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Ziani H, Nasri S, Kamaoui I, Skiker I. 5-Fluorouracil-induced acute leukoencephalopathy: Case report and literature review. Radiol Case Rep 2024; 19:2801-2803. [PMID: 38689804 PMCID: PMC11058063 DOI: 10.1016/j.radcr.2024.03.064] [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: 12/26/2023] [Revised: 03/18/2024] [Accepted: 03/24/2024] [Indexed: 05/02/2024] Open
Abstract
Toxic leukoencephalopathy (TL) refers to damage to the brain white matter following exposure to toxic agents. Multiple agents are incriminated in this condition, including chemotherapy drugs. 5-Fluorouracil, widely used in oncology, is responsible for neurotoxicity in less than 5% of cases. We report the case of a 54-year-old male patient who presented with neurological symptoms following 5-FU-based chemotherapy for gastric adenocarcinoma, and whose MRI scan revealed signs suggestive of toxic leukoencephalopathy. We also report on the evolution of the abnormalities described on his MRI after 1 year.
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Affiliation(s)
- Hamid Ziani
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Siham Nasri
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Imane Kamaoui
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Imane Skiker
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
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Kim KH, Park M, Park EY, Gwak HS, Kim SH, Seo JW, Hyun JW, Kim HJ, Dho YS, Shin SH, Yoo H, Chang Wang K. Disseminating Necrotizing Leukoencephalopathy Associated With Intra-CSF Methotrexate Chemotherapy: A Retrospective Observational Study. Neurology 2024; 102:e209167. [PMID: 38364192 DOI: 10.1212/wnl.0000000000209167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/14/2023] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Leptomeningeal metastases (LMs) are neoplasms that proliferate to membranes lining the brain and spinal cord. Intra-CSF methotrexate (MTX) chemotherapy is a prevalent treatment option. However, resultant long-term neurotoxicity can lead to irreversible disseminated necrotizing leukoencephalopathy (DNL). This study aims to determine the incidence, characteristics, risk factors, and outcomes of DNL following intra-CSF MTX chemotherapy for LM. METHODS We retrospectively reviewed patients with LM who received intra-CSF MTX between 2001 and 2021 at the National Cancer Center of Korea. Patients with a follow-up duration of <3 months and those without follow-up MRI after MTX administration were excluded. The primary outcome was the development of DNL, evaluated based on the clinical and radiologic definitions of DNL. Logistic and Cox proportional regression models were used to assess the risk of DNL in patients with LM receiving intra-CSF MTX chemotherapy. RESULTS Of the 577 patients included in the DNL investigation, 13 (2.3%) were identified to have irreversible DNL. The MRI features of DNL typically include necrotic changes in the bilateral anterior temporal region, extensive white matter, and/or brainstem lesions. All patients with DNL experienced fatal clinical course despite MTX cessation. Logistic regression analysis revealed that a cumulative dose of MTX significantly affected DNL occurrence. Multivariable analysis showed that the factor of ≥10 MTX rounds was significant for DNL development after adjusting for route of MTX administration and prior brain radiotherapy (odds ratio 7.32, 95% CI 1.42-37.77 at MTX rounds ≥10 vs < 10). In the Cox proportional hazards model considering time to occurrence of DNL, ≥10 rounds of MTX were identified as an independent predictor of DNL (hazard ratio 12.57, 95% CI 1.62-97.28, p = 0.015), even after adjusting for the synergistic effect of brain radiotherapy. DISCUSSION DNL is a rare but fatal complication of intra-CSF MTX chemotherapy, and its progression cannot be prevented despite early recognition. The cumulative dose of intra-CSF MTX was an independent risk factor for DNL occurrence. Thus, intra-CSF MTX treatment for patients with LM should be administered with caution considering the possibility of the cumulative irreversible neurotoxicity.
