1
|
Mahfooz K, Sohail H, Gvajaia A, Arif U, Grewal D, Muppidi MR, Vohra V, Tarique A, Vasavada A. Rasburicase in treating tumor lysis syndrome: An umbrella review. CANCER PATHOGENESIS AND THERAPY 2023; 1:262-271. [PMID: 38327601 PMCID: PMC10846299 DOI: 10.1016/j.cpt.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 02/09/2024]
Abstract
Tumor lysis syndrome (TLS) remains a debilitating cause of hospitalization and death in patients with cancer and is a significant challenge for healthcare providers despite advancements in its management. This umbrella review analyzed the results of meta-analyses on the use of rasburicase in the treatment of patients with cancer. A literature search was performed of five databases (PubMed, Google Scholar, Cochrane Library, Scopus, Global Index Medicus, and ScienceDirect) for articles with full texts available online. A measurement tool to assess systematic reviews 2 (AMSTAR 2) was used to assess the quality of the included studies, and Review Manager software was used to conduct all statistical analyses. The systematic search identified eight relevant meta-analyses, with primary analyses including outcome data that analyzed mortality, renal failure, and comparisons with allopurinol. The pooled data showed that rasburicase effectively reduced TLS development and serum uric acid levels in children and adults with malignancies. Most outcomes did not differ significantly compared with those of allopurinol. Future trials should focus on the cost-effectiveness of rasburicase compared to that of allopurinol while including high-, intermediate-, and low-risk patients. Rasburicase is safe and effective for managing patients with TLS. However, recent large-scale meta-analyses have reported conflicting results. Most meta-analyses were graded as low to critically low as per AMSTAR 2. The analysis revealed that the benefit of rasburicase did not differ significantly from that of allopurinol, which has higher cost-effectiveness and fewer side effects.
Collapse
Affiliation(s)
- Kamran Mahfooz
- Department of Internal Medicine, Lincoln Medical Center, Community Hospital, New York, 10451, USA
| | - Haris Sohail
- Department of Internal Medicine, Lincoln Medical Center, Community Hospital, New York, 10451, USA
| | - Ani Gvajaia
- Department of Internal Medicine, Lincoln Medical Center, Community Hospital, New York, 10451, USA
| | - Uroosa Arif
- Department of Internal Medicine, Lincoln Medical Center, Community Hospital, New York, 10451, USA
| | - Daisy Grewal
- Department of Internal Medicine, St. Georges University, St. Georges, Grenada
| | - Monica Reddy Muppidi
- Department of Internal Medicine, Lincoln Medical Center, Community Hospital, New York, 10451, USA
| | - Vanya Vohra
- Department of Pediatrics, St Barnabas Hospital, Bronx, NY, 10457, USA
| | - Aamir Tarique
- Department of Medicine, ESIC Medical College, Faridabad, 121001, India
| | - Advait Vasavada
- Department of Medicine, MP Shah Medical College, Jamnagar, 361008, India
| |
Collapse
|
2
|
Gencer G, Mancuso C, Chua KJ, Ling H, Costello CM, Chang MW, March JC. Engineering Escherichia coli for diagnosis and management of hyperuricemia. Front Bioeng Biotechnol 2023; 11:1191162. [PMID: 37288353 PMCID: PMC10242094 DOI: 10.3389/fbioe.2023.1191162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
Uric acid disequilibrium is implicated in chronic hyperuricemia-related diseases. Long-term monitoring and lowering of serum uric acid levels may be crucial for diagnosis and effective management of these conditions. However, current strategies are not sufficient for accurate diagnosis and successful long-term management of hyperuricemia. Moreover, drug-based therapeutics can cause side effects in patients. The intestinal tract plays an important role in maintaining healthy serum acid levels. Hence, we investigated the engineered human commensal Escherichia coli as a novel method for diagnosis and long-term management of hyperuricemia. To monitor changes in uric acid concentration in the intestinal lumen, we developed a bioreporter using the uric acid responsive synthetic promoter, pucpro, and uric acid binding Bacillus subtilis PucR protein. Results demonstrated that the bioreporter module in commensal E. coli can detect changes in uric acid concentration in a dose-dependent manner. To eliminate the excess uric acid, we designed a uric acid degradation module, which overexpresses an E. coli uric acid transporter and a B. subtilis urate oxidase. Strains engineered with this module degraded all the uric acid (250 µM) found in the environment within 24 h, which is significantly lower (p < 0.001) compared to wild type E. coli. Finally, we designed an in vitro model using human intestinal cell line, Caco-2, which provided a versatile tool to study the uric acid transport and degradation in an environment mimicking the human intestinal tract. Results showed that engineered commensal E. coli reduced (p < 0.01) the apical uric acid concentration by 40.35% compared to wild type E. coli. This study shows that reprogramming E. coli holds promise as a valid alternative synthetic biology therapy to monitor and maintain healthy serum uric acid levels.
Collapse
Affiliation(s)
- Gozde Gencer
- Biological and Environmental Engineering Department, Cornell University, Ithaca, NY, United States
| | - Christopher Mancuso
- Biomedical Engineering Department, Boston University, Boston, MA, United States
| | - Koon Jiew Chua
- Synthetic Biology Translational Research Program and Department of Biochemistry, Yong Loo Lin School of Medicine and NUS Synthetic Biology for Clinical and Technological Innovation (SynCTI), National University of Singapore, Singapore, Singapore
| | - Hua Ling
- Synthetic Biology Translational Research Program and Department of Biochemistry, Yong Loo Lin School of Medicine and NUS Synthetic Biology for Clinical and Technological Innovation (SynCTI), National University of Singapore, Singapore, Singapore
| | - Cait M. Costello
- Biological and Environmental Engineering Department, Cornell University, Ithaca, NY, United States
| | - Matthew Wook Chang
- Synthetic Biology Translational Research Program and Department of Biochemistry, Yong Loo Lin School of Medicine and NUS Synthetic Biology for Clinical and Technological Innovation (SynCTI), National University of Singapore, Singapore, Singapore
| | - John C. March
- Biological and Environmental Engineering Department, Cornell University, Ithaca, NY, United States
| |
Collapse
|
3
|
Majumdar S, Sharma N, Sengar M, Thorat J, Nayak L, Bonda A, Bagal B, Rajendra A, Sethi A, Jain H. A phase II study to evaluate the efficacy of low-dose rasburicase (1.5mg) in adolescent and adult acute leukemia and high-grade lymphomas with tumor lysis syndrome. Leuk Lymphoma 2023; 64:628-638. [PMID: 36891578 DOI: 10.1080/10428194.2023.2167491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
The FDA recommended dose of rasburicase 0.2 mg/kg/day till the resolution of TLS or up to 5 days, might be in excess and is prohibitively expensive. The quality of evidence supporting low dose rasburicase is limited. The objective is to study the plasma uric acid response rate. This is a single center, non-randomised phase II study. Duration is 10 June 2017 till 30 July 2019. Study setting is at Adult Hematolymphoid Unit, Tata Memorial Center. Participants are patients with acute leukemia and high-grade lymphomas aged >/=18 years, with ECOG PS of 0-3, with either laboratory or clinical TLS. Rasburicase was administered at fixed-dose of 1.5 mg. The subsequent doses (1.5 mg each dose) were administered only if plasma UA levels did not decline by >50% on day 2, at the physician's discretion. We demonstrate that a low-dose rasburicase strategy leads to rapid and sustained reductions of uric acid in about 52% patients.
