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Kessler ER, Callihan E, Hu J, Eule C, Srivastava G, Kemme DJ, Iruku P, Rana V, Moore J, Schuster SR, Amirault M, Flaig TW, Lam ET. A Phase I/II Clinical Trial of Pembrolizumab and Cabozantinib in Metastatic Renal Cell Carcinoma. CANCER RESEARCH COMMUNICATIONS 2023; 3:1004-1012. [PMID: 37377613 PMCID: PMC10249509 DOI: 10.1158/2767-9764.crc-23-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/18/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2023]
Abstract
Purpose Immune checkpoint inhibitor and VEGFR inhibitor combinations are effective treatments for patients with metastatic renal cell carcinoma (mRCC). This phase I/II clinical trial evaluated the safety and efficacy of pembrolizumab and cabozantinib in patients with mRCC. Experimental Design Eligible patients had mRCC with clear-cell or non-clear cell histology, adequate organ function, Eastern Cooperative Oncology Group 0-1 performance status, and no prior exposure to pembrolizumab or cabozantinib. The primary endpoint was objective response rate (ORR) at the recommended phase II dose (RP2D). Secondary endpoints included safety, disease control rate (DCR), duration of response (DoR), progression-free survival (PFS), and overall survival (OS). Results Forty-five patients were enrolled. A total of 40 patients were treated at the RP2D of pembrolizumab 200 mg i.v. every 3 weeks and cabozantinib 60 mg orally once daily, 38 of which were evaluable for response. The ORR was 65.8% [95% confidence interval (CI), 49.9-78.8] for all evaluable patients [78.6% as first-line therapy, 58.3% as second-line therapy]. The DCR was 97.4% (95% CI, 86.5-99.9). Median DoR was 8.3 months (interquartile range, 4.6-15.1). At a median follow-up of 23.54 months, the median PFS was 10.45 months (95% CI, 6.25-14.63) and median OS was 30.81 months (95% CI, 24.2-not reached). The most common grade 1 and/or 2 treatment-related adverse events (TRAE) were diarrhea, anorexia, dysgeusia, weight loss, and nausea. The most common grade 3 and/or 4 TRAEs were hypertension, hypophosphatemia, alanine transaminase elevation, diarrhea, and fatigue. There was one grade 5 TRAE of reversible posterior encephalopathy syndrome related to cabozantinib. Conclusions Pembrolizumab and cabozantinib treatment in patients with mRCC demonstrated encouraging preliminary efficacy and a manageable toxicity profile comparable with other available checkpoint inhibitor-tyrosine kinase inhibitor combinations. Trial Registration ClinicalTrials.gov Identifier: NCT03149822 https://clinicaltrials.gov/ct2/show/NCT03149822. Significance This study evaluated the safety and effectiveness of the combination of pembrolizumab and cabozantinib in patients with mRCC. The safety profile was manageable. The combination showed promising activity with an objective response rate of 65.8%, median PFS of 10.45 months, and median OS of 30.81 months.
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Affiliation(s)
- Elizabeth R. Kessler
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Eryn Callihan
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Junxiao Hu
- University of Colorado Cancer Center Biostatistics Core, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Corbin Eule
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Geetika Srivastava
- UCHealth Cancer Care and Hematology Clinic, Memorial Hospital Central, Colorado Springs, Colorado
| | - Douglas J. Kemme
- UCHealth Cancer Center Harmony Campus, Poudre Valley Hospital, Fort Collins, Colorado
| | - Praveena Iruku
- UCHealth Cancer Care and Hematology Clinic, Memorial Hospital Central, Colorado Springs, Colorado
| | - Vishal Rana
- UCHealth Cancer Care and Hematology Clinic, Memorial Hospital Central, Colorado Springs, Colorado
| | - James Moore
- UCHealth Cancer Center Harmony Campus, Poudre Valley Hospital, Fort Collins, Colorado
| | - Steven R. Schuster
- UCHealth Cancer Center Harmony Campus, Poudre Valley Hospital, Fort Collins, Colorado
| | - Mali Amirault
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Thomas W. Flaig
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Elaine T. Lam
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- UCHealth Lone Tree Medical Center, Lone Tree, Colorado
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Landini L, Marini M, Souza Monteiro de Araujo D, Romitelli A, Montini M, Albanese V, Titiz M, Innocenti A, Bianchini F, Geppetti P, Nassini R, De Logu F. Schwann Cell Insulin-like Growth Factor Receptor Type-1 Mediates Metastatic Bone Cancer Pain in Mice. Brain Behav Immun 2023; 110:348-364. [PMID: 36940752 DOI: 10.1016/j.bbi.2023.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/27/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023] Open
Abstract
Insulin growth factor-1 (IGF-1), an osteoclast-dependent osteolysis biomarker, contributes to metastatic bone cancer pain (MBCP), but the underlying mechanism is poorly understood. In mice, the femur metastasis caused by intramammary inoculation of breast cancer cells resulted in IGF-1 increase in femur and sciatic nerve, and IGF-1-dependent stimulus/non-stimulus-evoked pain-like behaviors. Adeno-associated virus-based shRNA selective silencing of IGF-1 receptor (IGF-1R) in Schwann cells, but not in dorsal root ganglion (DRG) neurons, attenuated pain-like behaviors. Intraplantar IGF-1 evoked acute nociception and mechanical/cold allodynia, which were reduced by selective IGF-1R silencing in DRG neurons and Schwann cells, respectively. Schwann cell IGF-1R signaling promoted an endothelial nitric oxide synthase-mediated transient receptor potential ankyrin 1 (TRPA1) activation and release of reactive oxygen species that, via macrophage-colony stimulating factor-dependent endoneurial macrophage expansion, sustained pain-like behaviors. Osteoclast derived IGF-1 initiates a Schwann cell-dependent neuroinflammatory response that sustains a proalgesic pathway that provides new options for MBCP treatment.
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Affiliation(s)
- Lorenzo Landini
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, 50139, Italy
| | - Matilde Marini
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, 50139, Italy
| | | | - Antonia Romitelli
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, 50139, Italy
| | - Marco Montini
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Medical Genetics Unit, University of Florence, 50141, Florence, Italy
| | - Valentina Albanese
- Department of Environmental and Prevention Sciences - DEPS, University of Ferrara, Ferrara, 44121, Italy
| | - Mustafa Titiz
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, 50139, Italy
| | - Alessandro Innocenti
- Plastic and Reconstructive Microsurgery - Careggi University Hospital, Florence, 50139, Italy
| | - Francesca Bianchini
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Section of Experimental Pathology and Oncology, University of Florence, 50141, Florence, Italy
| | - Pierangelo Geppetti
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, 50139, Italy
| | - Romina Nassini
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, 50139, Italy.
| | - Francesco De Logu
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, 50139, Italy
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Yamagishi N, Kawashima C. Prepartum measurement of serum biomarkers reflecting osteoclastic and osteoblastic bone metabolism for predicting the risk of milk fever in dairy cows. J DAIRY RES 2022; 89:1-9. [PMID: 35287772 DOI: 10.1017/s0022029922000218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated whether prepartum levels of serum bone biomarkers are related to the degree of parturient hypocalcaemia and risk of milk fever (MF) in dairy cows with advancing parity. A total of 58 late-pregnant cattle were assigned to four groups: nulliparous, primiparous, multiparous in the 2nd lactation and multiparous in the 3rd-5th lactation. The multiparous cows were further assigned to MF and non-MF groups according to the onset of MF. Serum samples were obtained from the cows during the 3 weeks prepartum to 5 d postpartum period for the measurement of serum calcium (Ca) and three bone biomarkers: tartrate-resistant acid phosphatase isoform 5b (TRAP5b), osteoprotegerin (OPG) and bone isoenzyme of alkaline phosphatase (ALP3). The ratios of OPG to TRAP5b (O/T ratio) and ALP3 to TRAP5b (A/T ratio) were calculated. The data from all cattle showed that the severity of hypocalcaemia at parturition increased with advancing parity/age. The MF cows had elevated serum TRAP5b activity and a decreased O/T ratio after parturition, suggesting an increased number of osteoclasts due to osteoclastogenesis, in response to severe hypocalcaemia. The MF cows showed lower serum ALP3 activity during the 3 weeks prepartum than the non-MF cows, therefore, prepartum osteoblast function was likely weak in the MF cows. During the 2-3 weeks prepartum, serum ALP3 activity and the A/T ratio had moderate associations with the serum Ca concentration at day 0 (day of calving) in the multiparous cows, and receiver operating characteristic curve analysis revealed that ALP3 activity had excellent ability to predict MF. In conclusion, prepartum serum ALP3 activity is a promising biomarker to predict MF in multiparous cows.
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Affiliation(s)
- Norio Yamagishi
- Division of Veterinary Science, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Osaka599-8531, Japan
- Division of Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido080-8555, Japan
| | - Chiho Kawashima
- Field Center of Animal Science and Agriculture, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido080-8555, Japan
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4
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Remash D, Prince DS, McKenzie C, Strasser SI, Kao S, Liu K. Immune checkpoint inhibitor-related hepatotoxicity: A review. World J Gastroenterol 2021; 27:5376-5391. [PMID: 34539139 PMCID: PMC8409159 DOI: 10.3748/wjg.v27.i32.5376] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/28/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
The application of immune checkpoint inhibitors (ICI) in advanced cancer has been a major development in the last decade. The indications for ICIs are constantly expanding into new territory across different cancers, disease stages and lines of therapy. With this increased use, adverse events including immune checkpoint inhibitor-related hepatotoxicity (ICH) have emerged as an important clinical problem. This along with the introduction of ICI as first- and second-line treatments for advanced hepatocellular carcinoma makes ICH very relevant to gastroenterologists and hepatologists. The incidence of ICH varies between 1%-20% depending on the number, type and dose of ICI received. Investigation and management generally involve excluding differential diagnoses and following a stepwise escalation of withholding or ceasing ICI, corticosteroid treatment and adding other immunosuppressive agents depending on the severity of toxicity. The majority of patients with ICH recover and some may even safely recommence ICI therapy. Guideline recommendations are largely based on evidence derived from retrospective case series which highlights a priority for future research.
