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Georgescu D, Lighezan DF, Lascu A, Buzas R, Faur A, Ionita I, Rosca CI, Suceava I, Calamar-Popovici D, Ionita M, Ancusa OE. Hepatic Veno-Occlusive Disease and Colorectal Cancer: Expect the Unexpected. Life (Basel) 2024; 14:845. [PMID: 39063599 PMCID: PMC11277572 DOI: 10.3390/life14070845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/15/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024] Open
Abstract
Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a rare liver vascular condition, potentially life-threatening, with clinical signs of portal hypertension, frequently reported in relation to bone marrow transplantation and possibly in non-transplantation-related chemotherapy. We report the case of a 65-year-old female patient who insidiously developed fatigue, mild tenderness of the right upper abdominal quadrant, hepato-splenomegaly and slight weight gain consecutive to ascites development, as well as persistent elevation of transaminases and mild thrombocytopenia. To note, she had a previous history of colorectal cancer (CRC) with liver metastases and several courses of chemotherapy. Abdominal duplex and elastography measurements made the diagnosis of cirrhosis improbable. A lot of lab work-ups were performed in order to rule out several diseases and conditions. Further, transjugular access was used to perform the measurement of the hepatic venous pressure gradient and liver biopsy that confirmed SOS/VOD. In late 2023, she was diagnosed with endometrial adenocarcinoma, requiring chemotherapy again. At present, the liver condition is stationary, but the prognosis is, however, uncertain. In conclusion, we presented the atypical case of a female patient who developed portal hypertension syndrome associated with the late onset of SOS/VOD, after 5-fluorouracil and oxaliplatin chemotherapy for CRC and liver metastases, subsequently diagnosed with endometrial adenocarcinoma, which posed many diagnostic and therapeutic challenges. Given the potentially bad outcome, an early diagnosis of SOS/VOD in patients receiving drugs of risk is important not only to stratify further risk, but also to initiate an appropriate therapy in order to improve the prognosis.
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Affiliation(s)
- Doina Georgescu
- Department of Internal Medicine I, “V Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.F.L.); (R.B.); (I.I.); (C.I.R.); (I.S.); (D.C.-P.); (M.I.); (O.E.A.)
| | - Daniel Florin Lighezan
- Department of Internal Medicine I, “V Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.F.L.); (R.B.); (I.I.); (C.I.R.); (I.S.); (D.C.-P.); (M.I.); (O.E.A.)
| | - Ana Lascu
- Department of Functional Sciences, “V Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Roxana Buzas
- Department of Internal Medicine I, “V Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.F.L.); (R.B.); (I.I.); (C.I.R.); (I.S.); (D.C.-P.); (M.I.); (O.E.A.)
| | - Alexandra Faur
- Department of Anatomy and Embriology, “V Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Ioana Ionita
- Department of Internal Medicine I, “V Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.F.L.); (R.B.); (I.I.); (C.I.R.); (I.S.); (D.C.-P.); (M.I.); (O.E.A.)
| | - Ciprian Ilie Rosca
- Department of Internal Medicine I, “V Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.F.L.); (R.B.); (I.I.); (C.I.R.); (I.S.); (D.C.-P.); (M.I.); (O.E.A.)
| | - Ioana Suceava
- Department of Internal Medicine I, “V Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.F.L.); (R.B.); (I.I.); (C.I.R.); (I.S.); (D.C.-P.); (M.I.); (O.E.A.)
| | - Despina Calamar-Popovici
- Department of Internal Medicine I, “V Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.F.L.); (R.B.); (I.I.); (C.I.R.); (I.S.); (D.C.-P.); (M.I.); (O.E.A.)
| | - Mihai Ionita
- Department of Internal Medicine I, “V Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.F.L.); (R.B.); (I.I.); (C.I.R.); (I.S.); (D.C.-P.); (M.I.); (O.E.A.)
| | - Oana Elena Ancusa
- Department of Internal Medicine I, “V Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.F.L.); (R.B.); (I.I.); (C.I.R.); (I.S.); (D.C.-P.); (M.I.); (O.E.A.)
