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Marinkovic M, Tran ON, Wang H, Abdul-Azees P, Dean DD, Chen XD, Yeh CK. Autologous mesenchymal stem cells offer a new paradigm for salivary gland regeneration. Int J Oral Sci 2023; 15:18. [PMID: 37165024 PMCID: PMC10172302 DOI: 10.1038/s41368-023-00224-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/20/2023] [Accepted: 03/29/2023] [Indexed: 05/12/2023] Open
Abstract
Salivary gland (SG) dysfunction, due to radiotherapy, disease, or aging, is a clinical manifestation that has the potential to cause severe oral and/or systemic diseases and compromise quality of life. Currently, the standard-of-care for this condition remains palliative. A variety of approaches have been employed to restore saliva production, but they have largely failed due to damage to both secretory cells and the extracellular matrix (niche). Transplantation of allogeneic cells from healthy donors has been suggested as a potential solution, but no definitive population of SG stem cells, capable of regenerating the gland, has been identified. Alternatively, mesenchymal stem cells (MSCs) are abundant, well characterized, and during SG development/homeostasis engage in signaling crosstalk with the SG epithelium. Further, the trans-differentiation potential of these cells and their ability to regenerate SG tissues have been demonstrated. However, recent findings suggest that the "immuno-privileged" status of allogeneic adult MSCs may not reflect their status post-transplantation. In contrast, autologous MSCs can be recovered from healthy tissues and do not present a challenge to the recipient's immune system. With recent advances in our ability to expand MSCs in vitro on tissue-specific matrices, autologous MSCs may offer a new therapeutic paradigm for restoration of SG function.
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Affiliation(s)
- Milos Marinkovic
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Research Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Olivia N Tran
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Hanzhou Wang
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Parveez Abdul-Azees
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Research Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - David D Dean
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Biomedical Engineering, University of Texas at San Antonio, San Antonio, TX, USA
| | - Xiao-Dong Chen
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
- Research Service, South Texas Veterans Health Care System, San Antonio, TX, USA.
- Department of Biomedical Engineering, University of Texas at San Antonio, San Antonio, TX, USA.
| | - Chih-Ko Yeh
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
- Geriatric Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, TX, USA.
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A novel cell-based transplantation method using a Rho kinase inhibitor and a specific catheter device for the treatment of salivary gland damage after head and neck radiotherapy. Biochem Biophys Rep 2022; 32:101385. [DOI: 10.1016/j.bbrep.2022.101385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022] Open
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Fat Grafting in Radiation-Induced Soft-Tissue Injury: A Narrative Review of the Clinical Evidence and Implications for Future Studies. Plast Reconstr Surg 2021; 147:819-838. [PMID: 33776031 DOI: 10.1097/prs.0000000000007705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
SUMMARY Radiation-induced changes in skin and soft tissue result in significant cosmetic and functional impairment with subsequent decrease in quality of life. Fat grafting has emerged as a therapy for radiation-induced soft-tissue injury, and this narrative review aims to evaluate the current clinical evidence regarding its efficacy. A review was conducted to examine the current clinical evidence of fat grafting as a therapy for radiation-induced injury to the skin and soft tissue and to outline the clinical outcomes that can be used to more consistently quantify chronic radiation-induced injury in future clinical studies. The current clinical evidence regarding the efficacy of fat grafting to treat radiation-induced injury of the skin and soft tissue suggests that fat grafting increases skin softness and pliability, induces volume restoration, improves hair growth in areas of alopecia, reduces pain, and improves cosmetic and functional outcomes. However, literature in this field is far from robust and mired by the retrospective nature of the studies, lack of adequate controls, and inherent limitations of small case series and cohorts. A series of actions have been identified to strengthen future clinical data, including the need for physical examination using a validated scale, appropriate imaging, skin biomechanics and microcirculation testing, and histologic analysis. In conclusion, radiation-induced soft-tissue injury is a significant health burden that can lead to severe functional and aesthetic sequelae. Although still in a preliminary research phase, there is promising clinical evidence demonstrating the benefits of fat grafting to treat chronic changes after radiation therapy. Future clinical studies will require larger cohorts, adequate controls, and consistent use of objective measurements.
