2
NEWS & VIEWS NATURE|Vol 436|28 July 2005 468 and radioactive contamination in the detector (around 28%). Moreover, geoneutrinos pro- duced from K decays are not — yet — detected at KamLAND, because their energies are below the threshold of 1.8 MeV required to trigger the existing detector system. The data reported by Araki et al. 1 are the results from their first experiment, which comprised just over two years of counting. Future observations at KamLAND, and at the Borexino detector under the Gran Sasso mountain in central Italy, which begins opera- tion in 2006, will generate more data and provide greater sensitivity in testing the nature and sources of geoneutrinos. A crucial advance will be to confirm that the geo- neutrino heat flux moving radially outwards from the Earth is directly proportional to the radiogenic heat flux. This will, however, require an exact knowledge of the abundance and distribution of K, Th and U in the Earth. To this end, a first detailed assessment has been made 11 of the predicted geoneutrino flux relative to the distribution of radioactive elements in the regional crust and underlying mantle near KamLAND, and throughout the Earth’s interior. Further in the future, combin- ing angle-integrated geoneutrino fluxes at dif- ferent detector sites 12 with element distribution maps will enable us to construct geoneutrino tomographic maps of the Earth that will tell us more about the planet-wide distribution of K, Th and U. Proposed sites for future (anti)neu- trino detectors must therefore be sure to include areas beneath both continental regions rich in K, Th and U and oceanic regions where the three radionuclides are depleted. The pioneering results from KamLAND presented by Araki et al. 1 , along with data from future work, will provide a fundamental con- straint for the Earth’s U and Th budget (and, it is to be hoped, shortly for that of K), and define the fractional contribution of radioactive heat- ing to the total energy budget. Later this year, particle physicists and Earth scientists will gather to discuss these exciting and common areas of research at a meeting on Hawaii 13 . William F. McDonough is in the Department of Geology, University of Maryland, College Park, Maryland 20742, USA. e-mail: [email protected] 1. Araki, T. et al. Nature 436, 499–503 (2005). 2. Eguchi, K. et al. Phys. Rev. Lett. 90, 021802 (2003). 3. Ahmad, Q. R. et al. Phys. Rev. Lett. 89, 011301 (2002). 4. Pollack, H. N., Hurter, S. J. & Johnson, J. R. Rev. Geophys. 31, 267–280 (1993). 5. Hofmeister, A. M. & Criss, R. E. Tectonophysics 395, 159–177 (2005). 6. McDonough, W. F. in Treatise on Geochemistry Vol. 2 (ed. Carlson, R. W.) 547–568 (Elsevier, Oxford, 2003). 7. Palme, H. & O’Neill, H. St C. in Treatise on Geochemistry Vol. 2 (ed. Carlson, R. W.) 1–38 (Elsevier, Oxford, 2003). 8. Rama Murthy, V., van Westrenen, W. & Fei, Y. Nature 423, 163–165 (2003). 9. Lee, K. K. M. & Jeanloz, R. Geophys. Res. Lett. 30, 2212 (2003). 10. Labrosse, S. Phys. Earth Planet. Inter. 140, 127–143 (2003). 11. Fiorentini, G., Lissia, M., Mantovani, F. & Vannucci, R. preprint at www.arxiv.org/hep-ph/0501111 (2005). 12. Field, B. D. & Hochmuth, K. A. preprint at www.arxiv.org/hep-ph/0406001 (2004). 13. www.phys.hawaii.edu/~sdye/hnsc.html before the vasculature shut down, and allowed the staged release of the two drugs. More specifically, the delivery of the anti-angiogenic factor could lead to a collapse of the vascular network and imprison the vehicle — still bear- ing its second payload of chemotherapeutic drug — in the tumour. The subsequent release of the latter drug within the tumour would kill the cancer cells. The authors exploited the fact that the blood vessels of tumours are ‘leaky’ 7 , so tumour tissue can take up larger particles than can normal tissues, promoting selectivity. They created composite vehicle particles of 80–120 nm, consisting of a solid biodegradable poly- mer core surrounded by a lipid membrane (Fig. 1). The anti-angiogenic drug combreta- statin was dissolved in the lipid layer, from which it rapidly escaped. This drug attacks the internal skeleton of cells, and quickly disrupts blood vessels. The chemotherapeutic drug doxorubicin was bound chemically to the inner core of