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Dulf PL, Mocan M, Coadă CA, Dulf DV, Moldovan R, Baldea I, Farcas AD, Blendea D, Filip AG. Doxorubicin-induced acute cardiotoxicity is associated with increased oxidative stress, autophagy, and inflammation in a murine model. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2023; 396:1105-1115. [PMID: 36645429 DOI: 10.1007/s00210-023-02382-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/01/2023] [Indexed: 01/17/2023]
Abstract
Drug-induced cardiotoxicity is a life-threatening side effect of doxorubicin (DOX) treatment that impacts patient prognosis and survival. In the majority of cases, the acute clinical form often remains asymptomatic, with few patients presenting rather nonspecific electrocardiographic abnormalities. While chronic toxicity has been more widely studied, the alterations appearing in acute cardiotoxicity are much less investigated. Thus, our in vivo study aimed to evaluate the process of DOX-induced acute myocardial toxicity by investigating oxidative stress and autophagy markers as mechanisms of myocardial toxicity in correlation with echocardiography and electrocardiography findings. Our results show that both autophagy and oxidative homeostasis were disrupted as soon as 7 days after DOX treatment, alterations that occurred even before the significant increase of NT-proBNP, a clinical marker for cardiac suffering. Moreover, we found a large number of alterations in the electrocardiography and echocardiography of treated rats. These findings suggest that DOX-induced myocardial toxicity started early after treatment initiation, possibly marking the initial phase of the unfolding process of cardiac damage. Further studies are required to completely decipher the mechanisms of DOX-induced cardiotoxicity.
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Affiliation(s)
- Patricia Lorena Dulf
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012, Cluj-Napoca-Napoca, Romania
| | - Mihaela Mocan
- Emergency Clinical County Hospital, 40006, Cluj-Napoca-Napoca, Romania.
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012, Cluj-Napoca-Napoca, Romania.
| | - Camelia Alexandra Coadă
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138, Bologna, Italy.
- Department of Molecular Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, 400394, Cluj-Napoca-Napoca, Romania.
| | - Daniel Vasile Dulf
- Iuliu Hatieganu University of Medicine and Pharmacy, 400012, Cluj-Napoca-Napoca, Romania
- Medisprof Cancer Center, 400641, Cluj-Napoca-Napoca, Romania
| | - Remus Moldovan
- Department of Functional Biosciences, Iuliu Hatieganu University of Medicine and Pharmacy, 400012, Cluj-Napoca-Napoca, Romania
| | - Ioana Baldea
- Department of Functional Biosciences, Iuliu Hatieganu University of Medicine and Pharmacy, 400012, Cluj-Napoca-Napoca, Romania
| | - Anca-Daniela Farcas
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012, Cluj-Napoca-Napoca, Romania
| | - Dan Blendea
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012, Cluj-Napoca-Napoca, Romania
- Department of Cardiology, Heart Institute, 40001, Cluj-Napoca-Napoca, Romania
| | - Adriana Gabriela Filip
- Department of Functional Biosciences, Iuliu Hatieganu University of Medicine and Pharmacy, 400012, Cluj-Napoca-Napoca, Romania
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2
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Furlong E, Kotecha RS, Conyers R, O'Brien TA, Hansford JR, Super L, Downie P, Eisenstat DD, Haeusler G, McMullan B, Phillips MB, Padhye B, Dalla-Pozza L, Alvaro F, Fraser CJ, Nicholls W, Clark JE, O'Connor M, Saxon BR, Tapp H, Heath J, Hunter SE, Tsui K, Winstanley M, Lyver A, Best EJ, Wadia U, Yeoh D, Blyth CC, Gottardo NG. COVID-19 vaccination in children and adolescents aged 5 years and older undergoing treatment for cancer and non-malignant haematological conditions: Australian and New Zealand Children's Haematology/Oncology Group consensus statement. Med J Aust 2022; 216:312-319. [PMID: 35201615 PMCID: PMC9115069 DOI: 10.5694/mja2.51444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/19/2022] [Accepted: 02/01/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The Australian Technical Advisory Group on Immunisation and New Zealand Ministry of Health recommend all children aged ≥ 5 years receive either of the two mRNA COVID-19 vaccines: Comirnaty (Pfizer), available in both Australia