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Inhibition of Vascular Endothelial Growth Factor Protects against the Development of Oxaliplatin-Induced Sinusoidal Obstruction Syndrome in Wild-Type but Not in CD39-Null Mice. Cancers (Basel) 2022; 14:cancers14235992. [PMID: 36497474 PMCID: PMC9739893 DOI: 10.3390/cancers14235992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/19/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Sinusoidal obstruction syndrome (SOS) after oxaliplatin-based chemotherapy is associated with unfavorable outcomes after partial hepatectomy for colorectal liver metastases (CLM). Bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF), may prevent SOS development. We investigated the impact of VEGF-inhibition on the development of SOS in a murine model. (2) Methods: Male wild-type and CD39-null mice received oxaliplatin, additional anti-VEGF (OxAV), or controls, and were sacrificed or subjected to major partial hepatectomy (MH). Specimen were used for histological analysis of SOS. Liver damage was assessed by plasma transaminases. The VEGF pathway was elucidated by quantitative PCR of liver tissue and protein analysis of plasma. (3) Results: Mice treated with oxaliplatin developed SOS. Concomitant anti-VEGF facilitated a reduced incidence of SOS, but not in CD39-null mice. SOS was associated with increased plasma VEGF-A and decreased hepatocyte growth factor (HGF). After OxAV treatment, VEGF-R2 was upregulated in wild-type but downregulated in CD39-null mice. Oxaliplatin alone was associated with higher liver damage after MH than in mice with concomitant VEGF-inhibition. (4) Conclusions: We established a murine model of oxaliplatin-induced SOS and provided novel evidence on the protective effect of VEGF-inhibition against the development of SOS that may be associated with changes in the pathway of VEGF and its receptor VEGF-R2.
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Shimagaki T, Sugimachi K, Mano Y, Onishi E, Iguchi T, Uehara H, Sugiyama M, Yamamoto M, Morita M, Toh Y. Simple systemic index associated with oxaliplatin‐induced liver damage can be a novel biomarker to predict prognosis after resection of colorectal liver metastasis. Ann Gastroenterol Surg 2022; 6:813-822. [PMID: 36338597 PMCID: PMC9628223 DOI: 10.1002/ags3.12580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/02/2022] [Indexed: 12/01/2022] Open
Abstract
Aim Oxaliplatin, an anticancer drug for advanced colorectal cancer, causes liver sinusoidal damage, sometimes with portal hypertension. We conducted a retrospective comparative study of the relationship of liver sinusoidal disorders and liver function with the prognosis in patients who underwent hepatectomy for colorectal liver metastasis (CRLM). Methods In total, 158 patients who underwent hepatectomy for CRLM were included in the study, and the effect of chemotherapy‐associated liver damage on the prognosis was examined. Results Preoperative oxaliplatin was used in 75 of 158 patients; of these 75 patients, 26 had intraoperative blue liver (BL). In a comparison of the BL group (n = 26) and non‐BL group (n = 132), patients in the BL group had a significantly lower serum albumin concentration and a significantly higher indocyanine green test result, aspartate aminotransferase‐to‐platelet ratio index (APRI), and FIB‐4 score. Operative morbidities were not significantly different between the two groups. The overall survival rate after hepatectomy was significantly worse in the BL group than in the non‐BL group. In the univariate analysis, the serum albumin concentration, indocyanine green test, a high tumor burden score (TBS), and the APRI were statistically significant poor prognostic factors. In the multivariate analysis, the APRI and a high TBS were independent poor prognostic factors. Conclusion The APRI and TBS in patients with CRLM are prognostic predictors after hepatectomy for metastatic liver cancer. This study indicated that liver damage in patients treated with preoperative oxaliplatin has an effect on the prognosis.
