Approach For Treatment Of Glioblastoma Research Articles

A Novel Approach for Glioblastoma Treatment by Combining Apoptosis Inducers (TMZ, MTX, and Cytarabine) with E.V.A. (Eltanexor, Venetoclax, and A1210477) Inhibiting XPO1, Bcl-2, and Mcl-1.

Adjuvant treatment for Glioblastoma Grade 4 with Temozolomide (TMZ) inevitably fails due to therapeutic resistance, necessitating new approaches. Apoptosis induction in GB cells is inefficient, due to an excess of anti-apoptotic XPO1/Bcl-2-family proteins. We assessed TMZ, Methotrexate (MTX), and Cytarabine (Ara-C) (apoptosis inducers) combined with XPO1/Bcl-2/Mcl-1-inhibitors (apoptosis rescue) in GB cell lines and primary GB stem-like cells (GSCs). Using CellTiter-Glo® and Caspase-3 activity assays, we generated dose-response curves and analyzed the gene and protein regulation of anti-apoptotic proteins via PCR and Western blots. Optimal drug combinations were examined for their impact on the cell cycle and apoptosis induction via FACS analysis, paralleled by the assessment of potential toxicity in healthy mouse brain slices. Ara-C and MTX proved to be 150- to 10,000-fold more potent in inducing apoptosis than TMZ. In response to inhibitors Eltanexor (XPO1; E), Venetoclax (Bcl-2; V), and A1210477 (Mcl-1; A), genes encoding for the corresponding proteins were upregulated in a compensatory manner. TMZ, MTX, and Ara-C combined with E, V, and A evidenced highly lethal effects when combined. As no significant cell death induction in mouse brain slices was observed, we conclude that this drug combination is effective in vitro and expected to have low side effects in vivo.

Abstract 279: Transient opening of the blood brain barrier by Tumor Treating Fields (TTFields)

Abstract Introduction Alternating electric fields of intermediate frequency and low intensity, known as Tumor Treating Fields (TTFields), are an effective and clinically approved approach for treatment of glioblastoma (GBM). The optimal frequency for treatment of glioma cells based on the cytotoxic response is at 200 kHz. Combination of TTFields with chemotherapy appears to be synergistic with further increase in overall survival of patients with GBM, beyond that with chemotherapy alone. The blood brain barrier (BBB) limits delivery of a majority of drugs to the brain thus limiting treatment options for GBM patients. Recent in vitro studies suggest that TTFields applied at 100 kHz can disturb the BBB. In this study, we investigated the potential use of TTFields to transiently disturb the BBB in animal models. Methods BBB permeation was tested in healthy rats subsequently to 100 kHz TTFields or sham (heat) application to the rat head. BBB permeability was analyzed by several staining agents: (1) Evans Blue (EB) that was quantified at 610 nm in brain homogenates; (2) 4 kDa TRITC-dextran (TD) that was quantified based on fluorescence intensity in brain cryosections; and (3) the MRI contrast agent Gd-DTPA. Accumulation and clearance of Gd-DTPA were tracked by serial dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). In addition, brain sections were stained for claudin-5, occludin, PECAM-1 and immunoglobulin G (IgG). BBB permeation induced by TTFields was further evaluated in rats orthotopically bearing F98 glioma cells and treated with TTFields at 100 kHz in combination with the chemotherapeutic drug paclitaxel (PTX) for a duration of 72 h. Tumor cell proliferation was assessed by Ki67 staining and the tumor volume was measured by T2 weighted MRI. Results BBB permeation of EB and TD staining agents was observed in the brains of healthy rats after TTFields application. Moreover, brain cryosections displayed delocalization of claudin-5 and occludin, but not of PECAM-1. Accumulation of IgG in the brain parenchyma was also noted. Confirming these observations, DCE-MRI post-TTFields treatment showed accumulation of Gd in the brain. Return to normal BBB integrity was detected 96 h after TTFields treatment cessation, indicating the effect was transient and reversible. In GBM-induced rats, the combination of PTX (a drug which normally does not cross the BBB) with TTFields significantly decreased tumor cell proliferation and tumor volume compared to animals treated with TTFields alone, sham alone, or sham combined with PTX. Conclusions Administration of 100 kHz TTFields to the brain of rats led to transient alterations in BBB integrity and permeability, allowing increased uptake of combination chemotherapy. These data indicate that TTFields treatment may be a feasible, novel clinical strategy for transient opening of the BBB to allow for enhanced and more effective delivery of permeable and non-permeable anticancer drugs to the brain. Citation Format: Catherine Tempel Brami, Ellaine Salvador, Almuth F. Kessler, Malgorzata Burek, Tali Voloshin, Moshe Giladi, Ralf-Ingo Ernestus, Mario Löhr, Carola Förster, Carsten Hagemann. Transient opening of the blood brain barrier by Tumor Treating Fields (TTFields) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 279.

