Glioblastoma brain tumors can have an unusual effect on the body’s immune system, often causing a dramatic drop in the number of circulating T-cells that help drive the body’s defenses.
Where the T-cells go has been unclear, even as immunotherapies are increasingly employed to stimulate the body’s natural ability to fight invasive tumors.
Now researchers at Duke Cancer Institute have tracked the missing T-cells in glioblastoma patients. They found them in abundance in the bone marrow, locked away and unable to function because of a process the brain stimulates in response to glioblastoma, to other tumors that metastasize in the brain and even to injury.
The findings, published online Aug. 13 in the journal Nature Medicine, open a new area of exploration for adjunct cancer drugs that could free trapped T-cells from the bone marrow, potentially improving the effectiveness of existing and new immunotherapies.
“Part of the problem with all these immunotherapies — particularly for glioblastoma and other tumors that have spread to the brain — is that the immune system is shot,” said lead author Peter E. Fecci, M.D., Ph.D., director of the Brain Tumor Immunotherapy Program in Duke’s Department of Neurosurgery.
“If the goal is to activate the T-cells and the T-cells aren’t there, you’re simply delivering therapy into a black hole.”
Fecci said the research team began its search for the missing T-cells after observing that many newly diagnosed glioblastoma patients have the equivalent immune systems of people with full-blown AIDS, even before they undergo surgery, chemotherapy and radiation.
Where most people have a CD-4 “helper” T-cell count upwards of 700-1,000, a substantial proportion of untreated glioblastoma patients have counts of 200 or less, marking poor immune function that makes them susceptible to all manner of infections and potentially to progression of their cancer.
Initially, the researchers hunted for the missing T-cells in the spleen, which is known to pathologically harbor the cells in certain disease states. But the spleens were abnormally small, as were the thymus glands — another potential T-cell haven. They decided to check the bone marrow to see if production was somehow stymied and instead found hordes of T-cells.
“It’s totally bizarre — this is not seen in any disease state,” Fecci said.
“This appears to be a mechanism that the brain possesses for keeping T-cells out, but it’s being usurped by tumors to limit the immune system’s ability to attack them.”
When examining the stashed T-cells, Fecci and colleagues found that they lacked a receptor on the cell surface called S1P1, which essentially serves as a key that enables them to leave the bone marrow and lymph system. Lacking that key, they instead get locked in, unable to circulate and fight infections, let alone cancer.
Fecci said the research team is now working to learn exactly how the brain triggers the dysfunction of this S1P1 receptor. He said the current theory is that the receptor somehow is signaled to retract from the cell surface into the cell interior.
“Interestingly, when we restore this receptor to T-cells in mice, the T-cells leave the bone marrow and travel to the tumor, so we know this process is reversible,” Fecci said.
His team is collaborating with Duke scientist Robert Lefkowitz, M.D., whose 2012 Nobel Prize in Chemistry honored discovery of the class of receptors to which S1P1 belongs. They are working to develop molecules that would restore the receptors on the cells’ surface.
“We are hopeful that this finding provides a missing element that would enable more immunotherapies to be effective for more people,” Fecci said. He said the finding could also work in reverse, offering a new approach to quell auto-immune disorders by activating the T-cell sequestration.
Focused Delivery For Brain Cancers
A person’s brainstem controls some of the body’s most important functions, including heart beat, respiration, blood pressure and swallowing. Tumor growth in this part of the brain is therefore twice as devastating. Not only can such a growth disrupt vital functions, but operating in this area is so risky, many medical professionals refuse to consider it as an option.
New, interdisciplinary research in Washington University in St. Louis has shown a way to target drug delivery to just that area of the brain using noninvasive measures, bolstered by a novel technology: focused ultrasound.
The research comes from the lab of Hong Chen, assistant professor of biomedical engineering in the School of Engineering & Applied Science and assistant professor of radiation oncology at Washington University School of Medicine. Chen has developed a novel way in which ultrasound and its contrast agent — consisting of tiny bubbles — can be paired with intranasal administration, to direct a drug to the brainstem.
The research, which also included faculty from the Mallinckrodt Institute of Radiology and the Department of Pediatrics at the School of Medicine, along with the Department of Energy, Environmental & Chemical Engineering in the School of Engineering & Applied Science, was published online this week and will be in the Sept. 28 issue of the Journal of Controlled Release.
