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Ouyang A, Zhang C, Adra N, Tesh RA, Sun H, Lei D, Jing J, Fan P, Paixao L, Ganglberger W, Briggs L, Salinas J, Bevers MB, Wrann CD, Chemali Z, Fricchione G, Thomas RJ, Rosand J, Tanzi RE, Westover MB. Effects of Aerobic Exercise on Brain Age and Health in Middle-Aged and Older Adults: A Single-Arm Pilot Clinical Trial. Life (Basel) 2024; 14:855. [PMID: 39063609 PMCID: PMC11278044 DOI: 10.3390/life14070855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/26/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUNDS Sleep disturbances are prevalent among elderly individuals. While polysomnography (PSG) serves as the gold standard for sleep monitoring, its extensive setup and data analysis procedures impose significant costs and time constraints, thereby restricting the long-term application within the general public. Our laboratory introduced an innovative biomarker, utilizing artificial intelligence algorithms applied to PSG data to estimate brain age (BA), a metric validated in cohorts with cognitive impairments. Nevertheless, the potential of exercise, which has been a recognized means of enhancing sleep quality in middle-aged and older adults to reduce BA, remains undetermined. METHODS We conducted an exploratory study to evaluate whether 12 weeks of moderate-intensity exercise can improve cognitive function, sleep quality, and the brain age index (BAI), a biomarker computed from overnight sleep electroencephalogram (EEG), in physically inactive middle-aged and older adults. Home wearable devices were used to monitor heart rate and overnight sleep EEG over this period. The NIH Toolbox Cognition Battery, in-lab overnight polysomnography, cardiopulmonary exercise testing, and a multiplex cytokines assay were employed to compare pre- and post-exercise brain health, exercise capacity, and plasma proteins. RESULTS In total, 26 participants completed the initial assessment and exercise program, and 24 completed all procedures. Data are presented as mean [lower 95% CI of mean, upper 95% CI of mean]. Participants significantly increased maximal oxygen consumption (Pre: 21.11 [18.98, 23.23], Post 22.39 [20.09, 24.68], mL/kg/min; effect size: -0.33) and decreased resting heart rate (Pre: 66.66 [63.62, 67.38], Post: 65.13 [64.25, 66.93], bpm; effect size: -0.02) and sleeping heart rate (Pre: 64.55 [61.87, 667.23], Post: 62.93 [60.78, 65.09], bpm; effect size: -0.15). Total cognitive performance (Pre: 111.1 [107.6, 114.6], Post: 115.2 [111.9, 118.5]; effect size: 0.49) was significantly improved. No significant differences were seen in BAI or measures of sleep macro- and micro-architecture. Plasma IL-4 (Pre: 0.24 [0.18, 0.3], Post: 0.33 [0.24, 0.42], pg/mL; effect size: 0.49) was elevated, while IL-8 (Pre: 5.5 [4.45, 6.55], Post: 4.3 [3.66, 5], pg/mL; effect size: -0.57) was reduced. CONCLUSIONS Cognitive function was improved by a 12-week moderate-intensity exercise program in physically inactive middle-aged and older adults, as were aerobic fitness (VO2max) and plasma cytokine profiles. However, we found no measurable effects on sleep architecture or BAI. It remains to be seen whether a study with a larger sample size and more intensive or more prolonged exercise exposure can demonstrate a beneficial effect on sleep quality and brain age.
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Affiliation(s)
- An Ouyang
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA 02131, USA
| | - Can Zhang
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Noor Adra
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Ryan A. Tesh
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Haoqi Sun
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Dan Lei
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Jin Jing
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Peng Fan
- Department of Physical Therapy & Human Movement Science, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Luis Paixao
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Wolfgang Ganglberger
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Logan Briggs
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Joel Salinas
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Matthew B. Bevers
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Christiane Dorothea Wrann
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Zeina Chemali
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Gregory Fricchione
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Robert J. Thomas
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Rudolph E. Tanzi
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
| | - Michael Brandon Westover
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114, USA (C.Z.); (R.A.T.); (H.S.); (C.D.W.)
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; (J.J.)
- Harvard Medical School, Boston, MA 02115, USA (M.B.B.); (R.J.T.)
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Ifejeokwu OV, Do A, El Khatib SM, Ho NH, Zavala A, Othy S, Acharya MM. Immune Checkpoint Inhibition-related Neuroinflammation Disrupts Cognitive Function. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.01.601087. [PMID: 39005282 PMCID: PMC11244914 DOI: 10.1101/2024.07.01.601087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Combinatorial blockade of Cytotoxic T-lymphocyte associated protein 4 (CTLA-4) and Programmed Cell Death Protein 1 (PD-1) significantly improve the progression-free survival of individuals with metastatic cancers, including melanoma. In addition to unleashing anti-tumor immunity, combination immune checkpoint inhibition (ICI) disrupts immune-regulatory networks critical for maintaining homeostasis in various tissues, including the central nervous system (CNS). Although ICI- and cancer-related cognitive impairments (CRCI) in survivors are increasingly becoming evident, our understanding of ICI-induced immune-related adverse effects (IREA) in the CNS remains incomplete. Here, our murine melanoma model reveals that combination ICI impairs hippocampal-dependent learning and memory, as well as memory consolidation processes. Mechanistically, combination ICI disrupted synaptic integrity, and neuronal plasticity, reduced myelin, and further predisposed CNS for exaggerated experimental autoimmune encephalomyelitis. Combination ICI substantially altered both lymphoid and myeloid cells in the CNS. Neurogenesis was unaffected, however, microglial activation persisted for two-months post- ICI, concurrently with cognitive deficits, which parallels clinical observations in survivors. Overall, our results demonstrate that blockade of CTLA-4 and PD-1 alters neuro-immune homeostasis and activates microglia, promoting long-term neurodegeneration and driving cognitive impairments. Therefore, limiting microglial activation is a potential avenue to mitigate CNS IRAE while maintaining the therapeutic benefits of rapidly evolving ICIs and their combinations. SIGNIFICANCE Despite the superior therapeutic efficacy of immune checkpoint inhibition (ICI) for cancers, its undesired effects on brain function are not fully understood. Here, we demonstrate that combination ICI elevates neuroinflammation, activates microglia, leading to detrimental neurodegenerative and neurocognitive sequelae.
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Suryan V, Chandra NC. Cholesterol and Cytokines: Molecular Links to Atherosclerosis and Carcinogenesis. Cell Biochem Biophys 2024:10.1007/s12013-024-01383-w. [PMID: 38943010 DOI: 10.1007/s12013-024-01383-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Abstract
An increase of cholesterol concentration within the artery obstructs arterial blood flow once it deposits alongside the arterial wall. This results in atherosclerosis. Carcinogenesis causes a quicker clearance of vascular cholesterol to meet the demands of tumour cell development. Both illnesses have an increased concentration of pro-inflammatory cytokines in the blood. To search the comparative characteristics of cholesterol and pro-inflammatory cytokines in the pathogenesis of atherosclerosis and carcinogenesis, a comprehensive online survey using MEDLINE, Scopus, PubMed, and Google Scholar was conducted for relevant journals with key search term cholesterol and cytokines in atherosclerotic and cancerous patients. According to reports, hypercholesterolaemia related dyslipidemia causes atherosclerosis in blood arteries and hypercholesterolaemia in cell nucleus is a reason for developing carcinogenesis. It is also noted that pro-inflammatory cytokines are involved in both of the aforementioned pathogenesis. Changes in anti-inflammatory cytokines are only the characteristic features of each kind. Thus, Cholesterol and pro-inflammatory cytokines are intensely interlinked in the genesis of atherosclerotic and carcinogenic consequences.
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Affiliation(s)
- Varsha Suryan
- Department of Biochemistry, Faculty of Medicine & Health Sciences, Shree Guru Gobind Singh Tricentenary University, Budhera, Gurugram (Delhi-NCR), Haryana, 122505, India
- Department of Paramedical Science, Faculty of Allied Health Sciences, Shree Guru Gobind Singh Tricentenary University, Budhera, Gurugram (Delhi-NCR), Haryana, 122505, India
| | - Nimai Chand Chandra
- Department of Biochemistry, Faculty of Medicine & Health Sciences, Shree Guru Gobind Singh Tricentenary University, Budhera, Gurugram (Delhi-NCR), Haryana, 122505, India.
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Duivon M, Lequesne J, Di Meglio A, Pradon C, Vaz-Luis I, Martin AL, Everhard S, Broutin S, Rigal O, Bousrih C, Lévy C, Lerebours F, Lange M, Joly F. Inflammation at diagnosis and cognitive impairment two years later in breast cancer patients from the Canto-Cog study. Breast Cancer Res 2024; 26:93. [PMID: 38840166 PMCID: PMC11151649 DOI: 10.1186/s13058-024-01850-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Inflammation could be related to cancer-related cognitive impairment (CRCI) and might be used as a predictive marker of long-term CRCI. We evaluated associations between inflammatory markers assessed at diagnosis of breast cancer and CRCI two years afterwards. METHODS Newly diagnosed stage I-III patients with breast cancer from the French CANTO-Cog (Cognitive sub-study of CANTO, NCT01993498) were included at diagnosis (baseline). Serum inflammatory markers (IL-2, IL-4, IL-6, IL-8, IL-10, TNFα, CRP) were assessed at baseline. Outcomes at year 2 post-baseline included overall cognitive impairment (≥ 2 impaired domains) and the following domains: episodic memory, working memory, attention, processing speed, and executive functions. Multivariable logistic regression models evaluated associations between markers and outcomes, controlling for age, education, and baseline cognitive impairment. RESULTS Among 200 patients, the mean age was 54 ± 11 years, with 127 (64%) receiving chemotherapy. Fifty-three (27%) patients had overall cognitive impairment at both timepoints. Overall cognitive impairment at year 2 was associated with high (> 3 mg/L) baseline CRP (OR = 2.84, 95%CI: 1.06-7.64, p = 0.037). In addition, associations were found between high CRP and processing speed impairment (OR = 2.47, 95%CI:1.05-5.87, p = 0.039), and between high IL-6 and episodic memory impairment (OR = 5.50, 95%CI:1.43-36.6, p = 0.010). CONCLUSIONS In this cohort, high levels of CRP and IL-6 assessed at diagnosis were associated with overall CRCI, processing speed and episodic memory impairments two years later. These findings suggest a potential inflammatory basis for long-term CRCI. CRP may represent an easily measurable marker in clinical settings and be potentially used to screen patients at greater risk of persistent CRCI.
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Affiliation(s)
- Mylène Duivon
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre Le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000, Caen, France
| | - Justine Lequesne
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre Le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000, Caen, France
- Clinical Research Department, UNICANCER, Centre François Baclesse, 3 Av. du Général Harris, 14000, Caen, France
- Services Unit PLATON, Cancer and Cognition Platform, University of Caen Normandy, 14000, Caen, France
| | - Antonio Di Meglio
- Cancer Survivorship Group, INSERM U981, Gustave Roussy, Villejuif, France
| | - Caroline Pradon
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- Cancer Survivorship Group, INSERM U981, Gustave Roussy, Villejuif, France
- DIOPP, Gustave Roussy, Villejuif, France
| | | | | | - Sophie Broutin
- Biological Resource Center, AMMICa, INSERM US23/CNRS UMS3655, Gustave Roussy, Villejuif, France
| | - Olivier Rigal
- Care Support Department, Centre Henri Becquerel, 76000, Rouen, France
- Medical Oncology Department, Centre Henri Becquerel, 76000, Rouen, France
| | | | - Christelle Lévy
- Institut Normand du Sein, Centre François Baclesse, 14000, Caen, France
| | | | - Marie Lange
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre Le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000, Caen, France.
- Clinical Research Department, UNICANCER, Centre François Baclesse, 3 Av. du Général Harris, 14000, Caen, France.
- Services Unit PLATON, Cancer and Cognition Platform, University of Caen Normandy, 14000, Caen, France.
| | - Florence Joly
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre Le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000, Caen, France
- Clinical Research Department, UNICANCER, Centre François Baclesse, 3 Av. du Général Harris, 14000, Caen, France
- Services Unit PLATON, Cancer and Cognition Platform, University of Caen Normandy, 14000, Caen, France
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Liao Y, Xu Y, Mo Z, Zhu T, Dong H, Zhou W, Xia Q. Interleukin-25 as a Potential Biomarker in Lung Metastasis of Hepatocellular Carcinoma with HBV History in Chinese Patients: A Single Center, Case-control Study. Int J Med Sci 2024; 21:1337-1343. [PMID: 38818476 PMCID: PMC11134585 DOI: 10.7150/ijms.90642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/22/2024] [Indexed: 06/01/2024] Open
Abstract
Background: Interleukin-25 (IL-25) has been proved to play a role in the pathogenesis and metastasis of Hepatocellular carcinoma (HCC), but the relationship between the level of IL-25 and the metastasis and prognosis of HCC is still not clear. This study aimed to investigate the expression of IL-25 and other potential biochemical indicators among healthy people, HBV-associated HCC patients without lung metastasis and HBV-associated HCC patients with lung metastasis. Methods: From September 2019 to November 2021, 33 HCC patients without lung metastasis, 37 HCC patients with lung metastasis and 29 healthy controls were included in the study. IL-25 and other commonly used biochemical markers were measured to establish predictors of overall survival (OS) and progression-free survival (PFS) after treatment. Results: The serum level of IL-25 was increased in HCC patients than healthy controls (p < 0.001) and HCC patients with lung metastasis had higher IL-25 level than HCC patients without metastasis (p = 0.035). Lung metastasis also indicated higher death rate (p < 0.001) by chi-square test, higher GGT level (p = 0.024) and higher AFP level (p = 0.049) by non-parametric test. Kaplan-Meier analysis demonstrated that IL-25 was negatively associated with PFS (p = 0.024). Multivariate Cox-regression analysis indicated IL-25 (p = 0.030) and GGT (p = 0.020) to be independent predictors of poorer PFS, while IL-25 showed no significant association with OS. Conclusion: The level of IL-25 was significantly associated with disease progression and lung metastasis of HBV-associated HCC. The high expression of IL-25 predicted high recurrence rate and death probability of HCC patients after treatment. Therefore, IL-25 may be an effective predictor of prognosis in HCC.
