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Harris JP, Ku E, Harada G, Hsu S, Chiao E, Rao P, Healy E, Nagasaka M, Humphreys J, Hoyt MA. Severity of Financial Toxicity for Patients Receiving Palliative Radiation Therapy. Am J Hosp Palliat Care 2024; 41:592-600. [PMID: 37406195 PMCID: PMC10772523 DOI: 10.1177/10499091231187999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Introduction: Financial toxicity has negative implications for patient well-being and health outcomes. There is a gap in understanding financial toxicity for patients undergoing palliative radiotherapy (RT). Methods: A review of patients treated with palliative RT was conducted from January 2021 to December 2022. The FACIT-COST (COST) was measured (higher scores implying better financial well-being). Financial toxicity was graded according to previously suggested cutoffs: Grade 0 (score ≥26), Grade 1 (14-25), Grade 2 (1-13), and Grade 3 (0). FACIT-TS-G was used for treatment satisfaction, and EORTC QLQ-C30 was assessed for global health status and functional scales. Results: 53 patients were identified. Median COST was 25 (range 0-44), 49% had Grade 0 financial toxicity, 32% Grade 1, 15% Grade 2, and 4% Grade 3. Overall, cancer caused financial hardship among 45%. Higher COST was weakly associated with higher global health status/Quality of Life (QoL), physical functioning, role functioning, and cognitive functioning; moderately associated with higher social functioning; and strongly associated with improved emotional functioning. Higher income or Medicare or private coverage (rather than Medicaid) was associated with less financial toxicity, whereas an underrepresented minority background or a non-English language preference was associated with greater financial toxicity. A multivariate model found that higher area income (HR .80, P = .007) and higher cognitive functioning (HR .96, P = .01) were significantly associated with financial toxicity. Conclusions: Financial toxicity was seen in approximately half of patients receiving palliative RT. The highest risk groups were those with lower income and lower cognitive functioning. This study supports the measurement of financial toxicity by clinicians.
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Affiliation(s)
- Jeremy P Harris
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Eric Ku
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Garrett Harada
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Sophie Hsu
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Elaine Chiao
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Pranathi Rao
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Erin Healy
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Misako Nagasaka
- Department of Medicine, Division of Hematology/Oncology, University of California Irvine, Orange, CA, USA
| | - Jessica Humphreys
- Department of Geriatrics and Extended Care, Division of Palliative Care, Tibor Rubin VA Medical Center, Long Beach, CA, USA
- Department of Medicine, Division of Palliative Medicine, University of California, San Francisco, CA, USA
| | - Michael A Hoyt
- Department of Population Health & Disease Prevention, University of California Irvine, Irvine, CA, USA
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Finney N, Tran T, Hasjim BJ, Jakowatz J, Chiao E, Eng O, Wolf R, Jutric Z, Yamamoto M, Tran TB. Primary sarcoma of the liver: A nationwide analysis of a rare mesenchymal tumor. J Surg Oncol 2024; 129:358-364. [PMID: 37796036 DOI: 10.1002/jso.27477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/10/2023] [Accepted: 09/23/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Primary liver sarcomas are rare malignancies. Prognostic factors associated with long-term survival remain poorly understood. The objective of this study is to determine factors associated with long-term survival. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients with visceral sarcoma arising from the liver. Demographic factors, tumor characteristics, resection status, and survival were evaluated. Multivariate Cox regression analysis was performed to determine predictors of survival. RESULTS A total of 743 patients with primary hepatic sarcoma were identified. The median tumor size was 10 cm. Only 30% (n = 221) of patients in the cohort underwent surgery. The 5-year overall survival rates were 47.9% for localized disease, 29.5% for regional disease, and 16.5% for distant disease, p < 0.001. Among patients who underwent surgical resection, patients with embryonal sarcoma had better 5-year survival compared with angiosarcoma and other histologic subtypes. On multivariate analysis, surgery was associated with improved survival, while older age, higher stage, and angiosarcoma histology were the strongest independent predictors of poor survival. CONCLUSIONS Surgery remains the mainstay of treatment for this rare malignancy but is performed in less than one-third of patients. Angiosarcoma histology is associated with worse overall survival, while surgical resection remains the strongest predictor of improved overall survival.
