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Kuang Z, Kong M, Yan N, Ma X, Wu M, Li J. Precision Cardio-oncology: Update on Omics-Based Diagnostic Methods. Curr Treat Options Oncol 2024; 25:679-701. [PMID: 38676836 PMCID: PMC11082000 DOI: 10.1007/s11864-024-01203-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/29/2024]
Abstract
OPINION STATEMENT Cardio-oncology is an emerging interdisciplinary field dedicated to the early detection and treatment of adverse cardiovascular events associated with anticancer treatment, and current clinical management of anticancer-treatment-related cardiovascular toxicity (CTR-CVT) remains limited by a lack of detailed phenotypic data. However, the promise of diagnosing CTR-CVT using deep phenotyping has emerged with the development of precision medicine, particularly the use of omics-based methodologies to discover sensitive biomarkers of the disease. In the future, combining information produced by a variety of omics methodologies could expand the clinical practice of cardio-oncology. In this review, we demonstrate how omics approaches can improve our comprehension of CTR-CVT deep phenotyping, discuss the positive and negative aspects of available omics approaches for CTR-CVT diagnosis, and outline how to integrate multiple sets of omics data into individualized monitoring and treatment. This will offer a reliable technical route for lowering cardiovascular morbidity and mortality in cancer patients and survivors.
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Affiliation(s)
- Ziyu Kuang
- Oncology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Miao Kong
- Oncology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ningzhe Yan
- Oncology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Xinyi Ma
- Oncology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Min Wu
- Cardiovascular Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Jie Li
- Oncology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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2
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Lee DH, Chandrasekhar S, Jain MD, Mhaskar R, Reid K, Lee SB, Corallo S, Hidalgo-Vargas MJ, Kumar A, Chavez J, Shah B, Lazaryan A, Khimani F, Nishihori T, Bachmeier C, Faramand R, Fradley MG, Jeong D, Oliveira GH, Locke FL, Davila ML, Alomar M. Cardiac and inflammatory biomarker differences in adverse cardiac events after chimeric antigen receptor T-Cell therapy: an exploratory study. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:18. [PMID: 37005652 PMCID: PMC10067156 DOI: 10.1186/s40959-023-00170-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Chimeric antigen receptor T- Cell (CAR-T) immunotherapy has been a breakthrough treatment for various hematological malignancies. However, cardiotoxicities such as new-onset heart failure, arrhythmia, acute coronary syndrome and cardiovascular death occur in 10-15% of patients treated with CAR-T. This study aims to investigate the changes in cardiac and inflammatory biomarkers in CAR-T therapy to determine the role of pro-inflammatory cytokines. METHODS In this observational study, ninety consecutive patients treated with CAR-T underwent baseline cardiac investigation with electrocardiogram (ECG), transthoracic echocardiogram (TTE), troponin-I, and B-type natriuretic peptide (BNP). Follow-up ECG, troponin-I and BNP were obtained five days post- CAR-T. In a subset of patients (N = 53), serum inflammatory cytokines interleukin (IL)-2, IL-6, IL-15, interferon (IFN)-γ, tumor necrosis factor (TNF)-α, granulocyte-macrophage colony-stimulating factor (GM-CSF), and angiopoietin 1 & 2 were tested serially, including baseline and daily during hospitalization. Adverse cardiac events were defined as new-onset cardiomyopathy/heart failure, acute coronary syndrome, arrhythmia and cardiovascular death. RESULTS Eleven patients (12%) had adverse cardiac events (one with new-onset cardiomyopathy and ten with new-onset atrial fibrillation). Adverse cardiac events appear to have occurred among patients with advanced age (77 vs. 66 years; p = 0.002), higher baseline creatinine (0.9 vs. 0.7 mg/dL; 0.007) and higher left atrial volume index (23.9 vs. 16.9mL/m2; p = 0.042). Day 5 BNP levels (125 vs. 63pg/mL; p = 0.019), but not troponin-I, were higher in patients with adverse cardiac events, compared to those without. The maximum levels of IL-6 (3855.0 vs. 254.0 pg/mL; p = 0.021), IFN-γ (474.0 vs. 48.8pg/mL; p = 0.006) and IL-15 (70.2 vs. 39.2pg/mL; p = 0.026) were also higher in the adverse cardiac events group. However, cardiac and inflammatory biomarker levels were not associated with cardiac events. Patients who developed cardiac events did not exhibit worse survival compared to patients without cardiac events (Log-rank p = 0.200). CONCLUSION Adverse cardiac events, predominantly atrial fibrillation, occur commonly after CAR-T (12%). The changes in serial inflammatory cytokine after CAR-T in the setting of adverse cardiac events suggests pro-inflammation as a pathophysiology and require further investigation for their role in adverse cardiac events. TWEET BRIEF HANDLE CAR-T related Cardiotoxicity has elevated cardiac and inflammatory biomarkers. #CARTCell #CardioOnc #CardioImmunology.
