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Mashiro E, Arao H, Aoki M, Matsumoto Y. What are the barriers to medical collaboration in community-based integrated care supporting cancer patients? A qualitative analysis of healthcare and long-term care providers' perceptions. Jpn J Clin Oncol 2023; 53:1162-1169. [PMID: 37680135 DOI: 10.1093/jjco/hyad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Patients required comprehensive cancer treatment in the community based on medical collaboration between designated cancer care hospitals and community medical and nursing care facilities to help them live life on their own terms. This study aims to describe the barriers to medical collaboration in community-based integrated care from the perspectives of healthcare providers (HCPs) and long-term care providers (LCPs) supporting cancer patients. METHODS Semi-structured interviews were conducted with 88 HCPs and LCPs supporting cancer patients. We analyzed interview data to describe barriers to medical collaboration between designated cancer care hospitals and community medical and nursing care facilities using content analysis in MAXQDA. RESULTS Participants were mostly HCPs, with physicians accounting for the largest proportion (27.3%). Totally, 299 codes were integrated into seven barriers to medical collaboration in community-based integrated care, including lack of information provision including life perspectives and a delay in sharing cancer patients' values with HCPs to provide end-of-life care according to the patients' wishes. Furthermore, insufficient coordination of cancer and non-cancer symptom management was identified as a barrier specific to older adults with cancer. CONCLUSIONS Barriers related to cancer treatment that integrate lifestyle perspectives, end-of-life care emphasizing patient values, and medical collaboration between cancer and non-cancer care are distinctive. They emphasize the importance of utilizing professionals to connect treatment and lifestyle information, establishing a central coordinating organization led by the DCCH, and developing a community palliative care network. Moreover, connecting cancer and non-cancer care through government and medical collaboration is crucial.
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Affiliation(s)
- Erina Mashiro
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Harue Arao
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Miwa Aoki
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshihisa Matsumoto
- Division of Palliative Medicine, Cancer Institute Hospital of JFCR, Tokyo, Japan
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2
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Toma RV, Anca Z, Trifănescu OG, Galeş LN, Folea AR, Stanca L, Bîlteanu L, Anghel RM. Early Echocardiography and ECG Changes Following Radiotherapy in Patients with Stage II-III HER2-Positive Breast Cancer Treated with Anthracycline-Based Chemotherapy with or without Trastuzumab-Based Therapy. Med Sci Monit 2023; 29:e941754. [PMID: 37772333 PMCID: PMC10521333 DOI: 10.12659/msm.941754] [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: 07/12/2023] [Accepted: 08/23/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Cardiotoxicity from radiotherapy and anti-cancer therapies have been reported in patients with breast cancer. This study aimed to investigate the early echocardiography and ECG changes following radiotherapy in 68 patients ages 30-78 years with stages II-III HER2-positive breast cancer treated with anthracycline-based chemotherapy with or without trastuzumab-based therapy from 2015 to 2021. MATERIAL AND METHODS We analyzed data of 68 breast cancer patients aged 30-78 years, predominantly in AJCC stages II-III (61) and HER2-positive (58), treated and monitored from 2015 to 2021. Cardiac function was assessed using echo- and electrocardiography. We employed univariate logistic models to gauge associations between pre-existing cardiac conditions, treatment modalities, and changes in cardiac function. RESULTS A decrease in the left ventricle ejection fraction (EF) by >5% was associated with heart doses >49.3 Gy and with maximum and average doses to the left anterior descending artery (LAD) exceeding 46.9 Gy and 32.7 Gy, respectively. An EF drop of ≥10% was correlated with anti-HER2 therapy, pre-existing ECG changes, and the onset of conditions in the left ventricle, major vessels, and valves. Conditions were exacerbated in patients with prior echocardiographic abnormalities, while some emerged concurrent with the EF decline. CONCLUSIONS This research emphasizes the importance of personalized heart monitoring and care for breast cancer patients undergoing multimodal therapies. Significant and potentially irreversible EF declines can result from radiation and anti-HER2 treatments.
