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Sapienza Passos J, Dartora VFMC, Cassone Salata G, Draszesski Malagó I, Lopes LB. Contributions of nanotechnology to the intraductal drug delivery for local treatment and prevention of breast cancer. Int J Pharm 2023; 635:122681. [PMID: 36738808 DOI: 10.1016/j.ijpharm.2023.122681] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/27/2022] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
Breast cancer is a major public health problem, affecting millions of people. It is a very heterogeneous disease, with localized and invasive forms, and treatment generally consists of a combination of surgery and radiotherapy followed by administration of estrogen receptor modulators or aromatase inhibitors. Given its heterogeneity, management strategies that take into consideration the type of disease and biological markers and can provide more personalized and local treatment are required. More recently, the intraductal administration (i.e., into the breast ducts) of drugs has attracted significant attention due to its ability of providing drug distribution through the ductal tree in a minimally invasive manner. Although promising, intraductal administration is not trivial, and difficulties in duct identification and cannulation are important challenges to the further development of this route. New drug delivery strategies such as nanostructured systems can help to achieve the full benefits of the route due to the possibility of prolonging tissue retention, improving targeting and selectivity, increasing cytotoxicity and reducing the frequency of administration. This review aims at discussing the potential benefits and challenges of intraductal administration, focusing on the design and use of nanocarriers as innovative and feasible strategies for local breast cancer therapy and prevention.
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Affiliation(s)
- Julia Sapienza Passos
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, Brazil
| | - Vanessa F M C Dartora
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, Brazil; College of Engineering, University of California-Davis, USA
| | - Giovanna Cassone Salata
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, Brazil
| | | | - Luciana B Lopes
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, Brazil.
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de Boorder T, Waaijer L, van Diest PJ, Witkamp AJ. Ex vivo feasibility study of endoscopic intraductal laser ablation of the breast. Lasers Surg Med 2017; 50:137-142. [PMID: 28990682 DOI: 10.1002/lsm.22745] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the feasibility and safety of breast endoscopic thulium laser ablation for treatment of intraductal neoplasia. STUDY DESIGN Ductoscopy is a minimally invasive endoscopic approach of the milk ducts of the breast via the nipple. Besides diagnosis in women with pathologic nipple discharge (PND), it allows non-invasive removal of intraductal lesions with a stalk like papillomas. Removal, however, is often incomplete and flat lesions cannot be targeted. We therefore developed laser ductoscopy. METHODS Dosimetry of laser ductoscopy was assessed in thirteen mastectomy specimens, applying power settings of 1-5 W with 100-1000 ms pulsed exposure to a 375-μm outer diameter thulium fiber laser. Subsequently histology was obtained from the breast tissue that was treated with the Thulium laser. RESULTS Endoscopic view was maintained during ductoscopic laser ablation at 1-3 W. Increasing power to 4-5 W caused impaired vision due to shrinkage of the main duct around the ductoscope tip. Histology revealed localized ablation of the duct wall. CONCLUSION We show for the first time that laser ductoscopy is technically feasible. The Thulium laser enables a superficial intraductal ablation and is a useful tool for intraductal interventions. An in vivo prospective study is needed to further demonstrate its potential. Lasers Surg. Med. 50:137-142, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Tjeerd de Boorder
- Departments of Medical Technology and Clinical Physics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Laurien Waaijer
- Departments of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Paul J van Diest
- Departments of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Arjen J Witkamp
- Departments of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Mills D, Gomberawalla A, Gordon EJ, Tondre J, Nejad M, Nguyen T, Pogoda JM, Rao J, Chatterton R, Henning S, Love SM. Examination of Duct Physiology in the Human Mammary Gland. PLoS One 2016; 11:e0150653. [PMID: 27073976 PMCID: PMC4830446 DOI: 10.1371/journal.pone.0150653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/16/2016] [Indexed: 11/23/2022] Open
Abstract
Background The human breast comprise several ductal systems, or lobes, which contain a small amount of fluid containing cells, hormones, proteins and metabolites. The complex physiology of these ducts is likely a contributing factor to the development of breast cancer, especially given that the vast majority of breast cancers begin in a single lobular unit. Methods We examined the levels of total protein, progesterone, estradiol, estrone sulfate, dehydroepiandrosterone sulfate, and macrophages in ductal fluid samples obtained from 3 ducts each in 78 women, sampled twice over a 6 month period. Samples were processed for both cytological and molecular analysis. Intraclass correlation coefficients and mixed models were utilized to identify significant data. Results We found that the levels of these ductal fluid components were generally uncorrelated among ducts within a single breast and over time, suggesting that each lobe within the breast has a distinct physiology. However, we also found that estradiol was more correlated in women who were nulliparous or produced nipple aspirate fluid. Conclusions Our results provide evidence that the microenvironment of any given lobular unit is unique to that individual unit, findings that may provide clues about the initiation and development of ductal carcinomas.
