251
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Structural Transcatheter Cardiac Interventions in the Cardio-Oncology Population. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00898-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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252
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Zhang X, Chen X, Wang L, He C, Shi Z, Fu Q, Xu W, Zhang S, Hu S. Review of the Efficacy and Mechanisms of Traditional Chinese Medicines as a Therapeutic Option for Ionizing Radiation Induced Damage. Front Pharmacol 2021; 12:617559. [PMID: 33658941 PMCID: PMC7917257 DOI: 10.3389/fphar.2021.617559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/11/2021] [Indexed: 12/16/2022] Open
Abstract
Ionizing radiation damage refers to acute, delayed, or chronic tissue damage associated with ionizing radiation. Specific or effective therapeutic options for systemic injuries induced by ionizing radiation have not been developed. Studies have shown that Chinese herbal Medicine or Chinese Herbal Prescription exhibit preventive properties against radiation damage. These medicines inhibit tissue injuries and promote repair with very minimal side effects. This study reviews traditional Chinese herbal medicines and prescriptions with radiation protective effects as well as their mechanisms of action. The information obtained will guide the development of alternative radioprotectants.
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Affiliation(s)
- Xiaomeng Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoying Chen
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Lei Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Changhao He
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Zhongyu Shi
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Qian Fu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Wenhui Xu
- Beijing Academy of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Shujing Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Sumin Hu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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253
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McMullen CJ, Chalmers S, Wood R, Cunningham MR, Currie S. Sunitinib and Imatinib Display Differential Cardiotoxicity in Adult Rat Cardiac Fibroblasts That Involves a Role for Calcium/Calmodulin Dependent Protein Kinase II. Front Cardiovasc Med 2021; 7:630480. [PMID: 33598481 PMCID: PMC7882511 DOI: 10.3389/fcvm.2020.630480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/29/2020] [Indexed: 01/13/2023] Open
Abstract
Background: Tyrosine kinase inhibitors (TKIs) have dramatically improved cancer treatment but are known to cause cardiotoxicity. The pathophysiological consequences of TKI therapy are likely to manifest across different cell types of the heart, yet there is little understanding of the differential adverse cellular effects. Cardiac fibroblasts (CFs) play a pivotal role in the repair and remodeling of the heart following insult or injury, yet their involvement in anti-cancer drug induced cardiotoxicity has been largely overlooked. Here, we examine the direct effects of sunitinib malate and imatinib mesylate on adult rat CF viability, Ca2+ handling and mitochondrial function that may contribute to TKI-induced cardiotoxicity. In particular, we investigate whether Ca2+/calmodulin dependent protein kinase II (CaMKII), may be a mediator of TKI-induced effects. Methods: CF viability in response to chronic treatment with both drugs was assessed using MTT assays and flow cytometry analysis. Calcium mobilization was assessed in CFs loaded with Fluo4-AM and CaMKII activation via oxidation was measured via quantitative immunoblotting. Effects of both drugs on mitochondrial function was determined by live mitochondrial imaging using MitoSOX red. Results: Treatment of CFs with sunitinib (0.1-10 μM) resulted in concentration-dependent alterations in CF phenotype, with progressively significant cell loss at higher concentrations. Flow cytometry analysis and MTT assays revealed increased cell apoptosis and necrosis with increasing concentrations of sunitinib. In contrast, equivalent concentrations of imatinib resulted in no significant change in cell viability. Both sunitinib and imatinib pre-treatment increased Angiotensin II-induced intracellular Ca2+ mobilization, with only sunitinib resulting in a significant effect and also causing increased CaMKII activation via oxidation. Live cell mitochondrial imaging using MitoSOX red revealed that both sunitinib and imatinib increased mitochondrial superoxide production in a concentration-dependent manner. This effect in response to both drugs was suppressed in the presence of the CaMKII inhibitor KN-93. Conclusions: Sunitinib and imatinib showed differential effects on CFs, with sunitinib causing marked changes in cell viability at concentrations where imatinib had no effect. Sunitinib caused a significant increase in Angiotensin II-induced intracellular Ca2+ mobilization and both TKIs caused increased mitochondrial superoxide production. Targeted CaMKII inhibition reversed the TKI-induced mitochondrial damage. These findings highlight a new role for CaMKII in TKI-induced cardiotoxicity, particularly at the level of the mitochondria, and confirm differential off-target toxicity in CFs, consistent with the differential selectivity of sunitinib and imatinib.
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Affiliation(s)
| | | | | | | | - Susan Currie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
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254
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Zhou H, Liu L, Ma X, Wang J, Yang J, Zhou X, Yang Y, Liu H. RIP1/RIP3/MLKL-mediated necroptosis contributes to vinblastine-induced myocardial damage. Mol Cell Biochem 2021; 476:1233-1243. [PMID: 33247805 PMCID: PMC7873015 DOI: 10.1007/s11010-020-03985-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023]
Abstract
Vinblastine (VBL) has been considered as a first-line anti-tumor drug for many years. However, vinblastine-caused myocardial damage has been continually reported. The underlying molecular mechanism of the myocardial damage remains unknown. Here, we show that vinblastine induces myocardial damage and necroptosis is involved in the vinblastine-induced myocardial damage both in vitro and in vivo. The results of WST-8 and flow cytometry analysis show that vinblastine causes damage to H9c2 cells, and the results of animal experiments show that vinblastine causes myocardial cell damage. The necrosome components, receptor-interacting protein 1 (RIP1) receptor-interacting protein 3 (RIP3), are significantly increased in vinblastine-treated H9c2 cells, primary neonatal rat ventricular myocytes and rat heart tissues. And the downstream substrate of RIP3, mixed lineage kinase domain like protein (MLKL) was also increased. Pre-treatment with necroptosis inhibitors partially inhibits the necrosome components and MLKL levels and alleviates vinblastine-induced myocardial injury both in vitro and in vivo. This study indicates that necroptosis participated in vinblastine-evoked myocardial cell death partially, which would be a potential target for relieving the chemotherapy-related myocardial damage.
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Affiliation(s)
- Huiling Zhou
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Clinical Center for Gene Diagnosis and Therapy, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Lijun Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Clinical Center for Gene Diagnosis and Therapy, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Xiaolong Ma
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jian Wang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Clinical Center for Gene Diagnosis and Therapy, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jinfu Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Clinical Center for Gene Diagnosis and Therapy, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Xinmin Zhou
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yifeng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Haidan Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
- Clinical Center for Gene Diagnosis and Therapy, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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255
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Chen DH, Tyebally S, Malloupas M, Roylance R, Spurrell E, Raja F, Ghosh AK. Cardiovascular Disease Amongst Women Treated for Breast Cancer: Traditional Cytotoxic Chemotherapy, Targeted Therapy, and Radiation Therapy. Curr Cardiol Rep 2021; 23:16. [PMID: 33501515 DOI: 10.1007/s11886-021-01446-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Cardiotoxicity can occur acutely during breast cancer treatment and impact the potential for the intended cancer treatment regime to be completed, or as a late effect affecting cancer survivorship. Indeed, the most common cause of mortality in females with early breast cancer is cardiovascular disease, especially in those over the age of 65. Optimal cancer care therefore needs to be delivered without jeopardising cardiovascular health. Understanding the different cardiotoxicities associated with breast cancer treatment is vital to this approach, and therefore, this article seeks to provide an overview of this. RECENT FINDINGS Tyrosine kinase inhibitors targeting human epidermal growth factor receptor (HER)-2, immune checkpoint inhibitors (ICI), and cyclin-dependent kinase (CDK) inhibitors are new targeted breast cancer treatments. In particular, ICI are associated with myocarditis that carries a significant mortality, whilst the CDK inhibitor ribociclib causes QT prolongation that requires cardiac surveillance and appropriate dose adjustment to prevent ventricular arrhythmias. The need has always been for strategies to mitigate the risks of cardiovascular toxicities, and new data is promising for the use of dexrazoxane in anthracyclines, and the role of beta blockers and angiotensin converting enzymes inhibitors in anthracyclines and HER-2 monoclonal antibodies such as trastuzumab. Significant headways in breast cancer treatment have resulted in reductions in disease recurrence and mortality, but cardiovascular complications continue to impact the ability to deliver some of these cancer treatments, and the period of cancer survivorship.
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Affiliation(s)
- Daniel H Chen
- Cardio-Oncology Service, Bart's Heart Centre, St Bartholomew's Hospital, London, EC1A 7BE, UK.,University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.,The Hatter Cardiovascular Institute, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Sara Tyebally
- Cardio-Oncology Service, Bart's Heart Centre, St Bartholomew's Hospital, London, EC1A 7BE, UK.,University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Michael Malloupas
- University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.,The Hatter Cardiovascular Institute, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Rebecca Roylance
- University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.,NIHR University College London Hospitals Biomedical Research Centre, Maple House 1st Floor, 149 Tottenham Court Road, London, W1T 7DN, UK
| | - Emma Spurrell
- University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.,Whittington Health, Magdala Avenue, London, N19 5NF, UK
| | - Fharat Raja
- University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.,North Middlesex University Hospital, Sterling Way, London, N18 1QX, UK
| | - Arjun K Ghosh
- Cardio-Oncology Service, Bart's Heart Centre, St Bartholomew's Hospital, London, EC1A 7BE, UK. .,University College London Hospital, 235 Euston Road, London, NW1 2BU, UK. .,The Hatter Cardiovascular Institute, 67 Chenies Mews, London, WC1E 6HX, UK.
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256
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Lane S, More LA, Asnani A. Zebrafish Models of Cancer Therapy-Induced Cardiovascular Toxicity. J Cardiovasc Dev Dis 2021; 8:jcdd8020008. [PMID: 33499052 PMCID: PMC7911266 DOI: 10.3390/jcdd8020008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/11/2021] [Accepted: 01/20/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose of review: Both traditional and novel cancer therapies can cause cardiovascular toxicity in patients. In vivo models integrating both cardiovascular and cancer phenotypes allow for the study of on- and off-target mechanisms of toxicity arising from these agents. The zebrafish is the optimal whole organism model to screen for cardiotoxicity in a high throughput manner, while simultaneously assessing the role of cardiotoxicity pathways on the cancer therapy’s antitumor effect. Here we highlight established zebrafish models of human cardiovascular disease and cancer, the unique advantages of zebrafish to study mechanisms of cancer therapy-associated cardiovascular toxicity, and finally, important limitations to consider when using the zebrafish to study toxicity. Recent findings: Cancer therapy-associated cardiovascular toxicities range from cardiomyopathy with traditional agents to arrhythmias and thrombotic complications associated with newer targeted therapies. The zebrafish can be used to identify novel therapeutic strategies that selectively protect the heart from cancer therapy without affecting antitumor activity. Advances in genome editing technology have enabled the creation of several transgenic zebrafish lines valuable to the study of cardiovascular and cancer pathophysiology. Summary: The high degree of genetic conservation between zebrafish and humans, as well as the ability to recapitulate cardiotoxic phenotypes observed in patients with cancer, make the zebrafish an effective model to study cancer therapy-associated cardiovascular toxicity. Though this model provides several key benefits over existing in vitro and in vivo models, limitations of the zebrafish model include the early developmental stage required for most high-throughput applications.
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Affiliation(s)
- Sarah Lane
- CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; (S.L.); (L.A.M.)
| | - Luis Alberto More
- CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; (S.L.); (L.A.M.)
| | - Aarti Asnani
- CardioVascular Institute, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; (S.L.); (L.A.M.)
- Harvard Medical School, Boston, MA 02115, USA
- Correspondence:
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257
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Moreland-Head LN, Coons JC, Seybert AL, Gray MP, Kane-Gill SL. Use of Disproportionality Analysis to Identify Previously Unknown Drug-Associated Causes of Cardiac Arrhythmias Using the Food and Drug Administration Adverse Event Reporting System (FAERS) Database. J Cardiovasc Pharmacol Ther 2021; 26:341-348. [PMID: 33403858 DOI: 10.1177/1074248420984082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Drug-induced QTc-prolongation is a well-known adverse drug reaction (ADR), however there is limited knowledge of other drug-induced arrhythmias. PURPOSE The objective of this study is to determine the drugs reported to be associated with arrhythmias other than QTc-prolongation using the FAERS database, possibly identifying potential drug causes that have not been reported previously. METHODS FAERS reports from 2004 quarter 1 through 2019 quarter 1 were combined to create a dataset of approximately 11.6 million reports. Search terms for arrhythmias of interest were selected from the Standardized MedDRA Queries (SMQ) Version 12.0. Frequency of the cardiac arrhythmias were determined for atrial fibrillation, atrioventricular block, bradyarrhythmia, bundle branch block, supraventricular tachycardia, and ventricular fibrillation and linked to the reported causal medications. Reports were further categorized by prior evidence associations using package inserts and established drug databases. A reporting odds ratio (ROR) and confidence interval (CI) were calculated for the ADRs for each drug and each of the 6 cardiac arrhythmias. RESULTS Of the 11.6 million reports in the FAERS database, 68,989 were specific to cardiac arrhythmias of interest. There were 61 identified medication-reported arrhythmia pairs for the 6 arrhythmia groups with 33 found to have an unknown reported association. Rosiglitazone was the most frequently medication reported across all arrhythmias [ROR 6.02 (CI: 5.82-6.22)]. Other medications with significant findings included: rofecoxib, digoxin, alendronate, lenalidomide, dronedarone, zoledronic acid, adalimumab, dabigatran, and interferon beta-1b. CONCLUSION Upon retrospective analysis of the FAERS database, the majority of drug-associated arrhythmias reported were unknown suggesting new potential drug causes. Cardiac arrhythmias other than QTc prolongation are a new area of focus for pharmacovigilance and medication safety. Consideration of future studies should be given to using the FAERS database as a timely pharmacovigilance tool to identify unknown adverse events of medications.
