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Pan Y, Hu J. Hormonal basis of brain fog in cancer treatment. J Exp Med 2024; 221:e20231942. [PMID: 38597926 PMCID: PMC11009970 DOI: 10.1084/jem.20231942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
The cognitive side effects of cancer treatment are common, but no targeted therapy exists yet to treat or prevent such neurological sequelae. We explore the role of hormones as mediators between cancer therapy and cognitive impairment, discussing potential future directions.
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Affiliation(s)
- Yuan Pan
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jian Hu
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Sciancalepore F, Fabozzi F, Albino G, Del Baldo G, Di Ruscio V, Laus B, Menegatti D, Premuselli R, Secco DE, Tozzi AE, Lacorte E, Vanacore N, Carai A, Mastronuzzi A. Frequency and characterization of cognitive impairments in patients diagnosed with paediatric central nervous system tumours: a systematic review. Front Oncol 2023; 13:1198521. [PMID: 37274224 PMCID: PMC10235613 DOI: 10.3389/fonc.2023.1198521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Background This systematic review has been conducted with the aim of characterizing cognitive deficits and analyzing their frequency in survivors of paediatric Central Nervous System tumours. Materials and methods All literature published up to January 2023 was retrieved searching the databases "PubMed", "Cochrane", "APA PsycInfo" and "CINAHL". The following set of pre-defined inclusion criteria were then individually applied to the selected articles in their full-text version: i) Retrospective/prospective longitudinal observational studies including only patients diagnosed with primary cerebral tumours at ≤ 21 years (range 0-21); ii) Studies including patients evaluated for neuro-cognitive and neuro-psychological deficits from their diagnosis and/or from anti-tumoral therapies; iii) Studies reporting standardized tests evaluating patients' neuro-cognitive and neuro-psychological performances; iv) Patients with follow-ups ≥ 2 years from the end of their anti-tumoral therapies; v) Studies reporting frequencies of cognitive deficits. Results 39 studies were included in the analysis. Of these, 35 assessed intellectual functioning, 30 examined memory domains, 24 assessed executive functions, 22 assessed attention, 16 examined visuo-spatial skills, and 15 explored language. A total of 34 studies assessed more than one cognitive function, only 5 studies limited their analysis on a single cognitive domain. Attention impairments were the most recurrent in this population, with a mean frequency of 52.3% after a median period post-treatment of 11.5 years. The other cognitive functions investigated in the studies showed a similar frequency of impairments, with executive functions, language, visuospatial skills and memory deficits occurring in about 40% of survivors after a similar post-treatment period. Longitudinal studies included in the systematic review showed a frequent decline over time of intellectual functioning. Conclusions Survivors of paediatric Central Nervous System tumours experience cognitive sequelae characterized by significant impairments in the attention domain (52.3%), but also in the other cognitive functions. Future studies in this research field need to implement more cognitive interventions and effective, but less neurotoxic, tumour therapies to preserve or improve neurocognitive functioning and quality of life of this population.
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Affiliation(s)
- Francesco Sciancalepore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Francesco Fabozzi
- Department of Oncology/Hematology, Cell Therapy Gene Therapies and Hemopoietic Transplant, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
- Department of Pediatrics, University of Tor Vergata, Rome, Italy
| | - Giulia Albino
- Department of Oncology/Hematology, Cell Therapy Gene Therapies and Hemopoietic Transplant, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
| | - Giada Del Baldo
- Department of Oncology/Hematology, Cell Therapy Gene Therapies and Hemopoietic Transplant, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Valentina Di Ruscio
- Department of Oncology/Hematology, Cell Therapy Gene Therapies and Hemopoietic Transplant, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
| | | | - Danilo Menegatti
- University of Rome “La Sapienza”, Department of Computer, Control, and Management Engineering (DIAG), Rome, Italy
| | - Roberto Premuselli
- Department of Oncology/Hematology, Cell Therapy Gene Therapies and Hemopoietic Transplant, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
| | - Domitilla Elena Secco
- Department of Oncology/Hematology, Cell Therapy Gene Therapies and Hemopoietic Transplant, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
| | - Alberto Eugenio Tozzi
- Multifactorial and Complex Diseases Research Area, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
| | - Eleonora Lacorte
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Andrea Carai
- Neurosurgery Unit, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
| | - Angela Mastronuzzi
- Department of Oncology/Hematology, Cell Therapy Gene Therapies and Hemopoietic Transplant, Scientific Institute for Research, Hospitalization and Healthcare Bambino Gesù Children’s Hospital, Rome, Italy
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Nordhjem BJT, Tjørnlund M, Thomsen BL, Hjerming M, Kjær TW, Pappot H, Hjalgrim LL. Protocol for a prospective, longitudinal study of cognitive impairment in young patients with cancer: a multidisciplinary neuroscience approach (MyBrain). BMJ Open 2023; 13:e070534. [PMID: 37202143 DOI: 10.1136/bmjopen-2022-070534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION The aim of this research is to investigate young cancer patients' cognitive functioning and the underlying neurobiological mechanisms when cognitive functions are impaired. The MyBrain protocol is a multidisciplinary study that investigates cancer-related cognitive impairment in children, adolescents and young adults, combining neuropsychology, cognitive neuroscience and cellular neuroscience. The study is exploratory with a wide focus on trajectories of cognitive functions from diagnosis to the end of treatment and into survivorship. METHODS AND ANALYSIS Prospective longitudinal study including patients diagnosed with non-brain cancers at age 7-29 years. Each patient is paired with a control matched on age and social circle. PRIMARY OBJECTIVE Evaluation of neurocognitive function over time. SECONDARY OBJECTIVES Evaluation of self-perceived quality of life and fatigue, P300 in an electroencephalography (EEG) oddball paradigm, power spectrum in resting state EEG, serum and cerebrospinal fluid levels of biomarkers of neuronal damage, neuroplasticity, proinflammatory and anti-inflammatory markers and their association with cognitive function. ETHICS AND DISSEMINATION The study is approved by the Regional Ethics Committee for the Capital Region of Denmark (no. H-21028495), and the Danish Data Protection Agency (no. P-2021-473). Results are expected to guide future interventions to prevent brain damage and support patients with cognitive difficulties. TRIAL REGISTRATION NUMBER The article is registered at clinicaltrials.gov NCT05840575 (https://clinicaltrials.gov/ct2/show/NCT05840575).
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Affiliation(s)
| | - Morten Tjørnlund
- Center for Rehabilitation of Brain Injury, University of Copenhagen, Copenhagen, Denmark
| | - Birthe Lykke Thomsen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Maiken Hjerming
- Department of Haematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Helle Pappot
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lisa Lyngsie Hjalgrim
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Maas A, Maurice-Stam H, van der Aa-van Delden AM, van Dalen EC, van Dulmen-den Broeder E, Tissing WJE, Loonen JJ, van der Pal HJH, de Vries ACH, van den Heuvel-Eibrink MM, Janssens GO, Ronckers C, Neggers S, Bresters D, Louwerens M, Versluys BAB, van der Heiden-van der Loo M, Kremer LCM, van Gorp M, Grootenhuis MA. Positive and negative survivor-specific psychosocial consequences of childhood cancer: the DCCSS-LATER 2 psycho-oncology study. J Cancer Surviv 2023:10.1007/s11764-023-01394-1. [PMID: 37170006 DOI: 10.1007/s11764-023-01394-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Numerous studies investigated generic psychosocial outcomes in survivors of childhood cancer (CCS). The present study aimed to describe survivor-specific psychosocial consequences in CCS, and to identify socio-demographic and medical associated factors. METHODS CCS from the Dutch Childhood Cancer Survivor Study (DCCSS)-LATER cohort (diagnosed 1963-2001) part 2 (age ≥ 18 years, diagnosed < 18 years, ≥ 5 years since diagnosis) completed the Benefit & Burden Scale (BBSC) and the Impact of Cancer-Childhood Cancer (IOC-CS). Items were scored on a 5-point Likert scale (range 1-5). We examined outcomes with descriptive statistics, and socio-demographic and medical associated factors with regression analyses, corrected for multiple testing (p < 0.004). RESULTS CCS, N = 1713, age mean (M) 36 years, 49% female, ≥ 15 years since diagnosis, participated. On average, CCS reported 'somewhat' Benefit (M = 2.9), and 'not at all' to 'a little' Burden (M = 1.5) of childhood cancer. Average scores on IOC-CS' positive impact scales ranged from 2.5 (Personal Growth) to 4.1 (Socializing), and on the negative impact scales from 1.4 (Financial Problems) to 2.4 (Thinking/Memory). Apart from cognitive problems, CCS reported challenges as worries about relationship status, fertility, and how cancer had affected siblings. Female sex was associated with more Personal Growth, and more negative impact. CCS more highly educated, partnered, and employed had higher positive and lower negative impact. CCS older at diagnosis reported more positive impact. CNS tumor survivors and those who had head/cranium radiotherapy had higher negative impact. CNS tumor survivors reported less positive impact. CONCLUSION AND IMPLICATIONS The majority of CCS reported positive impact of cancer while most CCS reported little negative impact. While this may indicate resiliency in most CCS, health care providers should be aware that they can also experience survivor-specific challenges that warrant monitoring/screening, information provision and psychosocial support.
