol Life Sci 2023; 80:282. [PMID: 37688612 PMCID: PMC10492883 DOI: 10.1007/s00018-023-04934-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/11/2023]
Abstract
Despite improvements in extracranial therapy, survival rate for patients suffering from brain metastases remains very poor. This is coupled with the incidence of brain metastases continuing to rise. In this review, we focus on core contributions of the blood-brain barrier to the origin of brain metastases. We first provide an overview of the structure and function of the blood-brain barrier under physiological conditions. Next, we discuss the emerging idea of a pre-metastatic niche, namely that secreted factors and extracellular vesicles from a primary tumor site are able to travel through the circulation and prime the neurovasculature for metastatic invasion. We then consider the neurotropic mechanisms that circulating tumor cells possess or develop that facilitate disruption of the blood-brain barrier and survival in the brain's parenchyma. Finally, we compare and contrast brain metastases at the blood-brain barrier to the primary brain tumor, glioma, examining the process of vessel co-option that favors the survival and outgrowth of brain malignancies.
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Affiliation(s)
- Brennan McDonald
- Institute of Anatomy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden School of Medicine, Dresden, Germany.
| | - Kathrin Barth
- Institute of Anatomy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden School of Medicine, Dresden, Germany
| | - Mirko H H Schmidt
- Institute of Anatomy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden School of Medicine, Dresden, Germany
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Rucher G, Prigent K, Simard C, Frelin AM, Coquemont-Guyot M, Elie N, Delcroix N, Perzo N, Guinamard R, Berger L, Manrique A. Targeted Radiation Exposure Induces Accelerated Aortic Valve Remodeling in ApoE -/- Mice. J Clin Med 2023; 12:5854. [PMID: 37762794 PMCID: PMC10531867 DOI: 10.3390/jcm12185854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/25/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Thoracic radiation therapy may result in accelerated atherosclerosis and in late aortic valve stenosis (AS). In this study, we assessed the feasibility of inducing radiation-induced AS using a targeted aortic valve irradiation (10 or 20 Grays) in two groups of C57Bl6/J (WT) and ApoE-/- mice compared to a control (no irradiation). Peak aortic jet velocity was evaluated by echocardiography to characterize AS. T2*-weighted magnetic resonance imaging after injection of MPIO-αVCAM-1 was used to examine aortic inflammation resulting from irradiation. A T2* signal void on valve leaflets and aortic sinus was considered positive. Valve remodeling and mineralization were assessed using von Kossa staining. Finally, the impact of radiation on cell viability and cycle from aortic human valvular interstitial cells (hVICs) was also assessed. The targeted aortic valve irradiation in ApoE-/- mice resulted in an AS characterized by an increase in peak aortic jet velocity associated with valve leaflet and aortic sinus remodeling, including mineralization process, at the 3-month follow-up. There was a linear correlation between histological findings and peak aortic jet velocity (r = 0.57, p < 0.01). In addition, irradiation was associated with aortic root inflammation, evidenced by molecular MR imaging (p < 0.01). No significant effect of radiation exposure was detected on WT animals. Radiation exposure did not affect hVICs viability and cell cycle. We conclude that targeted radiation exposure of the aortic valve in mice results in ApoE-/-, but not in WT, mice in an aortic valve remodeling mimicking the human lesions. This preclinical model could be a useful tool for future assessment of therapeutic interventions.
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Affiliation(s)
- Guillaume Rucher
- Normandie Univ, UNICAEN, UR 4650 PSIR, GIP Cyceron, 14000 Caen, France (K.P.); (C.S.); (R.G.); (L.B.)
| | - Kevin Prigent
- Normandie Univ, UNICAEN, UR 4650 PSIR, GIP Cyceron, 14000 Caen, France (K.P.); (C.S.); (R.G.); (L.B.)
- Department of Nuclear Medicine, CHU de Caen, 14000 Caen, France
| | - Christophe Simard
- Normandie Univ, UNICAEN, UR 4650 PSIR, GIP Cyceron, 14000 Caen, France (K.P.); (C.S.); (R.G.); (L.B.)
| | - Anne-Marie Frelin
- Grand Accélérateur National d’Ions Lourds (GANIL), CEA/DRF-CNRS/IN2P3, 14000 Caen, France
| | - Maëlle Coquemont-Guyot
- Normandie Univ, UNICAEN, SF 4207, PLATON Services Unit, Virtual’His, 14000 Caen, France (N.E.)
| | - Nicolas Elie
- Normandie Univ, UNICAEN, SF 4207, PLATON Services Unit, Virtual’His, 14000 Caen, France (N.E.)
| | - Nicolas Delcroix
- CNRS, UMS-3048, GIP Cyceron, Campus Jules Horowitz, 14000 Caen, France
| | - Nicolas Perzo
- Normandie Univ, UNIROUEN, INSERM U1096 EnVI, 76000 Rouen, France;
| | - Romain Guinamard
- Normandie Univ, UNICAEN, UR 4650 PSIR, GIP Cyceron, 14000 Caen, France (K.P.); (C.S.); (R.G.); (L.B.)
| | - Ludovic Berger
- Normandie Univ, UNICAEN, UR 4650 PSIR, GIP Cyceron, 14000 Caen, France (K.P.); (C.S.); (R.G.); (L.B.)
