Clozapine treatment during the COVID-19 pandemic

Introduction

Clozapine is an effective antipsychotic used in treatment-resistant schizophrenia. One of the serious complications of clozapine therapy is agranulocytosis, therefore regular monitoring of the level of white blood cells (WBC) in plasma is necessary. During acute inflammatory infections, including the COVID-19 infection, levels of clozapine may increase, by the CYP 450 system, leading to adverse effects such as sedation, hypersalivation and consequently to aspiration pneumonia.

Objectives

The aim of the study is to assess the validity of continuing clozapine treatment during the COVID-19 pandemic.

Methods

Brief literature review, based on research of scientific articles published in PubMed, using as keywords the terms “clozapine” and “COVID-19”.

Results

Research studies indicate that SARS-COV2 infection in patients treated with clozapine does not significantly reduce the level of neutrophils, despite commonly observed leucopenia with lymphopenia. Due to pandemic, existing WBC scheme has been modified with a trend towards less frequent measurements. To minimize the side effects of clozapine during infection, it is recommended to reduce the dose of clozapine by half and continue lower dose until 3 days after fever has subsided. Additionally, there have been reports of psychosis recurrence after discontinuation of clozapine causing difficulties in treatment COVID-19 as also comorbid mental disease.

Conclusions

Treatment of clozapine is associated with higher risk of COVID-19 complications and at the same time COVID-19 infection may increase clozapine toxicity. Therefore, the risks of COVID-19 infection present a challenge for safe clozapine use. Further research will be needed to assess these dependencies and strategies.

Disclosure

No significant relationships.

Biochemical markers of depression - an up-to-date review

Introduction

Depression or Major Depressive Disorder (MDD) is the most prevalent psychiatric disorder and a leading cause of disability worldwide. Currently affecting around 300 million people worldwide, depression is a major clinical, emotional, and socioeconomic strain for society. There is a growing interest in the biological underpinnings of depression, which are reflected by altered levels of biomarkers.

Objectives

The aim of the study was to present an up-to-date review of potential MDD biomarkers.

Methods

PubMed, Scopus, and Web of Science databases were searched.

Results

Enhanced inflammation has been reported in MDD, as reflected by increased concentrations of inflammatory markers – interleukin-6, C-reactive protein, tumor necrosis factor-α, and soluble interleukin-2 receptor. Dysregulation of the hypothalamus-pituitary-adrenals axis, along with increased cortisol levels, have also been reported in MDD. Oxidative and nitrosative stress also plays an important role in the pathophysiology of MDD. Notably, increased levels of lipid peroxidation markers are characteristic of MDD. Kynurenine metabolites, increased glutamate and decreased total cholesterol are also features of MDD. Finally, alterations in growth factors, with a significant decrease in brain-derived neurotrophic factor and an increase in fibroblast growth factor-2 and insulin-like growth factor-1 concentrations have also been found in MDD.

Conclusions

A group of substances holds promise as reliable biomarkers for MDD. However, biomarker research in depression faces many difficulties, such as insufficient understanding of MDD etiopathogenesis, substantial heterogeneity of the disorder and low specificity of biomarkers. The construction of biomarker panels and their evaluation with use of new technologies may have the potential to overcome the above mentioned obstacles.

Disclosure

No significant relationships.

The use of light, temperature and pressure in the treatment of depression

Introduction

Climate and weather have a great influence on the prevalence of depressive disorders. Selected physical parameters for instance light, temperature and pressure can be used to treat mood disorders.

Objectives

The present mini-review aims at approximating the mechanisms by which selected, strictly controlled physical parameters in particular light, temperature, and oxygen pressure can help in the treatment of depression and determine their potential effectiveness.

Methods

Relevant literature was identified by searching the PubMed/Medline database, by combining the search strategy of free text terms and exploding a range of MESH headings relating to the topics.

Results

Mechanisms that can modify the course of depression were briefly presented. Review of the literature showed the well-established position of bright light therapy (BLT) effective in treating seasonal (SAD) and non-seasonal affective disorders (non-SAD); safety and rapid-action of whole-body hyperthermia (WBH) and whole-body cryotherapy (WBC) were also demonstrated; the least data was available on hyperbaric oxygen therapy (HBOT), which had antidepressant properties only in people with concomitant neurological damages.

