Malignant gliomas are highly aggressive brain tumors. Surgical removal and chemoradiation of the tumor are the standard of care. Recently, the U.S. Food and Drug Administration (FDA) approved a compound called 5-aminolevulinic acid (5-ALA) as an imaging agent to aid in differentiating tumor from normal tissue during surgery. 5-ALA is a precursor in the heme biosynthesis pathway, which is inefficient in glioma cells because their strongly rewired metabolism does not rely on heme. When patients with malignant glioma ingest 5-ALA prior to surgery, the glioma cells fluoresce pink under a blue light due to their preferential uptake and conversion of 5-ALA to the final precursor in heme biosynthesis, the fluorescent molecule protoporphyrin IX (PpIX). We sought to investigate whether extracellular vesicles (EVs) released from PpIX-enriched glioma cells would fluoresce and be detectable in the blood of these patients.
We employed Amnis® Imaging Flow, which combines flow cytometry and microscopy to detect PpIX-positive EVs. We first determined the optimal 5-ALA dose to maximize fluorescence and minimize cell death. We used a combination of beads of different size (100-500nm) and liposomes with different emission spectra to ensure that the signal emitted in Channel 11 (~640nm) of the Amnis® output was indeed from PpIX, and that all other channels reported no signal. Controls also included lysis with Triton-X of liposomes and EVs.
Importantly, we showed that glioma cells released a significantly higher number of PpIX-positive EVs (247-fold increase) than normal endothelial cells (6-fold increase) after 5-ALA ingestion. We also used xenograft mouse models to show that the presence of PpIX-positive EVs in circulating plasma after 5-ALA ingestion correlated strongly with the presence of a primary brain tumor, while the signal from the plasma of normal control mice remained below background both before and after 5-ALA ingestion.
Finally, we tested the optimized assay in the plasma of patients with gliomas undergoing 5-ALA fluorescence guided surgery at the Massachusetts General Hospital. Samples were collected prior to 5-ALA intake as well as at the time of surgery, prior to tumor removal. Pre- and post-5-ALA plasma samples were kept in the dark to avoid bleaching of the PpIX signal, as were the patients for 24 hours post 5-ALA. We collected samples from 4 patients whose tumors were avidly fluorescent during surgery and 2 patients whose tumors showed minimal fluorescence. Interestingly, we detected PpIX-positive EVs only in the plasma samples from patients whose tumors were avidly fluorescent. Finally, when we compared the fold increase (pre/post-5-ALA) in PpIX-positive signal to the size of the tumor, we found a clear correlation, suggesting that the detected events are likely coming directly from the tumor. This is the first time intracranially derived EVs have been quantified in circulating plasma, and this development opens the door for many exciting studies that can shed light on brain-derived EV dynamics and half-life. For example, we detected between 3,000 and 8,000 PpIX-positive events per mL of plasma. Assuming each 1 mL of plasma contains roughly 1010 EV/mL, we can deduct that only 0.00008% of EVs in blood are of glioma tumor origin. Furthermore, this assay allows us to study EV dynamics in tumor patients undergoing therapy as well as determine the effects of medications such as dexamethasone on the release of EVs into the bloodstream.
Clinically, there is a major need for minimally invasive diagnosis of brain cancer, and characterizing circulating tumor-specific fluorescent EVs provides a window into the primary tumor’s presence and status. Detecting and characterizing fluorescent EVs after administering 5-ALA allows for diagnosis and potentially monitoring of malignant gliomas over time.
Jones PS, et al. Characterization of plasma-derived protoporphyrin-IX-positive extracellular vesicles following 5-ALA use in patients with malignant glioma. (2019) eBioMedicine 48:23-35. doi: 10.1016/j.ebiom.2019.09.025. PMID: 31628025.
I am a scientist at Scripps Research Institute in La Jolla, California working in the lab of Professor Hollis Cline. A thirst for knowledge is what originally attracted me to science. The potential to contribute, even in a small way, to alleviating suffering drives that thirst and passion even more.
Human biology has always fascinated me. Imagine for a moment how the human body is created. It starts with a single cell that multiplies to create a complex organism of trillions of cells. The human brain alone is estimated to contain more than 150 billion cells, 86 billion neurons and about an equal number of non-neuronal cells, all of a wide variety of specializations. It is mind boggling to imagine that a few founder cells contain the programming information that, through a series of cell fate decisions, produces a complex organ like the brain. What kind of communication and logistics are required to orchestrate the development and function of this behemoth?