the particle, and so was released more slowly as the bond holding the drug to the polymer broke down. Doxorubicin is a common chemotherapeutic agent, and its structure consists of chemical groups that are amenable to attachment to polymers. Sengupta et al. examined the effects of the drugs on two types of tumour in mice, and showed that, unsurprisingly, either drug alone slowed tumour growth, and that when the drugs were delivered simultaneously there was an additive effect. Strikingly, however, the staged release of the two drugs using the new delivery vehicle improved the outcome still further — survival time increased from approximately 30 days when the drugs were delivered simultaneously to more than 60 days when they were released sequentially. The delivery vehicles tended to accumulate in the tumours, rather than in other body tissues, and the drugs they transported killed both endothelial and cancer cells. The effect of the sequential delivery of these two drugs on tumour growth is dramatic, but we cannot assume a quick translation of these results to therapy for humans. The biological differences between mice and humans prevent direct comparison between the systems, and it will also be important to extend these studies to longer time periods. Moreover, it has been speculated that anti-angiogenic drugs may actually promote the spread of tumours to other tissues, owing to a complex feedback loop, although there is no evidence of this in CANCER One step at a time David Mooney Traditional chemotherapy kills tumour cells directly; some newer drugs work instead by cutting the tumour’s blood supply. An innovative approach combines these strategies sequentially to pack a double whammy. In 1971, Judah Folkman proposed that the progression of cancer might be halted by preventing tumours from recruiting new blood vessels (a process called angiogenesis) to provide them with oxygen and nutrients. Last year, this theory bore fruit with the approval by the US Food and Drug Administration of the first anti-angiogenic cancer treatment, Avastin (also known as bevacizumab) 1 . Sen- gupta and colleagues (page 568 of this issue) 2 advance this concept by designing a drug- delivery vehicle that sequentially releases an anti-angiogenic drug and a traditional chemotherapeutic drug at high concentrations specifically into a tumour. They report that their strategy can slow tumour growth in mice more than can either drug alone or the two drugs delivered at the same time. Traditional chemotherapeutic agents kill all rapidly growing cells in the body — both can- cer cells and other cells that divide quickly (for example, blood, hair and cells lining the intes- tine). This leads to the distressing side effects of chemotherapy, and limits the practical dose and frequency of application of the drugs. One tactic to avoid these effects is to target the drug specifically to the tumour, and approaches being tested include the incorporation of drugs into materials or complexes that can either be placed in, or directed to, tumours 3 . A second issue, however, is that some tumours develop resistance to a particular drug, so efforts to identify targets that are not prone to developing resistance continue. Endothelial cells, which line blood vessels, may provide an attractive target, as they are thought to be genetically more stable than can- cer cells and so less likely to develop mutations that might promote resistance. A number of drugs that kill endothelial cells or prevent their growth are proving effective in phase III clinical trials for treating colon, kidney and lung cancer, and gastrointestinal stromal tumours 1,4–6 . These drugs can be useful alone, but they are commonly combined with tradi- tional chemotherapy to prevent blood-vessel growth while also killing cancerous cells. Simultaneous delivery of chemotherapeutic and anti-angiogenic drugs is clearly beneficial, but because chemotherapy is blood-borne, shutting down the tumour’s blood supply with anti-angiogenic drugs may decrease the deliv- ery of drugs designed to kill the tumour cells. Sengupta et al. 2 hypothesized that a more effective strategy would be to use a delivery vehicle that became concentrated in tumours Nature Publishing Group ©2005

