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A comparison of the glycolytic rate as determined by positron emission tomography (PET) with 18F-deoxyglucose (FDG) and cerebral contrast computed tomography (CT) was carried out in 72 cases of cerebral glioma. FDG-PET is more accurate than contrast CT in predicting tumor grade.

Human glioma-derived cell lines previously determined by a microtiter chemotherapy assay to be either 'sensitive' or 'resistant' to 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) were treated with BCNU (1-80 micrograms/ml) and observed using microcinematography, scanning electron microscopy, and transmission electron microscopy. Striking bleb formation and cell retraction were observed to occur in a dose-dependent relationship within minutes in the cells known to be BCNU-sensitive. At 15 micrograms/ml, 69% of cells showed blebs by 30 min, 87% by 90 min, and 100% by 4 hr. This activity was not seen in BCNU-resistant cells. These morphological changes occur at a time too early to be accounted for by the known BCNU mechanism of DNA alkylation and cross-link formation and suggest that cytoplasmic and/or membrane events may be significant initial events in the cytotoxic actions of BCNU.

Using both immunohistochemical and immunoelectron microscopic techniques with periodatelysine-paraformaldehyde (PLP) fixation, we have studied the distribution of Factor VIII-related antigen (F VIII R: Ag) in 14 cases of human central nervous system (CNS) tumors and 1 sample of non-tumor brain tissue. F VIII R: Ag was localized to the vascular lumen, to the intercellular spaces between endothelial cells (apparently without tight junctions), and to the endothelial cell basement membrane. In the cytoplasm, F VIII R: Ag was found in the endoplasmic reticulum, perinuclear space, and intracytoplasmic vacuoles and vesicles only. Characteristic of malignant tumors (6 out of 7) was strongly-positive dilated endoplasmic reticulum, whereas only 1 of 5 benign tumors showed such staining. This appears to reflect increased F VIII R: Ag synthesis in the malignant vessels. The non-tumor brain tissue showed normal capillary structure and very little F VIII R: Ag immunoreactivity. Six of 12 tumors and the non-tumor brain showed perinuclear F VIII R: Ag. Although the basement membranes were more irregular in the malignant tumors, staining was not grossly different from that of the more benign lesions. The finding of both ad-and ablumial vesicles containing F VIII R: Ag suggests that endocytosis, transcellular transport, and/or exocytosis, as well as F VIII R: Ag synthesis, occurs in the tumor endothelial cells. The relationship of these F VIII R: Ag abnormalities to the hypercoagulable state seen in some malignant brain tumor patients remains to be clarified.

Using both immunohisto- and immunocytochemical techniques with periodate-lysine-paraformaldehyde (PLP) fixation, we have studied the distribution of Factor VIII-related antigen (FVIIIR:Ag) in 12 cases of tumors of the human central nervous system (CNS) and one sample of non-tumor brain tissue. FVIIIR:Ag was found both extracellularly and intracellularly. It was localized in the vascular lumen, between endothelial cells, and in the endothelial cell basement membrane. In the endothelial cell cytoplasm, FVIIIR:Ag was found in the endoplasmic reticulum, perinuclear space, and in intracytoplasmic vacuoles and vesicles. Characteristic of malignant tumors (six out of seven) was a strongly-positive dilated endoplasmic reticulum. This may reflect increased FVIIIR:Ag synthesis in the endothelial cells of malignant tumors. Only one of five benign tumors showed such staining. Six of 12 tumors and the non-tumor brain showed perinuclear FVIIIR:Ag. Both ad- and abluminal vesicles in the tumor endothelial cells contained FVIIIR:Ag suggesting that endocytosis, transcellular transport, and/or endocytosis, as well as FVIIIR:Ag synthesis occurs. The non-tumor brain showed normal capillary structure and very little FVIIIR:Ag immunoreactivity. The relationship of these FVIIIR:Ag abnormalities to the hypercoagulable state seen in some malignant brain tumor patients remains to be clarified.