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Shaw SM, Skoretz SA, O'Sullivan B, Hope A, Liu LWC, Martino R. Valid and reliable techniques for measuring fibrosis in patients with head and neck cancer postradiotherapy: A systematic review. Head Neck 2015; 38 Suppl 1:E2322-34. [DOI: 10.1002/hed.24249] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2015] [Indexed: 12/17/2022] Open
Affiliation(s)
- Stephanie M. Shaw
- Department of Speech-Language Pathology; University of Toronto; Ontario Canada
| | - Stacey A. Skoretz
- Department of Speech-Language Pathology; University of Toronto; Ontario Canada
- Mazankowski Alberta Heart Institute, Alberta Health Services; Alberta Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre; University Health Network; Ontario Canada
| | - Andrew Hope
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre; University Health Network; Ontario Canada
| | - Louis W. C. Liu
- Division of Gastroenterology, Department of Medicine, Toronto Western Hospital; University Health Network; Ontario Canada
| | - Rosemary Martino
- Department of Speech-Language Pathology; University of Toronto; Ontario Canada
- Department of Otolaryngology - Head and Neck Surgery; University of Toronto; Ontario Canada
- Health Care and Outcomes Research, Toronto Western Research Institute; University Health Network; Ontario Canada
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Ness AR, Waylen A, Hurley K, Jeffreys M, Penfold C, Pring M, Leary S, Allmark C, Toms S, Ring S, Peters TJ, Hollingworth W, Worthington H, Nutting C, Fisher S, Rogers SN, Thomas SJ. Establishing a large prospective clinical cohort in people with head and neck cancer as a biomedical resource: head and neck 5000. BMC Cancer 2014; 14:973. [PMID: 25519023 PMCID: PMC4301458 DOI: 10.1186/1471-2407-14-973] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 12/10/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Head and neck cancer is an important cause of ill health. Survival appears to be improving but the reasons for this are unclear. They could include evolving aetiology, modifications in care, improvements in treatment or changes in lifestyle behaviour. Observational studies are required to explore survival trends and identify outcome predictors. METHODS We are identifying people with a new diagnosis of head and neck cancer. We obtain consent that includes agreement to collect longitudinal data, store samples and record linkage. Prior to treatment we give participants three questionnaires on health and lifestyle, quality of life and sexual history. We collect blood and saliva samples, complete a clinical data capture form and request a formalin fixed tissue sample. At four and twelve months we complete further data capture forms and send participants further quality of life questionnaires. DISCUSSION This large clinical cohort of people with head and neck cancer brings together clinical data, patient-reported outcomes and biological samples in a single co-ordinated resource for translational and prognostic research.
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Affiliation(s)
- Andrew Robert Ness
- />National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol and School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Andrea Waylen
- />School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Katrina Hurley
- />Surgical Research Team, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Mona Jeffreys
- />School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Chris Penfold
- />National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol and School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Miranda Pring
- />School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Sam Leary
- />National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol and School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Christine Allmark
- />National Cancer Research Institute Consumer Liaison Group (NCRI CLG) and Independent Cancer Patients Voice (ICPV), London, UK
| | - Stu Toms
- />National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol and School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Susan Ring
- />MRC Integrative Epidemiology Unit and Avon Longitudinal Study of Parents and Children, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tim J Peters
- />School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Will Hollingworth
- />School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Helen Worthington
- />Cochrane Oral Health Group, School of Dentistry, University of Manchester, Manchester, UK
| | - Chris Nutting
- />Royal Marsden Hospital and the Institute for Cancer Research, London, UK
| | - Sheila Fisher
- />Leeds Institute for Cancer and Pathology, University of Leeds, Leeds, UK
| | - Simon N Rogers
- />Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| | - Steven J Thomas
- />School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - The Head and Neck 5000 Study Team
- />National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol and School of Oral and Dental Sciences, University of Bristol, Bristol, UK
- />School of Oral and Dental Sciences, University of Bristol, Bristol, UK
- />Surgical Research Team, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- />School of Social and Community Medicine, University of Bristol, Bristol, UK
- />National Cancer Research Institute Consumer Liaison Group (NCRI CLG) and Independent Cancer Patients Voice (ICPV), London, UK
- />MRC Integrative Epidemiology Unit and Avon Longitudinal Study of Parents and Children, School of Social and Community Medicine, University of Bristol, Bristol, UK
- />School of Clinical Sciences, University of Bristol, Bristol, UK
- />Cochrane Oral Health Group, School of Dentistry, University of Manchester, Manchester, UK
- />Royal Marsden Hospital and the Institute for Cancer Research, London, UK
- />Leeds Institute for Cancer and Pathology, University of Leeds, Leeds, UK
- />Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, UK
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West C, Azria D, Chang-Claude J, Davidson S, Lambin P, Rosenstein B, De Ruysscher D, Talbot C, Thierens H, Valdagni R, Vega A, Yuille M. The REQUITE project: validating predictive models and biomarkers of radiotherapy toxicity to reduce side-effects and improve quality of life in cancer survivors. Clin Oncol (R Coll Radiol) 2014; 26:739-42. [PMID: 25267305 DOI: 10.1016/j.clon.2014.09.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 09/04/2014] [Indexed: 12/25/2022]
Affiliation(s)
- C West
- University of Manchester, Manchester, UK.