Conclusions

In addition to the well-established position of BLT in the treatment of depression, further research is needed on other methods, such as WBH, WBC, HBOT.

Disclosure

No significant relationships.

Plasma Concentrations of Matrilysins MMP-7 and MMP-26 as Diagnostic Biomarkers in Breast Cancer

Metalloproteinases (MMPs) are a group of proteolytic enzymes involved in the maintenance of a proper structure of extracellular matrix (ECM). Matrilysins (MMP-7 and MMP-26) are members of the MMPs group that show promise as potential breast cancer (BC) markers. The aim of the study was to evaluate plasma levels of MMP-7, MMP-26 and CA 15-3 individually and in combination and assess the diagnostic utility of studied matrilysins in patients with BC. The study group consisted of 120 patients with BC, and the control group consisted of 40 subjects with benign breast cancer and 40 healthy women. Concentrations of MMP-7 and MMP-26 were determined by enzyme-linked immunosorbent assay, and CA 15-3 by chemiluminescent microparticle immunoassay. Plasma levels of MMP-7 were significantly higher in the BC group than in the control group. Concentrations of MMP-26 and CA 15-3 were highest in stages II and IV of the disease. The highest diagnostic sensitivity was observed in stages III and IV BC for the combination of all tested markers (92.5%). The highest diagnostic specificity was noted for all tested parameters combined in the BC group (95.0%). The area under the receiver operating characteristic (ROC) curve (AUC) for the combination of markers (MMP-7+MMP-26+CA 15-3) was the largest (0.9138) in stages III and IV. Individual marker analysis showed that MMP-7 had the highest AUC (0.8894) in advanced stages of the disease. Study results indicate that MMP-7 could be used as an additional marker that would improve the diagnostic utility of CA 15-3 in early stages of BC. Therefore, the combined assessment of MMP-7 and MMP-26 with CA 15-3 might be useful in determining disease progression. Further studies are needed to evaluate whether matrilysins show promise as potential markers for improving the diagnosis of BC.

Plasma Level of MMP-10 May Be a Prognostic Marker in Early Stages of Breast Cancer

Background: Stromelysins are potential breast cancer biomarkers. The aim of the study was to evaluate if plasma levels of selected metalloproteinases (MMPs) (stromelysin-1 (MMP-3) and stromelysin-10 (MMP-10)) and cancer antigen 15-3 (CA 15-3) used separately and in combination demonstrated diagnostic usefulness in breast cancer (BC). Methods: The study group consisted of 120 patients with BC, while the control group included 40 patients with benign breast cancer and 40 healthy individuals. Concentrations of MMP-3 and MMP-10 were determined by enzyme-linked immunosorbent assay; CA 15-3 was determined by chemiluminescent microparticle immunoassay. Results: In the group of patients with BC, the area under the curve (AUC) was significantly higher for all markers (except MMP-3) and all sets of markers. At the earliest disease stage, only MMP-10 had a significantly higher AUC (AUC = 0.8692, p < 0.001). Moreover, MMP-10 had the highest AUC (0.9166) among parameters tested separately. The highest AUC was observed for the combination of MMP-10 + CA 15-3 and MMP-3 + MMP-10 + CA 15-3 in line with disease progression (stage I 0.8884 and 0.8906, stage II 0.9244 and 0.9308, stages III + IV 0.9919 and 0.9944, respectively, p < 0.001 in all cases). Conclusions: The results suggest that MMP-10 could be a potential marker in early stages of BC. Moreover, plasma concentration of MMP-10 and MMP-3 in combination with CA 15-3 may improve diagnosis of this type of cancer.

C-C motif chemokine ligand 5 and C-C chemokine receptor type 5: possible diagnostic application in breast cancer patients

