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Rivers RJ, Meininger CJ. The Tissue Response to Hypoxia: How Therapeutic Carbon Dioxide Moves the Response toward Homeostasis and Away from Instability. Int J Mol Sci 2023; 24:ijms24065181. [PMID: 36982254 PMCID: PMC10048965 DOI: 10.3390/ijms24065181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/30/2023] Open
Abstract
Sustained tissue hypoxia is associated with many pathophysiological conditions, including chronic inflammation, chronic wounds, slow-healing fractures, microvascular complications of diabetes, and metastatic spread of tumors. This extended deficiency of oxygen (O2) in the tissue sets creates a microenvironment that supports inflammation and initiates cell survival paradigms. Elevating tissue carbon dioxide levels (CO2) pushes the tissue environment toward "thrive mode," bringing increased blood flow, added O2, reduced inflammation, and enhanced angiogenesis. This review presents the science supporting the clinical benefits observed with the administration of therapeutic CO2. It also presents the current knowledge regarding the cellular and molecular mechanisms responsible for the biological effects of CO2 therapy. The most notable findings of the review include (a) CO2 activates angiogenesis not mediated by hypoxia-inducible factor 1a, (b) CO2 is strongly anti-inflammatory, (c) CO2 inhibits tumor growth and metastasis, and (d) CO2 can stimulate the same pathways as exercise and thereby, acts as a critical mediator in the biological response of skeletal muscle to tissue hypoxia.
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Affiliation(s)
- Richard J Rivers
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Cynthia J Meininger
- Department of Medical Physiology, Texas A&M University School of Medicine, Bryan, TX 77807, USA
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Ahmad F, Hyvärinen A, Pirinen A, Olsson V, Rummukainen J, Immonen A, Närväinen J, Tuunanen P, Liimatainen T, Kärkkäinen V, Koistinaho J, Ylä-Herttuala S. Lentivirus vector‑mediated genetic manipulation of oncogenic pathways induces tumor formation in rabbit brain. Mol Med Rep 2021; 23:422. [PMID: 33846766 PMCID: PMC8047887 DOI: 10.3892/mmr.2021.12061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 12/04/2020] [Indexed: 12/04/2022] Open
Abstract
Translation of promising experimental therapies from rodent models to clinical success has been complicated as the novel therapies often fail in clinical trials. Existing rodent glioma models generally do not allow for preclinical evaluation of the efficiency of novel therapies in combination with surgical resection. Therefore, the aim of the present study was to develop a larger animal model utilizing lentivirus vector‑mediated oncogenic transformation in the rabbit brain. Lentiviruses carrying constitutively active AKT and H‑Ras oncogenes, and p53 small interfering (si)RNA were introduced into newborn rabbit neural stem cells (NSCs) and intracranially implanted into rabbits' brains to initiate tumor formation. In one of the ten rabbits a tumor was detected 48 days after the implantation of transduced NSCs. Histological features of the tumor mimic was similar to a benign Grade II ganglioglioma. Immunostaining demonstrated that the tissues were positive for AKT and H‑Ras. Strong expression of GFAP and Ki‑67 was also detected. Additionally, p53 expression was notably lower in the tumor area. The implantation of AKT, H‑Ras and p53 siRNA transduced NSCs for tumor induction resulted in ganglioglioma formation. Despite the low frequency of tumor formation, this preliminary data provided a proof of principle that lentivirus vectors carrying oncogenes can be used for the generation of brain tumors in rabbits. Moreover, these results offer noteworthy insights into the pathogenesis of a rare brain tumor, ganglioglioma.