2,5-Diaziridinyl-3,6-bis(carboethoxyamino)-1,4-benzoquinone (AZQ; Diaziquone, NSC 182986) is a rationally designed antitumor drug possessing sufficient lipid solubility to allow penetration into the central nervous system. Thirty-one patients with high-grade glioma and progressive disease following radiation, with or without previous chemotherapy, have been treated with 144 cycles of drug, consisting of 20 mg/sq m given as an i.v. infusion on Days 1 and 8 of a 28-day cycle. Responses were measured by serial computer tomography scanning. Of the 28 evaluable patients, 6 (21%) had limited improvement (10 to 40% reduction in tumor size) on computer tomography scan, 10 (36%) had disease stabilization, and 12 (43%) had progressive disease. The drug was well tolerated clinically, with little acute toxicity. The major toxicity was myelosuppression, which appeared cumulative, using this dose regimen. AZQ was measurable in both tumor tissue and tumor cyst fluid in patients on therapy. Plasma samples taken during the period of infusion confirm that 50% or more of the total AZQ exposure occurs during the infusion period. AZQ behaves as intended by design and demonstrates activity in this poor-prognosis group of patients.

Positron emission tomography was used to measure local cerebral glucose utilization by the 1-[18F]fluoro-2-deoxy-D-glucose technique in 23 patients with cerebral gliomas. All 10 high-grade (III and IV) astrocytomas demonstrated a region of high activity with a glucose consumption of 7.4 +/- 3.5 (SD) mg/100 gm per minute. The 13 low-grade (I and II) gliomas had a glucose metabolic rate of 4.0 +/- 1.8 mg/100 gm per minute, with no distinctly visible hot spot. Thus, we found a correlation between rate of glycolysis and malignancy in primary cerebral tumors. Cerebral cortical glucose utilization was often depressed in areas adjacent to or neurally connected to the tumor site, and there was focal irregular delta wave EEG activity in these areas.

Five patients who had undergone radiation therapy for cerebral tumors and whose conditions were deteriorating were examined by means of positron emission tomography (PET) with [18F] fluorodeoxyglucose. All five cases had similar clinical and computed tomographic findings. Using the PET technique the two cases of radiation necrosis were distinguished from the three recurrent tumors. In the two cases of radiation necrosis the rate of glucose utilization in the lesion was markedly reduced compared with the normal brain parenchyma. In the recurrent gliomas, however, the glucose metabolic rate was elevated. All five diagnoses were confirmed by biopsy or autopsy.

Five human cell lines cultured from high- and low-grade astrocytomas in cerebral hemisphere have been analyzed for DNA and protein distribution by flowcytometric (FCM) and correlated with cytogenetic profiles. Simultaneous calibration with chicken erythrocytes as a co-running standard provided an estimate of chromosomal number of predominate stem cells of each cell line by the ratio of the DNA content of the major peak (G1) to that of chicken erythrocyte (T/E ratio) of FCM. Various lines had different distributions of chromosomal number, ranging from near diploid to tetraploid. Each line had a stem-cell population and chromosomal markers indicative of clonal selection, but no common marker specific to astrocytomas. The histogram of DNA distribution obtained by FCM correlated well with the chromosomal distribution by cytogenetic analysis. In addition, simultaneous measurement of protein and DNA content in multidimensional FCM demonstrated a sigmoid configuration of the profiles, which indicated a gradual increase of protein content associated with an increase of chromosomal number or with progression of cell cycle. To avoid confusion of a bimodal chromosomal distribution with the G2/M phase of the cell cycle, and to determine chromosomal numbers associated with a DNA histogram, simultaneous cytogenetic and FCM study are required. More rapid than cytogenetic analysis, the T/E ratio allows estimation of chromosomal number of the stem-cell population associated with DNA histograms of cultured glioma-derived cell lines.

Authors have studied the ultrastructure of endothelial cells in the microvessels of malignant and benign gliomas and in particular, the numbers of tubular bodies (Weibel-Palade) in endothelial cells of glioma microvessels in related with blood vessel proliferation. Glioblastoma 6, astrocytoma grade II 1, oligodendroglioma 1 and 2 samples of non-tumor brain tissue were analyzed quantitatively using light and electron microscope with Karnovski fixative. All tissues were obtained from the center, the intermediate and the margin in each tumor tissue and just outside of the tumor at operation. 389 microvessels were examined in the total gliomas electronmicroscopically. Tubular body was first described by Weibel and Palade in the vascular endothelial cells of various organs in both man and animals. This is now considered to be an organelle specific to the endothelial cell, but its function is still unknown. Tubular body observed in the endothelial cells of the gliomas vessels consisted of a membrane-limited round, oval or elongated shaped intra cytoplasmic body (about 0.1-0.2 micron) which contained tubules of 150-200 A outer diameter. Tubular bodies were classified in the two types. One of them (mature type) was relatively electron dense to be more compact, the other (immature type) had relatively pale matrix. In the immature type they are located in close proximity to the Golgi complex or endoplasmic reticulum.(ABSTRACT TRUNCATED AT 250 WORDS)

