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Koltai T. Targeting the pH Paradigm at the Bedside: A Practical Approach. Int J Mol Sci 2020; 21:E9221. [PMID: 33287221 PMCID: PMC7730959 DOI: 10.3390/ijms21239221] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 02/07/2023] Open
Abstract
The inversion of the pH gradient in malignant tumors, known as the pH paradigm, is increasingly becoming accepted by the scientific community as a hallmark of cancer. Accumulated evidence shows that this is not simply a metabolic consequence of a dysregulated behavior, but rather an essential process in the physiopathology of accelerated proliferation and invasion. From the over-simplification of increased lactate production as the cause of the paradigm, as initially proposed, basic science researchers have arrived at highly complex and far-reaching knowledge, that substantially modified that initial belief. These new developments show that the paradigm entails a different regulation of membrane transporters, electrolyte exchangers, cellular and membrane enzymes, water trafficking, specialized membrane structures, transcription factors, and metabolic changes that go far beyond fermentative glycolysis. This complex world of dysregulations is still shuttered behind the walls of experimental laboratories and has not yet reached bedside medicine. However, there are many known pharmaceuticals and nutraceuticals that are capable of targeting the pH paradigm. Most of these products are well known, have low toxicity, and are also inexpensive. They need to be repurposed, and this would entail shorter clinical studies and enormous cost savings if we compare them with the time and expense required for the development of a new molecule. Will targeting the pH paradigm solve the "cancer problem"? Absolutely not. However, reversing the pH inversion would strongly enhance standard treatments, rendering them more efficient, and in some cases permitting lower doses of toxic drugs. This article's goal is to describe how to reverse the pH gradient inversion with existing drugs and nutraceuticals that can easily be used in bedside medicine, without adding toxicity to established treatments. It also aims at increasing awareness among practicing physicians that targeting the pH paradigm would be able to improve the results of standard therapies. Some clinical cases will be presented as well, showing how the pH gradient inversion can be treated at the bedside in a simple manner with repurposed drugs.
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Affiliation(s)
- Tomas Koltai
- Centro de Diagnostico y Tratamiento de la Obra Social del Personal de la Alimentacion, Talar de Pacheco, Buenos Aires 1617, Argentina
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2
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Karjalainen SL, Haapasalo HK, Aspatwar A, Barker H, Parkkila S, Haapasalo JA. Carbonic anhydrase related protein expression in astrocytomas and oligodendroglial tumors. BMC Cancer 2018; 18:584. [PMID: 29792187 PMCID: PMC5966923 DOI: 10.1186/s12885-018-4493-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 05/09/2018] [Indexed: 01/18/2023] Open
Abstract
Background Carbonic anhydrase related proteins (CARPs) VIII, X and XI functionally differ from the other carbonic anhydrase (CA) enzymes. Structurally, they lack the zinc binding residues, which are important for enzyme activity of classical CAs. The distribution pattern of the CARPs in fetal brain implies their role in brain development. In the adult brain, CARPs are mainly expressed in the neuron bodies but only weaker reactivity has been found in the astrocytes and oligodendrocytes. Altered expression patterns of CARPs VIII and XI have been linked to cancers outside the central nervous system. There are no reports on CARPs in human astrocytomas or oligodendroglial tumors. We wanted to assess the expression of CARPs VIII and XI in these tumors and study their association to different clinicopathological features and tumor-associated CAs II, IX and XII. Methods The tumor material for this study was obtained from surgical patients treated at the Tampere University Hospital in 1983–2009. CARP VIII staining was analyzed in 391 grade I-IV gliomas and CARP XI in 405 gliomas. Results CARP VIII immunopositivity was observed in 13% of the astrocytomas and in 9% of the oligodendrogliomas. Positive CARP XI immunostaining was observed in 7% of the astrocytic and in 1% of the oligodendroglial tumor specimens. In our study, the most benign tumors, pilocytic astrocytomas, did not express CARPs at all. In WHO grade II-IV astrocytomas, CARPs were associated with molecular events related to more benign behavior, which was the case with CARP VIII in oligodendrogliomas and oligoastrocytomas as well. Conclusions The study observations suggest that the CARPs play a role in tumorigenesis of diffusively infiltrating gliomas. Furthermore, the molecular mechanisms beneath the cancer promoting qualities of CARPs have not yet been discovered. Thus, more studies concerning role of CARPs in oncogenesis are needed. Electronic supplementary material The online version of this article (10.1186/s12885-018-4493-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sini L Karjalainen
- Faculty of Medicine and Life Sciences University of Tampere, Arvo Ylpön katu 34, 33014, Tampere, Finland.
