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Zhang K, Xu Y, Tan S, Wang X, Du M, Liu L. The association between plasma fibrinogen levels and lung cancer: a meta-analysis. J Thorac Dis 2019; 11:4492-4500. [PMID: 31903237 DOI: 10.21037/jtd.2019.11.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Published studies have presented an inconsistent association between plasma fibrinogen level and poor prognosis or clinicopathological characteristics in lung cancer. Methods In the absence of significant quality difference, combined hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were calculated according to overall survival (OS), progression-free survival (PFS) and disease-free survival (DFS). Risk ratio (RR), odds ratio (OR) and standardized mean difference (SMD) with CIs were pooled to appraise the effect of plasma fibrinogen on clinicopathological characteristics. Furthermore, we directly combined the P values to estimate the association of plasma fibrinogen and tumor size. We adjusted the publication bias using trim-and fill method. Results Twenty studies with 6,494 patients were contained in meta-analysis. The pooled data indicated that elevated fibrinogen level associated with poor prognosis in lung cancer. Typically, the pooled HRs were 1.44 (95% CI, 1.34-1.55), 1.49 (95% CI, 1.24-1.80) and 1.69 (95% CI, 1.31-2.17) for OS, PFS and DFS of lung cancer, respectively. In addition, the combined ORs were 1.50 (95% CI, 1.23-1.84) and 2.01 (95% CI, 1.66-2.44) for lymph node metastasis and III-IV stage; and the combined RR was 2.15 (95% CI, 1.11-4.15) for disease control rate (DCR). Moreover, patients with distant metastasis or III-IV stage had significantly higher plasma fibrinogen level (SMD: 0.20, 95% CI, 0.04-0.36; SMD: 0.31, 95% CI, 0.18-0.44, respectively). Conclusions The summary results indicated that plasma fibrinogen was a marker of prognosis and clinicopathological characteristics in lung cancer.
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Affiliation(s)
- Ke Zhang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ye Xu
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Shanyue Tan
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xueyan Wang
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Mulong Du
- Department of Genetic Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China.,Department of Biostatistics, Nanjing Medical University, Nanjing 211166, China
| | - Lingxiang Liu
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Fatahi S, Kord Varkaneh H, Teymouri A, Azadbakht L. Beneficiary effect of a-lipoic acid supplementation on C-reactive protein level among adults. ACTA ACUST UNITED AC 2018. [DOI: 10.1108/nfs-03-2018-0082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Clinical evidence has suggested that alpha-lipoic acid (ALA), a potent antioxidant, seems to have some effects on inflammatory process. However, these results are equivocal. The purpose of this paper is to investigate the nature of association between ALA and serum C-reactive protein (CRP) level by pooling the results from clinical trial studies.
Design/methodology/approach
Relevant studies were identified by systematic literature search of PubMed/MEDLINE, Scopus, Web of Sciences and Cochrane library up to September 2016 for randomized controlled trials (RCTs) evaluating the impact of ALA supplementation on CRP. The pooled data were summarized as weighted mean difference (WMD) and 95 per cent confidence interval (CI). Effect sizes of eligible studies were pooled using random- or fixed-effects (the DerSimonian–Laird estimator) depending on the results of heterogeneity tests.
Findings
Of 212 papers, 15 were eligible RCTs according to inclusion criteria. The selected studies comprised 1,408 cases and 457 controls. The dose of ALA supplement ranged from 300 to 1,200 mg, and the duration of follow-up was from 1 to 48 weeks. ALA supplementation significantly reduced the levels of circulating CRP (WMD: −0.088, 95 per cent CI: −0.131, −0.045, p < 0.001) with significant heterogeneity (I2 = 73.4 per cent, p < 0.001). Populations with age younger than 50 years (PMD: −0.060 mg/dl), receiving doses less than 600 mg/day (PMD: −0.057 mg/dl), having cardiovascular disease (PMD: −0.105 mg/dl), hemodialysis (PMD: −0.209 mg/dl), diabetes (PMD: −0.021 mg/dl) and otherwise healthy subjects (PMD: −0.045 mg/dl) were sources of heterogeneity.
Originality/Value
This meta-analysis of RCTs suggests that ALA supplementation seems to significantly reduce circulating CRP level.
