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Rana P, Aleo MD, Wen X, Kogut S. Hepatotoxicity reports in the FDA adverse event reporting system database: A comparison of drugs that cause injury via mitochondrial or other mechanisms. Acta Pharm Sin B 2021; 11:3857-3868. [PMID: 35024312 PMCID: PMC8727782 DOI: 10.1016/j.apsb.2021.05.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/24/2020] [Revised: 03/02/2021] [Accepted: 05/19/2021] [Indexed: 12/11/2022] Open
Abstract
Drug-induced liver injury (DILI) is a leading reason for preclinical safety attrition and post-market drug withdrawals. Drug-induced mitochondrial toxicity has been shown to play an essential role in various forms of DILI, especially in idiosyncratic liver injury. This study examined liver injury reports submitted to the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) for drugs associated with hepatotoxicity via mitochondrial mechanisms compared with non-mitochondrial mechanisms of toxicity. The frequency of hepatotoxicity was determined at a group level and individual drug level. A reporting odds ratio (ROR) was calculated as the measure of effect. Between the two DILI groups, reports for DILI involving mitochondrial mechanisms of toxicity had a 1.43 (95% CI 1.42-1.45; P < 0.0001) times higher odds compared to drugs associated with non-mitochondrial mechanisms of toxicity. Antineoplastic, antiviral, analgesic, antibiotic, and antimycobacterial drugs were the top five drug classes with the highest ROR values. Although the top 20 drugs with the highest ROR values included drugs with both mitochondrial and non-mitochondrial injury mechanisms, the top four drugs (ROR values > 18: benzbromarone, troglitazone, isoniazid, rifampin) were associated with mitochondrial mechanisms of toxicity. The major demographic influence for DILI risk was also examined. There was a higher mean patient age among reports for drugs that were associated with mitochondrial mechanisms of toxicity [56.1 ± 18.33 (SD)] compared to non-mitochondrial mechanisms [48 ± 19.53 (SD)] (P < 0.0001), suggesting that age may play a role in susceptibility to DILI via mitochondrial mechanisms of toxicity. Univariate logistic regression analysis showed that reports of liver injury were 2.2 (odds ratio: 2.2, 95% CI 2.12-2.26) times more likely to be associated with older patient age, as compared with reports involving patients less than 65 years of age. Compared to males, female patients were 37% less likely (odds ratio: 0.63, 95% CI 0.61-0.64) to be subjects of liver injury reports for drugs associated with mitochondrial toxicity mechanisms. Given the higher proportion of severe liver injury reports among drugs associated with mitochondrial mechanisms of toxicity, it is essential to understand if a drug causes mitochondrial toxicity during preclinical drug development when drug design alternatives, more clinically relevant animal models, and better clinical biomarkers may provide a better translation of drug-induced mitochondrial toxicity risk assessment from animals to humans. Our findings from this study align with mitochondrial mechanisms of toxicity being an important cause of DILI, and this should be further investigated in real-world studies with robust designs.
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Key Words
- AE, adverse event
- Adverse event reporting
- CI, confidence interval
- CNS, center nervous system
- DILI, drug-induced liver injury
- DNA, deoxyribonucleic acid
- Drug-induced liver injury
- FAERS database
- FAERS, FDA's Adverse Event Reporting System
- FDA, US Food and Drug Administration
- Hepatotoxicity
- MedDRA, Medical Dictionary for Regulatory Activities
- Mitochondrial toxicity
- NCTR-LTKB, National Center for Toxicological Research-Liver Toxicity Knowledge Base
- NSAID, nonsteroidal anti-inflammatory drugs
- ROR, Reporting Odds Ratio
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Affiliation(s)
- Payal Rana
- Drug Safety Research & Development, Pfizer, Groton, CT 06340, USA
- Corresponding author. Tel.: +1 0 715 6154.
| | - Michael D. Aleo
- Drug Safety Research & Development, Pfizer, Groton, CT 06340, USA
| | - Xuerong Wen
- University of Rhode Island, College of Pharmacy, Kingston, RI 02881, USA
| | - Stephen Kogut
- University of Rhode Island, College of Pharmacy, Kingston, RI 02881, USA
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Abstract
Objective Our objective is to describe how polydipsia and intake of nonsteroidal anti-inflammatory drugs (NSAIDs) after fasting while breastfeeding may result in acute symptomatic hyponatremia. Case Report We present the case of a 24-year-old woman at 4 weeks postpartum who engaged in a 20-hour fast from both eating and drinking, during which she continued to breastfeed her newborn child. After ending her fast, she noted decreased milk supply. Attributing her decreased milk supply to dehydration, she then consumed 4 L of water with little salt and also took NSAIDs for a headache, which continued to worsen. Upon presentation to the emergency department, she was found to have a sodium level of 124 mEq/L (normal, 135-145 mEq/L) and a urine specific gravity of 1.015 (normal, 1.005 – 1.030). Thyroid function and cortisol level test results were normal. She was diagnosed with acute symptomatic hypovolemic hyponatremia. After 1 L of normal saline her sodium rapidly corrected to normal and her symptoms resolved. At 2 months of follow-up she was asymptomatic and had no further episodes of hyponatremia. Discussion Due to the patient’s gender and small body size, 4 L of water was sufficient to lower her serum sodium rapidly from normal to 124 mEq/L. She was unable to excrete this water due to a combination of hypovolemia-mediated arginine vasopressin and NSAID use. Conclusion Clinicians should be cognizant that reproductive-age women are uniquely susceptible to hyponatremia and dangerous sequelae therein. They should counsel fasting individuals, particularly lactating women, to consume solute as well as fluid after fasting.
