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Xie J, Liu Z, Ma W, Ren L, He L, Lu S, Meng X, Xia R, Liu Y, Liu N. Association between glucose levels and all-cause mortality in cancer survivors: findings from NHANES 1999-2018. BMC Public Health 2024; 24:2002. [PMID: 39061034 PMCID: PMC11282799 DOI: 10.1186/s12889-024-19545-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 07/22/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Hyperglycemia is a rapidly increasing risk factor for cancer mortality worldwide. However, the dose‒response relationship between glucose levels and all-cause mortality in cancer survivors is still uncertain. METHODS We enrolled 4,491 cancer survivors (weighted population 19,465,739) from the 1999-2019 National Health and Nutrition Examination Survey (NHANES). Cancer survivors were defined based on the question of whether they had ever been diagnosed with cancer by a doctor or a health professional. Hemoglobin A1c (HbA1c) was selected in this study as a stable marker of glucose level. Mortality was ascertained by linkage to National Death Index records until December 31, 2019. Cox proportional hazard, Kaplan‒Meier survival curves and Restricted cubic spline regression models were used to evaluate the associations between HbA1c and all-cause mortality risk in cancer survivors. RESULTS In NHANES, after adjusting for confounders, HbA1c had an independent nonlinear association with increased all-cause mortality in cancer survivors (nonlinear P value < 0.05). The threshold value for HbA1c was 5.4%, and the HRs (95% CI) below and above the threshold value were 0.917 (0.856,0.983) and 1.026 (1.010,1.043), respectively. Similar associations were found between fasting glucose and all-cause mortality in cancer survivors, and the threshold value was 5.7 mmol/L. CONCLUSIONS HbA1c was nonlinearly associated with all-cause mortality in cancer survivors, and the critical value of HbA1c in decreased mortality was 5.4%, suggesting optimal glucose management in cancer survivors may be a key to preventing premature death in cancer survivors.
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Affiliation(s)
- Jing Xie
- Department of Pharmacy, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zeye Liu
- Department of Cardiac Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Wanlu Ma
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Liqun Ren
- Department of Gerontology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Liyun He
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shan Lu
- Department of Geriatrics, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Xiangzhi Meng
- Department of Thoracic Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruibing Xia
- Department of Medicine, University Hospital Munich, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Yun Liu
- Department of Information, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
- Department of Medical Informatics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China.
| | - Naifeng Liu
- Department of Pharmacy, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
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Shoda K, Tsuji S, Nakamura S, Egashira Y, Enomoto Y, Nakayama N, Shimazawa M, Iwama T, Hara H. Canagliflozin Inhibits Glioblastoma Growth and Proliferation by Activating AMPK. Cell Mol Neurobiol 2023; 43:879-892. [PMID: 35435536 DOI: 10.1007/s10571-022-01221-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/26/2022] [Indexed: 12/17/2022]
Abstract
Sodium-glucose transporter 2 (SGLT2) inhibitors are antidiabetic drugs affecting SGLT2. Recent studies have shown various cancers expressing SGLT2, and SGLT2 inhibitors attenuating tumor proliferation. We evaluated the antitumor activities of canagliflozin, a SGLT2 inhibitor, on glioblastoma (GBM). Three GBM cell lines, U251MG (human), U87MG (human), and GL261 (murine), were used. We assessed the expression of SGLT2 of GBM through immunoblotting, specimen-use, cell viability assays, and glucose uptake assay with canagliflozin. Then, we assessed phosphorylation of AMP-activated protein kinase (AMPK), p70 S6 kinase, and S6 ribosomal protein by immunoblotting. Concentrations of 5, 10, 20, and 40 μM canagliflozin were used in these tests. We also evaluated cell viability and immunoblotting using U251MG with siRNA knockdown of SGLT2. Furthermore, we divided the mice into vehicle group and canagliflozin group. The canagliflozin group was administrated with 100 mg/kg of canagliflozin orally for 10 days starting from the third days post-GBM transplant. The brains were removed and the tumor volume was evaluated using sections. SGLT2 was expressed in GBM cell and GBM allograft mouse. Canagliflozin administration at 40 μM significantly inhibited cell proliferation and glucose uptake into the cell. Additionally, canagliflozin at 40 μM significantly increased the phosphorylation of AMPK and suppressed that of p70 S6 kinase and S6 ribosomal protein. Similar results of cell viability assays and immunoblotting were obtained using siRNA SGLT2. Furthermore, although less effective than in vitro, the canagliflozin group significantly suppressed tumor growth in GBM-transplanted mice. This suggests that canagliflozin can be used as a potential treatment for GBM.
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Affiliation(s)
- Kenji Shoda
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan.,Department of Neurosurgery, Gifu University School of Medicine, Gifu, Japan
| | - Shohei Tsuji
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan
| | - Shinsuke Nakamura
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan
| | - Yusuke Egashira
- Department of Neurosurgery, Gifu University School of Medicine, Gifu, Japan
| | - Yukiko Enomoto
- Department of Neurosurgery, Gifu University School of Medicine, Gifu, Japan
| | - Noriyuki Nakayama
- Department of Neurosurgery, Gifu University School of Medicine, Gifu, Japan
| | - Masamitsu Shimazawa
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan
| | - Toru Iwama
- Department of Neurosurgery, Gifu University School of Medicine, Gifu, Japan
| | - Hideaki Hara
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, 1-25-4 Daigaku-nishi, Gifu, 501-1196, Japan.
