Recent studies have revealed that crosstalk between glioma cells and the brain microenvironment is a crucial regulator of cancer initiation and progression. A vast majority of glioma patients suffer from seizures, and this pathological neuronal activity has been proposed to contribute to increased glioma cell proliferation. Glioma patients also suffer from additional neurological symptoms, including deficits in attention, concentration, memory, and language. These neurological effects of gliomas along with the limited therapeutic options underscore the need for novel therapies. This thesis investigates the neuronal alterations at the margins of glioma which contribute to the neurological symptoms (Chapter 2), and on the effect of sensory stimulation on the glioma cells and microglia in the glioma microenvironment (Chapter 3). The work describes the development of new mouse models in which glioma cells are infiltrating the somatosensory cortex in mice that express GCaMP in neurons or microglia. Methodologies include a combination of in vivo two-photon calcium imaging and tissue-based analysis to determine the glioma-induced alteration on whisker stimulation-evoked responses of these different cell types. This work also tests the effects of pharmacologically inhibiting mTOR signaling on neuronal responses (Chapter 2) or purinergic signaling on microglial responses (Chapter 3). Together these studies demonstrate that glioma infiltration induces local effects in functionally-responsive cortex, and that many of these glioma-induced effects on neurons and microglia are ameliorated by pharmacological inhibition of mTOR or purinergic signaling. This reveals a highly dynamic and plastic nature of the glioma-induced alterations, and points towards new strategies to treat glioma-associated neurological symptoms while potentially slowing tumor progression.

Os gliomas de vias ópticas (GVO) representam 5% dos tumores cerebrais pediátricos e geralmente aparecem histologicamente como astrocitomas de baixo grau. Por causa do curso imprevisto dos GVO, as opções de tratamento ainda são controversas, envolvendo vigilância, cirurgia, quimioterapia e radioterapia. Neste estudo, realizamos a análise volumétricas de gliomas de vias ópticas envolvendo as regiões óptico-quiasmáticas e hipotalâmica (GOQH) para comparar a evolução as neoplasias tratadas com e sem quimioterapia, comparando o volume e componentes das lesões. Foram analisados retrospectivamente 14 pacientes com (GOQH) que foram submetidos a Ressonância Magnética em nosso departamento de janeiro de 2000 a outubro de 2015. Um total de 45 RM de encéfalo foram incluídas, com uma média de 3,2 estudos/paciente. A avaliação das lesões foi realizada manualmente por um Neurorradiologista, usando o Software DISPLAY. Quatro destes pacientes eram portadores de NF-1. Oito foram tratados com quimioterapia, sendo carboplatina e vincristina (Carbo/VCR) os agentes de primeira linha. As medidas volumétricas foram realizadas com separação entre os componentes sólidos e císticos das neoplasia, usando as sequências FLAIR e T1 pós contraste, com o apoio de imagens ponderadas em T1 e T2. Um aumento de aproximadamente 30% do volume para as lesões sólidas e uma redução de 19,4% no volume das lesões sólido-císticas foram observados no período global após o tratamento com quimioterapia, porém ambos sem significância estatística. Entre os pacientes não tratados, observou-se uma redução de 16,6 % do volume global das lesões durante o período de acompanhamento. A avaliação da eficácia do tratamento para pacientes com GOQH é difícil, dada a raridade de casos e heterogeneidade radiológica. Os dados de algumas publicações argumentam que o valor da quimioterapia é controverso e não se correlaciona com a resposta radiológica. Em nosso estudo observamos uma pequena redução do volume de neoplasias entre os pacientes tratados e não tratados com quimioterapia, porém sem significância estatística. Ensaios clínicos prospectivos são necessários para melhor avaliar o efeito da quimioterapia sobre OPG. / Optic pathway gliomas (OPG) represent 5% of pediatric brain tumors and generally appear histologically as low-grade astrocytomas. Because of the unpredictable course of OPG, adequate treatment method has been controversial, involving surveillance, surgery, chemotherapy and radiotherapy. In this study, we use volumetric imaging to compare evolution between OPG treated with and without chemotherapy, analyzing the volume and components of the lesions. We retrospectively analyzed 14 patients with OPG who underwent MRI in our department from January 2000 to October 2015. A total of 45 brain MRI were included, with an average of 3,2 studies/patient. The assessment of lesions was manually