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Page 1: Cancer: One step at a time

NEWS & VIEWS NATURE|Vol 436|28 July 2005

468

and radioactive contamination in the detector(around 28%). Moreover, geoneutrinos pro-duced from K decays are not — yet — detectedat KamLAND, because their energies arebelow the threshold of 1.8 MeV required totrigger the existing detector system.

The data reported by Araki et al.1 are theresults from their first experiment, whichcomprised just over two years of counting.Future observations at KamLAND, and at the Borexino detector under the Gran Sassomountain in central Italy, which begins opera-tion in 2006, will generate more data and provide greater sensitivity in testing the nature and sources of geoneutrinos. A crucialadvance will be to confirm that the geo-neutrino heat flux moving radially outwardsfrom the Earth is directly proportional to theradiogenic heat flux. This will, however,require an exact knowledge of the abundanceand distribution of K, Th and U in the Earth.

To this end, a first detailed assessment hasbeen made11 of the predicted geoneutrino flux relative to the distribution of radioactive elements in the regional crust and underlyingmantle near KamLAND, and throughout theEarth’s interior. Further in the future, combin-ing angle-integrated geoneutrino fluxes at dif-ferent detector sites12 with element distributionmaps will enable us to construct geoneutrinotomographic maps of the Earth that will tell usmore about the planet-wide distribution of K,Th and U. Proposed sites for future (anti)neu-trino detectors must therefore be sure toinclude areas beneath both continental regionsrich in K, Th and U and oceanic regions wherethe three radionuclides are depleted.

The pioneering results from KamLANDpresented by Araki et al.1, along with data fromfuture work, will provide a fundamental con-straint for the Earth’s U and Th budget (and, itis to be hoped, shortly for that of K), and definethe fractional contribution of radioactive heat-ing to the total energy budget. Later this year,particle physicists and Earth scientists willgather to discuss these exciting and commonareas of research at a meeting on Hawaii13. ■

William F. McDonough is in the Department ofGeology, University of Maryland, College Park,Maryland 20742, USA.e-mail: [email protected]

1. Araki, T. et al. Nature 436, 499–503 (2005).2. Eguchi, K. et al. Phys. Rev. Lett. 90, 021802 (2003).3. Ahmad, Q. R. et al. Phys. Rev. Lett. 89, 011301 (2002).4. Pollack, H. N., Hurter, S. J. & Johnson, J. R. Rev. Geophys.

31, 267–280 (1993).5. Hofmeister, A. M. & Criss, R. E. Tectonophysics 395,

159–177 (2005).6. McDonough, W. F. in Treatise on Geochemistry Vol. 2

(ed. Carlson, R. W.) 547–568 (Elsevier, Oxford, 2003).7. Palme, H. & O’Neill, H. St C. in Treatise on Geochemistry

Vol. 2 (ed. Carlson, R. W.) 1–38 (Elsevier, Oxford, 2003).8. Rama Murthy, V., van Westrenen, W. & Fei, Y. Nature 423,

163–165 (2003).9. Lee, K. K. M. & Jeanloz, R. Geophys. Res. Lett. 30, 2212 (2003).10. Labrosse, S. Phys. Earth Planet. Inter. 140, 127–143 (2003).11. Fiorentini, G., Lissia, M., Mantovani, F. & Vannucci, R.

preprint at www.arxiv.org/hep-ph/0501111 (2005).12. Field, B. D. & Hochmuth, K. A. preprint at

www.arxiv.org/hep-ph/0406001 (2004).13. www.phys.hawaii.edu/~sdye/hnsc.html

before the vasculature shut down, and allowedthe staged release of the two drugs. Morespecifically, the delivery of the anti-angiogenicfactor could lead to a collapse of the vascularnetwork and imprison the vehicle — still bear-ing its second payload of chemotherapeuticdrug — in the tumour. The subsequent releaseof the latter drug within the tumour would killthe cancer cells.

The authors exploited the fact that the bloodvessels of tumours are ‘leaky’7, so tumour tissue can take up larger particles than cannormal tissues, promoting selectivity. Theycreated composite vehicle particles of 80–120nm, consisting of a solid biodegradable poly-mer core surrounded by a lipid membrane(Fig. 1). The anti-angiogenic drug combreta-statin was dissolved in the lipid layer, fromwhich it rapidly escaped. This drug attacks theinternal skeleton of cells, and quickly disruptsblood vessels. The chemotherapeutic drugdoxorubicin was bound chemically to theinner core of the particle, and so was releasedmore slowly as the bond holding the drug tothe polymer broke down. Doxorubicin is acommon chemotherapeutic agent, and itsstructure consists of chemical groups that areamenable to attachment to polymers.

Sengupta et al. examined the effects of thedrugs on two types of tumour in mice, andshowed that, unsurprisingly, either drug aloneslowed tumour growth, and that when thedrugs were delivered simultaneously there wasan additive effect. Strikingly, however, thestaged release of the two drugs using the newdelivery vehicle improved the outcome stillfurther — survival time increased fromapproximately 30 days when the drugs weredelivered simultaneously to more than 60 dayswhen they were released sequentially. Thedelivery vehicles tended to accumulate in thetumours, rather than in other body tissues,and the drugs they transported killed bothendothelial and cancer cells.

