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Nguyen TV, Do LTK, Lin Q, Nagahara M, Namula Z, Wittayarat M, Hirata M, Otoi T, Tanihara F. Programmed cell death-1-modified pig developed using electroporation-mediated gene editing for in vitro fertilized zygotes. In Vitro Cell Dev Biol Anim 2024; 60:716-724. [PMID: 38485817 DOI: 10.1007/s11626-024-00869-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/10/2024] [Indexed: 08/03/2024]
Abstract
Programmed cell death-1 (PD-1) is an immunoinhibitory receptor required to suppress inappropriate immune responses such as autoimmunity. Immune checkpoint antibodies that augment the PD-1 pathway lead to immune-related adverse events (irAEs), organ non-specific side effects due to autoimmune activation in humans. In this study, we generated a PD-1 mutant pig using electroporation-mediated introduction of the CRISPR/Cas9 system into porcine zygotes to evaluate the PD-1 gene deficiency phenotype. We optimized the efficient guide RNAs (gRNAs) targeting PD-1 in zygotes and transferred electroporated embryos with the optimized gRNAs and Cas9 into recipient gilts. One recipient gilt became pregnant and gave birth to two piglets. Sequencing analysis revealed that both piglets were biallelic mutants. At 18 mo of age, one pig showed non-purulent arthritis of the left elbow/knee joint and oligozoospermia, presumably related to PD-1 modification. Although this study has a limitation because of the small number of cases, our phenotypic analysis of PD-1 modification in pigs will provide significant insight into human medicine and PD-1-deficient pigs can be beneficial models for studying human irAEs.
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Affiliation(s)
- Thanh-Van Nguyen
- Faculty of Bioscience and Bioindustry, Tokushima University, Ishii, Myozai-Gun, Tokushima, 7793233, Japan
- Faculty of Veterinary Medicine, Vietnam National University of Agriculture, Hanoi, 100000, Vietnam
| | - Lanh Thi Kim Do
- Faculty of Bioscience and Bioindustry, Tokushima University, Ishii, Myozai-Gun, Tokushima, 7793233, Japan
- Faculty of Veterinary Medicine, Vietnam National University of Agriculture, Hanoi, 100000, Vietnam
| | - Qingyi Lin
- Faculty of Bioscience and Bioindustry, Tokushima University, Ishii, Myozai-Gun, Tokushima, 7793233, Japan
- Bio-Innovation Research Center, Tokushima University, Ishii, Myozai-Gun, Tokushima, 7793233, Japan
| | - Megumi Nagahara
- Faculty of Bioscience and Bioindustry, Tokushima University, Ishii, Myozai-Gun, Tokushima, 7793233, Japan
- Bio-Innovation Research Center, Tokushima University, Ishii, Myozai-Gun, Tokushima, 7793233, Japan
| | - Zhao Namula
- Faculty of Bioscience and Bioindustry, Tokushima University, Ishii, Myozai-Gun, Tokushima, 7793233, Japan
- College of Coastal Agricultural Sciences, Guangdong Ocean University, Zhanjiang, 524088, China
| | - Manita Wittayarat
- Faculty of Veterinary Science, Prince of Songkla University, Songkhla, 90110, Thailand
| | - Maki Hirata
- Faculty of Bioscience and Bioindustry, Tokushima University, Ishii, Myozai-Gun, Tokushima, 7793233, Japan
- Bio-Innovation Research Center, Tokushima University, Ishii, Myozai-Gun, Tokushima, 7793233, Japan
| | - Takeshige Otoi
- Faculty of Bioscience and Bioindustry, Tokushima University, Ishii, Myozai-Gun, Tokushima, 7793233, Japan
- Bio-Innovation Research Center, Tokushima University, Ishii, Myozai-Gun, Tokushima, 7793233, Japan
| | - Fuminori Tanihara
- Faculty of Bioscience and Bioindustry, Tokushima University, Ishii, Myozai-Gun, Tokushima, 7793233, Japan.
