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Zeng Q, Li C, Yu T, Zhang H. Comparative Effects of Exercise Interventions and Mindfulness-Based Interventions for Cognitive Impairment and Quality of Life in Breast Cancer Survivors During or After Cancer Treatment: A Systematic Review and Bayesian Network Meta-analysis. Am J Phys Med Rehabil 2024; 103:777-788. [PMID: 38684135 DOI: 10.1097/phm.0000000000002531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The aim of this network meta-analysis was to compare the improvement effects of various exercise interventions and mindfulness-based interventions to determine the best interventions for the improvement of cognitive impairment. DESIGN Seven databases were searched to screen randomized controlled trials of exercise interventions and mindfulness-based interventions to improve cognitive impairment. The network meta-analysis was performed using Revman 5.3, R 4.2.1 and ADDIS 1.16.8 software. RESULTS Thirty-four randomized controlled trials involving 14 interventions were included in the study. In terms of cognitive function, except for mindfulness-based stress reduction, all interventions showed significantly greater improvement in cognitive function compared with conventional therapy. Physical activity and Qigong showed better effect in improving executive function. In terms of improving verbal memory, compensatory cognitive training, neurofeedback training, Qigong, and sham Qigong were more effective than other interventions. On performing surface under the cumulative ranking curve analysis, acceptance and commitment therapy, neurofeedback training, Qigong, and mediation had the best effects on cognitive function, quality of life, executive function, and processing speed, respectively. CONCLUSIONS Mindfulness-based interventions were found to be more effective than exercise interventions for alleviating cognitive impairment. More robust randomized controlled trials focusing on acceptance and commitment therapy for cognitive impairment are required to support the current evidence.
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Affiliation(s)
- Qing Zeng
- From the School of Nursing, Lanzhou University, Lanzhou, Gansu, People's Republic of China
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Kaur S, Ahuja P, Kapil L, Sharma D, Singh C, Singh A. Coenzyme Q10 ameliorates chemotherapy-induced cognitive impairment in mice: a preclinical study. Mol Biol Rep 2024; 51:930. [PMID: 39174728 DOI: 10.1007/s11033-024-09872-0] [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: 05/18/2024] [Accepted: 08/19/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Among the three most used anticancer drugs, cyclophosphamide, Adriamycin, and 5-Fluorouracil (CAF), the most significant outcome is chemobrain, caused by increased oxidative stress, inflammatory insult, and mitochondrial dysfunction. OBJECTIVE In this study, endogenous antioxidant coenzyme Q10 (CoQ10) was evaluated for its neuroprotective effects in CICI. MATERIALS AND METHODS The chemobrain was induced in Swiss albino female mice by administering CAF (40 + 4 + 25 mg/kg) intraperitoneal (i.p.) in three cycles (single injection per week) followed by treatment with CoQ10 (40 mg/kg; p.o.) for up to 3 weeks followed by behavioral, biochemical, molecular and histopathological analysis. RESULTS Treatment with CoQ10 significantly improved cognition by improving exploring time in novel objects recognition test followed by increasing the time spent in the target quadrant in MWM test as compared to CAF-treated animals. Moreover, CoQ10 demonstrated antioxidant properties by reducing the expression of LPO while increasing levels of GSH, SOD, and catalase as compared to CAF-treated animals. While the levels of AChEs were significantly reduced after CoQ10 treatment in CAF-treated animals. In terms of its mechanism, it effectively counteracted the pro-inflammatory substances (TNF-α and IL-1β) triggered by CAF while also enhancing the levels of anti-inflammatory markers (IL-10 and Nrf2). Moreover, CoQ10 showed mitochondrial enhancers and it improved the level of Complex (I, II, and IV). Besides that, mitochondrial morphological analysis was done by TEM, and neuronal morphology along with quantification analysis was performed by H&E staining using Image J software to confirm the neuroprotective effect of CoQ10 over CAF-induced cognitive impairment. CONCLUSION This study suggests CoQ10 can protect the mitochondria by imposing antioxidant, and anti-inflammatory properties, which could be a potential therapy for CICI.
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Affiliation(s)
- Simranjit Kaur
- Department of Pharmacology, ISF College of Pharmacy Affiliated to I.K Gujral Punjab Technical University, Jalandhar, Moga, Punjab, 142001, India
- Department of Pharmaceutical Sciences, School of Health Sciences & Technology, UPES, Dehradun, Uttarakhand, 248007, India
| | - Palak Ahuja
- Department of Pharmacology, ISF College of Pharmacy Affiliated to I.K Gujral Punjab Technical University, Jalandhar, Moga, Punjab, 142001, India
- Department of Pharmaceutical Sciences, School of Health Sciences & Technology, UPES, Dehradun, Uttarakhand, 248007, India
| | - Lakshay Kapil
- Department of Pharmacology, ISF College of Pharmacy Affiliated to I.K Gujral Punjab Technical University, Jalandhar, Moga, Punjab, 142001, India
- Department of Pharmaceutical Sciences, School of Health Sciences & Technology, UPES, Dehradun, Uttarakhand, 248007, India
| | - Deepali Sharma
- Department of Pharmacology, ISF College of Pharmacy Affiliated to I.K Gujral Punjab Technical University, Jalandhar, Moga, Punjab, 142001, India
- Department of Pharmaceutical Sciences, School of Health Sciences & Technology, UPES, Dehradun, Uttarakhand, 248007, India
| | - Charan Singh
- Department of Pharmaceutics (School of Pharmacy), H.N.B. Garhwal University, Garhwal, Srinagar, Uttarakhand, 246174, India
| | - Arti Singh
- Department of Pharmacology, ISF College of Pharmacy Affiliated to I.K Gujral Punjab Technical University, Jalandhar, Moga, Punjab, 142001, India.
- Department of Pharmaceutical Sciences, School of Health Sciences & Technology, UPES, Dehradun, Uttarakhand, 248007, India.
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Oliva G, Giustiniani A, Danesin L, Burgio F, Arcara G, Conte P. Cognitive impairment following breast cancer treatments: an umbrella review. Oncologist 2024; 29:e848-e863. [PMID: 38723166 PMCID: PMC11224991 DOI: 10.1093/oncolo/oyae090] [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: 02/05/2024] [Accepted: 04/16/2024] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVES Cancer-related cognitive impairment (CRCI) refers to a cognitive decline associated with cancer or its treatments. While research into CRCI is expanding, evidence remains scattered due to differences in study designs, methodologies, and definitions. The present umbrella review aims to provide a comprehensive overview of the current evidence regarding the impact of different breast cancer therapies on cognitive functioning, with a particular focus on the interplay among objective cognitive deficits (ie, measured with standardized tests), subjective cognitive concerns, (ie, self-reported), and other mediating psycho-physical factors. METHODS The search was made in Pubmed, Embase, and Scopus for articles published until July 2023, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis protocol. RESULTS Chemotherapy and endocrine therapy appear consistently associated with CRCI in patients with breast cancer, primarily affecting memory, attention/concentration, executive functioning, and processing speed. Subjective cognitive concerns were often found weakly or not associated with neuropsychological test results, while overall CRCI seemed consistently associated with psychological distress, fatigue, sleep quality, and inflammatory and biological factors. CONCLUSION Current evidence suggests that CRCI is common after chemotherapy and endocrine therapy for breast cancer. However, heterogeneity in study designs and the scarcity of studies on more recent treatments such as targeted therapies and immunotherapies, highlight the need for more systematic and harmonized studies, possibly taking into account the complex and multifactorial etiology of CRCI. This may provide valuable insights into CRCI's underlying mechanisms and potential new ways to treat it.
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Affiliation(s)
- Giulia Oliva
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, 35124 Padova, Italy
- IRCCS San Camillo Hospital, 30126 Venice, Italy
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Lin C, Li J, Wu Q, Luo T, Zheng Z. Postoperative Nausea and Vomiting in Female Patients Undergoing Laparoscopic Gastrointestinal Surgery with Double Prophylactic Therapy. Surg J (N Y) 2024; 10:e25-e30. [PMID: 38835494 PMCID: PMC11147651 DOI: 10.1055/s-0044-1787305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/08/2024] [Indexed: 06/06/2024] Open
Abstract
Purpose Postoperative nausea and vomiting (PONV) is a major problem after surgery. This study aimed to demonstrate the incidence of PONV and the potential associated factors in female patients undergoing laparoscopic gastrointestinal surgery against the background of double prophylactic therapy. Methods Our retrospective study recruited 109 female patients undergoing laparoscopic gastrointestinal surgery with double prophylactic therapy, combining palonosetron with dexamethasone, from October 2020 to March 2021, at the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Patient characteristics and perioperative management factors were included in univariate and multivariate analyses to identify factors influencing PONV. Results Four patients lacked complete records, and of the 105 patients included in the final analysis, 53 (50.5%) patients developed PONV. Two influencing factors for PONV were identified: a history of chemotherapy (odds ratio [OR] 0.325, 95% confidence interval [CI] 0.123-0.856; p = 0.023) and dosage of hydromorphone ≥ 0.02 mg/kg (OR 2.857, 95% CI 1.247-6.550; p = 0.013). The performance of the multivariate logistic regression was evaluated by analyzing receiver operating characteristic curves, resulting in an area under the curve value of 0.673. Conclusion The incidence of PONV remains high in female patients undergoing laparoscopic gastrointestinal surgery, even with double prophylactic therapy. A dosage of hydromorphone ≥ 0.02 mg/kg may increase risk of PONV, whereas a history of chemotherapy might be a protective factor.
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Affiliation(s)
- Chunmeng Lin
- Department of Anesthesia, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Li
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Center for Surgery and Anesthesia, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian Wu
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Center for Clinical Research, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tongfeng Luo
- Department of Anesthesia, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhinan Zheng
- Department of Anesthesia, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Hassan MAM, Wahdan SA, El-Naga RN, Abdelghany TM, El-Demerdash E. Ondansetron attenuates cisplatin-induced behavioral and cognitive impairment through downregulation of NOD-like receptor inflammasome pathway. Toxicol Appl Pharmacol 2024; 485:116875. [PMID: 38437957 DOI: 10.1016/j.taap.2024.116875] [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: 12/27/2023] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/06/2024]
Abstract
Cisplatin is an effective and commonly used chemotherapeutic drug; however, its use is accompanied by several adverse effects, including chemobrain. Ondansetron is a 5-HT3 antagonist, commonly used in prophylactic against chemotherapy-induced nausea and vomiting. Moreover, it has been identified as a novel neuroprotective agent in different animal models. However, its protective role against chemotherapy-induced chemobrain has not been investigated. The current study was the first study that explored the potential neuroprotective effect of ondansetron against cisplatin-induced chemobrain in rats. Cisplatin (5 mg/Kg) was injected intraperitoneally, once weekly, for 4 weeks with the daily administration of ondansetron (0.5 and 1 mg/Kg). Compared to the cisplatin-treated group, ondansetron administration showed a significant decrease in the latency time and a significant increase in ambulation, rearing, and grooming frequency in the open field test (OFT). Moreover, a significant improvement in the latency time in the rotarod and passive avoidance tests, following ondansetron administration. In addition, ondansetron treatment increased the percentage of alternation in the Y-maze test. Also, ondansetron showed a remarkable enhancement in the biochemical parameters in the hippocampus. It increased the acetylcholine (Ach) level and decreased the level of the acetylcholine esterase enzyme (AchE). Ondansetron significantly decreased interleukin-1β (Il-1β), tumor necrosis factor-alpha (TNF-α), toll-like receptor-4 (TLR-4), NOD-like receptor-3 (NLRP3) inflammasome as well as caspase-1 and caspase-3 levels. Furthermore, ondansetron significantly decreased the levels of copper transporter-1(CTR1) expression in the hippocampus. Collectively, these findings suggest that ondansetron may exhibit a neuroprotective and therapeutic activity against cisplatin-induced chemobrain.
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Affiliation(s)
- Mennat-Allah M Hassan
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Heliopolis University, Cairo 11785, Egypt
| | - Sara A Wahdan
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Egypt
| | - Reem N El-Naga
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Egypt
| | - Tamer M Abdelghany
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Heliopolis University, Cairo 11785, Egypt; Department of Pharmacology and Toxicology, Faculty of Pharmacy (Boys), Al-Azhar University, Nasr city, Cairo 11884, Egypt
| | - Ebtehal El-Demerdash
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Egypt.
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Amani O, Mazaheri MA, Moghani MM, Zarani F, Choolabi RH. Chemotherapy-induced cognitive impairment in breast cancer survivors: A systematic review of studies from 2000 to 2021. Cancer Rep (Hoboken) 2024; 7:e1989. [PMID: 38351543 PMCID: PMC10864736 DOI: 10.1002/cnr2.1989] [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: 06/28/2023] [Revised: 11/27/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Studies have indicated that apart from enhancing patient survival, chemotherapy has adverse side effects on the psychological, social, and cognitive functions of breast cancer survivors. AIMS This study was conducted to understand chemotherapy's impact on breast cancer survivors' cognitive functions. METHODS AND RESULTS Our study is a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We searched English databases, including PubMed/MEDLINE, PsycINFO, and Web of Science, and Persian databases, such as Irandoc and Elmnet, using Persian keywords of cancer, breast cancer, chemotherapy, cognitive functions, executive functions, and neuropsychological functions. Two reviewers independently evaluated the full text of the articles according to predefined criteria. Among the 937 available studies, 26 were selected based on the inclusion and exclusion criteria, of which 17 (65%) were longitudinal and 9 (35%) were cross-sectional. The findings indicated a significant relationship between the use of chemotherapy and cognitive impairments, most notably attention, working and short-term memory, and executive functions. However, the studies differed in their findings regarding the long-term persistence of cancer-related cognitive impairment (CRCI), which could be due to the wide range of tools used, different methods to measure cognitive functions, and the difference in the sample size of the studies. CONCLUSION Chemotherapy, affecting cortical and subcortical brain structures, causes a set of cognitive impairments that can lead to impairments in social responsibility acceptance, daily functioning, and quality of life of women. Therefore, rigorous and extensive research design is required to understand the causes and consequences of CRCI using standardized and sensitive measures of cognitive functions. Specifically, studies comparing the effects of different chemotherapy regimens on cognition and potential mechanisms and/or moderators of CRCI would be instrumental in designing more effective therapy regimens and evaluating the efficacy and cost-effectiveness of cognitive rehabilitation and supportive care programs.