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Affiliation(s)
- Yuan Liao
- Department of Laboratory Medicine, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Yixin Xu
- School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Ziying Mo
- Department of Laboratory Medicine, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Tianyi Zhu
- School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Huimin Dong
- Department of Laboratory Medicine, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Wenying Zhou
- Department of Laboratory Medicine, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Qing Xia
- Department of Oncology, State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
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Williams AM, Liu W, Ehrhardt MJ, Salehabadi SM, Panoskaltsis-Mortari A, Phillips NS, Mulrooney DA, Flerlage JE, Yasui Y, Srivastava D, Robison LL, Hudson MM, Ness KK, Sabin ND, Krull KR. Systemic Biological Mechanisms of Neurocognitive Dysfunction in Long-Term Survivors of Childhood Hodgkin Lymphoma. Clin Cancer Res 2024; 30:1822-1832. [PMID: 38381440 PMCID: PMC11062814 DOI: 10.1158/1078-0432.ccr-23-3709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/31/2024] [Accepted: 02/19/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE Hodgkin lymphoma (HL) survivors experience neurocognitive impairment despite receiving no central nervous system-directed therapy, though little is known about the underlying mechanisms. EXPERIMENTAL DESIGN HL survivors (n = 197) and age-, sex- and race/ethnicity frequency-matched community controls (n = 199) underwent standardized neurocognitive testing, and serum collection. Luminex multiplex or ELISA assays measured markers of inflammation and oxidative stress. Linear regression models compared biomarker concentrations between survivors and controls and with neurocognitive outcomes, adjusting for age, sex, race, body mass index, anti-inflammatory medication, and recent infections. RESULTS HL survivors [mean (SD) current age 36 (8) years, 22 (8) years after diagnosis] demonstrated higher concentrations of interleukin-6 (IL6), high-sensitivity c-reactive protein (hs-CRP), oxidized low-density lipoprotein, and glutathione peroxidase (GPx), compared with controls (P's < 0.001). Among survivors, higher concentrations of IL6 were associated with worse visuomotor processing speed (P = 0.046). hs-CRP ≥3 mg/L was associated with worse attention, processing speed, memory, and executive function (P's < 0.05). Higher concentrations of malondialdehyde were associated with worse focused attention and visual processing speed (P's < 0.05). Homocysteine was associated with worse short-term recall (P = 0.008). None of these associations were statistically significant among controls. Among survivors, hs-CRP partially mediated associations between cardiovascular or endocrine conditions and visual processing speed, whereas IL6 partially mediated associations between pulmonary conditions and visuomotor processing speed. CONCLUSIONS Neurocognitive function in long-term survivors of HL appears to be associated with inflammation and oxidative stress, both representing potential targets for future intervention trials.
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Affiliation(s)
- AnnaLynn M. Williams
- Departments of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Wei Liu
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Matthew J. Ehrhardt
- Departments of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | | | - Nicholas S. Phillips
- Departments of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel A. Mulrooney
- Departments of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jamie E. Flerlage
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Yutaka Yasui
- Departments of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Deokumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Leslie L. Robison
- Departments of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Melissa M. Hudson
- Departments of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Departments of Pediatrics and Medicine, University of Minnesota, Minneapolis, MN
| | - Kirsten K. Ness
- Departments of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Noah D. Sabin
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kevin R. Krull
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN
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Veronez LC, Lopes-Júnior LC. Cancer symptom cluster research in pediatric oncology: a work in progress. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2024; 5:400-408. [PMID: 38745774 PMCID: PMC11090779 DOI: 10.37349/etat.2024.00225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 01/15/2024] [Indexed: 05/16/2024] Open
Abstract
In the 21st century, advances in basic research have provided new insights in the field of pediatric oncology. Pediatric patients tend to experience higher levels of distressing symptoms, which together form a symptom cluster. In clinical practice, these symptom clusters are reported daily by children and adolescents with cancer. Translational research has emerged as the translation of new knowledge from basic science into clinical practice. Understanding how neuroimmunoendocrine pathways regulate cancer development and the aspects underlying the specific therapies, such as chemotherapy and immunotherapy, is an important frontier for future research in pediatric oncology. The goal of translational research is to show how different variables in tumor and patient characteristics explain the differential effects of interventions, as translational research provides new insights into the management of cancer symptoms in children and adolescents with cancer. Together, this approach could lead to improvements in pediatric oncology care worldwide.
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Affiliation(s)
- Luciana Chain Veronez
- Department of Childcare and Pediatrics, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP 14040-902, Brazil
| | - Luís Carlos Lopes-Júnior
- Health Sciences Center, Federal University of Espírito Santo (UFES), Vitoria, ES 29043-900, Brazil
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8
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Filippou C, Themistocleous SC, Marangos G, Panayiotou Y, Fyrilla M, Kousparou CA, Pana ZD, Tsioutis C, Johnson EO, Yiallouris A. Microbial Therapy and Breast Cancer Management: Exploring Mechanisms, Clinical Efficacy, and Integration within the One Health Approach. Int J Mol Sci 2024; 25:1110. [PMID: 38256183 PMCID: PMC10816061 DOI: 10.3390/ijms25021110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
This comprehensive review elucidates the profound relationship between the human microbiome and breast cancer management. Recent findings highlight the significance of microbial alterations in tissue, such as the gut and the breast, and their role in influencing the breast cancer risk, development, progression, and treatment outcomes. We delve into how the gut microbiome can modulate systemic inflammatory responses and estrogen levels, thereby impacting cancer initiation and therapeutic drug efficacy. Furthermore, we explore the unique microbial diversity within breast tissue, indicating potential imbalances brought about by cancer and highlighting specific microbes as promising therapeutic targets. Emphasizing a holistic One Health approach, this review underscores the importance of integrating insights from human, animal, and environmental health to gain a deeper understanding of the complex microbe-cancer interplay. As the field advances, the strategic manipulation of the microbiome and its metabolites presents innovative prospects for the enhancement of cancer diagnostics and therapeutics. However, rigorous clinical trials remain essential to confirm the potential of microbiota-based interventions in breast cancer management.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Andreas Yiallouris
- School of Medicine, European University Cyprus, 6 Diogenis Str., 2404 Engomi, P.O. Box 22006, Nicosia 1516, Cyprus
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Luo J, Schousboe JT, Ensrud KE, Hendryx M. Long-term changes of cognitive impairment among older breast cancer survivors. J Cancer Surviv 2023; 17:1760-1768. [PMID: 35624198 DOI: 10.1007/s11764-022-01220-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Cancer-related cognitive impairment is common during cancer treatment; however, it is unclear whether the impairment persists over time. Our study aimed to examine long-term cognitive impairment among older breast cancer survivors. METHODS Participants included 2420 community-dwelling women aged 65 years or older at enrollment (1986-1988) (404 breast cancer cases and 1:5 matched cancer-free controls) from the Study of Osteoporotic Fractures. Participants were followed for 20 years with measured cognitive function repeated up to 6 times. Cognitive impairment was defined by the Modified Mini-Mental State Examination and Trail Making Test B. Generalized linear models were used to model risk of cognitive impairment in relation to breast cancer status and time from breast cancer diagnosis. RESULTS Compared with controls, cognitive impairment in women with breast cancer significantly accelerated after cancer diagnosis. We also observed a more pronounced cognitive impairment after cancer diagnosis for women diagnosed with breast cancer at age ≥ 80 years or at advanced stage for both measures. CONCLUSION Our study with more than 20 years of follow-up data found that breast cancer survivors had accelerated cognitive impairment after cancer diagnosis, especially among women diagnosed at older age or at advanced stage, relative to women without cancer. IMPLICATIONS FOR CANCER SURVIVORS Breast cancer survivors may be encouraged to engage in both physical activity and cognitive training.
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Affiliation(s)
- Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, 47405, USA.
| | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners Inc, Minneapolis, MN, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Kristine E Ensrud
- Department of Medicine and Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, MN, USA
| | - Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, IN, USA
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10
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Patel SK, Breen EC, Paz IB, Kruper L, Mortimer J, Wong FL, Bhatia S, Irwin MR, Behrendt CE. Inflammation-related proteins as biomarkers of treatment-related behavioral symptoms: A longitudinal study of breast cancer patients and age-matched controls. Brain Behav Immun Health 2023; 32:100670. [PMID: 37637432 PMCID: PMC10450410 DOI: 10.1016/j.bbih.2023.100670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/29/2023] Open
Abstract
Background Behavioral symptoms in breast cancer (BC) survivors have been attributed to cancer treatment and resulting inflammation. However, studies linking behavioral symptoms to BC treatment have observed patients only after some treatment. Our prospective study with pre-treatment baseline investigates post-treatment changes in inflammation-related biomarkers and whether those changes correlate with changes in symptoms. Methods Participants were postmenopausal women, newly-diagnosed with stage 0-3 BC before any treatment (n = 173 "patients"), and age-matched women without cancer (n = 77 "controls"), who were assessed on plasma markers [soluble tumor necrosis factor receptor type 2 (sTNF-RII), interleukin (IL)-6, IL-1 receptor antagonist (IL-1RA), C-reactive protein (CRP)]) and symptoms (Physical Functioning, Pain, Attention/concentration, Perceived Cognitive Problems, Fatigue, Sleep Insufficiency, Depression). Participants were assessed again 1 month, 1 year, and 2 years after completing primary treatment or similar interval in controls. Generalized linear mixed models tested 4 treatments (surgery alone or with chemotherapy, radiation, or both) for association with change per marker. Joint models tested change per marker for association with change per symptom. Models considered demographic, socioeconomic, and clinical covariates. False Discovery Rate method controlled risk of error from multiple hypotheses. Results At one month post-completion of treatment, sTNF-RII and IL-6 were elevated by all BC treatments, as were IL-1RA and CRP after surgery alone (all, p < 0.05). By 1 year, markers' average values returned to baseline. Throughout 2-year follow-up, increase-from-baseline in sTNF-RII, IL-1RA, and IL-6 coincided with worsened Physical Functioning, and increase-from-baseline in sTNF-RII coincided with increased Pain (all, p < 0.01). These biomarker-symptom associations (excepting IL-6) were exclusive to patients. No other symptoms worsened, and baseline Fatigue and Depression improved in all participants. Conclusions BC treatment, even surgery, is associated with transient elevation in inflammatory markers. In patients post-treatment, increase-from-baseline in sTNF-RII accompanies increased Pain and decreased Physical Functioning, suggesting that sTNF-RII merits development as a clinical biomarker in BC patients.
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Affiliation(s)
- Sunita K. Patel
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, USA
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, USA
| | - Elizabeth C. Breen
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - I. Benjamin Paz
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Laura Kruper
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Joanne Mortimer
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - F. Lennie Wong
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Michael R. Irwin
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Carolyn E. Behrendt
- Department of Computational and Quantitative Medicine, Division of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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Correa DD, Vachha BA, Baser RE, Koch A, Wong P, Gohel S, Giralt S, Root JC. Neuroimaging and Neurocognitive Outcomes in Older Patients with Multiple Myeloma Treated with Chemotherapy and Autologous Stem Cell Transplantation. Cancers (Basel) 2023; 15:4484. [PMID: 37760454 PMCID: PMC10526394 DOI: 10.3390/cancers15184484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/21/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
There is a paucity of research on treatment-related neurotoxicity in older adults with multiple myeloma (MM) treated with high-dose chemotherapy (HDC) and autologous SCT (HDC/ASCT), despite the increasing use of this regimen. We examined resting state functional connectivity (RSFC), gray matter (GM) volume, neurocognitive function (NF), and proinflammatory cytokines (PCy) in older patients with MM pre- and post-HDC/ASCT. Eighteen patients underwent MRI, NF tests, and serum PCy measurements prior to HDC/ASCT, and fifteen patients completed a follow up five-months post-HDC/ASCT. There were significant decreases in RSFC post-HDC/ASCT in (1) the central executive network (CEN) involving the left dorsolateral prefrontal cortex and right posterior parietal cortex (p = 0.022) and (2) the CEN involving the right posterior parietal cortex and the salience network involving the right dorsal anterior cingulate cortex (p = 0.029). There were no significant changes in GM or NF, except for improvements in attention (Digit Span Backward, p = 0.03). There were significant increases in several PCy post-HDC/ASCT (p ≤ 0.05). In conclusion, RSFC decreased in frontal, parietal, and cingulate cortices post-HDC/ASCT, NF was relatively stable, and several PCy increased. These findings are congruent with other studies in cancer patients and provide supporting evidence for the vulnerability of frontoparietal regions to chemotherapy's adverse effects.
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Affiliation(s)
- Denise D. Correa
- Department of Neurology, MSKCC—Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Neurology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Behroze A. Vachha
- Department of Radiology, UMass Chan Medical School, Worcester, MA 01665, USA
| | - Raymond E. Baser
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Adrian Koch
- Department of Neurology, MSKCC—Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Phillip Wong
- Department of Immune Monitoring Facility, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Suril Gohel
- Department of Heath Informatics, Rutgers University School of Health Professions, Newark, NJ 08854, USA
| | - Sergio Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - James C. Root
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Departments of Psychiatry, Weill Cornell Medical College, New York, NY 10065, USA
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Kocyigit A, Guler EM, Durmus E, Yenigun VB, Kanimdan E, Ozman Z, Yasar O, Goren AC, Hekimoglu ER, Oruc HH, Aydogdu G. Propolis Enhances 5-Fluorouracil Mediated Antitumor Efficacy and Reduces Side Effects in Colorectal Cancer: An in Vitro and in Vivo Study. Chem Biodivers 2023; 20:e202300591. [PMID: 37497658 DOI: 10.1002/cbdv.202300591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 07/28/2023]
Abstract
In this study, we investigated the combined treatment of 5-fluorouracil (5-FU) and Anatolian propolis extract (PE) on colorectal cancer (CRC)using in vitro and in vivo studies. We exposed luciferase-transfected (Lovo-Luc CRC) cells and healthy colon cells (CCD-18Co) to varying concentrations of 5-FU and PE to assess their genotoxic, apoptotic, and cytotoxic effects, as well as their intracellular reactive oxygen species (iROS) levels. We also developed a xenograft model in nude mice and evaluated the anti-tumor effects of PE and 5-FU using various methods. Our findings showed that the combination of PE and 5-FU had selectivity against cancer cells, particularly at higher doses, and enhanced the anti-tumor effectiveness of 5-FU against colon CRC. The results suggest that PE can reduce side effects and increase the effectiveness of 5-FU through iROS generation in a dose-dependent manner.