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Bersanelli M, Buti S, Camisa R, Brighenti M, Lazzarelli S, Mazza G, Passalacqua R. Gefitinib plus interleukin-2 in advanced non-small cell lung cancer patients previously treated with chemotherapy. Cancers (Basel) 2014; 6:2035-48. [PMID: 25271833 PMCID: PMC4276955 DOI: 10.3390/cancers6042035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 08/21/2014] [Accepted: 09/15/2014] [Indexed: 01/05/2023] Open
Abstract
The activation of lymphocytes by gefitinib treatment has been described. In this phase II pilot trial, we explored the possible synergism between IL-2 and gefitinib for non-small cell lung cancer (NSCLC) treatment. From September, 2003, to November, 2006, 70 consecutive patients with advanced, progressive NSCLC, previously treated with chemotherapy, received oral gefitinib 250 mg daily. The first 39 patients received gefitinib alone (G group). The other 31 also received subcutaneous IL-2 (GIL-2 group): 1 MIU/m2 (Million International Unit/m2)twice a day on Days 1 and 2, once a day on Days 3, 4, 5 every week for four consecutive weeks with a four-week rest period. Median follow-up was 25.2 months. Grade 3–4 toxicity of gefitinib was represented by skin rash (7%), asthenia/anorexia (6%) and diarrhea (7%); patients treated with IL-2 showed grade 2–3 fever (46%), fatigue (21%) and arthralgia (13%). In the GIL-2 group and G-group, we respectively observed: an overall response rate of 16.1% (6.4% complete response) and 5.1% (only partial response); a disease control rate of 41.9% and 41%; a median time to progression of 3.5 (CI 95% = 3.2–3.8) and 4.1 (CI 95% = 2.6–5.7) months; a median overall survival of 20.1 (CI 95% = 5.1–35.1) and 6.9 (CI 95% = 4.9–8.9) months (p = 0.002); and an actuarial one-year survival rate of 54% and 30%. Skin toxicity (p < 0.001; HR = 0.29; CI 95% = 0.16–0.54) and use of IL-2 (p < 0.001; HR = 0.33; CI 95% = 0.18–0.60) were independently associated with improvement of survival. In this consecutive, non-randomized, series of advanced NSCLC patients, the use of IL-2 increased the efficacy of gefitinib.
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Affiliation(s)
- Melissa Bersanelli
- Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma, Italy.
| | - Sebastiano Buti
- Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma, Italy.
| | - Roberta Camisa
- Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma, Italy.
| | - Matteo Brighenti
- Oncology Unit, Azienda Istituti Ospitalieri di Cremona, Largo Priori, 1, 26100 Cremona, Italy.
| | - Silvia Lazzarelli
- Oncology Unit, Azienda Istituti Ospitalieri di Cremona, Largo Priori, 1, 26100 Cremona, Italy.
| | - Giancarlo Mazza
- Radiology Division, Spedali Civili di Brescia, P.le Spedali Civili,1, 25123 Brescia, Italy.
| | - Rodolfo Passalacqua
- Oncology Unit, Azienda Istituti Ospitalieri di Cremona, Largo Priori, 1, 26100 Cremona, Italy.
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Thornthwaite JT, Shah HR, Shah P, Peeples WC, Respess H. The formulation for cancer prevention & therapy. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/abc.2013.33040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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5
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Braun DP, Gupta D, Birdsall TC, Sumner M, Staren ED. Effect of naturopathic and nutritional supplement treatment on tumor response, control, and recurrence in patients with prostate cancer treated with radiation therapy. J Altern Complement Med 2012; 19:198-203. [PMID: 23036139 DOI: 10.1089/acm.2011.0657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Use of naturopathic and nutritional supplements (NNS) with antioxidant activity is controversial in patients receiving radiation therapy. The effects of concomitant use of NNS with antioxidant activity during radiation therapy for prostate cancer were investigated in terms of clinical tumor responsiveness, kinetics, and durability. MATERIALS AND METHODS A retrospective investigation was done of 134 patients treated with curative intent for limited-stage prostate cancer by radiation therapy. Patients self-selected to receive NNS as part of their treatment and maintenance during an extended post-treatment interval of at least 2 years. The outcome measures were the following: prostate-specific antigen (PSA) nadir; ≥24 months post-treatment PSA; time to reach nadir; and time to last follow-up were compared across +NNS and -NNS. RESULTS Sixty-nine (69) patients elected to receive NNS while 65 did not. Seventy-seven (77) (+NNS 39, -NNS 38) patients received hormone therapy while 57 (+NNS 30, -NNS 27) did not. In the nonhormone cohort, median pretreatment PSA, nadir, post-treatment PSA, time to reach nadir, and time to follow-up were 5.5 ng/mL, 0.56 ng/mL, 0.61 ng/mL, 25 months, and 39.7 months for the -NNS group and 5.1 ng/mL, 0.32 ng/mL, 0.44 ng/mL, 27 months, and 50.1 months for the +NNS group, respectively (p>0.05 for all). Similarly, no significant differences were observed between +NNS and -NNS in the hormone-receiving cohort. CONCLUSIONS The clinical tumor response to radiation therapy in patients with limited-stage prostate cancer is not inhibited by concomitant NNS based on the magnitude of the PSA response, the velocity of the PSA nadir, and the duration of PSA normalization.