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Affiliation(s)
- Dae Hyun Lee
- Division of Cardiovascular Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Sanjay Chandrasekhar
- Division of Cardiovascular Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Michael D Jain
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Kayla Reid
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Sae Bom Lee
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Salvatore Corallo
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Melanie J Hidalgo-Vargas
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Abhishek Kumar
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Julio Chavez
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Bijal Shah
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Aleksandr Lazaryan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Farhad Khimani
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Christina Bachmeier
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Rawan Faramand
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Michael G Fradley
- Cardio-Oncology Center of Excellence, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Daniel Jeong
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Guilherme H Oliveira
- Division of Cardiovascular Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Frederick L Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Marco L Davila
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Mohammed Alomar
- Division of Cardiovascular Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Drive, CSB 3130, Tampa, Florida, 33612, USA.
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Podyacheva E, Shmakova T, Kushnareva E, Onopchenko A, Martynov M, Andreeva D, Toropov R, Cheburkin Y, Levchuk K, Goldaeva A, Toropova Y. Modeling Doxorubicin-Induced Cardiomyopathy With Fibrotic Myocardial Damage in Wistar Rats. Cardiol Res 2022; 13:339-356. [PMID: 36660062 PMCID: PMC9822674 DOI: 10.14740/cr1416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/26/2022] [Indexed: 12/23/2022] Open
Abstract
Background Cardiovascular complications, arising after anthracycline chemotherapy, cause a significant deterioration in the life quality and expectancy of those patients who were previously successfully treated for malignant neoplasms. A number of clinical studies have demonstrated that patients with cardiotoxicity manifested during anthracyclines therapy also have extensive fibrotic changes in the cardiac muscle in the long term. Given the lack of an unambiguous understanding of the mechanisms of fibrotic changes formation under doxorubicin treatment in the myocardium, there is the obvious necessity to create a relevant experimental model of chronic doxorubicin-induced cardiomyopathy with fibrotic myocardial lesions and delayed development of diastolic dysfunction. Methods The study was divided into two stages: first stage (creation of acute doxorubicin cardiomyopathy) - 35 male Wistar rats; second stage (creation of chronic doxorubicin cardiomyopathy) - 40 male Wistar rats. The animals were split into eight groups (two control ones and six experimental ones), which determined the doxorubicin dose (first stage: 25, 20.4, 15 mg/kg; second stage: 5, 10, 15 mg/kg, intraperitoneally) and the frequency of injection. Echocardiographic, hematological, histological, and molecular methods were used to confirm the successful modeling of acute and chronic doxorubicin-induced cardiomyopathy with fibrotic lesions. Results A model of administration six times every other day with a cumulative dose of doxorubicin 20 mg/kg is suitable for evaluation of acute cardiotoxicity. The 15 mg/kg doxorubicin dose is highly cardiotoxic; what's more, it correlates with progressive deterioration of the clinical condition of the animals after 2 months. The optimal cumulative dose of doxorubicin leads to clinical manifestations confirmed by echocardiographic, histological, molecular changes associated with the development of chronic doxorubicin-induced cardiomyopathy with fibrotic lesions of the left ventricular of the cardiac muscle and ensure long-term survival of animals is 10 mg/kg doxorubicin. A dose of 5 mg/kg of the doxorubicin does not ensure the development of fibrous changes formation. Conclusion We assume that cumulative dose of 10 mg/kg with a frequency of administration of six times in 2 days can be used to study the mechanisms of anthracycline cardiomyopathy development.
