Real-time fMRI neurofeedback of the anterior insula using arterial spin labelling.

Arterial spin labelling (ASL) is the only non-invasive technique that allows absolute quantification of perfusion and is increasingly used in brain activation studies. Contrary to the blood oxygen level-dependent (BOLD) effect ASL measures the cerebral blood flow (CBF) directly. However, the ASL signal has a lower signal-to-noise ratio (SNR), than the BOLD signal, which constrains its utilization in neurofeedback studies. If successful, ASL neurofeedback can be used to aid in the rehabilitation of health conditions with impaired blood flow, for example, stroke. We provide the first ASL-based neurofeedback study incorporating a double-blind, sham-controlled design. A pseudo-continuous ASL (pCASL) approach with background suppression and 3D GRASE readout was combined with a real-time post-processing pipeline. The real-time pipeline allows to monitor the ASL signal and provides real-time feedback on the neural activity to the subject. In total 41 healthy adults (19-56 years) divided into three groups underwent a neurofeedback-based emotion imagery training of the left anterior insula. Two groups differing only in the explicitness level of instruction received real training and a third group received sham feedback. Only those participants receiving real feedback with explicit instruction showed significantly higher absolute CBF values in the trained region during neurofeedback than participants receiving sham feedback. However, responder analyses of percent signal change values show no differences in activation between the three groups. Persisting limitations, such as the lower SNR, confounding effects of arterial transit time and partial volume effects still impact negatively the implementation of ASL neurofeedback.

Fat tails and the need to disclose distribution parameters of qEEG databases.

Neurometry (a.k.a. quantitative EEG or qEEG) is a popular method to assess clinically relevant abnormalities in the electroencephalogram. Neurometry is based on norm values for the distribution of specific EEG parameters and believed to show good psychometric properties such as test-retest reliability. Many psychometric properties only hold under the Gaussian distribution and become problematic when distributions are fat-tailed. EEG signals are typically fat-tailed and do not show fast convergence to a Gaussian distribution. To circumvent this property of EEG, log-transformations have frequently, but not always been employed. In Monte Carlo simulations, we investigated the impact of fat-tails (i.e. deviations from Gaussian) on the cut-off criteria and changeability of what in neurometry is termed "abnormal EEG". Even slight deviations from the Gaussian distribution as measured by skewness and kurtosis lead to large inflation in the number of false positive qEEG findings. The more stringent the cutoff value adopted, the larger the inflation. Moreover, "abnormal EEG" seems to recover spontaneously at rates not compatible with the alleged test-retest reliability of qEEG. Alternative methods should be employed to determine cut-off values for diagnostics purposes, since a large number of false positive results emerge even when slight deviations from the Gaussian distribution are present. We argue that distribution properties of qEEG databases should be disclosed in much more detail by commercial providers to avoid questionable research practices and promote diagnostic transparency. We provide recommendations for the improvement of psychometric properties of existing qEEG databases.

An attempt to model the causal structure behind white matter aging and cognitive decline.

In this diffusion tension imaging study, voxel wise structural equation modeling was used to unravel the relation between white matter, cognition, and age. Four neurocognitive ageing models describing the interplay between age, white matter integrity, and cognition were investigated but only two models survived an Akaike information criterion-based model selection procedure. The independent factor model predicts that there is no relation between white matter integrity and cognition although both systems are affected by age. The cognitive mediation model predicts that the relation between age and white matter integrity is mediated through cognition. Roughly 60% of the observed voxels were in agreement with the independent factor model while 16% of the observed voxels were in agreement with the cognitive mediation model. Imaging results of the latter model suggest that the deterioration of fibers-that connect the two hemispheres with each other-is partly caused by an age-related decline in cognitive functioning.

Impaired Subcortical Detection of Auditory Changes in Schizophrenia but Not in Major Depression.

