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      Solid stress in brain tumours causes neuronal loss and neurological dysfunction and can be reversed by lithium

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          Abstract

          The compression of brain tissue by a tumour mass is believed to be a major cause of the clinical symptoms seen in patients with brain cancer. However, the biological consequences of these physical stresses on brain tissue are unknown. Here, via imaging studies in patients and by using mouse models of human brain tumours, we show that a subgroup of primary and metastatic brain tumours, classified as nodular on the basis of their growth pattern, exert solid stress on the surrounding brain tissue, causing a decrease in local vascular perfusion as well as neuronal death and impaired function. We demonstrate a causal link between solid stress and neurological dysfunction by applying and removing cerebral compression, which respectively mimic the mechanics of tumour growth and of surgical resection. We also show that, in mice, treatment with lithium reduces solid-stress-induced neuronal death and improves motor coordination. Our findings indicate that brain-tumour-generated solid stress impairs neurological function in patients, and that lithium as a therapeutic intervention could counter these effects.

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          Most cited references57

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          Role of extracellular matrix assembly in interstitial transport in solid tumors.

          The extracellular matrix (ECM) may contribute to the drug resistance of a solid tumor by preventing the penetration of therapeutic agents. We measured differences in interstitial resistance to macromolecule (IgG) motion in four tumor types and found an unexpected correspondence between transport resistance and the mechanical stiffness. The interstitial diffusion coefficient of IgG was measured in situ by fluorescence redistribution after photobleaching. Tissue elastic modulus and hydraulic conductivity were measured by confined compression of excised tissue. In apparent contradiction to an existing paradigm, these functional properties are correlated with total tissue content of collagen, not glycosaminoglycan. An extended collagen network was observed in the more penetration-resistant tumors. Collagenase treatment of the more penetration-resistant tumors significantly increased the IgG interstitial diffusion rate. We conclude that collagen influences the tissue resistance to macromolecule transport, possibly by binding and stabilizing the glycosaminoglycan component of the ECM. These findings suggest a new method to screen tumors for potential resistance to macromolecule-based therapy. Moreover, collagen and collagen-proteoglycan bonds are identified as potential targets of treatment to improve macromolecule delivery.
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            Is Open Access

            Nonlinear Elasticity in Biological Gels

            Unlike most synthetic materials, biological materials often stiffen as they are deformed. This nonlinear elastic response, critical for the physiological function of some tissues, has been documented since at least the 19th century, but the molecular structure and the design principles responsible for it are unknown. Current models for this response require geometrically complex ordered structures unique to each material. In this Article we show that a much simpler molecular theory accounts for strain stiffening in a wide range of molecularly distinct biopolymer gels formed from purified cytoskeletal and extracellular proteins. This theory shows that systems of semi-flexible chains such as filamentous proteins arranged in an open crosslinked meshwork invariably stiffen at low strains without the need for a specific architecture or multiple elements with different intrinsic stiffnesses.
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              Mechanical properties of gray and white matter brain tissue by indentation.

              The mammalian brain is composed of an outer layer of gray matter, consisting of cell bodies, dendrites, and unmyelinated axons, and an inner core of white matter, consisting primarily of myelinated axons. Recent evidence suggests that microstructural differences between gray and white matter play an important role during neurodevelopment. While brain tissue as a whole is rheologically well characterized, the individual features of gray and white matter remain poorly understood. Here we quantify the mechanical properties of gray and white matter using a robust, reliable, and repeatable method, flat-punch indentation. To systematically characterize gray and white matter moduli for varying indenter diameters, loading rates, holding times, post-mortem times, and locations we performed a series of n=192 indentation tests. We found that indenting thick, intact coronal slices eliminates the common challenges associated with small specimens: it naturally minimizes boundary effects, dehydration, swelling, and structural degradation. When kept intact and hydrated, brain slices maintained their mechanical characteristics with standard deviations as low as 5% throughout the entire testing period of five days post mortem. White matter, with an average modulus of 1.89 5kPa ± 0.592 kPa, was on average 39% stiffer than gray matter, p<0.01, with an average modulus of 1.389 kPa ± 0.289 kPa, and displayed larger regional variations. It was also more viscous than gray matter and responded less rapidly to mechanical loading. Understanding the rheological differences between gray and white matter may have direct implications on diagnosing and understanding the mechanical environment in neurodevelopment and neurological disorders. Copyright © 2015 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                101696896
                45929
                Nat Biomed Eng
                Nat Biomed Eng
                Nature biomedical engineering
                2157-846X
                6 December 2018
                07 January 2019
                March 2019
                07 July 2019
                : 3
                : 3
                : 230-245
                Affiliations
                [1 ]Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
                [2 ]Institut Curie Research Center, PSL Research University, Inserm U1021, CNRS UMR3347, 91405 Orsay, France.
                [3 ]The Department of Diagnostic Physics, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
                [4 ]Department of Chemical and Biological Engineering, Tufts University, Medford, Massachusetts 02155, USA.
                [5 ]Department of Radiology, UT Southwestern Medical Center, Dallas, Texas 75390, USA.
                [6 ]Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA.
                [7 ]Stephen E. and Catherine Pappas Center for Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
                [8 ]Department of Neuro-Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts 02114, USA.
                [9 ]Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
                [10 ]Center for Biomedical Engineering, Departments of Mechanical, Electrical and Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA.
                [11 ]Department of Biomedical Engineering, Bucknell University, Lewisburg, Pennsylvania 17837, USA.
                Author notes

                Author contributions: GS, HTN and KEE conceived the project and wrote the manuscript; GS conducted most of the experiments, performed data analysis and generated most of the experimental mice; HTN designed and developed the in vivo compression device and conducted the experiments on biomedical engineering experiments; KEE designed the patients’ stratification method and analysed the perfusion MRIs; JK, LR and VA performed OCT intravital angiography experiments on multiple models; MD, JR, SK and MG assisted with histological analyses, preclinical models and pharmacological treatments; MCP blindly classified the clinical cohorts using the VASARI features; WWH analysed RNA-Seq results; GBF provided expertise on the neuroscience parts of the manuscripts; ERG, TTB, PYW and NUL provided MRI images and patients characteristics from clinical trials; AJG, DF, PH, JWB, TPP and LLM contributed to discussions on crucial aspects of the project and drafted the manuscript; RKJ supervised the project and provided guidance on experimental design, data interpretation and writing of the manuscript.

                [* ]To whom correspondence may be addressed. jain@ 123456steele.mgh.harvard.edu.
                Article
                NIHMS1514423
                10.1038/s41551-018-0334-7
                6452896
                30948807
                3af38ba1-85c3-44f5-accf-d0032232a3bd

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