Collapse
Affiliation(s)
- Swaratika Majumdar
- Medical Oncology, MS Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Neha Sharma
- Medical Oncology, Tata Memorial Centre, Homi Bhabha National University, Mumbai, India
| | - Manju Sengar
- Medical Oncology, MS Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Jayashree Thorat
- Medical Oncology, MS Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Lingaraj Nayak
- Medical Oncology, MS Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Avinash Bonda
- Medical Oncology, Homi Bhabha Cancer Hospital & Research Centre, Tata Memorial Centre, Mumbai, India
| | - Bhausaheb Bagal
- Medical Oncology, MS Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Akhil Rajendra
- Department of Medical Oncology, Cancer Institute WIA, Adyar, Chennai, India
| | - Amit Sethi
- Department of Electrical Engineering, Indian Institute of Bombay, Powai, India
| | - Hasmukh Jain
- Medical Oncology, MS Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, Bangalore, India
| |
Collapse
|
4
|
Najjari A, Shahbazmohammadi H, Nojoumi SA, Omidinia E. PASylated Urate Oxidase Enzyme: Enhancing Biocatalytic Activity, Physicochemical Properties, and Plasma Half-Life. ACS OMEGA 2022; 7:46118-46130. [PMID: 36570261 PMCID: PMC9773812 DOI: 10.1021/acsomega.2c04071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/18/2022] [Indexed: 05/02/2023]
Abstract
Recombinant urate oxidase (UOX, E.C.1.7.3.3) is an important therapeutic enzyme used in preventing and treating chemotherapy-induced hyperuricemia and severe gout. However, UOX use is limited due to the poor stability and short plasma half-life. To solve this problem, we designed three PASylated variants of Aspergillus flavus UOX with different PAS sequences at the C- or N-terminus. The genes of native and PASylated variants (UOX-PAS20, PAS24-UOX, and UOX-PAS100) were designed and produced in Escherichia coli strain BL21 (DE3). The expressed recombinant native and PASylated enzymes were compared in terms of biophysical properties, kinetics parameters, and pharmacokinetics behavior using standard methods. PASylation of UOX with PAS100 polymer caused a 1.24-fold reduction in K m to 52.61 μM, and a 3.87-fold increase in K cat/K m for uric acid compared to the native variant. UOX-PAS100 retained its activity in different temperatures (20-55 °C); however, other variants lost nearly 50% of their original activity at 55 °C. UOX-PAS100 exhibited a 1.78-fold increase in hydrodynamic radius and a 1.64-fold larger apparent molecular size in comparison to the native UOX. Circular dichroism (CD) spectroscopy demonstrated that the addition of the PAS tag does not change the secondary structure of the fusion enzyme. The tryptophan fluorescence emission spectra for PASylated enzymes showed a significant modification in the conformational state of UOX by the PAS polymer presence. UOX-PAS100 retained 89.0% of the original activity following 72 h incubation in the presence of plasma at 37 °C. However, only about 61.0%, 57.0%, 50.0%, and 52.0% of activity from PAS24-UOX, UOX-PAS20, native UOX, and rasburicase (Fasturtec, Italy) remained, respectively, at the identical time. UOX-PAS100 had an increased biological half-life (8.21 h) when compared with the rasburicase (3.12 h) and native UOX (2.87 h) after being injected into a rat. Having considering everything, our results suggest that the UOX-PAS100, an A. flavus UOX fused with a C-terminally 100 amino acid PAS-residue, is a proper candidate with enhanced biological activity and extended plasma half-life for clinical therapy in patients suffering from hyperuricemia.
Collapse
Affiliation(s)
- Abbas Najjari
- Enzyme
Technology Laboratory, Department of Biochemistry, Genetic and Metabolism
Research Group, Pasteur Institute of Iran, Tehran 1316943551, Iran
| | - Hamid Shahbazmohammadi
- Cellular
and Molecular Research Center, Research Institute for Prevention of
Non-Communicable Diseases, Qazvin University
of Medical Sciences, Qazvin 15315-34199, Iran
- Emails
for H.S.: ;
| | - Seyed Ali Nojoumi
- Microbiology
Research Center, Pasteur Institute of Iran, Tehran 1316943551, Iran
| | - Eskandar Omidinia
- Enzyme
Technology Laboratory, Department of Biochemistry, Genetic and Metabolism
Research Group, Pasteur Institute of Iran, Tehran 1316943551, Iran
| |
Collapse
|
5
|
Frost K. Onco-Nephrology in the Critical Care Setting. Crit Care Nurs Clin North Am 2022; 34:453-466. [DOI: 10.1016/j.cnc.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
6
|
De Becker B, Hupkens E, Dewachter L, Coremans C, Delporte C, van Antwerpen P, Franck T, Zouaoui Boudjeltia K, Cullus P, van de Borne P. Acute effects of hypouricemia on endothelium, oxidative stress, and arterial stiffness: A randomized, double-blind, crossover study. Physiol Rep 2021; 9:e15018. [PMID: 34435469 PMCID: PMC8387791 DOI: 10.14814/phy2.15018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 01/07/2023] Open
Abstract
We hypothesized acute moderate and drastic reductions in uric acid concentration exert different effects on arterial function in healthy normotensive and hypertensive adults. Thirty-six adults (aged 58 [55;63] years) with or without primary hypertension participated in a three-way, randomized, double-blind, crossover study in which [placebo] and [febuxostat] and [febuxostat and rasburicase] were administered. Febuxostat and rasburicase reduce the uric acid concentration by xanthine oxidoreductase inhibition and uric acid degradation into allantoin, respectively. Endothelial function was assessed in response to acetylcholine, sodium nitroprusside, heating (with and without nitric oxide synthase inhibition) using a laser Doppler imager. Arterial stiffness was determined by applanation tonometry, together with blood pressure, renin-angiotensin system activity, oxidative stress, and inflammation. Uric acid concentration was 5.1 [4.1;5.9], 1.9 [1.2;2.2] and 0.2 [0.2;0.3] mg/dL with [placebo], [febuxostat] and [febuxostat-rasburicase] treatments, respectively (p < 0.0001). Febuxostat improved endothelial response to heat particularly when nitric oxide synthase was inhibited (p < 0.05) and reduced diastolic and mean arterial pressure (p = 0.008 and 0.02, respectively). The augmentation index decreased with febuxostat (ANOVA p < 0.04). Myeloperoxidase activity profoundly decreased with febuxostat combined with rasburicase (p < 0.0001). When uric acid dropped, plasmatic antioxidant capacity markedly decreased, while superoxide dismutase activity increased (p < 0.0001). Other inflammatory and oxidant markers did not differ. Acute moderate hypouricemia encompasses minor improvements in endothelial function, blood pressure, and arterial stiffness. Clinical Trial Registration: NCT03395977, https://clinicaltrials.gov/ct2/show/NCT03395977.
