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Tousif S, Singh AP, Umbarkar P, Galindo C, Wheeler N, Coro AT, Zhang Q, Prabhu SD, Lal H. Ponatinib Drives Cardiotoxicity by S100A8/A9-NLRP3-IL-1β Mediated Inflammation. Circ Res 2023; 132:267-289. [PMID: 36625265 PMCID: PMC9898181 DOI: 10.1161/circresaha.122.321504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The tyrosine kinase inhibitor ponatinib is the only treatment option for chronic myelogenous leukemia patients with T315I (gatekeeper) mutation. Pharmacovigilance analysis of Food and Drug Administration and World Health Organization datasets has revealed that ponatinib is the most cardiotoxic agent among all Food and Drug Administration-approved tyrosine kinase inhibitors in a real-world scenario. However, the mechanism of ponatinib-induced cardiotoxicity is unknown. METHODS The lack of well-optimized mouse models has hampered the in vivo cardio-oncology studies. Here, we show that cardiovascular comorbidity mouse models evidence a robust cardiac pathological phenotype upon ponatinib treatment. A combination of multiple in vitro and in vivo models was employed to delineate the underlying molecular mechanisms. RESULTS An unbiased RNA sequencing analysis identified the enrichment of dysregulated inflammatory genes, including a multifold upregulation of alarmins S100A8/A9, as a top hit in ponatinib-treated hearts. Mechanistically, we demonstrate that ponatinib activates the S100A8/A9-TLR4 (Toll-like receptor 4)-NLRP3 (NLR family pyrin domain-containing 3)-IL (interleukin)-1β signaling pathway in cardiac and systemic myeloid cells, in vitro and in vivo, thereby leading to excessive myocardial and systemic inflammation. Excessive inflammation was central to the cardiac pathology because interventions with broad-spectrum immunosuppressive glucocorticoid dexamethasone or specific inhibitors of NLRP3 (CY-09) or S100A9 (paquinimod) nearly abolished the ponatinib-induced cardiac dysfunction. CONCLUSIONS Taken together, these findings uncover a novel mechanism of ponatinib-induced cardiac inflammation leading to cardiac dysfunction. From a translational perspective, our results provide critical preclinical data and rationale for a clinical investigation into immunosuppressive interventions for managing ponatinib-induced cardiotoxicity.
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Affiliation(s)
- Sultan Tousif
- Division of Cardiovascular Disease, UAB | The University of Alabama at Birmingham, Birmingham, AL
| | - Anand P. Singh
- Division of Cardiovascular Disease, UAB | The University of Alabama at Birmingham, Birmingham, AL
| | - Prachi Umbarkar
- Division of Cardiovascular Disease, UAB | The University of Alabama at Birmingham, Birmingham, AL
| | - Cristi Galindo
- Department of Biology, Western Kentucky University, Bowling Green, KY 42101, USA35294-1913, USA
| | - Nicholas Wheeler
- Department of Biology, Western Kentucky University, Bowling Green, KY 42101, USA35294-1913, USA
| | - Angelica Toro Coro
- Division of Cardiovascular Disease, UAB | The University of Alabama at Birmingham, Birmingham, AL
| | - Qinkun Zhang
- Division of Cardiovascular Disease, UAB | The University of Alabama at Birmingham, Birmingham, AL
| | - Sumanth D. Prabhu
- Division of Cardiology, Department of Medicine, Washington University in St. Louis
| | - Hind Lal
- Division of Cardiovascular Disease, UAB | The University of Alabama at Birmingham, Birmingham, AL
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2
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Roa-Chamorro R, Torres-Quintero L, González-Bustos P, Manuel Puerta-Puerta J, Jaén-Águila F, Mediavilla-García JD. Dyslipidaemia in patients with haematology/oncology diseases. ENDOCRINOL DIAB NUTR 2022; 69:446-450. [PMID: 35778357 DOI: 10.1016/j.endien.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/11/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Ricardo Roa-Chamorro
- Unidad de Hipertensión y Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | | | - Pablo González-Bustos
- Unidad de Hipertensión y Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Fernando Jaén-Águila
- Unidad de Hipertensión y Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Juan Diego Mediavilla-García
- Unidad de Hipertensión y Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, Spain
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3
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New-generation tyrosine kinase inhibitor-associated asymptomatic cerebrovascular stenosis: two illustrative cases. Acta Neurochir (Wien) 2022; 164:1623-1626. [PMID: 34825968 DOI: 10.1007/s00701-021-05043-3] [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: 08/23/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
New-generation tyrosine kinase inhibitors (TKIs), nilotinib and ponatinib, for chronic myelogenous leukemia (CML) have been reported to cause symptomatic cerebral ischemia. Herein, we report two patients with asymptomatic cerebral artery stenosis associated with these TKIs, as a previously unreported finding. Both patients were in their 40 s and administered new-generation TKIs without vascular risk factors. New-generation TKIs for CML can cause major cerebrovascular stenosis without any symptoms. Examining the neck and intracranial arteries using magnetic resonance angiography and carotid ultrasonography may prevent future cerebral infarctions associated with these TKIs.
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Impact of the treatment of chronic myeloid leukaemia by tyrosine-kinase inhibitors on sick leaves refund: a nationwide cohort study. Support Care Cancer 2022; 30:5431-5440. [PMID: 35304631 DOI: 10.1007/s00520-022-06968-w] [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: 07/31/2021] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The advent of chronic myeloid leukaemia (CML) tyrosine-kinase inhibitors (TKI) has led to new paradigms including occupational rehabilitation. OBJECTIVES This study aimed to characterize the impact of CML treatment on sick leaves within the 2 years following diagnosis in working-age patients. METHODS A cohort of all 18-60-year-old newly diagnosed CML patients initiating a TKI between January 1st 2011 and December 31st 2014 in France was identified in the French National Healthcare database (Système National des Données de Santé [SNDS]). Patients with a sick leave identified in the 24 months after TKI initiation were compared with sex and initiation date matched controls in a nested case-control design. Factors associated with sick leaves were identified through a conditional logistic regression model, providing adjusted odds-ratio (OR) with their 95% confidence interval (CI). RESULTS Among 646 18-60-year-old patients, 268 were prescribed at least one sick leave in the study period, with 176 (27.2%) having their first sick leave prescribed after TKI initiation. The median number of sick days over the 2-years period was 115 per patient (interquartile range 25.5-384.5). In the nested case-control study (176 cases and 176 matched controls), sick leaves were more likely observed with second generation TKI (OR 4.11 [1.80-9.38]), whereas they were less likely observed in case if social deprivation (OR 0.07 [0.02-0.28]. CONCLUSION More than 25% of working-age CML patients had at least one sick leave within 2 years of TKI initiation, with a higher impact of second generation TKI, and with a median duration of 115 days.
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Motokawa T, Ikeda S, Ueno Y, Eguchi M, Minami T, Kawano H, Kobayashi K, Imaizumi Y, Maemura K. Comparison of Dasatinib- and Imatinib-Related Cardiotoxic Adverse Events in Japanese Patients With Chronic Myeloid Leukemia and Gastrointestinal Stromal Tumor. Circ Rep 2022; 4:1-8. [PMID: 35083382 PMCID: PMC8710638 DOI: 10.1253/circrep.cr-21-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background:
Despite the beneficial effects of
BCR-ABL1
tyrosine kinase inhibitors (TKIs) in the treatment of chronic myeloid leukemia (CML), they may also cause adverse events (AEs), especially cardiovascular toxicity. The incidence of TKI-induced AEs may vary among ethnic groups, and there is little specific information for Japanese patients. Methods and Results:
Sixty-nine consecutive patients who were started on treatment with dasatinib (n=25) or imatinib (n=44) for CML or gastrointestinal stromal tumor (GIST) between December 2008 and December 2019 were retrospectively recruited to the study. We determined the prevalence of AEs through October 2020 and compared the incidence of AEs between the 2 drugs. Baseline characteristics were comparable between the 2 groups. However, compared with the imatinib-treated group, the dasatinib-treated group had a higher incidence of congestive heart failure (CHF; 20.0% vs. 2.3%; P=0.04), pleural effusion (48% vs. 20.5%; P=0.03), pericardial effusion (24% vs. 4.6%; P=0.02), QT prolongation (4 vs. 0 patients; P=0.02), and pulmonary hypertension (3 vs. 0 patients; P=0.04). In the dasatinib-treated group, CHF tended to be associated with tricuspid valve regurgitation pressure gradient, and pleural effusion was observed in all patients. All-cause mortality and other cardiovascular events did not differ significantly between the 2 groups. Conclusions:
Cardiotoxic AEs occurred more frequently in Japanese patients with CML and GIST treated with dasatinib than imatinib.
