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Ex vivo ultrasonic samples of human brain tumors in the molecular era

Research output: Contribution to journalArticle

Alastair J. Kirby, José P Lavrador, Istvan Bodi, Francesco Vergani, Ranjeev Bhangoo, Keyoumars Ashkan, Gerald T Finnerty

Original languageEnglish
JournalNeuro-Oncology Advances
Early online date8 Feb 2020
DOIs
Accepted/In press6 Feb 2020
E-pub ahead of print8 Feb 2020

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Abstract

Background. Gliomas are composed of multiple clones of tumor cells. This intratumor heterogeneity contributes to the ability of gliomas to resist treatment. It is vital that gliomas are fully characterized at a molecular level when a diagnosis is made to maximize treatment effectiveness.
Methods. We collected ultrasonic tissue fragments during glioma surgery. Large tissue fragments were separated in the operating theatre and bathed continuously in oxygenated artificial cerebrospinal fluid to keep them alive. The ex vivo tissue fragments were transferred to a laboratory and incubated in 5-aminolevulinic acid (5-ALA). 5-ALA is metabolised to Protoporphyrin IX (PpIX), which accumulates in glioma cells and makes them fluorescent. The molecular and neuropathological features of the PpIX fluorescent ultrasonic tissue fragments were studied.
Results. We show that PpIX fluorescence can rapidly identify tissue fragments infiltrated by glioma in the laboratory. Ultrasonic tissue fragments from the tumor core provided molecular and neuropathological information about the glioma that was comparable to the surgical biopsy. We characterized the heterogeneity within individual gliomas by studying ultrasonic tissue fragments from different parts of the tumor. We found that gliomas exhibit a power relationship between cellular proliferation and tumor infiltration. Tissue fragments that deviate from this relationship may contain foci of more malignant glioma. The methylation status of the O6-methlguanine DNA methyltransferase (MGMT) gene promoter varied within each glioma.
Conclusion. Ex vivo ultrasonic tissue fragments can be rapidly screened for glioma infiltration. They offer a viable platform to characterize heterogeneity within individual gliomas, thereby enhancing their diagnosis and treatment.

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