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Mattar M, Umutoni F, Hassan MA, Wamburu MW, Turner R, Patton JS, Chen X, Lei W. Chemotherapy-Induced Peripheral Neuropathy: A Recent Update on Pathophysiology and Treatment. Life (Basel) 2024; 14:991. [PMID: 39202733 PMCID: PMC11355765 DOI: 10.3390/life14080991] [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: 06/20/2024] [Revised: 07/29/2024] [Accepted: 08/07/2024] [Indexed: 09/03/2024] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a major long-lasting side effect of some chemotherapy drugs, which threatens cancer survival rate. CIPN mostly affects sensory neurons and occasionally motor neurons, causing numbness, tingling, discomfort, and burning pain in the upper and lower extremities. The pathophysiology of CIPN is not completely understood; however, it is believed that chemotherapies induce peripheral neuropathy via directly damaging mitochondria, impairing the function of ion channels, triggering immunological mechanisms, and disrupting microtubules. The treatment of CIPN is a medical challenge, and there are no approved pharmacological options. Currently, duloxetine and other antidepressants, antioxidant, anti-inflammatory, and ion-channel targeted therapies are commonly used in clinics to relieve the symptoms of CIPN. Several other types of drugs, such as cannabinoids, sigma-1 receptor antagonists, and nicotinamides ribose, are being evaluated in preclinical and clinical studies. This paper summarizes the information related to the physiology of CIPN and medicines that could be used for treating this condition.
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Affiliation(s)
- Marina Mattar
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, SC 29325, USA; (M.M.); (M.A.H.)
| | - Florence Umutoni
- Department of Pharmaceutical and Graduate Life Sciences, College of Health Sciences, Nursing, and Pharmacy, Manchester University, Fort Wayne, IN 46845, USA; (F.U.); (J.S.P.)
| | - Marwa A. Hassan
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, SC 29325, USA; (M.M.); (M.A.H.)
| | - M. Wambui Wamburu
- Department of Pharmacy Practice, College of Health Sciences, Nursing, and Pharmacy, Manchester University, Fort Wayne, IN 46845, USA;
| | - Reagan Turner
- Department of Biology, Presbyterian College, Clinton, SC 29325, USA;
| | - James S. Patton
- Department of Pharmaceutical and Graduate Life Sciences, College of Health Sciences, Nursing, and Pharmacy, Manchester University, Fort Wayne, IN 46845, USA; (F.U.); (J.S.P.)
| | - Xin Chen
- Department of Pharmaceutical and Clinical Sciences, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC 27506, USA;
| | - Wei Lei
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, SC 29325, USA; (M.M.); (M.A.H.)
- Department of Pharmaceutical and Graduate Life Sciences, College of Health Sciences, Nursing, and Pharmacy, Manchester University, Fort Wayne, IN 46845, USA; (F.U.); (J.S.P.)
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Alhourani N, Wolfes J, Könemann H, Ellermann C, Frommeyer G, Güner F, Lange PS, Reinke F, Köbe J, Eckardt L. Relevance of mexiletine in the era of evolving antiarrhythmic therapy of ventricular arrhythmias. Clin Res Cardiol 2024; 113:791-800. [PMID: 38353682 PMCID: PMC11108884 DOI: 10.1007/s00392-024-02383-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/19/2024] [Indexed: 05/22/2024]
Abstract
Despite impressive developments in the field of ventricular arrhythmias, there is still a relevant number of patients with ventricular arrhythmias who require antiarrhythmic drug therapy and may, e.g., in otherwise drug and/or ablation refractory situations, benefit from agents known for decades, such as mexiletine. Through its capability of blocking fast sodium channels in cardiomyocytes, it has played a minor to moderate antiarrhythmic role throughout the recent decades. Nevertheless, certain patients with structural heart disease suffering from drug-refractory, i.e., mainly amiodarone refractory ventricular arrhythmias, as well as those with selected forms of congenital long QT syndrome (LQTS) may nowadays still benefit from mexiletine. Here, we outline mexiletine's cellular and clinical electrophysiological properties. In addition, the application of mexiletine may be accompanied by various potential side effects, e.g., nausea and tremor, and is limited by several drug-drug interactions. Thus, we shed light on the current therapeutic role of mexiletine for therapy of ventricular arrhythmias and discuss clinically relevant aspects of its indications based on current evidence.
