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Mounier NM, Abdel-Maged AES, Wahdan SA, Gad AM, Azab SS. Chemotherapy-induced cognitive impairment (CICI): An overview of etiology and pathogenesis. Life Sci 2020. [DOI: https://doi.org/10.1016/j.lfs.2020.118071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Chemotherapy-induced cognitive impairment (CICI): An overview of etiology and pathogenesis. Life Sci 2020; 258:118071. [PMID: 32673664 DOI: 10.1016/j.lfs.2020.118071] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/26/2020] [Accepted: 07/06/2020] [Indexed: 02/08/2023]
Abstract
Many cancer patients treated with chemotherapy develop chemotherapy-induced cognitive impairment (CICI), often referred to as chemo-brain, which manifest during or post-treatment with variable degrees, onset and duration thereby affecting the patients' quality of life. Several chemotherapeutic agents have been studied to determine its possible association with cognitive impairment and to fully comprehend their contribution to CICI. A vast number of studies have emerged proposing several candidate underlying mechanisms and etiologies contributing to CICI such as direct neurotoxicity, BBB disruption, decreased hippocampal neurogenesis, white matter abnormalities, secondary neuro-inflammatory response and increased oxidative stress; however, the exact underlying mechanisms are still not well defined. This review summarizes CICI associated with most commonly used chemotherapeutic agents with emphasizes the possible underlying pathogenesis in both animal and clinical studies.
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Yu Q, Zhong X, Chen B, Feng Y, Ma M, Diamond CA, Voeller JS, Kim M, DeSantes KB, Capitini CM, Patel NJ, Hoover-Regan ML, Burke MJ, Janko K, Puccetti DM, Ikonomidou C, Li L. Isobaric Labeling Strategy Utilizing 4-Plex N, N-Dimethyl Leucine (DiLeu) Tags Reveals Proteomic Changes Induced by Chemotherapy in Cerebrospinal Fluid of Children with B-Cell Acute Lymphoblastic Leukemia. J Proteome Res 2020; 19:2606-2616. [PMID: 32396724 PMCID: PMC7334086 DOI: 10.1021/acs.jproteome.0c00291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The use of mass spectrometry for protein identification and quantification in cerebrospinal fluid (CSF) is at the forefront of research efforts to identify and explore biomarkers for the early diagnosis and prognosis of neurologic disorders. Here we implemented a 4-plex N,N-dimethyl leucine (DiLeu) isobaric labeling strategy in a longitudinal study aiming to investigate protein dynamics in children with B-cell acute lymphoblastic leukemia (B-cell ALL) undergoing chemotherapy. The temporal profile of CSF proteome during chemotherapy treatment at weeks 5, 10-14, and 24-28 highlighted many differentially expressed proteins, such as neural cell adhesion molecule, neuronal growth regulator 1, and secretogranin-3, all of which play important roles in neurodegenerative diseases. A total of 63 proteins were significantly altered across all of the time points investigated. The most over-represented biological processes from gene ontology analysis included platelet degranulation, complement activation, cell adhesion, fibrinolysis, neuron projection, regeneration, and regulation of neuron death. We expect that results from this and future studies will provide a means to monitor neurotoxicity and develop strategies to prevent central nervous system injury in response to chemotherapy in children.
