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Wang L, Du L, Xiong X, Lin Y, Zhu J, Yao Z, Wang S, Guo Y, Chen Y, Geary K, Pan Y, Zhou F, Gao S, Zhang D, Yeung SCJ, Zhang H. Repurposing dextromethorphan and metformin for treating nicotine-induced cancer by directly targeting CHRNA7 to inhibit JAK2/STAT3/SOX2 signaling. Oncogene 2021; 40:1974-1987. [PMID: 33603170 PMCID: PMC7979537 DOI: 10.1038/s41388-021-01682-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 02/05/2023]
Abstract
Smoking is one of the most impactful lifestyle-related risk factors in many cancer types including esophageal squamous cell carcinoma (ESCC). As the major component of tobacco and e-cigarettes, nicotine is not only responsible for addiction to smoking but also a carcinogen. Here we report that nicotine enhances ESCC cancer malignancy and tumor-initiating capacity by interacting with cholinergic receptor nicotinic alpha 7 subunit (CHRNA7) and subsequently activating the JAK2/STAT3 signaling pathway. We found that aberrant CHRNA7 expression can serve as an independent prognostic factor for ESCC patients. In multiple ESCC mouse models, dextromethorphan and metformin synergistically repressed nicotine-enhanced cancer-initiating cells (CIC) properties and inhibited ESCC progression. Mechanistically, dextromethorphan non-competitively inhibited nicotine binding to CHRNA7 while metformin downregulated CHRNA7 expression by antagonizing nicotine-induced promoter DNA hypomethylation of CHRNA7. Since dextromethorphan and metformin are two safe FDA-approved drugs with minimal undesirable side-effects, the combination of these drugs has a high potential as either a preventive and/or a therapeutic strategy against nicotine-promoted ESCC and perhaps other nicotine-sensitive cancer types as well.
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Affiliation(s)
- Lu Wang
- Department of General Surgery, The First Affiliated Hospital of Jinan University, and Institute of Precision Cancer Medicine and Pathology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Liang Du
- Department of General Surgery, The First Affiliated Hospital of Jinan University, and Institute of Precision Cancer Medicine and Pathology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
- Department of Biomedical Sciences of Cells & Systems, Section Molecular Cell Biology and Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Xiao Xiong
- Department of General Surgery, The First Affiliated Hospital of Jinan University, and Institute of Precision Cancer Medicine and Pathology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Yusheng Lin
- Department of General Surgery, The First Affiliated Hospital of Jinan University, and Institute of Precision Cancer Medicine and Pathology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jianlin Zhu
- Department of General Surgery, The First Affiliated Hospital of Jinan University, and Institute of Precision Cancer Medicine and Pathology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Zhimeng Yao
- Department of General Surgery, The First Affiliated Hospital of Jinan University, and Institute of Precision Cancer Medicine and Pathology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Shuhong Wang
- Department of General Surgery, The First Affiliated Hospital of Jinan University, and Institute of Precision Cancer Medicine and Pathology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Yi Guo
- Endoscopy Center, Affiliated Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yuping Chen
- Department of Thoracic Surgery, Affiliated Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Kyla Geary
- Department of Bio-Medical Sciences, Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA, 19131, USA
| | - Yunlong Pan
- Department of General Surgery, The First Affiliated Hospital of Jinan University, and Institute of Precision Cancer Medicine and Pathology, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Fuyou Zhou
- The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang, 455001, Henan, China
- Department of Thoracic Surgery, Anyang Tumor Hospital, Anyang, 455001, Henan, China
| | - Shegan Gao
- College of Clinical Medicine, The First Affiliated Hospital of Henan University of Science and Technology, Henan Key Laboratory of Cancer Epigenetics, Luoyang, 471003, China
| | - Dianzheng Zhang
- Department of Bio-Medical Sciences, Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA, 19131, USA
| | - Sai-Ching Jim Yeung
- Department of Emergency Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hao Zhang
- Department of General Surgery, The First Affiliated Hospital of Jinan University, and Institute of Precision Cancer Medicine and Pathology, School of Medicine, Jinan University, Guangzhou, Guangdong, China.
