Abstract
The enduring impasse in the success rate of conventional treatment may be overcome by a critical re-appraisal of conventional research methods and available therapeutic tools, focussing on the complexity of the tumour microenvironment. Current methods do not reproduce the hypoxic, acidic conditions at the tumour site nor the mutual influences of cancer cells with reactive fibroblasts and immune cells. A peculiar feature of these interactions is an increased acidity of the extracellular environment, and this can be exploited for pharmacological therapies targeting the extrusion of protons from the cellular compartments, inducing selective cytotoxic effects on cancer cells, and for a photodynamic approach based on acid-seeking agents, extending the chances of conservative surgery.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Andreev OA, Dupuy AD, Segala M et al (2007) Mechanism and uses of a membrane peptide that targets tumors and other acidic tissues in vivo. Proc Natl Acad Sci USA 104:7893–7898
Aoki J, Watanabe H, Shinozaki T (2001) FDG-PET of primary benign and malignant bone tumours: standardized uptake value in 52 lesions. Radiology 219:774–777
Avnet S, Sciacca L, Salerno M et al (2009) Insulin receptor isoform a and insulin-like growth factor II as additional treatment targets in human osteosarcoma. Cancer Res 69:2443–2452
Bacci G, Ferrari S, Longhi A et al (1988) Prognostic significance of serum LDH in Ewing’s sarcoma of bone. Oncol Rep 6:807–811
Bacci G, Longhi A, Ferrari S et al (2004) Prognostic significance of serum lactate dehydrogenase in osteosarcoma of the extremity: experience at Rizzoli in 1421 patients treated over the last 30 years. Tumori 90:478–484
Baldini N, Scotlandi K, Barbanti-Brodano G et al (1995) Expression of P-glycoprotein in high-grade osteosarcomas in relation to clinical outcome. N Engl J Med 333:1380–1385
Bastiaannett E, Groen H, Jager PL (2004) The value of FDG-PET in the detection, grading and response to therapy of soft tissue and bone sarcomas; a systematic review and meta-analysis. Cancer Treat Rev 30:83–101
Bien E, Rapala M, Krazczyk M et al (2010) The serum levels of soluble interleukin-2 receptor alpha and lactate dehydrogenase but not B2-microglobulin correlate with selected clinico-pathological prognostic factors and response to therapy in childhood soft tissue sarcomas. J Cancer Res Clin Oncol 136:293–305
Bonuccelli G, Tisirigos A, Whitaker-Menezes D et al (2010) Ketones and lactate “fuel” tumor growth and metastasis: evidence that epithelial cancer cells use oxidative mitochondrial metabolism. Cell Cycle 9:3506–3514
Calcinotto A, Filipazzi P, Grioni M et al (2012) Modulation of microenvironment acidity reverses anergy in human and murine tumor-infiltrating T lymphocytes. Cancer Res 72:2746–2756
De Milito A, Canese R, Marinio ML et al (2010) pH-dependent antitumor activity of proton pump inhibitors against human melanoma is mediated by inhibition of tumor acidity. Int J Cancer 127:207–219
DeClerck K, Elble RC (2010) The role of hypoxia and acidosis in promoting metastasis and resistance to chemotherapy. Front Biosci 15:213–225
Engin K, Leeper DB, Cater JR et al (1995) Extracellular pH distribution in human tumours. Int J Hyperthermia 11:211–216
Fais S, De Milito A, You H et al (2007) Targeting vacuolar H+-ATPases as a new strategy against cancer. Cancer Res 67:10627–10630
Feldser D, Agani F, Iyer NV et al (1999) Reciprocal positive regulation of hypoxia-inducible factor 1alpha and insulin-like growth factor 2. Cancer Res 59:3915–3918
Gabrilovich DI, Nagaraj S (2009) Myeloid-derived suppressor cells as regulators of the immune system. Nat Rev Immunol 9:162–174
Gatenby RA, Gillies RJ (2008) A microenvironmental model of carcinogenesis. Nat Rev Cancer 8:56–61
Gullino PM, Grantham FH, Smith SH et al (1965) Modifications of the acid–base status of the internal milieu of tumors. J Natl Cancer Inst 34:857–869
Hanahan D, Coussens LM (2012) Accessories to the crime: functions of cells recruited to the tumor microenvironment. Cancer Cell 21:309–322