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Affiliation(s)
- Donald P Braun
- Office of Clinical Research, Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center, Zion, IL 60099, USA
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López-Erauskin J, Fourcade S, Galino J, Ruiz M, Schlüter A, Naudi A, Jove M, Portero-Otin M, Pamplona R, Ferrer I, Pujol A. Antioxidants halt axonal degeneration in a mouse model of X-adrenoleukodystrophy. Ann Neurol 2011; 70:84-92. [PMID: 21786300 PMCID: PMC3229843 DOI: 10.1002/ana.22363] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Axonal degeneration is a main contributor to disability in progressive neurodegenerative diseases in which oxidative stress is often identified as a pathogenic factor. We aim to demonstrate that antioxidants are able to improve axonal degeneration and locomotor deficits in a mouse model of X-adrenoleukodystrophy (X-ALD). METHODS X-ALD is a lethal disease caused by loss of function of the ABCD1 peroxisomal transporter of very long chain fatty acids (VLCFA). The mouse model for X-ALD exhibits a late onset neurological phenotype with locomotor disability and axonal degeneration in spinal cord resembling the most common phenotype of the disease, adrenomyeloneuropathy (X-AMN). Recently, we identified oxidative damage as an early event in life, and the excess of VLCFA as a generator of radical oxygen species (ROS) and oxidative damage to proteins in X-ALD. RESULTS Here, we prove the capability of the antioxidants N-acetyl-cysteine, α-lipoic acid, and α-tocopherol to scavenge VLCFA-dependent ROS generation in vitro. Furthermore, in a preclinical setting, the cocktail of the 3 compounds reversed: (1) oxidative stress and lesions to proteins, (2) immunohistological signs of axonal degeneration, and (3) locomotor impairment in bar cross and treadmill tests. INTERPRETATION We have established a direct link between oxidative stress and axonal damage in a mouse model of neurodegenerative disease. This conceptual proof of oxidative stress as a major disease-driving factor in X-AMN warrants translation into clinical trials for X-AMN, and invites assessment of antioxidant strategies in axonopathies in which oxidative damage might be a contributing factor.
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Affiliation(s)
- Jone López-Erauskin
- Neurometabolic Diseases Laboratory, The Bellvitge Institute of Biomedical Research, Hospitalet de Liobregat, Barcelona, Spain
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Abstract
Cachexia is a complex metabolic syndrome associated with many chronic or end-stage diseases, especially cancer, and is characterized by loss of muscle with or without loss of fat mass. The management of cachexia is a complex challenge that should address the different causes underlying this clinical event with an integrated or multimodal treatment approach targeting the different factors involved in its pathophysiology. The purpose of this article was to review the current medical treatment of cancer-related cachexia, in particular focusing on combination therapy and ongoing research. Among the treatments proposed in the literature for cancer-related cachexia, some proved to be ineffective, namely, cyproheptadine, hydrazine, metoclopramide, and pentoxifylline. Among effective treatments, progestagens are currently considered the best available treatment option for cancer-related cachexia, and they are the only drugs approved in Europe. Drugs with a strong rationale that have failed or have not shown univocal results in clinical trials so far include eicosapentaenoic acid, cannabinoids, bortezomib, and anti-TNF-alpha MoAb. Several emerging drugs have shown promising results but are still under clinical investigation (thalidomide, selective cox-2 inhibitors, ghrelin mimetics, insulin, oxandrolone, and olanzapine). To date, despite several years of coordinated efforts in basic and clinical research, practice guidelines for the prevention and treatment of cancer-related muscle wasting are lacking, mainly because of the multifactorial pathogenesis of the syndrome. From all the data presented, one can speculate that one single therapy may not be completely successful in the treatment of cachexia. From this point of view, treatments involving different combinations are more likely to be successful.