The mismatch negativity is a cortical response to auditory changes and its reduction is a consistent finding in schizophrenia. Recent evidence revealed that the human brain detects auditory changes already at subcortical stages of the auditory pathway. This finding, however, raises the question where in the auditory hierarchy the schizophrenic deficit first evolves and whether the well-known cortical deficit may be a consequence of dysfunction at lower hierarchical levels. Finally, it should be resolved whether mismatch profiles differ between schizophrenia and affective disorders which exhibit auditory processing deficits as well. We used functional magnetic resonance imaging to assess auditory mismatch processing in 29 patients with schizophrenia, 27 patients with major depression, and 31 healthy control subjects. Analysis included whole-brain activation, region of interest, path and connectivity analysis. In schizophrenia, mismatch deficits emerged at all stages of the auditory pathway including the inferior colliculus, thalamus, auditory, and prefrontal cortex. In depression, deficits were observed in the prefrontal cortex only. Path analysis revealed that activation deficits propagated from subcortical to cortical nodes in a feed-forward mechanism. Finally, both patient groups exhibited reduced connectivity along this processing stream. Auditory mismatch impairments in schizophrenia already manifest at the subcortical level. Moreover, subcortical deficits contribute to the well-known cortical deficits and show specificity for schizophrenia. In contrast, depression is associated with cortical dysfunction only. Hence, schizophrenia and major depression exhibit different neural profiles of sensory processing deficits. Our findings add to a converging body of evidence for brainstem and thalamic dysfunction as a hallmark of schizophrenia.

Expertise Modulates Students' Perception of Pain From a Self-Perspective: Quasi-Experimental Study.

BACKGROUND: Perception of stimuli presented in a virtual dentistry environment affects regions of the brain that are related to pain perception. OBJECTIVE: We investigated whether neural correlates of virtual pain perception are affected by education in dentistry. METHODS: In this functional magnetic resonance imaging study, a sample of 20 dental students and 20 age-matched controls viewed and listened to video clips presenting a dental treatment from the first-person perspective. An anxiety questionnaire was used to assess the level of dental anxiety. Neural correlates of pain perception were investigated through classic general linear model analysis and in-house classification methods. RESULTS: Dental students and naïve controls exhibited similar anxiety levels for invasive stimuli. Invasive dentistry scenes evoked a less affective component of pain in dental students compared with naïve controls (P<.001). Reduced affective pain perception went along with suppressed brain activity in pain matrix regions including the insula, anterior cingulate cortex, and basal ganglia. Furthermore, a substantial reduction of brain activity was observed in motor-related regions, particularly the supplementary motor area, premotor cortex, and basal ganglia. Within this context, a classifier analysis based on neural activity in the nucleus lentiformis could identify dental students and controls on the individual subject level in 85% of the cases (34 out of 40 participants, sensitivity=90%, specificity=80%). CONCLUSIONS: Virtual dental treatment activates pain-related brain regions in controls. By contrast, dental students suppress affective and motor-related aspects of pain. We speculate that dental students learn to control motoric aspects of pain perception during their education because it is a prerequisite for the professional manual treatment of patients. We discuss that a specific set of learning mechanisms might affect perceived self-efficacy of dental students, which in turn might reduce their affective component of pain perception.

On the homogeneity and heterogeneity of cortical thickness profiles in Homo sapiens sapiens.

Cortical thickness has been investigated since the beginning of the 20th century, but we do not know how similar the cortical thickness profiles among humans are. In this study, the local similarity of cortical thickness profiles was investigated using sliding window methods. Here, we show that approximately 5% of the cortical thickness profiles are similarly expressed among humans while 45% of the cortical thickness profiles show a high level of heterogeneity. Therefore, heterogeneity is the rule, not the exception. Cortical thickness profiles of somatosensory homunculi and the anterior insula are consistent among humans, while the cortical thickness profiles of the motor homunculus are more variable. Cortical thickness profiles of homunculi that code for muscle position and skin stimulation are highly similar among humans despite large differences in sex, education, and age. This finding suggests that the structure of these cortices remains well preserved over a lifetime. Our observations possibly relativize opinions on cortical plasticity.

Auditory mismatch impairments are characterized by core neural dysfunctions in schizophrenia.

