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Dos Santos DZ, Elbaz M, Branchard E, Schormann W, Brown CE, Meek AR, Njar VCO, Hamilton RJ, Reed MA, Andrews DW, Penn LZ. Sterol-like drugs potentiate statin-triggered prostate cancer cell death by inhibiting SREBP2 nuclear translocation. Biomed Pharmacother 2024; 177:116934. [PMID: 38889639 DOI: 10.1016/j.biopha.2024.116934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/07/2024] [Accepted: 06/09/2024] [Indexed: 06/20/2024] Open
Abstract
There is an urgent need to provide immediate and effective options for the treatment of prostate cancer (PCa) to prevent progression to lethal castration-resistant PCa (CRPC). The mevalonate (MVA) pathway is dysregulated in PCa, and statin drugs commonly prescribed for hypercholesterolemia, effectively target this pathway. Statins exhibit anti-PCa activity, however the resulting intracellular depletion of cholesterol triggers a feedback loop that restores MVA pathway activity, thus diminishing statin efficacy and contributing to resistance. To identify drugs that block this feedback response and enhance the pro-apoptotic activity of statins, we performed a high-content image-based screen of a 1508 drug library, enriched for FDA-approved compounds. Two of the validated hits, Galeterone (GAL) and Quinestrol, share the cholesterol-related tetracyclic structure, which is also evident in the FDA-approved CRPC drug Abiraterone (ABI). Molecular modeling revealed that GAL, Quinestrol and ABI not only share structural similarity with 25-hydroxy-cholesterol (25HC) but were also predicted to bind similarly to a known protein-binding site of 25HC. This suggested GAL, Quinestrol and ABI are sterol-mimetics and thereby inhibit the statin-induced feedback response. Cell-based assays demonstrated that these agents inhibit nuclear translocation of sterol-regulatory element binding protein 2 (SREBP2) and the transcription of MVA genes. Sensitivity was independent of androgen status and the Fluva-GAL combination significantly impeded CRPC tumor xenograft growth. By identifying cholesterol-mimetic drugs that inhibit SREBP2 activation upon statin treatment, we provide a potent "one-two punch" against CRPC progression and pave the way for innovative therapeutic strategies to combat additional diseases whose etiology is associated with SREBP2 dysregulation.
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Affiliation(s)
| | - Mohamad Elbaz
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, Toronto, ON M5G 1L7, Canada; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Helwan University, Ain Helwan, Helwan, Cairo, Egypt
| | - Emily Branchard
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, Toronto, ON M5G 1L7, Canada
| | - Wiebke Schormann
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Carla E Brown
- Krembil Research Institute, 60 Leonard Ave, Toronto, ON M5T 0S8, Canada
| | - Autumn R Meek
- Krembil Research Institute, 60 Leonard Ave, Toronto, ON M5T 0S8, Canada
| | - Vincent C O Njar
- Department of Pharmacology, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, USA; The Center for Biomolecular Therapeutics, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, USA; Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, USA
| | - Robert J Hamilton
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Mark A Reed
- Krembil Research Institute, 60 Leonard Ave, Toronto, ON M5T 0S8, Canada; Department of Pharmacology and Toxicology, Medical Sciences Building,1 King's College Circle, University of Toronto, M5S 1A8, Canada; Department of Chemistry, Lash Miller Building, 80 St. George Street, University of Toronto, Ontario M5S 3H6, Canada
| | - David W Andrews
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; Department of Biochemistry, University of Toronto, 27 King's College Cir, Toronto, ON M5S 1A1, Canada; Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto, ON M5G 1L7, Canada
| | - Linda Z Penn
- Princess Margaret Cancer Centre, University Health Network, 101 College Street, Toronto, ON M5G 1L7, Canada; Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto, ON M5G 1L7, Canada.