DDRE-23. THE COMBINATION PARP INHIBITOR OLAPARIB WITH TEMOZOLOMIDE IN AN EXPERIMENTAL GLIOBLASTOMA MODEL

Abstract Poly (ADP-ribose) polymerase (PARP) inhibition could enhance the efficacy of temozolomide and prolong survival in patients with glioblastoma. The aim of this study was to evaluate the combination of the PARP inhibitor olaparib with temozolomide in the treatment of glioblastoma by evaluating in vitro and in vivo antitumor effects in an experimental glioblastoma model. The authors investigated antitumor effects of olaparib on temozolomide-induced cytotoxicity on O6-methylguanine methyltransferase (MGMT) promotor methylated (U87MG, U251MG) and MGMT promotor unmethylated (T98G) glioblastoma cell lines using in vitro cell viability and apoptosis assay. We found that the combination of olaparib with temozolomide enhanced temozolomide-induced cytotoxicity in all glioblastoma cell lines regardless of the status of MGMT promotor methylation. For in vivo studies, nude mice bearing orthotopically xenografted glioblastoma cell lines (U87MG) were randomized to four experimental groups: (i) untreated, (ii) temozolomide alone, (iii) olaprib alone and, (iv) olaparib+temozolomide. Mice were treated daily for 4 weeks and monitored for tumor growth, and survival. However, the addition of olaparib had no impact on the efficacy of temozolomide. The combination of PARP inhibitor olaparib with temozolomide could be an effective therapeutic approach for treatment of glioblastoma regardless of MGMT promotor methylation status, although the efficacy still should be evaluated by in vivo and clinical studies.

The Botanical Drug PBI-05204, a Supercritical CO2 Extract of Nerium Oleander, Inhibits Growth of Human Glioblastoma, Reduces Akt/mTOR Activities, and Modulates GSC Cell-Renewal Properties.

Glioblastoma multiform (GBM) is the most common primary glial tumor resulting in very low patient survival despite current extensive therapeutic efforts. Emerging evidence suggests that more effective treatments are required to overcome tumor heterogeneity, drug resistance and a complex tumor-supporting microenvironment. PBI-05204 is a specifically formulated botanical drug consisting of a modified supercritical C02 extract of Nerium oleander that has undergone both phase I and phase II clinical trials in the United States for treatment of patients with a variety of advanced cancers. The present study was designed to investigate the antitumor efficacy of this botanical drug against glioblastoma using both in vitro and in vivo cancer models as well as exploring efficacy against glioblastoma stem cells. All three human GBM cell lines, U87MG, U251, and T98G, were inhibited by PBI-05204 in a concentration dependent manner that was characterized by induction of apoptosis as evidenced by increased ANNEXIN V staining and caspase activities. The expression of proteins associated with both Akt and mTOR pathway was suppressed by PBI-05240 in all treated human GBM cell lines. PBI-05204 significantly suppressed U87 spheroid formation and the expression of important stem cell markers such as SOX2, CD44, and CXCR4. Oral administration of PBI-05204 resulted in a dose-dependent inhibition of U87MG, U251, and T98G xenograft growth. Additionally, PBI-05204–treated mice carrying U87-Luc cells as an orthotropic model exhibited significantly delayed onset of tumor proliferation and significantly increased overall survival. Immunohistochemical staining of xenograft derived tumor sections revealed dose-dependent declines in expression of Ki67 and CD31 positive stained cells but increased TUNEL staining. PBI-05204 represents a novel therapeutic botanical drug approach for treatment of glioblastoma as demonstrated by significant responses with in vivo tumor models. Both in vitro cell culture and immunohistochemical studies of tumor tissue suggest drug induction of tumor cell apoptosis and inhibition of PI3k/mTOR pathways as well as cancer stemness. Given the fact that PBI-05204 has already been examined in phase I and II clinical trials for cancer patients, its efficacy when combined with standard of care chemotherapy and radiotherapy should be explored in future clinical trials of this difficult to treat brain cancer.