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Affiliation(s)
- Ekaterina Podyacheva
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation,Corresponding Author: Ekaterina Podyacheva, Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation.
| | - Tatiana Shmakova
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Ekaterina Kushnareva
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Anatoliya Onopchenko
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Mikhail Martynov
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Daria Andreeva
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Roman Toropov
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Yuri Cheburkin
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Ksenia Levchuk
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Alexandra Goldaeva
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
| | - Yana Toropova
- Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, 197341, Saint-Petersburg, Russian Federation
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Werida RH, Elshafiey RA, Ghoneim A, Elzawawy S, Mostafa TM. Role of alpha-lipoic acid in counteracting paclitaxel- and doxorubicin-induced toxicities: a randomized controlled trial in breast cancer patients. Support Care Cancer 2022; 30:7281-7292. [PMID: 35596774 PMCID: PMC9385783 DOI: 10.1007/s00520-022-07124-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/05/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Paclitaxel and doxorubicin are associated with neurotoxicity and cardiotoxicity respectively. This study aimed at investigating the role of alpha-lipoic acid (ALA) in counteracting paclitaxel-induced neuropathy and doxorubicin-associated cardiotoxicity in women with breast cancer. PATIENTS AND METHODS This randomized double-blind placebo-controlled prospective study included 64 patients with breast cancer who were randomized into control group (n = 32) which received 4 cycles of doxorubicin plus cyclophosphamide (every 21 days) followed by weekly doses of paclitaxel for 12 weeks plus placebo tablets once daily and ALA group (n = 32) which received the same chemotherapeutic regimen plus ALA 600 once daily for 6 months. Patients were assessed by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE version 4.0) for grading of neuropathy and by 12-item neurotoxicity questionnaire (Ntx-12). The assessment included also echocardiography and evaluation of serum levels of brain natriuretic peptide (BNP), tumor necrosis factor-alpha (TNF-α), malondialdehyde (MDA), and neurotensin (NT). Data were analyzed by paired and unpaired t-test, Mann-Whitney U test, and chi-square test. RESULTS As compared to placebo, ALA provoked significant improvement in NCI-CTCAE neuropathy grading and Ntx-12 score after the end of 9th and 12th weeks of paclitaxel intake (p = 0.039, p = 0.039, p = 0.03, p = 0.004, respectively). At the end of the chemotherapy cycles, ALA resulted in significant decline in serum levels of BNP, TNF-α, MDA, and neurotensin (p < 0.05) as compared to baseline data and placebo. CONCLUSION Alpha-lipoic acid may represent a promising adjuvant therapy to attenuate paclitaxel-associated neuropathy and doxorubicin-induced cardiotoxicity in women with breast cancer. TRIAL REGISTRATION ClinicalTrials.gov: NCT03908528.
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Affiliation(s)
- Rehab H Werida
- Clinical Pharmacy & Pharmacy Practice Department, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt.
| | - Reham A Elshafiey
- Clinical Pharmacy & Pharmacy Practice Department, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
| | - Asser Ghoneim
- Pharmacology & Toxicology Department, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
| | - Sherif Elzawawy
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tarek M Mostafa
- Clinical Pharmacy Department, Faculty of Pharmacy, Tanta University, Tanta, Egypt
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5
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Cardiovascular toxicity of breast cancer treatment: an update. Cancer Chemother Pharmacol 2021; 88:15-24. [PMID: 33864486 DOI: 10.1007/s00280-021-04254-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/28/2021] [Indexed: 10/21/2022]
Abstract
Novel chemotherapeutic agents have marked a new era in oncology during the past decade, prolonging significantly the overall survival of breast cancer patients. Nevertheless, contemporary antineoplastic treatments can frequently cause adverse cardiovascular side effects. Common manifestations of chemotherapy-induced cardiotoxicity include cardiomyopathy, ischemia, conduction disturbances, hypertension and thromboembolic events, while the type of the treatment regimen administered crucially determines clinical outcome. The aim of this literature review is to analyze the incidence and the underlying mechanisms of cardiovascular toxicity caused by agents approved for breast cancer, as well as to describe ways of monitoring and treating the cardiotoxic effects in breast cancer patients. Moreover, our work intends to provide an easy-to-grasp synopsis of recent and clinically meaningful advances in the field.
