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Ge L, Wang L, Pei D. Pulmonary mucinous adenocarcinoma: An overview of pathophysiology and advancements in treatment. Heliyon 2024; 10:e28881. [PMID: 38694119 PMCID: PMC11058725 DOI: 10.1016/j.heliyon.2024.e28881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/21/2024] [Accepted: 03/26/2024] [Indexed: 05/03/2024] Open
Abstract
Pulmonary mucinous adenocarcinoma (PMA), a distinct subtype of non-small cell lung cancer (NSCLC), is characterized by an abundance of mucin-producing cells. Although this subtype comprises a relatively small fraction of lung adenocarcinomas, PMA stands apart due to its unique clinical, pathological, and molecular features. This review comprehensively discusses the pathophysiology and etiology, clinical features, diagnostic methods, treatment strategies, prognosis, and future directions for PMA, drawing from relevant literature and existing studies. Advances in PMA treatment includes surgical intervention, targeted therapy, immunotherapy, and adjuvant therapy. Particularly, we discussed factors influencing the prognosis of PMAs, such as molecular markers, pathological features, and the impact of the latest treatment advances on prognosis. Moreover, we intended this review to be a comprehensive reference for diagnosing, treating, and assessing the prognosis of PMA, providing valuable guidance for clinical practice.
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Affiliation(s)
- Lihui Ge
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Linlin Wang
- Department of Thoracic Surgery, Shenyang Tenth People's Hospital, Shenyang, Liaoning, China
| | - Dongmei Pei
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Wajih N, Erali RA, Forsythe SD, Schaaf CR, Shen P, Levine EA, Soker S, Morris DL, Votanopoulos KI. Enhancing the Efficacy of HIPEC Through Bromelain: A Preclinical Investigation in Appendiceal Cancer. Ann Surg Oncol 2024:10.1245/s10434-024-15355-0. [PMID: 38704503 DOI: 10.1245/s10434-024-15355-0] [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: 02/16/2024] [Accepted: 04/09/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Appendiceal cancer (AC) excessive mucin production is a barrier to heated intraperitoneal chemotherapy (HIPEC) drug delivery. Bromelain is a pineapple stem extract with mucolytic properties. We explored bromelain treatment effects against mucinous AC in a patient-derived tumor organoid (PTO) model and an AC cell line. PATIENTS AND METHODS PTOs were fabricated from tumor specimens obtained from patients with AC undergoing cytoreductive surgery with HIPEC. PTOs underwent HIPEC treatment with bromelain, cisplatin, and mitomycin C (MMC) at 37 °C and 42 °C with and without bromelain pretreatment. RESULTS From October 2020 to May 2023, 16 specimens were collected from 13 patients with low-grade (12/16, 75%) and high-grade AC (4/16, 25%). The mucin-depleting effects of bromelain were most significant in combination with N-acetylcysteine (NAC) compared with bromelain (47% versus 10%, p = 0.0009) or NAC alone (47% versus 12.8%, p = 0.0027). Bromelain demonstrated > 31% organoid viability reduction at 60 min (p < 0.001) and > 66% in 48 h (p < 0.0001). Pretreatment with bromelain increased cytotoxicity of both cisplatin and MMC HIPEC conditions by 31.6% (p = 0.0001) and 35.5% (p = 0.0001), respectively. Ki67, CK20, and MUC2 expression decreased after bromelain treatment; while increased caspase 3/7 activity and decreased Bcl-2 (p = 0.009) and Bcl-xL (p = 0.01) suggest induction of apoptosis pathways. Furthermore, autophagy proteins LC3A/B I (p < 0.03) and II (p < 0.031) were increased; while ATG7 (p < 0.01), ATG 12 (p < 0.04), and Becline 1(p < 0.03), expression decreased in bromelain-treated PTOs. CONCLUSIONS Bromelain demonstrates cytotoxicity and mucolytic activity against appendiceal cancer organoids. As a pretreatment agent, it potentiates the cytotoxicity of multiple HIPEC regimens, potentially mediated through programmed cell death and autophagy.