Application prospect of peptide-modified nano targeting drug delivery system combined with PD-1/PD-L1 based immune checkpoint blockade in glioblastoma

Glioblastoma (GBM) is a type of primary malignant brain tumor with low median survival time, high recurrence rate and poor prognosis. The blood-brain barrier (BBB) and the diffuse infiltration of invasive GBM cells lead to a lower efficacy of traditional treatment. Recently, nanocarriers have become a promising method of brain drug delivery due to their ability to effectively cross the BBB. Especially, the peptide-modified nanocarriers can enhance the permeability, targeting and efficacy of chemotherapeutic agents against GBM. Moreover, the clinical application of immune checkpoint blockade (ICB) therapy in cancer treatment has attracted increasing attention, and the programmed death-1 receptor (PD-1) and PD-ligand-1 (PD-L1) monoclonal antibodies are considered to be a possible therapy for GBM. Consequently, we review the advances both in peptide-modified nano targeted drug delivery system and PD-1/PD-L1 based ICB in GBM treatment, and propose a new strategy combining the two methods, which may provide a novel approach for GBM treatment.

Abstract 6128: Evaluation of therapeutic efficacy of combination of 4HPR and SAHA for inhibition of growth of human glioblastoma T98G xenografts in zebrafish

Abstract Glioblastoma is the most aggressive and deadly primary brain cancer in humans. Despite the current treatments using surgery, radiotherapy, and chemotherapy, glioblastoma reappears due to drug resistance. New approaches for treatment of glioblastoma suggest that combination of two drugs may overcome the drug resistance. In this study, we have evaluated the efficacy of the combination of N-(4-hydroxphenyl) retinamide (4HPR) and suberoylanilide hydroxamic acid (SAHA) for inhibition of human glioblastoma T98G cells in a zebrafish xenograft model in our laboratory. Both 4HPR and SAHA have been approved by the United States Food and Drug Administration for treatment of cancers in the clinics. The synthetic retinoid 4HPR works via retinoic acid receptor signaling pathways to inhibit cancer cell proliferation and induce apoptosis, while SAHA is a histone deacetylase (HDAC) inhibitor that targets class I, II, and IV HDACs for controlling growth of cancer cells. Although rodent models have provided valuable insights into the biology and pathology of glioblastoma, these models are frankly unsuitable and increasingly unaffordable for high-throughput screening and profiling of novel therapeutic agents for rapid translation to the clinics. The optical transparency of zebrafish embryos and larvae provides the unique opportunity to track tumors in a way that is impossible in rodent models. Small size of zebrafish embryos allows for study design in small plates, making them a more useful laboratory system than other cancer models. Zebrafish lack a fully functioning adaptive immune response until 4 days post-fertilization, allowing rejection-free xenografts of human tumors during this period. Recently, zebrafish xenograft models have emerged as a new powerful tool for studying different types of human tumors including glioblastoma and for evaluating therapeutic efficacy of different drugs alone and in combination. Organ systems and cell types are common in human and zebrafish. Tumors that occur in the same organs in human and zebrafish look and behave alike, often share common genetic makeups, and employ basic mechanisms for tumor formation, expansion, and spread. Zebrafish xenograft model of human glioblastoma offers us a major opportunity for discovering key pathways of this tumor growth and for evaluating efficacy of a novel combination therapy. We loaded exponentially grown T98G cells labeled with CellTrace™ Red into the glass needle (0.75 mm internal diameter without filament, World Precision Instruments, FL) at a density of about 1 × 106 cells/200 µl. Using a micro-injector, each anesthetized zebrafish larva was microinjected with about 100 T98G cells into the duct of Cuvier at 1.5 - 3.0 psi. After injection, larvae were transferred to fresh egg water for recovery during 1 h at 28 ± 0.5°C and then incubated at 33°C for the rest of the experiment. After 2 days of tumor growth, we treated zebrafish larvae with 4 µM 4HPR and 8 µM SAHA alone and in combination and incubated for 3 days. Results showed that 4HPR and SAHA alone inhibited growth of T98G xenografts in zebrafish, but the combination of the two drugs most significantly reduced T98G cell proliferation inside of the zebrafish. Our work suggested that the zebrafish xenograft model could be useful to identify the therapeutic efficacy of combination of drugs in the treatment of glioblastoma. Citation Format: Firas Khathayer, Katie L. Kathrein, Mitzi Nagarkatti, Swapan K. Ray. Evaluation of therapeutic efficacy of combination of 4HPR and SAHA for inhibition of growth of human glioblastoma T98G xenografts in zebrafish [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 6128.