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Affiliation(s)
- Devika Remash
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney 2050, NSW, Australia
| | - David S Prince
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney 2050, NSW, Australia
| | - Catriona McKenzie
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney 2050, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney 2006, NSW, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney 2050, NSW, Australia
- New South Wales Health Pathology, New South Wales Health, Sydney 2050, NSW, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney 2050, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney 2006, NSW, Australia
| | - Steven Kao
- Sydney Medical School, University of Sydney, Sydney 2006, NSW, Australia
- Medical Oncology, Chris O’Brien Lifehouse, Sydney 2050, NSW, Australia
| | - Ken Liu
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney 2050, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney 2006, NSW, Australia
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5
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Whyne CM, Ferguson D, Clement A, Rangrez M, Hardisty M. Biomechanical Properties of Metastatically Involved Osteolytic Bone. Curr Osteoporos Rep 2020; 18:705-715. [PMID: 33074529 DOI: 10.1007/s11914-020-00633-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Skeletal metastasis involves the uncoupling of physiologic bone remodeling resulting in abnormal bone turnover and radical changes in bony architecture, density, and quality. Bone strength assessment and fracture risk prediction are critical in clinical treatment decision-making. This review focuses on bone tissue and structural mechanisms altered by osteolytic metastasis and the resulting changes to its material and mechanical behavior. RECENT FINDINGS Both organic and mineral phases of bone tissue are altered by osteolytic metastatic disease, with diminished bone quality evident at multiple length-scales. The mechanical performance of bone with osteolytic lesions is influenced by a combination of tissue-level and structural changes. This review considers the effects of osteolytic metastasis on bone biomechanics demonstrating its negative impact at tissue and structural levels. Future studies need to assess the cumulative impact of cancer treatments on metastatically involved bone quality, and its utility in directing multimodal treatment planning.
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Affiliation(s)
- Cari M Whyne
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada.
- Department of Surgery, University of Toronto, Toronto, Canada.
- Biomedical Engineering, University of Toronto, Toronto, Canada.
| | - Dallis Ferguson
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
- Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Allison Clement
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Mohammedayaz Rangrez
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Michael Hardisty
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
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6
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Takehana K, Kitani R, Hatate K, Onomi R, Yamagishi N. Anthropometric and blood data on a hand-reared captive Asian elephant (Elephas maximus) calf: A retrospective case report. J Vet Med Sci 2020; 82:943-947. [PMID: 32435003 PMCID: PMC7399311 DOI: 10.1292/jvms.19-0666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The anthropometric and blood data of an unsuccessfully hand-reared Asian elephant (Elephas maximus) calf were retrospectively compared with the data for calves
raised by their real mothers or allomothers, to identify potential reasons for poor outcomes in the hand-reared case. The hand-reared calf grew normally in terms of body weight and
withers height. However, blood biochemical data suggested reduced bone metabolism, low immune status, and malnutrition during its life. Blood bone markers were measured to
determine whether a skeletal disorder was present in the Asian elephant calf, which was not clear from the anthropometric data. Monitoring these parameters in hand-reared Asian
elephant calves, with the aim of keeping them within the normal range, may increase the success rate of hand-rearing of Asian elephant calves.
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Affiliation(s)
- Kazuya Takehana
- Ichihara Elephant Kingdom Zoological Park, Ichihara, Chiba 290-0521, Japan
| | - Ryohei Kitani
- Toyohashi Zoo and Botanical Park, Toyohashi, Aichi 441-3147, Japan
| | - Kaoru Hatate
- Department of Veterinary Sciences, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8550, Japan
| | - Rurika Onomi
- Graduate School of Veterinary Life Sciences and Agriculture, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8550, Japan
| | - Norio Yamagishi
- Department of Veterinary Sciences, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8550, Japan.,Graduate School of Veterinary Life Sciences and Agriculture, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8550, Japan
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7
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Galliera E, Massaccesi L, de Benedettis E, Longhi E, de Toma D, Corsi Romanelli MM, Banfi G. Longitudinal evaluation of Wnt inhibitors and comparison with others serum osteoimmunological biomarkers in osteolytic bone metastasis. J Leukoc Biol 2020; 108:697-704. [PMID: 32034807 DOI: 10.1002/jlb.1ab0120-212rr] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/17/2020] [Accepted: 01/23/2020] [Indexed: 12/13/2022] Open
Abstract
Bone and the immune system are closely linked: bone regulates the hematopoietic stem cells, which are precursors of immune cells, and several immunoregulatory cytokines influence the differentiation of bone cells, thus defining the osteoimmunological system. Cytokines and growth factors produced by immune and bone cells promote tumors in bone, supporting the vicious cycle of bone metastasis. Therefore osteoimmunological molecules linking the immune and bone systems could have diagnostic and prognostic potential for bone metastases. The osteoimmunologic Wnt pathway has been recently described as an important pathway with a vital role in bone carcinogenesis and metastatic progression. We examined the Wnt inhibitor DKK-1, sclerostin and several other osteoimmunological biomarkers involved in bone metastatic progression: RANKL, OPG, OPN, matrix metalloproteinase MMP-3 and the Receptor of Advanced Glycosylated End-products sRAGE. OPN and sclerostin proved good biomarkers of metastatic bone progression; the RANKL/OPG ratio was a good indicator of bone erosion in the metastatic process, while sRAGE had a protective role against metastatic progression in bone. These results serve to define a panel of new osteoimmunological biomarkers that could be useful in assessing the progress of osteolytic bone metastases.
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Affiliation(s)
- Emanuela Galliera
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Luca Massaccesi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | | | - Elisa Longhi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Domenico de Toma
- Oncologia 1 IRCCS Policlinico San Donato, San Donato, Milan, Italy
| | - Massimiliano M Corsi Romanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C SMEL-1 Patologia Clinica IRCCS Policlinico San Donato, San Donato, Milan, Italy
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8
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Takehana K, Onomi R, Hatate K, Yamagishi N. Determination of serum bone-specific alkaline phosphatase isoenzyme activity in captive Asian elephants (Elephas maximus) using an agarose gel electrophoresis method. J Vet Med Sci 2019; 81:551-554. [PMID: 30787213 PMCID: PMC6483906 DOI: 10.1292/jvms.18-0688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The bone-specific alkaline phosphatase (ALP) isoenzyme activity was measured in 51 serum
samples from four captive Asian elephants (Elephas maximus) using a
conventional method with wheat germ lectin precipitation and a commercial agarose gel
electrophoresis (AGE) kit; the isoenzymes were designated as bone-specific ALP (BAP) and
ALP isoenzyme 3 (ALP3), respectively. This study examined the suitability of the AGE kit
for analyzing blood biochemistry in Asian elephants. The serum ALP3 and BAP activities
were strongly positively correlated and met the evaluation criteria for agreement using
Bland-Altman analysis. The results indicate that the AGE kit can be used to examine the
blood biochemistry in Asian elephants instead of the conventional method.
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Affiliation(s)
- Kazuya Takehana
- Ichihara Elephant Kingdom Zoological Park, Ichihara, Chiba 290-0521, Japan
| | - Rurika Onomi
- Graduate School of Animal and Veterinary Sciences and Agriculture, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8550, Japan
| | - Kaoru Hatate
- United Graduate School of Veterinary Sciences, Gifu University, Gifu 501-1193, Japan.,Department of Veterinary Sciences, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8550, Japan
| | - Norio Yamagishi
- Graduate School of Animal and Veterinary Sciences and Agriculture, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8550, Japan.,United Graduate School of Veterinary Sciences, Gifu University, Gifu 501-1193, Japan.,Department of Veterinary Sciences, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8550, Japan
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9
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Chawalitpong S, Chokchaisiri R, Suksamrarn A, Katayama S, Mitani T, Nakamura S, Athamneh AA, Ritprajak P, Leelahavanichkul A, Aeimlapa R, Charoenphandhu N, Palaga T. Cyperenoic acid suppresses osteoclast differentiation and delays bone loss in a senile osteoporosis mouse model by inhibiting non-canonical NF-κB pathway. Sci Rep 2018; 8:5625. [PMID: 29618833 PMCID: PMC5884777 DOI: 10.1038/s41598-018-23912-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/21/2018] [Indexed: 12/15/2022] Open
Abstract
Cyperenoic acid is a terpenoid isolated from the root of a medicinal plant Croton crassifolius with a wide range of biological activities. In this study, the effects of cyperenoic acid on osteoclast differentiation were investigated both in vitro and in vivo using receptor activator of nuclear factor-κB ligand (RANKL)-induced bone marrow-derived osteoclasts and senescence-accelerated mouse prone 6 (SAMP6). Cyperenoic acid significantly suppressed RANKL-induced osteoclast differentiation at the concentrations with no apparent cytotoxicity. The half maximum inhibitory concentration (IC50) for osteoclast differentiation was 36.69 μM ± 1.02. Cyperenoic acid treatment evidently reduced the expression of two key transcription factors in osteoclast differentiation, NFATc1 and c-Fos. Detailed signaling analysis revealed that cyperenoic acid did not affect MAPK pathways and canonical NF-κB pathway but impaired activation of p100/p52 in the non-canonical NF-κB pathway upon RANKL stimulation. Moreover, the expression of osteoclast-related genes, nfatc1, ctsk, irf8, acp5 and cfos were disrupted by cyperenoic acid treatment. The bone resorption activity by cyperenoic acid-treated osteoclasts were impaired. In a senile osteoporosis mouse model SAMP6, mice fed on diet supplemented with cyperenoic acid showed delay in bone loss, compared to the control. Taken together, plant-derived cyperenoic acid shows great potential as therapeutic agent for osteoporosis.
