The authors would like to thank the MSKCC Tissue Procurement Service Team (TPS), specifically, Maria Corazon Mariano, Priscilla McNeil, Anas Idelbi, Daniel Navarrete and Katrina Allen, in all of their efforts in the successful pursuit of this project and funding from the following sources: 5 R21 CA158609-02 and the Conquer Cancer Foundation and the Breast Cancer Research Foundation. In addition, the authors would like to thank Eric Cottington PhD, Vice President of the Office of Research and Project Administration, the Office of Technology Development, Research Outreach and Compliance and RTM Information Systems Support, in the support of the submission of this manuscript.

HINWEIS: Patientengewebebeschaffung wurde durch institutionell Review Board (IRB) zugelassenen -zugelassene Biospecimen und Klinische Protokolle (Protokoll-Nummern 09-121 und 11-041, beziehungsweise) am Memorial Sloan Kettering Cancer Center. 1. Gewebebeschaffung <ol><li> Beschaffung von Patienten Primärtumor / Metastasen HINWEIS: Bis heute hat dieses Protokoll auf chirurgisch entfernt Pankreas, Magen-und Brusttumorarten, sowie, Lymphom Metastasen durchgeführt. <ol><li> Richten Sie die OP-Team, um die Probe per Kurier oder Rohrpostsystem der Pathologie-Abteilung in dicht verschlossenen und sterile dicht Kunststoffbeutel in sterilen Probenspritzwassergeschützte Behälter zu liefern. Richten Sie die OP-Team, um die Probe im frischen Zustand ohne Formalin oder Fixiermittel zu transportieren. </li><li> Richten Sie den Pathologen oder Pathologe Assistent der frischen Probe ernten mit sterilen Technik, die incLudes Verwendung von sterilen Handschuhen und Instrumente unter einer Steril. </li><li> Notieren Sie sich die Erntezeit der beschafften Probe, die streng unter 30 min von der Beendigung des chirurgischen Eingriffs gehalten wird. Unter Berücksichtigung der Effekte kalten Ischämie, Proben nehmen Sie nicht aus reseziert Proben mit einer kalten Ischämiezeit von&gt; 30 min 18. </li><li> Leiten der Pathologie Personal an eine primäre Tumorprobe von etwa 0,5 cm3 bis 1,0 cm 3 in einem Abzug mit laminarer Strömung zu entfernen, um eine sterile Umgebung aufrechtzuerhalten. Wenn möglich, wählen Tumorgewebe von der Peripherie der Läsion Indexpotential Frank zentrale Nekrose (Zelltod) zu vermeiden. HINWEIS: Die nekrotischen Gewebe kann grob durch eines der folgenden Kriterien erkennbar sein: Verlust von Farbe oder Blässe des Gewebes; Verlust von Kraft, in dem nekrotischen Gewebe ist weich und brüchig; eine deutliche Abgrenzung zwischen nekrotischen und lebensfähiges Gewebe. </li><li> Richten Sie die pathologist oder Pathologe Assistent peripheren Gewebe, das im Überschuss (chirurgische Ablage) ist nach sofortiger Abtastung des Tumor für Diagnostik liefern. Die Probe wird in einem 15 ml sterilen konischen Zentrifugenröhrchen mit annähernd 5 ml Minimalmedium (MEM), das 1% Antibiotika (Penicillin und Streptomycin). </li><li> Falls vorhanden (zB Lymphknoten Achsel Schwanz Mastektomie Probe), beschaffen grob positive Lymphknoten assoziiert Probe der gleichen Größe (0,5 cm 3 bis 1,0 cm 3) und zu vergleichen, um das Ansprechen auf Medikamente des Primärtumors. Wie die Primärtumorprobe, legen die zugehörigen Lymphknoten Probe in einem 15 ml sterilen konischen Zentrifugenröhrchen mit annähernd 5 ml Minimalmedium (MEM), das 1% Antibiotika (Penicillin und Streptomycin). </li><li> Wenn die Größe der chirurgischen Probe Genehmigungen (zB Mastektomie Probe), zu entfernen (entfernt von Primärtumor) einer Probe von normalem Gewebe (dhnormalen dicht / Faser Brustparenchym) und in eine 15 ml sterilen konischen Zentrifugenröhrchen mit etwa 5 ml Minimalmedium (MEM), die 1% Antibiotika für nur Übertragungszwecken. Nach dem Transfer auf die Laboreinrichtungen, übertragen Sie die &quot;normalen&quot; Probe einem Kryoröhrchen, &quot;Snap&quot; einzufrieren und an einem -80 ° C Gefrierschrank für zukünftige molekulare Analysen. </li><li> Legen Sie alle Proben auf nassem Eis und sofort in den Laborraum für ex vivo frischem Gewebe Schnitte zu transportieren. Abschnitt nicht die normale Probe, sondern in einem -80 ° C nicht speichern Gefrierschrank für zukünftige molekulare Analysen. Übertragen einen Teil des Primärtumors und der zugehörigen Metastasen in einem Kryoröhrchen, &quot;Snap&quot; einzufrieren und an einem -80 ° C Gefrierschrank für zukünftige molekulare Analysen. </li></ol></li><li> Beschaffung von Gewebe aus klinischen Studien (zB optional Kernnadelbiopsien (CNB)) HINWEIS: Wir erhalten Tumorgewebe von Patientenauf klinische Protokolle, die ihre Zustimmung zu einer CNB einer zugänglichen Tumormetastasierung vor Beginn der Therapie zu unterziehen geben eingeschrieben. CNBs bis heute haben sich auf Patienten mit Brust-, Randzone Lymphom, Mantelzell-Lymphom, Metastasen paraganglioma, des Gebärmutterhalses (Plattenepithelkarzinom) und Eierstockkrebs durchgeführt. <ol><li> Haben klinische Personal aus Interventionelle Radiologie oder Fachabteilung führen eine Vorbehandlung Stanzbiopsie und platzieren Sie die Probe in einem 15 ml konischen sterile Zentrifugenröhrchen mit etwa 5 ml