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Psallidas I, Kalomenidis I, Porcel JM, Robinson BW, Stathopoulos GT. Malignant pleural effusion: from bench to bedside. Eur Respir Rev 2017; 25:189-98. [PMID: 27246596 DOI: 10.1183/16000617.0019-2016] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/25/2016] [Indexed: 11/05/2022] Open
Abstract
Malignant pleural effusion (MPE) is a common but serious condition that is related with poor quality of life, morbidity and mortality. Its incidence and associated healthcare costs are rising and its management remains palliative, with median survival ranging from 3 to 12 months. During the last decade there has been significant progress in unravelling the pathophysiology of MPE, as well as its diagnostics, imaging, and management. Nowadays, formerly bed-ridden patients are genotyped, phenotyped, and treated on an ambulatory basis. This article attempts to provide a comprehensive overview of current advances in MPE from bench to bedside. In addition, it highlights unanswered questions in current clinical practice and suggests future directions for basic and clinical research in the field.
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Affiliation(s)
- Ioannis Psallidas
- Oxford Respiratory Trials Unit, Oxford Centre for Respiratory Medicine, Oxford University Hospitals Trust, Oxford, UK
| | - Ioannis Kalomenidis
- 1st Dept of Critical Care and Pulmonary Medicine, National and Kapodistrian University of Athens, School of Medicine, Evangelismos Hospital, Athens, Greece
| | - Jose M Porcel
- Pleural Medicine Unit, Dept of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida, Lleida, Spain
| | - Bruce W Robinson
- National Centre for Asbestos Related Disease, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia Dept of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Georgios T Stathopoulos
- Laboratory for Molecular Respiratory Carcinogenesis, Dept of Physiology, Faculty of Medicine, University of Patras, Achaia, Greece Comprehensive Pneumology Center (CPC), University Hospital, Ludwig-Maximilians University and Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
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Marazioti A, Kairi CA, Spella M, Giannou AD, Magkouta S, Giopanou I, Papaleonidopoulos V, Kalomenidis I, Snyder LA, Kardamakis D, Stathopoulos GT. Beneficial impact of CCL2 and CCL12 neutralization on experimental malignant pleural effusion. PLoS One 2013; 8:e71207. [PMID: 23967166 PMCID: PMC3743892 DOI: 10.1371/journal.pone.0071207] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/03/2013] [Indexed: 12/31/2022] Open
Abstract
Using genetic interventions, we previously determined that C-C motif chemokine ligand 2 (CCL2) promotes malignant pleural effusion (MPE) formation in mice. Here we conducted preclinical studies aimed at assessing the specific therapeutic potential of antibody-mediated CCL2 blockade against MPE. For this, murine MPEs or skin tumors were generated in C57BL/6 mice by intrapleural or subcutaneous delivery of lung (LLC) or colon (MC38) adenocarcinoma cells. Human lung adenocarcinoma cells (A549) were used to induce MPEs in severe combined immunodeficient mice. Intraperitoneal antibodies neutralizing mouse CCL2 and/or CCL12, a murine CCL2 ortholog, were administered at 10 or 50 mg/kg every three days. We found that high doses of CCL2/12 neutralizing antibody treatment (50 mg/kg) were required to limit MPE formation by LLC cells. CCL2 and CCL12 blockade were equally potent inhibitors of MPE development by LLC cells. Combined CCL2 and CCL12 neutralization was also effective against MC38-induced MPE and prolonged the survival of mice in both syngeneic models. Mouse-specific CCL2-blockade limited A549-caused xenogeneic MPE, indicating that host-derived CCL2 also contributes to MPE precipitation in mice. The impact of CCL2/12 antagonism was associated with inhibition of immune and vascular MPE-related phenomena, such as inflammation, new blood vessel assembly and plasma extravasation into the pleural space. We conclude that CCL2 and CCL12 blockade are effective against experimental MPE induced by murine and human adenocarcinoma in mice. These results suggest that CCL2-targeted therapies may hold promise for future use against human MPE.