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Laviv Y, Sapirstein E, Kanner AA, Berkowitz S, Fichman S, Benouaich-Amiel A, Yust-Katz S, Kasper EE, Siegal T. Significant Systemic Insulin Resistance is Associated With Unique Glioblastoma Multiforme Phenotype. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2023; 16:2632010X231207725. [PMID: 37920781 PMCID: PMC10619354 DOI: 10.1177/2632010x231207725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023]
Abstract
Background Some glioblastoma multiforme (GBM) are characterized by the presence of gemistocytes (GCs), a unique phenotype of reactive astrocytes. Certain GCs can be identified as neoplastic cells but these cells were also found to be associated with diabetes in non-neoplastic lesions of the central nervous system. Our aim was to find a correlation between insulin - resistance metabolic features and the presence of GCs in patients with newly diagnosed GBM. Methods Medical records from histologically confirmed GBM patients were retrospectively extracted for different systemic metabolic variables. A statistic-based comparison was made between GBM, diabetic patients with and without GC. Patients with poorly controlled diabetes (ie, hemoglobin A1C ⩾ 8.0) were also compared between the 2 groups. Results A total of 220 newly diagnosed GBM patients were included in our study. 58 (26.3%) patients had a history of diabetes mellitus type 2 (DM2) at the time of admission. The rate of poorly-controlled DM2 was nearly as twice in the GC-GBM group than in the non-GC GBM group (18.75% vs 9.5%; P = .130). In the DM2 cohort, the subgroup of GC-GBM was significantly associated with demographic and metabolic features related to insulin resistance such as male gender predominance (89% vs 50%, P = .073) and morbid obesity (weight ⩾85 kg: OR 6.16; P = .0019 and mean BMI: 34.1 ± 11.42 vs 28.7 ± 5.44; P = .034 for group with and without GCs, respectively). In the poorly-controlled DM2 group, none of the GC-GBM patients were using insulin prior to diagnosis, compared to 61.1% in the non-GC GBM patients (OR = 0.04, P = .045). Conclusion Systemic metabolic factors related to marked insulin resistance (DM2, morbid obesity, male gender) are associated with a unique histologic phenotype of GBM, characterized by the presence of GCs. This feature is prominent in poorly-controlled DM2 GBM patients who are not using synthetic insulin. This novel finding may add to the growing data on the relevance of glucose metabolism in astrocytes and in astrocytes associated with high-grade gliomas. In GBM patients, a correlation between patients' metabolic status, tumor's histologic phenotype, tumor's molecular changes, use of anti-diabetic drugs and the respective impact of these factor on survival warrants further investigation.
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Affiliation(s)
- Yosef Laviv
- Neurosurgery Department, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eilat Sapirstein
- Neurosurgery Department, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrew A Kanner
- Neurosurgery Department, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shani Berkowitz
- Neurosurgery Department, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Suzana Fichman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pathology Department, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Alexandra Benouaich-Amiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neuro-Oncology Unit, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Shlomit Yust-Katz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neuro-Oncology Unit, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Ekkehard E Kasper
- Neurosurgery Department, St. Elizabeth’s Medical Center, Boston University, Boston, MA, USA
| | - Tali Siegal
- Neuro-Oncology Unit, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Hebrew University, Jerusalem, Israel
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Orešković D, Kaštelančić A, Raguž M, Almahariq F, Romić D, Dlaka D, Janeš A, Milotić V, Novaković S, Chudy D. Glycemia and venous thromboembolism in patients with primary brain tumors - A speculative review. Med Hypotheses 2021; 157:110719. [PMID: 34717073 DOI: 10.1016/j.mehy.2021.110719] [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: 09/02/2021] [Accepted: 10/19/2021] [Indexed: 02/07/2023]
Abstract
Venous thromboembolism (VTE) is a significant public health issue causing severe morbidity and mortality. One of the most vulnerable populations for VTE development are cancer patients. And among them, patients with brain tumors have arguably the highest risk of developing this often fatal complication. Hyperglycemia is a well-known factor which leads to a wide variety of pro-thrombotic changes. In this article, we review the current literature on the topic of VTE in brain tumor patients. We also discuss the known correlation between VTE and glycemia, as well as the importance and frequency of glycemia dysregulation in brain tumor patients. Based on the already well-known importance of glucose metabolism in cancer patients, as well as the previous research of our group, we hypothesize that there is a significant number of brain tumor patients who have chronically elevated glycemia, a fact that so-far hasn't been reported. We argue that these patients carry a significantly higher risk of VTE development and would benefit greatly from strict glycemic control. We present our hypothesis, the ways in which to test it, as well as the possible counter-arguments against it. Our hope is that other investigators will be inspired by our article to continue this type of research, since we consider the topic of VTE in brain tumor patients highly important and urgent, primarily due to its prevalence and severity.
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Affiliation(s)
- Darko Orešković
- Department of Neurosurgery, Clinical Hospital "Dubrava", Zagreb, Croatia.
| | - Anđelo Kaštelančić
- Department of Neurosurgery, Clinical Hospital "Dubrava", Zagreb, Croatia
| | - Marina Raguž
- Department of Neurosurgery, Clinical Hospital "Dubrava", Zagreb, Croatia
| | - Fadi Almahariq
- Department of Neurosurgery, Clinical Hospital "Dubrava", Zagreb, Croatia
| | - Dominik Romić
- Department of Neurosurgery, Clinical Hospital "Dubrava", Zagreb, Croatia
| | - Domagoj Dlaka
- Department of Neurosurgery, Clinical Hospital "Dubrava", Zagreb, Croatia
| | - Andrea Janeš
- Department of Clinical Microbiology and Hospital Infections, Clinical Hospital "Dubrava", Zagreb, Croatia
| | - Vivian Milotić
- Department of Radiology, General Hospital Pula, Pula, Croatia; Department of Diagnostic and Intervention Radiology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Sabina Novaković
- Depatment of Haematology, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Darko Chudy
- Department of Neurosurgery, Clinical Hospital "Dubrava", Zagreb, Croatia; Zagreb University School of Medicine, Croatia
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