Minimalmedium (MEM), die 1% Antibiotika (Penicillin und Streptomycin). </li><li> Legen Sie die Biopsie auf nassem Eis und sofort auf den Laborraum für ex vivo frischem Gewebe Schnitte zu transportieren. </li></ol></li></ol> 2. Herstellung von Materialien für Schnitte und Vibratom Einstellungen <ol><li> Vorbereitung der Materialien für die Schnitte <ol><li> Stellen Sie einen 4% igen Lösung durch Zugabe von 4 g agastieg auf 100 ml PBS. Autoklaven (Zykluseinstellungen: flüssig, 121 ° C, 30 min, 15 Pfund pro Quadratzoll) die Lösung vor dem ersten Gebrauch. Für nachfolgende Verwendungen, legen Sie die 4% Agarose in der Mikrowelle auf (hohe Hitze für 30 Sekunden-Intervallen) vor jeder Verwendung zu verflüssigen und kühlen angemessen auf ~ 25 ° C (dh warm an) bewusst, dass Agarose erstarrt bei RT. </li><li> Verwenden Sie die 4% Agarose als nicht-ständiges Einbettung Gewebe Medien. Wenn die 4% Agarose ausreichend abgekühlt ist und sich noch in einem flüssigen Zustand mit einer sterilen Pinzette Platzieren der Gewebeprobe in einem Einbettmedium Form gießen und in 4% Agarose. </li><li> Die Gewebeprobe in der Nähe (ca. 2 mm Abstand), aber nicht direkt in der Schneidfläche Wand der Einbettung Form. Die 4% Agarose beginnt schnell zu verfestigen, damit entsprechend der Gewebeprobe zu positionieren schnell. Während des Schneidens, halten Sie die 4% Agarose in einem 55 ° C Wasserbad in Lösung zu halten. </li><li> Zu einem 24-Well-Platte für Schnittanalyse, 1 ml of Vollmedien (dh MEM + 10% fötales Rinderserum + 1% Antibiotika) in jede Vertiefung. Halten Sie die 24-Well-Platte bei RT (~ 25 ° C) während der Dauer der Schneiden. </li></ol></li><li> Vorbereitung der Vibratom Einstellungen <ol><li> Verwendung der vibrierenden Mikrotom, stellen Sie die Geschwindigkeit, mit der die Klinge nähert die Probe [0 (0,00 mm / s) auf 10 (2,5 mm / sec)] und die Frequenz der Klinge [0 (0 Hz) bis 10 (100 Hz) ]. Passen Sie die Einstellungen nach der Beschaffenheit des Gewebes (dh Dichte / Festigkeit). </li><li> Für einen primären Brusttumor von invasiven duktalen Karzinom, passen Sie die Einstellungen bis 6 und 3, Geschwindigkeit und Häufigkeit auf. Für weniger dicht / Firma Tumorgewebe, reduziert sich die Geschwindigkeit entsprechend zu erhöhen und Frequenz. </li><li> Stellen Sie die Schnittdicke innerhalb der Grenzen Instrument (1-999 um). Für diese Analysen, stellen Sie die Schnittdicke auf 200 um. </li><li> Montieren Sie die Agarose eingebettete Probe mit einer dünnen Schicht aus flüssigem Klebstoff auf der Objektplatte that in einem Reservoir von Medien, die in nassem Eis eingeschlossen ist taucht. </li></ol></li></ol> 3. Gewebe Schnitte, Behandlung &amp; Analysen <ol><li> Sofort nach Schneiden mit einer sterilen Pinzette und in eine Multi-Well-Platte mit 1 ml Vollmedium entfernen Sie die präzise geschnittenen Abschnitte. Wenn genügend Abschnitte sind für die Antwort und korrelativen Analysen erworben, legen Sie die Multi-Well-Platte zur Behandlung Reaktion in einem Gewebekulturbrutschrank bei Standardgewebekulturbedingungen eingestellt. </li><li> Nehmen mehrere Steuerabschnitte, die die behandelten Bereiche in dem Bemühen, eine dosisabhängige Reaktion zu bestätigen, im Gegensatz zu kultivierten Artefakte Buchstütze. Führen Schneiden schnell Gewebe (~ 30 - 40 min), der in jedes nachteiligen Auswirkungen der kalten Ischämiezeit (~ 2-4 h), 18. Führen Behandlung der Abschnitte erst nach einer Eingewöhnungszeit 1 Stunde. </li><li> Nach der Eingewöhnungszeit 1 Stunde, fügen steigenden Dosen (therapeutisch relevant ist; <em.&gt; ZB 0 - 10 uM Konzentrationen) von Arzneimittel zu den Abschnitten und Haus unter Standardzellkulturbedingungen für die Behandlungsdauer. Für diese Studie verwenden 24 und / oder 48 Stunden Veranlagungszeiträume. Jedoch wird die Kontrolle (nur Vehikel) Gewebeschnitte lebensfähig bleiben, wie in dieser Studie getestet, für Zeiträume bis zu einschließlich 96 Stunden Beurteilungszeiträume. </li><li> Nach der Behandlung entfernt alle Abschnitte steril und Formalin-fix, indem der Gewebeabschnitt in einer Röhre, die entweder 10% gepuffertem Formalin und Stelle bei RT O / N oder in einem Rohr, enthaltend 4% Paraformaldehyd (Verdünnung 16% Paraformaldehyd aus einem Fläschchen mit PBS für eine endgültige Konzentration von 4%) und Platz bei RT für 2 Stunden. <ol><li> Fix größeren Gewebeschnitten (zB., ~ 6 mm x 4 mm) 200 um dick in 10% Formalin O / N bei RT. Beheben kleinere Abschnitte (beispiels., 1 mm x 1 mm), 200 um dick, in 4% Paraformaldehyd 2 h bei RT. HINWEIS: Für eine effiziente Penetration der Fixierungs das Volumen von fixative sollte das Volumen des Gewebes 20x werden. Angesichts, dass dieses Protokoll zu extrem kleinen Gewebe Größen (zB 6 mm 3 Gewebe = 6 ul Volumen), für Sicherung der richtige Fixierung Verwendung von 1 ml Fixiermittel für alle Gewebe Größen. </li><li> Nach der Fixierung müssen die Gewebeproben in Paraffin durch die Pathologie-Abteilung Personal eingebettet. Abschnitt Probe Paraffinblöcke auf geladene Objektträger zu Hämatoxylin und Eosin gefärbt und bewertet immunhistochemisch (zB Apoptose) sein. </li></ol></li></ol>