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Affiliation(s)
- Supatta Chawalitpong
- Graduate Program in Biotechnology, Faculty of Science, Chulalongkorn University, Phayathai Road, Pathumwan, Bangkok, 10330, Thailand
| | | | - Apichart Suksamrarn
- Department of Chemistry and Center of Excellence for Innovation in Chemistry, Faculty of Science, Ramkhamhaeng University, Ramkhamhaeng Road, BangKapi, Bangkok, 10240, Thailand
| | - Shigeru Katayama
- Department of Bioscience and Biotechnology, Shinshu University, 8304 Minamiminowa, Kamiina, Nagano, Japan
| | - Takakazu Mitani
- Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, 8304 Minamiminowa, Kamiina, Nagano, Japan
| | - Soichiro Nakamura
- Department of Bioscience and Biotechnology, Shinshu University, 8304 Minamiminowa, Kamiina, Nagano, Japan
| | - Ahmad Ai Athamneh
- Department of Bioscience and Biotechnology, Shinshu University, 8304 Minamiminowa, Kamiina, Nagano, Japan
| | - Patcharee Ritprajak
- Department of Microbiology and Immunology and Research Unit of Oral Microbiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Asada Leelahavanichkul
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Phayathai Road, Pathumwan, Bangkok, 10330, Thailand
| | - Ratchaneevan Aeimlapa
- Department of Physiology, Faculty of Science, Mahidol University, Rama 6 Road, Bangkok, 10400, Thailand.,Center of Calcium and Bone Research (COCAB), Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
| | - Narattaphol Charoenphandhu
- Department of Physiology, Faculty of Science, Mahidol University, Rama 6 Road, Bangkok, 10400, Thailand.,Center of Calcium and Bone Research (COCAB), Faculty of Science, Mahidol University, Bangkok, 10400, Thailand.,Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Tanapat Palaga
- Department of Microbiology, Faculty of Science, Chulalongkorn University, Bangkok, Thailand. .,Center of Excellence in Immunology and Immune-mediated Diseases, Chulalongkorn University, Phayathai Road, Pathumwan, Bangkok, 10330, Thailand.
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10
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Plourde G. Case Report #5—Paraneoplastic Syndromes Associated With Prostate Cancer. Prostate Cancer 2018. [DOI: 10.1016/b978-0-12-815966-8.00005-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Takehana K, Hatate K, Yamagishi N. Serum activities of two bone markers in captive Asian elephants (Elephas maximus) at different ages. J Vet Med Sci 2017; 80:63-67. [PMID: 29151445 PMCID: PMC5797861 DOI: 10.1292/jvms.17-0465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The blood biochemical analysis of bone markers could have a role in the early diagnosis of metabolic bone disease in animals; however, there is limited information on bone markers in captive Asian elephants
(Elephas maximus). Serum samples from ten captive Asian elephants were obtained to clarify the relationship between age and the blood bone markers tartrate-resistant acid phosphatase isoform 5b
(TRAP5b) and bone specific alkaline phosphatase (BALP). Serum TRAP5b and BALP activities were negatively correlated with age. A positive correlation was observed between TRAP5b activity and BALP activity. These results
may contribute to the health management of captive Asian elephants.
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Affiliation(s)
- Kazuya Takehana
- Ichihara Elephant Kingdom Zoological Park, Ichihara, Chiba 290-0521, Japan
| | - Kaoru Hatate
- Department of Veterinary Sciences, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8550, Japan.,United Graduate School of Veterinary Sciences, Gifu University, Gifu 501-1193, Japan
| | - Norio Yamagishi
- Department of Veterinary Sciences, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8550, Japan.,United Graduate School of Veterinary Sciences, Gifu University, Gifu 501-1193, Japan
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Honda Y, Aikata H, Honda F, Nakano N, Nakamura Y, Hatooka M, Morio K, Kobayashi T, Fukuhara T, Nagaoki Y, Kawaoka T, Hiramatsu A, Imamura M, Kawakami Y, Chayama K. Clinical outcome and prognostic factors in hepatocellular carcinoma patients with bone metastases medicated with zoledronic acid. Hepatol Res 2017; 47:1053-1060. [PMID: 27862729 DOI: 10.1111/hepr.12844] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 09/12/2016] [Accepted: 11/10/2016] [Indexed: 12/14/2022]
Abstract
AIMS We retrospectively analyzed the clinical outcome and prognostic parameters in patients with hepatocellular carcinoma (HCC) and bone metastases who had received treatment with zoledronic acid (ZOL). METHODS Ninety-nine HCC patients with bone metastases who had been treated with ZOL were enrolled in this retrospective cohort study. We analyzed the prognostic factors, including serum N-telopeptide of type I collagen (NTX) levels, as bone metabolism markers. RESULTS The median overall survival (OS) time was 11.5 months. Child-Pugh grade A (P = 0.004) and intrahepatic tumor stage (IHTS) T0-3 (P = 0.010) correlated significantly with favorable OS. In 46 patients with grade A and T0-3, receiver operating characteristic curve analysis defined 16 nmol BCE/L serum NTX as the cut-off level for median OS. Multivariate analysis identified baseline serum NTX <16 nmol BCE/L (P = 0.045) as the only significant and independent determinant of OS. CONCLUSION Low baseline serum NTX level correlated with favorable outcome in bone metastatic HCC patients with Child-Pugh grade A and IHTS T0-3 treated with ZOL.
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Affiliation(s)
- Yohji Honda
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroshi Aikata
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Fumi Honda
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Norihito Nakano
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuki Nakamura
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Masahiro Hatooka
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kei Morio
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomoki Kobayashi
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Takayuki Fukuhara
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuko Nagaoki
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomokazu Kawaoka
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Akira Hiramatsu
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Michio Imamura
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoshiiku Kawakami
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuaki Chayama
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
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Irelli A, Cocciolone V, Cannita K, Zugaro L, Di Staso M, Lanfiuti Baldi P, Paradisi S, Sidoni T, Ricevuto E, Ficorella C. Bone targeted therapy for preventing skeletal-related events in metastatic breast cancer. Bone 2016; 87:169-75. [PMID: 27091227 DOI: 10.1016/j.bone.2016.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 03/04/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022]
Abstract
Cancer cells can alter physiological mechanisms within bone resulting in high bone turnover, and consequently in skeletal-related events (SREs), causing severe morbidity in affected patients. The goals of bone targeted therapy, as bisphosphonates and denosumab, are the reduction of incidence and the delay in occurrence of the SREs, to improve quality of life and pain control. The toxicity profile is similar between bisphosphonates and denosumab, even if pyrexia, bone pain, arthralgia, renal failure and hypercalcemia are more common with bisphosphonates, while hypocalcemia and toothache are more frequently reported with denosumab. Osteonecrosis of the jaw (ONJ) occurred infrequently without statistically significant difference. The present review aims to provide an assessment on bone targeted therapies for preventing the occurrence of SREs in bone metastatic breast cancer patients, critically analyzing the evidence available so far on their effectiveness, in light of the different mechanisms of action. Thus, we try to provide tools for the most fitting treatment of bone metastatic breast cancer patients. We also provide an overview on the usefulness of bone turnover markers in clinical practice and new molecules currently under study for the treatment of bone metastatic disease.
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Affiliation(s)
- Azzurra Irelli
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Valentina Cocciolone
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Katia Cannita
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy
| | - Luigi Zugaro
- Radiology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy
| | - Mario Di Staso
- Radiation Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy
| | - Paola Lanfiuti Baldi
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy
| | - Stefania Paradisi
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Tina Sidoni
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy
| | - Enrico Ricevuto
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Corrado Ficorella
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
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Effect of neoadjuvant chemotherapy on the serum levels of bone turnover markers in women with early-stage breast cancer. PLoS One 2015; 10:e0126053. [PMID: 25923354 PMCID: PMC4414610 DOI: 10.1371/journal.pone.0126053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 03/28/2015] [Indexed: 11/19/2022] Open
Abstract
Background To evaluate effects of neoadjuvant chemotherapy on the bone turnover markers of preoperational breast cancer patients. Methods Forty-one breast cancer patients (29 premenopausal and 12 postmenopausal) and 60 healthy women (30 premenopausal and 30 postmenopausal) aged 30-64 years, were evaluated for their bone status. Serum levels of the bone formation markers PINP and BAP, as well as the resorption markers ICTP and β-Crosslaps in addition to E2, FSH, 25(OH)D and PTH were measured at the initial diagnosis and at 24 hours after each four chemotherapy cycles. BMD T-scores were determined in 12 patients 6 months after the neoadjuvant chemotherapies. Results The baseline levels of both bone formation and resorption markers in premenopausal patients were higher than in premenopausal healthy women (p<0.05), while no statistic difference was observed between postmenopausal patients and postmenopausal healthy women. Regardless of the menopausal status, chemotherapy increased the ICTP and β-Crosslaps levels (p<0.05), but decreased the BAP and PINP levels (p<0.05), the later one significantly more with Taxane medication (p<0.01, p<0.05). Chemotherapy caused significant decreases of 25(OH)D levels in premenopausal (p<0.01) and postmenopausal (p<0.05) patients, however, did not affect the PTH concentrations. In premenopausal patients the E2 level decreased, while the FSH level increased after chemotherapy (p<0.05). Patients with pronounced ICTP and β-Crosslaps combined with reduced BAP and PINP serum concentrations after neoadjuvant chemotherapies were prone to develop osteoporosis 6 month later. Conclusions Neoadjuvant chemotherapy appeared to promote bone resorption and inhibit bone formation in both postmenopausal and premenopausal early-stage breast patients.
