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Naeem MT, Usman AH, Ali S, Raza H, Shah AN, Mahmmoud Fadelallah Eljack M. Intravesical mitomycin C efficacy in acidic and alkaline urinary pH: impact on recurrence-free survival rate after TURBT. Ann Med Surg (Lond) 2023; 85:5323-5327. [PMID: 37915689 PMCID: PMC10617880 DOI: 10.1097/ms9.0000000000001350] [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: 05/27/2023] [Accepted: 09/17/2023] [Indexed: 11/03/2023] Open
Abstract
Background Urinary bladder tumor recurrence following transurethral resection of bladder tumor (TURBT) is a common issue. This study aims to determine how urine alkalinization affects bladder tumor recurrence after surgery. Materials and methods Sixty patients receiving mitomycin C (MMC) therapy after TURBT were divided into two groups based on mean pH values. Twenty-six patients were in group A, whose urine pH was below 5.5. However, there were 34 patients in group B, and their urine pH was higher than 5.5. Both groups of patients were given intravesical MMC once weekly for 6 weeks following TURBT. A cystoscopy was performed as a follow-up at 3, 6, and 12 months. Urine pH and the recurrence-free survival rate were compared using Kaplan-Meier survival analysis and the COX proportional hazard model. Results The mean time to tumor recurrence in group A (intravesical MMC in acidic urine) and group B (intravesical MMC in alkaline urine) was 12.48 versus 16.84 months, respectively. Alkaline urine pH was identified as an independent predictor of preventing the recurrence of superficial bladder tumors by univariate COX regression analysis. Age, sex, and mean tumor size did not affect the likelihood of tumor recurrence. However, smoking had an association with increased tumor recurrence. Conclusion Tumor recurrence post-TURBT is delayed in patients with alkaline urine pH. Smoking is an independent risk factor for bladder tumors.
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Affiliation(s)
| | | | - Sarmad Ali
- Al-Shifa Hospital, Hospital Road, Mandi Bahuddin
| | - Hassan Raza
- Gujranwala Teaching Hospital, Gujranwala, Pakistan
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Chen C, Fa Y, Kuo Y, Liu Y, Lin C, Wang X, Lu Y, Chiang Y, Yang C, Wu L, Ho JA. Thiolated Mesoporous Silica Nanoparticles as an Immunoadjuvant to Enhance Efficacy of Intravesical Chemotherapy for Bladder Cancer. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2204643. [PMID: 36638276 PMCID: PMC9982584 DOI: 10.1002/advs.202204643] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 12/16/2022] [Indexed: 06/17/2023]
Abstract
The characteristics of global prevalence and high recurrence of bladder cancer has led numerous efforts to develop new treatments. The spontaneous voiding and degradation of the chemodrug hamper the efficacy and effectiveness of intravesical chemotherapy following tumor resection. Herein, the externally thiolated hollow mesoporous silica nanoparticles (MSN-SH(E)) is fabricated to serve as a platform for improved bladder intravesical therapy. Enhanced mucoadhesive effect of the thiolated nanovector is confirmed with porcine bladder. The permeation-enhancing effect is also verified, and a fragmented distribution pattern of a tight junction protein, claudin-4, indicates the opening of tight junction. Moreover, MSN-SH(E)-associated reprogramming of M2 macrophages to M1-like phenotype is observed in vitro. The antitumor activity of the mitomycin C (MMC)-loaded nanovector (MMC@MSN-SH(E)) is more effective than that of MMC alone in both in vitro and in vivo. In addition, IHC staining is used to analyze IFN-γ, TGF-β1, and TNF-α. These observations substantiated the significance of MMC@MSN-SH(E) in promoting anticancer activity, holding the great potential for being used in intravesical therapy for non-muscle invasive bladder cancer (NMIBC) due to its mucoadhesivity, enhanced permeation, immunomodulation, and prolonged and very efficient drug exposure.
