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Ruivo J, Tavares I, Pozza DH. Molecular targets in bone cancer pain: a systematic review of inflammatory cytokines. J Mol Med (Berl) 2024:10.1007/s00109-024-02464-2. [PMID: 38940936 DOI: 10.1007/s00109-024-02464-2] [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: 03/14/2024] [Revised: 06/06/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024]
Abstract
Bone cancer pain (BCP) profoundly impacts patient's quality of life, demanding more effective pain management strategies. The aim of this systematic review was to investigate the role of inflammatory cytokines as potential molecular targets in BCP. A systematic search for animal rodent models of bone cancer pain studies was conducted in PubMed, Scopus, and Web of Science. Methodological quality and risk of bias were assessed using the SYRCLE RoB tool. Twenty-five articles met the inclusion criteria, comprising animal studies investigating molecular targets related to inflammatory cytokines in BCP. A low to moderate risk of bias was reported. Key findings in 23 manuscripts revealed upregulated classic pro-inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-17, IL-18, IL-33) and chemokines in the spinal cord, periaqueductal gray, and dorsal root ganglia. Interventions targeting these cytokines consistently mitigated pain behaviors. Additionally, it was demonstrated that glial cells, due to their involvement in the release of inflammatory cytokines, emerged as significant contributors to BCP. This systematic review underscores the significance of inflammatory cytokines as potential molecular targets for alleviating BCP. It emphasizes the promise of targeted interventions and advocates for further research to translate these findings into effective therapeutic strategies. Ultimately, this approach holds the potential to enhance the patient's quality of life.
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Affiliation(s)
- Jacinta Ruivo
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319, Porto, Portugal
| | - Isaura Tavares
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319, Porto, Portugal
- Institute for Research and Innovation in Health and IBMC, University of Porto, 4200-135, Porto, Portugal
| | - Daniel H Pozza
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319, Porto, Portugal.
- Institute for Research and Innovation in Health and IBMC, University of Porto, 4200-135, Porto, Portugal.
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Greffier J, Frandon J, Durand Q, Kammoun T, Loisy M, Beregi JP, Dabli D. Contribution of an artificial intelligence deep-learning reconstruction algorithm for dose optimization in lumbar spine CT examination: A phantom study. Diagn Interv Imaging 2023; 104:76-83. [PMID: 36100524 DOI: 10.1016/j.diii.2022.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/12/2022] [Accepted: 08/29/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to assess the impact of the new artificial intelligence deep-learning reconstruction (AI-DLR) algorithm on image quality and radiation dose compared with iterative reconstruction algorithm in lumbar spine computed tomography (CT) examination. MATERIALS AND METHODS Acquisitions on phantoms were performed using a tube current modulation system for four DoseRight Indexes (DRI) (i.e., 26/23/20/15). Raw data were reconstructed using the Level 4 of iDose4 (i4) and three levels of AI-DLR (Smoother/Smooth/Standard) with a bone reconstruction kernel. The Noise power spectrum (NPS), task-based transfer function (TTF) and detectability index (d') were computed (d' modeled detection of a lytic and a sclerotic bone lesions). Image quality was subjectively assessed on an anthropomorphic phantom by two radiologists. RESULTS The Noise magnitude was lower with AI-DLR than i4 and decreased from Standard to Smooth (-31 ± 0.1 [SD]%) and Smooth to Smoother (-48 ± 0.1 [SD]%). The average NPS spatial frequency was similar with i4 (0.43 ± 0.01 [SD] mm-1) and Standard (0.42 ± 0.01 [SD] mm-1) but decreased from Standard to Smoother (0.36 ± 0.01 [SD] mm-1). TTF values at 50% decreased as the dose decreased but were similar with i4 and all AI-DLR levels. For both simulated lesions, d' values increased from Standard to Smoother levels. Higher detectabilities were found with a DRI at 15 and Smooth and Smoother levels than with a DRI at 26 and i4. The images obtained with these dose and AI-DLR levels were rated satisfactory for clinical use by the radiologists. CONCLUSION Using Smooth and Smoother levels with CT allows a significant dose reduction (up to 72%) with a high detectability of lytic and sclerotic bone lesions and a clinical overall image quality.
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Affiliation(s)
- Joël Greffier
- IMAGINE UR UM 103, Montpellier University, Department of Medical Imaging, Nîmes University Hospital, 30029 Nîmes, France; Department of Medical Physics, Nîmes University Hospital, 30029 Nîmes Cedex 9, France.