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6
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Antyufeeva ON, Budanova DA, Ilgisonis IS, Gadaev IY, Bochkarnikova OV, Sokolova IY, Belenkov YN, Ershov VI. [Assessment of the Dynamics of Oxidative Stress Indicators and Early Markers of Myocardial Damage and Dysfunction in Patients with Aggressive Lymphoproliferative Diseases During of Anticancer Therapy]. KARDIOLOGIYA 2021; 60:76-82. [PMID: 33522470 DOI: 10.18087/cardio.2020.12.n1394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022]
Abstract
Aim To evaluate the dynamics of indexes of oxidative stress and markers of myocardial injury and dysfunction in patients with aggressive type lymphomas during the antitumor therapy.Material and methods This study included 75 patients with lymphoproliferative diseases of aggressive type. The main group consisted of 53 patients who received one course of antitumor therapy during the study. The comparison group consisted of 22 patients who have not received any specific treatment so far. Troponin I (TnI), high-sensitivity troponin (hsTnI), heart-type fatty acid binding protein (Н-FAВР), N-terminal pro-brain natriuretic peptide (NT-prоBNP), superoxide dismutase (SOD), and myeloperoxidase (MPO) were measured in patients of both groups at baseline, and in the main group, they were measured at 4 hours after administration of antitumor agents and on completion of the course. Functional status of the cardiovascular system was evaluated by electrocardiography in all patients at baseline and after the course of antitumor treatment and by echocardiography.Results The chemotherapy was associated with increased levels of NT-prоBNP, SOD, and MPO (30.670±15.367 vs. 52.309±25.718 pmo l/l; 1.61±0.135 vs. 1.74±0.193 U/ml; and 507.54±91.51 vs. 742.3±49.01 ng/ml, respectively). The study results indicated activation of oxidative stress on the background of the administered antitumor therapy, progressive myocardial dysfunction, and increased frequency of arrhythmic episodes.Conclusion The study results allowed identifying NT-prоBNP, MPO, and SOD as important indexes for determining a patient group at high risk of cardiotoxicity during the antitumor treatment.
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Affiliation(s)
- O N Antyufeeva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow
| | - D A Budanova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - I S Ilgisonis
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - I Yu Gadaev
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - O V Bochkarnikova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - I Ya Sokolova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yu N Belenkov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - V I Ershov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Gonciar D, Mocan L, Zlibut A, Mocan T, Agoston-Coldea L. Cardiotoxicity in HER2-positive breast cancer patients. Heart Fail Rev 2021; 26:919-935. [PMID: 33405000 DOI: 10.1007/s10741-020-10072-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 01/22/2023]
Abstract
Due to the recent advances in diagnosis and management of patients with HER2-positive breast cancer, especially through novel HER2-targeted agents, cardiotoxicity becomes an emerging problem. Although chemotherapy significantly increases survival, the risk of cardiovascular disease development is high and still underestimated and could imply treatment discontinuation. Frequently, due to lack of rigorous diagnosis strategies, cardiotoxicity assessment is delayed, and, moreover, the efficacy of current therapy options in restoring heart function is questionable. For a comprehensive risk assessment, it is vital to characterize the clinical spectrum of HER2-targeted agents and anthracyclines, as well as their pathogenic pathways involved in cardiotoxicity. Advanced cardiovascular multimodal imaging and circulating biomarkers plays primary roles in early assessing cardiotoxicity and also in guiding specific preventive measures. Even though the knowledge in this field is rapidly expanding, there are still questions that arise regarding the optimal approach in terms of timing and methods. The aim of the current review aims to providean overview of currently available data.