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Affiliation(s)
- Em Tazi
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco
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8
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Rooks C, Faber T, Votaw J, Veledar E, Goldberg J, Raggi P, Quyyumi AA, Bremner JD, Vaccarino V. Effects of smoking on coronary microcirculatory function: a twin study. Atherosclerosis 2011; 215:500-6. [PMID: 21315354 PMCID: PMC3082474 DOI: 10.1016/j.atherosclerosis.2011.01.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 12/04/2010] [Accepted: 01/06/2011] [Indexed: 12/28/2022]
Abstract
BACKGROUND In asymptomatic smokers, coronary microcirculatory dysfunction, assessed by coronary flow reserve (CFR), is an early indicator of cardiovascular risk. Inflammation and oxidative stress may be the mechanisms through which smoking affects the microvasculature. OBJECTIVES The purpose of this study was to determine the relationship between smoking and CFR, taking into account potential shared genetic effects. METHODS We examined 360 male middle aged twins (288 non-smokers and 72 smokers), including 46 twin pairs discordant for current smoking. Coronary flow reserve (CFR) in response to adenosine was measured with positron emission tomography [N(13)] ammonia and quantitation of coronary blood flow at rest and after adenosine stress. Inflammation was assessed by measuring interleukin-6 and C-reactive protein, and oxidative stress was determined by measuring plasma hydroperoxides, glutathione (GSH), the oxidized form of GSH, GSSG, and the ratio of GSH to GSSG. RESULTS CFR was significantly lower in smokers compared to nonsmokers (2.25 vs. 2.75, p<0.01). This relationship persisted after accounting for known cardiovascular disease risk factors, and was marginally affected by adjusting for inflammatory and oxidative stress biomarkers. In addition, in smoking-discordant twin pairs, CFR in the smoking twin was significantly lower than in the non-smoking co-twin (2.25 vs. 2.67, p=0.03) even after adjustment for cardiovascular risk factors. CONCLUSIONS Our results demonstrate the adverse effects of smoking in the early phases of cardiovascular disease. Mechanisms other than peripherally measured inflammation and oxidative stress are involved.
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Affiliation(s)
- Cherie Rooks
- Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA 30322, USA
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9
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The free oxygen radicals test (FORT) to assess circulating oxidative stress in patients with acute myocardial infarction. Atherosclerosis 2010; 213:616-21. [DOI: 10.1016/j.atherosclerosis.2010.09.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 09/02/2010] [Accepted: 09/15/2010] [Indexed: 11/24/2022]
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10
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Martinez-Outschoorn UE, Whitaker-Menezes D, Pavlides S, Chiavarina B, Bonuccelli G, Casey T, Tsirigos A, Migneco G, Witkiewicz A, Balliet R, Mercier I, Wang C, Flomenberg N, Howell A, Lin Z, Caro J, Pestell RG, Sotgia F, Lisanti MP. The autophagic tumor stroma model of cancer or "battery-operated tumor growth": A simple solution to the autophagy paradox. Cell Cycle 2010; 9:4297-306. [PMID: 21051947 DOI: 10.4161/cc.9.21.13817] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The role of autophagy in tumorigenesis is controversial. Both autophagy inhibitors (chloroquine) and autophagy promoters (rapamycin) block tumorigenesis by unknown mechanism(s). This is called the "Autophagy Paradox". We have recently reported a simple solution to this paradox. We demonstrated that epithelial cancer cells use oxidative stress to induce autophagy in the tumor microenvironment. As a consequence, the autophagic tumor stroma generates recycled nutrients that can then be used as chemical building blocks by anabolic epithelial cancer cells. This model results in a net energy transfer from the tumor stroma to epithelial cancer cells (an energy imbalance), thereby promoting tumor growth. This net energy transfer is both unilateral and vectorial, from the tumor stroma to the epithelial cancer cells, representing a true host-parasite relationship. We have termed this new paradigm "The Autophagic Tumor Stroma Model of Cancer Cell Metabolism" or "Battery-Operated Tumor Growth". In this sense, autophagy in the tumor stroma serves as a "battery" to fuel tumor growth, progression and metastasis, independently of angiogenesis. Using this model, the systemic induction of autophagy will prevent epithelial cancer cells from using recycled nutrients, while the systemic inhibiton of autophagy will prevent stromal cells from producing recycled nutrients-both effectively "starving" cancer cells. We discuss the idea that tumor cells could become resistant to the systemic induction of autophagy, by the upregulation of natural endogenous autophagy inhibitors in cancer cells. Alternatively, tumor cells could also become resistant to the systemic induction of autophagy, by the genetic silencing/deletion of pro-autophagic molecules, such as Beclin1. If autophagy resistance develops in cancer cells, then the systemic inhibition of autophagy would provide a therapeutic solution to this type of drug resistance, as it would still target autophagy in the tumor stroma. As such, an anti-cancer therapy that combines the alternating use of both autophagy promoters and autophagy inhibitors would be expected to prevent the onset of drug resistance. We also discuss why anti-angiogenic therapy has been found to promote tumor recurrence, progression and metastasis. More specifically, anti-angiogenic therapy would induce autophagy in the tumor stroma via the induction of stromal hypoxia, thereby converting a non-aggressive tumor type to a "lethal" aggressive tumor phenotype. Thus, uncoupling the metabolic parasitic relationship between cancer cells and an autophagic tumor stroma may hold great promise for anti-cancer therapy. Finally, we believe that autophagy in the tumor stroma is the local microscopic counterpart of systemic wasting (cancer-associated cachexia), which is associated with advanced and metastatic cancers. Cachexia in cancer patients is not due to decreased energy intake, but instead involves an increased basal metabolic rate and increased energy expenditures, resulting in a negative energy balance. Importantly, when tumors were surgically excised, this increased metabolic rate returned to normal levels. This view of cachexia, resulting in energy transfer to the tumor, is consistent with our hypothesis. So, cancer-associated cachexia may start locally as stromal autophagy, and then spread systemically. As such, stromal autophagy may be the requisite precursor of systemic cancer-associated cachexia.