- Center for Development of Advanced Medical Technology, Jichi Medical University, Shimotsuke, Tochigi, 3290498, Japan.
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Lima IG, Silva IBUCD, Pípolo VC, Delfino VDA, Bignardi PR. Acute kidney injury associated with anti-PD-1 and anti-PD-L1 drugs: a meta-analysis of randomized clinical trials. Immunopharmacol Immunotoxicol 2024:1-12. [PMID: 38825890 DOI: 10.1080/08923973.2024.2360071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 05/18/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Immune Checkpoint Inhibitors (ICI) have been widely used in treating different types of cancer. They increase survival in many oncologic patients and enable cancer-specific therapy. Acute Kidney Injury (AKI) is one of the adverse effects associated with using ICI, where knowledge of the prevalence and renal histological findings are still reasons for discussion. OBJECTIVE Therefore, this meta-analysis evaluates the association between ICI use and AKI. METHODS The search was performed in PubMed, Lilacs, and Cochrane platforms. Studies published up to December 1, 2022, were included. RESULTS A total of 16 studies met the established PICOT criteria and were included in this review. Comparing the ICI plus chemotherapy against chemotherapy alone, the relative risk (RR) for AKI's development with ICI use was 2.89 (95%CI 1.37-6.10). In the analyses by class and drug type, programmed cell death 1 monoclonal antibody (anti-PD-1) showed an increased risk of 2.11 (95%CI 1.26-3.52), and pembrolizumab demonstrated a risk of AKI (RR= 2.77, 95%CI 1.46-5.26). Likewise, regarding the severity of AKI, AKI grade 3 or higher was more common in the ICI plus chemotherapy compared to the chemotherapy group: 3.66 (95%CI 1.19-11.30), while the subgroup analyses pooled studies comparing ICI alone versus chemotherapy alone in the control group did not demonstrate an association with AKI. CONCLUSIONS These findings suggest that ICI use is associated with an increased risk of AKI and that anti-PD-1 use is associated with a higher incidence of renal adverse events than programmed cell death ligand 1 monoclonal antibody (anti-PD-L1). Studies with adequate power and well-defined criteria for acute interstitial nephritis, nowadays taken as a synonym for AKI related to ICI, are necessary.
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Affiliation(s)
| | | | | | - Vinicius Daher Alvares Delfino
- School of Medicine, Pontifícia Universidade Católica do Paraná, Londrina, Brazil
- Universidade Estadual de Londrina, Londrina, Brazil
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Ando Y, Nishiyama H, Shimodaira H, Takano N, Sakaida E, Matsumoto K, Nakanishi K, Sakai H, Tsukamoto S, Komine K, Yasuda Y, Kato T, Fujiwara Y, Koyama T, Kitamura H, Kuwabara T, Yonezawa A, Okumura Y, Yakushijin K, Nozawa K, Goto H, Matsubara T, Hoshino J, Yanagita M. Chapter 3: Management of kidney injury caused by cancer drug therapy, from clinical practice guidelines for the management of kidney injury during anticancer drug therapy 2022. Int J Clin Oncol 2023; 28:1315-1332. [PMID: 37453935 DOI: 10.1007/s10147-023-02382-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
Cisplatin should be administered with diuretics and Magnesium supplementation under adequate hydration to avoid renal impairment. Patients should be evaluated for eGFR (estimated glomerular filtration rate) during the treatment with pemetrexed, as kidney injury has been reported. Pemetrexed should be administered with caution in patients with a CCr (creatinine clearance) < 45 mL/min. Mesna is used to prevent hemorrhagic cystitis in patients receiving ifosfamide. Febuxostat is effective in avoiding hyperuricemia induced by TLS (tumor lysis syndrome). Preventative rasburicase is recommended in high-risk cases of TLS. Thrombotic microangiopathy could be triggered by anticancer drugs and there is no evidence of efficacy of plasma exchange therapy. When proteinuria occurs during treatment with anti-angiogenic agents or multi-kinase inhibitors, dose reductions or interruptions based on grading should be considered. Grade 3 proteinuria and renal dysfunction require urgent intervention, including drug interruption or withdrawal, and referral to a nephrologist should be considered. The first-line drugs used for blood pressure elevation due to anti-angiogenic agents are ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers). The protein binding of drugs and their pharmacokinetics are considerably altered in patients with hypoalbuminemia. The clearance of rituximab is increased in patients with proteinuria, and the correlation with urinary IgG suggests similar pharmacokinetic changes when using other antibody drugs. AIN (acute interstitial nephritis) is the most common cause of ICI (immune checkpoint inhibitor)-related kidney injury that is often treated with steroids. The need for renal biopsy in patients with kidney injury that occurs during treatment with ICI remains controversial.