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Affiliation(s)
- Qinying Yu
- School of Pharmacy, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Xiaofang Zhong
- School of Pharmacy, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Bingming Chen
- School of Pharmacy, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Yu Feng
- School of Pharmacy, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Min Ma
- School of Pharmacy, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Carol A. Diamond
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant, Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Julie S. Voeller
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant, Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Miriam Kim
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant, Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Kenneth B. DeSantes
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant, Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Christian M. Capitini
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant, Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Neha J. Patel
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant, Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Margo L. Hoover-Regan
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant, Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Michael J. Burke
- Children’s Hospital of Wisconsin, Pediatric Leukemia & Lymphoma Program, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Kimberly Janko
- Department of Neurology, Division of Child Neurology, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Diane M. Puccetti
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant, Carbone Cancer Center, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Chrysanthy Ikonomidou
- Department of Neurology, Division of Child Neurology, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Lingjun Li
- School of Pharmacy, University of Wisconsin–Madison, Madison, Wisconsin, United States
- Department of Chemistry, University of Wisconsin–Madison, Madison, Wisconsin, United States
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Abstract
Survival rates of children with cancer are steadily increasing. This urges our attention to neurocognitive and psychiatric outcomes, as these can markedly influence the quality of life of these children. Neurobehavioral morbidity in childhood cancer survivors affects diverse aspects of cognitive function, which can include attention, memory, processing speed, intellect, academic achievement, and emotional health. Reasons for neurobehavioral morbidity are multiple with one major contributor being chemotherapy-induced central nervous system (CNS) toxicity. Clinical studies investigating the effects of chemotherapy on the CNS in children with cancer have reported causative associations with the development of leukoencephalopathies as well as smaller regional grey and white matter volumes, which have been found to correlate with neurocognitive deficits.Preclinical work has provided compelling evidence that chemotherapy drugs are potent neuro- and gliotoxins in vitro and in vivo and can cause brain injury via excitotoxic and apoptotic mechanisms. Furthermore, chemotherapy triggers DNA (deoxyribonucleic acid) damage directly or through increased oxidative stress. It can shorten telomeres and accelerate cell aging, cause cytokine deregulation, inhibit hippocampal neurogenesis, and reduce brain vascularization and blood flow. These mechanisms, when allowed to operate on the developing brain of a child, have high potential to not only cause brain injury, but also alter crucial developmental events, such as myelination, synaptogenesis, neurogenesis, cortical thinning, and formation of neuronal networks.This short review summarizes key publications describing neurotoxicity of chemotherapy in pediatric cancers and potential underlying pathomechanisms.
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Affiliation(s)
- Chrysanthy Ikonomidou
- Department of Neurology, Section of Child Neurology, University of Wisconsin Madison, Madison, WI, 53705, USA.
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Philipps G, Tate ED, Pranzatelli MR. Intensive Combination Immunotherapy and Neuroinflammation Resolution in a Child With Anti-PCA-1 (Yo) Paraneoplastic Syndrome and 2 Malignancies. Child Neurol Open 2018; 5:2329048X18795546. [PMID: 30288393 PMCID: PMC6168721 DOI: 10.1177/2329048x18795546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/28/2018] [Accepted: 07/12/2018] [Indexed: 11/19/2022] Open
Abstract
Paraneoplastic cerebellar degeneration is rare and noteworthy in children. In this
7-year-old, it was documented to have occurred within a year of ataxia presentation. The
instigating cancer was stage III adrenal adenocarcinoma, remitted after surgical resection
at age 2. When her severe ataxia progressed, neuroinflammation was characterized by high
cerebrospinal fluid Purkinje cell cytoplasmic antibody type 1 titers, oligoclonal bands,
and neurofilament light chain. The immunotherapy strategy was to replace IV
methylprednisolone, which lowered Purkinje cell cytoplasmic antibody type 1 titers without
clinical improvement, with induction of adrenocorticotropic hormone/intravenous
immunoglobulin/rituximab (ACTH/IVIG/rituximab) combination immunotherapy,
ACTH/dexamethasone transition, and intravenous immunoglobulin maintenance. She became
self-ambulatory and cerebrospinal fluid inflammatory markers regressed. Down syndrome
predisposed her to a second cancer, pre-B acute lymphoblastic leukemia, 4 years later.
Despite reversible cytosine arabinoside-provoked cerebellar toxicity, the ataxia is stable
on monthly intravenous immunoglobulin without relapse, now 5 years after initial
diagnosis. This report illustrates the use of cerebrospinal fluid biomarkers to detect,
target, and monitor neuroinflammation, and successful combinations of immunotherapy to
better the quality of life.