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Affiliation(s)
- Radu Valeriu Toma
- Department of Oncology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Oncological Institute „Alexandru Trestioreanu”, Bucharest, Romania
| | - Zgura Anca
- Department of Oncology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Oana Gabriela Trifănescu
- Department of Oncology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Oncological Institute „Alexandru Trestioreanu”, Bucharest, Romania
| | - Laurenţia Nicoleta Galeş
- Department of Oncology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Oncological Institute „Alexandru Trestioreanu”, Bucharest, Romania
| | | | - Loredana Stanca
- Department of Preclinical Science, Faculty of Veterinary Medicine, University of Agronomic Sciences and Veterinary Medicine, Bucharest, Romania
| | - Liviu Bîlteanu
- Oncological Institute „Alexandru Trestioreanu”, Bucharest, Romania
- Department of Preclinical Science, Faculty of Veterinary Medicine, University of Agronomic Sciences and Veterinary Medicine, Bucharest, Romania
- Laboratory of Molecular Nanotechnologies, National Institute for Research and Development in Microtechnologies, Voluntary, Romania
| | - Rodica M. Anghel
- Department of Oncology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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3
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Dias MTS, Aguilar EC, Campos GP, do Couto NF, Capettini LDSA, Braga WF, Andrade LDO, Alvarez-Leite J. Butyrate inhibits LPC-induced endothelial dysfunction by regulating nNOS-produced NO and ROS production. Nitric Oxide 2023; 138-139:42-50. [PMID: 37308032 DOI: 10.1016/j.niox.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/09/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023]
Abstract
Lipids oxidation is a key risk factor for cardiovascular diseases. Lysophosphatidylcholine (LPC), the major component of oxidized LDL, is an important triggering agent for endothelial dysfunction and atherogenesis. Sodium butyrate, a short-chain fatty acid, has demonstrated atheroprotective properties. So, we evaluate the role of butyrate in LPC-induced endothelial dysfunction. Vascular response to phenylephrine (Phe) and acetylcholine (Ach) was performed in aortic rings from male mice (C57BL/6J). The aortic rings were incubated with LPC (10 μM) and butyrate (0.01 or 0.1 Mm), with or without TRIM (an nNOS inhibitor). Endothelial cells (EA.hy296) were incubated with LPC and butyrate to evaluate nitric oxide (NO) and reactive oxygen species (ROS) production, calcium influx, and the expression of total and phosphorylated nNOS and ERK½. We found that butyrate inhibited LPC-induced endothelial dysfunction by improving nNOS activity in aortic rings. In endothelial cells, butyrate reduced ROS production and increased nNOS-related NO release, by improving nNOS activation (phosphorylation at Ser1412). Additionally, butyrate prevented the increase in cytosolic calcium and inhibited ERk½ activation by LPC. In conclusion, butyrate inhibited LPC-induced vascular dysfunction by increasing nNOS-derived NO and reducing ROS production. Butyrate restored nNOS activation, which was associated with calcium handling normalization and reduction of ERK½ activation.
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Affiliation(s)
- Melissa Tainan Silva Dias
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Av. Antônio Carlos 6627 - Campus Pampulha, Cx Post 468, CEP 31270-901, Belo Horizonte, MG, Brazil.
| | - Edenil Costa Aguilar
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Av. Antônio Carlos 6627 - Campus Pampulha, Cx Post 468, CEP 31270-901, Belo Horizonte, MG, Brazil.
| | - Gianne Paul Campos
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Minas Gerais, Av. Antônio Carlos 6627 - Campus Pampulha, Cx Post 468, CEP 31270-901, Belo Horizonte, MG, Brazil.
| | - Natalia Fernanda do Couto
- Department of Medicine. University of Illinois Chicago, Center of Cardiovascular Research, 909 South Wolcott Avenue, MC801 Chicago, IL, 60612, USA.
| | - Luciano Dos Santos Aggum Capettini
- Department of Pharmacology, Institute of Biological Sciences, Federal University of Minas Gerais, Av. Antônio Carlos 6627 - Campus Pampulha, Cx Post 468, CEP 31270-901, Belo Horizonte, MG, Brazil.
| | - Weslley Fernandes Braga
- Icahn School of Medicine. Mount Sinai, Nova Iorque, Gustave L. Levy Place, New York, NY, 10029-5674, USA.
| | - Luciana de Oliveira Andrade
- Department of Cell Biology, Institute of Biological Sciences, Federal University of Minas Gerais, Av. Antônio Carlos 6627 - Campus Pampulha, Cx Post 468, CEP 31270-901, Belo Horizonte, MG, Brazil.
| | - Jacqueline Alvarez-Leite
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Av. Antônio Carlos 6627 - Campus Pampulha, Cx Post 468, CEP 31270-901, Belo Horizonte, MG, Brazil.