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Affiliation(s)
- Yuichi Ando
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan.
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideki Shimodaira
- Division of Medical Oncology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Nao Takano
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Emiko Sakaida
- Department of Hematology, Chiba University Hospital, Chiba, Japan
| | | | - Koki Nakanishi
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Keigo Komine
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan
| | - Yoshinari Yasuda
- Department of Nephrology, Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taigo Kato
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yutaka Fujiwara
- Department of Thoracic Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Takafumi Koyama
- Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Takashige Kuwabara
- Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Atsushi Yonezawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Yuta Okumura
- Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Kimikazu Yakushijin
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Kazuki Nozawa
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
- Department of Center for Cancer Genomics and Advanced Therapeutics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hideaki Goto
- Department of Oncology and Hematology, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Hyogo, Japan
| | - Takeshi Matsubara
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Junichi Hoshino
- Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Motoko Yanagita
- Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto, Japan
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Vicente-Vicente L, Casanova AG, Tascón J, Prieto M, Morales AI. New Challenges in the Diagnosis of Kidney Damage Due to Immune Checkpoint Inhibitors Therapy: An Observational Clinical Study. Diagnostics (Basel) 2023; 13:2524. [PMID: 37568887 PMCID: PMC10416935 DOI: 10.3390/diagnostics13152524] [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: 07/04/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
In recent years, immunotherapy has been postulated as one of the most effective strategies in the fight against cancer. The greatest success in this field has been achieved with the inhibition of molecules involved in slowing down the adaptive immune response by immune checkpoint inhibitors (ICIs). Despite its efficacy, ICI treatment has side effects. Regarding kidney damage, it is estimated that 4.9% of patients treated with ICIs develop renal injury. Furthermore, cancer patients who develop renal dysfunction have a worse prognosis. Current diagnostics are insufficient to predict the underlying renal injury and to identify the type of damage. Our hypothesis is that the renal injury could be subclinical, so the possibility of using new urinary biomarkers could be a useful diagnostic tool that would allow these patients to be managed in a preventive (risk biomarkers) and early (early biomarkers) way and even to clarify whether the renal damage is due to this therapy or to other factors (differential diagnostic biomarkers). A prospective study to validate risk and early and differential biomarkers in patients treated with ICIs is proposed to test this hypothesis. The results derived from this study will improve the clinical practice of cancer treatment with ICIs and therefore the life expectancy and quality of life of patients. Trial Registration: ClinicalTrials.gov, NCT04902846.