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Affiliation(s)
- Anne Maas
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | | | | | | | | | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Beatrix Children's Hospital, University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Andrica C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Geert O Janssens
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cécile Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics Informatics and Epidemiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Sebastian Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Medicine, Section Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Birgitta A B Versluys
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marloes van Gorp
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Cole PD, Kim SY, Li Y, Schembri A, Kelly KM, Sulis ML, Vrooman L, Welch JJG, Ramjan S, Silverman LB, Sands SA. Feasibility of serial neurocognitive assessment using Cogstate during and after therapy for childhood leukemia. Support Care Cancer 2023; 31:109. [PMID: 36625831 DOI: 10.1007/s00520-022-07566-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Neurocognitive impairment is frequently observed among survivors of childhood acute lymphoblastic leukemia (ALL) within the domains of attention, working memory, processing speed, executive functioning, and learning and memory. However, few studies have characterized the trajectory of treatment-induced changes in neurocognitive function beginning in the first months of treatment, to test whether early changes predict impairment among survivors. If correct, we hypothesize that those children who are most susceptible to early impairment would be ideal subjects for clinical trials testing interventions designed to protect against treatment-related neurocognitive decline. METHODS In this pilot study, we prospectively assessed neurocognitive functioning (attention, working memory, executive function, visual learning, and processing speed), using the Cogstate computerized battery at six time points during the 2 years of chemotherapy treatment and 1-year post-treatment (Dana-Farber Cancer Institute ALL Consortium protocol 11-001; NCT01574274). RESULTS Forty-three patients with ALL consented to serial neurocognitive testing. Of the 31 participants who remained on study through the final time point, 1 year after completion of chemotherapy, 28 (90%) completed at least five of six planned Cogstate testing time points. Performance and completion checks indicated a high tolerability (≥ 88%) for all subtests. One year after completion of treatment, 10 of 29 patients (34%) exhibited neurocognitive function more than 2 standard deviations below age-matched norms on one or more Cogstate subtests. CONCLUSIONS Serial collection of neurocognitive data (within a month of diagnosis with ALL, during therapy, and 1-year post-treatment) is feasible and can be informative for evaluating treatment-related neurocognitive impairment.
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Affiliation(s)
- Peter D Cole
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Soo Young Kim
- Department of Psychiatry & Behavioral Sciences and Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA
| | - Yuelin Li
- Department of Psychiatry & Behavioral Sciences and Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA
| | | | - Kara M Kelly
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Maria-Luisa Sulis
- Department of Psychiatry & Behavioral Sciences and Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA
| | - Lynda Vrooman
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jennifer J G Welch
- Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sameera Ramjan
- Department of Psychiatry & Behavioral Sciences and Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA
| | - Lewis B Silverman
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Stephen A Sands
- Department of Psychiatry & Behavioral Sciences and Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA.
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Physical activity and exercise for cancer-related cognitive impairment among individuals affected by childhood cancer: a systematic review and meta-analysis. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:47-58. [PMID: 36309037 DOI: 10.1016/s2352-4642(22)00286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Individuals affected by childhood cancer can have cognitive dysfunction that persists into adulthood and negatively affects quality of life. In this study, we aimed to evaluate the effects of physical activity and exercise on cognitive function among individuals affected by childhood cancer. METHODS In this systematic review and meta-analysis, we searched seven databases (CINAHL Plus, Cochrane Library, Embase, MEDLINE, PsycINFO, SPORTDiscus, and Web of Science) and two clinical trial registries (ClinicalTrials.gov and the International Clinical Trials Registry Platform) for randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) published (or registered) from database inception to Jan 30, 2022, with no language restrictions. We included studies that compared the effects of physical activity or exercise interventions with controls (no intervention or usual care) on cognitive function among individuals diagnosed with any type of cancer at age 0-19 years. Two reviewers (JDKB and FR) independently screened records for eligibility and searched references of the selected studies; extracted study-level data from published reports; and assessed study risk of bias of RCTs and NRSIs using the Cochrane risk of bias tool for randomised trials (RoB 2) and Risk Of Bias In Non-randomised Studies-of Interventions (ROBINS-I) tools, certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, and any adverse events. We used intention-to-treat data and unpublished data if available. Cognitive function was assessed by standardised cognitive performance measures (primary outcome) and by validated patient-reported measures (secondary outcome). A random-effects meta-analysis model using the inverse-variance and Hartung-Knapp methods was used to calculate pooled estimates (Hedges' g) and 95% CI values. We estimated the heterogeneity variance by the restricted maximum likelihood method and calculated I2 values to measure heterogeneity. We examined funnel plots and used Egger's regression test to assess for publication bias. This study is registered with PROSPERO, CRD42021261061. FINDINGS We screened 12 425 titles and abstracts, which resulted in full-text assessment of 131 potentially relevant reports. We evaluated 22 unique studies (16 RCTs and six NRSIs) with data on 1277 individuals affected by childhood cancer and low-to-moderate risk of bias. Of the 1277 individuals, 674 [52·8%] were male and 603 [47·2%] were female; median age at study start was 12 (IQR 11-14) years, median time since the end of cancer treatment was 2·5 (IQR -1·1 to 3·0) years, and median intervention period was 12 [IQR 10-24] weeks. There was moderate-quality evidence that, compared with control, physical activity and exercise improved cognitive performance measures (five RCTs; Hedges' g 0·40 [95% CI 0·07-0·73], p=0·027; I2=18%) and patient-reported measures of cognitive function (13 RCTs; Hedges' g 0·26 [0·09-0·43], p=0·0070; I2=40%). No evidence of publication bias was found. Nine mild adverse events were reported. INTERPRETATION There is moderate-certainty evidence that physical activity and exercise improves cognitive function among individuals affected by childhood cancer, which supports the use of physical activity for managing cancer-related cognitive impairment. FUNDING Research Impact Fund of Research Grants Council of the Hong Kong University Grants Committee (R7024-20) and Seed Fund for Basic Research of the University of Hong Kong. COPYRIGHT © 2022 Published by Elsevier Ltd. All rights reserved.
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Jang A, Petrova B, Cheong TC, Zawadzki ME, Jones JK, Culhane AJ, Shipley FB, Chiarle R, Wong ET, Kanarek N, Lehtinen MK. Choroid plexus-CSF-targeted antioxidant therapy protects the brain from toxicity of cancer chemotherapy. Neuron 2022; 110:3288-3301.e8. [PMID: 36070751 PMCID: PMC9588748 DOI: 10.1016/j.neuron.2022.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 06/28/2022] [Accepted: 08/05/2022] [Indexed: 12/14/2022]
Abstract
For many cancer patients, chemotherapy produces untreatable life-long neurologic effects termed chemotherapy-related cognitive impairment (CRCI). We discovered that the chemotherapy methotrexate (MTX) adversely affects oxidative metabolism of non-cancerous choroid plexus (ChP) cells and the cerebrospinal fluid (CSF). We used a ChP-targeted adeno-associated viral (AAV) vector approach in mice to augment CSF levels of the secreted antioxidant SOD3. AAV-SOD3 gene therapy increased oxidative defense capacity of the CSF and prevented MTX-induced lipid peroxidation in the hippocampus. Furthermore, this gene therapy prevented anxiety and deficits in short-term learning and memory caused by MTX. MTX-induced oxidative damage to cultured human cortical neurons and analyses of CSF samples from MTX-treated lymphoma patients demonstrated that MTX diminishes antioxidant capacity of patient CSF. Collectively, our findings motivate the advancement of ChP- and CSF-targeted anti-oxidative prophylactic measures to relieve CRCI.
