Blood brain barrier

血脑屏障
  • 文章类型: Journal Article
    像其他体积电子显微镜方法一样,自动胶带收集超薄切除术(ATUM)可以通过扫描电子显微镜(SEM)对沉积在厚塑料胶带上的连续切片进行成像。ATUM在实现分层成像方面是独一无二的,因此可以有效筛选目标结构,根据相关的光学和电子显微镜的需要。然而,胶带上切片的SEM只能进入切片表面,从而将轴向分辨率限制为细胞囊泡的典型大小,其数量级低于获得的xy分辨率。相比之下,串联截面电子层析成像(ET),基于透射电子显微镜的方法,在全EM分辨率下产生各向同性体素,但是需要在电子稳定的薄膜和易碎的薄膜上沉积部分,从而使大切片库的筛选变得困难并且容易出现切片丢失。为了结合这两种方法的力量,我们开发了ATUM-Tomo,一种混合方法,首先通过可溶性涂层将部分可逆地附着到塑料胶带上,筛选后分离并转移到与ET相容的薄膜上。作为一个原则证明,我们应用相关的ATUM-Tomo研究了创伤性脑损伤小鼠模型中微血栓周围血脑屏障(BBB)渗漏的超微结构特征。通过注射的荧光和电子致密纳米颗粒的共聚焦成像来鉴定BBB渗漏的微血栓和相关部位。然后通过ATUM-SEM重新定位,最后被相关的ATUM-Tomo审问.总的来说,我们新的ATUM-Tomo方法将大大推进生物学现象的超微结构分析,这些生物学现象需要细胞和组织水平的环境化。
    Like other volume electron microscopy approaches, automated tape-collecting ultramicrotomy (ATUM) enables imaging of serial sections deposited on thick plastic tapes by scanning electron microscopy (SEM). ATUM is unique in enabling hierarchical imaging and thus efficient screening for target structures, as needed for correlative light and electron microscopy. However, SEM of sections on tape can only access the section surface, thereby limiting the axial resolution to the typical size of cellular vesicles with an order of magnitude lower than the acquired xy resolution. In contrast, serial-section electron tomography (ET), a transmission electron microscopy-based approach, yields isotropic voxels at full EM resolution, but requires deposition of sections on electron-stable thin and fragile films, thus making screening of large section libraries difficult and prone to section loss. To combine the strength of both approaches, we developed \'ATUM-Tomo, a hybrid method, where sections are first reversibly attached to plastic tape via a dissolvable coating, and after screening detached and transferred to the ET-compatible thin films. As a proof-of-principle, we applied correlative ATUM-Tomo to study ultrastructural features of blood-brain barrier (BBB) leakiness around microthrombi in a mouse model of traumatic brain injury. Microthrombi and associated sites of BBB leakiness were identified by confocal imaging of injected fluorescent and electron-dense nanoparticles, then relocalized by ATUM-SEM, and finally interrogated by correlative ATUM-Tomo. Overall, our new ATUM-Tomo approach will substantially advance ultrastructural analysis of biological phenomena that require cell- and tissue-level contextualization of the finest subcellular textures.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    肠道微生物生态系统在所谓的肠道-微生物组-脑轴中与大脑双向通信。双向信号通过几种途径发生,包括通过迷走神经的信号,微生物代谢物的循环,和免疫激活。肠道微生物群的改变与阿尔茨海默病(AD)有关,进行性神经退行性疾病.肠道微生物群落的扰动可能会通过改变微生物代谢产物的产生来影响肠道-微生物组-脑轴内的途径,包括γ-氨基丁酸(GABA),主要的抑制性哺乳动物神经递质。已显示GABA通过调节肠粘蛋白和紧密连接蛋白作用于肠完整性,并且可能参与迷走神经信号抑制。GABA能信号通路已被证明在AD中失调,并可能对干预作出反应。GABA的肠道微生物生产最近在神经系统疾病中受到关注,包括AD。拟杆菌和乳酸菌(LAB),包括乳酸菌,是GABA的主要生产者。这篇综述强调了与AD相关的肠道微生物群落的时间变化如何影响GABA能信号通路。肠屏障完整性,和AD相关的炎症。
    The gut microbial ecosystem communicates bidirectionally with the brain in what is known as the gut-microbiome-brain axis. Bidirectional signaling occurs through several pathways including signaling via the vagus nerve, circulation of microbial metabolites, and immune activation. Alterations in the gut microbiota are implicated in Alzheimer\'s disease (AD), a progressive neurodegenerative disease. Perturbations in gut microbial communities may affect pathways within the gut-microbiome-brain axis through altered production of