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Affiliation(s)
- Omid Amani
- Department of PsychologyShahid Beheshti UniversityTehranIran
| | | | | | - Fariba Zarani
- Department of PsychologyShahid Beheshti UniversityTehranIran
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Park SS, Kim SH, Kim BK, Shin MS, Jeong HT, Park JS, Kim TW. Treadmill exercise ameliorates chemotherapy-induced memory impairment through Wnt/β-catenin signaling pathway. J Exerc Rehabil 2023; 19:314-319. [PMID: 38188132 PMCID: PMC10766450 DOI: 10.12965/jer.2346594.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/30/2023] [Indexed: 01/09/2024] Open
Abstract
Doxorubicin (DOX) is a widely used chemotherapy drug for various cancers and it is known to induce cognitive impairment. The aim of this study was to investigate the effect of treadmill exercise on chemotherapy-induced memory impairment. We assessed whether DOX affects inflammation, mitochondrial Ca2+ retention capacity, and Wnt/β-catenin signaling. Male Sprague-Dawley rats were divided into control group, exercise group, DOX-injection group, and DOX-injection and exercise group. To create a DOX-induced memory impairment model, animals were injected intraperitoneally with DOX (2 mg/kg) dissolved in saline solution once a week for 4 weeks. Treadmill exercise was performed once a day, 5 days a week, for 8 consecutive weeks. Short-term memory was determined using the step-down avoidance test. Western blot was performed for the proinflammatory cytokines, Wnt/β-catenin signaling, brain-derived neurotrophic factor (BDNF), tropomyosin receptor kinase B (TrkB) in the hippocampus. Mitochondrial Ca2+ retention capacity in the hippocampus was also measured. DOX-injection rats showed deterioration of short-term memory along with decreased expression of BDNF and TrkB in the hippocampus. Levels of the proinflammatory cytokines, tumor necrosis factor-α and interleukin-6, were increased in the DOX-injection rats. Wnt/β-catenin signaling was activated and mitochondrial Ca2+ retention capacity was decreased in the DOX-injection rats. However, treadmill exercise alleviated short-term memory impairment, decreased proinflammatory cytokines, increased BDNF and TrkB expression, and enhanced mitochondrial Ca2+ retention capacity. Treadmill exercise restorated Wnt/β-catenin signaling pathway. This study demonstrated that treadmill exercise can be used for patients undergoing chemotherapy with DOX.
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Affiliation(s)
- Sang-Seo Park
- Department of Physiology, College of Medicine, Kyung Hee University, Seoul,
Korea
| | - Sang-Hoon Kim
- Department of Sport and Health Sciences, College of Art and Culture, Sangmyung University, Seoul,
Korea
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, NJ,
USA
| | - Bo-Kyun Kim
- Department of Emergency Technology, College of Health Science, Gachon University, Incheon,
Korea
| | - Mal-Soon Shin
- Division of Global Sport Studies, College of Culture and Sports, Korea University, Sejong,
Korea
| | - Hyun-Tae Jeong
- Division of Global Sport Studies, College of Culture and Sports, Korea University, Sejong,
Korea
| | - Jong-Suk Park
- Division of Global Sport Studies, College of Culture and Sports, Korea University, Sejong,
Korea
| | - Tae-Woon Kim
- Department of Human Health Care, Gyeongsang National University, Jinju,
Korea
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Edgar CJ, Bush EN, Adams HR, Ballinger R, Byrom B, Campbell M, Eremenco S, McDougall F, Papadopoulos E, Slagle AF, Coons SJ. Recommendations on the Selection, Development, and Modification of Performance Outcome Assessments: A Good Practices Report of an ISPOR Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:959-967. [PMID: 37385712 DOI: 10.1016/j.jval.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/05/2023] [Indexed: 07/01/2023]
Abstract
In evaluating the clinical benefit of new therapeutic interventions, it is critical that the treatment outcomes assessed reflect aspects of health that are clinically important and meaningful to patients. Performance outcome (PerfO) assessments are measurements based on standardized tasks actively undertaken by a patient that reflect physical, cognitive, sensory, and other functional skills that bring meaning to people's lives. PerfO assessments can have substantial value as drug development tools when the concepts of interest being measured best suit task performance and in cases where patients may be limited in their capacity for self-report. In their development, selection, and modification, including the evaluation and documentation of validity, reliability, usability, and interpretability, the good practice recommendations established for other clinical outcome assessment types should continue to be followed, with concept elicitation as a critical foundation. In addition, the importance of standardization, and the need to ensure feasibility and safety, as well as their utility in patient groups, such as pediatric populations, or those with cognitive and psychiatric challenges, may enhance the need for structured pilot evaluations, additional cognitive interviewing, and evaluation of quantitative data, such as that which would support concept confirmation or provide ecological evidence and other forms of construct evidence within a unitary approach to validity. The opportunity for PerfO assessments to inform key areas of clinical benefit is substantial and establishing good practices in their selection or development, validation, and implementation, as well as how they reflect meaningful aspects of health is critical to ensuring high standards and in furthering patient-focused drug development.
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Affiliation(s)
| | - Elizabeth Nicki Bush
- Endpoints and Measurement Strategy, The Janssen Pharmaceutical Companies of Johnson & Johnson, Raritan, NJ, USA
| | | | | | | | - Michelle Campbell
- Office of Neuroscience, Food and Drug Administration, Silver Spring, MD, USA
| | - Sonya Eremenco
- PRO Consortium, Critical Path Institute, Tucson, AZ, USA
| | | | - Elektra Papadopoulos
- Patient Experience Data & Strategy in Immunology and Oncology, AbbVie, North Chicago, IL, USA
| | - Ashley F Slagle
- Scientific and Regulatory Consulting, Aspen Consulting, LLC, Steamboat Springs, CO, USA
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Alsikhan RS, Aldubayan MA, Almami IS, Alhowail AH. Protective Effect of Galantamine against Doxorubicin-Induced Neurotoxicity. Brain Sci 2023; 13:971. [PMID: 37371449 DOI: 10.3390/brainsci13060971] [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: 05/22/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND AND AIMS Doxorubicin (DOX) causes cognitive impairment (chemobrain) in patients with cancer. While DOX damages the cholinergic system, few studies have focused on the protective effects of cholinergic function on chemobrain. The acetylcholinesterase inhibitor galantamine (GAL) demonstrates neuroprotective properties. We investigated the mechanisms associated with DOX-induced cognitive impairments and the potential protective role of GAL in preventing chemobrain. MAIN METHODS Female Wistar rats were divided into control, DOX, GAL, and DOX + GAL groups. The rats in the DOX group were administered DOX (5 mg/kg intraperitoneally twice weekly for two weeks), while those in the GAL group were orally administered GAL (2.5 mg/kg) via oral gavage once daily for 15 days. The combination group (DOX + GAL) received GAL (once daily) and DOX (two times per week) concurrently. The body weights and survival rates were monitored daily. The animals were subjected to behavioral tests to assess the memory function followed by the biochemical estimation of inflammatory markers, including tumor necrosis factor-α (TNF-α), interleukine-1β (IL-1β), and interleukine-6 (IL-6) in rat brain tissue and RT-qPCR. KEY FINDINGS DOX caused a reduction in the body weight and survival rate, which was alleviated by GAL concomitant treatment with DOX (DOX + GAL). These groups had reduced body weights and survival rates. DOX-treated animals exhibited an impairment of short-term spatial working memory, manifested as a behavioral alteration in the Y-maze test, the novel object recognition (NOR) test, and the elevated plus-maze (EPM) test. Concurrent treatment with GAL (DOX + GAL) showed improved memory function, as evidenced by an increase in the number of entries and time spent in the novel arm, the time spent exploring the novel object, and the transfer latency in the Y-maze, NOR test, and EPM test, respectively. These findings were also supported by biochemical observations showing the reversal of DOX-induced changes in IL-1β, IL-6, and TNF-α, as well as their relative expression of mRNA in brain tissue following concurrent GAL treatment. CONCLUSION GAL appeared to be a neuroprotective agent against neuroinflammation caused by DOX by reducing inflammatory markers in the brain.
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Affiliation(s)
- Rawan S Alsikhan
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Unaizah 51911, Saudi Arabia
| | - Maha A Aldubayan
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
| | - Ibtesam S Almami
- Department of Biology, College of Science, Qassim University, Buraydah 51452, Saudi Arabia
| | - Ahmad H Alhowail
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
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Ragothaman M, Yoo SY. Engineered Phage-Based Cancer Vaccines: Current Advances and Future Directions. Vaccines (Basel) 2023; 11:vaccines11050919. [PMID: 37243023 DOI: 10.3390/vaccines11050919] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/22/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Bacteriophages have emerged as versatile tools in the field of bioengineering, with enormous potential in tissue engineering, vaccine development, and immunotherapy. The genetic makeup of phages can be harnessed for the development of novel DNA vaccines and antigen display systems, as they can provide a highly organized and repetitive presentation of antigens to immune cells. Bacteriophages have opened new possibilities for the targeting of specific molecular determinants of cancer cells. Phages can be used as anticancer agents and carriers of imaging molecules and therapeutics. In this review, we explored the role of bacteriophages and bacteriophage engineering in targeted cancer therapy. The question of how the engineered bacteriophages can interact with the biological and immunological systems is emphasized to comprehend the underlying mechanism of phage use in cancer immunotherapy. The effectiveness of phage display technology in identifying high-affinity ligands for substrates, such as cancer cells and tumor-associated molecules, and the emerging field of phage engineering and its potential in the development of effective cancer treatments are discussed. We also highlight phage usage in clinical trials as well as the related patents. This review provides a new insight into engineered phage-based cancer vaccines.
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Affiliation(s)
- Murali Ragothaman
- BIO-IT Foundry Technology Institute, Pusan National University, Busan 46241, Republic of Korea
| | - So Young Yoo
- BIO-IT Foundry Technology Institute, Pusan National University, Busan 46241, Republic of Korea
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11
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Nevins S, McLoughlin CD, Oliveros A, Stein JB, Rashid MA, Hou Y, Jang MH, Lee KB. Nanotechnology Approaches for Prevention and Treatment of Chemotherapy-Induced Neurotoxicity, Neuropathy, and Cardiomyopathy in Breast and Ovarian Cancer Survivors. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023:e2300744. [PMID: 37058079 PMCID: PMC10576016 DOI: 10.1002/smll.202300744] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/05/2023] [Indexed: 06/19/2023]
Abstract
Nanotechnology has emerged as a promising approach for the targeted delivery of therapeutic agents while improving their efficacy and safety. As a result, nanomaterial development for the selective targeting of cancers, with the possibility of treating off-target, detrimental sequelae caused by chemotherapy, is an important area of research. Breast and ovarian cancer are among the most common cancer types in women, and chemotherapy is an essential treatment modality for these diseases. However, chemotherapy-induced neurotoxicity, neuropathy, and cardiomyopathy are common side effects that can affect breast and ovarian cancer survivors quality of life. Therefore, there is an urgent need to develop effective prevention and treatment strategies for these adverse effects. Nanoparticles (NPs) have extreme potential for enhancing therapeutic efficacy but require continued research to elucidate beneficial interventions for women cancer survivors. In short, nanotechnology-based approaches have emerged as promising strategies for preventing and treating chemotherapy-induced neurotoxicity, neuropathy, and cardiomyopathy. NP-based drug delivery systems and therapeutics have shown potential for reducing the side effects of chemotherapeutics while improving drug efficacy. In this article, the latest nanotechnology approaches and their potential for the prevention and treatment of chemotherapy-induced neurotoxicity, neuropathy, and cardiomyopathy in breast and ovarian cancer survivors are discussed.
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Affiliation(s)
- Sarah Nevins
- Department of Chemistry and Chemical Biology, Rutgers
University, the State University of New Jersey, 123 Bevier Road, Piscataway, NJ
08854, U.S.A
| | - Callan D. McLoughlin
- Department of Chemistry and Chemical Biology, Rutgers
University, the State University of New Jersey, 123 Bevier Road, Piscataway, NJ
08854, U.S.A
| | - Alfredo Oliveros
- Department of Neurosurgery, Robert Wood Johnson Medical
School, Rutgers University, the State University of New Jersey, 661 Hoes Ln W,
Piscataway, NJ, 08854, U.S.A
| | - Joshua B. Stein
- Department of Chemistry and Chemical Biology, Rutgers
University, the State University of New Jersey, 123 Bevier Road, Piscataway, NJ
08854, U.S.A
| | - Mohammad Abdur Rashid
- Department of Neurosurgery, Robert Wood Johnson Medical
School, Rutgers University, the State University of New Jersey, 661 Hoes Ln W,
Piscataway, NJ, 08854, U.S.A
| | - Yannan Hou
- Department of Chemistry and Chemical Biology, Rutgers
University, the State University of New Jersey, 123 Bevier Road, Piscataway, NJ
08854, U.S.A
| | - Mi-Hyeon Jang
- Department of Neurosurgery, Robert Wood Johnson Medical
School, Rutgers University, the State University of New Jersey, 661 Hoes Ln W,
Piscataway, NJ, 08854, U.S.A
| | - Ki-Bum Lee
- Department of Chemistry and Chemical Biology, Rutgers
University, the State University of New Jersey, 123 Bevier Road, Piscataway, NJ
08854, U.S.A
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12
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Srour AM, Dawood DH, Nossier ES, El-Shiekh RA, Mahmoud AE, Hussien AG, Omran MM, Ali MM. Design, synthesis and molecular docking simulation of oxindole-based derivatives with dual VEGFR-2 and cholinesterase inhibitory activities. J Mol Struct 2023. [DOI: 10.1016/j.molstruc.2022.134130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Yan W, Zhu H, Zhang P, Sun T, Gong S, Sun G, Ren Z. Heterotopic 4T1 breast cancer transplantation induces hippocampal inflammation and depressive-like behaviors in mice. Metab Brain Dis 2022; 37:2955-2963. [PMID: 35947291 DOI: 10.1007/s11011-022-01058-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/29/2022] [Indexed: 10/15/2022]
Abstract
Cancer and its accompanying treatments can lead to numerous physical and emotional concerns, including subclinical or clinical depression and anxiety, which could significantly impact one's well-being, quality of life, and survival. A large number of studies have elucidated that neuroinflammation is associated with depression. Here, we report the hippocampal pathological changes and depressive behaviors of a heterotopic breast cancer transplantation mouse model; hence, a heterotopic 4T1 breast cancer transplantation mouse model was established. Assessment of cognitive and locomotive functions of the experimental animals was conducted using open- and closed-field tests, including a tail suspension test. Expression levels of monoaminergic system markers, brain-derived neurotrophic factor (BDNF), pro-inflammatory cytokines, and nuclear factor-kappa B (NFκB) in the hippocampus and serum were detected using immunochemistry and western and enzyme-linked immunosorbent assay analysis. A comparison of the differences between model and control animals was performed. As per our findings, 4T1 tumor-bearing mice displayed cancer-related anorexia/cachexia with significant reductions in the travel distance and the total number of squares crossed in the open- and closed-field tests. Additionally, the 4T1 tumor-bearing mice withstood a more extended period of immobility during the tail suspension test. Immunohistochemistry studies revealed reduced levels of serotonin, norepinephrine, and BDNF in the hippocampus and serum. Elevated levels of NFκB and pro-inflammatory cytokines in the hippocampus were also observed. These findings suggest that hippocampal inflammation may have played an important role in the neurological function and depressive behavior in heterotopic 4T1 breast cancer transplantation mice.