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Affiliation(s)
| | - James C Coons
- Department of Pharmacy, 6595UPMC Presbyterian Hospital, Pittsburgh, PA, USA.,Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, PA, USA
| | - Amy L Seybert
- Department of Pharmacy, 6595UPMC Presbyterian Hospital, Pittsburgh, PA, USA.,Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, PA, USA
| | - Matthew P Gray
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, PA, USA
| | - Sandra L Kane-Gill
- Department of Pharmacy, 6595UPMC Presbyterian Hospital, Pittsburgh, PA, USA.,Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, PA, USA
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258
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Iacopo F, Branch M, Cardinale D, Middeldorp M, Sanders P, Cohen JB, Achirica MC, Jaiswal S, Brown SA. Preventive Cardio-Oncology: Cardiovascular Disease Prevention in Cancer Patients and Survivors. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00883-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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259
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Li L, Nie X, Zhang P, Huang Y, Ma L, Li F, Yi M, Qin W, Yuan X. Dexrazoxane ameliorates radiation-induced heart disease in a rat model. Aging (Albany NY) 2021; 13:3699-3711. [PMID: 33406500 PMCID: PMC7906151 DOI: 10.18632/aging.202332] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/03/2020] [Indexed: 12/13/2022]
Abstract
Treatment of thoracic tumors with radiotherapy can lead to severe cardiac injury. We investigated the effects of dexrazoxane, a USFDA-approved cardioprotective drug administered with chemotherapy, on radiation-induced heart disease (RIHD) in a rat model. Male Sprague-Dawley rats were irradiated with a single dose of 20 Gy to the heart and treated with dexrazoxane at the time of irradiation and for 12 subsequent weeks. Dexrazoxane suppressed radiation-induced myocardial apoptosis and significantly reversed changes in serum cardiac troponin I levels and histopathological characteristics six months post-radiation. Treatment with dexrazoxane did not alter the radiosensitivity of thoracic tumors in a tumor formation experiment using male nude Balb/C mice with tumors generated by H292 cells. Dexrazoxane reduced the accumulation of reactive oxygen species in rat cardiac tissues, but not in tumors in nude mice. Transcriptome sequencing showed that IKBKE, MAP3K8, NFKBIA, and TLR5, which are involved in Toll-like receptor signaling, may be associated with the anti-RIHD effects of dexrazoxane. Immunohistochemistry revealed that dexrazoxane significantly decreased NF-κB p65 expression in cardiomyocytes. These findings suggest dexrazoxane may protect against RIHD by suppressing apoptosis and oxidative stress in cardiomyocytes.
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Affiliation(s)
- Long Li
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiaoqi Nie
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Peng Zhang
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yongbiao Huang
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Li Ma
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Fang Li
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Minxiao Yi
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wan Qin
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xianglin Yuan
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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260
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Heinze-Milne SD, Keats MR, Blanchard C, Giacomantonio N, MacDonald D, Rajda M, Younis T, Grandy SA. Exercise to Prevent Anthracycline-Based Cardiotoxicity (EXACT): A Feasibility Study. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2021. [DOI: 10.1249/tjx.0000000000000168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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261
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Telomerase therapy attenuates cardiotoxic effects of doxorubicin. Mol Ther 2021; 29:1395-1410. [PMID: 33388418 PMCID: PMC8058493 DOI: 10.1016/j.ymthe.2020.12.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/17/2020] [Accepted: 12/23/2020] [Indexed: 12/15/2022] Open
Abstract
Doxorubicin is one of the most potent chemotherapeutic agents. However, its clinical use is restricted due to the severe risk of cardiotoxicity, partially attributed to elevated production of reactive oxygen species (ROS). Telomerase canonically maintains telomeres during cell division but is silenced in adult hearts. In non-dividing cells such as cardiomyocytes, telomerase confers pro-survival traits, likely owing to the detoxification of ROS. Therefore, we hypothesized that pharmacological overexpression of telomerase may be used as a therapeutic strategy for the prevention of doxorubicin-induced cardiotoxicity. We used adeno-associated virus (AAV)-mediated gene therapy for long-term expression of telomerase in in vitro and in vivo models of doxorubicin-induced cardiotoxicity. Overexpression of telomerase protected the heart from doxorubicin-mediated apoptosis and rescued cardiac function, which was accompanied by preserved cardiomyocyte size. At the mechanistic level, we observed altered mitochondrial morphology and dynamics in response to telomerase expression. Complementary in vitro experiments confirmed the anti-apoptotic effects of telomerase overexpression in human induced pluripotent stem cell-derived cardiomyocytes after doxorubicin treatment. Strikingly, elevated levels of telomerase translocated to the mitochondria upon doxorubicin treatment, which helped to maintain mitochondrial function. Thus, telomerase gene therapy could be a novel preventive strategy for cardiotoxicity by chemotherapy agents such as the anthracyclines.
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262
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Saidova MA, Avalyan AA, Oshchepkova EV, Shitov VN, Chazova IE. [Comparative capabilities of the speckle-tracking echocardiography technologiesin two-dimensional and three-dimensional modes in the detection of subclinical cardiotoxicity in patients with breast cancer]. TERAPEVT ARKH 2020; 92:142-147. [PMID: 33720586 DOI: 10.26442/00403660.2020.12.200431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 11/22/2022]
Abstract
AIM The study was to assess the deformation properties of the left ventricle (LV) myocardium in patients with breast cancer initially and after anthracycline chemotherapy according to 2D and 3D speckle-tracking echocardiography (STE). MATERIAL AND METHODS the study included 99 patients with triple negative breast cancer with hypertensionandnormotension. All patients underwent standard transthoracic echocardiography with assessment of systolic function of the LV. To assess the indicator of global longitudinal strain (GLS), as a marker of cardiotoxicity, STE was used in two-and three-dimensional modes. In the three-dimensional STE mode, a new strain parameter, the global area strain (GAS) was evaluated. RESULTS The study showed that in patients with breast cancer for a more accurate assessment of LV systolic function (ejection fraction) it is advisable to use 3D-echocardiography. A comparative analysis revealed statistically significantly lower values of the GLS according to the three-dimensional mode of STE compared to two-dimensional. The study also evaluated a new strain parameter GAS (%). In patients with breast cancer during ROC analysis with a value of -14.0, the GAS indicator for the development of subclinical cardiotoxicity showed a sensitivity of 81.5% and a specificity of 73.3%. Сonclusion.the advantage of the STE in the three-dimensional mode, in contrast to the two-dimensional mode, is the simultaneous and more accurate assessment of LVEF. The value of the additional parameter of LV deformation the area of deformation requires further study.
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Affiliation(s)
- M A Saidova
- National Medical Research Center of Cardiology
| | - A A Avalyan
- National Medical Research Center of Cardiology
| | | | - V N Shitov
- National Medical Research Center of Cardiology
| | - I E Chazova
- National Medical Research Center of Cardiology
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263
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Giudice V, Vecchione C, Selleri C. Cardiotoxicity of Novel Targeted Hematological Therapies. Life (Basel) 2020; 10:life10120344. [PMID: 33322351 PMCID: PMC7763613 DOI: 10.3390/life10120344] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/16/2022] Open
Abstract
Chemotherapy-related cardiac dysfunction, also known as cardiotoxicity, is a group of drug-related adverse events negatively affecting myocardial structure and functions in patients who received chemotherapy for cancer treatment. Clinical manifestations can vary from life-threatening arrythmias to chronic conditions, such as heart failure or hypertension, which dramatically reduce quality of life of cancer survivors. Standard chemotherapy exerts its toxic effect mainly by inducing oxidative stress and genomic instability, while new targeted therapies work by interfering with signaling pathways important not only in cancer cells but also in myocytes. For example, Bruton’s tyrosine kinase (BTK) inhibitors interfere with class I phosphoinositide 3-kinase isoforms involved in cardiac hypertrophy, contractility, and regulation of various channel forming proteins; thus, off-target effects of BTK inhibitors are associated with increased frequency of arrhythmias, such as atrial fibrillation, compared to standard chemotherapy. In this review, we summarize current knowledge of cardiotoxic effects of targeted therapies used in hematology.
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Affiliation(s)
- Valentina Giudice
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (C.V.); (C.S.)
- Clinical Pharmacology, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, 84131 Salerno, Italy
- Correspondence: ; Tel.: +39-089-672-493
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (C.V.); (C.S.)
- IRCCS Neuromed (Mediterranean Neurological Institute), 86077 Pozzilli, Italy
| | - Carmine Selleri
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy; (C.V.); (C.S.)
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, 84131 Salerno, Italy
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264
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Anthracycline-Induced Cardiotoxicity in Breast Cancer Patients from Southern Sri Lanka: An Echocardiographic Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1847159. [PMID: 33274195 PMCID: PMC7683106 DOI: 10.1155/2020/1847159] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 11/18/2022]
Abstract
Anthracycline-induced cardiotoxicity has never been investigated in Sri Lanka. Therefore, this study was conducted to determine the prevalence of anthracycline-induced cardiotoxicity in breast cancer patients using echocardiographic findings. A prospective cohort study was performed. All newly diagnosed breast cancer patients who were administered with anthracycline and cyclophosphamide (AC schedule) for the first time were enrolled in the study. In the hospital setting, anthracycline is administered only as a combination therapy, and only this combination was selected to limit the effect of other cardiotoxic chemotherapy agents. Records of echocardiography were obtained: one day before anthracycline chemotherapy (baseline), one day after the first chemotherapy dose, one day after the last chemotherapy dose, and six months after the completion of anthracycline chemotherapy. Following parameters were recorded from the echocardiography results: ejection fraction (EF, %), fractioning shortening (FS, %), posterior wall thickness, left ventricle (PWT, mm), the thickness of interventricular septum (IVS, mm), left ventricular end-diastolic diameter (LVEDD, mm), and left ventricular end-systolic diameter (LVESD, mm). Statistical analysis of the echocardiography results was performed using ANOVA at four stages. A p value <0.05 was considered significant. Subclinical cardiac dysfunction was defined as a fall of EF >10% during the follow-up echocardiography. There was no significant change (p > 0.05) between the baseline echocardiographic parameters and one day after the 1st anthracycline dose. However, significant differences (p < 0.05) were observed between the baseline echocardiographic parameters and one day after the last anthracycline dose and six months after the completion of anthracycline therapy with a gradual and progressive deterioration in functional parameters including EF, FS, PWT, and IVS over time. There were 65 patients out of 196 (33.16%) who developed subclinical cardiac dysfunction six months after the completion of anthracycline chemotherapy. The prevalence of subclinical anthracycline-induced cardiotoxicity was relatively higher in these patients. An equation was also developed based on left ventricular ejection fraction (LVEF) to predict the anthracycline-induced cardiotoxicity of a patient six months after the completion of anthracycline chemotherapy. We believe that this will help in the monitoring of patients who undergo anthracycline therapy for cardiotoxicity. It is recommended to carry out a long-term follow-up to detect early-onset chronic progressive cardiotoxicity in all patients who were treated with anthracycline therapy.