performed by a neuroradiologist, using software DISPLAY. Four of these patients had NF-1. Eight were treated with chemotherapy, using carboplatin and vincristine (Carbo/VCR) as first-line agents. Volumetric measurements of tumors were segmented into solid and cystic components using FLAIR and T1 weighted images after Gadolinium sequences, with support of T1 and T2 weighted images. An increase of approximately 30% of volume for solid lesions and a decrease of 19,4% for solid-cystic lesions were noted following chemotherapy in overall period, both with no statistical significance. Among patients not treated with chemotherapy, we observed a reduction of 16% in overall volume of the lesions Evaluation of treatment efficacy for OPG patients is difficult, given the rarity of cases and radiological heterogeneity. Data from some publications argued that the value of chemotherapy is controversial and does not correlate with radiological response. From our study we observed a small volume reduction of neoplasms among patients treated and not treated with chemotherapy. Larger prospective clinical trials are needed to better evaluate the effect of chemotherapy on OPG.

Os gliomas de vias ópticas (GVO) representam 5% dos tumores cerebrais pediátricos e geralmente aparecem histologicamente como astrocitomas de baixo grau. Por causa do curso imprevisto dos GVO, as opções de tratamento ainda são controversas, envolvendo vigilância, cirurgia, quimioterapia e radioterapia. Neste estudo, realizamos a análise volumétricas de gliomas de vias ópticas envolvendo as regiões óptico-quiasmáticas e hipotalâmica (GOQH) para comparar a evolução as neoplasias tratadas com e sem quimioterapia, comparando o volume e componentes das lesões. Foram analisados retrospectivamente 14 pacientes com (GOQH) que foram submetidos a Ressonância Magnética em nosso departamento de janeiro de 2000 a outubro de 2015. Um total de 45 RM de encéfalo foram incluídas, com uma média de 3,2 estudos/paciente. A avaliação das lesões foi realizada manualmente por um Neurorradiologista, usando o Software DISPLAY. Quatro destes pacientes eram portadores de NF-1. Oito foram tratados com quimioterapia, sendo carboplatina e vincristina (Carbo/VCR) os agentes de primeira linha. As medidas volumétricas foram realizadas com separação entre os componentes sólidos e císticos das neoplasia, usando as sequências FLAIR e T1 pós contraste, com o apoio de imagens ponderadas em T1 e T2. Um aumento de aproximadamente 30% do volume para as lesões sólidas e uma redução de 19,4% no volume das lesões sólido-císticas foram observados no período global após o tratamento com quimioterapia, porém ambos sem significância estatística. Entre os pacientes não tratados, observou-se uma redução de 16,6 % do volume global das lesões durante o período de acompanhamento. A avaliação da eficácia do tratamento para pacientes com GOQH é difícil, dada a raridade de casos e heterogeneidade radiológica. Os dados de algumas publicações argumentam que o valor da quimioterapia é controverso e não se correlaciona com a resposta radiológica. Em nosso estudo observamos uma pequena redução do volume de neoplasias entre os pacientes tratados e não tratados com quimioterapia, porém sem significância estatística. Ensaios clínicos prospectivos são necessários para melhor avaliar o efeito da quimioterapia sobre OPG. / Optic pathway gliomas (OPG) represent 5% of pediatric brain tumors and generally appear histologically as low-grade astrocytomas. Because of the unpredictable course of OPG, adequate treatment method has been controversial, involving surveillance, surgery, chemotherapy and radiotherapy. In this study, we use volumetric imaging to compare evolution between OPG treated with and without chemotherapy, analyzing the volume and components of the lesions. We retrospectively analyzed 14 patients with OPG who underwent MRI in our department from January 2000 to October 2015. A total of 45 brain MRI were included, with an average of 3,2 studies/patient. The assessment of lesions was manually performed by a neuroradiologist, using software DISPLAY. Four of these patients had NF-1. Eight were treated with chemotherapy, using carboplatin and vincristine (Carbo/VCR) as first-line agents. Volumetric measurements of tumors were segmented into solid and cystic components using FLAIR and T1 weighted images after Gadolinium sequences, with support of T1 and T2 weighted images. An increase of approximately 30% of volume for solid lesions and a decrease of 19,4% for solid-cystic lesions were noted following chemotherapy in overall period, both with no statistical significance. Among patients not treated with chemotherapy, we observed a reduction of 16% in overall volume of the lesions Evaluation of treatment efficacy for OPG patients is difficult, given the rarity of cases and radiological heterogeneity. Data from some publications argued that the value of chemotherapy is controversial and does not correlate with radiological response. From our study we observed a small volume reduction of neoplasms among patients treated and not treated with chemotherapy. Larger prospective clinical trials are needed to better evaluate the effect of chemotherapy on OPG.