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Affiliation(s)
- Abdurrahim Kocyigit
- Bezmialem Vakif University Medical Faculty, Department of Medical Biochemistry, 34093, Fatih, Istanbul, Turkey
- Bezmialem Vakif University Traditional and Complementary Medicine Advanced Research Applications and Research Center, Istanbul, Turkey
| | - Eray Metin Guler
- University of Health Sciences Turkey, Hamidiye School of Medicine, Department of Medical Biochemistry, Istanbul, Turkey
| | - Ezgi Durmus
- Bezmialem Vakif University Medical Faculty, Department of Medical Biochemistry, 34093, Fatih, Istanbul, Turkey
- Bezmialem Vakıf University Institute of Health Sciences, Medical Biochemistry, Turkey
| | - Vildan Betul Yenigun
- Bezmialem Vakif University Medical Faculty, Department of Medical Biochemistry, 34093, Fatih, Istanbul, Turkey
| | - Ebru Kanimdan
- Bezmialem Vakif University Medical Faculty, Department of Medical Biochemistry, 34093, Fatih, Istanbul, Turkey
- Istanbul University Institute of Science, Molecular Biology and Genetics, Turkey
| | - Zeynep Ozman
- Bezmialem Vakif University Medical Faculty, Department of Medical Biochemistry, 34093, Fatih, Istanbul, Turkey
- Bezmialem Vakıf University Institute of Health Sciences, Medical Biochemistry, Turkey
| | - Oznur Yasar
- Bezmialem Vakif University Medical Faculty, Department of Medical Biochemistry, 34093, Fatih, Istanbul, Turkey
| | - Ahmet Ceyhan Goren
- Faculty of Pharmacy, Department of Basic Pharmaceutical Sciences, Bezmialem Vakif University, Istanbul, Turkey
| | - Emine Rumeysa Hekimoglu
- Bezmialem Vakif University School of Medicine Department of Histology and Embryology, Istanbul, Turkey
| | - Hasan Huseyin Oruc
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Uludag University, Bursa, Turkey
| | - Gokhan Aydogdu
- Faculty of Veterinary Medicine Uludag University, Bursa, Turkey
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Jaiswara PK, Shukla SK. Chemotherapy-Mediated Neuronal Aberration. Pharmaceuticals (Basel) 2023; 16:1165. [PMID: 37631080 PMCID: PMC10459787 DOI: 10.3390/ph16081165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Chemotherapy is a life-sustaining therapeutic option for cancer patients. Despite the advancement of several modern therapies, such as immunotherapy, gene therapy, etc., chemotherapy remains the first-line therapy for most cancer patients. Along with its anti-cancerous effect, chemotherapy exhibits several detrimental consequences that restrict its efficacy and long-term utilization. Moreover, it effectively hampers the quality of life of cancer patients. Cancer patients receiving chemotherapeutic drugs suffer from neurological dysfunction, referred to as chemobrain, that includes cognitive and memory dysfunction and deficits in learning, reasoning, and concentration ability. Chemotherapy exhibits neurotoxicity by damaging the DNA in neurons by interfering with the DNA repair system and antioxidant machinery. In addition, chemotherapy also provokes inflammation by inducing the release of various pro-inflammatory cytokines, including NF-kB, IL-1β, IL-6, and TNF-α. The chemotherapy-mediated inflammation contributes to chemobrain in cancer patients. These inflammatory cytokines modulate several growth signaling pathways and reactive oxygen species homeostasis leading to systemic inflammation in the body. This review is an effort to summarize the available information which discusses the role of chemotherapy-induced inflammation in chemobrain and how it impacts different aspects of therapeutic outcome and the overall quality of life of the patient. Further, this article also discusses the potential of herbal-based remedies to overcome chemotherapy-mediated neuronal toxicity as well as to improve the quality of life of cancer patients.
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Affiliation(s)
| | - Surendra Kumar Shukla
- Department of Oncology Science, University of Oklahoma Health Science Centre, Oklahoma City, OK 73104, USA;
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Jahanbani Mazraeh E, Sadighi S, Manifar S, Bakhshandeh H, Rajabi M. Assessment of thyme honey oral gel for the prevention of adriamycin and cyclophosphamide chemotherapy-induced oral mucositis in patients with breast cancer. Support Care Cancer 2023; 31:497. [PMID: 37505326 DOI: 10.1007/s00520-023-07943-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Oral mucositis (OM) is a common complication of cancer treatment that has an impact on a patient's quality of life and the outcome of cancer therapy. This trial evaluated the effect of thyme honey oral gel for the prevention of chemotherapy-induced OM. METHODS One hundred ten breast cancer patients who received their first cycle of chemotherapy with adriamycin (60 mg/m2) and cyclophosphamide (600 mg/m2) were randomly recruited into two groups: group A were patients who followed general oral hygiene recommendations and rinsing saline 3 times a day, and group B were patients with similar protocol but supplied with our formulated oral gel to be applied 2 to 4 times a day. Patients were assessed by the World Health Organization (WHO) oral mucositis grading scales and self-assessment daily questionnaire. RESULTS The use of thyme honey was associated with diminishing incidence of OM grade ≥ 2 (95% CI, 0.12 to 0.90; P = 0.030), duration of OM (- 3.36 days; 95% CI, - 5.50 to - 1.22; P = 0.037) and delayed occurrence of OM grade ≥ 2 (95% CI, 0.10 to 0.80; P = 0.017). CONCLUSION Thyme honey can be considered as a prophylactic agent for OM and decrease the severity of its symptoms. TRIAL REGISTRATIONS This protocol was registered at the Iranian Registry of Clinical Trials: registration number IRCT201506063106N25, on June 12, 2015; approved by the institutional review board at the Deputy of Research, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran; and approved by the Ethics Committee of Medical Researches of Pharmaceutical Sciences Branch of Islamic Azad University, Tehran, Iran-reference number 5936, on August 17, 2014.
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Affiliation(s)
- Elnaz Jahanbani Mazraeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, P.O. Box 19419, Yasaman St., Yakhchal Ave., Qolhak Ave., Shariati Ave, Tehran, Iran
| | - Sanambar Sadighi
- Department of Hematology/Oncology, Cancer Institute of Iran, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Manifar
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Tehran, Iran
| | - Hooman Bakhshandeh
- Department of Epidemiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Rajabi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, P.O. Box 19419, Yasaman St., Yakhchal Ave., Qolhak Ave., Shariati Ave, Tehran, Iran.
- Department of Clinical Pharmacy, University Hospitals of North Midlands NHS Trust, Stoke-On-Trent, ST4 6QG, UK.
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15
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Arce B, Grañana N. [Cognitive deficits with chemotherapy in women with breast cancer: a bibliographic revisión]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2023; 80:126-133. [PMID: 37402295 PMCID: PMC10443418 DOI: 10.31053/1853.0605.v80.n2.40533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/07/2023] [Indexed: 07/06/2023] Open
Abstract
Background Patients with breast cancer may experience cognitive difficulties from chemotherapy. This alteration is called Chemoinduced Cognitive Impairment, also known as Chemobrain or Chemofog. Objective To identify the cognitive profile and the characteristics of the neuropsychological assessment in this population. Method: PubMed, SpringerLink and SciELO databases were revised. Articles from 1994 to September 2021 were selected. Keywords related to the study topic were used. Results Chemotherapy can cause cognitive impairment between 15 and 50% of women. This disturbance may be from multiple aetiologies and can be associated with biological factors and functional and/or structural changes of the CNS. Sociodemographic, clinical and psychological factors should be considered as modulating variables. It manifests mainly with memory problems, executive function, attention and processing speed impairment. It can be measured through neuropsychological evaluation instruments. Discussion and conclusion We suggest that chemo-induced cognitive impairment should be included to the informed consent. Further development of longitudinal studies complemented with neuroimages that allow us to advance in the knowledge of this problem is recommended. A neuropsychological protocol is proposed, which includes screening tests, clinical scales, specific cognitive tests and quality of life questionnaires, within the recommendations of the International Cognition and Cancer Task Force.
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Alsikhan RS, Aldubayan MA, Almami IS, Alhowail AH. Protective Effect of Galantamine against Doxorubicin-Induced Neurotoxicity. Brain Sci 2023; 13:971. [PMID: 37371449 DOI: 10.3390/brainsci13060971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND AND AIMS Doxorubicin (DOX) causes cognitive impairment (chemobrain) in patients with cancer. While DOX damages the cholinergic system, few studies have focused on the protective effects of cholinergic function on chemobrain. The acetylcholinesterase inhibitor galantamine (GAL) demonstrates neuroprotective properties. We investigated the mechanisms associated with DOX-induced cognitive impairments and the potential protective role of GAL in preventing chemobrain. MAIN METHODS Female Wistar rats were divided into control, DOX, GAL, and DOX + GAL groups. The rats in the DOX group were administered DOX (5 mg/kg intraperitoneally twice weekly for two weeks), while those in the GAL group were orally administered GAL (2.5 mg/kg) via oral gavage once daily for 15 days. The combination group (DOX + GAL) received GAL (once daily) and DOX (two times per week) concurrently. The body weights and survival rates were monitored daily. The animals were subjected to behavioral tests to assess the memory function followed by the biochemical estimation of inflammatory markers, including tumor necrosis factor-α (TNF-α), interleukine-1β (IL-1β), and interleukine-6 (IL-6) in rat brain tissue and RT-qPCR. KEY FINDINGS DOX caused a reduction in the body weight and survival rate, which was alleviated by GAL concomitant treatment with DOX (DOX + GAL). These groups had reduced body weights and survival rates. DOX-treated animals exhibited an impairment of short-term spatial working memory, manifested as a behavioral alteration in the Y-maze test, the novel object recognition (NOR) test, and the elevated plus-maze (EPM) test. Concurrent treatment with GAL (DOX + GAL) showed improved memory function, as evidenced by an increase in the number of entries and time spent in the novel arm, the time spent exploring the novel object, and the transfer latency in the Y-maze, NOR test, and EPM test, respectively. These findings were also supported by biochemical observations showing the reversal of DOX-induced changes in IL-1β, IL-6, and TNF-α, as well as their relative expression of mRNA in brain tissue following concurrent GAL treatment. CONCLUSION GAL appeared to be a neuroprotective agent against neuroinflammation caused by DOX by reducing inflammatory markers in the brain.
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Affiliation(s)
- Rawan S Alsikhan
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Unaizah 51911, Saudi Arabia
| | - Maha A Aldubayan
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
| | - Ibtesam S Almami
- Department of Biology, College of Science, Qassim University, Buraydah 51452, Saudi Arabia
| | - Ahmad H Alhowail
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
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Zhuang Y, Guo L, Huang W, Bo G, Zhang J, Zhu Z, Feng Y. Altered resting-state hippocampal functional connectivity in breast cancer survivors with chemotherapy-induced amenorrhea. Brain Behav 2023; 13:e3039. [PMID: 37157937 PMCID: PMC10275533 DOI: 10.1002/brb3.3039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/14/2023] [Accepted: 04/20/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Amenorrhea induced decrease of hormones is associated with cognitive impairment. This study aimed to evaluate hippocampal functional connectivity patterns in chemotherapy-induced amenorrhea (CIA) breast cancer (BC) patients, to evaluate the relationship between the functional connectivity features and hormone levels. METHOD Neuropsychological test, functional magnetic resonance imaging, and assessment of hormone levels were conducted in 21 premenopausal BC patients before chemotherapy (t0 ) and 1 week after completing chemotherapy (t1 ). Twenty matched healthy controls (HC) were also included and underwent the same assessments at similar time intervals. Mixed effect analysis and paired t-test were used to compare differences in brain functional connectivity. RESULTS Voxel-based paired t-tests revealed increased functional connectivity of the right and left hippocampus with the left fusiform gyrus, inferior and middle temporal gyrus, inferior occipital gyrus, left lingual gyrus, and parahippocampal gyrus after chemotherapy (p < .001) in CIA patients. Repeated measures analysis revealed significant group-by-time interactions in the left hippocampus with the bilateral fusiform gyrus, right parahippocampal gyrus, left inferior temporal gyrus, and left inferior occipital gyrus (p < .001). Premenopausal BC patients had no significant differences in cognitive function compared with HC at baseline. However, the CIA patients had high levels of self-rating depression scale, self-rating anxiety scale, total cholesterol, and triglycerides. Further, the CIA patients showed significant differences in hormone and fasting plasma glucose levels and cognitive performances between t0 and t1 (p < .05). Functional connectivity changes between the left hippocampus and the left inferior occipital gyrus was negatively correlated with E2 and luteinizing hormone changes (p < .05). CONCLUSION The CIA patients had cognitive dysfunction mainly in memory and visual mobility. Chemotherapy may affect hippocampal-posterior cortical circuit which mediates visual processing in CIA patients. Moreover, E2 may be involved in this process.
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Affiliation(s)
- Yingying Zhuang
- Department of Medical ImagingMedical Imaging Center, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical UniversityHuai'anJiangsuChina
| | - Lili Guo
- Department of Medical ImagingMedical Imaging Center, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical UniversityHuai'anJiangsuChina
| | - Wei Huang
- Department of Medical ImagingMedical Imaging Center, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical UniversityHuai'anJiangsuChina
| | - Genji Bo
- Department of Medical ImagingMedical Imaging Center, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical UniversityHuai'anJiangsuChina
| | - Jiandong Zhang
- Department of Medical ImagingMedical Imaging Center, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical UniversityHuai'anJiangsuChina
| | - Zhaohuan Zhu
- Department of Medical ImagingMedical Imaging Center, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical UniversityHuai'anJiangsuChina
| | - Yun Feng
- Department of Medical ImagingMedical Imaging Center, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical UniversityHuai'anJiangsuChina
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Nevins S, McLoughlin CD, Oliveros A, Stein JB, Rashid MA, Hou Y, Jang MH, Lee KB. Nanotechnology Approaches for Prevention and Treatment of Chemotherapy-Induced Neurotoxicity, Neuropathy, and Cardiomyopathy in Breast and Ovarian Cancer Survivors. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023:e2300744. [PMID: 37058079 PMCID: PMC10576016 DOI: 10.1002/smll.202300744] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/05/2023] [Indexed: 06/19/2023]
Abstract
Nanotechnology has emerged as a promising approach for the targeted delivery of therapeutic agents while improving their efficacy and safety. As a result, nanomaterial development for the selective targeting of cancers, with the possibility of treating off-target, detrimental sequelae caused by chemotherapy, is an important area of research. Breast and ovarian cancer are among the most common cancer types in women, and chemotherapy is an essential treatment modality for these diseases. However, chemotherapy-induced neurotoxicity, neuropathy, and cardiomyopathy are common side effects that can affect breast and ovarian cancer survivors quality of life. Therefore, there is an urgent need to develop effective prevention and treatment strategies for these adverse effects. Nanoparticles (NPs) have extreme potential for enhancing therapeutic efficacy but require continued research to elucidate beneficial interventions for women cancer survivors. In short, nanotechnology-based approaches have emerged as promising strategies for preventing and treating chemotherapy-induced neurotoxicity, neuropathy, and cardiomyopathy. NP-based drug delivery systems and therapeutics have shown potential for reducing the side effects of chemotherapeutics while improving drug efficacy. In this article, the latest nanotechnology approaches and their potential for the prevention and treatment of chemotherapy-induced neurotoxicity, neuropathy, and cardiomyopathy in breast and ovarian cancer survivors are discussed.
