Advances in biology and treatment of childhood brain tumors.

Childhood brain tumors are collectively the most common solid neoplasm and the leading cause of cancer-related death in children. They are a diverse group of diseases and outcome is extremely variable. Current treatment is dependent on histology, location, and in some instances, patient age. Advances in treatment have led to improved survival for some patients, but for many the outcome remains dismal despite aggressive treatment. A growing body of work is aimed at improving the outcome for children with brain tumors not only through clinical trials, but also by focusing on the biologic underpinning of these diseases that have been poorly understood.

Outcome for children with supratentorial primitive neuroectodermal tumors treated with surgery, radiation, and chemotherapy.

BACKGROUND: The outcome of a child with a primitive neuroectodermal tumors arising supratentorially (SPNET) is not well characterized and may differ from the outcome of a patient with a histologically similar cerebellar tumor (medulloblastoma [MB]). Recently, 5-year progression free survival rates as high as 80% have been reported for children with MB treated with craniospinal radiation (CRT) and chemotherapy including cisplatin, lomustine (CCNU), and vincristine (VCR). METHODS: The authors reviewed the outcome of 22 consecutive patients age 3 years and older (mean age, 10 years; range, 3-18 years) with SPNET who were treated at the study institutions between 1981 and 1996. Tumor location included was 13 pineal, 6 cortical, and 3 thalamic or suprasellar. Five patients had disease dissemination at diagnosis. All patients underwent surgery and staging, followed by CRT and chemotherapy with cisplatin, CCNU, and VCR. RESULTS: Of the 22 patients, 13 had developed disease progression and 10 had died at the time of last follow-up. Overall progression free survival (PFS) was 47% +/- 11% at 3 years and 37% +/- 11% at 5 years. There was a significant difference in PFS between patients with localized disease versus those with disseminated disease (P = 0.04). There was no statistical association between tumor location and survival. Although not significant (P = 0.21), there was a trend toward better survival of those patients with complete or near-complete resection compared with those with partial resection or biopsy. CONCLUSIONS: The results of the current study demonstrate that the outcome for children with SPNET treated with radiation and chemotherapy appears worse than for children with MB treated with identical therapy. This suggests that there may be biologic differences between supratentorial and infratentorial primitive neuroectodermal tumors, thus requiring refinements in treatment.

Enlarged parietal foramina: association with cerebral venous and cortical anomalies.

OBJECTIVE: To evaluate a series of patients with enlarged parietal foramina for associated brain anomalies. BACKGROUND: Enlarged parietal foramina are usually considered a benign calvarial defect. METHODS: Ten patients with enlarged parietal foramina were identified. Seven patients were evaluated with neuroimaging: two by cranial CT and five by CT and/or MRI. Three patients who underwent MRI also underwent MR angiography or MR venography. RESULTS: Six of seven patients had cranial imaging showing a persistent falcine venous sinus. Three of six patients had variations of occipital cortical infolding. One patient had focal encephalomalacia in close proximity to the persistent falcine venous sinus and one had a previously undiagnosed atretic occipital encephalocele. CONCLUSION: This constellation of findings suggests that aberrant vascular evolution during fetal development may affect cerebrovascular, brain, or skull development. Individuals with enlarged parietal foramina (>5 mm) warrant imaging of underlying brain parenchyma and vasculature.

Chemotherapy for low-grade gliomas.

Low-grade gliomas are the most common histological type of pediatric brain tumor. They can arise in any part of the nervous system. Although low-grade gliomas are slow growing, they often recur or progress, especially in areas such as the diencephalon or brain stem, where resection is limited by proximity to vital and eloquent structures. Radiation has been used to treat progressive low-grade gliomas, but it is not clear that it improves long-term outcome. Radiotherapy also has potential significant cognitive, endocrine, and vascular side- effects. There is a growing body of evidence to suggest that chemotherapy can delay and may obviate the need for radiation therapy or aggressive surgery. This chapter reviews the published chemotherapeutic trials. Chemotherapy appears to have a major role in the management of children with progressive low-grade gliomas.