The effect of the sequential delivery of thesetwo drugs on tumour growth is dramatic, butwe cannot assume a quick translation of theseresults to therapy for humans. The biologicaldifferences between mice and humans preventdirect comparison between the systems, and itwill also be important to extend these studiesto longer time periods. Moreover, it has beenspeculated that anti-angiogenic drugs mayactually promote the spread of tumours toother tissues, owing to a complex feedbackloop, although there is no evidence of this in

CANCER

One step at a timeDavid Mooney

Traditional chemotherapy kills tumour cells directly; some newer drugswork instead by cutting the tumour’s blood supply. An innovative approachcombines these strategies sequentially to pack a double whammy.

In 1971, Judah Folkman proposed that theprogression of cancer might be halted by preventing tumours from recruiting newblood vessels (a process called angiogenesis) to provide them with oxygen and nutrients. Lastyear, this theory bore fruit with the approvalby the US Food and Drug Administration ofthe first anti-angiogenic cancer treatment,Avastin (also known as bevacizumab)1. Sen-gupta and colleagues (page 568 of this issue)2

advance this concept by designing a drug-delivery vehicle that sequentially releases ananti-angiogenic drug and a traditionalchemotherapeutic drug at high concentrationsspecifically into a tumour. They report thattheir strategy can slow tumour growth in micemore than can either drug alone or the twodrugs delivered at the same time.

Traditional chemotherapeutic agents kill allrapidly growing cells in the body — both can-cer cells and other cells that divide quickly (forexample, blood, hair and cells lining the intes-tine). This leads to the distressing side effectsof chemotherapy, and limits the practical doseand frequency of application of the drugs. Onetactic to avoid these effects is to target the drugspecifically to the tumour, and approachesbeing tested include the incorporation ofdrugs into materials or complexes that caneither be placed in, or directed to, tumours3.

A second issue, however, is that sometumours develop resistance to a particulardrug, so efforts to identify targets that are not prone to developing resistance continue.Endothelial cells, which line blood vessels,may provide an attractive target, as they arethought to be genetically more stable than can-cer cells and so less likely to develop mutationsthat might promote resistance. A number ofdrugs that kill endothelial cells or prevent theirgrowth are proving effective in phase III clinical trials for treating colon, kidney andlung cancer, and gastrointestinal stromaltumours1,4–6. These drugs can be useful alone,but they are commonly combined with tradi-tional chemotherapy to prevent blood-vesselgrowth while also killing cancerous cells.

Simultaneous delivery of chemotherapeuticand anti-angiogenic drugs is clearly beneficial,but because chemotherapy is blood-borne,shutting down the tumour’s blood supply withanti-angiogenic drugs may decrease the deliv-ery of drugs designed to kill the tumour cells.Sengupta et al.2 hypothesized that a moreeffective strategy would be to use a deliveryvehicle that became concentrated in tumours

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© 2005 Nature Publishing Group

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humans8. It is promising, in this regard, thatSengupta and colleagues’ system produced noincrease in the expression of a factor (HIF-1�)that can link the low oxygen levels resultingfrom reduced blood flow with potential resis-tance to drug therapy and tumour invasive-ness. Finally, in contrast to combretastatin,many anti-angiogenic drugs require pro-longed tissue exposure to shut down the vasculature, and so may not be amenable tothe particular approach described by Senguptaand colleagues.

The general concept of timing the availabil-ity of drugs aimed at specific stages or targets in cancer is widely applicable, however, and is consistent with similar efforts to promoteblood-vessel formation in diseases involvinginsufficient blood flow9. Appropriate design ofdrugs will allow targeting of cancer cells orother specific cell types10, and the deliverydevice described by Sengupta et al. could read-ily be modified for this. It may also be necessaryto target multiple aspects of angiogenesis, eitherby using several drugs or by using a drug thatinterferes with several pathways (for example,MAPK inhibitors)11, to prevent tumours fromswitching on alternative angiogenesis path-ways. Ultimately, combining the developmentof advanced drug-delivery systems with theidentification of early markers of cancer mayallow early and highly effective intervention,and help to accomplish the US National CancerInstitute’s stated goal of eliminating the suffer-ing and death from cancer by 2015. ■

David Mooney is in the Division of Engineeringand Applied Sciences, Harvard University,Cambridge, Massachusetts 02138, USA. e-mail: [email protected]

1. Hurwitz, H. et al. N. Engl. J. Med. 350, 2335–2342 (2004).2. Sengupta, S. et al. Nature 436, 568–572 (2005).3. Moses, M. A. et al. Cancer Cell 4, 337–341 (2003).4. Escudier, B. et al. Annu. Meet. Am. Soc. Clin. Oncol.

abstr. LBA4510; www.asco.org/ac/1,1003,_12-002636-00_18-0034-00_19-0032211,00.asp (2005).