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Affiliation(s)
- Tetsufumi Motokawa
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Satoshi Ikeda
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Yuki Ueno
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Masamichi Eguchi
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Takako Minami
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Hiroaki Kawano
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Kazuma Kobayashi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Yoshitaka Imaizumi
- Department of Hematology, Atomic Bomb Disease and Hibakusya Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
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Telerman A, Granot G, Leibovitch C, Yarchovsky-Dolberg O, Shacham-Abulafia A, Partouche S, Yeshurun M, Ellis MH, Raanani P, Wolach O. Neutrophil Extracellular Traps Are Increased in Chronic Myeloid Leukemia and Are Differentially Affected by Tyrosine Kinase Inhibitors. Cancers (Basel) 2021; 14:cancers14010119. [PMID: 35008283 PMCID: PMC8750902 DOI: 10.3390/cancers14010119] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/13/2021] [Accepted: 12/24/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Neutrophil extracellular traps (NETs) are a recently described form of neutrophil cellular death that has been associated with a thrombotic tendency in many diseases. We studied NET formation in neutrophils derived from patients with chronic myeloid leukemia (CML) and in CML neutrophil cell lines and demonstrated that NETs are increased in CML and that certain drugs used to treat CML (tyrosine kinase inhibitors—TKIs) increase NET formation. These findings may shed light on a novel mechanism linking CML, TKIs and vascular toxicity. Abstract Cardiovascular complications are increasingly reported with the use of certain tyrosine kinase inhibitors (TKIs) to treat chronic myeloid leukemia (CML). We studied neutrophil extracellular trap (NET) formation in CML and evaluated the effect of TKIs on NET formation. Neutrophils isolated from treatment-naïve patients with CML showed a significant increase in NET formation compared to matched controls at baseline and after stimulation with ionomycin (IO) and phorbol 12-myristate 13-acetate (PMA). Expression of citrullinated histone H3 (H3cit), peptidyl arginine deiminase 4 (PAD4) and reactive oxygen species (ROS) was significantly higher in CML samples compared to controls. Pre-treatment of neutrophils with TKIs was associated with a differential effect on NET formation, and ponatinib significantly augmented NET-associated elastase and ROS levels as compared to controls and other TKIs. BCR-ABL1 retroviral transduced HoxB8-immortalized mouse hematopoietic progenitors, which differentiate into neutrophils in-vitro, demonstrated increased H3cit & myeloperoxidase (MPO) expression consistent with excess NET formation. This was inhibited by Cl-amidine, a PAD4 inhibitor, but not by the NADPH inhibitor diphenyleneiodonium (DPI). Ponatinib pre-exposure significantly increased H3cit expression in HoxB8-BCR-ABL1 cells after stimulation with IO. In summary, CML is associated with increased NET formation, which is augmented by ponatinib, suggesting a possible role for NETs in promoting vascular toxicity in CML.
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Affiliation(s)
- Alona Telerman
- Felsenstein Medical Research Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva 4941492, Israel; (A.T.); (G.G.); (S.P.)
| | - Galit Granot
- Felsenstein Medical Research Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva 4941492, Israel; (A.T.); (G.G.); (S.P.)
| | - Chiya Leibovitch
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv 39040, Israel; (C.L.); (O.Y.-D.); (A.S.-A.); (M.Y.); (M.H.E.); (P.R.)
- Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Beilinson Hospital, Petah-Tikva 4941492, Israel
| | - Osnat Yarchovsky-Dolberg
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv 39040, Israel; (C.L.); (O.Y.-D.); (A.S.-A.); (M.Y.); (M.H.E.); (P.R.)
- Meir Medical Center, Hematology Institute and Blood Bank, Kfar Saba 4428164, Israel
| | - Adi Shacham-Abulafia
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv 39040, Israel; (C.L.); (O.Y.-D.); (A.S.-A.); (M.Y.); (M.H.E.); (P.R.)
- Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Beilinson Hospital, Petah-Tikva 4941492, Israel
| | - Shirly Partouche
- Felsenstein Medical Research Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva 4941492, Israel; (A.T.); (G.G.); (S.P.)
| | - Moshe Yeshurun
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv 39040, Israel; (C.L.); (O.Y.-D.); (A.S.-A.); (M.Y.); (M.H.E.); (P.R.)
- Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Beilinson Hospital, Petah-Tikva 4941492, Israel
| | - Martin H. Ellis
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv 39040, Israel; (C.L.); (O.Y.-D.); (A.S.-A.); (M.Y.); (M.H.E.); (P.R.)
- Meir Medical Center, Hematology Institute and Blood Bank, Kfar Saba 4428164, Israel
| | - Pia Raanani
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv 39040, Israel; (C.L.); (O.Y.-D.); (A.S.-A.); (M.Y.); (M.H.E.); (P.R.)
- Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Beilinson Hospital, Petah-Tikva 4941492, Israel
| | - Ofir Wolach
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv 39040, Israel; (C.L.); (O.Y.-D.); (A.S.-A.); (M.Y.); (M.H.E.); (P.R.)
- Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Beilinson Hospital, Petah-Tikva 4941492, Israel
- Correspondence: ; Tel.: +972-50-406-5590
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7
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Mulas O, Caocci G, Mola B, La Nasa G. Arterial Hypertension and Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia: A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:674748. [PMID: 34630076 PMCID: PMC8493251 DOI: 10.3389/fphar.2021.674748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/03/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Off-target effects in chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKIs) are associated with cardiovascular toxicity. Hypertension represents an important cardiovascular complication and, if not appropriately managed, can contribute to developing thrombotic events. Third-generation TKI ponatinib is associated with hypertension development, and its use is more restricted than in the past. Few data are reported for second-generation TKI, nilotinib, dasatinib, and bosutinib. The aim of this article was to evaluate with a systematic review and meta-analysis the real incidence of hypertension in CML patients treated with second- or third-generation TKI. Methods: The PubMed database, Web of Science, Scopus, and ClinicalTrials.gov were systematically searched for studies published between January 1, 2000, and January 30, 2021; the following terms were entered in the database queries: Cardiovascular, Chronic Myeloid Leukemia, CML, Tyrosine kinases inhibitor, TKI, and Hypertension. The study was carried out according to the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) statement. Results: A pooled analysis of hypertension incidence was 10% for all new-generation TKI, with an even higher prevalence with ponatinib (17%). The comparison with the first-generation imatinib confirmed that nilotinib was associated with a significantly increased risk of hypertension (RR 2; 95% CI; 1.39-2.88, I2=0%, z=3.73, p=0.0002). The greatest risk was found with ponatinib (RR 9.21; 95% CI; 2.86-29.66, z=3.72, p=0.0002). Conclusion: Hypertension is a common cardiovascular complication in CML patients treated with second- or third-generation TKI.
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Affiliation(s)
- Olga Mulas
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanni Caocci
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Brunella Mola
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giorgio La Nasa
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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8
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Interventional Strategies in Cancer-induced Cardiovascular Disease. Curr Oncol Rep 2021; 23:133. [PMID: 34570291 DOI: 10.1007/s11912-021-01113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW To highlight the range of illnesses and procedures that the interventional onco-cardiologists face in their daily practice, along with the recent additions to anti-cancer therapies and their related cardiotoxicity. RECENT FINDINGS Immune checkpoint inhibitors (ICI) are not devoid of cardiotoxicity as thought earlier and lead to an increased incidence of myocarditis. Transcatheter valve replacement has been shown to be a safer alternative to surgical replacement in cancer patients. Interventional onco-cardiology is a novel field that addresses cardiovascular diseases in the setting of cancer. Traditionally excluding cancer patients from clinical trials has led to a dearth of information needed to tackle cardiac conditions like Takotsubo cardiomyopathy, malignant pericardial effusions, and radiation-induced vascular diseases encountered either exclusively or predominantly in this high-risk population. This review discusses the various treatment options available in the interventional armamentarium with a particular focus on ICI-myocarditis and transcatheter aortic valve replacement in cancer patients.
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9
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Tillie RJHA, Theelen TL, van Kuijk K, Temmerman L, de Bruijn J, Gijbels M, Betsholtz C, Biessen EAL, Sluimer JC. A Switch from Cell-Associated to Soluble PDGF-B Protects against Atherosclerosis, despite Driving Extramedullary Hematopoiesis. Cells 2021; 10:1746. [PMID: 34359916 PMCID: PMC8308020 DOI: 10.3390/cells10071746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 12/30/2022] Open
Abstract
Platelet-derived growth factor B (PDGF-B) is a mitogenic, migratory and survival factor. Cell-associated PDGF-B recruits stabilizing pericytes towards blood vessels through retention in extracellular matrix. We hypothesized that the genetic ablation of cell-associated PDGF-B by retention motif deletion would reduce the local availability of PDGF-B, resulting in microvascular pericyte loss, microvascular permeability and exacerbated atherosclerosis. Therefore, Ldlr-/-Pdgfbret/ret mice were fed a high cholesterol diet. Although plaque size was increased in the aortic root of Pdgfbret/ret mice, microvessel density and intraplaque hemorrhage were unexpectedly unaffected. Plaque macrophage content was reduced, which is likely attributable to increased apoptosis, as judged by increased TUNEL+ cells in Pdgfbret/ret plaques (2.1-fold) and increased Pdgfbret/ret macrophage apoptosis upon 7-ketocholesterol or oxidized LDL incubation in vitro. Moreover, Pdgfbret/ret plaque collagen content increased independent of mesenchymal cell density. The decreased macrophage matrix metalloproteinase activity could partly explain Pdgfbret/ret collagen content. In addition to the beneficial vascular effects, we observed reduced body weight gain related to smaller fat deposition in Pdgfbret/ret liver and adipose tissue. While dampening plaque inflammation, Pdgfbret/ret paradoxically induced systemic leukocytosis. The increased incorporation of 5-ethynyl-2'-deoxyuridine indicated increased extramedullary hematopoiesis and the increased proliferation of circulating leukocytes. We concluded that Pdgfbret/ret confers vascular and metabolic effects, which appeared to be protective against diet-induced cardiovascular burden. These effects were unrelated to arterial mesenchymal cell content or adventitial microvessel density and leakage. In contrast, the deletion drives splenic hematopoiesis and subsequent leukocytosis in hypercholesterolemia.
