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Vilaseca A, Campillo N, Torres M, Musquera M, Gozal D, Montserrat JM, Alcaraz A, Touijer KA, Farré R, Almendros I. Intermittent hypoxia increases kidney tumor vascularization in a murine model of sleep apnea. PLoS One 2017; 12:e0179444. [PMID: 28594929 PMCID: PMC5464763 DOI: 10.1371/journal.pone.0179444] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/29/2017] [Indexed: 12/11/2022] Open
Abstract
We investigate the effects of intermittent hypoxia (IH), a characteristic feature of obstructive sleep apnea (OSA), on renal cancer progression in an animal and cell model. An in vivo mouse model (Balb/c, n = 50) of kidney cancer was used to assess the effect of IH on tumor growth, metastatic capacity, angiogenesis and tumor immune response. An in vitro model tested the effect of IH on RENCA cells, macrophages and endothelial cells. Tumor growth, metastatic capacity, circulating vascular endothelial growth factor (VEGF) and content of endothelial cells, tumor associated macrophages and their phenotype were assessed in the tumor. In vitro, VEGF cell expression was quantified.Although IH did not boost tumor growth, it significantly increased endothelial cells (p = 0.001) and circulating VEGF (p<0.001) in the in vivo model. Macrophages exposed to IH in vitro increased VEGF expression, whereas RENCA cells and endothelial cells did not. These findings are in keeping with previous clinical data suggesting that OSA has no effect on kidney cancer size and that the association observed between OSA and higher Fuhrman grade of renal cell carcinoma may be mediated though a proangiogenic process, with a key role of macrophages.
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Affiliation(s)
- Antoni Vilaseca
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Urology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Noelia Campillo
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Institute for Bioengineering of Catalonia, Barcelona, Spain
| | - Marta Torres
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
- Laboratori del son, Servei de Pneumologia, Hospital Clínic, Barcelona, Spain
| | - Mireia Musquera
- Urology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, United States of America
| | - Josep M. Montserrat
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
- Laboratori del son, Servei de Pneumologia, Hospital Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Antonio Alcaraz
- Urology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Karim A. Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- * E-mail:
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Yaacoby-Bianu K, Hakim F. Sleep Disturbance and Cancer—Animal Models. CURRENT SLEEP MEDICINE REPORTS 2017. [DOI: 10.1007/s40675-017-0073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Balachandran DD, Bashoura L, Faiz SA. Sleep-Related Breathing Disorders and Cancer. CURRENT PULMONOLOGY REPORTS 2017. [DOI: 10.1007/s13665-017-0182-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Almendros I, Martinez-Garcia MÁ, Obeso A, Gozal D. Obstructive Sleep Apnea and Cancer: Insights from Intermittent Hypoxia Experimental Models. CURRENT SLEEP MEDICINE REPORTS 2017. [DOI: 10.1007/s40675-017-0064-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Affiliation(s)
- Diane C. Lim
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania 19104;
| | - Allan I. Pack
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104
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Intermittent Hypoxia and Unsaturated Aldehydes: Effects on Oral Epithelial Wound Healing. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1023:47-54. [PMID: 28681187 DOI: 10.1007/5584_2017_68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent sleep breathing disorder characterized by intermittent hypoxia (IH), leading to blood hypoxemia, hypercapnia, and sleep fragmentation. Studies on the effects of OSA on oral epithelial tissue healing are limited. Smoking is considered a risk factor for OSA through the exposure to chemically active toxins, present in the smoke. Acrolein is the most chemically active unsaturated aldehyde, impairing a variety of biological processes. The aim of this study was to determine the effect of IH on oral epithelial tissue healing, with and without acrolein. HaCaT cells were wounded by a cross-scratch made in the cell cultures, considered as time zero. Then, cells were exposed to 28 IH cycles (5-20% oxygen) during 12 h using the BioSpherix OxyCycler-C42 system. Control cells were maintained in normoxic conditions or in sustained hypoxia (SH) (5% oxygen) for the same durations, after which all cells were maintained for additional 12 h in normoxia. The migrating abilities of cells were measured after 24 h by calculating the percent of the residual cross-scratch area. In parallel experiments, 25 μM acrolein were added to each treatment. We found that the scratch closure was the slowest under IH. After 24 h, the residual scratch area in the IH treated cells was 29.5 ± 13.4% of the initial area, while in normoxia and SH it was 9.2 ± 5.8% and 10.3 ± 11.3%, respectively (p < 0.01 for both vs. IH). Adding acrolein further attenuated the migratory ability in IH as compared to normoxia and SH. We conclude that IH delays the healing process of oral epithelial tissue by slowing the cells' migratory abilities. The healing might be further attenuated by chemically active unsaturated aldehydes such as acrolein.
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Gildeh N, Drakatos P, Higgins S, Rosenzweig I, Kent BD. Emerging co-morbidities of obstructive sleep apnea: cognition, kidney disease, and cancer. J Thorac Dis 2016; 8:E901-E917. [PMID: 27747026 DOI: 10.21037/jtd.2016.09.23] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Obstructive sleep apnea (OSA) causes daytime fatigue and sleepiness, and has an established relationship with cardiovascular and metabolic disease. Recent years have seen the emergence of an evidence base linking OSA with an increased risk of degenerative neurological disease and associated cognitive impairment, an accelerated rate of decline in kidney function with an increased risk of clinically significant chronic kidney disease (CKD), and with a significantly higher rate of cancer incidence and death. This review evaluates the evidence base linking OSA with these seemingly unrelated co-morbidities, and explores potential mechanistic links underpinning their development in patients with OSA, including intermittent hypoxia (IH), sleep fragmentation, sympathetic excitation, and immune dysregulation.
