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Lévi F, Okyar A, Dulong S, Innominato PF, Clairambault J. Circadian Timing in Cancer Treatments. Annu Rev Pharmacol Toxicol 2010; 50:377-421. [DOI: 10.1146/annurev.pharmtox.48.113006.094626] [Citation(s) in RCA: 301] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
The circadian timing system is composed of molecular clocks, which drive 24-h changes in xenobiotic metabolism and detoxification, cell cycle events, DNA repair, apoptosis, and angiogenesis. The cellular circadian clocks are coordinated by endogenous physiological rhythms, so that they tick in synchrony in the host tissues that can be damaged by anticancer agents. As a result, circadian timing can modify 2- to 10-fold the tolerability of anticancer medications in experimental models and in cancer patients. Improved efficacy is also seen when drugs are given near their respective times of best tolerability, due to (a) inherently poor circadian entrainment of tumors and (b) persistent circadian entrainment of healthy tissues. Conversely, host clocks are disrupted whenever anticancer drugs are administered at their most toxic time. On the other hand, circadian disruption accelerates experimental and clinical cancer processes. Gender, circadian physiology, clock genes, and cell cycle critically affect outcome on cancer chronotherapeutics. Mathematical and systems biology approaches currently develop and integrate theoretical, experimental, and technological tools in order to further optimize and personalize the circadian administration of cancer treatments.
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Affiliation(s)
- Francis Lévi
- INSERM, U776 Rythmes Biologiques et Cancers, Hôpital Paul Brousse, Villejuif, F-94807, France
- Univ Paris-Sud, UMR-S0776, Orsay, F-91405, France
- Assistance Publique-Hôpitaux de Paris, Unité de Chronothérapie, Département de Cancérologie, Hôpital Paul Brousse, Villejuif, F-94807, France
| | - Alper Okyar
- INSERM, U776 Rythmes Biologiques et Cancers, Hôpital Paul Brousse, Villejuif, F-94807, France
- Istanbul University Faculty of Pharmacy, Department of Pharmacology, Beyazit TR-34116, Istanbul, Turkey
| | - Sandrine Dulong
- INSERM, U776 Rythmes Biologiques et Cancers, Hôpital Paul Brousse, Villejuif, F-94807, France
- Univ Paris-Sud, UMR-S0776, Orsay, F-91405, France
| | - Pasquale F. Innominato
- INSERM, U776 Rythmes Biologiques et Cancers, Hôpital Paul Brousse, Villejuif, F-94807, France
- Univ Paris-Sud, UMR-S0776, Orsay, F-91405, France
- Assistance Publique-Hôpitaux de Paris, Unité de Chronothérapie, Département de Cancérologie, Hôpital Paul Brousse, Villejuif, F-94807, France
| | - Jean Clairambault
- INSERM, U776 Rythmes Biologiques et Cancers, Hôpital Paul Brousse, Villejuif, F-94807, France
- Univ Paris-Sud, UMR-S0776, Orsay, F-91405, France
- INRIA Rocquencourt, Domaine de Voluceau, BP 105, F-78153 Rocquencourt, France;, , , ,
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Goyal M, Shukla P, Gupta D, Bisht SS, Dhawan A, Gupta S, Pant MC, Verma NS. Oral mucositis in morning vs. evening irradiated patients: a randomised prospective study. Int J Radiat Biol 2009; 85:504-9. [PMID: 19412843 DOI: 10.1080/09553000902883802] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Patients of head and neck cancer undergoing radiotherapy develop oral mucositis. The severity of mucositis may also depend on the time of administration of radiation apart from patient-related factors. The most radiosensitive phase of the cell cycle (G2-M) occurs in the late afternoon and evening in human oral mucosa; therefore, it is more vulnerable to radiation injury in the evening. The present study evaluated prospectively the severity of acute oral mucositis in head and neck carcinoma patients irradiated in the morning (08:00-11:00 h) versus late afternoon/evening (15:00-18:00 h). METHOD A total of 212 patients of head and neck carcinoma were randomised to morning (08:00-11:00 h) and evening (15:00-18:00 h) groups. The grades of oral mucosa ulceration were compared in the two groups. RESULTS The grades of mucositis were marginally higher in the evening-irradiated group than in the morning-irradiated group 38% vs. 26% (p = 0.08). CONCLUSION The observed incidence of grade III/IV mucositis in morning vs. evening irradiated patients may be because of the existence of circadian rhythm in the cell cycle of normal mucosa. This knowledge may provide a possibility of treating the patients with decreased toxicity to oral mucosa.