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Affiliation(s)
- Wenjing Yan
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Hulin Zhu
- Department of Stomatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Pengbo Zhang
- Department of General Surgery, Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Road, Xuzhou, 221004, People's Republic of China
| | - Ting Sun
- Department of Administration, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Shuai Gong
- Department of General Surgery, Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Road, Xuzhou, 221004, People's Republic of China
| | - Guoxiu Sun
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Zeqiang Ren
- Department of General Surgery, Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Road, Xuzhou, 221004, People's Republic of China.
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14
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Oo TT, Pratchayasakul W, Chattipakorn N, Chattipakorn SC. Emerging roles of toll-like receptor 4 in chemotherapy-induced neurotoxicity. Neurotoxicology 2022; 93:112-127. [PMID: 36152729 DOI: 10.1016/j.neuro.2022.09.006] [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: 07/08/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 10/14/2022]
Abstract
Chemotherapy-induced neurotoxicity is one of the most prevalent side effects in cancer patients and survivors. Cognitive decline and peripheral neuropathy are the most common chemotherapy-induced neurotoxic symptoms. These symptoms lead not only to the limiting of the dose of chemotherapy given to cancer patients, but also have an impact on the quality of life of cancer survivors. Although the exact mechanisms involved in chemotherapy-induced neurotoxicity are still unclear, neuroinflammation is widely regarded as being one of the major causes involved in chemotherapy-induced neurotoxicity. It is known that Toll-like receptor 4 (TLR4) plays a critical role in the inflammatory process, and it has been recently reported that it is associated with chemotherapy-induced neurotoxicity. In this review, we summarize and discuss all available evidence regarding the activation of the TLR4 signaling pathway in various models of chemotherapy-induced neurotoxicity. This review also emphasizes the evidence pertinent to TLR4 inhibition on chemotherapy-induced neurotoxicity in rodent studies. Understanding the role of the TLR4 signaling pathway behind chemotherapy-induced neurotoxicity is crucial for improving treatments and ensuring the long-term survival of cancer patients.
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Affiliation(s)
- Thura Tun Oo
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Center of Excellence in Cardiac Electrophysiology, Chiang Mai University, Chiang Mai, Thailand
| | - Wasana Pratchayasakul
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Center of Excellence in Cardiac Electrophysiology, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Center of Excellence in Cardiac Electrophysiology, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Center of Excellence in Cardiac Electrophysiology, Chiang Mai University, Chiang Mai, Thailand; Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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15
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Scholz S, Lewis K, Saulich F, Endres M, Boehmerle W, Huehnchen P. Induced pluripotent stem cell-derived brain organoids as potential human model system for chemotherapy induced CNS toxicity. Front Mol Biosci 2022; 9:1006497. [PMID: 36188215 PMCID: PMC9520921 DOI: 10.3389/fmolb.2022.1006497] [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: 07/29/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Neurotoxic phenomena are among the most common side effects of cytotoxic agents. The development of chemotherapy-induced polyneuropathy (CIPN) is a well-recognized adverse reaction in the peripheral nervous system, while changes of cognitive functions (post-chemotherapy cognitive impairment (PCCI)) are more diffuse and have only recently drawn scientific interest. PCCI in patients most often displays as short-term memory loss, reduced multitasking ability or deficits in language. Not least, due to a lack of preclinical human model systems, the underlying molecular mechanisms are poorly understood, and treatments are missing. We thus investigated whether induced pluripotent stem cell (iPSC)-derived brain organoids can serve as a human model system for the study of chemotherapy induced central nervous system toxicity. We robustly generated mature brain organoids from iPSC-derived neuronal precursor cells (NPC), which showed a typical composition with 1) dividing NPCs forming ventricle like structures 2) matured neurons and 3) supporting glial cells closer to the surface. Furthermore, upon stimulation the brain organoids showed functional signaling. When exposed to increasing concentrations of paclitaxel, a frequently used chemotherapy drug, we observed time dependent neurotoxicity with an EC50 of 153 nM, comparable to a published murine model system. Histological analysis after paclitaxel exposure demonstrated dose dependent apoptosis induction and reduced proliferation in the organoids with further Western blot analyses indicating the degradation of neuronal calcium sensor one protein (NCS-1) and activation of Caspase-3. We could also provide evidence that paclitaxel treatment negatively affects the pool of neuronal and astrocyte precursor cells as well as mature neurons. In summary our data suggests that human iPSC derived brain organoids are a promising preclinical model system to investigate molecular mechanisms underlying PCCI and to develop novel prevention and treatment strategies.
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Affiliation(s)
- Sophie Scholz
- Klinik und Hochschulambulanz für Neurologie, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Department of Molecular and Experimental Nutritional Medicine, Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Karyn Lewis
- Klinik und Hochschulambulanz für Neurologie, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Frederik Saulich
- Klinik und Hochschulambulanz für Neurologie, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Molecular Genetics Group, Institute of Biology, Humboldt University of Berlin, Berlin, Germany
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Cluster of Excellence, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Charité — Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Wolfgang Boehmerle
- Klinik und Hochschulambulanz für Neurologie, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Cluster of Excellence, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Charité — Universitätsmedizin Berlin, Berlin, Germany
- *Correspondence: Wolfgang Boehmerle,
| | - Petra Huehnchen
- Klinik und Hochschulambulanz für Neurologie, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Cluster of Excellence, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Charité — Universitätsmedizin Berlin, Berlin, Germany
- *Correspondence: Wolfgang Boehmerle,
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16
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Huehnchen P, Bangemann N, Lischewski S, Märschenz S, Paul F, Schmitz-Hübsch T, Blohmer JU, Eberhardt C, Rauch G, Flöel A, Adam S, Schwenkenbecher P, Meinhold-Heerlein I, Hoffmann O, Ziemssen T, Endres M, Boehmerle W. Rationale and design of the prevention of paclitaxel-related neurological side effects with lithium trial - Protocol of a multicenter, randomized, double-blind, placebo- controlled proof-of-concept phase-2 clinical trial. Front Med (Lausanne) 2022; 9:967964. [PMID: 36035422 PMCID: PMC9403739 DOI: 10.3389/fmed.2022.967964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Chemotherapy-induced polyneuropathy (CIPN) and post-chemotherapy cognitive impairment (PCCI) are frequent side effects of paclitaxel treatment. CIPN/PCCI are potentially irreversible, reduce quality of life and often lead to treatment limitations, which affect patients' outcome. We previously demonstrated that paclitaxel enhances an interaction of the Neuronal calcium sensor-1 protein (NCS-1) with the Inositol-1,4,5-trisphosphate receptor (InsP3R), which disrupts calcium homeostasis and triggers neuronal cell death via the calcium-dependent protease calpain in dorsal root ganglia neurons and neuronal precursor cells. Prophylactic treatment of rodents with lithium inhibits the NCS1-InsP3R interaction and ameliorates paclitaxel-induced polyneuropathy and cognitive impairment, which is in part supported by limited retrospective clinical data in patients treated with lithium carbonate at the time of chemotherapy. Currently no data are available from a prospective clinical trial to demonstrate its efficacy. Methods and analysis The PREPARE study will be conducted as a multicenter, randomized, double-blind, placebo-controlled phase-2 trial with parallel group design. N = 84 patients with breast cancer will be randomized 1:1 to either lithium carbonate treatment (targeted serum concentration 0.5-0.8 mmol/l) or placebo with sham dose adjustments as add-on to (nab-) paclitaxel. The primary endpoint is the validated Total Neuropathy Score reduced (TNSr) at 2 weeks after the last (nab-) paclitaxel infusion. The aim is to show that the lithium carbonate group is superior to the placebo group, meaning that the mean TNSr after (nab-) paclitaxel is lower in the lithium carbonate group than in the placebo group. Secondary endpoints include: (1) severity of CIPN, (2) amount and dose of pain medication, (3) cumulative dose of (nab-) paclitaxel, (4) patient-reported symptoms of CIPN, quality of life and symptoms of anxiety and depression, (5) severity of cognitive impairment, (6) hippocampal volume and changes in structural/functional connectivity and (7) serum Neurofilament light chain protein concentrations. Ethics and dissemination The study protocol was approved by the Berlin ethics committee (reference: 21/232 - IV E 10) and the respective federal agency (Bundesinstitut für Arzneimittel und Medizinprodukte, reference: 61-3910-4044771). The results of the study will be published in peer-reviewed medical journals as well as presented at relevant (inter)national conferences. Clinical trial registration [https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00027165], identifier [DRKS00027165].
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Affiliation(s)
- Petra Huehnchen
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Klinik und Hochschulambulanz für Neurologie, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Nikola Bangemann
- Carl-Thiem-Klinikum Cottbus, Klinik für Senologie und Systemische Gynäkoonkologie mit Brustzentrum, Cottbus, Germany
| | - Sandra Lischewski
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Klinik und Hochschulambulanz für Neurologie, Humboldt-Universität zu Berlin, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, NeuroCure Clinical Research Center (NCRC), Berlin, Germany
| | - Stefanie Märschenz
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Klinik und Hochschulambulanz für Neurologie, Humboldt-Universität zu Berlin, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, NeuroCure Clinical Research Center (NCRC), Berlin, Germany
| | - Friedemann Paul
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Klinik und Hochschulambulanz für Neurologie, Humboldt-Universität zu Berlin, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, NeuroCure Clinical Research Center (NCRC), Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Tanja Schmitz-Hübsch
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, NeuroCure Clinical Research Center (NCRC), Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Jens-Uwe Blohmer
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Klinik für Gynäkologie und Brustzentrum, Berlin, Germany
| | - Cornelia Eberhardt
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Pharmacy, Berlin, Germany
| | - Geraldine Rauch
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institut für Biometrie und Klinische Epidemiologie, Berlin, Germany
| | - Agnes Flöel
- Universitätsmedizin Greifswald, Department of Neurology, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | | | | | - Ivo Meinhold-Heerlein
- Universitätsklinikum Giessen, Klinik für Gynäkologie und Geburtshilfe, Giessen, Germany
| | - Oliver Hoffmann
- Universitätsklinikum Essen, Klinik für Frauenheilkunde und Geburtshilfe, Essen, Germany
| | - Tjalf Ziemssen
- Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Neurologie, Dresden, Germany
| | - Matthias Endres
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Klinik und Hochschulambulanz für Neurologie, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
- Carl-Thiem-Klinikum Cottbus, Klinik für Senologie und Systemische Gynäkoonkologie mit Brustzentrum, Cottbus, Germany
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Wolfgang Boehmerle
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Klinik und Hochschulambulanz für Neurologie, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
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17
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Owrangi M, Gholamzadeh MJ, Vasaghi Gharamaleki M, Mousavi SZ, Kamali AM, Dehghani M, Chakrabarti P, Nami M. Comparative analysis of the chemotherapy-related cognitive impairments in patients with breast cancer: a community-based research. Cancer Invest 2022; 40:811-821. [PMID: 35880822 DOI: 10.1080/07357907.2022.2106489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
This study aimed to evaluate the effects of two common chemotherapy regimens on breast cancer (BC) survivors' cognition. The participants comprised 35 patients with BC who underwent two chemotherapy regimens, AC-T and TAC, and 24 matched healthy volunteers. The participants were assessed regarding cognitive function through Addenbrooke's Cognitive Examination and Cambridge Brain Science tests. The results represent the AC-T regimen to be more toxic than the TAC in domains of language, concentration, and visuospatial working memory (P-value =0.036, 0.008, and 0.031, respectively) and should be prescribed with caution in patients with BC suffering from baseline cognitive impairments.
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Affiliation(s)
- Maryam Owrangi
- Students' Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Seyedeh Zahra Mousavi
- Students' Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali-Mohammad Kamali
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.,DANA Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran
| | - Mehdi Dehghani
- Hematology research center, Department of Hematology and Medical Oncology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohammad Nami
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.,DANA Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran.,Academy of Health, Senses Cultural Foundation, Sacramento, CA, USA.,Neuroscience Center, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), City of Knowledge, Panama City, Republic of Panama.,Department of Cognitive Neuroscience, Institute for Cognitive Science Studies (ICSS), Pardis, Tehran, Iran.,Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA, USA
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18
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Onzi GR, D'Agustini N, Garcia SC, Guterres SS, Pohlmann PR, Rosa DD, Pohlmann AR. Chemobrain in Breast Cancer: Mechanisms, Clinical Manifestations, and Potential Interventions. Drug Saf 2022; 45:601-621. [PMID: 35606623 DOI: 10.1007/s40264-022-01182-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Abstract
Among the potential adverse effects of breast cancer treatment, chemotherapy-related cognitive impairment (CRCI) has gained increased attention in the past years. In this review, we provide an overview of the literature regarding CRCI in breast cancer, focusing on three main aspects. The first aspect relates to the molecular mechanisms linking individual drugs commonly used to treat breast cancer and CRCI, which include oxidative stress and inflammation, reduced neurogenesis, reduced levels of specific neurotransmitters, alterations in neuronal dendrites and spines, and impairment in myelin production. The second aspect is related to the clinical characteristics of CRCI in patients with breast cancer treated with different drug combinations. Data suggest the incidence rates of CRCI in breast cancer vary considerably, and may affect more than 50% of treated patients. Both chemotherapy regimens with or without anthracyclines have been associated with CRCI manifestations. While cross-sectional studies suggest the presence of symptoms up to 20 years after treatment, longitudinal studies confirm cognitive impairments lasting for at most 4 years after the end of chemotherapy. The third and final aspect is related to possible therapeutic interventions. Although there is still no standard of care to treat CRCI, several pharmacological and non-pharmacological approaches have shown interesting results. In summary, even if cognitive impairments derived from chemotherapy resolve with time, awareness of CRCI is crucial to provide patients with a better understanding of the syndrome and to offer them the best care directed at improving quality of life.