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Affiliation(s)
- Ahram Jang
- Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Boryana Petrova
- Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Taek-Chin Cheong
- Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Miriam E Zawadzki
- Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA; Graduate Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA 02115, USA; Harvard, MIT MD-PhD Program, Harvard Medical School, Boston, MA 02115, USA
| | - Jill K Jones
- Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA; Harvard, MIT MD-PhD Program, Harvard Medical School, Boston, MA 02115, USA
| | - Andrew J Culhane
- Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Frederick B Shipley
- Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA; Graduate Program in Biophysics, Harvard University, Cambridge, MA 02138, USA
| | - Roberto Chiarle
- Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA; Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino 10126, Italy
| | - Eric T Wong
- Brain Tumor Center & Neuro-Oncology Unit, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
| | - Naama Kanarek
- Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA; Graduate Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA 02115, USA; Graduate Program in Biophysics, Harvard University, Cambridge, MA 02138, USA.
| | - Maria K Lehtinen
- Department of Pathology, Boston Children's Hospital, Boston, MA 02115, USA; Graduate Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA 02115, USA; Graduate Program in Biophysics, Harvard University, Cambridge, MA 02138, USA.
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Whitaker AM, Kayser K. Neuropsychological surveillance model for survivors of pediatric cancer: A descriptive report of methodology and feasibility. Clin Neuropsychol 2022; 36:1746-1766. [PMID: 33941039 DOI: 10.1080/13854046.2021.1912831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: Neuropsychological late effects of pediatric cancer may not become apparent for years after therapy; therefore, serial monitoring is necessary for detecting changes to ensure timely intervention. Unfortunately, lack of access to neuropsychologists, increased patient volume, insurance authorization and reimbursement issues, time required for neuropsychological evaluation, and practice effects related to repeat testing present many challenges to provision of neuropsychological care for survivors of childhood cancer. Models involving surveillance and monitoring have been proposed, though minimal data exist related to the implementation and feasibility of such models. Method: In this descriptive feasibility study, the Neuropsychology Consult Clinic (NCC) at Children's Hospital Los Angeles is presented, outlining a methodology and algorithm for neuropsychological surveillance of survivors of non-CNS pediatric cancer and an account of the first three years of clinic implementation. Participants included 215 survivors (x̅ age = 5.6 years), including 75.3% Latinx patients. Results: The overall clinic implementation was found to be feasible, with approximately 75% of patients "passing" the screening and 25% "failing" the screening. Clinical judgment only conflicted with the algorithm 8.6% of the time. However, several limitations to feasibility were noted, including validity concerns and ability/time to complete parent-reported outcomes using Spanish forms, as well as access to bilingual examiners. Conclusions: These preliminary data support the feasibility of the NCC model with limitations as outlined above. This is the first phase in a multiphase plan to develop an appropriate screening clinic for survivors of pediatric cancer, with the next phase focusing on sensitivity/specificity of measures.
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Affiliation(s)
- Ashley M Whitaker
- Cancer and Blood Disease Institute, Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kimberly Kayser
- Cancer and Blood Disease Institute, Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Duffau H. White Matter Tracts and Diffuse Lower-Grade Gliomas: The Pivotal Role of Myelin Plasticity in the Tumor Pathogenesis, Infiltration Patterns, Functional Consequences and Therapeutic Management. Front Oncol 2022; 12:855587. [PMID: 35311104 PMCID: PMC8924360 DOI: 10.3389/fonc.2022.855587] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/14/2022] [Indexed: 12/18/2022] Open
Abstract
For many decades, interactions between diffuse lower-grade glioma (LGG) and brain connectome were neglected. However, the neoplasm progression is intimately linked to its environment, especially the white matter (WM) tracts and their myelin status. First, while the etiopathogenesis of LGG is unclear, this tumor seems to appear during the adolescence, and it is mostly located within anterior and associative cerebral areas. Because these structures correspond to those which were myelinated later in the brain maturation process, WM myelination could play a role in the development of LGG. Second, WM fibers and the myelin characteristics also participate in LGG diffusion, since glioma cells migrate along the subcortical pathways, especially when exhibiting a demyelinated phenotype, which may result in a large invasion of the parenchyma. Third, such a migratory pattern can induce functional (neurological, cognitive and behavioral) disturbances, because myelinated WM tracts represent the main limitation of neuroplastic potential. These parameters are critical for tailoring an individualized therapeutic strategy, both (i) regarding the timing of active treatment(s) which must be proposed earlier, before a too wide glioma infiltration along the WM bundles, (ii) and regarding the anatomic extent of surgical resection and irradiation, which should take account of the subcortical connectivity. Therefore, the new science of connectomics must be integrated in LGG management, based upon an improved understanding of the interplay across glioma dissemination within WM and reactional neural networks reconfiguration, in order to optimize long-term oncological and functional outcomes. To this end, mechanisms of activity-dependent myelin plasticity should be better investigated.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", Institute of Functional Genomics, National Institute for Health and Medical Research (INSERM) U1191, University of Montpellier, Montpellier, France
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Perazzo D, Moore R, Kasparian NA, Rodts M, Horowitz-Kraus T, Crosby L, Turpin B, Beck AF, Hutton J. Chronic pediatric diseases and risk for reading difficulties: a narrative review with recommendations. Pediatr Res 2022; 92:966-978. [PMID: 35121848 PMCID: PMC9586865 DOI: 10.1038/s41390-022-01934-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 11/02/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022]
Abstract
Literacy is a major social determinant of health, rooted in skills that develop during early childhood. Children arriving at kindergarten unprepared to learn to read are more likely to have low reading proficiency thereafter. General and health literacy are highly correlated, affecting understanding of health conditions, treatment adherence, and transition to self-care and adult healthcare services. The American Academy of Pediatrics (AAP) recommends literacy and school readiness promotion during well-visits and neurodevelopmental surveillance is emphasized across primary and subspecialty care. While genetic and environmental risk factors for reading difficulties are well-established, risks related to complex and chronic medical conditions are less appreciated and under-researched. This review applies an eco-bio-developmental framework to explore literacy across five complex chronic conditions affecting millions of children worldwide: asthma, cancer, congenital heart disease, epilepsy, and sickle cell disease. In each, integration of an efficient reading brain network may be impacted by direct factors, such as ischemia, anesthesia, and/or medications, and also indirect factors, such as altered parent-child routines, hospital stays, and missed school. By integrating literacy into care management plans for affected children, pediatric primary care and specialty providers are poised to identify risks early, target guidance and interventions, and improve academic and health outcomes. IMPACT: While genetic and environmental risk factors for reading difficulties are well-established, risks related to complex and/or chronic medical conditions such as asthma, cancer, congenital heart disease, epilepsy, and sickle cell disease are substantial, less appreciated, and under-researched. General and health literacy are highly correlated, with implications for the understanding one's health condition, treatment adherence, and transitioning to self-care, which is especially important for children with complex and/or chronic illness. Pediatric primary care and specialty providers are poised to integrate reading and literacy into care management plans for children with complex and/or chronic illness, including early screening, guidance, support, and interventions.