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Affiliation(s)
- Laura Vicente-Vicente
- Toxicology Unit, Universidad de Salamanca, 37007 Salamanca, Spain; (L.V.-V.); (A.G.C.); (J.T.); (M.P.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Universidad de Salamanca, 37007 Salamanca, Spain
- RICORS2040-Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alfredo G. Casanova
- Toxicology Unit, Universidad de Salamanca, 37007 Salamanca, Spain; (L.V.-V.); (A.G.C.); (J.T.); (M.P.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Universidad de Salamanca, 37007 Salamanca, Spain
- RICORS2040-Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Javier Tascón
- Toxicology Unit, Universidad de Salamanca, 37007 Salamanca, Spain; (L.V.-V.); (A.G.C.); (J.T.); (M.P.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Universidad de Salamanca, 37007 Salamanca, Spain
- RICORS2040-Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marta Prieto
- Toxicology Unit, Universidad de Salamanca, 37007 Salamanca, Spain; (L.V.-V.); (A.G.C.); (J.T.); (M.P.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Universidad de Salamanca, 37007 Salamanca, Spain
- RICORS2040-Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ana I. Morales
- Toxicology Unit, Universidad de Salamanca, 37007 Salamanca, Spain; (L.V.-V.); (A.G.C.); (J.T.); (M.P.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Universidad de Salamanca, 37007 Salamanca, Spain
- RICORS2040-Instituto de Salud Carlos III, 28029 Madrid, Spain
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Takada H, Yamashita K, Osawa L, Komiyama Y, Nakakuki N, Muraoka M, Suzuki Y, Sato M, Takano S, Fukasawa M, Yamaguchi T, Maekawa S, Takahashi K, Uchimura K, Enomoto N. Impact of Renal Function on the Prognosis of Patients Receiving Atezolizumab/Bevacizumab Combination Therapy and Lenvatinib Monotherapy for Unresectable Hepatocellular Carcinoma. Oncology 2023; 101:609-623. [PMID: 37279708 DOI: 10.1159/000531111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/03/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Several studies have reported kidney injury caused by immune checkpoint inhibitors, and proteinuria caused by vascular endothelial growth factor inhibitors for unresectable hepatocellular carcinoma (u-HCC). We investigated the relationship between renal function and prognosis in patients with u-HCC receiving atezolizumab and bevacizumab (AB) and lenvatinib (LEN) therapy. METHODS Fifty-one patients who received AB and 50 patients who received LEN therapy were included. We analyzed prognostic factors related to the overall survival (OS), and characteristics related to renal function. RESULTS In patients with AB therapy, OS was shorter in patients with baseline proteinuria of 1+ or higher, as assessed by urine dipstick test, compared to those with -/± (p = 0.024). There were many cases with two or more drugs with a high risk of renal dysfunction (p = 0.019) in patients with 1+ or higher. Furthermore, OS was shorter in the group with estimated glomerular filtration rate (eGFR) grade deterioration without urinary protein-creatinine ratio (UPCR) of 2 g/g·Cre or higher than in the other groups (p = 0.027). In the group where eGFR worsened without an increase in UPCR, there were many cases with a daily salt intake of 10 g or more (p = 0.027), three or more drugs with a high risk of renal dysfunction (p = 0.021), and a history of arteriosclerosis (p = 0.021). On the other hand, in patients with LEN therapy, OS tends to be shorter in patients with proteinuria of ± or higher, compared to those without (p = 0.074). There were many cases with a daily salt intake of 10 g or more in patients with ± or higher (p = 0.002). CONCLUSION In patients receiving AB and LEN therapy, baseline proteinuria was associated with OS. Renal function deterioration without proteinuria was associated with a poor prognosis in AB therapy. Excessive salt intake, preexisting atherosclerotic disease, and drug with a high risk of renal dysfunction were risk factors for renal deterioration.