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Lee SG, Kim B, Soung DY, Vance T, Lee JS, Lee JY, Koo SI, Kim DO, Drissi H, Chun OK. Relationship between oxidative stress and bone mass in obesity and effects of berry supplementation on bone remodeling in obese male mice: an exploratory study. J Med Food 2014; 18:476-82. [PMID: 25198411 DOI: 10.1089/jmf.2013.0182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Berry consumption can prevent bone loss. However, the effects of different berries with distinct anthocyanin composition have not been thoroughly examined. The present study compared the effects of blueberry, blackberry, and black currant on bone health using a mouse model of diet-induced obesity. To investigate the effect of different berry supplements against a high-fat (HF) diet in vivo, 40 HF diet-induced obese (DIO) C57BL mice were assigned into four groups and fed a HF diet (35% w/w) with or without berry supplementation for 12 weeks (n=10). We measured adipose tissue mass (epididymal and retroperitoneal), plasma antioxidant, bone-related biomarkers, femur bone mineral density (BMD), and bone mineral content (proximal and distal). Adipose masses were negatively correlated with proximal BMD, but positively associated with plasma superoxide dismutase (SOD) concentrations (P<.001). Berry supplementation did not change the plasma ferric reducing antioxidant power, SOD, and insulin-like growth factor-1. However, the black currant group exhibited greater plasma alkaline phosphatase compared with the control group (P<.05). BMD in the distal epiphysis was significantly different between the blueberry and blackberry group (P<.05). However, berry supplementation did not affect bone mass compared with control. The present study demonstrates a negative relationship between fat mass and bone mass. In addition, our findings suggest that the anthocyanin composition of berries will affect bone turnover, warranting further research to investigate the underlying mechanisms.
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Affiliation(s)
- Sang Gil Lee
- 1 Department of Nutritional Sciences, University of Connecticut , Storrs, Connecticut, USA
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16
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Inanc M, Kaynar L, Enhos S, Pala C, Karaca H, Berk V, Ozkan M, Sıvgın S, Eser B, Cetin M, Elmali F. Nuclear factor-kappa B ligand and osteoprotegerin levels in serum and gingival crevicular fluid in patients with bone metastases treated with zoledronic acid. Med Oncol 2014; 31:837. [PMID: 24448976 DOI: 10.1007/s12032-013-0837-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 12/30/2013] [Indexed: 02/05/2023]
Abstract
Bone metastases are frequently observed in patients with certain types of cancer and are significant cause of morbidity. Zoledronic acid (ZA) is routinely prescribed for patients with bone metastases by affecting osteoclast function. We aimed to assess the effect of ZA over time in patients with bone metastases by analyzing novel bone turnover marker levels including receptor activator of nuclear factor-k B ligand (RANKL) and osteoprotegerin (OPG) in serum and gingival crevicular fluid (GCF). Also, associations between these bone turnover markers with hematological and biochemistry dysregulation were studied. The study enrolled patients with bone metastases including 32 patients diagnosed with solid tumors and 15 patients with multiple myeloma. In these patients, GCF and serum RANKL and OPG levels were measured and compared with measures of hematological and biochemical parameters before and after 3 months of ZA therapy. Mean subject age was 54 years old with a range of 28-80 years. Skeletal-related events were observed in 8.5% of all patients. After the 3-month treatment of ZA therapy, no significant differences were found in serum and GCF levels of RANKL and OPG when compared with before treatment levels. GCF RANKL levels at baseline and following 3 months of ZA therapy were significantly higher in patients with solid tumors when compared patients diagnosed with multiple myeloma (p=0.001; p<0.001, respectively). GCF OPG levels after the entire course of ZA therapy were greater in patients with 5 or more bone metastases (p=0.04). For patients with multiple myeloma, control GCF OPG was negatively correlated with control platelet and WBC counts (p=0.018 and p=0.027, respectively). A negative correlation was observed between control serum RANKL and control serum OPG levels in myeloma patients (p=0.001). After 3 months of ZA therapy, no significant differences were observed in GCF and serum RANKL and OPG levels when compared with baseline. A negative correlation was observed between serum control RANKL and OPG levels in myeloma patients. OPG levels were greater in patients with 5 or more bone metastases. In patients diagnosed with multiple myeloma, GCF OPG levels were negatively associated with WBC and platelet counts.
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Affiliation(s)
- Mevlude Inanc
- Medical Oncology Department, Kayseri Training and Research Hospital, Kayseri, 38039, Turkey,
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Sun L, Guo W, Yin C, Zhang S, Qu G, Hou Y, Rong H, Ji H, Liu S. Hepcidin deficiency undermines bone load-bearing capacity through inducing iron overload. Gene 2014; 543:161-5. [PMID: 24561287 DOI: 10.1016/j.gene.2014.02.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/24/2014] [Accepted: 02/04/2014] [Indexed: 12/21/2022]
Abstract
Osteoporosis is one of the leading disorders among aged people. Bone loss results from a number of physiological alterations, such as estrogen decline and aging. Meanwhile, iron overload has been recognized as a risk factor for bone loss. Systemic iron homeostasis is fundamentally governed by the hepcidin-ferroportin regulatory axis, where hepcidin is the key regulator. Hepcidin deficiency could induce a few disorders, of which iron overload is the most representative phenotype. However, there was little investigation of the effects of hepcidin deficiency on bone metabolism. To this end, hepcidin-deficient (Hamp1(-/-)) mice were employed to address this issue. Our results revealed that significant iron overload was induced in Hamp1(-/-) mice. Importantly, significant decreases of maximal loading and maximal bending stress were found in Hamp1(-/-) mice relative to wildtype (WT) mice. Moreover, the levels of the C-telopeptide of type I collagen (CTX-1) increased in Hamp1(-/-) mice. Therefore, hepcidin deficiency resulted in a marked reduction of bone load-bearing capacity likely through enhancing bone resorption, suggesting a direct correlation between hepcidin deficiency and bone loss. Targeting hepcidin or the pathway it modulates may thus represent a therapeutic for osteopenia or osteoporosis.
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Affiliation(s)
- Li Sun
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan 250062, China; State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Wenli Guo
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Chunyang Yin
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Shuping Zhang
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Guangbo Qu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Yanli Hou
- Shandong Institute of Endocrine and Metabolic Diseases, Shandong Academy of Medical Sciences, Jinan 250062, China
| | - Haiqin Rong
- Shandong Institute of Endocrine and Metabolic Diseases, Shandong Academy of Medical Sciences, Jinan 250062, China
| | - Hong Ji
- Shandong Institute of Endocrine and Metabolic Diseases, Shandong Academy of Medical Sciences, Jinan 250062, China
| | - Sijin Liu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China.
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18
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Tang Q, Zhao H, Jia R, Liu L. [Correlation of the levels of the bone turnover markers BAP and β-CTX with bone metastasis progress in lung cancer patients]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 16:144-7. [PMID: 23514943 PMCID: PMC6015133 DOI: 10.3779/j.issn.1009-3419.2013.03.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
背景与目的 肺癌易发生骨转移,Ⅰ型胶原羧基端肽β特殊序列(β isomer of C-terminal telopeptide of type Ⅰ collagen, β-CTX)和骨源性碱性磷酸酶(bone-specific alkaline phosphates, BAP)在骨质代谢中是重要的生化标记物,本研究旨在探讨骨代谢生化指标和肺癌骨转移进展程度的相关性,有助于早期判断是否有肺癌骨转移的发生。 方法 天津市人民医院2009年7月-2012年7月共收治92例肺癌并发生骨转移患者,全部病例其原发灶均经细胞学检查证实,骨转移灶的数目及类型经ECT结合X线片、CT证实,采用ELISA方法检测血β-CTX、BAP的浓度水平。 结果 收集的92例肺癌伴骨转移的患者中,转移灶 < 3处为58例,≥3处为34例;溶骨型68例,成骨型9例,混合型15例。血β-CTX、BAP水平在不同的骨转移数目组间差异有统计学意义(P < 0.05),β-CTX在肺癌溶骨型骨转移患者中具有较高的敏感性。 结论 骨代谢生化指标β-CTX、BAP对肺癌骨转移具有辅助诊断意义,是判断转移进展程度的良好指标。
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Affiliation(s)
- Qiong Tang
- Department of Respiratory Medicine, Tianjin Union Medicine Center, Tianjin 300121, China
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Krempien R, Niethammer A, Harms W, Debus J. Bisphosphonates and bone metastases: current status and future directions. Expert Rev Anticancer Ther 2014; 5:295-305. [PMID: 15877526 DOI: 10.1586/14737140.5.2.295] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since bone metastases in advanced cancer are common and frequently lead to skeletal-related morbid complications, their treatment remains a major challenge in cancer therapy. Bisphosphonates not only significantly decreased the odds ratios for fracture, need for radiotherapy, and incidence of hypercalcemia, but also had proven ability in the preservation of the 3D microstructure of bone that is responsible for bone stability. Bisphosphonates are well tolerated and have a very low incidence of serious side effects. Consequently, bisphosphonates have become the standard of care for the treatment of malignant bone disease. Benefits of bisphosphonate treatment appears to be more pronounced with longer treatment, indicating that they should be continued until no longer clinically relevant. As this advice has substantial implications on resources, it is essential that the use of bisphosphonates is evidence based.
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Affiliation(s)
- Robert Krempien
- Department of Radiation Oncology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany.