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Affiliation(s)
- Donna Perazzo
- grid.24827.3b0000 0001 2179 9593Reading and Literacy Discovery Center, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Ryan Moore
- grid.24827.3b0000 0001 2179 9593The Heart Institute, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Nadine A. Kasparian
- grid.24827.3b0000 0001 2179 9593The Heart Institute, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Center for Heart Disease and Mental Health, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Megan Rodts
- grid.24827.3b0000 0001 2179 9593The Heart Institute, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Tzipi Horowitz-Kraus
- grid.24827.3b0000 0001 2179 9593Reading and Literacy Discovery Center, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,grid.6451.60000000121102151Educational Neuroimaging Center, Faculty of Education in Science and Technology and Faculty of Biomedical Engineering, Technion, Haifa, Israel
| | - Lori Crosby
- grid.24827.3b0000 0001 2179 9593Center for Clinical and Translational Science and Training and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Brian Turpin
- grid.24827.3b0000 0001 2179 9593Division of Oncology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Andrew F. Beck
- grid.24827.3b0000 0001 2179 9593Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - John Hutton
- Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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11
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Ryder-Burbidge C, Diaz RL, Barr RD, Gupta S, Nathan PC, McKillop SJ, Fidler-Benaoudia MM. The Burden of Late Effects and Related Risk Factors in Adolescent and Young Adult Cancer Survivors: A Scoping Review. Cancers (Basel) 2021; 13:cancers13194870. [PMID: 34638350 PMCID: PMC8508204 DOI: 10.3390/cancers13194870] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary It is unclear what the risk of negative health outcomes is after cancer during adolescence and young adulthood. We conducted a review to understand the risk of second cancers, chronic conditions, and death in adolescent and young adult (AYA) cancer survivors and found factors that increase the risk. In total, 652 studies were identified, of which 106 were included in the review: 23 for second cancers, 34 for chronic conditions, and 54 for deaths. The number of included studies increased over time, from four studies in 2010 to 17 in 2020. The studies found that AYA cancer survivors are at an increased risk of second cancers, chronic conditions, and deaths. In particular, the following factors increased risk: radiation exposure for second cancers; younger attained age and earlier calendar period of diagnosis for chronic conditions; and non-Hispanic Black or Hispanic, low socioeconomic status, and earlier calendar period of diagnosis for deaths. Abstract Risk factors associated with late effects in survivors of adolescent and young adult (AYA) cancer are poorly understood. We conducted a systematic scoping review to identify cohort studies published in English from 2010–2020 that included: (1) cancer survivors who were AYAs (age 15–39 years) at diagnosis and (2) outcomes of subsequent malignant neoplasms (SMNs), chronic conditions, and/or late mortality (>5 years postdiagnosis). There were 652 abstracts identified and, ultimately, 106 unique studies were included, of which 23, 34, and 54 studies related to the risk of SMNs, chronic conditions, and mortality, respectively. Studies investigating late effects among survivors of any primary cancer reported that AYA cancer survivors were at higher risk of SMN, chronic conditions, and all-cause mortality compared to controls. There was an indication that the following factors increased risk: radiation exposure (n = 3) for SMNs; younger attained age (n = 4) and earlier calendar period of diagnosis (n = 3) for chronic conditions; and non-Hispanic Black or Hispanic (n = 5), low socioeconomic status (n = 3), and earlier calendar period of diagnosis (n = 4) for late mortality. More studies including the full AYA age spectrum, treatment data, and results stratified by age, sex, and cancer type are needed to advance knowledge about late effects in AYA cancer survivors.
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Affiliation(s)
- Charlotte Ryder-Burbidge
- Cancer Care Alberta, Alberta Health Services, Holy Cross Centre, Department of Cancer Epidemiology and Prevention Research, 5th Floor, BOX ACB, 2210-2 St. SW, Calgary, AB T2S 3C3, Canada; (C.R.-B.); (R.L.D.)
| | - Ruth L. Diaz
- Cancer Care Alberta, Alberta Health Services, Holy Cross Centre, Department of Cancer Epidemiology and Prevention Research, 5th Floor, BOX ACB, 2210-2 St. SW, Calgary, AB T2S 3C3, Canada; (C.R.-B.); (R.L.D.)
| | - Ronald D. Barr
- Health Sciences Centre 3A, Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada;
| | - Sumit Gupta
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; (S.G.); (P.C.N.)
| | - Paul C. Nathan
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; (S.G.); (P.C.N.)
| | - Sarah J. McKillop
- Department of Pediatrics, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, AL T6G 1C9, Canada;
| | - Miranda M. Fidler-Benaoudia
- Cancer Care Alberta, Alberta Health Services, Holy Cross Centre, Department of Cancer Epidemiology and Prevention Research, 5th Floor, BOX ACB, 2210-2 St. SW, Calgary, AB T2S 3C3, Canada; (C.R.-B.); (R.L.D.)
- Departments of Oncology and Community Health Sciences, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
- Correspondence:
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12
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Bava L, Freyer DR, Radbill LM, Johns AL. Association of language proficiency, sociodemographics, and neurocognitive functioning in dual-language Latino survivors of childhood acute lymphoblastic leukemia and lymphoma. Pediatr Blood Cancer 2021; 68:e29118. [PMID: 34019328 DOI: 10.1002/pbc.29118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Survivors of childhood acute lymphoblastic leukemia and lymphoma (ALL/LL) are at risk for cognitive dysfunction, but little is known about its relationship with language proficiency and sociodemographics. PROCEDURE In this cross-sectional cohort study of Latino survivors of childhood ALL/LL, English and Spanish language proficiency and cognitive and academic functioning were measured and their associations determined using paired t-tests, Pearson correlations, and linear regressions. RESULTS Participants (N = 57; 50.9% female) had mean ages (years ± SD) of 4.3 ± 2.6 at diagnosis and 10.6 ± 2.9 at testing (range 6-16); mean time post treatment was 3.7 ± 2.6 years. The majority (73.7%) had low socioeconomic status (SES). Most (78.8%) were dual-language learners in English and Spanish. English proficiency was graded as limited-to-fluent and was significantly higher than Spanish (p < .001). Higher SES was correlated with higher English proficiency (r = 0.31, p = .020). Males had higher Spanish proficiency (r = -0.32, p = .034). Controlling for SES and sex, English proficiency accounted for 43% of cognitive functioning variance (F = 14.86, p < .001), 55% of reading comprehension variance (F = 22.14, p < .001), and 21% of mathematics variance (F = 5.76, p = .002). CONCLUSIONS Low language proficiency correlated with SES but was independently associated with lower cognitive and academic functioning. Research and surveillance for neurocognitive late effects in Latino ALL/LL survivors should incorporate measures of language proficiency and SES to account for their effects on cognitive and academic functioning.
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Affiliation(s)
- Laura Bava
- Survivorship and Supportive Care Program, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - David R Freyer
- Survivorship and Supportive Care Program, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Linda M Radbill
- Survivorship and Supportive Care Program, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Alexis L Johns
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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13
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Barbet V, Broutier L. Future Match Making: When Pediatric Oncology Meets Organoid Technology. Front Cell Dev Biol 2021; 9:674219. [PMID: 34327198 PMCID: PMC8315550 DOI: 10.3389/fcell.2021.674219] [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] [Received: 02/28/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Unlike adult cancers that frequently result from the accumulation in time of mutational “hits” often linked to lifestyle, childhood cancers are emerging as diseases of dysregulated development through massive epigenetic alterations. The ability to reconstruct these differences in cancer models is therefore crucial for better understanding the uniqueness of pediatric cancer biology. Cancer organoids (i.e., tumoroids) represent a promising approach for creating patient-derived in vitro cancer models that closely recapitulate the overall pathophysiological features of natural tumorigenesis, including intra-tumoral heterogeneity and plasticity. Though largely applied to adult cancers, this technology is scarcely used for childhood cancers, with a notable delay in technological transfer. However, tumoroids could provide an unprecedented tool to unravel the biology of pediatric cancers and improve their therapeutic management. We herein present the current state-of-the-art of a long awaited and much needed matchmaking.
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Affiliation(s)
- Virginie Barbet
- Childhood Cancer & Cell Death (C3), Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon (CRCL), Lyon, France
| | - Laura Broutier
- Childhood Cancer & Cell Death (C3), Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon (CRCL), Lyon, France
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14
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Chen YC, Sheen JM, Wang SC, Hsu MH, Hsiao CC, Chang KA, Huang LT. Methotrexate Neurotoxicity Is Related to Epigenetic Modification of the Myelination Process. Int J Mol Sci 2021; 22:6718. [PMID: 34201550 PMCID: PMC8267729 DOI: 10.3390/ijms22136718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/12/2021] [Accepted: 06/17/2021] [Indexed: 12/29/2022] Open
Abstract
With the improvement of the survival rate of acute lymphoblastic leukemia (ALL) in children, some children ALL survivors reveal inferior intellectual and cognition outcome. Methotrexate (MTX), while serving as an essential component in ALL treatment, has been reported to be related to various neurologic sequelae. Using combined intrathecal (IT) and intraperitoneal (IP) MTX model, we had demonstrated impaired spatial memory function in developing rats, which can be rescued by melatonin treatment. To elucidate the impact of MTX treatment on the epigenetic modifications of the myelination process, we examined the change of neurotrophin and myelination-related transcriptomes in the present study and found combined IT and IP MTX treatment resulted in altered epigenetic modification on the myelination process, mainly in the hippocampus. Further, melatonin can restore the MTX effect through alterations of the epigenetic pathways.
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Affiliation(s)
- Yu-Chieh Chen
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (J.-M.S.); (S.-C.W.); (M.-H.H.); (C.-C.H.)
