1
|
Hoffman E, Urbano L, Martin A, Mahendran R, Patel A, Murnane D, Page C, Dailey LA, Forbes B, Hutter V. Profiling alveolar macrophage responses to inhaled compounds using in vitro high content image analysis. Toxicol Appl Pharmacol 2023; 474:116608. [PMID: 37385476 DOI: 10.1016/j.taap.2023.116608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023]
Abstract
One of the main hurdles in the development of new inhaled medicines is the frequent observation of foamy macrophage (FM) responses in non-clinical studies in experimental animals, which raises safety concerns and hinders progress into clinical trials. We have investigated the potential of a novel multi-parameter high content image analysis (HCIA) assay as an in vitro safety screening tool to predict drug induced FM. Rat (NR8383) and human U937-derived alveolar macrophages were exposed in vitro to a panel of model compounds with different biological activity, including inhaled bronchodilators, inhaled corticosteroids (ICS), phospholipidosis inducers and proapoptotic agents. An HCIA was utilized to produce drug-induced cell response profiles based on individual cell health, morphology and lipid content parameters. The profiles of both rat and human macrophage cell lines differentiated between cell responses to marketed inhaled drugs and compounds known to induce phospholipidosis and apoptosis. Hierarchical clustering of the aggregated data allowed identification of distinct cell profiles in response to exposure to phospholipidosis and apoptosis inducers. Additionally, in NR8383 cell responses formed two distinct clusters, associated with increased vacuolation with or without lipid accumulation. U937 cells presented a similar trend but appeared less sensitive to drug exposure and presented a narrower range of responses. These results indicate that our multi-parameter HCIA assay is suitable to generate characteristic drug-induced macrophage response profiles, thus enabling differentiation of foamy macrophage phenotypes associated with phospholipidosis and apoptosis. This approach shows great potential as pre-clinical in vitro screening tool for safety assessment of candidate inhaled medicines.
Collapse
Affiliation(s)
- Ewelina Hoffman
- Centre for Topical Drug Delivery and Toxicology, School of Life and medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Laura Urbano
- Centre for Topical Drug Delivery and Toxicology, School of Life and medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Abigail Martin
- Centre for Topical Drug Delivery and Toxicology, School of Life and medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Rhamiya Mahendran
- Centre for Topical Drug Delivery and Toxicology, School of Life and medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Aateka Patel
- Centre for Topical Drug Delivery and Toxicology, School of Life and medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; Sackler Institute of Pulmonary Pharmacology, Faculty of Life Sciences & Medicine, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK
| | - Darragh Murnane
- Centre for Topical Drug Delivery and Toxicology, School of Life and medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK.
| | - Clive Page
- Sackler Institute of Pulmonary Pharmacology, Faculty of Life Sciences & Medicine, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK
| | - Lea Ann Dailey
- Division of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, UZA II, Josef-Holaubek-Platz 2, 1090 Wien, Austria
| | - Ben Forbes
- King's College London, Institute of Pharmaceutical Science, London SE1 9NH, UK
| | - Victoria Hutter
- Centre for Topical Drug Delivery and Toxicology, School of Life and medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK.
| |
Collapse
|
2
|
Li L, Mok H, Jhaveri P, Bonnen MD, Sikora AG, Eissa NT, Komaki RU, Ghebre YT. Anticancer therapy and lung injury: molecular mechanisms. Expert Rev Anticancer Ther 2018; 18:1041-1057. [PMID: 29996062 PMCID: PMC6290681 DOI: 10.1080/14737140.2018.1500180] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Chemotherapy and radiation therapy are two mainstream strategies applied in the treatment of cancer that is not operable. Patients with hematological or solid tumor malignancies substantially benefit from chemotherapeutic drugs and/or ionizing radiation delivered to the site of malignancy. However, considerable adverse effects, including lung inflammation and fibrosis, are associated with the use of these treatment modalities. Areas covered: As we move toward the era of precision health, we are compelled to understand the molecular basis of chemoradiation-induced pathological lung remodeling and to develop effective treatment strategies that mitigate the development of chronic lung disease (i.e. fibrosis) in cancer patients. The review discusses chemotherapeutic agents that are reported to induce or associate with acute and/or chronic lung injury. Expert commentary: There is a need to molecularly understand how chemotherapeutic drugs induce or associate with respiratory toxicities and whether such characteristics are inherently related to their antitumor effect or are collateral. Once such mechanisms have been identified and/or fully characterized, they may be able to guide disease-management decisions including effective intervention strategies for the adverse effects. In the meantime, radiation oncologists should be judicious on the dose of radiation delivered to the lungs, the volume of lung irradiated, and concurrent use of chemotherapeutic drugs.