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Affiliation(s)
- Ki Hoon Kim
- From the Department of Neurology (K.H.K., S.-H.K., J.-W.H., H.J.K.), Department of Neurosurgery/Neuro-oncology Clinic (M.P., H.-S.G., Y.-S.D., S.-H.S., H.Y., K.C.W.), Biostatistics Collaboration Team (E.Y.P.), Department of Cancer Control (H.-S.G.), Graduate School of Cancer Science and Policy, and Department of Radiology (J.W.S.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Moowan Park
- From the Department of Neurology (K.H.K., S.-H.K., J.-W.H., H.J.K.), Department of Neurosurgery/Neuro-oncology Clinic (M.P., H.-S.G., Y.-S.D., S.-H.S., H.Y., K.C.W.), Biostatistics Collaboration Team (E.Y.P.), Department of Cancer Control (H.-S.G.), Graduate School of Cancer Science and Policy, and Department of Radiology (J.W.S.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Eun Young Park
- From the Department of Neurology (K.H.K., S.-H.K., J.-W.H., H.J.K.), Department of Neurosurgery/Neuro-oncology Clinic (M.P., H.-S.G., Y.-S.D., S.-H.S., H.Y., K.C.W.), Biostatistics Collaboration Team (E.Y.P.), Department of Cancer Control (H.-S.G.), Graduate School of Cancer Science and Policy, and Department of Radiology (J.W.S.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Ho-Shin Gwak
- From the Department of Neurology (K.H.K., S.-H.K., J.-W.H., H.J.K.), Department of Neurosurgery/Neuro-oncology Clinic (M.P., H.-S.G., Y.-S.D., S.-H.S., H.Y., K.C.W.), Biostatistics Collaboration Team (E.Y.P.), Department of Cancer Control (H.-S.G.), Graduate School of Cancer Science and Policy, and Department of Radiology (J.W.S.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Su-Hyun Kim
- From the Department of Neurology (K.H.K., S.-H.K., J.-W.H., H.J.K.), Department of Neurosurgery/Neuro-oncology Clinic (M.P., H.-S.G., Y.-S.D., S.-H.S., H.Y., K.C.W.), Biostatistics Collaboration Team (E.Y.P.), Department of Cancer Control (H.-S.G.), Graduate School of Cancer Science and Policy, and Department of Radiology (J.W.S.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Ji Won Seo
- From the Department of Neurology (K.H.K., S.-H.K., J.-W.H., H.J.K.), Department of Neurosurgery/Neuro-oncology Clinic (M.P., H.-S.G., Y.-S.D., S.-H.S., H.Y., K.C.W.), Biostatistics Collaboration Team (E.Y.P.), Department of Cancer Control (H.-S.G.), Graduate School of Cancer Science and Policy, and Department of Radiology (J.W.S.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Jae-Won Hyun
- From the Department of Neurology (K.H.K., S.-H.K., J.-W.H., H.J.K.), Department of Neurosurgery/Neuro-oncology Clinic (M.P., H.-S.G., Y.-S.D., S.-H.S., H.Y., K.C.W.), Biostatistics Collaboration Team (E.Y.P.), Department of Cancer Control (H.-S.G.), Graduate School of Cancer Science and Policy, and Department of Radiology (J.W.S.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Ho Jin Kim
- From the Department of Neurology (K.H.K., S.-H.K., J.-W.H., H.J.K.), Department of Neurosurgery/Neuro-oncology Clinic (M.P., H.-S.G., Y.-S.D., S.-H.S., H.Y., K.C.W.), Biostatistics Collaboration Team (E.Y.P.), Department of Cancer Control (H.-S.G.), Graduate School of Cancer Science and Policy, and Department of Radiology (J.W.S.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Yun-Sik Dho
- From the Department of Neurology (K.H.K., S.-H.K., J.-W.H., H.J.K.), Department of Neurosurgery/Neuro-oncology Clinic (M.P., H.-S.G., Y.-S.D., S.-H.S., H.Y., K.C.W.), Biostatistics Collaboration Team (E.Y.P.), Department of Cancer Control (H.-S.G.), Graduate School of Cancer Science and Policy, and Department of Radiology (J.W.S.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Sang-Hoon Shin
- From the Department of Neurology (K.H.K., S.-H.K., J.-W.H., H.J.K.), Department of Neurosurgery/Neuro-oncology Clinic (M.P., H.-S.G., Y.-S.D., S.-H.S., H.Y., K.C.W.), Biostatistics Collaboration Team (E.Y.P.), Department of Cancer Control (H.-S.G.), Graduate School of Cancer Science and Policy, and Department of Radiology (J.W.S.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Heon Yoo
- From the Department of Neurology (K.H.K., S.-H.K., J.-W.H., H.J.K.), Department of Neurosurgery/Neuro-oncology Clinic (M.P., H.-S.G., Y.-S.D., S.-H.S., H.Y., K.C.W.), Biostatistics Collaboration Team (E.Y.P.), Department of Cancer Control (H.-S.G.), Graduate School of Cancer Science and Policy, and Department of Radiology (J.W.S.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Kyu Chang Wang
