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Qiao L, Zhang J, Jiang Y, Ma B, Chen H, Gao P, Zhang P, Wang A, Sheldon RA. Near-infrared light-driven asymmetric photolytic reduction of ketone using inorganic-enzyme hybrid biocatalyst. Int J Biol Macromol 2024; 264:130612. [PMID: 38447845 DOI: 10.1016/j.ijbiomac.2024.130612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/18/2024] [Accepted: 03/02/2024] [Indexed: 03/08/2024]
Abstract
Effective photolytic regeneration of the NAD(P)H cofactor in enzymatic reductions is an important and elusive goal in biocatalysis. It can, in principle, be achieved using a near-infrared light (NIR) driven artificial photosynthesis system employing H2O as the sacrificial reductant. To this end we utilized TiO2/reduced graphene quantum dots (r-GQDs), combined with a novel rhodium electron mediator, to continuously supply NADPH in situ for aldo-keto reductase (AKR) mediated asymmetric reductions under NIR irradiation. This upconversion system, in which the Ti-O-C bonds formed between r-GQDs and TiO2 enabled efficient interfacial charge transfer, was able to regenerate NADPH efficiently in 64 % yield in 105 min. Based on this, the pharmaceutical intermediate (R)-1-(3,5-bis(trifluoromethyl)phenyl)ethan-1-ol was obtained, in 84 % yield and 99.98 % ee, by reduction of the corresponding ketone. The photo-enzymatic system is recyclable with a polymeric electron mediator, which maintained 66 % of its original catalytic efficiency and excellent enantioselectivity (99.9 % ee) after 6 cycles.
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Affiliation(s)
- Li Qiao
- Key Laboratory of Organosilicon Chemistry and Materials Technology, Ministry of Education, College of Materials Chemistry and Chemical Engineering, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Jing Zhang
- Key Laboratory of Organosilicon Chemistry and Materials Technology, Ministry of Education, College of Materials Chemistry and Chemical Engineering, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Yongjian Jiang
- Key Laboratory of Organosilicon Chemistry and Materials Technology, Ministry of Education, College of Materials Chemistry and Chemical Engineering, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Bianqin Ma
- Key Laboratory of Organosilicon Chemistry and Materials Technology, Ministry of Education, College of Materials Chemistry and Chemical Engineering, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Haomin Chen
- Key Laboratory of Organosilicon Chemistry and Materials Technology, Ministry of Education, College of Materials Chemistry and Chemical Engineering, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Peng Gao
- Key Laboratory of Organosilicon Chemistry and Materials Technology, Ministry of Education, College of Materials Chemistry and Chemical Engineering, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Pengfei Zhang
- Key Laboratory of Organosilicon Chemistry and Materials Technology, Ministry of Education, College of Materials Chemistry and Chemical Engineering, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Anming Wang
- Key Laboratory of Organosilicon Chemistry and Materials Technology, Ministry of Education, College of Materials Chemistry and Chemical Engineering, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China.
| | - Roger A Sheldon
- Molecular Sciences Institute, School of Chemistry, University of the Witwatersrand, PO Wits, 2050 Johannesburg, South Africa; Department of Biotechnology, Section BOC, Delft University of Technology, Van der Maasweg 9, 2629 HZ Delft, the Netherlands.