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Affiliation(s)
- Renée J. H. A. Tillie
- Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (R.J.H.A.T.); (T.L.T.); (K.v.K.); (L.T.); (J.d.B.); (M.G.); (E.A.L.B.)
| | - Thomas L. Theelen
- Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (R.J.H.A.T.); (T.L.T.); (K.v.K.); (L.T.); (J.d.B.); (M.G.); (E.A.L.B.)
| | - Kim van Kuijk
- Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (R.J.H.A.T.); (T.L.T.); (K.v.K.); (L.T.); (J.d.B.); (M.G.); (E.A.L.B.)
| | - Lieve Temmerman
- Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (R.J.H.A.T.); (T.L.T.); (K.v.K.); (L.T.); (J.d.B.); (M.G.); (E.A.L.B.)
| | - Jenny de Bruijn
- Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (R.J.H.A.T.); (T.L.T.); (K.v.K.); (L.T.); (J.d.B.); (M.G.); (E.A.L.B.)
| | - Marion Gijbels
- Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (R.J.H.A.T.); (T.L.T.); (K.v.K.); (L.T.); (J.d.B.); (M.G.); (E.A.L.B.)
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Christer Betsholtz
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, 751 85 Uppsala, Sweden;
| | - Erik A. L. Biessen
- Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (R.J.H.A.T.); (T.L.T.); (K.v.K.); (L.T.); (J.d.B.); (M.G.); (E.A.L.B.)
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, 52074 Aachen, Germany
| | - Judith C. Sluimer
- Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (R.J.H.A.T.); (T.L.T.); (K.v.K.); (L.T.); (J.d.B.); (M.G.); (E.A.L.B.)
- BHF Centre for Cardiovascular Sciences (CVS), University of Edinburgh, Edinburgh EH16 4TJ, UK
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10
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Roa-Chamorro R, Torres-Quintero L, González-Bustos P, Puerta-Puerta JM, Jaén-Águila F, Mediavilla-García JD. Dyslipemia in patients with onco-hematological diseases. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00155-5. [PMID: 34244098 DOI: 10.1016/j.endinu.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Ricardo Roa-Chamorro
- Unidad de Hipertensión y Riesgo Vascular. Servicio de Medicina Interna. Hospital Universitario Virgen de las Nieves, Granada, España.
| | | | - Pablo González-Bustos
- Unidad de Hipertensión y Riesgo Vascular. Servicio de Medicina Interna. Hospital Universitario Virgen de las Nieves, Granada, España
| | | | - Fernando Jaén-Águila
- Unidad de Hipertensión y Riesgo Vascular. Servicio de Medicina Interna. Hospital Universitario Virgen de las Nieves, Granada, España
| | - Juan Diego Mediavilla-García
- Unidad de Hipertensión y Riesgo Vascular. Servicio de Medicina Interna. Hospital Universitario Virgen de las Nieves, Granada, España
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11
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Nonaka M, Hosoda H, Uezono Y. Cancer treatment-related cardiovascular disease: Current status and future research priorities. Biochem Pharmacol 2021; 190:114599. [PMID: 33989656 DOI: 10.1016/j.bcp.2021.114599] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
With the development of new drugs, such as molecular-targeted drugs, and multidisciplinary therapies, cancer treatment outcomes have improved, and the number of cancer survivors is increasing every year. However, some chemotherapeutic agents cause cardiovascular complications (cancer treatment-related cardiovascular disease, CTRCVD), which affect the life prognosis and quality of life (QOL) of cancer patients. Therefore, it is necessary to select treatment methods that take into account the prognosis and QOL of cancer patients, and to take measures against CTRCVD. The mechanism of cardiotoxicity of high-risk drugs, such as doxorubicin and HER2 inhibitors, are still unclear; genetic factors, and cardiovascular disease risk factors (e.g., hypertension, dyslipidemia, and diabetes) are associated with CTRCVD progression. The establishment of methods for prevention, early diagnosis, and treatment of CTRCVD and the generation of evidence for these methods are needed. It is also necessary to develop screening methods for chemotherapy cardiotoxicity. In this review, we discuss the current status of CTRCVD, its complications, and expected countermeasures.
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Affiliation(s)
- Miki Nonaka
- Department of Pain Control Research, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan(1)
| | - Hiroshi Hosoda
- Department of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center Research Institute, 6-1, Kishibe-Shimmachi, Suita-City, Osaka 564-8565, Japan(1)
| | - Yasuhito Uezono
- Department of Pain Control Research, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan(1); Department of Pain Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; Supportive and Palliative Care Research Support Office, National Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-City, Chiba 277-8577, Japan; Project for Supportive Care Research, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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12
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Spadaccio C, Antoniades C, Nenna A, Chung C, Will R, Chello M, Gaudino MFL. Preventing treatment failures in coronary artery disease: what can we learn from the biology of in-stent restenosis, vein graft failure, and internal thoracic arteries? Cardiovasc Res 2020; 116:505-519. [PMID: 31397850 DOI: 10.1093/cvr/cvz214] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/01/2019] [Accepted: 08/08/2019] [Indexed: 12/18/2022] Open
Abstract
Coronary artery disease (CAD) remains one of the most important causes of morbidity and mortality worldwide, and the availability of percutaneous or surgical revascularization procedures significantly improves survival. However, both strategies are daunted by complications which limit long-term effectiveness. In-stent restenosis (ISR) is a major drawback for intracoronary stenting, while graft failure is the limiting factor for coronary artery bypass graft surgery (CABG), especially using veins. Conversely, internal thoracic artery (ITA) is known to maintain long-term patency in CABG. Understanding the biology and pathophysiology of ISR and vein graft failure (VGF) and mechanisms behind ITA resistance to failure is crucial to combat these complications in CAD treatment. This review intends to provide an overview of the biological mechanisms underlying stent and VGF and of the potential therapeutic strategy to prevent these complications. Interestingly, despite being different modalities of revascularization, mechanisms of failure of stent and saphenous vein grafts are very similar from the biological standpoint.
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Affiliation(s)
- Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Agamemnon St, Clydebank, G81 4DY Glasgow, UK
| | | | - Antonio Nenna
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Calvin Chung
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Agamemnon St, Clydebank, G81 4DY Glasgow, UK
| | - Ricardo Will
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Agamemnon St, Clydebank, G81 4DY Glasgow, UK
| | - Massimo Chello
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
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13
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Karakulak UN, Aladag E, Hekimsoy V, Sahiner ML, Kaya EB, Ozer N, Aksu S, Demiroglu H, Goker H, Buyukasik Y, Ozcebe O, Sayinalp N, Haznedaroglu IC. Four-Dimensional Echocardiographic Evaluation of Left Ventricular Systolic Functions in Patients with Chronic Myeloid Leukaemia Receiving Tyrosine Kinase Inhibitors. Cardiovasc Toxicol 2020; 21:216-223. [PMID: 33068232 DOI: 10.1007/s12012-020-09613-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
Tyrosine kinase inhibitors (TKIs) are established treatment for haematological malignancies. However, cardiac adverse effects, including the reduction in left ventricular ejection fraction and symptomatic heart failure remain clinical problems. The purpose of this study was to evaluate the left ventricular systolic functions in patients with chronic myeloid leukaemia receiving TKIs. A cross-sectional and observational study was conducted of 37 patients with chronic myeloid leukaemia receiving dasatinib or nilotinib after imatinib failure. Left ventricular systolic functions were evaluated using four-dimensional speckle tracking echocardiography derived global longitudinal (GLS), circumferential (GCS), radial (GRS), and area (GAS) strain indices. Mean ejection fraction, stroke volume, cardiac output and left ventricular mass index were similar between control and patient groups and within normal limits. GLS (- 16.7% vs - 20.8%, p < 0.001), GCS (- 13.0% vs - 15.6%, p = 0.002), and GAS (- 26.2% vs - 31.0, p < 0.001) values were significantly higher in the patient population than those of the controls. Dasatinib and nilotinib groups did not show differences regarding strain indices. In multivariate regression analysis, only the usage of dasatinib or nilotinib was found to be an independent risk factor for diminished GAS (β = 4.406, p = 0.016), GLS (β = 3.797, p = 0.001), and GCS (β = 2.404, p = 0.040). Although imatinib, nilotinib, and dasatinib seem to be clinically safe in terms of cardiac function, monitoring of systolic functions using strain imaging, and long-term observation of patients may provide early detection of the possible cardiac toxicity.
