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Walczak P, Janowski M. Chemobrain as a Product of Growing Success in Chemotherapy - Focus on Glia as both a Victim and a Cure. ACTA ACUST UNITED AC 2019; 9:2207-2216. [PMID: 31316584 DOI: 10.4172/neuropsychiatry.1000565] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chemotherapy-induced cognitive impairment or chemobrain is a frequent consequence of cancer treatment with many psychiatric features. Ironically, the increasing efficacy of chemotherapy leaves growing number of patients alive with chemobrain. Therefore, there is an urgent need for strategies capable of returning cancer survivors back to their pre-morbid quality of life. Molecular mechanisms of chemobrain are largely unknown. Over the last decade there was a lot of emphasis in preclinical research on inflammatory consequences of chemotherapy and oxidative stress but so far none of these approaches were translated into clinical scenario. The co-administration of chemotherapy with protective agents was evaluated preclinically but it should be introduced with caution as potential interference was not yet studied and that could blunt therapeutic efficacy. Stem cell-based regenerative medicine approach has so far been exploited very sparsely in the context of chemobrain and the focus was on indirect mechanisms or neuronal replacement in the hippocampus. However, there is evidence for widespread white matter abnormalities in patients with chemobrain. This is quite logical considering life-long proliferation and turnover of glial cells, which makes them vulnerable to chemotherapeutic agents. Feasibility of glia replacement has been established in mice with global dysmyelination where profound therapeutic effect has been observed but only in case of global cell engraftment (across the entire brain). While global glia replacement has been achieved in mice translation to clinical setting might be challenging due to much larger brain size. Therefore, a lot of attention should be directed towards the route of administration to accomplish widespread cell delivery. Techniques facilitating that broad cell distribution including intra-arterial and intrathecal methods should be considered as very compelling options. Summarizing, chemobrain is a rapidly growing medical problem and global glia replacement should be considered as worthwhile therapeutic strategy.
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Affiliation(s)
- Piotr Walczak
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurology and Neurosurgery, University of Warmia and Mazury, Olsztyn, Poland
| | - Miroslaw Janowski
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Caeyenberghs K, Duprat R, Leemans A, Hosseini H, Wilson PH, Klooster D, Baeken C. Accelerated intermittent theta burst stimulation in major depression induces decreases in modularity: A connectome analysis. Netw Neurosci 2018; 3:157-172. [PMID: 30793079 PMCID: PMC6372023 DOI: 10.1162/netn_a_00060] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/11/2018] [Indexed: 01/03/2023] Open
Abstract
Accelerated intermittent theta burst stimulation (aiTBS) is a noninvasive neurostimulation technique that shows promise for improving clinical outcome in patients suffering from treatment-resistant depression (TRD). Although it has been suggested that aiTBS may evoke beneficial neuroplasticity effects in neuronal circuits, the effects of aiTBS on brain networks have not been investigated until now. Fifty TRD patients were enrolled in a randomized double-blind sham-controlled crossover trial involving aiTBS, applied to the left dorsolateral prefrontal cortex. Diffusion-weighted MRI data were acquired at each of three time points (T1 at baseline; T2 after the first week of real/sham aiTBS stimulation; and T3 after the second week of treatment). Graph analysis was performed on the structural connectivity to examine treatment-related changes in the organization of brain networks. Changes in depression severity were assessed using the Hamilton Depression Rating Scale (HDRS). Baseline data were compared with 60 healthy controls. We observed a significant reduction in depression symptoms over time (p < 0.001). At T1, both TRD patients and controls exhibited a small-world topology in their white matter networks. More importantly, the TRD patients demonstrated a significantly shorter normalized path length (p AUC = 0.01), and decreased assortativity (p AUC = 0.035) of the structural networks, compared with the healthy control group. Within the TRD group, graph analysis revealed a less modular network configuration between T1 and T2 in the TRD group who received real aiTBS stimulation in the first week (p < 0.013). Finally, there were no significant correlations between changes on HDRS scores and reduced modularity. Application of aiTBS in TRD is characterized by reduced modularity, already evident 4 days after treatment. These findings support the potential clinical application of such noninvasive brain stimulation in TRD.