microbial metabolites including ɣ-aminobutyric acid (GABA), the primary inhibitory mammalian neurotransmitter. GABA has been shown to act on gut integrity through modulation of gut mucins and tight junction proteins and may be involved in vagus nerve signal inhibition. The GABAergic signaling pathway has been shown to be dysregulated in AD, and may be responsive to interventions. Gut microbial production of GABA is of recent interest in neurological disorders, including AD. Bacteroides and Lactic Acid Bacteria (LAB), including Lactobacillus, are predominant producers of GABA. This review highlights how temporal alterations in gut microbial communities associated with AD may affect the GABAergic signaling pathway, intestinal barrier integrity, and AD-associated inflammation.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    血管危险因素有助于认知老化,其中一个危险因素是血脑屏障(BBB)功能障碍。使用非侵入性磁共振成像(MRI)技术的研究,如扩散制备动脉自旋标记(DP-ASL),可以通过测量水交换率(kw)来估计BBB函数。DP-ASLkw与认知相关,但是这种关系的方向性和强度仍在调查中。测量细胞外空间中的水并影响认知的另一个变量,MRI自由水(FW),可能有助于解释先前的发现。共有94名没有痴呆的老年人(平均年龄=74.17岁,59.6%女性)接受了MRI(DP-ASL,弥散加权成像(DWI))和认知评估。计算整个大脑的平均千瓦数(WB),计算所有白质的平均白质FW。kw与三个认知域(执行功能,处理速度,记忆)使用多元线性回归进行测试。使用过程宏测试了FW作为kw-认知关系的中介。发现WBkw与执行功能之间存在正相关[F(4,85)=7.81,p<.001,R2=0.269;β=.245,p=.014]。Further,该效应被随后的结果显示FW是WBkw-执行功能关系的中介(间接效应结果:标准化效应=.060,bootstrap置信区间=.0006至.1411)所证实.结果表明,较低的水交换率(kw)可能有助于增加总白质(WM)FW,反过来,可能会扰乱执行功能。一起来看,BBB处适当的液体清除有助于更高阶的认知能力。
    Vascular risk factors contribute to cognitive aging, with one such risk factor being dysfunction of the blood brain barrier (BBB). Studies using non-invasive magnetic resonance imaging (MRI) techniques, such as diffusion prepared arterial spin labeling (DP-ASL), can estimate BBB function by measuring water exchange rate (kw). DP-ASL kw has been associated with cognition, but the directionality and strength of the relationship is still under investigation. An additional variable that measures water in extracellular space and impacts cognition, MRI free water (FW), may help explain prior findings. A total of 94 older adults without dementia (Mean age = 74.17 years, 59.6% female) underwent MRI (DP-ASL, diffusion weighted imaging (DWI)) and cognitive assessment. Mean kw was computed across the whole brain (WB), and mean white matter FW was computed across all white matter. The relationship between kw and three cognitive domains (executive function, processing speed, memory) was tested using multiple linear regression. FW was tested as a mediator of the kw-cognitive relationship using the PROCESS macro. A positive association was found between WB kw and executive function [F(4,85) = 7.81, p < .001, R2= 0.269; β = .245, p = .014]. Further, this effect was qualified by subsequent results showing that FW was a mediator of the WB kw-executive function relationship (indirect effect results: standardized effect = .060, bootstrap confidence interval = .0006 to .1411). Results suggest that lower water exchange rate (kw) may contribute to greater total white matter (WM) FW which, in turn, may disrupt executive function. Taken together, proper fluid clearance at the BBB contributes to higher-order cognitive abilities.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    这篇综述讨论了磁共振引导聚焦超声(MRgFUS)和其他超声平台在神经系统疾病和神经肿瘤学中瞬时渗透血脑屏障(BBB)的临床应用进展。从广泛的临床前研究开始,人体安全性试验,展示了令人放心的安全性,并为阿尔茨海默病的许多转化临床试验铺平了道路,帕金森病,原发性和转移性脑肿瘤。未来的方向包括改进超声输送设备,探索替代递送方法,如纳米液滴,并将其应用扩展到其他神经系统疾病。