- From the Department of Neurology (K.H.K., S.-H.K., J.-W.H., H.J.K.), Department of Neurosurgery/Neuro-oncology Clinic (M.P., H.-S.G., Y.-S.D., S.-H.S., H.Y., K.C.W.), Biostatistics Collaboration Team (E.Y.P.), Department of Cancer Control (H.-S.G.), Graduate School of Cancer Science and Policy, and Department of Radiology (J.W.S.), Research Institute and Hospital of National Cancer Center, Goyang, South Korea
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Bhattacharya K, Nigam K, Choudhari AKJ, Shetty NS, Gala K, Chandra D, Kulkarni S. Imaging of central nervous system emergencies in oncology. Emerg Radiol 2023; 30:499-512. [PMID: 37160605 DOI: 10.1007/s10140-023-02139-4] [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: 01/17/2023] [Accepted: 04/19/2023] [Indexed: 05/11/2023]
Abstract
Central nervous system (CNS) may be predisposed to devastating complications in cancer patients which may add to morbidity and mortality in this group. Majority of the complications are vascular in nature due to the altered coagulation profile and pro-inflammatory state in these patients. However, there are a host of other conditions which may affect the clinical course of these patients including metabolic and toxic encephalopathies, infections, and paraneoplastic syndromes. Moreover, multimodality management of these patients, which is often used in majority of the cancers, exposes them to treatment related complications. This pictorial review aims to enlighten the reader regarding the various complications affecting the CNS as seen at our tertiary cancer care institute. We aim to highlight the emergent nature of these complications and the need to identify them quickly and accurately on imaging which helps to institute early appropriate management and prevents further morbidity and mortality.
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Affiliation(s)
- Kajari Bhattacharya
- Department of Radiology, Tata Memorial Centre, Mumbai, India.
- Homi Bhabha National Institute, Mumbai, India.
| | - Kunal Nigam
- Department of Radiology, Tata Memorial Centre, Mumbai, India
| | - Amit Kumar J Choudhari
- Department of Radiology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Nitin Sudhakar Shetty
- Department of Radiology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Kunal Gala
- Department of Radiology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Daksh Chandra
- Department of Radiology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Suyash Kulkarni
- Department of Radiology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
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El Aissaouy M, Douqchi B, El Aidouni G, Bkiyar H, Housni B. Chemotherapy-Induced Leukoencephalopathy Revealed by Seizure and Alteration of the Mental Status. Cureus 2023; 15:e39364. [PMID: 37362474 PMCID: PMC10285338 DOI: 10.7759/cureus.39364] [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] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Leukoencephalopathy is progressive demyelination of the white matter, induced by a variety of factors. Among the causes of leukoencephalopathy, chemotherapy is an uncommon cause that generates potentially reversible lesions. The clinical presentation is classically made of alterations in mental status, hallucinations, hypertension, seizures, and acute visual changes. Imaging plays an important role in the diagnosis of this entity, especially by conventional and diffusion-weighted magnetic resonance imaging which enables an accurate diagnosis by identifying symmetric white matter lesions, especially in the parietal and occipital lobes. Herein, we report a 54-year-old female patient, newly diagnosed with non-metastatic moderately differentiated adenocarcinoma of the cecum. The patient received her first cancer chemotherapy (5-fluorouracil at 300 mg/m2). Five days later she was admitted to the intensive care unit for confusion following two generalized seizures. Conventional and diffusion-weighted magnetic resonance imaging was performed and showed diffuse white matter lesions of the parietal and occipital lobes. A diagnosis of 5-fluorouracil-induced leukoencephalopathy was established. The diagnosis of leukoencephalopathy should be considered in patients receiving cancer chemotherapy with alterations in mental status and seizures.