Abstract 5725: Epigenetic and transcriptional profiling reveal endosomal protein sorting as a glioblastoma cancer stem cell dependency

Abstract Glioblastoma is a highly lethal primary intrinsic brain tumor for which current standard-of-care therapies are merely palliative. Functionally defined glioblastoma stem cells (GSCs) contribute to this poor prognosis by driving therapeutic resistance, maintenance of cellular heterogeneity, and disease recurrence. A deeper appreciation for the specific features that distinguish normal from neoplastic stem cells may inform selective therapeutic targeting. To further understand the molecular processes essential for maintaining cancer stem cell populations, we interrogated the active enhancer landscapes and transcriptional output of GSCs and normal neural stem cells (NSCs) through H3K27ac ChIP-seq and RNA-seq respectively. GSC-specific targets that held prognostic significance in patient datasets and which were essential in whole genome CRISPR screening data implicated endosomal protein sorting as a key feature in GSC biology. Targeting endosomal sorting impaired GSC viability and proliferation and contributed to apoptosis, while NSCs displayed a reduced cell proliferation deficit. Impaired endosomal protein sorting led to a reduction in the mRNA and protein levels of the stem and neuro-developmental transcription factors SOX2 and OLIG2 and reduced self-renewal capacity of GSCs, suggesting a role in the maintenance of stemness. Mechanistically, regulation of endosomal sorting may impact localization and stability of receptor tyrosine kinases and WNT signaling elements to control GSC maintenance. High expression of this endosomal sorting factor is associated with poor glioblastoma patient prognosis, suggesting its clinical importance. Thus, targeting the endosomal sorting pathway may represent a novel therapeutic approach for glioblastoma treatment. Citation Format: Ryan C. Gimple, Guoxin Zhang, Jeremy N. Rich. Epigenetic and transcriptional profiling reveal endosomal protein sorting as a glioblastoma cancer stem cell dependency [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5725.

Cyclin-dependent kinase inhibitors in brain cancer: current state and future directions.