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Affiliation(s)
- Nicole Finney
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Tu Tran
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Bima J Hasjim
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - James Jakowatz
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Elaine Chiao
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Oliver Eng
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Ronald Wolf
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Zeljika Jutric
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Maki Yamamoto
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
| | - Thuy B Tran
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, California, USA
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Ku E, Harada G, Chiao E, Rao P, Hosseinian S, Seyedin S, Healy E, Maxim P, Chow W, Stitzlein R, Limoli C, Harris J. The Correlation Between Lymphocyte Nadir and Radiation Therapy for Soft Tissue Sarcoma: Defining Key Dosimetric Parameters and Outlining Clinical Significance. Adv Radiat Oncol 2024; 9:101309. [PMID: 38260229 PMCID: PMC10801664 DOI: 10.1016/j.adro.2023.101309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/28/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose The objectives of this study were to identify key dosimetric parameters associated with postradiation therapy lymphopenia and uncover any effect on clinical outcomes. Methods and Materials This was a retrospective review of 69 patients (between April 2010 and January 2023) who underwent radiation therapy (RT) as a part of curative intent for soft tissue sarcoma (STS) at a single academic institution. All patients with treatment plans available to review and measurable absolute lymphocyte count (ALC) nadir within a year after completion of RT were included. Results Median follow-up was 22 months after the start of RT. A decrease in lymphocyte count was noted as early as during treatment and persisted at least 3 months after the completion of RT. On multivariable linear regression, the strongest correlations with ALC nadir were mean body dose, body V10 Gy, mean bone dose, bone V10 Gy, and bone V20 Gy. Five-year overall survival was 60% and 5-year disease-free survival was 44%. Advanced T-stage, chemotherapy use, use of intensity-modulated RT, lower ALC nadir, and the development of grade ≥2 lymphopenia at nadir were associated with worse overall survival and disease-free survival. Conclusions Post-RT lymphopenia was associated with worse outcomes in STS. There were associations between higher body V10 Gy and bone V10 Gy and lower post-RT ALC nadir, despite the varying sites of STS presentation, which aligns with the well-known radiosensitivity of lymphocyte cell lines. These findings support efforts to reduce treatment-related hematopoietic toxicity as a way to improve oncologic outcomes. Additionally, this study supports the idea that the effect of radiation on lymphocyte progenitors in the bone marrow is more significant than that on circulating lymphocytes in treatments with limited involvement of the heart and lung.
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Affiliation(s)
- Eric Ku
- Department of Radiation Oncology, University of California, Irvine, Orange, California
| | - Garrett Harada
- Department of Radiation Oncology, University of California, Irvine, Orange, California
| | - Elaine Chiao
- School of Medicine, University of California, Irvine, Irvine, California
| | - Pranathi Rao
- School of Medicine, University of California, Irvine, Irvine, California
| | - Sina Hosseinian
- School of Medicine, University of California, Irvine, Irvine, California
| | - Steven Seyedin
- Department of Radiation Oncology, University of California, Irvine, Orange, California
| | - Erin Healy
- Department of Radiation Oncology, University of California, Irvine, Orange, California
| | - Peter Maxim
- Department of Radiation Oncology, University of California, Irvine, Orange, California
| | - Warren Chow
- Department of Hematology/Oncology, University of California, Irvine, Orange, California
| | - Russell Stitzlein
- Orthopedic Surgery, University of California, Irvine, Orange, California
| | - Charles Limoli
- Department of Radiation Oncology, University of California, Irvine, Orange, California
| | - Jeremy Harris
- Department of Radiation Oncology, University of California, Irvine, Orange, California
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Mahadevan A, Warnecke B, Chiao E, Nafissi N, Parajuli K, Rijal N, Parajuli R. Goserelin-Induced Chemical Burn: A Case Report and Review of the Literature. Cureus 2023; 15:e45692. [PMID: 37745751 PMCID: PMC10513001 DOI: 10.7759/cureus.45692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 09/26/2023] Open
Abstract
A chemical burn resulting from luteinizing hormone-releasing hormone agonists (LHRHa) is a rare adverse effect that has not been well-documented in prior literature. In this case report, we report a partial-thickness burn that developed following a single subcutaneous injection of goserelin. To our knowledge, this is the first description of goserelin-induced chemical burn in the literature. The importance of early identification and treatment of LHRHa-associated cutaneous reactions must be highlighted to ensure optimal oncologic management and patient comfort.