This technique may bring medicine one step closer to curing brain-based diseases such as diffuse intrinsic pontine gliomas (DIPG), a childhood brain cancer with a five-year survival rate of a scant two percent, a dismal prognosis that has remained unchanged over the past 40 years. (To add perspective, the most common childhood cancer, acute lymphoblastic leukemia, has a five-year survival rate of nearly 90 percent).
“Each year in the United States, there are no more than 300 cases,” Chen said.
“All pediatric diseases are rare; luckily, this is even more rare. But we cannot count numbers in this way, because for kids that have this disease and their families, it is devastating.”
Chen’s technique combines Focused UltraSound with IntraNasal delivery, (FUSIN). The intranasal delivery takes advantage of a unique property of the olfactory and trigeminal nerves: they can carry nanoparticles directly to the brain, bypassing the blood brain barrier, an obstacle to drug delivery in the brain.
This unique capability of intranasal delivery was demonstrated last year by co-authors Ramesh Raliya, research scientist, and Pratim Biswas, assistant vice chancellor and chair of the Department of Energy, Environmental & Chemical Engineering and the Lucy & Stanley Lopata Professor, in their 2017 publication in Scientific Reports.
“At the beginning, I couldn’t even believe this could work,” Hong said of delivering drugs to the brain intranasally.
“I thought our brains are fully protected. But these nerves actually directly connect with the brain and provide direct access to the brain.”
While nasal brain drug delivery is a huge step forward, it isn’t yet possible to target a drug to a specific area. Chen’s targeted ultrasound technique is addressing that problem.
When doing an ultrasound scan, the contrast agent used to highlight images is composed of microbubbles. Once injected into the bloodstream, the microbubbles behave like red blood cells, traversing the body as the heart pumps.
Once they reach the site where the ultrasound wave is focused, they do something unusual.
“They start to expand and contract,” Chen said.
As they do so, they act as a pump to the surrounding blood vessels as well as the perivascular space — the space surrounding the blood vessels.
“Consider the blood vessels like a river,” Chen said.
“The conventional way to deliver drugs is to dump them in the river.”
In other parts of the body, the banks of the river are a bit “leaky,” Chen said, allowing the drugs to seep into the surrounding tissue. But the blood brain barrier, which forms a protective layer around blood vessels in the brain, prevents this leakage, particularly in the brains of young patients, such as those with with DIPG.
“We will deliver the drug from the nose to directly outside the river,” Chen said, “in the perivascular space.”
Then, once ultrasound is applied at the brain stem, the microbubbles will begin to expand and contract. The oscillating microbubbles push and pull, pumping the drug toward the brainstem. This technique also addresses the problem of drug toxicity — the drugs will go directly to the brain instead of circulating through the whole body. In collaboration with Yongjian Liu, an associate professor of radiology, and Yuan-Chuan Tai, an associate professor of radiology, Chen used positron emission tomography (PET scan) to verify that there was minimal accumulation of intranasal-administered nanoparticles in major organs, including lungs, liver, spleen, kidney and heart.
So far, Chen’s lab has had success using their technique in mice for the delivery of gold nanoclusters made by the team led by Liu.
“The next step is to demonstrate the therapeutic efficacy of FUSIN in the delivery of chemotherapy drugs for the treatment of DIPG,” said Dezhuang Ye, lead author of the paper, who is Chen’s graduate student from the Department of Mechanical Engineering & Materials Science.
The lab has also teamed up with Biswas to develop a new aerosol nasal delivery device to scale up the technique from a mouse to a large animal model.
Chen’s lab collaborated on this research with pediatric neuro-oncologist Joshua Rubin, MD, PhD, a professor of pediatrics at the School of Medicine who treats patients at St. Louis Children’s Hospital. Chen said the team hopes to translate the findings of this study into clinical trials for children with DIPG.
There are difficulties ahead, but Chen believes researchers will need to continue to innovate when it comes to solving such a difficult problem as treating DIPG.