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Affiliation(s)
- Nadia Gildeh
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Panagis Drakatos
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sean Higgins
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK;; Danish Epilepsy Centre, Dianalund, Denmark
| | - Brian D Kent
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Almendros I, Khalyfa A, Trzepizur W, Gileles-Hillel A, Huang L, Akbarpour M, Andrade J, Farré R, Gozal D. Tumor Cell Malignant Properties Are Enhanced by Circulating Exosomes in Sleep Apnea. Chest 2016; 150:1030-1041. [PMID: 27568581 DOI: 10.1016/j.chest.2016.08.1438] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/16/2016] [Accepted: 08/01/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND OSA is associated with increased cancer incidence and mortality. Exosomes are vesicles secreted by most cells. They are released into the bloodstream and play a role in tumor progression and metastasis. We evaluated whether the chronic intermittent hypoxia (IH) that characterizes OSA leads to release of tumor-promoting exosomes in the circulation. METHODS C57/B6 male mice were randomized to 6 weeks of IH or room air (RA). A subgroup was injected with TC1 lung carcinoma cells in the left flank after 2 weeks of IH. Exosomes from mouse plasma and from 10 adult human patients with OSA before and after treatment for 6 weeks were cocultured with mouse TC1 and human adenocarcinoma cells lines. Malignant tumor properties such as proliferation, migration, invasion, and endothelial monolayer disruption were assessed, as was micro-RNA (miRNA), exosomal content, and transcriptomic effects of exosomes on TC1 cells in vitro to identify target genes. RESULTS Application of IH-induced exosomes from either IH-exposed tumor-bearing (IH+) or non-tumor-bearing (IH-) mice significantly promoted TC1 malignant properties. Similarly, before adherent treatment, exosomes from patients with OSA significantly enhanced proliferation and migration of human adenocarcinoma cells compared with after adherent treatment. Eleven distinct miRNAs emerged in IH-exposed mice, and their gene targets in TC1 cells were identified. CONCLUSIONS Circulating exosomes released under IH conditions in vivo selectively enhance specific properties of lung tumor cell cultures. Thus, plasma exosomes participate in the increased tumor aggressiveness observed in patients with OSA.
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Affiliation(s)
- Isaac Almendros
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL; Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona-IDIBAPS, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Abdelnaby Khalyfa
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Wojciech Trzepizur
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Alex Gileles-Hillel
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Lei Huang
- Center for Research Informatics, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Mahzad Akbarpour
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Jorge Andrade
- Center for Research Informatics, Biological Sciences Division, The University of Chicago, Chicago, IL
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona-IDIBAPS, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - David Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL.
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Martínez-García MÁ, Campos-Rodriguez F, Barbé F. Cancer and OSA: Current Evidence From Human Studies. Chest 2016; 150:451-63. [PMID: 27164292 DOI: 10.1016/j.chest.2016.04.029] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/18/2016] [Accepted: 04/26/2016] [Indexed: 12/23/2022] Open
Abstract
Despite the undeniable medical advances achieved in recent decades, cancer remains one of the main causes of mortality. It is thus extremely important to make every effort to discover new risk factors for this disease, particularly ones that can be treated or modified. Various pathophysiologic pathways have been postulated as possible causes of cancer or its increased aggressiveness, and also of greater resistance to antitumoral treatment, in the presence of both intermittent hypoxia and sleep fragmentation (both inherent to sleep apnea). Thus far, these biological hypotheses have been supported by various experimental studies in animals. Meanwhile, recent human studies drawing on preexisting databases have observed an increase in cancer incidence and mortality in patients with a greater severity of sleep-disordered breathing. However, the methodologic limitations of these studies (which are mostly retrospective and lack any measurement of direct markers of intermittent hypoxia or sleep fragmentation) highlight the need for controlled, prospective studies that would provide stronger scientific evidence regarding the existence of this association and its main characteristics, as well as explore its nature and origin in greater depth. The great epidemiologic impact of both cancer and sleep apnea and the potential for clinical treatment make this field of research an exciting challenge.
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Affiliation(s)
- Miguel Ángel Martínez-García
- Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain.
| | | | - Ferrán Barbé
- Respiratory Department, Institut de Recerca Biomedica (IRBLeida), Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
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Obstructive sleep apnea and Fuhrman grade in patients with clear cell renal cell carcinoma treated surgically. World J Urol 2016; 35:51-56. [PMID: 27108420 DOI: 10.1007/s00345-016-1830-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 04/12/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To assess the association between obstructive sleep apnea (OSA) and Fuhrman grade in patients with clear cell renal cell carcinoma (ccRCC). As secondary endpoints, we studied its association with tumor size, metastasis-free survival (MFS) and cancer-specific survival (CSS). METHODS We reviewed the databases of two tertiary care centers, identifying 2579 patients who underwent partial or radical nephrectomy for ccRCC between 1991 and 2014. Descriptive statistics were used to compare pathologic variables between patients with and without OSA. Linear and logistic regression models were used to assess the association of OSA with Fuhrman grade and tumor size. A Cox proportional hazards model was used to determine OSA association with MFS and CSS. A pathway analysis was performed on a cohort with available gene expression data. RESULTS In total, 172 patients (7 %) had self-reported OSA at diagnosis. More patients with OSA had high Fuhrman grade compared to those without OSA [51 vs. 38 %; 13 % risk difference; 95 % confidence interval (CI), 5-20 %; p = 0.003]. On multivariable analysis, the association remained significant (OR 1.41; 95 % CI 1.00-1.99; p = 0.048). OSA was not associated with tumor size (p > 0.5), MFS (p = 0.5) or CSS (p = 0.4). A trend toward vascular endothelial growth factor pathway enrichment was seen in OSA patients (p = 0.08). CONCLUSIONS OSA is associated with high Fuhrman grade in patients undergoing surgery for ccRCC. Pending validation of this novel finding in further prospective studies, it could help shape future research to better understand etiological mechanisms associated.
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Gozal D, Farré R, Nieto FJ. Putative Links Between Sleep Apnea and Cancer: From Hypotheses to Evolving Evidence. Chest 2016; 148:1140-1147. [PMID: 26020135 DOI: 10.1378/chest.15-0634] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
In recent years, the potentially adverse role of sleep-disordered breathing in cancer incidence and outcomes has emerged. In parallel, animal models of intermittent hypoxia (IH) and sleep fragmentation (SF) emulating the two major components of OSA have lent support to the notion that OSA may enhance the proliferative and invasive properties of solid tumors. Based on several lines of evidence, we propose that OSA-induced increases in sympathetic outflow and alterations in immune function are critically involved in modifying oncologic processes including angiogenesis. In this context, we suggest that OSA, via IH (and potentially SF), promotes changes in several signaling pathways and transcription factors that coordinate malignant transformation and expansion, disrupts host immunologic surveillance, and consequently leads to increased probability of oncogenesis, accelerated tumor proliferation, and invasion, ultimately resulting in adverse outcomes.
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Affiliation(s)
- David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL.