Cyclin-dependent kinases (CDKs) are important regulatory enzymes in the normal physiological processes that drive cell-cycle transitions and regulate transcription. Virtually all cancers harbour genomic alterations that lead to the constitutive activation of CDKs, resulting in the proliferation of cancer cells. CDK inhibitors (CKIs) are currently in clinical use for the treatment of breast cancer, combined with endocrine therapy. In this review, we describe the potential of CKIs for the treatment of cancer with specific focus on glioblastoma (GBM), the most common and aggressive primary brain tumour in adults. Despite intense effort to combat GBM with surgery, radiation and temozolomide chemotherapy, the median survival for patients is 15 months and the majority of patients experience disease recurrence within 6-8 months of treatment onset. Novel therapeutic approaches are urgently needed for both newly diagnosed and recurrent GBM patients. In this review, we summarise the current preclinical and clinical findings emphasising that CKIs could represent an exciting novel approach for GBM treatment.

P11.42 Magnetic targeting of the granzyme B functionalized nanoparticles for therapy of glioblastoma

Abstract BACKGROUND Magnetic drug targeting by employing external magnetic fields represents a promising approach for treatment of glioblastoma. To increase the anti-tumor therapeutic effect magnetic nanocarriers could be functionalized with tumor-targeting bioligands such as granzyme B (GrB). The serine protease GrB that is produced as an effector molecule by activated NK and T cells can induce specific tumor cell apoptosis. MATERIAL AND METHODS The targeting potential of the dextran-coated superparamagnetic iron oxide nanoparticles conjugated with GrB (GrB-SPIONs) was assessed in glioblastoma cells (U87, C6, GL261) by flow cytometry, confocal and electron microscopies. Magnetic field strength (320 mT) in the models of U87 glioblastoma in NMRI nu/nu mice and C6 glioma in Wistar rats was achieved by employing NdFeB cylindrical ferromagnet. The irradiation of the implanted tumors was performed using the CT-image guided Small Animal Radiation Research Platform (SARRP). Accumulation of the nanoparticles was assessed in paraffine-embedded specimens employing Prussian blues staining. Sections were additionally analyzed by IHC for apoptosis (caspase 3). RESULTS Synthesized GrB-SPIONs incorporated into the cytoplasm of tumor cells via the endolysosomal pathway and induced apoptosis in a dose-dependent manner. Intravenous injection of GrB-SPIONs resulted in the glioma-specific retention of the nanoparticles as was shown by high-field (11 T) magnetic resonance imaging and biodistribution studies (NLR-M2 measurements). Magnetic targeting of the nanoparticles in vivo drastically enhanced the accumulation of nanoparticles to the location of the magnet. Thus the local retention of nanoparticles was 12.3-fold higher as compared to application of GrB-SPIONs without external magnetic field. The presence of granzyme B on SPIONs has been shown to promote tumor cells death (IHC staining for caspase 3) and significantly increased overall survival. A combination of nanoparticle treatment with a single radiation dose (10 Gy) significantly prolonged the survival of rats as compared to animals treated only with magnetic targeting of GrB-SPIONs or radiotherapy alone (P<0.001). CONCLUSION Single-agent therapy with GrB-SPIONs demonstrated an impressive increase in overall survival of tumor-bearing animals. Combinatorial regimen employing magnetic targeting and stereotactic radiotherapy further enhanced the therapeutic potential of magnetic conjugates.

Abstract 5224: Conversion of human glioblastoma cells into neurons by neuronal transcription factors