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Distefano R, Ilieva M, Madsen JH, Rennie S, Uchida S. DoxoDB: A Database for the Expression Analysis of Doxorubicin-Induced lncRNA Genes. Noncoding RNA 2023; 9:39. [PMID: 37489459 PMCID: PMC10366827 DOI: 10.3390/ncrna9040039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/08/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023] Open
Abstract
Cancer and cardiovascular disease are the leading causes of death worldwide. Recent evidence suggests that these two life-threatening diseases share several features in disease progression, such as angiogenesis, fibrosis, and immune responses. This has led to the emergence of a new field called cardio-oncology. Doxorubicin is a chemotherapy drug widely used to treat cancer, such as bladder and breast cancer. However, this drug causes serious side effects, including acute ventricular dysfunction, cardiomyopathy, and heart failure. Based on this evidence, we hypothesize that comparing the expression profiles of cells and tissues treated with doxorubicin may yield new insights into the adverse effects of the drug on cellular activities. To test this hypothesis, we analyzed published RNA sequencing (RNA-seq) data from doxorubicin-treated cells to identify commonly differentially expressed genes, including long non-coding RNAs (lncRNAs) as they are known to be dysregulated in diseased tissues and cells. From our systematic analysis, we identified several doxorubicin-induced genes. To confirm these findings, we treated human cardiac fibroblasts with doxorubicin to record expression changes in the selected doxorubicin-induced genes and performed a loss-of-function experiment of the lncRNA MAP3K4-AS1. To further disseminate the analyzed data, we built the web database DoxoDB.
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Affiliation(s)
- Rebecca Distefano
- Department of Biology, University of Copenhagen, DK-2200 Copenhagen N, Denmark
| | - Mirolyuba Ilieva
- Center for RNA Medicine, Department of Clinical Medicine, Aalborg University, DK-2450 Copenhagen SV, Denmark
| | - Jens Hedelund Madsen
- Center for RNA Medicine, Department of Clinical Medicine, Aalborg University, DK-2450 Copenhagen SV, Denmark
| | - Sarah Rennie
- Department of Biology, University of Copenhagen, DK-2200 Copenhagen N, Denmark
| | - Shizuka Uchida
- Center for RNA Medicine, Department of Clinical Medicine, Aalborg University, DK-2450 Copenhagen SV, Denmark
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5
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Białek A, Białek M, Lepionka T, Ruszczyńska A, Bulska E, Czauderna M. Cancer Influences the Elemental Composition of the Myocardium More Strongly than Conjugated Linoleic Acids-Chemometric Approach to Cardio-Oncological Studies. Molecules 2021; 26:7127. [PMID: 34885709 PMCID: PMC8659207 DOI: 10.3390/molecules26237127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 12/05/2022] Open
Abstract
The aim of the study was to verify in a cardio-oncological model experiment if conjugated linoleic acids (CLA) fed to rats with mammary tumors affect the content of selected macro- and microelements in their myocardium. The diet of Sprague-Dawley females was supplemented either with CLA isomers or with safflower oil. In hearts of rats suffering from breast cancer, selected elements were analyzed with a quadrupole mass spectrometer with inductively coupled plasma ionization (ICP-MS). In order to better understand the data trends, cluster analysis, principal component analysis and linear discriminant analysis were applied. Mammary tumors influenced macro- and microelements content in the myocardium to a greater extent than applied diet supplementation. Significant influences of diet (p = 0.0192), mammary tumors (p = 0.0200) and interactions of both factors (p = 0.0151) were documented in terms of Fe content. CLA significantly decreased the contents of Cu and Mn (p = 0.0158 and p = 0.0265, respectively). The level of Ni was significantly higher (p = 0.0073), which was more pronounced in groups supplemented with CLA. The obtained results confirmed antioxidant properties of CLA and the relationship with Se deposition. Chemometric techniques distinctly showed that the coexisting pathological process induced differences to the greater extent than diet supplementation in the elemental content in the myocardium, which may impinge on cardiac tissue's susceptibility to injuries.