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Affiliation(s)
- Mohammed El Aissaouy
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, MAR
- Anesthesiology, Mohammed I University, Oujda, MAR
| | - Badie Douqchi
- Intensive Care Unit, Mohammed VI University Hospital Center, Oujda, MAR
- Intensive Care Unit, Mohammed I University, Oujda, MAR
| | | | - Houssam Bkiyar
- Anesthesiology/Critical Care Unit, Mohammed VI University Hospital Center, Oujda, MAR
| | - Brahim Housni
- Anesthesiology/Critical Care Unit, Mohammed VI University Hospital Center, Oujda, MAR
- Intensive Care Unit/Anesthesiology, Mohammed I University, Oujda, MAR
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Evaluation of toxic effects of chemotherapy in lung malignancies on cerebral white matter using diffusion tensor imaging. Radiol Oncol 2022; 56:150-155. [PMID: 35502917 PMCID: PMC9122291 DOI: 10.2478/raon-2022-0017] [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: 12/02/2021] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) is a leading cause of morbidity and mortality. Carboplatin and cisplatin based regimens are used in the treatment of NSCLC. The aim of the study was to find out whether there is a difference in white matter (WM) changes between two platinum-based chemotherapy agents using diffusion tensor imaging (DTI). PATIENTS AND METHODS 25 patients who received chemotherapy for NSCLC and 27 age-matched healthy controls were enrolled in the study. Fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD) and radial diffusivity (RD) values of the study population were measured from 11 regions of interest in pre-chemotherapy and post-chemotherapy MRI data. RESULTS Cisplatin group showed a significant decrease in the FA of the inferior longitudinal fasciculus (P = 0.028). Carboplatin group showed a significant FA decrease and RD increase in the forceps minor (P = 0.022 and P = 0.011, respectively), and a significant reduction in AD and increase in MD in frontal white matter (WM) (P = 0.008 and P = 0.029, respectively). In comparison of post chemotherapy DTI values of the two groups, carboplatin group showed lower FA, and higher MD and RD values than cisplatin group in parieto-occipital WM (P = 0.034, P = 0.034, P = 0.029, respectively). CONCLUSIONS The findings of the study suggest that subtle effects of chemotherapy detectable with DTI may emerge after the treatment. In addition, carboplatin regimen may have more impact on WM than cisplatin regimen.
