Survival of rats bearing advanced intracerebral F 98 tumors after glutathione depletion and microbeam radiation therapy: conclusions from a pilot project.

BACKGROUND: Resistance to radiotherapy is frequently encountered in patients with glioblastoma multiforme. It is caused at least partially by the high glutathione content in the tumour tissue. Therefore, the administration of the glutathione synthesis inhibitor Buthionine-SR-Sulfoximine (BSO) should increase survival time. METHODS: BSO was tested in combination with an experimental synchrotron-based treatment, microbeam radiation therapy (MRT), characterized by spatially and periodically alternating microscopic dose distribution. One hundred thousand F98 glioma cells were injected into the right cerebral hemisphere of adult male Fischer rats to generate an orthotopic small animal model of a highly malignant brain tumour in a very advanced stage. Therapy was scheduled for day 13 after tumour cell implantation. At this time, 12.5% of the animals had already died from their disease. The surviving 24 tumour-bearing animals were randomly distributed in three experimental groups: subjected to MRT alone (Group A), to MRT plus BSO (Group B) and tumour-bearing untreated controls (Group C). Thus, half of the irradiated animals received an injection of 100 µM BSO into the tumour two hours before radiotherapy. Additional tumour-free animals, mirroring the treatment of the tumour-bearing animals, were included in the experiment. MRT was administered in bi-directional mode with arrays of quasi-parallel beams crossing at the tumour location. The width of the microbeams was ≈28 µm with a center-to-center distance of ≈400 µm, a peak dose of 350 Gy, and a valley dose of 9 Gy in the normal tissue and 18 Gy at the tumour location; thus, the peak to valley dose ratio (PVDR) was 31. RESULTS: After tumour-cell implantation, otherwise untreated rats had a mean survival time of 15 days. Twenty days after implantation, 62.5% of the animals receiving MRT alone (group A) and 75% of the rats given MRT + BSO (group B) were still alive. Thirty days after implantation, survival was 12.5% in Group A and 62.5% in Group B. There were no survivors on or beyond day 35 in Group A, but 25% were still alive in Group B. Thus, rats which underwent MRT with adjuvant BSO injection experienced the largest survival gain. CONCLUSIONS: In this pilot project using an orthotopic small animal model of advanced malignant brain tumour, the injection of the glutathione inhibitor BSO with MRT significantly increased mean survival time.

Microbeam radiation therapy: Clinical perspectives.

Microbeam radiation therapy (MRT), a novel form of spatially fractionated radiotherapy (RT), uses arrays of synchrotron-generated X-ray microbeams (MB). MRT has been identified as a promising treatment concept that might be applied to patients with malignant central nervous system (CNS) tumours for whom, at the current stage of development, no satisfactory therapy is available yet. Preclinical experimental studies have shown that the CNS of healthy rodents and piglets can tolerate much higher radiation doses delivered by spatially separated MBs than those delivered by a single, uninterrupted, macroscopically wide beam. High-dose, high-precision radiotherapies such as MRT with reduced probabilities of normal tissue complications offer prospects of improved therapeutic ratios, as extensively demonstrated by results of experiments published by many international groups in the last two decades. The significance of developing MRT as a new RT approach cannot be understated. Up to 50% of cancer patients receive conventional RT, and any new treatment that provides better tumour control whilst preserving healthy tissue is likely to significantly improve patient outcomes.

Quercetin attenuates inflammatory processes after spinal cord injury in an animal model.