Major theories on the neural basis of schizophrenic core symptoms highlight aberrant salience network activity (insula and anterior cingulate cortex), prefrontal hypoactivation, sensory processing deficits as well as an impaired connectivity between temporal and prefrontal cortices. The mismatch negativity is a potential biomarker of schizophrenia and its reduction might be a consequence of each of these mechanisms. In contrast to the previous electroencephalographic studies, functional magnetic resonance imaging may disentangle the involved brain networks at high spatial resolution and determine contributions from localized brain responses and functional connectivity to the schizophrenic impairments. Twenty-four patients and 24 matched control subjects underwent functional magnetic resonance imaging during an optimized auditory mismatch task. Haemodynamic responses and functional connectivity were compared between groups. These data sets further entered a diagnostic classification analysis to assess impairments on the individual patient level. In the control group, mismatch responses were detected in the auditory cortex, prefrontal cortex and the salience network (insula and anterior cingulate cortex). Furthermore, mismatch processing was associated with a deactivation of the visual system and the dorsal attention network indicating a shift of resources from the visual to the auditory domain. The patients exhibited reduced activation in all of the respective systems (right auditory cortex, prefrontal cortex, and the salience network) as well as reduced deactivation of the visual system and the dorsal attention network. Group differences were most prominent in the anterior cingulate cortex and adjacent prefrontal areas. The latter regions also exhibited a reduced functional connectivity with the auditory cortex in the patients. In the classification analysis, haemodynamic responses yielded a maximal accuracy of 83% based on four features; functional connectivity data performed similarly or worse for up to about 10 features. However, connectivity data yielded a better performance when including more than 10 features yielding up to 90% accuracy. Among others, the most discriminating features represented functional connections between the auditory cortex and the anterior cingulate cortex as well as adjacent prefrontal areas. Auditory mismatch impairments incorporate major neural dysfunctions in schizophrenia. Our data suggest synergistic effects of sensory processing deficits, aberrant salience attribution, prefrontal hypoactivation as well as a disrupted connectivity between temporal and prefrontal cortices. These deficits are associated with subsequent disturbances in modality-specific resource allocation. Capturing different schizophrenic core dysfunctions, functional magnetic resonance imaging during this optimized mismatch paradigm reveals processing impairments on the individual patient level, rendering it a potential biomarker of schizophrenia.

Diagnosing developmental dyscalculia on the basis of reliable single case FMRI methods: promises and limitations.

FMRI-studies are mostly based on a group study approach, either analyzing one group or comparing multiple groups, or on approaches that correlate brain activation with clinically relevant criteria or behavioral measures. In this study we investigate the potential of fMRI-techniques focusing on individual differences in brain activation within a test-retest reliability context. We employ a single-case analysis approach, which contrasts dyscalculic children with a control group of typically developing children. In a second step, a support-vector machine analysis and cluster analysis techniques served to investigate similarities in multivariate brain activation patterns. Children were confronted with a non-symbolic number comparison and a non-symbolic exact calculation task during fMRI acquisition. Conventional second level group comparison analysis only showed small differences around the angular gyrus bilaterally and the left parieto-occipital sulcus. Analyses based on single-case statistical procedures revealed that developmental dyscalculia is characterized by individual differences predominantly in visual processing areas. Dyscalculic children seemed to compensate for relative under-activation in the primary visual cortex through an upregulation in higher visual areas. However, overlap in deviant activation was low for the dyscalculic children, indicating that developmental dyscalculia is a disorder characterized by heterogeneous brain activation differences. Using support vector machine analysis and cluster analysis, we tried to group dyscalculic and typically developing children according to brain activation. Fronto-parietal systems seem to qualify for a distinction between the two groups. However, this was only effective when reliable brain activations of both tasks were employed simultaneously. Results suggest that deficits in number representation in the visual-parietal cortex get compensated for through finger related aspects of number representation in fronto-parietal cortex. We conclude that dyscalculic children show large individual differences in brain activation patterns. Nonetheless, the majority of dyscalculic children can be differentiated from controls employing brain activation patterns when appropriate methods are used.

Are reaction times obtained during fMRI scanning reliable and valid measures of behavior?