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Perrain V, Bihan K, Bompaire F, Houillier C, Jomier F, Leclercq D, Combret S, Mahé J, Ricard D, Berzero G, Psimaras D. Leukoencephalopathy with transient splenial lesions related to 5-fluorouracil or capecitabine. Eur J Neurol 2021; 28:2396-2402. [PMID: 33817933 DOI: 10.1111/ene.14857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND 5-Fluorouracil (5-FU) and its oral prodrug capecitabine have been rarely but consistently associated with acute central nervous system toxicity, including transient leukoencephalopathies involving the splenium of the corpus callosum. METHODS We performed a retrospective search in the French Pharmacovigilance database (FPDB) (January 1985-July 2020) for adult patients affected by solid cancers who developed acute toxic leukoencephalopathies with splenial lesions following treatment with 5-FU or capecitabine. A comprehensive review of the literature helped to circumstantiate our findings. RESULTS Our research in the FPDB identified six patients who, within 3 days from their first cycle of 5-FU or capecitabine, developed acute neurological symptoms, including gait ataxia (n = 4), dysarthria (n = 3), dysmetria (n = 2), headache (n = 2), and confusion (n = 2). Brain magnetic resonance imaging (MRI) showed T2/FLAIR (fluid-attenuated inversion recovery) hyperintensities in the corpus callosum, with diffusion restriction and no contrast enhancement, generally accompanied by additional alterations in the bilateral supratentorial white matter (n = 5). All patients discontinued the agent supposedly responsible for the toxicity and experienced full recovery after a median of 8.5 days from symptom onset. Control MRI showed a progressive normalization of acute MRI abnormalities. Literature review identified 26 cases with similar clinical and paraclinical characteristics. A single patient from the literature resumed 5-FU at a lower dose, with no recurrent toxicity. CONCLUSIONS 5-FU and capecitabine might be responsible for acute leukoencephalopathies with transient splenial lesions that are generally reversible upon drug discontinuation. Resuming the agent responsible for toxicity might be feasible in selected cases, after having excluded dihydropyrimidine dehydrogenase deficiency, if expected benefits outweigh the risks.
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Affiliation(s)
- Valentine Perrain
- AP-HP Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Kevin Bihan
- Regional Pharmacovigilance Center, Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France.,OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix et Hôpital Percy, Paris, France
| | - Flavie Bompaire
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix et Hôpital Percy, Paris, France.,Department of Neurology, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Caroline Houillier
- AP-HP Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Fanny Jomier
- Service de Neurologie, Hôpital Saint Joseph, Paris, France
| | - Delphine Leclercq
- Service de Neuroradiologie, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Sandrine Combret
- Department of Pharmacology, Regional Pharmacovigilance Center, Dijon, France
| | - Julien Mahé
- Department of Pharmacology, Regional Pharmacovigilance Center, Nantes, France
| | - Damien Ricard
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix et Hôpital Percy, Paris, France.,Department of Neurology, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Giulia Berzero
- AP-HP Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Dimitri Psimaras
- AP-HP Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix et Hôpital Percy, Paris, France
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Alexander JF, Seua AV, Arroyo LD, Ray PR, Wangzhou A, Heiβ-Lückemann L, Schedlowski M, Price TJ, Kavelaars A, Heijnen CJ. Nasal administration of mitochondria reverses chemotherapy-induced cognitive deficits. Theranostics 2021; 11:3109-3130. [PMID: 33537077 PMCID: PMC7847685 DOI: 10.7150/thno.53474] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/12/2020] [Indexed: 12/15/2022] Open
Abstract
Up to seventy-five percent of patients treated for cancer suffer from cognitive deficits which can persist for months to decades, severely impairing quality of life. Although the number of cancer survivors is increasing tremendously, no efficacious interventions exist. Cisplatin, most commonly employed for solid tumors, leads to cognitive impairment including deficits in memory and executive functioning. We recently proposed deficient neuronal mitochondrial function as its underlying mechanism. We hypothesized nasal administration of mitochondria isolated from human mesenchymal stem cells to mice, can reverse cisplatin-induced cognitive deficits. Methods: Puzzle box, novel object place recognition and Y-maze tests were used to assess the cognitive function of mice. Immunofluorescence and high-resolution confocal microscopy were employed to trace the nasally delivered mitochondria and evaluate their effect on synaptic loss. Black Gold II immunostaining was used to determine myelin integrity. Transmission electron microscopy helped determine mitochondrial and membrane integrity of brain synaptosomes. RNA-sequencing was performed to analyse the hippocampal transcriptome. Results: Two nasal administrations of mitochondria isolated from human mesenchymal stem cells to mice, restored executive functioning, working and spatial memory. Confocal imaging revealed nasally delivered mitochondria rapidly arrived in the meninges where they were readily internalized by macrophages. The administered mitochondria also accessed the rostral migratory stream and various other brain regions including the hippocampus where they colocalized with GFAP+ cells. The restoration of cognitive function was associated with structural repair of myelin in the cingulate cortex and synaptic loss in the hippocampus. Nasal mitochondrial donation also reversed the underlying synaptosomal mitochondrial defects. Moreover, transcriptome analysis by RNA-sequencing showed reversal of cisplatin-induced changes in the expression of about seven hundred genes in the hippocampus. Pathway analysis identified Nrf2-mediated response as the top canonical pathway. Conclusion: Our results provide key evidence on the therapeutic potential of isolated mitochondria - restoring both brain structure and function, their capability to enter brain meninges and parenchyma upon nasal delivery and undergo rapid cellular internalization and alter the hippocampal transcriptome. Our data identify nasal administration of mitochondria as an effective strategy for reversing chemotherapy-induced cognitive deficits and restoring brain health, providing promise for the growing population of both adult and pediatric cancer survivors.