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Affiliation(s)
- Giovana R Onzi
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Av. Ipiranga 2752, Porto Alegre, RS, 90610-000, Brazil.
| | - Nathalia D'Agustini
- Programa de Pós-Graduação em Patologia da Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Solange C Garcia
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Av. Ipiranga 2752, Porto Alegre, RS, 90610-000, Brazil
| | - Silvia S Guterres
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Av. Ipiranga 2752, Porto Alegre, RS, 90610-000, Brazil
| | - Paula R Pohlmann
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniela D Rosa
- Programa de Pós-Graduação em Patologia da Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
- Serviço de Oncologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Adriana R Pohlmann
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Av. Ipiranga 2752, Porto Alegre, RS, 90610-000, Brazil.
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19
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Hamdan DI, Salah S, Hassan WHB, Morsi M, Khalil HMA, Ahmed-Farid OAH, El-Shiekh RA, Nael MA, Elissawy AM. Anticancer and Neuroprotective Activities of Ethyl Acetate Fractions from Morus macroura Miq. Plant Organs with Ultraperformance Liquid Chromatography-Electrospray Ionization-Tandem Mass Spectrometry Profiling. ACS OMEGA 2022; 7:16013-16027. [PMID: 35571826 PMCID: PMC9096986 DOI: 10.1021/acsomega.2c01148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
Column chromatography afforded the isolation of seven secondary metabolites (1-(2,4,6-trihydroxy phenyl)-ethanone-4-O-β-d-glucopyranoside, naringenin-7-O-β-d-glucopyranoside, kaempferol-3-O-α-l-rhamnoside, kaempferol-3-O-β-d-glucopyranoside, quercetin-3-O-β-d-glucopyranoside, quercetin-3-O-β-d-galactopyranoside, rutin) from the ethyl acetate (ET) fractions of Morus macroura Miq. stems (S), leaves (L), and fruits (F). Their identification based on ultraviolet (UV), electron ionization (EI), electrospray ionization-mass spectrometry (ESI-MS), and 1D and 2D NMR data. In addition, profiling of ET fractions using ultraperformance liquid chromatography-electrospray ionization-tandem mass spectrometry (UPLC-ESI-MS/MS) resulted in the identification of 82 compounds belonging to different classes, mainly polyphenolic constituents. Chemical profiling as well as molecular docking directed us to biological evaluation. Interestingly, the ET-L fraction exhibited a robust cytotoxic activity against HepG-2, MCF-7, and HELA cell lines. Also, it displayed a neuromodulatory activity against cisplatin neurotoxicity in rats by ameliorating the neurobehavioral dysfunction visualized in the open field and Y-maze test and modulating the neurochemical parameters such as brain amino acid levels (glutamate, aspartate, serine, and histidine), oxidative stress markers (GSH, MDA, and 8-hydroxy-2'-deoxyguanosine), and purinergic cell energy (adenosine triphosphate (ATP) and adenosine monophosphate (AMP)). In conclusion, the isolated compounds (kaempferol-3-O-β-glucoside and quercetin-3-O-β-glucoside) from the ET-L fraction could serve as potent anticancer agents due to their strong antioxidant, in vitro cytotoxicity, and in vivo neuroprotective activity.
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Affiliation(s)
- Dalia Ibrahim Hamdan
- Department
of Pharmacognosy, Faculty of Pharmacy Menoufia
University, Shibin
Elkom 32511, Egypt
| | - Samia Salah
- Department
of Pharmacognosy, Faculty of Pharmacy, Zagazig
University, Zagazig 44519, Egypt
| | | | - Mai Morsi
- Department
of Pharmacognosy, Faculty of Pharmacy, Zagazig
University, Zagazig 44519, Egypt
| | - Heba Muhammed Ali Khalil
- Department
of Veterinary Hygiene and Management, Faculty of Veterinary Medicine, Cairo University, Giza 12211, Egypt
| | | | - Riham Adel El-Shiekh
- Department
of Pharmacognosy, Faculty of Pharmacy, Cairo
University, Kasr el Aini
Street, Cairo 11562, Egypt
| | - Manal AbdElaziz Nael
- Department
of Pharmaceutical Chemistry, Faculty of Pharmacy, Tanta University, Tanta 31527, Egypt
| | - Ahmed Mohamed Elissawy
- Pharmacognosy
Department, Faculty of Pharmacy, Ain Shams
University, Abbassia, Cairo 11566, Egypt
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20
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Alimena S, Philp L, Orav EJ, Sullivan MW, Del Carmen M, Goodman A, Growdon WB, Bregar A, Eisenhauer E, Sisodia RC. Patient-reported outcomes and chemotherapy-related cognitive impairment in gynecologic malignancy. Int J Gynecol Cancer 2022; 32:781-787. [DOI: 10.1136/ijgc-2021-003094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
ObjectiveChemotherapy has multiple adverse effects, including chemotherapy-related cognitive impairment, the phenomenon colloquially referred to as ‘chemobrain’. The objective of this study was to understand patient-reported experiences of this phenomenon in relation to chemotherapy administration among gynecologic oncology patients.MethodsA prospective patient-reported outcomes program was implemented in the Gynecologic Oncology clinic of a tertiary academic institution in January 2018. Patients with endometrial or ovarian cancer who received chemotherapy were included through September 2019 in this cohort study. Patients completed the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire. Serial responses were compared before, during, and after chemotherapy using a mixed effects linear regression with random effects for repeated measures within patients and a fixed effect for endometrial versus ovarian cancer.ResultsFifty patients were included who completed a total of 152 patient-reported outcome measures. Thirty-five questionnaires were administered before chemotherapy, 59 during treatment, and 58 at a median of 161 days after the final cycle of chemotherapy. Seventy-one percent of patients reported no difficulties with concentration before chemotherapy, which remained stable after chemotherapy (72%). Sixty-six percent reported no difficulty with memory before chemotherapy versus 52% after chemotherapy. There were significant differences in feeling tension (p<0.001), worry (p<0.001), and depression (p=0.02) before and after chemotherapy on mixed effects linear regression, with higher levels of adverse emotional symptoms before chemotherapy administration compared with after. Women reported more interference with their social lives during chemotherapy (mean 1.08) compared with before (mean 0.85) and after chemotherapy (0.75, p=0.04).ConclusionsWhile no overt memory issues were discovered with serial administration of patient-reported outcome measures, rates of adverse emotional symptoms such as depression, tension, and worry diminished after chemotherapy administration. Further study is needed about the phenomenon of chemotherapy-related cognitive impairment using a larger cohort.
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21
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Oh PJ, Kim JH. The Experience of Chemotherapy Related Cognitive Impairment in Patients with Cancer. ASIAN ONCOLOGY NURSING 2022. [DOI: 10.5388/aon.2022.22.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Pok Ja Oh
- College of Nursing, Sahmyook University, Seoul, Korea
| | - Ji Hyun Kim
- College of Nursing, Sahmyook University, Seoul, Korea
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22
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Országhová Z, Mego M, Chovanec M. Long-Term Cognitive Dysfunction in Cancer Survivors. Front Mol Biosci 2022; 8:770413. [PMID: 34970595 PMCID: PMC8713760 DOI: 10.3389/fmolb.2021.770413] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022] Open
Abstract
Cancer-related cognitive impairment (CRCI) is a frequent side effect experienced by an increasing number of cancer survivors with a significant impact on their quality of life. Different definitions and means of evaluation have been used in available literature; hence the exact incidence of CRCI remains unknown. CRCI can be described as cognitive symptoms reported by cancer patients in self-reported questionnaires or as cognitive changes evaluated by formal neuropsychological tests. Nevertheless, association between cognitive symptoms and objectively assessed cognitive changes is relatively weak or absent. Studies have focused especially on breast cancer patients, but CRCI has been reported in multiple types of cancer, including colorectal, lung, ovarian, prostate, testicular cancer and hematological malignancies. While CRCI has been associated with various treatment modalities, including radiotherapy, chemotherapy, hormone therapy and novel systemic therapies, it has been also detected prior to cancer treatment. Therefore, the effects of cancer itself with or without the psychological distress may be involved in the pathogenesis of CRCI as a result of altered coping mechanisms after cancer diagnosis. The development of CRCI is probably multifactorial and the exact mechanisms are currently not completely understood. Possible risk factors include administered treatment, genetic predisposition, age and psychological factors such as anxiety, depression or fatigue. Multiple mechanisms are suggested to be responsible for CRCI, including direct neurotoxic injury of systemic treatment and radiation while other indirect contributing mechanisms are hypothesized. Chronic neuroinflammation mediated by active innate immune system, DNA-damage or endothelial dysfunction is hypothesized to be a central mechanism of CRCI pathogenesis. There is increasing evidence of potential plasma (e.g., damage associated molecular patterns, inflammatory components, circulating microRNAs, exosomes, short-chain fatty acids, and others), cerebrospinal fluid and radiological biomarkers of cognitive dysfunction in cancer patients. Discovery of biomarkers of cognitive impairment is crucial for early identification of cancer patients at increased risk for the development of CRCI or development of treatment strategies to lower the burden of CRCI on long-term quality of life. This review summarizes current literature on CRCI with a focus on long-term effects of different cancer treatments, possible risk factors, mechanisms and promising biomarkers.
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Affiliation(s)
- Zuzana Országhová
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Michal Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
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23
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Groves T, Corley C, Byrum SD, Allen AR. The Effects of 5-Fluorouracil/Leucovorin Chemotherapy on Cognitive Function in Male Mice. Front Mol Biosci 2021; 8:762116. [PMID: 34778377 PMCID: PMC8581634 DOI: 10.3389/fmolb.2021.762116] [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: 08/21/2021] [Accepted: 10/04/2021] [Indexed: 12/14/2022] Open
Abstract
5-Fluorouracil (5-Fu) and leucovorin (LV) are often given in combination to treat colorectal cancer. 5-Fu/LV prevents cell proliferation by inhibiting thymidylate synthase, which catalyzes the conversion of deoxyuridine monophosphate to deoxythymidine monophosphate. While 5-Fu has been shown to cause cognitive impairment, the synergistic effect of 5-Fu with LV has not been fully explored. The present investigation was designed to assess how the combination of 5-Fu and LV affect cognition in a murine model. Six-month-old male mice were used in this study; 15 mice received saline injections and 15 mice received 5-Fu/LV injections. One month after treatment, the elevated plus maze, Y-maze, and Morris water maze behavioral tasks were performed. Brains were then extracted, cryosectioned, and stained for CD68 to assay microglial activation and with tomato lectin to assay the vasculature. All animals were able to locate the visible and hidden platform locations in the water maze. However, a significant impairment in spatial memory retention was observed in the probe trial after the first day of hidden-platform training (first probe trial) in animals that received 5-Fu/LV, but these animals showed spatial memory retention by day 5. There were no significant increases in inflammation as measured by CD68, but 5-Fu/LV treatment did modulate blood vessel morphology. Tandem mass tag proteomics analysis identified 6,049 proteins, 7 of which were differentially expressed with a p-value of <0.05 and a fold change of >1.5. The present data demonstrate that 5-Fu/LV increases anxiety and significantly impairs spatial memory retention.
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Affiliation(s)
- Thomas Groves
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Christa Corley
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Stephanie D Byrum
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Arkansas Children's Research Institute, Little Rock, AR, United States
| | - Antiño R Allen
- Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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24
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Ali AE, Elsherbiny DM, Azab SS, El-Demerdash E. The diuretic amiloride attenuates doxorubicin-induced chemobrain in rats: Behavioral and mechanistic study. Neurotoxicology 2021; 88:1-13. [PMID: 34656704 DOI: 10.1016/j.neuro.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/26/2022]
Abstract
Cognitive impairment or "chemobrain" is a troublesome adverse effect which had been increasingly reported by cancer patients after doxorubicin (DOX) chemotherapy. Notably, Hypertension, a very common comorbidity in cancer patients, could pose a greater risk for negative cognitive outcomes. Amiloride (AML) is an antihypertensive, potassium-sparing diuretic that has been proven to be neuroprotective in different experimental models; this can be attributed to its ability to inhibit different ion transporters such as Na+/H+ exchanger (NHE), which upon excessive activation can result in intracellular cationic overload, followed by oxidative damage and cellular death. Accordingly, this study was designed to investigate the potential neuroprotective effect of AML against DOX-induced chemobrain and to elucidate possible underlying mechanisms. Briefly, Histopathological examination and neurobehavioral testing (Morris water maze, Y maze and passive avoidance test) showed that AML co-treatment (10 mg/kg/day) markedly attenuated DOX (2 mg/kg/week)-induced neurodegeneration and memory impairment after 4 weeks of treatments. We found that DOX administration up-regulated NHE expression and increased lactic acid content in the hippocampus which were markedly opposed by AML. Moreover, AML mitigated DOX-induced neuroinflammation and decreased hippocampal tumor necrosis factor-α level, nuclear factor kappa-B, and cyclooxygenase-2 expression. Additionally, AML counteracted DOX-induced hippocampal oxidative stress as indicated by normalized malondialdehyde and glutathione levels. Furthermore, AML halted DOX-induced hippocampal apoptosis as evidenced by decreased caspase-3 activity and lower cytochrome c immunoexpression. Our results in addition to the previously reported antitumor effects of AML and its ability to mitigate cancer resistance to DOX therapy could point toward possible new repositioning scenarios of the diuretic AML especially regarding hypertensive cancer patients.