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Affiliation(s)
- Agnieszka Białek
- Department of Biotechnology and Nutrigenomics, Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Postępu 36A Jastrzębiec, 05-552 Magdalenka, Poland;
| | - Małgorzata Białek
- Department of Animal Nutrition, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Instytucka 3, 05-110 Jabłonna, Poland; (M.B.); (M.C.)
| | - Tomasz Lepionka
- Department of Bioaerosols, The Biological Threats Identification and Countermeasure Center of the General Karol Kaczkowski Military Institute of Hygiene and Epidemiology, Lubelska 4 St, 24-100 Puławy, Poland
| | - Anna Ruszczyńska
- Biological and Chemical Research Centre, Faculty of Chemistry, University of Warsaw, Żwirki i Wigury 101, 02-089 Warsaw, Poland; (A.R.); (E.B.)
| | - Ewa Bulska
- Biological and Chemical Research Centre, Faculty of Chemistry, University of Warsaw, Żwirki i Wigury 101, 02-089 Warsaw, Poland; (A.R.); (E.B.)
| | - Marian Czauderna
- Department of Animal Nutrition, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Instytucka 3, 05-110 Jabłonna, Poland; (M.B.); (M.C.)
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6
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Dobson R, Ghosh AK, Ky B, Marwick T, Stout M, Harkness A, Steeds R, Robinson S, Oxborough D, Adlam D, Stanway S, Rana B, Ingram T, Ring L, Rosen S, Plummer C, Manisty C, Harbinson M, Sharma V, Pearce K, Lyon AR, Augustine DX. British Society for Echocardiography and British Cardio-Oncology Society guideline for transthoracic echocardiographic assessment of adult cancer patients receiving anthracyclines and/or trastuzumab. Echo Res Pract 2021; 8:G1-G18. [PMID: 34106116 PMCID: PMC8052569 DOI: 10.1530/erp-21-0001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022] Open
Abstract
The subspecialty of cardio-oncology aims to reduce cardiovascular morbidity and mortality in patients with cancer or following cancer treatment. Cancer therapy can lead to a variety of cardiovascular complications, including left ventricular systolic dysfunction, pericardial disease, and valvular heart disease. Echocardiography is a key diagnostic imaging tool in the diagnosis and surveillance for many of these complications. The baseline assessment and subsequent surveillance of patients undergoing treatment with anthracyclines and/or human epidermal growth factor (EGF) receptor (HER) 2-positive targeted treatment (e.g. trastuzumab and pertuzumab) form a significant proportion of cardio-oncology patients undergoing echocardiography. This guideline from the British Society of Echocardiography and British Cardio-Oncology Society outlines a protocol for baseline and surveillance echocardiography of patients undergoing treatment with anthracyclines and/or trastuzumab. The methodology for acquisition of images and the advantages and disadvantages of techniques are discussed. Echocardiographic definitions for considering cancer therapeutics-related cardiac dysfunction are also presented.
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Affiliation(s)
- Rebecca Dobson
- Cardio-Oncology Service, Liverpool Heart and Chest NHS Foundation Trust, Liverpool, UK
| | - Arjun K Ghosh
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Cardio-Oncology Service, Hatter Cardiovascular Research Institute, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Bonnie Ky
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tom Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Martin Stout
- University Hospital South Manchester NHS Foundation Trust, Manchester, UK
| | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Rick Steeds
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - David Adlam
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Susannah Stanway
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, London, UK
| | - Thomas Ingram
- The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Liam Ring
- West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
| | - Stuart Rosen
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Chris Plummer
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Charlotte Manisty
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | | | - Vishal Sharma
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Keith Pearce
- University Hospital South Manchester NHS Foundation Trust, Manchester, UK
| | - Alexander R Lyon
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
| | - Daniel X Augustine
- Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | - the British Society of Echocardiography (BSE) and the British Society of Cardio-Oncology (BCOS)
- Cardio-Oncology Service, Liverpool Heart and Chest NHS Foundation Trust, Liverpool, UK
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Cardio-Oncology Service, Hatter Cardiovascular Research Institute, University College London and University College London Hospitals NHS Foundation Trust, London, UK
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Baker Heart and Diabetes Institute, Melbourne, Australia
- University Hospital South Manchester NHS Foundation Trust, Manchester, UK
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- North West Anglia Foundation Trust, UK
- Liverpool John Moores University, Liverpool, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
- West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Belfast Health and Social Care Trust, Belfast, UK
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
- Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department for Health, University of Bath, Bath, UK
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7
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Dobson R, Ghosh AK, Ky B, Marwick T, Stout M, Harkness A, Steeds R, Robinson S, Oxborough D, Adlam D, Stanway S, Rana B, Ingram T, Ring L, Rosen S, Plummer C, Manisty C, Harbinson M, Sharma V, Pearce K, Lyon AR, Augustine DX. BSE and BCOS Guideline for Transthoracic Echocardiographic Assessment of Adult Cancer Patients Receiving Anthracyclines and/or Trastuzumab. JACC CardioOncol 2021; 3:1-16. [PMID: 34396303 PMCID: PMC8352267 DOI: 10.1016/j.jaccao.2021.01.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 01/06/2023] Open
Abstract
The subspecialty of cardio-oncology aims to reduce cardiovascular morbidity and mortality in patients with cancer or following cancer treatment. Cancer therapy can lead to a variety of cardiovascular complications, including left ventricular systolic dysfunction, pericardial disease, and valvular heart disease. Echocardiography is a key diagnostic imaging tool in the diagnosis and surveillance for many of these complications. The baseline assessment and subsequent surveillance of patients undergoing treatment with anthracyclines and/or human epidermal growth factor receptor (HER) 2-positive targeted treatment (e.g., trastuzumab and pertuzumab) form a significant proportion of cardio-oncology patients undergoing echocardiography. This guideline from the British Society of Echocardiography and British Cardio-Oncology Society outlines a protocol for baseline and surveillance echocardiography of patients undergoing treatment with anthracyclines and/or trastuzumab. The methodology for acquisition of images and the advantages and disadvantages of techniques are discussed. Echocardiographic definitions for considering cancer therapeutics-related cardiac dysfunction are also presented.
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Key Words
- 2D, 2-dimensional
- 3D, 3-dimensional
- A2C, apical 2-chamber
- A3C, apical 3-chamber
- A4C, apical 4-chamber
- BSE, British Society of Echocardiography
- CMR, cardiac magnetic resonance
- CTRCD, cancer therapy–related cardiac dysfunction
- ECG, electrocardiogram
- GLS, global longitudinal strain
- HER2 therapy
- HER2, human epidermal growth factor receptor 2
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- MV, mitral valve
- RH, right heart
- ROI, region of interest
- RV, right ventricular
- TDI, tissue Doppler imaging
- TRV, tricuspid regurgitant velocity
- anthracycline
- echocardiography
- guidelines
- imaging
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Affiliation(s)
- Rebecca Dobson
- Cardio-Oncology Service, Liverpool Heart and Chest NHS Foundation Trust, Liverpool, United Kingdom
| | - Arjun K. Ghosh
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Cardio-Oncology Service, Hatter Cardiovascular Research Institute, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Bonnie Ky
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Tom Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Martin Stout
- University Hospital South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom
| | - Rick Steeds
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | - David Adlam
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Susannah Stanway
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Thomas Ingram
- The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, United Kingdom
| | - Liam Ring
- West Suffolk NHS Foundation Trust, Bury St. Edmunds, United Kingdom
| | - Stuart Rosen
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, United Kingdom
| | - Chris Plummer
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Charlotte Manisty
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Mark Harbinson
- Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Vishal Sharma
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Keith Pearce
- University Hospital South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Alexander R. Lyon
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, United Kingdom
| | - Daniel X. Augustine
- Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - British Society of Echocardiography (BSE) and theBritish Society of Cardio-Oncology (BCOS)
- Cardio-Oncology Service, Liverpool Heart and Chest NHS Foundation Trust, Liverpool, United Kingdom
- Cardio-Oncology Service, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Cardio-Oncology Service, Hatter Cardiovascular Research Institute, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
- Baker Heart and Diabetes Institute, Melbourne, Australia
- University Hospital South Manchester NHS Foundation Trust, Manchester, United Kingdom
- East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- North West Anglia Foundation Trust, United Kingdom
- Liverpool John Moores University, Liverpool, United Kingdom
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
- The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, United Kingdom
- West Suffolk NHS Foundation Trust, Bury St. Edmunds, United Kingdom
- Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, United Kingdom
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
- Belfast Health and Social Care Trust, Belfast, United Kingdom
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
- Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
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8