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Affiliation(s)
- Hitomi Takada
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Koji Yamashita
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Leona Osawa
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yasuyuki Komiyama
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Natsuko Nakakuki
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Masaru Muraoka
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yuichiro Suzuki
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Mitsuaki Sato
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Shinichi Takano
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Mitsuharu Fukasawa
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tatsuya Yamaguchi
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Shinya Maekawa
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Kazuya Takahashi
- Nephrology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Kohei Uchimura
- Nephrology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Nobuyuki Enomoto
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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Nguyen HH, Bui KC, Nguyen TML, Pham C, Nham TPL, Ngo TH, Ho VH, Ta VH, Bozko P, Nguyen LT, Can VM. The safety of CAR-T cells and PD-1 antibody combination on an experimental model. Biochem Biophys Res Commun 2023; 649:25-31. [PMID: 36739696 DOI: 10.1016/j.bbrc.2023.01.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/18/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023]
Abstract
Chimeric antigen receptor (CAR) T cells and PD-1 antibodies (PD-1 Ab) are emergent immunotherapies with unprecedented efficacy. The presence of PD-1 on T cells contributes to hypofunction of CAR-T therapy and inhibition of PD-1 enhances anti-cancer effect of CAR-T cells. Therefore, the combination of CAR-T cells and PD-1 antibody is a promissing strategy for cancer treatment. This study aims to establish our in-house CAR-T cells and evaluate the safety of CAR-T cells in combination with PD-1 antibody in animals. The toxicity of CD19-CAR-T cells was examined using Swiss Webster mice. Four mouse groups were treated with control, CAR-T, PD-1 antibody or CAR-T + PD-1 antibody. Mice's overall status was monitored and recorded. At the end-point, hematological and biochemical indices were quantified, histopathology of liver and kidney was evaluated by pathologists. The relative abnormal ratio and absolute values were compared between groups. We generated our in-house CAR-T cells and used them for safety evaluation in mice. The increase in mouse weight was observed in all groups after treatment and the weight was comparable between groups. The hematological, biochemical and histopathological parameters were equivalent between groups, except for liver grain degeneration occurred in treatment groups. Thus, CAR-T cells, PD-1 Ab and their combination were safe in mice. We successfully produced our in-house CAR-T cells and the combination of our CAR-T cells and PD-1 antibody was safe in mice with comparable values of hematopoietic indices, liver and kidney functions. Longer follow-up might be necessary to evaluate their effect on the liver.
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Affiliation(s)
- Hien Hanh Nguyen
- Department of Hematology and Transfusion, Military Hospital 103, Hanoi, Viet Nam; Department of Pathophysiology, Vietnam Military Medical University, Viet Nam
| | - Khac Cuong Bui
- Department of Pathophysiology, Vietnam Military Medical University, Viet Nam; Laboratory Animal Research Center, Vietnam Military Medical University, Viet Nam
| | | | - Chi Pham
- Laboratory Animal Research Center, Vietnam Military Medical University, Viet Nam
| | - Thi Phuong Linh Nham
- Laboratory Animal Research Center, Vietnam Military Medical University, Viet Nam
| | - Thu Hang Ngo
- Department of Pathophysiology, Vietnam Military Medical University, Viet Nam
| | - Viet Hoanh Ho
- Oncology Centre, Military Hospital 103, Hanoi, Viet Nam
| | - Viet Hung Ta
- Department of Hematology and Transfusion, Military Hospital 103, Hanoi, Viet Nam
| | - Przemyslaw Bozko
- Department of Internal Medicine I, Medical University Hospital, University of Tübingen, Germany
| | - Linh Toan Nguyen
- Department of Pathophysiology, Vietnam Military Medical University, Viet Nam
| | - Van Mao Can
- Department of Pathophysiology, Vietnam Military Medical University, Viet Nam.
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Nikolopoulos P, Liapis G, Giannakopoulos P, Kotsantis I, Drouzas K, Lionaki S. Rapidly Progressive Pauci-Immune Glomerulonephritis with Aberrant Fibrinoid Necrosis Associated with Atezolizumab, an Immune Check Point Inhibitor: A Case Report and Review of Literature. Antibodies (Basel) 2023; 12:antib12010010. [PMID: 36810515 PMCID: PMC9944432 DOI: 10.3390/antib12010010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
Stimulation of the antitumor activity of the immune system using immune checkpoint inhibitors (ICIs) has proven efficacy in the treatment of multiple types of cancer, inducing the speedily expanding approval of therapeutic indications for ICIs. The literature regarding the immune-related toxicities and nephrotoxicity of ICIs is limited. Herein, we present a patient with lung cancer treated with atezolizumab, an IgG1 monoclonal antibody aimed at the programmed death ligand 1 (PD-L1), who presented with vasculitic skin rash and rapidly deteriorating renal function, new onset of significant glomerular hematuria and proteinuria. The renal biopsy revealed acute necrotizing pauci-immune vasculitis, with fibrinoid necrosis. The patient received a course of high-dose glucocorticoids with recovery of renal function and skin lesions. Further immunosuppressive therapy was withheld, due to active malignancy in the lung, while oncology consultation recommended the continuation of treatment with atezolizumab, as the patient had shown substantial response.
