Five-Aminolevulinic Acid for Fluorescence-Guided Resection of Recurrent Malignant Gliomas

Nabavi, Arya; Thurm, Holger; Zountsas, Basilios; Pietsch, Thorsten; Lanfermann, Heinrich; Pichlmeier, Uwe; Mehdorn, Maximilian

doi:10.1227/01.neu.0000360128.03597.c7

Cited by 184 publications

(131 citation statements)

References 33 publications

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“…Although in our recent study we identified significant differences between recurrent and newly diagnosed glioma patients with respect to neurological outcome and incidence of postoperative ischemic lesions, there are still few and contradictory data available on the resection of recurrent intrinsic brain tumors. 1,2,4,8,15,19,28,29 Ultimately, even though we were able to detect relevant ischemic events by intraoperative monitoring, the key question remains of how to avoid these events. Certainly a meticulous surgical technique tailored to the vascular architecture at risk, whether cortical arteries and draining veins or subcortical perforating arteries, is the mainstay of a safe resection.…”

Section: Discussionmentioning

confidence: 91%

Postoperative ischemic changes after glioma resection identified by diffusion-weighted magnetic resonance imaging and their association with intraoperative motor evoked potentials

Gempt¹,

Krieg

Hüttinger

et al. 2013

JNS

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Object The aim of surgical glioma treatment is the complete resection of tumor tissue while preserving neurological function. Surgery-related neurological deficits arise from direct damage to the cortical or subcortical structures or from ischemia. The authors aimed to assess the incidence of resection-related ischemia of newly diagnosed or recurrent supratentorial gliomas and the sensitivity of intraoperative neuromonitoring (IOM) of motor evoked potentials (MEPs) for detecting such ischemic events and their influence on neurological motor function. Methods Between January 2009 and December 2010, 70 patients with tumors in motor-eloquent brain areas underwent intraoperative MEP monitoring during glioma resection and were examined by early postoperative MRI including diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping. Postoperative areas of restricted diffusion were assessed by investigators blinded to the course of intraoperative MEPs and the neurological course. Results Among the 70 enrolled patients, a MEP amplitude decline below 50% of the baseline level was observed in 21 patients (30%). Sixteen of these patients (76%) had ischemic lesions identified on postoperative MRI scans. Forty-nine patients (70%) showed no decline in MEP amplitude, and only 16 (33%) of these patients harbored ischemic lesions. Moreover, 9 (69%) of 13 patients with a permanent loss of MEP amplitude showed postoperative ischemic lesions. Factors that promoted the occurrence of postoperative infarction were previous radiotherapy and location of the tumor close to the central arteries. Conclusions Alterations in the MEP amplitude during tumor resection and postoperative ischemic lesions are associated with postoperative impairment of motor function. Rather than cortical or subcortical structural damage of eloquent brain tissue alone, peri- or postoperative ischemic lesions play a crucial role in the development of surgery-related motor deficits.

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Section: Discussionmentioning

confidence: 91%

Postoperative ischemic changes after glioma resection identified by diffusion-weighted magnetic resonance imaging and their association with intraoperative motor evoked potentials

Gempt¹,

Krieg

Hüttinger

et al. 2013

JNS

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“…17,19,[25][26][27][28][29][30][31] We attempted to approach this important issue in the present report.…”

Section: Discussionmentioning

confidence: 99%

¹¹C‐methionine uptake and intraoperative 5‐aminolevulinic acid‐induced fluorescence as separate index markers of cell density in glioma

Arita

Kinoshita

Kagawa

et al. 2011

Cancer

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BACKGROUND:The extent of tumor resection is acknowledged as 1 of the prognostic factors for glioma. 5-Aminolevulinic acid (5-ALA)-induced fluorescence guidance and neuronavigation integrated with 11 C-methionine positron emission tomography (PET) are widely utilized under the expectation of improving the extent of resection. These 2 novel approaches are beneficial for glioma resections, and the combination of these approaches appears rational. However, biological characteristics reflecting 5-ALA-induced fluorescence and 11 C-methionine uptake have not been clearly elucidated, and studies about the relationship between 5-ALA-induced fluorescence and 11 C-methionine uptake have been limited. The present study aimed to clarify this issue. METHODS: Data from 11 consecutive patients harboring astrocytic tumors were analyzed: 2 grade II and 2 grade III, and 7 grade IV tumors were included. Thirty samples from these patients were obtained from the relative periphery of each tumor. Relationships among histology, 5-ALA-induced fluorescence and 11 C-methionine uptake were analyzed by stereotactic sampling and image analysis. RESULTS:Uptake of 11 C-methionine correlated with cell density (R 2 ¼ 0.322, P ¼ .0059). Cell density was higher in fluorescence-positive areas than in negative areas (2760 AE 1080 vs 1450 AE 1380/mm 2 , P ¼ .0132). Although both 11 C-methionine uptake and fluorescence seemed to correlate with cell density, no significant difference in 11 C-methionine uptake was seen between fluorescence-positive and -negative areas (P ¼ .367). Multiple linear regression analysis revealed 11 C-methionine uptake and 5-ALA-induced fluorescence as independent indices for tumor cell density. CONCLUSIONS:These results indicate that 5-ALA fluorescence and 11 C-methionine PET image are separate index markers for cytoreduction surgery of gliomas.

