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DSilva F, Singh P, Javeth A. Determinants of Cancer-Related Fatigue among Cancer Patients: A Systematic Review. J Palliat Care 2023; 38:432-455. [PMID: 36245333 DOI: 10.1177/08258597221131133] [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] [Indexed: 11/17/2022]
Abstract
Objectives: This systematic review aims to assess and explore various determinants of cancer- related fatigue. Methods: A systematic search of various determinants of Cancer-related fatigue (CRF) was performed in different databases like PubMed, Google Scholar, Science Direct and Clinical Key dating from 1990 to September 2020. Results: A total of 6115 studies were screened and 95 articles related to determinants of fatigue were retained. Various modifiable and non-modifiable determinants including socio-demographic, clinical, treatment related, plasma biomarker related, genetic, behavioural, concurrent symptoms related and psychological determinants were identified. Depression was one of the significant factors reported in 28% of studies, followed by pain, (17%), performance status (16%), chemotherapy and anxiety (15%). Conclusion: It is recommended that nurses and clinicians should anticipate, identify and take appropriate interventions to manage those modifiable factors. Ultimately, managing the modifiable factors helps in the comprehensive care of cancer patients.
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Affiliation(s)
- Fatima DSilva
- Nitte Usha Institute of Nursing Sciences, Nitte University, Mangalore, Karnataka, India
| | - Pritanjali Singh
- Department of Radiation Oncology, All India Institute of Medical Science (AIIMS), Patna, Bihar, India
| | - Athar Javeth
- College of Nursing, All India Institute of Medical Science (AIIMS), Patna, Bihar, India
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Liu Q, Wang F, Wang G, Liu L, Hu X. Recent evidence and progress for developing precision nursing in symptomatology: A scoping review. Int Nurs Rev 2023; 70:415-424. [PMID: 36597558 DOI: 10.1111/inr.12816] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/24/2022] [Indexed: 01/05/2023]
Abstract
AIM To summarize the omics results of symptomatic research that can help nurses identify intervention targets and design precision interventions for pain, mental health, cognitive impairment, sleep disorder, fatigue, lymphedema, and quality of life, so as to provide a comprehensive summary of help and inspire to precision nursing. METHODS CINAHL, PubMed, Web of Science, and ScienceDirect databases were searched. Retrieval time was from January 2012 to December 2021. Symptomatology research applying omics that can be used to guide nurses in designing targeted interventions was included. RESULTS Forty-six studies were included in the final review. Symptomatology research that can be integrated with nursing science to develop precision nursing focused on pain, mental health, cognitive impairment, sleep disorder, fatigue, lymphedema, and quality of life. Most studies were related to cognitive impairment (n = 10; 21.74%), pain (n = 9; 19.57%), and mental health (n = 8; 17.39%). Moreover, the included studies involved various omics technologies, such as whole genome, epigenome, transcriptome, proteome, and metabolome. CONCLUSION The rapid development of various omic technologies promotes symptomatology research, which can help nurses fully understand the information of patients. Phenotypic characteristics and biomarkers shown in symptomatology research help nurses identify intervention targets and develop individualization interventions, so as to prevent and reduce symptoms and improve the quality of life. IMPLICATION FOR NURSING AND HEALTH POLICY This scoping review is the first synthesis of all peer-reviewed literature to summarize and provide important information and references from the omic results of symptomatology studies to develop precision nursing, highlighting the status and development of precision nursing. Nursing education policies should introduce the development and importance of precision nursing. Further research could consider investing more attention in precision nursing. Nursing researchers can carry out some studies applying omics technology to explore more biomarkers, helping guide the formulation of clinical intervention for symptoms.