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No conflicts of interest disclosed.

Krebs Biologen vor großen Herausforderungen, wenn man versucht, wirksame therapeutische Strategien zu entwickeln. Testen von Medikamenten in der Entwicklung auf etablierte Krebszelllinien nicht genau in vivo Reaktion und in vivo Versuchen an PDX Modelle sind arbeitsintensiv und sehr teuer. Angesichts des Vorstehenden wird die Anwendung der Ex-vivo-Techniken der Primärtumoren Patienten 14, 15 wird nun neben der molekularen Analyse von etablierten Tumorzelllinien und von einem Patie...

Entwicklung wirksamer Krebstherapeutika hat sich als äußerst schwierig. Krebszelllinien und Tumor Explantate - ebenso wie Heterotransplantate wurden in der Krebsforschung seit über einem halben Jahrhundert 1,2,3 verwendet. Bis heute ist die molekulare Analyse von Arzneimittelempfindlichkeit und Widerstand in beiden etablierten Krebszelllinien und Patienten abgeleitete Xenografts (PDX) unverzichtbar. Jedoch ist der Test-Verbindungen in etablierte Krebszelllinien oft nicht prädiktiv für die Wirksamkeit in vivo, und die entsprechenden in vivo-Untersuchungen an Tieren, insbesondere in PDX Modelle, ist sehr teuer und zeitaufwendig. Die Grenzen dieser Modellsysteme, nämlich der Unfähigkeit, über den Einfluss der nativen Mikroumgebung der Tumorprogression und der Reaktion auf therapeutische Strategien zu informieren, hat das Forschungsfeld, um zusätzliche Methoden, um diese Analysen zu entwickeln Kompliment geführt. Der letzten, ist erhöhte Aufmerksamkeit in Richtung Ex-vivo-Analyse von Patienten TUM bezahltoder Explantaten 4, 5 aufgrund der besseren Verständnis, dass Krebs therapeutische Antwort nicht exklusiv ist, um die inhärente molekulare Zusammensetzung von Krebszellen, sondern wird stark durch die Tumorzelle Mikro 6, 7 eine Funktion, die nicht durch herkömmliche Kultivierungsverfahren und rekapitulieren beeinflusst / oder PDX. Ex-vivo-Analyse in der obigen Kontext (dh., Einfluss der benachbarten Umgebung von Tumorzellen Mikroumgebung) impliziert Bewertung von lebensfähigen primären Tumor / Metastasen Abschnitte, statt ex vivo Analyse zellulärer Isolate 8, 9. Wir berichten hier über einen Ex-vivo-Technik (dh., Präzise geschnittenen frischen Gewebeschnitten) der beiden Patienten Primärtumoren und Metastasen assoziiert (dh Lymphknoten), die treu informiert über Antwort (IC50), Off-Target-Effekte und ermöglicht für die molekulare Analyse von Widerstand und Feedback-Mechanismen. Zusätzlich wird ein Korrelat Analyse therapeUTIC Empfindlichkeit / Resistenz gegen Biomarker und Genexpressionsprofil kann in dem Bemühen, Patienten eher zu dem experimentellen Medikament von Interesse reagieren zu identifizieren durchgeführt werden (dh., hohe Medikamentenantwort passt Patienten mit bestimmten biologischen Profil). Anwendung der Ex-vivo-Technik und Bewertung in einer Multi-Parameter-Mode ist Bewegung in Richtung Patientenauswahl und die allgemeine Verbesserung der klinischen Ergebnisse. Ex-vivo-Behandlung Response-Analyse konnte ein Standardwerkzeug in der präklinischen und klinischen Entwicklung von Krebstherapeutika zu werden und wird als ein Schritt hin zu einer personalisierten Medizin Ansatz in der therapeutischen Entwicklungsstrategien in Betracht gezogen.