- Department of Traditional Medicine, Chang Gung University, Guishan, Taoyuan 333, Taiwan
| | - Jiunn-Ming Sheen
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (J.-M.S.); (S.-C.W.); (M.-H.H.); (C.-C.H.)
- Department of Traditional Medicine, Chang Gung University, Guishan, Taoyuan 333, Taiwan
| | - Su-Chen Wang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (J.-M.S.); (S.-C.W.); (M.-H.H.); (C.-C.H.)
| | - Mei-Hsin Hsu
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (J.-M.S.); (S.-C.W.); (M.-H.H.); (C.-C.H.)
| | - Chih-Cheng Hsiao
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (J.-M.S.); (S.-C.W.); (M.-H.H.); (C.-C.H.)
- Department of Traditional Medicine, Chang Gung University, Guishan, Taoyuan 333, Taiwan
| | - Kow-Aung Chang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan;
| | - Li-Tung Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (J.-M.S.); (S.-C.W.); (M.-H.H.); (C.-C.H.)
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15
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van Erp LME, Maurice-Stam H, Kremer LCM, Tissing WJE, van der Pal HJH, de Vries ACH, van den Heuvel-Eibrink MM, Versluys BAB, van der Heiden-van der Loo M, Huizinga GA, Grootenhuis MA. A vulnerable age group: the impact of cancer on the psychosocial well-being of young adult childhood cancer survivors. Support Care Cancer 2021; 29:4751-4761. [PMID: 33527229 PMCID: PMC8236461 DOI: 10.1007/s00520-021-06009-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/19/2021] [Indexed: 02/04/2023]
Abstract
Purpose This study aimed to increase our understanding of the psychosocial well-being of young adult childhood cancer survivors (YACCS) as well as the positive and negative impacts of cancer. Methods YACCS (aged 18–30, diagnosed ≤ 18, time since diagnosis ≥ 5 years) cross-sectionally filled out the “Pediatric Quality of Life Inventory Young Adults” (PedsQL-YA), “Hospital Anxiety and Depression Scale” (HADS), and “Checklist Individual Strengths” (CIS-20R) to measure fatigue and survivor-specific “Impact of Cancer - Childhood Survivors” (IOC-CS), which measures the long-term impact of childhood cancer in several domains. Descriptive statistics (IOC-CS), logistic regression (HADS, CIS-20R), and ANOVA (PedsQL-YA, HADS, CIS-20R) were performed. Associations between positive and negative impacts of childhood cancer and psychosocial outcomes were examined with linear regression analyses. Results YACCS (N = 151, 61.6% female, mean age 24.1 ± 3.6, mean time since diagnosis 13.6 ± 3.8) reported lower HRQOL (− .4 ≤ d ≤ − .5, p ≤ .001) and more anxiety (d = .4, p ≤ .001), depression (d = .4, p ≤ .01), and fatigue (.3 ≤ d ≤ .5, p ≤ .001) than young adults from the general Dutch population. They were at an increased risk of experiencing (sub)clinical anxiety (OR = 1.8, p = .017). YACCS reported more impact on scales representing a positive rather than negative impact of CC. Various domains of impact of childhood cancer were related to psychosocial outcomes, especially “Life Challenges” (HRQOL β = − .18, anxiety β = .36, depression β = .29) and “Body & Health” (HRQOL β = .27, anxiety β = − .25, depression β = − .26, fatigue β = − .47). Conclusion YACCS are vulnerable to psychosocial difficulties, but they also experience positive long-term impacts of childhood cancer. Positive and negative impacts of childhood cancer were associated with psychosocial outcomes in YACCS. Screening of psychosocial outcomes and offering targeted interventions are necessary to optimize psychosocial long-term follow-up care for YACCS.
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Affiliation(s)
- L M E van Erp
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands
| | - H Maurice-Stam
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands.
| | - L C M Kremer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W J E Tissing
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands.,Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - H J H van der Pal
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands
| | - A C H de Vries
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands.,Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands.,Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | - B A B Versluys
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands.,Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - G A Huizinga
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands.,Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - M A Grootenhuis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584CS, Utrecht, The Netherlands
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16
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Spitzhüttl JS, Kronbichler M, Kronbichler L, Benzing V, Siegwart V, Pastore‐Wapp M, Kiefer C, Slavova N, Grotzer M, Roebers CM, Steinlin M, Leibundgut K, Everts R. Impact of non-CNS childhood cancer on resting-state connectivity and its association with cognition. Brain Behav 2021; 11:e01931. [PMID: 33205895 PMCID: PMC7821559 DOI: 10.1002/brb3.1931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/10/2020] [Accepted: 10/09/2020] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Non-central nervous system cancer in childhood (non-CNS CC) and its treatments pose a major threat to brain development, with implications for functional networks. Structural and functional alterations might underlie the cognitive late-effects identified in survivors of non-CNS CC. The present study evaluated resting-state functional networks and their associations with cognition in a mixed sample of non-CNS CC survivors (i.e., leukemia, lymphoma, and other non-CNS solid tumors). METHODS Forty-three patients (off-therapy for at least 1 year and aged 7-16 years) were compared with 43 healthy controls matched for age and sex. High-resolution T1-weighted structural magnetic resonance and resting-state functional magnetic resonance imaging were acquired. Executive functions, attention, processing speed, and memory were assessed outside the scanner. RESULTS Cognitive performance was within the normal range for both groups; however, patients after CNS-directed therapy showed lower executive functions than controls. Seed-based connectivity analyses revealed that patients exhibited stronger functional connectivity between fronto- and temporo-parietal pathways and weaker connectivity between parietal-cerebellar and temporal-occipital pathways in the right hemisphere than controls. Functional hyperconnectivity was related to weaker memory performance in the patients' group. CONCLUSION These data suggest that even in the absence of brain tumors, non-CNS CC and its treatment can lead to persistent cerebral alterations in resting-state network connectivity.