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Affiliation(s)
- Alaa Emam Ali
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Doaa Mokhtar Elsherbiny
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Samar S Azab
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Ebtehal El-Demerdash
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
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25
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Moretti RL, Dias EN, Kiel SG, Augusto MCM, Rodrigues PS, Sampaio ACS, Medeiros LS, Martins MFM, Suffredini IB, Cardoso CV, Bondan EF. Behavioral and morphological effects of resveratrol and curcumin in rats submitted to doxorubicin-induced cognitive impairment. Res Vet Sci 2021; 140:242-250. [PMID: 34536813 DOI: 10.1016/j.rvsc.2021.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 08/08/2021] [Accepted: 09/06/2021] [Indexed: 12/24/2022]
Abstract
Doxorubicin (DOX) is known to cause cognitive impairments in patients submitted to long-term chemotherapy (deficits also known as chemobrain). Therefore, there is an urgent need for therapeutic strategies capable of returning cancer survivors back to their previous quality of life. The present study investigated whether resveratrol (RSV) or curcumin (CUR) administration could affect mnemonic function and brain morphological changes following DOX administration in rats. Male Wistar rats were divided into 4 groups: DOX group (2.5 mg/kg/week for 4 weeks, i.p., plus distilled water for 28 days, oral gavage - OG), DOX + RSV group (DOX, 2.5 mg/kg/week for 4 weeks, i.p., plus RSV, 10 mg/kg/day for 28 days, OG), DOX + CUR group (DOX, 2.5 mg/kg/week for 4 weeks, i.p., plus CUR, 100 mg/kg/day for 28 days, OG) and control (CTR) group (0.9% saline solution weekly for 4 weeks, i.p., plus distilled water for 28 days, OG). Behavioral analyses (open field - OF - and the novel object recognition test - NORT) were performed. Brains were collected and analyzed by hematoxylin-eosin and luxol fast blue staining techniques and by immunohistochemistry for GFAP (glial fibrillary acidic protein) expression in astrocytes and Iba1 (ionized calcium-binding adaptor molecule 1) expression in microglia. DOX-injected rats presented short-term and long-term memory impairments as seen in the NORT at 3 and 24 h after habituation and increased GFAP and Iba1 expression, respectively, in astrocytes and microglia of the frontal cortex, hypothalamus and hippocampus. Such cognitive deficits were prevented by CUR at both periods and by RSV at 24 h. DOX-induced astrogliosis and microgliosis were avoided by RSV and CUR. No signs of demyelination or neuronal loss were found in any group. Thus, CUR and RSV prevented memory loss, astrogliosis and microgliosis induced by DOX monotherapy.
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Affiliation(s)
- R L Moretti
- Graduate Program in Environmental and Experimental Pathology, University Paulista, Rua Doutor Bacelar, 1212, 4th Floor, São Paulo, SP, 04026-002, Brazil
| | - E N Dias
- Department of Veterinary Medicine, University Cruzeiro do Sul, Avenida Tenente, Laudelino Ferreira do Amaral, 700, São Paulo, SP, 08060-000, Brazil
| | - S G Kiel
- Graduate Program in Environmental and Experimental Pathology, University Paulista, Rua Doutor Bacelar, 1212, 4th Floor, São Paulo, SP, 04026-002, Brazil
| | - M C M Augusto
- Graduate Program in Environmental and Experimental Pathology, University Paulista, Rua Doutor Bacelar, 1212, 4th Floor, São Paulo, SP, 04026-002, Brazil
| | - P S Rodrigues
- Graduate Program in Environmental and Experimental Pathology, University Paulista, Rua Doutor Bacelar, 1212, 4th Floor, São Paulo, SP, 04026-002, Brazil
| | - A C S Sampaio
- Graduate Program in Environmental and Experimental Pathology, University Paulista, Rua Doutor Bacelar, 1212, 4th Floor, São Paulo, SP, 04026-002, Brazil
| | - L S Medeiros
- Graduate Program in Environmental and Experimental Pathology, University Paulista, Rua Doutor Bacelar, 1212, 4th Floor, São Paulo, SP, 04026-002, Brazil
| | - M F M Martins
- Department of Veterinary Medicine, University Cruzeiro do Sul, Avenida Tenente, Laudelino Ferreira do Amaral, 700, São Paulo, SP, 08060-000, Brazil
| | - I B Suffredini
- Graduate Program in Environmental and Experimental Pathology, University Paulista, Rua Doutor Bacelar, 1212, 4th Floor, São Paulo, SP, 04026-002, Brazil
| | - C V Cardoso
- Graduate Program in Environmental and Experimental Pathology, University Paulista, Rua Doutor Bacelar, 1212, 4th Floor, São Paulo, SP, 04026-002, Brazil
| | - E F Bondan
- Graduate Program in Environmental and Experimental Pathology, University Paulista, Rua Doutor Bacelar, 1212, 4th Floor, São Paulo, SP, 04026-002, Brazil; Department of Veterinary Medicine, University Cruzeiro do Sul, Avenida Tenente, Laudelino Ferreira do Amaral, 700, São Paulo, SP, 08060-000, Brazil.
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26
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Rodríguez Martín B, Fernández Rodríguez EJ, Rihuete Galve MI, Cruz Hernández JJ. Study of Chemotherapy-Induced Cognitive Impairment in Women with Breast Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238896. [PMID: 33265966 PMCID: PMC7730121 DOI: 10.3390/ijerph17238896] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/02/2020] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Abstract
Background: Oncology patients experience a large number of symptoms and, those referring to cognitive performance has an ever-increasing importance in clinical practice, due to the increase in survival rates and interest in the patient’s quality of life. The studies reviewed showed that chemotherapy-related cognitive impairment might occur in 15 and 50% of oncology patients. The main objective of this research was to study the impact of chemotherapy on the cognitive function of patients with locoregional breast cancer. Method: Analytical, prospective, longitudinal study using three measures, unifactorial intrasubject design, non-probability, and random selection sampling. The sample comprised women newly diagnosed with locoregional breast cancer in stages I, II, IIIA who received chemotherapy at the University Hospital of Salamanca (Complejo Asistencial Universitario de Salamanca), randomly selected for three years. Semi-structured interviews were conducted, and anxiety and depression (Hospital Anxiety and Depression scale, HAD); quality of life (QLQ-BR23 scale) and the following cognitive variables were assessed—processing speed, attention, memory, and executive functions (subtests of the Wechsler Intelligence Scale and the Trail Making Test). Results: The final sample size included 151 participants; 23 were excluded. A decline in cognitive performance was observed in patients, which did not completely recover two months after chemotherapy was completed. Additionally, worse cognitive performance was observed in patients with anxious or depressive symptoms. There was a negative impact on the quality of life. Conclusion: Chemotherapy had an impact on the cognitive performance of oncology patients in most cognitive domains studied.
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Affiliation(s)
- Blanca Rodríguez Martín
- Medical Oncology Service, Salamanca University Hospital, 37007 Salamanca, Spain; (E.J.F.R.); (M.I.R.G.); (J.J.C.H.)
- Correspondence:
| | - Eduardo José Fernández Rodríguez
- Medical Oncology Service, Salamanca University Hospital, 37007 Salamanca, Spain; (E.J.F.R.); (M.I.R.G.); (J.J.C.H.)
- Nursing and Physiotherapy Department, University of Salamanca, 37007 Salamanca, Spain
| | - María Isabel Rihuete Galve
- Medical Oncology Service, Salamanca University Hospital, 37007 Salamanca, Spain; (E.J.F.R.); (M.I.R.G.); (J.J.C.H.)
- Nursing and Physiotherapy Department, University of Salamanca, 37007 Salamanca, Spain
| | - Juan Jesús Cruz Hernández
- Medical Oncology Service, Salamanca University Hospital, 37007 Salamanca, Spain; (E.J.F.R.); (M.I.R.G.); (J.J.C.H.)
- Medicine Department, University of Salamanca, 37007 Salamanca, Spain
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27
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Changes in Fatigue, Psychological Distress, and Quality of Life After Chemotherapy in Women with Breast Cancer: A Prospective Study. Cancer Nurs 2020; 43:E54-E60. [PMID: 30601265 DOI: 10.1097/ncc.0000000000000689] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chemotherapy leads to various symptoms and psychological distress, which contribute to a significant decrease in the quality of life of the patients. OBJECTIVES The aim of this study was to identify changes and interrelationships in the fatigue-depression-anxiety symptom cluster and quality of life during the cancer care trajectory in women with breast cancer. METHODS Fifty women participated in the study and completed questionnaires at 3 different times: prechemotherapy, postchemotherapy, and 6 months after the completion of chemotherapy. The assessment tools were the Functional Assessment of Cancer Therapy-Fatigue Scale, Hospital Anxiety and Depression Scale, and Functional Assessment of Cancer Therapy-Breast Cancer version 4 Scale. Data were analyzed using descriptive and repeated-measures analysis of variance statistics. RESULTS A significant increase in fatigue (F = 41.95, P < .001) and psychological distress (F = 26.55, P < .001) from prechemotherapy to postchemotherapy was noted. Improvement was observed 6 months after the completion of chemotherapy. A positive or negative change in fatigue was associated with the same in psychological distress. Quality of life (F = 65.22, P < .001) also showed similar change patterns as observed with fatigue and psychological distress. Fatigue had a greater impact on quality of life at postchemotherapy, but psychological distress had a greater impact at prechemotherapy and at the 6-month follow-up. CONCLUSION These results suggest that chemotherapy is highly associated with the fatigue-depression-anxiety symptom cluster and quality of life in women with breast cancer. IMPLICATIONS FOR PRACTICE Nursing intervention is needed to relieve the intensity of the fatigue-depression-anxiety symptom cluster and thus improve the quality of life of patients undergoing chemotherapy from before treatment to follow-up.
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28
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Costa DS, Mercieca‐bebber R, Rutherford C, Gabb L, King MT. The Impact of Cancer on Psychological and Social Outcomes. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12165] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Daniel Sj Costa
- Quality of Life Office, Psycho‐oncology Co‐operative Research Group, School of Psychology, University of Sydney,
| | - Rebecca Mercieca‐bebber
- Quality of Life Office, Psycho‐oncology Co‐operative Research Group, School of Psychology, University of Sydney,
| | - Claudia Rutherford
- Quality of Life Office, Psycho‐oncology Co‐operative Research Group, School of Psychology, University of Sydney,
| | | | - Madeleine T King
- Quality of Life Office, Psycho‐oncology Co‐operative Research Group, School of Psychology, University of Sydney,
- Sydney Medical School, University of Sydney,
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29
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Turrina S, Gibelli F, De Leo D. Chemotherapy-induced cognitive impairment from the forensic medicine perspective: A review of the updated literature. J Forensic Leg Med 2020; 76:102070. [PMID: 33099125 DOI: 10.1016/j.jflm.2020.102070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/05/2020] [Accepted: 10/10/2020] [Indexed: 11/15/2022]
Abstract
Chemotherapy treatments in some neoplastic patients can cause unwanted side-effects that can be accompanied by a physical weakening due to changes in executive functioning, processing speed and reaction times with a consequent inability to carry out daily life activities (ADL) or a working disability due to the loss of working memory and the inability to organize fundamental skills, influencing the quality of everyday life. Although chemotherapy-induced cognitive impairment (CICI), also known as post-chemotherapy cognitive impairment (PCCI), chemo-brain or chemo-fog, has been described in the literature since the late 1980s, the neurobiological factors behind this pathology to date are not yet fully understood. According to the finding of most studies conducted on patients affected by different forms of neoplastic diseases, there are strong enough evidence of a prominent role of some drug such as doxorubicin, cyclophosphamide, cytarabine, methotrexate, 5-fluorouracil and cisplatin in causing chemo-fog related neurological impairment. The physical incapacity that affects the patients seems, therefore, to be related to the cytotoxic effects that the chemotherapy drugs exert on the central nervous system, causing a short or long-term neurological decline. Cognitive dysfunctions could influence individual self-determination by configuring a state of transient or habitual mental infirmity capable of altering the preservation of the person's voluntary faculties, with potential consequences on the legal validity of any deeds signed by the person. The growing interest in this pathological condition by the forensic medicine community is due precisely to the non-negligible medico-legal implications that derive from it affecting aspects of private law. In this article, a review of the literature on chemotherapy-induced cognitive impairment and related issues that may arise in forensic medicine and private law was conducted.
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Affiliation(s)
- Stefania Turrina
- Department of Diagnostics and Public Health - Institute of Legal Medicine, University of Verona, P.le L.A. Scuro 10, Verona, Italy.
| | - Filippo Gibelli
- Department of Diagnostics and Public Health - Institute of Legal Medicine, University of Verona, P.le L.A. Scuro 10, Verona, Italy
| | - Domenico De Leo
- Department of Diagnostics and Public Health - Institute of Legal Medicine, University of Verona, P.le L.A. Scuro 10, Verona, Italy
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30
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Mounier NM, Abdel-Maged AES, Wahdan SA, Gad AM, Azab SS. Chemotherapy-induced cognitive impairment (CICI): An overview of etiology and pathogenesis. Life Sci 2020. [DOI: https://doi.org/10.1016/j.lfs.2020.118071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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31
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Wang J, Lian CL, Zheng H, Lin LE, Yu YF, Lin Q, Wu SG. Cognitive dysfunction in patients with nasopharyngeal carcinoma after induction chemotherapy. Oral Oncol 2020; 111:104921. [PMID: 32763779 DOI: 10.1016/j.oraloncology.2020.104921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/19/2020] [Indexed: 12/08/2022]
Abstract
OBJECTIVE This prospective study aimed to assess the incidence, details of the change of cognitive dysfunction, and predictive factors of cognitive function impairment associated with induction chemotherapy (IC) in nasopharyngeal carcinoma (NPC) patients. METHOD We prospectively included NPC patients who treated with IC from December 2018 to January 2020. Montreal cognitive assessment (MoCA) was used to measure cognitive function, and score less than 26 was defined as cognitive dysfunction. Multivariate logistic regression analysis was applied to assess the independent predictors associated with cognitive function impairment. RESULTS A total of 76 patients were recruited, 10 patients were excluded due to refusal or unable to finish the questionnaire, and 66 patients were analyzed in this study. The median age of the patients was 48.5 years (range, 24-69 years). There was 89.4% of patients received ≥3 circles of IC. For the entire group, 27.3% had cognitive dysfunction, of which attention, language, short-term memory, and orientation showed significant downward trends, while visuospatial/executive function, naming, and abstraction demonstrated no prominent decrease. In patients having cognitive function impairment, 77.8% of them occurred after the first circle of IC. Gender (P = 0.039) and education (P = 0.03) were significant predictors for cognitive dysfunction. Female patients (female vs. male: 50% vs. 20%) and patients with lower educational levels (lower vs. higher: 37.8% vs. 11.8%) were more likely to suffer cognitive dysfunction. In addition, age (P = 0.572) and chemotherapy circles (P = 0.68) had no association with cognitive dysfunction. CONCLUSION Approximately 25% of NPC patients suffered cognitive dysfunction after IC, especially in female patients and patients with lower educational levels.