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20
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Dushyanthen S, Cossigny DAF, Quan GMY. The osteoblastic and osteoclastic interactions in spinal metastases secondary to prostate cancer. CANCER GROWTH AND METASTASIS 2013; 6:61-80. [PMID: 24665208 PMCID: PMC3941153 DOI: 10.4137/cgm.s12769] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 10/06/2013] [Accepted: 10/07/2013] [Indexed: 12/30/2022]
Abstract
Prostate cancer (PC) is one of the most common cancers arising in men and has a high propensity for bone metastasis, particularly to the spine. At this stage, it often causes severe morbidity due to pathological fracture and/or metastatic epidural spinal cord compression which, if untreated, inevitably leads to intractable pain, neurological deficit, and paralysis. Unfortunately, the underlying molecular mechanisms driving growth of secondary PC in the bony vertebral column remain largely unknown. Further investigation is warranted in order to identify therapeutic targets in the future. This review summarizes the current understanding of PC bone metastasis in the spine, highlighting interactions between key tumor and bone-derived factors which influence tumor progression, especially the functional roles of osteoblasts and osteoclasts in the bone microenvironment through their interactions with metastatic PC cells and the critical pathway RANK/RANKL/OPG in bone destruction.
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Affiliation(s)
- Sathana Dushyanthen
- Spinal Biology Research Laboratory, Department of Spinal Surgery, University of Melbourne Department of Surgery, Austin Health, Heidelberg Victoria, Australia
| | - Davina A F Cossigny
- Spinal Biology Research Laboratory, Department of Spinal Surgery, University of Melbourne Department of Surgery, Austin Health, Heidelberg Victoria, Australia
| | - Gerald M Y Quan
- Spinal Biology Research Laboratory, Department of Spinal Surgery, University of Melbourne Department of Surgery, Austin Health, Heidelberg Victoria, Australia
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Tang C, Liu Y, Qin H, Li X, Guo W, Li J, Wang W, Qu L, Hu H, Xu C, Zheng L, Huang Y, Liu B, Gao H, Halleen JM, Liu X. Clinical significance of serum BAP, TRACP 5b and ICTP as bone metabolic markers for bone metastasis screening in lung cancer patients. Clin Chim Acta 2013; 426:102-7. [PMID: 24055775 DOI: 10.1016/j.cca.2013.09.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/17/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND We investigated the clinical significance of serum bone-specific alkaline phosphatase (BAP), tartrate-resistant acid phosphatase isoform 5b (TRACP 5b) and type I collagen carboxyterminal telopeptide (ICTP) as bone metabolic markers for bone metastasis (BM) screening in lung cancer patients. METHODS Newly diagnosed advanced lung cancer patients with (N = 130) and without (N = 135) BM were enrolled in the study. Serum BAP, TRACP 5b and ICTP were measured before the treatment. RESULTS BAP, TRACP 5b and ICTP values were higher in patients with BM compared with patients without BM (all P < 0.0001). Area under ROC curve (AUC) of BAP, TRACP 5b and ICTP was 0.760, 0.753 and 0.835 (all P < 0.0001), respectively. The cut-off values for BAP, TRACP 5b and ICTP were 21.8 μg/l, 7.8 U/l and 8.8 μg/l, respectively. When TRACP 5b and ICTP were combined, AUC was elevated to 0.895 (P < 0.0001), and the cut-off values were TRACP 5b 7.6 U/l and ICTP 8.4 μg/l. CONCLUSIONS We conclude that serum BAP, TRACP 5b and ICTP may serve as useful tools for BM screening in lung cancer patients.
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Affiliation(s)
- Chuanhao Tang
- Department of Lung Cancer, Affiliated Hospital of Academy of Military Medical Sciences, No. 8 Dongdajie, Beijing 100071, China
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22
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Morcos NY, Zakhary NI, Said MM, Tadros MM. Postoperative simple biochemical markers for prediction of bone metastases in Egyptian breast cancer patients. Ecancermedicalscience 2013; 7:305. [PMID: 23653670 PMCID: PMC3640610 DOI: 10.3332/ecancer.2013.305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Indexed: 11/16/2022] Open
Abstract
Objective: The present study was undertaken to identify patient populations at high risk for bone metastases (BM) at any time after diagnosis of operable breast cancer. Subjects and methods: A total number of 59 cases with breast cancer after mastectomy was subdivided into two main groups that included 30 patients with radiologically confirmed BM and 29 patients with no bone metastasis (NBM). Patients with NBM were formerly observed for a one-year follow-up interval to monitor the development of bone metastasis (new BM). Parameters included a full blood picture, tumour markers (carcinoembryonic antigen and CA 15.3) and some biochemical markers (vascular endothelial growth factor and zinc levels, as well as tartrate-resistant acid phosphatase and alkaline phosphatase activities). Results: A significant elevation was recorded in carcinoembryonic antigen level and alkaline phosphatase activity, as well as inflammation and vascularisation markers at the time of primary diagnosis in patients with BM, compared with those without BM. CA 15.3 was significantly higher in the new BM group as compared with the other two groups (patients free of bone metastasis [free BM] and BM). According to the likelihood ratio, a panel of single, calculated as well as combined markers was proposed to predict BM within one year in breast cancer patients. Conclusion: Vascularisation and inflammation markers, as well as CA 15.3 are predictive of bone recurrence within one year in breast carcinoma patients. We suggest that in cancer validation studies it is imperative to search for markers that link to the premetastatic process and to determine what type of mechanism is active in each stage.
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Affiliation(s)
- Nadia Ys Morcos
- Biochemistry Department, Faculty of Science, Ain Shams University, Egypt
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So A, Chin J, Fleshner N, Saad F. Management of skeletal-related events in patients with advanced prostate cancer and bone metastases: Incorporating new agents into clinical practice. Can Urol Assoc J 2013; 6:465-70. [PMID: 23282666 DOI: 10.5489/cuaj.12149] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Skeletal-related events (SREs) are a common complication of bone metastases, and have serious negative consequences for patients with castrate-resistant prostate cancer (CRPC). SREs can lead to severe pain, increased risk of death, increased health care costs and reduced quality of life. Until recently, zoledronic acid has been the sole standard of care for the prevention of SREs in men with CRPC with bone metastases. Denosumab, a receptor activator of nuclear factor kappa-B ligand (RANK-L) inhibitor, has been recently approved for use in Canada for this indication, thus presenting another option for these patients. Denosumab was shown to be superior to zoledronic acid in delaying the time to first or subsequent SREs in CRPC patients with bone metastases. This review discusses current and previous trials examining agents designed to prevent SREs in men with CRPC and bone metastases. It also discusses the practical aspects of administering a bone-targeted therapy, including choosing a bone-targeted therapy, monitoring at the onset and during therapy, switching from one therapy to another, and assessing potential complications.
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Affiliation(s)
- Alan So
- Department of Urological Sciences, University of British Columbia, Vancouver, BC
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Zheng Y, Zhou H, Dunstan CR, Sutherland RL, Seibel MJ. The role of the bone microenvironment in skeletal metastasis. J Bone Oncol 2012; 2:47-57. [PMID: 26909265 PMCID: PMC4723345 DOI: 10.1016/j.jbo.2012.11.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 11/22/2012] [Accepted: 11/22/2012] [Indexed: 01/27/2023] Open
Abstract
The bone microenvironment provides a fertile soil for cancer cells. It is therefore not surprising that the skeleton is a frequent site of cancer metastasis. It is believed that reciprocal interactions between tumour and bone cells, known as the “vicious cycle of bone metastasis” support the establishment and orchestrate the expansion of malignant cancers in bone. While the full range of molecular mechanisms of cancer metastasis to bone remain to be elucidated, recent research has deepened our understanding of the cell-mediated processes that may be involved in cancer cell survival and growth in bone. This review aims to address the importance of the bone microenvironment in skeletal cancer metastasis and discusses potential therapeutic implications of novel insights.
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Affiliation(s)
- Yu Zheng
- Bone Research Program, ANZAC Research Institute, University of Sydney, NSW 2139, Australia; The Kinghorn Cancer Centre and Cancer Research Program, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia
| | - Hong Zhou
- Bone Research Program, ANZAC Research Institute, University of Sydney, NSW 2139, Australia
| | - Colin R Dunstan
- Bone Research Program, ANZAC Research Institute, University of Sydney, NSW 2139, Australia; Department of Biomedical Engineering, University of Sydney, NSW 2006, Australia
| | - Robert L Sutherland
- The Kinghorn Cancer Centre and Cancer Research Program, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia
| | - Markus J Seibel
- Bone Research Program, ANZAC Research Institute, University of Sydney, NSW 2139, Australia; Department of Endocrinology & Metabolism, Concord Hospital, Concord, Sydney, NSW 2139, Australia
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Li J, Hou Y, Zhang S, Ji H, Rong H, Qu G, Liu S. Excess iron undermined bone load-bearing capacity through tumor necrosis factor-α-dependent osteoclastic activation in mice. Biomed Rep 2012; 1:85-88. [PMID: 24648899 DOI: 10.3892/br.2012.6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 07/31/2012] [Indexed: 12/17/2022] Open
Abstract
Iron overload has been associated with bone mass loss. To elucidate the effects of excess iron on bone metabolism, an iron-overloading mouse model was established by administering iron-dextran at 250 mg/kg to female BALB/c mice. After 4 weeks, the mice were sacrificed and the biomechanical properties of the femurs were examined. The results suggested a notable decrease of the maximal bending stress and the modulus of bending elasticity in the femurs obtained from the excess iron-treated mice compared to the control mice. The levels of the serum osteocalcin, C-telopeptide of type I collagen (CTX-1) and tumor necrosis factor-α (TNF-α) were measured in order to investigate the underlying mechanism responsible for the excess iron-induced bone strength reduction. Overall, the results suggested that iron overload resulted in a marked reduction of bone load-bearing capacity through a TNF-triggered osteoclast differentiation and resorption mechanism.