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Affiliation(s)
- Dixie Mills
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA, 90403, United States of America
| | - Ameer Gomberawalla
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA, 90403, United States of America
- Columbia University Medical Center, Department of Breast Surgery, New York, NY, United States of America
- * E-mail:
| | - Eva J. Gordon
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA, 90403, United States of America
| | - Julie Tondre
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA, 90403, United States of America
| | - Mitra Nejad
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA, 90403, United States of America
| | - Tinh Nguyen
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA, 90403, United States of America
| | - Janice M. Pogoda
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, 90089, United States of America
| | - Jianyu Rao
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, 90095, United States of America
| | - Robert Chatterton
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 710 North Fairbanks Court, Chicago, IL, 60611, United States of America
| | - Susanne Henning
- Center for Human Nutrition, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, 90095, United States of America
| | - Susan M. Love
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA, 90403, United States of America
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Abstract
Today breast cancer remains a major public health problem, although reducing its risk is now an achievable medical objective. Risk-assessment models may be used in estimating a woman's risk for developing breast cancer and to direct suitable candidates for preventive therapy. Researchers are attempting to enhance individualized risk assessment through incorporation of phenotypic biomarkers. Individual selective estrogen receptor modulators have been approved for breast cancer risk reduction, and other drug categories are being studied. It is critical that obstetrician-gynecologists be familiar with the evolving science of the risk assessment of breast cancer as well as interventional and surveillance strategies.
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Affiliation(s)
- Victoria L Green
- Department of Obstetrics and Gynecology, Gynecology Breast Clinic, Avon Comprehensive Breast Center, Winship Cancer Institute, Emory University at Grady Memorial Hospital, 69 Jesse Hill Jr Drive, Atlanta, GA 30303, USA.
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Wang KR, Ye YQ, Zhang YL, Zhao LH, Gu YQ, Ma CL, Hou CM, Huang KK, Xu ZL. Evaluation of factors associated with pain experienced during mammary ductoscopy. Oncol Res Treat 2014; 37:204-8. [PMID: 24732645 DOI: 10.1159/000360784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 02/19/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to evaluate patient characteristics and findings after mammary ductoscopy in an effort to reduce the pain experienced during the procedure. PATIENTS AND METHODS We evaluated outpatients in whom mammary ductoscopy was performed under local or intraductal anesthesia without preference, and their clinical characteristics and findings were recorded. Average and maximum pain scores were determined after the examination for statistical analysis. RESULTS The overall average pain score was 3.74 ± 1.353, and the maximum pain score was 6.40 ± 1.681. The type of anesthesia, total operation time, nipple retraction, and discharge status significantly correlated with the pain score. Intraductal anesthesia lowered the average pain score by 0.60, whereas a total procedure time greater than 12 min increased the average pain score by 0.956. The pain score decreased if patients had nipple retraction, and intraductal anesthesia proved suitable for patients with normal nipples. CONCLUSION Intraductal anesthesia is suitable for most patients, and ductoscopy should not exceed 12 min to minimize the pain. Nipple retraction does not significantly increase pain, but local anesthesia should be used in patients with retracted nipples. Patient age, breastfeeding history, menstrual stage, and presence of intraductal tumors were not associated with the level of pain experienced.