Collapse
Affiliation(s)
- Benjamin De Becker
- Department of CardiologyErasme HospitalUniversité Libre de BruxellesBrusselsBelgium
| | - Emeline Hupkens
- Laboratory of Physiology and PharmacologyFaculty of MedicineUniversité Libre de BruxellesBrusselsBelgium
| | - Laurence Dewachter
- Laboratory of Physiology and PharmacologyFaculty of MedicineUniversité Libre de BruxellesBrusselsBelgium
| | - Catherine Coremans
- RD3 – Pharmacognosy, Bioanalysis and Drug Discovery & Analytical Platform of the Faculty of Pharmacy (APFP)Faculty of PharmacyUniversité Libre de BruxellesBrusselsBelgium
| | - Cédric Delporte
- RD3 – Pharmacognosy, Bioanalysis and Drug Discovery & Analytical Platform of the Faculty of Pharmacy (APFP)Faculty of PharmacyUniversité Libre de BruxellesBrusselsBelgium
| | - Pierre van Antwerpen
- RD3 – Pharmacognosy, Bioanalysis and Drug Discovery & Analytical Platform of the Faculty of Pharmacy (APFP)Faculty of PharmacyUniversité Libre de BruxellesBrusselsBelgium
| | - Thierry Franck
- Centre of Oxygen, Research and DevelopmentInstitute of Chemistry B 6aUniversity of Liege ‐ Sart TilmanLiègeBelgium
| | - Karim Zouaoui Boudjeltia
- Laboratory of Experimental Medicine (ULB 222)Medicine FacultyUniversité Libre de BruxellesCHU de Charleroi, Hopital VesaleMontigny‐le‐TilleulBelgium
| | - Pierre Cullus
- Biostatistics department, Medicine FacultyUniversité Libre de BruxellesBrusselsBelgium
| | | |
Collapse
|
7
|
Yaman S, Başcı S, Turan G, Ulu BU, Yiğenoğlu TN, Dal MS, Kızıl Çakar M, Altuntaş F. Single-Dose Rasburicase Might Be Adequate To Overcome Tumor Lysis Syndrome In Hematological Malignancies. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 22:e71-e76. [PMID: 34565690 DOI: 10.1016/j.clml.2021.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/16/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Tumor lysis syndrome (TLS) is a commonly observed oncological emergency that requires prompt diagnosis and treatment. Rasburicase is a recombinant urate oxidase endorsed in TLS for the treatment of hyperuricemia. The effect of single-dose 7.5 mg rasburicase at longer follow-ups was not widely investigated. PATIENTS AND METHODS Eighty-two patients included in the study with clinical TLS and laboratory TLS. The primary endpoint was the normalization of uric acid (<6mg/dL) within 24 hours of rasburicase administration, which was described as treatment success. The secondary endpoint was defined as having sustained response at the first week. The third endpoint was defined as the reaching the baseline renal function before TLS. RESULTS We found that the use of a 7.5 mg dose of rasburicase controlled uric acid in 74 of 82 (90,2%) patients at the 24th hour. In the first week, uric acid remained at normal levels in 69 of 82 (84,1%) patients. At 24 hours, the TLS risk group was the only predictor for failing uric acid normalization; at the end of the first week, no predictive factor was identified for failing uric acid normalization. CONCLUSION Rasburicase at 7.5 mg dose is an important agent for controlling laboratory and clinical TLS at 24 hours and extending its effect to the first week.
Collapse
Affiliation(s)
- Samet Yaman
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
| | - Semih Başcı
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Gökhan Turan
- Department of Internal Medicine, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Bahar Uncu Ulu
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Tuğçe Nur Yiğenoğlu
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Sinan Dal
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Merih Kızıl Çakar
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Fevzi Altuntaş
- Department of Hematology and Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| |
Collapse
|
8
|
Clark AJ, Matevish L, Hernanz-Schulman M, Mason EF, Hunley TE. Malaise, Weight Loss, and Acute Kidney Injury in a 13-year-old Girl. Pediatr Rev 2021; 42:e28-e32. [PMID: 34210763 DOI: 10.1542/pir.2018-0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Amanda J Clark
- Division of Pediatric Nephrology, Boston Children's Hospital, Boston, MA
| | | | - Marta Hernanz-Schulman
- Division of Diagnostic Imaging, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - Emily F Mason
- Division of Hematopathology, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Tracy E Hunley
- Division of Pediatric Nephrology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| |
Collapse
|
9
|
Marchetti M, Faggiano S, Mozzarelli A. Enzyme Replacement Therapy for Genetic Disorders Associated with Enzyme Deficiency. Curr Med Chem 2021; 29:489-525. [PMID: 34042028 DOI: 10.2174/0929867328666210526144654] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/23/2021] [Accepted: 03/17/2021] [Indexed: 11/22/2022]
Abstract
Mutations in human genes might lead to loss of functional proteins, causing diseases. Among these genetic disorders, a large class is associated with the deficiency in metabolic enzymes, resulting in both an increase in the concentration of substrates and a loss in the metabolites produced by the catalyzed reactions. The identification of therapeutic actions based on small molecules represents a challenge to medicinal chemists because the target is missing. Alternative approaches are biology-based, ranging from gene and stem cell therapy, CRISPR/Cas9 technology, distinct types of RNAs, and enzyme replacement therapy (ERT). This review will focus on the latter approach that since the 1990s has been successfully applied to cure many rare diseases, most of them being lysosomal storage diseases or metabolic diseases. So far, a dozen enzymes have been approved by FDA/EMA for lysosome storage disorders and only a few for metabolic diseases. Enzymes for replacement therapy are mainly produced in mammalian cells and some in plant cells and yeasts and are further processed to obtain active, highly bioavailable, less degradable products. Issues still under investigation for the increase in ERT efficacy are the optimization of enzymes interaction with cell membrane and internalization, the reduction in immunogenicity, and the overcoming of blood-brain barrier limitations when neuronal cells need to be targeted. Overall, ERT has demonstrated its efficacy and safety in the treatment of many genetic rare diseases, both saving newborn lives and improving patients' life quality, and represents a very successful example of targeted biologics.
Collapse
Affiliation(s)
- Marialaura Marchetti
- Biopharmanet-TEC Interdepartmental Center, University of Parma, Parco Area delle Scienze, Bldg 33., 43124, Parma, Italy
| | - Serena Faggiano
- Department of Food and Drug, University of Parma, Parco Area delle Scienze 23/A, 43124, Parma, Italy
| | - Andrea Mozzarelli
- Institute of Biophysics, National Research Council, Via Moruzzi 1, 56124, Pisa, Italy
| |
Collapse
|
10
|
Ahmed M, Sanchez T, Norgbe S, Picking CR, Millner PG. Rasburicase-Induced Methemoglobinemia. Cureus 2021; 13:e14406. [PMID: 33987056 PMCID: PMC8110197 DOI: 10.7759/cureus.14406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Methemoglobinemia occurs as iron in heme is oxidized to its ferric state, resulting in a decreased ability of hemoglobin to bind and release oxygen. Rasburicase is a recombinant urate-oxidase enzyme used in the prevention of tumor lysis syndrome. Methemoglobinemia can occur as a rare complication of treatment with rasburicase, primarily in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Methylene blue, an agent used for treating methemoglobinemia, should be avoided in patients with G6PD deficiency. In patients with G6PD deficiency, methylene blue is inadequately reduced to its active form, which then causes the methylene blue to further the oxidize the hemoglobin to methemoglobin that can result in hemolysis.