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Ferroni P, Zanzotto FM, Scarpato N, Spila A, Fofi L, Egeo G, Rullo A, Palmirotta R, Barbanti P, Guadagni F. Machine learning approach to predict medication overuse in migraine patients. Comput Struct Biotechnol J 2020; 18:1487-1496. [PMID: 32637046 PMCID: PMC7327028 DOI: 10.1016/j.csbj.2020.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 10/28/2019] [Revised: 05/19/2020] [Accepted: 06/05/2020] [Indexed: 11/23/2022] Open
Abstract
Machine learning (ML) is largely used to develop automatic predictors in migraine classification but automatic predictors for medication overuse (MO) in migraine are still in their infancy. Thus, to understand the benefits of ML in MO prediction, we explored an automated predictor to estimate MO risk in migraine. To achieve this objective, a study was designed to analyze the performance of a customized ML-based decision support system that combines support vector machines and Random Optimization (RO-MO). We used RO-MO to extract prognostic information from demographic, clinical and biochemical data. Using a dataset of 777 consecutive migraine patients we derived a set of predictors with discriminatory power for MO higher than that observed for baseline SVM. The best four were incorporated into the final RO-MO decision support system and risk evaluation on a five-level stratification was performed. ROC analysis resulted in a c-statistic of 0.83 with a sensitivity and specificity of 0.69 and 0.87, respectively, and an accuracy of 0.87 when MO was predicted by at least three RO-MO models. Logistic regression analysis confirmed that the derived RO-MO system could effectively predict MO with ORs of 5.7 and 21.0 for patients classified as probably (3 predictors positive), or definitely at risk of MO (4 predictors positive), respectively. In conclusion, a combination of ML and RO - taking into consideration clinical/biochemical features, drug exposure and lifestyle - might represent a valuable approach to MO prediction in migraine and holds the potential for improving model precision through weighting the relative importance of attributes.
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Key Words
- AI, Artificial Intelligence
- AUC, Area Under the Curve
- Artificial intelligence
- BMI, body mass index
- CI, Confidence Interval
- DBH 19-bp I/D polymorphism, Dopamine-Beta-Hydroxylase 19 bp insertion/deletion polymorphism
- DSS, Decision Support System
- Decision support systems
- ICT, Information and Communications Technology
- KELP, Kernel-based Learning Platform
- LRs, likelihood ratios
- MKL, Multiple Kernel Learning
- ML, Machine Learning
- MO, Medication Overuse
- Machine learning
- Medication overuse
- Migraine
- NSAID, nonsteroidal anti-inflammatory drugs
- PVI, Predictive Value Imputation
- RO, Random Optimization
- ROC, Receiver operating characteristic
- SE, Standard Error
- SVM, Support Vector Machine
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Affiliation(s)
- Patrizia Ferroni
- BioBIM (InterInstitutional Multidisciplinary Biobank), IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Rome, Italy
- Dept. of Human Sciences & Quality of Life Promotion, San Raffaele Roma Open University, Via di Val Cannuta 247, 00166 Rome, Italy
| | - Fabio M. Zanzotto
- Department of Enterprise Engineering, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Noemi Scarpato
- Dept. of Human Sciences & Quality of Life Promotion, San Raffaele Roma Open University, Via di Val Cannuta 247, 00166 Rome, Italy
| | - Antonella Spila
- BioBIM (InterInstitutional Multidisciplinary Biobank), IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Rome, Italy
| | - Luisa Fofi
- Headache and Pain Unit, Dept. of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Rome, Italy
| | - Gabriella Egeo
- Headache and Pain Unit, Dept. of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Rome, Italy
| | - Alessandro Rullo
- Neatec S.p.A., Via Campi Flegrei, 34, 80078 Pozzuoli, Naples, Italy
| | - Raffaele Palmirotta
- Department of Biomedical Sciences & Human Oncology, University of Bari ‘Aldo Moro’, Bari, Italy
| | - Piero Barbanti
- Dept. of Human Sciences & Quality of Life Promotion, San Raffaele Roma Open University, Via di Val Cannuta 247, 00166 Rome, Italy
- Headache and Pain Unit, Dept. of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Rome, Italy
| | - Fiorella Guadagni
- BioBIM (InterInstitutional Multidisciplinary Biobank), IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166 Rome, Italy
- Dept. of Human Sciences & Quality of Life Promotion, San Raffaele Roma Open University, Via di Val Cannuta 247, 00166 Rome, Italy
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Draghiciu O, Lubbers J, Nijman HW, Daemen T. Myeloid derived suppressor cells-An overview of combat strategies to increase immunotherapy efficacy. Oncoimmunology 2015; 4:e954829. [PMID: 25949858 PMCID: PMC4368153 DOI: 10.4161/21624011.2014.954829] [Citation(s) in RCA: 188] [Impact Index Per Article: 20.9] [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: 06/16/2014] [Accepted: 07/07/2014] [Indexed: 01/08/2023] Open
Abstract
Myeloid-derived suppressor cells (MDSCs) contribute to tumor-mediated immune escape and negatively correlate with overall survival of cancer patients. Nowadays, a variety of methods to target MDSCs are being investigated. Based on the intervention stage of MDSCs, namely development, expansion and activation, function and turnover, these methods can be divided into: (I) prevention or differentiation to mature cells, (II) blockade of MDSC expansion and activation, (III) inhibition of MDSC suppressive activity or (IV) depletion of intratumoral MDSCs. This review describes effective mono- or multimodal-therapies that target MDSCs for the benefit of cancer treatment.