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Affiliation(s)
- Petros Nikolopoulos
- 2nd Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Attikon Hospital, Section of Nephrology, 124 62 Athens, Greece
- Correspondence: (P.N.); (S.L.)
| | - George Liapis
- 1st Department of Pathology, National and Kapodistrian University of Athens, Laiko Hospital, 115 27 Athens, Greece
| | - Panagiotis Giannakopoulos
- 2nd Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Attikon Hospital, Section of Nephrology, 124 62 Athens, Greece
| | - Ioannis Kotsantis
- 2nd Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Attikon Hospital, Section of Medical Oncology, 124 62 Athens, Greece
| | - Konstantinos Drouzas
- 2nd Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Attikon Hospital, Section of Nephrology, 124 62 Athens, Greece
| | - Sophia Lionaki
- 2nd Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Attikon Hospital, Section of Nephrology, 124 62 Athens, Greece
- Correspondence: (P.N.); (S.L.)
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8
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Editorial: Advancements in the management of kidney disease and electrolyte derangements. Curr Opin Nephrol Hypertens 2022; 31:395-398. [PMID: 35894272 DOI: 10.1097/mnh.0000000000000823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Kanbay M, Copur S, Siriopol D, Yildiz AB, Berkkan M, Popa R, Hasbal NB, Ortiz A, Perazella MA. The association of acute kidney injury on outcomes in cancer patients receiving immune checkpoint inhibitor therapy: a systematic review and meta-analysis. Clin Kidney J 2022; 16:817-826. [PMID: 37151409 PMCID: PMC10157786 DOI: 10.1093/ckj/sfac194] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Immune checkpoint inhibitors (ICPIs) are a novel therapeutic approach to cancer treatment that has changed the landscape of cancer therapy but also has some considerable drawbacks. Acute kidney injury (AKI) is one of these potential complications that may have effects on patient outcomes. In this review, we assessed the effect of AKI on mortality outcomes in cancer patients receiving this immunotherapy.
Materials and methods
We performed a systematic review and meta-analysis of prospective, retrospective, randomized, and non-randomized studies, which examined the effects of AKI in cancer patients receiving immune checkpoint inhibitors. We searched through PubMed, Medline, Web of Science, Scopus, and Cochrane Library databases.
Results
7 studies were included in the final analysis, with a total number of patients of 761. Overall, the risk of death was higher in patients that developed AKI during ICPI treatment (HR 1.42, 95% CI 1.05 to 1.92, P = 0.02; heterogeneity χ2 = 11.68, I2 = 66%, P = 0.02) compared to patients that did not develop AKI. In addition, there was a trend to a better survival in those with less severe AKI patients compared to those with more severe AKI (HR 1.35, 95% CI 0.99 to 1.83, P = 0.05). Lastly, it was seen that patients with persistent kidney dysfunction (non-recovery) had an increased risk for all-cause mortality (HR 2.93, 95% CI 1.41 to 6.08, P = 0.004; heterogeneity χ2 = 0.53, I2 = 0%, P = 0.47).
Conclusions
Development of AKI in patients with cancer receiving immune checkpoint inhibitors is associated with increased risk of mortality.