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Affiliation(s)
- Ugur Nadir Karakulak
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey.
| | - Elifcan Aladag
- Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Vedat Hekimsoy
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Mehmet Levent Sahiner
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Ergun Baris Kaya
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Necla Ozer
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Salih Aksu
- Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Haluk Demiroglu
- Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hakan Goker
- Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yahya Buyukasik
- Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Osman Ozcebe
- Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nilgun Sayinalp
- Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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14
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Molica M, Noguera NI, Trawinska MM, Martinelli G, Cerchione C, Abruzzese E. Treatment free remission in chronic myeloid leukemia: Lights and shadows. Hematol Rep 2020; 12:8950. [PMID: 33042501 PMCID: PMC7520857 DOI: 10.4081/hr.2020.8950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Indexed: 01/03/2023] Open
Abstract
In addition to the best possible overall survival, discontinuation of the tyrosine kinase-inhibitor (TKI) treatment [treatment free remission (TFR)] without observing a recurrence of the disease has become a standard part of chronic myeloid leukemia (CML) care. Worldwide, more than 2000 patients with CML have attempted TFR, and very rare instances of disease transformation have been reported. Several studies in the last decade have demonstrated the feasibility and safety of TKI discontinuation in selected patients with CML who achieve deep and sustained molecular response with TKI. This has moved prime-time into clinical practice although open questions remain in terms of understanding the disease biology that leads to successful TKI cessation in some patients while not in others. Despite the remaining questions regarding which factors may be considered predictive for TFR, treatment interruption is a safe option provided that adequate molecular monitoring is available, with prompt re-initiation of TKIs as soon as major molecular response has been lost. Data from ongoing trials should help refine decisions as to which patients are the best candidates to attempt TKI discontinuation, frequency of a safe monitoring, optimal strategies to sustain ongoing TFR and increase the number of patients who can access to discontinuation programs.
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Affiliation(s)
| | - Nelida I Noguera
- Department of Biomedicine and Prevention, Tor Vergata University of Rome
| | | | - Giovanni Martinelli
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - Claudio Cerchione
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
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15
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Haguet H, Bouvy C, Delvigne AS, Modaffari E, Wannez A, Sonveaux P, Dogné JM, Douxfils J. The Risk of Arterial Thrombosis in Patients With Chronic Myeloid Leukemia Treated With Second and Third Generation BCR-ABL Tyrosine Kinase Inhibitors May Be Explained by Their Impact on Endothelial Cells: An In-Vitro Study. Front Pharmacol 2020; 11:1007. [PMID: 32719607 PMCID: PMC7350860 DOI: 10.3389/fphar.2020.01007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022] Open
Abstract
BCR-ABL tyrosine kinase inhibitors (TKIs) revolutionized the treatment of chronic myeloid leukemia, inducing deep molecular responses, largely improving patient survival and rendering treatment-free remission possible. However, three of the five BCR-ABL TKIs, dasatinib, nilotinib, and ponatinib, increase the risk of developing arterial thrombosis. Prior investigations reported that nilotinib and ponatinib affect the endothelium, but the mechanisms by which they exert their toxic effects are still unclear. The impact of dasatinib and bosutinib on endothelial cells has been poorly investigated. Here, we aimed to provide an in vitro homogenous evaluation of the effects of BCR-ABL TKIs on the endothelium, with a special focus on the type of cell death to elucidate the mechanisms responsible for the potential cytotoxic effects of BCR-ABL TKIs nilotinib and ponatinib on endothelial cells. We tested the five BCR-ABL TKIs at three concentrations on human umbilical venous endothelial cells (HUVECs). This study highlights the endothelial toxicity of ponatinib and provides insights about the mechanisms by which it affects endothelial cell viability. Ponatinib induced apoptosis and necrosis of HUVECs after 72 h. Dasatinib affected endothelial cells in vitro by inhibiting their proliferation and decreased wound closure as soon as 24 h of treatment and even at infra-therapeutic dose (0.005 µM). Comparatively, imatinib, nilotinib, and bosutinib had little impact on endothelial cells at therapeutic concentrations. They did not induce apoptosis nor necrosis, even after 72 h of treatment but they inhibited HUVEC proliferation. Overall, this study reports various effects of BCR-ABL TKIs on endothelial cells and suggests that ponatinib and dasatinib induce arterial thrombosis through endothelial dysfunction.
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Affiliation(s)
- Hélène Haguet
- Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), University of Namur, Namur, Belgium
| | | | | | | | - Adeline Wannez
- Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), University of Namur, Namur, Belgium
| | - Pierre Sonveaux
- Pole of Pharmacology and Therapeutics, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Jean-Michel Dogné
- Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), University of Namur, Namur, Belgium
| | - Jonathan Douxfils
- Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), University of Namur, Namur, Belgium
- QUALIblood s.a., Namur, Belgium
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16
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Boons CCLM, Timmers L, Janssen JJWM, Westerweel PE, Blijlevens NMA, Smit WM, Bartelink IH, Wilschut JA, Swart EL, Hendrikse NH, Hugtenburg JG. Response and Adherence to Nilotinib in Daily practice (RAND study): an in-depth observational study of chronic myeloid leukemia patients treated with nilotinib. Eur J Clin Pharmacol 2020; 76:1213-1226. [PMID: 32488333 PMCID: PMC7419465 DOI: 10.1007/s00228-020-02910-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 05/22/2020] [Indexed: 12/27/2022]
Abstract
Introduction This comprehensive observational study aimed to gain insight into adherence to nilotinib and the effect of (non)adherence on exposure (Cmin) and treatment outcomes. Methods Chronic myeloid leukemia (CML) patients using nilotinib were followed for 12 months. Adherence was measured by Medication Event Monitoring System (MEMS), pill count, and Medication Adherence Report Scale (MARS-5). Nilotinib Cmin and patient-reported outcomes (i.e., quality of life, side effects, beliefs, satisfaction) were measured at baseline, 3, 6, and 12 months. Results Sixty-eight patients (57.5 ± 15.0 years, 49% female) participated. Median adherence to nilotinib (MEMS and pill count) was ≥ 99% and adherence < 90% was rare. Self-reported nonadherence (MARS-5) increased in the first year of treatment to a third of patients. In line with the strong beliefs in the necessity of taking nilotinib, forgetting to take a dose was more prevalent than intentionally adjusting/skipping doses. Nilotinib Cmin were generally above the therapeutic target in 95% of patients. Patients reported a variety of side effects, of which fatigue was most frequent. The mean Cmin was higher in patients who reported severe itching and fatigue. The overall 1-year MMR rate ranged from 47 to 71%. Conclusion Substantial nonadherence (< 90%) to nilotinib was rare and nilotinib Cmin were generally above the therapeutic target. Lack of response in our group of patients was not related to nonadherence or inadequate Cmin. Nevertheless, a considerable number of patients experienced difficulties in adhering to the twice daily fasted dosing regimen, emphasizing the importance of continuous support of medication adherence in CML. Clinical trial registration NTR3992 (Netherlands Trial Register, www.trialregister.nl) Electronic supplementary material The online version of this article (10.1007/s00228-020-02910-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christel C L M Boons
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Lonneke Timmers
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jeroen J W M Janssen
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Peter E Westerweel
- Department of Hematology, Albert Schweitzer Ziekenhuis, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands
| | - Nicole M A Blijlevens
- Department of Hematology, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Willem M Smit
- Department of Hematology, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, The Netherlands
| | - Imke H Bartelink
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Janneke A Wilschut
- Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Eleonora L Swart
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - N Harry Hendrikse
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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17
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Sase K. [Clinical pharmacology of cardio-oncology: a novel interdisciplinary platform for basic and translational research]. Nihon Yakurigaku Zasshi 2020; 155:179-184. [PMID: 32378640 DOI: 10.1254/fpj.19137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Advances in cancer treatment have led to dramatic increase in cancer survivors. In addition to cardiotoxicity resulting from anthracyclines and radiation therapy, the emergence of novel cancer treatment-related cardiovascular disease (CTRCD) with molecularly targeted therapies and immune checkpoint inhibitors has been recognized as an unmet medical need. Cardio-oncology is a new interdisciplinary research opportunity at the intersection of cardiovascular disease and cancer. Research priorities need to be identified for diagnosis, treatment, and prevention of previously unknown CTRCD(s), including (a) cardiac dysfunction and heart failure, (b) coronary artery disease, (c) valvular disease, (d) arrhythmias and QT-prolongation, (e) arterial hypertension, (f) thromboembolic disease, and (g) other cardiovascular disorders. In particular, understanding the fundamental mechanisms underlying CTRCD is essential for developing new methods. Applying more appropriate disease models and more effective methods for toxicity screening will help to better understand CTRCD. Although animal models have been used to predict potential problems, more advanced predictive models are also needed. Biobanks and other specimens with patient registries are expected to facilitate the validation of new biomarkers, genomic analysis, and imaging methods.