    This review discusses the current progress in the clinical use of magnetic resonance-guided focused ultrasound (MRgFUS) and other ultrasound platforms to transiently permeabilize the blood-brain barrier (BBB) for drug delivery in neurological disorders and neuro-oncology. Safety trials in humans have followed on from extensive pre-clinical studies, demonstrating a reassuring safety profile and paving the way for numerous translational clinical trials in Alzheimer\'s disease, Parkinson\'s disease, and primary and metastatic brain tumors. Future directions include improving ultrasound delivery devices, exploring alternative delivery approaches such as nanodroplets, and expanding the application to other neurological conditions.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    在过去的几十年中,组织芯片技术彻底改变了生物医学应用和医学科学领域。目前,与单层二维(2D)细胞培养相比,组织芯片是帮助体外工作以准确预测研究结果的最强大的研究工具之一。虽然2D细胞培养物占据了很长时间,他们缺乏仿生技术导致了向3D细胞培养的过渡,包括组织芯片技术,克服在体外研究中经常出现的差异。由于其广泛的应用,多年来已经研究了不同的器官系统,其中之一是血脑屏障(BBB),本文对此进行了综述。血脑屏障是一个令人难以置信的身体保护单位,防止病原体通过脉管系统进入大脑。然而,有一些微生物和某些疾病会破坏这种屏障的功能,从而导致有害的后果。在过去的几年里,已经提出了BBB的各种设计并建模,以研究地球上的药物递送和疾病建模。最近,研究人员已经开始利用太空中的组织芯片来研究微重力对人类健康的影响。空间中的BBB组织芯片可以是理解功能机制和治疗方法的工具。这篇综述解决了利用组织芯片技术可以克服的单层细胞培养的局限性。讨论了地球上当前的BBB模型以及它们的制造方式以及影响组织芯片中BBB细胞培养的因素。然后,本文回顾了这些技术的应用以及在太空中整合生物传感器将如何有助于预测特定组织或器官芯片中更准确的生理反应。最后,还讨论了当前在太空中使用的平台以及克服未来BBB组织芯片研究的一些缺点的一些解决方案。
    Tissue chip technology has revolutionized biomedical applications and the medical science field for the past few decades. Currently, tissue chips are one of the most powerful research tools aiding in in vitro work to accurately predict the outcome of studies when compared to monolayer two-dimensional (2D) cell cultures. While 2D cell cultures held prominence for a long time, their lack of biomimicry has resulted in a transition to 3D cell cultures, including tissue chips technology, to overcome the discrepancies often seen in in vitro studies. Due to their wide range of applications, different organ systems have been studied over the years, one of which is the blood brain barrier (BBB) which is discussed in this review. The BBB is an incredible protective unit of the body, keeping out pathogens from entering the brain through vasculature. However, there are some microbes and certain diseases that disrupt the function of this barrier which can lead to detrimental outcomes. Over the past few years, various designs of the BBB have been proposed and modeled to study drug delivery and disease modeling on Earth. More recently, researchers have started to utilize tissue chips in space to study the effects of microgravity on human health. BBB tissue chips in space can be a tool to understand function mechanisms and therapeutics. This review addresses the limitations of monolayer cell culture which could be overcome with utilizing tissue chips technology. Current BBB models on Earth and how they are fabricated as well as what influences the BBB cell culture in tissue chips are discussed. Then, this article reviews how application of these technologies together with incorporating biosensors in space would be beneficial to help in predicting a more accurate physiological response in specific tissue or organ chips. Finally, the current platforms used in space and some solutions to overcome some shortcomings for future BBB tissue chip research are also discussed.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    血管生成,或者新血管的形成,是一种天然的防御机制,有助于在缺血性中风后恢复氧气和营养向受伤的脑组织输送。血管生成,通过增加船只的发展,可以维持脑灌注,使神经元存活,大脑可塑性,和神经系统恢复。血管生成的诱导和新血管的形成有助于神经修复过程,例如神经发生和突触发生。先进的纳米药物递送系统通过促进跨血脑屏障的有效运输并维持最佳药物浓度,有望治疗中风。纳米粒子最近被证明可以大大促进血管生成和降低血管通透性,以及改善缺血性卒中后的神经可塑性和神经功能恢复。我们描述了目前在开发基于纳米粒子的治疗方法方面的突破,以使用聚合物纳米粒子更好地治疗缺血性中风的血管生成。脂质体,无机纳米粒子,和仿生纳米粒子在这项研究中。我们详细概述了新的纳米粒子,回顾将纳米颗粒输送到病变的障碍和策略,并证明了纳米颗粒在血管生成治疗中风方面的最新进展。