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona-IDIBAPS, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Bunyola, Spain
| | - F Javier Nieto
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI
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Perini S, Martinez D, Montanari CC, Fiori CZ. Enhanced expression of melanoma progression markers in mouse model of sleep apnea. REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 22:209-13. [PMID: 26775793 DOI: 10.1016/j.rppnen.2015.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/08/2015] [Accepted: 11/10/2015] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnea has been associated with higher cancer incidence and mortality. Increased melanoma aggressivity was reported in obstructive sleep apnea patients. Mice exposed to intermittent hypoxia (IH) mimicking sleep apnea show enhanced melanoma growth. Markers of melanoma progression have not been investigated in this model. OBJECTIVE The present study examined whether IH affects markers of melanoma tumor progression. METHODS Mice were exposed to isocapnic IH to a nadir of 8% oxygen fraction for 14 days. One million B16F10 melanoma cells were injected subcutaneously. Immunohistochemistry staining for Ki-67, PCNA, S100-beta, HMB-45, Melan-A, TGF-beta, Caspase-1, and HIF-1alpha were quantified using Photoshop. RESULTS Percentage of positive area stained was higher in IH than sham IH group for Caspase-1, Ki-67, PCNA, and Melan-A. The greater expression of several markers of tumor aggressiveness, including markers of ribosomal RNA transcription (Ki-67) and of DNA synthesis (PCNA), in mice exposed to isocapnic IH than in controls provide molecular evidence for a apnea-cancer relationship. CONCLUSIONS These findings have potential repercussions in the understanding of differences in clinical course of tumors in obstructive sleep apnea patients. Further investigation is necessary to confirm mechanisms of these descriptive results.
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Affiliation(s)
- S Perini
- Graduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), RS, Brazil
| | - D Martinez
- Graduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), RS, Brazil; Cardiology Unit, Hospital de Clínicas de Porto Alegre (HCPA), RS, Brazil; Graduate Program in Cardiology and Cardiovascular Sciences, UFRGS, RS, Brazil
| | - C C Montanari
- Graduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), RS, Brazil; Cardiology Unit, Hospital de Clínicas de Porto Alegre (HCPA), RS, Brazil.
| | - C Z Fiori
- Cardiology Unit, Hospital de Clínicas de Porto Alegre (HCPA), RS, Brazil; Graduate Program in Cardiology and Cardiovascular Sciences, UFRGS, RS, Brazil
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Zhang XB, Peng LH, Lyu Z, Jiang XT, Du YP. Obstructive sleep apnoea and the incidence and mortality of cancer: a meta-analysis. Eur J Cancer Care (Engl) 2015; 26. [PMID: 26660307 DOI: 10.1111/ecc.12427] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 12/27/2022]
Affiliation(s)
- Xiao-Bin Zhang
- Department of Respiratory Medicine; Zhongshan Hospital; Xiamen University; Xiamen China
- Teaching Hospital of Fujian Medical University; Xiamen China
| | - Li-Hong Peng
- Department of Respiratory Medicine; Zhongshan Hospital; Xiamen University; Xiamen China
- Teaching Hospital of Fujian Medical University; Xiamen China
| | - Zhi Lyu
- Department of Respiratory Medicine; Zhongshan Hospital; Xiamen University; Xiamen China
- Teaching Hospital of Fujian Medical University; Xiamen China
| | - Xing-Tang Jiang
- Department of Respiratory Medicine; Zhongshan Hospital; Xiamen University; Xiamen China
- Teaching Hospital of Fujian Medical University; Xiamen China
| | - Yan-Ping Du
- Department of Respiratory Medicine; Zhongshan Hospital; Xiamen University; Xiamen China
- Teaching Hospital of Fujian Medical University; Xiamen China
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Kukwa W, Migacz E, Druc K, Grzesiuk E, Czarnecka AM. Obstructive sleep apnea and cancer: effects of intermittent hypoxia? Future Oncol 2015; 11:3285-98. [PMID: 26562000 DOI: 10.2217/fon.15.216] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common disorder characterized by pauses in regular breathing. Apneic episodes lead to recurrent hypoxemia-reoxygenation cycles with concomitant cellular intermittent hypoxia. Studies suggest that intermittent hypoxia in OSA may influence tumorigenesis. This review presents recent articles on the potential role of OSA in cancer development. Relevant research has focused on: molecular pathways mediating the influence of intermittent hypoxia on tumor physiology, animal and epidemiological human studies linking OSA and cancer. Current data relating OSA to risk of neoplastic disease remain scarce, but recent studies reveal the potential for a strong relation. More work is, therefore, needed on the impact of OSA on many cancer-related aspects. Results may offer enlightenment for improved cancer diagnosis and treatment.
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Affiliation(s)
- Wojciech Kukwa
- Department of Otorhinolaryngology, Faculty of Medicine & Dentistry, Medical University of Warsaw, 19/25 Stepinska Street, 00-739 Warsaw, Poland
| | - Ewa Migacz
- Department of Otorhinolaryngology, Faculty of Medicine & Dentistry, Medical University of Warsaw, 19/25 Stepinska Street, 00-739 Warsaw, Poland
| | - Karolina Druc
- Laboratory of Molecular Oncology, Department of Oncology, Military Institute of Medicine, 128 Szaserow Street, 04-141 Warsaw, Poland
| | - Elzbieta Grzesiuk
- Institute of Biochemistry & Biophysics PAS, Molecular Biology Department, 5a Pawinskiego Street, 02-106 Warszawa, Poland
| | - Anna M Czarnecka
- Laboratory of Molecular Oncology, Department of Oncology, Military Institute of Medicine, 128 Szaserow Street, 04-141 Warsaw, Poland
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Gaoatswe G, Kent BD, Corrigan MA, Nolan G, Hogan AE, McNicholas WT, O'Shea D. Invariant Natural Killer T Cell Deficiency and Functional Impairment in Sleep Apnea: Links to Cancer Comorbidity. Sleep 2015; 38:1629-34. [PMID: 26414901 DOI: 10.5665/sleep.5062] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 05/28/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Emerging evidence links obstructive sleep apnea (OSA) with increased cancer incidence and mortality. Invariant natural killer T (iNKT) cells play an important role in cancer immunity. We hypothesized that patients with OSA have low number of circulating invariant natural killer T (iNKT) cells, which may also be functionally impaired. This study aims to evaluate the frequency of circulating iNKT cells in OSA. DESIGN We evaluated the frequency of circulating iNKT cells by flow cytometry in 33 snorers being assessed for possible OSA. Using iNKT cell lines, we also evaluated the effect of exposure to hypoxia over 24 hours on apoptosis, cytotoxicity, and cytokine production. SETTING Teaching hospital based sleep unit and research laboratory. PATIENTS Thirty-three snorers were evaluated: 9 with no OSA (apnea-hypopnea frequency [AHI] < 5/h), 12 with mild-moderate OSA (AHI 5-30) and 12 with severe OSA (AHI > 30). MEASUREMENTS AND RESULTS Patients with severe OSA had considerably fewer iNKT cells (0.18%) compared to patients with mild-moderate (0.24%) or no OSA (0.35%), P = 0.0026. The frequency of iNKT cells correlated negatively with apnea-hypopnea index (r = -0.58, P = 0.001), oxygen desaturation index (r = -0.58, P = 0.0003), and SpO2% < 90% (r = -0.5407, P = 0.005). The frequency of iNKT cells increased following 12 months of nCPAP therapy (P = 0.015). Hypoxia resulted in increased apoptosis (P = 0.016) and impaired cytotoxicity (P = 0.035). CONCLUSION Patients with obstructive sleep apnea (OSA) have significantly reduced levels of circulating invariant natural killer T (iNKT) cells and hypoxia leads to impaired iNKT cell function. These observations may partly explain the increased cancer risk reported in patients with OSA.