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Affiliation(s)
- Cheng‐Che Chen
- BioAnalytical Chemistry and Nanobiomedicine LaboratoryDepartment of Biochemical Science and TechnologyNational Taiwan University10617TaipeiTaiwan
- Department of UrologyTaichung Veterans General Hospital40705TaichungTaiwan
| | - Yu‐Chen Fa
- BioAnalytical Chemistry and Nanobiomedicine LaboratoryDepartment of Biochemical Science and TechnologyNational Taiwan University10617TaipeiTaiwan
| | - Yen‐Yu Kuo
- Department of ChemistryNational Tsing Hua University300044HsinchuTaiwan
| | - Yi‐Chun Liu
- BioAnalytical Chemistry and Nanobiomedicine LaboratoryDepartment of Biochemical Science and TechnologyNational Taiwan University10617TaipeiTaiwan
| | - Chih‐Yu Lin
- Department of ChemistryNational Tsing Hua University300044HsinchuTaiwan
| | - Xin‐Hui Wang
- Instrumentation CenterNational Taiwan University10617TaipeiTaiwan
| | - Yu‐Huan Lu
- Department of ChemistryNational Tsing Hua University300044HsinchuTaiwan
| | - Yu‐Han Chiang
- Department of ChemistryNational Taiwan University10617TaipeiTaiwan
| | - Chia‐Min Yang
- Department of ChemistryNational Tsing Hua University300044HsinchuTaiwan
- Frontier Research Center on Fundamental and Applied Sciences of MattersNational Tsing Hua University300044HsinchuTaiwan
| | - Li‐Chen Wu
- Department of Applied ChemistryNational Chi Nan UniversityPuliNantou54561Taiwan
| | - Ja‐an Annie Ho
- BioAnalytical Chemistry and Nanobiomedicine LaboratoryDepartment of Biochemical Science and TechnologyNational Taiwan University10617TaipeiTaiwan
- Department of ChemistryNational Taiwan University10617TaipeiTaiwan
- Center for Emerging Materials and Advance DevicesNational Taiwan University10617TaipeiTaiwan
- Center for BiotechnologyNational Taiwan University10617TaipeiTaiwan
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Menchikov LG, Shestov AA, Popov AV. Warburg Effect Revisited: Embodiment of Classical Biochemistry and Organic Chemistry. Current State and Prospects. BIOCHEMISTRY (MOSCOW) 2023; 88:S1-S20. [PMID: 37069111 DOI: 10.1134/s0006297923140018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The Nobel Prize Winner (1931) Dr. Otto H. Warburg had established that the primary energy source of the cancer cell is aerobic glycolysis (the Warburg effect). He also postulated the hypothesis about "the prime cause of cancer", which is a matter of debate nowadays. Contrary to the hypothesis, his discovery was recognized entirely. However, the discovery had almost vanished in the heat of battle about the hypothesis. The prime cause of cancer is essential for the prevention and diagnosis, yet the effects that influence tumor growth are more important for cancer treatment. Due to the Warburg effect, a large amount of data has been accumulated on biochemical changes in the cell and the organism as a whole. Due to the Warburg effect, the recovery of normal biochemistry and oxygen respiration and the restoration of the work of mitochondria of cancer cells can inhibit tumor growth and lead to remission. Here, we review the current knowledge on the inhibition of abnormal glycolysis, neutralization of its consequences, and normalization of biochemical parameters, as well as recovery of oxygen respiration of a cancer cell and mitochondrial function from the point of view of classical biochemistry and organic chemistry.
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Affiliation(s)
- Leonid G Menchikov
- N. D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Moscow, 119991, Russian Federation
| | - Alexander A Shestov
- University of Pennsylvania, Department of Pathology and Laboratory Medicine, Perelman Center for Advanced Medicine, Philadelphia, PA 19104, USA
| | - Anatoliy V Popov
- University of Pennsylvania, Department of Radiology, Philadelphia, PA 19104, USA.