One requirement is a package delivery mechanism; think of it as the body’s UPS, which allows information and material transfer between cells. Over the past decade, researchers have discovered that our bodies employ amazing inter-cellular couriers called exosomes or extracellular vesicles to transport fundamental biomolecules like proteins, nucleic acids and lipids. Exosomes can also perform additional duties, such as scouting and laying the path for a growing axon or migrating cells. For example, cancer cells use exosomes to lay the foundation of their migration out of a tumor, leading to metastasis.
Our work has uncovered a fundamental role of exosome communication in brain development. We show that exosomes secreted by neurons contain signals to direct the development and function of neural circuits. Importantly we have discovered that exosomes have the potential to become therapeutics for neurodevelopmental disorders, including Rett Syndrome.
Our brain works like a musical ensemble. The neurons fire to produce a pattern of activity very much like an ensemble of musicians playing together to produce a melody. Historically, a vast majority of studies directed towards understanding brain function focused on the skills of the individual neurons or their training together in producing a melody. We found that when these musicians in our brain called neurons, hang together and socialize, they use exosomes to communicate between themselves. These exosomes contained messages that provided them great collective motivation and were extremely helpful in their training and performance. Extending this analogy to the case of Rett Syndrome, Rett neurons practice very hard but are unable to play together and produce a melody. Rett neurons not only lacked some music skills, they had problems coordinating their music with each other. We found that the Rett exosome no longer contained motivating messages to help the neurons with their music skills and coordination.
We thought that maybe if we take exosomes from healthy neurons and give them to Rett neurons, it will provide them the message they are lacking and help motivate them to play a melody. Remarkably, the exosome message from healthy neurons let Rett Syndrome neurons overcome their shortcomings and fire together in a synchronous way to produce a melody.
For the scientifically inclined readers I’ll provide a more scientific description. All cells in the brain secrete exosomes. However, it was not very clear what function the exosomes perform in the brain. We purified exosomes from functional neural cultures and asked, could these exosomes contain a bioactivity to perform any function in a developing neural circuit? We observed that exosome treatment led to an increase in neuronal number. This led to a further question – if exosomes have a role in developing neural circuits, what happens when the neural development is deficient? A good way to find that out is to compare exosomes from healthy neurons to exosomes from neurons with a neurodevelopmental disorder.
We decided to explore this question by experimenting with induced pluripotent stem cells (iPSC) from a Rett Syndrome patient. Rett is caused by disruption of a single gene, MECP2. We restored the function of the MECP2 gene in the iPSCs using CRISPR gene editing. We therefore had two human iPSC neural cultures that are identical to each other genetically except in the function of just one protein, MECP2. This was an ideal setup to study the fundamental role of exosomes in normal neural circuit development and compare it to a condition where neural circuit development is deficient.
The Rett patient iPSC derived neural cultures displayed cellular and circuit manifestations of Rett Syndrome, whereas CRISPR corrected controls were normal. We then purified exosomes secreted by each culture, yielding normal control exosomes and Rett exosomes, and compared them. Our results were so remarkable that it took us a while to appreciate them.
First, exosomes were full of proteins that are important in development of neurons and formation and maintenance of synapses. Synapses are conduits of electrochemical information flow between neurons, and are critical to proper brain function.
Second, the Rett exosomes displayed specific alterations in their signaling capacities, like proliferation, neural development, and synaptic function. In short, we found that normal exosomes could potentially guide proliferation, neuron development, and synapse function, and Rett exosomes are somewhat deficient in that function.
Taking cues from these results, we compared the bioactivity and found that normal exosomes boosted proliferation of neural stem cells and Rett exosomes did not. In addition, normal exosome treatment led to a big increase in neural progeny and modest increase in astrocyte progeny; astrocytes are another cell type in the brain that have a range of ancillary functions. In comparison, Rett exosome treatment, while it lacked the capability to increase neural progeny, still directed the modest increase of astrocyte progeny. This result shows that Rett exosomes retain some functions, but their neural specific functions are lacking.
However, the most important question was still nagging us. Could treatment with normal control exosomes rescue deficits in Rett Syndrome neural cultures? After an onerous journey of problem solving and establishment of assays, we successfully demonstrated that treatment of Rett neural cultures with normal control exosomes could increase neuron number, boost the number of synapses, and make neurons fire in a more synchronized way. Importantly, exosome treatment showed improvements at the cellular, synaptic, and functional level.