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Matsuda Y, Hasuo H, Narita K, Matsuoka H, Morita R, Kiuchi D, Ikari T, Hori T, Okazaki K, Sakai K, Aiki S, Okabayashi H, Oyamada S, Ariyoshi K, Tokoro A, Fukunaga M. Relationship between dyspnoea and related factors in patients with cancer: a cross-sectional study. BMJ Support Palliat Care 2024; 13:e1126-e1132. [PMID: 38557730 DOI: 10.1136/bmjspcare-2021-003484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 04/15/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Dyspnoea is a common and distressing symptom in patients with cancer. We aimed to analyse the association between dyspnoea and related factors and to estimate their causal relationship. METHODS A cross-sectional study was conducted. Patients with cancer with dyspnoea and a mean Numerical Rating Scale (NRS) of ≥3 over 24 hours were enrolled at 10 institutions in Japan from December 2019 to February 2021. The outcomes included dyspnoea, cough and pain NRS over 24 hours, Eastern Cooperative Oncology Group Performance Status, Hospital Anxiety and Depression Scale, Somatosensory Amplification Scale, opioids for dyspnoea and respiratory failure. Path analyses were conducted to estimate the direct and indirect paths with reference to dyspnoea and related factors. RESULTS A total of 209 patients were enrolled and 208 patients were included in the analysis. Cough worsened dyspnoea (β=0.136), dyspnoea increased emotional distress (β=1.104), emotional distress increased somatosensory amplification (β=0.249) and somatosensory amplification worsened cough (β=0.053) according to path analysis. CONCLUSION There may be a vicious circle among dyspnoea and related factors: cough worsened dyspnoea, dyspnoea increased emotional distress, emotional distress increased somatosensory amplification and somatosensory amplification worsened cough. When treating dyspnoea in patients with cancer, managing these factors aimed at interrupting this vicious circle may be useful. TRIAL REGISTRATION NUMBER UMIN Clinical Trials Registry (UMIN000038820).
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Affiliation(s)
- Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Hideaki Hasuo
- Department of Psychosomatic Medicine, Kansai Medical University, Hirakata, Japan
| | - Keiichi Narita
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiromichi Matsuoka
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ryo Morita
- Department of Respiratory Medicine, Akita Kosei Medical Center, Akita, Japan
| | - Daisuke Kiuchi
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoo Ikari
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuo Hori
- Department of Clinical Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Koya Okazaki
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kiyohiro Sakai
- Department of Psychosomatic Medicine, Kindai University Faculty of Medicine Hospital, Osakasayama, Japan
| | - Sayo Aiki
- Department of Palliative Care, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hiroko Okabayashi
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | | | | | - Akihiro Tokoro
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Mikihiko Fukunaga
- Department of Psychosomatic Medicine, Kansai Medical University, Hirakata, Japan
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Kornfield J, De La Torre U, Mize E, Drake MG. Illuminating Airway Nerve Structure and Function in Chronic Cough. Lung 2023; 201:499-509. [PMID: 37985513 PMCID: PMC10673771 DOI: 10.1007/s00408-023-00659-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
Airway nerves regulate vital airway functions including bronchoconstriction, cough, and control of respiration. Dysregulation of airway nerves underlies the development and manifestations of airway diseases such as chronic cough, where sensitization of neural pathways leads to excessive cough triggering. Nerves are heterogeneous in both expression and function. Recent advances in confocal imaging and in targeted genetic manipulation of airway nerves have expanded our ability to visualize neural organization, study neuro-immune interactions, and selectively modulate nerve activation. As a result, we have an unprecedented ability to quantitatively assess neural remodeling and its role in the development of airway disease. This review highlights our existing understanding of neural heterogeneity and how advances in methodology have illuminated airway nerve morphology and function in health and disease.
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Affiliation(s)
- James Kornfield
- OHSU Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code UHN67, Portland, OR, 97239, USA
| | - Ubaldo De La Torre
- OHSU Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code UHN67, Portland, OR, 97239, USA
| | - Emily Mize
- OHSU Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code UHN67, Portland, OR, 97239, USA
| | - Matthew G Drake
- OHSU Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code UHN67, Portland, OR, 97239, USA.