Collapse
Affiliation(s)
- Moeed Ahmed
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Thomas Sanchez
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Selinam Norgbe
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | | | - Paul G Millner
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| |
Collapse
|
11
|
Najjari A, Shahbazmohammadi H, Omidinia E, Movafagh AM. The Effective Control of Hyperuricemia in Cancer Patients: A New Recombinant Conjugated Variant of Urate Oxidase. Asian Pac J Cancer Prev 2021; 22:627-632. [PMID: 33639683 PMCID: PMC8190373 DOI: 10.31557/apjcp.2021.22.2.627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 11/25/2022] Open
Abstract
Objective: Management of hyperuricemia is crucial to controlling tumor lysis syndrome (TLS) during cancer therapy. Urate oxidase (UOX) that catalyzes the enzymatic oxidation of uric acid into allantoin, is effective in lowering plasma uric acid levels and controlling hyperuricemia. Recently, we developed a new recombinant conjugate variant of UOX therapeutic drug using PASylation technology. This study was designed to evaluate the stability, plasma half-life and immunogencity of PASylated UOX. Methods: A recombinant variant of PASylated UOX from the Aspergillus flavus was manufactured using bioinformatics and experimental techniques. Ex vivo evaluation of stability of PASylated UOX was done in 50% human serum. For half-life test, recombinant PASylated UOX and rasburicase were administered at 1.5 mg/kg to 10 rats in two different groups and samples were collected after injection Production of antibodies against PASylated drug was also assayed. Results: Residual activity of PASylated UOX in 50% human serum was higher than rasburicase and native UOX. Stability of PASylated UOX at 25°C and 37°C was also higher than rasburicase and native UOX. The PASylated half-life was ~32.1 hours, whereas half-life for rasburicase and native UOX was ~25.1 and ~22.8 hours, respectively. In immunogenicity examination, there is 33% and 36% decrease in the absorbance of native UOX and rasburicase, respectively when compared with that of PASylated UOX. Conclusion: Our data confirmed the efficacy and stability of PASylated UOX in comparison to the rasburicase. In summary, the results indicated that PASylated UOX drug is effective at lowering plasma uric acid levels with prolonged plasma half-life and decreased cost.
Collapse
Affiliation(s)
- Abbas Najjari
- Enzyme Technology Laboratory, Department of Biochemistry, Genetic and Metabolism Research Group,Pasteur Institute of Iran, Tehran, Iran
| | - Hamid Shahbazmohammadi
- Enzyme Technology Laboratory, Department of Biochemistry, Genetic and Metabolism Research Group,Pasteur Institute of Iran, Tehran, Iran
| | - Eskandar Omidinia
- Enzyme Technology Laboratory, Department of Biochemistry, Genetic and Metabolism Research Group,Pasteur Institute of Iran, Tehran, Iran
| | - Abolfazl M Movafagh
- Department Medical Genetic, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
12
|
Najjari A, Rahimi H, Nojoumi SA, Omidinia E. Computational Approach for Rational Design of Fusion Uricase with PAS Sequences. INTERNATIONAL JOURNAL OF MOLECULAR AND CELLULAR MEDICINE 2020; 9:90-103. [PMID: 32832488 PMCID: PMC7422847 DOI: 10.22088/ijmcm.bums.9.1.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Tumor lysis syndrome is a life-threatening condition for humans due to the lack of urate oxidase. In this study, several variants of PASylated uricase from the Aspergillus flavus species were analyzed computationally to find the appropriate fusions to solve short half-life and stability concern. The Ab initio method was performed using Rosetta software to structurally characterize the PAS sequences. The 3D structures of fusions were predicted for fused C- or N-terminally PAS sequences in different length to the uricase. The refinement and energy minimization steps revealed that physicochemical and conformational properties of fusions improved while the structures possessed prolonged PAS sequences. Molecular docking results showed that the highest binding affinity to uric acid belonged to uricase-PAS1-100 by the formation of six hydrogen and four non-hydrogen bonds. Altogether, the results indicated that the PASylation process would be promising upon the production of urate oxidase with improved solubility and stability.
Collapse
Affiliation(s)
- Abbas Najjari
- Enzyme Technology Laboratory, Department of Biochemistry,Genetic and Metabolism Research Group, Pasteur Institute of Iran,Tehran, Iran
| | - Hamzeh Rahimi
- Molecular Medicine Department, Pasteur Institute of Iran, Tehran, Iran
| | - Seyed Ali Nojoumi
- Microbiology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Eskandar Omidinia
- Enzyme Technology Laboratory, Department of Biochemistry,Genetic and Metabolism Research Group, Pasteur Institute of Iran,Tehran, Iran
| |
Collapse
|
13
|
Puri I, Sharma D, Gunturu KS, Ahmed AA. Diagnosis and management of tumor lysis syndrome. J Community Hosp Intern Med Perspect 2020; 10:269-272. [PMID: 32850076 PMCID: PMC7426989 DOI: 10.1080/20009666.2020.1761185] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Tumor lysis syndrome (TLS) is an oncological emergency characterized by a classic tetrad of hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Risk assessment and prophylactic therapy is critical in preventing this oncological emergency. Treatment of established TLS involves aggressive hydration, electrolyte management, and the use of hypouricemic agents.
Collapse
Affiliation(s)
- Isha Puri
- Department of Hospital Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Deep Sharma
- Department of Medicine (Nephrology), Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Krishna S Gunturu
- Department of Hematology and Oncology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Andaleeb A Ahmed
- Department of Anesthesiology and Perioperative Medicine, Tufts School of Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| |
Collapse
|
14
|
Structure-Based Immunogenicity Prediction of Uricase from Fungal (Aspergillus flavus), Bacterial (Bacillus subtillis) and Mammalian Sources Using Immunoinformatic Approach. Protein J 2020; 39:133-144. [DOI: 10.1007/s10930-020-09886-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
15
|
Synchronous Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma and Metastatic Squamous Cell Carcinoma of the Cervix Involving the Coronary Arteries Leading to Acute Myocardial Infarction. Case Rep Oncol Med 2020; 2020:6192754. [PMID: 32158573 PMCID: PMC7060405 DOI: 10.1155/2020/6192754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/11/2020] [Indexed: 12/04/2022] Open
Abstract
A 66-year-old woman presented to the hospital with a one-month history of shortness of breath, fatigue, and postmenopausal vaginal bleeding and a one-week history of chest pain. This case report discusses the rare synchronous occurrence of two different malignancies in the setting of non-ST segment elevation myocardial infarction and the relation between these unfortunate events. Besides the case presented in this report, there have been only 13 reported cases of synchronous chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) associated with metastatic squamous cell carcinoma. While it is well known that malignancy causes a hypercoagulable state, there are other mechanisms which may have contributed to the patient's myocardial ischemia including external vascular compression, tumor lysis syndrome, and anemia. This case report discusses the rarity of synchronous malignancies but the importance of understanding and consideration of cardiac events in this population.
Collapse
|
16
|
Rohilla S, Dureja H, Chawla V. Cytoprotective Agents to Avoid Chemotherapy Induced Sideeffects on Normal Cells: A Review. Curr Cancer Drug Targets 2019; 19:765-781. [DOI: 10.2174/1568009619666190326120457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 03/01/2019] [Accepted: 03/10/2019] [Indexed: 01/16/2023]
Abstract
Anticancer agents play a vital role in the cure of patients suffering from malignancy. Though, the chemotherapeutic agents are associated with various adverse effects which produce significant toxic symptoms in the patients. But this therapy affects both the malignant and normal cells and leads to constricted therapeutic index of antimalignant drugs which adversely impacts the quality of patients’ life. Due to these adversities, sufficient dose of drug is not delivered to patients leading to delay in treatment or improper treatment. Chemoprotective agents have been developed either to minimize or to mitigate the toxicity allied with chemotherapeutic agents. Without any concession in the therapeutic efficacy of anticancer drugs, they provide organ specific guard to normal tissues.