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Affiliation(s)
- Guillermo Philipps
- Department of Pediatric Neurology, Golisano Children's Hospital of Southwest FL, Fort Myers, FL, USA.,National Pediatric Myoclonus Center and National Pediatric Neuroinflammation Organization, Inc., Orlando, FL, USA
| | - Elizabeth D Tate
- National Pediatric Myoclonus Center and National Pediatric Neuroinflammation Organization, Inc., Orlando, FL, USA
| | - Michael R Pranzatelli
- National Pediatric Myoclonus Center and National Pediatric Neuroinflammation Organization, Inc., Orlando, FL, USA
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Borland KM, AbdulSalam SF, Solivio MJ, Burke MP, Wolfkiel PR, Lawson SM, Stockman CA, Andersen JM, Smith S, Tolstolutskaya JN, Gurjar PN, Bercz AP, Merino EJ, Litosh VA. Base-modified thymidines capable of terminating DNA synthesis are novel bioactive compounds with activity in cancer cells. Bioorg Med Chem 2015; 23:1869-81. [PMID: 25778768 DOI: 10.1016/j.bmc.2015.01.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 01/22/2015] [Accepted: 01/30/2015] [Indexed: 10/24/2022]
Abstract
Current FDA-approved chemotherapeutic antimetabolites elicit severe side effects that warrant their improvement; therefore, we designed compounds with mechanisms of action focusing on inhibiting DNA replication rather than targeting multiple pathways. We previously discovered that 5-(α-substituted-2-nitrobenzyloxy)methyluridine-5'-triphosphates were exquisite DNA synthesis terminators; therefore, we synthesized a library of 35 thymidine analogs and evaluated their activity using an MTT cell viability assay of MCF7 breast cancer cells chosen for their vulnerability to these nucleoside derivatives. Compound 3a, having an α-tert-butyl-2-nitro-4-(phenyl)alkynylbenzyloxy group, showed an IC50 of 9±1μM. The compound is more selective for cancer cells than for fibroblast cells compared with 5-fluorouracil. Treatment of MCF7 cells with 3a elicits the DNA damage response as indicated by phosphorylation of γ-H2A. A primer extension assay of the 5'-triphosphate of 3a revealed that 3aTP is more likely to inhibit DNA polymerase than to lead to termination events upon incorporation into the DNA replication fork.
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Affiliation(s)
- Kayla M Borland
- Department of Chemistry, University of Cincinnati, 301 Clifton Ct. ML 0172, Cincinnati, OH 45221-0172, USA
| | - Safnas F AbdulSalam
- Department of Chemistry, University of Cincinnati, 301 Clifton Ct. ML 0172, Cincinnati, OH 45221-0172, USA
| | - Morwena J Solivio
- Department of Chemistry, University of Cincinnati, 301 Clifton Ct. ML 0172, Cincinnati, OH 45221-0172, USA
| | - Matthew P Burke
- Department of Chemistry, University of Cincinnati, 301 Clifton Ct. ML 0172, Cincinnati, OH 45221-0172, USA
| | - Patrick R Wolfkiel
- Department of Chemistry, University of Cincinnati, 301 Clifton Ct. ML 0172, Cincinnati, OH 45221-0172, USA
| | - Sean M Lawson
- Department of Chemistry, University of Cincinnati, 301 Clifton Ct. ML 0172, Cincinnati, OH 45221-0172, USA
| | - Courtney A Stockman
- Department of Chemistry, University of Cincinnati, 301 Clifton Ct. ML 0172, Cincinnati, OH 45221-0172, USA
| | - Joel M Andersen
- Department of Chemistry, University of Cincinnati, 301 Clifton Ct. ML 0172, Cincinnati, OH 45221-0172, USA
| | - Skyler Smith
- Department of Chemistry, University of Cincinnati, 301 Clifton Ct. ML 0172, Cincinnati, OH 45221-0172, USA
| | - Julia N Tolstolutskaya
- Department of Chemistry, University of Cincinnati, 301 Clifton Ct. ML 0172, Cincinnati, OH 45221-0172, USA
| | - Purujit N Gurjar
- Department of Chemistry, University of Cincinnati, 301 Clifton Ct. ML 0172, Cincinnati, OH 45221-0172, USA
| | - Aron P Bercz
- Department of Chemistry, University of Cincinnati, 301 Clifton Ct. ML 0172, Cincinnati, OH 45221-0172, USA
| | - Edward J Merino
- Department of Chemistry, University of Cincinnati, 301 Clifton Ct. ML 0172, Cincinnati, OH 45221-0172, USA
| | - Vladislav A Litosh
- Department of Chemistry, University of Cincinnati, 301 Clifton Ct. ML 0172, Cincinnati, OH 45221-0172, USA.
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Chemotherapy-related cognitive dysfunction: current animal studies and future directions. Brain Imaging Behav 2014; 7:453-9. [PMID: 23949877 DOI: 10.1007/s11682-013-9250-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cognitive impairment is a potential long-term side effect of adjuvant chemotherapy that can have a major impact on the quality of life of cancer survivors. There is a growing number of preclinical studies addressing this issue, thereby extending our knowledge of the mechanisms underlying chemotherapy-induced neurotoxicity. In this review, we will summarize the recent advances and important findings presented in these studies. Emerging challenges, such as the development of neuroprotective strategies, and the role of the blood-brain barrier on cognitive impairment will be described and future directions in this field of investigation will be outlined.