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Affiliation(s)
- Qian Liu
- West China School of Nursing, Sichuan University/ Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Sichuan, China
| | - Fang Wang
- West China School of Nursing, Sichuan University/ Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Sichuan, China
| | - Guan Wang
- West China School of Nursing, Sichuan University/ Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Sichuan, China
| | - Li Liu
- West China School of Nursing, Sichuan University/ Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Sichuan, China
| | - Xiuying Hu
- West China School of Nursing, Sichuan University/ Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Sichuan, China
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Aryankalayil MJ, Bylicky MA, Martello S, Chopra S, Sproull M, May JM, Shankardass A, MacMillan L, Vanpouille-Box C, Dalo J, Scott KMK, Norman Coleman C. Microarray analysis identifies coding and non-coding RNA markers of liver injury in whole body irradiated mice. Sci Rep 2023; 13:200. [PMID: 36604457 PMCID: PMC9814510 DOI: 10.1038/s41598-022-26784-w] [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: 05/02/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
Radiation injury from medical, accidental, or intentional sources can induce acute and long-term hepatic dysregulation, fibrosis, and cancer. This long-term hepatic dysregulation decreases quality of life and may lead to death. Our goal in this study is to determine acute changes in biological pathways and discover potential RNA biomarkers predictive of radiation injury. We performed whole transcriptome microarray analysis of mouse liver tissue (C57BL/6 J) 48 h after whole-body irradiation with 1, 2, 4, 8, and 12 Gray to identify significant expression changes in mRNAs, lncRNAs, and miRNAs, We also validated changes in specific RNAs through qRT-PCR. We used Ingenuity Pathway Analysis (IPA) to identify pathways associated with gene expression changes. We observed significant dysregulation of multiple mRNAs across all doses. In contrast, miRNA dysregulation was observed upwards of 2 Gray. The most significantly upregulated mRNAs function as tumor suppressors: Cdkn1a, Phlda3, and Eda2r. The most significantly downregulated mRNAs were involved in hemoglobin synthesis, inflammation, and mitochondrial function including multiple members of Hbb and Hba. The most significantly upregulated miRNA included: miR-34a-5p, miR-3102-5p, and miR-3960, while miR-342-3p, miR-142a-3p, and miR-223-3p were most significantly downregulated. IPA predicted activation of cell cycle checkpoint control pathways and inhibition of pathways relevant to inflammation and erythropoietin. Clarifying expression of mRNA, miRNA and lncRNA at a short time point (48 h) offers insight into potential biomarkers, including radiation markers shared across organs and animal models. This information, once validated in human models, can aid in development of bio-dosimetry biomarkers, and furthers our understanding of acute pathway dysregulation.
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Affiliation(s)
- Molykutty J. Aryankalayil
- grid.48336.3a0000 0004 1936 8075Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B406, Bethesda, MD 20892 USA
| | - Michelle A. Bylicky
- grid.48336.3a0000 0004 1936 8075Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B406, Bethesda, MD 20892 USA
| | - Shannon Martello
- grid.48336.3a0000 0004 1936 8075Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B406, Bethesda, MD 20892 USA
| | - Sunita Chopra
- grid.48336.3a0000 0004 1936 8075Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B406, Bethesda, MD 20892 USA
| | - Mary Sproull
- grid.48336.3a0000 0004 1936 8075Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B406, Bethesda, MD 20892 USA
| | - Jared M. May
- grid.48336.3a0000 0004 1936 8075Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B406, Bethesda, MD 20892 USA
| | - Aman Shankardass
- grid.48336.3a0000 0004 1936 8075Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B406, Bethesda, MD 20892 USA
| | - Laurel MacMillan
- grid.420517.50000 0004 0490 0428Gryphon Scientific, Takoma Park, MD 20912 USA
| | - Claire Vanpouille-Box
- grid.5386.8000000041936877XDepartment of Radiation Oncology, Weill Cornell Medicine, New York, NY 10065 USA
| | - Juan Dalo
- grid.48336.3a0000 0004 1936 8075Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B406, Bethesda, MD 20892 USA
| | - Kevin M. K. Scott
- grid.48336.3a0000 0004 1936 8075Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B406, Bethesda, MD 20892 USA
| | - C. Norman Coleman
- grid.48336.3a0000 0004 1936 8075Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Room B3B406, Bethesda, MD 20892 USA ,grid.48336.3a0000 0004 1936 8075Radiation Research Program, National Cancer Institute, National Institutes of Health, Rockville, MD 20850 USA
