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Murphy L, Maloney K, Gore L, Blanchette E. Hypertension in Pediatric Acute Lymphoblastic Leukemia Patients: Prevalence, Impact, and Management Strategies. Integr Blood Press Control 2022; 15:1-10. [PMID: 35082528 PMCID: PMC8784271 DOI: 10.2147/ibpc.s242244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/17/2021] [Indexed: 01/27/2023] Open
Abstract
Acute lymphoblastic leukemia (ALL) is the most common cancer diagnosed in children under the age of 18. While modern diagnostic technologies, risk-stratification, and therapy intensification have led to outstanding outcomes for many children with ALL, the side effects and consequences of therapy are not to be underestimated. Hypertension is a well-known acute and chronic side effect of treatment for childhood ALL, although limited data are available regarding the prevalence of hypertension in children undergoing treatment for ALL. In this review of hypertension in pediatric ALL patients, we examine the existing data on incidence and prevalence during treatment and in pediatric ALL survivors. We describe independent risk factors for development of hypertension along with treatment-related causes. Long-term consequences and the risk to survivors of pediatric ALL are further defined. While many ALL patients require antihypertensive medications during some portion of their treatment, there are no clear guidelines on treating inpatient hypertension given challenges that exist in recognizing and managing hypertension in this setting and in this population. Here, we propose an algorithmic approach to diagnose and treat pediatric ALL patients with HTN, along with monitoring and continuation versus cessation of antihypertensive therapy as an outpatient.
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Affiliation(s)
- Lindsey Murphy
- Department of Pediatrics, Sections of Hematology/Oncology/Bone Marrow Transplant-Cellular Therapeutics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
| | - Kelly Maloney
- Department of Pediatrics, Sections of Hematology/Oncology/Bone Marrow Transplant-Cellular Therapeutics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Lia Gore
- Department of Pediatrics, Sections of Hematology/Oncology/Bone Marrow Transplant-Cellular Therapeutics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Cancer Center, Aurora, CO, USA
- Correspondence: Lia Gore Tel +17207776458Fax +17207777339 Email
| | - Eliza Blanchette
- Department of Pediatrics, Section of Nephrology, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
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Endothelial Progenitor Cells Dysfunctions and Cardiometabolic Disorders: From Mechanisms to Therapeutic Approaches. Int J Mol Sci 2021; 22:ijms22136667. [PMID: 34206404 PMCID: PMC8267891 DOI: 10.3390/ijms22136667] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 12/12/2022] Open
Abstract
Metabolic syndrome (MetS) is a cluster of several disorders, such as hypertension, central obesity, dyslipidemia, hyperglycemia, insulin resistance and non-alcoholic fatty liver disease. Despite health policies based on the promotion of physical exercise, the reduction of calorie intake and the consumption of healthy food, there is still a global rise in the incidence and prevalence of MetS in the world. This phenomenon can partly be explained by the fact that adverse events in the perinatal period can increase the susceptibility to develop cardiometabolic diseases in adulthood. Individuals born after intrauterine growth restriction (IUGR) are particularly at risk of developing cardiovascular diseases (CVD) and metabolic disorders later in life. It has been shown that alterations in the structural and functional integrity of the endothelium can lead to the development of cardiometabolic diseases. The endothelial progenitor cells (EPCs) are circulating components of the endothelium playing a major role in vascular homeostasis. An association has been found between the maintenance of endothelial structure and function by EPCs and their ability to differentiate and repair damaged endothelial tissue. In this narrative review, we explore the alterations of EPCs observed in individuals with cardiometabolic disorders, describe some mechanisms related to such dysfunction and propose some therapeutical approaches to reverse the EPCs dysfunction.