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Affiliation(s)
- Farizan Ahmad
- A.I Virtanen Institute for Molecular Sciences, University of Eastern Finland, FI-70211 Kuopio, Finland
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan 16150, Malaysia
| | - Anna Hyvärinen
- A.I Virtanen Institute for Molecular Sciences, University of Eastern Finland, FI-70211 Kuopio, Finland
- Department of Pediatric Surgery, Tampere University Hospital, FI-33520 Tampere, Finland
- Tampere University, FI-33014 Tampere, Finland
- Department of Surgery, North Karelia Central Hospital, FI-80210 Joensuu, Finland
| | - Agnieszka Pirinen
- A.I Virtanen Institute for Molecular Sciences, University of Eastern Finland, FI-70211 Kuopio, Finland
| | - Venla Olsson
- A.I Virtanen Institute for Molecular Sciences, University of Eastern Finland, FI-70211 Kuopio, Finland
| | - Jaana Rummukainen
- Department of Pathology, Kuopio University Hospital, FI-70029 Kuopio, Finland
| | - Arto Immonen
- Department of Neurosurgery, Neurocenter in Kuopio University Hospital, FI-70029 Kuopio, Finland
| | - Johanna Närväinen
- A.I Virtanen Institute for Molecular Sciences, University of Eastern Finland, FI-70211 Kuopio, Finland
- VTT Technical Research Centre of Finland, FI-70210 Kuopio, Finland
| | - Pasi Tuunanen
- A.I Virtanen Institute for Molecular Sciences, University of Eastern Finland, FI-70211 Kuopio, Finland
- Department of Clinical Neurophysiology, Kuopio University Hospital, FI-70029 Kuopio, Finland
| | - Timo Liimatainen
- A.I Virtanen Institute for Molecular Sciences, University of Eastern Finland, FI-70211 Kuopio, Finland
- Research Unit for Medical Imaging, Physics and Technology, University of Oulu, FI-90014 Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, FI-90220 Oulu, Finland
| | - Virve Kärkkäinen
- Department of Neurosurgery, Neurocenter in Kuopio University Hospital, FI-70029 Kuopio, Finland
| | - Jari Koistinaho
- A.I Virtanen Institute for Molecular Sciences, University of Eastern Finland, FI-70211 Kuopio, Finland
- Neuroscience Center, Helsinki Institute of Life Sciences, University of Helsinki, FI-00014 Helsinki, Finland
| | - Seppo Ylä-Herttuala
- A.I Virtanen Institute for Molecular Sciences, University of Eastern Finland, FI-70211 Kuopio, Finland
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Maruyama K, Okada T, Ueha T, Isohashi K, Ikeda H, Kanai Y, Sasaki K, Gentsu T, Ueshima E, Sofue K, Nogami M, Yamaguchi M, Sugimoto K, Sakai Y, Hatazawa J, Murakami T. In vivo evaluation of percutaneous carbon dioxide treatment for improving intratumoral hypoxia using 18F-fluoromisonidazole PET-CT. Oncol Lett 2021; 21:207. [PMID: 33574946 PMCID: PMC7816357 DOI: 10.3892/ol.2021.12468] [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: 07/31/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022] Open
Abstract
Carbon dioxide (CO2) treatment is reported to have an antitumor effect owing to the improvement in intratumoral hypoxia. Previous studies were based on histological analysis alone. In the present study, the improvement in intratumoral hypoxia by percutaneous CO2 treatment in vivo was determined using 18F-fluoromisonidazole positron emission tomography-computed tomography (18F-FMISO PET-CT) images. Twelve Japanese nude mice underwent implantation of LM8 tumor cells in the dorsal subcutaneous area 2 weeks before percutaneous CO2 treatment and 18F-FMISO PET-CT scans. Immediately after intravenous injection of 18F-FMISO, CO2 and room air were administered transcutaneously in the CO2-treated group (n=6) and a control group (n=6), respectively; each treatment was performed for 10 minutes. PET-CT was performed 2 h after administration of 18F-FMISO. 18F-FMISO tumor uptake was quantitatively evaluated using the maximum standardized uptake value (SUVmax), tumor-to-liver ratio (TLR), tumor-to-muscle ratio (TMR), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Mean ± standard error of the mean (SEM) of the tumor volume was not significantly different between the two groups (CO2-treated group, 1.178±0.450 cm3; control group, 1.368±0.295 cm3; P=0.485). Mean ± SEM of SUVmax, TLR, MTV (cm3) and TLG were significantly lower in the CO2-treated group compared with the control group (0.880±0.095 vs. 1.253±0.071, P=0.015; 1.063±0.147361 vs. 1.455±0.078, P=0.041; 0.353±0.139 vs. 1.569±0.438, P=0.015; 0.182±0.070 vs. 1.028±0.338, P=0.015), respectively. TMR was not significantly different between the two groups (4.520±0.503 vs. 5.504±0.310; P=0.240). In conclusion, 18F-FMISO PET revealed that percutaneous CO2 treatment improved intratumoral hypoxia in vivo. This technique enables assessment of the therapeutic effect in CO2 treatment by imaging, and may contribute to its clinical application.
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Affiliation(s)
- Koji Maruyama
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Takuya Okada
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Takeshi Ueha
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Kayako Isohashi
- Department of Tracer Kinetics and Nuclear Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Hayato Ikeda
- Department of Tracer Kinetics and Nuclear Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Yasukazu Kanai
- Department of Tracer Kinetics and Nuclear Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Koji Sasaki
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Tomoyuki Gentsu
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Eisuke Ueshima
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Munenobu Nogami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Masato Yamaguchi
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Koji Sugimoto
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
| | - Jun Hatazawa
- Department of Tracer Kinetics and Nuclear Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo 650-0017, Japan
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