Mitsou John D, Tseveleki Vivian, Dimitrakopoulos Foteinos-Ioannis, Konstantinidis Konstantinos, Kalofonos Haralabos
Department of Plastic and Reconstructive Surgery, Athens Medical Center, 15125 Maroussi, Greece.
Laboratory of Molecular Genetics, Hellenic Pasteur Institute, 11521 Athens, Greece.
Cancers (Basel). 2023 Jul 25;15(15):3758. doi: 10.3390/cancers15153758.
This preliminary study seeks to determine the effect of R&P denervation on tumor growth and survival in immunocompetent rats bearing an aggressive and metastatic breast solid tumor. A novel microsurgical approach was applied "in situ", aiming to induce R&P denervation through the division of every single nerve fiber connecting the host with the primary tumor via its complete detachment and re-attachment, by resecting and reconnecting its supplying artery and vein (anastomosis). This preparation, known as microsurgical graft or flap, is radically denervated by definition, but also effectively delays or even impedes the return of innervation for a significant period of time, thus creating a critical and therapeutic time window. Mammary adenocarcinoma cells (HH-16.cl4) were injected into immunocompetent Sprague Dawley adult rats. When the tumors reached a certain volume, the subjects entered the study. The primary tumor, including a substantial amount of peritumoral tissue, was surgically isolated on a dominant artery and vein, which was resected and reconnected using a surgical microscope (orthotopic tumor auto-transplantation). Intending to simulate metastasis, two or three tumors were simultaneously implanted and only one was treated, using the surgical technique described herein. Primary tumor regression was observed in all of the microsurgically treated subjects, associated with a potent systemic anticancer effect and prolonged survival. In stark contrast, the subjects received a close to identical surgical operation; however, with the intact neurovascular connection, they did not achieve the therapeutic result. Animals bearing multiple tumors and receiving the same treatment in only one tumor exhibited regression in both the "primary" and remote- untreated tumors at a clinically significant percentage, with regression occurring in more than half of the treated subjects. A novel therapeutic approach is presented, which induces the permanent regression of primary and, notably, remote tumors, as well as, evidently, the naturally occurring metastatic lesions, at a high rate. This strategy is aligned with the impetus that comes from the current translational research data, focusing on the abrogation of the neuro-tumoral interaction as an alternative treatment strategy. More data regarding the clinical significance of this are expected to come up from a pilot clinical trial that is ongoing.
这项初步研究旨在确定R&P去神经支配对患有侵袭性转移性乳腺实体瘤的免疫健全大鼠肿瘤生长和存活的影响。采用了一种新颖的显微外科方法“原位”进行操作,旨在通过切断连接宿主与原发性肿瘤的每一根神经纤维来诱导R&P去神经支配,具体操作是通过完全分离并重新连接其供应动脉和静脉(吻合术),将肿瘤从其供应血管上完全分离并重新附着。这种制备方法,即显微外科移植或皮瓣,从定义上讲是完全去神经支配的,但在相当长的一段时间内也能有效延迟甚至阻碍神经再支配的恢复,从而创造一个关键的治疗时间窗。将乳腺腺癌细胞(HH-16.cl4)注射到免疫健全的成年Sprague Dawley大鼠体内。当肿瘤达到一定体积时,这些实验对象进入研究。在一条主要动脉和静脉上通过手术分离出包括大量肿瘤周围组织的原发性肿瘤,然后使用手术显微镜进行切除并重新连接(原位肿瘤自体移植)。为了模拟转移,同时植入两到三个肿瘤,仅对其中一个使用本文所述的手术技术进行治疗。在所有接受显微外科治疗的实验对象中均观察到原发性肿瘤消退,同时伴有强大的全身抗癌作用和生存期延长。与之形成鲜明对比的是,另一组实验对象接受了几乎相同的外科手术;然而,由于神经血管连接完整,他们并未取得治疗效果。携带多个肿瘤且仅对其中一个肿瘤进行相同治疗的动物,其“原发性”肿瘤和未治疗的远处肿瘤均出现了具有临床意义的消退,超过半数的治疗对象出现了肿瘤消退。本文提出了一种新颖的治疗方法,该方法能以较高的比率诱导原发性肿瘤以及明显的远处肿瘤,还有自然发生的转移病灶永久性消退。这一策略与当前转化研究数据所推动的方向一致,即将消除神经-肿瘤相互作用作为一种替代治疗策略。预计正在进行的一项试点临床试验将提供更多关于此临床意义的数据。