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Tsilingiris D, Vallianou NG, Spyrou N, Kounatidis D, Christodoulatos GS, Karampela I, Dalamaga M. Obesity and Leukemia: Biological Mechanisms, Perspectives, and Challenges. Curr Obes Rep 2024; 13:1-34. [PMID: 38159164 PMCID: PMC10933194 DOI: 10.1007/s13679-023-00542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE OF REVIEW To examine the epidemiological data on obesity and leukemia; evaluate the effect of obesity on leukemia outcomes in childhood acute lymphoblastic leukemia (ALL) survivors; assess the potential mechanisms through which obesity may increase the risk of leukemia; and provide the effects of obesity management on leukemia. Preventive (diet, physical exercise, obesity pharmacotherapy, bariatric surgery) measures, repurposing drugs, candidate therapeutic agents targeting oncogenic pathways of obesity and insulin resistance in leukemia as well as challenges of the COVID-19 pandemic are also discussed. RECENT FINDINGS Obesity has been implicated in the development of 13 cancers, such as breast, endometrial, colon, renal, esophageal cancers, and multiple myeloma. Leukemia is estimated to account for approximately 2.5% and 3.1% of all new cancer incidence and mortality, respectively, while it represents the most frequent cancer in children younger than 5 years. Current evidence indicates that obesity may have an impact on the risk of leukemia. Increased birthweight may be associated with the development of childhood leukemia. Obesity is also associated with worse outcomes and increased mortality in leukemic patients. However, there are several limitations and challenges in meta-analyses and epidemiological studies. In addition, weight gain may occur in a substantial number of childhood ALL survivors while the majority of studies have documented an increased risk of relapse and mortality among patients with childhood ALL and obesity. The main pathophysiological pathways linking obesity to leukemia include bone marrow adipose tissue; hormones such as insulin and the insulin-like growth factor system as well as sex hormones; pro-inflammatory cytokines, such as IL-6 and TNF-α; adipocytokines, such as adiponectin, leptin, resistin, and visfatin; dyslipidemia and lipid signaling; chronic low-grade inflammation and oxidative stress; and other emerging mechanisms. Obesity represents a risk factor for leukemia, being among the only known risk factors that could be prevented or modified through weight loss, healthy diet, and physical exercise. Pharmacological interventions, repurposing drugs used for cardiometabolic comorbidities, and bariatric surgery may be recommended for leukemia and obesity-related cancer prevention.
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Affiliation(s)
- Dimitrios Tsilingiris
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | - Natalia G Vallianou
- Department of Internal Medicine, Evangelismos General Hospital, 45-47 Ipsilantou str, 10676, Athens, Greece
| | - Nikolaos Spyrou
- Tisch Cancer Institute Icahn School of Medicine at Mount Sinai, 1190 One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Dimitris Kounatidis
- Department of Internal Medicine, Evangelismos General Hospital, 45-47 Ipsilantou str, 10676, Athens, Greece
| | | | - Irene Karampela
- 2nd Department of Critical Care, Medical School, University of Athens, Attikon General University Hospital, 1 Rimini Str, 12462, Athens, Greece
| | - Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias str, 11527, Athens, Greece.
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Han JE, Kim J, Cheong JY, Kim SS, Lim SG, Yang MJ, Noh CK, Lee GH, Eun JW, Park B, Cho HJ. The Impact of Statins on the Survival of Patients with Advanced Hepatocellular Carcinoma Treated with Sorafenib or Lenvatinib. Cancers (Basel) 2024; 16:249. [PMID: 38254739 PMCID: PMC10813381 DOI: 10.3390/cancers16020249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024] Open
Abstract
We aimed to evaluate the survival benefits of coadministering statins and multityrosine kinase inhibitors (TKIs) in patients with advanced hepatocellular carcinoma (HCC). Data from the Health Insurance Review and Assessment Service in Korea (2010-2020) were utilized. Statin use (≥28 cumulative defined daily doses) was analyzed, with 1534 statin users matched to 6136 non-users (1:4 ratio) using propensity scores. Primary and secondary outcomes were overall survival (OS) and progression-free survival (PFS). Statin use significantly improved OS (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.72-0.82, p < 0.001) and PFS (HR 0.78, 95% CI 0.74-0.84, p < 0.001). Continuous or post-TKI statin users had better OS, while discontinuation after TKI use led to poorer OS. Both lipophilic and hydrophilic statins improved OS and PFS, particularly with ≥730 cumulative defined daily doses. In conclusion, combining statins and TKIs in patients with advanced HCC yielded significant survival benefits, influenced by statin dosage and duration. Continuous statin administration post-TKI treatment is crucial for improving outcomes in patients with HCC.
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Affiliation(s)
- Ji Eun Han
- Department of Gastroenterology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.E.H.); (J.Y.C.); (S.S.K.); (S.G.L.); (M.J.Y.); (C.-K.N.); (G.H.L.); (J.W.E.)
| | - Jisu Kim
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon 16499, Republic of Korea; (J.K.); (B.P.)