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Affiliation(s)
- Jun Wang
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Chen-Lu Lian
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Hua Zheng
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Li-E Lin
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Yi-Feng Yu
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, People's Republic of China
| | - Qin Lin
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, People's Republic of China.
| | - San-Gang Wu
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, People's Republic of China.
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32
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Correlates of cognitive impairment in adult cancer survivors who have received chemotherapy and report cognitive problems. Support Care Cancer 2020; 29:1377-1386. [PMID: 32666213 PMCID: PMC10109511 DOI: 10.1007/s00520-020-05616-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/03/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Cognitive impairment negatively affects some cancer survivors who have completed chemotherapy; however, factors underlying this cognitive impairment remain poorly understood. We aimed to investigate (1) the relative importance of demographics, medical, and psychological characteristics associated with cognitive impairment and (2) the specific variables associated with cognitive impairment in adult cancer survivors who completed adjuvant chemotherapy. METHODS We performed post hoc analyses of baseline data from early-stage cancer survivors with cognitive complaints who received adjuvant chemotherapy 0.5-5 years earlier and volunteered for a trial designed to improve cognition. The primary outcome of self-reported cognitive impairment was measured using a questionnaire; secondary outcome of objective cognitive impairment was measured using a computerized neuropsychological test battery. Hierarchical linear regression determined the relative importance of demographics, medical, and psychological characteristics in associations with both self-reported and objective cognitive impairment. RESULTS The sample was 95% female and 89% breast cancer patients. The final model accounted for 33% of variation in self-reported cognitive impairment (n = 212, demographics 5%, medical 3%, and psychological 25%), with fatigue and stress as significant individual correlates (p values ≤ 0.0001). For the secondary analysis, the final model accounted for 19% of variation in objective cognitive impairment (n = 206, demographics 10%, medical 5%, and psychological 4%), with age, smoking history, and number of chemotherapy cycles as significant individual correlates. CONCLUSION We found that psychological characteristics are more important than demographic and medical characteristics in self-reported cognitive impairment, whereas other characteristics are more important in objective cognitive impairment. This suggests clinicians should investigate possible psychological problems in cancer survivors who self-report cognitive impairment.
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Chemotherapy-induced cognitive impairment (CICI): An overview of etiology and pathogenesis. Life Sci 2020; 258:118071. [PMID: 32673664 DOI: 10.1016/j.lfs.2020.118071] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/26/2020] [Accepted: 07/06/2020] [Indexed: 02/08/2023]
Abstract
Many cancer patients treated with chemotherapy develop chemotherapy-induced cognitive impairment (CICI), often referred to as chemo-brain, which manifest during or post-treatment with variable degrees, onset and duration thereby affecting the patients' quality of life. Several chemotherapeutic agents have been studied to determine its possible association with cognitive impairment and to fully comprehend their contribution to CICI. A vast number of studies have emerged proposing several candidate underlying mechanisms and etiologies contributing to CICI such as direct neurotoxicity, BBB disruption, decreased hippocampal neurogenesis, white matter abnormalities, secondary neuro-inflammatory response and increased oxidative stress; however, the exact underlying mechanisms are still not well defined. This review summarizes CICI associated with most commonly used chemotherapeutic agents with emphasizes the possible underlying pathogenesis in both animal and clinical studies.
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da Costa R, Passos GF, Quintão NL, Fernandes ES, Maia JRL, Campos MM, Calixto JB. Taxane-induced neurotoxicity: Pathophysiology and therapeutic perspectives. Br J Pharmacol 2020; 177:3127-3146. [PMID: 32352155 PMCID: PMC7312267 DOI: 10.1111/bph.15086] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/17/2020] [Accepted: 04/25/2020] [Indexed: 12/28/2022] Open
Abstract
Taxane-derived drugs are antineoplastic agents used for the treatment of highly common malignancies. Paclitaxel and docetaxel are the most commonly used taxanes; however, other drugs and formulations have been used, such as cabazitaxel and nab-paclitaxel. Taxane treatment is associated with neurotoxicity, a well-known and relevant side effect, very prevalent amongst patients undergoing chemotherapy. Painful peripheral neuropathy is the most dose-limiting side effect of taxanes, affecting up to 97% of paclitaxel-treated patients. Central neurotoxicity is an emerging side effect of taxanes and it is characterized by cognitive impairment and encephalopathy. Besides impairing compliance to chemotherapy treatment, taxane-induced neurotoxicity (TIN) can adversely affect the patient's life quality on a long-term basis. Despite the clinical relevance, not many reviews have comprehensively addressed taxane-induced neurotoxicity when they are used therapeutically. This article provides an up-to-date review on the pathophysiology of TIN and the novel potential therapies to prevent or treat this side effect.
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Affiliation(s)
- Robson da Costa
- Faculdade de FarmáciaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrazil
| | - Giselle F. Passos
- Faculdade de FarmáciaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrazil
| | - Nara L.M. Quintão
- Programa de Pós‐graduação em Ciências FarmacêuticasUniversidade do Vale do ItajaíItajaíSCBrazil
| | - Elizabeth S. Fernandes
- Instituto Pelé Pequeno PríncipeCuritibaPRBrazil
- Programa de Pós‐graduação em Biotecnologia Aplicada à Saúde da Criança e do AdolescenteFaculdades Pequeno PríncipeCuritibaPRBrazil
| | | | - Maria Martha Campos
- Escola de Ciências da Saúde e da VidaPontifícia Universidade Católica do Rio Grande do SulPorto AlegreRSBrazil
| | - João B. Calixto
- Centro de Inovação e Ensaios Pré‐clínicos ‐ CIEnPFlorianópolisSCBrazil
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Connectome analysis of brain functional network alterations in breast cancer survivors with and without chemotherapy. PLoS One 2020; 15:e0232548. [PMID: 32365133 PMCID: PMC7197781 DOI: 10.1371/journal.pone.0232548] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/16/2020] [Indexed: 01/31/2023] Open
Abstract
Purpose Treatment modalities for breast cancer, the leading cause of cancer-related deaths in women worldwide, include surgery, radiotherapy, adjuvant chemotherapy, targeted therapy, and hormonal therapy. The advancement in medical technology has facilitated substantial reduction in breast cancer mortality. However, patients may experience cognitive impairment after chemotherapy. This phenomenon called chemotherapy-induced cognitive impairment (i.e., “chemobrain”) is common among breast cancer survivors. However, cognitive function deficits may exist before chemotherapy initiation. This study examined the functional network alterations in breast survivors by using resting-state functional magnetic resonance imaging (fMRI). Methods We recruited 172 female participants and separated them into three groups: C+ (57 breast cancer survivors who had finished 3–12-month-long chemotherapy), C- (45 breast cancer survivors who had not undergone chemotherapy), and HC (70 participants with no breast cancer history). We analyzed mean fractional amplitudes of low-frequency fluctuation and graph theoretical topologies from resting-state fMRI and applied network-based analysis to portray functional changes among the three groups. Results Among the three groups, the C- group demonstrated hyperactivity in the prefrontal cortex, bilateral middle temporal gyrus, right inferior temporal gyrus and right angular gyrus. Only the left caudate demonstrated significantly more hypoactivity in the C- group than in the C+ group. Graph theoretical analysis demonstrated that the brains of the C+ group became inclined toward regular networks and the brains of the C- group became inclined toward random networks. Conclusion Subtle alterations were noted in the brain activity and networks of our cancer survivors. Moreover, functional network disruptions occurred regardless of chemotherapeutic agent administration.
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Demby TC, Rodriguez O, McCarthy CW, Lee YC, Albanese C, Mandelblatt J, Rebeck GW. A mouse model of chemotherapy-related cognitive impairments integrating the risk factors of aging and APOE4 genotype. Behav Brain Res 2020; 384:112534. [PMID: 32027870 PMCID: PMC7082850 DOI: 10.1016/j.bbr.2020.112534] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/22/2020] [Accepted: 02/01/2020] [Indexed: 01/05/2023]
Abstract
Some cancer survivors experience marked cognitive impairment, referred to as cancer-related cognitive impairment (CRCI). CRCI has been linked to the genetic factor APOE4, the strongest genetic risk factor for Alzheimer's disease (AD). We used APOE knock-in mice to test whether the relationship between APOE4 and CRCI can be demonstrated in a mouse model, to identify associations of chemotherapy with behavioural and structural correlates of cognition, and to test whether chemotherapy affects markers of AD. Twelve-month old C57BL/6 J female APOE3 (n = 30) and APOE4 (n = 31) knock-in mice were randomized to treatment with either doxorubicin (10 mg/kg) or saline. Behavioural assays at 2-21 weeks-post exposure included open field maze, elevated zero maze, pre-pulse inhibition, Barnes maze, and fear conditioning. Ex-vivo magnetic resonance imaging was used to determine regional volume differences at 31-35 weeks-post exposure, and tissue sections were analyzed for markers of AD pathogenesis. Minimal toxicities were observed in the aged mice after doxorubicin exposure. In the Barnes maze assay, APOE3 mice did not exhibit impairment in spatial learning after doxorubicin treatment, but APOE4 mice demonstrated significant impairments in both the initial identification of the escape hole and the latency to full escape at 6 weeks post-exposure. Both APOE3 and APOE4 mice treated with doxorubicin showed impairment of spatial memory. Grey matter volume in the frontal cortex decreased in APOE4 mice treated with doxorubicin vs. APOE3 mice. This study demonstrates cognitive impairments in aged APOE4 knock-in mice after doxorubicin treatment and establishes this system as a novel and powerful model of CRCI.
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Affiliation(s)
- Tamar C Demby
- Tumor Biology Program, Georgetown University Medical Center, Washington DC United States
| | - Olga Rodriguez
- Department of Oncology, Molecular Oncology Program, Georgetown University Medical Center, Washington DC United States; Center for Translational Imaging, Georgetown University Medical Center, Washington DC, United States
| | - Camryn W McCarthy
- Department of Neuroscience, Georgetown University Medical Center, Washington DC United States
| | - Yi-Chien Lee
- Department of Oncology, Molecular Oncology Program, Georgetown University Medical Center, Washington DC United States; Center for Translational Imaging, Georgetown University Medical Center, Washington DC, United States
| | - Christopher Albanese
- Department of Oncology, Molecular Oncology Program, Georgetown University Medical Center, Washington DC United States; Center for Translational Imaging, Georgetown University Medical Center, Washington DC, United States
| | - Jeanne Mandelblatt
- Department of Oncology, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington DC, United States
| | - G William Rebeck
- Department of Neuroscience, Georgetown University Medical Center, Washington DC United States.
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Yi LT, Dong SQ, Wang SS, Chen M, Li CF, Geng D, Zhu JX, Liu Q, Cheng J. Curcumin attenuates cognitive impairment by enhancing autophagy in chemotherapy. Neurobiol Dis 2020; 136:104715. [PMID: 31843707 DOI: 10.1016/j.nbd.2019.104715] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/13/2019] [Accepted: 12/13/2019] [Indexed: 12/30/2022] Open
Abstract
Cisplatin, a commonly used chemotherapy drug, can increase the survival rate of cancer patients. However, it often causes various side effects, including neuronal deficit-induced cognitive impairment. Considering that curcumin is effective in neuronal protection, the action of curcumin on cognitive improvement was evaluated in cisplatin-treated C57BL/6 mice in the present study. Our results first showed that curcumin restored impaired cognitive behaviors. Consistent with this, neurogenesis and synaptogenesis were improved by curcumin. In addition, cisplatin-induced dysfunction of apoptosis-related proteins was partly reversed by curcumin. Moreover, cisplatin-induced autophagy was enhanced by curcumin. Our results also indicated that cisplatin induced autophagy through the endoplasmic reticulum (ER) stress-mediated ATF4-Akt-mTOR signaling pathway. Curcumin activated AMPK-JNK signaling, which mediated both mTOR inhibition and Bcl-2 upregulation and in turn enhanced autophagy and suppressed apoptosis, respectively. In contrast, pretreatment with the autophagy inhibitor 3-methyladenine (3-MA) completely abolished the effects of curcumin on cognitive improvement and improved neurogenesis, synaptogenesis and autophagy. Our results show that cognitive improvement induced by curcumin during chemotherapy is mediated by the enhancement of hippocampal autophagy.