Collapse
Affiliation(s)
- Seema Rohilla
- Department of Pharmaceutics, Hindu College of Pharmacy, Sonepat- 131001, India
| | - Harish Dureja
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak-124001, India
| | - Vinay Chawla
- Institute of Pharmaceutical Sciences, Baba Farid University of Health Sciences, Faridkot-151203, India
| |
Collapse
|
17
|
Yainoy S, Phuadraksa T, Wichit S, Sompoppokakul M, Songtawee N, Prachayasittikul V, Isarankura-Na-Ayudhya C. Production and Characterization of Recombinant Wild Type Uricase from Indonesian Coelacanth ( L. menadoensis) and Improvement of Its Thermostability by In Silico Rational Design and Disulphide Bridges Engineering. Int J Mol Sci 2019; 20:ijms20061269. [PMID: 30871218 PMCID: PMC6471336 DOI: 10.3390/ijms20061269] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/09/2019] [Accepted: 03/10/2019] [Indexed: 12/12/2022] Open
Abstract
The ideal therapeutic uricase (UOX) is expected to have the following properties; high expression level, high activity, high thermostability, high solubility and low immunogenicity. The latter property is believed to depend largely on sequence identity to the deduced human UOX (dH-UOX). Herein, we explored L. menadoensis uricase (LM-UOX) and found that it has 65% sequence identity to dH-UOX, 68% to the therapeutic chimeric porcine-baboon UOX (PBC) and 70% to the resurrected ancient mammal UOX. To study its biochemical properties, recombinant LM-UOX was produced in E. coli and purified to more than 95% homogeneity. The enzyme had specific activity up to 10.45 unit/mg, which was about 2-fold higher than that of the PBC. One-litre culture yielded purified protein up to 132 mg. Based on homology modelling, we successfully engineered I27C/N289C mutant, which was proven to contain inter-subunit disulphide bridges. The mutant had similar specific activity and production yield to that of wild type (WT) but its thermostability was dramatically improved. Up on storage at −20 °C and 4 °C, the mutant retained ~100% activity for at least 60 days. By keeping at 37 °C, the mutant retained ~100% activity for 15 days, which was 120-fold longer than that of the wild type. Thus, the I27C/N289C mutant has potential to be developed for treatment of hyperuricemia.
Collapse
Affiliation(s)
- Sakda Yainoy
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand.
| | - Thanawat Phuadraksa
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand.
| | - Sineewanlaya Wichit
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand.
| | - Maprang Sompoppokakul
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand.
| | - Napat Songtawee
- Department of Clinical Chemistry, Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand.
| | - Virapong Prachayasittikul
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand.
| | | |
Collapse
|
18
|
Baumann A, Skaljac M, Lehmann R, Vilcinskas A, Franta Z. Urate Oxidase produced by Lucilia sericata medical maggots is localized in Malpighian tubes and facilitates allantoin production. INSECT BIOCHEMISTRY AND MOLECULAR BIOLOGY 2017; 83:44-53. [PMID: 28235562 DOI: 10.1016/j.ibmb.2017.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 06/06/2023]
Abstract
Lucilia sericata maggots are the only species currently approved for maggot debridement therapy (MDT), an alternative treatment for chronic and recalcitrant wounds. Maggots promote wound debridement, disinfection and healing by producing a complex mixture of proteins, peptides and low-molecular-weight compounds in their secretions and excretions, but the individual components are not well characterized at the molecular level. Here we investigated the purine catabolism pathway in L. sericata, focusing on the production of allantoin by Urate Oxidase (UO), which is thought to promote wound healing. We produced recombinant L. sericata UO in Escherichia coli, and characterized the properties of the pure enzyme in terms of the optimum pH (7-10) and temperature (20-25 °C), its stability, sensitivity to inhibition and ion dependency. We used quantitative RT-PCR and RNA in situ hybridization to monitor the expression of the UO gene, and we used a guinea pig anti-UO antibody to detect the native enzyme by western blot and by florescence immunohistochemistry in larval tissues. We found that L. sericata UO is exclusively present in the larval excretion organ (the Malpighian tubes) and is freely available in the cytoplasm rather than restricted to a specific subcellular compartment. Allantoin is a final product of L. sericata purine catabolism. It is produced by UO in the Malpighian tubes to remove uric acid from the hemolymph and is consequently excreted via the hindgut. Our findings confirm the hypothesis that both actively secreted molecules and excretion products contribute to the beneficial effects of MDT.
Collapse
Affiliation(s)
- Andre Baumann
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Winchesterstraße 2, 35394 Giessen, Germany
| | - Marisa Skaljac
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Winchesterstraße 2, 35394 Giessen, Germany
| | - Rüdiger Lehmann
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Winchesterstraße 2, 35394 Giessen, Germany
| | - Andreas Vilcinskas
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Winchesterstraße 2, 35394 Giessen, Germany; Justus-Liebig-University of Giessen, Institute for Insect Biotechnology, Heinrich-Buff-Ring 26-32, 35392 Giessen, Germany
| | - Zdenӗk Franta
- Department of Bioresources, Fraunhofer Institute for Molecular Biology and Applied Ecology, Winchesterstraße 2, 35394 Giessen, Germany.
| |
Collapse
|
19
|
Ibrahim U, Saqib A, Mohammad F, Atallah JP, Odaimi M. Rasburicase-induced methemoglobinemia: The eyes do not see what the mind does not know. J Oncol Pharm Pract 2017; 24:309-313. [PMID: 28345492 DOI: 10.1177/1078155217701295] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rasburicase is indicated for the prevention and treatment of tumor lysis syndrome which can be a potentially life-threatening emergency. The drug has oxidizing potential and as an adverse effect, it can convert the ferrous form of iron in erythrocytes to its ferric form resulting in the formation of methemoglobin which makes the heme component incapable of carrying oxygen. Patients with glucose-6-phosphate dehydrogenase enzyme deficiency are at high risk of methemoglobinemia from oxidizing agents. Symptoms of methemoglobinemia range from none to life-threatening hypoxemia, cyanosis and respiratory compromise. Treatment is indicated at levels above 20% and at lower levels if the patient is significantly anemic. We present a case of a 60-year-old male with diffuse large B cell lymphoma at high risk of tumor lysis syndrome. Rasburicase was administered to prevent renal failure and further rise in uric acid. Twenty-four hours later, a bedside pulse oximetry showed an oxygen saturation ranging from 60 to 65% with minimal cyanosis. Co-oximetry revealed a methemoglobin level of 9.8%. Methylene blue was administered and the methemoglobin level decreased to 2.6%. However, the patient developed hemolysis several hours later, likely secondary to rasburicase and methylene blue, requiring transfusion support. We discuss this potentially fatal and initially asymptomatic adverse effect of rasburicase along with diagnostic and treatment considerations, and review the cases described in the current literature.