Collapse
Affiliation(s)
- Li Li
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
- Departmet of Endocrinology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Henry Mok
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Pavan Jhaveri
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Mark D Bonnen
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew G Sikora
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - N. Tony Eissa
- Department of Medicine, Section on Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ritsuko U Komaki
- University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Yohannes T Ghebre
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine, Section on Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
3
|
Thota R, Shah C, Richardson T, Koury M. Dysfunctional neobladder causing pulmonary toxicity after combination chemotherapy for lymphoma. Am J Hematol 2015; 90:468-9. [PMID: 25644861 DOI: 10.1002/ajh.23951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/15/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Ramya Thota
- Division of Hematology-Oncology; Vanderbilt University School of Medicine; Nashville Tennessee
| | - Chirayu Shah
- Department of Radiology; Vanderbilt University Medical Center; Nashville Tennessee
| | - Travis Richardson
- Division of Cardiovascular Medicine; Vanderbilt University Medical Center; Nashville Tennessee
| | - Mark Koury
- Division of Hematology-Oncology; Vanderbilt University School of Medicine; Nashville Tennessee
| |
Collapse
|
4
|
Kelsey CR, Vujaskovic Z, Jackson IL, Riedel RF, Marks LB. Lung. ALERT • ADVERSE LATE EFFECTS OF CANCER TREATMENT 2014. [PMCID: PMC7121399 DOI: 10.1007/978-3-540-75863-1_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The lungs are particularly sensitive to RT, and are often the primary dose-limiting structure during thoracic therapy. The alveolar/capillary units and pneumocytes within the alveoli appear to be particularly sensitive to RT. Hypoxia may be important in the underlying physiology of RT-associated lung injury. The cytokine transforming growth factor-beta (TGF-β), plays an important role in the development of RT-induced fibrosis. The histopathological changes observed in the lung after RT are broadly characterized as diffuse alveolar damage. The interaction between pre-treatment PFTs and the risk of symptomatic lung injury is complex. Similarly, the link between changes in PFTs and the development of symptoms is uncertain. The incidence of symptomatic lung injury increases with increase in most dosimetric parameters. The mean lung dose (MLD) and V20 have been the most-often considered parameters. MLD might be a preferable metric since it considers the entire 3D dose distribution. Radiation to the lower lobes appears to be more often associated with clinical symptoms than is radiation to the upper lobes. This might be related to incidental cardiac irradiation. In pre-clinical models, there appears to be a complex interaction between lung and heart irradiation. TGF-β has been suggested in several studies to predict for RT-induced lung injury, but the data are still somewhat inconsistent. Oral prednisone (Salinas and Winterbauer 1995), typically 40–60 mg daily for 1–2 weeks with a slow taper, is usually effective in treating pneumonitis. There are no widely accepted treatments for fibrosis. A number of chemotherapeutic agents have been suggested to be associated with a range of pulmonary toxicities.
Collapse
|
5
|
Watanabe A, Higami T, Ohori S, Koyanagi T, Nakashima S, Mawatari T. Is lung cancer resection indicated in patients with idiopathic pulmonary fibrosis? J Thorac Cardiovasc Surg 2008; 136:1357-63, 1363.e1-2. [DOI: 10.1016/j.jtcvs.2008.07.016] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2007] [Revised: 05/16/2008] [Accepted: 07/05/2008] [Indexed: 11/26/2022]
|
6
|
Vahid B, Marik PE. Pulmonary complications of novel antineoplastic agents for solid tumors. Chest 2008; 133:528-38. [PMID: 18252919 DOI: 10.1378/chest.07-0851] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Antineoplastic agent-induced pulmonary toxicity is an important cause of respiratory failure. Although the incidence of antineoplastic agent-induced pulmonary toxicity seems to be low, more cases can be expected, with increasing numbers of patients receiving the new generations of antineoplastic agents. Antineoplastic agents have previously been associated with bronchospasm, hypersensitivity reactions, venous thromboembolism, and pulmonary hemorrhage. Physicians should be aware of the clinical and radiographic presentations of the pulmonary toxicities associated with the newer antineoplastic agents. The approach to diagnosis, risk factors, and possible mechanisms of antineoplastic agent-induced pulmonary toxicity are discussed in this article.
Collapse
Affiliation(s)
- Bobbak Vahid
- Department of Pulmonary and Critical Care Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | | |
Collapse
|
7
|
Post MC, Grutters JC, Verzijlbergen JF, Biesma DH. PET Scintigraphy of Etoposide-Induced Pulmonary Toxicity. Clin Nucl Med 2007; 32:683-4. [PMID: 17710018 DOI: 10.1097/rlu.0b013e318123f78d] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A patient with chronic myelomonocytic leukemia developed drug-induced pulmonary toxicity after using low dose oral etoposide. Because etoposide-induced pulmonary toxicity is an uncommon but serious adverse event, clinicians must be vigilant about the possibility of it, so that the optimal treatment can start as soon as possible. This report demonstrates that PET scintigraphy might be a helpful tool in the early diagnosis of drug-induced pulmonary toxicity.