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Flowers E, Flentje A, Levine J, Olshen A, Hammer M, Paul S, Conley Y, Miaskowski C, Kober KM. A Pilot Study Using a Multistaged Integrated Analysis of Gene Expression and Methylation to Evaluate Mechanisms for Evening Fatigue in Women Who Received Chemotherapy for Breast Cancer. Biol Res Nurs 2019; 21:142-156. [PMID: 30701989 PMCID: PMC6700896 DOI: 10.1177/1099800418823286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT Fatigue is the most common symptom associated with cancer and its treatment. Investigation of molecular mechanisms associated with fatigue may identify new therapeutic targets. OBJECTIVE The objective of this pilot study was to evaluate the relationships between gene expression and methylation status and evening fatigue severity in women with breast cancer who received chemotherapy. METHODS Latent class analysis (LCA) was used to identify evening fatigue phenotypes. In this analysis, the lowest (i.e., moderate, n = 7) and highest (i.e., very high, n = 29) fatigue-severity classes identified using LCA were analyzed via two stages. First, a total of 32,609 transcripts from whole blood were evaluated for differences in expression levels between the classes. Next, 637 methylation sites located within the putative transcription factor binding sites for those genes demonstrating differential expression were evaluated for differential methylation state between the classes. RESULTS A total of 89 transcripts in 75 unique genes were differentially expressed between the moderate (the lowest fatigue-severity class identified) and very high evening fatigue classes. In addition, 23 differentially methylated probes and three differentially methylated regions were found between the moderate and very high evening fatigue classes. CONCLUSIONS Using a multistaged integrated analysis of gene expression and methylation, differential methylation was identified in the regulatory regions of genes associated with previously hypothesized mechanisms for fatigue, including inflammation, immune function, neurotransmission, circadian rhythm, skeletal muscle energy, carbohydrate metabolism, and renal function as well as core biological processes including gene transcription and the cell-cycle regulation.
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Affiliation(s)
- Elena Flowers
- School of Nursing, University of California, San Francisco, San Francisco,
CA, USA
| | - Annesa Flentje
- School of Nursing, University of California, San Francisco, San Francisco,
CA, USA
| | - Jon Levine
- School of Medicine, University of California, San Francisco, San Francisco,
CA, USA
| | - Adam Olshen
- School of Medicine, University of California, San Francisco, San Francisco,
CA, USA
| | - Marilyn Hammer
- Department of Nursing, Mount Sinai Hospital, New York, NY, USA
| | - Steven Paul
- School of Nursing, University of California, San Francisco, San Francisco,
CA, USA
| | - Yvette Conley
- School of Nursing, University of Pittsburg, Pittsburg, PA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, San Francisco,
CA, USA
| | - Kord M. Kober
- School of Nursing, University of California, San Francisco, San Francisco,
CA, USA
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Hasan S, Renz P, Packard M, Horrigan S, Gresswell S, Kirichenko AV. Effect of Daily and Every Other Day Stereotactic Body Radiation Therapy Schedules on Treatment-Related Fatigue in Patients With Hepatocellular Carcinoma. Pract Radiat Oncol 2019; 9:e38-e45. [PMID: 30612721 DOI: 10.1016/j.prro.2018.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/04/2018] [Accepted: 06/24/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE We compared the rate and severity of fatigue in patients who completed stereotactic body radiation therapy (SBRT) to the liver daily (QD) compared with every other day (QOD). METHODS AND MATERIALS From 2010 to 2017, 91 patients with Child Pugh (CP) A (n = 57) or CP-B (n = 34) cirrhosis who completed 100 SBRT sessions to 110 hepatocellular carcinoma (HCC) lesions were analyzed in this study. Confounding variables with fatigue such as CP-C cirrhosis, Eastern Cooperative Oncology Group score >2, or a history of ascites or encephalopathy were excluded. Fatigue was assessed against several treatment- and patient-related variables with univariate and propensity score-matched multivariate analysis. The median follow-up time was 18 months. RESULTS Patients with HCC and Barcelona-Clinic Liver Cancer stages 0 (n = 10), A (n = 32), and B (n = 58), and a median age of 62 years were analyzed. The median tumor diameter was 3 cm (1.1-11 cm). The Eastern Cooperative Oncology Group performance status score was 0 (n = 44), 1 (n = 43), or 2 (n = 13). The median dose was 45 Gy in 5 fractions, and 65 treatments were QD and 45 QOD. Grades 1 and 2 fatigue developed in 49% and 14% of treatments, respectively. Among the patients who were treated daily, 78% developed Grade 1 or 2 fatigue compared with 44% who were treated QOD (odds ratio: 4.52; P = .001). Grade 2 fatigue occurred in 22% of patients compared with 7.3% for QD and QOD treatment, respectively (odds ratio: 3.83; P = .048). There was no difference in fatigue rate for time of treatment (morning or afternoon), dose, treated volume, CP score, Barcelona-Clinic Liver Cancer stage, or performance status, which were not associated with any level of fatigue. There was no difference in local control between QD and QOD treatments. CONCLUSIONS Compared with traditional daily treatment fractions, SBRT that is delivered QOD to cirrhotic patients with HCC may reduce the risk of fatigue.