Collapse
Affiliation(s)
- Uroosa Ibrahim
- 1 Department of Hematology/Oncology, Staten Island University Hospital, Staten Island, NY, USA
| | - Amina Saqib
- 2 Department of Pulmonary/Critical Care, Staten Island University Hospital, Staten Island, NY, USA
| | - Farhan Mohammad
- 2 Department of Pulmonary/Critical Care, Staten Island University Hospital, Staten Island, NY, USA
| | - Jean Paul Atallah
- 2 Department of Pulmonary/Critical Care, Staten Island University Hospital, Staten Island, NY, USA
| | - Marcel Odaimi
- 2 Department of Pulmonary/Critical Care, Staten Island University Hospital, Staten Island, NY, USA
| |
Collapse
|
20
|
Alakel N, Middeke JM, Schetelig J, Bornhäuser M. Prevention and treatment of tumor lysis syndrome, and the efficacy and role of rasburicase. Onco Targets Ther 2017; 10:597-605. [PMID: 28203093 PMCID: PMC5295804 DOI: 10.2147/ott.s103864] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Tumor lysis syndrome (TLS) is a potentially life-threatening condition that occurs in oncologic and hematologic patients with large tumor burden, either due to cytotoxic therapy or, less commonly, spontaneously because of massive tumor cell lysis. TLS is clinically characterized by acute renal failure, hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. While limited options are available for treating TLS, identifying patients at high risk for developing TLS and prevention in high-risk patients remain an important aspect in the treatment of cancer patients. In general, treatment of TLS consists of intensive hydration, stimulation of diuresis, and, more specifically, in the use of allopurinol and rasburicase. Rasburicase, a recombinant urate oxidase, rapidly and effectively reduces hyperuricemia, which subsequently significantly decreases the risk of acute renal failure and other clinical manifestations of TLS. For this review, a comprehensive literature search using the term “tumor lysis syndrome” and/or “rasburicase” was performed considering articles listed in MEDLINE. Incidence, prevention, and therapy of TLS with a special focus on the role of rasburicase are discussed. We evaluated 120 relevant articles including 35 case reports, 32 clinical trials, and 14 meta-analyses.
Collapse
Affiliation(s)
- Nael Alakel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Dresden
| | - Jan Moritz Middeke
- Department of Internal Medicine I, University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Dresden
| | - Johannes Schetelig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Dresden; German Bone Marrow Donor Center DKMS, Tübigen, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus at the Technische Universitaet Dresden, Dresden
| |
Collapse
|
21
|
A Therapeutic Uricase with Reduced Immunogenicity Risk and Improved Development Properties. PLoS One 2016; 11:e0167935. [PMID: 28002433 PMCID: PMC5176304 DOI: 10.1371/journal.pone.0167935] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/22/2016] [Indexed: 02/04/2023] Open
Abstract
Humans and higher primates are unique in that they lack uricase, the enzyme capable of oxidizing uric acid. As a consequence of this enzyme deficiency, humans have high serum uric acid levels. In some people, uric acid levels rise above the solubility limit resulting in crystallization in joints, acute inflammation in response to those crystals causes severe pain; a condition known as gout. Treatment for severe gout includes injection of non-human uricase to reduce serum uric acid levels. Krystexxa® is a hyper-PEGylated pig-baboon chimeric uricase indicated for chronic refractory gout that induces an immunogenic response in 91% of treated patients, including infusion reactions (26%) and anaphylaxis (6.5%). These properties limit its use and effectiveness. An innovative approach has been used to develop a therapeutic uricase with improved properties such as: soluble expression, neutral pH solubility, high E. coli expression level, thermal stability, and excellent activity. More than 200 diverse uricase sequences were aligned to guide protein engineering and reduce putative sequence liabilities. A single uricase lead candidate was identified, which showed low potential for immunogenicity in >200 human donor samples selected to represent diverse HLA haplotypes. Cysteines were engineered into the lead sequence for site specific PEGylation and studies demonstrated >95% PEGylation efficiency. PEGylated uricase retains enzymatic activity in vitro at neutral pH, in human serum and in vivo (rats and canines) and has an extended half-life. In canines, an 85% reduction in serum uric acid levels was observed with a single subcutaneous injection. This PEGylated, non-immunogenic uricase has the potential to provide meaningful benefits to patients with gout.
Collapse
|
22
|
Sampling on ice will not yield reliable uric acid monitoring in rasburicase-treated patients. Clin Biochem 2016; 49:1390-1395. [DOI: 10.1016/j.clinbiochem.2016.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/22/2016] [Accepted: 04/24/2016] [Indexed: 11/18/2022]
|
23
|
Melendez-Rosado JM, Zetir M, Stancampiano FF. 50-Year-Old Man With New-Onset Acute Kidney Injury. Mayo Clin Proc 2015; 90:1420-3. [PMID: 26434967 DOI: 10.1016/j.mayocp.2015.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/27/2015] [Accepted: 04/02/2015] [Indexed: 11/22/2022]
Affiliation(s)
- Jose M Melendez-Rosado
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Jacksonville, FL
| | - Mohamad Zetir
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Jacksonville, FL
| | - Fernando F Stancampiano
- Advisor to residents and Consultant in Community Internal Medicine, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
24
|
Platteborze PL, Wilhelms KW. Request for Uric Acid Analysis on an Iced Specimen. Clin Chem 2015; 61:1212-3. [PMID: 26319454 DOI: 10.1373/clinchem.2015.238808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Peter L Platteborze
- Core/Reference Laboratory, Department of Pathology and Area Laboratory Services, Brooke Army Medical Center, JBSA-Fort Sam Houston, TX.
| | - Kelly W Wilhelms
- Core/Reference Laboratory, Department of Pathology and Area Laboratory Services, Brooke Army Medical Center, JBSA-Fort Sam Houston, TX
| |
Collapse
|
25
|
Jayabose S, Kumar V, Dhanabalan R, Rajan P, Rathnam K, Viswanathan TK. Low-dose rasburicase in hematologic malignancies. Indian J Pediatr 2015; 82:458-61. [PMID: 25338496 DOI: 10.1007/s12098-014-1606-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To define the efficacy and safety of low-dose rasburicase in children from south India with hematologic malignancies. METHODS This study is a retrospective analysis of data on 41 children with hematologic malignacies with laboratory evidence of tumor lysis syndrome (TLS) or clinical features indicating high risk for developing TLS. Patients were treated with rasburicase in doses of 0.1-0.15 mg/kg dose, repeated when necessary. RESULTS Male : Female ratio was 32:9. Thirty-six children had laboratory evidence of TLS and 5 were at risk for TLS. Diagnoses were T-cell acute lymphoblastic leukemia (ALL), 19; Pre-B ALL, 17; B-non-Hodgkin lymphoma (NHL), 2; T-NHL, 2; and acute myeloid leukemia (AML), 1. Initial plasma uric acid (PUA): median, 8.5 mg/dl (range, 4.3 to 45.5). Six had creatinine levels of >2 mg/dl on admission; and 10 had peak PO4 levels of >10 mg/dl. Dose of rasburicase used: median, 0.12 mg/kg (range, 0.08-0.24). Median reduction of PUA at 6 h: 80 % (range 40 to 98 %). Twenty-seven needed only one dose; 12 needed 2 or 3 doses; and two needed 5 doses each. One child required dialysis. None of the children developed anaphylaxis or hemolysis and there were no deaths from TLS. CONCLUSIONS Low-dose rasburicase (0.1-0.15 mg/kg) is safe and effective in reducing PUA in Indian children with lymphoid malignancies, and thus it may reduce the risk of renal failure from TLS.