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Affiliation(s)
- Gadintshware Gaoatswe
- Obesity Immunology Group, Education & Research Center, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Brian D Kent
- Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital, Dublin, and School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Michelle A Corrigan
- Obesity Immunology Group, Education & Research Center, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Geraldine Nolan
- Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital, Dublin, and School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Andrew E Hogan
- Obesity Immunology Group, Education & Research Center, St Vincent's University Hospital, University College Dublin, Dublin, Ireland.,Obesity Immunology Group, National Children's Research Center, Dublin, Ireland
| | - Walter T McNicholas
- Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital, Dublin, and School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Donal O'Shea
- Obesity Immunology Group, Education & Research Center, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
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Abstract
Obstructive sleep apnoea syndrome (OSAS) is a common clinical condition in which the throat narrows or collapses repeatedly during sleep, causing obstructive sleep apnoea events. The syndrome is particularly prevalent in middle-aged and older adults. The mechanism by which the upper airway collapses is not fully understood but is multifactorial and includes obesity, craniofacial changes, alteration in upper airway muscle function, pharyngeal neuropathy and fluid shift towards the neck. The direct consequences of the collapse are intermittent hypoxia and hypercapnia, recurrent arousals and increase in respiratory efforts, leading to secondary sympathetic activation, oxidative stress and systemic inflammation. Excessive daytime sleepiness is a burden for the majority of patients. OSAS is also associated with cardiovascular co-morbidities, including hypertension, arrhythmias, stroke, coronary heart disease, atherosclerosis and overall increased cardiovascular mortality, as well as metabolic dysfunction. Whether treating sleep apnoea can fully reverse its chronic consequences remains to be established in adequately designed studies. Continuous positive airway pressure (CPAP) is the primary treatment modality in patients with severe OSAS, whereas oral appliances are also widely used in mild to moderate forms. Finally, combining different treatment modalities such as CPAP and weight control is beneficial, but need to be evaluated in randomized controlled trials. For an illustrated summary of this Primer, visit: http://go.nature.com/Lwc6te.
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69
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Gozal D, Farré R, Nieto FJ. Obstructive sleep apnea and cancer: Epidemiologic links and theoretical biological constructs. Sleep Med Rev 2015; 27:43-55. [PMID: 26447849 DOI: 10.1016/j.smrv.2015.05.006] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/21/2015] [Accepted: 05/25/2015] [Indexed: 12/19/2022]
Abstract
Sleep disorders have emerged as highly prevalent conditions in the last 50-75 y. Along with improved understanding of such disorders, the realization that perturbations in sleep architecture and continuity may initiate, exacerbate or modulate the phenotypic expression of multiple diseases including cancer has gained increased attention. Furthermore, the intermittent hypoxia that is attendant to sleep disordered breathing, has recently been implicated in increased incidence and more adverse prognosis of cancer. The unifying conceptual framework linking these associations proposes that increased sympathetic activity and/or alterations in immune function, particularly affecting innate immune cellular populations, underlie the deleterious effects of sleep disorders on tumor biology. In this review, the epidemiological evidence linking disrupted sleep and intermittent hypoxia to oncological outcomes, and the potential biological underpinnings of such associations as illustrated by experimental murine models will be critically appraised. The overarching conclusion appears supportive in the formulation of an hypothetical framework, in which fragmented sleep and intermittent hypoxia may promote changes in multiple signalosomes and transcription factors that can not only initiate malignant transformation, but will also alter the tumor microenvironment, disrupt immunosurveillance, and thus hasten tumor proliferation and increase local and metastatic invasion. Future bench-based experimental studies as well as carefully conducted and controlled clinical epidemiological studies appear justified for further exploration of these hypotheses.
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Affiliation(s)
- David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA.
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona-IDIBAPS, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - F Javier Nieto
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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70
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Martínez-García MÁ, Campos-Rodríguez F, Almendros I, Farré R. Relationship Between Sleep Apnea and Cancer. Arch Bronconeumol 2015; 51:456-61. [PMID: 25843225 DOI: 10.1016/j.arbres.2015.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 12/15/2022]
Abstract
In the light of relationships reported between hypoxemia (tissue hypoxia) and cancer, Abrams et al. concluded in 2008 that sleep apnea-hypopnea syndrome (SAHS) and its main consequence, intermittent hypoxia, could be related with increased susceptibility to cancer or poorer prognosis of a pre-existing tumor. This pathophysiological association was confirmed in animal studies. Two large independent historical cohort studies subsequently found that the degree of nocturnal hypoxia in patients with SAHS was associated with higher cancer incidence and mortality. This finding has been confirmed in almost all subsequent studies, although the retrospective nature of some requires that they be considered as hypothesis-generating only. The relationship between sleep apnea and cancer, and the pathophysiological mechanisms governing it, could be clarified in the near future in a currently on-going study in a large group of melanoma patients.