A targeted inspiration
Hong Chen’s lab collaborated with Joshua Rubin, MD, PhD, a professor of pediatrics at the School of Medicine on this research. And it all started with a couple of colleagues talking one day:
“My work in this field started with a conversation with him,” Chen said.
“He said, ‘Wow, this would be a perfect technique for treating this deadly disease.’ Without him to point me in this direction, I probably wouldn’t have known this application existed.
“That’s why I consider the Washington University environment, and the School of Engineering & Applied Science, so unique. It provides you so much opportunity to work with people from different backgrounds. It allowed me to expand my research scope and to be able to work on clinically relevant questions.”
Secret Tunnels Discovered Between The Skull And The Brain
Bone marrow, the spongy tissue inside most of our bones, produces red blood cells as well as immune cells that help fight off infections and heal injuries. According to a new study of mice and humans, tiny tunnels run from skull bone marrow to the lining of the brain and may provide a direct route for immune cells responding to injuries caused by stroke and other brain disorders. The study was funded in part by the National Institutes of Health and published in Nature Neuroscience.
“We always thought that immune cells from our arms and legs traveled via blood to damaged brain tissue. These findings suggest that immune cells may instead be taking a shortcut to rapidly arrive at areas of inflammation,” said Francesca Bosetti, Ph.D., program director at the NIH’s National Institute of Neurological Disorders and Stroke (NINDS), which provided funding for the study.
“Inflammation plays a critical role in many brain disorders and it is possible that the newly described channels may be important in a number of conditions. The discovery of these channels opens up many new avenues of research.”
Using state-of-the-art tools and cell-specific dyes in mice, Matthias Nahrendorf, M.D., Ph.D., professor at Harvard Medical School and Massachusetts General Hospital in Boston, and his colleagues were able to distinguish whether immune cells traveling to brain tissue damaged by stroke or meningitis, came from bone marrow in the skull or the tibia, a large legbone. In this study, the researchers focused on neutrophils, a particular type of immune cell, which are among the first to arrive at an injury site.
Results in mouse brains showed that during stroke, the skull is more likely to supply neutrophils to the injured tissue than the tibia. In contrast, following a heart attack, the skull and tibia provided similar numbers of neutrophils to the heart, which is far from both of those areas.
Dr. Nahrendorf’s group also observed that six hours after stroke, there were fewer neutrophils in the skull bone marrow than in the tibia bone marrow, suggesting that the skull marrow released many more cells to the injury site. These findings indicate that bone marrow throughout the body does not uniformly contribute immune cells to help injured or infected tissue and suggests that the injured brain and skull bone marrow may “communicate” in some way that results in a direct response from adjacent leukocytes.
Dr. Nahrendorf’s team found that differences in bone marrow activity during inflammation may be determined by stromal cell-derived factor-1 (SDF-1), a molecule that keeps immune cells in the bone marrow. When levels of SDF-1 decrease, neutrophils are released from marrow. The researchers observed levels of SDF-1 decreasing six hours after stroke, but only in the skull marrow, and not in the tibia. The results suggest that the decrease in levels of SDF-1 may be a response to local tissue damage and alert and mobilize only the bone marrow that is closest to the site of inflammation.
Next, Dr. Nahrendorf and his colleagues wanted to see how the neutrophils were arriving at the injured tissue.
“We started examining the skull very carefully, looking at it from all angles, trying to figure out how neutrophils are getting to the brain,” said Dr. Nahrendorf.
“Unexpectedly, we discovered tiny channels that connected the marrow directly with the outer lining of the brain.”
With the help of advanced imaging techniques, the researchers watched neutrophils moving through the channels. Blood normally flowed through the channels from the skull’s interior to the bone marrow, but after a stroke, neutrophils were seen moving in the opposite direction to get to damaged tissue.
Dr. Nahrendorf’s team detected the channels throughout the skull as well as in the tibia, which led them to search for similar features in the human skull. Detailed imaging of human skull samples obtained from surgery uncovered the presence of the channels. The channels in the human skull were five times larger in diameter compared to those found in mice. In human and mouse skulls, the channels were found in the both in the inner and outer layers of bone.