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Affiliation(s)
- Nadeem Wajih
- Wake Forest Department of General Surgery, Wake Forest Organoid Research Center (WFORCE), Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Wake Forest Institute of Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Richard A Erali
- Wake Forest Department of General Surgery, Wake Forest Organoid Research Center (WFORCE), Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Wake Forest Institute of Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven D Forsythe
- Wake Forest Department of General Surgery, Wake Forest Organoid Research Center (WFORCE), Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Wake Forest Institute of Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Wake Forest Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Cecilia R Schaaf
- Wake Forest Department of General Surgery, Wake Forest Organoid Research Center (WFORCE), Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Wake Forest Institute of Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Perry Shen
- Section of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Edward A Levine
- Section of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Shay Soker
- Wake Forest Department of General Surgery, Wake Forest Organoid Research Center (WFORCE), Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Wake Forest Institute of Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - David L Morris
- Department of Surgery, St. George Hospital, University of New South Wales, Sydney, Australia
| | - Konstantinos I Votanopoulos
- Wake Forest Department of General Surgery, Wake Forest Organoid Research Center (WFORCE), Wake Forest University School of Medicine, Winston-Salem, NC, USA.
- Wake Forest Institute of Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
- Wake Forest Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
- Section of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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Wen HK, Valle SJ, Morris DL. Bromelain and acetylcysteine (BromAc ®): a novel approach to the treatment of mucinous tumours. Am J Cancer Res 2023; 13:1522-1532. [PMID: 37168359 PMCID: PMC10164791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/07/2023] [Indexed: 05/13/2023] Open
Abstract
Mucins are a significant extracellular component of neoplastic entities such as pseudomyxoma peritonei and several gastrointestinal adenocarcinomas. Mucinous tumours present a challenge for systemic treatments due to poor drug penetrance and increased resistance. Therefore, the development of an effective mucolytic therapy has significant therapeutic implications for these tumour types. BromAc® is a novel mucolytic agent consisting of bromelain and acetylcysteine. It has demonstrated significant mucolysis and antitumour effects in vitro and in vivo for several mucinous tumours. It has also exhibited a synergistic potentiation of the effect of several cytotoxic agents on mucinous tumours in preclinical studies. Furthermore, it demonstrates locoregional safety and efficacy in animal and clinical studies. This literature review will summarise the history of BromAc® for mucinous tumours, including its conception, preclinical development in vitro and in vivo, and clinical evidence. The implications of current data and directions for future research are then discussed.
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Affiliation(s)
- Henry K Wen
- St George and Sutherland Clinical School, University of New South WalesKogarah, Sydney, NSW, Australia
| | - Sarah J Valle
- Mucpharm Pty Ltd, KogarahSydney, NSW, Australia
- Intensive Care Unit, St George HospitalKogarah, NSW, Australia
| | - David L Morris
- St George and Sutherland Clinical School, University of New South WalesKogarah, Sydney, NSW, Australia
- Mucpharm Pty Ltd, KogarahSydney, NSW, Australia
- Department of Surgery, St George HospitalKogarah, NSW, Australia
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Liu Y, Wu W, Cai C, Zhang H, Shen H, Han Y. Patient-derived xenograft models in cancer therapy: technologies and applications. Signal Transduct Target Ther 2023; 8:160. [PMID: 37045827 PMCID: PMC10097874 DOI: 10.1038/s41392-023-01419-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Patient-derived xenograft (PDX) models, in which tumor tissues from patients are implanted into immunocompromised or humanized mice, have shown superiority in recapitulating the characteristics of cancer, such as the spatial structure of cancer and the intratumor heterogeneity of cancer. Moreover, PDX models retain the genomic features of patients across different stages, subtypes, and diversified treatment backgrounds. Optimized PDX engraftment procedures and modern technologies such as multi-omics and deep learning have enabled a more comprehensive depiction of the PDX molecular landscape and boosted the utilization of PDX models. These irreplaceable advantages make PDX models an ideal choice in cancer treatment studies, such as preclinical trials of novel drugs, validating novel drug combinations, screening drug-sensitive patients, and exploring drug resistance mechanisms. In this review, we gave an overview of the history of PDX models and the process of PDX model establishment. Subsequently, the review presents the strengths and weaknesses of PDX models and highlights the integration of novel technologies in PDX model research. Finally, we delineated the broad application of PDX models in chemotherapy, targeted therapy, immunotherapy, and other novel therapies.