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Affiliation(s)
- Ke-Ren Wang
- Department of Breast Surgery, China Japan Union Hospital of Jilin University, Changchun, China
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Mahoney ME, Gordon EJ, Rao JY, Jin Y, Hylton N, Love SM. Intraductal therapy of ductal carcinoma in situ: a presurgery study. Clin Breast Cancer 2013; 13:280-6. [PMID: 23664819 DOI: 10.1016/j.clbc.2013.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 02/04/2013] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Ductal carcinoma in situ (DCIS) is a noninvasive breast cancer wherein malignant cells are confined within a ductal lobular unit. Although less than half the cases of DCIS will progress to invasive disease, most women are treated aggressively with surgery, radiation, and/or hormone therapy due to the inability to clinically evaluate the extent and location of the disease. Intraductal therapy, in which a drug is administered directly into the mammary duct through the nipple, is a promising approach for treating DCIS, but the feasibility of instilling drug into a diseased duct has not been established. PATIENTS AND METHODS Four to 6 weeks before their scheduled surgery, 13 women diagnosed with DCIS were subjected to cannulation of the affected duct. After both the absence of perforation and presence of dye in the duct were confirmed by ductogram, pegylated liposomal doxorubicin was instilled. Histopathologic assessment was performed after surgery to assess the treatment effects. RESULTS Of the 13 women enrolled in the study, 6 had their DCIS duct successfully cannulated without perforation and instilled with the drug. The treatment was well tolerated, and no serious adverse events have been reported. Biomarker studies indicated a general decrease in Ki-67 levels but an increase in annexin-1 and 8-hydroxydeoxyguanosine in the lumen of DCIS-containing ducts, which suggests a local response to pegylated liposomal doxorubicin treatment. CONCLUSIONS Intraductal therapy offers a nonsurgical strategy to treat DCIS at the site of disease, potentially minimizing the adverse effects of systemic treatment while preventing development of invasive cancer.
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Twelves D, Nerurkar A, Osin P, Ward A, Isacke CM, Gui GP. The feasibility of nipple aspiration and duct lavage to evaluate the breast duct epithelium of women with increased breast cancer risk. Eur J Cancer 2013; 49:65-71. [DOI: 10.1016/j.ejca.2012.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 05/18/2012] [Accepted: 07/12/2012] [Indexed: 11/29/2022]
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Love SM, Zhang W, Gordon EJ, Rao J, Yang H, Li J, Zhang B, Wang X, Chen G, Zhang B. A feasibility study of the intraductal administration of chemotherapy. Cancer Prev Res (Phila) 2012; 6:51-8. [PMID: 23169924 DOI: 10.1158/1940-6207.capr-12-0228] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preclinical data have shown the potential of the intraductal administration of chemotherapy for breast cancer prevention. Direct translation of this work has been stymied by the anatomical differences between rodents (one duct per teat) and women (5-9 ductal systems per breast). The objective of this phase I study was to show the safety and feasibility of intraductal administration of chemotherapy drugs into multiple ducts within one breast in women awaiting mastectomy for treatment of invasive cancer. Thirty subjects were enrolled in this dose escalation study conducted at a single center in Beijing, China. Under local anesthetic, one of two chemotherapy drugs, carboplatin or pegylated liposomal doxorubicin (PLD), was administered into five to eight ducts at three dose levels. Pharmacokinetic analysis has shown that carboplatin was rapidly absorbed into the bloodstream, whereas PLD, though more erratic, was absorbed after a delay. Pathologic analysis showed marked effects on breast duct epithelium in ducts treated with either drug compared with untreated ducts. The study investigators had no difficulty in identifying or cannulating ducts except in one case with a central cancer with subareolar involvement. This study shows the safety and feasibility of intraductal administration of chemotherapy into multiple ducts for the purpose of breast cancer prevention. This is an important step toward implementation of this strategy as a "chemical mastectomy", where the potential for carcinogenesis in the ductal epithelium is eliminated pharmacologically, locally, and without the need for surgery.