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Affiliation(s)
- Miguel Ángel Martínez-García
- Servicio de Neumología. Hospital Universitario y Politécnico La Fe, Valencia, España; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España.
| | | | - Isaac Almendros
- Unidad de Biofísica y Bioingeniería, Facultad de Medicina, Universidad de Barcelona, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Ramón Farré
- Unidad de Biofísica y Bioingeniería, Facultad de Medicina, Universidad de Barcelona, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España
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71
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Dewan NA, Nieto FJ, Somers VK. Intermittent hypoxemia and OSA: implications for comorbidities. Chest 2015; 147:266-274. [PMID: 25560865 DOI: 10.1378/chest.14-0500] [Citation(s) in RCA: 394] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OSA is a common chronic disorder that is associated with significant morbidity and mortality including cardiovascular, metabolic, and neurocognitive disease and increased cancer-related deaths. OSA is characterized by recurrent episodes of apneas and hypopneas associated with repetitive episodes of intermittent hypoxemia, intrathoracic pressure changes, and arousals. Intermittent hypoxemia (IH) is now being recognized as a potential major factor contributing to the pathogenesis of OSA-related comorbidities. OSA-related high-frequency IH is characterized by cycles of hypoxemia with reoxygenation that is distinctly different than sustained low-frequency hypoxia and contributes to ischemia-reperfusion injury. Data from both animal and human studies support mechanistic links between IH and its adverse impact at the tissue level. IH promotes oxidative stress by increased production of reactive oxygen species and angiogenesis, increased sympathetic activation with BP elevation, and systemic and vascular inflammation with endothelial dysfunction that contributes to diverse multiorgan chronic morbidity and mortality affecting cardiovascular disease, metabolic dysfunction, cognitive decline, and progression of cancer. Data from observational studies in large population groups also support the role for hypoxia in the pathogenesis of OSA comorbidity. Treatment with CPAP to reverse OSA-related symptoms and comorbidities has been shown to provide variable benefit in some but not all patient groups. Early treatment with CPAP makes intuitive sense to promote maximal functional recovery and minimize residual injury. More studies are needed to determine the interacting effects of IH and obesity, differential effects of both short-term and long-term hypoxemia, and the effect of CPAP treatment.
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Affiliation(s)
- Naresh A Dewan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mayo Clinic, Mayo Foundation for Medical Education and Research, Rochester, MN..
| | - F Javier Nieto
- Department of Medicine, Creighton University and Pulmonary Section, Omaha VA Medical Center, US Department of Veterans Affairs, Omaha, NE; Population Health Sciences, School of Medicine and Public Health, Mayo Clinic, Mayo Foundation for Medical Education and Research, Rochester, MN; Population Health Sciences, School of Medicine and Public Health, Mayo Clinic, Mayo Foundation for Medical Education and Research, Rochester, MN
| | - Virend K Somers
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mayo Clinic, Mayo Foundation for Medical Education and Research, Rochester, MN.; University of Wisconsin-Madison, Board of Regents of the University of Wisconsin System, Madison, WI; and Sleep and Cardiovascular Clinical Research Unit, College of Medicine, Mayo Clinic, Mayo Foundation for Medical Education and Research, Rochester, MN; Sleep and Cardiovascular Clinical Research Unit, College of Medicine, Mayo Clinic, Mayo Foundation for Medical Education and Research, Rochester, MN
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72
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Gouveris H. Obstructive sleep apnea: An interdisciplinary challenge for otorhinolaryngologists. World J Otorhinolaryngol 2015; 5:1-4. [DOI: 10.5319/wjo.v5.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 12/31/2014] [Accepted: 01/19/2015] [Indexed: 02/06/2023] Open
Abstract
Otolaryngologists play a pivotal role in the diagnosis and management of sleep-related breathing disorders (SRBD) in both adults and children. Otolaryngologists are often the first medical specialists to be contacted by patients with complaints as snoring, episodic sleep apnea observed by the bed partners with or without reported excessive daytime sleepiness and therefore emerge as important gatekeepers of the general health of an individual by means of an active preventive, and in many cases therapeutic, role. Comprehensive diagnosis and treatment of SRBD requires a team approach and hence building interdisciplinary teams with other involved relevant specialties is necessary from the patients’ perspective.
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73
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Cao J, Feng J, Li L, Chen B. Obstructive sleep apnea promotes cancer development and progression: a concise review. Sleep Breath 2015; 19:453-7. [DOI: 10.1007/s11325-015-1126-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/16/2014] [Accepted: 12/23/2014] [Indexed: 12/17/2022]
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74
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Chang WP, Liu ME, Chang WC, Yang AC, Ku YC, Pai JT, Lin YW, Tsai SJ. Sleep apnea and the subsequent risk of breast cancer in women: a nationwide population-based cohort study. Sleep Med 2014; 15:1016-20. [DOI: 10.1016/j.sleep.2014.05.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/08/2014] [Accepted: 05/27/2014] [Indexed: 01/06/2023]
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Kendzerska T, Leung RS, Hawker G, Tomlinson G, Gershon AS. Obstructive sleep apnea and the prevalence and incidence of cancer. CMAJ 2014; 186:985-92. [PMID: 25096668 DOI: 10.1503/cmaj.140238] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A link between obstructive sleep apnea and cancer development or progression has been suggested, possibly through chronic hypoxemia, but supporting evidence is limited. We examined the association between the severity of obstructive sleep apnea and prevalent and incident cancer, controlling for known risk factors for cancer development. METHODS We included all adults referred with possible obstructive sleep apnea who underwent a first diagnostic sleep study at a single large academic hospital between 1994 and 2010. We linked patient data with data from Ontario health administrative databases from 1991 to 2013. Cancer diagnosis was derived from the Ontario Cancer Registry. We assessed the cross-sectional association between obstructive sleep apnea and prevalent cancer at the time of the sleep study (baseline) using logistic regression analysis. Cox regression models were used to investigate the association between obstructive sleep apnea and incident cancer among patients free of cancer at baseline. RESULTS Of 10 149 patients who underwent a sleep study, 520 (5.1%) had a cancer diagnosis at baseline. Over a median follow-up of 7.8 years, 627 (6.5%) of the 9629 patients who were free of cancer at baseline had incident cancer. In multivariable regression models, the severity of sleep apnea was not significantly associated with either prevalent or incident cancer after adjustment for age, sex, body mass index and smoking status at baseline (apnea-hypopnea index > 30 v. < 5: adjusted odds ratio [OR] 0.96, 95% confidence interval [CI] 0.71-1.30, for prevalent cancer, and adjusted hazard ratio [HR] 1.02, 95% CI 0.80-1.31, for incident cancer; sleep time spent with oxygen saturation < 90%, per 10-minute increase: adjusted OR 1.01, 95% CI 1.00-1.03, for prevalent cancer, and adjusted HR 1.00, 95% CI 0.99-1.02, for incident cancer). INTERPRETATION In a large cohort, the severity of obstructive sleep apnea was not independently associated with either prevalent or incident cancer. Additional studies are needed to elucidate whether there is an independent association with specific types of cancer.