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Coveñas R, Rodríguez FD, Robinson P, Muñoz M. The Repurposing of Non-Peptide Neurokinin-1 Receptor Antagonists as Antitumor Drugs: An Urgent Challenge for Aprepitant. Int J Mol Sci 2023; 24:15936. [PMID: 37958914 PMCID: PMC10650658 DOI: 10.3390/ijms242115936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
The substance P (SP)/neurokinin-1 receptor (NK-1R) system is involved in cancer progression. NK-1R, activated by SP, promotes tumor cell proliferation and migration, angiogenesis, the Warburg effect, and the prevention of apoptosis. Tumor cells overexpress NK-1R, which influences their viability. A typical specific anticancer strategy using NK-1R antagonists, irrespective of the tumor type, is possible because these antagonists block all the effects mentioned above mediated by SP on cancer cells. This review will update the information regarding using NK-1R antagonists, particularly Aprepitant, as an anticancer drug. Aprepitant shows a broad-spectrum anticancer effect against many tumor types. Aprepitant alone or in combination therapy with radiotherapy or chemotherapy could reduce the sequelae and increase the cure rate and quality of life of patients with cancer. Current data open the door to new cancer research aimed at antitumor therapeutic strategies using Aprepitant. To achieve this goal, reprofiling the antiemetic Aprepitant as an anticancer drug is urgently needed.
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Affiliation(s)
- Rafael Coveñas
- Laboratory of Neuroanatomy of the Peptidergic Systems, Institute of Neurosciences of Castilla y León (INCYL), University of Salamanca, 37007 Salamanca, Spain;
- Group GIR-BMD (Bases Moleculares del Desarrollo), University of Salamanca, 37007 Salamanca, Spain;
| | - Francisco D. Rodríguez
- Group GIR-BMD (Bases Moleculares del Desarrollo), University of Salamanca, 37007 Salamanca, Spain;
- Department of Biochemistry and Molecular Biology, Faculty of Chemical Sciences, University of Salamanca, 37007 Salamanca, Spain
| | - Prema Robinson
- Department of Infectious Diseases, Infection Control, and Employee Health, MD Anderson Cancer Center, The University of Texas, Houston, TX 77030, USA
| | - Miguel Muñoz
- Pediatric Intensive Care Unit, Research Laboratory on Neuropeptides (IBIS), Virgen del Rocío University Hospital, 41013 Seville, Spain;
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Becerik Ç, Karaca ÇT, Özcan Z, Kul S, Toros SZ. The Role of Substance P Receptor Antagonists in Allergic Rhinitis: Ovalbumin-Induced Rat Model. Laryngoscope 2023; 133:2891-2897. [PMID: 36856158 DOI: 10.1002/lary.30628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Substance P is a peptide from the tachykinin family, which is found in peripheral and central nervous systems, causing vasodilation and increased secretion in the nasal mucosa. In this study, we aimed to investigate whether the experimental model of allergic rhinitis will cause allergic changes in the larynx and to compare the effects of aprepitant, a substance P antagonist, on nasal symptoms in allergic rhinitis, and histopathological changes in the nasal and laryngeal mucosa with antihistamine and leukotriene receptor antagonists (LTRA). STUDY DESIGN An experimental animal study. METHOD The study was carried out on 34 healthy 8-12 weeks old female Sprague Dawley rats in 5 groups. The rats in which an experimental allergic rhinitis model was created with ovalbumin were scored by observing their nasal symptoms, and nasal and laryngeal mucous membranes included in the study were evaluated histopathologically after medications. RESULTS As a result of the analysis of the data obtained from the study, antihistamine and LTRA significantly reduced the symptoms of nose scratching and sneezing, while aprepitant did not affect nasal symptoms. In the histopathological examination of the larynx, effects that would make a significant difference were found in the allergy group when compared to the control group. On the larynx, aprepitant reduced pseudostratification significantly compared to the allergy group. CONCLUSION Aprepitant provides histopathological changes in the treatment of allergic rhinitis, but does not have sufficient effect on nasal symptoms. The effect of aprepitant on the larynx has not been clearly demonstrated. LEVEL OF EVIDENCE NA Laryngoscope, 133:2891-2897, 2023.
