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Therapeutic Opening of the Blood-Brain Barrier in Man

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Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 103))

Abstract

The blood-brain barrier (BBB) continues to interest neuroscientists, and is studied widely in a number of animal models and disease states. The breakdown of the BBB as a consequence of disease or injury is also studied extensively in animals and humans. However, the idea of transiently opening the BBB in a controlled fashion for the purpose of achieving increased drug permeability across the barrier is a relatively new concept. To adapt these techniques to the clinical setting has been considered desirable for improved treatment of central nervous system (CNS) disease, and recent progress has made this possible.

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Abbreviations

ACNU:

3-[(4-Amino-2-methyl-5-pyrimidinyl)methyl]-1-(2-chloroethyl)-1-nitrosourea

BBB:

Blood-brain barrier

BCNU:

1,3-bis(2-chloroethyl)-1-nitrosourea

CNS:

Central nervous system

CT:

Computerized tomography

DTPA:

Diethylenetriaminepentaacetic acid

FDA:

Federal Drug Agency

ICP:

Intracranial pressure

Ig:

Immunoglobulin

MAb:

Monoclonal antibody

MRI:

Magnetic resonance imaging

PET:

Positron emission tomography

PFI:

Progression-free interval

SPECT:

Single photon emission computerized tomography

VER:

Visual evoked response

References

  • Beaumier PL, Neuzil D, Yang HM et al. (1986) Immunoreactivity assay for labeled antimelanoma monclonal antibodies. J Nucl Med 27:824–828

    PubMed  CAS  Google Scholar 

  • Blasberg RG, Patlak C, Fenstermacher JD (1985) Intrathecal chemotherapy: brain tissue profiles after ventriculocisternal perfusion. J Pharmacol Exp Ther 195: 73–83

    Google Scholar 

  • Bonstelle CT, Kori SH, Rekate H (1983) Intracarotid chemotherapy of glioblastoma after induced blood-brain barrier disruption. AJNR 4:810–812

    PubMed  CAS  Google Scholar 

  • Chamberlain MC, Murovic JA, Levin VA (1988) Absence of contrast enhancement on CT brain scans of patients with supratentorial malignant gliomas. Neurology 28:1371–1374

    Google Scholar 

  • Chiras J, Dormont D, Fauchon F, Debussche C, Bories J (1988) Intra-arterial chemotherapy of malignant gliomas. J Neuroradiol 15:31–48

    PubMed  CAS  Google Scholar 

  • Ervin T, C’anellos GP (1980) Successful treatment of recurrent primary central nervous system lymphoma with high-dose methotrexate. Cancer 45:1556–1557

    Article  PubMed  CAS  Google Scholar 

  • Fauchon F, Chiras J, Poisson M, Rose M, Terrier L, Bories J, Guerin RA (1986) Intra-arterial chemotherapy by cisplatin and cytarabine after temporary disruption of the blood-brain barrier for the treatment of malignant gliomas in adults. J Neuroradiol 13:151–162

    PubMed  CAS  Google Scholar 

  • Groothuis DR, Molnar P, Blasberg RG (1984) Regional blood flow and blood-to-tissue transport in five brain tumor models. Prog Exp Tumor Res 27:132–153

    PubMed  CAS  Google Scholar 

  • Gumerlock MK, Neuwelt EA (1987) Principles of chemotherapy in brain neoplasia. In: Jellinger K (ed) Therapy of malignant brain tumors. Springer, Berlin Heidelberg New York, pp 277–348

    Google Scholar 

  • Gumerlock MK, Belshe BD, Madsen R, Watts C (1992) Osmotic blood-brain barrier disruption and chemotherapy in the treatment of high grade malignant glioma: patient series and literature review. J Neurooncol 12:33–46

    Article  PubMed  CAS  Google Scholar 

  • Heimberger K, Samec P, Podreka I, Binder H, Suess E, Reisner T, Deecke L, Steger G, Hiesmayr M, Dittrich C, Horaczek A, Zimpfer M (1987) Reversible opening of the blood-brain barrier in the chemotherapy of malignant gliomas (in German) Wien Klin Wochenschr 99:385–388

    PubMed  CAS  Google Scholar 

  • Hiesmayr M, Dirnberger H, Aloy A, Heimberger K, Horaczek A, Brandstatter B, Zimpfer M (1987) Hemodynamic effects of an osmotic bolus for the reversible opening of the blood-brain barrier (in German). Schweiz Med Wochenschr 117:450–454