Hashiguchi S, Kusuzaki K, Murata H et al (2002) Acridine orange excited by low-dose radiation has a strong cytocidal effect on mouse osteosarcoma. Oncology 62:85–93
International Agency for Research on Cancer (1978) Acridine orange. In: IARC monographs program on the evaluation of carcinogenic risks to humans, vol 16. IARC Press, Lyon, p 145
Krähling H, Mally S, Eble JA et al (2009) The glycocalyx maintains a cell surface pH nanoenvironment crucial for integrin-mediated migration of human melanoma cells. Pflugers Arch 458:1069–1083
Krolenko SA, Adamyan SY, Belyaeva TN et al (2006) Acridine orange accumulation in acid organelles of normal and vacuolated frog skeletal muscle fibres. Cell Biol Int 30:933–939
Kusuzaki K, Aomori K, Suginoshita T et al (2000) Total tumor cell elimination with minimum damage to normal tissues in musculoskeletal sarcomas by photodynamic reaction with acridine orange. Oncology 59:174–180
Kusuzaki K, Minami G, Takeshita H et al (2000) Photodynamic inactivation with acridine orange on a multi-drug-resistant mouse osteosarcoma cell line. Jpn J Cancer Res 91:439–445
Kusuzaki K, Murata H, Matsubara T et al (2005) Clinical outcome of a new photodynamic therapy with acridine orange for synovial sarcomas. Photochem Photobiol 81:705–709
Kusuzaki K, Murata H, Matsubara T et al (2005) Clinical trial of photodynamic therapy using acridine orange with/without low dose radiation as new limb salvage modality in musculoskeletal sarcomas. Anticancer Res 25:1225–1236
Kusuzaki K, Murata H, Takeshita H et al (2000) Intracellular binding sites of acridine orange in living osteosarcoma cells. Anticancer Res 20:971–976
Lu X, Qin W, Li J et al (2005) The growth of metastasis of human hepatocellular carcinoma xenografts are inhibited by small interfering RNA targeting to the subunit ATP6L of proton pump. Cancer Res 65:6843–6849
Martinez-Outschoorn UE, Balliet RM, Rivadeneira DB et al (2010) Oxidative stress in cancer associated fibroblasts drives tumor-stroma co-evolution: a new paradigm for understanding tumor metabolism, the field effect and genomic instability in cancer cells. Cell Cycle 9:3256–3276
Martinez-Outschoorn UE, Lin Z, Whitaker-Menezes D et al (2010) Autophagy in cancer associated fibroblasts promotes tumor cell survival: role of hypoxia, HIF1 induction and NFκB activation in the tumor stromal microenvironment. Cell Cycle 9:3515–3533
Martinez-Zaguilan R, Seftor EA et al (1996) Acidic pH enhances the invasive behavior of human melanoma cells. Clin Exp Metastasis 14:176–186
Matsubara T, Kusuzaki K, Matsumine A et al (2006) Acridine orange used for photodynamic therapy accumulates in malignant musculoskeletal tumors depending on pH gradient. Anticancer Res 26:187–194
Matsubara T, Kusuzaki K, Matsumine A et al (2009) A new therapeutic modality involving acridine orange excitation by photon energy used during reduction surgery for rhabdomyosarcomas. Oncol Rep 21:89–94
Matsubara T, Kusuzaki K, Matsumine A et al (2010) Clinical outcomes of minimally invasive surgery using acridine orange for musculoskeletal sarcomas around the forearm, compared with conventional limb salvage surgery after wide resection. J Surg Oncol 102:271–275
Matsubara T, Kusuzaki K, Matsumine A et al (2010) Photodynamic therapy with acridine orange in musculoskeletal sarcomas. J Bone Joint Surg Br 92:760–762
McCann J, Ames BN (1976) Detection of carcinogens as mutagens in the Salmonella/microsome test: assay of 300 chemicals: discussion. Proc Natl Acad Sci USA 73:950–954
Mizobuchi H, Garcia-Castellano JM, Philip S et al (2008) Hypoxia markers in human osteosarcoma: an exploratory study. Clin Orthop Relat Res 466:2052–2059
Mohyeldin A, Garzòn-Muvdi T, Quiñones-Hinolojosa A (2010) Oxygen in stem cell biology: a critical component of the stem cell niche. Cell Stem Cell 7:150–161
Morimura T, Fujita K, Akita M et al (2008) The proton pump inhibitor inhibits cell growth and induces apoptosis in human hepatoblastoma. Pediatr Surg Int 24:1087–1094
Moussavi-Harami F, Mollano A, Martin JA et al (2006) Intrinsic radiation resistance in human chondrosarcoma. Biochem Biophys Res Commun 346:379–385