    Angiogenesis, or the formation of new blood vessels, is a natural defensive mechanism that aids in the restoration of oxygen and nutrition delivery to injured brain tissue after an ischemic stroke. Angiogenesis, by increasing vessel development, may maintain brain perfusion, enabling neuronal survival, brain plasticity, and neurologic recovery. Induction of angiogenesis and the formation of new vessels aid in neurorepair processes such as neurogenesis and synaptogenesis. Advanced nano drug delivery systems hold promise for treatment stroke by facilitating efficient transportation across the the blood-brain barrier and maintaining optimal drug concentrations. Nanoparticle has recently been shown to greatly boost angiogenesis and decrease vascular permeability, as well as improve neuroplasticity and neurological recovery after ischemic stroke. We describe current breakthroughs in the development of nanoparticle-based treatments for better angiogenesis therapy for ischemic stroke employing polymeric nanoparticles, liposomes, inorganic nanoparticles, and biomimetic nanoparticles in this study. We outline new nanoparticles in detail, review the hurdles and strategies for conveying nanoparticle to lesions, and demonstrate the most recent advances in nanoparticle in angiogenesis for stroke treatment.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    帕金森病(PD)的有效治疗,一种普遍的中枢神经退行性疾病,特别影响老年人群,仍然是一个巨大的挑战。我们在这里提出了一种新型的纳米药物制剂,该制剂基于与纤连蛋白(FN)复合的生物活性羟基封端的磷树枝状聚合物(称为AK123),具有抗炎和抗氧化活性。所产生的尺寸为223nm的优化的AK123/FN纳米复合物(NCs)在水溶液中显示出良好的胶体稳定性,并且可以通过FN介导的靶向被小胶质细胞特异性吸收。我们表明,AK123/FNNCs能够消耗过量的活性氧,促进小胶质细胞M2极化,抑制核因子-κB信号通路下调炎症因子。树枝状聚合物具有丰富的表面羟基端基,开发的NCs能够穿过血脑屏障(BBB),通过AK123介导的小胶质细胞M2极化的抗炎和FN介导的抗氧化和抗炎作用,对PD小鼠模型进行靶向治疗,从而减少α-突触核蛋白的聚集,并将体内多巴胺和酪氨酸羟化酶的含量恢复到正常水平。开发的树枝状聚合物/FNNCs结合了BBB交叉羟基封端的生物活性物质本身磷树枝状聚合物和FN的优点,有望扩展用于治疗不同的神经退行性疾病。
    Effective treatment of Parkinson\'s disease (PD), a prevalent central neurodegenerative disorder particularly affecting the elderly population, still remains a huge challenge. We present here a novel nanomedicine formulation based on bioactive hydroxyl-terminated phosphorous dendrimers (termed as AK123) complexed with fibronectin (FN) with anti-inflammatory and antioxidative activities. The created optimized AK123/FN nanocomplexes (NCs) with a size of 223 nm display good colloidal stability in aqueous solution and can be specifically taken up by microglia through FN-mediated targeting. We show that the AK123/FN NCs are able to consume excessive reactive oxygen species, promote microglia M2 polarization and inhibit the nuclear factor-kappa B signaling pathway to downregulate inflammatory factors. With the abundant dendrimer surface hydroxyl terminal groups, the developed NCs are able to cross blood-brain barrier (BBB) to exert targeted therapy of a PD mouse model through the AK123-mediated anti-inflammation for M2 polarization of microglia and FN-mediated antioxidant and anti-inflammatory effects, thus reducing the aggregation of α-synuclein and restoring the contents of dopamine and tyrosine hydroxylase to normal levels in vivo. The developed dendrimer/FN NCs combine the advantages of BBB-crossing hydroxyl-terminated bioactive per se phosphorus dendrimers and FN, which is expected to be extended for the treatment of different neurodegenerative diseases.