Cell strains derived by culture of malignant glioma (astrocytoma grade III-IV) surgical specimens were tested for the production of DNA interstrand cross-links (ISC) and DNA-protein cross-links following treatment in vitro with 1-(2-chloroethyl)-1-nitrosourea, 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU, carmustine), 1-(2-chloroethyl)-3-(2,6-dioxo-1-piperidyl)-1-nitrosourea (PCNU), cis-dichlorodiammineplatinum(II) (cisplatin), and 3,6-diaziridinyl-2,5-bis(carboethoxyamino)-1,4-benzoquinone (diaziquone). ISC and DNA-protein crosslinks were measured by means of the DNA alkaline elution technique. Large differences among the cell strains were observed in DNA cross-linking responses to individual agents. The DNA responses to the chloroethylnitrosoureas, cisplatin, and diaziquone were largely independent of each other, except for a weak correlation between ISC responses to chloroethylnitrosoureas were distributed bimodally, in accord with a phenotypic distinction between Mer+ and Mer- cells. ISC responses to cisplatin and diaziquone showed significant variation among cell strains, but the distributions were not bimodal. The results demonstrate the existence of diverse DNA cross-linking response patterns among cell strains from different tumors of a given histological type.

Many glioma-derived cell lines have the capability of escaping cell-mediated immune attack. One mechanism of escape is the secretion of a hyaluronidase-sensitive mucopolysaccharide coat by these cells. This coat prevents contact and tumor cell killing by specific cytolytic allogeneic lymphocytes. The production of the coat by the tumor cells is stimulated by a macromolecular factor released by peripheral blood mononuclear (PBMC) cells in culture. We have examined the morphologic and ultrastructural features of this extracellular matrix. Three coat-producing lines were studied. Under phase contrast light microscopy, the coat is a clear pericellular 'halo'. To stain this zone, ruthenium red and Alcian Blue 8 G stains, which bind to acid mucopolysaccharides (to a large extent, hyaluronic acid), were used. The two stains produced similar results. With light microscopy, a weblike pattern of stain was evident throughout the halo region. With transmission electron microscopy, staining was found along the plasma membrane of the glioma cells and their microvilli, stretching in long, branching filaments from these surfaces and, in some instances, from one microvillus to the next. Since mucopolysaccharide matrices have a large aqueous component, it was necessary to determine whether dehydration alters the stain pattern. Therefore, undehydrated ruthenium red stained specimens from each culture were embedded in Quetal 651 (Ted Pella, Inc., Tustin, CA), a water soluble plastic. No morphologic differences were noted between the hydrated and dehydrated specimens. This study indicates that numerous long microvilli and a secreted mucopolysaccharide matrix are important structural elements of the lymphocyte-stimulated tumor cell halo in vitro. The mechanism by which the PBMC factor stimulates coat formation and the importance of the coat in in vivo tumor defenses remain to be elucidated.

Fibronectin, a large molecular weight glycoprotein normally found on the surface of many cells, was measured in the plasma of 15 normal volunteers and 75 patients with various kinds of brain tumors or other kinds of neurological disorders. The mean plasma fibronectin in the control group was 253 micrograms/ml. Statistically significant elevations in fibronectin levels were found in patients with progressive high grade astrocytomas (mean = 413 micrograms/ml). The majority of patients with high grade astrocytomas in remission had normal levels of fibronectin (mean = 273 micrograms/ml). Elevations were noted in patients with low grade astrocytomas, meningiomas, and benign nonneoplastic neurological disorders. Plasma fibronectin may be useful diagnostically and therapeutically in identifying and managing some patients with high grade gliomas. However, of greater importance is the observation that fibronectin elevation is the result of a tumor-host interaction.