Assuming that behavior observed during functional magnetic resonance imaging (fMRI) is comparable with behavior outside the scanner appears to be a basic tenet in cognitive neuroscience. Nevertheless, this assumption has rarely been tested directly. Here, we examined the reliability and validity of speeded performance during fMRI scanning by having the same 30 participants perform a battery of five reaction time (RT) tasks in two separate fMRI sessions and a standard laboratory (i.e., outside-scanner) session. Medium-to-high intra-class correlations between the three sessions showed that individual RT differences were conserved across sessions. Thus, for the range of tasks used, test-retest reliability and criterion validity of performance during scanning were satisfactory. Further, the pattern of between-task relations did not change within the scanner, attesting to the construct validity of performance measurements during scanning. In some tasks, however, RTs obtained from fMRI conditions were significantly shorter than those observed under normal laboratory conditions. In summary, RTs obtained during fMRI scanning appear to be largely reliable and valid measures of behavior. The observed RT speed-up during scanning might reflect task-specific interactions with a slightly different neuro-cognitive state, indicating some limits to generalizing brain-behavior relations observed with fMRI. These findings encourage further efforts in fMRI research to establish the external validity of within-scanner task performance.

Intratumoural interleukin-2 therapy can induce regression of non-resectable mastocytoma in dogs.

AIM: Mast cell tumours (MCT) are common skin tumours in dogs. If complete surgical removal of the tumours is not possible, then another therapy is needed. In the current study we tested the therapeutic effect of intratumoural injection of interleukin-2 (IL-2). MATERIALS AND METHODS: Seven dogs had non-resectable cutaneous MCT. The tumours were injected with 4.5×10(6) IU IL-2. RESULTS: The early clinical effects in the seven dogs with cutaneous MCT were: complete regression (CR) in two dogs; partial regression (PR) in four, and stable disease (SD) in one dog. The final clinical effects were CR in three dogs, PR in two dogs, and PD in two dogs. CONCLUSION: This pilot study shows that intratumoural IL-2 application can exert an anti-MCT effect. A larger study would be required to precisely establish the magnitude of the therapeutic effect against MCT. A single application of IL-2 in cases of non-resectable MCT has no observable side-effects.

The role of finger representations and saccades for number processing: an FMRI study in children.

A possible functional role of finger representations for the development of early numerical cognition has been the subject of recent debate; however, until now, only behavioral studies have directly supported this view. Working from recent models of number processing, we focused on the neural networks involved in numerical tasks and their relationship to the areas underlying finger representations and saccades in children aged 6-12 years. We were able to differentiate three parietal circuits that were related to distinct aspects of number processing. Abstract magnitude processing was subserved by an association area also activated by saccades and visually guided finger movements. Addition processes led to activation in an area only engaged during saccade encoding, whereas counting processes resulted in the activation of an area only activated during visually guided finger movements, namely in the anterior intraparietal sulcus. Apart from this area, a large network of specifically finger-related brain areas including the ventral precentral sulcus, supplementary motor area, dorso-lateral prefrontal cortex, insula, thalamus, midbrain, and cerebellum was activated during (particularly non-symbolic) exact addition but not during magnitude comparison. Moreover, a finger-related activation cluster in the right ventral precentral sulcus was only present during non-symbolic addition and magnitude comparison, but not during symbolic number processing tasks. We conclude that finger counting may critically mediate the step from non-symbolic to symbolic and exact number processing via somatosensory integration processes and therefore represents an important example of embodied cognition.

Micro and macro pattern analyses of FMRI data support both early and late interaction of numerical and spatial information.

Numbers and space are two semantic primitives that interact with each other. Both recruit brain regions along the dorsal pathway, notably parietal cortex. This makes parietal cortex a candidate for the origin of numerical-spatial interaction. The underlying cognitive architecture of the interaction is still under scrutiny. Two classes of explanations can be distinguished. The early interaction approach assumes that numerical and spatial information are integrated into a single representation at a semantic level. A second approach postulates independent semantic representations. Only at the stage of response selection and preparation these two streams interact. In this study we used a numerical landmark task to identify the locus of the interaction between numbers and space. While lying in an MR scanner participants decided on the smaller of two numerical intervals in a visually presented number triplet. The spatial position of the middle number was varied; hence spatial intervals were congruent or incongruent with the numerical intervals. Responses in incongruent trials were slower and less accurate than in congruent trials. By combining across-vertex correlations (micro pattern) with a cluster analysis (macro pattern) we identified large-scale networks that were devoted to number processing, eye movements, and sensory-motor functions. Using support vector classification in different regions of interest along the intraparietal sulcus, the frontal eye fields, and supplementary motor area we were able to distinguish between congruent and incongruent trials in each of the networks. We suggest that the identified networks participate in the integration of numerical and spatial information and that the exclusive assumption of either an early or a late interaction between numerical and spatial information does not do justice to the complex interaction between both dimensions.