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Affiliation(s)
- Çağrı Becerik
- Department of Otorhinolaryngology, Kemalpaşa State Hospital, İzmir, Turkey
| | - Çiğdem T Karaca
- Department of Otorhinolaryngology, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Zühal Özcan
- Department of Pathology, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Selim Kul
- Department of Otorhinolaryngology, Çerkezköy State Hospital, Tekirdağ, Turkey
| | - Sema Z Toros
- Department of Otorhinolaryngology, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
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Sharma A, Ganguly S, C SK, Pillai AS, Dhawan D, Sreenivas V, Bakhshi S. Addition of aprepitant improves acute emesis control in children and adolescents receiving induction chemotherapy for acute myeloid leukaemia: a randomised, open-label trial. BMJ Support Palliat Care 2023; 13:e156-e162. [PMID: 33122168 DOI: 10.1136/bmjspcare-2020-002595] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/22/2020] [Accepted: 10/05/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES More than 50% patients develop emesis during induction therapy for acute myeloid leukaemia (AML). The addition of aprepitant for emesis control in children receiving induction for AML have not been explored. METHODS A single-institutional randomised, open-label trial (NCT02979548) was conducted where children between 5 and 18 years with the diagnosis of AML being planned for 3+7 induction regimen were included. All study participants received ondansetron (0.15 mg/kg) every 8 hours for 8 days starting 30 min prior to chemotherapy. Children belonging to aprepitant group additionally received aprepitant capsules (15-40 kg=days 1-3, 80 mg; >40 kg=day 1, 125 mg and days 2-3, 80 mg) starting from 1 hour prior to chemotherapy. The proportion of patients with complete response (CR) in chemotherapy induced vomiting (CIV) in acute phase (day 1-8), delayed phase (day 9-13), overall and initial 96 hours were recorded along with severity of vomiting and adverse effects. RESULTS Total 78 children were randomised (Aprepitant group: 37 and control group: 41). The proportion of patients with CR in CIV was significantly higher in Aprepitant group in acute phase (p=0.007), overall phase (p=0.007) and in initial 96 hours (p<0.001) but it was not different in delayed phase (p=0.07). The first episode of vomiting was also significantly delayed in aprepitant group (p=0.02). Adverse effect profile was similar in two groups. CONCLUSION Aprepitant significantly improves emesis control in children receiving induction therapy for AML, especially in acute phase and should be routinely incorporated as part of antiemetic prophylaxis. TRIAL REGISTRATION NUMBER The study was registered at ClinicalTrials.gov (NCT02979548).
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Affiliation(s)
- Atul Sharma
- Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Shuvadeep Ganguly
- Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Santosh Kumar C
- Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ashwati S Pillai
- Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Deepa Dhawan
- Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sameer Bakhshi
- Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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A case report of an 18-year-old receiving nebulized lidocaine for treatment of COVID-19 cough. Heart Lung 2023; 57:140-143. [PMID: 36201924 PMCID: PMC9515246 DOI: 10.1016/j.hrtlng.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 12/13/2022]
Abstract
An 18-year-old girl presenting with respiratory and gastrointestinal symptoms was found to have COVID-19 pneumonia and severe acute respiratory distress syndrome (ARDS). She was transferred to our pediatric intensive care unit (PICU) for ongoing mechanical ventilation and initiation of venovenous extracorporeal membrane oxygenation (VV-ECMO) for management of progressive hypoxic respiratory failure. She developed a worsening cough with associated life-threatening desaturation events that impaired ECMO flow and required deep sedation. Despite multiple sedative agents, our patient continued to have frequent coughing episodes with associated tachycardia, hypertension, and hypoxemia. The PICU team started nebulized lidocaine 1% 4 mL (40 mg) every 6 hours with albuterol pretreatment, gabapentin, and scheduled ipratropium. Lidocaine levels were <1 mcg/mL throughout the treatment duration. Nebulized lidocaine was stopped after 18 days given improvement in coughing episode severity. Our patient is one of the first reports of an adolescent patient receiving nebulized lidocaine for COVID-19 associated cough. Administration of nebulized lidocaine was well tolerated in this patient without adverse effects and was associated with decreased sedation needs. Given the widespread impact of the COVID-19 pandemic and its sequelae in pediatric, adolescent, and adult patients, additional research is warranted to explore options for management of COVID-19 associated cough.