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Affiliation(s)
- Diana Gonciar
- 2nd Department of Internal Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lucian Mocan
- 3rd Surgery Department, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Nanomedicine, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Alexandru Zlibut
- 2nd Department of Internal Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Teodora Mocan
- Physiology Department, Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Nanomedicine, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Lucia Agoston-Coldea
- 2nd Department of Internal Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
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8
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Zhang H, Gan Y, Yang S, Sheng K, Wang P. Low limit of detection of the AlGaN/GaN-based sensor by the Kelvin connection detection technique. MICROSYSTEMS & NANOENGINEERING 2021; 7:51. [PMID: 34567764 PMCID: PMC8433396 DOI: 10.1038/s41378-021-00278-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/16/2021] [Accepted: 04/26/2021] [Indexed: 05/02/2023]
Abstract
The AlGaN/GaN-based sensor is a promising POCT (point-of-care-testing) device featuring miniaturization, low cost, and high sensitivity. BNP is an effective protein biomarker for the early diagnosis of HF (heart failure). In this work, a novel AlGaN/GaN device with the Kelvin connection structure and the corresponding detection technique was proposed. This technique can effectively suppress the background noise and improve the SNR (signal-to-noise ratio). A BNP detection experiment was carried out to verify the effectiveness of this technique. It is shown that compared with that of the traditional detection method, the LOD (limit of detection) was improved from 0.47 ng/mL to 1.29 pg/mL. The BNP detection experiment was also carried out with a traditional electrochemical Au-electrode sensor with the same surface functionalization steps. The AlGaN/GaN sensor showed a better LOD than the Au-electrode sensor. Moreover, the influence of AlGaN/GaN sensor package on background noise was investigated with the mechanism of the noise source revealed. Finally, based on the optimized package, the optimal SNR quiescent operating point of the AlGaN/GaN sensor was determined. By biasing the sensor at the optimal quiescent operating point and immobilizing the magnetic beads with anti-BNP on the gate of the AlGaN/GaN sensor, the LOD for BNP detection was further improved to 0.097 pg/mL.
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Affiliation(s)
- Hanyuan Zhang
- College of Electrical Engineering, Zhejiang University, 310027 Hangzhou, China
| | - Ying Gan
- Biosensor National Special Laboratory, Department of Biomedical Engineering, Zhejiang University, 310027 Hangzhou, China
| | - Shu Yang
- College of Electrical Engineering, Zhejiang University, 310027 Hangzhou, China
- Hangzhou Global Scientific and Technological Innovation Center, Zhejiang University, 310027 Hangzhou, China
| | - Kuang Sheng
- College of Electrical Engineering, Zhejiang University, 310027 Hangzhou, China
- Hangzhou Global Scientific and Technological Innovation Center, Zhejiang University, 310027 Hangzhou, China
| | - Ping Wang
- Biosensor National Special Laboratory, Department of Biomedical Engineering, Zhejiang University, 310027 Hangzhou, China
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Haider A, Bengs S, Schade K, Wijnen WJ, Portmann A, Etter D, Fröhlich S, Warnock GI, Treyer V, Burger IA, Fiechter M, Kudura K, Fuchs TA, Pazhenkottil AP, Buechel RR, Kaufmann PA, Meisel A, Stolzmann P, Gebhard C. Myocardial 18F-FDG Uptake Pattern for Cardiovascular Risk Stratification in Patients Undergoing Oncologic PET/CT. J Clin Med 2020; 9:jcm9072279. [PMID: 32709049 PMCID: PMC7408629 DOI: 10.3390/jcm9072279] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 12/03/2022] Open
Abstract