Le traitement sémantique est le processus mental par lequel nous accédons au sens. Il occupe donc une place centrale dans la compréhension et la production du langage, mais également dans le fonctionnement humain en général, puisqu'il permet de conceptualiser le monde qui nous entoure et de lui donner un sens, en le confrontant en pleine conscience aux connaissances que nous emmagasinons au fil de nos expériences. Si les bases neurales corticales du traitement sémantique sont bien documentées par de nombreuses études basées sur les données de l'imagerie fonctionnelle notamment, l'analyse de la connectivité sous-corticale impliquée dans ce traitement a jusqu'ici reçu moins d'attention. Les auteurs s'accordent néanmoins sur l'existence d'une voie ventrale sémantique, parallèle à une voie dorsale dédiée au traitement phonologique. Le présent ouvrage se propose d'apporter un nouvel éclairage à la connaissance des bases neurales du traitement sémantique du mot isolé, en lien avec le cadre plus large du traitement sémantique non-verbal, par l'étude des habiletés sémantiques de patients présentant un gliome de grade 2 OMS et pour lequel ils bénéficient d'une prise en charge chirurgicale en condition éveillée, avec cartographie cortico-sous-corticale peropératoire. Il met ainsi en évidence l'importance cruciale du faisceau fronto-occipital inférieur gauche dans cette voie ventrale sémantique, au sein d'une organisation cérébrale fonctionnelle en réseaux parallèles et distribués de zones corticales interconnectées par des faisceaux d'association de substance blanche. Il souligne également le caractère interactif du fonctionnement cognitif, ainsi que l'importance des mécanismes de contrôle dans le traitement du langage, et de la mesure de la chronométrie mentale lors son évaluation. Ces différentes considérations nous amènent à proposer un modèle hodotopique général d'organisation anatomo-fonctionnelle du langage. Les résultats présentés dans cet ouvrage peuvent donc avoir des implications cliniques et scientifiques majeures, quant à la compréhension de l'organisation cérébrale fonctionnelle du langage, de ses dysfonctionnements, des mécanismes de réorganisation fonctionnelle en cas de lésion et à l'élaboration de programmes de réhabilitation. / Semantic processing is the mental process by which we access to meaning. Therefore, it takes a central place in language comprehension and production, but also in the whole human functioning, since it allows conceptualizing and giving a meaning to the world, by confronting it consciously with the knowledge we store over our experiences. If the neural bases of semantic processing are well known at the cortical level, thanks to numerous studies based particularly on functional neuroimaging data, the analysis of the subcortical connectivity underlying this processing received so far less attention. Nevertheless, the authors agree on the existence of a semantic ventral stream, parallel to a phonological dorsal stream.The present work mean to bring a new highlight on the knowledge of the neural bases of semantic processing at the level of the single word, in connection with the wider setting of non verbal semantic processing, by the study of semantic skills in patients presenting with WHO grade 2 glioma, and for which they undergo a surgery in awaken conditions, with cortico-subcortical intraoperative mapping. Thus, this work highlights the crucial role of the inferior fronto-occipital fascicle, in this ventral semantic route, within a functional brain organization in parallel and distributed networks of cortical areas interconnected by white matter association fibers.it underlines also the interactive feature of cognitive functioning, and the significance of control mechanisms in language processing, as well as the measuring of mental chronometry when assessing it. These considerations lead us to propose a general hodotopical model of language anatomo-functional organization.The results presented in this work may thus have important clinical and scientific implications, regarding the comprehension of language brain functional organization, of its dysfunctioning, of functional reorganization mechanisms in case of brain lesion, and the elaboration of rehabilitation programs.