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Affiliation(s)
- Aditya Mahadevan
- Department of Hematology and Oncology, University of California Irvine School of Medicine, Orange, USA
| | - Brian Warnecke
- Department of Hematology and Oncology, University of California Irvine Medical Center, Orange, USA
| | - Elaine Chiao
- Department of Hematology and Oncology, University of California Irvine School of Medicine, Orange, USA
| | - Nellie Nafissi
- Department of Hematology and Oncology, University of California Irvine Medical Center, Orange, USA
| | - Kritisha Parajuli
- Department of Medicine, Nepal Medical College and Teaching Hospital, Kathmandu, NPL
| | - Nejina Rijal
- Department of Medicine, Kathmandu Medical College, Kathmandu, NPL
| | - Ritesh Parajuli
- Department of Hematology and Oncology, University of California Irvine Medical Center, Orange, USA
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Lee KT, Chiao E, Lim D, Mouslim M, Wang C, Mangini N, Stearns V, Smith KL. Predictors of non-receipt of first-line CDK 4/6 inhibitors (CDK4/6i) among patients with metastatic breast cancer (MBC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.1016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1016 Background: CDK4/6i improve survival outcomes for first-line treatment of patients with hormone receptor positive (HR+), human epidermal growth factor-2 negative (HER2-) MBC. Yet, not all eligible patients (pts) receive a first-line CDK4/6i. We sought to describe factors associated with not receiving a first-line CDK 4/6i among MBC pts treated at our institution. Methods: Retrospective cohort of pts with HR+, HER2- MBC diagnosed between May 1, 2015 and June 30, 2019 treated at Johns Hopkins clinic sites in Baltimore City (BCi), Baltimore County (BCo), and Washington DC (DC). Primary outcome was receipt of a first-line CDK 4/6i. Clinical and demographic factors were abstracted from the electronic medical record. Patient zip-code was used to define a low-income neighborhood (LIN) as an area where >10% of households have median income below the federal poverty level. Univariate and multivariable logistic regression models (determined using a stepwise model selection approach) were performed to identify factors associated with not receiving a first-line CDK 4/6i. Results: Of the 211 pts in the cohort, 203 (96.2%) were female, 133 (63%) were White, and 53 (25%) were Black. Median age was 58 yrs (range 25-90 yrs). 26% of pts had de novo MBC and 44% had visceral disease at diagnosis. About half, 104 (49%), were privately insured, 83 (49%) had Medicare, and 15 (7.1%) had managed care plans including Medicaid. 118 (56%), 43 (20%), and 50 (24%) pts were treated in BCi, BCo, and DC respectively. 60% (n=126) of pts received a first-line CDK 4/6i and there was a trend of increased utilization over time with 39% of pts receiving first-line CDK4/6i in 2015 and 67% in 2019. On univariate analysis, LIN, clinic site, and year of MBC diagnosis (2015-2017 vs 2018-2019) were associated with first-line CDK4/6i use. The multivariable model included age, race, clinic site, LIN, and year of MBC diagnosis. In this model, pts treated in BCi were 58% less likely to receive first-line CDK 4/6i compared to those treated in BCo (OR 0.42, 95% CI 0.18-0.95). Those diagnosed with MBC in 2017 or later were 2.6 times more likely to receive first-line CDK4/6i than those diagnosed prior (OR 2.63, 95% CI 1.45-4.83). Those who lived in a LIN were 39% less likely to receive first-line CDK4/6i vs those in a non-LIN, though this was no longer statistically significant (OR 0.61, 95% CI 0.32-1.13). Conclusions: We identified disparities in the use of CDK4/6i for first-line treatment of MBC. Lower use was observed among pts who received care at our urban Baltimore city site with a trend towards lower use among pts from lower-income neighborhoods. These findings highlight potential barriers with accessing oral cancer therapies - cost, patient distrust, and/or systemic bias. Further work is needed to delineate the multi-level factors contributing to these disparities and to develop resources to overcome these barriers and achieve equitable utilization of these drugs.