OBJECTIVES: We have shown earlier that administration of the flavonoid quercetin significantly contributed to recovery of motor function after spinal cord compression injury in the adult rat. Using the same animal model, we have now designed a set of experiments to test the hypothesis that quercetin attenuates oxidative stress-related inflammatory processes early after spinal cord trauma. METHODS: Mid-thoracic spinal cord compression injury in adult male Wistar rats was caused by extradural application and closure of a 50 g calibrated aneurysm clip for 5 s. Myeloperoxidase (MPO) levels were determined in spinal cord tissue and serum of quercetin-treated animals and controls at 6, 12, 24 and 72 h after injury. The white blood count was followed until 72 h after injury. RESULTS: In quercetin-treated animals, MPO activity was significantly decreased in tissue at 12 and 24 h and in serum at 6, 12 and 24 h after injury, compared with saline controls. In quercetin-treated animals, the prevalence of ED-1 and MPO positive cells was significantly lower than in saline controls. White blood count in venous blood was significantly decreased in quercetin-treated animals at 12 and 24 h after injury. CONCLUSION: Quercetin attenuated the recruitment of neutrophils to the site of injury. The resulting lower MPO release in the injured tissue is likely to decrease the extent of secondary injury and might at least partially explain the neuroprotective effect of the flavonoid quercetin.

Quercetin administration after spinal cord trauma changes S-100 levels.

BACKGROUND: It has been shown previously that S-100beta levels in serum correspond with the severity of central nervous system (CNS) trauma. It also has been suggested that S-100beta in CNS tissue is involved in neuroprotection and neuroregeneration. We have previously shown that administration of quercetin results in improved motor function in an animal model of spinal cord trauma. METHODS: Mid-thoracic spinal cord compression injury was produced in adult male Wistar rats. Serum and tissue samples were acquired from quercetin-treated animals (25 micromol/kg) and saline controls at 6, 12 and 24 hours after the trauma. S-100beta levels were measured using a luminometric assay in the damaged tissue and in the serum of the animals. RESULTS: The increase in serum S-100beta levels seen in saline controls after spinal cord trauma was ameliorated in the quercetin-treated animals at all time points, although the difference to saline controls became statistically significant only at 24 hrs after the trauma. Compared to tissue S-100beta levels in healthy animals, values were significantly decreased in saline controls at all three time points, while they were decreased at 6 hrs and increased at both 12 and 24 hrs in quercetin-treated animals. At all three time points tissue S-100beta levels were significantly higher in quercetin-treated animals than in saline controls. CONCLUSIONS: Administration of quercetin results in modification of S-100beta levels in the setting of experimental spinal cord trauma. The kinetic patterns of the S-100beta fluctuations in serum and tissue suggest that post-traumatic administration of quercetin decreases the extent of CNS injury.

Quercetin in an animal model of spinal cord compression injury: correlation of treatment duration with recovery of motor function.

OBJECTIVES: We have shown previously that administration of quercetin after spinal cord injury in a rat model induced significant recovery of motor function. In the same model for spinal cord compression injury, we now have correlated the treatment duration with the extent to which motor function is recovered. METHODS: Seventy-four male Wistar rats were assigned to eight experimental groups. Mid-thoracic spinal cord injury was produced in the animals of seven groups. Quercetin was administered intraperitoneally in individual doses of 25 micromol kg(-1). Treatment onset was 1 h after the injury. The length of treatment ranged from one single injection to 10 days, with injection frequencies of two or three times daily. BBB (Basso, Beattie and Bresnahan) scores were obtained and tissue preservation at the site of injury was analyzed. RESULTS: None of the untreated control animals recovered motor function sufficient to walk. When quercetin was administered twice daily over a period of either 3 or 10 days, about 50% of the animals recovered sufficient motor function to walk. Stepping/walking (BBB > or =10) were seen in two of six animals receiving only a single injection and in one of the six animal receiving three injections. Surprisingly, none of the animals that received quercetin injections three times daily recovered the ability to walk (all BBB < or = 9). CONCLUSION: Quercetin administration results in preservation of tissue bridges at the site of injury. Treatment success depends on frequency of administration and overall dose.

Can admission S-100beta predict the extent of brain damage in head trauma patients?