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Ide H, Kikuchi E, Ogihara K, Niwa N, Shigeta K, Masuda T, Baba Y, Mizuno R, Oya M. Urinary pH is an independent predictor of upper tract recurrence in non-muscle-invasive bladder cancer patients with a smoking history. Sci Rep 2021; 11:20675. [PMID: 34667220 PMCID: PMC8526685 DOI: 10.1038/s41598-021-00184-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/01/2021] [Indexed: 11/15/2022] Open
Abstract
Limited information is currently available on predictors of upper tract urothelial carcinoma (UTUC) recurrence in non-muscle-invasive bladder cancer (NMIBC) patients according to smoking history, although smoking probably contributes to urothelial carcinogenesis. Therefore, the present study aimed to identify independent predictors of UTUC recurrence in all patients and those with a smoking history. Our study population comprised 1190 NMIBC patients who underwent transurethral resection of bladder tumor. UTUC developed in 43 patients during the follow-up. A history of bacillus Calmette-Guérin (BCG) therapy was independently associated with a lower incidence of UTUC (HR = 0.43; P = 0.011). In a subgroup of NMIBC patients with a smoking history, concomitant carcinoma in situ (CIS) and a lower urinary pH (< 6) were independently associated with a higher incidence of UTUC recurrence (HR = 3.34, P = 0.006 and HR = 3.73, P = 0.008, respectively). Among patients with a longer smoking duration (≥ 20 years) or larger smoking intensity (≥ 20 cigarettes per day), those with lower urinary pH (< 6) had a significantly higher UTUC recurrence rate than their counterparts. These results suggest that BCG instillation may prevent UTUC recurrence in NMIBC patients, while a lower urinary pH and concomitant CIS increase the risk of UTUC recurrence in those with a smoking history.
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Affiliation(s)
- Hiroki Ide
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan.
| | - Koichiro Ogihara
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Naoya Niwa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Tsukasa Masuda
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Yuto Baba
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Miyata Y, Tsurusaki T, Hayashida Y, Imasato Y, Takehara K, Aoki D, Nishikido M, Watanabe J, Mitsunari K, Matsuo T, Ohba K, Taniguchi K, Sakai H. Intravesical mitomycin C (MMC) and MMC + cytosine arabinoside for non-muscle-invasive bladder cancer: a randomised clinical trial. BJU Int 2021; 129:534-541. [PMID: 34383381 PMCID: PMC9290455 DOI: 10.1111/bju.15571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/29/2021] [Accepted: 08/07/2021] [Indexed: 12/01/2022]
Abstract
Objectives To compare the urinary pH, recurrence‐free survival (RFS), and safety of adjuvant intravesical therapy in patients with non‐muscle‐invasive bladder cancer (NMIBC) receiving mitomycin C (MMC) therapy and MMC + cytosine arabinoside (Ara‐C) therapy. Patients and Methods A total of 165 patients with NMIBC from six hospitals were randomly allocated to two groups: weekly instillation of MMC + Ara‐C (30 mg/30 mL + 200 mg/10 mL) for 6 weeks and the same instillation schedule of MMC (30 mg/40 mL). The primary outcome was RFS, and secondary outcomes were urinary pH and toxicity in the two groups. Results A total of 81 and 87 patients were randomised into the MMC and MMC + Ara‐C groups, respectively. Overall, the RFS in the MMC + Ara‐C group was significantly longer (P = 0.018) than that in the MMC group. A similar significant difference was detected in patients with intermediate‐risk NMIBC, but not in those with high‐risk NMIBC. The mean (SD) urinary pH was significantly higher in the MMC + Ara‐C group than in the MMC group, at 6.56 (0.61) vs 5.78 (0.64) (P < 0.001), and the frequency of a urinary pH of >7.0 in the MMC and MMC + Ara‐C groups was 6.3% and 26.7%, respectively (P < 0.001). Multivariate analysis models including clinicopathological features and second transurethral resection demonstrated that increased urinary pH was associated with better outcomes (hazard ratio 0.18, 95% confidential interval 0.18–0.038; P < 0.001). In all, there were 14 and 10 adverse events in the MMC and MMC + Ara‐C groups, respectively, without a significant difference (P = 0.113). Conclusions Our randomised clinical trial suggested that intravesical therapy with MMC and Ara‐C is useful and safe for patients with intermediate‐risk NMIBC. Increase in urinary pH with Ara‐C is speculated as a mechanism for increased anti‐cancer effects.