The potential use of bromodeoxyuridine (BUdR) as a radiosensitizer given by an intermittent intravenous route is being studied in a Phase I/II trial at the National Cancer Institute. In order to assess the extent of radiosensitization, we have studied the radiation response of human bone marrow cells CFUc taken from 6 patients prior to and after a 14-day infusion of BUdR. Varying concentrations (1000-1500 mg) of BUdR were infused for 12 hours every 24 hours for up to 14 consecutive days. Cell survival was determined by colony formation of CFUc in soft agar suspension. X ray survival curves were generated over a dose range of 0-300 rad and the slopes of the survival curves (DO) before and after BUdR infusion were compared. Radiation enhancement ratios (ER) (DO pre-BUdR/DO post-BUdR) ranged from 1.0-2.2 and appeared to be BUdR dose dependent. Above 650 mg/m2, the radiation ER was greater than or equal to 1.5. Dose dependent systemic toxicity to bone marrow and skin was also observed with intermittent intravenous infusions of BUdR. From our study, it appears that an intravenous dose of less than 700 mg/m2/12 hours is well tolerated and may result in radiosensitization of CFUc in man.

The serologic responses of 42 patients with gliomas have been evaluated in a quantitative microcytotoxicity assay utilizing autologous cultured glioma cells. Forty-five percent of patients had detectable cytotoxic antibody apparently directed to their own cultured cells. When tumor grade was correlated with immune response, 15/20 patients with Grade I, II and III astrocytomas had antigens detectable in autologous sera whereas only 5/22 patients with Grade IV astrocytomas had such responses. None of the autologous fibroblasts from the 15 patients with paired gliomas and fibroblast lines had membrane antigens detectable using autologous sera and fibroblast absorption did not reduce antiglioma activity. Thus, the cytotoxicity observed in this assay appears to be restricted to tumor cells, suggesting reactivity against tumor-associated antigen. In addition, it appears that these immune responses are highly correlated with survival in primary malignant brain tumor patients.

This report presents the results of a study using multiple techniques of the established human cell line, LM, which has been developed in culture medium from a patient with a right temporoparietal glioblastoma. This cell line has human subtetraploid karyotype and has several features of a transformed line in culture. These include continuous propagation for 10 years, ability to form tumor nodules when transplanted into immunologically suppressed hamsters, and pleomorphic appearance. Ultrastructurally, it is characterized by multiple nuclei, few actin cables, and numerous surface-membrane microvilli, as well as abundant 9- to 10-nm cytoplasmic filaments. By its immunological reactivity, the line can be shown to contain glial fibrillary acidic protein at low levels, consistent with its glial origin and continued nature. Dibutyryl cyclic adenosine monophosphate (db-cAMP) induces formation of long astrocytic-like processes as well. Its membrane electrical characteristics include a low resting membrane potential and short time constant. Used in a microtiter antiglioma antibody cytotoxicity assay, LM yields a positive reaction to antibodies in the sera of 80% of patients with astrocytomas and only 9% of normal blood-bank donors, suggesting that it shares common antigens with other astrocytic tumor lines. The varied characteristics of this glioblastoma-derived line emphasize the "multiforme" nature on the neoplasm and suggest that for characterization of any such line, multiple parameters are necessary to allow comparison with other long-term glioblastoma lines in the literature. The usefulness of the LM line in in vitro cell biological, immunological, chemotherapeutic, and radiobiological studies of gliomas makes such efforts very worthwhile.

In previous work reported from this laboratory we found that diphenylhydantoin (DPH) inhibited the growth of 7 of 10 tissue-cultured human astrocytoma cell lines in a microtiter system. In this report we describe significant growth inhibition by DPH of two murine astrocytoma tissue cultures and correlate these in vitro findings with the in vivo activity of DPH in rat subcutaneous and intracranial tumor models. In the in vivo studies, rats were inoculated either subcutaneously or intracranially with RT9 or C6 rat gliomas. DPH or placebo was injected intraperitoneally in doses ranging from 50 to 150 mg/kg daily for 15 days. The DPH-treated rats showed significantly slower rates of tumor growth than untreated rats (p less than 0.01) in both the subcutaneous and intracranial models. At sacrifice, the tumor volume of the rats with subcutaneous tumors treated with DPH (100 mg/kg daily) was 62% less than the tumor volume of the control rats. Also, the number of "clonogenic" cells and thus, indirectly, the number of actively dividing tumor cells was 54% less in the intracranial tumors of the DPH-treated rats. These findings indicate that DPH may be a potentially useful adjunctive agent in the clinical chemotherapy of astrocytic tumors. Furthermore, the data presented indicate that in vitro test results are predictive for in vivo effects, supporting the idea that tissue culture can be used to screen for the effectiveness of clinically used chemotherapeutic agents.