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Affiliation(s)
- Mehmet Kanbay
- Department of Medicine, Section of Nephrology, Koc University School of Medicine , Istanbul , Turkey
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine , Istanbul , Turkey
| | - Dimitrie Siriopol
- Department of Nephrology, “Saint John the New” County Hospital , Suceava , Romania
| | | | - Metehan Berkkan
- Department of Medicine, Koc University School of Medicine , Istanbul , Turkey
| | - Raluca Popa
- Department of Nephrology, “Saint John the New” County Hospital , Suceava , Romania
| | - Nuri Baris Hasbal
- Department of Medicine, Section of Nephrology, Koc University School of Medicine , Istanbul , Turkey
| | - Alberto Ortiz
- Department of Medicine, Universidad Autonoma de Madrid and IIS-Fundacion Jimenez Diaz , Madrid , Spain
| | - Mark A Perazella
- Department of Internal Medicine Section of Nephrology, Yale University School of Medicine , CT, USA
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10
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Kanji S, Morin S, Agtarap K, Purkayastha D, Thabet P, Bosse D, Wang X, Lunny C, Hutton B. Adverse Events Associated with Immune Checkpoint Inhibitors: Overview of Systematic Reviews. Drugs 2022; 82:793-809. [PMID: 35416592 DOI: 10.1007/s40265-022-01707-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recognition and management of adverse events (AEs) associated with immune checkpoint inhibitor (ICI) use by cancer patients requires expertise from multiple disciplines. Greater awareness of potential AEs may result in earlier recognition, appropriate management, and better patient outcomes. OBJECTIVE The primary objective of this overview of systematic reviews was to synthesize and consolidate systematic review evidence describing the incidence proportion and severity of AEs associated with various ICI therapies across different cancers. METHODS A systematic literature search of four databases was conducted to identify systematic reviews that describe the incidence proportion and severity of AEs related to ICI therapy in cancer patients. A systematic review was eligible if it included adults with cancer; on ICI alone or in combination with another ICI, chemotherapy, or targeted therapy; severity (graded according to the Common Terminology Criteria for Adverse Events) and incidence proportion of AEs and whether it reported its eligibility criteria. AEs of interest were identified through an iterative ranking exercise by key stakeholders and knowledge users. Extraction of PICOTTS elements and quality indicators (AMSTAR-2) were used to manage overlap of primary studies across systematic reviews at the outcome level. Cancer subtypes were mapped to drug class and AE severity. RESULTS Overall, 129 systematic reviews met the inclusion criteria for data mapping. Systematic reviews reported incidence proportions for more than 76 AEs, of which 34 were identified as AEs of interest. After overlap assessment, 65 systematic reviews were chosen for data extraction. The three AEs with the highest median incidence were fatigue (18.3%, interquartile range [IQR] 15.0-28.0%), diarrhea (15.3%, IQR 9.7-29.2%) and rash (14.4%, IQR 10.3-19.2%). The three AEs (high-grade) with the highest median incidence were diarrhea (1.5%, IQR 1.2-6.0%), colitis (1.3%, IQR 0.6-6.1%) and neutropenia (1.2%, IQR 0.4-3.3%). Incidence proportions of high-grade AEs were often considerably lower than all-grade AEs and combination therapy (ICI combinations or combinations of ICI with chemotherapy or targeted therapy) was responsible for some of the highest incidence proportions regardless of AE. Rare AEs and certain cancer subtypes were not well reported. CONCLUSIONS Early recognition of AEs associated with ICIs requires expertise from diverse specialists, not just oncologists. Greater awareness of potential AEs may result in earlier recognition, appropriate management, and better patient outcomes. PROSPERO REGISTRATION CRD42021231593.
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Affiliation(s)
- Salmaan Kanji
- The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada. .,Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | | | | | | | | | - Dominick Bosse
- The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Xiang Wang
- The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Carole Lunny
- St. Michaels Hospital, Unity Health Toronto, Toronto, ON, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
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11
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Skjånes K, Aesoy R, Herfindal L, Skomedal H. Bioactive peptides from microalgae: Focus on anti-cancer and immunomodulating activity. PHYSIOLOGIA PLANTARUM 2021; 173:612-623. [PMID: 34085279 DOI: 10.1111/ppl.13472] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/06/2021] [Accepted: 05/31/2021] [Indexed: 06/12/2023]
Abstract
In addition to the rapidly expanding field of using microalgae for food and feed, microalgae represent a tremendous potential for new bioactive compounds with health-promoting effects. One field where new therapeutics is needed is cancer therapy. As cancer therapy often cause severe side effects and loose effect due to development of drug resistance, new therapeutic agents are needed. Treating cancer by modulating the immune response using peptides has led to unprecedented responses in patients. In this review, we want to elucidate the potential for microalgae as a source of new peptides for possible use in cancer management. Among the limited studies on anti-cancer effects of peptides, positive results were found in a total of six different forms of cancer. The majority of studies have been performed with different strains of Chlorella, but effects have also been found using peptides from other species. This is also the case for peptides with immunomodulating effects and peptides with other health-promoting effects (e.g., role in cardiovascular diseases). However, the active peptide sequence has been determined in only half of the studies. In many cases, the microalga strain and the cultivation conditions used for producing the algae have not been reported. The low number of species that have been explored, as opposed to the large number of species available, is a clear indication that the potential for new discoveries is large. Additionally, the availability and cost-effectiveness of microalgae make them attractive in the search for bioactive peptides to prevent cancer.