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Affiliation(s)
- Janine S. Spitzhüttl
- Department of PsychologyUniversity of BernBernSwitzerland
- Neuropediatrics, Development and RehabilitationUniversity Children's Hospital Bern, and University of BernBernSwitzerland
- Department of Pediatric Hematology and OncologyUniversity Children's Hospital BernUniversity of BernBernSwitzerland
| | - Martin Kronbichler
- Centre for Cognitive Neuroscience and Department of PsychologyUniversity of SalzburgSalzburgAustria
- Neuroscience InstituteChristian‐Doppler Medical CentreParacelsus Medical UniversitySalzburgAustria
| | - Lisa Kronbichler
- Centre for Cognitive Neuroscience and Department of PsychologyUniversity of SalzburgSalzburgAustria
- Neuroscience InstituteChristian‐Doppler Medical CentreParacelsus Medical UniversitySalzburgAustria
- Department of Psychiatry, Psychotherapy and PsychosomaticsChristian‐Doppler Medical Centre, Paracelsus Medical UniversitySalzburgAustria
| | - Valentin Benzing
- Department of Pediatric Hematology and OncologyUniversity Children's Hospital BernUniversity of BernBernSwitzerland
- Institute of Sport ScienceUniversity of BernBernSwitzerland
| | - Valerie Siegwart
- Neuropediatrics, Development and RehabilitationUniversity Children's Hospital Bern, and University of BernBernSwitzerland
- Department of Pediatric Hematology and OncologyUniversity Children's Hospital BernUniversity of BernBernSwitzerland
| | - Manuela Pastore‐Wapp
- Support Center for Advanced Neuroimaging (SCAN)Institute of Diagnostic and Interventional Neuroradiology, InselspitalBern University Hospital, and University of BernBernSwitzerland
| | - Claus Kiefer
- Support Center for Advanced Neuroimaging (SCAN)Institute of Diagnostic and Interventional Neuroradiology, InselspitalBern University Hospital, and University of BernBernSwitzerland
| | - Nedelina Slavova
- Support Center for Advanced Neuroimaging (SCAN)Institute of Diagnostic and Interventional Neuroradiology, InselspitalBern University Hospital, and University of BernBernSwitzerland
| | - Michael Grotzer
- Department of Pediatric OncologyUniversity Children's Hospital ZurichZurichSwitzerland
| | | | - Maja Steinlin
- Neuropediatrics, Development and RehabilitationUniversity Children's Hospital Bern, and University of BernBernSwitzerland
| | - Kurt Leibundgut
- Department of Pediatric Hematology and OncologyUniversity Children's Hospital BernUniversity of BernBernSwitzerland
| | - Regula Everts
- Neuropediatrics, Development and RehabilitationUniversity Children's Hospital Bern, and University of BernBernSwitzerland
- Department of Pediatric Hematology and OncologyUniversity Children's Hospital BernUniversity of BernBernSwitzerland
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17
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Gummersall T, Skaczkowski G, Wilson C. Childhood cancer, age at diagnosis and educational attainment: A meta-analysis. Crit Rev Oncol Hematol 2020; 145:102838. [DOI: 10.1016/j.critrevonc.2019.102838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/25/2019] [Accepted: 11/20/2019] [Indexed: 12/23/2022] Open
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18
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Brace KM, Lee WW, Cole PD, Sussman ES. Childhood leukemia survivors exhibit deficiencies in sensory and cognitive processes, as reflected by event-related brain potentials after completion of curative chemotherapy: A preliminary investigation. J Clin Exp Neuropsychol 2019; 41:814-831. [PMID: 31156064 PMCID: PMC6663575 DOI: 10.1080/13803395.2019.1623865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
Objective: The purpose of this study was to characterize post-chemotherapy sensory, memory, and attention abilities in childhood survivors of acute lymphoblastic leukemia (ALL) to better understand how treatment affects cognitive functioning. Methods: Eight ALL survivors and eight age-matched, healthy children between the ages of 5-11 years participated in the study. Among the ALL survivors, a median of 63 days (range 22-267 days) elapsed between completion of chemotherapy and this assessment. Sounds were presented in an oddball paradigm while recording the electroencephalogram in separate conditions of passive listening and active task performance. To assess different domains of cognition, we measured event-related brain potentials (ERPs) reflecting sensory processing (P1 component), working memory (mismatch negativity [MMN] component), attentional orienting (P3a), and target detection (P3b component) in response to the sounds. We also measured sound discrimination and response speed performance. Results: Relative to control subjects, ALL survivors had poorer performance on auditory tasks, as well as decreased amplitude of the P1, MMN, P3a, and P3b components. ALL survivors also did not exhibit the amplitude gain typically observed in the sensory P1 component when attending to the sound input compared to when passively listening. Conclusions: Atypical responses were observed in brain processes associated with sensory discrimination, auditory working memory, and attentional control in pediatric ALL survivors indicating deficiencies in all cognitive domains compared to age-matched controls. Significance: ERPs differentiated aspects of cognitive functioning, which may provide a useful tool for assessing recovery and risk of post-chemotherapy cognitive deficiencies in young children. The decreased MMN amplitude in ALL survivors may indicate (N-methyl D-aspartate) NMDA dysfunction induced by methotrexate, and thus provides a potential therapeutic target for chemotherapy-associated cognitive impairments.
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Affiliation(s)
- Kelin M. Brace
- Department of Neuroscience, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, United States
| | - Wei Wei Lee
- Department of Neuroscience, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, United States
| | - Peter D. Cole
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901, United States
| | - Elyse S. Sussman
- Department of Neuroscience, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, United States
- Department of Otorhinolaryngology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, United States
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19
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Geraghty AC, Gibson EM, Ghanem RA, Greene JJ, Ocampo A, Goldstein AK, Ni L, Yang T, Marton RM, Paşca SP, Greenberg ME, Longo FM, Monje M. Loss of Adaptive Myelination Contributes to Methotrexate Chemotherapy-Related Cognitive Impairment. Neuron 2019; 103:250-265.e8. [PMID: 31122677 DOI: 10.1016/j.neuron.2019.04.032] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 01/29/2019] [Accepted: 04/22/2019] [Indexed: 01/05/2023]
Abstract
Activity-dependent myelination is thought to contribute to adaptive neurological function. However, the mechanisms by which activity regulates myelination and the extent to which myelin plasticity contributes to non-motor cognitive functions remain incompletely understood. Using a mouse model of chemotherapy-related cognitive impairment (CRCI), we recently demonstrated that methotrexate (MTX) chemotherapy induces complex glial dysfunction for which microglial activation is central. Here, we demonstrate that remote MTX exposure blocks activity-regulated myelination. MTX decreases cortical Bdnf expression, which is restored by microglial depletion. Bdnf-TrkB signaling is a required component of activity-dependent myelination. Oligodendrocyte precursor cell (OPC)-specific TrkB deletion in chemotherapy-naive mice results in impaired cognitive behavioral performance. A small-molecule TrkB agonist rescues both myelination and cognitive impairment after MTX chemotherapy. This rescue after MTX depends on intact TrkB expression in OPCs. Taken together, these findings demonstrate a molecular mechanism required for adaptive myelination that is aberrant in CRCI due to microglial activation.
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Affiliation(s)
- Anna C Geraghty
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA 94305, USA
| | - Erin M Gibson
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA 94305, USA
| | - Reem A Ghanem
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA 94305, USA
| | - Jacob J Greene
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA 94305, USA
| | - Alfonso Ocampo
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA 94305, USA
| | - Andrea K Goldstein
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA 94305, USA
| | - Lijun Ni
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA 94305, USA
| | - Tao Yang
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA 94305, USA
| | - Rebecca M Marton
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Sergiu P Paşca
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | | | - Frank M Longo
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA 94305, USA
| | - Michelle Monje
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA 94305, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA; Department of Pathology, Stanford University, Stanford, CA 94305, USA; Department of Pediatrics, Stanford University, Stanford, CA 94305, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305, USA.
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20
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Cognitive functioning in thyroid cancer survivors: a systematic review and meta-analysis. J Cancer Surviv 2019; 13:231-243. [DOI: 10.1007/s11764-019-00745-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/12/2019] [Indexed: 12/17/2022]
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21
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Filbin M, Monje M. Developmental origins and emerging therapeutic opportunities for childhood cancer. Nat Med 2019; 25:367-376. [PMID: 30842674 DOI: 10.1038/s41591-019-0383-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 02/01/2019] [Indexed: 02/07/2023]
Abstract
Cancer is the leading disease-related cause of death in children in developed countries. Arising in the context of actively growing tissues, childhood cancers are fundamentally diseases of dysregulated development. Childhood cancers exhibit a lower overall mutational burden than adult cancers, and recent sequencing studies have revealed that the genomic events central to childhood oncogenesis include mutations resulting in broad epigenetic changes or translocations that result in fusion oncoproteins. Here, we will review the developmental origins of childhood cancers, epigenetic dysregulation in tissue stem/precursor cells in numerous examples of childhood cancer oncogenesis and emerging therapeutic opportunities aimed at both cell-intrinsic and microenvironmental targets together with new insights into the mechanisms underlying long-term sequelae of childhood cancer therapy.
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Affiliation(s)
- Mariella Filbin
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorder Center and Harvard Medical School, Boston, MA, USA
| | - Michelle Monje
- Department of Neurology, Stanford University, Stanford, CA, USA.
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22
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Gibson EM, Nagaraja S, Ocampo A, Tam LT, Wood LS, Pallegar PN, Greene JJ, Geraghty AC, Goldstein AK, Ni L, Woo PJ, Barres BA, Liddelow S, Vogel H, Monje M. Methotrexate Chemotherapy Induces Persistent Tri-glial Dysregulation that Underlies Chemotherapy-Related Cognitive Impairment. Cell 2019; 176:43-55.e13. [PMID: 30528430 PMCID: PMC6329664 DOI: 10.1016/j.cell.2018.10.049] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/12/2018] [Accepted: 10/23/2018] [Indexed: 02/07/2023]
Abstract
Chemotherapy results in a frequent yet poorly understood syndrome of long-term neurological deficits. Neural precursor cell dysfunction and white matter dysfunction are thought to contribute to this debilitating syndrome. Here, we demonstrate persistent depletion of oligodendrocyte lineage cells in humans who received chemotherapy. Developing a mouse model of methotrexate chemotherapy-induced neurological dysfunction, we find a similar depletion of white matter OPCs, increased but incomplete OPC differentiation, and a persistent deficit in myelination. OPCs from chemotherapy-naive mice similarly exhibit increased differentiation when transplanted into the microenvironment of previously methotrexate-exposed brains, indicating an underlying microenvironmental perturbation. Methotrexate results in persistent activation of microglia and subsequent astrocyte activation that is dependent on inflammatory microglia. Microglial depletion normalizes oligodendroglial lineage dynamics, myelin microstructure, and cognitive behavior after methotrexate chemotherapy. These findings indicate that methotrexate chemotherapy exposure is associated with persistent tri-glial dysregulation and identify inflammatory microglia as a therapeutic target to abrogate chemotherapy-related cognitive impairment. VIDEO ABSTRACT.