Abstract Background: Glioblastoma is one of the most severe primary cancer types in the central nervous system. Because of genomic and epigenetic heterogeneity, GBM is infiltrative and resistant to conventional treatments such as radiation, chemotherapy and molecular targeting drugs. Glioblastoma often arises from astrocytes, which can be directly converted into neurons according to our earlier work, so we hypothesize that glioblastoma cells might also be converted into non-proliferating neurons. This trans-differentiation therapy might provide a unique approach for glioblastoma treatment. Methods: NeuroD1 was chosen as one of the candidate factors in this study because we have shown its critical roles in astrocyte-to-neuron conversion. Neurog2 and Ascl1 were also tested to understand possible different conversion mechanisms. Single transcription factor or GFP was overexpressed via retrovirus in human glioblastoma cells. Twelve hours after virus infection, culture medium was changed into differentiation medium containing neurotropic factors for neuronal maturation. Immuostainng and other tests were conducted at different days post infection. Results: Retrovirus yielded high infection efficiency in fast-proliferating glioblastoma cells. All three factors tested were capable of converting glioblastoma cells into neuron-like cells efficiently. Besides morphological change, robust pan-neuronal markers were expressed during the conversion, such as immature neuronal markers DCX, Tuj1 and mature neuronal makers MAP2, NeuN. Majority of the converted cells from glioma were immunopositive for glutamatergic neuron marker vGluT1 and hippocampal neuron marker Prox1. Reactive astroglial marker GFAP decreased after conversion, but cancer marker EGFR and IL13Ra2 remained during conversion. Cell proliferation was inhibited during conversion indicated by Ki67 and BrdU. Robust synaptic puncta along dendrites were found in glioma-converted cells, indicated by SV2 immunostaining. Patch-clamp recordings revealed that most of the converted neurons could fire multiple action potentials or single action potential. Conclusion: Our data suggest that several neuronal transcription factors are capable to convert human glioblastoma cells into neuron-like cells efficiently. The converted cells obtained a variety of neuron-specific markers with functional synaptic networks and active electrophysiological properties. This neuronal conversion was also confirmed by reduction of reactive astroglial marker GFAP. Although some cancer markers remain in the converted neurons, glioblastoma cells stopped proliferating once being converted. In summary, our study suggests that converting human glioblastoma cells into neurons could be a potential therapeutic approach for glioblastoma treatment to at least control cancer cell proliferation and inhibit tumor progression. Citation Format: Xin Wang, Zifei Pei, Aasma Hossain, Tania T. Barnatan, Yuting Bai, Gong Chen. Conversion of human glioblastoma cells into neurons by neuronal transcription factors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5224.

Anti-cancer effects of the HuR inhibitor, MS-444, in malignant glioma cells

ABSTRACTGlioblastoma is a highly malignant and typically fatal tumor of the central nervous system. The tumor is characterized by marked cellular and molecular heterogeneity, including a subpopulation of brain tumor initiating cells (BTICs) that are highly resistant to radiation and chemotherapy. We previously reported that the RNA-binding protein HuR is: (1) overexpressed in glioblastoma, (2) necessary for tumor growth in vivo, and (3) a positive regulator of tumor-promoting genes in glioblastoma. These findings provide strong evidence that HuR might be a viable therapeutic target in glioblastoma. In this report, we investigated the effects of MS-444, a small molecule inhibitor of HuR, in xenograft-derived human glioblastoma cells and BTICs. We found that MS-444 treatment of glioblastoma cells resulted in loss of viability and induction of apoptosis, with evidence implicating death receptor 5. BTICs were particularly sensitive to MS-444. At sub-lethal doses, MS-444 attenuated invasion of glioblastoma cells and BTICs in a transwell model. At the molecular level, MS-444 treatment led to an attenuation of mRNAs in different tumor promoting pathways including angiogenesis, immune evasion and suppression of apoptosis. Although cytoplasmic HuR was reduced with MS-444 treatment, the attenuation of mRNAs could not be explained by RNA destabilization. In summary, this report provides proof of concept that small molecule inhibition of HuR could be a viable approach for treatment of glioblastoma.

Modulation of MKNK2 alternative splicing by splice-switching oligonucleotides as a novel approach for glioblastoma treatment.