Malignant human gliomas express an amiloride-sensitive Na+ conductance.

Human astrocytoma cells were studied using whole cell patch-clamp recording. An inward, amiloride-sensitive Na+ current was identified in four continuous cell lines originally derived from human glioblastoma cells (CH235, CRT, SKMG-1, and U251-MG) and in three primary cultures of cells obtained from glioblastoma multiforme tumors (up to 4 passages). In addition, cells freshly isolated from a resected medulloblastoma tumor displayed this same characteristic inward current. In contrast, amiloride-sensitive currents were not observed in normal human astrocytes, low-grade astrocytomas, or juvenile pilocytic astrocytomas. The only amiloride-sensitive Na+ channels thus far molecularly identified in brain are the brain Na+ channels (BNaCs). RT-PCR analyses demonstrated the presence of mRNA for either BNaC1 or BNaC2 in these tumors and in normal astrocytes. These results indicate that the functional expression of amiloride-sensitive Na+ currents is a characteristic feature of malignant brain tumor cells and that this pathway may be a potentially useful target for therapeutic intervention.

Medulloblastoma.

The utilization of multi-modal therapy in the treatment of medulloblastoma has improved survival rates and overall outcome. Recent large clinical trials have supported the use of radiation and chemotherapy as adjuvant treatment. Treatment advances have been made despite a poor understanding of the biological underpinnings of medulloblastoma. Current laboratory investigations are shedding light on the oncogenesis of medulloblastoma and may lead to improved treatments.

Pediatric central nervous system tumors.

Much of the recent change in the management of brain tumors in children has centered on the expanded use of chemotherapy. The addition of chemotherapy has resulted in better survival rates for children with medulloblastoma and altered the management for those with low-grade gliomas. For other tumor types, therapeutic advances have been slower. High-dose chemotherapy increasingly is being employed to treat malignant childhood tumors, with variable results.

Interferon-gamma-induced astrocyte class II major histocompatibility complex gene expression is associated with both protein kinase C activation and Na+ entry.

Astrocytes can be induced by interferon-gamma (IFN-gamma) to express class II major histocompatibility complex (MHC) antigens. This study was undertaken to elucidate the intracellular signaling pathways involved in IFN-gamma induction of class II MHC. We examined the effects of Na+/H+ antiporter and protein kinase C (PKC) inhibitors on class II expression and Na+ influx in astrocytes. We found that amiloride and ethyl isopropylamiloride, inhibitors of Na+/H+ exchange, blocked IFN-gamma-induced class II gene expression. IFN-gamma stimulated Na+ influx, and this increased influx was inhibited by amiloride. Treatment of astrocytes with the PKC inhibitor H7 also blocked the increase in Na+ uptake induced by IFN-gamma, indicating that IFN-gamma-induced PKC activation is required for subsequent Na+ influx. IFN-gamma treatment produced an increase of total PKC activity, which was associated with a rapid translocation of PKC activity from cytosolic to particulate fraction. H7 and another PKC inhibitor, staurosporine, inhibited IFN-gamma-induced class II gene expression. However, 4 beta-phorbol 12 beta-myristate 13 alpha-acetate, a potent PKC activator, did not affect class II expression. Taken together, our data indicate that both IFN-gamma-induced PKC activation and Na+ influx are required for class II MHC expression in astrocytes but that activation of PKC alone is not sufficient for ultimate expression of this gene.

Perturbations in carbohydrate metabolism during cypermethrin toxicity in fish, Tilapia mossambica.

Sublethal concentrations (0.04 ppm) of cypermethrin induced significant metabolic changes in brain, liver and gill tissues of fish, T. mossambica. While cypermethrin caused depletion in glycogen and pyruvate levels lactate content was elevated in all the tissues. While phosphorylase 'a' and aldolase activity increased, phosphorylase 'b' activity registered a decrease in the present study. A decrease in lactate dehydrogenase activity with increase in lactate levels suggests reduced mobilization of pyruvate into citric acid cycle. Glucose-6-phosphate dehydrogenase activity was also elevated indicating enhanced oxidation through HMP pathway during cypermethrin toxicity. Inhibition of succinate, malate and isocitrate dehydrogenases and cytochrome c oxidase activity indicates impaired oxidation of carbohydrates through citric acid cycle.

