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Voss M, Wenger KJ, von Mettenheim N, Bojunga J, Vetter M, Diehl B, Gerlach R, Ronellenfitsch MW, Franz K, Harter PN, Hattingen E, Steinbach JP, Rödel C, Rieger J. OS05.9.A Short-term fasting in glioma patients - Analysis of diet diaries and metabolic parameters of the ERGO2 trial. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
The prospective, randomized ERGO2 trial investigated the effect of fasting / calorie restricted ketogenic diet (KD-IF) on re-irradiation for recurrent brain tumors (Clinicaltrials.gov number: NCT01754350). The study did not meet its primary endpoint of improved progression-free survival in comparison to a standard diet (SD). We here report the results of the quality of life questionnaire, neurocognition testing, detailed analysis of the diet diaries and the alterations of metabolic parameters.
MATERIAL AND METHODS
50 Patients were randomized 1:1 to re-irradiation combined with either SD or KD-IF. The KD-IF schedule included 3 days of ketogenic diet (KD: 21–23 kcal/kg/d, carbohydrate intake limited to 50 g/d), followed by 3 days of fasting and again 3 days of KD. Follow-up included examination of cognition, quality of life and serum samples.
RESULTS
The 20 patients who completed KD-IF met the prespecified goals for calorie and carbohydrate restriction. In these, a decrease in leptin and insulin and an increase in uric acid was observed. The SD group had a lower calorie intake of 21 kcal/kg/d than the expected 30 kcal/kg/d. Neither quality of life nor cognition were affected by the diet. Low glucose emerged as a significant prognostic parameter in a best responder analysis.
CONCLUSION
The strict caloric goals of the ERGO2 trial could be achieved by patients with recurrent brain tumor. The unexpected lower calorie intake of the SD group might have hampered the interpretation of the trial. However, the short diet schedule already led to significant metabolic alterations, suggesting that short-term dietary interventions might be therapeutically useful, possibly combined with other modalities.
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Affiliation(s)
- M Voss
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - K J Wenger
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - N von Mettenheim
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - J Bojunga
- Department of Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - M Vetter
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - B Diehl
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - R Gerlach
- Department of Neurosurgery, Helios Hospital Erfurt, Erfurt, Germany
| | - M W Ronellenfitsch
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - K Franz
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - P N Harter
- Institute of Neurology (Edinger-Institute), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - E Hattingen
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - J P Steinbach
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - C Rödel
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - J Rieger
- Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Tübingen, Germany
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Wenger KJ, Steinbach JP, Bähr O, Pilatus U, Hattingen E. Lower Lactate Levels and Lower Intracellular pH in Patients with IDH-Mutant versus Wild-Type Gliomas. AJNR Am J Neuroradiol 2020; 41:1414-1422. [PMID: 32646946 DOI: 10.3174/ajnr.a6633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Preclinical evidence points toward a metabolic reprogramming in isocitrate dehydrogenase (IDH) mutated tumor cells with down-regulation of the expression of genes that encode for glycolytic metabolism. We noninvasively investigated lactate and Cr concentrations, as well as intracellular pH using 1H/phosphorus 31 (31P) MR spectroscopy in a cohort of patients with gliomas. MATERIALS AND METHODS Thirty prospectively enrolled, mostly untreated patients with gliomas met the spectral quality criteria (World Health Organization II [n = 7], III [n = 16], IV [n = 7]; IDH-mutant [n = 23]; IDH wild-type [n = 7]; 1p/19q codeletion [n = 9]). MR imaging protocol included 3D 31P chemical shift imaging and 1H single-voxel spectroscopy (point-resolved spectroscopy sequence at TE = 30 ms and TE = 97 ms with optimized echo spacing for detection of 2-hydroxyglutarate) from the tumor area. Values for absolute metabolite concentrations were calculated (phantom replacement method). Intracellular pH was determined from 31P chemical shift imaging. RESULTS At TE = 97 ms, lactate peaks can be fitted with little impact of lipid/macromolecule contamination. We found a significant difference in lactate concentrations, lactate/Cr ratios, and intracellular pH when comparing tumor voxels of patients with IDH-mutant with those of patients with IDH wild-type gliomas, with reduced lactate levels and near-normal intracellular pH in patients with IDH-mutant gliomas. We additionally found evidence for codependent effects of 1p/19q codeletion and IDH mutations with regard to lactate concentrations for World Health Organization tumor grades II and III, with lower lactate levels in patients exhibiting the codeletion. There was no statistical significance when comparing lactate concentrations between IDH-mutant World Health Organization II and III gliomas. CONCLUSIONS We found indirect evidence for metabolic reprogramming in IDH-mutant tumors with significantly lower lactate concentrations compared with IDH wild-type tumors and a near-normal intracellular pH.