Sensitivity, reproducibility, and reliability of self-paced versus fixed stimulus presentation in an fMRI study on exact, non-symbolic arithmetic in typically developing children aged between 6 and 12 years.

Fixed stimulus presentation times pose several methodological problems for developmental functional magnetic resonance imaging (fMRI) studies that can be avoided by self-paced study designs. Yet, methodological issues of self-paced stimulus presentation for fMRI studies are largely understudied. Therefore, we compared sensitivity, reproducibility, and reliability of neural activation of a fixed and a self-paced design for an exact, non-symbolic addition paradigm in a sample of children aged 6-12 years. Both design types were comparable in sensitivity, and the self-paced design was superior in reproducibility and reliability. Therefore, self-paced study designs seem to be a valid option for developmental fMRI studies on higher cognition.

Histopathologic studies of the below-the-knee great saphenous vein after endovenous laser ablation.

BACKGROUND: There has been hesitation to use endovenous laser ablation (EVLA) for the treatment of incompetence of the below-the-knee great saphenous vein (GSV). OBJECTIVE: To assess early pathologic changes in the below-the-knee nonvaricose GSV and adjacent tissue after EVLA in legs scheduled for below-the-knee amputation. METHODS: The below-the-knee GSV in five patients was exposed to EVLA using 14-, 12-, and 10-watt laser power with continuous or intermittent laser exposure using a 600-nm core, bare tip fiber. Six segments (3 x 3 cm) of GSV with adjacent tissue were excised, examined histologically, and compared with non-laser-exposed parts of the vessel. RESULTS: Histologic evaluation revealed thermal damage of the intima and the internal part of the media. At the site of the laser tip, carbonization and necrosis was observed. Vascular perforation with subsequent perivascular bleeding was occasionally (<10%) seen in cases treated with 40 to 80 J/cm and in all cases treated with 110 to 200 J/cm. The saphenous nerve was not damaged. CONCLUSION: Based on this histopathologic study, acute thermal damage of the below-the-knee GSV after EVLA was limited to the intima and the inner third of the media. No acute damage of perivascular nerve tissue was observed.

Genetic contribution to variation in cognitive function: an FMRI study in twins.

Little is known about the genetic contribution to individual differences in neural networks subserving cognition function. In this functional magnetic resonance imaging (fMRI) twin study, we found a significant genetic influence on brain activation in neural networks supporting digit working memory tasks. Participants activating frontal-parietal networks responded faster than individuals relying more on language-related brain networks. There were genetic influences on brain activation in language-relevant brain circuits that were atypical for numerical working memory tasks as such. This suggests that differences in cognition might be related to brain activation patterns that differ qualitatively among individuals.

Local therapy of cancer with free IL-2.