The gene encoding the kinase Mnk2 (MKNK2) is alternatively spliced to produce two isoforms—Mnk2a and Mnk2b. We previously showed that Mnk2a is downregulated in several types of cancer and acts as a tumor suppressor by activation of the p38–MAPK stress pathway, inducing apoptosis. Moreover, Mnk2a overexpression suppressed Ras-induced transformation in culture and in vivo. In contrast, the Mnk2b isoform acts as a pro-oncogenic factor. In this study, we designed modified-RNA antisense oligonucleotides and screened for those that specifically induce a strong switch in alternative splicing of the MKNK2 gene (splice switching oligonucleotides or SSOs), elevating the tumor suppressive isoform Mnk2a at the expense of the pro-oncogenic isoform Mnk2b. Induction of Mnk2a by SSOs in glioblastoma cells activated the p38–MAPK pathway, inhibited the oncogenic properties of the cells, re-sensitized the cells to chemotherapy and inhibited glioblastoma development in vivo. Moreover, inhibition of p38–MAPK partially rescued glioblastoma cells suggesting that most of the anti-oncogenic activity of the SSO is mediated by activation of this pathway. These results suggest that manipulation of MKNK2 alternative splicing by SSOs is a novel approach to inhibit glioblastoma tumorigenesis.

Abstract 617: Evaluating the in-vitro effects of tumor treating fields on T cell responses

Abstract BACKGROUND: Tumor Treating Fields (TTFields) are low-intensity electrical fields that target proliferating cells by hindering formation of mitotic spindle and translocation of charged organelles. TTFields have been recently approved for the treatment of both recurrent and newly diagnosed Glioblastoma (GBM). Immunotherapeutic approaches for treatment of GBM are considered promising, and multiple strategies are currently being evaluated in basic research and clinical trials. Combining TTFields and immune-based therapies is a rational approach as they possess markedly different mechanisms of action (MOA). Conversely, TTFields may potentially abrogate various cellular functions required for effective T cell responses. We performed an in-vitro evaluation on the effect of TTFields on select human T cell functions that are pivotal for an effective anti-tumoral response. The study objective was to evaluate the potential compatibility between immune-based therapies and TTFields. METHODS: Peripheral blood mononuclear cells were isolated from healthy donors. Cells were cultured under normal versus TTFields conditions using the inovitro TTFields system, either with or without Phytohemaglutenin (PHA - a super antigen). Cellular responses were monitored using an 8-color flow cytometry panel that concurrently evaluated proliferation (CFSE dilution), cytokine secretion (IFNγ), cytotoxic degranulation (CD107a surface presentation), and T cell activation/ exhaustion (PD1 expression). The effect on T cell viability was assessed in a separate assay, by comparing the live-to-dead ratio of cells cultured in normal versus TTFields settings. RESULTS: TTFields did not alter the functionality of non-activated T cells. Viable PHA-activated T cells cultured under TTFields exhibited no change in PD1 up-regulation, IFNγ secretion and CD107a surface-expression. The T cells exhibited reduced proliferation, which is in line with the known MOA of TTFields. As the presence of polyfunctional T cells is associated with effective anti-tumoral responses, a single-cell level polyfunctionality analysis of activated T cells was performed. The analysis demonstrated that under TTFields conditions non proliferating cells retained all other combinations of immune functions. TTFields were found to have a minor effect on the viability of un-activated T cells. In activated cells, there was a moderate effect on cells that did not attempt to proliferate, but TTFields substantially reduced the viability rate of cells that had proliferated. These findings were true for both helper and cytotoxic T cells. CONCLUSIONS: Pivotal T-cell response parameters, but not proliferation, were found to be unhindered by TTFields. Our current data suggests that the integration of TTFields with various immunotherapeutic approaches may be a rational strategy to explore for the treatment of brain tumors. Citation Format: Gil Diamant, Ilan Volovitz, Zvi Ram. Evaluating the in-vitro effects of tumor treating fields on T cell responses [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 617. doi:10.1158/1538-7445.AM2017-617

Immune Evasion Strategies of Glioblastoma.

Glioblastoma (GBM) is the most devastating brain tumor, with associated poor prognosis. Despite advances in surgery and chemoradiation, the survival of afflicted patients has not improved significantly in the past three decades. Immunotherapy has been heralded as a promising approach in treatment of various cancers; however, the immune privileged environment of the brain usually curbs the optimal expected response in central nervous system malignancies. In addition, GBM cells create an immunosuppressive microenvironment and employ various methods to escape immune surveillance. The purpose of this review is to highlight the strategies by which GBM cells evade the host immune system. Further understanding of these strategies and the biology of this tumor will pave the way for developing novel immunotherapeutic approaches for treatment of GBM.