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Affiliation(s)
- Ubaldo E Martinez-Outschoorn
- The Jefferson Stem Cell Biology and Regenerative Medicine Center, Thomas Jefferson University, Philadelphia, PA, USA
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11
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Lisanti MP, Martinez-Outschoorn UE, Chiavarina B, Pavlides S, Whitaker-Menezes D, Tsirigos A, Witkiewicz A, Lin Z, Balliet R, Howell A, Sotgia F. Understanding the "lethal" drivers of tumor-stroma co-evolution: emerging role(s) for hypoxia, oxidative stress and autophagy/mitophagy in the tumor micro-environment. Cancer Biol Ther 2010; 10:537-42. [PMID: 20861671 DOI: 10.4161/cbt.10.6.13370] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We have recently proposed a new model for understanding how tumors evolve. To achieve successful "Tumor-Stroma Co-Evolution", cancer cells induce oxidative stress in adjacent fibroblasts and possibly other stromal cells. Oxidative stress in the tumor stroma mimics the effects of hypoxia, under aerobic conditions, resulting in an excess production of reactive oxygen species (ROS). Excess stromal production of ROS drives the onset of an anti-oxidant defense in adjacent cancer cells, protecting them from apoptosis. Moreover, excess stromal ROS production has a "Bystander-Effect", leading to DNA damage and aneuploidy in adjacent cancer cells, both hallmarks of genomic instability. Finally, ROS-driven oxidative stress induces autophagy and mitophagy in the tumor micro-environment, leading to the stromal over-production of recycled nutrients (including energy-rich metabolites, such as ketones and L-lactate). These recycled nutrients or chemical building blocks then help drive mitochondrial biogenesis in cancer cells, thereby promoting the anabolic growth of cancer cells (via an energy imbalance). We also show that ketones and lactate help "fuel" tumor growth and cancer cell metastasis and can act as chemo-attractants for cancer cells. We have termed this new paradigm for accelerating tumor-stroma co-evolution, "The Autophagic Tumor Stroma Model of Cancer Cell Metabolism". Heterotypic signaling in cancer-associated fibroblasts activates the transcription factors HIF1alpha and NFκB, potentiating the onset of hypoxic and inflammatory response(s), which further upregulates the autophagic program in the stromal compartment. Via stromal autophagy, this hypoxic/inflammatory response may provide a new escape mechanism for cancer cells during anti-angiogenic therapy, further exacerbating tumor recurrence and metastasis.
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Affiliation(s)
- Michael P Lisanti
- The Jefferson Stem Cell Biology and Regenerative Medicine Center, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
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Mantovani G, Macciò A, Madeddu C, Serpe R, Massa E, Dessì M, Panzone F, Contu P. Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist 2010; 15:200-11. [PMID: 20156909 DOI: 10.1634/theoncologist.2009-0153] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE A phase III, randomized study was carried out to establish the most effective and safest treatment to improve the primary endpoints of cancer cachexia-lean body mass (LBM), resting energy expenditure (REE), and fatigue-and relevant secondary endpoints: appetite, quality of life, grip strength, Glasgow Prognostic Score (GPS) and proinflammatory cytokines. PATIENTS AND METHODS Three hundred thirty-two assessable patients with cancer-related anorexia/cachexia syndrome were randomly assigned to one of five treatment arms: arm 1, medroxyprogesterone (500 mg/day) or megestrol acetate (320 mg/day); arm 2, oral supplementation with eicosapentaenoic acid; arm 3, L-carnitine (4 g/day); arm 4, thalidomide (200 mg/day); and arm 5, a combination of the above. Treatment duration was 4 months. RESULTS Analysis of variance showed a significant difference between treatment arms. A post hoc analysis showed the superiority of arm 5 over the others for all primary endpoints. An analysis of changes from baseline showed that LBM (by dual-energy X-ray absorptiometry and by L3 computed tomography) significantly increased in arm 5. REE decreased significantly and fatigue improved significantly in arm 5. Appetite increased significantly in arm 5; interleukin (IL)-6 decreased significantly in arm 5 and arm 4; GPS and Eastern Cooperative Oncology Group performance status (ECOG PS) score decreased significantly in arm 5, arm 4, and arm 3. Toxicity was quite negligible, and was comparable between arms. CONCLUSION The most effective treatment in terms of all three primary efficacy endpoints and the secondary endpoints appetite, IL-6, GPS, and ECOG PS score was the combination regimen that included all selected agents.
