CRYOSENSITIZERS: Ablation at the Edge

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1 CRYOSENSITIZERS: Ablation at the Edge John G. Baust Institute of Biomedical Technology State University of New York Binghamton, NY USA

2 Precision targeting Challenge Uncertain margin Responsiveness gradient

3 -15 o C 0 o C

4 Cryolesion Thermal variability within lesion Cooling rates Temperature Necrosis Apoptosis Multiple Modes of Cell Death Freeze Rupture Necrosis Apoptosis Freeze Rupture

5 Effect of Freezing on Viability of Prostate Cancer Cells In Vitro % Viability Clarke (2000) Hollister (1998) Bischoff (1997) Znati (1998) Temperature (C)

6 Freezing Response (15 min) of Human Prostate Cancer Cells (LNCaP) Treated with Double Freeze Cycle Percent Viability Control -5 C -10 C -15 C -20 C -25 C -40 C Condition * * * Pre-Freeze Day 1 Day 3 Day 5 Day 7 Day 9 p< Freezing Response (15 min) of Human Prostate Cancer Cells (PC-3) Treated with Double Freeze Cycle Percent Viability * * * Pre-Freeze Day 1 Day 3 Day 5 Day 7 Day 9 0 Control -5 C -10 C -15 C -20 C -25 C -40 C Condition p< 0.005

7 Tissue-Engineered Prostate Model 1-Day Post Freeze PC-3 PC-3 LNCaP LNCaP

8 PC-3 Cell Recovery After Cryo, Chemo, and Combination * Percent Viable Days 4 Days 6 Days * * 0 Control 5-FU 2day 5-FU 4day hr prior 1 day prior 2 day prior 4 day prior P < 0.001

9 110 PC-3 Cell Recovery Following Exposure to Freezing (-15 0 C) Alone or in Combination with Cytotoxic Agents % Viable Days 5 Days 8 Days 11 Days 14 Days Control Fre (-15) 5FU/Fre Tax/Fre Etop/Fre Cis/Fre FA/Fre

10 Comparison of Combinatorial Approaches to Cryosurgery -105 C -60 C -40 C -20 C -1 C Single Freeze -105 C -60 C -40 C -20 C -5 C Double Freeze Double Freeze/TRAIL Double Freeze/Taxotere

11 Factors Underlying Ablative Response Hypothermia Metabolic Uncoupling Energy Deprivation Waste Accumulation Ionic Imbalance ph Shifts (acidosis) Membrane Phase Transitions Cytoskeletal Disassembly Freezing Extracellular Ice Hyperosmolality Cell Volume Disruption Protein Denaturation Intracellular Ice Shearing Membrane Disruption Vascular Stasis Induction of Apoptosis Ischemia Hypoxia Nutrient deprivation Ionic imbalance Increased free radicals Energy deprivation Membrane alterations Biochemical alterations Induction of Necrosis All Events

12 Hallmarks of Cancer Proliferative Signaling Evade Growth Suppressors Resist Apoptosis Induce Angiogenesis Avoid Immune System Destruction Reprogram Cellular Energetics Enable Replicative Immortality (CSC) Recruit Non-cancerous Stromal Cell to Create Microenvironment Mobilization = Metastasis

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14 120 Effects of VD3 and Freezing at -15 C (15 min) on Human Prostate Cancer Cell Lines LNCaP LP and PC-3 AR 100 Percent Viability Pre-Freeze Day 1 Day 3 Day 5 Day 7 Day Control 50nM FR C Only -15 C with 50nM FR171 LNCaP LP Condition Control 50nM FR C Only -15 C with 50nM FR171 PC-3 AR BJU Intl 2011

15 120 Effects of VD3 and Freezing at -15 C (15 min) on Human Prostate Cancer Cell Lines LNCaP HP and PC Percent Viability Pre-Freeze Day 1 Day 3 Day 5 Day 7 Day Control 50nM FR C Only -15 C with 50nM FR 171 Control 50nM FR C Only -15 C with 50nM FR 171 LNCaP HP Condition PC-3 BJU Intl 2011

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18 BJU Intl. 2011

19 Hallmarks of Cancer Proliferative Signaling loss of cell cycle control Evade Growth Suppressors - -p53 Resist Apoptosis - +Bcl-2, -p53 Induce Angiogenesis - +VEGF Avoid Immune System Destruction surface markers Reprogram Cellular Energetics - glycolysis Enable Replicative Immortality - CSC Recruit Non-cancerous Stromal Cells Create to Microenvironment tumor associated-endothelium Mobilization = Metastasis - - cell adhesion molecules