5. Sandler, A. B. et al. Annu. Meet. Am. Soc. Clin. Oncol.abstr. LBA4; www.asco.org/ac/1,1003,_12-002643-00_18-0034-00_19-0033325,00.asp (2005).

6. Demetri, G. D. et al. Annu. Meet. Am. Soc. Clin. Oncol.abstr. 4500; www.asco.org/ac/1,1003,_12-002643-00_18-0034-00_19-0034169,00.asp (2005).

7. Jain, R. K. Adv. Drug Deliv. Rev. 46, 149–168 (2001).

Figure 1 | Step-by-step in fighting cancer. The delivery system of Sengupta et al.2 causes the sequential loss of blood vessels and the death of tumour cells. a, Nanometre-scale particles have an outer lipid layer (blue) and an inner core (yellow). b, Once injected into the bloodstream, the particle is selectively takenup into tumour tissues, where the lipid layer rapidly releases a drug that kills endothelial cells and disrupts blood vessels. c, The inner core gradually releasesa chemotherapeutic drug to destroy the cancer cells (d).

CARBON CYCLE

The age of the Amazon’s breathPeter A. Raymond

The inorganic carbon carried in rivers of the Amazon basin seems to originatelargely from the decomposition of young plant material — a finding thatimproves our understanding of the role of rivers in the carbon cycle.

Increases in atmospheric carbon dioxide fromthe burning of fossil fuels have unknowneffects on the global climate and economy. Sci-entists aim to understand more about theseeffects by studying the mechanisms that con-trol the exchange of carbon between land, theatmosphere and the oceans. Processes thatremove CO2 from the atmosphere, where itcould cause global warming, and move it intolong-term storage on land or in the oceans, areof particular interest in this context. Becausethey connect land and sea, rivers are a vitallink in these processes (Fig. 1, overleaf). Onpage 538 of this issue, Mayorga et al.1 provideinsights into how this river linkage works forthe world’s largest river system — the Amazon.

There are two main forms of carbon: organic(such as the biomass within a tree) and inor-ganic (CO2 in the atmosphere, for example).These forms are intimately coupled throughphotosynthesis in plants, which creates organicfrom inorganic carbon, and decomposition,which returns plant-produced carbon to itsinorganic form. In rivers, organic and inorganic

carbon exist in approximately equal propor-tions, and originate mainly when rainfall hitscontinental surfaces and either dissolves car-bon, or carries it to rivers in particulate form.

A single river can drain a landscape that hasa wide array of plant species, land uses, soilsand climatic zones. This complexity has madeit difficult to pin down exactly where mostriver carbon originates, how long it existed onland before being carried to a river, and howreactive it might be once in a river and, later, inthe coastal ocean. Most of the carbon in riversultimately comes from atmospheric CO2 andtherefore represents mobile ‘greenhouse car-bon’ that either cycles back to the atmosphereand contributes to global warming, or enters astorage compartment that is not in contactwith the atmosphere (coastal sediments, forexample; Fig. 1).

The Amazon basin is a central player in theglobal carbon balance because it stores largeamounts of carbon in biomass above ground,and this carbon is being returned to the atmos-phere by slash-and-burn agriculture2. But the

8. Blagosklonny, M. V. Cancer Cell 5, 13–17 (2004).9. Richardson, T. P., Peters, M. C., Ennett, A. & Mooney, D. J.

Nature Biotechnol. 19, 1029–1034 (2001).10. Nori, A. & Kopecek, J. Adv. Drug Deliv. Rev. 57, 609–636

(2005).11. Kim, D. W., Lu, B. & Hallahan, D. E. Curr. Opin. Invest. Drugs

5, 597–604 (2004).

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© 2005 Nature Publishing Group