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Zou H, Wong RSM, Yan X. Thrombopoietin treats erythropoietin resistance by correcting EPO-induced progenitorcell depletion. Biochem Pharmacol 2024; 220:116008. [PMID: 38154543 DOI: 10.1016/j.bcp.2023.116008] [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: 10/26/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
Recombinant human erythropoietin (rHuEPO) is a prevalent treatment for anemia in patients with chronic kidney disease. However, up to 10% of these patients exhibit EPO resistance or hyporesponsiveness, which may be caused by the depletion of erythroid progenitor cells. Thrombopoietin (TPO) has the potential to promote the growth of early progenitor cells and correct the depletion. In this study, we investigate the efficacy and the underlying mechanism of the combination therapy of TPO and EPO to EPO resistance. First, the in vivo studies suggested that intensive EPO treatment induced progenitor cell depletion in the bone marrow, where the depletion was corrected by TPO. Then, colony assays showed that EPO and TPO synergistically enhanced the burst-forming unit-erythroid (BFU-E) production but antagonistically boosted the colony-forming units of megakaryocytes (CFU-MK) production. Also, we found TPO promoted hematopoietic stem and progenitor cells (HSPCs) production, while EPO drove HSPCs toward the erythroid lineage. Additionally, EPO induced more megakaryocytic-erythroid progenitors (MEPs) toward the erythroid output. Model-based simulations indicate the efficacy of this combination therapy for treating EPO-resistant anemia in rats. In conclusion, our study demonstrated the efficacy of combination therapy in addressing EPO-resistant anemia by correcting EPO-induced erythroid progenitor depletion.
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Affiliation(s)
- Huixi Zou
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Raymond S M Wong
- Division of Hematology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Xiaoyu Yan
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
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Harvey RD, Carthon BC, Lewis C, Hossain MS, Zhang C, Chen Z, Harris WB, Alese OB, Shaib W, Bilen MA, Lawson DH, Wu C, Steuer CE, El-Rayes BF, Khuri FR, Lonial S, Waller EK, Ramalingam SS, Owonikoko TK. Phase 1 safety and pharmacodynamic study of lenalidomide combined with everolimus in patients with advanced solid malignancies with efficacy signal in adenoid cystic carcinoma. Br J Cancer 2020; 123:1228-1234. [PMID: 32704173 PMCID: PMC7553949 DOI: 10.1038/s41416-020-0988-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 06/15/2020] [Accepted: 07/01/2020] [Indexed: 11/17/2022] Open
Abstract
Background Purpose: The combination of a mammalian target of rapamycin inhibitor and lenalidomide showed enhanced preclinical cytotoxicity. We conducted a phase 1 study in advanced solid tumour patients to assess safety, efficacy and pharmacodynamic (PD) outcomes. Methods We employed a 3+3 dose escalation design to establish the safety and recommended phase 2 doses (RP2D) of daily everolimus and lenalidomide in patients with advanced solid tumours. The starting doses were 5 and 10 mg, respectively, with planned escalation to maximum single-agent doses of 10 and 25 mg in the absence of dose-limiting toxicity. PD endpoints of lymphocyte subsets and immune cytokines were assessed in peripheral blood using multiparameter flow cytometry and LUMINEX assay. Efficacy was evaluated by cross-sectional imaging after every two cycles of treatment. Results The study enrolled 44 patients, median age of 58 years and 28 males (63.6%). The RP2D was established as 10 and 25 mg daily continuously for everolimus and lenalidomide. Common (>5%) grade ≥3 adverse events included rash (19%), neutropenia (19%), hypokalaemia (11%) and fatigue (9%). Best efficacy outcomes in 36 evaluable patients were partial response in 5 (13.8%), stable disease in 24 (55.8%) and progressive disease in 7 (19.4%) patients. PD assessment revealed significant association of cytokine levels (interleukin-2 (IL2), IL21 and IL17), baseline activated and total CD8+ lymphocytes and change in B cell lymphocytes and activated NK cells with clinical benefit. Conclusions The study demonstrated the safety of everolimus and lenalidomide with promising efficacy signal in thyroid and adenoid cystic cancers. Clinical Trial Registration NCT01218555
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Affiliation(s)
- R Donald Harvey
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Bradley C Carthon
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Colleen Lewis
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Mohammad S Hossain
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Chao Zhang
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Department of Statistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Zhengjia Chen
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Department of Statistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Wayne B Harris
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Olatunji B Alese
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Walid Shaib
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Mehmet A Bilen
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - David H Lawson
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Christina Wu
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Conor E Steuer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Bassel F El-Rayes
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Fadlo R Khuri
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA.,American University of Beirut, Beirut, Lebanon
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Suresh S Ramalingam
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA. .,Winship Cancer Institute of Emory University, Atlanta, GA, USA.
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