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Affiliation(s)
- Karen Caeyenberghs
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Romain Duprat
- Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hadi Hosseini
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, USA
| | - Peter H. Wilson
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Debby Klooster
- Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, The Netherlands
- Academic Center for Epileptology Kempenhaeghe, Heeze, The Netherlands
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital UZBrussel, Brussels, Belgium; and Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
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53
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Nasal administration of mesenchymal stem cells restores cisplatin-induced cognitive impairment and brain damage in mice. Oncotarget 2018; 9:35581-35597. [PMID: 30473752 PMCID: PMC6238972 DOI: 10.18632/oncotarget.26272] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 10/06/2018] [Indexed: 12/13/2022] Open
Abstract
Cognitive impairments are a common side effect of chemotherapy that often persists long after treatment completion. There are no FDA-approved interventions to treat these cognitive deficits also called ‘chemobrain’. We hypothesized that nasal administration of mesenchymal stem cells (MSC) reverses chemobrain. To test this hypothesis, we used a mouse model of cognitive deficits induced by cisplatin that we recently developed. Mice were treated with two cycles of cisplatin followed by nasal administration of MSC. Cisplatin treatment induced deficits in the puzzle box, novel object/place recognition and Y-maze tests, indicating cognitive impairment. Nasal MSC treatment fully reversed these cognitive deficits in males and females. MSC also reversed the cisplatin-induced damage to cortical myelin. Resting state functional MRI and connectome analysis revealed a decrease in characteristic path length after cisplatin, while MSC treatment increased path length in cisplatin-treated mice. MSCs enter the brain but did not survive longer than 12-72 hrs, indicating that they do not replace damaged tissue. RNA-sequencing analysis identified mitochondrial oxidative phosphorylation as a top pathway activated by MSC administration to cisplatin-treated mice. Consistently, MSC treatment restored the cisplatin-induced mitochondrial dysfunction and structural abnormalities in brain synaptosomes. Nasal administration of MSC did not interfere with the peripheral anti-tumor effect of cisplatin. In conclusion, nasal administration of MSC may represent a powerful, non-invasive, and safe regenerative treatment for resolution of chemobrain.
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Stouten-Kemperman MM, de Ruiter MB, Boogerd W, Kerst JM, Kirschbaum C, Reneman L, Schagen SB. Brain Hyperconnectivity >10 Years After Cisplatin-Based Chemotherapy for Testicular Cancer. Brain Connect 2018; 8:398-406. [DOI: 10.1089/brain.2017.0569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Myrle M. Stouten-Kemperman
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel B. de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem Boogerd
- Department of Neuro-Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - J. Martijn Kerst
- Department of Medical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Clemens Kirschbaum
- Department of Biological Psychology, Technische Universität Dresden, Dresden, Germany
| | - Liesbeth Reneman
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sanne B. Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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55
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Zeng Y, Cheng ASK, Song T, Sheng X, Wang S, Xie J, Chan CCH. Effects of Acupuncture on Cancer-Related Cognitive Impairment in Chinese Gynecological Cancer Patients: A Pilot Cohort Study. Integr Cancer Ther 2018; 17:737-746. [PMID: 29806502 PMCID: PMC6142078 DOI: 10.1177/1534735418777109] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Among women in China, gynecological cancers are the
second most common cancers after breast cancer. Cancer-related cognitive
impairment (CRCI) has emerged as a significant problem affecting gynecological
cancer survivors. While acupuncture has been used in different aspects of cancer
care, the possible positive effects of acupuncture on cognitive impairment have
received little attention. This study hypothesized that patients would
demonstrate lower neurocognitive performance and lower structural connectivity
compared to healthy controls. This pilot study also hypothesized that
acupuncture may potentially be effective in treating CRCI of cancer patients by
increasing brain structural connectivity and integrity. Methods:
This prospective cohort study consisted of 3 stages: the first stage included a
group of gynecological cancer patients and a group of age-matched healthy
controls. This baseline stage used a core set of neurocognitive tests to screen