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Affiliation(s)
- Kari Skjånes
- Division of Biotechnology and Plant Health, Norwegian Institute of Bioeconomy Research (NIBIO), Ås, Norway
| | - Reidun Aesoy
- Department of Clinical Science, Centre for Pharmacy, University of Bergen, Bergen, Norway
| | - Lars Herfindal
- Department of Clinical Science, Centre for Pharmacy, University of Bergen, Bergen, Norway
| | - Hanne Skomedal
- Division of Biotechnology and Plant Health, Norwegian Institute of Bioeconomy Research (NIBIO), Ås, Norway
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12
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Qu J, Ding Y, Jiang K, Hao J, Li Y, Zhang A, Li Z, Qi G, Xu Z, Liu X, Ma J, Bi K, Li Z. Nephrotoxicity of Immune Checkpoint Inhibitors: A Disproportionality Analysis from 2013 to 2020. TOHOKU J EXP MED 2021; 254:275-282. [PMID: 34433731 DOI: 10.1620/tjem.254.275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nephrotoxicity occasionally occurs during treatment with immune checkpoint inhibitors (ICIs). Few related studies compare the differences between these drugs. This study aimed to systematically characterize nephrotoxicity after ICI initiation. Data were extracted from the US FDA Adverse Event Reporting System (FAERS) database. Disproportionality analysis, including information components (ICs) and reporting odds ratios (RORs), was performed to determine the potential renal toxicity of ICIs. A total of 7,204 reports of renal adverse events (AEs) were identified in the FAERS database. Renal AEs were most commonly reported for nivolumab (46.84%). Strong signals were detected in male patients combined with ICIs. In the clinical application of ICIs, attention should be paid to patients, especially male patients, with acute kidney injury, nephritis, autoimmune nephritis and other nephrotoxic AEs. The use of ICIs is likely to aggravate their condition.
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Affiliation(s)
- Jiaming Qu
- School of Pharmacy, Shenyang Pharmaceutical University
| | - Yanming Ding
- School of Life Sciences and Biopharmaceuticals, Shenyang Pharmaceutical University
| | - Kaiwen Jiang
- School of Pharmacy, Shenyang Pharmaceutical University
| | - Junxia Hao
- School of Pharmacy, Shenyang Pharmaceutical University
| | - Yuanzhi Li
- School of Life Sciences and Biopharmaceuticals, Shenyang Pharmaceutical University
| | - Aijun Zhang
- School of Pharmacy, Shenyang Pharmaceutical University
| | - Zhaohang Li
- School of Pharmacy, Shenyang Pharmaceutical University
| | - Guanpeng Qi
- School of Pharmacy, Shenyang Pharmaceutical University
| | - Ze Xu
- School of Pharmacy, Shenyang Pharmaceutical University
| | - Xin Liu
- School of Pharmacy, Shenyang Pharmaceutical University
| | - Juman Ma
- School of Pharmacy, Shenyang Pharmaceutical University
| | - Kaishun Bi
- School of Pharmacy, Shenyang Pharmaceutical University
| | - Zuojing Li
- School of Medical Devices, Shenyang Pharmaceutical University
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