Imaging genomics of Glioblastoma: state of the art bridge between genomics and neuroradiology.

Glioblastoma (GBM) is the most common and most aggressive primary malignant tumor of the central nervous system. Recently, researchers concluded that the "one-size-fits-all" approach for treatment of GBM is no longer valid and research should be directed toward more personalized and patient-tailored treatment protocols. Identification of the molecular and genomic pathways underlying GBM is essential for achieving this personalized and targeted therapeutic approach. Imaging genomics represents a new era as a noninvasive surrogate for genomic and molecular profile identification. This article discusses the basics of imaging genomics of GBM, its role in treatment decision-making, and its future potential in noninvasive genomic identification.

Abstract LB-229: PTEN modulates EGFRvIII-mediated SHP-2 activation and translocation to affect glioblastoma sensitivity to tyrosine kinase inhibitors (TKI)

Abstract EGFRvIII, a constitutively active truncated mutant of epidermal growth factor receptor (EGFR), has been associated with increase neoplastic transformation and poor overall survival (OS). An earlier report showed that expression of EGFRvIII in gliomas provides resistance to chemotherapy. Co-expression of EGFRvIII and PTEN in a small subset of recurrent GBMs has been shown to increase sensitivity to tyrosine kinase inhibitors (TKI), including Erlotinib (tarceva) and Geftinib. However, the exact mechanism of EGFRvIII and PTEN interaction in response to TKI is still unresolved. Our recent reports showed that SHP-2 PTPase and its phosphatase activity are required for the EGFRvIII-mediated transformation. The aim of the present work was to investigate the molecular interaction between EGFRvIII/SHP-2 activation complex and PTEN in response to tarceva treatment and its effect on glioblastoma transformation. Our recent report demonstrated an increased SHP-2 phosphorylation in U87MG. EGFRvIII (PTEN-deficient) when compared to PTEN-intact LN229.EGFRvIII cells. In the present study, we show that tarceva treatment abolished EGFRvIII, EGFR, SHP-2 and Erk1/2, but Src family kinase (SFK), phosphorylation in LN229.EGFRvIII cells at all time intervals ranging from 30 minutes to 6 hours. On the contrary, phosphorylation of EGFRvIII, Src and Erk1/2 in U87MG. EGFRvIII cells was inhibited in early time points, but was restored in 2 to 6 hours. Surprisingly, phosphorylation of SHP-2 at Tyr542 residue was unaffected by tarceva treatment, but EGFR phosphorylation was inhibited in a time-dependent manner. PTEN deficiency resulted in resistance to tarceva treatment as assessed by MTT proliferation and soft agar transformation assays. Immunofluorescent labeling of U87MG. EGFRvIII cells with anti-phospho-SHP-2 (Tyr542) antibody showed perinuclear localization of SHP-2, whereas LN229.EGFRvIII cells exhibited membrane staining of phosphorylated SHP-2 (Tyr542). Our results showed that tarceva increased perinuclear SHP-2 Tyr542 in U87MG. EGFRvIII cells. Interestingly, stable expression of PTEN in U87MG. EGFRvIII cells conferred relocalization of phospho-SHP-2 to the membrane, a phenotype resembling LN229.EGFRvIII cells. Moreover, PTEN-expressing U87MG. EGFRvIII clones grew slower and showed a partially untransformed phenotype. These results suggest that SHP-2 is downstream effectors of PTEN and that PTEN deficiency may lead to SHP-2 activation and perinuclear localization by EGFRvIII, which may results in increased resistance to TKIs. Therefore, targeting SHP-2 may provide a new and effective therapeutic approach for treatment of glioblastoma. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr LB-229.