Collapse
Affiliation(s)
- Somasundaram Jayabose
- Division of Pediatric Hematology-Oncology, Meenakshi Mission Hospital & Research Centre, Lake Area, Melur Road, Madurai, Tamil Nadu, India,
| | | | | | | | | | | |
Collapse
|
26
|
Nguyen AP, Ness GL. Hemolytic anemia following rasburicase administration: a review of published reports. J Pediatr Pharmacol Ther 2015; 19:310-6. [PMID: 25762877 DOI: 10.5863/1551-6776-19.4.310] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Tumor lysis syndrome (TLS) is a potentially lethal complication of anticancer treatment. It is caused by the rapid death of malignant cells after initiation of cytotoxic therapy and is typically observed in patients with bulky or highly proliferative malignancies. Currently, rasburicase is one of the recommended therapies for this oncologic emergency. Although this drug is generally well tolerated among patients, there have been several reports of hemolytic anemia following rasburicase infusions. With drug-induced hemolytic anemia, the condition usually resolves shortly after the offending agent is discontinued. However, anemia that is prolonged or severe can lead to problems such as splenomegaly and rapid heart rate. This paper will review primary literature identified through PubMed, International Pharmaceutical Abstracts, and Embase concerning the incidence of hemolytic anemia with rasburicase use. From the available data, the occurrence of hemolytic anemia will be discussed.
Collapse
Affiliation(s)
| | - Genevieve L Ness
- Christy Houston Foundation Drug Information Center, Belmont University College of Pharmacy, Nashville, Tennessee ; Department of Pharmaceutical, Social and Administrative Sciences, Belmont University College of Pharmacy, Nashville, Tennessee
| |
Collapse
|
27
|
Zhang B, Lee AI, Podoltsev N. Tumor lysis syndrome and acute anemia in an African-American man with chronic lymphocytic leukemia. Oxf Med Case Reports 2014; 2014:138-40. [PMID: 25988058 PMCID: PMC4369993 DOI: 10.1093/omcr/omu053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/08/2014] [Accepted: 10/15/2014] [Indexed: 11/14/2022] Open
Abstract
Tumor lysis syndrome (TLS) is a life-threating hematologic emergency caused by massive lysis of tumor cells into the blood stream. TLS can be prevented and treated with rasburicase. Rasburicase-induced hemolysis and methemoglobinemia is a rare but serious complication. Screening for G6PD should be considered for patients at higher risk for G6PD deficiency who may be also at high risk for TLS on the basis of clinical parameters. G6PD level in G6PD-deficient patients may be normal during an acute hemolytic episode and may not help to clarify the diagnosis at the time of presentation. The characteristic peripheral blood smear findings of ‘bite’ and ‘blister’ cells representing oxidative damage to red blood cells can help to quickly establish the diagnosis of G6PD deficiency-related hemolysis. The treatment of an acute hemolytic episode in a patient with G6PD deficiency requires avoiding the source of oxidative stress and using transfusion support as needed.
Collapse
Affiliation(s)
| | - Alfred Ian Lee
- Section of Hematology, Department of Internal Medicine , Yale School of Medicine , New Haven, CT , USA
| | - Nikolai Podoltsev
- Section of Hematology, Department of Internal Medicine , Yale School of Medicine , New Haven, CT , USA
| |
Collapse
|
28
|
Bontant T, Le Garrec S, Avran D, Dauger S. Methaemoglobinaemia in a G6PD-deficient child treated with rasburicase. BMJ Case Rep 2014; 2014:bcr-2014-204706. [PMID: 25115783 DOI: 10.1136/bcr-2014-204706] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 5-year-old boy from the Congo, was admitted for hyperleucocytic acute lymphoblastic leukaemia, with a high risk of tumour lysis syndrome (TLS). He had splenomegaly and mediastinal lymphadenopathy on chest X-ray. We started steroids and hyperhydration with rasburicase to prevent TLS. Respiratory failure with mediastinal enlargement developed rapidly. A few hours after intensive care unit (ICU) admission, he was started on mechanical ventilation. Chemotherapy was started immediately given the strong suspicion of mediastinal compression. Low oxygen saturation with high partial arterial oxygen pressure persisted. Blood tests confirmed 20% methaemoglobinaemia and glucose-6-phosphate dehydrogenase (G6PD) deficiency. Allopurinol was substituted for rasburicase. The methaemoglobinaemia disappeared rapidly and he was discharged from the ICU after 72 h. In case of rasburicase use, a close clinical monitoring is mandatory, especially in populations where G6PD deficiency is highly prevalent. Methaemoglobinaemia must be suspected in case of low oxygen saturation when all other potential causes have been ruled out.
Collapse
Affiliation(s)
- Thomas Bontant
- PICU, Hopital Robert Debré, AP-HP and Paris Diderot, Paris 7 University, Paris, France
| | - Sophie Le Garrec
- PICU, Hopital Robert Debré, AP-HP and Paris Diderot, Paris 7 University, Paris, France
| | - David Avran
- PICU, Hopital Robert Debré, AP-HP and Paris Diderot, Paris 7 University, Paris, France
| | - Stephane Dauger
- PICU, Hopital Robert Debré, AP-HP and Paris Diderot, Paris 7 University, Paris, France
| |
Collapse
|
29
|
Bakhshi S, Singh RB, Munot K, Pathania S. Complications of "very high" leukocytosis in pediatric acute leukemia patients managed without rasburicase and leukopheresis. Indian J Pediatr 2014; 81:817-20. [PMID: 24078288 DOI: 10.1007/s12098-013-1187-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 07/15/2013] [Indexed: 10/26/2022]
Abstract
The authors evaluated complications in pediatric acute leukemia with "very high" leukocytosis (VHL) prior to rasburicase availability and without leukopheresis. From Jun 2003 through Dec 2009, 45 out of 457 (10 %) pediatric acute leukemia patients had VHL. Median WBC for acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) patients was 296,500/mm3 (200,000-615,220) and 206,300/mm3 (106,100-541,900) respectively. Laboratory and clinical tumor-lysis-syndrome was seen in 37.7 % and 13.3 % patients respectively; none required dialysis; 6.6 % died due to CNS/pulmonary bleed. Thrombocytopenia <31,000/mm3 was associated with hypocalcemia (p = 0.04) and mortality (p = 0.04), and hypoalbuminemia with kidney dysfunction (p = 0.04). In resource-limited setting, VHL patients with thrombocytopenia may warrant rasburicase with or without leukopheresis, and aggressive platelet support.