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Affiliation(s)
- Erin M Gibson
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA 94305, USA
| | - Surya Nagaraja
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA 94305, USA
| | - Alfonso Ocampo
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA 94305, USA
| | - Lydia T Tam
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA 94305, USA
| | - Lauren S Wood
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA 94305, USA
| | - Praveen N Pallegar
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA 94305, USA
| | - Jacob J Greene
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA 94305, USA
| | - Anna C Geraghty
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA 94305, USA
| | - Andrea K Goldstein
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA 94305, USA
| | - Lijun Ni
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA 94305, USA
| | - Pamelyn J Woo
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA 94305, USA
| | - Ben A Barres
- Department of Neurobiology, Stanford University, Palo Alto, CA 94305, USA
| | - Shane Liddelow
- Department of Neurobiology, Stanford University, Palo Alto, CA 94305, USA; Department of Neuroscience and Physiology, NYU Neuroscience Institute, New York University School of Medicine, New York, NY 10016, USA
| | - Hannes Vogel
- Department of Pathology, Stanford University, Palo Alto, CA 94305, USA
| | - Michelle Monje
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA 94305, USA; Department of Pathology, Stanford University, Palo Alto, CA 94305, USA; Department of Pediatrics, Stanford University, Palo Alto, CA 94305, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA 94305, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Palo Alto, CA 94305, USA.
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23
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Wen J, Maxwell RR, Wolf AJ, Spira M, Gulinello ME, Cole PD. Methotrexate causes persistent deficits in memory and executive function in a juvenile animal model. Neuropharmacology 2018; 139:76-84. [PMID: 29990472 PMCID: PMC6089371 DOI: 10.1016/j.neuropharm.2018.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/27/2018] [Accepted: 07/05/2018] [Indexed: 01/22/2023]
Abstract
Methotrexate is a dihydrofolate reductase inhibitor widely employed in curative treatment for children with acute lymphoblastic leukemia (ALL). However, methotrexate administration is also associated with persistent cognitive deficits among long-term childhood cancer survivors. Animal models of methotrexate-induced cognitive deficits have primarily utilized adult animals. The purpose of present study is to investigate the neurotoxicity of methotrexate in juvenile rats and its relevant mechanisms. The doses and schedule of systemic and intrathecal methotrexate, given from post-natal age 3-7 weeks, were chosen to model the effects of repeated methotrexate dosing on the developing brains of young children with ALL. This methotrexate regimen had no visible acute toxicity and no effect on growth. At 15 weeks of age (8 weeks after the last methotrexate dose) both spatial pattern memory and visual recognition memory were impaired. In addition, methotrexate-treated animals demonstrated impaired performance in the set-shifting assay, indicating decreased cognitive flexibility. Histopathological analysis demonstrated decreased cell proliferation in methotrexate-treated animals compared to controls, as well as changes in length and thickness of the corpus callosum. Moreover, methotrexate suppressed microglia activation and RANTES production. In conclusion, our study demonstrated that a clinically relevant regimen of systemic and intrathecal methotrexate induces persistent deficits in spatial pattern memory, visual recognition memory and executive function, lasting at least 8 weeks after the last injection. The mechanisms behind methotrexate-induced deficits are likely multifactorial and may relate to suppression of neurogenesis, alterations in neuroinflammation and microglial activation, and structural changes in the corpus callosum.
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Affiliation(s)
- Jing Wen
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rochelle R Maxwell
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alexander J Wolf
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Menachem Spira
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maria E Gulinello
- Behavioral Core Facility, Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Peter D Cole
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA; Rutgers Cancer Institute of New Jersey, Division of Pediatric Hematology/Oncology, New Brunswick, NJ, USA.
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24
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Sun LR, Cooper S. Neurological Complications of the Treatment of Pediatric Neoplastic Disorders. Pediatr Neurol 2018; 85:33-42. [PMID: 30126755 DOI: 10.1016/j.pediatrneurol.2018.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/25/2018] [Indexed: 01/19/2023]
Abstract
Neurological complications resulting from childhood cancer treatments are common. Treatment for childhood neoplastic disorders is often multimodal and may include procedures, cranial irradiation, chemotherapy, transplant, and immunotherapy, each of which carries distinct neurological risks. Procedures, such as lumbar punctures, are commonly used in this population for diagnostic purposes as well as intrathecal medication administration. Surgery is associated with an array of potential neurological complications, with posterior fossa syndrome being a common cause of morbidity in pediatric brain tumor patients after neurosurgical resection. Cranial irradiation can cause late neurological sequelae such as stroke, cerebral vasculopathy, secondary malignancy, and cognitive dysfunction. Neurotoxic effects of chemotherapeutic agents are common and include neuropathy, coagulopathy causing stroke or cerebral sinovenous thrombosis, encephalopathy, seizures, cerebellar dysfunction, myelopathy, and neuropsychologic difficulties. Hematopoietic stem cell transplant has a high risk of neurological complications including central nervous system infection, seizures, and stroke. Immunotherapies, including chimeric antigen receptor-modified T-cells (CAR T-cells) and immune checkpoint inhibitors, are emerging as potentially effective strategies to treat some types of childhood cancer, but may carry with them substantial neurotoxicity which is just beginning to be recognized and studied. With evolving treatment protocols, childhood cancer survivorship is increasing, and the role of the neurologist in managing both the acute and chronic neurological consequences of treatment is becoming more important. Prevention, early recognition, and treatment of therapy-associated neurotoxicity are imperative to ensuring children can remain on the most effective therapeutic regimens and to improve the neurological function and quality of life of childhood cancer survivors.
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Affiliation(s)
- Lisa R Sun
- The Johns Hopkins University School of Medicine, Department of Neurology, Division of Pediatric Neurology, Baltimore, Maryland; The Johns Hopkins University School of Medicine, Department of Neurology, Division of Cerebrovascular Neurology, Baltimore, Maryland.
| | - Stacy Cooper
- The Johns Hopkins University School of Medicine, Department of Oncology, Division of Pediatric Oncology, Baltimore, Maryland
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25
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Liposomal Cytarabine Induces Less Neurocognitive Dysfunction Than Intrathecal Methotrexate in an Animal Model. J Pediatr Hematol Oncol 2018; 40:e91-e96. [PMID: 28654460 PMCID: PMC5743776 DOI: 10.1097/mph.0000000000000888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Liposomal cytarabine is currently being tested clinically as an alternative to intrathecal (IT) methotrexate (MTX) for preventing relapse within the central nervous system among patients with acute lymphoblastic leukemia. To compare the toxicity and cognitive deficits caused by IT MTX versus liposomal cytarabine, juvenile Long Evans rats were treated with IT injections of MTX 1 mg/kg×4 doses over 8 days, or liposomal cytarabine 0.8 mg once. Mean concentrations of free cytarabine in cerebrospinal fluid remained above the cytotoxic threshold of 0.4 μM for 2 weeks after dosing. Animals treated with liposomal cytarabine exhibited normal recognition and spatial memory 4 weeks after injection. In contrast, exposure to IT MTX led to impaired cognitive function. In addition, mean hematocrit on day 11 was significantly lower in the MTX-treated animals (30.8%; 95% confidence interval, 27.0%-34.7%; n=6) compared with that in the liposomal cytarabine-treated animals (39.5%; 95% confidence interval, 38.4%-40.6%; n=6; P<0.0001). Our data suggest that liposomal cytarabine induces fewer neurocognitive deficits and less acute hematologic toxicity compared with IT MTX. Liposomal cytarabine may therefore have therapeutic advantages over IT MTX, if it is equally effective in preventing relapse.