<table border="0" cellpadding="0" cellspacing="0" width="598">
	<tbody>
		<tr height="43">
			<td height="43" style="height:43px;width:216px;">Name of Material/ Equipment</td>
			<td style="width:96px;">Company</td>
			<td style="width:119px;">Catalog Number</td>
			<td style="width:167px;">Comments/Description</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Vibratome Leica VT1000s</td>
			<td style="width:96px;">Leica</td>
			<td style="width:119px;">14047235613</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">UltraPure agarose</td>
			<td style="width:96px;">Invitrogen</td>
			<td style="width:119px;">16500500</td>
			<td style="width:167px;">Prepare 4% and 6% before use</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Injector blade</td>
			<td style="width:96px;">Ted Pella</td>
			<td style="width:119px;">121-4</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:216px;">MEM with Penicillin&#160; + Streptomycin</td>
			<td style="width:96px;">Media Core Facilities (MSKCC)</td>
			<td style="width:119px;"></td>
			<td style="width:167px;">The media is prepared at Memorial Sloan Kettering Cancer Center&#160;</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Scalpel no. 10</td>
			<td style="width:96px;">Thermo Scientific</td>
			<td style="width:119px;">31-200-32</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Disposable forceps</td>
			<td style="width:96px;">Cole-Parmer</td>
			<td style="width:119px;">84011182</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:216px;">Embedding mold</td>
			<td style="width:96px;">Electron Microscopy Science</td>
			<td style="width:119px;">70181</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">FBS (heat inactivated)</td>
			<td style="width:96px;">Gemini</td>
			<td style="width:119px;">100106</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">24 well plates</td>
			<td style="width:96px;">Corning</td>
			<td style="width:119px;">3524</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Formalin (10%)</td>
			<td style="width:96px;">Sigma Diagnostics</td>
			<td style="width:119px;">SDHT501128&#160;</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">16% Formaldehyde solution</td>
			<td style="width:96px;">Thermo Scientific</td>
			<td style="width:119px;">28908</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Embedding microsettes</td>
			<td style="width:96px;">Simport</td>
			<td style="width:119px;">M503-2</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Ethanol (70%)</td>
			<td style="width:96px;">Fisher Scientific</td>
			<td style="width:119px;">A405P-4</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Waterbath</td>
			<td style="width:96px;">Fisher Scientific</td>
			<td style="width:119px;">15-462-2SQ</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Microwave</td>
			<td style="width:96px;">General Electric</td>
			<td style="width:119px;">ModelJES2051DNBB</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Adhesive (Ethyl Cyanoacrylate)</td>
			<td style="width:96px;">Sigma-Aldrich</td>
			<td style="width:119px;">E1505-5G</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">10mm dishes</td>
			<td style="width:96px;">BD Falcon</td>
			<td style="width:119px;">353003</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:216px;">15ml tubes</td>
			<td style="width:96px;">BD Falcon</td>
			<td style="width:119px;">352096</td>
			<td style="width:167px;"></td>
		</tr>
	</tbody>
</table>

ex vivo treatment response of primary tumors and/or associated metastases for preclinical and clinical development of therapeutics

The molecular analysis of established cancer cell lines has been the mainstay of cancer research for the past several decades. Cell culture provides both direct and rapid analysis of therapeutic sensitivity and resistance. However, recent evidence suggests that therapeutic response is not exclusive to the inherent molecular composition of cancer cells but rather is greatly influenced by the tumor cell microenvironment, a feature that cannot be recapitulated by traditional culturing methods. Even implementation of tumor xenografts, though providing a wealth of information on drug delivery/efficacy, cannot capture the tumor cell/microenvironment crosstalk (i.e., soluble factors) that occurs within human tumors and greatly impacts tumor response. To this extent, we have developed an ex vivo (fresh tissue sectioning) technique which allows for the direct assessment of treatment response for preclinical and clinical therapeutics development. This technique maintains tissue integrity and cellular architecture within the tumor cell/microenvironment context throughout treatment response providing a more precise means to assess drug efficacy.