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265
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Rüger AM, Schneeweiss A, Seiler S, Tesch H, van Mackelenbergh M, Marmé F, Lübbe K, Sinn B, Karn T, Stickeler E, Müller V, Schem C, Denkert C, Fasching PA, Nekljudova V, Garfias‐Macedo T, Hasenfuß G, Haverkamp W, Loibl S, von Haehling S. Cardiotoxicity and Cardiovascular Biomarkers in Patients With Breast Cancer: Data From the GeparOcto-GBG 84 Trial. J Am Heart Assoc 2020; 9:e018143. [PMID: 33191846 PMCID: PMC7763783 DOI: 10.1161/jaha.120.018143] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/21/2020] [Indexed: 12/17/2022]
Abstract
Background Patients with breast cancer can be affected by cardiotoxic reactions through cancer therapies. Cardiac biomarkers, like NT-proBNP (N-terminal pro-B-type natriuretic peptide) and high-sensitivity cardiac troponin T, might have predictive value. Methods and Results Echocardiography, ECG, hemodynamic parameters, NT-proBNP and high-sensitivity cardiac troponin T were assessed in 853 patients with early-stage breast cancer randomized in the German Breast Group GeparOcto-GBG 84 phase III trial. Patients received neo-adjuvant dose-dense, dose-intensified epirubicin, paclitaxel, and cyclophosphamide (iddEPC group, n=424) or paclitaxel, non-pegylated doxorubicin, and in triple negative breast cancer, (paclitaxel, non-pegylated doxorubicin, carboplatin group, n=429) treatment for 18 weeks. Patients positive for human epidermal growth receptor 2 (n=354, 41.5%) received monoclonal antibodies on top of allocated therapy; 119 (12.9%) of all patients showed a cardiotoxic reaction during therapy (15 [1.8%] using a more strict definition). Presence of cardiotoxic reactions was irrespective of treatment allocation (P=0.31). Small but significant increases in NT-proBNP developed early in patients with a cardiotoxic reaction as compared with those without in whom NT-proBNP rose only towards the end of therapy (P=0.04). High-sensitivity cardiac troponin T rose early in both groups. Logistic regression showed that NT-proBNP (odds ratio [OR], 1.03; 95% CI, 1.008-1.055; P=0.01) and hemoglobin (OR, 1.31; 95% CI, 1.05-1.63; P=0.02) measured at 6 weeks after treatment initiation were significantly associated with cardiotoxic reactions. Conclusions NT-proBNP and hemoglobin are significantly associated with cardiotoxic reactions in patients with early-stage breast cancer undergoing dose-dense and dose-intensified chemotherapy, but high-sensitivity cardiac troponin T is not. Registration URL: http://www.clinicaltrials.gov; Unique identifier: NCT02125344.
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Affiliation(s)
- Alexandra Maria Rüger
- Department of CardiologyCharité – Universitätsmedizin BerlinBerlin, Campus Virchow‐KlinikumBerlinGermany
| | - Andreas Schneeweiss
- National Center for Tumor DiseasesUniversity Hospital and German Cancer Research CenterHeidelbergGermany
| | - Sabine Seiler
- German Breast GroupNeu‐Isenburg and Center for Hematology and Oncology BethanienFrankfurtGermany
| | | | | | - Frederik Marmé
- Department of Gynecologic OncologyMedical Faculty MannheimHeidelberg UniversityUniversity Hospital MannheimMannheimGermany
| | | | - Bruno Sinn
- Charité Universitätsmedizin BerlinBerlinGermany
| | - Thomas Karn
- Goethe University Hospital FrankfurtFrankfurtGermany
| | | | - Volkmar Müller
- Department of GynecologyUniversity Medical Center Hamburg EppendorfHamburgGermany
| | | | | | | | - Valentina Nekljudova
- German Breast GroupNeu‐Isenburg and Center for Hematology and Oncology BethanienFrankfurtGermany
| | - Tania Garfias‐Macedo
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
- German Center for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Gerd Hasenfuß
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
- German Center for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Wilhelm Haverkamp
- Department of CardiologyCharité – Universitätsmedizin BerlinBerlin, Campus Virchow‐KlinikumBerlinGermany
| | - Sibylle Loibl
- German Breast GroupNeu‐Isenburg and Center for Hematology and Oncology BethanienFrankfurtGermany
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
- German Center for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
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266
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Vascular Endothelial Growth Factor (VEGF) Inhibitor Cardiotoxicity: What Should We Know? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00866-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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267
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Pang L, Liu Z, Wei F, Cai C, Yang X. Improving cardiotoxicity prediction in cancer treatment: integration of conventional circulating biomarkers and novel exploratory tools. Arch Toxicol 2020; 95:791-805. [PMID: 33219404 DOI: 10.1007/s00204-020-02952-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/05/2020] [Indexed: 12/31/2022]
Abstract
Early detection strategies and improvements in cancer treatment have dramatically reduced the cancer mortality rate in the United States (US). However, cardiovascular (CV) side effects of cancer therapy are frequent among the 17 million cancer survivors in the US today, and cardiovascular disease (CVD) has become the second leading cause of morbidity and mortality among cancer survivors. Circulating biomarkers are ideal for detecting and monitoring CV side effects of cancer therapy. Here, we summarize the current state of clinical studies on conventional serum and plasma CVD biomarkers to detect and prevent cardiac injury during cancer treatment. We also review how novel exploratory tools such as genetic testing, human stem cell-derived cardiomyocytes, Omics technologies, and artificial intelligence can elucidate underlying molecular and genetic mechanisms of CV injury and to improve predicting cancer therapy-related cardiotoxicity (CTRC). Current regulatory requirements for biomarker qualifications are also addressed. We present generally applicable lessons learned from published studies, particularly on how to improve reproducibility. The combination of conventional circulating biomarkers and novel exploratory tools will pave the way for precision medicine and improve the clinical practice of prediction, detection, and management of CTRC.
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Affiliation(s)
- Li Pang
- Division of Systems Biology, National Center for Toxicological Research, US. Food and Drug Administration, 3900 NCTR Road, Jefferson, AR, 72079, USA.
| | - Zhichao Liu
- Division of Bioinformation and Biostatistics, National Center for Toxicological Research, US. Food and Drug Administration, Jefferson, AR, USA
| | - Feng Wei
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Chengzhong Cai
- Division of Systems Biology, National Center for Toxicological Research, US. Food and Drug Administration, 3900 NCTR Road, Jefferson, AR, 72079, USA
| | - Xi Yang
- Division of Pharmacology & Toxicology, Office of Cardiology, Hematology, Endocrinology, & Nephrology, Office of New Drug, Center for Drug Evaluation and Research, US. Food and Drug Administration, Silver Spring, MD, USA
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268
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Dinnessen MA, Visser O, Tonino SH, Poel MW, Blijlevens NM, Kersten MJ, Lugtenburg PJ, Dinmohamed AG. The impact of prior malignancies on the development of second malignancies and survival in follicular lymphoma: A population‐based study. EJHAEM 2020; 1:489-497. [PMID: 35844986 PMCID: PMC9175939 DOI: 10.1002/jha2.108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/20/2022]
Abstract
We assessed the impact of a prior malignancy diagnosis (PMD) – as a potential proxy for genetic cancer susceptibility – on the development of a second primary malignancy (SPM) and mortality in follicular lymphoma (FL) patients. From the nationwide Netherlands Cancer Registry, we selected all adult FL patients diagnosed in 1994‐2012 (n = 8028) and PMDs and SPMs relative to FL, with follow‐up until 2017. We constructed two Fine and Gray models – with death as a competing risk – to assess the association between a PMD and SPM incidence. A PMD was associated with an increased incidence of SPMs (subdistribution hazard ratio [SHR], 1.30; 95% confidence interval [CI], 1.03‐1.64) – especially carcinomas of the respiratory tract (SHR, 1.83; 95% CI, 1.10‐3.05) and cutaneous squamous cell carcinomas (SHR, 1.58; 95% CI, 1.01‐2.45) – and a higher risk of mortality in a multivariable model (HR, 1.43; 95% CI, 1.19‐1.71). However, when additionally adjusted for the receipt of systemic therapy and/or radiotherapy before FL diagnosis, only patients who received such therapies had an increased incidence of SPMs (SHR, 1.40; 95% CI, 1.02‐1.93). In conclusion, patients with a PMD had a higher rate of SPMs and mortality than those without a PMD, which might have resulted from therapy‐related carcinogenesis.
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Affiliation(s)
- Manette A.W. Dinnessen
- Department of Research and Development Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
| | - Otto Visser
- Department of Registration Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
| | - Sanne H. Tonino
- Department of Hematology Cancer Center Amsterdam LYMMCARE (Lymphoma and Myeloma Center Amsterdam) Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Marjolein W.M. Poel
- Department of Internal Medical Division of Hematology Maastricht University Medical Center Maastricht The Netherlands
| | | | - Marie José Kersten
- Department of Hematology Cancer Center Amsterdam LYMMCARE (Lymphoma and Myeloma Center Amsterdam) Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | | | - Avinash G. Dinmohamed
- Department of Research and Development Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
- Department of Hematology Cancer Center Amsterdam LYMMCARE (Lymphoma and Myeloma Center Amsterdam) Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
- Amsterdam UMC Vrije Universiteit Amsterdam Department of Hematology Cancer Center Amsterdam Amsterdam The Netherlands
- Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands
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269
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Dong H, Yao L, Wang M, Wang M, Li X, Sun X, Yu X, Guo J, Li X, Xu Y. Can ACEI/ARB prevent the cardiotoxicity caused by chemotherapy in early-stage breast cancer?-a meta-analysis of randomized controlled trials. Transl Cancer Res 2020; 9:7034-7043. [PMID: 35117309 PMCID: PMC8799108 DOI: 10.21037/tcr-20-1869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 09/18/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Administration of anthracycline-based chemotherapy with or without trastuzumab is recognized as standard care for breast cancer, but it is associated with a decline in left ventricular ejection fraction (LVEF). Angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB) might decrease this cardiac dysfunction caused by the anti-cancer therapy. We sought to evaluate the prophylactic effects of the cardioprotective agents ACEI/ARB for early-stage breast cancer. METHODS We systematically searched the electronic databases Cochrane, PubMed, and Embase for randomized controlled trials (RCTs) evaluating the effect of ACEI/ARB. This meta-analysis calculated weighted mean differences with 95% CI, for ejection fraction and pooled odds ratios (OR) with 95% CI, for cardiac events. Pooled analyses were used in a random-effect model. The primary endpoint was the change of LVEF in the ACEI/ARB group versus the control group from baseline through completion of the studies. RESULTS our meta-analysis includes 5 studies encompassing 702 early-stage breast cancer patients. There was statistically significant diversity in the magnitude of the change of mean LVEF in patients receiving ACEI/ARB compared with control groups, with a mean difference of 4.08% (95% CI: 0.8% to 7.35%, P=0.01). However, regarding patient outcomes, ACEI/ARB did not significantly reduce the risk of cardiac events (OR 0.91, 95% CI: 0.62 to 1.34, P=0.64) or increase the incidence of hypotension events as compared with controls (OR 2.72, 95% CI: 0.69 to 10.73, P=0.15). CONCLUSIONS Our study suggests that ACEI/ARB significantly attenuate the cardiac dysfunction caused by anthracycline-based chemotherapy and/or trastuzumab. Further studies are required to confirm the effectiveness of this cardioprotective agent.
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Affiliation(s)
- Haoran Dong
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Litong Yao
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Mozhi Wang
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Mengshen Wang
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xinyan Li
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiangyu Sun
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China.,Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xueting Yu
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jingyi Guo
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiang Li
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yingying Xu
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China
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270
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Noninvasive Radioablation of Ventricular Tachycardia. Cardiol Rev 2020; 28:283-290. [PMID: 33017363 DOI: 10.1097/crd.0000000000000321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ventricular tachycardia (VT) occurs most commonly in the presence of structural heart disease or myocardial scarring from prior infarction. It is associated with increased mortality, especially when it results in cardiac arrest outside of a hospital. When not due to reversible causes (such as acute ischemia/infarction), placement of an implantable cardioverter-defibrillator for prevention of future sudden death is indicated. The current standard of care for recurrent VT is medical management with antiarrhythmic agents followed by invasive catheter ablation for VT that persists despite appropriate medical therapy. Stereotactic arrhythmia radioablation (STAR) is a novel, noninvasive method of treating VT that has been shown to reduce VT burden for patients who are refractory to medical therapy and/or catheter ablation, or who are unable to tolerate catheter ablation. STAR is the term applied to the use of stereotactic body radiation therapy for the treatment of arrhythmogenic cardiac tissue and requires collaboration between an electrophysiologist and a radiation oncologist. The process involves identification of VT substrate through a combination of electroanatomic mapping and diagnostic imaging (computed tomography, magnetic resonance imaging, positron emission tomography) followed by carefully guided radiation therapy. In this article, we review currently available literature describing the utilization, efficacy, safety profile, and potential future applications of STAR for the management of VT.