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26
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Bava L, Johns A, Kayser K, Freyer DR. Cognitive outcomes among Latino survivors of childhood acute lymphoblastic leukemia and lymphoma: A cross-sectional cohort study using culturally competent, performance-based assessment. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26844. [PMID: 28988412 PMCID: PMC7521146 DOI: 10.1002/pbc.26844] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/24/2017] [Accepted: 09/10/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND This study sought to characterize cognitive outcomes among Latino survivors of childhood acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LL). PROCEDURE In this cross-sectional cohort study, Latino survivors of ALL (n = 57) and LL (n = 5) aged 6-16 years were pooled and evaluated using validated measures of cognitive, academic, and behavioral function and English language proficiency. Performance was compared with norms using single-sample t-tests. RESULTS In this cohort (n = 62, 50% male), mean ages at diagnosis and testing were 4.5 and 10.8 years, respectively; mean time off treatment was 44.7 months. All participants spoke English and over half (57%) identified Spanish as the primary language in the home. Forty-two families (68%) placed in the two lowest Hollingshead socioeconomic status categories. Participants were below average for working memory (P < 0.001). Overall, participants were in the average range, but significantly lower than published norms on domain-specific measures of verbal comprehension (P < 0.001); perceptual reasoning (P = 0.033); processing speed (P = 0.003); visual memory (P < 0.001); visuomotor attention, scanning, and sequencing (P = 0.005); and reading comprehension (P = 0.001). Parents reported concerns with working memory (P < 0.001) and metacognition (P = 0.014). CONCLUSIONS Similar to other childhood ALL/LL survivors, overall cognitive function in this Latino sample was relatively preserved but selected deficits were observed. Routine cognitive screening is indicated in this population.
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Affiliation(s)
- Laura Bava
- Survivorship and Supportive Care Program, Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
| | - Alexis Johns
- Department of Plastic and Maxillofacial Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kimberly Kayser
- Survivorship and Supportive Care Program, Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - David R. Freyer
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
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Holland AA, Colaluca B, Bailey L, Stavinoha PL. Impact of attention on social functioning in pediatric medulloblastoma survivors. Pediatr Hematol Oncol 2018; 35:76-89. [PMID: 29652554 DOI: 10.1080/08880018.2018.1440333] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Parent-reported attention problems have been associated with social functioning in a broad sample of pediatric cancer survivors. OBJECTIVE The present study focused on a more homogeneous sample (pediatric medulloblastoma survivors), with the novel inclusion of self-reported attention ratings. PARTICIPANTS/METHODS Thirty-three pediatric medulloblastoma survivors, ages 7-18 years, completed a brief IQ measure and self-report of attentional and social functioning. Parents rated patients' attentional and social functioning. RESULTS Mean attention ratings were average based on both parent- and self-report, though parent ratings were significantly discrepant from normative means. No significant demographic or treatment-related predictors of self-reported attention problems were identified, whereas female gender was associated with greater parent-reported attention problems. Canonical correlation analysis revealed a significant association between parent-reported attention difficulties and social functioning in pediatric medulloblastoma survivors, but there was no association between self-reported attention problems and measures of social functioning. CONCLUSIONS Consistent with existing literature in broader samples of pediatric cancer survivors, the present study further affirms attention deficits as an underlying contributor to social deficits in pediatric medulloblastoma survivors while also finding little relationship between self-reports of attention and social performance. Notably, present findings provide additional support suggesting that attention functioning is a more significant contributor to social outcomes for pediatric medulloblastoma survivors than the level of cognitive ability.
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Affiliation(s)
- Alice Ann Holland
- a University of Texas Southwestern Medical Center , Dallas , Texas , USA.,b Children's Medical Center , Dallas , Texas , USA
| | - Beth Colaluca
- c Cook Children's Health Care System , Fort Worth , Texas , USA
| | - Laurie Bailey
- c Cook Children's Health Care System , Fort Worth , Texas , USA
| | - Peter L Stavinoha
- a University of Texas Southwestern Medical Center , Dallas , Texas , USA.,b Children's Medical Center , Dallas , Texas , USA
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28
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Van Der Plas E, Erdman L, Nieman BJ, Weksberg R, Butcher DT, O'connor DL, Aufreiter S, Hitzler J, Guger SL, Schachar RJ, Ito S, Spiegler BJ. Characterizing neurocognitive late effects in childhood leukemia survivors using a combination of neuropsychological and cognitive neuroscience measures. Child Neuropsychol 2017; 24:999-1014. [PMID: 29017430 DOI: 10.1080/09297049.2017.1386170] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Knowledge about cognitive late effects in survivors of childhood acute lymphoblastic leukemia (ALL) is largely based on standardized neuropsychological measures and parent reports. To examine whether cognitive neuroscience paradigms provided additional insights into neurocognitive and behavioral late effects in ALL survivors, we assessed cognition and behavior using a selection of cognitive neuroscience tasks and standardized measures probing domains previously demonstrated to be affected by chemotherapy. 130 ALL survivors and 158 control subjects, between 8 and 18 years old at time of testing, completed the n-back (working memory) and stop-signal (response inhibition) tasks. ALL survivors also completed standardized measures of intelligence (Wechsler Intelligence Scales [WISC-IV]), motor skills (Grooved Pegboard), math abilities (WIAT-III), and executive functions (Delis-Kaplan Executive Function System). Parents completed behavioral measures of executive functions (Behavior Rating Inventory of Executive Function [BRIEF]) and attention (Conners-3). ALL survivors exhibited deficiencies in working memory and response inhibition compared with controls. ALL survivors also exhibited deficits on WISC-IV working memory and processing speed, Grooved Pegboard, WIAT-III addition and subtraction fluency, and numerical operations, as well as DKEFS number-letter switching. Parent reports suggested more attention deficits (Conners-3) and behavioral difficulties (BRIEF) in ALL survivors compared with referenced norms. Low correspondence between standardized and experimental measures of working memory and response inhibition was noted. The use of cognitive neuroscience paradigms complements our understanding of the cognitive deficits evident after treatment of ALL. These measures could further delineate cognitive processes involved in neurocognitive late effects, providing opportunities to explore their underlying mechanisms.
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Affiliation(s)
- Ellen Van Der Plas
- a Translational Medicine , The Hospital for Sick Children Research Institute , Toronto , Canada.,b Psychiatry Research , The Hospital for Sick Children , Toronto , Canada
| | - Lauren Erdman
- c Genetics and Genome Biology , The Hospital for Sick Children Research Institute , Toronto , Canada.,d Department of Computer Science , The University of Toronto , Toronto , Canada
| | - Brian J Nieman
- a Translational Medicine , The Hospital for Sick Children Research Institute , Toronto , Canada.,e Mouse Imaging Centre , The Hospital for Sick Children , Toronto , Canada.,f Ontario Institute for Cancer Research , Toronto , Canada.,g Department of Medical Biophysics , The University of Toronto , Toronto , Canada
| | - Rosanna Weksberg
- c Genetics and Genome Biology , The Hospital for Sick Children Research Institute , Toronto , Canada.,h Department of Pediatrics, Faculty of Medicine , The University of Toronto , Toronto , Canada.,i Institutes of Medical Science , The University of Toronto , Toronto , Canada
| | - Darci T Butcher
- c Genetics and Genome Biology , The Hospital for Sick Children Research Institute , Toronto , Canada
| | - Deborah L O'connor
- a Translational Medicine , The Hospital for Sick Children Research Institute , Toronto , Canada.,j Nutritional Sciences , The University of Toronto , Toronto , Canada
| | - Susanne Aufreiter
- a Translational Medicine , The Hospital for Sick Children Research Institute , Toronto , Canada
| | - Johann Hitzler
- h Department of Pediatrics, Faculty of Medicine , The University of Toronto , Toronto , Canada.,k Department of Haematology/Oncology , The Hospital for Sick Children , Toronto , Canada
| | - Sharon L Guger
- l Department of Psychology , The Hospital for Sick Children , Toronto , Canada
| | - Russell J Schachar
- b Psychiatry Research , The Hospital for Sick Children , Toronto , Canada.,i Institutes of Medical Science , The University of Toronto , Toronto , Canada.,m Department of Psychiatry, Faculty of Medicine , The University of Toronto , Toronto , Canada
| | - Shinya Ito
- a Translational Medicine , The Hospital for Sick Children Research Institute , Toronto , Canada.,n Clinical Pharmacology and Toxicology , The Hospital for Sick Children , Toronto , Canada.,o Department of Pharmacology and Toxicology, Faculty of Medicine , The University of Toronto , Toronto , Canada
| | - Brenda J Spiegler
- h Department of Pediatrics, Faculty of Medicine , The University of Toronto , Toronto , Canada.,l Department of Psychology , The Hospital for Sick Children , Toronto , Canada
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29
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