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Quintão NLM, Santin JR, Stoeberl LC, Corrêa TP, Melato J, Costa R. Pharmacological Treatment of Chemotherapy-Induced Neuropathic Pain: PPARγ Agonists as a Promising Tool. Front Neurosci 2019; 13:907. [PMID: 31555078 PMCID: PMC6722212 DOI: 10.3389/fnins.2019.00907] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/14/2019] [Indexed: 12/24/2022] Open
Abstract
Chemotherapy-induced neuropathic pain (CINP) is one of the most severe side effects of anticancer agents, such as platinum- and taxanes-derived drugs (oxaliplatin, cisplatin, carboplatin and paclitaxel). CINP may even be a factor of interruption of treatment and consequently increasing the risk of death. Besides that, it is important to take into consideration that the incidence of cancer is increasing worldwide, including colorectal, gastric, lung, cervical, ovary and breast cancers, all treated with the aforementioned drugs, justifying the concern of the medical community about the patient’s quality of life. Several physiopathological mechanisms have already been described for CINP, such as changes in axonal transport, mitochondrial damage, increased ion channel activity and inflammation in the central nervous system (CNS). Another less frequent event that may occur after chemotherapy, particularly under oxaliplatin treatment, is the central neurotoxicity leading to disorders such as mental confusion, catatonia, hyporeflexia, etc. To date, no pharmacological therapy has shown satisfactory effect in these cases. In this scenario, duloxetine is the only drug currently in clinical use. Peroxisome proliferator-activated receptors (PPARs) belong to the class of nuclear receptors and are present in several tissues, mainly participating in lipid and glucose metabolism and inflammatory response. There are three PPAR isoforms: α, β/δ and γ. PPARγ, the protagonist of this review, is expressed in adipose tissue, large intestine, spleen and neutrophils. This subtype also plays important role in energy balance, lipid biosynthesis and adipogenesis. The effects of PPARγ agonists, known for their positive activity on type II diabetes mellitus, have been explored and present promising effects in the control of neuropathic pain, including CINP, and also cancer. This review focuses largely on the mechanisms involved in chemotherapy-induced neuropathy and the effects of the activation of PPARγ to treat CINP. It is the aim of this review to help understanding and developing novel CINP therapeutic strategies integrating PPARγ signalling.
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Affiliation(s)
| | | | | | | | - Jéssica Melato
- School of Heath Science, Universidade do Vale do Itajaí, Itajaí, Brazil
| | - Robson Costa
- School of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Wolfson Centre for Age-Related Diseases, King's College London, London, United Kingdom
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Martin E, Narjoz C, Decleves X, Labat L, Lambert C, Loriot MA, Ducheix G, Dualé C, Pereira B, Pickering G. Dextromethorphan Analgesia in a Human Experimental Model of Hyperalgesia. Anesthesiology 2019; 131:356-368. [DOI: 10.1097/aln.0000000000002736] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Background
Central pain sensitization is often refractory to drug treatment. Dextromethorphan, an N-methyl-d-aspartate receptor antagonist, is antihyperalgesic in preclinical pain models. The hypothesis is that dextromethorphan is also antihyperalgesic in humans.
Methods
This randomized, double-blind, placebo-controlled, crossover study explores the antihyperalgesic effect of single and repeated 30-mg dose of oral dextromethorphan in 20 volunteers, using the freeze-injury pain model. This model leads to development of primary and secondary hyperalgesia, which develops away from the site of injury and is associated with central sensitization and activation of N-methyl-d-aspartate receptor in the spinal cord. The primary outcome was antihyperalgesia calculated with the area under the curve of the percentage change in mechanical pain threshold (electronic von Frey) on the area of secondary hyperalgesia. The secondary outcomes were mechanical pain threshold on the area of primary hyperalgesia and cognitive (reaction time) effect.
Results
Single 30-mg results are reported. Antihyperalgesia (% · min) is significantly higher on the area of secondary hyperalgesia with dextromethorphan than placebo (median [interquartile range]: 3,029 [746; 6,195] vs. 710 [–3,248; 4,439], P = 0.009, Hedge’s g = 0.8, 95% CI [0.1; 1.4]). On primary hyperalgesia area, mechanical pain threshold 2 h after drug intake is significantly higher with dextromethorphan (P = 0.011, Hedge’s g = 0.63, 95% CI [0.01; 1.25]). No difference in antinociception is observed after thermal painful stimuli on healthy skin between groups. Reaction time (ms) is shorter with placebo than with dextromethorphan (median [interquartile range]: 21.6 [–37.4; 0.1] vs. –1.2 [–24.3; 15.4], P = 0.015, Hedge’s g = 0.75, 95% CI [0.12; 1.39]). Nonserious adverse events occurrence (15%, 3 of 20 volunteers) was similar in both groups.
Conclusions
This study shows that low-dose (30-mg) dextromethorphan is antihyperalgesic in humans on the areas of primary and secondary hyperalgesia and reverses peripheral and central neuronal sensitization. Because dextromethorphan had no intrinsic antinociceptive effect in acute pain on healthy skin, N-methyl-d-aspartate receptor may need to be sensitized by pain for dextromethorphan to be effective.