| | - D Azria
- University of Montpellier, Montpellier, France
| | - J Chang-Claude
- German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - S Davidson
- The Christie NHS Foundation Trust, Manchester, UK
| | - P Lambin
- University of Maastricht (Maastro-GROW), Maastricht, The Netherlands
| | - B Rosenstein
- Mount Sinai School of Medicine, New York, NY, USA
| | | | - C Talbot
- University of Leicester, Leicester, UK
| | | | - R Valdagni
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Vega
- Fundación Pública Galega Medicina Xenómica, Santiago de Compostela, Spain
| | - M Yuille
- University of Manchester, Manchester, UK
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Human salivary gland stem cells ameliorate hyposalivation of radiation-damaged rat salivary glands. Exp Mol Med 2013; 45:e58. [PMID: 24232257 PMCID: PMC3849572 DOI: 10.1038/emm.2013.121] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/06/2013] [Accepted: 08/28/2013] [Indexed: 11/09/2022] Open
Abstract
Salivary function in mammals may be defective for various reasons, such as aging, Sjogren's syndrome or radiation therapy in head and neck cancer patients. Recently, tissue-specific stem cell therapy has attracted public attention as a next-generation therapeutic reagent. In the present study, we isolated tissue-specific stem cells from the human submandibular salivary gland (hSGSCs). To efficiently isolate and amplify hSGSCs in large amounts, we developed a culture system (lasting 4–5 weeks) without any selection. After five passages, we obtained adherent cells that expressed mesenchymal stem cell surface antigen markers, such as CD44, CD49f, CD90 and CD105, but not the hematopoietic stem cell markers, CD34 and CD45, and that were able to undergo adipogenic, osteogenic and chondrogenic differentiation. In addition, hSGSCs were differentiated into amylase-expressing cells by using a two-step differentiation method. Transplantation of hSGSCs to radiation-damaged rat salivary glands rescued hyposalivation and body weight loss, restored acinar and duct cell structure, and decreased the amount of apoptotic cells. These data suggest that the isolated hSGSCs, which may have characteristics of mesenchymal-like stem cells, could be used as a cell therapy agent for the damaged salivary gland.
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Xu L, Yang X, Cai J, Ma J, Cheng H, Zhao K, Yang L, Cao Y, Qin Q, Zhang C, Zhang Q, Sun X. Resveratrol attenuates radiation-induced salivary gland dysfunction in mice. Laryngoscope 2013; 123:E23-9. [PMID: 23794219 DOI: 10.1002/lary.24276] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/04/2013] [Accepted: 06/04/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS In our study we investigated the radioprotective effect of resveratrol (RES) in a murine model of radiation-induced salivary gland dysfunction. STUDY DESIGN Ninety-six Institute of Cancer Research mice were randomly divided into four groups: solvent (group I), RES treated (group II; 20 mg/kg/d), 15 Gy irradiation with solvent treatment (group III), and 15 Gy irradiation with RES treatment (group IV; 15 Gy and 20 mg/kg/d RES). RES (group II and IV) was administered intraperitoneally 3 days prior to irradiation through the conclusion of the experiment. METHODS Saliva and submandibular gland tissues were obtained for biochemical, morphological, immunohistochemical, and Western blot analyses at 8 hours, 24 hours, and 30 days after localized irradiation. RESULTS Radiation caused a reduction of saliva secretion, salivary amylase activity, superoxide dismutase, and an elevation of malondialdehyde. Administration of RES reversed the reduction of saliva secretion induced by irradiation and restored salivary amylase and superoxide dismutase activity. In addition, RES could inhibit increases in transforming growth factor-β1 expression induced by radiation. CONCLUSIONS RES can protect salivary glands against the negative effects of irradiation and has great potential as a treatment for successful radiotherapy in clinical practice.