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Affiliation(s)
- Li-Tao Yi
- Department of Chemical and Pharmaceutical Engineering, College of Chemical Engineering, Huaqiao University, Xiamen 361021, Fujian, People's Republic of China; Institute of Pharmaceutical Engineering, Huaqiao University, Xiamen 361021, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Biochemical Technology, Huaqiao University, Xiamen 361021, Fujian, People's Republic of China.
| | - Shu-Qi Dong
- Department of Chemical and Pharmaceutical Engineering, College of Chemical Engineering, Huaqiao University, Xiamen 361021, Fujian, People's Republic of China
| | - Shuang-Shuang Wang
- Department of Chemical and Pharmaceutical Engineering, College of Chemical Engineering, Huaqiao University, Xiamen 361021, Fujian, People's Republic of China
| | - Min Chen
- Department of Chemical and Pharmaceutical Engineering, College of Chemical Engineering, Huaqiao University, Xiamen 361021, Fujian, People's Republic of China
| | - Cheng-Fu Li
- Xiamen Hospital of Traditional Chinese Medicine, Xiamen 361009, Fujian, People's Republic of China
| | - Di Geng
- Department of Chemical and Pharmaceutical Engineering, College of Chemical Engineering, Huaqiao University, Xiamen 361021, Fujian, People's Republic of China; Institute of Pharmaceutical Engineering, Huaqiao University, Xiamen 361021, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Biochemical Technology, Huaqiao University, Xiamen 361021, Fujian, People's Republic of China
| | - Ji-Xiao Zhu
- Research Center of Natural Resources of Chinese Medicinal Materials and Ethnic Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, Jiangxi, People's Republic of China
| | - Qing Liu
- Department of Chemical and Pharmaceutical Engineering, College of Chemical Engineering, Huaqiao University, Xiamen 361021, Fujian, People's Republic of China; Institute of Pharmaceutical Engineering, Huaqiao University, Xiamen 361021, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Biochemical Technology, Huaqiao University, Xiamen 361021, Fujian, People's Republic of China
| | - Jie Cheng
- Department of Chemical and Pharmaceutical Engineering, College of Chemical Engineering, Huaqiao University, Xiamen 361021, Fujian, People's Republic of China; Institute of Pharmaceutical Engineering, Huaqiao University, Xiamen 361021, Fujian, People's Republic of China; Fujian Provincial Key Laboratory of Biochemical Technology, Huaqiao University, Xiamen 361021, Fujian, People's Republic of China
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Hormozi M, Hashemi SM, Shahraki S. Investigating Relationship between Pre- and Post- Chemotherapy Cognitive Performance with Levels of Depression and Anxiety in Breast Cancer Patients: A Cross-Sectional Study. Asian Pac J Cancer Prev 2019; 20:3831-3837. [PMID: 31870129 PMCID: PMC7173396 DOI: 10.31557/apjcp.2019.20.12.3831] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Evidence suggests that cancer and chemotherapy-related cognitive impairments are an important clinical issue that can have a negative impact on the quality of life (QOL) of many cancer patients during and after treatment. The aim of the current study was to investigate the relationship between cognitive performance before and after chemotherapy with levels of depression and anxiety in patients with breast cancer. MATERIALS AND METHODS This cross-sectional descriptive-analytical study was performed on 100 women with breast cancer in south of Iran. Patients included in the study were evaluated for cognitive performance before chemotherapy and 1, 3, and 6 months after chemotherapy. Patients' cognitive performance was assessed by Mini-Mental State Examination (MMSE). Patients were also assessed for their level of anxiety and depression using Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Descriptive tests (percentage, frequency and mean) and ANOVA test used for statistical analysis. RESULTS Results of ANOVA test showed a significant difference between the cognitive performance of patients with breast cancer at 1, 3, and 6 months after chemotherapy compared to pre- chemotherapy phase. The above test also revealed a significant relationship between cognitive performance of patients and anxiety and depression. CONCLUSION The results showed that, due to the decrease in cognitive performance and increased anxiety and depression after initiation of chemotherapy in patients with breast cancer, it is necessary to closely monitor the mental and psychological status of these patients by their family and the treatment staffs so that the patient be able to cope with the disease more optimally and to recover.
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Affiliation(s)
| | - Seyed-Mehdi Hashemi
- Clinical Immunology Research Center, Department of Internal Medicine, Hematology and Medical Oncology Ward, Ali-Ebne-Abitalelb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Sara Shahraki
- GP, Zahedan University of Medical Sciences, Zahedan, Iran
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Huehnchen P, van Kampen A, Boehmerle W, Endres M. Cognitive impairment after cytotoxic chemotherapy. Neurooncol Pract 2019; 7:11-21. [PMID: 32257280 DOI: 10.1093/nop/npz052] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Neurotoxicity is a frequent side effect of cytotoxic chemotherapy and affects a large number of patients. Despite the high medical need, few research efforts have addressed the impact of cytotoxic agents on cognition (ie, postchemotherapy cognitive impairment; PCCI). One unsolved question is whether individual cytotoxic drugs have differential effects on cognition. We thus examine the current state of research regarding PCCI. Neurological symptoms after targeted therapies and immunotherapies are not part of this review. Methods A literature search was conducted in the PubMed database, and 1215 articles were reviewed for predefined inclusion and exclusion criteria. Thirty articles were included in the systematic review. Results Twenty-five of the included studies report significant cognitive impairment. Of these, 21 studies investigated patients with breast cancer. Patients mainly received combinations of 5-fluorouracil, epirubicin, cyclophosphamide, doxorubicin, and taxanes (FEC/FEC-T). Five studies found no significant cognitive impairment in chemotherapy patients. Of these, 2 studies investigated patients with colon cancer receiving 5-fluorouracil and oxaliplatin (FOLFOX). Independent risk factors for PCCI were patient age, mood alterations, cognitive reserve, and the presence of apolipoprotein E e4 alleles. Conclusions There is evidence that certain chemotherapy regimens cause PCCI more frequently than others as evidenced by 21 out of 23 studies in breast cancer patients (mainly FEC-T), whereas 2 out of 3 studies with colon cancer patients (FOLFOX) did not observe significant changes. Further studies are needed defining patient cohorts by treatment protocol in addition to cancer type to elucidate the effects of individual cytotoxic drugs on cognitive functions.
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Affiliation(s)
- Petra Huehnchen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik und Hochschulambulanz für Neurologie, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Cluster of Excellence NeuroCure, Germany.,Berlin Institute of Health, Germany
| | - Antonia van Kampen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik und Hochschulambulanz für Neurologie, Germany
| | - Wolfgang Boehmerle
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik und Hochschulambulanz für Neurologie, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Cluster of Excellence NeuroCure, Germany
| | - Matthias Endres
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik und Hochschulambulanz für Neurologie, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Cluster of Excellence NeuroCure, Germany.,Berlin Institute of Health, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Stroke Research Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Germany
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Vega JN, Albert KM, Mayer IA, Taylor WD, Newhouse PA. Nicotinic treatment of post-chemotherapy subjective cognitive impairment: a pilot study. J Cancer Surviv 2019; 13:673-686. [PMID: 31338732 PMCID: PMC6993088 DOI: 10.1007/s11764-019-00786-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/04/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Persistent chemotherapy-related cognitive impairment (pCRCI) is commonly reported following cancer treatment and negatively affects quality of life; however, there is currently no pharmacological treatment indicated for pCRCI. This pilot study obtained preliminary data regarding the use of transdermal nicotine patches as a therapeutic strategy for women with pCRCI to (1) reduce subjective cognitive complaints and (2) enhance objective cognitive performance in breast, colon, lymphoma, or ovarian cancer survivors with pCRCI. METHODS Participants were randomized to either placebo (n = 11) or transdermal nicotine (n = 11) for 6 weeks, followed by 2 weeks of treatment withdrawal for a total of 8 weeks. Participants were assessed using both subjective and objective measures of cognitive functioning at five visits before, during, and after treatment. RESULTS Over the course of the study, women in both groups improved substantially in severity of self-reported cognitive complaints measured by Functional Assessment of Cancer Therapy-Cognitive Function Perceived Cognitive Impairments regardless of treatment arm. Additionally, objective cognitive performance measures improved in both groups; however, there was no significant difference in improvement between groups. CONCLUSIONS Due to a large placebo response, we were unable to determine if a drug effect was present. However, we did observe substantial improvement in self-reported cognitive symptoms, likely resulting from factors related to participation in the trial rather than specific drug treatment effects. TRIAL REGISTRATION The study was registered with clinicaltrials.gov (trial registration: NCT02312943). IMPLICATIONS FOR CANCER SURVIVORS These results suggest that women with pCRCI can exhibit improvement in subjective cognition, with attention paid to symptoms and close follow-up over a short period of time.
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Affiliation(s)
- Jennifer N Vega
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave. South, Nashville, TN, 37212, USA.
| | - Kimberly M Albert
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave. South, Nashville, TN, 37212, USA
| | - Ingrid A Mayer
- Department of Medicine, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Warren D Taylor
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave. South, Nashville, TN, 37212, USA
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
| | - Paul A Newhouse
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave. South, Nashville, TN, 37212, USA
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
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Cardoso CV, de Barros MP, Bachi ALL, Bernardi MM, Kirsten TB, de Fátima Monteiro Martins M, Rocha PRD, da Silva Rodrigues P, Bondan EF. Chemobrain in rats: Behavioral, morphological, oxidative and inflammatory effects of doxorubicin administration. Behav Brain Res 2019; 378:112233. [PMID: 31521736 DOI: 10.1016/j.bbr.2019.112233] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/15/2019] [Accepted: 09/11/2019] [Indexed: 02/07/2023]
Abstract
Doxorubicin (DOX) is known to cause cognitive impairments in patients submitted to long-term chemotherapy (deficits also known as chemobrain). The present study investigated whether DOX administration could affect behavior and brain morphology, as well as oxidative and inflammatory status in rats. Male Wistar rats were injected with DOX (2.5 mg/kg/week, 4 weeks, i.p.) or saline. Behavioral analyses were performed. Brains were collected and analyzed by hematoxylin-eosin and luxol fast blue staining techniques and by immunohistochemistry (for glial fibrillary acidic protein expression in astrocytes; GFAP). Serum and brain levels of TNF-α, IL-1β, IL-6, IL-8, IL-10 and CXCL-1 were determined. Oxidative parameters, such as superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR), nitric oxide (NO•), brain iron and ferritin levels, as well as reduced and oxidized glutathione (GSH and GSSG, respectively) and thiobarbituric acid reactive substances (TBARS) were also assessed in brain. DOX-injected rats presented cognitive/memory impairments, increased GFAP expression, increased levels of TBARS, NO and GR, but decreased GSSG and ferritin levels in brain homogenate. In addition, increased serum and brain levels of IL-6, IL-8 and CXCL1 were noted in the DOX group, although IL-10 decreased. As DOX has a poor penetration across the blood-brain barrier (BBB), it is proposed that this drug elicits a systemic proinflammatory response with increase of proinflammatory cytokines which cross the BBB and can be involved in the induction of oxidative molecules and proinflammatory cytokines that altogether induce astrogliosis all over the brain. These events may be responsable for chemotherapy-induced cognitive/memory deficits.
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Affiliation(s)
- Carolina Vieira Cardoso
- Graduate Program in Environmental and Experimental Pathology, University Paulista, Rua Doutor Bacelar, 1212, 4th Floor, São Paulo (SP), 04026-002, Brazil.
| | - Marcelo Paes de Barros
- Institute of Physical Activity and Sports Science (ICAFE), University Cruzeiro do Sul, Rua Galvão Bueno 868, Building B, 13th Floor, São Paulo (SP), 01506-000, Brazil
| | - André Luís Lacerda Bachi
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Rua Pedro Ernesto, 240, São José dos Campos (SP), 12245-520, Brazil; Department of Otorhinolaryngology, Federal University of São Paulo, Rua Pedro de Toledo, 947, São Paulo (SP), 04039-002, Brazil
| | - Maria Martha Bernardi
- Graduate Program in Environmental and Experimental Pathology, University Paulista, Rua Doutor Bacelar, 1212, 4th Floor, São Paulo (SP), 04026-002, Brazil
| | - Thiago Berti Kirsten
- Graduate Program in Environmental and Experimental Pathology, University Paulista, Rua Doutor Bacelar, 1212, 4th Floor, São Paulo (SP), 04026-002, Brazil
| | - Maria de Fátima Monteiro Martins
- School of Veterinary Medicine, University Cruzeiro do Sul, Avenida Tenente Laudelino Ferreira do Amaral, 700, São Paulo (SP), 08060-000, Brazil
| | - Paulo Ricardo Dell'Armelina Rocha
- Graduate Program in Environmental and Experimental Pathology, University Paulista, Rua Doutor Bacelar, 1212, 4th Floor, São Paulo (SP), 04026-002, Brazil
| | - Paula da Silva Rodrigues
- Graduate Program in Environmental and Experimental Pathology, University Paulista, Rua Doutor Bacelar, 1212, 4th Floor, São Paulo (SP), 04026-002, Brazil
| | - Eduardo Fernandes Bondan
- Graduate Program in Environmental and Experimental Pathology, University Paulista, Rua Doutor Bacelar, 1212, 4th Floor, São Paulo (SP), 04026-002, Brazil.
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Lee JR, Oh PJ. [A Structural Model for Chemotherapy Related Cognitive Impairment and Quality of Life in Breast Cancer Patients]. J Korean Acad Nurs 2019; 49:375-385. [PMID: 31477668 DOI: 10.4040/jkan.2019.49.4.375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to develop and test a structural model for chemotherapy-related cognitive impairment of breast cancer patients based on a literature review and Hess and Insel's chemotherapy-related cognitive change model. METHODS The Participants consisted of 250 patients who were ≥19 years of age. The assessment tools included the Menopause Rating Scale, Symptom Experience Scale, Hospital Anxiety and Depression Scale, Everyday Cognition, and Functional Assessment of Cancer Therapy-Breast Cancer. Data were analyzed using the SPSS 21.0 and AMOS 21.0 programs. RESULTS The modified model was a good fit for the data. The model fit indices were χ²=423.18 (p<.001), χ²/df=3.38, CFI=.91, NFI=.91, TLI=.89, SRMR=.05, RMSEA=.09, and AIC=515.18. Chemotherapy-related cognitive impairment was directly influenced by menopausal symptoms (β=.38, p=.002), depression and anxiety (β=.25, p=.002), and symptom experiences (β=.19, p=.012). These predictors explained 47.7% of the variance in chemotherapy-related cognitive impairment. Depression and anxiety mediated the relations among menopausal symptoms, symptom experiences, and with chemotherapy related cognitive impairment. Depression and anxiety (β=-.51, p=.001), symptom experiences (β=-.27, p=.001), menopausal symptoms (β=-.22, p=.008), and chemotherapy-related cognitive impairment (β=-.15, p=.024) had direct effects on the quality of life and these variables explained 91.3%. CONCLUSION These results suggest that chemotherapy-related toxicity is highly associated with cognitive decline and quality of life in women with breast cancer. Depression and anxiety increased vulnerability to cognitive impairment after chemotherapy. Nursing intervention is needed to relieve chemotherapy-related toxicity and psychological factor as well as cognitive decline for quality of life in patients undergoing chemotherapy.
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Affiliation(s)
- Jung Ran Lee
- Department of Nursing, Korea Cancer Center Hospital, Seoul, Korea
| | - Pok Ja Oh
- Department of Nursing, Sahmyook University, Seoul, Korea.