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13
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Mantovani G, Madeddu C. Cancer cachexia: medical management. Support Care Cancer 2009; 18:1-9. [PMID: 19688225 DOI: 10.1007/s00520-009-0722-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 08/03/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cachexia is a complex metabolic syndrome associated with many chronic or end-stage diseases, especially cancer, and is characterized by loss of muscle with or without loss of fat mass. The management of cachexia is a complex challenge that should address the different causes underlying this clinical event with an integrated or multimodal treatment approach targeting the different factors involved in its pathophysiology. MATERIALS AND METHODS The purpose of this article was to review the current medical treatment of cancer-related cachexia, in particular focusing on combination therapy and ongoing research. RESULTS Among the treatments proposed in the literature for cancer-related cachexia, some proved to be ineffective, namely, cyproheptadine, hydrazine, metoclopramide, and pentoxifylline. Among effective treatments, progestagens are currently considered the best available treatment option for cancer-related cachexia, and they are the only drugs approved in Europe. Drugs with a strong rationale that have failed or have not shown univocal results in clinical trials so far include eicosapentaenoic acid, cannabinoids, bortezomib, and anti-TNF-alpha MoAb. Several emerging drugs have shown promising results but are still under clinical investigation (thalidomide, selective cox-2 inhibitors, ghrelin mimetics, insulin, oxandrolone, and olanzapine). CONCLUSIONS To date, despite several years of co-ordinated efforts in basic and clinical research, practice guidelines for the prevention and treatment of cancer-related muscle wasting are lacking, mainly because of the multifactorial pathogenesis of the syndrome. From all the data presented, one can speculate that one single therapy may not be completely successful in the treatment of cachexia. From this point of view, treatments involving different combinations are more likely to be successful.
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Affiliation(s)
- Giovanni Mantovani
- Department of Medical Oncology, University of Cagliari, Cagliari, Italy.
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14
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Strategies for reconstituting and boosting T cell-based immunity following haematopoietic stem cell transplantation: pre-clinical and clinical approaches. Semin Immunopathol 2008; 30:457-77. [PMID: 18982327 DOI: 10.1007/s00281-008-0140-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Accepted: 10/14/2008] [Indexed: 12/14/2022]
Abstract
Poor immune recovery is characteristic of bone marrow transplantation and leads to high levels of morbidity and mortality. The primary underlying cause is a compromised thymic function, resulting from age-induced atrophy and further compounded by the damaging effects of cytoablative conditioning regimes on thymic epithelial cells (TEC). Several strategies have been proposed to enhance T cell reconstitution. Some, such as the use of single biological agents, are currently being tested in clinical trials. However, a more rational approach to immune restoration will be to leverage the evolving repertoire of new technologies. Specifically, the combined targeting of TEC, thymocytes and peripheral T cells, together with the bone marrow niches, promises a more strategic clinical therapeutic platform.
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Grim-Stieger M, Keilani M, Mader RM, Marosi C, Schmidinger M, Zielinski CC, Fialka-Moser V, Crevenna R. Serum levels of tumour necrosis factor-alpha and interleukin-6 and their correlation with body mass index, weight loss, appetite and survival rate--preliminary data of Viennese outpatients with metastatic cancer during palliative chemotherapy. Eur J Cancer Care (Engl) 2008; 17:454-62. [PMID: 18637115 DOI: 10.1111/j.1365-2354.2007.00874.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The serum cytokine levels (in particular interleukine-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha)) of 61 advanced stage cancer patients receiving palliative chemotherapy as outpatients were determined with quantikine immunoassays. The values were correlated with body mass index (BMI), weight loss and appetite. Furthermore cytokine levels of patients who have died within one year were compared with those of patients who have survived more than a year. Serum levels of IL-6 (median: 1.93 pg/ml, range: 0.32-42.87) and of TNF-alpha (median: 2.55 pg/ml, range: 1.03-34.06) did not correlate with BMI, weight loss and appetite. Serum IL-6 levels of patients with survival time less than one year were significantly higher than the levels of patients who survived more than one year, no significant differences in TNF-alpha serum levels were evident. The data of this observation are consistent with current literature. Due to changes in serum levels of proinflammatory cytokines in response to chemotherapy and additional therapy, it is unlikely that IL-6 and TNF-alpha can be used as independent indicators for weight loss and appetite. Nevertheless, high serum levels of IL-6 correlate with short-time mortality.