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Białek A, Białek M, Lepionka T, Pachniewicz P, Czauderna M. Oxysterols and lipidomic profile of myocardium of rats supplemented with pomegranate seed oil and/or bitter melon aqueous extract - Cardio-oncological animal model research. Chem Phys Lipids 2021; 235:105057. [PMID: 33515592 DOI: 10.1016/j.chemphyslip.2021.105057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 12/15/2022]
Abstract
A close link between cardiovascular diseases and cancer results from sharing the same modifiable risk factors (e.g. nutritional) and cardiotoxicity of anti-cancerous therapies. It justifies cardio-oncological preliminary studies on dietary factors, especially on those of possible anti-carcinogenic or cardioprotective properties. The main purpose was to evaluate the effect of pomegranate seed oil (PSO) and/or bitter melon extract (BME) supplementation of the diet of female rats suffering from mammary tumors on lipidomic profile (expressed as fatty acids, conjugated fatty acids (CFA), malondialdehyde (MDA), cholesterol and oxysterols content) of cardiac tissue. Total lipidomic profile and intensity of lipid peroxidation in hearts of DMBA-treated Sprague-Dawley rats and their healthy equivalents, both obtaining diet supplementation, were evaluated with different chromatographic techniques coupled with appropriate detection systems (GC-MS, GC-TOFMS, Ag+-HPLC-DAD, UF-HPLC-DAD). Dietary modifications neither diminished breast cancer incidence nor exerted explicit cardio-protective influence, however, they diminished cholesterol content, i.a. because of inhibition of the endogenous conversion of squalene to cholesterol in cardiac tissue. CFA were incorporated into cardiac tissue to a lesser extent in the cancerous process. PSO and BME anti-oxidant properties in pathological condition were only slightly reflected in MDA levels but not in oxysterols formation. Obtained results indicate considerable changes in dietary supplements' biological activity in pathological conditions and the need for clear distinction of drugs and dietary supplements, which is of utmost importance, especially for cancer survivors.
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Affiliation(s)
- Agnieszka Białek
- Department of Bromatology, Medical University of Warsaw, Banacha 1, 02-097, Warsaw, Poland; Department of Biotechnology and Nutrigenomics, Institute of Genetics and Animal Biotechnology of Polish Academy of Sciences, Postępu 36A Jastrzębiec, 05-552, Magdalenka, Poland.
| | - Małgorzata Białek
- The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Instytucka 3, 05-110, Jabłonna, Poland
| | - Tomasz Lepionka
- The Biological Threats Identification and Countermeasure Center of the General Karol Kaczkowski Military Institute of Hygiene and Epidemiology, Lubelska 4 St, 24-100, Puławy, Poland
| | - Paulina Pachniewicz
- Department of Bromatology, Medical University of Warsaw, Banacha 1, 02-097, Warsaw, Poland
| | - Marian Czauderna
- The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Instytucka 3, 05-110, Jabłonna, Poland
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9
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Chong J, Ho AF, Yap J, Bulluck H, Hausenloy DJ. Is there a role for remote ischemic conditioning in preventing 5-fluorouracil-induced coronary vasospasm? CONDITIONING MEDICINE 2019; 2:204-212. [PMID: 32133437 PMCID: PMC7055861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cardiac ischemia associated with chemotherapy has been linked to several anti-neoplastic agents and is multifactorial in etiology. Coronary artery vasospasm is one of the most commonly reported effects of cancer therapy that can lead to myocardial ischemia or infarction. The chemotherapy agent 5-fluorouracil (5-FU) or its oral pro-drug capecitabine can result in coronary vascular endothelial dysfunction causing coronary artery spasm, and possibly coronary thrombosis. These drugs have also been shown to be associated with myocardial infarction, malignant ventricular arrhythmias, heart failure, cardiogenic shock, and sudden death. The proposed mechanisms underlying cardiotoxicity induced by 5-FU are vascular endothelial damage followed by thrombus formation, ischemia secondary to coronary artery vasospasm, direct toxicity on myocardium, and thrombogenicity. There remains a pressing need to discover novel and effective therapies that can prevent or ameliorate 5-FU associated cardiotoxicity. To this point, promising overlap has been observed between proposed remote ischemic conditioning (RIC) cardioprotective mechanisms and 5FU-associated cardiotoxic cellular pathways. RIC, in which transient episodes of limb ischemia and reperfusion (induced by inflations and deflations of a pneumatic cuff placed on the upper arm or thigh), confer both cardioprotective and vasculoprotective effects, and may therefore prevent 5-FU coronary artery spasm/cardiotoxicity. In this review, we will be discussing the following potentially therapeutic aspects of RIC in ameliorating 5-FU associated cardiotoxicity: sequential phases of 5-FU cardiotoxicity as possible targets for dual windows of cardioprotection characteristic of RIC; protective effects of RIC on endothelial function and microvasculature in relation to 5-FU induced endothelial dysfunction/microvascular dysfunction; reduction in platelet activation by RIC in the context of 5-FU induced thrombogenicity; and the utility of improvement in mitochondrial function conferred by RIC in 5-FU induced cellular toxicity secondary to mitochondrial dysfunction.