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Koros C, Kitraki E. Effect of cytosine arabinoside on cerebellar neurofilaments during development: A sexual dimorphism. Toxicol Rep 2014; 1:650-657. [PMID: 28962278 PMCID: PMC5598478 DOI: 10.1016/j.toxrep.2014.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/23/2014] [Accepted: 08/26/2014] [Indexed: 11/12/2022] Open
Abstract
Previous reports suggest that the resistance of neuronal cytoskeleton to drug toxicity may vary with age and gender. The aim of the present study was to assess the impact of cytosine arabinoside (AraC) treatment on neurofilament (NF) levels and phosphorylation status in the developing cerebellum of male, female and testosterone propionate (1.25 mg/rat)-androgenized female rats. AraC (200 mg/kg bw) was administered from postnatal day (PND) 14–16 and changes in the level and phosphorylation of NFs were detected at PND 16 by Western blot analysis. The drug had no effect in male pups, while it increased the non-phosphorylated NF subunits of medium and low molecular weight in females. Androgenization of females prevented the AraC-induced increase in NF subunits. The levels of estrogen receptor beta (ER-β), known to mediate neuroprotective actions of estrogens in the brain, were significantly higher in the developing female cerebellum, as compared to males and androgenized females. These data show that the neurofilament cytoskeleton in the developing rat cerebellum exhibits resistance to AraC that appears sexually dimorphic. In young males the resistance is exemplified by a lack of responsiveness, whereas in juvenile females it is presented by an androgenization-sensitive NF upregulation.
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Braunagel D, Schaich M, Kramer M, Dransfeld CL, Ehninger G, Mahlknecht U. The T_T genotype within the NME1 promoter single nucleotide polymorphism -835 C/T is associated with an increased risk of cytarabine induced neurotoxicity in patients with acute myeloid leukemia. Leuk Lymphoma 2011; 53:952-7. [PMID: 22035418 DOI: 10.3109/10428194.2011.635862] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recently, numerous studies have been published on inter-individual variations in the response to specific treatment with cytostatic agents such as cytarabine (Ara-C) in patients with acute myeloid leukemia (AML). Differences at the genetic level and potentially associated changes in the expression and/or function of specific drug metabolizing enzymes appear to play an important role in this inter-individual susceptibility. Single nucleotide polymorphisms (SNPs) can be easily assessed in order to further investigate and explain inter-individual differences as to Ara-C associated toxicity and response to treatment. In this retrospective study we correlated five SNPs within the NME1 promoter with drug-induced toxicity, disease-free survival and overall survival (OS) in 360 Caucasian patients suffering from AML. A significant correlation between SNPs and disease-free survival or overall survival was not found. For the NME1 promoter SNP - 835 C/T (rs2302254) we identified a significant correlation between low platelet counts and better Eastern Cooperative Oncology Group performance status (grade 3/4). An increased risk of neurotoxicity was identified for the NME1 promoter SNP - 835 C/T (rs2302254) genotype T_T. Multivariate analyses also showed that these variables were independent risk factors. Ara-C causes neuronal cell death by introduction of apoptosis with reactive oxygen species, causing oxidative DNA damage and initiating the p53-dependent apoptotic program. Recent data show that oral administration of the antioxidant N-acetylcysteine for 14 days is able to prevent Ara-C induced behavioral deficits and cellular alterations of the adult cerebellum in a rat model.
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Affiliation(s)
- Dominic Braunagel
- Department of Internal Medicine, Saarland University Medical Center, Homburg, Germany
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Braunagel D, Schaich M, Kramer M, Dransfeld CL, Ehninger G, Mahlknech U. A NME1 promoter SNP predicts Ara-C associated neurotoxicity in AML patients. Leuk Lymphoma 2011:1-11. [PMID: 21824052 DOI: 10.3109/10428194.2011.610015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Seigers R, Fardell JE. Neurobiological basis of chemotherapy-induced cognitive impairment: A review of rodent research. Neurosci Biobehav Rev 2011; 35:729-41. [DOI: 10.1016/j.neubiorev.2010.09.006] [Citation(s) in RCA: 174] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 09/15/2010] [Accepted: 09/16/2010] [Indexed: 10/19/2022]
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