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Affiliation(s)
- M Grim-Stieger
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria
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16
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Mantovani G, Macciò A, Madeddu C, Gramignano G, Serpe R, Massa E, Dessì M, Tanca FM, Sanna E, Deiana L, Panzone F, Contu P, Floris C. Randomized phase III clinical trial of five different arms of treatment for patients with cancer cachexia: interim results. Nutrition 2008; 24:305-13. [PMID: 18262758 DOI: 10.1016/j.nut.2007.12.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Revised: 12/10/2007] [Accepted: 12/13/2007] [Indexed: 11/30/2022]
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Abstract
INTRODUCTION Laryngeal transplantation remains an increasingly viable option for patients with irreversible disease or damage to the larynx. Successful organ transplantation relies on minimising surgical, ischaemic and immunological insults. The inherent immunogenicity of an organ is dependent on the amount of immunologically active cells within it. The presence of immunologically active cells within non-transplanted NIH-minipigs was investigated and an in vivo laryngeal transplant model was developed. MATERIALS AND METHODS Quantitative, multiple-colour immunofluorescence using pig-specific monoclonal antibodies was used to assess the normal immunological architecture and the short-term immunological changes associated with 3 h of cold ischaemia and 8 h of reperfusion in an MHC-matched animal model. RESULTS AND CONCLUSIONS There is a complex immunological architecture within the non-transplanted, healthy pig larynx. In addition, an in vivo laryngeal transplant model was developed that allowed successful perfusion for 8 h post transplantation. There were significant changes in cell numbers within different anatomical subsites of the larynx. However, the biological significance remains debatable in view of the large range of cell numbers both within and between individual animals.
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Affiliation(s)
- Emma V Barker
- Department of Otorhinolaryngology, Wessex Deanery, Southampton, UK.
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18
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De Cosmo S, Lamacchia O, Rauseo A, Viti R, Gesualdo L, Pilotti A, Trischitta V, Cignarelli M. Cigarette smoking is associated with low glomerular filtration rate in male patients with type 2 diabetes. Diabetes Care 2006; 29:2467-70. [PMID: 17065686 DOI: 10.2337/dc06-0940] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The relationship between cigarette smoking and renal dysfunction in diabetes has predominantly been documented in patients with type 1 diabetes. The aim of the present study was to explore the relationship between cigarette smoking and glomerular filtration rate (GFR) in a large cross-sectional study carried out in male subjects with type 2 diabetes. The role of metabolic syndrome in modulating this relationship was also investigated. RESEARCH DESIGN AND METHODS One hundred fifty-eight current smokers and 158 never smokers with type 2 diabetes were consecutively recruited. Low GFR was defined as GFR <60 ml/min per 1.73 m(2). RESULTS The proportion of patients affected by low GFR was significantly higher in current smokers (20.9 vs. 12.0%, P = 0.03). The adjusted risk (odds ratio [OR]) of low GFR in current smokers was 2.20 (95% CI 1.14-4.26, P = 0.02) and markedly higher in patients from the first tertile of disease duration (4.27 [1.26-14.40], P = 0.02). When metabolic syndrome was added to the statistical model exploring the relationship between smoking and low GFR, the risk of low GFR showed a small change, although it did not become any more significant (1.84 [0.98-3.45], P = 0.06). Current smokers showed even higher free oxygen radical test unit values (560.0 +/- 91.5 vs. 442.7 +/- 87.2, P < 0.0001). CONCLUSIONS In a large population of male patients with type 2 diabetes, the risk of low GFR is markedly enhanced by smoking and is at least partially mediated by metabolic syndrome.
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Affiliation(s)
- Salvatore De Cosmo
- Unit of Endocrinology and Metabolic Diseases, Department of Medical Sciences, University of Foggia, via Luigi Pinto, 71100 Foggia, Italy
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Barker E, Haverson K, Stokes CR, Birchall M, Bailey M. The larynx as an immunological organ: immunological architecture in the pig as a large animal model. Clin Exp Immunol 2006; 143:6-14. [PMID: 16367928 PMCID: PMC1809556 DOI: 10.1111/j.1365-2249.2005.02950.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2005] [Indexed: 12/01/2022] Open
Abstract
The larynx is a mucosal organ positioned at the divergence of the respiratory and digestive tracts. It is exposed to a wide variety of environmental components, including foreign antigens, tobacco smoke, laryngopharyngeal reflux and pollutants. The mucosal immune system generates either active immune responses or tolerance, depending on the nature of the antigen and we hypothesize that the larynx is important organ for immunological decision-making in the airway. Because the pig is an ideal large animal model in which to explore laryngological research questions, such as those relating to laryngeal transplantation, we investigated the normal mucosal immunology of the porcine larynx. Pig larynges and tracheae were processed and prepared for bright-field microscopy and quantitative, multiple-colour immunofluorescence histology using pig-specific monoclonal antibodies. There was an abundance of immunologically active cells within the mucosa of the larynx and trachea of both the newborn and adult animal. Specifically, major histocompatibility complex class II (MHC class II+) cells, CD4+ and CD8+ cells were identified, although regional differences in numbers were apparent: specifically, the supraglottis contained fewer immunologically relevant cells than other sites sampled. There was a significant correlation between the numbers of MHC class II+ and CD4+ cells indicating co-ordinate regulation and therefore functional local interactions. The presence of such an immunological structure suggests that the larynx may have important functions in respiratory immunology and that it may trigger strong alloresponses after laryngeal transplantation.