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Affiliation(s)
- Sarah Nevins
- Department of Chemistry and Chemical Biology, Rutgers
University, the State University of New Jersey, 123 Bevier Road, Piscataway, NJ
08854, U.S.A
| | - Callan D. McLoughlin
- Department of Chemistry and Chemical Biology, Rutgers
University, the State University of New Jersey, 123 Bevier Road, Piscataway, NJ
08854, U.S.A
| | - Alfredo Oliveros
- Department of Neurosurgery, Robert Wood Johnson Medical
School, Rutgers University, the State University of New Jersey, 661 Hoes Ln W,
Piscataway, NJ, 08854, U.S.A
| | - Joshua B. Stein
- Department of Chemistry and Chemical Biology, Rutgers
University, the State University of New Jersey, 123 Bevier Road, Piscataway, NJ
08854, U.S.A
| | - Mohammad Abdur Rashid
- Department of Neurosurgery, Robert Wood Johnson Medical
School, Rutgers University, the State University of New Jersey, 661 Hoes Ln W,
Piscataway, NJ, 08854, U.S.A
| | - Yannan Hou
- Department of Chemistry and Chemical Biology, Rutgers
University, the State University of New Jersey, 123 Bevier Road, Piscataway, NJ
08854, U.S.A
| | - Mi-Hyeon Jang
- Department of Neurosurgery, Robert Wood Johnson Medical
School, Rutgers University, the State University of New Jersey, 661 Hoes Ln W,
Piscataway, NJ, 08854, U.S.A
| | - Ki-Bum Lee
- Department of Chemistry and Chemical Biology, Rutgers
University, the State University of New Jersey, 123 Bevier Road, Piscataway, NJ
08854, U.S.A
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19
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Abstract
The recently uncovered key role of the peripheral and central nervous systems in controlling tumorigenesis and metastasis has opened a new area of research to identify innovative approaches against cancer. Although the 'neural addiction' of cancer is only partially understood, in this Perspective we discuss the current knowledge and perspectives on peripheral and central nerve circuitries and brain areas that can support tumorigenesis and metastasis and the possible reciprocal influence that the brain and peripheral tumours exert on one another. Tumours can build up local autonomic and sensory nerve networks and are able to develop a long-distance relationship with the brain through circulating adipokines, inflammatory cytokines, neurotrophic factors or afferent nerve inputs, to promote cancer initiation, growth and dissemination. In turn, the central nervous system can affect tumour development and metastasis through the activation or dysregulation of specific central neural areas or circuits, as well as neuroendocrine, neuroimmune or neurovascular systems. Studying neural circuitries in the brain and tumours, as well as understanding how the brain communicates with the tumour or how intratumour nerves interplay with the tumour microenvironment, can reveal unrecognized mechanisms that promote cancer development and progression and open up opportunities for the development of novel therapeutic strategies. Targeting the dysregulated peripheral and central nervous systems might represent a novel strategy for next-generation cancer treatment that could, in part, be achieved through the repurposing of neuropsychiatric drugs in oncology.
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Affiliation(s)
- Claire Magnon
- Laboratory of Cancer and Microenvironment-National Institute of Health and Medical Research (INSERM), Institute of Biology François Jacob-Atomic Energy Commission (CEA), University of Paris Cité, University of Paris-Saclay, Paris, France.
| | - Hubert Hondermarck
- School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
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20
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Correa DD, Vachha BA, Baser RE, Koch A, Wong P, Gohel S, Giralt S, Root JC. Neuroimaging and Neurocognitive Outcomes in Older Patients with Multiple Myeloma Treated with Chemotherapy and Autologous Stem Cell Transplantation. RESEARCH SQUARE 2023:rs.3.rs-2733807. [PMID: 37066224 PMCID: PMC10104268 DOI: 10.21203/rs.3.rs-2733807/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background Many patients with hematological malignancies treated with stem cell transplantation (SCT) experience cognitive dysfunction. However, few studies have investigated treatment-related neurotoxicity in older adults with multiple myeloma (MM) treated with high dose chemotherapy (HDC) and autologous SCT (HDC/ASCT). In this study, we examined gray matter (GM) volume, resting state functional connectivity (RSFC), neurocognitive function (NF), and proinflammatory cytokines (PCy) in older patients with MM pre- and post-HDC/ASCT. Methods Eighteen MM patients underwent magnetic resonance imaging, neurocognitive tests, and serum PCy measurement prior to HDC/ASCT, and fifteen patients completed follow ups an average of five months post-HDC/ASCT. Results There were significant decreases in RSFC from pre- to post-HDC/ASCT in (1) the central executive network (CEN) involving the left dorsolateral prefrontal cortex and right posterior parietal cortex (p = 0.022), and (2) the CEN involving the right posterior parietal cortex and the salience network involving the right dorsal anterior cingulate cortex (p = 0.029); these comparisons were no longer significant after multiple comparisons correction. There were no significant changes in GM volumes or NF, except for improvement in attention (Digit Span Backward, p = 0.03). There were significant increases in several PCy post-HDC/ASCT (p ≤ 0.05). Conclusions This pilot study showed decreased RSFC involving the left frontal, right posterior parietal and right anterior cingulate cortices in MM patients post-HDC/ASCT, relatively stable NF, and increases in PCy. These findings are congruent with studies in patients with hematological malignancies and other cancers and provide supporting evidence for the vulnerability of frontoparietal regions to chemotherapy adverse effects.
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Affiliation(s)
| | | | | | | | | | - Suril Gohel
- Rutgers University School of Health Professions
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21
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Fleming B, Edison P, Kenny L. Cognitive impairment after cancer treatment: mechanisms, clinical characterization, and management. BMJ 2023; 380:e071726. [PMID: 36921926 DOI: 10.1136/bmj-2022-071726] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Cognitive impairment is a debilitating side effect experienced by patients with cancer treated with systemically administered anticancer therapies. With around 19.3 million new cases of cancer worldwide in 2020 and the five year survival rate growing from 50% in 1970 to 67% in 2013, an urgent need exists to understand enduring side effects with severe implications for quality of life. Whereas cognitive impairment associated with chemotherapy is recognized in patients with breast cancer, researchers have started to identify cognitive impairment associated with other treatments such as immune, endocrine, and targeted therapies only recently. The underlying mechanisms are diverse and therapy specific, so further evaluation is needed to develop effective therapeutic interventions. Drug and non-drug management strategies are emerging that target mechanistic pathways or the cognitive deficits themselves, but they need to be rigorously evaluated. Clinically, consistent use of objective diagnostic tools is necessary for accurate diagnosis and clinical characterization of cognitive impairment in patients treated with anticancer therapies. This should be supplemented with clinical guidelines that could be implemented in daily practice. This review summarizes the recent advances in the mechanisms, clinical characterization, and novel management strategies of cognitive impairment associated with treatment of non-central nervous system cancers.
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Affiliation(s)
- Ben Fleming
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Paul Edison
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Laura Kenny
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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22
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Giustiniani A, Danesin L, Pezzetta R, Masina F, Oliva G, Arcara G, Burgio F, Conte P. Use of Telemedicine to Improve Cognitive Functions and Psychological Well-Being in Patients with Breast Cancer: A Systematic Review of the Current Literature. Cancers (Basel) 2023; 15:cancers15041353. [PMID: 36831693 PMCID: PMC9954456 DOI: 10.3390/cancers15041353] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
The diagnosis and side effects of breast cancer (BC) treatments greatly affect the everyday lives of women suffering from this disease, with relevant psychological and cognitive consequences. Several studies have reported the psychological effects of receiving a diagnosis of BC. Moreover, women undergoing anticancer therapies may exhibit cognitive impairment as a side effect of the treatments. The access to cognitive rehabilitation and psychological treatment for these patients is often limited by resources; women of childbearing age often encounter difficulties in completing rehabilitation programs requiring access to care institutions. Telemedicine, which provides health services using information and communication technologies, is a useful tool to overcome these limitations. In particular, telemedicine may represent an optimal way to guarantee cognitive rehabilitation, psychological support, and recovery to BC patients. Previous studies have reviewed the use of telemedicine to improve psychological well-being in BC patients, and a few have investigated the effect of telerehabilitation on cognitive deficits. This study systematically reviewed the evidence on the cognitive and psychological effects of telemedicine in BC patients. Current evidence suggests that telemedicine may represent a promising tool for the management of some psychological problems experienced by breast cancer patients, but more controlled studies are needed to clarify its effectiveness, especially for cognitive deficits. The results are also discussed in light of the intervening and modulating factors that may mediate both side effect occurrence and the success of the interventions.
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23
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Hsu YH, Chen HJ, Wu SI, Tzang BS, Hsieh CC, Weng YP, Hsu YT, Hsiao HP, Chen VCH. Cognitive function and breast cancer molecular subtype before and after chemotherapy. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-8. [PMID: 36773021 DOI: 10.1080/23279095.2023.2176233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Chemotherapy-related cognitive impairment has been reported in patients with breast cancer and received growing attention due to increased survival rate. However, cognitive outcome according to pathological tumor features, especially human epidermal growth factor receptor (HER2) status, has not been clearly elucidated. Despite its potential link with cognitive status through neuroinflammatory response, existing research is sparse and limited to cross-sectional studies. In this observational cohort study, 52 breast cancer patients received a series of neuropsychological examinations before and after chemotherapy. Patients' performances were compared with normative data, and analyzed with Reliable Change Indices and mixed-model analysis of covariance. Results showed that there was a higher percentage of HER2+ patients than HER2- patients who showed defective attention and processing speed before chemotherapy, and that there were more patients with HER2+ status showing cognitive decline on tests of attention and executive functions following chemotherapy. Group-wise analyses confirmed the foregoing pattern and further revealed that patients with HER2+ status also tended to deteriorate more in verbal memory after chemotherapy. These findings indicate that HER2 overexpression may serve as prognostic factors that help explain the heterogeneous cognitive outcome in breast cancer survivors. Further studies are needed to replicate this finding and delineate the underlying mechanisms.
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Affiliation(s)
- Yen-Hsuan Hsu
- Department of Psychology, National Chung Cheng University, Chiayi County, Taiwan
- Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Chiayi County, Taiwan
| | - Hui-Jyuan Chen
- Department of Psychology, National Chung Cheng University, Chiayi County, Taiwan
| | - Shu-I Wu
- Department of Medicine, Mackay Medical College, Taipei, Taiwan
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Bor-Show Tzang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Biochemistry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ching-Chuan Hsieh
- Graduate Institute of Clinical Medical Sciences, College of Medicine Chang-Gung University, Taoyuan, Taiwan
- Department of Surgery, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi County, Taiwan
| | - Yi-Ping Weng
- Breast Center, Chiayi Chang Gung Memorial Hospital and University, Puzi, Chiayi County, Taiwan
| | - Ya-Ting Hsu
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi County, Taiwan
| | - Han-Pin Hsiao
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi County, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi County, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
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24
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Grant CV, Sullivan KA, Wentworth KM, Otto LD, Strehle LD, Otero JJ, Pyter LM. Microglia are implicated in the development of paclitaxel chemotherapy-associated cognitive impairment in female mice. Brain Behav Immun 2023; 108:221-232. [PMID: 36494047 PMCID: PMC9899068 DOI: 10.1016/j.bbi.2022.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/30/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Chemotherapy remains a mainstay in the treatment of many types of cancer even though it is associated with debilitating behavioral side effects referred to as "chemobrain," including difficulty concentrating and memory impairment. The predominant hypothesis in the field is that systemic inflammation drives these cognitive impairments, although the brain mechanisms by which this occurs remain poorly understood. Here, we hypothesized that microglia are activated by chemotherapy and drive chemotherapy-associated cognitive impairments. To test this hypothesis, we treated female C57BL/6 mice with a clinically-relevant regimen of a common chemotherapeutic, paclitaxel (6 i.p. doses at 30 mg/kg), which impairs memory of an aversive stimulus as assessed via a contextual fear conditioning (CFC) paradigm. Paclitaxel increased the percent area of IBA1 staining in the dentate gyrus of the hippocampus. Moreover, using a machine learning random forest classifier we identified immunohistochemical features of reactive microglia in multiple hippocampal subregions that were distinct between vehicle- and paclitaxel-treated mice. Paclitaxel treatment also increased gene expression of inflammatory cytokines in a microglia-enriched population of cells from mice. Lastly, a selective inhibitor of colony stimulating factor 1 receptor, PLX5622, was employed to deplete microglia and then assess CFC performance following paclitaxel treatment. PLX5622 significantly reduced hippocampal gene expression of paclitaxel-induced proinflammatory cytokines and restored memory, suggesting that microglia play a critical role in the development of chemotherapy-associated neuroinflammation and cognitive impairments. This work provides critical evidence that microglia drive paclitaxel-associated cognitive impairments, a key mechanistic detail for determining preventative and intervention strategies for these burdensome side effects.
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Affiliation(s)
- Corena V Grant
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kyle A Sullivan
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, USA; Computational and Predictive Biology, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - Kylie M Wentworth
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lauren D Otto
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lindsay D Strehle
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jose J Otero
- Department of Pathology, Ohio State University, Columbus, OH, USA
| | - Leah M Pyter
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, USA; Departments of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA; Department of Neuroscience, Ohio State University, Columbus, OH, USA.