| | - Julien Frandon
- IMAGINE UR UM 103, Montpellier University, Department of Medical Imaging, Nîmes University Hospital, 30029 Nîmes, France
| | - Quentin Durand
- IMAGINE UR UM 103, Montpellier University, Department of Medical Imaging, Nîmes University Hospital, 30029 Nîmes, France
| | - Tarek Kammoun
- IMAGINE UR UM 103, Montpellier University, Department of Medical Imaging, Nîmes University Hospital, 30029 Nîmes, France
| | - Maeliss Loisy
- IMAGINE UR UM 103, Montpellier University, Department of Medical Imaging, Nîmes University Hospital, 30029 Nîmes, France
| | - Jean-Paul Beregi
- IMAGINE UR UM 103, Montpellier University, Department of Medical Imaging, Nîmes University Hospital, 30029 Nîmes, France
| | - Djamel Dabli
- IMAGINE UR UM 103, Montpellier University, Department of Medical Imaging, Nîmes University Hospital, 30029 Nîmes, France; Department of Medical Physics, Nîmes University Hospital, 30029 Nîmes Cedex 9, France
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Yang R, Singh S, Falk A, Wang J, Thornhill B, Fox J, Sen M, Hoang B, Geller DS. Percutaneous Screw Stabilization of Non-Periacetabular Pelvic Lesions Caused by Metastatic Cancer and Multiple Myeloma. J Bone Joint Surg Am 2022; 104:577-585. [PMID: 35139049 DOI: 10.2106/jbjs.21.00518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The pelvis is one of the most common locations for metastatic bone disease. While many of the publications that describe surgical treatments focus on periacetabular lesions (Enneking zone II), there is a lack of investigation into lesions in the non-periacetabular areas (zones I, III, and IV). We recently described a minimally invasive percutaneous screw application for metastatic zone-II lesions with excellent results. In the present study, we aimed to extend this approach to the other pelvic areas. METHODS Twenty-two consecutive patients with painful non-periacetabular pelvic metastatic cancer were included based on retrospective chart review. There were 16 women and 6 men with an average age of 60 years (range, 36 to 81 years). The most common primary cancers were multiple myeloma (7 cases) and breast (5 cases). The most common locations were the sacrum and the ilium. A pathologic fracture was identified in 15 patients. Most of the lesions were treated with multiple large-diameter screws, except for the isolated zone-III lesions. All of the procedures were completed in a standard operating room without the need for special instruments. Radiation therapy was given to 19 patients; the average dose was 15 Gy. The studied outcomes were pain and functionality as assessed by a visual analog scale (VAS) score and the Eastern Cooperative Oncology Group score (ECOG), respectively. RESULTS There were no surgical complications and no need for blood transfusion. The average follow-up time was 7 months (range, 0.3 to 34.0 months). Two patients died within 4 weeks of surgery due to COVID-19 infection. There was significant improvement in the postoperative VAS pain score (p < 0.0001) and the ECOG score (p < 0.05) when compared with the preoperative scores. There was no implant failure or revision surgery. Local bone-healing was observed in 12 of 14 patients (86%) who survived for >3 months after surgery. CONCLUSIONS Percutaneous screw application is safe and effective in the treatment of metastatic non-periacetabular pelvic lesions. Given the simplicity of the technique and the instrumentation and the tolerance for concomitant treatments, this approach is worthy of broader consideration. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Rui Yang
- Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Swapnil Singh
- Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Alessandra Falk
- Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jichuan Wang
- Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Beverly Thornhill
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jana Fox
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Milan Sen
- Division of Orthopaedic Surgery, Jacobi Medical Center, Bronx, New York
| | - Bang Hoang
- Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - David S Geller
- Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Yang R, Goch A, Murphy D, Wang J, Charubhumi V, Fox J, Sen M, Hoang B, Geller D. A Novel Tripod Percutaneous Reconstruction Technique in Periacetabular Lesions Caused by Metastatic Cancer. J Bone Joint Surg Am 2020; 102:592-599. [PMID: 32079881 DOI: 10.2106/jbjs.19.00936] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Metastatic lesions in the periacetabular region can cause pain and immobility. Symptomatic patients are often treated surgically with a total hip replacement using various modified Harrington methods. These open surgical procedures confer inherent risks. Prolonged recovery and potential complications may delay adjuvant radiation and systemic therapy. METHODS We describe a novel technique for acetabular reconstruction. Three large-bore cannulated screws are placed percutaneously under fluoroscopy in a tripod configuration to reinforce the mechanical axes of the acetabulum. Increased stability improves pain control and permits weight-bearing. RESULTS Twenty consecutive patients with periacetabular metastases were treated using the tripod technique. Eighteen patients (90%) had Harrington class-III lesions, and 2 patients had Harrington class-II lesions. The mean surgical time was 2.3 hours. Sixteen patients (80%) were able to get out of bed on postoperative day 1. At 3 months postoperatively, there was significant improvement in pain as documented on their visual analog scale (p < 0.01) and in functionality as measured by the Eastern Cooperative Oncology Group score (p < 0.01). The mean follow-up time was 7 months (range, 0.6 to 20 months). At the most recent follow-up, only 3 among the 16 surviving patients were using opioids chronically for pain. Total hip arthroplasty was performed in 4 patients (20%) in a staged fashion using the previously placed screws as support for a cemented cup and obviating the need for a cage device. Of the 16 patients, 15 could walk either independently (6 patients) or using an ambulatory aid (9 patients). Eight patients with the primary tripod reconstruction survived >6 months postoperatively. They were found to have either new bone formation filling the defects or healing of the pathological fractures. There has been no implant loosening or failure. CONCLUSIONS The tripod technique is a novel application to provide safe and effective pain relief in the context of periacetabular metastatic disease. It can be easily converted to support a cemented acetabular cup for a total hip replacement should disease progression occur. This technique provides an alternative to open surgery as currently practiced in these patients. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Rui Yang
- Departments of Orthopaedic Surgery (R.Y., A.G., D.M., J.W., V.C., B.H., and D.G.) and Radiation Oncology (J.F.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Abraham Goch
- Departments of Orthopaedic Surgery (R.Y., A.G., D.M., J.W., V.C., B.H., and D.G.) and Radiation Oncology (J.F.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Dennis Murphy
- Departments of Orthopaedic Surgery (R.Y., A.G., D.M., J.W., V.C., B.H., and D.G.) and Radiation Oncology (J.F.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jichuan Wang
- Departments of Orthopaedic Surgery (R.Y., A.G., D.M., J.W., V.C., B.H., and D.G.) and Radiation Oncology (J.F.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.,Department of Orthopaedic Oncology, Peking University, People's Hospital, Beijing, China
| | - Vanessa Charubhumi
- Departments of Orthopaedic Surgery (R.Y., A.G., D.M., J.W., V.C., B.H., and D.G.) and Radiation Oncology (J.F.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jana Fox
- Departments of Orthopaedic Surgery (R.Y., A.G., D.M., J.W., V.C., B.H., and D.G.) and Radiation Oncology (J.F.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Milan Sen