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Affiliation(s)
- E Barker
- Clinical Science at North Bristol, University of Bristol, Southmead Hospital, Bristol, UK.
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20
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Abramson JL, Hooper WC, Jones DP, Ashfaq S, Rhodes SD, Weintraub WS, Harrison DG, Quyyumi AA, Vaccarino V. Association between novel oxidative stress markers and C-reactive protein among adults without clinical coronary heart disease. Atherosclerosis 2005; 178:115-21. [PMID: 15585208 DOI: 10.1016/j.atherosclerosis.2004.08.007] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2003] [Accepted: 08/10/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Increases in the inflammatory marker C-reactive protein (CRP) have been associated with a higher risk of incident coronary heart disease (CHD). The causes of increased CRP, however, are not completely understood. Studies suggest that oxidative stress may have pro-inflammatory effects, but data on the relationship between oxidative stress and CRP in healthy persons is sparse. METHODS AND RESULTS We conducted a cross-sectional study of oxidative stress markers and high sensitivity CRP (hsCRP) among 126 adults without CHD. Markers of oxidative stress included the free oxygen radical test (FORT), which reflects levels of organic hydroperoxides, and the redox potential of the reduced glutathione/glutathione disulfide couple, (Eh) GSH/GSSG. In a linear regression model that adjusted for age, sex, body mass index, and other potential hsCRP determinants, the FORT was positively associated with log-transformed hsCRP and explained 14% of log-transformed hsCRP variance (P < 0.001). In contrast, (Eh) GSH/GSSG showed little association with hsCRP. CONCLUSIONS Among adults free of CHD, oxidative stress, as measured by the FORT, is significantly associated with higher hsCRP levels, independent of BMI and other CRP determinants. This result suggests that oxidative stress may be a determinant of CRP levels and promote pro-atherosclerotic inflammatory processes at the earliest stages of CHD development.
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Affiliation(s)
- Jerome L Abramson
- Department of Medicine, Division of Cardiology, School of Medicine, Emory University, Briarcliff Complex, Atlanta, GA 30322, USA.
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Ramos EJB, Suzuki S, Marks D, Inui A, Asakawa A, Meguid MM. Cancer anorexia-cachexia syndrome: cytokines and neuropeptides. Curr Opin Clin Nutr Metab Care 2004; 7:427-34. [PMID: 15192446 DOI: 10.1097/01.mco.0000134363.53782.cb] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Cancer anorexia-cachexia syndrome is observed in 80% of patients in the advanced stages of cancer and is a strong independent risk factor for mortality. Numerous cytokines produced by tumor and immune cells, interacting with the neuropeptidergic system, mediate the cachectic effect of cancer. Since there is currently no effective pharmacological treatment and the anorexia-cachexia syndrome continues to be defined biochemically, we review the role of cytokines and neuropeptides in this process. RECENT FINDINGS Currently data suggest that cancer anorexia-cachexia syndrome results from a multifactorial process involving many mediators, including hormones (e.g. leptin), neuropeptides (e.g. neuropeptide Y, melanocortin, melanin-concentrating hormone and orexin) and cytokines (e.g. interleukin 1, interleukin 6, tumor necrosis factor alpha and interferon gamma). It is likely that close interrelation among these mediators exists in the hypothalamus, decreasing food intake and leading to cachexia. SUMMARY In the pathogenesis of cancer anorexia, cytokines play a pivotal role influencing the imbalance of orexigenic and anorexigenic circuits that regulate the homeostatic loop of body-weight regulation, leading to cachexia. Interfering pharmacologically with cytokine expression or neural transduction of cytokine signals can be an effective therapeutic strategy in anorectic patients before they develop cancer anorexia-cachexia syndrome.
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Affiliation(s)
- Eduardo J B Ramos
- Surgical Metabolism and Nutrition Laboratory, Neuroscience Program, Department of Surgery, University Hospital, Upstate Medical University, Syracuse, NY 13210, USA
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