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Chemotherapy-induced cognitive impairments: A systematic review of the animal literature. Neurosci Biobehav Rev 2019; 102:382-399. [DOI: 10.1016/j.neubiorev.2019.05.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/02/2019] [Accepted: 05/01/2019] [Indexed: 12/14/2022]
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Oh PJ, Moon SM. Changes of Cognitive Function and Fatigue following Chemotherapy in Patients with Gastrointestinal Cancer: A Prospective Controlled Study. ASIAN ONCOLOGY NURSING 2019. [DOI: 10.5388/aon.2019.19.3.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Pok-Ja Oh
- Department of Nursing, Sahmyook University, Seoul, South Korea
| | - Sun Mi Moon
- Surgical Department, Korea Cancer Center Hospital, Seoul, South Korea
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Ha SH, Shim IH, Bae DS. Differences in depressive and anxiety symptoms between cancer and noncancer patients with psychological distress. Indian J Psychiatry 2019; 61:395-399. [PMID: 31391644 PMCID: PMC6657556 DOI: 10.4103/psychiatry.indianjpsychiatry_342_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cancer patients are particularly vulnerable to psychological problems. The purpose of the present study was to compare differences in psychological difficulties, including depression and anxiety, between cancer patients and noncancer patients. This study assessed the differences in depressive and anxiety symptoms between patients with and without cancer. MATERIALS AND METHODS Participants included 219 patients at The Cancer Center, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea, who reported depressive or anxiety symptoms between April 2014 and April 2016. Patients were categorized into cancer and noncancer groups based on medical histories showing a diagnosis of any type of cancer. The Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were used to evaluate psychological distress at each patient's first visit. Patients' charts were reviewed for clinical data, including BDI and BAI scores and duration of cancer treatment, and for demographic data such as age and sex. RESULTS The results showed that patients in the cancer group experienced greater discomfort related to somatic symptoms; higher BDI subscale scores were related to work difficulties, insomnia, loss of appetite, somatic worries (fatigue), and loss of libido compared with patients in the noncancer group. The BAI subscale scores for fear of the worst happening, feeling unsteady, feeling terrified or afraid, a sense of choking, fear of dying, and feeling scared were higher in patients with than in those without cancer. CONCLUSION High levels of depressive symptoms related to somatic discomfort and anxiety symptoms related to fear of cancer were associated with considerable psychological distress in patients with cancer diagnosis and treatment.
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Affiliation(s)
- Su Hong Ha
- Department of Psychiatry, Cancer Center, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
| | - In Hee Shim
- Department of Psychiatry, Cancer Center, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
| | - Dong Sik Bae
- Department of Surgery, College of Medicine, Haeundae Paik Hospital, Inje University, Busan, Korea
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Wu G, Fu G, Zhang L, Zhang Z, Wang X. Effects of neoadjuvant chemotherapy on the depth of total intravenous anesthesia in patients with breast cancer undergoing unilateral modified radical mastectomy: A prospective observational study. Medicine (Baltimore) 2018; 97:e13776. [PMID: 30572532 PMCID: PMC6319789 DOI: 10.1097/md.0000000000013776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Toxic effects of neoadjuvant chemotherapy (NC) on nervous, hepatorenal, and pulmonary systems might affect general anesthesia depth. This study aimed to evaluate the effects of NC on depth of total intravenous anesthesia.This prospective observational study enrolled 60 patients undergoing elective unilateral modified radical mastectomy during total intravenous anesthesia with propofol and remifentanil (January-June 2015; Liaocheng People's Hospital, China): the NC group (n = 30) received NC, while the control group (n = 30) did not. Propofol and remifentanil dosages were adjusted according to indexes of consciousness (IoC1: sedation; IoC2: analgesia) to control fluctuations of blood pressure and heart rate within 20% of baseline values. Parameters reflecting propofol/remifentanil dosages, intraoperative adverse events, and quality of anesthetic recovery were recorded.The duration of propofol infusion (1.3 ± 0.4 vs 1.8 ± 0.5 hours, P < .05), mean propofol dosage (8.0 ± 1.0 vs 9.3 ± 1.5 mg kg h, P < .05), and adjustment frequency of target-controlled remifentanil infusion (2.9 ± 1.8 vs 4.4 ± 2.6 times/surgery, P < .05) were significantly lower in the NC group than in the control group; adjustment frequency of target-controlled propofol infusion was also numerically lower (2.0 ± 1.1 vs 2.7 ± 1.5 times/surgery, P = .053). Duration of remifentanil infusion, mean remifentanil dosage, voluntary eye opening, extubation time, and recovery score were not significantly different between groups. The incidence of tachycardia was lower in the NC group than in the control group (7.1% vs 37.0%, P < .05), but there was no significant difference in the incidence of total adverse events between groups.NC can enhance the sensitivity of breast cancer patients to the anesthetic effect of propofol.
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Gokal K, Munir F, Ahmed S, Kancherla K, Wallis D. Does walking protect against decline in cognitive functioning among breast cancer patients undergoing chemotherapy? Results from a small randomised controlled trial. PLoS One 2018; 13:e0206874. [PMID: 30485297 PMCID: PMC6261560 DOI: 10.1371/journal.pone.0206874] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/21/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cancer related cognitive impairments have been subjectively reported and objectively detected in breast cancer patients treated with chemotherapy and are known to have a profound negative impact on productivity, psychosocial well-being and overall quality of life. Moderate levels of walking are known to be of benefit to the psychosocial well-being of those affected by breast cancer and for managing cognitive impairment in healthy adults, children, and the elderly. The purpose of this study is to investigate the effects of a home-based, self-managed, moderate intensity walking intervention on subjective and objective cognitive functioning in breast cancer patients undergoing chemotherapy. METHODS A home-based, self-managed intervention that consisted of moderate levels of walking was compared to usual care among breast cancer patients treated with chemotherapy in a randomised controlled trial. Outcome measures included changes in subjective (CFQ) and objectively detected cognitive functioning (Stroop, SART and two subscales from the WAIS- Digit Span and Block Design). Fifty participants were randomised to either the intervention group (n = 25), who completed 12 weeks of moderate intensity walking, or to the control group (n = 25) mid-way through chemotherapy. RESULTS Compared with the control group, the self-managed walking intervention had positive effects on perceived cognitive function but not on sustained attention, executive function, memory or visual spatial skills when assessed objectively using neuropsychological measures. CONCLUSION This home-based, self-managed intervention is beneficial for protecting against perceived cognitive decline in breast cancer patients treated with chemotherapy. There is a need for further research to objectively assess cognitive decline within this population with larger sample sizes of patients. TRIAL REGISTRATION Current Controlled Trials ISRCTN50709297.
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Affiliation(s)
- Kajal Gokal
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Fehmidah Munir
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, United Kingdom
| | - Samreen Ahmed
- Leicester Royal Infirmary, University Hospitals of Leicester, Leicestershire, United Kingdom
| | - Kiran Kancherla
- Leicester Royal Infirmary, University Hospitals of Leicester, Leicestershire, United Kingdom
| | - Deborah Wallis
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, United Kingdom
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Cisplatin treatment induces attention deficits and impairs synaptic integrity in the prefrontal cortex in mice. Sci Rep 2018; 8:17400. [PMID: 30479361 PMCID: PMC6258730 DOI: 10.1038/s41598-018-35919-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/08/2018] [Indexed: 12/15/2022] Open
Abstract
Patients treated for cancer frequently experience chemobrain, characterized by impaired memory and reduced attention. These deficits often persist after treatment, and no preventive or curative interventions exist. In mice, we assessed the effect of cisplatin chemotherapy on attention using the 5-choice serial reaction time task and on synaptic integrity. We also assessed the capacity of mesenchymal stem cells to normalize the characteristics of chemobrain. Mice were trained in the 5-choice serial reaction time task. After reaching advancement criteria at a 4-second stimulus time, they were treated with cisplatin followed by nasal administration of mesenchymal stem cells. Cisplatin reduced the percentage of correct responses due to an increase in omissions, indicating attention deficits. Mesenchymal stem cell treatment reversed these cisplatin-induced deficits in attention. Cisplatin also induced abnormalities in markers of synaptic integrity in the prefrontal cortex. Specifically, cisplatin decreased expression of the global presynaptic marker synaptophysin and the glutamatergic presynaptic marker vGlut2. Expression of the presynaptic GABAergic marker vGAT increased. Nasal mesenchymal stem cell administration normalized these markers of synaptic integrity. In conclusion, cisplatin induces long-lasting attention deficits that are associated with decreased synaptic integrity in the prefrontal cortex. Nasal administration of mesenchymal stem cells reversed these behavioural and structural deficits.
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Cerulla N, Arcusa À, Navarro JB, de la Osa N, Garolera M, Enero C, Chico G, Fernández-Morales L. Cognitive impairment following chemotherapy for breast cancer: The impact of practice effect on results. J Clin Exp Neuropsychol 2018; 41:290-299. [PMID: 30477390 DOI: 10.1080/13803395.2018.1546381] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Chemotherapy-Related Cognitive Impairment (CRCI) can be an adverse effect in women treated for breast cancer. Some longitudinal studies reported deficits in attention, memory, and executive function following treatment, but other studies did not find cognitive changes. It is known that practice effects (PE) on repeated assessments with cognitive tests contribute to the discrepancies in these results, but its influence on scores has not been systematically explored. The present study examines the impact of PE on retest scores in a group of women with breast cancer treated with chemotherapy and evaluated longitudinally. METHOD 51 women with breast cancer treated with a combination of 5-fluorouracil, epirubicin, and cyclophosphamide with or without taxanes were assessed after surgery but before chemotherapy (T1), post-chemotherapy (T2), and at one year after T2 (T3). Longitudinal changes on cognitive performance were analyzed twice: when retest scores were not corrected for PE and when correction for PE was applied to T2 and T3 scores. RESULTS When PE was not corrected, progressive improvement over time in measures of memory and divided attention at T2 and T3 was observed. In contrast, when PE was corrected, worsening was found in measures of memory, fluency, executive function, and attention at T2 and in attention and executive function at T3. Results after correction for PE are in line with previous longitudinal studies that report cognitive impairment after treatment with chemotherapy for breast cancer. CONCLUSION Accounting for PE is recommended to identify true change on cognition through treatment with chemotherapy for breast cancer.
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Affiliation(s)
- Noemí Cerulla
- a Memory Unit , Consorci Sanitari de Terrassa (CST), Terrassa , Barcelona , Spain.,b Brain, Cognition and Behaviour Research Group , Unitat d'Investigació biomèdica UAB-CST (UIB), Terrassa , Barcelona , Spain.,c Department of Clinical and Health Psychology , Universitat Autònoma de Barcelona (UAB), Bellaterra , Barcelona , Spain
| | - Àngels Arcusa
- d Department of Oncology , Consorci Sanitari de Terrassa (CST), Terrassa , Barcelona , Spain
| | - José-Blas Navarro
- e Department of Psychobiology and Methodology of Health Sciences , Universitat Autònoma de Barcelona (UAB), Bellaterra , Barcelona , Spain
| | - Nuria de la Osa
- c Department of Clinical and Health Psychology , Universitat Autònoma de Barcelona (UAB), Bellaterra , Barcelona , Spain
| | - Maite Garolera
- b Brain, Cognition and Behaviour Research Group , Unitat d'Investigació biomèdica UAB-CST (UIB), Terrassa , Barcelona , Spain.,f Neuropsychology Unit , Consorci Sanitari de Terrassa (CST), Terrassa , Barcelona , Spain
| | - Cristina Enero
- g Department of Mental Health , Consorci Sanitari de Terrassa (CST), Terrassa , Barcelona , Spain
| | - Glòria Chico
- a Memory Unit , Consorci Sanitari de Terrassa (CST), Terrassa , Barcelona , Spain.,b Brain, Cognition and Behaviour Research Group , Unitat d'Investigació biomèdica UAB-CST (UIB), Terrassa , Barcelona , Spain
| | - Luís Fernández-Morales
- d Department of Oncology , Consorci Sanitari de Terrassa (CST), Terrassa , Barcelona , Spain.,h Department of Oncology , Corporació Sanitària Parc Taulí, Sabadell , Barcelona , Spain
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McLeary F, Davis A, Rudrawar S, Perkins A, Anoopkumar-Dukie S. Mechanisms underlying select chemotherapeutic-agent-induced neuroinflammation and subsequent neurodegeneration. Eur J Pharmacol 2018; 842:49-56. [PMID: 30287154 DOI: 10.1016/j.ejphar.2018.09.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 01/19/2023]
Abstract
This review demonstrates the importance of uncovering the mechanisms that underlie chemotherapy-induced neuroinflammation. It builds upon the well-established connection between chemotherapeutic-agents and neurotoxicity along with widespread peripheral toxicities. This article summarises the major studies which have linked chemotherapy-induced neurodegeneration with direct evidence of neuroinflammation. Cancer and chemotherapy-related adverse effects impact a large proportion of the population. A better understanding of the link between chemotherapy, neurotoxicity and specifically the mechanisms of neuroinflammation, will allow the development of strategies to improve the management of side effects, and overall to reduce the burden on cancer patients receiving chemotherapy. This review has developed a summary schematic of the relationship between different chemotherapeutic agents and inflammatory markers within the central nervous system and links this correlation with some major ailments associated with chemotherapy use.
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Affiliation(s)
- Fleur McLeary
- Quality Use of Medicines Network, Griffith University, Gold Coast, QLD 4222, Australia; School of Pharmacy and Pharmacology, Griffith University, Gold Coast, QLD 4222, Australia
| | - Arie Davis
- Quality Use of Medicines Network, Griffith University, Gold Coast, QLD 4222, Australia; School of Pharmacy and Pharmacology, Griffith University, Gold Coast, QLD 4222, Australia
| | - Santosh Rudrawar
- Quality Use of Medicines Network, Griffith University, Gold Coast, QLD 4222, Australia; School of Pharmacy and Pharmacology, Griffith University, Gold Coast, QLD 4222, Australia
| | - Anthony Perkins
- School of Medical Science, Griffith University, Gold Coast, QLD 4222, Australia
| | - Shailendra Anoopkumar-Dukie
- Quality Use of Medicines Network, Griffith University, Gold Coast, QLD 4222, Australia; School of Pharmacy and Pharmacology, Griffith University, Gold Coast, QLD 4222, Australia.
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