- Division of Orthopaedic Surgery, Jacobi Medical Center, Bronx, New York
| | - Bang Hoang
- Departments of Orthopaedic Surgery (R.Y., A.G., D.M., J.W., V.C., B.H., and D.G.) and Radiation Oncology (J.F.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - David Geller
- Departments of Orthopaedic Surgery (R.Y., A.G., D.M., J.W., V.C., B.H., and D.G.) and Radiation Oncology (J.F.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Trivedi T, Zheng Y, Fournier PGJ, Murthy S, John S, Schillo S, Dunstan CR, Mohammad KS, Zhou H, Seibel MJ, Guise TA. The vitamin D receptor is involved in the regulation of human breast cancer cell growth via a ligand-independent function in cytoplasm. Oncotarget 2018; 8:26687-26701. [PMID: 28460457 PMCID: PMC5432290 DOI: 10.18632/oncotarget.15803] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/15/2017] [Indexed: 12/31/2022] Open
Abstract
Vitamin D has pleiotropic effects on multiple tissues, including malignant tumors. Vitamin D inhibits breast cancer growth through activation of the vitamin D receptor (VDR) and via classical nuclear signaling pathways. Here, we demonstrate that the VDR can also function in the absence of its ligand to control behaviour of human breast cancer cells both outside and within the bone microenvironment. Stable shRNA expression was used to knock down VDR expression in MCF-7 cells, generating two VDR knockdown clonal lines. In ligand-free culture, knockdown of VDR in MCF-7 cells significantly reduced proliferation and increased apoptosis, suggesting that the VDR plays a ligand-independent role in cancer cell growth. Implantation of these VDR knockdown cells into the mammary fat pad of nude mice resulted in reduced tumor growth in vivo compared with controls. In the intra-tibial xenograft model, VDR knockdown greatly reduced the ability of the cells to form tumors in the bone microenvironment. The in vitro growth of VDR knockdown cells was rescued by the expression of a mutant form of VDR which is unable to translocate to the nucleus and hence accumulates in the cytoplasm. Thus, our data indicate that in the absence of ligand, the VDR promotes breast cancer growth both in vitro and in vivo and that cytoplasmic accumulation of VDR is sufficient to produce this effect in vitro. This new mechanism of VDR action in breast cancer cells contrasts the known anti-proliferative nuclear actions of the VDR-vitamin D ligand complex.
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Affiliation(s)
- Trupti Trivedi
- Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, Australia.,Division of Endocrinology, Department of Medicine, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA
| | - Yu Zheng
- Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, Australia
| | - Pierrick G J Fournier
- Division of Endocrinology, Department of Medicine, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA.,Biomedical Innovation Department, Scientific Research and High Education Center from Ensenada (CICESE), Ensenada, Baja California, Mexico
| | - Sreemala Murthy
- Division of Endocrinology, Department of Medicine, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA
| | - Sutha John
- Division of Endocrinology, Department of Medicine, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA
| | - Suzanne Schillo
- Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, Australia
| | - Colin R Dunstan
- Department of Biomedical Engineering, University of Sydney, Sydney, Australia
| | - Khalid S Mohammad
- Division of Endocrinology, Department of Medicine, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA
| | - Hong Zhou
- Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, Australia
| | - Markus J Seibel
- Bone Research Program, ANZAC Research Institute, University of Sydney, Sydney, Australia.,Department of Endocrinology and Metabolism, Concord Hospital, Concord, Sydney, Australia
| | - Theresa A Guise
- Division of Endocrinology, Department of Medicine, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA
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Sarabia-Estrada R, Ruiz-Valls A, Guerrero-Cazares H, Ampuero AM, Jimenez-Estrada I, De Silva S, Bernhardt LJ, Goodwin CR, Ahmed AK, Li Y, Phillips NA, Gokaslan ZL, Quiñones-Hinojosa A, Sciubba DM. Metastatic human breast cancer to the spine produces mechanical hyperalgesia and gait deficits in rodents. Spine J 2017; 17:1325-1334. [PMID: 28412561 PMCID: PMC5628502 DOI: 10.1016/j.spinee.2017.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/10/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Metastases to the spine are a common source of severe pain in cancer patients. The secondary effects of spinal metastases include pain, bone fractures, hypercalcemia, and neurological deficits. As the disease progresses, pain severity can increase until it becomes refractory to medical treatments and leads to a decreased quality of life for patients. A key obstacle in the study of pain-induced spinal cancer is the lack of reliable and reproducible spine cancer animal models. In the present study, we developed a reproducible and reliable rat model of spinal cancer using human-derived tumor tissue to evaluate neurological decline using imaging and behavioral techniques. PURPOSE The present study outlines the development and characterization of an orthotopic model of human breast cancer to the spine in immunocompromised rats. STUDY DESIGN/SETTING This is a basic science study. METHODS Female immunocompromised rats were randomized into three groups: tumor (n=8), RBC3 mammary adenocarcinoma tissue engrafted in the L5 vertebra body; sham (n=6), surgery performed but not tumor engrafted; and control (n=6), naive rats, no surgery performed. To evaluate the neurological impairment due to tumor invasion, functional assessment was done in all rodents at day 40 after tumor engraftment using locomotion gait analysis and pain response to a mechanical stimulus (Randall-Selitto test). Bioluminescence (BLI) was used to evaluate tumor growth in vivo and cone beam computed tomography (CBCT) was performed to evaluate bone changes due to tumor invasion. The animals were euthanized at day 45 and their spines were harvested and processed for hematoxylin and eosin (H&E) staining. RESULTS Tumor growth in the spine was confirmed by BLI imaging and corroborated by histological analysis. Cone beam computed tomography images were characterized by a decrease in the bone intensity in the lumbar spine consistent with tumor location on BLI. On H&E staining of tumor-engrafted animals, there was a near-complete ablation of the ventral and posterior elements of the L5 vertebra with severe tumor invasion in the bony components displacing the spinal cord. Locomotion gait analysis of tumor-engrafted rats showed a disruption in the normal gait pattern with asignificant reduction in length (p=.02), duration (p=.002), and velocity (p=.002) of right leg strides and only in duration (p=.0006) and velocity (p=.001) of left leg strides, as compared with control and sham rats. Tumor-engrafted animals were hypersensitive to pain stimulus shown as a significantly reduced response in time (p=.02) and pressure (p=.01) applied when compared with control groups. CONCLUSIONS We developed a system for the quantitative analysis of pain and locomotion in an animal model of metastatic human breast cancer of the spine. Tumor-engrafted animals showed locomotor and sensory deficits that are in accordance with clinical manifestation in patients with spine metastasis. Pain response and locomotion gait analysis were performed during follow-up. The Randall-Selitto test was a sensitive method to evaluate pain in the rat's spine. We present a model for the study of bone-associated cancer pain secondary to cancer metastasis to the spine, as well as for the study of new therapies and treatments to lessen pain from metastatic cancer to the neuroaxis.