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Affiliation(s)
- Yasuyoshi Miyata
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Toshifumi Tsurusaki
- Department of Urology, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Yasushi Hayashida
- Department of Urology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Yushi Imasato
- Department of Urology, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Kosuke Takehara
- Department of Urology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Daiyu Aoki
- Department of Urology, Japan Community Health care Organization Isahaya General Hospital, Isahaya, Japan
| | - Masaharu Nishikido
- Department of Urology, National Hospital Organization Nagasaki Medical Center, Ohmura, Japan
| | - Junichi Watanabe
- Department of Urology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Kensuke Mitsunari
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Tomohiro Matsuo
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Kojiro Ohba
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Keisuke Taniguchi
- Department of Urology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Hideki Sakai
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Elkashef A, Barakat N, Khater SM, Awadalla A, Belal F, El-Assmy AM, Sheir KZ, Shokeir AA. Effect of low-energy shock wave therapy on intravesical epirubicin delivery in a rat model of bladder cancer. BJU Int 2020; 127:80-89. [PMID: 32654305 DOI: 10.1111/bju.15173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To study the efficacy of low-energy shock wave therapy (LESW) on enhancing intravesical epirubicin (EPI) delivery in a rat model of bladder cancer (BCa). MATERIALS AND METHODS A total of 100 female Fischer rats were randomly allocated into five groups: control; BCa; LESW; EPI; and EPI plus LESW. After BCa induction by N-butyl-N-(4-hydroxybutyl)nitrosamine, EPI (0.6 mg/0.3 mL of EPI diluted in 0.3 mL saline) or saline (0.6 mL) was administered and retained in the bladders for 1 h with or without LESW treatment (300 pulses at 0.12 mJ/mm2 ). This was repeated weekly for 6 weeks. Survival was then calculated, rats were weighed and their bladders were harvested for bladder/body ratio estimation, histopathological examination, p53 immunostaining, miR-210, hypoxia-inducible factor (HIF)-1α, tumour necrosis factor (TNF)-α and interleukin (IL)-6 relative gene expression and fluorescence spectrophotometric drug quantification. Heart and blood samples were also collected for assessment of the safety profile and toxicity. RESULTS The EPI plus LESW group had significantly lower mortality rates, loss of body weight and bladder/body ratio. Histopathological results in terms of grossly visible bladder lesions, mucosal thickness, dysplasia formation and tumour invasion were significantly better in the combined treatment group. The EPI plus LESW group also had statistically significant lower expression levels of p53 , miR-210, HIF-1α, TNF-α and IL-6. LESW increased urothelial concentration of EPI by 5.7-fold (P < 0.001). No laboratory variable exceeded the reference ranges in any of the groups. There was an improvement of the indicators of EPI-induced cardiomyopathy in terms of congestion, hyalinization and microvesicular steatosis of cardiomyocytes (P = 0.068, 0.003 and 0.046, respectively) in the EPI plus LESW group. CONCLUSIONS The combined use of intravesical EPI and LESW results in less BCa invasion and less dysplasia formation, as LESW increases urothelial permeability of EPI and enhances its delivery into tumour tissues, without subsequent toxicity.
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Affiliation(s)
- Ahmed Elkashef
- Department of Urology, Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt
| | - Nashwa Barakat
- Department of Urology, Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt
| | - Sherry M Khater
- Department of Urology, Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt
| | - Amira Awadalla
- Center of Excellence for Genome and Cancer Research, Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt
| | - Fathallah Belal
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - Ahmed M El-Assmy
- Department of Urology, Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt
| | - Khaled Z Sheir
- Department of Urology, Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt
| | - Ahmed A Shokeir
- Department of Urology, Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt.,Center of Excellence for Genome and Cancer Research, Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt
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7
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Abstract
PRECIS The use of mitomycin-C as a mixed formulation with lidocaine and epinephrine for filtration surgery may alter its pH and consequently affect clinical effectivity.