patients with cognitive impairment and used a multimodal approach of brain
magnetic resonance imaging (MRI) to explore the possible neurobiological
mechanism of cognitive impairment in cancer patients, comparing the results with
a group of noncancer controls. The second stage involved assigning CRCI patients
into the acupuncture intervention group, while patients without CRCI were
assigned into the cancer control group. The third stage was a postintervention
assessment of neurocognitive function by the same set of neurocognitive tests at
baseline. To explore the possible neurobiological basis of acupuncture for
treating CRCI, this study also used a multimodal MRI approach to assess changes
in brain structural connectivity, and neurochemical properties in patients at
pre- and postacupuncture intervention. Results: This study found
that the prevalence of cognitive impairment in Chinese gynecological cancer
patients at diagnosis was 26.67%. When investigating the microstructural white
matter in the brain, diffusion tensor imaging data in this study indicated that
premorbid cognitive functioning (before clinical manifestations become evident)
has already existed, as the global and local connectome properties in the entire
patient group were lower than in the healthy control group. Using magnetic
resonance spectroscopy, this study indicated there was a significant reduction
of relative concentration of NAA (N-acetyl aspartate) in the
left hippocampus, comparing these results with healthy controls. Regarding the
effects of acupuncture on reducing CRCI, patients in the acupuncture group
reported better neurocognitive test performance after matching for age,
menopausal status, cancer stage, and chemotherapy regimen dosage. On a
microstructural level, acupuncture’s ability to reduce CRCI may be attributed to
a reduction in demyelination and an enhancement of the neuronal viability of
white matter in the hippocampus. Conclusion: This pilot study
indicates that acupuncture is a promising intervention in treating CRCI in
gynecological cancer patients undergoing chemotherapy; however, it requires
evaluation in larger randomized controlled studies to definitively assess its
benefit. By using a multimodal imaging approach, this pilot study also provides
novel insights into the neurobiological basis of cognitive impairment on the
human brain that has been induced by cancer and/or its treatment.
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Affiliation(s)
- Yingchun Zeng
- 1 The Hong Kong Polytechnic University, Hong Kong, SAR, China.,2 The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Andy S K Cheng
- 1 The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Ting Song
- 2 The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiujie Sheng
- 2 The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shaojing Wang
- 2 The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianfei Xie
- 3 The Third Xiangya Hospital of Central South University, Changsha, China
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McDonald BC. Editorial: Cognitive and Neuroimaging Effects of Chemotherapy: Evidence Across Cancer Types and Treatment Regimens. J Natl Cancer Inst 2017; 109:3855271. [PMID: 30053073 PMCID: PMC5445648 DOI: 10.1093/jnci/djx096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 04/20/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Brenna C. McDonald
- Affiliations of authors: Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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Zeng Y, Cheng ASK, Song T, Sheng X, Zhang Y, Liu X, Chan CCH. Subjective cognitive impairment and brain structural networks in Chinese gynaecological cancer survivors compared with age-matched controls: a cross-sectional study. BMC Cancer 2017; 17:796. [PMID: 29179739 PMCID: PMC5704431 DOI: 10.1186/s12885-017-3793-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/16/2017] [Indexed: 12/31/2022] Open
Abstract
Background Subjective cognitive impairment can be a significant and prevalent problem for gynaecological cancer survivors. The aims of this study were to assess subjective cognitive functioning in gynaecological cancer survivors after primary cancer treatment, and to investigate the impact of cancer treatment on brain structural networks and its association with subjective cognitive impairment. Methods This was a cross-sectional survey using a self-reported questionnaire by the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) to assess subjective cognitive functioning, and applying DTI (diffusion tensor imaging) and graph theoretical analyses to investigate brain structural networks after primary cancer treatment. Results A total of 158 patients with gynaecological cancer (mean age, 45.86 years) and 130 age-matched non-cancer controls (mean age, 44.55 years) were assessed. Patients reported significantly greater subjective cognitive functioning on the FACT-Cog total score and two subscales of perceived cognitive impairment