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Affiliation(s)
- Tomonari Shimagaki
- Department of Hepatobiliary and Pancreatic Surgery National Hospital Organization Kyushu Cancer Center Fukuoka Japan
| | - Keishi Sugimachi
- Department of Hepatobiliary and Pancreatic Surgery National Hospital Organization Kyushu Cancer Center Fukuoka Japan
| | - Yohei Mano
- Department of Hepatobiliary and Pancreatic Surgery National Hospital Organization Kyushu Cancer Center Fukuoka Japan
| | - Emi Onishi
- Department of Hepatobiliary and Pancreatic Surgery National Hospital Organization Kyushu Cancer Center Fukuoka Japan
| | - Tomohiro Iguchi
- Department of Hepatobiliary and Pancreatic Surgery National Hospital Organization Kyushu Cancer Center Fukuoka Japan
| | - Hideo Uehara
- Department of Gastroenterological Surgery National Hospital Organization Kyushu Cancer Center Fukuoka Japan
| | - Masahiko Sugiyama
- Department of Gastroenterological Surgery National Hospital Organization Kyushu Cancer Center Fukuoka Japan
| | - Manabu Yamamoto
- Department of Gastroenterological Surgery National Hospital Organization Kyushu Cancer Center Fukuoka Japan
| | - Masaru Morita
- Department of Gastroenterological Surgery National Hospital Organization Kyushu Cancer Center Fukuoka Japan
| | - Yasushi Toh
- Department of Gastroenterological Surgery National Hospital Organization Kyushu Cancer Center Fukuoka Japan
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Otaka F, Ito Y, Goto T, Eshima K, Amano H, Koizumi W, Majima M. Platelets prevent the development of monocrotaline-induced liver injury in mice. Toxicol Lett 2020; 335:71-81. [PMID: 33122006 DOI: 10.1016/j.toxlet.2020.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/05/2020] [Accepted: 10/16/2020] [Indexed: 12/28/2022]
Abstract
Destruction of liver sinusoidal endothelial cells (LSECs) is an initial event in sinusoidal obstruction syndrome (SOS) that leads to accumulation of platelets in the liver. Herein, we explored the role of platelets during progression of experimental SOS induced by monocrotaline (MCT) in mice. Depletion of platelets using an anti-CD41 antibody or anti-thrombocyte serum exacerbated MCT-induced liver injury in C57BL/6 mice, as indicated by an increase in the alanine transaminase (ALT) level, which was associated with hemorrhagic necrosis. Thrombocytosis induced by thrombopoietin (TPO) or the TPO receptor agonist romiplostim (ROM) attenuated MCT-induced liver injury, as evidenced by lower levels of ALT and mRNA encoding matrix metalloproteinase (MMP) 9, and higher levels of mRNA encoding vascular endothelial growth factor receptor (VEGFR) 2 and VEGFR3. The level of activated hepatic platelets was higher in TPO- and ROM-treated mice than in saline-treated mice. Co-culture with a high number of platelets increased the viability of LSECs and their mRNA levels of CD31, VEGFR2, and VEGFR3, and decreased their mRNA level of MMP9. The level of VEGF-A was increased in the culture medium of LSECs co-cultured with platelets. These results indicate that platelets attenuate MCT-induced liver injury by minimizing damage to LSECs.
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Affiliation(s)
- Fumisato Otaka
- Department of Molecular Pharmacology, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Kanagawa 252-0374, Japan; Departments of Pharmacology, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan; Departments of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Yoshiya Ito
- Department of Molecular Pharmacology, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Kanagawa 252-0374, Japan; Departments of Pharmacology, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan.
| | - Takuya Goto
- Department of Molecular Pharmacology, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Kanagawa 252-0374, Japan
| | - Koji Eshima
- Departments of Immunology, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Hideki Amano
- Department of Molecular Pharmacology, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Kanagawa 252-0374, Japan; Departments of Pharmacology, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Wasaburo Koizumi
- Departments of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
| | - Masataka Majima
- Department of Molecular Pharmacology, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Kanagawa 252-0374, Japan; Departments of Pharmacology, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan; Department of Medical Therapeutics, Kanagawa Institute of Technology, Atsugi, Kanagawa 243-0292, Japan
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Gangi A, Lu SC. Chemotherapy-associated liver injury in colorectal cancer. Therap Adv Gastroenterol 2020; 13:1756284820924194. [PMID: 32547639 PMCID: PMC7249601 DOI: 10.1177/1756284820924194] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/15/2020] [Indexed: 02/04/2023] Open
Abstract
Patients with colorectal cancer (CRC) have benefited significantly from advances in multimodal treatment with significant improvements in long-term survival. More patients are currently being treated with surgical resection or ablation following neoadjuvant or adjuvant chemotherapy. However, several cytotoxic agents that are administered routinely have been linked to liver toxicities that impair liver function and regeneration. Recognition of chemotherapy-related liver toxicity emphasizes the importance of multidisciplinary planning to optimize care. This review aims to summarize current data on multimodal treatment concepts for CRC, provide an overview of liver damage caused by commonly administered chemotherapeutic agents, and evaluate currently suggested protective agents.
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Affiliation(s)
- Alexandra Gangi
- Division of Surgical Oncology, Department of Surgery, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
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Chen Z, Jiang L. The clinical application of fruquintinib on colorectal cancer. Expert Rev Clin Pharmacol 2019; 12:713-721. [PMID: 31177854 DOI: 10.1080/17512433.2019.1630272] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Zhongguang Chen
- Department of Pharmaceutical, Central Hospital of Linyi City, Yishui, Shandong, China
| | - Lili Jiang
- Ultrasound Medical Department, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
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