This is a position paper about the therapeutic effects of locally applied free IL-2 in the treatment of cancer. Local therapy: IL-2 therapy of cancer was originally introduced as a systemic therapy. This therapy led to about 20% objective responses. Systemic therapy however was very toxic due to the vascular leakage syndrome. Nevertheless, this treatment was a break-through in cancer immunotherapy and stimulated some interesting questions: Supposing that the mechanism of IL-2 treatment is both proliferation and tumoricidal activity of the tumor infiltrating cells, then locally applied IL-2 should result in a much higher local IL-2 concentration than systemic IL-2 application. Consequently a greater beneficial effect could be expected after local IL-2 application (peritumoral = juxtatumoral, intratumoral, intra-arterial, intracavitary, or intratracheal = inhalation). Free IL-2: Many groups have tried to prepare a more effective IL-2 formulation than free IL-2. Examples are slow release systems, insertion of the IL-2 gene into a tumor cell causing prolonged IL-2 release. However, logistically free IL-2 is much easier to apply; hence we concentrated in this review and in most of our experiments on the use of free IL-2. Local therapy with free IL-2 may be effective against transplanted tumors in experimental animals, and against various spontaneous carcinomas, sarcomas, and melanoma in veterinary and human cancer patients. It may induce rejection of very large, metastasized tumor loads, for instance advanced clinical tumors. The effects of even a single IL-2 application may be impressive. Not each tumor or tumor type is sensitive to local IL-2 application. For instance transplanted EL4 lymphoma or TLX9 lymphoma were not sensitive in our hands. Also the extent of sensitivity differs: In Bovine Ocular Squamous Cell Carcinoma (BOSCC) often a complete regression is obtained, whereas with the Bovine Vulval Papilloma and Carcinoma Complex (BVPCC) mainly stable disease is attained. Analysis of the results of local IL-2 therapy in 288 cases of cancer in human patients shows that there were 27% Complete Regressions (CR), 23% Partial Regressions (PR), 18% Stable Disease (SD), and 32% Progressive Disease (PD). In all tumors analyzed, local IL-2 therapy was more effective than systemic IL-2 treatment. Intratumoral IL-2 applications are more effective than peritumoral application or application at a distant site. Tumor regression induced by intratumoral IL-2 application may be a fast process (requiring about a week) in the case of a highly vascular tumor since IL-2 induces vascular leakage/edema and consequently massive tumor necrosis. The latter then stimulates an immune response. In less vascular tumors or less vascular tumor sites, regression may require 9-20 months; this regression is mainly caused by a cytotoxic leukocyte reaction. Hence the disadvantageous vascular leakage syndrome complicating systemic treatment is however advantageous in local treatment, since local edema may initiate tumor necrosis. Thus the therapeutic effect of local IL-2 treatment is not primarily based on tumor immunity, but tumor immunity seems to be useful as a secondary component of the IL-2 induced local processes. If local IL-2 is combined with surgery, radiotherapy or local chemotherapy the therapeutic effect is usually greater than with either therapy alone. Hence local free IL-2 application can be recommended as an addition to standard treatment protocols. Local treatment with free IL-2 is straightforward and can readily be applied even during surgical interventions. Local IL-2 treatment is usually without serious side effects and besides minor complaints it is generally well supported. Only small quantities of IL-2 are required. Hence the therapy is relatively cheap. A single IL-2 application of 4.5 million U IL-2 costs about 70 Euros. Thus combined local treatment may offer an alternative in those circumstances when more expensive forms of treatment are not available, for instance in resource poor countries.

Locoregional IL-2 low dose applications for gastrointestinal tumors.

AIM: To explore the feasibility of local interleukin 2 (IL-2) in patients with different forms of abdominal cancer. This required experimentation with the time interval between IL-2 applications and the methods of application. METHODS: Sixteen patients with stages III and IV of gastrointestinal malignancies (primary or metastatic) who were admitted to our Department of Gastroenterology were treated with locoregionally applied IL-2 in low doses. RESULTS: No major problems applying locoregional IL-2 were encountered. In 6 out of 16 patients, a modest but clinically worthwhile improvement was obtained. Adverse effects were minimal. The therapeutic scheme was well tolerated, even in patients in a poor condition. CONCLUSION: This study demonstrates the feasibility of low dose locoregional IL-2 application in advanced abdominal cancer. Local IL-2 therapy gives only negligible adverse effects. The results suggest that it is important to apply intratumorally. Local IL-2 may be given adjunct to standard therapeutic regimes and does not imply complex surgical interventions. These initial results are encouraging.

In situ crosslinked biodegradable hydrogels loaded with IL-2 are effective tools for local IL-2 therapy.

