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Lyu C, Xiao H, Yin X, Li Z, Han C, Xu R. Acupuncture in Multiple Myeloma Peripheral Neuropathy: A Systematic Review. J Pain Res 2024; 17:1571-1581. [PMID: 38699068 PMCID: PMC11063468 DOI: 10.2147/jpr.s448634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
Background Peripheral neuropathy (PN) is a prevalent complication of multiple myeloma (MM), due to the disease itself or its treatment. Despite extensive research, the optimal treatment for multiple myeloma peripheral neuropathy (MMPN) remains unclear. Clinical practice has shown the potential efficacy of acupuncture in managing MMPN. This study aimed to conduct a comprehensive analysis of the literature to assess the effectiveness and safety of acupuncture as a treatment for MMPN. Methods The PubMed, Web of Science, MEDLINE, Cochrane Library, and Embase databases were comprehensively searched from inception to November 1, 2023 to identify relevant studies pertaining to the use of acupuncture to treat MMPN. Results A total of five studies, encompassing 97 patients diagnosed with drug-related PN, were ultimately included in this analysis. The literature lacks any reports pertaining to the utilization of acupuncture for disease-related PN. ST36, LI4, SP6, and EX-LE-10 were found to be the most frequently chosen acupoints. Following acupuncture treatment, there was a consistent reduction in scores on the Visual Analogue Scale (VAS), Neuropathic Pain Scale (NPS), Brief Pain Inventory-Short Form (BPI-SF), and Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) among MMPN patients. The results of Nerve Conduction Velocity (NCV) tests yielded conflicting results. No severe adverse effects were reported. Conclusion The use of acupuncture for disease-related PN has not been studied to date. Acupuncture is safe for drug-related PN and is helpful for relieving pain. But uncertainty exists regarding the efficacy of this approach because there is substantial heterogeneity with respect to acupuncture treatment regimens, and more high-quality studies on this topic are warranted.
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Affiliation(s)
- Chunyi Lyu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, 250014, People’s Republic of China
| | - Hongyan Xiao
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, 250014, People’s Republic of China
| | - Xuewei Yin
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250002, People’s Republic of China
| | - Zonghong Li
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, 250014, People’s Republic of China
| | - Chen Han
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, 250014, People’s Republic of China
| | - Ruirong Xu
- Key Laboratory of Integrated Traditional Chinese and Western Medicine for Hematology, Health Commission of Shandong Province; Institute of Hematology, Shandong University of Traditional Chinese Medicine, Jinan, 250014, People’s Republic of China
- Department of Hematology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014, People’s Republic of China
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Diaz-delCastillo M, Palasca O, Nemler TT, Thygesen DM, Chávez-Saldaña NA, Vázquez-Mora JA, Ponce Gomez LY, Jensen LJ, Evans H, Andrews RE, Mandal A, Neves D, Mehlen P, Caruso JP, Dougherty PM, Price TJ, Chantry A, Lawson MA, Andersen TL, Jimenez-Andrade JM, Heegaard AM. Metastatic Infiltration of Nervous Tissue and Periosteal Nerve Sprouting in Multiple Myeloma-Induced Bone Pain in Mice and Human. J Neurosci 2023; 43:5414-5430. [PMID: 37286351 PMCID: PMC10359036 DOI: 10.1523/jneurosci.0404-23.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/15/2023] [Accepted: 05/12/2023] [Indexed: 06/09/2023] Open
Abstract
Multiple myeloma (MM) is a neoplasia of B plasma cells that often induces bone pain. However, the mechanisms underlying myeloma-induced bone pain (MIBP) are mostly unknown. Using a syngeneic MM mouse model, we show that periosteal nerve sprouting of calcitonin gene-related peptide (CGRP+) and growth associated protein 43 (GAP43+) fibers occurs concurrent to the onset of nociception and its blockade provides transient pain relief. MM patient samples also showed increased periosteal innervation. Mechanistically, we investigated MM induced gene expression changes in the dorsal root ganglia (DRG) innervating the MM-bearing bone of male mice and found alterations in pathways associated with cell cycle, immune response and neuronal signaling. The MM transcriptional signature was consistent with metastatic MM infiltration to the DRG, a never-before described feature of the disease that we further demonstrated histologically. In the DRG, MM cells caused loss of vascularization and neuronal injury, which may contribute to late-stage MIBP. Interestingly, the transcriptional signature of a MM patient was consistent with MM cell infiltration to the DRG. Overall, our results suggest that MM induces a plethora of peripheral nervous system alterations that may contribute to the failure of current analgesics and suggest neuroprotective drugs as appropriate strategies to treat early onset MIBP.SIGNIFICANCE STATEMENT Multiple myeloma (MM) is a painful bone marrow cancer that significantly impairs the quality of life of the patients. Analgesic therapies for myeloma-induced bone pain (MIBP) are limited and often ineffective, and the mechanisms of MIBP remain unknown. In this manuscript, we describe cancer-induced periosteal nerve sprouting in a mouse model of MIBP, where we also encounter metastasis to the dorsal root ganglia (DRG), a never-before described feature of the disease. Concomitant to myeloma infiltration, the lumbar DRGs presented blood vessel damage and transcriptional alterations, which may mediate MIBP. Explorative studies on human tissue support our preclinical findings. Understanding the mechanisms of MIBP is crucial to develop targeted analgesic with better efficacy and fewer side effects for this patient population.