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Muñoz M, Muñoz ME, Morell F, Coveñas R. Why use aprepitant only as a cough suppressant in lung cancer when at higher doses it could also exert an antitumor action? ARCHIVOS DE BRONCONEUMOLOGÍA 2022; 58:727-728. [DOI: 10.1016/j.arbres.2022.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/27/2022]
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Pavón-Romero GF, Serrano-Pérez NH, García-Sánchez L, Ramírez-Jiménez F, Terán LM. Neuroimmune Pathophysiology in Asthma. Front Cell Dev Biol 2021; 9:663535. [PMID: 34055794 PMCID: PMC8155297 DOI: 10.3389/fcell.2021.663535] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/15/2021] [Indexed: 12/26/2022] Open
Abstract
Asthma is a chronic inflammation of lower airway disease, characterized by bronchial hyperresponsiveness. Type I hypersensitivity underlies all atopic diseases including allergic asthma. However, the role of neurotransmitters (NT) and neuropeptides (NP) in this disease has been less explored in comparison with inflammatory mechanisms. Indeed, the airway epithelium contains pulmonary neuroendocrine cells filled with neurotransmitters (serotonin and GABA) and neuropeptides (substance P[SP], neurokinin A [NKA], vasoactive intestinal peptide [VIP], Calcitonin-gene related peptide [CGRP], and orphanins-[N/OFQ]), which are released after allergen exposure. Likewise, the autonomic airway fibers produce acetylcholine (ACh) and the neuropeptide Y(NPY). These NT/NP differ in their effects; SP, NKA, and serotonin exert pro-inflammatory effects, whereas VIP, N/OFQ, and GABA show anti-inflammatory activity. However, CGPR and ACh have dual effects. For example, the ACh-M3 axis induces goblet cell metaplasia, extracellular matrix deposition, and bronchoconstriction; the CGRP-RAMP1 axis enhances Th2 and Th9 responses; and the SP-NK1R axis promotes the synthesis of chemokines in eosinophils, mast cells, and neutrophils. In contrast, the ACh-α7nAChR axis in ILC2 diminishes the synthesis of TNF-α, IL-1, and IL-6, attenuating lung inflammation whereas, VIP-VPAC1, N/OFQ-NOP axes cause bronchodilation and anti-inflammatory effects. Some NT/NP as 5-HT and NKA could be used as biomarkers to monitor asthma patients. In fact, the asthma treatment based on inhaled corticosteroids and anticholinergics blocks M3 and TRPV1 receptors. Moreover, the administration of experimental agents such as NK1R/NK2R antagonists and exogenous VIP decrease inflammatory mediators, suggesting that regulating the effects of NT/NP represents a potential novel approach for the treatment of asthma.
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Affiliation(s)
| | | | | | | | - Luis M. Terán
- Department of Immunogenetics and Allergy, Instituto Nacional Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
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Smith JA, Harle A, Dockry R, Holt K, Russell P, Molassiotis A, Yorke J, Robinson R, Birrell MA, Belvisi MG, Blackhall F. Aprepitant for Cough in Lung Cancer. A Randomized Placebo-controlled Trial and Mechanistic Insights. Am J Respir Crit Care Med 2021; 203:737-745. [PMID: 32966755 PMCID: PMC7958516 DOI: 10.1164/rccm.202006-2359oc] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/18/2020] [Indexed: 01/26/2023] Open
Abstract
Rationale: Effective cough treatments are a significant unmet need in patients with lung cancer. Aprepitant is a licensed treatment for nausea and vomiting, which blocks substance P activation of NK-1 (neurokinin 1) receptors, a mechanism also implicated in cough.Objectives: To assess aprepitant in patients with lung cancer with cough and evaluate mechanisms in vagal nerve tissue.Methods: Randomized double-blind crossover trial of patients with lung cancer and bothersome cough. They received 3 days of aprepitant or matched placebo; after a 3-day washout, patients crossed to the alternative treatment. The primary endpoint was awake cough frequency measured at screening and Day 3 of each treatment; secondary endpoints included patient-reported outcomes. In vitro, the depolarization of isolated guinea pig and human vagus nerve sections in grease-gap recording chambers, indicative of sensory nerve activation, was measured to evaluate