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271
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Gil Marques F, Poli E, Malaquias J, Carvalho T, Portêlo A, Ramires A, Aldeia F, Ribeiro RM, Vitorino E, Diegues I, Costa L, Coutinho J, Pina F, Mareel M, Constantino Rosa Santos S. Low doses of ionizing radiation activate endothelial cells and induce angiogenesis in peritumoral tissues. Radiother Oncol 2020; 151:322-327. [PMID: 33004178 DOI: 10.1016/j.radonc.2020.06.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 10/23/2022]
Abstract
PURPOSE During radiotherapy the peritumoral tissues are daily exposed to subtherapeutic doses of ionizing radiation. Herein, the biological and molecular effects of doses lower than 0.8 Gy per fraction (LDIR), previously described as angiogenesis inducers, were assessed in human peritumoral tissues. MATERIAL AND METHODS Paired biopsies of preperitoneal adipose tissue were surgically collected from 16 patients diagnosed with locally advanced rectal cancer who underwent neo-adjuvant radiotherapy. One of the biopsies is located in the vicinity of the region where the tumor received the prescribed dose of radiation, and thus exposed to LDIR; the other specimen, outside all beam apertures, was used as an internal calibrator (IC). Microvessel density (MDV) was quantified by immunohistochemistry and the expression of angiogenic, pro-inflammatory, adhesion and oxidative stress genes was assessed by quantitative RT-PCR using exclusively endothelial cells (ECs) isolated by laser capture microdissection microscopy. RESULTS LDIR activated peritumoral ECs by significantly up-regulating the expression of several pro-angiogenic genes such as VEGFR1, VEGFR2, ANGPT2, TGFB2, VWF, FGF2, HGF and PDGFC and down-regulating the pro-inflammatory IL8 marker. Accordingly, the MVD was significantly increased in peritumoral tissues exposed to LDIR, compared to the IC. The patients that yielded a larger pro-angiogenic response, also showed the highest MVD. CONCLUSIONS LDIR activate ECs in peritumoral tissues that are associated with increased MVD. Although the technological advances in radiotherapy have contributed to reduce the damage to healthy tissues over the past years, the anatomical regions receiving LDIR should be taken into account in the treatment plan report for patient follow-up and in future studies to correlate these doses with tumor dissemination.
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Affiliation(s)
- Filipa Gil Marques
- Angiogenesis Laboratory, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Esmeralda Poli
- Radiotherapy Service, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - João Malaquias
- Department of Surgery, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - Tânia Carvalho
- Histology and Comparative Pathology Laboratory, Instituto de Medicina Molecular; Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Ana Portêlo
- Instituto de Medicina Molecular; Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Afonso Ramires
- Department of Surgery, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - Fernando Aldeia
- Department of Surgery, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - Ruy Miguel Ribeiro
- Biomathematics Laboratory, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Emília Vitorino
- Department of Pathology, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - Isabel Diegues
- Radiotherapy Service, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - Luís Costa
- Oncology Department, Centro Hospitalar Universitário Lisboa Norte; Instituto de Medicina Molecular; Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - João Coutinho
- Department of Surgery, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - Filomena Pina
- Radiotherapy Service, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - Marc Mareel
- Department of Radiotherapy and Laboratory of Experimental Cancer Research, Ghent University Hospital, Belgium
| | - Susana Constantino Rosa Santos
- Angiogenesis Laboratory, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal.
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272
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Anthracycline-induced cardiotoxicity in patients with early-stage breast cancer: the Canadian Cancer Trials Group (CCTG) MA.21 experience. Breast Cancer Res Treat 2020; 184:733-741. [PMID: 32940847 DOI: 10.1007/s10549-020-05887-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/17/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Anthracyclines are frequently used in adjuvant treatment for early-stage breast cancer (ESBC). The purpose of this study was to evaluate cardiotoxic effects in the first five years after treatment with different anthracycline-based regimens. METHODS CCTG MA.21 (NCT000142) was a phase III trial in ESBC that compared cyclophosphamide (75 mg/m2) orally for 14 days, epirubicin (60 mg/m2) and fluorouracil, IV days one and eight (CEF) for six cycles; dose-dense epirubicin (120 mg/m2) and cyclophosphamide, IV every 2 weeks for six cycles with concurrent G-CSF then paclitaxel every 2 weeks for four cycles (ddEC/T); doxorubicin (60 mg/m2) and cyclophosphamide (600 mg/m2) every 3 weeks for four cycles then four cycles q3 weekly paclitaxel (175 mg/m2) (AC/T). ENDPOINTS LVEF decline; LV function changes (heart failure), or Grade 3-4 cardiac ischemia/infarction. A competing risk analysis was performed with endpoints of cardiotoxicity or recurrence in first 5 years after completion of chemotherapy. RESULTS 2104 women were randomized. Compliance with cardiac LVEF assessments was 70% at 5 years in all arms. The 5-year cumulative risks of any cardiac event for CEF, ddECT, and AC/T were 22.3% (95%CI 18.9 to 25.7), 14.2% (95%CI 11.0 to 17.3), and 8.1% (95%CI 5.8 to 10.4), respectively, p < 0.0001. At 5 years, women in the ddEC/T and AC/T group had significantly lower risk of cardiotoxicity than those given CEF (HR 0.599 and 0.371, respectively). Most events were asymptomatic drop in LVEF. CONCLUSIONS Asymptomatic changes in LVEF accounted for most of the cardiotoxicity. The majority of cardiac events occurred in year one although occurrence of cardiotoxicity over time highlights the need for improved risk stratification to guide cardiac surveillance strategies.
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273
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Yan R, Li X, Song J, Guo M, Cai H, Wu Z, Wu P, Li L, Yang M, Wang Y, Li S. Metabolic Changes Precede Radiation-Induced Cardiac Remodeling in Beagles: Using Noninvasive 18F-FDG ( 18F-Fludeoxyglucose) and 13N-Ammonia Positron Emission Tomography/Computed Tomography Scans. J Am Heart Assoc 2020; 9:e016875. [PMID: 32914660 PMCID: PMC7727013 DOI: 10.1161/jaha.120.016875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background This study was performed to characterize the metabolic, functional, and structural cardiac changes in a canine model of radiation‐induced heart disease by serial in vivo imaging and ex vivo analyses. Methods and Results Thirty‐six dogs were randomly assigned to control or irradiated groups at 3 time points (months 3, 6, and 12 after radiation; each group comprised 6 dogs). The left anterior myocardium of dogs in irradiated groups was irradiated locally with a single dose of 20‐Gy X‐ray. The irradiated myocardial regions showed increased myocardial uptake of 18F‐FDG (18F‐fludeoxyglucose) in the irradiated beagles, but the increased uptake area decreased at months 6 and 12 compared with month 3 after radiation. Abnormality of myocardial perfusion and cardiac function were detected at month 6 after radiation. Compared with the control groups, the protein expression of GLUT4 (glucose transporter 4) was upregulated in the irradiated groups, correlating with significantly decreased CPT1 (carnitine acyltransferase 1) expression. Mitochondria degeneration, swelling, and count reduction in the irradiated groups were observed. The difference in CD68 of macrophage markers and the inflammatory cytokines (IL‐6 [interleukin 6], TNF‐α [tumor necrosis factor α]) between the irradiation and control groups was not significant. Furthermore, the progressive aggravation of apoptosis and fibrosis was displayed. Conclusions Elevated 18F‐FDG uptake occurred after irradiation and subsequently led to ventricular perfusion defects and dysfunction. The process was associated with myocardial metabolic substrate remodeling, cardiac muscle cell apoptosis, and myocardial fibrosis rather than inflammation.
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Affiliation(s)
- Rui Yan
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China
| | - Xiang Li
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China.,Division of Nuclear Medicine Department of Biomedical Imaging and Image-Guided Therapy Medical University of Vienna Vienna Austria
| | - Jianbo Song
- Department of Radiotherapy Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences) Taiyuan China
| | - Min Guo
- Department of Cardiology of First Hospital Shanxi Medical University Taiyuan China
| | - Honghong Cai
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China
| | - Zhifang Wu
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China
| | - Ping Wu
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China
| | - Li Li
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China
| | - Minfu Yang
- Department of Nuclear Medicine Beijing Chao-Yang Hospital Capital Medical University Beijing China
| | - Yuetao Wang
- Department of Nuclear Medicine The Third Affiliated Hospital of Soochow University The First People's Hospital of Changzhou Changzhou China
| | - Sijin Li
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China.,Province-Ministry Co-construction Cooperative Innovation Center of Precise Diagnosis and Treatment of Molecular Image Taiyuan China
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274
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Kaneko H, Itoh H, Yotsumoto H, Kiriyama H, Kamon T, Fujiu K, Morita K, Michihata N, Jo T, Takeda N, Morita H, Yasunaga H, Komuro I. Association of Cancer With Outcomes in Patients Hospitalized for Heart Failure. Circ J 2020; 84:1771-1778. [PMID: 32921679 DOI: 10.1253/circj.cj-20-0314] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The complex clinical status of heart failure (HF) patients with concomitant cancer is gaining clinical interest. This study sought to explore the prevalence of cancer in patients with HF and its effect on outcomes using a nationwide inpatient database.Methods and Results:In total, 447,818 HF patients who were admitted and discharged between January 2010 and March 2018 were studied and included in the Diagnosis Procedure Combination (DPC) database. The median age was 81 years; 238,192 patients (53.2%) were men and 25,951 (5.8%) had concomitant cancer. The prevalence of cancer peaked in patients aged in their 70 s and 80 s and increased with time. Patients with cancer were older and more likely to be male. Cigarette smoking was more common in patients with cancer. Patients with cancer more frequently had infectious complications during hospitalization. Advanced medical procedures were less frequently performed for patients with cancer. In-hospital mortality was higher in patients with cancer than those without (10.0% vs. 6.7%, P<0.001). Among patients with cancer, in-hospital mortality was higher in patients with metastasis than those without (18.9% vs. 9.4%, P<0.001). Multivariable logistic regression analysis, fitted with a generalized estimating equation, indicated cancer is associated with higher in-hospital mortality (odds ratio 1.51, 95% confidential interval 1.43-1.59, P<0.001). CONCLUSIONS Cancer was frequently observed in patients hospitalized for worsened HF, and its prevalence increased with time. The presence of cancer increased the risk of in-hospital death. Further studies are warranted to establish the optimal management strategy for HF patients with cancer in the field of cardio-oncology.
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Affiliation(s)
- Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo.,Department of Advanced Cardiology, The University of Tokyo
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine, The University of Tokyo
| | | | | | - Tatsuya Kamon
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo.,Department of Advanced Cardiology, The University of Tokyo
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba
| | | | - Taisuke Jo
- Department of Health Services Research, The University of Tokyo
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo
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275
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Beasley GS, Towbin JA. Acquired and modifiable cardiovascular risk factors in patients treated for cancer. J Thromb Thrombolysis 2020; 51:846-853. [PMID: 32918669 DOI: 10.1007/s11239-020-02273-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 11/28/2022]
Abstract
Cardiac mortality is the leading cause of death secondary to malignancy in survivors of cancer. The field of cardio-oncology is dedicated to identifying and, if possible, modifying risk factors that contribute to significant cardiac morbidity and mortality. Many risk factors for the development of cancer-related cardiotoxicity overlap with risk factors in cardiovascular disease such as hypertension, obesity, dyslipidemia, and diabetes among others. These risk factors are usually modifiable while others such as genetics, type of malignancy, and need for chemotherapy are less modifiable. This article summarizes acquired and modifiable risk factors in both pediatric and adult patients treated for cancer.
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Affiliation(s)
- Gary S Beasley
- Department of Pediatrics, Division of Cardiology Le Bonheur Children's Hospital and The Heart Institute, University of Tennessee Health Science Center, College of Medicine, 49 N. Dunlap Street, 3rd Floor, Faculty Office Building, Memphis, TN, 38105, USA. .,Cardio-Hema-Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Jeffrey A Towbin
- Department of Pediatrics, Division of Cardiology Le Bonheur Children's Hospital and The Heart Institute, University of Tennessee Health Science Center, College of Medicine, 49 N. Dunlap Street, 3rd Floor, Faculty Office Building, Memphis, TN, 38105, USA.,Cardio-Hema-Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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276
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Dong S, Luo C, Hu X, Zhang J, Cai Q, Qian Y, Ran F, Ou W, Wang J, Huang Q, Ren T, Han G, Zhang F, Wei W, Liang X, Xu H, Wang S, Shi L, Wei S, Hu S. Expert Consensus for Treating Cancer Patients During the Pandemic of SARS-CoV-2. Front Oncol 2020; 10:1555. [PMID: 33014801 PMCID: PMC7462010 DOI: 10.3389/fonc.2020.01555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
The sudden pandemic of SARS-Cov-2 (also known as novel coronavirus disease 2019, COVID-19) poses a severe threat to hundreds of millions of lives in the world. The complete cure of the virus largely relies on the immune system, which becomes particularly a challenge for the cancer subjects, whose immunity is generally compromised. However, in a constant evolving situation, the clinical data on the prevalence of SARS-Cov-2 for cancer patients is still limited. On top of a wide range of medical references and interim guidelines including CDC, NCI, ASCO, ESMO, NCCN, AACR, ESMO, and the National Health Commission of China, etc., we formed into a guideline based on our experience in our specialized cancer hospital in Wuhan, the originally endemic center of the virus. Furthermore, we formulated an expert consensus which was developed by all contributors from different disciplines after fully discussion based on our understanding and analysis of limited information of COVID-19. The consensus highlighted a multidisciplinary team diagnostic model with assessment of the balance between risks and benefits prior to treatment, individualizing satisfaction of patients' medical needs, and acceptability in ethics and patients' socio-economic conditions.