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Jae Youn Cheong
- Department of Gastroenterology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.E.H.); (J.Y.C.); (S.S.K.); (S.G.L.); (M.J.Y.); (C.-K.N.); (G.H.L.); (J.W.E.)
| | - Soon Sun Kim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.E.H.); (J.Y.C.); (S.S.K.); (S.G.L.); (M.J.Y.); (C.-K.N.); (G.H.L.); (J.W.E.)
| | - Sun Gyo Lim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.E.H.); (J.Y.C.); (S.S.K.); (S.G.L.); (M.J.Y.); (C.-K.N.); (G.H.L.); (J.W.E.)
| | - Min Jae Yang
- Department of Gastroenterology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.E.H.); (J.Y.C.); (S.S.K.); (S.G.L.); (M.J.Y.); (C.-K.N.); (G.H.L.); (J.W.E.)
| | - Choong-Kyun Noh
- Department of Gastroenterology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.E.H.); (J.Y.C.); (S.S.K.); (S.G.L.); (M.J.Y.); (C.-K.N.); (G.H.L.); (J.W.E.)
| | - Gil Ho Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.E.H.); (J.Y.C.); (S.S.K.); (S.G.L.); (M.J.Y.); (C.-K.N.); (G.H.L.); (J.W.E.)
| | - Jung Woo Eun
- Department of Gastroenterology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.E.H.); (J.Y.C.); (S.S.K.); (S.G.L.); (M.J.Y.); (C.-K.N.); (G.H.L.); (J.W.E.)
| | - Bumhee Park
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon 16499, Republic of Korea; (J.K.); (B.P.)
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Hyo Jung Cho
- Department of Gastroenterology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.E.H.); (J.Y.C.); (S.S.K.); (S.G.L.); (M.J.Y.); (C.-K.N.); (G.H.L.); (J.W.E.)
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Lu Z, Li Y. New Clues to Cardiovascular Disease: Erythrocyte Lifespan. Aging Dis 2023; 14:2003-2014. [PMID: 37199588 PMCID: PMC10676783 DOI: 10.14336/ad.2023.0506] [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: 01/01/2023] [Accepted: 05/06/2023] [Indexed: 05/19/2023] Open
Abstract
Determination of erythrocyte lifespan is an important part of the diagnosis of hemolytic diseases. Recent studies have revealed alterations in erythrocyte lifespan among patients with various cardiovascular diseases, including atherosclerotic coronary heart disease, hypertension, and heart failure. This review summarizes the progress of research on erythrocyte lifespan in cardiovascular diseases.
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Affiliation(s)
- Ziyu Lu
- Department of Cardiology, the Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Yuanmin Li
- Department of Cardiology, the Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
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Milojkovic D, Lyon AR, Mehta P, Dimitriadou E, Choudhuri S, Manisty C, Cheshire N, Crozier K, Basker N, Amer K, Purcell S, Tan S, Clark RE. Cardiovascular risk in chronic myeloid leukaemia: A multidisciplinary consensus on screening and management. Eur J Haematol 2023. [PMID: 37186398 DOI: 10.1111/ejh.13983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Tyrosine kinase inhibitors (TKIs) have become the mainstay of treatment for chronic myeloid leukaemia (CML), but cardiovascular (CV) risk and exacerbation of underlying risk factors associated with TKIs have become widely debated. Real-world evidence reveals little application of CV risk factor screening or continued monitoring within UK CML management. This consensus paper presents practical recommendations to assist healthcare professionals in conducting CV screening/comorbidity management for patients receiving TKIs. METHODS We conducted a multidisciplinary panel meeting and two iterative surveys involving 10 CML specialists: five haematologists, two cardio-oncologists, one vascular surgeon, one haemato-oncology pharmacist and one specialist nurse practitioner. RESULTS The panel recommended that patients commencing second-/third-generation TKIs undergo formal CV risk assessment at baseline, with additional investigations and involvement of cardiologists/vascular surgeons for those with high CV risk. During treatment, patients should undergo CV monitoring, with the nature and frequency of testing dependent on TKI and baseline CV risk. For patients who develop CV adverse events, decision-making around TKI interruption, cessation or change should be multidisciplinary and balance CV and haematological risk. CONCLUSION The panel anticipates these recommendations will support healthcare professionals in implementing CV risk screening and monitoring, broadly and consistently, and thereby help optimise TKI treatment for CML.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Susan Tan
- Envision Pharma Group, Sydney, Australia
| | - Richard E Clark
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