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Affiliation(s)
- Tetyana Kendzerska
- Institute of Health Policy, Management and Evaluation (Tomlinson), University of Toronto; Institute for Clinical Evaluative Sciences (Kendzerska, Hawker, Gershon); Women's College Research Institute (Kendzerska, Hawker), Women's College Hospital, University of Toronto; Department of Medicine (Kendzerska, Leung, Hawker, Gershon), University of Toronto; Department of Medicine (Leung), St. Michael's Hospital; Department of Medicine (Tomlinson), University Health Network and Mount Sinai Hospital; Department of Medicine (Gershon), Sunnybrook Health Sciences Centre, Toronto, Ont.
| | - Richard S Leung
- Institute of Health Policy, Management and Evaluation (Tomlinson), University of Toronto; Institute for Clinical Evaluative Sciences (Kendzerska, Hawker, Gershon); Women's College Research Institute (Kendzerska, Hawker), Women's College Hospital, University of Toronto; Department of Medicine (Kendzerska, Leung, Hawker, Gershon), University of Toronto; Department of Medicine (Leung), St. Michael's Hospital; Department of Medicine (Tomlinson), University Health Network and Mount Sinai Hospital; Department of Medicine (Gershon), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Gillian Hawker
- Institute of Health Policy, Management and Evaluation (Tomlinson), University of Toronto; Institute for Clinical Evaluative Sciences (Kendzerska, Hawker, Gershon); Women's College Research Institute (Kendzerska, Hawker), Women's College Hospital, University of Toronto; Department of Medicine (Kendzerska, Leung, Hawker, Gershon), University of Toronto; Department of Medicine (Leung), St. Michael's Hospital; Department of Medicine (Tomlinson), University Health Network and Mount Sinai Hospital; Department of Medicine (Gershon), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - George Tomlinson
- Institute of Health Policy, Management and Evaluation (Tomlinson), University of Toronto; Institute for Clinical Evaluative Sciences (Kendzerska, Hawker, Gershon); Women's College Research Institute (Kendzerska, Hawker), Women's College Hospital, University of Toronto; Department of Medicine (Kendzerska, Leung, Hawker, Gershon), University of Toronto; Department of Medicine (Leung), St. Michael's Hospital; Department of Medicine (Tomlinson), University Health Network and Mount Sinai Hospital; Department of Medicine (Gershon), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Andrea S Gershon
- Institute of Health Policy, Management and Evaluation (Tomlinson), University of Toronto; Institute for Clinical Evaluative Sciences (Kendzerska, Hawker, Gershon); Women's College Research Institute (Kendzerska, Hawker), Women's College Hospital, University of Toronto; Department of Medicine (Kendzerska, Leung, Hawker, Gershon), University of Toronto; Department of Medicine (Leung), St. Michael's Hospital; Department of Medicine (Tomlinson), University Health Network and Mount Sinai Hospital; Department of Medicine (Gershon), Sunnybrook Health Sciences Centre, Toronto, Ont
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76
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Almendros I, Wang Y, Gozal D. The polymorphic and contradictory aspects of intermittent hypoxia. Am J Physiol Lung Cell Mol Physiol 2014; 307:L129-40. [PMID: 24838748 DOI: 10.1152/ajplung.00089.2014] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Intermittent hypoxia (IH) has been extensively studied during the last decade, primarily as a surrogate model of sleep apnea. However, IH is a much more pervasive phenomenon in human disease, is viewed as a potential therapeutic approach, and has also been used in other disciplines, such as in competitive sports. In this context, adverse outcomes involving cardiovascular, cognitive, metabolic, and cancer problems have emerged in obstructive sleep apnea-based studies, whereas beneficial effects of IH have also been identified. Those a priori contradictory findings may not be as contradictory as initially thought. Indeed, the opposite outcomes triggered by IH can be explained by the specific characteristics of the large diversity of IH patterns applied in each study. The balance between benefits and injury appears to primarily depend on the ability of the organism to respond and activate adaptive mechanisms to IH. In this context, the adaptive or maladaptive responses can be generally predicted by the frequency, severity, and duration of IH. However, the presence of underlying conditions such as hypertension or obesity, as well as age, sex, or genotypic variance, may be important factors tilting the balance between an appropriate homeostatic response and decompensation. Here, the two possible facets of IH as derived from human and experimental animal settings will be reviewed.
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Affiliation(s)
- Isaac Almendros
- Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Yang Wang
- Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - David Gozal
- Department of Pediatrics, Comer Children's Hospital, Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
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77
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Taylor CT, Kent BD, Crinion SJ, McNicholas WT, Ryan S. Human adipocytes are highly sensitive to intermittent hypoxia induced NF-kappaB activity and subsequent inflammatory gene expression. Biochem Biophys Res Commun 2014; 447:660-5. [PMID: 24755071 DOI: 10.1016/j.bbrc.2014.04.062] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/13/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Intermittent hypoxia (IH)-induced activation of pro-inflammatory pathways is a major contributing factor to the cardiovascular pathophysiology associated with obstructive sleep apnea (OSA). Obesity is commonly associated with OSA although it remains unknown whether adipose tissue is a major source of inflammatory mediators in response to IH. The aim of this study was to test the hypothesis that IH leads to augmented inflammatory responses in human adipocytes when compared to cells of non-adipocyte lineages. METHODS AND RESULTS Human primary subcutaneous and visceral adipocytes, human primary microvascular pulmonary endothelial cells (HUMEC-L) and human primary small airway epithelial cells (SAEC) were exposed to 0, 6 or 12 cycles of IH or stimulated with tumor necrosis factor (TNF)-α. IH led to a robust increase in NF-κB DNA-binding activity in adipocytes compared with normoxic controls regardless of whether the source of adipocytes was visceral or subcutaneous. Notably, the NF-κB response of adipocytes to both IH and TNF-α was significantly greater than that in HUMEC-L and SAEC. Western blotting confirmed enhanced nuclear translocation of p65 in adipocytes in response to IH, accompanied by phosphorylation of I-κB. Parallel to p65 activation, we observed a significant increase in secretion of the adipokines interleukin (IL)-8, IL-6 and TNF-α with IH in adipocytes accompanied by significant upregulation of mRNA expression. PCR-array suggested profound influence of IH on pro-inflammatory gene expression in adipocytes. CONCLUSION Human adipocytes demonstrate strong sensitivity to inflammatory gene expression in response to acute IH and hence, adipose tissue may be a key source of inflammatory mediators in OSA.