and New Zealand, or Spikevax (Moderna), available in Australia only. Both vaccines are efficacious and safe in the general population, including children. Children and adolescents undergoing treatment for cancer and immunosuppressive therapy for non-malignant haematological conditions are particularly vulnerable, with an increased risk of severe or fatal COVID-19. There remains a paucity of data regarding the immune response to COVID-19 vaccines in immunosuppressed paediatric populations, with data suggestive of reduced immunogenicity of the vaccine in immunocompromised adults. RECOMMENDATIONS Considering the safety profile of mRNA COVID-19 vaccines and the increased risk of severe COVID-19 in immunocompromised children and adolescents, COVID-19 vaccination is strongly recommended for this at-risk population. We provide a number of recommendations regarding COVID-19 vaccination in this population where immunosuppressive, chemotherapeutic and/or targeted biological agents are used. These include the timing of vaccination in patients undergoing active treatment, management of specific situations where vaccination is contraindicated or recommended under special precautions, and additional vaccination recommendations for severely immunocompromised patients. Finally, we stress the importance of upcoming clinical trials to identify the safest and most efficacious vaccination regimen for this population. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT This consensus statement provides recommendations for COVID-19 vaccination in children and adolescents aged ≥ 5 years with cancer and immunocompromising non-malignant haematological conditions, based on evidence, national and international guidelines and expert opinion. ENDORSED BY The Australian and New Zealand Children's Haematology/Oncology Group.
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Affiliation(s)
- Eliska Furlong
- Perth Children's Hospital, Perth, WA.,Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA
| | - Rishi S Kotecha
- Perth Children's Hospital, Perth, WA.,Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA.,Curtin University, Perth, WA
| | - Rachel Conyers
- Murdoch Children's Research Institute, Melbourne, VIC.,Children's Cancer Centre, Royal Children's Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Tracey A O'Brien
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW.,University of New South Wales, Sydney, NSW
| | - Jordan R Hansford
- Murdoch Children's Research Institute, Melbourne, VIC.,Children's Cancer Centre, Royal Children's Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Leanne Super
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, VIC.,Monash University, Melbourne, VIC
| | - Peter Downie
- Monash University, Melbourne, VIC.,Monash Children's Hospital, Melbourne, VIC.,Hudson Institute of Medical Research, Melbourne, VIC
| | - David D Eisenstat
- Murdoch Children's Research Institute, Melbourne, VIC.,Children's Cancer Centre, Royal Children's Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Gabrielle Haeusler
- Murdoch Children's Research Institute, Melbourne, VIC.,Paediatric Integrated Cancer Service, Melbourne, VIC.,National Centre for Infections in Cancer, Melbourne, VIC
| | - Brendan McMullan
- University of New South Wales, Sydney, NSW.,National Centre for Infections in Cancer, Melbourne, VIC.,Sydney Children's Hospital, Sydney, NSW
| | | | - Bhavna Padhye
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW
| | - Luciano Dalla-Pozza
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW
| | - Frank Alvaro
- John Hunter Children's Hospital, Newcastle, NSW.,University of Newcastle, Newcastle, NSW
| | | | - Wayne Nicholls
- Queensland Children's Hospital, Brisbane, QLD.,University of Queensland, Brisbane, QLD
| | - Julia E Clark
- Queensland Children's Hospital, Brisbane, QLD.,University of Queensland, Brisbane, QLD
| | - Matthew O'Connor
- Michael Rice Centre for Haematology and Oncology, Women's and Children's Hospital, Adelaide, SA
| | - Benjamin R Saxon
- Michael Rice Centre for Haematology and Oncology, Women's and Children's Hospital, Adelaide, SA
| | - Heather Tapp
- Michael Rice Centre for Haematology and Oncology, Women's and Children's Hospital, Adelaide, SA
| | - John Heath
- Children's and Adolescent/Young Adult Cancer Centre, Royal Hobart Hospital, Hobart, TAS
| | - Sarah E Hunter
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, NZ