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Affiliation(s)
- Liping Xu
- The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu Province, China
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9
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Value of the Hospital Anxiety and Depression Scale in the follow up of head and neck cancer patients. The Journal of Laryngology & Otology 2013; 127:285-94. [PMID: 23398854 DOI: 10.1017/s0022215113000078] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Few studies have prospectively investigated psychological morbidity in UK head and neck cancer patients. This study aimed to explore changes in psychological symptoms over time, and associations with patients' tumour and treatment characteristics, including toxicity. METHODS Two hundred and twenty patients were recruited to complete the Hospital Anxiety and Depression Scale and the Late Effects on Normal Tissue (Subjective, Objective, Management and Analytic) ('LENT-SOMA') questionnaires, both pre- and post-treatment. RESULTS Anxiety was highest pre-treatment (38 per cent) and depressive symptoms peaked at the end of treatment (44 per cent). Anxiety significantly decreased and depression significantly increased, comparing pre- versus post-treatment responses (p < 0.001). Hospital Anxiety and Depression Scale scores were significantly correlated with toxicity, age and chemotherapy (p < 0.01 for all). CONCLUSION This is the first study to analyse the relationship between Hospital Anxiety and Depression Scale scores and toxicity scores in head and neck cancer patients. It lends support for the use of the Hospital Anxiety and Depression Scale and the Late Effects on Normal Tissue (Subjective, Objective, Management and Analytic) questionnaire in routine clinical practice; furthermore, continued surveillance is required at multiple measurement points.
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Digonnet A, Hamoir M, Andry G, Haigentz M, Takes RP, Silver CE, Hartl DM, Strojan P, Rinaldo A, de Bree R, Dietz A, Grégoire V, Paleri V, Langendijk JA, Vander Poorten V, Hinni ML, Rodrigo JP, Suárez C, Mendenhall WM, Werner JA, Genden EM, Ferlito A. Post-therapeutic surveillance strategies in head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 2012; 270:1569-80. [DOI: 10.1007/s00405-012-2172-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 08/15/2012] [Indexed: 12/17/2022]
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Tang B, Giuliani M, Le LW, Higgins J, Bezjak A, Brade A, Cho BCJ, Sun A, Hope AJ. Capturing acute toxicity data during lung radiotherapy by using a patient-reported assessment tool. Clin Lung Cancer 2012; 14:108-12. [PMID: 22885348 DOI: 10.1016/j.cllc.2012.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 06/12/2012] [Accepted: 06/26/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Comprehensive and accurate assessment of symptoms experienced by patients undergoing lung radiotherapy (RT) is challenging. This study aims to evaluate the feasibility and utility of collecting acute toxicity information by using a patient-reported instrument, the Thoracic Symptom Self-Assessment Tool (TSSAT). METHODS The TSSAT is based on the CTCAE v3.0(Common Toxicity Criteria of Adverse Events). All patients undergoing lung RT at our center from May 2008 to April 2009 were asked to complete the TSSAT on day 1 and weekly during RT. TSSAT scores were compared with clinician reporting of the same symptoms. Descriptive statistics and weighted kappa values were calculated to measure the agreement between patient- and clinician-reported acute toxicity. RESULTS Of 300 consecutive patients approached, 49% (148/300) completed the TSSAT at least once. Patient participation and compliance were associated with treatment intent; radical (87%) vs. palliative (25%); P = <.0001. The average data completion rate by patients was 72%, and the average toxicity documentation rate by clinicians was 67%. Agreement between patients and clinicians was fair to moderate for most symptoms; the majority (>79%) of the differences were within one grade. Patients reported greater severity than clinicians for subjective symptoms. Clinicians graded greater severity than patients for the more observable symptoms. CONCLUSIONS The TSSAT has been shown to be feasible and accepted by patients receiving radical dose RT. Patient-reported assessments may improve acute symptom management in the future.
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Affiliation(s)
- Brooke Tang
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada
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12
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Gene delivery in salivary glands: from the bench to the clinic. Biochim Biophys Acta Mol Basis Dis 2011; 1812:1515-21. [PMID: 21763423 DOI: 10.1016/j.bbadis.2011.06.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 06/22/2011] [Accepted: 06/22/2011] [Indexed: 12/11/2022]
Abstract
In vivo gene delivery has long been seen as providing opportunities for the development of novel treatments for disorders refractory to existing therapies. Over the last two decades, salivary glands have proven to be a useful, if somewhat unconventional, target tissue for studying several potential clinical applications of therapeutic gene delivery. Herein, we follow the progress, address some problems and assess the outlook for clinical applications of salivary gland gene delivery. Our experience with these tissues provides a roadmap for the process of moving an idea from the laboratory bench to patients.