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Affiliation(s)
- Junping Li
- Shandong Institute of Endocrine and Metabolic Diseases, Jinan 250062; ; State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, P.R. China
| | - Yanli Hou
- Shandong Institute of Endocrine and Metabolic Diseases, Jinan 250062; ; State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, P.R. China
| | - Shuping Zhang
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, P.R. China
| | - Hong Ji
- Shandong Institute of Endocrine and Metabolic Diseases, Jinan 250062
| | - Haiqin Rong
- Shandong Institute of Endocrine and Metabolic Diseases, Jinan 250062
| | - Guangbo Qu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, P.R. China
| | - Sijin Liu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, P.R. China
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Kamiya N, Suzuki H, Endo T, Yano M, Naoi M, Nishimi D, Kawamura K, Imamoto T, Ichikawa T. Clinical usefulness of bone markers in prostate cancer with bone metastasis. Int J Urol 2012; 19:968-79. [PMID: 22805007 DOI: 10.1111/j.1442-2042.2012.03098.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bone metastases occur in approximately 70% of patients with advanced prostate cancer. Skeletal-related events have been correlated with reduced survival and quality of life of patients with prostate cancer. Biochemical markers of bone metabolism (e.g. bone formation, bone resorption, osteoclastogenesis) might meet an unmet need for useful, non-invasive and sensitive surrogate information for following patients' skeletal health. Recently, zoledronic acid and denosumab have been proven to have the potential for preventing skeletal-related events among prostate cancer patients with bone metastasis. An improved understanding of the mechanisms underlying bone metastasis has also led to the recognition of multiple molecular targets and advances in therapy. However, estimating the efficacy of these agents is difficult. A clinical trial for castration-resistant prostate cancer is currently underway based on the definition of The Prostate Cancer Clinical Trials Working Group, and bone turnover markers are being used as conventional end-points for the clinical trial. Bone turnover markers are useful surrogate markers reflecting the effect of new therapeutic drugs and prognosis, as well as assessment of bone metastases. In particular, N-terminal cross-linked telopeptide of type 1 collagen and bone-specific alkaline phosphatase are widely used bone metabolism markers, and offer reliable surrogate markers to detect bone metastatic spread and to predict prognosis for prostate cancer patients with bone metastases.
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Affiliation(s)
- Naoto Kamiya
- Department of Urology, Toho University Sakura Medical Center, Sakura, Japan.
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27
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Anand A, Srivastava PK. A molecular description of acid phosphatase. Appl Biochem Biotechnol 2012; 167:2174-97. [PMID: 22684363 DOI: 10.1007/s12010-012-9694-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 04/11/2012] [Indexed: 11/25/2022]
Abstract
Acid phosphatase is ubiquitous in distribution in various organisms. Although it catalyzes simple hydrolytic reactions, it is considered as an interesting enzyme in biological systems due to its involvement in different physiological activities. However, earlier reviews on acid phosphatase reveal some fragmentary information and do not give a holistic view on this enzyme. So, the present review summarizes studies on biochemical properties, structure, catalytic mechanism, and applications of acid phosphatase. Recent advancement of acid phosphatase in agricultural and clinical fields is emphasized where it is presented as potent agent for sustainable agricultural practices and diagnostic marker in bone metabolic disorders. Also, its significance in prostate cancer therapies as a therapeutic target has been discussed. At the end, current studies and prospects of immobilized acid phosphatase are included.
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Affiliation(s)
- Asha Anand
- Department of Biochemistry, Faculty of Science, Banaras Hindu University, Varanasi 221005, India
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28
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Huang Q, Ouyang X. Biochemical-markers for the diagnosis of bone metastasis: A clinical review. Cancer Epidemiol 2012; 36:94-8. [PMID: 21474411 DOI: 10.1016/j.canep.2011.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 02/03/2011] [Accepted: 02/04/2011] [Indexed: 11/15/2022]
Affiliation(s)
- Qian Huang
- Fujian University of Traditional Chinese Medicine, Fujian, China
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29
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Ponnapakkam T, Katikaneni R, Nichols T, Tobin G, Sakon J, Matsushita O, Gensure RC. Prevention of chemotherapy-induced osteoporosis by cyclophosphamide with a long-acting form of parathyroid hormone. J Endocrinol Invest 2011; 34:e392-7. [PMID: 21750397 DOI: 10.3275/7864] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Most chemotherapeutics reduce bone mineral density (BMD) and increase risk for fractures by causing gonadal suppression, which in turn increases bone removal. Cyclophosphamide (CYP) also has a direct effect of inhibiting bone formation and removal, making the resulting bone loss particularly difficult to treat with antiresorptive therapy. AIM We tested whether a single dose of the anabolic agent PTH linked to a collagen binding domain (PTHCBD) could prevent the effects of CYP-induced bone loss. METHODS Mice received either buffer alone, CYP, or CYP+ PTH-CBD. BMD and alkaline phosphatase were measured every 2 weeks for a total of 8 weeks. RESULTS After 6 weeks, mice treated with CYP showed expected reductions in BMD (increase from baseline: 7.4 ± 6.9 vs 24.35 ± 4.86% in mice without chemotherapy, p<0.05) and decrease in alkaline phosphatase levels (42.78 ± 6.06 vs 60.62 ± 6.23 IU/l in mice without chemotherapy, p<0.05), consistent with osteoporosis from impaired bone formation. Administration of a single dose of PTH-CBD (320 μg/kg ip) prior to CYP treatment improved BMD (change from baseline: 23.4 ± 5.4 vs 7.4 ± 6.9%, CYP treatment alone, p<0.05) and increased alkaline phosphatase levels (50.14 ± 4.86 vs 42.78 ± 6.06 IU/l in CYP treatment alone, p<0.05). BMD values and alkaline phosphatase levels were restored to those seen in mice not receiving chemotherapy. CONCLUSIONS A single dose of PTHCBD prior to chemotherapy reversed CYP-induced suppression of bone formation and prevented CYP-induced bone loss in mice.
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Affiliation(s)
- T Ponnapakkam
- Department of Pediatric Endocrinology, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY, USA.
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30
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Korde LA, Gralow JR. Can we predict who's at risk for developing bone metastases in breast cancer? J Clin Oncol 2011; 29:3600-4. [PMID: 21859994 DOI: 10.1200/jco.2011.35.7038] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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31
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Wood SL, Brown JE. Skeletal metastasis in renal cell carcinoma: current and future management options. Cancer Treat Rev 2011; 38:284-91. [PMID: 21802857 DOI: 10.1016/j.ctrv.2011.06.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Revised: 06/25/2011] [Accepted: 06/29/2011] [Indexed: 01/06/2023]
Abstract
Metastasis to the skeleton is common in advanced renal cancer and leads to debilitating skeletal complications including severe pain, increased fracture rate and spinal cord compression. The incidence of renal cell carcinoma is increasing by around 2% per year and recent advances in targeted anti-angiogenic therapy for advanced disease are expected to lead to longer survival times. The clinical management of metastatic bone disease in renal cell carcinoma therefore merits greater focus than hitherto. Bone metastases arising from renal cancer are highly osteolytic and particularly destructive. Fortunately, the continuing development of anti-resorptive drugs is revolutionising the medical management of metastatic bone disease across many tumour types and making a major impact on quality of life. The bisphosphonate zoledronic acid is now licensed for use in advanced renal cell carcinoma and appears to yield a greater benefit in terms of reduction in skeletal related events than in bone metastases arising from other tumour types. Drugs which are directed at specific targets in the bone metastasis pathway are in development, including denosumab, a fully human monoclonal antibody against receptor activator of nuclear factor kappa B ligand, which has recently been licensed in the United States for use in renal cell carcinoma, with European licensing expected soon. This review examines the increasing options for treatment of metastatic bone disease in renal cell carcinoma, with a focus on drug-based advances and progress in the development of existing and new biomarkers to support clinical management.
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Affiliation(s)
- Steven L Wood
- Cancer Research UK Clinical Centre at Leeds, University of Leeds, St. James's Hospital, UK.
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32
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Bone-marker levels in patients with prostate cancer: potential correlations with outcomes. Curr Opin Support Palliat Care 2011; 4:127-34. [PMID: 20489645 DOI: 10.1097/spc.0b013e32833ac6d6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The skeleton is typically the first site of metastasis in patients with prostate cancer, and bone metastases can result in severe bone pain and potentially debilitating fractures. Although bone scans are a reliable means of assessing osteoblastic lesions, tools for monitoring early changes in bone health are lacking. Biochemical markers of bone turnover might fulfill this unmet need. RECENT FINDINGS Correlative studies have suggested that bone-marker levels may have utility in assessing disease progression and response to bone-directed therapy. Elevated levels of the markers, N-telopeptide of type I collagen and bone-specific alkaline phosphatase, are associated with higher rates of death and skeletal-related events in the bone metastasis setting. Marker levels also correlate with response to zoledronic acid treatment, and similar data with the investigational agent, denosumab, are emerging. SUMMARY Changes in bone-marker levels reflect alterations in skeletal homeostasis and can provide important insights into bone disease progression and response to bone-directed therapy in patients with prostate cancer. More mature data from currently ongoing clinical trials will provide further insight on the utility of marker assessments as an adjunct to established monitoring methods in prostate cancer.