Why The Brain System Needs Sleep
Sleep is essential for brain functionality and overall health but understanding how sleep delivers its beneficial effects remains largely unknown. In an article publishing on August 9 in the open access journal PLOS Biology, Shanaz Diessler and Maxime Jan at the University of Lausanne and the SIB Swiss Institute of Bioinformatics (Switzerland), sleep researchers are exploring new and unbiased approaches that can take sleep to a systems level. In one such approach, referred to as ‘systems genetics’, inferences about biological phenomena can be made by linking together several levels of information from DNA to phenotype via gene expression, proteins and metabolism at the level of a population. Systems genetics offers a global and interconnected view of biological phenomena and is therefore considered critical towards predicting disease susceptibility.
The study performed systems genetics analysis in mice with the aim of identifying the molecular signaling pathways that predict the resilience or susceptibility of sleep loss. Seven years of work culminated in an open access and interactive knowledgebase quantifying the effects of sleep deprivation and of the genome at the level of the brain and liver transcriptome, of the blood metabolome, and, finally, of the sleep-wake phenome referring to an unprecedented detailed dissection of brain activity and sleep-wake behavior.
Initial exploration yielded several remarkable new insights. Preventing sleep during the first half of the habitual rest phase (the light period in the mouse), pervasively affected all systems levels with 78% of all expressed genes in the brain changing their expression. The authors identified a number of genetic variants that exerted their action only after the sleep deprivation challenge and not when left undisturbed. Moreover, these variants not only determined the magnitude of the molecular or sleep response to sleep loss but also, in some cases, the direction of the change, explaining the strong inter-individual changes in coping with insufficient sleep.
Perhaps the most striking observation that came from these analyses is that molecules and metabolic pathways active in peripheral tissue only (the liver) seem to directly influence phenotypes considered strictly central such as the frequency of oscillations known to originate from specific brain areas such as the hippocampus. Converging evidence drawing on all four levels of organization implicated fatty acid metabolism as a substrate of the negative consequences of sleep loss. Such findings not only can direct novel therapeutic strategies but also challenge the largely brain-centric view of sleep that has long guided hypotheses on its function and regulation.
The two groups led by Paul Franken and Ioannis Xenarios continue their collaboration and further explore and strengthen this unique resource by adding a third regulatory molecular layer and by developing the bioinformatic tools needed to bring to light the many interactions and pathways still hidden in the data. The authors hope that through this unbiased approach, we will learn why the system needs sleep.
Like Us on Facebook
Children Carry Evidence Of Toxins From Home Flooring And Furniture
Children living in homes with all vinyl flooring or flame-retardant chemicals in the sofa have significantly higher concentrations of potentially...
Your Home Is A Hidden Source Of Air Pollution
Cooking, cleaning and other routine household activities generate significant levels of volatile and particulate chemicals inside the average home, leading...
Diet Drinks May Be Associated With Strokes Among Post-Menopausal Women
Among post-menopausal women, drinking multiple diet drinks daily was associated with an increase in the risk of having a stroke caused...
Diabetes: Human Cells Can Also Change Jobs
Biology textbooks teach us that adult cell types remain fixed in the identity they have acquired upon differentiation. By inducing...
Breakthrough Toward Developing Blood Test For Pain
INDIANAPOLIS—A breakthrough test developed by Indiana University School of Medicine researchers to measure pain in patients could help stem the...
Children Who Eat Lunch Score 18% Higher In Reading Tests
The powerful connection between nutrition and education has been revealed by new research from ESMT Berlin. Primary school children who...
Effect Of Breastfeeding Versus Pumping On Human Milk Microbiome
A large-scale analysis in humans reveals that indirect breastfeeding using pumped milk is associated with the depletion of oral bacteria...
LISTS12 months ago
12 Types of Consultants You Will Meet
News4 weeks ago
Childhood Lead Exposure Linked To Poor Adult Mental Health
LISTS9 months ago
9 Medical Terms You Can Use Everyday To Sound Smarter 🤓
NEUROLOGY10 months ago
Soccer Heading Shown To Impair Players Cognitively
LISTS11 months ago
13 Types of Students You Meet at Medical School
LISTS12 months ago
13 Things You Did The First Time You Started Seeing Patients
LISTS9 months ago
10 Types of Medical Students During Exams
ENDOCRINOLOGY12 months ago
Researchers Identified The Body’s Glucostat