The chemokine CCL5 and its receptor CCR5 play important roles in cancer invasion and metastasis. Based on our knowledge, our results were the first that presented the diagnostic usefulness of CCL5 and CCR5 in breast cancer (BC) patients, based on receiver operating characteristic (ROC) curve analysis. We wished to examine further if CCL5 and CCR5 are appropriate to be applied as BC markers for early screening. Values of tested parameters in patients' plasma were determined by CMIA method (Chemiluminescent Microparticle Immunoassay, CA 15-3) as well as by ELISA method (Enzyme-Linked Immunosorbent Assay, CCL5 and CCR5). Levels of CCL5 in the plasma were markedly increased, while those of CCR5 were remarkably lower in BC patients when compared to the control groups. Moreover, higher levels of CCL5 in BC corresponded to advanced tumor stage, while the levels of CCR5 decreased with increasing the disease stage. CCL5 concentration was characterized by high sensitivity (SE) (68.04%) and high specificity (SP) (100.00%) in the BC patients. Results indicated that area under the curve (AUC) corresponding to CCL5 (0.8116) had a higher value than this corresponding to CA 15-3. The AUC value of CCL5 was significantly increased in the early phase of BC (stage I - 0.7089; stage II - 0.8313). The maximum range in the BC patients was observed for the combined analysis of the tested measurands with CA 15-3 (0.8335). In conclusion, our research indicates that examination of plasma CCL5 and CCR5 may be useful in BC diagnosis at the early stage of the disorder, especially when combined with CA 15-3.

Matrilysins and Stromelysins in Pathogenesis and Diagnostics of Cancers

Matrix metalloproteinases (MMPs) are endopeptidases which are widely studied in terms of their role in the physiological and pathological processes in the organism. In this article, we consider usefulness of matrilysins and stromelysins in pathogenesis and diagnostic of the most common malignancies in the world, e.g., lung, breast, prostate, and colorectal cancers. In all of the mentioned cancers, matrilysins and stromelysins have a pivotal role in their development and also may have diagnostic utility. Influence to the cancerous process is connected with specific dependencies between these enzymes and components of the extracellular matrix (ECM), non-matrix components like cell surface components. All the information provided below allows to take a closer look at matrilysins and stromelysins and their functions in the cancer development.

Possible Diagnostic Application of CXCL12 and CXCR4 as Tumor Markers in Breast Cancer Patients

BACKGROUND/AIM

Chemokines are cytokines involved not only in inflammatory but also in inappropriate response of the immune system in breast cancer (BC) progression. We examined the diagnostic usefulness of CXCL12, CXCR4 and CA 15-3 in BC patients, based on ROC curve analysis.

MATERIALS AND METHODS

The study group consisted of 100 patients with BC; the control group consisted of 35 women with benign breast disease and 35 healthy patients. The median concentration of chemokines was measured by ELISA and that of CA 15-3 by chemiluminescent microparticle immunoassay.

RESULTS

The concentrations of CXCL12 and CXCR4 in the BC group were significantly higher than those in the control groups. The AUC value of CXCL12 (0.7502) was the highest of all the chemokines measured in the BC patients.

CONCLUSION

There may be a link between CXCL12, CXCR4 and BC that can assist in the diagnosis, markedly when combined with CA 15-3.

Plasma Levels and Tissue Expression of Selected Cytokines, Metalloproteinases and Tissue Inhibitors in Patients With Cervical Cancer

BACKGROUND

Cytokines, metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) take part in many processes involved in tumor progression and invasion such as degradation of the extracellular matrix, influence on immune cells associated with tumor tissue, and angiogenesis. Thus, the aim of this study was to compare the concentration of plasma levels and tissue expression of macrophage colony-stimulating factor (M-CSF), vascular endothelial growth factor (VEGF), matrix metalloproteinases (MMP)-2 and MMP9, and their tissue inhibitors TIMP1 and TIMP2 in patients with cervical cancer, patients with high-grade cervical intraepithelial dysplasia (CIN3) and patients with ectropion.

PATIENTS AND METHODS

Concentration and expression of all tested parameters was measured in serum with enzyme-linked immunosorbent assay (ELISA) and in tissue with immunohistochemistry method.

RESULTS

The epithelial expression of M-CSF and TIMP1 in cancer tissue was much stronger as compared to that in ectropion and CIN3. In the case of MMP2, lack of or weak expression in epithelial cells was observed in all tested groups. Our studies showed statistical differences of tested parameters in tissue expression and in plasma concentrations in patients with cervical cancer, patients with CIN3 and patients with ectropion. Moreover, data revealed positive correlation between plasma level and cervical cancer cell expression of VEGF.

CONCLUSION

Our findings indicate a potential role of all the proteins tested here in cervical cancer diagnosis, especially VEGF. However, further studies will show whether they play a role in the progression of cancerous changes in epithelial tissue of the cervix.