Für diese Studie wurde die Ex-vivo-Technik in einem korrelativen Analyse der therapeutischen Empfindlichkeit / Widerstand eines Hitzeschockprotein 90-Inhibitor (Hsp90i) verwendet. In einer präklinischen Bewertung dieses Hsp90i, den Primärtumor Brustkrebs, einem ER + invasive duktale Karzinom (IDC) und die zugehörigen Lymphknoten-Metastasen wurden ex vivo zur Behandlung Reaktion analysiert &#160; (Abbildung 1). Mehrere 200 um serielle Schnitte wurden mit Vehikel all...

Watch this Scientific Journal Video about Ex Vivo Treatment Response of Primary Tumors and/or Associated Metastases for Preclinical and Clinical Development of Therapeutics at JoVE.com

Ex Vivo Treatment Response of Primary Tumors and/or Associated Metastases for Preclinical and Clinical Development of Therapeutics

Gegründet Krebszelllinien und Heterotransplantate waren die Hauptstütze der Krebsforschung in den letzten Jahrzehnten. Jedoch schlägt letzten Beweis, dass therapeutische Reaktion wird durch die Tumorzelle Mikro beeinflusst. Daher haben wir eine ex vivo-Analyse des Primärtumorproben für die Arzneimittelentwicklung Zwecke entwickelt.

Ex-vivo-Ansprechen auf die Behandlung von Primärtumoren und / oder assoziierten Metastasen für die präklinische und klinische Entwicklung von Therapeutika

The molecular analysis of established cancer cell lines has been the mainstay of cancer research for the past several decades. Cell culture provides both ...

ex-vivo-treatment-response-primary-tumors-andor-associated-metastases

Research

JoVE Journal

Medicine

Ex Vivo Treatment Response of Primary Tumors and/or Associated Metastases for Preclinical and Clinical Development of Therapeutics

14.6K Aufrufe.  Memorial Sloan Kettering Cancer Center.  Gegründet Krebszelllinien und Heterotransplantate waren die Hauptstütze der Krebsforschung in den letzten Jahrzehnten. Jedoch schlägt letzten Beweis, dass therapeutische Reaktion wird durch die Tumorzelle Mikro beeinflusst. Daher haben wir eine ex vivo-Analyse des Primärtumorproben für die Arzneimittelentwicklung Zwecke entwickelt. 

Serie: Ex Vivo Treatment Response of Primary Tumors and/or Associated Metastases for Preclinical and Clinical Development of Therapeutics

Thermal Ablation for the Treatment of Abdominal Tumors

Percutaneous thermal ablation is an emerging treatment option for many tumors of the abdomen not amenable to conventional treatments. During a thermal ablation procedure, a thin applicator is guided into the target tumor under imaging guidance. Energy is then applied to the tissue until temperatures rise to cytotoxic levels (50-60 &deg;C). Various energy sources are available to heat biological tissues, including radiofrequency (RF) electrical current, microwaves, laser light and ultrasonic waves. Of these, RF and microwave ablation are most commonly used worldwide.
During RF ablation, alternating electrical current (~500 kHz) produces resistive heating around the interstitial electrode. Skin surface electrodes (ground pads) are used to complete the electrical circuit. RF ablation has been in use for nearly 20 years, with good results for local tumor control, extended survival and low complication rates1,2. Recent studies suggest RF ablation may be a first-line treatment option for small hepatocellular carcinoma and renal-cell carcinoma3-5. However, RF heating is hampered by local blood flow and high electrical impedance tissues (eg, lung, bone, desiccated or charred tissue)6,7. Microwaves may alleviate some of these problems by producing faster, volumetric heating8-10. To create larger or conformal ablations, multiple microwave antennas can be used simultaneously while RF electrodes require sequential operation, which limits their efficiency. Early experiences with microwave systems suggest efficacy and safety similar to, or better than RF devices11-13.
Alternatively, cryoablation freezes the target tissues to lethal levels (-20 to -40 &deg;C). Percutaneous cryoablation has been shown to be effective against RCC and many metastatic tumors, particularly colorectal cancer, in the liver14-16. Cryoablation may also be associated with less post-procedure pain and faster recovery for some indications17. Cryoablation is often contraindicated for primary liver cancer due to underlying coagulopathy and associated bleeding risks frequently seen in cirrhotic patients. In addition, sudden release of tumor cellular contents when the frozen tissue thaws can lead to a potentially serious condition known as cryoshock 16.
Thermal tumor ablation can be performed at open surgery, laparoscopy or using a percutaneous approach. When performed percutaneously, the ablation procedure relies on imaging for diagnosis, planning, applicator guidance, treatment monitoring and follow-up. Ultrasound is the most popular modality for guidance and treatment monitoring worldwide, but computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used as well. Contrast-enhanced CT or MRI are typically employed for diagnosis and follow-up imaging.

A thermal tumor ablation procedure is described. The entire procedure is detailed, including pretreatment planning and imaging studies, anesthesia, adjuvant techniques to facilitate a percutaneous approach, imaging guidance of the ablation device to the tumor, thermal treatment, post-treatment care and follow-up.

Thermische Ablation zur Behandlung von Abdominaltumoren

Percutaneous thermal ablation is an emerging treatment option for many tumors of the abdomen not amenable to conventional treatments. During a thermal ...