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Affiliation(s)
- Shaakir Hasan
- Allegheny Health Network, Division of Radiation Oncology, Pittsburgh, Pennsylvania.
| | - Paul Renz
- Allegheny Health Network, Division of Radiation Oncology, Pittsburgh, Pennsylvania
| | - Matthew Packard
- Allegheny Health Network, Division of Radiation Oncology, Pittsburgh, Pennsylvania
| | - Sean Horrigan
- Allegheny Health Network, Division of Radiation Oncology, Pittsburgh, Pennsylvania
| | - Steven Gresswell
- Allegheny Health Network, Division of Radiation Oncology, Pittsburgh, Pennsylvania
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de Alcântara BBR, Cruz FM, Fonseca FLA, da Costa Aguiar Alves B, Perez MM, Varela P, Pesquero JB, de Iracema Gomes Cubero D, De Melo Sette CV, Del Giglio A. Chemotherapy-induced fatigue is associated with changes in gene expression in the peripheral blood mononuclear cell fraction of patients with locoregional breast cancer. Support Care Cancer 2018; 27:2479-2486. [DOI: 10.1007/s00520-018-4519-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/16/2018] [Indexed: 01/27/2023]
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Black DS, Cole S, Christodoulou G, Figueiredo JC. Genomic mechanisms of fatigue in survivors of colorectal cancer. Cancer 2018; 124:2637-2644. [PMID: 29579369 PMCID: PMC5990448 DOI: 10.1002/cncr.31356] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/01/2018] [Accepted: 03/04/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Many cancer survivors experience fatigue as a nagging symptom lasting years after treatment. To learn of the relevant biological pathways involved in fatigue among cancer survivors, the authors tested for an association between fatigue levels and leukocyte gene expression profiles and determined the specific mediating immune cell types. METHODS A sample of 89 Hispanic/Latino adults aged 60.5 years, 62% of whom were male, who were diagnosed with colorectal cancer and were 2.9 years since diagnosis provided blood for transcriptome profiling and completed a validated measure of fatigue (Multidimensional Fatigue Symptom Inventory-Short Form). The authors applied genome-wide transcriptional profiling of leukocyte RNA to identify gene expression activity associated with fatigue, tested for the activity of specific transcription factors involved in previously established markers of inflammation and immunologic activation, and identified the specific cell types mediating these transcriptional alterations. RESULTS In analyses adjusting for demographic and behavioral health risk factors, results linked fatigue with increased activation of B lymphocytes and CD8-positive T cells, as well as several transcription factors involved in immune activation (nuclear factor κB [NF-κB], signal transducer and activator of transcription [STAT], and cAMP responsive element-binding protein [CREB]). Results also replicated several specific genomic effects previously observed in fatigued cancer survivors, including upregulated expression of α-synuclein (SNCA) and hemoglobin subunits (HBA and HBB). CONCLUSIONS Cancer survivors' heightened fatigue levels may be partially explained by activation of specific immune cell subsets, thereby providing a potential molecular biomarker for clinical interventions targeting the remediation of fatigue. Cancer 2018;124:2637-44. © 2018 American Cancer Society.