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Key Words
- 5-FU, 5-fluorouracil
- 5-Fluorouracil
- ADAM17, metalloproteinase domain-containing protein 17
- APCs, antigen presenting cells
- ARG1, arginase-1
- ATRA, all-trans retinoic acid
- CCL2, chemokine (C-C motif) ligand 2
- CD62L, L-selectin
- CDDO-Me, bardoxolone methyl
- COX2, cyclooxygenase 2
- CTLs, cytotoxic T lymphocytes
- CXCL12, chemokine (C-X-C motif) ligand 12
- CXCL15, chemokine (C-X-C motif) ligand 15
- DCs, dendritic cells
- ERK1/2, extracellular signal-regulated kinases
- Flt3, Fms-like tyrosine kinase 3
- FoxP3, forkhead box P3
- GITR, anti-glucocorticoid tumor necrosis factor receptor
- GM-CSF/CSF2, granulocyte monocyte colony stimulating factor
- GSH, glutathione
- HIF-1α, hypoxia inducible factor 1α
- HLA, human leukocyte antigen
- HNSCC, head and neck squamous cell carcinoma
- HPV-16, human papillomavirus 16
- HSCs, hematopoietic stem cells
- ICT, 3, 5, 7-trihydroxy-4′-emthoxy-8-(3-hydroxy-3-methylbutyl)-flavone
- IFNγ, interferon γ
- IL-10, interleukin 10
- IL-13, interleukin 13
- IL-1β, interleukin 1 β
- IL-4, interleukin 4
- IL-6, interleukin 6
- IMCs, immature myeloid cells
- JAK2, Janus kinase 2
- MDSCs, myeloid-derived suppressor cells
- MMPs, metalloproteinases (e.g., MMP9)
- Myd88, myeloid differentiation primary response protein 88
- NAC, N-acetyl cysteine
- NADPH, nicotinamide adenine dinucleotide phosphate-oxidase NK cells, natural killer cells
- NO, nitric oxide
- NOHA, N-hydroxy-L-Arginine
- NSAID, nonsteroidal anti-inflammatory drugs
- ODN, oligodeoxynucleotides
- PDE-5, phosphodiesterase type 5
- PGE2, prostaglandin E2
- RNS, reactive nitrogen species
- ROS, reactive oxygen species
- SCF, stem cell factor
- STAT3, signal transducer and activator of transcription 3
- TAMs, tumor-associated macrophages
- TCR, T cell receptor
- TGFβ, transforming growth factor β
- TNFα, tumor necrosis factor α
- Tregs, regulatory T cells
- VEGFR, vascular endothelial growth factor receptor
- WA, withaferin A
- WRE, Withaferin somnifera
- all-trans retinoic acid
- bisphosphonates
- c-kit, Mast/stem cell growth factor receptor
- gemcitabine
- iNOS2, inducible nitric oxid synthase 2
- immune suppressive mechanisms
- mRCC, metastatic renal cell carcinoma
- myeloid-derived suppressor cells
- sunitinib therapeutic vaccination
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Affiliation(s)
- Oana Draghiciu
- Department of Medical Microbiology; Tumor Virology and Cancer Immunotherapy; University of Groningen; University Medical Center Groningen ; Groningen, The Netherlands
| | - Joyce Lubbers
- Department of Medical Microbiology; Tumor Virology and Cancer Immunotherapy; University of Groningen; University Medical Center Groningen ; Groningen, The Netherlands
| | - Hans W Nijman
- Department of Gynecology; University of Groningen; University Medical Center Groningen ; Groningen, The Netherlands
| | - Toos Daemen
- Department of Medical Microbiology; Tumor Virology and Cancer Immunotherapy; University of Groningen; University Medical Center Groningen ; Groningen, The Netherlands
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