An in vitro microcytotoxicity assay was utilized to determine the sensitivity of 58 cultured human malignant gliomas to the chemotherapy agent 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU). Of 58 such tumors, 42 (72%) showed a statistically significant cytotoxic response to BCNU in this assay. For those responding tumor lines, the cytotoxic index ranged from 0.25 to 0.76, with most clustered at the 0.40 level. To determine the therapeutic predictive relevance of such microcytotoxicity testing, the clinical course of patients receiving postoperative radiation therapy plus two or more doses of nitrosourea chemotherapy, as well as two or more computerized tomographic scans, was evaluated. In the 14 patients meeting all these criteria, tumor size increased in all five patients whose tumors did not respond to BCNU in the microcytotoxicity test. Six of the nine patients whose tumors in culture showed significant sensitivity to BCNU in vitro showed a clear decrease in tumor size over periods ranging from 17 to 48 months. Tumors in two patients increased in size, and one remained unchanged over the interval studied. These data support the concept that in vitro microcytotoxicity testing can be predictive of clinical response. Further study of this correlation seems warranted.

Positron emission tomography (PET) scanning with [18F]-2-fluoro-2-deoxy-D-glucose (FDG) was used to study 59 patients with astrocytomas and three patients with other cerebral mass lesions. Suppression of gray-matter glucose utilization ranging from 8% to 64% (mean, 30%) was seen in 92% of cases. Three categories of suppression were apparent, with the greatest degrees of suppression occurring in edematous gray matter adjacent to mass lesions. Lesser degrees of suppression were noted in nonedematous structures (normal attenuation on computed tomographic scan) adjacent to the lesion. Significant suppression was also present in gray matter spatially remote from but functionally linked to the site of the lesion. This approach may become a useful tool for improved understanding of the clinical presentation of certain pathologic entities and for evaluation of disease progression and response to treatment.

Fifty-four patients with supratentorial tumor and one with brainstem tumor were examined with positron emission tomography (PET) using [18F]fluoro-deoxyglucose (FDG). Twenty-one of these cases had satisfactory studies of the cerebellum. Of these, 12 showed significant metabolic asymmetry between the two cerebellar hemispheres, with the rate of glucose utilization in the hemisphere contralateral to the cerebral tumor being 8-34% lower than on the ipsilateral side, as compared with a right-left asymmetry of only--1.6% +/- 2.1% standard deviation for a group of 5 normal subjects. In these 12 cases the tumor involved the sensorimotor cortex and/or the thalamus with varying degrees of hemiparesis being present. For the remaining 9 patients with no significant cerebellar metabolic asymmetry, the tumor involved regions other than the sensorimotor cortex, and unilateral motor dysfunction was not a prominent clinical feature. The correlation between cerebellar metabolic suppression and unilateral motor dysfunction observed in our cases appears to be due to impairment or interruption of the cortico-thalamo-ponto-olivo-cerebellar circuitry by either the tumor itself or by edema. These results illustrate the ability of FDG-PET scans to detect metabolic changes, not apparent on CT scans, in areas of the brain remote from the primary lesion.

We have examined the ability of cultured human glioma cells to elicit allogeneic cytolytic lymphocyte responses in vitro in order to delineate properties of glioma cells that may contribute to their ability to escape cellular immune attack. When glioma cells were cultured together with allogeneic peripheral blood mononuclear cells (PBMC) in mixed lymphocyte-tumor cultures (MLTC), it was observed that cells from eight of 12 glioma lines were surrounded by clear pericellular "halos," which appeared to impede contact between PBMC and the glioma cells. Enzymatic, histochemical, and immunochemical studies indicated that these halos represented glycosaminoglycan (GAG) coats that contained hyaluronic acid (HA) as a major constituent. Electron microscopic studies demonstrated the presence of many thin microvillous processes spanning the width of the halos. The presence of GAG coats around glioma cells in MLTC reduced the generation of cytolytic T lymphocytes specific for antigens on the glioma cells. Likewise, these cell coats decreased the lysis of glioma cells by cytolytic lymphocytes, once generated. The production of thick coats of GAG by glioma cells was induced by interaction of glioma cells with a nondialyzable factor produced by PBMC in culture. This factor did not cause glioma cells to release increased amounts of HA into the medium, but rather increased the production of HA that remained associated with the glioma cell surface. The formation of thick, protective GAG coats by glioma cells as a result of their interaction with the PBMC-derived factor constitutes a nonspecific suppressor mechanism that may contribute to the ability of this class of human solid tumors to evade cellular immune attack.