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Affiliation(s)
- Kimberley T Lee
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - David Lim
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
| | | | | | | | - Vered Stearns
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins School of Medicine, Baltimore, MD
| | - Karen L. Smith
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
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Yoder A, Wang S, Roque D, Son C, Ludwig M, Chiao E, Levinson K, Lin L. Cervical Cancer Outcomes in Women Living With HIV in the Age of Anti-Retroviral Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rajdev L, Lensing S, Ramos J, Baiocchi R, Wang CC, Ratner L, Rubinstein P, Ambinder R, Henry D, Streicher H, Little R, Chiao E, Lee M, Dittmer D, Einstein M, Sparano J, Mitsuyasu R. 1023MO AMC 095: A report of nivolumab (nivo) in advanced HIV associated solid tumours (ST). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Wilde D, Castro P, Haugen A, Shi J, Lai S, Chiao E, Hernandez D, Sikora A, Sandulache V. The Evolution of Intermediate Risk Oropharyngeal Cancer in a Veteran Population: a 15 Year Study. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Badr H, Chhabria K, Sandulache VC, Chiao E, Wagner T. Results of a Randomized Pilot Trial of SHARE: A Self-Management Intervention for Head and Neck Cancer Patients Undergoing Radiotherapy and their Spousal Caregivers. Cancer Epidemiol Biomarkers Prev 2019. [DOI: 10.1158/1055-9965.epi-19-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Head and neck cancer (HNC) patients experience significant physical and psychological morbidity during radiotherapy (XRT) which contributes to treatment interruptions and poor quality of life. Although spouses/partners can help by encouraging patient self-management (e.g., self-care) during XRT, they often experience high psychological distress rates, lack basic healthcare knowledge/skills, and report increased marital conflict regarding patient self-management. This pilot study examined the feasibility and acceptability of a six-session telephone-based intervention called SHARE (Spouses coping with the Head And neck Radiation Experience), which teaches self-management, communication, and coping skills to HNC patients and their spouses. Treatment effects of SHARE relative to usual medical care (UMC) in controlling patient physical symptoms and improving patient/spouse psychological and marital functioning were also examined. METHODS: Thirty patients initiating XRT and their spouses (N = 60 participants; 40% racial/ethnic minorities) were randomized to SHARE or UMC, and pre- and post-intervention assessments were completed. RESULTS: Solid recruitment (70%) and low attrition rates (7%) demonstrated feasibility. Strong program evaluations and homework completion rates (72%) supported acceptability. Significant treatment effects (medium in magnitude) were observed for SHARE relative to UMC with regard to HNC-specific physical symptom burden (Cohen's d = −0.89) and symptom interference (d = −0.86). Medium-to-large effects favoring SHARE were also found for patient and spouse depressive symptoms (d = −0.84) and cancer-specific distress (d = −1.05). CONCLUSION: Findings support the feasibility, acceptability, and preliminary efficacy of SHARE. They also suggest that programs that empower HNC couples with the necessary skills to coordinate care and manage the challenges of XRT together hold great promise for controlling patient physical symptoms and improving both partners' psychological functioning.