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Yoon SH, Ryu JY, Lee Y, Lee ZH, Kim HH. Adenylate cyclase and calmodulin-dependent kinase have opposite effects on osteoclastogenesis by regulating the PKA-NFATc1 pathway. J Bone Miner Res 2011; 26:1217-29. [PMID: 21611964 DOI: 10.1002/jbmr.310] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Nuclear factor of activated T cells c1 (NFATc1) is a transcription factor crucial for the differentiation of osteoclasts. In this study we discovered new signaling pathways involving cAMP regulators that modulate NFATc1 during osteoclastogenesis. The osteoclast differentiation factor receptor activator of NF-κB ligand (RANKL) increased the expression of adenylate cyclase 3 (AC3), accompanied by a rise in the intracellular cAMP level in osteoclasts. The knockdown of AC3 enhanced in vitro osteoclastogenesis and in vivo bone resorption, whereas cAMP-elevating agents showed opposite effects. The antiosteoclastogenic effect of the AC3-cAMP pathway was mediated by the inhibition of NFATc1 nuclear translocation and its autoamplification via a protein kinase A (PKA)-dependent mechanism. RANKL has been shown to activate Ca(2+) /calmodulin-dependent protein kinases (CaMKs). Knockdown or catalytic inhibition of CaMKs elevated intracellular cAMP levels in RANKL-treated osteoclast precursors and suppressed the activation of NFATc1. Taken together, our results demonstrate a pivotal role for the cAMP-PKA-NFATc1 signaling pathway during osteoclast differentiation, suggesting a mechanism by which osteoclastogenesis is fine-tuned by a balance between AC3 and CaMKs activities.
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Affiliation(s)
- Soo-Hyun Yoon
- Department of Cell and Developmental Biology, BK21 and DRI, Seoul National University, Seoul, Korea
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34
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Consensus on the utility of bone markers in the malignant bone disease setting. Crit Rev Oncol Hematol 2011; 80:411-32. [PMID: 21411334 DOI: 10.1016/j.critrevonc.2011.02.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 02/09/2011] [Accepted: 02/17/2011] [Indexed: 01/23/2023] Open
Abstract
Biochemical markers of bone turnover provide insight into ongoing rates of skeletal metabolism and tumor-bone interactions in patients with malignant bone disease. This article reviews the available recent evidence assessing the potential of bone markers for detecting and monitoring malignant bone lesions in patients with advanced cancers, and for assessing overall skeletal health and response to antiresorptive therapies in patients at all stages of cancer progression. Most data thus far are for urinary N-terminal cross-linked telopeptide of type I collagen (NTX) in predicting risks of skeletal morbidity and death and monitoring response to zoledronic acid in patients with bone metastases. Ongoing studies are evaluating such correlations for other markers and therapies. Emerging evidence suggests that bone markers may help identify patients at high risk for bone metastasis or bone lesion progression, thereby allowing improved follow-up. Results from ongoing clinical trials evaluating such potential applications of bone markers are awaited.
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35
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Evolving role of bone biomarkers in castration-resistant prostate cancer. Neoplasia 2011; 12:685-96. [PMID: 20824045 DOI: 10.1593/neo.10610] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 06/15/2010] [Accepted: 06/15/2010] [Indexed: 12/18/2022] Open
Abstract
The preferential metastasis of prostate cancer cells to bone disrupts the process of bone remodeling and results in lesions that cause significant pain and patient morbidity. Although prostate-specific antigen (PSA) is an established biomarker in prostate cancer, it provides only limited information relating to bone metastases and the treatment of metastatic bone disease with bisphosphonates or novel noncytotoxic targeted or biological agents that may provide clinical benefits without affecting PSA levels. As bone metastases develop, factors derived from bone metabolism are released into blood and urine, including N- and C-terminal peptide fragments of type 1 collagen and bone-specific alkaline phosphatase, which represent potentially useful biomarkers for monitoring metastatic bone disease. A number of clinical trials have investigated these bone biomarkers with respect to their diagnostic, prognostic, and predictive values. Results suggest that higher levels of bone biomarkers are associated with an increased risk of skeletal-related events and/or death. As a result of these findings, bone biomarkers are now being increasingly used as study end points, particularly in studies investigating novel agents with putative bone effects. Data from prospective clinical trials are needed to validate the use of bone biomarkers and to confirm that marker levels provide additional information beyond traditional methods of response evaluation for patients with metastatic prostate cancer.
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36
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Saad F, Eastham JA, Smith MR. Biochemical markers of bone turnover and clinical outcomes in men with prostate cancer. Urol Oncol 2010; 30:369-78. [PMID: 21163673 DOI: 10.1016/j.urolonc.2010.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 08/09/2010] [Accepted: 08/10/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Disrupted skeletal homeostasis is common in patients with prostate cancer. Low bone density is common at diagnosis, and fracture risk is further elevated by the effects of androgen-deprivation therapy. Later in the disease course, bone metastases can result in skeletal morbidity. Although prostate-specific antigen (PSA) levels can provide important insights into overall disease progression, convenient, noninvasive tools for monitoring skeletal health are lacking. Biochemical markers released into serum and urine as a result of bone turnover might fulfill this unmet need. The objectives of this article are to assess current evidence examining the potential utility of bone turnover markers for monitoring skeletal health, bone disease progression, and response to antiresorptive therapies in the prostate cancer setting. METHODS Published articles and abstracts from major oncology or urology congresses pertaining to the use of bone turnover markers to monitor skeletal health and disease progression were identified and assessed for relevance and methodologic stringency. RESULTS Several randomized trials and correlative studies support the utility of bone marker level changes to assess disease progression in the metastatic setting, bone health during hormonal therapy, and response to bisphosphonate therapy. The available data support potential associations between levels of the collagen type I telopeptides (NTX and CTX) and the severity of metastatic bone disease as well as outcomes during antiresorptive therapy. Evidence linking bone marker level changes with early diagnosis of skeletal metastases is emerging. Although several markers have shown promising results in correlative studies, results from ongoing prospective trials are needed to establish the role of bone markers in this setting. CONCLUSIONS Bone marker levels reflect ongoing skeletal metabolism and can provide important insights into bone health and response to bisphosphonate therapy in patients with prostate cancer. The data supporting a role for bone markers to monitor skeletal disease progression and response to zoledronic acid therapy are especially strong. Bone marker assessments may complement established diagnostic and monitoring paradigms in prostate cancer.
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Affiliation(s)
- Fred Saad
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
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37
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Chao TY, Wu YY, Janckila AJ. Tartrate-resistant acid phosphatase isoform 5b (TRACP 5b) as a serum maker for cancer with bone metastasis. Clin Chim Acta 2010; 411:1553-64. [PMID: 20599857 DOI: 10.1016/j.cca.2010.06.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 06/24/2010] [Accepted: 06/25/2010] [Indexed: 10/19/2022]
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38
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The use of biochemical markers of bone remodeling in multiple myeloma: a report of the International Myeloma Working Group. Leukemia 2010; 24:1700-12. [DOI: 10.1038/leu.2010.173] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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39
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:207-27. [DOI: 10.1097/spc.0b013e32833e8160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Markers of bone remodeling and skeletal morbidity in patients with solid tumors metastatic to the skeleton receiving the biphosphonate zoledronic acid. Transl Res 2010; 155:247-55. [PMID: 20403580 DOI: 10.1016/j.trsl.2010.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 12/20/2009] [Accepted: 01/09/2010] [Indexed: 11/19/2022]
Abstract
The molecular triad, which includes the receptor activator of nuclear factor kappa-B ligand (RANKL), its receptor RANK, and the endogenous soluble RANKL decoy receptor osteoprotegerin (OPG), has emerged as an important determinant of bone metabolism. We aimed to evaluate the effect of treatment with the biphosphonate zoledronic acid (ZA) on biochemical markers of bone remodeling and to detect possible correlations of markerlevel changes with skeletal morbidity and clinical outcomes in patients with solid tumors and osseous metastases. The following serum markers were measured at the onset of skeletal metastases and after 6 months of treatment with ZA (4 mg intravenously monthly) in 70 patients with breast (n = 30), lung (n = 18), or prostate (n = 22) cancer: RANKL, OPG, C-terminal cross-linking telopeptide of type I collagen (CTX), tartrate-resistant acid phosphatase isoform 5b (TRACP-5b), bone-specific alkaline phosphatase (bALP), and osteopontin (OPN). Logistic regression models were applied to assess the correlation between marker-level changes and skeletal related events (SRE, primary endpoint), recurrence or progression, and death. Within a median follow-up of 32 months, 34 patients (48.6%) presented with at least 1 SRE and 48 patients (68.6%) relapsed. The RANKL/OPG ratio was upregulated in patients with breast and lung cancer, and it tended to decline after treatment with ZA, whereas prostate cancer patients presented with profound elevation of OPG only that persisted after treatment. CTX levels were significantly reduced after treatment in the whole study population (P = 0.003). None of the markers was able to predict skeletal morbidity or clinical outcomes independently of well-established prognostic clinical parameters.
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41
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Brown JE, Coleman RE. Biomarkers of bone turnover in oncology: applications in diagnosis and treatment. ACTA ACUST UNITED AC 2010; 4:125-38. [DOI: 10.1517/17530050903473147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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42
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Clinical and imaging correlations of bone turnover markers in prostate cancer patients with bone only metastases. Nucl Med Commun 2010; 31:249-53. [DOI: 10.1097/mnm.0b013e328335a5ed] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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43
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Yamagishi N, Takehana K, Kim D, Miura M, Hirata TI, Devkota B, Sato S, Furuhama K. Fluorometric method for measuring plasma tartrate-resistant acid phosphatase isoform 5b and its application in cattle. J Vet Med Sci 2010; 71:1637-42. [PMID: 20046032 DOI: 10.1292/jvms.001637] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study determined the appropriate biochemical assay for measuring plasma tartrate-resistant acid phosphatase isoform 5b (TRAP5b) activity; this information is important to clarify the relationship between plasma TRAP5b and known biochemical bone markers in cattle. When plasma TRAP5b was measured using fluorometric and spectrophotometric methods, hemolysis products in plasma did not affect the former method. In plasma from healthy cattle, there was a good correlation (r=0.66) between the 2 methods. In age-related profiles, plasma TRAP5b (r=-0.53), hydroxyproline (HYP, r=-0.56) and bone-specific alkaline phosphatase (BALP, r=-0.44) showed significant negative correlations with age; these three parameters decreased until 4 or 5 years of age and then remained constant. There were significant correlations between TRAP5b and HYP (r=0.83) or BALP (r=0.83). Our results show that the fluorometric assay can be performed with a high degree of precision and reproducibility without interference from hemolysis, and that the age-related changes in plasma TRAP5b, HYP, and BALP constitute additional background values for clinical guidance in bovine medicine.