- Department of Vascular Surgery, Normandie Univ, UNICAEN, UR 4650 PSIR, CHU de Caen, 14000 Caen, France
| | - Alain Manrique
- Normandie Univ, UNICAEN, UR 4650 PSIR, GIP Cyceron, 14000 Caen, France (K.P.); (C.S.); (R.G.); (L.B.)
- Department of Nuclear Medicine, CHU de Caen, 14000 Caen, France
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8
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Goeckeritz J, Cerillo J, Sanghadia C, Hosseini M, Clark A, Pierre K, Lucke-Wold B. Principles of Lung Cancer Metastasis to Brain. JOURNAL OF SKELETON SYSTEM 2022; 1:https://www.mediresonline.org/article/principles-of-lung-cancer-metastasis-to-brain. [PMID: 36745145 PMCID: PMC9893877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lung cancer is a disease associated with significant morbidity and mortality on a global setting. This form of cancer commonly gives raise to metastatic lesions the brain, which can further worsen outcomes. In this focused review, we discuss an overview of lung cancers that metastasize to the brain: known risk factors; means of detection and diagnosis; and options for treatment including a comparison between surgical resection, stereotactic radiosurgery, and whole-brain radiation therapy. These interventions are still being assessed by clinical trials and continue to be modified through evidence-based practice.
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Affiliation(s)
| | - John Cerillo
- College of Osteopathic Medicine, Nova Southeastern University, Clearwater, FL
| | | | | | - Alec Clark
- College of Medicine, University of Central Florida, Orlando, FL
| | - Kevin Pierre
- Department of Radiology, University of Florida, Gainesville, FL
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9
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Lyu Q, Namjoshi SV, McTyre E, Topaloglu U, Barcus R, Chan MD, Cramer CK, Debinski W, Gurcan MN, Lesser GJ, Lin HK, Munden RF, Pasche BC, Sai KK, Strowd RE, Tatter SB, Watabe K, Zhang W, Wang G, Whitlow CT. A transformer-based deep-learning approach for classifying brain metastases into primary organ sites using clinical whole-brain MRI images. PATTERNS 2022; 3:100613. [PMID: 36419451 PMCID: PMC9676537 DOI: 10.1016/j.patter.2022.100613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/08/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022]
Abstract
Treatment decisions for brain metastatic disease rely on knowledge of the primary organ site and are currently made with biopsy and histology. Here, we develop a deep-learning approach for accurate non-invasive digital histology with whole-brain magnetic resonance imaging (MRI) data. Contrast-enhanced T1-weighted and fast spoiled gradient echo brain MRI exams (n = 1,582) were preprocessed and input to the proposed deep-learning workflow for tumor segmentation, modality transfer, and primary site classification into one of five classes. Tenfold cross-validation generated an overall area under the receiver operating characteristic curve (AUC) of 0.878 (95% confidence interval [CI]: 0.873,0.883). These data establish that whole-brain imaging features are discriminative enough to allow accurate diagnosis of the primary organ site of malignancy. Our end-to-end deep radiomic approach has great potential for classifying metastatic tumor types from whole-brain MRI images. Further refinement may offer an invaluable clinical tool to expedite primary cancer site identification for precision treatment and improved outcomes.
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Affiliation(s)
- Qing Lyu
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Sanjeev V. Namjoshi
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Emory McTyre
- Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Radiology Informatics & Image Processing Laboratory, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Umit Topaloglu
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Richard Barcus
- Radiology Informatics & Image Processing Laboratory, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael D. Chan
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christina K. Cramer
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Waldemar Debinski
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Metin N. Gurcan
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Glenn J. Lesser
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hui-Kuan Lin
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Reginald F. Munden
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Boris C. Pasche
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kiran K.S. Sai
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Radiology Informatics & Image Processing Laboratory, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Roy E. Strowd
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen B. Tatter
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kounosuke Watabe
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Wei Zhang
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ge Wang
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
- Corresponding author
| | - Christopher T. Whitlow
- Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Radiology Informatics & Image Processing Laboratory, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Corresponding author
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