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Affiliation(s)
| | - Alejandro Ruiz-Valls
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Ana M. Ampuero
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ismael Jimenez-Estrada
- Physiology, Biophysics and Neurosciences, Research Center and Advanced Studies, IPN, Mexico City, MEXICO
| | - Samantha De Silva
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lydia J. Bernhardt
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C. Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A. Karim Ahmed
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yuxin Li
- Department of Neurosurgery, Jinan General Hospital of PLA, Jinan, 250031, CHINA
| | - Neil A. Phillips
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ziya L. Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University Providence, Rhode Island, USA
| | | | - Daniel M. Sciubba
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Abstract
We previously demonstrated that the chemokine receptor CXCR4 plays an important role in cancer-induced bone pain by activating spinal neurons and glial cells. However, the specific neuronal mechanism of CXCR4 signaling is not clear. We further report that CXCR4 contributes to the activation of the neuronal CaMKII/CREB pathway in cancer-induced bone pain. We used a tumor cell implantation (TCI) model and observed that CXCR4, p-CaMKII and p-CREB were persistently up-regulated in spinal neurons. CXCR4 also co-expressed with p-CaMKII and p-CREB, and mediated p-CaMKII and p-CREB expression after TCI. Intrathecal delivery of CXCR4 siRNA or CaMKII inhibitor AIP2 abrogated TCI-induced pain hypersensitivity and TCI-induced increase in p-CaMKII and p-CREB expression. Intrathecal injection of the principal ligand for CXCR4, SDF-1, promoted p-CaMKII and p-CREB expression in naive rats, which was prevented by post-administration of CXCR4 inhibitor Plerixafor or PLC inhibitor U73122. Plerixafor, U73122, or AIP2 also alleviated SDF-1-elicited pain behaviors. Intrathecal injection of CXCR4 siRNA significantly suppressed TCI-induced up-regulation of NMDAR1 mRNA and protein, which is a known gene target of CREB. Collectively, these results suggest that the CaMKII/CREB pathway in spinal neurons mediates CXCR4-facilitated pain hypersensitivity in cancer rats.
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Filippiadis D, Mavrogenis AF, Mazioti A, Palialexis K, Megaloikonomos PD, Papagelopoulos PJ, Kelekis A. Metastatic bone disease from breast cancer: a review of minimally invasive techniques for diagnosis and treatment. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:729-736. [PMID: 28597402 DOI: 10.1007/s00590-017-1986-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/30/2017] [Indexed: 01/20/2023]
Abstract
Skeletal-related events in patients with metastatic bone disease include intractable severe pain, pathologic fracture, spinal cord and nerve compression, hypercalcemia and bone marrow aplasia. In patients with breast cancer, the skeleton is the most frequent site for metastases. Treatment options for metastatic bone disease in these patients include bisphosphonates, chemotherapeutic agents, opioids, hormonal therapy, minimally invasive/interventional and surgical techniques. Interventional oncology techniques for breast cancer patients with bone metastases include diagnostic (biopsy) and therapeutic (palliative and curative) approaches. In the latter, percutaneous ablation, augmentation and stabilization are included. The purpose of this article is to describe the basic concepts of biopsy, ablation, embolization and peripheral skeleton augmentation techniques in patients with metastatic bone disease from breast carcinoma. The necessity for a tailored approach applying different techniques for different cases and locations will be addressed.
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Affiliation(s)
- Dimitrios Filippiadis
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece.