Forschung

Medizin

Monitoring Tumor Metastases and Osteolytic Lesions with Bioluminescence and Micro CT Imaging

Following intracardiac delivery of MDA-MB-231-luc-D3H2LN cells to Nu/Nu mice, systemic metastases developed in the injected animals. Bioluminescence imaging using IVIS Spectrum was employed to monitor the distribution and development of the tumor cells following the delivery procedure including DLIT reconstruction to measure the tumor signal and its location.
Development of metastatic lesions to the bone tissues triggers osteolytic activity and lesions to tibia and femur were evaluated longitudinally using micro CT. Imaging was performed using a Quantum FX micro CT system with fast imaging and low X-ray dose. The low radiation dose allows multiple imaging sessions to be performed with a cumulative X-ray dosage far below LD50. A mouse imaging shuttle device was used to sequentially image the mice with both IVIS Spectrum and Quantum FX achieving accurate animal positioning in both the bioluminescence and CT images. The optical and CT data sets were co-registered in 3-dimentions using the Living Image 4.1 software. This multi-mode approach allows close monitoring of tumor growth and development simultaneously with osteolytic activity.

An experimental mouse model of bone metastasis was established following intracardiac delivery of luciferase expressing mammary tumor cells. Tumor development and resulted osteolytic lesion were monitored longitudinally with bioluminescence and micro CT imaging.

Überwachung Tumormetastasen und Osteolysen mit Biolumineszenz und Micro-CT Imaging

Following intracardiac delivery of MDA-MB-231-luc-D3H2LN cells to Nu/Nu mice, systemic metastases developed in the injected animals. Bioluminescence ...

A Novel High-resolution In vivo Imaging Technique to Study the Dynamic Response of Intracranial Structures to Tumor Growth and Therapeutics

We have successfully integrated previously established Intracranial window (ICW) technology 1-4 with intravital 2-photon confocal microscopy to develop a novel platform that allows for direct long-term visualization of tissue structure changes intracranially. Imaging at a single cell resolution in a real-time fashion provides supplementary dynamic information beyond that provided by standard end-point histological analysis, which looks solely at 'snap-shot' cross sections of tissue.
Establishing this intravital imaging technique in fluorescent chimeric mice, we are able to image four fluorescent channels simultaneously. By incorporating fluorescently labeled cells, such as GFP+ bone marrow, it is possible to track the fate of these cells studying their long-term migration, integration and differentiation within tissue. Further integration of a secondary reporter cell, such as an mCherry glioma tumor line, allows for characterization of cell:cell interactions. Structural changes in the tissue microenvironment can be highlighted through the addition of intra-vital dyes and antibodies, for example CD31 tagged antibodies and Dextran molecules.
Moreover, we describe the combination of our ICW imaging model with a small animal micro-irradiator that provides stereotactic irradiation, creating a platform through which the dynamic tissue changes that occur following the administration of ionizing irradiation can be assessed.
Current limitations of our model include penetrance of the microscope, which is limited to a depth of up to 900 &mu;m from the sub cortical surface, limiting imaging to the dorsal axis of the brain. The presence of the skull bone makes the ICW a more challenging technical procedure, compared to the more established and utilized chamber models currently used to study mammary tissue and fat pads 5-7. In addition, the ICW provides many challenges when optimizing the imaging.

A Novel High-resolution In vivo Imaging Technique to Study the Dynamic Response of Intracranial Structures to Tumor Growth and Therapeutics

We describe a novel in vivo imaging technique that couples fluorescent chimeric mice with intracranial windows and high-resolution 2-photon microscopy. This imaging platform aids studies of dynamic changes in brain tissue and microvasculature, at a single-cell level, following pathological insults and is adaptable to assess intracranial drug delivery and distribution.

A Novel Hochauflösende<em&gt; In vivo</em&gt; Bildtechnik, um die Dynamik der intrakranielle Strukturen zu Tumorwachstum und Therapeutics Studieren

We have successfully integrated previously established Intracranial window (ICW) technology 1-4 with intravital 2-photon confocal microscopy to develop a ...

Adaptation of Semiautomated Circulating Tumor Cell (CTC) Assays for Clinical and Preclinical Research Applications

The majority of cancer-related deaths occur subsequent to the development of metastatic disease. This highly lethal disease stage is associated with the presence of circulating tumor cells (CTCs). These rare cells have been demonstrated to be of clinical significance in metastatic breast, prostate, and colorectal cancers. The current gold standard in clinical CTC detection and enumeration is the FDA-cleared CellSearch system (CSS). This manuscript outlines the standard protocol utilized by this platform as well as two&#160;additional adapted protocols that describe the detailed process of user-defined marker optimization for protein characterization of patient CTCs and a comparable protocol for CTC capture in very low volumes of blood, using standard CSS reagents, for studying in vivo preclinical mouse models of metastasis. In addition, differences in CTC quality between healthy donor blood spiked with cells from tissue culture versus patient blood samples are highlighted. Finally, several commonly discrepant items that can lead to CTC misclassification errors are outlined. Taken together, these protocols will provide a useful resource for users of this platform interested in preclinical and clinical research pertaining to metastasis and CTCs.