Collapse
Affiliation(s)
- Martijn C Post
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | | |
Collapse
|
8
|
|
9
|
Abstract
PURPOSE To describe thin-section computed tomographic (CT) findings in patients with drug-induced pneumonitis, to compare these CT findings, and to correlate them with arterial oxygen tension level. MATERIALS AND METHODS Thin-section CT scans obtained in 60 patients with drug-induced pneumonitis were evaluated retrospectively. The patients had 31 cases of antineoplastic agent-induced pneumonitis and 29 cases of nonneoplastic agent-induced pneumonitis (antibiotic agent, 20 cases; herbal medicine [sho-saiko-to], four cases; antirheumatic agent, three cases; phenytoin, one case; disodium cromoglycate, one case). CT scans were reviewed by two chest radiologists in consensus. Correlation between arterial oxygen tension level and the extent of disease at CT was available in 21 patients. These two factors were compared by using the Spearman rank correlation coefficient. RESULTS The predominant findings in antineoplastic agent-induced pneumonitis were diffuse or multifocal ground-glass opacities with intralobular interstitial thickening. The predominant CT findings in antibiotic agent-induced pneumonitis were patchy ground-glass opacities with centrilobular opacities and interlobular septal lines. The predominant CT findings in herbal medicine-induced pneumonitis were diffuse ground-glass opacities with patchy consolidation. Interlobular septal lines and centrilobular opacities were observed more frequently in antibiotic agent-induced pneumonitis, and intralobular interstitial thickening was observed more frequently in antineoplastic agent-induced pneumonitis. A significant correlation was established between arterial oxygen tension level and extent of disease at CT (r = -0.84, P <.05). CONCLUSION In addition to ground-glass opacities and interlobular septal lines, the most common thin-section CT findings were intralobular interstitial thickening, observed in antineoplastic agent-induced pneumonitis, and centrilobular opacities, observed in antibiotic-induced pneumonitis.
Collapse
Affiliation(s)
- Masanori Akira
- Department of Radiology, National Kinki Chuo Hospital for Chest Disease, 1180 Nagasone-cho, Sakai City, Osaka 591-8555, Japan.
| | | | | |
Collapse
|
10
|
Cutillas JR, Rodríguez EG, Viñals NB. Chemotherapy-induced pulmonary toxicity in lung cancer management. REVISTA DE ONCOLOGÍA 2001. [PMCID: PMC7149244 DOI: 10.1007/bf02712689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Chemotherapy is the cornerstone of therapy in many stages of lung cancer. Many diagnostic options have to be taken into account when a patient suffering from lung cancer presents with nonspecific, respiratory, clinical manifestations. A multidisciplinary diagnostic approach is then warranted. The top priority is to rule out those life-threatening causes, such as lung infection, that could be properly treated if a right diagnosis is early. To reach a definite diagnosis frequently requires that one or more diagnostic, pneumologic techniques are performed. Regarding to drug-induced pulmonary disease, prevention is mandatory. In this review we have tried to highlight the risk and characteristics of cytostatic-induced pulmonary toxicity caused by those agents that have been commonly employed to treat lung cancer for the last decades. When treating lung cancer patients, a high clinical suspicion of chemotherapy-induced lung toxicity should be kept in mind since an early withdrawal of the offending drug is the most efficacious therapy.
Collapse
|
11
|
Blanke C, DeVore R, Shyr Y, Epstein B, Murray M, Hande K, Stewart S, Johnson D. A pilot study of protracted low dose cisplatin and etoposide with concurrent thoracic radiotherapy in unresectable stage III nonsmall cell lung cancer. Int J Radiat Oncol Biol Phys 1997; 37:111-6. [PMID: 9054884 DOI: 10.1016/s0360-3016(96)00478-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE A Phase II study to evaluate the response rate and toxicity of daily protracted cisplatin and etoposide with concurrent chest irradiation in patients with locally advanced, unresectable nonsmall cell lung cancer (NSCLC). METHODS AND MATERIALS Twenty-one patients with histologically confirmed locally advanced inoperable NSCLC (Stage IIIA or IIIB) were entered on study. Radiotherapy consisted of 50.4 Gy in 1.8 Gy fractions followed by a 10 Gy boost in 2 Gy fractions. Chemotherapy included the following: Cisplatin was given at 5 mg/m2 i.v. Monday-Friday before RT weeks 1-6. Etoposide was given at 25 mg/m2 i.v. M-F weeks 1, 2, 5, and 6, with 50 mg/m2 p.o. daily on the same weekends. Because of severe myelosuppression in the first two patients, etoposide only was subsequently changed to 20 mg/m2 i.v. M-F weeks 1, 2, 5, and 6. RESULTS Twenty patients were eligible and evaluable. The overall response rate was 65% (95% confidence interval 41-85%). The median progression-free survival was 43 weeks. The median overall survival was 50.2 weeks with a 1-year survival rate of 45%. Five patients (25%) developed severe radiation pneumonitis, leading to early closure of the study. CONCLUSIONS Combining daily protracted cisplatin and etoposide with concurrent thoracic irradiation in patients with locally advanced unresectable NSCLC yields a high overall response rate and a median survival that is at least comparable to other combined modality trials. However, future studies using protracted radiosensitizing chemotherapy should be approached cautiously in light of the high incidence of severe radiation pneumonitis encountered in this trial.
Collapse
Affiliation(s)
- C Blanke
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | | | | | | | | |
Collapse
|