Depuis que Parsons et col. ont découvert en 2008 que le gène de l’isocitrate déhydrogénase 1 (IDH1) est fréquemment muté dans les glioblastomes (12%), de nombreuses équipes ont étudié la prévalence et les caractéristiques des mutations des gènes IDH1 et 2 dans les gliomes.Les mutations du gène IDH1 sont observées dans environ 40% des gliomes. La mutation d’IDH1 la plus fréquentes dans les gliomes (>90% des cas) est la mutation R132H. La fréquence des mutations IDH1 et 2 est inversement corrélée au grade des gliomes (grade II ~80%, III ~50%, and IV ~10%). Les mutations IDH1/2 ont une valeur diagnostique ainsi que pronostique (associées à une meilleure survie). Pendant ce travail de thèse nous avons dans une première partie analysé la distribution de ces mutations IDH1/2 dans les différents gliomes, leur association avec d’autres altérations génétiques, ainsi que leur valeur diagnostique et pronostique dans une cohorte de 1332 patients atteints de gliomes. Nous confirmons sur cette très grande cohorte les données de la littérature et affinons la valeur pronostique des mutations IDH1/2. Dans une seconde partie, nous avons mis en évidence dans les gliomes un polymorphisme (SNP) du gène IDH1 (SNP rs 11554137; C (cytosine) substituted by T (thymin)) précédemment observé dans les leucémies myéloïdes aigues. Ce SNP, codon 105, est localisé dans le même exon que le codon 132 fréquemment muté, et nous avons montré qu’il est associé à une moins bonne survie des patients atteints de gliomes. Les mutations du codon 132 causent une baisse de l’activité enzymatique normale d’IDH1/2 qui est remplacé par le gain d’une nouvelle. Les protéines IDH1/2 mutés, au lieu de produire de l’alpha-cétoglutarate de façon NADP dépendante, réduisent de façon NADPH dépendante l’alpha-cétoglutarate en 2-hydroxyglutarate (2HG). Une forte concentration de 2HG et une baisse de la quantité de NADPH peuvent sensibiliser les tumeurs au stress oxidatif et donc potentialiser l’effet de la radiothérapie, ce qui pourrait expliquer la meilleure survie de ces patients. Nous avons donc dans une troisième partie étudié in vitro l’impact de la mutation IDH1R132H sur la survie après radiothérapie de cellules tumorales exprimant de façon stable ce gène muté. Les résultats obtenus montrent que dans certaines conditions ces cellules pourraient être plus radiosensibles que les mêmes cellules exprimant le gène IDH1 non-muté.Dans ce travail de thèse, nous avons donc étudié le gène IDH1 dans les gliomes de patients et tenté par une approche fonctionnelle in vitro d’évaluer l’impact de la mutation IDH1R132H sur la radiosensibilité des cellules tumorales. / Since Parsons et al. (2008) found the frequent mutations of IDH1 (12%) in GBMs, various reports have studied the prevalence and characteristic of IDH1 and IDH2 mutations.The mutations in the isocitrate dehydrogenase 1 (IDH1) gene occur in nearly 40% of gliomas. The frequency of IDH1 mutations are inversely connected with grade II (~80%), III (~50%), and IV (~ 10%) gliomas. Importantly, the status of IDH1 mutations is associated with a better outcome and demonstrated a diagnostic value. We analyzed also these mutations in distribution, association with tumor-derived other genetic alterations and the diagnostic and prognostic value in a cohort of 1332 glioma patients.A synonymous single nucleotide polymorphism [SNP rs 11554137; C (cytosine) substituted by T (thymin)] has been studied in gliomas patients. The SNP rs 11554137 (in codon 105) are located in the same exon with the IDH1 R132 mutations (in codon 132). And gliomas patients with SNP rs 11554137: C>T had a poorer outcome than patients without SNP rs 11554137. This was observed a similarly adverse effect in survival in patients with