| | - Hannu K Haapasalo
- Fimlab Laboratories, Department of Pathology, Tampere University Hospital, Biokatu 4, PL 2000, 33521, Tampere, Finland
| | - Ashok Aspatwar
- Faculty of Medicine and Life Sciences University of Tampere, Arvo Ylpön katu 34, 33014, Tampere, Finland.,Fimlab Laboratories, Department of Pathology, Tampere University Hospital, Biokatu 4, PL 2000, 33521, Tampere, Finland
| | - Harlan Barker
- Faculty of Medicine and Life Sciences University of Tampere, Arvo Ylpön katu 34, 33014, Tampere, Finland
| | - Seppo Parkkila
- Faculty of Medicine and Life Sciences University of Tampere, Arvo Ylpön katu 34, 33014, Tampere, Finland.,Fimlab Laboratories, Department of Pathology, Tampere University Hospital, Biokatu 4, PL 2000, 33521, Tampere, Finland
| | - Joonas A Haapasalo
- Faculty of Medicine and Life Sciences University of Tampere, Arvo Ylpön katu 34, 33014, Tampere, Finland.,Fimlab Laboratories, Department of Pathology, Tampere University Hospital, Biokatu 4, PL 2000, 33521, Tampere, Finland.,Unit of Neurosurgery, Tampere University Hospital, Teiskontie 35, 33521, Tampere, Finland
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Mboge MY, Mahon BP, McKenna R, Frost SC. Carbonic Anhydrases: Role in pH Control and Cancer. Metabolites 2018; 8:E19. [PMID: 29495652 PMCID: PMC5876008 DOI: 10.3390/metabo8010019] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/08/2018] [Accepted: 02/22/2018] [Indexed: 02/07/2023] Open
Abstract
The pH of the tumor microenvironment drives the metastatic phenotype and chemotherapeutic resistance of tumors. Understanding the mechanisms underlying this pH-dependent phenomenon will lead to improved drug delivery and allow the identification of new therapeutic targets. This includes an understanding of the role pH plays in primary tumor cells, and the regulatory factors that permit cancer cells to thrive. Over the last decade, carbonic anhydrases (CAs) have been shown to be important mediators of tumor cell pH by modulating the bicarbonate and proton concentrations for cell survival and proliferation. This has prompted an effort to inhibit specific CA isoforms, as an anti-cancer therapeutic strategy. Of the 12 active CA isoforms, two, CA IX and XII, have been considered anti-cancer targets. However, other CA isoforms also show similar activity and tissue distribution in cancers and have not been considered as therapeutic targets for cancer treatment. In this review, we consider all the CA isoforms and their possible role in tumors and their potential as targets for cancer therapy.
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Affiliation(s)
- Mam Y Mboge
- University of Florida, College of Medicine, Department of Biochemistry and Molecular Biology, P.O. Box 100245, Gainesville, FL 32610, USA.
| | - Brian P Mahon
- University of Florida, College of Medicine, Department of Biochemistry and Molecular Biology, P.O. Box 100245, Gainesville, FL 32610, USA.
| | - Robert McKenna
- University of Florida, College of Medicine, Department of Biochemistry and Molecular Biology, P.O. Box 100245, Gainesville, FL 32610, USA.
| | - Susan C Frost
- University of Florida, College of Medicine, Department of Biochemistry and Molecular Biology, P.O. Box 100245, Gainesville, FL 32610, USA.