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Argyro Mazioti
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Konstantinos Palialexis
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Panayiotis D Megaloikonomos
- First Department of Orthopaedics, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedics, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Alexis Kelekis
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
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Bodnar J. A Review of Agents for Palliative Sedation/Continuous Deep Sedation: Pharmacology and Practical Applications. J Pain Palliat Care Pharmacother 2017; 31:16-37. [PMID: 28287357 DOI: 10.1080/15360288.2017.1279502] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Continuous deep sedation at the end of life is a specific form of palliative sedation requiring a care plan that essentially places and maintains the patient in an unresponsive state because their symptoms are refractory to any other interventions. Because this application is uncommon, many providers may lack practical experience in this specialized area and resources they can access are outdated, nonspecific, and/or not comprehensive. The purpose of this review is to provide an evidence- and experience-based reference that specifically addresses those medications and regimens and their practical applications for this very narrow, but vital, aspect of hospice care. Patient goals in a hospital and hospice environments are different, so the manner in which widely used sedatives are dosed and applied can differ greatly as well. Parameters applied in end-of-life care that are based on experience and a thorough understanding of the pharmacology of those medications will differ from those applied in an intensive care unit or other medical environments. By recognizing these different goals and applying well-founded regimens geared specifically for end-of-life sedation, we can address our patients' symptoms in a more timely and efficacious manner.
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Falivene S, Pezzulla D, Di Franco R, Giugliano FM, Esposito E, Scoglio C, Amato B, Borzillo V, D'Aiuto M, Muto P. Painful bone metastasis in elderly treated with radiation therapy: Single- or multiple-fraction regimen? A multicentre retrospective observational analysis. Aging Clin Exp Res 2017; 29:143-147. [PMID: 27844454 DOI: 10.1007/s40520-016-0671-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/03/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Bone metastases are a frequent complication of advanced oncologic disease. Pain associated to bone metastasis is a major cause of morbidity in cancer patients, especially in elderly. AIMS The aim of this multicentric retrospective observational study is to evaluate the efficacy of different schedules of radiation therapy in elderly patients in terms of pain relief. METHODS 206 patients over the age of 60 were enrolled in 1 year time for a multicentre retrospective observational study. Patients were treated with palliative purposes for painful bone metastases. RESULTS Pain intensity difference (PID) was found in 72% of patients. Reported PID was statistically significant for p < 0.01. Pain intensity measured by a point numeric rating scale was statistically significant reduced for p < 0.05 by one-fraction regimen compared to other two regimens. DISCUSSION In recent years, numerous studies have evaluated the most appropriate regimen of fractionation in individual cases, despite this, a consensus about the best schedule is still debated. CONCLUSIONS On our analysis, single-fractionation scheme (8 Gy) confirmed to be statistical significant effective in providing pain reduction due to bone metastases. Radiation therapy provides significant pain relief of symptomatic bone metastases, but appropriate radiotherapy scheduled is needed in order to get significant response to treatment. Multidisciplinary approach is warranted to value the balance between the therapeutic objectives and the patient quality of life.
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Affiliation(s)
- S Falivene
- Division of Radiation Oncology, Istituto Nazionale per lo studio e la cura dei tumori "Fondazione Giovanni Pascale" - IRCCS, Via Mariano Semmola, 80131, Naples, Italy
| | - D Pezzulla
- Second University of Naples, Piazza Miraglia, 80131, Naples, Italy
| | - R Di Franco
- Division of Radiation Oncology, Istituto Nazionale per lo studio e la cura dei tumori "Fondazione Giovanni Pascale" - IRCCS, Via Mariano Semmola, 80131, Naples, Italy
| | - F M Giugliano
- European Medical Imaging - Radiation Oncology, Fondazione Muto-onlus, Napoli, Italia, Via Taverna Rossa, 169, 80020, Casavatore, Naples, Italy
| | - E Esposito
- Department of Breast Cancer, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Via Mariano Semmola, 80131, Naples, Italy.
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
| | - C Scoglio
- Second University of Naples, Piazza Miraglia, 80131, Naples, Italy
| | - B Amato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - V Borzillo
- Division of Radiation Oncology, Istituto Nazionale per lo studio e la cura dei tumori "Fondazione Giovanni Pascale" - IRCCS, Via Mariano Semmola, 80131, Naples, Italy
| | - M D'Aiuto
- Department of Breast Cancer, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Via Mariano Semmola, 80131, Naples, Italy
| | - P Muto
- Division of Radiation Oncology, Istituto Nazionale per lo studio e la cura dei tumori "Fondazione Giovanni Pascale" - IRCCS, Via Mariano Semmola, 80131, Naples, Italy
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Abstract
Interventional oncologists are playing an ever greater role in improving the quality of life of their patients through minimally invasive procedures, many of which can be performed on an outpatient basis. Some of the most common palliative procedures currently performed will be discussed including management of intractable ascites and pleural effusions, neurolytic plexus blocks, and palliation of pain and bleeding associated with metastatic tumors.
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Distinguishing Untreated Osteoblastic Metastases From Enostoses Using CT Attenuation Measurements. AJR Am J Roentgenol 2016; 207:362-8. [DOI: 10.2214/ajr.15.15559] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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13
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Pamidronate functionalized nanoconjugates for targeted therapy of focal skeletal malignant osteolysis. Proc Natl Acad Sci U S A 2016; 113:E4601-9. [PMID: 27457945 DOI: 10.1073/pnas.1603316113] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Malignant osteolysis associated with inoperable primary bone tumors and multifocal skeletal metastases remains a challenging clinical problem in cancer patients. Nanomedicine that is able to target and deliver therapeutic agents to diseased bone sites could potentially provide an effective treatment option for different types of skeletal cancers. Here, we report the development of polylactide nanoparticles (NPs) loaded with doxorubicin (Doxo) and coated with bone-seeking pamidronate (Pam) for the targeted treatment of malignant skeletal tumors. In vivo biodistribution of radiolabeled targeted Pam-NPs demonstrated enhanced bone tumor accumulation and prolonged retention compared with nontargeted NPs. In a murine model of focal malignant osteolysis, Pam-functionalized, Doxo-loaded NPs (Pam-Doxo-NPs) significantly attenuated localized osteosarcoma (OS) progression compared with nontargeted Doxo-NPs. Importantly, we report on the first evaluation to our knowlege of Pam-Doxo-NPs in dogs with OS, which possess tumors of anatomic size and physiology comparable to those in humans. The repeat dosing of Pam-Doxo-NPs in dogs with naturally occurring OS indicated the therapeutic was well tolerated without hematologic, nonhematologic, and cardiac toxicities. By nuclear scintigraphy, the biodistribution of Pam-Doxo-NPs demonstrated malignant bone-targeting capability and exerted measurable anticancer activities as confirmed with percent tumor necrosis histopathology assessment.