AML. Mutations in codon 132 can cause a decrease of IDH1/2 activity and also gain a new enzyme function for the NADPH dependent reduction of alpha-ketoglutarate to 2-hydroxyglutarate. High 2HG and low NADPH levels might sensitize tumors to oxidative stress, potentiating response to radiotherapy, and may account for the prolonged survival of patients harboring the mutations. So we studied further the alterations of function in IDH1R132H mutant cells in vitro. Based on the decrease of defence and the increase of impairing factors in tumor cells, we found that the tumors harbouring IDH1 mutations may have an elevated radiosensitivity. In the present study, we described the impact of IDH1 mutations in gliomas and search for new perspectives for the treatment strategy.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-06-28T19:56:24Z No. of bitstreams: 1 DIS_ANA_HELENA_BRETANHA_LOPES_TORT_COMPLETO.pdf: 1228563 bytes, checksum: 1ae15f2eb2fe5ed55580c78c418cb7be (MD5) / Made available in DSpace on 2016-06-28T19:56:24Z (GMT). No. of bitstreams: 1 DIS_ANA_HELENA_BRETANHA_LOPES_TORT_COMPLETO.pdf: 1228563 bytes, checksum: 1ae15f2eb2fe5ed55580c78c418cb7be (MD5) Previous issue date: 2016-02-15 / Gliomas are primary tumors of the central nervous system that are associated with a high mortality rate; they course with an average survival rate of 2 years after the diagnosis. Less than 5 % of glioma patients survive more than five years after diagnosis, even those treated with state of the art protocols, which include surgery, radiotherapy and chemotherapy. Tumors result from impairments of intracellular signaling pathways, including the p38/MAPK pathway, which, are responsible to control of cell proliferation and tumorigenesis, among other cellular responses. The goal of the present work was to investigate the effects of ML3403, an inhibitor of p38/MAPK, on the viability and proliferation of glioma cells, and to assess its effect when combined with bevacizumab (BVZ). BVZ already used in the clinical setting as anadjuvant for treating gliomas. It is a monoclonal antibody against VEGF-A receptor and thus reduces the signaling involved in tumor angiogenesis. U138 and U251 glioma cells were treated with ML3403 (0.1 to 200 ?M) and BVZ (1 to 200 ?g/mL) and later assessedfor cell viability, by MTT method and proliferation by cell counting. The results demonstrate that treatment with ML3403 reduces glioma cell viability and proliferation. Co-treatment with BVZ does not present any significant effect. The use of p38/MAPK inhibitors may constitute an interesting treatment against glioma progression. / Por serem tumores prim?rios localizados no sistema nervoso central, os gliomas apresentam altas taxas de mortalidade com sobrevida m?dia de dois anos. Menos de 5% dos pacientes com gliomas sobrevivem mais de cinco anos ap?s o diagn?stico, mesmo com os tratamentos mais avan?ados, os quais envolvem cirurgia, radia??o e quimioterapia. Os tumores resultam de diferentes defeitos em vias de sinaliza??o intracelulares, incluindo a via p38/MAPK. Entre as respostas celulares mediadas pela fam?lia de p38/MAPK, destaca-se a regula??o da produ??o do fator de crescimento endotelial vascular (VEGF). O objetivo deste trabalho foi investigar os efeitos de ML3403, um inibidor da p38/MAPK, sobre a viabilidade das c?lulas de glioma, e avaliar o seu efeito combinado com bevacizumab (BVZ). O BVZ, j? utilizado na cl?nica como adjuvante no tratamento de gliomas, ? um anticorpo monoclonal contra o receptor de VEGF-Ae reduz a sinaliza??o envolvida no processo de angiog?nese tumoral. As c?lulas de gliomas U138MG e U251MG foram tratadas com ML3403 (0,1 a 200?M) e BVZ (1 a 200 ?g/mL)e avaliadas para viabilidade celular, atrav?s do m?todo do MTT e prolifera??o celular, atrav?s da contagem do n?mero de c?lulas. Os resultados obtidos demonstraram redu??o da viabilidade e prolifera??o celular ap?s o tratamento com ML3403. O co-tratamento com BVZ n?o apresentou efeito aditivo. A utiliza??o de inibidores da via de sinaliza??o p38/MAPK pode ser considerada como um tratamento promissor na diminui??o do crescimento de gliomas.