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8
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De Coninck V, Keller EX, Rodríguez-Monsalve M, Doizi S, Audouin M, Haymann JP, Traxer O. Evaluation of a Portable Urinary pH Meter and Reagent Strips. J Endourol 2018; 32:647-652. [DOI: 10.1089/end.2018.0202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Vincent De Coninck
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Etienne Xavier Keller
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - María Rodríguez-Monsalve
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France
| | - Steeve Doizi
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France
| | - Marie Audouin
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France
| | - Jean-Philippe Haymann
- Service d'Explorations Fonctionnelles, Institut National de la Santé et de la Recherche Médicale, UMR_S1155, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France
| | - Olivier Traxer
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France
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Recommended oral sodium bicarbonate administration for urine alkalinization did not affect the concentration of mitomycin-C in non-muscle invasive bladder cancer patients. Oncotarget 2017; 8:96117-96125. [PMID: 29221191 PMCID: PMC5707085 DOI: 10.18632/oncotarget.21755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/30/2017] [Indexed: 12/24/2022] Open
Abstract
Objective Sodium bicarbonate has been reported to maximize the efficacy of intravesical instillation of mitomycin-C (IVI-MMC) therapy by urine alkalinization in non-muscle-invasive bladder cancer (NMIBC). This study aimed to analyze the changes in MMC concentration according to urinary pH and evaluate the efficacy of sodium bicarbonate to maintain the concentration of active form of MMC during IVI-MMC. Methods We prospectively enrolled 26 patients with NMIBC after transurethral resection of bladder tumor. Patients with very high-risk and low-risk NMIBC were excluded. Urinary creatinine, volume, pH, and concentrations of MMC and its degraded form were measured immediately before and after IVI-MMC. The patients were administered 1.5 g of oral sodium bicarbonate during the preceding evening, in the morning, and immediately before the fourth cycle of the six-cycle IVI-MMC. The correlation between MMC concentration and urinary pH changes was explored with or without oral bicarbonate therapy. Results Recurrence without progression to muscle-invasive disease was noted in 4 of 26 patients in a 23.7-month follow-up. The mean urinary pH before and after the therapy increased from 6.03 to 6.50, and 6.46 to 7.24, without or with oral SB therapy, respectively. Despite this increase, the concentration of active form of MMC did not change significantly. No correlation was found between urinary pH and MMC concentration. Urine alkalinization by SB administration did not maintain the high concentration of urinary MMC. Conclusions Urine alkalinization by sodium bicarbonate administration for IVI-MMC did not maintain the high concentration of active urinary MMC in NMIBC.
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Ide H, Kikuchi E, Hagiwara M, Hayakawa N, Hongo H, Miyajima A, Oya M. Urinary pH Levels are Strongly Associated with Bladder Recurrence After Nephroureterectomy in Upper Tract Urothelial Carcinoma Patients with a Smoking History. Ann Surg Oncol 2016; 23:1029-1038. [PMID: 27613550 DOI: 10.1245/s10434-016-5555-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Aromatic amines, well-known bladder carcinogens, derived from cigarette smoke are activated by acidic urine. We herein determined whether urinary pH levels are associated with bladder recurrence in upper tract urothelial carcinoma patients with a positive smoking history. METHODS A total of 256 upper tract urothelial carcinoma patients who were surgically treated at our institution between 1990 and 2013 were included. Urinary pH levels were defined as the median of at least two consecutive measurements within 1 month of surgery. RESULTS Ninety-six patients (37.5 %) had pH <5.5 and 160 (62.5 %) had pH ≥5.5, and urinary pH levels were identified as one of the significant predictors for bladder recurrence in univariate but not multivariate Cox regression analysis in overall. In patients with a positive smoking history among those without a history of bladder tumor (N = 110), the 5-year bladder recurrence-free survival rate was 52.5 % in patients with pH ≥5.5, which was significantly higher than that in those with pH <5.5 (25.9 %, p = 0.032). In the multivariate analysis, urinary pH <5.5 (p = 0.022, HR; 1.86) was independently associated with bladder recurrence. No significant difference for bladder recurrence was observed between these two groups in patients with no smoking history among them. CONCLUSIONS Urinary pH <5.5 is associated with an increased risk of bladder recurrence in upper tract urothelial carcinoma patients with a positive smoking history among those without a history of bladder tumor. Modifications to pH for urine alkalization may prevent bladder recurrence.
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Affiliation(s)
- Hiroki Ide
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
| | - Masayuki Hagiwara
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hiroshi Hongo
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Akira Miyajima
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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11
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Yang Y, Deng S, Zeng Q, Hu W, Chen T. Highly stable selenadiazole derivatives induce bladder cancer cell apoptosis and inhibit cell migration and invasion through the activation of ROS-mediated signaling pathways. Dalton Trans 2016; 45:18465-18475. [PMID: 27711726 DOI: 10.1039/c6dt02045c] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Herein highly stable selenadiazole derivatives were synthesized and found to be able to induce bladder cancer cell apoptosis and inhibit cell migration and invasion through the activation of ROS-mediated pathways.