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Zheng C, Cotrim AP, Rowzee A, Swaim W, Sowers A, Mitchell JB, Baum BJ. Prevention of radiation-induced salivary hypofunction following hKGF gene delivery to murine submandibular glands. Clin Cancer Res 2011; 17:2842-51. [PMID: 21367751 DOI: 10.1158/1078-0432.ccr-10-2982] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Salivary glands are significantly affected when head and neck cancer patients are treated by radiation. We evaluated the effect of human keratinocyte growth factor (hKGF) gene transfer to murine salivary glands on the prevention of radiation-induced salivary hypofunction. EXPERIMENTAL DESIGN A hybrid serotype 5 adenoviral vector encoding hKGF (AdLTR(2)EF1α-hKGF) was constructed. Female C3H mice, 8 weeks old, were irradiated by single (15 Gy) or fractionated (6 Gy for 5 days) doses to induce salivary hypofunction. AdLTR(2)EF1α-hKGF or AdControl was administered (10(8) - 10(10) particles per gland) to both submandibular glands (SG) by retrograde ductal instillation before irradiation (IR). Salivary flow was measured following pilocarpine stimulation. Human KGF levels were measured by ELISA. SG cell proliferation was measured with bromodeoxyuridine labeling. Endothelial and progenitor or stem cells in SGs were measured by flow cytometry. The effect of SG hKGF production on squamous cell carcinoma (SCC VII) tumor growth was assessed. RESULTS In 3 separate single-dose IR experiments, salivary flow rates of mice administered the AdLTR(2)EF1α-hKGF vector were not significantly different from nonirradiated control mice (P > 0.05). Similarly, in 3 separate fractionated IR experiments, the hKGF-expressing vector prevented salivary hypofunction dramatically. Transgenic hKGF protein was found at high levels in serum and SG extracts. AdLTR(2)EF1α-hKGF-treated mice showed increased cell proliferation and numbers of endothelial cells, compared with mice treated with AdControl. hKGF gene transfer had no effect on SCC VII tumor growth ± radiation. CONCLUSIONS hKGF gene transfer prevents salivary hypofunction caused by either single or fractionated radiation dosing in mice. The findings suggest a potential clinical application.
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Affiliation(s)
- Changyu Zheng
- Molecular Physiology and Therapeutics Branch, National Institute of Dental and Craniofacial Research, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland 20892-1190, USA
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Farnell DJ, Mandall P, Anandadas C, Routledge J, Burns MP, Logue JP, Wylie JP, Swindell R, Livsey J, West CM, Davidson SE. Development of a patient-reported questionnaire for collecting toxicity data following prostate brachytherapy. Radiother Oncol 2010; 97:136-42. [DOI: 10.1016/j.radonc.2010.05.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 04/28/2010] [Accepted: 05/06/2010] [Indexed: 11/29/2022]
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AAV2-mediated transfer of the human aquaporin-1 cDNA restores fluid secretion from irradiated miniature pig parotid glands. Gene Ther 2010; 18:38-42. [PMID: 20882054 PMCID: PMC3015016 DOI: 10.1038/gt.2010.128] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Previously (Shan et al, 2005), we reported that adenoviral vector-mediated transfer of the human aquaporin-1 (hAQP1) cDNA to minipig parotid glands following irradiation (IRti) transiently restored salivary flow to near normal levels. This study evaluated a serotype 2, adeno-associated viral (AAV2) vector for extended correction of IR (single dose; 20 Gy)-induced, parotid salivary hypofunction in minipigs. Sixteen weeks following IR, parotid salivary flow decreased by 85-90%. AAV2hAQP1 administration at week 17 transduced only duct cells and resulted in a dose-dependent increase in salivary flow to ∼35% of pre-IR levels (to ∼1ml/10min) after 8 weeks (peak response). Administration of a control AAV2 vector or saline, was without effect. Little change was observed in clinical chemistry and hematology values after AAV2hAQP1 delivery. Vector treated animals generated high anti-AAV2 neutralizing antibody titers by week 4 (∼1:1600) and significant elevations in salivary (∼15%), but not serum, GM-CSF levels. Following vector administration, salivary [Na+] was dramatically increased, from ∼10mM to ∼55 (at 4 weeks) and 39 mM (8 weeks). The findings demonstrate that localized delivery of AAV2hAQP1 to IR-damaged parotid glands leads to increased fluid secretion from surviving duct cells, and may be useful in providing extended relief of salivary hypofunction in previously irradiated patients.