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25
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Chan A, Cheng I, Wang C, Tan CJ, Toh YL, Ng DQ, Koh YQ, Zhou H, Foo KM, Chan RJ, Ho HK, Chew L, Farid M, Tannock I. Cognitive impairment in adolescent and young adult cancer patients: Pre-treatment findings of a longitudinal study. Cancer Med 2023; 12:4821-4831. [PMID: 36221816 PMCID: PMC9972136 DOI: 10.1002/cam4.5295] [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: 09/02/2022] [Revised: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND There is little information about cancer-related cognitive impairment (CRCI) in adolescent and young adults (AYA, 15-39 years old) due to its rare incidence. Here, we present the pre-treatment (before chemotherapy or radiotherapy) evaluation of cognitive function and ability of AYA with cancer (AYAC) in a multicentered cohort study. METHODS Newly diagnosed AYAC and age-matched healthy controls (HC) were recruited between 2018 and 2021. The primary outcome was the comparison of pre-treatment cognitive impairment defined as 2 standard deviations (SDs) below the HC on ≥1 cognitive test, or >1.5 SDs below on ≥2 tests using CANTAB® between AYAC and HC. Secondary outcomes included self-perceived cognitive ability assessed by FACT-Cog v3 and biomarkers (inflammatory cytokines and brain-derived neurotrophic factor [BDNF]). RESULTS We recruited 74 AYAC (median age = 34) and 118 HC (median age = 32). On objective cognitive testing, we observed three times more AYAC patients performed poorly on at least 2 cognitive tests compared to HC (40.5% vs. 13.6%, p < 0.001). AYAC self-perceived less degree of cognitive impairment than HC (p < 0.001). However, AYAC perceived a greater impact of cognitive changes on their quality of life compared to HC (p = 0.039). Elevated baseline inflammatory markers (IL-2, IL-4, IL-6, IL-8, IL-10 and IFN-γ) were observed among AYAC compared to HC, and baseline BDNF was lower in AYAC compared to HC. Interaction effects between cancer diagnosis and biomarkers were observed in predicting cognitive function. CONCLUSION With the pre-existence of CRCI and risk factors of neuroinflammation even prior to systemic therapy, AYAC should receive early rehabilitation to prevent further deterioration of cognitive function after initiation of systemic therapies. (ClinicalTrials.gov Identifier: NCT03476070).
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Affiliation(s)
- Alexandre Chan
- Department of Clinical Pharmacy Practice, University of California Irvine, Irvine, California, USA.,Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - Ivy Cheng
- Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - Claire Wang
- Department of Pharmacy, National University of Singapore, Singapore
| | - Chia Jie Tan
- Department of Pharmacy, National University of Singapore, Singapore
| | - Yi Long Toh
- Department of Pharmacy, National University of Singapore, Singapore
| | - Ding Quan Ng
- Department of Clinical Pharmacy Practice, University of California Irvine, Irvine, California, USA
| | - Yong Qin Koh
- Department of Pharmacy, National University of Singapore, Singapore
| | - Hanzhang Zhou
- Department of Pharmacy, National University of Singapore, Singapore
| | - Koon Mian Foo
- Department of Pharmacy, KK Women and Children's Hospital, Singapore
| | - Raymond Javan Chan
- Caring Futures Institutes, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Han Kiat Ho
- Department of Pharmacy, National University of Singapore, Singapore
| | - Lita Chew
- Department of Pharmacy, National Cancer Centre Singapore, Singapore.,Department of Pharmacy, National University of Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Ian Tannock
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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26
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Carroll JE, Nakamura ZM, Small BJ, Zhou X, Cohen HJ, Ahles TA, Ahn J, Bethea TN, Extermann M, Graham D, Isaacs C, Jim HS, Jacobsen PB, McDonald BC, Patel SK, Rentscher K, Root J, Saykin AJ, Tometich DB, Van Dyk K, Zhai W, Breen EC, Mandelblatt JS. Elevated C-Reactive Protein and Subsequent Patient-Reported Cognitive Problems in Older Breast Cancer Survivors: The Thinking and Living With Cancer Study. J Clin Oncol 2023; 41:295-306. [PMID: 36179271 PMCID: PMC9839283 DOI: 10.1200/jco.22.00406] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/24/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To examine longitudinal relationships between levels of C-reactive protein (CRP) and cognition in older breast cancer survivors and noncancer controls. METHODS English-speaking women age ≥ 60 years, newly diagnosed with primary breast cancer (stage 0-III), and frequency-matched controls were enrolled from September 2010 to March 2020; women with dementia, neurologic disorders, and other cancers were excluded. Assessments occurred presystemic therapy/enrollment and at annual visits up to 60 months. Cognition was measured using the Functional Assessment of Cancer Therapy-Cognitive Function and neuropsychological testing. Mixed linear effect models tested for survivor-control differences in natural log (ln)-transformed CRP at each visit. Random effect-lagged fluctuation models tested directional effects of ln-CRP on subsequent cognition. All models controlled for age, race, study site, cognitive reserve, obesity, and comorbidities; secondary analyses evaluated if depression or anxiety affected results. RESULTS There were 400 survivors and 329 controls with CRP specimens and follow-up data (average age of 67.7 years; range, 60-90 years). The majority of survivors had stage I (60.9%), estrogen receptor-positive (87.6%) tumors. Survivors had significantly higher adjusted mean ln-CRP than controls at baseline and 12-, 24-, and 60-month visits (all P < .05). Higher adjusted ln-CRP predicted lower participant-reported cognition on subsequent visits among survivors, but not controls (P interaction = .008); effects were unchanged by depression or anxiety. Overall, survivors had adjusted Functional Assessment of Cancer Therapy-Cognitive Function scores that were 9.5 and 14.2 points lower than controls at CRP levels of 3.0 and 10.0 mg/L. Survivors had poorer neuropsychological test performance (v controls), with significant interactions with CRP only for the Trails B test. CONCLUSION Longitudinal relationships between CRP and cognition in older breast cancer survivors suggest that chronic inflammation may play a role in development of cognitive problems. CRP testing could be clinically useful in survivorship care.
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Affiliation(s)
- Judith E. Carroll
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Zev M. Nakamura
- Department of Psychiatry, University of North Carolina–Chapel Hill, Chapel Hill, NC
| | - Brent J. Small
- School of Aging Studies, University of South Florida, Tampa, FL
| | - Xingtao Zhou
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | - Harvey J. Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC
| | - Tim A. Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | - Traci N. Bethea
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | - Martine Extermann
- Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL
| | - Deena Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | | | - Paul B. Jacobsen
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Brenna C. McDonald
- Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN
| | | | - Kelly Rentscher
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - James Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew J. Saykin
- Department of Radiology and Imaging Sciences, Melvin and Bren Simon Comprehensive Cancer Center, and Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN
| | | | - Kathleen Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Wanting Zhai
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, DC
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
| | - Elizabeth C. Breen
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Jeanne S. Mandelblatt
- Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University, Washington, DC
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27
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Saita K, Amano S, Kaneko F, Okamura H. A scoping review of cognitive assessment tools and domains for chemotherapy-induced cognitive impairments in cancer survivors. Front Hum Neurosci 2023; 17:1063674. [PMID: 36891148 PMCID: PMC9987518 DOI: 10.3389/fnhum.2023.1063674] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
Backgrounds Cancer survivors suffer from specific symptoms known as chemotherapy-induced cognitive impairments (CICIs). CICIs are difficult to capture with existing assessments such as the brief screening test for dementia. Although recommended neuropsychological tests (NPTs) exist, international consensus and shared cognitive domains of assessment tools are unknown. The aim of this scoping review was as follows: (1) to identify studies that assess CICIs in cancer survivors; (2) to identify shared cognitive assessment tools and domains by mapping the domains reported in studies using the International Classification of Functioning, Disability and Health (ICF) framework. Methods The study followed the recommendations made by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We searched the following three databases through October 2021: PubMed, CINAHL, and Web of Science. Prospective longitudinal or cross-sectional studies were selected to determine CICI-specific assessment tools for adult cancer survivors. Results Sixty-four prospective studies (36 longitudinal studies and 28 cross-sectional studies) were included after checking for eligibility. The NPTs were divided into seven main cognitive domains. The specific mental functions were often used in the order of memory, attention, higher-level cognitive functions, and psychomotor functions. Perceptual functions were used less frequently. In some ICF domains, shared NPTs were not clearly identified. In some different domains, the same NPTs were used, such as the trail making test and the verbal fluency test. When the association between the publishing year and the amount of NPT use was examined, it was found that the amount of tool use tended to decline over the publication years. The Functional Assessment of Cancer Therapy-Cognitive function (FACT-Cog) was a shared consensus tool among the patient-reported outcomes (PROs). Conclusion Chemotherapy-induced cognitive impairments are currently gaining interest. Shared ICF domains such as memory and attention were identified for NPTs. There was a gap between the publicly recommended tools and the tools actually used in the studies. For PROs, a clearly shared tool, FACT-Cog, was identified. Mapping the domains reported in studies using the ICF can help in the process of reviewing consensus on which NPTs may be used to target cognitive domains. Systematic review registration https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000053710, identifier UMIN000047104.
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Affiliation(s)
- Kazuya Saita
- Department of Psychosocial Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Satoru Amano
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Fumiko Kaneko
- Department of Psychosocial Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hitoshi Okamura
- Department of Psychosocial Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Syed Alwi SM, Mazlan M, Mohd Taib NA, Che Din N, Narayanan V. A Delphi technique toward the development of a cognitive intervention framework module for breast cancer survivors with cognitive impairment following chemotherapy. PLoS One 2022; 17:e0277056. [PMID: 36395277 PMCID: PMC9671464 DOI: 10.1371/journal.pone.0277056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 10/18/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Chemotherapy-related cognitive impairment (CRCI) is a well-known phenomenon among breast cancer survivors. Cognitive impairment among breast cancer survivors can significantly affect their quality of life and ability to function independently. However, there is a lack of specific and focused cognitive intervention to improve their cognitive performances. This study aimed to develop a tailored cognitive intervention framework module by adapting the attention and memory interventions from the Cognitive Rehabilitation Manual of the Brain Injury Interdisciplinary Special Interest Group (BI-SIG) of the American Congress of Rehabilitation Medicine (ACRM) and incorporating them with the relevant exercises for cognitive rehabilitation for Malaysian breast cancer survivors with CRCI based on the consensus agreement of the expert panel. Methods and analysis The Delphi consensus technique was conducted online to review and evaluate the framework module. A panel of experts, including rehabilitation medicine physicians, occupational therapists, and clinical psychologists in Malaysia, was invited to participate in this study. For each round, the expert consensus was defined as more than 90% of the expert panel agreeing or strongly agreeing with the proposed items. Results A total of 33 practitioners completed the three Delphi rounds. 72.7% of the expert panel have been practising in their relevant clinical fields for more than six years (M = 10.67, SD = 5.68). In Round 1, 23% of the experts suggested that the framework module for attention training required further improvements, specifically in the language (M = 1.97, SD = 0.75) and instructions (M = 2.03, SD = 0.71) provided. In Round 2, 15% of the experts recommended additional changes in the instruction (M = 2.15, SD = 0.67) for attention training. Amendments made to the framework module in line with the recommendations provided by the experts resulted in a higher level of consensus, as 94% to 100% of the experts in Round 3 concluded the framework module was suitable and comprehensive for our breast cancer survivors. Following the key results, the objectives were practical, and the proposed approaches, strategies, and techniques for attention and memory training were feasible. The clarity of the instructions, procedures, verbatim transcripts, and timeframe further enhanced the efficacy and utility of the framework module. Conclusions This study found out that the cognitive intervention framework module for breast cancer survivors with cognitive impairment following chemotherapy can be successfully developed and feasible to be implemented using Delphi technique.
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Affiliation(s)
| | - Mazlina Mazlan
- Department of Rehabilitation Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Normah Che Din
- School of Healthcare Sciences, Faculty of Health Science, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Vairavan Narayanan
- Department of Surgery, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
- * E-mail:
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29
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Bradley-Garcia M, Winocur G, Sekeres MJ. Episodic Memory and Recollection Network Disruptions Following Chemotherapy Treatment in Breast Cancer Survivors: A Review of Neuroimaging Findings. Cancers (Basel) 2022; 14:4752. [PMID: 36230678 PMCID: PMC9563268 DOI: 10.3390/cancers14194752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Long-term memory disturbances are amongst the most common and disruptive cognitive symptoms experienced by breast cancer survivors following chemotherapy. To date, most clinical assessments of long-term memory dysfunction in breast cancer survivors have utilized basic verbal and visual memory tasks that do not capture the complexities of everyday event memories. Complex event memories, including episodic memory and autobiographical memory, critically rely on hippocampal processing for encoding and retrieval. Systemic chemotherapy treatments used in breast cancer commonly cause neurotoxicity within the hippocampus, thereby creating a vulnerability to memory impairment. We review structural and functional neuroimaging studies that have identified disruptions in the recollection network and related episodic memory impairments in chemotherapy-treated breast cancer survivors, and argue for the need to better characterize hippocampally mediated memory dysfunction following chemotherapy treatments. Given the importance of autobiographical memory for a person's sense of identity, ability to plan for the future, and general functioning, under-appreciation of how this type of memory is impacted by cancer treatment can lead to overlooking or minimizing the negative experiences of breast cancer survivors, and neglecting a cognitive domain that may benefit from intervention strategies.
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Affiliation(s)
| | - Gordon Winocur
- Rotman Research Institute, Baycrest Centre, Toronto, ON M6A 2E1, Canada
- Department of Psychology, Department of Psychiatry, University of Toronto, Toronto, ON M5S 3G3, Canada
- Department of Psychology, Trent University, Peterborough, ON K9J 7B8, Canada
| | - Melanie J Sekeres
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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30
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Oppegaard KR, Armstrong TS, Anguera JA, Kober KM, Debr LK, Laister RC, Saligan LN, Ayala AP, Kuruvilla J, Alm MW, Byker WH, Miaskowski C, Mayo SJ. Blood-Based Biomarkers of Cancer-Related Cognitive Impairment in Non-Central Nervous System Cancer: A Scoping Review. Crit Rev Oncol Hematol 2022; 180:103822. [PMID: 36152911 DOI: 10.1016/j.critrevonc.2022.103822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
This scoping review was designed to synthesize the extant literature on associations between subjective and/or objective measures of cancer-related cognitive impairment (CRCI) and blood-based biomarkers in adults with non-central nervous system cancers. The literature search was done for studies published from the start of each database searched (i.e., MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, grey literature) through to October 20, 2021. A total of 95 studies are included in this review. Of note, a wide variety of biomarkers were evaluated. Most studies evaluated patients with breast cancer. A variety of cognitive assessment measures were used. The most consistent significant findings were with various subjective and objective measures of CRCI and levels of interleukin-6 and tumor necrosis factor. Overall, biomarker research is in an exploratory phase. However, this review synthesizes findings and proposes directions for future research.