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Affiliation(s)
- David S. Black
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
- Norris Comprehensive Cancer Center, University of Southern California
| | - Steve Cole
- Departments of Medicine and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
| | - Georgia Christodoulou
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Jane C. Figueiredo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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Differential expression of genes and differentially perturbed pathways associated with very high evening fatigue in oncology patients receiving chemotherapy. Support Care Cancer 2017; 26:739-750. [PMID: 28944404 DOI: 10.1007/s00520-017-3883-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Fatigue is the most common symptom associated with cancer and its treatment. Investigation of molecular mechanisms associated with fatigue in oncology patients may identify new therapeutic targets. The objectives of this study were to evaluate the relationships between gene expression and perturbations in biological pathways and evening fatigue severity in oncology patients who received chemotherapy (CTX). METHODS The Lee Fatigue Scale (LFS) and latent class analysis were used to identify evening fatigue phenotypes. We measured 47,214 ribonucleic acid transcripts from whole blood collected prior to a cycle of CTX. Perturbations in biological pathways associated with differential gene expression were identified from public data sets (i.e., Kyoto Encyclopedia Gene and Genomes, BioCarta). RESULTS Patients were classified into Moderate (n = 65, mean LFS score 3.1) or Very High (n = 195, mean LFS score 6.4) evening fatigue groups. Compared to patients with Moderate fatigue, patients with Very High fatigue exhibited differential expression of 29 genes. A number of the perturbed pathways identified validated prior mechanistic hypotheses for fatigue, including alterations in immune function, inflammation, neurotransmission, energy metabolism, and circadian rhythms. Based on our findings, energy metabolism was further divided into alterations in carbohydrate metabolism and skeletal muscle energy. Alterations in renal function-related pathways were identified as a potential new mechanism. CONCLUSIONS This study identified differential gene expression and perturbed biological pathways that provide new insights into the multiple and likely inter-related mechanisms associated with evening fatigue in oncology patients.
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Hsiao CP, Daly B, Saligan LN. The Etiology and management of radiotherapy-induced fatigue. ACTA ACUST UNITED AC 2016; 1:323-328. [PMID: 29651466 DOI: 10.1080/23809000.2016.1191948] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fatigue is one of the most common side-effects accompanying radiotherapy, but arguably the least understood. Radiotherapy-induced fatigue (RIF) is a clinical subtype of cancer treatment-related fatigue. It is described as a pervasive, subjective sense of tiredness persisting over time, interferes with activities of daily living, and is not relieved by adequate rest or sleep. RIF is one of the early side-effects and long-lasting for cancer patients treated with localized radiation. Although the underlying mechanisms of fatigue have been studied in several disease conditions, the etiology, mechanisms, and risk factors of RIF remain elusive, and this symptom remains poorly managed. The purpose of this paper is to review and discuss recent articles that defined, proposed biologic underpinnings and mechanisms to explain the pathobiology of RIF, as well as articles that proposed interventions to manage RIF. Understanding the mechanisms of RIF can describe promising pathways to identify at-risk individuals and identify potential therapeutic targets to alleviate and prevent RIF using a multimodal, multidisciplinary approach.
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Affiliation(s)
- Chao-Pin Hsiao
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Barbara Daly
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Leorey N Saligan
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
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Assessment of Radiation Induced Therapeutic Effect and Cytotoxicity in Cancer Patients Based on Transcriptomic Profiling. Int J Mol Sci 2016; 17:250. [PMID: 26907258 PMCID: PMC4783980 DOI: 10.3390/ijms17020250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 01/31/2016] [Accepted: 02/03/2016] [Indexed: 12/11/2022] Open
Abstract
Toxicity induced by radiation therapy is a curse for cancer patients undergoing treatment. It is imperative to understand and define an ideal condition where the positive effects notably outweigh the negative. We used a microarray meta-analysis approach to measure global gene-expression before and after radiation exposure. Bioinformatic tools were used for pathways, network, gene ontology and toxicity related studies. We found 429 differentially expressed genes at fold change >2 and p-value <0.05. The most significantly upregulated genes were synuclein alpha (SNCA), carbonic anhydrase I (CA1), X-linked Kx blood group (XK), glycophorin A and B (GYPA and GYPB), and hemogen (HEMGN), while downregulated ones were membrane-spanning 4-domains, subfamily A member 1 (MS4A1), immunoglobulin heavy constant mu (IGHM), chemokine (C-C motif) receptor 7 (CCR7), BTB and CNC homology 1 transcription factor 2 (BACH2), and B-cell CLL/lymphoma 11B (BCL11B). Pathway analysis revealed calcium-induced T lymphocyte apoptosis and the role of nuclear factor of activated T-cells (NFAT) in regulation of the immune response as the most inhibited pathways, while apoptosis signaling was significantly activated. Most of the normal biofunctions were significantly decreased while cell death and survival process were activated. Gene ontology enrichment analysis revealed the immune system process as the most overrepresented group under the biological process category. Toxicity function analysis identified liver, kidney and heart to be the most affected organs during and after radiation therapy. The identified biomarkers and alterations in molecular pathways induced by radiation therapy should be further investigated to reduce the cytotoxicity and development of fatigue.
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