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Affiliation(s)
- Yahui Yang
- Department of Chemistry
- Jinan University Guangzhou 510632
- China
| | - Shulin Deng
- Department of Chemistry
- Jinan University Guangzhou 510632
- China
| | - Qinsong Zeng
- Department of Urology
- General Hospital of Guangzhou Military Command of PLA
- Guangzhou 510010
- China
| | - Weilie Hu
- Department of Urology
- General Hospital of Guangzhou Military Command of PLA
- Guangzhou 510010
- China
| | - Tianfeng Chen
- Department of Chemistry
- Jinan University Guangzhou 510632
- China
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12
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[Assessment of the optimization of the conditions of mitomycin C intravesical instillation completion in the setting of non-muscle invasive bladder cancer treatment]. Prog Urol 2015; 26:79-82. [PMID: 26653577 DOI: 10.1016/j.purol.2015.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/03/2015] [Accepted: 10/15/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The efficacy of intravesical instillation of mitomycin C (MMC) requires alkalinisation and concentration of urine before each instillation. The objective of the study was to assess compliance and effectiveness of urine alkalinazation and fluid restriction protocols in patients treated with intravesical instillations of MMC for TVNIM. MATERIAL ET METHOD Descriptive prospective epidemiological study in all patients consecutively treated with intravesical instillations of MMC for non-muscle invasive bladder cancer (NMIBC). Patients should be advised to drink 2 liters of water from Vichy and to perform fluid restriction the day before the instillations. Before each instillation, a questionnaire on the implementation of these measures was filled, density and pH were determined by urinalysis strips. RESULTS On 126 questionnaires fulfilled, 117 patients (93%) and 106 patients (84%) reported having made alkalinization and fluid restriction, respectively. Ninety-one of patients (78%) reported having performed alkalinization had a pH greater than or equal to 6.5 and the mean urinary pH was 6.94 vs. 5.94 in patients stating not to have made alkalizing (P=0.0001). No significant differences in urine density according to fluid restriction was found. CONCLUSION The observance of the instructions regarding urine alkalinization before MMC instillations was satisfactory and has achieved a sufficiently high urinary pH to prevent degradation of the product in 91% of cases. Conversely, the fluid restriction was not followed closely and has not shown its effectiveness on the concentration of urine.
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13
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Optimizing intravesical mitomycin C therapy in non-muscle-invasive bladder cancer. Nat Rev Urol 2014; 11:220-30. [DOI: 10.1038/nrurol.2014.52] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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[Intravesical chemotherapy]. Urologia 2013; 80 Suppl 21:20-3. [PMID: 23559134 DOI: 10.5301/ru.2013.10857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2012] [Indexed: 11/20/2022]
Abstract
Bladder cancer care continues to represent a significant financial burden on the population and on the healthcare system. The incidence of bladder cancer has increased over the last two decades. Therapeutic advances have occurred in bladder cancer care, but at an increased cost to payers, providers, and patients. Intravesical treatment of non-muscle invasive tumors represents one of the main costs. For this reason therapeutic schedules need to be rationalized. In this perspective, we present some critical remarks on: the use of gemcitabine in clinical practice; the real impact of the perioperative chemotherapy, emphasizing the cost and effectiveness in high-risk patients, and finally the optimization of intravesical treatments. There is a need for the scientific community to focus on their resources and convey efforts not in the treatment of low-risk cancers (present in significant numbers in various studies), which the Anglo-Saxons call "nuisance tumor" since they can be treated easily and effectively at low cost, but definitely to engage in the study of the treatment of cancer at high risk of recurrence and progression, and it is on this field that the cost (economic, management, subjective) / benefit ratio must be assessed.