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Affiliation(s)
- Shuang Dong
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Chenggang Luo
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- The Cancer Quality Control Center of Hubei Province, Wuhan, China
- Department of Radiological Intervention, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuebo Hu
- Laboratory of Drug Discovery and Molecular Engineering, Department of Medicinal Plants, College of Plant Science and Technology, Huazhong Agricultural University, Wuhan, China
| | - Jing Zhang
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Qian Cai
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Yu Qian
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Fengming Ran
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Wuling Ou
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- The Cancer Quality Control Center of Hubei Province, Wuhan, China
| | - Jun Wang
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Qing Huang
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Tianhua Ren
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Guang Han
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Zhang
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- Department of Hepatobiliary and Pancreatic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- The Administration of Cancer Clinical Trials and GCP, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Wei
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- The Cancer Quality Control Center of Hubei Province, Wuhan, China
- Radiotherapy Center, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinjun Liang
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Huiting Xu
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
| | - Sheng Wang
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- Department of Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lulu Shi
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- The Cancer Quality Control Center of Hubei Province, Wuhan, China
- The Administration of Cancer Clinical Trials and GCP, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaozhong Wei
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- The Cancer Quality Control Center of Hubei Province, Wuhan, China
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Hu
- Department of Medical Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Cancer Center, Wuhan, China
- The Office of Hubei Provincial Cancer Prevention, Wuhan, China
- The Cancer Quality Control Center of Hubei Province, Wuhan, China
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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277
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van der Zee EN, Epker JL, Bakker J, Benoit DD, Kompanje EJO. Treatment Limitation Decisions in Critically Ill Patients With a Malignancy on the Intensive Care Unit. J Intensive Care Med 2020; 36:42-50. [PMID: 32787659 PMCID: PMC7705645 DOI: 10.1177/0885066620948453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background: Treatment limitation decisions (TLDs) on the ICU can be challenging, especially in patients with a malignancy. Up-to-date literature regarding TLDs in critically ill patients with a malignancy admitted to the ICU is scarce. The aim was to compare the incidence of written TLDs between patients with an active malignancy, patients with a malignancy in their medical history (complete remission, CR) and patients without a malignancy admitted unplanned to the ICU. Methods: We conducted a retrospective cohort study in a large university hospital in the Netherlands. We identified all unplanned admissions to the ICU in 2017 and categorized the patients in 3 groups: patients with an active malignancy (study population), with CR and without a malignancy. A TLD was defined as a written instruction not to perform life-saving treatments, such as CPR in case of cardiac arrest. A multivariate binary logistic regression analysis was used to identify whether having a malignancy was associated with TLDs. Results: Of the 1046 unplanned admissions, 125 patients (12%) had an active malignancy and 76 (7.3%) patients had CR. The incidence of written TLDs in these subgroups were 37 (29.6%) and 20 (26.3%). Age (OR 1.03; 95% CI 1.01 -1.04), SOFA score at ICU admission (OR 1.11; 95% CI 1.05 -1.18) and having an active malignancy (OR 1.75; 95% CI 1.04-2.96) compared to no malignancy were independently associated with written TLDs. SOFA scores on the day of the TLD were not significantly different in patients with and without a malignancy. Conclusions: This study shows that the presence of an underlying malignancy is independently associated with written TLDs during ICU stay. Patients with CR were not at risk of more written TLDs. Whether this higher incidence of TLDs in patients with a malignancy is justified, is at least questionable and should be evaluated in future research.
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Affiliation(s)
- Esther N van der Zee
- Department of Intensive Care, 6993Erasmus MC-University Medical Center Rotterdam, the Netherlands
| | - Jelle L Epker
- Department of Intensive Care, 6993Erasmus MC-University Medical Center Rotterdam, the Netherlands
| | - Jan Bakker
- Department of Intensive Care, 6993Erasmus MC-University Medical Center Rotterdam, the Netherlands.,Department of Pulmonology and Critical Care, New York University NYU Langone Medical Center, New York, NY, USA.,Department of Pulmonology and Critical Care, Columbia University Medical Center, New York, NY, USA.,Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Dominique D Benoit
- Department of Intensive Care, 60200Ghent University Hospital, Ghent, Belgium
| | - Erwin J O Kompanje
- Department of Intensive Care, 6993Erasmus MC-University Medical Center Rotterdam, the Netherlands
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278
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Sha X, Gong G, Han C, Qiu Q, Yin Y. Quantification of Myocardial Dosimetry and Glucose Metabolism Using a 17-Segment Model of the Left Ventricle in Esophageal Cancer Patients Receiving Radiotherapy. Front Oncol 2020; 10:1599. [PMID: 32850464 PMCID: PMC7431519 DOI: 10.3389/fonc.2020.01599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/23/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Previous studies have shown that increased cardiac uptake of 18F-fluorodeoxyglucose (FDG) on positron emission tomography (PET) may be an indicator of myocardial injury after radiotherapy (RT). The primary objective of this study was to quantify cardiac subvolume dosimetry and 18F-FDG uptake on oncologic PET using a 17-segment model of the left ventricle (LV) and to identify dose limits related to changes in cardiac 18F-FDG uptake after RT. METHODS Twenty-four esophageal cancer (EC) patients who underwent consecutive oncologic 18F-FDG PET/CT scans at baseline and post-RT were enrolled in this study. The radiation dose and the 18F-FDG uptake were quantitatively analyzed based on a 17-segment model. The 18F-FDG uptake and doses to the basal, middle and apical regions, and the changes in the 18F-FDG uptake for different dose ranges were analyzed. RESULTS A heterogeneous dose distribution was observed, and the basal region received a higher median mean dose (18.36 Gy) than the middle and apical regions (5.30 and 2.21 Gy, respectively). Segments 1, 2, 3, and 4 received the highest doses, all of which were greater than 10 Gy. Three patterns were observed for the myocardial 18F-FDG uptake in relation to the radiation dose before and after RT: an increase (5 patients), a decrease (13 patients), and no change (6 patients). In a pairing analysis, the 18F-FDG uptake after RT decreased by 28.93 and 12.12% in the low-dose segments (0-10 Gy and 10-20 Gy, respectively) and increased by 7.24% in the high-dose segments (20-30 Gy). CONCLUSION The RT dose varies substantially within LV segments in patients receiving thoracic EC RT. Increased 18F-FDG uptake in the myocardium after RT was observed for doses above 20 Gy.
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Affiliation(s)
- Xue Sha
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Guanzhong Gong
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Chunlei Han
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Qingtao Qiu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yong Yin
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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279
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Koop Y, El Messaoudi S, Vermeulen H, Maas AHEM, Atsma F. Healthcare utilization and hospital variation in cardiac surveillance during breast cancer treatment: a nationwide prospective study in 5000 Dutch breast cancer patients. CARDIO-ONCOLOGY 2020; 6:14. [PMID: 32782828 PMCID: PMC7414746 DOI: 10.1186/s40959-020-00068-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/28/2020] [Indexed: 02/06/2023]
Abstract
Background Various breast cancer (BC) treatments, such as chemotherapy and targeted therapies, increase cardiotoxicity-risk and lead to premature ischemic heart disease and heart failure among survivors. Reducing this adverse risk through early recognition and (preventive) treatment is therefore important. Conversely, we feel that screening for cardiotoxicity is currently insufficiently standardized in daily practice. A fundamental first step in identifying areas of improvement is providing an overview of current practice. Objective This study aims to describe current cardiac surveillance for women with BC during and after cardiotoxic cancer treatment, using routinely collected hospital data in the Netherlands. The study also describes hospital variation in cardiac surveillance. Methods This observational study was performed on claims data provided by Statistics Netherlands. From the data, newly diagnosed BC patients in 2013 (N = 16,040) were selected and followed up until 2015. Healthcare utilization analyses were performed for all cardiac and oncologic healthcare activities but with a specific focus on cardiac surveillance healthcare activities. In addition, differences between types and individual hospitals were evaluated. Results Almost one third of all BC patients received high risk cardiotoxic treatments (N = 5157), but cardiac surveillance was rarely performed. Cardiac care provided to patients mainly consisted of ECGs (52.0%) and MUGA scans (26.5%). Cardiac MRI was performed in 0.7% of the patients, echocardiography in 17.7%, and measurement of Troponin and NT-proBNP in 5.1 and 5.8%, respectively. Moreover, we observed a substantial variation in cardiac surveillance between different hospital types and between individual hospitals. Conclusion This study shows that women treated for BC with cardiotoxic treatments do not receive recommended cardiac surveillance. Standardized approaches in clinical care are lacking, resulting in low rates of diagnostic testing and a substantial variation in surveillance between hospitals. A structured approach and increased interprofessional collaboration could lead to tailored cardiac surveillance for early detection of cardiotoxicity and therefore start of treatment.
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Affiliation(s)
- Yvonne Koop
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein 10 - route 616, Postbus 9101, 6500 Nijmegen, HB The Netherlands
| | - Saloua El Messaoudi
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein 10 - route 616, Postbus 9101, 6500 Nijmegen, HB The Netherlands
| | - Hester Vermeulen
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.,Research Department of Emergency and Critical Care, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein 10 - route 616, Postbus 9101, 6500 Nijmegen, HB The Netherlands
| | - Femke Atsma
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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280
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Milluzzo A, Vigneri P, Martorana F, Vigneri R, Sciacca L. Type 2 diabetes and cancer: problems and suggestions for best patient management. EXPLORATION OF MEDICINE 2020. [DOI: 10.37349/emed.2020.00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Diabetes and cancer are widespread worldwide and the number of subjects presenting both diseases increased over the years. The management of cancer patients having diabetes represents a challenge not only because of the complexity and heterogeneity of these pathologies but also for the lack of standardised clinical guidelines. The diagnosis of cancer is traumatizing and monopolizes the attention of both patients and caregivers. Thus, pre-existent or new-onset diabetes can be overshadowed thus increasing the risk for short- and long-term adverse events. Moreover, drugs used for each disease can interfere with the clinical course of the concomitant disease, making challenging the management of these patients. Over the years, this issue has become more relevant because of the increased patients’ life expectancy due to the improved efficacy of diabetes and cancer therapies.
The purpose of this review is to highlight what is known and what should be taken into consideration to optimise the clinical management of patients with diabetes and cancer. Due to the complexity of these diseases, a multidisciplinary, shared approach, including all the protagonists involved, is necessary to improve patients’ quality of life and lifespan.
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Affiliation(s)
- Agostino Milluzzo
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania Medical School, 95122 Catania, Italy
| | - Paolo Vigneri
- Center of Experimental Oncology and Hematology, Department of Clinical and Experimental Medicine, University of Catania, A.O.U. Policlinico-Vittorio Emanuele, 95124 Catania, Italy
| | - Federica Martorana
- Center of Experimental Oncology and Hematology, Department of Clinical and Experimental Medicine, University of Catania, A.O.U. Policlinico-Vittorio Emanuele, 95124 Catania, Italy
| | - Riccardo Vigneri
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania Medical School, 95122 Catania, Italy; Institute of Crystallography, Catania Section, National Research Council, CNR, 95126 Catania, Italy
| | - Laura Sciacca
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania Medical School, 95122 Catania, Italy
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281
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Song L, Guan T, Guo P, Song F, Van Houtven C, Tan X, Keyserling TC. Cardiovascular disease, risk factors, and health behaviors among cancer survivors and spouses: A MEPS Study. Cancer Med 2020; 9:6864-6874. [PMID: 32750221 PMCID: PMC7520310 DOI: 10.1002/cam4.3336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/30/2020] [Accepted: 07/08/2020] [Indexed: 01/26/2023] Open
Abstract
Purpose The purpose of this study was to examine the prevalences of CVD, CVD risk factors. and health behaviors among cancer survivor‐spouse dyads, assess how these prevalences differ by role (survivor vs spouse) and gender, and report congruences in health behaviors between survivors and their spouses. Methods We identified 1026 survivor‐spouse dyads from the 2010‐2015 Medical Expenditure Panel Survey. We used weighted multivariable logistic and linear regressions to analyze the data related to CVD, CVD risk factors, and health behaviors. Results Survivors and spouses reported high prevalences of CVD and CVD risk factors but low engagement in healthy behaviors, including non‐smoking, physical activity, and maintaining a healthy weight (proxy for healthy diet). Gender and role differences were significantly related to the prevalence of CVD, CVD risk factors, and health behaviors among survivors and spouses. From 39% to 88% of survivors and spouses were congruent in their current smoking status, physical activity engagement/disengagement, and BMI. Conclusion Cancer survivors and spouses have high rates of CVD and CVD risk factors and poor engagement in healthful lifestyle behaviors. A high proportion of survivors and spouses were congruent in their current smoking status, physical activity engagement/disengagement, and BMI. Effective lifestyle interventions are needed for this high‐risk population. Couple‐focused interventions may be well‐suited for these dyads and warrant further study. Implications for Cancer Survivors Both cancer survivors and their spouses need to be non‐moking, more physically active, and maintain normal BMI in order to reduce their high risk of CVD and CVD risk factors.