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Affiliation(s)
- Kate R Oppegaard
- University of California San Francisco, School of Nursing, Department of Physiological Nursing, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, USA
| | - Joaquin A Anguera
- University of California San Francisco, Department of Neurology and Psychiatry, USA
| | - Kord M Kober
- University of California San Francisco, School of Nursing, Department of Physiological Nursing, USA
| | - Lynch Kelly Debr
- University of Florida, College of Nursing, USA; University of Florida Health Cancer Center, USA
| | - Rob C Laister
- Princess Margaret Health Center, University Health Network, Canada
| | - Leorey N Saligan
- Symptoms Biology Unit, Division of Intramural Research, National Institutes of Health, USA
| | | | - John Kuruvilla
- Princess Margaret Health Center, University Health Network, Canada
| | - Mark W Alm
- Toronto General Hospital, University Health Network, Canada
| | | | - Christine Miaskowski
- University of California San Francisco, School of Medicine, Department of Anesthesia and Perioperative Care, USA
| | - Samantha J Mayo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada.
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Hajj A, Khoury R, Hachem R, Awad A, Hallit S, Sacre H, Nasr F, Karak FE, Chahine G, Kattan J, Khabbaz LR. Clinical and genetic factors associated with self-reported cognitive deficits in women with breast cancer: the "CAGE-Cog" study. BMC Cancer 2022; 22:996. [PMID: 36123640 PMCID: PMC9487123 DOI: 10.1186/s12885-022-10077-6] [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] [Received: 05/04/2022] [Accepted: 09/06/2022] [Indexed: 11/27/2022] Open
Abstract
Background Breast cancer patients undergoing chemotherapy treatment are at particular risk of experiencing acute cognitive impairment leading to daily challenges in decision-making and reduced quality of life and functional autonomy. The aim was to assess the relationship between clinical and genetic factors and cognitive function in a sample of patients with breast cancer undergoing chemotherapy. Methods A cross-sectional study was carried out between November 2017 and June 2019 on women (N = 112) treated for breast cancer by intravenous chemotherapy at the oncology outpatient unit of Hôtel-Dieu de France Hospital, Beirut. Patients were evaluated with the 37-item Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog). Other validated scales were also used to assess depression, anxiety, sleep disorders, pain, and fatigue. DNA was obtained by a buccal swab (FTA®technology) for genotyping of different genes (ABCB1, COMT, DRD2, OPRM1, CLOCK, CRY2, and PER2) using the Lightcycler®(Roche). Results The mean age of participants was 56.04 years. Multivariable analysis, taking the four FACT-Cog subscores as the dependent variables, showed that the mean cognitive score decreased with higher depression, anxiety, and insomnia scores. Patients with university education levels had better perceived cognitive abilities than those with primary education. Moreover, carrying the G allele for the OPRM1 polymorphism (c.118A > G;rs197791) was significantly associated with a better cognitive function compared to AA patients (B = 2.05; p = 0.038). Conclusions A comprehensive oncological care plan should include a personalized assessment of all factors related to cognitive functioning in cancer patients, particularly anxiety and depression, to achieve an optimal patient outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10077-6.
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Affiliation(s)
- Aline Hajj
- Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon. .,Laboratoire de Pharmacologie, Pharmacie Clinique Et Contrôle de Qualité Des Médicaments, Saint-Joseph University of Beirut, Beirut, Lebanon. .,Faculty of Pharmacy, Université Laval, Québec, Canada.
| | - Rita Khoury
- Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon.,Laboratoire de Pharmacologie, Pharmacie Clinique Et Contrôle de Qualité Des Médicaments, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Roula Hachem
- Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon.,Laboratoire de Pharmacologie, Pharmacie Clinique Et Contrôle de Qualité Des Médicaments, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Aya Awad
- Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Psychology Department, College of Humanities, Effat University, Jeddah, 21478, Saudi Arabia
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon
| | - Fady Nasr
- Department of Hemato-Oncology, Faculty of Medicine, Hôtel-Dieu de France Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Fadi El Karak
- Department of Hemato-Oncology, Faculty of Medicine, Hôtel-Dieu de France Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Georges Chahine
- Department of Hemato-Oncology, Faculty of Medicine, Hôtel-Dieu de France Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Joseph Kattan
- Department of Hemato-Oncology, Faculty of Medicine, Hôtel-Dieu de France Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Lydia Rabbaa Khabbaz
- Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon.,Laboratoire de Pharmacologie, Pharmacie Clinique Et Contrôle de Qualité Des Médicaments, Saint-Joseph University of Beirut, Beirut, Lebanon
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Chen SH, Wang X. A high preoperative serum IL-25 level is a negative prognosis predictor after liver resection for HBV-HCC. Front Oncol 2022; 12:858151. [PMID: 36119529 PMCID: PMC9478489 DOI: 10.3389/fonc.2022.858151] [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: 01/21/2022] [Accepted: 08/10/2022] [Indexed: 12/24/2022] Open
Abstract
Objective The aim of this study was to evaluate the association between preoperative IL-25 levels and HBV-HCC patient outcomes following liver surgery. Methods This study enrolled consecutive HCC patients that had undergone liver surgery from 2008 to 2015. Baseline patient clinical properties were assessed to establish predictors of postoperative overall survival and recurrence-free survival (OS and RFS, respectively) following liver resection. In addition, serum IL-25 levels were assessed via ELISA. Results Cox regression analyses revealed IL-25 levels to be independently related to the OS and RFS of 896 HBV-associated HCC patients. An optimal IL-25 cutoff level of 14.9 μg/ml was identified, with 206 patients in this cohort having IL-25 levels above this threshold. Both the OS and RFS of patients with an IL-25 level <14.9 μg/ml were significantly better after liver resection as compared to those of patients with higher preoperative levels of this cytokine (p < 0.05). Cox multivariate regression analyses revealed an IL-25 level ≥ 14.9 μg/L to be an independent predictor of poorer RFS and OS. A combination of IL-25 levels and tumor diameter may be an even more reliable predictor of OS. Conclusions IL-25 levels are independent predictors of postoperative survival within HCC patients undergoing liver resection.
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Affiliation(s)
- Shao-hua Chen
- Department of Hepatobiliary Surgery, 900TH Hospital of Logistics Support Force, Fuzhou, China
| | - Xu Wang
- Outpatient Department, Meng chao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
- *Correspondence: Xu Wang,
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33
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Cristiano C, Cuozzo M, Coretti L, Liguori F, Cimmino F, Turco L, Avagliano C, Aviello G, Mollica M, Lembo F, Russo R. Oral sodium butyrate supplementation ameliorates paclitaxel-induced behavioral and intestinal dysfunction. Biomed Pharmacother 2022; 153:113528. [DOI: 10.1016/j.biopha.2022.113528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 12/16/2022] Open
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34
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Khan MA, Bhurani D, Hoda U, Sehar N, Agarwal N. Cognitive impairment and elevated peripheral cytokines in breast cancer patients receiving chemotherapy. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:786-793. [PMID: 36252586 PMCID: PMC9703892 DOI: 10.1055/s-0042-1755234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Anthracyclines-based regimen (5-fluorouracil, doxorubicin, and cyclophosphamide (FAC); cyclophosphamide, epirubicin, and 5-fluorouracil [CEF]) and non-anthracycline based regimens (cyclophosphamide, methotrexate, and 5-fluorouracil [CMF]) are widely used as neoadjuvant chemotherapy for breast cancer patients. OBJECTIVE The present study was conducted to observe the effects of FAC, CEF, and CMF regimen on cognition and circulatory proinflammatory cytokines (interleukin 6 [IL-6] and interleukin 1β [IL-1β]) for the duration of three cycles of chemotherapy in breast cancer patients. METHODS Eighty newly diagnosed HER-2 negative breast cancer patients were enrolled and divided into 3 groups as FAC- (n = 27), CEF- (n = 26), and CMF- (n = 27) receiving patients. Serum IL-6 and IL-1β levels were measured by using enzyme-linked immunosorbent assay (ELISA), and cognition was assessed using the Mini-Mental State examination (MMSE) questionnaire. RESULTS Anthracycline-based regimen was found to increase the levels of IL-6, IL-1β, and decreased MMSE scores compared with CMF regimen (p < 0.05). CONCLUSION Anthracycline-based regimen caused comparatively higher peripheral inflammation, which could be the reason for more decline in cognition in anthracycline-receiving patients than non-anthracycline group.
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Affiliation(s)
- Mohd Ashif Khan
- Jamia Hamdard, School of Chemical and Life Sciences, Centre for Translational and Clinical Research, New Delhi, India,Jamia Hamdard, School of Pharmaceutical Education and Research, Department of Pharmaceutical Medicine, New Delhi, India
| | - Dinesh Bhurani
- Rajiv Gandhi Cancer Institute & Research Centre, Department of Hemato-Oncology & Bone Marrow Transplantation, Rohini, New Delhi, India
| | - Ubedul Hoda
- Jamia Hamdard, School of Pharmaceutical Education and Research, Department of Pharmacology, New Delhi, India
| | - Nouroz Sehar
- Jamia Hamdard, School of Chemical and Life Sciences, Department of Medical Elementology and Toxicology, New Delhi, India
| | - Nidhi Agarwal
- Jamia Hamdard, School of Chemical and Life Sciences, Centre for Translational and Clinical Research, New Delhi, India
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35
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Principe DR, Kamath SD, Korc M, Munshi HG. The immune modifying effects of chemotherapy and advances in chemo-immunotherapy. Pharmacol Ther 2022; 236:108111. [PMID: 35016920 PMCID: PMC9271143 DOI: 10.1016/j.pharmthera.2022.108111] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/06/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023]
Abstract
Immune checkpoint inhibitors (ICIs) have transformed the treatment paradigm for several malignancies. While the use of single-agent or combined ICIs has achieved acceptable disease control rates in a variety of solid tumors, such approaches have yet to show substantial therapeutic efficacy in select difficult-to-treat cancer types. Recently, select chemotherapy regimens are emerging as extensive modifiers of the tumor microenvironment, leading to the reprogramming of local immune responses. Accordingly, data is now emerging to suggest that certain anti-neoplastic agents modulate various immune cell processes, most notably the cross-presentation of tumor antigens, leukocyte trafficking, and cytokine biosynthesis. As such, the combination of ICIs and cytotoxic chemotherapy are beginning to show promise in many cancers that have long been considered poorly responsive to ICI-based immunotherapy. Here, we discuss past and present attempts to advance chemo-immunotherapy in these difficult-to-treat cancer histologies, mechanisms through which select chemotherapies modify tumor immunogenicity, as well as important considerations when designing such approaches to maximize efficacy and improve therapeutic response rates.
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Affiliation(s)
- Daniel R Principe
- Medical Scientist Training Program, University of Illinois College of Medicine, Chicago, IL, USA; Department of Surgery, Division of Surgical Oncology, University of Illinois at Chicago, Chicago, IL, USA.
| | - Suneel D Kamath
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Murray Korc
- Department of Developmental and Cell Biology, University of California, Irvine, CA, USA
| | - Hidayatullah G Munshi
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Jesse Brown VA Medical Center, Chicago, IL, USA
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Change in Patients' Perceived Cognition Following Chimeric Antigen Receptor T-Cell Therapy for Lymphoma. Transplant Cell Ther 2022; 28:401.e1-401.e7. [PMID: 35580732 PMCID: PMC9339228 DOI: 10.1016/j.jtct.2022.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/13/2022] [Accepted: 05/10/2022] [Indexed: 12/17/2022]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy can lead to durable responses in patients with relapsed/refractory hematologic malignancies. Immune effector cell-associated neurotoxicity syndrome (ICANS) and cytokine release syndrome (CRS) are common and may place patients at risk for longer-term cognitive impairment. This study examined changes in cognition in the first year after CD19-directed CAR T-cell therapy for lymphoma, as well as CAR T-cell therapy-specific risk-factors (e.g., ICANS, CRS) and nonspecific risk factors (e.g., baseline quality of life, frailty) for worsening cognition. Patients' perceived cognition was assessed at baseline and at days 90 and 360. Clinical variables were abstracted from medical records. Piecewise mixed models were used to examine acute change (i.e., within 90 days) and longer-term change (i.e., from 90 days to 360 days) in cognition, as well as to explore risk factors for worsening cognition. Among 118 participants (mean age 61, 59% male), mean levels of perceived cognition did not change from baseline to day 90 (P> .05) but worsened from day 90 to day 360 in global cognition and in the domains of memory, language, organization, and divided attention (P< .05). Although statistically significant, changes were small (d values 0.15-0.28). Greater baseline fatigue, anxiety, and depression were associated with worse global cognition at day 90 (P< .01). Patients with more severe ICANS post-CART reported worse global cognition at day 360 (P< .05), although there were no differences in perceived cognition by severity of CRS (P> .05). Other putative risk factors were not associated with acute or longer-term changes in perceived cognition (P> .05). CAR T-cell therapy recipients reported delayed deterioration in several cognitive domains, although changes were small. These findings may be useful when educating future patients on what to expect when receiving CAR T-cell therapy.
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Eroğlu İ, Eroğlu BÇ. Potential role of tryptophan catabolism in cancer-related cognitive impairment. Nutrition 2022; 103-104:111765. [PMID: 35908496 DOI: 10.1016/j.nut.2022.111765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/31/2022] [Indexed: 12/24/2022]
Abstract
Oncology may be the most rapidly expanding field in medicine, with several innovative diagnostic and therapeutic procedures appearing daily. Advances in oncology have improved the survival rate for patients with cancer and promoting quality of life is now one of the goals in the care of these patients. Patients face a variety of disease- and treatment-related side effects, including anorexia, nausea, vomiting, recurring infections, and sleep difficulties. Cancer-related cognitive impairment (CRCI) is an overlooked clinical condition found in oncologic practice, particularly in patients with breast cancer. Although several potential mechanisms for CRCI have been hypothesized, to our knowledge, the exact mechanism is still unknown. Alterations in the tryptophan kynurenine pathway have been shown to impair cognitive skills in several mental illnesses. However, its possible function in CRCI has yet to be investigated. The aim of this was to examine the possible interactions between tryptophan catabolism and CRCI.
