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Clinical features, diagnosis, and management of dasatinib-induced nephrotic syndrome. Invest New Drugs 2022; 40:1153-1159. [PMID: 35867286 DOI: 10.1007/s10637-022-01288-6] [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: 05/02/2022] [Accepted: 07/18/2022] [Indexed: 12/15/2022]
Abstract
Knowledge of dasatinib-induced nephrotic syndrome is largely based on case reports. The clinical features of dasatinib-induced nephrotic syndrome are unknown. We collected case reports of 25 patients with nephrotic syndrome and analyzed their clinical characteristics. Overall, the onset of nephrotic syndrome ranged from 10 days to 5 years after dasatinib administration. Nine patients (36.0%) had clinical symptoms, mainly periorbital edema and lower-extremity edema. Serum albumin ranged from 1.2 g/dL to 3.7 g/dL in 10 patients (38.5%). The 24-h urine protein values ranged from 3.54 g/day to 118 g/day. Kidney biopsy of 13 patients (52.0%) mainly showed focal foot process effacement, mesangial hyperplasia, endothelial cell damage and focal segmental glomerulosclerosis. Proteinuria resolved or recovered after dasatinib discontinuation or dose reduction or switching to other tyrosine kinase inhibitors (TKIs).
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Kayabasi C, Yilmaz Susluer S, Balci Okcanoglu T, Ozmen Yelken B, Mutlu Z, Goker Bagca B, Caliskan Kurt C, Saydam G, Durmuskahya C, Kayalar H, Ozbilgin A, Biray Avci C, Gunduz C. Origanum Sipyleum Methanol Extract in Combination with Ponatinib Shows Synergistic anti-Leukemic Activities on Chronic Myeloid Leukemia Cells. Nutr Cancer 2022; 74:3679-3691. [PMID: 35608652 DOI: 10.1080/01635581.2022.2077969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Origanum sipyleum is used in folk medicine due to its anti-inflammatory, antimicrobial, and antioxidant properties. Ponatinib, an effective tyrosine kinase inhibitor in the treatment of chronic myeloid leukemia (CML), has severe side effects. Thus, we aimed to determine a novel herbal combination therapy that might not only increase the anti-leukemic efficacy but also reduce the dose of ponatinib in targeting CML cells. Origanum sipyleum was extracted with methanol (OSM), and secondary metabolites were determined by phytochemical screening tests. The cytotoxic effects of OSM on K562 cells were measured by WST-1 assay. Median-effect equation was used to analyze the combination of ponatinib and OSM (p-OSM). Apoptosis, proliferation, and cell-cycle were investigated by flow-cytometry. Cell-cycle-related gene expressions were evaluated by qRT-PCR. OSM that contains terpenoids, flavonoids, tannins, and anthracenes exhibited cytotoxic effects on K562 cells. The median-effect of p-OSM was found as synergistic; OSM reduced the ponatinib dose ∼5-fold. p-OSM elevated the apoptotic and anti-proliferative activity of ponatinib. Consistently, p-OSM blocked cell-cycle progression in G0/G1, S phases accompanied by regulations in TGFB2, ATR, PP2A, p18, CCND1, CCND2, and CCNA1 expressions. OSM enhanced the anti-leukemic activity of ponatinib synergistically via inducing apoptosis, suppressing proliferation, and cell-cycle. As a result, OSM might offer a potential strategy for treating patients with CML.
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Affiliation(s)
- Cagla Kayabasi
- Faculty of Medicine, Medical Biology Department, Ege University, Izmir, Turkey
| | | | | | - Besra Ozmen Yelken
- Faculty of Medicine, Department of Medical Biology, Izmir Bakircay University, Izmir, Turkey
| | - Zeynep Mutlu
- Faculty of Medicine, Medical Biology Department, Ege University, Izmir, Turkey
| | - Bakiye Goker Bagca
- Faculty of Medicine, Department of Medical Biology, Aydın Adnan Menderes University, Aydın, Turkey
| | - Cansu Caliskan Kurt
- Faculty of Medicine, Medical Biology Department, Ege University, Izmir, Turkey
| | - Guray Saydam
- Faculty of Medicine, Internal Medicine Department, Division of Hematology, Ege University, Izmir, Turkey
| | - Cenk Durmuskahya
- Faculty of Forestry, Department of Forest Engineering, Izmir Katip Celebi University, Izmir, Turkey
| | - Husniye Kayalar
- Faculty of Pharmacy, Department of Pharmacognosy, Ege University, Izmir, Turkey
| | - Ahmet Ozbilgin
- Faculty of Medicine, Department of Parasitology, Celal Bayar University, Manisa, Turkey
| | - Cigir Biray Avci
- Faculty of Medicine, Medical Biology Department, Ege University, Izmir, Turkey
| | - Cumhur Gunduz
- Faculty of Medicine, Medical Biology Department, Ege University, Izmir, Turkey
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ElShaer A, Almasry M, Alawar M, Masoud H, El Kinge AR. Dasatinib-Induced Nephrotic Syndrome: A Case Report. Cureus 2021; 13:e20330. [PMID: 34912656 PMCID: PMC8665416 DOI: 10.7759/cureus.20330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 12/22/2022] Open
Abstract
Second-generation tyrosine kinase inhibitors (TKI), such as nilotinib and dasatinib, are used in the first-line treatment of chronic myeloid leukemia (CML), usually after the failure or resistance to imatinib. Despite a good safety profile, medications in this category have an increased incidence of specific adverse events such as pulmonary hypertension, pleural effusion, and cardiovascular/peripheral arterial events. However, renal complications are rarely reported and observed. We herein report a case of a 46-year-old patient with CML who developed nephrotic syndrome upon switching from imatinib to dasatinib therapy, with the resolution of symptoms upon treatment discontinuation and switching to nilotinib. Limited cases were reported in the literature. It is thought that the inhibition of the vascular endothelial growth factor (VEGF) pathway is the main mechanism leading to proteinuria. Dasatinib-induced nephrotic syndrome should be looked for as it can be resolved by either reducing the dose or stopping it altogether and switching to another TKI.
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Affiliation(s)
- Ahmed ElShaer
- Internal Medicine, Alfaisal University College of Medicine, Riyadh, SAU
| | - Mazen Almasry
- Internal Medicine, Alfaisal University College of Medicine, Riyadh, SAU
| | - Maher Alawar
- Nephrology, Specialized Medical Center, Riyadh, SAU
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