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Gonzalez MA, Olivas IM, Bencomo‐Alvarez AE, Rubio AJ, Barreto‐Vargas C, Lopez JL, Dang SK, Solecki JP, McCall E, Astudillo G, Velazquez VV, Schenkel K, Reffell K, Perkins M, Nguyen N, Apaflo JN, Alvidrez E, Young JE, Lara JJ, Yan D, Senina A, Ahmann J, Varley KE, Mason CC, Eide CA, Druker BJ, Nurunnabi M, Padilla O, Bajpeyi S, Eiring AM. Loss of G0/G1 switch gene 2 (G0S2) promotes disease progression and drug resistance in chronic myeloid leukaemia (CML) by disrupting glycerophospholipid metabolism. Clin Transl Med 2022; 12:e1146. [PMID: 36536477 PMCID: PMC9763536 DOI: 10.1002/ctm2.1146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Tyrosine kinase inhibitors (TKIs) targeting BCR::ABL1 have turned chronic myeloid leukaemia (CML) from a fatal disease into a manageable condition for most patients. Despite improved survival, targeting drug-resistant leukaemia stem cells (LSCs) remains a challenge for curative CML therapy. Aberrant lipid metabolism can have a large impact on membrane dynamics, cell survival and therapeutic responses in cancer. While ceramide and sphingolipid levels were previously correlated with TKI response in CML, the role of lipid metabolism in TKI resistance is not well understood. We have identified downregulation of a critical regulator of lipid metabolism, G0/G1 switch gene 2 (G0S2), in multiple scenarios of TKI resistance, including (1) BCR::ABL1 kinase-independent TKI resistance, (2) progression of CML from the chronic to the blast phase of the disease, and (3) in CML versus normal myeloid progenitors. Accordingly, CML patients with low G0S2 expression levels had a worse overall survival. G0S2 downregulation in CML was not a result of promoter hypermethylation or BCR::ABL1 kinase activity, but was rather due to transcriptional repression by MYC. Using CML cell lines, patient samples and G0s2 knockout (G0s2-/- ) mice, we demonstrate a tumour suppressor role for G0S2 in CML and TKI resistance. Our data suggest that reduced G0S2 protein expression in CML disrupts glycerophospholipid metabolism, correlating with a block of differentiation that renders CML cells resistant to therapy. Altogether, our data unravel a new role for G0S2 in regulating myeloid differentiation and TKI response in CML, and suggest that restoring G0S2 may have clinical utility.
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Affiliation(s)
- Mayra A. Gonzalez
- Department of Molecular and Translational MedicineCenter of Emphasis in CancerTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Idaly M. Olivas
- Department of Molecular and Translational MedicineCenter of Emphasis in CancerTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
- L. Frederick Francis Graduate School of Biomedical SciencesTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Alfonso E. Bencomo‐Alvarez
- Department of Molecular and Translational MedicineCenter of Emphasis in CancerTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Andres J. Rubio
- Department of Molecular and Translational MedicineCenter of Emphasis in CancerTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | | | - Jose L. Lopez
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Sara K. Dang
- L. Frederick Francis Graduate School of Biomedical SciencesTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Jonathan P. Solecki
- L. Frederick Francis Graduate School of Biomedical SciencesTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Emily McCall
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Gonzalo Astudillo
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Vanessa V. Velazquez
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Katherine Schenkel
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Kelaiah Reffell
- L. Frederick Francis Graduate School of Biomedical SciencesTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Mariah Perkins
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Nhu Nguyen
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Jehu N. Apaflo
- Metabolic, Nutrition and Exercise Research (MiNER) Laboratory, Department of KinesiologyUniversity of Texas at El PasoEl PasoTexasUSA
| | - Efren Alvidrez
- Department of Pharmaceutical SciencesSchool of PharmacyUniversity of Texas at El PasoEl PasoTexasUSA
| | - James E. Young
- L. Frederick Francis Graduate School of Biomedical SciencesTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Joshua J. Lara
- L. Frederick Francis Graduate School of Biomedical SciencesTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Dongqing Yan
- Huntsman Cancer InstituteThe University of UtahSalt Lake CityUtahUSA
| | - Anna Senina
- Huntsman Cancer InstituteThe University of UtahSalt Lake CityUtahUSA
| | - Jonathan Ahmann
- Huntsman Cancer InstituteThe University of UtahSalt Lake CityUtahUSA
| | | | - Clinton C. Mason
- Huntsman Cancer InstituteThe University of UtahSalt Lake CityUtahUSA
| | - Christopher A. Eide
- Knight Cancer InstituteDivision of Hematology/Medical OncologyOregon Health & Science UniversityPortlandOregonUSA
| | - Brian J. Druker
- Knight Cancer InstituteDivision of Hematology/Medical OncologyOregon Health & Science UniversityPortlandOregonUSA
| | - Md Nurunnabi
- Department of Pharmaceutical SciencesSchool of PharmacyUniversity of Texas at El PasoEl PasoTexasUSA
| | - Osvaldo Padilla