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Diabetic endothelial colony forming cells have the potential for restoration with glycomimetics. Sci Rep 2019; 9:2309. [PMID: 30783159 PMCID: PMC6381138 DOI: 10.1038/s41598-019-38921-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/11/2019] [Indexed: 12/18/2022] Open
Abstract
Endothelial colony forming progenitor cell (ECFC) function is compromised in diabetes, leading to poor vascular endothelial repair, which contributes to impaired diabetic foot ulcer healing. We have generated novel glycomimetic drugs with protective effects against endothelial dysfunction. We investigated the effect of glycomimetic C3 on the functional capacity of diabetic ECFCs. ECFCs were isolated from healthy controls and patients with diabetes with neuroischaemic (NI) or neuropathic (NP) foot ulcers. Functionally, diabetic ECFCs demonstrated delayed colony formation (p < 0.02), differential proliferative capacity (p < 0.001) and reduced NO bioavailability (NI ECFCs; p < 0.05). Chemokinetic migration and angiogenesis were also reduced in diabetic ECFCs (p < 0.01 and p < 0.001), and defects in wound closure and tube formation were apparent in NP ECFCs (p < 0.01). Differential patterns in mitochondrial activity were pronounced, with raised activity in NI and depressed activity in NP cells (p < 0.05). The application of glycomimetic improved scratch wound closure in vitro in patient ECFCs (p < 0.01), most significantly in NI cells (p < 0.001), where tube formation (p < 0.05) was also improved. We demonstrate restoration of the deficits in NI cells but not NP cells, using a novel glycomimetic agent, which may be advantageous for therapeutic cell transplantation or as a localised treatment for NI but not NP patients.
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Levy E, Samoilenko M, Morel S, England J, Amre D, Bertout L, Drouin S, Laverdière C, Krajinovic M, Sinnett D, Lefebvre G, Marcil V. Cardiometabolic Risk Factors in Childhood, Adolescent and Young Adult Survivors of Acute Lymphoblastic Leukemia - A Petale Cohort. Sci Rep 2017; 7:17684. [PMID: 29247169 PMCID: PMC5732194 DOI: 10.1038/s41598-017-17716-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/29/2017] [Indexed: 12/18/2022] Open
Abstract
Our objectives were to assess the prevalence of cardiometabolic complications in children, adolescents, and young adult survivors of childhood acute lymphoblastic leukemia (cALL), to identify their predictors and the risk compared to the Canadian population. We performed a cardiometabolic assessment of cALL survivors from the PETALE cohort (n = 247, median age at visit of 21.7 years). In our group, overweight and obesity affected over 70% of women. Pre-hypertension and hypertension were mostly common in men, both adults (20%) and children (19%). Prediabetes was mainly present in women (6.1% of female adult survivors) and 41.3% had dyslipidemia. Cranial radiation therapy was a predictor of dyslipidemia (RR: 1.60, 95% CI: 1.07–2.41) and high LDL-cholesterol (RR: 4.78, 95% CI: 1.72–13.28). Male gender was a predictor for pre-hypertension and hypertension (RR: 5.12, 95% CI: 1.81–14.46). Obesity at the end of treatment was a predictor of obesity at interview (RR: 2.07, 95% CI: 1.37–3.14) and of metabolic syndrome (RR: 3.04, 95% CI: 1.14–8.09). Compared to the general population, cALL survivors were at higher risk of having the metabolic syndrome, dyslipidemia, pre-hypertension/hypertension and high LDL-cholesterol, while the risk for obesity was not different. Our results support the need for early screening and lifestyle intervention in this population.
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Affiliation(s)
- Emile Levy
- Research Centre of Sainte-Justine University Health Center, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada.,Department of Nutrition, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada
| | - Mariia Samoilenko
- Research Centre of Sainte-Justine University Health Center, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada.,Department of Mathematics, Université du Québec à Montréal, Montréal, Quebec, H3C 3P8, Canada
| | - Sophia Morel
- Research Centre of Sainte-Justine University Health Center, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada.,Department of Nutrition, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada
| | - Jade England
- Research Centre of Sainte-Justine University Health Center, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada
| | - Devendra Amre
- Research Centre of Sainte-Justine University Health Center, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada
| | - Laurence Bertout
- Research Centre of Sainte-Justine University Health Center, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada
| | - Simon Drouin
- Research Centre of Sainte-Justine University Health Center, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada
| | - Caroline Laverdière
- Research Centre of Sainte-Justine University Health Center, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada
| | - Maja Krajinovic
- Research Centre of Sainte-Justine University Health Center, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada
| | - Daniel Sinnett
- Research Centre of Sainte-Justine University Health Center, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada
| | - Geneviève Lefebvre
- Research Centre of Sainte-Justine University Health Center, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada.,Department of Mathematics, Université du Québec à Montréal, Montréal, Quebec, H3C 3P8, Canada
| | - Valérie Marcil
- Research Centre of Sainte-Justine University Health Center, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada. .,Department of Nutrition, Université de Montréal, Montréal, Quebec, H3T 1C5, Canada.
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