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Affiliation(s)
- Marta Diaz-delCastillo
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen 2100, Denmark
- Department of Forensic Medicine, Aarhus University, Aarhus 8870, Denmark
- Department of Oncology & Metabolism, University of Sheffield, Sheffield S10 2RX, United Kingdom
- Mellanby Centre for Bone Research, University of Sheffield, Sheffield S10 2RX, United Kingdom
- Sheffield Teaching Hospitals, Sheffield S10 2JF, United Kingdom
- The Danish Spatial Imaging Consortium (DanSIC), Denmark
| | - Oana Palasca
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen 2200, Denmark
| | - Tim T Nemler
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen 2100, Denmark
| | - Didde M Thygesen
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen 2100, Denmark
| | - Norma A Chávez-Saldaña
- Unidad Académica Multidisciplinaria Reynosa Aztlan, Autonomic University of Tamaulipas, Reynosa 88740, Mexico
| | - Juan A Vázquez-Mora
- Unidad Académica Multidisciplinaria Reynosa Aztlan, Autonomic University of Tamaulipas, Reynosa 88740, Mexico
| | - Lizeth Y Ponce Gomez
- Unidad Académica Multidisciplinaria Reynosa Aztlan, Autonomic University of Tamaulipas, Reynosa 88740, Mexico
| | - Lars Juhl Jensen
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen 2200, Denmark
| | - Holly Evans
- Department of Oncology & Metabolism, University of Sheffield, Sheffield S10 2RX, United Kingdom
- Mellanby Centre for Bone Research, University of Sheffield, Sheffield S10 2RX, United Kingdom
| | - Rebecca E Andrews
- Department of Oncology & Metabolism, University of Sheffield, Sheffield S10 2RX, United Kingdom
- Mellanby Centre for Bone Research, University of Sheffield, Sheffield S10 2RX, United Kingdom
- Sheffield Teaching Hospitals, Sheffield S10 2JF, United Kingdom
| | - Aritri Mandal
- Department of Oncology & Metabolism, University of Sheffield, Sheffield S10 2RX, United Kingdom
- Mellanby Centre for Bone Research, University of Sheffield, Sheffield S10 2RX, United Kingdom
- Sheffield Teaching Hospitals, Sheffield S10 2JF, United Kingdom
| | | | - Patrick Mehlen
- NETRIS Pharma, Lyon 69008, France
- Apoptosis, Cancer and Development Laboratory-Equipe labellisée 'La Ligue,' LabEx DEVweCAN, Centre de Recherche en Cancérologie de Lyon, Lyon 69008, France
| | - James P Caruso
- Department of Neuroscience and Center for Advanced Pain, The University of Texas at Dallas, Dallas, Texas 75080
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390
| | - Patrick M Dougherty
- Department of Pain Medicine, Division of Anesthesiology, MD Anderson Cancer Center, Houston, Texas 77030
| | - Theodore J Price
- Department of Neuroscience and Center for Advanced Pain, The University of Texas at Dallas, Dallas, Texas 75080
| | - Andrew Chantry
- Department of Oncology & Metabolism, University of Sheffield, Sheffield S10 2RX, United Kingdom
- Mellanby Centre for Bone Research, University of Sheffield, Sheffield S10 2RX, United Kingdom
- Sheffield Teaching Hospitals, Sheffield S10 2JF, United Kingdom
| | - Michelle A Lawson
- Department of Oncology & Metabolism, University of Sheffield, Sheffield S10 2RX, United Kingdom
- Mellanby Centre for Bone Research, University of Sheffield, Sheffield S10 2RX, United Kingdom
| | - Thomas L Andersen
- Department of Forensic Medicine, Aarhus University, Aarhus 8870, Denmark
- The Danish Spatial Imaging Consortium (DanSIC), Denmark
- Department of Clinical Cell Biology, University of Southern Denmark, Odense 5230, Denmark
- Department of Clinical Pathology, Odense University Hospital, Odense 5000, Denmark
| | - Juan M Jimenez-Andrade
- Unidad Académica Multidisciplinaria Reynosa Aztlan, Autonomic University of Tamaulipas, Reynosa 88740, Mexico
| | - Anne-Marie Heegaard
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen 2100, Denmark
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Dong M, Zhang J, Chen Q, He D, Yan H, Zheng G, Han X, He J, Cai Z. High serum IL-17A is associated with bone destruction in newly diagnosed multiple myeloma patients. Front Oncol 2022; 12:936670. [PMID: 36119497 PMCID: PMC9471080 DOI: 10.3389/fonc.2022.936670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/08/2022] [Indexed: 01/10/2023] Open
