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Telerman A, Granot G, Leibovitch C, Yarchovsky-Dolberg O, Shacham-Abulafia A, Partouche S, Yeshurun M, Ellis MH, Raanani P, Wolach O. Neutrophil Extracellular Traps Are Increased in Chronic Myeloid Leukemia and Are Differentially Affected by Tyrosine Kinase Inhibitors. Cancers (Basel) 2021; 14:cancers14010119. [PMID: 35008283 PMCID: PMC8750902 DOI: 10.3390/cancers14010119] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/13/2021] [Accepted: 12/24/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Neutrophil extracellular traps (NETs) are a recently described form of neutrophil cellular death that has been associated with a thrombotic tendency in many diseases. We studied NET formation in neutrophils derived from patients with chronic myeloid leukemia (CML) and in CML neutrophil cell lines and demonstrated that NETs are increased in CML and that certain drugs used to treat CML (tyrosine kinase inhibitors—TKIs) increase NET formation. These findings may shed light on a novel mechanism linking CML, TKIs and vascular toxicity. Abstract Cardiovascular complications are increasingly reported with the use of certain tyrosine kinase inhibitors (TKIs) to treat chronic myeloid leukemia (CML). We studied neutrophil extracellular trap (NET) formation in CML and evaluated the effect of TKIs on NET formation. Neutrophils isolated from treatment-naïve patients with CML showed a significant increase in NET formation compared to matched controls at baseline and after stimulation with ionomycin (IO) and phorbol 12-myristate 13-acetate (PMA). Expression of citrullinated histone H3 (H3cit), peptidyl arginine deiminase 4 (PAD4) and reactive oxygen species (ROS) was significantly higher in CML samples compared to controls. Pre-treatment of neutrophils with TKIs was associated with a differential effect on NET formation, and ponatinib significantly augmented NET-associated elastase and ROS levels as compared to controls and other TKIs. BCR-ABL1 retroviral transduced HoxB8-immortalized mouse hematopoietic progenitors, which differentiate into neutrophils in-vitro, demonstrated increased H3cit & myeloperoxidase (MPO) expression consistent with excess NET formation. This was inhibited by Cl-amidine, a PAD4 inhibitor, but not by the NADPH inhibitor diphenyleneiodonium (DPI). Ponatinib pre-exposure significantly increased H3cit expression in HoxB8-BCR-ABL1 cells after stimulation with IO. In summary, CML is associated with increased NET formation, which is augmented by ponatinib, suggesting a possible role for NETs in promoting vascular toxicity in CML.
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Affiliation(s)
- Alona Telerman
- Felsenstein Medical Research Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva 4941492, Israel; (A.T.); (G.G.); (S.P.)
| | - Galit Granot
- Felsenstein Medical Research Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva 4941492, Israel; (A.T.); (G.G.); (S.P.)
| | - Chiya Leibovitch
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv 39040, Israel; (C.L.); (O.Y.-D.); (A.S.-A.); (M.Y.); (M.H.E.); (P.R.)
- Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Beilinson Hospital, Petah-Tikva 4941492, Israel
| | - Osnat Yarchovsky-Dolberg
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv 39040, Israel; (C.L.); (O.Y.-D.); (A.S.-A.); (M.Y.); (M.H.E.); (P.R.)
- Meir Medical Center, Hematology Institute and Blood Bank, Kfar Saba 4428164, Israel
| | - Adi Shacham-Abulafia
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv 39040, Israel; (C.L.); (O.Y.-D.); (A.S.-A.); (M.Y.); (M.H.E.); (P.R.)
- Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Beilinson Hospital, Petah-Tikva 4941492, Israel
| | - Shirly Partouche
- Felsenstein Medical Research Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva 4941492, Israel; (A.T.); (G.G.); (S.P.)
| | - Moshe Yeshurun
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv 39040, Israel; (C.L.); (O.Y.-D.); (A.S.-A.); (M.Y.); (M.H.E.); (P.R.)
- Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Beilinson Hospital, Petah-Tikva 4941492, Israel
| | - Martin H. Ellis
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv 39040, Israel; (C.L.); (O.Y.-D.); (A.S.-A.); (M.Y.); (M.H.E.); (P.R.)
- Meir Medical Center, Hematology Institute and Blood Bank, Kfar Saba 4428164, Israel
| | - Pia Raanani
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv 39040, Israel; (C.L.); (O.Y.-D.); (A.S.-A.); (M.Y.); (M.H.E.); (P.R.)
- Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Beilinson Hospital, Petah-Tikva 4941492, Israel
| | - Ofir Wolach
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv 39040, Israel; (C.L.); (O.Y.-D.); (A.S.-A.); (M.Y.); (M.H.E.); (P.R.)
- Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Beilinson Hospital, Petah-Tikva 4941492, Israel
- Correspondence: ; Tel.: +972-50-406-5590
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Leader A, Benyamini N, Gafter-Gvili A, Dreyer J, Calvarysky B, Amitai A, Yarchovsky-Dolberg O, Sharf G, Tousset E, Caspi O, Ellis M, Levi I, De Geest S, Raanani P. Effect of Adherence-enhancing Interventions on Adherence to Tyrosine Kinase Inhibitor Treatment in Chronic Myeloid Leukemia (TAKE-IT): A Quasi-experimental Pre–Post Intervention Multicenter Pilot Study. Clinical Lymphoma Myeloma and Leukemia 2018; 18:e449-e461. [DOI: 10.1016/j.clml.2018.06.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/08/2018] [Accepted: 06/19/2018] [Indexed: 01/28/2023]
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Leader A, Gafter-Gvili A, Benyamini N, Dreyer J, Calvarysky B, Amitai A, Yarchovsky-Dolberg O, Sharf G, Tousset E, Caspi O, Ellis M, Levi I, Raanani P, De Geest S. Identifying Tyrosine Kinase Inhibitor Nonadherence in Chronic Myeloid Leukemia: Subanalysis of TAKE-IT Pilot Study. Clin Lymphoma Myeloma Leuk 2018; 18:e351-e362. [PMID: 30122203 DOI: 10.1016/j.clml.2018.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/07/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND There are inconsistencies in reports on correlates for nonadherence (NA) to tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML). The diagnostic accuracy of subjective adherence measures using electronic monitoring (EM) as the reference standard is yet to be determined. This study aimed to evaluate correlates of TKI NA using EM and test the diagnostic accuracy of subjective adherence measures. PATIENTS AND METHODS CML patients receiving a TKI for any duration were enrolled at 4 hematology institutes, and adherence was measured for 4 months. EM adherence was the reference adherence measure, expressed as the percentage of days with the drug taken as prescribed. Subjective adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) self-report and clinician-reported visual analog scale (VAS) at 2 time points. Baseline theory-derived correlates of NA were identified using single and multiple regression analysis. The diagnostic accuracy of BAASIS and clinician-reported VAS was tested against an exploratory EM NA cutoff of < 95%. RESULTS The median EM adherence (n = 55) was 97.5% (range, 48-100%), while the 25th percentile was 92.1%. Lack of membership in a CML patient support group, living alone, and third-line treatment were associated with EM NA on multiple regression analysis. The BAASIS self-report (n = 94) had a sensitivity of 67% and a specificity of 71% for diagnosing NA, while clinician-reported VAS (n = 89) had a sensitivity of 78% and specificity of 42%. CONCLUSION A quarter of patients had potentially clinically meaningful NA. These NA correlates and the BAASIS provide a basis for identifying nonadherent patients who can be targeted by interventions.
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Affiliation(s)
- Avi Leader
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
| | - Anat Gafter-Gvili
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Israel; Department of Medicine A, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Noam Benyamini
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Juliet Dreyer
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Bronya Calvarysky
- Department of Pharmacy, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Alina Amitai
- Department of Pharmacy, Meir Medical Center, Kfar Saba, Israel
| | - Osnat Yarchovsky-Dolberg
- Sackler School of Medicine, Tel Aviv University, Israel; Hematology Institute and Blood Bank, Meir Medical Center, Kfar Saba, Israel
| | - Giora Sharf
- Israeli CML Patients Organization, Netanya, Israel
| | | | - Opher Caspi
- Sackler School of Medicine, Tel Aviv University, Israel; Integrative medicine and Cancer Survivorship Program; Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Martin Ellis
- Sackler School of Medicine, Tel Aviv University, Israel; Integrative medicine and Cancer Survivorship Program; Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Itai Levi
- Hematology Institute, Soroka University Medical Center, Beer-Sheva, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; Academic Center of Nursing and Midwifery, Department Public Health and Primary Care, KU Leuven, Belgium
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Abstract
Immune thrombocytopenia (ITP) is a rare autoimmune disorder with an incidence of 3 to 5 per 100 000 individuals. In children, the disease is self-limited and is most commonly virus related (acute ITP) whereas in adults, the disease is typically chronic. The age distribution of adult ITP displays 2 peaks; the first in younger adults aged 18 to 40 with a female predominance and the second in people aged older than 60 with men and women affected equally. Our approach to ITP has evolved over the past several years: there has been a change in nomenclature and ITP now denotes “immune thrombocytopenia” (the “I” no longer denoting “idiopathic”) and “purpura” no longer features in the name of the disease; new insights into the pathogenesis of ITP have revealed the importance of impaired megakaryocytopoiesis in the condition; underlying mechanisms of secondary ITP have been elucidated and finally novel thrombopoietic agents have been shown to be effective in the treatment of ITP in randomized clinical trials. In this article, we review important recent advances in the pathogenesis and treatment of ITP.
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Affiliation(s)
- Uri Abadi
- Hematology Institute, Meir Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Yarchovsky-Dolberg
- Hematology Institute, Meir Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Martin H. Ellis
- Hematology Institute, Meir Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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