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Affiliation(s)
- K J Wenger
- From the Departments of Neuroradiology (K.J.W., U.P., E.H.) .,German Cancer Consortium Partner Site (K.J.W., J.P.S., O.B., U.P., E.H.), Frankfurt am Main/Mainz, Germany.,German Cancer Research Center (K.J.W., J.P.S., O.B., U.P., E.H.), Heidelberg, Germany
| | - J P Steinbach
- Neurooncology (J.P.S., O.B.), University Hospital Frankfurt, Frankfurt am Main, Germany.,German Cancer Consortium Partner Site (K.J.W., J.P.S., O.B., U.P., E.H.), Frankfurt am Main/Mainz, Germany.,German Cancer Research Center (K.J.W., J.P.S., O.B., U.P., E.H.), Heidelberg, Germany
| | - O Bähr
- Neurooncology (J.P.S., O.B.), University Hospital Frankfurt, Frankfurt am Main, Germany.,German Cancer Consortium Partner Site (K.J.W., J.P.S., O.B., U.P., E.H.), Frankfurt am Main/Mainz, Germany.,German Cancer Research Center (K.J.W., J.P.S., O.B., U.P., E.H.), Heidelberg, Germany
| | - U Pilatus
- From the Departments of Neuroradiology (K.J.W., U.P., E.H.).,German Cancer Consortium Partner Site (K.J.W., J.P.S., O.B., U.P., E.H.), Frankfurt am Main/Mainz, Germany.,German Cancer Research Center (K.J.W., J.P.S., O.B., U.P., E.H.), Heidelberg, Germany
| | - E Hattingen
- From the Departments of Neuroradiology (K.J.W., U.P., E.H.).,German Cancer Consortium Partner Site (K.J.W., J.P.S., O.B., U.P., E.H.), Frankfurt am Main/Mainz, Germany.,German Cancer Research Center (K.J.W., J.P.S., O.B., U.P., E.H.), Heidelberg, Germany
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Wenger KJ, Berkefeld J, Wagner M. Flat panel detector computed tomography for the interaction between contrast-enhanced thrombi and stent retrievers in stroke therapy: a pilot study. Clin Neuroradiol 2013; 24:251-4. [PMID: 23949606 DOI: 10.1007/s00062-013-0246-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 07/20/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The purpose of this study was to create virtual 3D views of the interaction between contrast-enhanced thrombi and three different types of stent retrievers. MATERIALS AND METHODS Artificial thrombi with and without contrast agent were created and introduced into a silicone tube with saline solution. The stent retrievers (Aperio (A), Solitaire FR (B), Revive (C)) were released around the thrombi. For each retriever, two sets (0 min, 5 min) of flat panel computed tomography (CT) data were acquired on a Siemens Axiom Artis Zee biplane angiography system and reconstructed using syngo InSpace 3D software. RESULTS The filaments of all three stent retrievers were displaced by the thrombus immediately after deployment. Another study series after 5 min showed further expansion of the stents into the thrombus. A tends to appose best around obstacles. A and B allow cushion-like bulging of clot material into the stent lumen. C showed only moderate curvilinear bulging and a minor degree of interaction in between stent filaments and thrombus. CONCLUSIONS Flexible design allows better apposition of the device to the surface of the thrombus. A relatively strong longitudinal structure combined with large gaps in between the stent filaments seems to favor migration into the clot. The main capture mechanism seems to be engagement of the clot between the crossings of stent struts.
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Affiliation(s)
- K J Wenger
- Department of Neuroradiology, Johann Wolfgang Goethe University, Schleusenweg 2-16, Haus 95, 60528, Frankfurt am Main, Germany,
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