- Department of PathologyTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Sudip Bajpeyi
- Metabolic, Nutrition and Exercise Research (MiNER) Laboratory, Department of KinesiologyUniversity of Texas at El PasoEl PasoTexasUSA
| | - Anna M. Eiring
- Department of Molecular and Translational MedicineCenter of Emphasis in CancerTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
- L. Frederick Francis Graduate School of Biomedical SciencesTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El PasoEl PasoTexasUSA
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Lopina N, Dmytrenko I, Hamov D, Lopin D, Dyagil I. A New Paradigm of Cardio-Hematological Monitoring in Chronic Myeloid Leukemia Patients Treated With Tyrosine Kinase Inhibitors. Cureus 2022; 14:e25766. [PMID: 35812557 PMCID: PMC9270100 DOI: 10.7759/cureus.25766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/30/2022] Open
Abstract
Significant progress has been achieved in treating patients with onco-hematological diseases, including chronic myeloid leukemia (CML). This is primarily associated with the development of targeted therapy involving tyrosine kinase inhibitors (TKIs), such as imatinib, nilotinib, bosutinib, dasatinib, and ponatinib. Along with the increased survival of patients with CML, special attention has recently been paid to cardiovascular complications in CML patients due to the prevalence of cardiovascular diseases in the general population and the toxicity profile of targeted drugs. This article presents the strategy for reducing cardiovascular risk in CML patients treated with TKIs. We discuss the components of cardiovascular risk in CML patients and the findings of current studies. Current data confirm the increased cardiovascular risk in the CML population compared to the general population, which necessitates the widespread introduction of cardiovascular prevention strategies in CML patients. The pharmacokinetics and pharmacodynamics of TKIs on the cardiovascular system are discussed. We propose two main approaches in the strategy of cardiovascular risk prevention in patients with CML, namely, before the start of TKI administration and during TKI treatment. This article presents the diagnostic assessment before prescribing TKIs, as well as while monitoring TKI therapy, and discusses the features of the choice of TKIs depending on patients’ general and cardiovascular comorbidity. Emphasis is placed on the risk stratification in patients with CML following general population algorithms, lifestyle modifications, and statin therapy for achieving the target levels of cardiovascular indicators. We also discuss unsolved questions in the current clinical guidelines and ways to further develop a cardiovascular risk-reducing strategy for CML patients.
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Akotiah A, Walker D, Boddie S, Campbell RB. Drug Targeting and Therapeutic Management of Chronic Myeloid Leukemia: Conventional and Nanotherapeutic Drug Options. Anticancer Agents Med Chem 2022; 22:2933-2941. [PMID: 35473533 DOI: 10.2174/1871520622666220426104631] [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: 11/04/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/22/2022]
Abstract
Chronic myeloid leukemia (CML) is a blood cancer predominantly affecting older adult patients. According to the American Cancer Society, an estimated 8,860 people will be diagnosed with CML in 2022. Treatments for CML have evolved with a focus on CML phase severity or progression. Overall, there have been some breakthrough treatment options for a high percentage of patients with CML. This is largely due to the discovery of tyrosine kinase inhibitors (TKI); however, drug resistance continues to present a significant challenge for the management of CML disease. The use of interferon (IFN), antimetabolites, and bone marrow transplants provide alternative treatment options, but also present with limitations including severe side effects, toxicity, and graft versus host disease. Nanomedicine has demonstrated benefits in terms of efficacy, often reducing or eliminating unwanted toxicities associated with the use of conventional drug agents. This review summarizes rational molecular targets of CML drugs and provides highlights of current FDA-approved agents for the treatment of CML. Additionally, this communication includes an overview of the limitations of conventional treatments and how nanomedicine has addressed challenges encountered during CML treatment. .
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Affiliation(s)
- Akrofi Akotiah
- MCPHS University Department of Pharmaceutical Sciences 19 Foster Street Worcester, MA 01608, USA
| | - Dominique Walker
- MCPHS University Department of Pharmaceutical Sciences 19 Foster Street Worcester, MA 01608, USA
| | - Sarah Boddie
- MCPHS University Department of Pharmaceutical Sciences 19 Foster Street Worcester, MA 01608, USA
| | - Robert B Campbell
- MCPHS University Department of Pharmaceutical Sciences 19 Foster Street Worcester, MA 01608, USA
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