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Affiliation(s)
- Kazuhiro Sase
- Clinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University
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18
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Boons CCLM, den Hartog YM, Janssen JJWM, Zandvliet AS, Vos RM, Swart EL, Hendrikse NH, Hugtenburg JG. Food-effect study of nilotinib in chronic myeloid leukaemia (NiFo study): Enabling dose reduction and relief of treatment burden. Eur J Haematol 2020; 105:148-155. [PMID: 32243653 PMCID: PMC7496780 DOI: 10.1111/ejh.13418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/19/2022]
Abstract
Objectives Taking advantage of its food‐dependent bioavailability, the present study investigated the effect of a reduced dose taken with real‐life meals on the pharmacokinetics (PK) of nilotinib in chronic myeloid leukaemia (CML) patients. Methods Nilotinib was taken fasted (300 mg BID, days 1‐4) or with real‐life meals (200 mg BID, days 5‐11). Rich sampling (days 1, 3, 8, 11) allowed for non‐compartmental PK analysis. Nilotinib exposure (AUC0–12 h ‐Cmin ‐Cmax) and its intra‐ and interpatient variability were compared between the two regimens. Adverse events were recorded by means of a patient diary and ECG monitoring. Results Fifteen patients aged 40‐74 years participated. Nilotinib PK following 200 mg BID taken with a meal strongly resembled that of 300 mg BID taken fasted (Cmin percentile (P)10‐P90: 665‐1404 ng/mL and 557‐1743 ng/mL, respectively). Meals delayed nilotinib absorption. Intra‐ and interpatient variability were not increased by intake with meals. Nilotinib with food was well tolerated. Conclusion With support of therapeutic drug monitoring, the use of a reduced 200 mg nilotinib dose with real‐life meals seems feasible and safe. Future (confirmatory) studies should further explore the usefulness of nilotinib dosing together with food, including the relationship with treatment efficacy as well as long‐term effects on quality of life. Clinical Trial Registration: NTR5000 (Netherlands Trial Register, www.trialregister.nl).
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Affiliation(s)
- Christel C L M Boons
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Pharmacology and Pharmacy, Cancer Centre Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Yvonne M den Hartog
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Haematology, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - Jeroen J W M Janssen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Haematology, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - Anthe S Zandvliet
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Pharmacology and Pharmacy, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - René M Vos
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Pharmacology and Pharmacy, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - Eleonora L Swart
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Pharmacology and Pharmacy, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - N Harry Hendrikse
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Pharmacology and Pharmacy, Cancer Centre Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - Jacqueline G Hugtenburg
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Pharmacology and Pharmacy, Cancer Centre Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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19
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Bora A, Durmuş K, Terzi H, Altuntaş EE. Examining the Early Period Effect of Nilotinib on Hearing: An Experimental Study. J Int Adv Otol 2020; 16:77-86. [PMID: 31287435 PMCID: PMC7224425 DOI: 10.5152/iao.2019.5908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Nilotinib has very few side effects, including neutropenia, thrombocytopenia, cardiotoxicity, high pancreatic lipase, ischemia, and vascular occlusion. We aimed to investigate whether short-term administration of nilotinib had ototoxic effects in rats. MATERIALS AND METHODS Wistar-albino rats were categorized into three groups: group C (administered 0.25 mL of distilled water, no nilotinib), group N-20 (administered 20 mg/kg/day of nilotinib dissolved in distilled water), and group N-50 (administered 50 mg/kg/day of nilotinib dissolved in distilled water). A single dose was administered once per day, at the same hour, over 21 days. Auditory brainstem response (ABR) thresholds were recorded on day 0 and day 21. RESULTS There were no changes in ABR threshold values obtained on day 0 (baseline) and on day 21 across all three groups. A statistically significant difference was not found in terms of the mean latency of waves V and III, interpeak latency values of waves III-V, and amplitude ratios of waves III-V and V/Va at baseline and on day 21 across all three groups on within-group or between-group evaluation. CONCLUSION Consequently, further studies are needed that involve different drug doses, prolonged administration of drugs, as well as distortion otoacoustic emission test for the evaluation of cochlear activation and ABR. Furthermore, histopathological studies are needed to indicate whether the cochlea is affected to prove that nilotinib has definitively no ototoxic effect.
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Affiliation(s)
- Adem Bora
- Department of Otolaryngology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Kasım Durmuş
- Department of Otolaryngology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Hatice Terzi
- Department of Internal Medicine, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Emine Elif Altuntaş
- Department of Otolaryngology, Cumhuriyet University School of Medicine, Sivas, Turkey
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20
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Do YR, Kwak JY, Kim JA, Kim HJ, Chung JS, Shin HJ, Kim SH, Bunworasate U, Choi CW, Zang DY, Oh SJ, Jootar S, Reksodiputro AH, Lee WS, Mun YC, Kong JH, Caguioa PB, Kim H, Park J, Kim DW. Long-term data from a phase 3 study of radotinib versus imatinib in patients with newly diagnosed, chronic myeloid leukaemia in the chronic phase (RERISE). Br J Haematol 2020; 189:303-312. [PMID: 32012231 PMCID: PMC7187446 DOI: 10.1111/bjh.16381] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/25/2019] [Indexed: 12/22/2022]
Abstract
In the phase 3 study RERISE, patients with newly diagnosed chronic myeloid leukaemia in chronic phase demonstrated significantly faster and higher rates of major molecular response (MMR) with twice‐daily radotinib 300 mg (n = 79) or 400 mg (n = 81) than with once‐daily imatinib 400 mg (n = 81) after 12 months. With ≥48 months’ follow‐up, MMR was higher with radotinib 300 mg (86%) or 400 mg (83%) than with imatinib (75%). Among patients with BCR‐ABL1 ≤ 10% at three months, MMR and molecular response 4·5 (MR4·5) were achieved within 48 months by more radotinib‐treated patients (300 mg: 84% and 52%, respectively; 400 mg: 74% and 44%, respectively) than imatinib‐treated patients (71% and 44%, respectively). Estimated overall and progression‐free survival rates at 48 months were not significantly different between imatinib (94% and 94%, respectively) and radotinib 300 mg (99% and 97%, respectively) or 400 mg (95% and 93%, respectively). The treatment failure rate was significantly higher with imatinib (19%) than with radotinib 300 mg (6%; P = 0·0197) or 400 mg (5%; P = 0·0072). Safety profiles were consistent with previous reports; most adverse events occurred within 12 months. Radotinib continues to demonstrate robust, deep molecular responses, suggesting that treatment‐free remission may be attainable.
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Affiliation(s)
- Young Rok Do
- Dongsan Medical Center, Keimyung University, Daegu, South Korea
| | - Jae-Yong Kwak
- Chonbuk National University Medical School & Hospital, Jeonju, South Korea
| | - Jeong A Kim
- St. Vincent Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Hyeoung Joon Kim
- Chonnam National University, Hwasun Hospital, Hwasun, South Korea
| | | | - Ho-Jin Shin
- Pusan National University Hospital, Busan, South Korea
| | - Sung-Hyun Kim
- Dong-A University Medical Center, Busan, South Korea
| | - Udomsak Bunworasate
- King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | | | - Dae Young Zang
- Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Suk Joong Oh
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Saengsuree Jootar
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Won Sik Lee
- Inje University Busan Paik Hospital, Busan, South Korea
| | - Yeung-Chul Mun
- Ewha Womans University College of Medicine, Seoul, South Korea
| | - Jee Hyun Kong
- Wonju Severance Christian Hospital, Wonju, South Korea
| | | | - Hawk Kim
- Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Jinny Park
- Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Dong-Wook Kim
- Seoul St. Mary's Hematology Hospital, Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea
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21
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Wang Q, Jiang C, Zhang Y, Zhang Y, Yue B, Zheng-Lin B, Zhao Y, Mauro MJ. Cardiovascular mortality among chronic myeloid leukemia patients in the pre-tyrosine kinase inhibitor (TKI) and TKI eras: a surveillance, epidemiology and end results (SEER) analysis. Leuk Lymphoma 2020; 61:1147-1157. [PMID: 31985308 DOI: 10.1080/10428194.2019.1711074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Despite remarkable efficacy, there is an emerging concern regarding TKI-associated cardiovascular toxicity in CML. Long term follow-up studies on association between TKI therapy and cardiovascular outcome have been limited. CML patients were accessed from the SEER 18 database from 1992 to 2011. Cardiovascular disease (CVD) specific mortality was calculated comparing the pre-TKI era to the TKI era using the Fine-Gray competing risk model. Overall, the TKI era was associated with a reduced cardiovascular mortality compared with the pre-TKI era (HR = 0.72; 95%CI, 0.59-0.89). Our results argue for continued aggressive screening, identification and management of cardiovascular risk factors among all CML patients, especially the elderly, and further investigation into specific mechanisms, factors and predictors of risks in TKI-treated CML.
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Affiliation(s)
- Qian Wang
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai St. Luke's and Mount Sinai West, New York, NY, USA
| | - Changchuan Jiang
- Department of Medicine, Icahn School of Medicine at Mount Sinai St. Luke's and Mount Sinai West, New York, NY, USA
| | - Yaning Zhang
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Yu Zhang
- Department of Hematology, Chinese People's Liberation Army Hospital 307, Beijing, China
| | - Bing Yue
- Department of Medicine, Icahn School of Medicine at Mount Sinai St. Luke's and Mount Sinai West, New York, NY, USA
| | - Binbin Zheng-Lin
- Department of Medicine, Icahn School of Medicine at Mount Sinai St. Luke's and Mount Sinai West, New York, NY, USA
| | - Yang Zhao
- Division of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Michael J Mauro
- Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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22
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Yao F, Yao Z, Zhong T, Zhang J, Wang T, Zhang B, He Q, Ding L, Yang B. Imatinib prevents elastase-induced abdominal aortic aneurysm progression by regulating macrophage-derived MMP9. Eur J Pharmacol 2019; 860:172559. [PMID: 31325435 DOI: 10.1016/j.ejphar.2019.172559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 01/20/2023]
Abstract
Abdominal aortic aneurysm (AAA) is characterized with progressive weakening and considerable dilation of the aortic wall. Despite the high risk of mortality in the elderly population, there are still no clinical pharmacological therapies to alleviate AAA progression. Macrophage-derived MMP9 acts as a key factor in extracellular matrix degradation and is crucial for aortic aneurysm development and aortic rupture. Here, we demonstrated that the transcription level of MMP9 was suppressed with a concentration-dependent manner in macrophages after Imatinib treatment, which was accompanied by the down-regulation of MMP9 protein expression and reduced MMP9 secretion in vitro. Imatinib administration (50 mg/kg/d, i.g.) was carried out one week after the establishment of elastase-induced AAA in rats, stabilizing aneurysm progression and improving survival rate via decreasing the aortic diameter and preventing elastin degradation. Expression and activity of MMP9 in the artery tissues were significantly suppressed after Imatinib treatment via in situ assessment like immunohistochemistry and zymography, although macrophage infiltration was not affected. Furthermore, we found that Imatinib inhibited MMP9 transcription through reduction of STAT3 phosphorylation and translocation from nucleus to cytoplasm. These observations indicated that Imatinib prevents aneurysm progression by inhibiting STAT3-mediated MMP9 expression and activation, suggesting a new application of Imatinib on AAA clinical therapy.