Objective: Positron emission tomography/computed tomography with 18F-fluorodeoxy-glucose (18F-FDG-PET/CT) has become the standard staging modality in various tumor entities. Cancer patients frequently receive cardio-toxic therapies. However, routine cardiovascular assessment in oncologic patients is not performed in current clinical practice. Accordingly, this study sought to assess whether myocardial 18F-FDG uptake patterns of patients undergoing oncologic PET/CT can be used for cardiovascular risk stratification. Methods: Myocardial 18F-FDG uptake pattern was assessed in 302 patients undergoing both oncologic whole-body 18F-FDG-PET/CT and myocardial perfusion imaging by single-photon emission computed tomography (SPECT-MPI) within a six-month period. Primary outcomes were myocardial 18F-FDG uptake pattern, impaired myocardial perfusion, ongoing ischemia, myocardial scar, and left ventricular ejection fraction. Results: Among all patients, 109 (36.1%) displayed no myocardial 18F-FDG uptake, 77 (25.5%) showed diffuse myocardial 18F-FDG uptake, 24 (7.9%) showed focal 18F-FDG uptake, and 92 (30.5%) had a focal on diffuse myocardial 18F-FDG uptake pattern. In contrast to the other uptake patterns, focal myocardial 18F-FDG uptake was predominantly observed in patients with myocardial abnormalities (i.e., abnormal perfusion, impaired LVEF, myocardial ischemia, or scar). Accordingly, a multivariate logistic regression identified focal myocardial 18F-FDG uptake as a strong predictor of abnormal myocardial function/perfusion (odds ratio (OR) 5.32, 95% confidence interval (CI) 1.73–16.34, p = 0.003). Similarly, focal myocardial 18F-FDG uptake was an independent predictor of ongoing ischemia and myocardial scar (OR 4.17, 95% CI 1.53–11.4, p = 0.005 and OR 3.78, 95% CI 1.47–9.69, p = 0.006, respectively). Conclusions: Focal myocardial 18F-FDG uptake seen on oncologic PET/CT indicates a significantly increased risk for multiple myocardial abnormalities. Obtaining and taking this information into account will help to stratify patients according to risk and will reduce unnecessary cardiovascular complications in cancer patients.
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Affiliation(s)
- Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
- Center for Molecular Cardiology, University of Zurich, 8952 Schlieren, Switzerland
- Correspondence:
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
- Center for Molecular Cardiology, University of Zurich, 8952 Schlieren, Switzerland
| | - Katharina Schade
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
- Center for Molecular Cardiology, University of Zurich, 8952 Schlieren, Switzerland
| | - Winandus J. Wijnen
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
- Center for Molecular Cardiology, University of Zurich, 8952 Schlieren, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
- Center for Molecular Cardiology, University of Zurich, 8952 Schlieren, Switzerland
| | - Dominik Etter
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
- Center for Molecular Cardiology, University of Zurich, 8952 Schlieren, Switzerland
| | - Sandro Fröhlich
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
- Center for Molecular Cardiology, University of Zurich, 8952 Schlieren, Switzerland
| | - Geoffrey I. Warnock
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
- Center for Molecular Cardiology, University of Zurich, 8952 Schlieren, Switzerland
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
| | - Irene A. Burger
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
| | - Michael Fiechter
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
- Center for Molecular Cardiology, University of Zurich, 8952 Schlieren, Switzerland
- Swiss Paraplegic Center, 6207 Nottwil, Switzerland
| | - Ken Kudura
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
| | - Tobias A. Fuchs
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
| | - Aju P. Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
| | - Ronny R. Buechel
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
| | - Philipp A. Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
| | - Alexander Meisel
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
- Center for Molecular Cardiology, University of Zurich, 8952 Schlieren, Switzerland
| | - Paul Stolzmann
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland; (S.B.); (K.S.); (W.J.W.); (A.P.); (D.E.); (S.F.); (G.I.W.); (V.T.); (I.A.B.); (M.F.); (K.K.); (T.A.F.); (A.P.P.); (R.R.B.); (P.A.K.); (A.M.); (P.S.); (C.G.)
- Center for Molecular Cardiology, University of Zurich, 8952 Schlieren, Switzerland
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria
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