BACKGROUND: As has been shown previously, S-100beta levels in serum can be a useful predictor of brain damage after head trauma. This pilot study was designed to investigate whether urine samples, which are much easier to obtain, could be used for the same purpose instead of serum samples. METHODS: Ninety-six consecutive patients admitted with head trauma were recruited in the study. After exclusion of 54 patients, mostly because of significant additional trauma, S-100beta levels were analyzed in serum and urine of 42 patients using a luminometric assay. A range for normal values was established based on samples from ten healthy volunteers. RESULTS: S-100beta serum levels increased proportional to the severity of the head trauma, as had been previously shown by several other groups. In many patients, initial increases in urine S-100beta levels were seen later than in serum, after which the kinetics of S-100beta levels in urine seemed to follow that established for serum levels. S-100beta values in urine were on average about 54% lower in urine than in serum. CONCLUSIONS: S-100beta levels in urine obtained on admission to the hospital are not a good indicator for the extent of brain damage. However, urine S-100beta levels obtained at later time points might be a useful indicator for the development of secondary brain injury.

Synchrotron-based in vivo tracking of implanted mammalian cells.

We have developed an X-ray imaging protocol that permits 3D visualisation of a small number of implanted cells within bulk tissue. The cells are marked using natural endocytosis of inert gold nano-particles. The resulting local increase in electron density allows high imaging contrast to be obtained from small clusters of these marked cells. Using this technique we have imaged C6 glioma cells within the brain of a model animal. The cells were marked by exposing them to colloidal gold incorporated in the growth media. Gold-loaded glioma cells were implanted into the brains of adult male Wistar rats. After tumours had been allowed to develop for up to 2 weeks, the animals were sacrificed and images of the intact cranium were acquired at the SYRMEP imaging station on the Elettra synchrotron in Italy. Computed tomography was performed using mixed absorption and phase contrast techniques at an X-ray energy of 24 keV. In the resulting volume datasets the tumour bulk is clearly visible and the infiltrating nature of the malignant growth is well demonstrated. Although the protocol was developed using this particular model of malignant brain tumour, it is believed that it will be possible to use it with other cell lines.

Analyzer-based imaging of spinal fusion in an animal model.

Analyzer-based imaging (ABI) utilizes synchrotron radiation sources to create collimated monochromatic x-rays. In addition to x-ray absorption, this technique uses refraction and scatter rejection to create images. ABI provides dramatically improved contrast over standard imaging techniques. Twenty-one adult male Wistar rats were divided into four experimental groups to undergo the following interventions: (1) non-injured control, (2) decortication alone, (3) decortication with iliac crest bone grafting and (4) decortication with iliac crest bone grafting and interspinous wiring. Surgical procedures were performed at the L5-6 level. Animals were killed at 2, 4 and 6 weeks after the intervention and the spine muscle blocks were excised. Specimens were assessed for the presence of fusion by (1) manual testing, (2) conventional absorption radiography and (3) ABI. ABI showed no evidence of bone fusion in groups 1 and 2 and showed solid or possibly solid fusion in subjects from groups 3 and 4 at 6 weeks. Metal artifacts were not present in any of the ABI images. Conventional absorption radiographs did not provide diagnostic quality imaging of either the graft material or fusion masses in any of the specimens in any of the groups. Synchrotron-based ABI represents a novel imaging technique which can be used to assess spinal fusion in a small animal model. ABI produces superior image quality when compared to conventional radiographs.

Assessment of rat optic nerve damage due to microbeam radiation therapy in the treatment of glioblastomas.

Glioblastomas are the most common and aggressive subtype of human primary brain tumors. Due to their uncontrolled cellular proliferation, intense invasion, and lack of apoptosis, they are extremely difficult to treat. Currently, different approaches such as surgery, chemotherapy and radiation therapy have been employed as possible treatments however thus far; these treatments are not curative. Currently, microbeam radiation therapy (MRT) is being trialed in animal models of malignant brain tumors (rats) to aid in treatment. Some of the protocols tested have been shown to significantly increase survival rates. However, due to the high x-ray doses uses in MRT, the surrounding tissue of the targeted Glioblastomas may be irreversibly damaged. In previous studies, lens damage and clouding of the cornea have been observed in microbeam exposed eyes. However, to date no studies have assessed optic nerve damage. Therefore, this study examines the potential rat optic nerve damage following exposure to microbeam radiation therapy in the treatment of Glioblastomas. Although there appears to be no significant damage to the optic nerve, slight inflammation was observed within the extra ocular muscle.