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14
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Feng H, Wang J, Xu J, Chen W, Zhang Y. The surgical management and treatment of metastatic lesions in the proximal femur: A mini review. Medicine (Baltimore) 2016; 95:e3892. [PMID: 27428183 PMCID: PMC4956777 DOI: 10.1097/md.0000000000003892] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Review current treatments of metastatic lesions in the proximal femur.We reviewed published literature related to diagnosis and surgical treatments and summarized current treatment options.Surgical management mainly consist of internal fixation, hip replacement, and percutaneous femoroplasty (PFP) which has been newly applied in clinical practice.An appropriate series of treatments is necessary for patients to avoid the occurrence of paraplegia and prolong survival time.
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Affiliation(s)
- Helin Feng
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University
| | - Jin Wang
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University
| | - Jianfa Xu
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University
| | - Wei Chen
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yingze Zhang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Correspondence: Yingze Zhang, The Third Hospital of Hebei Medical University, Shijiazhuang, China (e-mail: )
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15
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Sciubba JJ. End-of-life care in the head and neck cancer patient. Oral Dis 2016; 22:740-744. [DOI: 10.1111/odi.12506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 01/10/2023]
Affiliation(s)
- JJ Sciubba
- The Milton J. Dance Head and Neck Center; The Johns Hopkins School of Medicine; Baltimore MD USA
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Wang J, Zhang R, Dong C, Jiao L, Xu L, Liu J, Wang Z, Lao L. Transient Receptor Potential Channel and Interleukin-17A Involvement in LTTL Gel Inhibition of Bone Cancer Pain in a Rat Model. Integr Cancer Ther 2016; 14:381-93. [PMID: 26100378 DOI: 10.1177/1534735415580677] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cancer pain management is a challenge for which Chinese herbal medicine might be useful. To study the spinal mechanisms of the Chinese medicated gel Long-Teng-Tong-Luo (LTTL), a 7-herb compound, on bone cancer pain, a bone cancer pain model was made by inoculating the tibias of female rats with Walker 256 cells. LTTL gel or inert gel, 0.5 g/cm(2)/d, was applied to the skin of tumor-bearing tibias for 21 days beginning a day after the inoculation. Mechanical threshold and paw withdrawal latency to thermal stimulation was measured. Transient receptor potential (TRP) cation channels in lumbar dorsal root ganglia (DRG) were immunostained and counted, and lumbar spinal cord interleukin-17A (IL-17A) was measured with real-time polymerase chain reaction and enzyme-linked immunosorbent assay. TRP antagonists and interleukin (IL)-17A antibodies were intrathecally administered to determine their effects on bone cancer pain. The gel significantly (P < .05) alleviated cancer-induced mechanical allodynia and thermal hyperalgesia and inhibited cancer-enhanced expression of IL-17A in spinal astrocytes and the TRP subfamily members V1, A1, and V4 in lumbar DRG. Intrathecal TRP antagonists at 10 µg significantly (P < .05) attenuated mechanical allodynia, thermal hyperalgesia, and IL-17A expression, indicating that TRP channels facilitate spinal IL-17 expression and cancer pain. IL-17A antibodies inhibited cancer pain, suggesting that IL-17A promotes such pain. The data show that LTTL gel inhibits cancer pain, and this might be accounted for by the decrease in expression of DRG TRP channels and spinal astrocyte IL-17A.
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Affiliation(s)
- Juyong Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ruixin Zhang
- Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Changsheng Dong
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lijing Jiao
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ling Xu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiyong Liu
- The Ministry of Education Key Laboratory for Standardization of Chinese Medicines, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhengtao Wang
- The Ministry of Education Key Laboratory for Standardization of Chinese Medicines, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lixing Lao
- Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, MD, USA
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Abdelaziz DM, Stone LS, Komarova SV. Localized experimental bone metastasis drives osteolysis and sensory hypersensitivity at distant non-tumor-bearing sites. Breast Cancer Res Treat 2015. [PMID: 26208488 DOI: 10.1007/s10549-015-3517-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patients with breast cancer metastasis to bone suffer from inadequate pain relief. Animal models provide increased understanding of cancer-induced bone and sensory alterations. The objective of this study was to investigate the measures of pain at distant non-tumor-bearing sites in animals with localized bone metastasis. Immunocompetent BALB/c mice are injected intra-tibially with murine mammary carcinoma cells (4T1) or saline, and the sensitivity to mechanical and thermal stimuli in the contralateral paw was examined. In addition to previously demonstrated development of osteolysis and hypersensitivity to mechanical and thermal stimuli in the cancer-injected tibia, these animals exhibited an increase in sensory hypersensitivity in the contralateral limb. No bone lesions were evident on radiographs of the contralateral limbs. Histomorphometry detected decreased bone volume per tissue volume and increased osteoclast number in the contralateral tibia and vertebral bones of cancer-bearing animals. Neuroplasticity was examined by immunofluorescence for calcitonin gene-related peptide (CGRP) in sensory neurons and glial fibrillary acidic protein (GFAP) in lumbar spinal cords. CGRP-immunoreactivity and GFAP-immunoreactivity were significantly elevated both ipsilateral and contralateral in tumor-bearing animals. The anti-inflammatory and osteolysis-targeting drug rapamycin reduced hypersensitivity to mechanical and cold stimuli, attenuated GFAP over-expression, and lowered osteoclast number. The osteoclast-targeting drug pamidronate reduced sensitivity to cold and protected against bone loss. Localized bone cancer drives hypersensitivity, bone remodeling, and sensory neuron plasticity at sites distant from the primary tumor area. Drugs targeting these mechanisms may be useful in the treatment of pain distant from the primary tumor site.