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Affiliation(s)
- Fengqi Yao
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, PR China
| | - Zhangting Yao
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, PR China
| | - Tiecheng Zhong
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, PR China
| | - Jieqiong Zhang
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, PR China
| | - Tingting Wang
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, PR China
| | - Bo Zhang
- Translational Medicine Research Center, Nanjing Medical University, Affiliated Hangzhou Hospital, Hangzhou First People's Hospital, Hangzhou, Zhejiang, 310006, PR China
| | - Qiaojun He
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, PR China
| | - Ling Ding
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, PR China.
| | - Bo Yang
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, PR China.
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Hypertension in hematologic malignancies and hematopoietic cell transplantation: An emerging issue with the introduction of novel treatments. Blood Rev 2019; 35:51-58. [DOI: 10.1016/j.blre.2019.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 12/29/2018] [Accepted: 03/12/2019] [Indexed: 12/12/2022]
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Cortes J, Rea D, Lipton JH. Treatment-free remission with first- and second-generation tyrosine kinase inhibitors. Am J Hematol 2019; 94:346-357. [PMID: 30394563 PMCID: PMC6587857 DOI: 10.1002/ajh.25342] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/26/2018] [Accepted: 10/31/2018] [Indexed: 12/20/2022]
Abstract
Chronic myeloid leukemia (CML) has become a chronic disease, for which the chronic phase is manageable with tyrosine kinase inhibitor (TKI) therapy. Patients with optimal responses to TKIs have achieved long-term survival, and treatment-free remission (TFR) has since become an additional treatment goal in CML. In this review, we discuss important factors to consider prior to stopping treatment. In addition, published and presented data with the first-generation TKI imatinib, as well as current clinical trials evaluating TFR with the second-generation TKIs dasatinib and nilotinib, are examined. Results obtained outside of clinical trials have been included as well. Because successful TKI discontinuation depends upon accurate BCR-ABL1 monitoring, emerging technologies are also discussed. Clinical data obtained to date indicate that for many patients who achieve deep molecular response (DMR) on TKI therapy, TFR is a safe treatment goal, and, if the response is lost, patients can expect to regain their responses immediately upon reinitiation of TKI. It is also clear that there remains much room for improvement to make TFR a successful reality for most patients. Data from ongoing trials should help refine decisions as to which patients are the best candidates to attempt TKI discontinuation with safe monitoring in place.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Clinical Trials as Topic
- Dasatinib/therapeutic use
- Disease Management
- Drug Administration Schedule
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Gene Expression
- Humans
- Imatinib Mesylate/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Monitoring, Physiologic
- Protein Kinase Inhibitors/therapeutic use
- Pyrimidines/therapeutic use
- Remission Induction
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- Jorge Cortes
- Department of LeukemiaUniversity of Texas MD Anderson Cancer CenterHoustonTexas
| | | | - Jeffrey H. Lipton
- Department of Medicine, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
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Assunção PM, Lana TP, Delamain MT, Duarte GO, Zulli R, Lorand-Metze I, de Souza CA, de Paula EV, Barbosa Pagnano KB. Cardiovascular Risk and Cardiovascular Events in Patients With Chronic Myeloid Leukemia Treated With Tyrosine Kinase Inhibitors. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:162-166. [DOI: 10.1016/j.clml.2018.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/28/2018] [Accepted: 12/12/2018] [Indexed: 01/22/2023]
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26
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Tini G, Sarocchi M, Tocci G, Arboscello E, Ghigliotti G, Novo G, Brunelli C, Lenihan D, Volpe M, Spallarossa P. Arterial hypertension in cancer: The elephant in the room. Int J Cardiol 2019; 281:133-139. [PMID: 30718135 DOI: 10.1016/j.ijcard.2019.01.082] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/19/2019] [Accepted: 01/22/2019] [Indexed: 12/21/2022]
Abstract
The great therapeutical success achieved by oncology is counterbalanced by growing evidences of cardiovascular (CV) toxicity due to many antineoplastic treatments. Cardiac adverse events may cause premature discontinuation of effective oncologic treatments or occur as late events undermining the oncologic success. Arterial hypertension is both the most common comorbidity in cancer patients and a frequent adverse effect of anticancer therapies. A pre-existing hypertension is known to increase the risk of other cardiac adverse events due to oncologic treatments, in particular heart failure. Moreover, as a strict association between cancer and CV diseases has emerged over the recent years, various analyses have shown a direct relationship between hypertension and cancer incidence and mortality. Finally, many antineoplastic treatments may cause a rise in blood pressure (BP) values, particularly the novel anti VEGF agents, this possibly compromising efficacy of chemotherapy. Aim of this review is to revise the topic and the many aspects linking arterial hypertension and cancer, and to provide a comprehensive and practical guide of the current treatment approaches.
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Affiliation(s)
- Giacomo Tini
- Clinic of Cardiovascular Diseases, IRCCS San Martino Policlinic Hospital, University of Genova, Italy
| | - Matteo Sarocchi
- Clinic of Cardiovascular Diseases, IRCCS San Martino Policlinic Hospital, University of Genova, Italy
| | - Giuliano Tocci
- Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Ospedale Sant'Andrea, Rome, Italy; IRCCS, Neuromed, Pozzilli, IS, Italy
| | - Eleonora Arboscello
- Department of Emergency, IRCCS San Martino Policlinic Hospital, University of Genova, Italy
| | - Giorgio Ghigliotti
- Clinic of Cardiovascular Diseases, IRCCS San Martino Policlinic Hospital, University of Genova, Italy
| | - Giuseppina Novo
- Division of Cardiology, Department of Internal Medicine and Specialties, University of Palermo, Palermo, Italy
| | - Claudio Brunelli
- Clinic of Cardiovascular Diseases, IRCCS San Martino Policlinic Hospital, University of Genova, Italy
| | - Daniel Lenihan
- Cardiovascular Division, Cardio-Oncology Centre of Excellence, Washington University in St. Louis, St. Louis, MO, USA
| | - Massimo Volpe
- Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Ospedale Sant'Andrea, Rome, Italy; IRCCS, Neuromed, Pozzilli, IS, Italy
| | - Paolo Spallarossa
- Clinic of Cardiovascular Diseases, IRCCS San Martino Policlinic Hospital, University of Genova, Italy.
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27
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Guha A, Armanious M, Fradley MG. Update on cardio-oncology: Novel cancer therapeutics and associated cardiotoxicities. Trends Cardiovasc Med 2019; 29:29-39. [DOI: 10.1016/j.tcm.2018.06.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/22/2018] [Accepted: 06/03/2018] [Indexed: 02/08/2023]
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28
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Zulbaran-Rojas A, Lin HK, Shi Q, Williams LA, George B, Garcia-Manero G, Jabbour E, O'Brien S, Ravandi F, Wierda W, Estrov Z, Borthakur G, Kadia T, Cleeland C, Cortes JE, Kantarjian H. A prospective analysis of symptom burden for patients with chronic myeloid leukemia in chronic phase treated with frontline second- and third-generation tyrosine kinase inhibitors. Cancer Med 2018; 7:5457-5469. [PMID: 30318751 PMCID: PMC6246941 DOI: 10.1002/cam4.1808] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/28/2018] [Accepted: 09/10/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Treatment with tyrosine kinase inhibitors (TKIs) for patients with chronic myeloid leukemia (CML) is effective but needs to continue for several years, possibly indefinitely. Although generally safe, TKI may have hitherto poorly recognized effects in the quality of life (QoL) of such patients. METHODS We prospectively measured the symptom burden of patients with chronic phase CML enrolled on frontline TKI trials with dasatinib, nilotinib, or ponatinib. A total of 219 patients were enrolled and filled out the MD Anderson Symptom Inventory (MDASI)-CML questionnaire before the start of therapy and during follow-up at defined time points of 3, 6, 9, 12, 18, and 24 months. RESULTS The median age was 50 years. Longitudinal analysis showed relatively stable symptom severity scores over time. Fatigue was the most common symptom in all three cohorts, both prior to the start of therapy and during therapy, including after achievement of deep molecular remission. Work was the most affected component of daily living. Overall patients tolerated therapy well with improvement of their symptoms from baseline, with few dose reductions related to toxicity or symptomatology. Although 31% of the patients who completed MDASI-CML achieved complete molecular remission by 24 months of treatment, nearly 90% experienced persistent mild symptoms. CONCLUSION Side effects related to TKIs may impact the quality of life in patients with CML-CP. Further studies should investigate factors (comorbidities, concomitant medications, dose and schedule, etc) associated with these symptoms and interventions that may improve the patients' QoL, including treatment discontinuation when safely feasible.