Cypermethrin induced changes in nitrogen metabolism of fish, Tilapia mossambica.

At sublethal concentrations, cypermethrin caused a decrease in total proteins and an increase in free amino acids, protease, alanine aminotransferase and aspartate aminotransferase in liver, brain and gill tissues of Tilapia mossambica. Nitrogen metabolic profiles like ammonia, urea and glutamine were also elevated in all the tissues as a consequence of cypermethrin toxicity. Glutamate dehydrogenase, AMP deaminase and adenosine deaminase activity was also increased in the present study.

Sensitivity of brain cholinesterase to cypermethrin toxicity in freshwater teleost Tilapia mossambica.

Cypermethrin at sublethal concentrations induced significant changes in acetylcholinesterase (AChE) activity and acetylcholine (ACh) content in the brain tissue of both juvenile and adult-fish. Maximum inhibition of AChE activity is noticed at 6h and 12h after exposure to cypermethrin in juvenile and adult fish respectively. In contrast, the ACh levels registered an elevation in both the cases. During subsequent periods the rate of recovery in AChE activity and ACh content is variable in both the groups.

Cypermethrin induced modulations in lipid metabolism of freshwater teleost, Tilapia mossambica.

Significant changes in lipid metabolic profiles were observed in brain, liver and gill tissues of T. mossambica under chronic exposure to sublethal concentrations of cypermethrin. Increase in total lipid, lipase and free fatty acids with decrease in glycerol content suggests simultaneous operation of lipogenesis and lipolysis during cypermethrin stress. Phospholipid levels dropped, while cholesterol content increased in all the tissues as a consequence of cypermethrin toxicity.

Fenvalerate induced changes in evoked potentials from the ventral nerve cord (VNC) of cockroach, Periplaneta americana.

Changes in evoked potentials from the VNC of P. americana were recorded under in vitro and topical application of sublethal doses of fenvalerate. In this study significant changes in physical characteristics of action potentials like threshold voltage, duration, latency and amplitude were noticed. In in vitro studies the effects were found to be dose dependent, while in topical exposure maximum effect was noticed at 3h, followed by recovery during subsequent periods of exposure. Moreover, changes were more pronounced in in vitro than topical exposure.

The possible metabolic diversions adapted by the cockroach, Periplaneta americana to counteract the toxicity of fenvalerate.

Effects of sublethal doses of fenvalerate through topical application were monitored in the central nervous system (CNS) of P. americana. A decrease in total and soluble proteins with an increase in free amino acids, alanine aminotransferase (AlAT) and aspartate aminotransferase (AAT) was observed during fenvalerate toxicity. Further the levels of glycogen, pyruvate and activities of succinate dehydrogenase (SDH) and malate dehydrogenase (MDH) dropped significantly. Lactate content and lactate dehydrogenase (LDH) activity also showed an elevation following fenvalerate toxicity.

Effect in vitro of propoxur on calcium dependent ATP hydrolysis and calcium uptake by the rat brain synaptosomes.

Effect in vitro of propoxur on the specific activity of calcium stimulated ATPase and calcium uptake was studied in the rat brain synaptosomes. The data suggest that propoxur might disrupt the synaptic function by altering the calcium dependent ATP hydrolysis and calcium uptake in the central nervous system.

Modulations in ionic composition and ATPase system in the brain of albino rat under induced propoxur toxicity.

Modulations in ionic composition were seen in the rat brain during propoxur treatment indicating an impairment in the electric activity of neurons, oxygen consumption, ATPase system, disruption in the movement of ions across ionic pumps and synaptic transmission. The specific activity levels of ATPases were also altered confirming that the impairment in the ATPase system might be due to the ionic imbalances under propoxur stress.