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Affiliation(s)
- Jun Chong
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
- National Heart Centre Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore
| | - Andrew Fw Ho
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital
| | - Jonathan Yap
- Center for Cardiovascular Research, John A. Burns School of Medicine, University of Hawaii, USA
| | | | - Derek J Hausenloy
- National Heart Centre Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
- The Hatter Cardiovascular Institute, University College London, London, UK
- Tecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Nuevo Leon, Mexico
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10
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Seraphim A, Westwood M, Bhuva AN, Crake T, Moon JC, Menezes LJ, Lloyd G, Ghosh AK, Slater S, Oakervee H, Manisty CH. Advanced Imaging Modalities to Monitor for Cardiotoxicity. Curr Treat Options Oncol 2019; 20:73. [PMID: 31396720 PMCID: PMC6687672 DOI: 10.1007/s11864-019-0672-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Early detection and treatment of cardiotoxicity from cancer therapies is key to preventing a rise in adverse cardiovascular outcomes in cancer patients. Over-diagnosis of cardiotoxicity in this context is however equally hazardous, leading to patients receiving suboptimal cancer treatment, thereby impacting cancer outcomes. Accurate screening therefore depends on the widespread availability of sensitive and reproducible biomarkers of cardiotoxicity, which can clearly discriminate early disease. Blood biomarkers are limited in cardiovascular disease and clinicians generally still use generic screening with ejection fraction, based on historical local expertise and resources. Recently, however, there has been growing recognition that simple measurement of left ventricular ejection fraction using 2D echocardiography may not be optimal for screening: diagnostic accuracy, reproducibility and feasibility are limited. Modern cancer therapies affect many myocardial pathways: inflammatory, fibrotic, metabolic, vascular and myocyte function, meaning that multiple biomarkers may be needed to track myocardial cardiotoxicity. Advanced imaging modalities including cardiovascular magnetic resonance (CMR), computed tomography (CT) and positron emission tomography (PET) add improved sensitivity and insights into the underlying pathophysiology, as well as the ability to screen for other cardiotoxicities including coronary artery, valve and pericardial diseases resulting from cancer treatment. Delivering screening for cardiotoxicity using advanced imaging modalities will however require a significant change in current clinical pathways, with incorporation of machine learning algorithms into imaging analysis fundamental to improving efficiency and precision. In the future, we should aspire to personalized rather than generic screening, based on a patient’s individual risk factors and the pathophysiological mechanisms of the cancer treatment they are receiving. We should aspire that progress in cardiooncology is able to track progress in oncology, and to ensure that the current ‘one size fits all’ approach to screening be obsolete in the very near future.
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Affiliation(s)
- Andreas Seraphim
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute of Cardiovascular Sciences, University College London, Chenies Mews, London, UK
| | - Mark Westwood
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Department of Cardio-oncology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Anish N Bhuva
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute of Cardiovascular Sciences, University College London, Chenies Mews, London, UK
| | - Tom Crake
- Department of Cardio-oncology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - James C Moon
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute of Cardiovascular Sciences, University College London, Chenies Mews, London, UK
| | - Leon J Menezes
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Guy Lloyd
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Arjun K Ghosh
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Department of Cardio-oncology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Sarah Slater
- Department of Haematology, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Heather Oakervee
- Department of Oncology, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Charlotte H Manisty
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK. .,Institute of Cardiovascular Sciences, University College London, Chenies Mews, London, UK. .,Department of Cardio-oncology, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.