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Biggerstaff KS, Frankfort BJ, Orengo-Nania S, Garcia J, Chiao E, Kramer JR, White D. Validity of code based algorithms to identify primary open angle glaucoma (POAG) in Veterans Affairs (VA) administrative databases. Ophthalmic Epidemiol 2017; 25:162-168. [PMID: 28945495 DOI: 10.1080/09286586.2017.1378688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The validity of the International Classification of Diseases, 9th revision, Clinical Modification (ICD-9) code for primary open angle glaucoma (POAG) in the Department of Veterans Affairs (VA) electronic medical record has not been examined. We determined the accuracy of the ICD-9 code for POAG and developed diagnostic algorithms for the detection of POAG. METHODS We conducted a retrospective study of abstracted data from the Michael E. DeBakey VA Medical Center's medical records of 334 unique patients with at least one visit to the Eye Clinic between 1999 and 2013. Algorithms were developed to validly identify POAG using ICD-9 codes and pharmacy data. The positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and percent agreement of the various algorithms were calculated. RESULTS For the ICD-9 code 365.1x, the PPV was 65.9%, NPV was 95.2%, sensitivity was 100%, specificity was 82.6%, and percent agreement was 87.8%. The algorithm with the highest PPV was 76.3%, using pharmacy data in conjunction with two or more ICD-9 codes for POAG, but this algorithm also had the lowest NPV at 88.2%. CONCLUSIONS Various algorithms for identifying POAG in the VA administrative databases have variable validity. Depending on the type of research being done, the ICD-9 code 365.1x can be used for epidemiologic or health services database research.
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Affiliation(s)
- K S Biggerstaff
- a Houston Center for Innovations in Quality, Effectiveness and Safety , Michael E. DeBakeyVeterans Affairs Medical Center , Houston , TX , USA.,b Eye Care Line , Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.,c Department of Ophthalmology , Baylor College of Medicine , Houston , TX , USA
| | - B J Frankfort
- c Department of Ophthalmology , Baylor College of Medicine , Houston , TX , USA
| | - S Orengo-Nania
- b Eye Care Line , Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA.,c Department of Ophthalmology , Baylor College of Medicine , Houston , TX , USA
| | - J Garcia
- d Division of Diabetes, Endocrinology and Metabolism, MCL, Center for Translational Research on Inflammatory Diseases , Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine , Houston , TX , USA.,e Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System , University of Washington , Seattle , WA , USA
| | - E Chiao
- a Houston Center for Innovations in Quality, Effectiveness and Safety , Michael E. DeBakeyVeterans Affairs Medical Center , Houston , TX , USA.,f Section of Health Services Research, Department of Medicine , Baylor College of Medicine , Houston , TX , USA
| | - J R Kramer
- a Houston Center for Innovations in Quality, Effectiveness and Safety , Michael E. DeBakeyVeterans Affairs Medical Center , Houston , TX , USA.,f Section of Health Services Research, Department of Medicine , Baylor College of Medicine , Houston , TX , USA
| | - D White
- a Houston Center for Innovations in Quality, Effectiveness and Safety , Michael E. DeBakeyVeterans Affairs Medical Center , Houston , TX , USA.,f Section of Health Services Research, Department of Medicine , Baylor College of Medicine , Houston , TX , USA
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Cohen JD, Babiarz JE, Abrams RM, Guo L, Kameoka S, Chiao E, Taunton J, Kolaja KL. Use of human stem cell derived cardiomyocytes to examine sunitinib mediated cardiotoxicity and electrophysiological alterations. Toxicol Appl Pharmacol 2011; 257:74-83. [PMID: 21906609 DOI: 10.1016/j.taap.2011.08.020] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 08/19/2011] [Accepted: 08/22/2011] [Indexed: 01/01/2023]
Abstract
Sunitinib, an oral tyrosine kinase inhibitor approved to treat advanced renal cell carcinoma and gastrointestinal stroma tumor, is associated with clinical cardiac toxicity. Although the precise mechanism of sunitinib cardiotoxicity is not known, both the key metabolic energy regulator, AMP-activated protein kinase (AMPK), and ribosomal S 6 kinase (RSK) have been hypothesized as causative, albeit based on rodent models. To study the mechanism of sunitinib-mediated cardiotoxicity in a human model, induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) having electrophysiological and contractile properties of native cardiac tissue were investigated. Sunitinib was cardiotoxic in a dose-dependent manner with an IC₅₀ in the low micromolar range, observed by a loss of cellular ATP, an increase in oxidized glutathione, and induction of apoptosis in iPSC-CMs. Pretreatment of iPSC-CMs with AMPK activators AICAR or metformin, increased the phosphorylation of pAMPK-T172 and pACC-S79, but only marginally attenuated sunitinib mediated cell death. Furthermore, additional inhibitors of AMPK were not directly cytotoxic to iPSC-CMs up to 250 μM concentrations. Inhibition of RSK with a highly specific, irreversible, small molecule inhibitor (RSK-FMK-MEA) did not induce cytotoxicity in iPSC-CMs below 250 μM. Extensive electrophysiological analysis of sunitinib and RSK-FMK-MEA mediated conduction effects were performed. Taken together, these findings suggest that inhibition of AMPK and RSK are not a major component of sunitinib-induced cardiotoxicity. Although the exact mechanism of cardiotoxicity of sunitinib is not known, it is likely due to inhibition of multiple kinases simultaneously. These data highlight the utility of human iPSC-CMs in investigating the potential molecular mechanisms underlying drug-induced cardiotoxicity.