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Shangkuan WC, Lin HC, Chang YT, Jian CE, Fan HC, Chen KH, Liu YF, Hsu HM, Chou HL, Yao CT, Chu CM, Su SL, Chang CW. Risk analysis of colorectal cancer incidence by gene expression analysis. PeerJ 2017; 5:e3003. [PMID: 28229027 PMCID: PMC5314952 DOI: 10.7717/peerj.3003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/19/2017] [Indexed: 01/14/2023] Open
Abstract
Background Colorectal cancer (CRC) is one of the leading cancers worldwide. Several studies have performed microarray data analyses for cancer classification and prognostic analyses. Microarray assays also enable the identification of gene signatures for molecular characterization and treatment prediction. Objective Microarray gene expression data from the online Gene Expression Omnibus (GEO) database were used to to distinguish colorectal cancer from normal colon tissue samples. Methods We collected microarray data from the GEO database to establish colorectal cancer microarray gene expression datasets for a combined analysis. Using the Prediction Analysis for Microarrays (PAM) method and the GSEA MSigDB resource, we analyzed the 14,698 genes that were identified through an examination of their expression values between normal and tumor tissues. Results Ten genes (ABCG2, AQP8, SPIB, CA7, CLDN8, SCNN1B, SLC30A10, CD177, PADI2, and TGFBI) were found to be good indicators of the candidate genes that correlate with CRC. From these selected genes, an average of six significant genes were obtained using the PAM method, with an accuracy rate of 95%. The results demonstrate the potential of utilizing a model with the PAM method for data mining. After a detailed review of the published reports, the results confirmed that the screened candidate genes are good indicators for cancer risk analysis using the PAM method. Conclusions Six genes were selected with 95% accuracy to effectively classify normal and colorectal cancer tissues. We hope that these results will provide the basis for new research projects in clinical practice that aim to rapidly assess colorectal cancer risk using microarray gene expression analysis.
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Affiliation(s)
| | - Hung-Che Lin
- National Defense Medical Center, Taipei, Taiwan; Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Tien Chang
- National Defense Medical Center, Taipei, Taiwan; Section of Biostatistics and Informatics, Department of Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chen-En Jian
- National Defense Medical Center, Taipei, Taiwan; Section of Biostatistics and Informatics, Department of Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Hueng-Chuen Fan
- Department of Pediatrics, Tungs' Taichung MetroHarbor Hospital, Wuchi, Taichung, Taiwan; Department of Medical Research, Tungs' Taichung MetroHarbor Hospital, Wuchi, Taichung, Taiwan; Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Kang-Hua Chen
- Department of Nursing, College of Medicine, Chang Gung University , Taoyuan , Taiwan
| | - Ya-Fang Liu
- Section of Biostatistics and Informatics, Department of Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan; Department of Education and Research, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Huan-Ming Hsu
- National Defense Medical Center, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan
| | - Hsiu-Ling Chou
- Department of Nursing, Far Eastern Memorial Hospital and Oriental Institute of Technology , New Taipei City , Taiwan
| | - Chung-Tay Yao
- Department of Emergency, Cathay General Hospital and School of Medicine, Fu-Jen Catholic University , Taipei , Taiwan
| | - Chi-Ming Chu
- National Defense Medical Center, Taipei, Taiwan; Section of Biostatistics and Informatics, Department of Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Sui-Lung Su
- National Defense Medical Center, Taipei, Taiwan; Section of Biostatistics and Informatics, Department of Epidemiology, School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Wen Chang
- RN, PhD, Assistant Professor, School of Nursing, College of Medicine, Chang Gung University & Assistant Research Fellow, Division of Endocrinology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital , Taiwan
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Monti DM, De Simone G, Langella E, Supuran CT, Di Fiore A, Monti SM. Insights into the role of reactive sulfhydryl groups of Carbonic Anhydrase III and VII during oxidative damage. J Enzyme Inhib Med Chem 2016; 32:5-12. [PMID: 27766895 PMCID: PMC6010095 DOI: 10.1080/14756366.2016.1225046] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Carbonic anhydrases (CAs) III and VII are two cytosolic isoforms of the α-CA family which catalyze the physiological reaction of carbon dioxide hydration to bicarbonate and proton. Despite these two enzymes share a 49% sequence identity and present a very similar three-dimensional structure, they show profound differences when comparing the specific activity for CO2 hydration reaction, with CA VII being much more active than CA III. Recently, CA III and CA VII have been proposed to play a new role as scavenger enzymes in cells where oxidative damage occurs. Here, we will examine functional and structural features of these two isoforms giving insights into their newly proposed protective role against oxidative stress.