Adaptation of Semiautomated Circulating Tumor Cell CTC Assays for Clinical and Preclinical Research Applications

Circulating tumor cells (CTCs) are prognostic in several metastatic cancers. This manuscript describes the gold standard CellSearch system (CSS) CTC enumeration platform and highlights common misclassification errors. In addition, two&#160;adapted protocols are described for user-defined marker characterization of CTCs and CTC enumeration in preclinical mouse models of metastasis using this technology.

Halbautomatische Anpassung der Umlauftumorzellen (CTC)-Assays für die klinische und vorklinische Forschungsanwendungen

The majority of cancer-related deaths occur subsequent to the development of metastatic disease. This highly lethal disease stage is associated with the ...

A Preclinical Murine Model of Hepatic Metastases

Numerous murine models have been developed to study human cancers and advance the understanding of cancer treatment and development. Here, a preclinical, murine pancreatic tumor model of hepatic metastases via a hemispleen injection of syngeneic murine pancreatic tumor cells is described. This model mimics many of the clinical conditions in patients with metastatic disease to the liver. Mice consistently develop metastases in the liver allowing for investigation of the metastatic process, experimental therapy testing, and tumor immunology research.

A preclinical, murine model of hepatic metastases performed via a hemispleen injection technique.

Einer präklinischen Mausmodell der Lebermetastasen

Numerous murine models have been developed to study human cancers and advance the understanding of cancer treatment and development. Here, a preclinical, ...

Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic agent melphalan. Briefly, the procedure starts with the setup of a percutaneous veno-venous bypass from the femoral vein to the external jugular vein. Via a laparotomy, catheters are then inserted into the proper hepatic artery and the caval vein. The portal vein and the caval vein, both supra- and infrahepatically, are then clamped. The arterial and venous catheters are connected to a heart lung machine and the liver is perfused with melphalan (1 mg/kg body weight) for 60 min. This way it is possible to locally perfuse the liver with a high dose of a chemotherapeutic agent, without leakage to the systemic circulation.
In previous studies including patients with isolated liver metastases of uveal melanoma, an overall response rate of 33-100% and a median survival between 9 and 13 months, have been reported. The aim of this protocol is to give a clear description of how to perform the procedure and to discuss IHP as a treatment option for liver metastases of uveal melanoma.

Here, we present a protocol how to perform an isolated liver perfusion (IHP) with melphalan and we also discuss IHP as a treatment option for liver metastases of uveal melanoma.

Isolierte Leberperfusion als Behandlung für Lebermetastasen von Aderhautmelanom

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic ...

Generation of Microtumors Using 3D Human Biogel Culture System and Patient-derived Glioblastoma Cells for Kinomic Profiling and Drug Response Testing

The use of patient-derived xenografts for modeling cancers has provided important insight into cancer biology and drug responsiveness. However, they are time consuming, expensive, and labor intensive. To overcome these obstacles, many research groups have turned to spheroid cultures of cancer cells. While useful, tumor spheroids or aggregates do not replicate cell-matrix interactions as found in vivo. As such, three-dimensional (3D) culture approaches utilizing an extracellular matrix scaffold provide a more realistic model system for investigation. Starting from subcutaneous or intracranial xenografts, tumor tissue is dissociated into a single cell suspension akin to cancer stem cell neurospheres. These cells are then embedded into a human-derived extracellular matrix, 3D human biogel, to generate a large number of microtumors. Interestingly, microtumors can be cultured for about a month with high viability and can be used for drug response testing using standard cytotoxicity assays such as 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and live cell imaging using Calcein-AM. Moreover, they can be analyzed via immunohistochemistry or harvested for molecular profiling, such as array-based high-throughput kinomic profiling, which is detailed here as well. 3D microtumors, thus, represent a versatile high-throughput model system that can more closely replicate in vivo tumor biology than traditional approaches.

Patient-derived xenografts of glioblastoma multiforme can be miniaturized into living microtumors using 3D human biogel culture system. This in vivo-like 3D tumor assay is suitable for drug response testing and molecular profiling, including kinomic analysis.

Die Erzeugung von Microtumors Mit 3D Human Biogel Kultursystem und Patienten stammGlioblastomZellen für Kinomic Profilieren and Drug Response-Testing

The use of patient-derived xenografts for modeling cancers has provided important insight into cancer biology and drug responsiveness. However, they are ...

Assessment of Spontaneous Alternation, Novel Object Recognition and Limb Clasping in Transgenic Mouse Models of Amyloid-&#946; and Tau Neuropathology

Here we describe a staged, behavioral testing approach that can be used to screen for compounds that exhibit in vivo efficacy on cognitive and functional motor behaviors in transgenic mouse models of &#946;-amyloidosis and tauopathy. The paradigm includes tests for spontaneous alternation in a Y-maze, novel object recognition, and limb clasping. These tests were selected because they: 1) interrogate function of cognitive or motor domains and the correlate neural circuitry relevant to the human disease state, 2) have clearly defined endpoints, 3) have easily implementable quality control checks, 4) can be run in a moderate throughput format, and 5) require little intervention by the investigator. These methods are designed for investigators looking to screen compounds for activity in short-term and working memory tasks, or functional motor behaviors associated with Alzheimer's disease mouse models. The methods described here use behavioral tests that engage a number of different brain regions including hippocampus and various cortical areas. Investigators that desire cognitive tests that specifically assess cognition mediated by a single brain region could use these techniques to supplement other behavioral tests.