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Affiliation(s)
- J D Cohen
- Early and Investigative Safety, Nonclinical Safety, Hoffmann-La Roche, 340 Kingsland Street, Nutley, NJ 07110, USA
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Teruya-Feldstein J, Chiao E, Filippa DA, Lin O, Comenzo R, Coleman M, Portlock C, Noy A. CD20-negative large-cell lymphoma with plasmablastic features: a clinically heterogenous spectrum in both HIV-positive and -negative patients. Ann Oncol 2005; 15:1673-9. [PMID: 15520070 DOI: 10.1093/annonc/mdh399] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Plasmablastic lymphoma (PBL) has been described as a rapidly progressive and almost invariably fatal CD20- VS38c+ diffuse large-cell lymphoma with plasmablastic features, almost exclusively involving the jaw and oral mucosa in HIV-positive patients. METHODS From 2001 to 2003 we evaluated 12 men with PBL, and report the pathology, clinical findings, treatment and outcome. Six of 12 were HIV-positive while among the others, one was post-renal transplant, one had ulcerative colitis and four had no known immunodeficiency. RESULTS Tumor growth pattern, in general, showed cohesiveness and a starry-sky pattern; the morphology varied from typical plasmablastic to centroblastic cells. Partial immunophenotypes were (+/total): CD138, 11 of 12 (91.7%); MIB1 10 of 11 (4+, range 75-95%); p63/VS38c, nine of 10 (90%); EBV, eight of 11 (73%); LCA(CD45), two of 12 (16.7%); HHV8/LANA, zero of 10; ALK, zero of seven; and CD20, zero of 12. Three had stage IE and nine stage IV disease. Nine of 12 had an intermediate/high International Prognostic Index or high-risk disease. Computed tomography and positron emission tomography scan in four of 12 revealed extensive bone metastases. Eight of 12 are alive after treatment, with a median follow-up of 11+ months (range 1-24). Of the HIV-positive patients, five of six are alive with a median follow-up of 17 months. CONCLUSIONS It appears that PBL are heterogenous in terms of clinical presentation and morphology. The outcome presented here is superior to that originally reported.
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Affiliation(s)
- J Teruya-Feldstein
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, NY 10021, USA.
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Abstract
Cytochrome P450c17 is the single enzyme having steroid 17 alpha-hydroxylase and 17,20 lyase activities. We sought to model the active site of this enzyme to identify residues contributing to its catalytic activities, and to test the roles of the identified amino acids by altering them via site-directed mutagenesis. Using the MIDAS-plus program, we modeled P450c17 and the structurally related steroid 21-hydroxylase, P450c21, on the crystallographically determined structure of bacterial P450cam. By positioning the progesterone substrate into each model, we identified five residues that appeared crucial for determining whether progesterone would undergo 17 alpha-hydroxylation (by P450c17) or 21-hydroxylation (by P450c21). Each identified residue in the P450c17 sequence was changed to the corresponding residue in the P450c21 sequence, yielding the four P450c17 mutants L102Y, G111D, G301l, and M369L + l371L. The mutants were transfected into COS-1 cells and their 17 alpha-hydroxylase, 17,20 lyase, and 21-hydroxylase activities were assayed by incubation with [14C]pregnenolone, [3H]17OH-pregnenolone, and [3H]17OH-progesterone and TLC. The L102Y and M369L + l371L mutants retained 50-80% of 17 alpha-hydroxylase and 70-100% of 17,20 lyase activity, while the G111D and G301l mutants lost both activities, but no mutants acquired detectable 21-hydroxylase activity (0.1% of wild type P450c21). Combination of the two mutants that retained partial activity (L102Y and M369L + l371L) yielded a single protein that retained 40% of 17 alpha-hydroxylase and 50% of 17,20 lyase activity, but none of the seven possible vectors expressing two, three, or all four of the mutations in a single enzyme yielded detectable 21-hydroxylase activity. The mutations D298V and D298S were predicted to ablate 17,20 lyase activity while retaining 17 alpha-hydroxylase activity, but were both inactive. These studies indicate that models based on the crystal structure of P450cam correctly predict many gross architectural features of steroidogenic enzymes and that many of the predicted residues are in or near the active site of P450c17. However, because enzymatic activity requires interactions between the enzyme and substrate at distances of less than 1 A, and modeling cannot predict atomic loci to greater than 1.5-2.0 A, it was not possible to design mutants that would confer 21-hydroxylase activity to P450c17. Currently available data cannot predict the structural and amino acid sequence requirements for a specific P450 activity.