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    在今天的工业化社会中,食物消费已经发生了巨大的变化,增加了红肉的摄入量,使用人造甜味剂代替谷物和蔬菜或糖,分别。这些饮食变化通过增加糖尿病和肥胖症等代谢性疾病的发病率来影响公众健康。心肾并发症的风险进一步升高。研究表明,高红肉摄入量和人造甜味剂的摄入可以改变微生物组成和进一步的肠壁屏障通透性,从而增加尿毒症毒素的传播,如硫酸对甲苯酯,硫酸吲哚酚,三甲胺n-氧化物和苯乙酰谷氨酰胺进入血流,引起一系列病理生理作用,特别是作为肾脏的菌株,因为他们负责清除毒素。在这次审查中,我们讨论了西方饮食的负担如何影响肠道微生物组,改变微生物组成和增加尿毒症毒素的肠道通透性,以及其对早期血管老化的不利影响,肾脏本身和血脑屏障,除了对饮食变化/干预措施的潜在影响,以保护未来与慢性病相关的健康问题。
    In today\'s industrialized society food consumption has changed immensely toward heightened red meat intake and use of artificial sweeteners instead of grains and vegetables or sugar, respectively. These dietary changes affect public health in general through an increased incidence of metabolic diseases like diabetes and obesity, with a further elevated risk for cardiorenal complications. Research shows that high red meat intake and artificial sweeteners ingestion can alter the microbial composition and further intestinal wall barrier permeability allowing increased transmission of uremic toxins like p-cresyl sulfate, indoxyl sulfate, trimethylamine n-oxide and phenylacetylglutamine into the blood stream causing an array of pathophysiological effects especially as a strain on the kidneys, since they are responsible for clearing out the toxins. In this review, we address how the burden of the Western diet affects the gut microbiome in altering the microbial composition and increasing the gut permeability for uremic toxins and the detrimental effects thereof on early vascular aging, the kidney per se and the blood-brain barrier, in addition to the potential implications for dietary changes/interventions to preserve the health issues related to chronic diseases in future.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    背景:幼年特发性关节炎(JIA)是儿童中最常见的风湿性疾病,炎症过程被广泛研究,主要表现为对关节健康的影响。新出现的证据表明,JIA也可能影响中枢神经系统(CNS)。本研究通过分析血浆中星形胶质细胞衍生的细胞外囊泡(EV)和S100B蛋白的存在,调查了JIA中潜在的中枢神经系统参与。两者都表明星形胶质细胞活性和血脑屏障(BBB)完整性。
    方法:来自90名诊断为JIA的儿童和10名健康对照的EDTA血浆,年龄和性别相匹配,通过流式细胞术测量分析细胞外囊泡。使用具有水通道蛋白4(AQP-4)和神经胶质原纤维酸性蛋白(GFAP)标记的流式细胞术鉴定星形胶质细胞衍生的EV。使用商业ELISA测量S100B蛋白的水平。使用青少年关节炎疾病活动评分(JADAS27,0-57)评估疾病活动,和疼痛水平使用视觉模拟量表(VAS,0-10厘米)。
    结果:我们的分析显示,与健康对照组相比,JIA患儿血浆中星形胶质细胞衍生的EV浓度明显更高。此外,JADAS27评分为1分或更高的儿童表现出更高水平的这些EV。仅在JIA组中可检测到S100B蛋白。
    结论:JIA患儿中星形胶质细胞衍生的EV水平升高和S100B的存在提供了BBB破坏和中枢神经系统受累的证据。特别是那些疾病活动较高的人。这些发现强调了在JIA的综合管理中考虑CNS健康的重要性。需要进一步的研究来阐明中枢神经系统参与JIA的机制,并开发解决该疾病的关节和中枢神经系统表现的治疗方法。
    BACKGROUND: Juvenile idiopathic arthritis (JIA) is the most prevalent rheumatic disease in children, and the inflammatory process is widely studied, primarily characterized by its impact on joint health. Emerging evidence suggests that JIA may also affect the central nervous system (CNS). This study investigates the potential CNS involvement in JIA by analyzing the presence of astrocyte-derived extracellular vesicles (EVs) and the S100B protein in plasma, both of which are indicative of astrocyte activity and blood-brain barrier (BBB) integrity.
