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Published ahead of print on April 3, 2008, doi:10.1164/rccm.200710-1513OC

Am. J. Respir. Crit. Care Med., Volume 178, Number 1, July 2008, 50-59

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Submitted on October 12, 2007
Accepted on April 3, 2008

Zoledronic Acid is Effective Against Experimental Malignant Pleural Effusion

Georgios T Stathopoulos1*, Charalampos Moschos1, Heleni Loutrari1, Androniki Kollintza1, Ioannis Psallidas1, Sophia Karabela1, Sophia Magkouta1, Zongmin Zhou1, Spyros A Papiris2, Charis Roussos1, and Ioannis Kalomenidis3

1 Department of Critical Care and Pulmonary Services, Applied Biomedical Research and Training Center "Marianthi Simou" and "George P. Livanos" Laboratory, General Hospital "Evangelismos", School of Medicine, National and Kapodistrian University of Athens, Athens, Greece, 2 2nd Pulmonary Department, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece, 3 Department of Critical Care and Pulmonary Services, Applied Biomedical Research and Training Center "Marianthi Simou" and "George P. Livanos" Laboratory, General Hospital "Evangelismos", School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; 2nd Pulmonary Department, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

* To whom correspondence should be addressed. E-mail: gstathop{at}med.uoa.gr.

Rationale: Aminobiphosphonates, such as zoledronic acid (ZA), exert potent indirect anti-tumor effects and are currently tested against human solid tumors. The anti-tumor actions of aminobiphosphonates, including angiostasis, are relevant to the pathogenesis of malignant pleural effusion (MPE), but no study has addressed the efficacy of these compounds against malignant pleural disease. Objectives: Here we hypothesized that treatment of immunocompetent mice with ZA would halt tumor progression in a mouse model of adenocarcinoma-induced MPE. Methods: To induce MPE in mice, Lewis lung carcinoma (LLC) cells were delivered directly into the pleural space. Subsequently, animals were treated with ZA in both a prevention and a regression protocol. Measurements and Main Results: ZA treatment resulted in significant reductions in pleural fluid accumulation and tumor dissemination, while it significantly prolonged survival. These effects of ZA were linked to enhanced apoptosis of pleural tumor cells, decreased formation of new vessels in pleural tumors, and reduced pleural vascular permeability. In addition, ZA was able to inhibit the recruitment of mononuclear cells to pleural tumors, with concomitant reductions in matrix metalloproteinase (MMP)-9 release into the pleural space. Finally, ZA limited the expression of proinflammatory and angiogenic mediators, as well as the activity of small GTP-proteins Ras and RhoA, in tumor cells in vivo and in vitro. Conclusions: ZA is effective against experimental MPE, suggesting that this intervention should be considered for testing in clinical trials.


Key words: pleural disease, monocyte chemoattractant protein, vascular endothelial growth factor, angiogenesis, aminobiphosphonate




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Y. C. G. Lee and S. Wilkosz
Malignant Pleural Effusions: Fixing the Leaky Faucet
Am. J. Respir. Crit. Care Med., July 1, 2008; 178(1): 3 - 5.
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