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Affiliation(s)
- Cormac T Taylor
- School of Medicine and Medical Science, The Conway Institute, University College Dublin, Ireland
| | - Brian D Kent
- School of Medicine and Medical Science, The Conway Institute, University College Dublin, Ireland; Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland
| | - Sophie J Crinion
- School of Medicine and Medical Science, The Conway Institute, University College Dublin, Ireland; Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland
| | - Walter T McNicholas
- School of Medicine and Medical Science, The Conway Institute, University College Dublin, Ireland; Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland
| | - Silke Ryan
- School of Medicine and Medical Science, The Conway Institute, University College Dublin, Ireland; Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland.
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78
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Kim R, Kapur VK. Emerging from the shadows: a possible link between sleep apnea and cancer. J Clin Sleep Med 2014; 10:363-4. [PMID: 24733979 DOI: 10.5664/jcsm.3602] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Richard Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA
| | - Vishesh K Kapur
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA
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79
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Marshall NS, Wong KKH, Cullen SRJ, Knuiman MW, Grunstein RR. Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton Health Study cohort. J Clin Sleep Med 2014; 10:355-62. [PMID: 24733978 DOI: 10.5664/jcsm.3600] [Citation(s) in RCA: 333] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To ascertain whether objectively measured obstructive sleep apnea (OSA) independently increases the risk of all cause death, cardiovascular disease (CVD), coronary heart disease (CHD), stroke or cancer. DESIGN Community-based cohort. SETTING AND PARTICIPANTS 400 residents of the Western Australian town of Busselton. MEASURES OSA severity was quantified via the respiratory disturbance index (RDI) as measured by a single night recording in November-December 1990 using the MESAM IV device, along with a range of other risk factors. Follow-up for deaths and hospitalizations was ascertained via record linkage to the end of 2010. RESULTS We had follow-up data in 397 people and then removed those with a previous stroke (n = 4) from the mortality/ CVD/CHD/stroke analyses and those with cancer history from the cancer analyses (n = 7). There were 77 deaths, 103 cardiovascular events (31 strokes, 59 CHD) and 125 incident cases of cancer (39 cancer fatalities) during 20 years follow-up. In fully adjusted models, moderate-severe OSA was significantly associated with all-cause mortality (HR = 4.2; 95% CI 1.9, 9.2), cancer mortality (3.4; 1.1, 10.2), incident cancer (2.5; 1.2, 5.0), and stroke (3.7; 1.2, 11.8), but not significantly with CVD (1.9; 0.75, 4.6) or CHD incidence (1.1; 0.24, 4.6). Mild sleep apnea was associated with a halving in mortality (0.5; 0.27, 0.99), but no other outcome, after control for leading risk factors. CONCLUSIONS Moderate-to-severe sleep apnea is independently associated with a large increased risk of all-cause mortality, incident stroke, and cancer incidence and mortality in this community-based sample.
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Affiliation(s)
- Nathaniel S Marshall
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia ; Sydney Nursing School, University of Sydney, Sydney, Australia
| | - Keith K H Wong
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia ; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Matthew W Knuiman
- School of Population Health, University of Western Australia, Perth, Australia
| | - Ronald R Grunstein
- NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia ; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
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80
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Almendros I, Wang Y, Becker L, Lennon FE, Zheng J, Coats BR, Schoenfelt KS, Carreras A, Hakim F, Zhang SX, Farré R, Gozal D. Intermittent hypoxia-induced changes in tumor-associated macrophages and tumor malignancy in a mouse model of sleep apnea. Am J Respir Crit Care Med 2014; 189:593-601. [PMID: 24471484 PMCID: PMC3977714 DOI: 10.1164/rccm.201310-1830oc] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/20/2014] [Indexed: 12/11/2022] Open
Abstract
RATIONALE An increased cancer aggressiveness and mortality have been recently reported among patients with obstructive sleep apnea (OSA). Intermittent hypoxia (IH), a hallmark of OSA, enhances melanoma growth and metastasis in mice. OBJECTIVES To assess whether OSA-related adverse cancer outcomes occur via IH-induced changes in host immune responses, namely tumor-associated macrophages (TAMs). MEASUREMENTS AND MAIN RESULTS Lung epithelial TC1 cell tumors were 84% greater in mice subjected to IH for 28 days compared with room air (RA). In addition, TAMs in IH-exposed tumors exhibited reductions in M1 polarity with a shift toward M2 protumoral phenotype. Although TAMs from tumors harvested from RA-exposed mice increased TC1 migration and extravasation, TAMs from IH-exposed mice markedly enhanced such effects and also promoted proliferative rates and invasiveness of TC1 cells. Proliferative rates of melanoma (B16F10) and TC1 cells exposed to IH either in single culture or in coculture with macrophages (RAW 264.7) increased only when RAW 264.7 macrophages were concurrently present. CONCLUSIONS Our findings support the notion that IH-induced alterations in TAMs participate in the adverse cancer outcomes reported in OSA.