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Affiliation(s)
- İmdat Eroğlu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey.
| | - Burcu Çelik Eroğlu
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
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Li S, Zhao S, Guo Y, Yang Y, Huang J, Wang J, Lu S, Wang B, Chai C, Xu Z, Chin Y. Clinical Efficacy and Potential Mechanisms of Acupoint Stimulation Combined With Chemotherapy in Combating Cancer: A Review and Prospects. Front Oncol 2022; 12:864046. [PMID: 35547876 PMCID: PMC9082419 DOI: 10.3389/fonc.2022.864046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/23/2022] [Indexed: 11/14/2022] Open
Abstract
Although chemotherapy is the first-line treatment strategy for a variety of tumors, its side effects have limited its efficacy. This review summarizes the progress on the use of acupoint stimulation to combat chemotherapy-associated side effects, including chemotherapy-induced peripheral neuropathy (CIPN), cognitive impairment (CICI), and gastrointestinal toxicity (GI), as well as myelosuppression and immunosuppression. It was found that acupoint stimulation attenuated CIPN and GI by modulating the 5-hydroxytryptamine system in dorsal root ganglia, the dorsal horn of the spinal cord, and the duodenum by reducing oxidative stress and neuroinflammation. Acupoint stimulation also alleviated GI by activating vagal activity in the nucleus tractus solitarius and promoting the secretion of gastrointestinal neuropeptide hormones. Acupoint stimulation restored both bone marrow hematopoiesis and immune function to combat cancer. In addition, the combination of acupoint stimulation and chemotherapy could inhibit tumor growth by promoting tumor cell apoptosis and the enrichment of chemotherapeutic agents in tumor tissue and by modulating the tumor immune microenvironment and normalizing the vasculature. Multiple evidence also indicates that neuroimmune regulation may be involved in the effects of acupoint stimulation. In conclusion, the evidence suggests that acupoint stimulation can alleviate the side effects of chemotherapy and can also assist chemotherapeutic agents in inhibiting tumor growth, which expands the clinical application of acupoint stimulation in cancer treatment. However, more high-quality clinical studies are needed to confirm the clinical value of acupoint stimulation.
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Affiliation(s)
- Shanshan Li
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Suhong Zhao
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yi Guo
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yuanzhen Yang
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jin Huang
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jiaqi Wang
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shanshan Lu
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Bin Wang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Chao Chai
- Department of Radiology, Tianjin Institute of Imaging Medicine, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Zhifang Xu
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.,School of Acupuncture and Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yenlie Chin
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Belcher EK, Culakova E, Gilmore NJ, Hardy SJ, Kleckner AS, Kleckner IR, Lei L, Heckler C, Sohn MB, Thompson BD, Lotta LT, Werner ZA, Geer J, Hopkins JO, Corso SW, Rich DQ, van Wijngaarden E, Janelsins MC. Inflammation, Attention, and Processing Speed in Patients With Breast Cancer Before and After Chemotherapy. J Natl Cancer Inst 2022; 114:712-721. [PMID: 35134984 PMCID: PMC9086766 DOI: 10.1093/jnci/djac022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/20/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammation may contribute to cognitive difficulties in patients with breast cancer. We tested 2 hypotheses: inflammation is elevated in patients with breast cancer vs noncancer control participants and inflammation in patients is associated with worse attention and processing speed over the course of chemotherapy. METHODS Serum cytokines (interleukin [IL]-4, 6, 8, 10; tumor necrosis factor [TNF]-α) and soluble receptors [sTNFRI, II]) were measured in 519 females with breast cancer before and after chemotherapy and 338 females without cancer serving as control participants. Attention and processing speed were measured by Rapid Visual Processing (RVP), Backward Counting (BCT), and Trail Making-A (TMT-A) tests. Linear regression models examined patient vs control cytokines and receptor levels, adjusting for covariates. Linear regression models also examined relationships between patient cytokines and receptor levels and test performance, adjusting for age, body mass index, anxiety, depression, cognitive reserve, and chemotherapy duration. Statistical tests were 2-sided (α = .05). RESULTS sTNFRI and sTNFRII increased over time in patients relative to controls, whereas IL-4, IL-6, and IL-10 decreased. Prechemotherapy, higher IL-8 associated with worse BCT (β = 0.610, SE = 0.241, P = .01); higher IL-4 (β = -1.098, SE = 0.516, P = .03) and IL-10 (β = -0.835, SE = 0.414, P = .04) associated with better TMT-A. Postchemotherapy, higher IL-8 (β = 0.841, SE = 0.260, P = .001), sTNFRI (β = 6.638, SE = 2.208, P = .003), and sTNFRII (β = 0.913, SE = 0.455, P = .045) associated with worse BCT; higher sTNFRII also associated with worse RVP (β = -1.316, SE = 0.587, P = .03). At prechemotherapy, higher IL-4 predicted RVP improvement over time (β = 0.820, SE = 0.336, P = .02); higher sTNFRI predicted worse BCT over time (β = 5.566, SE = 2.367, P = .02). Longitudinally, increases in IL-4 associated with BCT improvement (β = -0.564, SE = 0.253, P = .03). CONCLUSIONS Generally, worse attention and processing speed were associated with higher inflammatory cytokines and receptors and lower anti-inflammatory cytokines in patients; future confirmatory studies are needed.
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Affiliation(s)
- Elizabeth K Belcher
- Department of Surgery, Supportive Care in Cancer Division, University of Rochester Medical Center, Rochester, NY, USA
| | - Eva Culakova
- Department of Surgery, Supportive Care in Cancer Division, University of Rochester Medical Center, Rochester, NY, USA
| | - Nikesha J Gilmore
- Department of Surgery, Supportive Care in Cancer Division, University of Rochester Medical Center, Rochester, NY, USA
| | - Sara J Hardy
- Department of Surgery, Supportive Care in Cancer Division, University of Rochester Medical Center, Rochester, NY, USA
- Department of Radiation Oncology and Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Amber S Kleckner
- Department of Surgery, Supportive Care in Cancer Division, University of Rochester Medical Center, Rochester, NY, USA
| | - Ian R Kleckner
- Department of Surgery, Supportive Care in Cancer Division, University of Rochester Medical Center, Rochester, NY, USA
| | - Lianlian Lei
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Charles Heckler
- Department of Surgery, Supportive Care in Cancer Division, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael B Sohn
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Bryan D Thompson
- Department of Surgery, Supportive Care in Cancer Division, University of Rochester Medical Center, Rochester, NY, USA
| | - Louis T Lotta
- Department of Surgery, Supportive Care in Cancer Division, University of Rochester Medical Center, Rochester, NY, USA
| | - Zachary A Werner
- Department of Surgery, Supportive Care in Cancer Division, University of Rochester Medical Center, Rochester, NY, USA
| | - Jodi Geer
- Metro Minnesota Community Oncology Research Consortium, Louis Park, MN, USA
| | | | - Steven W Corso
- Upstate Carolina National Cancer Institute Community Oncology Research Program, Spartanburg Regional Medical Center, Spartanburg, SC, USA
| | - David Q Rich
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Michelle C Janelsins
- Department of Surgery, Supportive Care in Cancer Division, University of Rochester Medical Center, Rochester, NY, USA
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Effects of Baduanjin exercise on cognitive function and cancer-related symptoms in women with breast cancer receiving chemotherapy: a randomized controlled trial. Support Care Cancer 2022; 30:6079-6091. [PMID: 35416502 DOI: 10.1007/s00520-022-07015-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/25/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE Cognitive decline is one of the main side effects of breast cancer patients after relevant treatment, but there is a lack of clear measures for prevention and management without definite mechanism. Moreover, postoperative patients also have a need for limb rehabilitation. Whether the cognitive benefits of Baduanjin exercise can improve the overall well-being of breast cancer patients remains unknown. METHODS This randomized controlled trial was conducted on 70 patients with breast cancer receiving chemotherapy who were randomly assigned and allocated to (1:1) a supervised Baduanjin intervention group (5 times/week, 30 min each time) or a control group for 3 months. The effects of Baduanjin exercise intervention were evaluated by outcome measures including subjective cognitive function, symptoms (fatigue, depression, and anxiety), and health-related quality of life at pre-intervention (T0), 4 weeks (T1), 8 weeks (T2), and 12 weeks (T3). The collected data were analyzed by using an intention-to-treat principle and linear mixed-effects modeling. RESULTS Participants in the Baduanjin intervention group had a significantly greater improvement in terms of FACT-Cog (F = 14.511; p < 0.001), PCI (F = 15.789; p < 0.001), PCA (F = 6.261; p = 0.015), and FACT-B scores (F = 8.900; p = 0.004) compared with the control group over the time. The exercise-cognition relationship was significantly mediated through the reduction of fatigue (indirect effect: β = 0.132; 95% CI 0.046 to 0.237) and the improvement of anxiety (indirect effect: β = - 0.075; 95% CI - 0.165 to -0.004). CONCLUSIONS This pilot study revealed the benefits of Baduanjin exercise for subjective cognition and health-related quality of life of Chinese breast cancer patients receiving chemotherapy and outlined the underlying mediating mechanism of exercise-cognition. The findings provided insights into the development of public health initiatives to promote brain health and improve quality of life among breast cancer patients. TRIAL REGISTRATION NUMBER ChiCTR 2,000,033,152.
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Dias-Carvalho A, Ferreira M, Reis-Mendes A, Ferreira R, Bastos ML, Fernandes E, Sá SI, Capela JP, Carvalho F, Costa VM. Chemobrain: mitoxantrone-induced oxidative stress, apoptotic and autophagic neuronal death in adult CD-1 mice. Arch Toxicol 2022; 96:1767-1782. [PMID: 35306571 DOI: 10.1007/s00204-022-03261-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/17/2022] [Indexed: 12/17/2022]
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Neuroprotective effect of Mulmina Mango against chemotherapy-induced cognitive decline in mouse model of mammary carcinoma. Sci Rep 2022; 12:3072. [PMID: 35197512 PMCID: PMC8866531 DOI: 10.1038/s41598-022-06862-9] [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: 09/02/2021] [Accepted: 02/01/2022] [Indexed: 11/08/2022] Open
Abstract
The post-treatment status of breast cancer survivors has become a concern because of the toxicity induced by chemotherapeutic agents in the brain tissues resulting in cognitive deficits, which is generally referred as chemobrain. The aim of this study was to assess the effect of a proprietary ayurvedic formulation Mulmina Mango against chemotherapy-induced cognitive impairment (CICI). Mammary carcinoma was induced by subcutaneously inoculating 4T1 cells into the mammary fat pad of the animals. Intraperitoneal administration of Cyclophosphamide, Methotrexate, 5-Fluorouracil (CMF) regimen was carried out once a week for three weeks. Treatment of Mulmina began one week before chemotherapy and continued till the end of the chemotherapy cycle. After three cycles of chemotherapy, cognitive decline was assessed by Morris water maze task followed by assessment of locomotor activity by open-field test. Tumor progression was evaluated by measurement of tumor volume. Oxidative and neuroinflammatory markers were also evaluated from the isolated brain samples. CMF treatment resulted in a considerable reduction in tumour volume. We found chemotherapy negatively affected behavioral and biochemical parameters in animals and Mulmina treatment ameliorated these cognitive impairments by restoring antioxidant and maintaining cytokine levels. The combination of phytochemicals in Mulmina proved its possible ability to alleviate CICI without affecting chemotherapeutic efficiency and could pave the way for identifying treatment strategies to combat chemobrain.
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Janelsins MC, Lei L, Netherby-Winslow C, Kleckner AS, Kerns S, Gilmore N, Belcher E, Thompson BD, Werner ZA, Hopkins JO, Long J, Cole S, Culakova E. Relationships between cytokines and cognitive function from pre- to post-chemotherapy in patients with breast cancer. J Neuroimmunol 2022; 362:577769. [PMID: 34871864 PMCID: PMC10659959 DOI: 10.1016/j.jneuroim.2021.577769] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/01/2021] [Accepted: 11/15/2021] [Indexed: 11/20/2022]
Abstract
Cancer-related cognitive decline (CRCD) is a clinically important problem and negatively affects daily functioning and quality of life. We conducted a pilot longitudinal study from pre- to post-chemotherapy in patients with breast cancer to assess changes in inflammation and cognition over time, as well as the impact of baseline cytokine level on post-chemotherapy cognitive scores. We found that concentrations of IL-6, MCP-1, sTNFRI, and sTNFRII significantly increased in patients, while IL-1β significantly decreased (p < 0.05). After controlling for covariates, increases in IL-6 and MCP-1 were associated with worse executive function and verbal fluency in patients from pre- to post-chemotherapy (p < 0.05). Higher baseline IL-6 was associated with better performance on executive function and verbal fluency post chemotherapy (p < 0.05). Overall, these results suggest that chemotherapy-associated increases in cytokines/receptors is associated with worse cognitive function. Larger studies are needed to confirm these findings.