    PubMed  CAS  Google Scholar 

  • Hildebrand J (1986) Radiotherapy and chemotherapy of malignant brain gliomas. Drugs Clin Res 12:167–175

    CAS  Google Scholar 

  • Houghton AN, Mintzer D, Cordon-Cardo C et al. (1985) Mouse monoclonal I3 antibody detecting GD3 ganglioside: a phase I trial in patients with malignant melanoma. Proc Natl Acad Sci USA 82:1242–1246

    Article  PubMed  CAS  Google Scholar 

  • Johnson DW, Parkinson D, Wolpert SM, Kasdon D, Kwan ES, Laucella M, Anderson ML (1987) Intracarotid chemotherapy with 1,3-Bis-(2-chloroethyl)-1- nitrosourea (BCNU) in 5% dextrose in water in the treatment of malignant glioma. Neurosurgery 20:577–583

    Article  PubMed  CAS  Google Scholar 

  • Li V, Levin AB, Turski P (1988) Intra-arterial chemotherapy following blood-brain barrier disruption in patients with recurrent high grade astrocytomas (abstract). Proc Am Ass Neurol Surg 274:404

    Google Scholar 

  • Markowsky SJ, Zimmerman CL, Tholl D, Soria I, Castillo R (1991) Methotrexate disposition following disruption of the blood-brain barrier. Ther Drug Monit 13:24–31

    Article  PubMed  CAS  Google Scholar 

  • Millay RH, Klein ML, Shults WT, Dahlborg SA, Neuwelt EA (1986) Maculopathy associated with combination chemotherapy and osmotic opening of the blood- brain barrier. Am J Ophthmol 102:626–632

    CAS  Google Scholar 

  • Miller DF, Bay JW, Lederman RJ, Purvis JD, Rogers LR, Tomsak RL (1985) Ocular and orbital toxicity following intracarotid injection of BCNU (carmustine) and cisplatinum for malignant gliomas. Ophthalmology 92:402–406

    PubMed  CAS  Google Scholar 

  • Miyagami M, Kagawa Y, Tusbokawa T (1985) ACNU delivery to malignant glioma tissue by osmotic blood brain barrier modification with intracarotid infusion of hyperosmolar mannitol. No Shinkei Geka 13:955–963

    PubMed  CAS  Google Scholar 

  • Miyagami M, Tsubokawa T, Tazoe M, Kagawa Y (1990) Intra-arterial ACNU chemotherapy employing 20% mannitol osmotic blood-brain barrier disruption for malignant brain tumors. Neurol Med Chir (Tokyo) 30:582–590

    Article  CAS  Google Scholar 

  • Neuwelt EA, Dahlborg SA (1987) Chemotherapy administered in conjunction with osmotic blood-brain barrier modification in patients with brain metastases. J Neurooncol 4:195–207

    Article  PubMed  CAS  Google Scholar 

  • Neuwelt EA, Dahlborg SA (1989) Blood-brain barrier disruption in the treatment of brain tumors: Clinical implications. In: Neuwelt EA (ed) Implications of the blood-brain barrier and its manipulation, vol 2. Plenum, New York, pp 195–261

    Chapter  Google Scholar 

  • Neuwelt EA, Frenkel EP, Diehl JT et al (1980) Reversible osmotic blood-brain barrier disruption in humans: implications for chemotherapy of malignant brain tumors. Neurosurgery 7:44–52

    Article  PubMed  CAS  Google Scholar 

  • Neuwelt EA, Glasberg M, Diehl J, Frenkel EP, Barnett P (1981) Osmotic blood- brain barrier disruption the posterior fossa of the dog. J Neurosurg 55:742–748

    Article  PubMed  CAS  Google Scholar 

  • Neuwelt EA, Specht HD, Howieson J (1983) Osmotic blood-brain barrier modification: clinical documentation by enhanced CT scanning and/or radionuclide brain scanning. AJNR 4:907–913

    Google Scholar 

  • Neuwelt EA, Barnett PA, Frenkel EP (1984) Chemotherapeutic agent permeability to normal brain and delivery to avian sarcoma virus-induced brain tumors in the rodent: observations on problems of drug delivery. Neurosurgery 14:154–159

    Article  PubMed  CAS  Google Scholar 

  • Neuwelt EA, Frenkel E, d’Agostino AN (1985) Growth of human lung tumor in the brain of the nude rat as a model to evaluate antitumor agent delivery across the blood-brain barrier. Cancer Res 45:2827–2833

    PubMed  CAS  Google Scholar 

  • Neuwelt EA, Frenkel EP, Gumerlock MK, Braziel R, Dana B, Hill SA (1986a) Developments in the diagnosis and treatment of primary CNS lymphoma: a prospective series. Cancer 58:1609–1620

