Visualizing reactive astrogliosis extends survival in glioblastoma patients
Ko, H. Y.; Chung, J.-I.; Kim, D.; Park, Y. M.; Jo, H. H.; Lee, S.; Kim, S. Y.; Kim, J.; Chun, J.-H.; Han, K.-S.; Lee, M.; Ju, Y.; Park, S. J.; Park, K. D.; Nam, M.-H.; Kim, S. H.; Chang, J. H.; Lee, C. J.; Yun, M.
Show abstract
Glioblastoma multiforme (GBM) is a devastating brain tumor with dismal prognosis of only 15-month survival regardless of surgical resection. Here, we report an advanced neuroimaging technique combining 11C-acetate PET and MRI (AcePET), visualizing the boundary beyond the MRI-defined tumor. Targeted biopsy of the regions with increased 11C-acetate uptake revealed the presence of reactive astrocytes with enhanced acetate-transporter MCT1, along with cancer stem cells. Reactive astrogliosis and MCT1-dependent 11C-acetate-uptake were recapitulated in U87MG-orthotopic models. Mechanistically, glycolytic tumor cells release excessive acetate causing reactive astrogliosis, leading to the release of aberrant astrocytic GABA and H2O2, which further down-regulate the neuronal glucose uptake through GLUT3. Clincally, AcePET-guided surgery allows complete tumor resection of infiltrating cancer stem cells and extends the overall survival of patients by 5.25 months compared to conventional MRI-guided surgery. We established a new concept of the metabolic interactions between GBM cells and neighboring neurons through reactive astrocytes and developed AcePET-guided surgery to fight against GBM.
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