While a very exciting result, we wanted to take this a step further into live animals. So we took healthy exosomes and injected them into the brain of developing mice and monitored neuronal proliferation in hippocampus, a brain area important for learning and memory. Exosome injections led to a remarkable boost in neuronal proliferation in hippocampus, just like human in vitro disease models. This showed that if delivered to the brain in live animals, the exosomes can deliver the promised bioactivity.
I belive exosomes have immense therapeutic potential as they have inherent advantages. Unlike stem cells, there is no possibility that they can go rogue and form tumors. Importantly, exosomes do not elicit an immunune response when injected into the patient. Exosomes can be sourced from cultured neurons made from the patient’s own cells, providing personalized medicine.
Neural exosomes are thought to contain signals that guide the exosome to the brain. They can be loaded with any therapeutic drugs or molecules developed for Rett Syndrome and delivered to the brain. Our future work will focus on optimizing exosomes for specific and efficient delivery to the brain; finding the least invasive way of delivering exosomes to the brain; and showing that exosomes can be used to rescue disease in a mouse model of Rett Syndrome.
Acknowledgements: This symphony would have been impossible without our musical ensemble of Hollis T. Cline, Alysson R. Muotri, John R. Yates III, Pinar Mesci, Cassiano Carromeu, Daniel B. McClatchy and Lucio Schiapparelli. I sincerely thank Monica Coenraads for help in providing better voice to my words.
This blog originated as a press release from the University of Sussex.
New research by scientists at the University of Sussex could be the first step towards developing a blood test to diagnose the most aggressive type of brain tumour, known as Glioblastoma.
A team from Professor Georgios Giamas’ lab at the University of Sussex has identified novel biomarkers within bodily fluids, which signal the presence of the tumour. Dr. Giamas is Professor of Cancer Cell Signalling in the School of Life Sciences.
Cancer biomarkers are molecules that are either exclusively found or over-expressed in cancer cells, as compared to ‘normal’, healthy cells. Biomarkers can be considered as biological signatures for a disease, as they indicate the presence of cancer in the body.
In a new paper published in the Nature journal Communications Biology, Professor Giamas and his team describe particular biomarkers that are associated with extracellular vesicles – small ’packages’ released by cells into bodily fluids so cells can communicate with each other.
The discovery suggests that bodily fluids like blood could be a simpler way to test for glioblastoma, rather than a biopsy, which is both invasive and painful for the patient as well as taking considerable time to get the results.
Giamas said, “At the moment, the outlook for glioblastoma patients is bleak. As the most aggressive type of brain tumour, survival rate is low.
“Our research provides more information about the markers which can signal the presence of glioblastoma – and the fact we’ve been able to identify ones that are associated with extracellular vesicles suggests that there could be a way to use bodily fluids to test for the tumour in future.”
Currently, a growing body of research is looking into the possibility of developing liquid biopsies like blood tests to spot other types of cancers (e.g. pancreatic). Rather than taking a piece of tissue from the relevant organ, liquid biopsies would allow doctors to take a small sample of blood and test for a range of biomarkers which will help identify the subtype of tumour.
Dr Thomas Simon, co-author of this study, highlighted that: “Liquid biopsies mean a less invasive procedure for patients, and arguably quicker results – something which is invaluable for those with an aggressive tumour that severely cuts life expectancy.
“But it could also mean better patient follow-up care, as a simple test can be carried out to check for the efficacy of existing treatments or for monitoring relapse.
“The more we know about biomarkers the better, so this is a step which should provide hope for anyone whose lives have been impacted by glioblastoma.”
There are three sub-types of glioblastoma which all have biomarkers containing different information. The more researchers find out about these signatures, the more work can be done to improve the accuracy of diagnosis and to personalise treatment depending on the sub-type of cancer.
Rosemary Lane, a PhD student in Professor Giamas’ lab and co-author of the study, added: “Glioblastoma subtyping is crucial for patient prognosis and personalised therapies. The fact that we can identify these molecular differences in extracellular vesicles is very exciting and will be of huge importance for discovering new biomarkers in the future.”
Marian Vintu, a neurosurgeon and co-author, said: “Clinical research in brain cancer is such a powerful tool to expand our knowledge in this terrible disease and improve our patient’s outcome.”
The next step for Professor Giamas’ team will be to test and validate the presence of these newly described biomarkers in glioblastoma patients.
The research, funded by the charity Action Against Cancer, suggests that this technique could ultimately become an option for diagnosing glioblastoma.