Myelin structure is a key difference in the x-ray scattering signature between meningioma, schwannoma and glioblastoma multiforme.

Small angle x-ray scattering (SAXS) patterns of benign and malignant brain tumour tissue were examined. Independent component analysis was used to find a feature set representing the images collected. A set of coefficients was then used to describe each image, which allowed the use of the statistical technique of flexible discriminant analysis to discover a hidden order in the data set. The key difference was found to be in the intensity and spectral content of the second and fourth order myelin scattering peaks. This has clearly demonstrated that significant differences in the structure of myelin exist in the highly malignant glioblastoma multiforme as opposed to the benign: meningioma and schwannoma.

A Fourier transform infrared microspectroscopic imaging investigation into an animal model exhibiting glioblastoma multiforme.

Glioblastoma multiforme (GBM) is a highly malignant human brain tumour for which no cure is available at present. Numerous clinical studies as well as animal experiments are under way with the goal being to understand tumour biology and develop potential therapeutic approaches. C6 cell glioma in the adult rat is a frequently used and well accepted animal model for the malignant human glial tumour. By combining standard analytical methods such as histology and immunohistochemistry with Fourier Transform Infrared (FTIR) microspectroscopic imaging and multivariate statistical approaches, we are developing a novel approach to tumour diagnosis which allows us to obtain information about the structure and composition of tumour tissues that could not be obtained easily with either method alone. We have used a "Stingray" FTIR imaging spectrometer to analyse and compare the compositions of coronal brain tissue sections of a tumour-bearing animal and those from a healthy animal. We have found that the tumour tissue has a characteristic chemical signature, which distinguishes it from tumour-free brain tissue. The physical-chemical differences, determined by image and spectral comparison are consistent with changes in total protein absorbance, phosphodiester absorbance and physical dispersive artefacts. The results indicate that FTIR imaging analysis could become a valuable analytic method in brain tumour research and possibly in the diagnosis of human brain tumours.

Quercetin promotes functional recovery following acute spinal cord injury.

We tested the hypothesis that quercetin, a potent Fe(2+)-chelating flavonoid, would decrease secondary damage following spinal cord trauma. MRI studies using the relaxation of the T1 proton signal caused by Fe(2+) ions and the dose-dependent reversal of this effect by addition of quercetin in aqueous solution were used to guide us to the dosage of quercetin to be used in animal experimentations. Forty-four male Wistar rats were used in two experimental series to test the hypothesis that administration of quercetin improves recovery of motor function after acute traumatic spinal cord injury. Animals were subjected to laminectomy and subjected to an extradural 40-g force clip compression for 5 sec at T7. Quercetin or saline was administered intraperitoneally 1 h after injury and then every 12 hr thereafter. Recovery of motor function was assessed using BBB scores at weekly intervals for 4 weeks. A dose of 2.5 micromoles quercetin/kg body weight did not result in significantly better functional outcome, whereas doses ranging from 5 to 100 micromoles quercetin/kg body weight resulted in a significantly better functional outcome with half or more of the animals walking, although with deficit; in contrast, no animals walked in the group of saline-treated animals. No significant differences in behavioral outcome were seen amongst the doses ranging from 5 to 100 micromol/kg, nor was there a difference if animals were treated for 4 or 10 days. Therapeutic outcome was coincident with more efficient iron clearance, suggesting that one possible mechanism whereby quercetin decreases secondary damage is through iron chelation.