and perceived cognitive ability (all p values <0.001). Compared with patients who had received surgery only and non-cancer controls, patients treated with chemotherapy indicated the most altered global brain structural networks, especially in one of properties of small-worldness (p = 0.004). Reduced small-worldness was significantly associated with a lower FACT-Cog total score (r = 0.412, p = 0.024). Increased characteristic path length was also significantly associated with more subjective cognitive impairment (r = −0.388, p = 0.034). Conclusion When compared with non-cancer controls, a considerable proportion of gynaecological cancer survivors may exhibit subjective cognitive impairment. This study provides the first evidence of brain structural network alteration in gynaecological cancer patients at post-treatment, and offers novel insights regarding the possible neurobiological mechanism of cancer-related cognitive impairment (CRCI) in gynaecological cancer patients. As primary cancer treatment can result in a more random organisation of structural brain networks, this may reduce brain functional specificity and segregation, and have implications for cognitive impairment. Future prospective and longitudinal studies are needed to build upon the study findings in order to assess potentially relevant clinical and psychosocial variables and brain network measures, so as to more accurately understand the specific risk factors related to subjective cognitive impairment in the gynaecological cancer population. Such knowledge could inform the development of appropriate treatment and rehabilitation efforts to ameliorate cognitive impairment in gynaecological cancer survivors.
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Affiliation(s)
- Yingchun Zeng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.,Research Institute of Gynecology and Obstetrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Andy S K Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
| | - Ting Song
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiujie Sheng
- Research Institute of Gynecology and Obstetrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yang Zhang
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Xiangyu Liu
- Department of Nursing, Hunan Cancer Hospital, The Third Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Chetwyn C H Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
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58
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Kesler SR, Rao A, Blayney DW, Oakley-Girvan IA, Karuturi M, Palesh O. Predicting Long-Term Cognitive Outcome Following Breast Cancer with Pre-Treatment Resting State fMRI and Random Forest Machine Learning. Front Hum Neurosci 2017; 11:555. [PMID: 29187817 PMCID: PMC5694825 DOI: 10.3389/fnhum.2017.00555] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 11/01/2017] [Indexed: 01/09/2023] Open
Abstract
We aimed to determine if resting state functional magnetic resonance imaging (fMRI) acquired at pre-treatment baseline could accurately predict breast cancer-related cognitive impairment at long-term follow-up. We evaluated 31 patients with breast cancer (age 34–65) prior to any treatment, post-chemotherapy and 1 year later. Cognitive testing scores were normalized based on data obtained from 43 healthy female controls and then used to categorize patients as impaired or not based on longitudinal changes. We measured clustering coefficient, a measure of local connectivity, by applying graph theory to baseline resting state fMRI and entered these metrics along with relevant patient-related and medical variables into random forest classification. Incidence of cognitive impairment at 1 year follow-up was 55% and was predicted by classification algorithms with up to 100% accuracy (p < 0.0001). The neuroimaging-based model was significantly more accurate than a model involving patient-related and medical variables (p = 0.005). Hub regions belonging to several distinct functional networks were the most important predictors of cognitive outcome. Characteristics of these hubs indicated potential spread of brain injury from default mode to other networks over time. These findings suggest that resting state fMRI is a promising tool for predicting future cognitive impairment associated with breast cancer. This information could inform treatment decision making by identifying patients at highest risk for long-term cognitive impairment.
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Affiliation(s)
- Shelli R Kesler
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Arvind Rao
- Department of Bioinformatics and Computational Biology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Douglas W Blayney
- Division of Medical Oncology, School of Medicine, Stanford University, Palo Alto, CA, United States
| | | | - Meghan Karuturi
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Palo Alto, CA, United States
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