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Affiliation(s)
| | - Huei-Kan Lin
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qiuling Shi
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Loretta A Williams
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Binsah George
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan O'Brien
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zeev Estrov
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tapan Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jorge E Cortes
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
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29
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Alsaad AMS. Dasatinib induces gene expression of CYP1A1, CYP1B1, and cardiac hypertrophy markers (BNP, β-MHC) in rat cardiomyocyte H9c2 cells. Toxicol Mech Methods 2018; 28:678-684. [DOI: 10.1080/15376516.2018.1497746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Abdulaziz M. S. Alsaad
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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30
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Kallus S, Englinger B, Senkiv J, Laemmerer A, Heffeter P, Berger W, Kowol CR, Keppler BK. Nanoformulations of anticancer FGFR inhibitors with improved therapeutic index. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2018; 14:2632-2643. [PMID: 30121385 DOI: 10.1016/j.nano.2018.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 06/25/2018] [Accepted: 08/08/2018] [Indexed: 01/09/2023]
Abstract
Fibroblast growth factor receptor (FGFR) inhibitors like ponatinib and nintedanib are clinically approved for defined cancer patient cohorts but often exert dose-limiting adverse effects. Hence, we encapsulated the FGFR inhibitors ponatinib, PD173074, and nintedanib into polylactic acid nanoparticles and liposomes to enable increased tumor accumulation/specificity and reduce side effects. Different methods of drug loading were tested and the resulting formulations compared regarding average size distribution as well as encapsulation efficiency. Appropriate encapsulation levels were achieved for liposomal preparations only. Nanoencapsulation resulted in significantly decelerated uptake kinetics in vitro with clearly decreased short-term (up to 72 h) cytotoxicity at higher concentrations. However, in long-term clonogenic assays liposomal formations were equally or even more active as compared to the free drugs. Accordingly, in an FGFR inhibitor-sensitive murine osteosarcoma transplantation model (K7M2), only liposomal but not free ponatinib resulted in significant tumor growth inhibition (by 60.4%) at markedly reduced side effects.
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Affiliation(s)
- Sebastian Kallus
- University of Vienna, Faculty of Chemistry, Institute of Inorganic Chemistry, Vienna, Austria
| | - Bernhard Englinger
- Institute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Julia Senkiv
- Institute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute of Cell Biology of National Academy of Sciences of Ukraine, Lviv, Ukraine
| | - Anna Laemmerer
- Institute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Petra Heffeter
- Institute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Research Cluster "Translational Cancer Therapy Research", Vienna, Austria
| | - Walter Berger
- Institute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Research Cluster "Translational Cancer Therapy Research", Vienna, Austria.
| | - Christian R Kowol
- University of Vienna, Faculty of Chemistry, Institute of Inorganic Chemistry, Vienna, Austria; Research Cluster "Translational Cancer Therapy Research", Vienna, Austria.
| | - Bernhard K Keppler
- University of Vienna, Faculty of Chemistry, Institute of Inorganic Chemistry, Vienna, Austria; Research Cluster "Translational Cancer Therapy Research", Vienna, Austria
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32
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Rhea IB, Oliveira GH. Cardiotoxicity of Novel Targeted Chemotherapeutic Agents. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:53. [DOI: 10.1007/s11936-018-0649-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Romero L, Cano J, Gomis-Tena J, Trenor B, Sanz F, Pastor M, Saiz J. In Silico QT and APD Prolongation Assay for Early Screening of Drug-Induced Proarrhythmic Risk. J Chem Inf Model 2018; 58:867-878. [PMID: 29547274 DOI: 10.1021/acs.jcim.7b00440] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Drug-induced proarrhythmicity is a major concern for regulators and pharmaceutical companies. For novel drug candidates, the standard assessment involves the evaluation of the potassium hERG channels block and the in vivo prolongation of the QT interval. However, this method is known to be too restrictive and to stop the development of potentially valuable therapeutic drugs. The aim of this work is to create an in silico tool for early detection of drug-induced proarrhythmic risk. The system is based on simulations of how different compounds affect the action potential duration (APD) of isolated endocardial, midmyocardial, and epicardial cells as well as the QT prolongation in a virtual tissue. Multiple channel-drug interactions and state-of-the-art human ventricular action potential models ( O'Hara , T. , PLos Comput. Biol. 2011 , 7 , e1002061 ) were used in our simulations. Specifically, 206.766 cellular and 7072 tissue simulations were performed by blocking the slow and the fast components of the delayed rectifier current ( IKs and IKr, respectively) and the L-type calcium current ( ICaL) at different levels. The performance of our system was validated by classifying the proarrhythmic risk of 84 compounds, 40 of which present torsadogenic properties. On the basis of these results, we propose the use of a new index (Tx) for discriminating torsadogenic compounds, defined as the ratio of the drug concentrations producing 10% prolongation of the cellular endocardial, midmyocardial, and epicardial APDs and the QT interval, over the maximum effective free therapeutic plasma concentration (EFTPC). Our results show that the Tx index outperforms standard methods for early identification of torsadogenic compounds. Indeed, for the analyzed compounds, the Tx tests accuracy was in the range of 87-88% compared with a 73% accuracy of the hERG IC50 based test.
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Affiliation(s)
- Lucia Romero
- Centro de Investigación e Innovación en Bioingeniería (CI2B) , Universitat Politècnica de València , camino de Vera, s/n , 46022 Valencia , Spain
| | - Jordi Cano
- Centro de Investigación e Innovación en Bioingeniería (CI2B) , Universitat Politècnica de València , camino de Vera, s/n , 46022 Valencia , Spain
| | - Julio Gomis-Tena
- Centro de Investigación e Innovación en Bioingeniería (CI2B) , Universitat Politècnica de València , camino de Vera, s/n , 46022 Valencia , Spain
| | - Beatriz Trenor
- Centro de Investigación e Innovación en Bioingeniería (CI2B) , Universitat Politècnica de València , camino de Vera, s/n , 46022 Valencia , Spain
| | - Ferran Sanz
- Research Programme on Biomedical Informatics (GRIB), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Department of Experimental and Health Sciences , Universitat Pompeu Fabra , Carrer del Dr. Aiguader 88 , 08002 Barcelona , Spain
| | - Manuel Pastor
- Research Programme on Biomedical Informatics (GRIB), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Department of Experimental and Health Sciences , Universitat Pompeu Fabra , Carrer del Dr. Aiguader 88 , 08002 Barcelona , Spain
| | - Javier Saiz
- Centro de Investigación e Innovación en Bioingeniería (CI2B) , Universitat Politècnica de València , camino de Vera, s/n , 46022 Valencia , Spain
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Jin YP, Valenzuela NM, Zhang X, Rozengurt E, Reed EF. HLA Class II-Triggered Signaling Cascades Cause Endothelial Cell Proliferation and Migration: Relevance to Antibody-Mediated Transplant Rejection. THE JOURNAL OF IMMUNOLOGY 2018; 200:2372-2390. [PMID: 29475988 DOI: 10.4049/jimmunol.1701259] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 01/16/2018] [Indexed: 12/13/2022]
Abstract
Transplant recipients developing donor-specific HLA class II (HLA-II) Abs are at higher risk for Ab-mediated rejection (AMR) and transplant vasculopathy. To understand how HLA-II Abs cause AMR and transplant vasculopathy, we determined the signaling events triggered in vascular endothelial cells (EC) following Ab ligation of HLA-II molecules. HLA-II expression in EC was induced by adenoviral vector expression of CIITA or by pretreatment with TNF-α/IFN-γ. Ab ligation of class II stimulated EC proliferation and migration. Class II Ab also induced activation of key signaling nodes Src, focal adhesion kinase, PI3K, and ERK that regulated downstream targets of the mammalian target of rapamycin (mTOR) pathway Akt, p70 ribosomal S6 kinase, and S6 ribosomal protein. Pharmacological inhibitors and small interfering RNA showed the protein kinases Src, focal adhesion kinase, PI3K/Akt, and MEK/ERK regulate class II Ab-stimulated cell proliferation and migration. Treatment with rapalogs for 2 h did not affect HLA-II Ab-induced phosphorylation of ERK; instead, mTOR complex (mTORC)1 targets were dependent on activation of ERK. Importantly, suppression of mTORC2 for 24 h with rapamycin or everolimus or treatment with mTOR active-site inhibitors enhanced HLA-II Ab-stimulated phosphorylation of ERK. Furthermore, knockdown of Rictor with small interfering RNA caused overactivation of ERK while abolishing phosphorylation of Akt Ser473 induced by class II Ab. These data are different from HLA class I Ab-induced activation of ERK, which is mTORC2-dependent. Our results identify a complex signaling network triggered by HLA-II Ab in EC and indicate that combined ERK and mTORC2 inhibitors may be required to achieve optimal efficacy in controlling HLA-II Ab-mediated AMR.