| | - Karen Tsui
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, NZ
| | - Mark Winstanley
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, NZ
| | - Amanda Lyver
- Children's Haematology Oncology Centre, Christchurch Hospital, Christchurch, NZ
| | - Emma J Best
- Starship Children's Hospital, Auckland, NZ.,Immunisation Advisory Centre, University of Auckland, Auckland, NZ.,University of Auckland, Auckland, NZ
| | - Ushma Wadia
- Perth Children's Hospital, Perth, WA.,Fiona Stanley Hospital, Perth, WA.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
| | - Daniel Yeoh
- Perth Children's Hospital, Perth, WA.,National Centre for Infections in Cancer, Melbourne, VIC
| | - Christopher C Blyth
- Perth Children's Hospital, Perth, WA.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA.,University of Western Australia, Perth, WA
| | - Nicholas G Gottardo
- Perth Children's Hospital, Perth, WA.,Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA.,University of Western Australia, Perth, WA
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Dong T, Chami T, Chami B, Al-Kindi S, Hoit BD. Cytarabine-induced pericarditis confirmed using cardiac MRI: A case report. Echocardiography 2021; 38:1446-1449. [PMID: 34184297 DOI: 10.1111/echo.15135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/05/2021] [Accepted: 05/31/2021] [Indexed: 11/26/2022] Open
Abstract
Pericarditis is a rare but debilitating complication of cytarabine therapy. While echocardiography can aid with the diagnosis, cardiac MRI has superior accuracy in establishing the diagnosis. In this case, we describe a 65-year-old patient receiving cytarabine as part of induction chemotherapy for acute myeloid leukemia who developed acute pericarditis. Her cardiac MRI revealed pericardial edema on T2-weighted STIR imaging and pericardial late gadolinium enhancement which confirmed the diagnosis.
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Affiliation(s)
- Tony Dong
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Tarek Chami
- Harrington Heart and Vascular Institute, University Hospital Cleveland Medical Center, Cleveland, Ohio, USA
| | - Besher Chami
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Sadeer Al-Kindi
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Case Western Reserve University, Cleveland, Ohio, USA
| | - Brian D Hoit
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Case Western Reserve University, Cleveland, Ohio, USA
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Abstract
Doxorubicin-induced cardiotoxicity in childhood cancer survivors is a growing problem. The population of patients at risk for cardiovascular disease is steadily increasing, as five-year survival rates for all types of childhood cancers continue to improve. Doxorubicin affects the developing heart differently from the adult heart and in a subset of exposed patients, childhood exposure leads to late, irreversible cardiomyopathy. Notably, the prevalence of late-onset toxicity is increasing in parallel with improved survival. By the year 2020, it is estimated that there will be 500,000 childhood cancer survivors and over 50,000 of them will suffer from doxorubicin-induced cardiotoxicity. The majority of the research to-date, concentrated on childhood cancer survivors, has focused mostly on clinical outcomes through well-designed epidemiological and retrospective cohort studies. Preclinical studies have elucidated many of the cellular mechanisms that elicit acute toxicity in cardiomyocytes. However, more research is needed in the areas of early- and late-onset cardiotoxicity and more importantly improving the scientific understanding of how other cells present in the cardiac milieu are impacted by doxorubicin exposure. The overall goal of this review is to succinctly summarize the major clinical and preclinical studies focused on doxorubicin-induced cardiotoxicity. As the prevalence of patients affected by doxorubicin exposure continues to increase, it is imperative that the major gaps in existing research are identified and subsequently utilized to develop appropriate research priorities for the coming years. Well-designed preclinical research models will enhance our understanding of the pathophysiology of doxorubicin-induced cardiotoxicity and directly lead to better diagnosis, treatment, and prevention. © 2019 American Physiological Society. Compr Physiol 9:905-931, 2019.