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Affiliation(s)
- Nawar Alhourani
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany.
| | - Julian Wolfes
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Hilke Könemann
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Christian Ellermann
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Fatih Güner
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Philipp Sebastian Lange
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Florian Reinke
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Julia Köbe
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
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Wang GC, Li XR, Huang N, Tian HT. Sudden ventricular fibrillation due to absence of pericardium in left upper lobectomy -a case report. Korean J Anesthesiol 2024; 77:401-404. [PMID: 38225739 PMCID: PMC11150111 DOI: 10.4097/kja.23625] [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: 08/16/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Congenital absence of the pericardium (CAP) is a rare cardiac abnormality. As pericardial defects are usually asymptomatic, most cases are diagnosed during surgery or on autopsy. The patient in this case was found to have CAP during thoracoscope. CASE We present the unusual case of a 69-year-old patient with CAP who experienced sudden ventricular arrhythmia and developed ventricular fibrillation during left upper lobectomy. Surgical operations, the lateral decubitus position, and other external stimuli may be important risk factors for ventricular fibrillation. The patient regained sinus rhythm soon after intrathoracic cardiac compression and pharmacological treatment, including lidocaine spray (2%, 10 ml) administered to the heart surface. The surgery was then completed without any additional instances of ventricular arrhythmia. CONCLUSIONS Patients with CAP are more susceptible to cardiac-related adverse events during thoracotomy or thoracoscopy. Treatment of ventricular arrhythmias that occur during lung resection in patients with CAP should be emphasized.
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Affiliation(s)
- Guo-Cao Wang
- School of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
- Department of Anesthesiology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Xi-Rong Li
- Department of Anesthesiology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Ning Huang
- Department of Anesthesiology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Hai-Tao Tian
- School of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
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Yartsev A, Scott A. Massive lignocaine overdose while on veno-arterial extracorporeal membrane oxygenation (VA ECMO). Toxicol Rep 2024; 12:463-468. [PMID: 38699074 PMCID: PMC11063992 DOI: 10.1016/j.toxrep.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/05/2024] Open
Abstract
We present the extraordinary circumstance of a female patient in her sixties who suffered a massive lignocaine overdose while undergoing treatment with Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) following an emergency coronary artery bypass graft (CABG). The patient was initially admitted to the Intensive Care Unit (ICU) due to unstable angina and a history of insulin-dependent type two diabetes mellitus, hypertension, hypercholesterolemia, carotid artery stenosis, and an extensive smoking history. Despite initial improvements following surgery, she experienced repeated episodes of nonsustained polymorphic ventricular tachycardia (VT) that were refractory to conventional antiarrhythmic medications. The overdose occurred due to a medication administration error, leading to the infusion of lignocaine at a rate eight times higher than intended, over the course of 36 h (total dose of 9964 mg, or 153 mg/kg). Remarkably, the patient remained haemodynamically stable throughout the overdose period, with normal sinus rhythm, requiring minimal ECMO support and no vasoactive agents. Further investigation into the pharmacokinetics of lignocaine during VA ECMO treatment suggested that the patient's unexpected stability and survival could be attributed to the adsorption of lignocaine onto the components of the ECMO circuit. This phenomenon potentially mitigated the cardiotoxic effects typically associated with such high doses of lignocaine, thus presenting an unusual but critical aspect of pharmacokinetics in the context of ECMO support. This case underscores the importance of investigating the complex interactions between medications and extracorporeal circuits, which can significantly alter drug pharmacokinetics and toxicity profiles.
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Affiliation(s)
- Alex Yartsev
- Westmead Hospital, Sydney, Australia
- Westmead ICU, Westmead Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
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Fantone S, Piani F, Olivieri F, Rippo MR, Sirico A, Di Simone N, Marzioni D, Tossetta G. Role of SLC7A11/xCT in Ovarian Cancer. Int J Mol Sci 2024; 25:587. [PMID: 38203758 PMCID: PMC10779187 DOI: 10.3390/ijms25010587] [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: 11/18/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Ovarian cancer is one of the most dangerous gynecologic cancers worldwide and has a high fatality rate due to diagnosis at an advanced stage of the disease as well as a high recurrence rate due to the occurrence of chemotherapy resistance. In fact, chemoresistance weakens the therapeutic effects, worsening the outcome of this pathology. Solute Carrier Family 7 Member 11 (SLC7A11, also known as xCT) is the functional subunit of the Xc- system, an anionic L-cystine/L-glutamate antiporter expressed on the cell surface. SLC7A11 expression is significantly upregulated in several types of cancers in which it can inhibit ferroptosis and favor cancer cell proliferation, invasion and chemoresistance. SLC7A11 expression is also increased in ovarian cancer tissues, suggesting a possible role of this protein as a therapeutic target. In this review, we provide an overview of the current literature regarding the role of SLC7A11 in ovarian cancer to provide new insights on SLC7A11 modulation and evaluate the potential role of SLC7A11 as a therapeutic target.
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Affiliation(s)
- Sonia Fantone
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (S.F.); (F.O.)
| | - Federica Piani
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy;
| | - Fabiola Olivieri
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (S.F.); (F.O.)
- Department of Clinical and Molecular Sciences, DISCLIMO, Università Politecnica delle Marche, 60126 Ancona, Italy;
| | - Maria Rita Rippo
- Department of Clinical and Molecular Sciences, DISCLIMO, Università Politecnica delle Marche, 60126 Ancona, Italy;
| | - Angelo Sirico
- Obstetrics and Gynecology Unit, Sant’Anna e San Sebastiano Hospital, 81100 Caserta, Italy;
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Daniela Marzioni
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, 60126 Ancona, Italy;
| | - Giovanni Tossetta
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, 60126 Ancona, Italy;
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