Murakami T, Shibuya I, Ise T et al (2001) Elevated expression of vacuolar proton pump genes and cellular pHin cisplatin resistance. Int J Cancer 93:869–874
Nagaraj NS, Vigneswaran N, Zacharias W (2007) Hypoxia inhibits TRAIL-induced tumor cell apoptosis: involvement of lysosomal cathepsins. Apoptosis 12:125–139
Nakamura T, Kusuzaki K, Matsubara T et al (2008) A new limb salvage surgery in cases of high-grade soft tissue sarcoma using photodynamic surgery, followed by photo- and radio- dynamic therapy with acridine orange. J Surg Oncol 97:523–528
Newell K, Franchi A, Pouyssegur J et al (1993) Studies with glycolysis-deficient cells suggest that production of lactic acid is not the only cause of tumor acidity. Proc Natl Acad Sci USA 90:1127–1131
Noebauer-Huhmann IM, Panotopoulos J, Kotz RI (2010) Bone tumours: work up 2009. In: Bentley G (ed) European instructional lectures, vol 10. Springer, Berlin, pp 23–36
Nygren P, Larsson R (2003) Overview of the clinical efficacy of investigational anticancer drugs. J Intern Med 253:46–75
Ocana A, Pandiella A, Siu LL et al (2011) Preclinical development of molecular-targeted agents for cancer. Nat Rev Clin Oncol 8:200–209
Parks SK, Chiche J, Poyssegur J (2011) pH control mechanisms of tumor survival and growth. J Cell Physiol 226:299–308
Pavlides S, Tsirigos A, Migneco G et al (2010) The autophagic tumor stroma model of cancer: role of oxidative stress and ketone production in fueling tumor cell metabolism. Cell Cycle 9:3485–3505
Pavlides S, Whitaker-Menezes D, Castello-Cros R et al (2009) The reverse Warburg effect: aerobic glycolysis in cancer associated fibroblasts and the tumor stroma. Cell Cycle 8:3984–4001
Rofstad EK, Mathiesen N, Kindem K et al (2006) Acidic extracellular pH promotes experimental metastasis of human melanoma cells in athymic nude mice. Cancer Res 66:6699–6707
Schwickert G, Walenta S, Sundfør K et al (1995) Correlation of high lactate levels in human cervical cancer with incidence of metastasis. Cancer Res 55:4757–4759
Swietach P, Patiar S, Supuran C et al (2009) The role of carbonic anhydrase 9 in regulating extracellular and intracellular pH in three-dimensional tumor cell growth. J Biol Chem 284:20299–20310
Szendröi M, Sápi Z, Karlinger K et al (2010) Diagnosis and treatment of soft tissue sarcomas. In: Bentley G (ed) European instructional lectures, vol 10. Springer, Berlin, pp 37–50
Tian L, Bae YH (2012) Cancer nanomedicine targeting tumor extracellular pH. Colloids Surf B Biointerfaces 99:116–126
Van Duuren BL, Sivak A, Katz C et al (1969) Tumorigenicity of acridine orange. Br J Cancer 23:587–590
Warburg O, Posener K, Negelein E (1924) Über den Stoffwechsel der Tumoren. Biochem Zeitschrift 152:319–344
Warren L, Jardillier JC, Malarska A et al (1992) Increased accumulation of drugs in multidrug-resistant cells induced by liposomes. Cancer Res 52:3241–3245
Yang QC, Zeng BF, Dong Y et al (2007) Overexpression of hypoxia-inducible factor-1(alpha) in human osteosarcoma: correlation with clinicopathological parameters and survival outcome. Jpn J Clin Oncol 37:127–134
Zdolsek JM (1993) Acridine orange-mediated photodamage to cultured cells. APMIS 101:127–132
Zelenin AV (1966) Fluorescence microscopy of lysosomes and related structures in living cells. Nature 212:425–426
Zelenin AV, Liapunova EA (1964) Inhibition of protein synthesis by acridine orange. Nature 204:45–46
Acknowledgment
Grant support: Ministry of Health (Grant RBAP10447J_004 to N. Baldini), Italian Association for Cancer Research (Grant 11426 to N. Baldini), IOR “5 per mille”.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 EFORT
About this chapter
Cite this chapter
Baldini, N., Kusuzaki, K. (2013). New Trends Based on Experimental Results in the Treatment of Sarcoma. In: Bentley, G. (eds) European Instructional Lectures. European Instructional Lectures, vol 13. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36149-4_4
Download citation
DOI: https://doi.org/10.1007/978-3-642-36149-4_4
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-36148-7
Online ISBN: 978-3-642-36149-4
eBook Packages: MedicineMedicine (R0)