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11
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Chong JH, Ghosh AK. Coronary Artery Vasospasm Induced by 5-fluorouracil: Proposed Mechanisms, Existing Management Options and Future Directions. ACTA ACUST UNITED AC 2019; 14:89-94. [PMID: 31178935 PMCID: PMC6545978 DOI: 10.15420/icr.2019.12] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/17/2019] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease and cancer are leading contributors to the global disease burden. As a result of cancer therapy-related cardiotoxicities, cardiovascular disease results in significant morbidity and mortality in cancer survivors and patients with active cancer. There is an unmet need for management of cardio-oncology conditions, which is predicted to reach epidemic proportions, and better understanding of their pathophysiology and treatment is urgently required. The proposed mechanisms underlying cardiotoxicity induced by 5-fluorouracil (5-FU) are vascular endothelial damage followed by thrombus formation, ischaemia secondary to coronary artery vasospasm, direct toxicity on myocardium and thrombogenicity. In patients with angina and electrocardiographic evidence of myocardial ischaemia due to chemotherapy-related coronary artery vasospasm, termination of chemotherapy and administration of calcium channel blockers or nitrates can improve ischaemic symptoms. However, coronary artery vasospasm can reoccur with 5-FU re-administration with limited effectiveness of vasodilator prophylaxis observed. While pre-existing coronary artery disease may increase the ischaemic potential of 5-FU, cardiovascular risk factors do not appear to completely predict the development of cardiac complications. Pharmacogenomic studies and genetic profiling may help predict the occurrence and streamline the treatment of 5-FU-induced coronary artery vasospasm. Echocardiographic measures such as the Tei index may help detect subclinical 5-FU cardiotoxicity. Further research is required to explore the cardioprotective effect of agents such as coenzyme complex, GLP-1 analogues and degradation inhibitors on 5-FU-induced coronary artery vasospasm.
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Affiliation(s)
- Jun Hua Chong
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Arjun K Ghosh
- Cardio-Oncology Service, Barts Heart Centre, St Bartholomew's Hospital London, UK.,Cardio-Oncology Service, University College London Hospital, Hatter Cardiovascular Institute London, UK
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12
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Das D, Asher A, Ghosh AK. Cancer and Coronary Artery Disease: Common Associations, Diagnosis and Management Challenges. Curr Treat Options Oncol 2019; 20:46. [DOI: 10.1007/s11864-019-0644-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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13
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Florescu DR, Nistor DE. Therapy-induced cardiotoxicity in breast cancer patients: a well-known yet unresolved problem. Discoveries (Craiova) 2019; 7:e89. [PMID: 32309607 PMCID: PMC7093073 DOI: 10.15190/d.2019.2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 12/24/2022] Open
Abstract
Breast cancer is the second most commonly diagnosed cancer, being one of the main health issues that needs to be addressed worldwide. New therapies have led to a remarkable increase in survival rates, which is unfortunately overshadowed by their negative impact on cardiac structure and function in disease-free patients. Since anthracyclines and trastuzumab cause the most undesired outcome in breast cancer patients - cardiac-related mortality, they have been widely studied. However, other therapies (such as hormonal therapy, tyrosine kinase inhibitors, anti-VEGF drugs etc.) can also affect the cardiovascular system and lead to ischemia, hypertension or vascular thromboembolism. Even though excessive research has been conducted in thepast decades, there are still no guidelines regarding the most adequate methods neither to detect and prevent severe cardiotoxicity that can finally lead to heart failure and ultimately death nor for the further management of patients after cardiotoxicity is detected. Biomarkers of ischemia (troponins T and I) and of overload (BNP and NT-proBNP) in association with periodic echocardiographies (assessment of the global longitudinal strain) are two of the most important means used by physicians in the evaluation of cardiac disease in this group of patients. Given that no internationally accepted guidelines for screening and surveillance of different populations exist, the cardio-oncology team is crucial in the management of these patients, their collaboration resulting in individualized treatment regimens. After careful evaluation of different variables (treatment effects, malignancy status, and the patient's pre-existing conditions), a decision is made to either reduce the dosage or rate of administration, change the medication or interrupt the treatment and initiate the cardioprotective therapeutic associations. Consequently, it is an absolute necessity the development of customized treatment guidelines and the conduction of multiple clinical studies in order to demonstrate their effect on long-term survival.
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Affiliation(s)
| | - Diana Elena Nistor
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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