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Affiliation(s)
- Yihan Liu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, P.R. China
| | - Wantao Wu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, P.R. China
| | - Changjing Cai
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, P.R. China
| | - Hao Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Hong Shen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, P.R. China.
| | - Ying Han
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, P.R. China.
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Pezzani R, Jiménez-Garcia M, Capó X, Sönmez Gürer E, Sharopov F, Rachel TYL, Ntieche Woutouoba D, Rescigno A, Peddio S, Zucca P, Tsouh Fokou PV, Martorell M, Gulsunoglu-Konuskan Z, Ydyrys A, Bekzat T, Gulmira T, Hano C, Sharifi-Rad J, Calina D. Anticancer properties of bromelain: State-of-the-art and recent trends. Front Oncol 2023; 12:1068778. [PMID: 36698404 PMCID: PMC9869248 DOI: 10.3389/fonc.2022.1068778] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023] Open
Abstract
Bromelain is a key enzyme found in pineapple (Ananas comosus (L.) Merr.); a proteolytic substance with multiple beneficial effects for human health such as anti-inflammatory, immunomodulatory, antioxidant and anticarcinogenic, traditionally used in many countries for its potential therapeutic value. The aim of this updated and comprehensive review focuses on the potential anticancer benefits of bromelain, analyzing the cytotoxic, apoptotic, necrotic, autophagic, immunomodulating, and anti-inflammatory effects in cancer cells and animal models. Detailed information about Bromelain and its anticancer effects at the cellular, molecular and signaling levels were collected from online databases such as PubMed/MedLine, TRIP database, GeenMedical, Scopus, Web of Science and Google Scholar. The results of the analyzed studies showed that Bromelain possesses corroborated pharmacological activities, such as anticancer, anti-edema, anti-inflammatory, anti-microbial, anti-coagulant, anti-osteoarthritis, anti-trauma pain, anti-diarrhea, wound repair. Nonetheless, bromelain clinical studies are scarce and still more research is needed to validate the scientific value of this enzyme in human cancer diseases.
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Affiliation(s)
- Raffaele Pezzani
- Phytotherapy Lab, Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy,Associazione Italiana per la Ricerca Oncologica di Base (AIROB), Padova, Italy
| | - Manuel Jiménez-Garcia
- Laboratory of Neurophysiology, Biology Department, University of Balearic Islands (UIB), Palma de Mallorca, Spain
| | - Xavier Capó
- Research Group in Community Nutrition and Oxidative Stress and Health Research Institute of the Balearic Islands (IdISBa), University of Balearic Islands, Palma de Mallorca, Spain
| | - Eda Sönmez Gürer
- Faculty of Pharmacy, Department of Pharmacognosy, Sivas Cumhuriyet University, Sivas, Turkey
| | - Farukh Sharopov
- Research Institution “Chinese-Tajik Innovation Center for Natural Products” of the National Academy of Sciences of Tajikistan, Dushanbe, Tajikistan
| | | | - David Ntieche Woutouoba
- Antimicrobial and Biocontrol Agents Unit, Department of Biochemistry, Faculty of Science, University of Yaounde, Yaounde, Cameroon
| | - Antonio Rescigno
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Stefania Peddio
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Paolo Zucca
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy,*Correspondence: Javad Sharifi-Rad, ; Christophe Hano, ; Daniela Calina, ; Paolo Zucca,
| | | | - Miquel Martorell