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Affiliation(s)
- Norio Yamagishi
- Department of Veterinary Medicine, Faculty of Agriculture, Iwate University, Morioka, Iwate 020-8550, Japan.
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44
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Lund T, Abildgaard N, Andersen TL, Delaisse JM, Plesner T. Multiple myeloma: changes in serum C-terminal telopeptide of collagen type I and bone-specific alkaline phosphatase can be used in daily practice to detect imminent osteolysis. Eur J Haematol 2010; 84:412-20. [PMID: 20070853 PMCID: PMC2871171 DOI: 10.1111/j.1600-0609.2010.01417.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective: Monitoring of bone disease in multiple myeloma is becoming increasingly important because bone-protecting treatment with bisphosphonate is becoming restricted after the awareness of osteonecrosis of the jaw. Despite the potential of biochemical markers of bone remodeling to monitor dynamic bone turnover, they are not used in everyday practice. Here, we investigate their usefulness to detect imminent progressive osteolysis in relapsing patients with multiple myeloma. Methods: In an unselected cohort of 93 patients, we measured the bone resorption markers C-terminal telopeptide of collagen type I (CTX-I), C-terminal cross-linked telopeptide of type-I collagen generated by MMPs (ICTP), N-terminal cross-linked telopeptide of type-I collagen (NTX-I), and the bone formation marker bone-specific alkaline phosphatase (bALP) monthly for 2 yr. Retrospectively, we identified 40 cases where patients had progressive disease. We investigated how the bone markers developed prior to disease progression. Results: We observed that CTX-I and bALP changed significantly before progressive disease were recognized. More interestingly, these changes differed depending on whether concurrent progressive osteolysis was present. In patients with progressive osteolysis, there was a large increase in bone resorption which was not compensated by increased bone formation. In contrasts, patients with stable bone disease had only a slight increase in bone resorption which was compensated by concurrent increased bone formation. By calculating a patient-specific CTX-I/bALP ratio, we quantified the risk a patient experiences if the ratio increases. Conclusion: By analyzing patient-specific changes in the ratio of CTX-I/bALP, we might tailor treatment with bone-protecting agents in the individual patient.
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Affiliation(s)
- Thomas Lund
- Department of Haematology, Vejle Hospital, Vejle, Denmark.
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Janckila AJ, Yam LT. Biology and clinical significance of tartrate-resistant acid phosphatases: new perspectives on an old enzyme. Calcif Tissue Int 2009; 85:465-83. [PMID: 19915788 DOI: 10.1007/s00223-009-9309-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 10/12/2009] [Indexed: 12/20/2022]
Abstract
Type 5 tartrate-resistant acid phosphatase (TRAP) has been a clinically relevant biomarker for about 50 years. It has always been a reliable and specific cytochemical marker for hairy cell leukemia and for differentiated cells of monocytic lineage. Only recently has the test for serum TRAP activity been accepted as sensitive and specific enough for clinical use as a marker of osteoclasts and bone resorption. This has come about through steady advances in knowledge about TRAP enzymology, structure, function, and molecular regulation and a consequent appreciation that TRAP isoforms 5a and 5b have very different clinical significance. As a measure of osteoclast number and bone resorption, TRAP 5b has diagnostic and prognostic applications in osteoporosis, cancers with bone metastasis, chronic renal failure, and perhaps other metabolic and pathologic bone diseases. Serum TRAP 5a, on the other hand, has no relationship to bone metabolism but seems instead to be a measure of activated macrophages and chronic inflammation. Exploration of the real clinical usefulness of serum TRAP 5a for diagnosis and disease management in a wide variety of chronic inflammatory diseases is only now beginning. This perspective traces the important basic scientific developments that have led up to the refinement of serum TRAP isoform immunoassays and their validation as biomarkers of disease. Many unanswered questions remain, providing a wealth of opportunity for continued research of this multifaceted enzyme.
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Affiliation(s)
- Anthony J Janckila
- Special Hematology Laboratory, U.S. Department of Veterans Affairs Medical Center, 800 Zorn Ave., Louisville, KY 40206, USA.
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Mountzios G, Dimopoulos MA, Bamias A, Papadopoulos G, Kastritis E, Syrigos K, Pavlakis G, Terpos E. Abnormal bone remodeling process is due to an imbalance in the receptor activator of nuclear factor-kappaB ligand (RANKL)/osteoprotegerin (OPG) axis in patients with solid tumors metastatic to the skeleton. Acta Oncol 2009; 46:221-9. [PMID: 17453373 DOI: 10.1080/02841860600635870] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The role of receptor activator of nuclear factor-kappaB ligand (RANKL)/osteoprotegerin (OPG) system, and osteopontin (OPN) was studied in patients with solid tumors metastatic to the bone in relation to the type of malignancy and the neoplastic burden to the skeleton. Levels of soluble RANKL (sRANKL), OPG and OPN were assessed in 61 patients with breast, lung and prostate cancer with newly-diagnosed metastasis to the bone, in parallel with bone resorption [C-telopeptide of type-I collagen (CTX), tartrate-resistant acid phosphatase-5b (TRACP-5b)] and bone formation markers [bone-alkaline phosphatase (bALP), osteocalcin (OC), and C-terminal propeptide of collagen type-I (CICP)]. Patients had elevated serum levels of sRANKL, OPG, OPN, TRACP-5b, and bALP, and reduced OC levels compared to controls. OPG correlated with the extent of metastatic bone burden. Patients with breast and lung cancer shared increased levels of sRANKL, OPG, and OPN whereas prostate cancer patients had elevated values of OPG and bALP only. These results suggest that patients with solid tumors metastatic to the bone have severe disruption of the sRANKL/OPG axis. Breast and lung cancer seem to exert their osteolytic action through upregulation of the sRANKL/OPG system and OPN, whereas prostate cancer seems to provoke profound elevation of OPG levels only, thus leading to increased osteoblastic activity.
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Affiliation(s)
- Giannis Mountzios
- Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece.
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Pecherstorfer M. Treatment Options for Breast Cancer and Bone Metastases. WOMENS HEALTH 2009; 5:149-63. [DOI: 10.2217/17455057.5.2.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The most common destination for breast cancer metastases is bone. If bone metastases are detected, treatment algorithms should include the continuation of cytoreductive therapy with the addition of treatment to counter skeletal-related events, including bone pain. The range of current treatment options includes bisphosphonates, surgical intervention to improve structural integrity and palliative focal radiotherapy. This article focuses on the role of bisphosphonate therapy in metastatic breast cancer. Bisphosphonate therapy significantly reduces the impact of skeletal-related events, reduces bone pain and increases patient quality of life. Our current understanding is that bisphosphonates may also disrupt the metastatic process and reduce the development of bone lesions. Ultimately, this may lead to further expansion of bisphosphonate-based therapy in the future.
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Affiliation(s)
- Martin Pecherstorfer
- Martin Pecherstorfer, Hematologic–Oncologic Service, Landesklinikum Krems, A-3500 Krems, Austria, Tel.: +43 2732 804 4425, Fax: +43 2732 804 6708,
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Coleman R, Brown J, Terpos E, Lipton A, Smith MR, Cook R, Major P. Bone markers and their prognostic value in metastatic bone disease: clinical evidence and future directions. Cancer Treat Rev 2008; 34:629-39. [PMID: 18579314 DOI: 10.1016/j.ctrv.2008.05.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 05/02/2008] [Indexed: 12/31/2022]
Abstract
BACKGROUND Bone metastases are prevalent among patients with advanced solid tumors. Metastatic bone disease alters bone homeostasis, resulting in reduced bone integrity and, consequently, increased skeletal complications. Biochemical markers of bone metabolism may meet an unmet need for useful, noninvasive, and sensitive surrogate information for following patients' skeletal health. MATERIALS AND METHODS Data for this review were identified by searches of PubMed, and references from relevant articles using the search terms "bone markers" or individual bone marker nomenclature, "cancer," and "metastases." Abstracts and reports from meetings were included only when they related directly to previously published work. Only papers published in English between 1990 and 2007 were included. RESULTS Recent retrospective analyses with bisphosphonates, and particularly with zoledronic acid, have shown significant correlations between biochemical markers of bone metabolism levels and clinical outcomes, especially for bone resorption markers. Clinical results for biochemical markers of bone formation and resorption and other emerging markers of bone metabolism including bone sialoprotein, receptor-activator of nuclear factor-kappaB ligand, osteoprotegerin, and other markers are presented. However, biochemical markers of bone metabolism are not yet an established surrogate endpoint for treatment efficacy. CONCLUSIONS Biochemical markers of bone metabolism may allow physicians to identify which patients with metastatic bone disease are at high risk for skeletal-related events or death and who may be responding to therapy. Prospective randomized clinical trials are underway to further assess the utility of markers of bone metabolism in patients with bone metastases.
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Affiliation(s)
- Robert Coleman
- Academic Unit of Clinical Oncology, Cancer Research Centre, Weston Park Hospital, Sheffield S10 2SJ, UK.
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