The large size of the datasets produced by medical imaging protocols contributes to the success of supervised discriminative methods for semantic labelling of images. Our study makes use of a general and efficient emerging framework, discriminative random forests, for the detection of brain lesions in multi-modal magnetic resonance images (MRIs). The contribution is three-fold. First, we focus on segmentation of brain lesions which is an essential task to diagnosis, prognosis and therapy planning. A context-aware random forest is designed for the automatic multi-class segmentation of MS lesions, low grade and high grade gliomas in MR images. It uses multi-channel MRIs, prior knowledge on tissue classes, symmetrical and long-range spatial context to discriminate lesions from background. Then, we investigate the promising perspective of estimating the brain tumor cell density from MRIs. A generative-discriminative framework is presented to learn the latent and clinically unavailable tumor cell density from model-based estimations associated with synthetic MRIs. The generative model is a validated and publicly available biophysiological tumor growth simulator. The discriminative model builds on multi-variate regression random forests to estimate the voxel-wise distribution of tumor cell density from input MRIs. Finally, we present the "Spatially Adaptive Random Forests" which merge the benefits of multi-scale and random forest methods and apply it to previously cited classification and regression settings. Quantitative evaluation of the proposed methods are carried out on publicly available labeled datasets and demonstrate state of the art performance.

Malignant brain tumor is one of the most lethal forms of cancers. In the United States alone, approximately 20,500 new cases of primary malignant brain and central nervous system tumors are expected to be diagnosed in 2007 with 12,740 deaths estimated. Treatment of malignant brain tumor remains a major challenge despite recent advance in surgery and other adjuvant therapies, such as chemotherapy. The failure of potential effective chemotherapeutics for brain tumor treatment is usually not due to the lack of potency of the drug, but rather can be attributed to lack of therapeutic strategies capable of overcoming blood brain barrier for effective delivery of drug to the brain tumor. In this thesis, we developed a minimally invasive sustained release system for glioma therapy. The present study was initiated in an effort to incorporated Doxorubicin (DOX) loaded PLGA particle into an agarose gel, which can provide a continuous release of DOX locally to the tumor site. DOX, a toposiomearase II inhibitor, is not currently used clinically for brain tumor treatment because when delivered systemically it does not cross BBB. Our hydrogel particle system can overcome this shortcoming of DOX. The results from this study demonstrate that the DOX/PLGA particle gel system can maintain the bioactivity of DOX and sustained release DOX for at least 15 day in vitro. The result of in vivo study showed the DOX/PLGA particle gel treated group had significantly extend the medium survival of 9L glioma bearing rat from 21 days to 29 days. Therefore, the success experience of this local and sustained delivery device might benefit the development of future glioma therapy strategy.