- Department of Nutrition and Dietetics, Faculty of Pharmacy, and Centre for Healthy Living, University of Concepción, Concepción, Chile,Universidad de Concepción, Unidad de Desarrollo Tecnológico, UDT, Concepción, Chile
| | - Zehra Gulsunoglu-Konuskan
- Faculty of Health Science, Nutrition and Dietetics Department, Istanbul Aydin University, Istanbul, Turkey
| | - Alibek Ydyrys
- Biomedical Research Centre, Al-Farabi Kazakh National University, Almaty, Kazakhstan,The Elliott School of International Affairs, George Washington University, Washington, DC, United States
| | - Tynybekov Bekzat
- Department of Biodiversity and Bioresources, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Tussupbekova Gulmira
- Department of Biophysics, Biomedicine and Neuroscience, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Christophe Hano
- Department of Biological Chemistry, University of Orleans, Chartres, France,*Correspondence: Javad Sharifi-Rad, ; Christophe Hano, ; Daniela Calina, ; Paolo Zucca,
| | - Javad Sharifi-Rad
- Facultad de Medicina, Universidad del Azuay, Cuenca, Ecuador,*Correspondence: Javad Sharifi-Rad, ; Christophe Hano, ; Daniela Calina, ; Paolo Zucca,
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, Craiova, Romania,*Correspondence: Javad Sharifi-Rad, ; Christophe Hano, ; Daniela Calina, ; Paolo Zucca,
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6
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Weitz J, Hurtado de Mendoza T, Tiriac H, Lee J, Sun S, Garg B, Patel J, Li K, Baumgartner J, Kelly KJ, Veerapong J, Hosseini M, Chen Y, Lowy AM. An Ex Vivo Organotypic Culture Platform for Functional Interrogation of Human Appendiceal Cancer Reveals a Prominent and Heterogenous Immunological Landscape. Clin Cancer Res 2022; 28:4793-4806. [PMID: 36067351 DOI: 10.1158/1078-0432.ccr-22-0980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/04/2022] [Accepted: 08/31/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Epithelial neoplasms of the appendix are difficult to study preclinically given their low incidence, frequent mucinous histology, and absence of a comparable organ in mice for disease modeling. Although surgery is an effective treatment for localized disease, metastatic disease has a poor prognosis as existing therapeutics borrowed from colorectal cancer have limited efficacy. Recent studies reveal that appendiceal cancer has a genomic landscape distinct from colorectal cancer and thus preclinical models to study this disease are a significant unmet need. EXPERIMENTAL DESIGN We adopted an ex vivo slice model that permits the study of cellular interactions within the tumor microenvironment. Mucinous carcinomatosis peritonei specimens obtained at surgical resection were cutoff using a vibratome to make 150-μm slices cultured in media. RESULTS Slice cultures were viable and maintained their cellular composition regarding the proportion of epithelial, immune cells, and fibroblasts over 7 days. Within donor specimens, we identified a prominent and diverse immune landscape and calcium imaging confirmed that immune cells were functional for 7 days. Given the diverse immune landscape, we treated slices with TAK981, an inhibitor of SUMOylation with known immunomodulatory functions, in early-phase clinical trials. In 5 of 6 donor samples, TAK981-treated slices cultures had reduced viability, and regulatory T cells (Treg). These data were consistent with TAK981 activity in purified Tregs using an in vitro murine model. CONCLUSIONS This study demonstrates an approach to study appendiceal cancer therapeutics and pathobiology in a preclinical setting. These methods may be broadly applicable to the study of other malignancies.