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Affiliation(s)
- Trevi R Mancilla
- University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Brian Iskra
- University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Gregory J Aune
- University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
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6
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Framarino-dei-Malatesta M, Perrone G, Giancotti A, Ventriglia F, Derme M, Iannini I, Tibaldi V, Galoppi P, Sammartino P, Cascialli G, Brunelli R. Epirubicin: a new entry in the list of fetal cardiotoxic drugs? Intrauterine death of one fetus in a twin pregnancy. Case report and review of literature. BMC Cancer 2015; 15:951. [PMID: 26673573 PMCID: PMC4682214 DOI: 10.1186/s12885-015-1976-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/05/2015] [Indexed: 12/28/2022] Open
Abstract
Background Current knowledge indicate that epirubicin administration in late pregnancy is almost devoid of any fetal cardiotoxicity. We report a twin pregnancy complicated by breast cancer in which epirubicin administration was causatively linked to the death of one twin who was small for gestational age (SGA) and in a condition of oligohydramnios and determined the onset of a transient cardiotoxicity of the surviving fetus/newborn. Case presentation A 38-year-old caucasic woman with a dichorionic twin pregnancy was referred to our center at 20 and 1/7 weeks for a suspected breast cancer, later confirmed by the histopathology report. At 31 and 3/7 weeks, after the second chemotherapy cycle, ultrasound examination evidenced the demise of one twin while cardiac examination revealed a monophasic diastolic ventricular filling, i.e. a diastolic dysfunction of the surviving fetus who was delivered the following day due to the occurrence of grade II placental abruption. The role of epirubicin cardiotoxicity in the death of the first twin was supported by post-mortem cardiac and placental examination and by the absence of structural or genomic abnormalities that may indicate an alternative etiology of fetal demise. The occurrence of epirubicin cardiotoxicity in the surviving newborn was confirmed by the report of high levels of troponin and transient left ventricular septal hypokinesia. Conclusion Based on our findings we suggest that epirubicin administration in pregnancy should be preceded by the screening of some fetal conditions like SGA and oligohydramnios that may increase its cardiotoxicity and that, during treatment, the diastolic function of the fetal right ventricle should be specifically monitored by a pediatric cardiologist; also, epirubicin and desamethasone for lung maturation should not be closely administered since placental effects of glucocorticoids may increase epirubicin toxicity.
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Affiliation(s)
| | - Giuseppina Perrone
- Department of Gynecologic Obstetrics and Urology Sciences, University of Rome "Sapienza", Rome, Italy.
| | - Antonella Giancotti
- Department of Gynecologic Obstetrics and Urology Sciences, University of Rome "Sapienza", Rome, Italy.
| | - Flavia Ventriglia
- Department of Pediatrics, University of Rome "Sapienza", Rome, Italy.
| | - Martina Derme
- Department of Gynecologic Obstetrics and Urology Sciences, University of Rome "Sapienza", Rome, Italy.
| | - Isabella Iannini
- Department of Gynecologic Obstetrics and Urology Sciences, University of Rome "Sapienza", Rome, Italy.
| | - Valentina Tibaldi
- Department of Gynecologic Obstetrics and Urology Sciences, University of Rome "Sapienza", Rome, Italy.
| | - Paola Galoppi
- Department of Gynecologic Obstetrics and Urology Sciences, University of Rome "Sapienza", Rome, Italy.
| | - Paolo Sammartino
- Department of Surgery "Pietro Valdoni", University of Rome "Sapienza", Rome, Italy.
| | - Gianluca Cascialli
- Department of Gynecologic Obstetrics and Urology Sciences, University of Rome "Sapienza", Rome, Italy.
| | - Roberto Brunelli
- Department of Gynecologic Obstetrics and Urology Sciences, University of Rome "Sapienza", Rome, Italy.
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