20 Hallmarks of Cancer VD3 + Cryo Induced Changes Proliferative Signaling restores of cell cycle control Evade Growth Suppressors - Resist Apoptosis - +bcl2, -p53 Induce Angiogenesis - +VEGF Avoid Immune System Destruction - Reprogram Cellular Energetics - Enable Replicative Immortality - CSC Recruit Non-cancerous Stromal Cell to Create Microenvironment - Mobilization = Metastasis - -cell adhesion molecules

21 Hallmarks of Cancer VD3 + Cryo Induced Changes Proliferative Signaling restores of cell cycle control Evade Growth Suppressors restores p27, p53 Resist Apoptosis - +bcl2, -p53 Induce Angiogenesis - +VEGF Avoid Immune System Destruction - Reprogram Cellular Energetics - Enable Replicative Immortality - CSC Recruit Non-cancerous Stromal Cell to Create Microenvironment - Mobilization = Metastasis - -cell adhesion molecules

22 Hallmarks of Cancer VD3 + Cryo Induced Changes Proliferative Signaling restores of cell cycle control Evade Growth Suppressors restores p27, p53 Resist Apoptosis inhibits Bcl-2 Induce Angiogenesis - +VEGF Avoid Immune System Destruction - Reprogram Cellular Energetics - Enable Replicative Immortality - CSC Recruit Non-cancerous Stromal Cell to Create Microenvironment - Mobilization = Metastasis - -cell adhesion molecules

23 Hallmarks of Cancer VD3 + Cryo Induced Changes Proliferative Signaling restores of cell cycle control Evade Growth Suppressors restores p27, p53 Resist Apoptosis inhibits Bcl-2 Induce Angiogenesis inhibits VEGF transcription Avoid Immune System Destruction - Reprogram Cellular Energetics - Enable Replicative Immortality - CSC Recruit Non-cancerous Stromal Cell to Create Microenvironment - Mobilization = Metastasis - -cell adhesion molecules

24 Hallmarks of Cancer VD3 + Cryo Induced Changes Proliferative Signaling restores of cell cycle control Evade Growth Suppressors restores p27, p53 Resist Apoptosis inhibits Bcl-2 Induce Angiogenesis inhibits VEGF transcription Avoid Immune System Destruction -? Reprogram Cellular Energetics uncouples metabolism Enable Replicative Immortality - CSC Recruit Non-cancerous Stromal Cell to Create Microenvironment - Mobilization = Metastasis - -cell adhesion molecules

25 Hallmarks of Cancer VD3 + Cryo Induced Changes Proliferative Signaling restores of cell cycle control Evade Growth Suppressors restores p27, p53 Resist Apoptosis inhibits Bcl-2 Induce Angiogenesis inhibits VEGF transcription Avoid Immune System Destruction -? Reprogram Cellular Energetics uncouples metabolism Enable Replicative Immortality - ablates CSC (?) Recruit Non-cancerous Stromal Cell to Create Microenvironment - Mobilization = Metastasis - -cell adhesion molecules

26 Hallmarks of Cancer VD3 + Cryo Induced Changes Proliferative Signaling restores of cell cycle control Evade Growth Suppressors restores p27, p53 Resist Apoptosis inhibits Bcl-2 Induce Angiogenesis inhibits VEGF transcription Avoid Immune System Destruction -? Reprogram Cellular Energetics uncouples metabolism Enable Replicative Immortality - ablates CSC (?) Recruit Non-cancerous Stromal Cell to Create Microenvironment ablates stromal cells Mobilization = Metastasis - -cell adhesion molecules

27 Hallmarks of Cancer VD3 + Cryo Induced Changes Proliferative Signaling restores of cell cycle control Evade Growth Suppressors restores p27, p53 Resist Apoptosis inhibits Bcl-2 Induce Angiogenesis inhibits VEGF transcription Avoid Immune System Destruction -? Reprogram Cellular Energetics uncouples metabolism Enable Replicative Immortality - ablates CSC (?) Recruit Non-cancerous Stromal Cell to Create Microenvironment ablates stromal cells Mobilization = Metastasis - ++cell adhesion molecules

28 Vitamin D3 Increases Cryoablation Efficacy Key Findings VD3 pre-treatment pulse (2 days) followed by freezing (in vitro and in vivo) resulted in Total cell ablation without of re-growth for both androgen-sensitive (AS) and androgen-insensitive (AI) prostate cancers. Increased levels of both necrotic and apoptotic cell death cascades. Increased caspase activity and duration in AI cells more significantly than was observed for AS cells. Elevated caspase-9 activity in the AI cells indicates that vitamin D3 treatment prior to freezing was able to increase mitochondrial mediated apoptotic cascades to levels comparable with freeze-sensitive AS cells. Single Pulse Vitamin D3 exposure offers a promising neo-adjunctive cryosensitization strategy.

29 Cryosurgical Technology (boat) Cryoablation: Self Taught