Dickinson Peter J, LeCouteur Richard A, Higgins Robert J, Bringas John R, Roberts Byron, Larson Richard F, Yamashita Yoji, Krauze Michal, Noble Charles O, Drummond Daryl, Kirpotin Dmitri B, Park John W, Berger Mitchel S, Bankiewicz Krystof S
Department of Surgical and Radiological Sciences, Tupper Hall, School of Veterinary Medicine, University of California, Davis, CA 95616, USA.
J Neurosurg. 2008 May;108(5):989-98. doi: 10.3171/JNS/2008/108/5/0989.
Many factors relating to the safety and efficacy of convection-enhanced delivery (CED) into intracranial tumors are poorly understood. To investigate these factors further and establish a more clinically relevant large animal model, with the potential to investigate CED in large, spontaneous tumors, the authors developed a magnetic resonance (MR) imaging-compatible system for CED of liposomal nanoparticles into the canine brain, incorporating real-time MR imaging. Additionally any possible toxicity of liposomes containing Gd and the chemotherapeutic agent irinotecan (CPT-11) was assessed following direct intraparenchymal delivery.
Four healthy laboratory dogs were infused with liposomes containing Gd, rhodamine, or CPT-11. Convection-enhanced delivery was monitored in real time by sequential MR imaging, and the volumes of distribution were calculated from MR images and histological sections. Assessment of any toxicity was based on clinical and histopathological evaluation. Convection-enhanced delivery resulted in robust volumes of distribution in both gray and white matter, and real-time MR imaging allowed accurate calculation of volumes and pathways of distribution.
Infusion variability was greatest in the gray matter, and was associated with leakage into ventricular or subarachnoid spaces. Complications were minimal and included mild transient proprioceptive deficits, focal hemorrhage in 1 dog, and focal, mild perivascular, nonsuppurative encephalitis in 1 dog.
Convection-enhanced delivery of liposomal Gd/CPT-11 is associated with minimal adverse effects in a large animal model, and further assessment for use in clinical patients is warranted. Future studies investigating real-time monitored CED in spontaneous gliomas in canines are feasible and will provide a unique, clinically relevant large animal translational model for testing this and other therapeutic strategies.
与对流增强递送(CED)进入颅内肿瘤的安全性和有效性相关的许多因素目前仍知之甚少。为了进一步研究这些因素并建立一个更具临床相关性的大型动物模型,以便有潜力在大型自发性肿瘤中研究CED,作者开发了一种用于将脂质体纳米颗粒对流增强递送至犬脑的磁共振(MR)成像兼容系统,并结合实时MR成像。此外,在直接脑实质内递送后,评估了含有钆和化疗药物伊立替康(CPT-11)的脂质体的任何潜在毒性。
给4只健康的实验犬输注含有钆、罗丹明或CPT-11的脂质体。通过连续MR成像实时监测对流增强递送,并根据MR图像和组织学切片计算分布体积。基于临床和组织病理学评估对任何毒性进行评估。对流增强递送导致灰质和白质中均有强大的分布体积,并且实时MR成像允许准确计算分布体积和途径。
灰质中的输注变异性最大,并且与漏入脑室或蛛网膜下腔有关。并发症极少,包括轻度短暂本体感觉缺陷、1只犬出现局灶性出血,以及1只犬出现局灶性、轻度血管周围非化脓性脑炎。
脂质体钆/CPT-11的对流增强递送在大型动物模型中不良反应极小,有必要进一步评估其在临床患者中的应用。未来研究在犬自发性胶质瘤中进行实时监测的CED是可行的,并且将为测试该治疗策略及其他治疗策略提供一个独特的、具有临床相关性的大型动物转化模型。