    Article  PubMed  CAS  Google Scholar 

  • Neuwelt EA, Howieson J, Frenkel EP, Specht HD, Weigel R, Buchan CG, Hill SA (1986b) Therapeutic efficacy of multiagent chemotherapy with drug delivery enhancement by blood-brain barrier modification in glioblastoma. Neurosurgery 19:573–582

    Article  PubMed  CAS  Google Scholar 

  • Neuwelt EA, Specht HD, Larson S et al. (1987) Increased delivery of tumor-specific monoclonal antibodies to brain after osmotic blood-brain barrier modification in patients with melanomaa metastatic to the central nervous system. Neurosurgery 20:885–895

    Article  PubMed  CAS  Google Scholar 

  • Neuwelt EA, Enzmann DR, Pagel MA, Miller G (1989) Bacterial and fungal brain abscess and the blood-brain barrier. In: Neuwelt EA (ed) Implications of the blood-brain barrier and its manipulation, vol 2. Plenum, New York, pp 263–305

    Chapter  Google Scholar 

  • Neuwelt EA, Goldman DL, Dahlborg SA, Crossen J, Ramsey F, Roman-Goldstein S, Braziel R, Dana B (1991) Primary central nervous system lymphoma treated with osmotic blood-brain barrier disruption: prolonged survival and preservation of cognitive function. J Clin Oncol 9:1580–1590

    PubMed  CAS  Google Scholar 

  • Phillips JP, Alderson T, Sikora K et al. (1983) Localization of malignant glioma by a radiolabeled human monoclonal antibody. J Neurosurg 46:388–392

    CAS  Google Scholar 

  • Roman-Goldstein SM, Barnett PA, Mormick CI, Ball MJ, Ramsey F, Neuwelt EA (1991) Imaging and toxicity of gadopentate dimeglumine administered after osmotic blood-brain barrier disruption. AJNR 12:885–890

    PubMed  CAS  Google Scholar 

  • Runge VM, Price AC, Wehr CJ, Atkinson JB, Tweedle MF (1985) Contrast enhanced MRI evaluation of a canine model of osmotic blood-brain barrier disruption. Invest Radiol 20:830–844

    Article  PubMed  CAS  Google Scholar 

  • Sato S, Toya S, Otani M (1985a) Barrier opening microcirculation in human brain tumor. No To Shinkei 37:109–113

    PubMed  CAS  Google Scholar 

  • Sato S, Yoshinori A, Kodama R, Fujioka M, Otani M, Inoue H, Toya S (1985b) Blood-brain barrier opening CT. Prog Comput Tomogr 7:43–48

    Google Scholar 

  • Schag CC, Heinrich RL, Ganz PA (1984) Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol 2:187–193

    PubMed  CAS  Google Scholar 

  • Stewart DJ, Grahovak Z, Maroun J et al. (1985) Intraarterial chemotherapy for brain tumors. Proc Am Soc Clin Oncol 4:C513

    Google Scholar 

  • Suda K, Nakasu S, Saito A (1985) Ocular complication of combined intracarotid chemotherapy and osmotic blood-brain barrier disruption. Nippon Geka Hokan 54:359–363

    PubMed  CAS  Google Scholar 

  • Williams WT, Lowry RL, Eggers GWN (1986) Anesthetic management during therapeutic disruption of the blood-brain barrier. Anesth Analg 65:188–190

    PubMed  CAS  Google Scholar 

  • Yamada K, Takahama H, Nakai O, Takanashi T, Hosoya T (1989) Intra-arterial chemotherapy for malignant glioma after osmotic blood-brain barrier disruption. Gan To Kagaku Ryoho 16:2692–2696

    PubMed  CAS  Google Scholar 

  • York D, Legan M, Benner S, Watts C (1984) Further studies with a noninvasive method of intracranial pressure estimation. Neurosurgery 14:456–461

    Article  PubMed  CAS  Google Scholar 

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© 1992 Springer-Verlag Berlin Heidelberg

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Gumerlock, M.K., Neuwelt, E.A. (1992). Therapeutic Opening of the Blood-Brain Barrier in Man. In: Bradbury, M.W.B. (eds) Physiology and Pharmacology of the Blood-Brain Barrier. Handbook of Experimental Pharmacology, vol 103. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-76894-1_21

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  • DOI: https://doi.org/10.1007/978-3-642-76894-1_21

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-76896-5

  • Online ISBN: 978-3-642-76894-1

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