    METHODS: EDTA plasma from 90 children diagnosed with JIA and 10 healthy controls, matched by age and gender, was analyzed for extracellular vesicles by flow cytometric measurement. Astrocyte-derived EVs were identified using flow cytometry with markers for aquaporin 4 (AQP-4) and glial fibrillary acidic protein (GFAP). Levels of the S100B protein were measured using a commercial ELISA. Disease activity was assessed using the Juvenile Arthritis Disease Activity Score (JADAS27, 0-57), and pain levels were measured using a visual analogue scale (VAS, 0-10 cm).
    RESULTS: Our analyses revealed a significantly higher concentration of astrocyte-derived EVs in the plasma of children with JIA compared with healthy controls. Furthermore, children with JADAS27 scores of 1 or higher exhibited notably higher levels of these EVs. The S100B protein was detectable exclusively in the JIA group.
    CONCLUSIONS: The elevated levels of astrocyte-derived EVs and the presence of S100B in children with JIA provide evidence of BBB disruption and CNS involvement, particularly in those with higher disease activity. These findings underscore the importance of considering CNS health in the comprehensive management of JIA. Further research is required to elucidate the mechanisms behind CNS engagement in JIA and to develop treatments that address both joint and CNS manifestations of the disease.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    目的:由于全身毒性和血脑屏障(BBB)通透性的限制,全身治疗胶质母细胞瘤(GBM)的疗效仍然有限。颞顶筋膜瓣(TPFFs)和血管化的颅周皮瓣(PCF)不受血脑屏障(BBB)的限制,因为它们的血管供应来自颈外动脉的分支。血管化TPFF或PCF沿着GBM切除腔的转位可将不受BBB限制的自体组织带到肿瘤床微环境附近。允许由外部循环供给的血管通道向内生长,并提供一种绕过血脑屏障的机制。此外,血管化皮瓣中的循环免疫细胞可以更好地接触肿瘤微环境中的肿瘤相关抗原(TAA)。我们进行了一项首次人体I期试验,评估了新诊断的GBM患者的自体TPFF/PCF内衬切除腔的安全性。
    方法:12名患者接受了安全,新诊断GBM的最大手术切除,然后是带蒂的切除腔内衬,自体TPFF或PCF。通过监测不良事件评估安全性。疗效的次要分析被检查为经历无进展疾病(PFS)的患者比例,如神经肿瘤学(RANO)标准和总生存期(OS)中的反应评估所指示的。该研究能够根据这些早期结果确定是否需要进行II期研究。对于这个分析,在最后一次随访时仍存活且未进展的受试者被视为审查,在最后一次随访时仍存活的所有存活患者被视为总生存期审查.为简单起见,我们假设6个月时70%的PFS率被认为是一个令人鼓舞的反应,并为进一步调查该手术提供了依据.