Amelioration of experimental allergic encephalitis (EAE) through phase 2 enzyme induction.

The multiple sclerosis (MS) lesion is characterized by an inflammatory cell mediated attack on white matter. Oxidative stress appears to play a role in the onset and progression of MS. We reasoned that decreasing oxidative stress might ameliorate MS. One way of decreasing oxidative stress is to induce phase 2 enzymes. The model chosen to test this hypothesis was experimental allergenic encephalomyelitis (EAE) induced in the Lewis rat. The 26 animals were placed into two groups: 1) those on normal rat chow, 2) those on rat chow containing 250 mumoles t-butylhydroxyanisole (BHA)/kg. After 2 weeks, animals were administered 100 micrograms guinea pig myelin basic protein and examined daily in a blinded fashion. Twenty-nine days later, animals were sacrificed, blood collected for glutathione (GSH) measurements and tissues collected for histology. Six of the 13 control chow animals developed hindlimb weakness or paralysis while 5 developed tail weakness only. Only 1 BHA fed animal exhibited symptoms--hindlimb weakness. Clinical symptoms correlated well with the extent of perivascular lymphocyte infiltration. Animals with BHA in the diet had 20% higher red cell GSH indicting induction of phase 2 enzymes. We conclude that dietary phase 2 enzyme inducers should be examined for their ability to ameliorate MS.

Ludwig Guttmann: emerging concept of rehabilitation after spinal cord injury.

Ludwig Guttmann was a pioneer of the idea of rehabilitation for victims of spinal cord injury. He looked beyond the physical survival of his patients, to their re-integration into a social life worth living. While the International Stoke Mandeville Games are fairly well known to the general public as a gathering for physically handicapped athletes, less is known about the man who helped start the movement. On the occasion of the recent Sydney 2000 Paralympics, this paper reviews the contribution of Ludwig Guttmann, who introduced sport into the life of paralyzed patients.

An easy and safe method to store and disinfect explanted skull bone.

In our department extensive decompression craniectomies became the treatment of choice for patients with massive cerebral oedema following either trauma or acute cerebral infarction. The remarkable survival rates of this neurosurgical technique created the problem of adequate vault defect reconstruction. To evaluate the biological safety of using stored autologous skull flaps for this purpose, we compared three different disinfection methods. Skull bone fragments stored at -21 degrees C for different periods of time were artificially contaminated with clinically relevant strains of Serratia marcescens, Enterococcus faecium and Staphylococcus aureus. As potential methods for disinfection we tested immersion in 3% H2O2, boiling in normal saline for 15 and 30 minutes and a special process of steam disinfection at a temperature of 75 degrees C for 20 minutes. We were able to demonstrate that only steam disinfection completely eliminated the bacterial strains tested. Refrigeration plus steam disinfection of autologous skull bone prior to re-implantation seems to offer reliable safety for its use for defect closure. It is available at reasonable cost in many hospitals and does not require a bone bank.

Glutathione release and catabolism during energy substrate restriction in astrocytes.

This study examined the effect of simulated ischemia (deprivation of both oxygen and substrate) on astrocyte reduced-glutathione (GSH). We have demonstrated that under normoxic conditions there is no GSH efflux from living astrocytes; this suggests that the high levels of GSH in astrocytes in vivo are not available for neighbouring neural cells. Under simulated ischemia there is release of GSH from astrocytes only when astrocytes die. Furthermore, when astrocytic energy stores are depleted GSH is catabolized, such that after 12 h of simulated ischemia approximately 20% of GSH is catabolized. This GSH catabolism can be increased at an earlier time by causing increased ATP utilization through activating the sodium pump either by introducing glutamate into the culture medium or by raising medium potassium. Since GSH is catabolized into glycine, glutamate and cysteine, the latter two amino acids being neurotoxic, our findings indicate that the high levels of GSH in astrocytes may be used by these cells to survive ischemic insults, but the catabolism of GSH may result in increased neuronal damage.