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Abstract
CONTEXT Methanol, ethylene glycol, diethylene glycol, and propylene glycol intoxications are associated with cellular dysfunction and an increased risk of death. Adverse effects can develop quickly; thus, there is a need for methods for rapidly detecting their presence. OBJECTIVE To examine the value and limitations of present methods to diagnose patients with possible toxic alcohol exposure. METHODS I searched MEDLINE for articles published between 1969 and 2014 using the terms: toxic alcohols, serum osmolality, serum osmol gap, serum anion gap, metabolic acidosis, methanol, ethylene glycol, diethylene glycol, propylene glycol, and fomepizole. Each article was reviewed for additional references. RESULTS The diagnosis of toxic alcohol exposure is often made on the basis of this history and physical findings along with an increase in the serum osmol and anion gaps. However, an increase in the osmol and/or anion gaps is not always present. Definitive detection in blood requires gas or liquid chromatography, laborious and expensive procedures which are not always available. Newer methods including a qualitative colorimetric test for detection of all alcohols or enzymatic tests for a specific alcohol might allow for more rapid diagnosis. CONCLUSIONS Exposure to toxic alcohols is associated with cellular dysfunction and increased risk of death. Treatment, if initiated early, can markedly improve outcome, but present methods of diagnosis including changes in serum osmol and anion gap, and use of gas or liquid chromatography have important limitations. Development of more rapid and effective tests for detection of these intoxications is essential for optimal care of patients.
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Affiliation(s)
- Jeffrey A Kraut
- Medical and Research Services Veterans Administration Greater Los Angeles Healthcare System, UCLA Membrane Biology Laboratory, and Division of Nephrology, Veterans Administration Greater Los Angeles Healthcare System, and David Geffen School of Medicine , Los Angeles , California
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Sato M, Inage K, Sakuma Y, Sato J, Orita S, Yamauchi K, Eguchi Y, Ochiai N, Kuniyoshi K, Aoki Y, Nakamura J, Miyagi M, Suzuki M, Kubota G, Sainoh T, Fujimoto K, Shiga Y, Abe K, Kanamoto H, Inoue G, Takahashi K, Ohtori S. Anti-RANKL antibodies decrease CGRP expression in dorsal root ganglion neurons innervating injured lumbar intervertebral discs in rats. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:2017-22. [PMID: 26071945 DOI: 10.1007/s00586-015-4058-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 05/26/2015] [Accepted: 06/07/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Nuclear factor-κB (NF-κB), receptor activator of NF-κB (RANK), and RANK ligand (RANKL) are transcriptional regulators of inflammatory cytokines. RANKL expression in dorsal root ganglion (DRG) neurons is elevated in animal models of pain or intervertebral disc herniation. We sought to evaluate the effect of anti-RANKL antibodies on sensory nerves innervating injured intervertebral discs. METHOD We labeled DRG neurons innervating L5-6 discs with FluoroGold (FG). The L5-6 discs of 36 rats were punctured using a 23-gage needle and 18 rats underwent sham surgery without disc puncture. The puncture group was evenly subdivided into a group in which 10 μl saline was administered to the injured disc and a group in which 10 μl of anti-RANKL antibody was administered. Seven and 14 days postsurgery, DRGs at L2 level were harvested, sectioned, and immunostained for calcitonin gene-related peptide (CGRP). The proportion of CGRP-immunoreactive (IR) DRG neurons of all FG-positive neurons was determined. Amount of tumor necrosis factor (TNF)-α and interleukin(IL)-6 was measured within the intervertebral discs in each group at 7 and 14 days after surgery using an enzyme-linked immunosorbent assay (ELISA). RESULTS The proportion of CGRP-IR DRG neurons to total FG-labeled neurons innervating injured intervertebral discs and amount of TNF-α and IL-6 in the injured discs in the saline control group was significantly increased compared with that found in rats from the sham surgery group (P < 0.05). However, application of anti-RANKL antibody to the injured discs significantly decreased the proportion of CGRP-IR DRG neurons to total FG-labeled neurons and amount of TNF-α and IL-6 in the injured discs (P < 0.05). CONCLUSIONS TNF-α and IL-6 in the injured discs increased and CGRP expression increased in DRG neurons innervating injured discs, and antibodies to RANKL could suppress this increased TNF-α, IL-6, and CGRP expression. RANKL may be a therapeutic target for pain control in patients with lumbar disc degeneration.