Abstract
Background Multiple myeloma (MM) is a malignant proliferative disease of the blood system, characterized by the abnormal growth of clonal plasma cells in the bone marrow. The bone marrow microenvironment (BMM) is highly critical in the pathological process of MM. Many studies have shown that serum interleukin-17A (IL-17A) plays a key role in various infectious diseases, autoimmune diseases, and cancers. However, more clinical studies need to be performed to further prove the influence of serum IL-17A levels on multiple myeloma patients. Methods Among a total of 357 participants in our institution’s MM cohort, 175 were eligible for the retrospective study. Multivariate regression models adjusted by potential confounding factors, the violin plots, the generalized additive model and smooth curve fittings, receiver operating characteristic (ROC) curve, and Kaplan–Meier (K-M) curve analysis were applied to the research. Results A total of 175 patients with newly diagnosed MM were enrolled in this study. The multivariate linear regression analysis showed that serum IL-17A level in MM patients correlated with the degree of bone lesions and fracture incidence (fully adjusted model, pbone lesion < 0.0001, pfracture < 0.0001). The violin plot showed that MM patients with higher serum IL-17A levels had more severe bone lesions and higher fracture incidence than those with lower serum IL-17A levels. A total of 171 patients were included in the study of the relationship between serum IL-17A and best overall effect (BOE). We found that serum IL-17A levels were independently related to the best inductive therapeutic efficacy (fully adjusted model, p = 0.037), and the relationship was especially obvious in the light chain group (fully adjusted model, p = 0.009) and IgA group (fully adjusted model, p = 0.0456). It could be deduced from the smooth curve that the higher the serum IL-17A level, the worse the BOE (p = 0.0163). The ROC prediction curve suggested that serum IL-17A could predict the BOE to a certain extent (area under the curve (AUC) = 0.717, p = 0.0327). A total of 148 MM patients were observed in the longitudinal study of the relationship between serum IL-17A and progression-free survival/overall survival (PFS/OS). The K-M curve analysis indicated that serum IL-17A levels in MM patients were not significantly correlated with PFS and OS. However, in the light chain subgroup, MM patients with high serum IL-17A had worse PFS (p = 0.015) and OS (p = 0.0076) compared to those with low serum IL-17A. In the IgA type subgroup, the higher IL-17A level was related to worse OS (p = 0.0061). Conclusion This retrospective study found that higher levels of serum IL-17A were independently correlated with higher severity of bone disease and fracture incidence in newly diagnosed MM patients. High serum IL-17A level was related to poor best overall efficacy in the light chain type. High serum IL-17A was also associated with poor PFS and OS in the light chain type and OS in the IgA type subgroup.
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Affiliation(s)
- Mengmeng Dong
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jinna Zhang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qingxiao Chen
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Donghua He
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Haimeng Yan
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Gaofeng Zheng
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoyan Han
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jingsong He
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Zhen Cai, ; Jingsong He,
| | - Zhen Cai
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Institute of Hematology, Zhejiang University, Hangzhou, China
- *Correspondence: Zhen Cai, ; Jingsong He,
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