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Ersoy H, Yaytokgil M, Karakoyunlu AN, Topaloglu H, Sagnak L, Ozok HU. Single early instillation of mitomycin C and urinary alkalinization in low-risk non-muscle-invasive bladder cancer: a preliminary study. DRUG DESIGN DEVELOPMENT AND THERAPY 2013; 7:1-6. [PMID: 23300343 PMCID: PMC3536351 DOI: 10.2147/dddt.s39541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The purpose of this study was to determine the effectiveness of a single early instillation of mitomycin C (MMC) after transurethral resection of bladder tumor (TURBT) together with urinary alkalinization in patients with low-risk non-muscle-invasive bladder cancer (NMIBC). Methods Between February 2006 and November 2010, patients diagnosed as having a primary bladder tumor were randomized into standard and optimized treatment groups. The treatment groups were formed prospectively from patients with NMIBC according to results of pathological examination postoperatively, whereas the control group was formed retrospectively. Patients in the standard group (n = 11) were given intravesical MMC 40 mg in the first 6 hours after TURBT, while the patients in the optimized group (n = 15) underwent urinary alkalinization prior to MMC. In the control group (n = 23), no drug treatment was given. The patients were followed after surgery at months 3 and 12, and then annually for the first 5 years using cystoscopy and ultrasound. Time to recurrence and recurrence-free survival rates were calculated. Results There were no statistically significant differences between the standard and optimized groups, between the control and optimized groups, or between the control and standard groups in terms of mean recurrence-free survival rates (P = 0.132, 0.645, and 0.173, respectively). The mean time to recurrence was 34.8 (range 28.5–41.1) months in the optimized group and 51.8 (range 44.3–59.2) months in the control group. There was no recurrence during the follow-up period in the standard group. Conclusion The results of this preliminary study could not demonstrate the efficacy of urinary alkalinization before a single dose of early MMC following TURBT to increase the effectiveness of the MMC, so we did not continue the study further.
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Affiliation(s)
- Hamit Ersoy
- Department of Urology, Diskapı Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Vásquez JL, Gehl J, Hermann GG. Electroporation enhances mitomycin C cytotoxicity on T24 bladder cancer cell line: a potential improvement of intravesical chemotherapy in bladder cancer. Bioelectrochemistry 2012; 88:127-33. [PMID: 22940093 DOI: 10.1016/j.bioelechem.2012.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 07/31/2012] [Accepted: 08/02/2012] [Indexed: 11/25/2022]
Abstract
Intravesical mitomycin instillation combined with electric pulses is being used experimentally for the treatment of T1 bladder tumors, in patients unfit for surgery. Electroporation may enhance the uptake of chemotherapeutics by permeabilization of cell membranes. We investigated if electroporation improves the cytotoxicity of mitomycin. In two cell lines, T24 (bladder cancer cell line) and DC3F (Chinese hamster fibroblast), exposure to different concentrations of mitomycin (0.01-2000μM) was tested with and without electroporation (6 pulses of 1kV/cm, duration: 99μs, frequency: 1Hz). Cell viability was assessed by colorimetric assay (MTT). For both cell lines, mitomycin's IC_50 was approximately 1000μM in both pulsed and unpulsed cells. On T24 cells, electroporation and mitomycin caused (relative reduction) RR of survival of: 25%, 31% and 29%, by concentrations 0μM, 500μM and 1000μM respectively. For DC3F cells, the RRs of survival were: 28%, 29%, and 33%, by concentrations 0μM, 500μM and 1000μM respectively. In conclusion, electroporation and mitomycin together are about 30% more effective than mitomycin alone. The results help to elucidate the additive effect of mitomycin and electric pulses and support the use of this combination in the treatment of bladder cancer.
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Affiliation(s)
- Juan L Vásquez
- Center for Drug and Gene Electrotransfer, Department of Oncology 54B1, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark.
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Current world literature. Curr Opin Urol 2012; 22:432-43. [PMID: 22854603 DOI: 10.1097/mou.0b013e3283572fe1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Inflammatory pathways as promising targets to increase chemotherapy response in bladder cancer. Mediators Inflamm 2012; 2012:528690. [PMID: 22811589 PMCID: PMC3395159 DOI: 10.1155/2012/528690] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 05/22/2012] [Accepted: 05/22/2012] [Indexed: 12/21/2022] Open
Abstract
While more and more physicians are choosing chemotherapy for patients with bladder cancer, the current treatment is still far from satisfactory due to low response rate and severe side effects. Emerging evidence indicates that inflammatory microenvironment is involved in the pathogenesis of bladder cancer. Recent studies have also provided ample evidence that chemotherapy response is influenced by activation of major inflammatory mediators, including transcription factors, cytokines, chemokines, and COX-2. We reviewed all published literature addressing the roles of inflammatory microenvironment in bladder cancer and evaluating emerging evidence that inflammatory pathways represent potential therapeutic targets to enhance chemotherapy of bladder cancer.
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Urine alkalization might improve response to mitomycin C. Nat Rev Urol 2011; 8:122. [DOI: 10.1038/nrurol.2011.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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