Assessment of Spontaneous Alternation, Novel Object Recognition and Limb Clasping in Transgenic Mouse Models of Amyloid-&amp;#946; and Tau Neuropathology

Described here is a staged, behavioral screening approach that can be used to screen for compounds that exhibit in vivo efficacy on cognitive and functional motor behaviors in transgenic mouse models of &#946;-amyloidosis and tauopathy. These methods are optimized to screen compounds for activity in short-term and working memory tasks.

Assessment of Spontane Alternation, neuartige Objekterkennung und Gliedmaßenverkürzung in transgenen Mausmodellen der Amyloid-β- und Tau-Neuropathologie

Here we describe a staged, behavioral testing approach that can be used to screen for compounds that exhibit in vivo efficacy on cognitive and functional ...

Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy

The prognosis of patients with metastatic cancers has improved in the past decades due to effective chemotherapy and oligometastatic surgery. For inoperable patients, local ablation therapies, such as stereotactic body radiotherapy (SBRT), can provide effective local tumor control with minimal toxicity. Because of its high precision and accuracy, SBRT delivers a higher radiation dose per fraction, is more effective, and targets smaller irradiation volumes than does conventional radiotherapy. In addition, steep dose gradients from target lesions to surrounding normal tissues are achieved using SBRT; thus, SBRT provides more effective tumor control and exhibits fewer side effects than conventional radiotherapy. The use of SBRT is prevalent for treating intracranial lesions (known as stereotactic radiosurgery); however, it is now also used for treating spinal and adrenal metastases. Because of advancements in image-guided assistance and respiratory motion management, several studies have investigated the use of SBRT for treating lung or liver tumors, which move as a patient breathes. The results of these studies have suggested that SBRT favorably controls tumors in the case of moving lesions.
Four-dimensional computed tomography (4D-CT) with an abdominal compressor (AC) is clinically convenient for effective respiratory motion management. Because this method is noninvasive and allows free breathing, its use reduces complications. Furthermore, patients consider this method convenient. Moreover, it is considered more efficient than other methods of respiratory motion management by physicians and therapists. The use of 4D-CT with an AC for treating pulmonary lesions has also been widely investigated, and the technique is gaining acceptance for treating hepatic lesions. However, the protocols for using 4D-CT with an AC for treating hepatic lesions are different from those used for treating pulmonary lesions. In this article, we describe a new protocol for SBRT with 4D-CT and an AC for treating liver metastases.

Stereotactic body radiotherapy (SBRT) requires rigorous accuracy and precision for delivering high radiation doses per fraction to small treatment volumes to improve tumor control and simultaneously reduce toxicity. Herein, we present a noninvasive and clinically convenient respiratory motion management protocol for SBRT for liver metastases.

Behandlung von Lebermetastasen mit ein internes Ziel-Volumen-Methode für Stereotaktische Körper Strahlentherapie

The prognosis of patients with metastatic cancers has improved in the past decades due to effective chemotherapy and oligometastatic surgery. For ...

Contractions of Human-iPSC-derived Cardiomyocyte Syncytia Measured with a Ca-sensitive Fluorescent Dye in Temperature-controlled 384-well Plates

Spontaneously contracting syncytia of cardiomyocytes derived from human-induced pluripotent stem cells (hiPSC-CM) are a useful model of human cardiac physiology and pharmacology. Various methods have been proposed to record this spontaneous activity and to evaluate drug effects, but many of these methods suffer from limited throughput and/or physiological relevance. We developed a high-throughput screening system to quantify the effects of exogenous compounds on hiPSC-CM's beating frequency, using a Ca-sensitive fluorescent dye and a temperature-controlled imaging multi-well plate reader. We describe how to prepare the cell plates and the compound plates and how to run the automated assay to achieve high sensitivity and reproducibility. We also describe how to transform and analyze the fluorescence data to provide reliable measures of drug effects on spontaneous rhythm. This assay can be used in drug discovery programs to guide chemical optimization away from, or toward, compounds affecting human cardiac function.

Spontaneously contracting syncytia of cardiomyocytes derived from human-induced pluripotent stem cells are useful models of human cardiac physiology and pharmacology. Here we present a high-throughput screening system to quantify the effects of exogenous compounds on beating frequency, using a Ca-sensitive fluorescent dye and a temperature-controlled imaging multi-well plate reader.

Kontraktionen der iPSC abgeleitete Cardiomyocyte Syncytia gemessen mit einem Ca-sensitiven Fluoreszenzfarbstoff in temperaturgesteuerten 384-Well-Platten

Spontaneously contracting syncytia of cardiomyocytes derived from human-induced pluripotent stem cells (hiPSC-CM) are a useful model of human cardiac ...