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Affiliation(s)
- Daria M Monti
- a Department of Chemical Sciences , University of Naples Federico II , Naples , Italy
| | | | - Emma Langella
- b Institute of Biostructures and Bioimaging, CNR , Naples , Italy
| | - Claudiu T Supuran
- c Dipartimento Neurofarba, Sezione di Scienze Farmaceutiche e Nutraceutiche , Università degli Studi di Firenze , Florence , Italy
| | - Anna Di Fiore
- b Institute of Biostructures and Bioimaging, CNR , Naples , Italy
| | - Simona M Monti
- b Institute of Biostructures and Bioimaging, CNR , Naples , Italy
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Viikilä P, Kivelä AJ, Mustonen H, Koskensalo S, Waheed A, Sly WS, Pastorek J, Pastorekova S, Parkkila S, Haglund C. Carbonic anhydrase enzymes II, VII, IX and XII in colorectal carcinomas. World J Gastroenterol 2016; 22:8168-8177. [PMID: 27688658 PMCID: PMC5037085 DOI: 10.3748/wjg.v22.i36.8168] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/09/2016] [Accepted: 07/21/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate expression of four alpha-carbonic anhydrases (CAs) in colorectal carcinomas (CRC) and compare the results with patients’ survival.
METHODS Colorectal carcinoma samples from 539 CRC patients and control tissues were arranged as tissue microarrays and analyzed with antibodies against CA II, CA VII, CA IX, and CA XII. Intensity and extent of staining were both scored from 0 to 3 in each sample. These enzyme expression levels were then correlated to patients’ survival and clinicopathological parameters, which were tumor differentiation grade and stage, site of tumor, patients’ age, and gender. Kaplan-Meier analysis and Cox regression hazard ratio model were used to analyze survival data.
RESULTS CA II and CA XII staining intensities correlated with patients’ survival in that higher expression indicated poorer prognosis. In Cox regression analysis one unit increase in the CA II intensity increased the hazard ratio to 1.19 fold (CI: 1.04-1.37, P = 0.009). A significant correlation was also found when comparing CA XII staining intensity with survival of CRC patients (HR = 1.18, 95%CI: 1.01-1.38, P = 0.036). The extent of CA XII immunostaining did not correlate to the patients’ survival (P = 0.242, Kaplan-Meier analysis). A significant interaction between age group and extent of the CA II staining was found. Increased extent of CA II had a significant hazard ratio among patients 65 years and older (1.42, 95%CI: 1.16-1.73, P = 0.0006). No correlations were found between CA VII (intensity P = 0.566, extent P = 0.495, Kaplan-Meier analysis), or CA IX (intensity P = 0.879, extent P = 0.315, Kaplan-Meier analysis) immunostaining results and survival, or the other parameters.
CONCLUSION The present findings indicate that CA II and CA XII could be useful in predicting survival in CRC.