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Affiliation(s)
- E. Martin
- From University Clermont Auvergne, Department of Fundamental and Clinical Pharmacology of Pain, NeuroDol, F-63000 Clermont-Ferrand, France (E.M., C.D., G.P.); Inserm UMR-S1147, Saints-Pères University Centre, Paris, France (C.N., M.-A.L.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (C.N., M.-A.L.); Assistance Publique—Paris Hospital (AP-HP), Georges Pompidou European Hospital,
| | - C. Narjoz
- From University Clermont Auvergne, Department of Fundamental and Clinical Pharmacology of Pain, NeuroDol, F-63000 Clermont-Ferrand, France (E.M., C.D., G.P.); Inserm UMR-S1147, Saints-Pères University Centre, Paris, France (C.N., M.-A.L.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (C.N., M.-A.L.); Assistance Publique—Paris Hospital (AP-HP), Georges Pompidou European Hospital,
| | - X. Decleves
- From University Clermont Auvergne, Department of Fundamental and Clinical Pharmacology of Pain, NeuroDol, F-63000 Clermont-Ferrand, France (E.M., C.D., G.P.); Inserm UMR-S1147, Saints-Pères University Centre, Paris, France (C.N., M.-A.L.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (C.N., M.-A.L.); Assistance Publique—Paris Hospital (AP-HP), Georges Pompidou European Hospital,
| | - L. Labat
- From University Clermont Auvergne, Department of Fundamental and Clinical Pharmacology of Pain, NeuroDol, F-63000 Clermont-Ferrand, France (E.M., C.D., G.P.); Inserm UMR-S1147, Saints-Pères University Centre, Paris, France (C.N., M.-A.L.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (C.N., M.-A.L.); Assistance Publique—Paris Hospital (AP-HP), Georges Pompidou European Hospital,
| | - C. Lambert
- From University Clermont Auvergne, Department of Fundamental and Clinical Pharmacology of Pain, NeuroDol, F-63000 Clermont-Ferrand, France (E.M., C.D., G.P.); Inserm UMR-S1147, Saints-Pères University Centre, Paris, France (C.N., M.-A.L.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (C.N., M.-A.L.); Assistance Publique—Paris Hospital (AP-HP), Georges Pompidou European Hospital,
| | - M.-A. Loriot
- From University Clermont Auvergne, Department of Fundamental and Clinical Pharmacology of Pain, NeuroDol, F-63000 Clermont-Ferrand, France (E.M., C.D., G.P.); Inserm UMR-S1147, Saints-Pères University Centre, Paris, France (C.N., M.-A.L.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (C.N., M.-A.L.); Assistance Publique—Paris Hospital (AP-HP), Georges Pompidou European Hospital,
| | - G. Ducheix
- From University Clermont Auvergne, Department of Fundamental and Clinical Pharmacology of Pain, NeuroDol, F-63000 Clermont-Ferrand, France (E.M., C.D., G.P.); Inserm UMR-S1147, Saints-Pères University Centre, Paris, France (C.N., M.-A.L.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (C.N., M.-A.L.); Assistance Publique—Paris Hospital (AP-HP), Georges Pompidou European Hospital,
| | - C. Dualé
- From University Clermont Auvergne, Department of Fundamental and Clinical Pharmacology of Pain, NeuroDol, F-63000 Clermont-Ferrand, France (E.M., C.D., G.P.); Inserm UMR-S1147, Saints-Pères University Centre, Paris, France (C.N., M.-A.L.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (C.N., M.-A.L.); Assistance Publique—Paris Hospital (AP-HP), Georges Pompidou European Hospital,
| | - B. Pereira
- From University Clermont Auvergne, Department of Fundamental and Clinical Pharmacology of Pain, NeuroDol, F-63000 Clermont-Ferrand, France (E.M., C.D., G.P.); Inserm UMR-S1147, Saints-Pères University Centre, Paris, France (C.N., M.-A.L.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (C.N., M.-A.L.); Assistance Publique—Paris Hospital (AP-HP), Georges Pompidou European Hospital,
| | - G. Pickering
- From University Clermont Auvergne, Department of Fundamental and Clinical Pharmacology of Pain, NeuroDol, F-63000 Clermont-Ferrand, France (E.M., C.D., G.P.); Inserm UMR-S1147, Saints-Pères University Centre, Paris, France (C.N., M.-A.L.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (C.N., M.-A.L.); Assistance Publique—Paris Hospital (AP-HP), Georges Pompidou European Hospital,
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Nguyen L, Thomas KL, Lucke-Wold BP, Cavendish JZ, Crowe MS, Matsumoto RR. Dextromethorphan: An update on its utility for neurological and neuropsychiatric disorders. Pharmacol Ther 2016; 159:1-22. [PMID: 26826604 DOI: 10.1016/j.pharmthera.2016.01.016] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Dextromethorphan (DM) is a commonly used antitussive and is currently the only FDA-approved pharmaceutical treatment for pseudobulbar affect. Its safety profile and diverse pharmacologic actions in the central nervous system have stimulated new interest for repurposing it. Numerous preclinical investigations and many open-label or blinded clinical studies have demonstrated its beneficial effects across a variety of neurological and psychiatric disorders. However, the optimal dose and safety of chronic dosing are not fully known. This review summarizes the preclinical and clinical effects of DM and its putative mechanisms of action, focusing on depression, stroke, traumatic brain injury, seizure, pain, methotrexate neurotoxicity, Parkinson's disease and autism. Moreover, we offer suggestions for future research with DM to advance the treatment for these and other neurological and psychiatric disorders.
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Affiliation(s)
- Linda Nguyen
- Department of Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA
| | - Kelan L Thomas
- College of Pharmacy, Touro University California, Vallejo, CA 94592, USA
| | - Brandon P Lucke-Wold
- Graduate Program in Neuroscience, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - John Z Cavendish
- Graduate Program in Neuroscience, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Molly S Crowe
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
| | - Rae R Matsumoto
- Department of Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, WV 26506, USA; College of Pharmacy, Touro University California, Vallejo, CA 94592, USA.
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