We investigated the therapeutic efficacy of recombinant human interleukin-2 (rhIL-2)-loaded, in situ gelling, physically crosslinked dextran hydrogels, locally applied to SL2 lymphoma in mice. The physical crosslinking was established by stereocomplex formation between d-lactic acid oligomers and l-lactic acid oligomers grafted separately to dextrans. The stereocomplex hydrogel as described in our manuscript has several favourable characteristics, which enables its use as system for the controlled release of pharmaceutically active proteins. Firstly, the hydrogel system is a physically crosslinked system. In physically crosslinked gels, the use of chemical crosslinking agents is avoided. Such agents can potentially inactivate the protein and can covalently link the protein to the hydrogel network. Secondly, the hydrogel formation takes place at room temperature and physiological pH, and, importantly, in an all-aqueous environment. All factors are important to preserve the three-dimensional structure, and thus the biological activity, of the protein to be entrapped and released from the gels. Thirdly, the gel formation does not occur instantaneously. This means that a liquid formulation can be injected which solidifies after injection (in situ gel formation is possible). Fourthly, no pH drop during degradation is expected during degradation. As a control, free rhIL-2 was administered locally in either a single injection or at five consecutive days. All mice received the same total dose of rhIL-2. The rhIL-2-loaded hydrogels released most IL-2 over a period of about 5 days. The biocompatibility and biodegradability of the gels were excellent, as there were no acute or chronic inflammatory reaction and as the gels were replaced completely by fibroblasts after 15 days. The therapeutic efficacy of rhIL-2-loaded in situ gelled hydrogels is very good, as was demonstrated in DBA/2 mice bearing SL2. The therapeutic effect of a single application of gels loaded with 1 x 10(6) IU rhIL-2 is at least comparable to the therapeutic effect of injection of an equal dose of free rhIL-2. All mice cured with rhIL-2-loaded hydrogels survived a subsequent challenge, rejecting 10(6) intraperitoneal (i.p.) injected SL2 cells. In conclusion, this study demonstrates that in situ gelling, physically crosslinked dextran hydrogels slowly release encapsulated rhIL-2 in such a way that it is intact and biologically and therapeutically active. These hydrogels may greatly enhance the clinical applicability of rhIL-2 immunotherapy as only a single treatment is required and as these hydrogels are completely biodegradable.

Further development of local IL-2 therapy of cancer: multiple versus single IL-2 treatment of transplanted murine colon carcinoma.

We have compared the effect of one and up to four local IL-2 treatments of transplanted MC38 colon carcinoma. A single IL-2 treatment prolonged the survival time ( p=0.015), but no cure was obtained. One local IL-2 treatment inhibited tumor growth for about 1 week. After the start of tumor regrowth, a further IL-2 injection was given. After four IL-2 injections 6 out of 13 mice were cured. Histological studies show that IL-2 induced a local vascular leakage syndrome leading to massive peritumoral edema and subsequent necrosis of tumor tissue. IL-2 also attracted infiltrating cells, mainly macrophages. Subsequent IL-2 injections led to complete tumor regression. We believe that the combination of necrotic tumor debris and the IL-2-induced macrophage reaction enhanced a tumor-specific immune response. This local IL-2 application was not toxic.

Therapeutic effect of a single peritumoural dose of IL-2 on transplanted murine breast cancer.

Interleukin-2 therapy is not clearly effective against breast cancer both in mouse models and in human patients. However, the study of IL-2 therapy of breast cancer remains important, as 3,700 women died from this malignancy in the Netherlands in 2000. Previously we have shown the therapeutical efficacy of a single peritumoural IL-2 application in different experimental models and in veterinary patients. Here we apply this mode of IL-2 therapy to advanced mouse mammary carcinoma models, i.e., severe metastasised tumours in A/Sn mice and non-metastasised carcinomas in BALB/c mice. Mice with advanced transplanted mammary carcinomas were given a single peritumoural treatment with 2.5 x 10(6) IU IL-2 at days 10-14 after i.p. or s.c. inoculation of 10(6) carcinoma cells. Within each experiment it was always possible to distinguish relatively slowly and fast growing tumours which allows the therapeutical effect of IL-2 in tumours with different growth rates to be studied. A new approach to analyse results enabled us to show that survival of mice with transplanted, advanced metastasised breast cancer can be significantly improved after a single local treatment with IL-2. Advanced relatively fast i.p and s.c. growing mammary carcinomas seem to be more sensitive to a single IL-2 treatment than relatively slowly growing tumours. IL-2 was most effective against non-metastasised mouse breast cancer.