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Affiliation(s)
- Lixin Song
- School of Nursing, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC, USA
| | - Ting Guan
- School of Social Work, UNC-CH, Chapel Hill, NC, USA
| | - Peiran Guo
- School of Nursing, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC, USA
| | - Fengyu Song
- General Education, West Coast University, Anaheim, CA, USA
| | - Courtney Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Xianming Tan
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC, USA.,Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, USA
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282
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Kirkham AA, Pituskin E, Neil-Sztramko SE. Age-dependent increased odds of cardiovascular risk factors in cancer survivors: Canadian Longitudinal Study on Aging cohort. Curr Oncol 2020; 27:e368-e376. [PMID: 32905332 PMCID: PMC7467781 DOI: 10.3747/co.27.6117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background This study compared the odds of self-reported and objectively measured cardiovascular (cv) risk factors in a sample of Canadian cancer survivors and individuals without cancer. Methods A nationally representative sample of 45- to 85-year-old cancer survivors (n = 6288) in the Canadian Longitudinal Study on Aging were compared with individuals without cancer (n = 44,051). Results The most prevalent risk factors in cancer survivors were all self-reported or easily measured in clinic: overweight or obesity (68.0%), former smoking (62.9%), fewer than 5 daily servings of fruits and vegetables (59.8%), hypertension (43.7%), and high waist circumference (47.0%). After adjustment for sex and education, the odds ratios of several cv risk factors varied by age in cancer survivors and the non-cancer controls. At ages 50 and 60, cancer survivors have increased odds of overweight or obesity, former smoking, hypertension, high waist circumference and truncal fat, diabetes, lung disease, and heart rate greater than 80 bpm compared with non-cancer controls. At age 70, odds did not differ for many risk factors; at age 80, no differences were evident. Without modification by age, low physical activity was more prevalent in cancer survivors (odds ratio: 1.27; 95% confidence interval: 1.17 to 1.39). There were no differences in the odds of cv risk factors measured by specialized equipment, including electrocardiography, carotid ultrasonography, spirometry, and dual-energy X-ray absorptiometry. Conclusions The odds of several easy-to-assess cv disease risk factors are higher among middle-aged, but not older, cancer survivors relative to the general Canadian population. Initial assessment of cv risk for middle-aged adults in the survivorship setting could be quickly and inexpensively performed using self-reported and easily measured metrics.
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Affiliation(s)
- A A Kirkham
- Current: Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON; former: Department of Biomedical Engineering, University of Alberta, Edmonton, AB
| | - E Pituskin
- Faculty of Nursing, University of Alberta, Edmonton, AB
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283
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Abstract
The era of modern oncology incorporates an ever-evolving personalized approach to hematological malignancies and solid tumors. As a result, patient survival rates have, in part, substantially improved, depending on the specific type of underlying malignancy. However, systemic therapies may come along with potential cardiotoxic effects resulting in heart failure with increased morbidity and mortality. Ultimately, patients may survive their malignancy but die as a result of cancer treatment. Cardiovascular magnetic resonance imaging has long been in use for the assessment of function and tissue characteristics in patients with various nonischemic cardiac diseases. Besides an introductory overview on the general definition of cardiotoxicity including potential underlying mechanisms, this review provides insight into the application of various cardiovascular magnetic resonance imaging techniques in the setting of cancer therapy-related cardiac and vascular toxicity. Early identification of cardiotoxic effects may allow for on-time therapy adjustment and/or cardioprotective measures to avoid subsequent long-term heart failure with increased mortality.
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284
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Novo G, Nugara C, Fava A, Mantero A, Citro R. Early Detection of Myocardial Damage: A Multimodality Approach. J Cardiovasc Echogr 2020; 30:S4-S10. [PMID: 32566460 PMCID: PMC7293866 DOI: 10.4103/jcecho.jcecho_2_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/17/2019] [Accepted: 10/03/2019] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular diseases are possible complications of antineoplastic treatment and may lead to premature morbidity and mortality among cancer survivors. A symptom-based follow-up is ineffective, and there are growing evidences that early detection of myocardial damage in patients treated with antineoplastic drugs is the key point to prevent the occurrence of damage and improve the prognosis of these patients. Different techniques have been proposed to monitor cardiac function in oncologic patients such as cardiac imaging (echocardiography, nuclear imaging, and cardiac magnetic resonance) and biomarkers (troponin and natriuretic peptides). The European Association of Cardiovascular Imaging/American Society of Echocardiography consensus document encourages an integrated approach to early detect cardiotoxicity.
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Affiliation(s)
- Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Division of Cardiology University Hospital P. Giaccone, Palermo, Italy
| | - Cinzia Nugara
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Division of Cardiology University Hospital P. Giaccone, Palermo, Italy.,Neurolesi Center IRCCS "Bonino Pulejo", Messina, Italy
| | - Antonella Fava
- Department of Cardiology, University Hospital "Città della Salute e Della Scienza", Molinette Hospital, Turin, Italy
| | | | - Rodolfo Citro
- Heart Department, University Hospital of Salerno, Salerno, Italy
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285
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Sipahi NF, Akhyari P, Aubin H, Mehdiani A, Erbel S, Westenfeld R, Scheiber D, Dalyanoglu H, Lichtenberg A, Boeken U. Successful Heart Transplant in a Childhood Cancer Survivor With Chemoradiotherapy-Induced Cardiomyopathy. EXP CLIN TRANSPLANT 2020; 18:533-535. [PMID: 32552629 DOI: 10.6002/ect.2020.0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cancer therapy-related cardiotoxicity has been presenting a major problem in cancer survivors, who constitute a growing population caused by a significant improvement in cancer therapy during the past decades. Although some listing criteria have been defined for these patients, it is still a compelling decision to list patients with a complex cancer anamnesis. We describe herein a childhood cancer survivor after a cancer anamnesis with 2 different malignancies and an end-stage heart failure following chemoradiotherapy who was successfully treated with orthotopic heart transplant.
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Affiliation(s)
- Nihat Firat Sipahi
- From the Department of Cardiac Surgery, Heinrich-Heine University Hospital, Düsseldorf, Germany
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286
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Bracun V, Aboumsallem JP, van der Meer P, de Boer RA. Cardiac Biomarkers in Patients with Cancer: Considerations, Clinical Implications, and Future Avenues. Curr Oncol Rep 2020; 22:67. [PMID: 32514994 PMCID: PMC7280346 DOI: 10.1007/s11912-020-00930-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF THE REVIEW As the number of cancer survivors increases due to early screening and modern (antineoplastic) treatments, cancer treatment associated cardiotoxicity (CTAC) is becoming an increasing health burden that affects survival and quality of life among cancer survivors. Thus, clinicians need to identify adverse events early, in an effort to take suitable measures before the occurrence of permanent or irreversible cardiac dysfunction. RECENT FINDINGS Cardiac troponin (cTn) and B-type natriuretic peptide (BNP) have been proven to detect subclinical cardiotoxicity during antineoplastic treatment. As such, these cardio-specific biomarkers could predict which patients are at risk of developing CTAC even before the start of therapy. Nevertheless, there are inconsistent data from published studies, and the recommendations regarding the use of these biomarkers and their validity are mostly based on expert consensus opinion. In this review, we summarize available literature that evaluates biomarkers of CTAC, and we encourage strategies that integrate circulating biomarkers and cardiac imaging in identifying cancer patients that are at high risk.
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Affiliation(s)
- Valentina Bracun
- Department of Cardiology, University Medical Center Groningen, University of Groningen, AB31, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Joseph Pierre Aboumsallem
- Department of Cardiology, University Medical Center Groningen, University of Groningen, AB31, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, AB31, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Rudolf A. de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, AB31, PO Box 30.001, 9700 RB Groningen, the Netherlands
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287
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Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, Zucker DS, Matthews CE, Ligibel JA, Gerber LH, Morris GS, Patel AV, Hue TF, Perna FM, Schmitz KH. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc 2020; 51:2375-2390. [PMID: 31626055 DOI: 10.1249/mss.0000000000002116] [Citation(s) in RCA: 1307] [Impact Index Per Article: 326.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE The number of cancer survivors worldwide is growing, with over 15.5 million cancer survivors in the United States alone-a figure expected to double in the coming decades. Cancer survivors face unique health challenges as a result of their cancer diagnosis and the impact of treatments on their physical and mental well-being. For example, cancer survivors often experience declines in physical functioning and quality of life while facing an increased risk of cancer recurrence and all-cause mortality compared with persons without cancer. The 2010 American College of Sports Medicine Roundtable was among the first reports to conclude that cancer survivors could safely engage in enough exercise training to improve physical fitness and restore physical functioning, enhance quality of life, and mitigate cancer-related fatigue. METHODS A second Roundtable was convened in 2018 to advance exercise recommendations beyond public health guidelines and toward prescriptive programs specific to cancer type, treatments, and/or outcomes. RESULTS Overall findings retained the conclusions that exercise training and testing were generally safe for cancer survivors and that every survivor should "avoid inactivity." Enough evidence was available to conclude that specific doses of aerobic, combined aerobic plus resistance training, and/or resistance training could improve common cancer-related health outcomes, including anxiety, depressive symptoms, fatigue, physical functioning, and health-related quality of life. Implications for other outcomes, such as peripheral neuropathy and cognitive functioning, remain uncertain. CONCLUSIONS The proposed recommendations should serve as a guide for the fitness and health care professional working with cancer survivors. More research is needed to fill remaining gaps in knowledge to better serve cancer survivors, as well as fitness and health care professionals, to improve clinical practice.
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Affiliation(s)
- Kristin L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, CANADA
| | - Kerri M Winters-Stone
- School of Nursing and Knight Cancer Institute, Oregon Health Sciences University, Portland, OR
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Clinic, Heidelberg, GERMANY
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
| | - Anna L Schwartz
- School of Nursing, Northern Arizona University, Flagstaff, AZ
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, CANADA
| | - David S Zucker
- Cancer Rehabilitation Medicine Services, Swedish Cancer Institute, Swedish Health Services, Seattle, WA
| | - Charles E Matthews
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | | | - Lynn H Gerber
- Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA.,Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, VA
| | | | - Alpa V Patel
- Epidemiology Research, American Cancer Society, Atlanta, GA
| | - Trisha F Hue
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Frank M Perna
- Division of Cancer Control and Population Sciences, Behavioral Research Program, Health Behaviors Research Branch, National Cancer Institute, Rockville, MD
| | - Kathryn H Schmitz
- Public Health Science, Penn State Cancer Institute, Penn State College of Medicine, Hershey, PA
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288
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Gallo S, Spilinga M, Albano R, Ferrauto G, Di Gregorio E, Casanova E, Balmativola D, Bonzano A, Boccaccio C, Sapino A, Comoglio PM, Crepaldi T. Activation of the MET receptor attenuates doxorubicin-induced cardiotoxicity in vivo and in vitro. Br J Pharmacol 2020; 177:3107-3122. [PMID: 32133617 PMCID: PMC7280013 DOI: 10.1111/bph.15039] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 12/16/2022] Open
Abstract
Background and Purpose Doxorubicin anti‐cancer therapy is associated with cardiotoxicity, resulting from DNA damage response (DDR). Hepatocyte growth factor (HGF) protects cardiomyocytes from injury, but its effective use is compromised by low biodistribution. In this study, we have investigated whether the activation of the HGF receptor—encoded by the Met gene—by an agonist monoclonal antibody (mAb) could protect against doxorubicin‐induced cardiotoxicity. Experimental Approach The mAb (5 mg·kg−1) was injected in vivo into C57BL/6J mice, before doxorubicin (three doses of 7 mg·kg−1). Cardiac functions were evaluated through MRI after treatment termination. Heart histological staining and mRNA levels of genes associated with heart failure (Acta1 and Nppa), inflammation (IL‐6), and fibrosis (Ctgf, Col1a2, Timp1, and Mmp9) were assessed. MAb (100 nM) was administered in vitro to H9c2 cardiomyoblasts before addition of doxorubicin (25 μM). DDR and apoptosis markers were evaluated by quantitative western blotting, flow cytometry, and immunofluorescence. Stattic was used for pharmacological inactivation of STAT3. Key Results In vivo, administration of the mAb alleviated doxorubicin‐induced cardiac dysfunction and fibrosis. In vitro, mAb mimicked the response to HGF by (a) inhibiting histone H2AX phosphorylation at S139, (b) quenching the expression of the DNA repair enzyme PARP1, and (c) reducing the proteolytic activation of caspase 3. The MET‐driven cardioprotection involved, at least in vitro, the phosphorylation of STAT3. Conclusion and Implications The MET agonist mAb provides a new tool for cardioprotection against anthracycline cardiotoxicity.