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Affiliation(s)
- Isaac Almendros
- Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, and
| | - Yang Wang
- Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, and
| | - Lev Becker
- Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, and
| | - Frances E. Lennon
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | - Jiamao Zheng
- Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, and
| | - Brittney R. Coats
- Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, and
| | - Kelly S. Schoenfelt
- Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, and
| | - Alba Carreras
- Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, and
| | - Fahed Hakim
- Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, and
| | - Shelley X. Zhang
- Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, and
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona-IDIBAPS, Barcelona, Spain; and
- CIBER de Enfermedades Respiratorias, Bunyola, Spain
| | - David Gozal
- Department of Pediatrics, Comer Children’s Hospital, Pritzker School of Medicine, and
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81
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Kim SM, Kim H, Lee JS, Park KS, Jeon GS, Shon J, Ahn SW, Kim SH, Lee KM, Sung JJ, Lee KW. Intermittent hypoxia can aggravate motor neuronal loss and cognitive dysfunction in ALS mice. PLoS One 2013; 8:e81808. [PMID: 24303073 PMCID: PMC3841127 DOI: 10.1371/journal.pone.0081808] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 10/16/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with ALS may be exposed to variable degrees of chronic intermittent hypoxia. However, all previous experimental studies on the effects of hypoxia in ALS have only used a sustained hypoxia model and it is possible that chronic intermittent hypoxia exerts effects via a different molecular mechanism from that of sustained hypoxia. No study has yet shown that hypoxia (either chronic intermittent or sustained) can affect the loss of motor neurons or cognitive function in an in vivo model of ALS. OBJECTIVE To evaluate the effects of chronic intermittent hypoxia on motor and cognitive function in ALS mice. METHODS Sixteen ALS mice and 16 wild-type mice were divided into 2 groups and subjected to either chronic intermittent hypoxia or normoxia for 2 weeks. The effects of chronic intermittent hypoxia on ALS mice were evaluated using the rotarod, Y-maze, and wire-hanging tests. In addition, numbers of motor neurons in the ventral horn of the spinal cord were counted and western blot analyses were performed for markers of oxidative stress and inflammatory pathway activation. RESULTS Compared to ALS mice kept in normoxic conditions, ALS mice that experienced chronic intermittent hypoxia had poorer motor learning on the rotarod test, poorer spatial memory on the Y-maze test, shorter wire hanging time, and fewer motor neurons in the ventral spinal cord. Compared to ALS-normoxic and wild-type mice, ALS mice that experienced chronic intermittent hypoxia had higher levels of oxidative stress and inflammation. CONCLUSIONS Chronic intermittent hypoxia can aggravate motor neuronal death, neuromuscular weakness, and probably cognitive dysfunction in ALS mice. The generation of oxidative stress with activation of inflammatory pathways may be associated with this mechanism. Our study will provide insight into the association of hypoxia with disease progression, and in turn, the rationale for an early non-invasive ventilation treatment in patients with ALS.
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Affiliation(s)
- Sung-Min Kim
- Department of Neurology, Seoul National University, College of Medicine, Seoul, Korea
| | - Heejaung Kim
- Department of Neurology, Hanyang University, College of Medicine, Seoul, Korea
| | - Jeong-Seon Lee
- Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Korea
| | - Kyung Seok Park
- Department of Neurology, Seoul National University, College of Medicine, Seoul, Korea
| | - Gye Sun Jeon
- Department of Neurology, Seoul National University, College of Medicine, Seoul, Korea
| | - Jeeheun Shon
- Department of Neurology, Seoul National University, College of Medicine, Seoul, Korea
| | - Suk-Won Ahn
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyun Kim
- Department of Neurology, Hanyang University, College of Medicine, Seoul, Korea
| | - Kyung Min Lee
- Department of Neurology, Seoul National University, College of Medicine, Seoul, Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University, College of Medicine, Seoul, Korea
| | - Kwang-Woo Lee
- Department of Neurology, Seoul National University, College of Medicine, Seoul, Korea
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Christensen AS, Clark A, Salo P, Nymann P, Lange P, Prescott E, Rod NH. Symptoms of sleep disordered breathing and risk of cancer: a prospective cohort study. Sleep 2013; 36:1429-35. [PMID: 24082302 DOI: 10.5665/sleep.3030] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Sleep disordered breathing (SDB) has been associated with oxidative stress, inflammation, and altered hormonal levels, all of which could affect the risk of cancer. The aim of the study is to examine if symptoms of SDB including snoring, breathing cessations, and daytime sleepiness affect the incidence of total cancer and subtypes of cancer. DESIGN Prospective cohort study. SETTING The third wave (1991-1993) of the Copenhagen City Heart Study. PARTICIPANTS There were 8,783 men and women in whom cancer had not been previously diagnosed. MEASUREMENTS AND RESULTS Participants answered questions about snoring and breathing cessations in 1991-1993, whereas information about daytime sleepiness based on the Epworth Sleepiness Scale was collected in a subset of the participants (n = 5,894) in 1998. First-time incidence of cancer was followed until December 2009 in a nationwide cancer register. We found no overall association between symptoms of SDB and incident cancer. Yet, in the small group with high daytime sleepiness, we observed a surprisingly higher cancer incidence (hazard ratio = 4.09; 95% CI 1.58-10.55) in persons younger than 50 years. We also found a higher risk of virus/immune-related cancers (2.73; 1.27-5.91) and alcohol-related cancers (4.92; 1.45-16.76) among persons with daytime sleepiness. More SDB symptoms were associated with a higher risk of smoking-related cancers (Ptrend: 0.04). Apart from these findings there were no clear associations between symptoms of sleep disordered breathing and cancer subtypes. CONCLUSION We found very limited evidence of relationship between symptoms of sleep disordered breathing and incidence of cancer.
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Affiliation(s)
- Anne Sofie Christensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark ; Copenhagen Stress Research Center, Copenhagen, Denmark
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Almendros I, Montserrat JM, Torres M, Dalmases M, Cabañas ML, Campos-Rodríguez F, Navajas D, Farré R. Intermittent hypoxia increases melanoma metastasis to the lung in a mouse model of sleep apnea. Respir Physiol Neurobiol 2013; 186:303-7. [PMID: 23499797 DOI: 10.1016/j.resp.2013.03.001] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 03/01/2013] [Accepted: 03/04/2013] [Indexed: 01/12/2023]
Abstract
Obstructive sleep apnea (OSA) has recently been associated with an increased risk of cancer incidence and mortality in humans. Experimental data in mice have also shown that intermittent hypoxia similar to that observed in OSA patients enhances tumor growth. The aim of this study was to test the hypothesis that intermittent hypoxia mimicking OSA enhances lung metastasis. A total of 75 C57BL/6J male mice (10-week-old) were subjected to either spontaneous or induced melanoma lung metastasis. Normoxic animals breathed room air and intermittent hypoxic animals were subjected to cycles of 20s of 5% O2 followed by 40s of room air for 6h/day. Spontaneous and induced lung metastases were studied after subcutaneous and intravenous injection of B16F10 melanoma cells, respectively. Compared with normoxia, intermittent hypoxia induced a significant increase in melanoma lung metastasis. These animal model results suggest that intermittent hypoxia could contribute to cancer metastasis in patients with OSA.
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Nieto FJ, Peppard PE, Finn L, Hla KM, Young T, Farré R. Reply: Sleep-disordered Breathing, Hypoxemia, and Cancer Mortality. Am J Respir Crit Care Med 2013; 187:331-2. [DOI: 10.1164/ajrccm.187.3.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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