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Affiliation(s)
- Jenolyn F. Alexander
- Laboratories of Neuroimmunology, Department of Symptom Research, Division of Internal Medicine, The University of Texas, M.D. Anderson Cancer Center, Houston, Texas, United States
| | - Alexandre V. Seua
- Laboratories of Neuroimmunology, Department of Symptom Research, Division of Internal Medicine, The University of Texas, M.D. Anderson Cancer Center, Houston, Texas, United States
| | - Luis D. Arroyo
- Laboratories of Neuroimmunology, Department of Symptom Research, Division of Internal Medicine, The University of Texas, M.D. Anderson Cancer Center, Houston, Texas, United States
| | - Pradipta R. Ray
- School of Behavioral and Brain Sciences and Center for Advanced Pain Studies, The University of Texas at Dallas, Richardson, Texas, United States
| | - Andi Wangzhou
- School of Behavioral and Brain Sciences and Center for Advanced Pain Studies, The University of Texas at Dallas, Richardson, Texas, United States
| | - Laura Heiβ-Lückemann
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Theodore J. Price
- School of Behavioral and Brain Sciences and Center for Advanced Pain Studies, The University of Texas at Dallas, Richardson, Texas, United States
| | - Annemieke Kavelaars
- Laboratories of Neuroimmunology, Department of Symptom Research, Division of Internal Medicine, The University of Texas, M.D. Anderson Cancer Center, Houston, Texas, United States
| | - Cobi J. Heijnen
- Laboratories of Neuroimmunology, Department of Symptom Research, Division of Internal Medicine, The University of Texas, M.D. Anderson Cancer Center, Houston, Texas, United States
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A Role of Microtubules in Oligodendrocyte Differentiation. Int J Mol Sci 2020; 21:ijms21031062. [PMID: 32033476 PMCID: PMC7037135 DOI: 10.3390/ijms21031062] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/29/2020] [Accepted: 02/03/2020] [Indexed: 12/17/2022] Open
Abstract
Oligodendrocytes are specialized cells that myelinate axons in the central nervous system. Defects in oligodendrocyte function and failure to form or maintain myelin sheaths can cause a number of neurological disorders. Oligodendrocytes are differentiated from oligodendrocyte progenitor cells (OPCs), which extend several processes that contact, elaborate, and eventually wrap axonal segments to form multilayered myelin sheaths. These processes require extensive changes in the cytoarchitecture and must be regulated by reorganization of the cytoskeleton. Here, we established a simple protocol to isolate and differentiate mouse OPCs, and by using this method, we investigated a role of microtubules (MTs) in oligodendrocyte differentiation. Oligodendrocytes developed a complex network of MTs during differentiation, and treatment of differentiating oligodendrocytes with nanomolar concentrations of MT-targeting agents (MTAs) markedly affected oligodendrocyte survival and differentiation. We found that acute exposure to vincristine and nocodazole at early stages of oligodendrocyte differentiation markedly increased MT arborization and enhanced differentiation, whereas taxol and epothilone B treatment produced opposing outcomes. Furthermore, treatment of myelinating co-cultures of oligodendrocytes and neurons with nanomolar concentrations of MTAs at late stages of oligodendrocyte differentiation induced dysmyelination. Together, these results suggest that MTs play an important role in the survival, differentiation, and myelination of oligodendrocytes.