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Affiliation(s)
- Michelle C Janelsins
- Department of Surgery, Supportive Care in Cancer, University of Rochester, 265 Crittenden Blvd., Rochester, NY 14642, United States; Wilmot Cancer Institute, Rochester, NY 14642, United States.
| | - Lianlian Lei
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Colleen Netherby-Winslow
- Department of Surgery, Supportive Care in Cancer, University of Rochester, 265 Crittenden Blvd., Rochester, NY 14642, United States
| | - Amber S Kleckner
- Department of Surgery, Supportive Care in Cancer, University of Rochester, 265 Crittenden Blvd., Rochester, NY 14642, United States; Wilmot Cancer Institute, Rochester, NY 14642, United States
| | - Sarah Kerns
- Wilmot Cancer Institute, Rochester, NY 14642, United States; Department of Radiation Oncology, University of Rochester, Rochester, NY 14624, United States
| | - Nikesha Gilmore
- Department of Surgery, Supportive Care in Cancer, University of Rochester, 265 Crittenden Blvd., Rochester, NY 14642, United States; Wilmot Cancer Institute, Rochester, NY 14642, United States
| | - Elizabeth Belcher
- Department of Surgery, Supportive Care in Cancer, University of Rochester, 265 Crittenden Blvd., Rochester, NY 14642, United States; Wilmot Cancer Institute, Rochester, NY 14642, United States
| | - Bryan D Thompson
- Department of Surgery, Supportive Care in Cancer, University of Rochester, 265 Crittenden Blvd., Rochester, NY 14642, United States
| | - Zachary A Werner
- Department of Surgery, Supportive Care in Cancer, University of Rochester, 265 Crittenden Blvd., Rochester, NY 14642, United States
| | - Judith O Hopkins
- Southeast Clinical Oncology Research Consortium (SCOR), 2150 Country Club Road Suite 200, Winston Salem, NC 27104, United States
| | - Joan Long
- Cancer Research Consortium of West Michigan NCORP (CRCWM), 25 Michigan St. NE, Suite 3100, Grand Rapids, MI 49503, United States
| | - Sharon Cole
- Dayton Clinical Oncology Program, 3123 Research Blvd., Suite 150, Dayton, OH 45420, United States
| | - Eva Culakova
- Department of Surgery, Supportive Care in Cancer, University of Rochester, 265 Crittenden Blvd., Rochester, NY 14642, United States
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Kuzu B, Hepokur C, Alagoz MA, Burmaoglu S, Algul O. Synthesis, Biological Evaluation and
In Silico
Studies of Some 2‐Substituted Benzoxazole Derivatives as Potential Anticancer Agents to Breast Cancer. ChemistrySelect 2022. [DOI: 10.1002/slct.202103559] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Burak Kuzu
- Department of Pharmaceutical Chemistry Mersin University Faculty of Pharmacy 33169 Mersin Turkey
- Department of Pharmaceutical Chemistry Van Yuzuncu Yil University Faculty of Pharmacy 65080 Van Turkey
| | - Ceylan Hepokur
- Department of Basic Pharmaceutical Sciences Division of Biochemistry Sivas Cumhuriyet University Faculty of Pharmacy 58100 Sivas Turkey
| | - Mehmet Abdullah Alagoz
- Department of Pharmaceutical Chemistry Inonu University Faculty of Pharmacy 44280 Malatya Turkey
| | - Serdar Burmaoglu
- Chemistry Atatürk University Faculty of Science 25240 Erzurum Turkey
| | - Oztekin Algul
- Department of Pharmaceutical Chemistry Mersin University Faculty of Pharmacy 33169 Mersin Turkey
- Pharmaceutical Chemistry Erzincan Binali Yildirim University Faculty of Pharmacy 24100 Erzincan Turkey
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Sullivan KA, Grant CV, Jordan KR, Obrietan K, Pyter LM. Paclitaxel chemotherapy disrupts behavioral and molecular circadian clocks in mice. Brain Behav Immun 2022; 99:106-118. [PMID: 34563619 PMCID: PMC8671246 DOI: 10.1016/j.bbi.2021.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/07/2021] [Accepted: 09/18/2021] [Indexed: 01/03/2023] Open
Abstract
Cancer patients experience circadian rhythm disruptions in activity cycles and cortisol release that correlate with poor quality of life and decreased long-term survival rates. However, the extent to which chemotherapy contributes to altered circadian rhythms is poorly understood. In the present study, we examined the extent to which paclitaxel, a common chemotherapy drug, altered entrained and free-running circadian rhythms in wheel running behavior, circulating corticosterone, and circadian clock gene expression in the brain and adrenal glands of tumor-free mice. Paclitaxel injections delayed voluntary wheel running activity onset in a light-dark cycle (LD) and lengthened the free-running period of locomotion in constant darkness (DD), indicating an effect on inherent suprachiasmatic nucleus (SCN) pacemaker activity. Paclitaxel attenuated clock gene rhythms in multiple brain regions in LD and DD. Furthermore, paclitaxel disrupted circulating corticosterone rhythms in DD by elevating its levels across a 24-hour cycle, which correlated with blunted amplitudes of Arntl, Nr1d1, Per1, and Star rhythms in the adrenal glands. Paclitaxel also shortened SCN slice rhythms, increased the amplitude of adrenal gland oscillations in PER2::luciferase cultures, and increased the concentration of pro-inflammatory cytokines and chemokines released from the SCN. These findings indicate that paclitaxel disrupts clock genes and behavior driven by the SCN, other brain regions, and adrenal glands, which were associated with chemotherapy-induced inflammation. Together, this preclinical work demonstrates that chemotherapy disrupts both central and peripheral circadian rhythms and supports the possibility that targeted circadian realignment therapies may be a novel and non-invasive way to improve patient outcomes after chemotherapy.
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Affiliation(s)
- Kyle A. Sullivan
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, USA,Department of Neuroscience, Ohio State University, Columbus, OH, USA,James Comprehensive Cancer Center and Solove Research Institute, Ohio State University, Columbus, OH USA
| | - Corena V. Grant
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, USA,James Comprehensive Cancer Center and Solove Research Institute, Ohio State University, Columbus, OH USA
| | - Kelley R. Jordan
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Karl Obrietan
- Department of Neuroscience, Ohio State University, Columbus, OH, USA
| | - Leah M. Pyter
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, USA,Department of Neuroscience, Ohio State University, Columbus, OH, USA,James Comprehensive Cancer Center and Solove Research Institute, Ohio State University, Columbus, OH USA,Departments of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA,Corresponding author: Leah M. Pyter, Ohio State University, 219 Institute for Behavioral Medicine Research, 460 Medical Center Dr, Columbus OH 43210, t. 614.293.3496, f. 614.366.2097,
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Rao V, Bhushan R, Kumari P, Cheruku SP, Ravichandiran V, Kumar N. Chemobrain: A review on mechanistic insight, targets and treatments. Adv Cancer Res 2022; 155:29-76. [DOI: 10.1016/bs.acr.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Országhová Z, Mego M, Chovanec M. Long-Term Cognitive Dysfunction in Cancer Survivors. Front Mol Biosci 2022; 8:770413. [PMID: 34970595 PMCID: PMC8713760 DOI: 10.3389/fmolb.2021.770413] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022] Open
Abstract
Cancer-related cognitive impairment (CRCI) is a frequent side effect experienced by an increasing number of cancer survivors with a significant impact on their quality of life. Different definitions and means of evaluation have been used in available literature; hence the exact incidence of CRCI remains unknown. CRCI can be described as cognitive symptoms reported by cancer patients in self-reported questionnaires or as cognitive changes evaluated by formal neuropsychological tests. Nevertheless, association between cognitive symptoms and objectively assessed cognitive changes is relatively weak or absent. Studies have focused especially on breast cancer patients, but CRCI has been reported in multiple types of cancer, including colorectal, lung, ovarian, prostate, testicular cancer and hematological malignancies. While CRCI has been associated with various treatment modalities, including radiotherapy, chemotherapy, hormone therapy and novel systemic therapies, it has been also detected prior to cancer treatment. Therefore, the effects of cancer itself with or without the psychological distress may be involved in the pathogenesis of CRCI as a result of altered coping mechanisms after cancer diagnosis. The development of CRCI is probably multifactorial and the exact mechanisms are currently not completely understood. Possible risk factors include administered treatment, genetic predisposition, age and psychological factors such as anxiety, depression or fatigue. Multiple mechanisms are suggested to be responsible for CRCI, including direct neurotoxic injury of systemic treatment and radiation while other indirect contributing mechanisms are hypothesized. Chronic neuroinflammation mediated by active innate immune system, DNA-damage or endothelial dysfunction is hypothesized to be a central mechanism of CRCI pathogenesis. There is increasing evidence of potential plasma (e.g., damage associated molecular patterns, inflammatory components, circulating microRNAs, exosomes, short-chain fatty acids, and others), cerebrospinal fluid and radiological biomarkers of cognitive dysfunction in cancer patients. Discovery of biomarkers of cognitive impairment is crucial for early identification of cancer patients at increased risk for the development of CRCI or development of treatment strategies to lower the burden of CRCI on long-term quality of life. This review summarizes current literature on CRCI with a focus on long-term effects of different cancer treatments, possible risk factors, mechanisms and promising biomarkers.
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Affiliation(s)
- Zuzana Országhová
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Michal Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
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Schroyen G, Vissers J, Smeets A, Gillebert CR, Lemiere J, Sunaert S, Deprez S, Sleurs C. Blood and neuroimaging biomarkers of cognitive sequelae in breast cancer patients throughout chemotherapy: A systematic review. Transl Oncol 2021; 16:101297. [PMID: 34896851 PMCID: PMC8681023 DOI: 10.1016/j.tranon.2021.101297] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022] Open
Abstract
Breast cancer treatment can induce alterations in blood- and neuroimaging-based markers. However, an overview of the predictive value of these markers for cognition is lacking for breast cancer survivors. This systematic review summarized studies of the last decade, using the PubMed database, evaluating blood markers, and the association between blood- or structural neuroimaging markers and cognition across the chemotherapy trajectory for primary breast cancer, following PRISMA guidelines. Forty-four studies were included. Differences were observed in all blood marker categories, from on-therapy until years post-chemotherapy. Associations were found between cognitive functioning and (1) blood markers (mainly inflammation-related) during, shortly-, or years post-chemotherapy and (2) white and gray matter metrics in frontal, temporal and parietal brain regions months up until years post-chemotherapy. Preliminary evidence exists for epigenetic and metabolic changes being associated with cognition, only after chemotherapy. This review demonstrated time-dependent associations between specific blood-based and structural neuroimaging markers with cognitive impairment in patients with breast cancer. Future studies are encouraged to include both neuroimaging- and blood markers (e.g. of neuronal integrity, epigenetics and metabolism) to predict long-term cognitive effects of chemotherapy.
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Affiliation(s)
- Gwen Schroyen
- Leuven Brain Institute, KU Leuven, Leuven, Belgium; Leuven Cancer Institute, KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
| | - Julie Vissers
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Ann Smeets
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium; Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Céline R Gillebert
- Leuven Brain Institute, KU Leuven, Leuven, Belgium; Department of Brain and Cognition, KU Leuven, Leuven 3000, Belgium
| | - Jurgen Lemiere
- Leuven Cancer Institute, KU Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium; Pediatric Hemato-Oncology, University Hospitals Leuven, Leuven 3000, Belgium
| | - Stefan Sunaert
- Leuven Brain Institute, KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; Radiology, University Hospitals Leuven, Leuven 3000, Belgium
| | - Sabine Deprez
- Leuven Brain Institute, KU Leuven, Leuven, Belgium; Leuven Cancer Institute, KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Charlotte Sleurs
- Leuven Brain Institute, KU Leuven, Leuven, Belgium; Leuven Cancer Institute, KU Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium
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Oppegaard K, Harris CS, Shin J, Paul SM, Cooper BA, Chan A, Anguera JA, Levine J, Conley Y, Hammer M, Miaskowski CA, Chan RJ, Kober KM. Cancer-related cognitive impairment is associated with perturbations in inflammatory pathways. Cytokine 2021; 148:155653. [PMID: 34388477 PMCID: PMC10792770 DOI: 10.1016/j.cyto.2021.155653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023]
Abstract
Cancer-related cognitive impairment (CRCI) is a significant problem for patients receiving chemotherapy. While a growing amount of pre-clinical and clinical evidence suggests that inflammatory mechanisms underlie CRCI, no clinical studies have evaluated for associations between CRCI and changes in gene expression. Therefore, the purpose of this study was to evaluate for differentially expressed genes and perturbed inflammatory pathways across two independent samples of patients with cancer who did and did not report CRCI. The Attentional Function Index (AFI) was the self-report measure used to assess CRCI. AFI scores of <5 and of >7.5 indicate low versus high levels of cognitive function, respectively. Of the 185 patients in Sample 1, 49.2% had an AFI score of <5 and 50.8% had an AFI score of >7.5. Of the 158 patients in Sample 2, 50.6% had an AFI score of <5 and 49.4% had an AFI score of >7.5. Data from 182 patients in Sample 1 were analyzed using RNA-seq. Data from 158 patients in Sample 2 were analyzed using microarray. Twelve KEGG signaling pathways were significantly perturbed between the AFI groups, five of which were signaling pathways related to inflammatory mechanisms (e.g., cytokine-cytokine receptor interaction, tumor necrosis factor signaling). This study is the first to describe perturbations in inflammatory pathways associated with CRCI. Findings highlight the role of cytokines both in terms of cytokine-specific pathways, as well as pathways involved in cytokine production and cytokine activation. These findings have the potential to identify new targets for therapeutics and lead to the development of interventions to improve cognition in patients with cancer.
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Affiliation(s)
- Kate Oppegaard
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Carolyn S Harris
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Joosun Shin
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Steven M Paul
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Bruce A Cooper
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Alexandre Chan
- School of Pharmacy and Pharmaceutical Sciences, University of California Irvine, 147B Bison Modular, Irvine, CA 92697, USA.
| | - Joaquin A Anguera
- School of Medicine, University of California, 675 Nelson Rising Lane, San Francisco, CA 94158, USA.
| | - Jon Levine
- School of Medicine, University of California, 675 Nelson Rising Lane, San Francisco, CA 94158, USA; School of Dentistry, University of California, 513 Parnassus Ave, MSB, San Francisco, CA 94117, USA.
| | - Yvette Conley
- School of Nursing, University of Pittsburgh, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA.
| | - Marilyn Hammer
- Dana-Farber Cancer Institute, 450 Brookline Avenue, LW523, Boston, MA 02215, USA.
| | - Christine A Miaskowski
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA; School of Medicine, University of California, 675 Nelson Rising Lane, San Francisco, CA 94158, USA.
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park SA5042, Australia.
| | - Kord M Kober
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
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Predictors of health-related quality of life after completion of chemotherapy among Malaysian early-stage breast cancer survivors. Support Care Cancer 2021; 30:2793-2801. [PMID: 34841453 DOI: 10.1007/s00520-021-06686-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Health-related quality of life (QoL) is an important outcome measure in breast cancer management. Evidence of QoL of breast cancer patients in lower and middle-income countries remains scarce. We examined the level of QoL, cognitive impairment, psychological distresses, and the predictors of QoL among multiethnic Malaysian early-stage breast cancer survivors 1 to 3 years following chemotherapy. METHODS A total of 160 breast cancer survivors from the University of Malaya Medical Centre (UMMC) participated in this cross-sectional study. Their QoL was evaluated with the Malay version of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) version 3.0. Cognitive functioning and psychological distress were evaluated using the Malay version of the Montreal Cognitive Assessment (MoCA-BM) and Hospital Anxiety and Depression Scale (HADS), respectively. Data analysis was performed with Pearson's correlation and multiple regression analyses. RESULTS At 1- to 3-year post-chemotherapy, the mean EORTC QLQ-C30 global health status of the breast cancer survivors was relatively low (60.5 over 100, SD = 10.88). One-third (31.9%) of them demonstrated cognitive impairment, and another 3.2% showed moderate to severe anxiety levels. The significant predictors for global health status and functioning included age, psychological distresses, cognitive performance, fatigue, appetite loss, insomnia, pain, and constipation. CONCLUSION Our breast cancer survivors demonstrated poor global health status. Health care providers and policymakers must strive to provide holistic intervention strategies to improve the multiple dimensions of QoL and the cognitive and psychological functioning of this vulnerable population.
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