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Affiliation(s)
- Jonathan Weitz
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, California
| | - Tatiana Hurtado de Mendoza
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, California
| | - Herve Tiriac
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, California
| | - James Lee
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, California
| | - Siming Sun
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, California
| | - Bharti Garg
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, California
| | - Jay Patel
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, California
| | - Kevin Li
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, California
| | - Joel Baumgartner
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, California
| | - Kaitlin J Kelly
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, California
| | - Jula Veerapong
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, California
| | - Mojgan Hosseini
- Department of Pathology and Laboratory Medicine, University of California, San Diego, California
| | - Yuan Chen
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, California
| | - Andrew M Lowy
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, California
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Liu G, Xiao X, Xia Y, Huang W, Chen W, Xu J, Chen S, Wang H, Wei J, Li H, Shu M, Lu X, Zhang C, He Y. Organoids From Mucinous Appendiceal Adenocarcinomas as High-Fidelity Models for Individual Therapy. Front Med (Lausanne) 2022; 9:829033. [PMID: 35721089 PMCID: PMC9201037 DOI: 10.3389/fmed.2022.829033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 04/25/2022] [Indexed: 12/29/2022] Open
Abstract
Background Mucinous appendiceal adenocarcinoma (MAA) is a rare, heterogeneous disease. Patients with unrespectable mucinous appendiceal adenocarcinoma presenting with peritoneal spread are treated by intraperitoneal chemotherapy, hyperthermic intraperitoneal chemotherapy, systemic chemotherapy, or targeted therapy. However, there are no guidelines for efficacious drugs against mucinous appendiceal adenocarcinoma. Therefore, relevant high-fidelity models should be investigated to identify effective drugs for individual therapy. Methods Surgical tumor specimens were obtained from a mucinous appendiceal adenocarcinoma patient. The tissue was digested and organoid culture was established. H&E and immunohistochemistry staining as well as DNA sequencing was performed on tissue and organoid. The pathological characteristics and gene mutations of the organoid were compared to those of the original tumor. Drug sensitivity tests were performed on organoid and the patient clinical responds to chemotherapy and targeted therapy was compared. Results Organoids were successfully established and stably passaged. Pathological characteristics of organoids including H&E staining and expression of protein markers (CK20, CDX-2, STAB2, CD7, PAX8) were consistent to those of the original tumor. Moreover, the organoids carried the same gene mutations as the primary tumor. Sensitivity of the organoids to chemotherapeutic drugs and tyrosine kinase inhibitors included: 5-FU (IC50 43.95 μM), Oxaliplatin (IC50 23.49 μM), SN38 (IC50 1.02 μM), Apatinib (IC50 0.10 μM), Dasatinib (IC50 2.27 μM), Docetaxel (IC50 5.26 μM), Regorafenib (IC50 18.90 μM), and Everolimus (IC50 9.20 μM). The sensitivities of organoid to these drugs were comparable to those of the patient's clinical responses. Conclusion The mucinous appendiceal adenocarcinoma organoid model which retained the characteristics of the primary tumor was successfully established. Combined organoid-based drug screening and high throughput sequencing provided a promising way for mucinous appendiceal adenocarcinoma treatment.
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Affiliation(s)
- Guangyao Liu
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Xing Xiao
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Yujian Xia
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Weibing Huang
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Wei Chen
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Jiannan Xu
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Songyao Chen
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Huijin Wang
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Jitao Wei
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Huan Li
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Man Shu
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaofang Lu
- Department of Pathology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Changhua Zhang
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Yulong He
- Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.,Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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8
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Dong L, Ke K, Badar S, Mekkawy AH, Akhter J, Pillai K, Carter CJ, Morris DL. A novel method for potentiation of chemotherapy in soft tissue sarcomas with BromAc. Am J Transl Res 2022; 14:2894-2909. [PMID: 35702130 PMCID: PMC9185037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 12/04/2021] [Indexed: 06/15/2023]
Abstract
Single-agent doxorubicin currently forms part of standard care for patients with sarcomas. However, efficacy is limited by the presence of dose-dependent cardiotoxicity and toxicity to renal, hepatic, and neurological systems. Therefore, there is a pressing need for novel drug regimens which can provide increased efficacy and safety. BromAc is a novel drug combination developed as a mucolytic agent which has demonstrated anticancer activity both in vitro and in vivo in several cancers. Here, we investigated the efficacy of BromAc in combination with doxorubicin for four subtypes of sarcoma. Cell proliferation, alongside western blot for a variety of cell cycle, apoptosis, and autophagy biomarkers assays was performed following treatment of cell lines in vitro at various concentrations of BromAc and doxorubicin. The impact of drug treatment on MUC1 and MUC4 levels was assessed through immune-cytological methods. Drug agent synergy was assessed through the Chou-Talalay framework. BromAc treatment in combination with doxorubicin was more efficacious than single-agent doxorubicin, with synergistic effects observed. The immuno-cytological analysis demonstrated significant mucin depletion following treatment with BromAc and doxorubicin used in combination, providing a potential mechanistic underpinning for the observed anticancer effects.