Collapse
|
30
|
Pavo García MR, Núñez-Ramos R, Peralta Salas JE, Vivanco Martínez JL. [Rasburicase-induced methemoglobinemia in a patient with leukemia recurrence]. An Pediatr (Barc) 2014; 81:e38-9. [PMID: 24588957 DOI: 10.1016/j.anpedi.2014.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 12/26/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022] Open
Affiliation(s)
- M R Pavo García
- Unidad de Hemato-Oncología Pediátrica, Hospital 12 de Octubre, Madrid, España
| | | | | | | |
Collapse
|
31
|
Malaguarnera G, Giordano M, Malaguarnera M. Rasburicase for the treatment of tumor lysis in hematological malignancies. Expert Rev Hematol 2014; 5:27-38. [DOI: 10.1586/ehm.11.73] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
32
|
Middeke JM, Bruck N, Parmentier S, Bornhäuser M, Schetelig J. Use of rasburicase in a pregnant woman with acute lymphoblastic leukaemia and imminent tumour lysis syndrome. Ann Hematol 2013; 93:531-2. [DOI: 10.1007/s00277-013-1836-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
|
33
|
Bauters T, Mondelaers V, Robays H, De Wilde H, Benoit Y, De Moerloose B. Methemoglobinemia and hemolytic anemia after rasburicase administration in a child with leukemia. Int J Clin Pharm 2013; 35:303-5. [DOI: 10.1007/s11096-010-9447-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 10/11/2010] [Indexed: 11/30/2022]
|
34
|
Feng X, Dong K, Pham D, Pence S, Inciardi J, Bhutada NS. Efficacy and cost of single-dose rasburicase in prevention and treatment of adult tumour lysis syndrome: a meta-analysis. J Clin Pharm Ther 2013; 38:301-8. [DOI: 10.1111/jcpt.12061] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 03/04/2013] [Indexed: 12/22/2022]
Affiliation(s)
- X. Feng
- Department of Clinical and Administrative Sciences; California Northstate University College of Pharmacy; Rancho Cordova CA USA
| | - K. Dong
- Department of Clinical and Administrative Sciences; California Northstate University College of Pharmacy; Rancho Cordova CA USA
| | - D. Pham
- Department of Clinical and Administrative Sciences; California Northstate University College of Pharmacy; Rancho Cordova CA USA
| | - S. Pence
- Department of Clinical and Administrative Sciences; California Northstate University College of Pharmacy; Rancho Cordova CA USA
| | - J. Inciardi
- Department of Clinical and Administrative Sciences; California Northstate University College of Pharmacy; Rancho Cordova CA USA
| | - N. S. Bhutada
- Department of Clinical and Administrative Sciences; California Northstate University College of Pharmacy; Rancho Cordova CA USA
| |
Collapse
|
35
|
Sonbol MB, Yadav H, Vaidya R, Rana V, Witzig TE. Methemoglobinemia and hemolysis in a patient with G6PD deficiency treated with rasburicase. Am J Hematol 2013; 88:152-4. [PMID: 22573495 DOI: 10.1002/ajh.23182] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 02/27/2012] [Indexed: 01/12/2023]
Affiliation(s)
| | - Hemang Yadav
- Division of Internal Medicine; Mayo Clinic; Rochester; Minnesota
| | - Rakhee Vaidya
- Division of Hematology; Mayo Clinic; Rochester; Minnesota
| | - Vishal Rana
- Division of Hematology; Mayo Clinic; Rochester; Minnesota
| | | |
Collapse
|
36
|
Garay RP, El-Gewely MR, Labaune JP, Richette P. Therapeutic perspectives on uricases for gout. Joint Bone Spine 2012; 79:237-42. [DOI: 10.1016/j.jbspin.2012.01.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2011] [Indexed: 11/28/2022]
|
37
|
Bauters T, Mondelaers V, Robays H, De Wilde H, Benoit Y, De Moerloose B. Methemoglobinemia and hemolytic anemia after rasburicase administration in a child with leukemia. Int J Clin Pharm 2011; 33:58-60. [DOI: 10.1007/s11096-011-9484-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 10/11/2010] [Indexed: 11/24/2022]
|
38
|
Abstract
Acute tumor lysis syndrome (TLS) is characterized by the triad of hyperuricemia, hyperkalemia, and hyperphosphatemia and is caused by the death of tumor cells and release of intracellular contents into the circulation. This syndrome is most frequently associated with hematopoietic malignancies with a high growth fraction, including acute leukemias and lymphomas, but can be encountered in patients with nonhematopoietic solid tumors. Acute tumor lysis is typically precipitated by chemotherapy leading to rapid cell death, but may also occur spontaneously prior to treatment. In severe cases, the metabolic abnormalities of TLS can cause renal failure, cardiac arrhythmias, and death. Standard therapies include intravenous hydration, alkalinization of the urine to increase the solubility of uric acid, and administration of allopurinol to block production of uric acid. Recombinant urate oxidase (rasburicase) is a newer agent that directly cleaves uric acid. It is important for the clinician to maintain a high level of clinical suspicion for TLS when initiating therapy in children newly diagnosed with cancer, including those with solid tumors, and to know how to prevent and treat this potentially deadly metabolic complication.
Collapse
|
39
|
Coiffier B, Altman A, Pui CH, Younes A, Cairo MS. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol 2008; 26:2767-78. [PMID: 18509186 DOI: 10.1200/jco.2007.15.0177] [Citation(s) in RCA: 407] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Tumor lysis syndrome (TLS) has recently been subclassified into either laboratory TLS or clinical TLS, and a grading system has been established. Standardized guidelines, however, are needed to aid in the stratification of patients according to risk and to establish prophylaxis and treatment recommendations for patients at risk or with established TLS. METHODS A panel of experts in pediatric and adult hematologic malignancies and TLS was assembled to develop recommendations and guidelines for TLS based on clinical evidence and standards of care. A review of relevant literature was also used. RESULTS New guidelines are presented regarding the prevention and management of patients at risk of developing TLS. The best management of TLS is prevention. Prevention strategies include hydration and prophylactic rasburicase in high-risk patients, hydration plus allopurinol or rasburicase for intermediate-risk patients, and close monitoring for low-risk patients. Primary management of established TLS involves similar recommendations, with the addition of aggressive hydration and diuresis, plus allopurinol or rasburicase for hyperuricemia. Alkalinization is not recommended. Although guidelines for rasburicase use in adults are provided, this agent is currently only approved for use in pediatric patients in the United States. CONCLUSION The potential severity of complications resulting from TLS requires measures for prevention in high-risk patients and prompts treatment in the event that symptoms arise. Recognition of risk factors, monitoring of at-risk patients, and appropriate interventions are the key to preventing or managing TLS. These guidelines should assist in the prevention of TLS and improve the management of patients with established TLS.
Collapse
Affiliation(s)
- Bertrand Coiffier
- Department of Hematology, Hospices Civils de Lyon and University Claude Bernard, Lyon, France
| | | | | | | | | |
Collapse
|
40
|
Cammalleri L, Malaguarnera M. Rasburicase represents a new tool for hyperuricemia in tumor lysis syndrome and in gout. Int J Med Sci 2007; 4:83-93. [PMID: 17396159 PMCID: PMC1838823 DOI: 10.7150/ijms.4.83] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 03/01/2007] [Indexed: 02/05/2023] Open
Abstract
Hyperuricemia is a feature of several pathologies and requires an appropriate and often early treatment, owing to the severe consequences that it may cause. A rapid and massive raise of uric acid, during tumor lysis syndrome (TLS), and also a lower and chronic hyperuricemia, as in gout, mainly damage the kidney. To prevent or treat these consequences, a new therapeutic option is represented by rasburicase, a recombinant form of an enzyme, urate oxidase. This enzyme converts hypoxanthine and xanthine into allantoin, a more soluble molecule, easily cleared by kidney. The several types of urate oxidase have followed each other, with progressive reduction of adverse reactions. The most important among them are allergenicity and the development of antibodies which compromise their effectiveness. Nevertheless, a limit of rasburicase's use remains its cost, which obliges to a judicious choice to prevent TLS in high risk patients with cancer and in case of allergy or impossibility to take allopurinol orally both in TLS and in gout. A large body of evidence confirms the efficacy and safety of rasburicase, even in comparison to the standard drugs used in the aforementioned pathologies.
Collapse
Affiliation(s)
- Lisa Cammalleri
- Dept of Senescence, Urological and Neurological Sciences, University of Catania, Catania, Italy
| | | |
Collapse
|