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Affiliation(s)
- Yi-Ping Jin
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA 90095; and
| | - Nicole M Valenzuela
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA 90095; and
| | - Xiaohai Zhang
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA 90095; and
| | - Enrique Rozengurt
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095
| | - Elaine F Reed
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA 90095; and
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Dong J, Chen H. Cardiotoxicity of Anticancer Therapeutics. Front Cardiovasc Med 2018; 5:9. [PMID: 29473044 PMCID: PMC5810267 DOI: 10.3389/fcvm.2018.00009] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/22/2018] [Indexed: 12/31/2022] Open
Abstract
As cancer therapeutics continues to improve and progress, the adverse side effects associated with anticancer treatments have also attracted more attention and have become extensively explored. Consequently, the importance of posttreatment follow-ups is becoming increasingly relevant to the discussion. Contemporary treatment methods, such as tyrosine kinase inhibitors, anthracycline chemotherapy, and immunotherapy regimens are effective in treating different modalities of cancers; however, these reagents act through interference with DNA replication or prevent DNA repair, causing endothelial dysfunction, generating reactive oxygen species, or eliciting non-specific immune responses. Therefore, cardiotoxic effects, such as hypertension, heart failure, and left ventricular dysfunction, arise posttreatment. Rising awareness of cardiovascular complications has led to meticulous attention for the evolution of treatment strategies and carefully monitoring between enhanced treatment effectiveness and minimization of adverse toxicity to the cardiovasculature, in which psychological assessments, early detection methods such as biomarkers, magnetic resonance imaging, and various drugs to reverse the damage from cardiotoxic events are more prevalent and their emphasis has increased tremendously. Fully understanding the mechanisms by which the risk factors action for various patients undergoing cancer treatment is also becoming more prevalent in preventing cardiotoxicity down the line.
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Affiliation(s)
- Jerry Dong
- Cardiovascular Biology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
- Case Western Reserve University, Cleveland, OH, United States
- Department of Surgery, Vascular Biology Program, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Hong Chen
- Cardiovascular Biology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
- Department of Surgery, Vascular Biology Program, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
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Yang Q, Wen L, Meng Z, Chen Y. Blockage of endoplasmic reticulum stress attenuates nilotinib-induced cardiotoxicity by inhibition of the Akt-GSK3β-Nox4 signaling. Eur J Pharmacol 2018; 822:85-94. [PMID: 29355557 DOI: 10.1016/j.ejphar.2018.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/08/2018] [Accepted: 01/15/2018] [Indexed: 12/21/2022]
Abstract
Cardiotoxicity is a critical side-effect of nilotinib during treatment for cancer, such as chronic myeloid leukemia, while the potential signaling mechanisms remain unclear. The role of and the relationship between endoplasmic reticulum (ER) stress and mitochondrial dysfunction was investigated in nilotinib-induced cardiac H9C2 injury as a suitable cell model. Our results showed that ER stress was persistently induced in nilotinib-treated cells, evidenced by increase of GRP78, CHOP, ATF4 and XBP1 as well as phospho-PERKThr980. The results from 4-phenylbutyrate (PBA, an ER stress inhibitor) and SC79 (a specific Akt activator) suggested that ER stress increased activity of glycogen synthase kinase-3 beta (GSK3β) that is reflected by decrease of phospho-GSK3βSer9, through downregulation of phospho-AktSer473, and that prolonged ER stress and activated GSK3β involved nilotinib-induced apoptosis. In addition, the data from JNK inhibition using SP600125 showed that over-activated JNK was responsible for Akt de-phosphorylation. Moreover, the abundance of NADPH oxidase (Nox4) was significantly increased following nilotinib treatment, which was prevented by SB216763 (a specific GSK3β inhibitor). Additionally, mitochondrial dysfunction was indicated by reduced mitochondrial membrane potential (MMP) level and increased reactive oxygen species level. In nilotinib-treated cells, knockdown of Nox4 preserved MMP level, abrogated reactive oxygen species production, and decreased apoptosis. Accordingly, our data demonstrated that inhibition of ER stress may protect cardiomyocytes against nilotinib toxicity potentially through inactivation of Akt-GSK3β-Nox4 signaling. These findings may provide an attractive therapeutic target for treatment of nilotinib-related cardiotoxicity.
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Affiliation(s)
- Qinghui Yang
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Liang Wen
- Department of Cardiology, Hanzhong Central Hospital, Hanzhong, China
| | - Zenghui Meng
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yanjun Chen
- Department of Cardiology, Peking University Shenzhen Hospital, Shenzhen, China.
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Zheng P, Li J, Kros JM. Breakthroughs in modern cancer therapy and elusive cardiotoxicity: Critical research-practice gaps, challenges, and insights. Med Res Rev 2018; 38:325-376. [PMID: 28862319 PMCID: PMC5763363 DOI: 10.1002/med.21463] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 07/14/2017] [Accepted: 07/15/2017] [Indexed: 12/16/2022]
Abstract
To date, five cancer treatment modalities have been defined. The three traditional modalities of cancer treatment are surgery, radiotherapy, and conventional chemotherapy, and the two modern modalities include molecularly targeted therapy (the fourth modality) and immunotherapy (the fifth modality). The cardiotoxicity associated with conventional chemotherapy and radiotherapy is well known. Similar adverse cardiac events are resurging with the fourth modality. Aside from the conventional and newer targeted agents, even the most newly developed, immune-based therapeutic modalities of anticancer treatment (the fifth modality), e.g., immune checkpoint inhibitors and chimeric antigen receptor (CAR) T-cell therapy, have unfortunately led to potentially lethal cardiotoxicity in patients. Cardiac complications represent unresolved and potentially life-threatening conditions in cancer survivors, while effective clinical management remains quite challenging. As a consequence, morbidity and mortality related to cardiac complications now threaten to offset some favorable benefits of modern cancer treatments in cancer-related survival, regardless of the oncologic prognosis. This review focuses on identifying critical research-practice gaps, addressing real-world challenges and pinpointing real-time insights in general terms under the context of clinical cardiotoxicity induced by the fourth and fifth modalities of cancer treatment. The information ranges from basic science to clinical management in the field of cardio-oncology and crosses the interface between oncology and onco-pharmacology. The complexity of the ongoing clinical problem is addressed at different levels. A better understanding of these research-practice gaps may advance research initiatives on the development of mechanism-based diagnoses and treatments for the effective clinical management of cardiotoxicity.
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Affiliation(s)
- Ping‐Pin Zheng
- Cardio‐Oncology Research GroupErasmus Medical CenterRotterdamthe Netherlands
- Department of PathologyErasmus Medical CenterRotterdamthe Netherlands
| | - Jin Li
- Department of OncologyShanghai East Hospital, Tongji University School of MedicineShanghaiChina
| | - Johan M Kros
- Department of PathologyErasmus Medical CenterRotterdamthe Netherlands
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Haguet H, Douxfils J, Chatelain C, Graux C, Mullier F, Dogné JM. BCR-ABL Tyrosine Kinase Inhibitors: Which Mechanism(s) May Explain the Risk of Thrombosis? TH OPEN 2018; 2:e68-e88. [PMID: 31249931 PMCID: PMC6524858 DOI: 10.1055/s-0038-1624566] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/27/2017] [Indexed: 12/12/2022] Open
Abstract
Imatinib, the first-in-class BCR-ABL tyrosine kinase inhibitor (TKI), had been a revolution for the treatment of chronic myeloid leukemia (CML) and had greatly enhanced patient survival. Second- (dasatinib, nilotinib, and bosutinib) and third-generation (ponatinib) TKIs have been developed to be effective against BCR-ABL mutations making imatinib less effective. However, these treatments have been associated with arterial occlusive events. This review gathers clinical data and experiments about the pathophysiology of these arterial occlusive events with BCR-ABL TKIs. Imatinib is associated with very low rates of thrombosis, suggesting a potentially protecting cardiovascular effect of this treatment in patients with BCR-ABL CML. This protective effect might be mediated by decreased platelet secretion and activation, decreased leukocyte recruitment, and anti-inflammatory or antifibrotic effects. Clinical data have guided mechanistic studies toward alteration of platelet functions and atherosclerosis development, which might be secondary to metabolism impairment. Dasatinib, nilotinib, and ponatinib affect endothelial cells and might induce atherogenesis through increased vascular permeability. Nilotinib also impairs platelet functions and induces hyperglycemia and dyslipidemia that might contribute to atherosclerosis development. Description of the pathophysiology of arterial thrombotic events is necessary to implement risk minimization strategies.
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Affiliation(s)
- Hélène Haguet
- University of Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), Department of Pharmacy, Namur, Belgium
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory, Yvoir, Belgium
| | - Jonathan Douxfils
- University of Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), Department of Pharmacy, Namur, Belgium
- QUALIblood s.a., Namur, Belgium
| | - Christian Chatelain
- University of Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), Department of Pharmacy, Namur, Belgium
| | - Carlos Graux
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Department of Hematology, Yvoir, Belgium
| | - François Mullier
- Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory, Yvoir, Belgium
| | - Jean-Michel Dogné
- University of Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), Department of Pharmacy, Namur, Belgium
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