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Affiliation(s)
- D Lin
- Department of Pediatrics, University of California San Francisco 94143-0978
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14
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Abstract
We describe in this paper an investigation of mammalian expression systems for P450c21 (21-hydroxylase). Four different promoters, the SV40 early and late promoters, MMTV-LTR, and CMV immediate early promoter were tested for their ability to drive the expression of P450c21 in cultured COS-1 cells. With the exception of MMTV-LTR, all drove the expression of similar levels of functional 21-hydroxylase. In addition, the Rat-1 cell line was tested and shown to be suitable for the stable expression of functional P450c21. We have established cell lines derived from Rat-1 either normal or mutant P450c21 stably expressed together with amplifiable markers. The expression of P450c21 was further increased by selection in methotrexate.
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Affiliation(s)
- M H Ricketts
- Institute of Molecular Biology, Academia Sinica, Nankang, Taipei, Taiwan, Republic of China
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15
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Hoekstra MF, Burbee D, Singer J, Mull E, Chiao E, Heffron F. A Tn3 derivative that can be used to make short in-frame insertions within genes. Proc Natl Acad Sci U S A 1991; 88:5457-61. [PMID: 1647034 PMCID: PMC51892 DOI: 10.1073/pnas.88.12.5457] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A Tn3 derivative was constructed to make small in-frame insertions within genes. The transposon contains the URA3 gene, the tetA gene, a truncated lacZ, and phage P1 loxP recombination sites at either end. Insertions that have fused lacZ to an open reading frame are lac+ because they express the truncated lacZ. In the presence of the phage P1 cyclization recombinase cre, the transposon can delete the URA3, tetA, and lacZ genes between the two loxP sites. The remaining short imperfect palindrome contains the ends of Tn3 and a loxP site and does not contain a translational termination codon in the correct reading frame. We have analyzed several insertions within the yeast HO gene. Several insertions inactivate HO and prohibit initiation of mating-type switching. In contrast, an epitope inserted in the central portion encodes a functional HO endonuclease.
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Affiliation(s)
- M F Hoekstra
- Molecular Biology/Virology Laboratory, Salk Institute, La Jolla, CA 92038
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16
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Abstract
Salmonella typhimurium is a facultative intracellular pathogen capable of surviving within host phagocytic cells. Salmonella strains carrying phoP mutations are avirulent, unable to survive in macrophages, and extremely sensitive to peptides having antimicrobial activity such as the host-derived defensins. We present here the DNA sequence of the phoP gene and show that the deduced amino acid sequence of phoP has extensive homology with the Escherichia coli transcriptional regulators PhoB and OmpR, which control the expression of loci in response to different environmental stimuli. The psiD locus, which is regulated by phosphate availability, was found to be under the control of the phoP gene product. Sequences homologous to phoP were found in several Gram-negative species and in the yeast Saccharomyces cerevisiae.
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Affiliation(s)
- E A Groisman
- Department of Molecular Biology, Scripps Clinic and Research Foundation, La Jolla, CA 92037
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