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“…PPIX preferentially accumulates into cancer cells due to their ferrochelatase deficiency [7]. In addition, 5-ALA is already efficiently used in tumor photodetection, notably in the case of glioblastoma surgical resection [8][9][10]. Furthermore, the use of 5-ALA in the context of PDT constitutes a promising treatment as it has already been successfully used in the case of a non-resectable glioblastoma [11].…”

Section: Introductionmentioning

confidence: 99%

NF-kappaB inhibition improves the sensitivity of human glioblastoma cells to 5-aminolevulinic acid-based photodynamic therapy

Coupienne

Bontems

Dewaele

et al. 2011

Biochemical Pharmacology

101

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To cite this version:Isabelle Coupienne Isabelle Coupienne, Sébastien Bontems, Michael Dewaele, Noemi Rubio, Yvette Habraken, et al.. NF-kappaB inhibition improves the sensitivity of human glioblastoma cells to 5-aminolevulinic acid-based photodynamic therapy. Biochemical Pharmacology, Elsevier, 2011, 81 (5) This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. A c c e p t e d M a n u s c r i p t 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 AbstractGlioblastoma constitute the most frequent and deadliest brain tumors of astrocytic origin.They are very resistant to all current therapies and are associated with a huge rate of recurrence. In most cases, this type of tumor is characterized by a constitutive activation of the nuclear factor-kappaB (NF-B). This factor is known to be a key regulator of various physiological processes such as inflammation, immune response, cell growth or apoptosis. In the present study, we explored the role of NF-B activation in the sensitivity of human glioblastoma cells to a treatment by 5-aminolevulinic acid (5-ALA)-based photodynamic therapy (PDT). 5-ALA is a physiological compound widely used in PDT as well as in tumor photodetection (PDD). Our results show that inhibition of NF-κB improves glioblastoma cell death in response to 5-ALA-PDT. We then studied the molecular mechanisms underlying the cell death induced by PDT combined or not with NF-B inhibition. We found that apoptosis was induced by PDT but in an incomplete manner and that, unexpectedly, NF-B inhibition reduced its level. Oppositely PDT mainly induces necrosis in glioblastoma cells and NF-B is found to have anti-necrotic functions in this context. The autophagic flux was also enhanced as a result of 5-ALA-PDT and we demonstrate that stimulation of autophagy acts as a prosurvival mechanism confering protection against PDT-mediated necrosis. These data point out that 5-ALA-PDT has an interesting potential as a mean to treat glioblastoma and that inhibition of NF-B renders glioblastoma cells more sensitive to the treatment.

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Five-Aminolevulinic Acid for Fluorescence-Guided Resection of Recurrent Malignant Gliomas

Cited by 184 publications

References 33 publications

Postoperative ischemic changes after glioma resection identified by diffusion-weighted magnetic resonance imaging and their association with intraoperative motor evoked potentials

Postoperative ischemic changes after glioma resection identified by diffusion-weighted magnetic resonance imaging and their association with intraoperative motor evoked potentials

¹¹C‐methionine uptake and intraoperative 5‐aminolevulinic acid‐induced fluorescence as separate index markers of cell density in glioma

NF-kappaB inhibition improves the sensitivity of human glioblastoma cells to 5-aminolevulinic acid-based photodynamic therapy

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Five-Aminolevulinic Acid for Fluorescence-Guided Resection of Recurrent Malignant Gliomas

Cited by 184 publications

References 33 publications

Postoperative ischemic changes after glioma resection identified by diffusion-weighted magnetic resonance imaging and their association with intraoperative motor evoked potentials

Postoperative ischemic changes after glioma resection identified by diffusion-weighted magnetic resonance imaging and their association with intraoperative motor evoked potentials

11C‐methionine uptake and intraoperative 5‐aminolevulinic acid‐induced fluorescence as separate index markers of cell density in glioma

NF-kappaB inhibition improves the sensitivity of human glioblastoma cells to 5-aminolevulinic acid-based photodynamic therapy

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¹¹C‐methionine uptake and intraoperative 5‐aminolevulinic acid‐induced fluorescence as separate index markers of cell density in glioma