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Affiliation(s)
- Manish Goyal
- Department of Physiology, King George's Medical University, Lucknow, India
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Bjarnason GA, MacKenzie RG, Nabid A, Hodson ID, El-Sayed S, Grimard L, Brundage M, Wright J, Hay J, Ganguly P, Leong C, Wilson J, Jordan RC, Walker M, Tu D, Parulekar W. Comparison of Toxicity Associated With Early Morning Versus Late Afternoon Radiotherapy in Patients With Head-and-Neck Cancer: A Prospective Randomized Trial of the National Cancer Institute of Canada Clinical Trials Group (HN3). Int J Radiat Oncol Biol Phys 2009; 73:166-72. [DOI: 10.1016/j.ijrobp.2008.07.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 07/02/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
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Abstract
Rhythmicity in cell proliferation is well established in the gastrointestinal tract and skin, both in rodents and humans. This is the basis for studies on the timing of both chemotherapy and radiotherapy. More recently, circadian rhythm studies of cell-cycle proteins have confirmed earlier findings based on thymidine labeling and flow cytometry. The genetic control of circadian rhythms has been elucidated recently and a possible connection between the circadian clock and the timing of cell-cycle events has been suggested. The data for gastrointestinal mucosa and skin are reviewed and the potential clinical implications of these results are discussed.
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Affiliation(s)
- Georg A Bjarnason
- Division of Medical Oncology, Toronto-Sunnybrook Regional Cancer Centre, University of Toronto, Canada.
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Bjarnason GA, Jordan R. Circadian variation of cell proliferation and cell cycle protein expression in man: clinical implications. PROGRESS IN CELL CYCLE RESEARCH 2000; 4:193-206. [PMID: 10740826 DOI: 10.1007/978-1-4615-4253-7_17] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Most physiological, biochemical and behavioural processes have been shown to vary in a regular and predictable periodic manner with respect to time. This review focuses on the circadian rhythm in cell proliferation in bone marrow and gut and how this is associated with a circadian expression of cell cycle proteins in human oral mucosa. The control of circadian rhythms by the suprachiasmatic nuclei and the evolving understanding of the genetic and molecular biology of the circadian clock is outlined. Finally, the potential clinical impact of chronobiology in cancer medicine is discussed.
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Affiliation(s)
- G A Bjarnason
- Division of Medical Oncology, Toronto-Sunnybrook Regional Cancer Centre, Ontario, Canada
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Bjarnason GA, Jordan RC, Sothern RB. Circadian variation in the expression of cell-cycle proteins in human oral epithelium. THE AMERICAN JOURNAL OF PATHOLOGY 1999; 154:613-22. [PMID: 10027418 PMCID: PMC1849996 DOI: 10.1016/s0002-9440(10)65306-0] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
At the tissue level, there is experimental and clinical data to suggest a cytokinetic coordination of the cell cycle with a greater proportion of cycling cells entering S-phase and mitosis at specific times of the day. The association of certain cell-cycle proteins with defined events in the cell cycle is well established and may be used to study the timing of cell-cycle phases over 24 hours. In this study oral mucosal biopsies were obtained from six normal human volunteers at 4-hour intervals, six times over 24 hours. Using immunohistochemistry, the number of positive cells expressing the proteins p53, cyclin-E, cyclin-A, cyclin-B1, and Ki-67 was determined for each biopsy and expressed as the number of positive cells per mm of basement membrane. We found a statistically significant circadian variation in the nuclear expression of all of these proteins with the high point of expression for p53 at 10:56 hours, cyclin-E at 14:59 hours, cyclin-A at 16:09 hours, cyclin-B1 at 21:13 hours, and Ki-67 at 02:50 hours. The circadian variation in the nuclear expression of cyclins-E (G1/S phase), -A (G2-phase), and -B1 (M-phase) with a normal physiological progression over time suggests a statistically significant circadian variation in oral epithelial cell proliferation. The finding of a circadian variation in the nuclear expression of p53 protein corresponding to late G1 is novel. This information has clinical implications regarding the timing of chemotherapy and radiotherapy.
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Affiliation(s)
- G A Bjarnason
- Toronto-Sunnybrook Regional Cancer Centre, Department of Medicine, University of Toronto, Ontario, Canada.
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