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Affiliation(s)
- Masashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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Evaluation of behavior and expression of receptor activator of nuclear factor-kappa B ligand in dorsal root Ganglia after sciatic nerve compression and application of nucleus pulposus in rats. Asian Spine J 2014; 8:557-64. [PMID: 25346807 PMCID: PMC4206804 DOI: 10.4184/asj.2014.8.5.557] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/05/2013] [Accepted: 11/07/2013] [Indexed: 12/19/2022] Open
Abstract
Study Design Experimental animal study. Purpose To evaluate pain-related behavior and changes in nuclear factor-kappa B (NF-kB), receptor activator of NF-kB (RANK), and ligand (RANKL) in dorsal root ganglia (DRG) after combined sciatic nerve compression and nucleus pulposus (NP) application in rats. Overview of Literature The pathological mechanisms underlying pain from lumbar-disc herniation have not been fully elucidated. RANKL are transcriptional regulators of inflammatory cytokines. Our aim was to evaluate pain-related behavior and RANKL expression in DRG after sciatic-nerve compression and application of NP in rats. Methods Mechanical hyperalgesia and RANKL expression were assessed in three groups of rats: NP+sciatic nerve compression (2 seconds), sham-operated, and controls (n=20 each). Mechanical hyperalgesia was measured every other day for 3 weeks using von Frey filaments. RANKL expression in L5 DRGs was examined at five and ten days after surgery using immunohistochemistry. Results Mechanical hyperalgesia was observed over the 12-day observation period in the NP+nerve compression group, but not in the control and sham-operated animal groups (p<0.05). RANKL immunoreactivity was seen in the nuclei of L5 DRG neurons, and its expression was significantly upregulated in NP+nerve compression rats compared with control and sham-operated rats (p<0.01). Conclusions The exposure of sciatic nerves to mechanical compression and NP produces pain-related behavior and up-regulation of RANKL in DRG neurons. RANKL may play an important role in mediating pain after sciatic nerve injury with exposure to NP.
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Chhatre S, Metzger DS, Malkowicz SB, Woody G, Jayadevappa R. Substance use disorder and its effects on outcomes in men with advanced-stage prostate cancer. Cancer 2014; 120:3338-45. [PMID: 25042396 DOI: 10.1002/cncr.28861] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/20/2014] [Accepted: 05/21/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Substance use disorder in patients with cancer has implications for outcomes. The objective of this study was to analyze the effects of the type and timing of substance use on outcomes in elderly Medicare recipients with advanced prostate cancer. METHODS This was an observational cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from 2000 to 2009. Among men who were diagnosed with advanced prostate cancer between 2001 and 2004, we identified those who had a claim for substance use disorder in the year before cancer diagnosis, 1 year after cancer diagnosis, and an additional 4 years after diagnosis. The outcomes investigated were use of health services, costs, and mortality. RESULTS The prevalence of substance use disorder was 10.6%. The category drug psychoses and related had greater odds of inpatient hospitalizations (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.9-2.8), outpatient hospital visits (OR, 2.6; 95% CI, 1.9-3.6), and emergency room visits (OR, 1.7; 95% CI, 1.2-2.4). Substance use disorder in the follow-up phase was associated with greater odds of inpatient hospitalizations (OR, 2.0; 95% CI, 1.8-2.2), outpatient hospital visits (OR, 2.0; 95% CI, 1.7-2.4), and emergency room visits (OR, 1.7; 95% CI, 1.5-2.1). Compared with men who did not have substance use disorder, those in the category drug psychoses and related had 70% higher costs, and those who had substance use disorder during the follow-up phase had 60% higher costs. The hazard of all-cause mortality was highest for patients in the drug psychoses and related category (hazard ratio, 1.3; 95% CI, 1.1-1.7) and the substance use disorder in treatment phase category (hazard ratio, 1.5; 95% CI, 1.3-1.7). CONCLUSIONS The intersection of advanced prostate cancer and substance use disorder may adversely affect outcomes. Incorporating substance use screening and treatments into prostate cancer care guidelines and coordination of care is desirable.
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Affiliation(s)
- Sumedha Chhatre
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Li F, Wang W, Li L, Chang Y, Su D, Guo G, He X, Li M. An Effective Therapy to Painful Bone Metastases: Cryoablation Combined with Zoledronic Acid. Pathol Oncol Res 2014; 20:885-91. [DOI: 10.1007/s12253-014-9769-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 03/20/2014] [Indexed: 02/02/2023]
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Verron E, Schmid-Antomarchi H, Pascal-Mousselard H, Schmid-Alliana A, Scimeca JC, Bouler JM. Therapeutic strategies for treating osteolytic bone metastases. Drug Discov Today 2014; 19:1419-26. [PMID: 24742971 DOI: 10.1016/j.drudis.2014.04.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 03/11/2014] [Accepted: 04/07/2014] [Indexed: 01/15/2023]
Abstract
The recent progress in oncologic management of patients with localized cancer or metastatic disease has permitted a significant improvement in life expectancy. Nevertheless, bone metastases and their consequent skeletal-related events (SREs) are still associated with unfavorable prognosis and greatly affect quality of life. Global management of these bone metastases includes traditional local approaches (surgery, radiotherapy, etc.) and systemic administration of chemotherapeutic agents. This review focuses on treatments specific for bone metastases and, in particular, on inhibitors of bone resorption that are effective for preventing and delaying the development of SREs.
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Affiliation(s)
- Elise Verron
- INSERM U791, Université de Nantes, Faculté de Chirurgie Dentaire, 44042 Nantes, France.
| | | | | | - Annie Schmid-Alliana
- Univ Nice Sophia Antipolis, CNRS, iBV, UMR7277, UFR Médecine, 06107 Nice Cedex 2, France
| | - Jean-Claude Scimeca
- Univ Nice Sophia Antipolis, CNRS, iBV, UMR7277, UFR Médecine, 06107 Nice Cedex 2, France
| | - Jean-Michel Bouler
- INSERM U791, Université de Nantes, Faculté de Chirurgie Dentaire, 44042 Nantes, France
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