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Kessler AT, Bhatt AA. Brain tumour post-treatment imaging and treatment-related complications. Insights Imaging 2018; 9:1057-1075. [PMID: 30411280 PMCID: PMC6269328 DOI: 10.1007/s13244-018-0661-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/11/2018] [Accepted: 09/18/2018] [Indexed: 01/18/2023] Open
Abstract
Purpose The imaging of primary and metastatic brain tumours is very complex and relies heavily on advanced magnetic resonance imaging (MRI). Utilisation of these advanced imaging techniques is essential in helping clinicians determine tumour response after initiation of treatment. Many options are currently available to treat brain tumours, and each can significantly alter the brain tumour appearance on post-treatment imaging. In addition, there are several common and uncommon treatment-related complications that are important to identify on standard post-treatment imaging. Methods This article provides a review of the various post-treatment-related imaging appearances of brain neoplasms, including a discussion of advanced MR imaging techniques available and treatment response criteria most commonly used in clinical practice. This article also provides a review of the multitude of treatment-related complications that can be identified on routine post-treatment imaging, with an emphasis on radiation-induced, chemotherapy-induced, and post-surgical entities. Summary/Conclusion Although radiological evaluation of brain tumours after treatment can be quite challenging, knowledge of the various imaging techniques available can help the radiologist distinguish treatment response from tumour progression and has the potential to save patients from inappropriate alterations in treatment. In addition, knowledge of common post-treatment-related complications that can be identified on imaging can help the radiologist play a key role in preventing significant patient morbidity/mortality. Teaching points • Contrast enhancement does not reliably define tumour extent in many low-grade or infiltrative gliomas. • Focal regions of elevated cerebral blood volume (rCBV) on dynamic susceptibility contrast (DSC) perfusion-weighted imaging are suggestive of tumour growth/recurrence. • Brain tumour treatment response criteria rely on both imaging and clinical parameters. • Chemotherapeutic agents can potentiate many forms of radiation-induced injury. • Ipilimumab-induced hypophysitis results in transient diffuse enlargement of the pituitary gland.
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Affiliation(s)
- Alexander T Kessler
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 648, Rochester, NY, 14642, USA
| | - Alok A Bhatt
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, P.O. Box 648, Rochester, NY, 14642, USA.
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Abstract
Survival rates of children with cancer are steadily increasing. This urges our attention to neurocognitive and psychiatric outcomes, as these can markedly influence the quality of life of these children. Neurobehavioral morbidity in childhood cancer survivors affects diverse aspects of cognitive function, which can include attention, memory, processing speed, intellect, academic achievement, and emotional health. Reasons for neurobehavioral morbidity are multiple with one major contributor being chemotherapy-induced central nervous system (CNS) toxicity. Clinical studies investigating the effects of chemotherapy on the CNS in children with cancer have reported causative associations with the development of leukoencephalopathies as well as smaller regional grey and white matter volumes, which have been found to correlate with neurocognitive deficits.Preclinical work has provided compelling evidence that chemotherapy drugs are potent neuro- and gliotoxins in vitro and in vivo and can cause brain injury via excitotoxic and apoptotic mechanisms. Furthermore, chemotherapy triggers DNA (deoxyribonucleic acid) damage directly or through increased oxidative stress. It can shorten telomeres and accelerate cell aging, cause cytokine deregulation, inhibit hippocampal neurogenesis, and reduce brain vascularization and blood flow. These mechanisms, when allowed to operate on the developing brain of a child, have high potential to not only cause brain injury, but also alter crucial developmental events, such as myelination, synaptogenesis, neurogenesis, cortical thinning, and formation of neuronal networks.This short review summarizes key publications describing neurotoxicity of chemotherapy in pediatric cancers and potential underlying pathomechanisms.
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Affiliation(s)
- Chrysanthy Ikonomidou
- Department of Neurology, Section of Child Neurology, University of Wisconsin Madison, Madison, WI, 53705, USA.
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