the mechanism.Measurements and Main Results: Twenty patients with lung cancer enrolled, with a mean age 66 years (±7.7); 60% were female and 80% had non-small cell cancer, 50% had advanced stage, and 55% had World Health Organization performance status 1. Cough frequency improved with aprepitant, reducing by 22.2% (95% confidence interval [CI], 2.8-37.7%) over placebo while awake (P = 0.03), 30.3% (95% CI, 12.7-44.3) over 24 hours (P = 0.002), and 59.8% (95% CI, 15.1-86.0) during sleep (P = 0.081). Patient-reported outcomes all significantly improved. Substance P depolarized both guinea pig and human vagus nerve. Aprepitant significantly inhibited substance P-induced depolarization by 78% in guinea pig (P = 0.0145) and 94% in human vagus (P = 0.0145).Conclusions: Substance P activation of NK-1 receptors appears to be an important mechanism driving cough in lung cancer, and NK-1 antagonists show promise as antitussive therapies.
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Affiliation(s)
- Jaclyn A. Smith
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre
- Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Amélie Harle
- Division of Molecular and Clinical Cancer Sciences, Manchester Academic Health Sciences Centre, and
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Rachel Dockry
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre
- Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Kimberley Holt
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre
- Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Philip Russell
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Alex Molassiotis
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Ryan Robinson
- Division of Airway Disease, Respiratory Pharmacology Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Mark A. Birrell
- Division of Airway Disease, Respiratory Pharmacology Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
- Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Maria G. Belvisi
- Division of Airway Disease, Respiratory Pharmacology Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
- Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Fiona Blackhall
- Division of Molecular and Clinical Cancer Sciences, Manchester Academic Health Sciences Centre, and
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
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Shapiro CO, Proskocil BJ, Oppegard LJ, Blum ED, Kappel NL, Chang CH, Fryer AD, Jacoby DB, Costello RW, Drake MG. Airway Sensory Nerve Density Is Increased in Chronic Cough. Am J Respir Crit Care Med 2021; 203:348-355. [PMID: 32809840 DOI: 10.1164/rccm.201912-2347oc] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Rationale: Chronic cough is characterized by frequent urges to cough and a heightened sensitivity to inhaled irritants. Airway sensory nerves trigger cough. We hypothesized that sensory nerve density is increased in chronic cough, which may contribute to excessive and persistent coughing.Objectives: To measure airway nerve density (axonal length) and complexity (nerve branching, neuropeptide expression) in humans with and without chronic cough.Methods: Bronchoscopic human airway biopsies were immunolabeled for nerves and the sensory neuropeptide substance P. Eosinophil peroxidase was also quantified given previous reports showing associations between eosinophils and nerve density. Three-dimensional image z-stacks of epithelium and subepithelium were generated using confocal microscopy, and from these z-stacks, total nerve length, the number of nerve branch points, substance P expression, and eosinophil peroxidase were quantified within each airway compartment.Measurements and Main Results: Nerve length and the number of branch points were significantly increased in epithelium, but not subepithelium, in chronic cough compared with healthy airways. Substance P expression was scarce and was similar in chronic cough and healthy airways. Nerve length and branching were not associated with eosinophil peroxidase nor with demographics such as age and sex in either group.Conclusions: Airway epithelial sensory nerve density is increased in chronic cough, suggesting sensory neuroplasticity contributes to cough hypersensitivity.