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Affiliation(s)
- Simona Gallo
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Martina Spilinga
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Turin, Italy
| | | | - Giuseppe Ferrauto
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Enza Di Gregorio
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Elena Casanova
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | | | | | - Carla Boccaccio
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Turin, Italy
| | - Anna Sapino
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Tiziana Crepaldi
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Turin, Italy
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289
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A Comparative Study of Rat Urine 1H-NMR Metabolome Changes Presumably Arising from Isoproterenol-Induced Heart Necrosis Versus Clarithromycin-Induced QT Interval Prolongation. BIOLOGY 2020; 9:biology9050098. [PMID: 32414184 PMCID: PMC7284797 DOI: 10.3390/biology9050098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 12/18/2022]
Abstract
Cardiotoxicity remains a challenging concern both in drug development and in the management of various clinical situations. There are a lot of examples of drugs withdrawn from the market or stopped during clinical trials due to unpredicted cardiac adverse events. Obviously, current conventional methods for cardiotoxicity assessment suffer from a lack of predictivity and sensitivity. Therefore, there is a need for developing new tools to better identify and characterize any cardiotoxicity that can occur during the pre-clinical and clinical phases of drug development as well as after marketing in exposed patients. In this study, isoproterenol and clarithromycin were used as prototypical cardiotoxic agents in rats in order to evaluate potential biomarkers of heart toxicity at very early stages using 1H-NMR-based metabonomics. While isoproterenol is known to cause heart necrosis, clarithromycin may induce QT interval prolongation. Heart necrosis and QT prolongation were validated by histological analysis, serum measurement of lactate dehydrogenase/creatine phosphate kinase and QTc measurement by electrocardiogram (ECG). Urine samples were collected before and repeatedly during daily exposure to the drugs for 1H-NMR based-metabonomics investigations. Specific metabolic signatures, characteristic of each tested drug, were obtained from which potential predictive biomarkers for drug-induced heart necrosis and drug-induced QT prolongation were retrieved. Isoproterenol-induced heart necrosis was characterized by higher levels of taurine, creatine, glucose and by lower levels of Krebs cycle intermediates, creatinine, betaine/trimethylamine N-oxide (TMAO), dimethylamine (DMA)/sarcosine. Clarithromycin-induced QT prolongation was characterized by higher levels of creatinine, taurine, betaine/TMAO and DMA/sarcosine and by lower levels of Krebs cycle intermediates, glucose and hippurate.
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290
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Gioffré S, Chiesa M, Cardinale DM, Ricci V, Vavassori C, Cipolla CM, Masson S, Sandri MT, Salvatici M, Ciceri F, Latini R, Staszewsky LI, Pompilio G, Colombo GI, D’Alessandra Y. Circulating MicroRNAs as Potential Predictors of Anthracycline-Induced Troponin Elevation in Breast Cancer Patients: Diverging Effects of Doxorubicin and Epirubicin. J Clin Med 2020; 9:jcm9051418. [PMID: 32403263 PMCID: PMC7290665 DOI: 10.3390/jcm9051418] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/27/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023] Open
Abstract
Anthracyclines are anti-neoplastic drugs presenting cardiotoxicity as a side effect. Cardiac troponins (cTn) and echocardiography are currently used to assess cardiac damage and dysfunction, but early biomarkers identifying patients in need of preventive treatments remain a partially met need. Circulating microRNAs (miRNAs) represent good candidates, so we investigated their possible roles as predictors of troponin elevation upon anthracycline treatment. Eighty-eight female breast cancer patients administered with doxorubicin (DOX) or epirubicin (EPI) were divided into four groups basing on drug type and cTn positive (cTn+) or negative (cTn−) levels: DOX cTn−, DOX cTn+, EPI cTn− and EPI cTn+. Blood was collected at baseline, during treatment, and at follow-up. We identified plasma miRNAs of interest by OpenArray screening and single assay validation. Our results showed miR-122-5p, miR-499a-5p and miR-885-5p dysregulation in DOX patients at T0, identifying a signature separating, with good accuracy, DOX cTn− from DOX cTn+. No miRNAs showed differential expression in EPI subjects. Conversely, an anthracycline-mediated modulation (regardless of cTn) was observed for miR-34a-5p, -122-5p and -885-5p. Our study indicates specific circulating miRNAs as possible prediction markers for cardiac troponin perturbation upon anthracycline treatment. Indeed, our findings hint at the possible future use of plasma miRNAs to predict the cardiac responsiveness of patients to different anticancer agents.
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Affiliation(s)
- Sonia Gioffré
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino-IRCCS, 20138 Milan, Italy; (S.G.); (M.C.); (V.R.); (C.V.); (G.I.C.)
| | - Mattia Chiesa
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino-IRCCS, 20138 Milan, Italy; (S.G.); (M.C.); (V.R.); (C.V.); (G.I.C.)
| | - Daniela Maria Cardinale
- Cardiology Division, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (D.M.C.); (C.M.C.)
| | - Veronica Ricci
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino-IRCCS, 20138 Milan, Italy; (S.G.); (M.C.); (V.R.); (C.V.); (G.I.C.)
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80138 Napoli, Italy
| | - Chiara Vavassori
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino-IRCCS, 20138 Milan, Italy; (S.G.); (M.C.); (V.R.); (C.V.); (G.I.C.)
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Carlo Maria Cipolla
- Cardiology Division, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (D.M.C.); (C.M.C.)
| | - Serge Masson
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (S.M.); (R.L.); (L.I.S.)
| | - Maria Teresa Sandri
- Laboratory Medicine Division, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy; (M.T.S.); (M.S.)
| | - Michela Salvatici
- Laboratory Medicine Division, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy; (M.T.S.); (M.S.)
| | - Fabio Ciceri
- Hematology/Transplant Unit, Istituto Scientifico H. San Raffaele IRCCS, 20132 Milan, Italy;
| | - Roberto Latini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (S.M.); (R.L.); (L.I.S.)
| | - Lidia Irene Staszewsky
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy; (S.M.); (R.L.); (L.I.S.)
| | - Giulio Pompilio
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122 Milan, Italy;
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Gualtiero I. Colombo
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino-IRCCS, 20138 Milan, Italy; (S.G.); (M.C.); (V.R.); (C.V.); (G.I.C.)
| | - Yuri D’Alessandra
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino-IRCCS, 20138 Milan, Italy; (S.G.); (M.C.); (V.R.); (C.V.); (G.I.C.)
- Correspondence: ; Tel.: +39-02-5800-2852; Fax: +39-02-5800-2750
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291
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The Role of Antioxidants in Ameliorating Cyclophosphamide-Induced Cardiotoxicity. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:4965171. [PMID: 32454939 PMCID: PMC7238386 DOI: 10.1155/2020/4965171] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/09/2020] [Accepted: 04/21/2020] [Indexed: 12/11/2022]
Abstract
The chemotherapeutic and immunosuppressive agent cyclophosphamide has previously been shown to induce complications within the setting of bone marrow transplantation. More recently, cardiotoxicity has been shown to be a dose-limiting factor during cyclophosphamide therapy, and cardiooncology is getting wider attention. Though mechanism of cyclophosphamide-induced cardiotoxicity is not completely understood, it is thought to encompass oxidative and nitrative stress. As such, this review focuses on antioxidants and their role in preventing or ameliorating cyclophosphamide-induced cardiotoxicity. It will give special emphasis to the cardioprotective effects of natural, plant-derived antioxidants that have garnered significant interest in recent times.
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292
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Electrocardiographic characteristics of diffuse large B-cell lymphoma patients treated with anthracycline-based chemotherapy. J Electrocardiol 2020; 60:195-199. [PMID: 32413696 DOI: 10.1016/j.jelectrocard.2020.04.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/22/2020] [Accepted: 04/30/2020] [Indexed: 01/13/2023]
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293
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Zhang D, Lv J, Zhang B, Zhang X, Jiang H, Lin Z. The characteristics and regularities of cardiac adverse drug reactions induced by Chinese materia medica: A bibliometric research and association rules analysis. JOURNAL OF ETHNOPHARMACOLOGY 2020; 252:112582. [PMID: 31972324 DOI: 10.1016/j.jep.2020.112582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/06/2020] [Accepted: 01/15/2020] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Chinese materia medica (CMM) has been widely used as an approach of ethnomedicine worldwide. Recently, there are growing concerns related to the potential cardiotoxicity of herbal medicines but comprehensive studies are limited. METHODS Comprehensive literature retrieval via publicly available electronic databases was performed to identify the case reports that focused on cardiac adverse reactions (ADRs) triggered by oral CMMs. And a bibliometric survey was conducted to analyze the most commonly suspected risk factors in terms of responsible CMMs, susceptible patients and clinical administration of cardiac ADRs. Moreover, the techniques of data mining were utilized to investigate the regularities and association between the ADRs status and major contributory factors. RESULTS The available evidence of current research indicated that many influential factors were strongly associated with cardiac ADRs caused by oral CMMs inevitably, including pediatric patients, poisonous CMMs (especially herbs of Aconitum species), overdose and self-medication. Specifically, the timely and effective resuscitation could attribute their favorable capacity to reduce mortality for cardiac ADRs. Notably, the cardiac ADRs cases had often concomitant the ADRs of the nervous system and digestive system. CONCLUSION The comprehensive features and risk factors of cardiac ADRs induced by oral CMMs can be discovered and elucidated through the approaches of bibliometric research, association rules analysis, and data mining technology, which raise the profile and awareness of the rational applications of CMMs and pharmacovigilance within relevant heart side effects.
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Affiliation(s)
- Dan Zhang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 North Three-ring East Road, Chao Yang District, Beijing, 100029, China.
| | - Jintao Lv
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 North Three-ring East Road, Chao Yang District, Beijing, 100029, China.
| | - Bing Zhang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 North Three-ring East Road, Chao Yang District, Beijing, 100029, China; Center for Pharmacovigilance and Rational Use of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China.
| | - Xiaomeng Zhang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 North Three-ring East Road, Chao Yang District, Beijing, 100029, China.
| | - Hao Jiang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 North Three-ring East Road, Chao Yang District, Beijing, 100029, China.
| | - Zhijian Lin
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 North Three-ring East Road, Chao Yang District, Beijing, 100029, China.
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294
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Reding KW, Aragaki AK, Cheng RK, Barac A, Wassertheil-Smoller S, Chubak J, Limacher MC, Hundley WG, D'Agostino R, Vitolins MZ, Brasky TM, Habel LA, Chow EJ, Jackson RD, Chen C, Morgenroth A, Barrington WE, Banegas M, Barnhart M, Chlebowski RT. Cardiovascular Outcomes in Relation to Antihypertensive Medication Use in Women with and Without Cancer: Results from the Women's Health Initiative. Oncologist 2020; 25:712-721. [PMID: 32250503 DOI: 10.1634/theoncologist.2019-0977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/14/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Recent clinical trials have evaluated angiotensin-converting enzyme (ACE) inhibitors (ACEis), angiotensin receptor blockers (ARBs), and beta blockers (BBs) in relation to cardiotoxicity in patients with cancer, typically defined by ejection fraction declines. However, these trials have not examined long-term, hard clinical endpoints. Within a prospective study, we examined the risk of heart failure (HF) and coronary heart disease (CHD) events in relation to use of commonly used antihypertensive medications, including ACEis/ARBs, BBs, calcium channel blockers (CCB), and diuretics, comparing women with and without cancer. MATERIALS AND METHODS In a cohort of 56,997 Women's Health Initiative study participants free of cardiovascular disease who received antihypertensive treatment, we used multivariable-adjusted Cox regression models to calculate the hazard ratios (HRs) of developing CHD, HF, and a composite outcome of cardiac events (combining CHD and HF) in relation to use of ACEis/ARBs, CCBs, or diuretics versus BBs, separately in women with and without cancer. RESULTS Whereas there was no difference in risk of cardiac events comparing ACEi/ARB with BB use among cancer-free women (HR = 0.99 [0.88-1.12]), among cancer survivors ACEi/ARB users were at a 2.24-fold risk of total cardiac events (1.18-4.24); p-interaction = .06). When investigated in relation to CHD only, an increased risk was similarly observed in ACEi/ARB versus BB use for cancer survivors (HR = 1.87 [0.88-3.95]) but not in cancer-free women (HR = 0.91 [0.79-1.06]; p-interaction = .04). A similar pattern was also seen in relation to HF but did not reach statistical significance (p-interaction = .23). CONCLUSION These results from this observational study suggest differing risks of cardiac events in relation to antihypertensive medications depending on history of cancer. Although these results require replication before becoming actionable in a clinical setting, they suggest the need for more rigorous examination of the effect of antihypertensive choice on long-term cardiac outcomes in cancer survivors. IMPLICATIONS FOR PRACTICE Although additional research is needed to replicate these findings, these data from a large, nationally representative sample of postmenopausal women indicate that beta blockers are favorable to angiotensin-converting enzyme inhibitors in reducing the risk of cardiac events among cancer survivors. This differs from the patterns observed in a noncancer cohort, which largely mirrors what is found in the randomized clinical trials in the general population.