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Affiliation(s)
- Antonia Marazioti
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, Greece
| | - Chrysoula A. Kairi
- First Department of Critical Care and Pulmonary Medicine, University of Athens School of Medicine, General Hospital Evangelismos, Athens, Attica, Greece
| | - Magda Spella
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, Greece
| | - Anastasios D. Giannou
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, Greece
| | - Sophia Magkouta
- First Department of Critical Care and Pulmonary Medicine, University of Athens School of Medicine, General Hospital Evangelismos, Athens, Attica, Greece
| | - Ioanna Giopanou
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, Greece
| | - Vassilios Papaleonidopoulos
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, Greece
| | - Ioannis Kalomenidis
- First Department of Critical Care and Pulmonary Medicine, University of Athens School of Medicine, General Hospital Evangelismos, Athens, Attica, Greece
| | - Linda A. Snyder
- Janssen R&D, LLC, Oncology Discovery Research, Spring House, Pennsylvania, United States of America
| | - Dimitrios Kardamakis
- Department of Radiation Oncology and Stereotactic Radiotherapy, Faculty of Medicine, University of Patras, Rio, Achaia, Greece
| | - Georgios T. Stathopoulos
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Rio, Achaia, Greece
- First Department of Critical Care and Pulmonary Medicine, University of Athens School of Medicine, General Hospital Evangelismos, Athens, Attica, Greece
- * E-mail:
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Skopiński P, Bałan BJ, Kocik J, Zdanowski R, Lewicki S, Niemcewicz M, Gawrychowski K, Skopińska-Różewska E, Stankiewicz W. Inhibitory effect of herbal remedy PERVIVO and anti-inflammatory drug sulindac on L-1 sarcoma tumor growth and tumor angiogenesis in Balb/c mice. Mediators Inflamm 2013; 2013:289789. [PMID: 23935247 PMCID: PMC3712210 DOI: 10.1155/2013/289789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 06/10/2013] [Indexed: 11/18/2022] Open
Abstract
Anticancer activity of many herbs was observed for hundreds of years. They act as modifiers of biologic response, and their effectiveness may be increased by combining multiple herbal extracts . PERVIVO, traditional digestive herbal remedy, contains some of them, and we previously described its antiangiogenic activity. Numerous studies documented anticancer effects of nonsteroidal anti-inflammatory drugs. We were the first to show that sulindac and its metabolites inhibit angiogenesis. In the present paper the combined in vivo effect of multicomponent herbal remedy PERVIVO and nonsteroidal anti-inflammatory drug sulindac on tumor growth, tumor angiogenesis, and tumor volume in Balb/c mice was studied. These effects were checked after grafting cells collected from syngeneic sarcoma L-1 tumors into mice skin. The strongest inhibitory effect was observed in experimental groups treated with PERVIVO and sulindac together. The results of our investigation showed that combined effect of examined drugs may be the best way to get the strongest antiangiogenic and antitumor effect.
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Affiliation(s)
- P. Skopiński
- Department of Histology and Embryology, Center for Biostructure Research, Warsaw Medical University, Chałubińskiego 5, 02-004 Warsaw, Poland
| | - B. J. Bałan
- Department of Immunology, Biochemistry and Nutrition, Warsaw Medical University, Pawińskiego 3a, 01-002 Warsaw, Poland
| | - J. Kocik
- Department of Regenerative Medicine, Military Institute of Hygiene and Epidemiology, Kozielska 4, 01-163 Warsaw, Poland
| | - R. Zdanowski
- Department of Regenerative Medicine, Military Institute of Hygiene and Epidemiology, Kozielska 4, 01-163 Warsaw, Poland
| | - S. Lewicki
- Department of Regenerative Medicine, Military Institute of Hygiene and Epidemiology, Kozielska 4, 01-163 Warsaw, Poland
| | - M. Niemcewicz
- Biological Threats Identification and Countermeasure Center of the Military Institute of Hygiene and Epidemiology, Lubelska 2, 24-100 Pulawy, Poland
| | - K. Gawrychowski
- Department of Gynecological Oncology and Oncology, Medicover Hospital, Aleja Rzeczypospolitej 5, 02-972 Warsaw, Poland
| | - E. Skopińska-Różewska
- Pathology Department, Center for Biostructure Research, Warsaw Medical University, Chałubińskiego 5, 02-004 Warsaw, Poland
- Department of Microwave Safety, Military Institute of Hygiene and Epidemiology, Kozielska 4, 01-163 Warsaw, Poland
| | - W. Stankiewicz
- Department of Microwave Safety, Military Institute of Hygiene and Epidemiology, Kozielska 4, 01-163 Warsaw, Poland
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Stathopoulos GT, Kalomenidis I. Malignant pleural effusion: tumor-host interactions unleashed. Am J Respir Crit Care Med 2012; 186:487-92. [PMID: 22652027 PMCID: PMC5650050 DOI: 10.1164/rccm.201203-0465pp] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Malignant pleural effusion (MPE) poses a significant clinical problem. Current nonetiologic management is suboptimal in terms of efficacy and safety. In light of recent research progress, we propose herein a new view of MPE development, which may rapidly translate into meaningful changes in therapeutics. In addition to tumor-induced impairment of pleural fluid drainage, pertinent findings point toward another pathway to MPE formation: a vicious loop of interactions between pleural-based tumor cells and the host vasculature and immune system that results in increased net fluid production via enhanced plasma extravasation into the pleural space. The ability of tumor cells to trigger this cascade likely rests on a specific and distinct transcriptional repertoire, which results in important vasoactive events in the pleural space. Although the characterization of tumor-derived factors responsible for MPE development is in the making, an additional, indirect path to MPE was recently demonstrated: tumor cells recruit and co-opt host cells and mediators, which, in turn, amplify tumor cell-primed fluid leakage and impact tumor cell functions. Importantly, recent evidence suggests that the biologic events that culminate in clinical MPE are likely amenable to therapeutic inhibition and even prevention. In this perspective, the scientific basis for an update of current concepts of MPE formation is highlighted. Key questions for future research are posed. Finally, a vision for novel, effective, safe, and convenient treatment modalities that can be offered to outpatients with MPE is set forth.
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Affiliation(s)
- Georgios T Stathopoulos
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Basic Biomedical Sciences Building, 2nd floor, Room B40, 1 Asklepiou Street, University Campus (Panepistimioupolis), 26504 Rio, Greece.
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