    结果:纳入患者的中位年龄为57岁(范围46-69岁)。所有患者均为异柠檬酸脱氢酶(IDH)野生型。平均肿瘤体积为56.6cm3(范围14-145cm3)。在所有患者中,所有增强疾病的切除均被视为总切除(GTR)。3例患者出现III级或以上不良事件。术后即刻未发生IV级或V级严重不良事件,包括癫痫发作。感染,中风,或者肿瘤沿着皮瓣生长。仅在4例(33%)患者中发现了原始肿瘤部位的疾病进展(中位数为23个月,范围8-25个月),其中3人接受了再次手术。在重复手术中对那些植入的皮瓣和肿瘤床活检的组织病理学分析显示,移植的皮瓣内有强大的免疫浸润。重要的是,没有患者表现出肿瘤浸润到植入的皮瓣中的证据。在这份手稿准备的时候,只有4/12(33%)的患者死亡。基于上述统计学考虑,并且包括所有12名患者10/12(83.3%)具有6个月PFS。中位PFS为9.10个月,OS为17.6个月。4/12(33%)的患者存活超过两年,我们目前存活时间最长的患者存活时间为60个月。
    结论:这项初步研究表明,沿着GBM切除腔插入带蒂自体TPFF/PCF是安全可行的。基于6个月PFS和OS的令人鼓舞的响应率,有必要进行更大的第二阶段研究来评估和重现安全性,可行性,和功效。前瞻性注册试验的试验注册编号和注册日期:ClinicalTrials.govIDNCT03630289,日期:08/02/2018。
    OBJECTIVE: The efficacy of systemic therapies for glioblastoma (GBM) remains limited due to the constraints of systemic toxicity and blood-brain barrier (BBB) permeability. Temporoparietal fascial flaps (TPFFs) and vascularized peri cranial flaps (PCF) are not restricted by the blood-brain barrier (BBB), as they derive their vascular supply from branches of the external carotid artery. Transposition of a vascularized TPFF or PCF along a GBM resection cavity may bring autologous tissue not restricted by the BBB in close vicinity to the tumor bed microenvironment, permit ingrowth of vascular channels fed by the external circulation, and offer a mechanism of bypassing the BBB. In addition, circulating immune cells in the vascularized flap may have better access to tumor-associated antigens (TAA) within the tumor microenvironment. We conducted a first-in-human Phase I trial assessing the safety of lining the resection cavity with autologous TPFF/PCF of newly diagnosed patients with GBM.
    METHODS: 12 patients underwent safe, maximal surgical resection of newly diagnosed GBMs, followed by lining of the resection cavity with a pedicled, autologous TPFF or PCF. Safety was assessed by monitoring adverse events. Secondary analysis of efficacy was examined as the proportion of patients experiencing progression-free disease (PFS) as indicated by response assessment in neuro-oncology (RANO) criteria and overall survival (OS). The study was powered to determine whether a Phase II study was warranted based on these early results. For this analysis, subjects who were alive and had not progressed as of the date of the last follow-up were considered censored and all living patients who were alive as of the date of last follow-up were considered censored for overall survival. For simplicity, we assumed that a 70% PFS rate at 6 months would be considered an encouraging response and would make an argument for further investigation of the procedure.
    RESULTS: Median age of included patients was 57 years (range 46-69 years). All patients were Isocitrate dehydrogenase (IDH) wildtype. Average tumor volume was 56.6 cm3 (range 14-145 cm3). Resection was qualified as gross total resection (GTR) of all of the enhancing diseases in all patients. Grade III or above adverse events were encountered in 3 patients. No Grade IV or V serious adverse events occurred in the immediate post-operative period including seizure, infection, stroke, or tumor growing along the flap. Disease progression at the site of the original tumor was identified in only 4 (33%) patients (median 23 months, range 8-25 months), 3 of whom underwent re-operation. Histopathological analyses of those implanted flaps and tumor bed biopsy at repeat surgery demonstrated robust immune infiltrates within the transplanted flap. Importantly, no patient demonstrated evidence of tumor infiltration into the implanted flap. At the time of this manuscript preparation, only 4/12 (33%) of patients have died. Based on the statistical considerations above and including all 12 patients 10/12 (83.3%) had 6-month PFS. The median PFS was 9.10 months, and the OS was 17.6 months. 4/12 (33%) of patients have been alive for more than two years and our longest surviving patient currently is alive at 60 months.
    CONCLUSIONS: This pilot study suggests that insertion of pedicled autologous TPFF/PCF along a GBM resection cavity is safe and feasible. Based on the encouraging response rate in 6-month PFS and OS, larger phase II studies are warranted to assess and reproduce safety, feasibility, and efficacy. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION FOR PROSPECTIVELY REGISTERED TRIALS: ClinicalTrials.gov ID NCT03630289, dated: 08/02/2018.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

公众号