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Affiliation(s)
- Susan M Love
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA 90403, USA.
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Mills D, Gordon EJ, Casano A, Lahti SM, Nguyen T, Preston A, Tondre J, Wu K, Yanase T, Chan H, Chia D, Esfandiari M, Himmel T, Love SM. The physiology of the normal human breast: an exploratory study. J Physiol Biochem 2011; 67:621-7. [PMID: 21983803 DOI: 10.1007/s13105-011-0109-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 07/19/2011] [Indexed: 01/16/2023]
Abstract
The physiology of the nonlactating human breast likely plays a key role in factors that contribute to the etiology of breast cancer and other breast conditions. Although there has been extensive research into the physiology of lactation, few reports explore the physiology of the resting mammary gland, including mechanisms by which compounds such as hormones, drugs, and potential carcinogens enter the breast ducts. The purpose of this study was to explore transport of exogenous drugs into ductal fluid in nonlactating women and determine if their concentrations in the fluid are similar to those observed in the breast milk of lactating women. We selected two compounds that have been well characterized during lactation, caffeine and cimetidine. Caffeine passively diffuses into breast milk, but cimetidine is actively transported and concentrated in breast milk. After ingestion of caffeine and cimetidine, 14 nonlactating subjects had blood drawn and underwent ductal lavage at five time points over 12 h to measure drug levels in the fluid and blood. The concentrations of both caffeine and cimetidine in lavage fluid were substantially less than those observed in breast milk. Our results support recent evidence that the cimetidine transporter is not expressed in the nonlactating mammary gland, and highlight intriguing differences in the physiology and molecular transport of the lactating and nonlactating breast. The findings of this exploratory study warrant further exploration into the physiology of the nonlactating mammary gland to elucidate factors involved in disease initiation and progression.
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Affiliation(s)
- Dixie Mills
- Dr. Susan Love Research Foundation, 2811 Wilshire Blvd., Suite 500, Santa Monica, CA 90403, USA
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Grafton MMG, Wang L, Vidi PA, Leary J, Lelièvre SA. Breast on-a-chip: mimicry of the channeling system of the breast for development of theranostics. Integr Biol (Camb) 2011; 3:451-9. [PMID: 21234506 DOI: 10.1039/c0ib00132e] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Improved detection and therapy of breast neoplasia might benefit from nanodevices traveling inside mammary ducts. However, the decreasing size of branched mammary ducts prevents access to remote areas of the ductal system using a pressure-driven fluid-based approach. Magnetic field guidance of superparamagnetic submicron particles (SMPs) in a stationary fluid might provide a possible alternative but it is critical to first reproduce the breast ductal system to assess the use of such devices for future therapeutic & diagnostic ("theranostic") purposes. Here we describe the engineering of a portion of a breast ductal system using polydimethylsiloxane (PDMS) microfluidic channels with a total volume of 0.09 μl. A magnet was used to move superparamagnetic/fluorescent SMPs through a static fluid inside the microchannels. Non-neoplastic mammary epithelial S1 cells developed basoapical polarity as a flat monolayer on the PDMS surface when cultured in the presence of laminin 111, and incubation with SMPs did not result in detectable toxicity. Cells could not withstand the fluid pressure if microinjected directly in completed channels. Whereas, they readily covered laminin 111-coated PDMS surfaces when cultured in U-shaped "hemichannels" before completing the channels. This breast-on-chip model represents a critical step towards the mimicry of the tree-like ductal system of the breast for further testing and targeting of SMPs.
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Affiliation(s)
- Meggie M G Grafton
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907-2026, USA
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Love SM, Mills DJ. The Role of Ductal Lavage: A Cautionary Tale. Breast Cancer 2010. [DOI: 10.1007/978-1-84996-314-5_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lobar Anatomy of Human Breast and Its Importance for Breast Cancer. Breast Cancer 2010. [DOI: 10.1007/978-1-84996-314-5_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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