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Yang GZ, Hu L, Cai J, Chen HY, Zhang Y, Feng D, Qi CY, Zhai YX, Gong H, Fu H, Cai QP, Gao CF. Prognostic value of carbonic anhydrase VII expression in colorectal carcinoma. BMC Cancer 2015; 15:209. [PMID: 25885898 PMCID: PMC4406128 DOI: 10.1186/s12885-015-1216-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/18/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Carbonic anhydrases (CAs) have been implicated in the pathogenesis of human cancers. Carbonic anhydrase VII (CA7), a member of the CA gene family, was recently demonstrated to be expressed in several human tissues including colon. Nevertheless, the expression and clinical relevance of CA7 in colorectal carcinoma (CRC) has not been investigated. METHODS Real-time PCR, western blot, and immunohistochemistry analyses were used to determine CA7 expression in CRC clinical samples. The correlation of CA7 expression with clinicopathologic features was assessed in 228 patients from Luoyang, China (training cohort) and validated in 151 patients from Shanghai, China (validation cohort). Kaplan-Meier and Cox proportional regression analyses were used to estimate the association between CA7 expression and patients' survival. RESULTS CA7 expression was frequently downregulated in CRC tissues at both the mRNA and protein levels. Reduced expression of CA7 was significantly correlated with poor differentiation, positive lymph node metastasis, advanced TNM stage and unfavorable clinical outcome not only in the training cohort but also in the validation set. Survival analysis indicated that patients with lower CA7 expression had a significantly shorter disease-specific survival (DSS) than those with higher CA7 expression. Importantly, further stage-based analyses revealed that decreased CA7 expression significantly predicted poor DSS and was an independent adverse prognostic indicator for patients with early stage tumors in both cohorts. CONCLUSIONS Our results indicate that decreased expression of CA7 correlates with disease progression and predicts poor prognosis in CRC, especially for patients with early stage tumors.
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Affiliation(s)
- Guang-Zhen Yang
- Anal-Colorectal Surgery Institute, 150th Hospital of PLA, Luoyang, China. .,Department of Clinical Laboratory, 150th Hospital of PLA, Luoyang, China.
| | - Liang Hu
- Anal-Colorectal Surgery Institute, 150th Hospital of PLA, Luoyang, China.
| | - Jian Cai
- Department of Colorectal Surgery, 150th Hospital of PLA, Luoyang, China.
| | - Hai-Yang Chen
- Department of Oncology, 150th Hospital of PLA, Luoyang, China.
| | - Yu Zhang
- Anal-Colorectal Surgery Institute, 150th Hospital of PLA, Luoyang, China.
| | - Dan Feng
- Department of Oncology, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Chen-Ye Qi
- Anal-Colorectal Surgery Institute, 150th Hospital of PLA, Luoyang, China.
| | - Yan-Xia Zhai
- Anal-Colorectal Surgery Institute, 150th Hospital of PLA, Luoyang, China.
| | - Hui Gong
- Anal-Colorectal Surgery Institute, 150th Hospital of PLA, Luoyang, China.
| | - Hao Fu
- Anal-Colorectal Surgery Institute, 150th Hospital of PLA, Luoyang, China.
| | - Qing-Ping Cai
- Department of Gastrointestine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Chun-Fang Gao
- Anal-Colorectal Surgery Institute, 150th Hospital of PLA, Luoyang, China.
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Kivelä AJ, Knuuttila A, Räsänen J, Sihvo E, Salmenkivi K, Saarnio J, Pastorekova S, Pastorek J, Waheed A, Sly WS, Salo JA, Parkkila S. Carbonic anhydrase IX in malignant pleural mesotheliomas: A potential target for anti-cancer therapy. Bioorg Med Chem 2013; 21:1483-8. [DOI: 10.1016/j.bmc.2012.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 09/06/2012] [Accepted: 09/11/2012] [Indexed: 10/27/2022]
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Natural product coumarins that inhibit human carbonic anhydrases. Bioorg Med Chem 2013; 21:1539-43. [DOI: 10.1016/j.bmc.2012.07.021] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 07/13/2012] [Accepted: 07/13/2012] [Indexed: 11/19/2022]
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