The invasive nature of glioblastoma (GBM) represents a significant challenge to the standard of care and contributes to poor clinical outcomes. Invasion of tumors into healthy brain restricts chemotherapeutic access and complicates surgical resection. The central hypothesis of the thesis is that an effective anti-invasive agent can enhance the standard chemotherapeutic response in invasive brain tumors. Through a screen of novel compounds, a new anti-invasive small molecule, Imipramine Blue (IB), was identified. This triphenylmethane compound inhibits invasion of highly invasive glioma in vitro and in vivo. To elicit a response in vivo, Imipramine Blue was liposomally encapsulated to yield better delivery to tumor. Using this formulation, it is shown that IB attenuates invasion of glioma in vivo leading to a more compact tumor in an aggressively invasive rodent glioma model. Further, it is shown that this novel compound binds NADPH oxidases and alters expression of actin regulatory elements to elicit this anti-invasive activity. To test our hypothesis that anti-invasive therapy coupled with chemotherapy will enhance efficacy, nano-IB therapy was followed by liposomally encapsulated doxorubicin (DXR) chemotherapy. Additionally, a co-encapsulated formulation of IB and DXR was developed and tested in vivo. This combination therapy significantly enhanced survival compared to IB or DXR alone, resulting in long-term survival in the syngeneic invasive rat astrocytoma model RT2. It was seen that sequential treatment was more effective than the co-encapsulated treatment indicating a benefit of pre-treating the tumor with the anti-invasive. This thesis demonstrates that novel anti-invasive IB mediated 'containment' of diffuse glioma significantly enhances the efficacy of DXR chemotherapy compared to chemotherapy or anti-invasive therapy alone.

Liposomal nanocarriers offer much promise in chemotherapeutic drug delivery because they may be specifically targeted to tumors thereby shielding healthy organs from toxic side effects of incorporated drugs. Passive targeting of liposomes is achieved through the inclusion of PEG to evade the RES and prolong circulation in the bloodstream. Since tumor vasculature exhibits increased permeability, prolonged circulation results in passive accumulation of liposomes to tumor. Active targeting is accomplished through the inclusion of agents targeted to over-expressed receptors on tumor cells. In vitro studies have demonstrated increased cytotoxicity of actively targeted liposomes due to specific uptake by tumor cells. In vivo, however, actively targeted liposomal nanocarriers have failed to meet the expectations established by the promising outcomes of in vitro studies. This is attributed to the fact that the inclusion of targeting agents results in accelerated clearance from the bloodstream and reductions in passive targeting to tumor thereby offsetting the benefits of active targeting. The central focus of this thesis was to engineer a multi-functional nanoscale drug delivery system which would enable active targeting without compromising RES evasion and passive accumulation to tumor. It was shown that the use of folate in liposomal formulations significantly reduced blood circulation times. To prevent RES recognition of folate on targeted liposomal formulations, a cysteine cleavable phospholipid-PEG conjugate was utilized to "mask" targeting ligands while liposomes were in circulation. Once passive accumulation at the tumor was achieved, cysteine was administered to detach PEG chains, expose folate, and promote uptake by tumor cells. In vivo studies demonstrated that cleavable DSPE-PEG5000 was capable of concealing folate on liposomes to maintain prolonged circulation times. In vitro studies verified the ability to conceal and expose folate on demand, permitting receptor mediated targeting and delivery of drug to target cells. Studies conducted to analyze drug uptake by tumor cells in vivo confirmed that delivery was enhanced when tumor-inoculated animals received targeted liposomes containing cleavable PEG chains followed by a cysteine infusion to expose folate. These results indicate that detachable PEG chains can be used in targeted liposomal formulations to enhance efficacy of chemotherapy in the treatment of glioma.