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Affiliation(s)
- Clare O Shapiro
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; and
| | - Becky J Proskocil
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; and
| | - Laura J Oppegard
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; and
| | - Emily D Blum
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; and
| | - Nicole L Kappel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; and
| | - Christopher H Chang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; and
| | - Allison D Fryer
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; and
| | - David B Jacoby
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; and
| | - Richard W Costello
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Matthew G Drake
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; and
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The Neurokinin-1 Receptor Antagonist Aprepitant: An Intelligent Bullet against Cancer? Cancers (Basel) 2020; 12:cancers12092682. [PMID: 32962202 PMCID: PMC7564414 DOI: 10.3390/cancers12092682] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 12/21/2022] Open
Abstract
Neurokinin-1 receptor (NK-1R) antagonists exert antitumor action, are safe and do not cause serious side-effects. These antagonists (via the NK-1R) exert multiple actions against cancer: antiproliferative and anti-Warburg effects and apoptotic, anti-angiogenic and antimetastatic effects. These multiple effects have been shown for a broad spectrum of cancers. The drug aprepitant (an NK-1R antagonist) is currently used in clinical practice as an antiemetic. In in vivo and in vitro studies, aprepitant also showed the aforementioned multiple antitumor actions against many types of cancer. A successful combination therapy (aprepitant and radiotherapy) has recently been reported in a patient suffering from lung carcinoma: the tumor mass disappeared and side-effects were not observed. Aprepitant could be considered as an intelligent bullet against cancer. The administration of aprepitant in cancer patients to prevent recurrence and metastasis after surgical procedures, thrombosis and thromboembolism is discussed, as is the possible link, through the substance P (SP)/NK-1R system, between cancer and depression. Our main aim is to review the multiple antitumor actions exerted by aprepitant, and the use of this drug is suggested in cancer patients. Altogether, the data support the reprofiling of aprepitant for a new therapeutic use as an antitumor agent.
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Spanevello A, Beghé B, Visca D, Fabbri LM, Papi A. Chronic cough in adults. Eur J Intern Med 2020; 78:8-16. [PMID: 32434660 DOI: 10.1016/j.ejim.2020.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 12/12/2022]
Abstract
Cough, a defense mechanism for clearing the airways of secretions, exudate, or foreign bodies, may become a troublesome symptom. Chronic cough, one of the most frequent symptoms requiring medical attention, is often not due to identifiable causes in adults. Chronic productive cough defines chronic bronchitis, and thus is present in 100% of these patients, and frequently in patients with bronchiectasis, cystic fibrosis, and chronic infectious respiratory diseases. However, chronic cough is most frequently dry. Thus, chronic cough in adults is a difficult syndrome requiring multidisciplinary approaches, particularly to diagnose and treat the most frequent identifiable causes, but also to decide which patients may benefit by treating the central cough hypersensitivity by neuromodulatory therapy and/or non-pharmacologic treatment (speech pathology therapy). Recent guidelines provide algorithms for diagnosis and assessment of cough severity; particularly chronic cough in adults. After excluding life-threatening diseases, chronic cough due to identifiable causes (triggers and/or diseases), particularly smoking and/or the most frequent diseases (asthma, chronic bronchitis, chronic obstructive pulmonary disease, eosinophilic bronchitis, and adverse reactions to drugs [angiotensin-converting enzyme inhibitors and sitagliptin]) should be treated by avoiding triggers and/or according to guidelines for each underlying disease. In patients with troublesome chronic cough due to unknown causes or persisting even after adequate avoidance of triggers, and/or treatment of the underlying disease(s), a symptomatic approach with neuromodulators and/or speech pathology therapy should be considered. Additional novel promising neuromodulatory agents in clinical development (e.g., P2X3 inhibitors) will hopefully become available in the near future.
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Affiliation(s)
- Antonio Spanevello
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Tradate, Tradate, Varese, Italy; Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - Bianca Beghé
- Department of Medicine, Section of Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Dina Visca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Tradate, Tradate, Varese, Italy; Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - Leonardo M Fabbri
- Azienda Ospedaliera Universitaria, Department of Medical Sciences, Section of Cardiorespiratory and Internal Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Cona Ferrara, Italy.
| | - Alberto Papi
- Azienda Ospedaliera Universitaria, Department of Medical Sciences, Section of Cardiorespiratory and Internal Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
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