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Affiliation(s)
- Kerryn W Reding
- University of Washington School of Nursing, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington, USA
| | - Aaron K Aragaki
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington, USA
| | - Richard K Cheng
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Ana Barac
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Marian C Limacher
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - W Gregory Hundley
- Virginia Commonwealth University Pauley Heart Center, Richmond, Virginia, USA
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ralph D'Agostino
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mara Z Vitolins
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Laurel A Habel
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Eric J Chow
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Rebecca D Jackson
- The Ohio State University Department of Medicine, Columbus, Ohio, USA
| | - Chu Chen
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington, USA
| | - April Morgenroth
- Seattle Pacific University College of Nursing, Seattle, Washington, USA
| | - Wendy E Barrington
- University of Washington School of Nursing, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington, USA
| | - Matthew Banegas
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Matthew Barnhart
- Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Rowan T Chlebowski
- Harbor-University of California Los Angeles Medical Center, Los Angeles, California, USA
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295
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Yang B, Chen Y, Shi J. Tumor‐Specific Chemotherapy by Nanomedicine‐Enabled Differential Stress Sensitization. Angew Chem Int Ed Engl 2020. [DOI: 10.1002/ange.202002306] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Bowen Yang
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructureShanghai Institute of CeramicsChinese Academy of Sciences Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics EngineeringUniversity of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Yu Chen
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructureShanghai Institute of CeramicsChinese Academy of Sciences Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics EngineeringUniversity of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Jianlin Shi
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructureShanghai Institute of CeramicsChinese Academy of Sciences Shanghai 200050 P. R. China
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296
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Yang B, Chen Y, Shi J. Tumor-Specific Chemotherapy by Nanomedicine-Enabled Differential Stress Sensitization. Angew Chem Int Ed Engl 2020; 59:9693-9701. [PMID: 32162453 DOI: 10.1002/anie.202002306] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/09/2020] [Indexed: 12/31/2022]
Abstract
Most of current nanomedicines are administrated intravenously to favour tumor accumulation through enhanced permeability and retention (EPR) effect, which, however, suffers from several drawbacks such as low drug bioavailability and severe side effect. In this work, we have constructed a doxorubicin(Dox)-based liposomal nanosystem for tumor-specific chemotherapy, by enabling differential stress sensitization between cancer and normal cells for restricting the chemodrug toxicity exclusively in tumor regions. 2-Deoxy-D-glucose (2DG) was loaded in the nanoliposome to inhibit glycolysis of cancer cells, which works in synergy with the co-loaded chemodrug Dox to promote mitochondrial depolarization and subsequent apoptosis. In addition, the starvation effect of 2DG can counteract the toxicity of Dox in normal cells and thus mitigates the harmful side effect of chemotherapy. It is expected that such a differential stress sensitization strategy may greatly benefit future nanomedicine design.
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Affiliation(s)
- Bowen Yang
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, P. R. China
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
| | - Yu Chen
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, P. R. China
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
| | - Jianlin Shi
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, 200050, P. R. China
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297
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Yang Q, Chen Y, Gao H, Zhang J, Zhang J, Zhang M, Jing J, Zhu P, Zhou H, Hu S. Chemotherapy-Related Anatomical Coronary-Artery Disease in Lung Cancer Patients Evaluated by Coronary-Angiography SYNTAX Score. Arq Bras Cardiol 2020; 114:1004-1012. [PMID: 32236322 PMCID: PMC8416133 DOI: 10.36660/abc.20190201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/23/2019] [Indexed: 12/27/2022] Open
Abstract
Fundamento A doença arterial coronariana (DAC) associada à quimioterapia está se tornando um tema emergente na prática clínica. Contudo, o mecanismo subjacente da quimioterapia associada à DAC permanence incerto. Objetivos O estudo investigou a associação entre a quimioterapia e as anomalias anatômicas ateroscleróticas das artérias coronárias dentre pacientes com cancer de pulmão. Métodos Foram incluídos pacientes submetidos à angiografia coronária (AGC), entre 2010 e 2017, com câncer de pulmão prévio. Os fatores de risco associados à DAC e os dados sobre o câncer de pulmão foram avaliados. Avaliamos as anomalias das artérias coronárias de acordo com o escore SYNTAX (SXescore) calculado à AGC. Na análise de regressão logística, o escore SYNTAX foi classificado como alto (SXescoreALTO) se ≥22. Os dados foram analisados através de estatística descritiva e análise de regressão. Resultados Ao todo, 94 pacientes foram incluídos no estudo. O SXescore foi mais alto no grupo com quimioterapia quando comparado com o grupo sem quimioterapia (25,25, IIQ [4,50–30,00] versus 16,50, IIQ [5,00–22,00]; p = 0,0195). A taxa do SXescoreALTO foi maior no grupo com quimioterapia do que no no grupo sem quimioterapia (58,33% versus 25,86; p = 0,0016). Tanto a análise de regressão logística univariada (OR: 4,013; 95% IC:1,655–9,731) quanto a multivariada (OR: 5,868; 95% IC:1,778–19,367) revelaram que a quimioterapia aumentou o risco de uma maior taxa do SXescoreALTO. A análise multivariada de regressão logística Stepwise mostrou que o risco para DAC anatômica mais grave aumenta com a quimioterapia como um todo em 5.323 vezes (95% IC: 2,002–14,152), e com o regime à base de platina em 5,850 vezes (95% IC: 2,027–16,879). Conclusões A quimioterapia está associada com a complexidade e gravidade anatômica da DAC, o que pode explicar, em parte, o maior risco de DAC associada à quimioterapia dentre pacientes com câncer de pulmão. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)
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Affiliation(s)
- Qian Yang
- Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yundai Chen
- Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hai Gao
- Department of Cardiology, Chaoyang-qu, Beijing An Zhen Hospital, Beijing, China
| | | | - Juan Zhang
- Department of Oncology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Mingjie Zhang
- Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Jing
- Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Pingjun Zhu
- Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hao Zhou
- Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shunying Hu
- Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing, China
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298
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Xia P, Chen J, Liu Y, Fletcher M, Jensen BC, Cheng Z. Doxorubicin induces cardiomyocyte apoptosis and atrophy through cyclin-dependent kinase 2-mediated activation of forkhead box O1. J Biol Chem 2020; 295:4265-4276. [PMID: 32075913 PMCID: PMC7105316 DOI: 10.1074/jbc.ra119.011571] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/17/2020] [Indexed: 12/29/2022] Open
Abstract
Recent clinical investigations indicate that anthracycline-based chemotherapies induce early decline in heart mass in cancer patients. Heart mass decline may be caused by a decrease in cardiac cell number because of increased cell death or by a reduction in cell size because of atrophy. We previously reported that an anthracycline, doxorubicin (DOX), induces apoptotic death of cardiomyocytes by activating cyclin-dependent kinase 2 (CDK2). However, the signaling pathway downstream of CDK2 remains to be characterized, and it is also unclear whether the same pathway mediates cardiac atrophy. Here we demonstrate that DOX exposure induces CDK2-dependent phosphorylation of the transcription factor forkhead box O1 (FOXO1) at Ser-249, leading to transcription of its proapoptotic target gene, Bcl-2-interacting mediator of cell death (Bim). In cultured cardiomyocytes, treatment with the FOXO1 inhibitor AS1842856 or transfection with FOXO1-specific siRNAs protected against DOX-induced apoptosis and mitochondrial damage. Oral administration of AS1842856 in mice abrogated apoptosis and prevented DOX-induced cardiac dysfunction. Intriguingly, pharmacological FOXO1 inhibition also attenuated DOX-induced cardiac atrophy, likely because of repression of muscle RING finger 1 (MuRF1), a proatrophic FOXO1 target gene. In conclusion, DOX exposure induces CDK2-dependent FOXO1 activation, resulting in cardiomyocyte apoptosis and atrophy. Our results identify FOXO1 as a promising drug target for managing DOX-induced cardiotoxicity. We propose that FOXO1 inhibitors may have potential as cardioprotective therapeutic agents during cancer chemotherapy.
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Affiliation(s)
- Peng Xia
- Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington 99202-2131
| | - Jingrui Chen
- Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington 99202-2131
| | - Yuening Liu
- Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington 99202-2131
| | - Maya Fletcher
- Department of Biology, Gonzaga University, Spokane, Washington 99258
| | - Brian C Jensen
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7075
| | - Zhaokang Cheng
- Department of Pharmaceutical Sciences, Washington State University, Spokane, Washington 99202-2131.
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299
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Cardinale D, Iacopo F, Cipolla CM. Cardiotoxicity of Anthracyclines. Front Cardiovasc Med 2020; 7:26. [PMID: 32258060 PMCID: PMC7093379 DOI: 10.3389/fcvm.2020.00026] [Citation(s) in RCA: 204] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/18/2020] [Indexed: 12/12/2022] Open
Abstract
Cardiotoxicity is a feared side effect that may limit the clinical use of anthracyclines. It may indeed affect the quality of life and survival of patients with cancer, regardless of oncological prognosis. This paper provides an overview of anthracycline-induced cardiotoxicity in terms of definition, classification, incidence, risk factors, possible mechanisms, diagnosis, and treatment. We also report effective strategies for preventing cardiotoxicity. In addition, we discuss limiting current approaches, the need for a new classification, and early cardiotoxicity detection and treatment. Probably, anthracycline-induced cardiotoxicity is a continuous phenomenon that starts from myocardial cell injury; it is followed by left ventricular ejection fraction (LVEF) and, if not diagnosed and cured early, progressively leads to symptomatic heart failure. Anthracycline-induced cardiotoxicity can be detected at a preclinical phase. The role of biomarkers, in particular troponins, in identifying subclinical cardiotoxicity and its therapy with angiotensin-converting enzyme inhibitors (mainly enalapril) to prevent LVEF reduction is a recognized and effective strategy. If cardiac dysfunction has already occurred, partial or complete LVEF recovery may still be obtained in case of early detection of cardiotoxicity and prompt heart failure treatment.
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Affiliation(s)
- Daniela Cardinale
- Cardioncology Unit, European Institute of Oncology, IRCCS, Milan, Italy
| | - Fabiani Iacopo
- Cardioncology Unit, European Institute of Oncology, IRCCS, Milan, Italy
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300
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Gradalski T. Multicomponent Compression Bandaging Combined with Diuretic Therapy of Anasarca Secondary to Palliative Chemotherapy: A Case Report. J Palliat Med 2020; 24:144-147. [PMID: 32181697 DOI: 10.1089/jpm.2019.0691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Although decongestive physiotherapy combined with diuretics may be efficient in limb edemas, no such therapy has been described in the context of anasarca. Case Description: A bedbound 62-year-old man with stage IV pancreatic cancer, presenting with progressing severe dyspnea at rest and anasarca, was admitted to the free-standing hospice 3 weeks after receiving nab-paclitaxel with gemcitabine. Two weeks before admission, oral loop and potassium-sparing diuretics were started for bilateral lower limb edema, which progressed to anasarca even though the drug dose was increased. Hypotension hindered further dose escalation of diuretics. Supportive multicomponent bandage compression on both legs with concurrent intravenous furosemide in hypersaline infusion was implemented with good clinical toleration. Afterward, the loop diuretic dose was increased, and supplemented with dexamethasone. A spectacular edema decrease and marked dyspnea improvement with 19 kg body weight reduction were observed within 7 days. Furosemide was switched to oral route and the patient was discharged needing only occasional assistance in daily living. Conclusion: Compression bandaging with diuretic therapy may be considered even in advanced generalized edemas; however, further studies are needed to determine the adequate therapeutic regime.
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