Gary R. Simonds

Connexin 43 Inhibition Sensitizes Chemoresistant Glioblastoma Cells to Temozolomide.

Resistance of glioblastoma (GBM) to the front-line chemotherapeutic agent temozolomide (TMZ) continues to challenge GBM treatment efforts. The repair of TMZ-induced DNA damage by O-6-methylguanine-DNA methyltransferase (MGMT) confers one mechanism of TMZ resistance. Paradoxically, MGMT-deficient GBM patients survive longer despite still developing resistance to TMZ. Recent studies indicate that the gap junction protein connexin 43 (Cx43) renders GBM cells resistant to TMZ through its carboxyl terminus (CT). In this study, we report insights into how Cx43 promotes TMZ resistance. Cx43 levels were inversely correlated with TMZ sensitivity of GBM cells, including GBM stem cells. Moreover, Cx43 levels inversely correlated with patient survival, including as observed in MGMT-deficient GBM patients. Addition of the C-terminal peptide mimetic αCT1, a selective inhibitor of Cx43 channels, sensitized human MGMT-deficient and TMZ-resistant GBM cells to TMZ treatment. Moreover, combining αCT1 with TMZ-blocked AKT/mTOR signaling, induced autophagy and apoptosis in TMZ-resistant GBM cells. Our findings suggest that Cx43 may offer a biomarker to predict the survival of patients with MGMT-independent TMZ resistance and that combining a Cx43 inhibitor with TMZ could enhance therapeutic responses in GBM, and perhaps other TMZ-resistant cancers.

Effects of intraventricular substantia nigra allografts as a function of donor age

Transplantation of fetal substantia nigra into the brain can alleviate some of the manifestations of animal models of Parkinsons disease. The purpose of the present experiment was to determine the optimal embryonic donor age for solid tissue substantia nigra grafts. Rats with unilateral substantia nigra lesions were tested for rotational behavior in response to apomorphine. Animals then received intraventricular grafts of ventral mesencephalon from fetal donors of 11, 13, 15, 17, or 19 days gestational age, and were tested for rotational behavior 6 and 12 weeks after transplantation. After 12 weeks, animals receiving grafts from donors of 11 through 17 days gestation showed similar decreases (means = 42-58%) in rotation. All 4 groups showed greater decreases in rotation than the 19 day group (17%). In both the 11 and 13 day groups, however, there were substantial decreases in rotational behavior from the 6th to the 12th week testing periods. This study confirms that during a critical period of rat fetal development, between 17 and 19 days gestational age, the substantia nigra loses much of its ability to produce functional effects after transplantation. Grafts from very immature donors did not, however, produce markedly greater effects, and the youngest grafts required more time for the development of maximal effects.

Occult intrasacral meningocele: clinical and radiographic diagnosis.

We evaluated four patients who had occult intrasacral meningocele with multimodality radiographic imaging techniques. The clinical features, radiological findings, gross appearances of the lesion at surgery, surgical technique, histopathological features of the cyst wall, and surgical outcome are described. The role of magnetic resonance imaging in the preoperative evaluation compared with standard radiographic techniques is discussed. Theories regarding the pathogenesis of this lesion are reviewed.

Patient-derived glioblastoma stem cells respond differentially to targeted therapies

The dismal prognosis of glioblastoma is, at least in part, attributable to the difficulty in eradicating glioblastoma stem cells (GSCs). However, whether this difficulty is caused by the differential responses of GSCs to drugs remains to be determined. To address this, we isolated and characterized ten GSC lines from established cell lines, xenografts, or patient specimens. Six lines formed spheres in a regular culture condition, whereas the remaining four lines grew as monolayer. These adherent lines formed spheres only in plates coated with poly-2-hydroxyethyl methacrylate. The self-renewal capabilities of GSCs varied, with the cell density needed for sphere formation ranging from 4 to 23.8 cells/well. Moreover, a single non-adherent GSC either remained quiescent or divided into two cells in four-seven days. The stem cell identity of GSCs was further verified by the expression of nestin or glial fibrillary acidic protein. Of the two GSC lines that were injected in immunodeficient mice, only one line formed a tumor in two months. The protein levels of NOTCH1 and platelet derived growth factor receptor alpha positively correlated with the responsiveness of GSCs to γ-secretase inhibitor IX or imatinib, two compounds that inhibit these two proteins, respectively. Furthermore, a combination of temozolomide and a connexin 43 inhibitor robustly inhibited the growth of GSCs. Collectively, our results demonstrate that patient-derived GSCs exhibit different growth rates in culture, possess differential capabilities to form a tumor, and have varied responses to targeted therapies. Our findings underscore the importance of patient-derived GSCs in glioblastoma research and therapeutic development.

PIK3CB/p110β is a selective survival factor for glioblastoma

Background Glioblastoma (GBM) is difficult to treat. Phosphoinositide 3-kinase (PI3K) is an attractive therapeutic target for GBM; however, targeting this pathway to effectively treat GBM is not successful because the roles of PI3K isoforms remain to be defined. The aim of this study is to determine whether PIK3CB/p110β, but not other PI3K isoforms, is a biomarker for GBM recurrence and important for cell survival. Methods Gene expression and clinical relevance of PI3K genes in GBM patients were analyzed using online databases. Expression/activity of PI3K isoforms was determined using immunoblotting. PI3K genes were inhibited using short hairpin RNAs or isoform-selective inhibitors. Cell viability/growth was assessed by the MTS assay and trypan blue exclusion assay. Apoptosis was monitored using the caspase activity assay. Mouse GBM xenograft models were used to gauge drug efficacy. Results PIK3CB/p110β was the only PI3K catalytic isoform that significantly correlated with high incidence rate, risk, and poor survival of recurrent GBM. PIK3CA/p110α, PIK3CB/p110β, and PIK3CD/p110δ were differentially expressed in GBM cell lines and primary tumor cells derived from patient specimens, whereas PIK3CG/p110γ was barely detected. PIK3CB/p110β protein levels presented a stronger association with the activities of PI3K signaling than other PI3K isoforms. Blocking p110β deactivated PI3K signaling, whereas inhibition of other PI3K isoforms had no effect. Specific inhibitors of PIK3CB/p110β, but not other PI3K isoforms, remarkably suppressed viability and growth of GBM cells and xenograft tumors in mice, with minimal cytotoxic effects on astrocytes. Conclusions PIK3CB/p110β is a biomarker for GBM recurrence and selectively important for GBM cell survival.

CNS fungal meningitis to the “Top of the basilar”

Abstract Central nervous system (CNS) infections are a rare complication of epidural steroid injections and without strong clinical suspicion, fungal organisms may be overlooked among the long differential of causes of meningitis. Rare sequela of fungal meningitis is the development of stroke. To our knowledge, we present the first case of post epidural steroid injection (ESI) fungal meningitis leading to a basilar artery stroke, otherwise known as “top of the basilar” syndrome. We present a 49-year-old female with a history of ESIs who presented to the emergency department with headache, neck stiffness, and abdominal pain. She was discharged after her labs and symptoms were deemed inconsistent with meningitis. She was eventually admitted and twelve days after her original ED visit, she was diagnosed with meningitis and started on anti-fungal treatment. She was discharged 88 days later but was readmitted due to left sided weakness and mental status changes. She quickly lost motor and bulbar functions. An MRA showed diminished distal flow through the basilar artery, suggesting near complete occlusion. Although appropriate long term anti-fungal treatment was started, the patient still succumbed to a rare vascular event. Physicians who are treating patients for ESI meningitis should be aware of the potential for vasculitic and encephalitic complications.