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Affiliation(s)
- Lillian Dong
- University of New South Wales, St. George & Sutherland Clinical SchoolSydney, NSW 2217, Australia
| | - Kevin Ke
- Department of Surgery, St. George HospitalKogarah, NSW 2217, Australia
- Mucpharm Pty LtdAustralia
| | - Samina Badar
- University of New South Wales, St. George & Sutherland Clinical SchoolSydney, NSW 2217, Australia
- Department of Surgery, St. George HospitalKogarah, NSW 2217, Australia
| | - Ahmed H Mekkawy
- Department of Surgery, St. George HospitalKogarah, NSW 2217, Australia
- Mucpharm Pty LtdAustralia
| | - Javed Akhter
- Department of Surgery, St. George HospitalKogarah, NSW 2217, Australia
- Mucpharm Pty LtdAustralia
| | - Krishna Pillai
- Department of Surgery, St. George HospitalKogarah, NSW 2217, Australia
- Mucpharm Pty LtdAustralia
| | - Carly J Carter
- Department of Surgery, St. George HospitalKogarah, NSW 2217, Australia
- Mucpharm Pty LtdAustralia
| | - David L Morris
- University of New South Wales, St. George & Sutherland Clinical SchoolSydney, NSW 2217, Australia
- Department of Surgery, St. George HospitalKogarah, NSW 2217, Australia
- Mucpharm Pty LtdAustralia
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9
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Ke K, Pillai K, Mekkawy AH, Akhter J, Badar S, Valle SJ, Morris DL. The effect of intraperitoneal administration of BromAc on blood parameters: phase 1 study. Discov Oncol 2021; 12:25. [PMID: 35201475 PMCID: PMC8777505 DOI: 10.1007/s12672-021-00418-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/19/2021] [Indexed: 11/05/2022] Open
Abstract
Intraperitoneal administration of BromAc (bromelain + acetylcysteine) is currently undergoing a phase 1 clinical trial for pseudomyxoma peritonei at our institution. This study reports on analysis of routine blood parameters before and after treatment for a series of 25 patients in this trial. Blood parameters assessed included full blood count, electrolytes, urea, and creatinine, liver function tests, coagulation studies, as well as inflammatory markers (CRP). Certain parameters such as CRP, and white cell count, were significantly elevated after treatment whilst serum albumin level was reduced indicating an inflammatory reaction. However, liver enzymes, coagulation studies, and other parameters were not affected. Therefore, there are no additional safety signals evident upon analysis of routine blood parameter testing.
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Affiliation(s)
- Kevin Ke
- Department of Surgery, St. George Hospital, Kogarah, NSW, 2217, Australia
- Mucpharm Pty Ltd, Kogarah, NSW, 2217, Australia
| | - Krishna Pillai
- Department of Surgery, St. George Hospital, Kogarah, NSW, 2217, Australia
- Mucpharm Pty Ltd, Kogarah, NSW, 2217, Australia
| | - Ahmed H Mekkawy
- Department of Surgery, St. George Hospital, Kogarah, NSW, 2217, Australia
- Mucpharm Pty Ltd, Kogarah, NSW, 2217, Australia
| | - Javed Akhter
- Department of Surgery, St. George Hospital, Kogarah, NSW, 2217, Australia
- Mucpharm Pty Ltd, Kogarah, NSW, 2217, Australia
| | - Samina Badar
- Department of Surgery, St. George Hospital, Kogarah, NSW, 2217, Australia
- St George & Sutherland Clinical School, University of New South Wales, Sydney, NSW, 2217, Australia
| | - Sarah J Valle
- Department of Surgery, St. George Hospital, Kogarah, NSW, 2217, Australia
- Mucpharm Pty Ltd, Kogarah, NSW, 2217, Australia
| | - David L Morris
- Department of Surgery, St. George Hospital, Kogarah, NSW, 2217, Australia.
- Mucpharm Pty Ltd, Kogarah, NSW, 2217, Australia.
- St George & Sutherland Clinical School, University of New South Wales, Sydney, NSW, 2217, Australia.
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