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Ho KF, Farnell DJJ, Routledge JA, Burns MP, Sykes AJ, Slevin NJ, Davidson SE. Comparison of patient-reported late treatment toxicity (LENT-SOMA) with quality of life (EORTC QLQ-C30 and QLQ-H&N35) assessment after head and neck radiotherapy. Radiother Oncol 2010; 97:270-5. [PMID: 20554338 DOI: 10.1016/j.radonc.2010.01.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 12/09/2009] [Accepted: 01/29/2010] [Indexed: 01/23/2023]
Abstract
PURPOSE The patient's role in toxicity reporting is increasingly acknowledged but requires the adaptation and validation of toxicity reporting instruments for patient use as most toxicity scales are designed for physician use. Recording of radiotherapy related late toxicity is important and needs to be improved. A patient-scored symptom questionnaire of late treatment effects using LENT-SOMA was compared with a recognised quality of life tool (EORTC QLQ-C30/H&N35). MATERIALS/METHODS LENT-SOMA and EORTC QLQ-C30 patient questionnaires were prospectively completed by 220 head and neck cancer patients over 3 years and 72 completed EORTC QLQ-H&N35 questionnaires at 2 years post-radiotherapy. RESULTS Endpoints common to both questionnaires (pain, swallowing, dental pain, dry mouth, opening mouth, analgesics) were matched. Spearman rank correlation coefficients with ρ>0.6 (P<0.001) were obtained for all "matched" scales except for analgesics scale, ρ=0.267 (P<0.05). There was good agreement between LENT-SOMA and EORTC QLQ-H&N35 except for analgesic endpoints. Global quality of life scores correlated negatively with average LENT-SOMA scores (P<0.001). Significant differences in average LENT-SOMA scores between treatment modalities were found. The LENT-SOMA questionnaire has demonstrated a high Cronbach's α value (0.786) indicating good reliability. CONCLUSIONS LENT-SOMA patient questionnaire results agreed well with those from the EORTC QLQ-H&N35 questionnaire for toxicity items where they could be compared explicitly, particularly for subjective endpoints. Patient-reported late toxicity had a negative impact on quality of life. The LENT-SOMA patient questionnaire is both reliable and sensitive to differences between patients treated with different modalities. A patient-based questionnaire is an important contributor to capturing late radiotherapy effects.
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Affiliation(s)
- Kean Fatt Ho
- Academic Radiation Oncology, University of Manchester, The Christie NHS Foundation Trust, Manchester, UK.
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:134-45. [PMID: 20234215 DOI: 10.1097/moo.0b013e3283383ef9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Efficacy of data capture for patient-reported toxicity following radiotherapy for prostate or cervical cancer. Eur J Cancer 2010; 46:534-40. [DOI: 10.1016/j.ejca.2009.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 11/13/2009] [Accepted: 11/19/2009] [Indexed: 11/18/2022]
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Baum BJ, Zheng C, Alevizos I, Cotrim AP, Liu S, McCullagh L, Goldsmith CM, McDermott N, Chiorini JA, Nikolov NP, Illei GG. Development of a gene transfer-based treatment for radiation-induced salivary hypofunction. Oral Oncol 2009; 46:4-8. [PMID: 19892587 DOI: 10.1016/j.oraloncology.2009.09.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 09/16/2009] [Accepted: 09/17/2009] [Indexed: 10/20/2022]
Abstract
A significant long-term side effect of radiation therapy for head and neck cancers is xerostomia, a dry mouth, due to salivary gland damage. Despite continuing efforts to eliminate this problem, many patients continue to suffer. This brief review describes our efforts to develop a gene transfer approach, employing the aquaporin-1 cDNA, to treat patients with existing radiation-induced salivary hypofunction. A Phase I/II clinical trial, using a recombinant adenoviral vector to mediate gene transfer, is currently underway.
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Affiliation(s)
- Bruce J Baum
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA.
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