Fatal cesium chloride toxicity after alternative cancer treatment

The unexplored role of alkali and alkaline earth elements (ALAEs) on the structure, processing, and biological effects of bioactive glasses

Bioactive glass has been employed in several medical applications since its inception in 1969. The compositions of these materials have been investigated extensively with emphasis on glass network formers, therapeutic transition metals, and glass network modifiers. Through these experiments, several commercial and experimental compositions have been developed with varying chemical durability, induced physiological responses, and hydroxyapatite forming abilities. In many of these studies, the concentrations of each alkali and alkaline earth element have been altered to monitor changes in structure and biological response. This review aims to discuss the impact of each alkali and alkaline earth element on the structure, processing, and biological effects of bioactive glass. We explore critical questions regarding these elements from both a glass science and biological perspective. Should elements with little biological impact be included? Are alkali free bioactive glasses more promising for greater biological responses? Does this mixed alkali effect show increased degradation rates and should it be employed for optimized dissolution? Each of these questions along with others are evaluated comprehensively and discussed in the final section where guidance for compositional design is provided.

Quantitative dual-energy computed tomography with cesium as a novel contrast agent for localization of thermochemical ablation in phantoms and ex vivo models

BACKGROUND

Thermochemical ablation (TCA) is a minimally invasive therapy under development for hepatocellular carcinoma. TCA simultaneously delivers an acid (acetic acid, AcOH) and base (sodium hydroxide, NaOH) directly into the tumor, where the acid/base chemical reaction produces an exotherm that induces local ablation. However, AcOH and NaOH are not radiopaque, making monitoring TCA delivery difficult.

PURPOSE

We address the issue of image guidance for TCA by utilizing cesium hydroxide (CsOH) as a novel theranostic component of TCA that is detectable and quantifiable with dual-energy CT (DECT).

MATERIALS AND METHODS

To quantify the minimum concentration of CsOH that can be positively identified by DECT, the limit of detection (LOD) was established in an elliptical phantom (Multi-Energy CT Quality Assurance Phantom, Kyoto Kagaku, Kyoto, Japan) with two DECT technologies: a dual-source system (SOMATOM Force, Siemens Healthineers, Forchheim, Germany) and a split-filter, single-source system (SOMATOM Edge, Siemens Healthineers). The dual-energy ratio (DER) and LOD of CsOH were determined for each system. Cesium concentration quantification accuracy was evaluated in a gelatin phantom before quantitative mapping was performed in ex vivo models.

RESULTS

On the dual-source system, the DER and LOD were 2.94 and 1.36-mM CsOH, respectively. For the split-filter system, the DER and LOD were 1.41- and 6.11-mM CsOH, respectively. The signal on cesium maps in phantoms tracked linearly with concentration (R2  = 0.99) on both systems with an RMSE of 2.56 and 6.72 on the dual-source and split-filter system, respectively. In ex vivo models, CsOH was detected following delivery of TCA at all concentrations.

CONCLUSIONS

DECT can be used to detect and quantify the concentration of cesium in phantom and ex vivo tissue models. When incorporated in TCA, CsOH performs as a theranostic agent for quantitative DECT image-guidance.

Cesium activates the neurotransmitter receptor for glycine

The monovalent cations sodium and potassium are crucial for the proper functioning of excitable cells, but, in addition, other monovalent alkali metal ions such as cesium and lithium can also affect neuronal physiology. For instance, there have been recent reports of adverse effects resulting from self-administered high concentrations of cesium in disease conditions, prompting the Food and Drug Administration (FDA) to issue an alert concerning cesium chloride. As we recently found that the monovalent cation NH4+ activates glycine receptors (GlyRs), we investigated the effects of alkali metal ions on the function of the GlyR, which belongs to one of the most widely distributed neurotransmitter receptors in the peripheral and central nervous systems. Whole-cell voltage clamp electrophysiology was performed with HEK293T cells transiently expressing different splice and RNA-edited variants of GlyR α2 and α3 homopentameric channels. By examining the influence of various milli- and sub-millimolar concentrations of lithium, sodium, potassium, and cesium on these GlyRs in comparison to its natural ligand glycine (0.1 mM), we could show that cesium activates GlyRs in a concentration- and post-transcriptional-dependent way. Additionally, we conducted atomistic molecular dynamic simulations on GlyR α3 embedded in a membrane bilayer with potassium and cesium, respectively. The simulations revealed slightly different GlyR-ion binding profiles for potassium and cesium, identifying interactions near the glycine binding pocket (potassium and cesium) and close to the RNA-edited site (cesium) in the extracellular GlyR domain. Together, these findings show that cesium acts as an agonist of GlyRs.

Combating antimicrobial resistance: an evidence-based overview of bacteriophage therapy

Antimicrobial resistance (AMR) problems cause an enormous challenge to our world in medicine and in agriculture and many other fields. The current situation makes bacteriophage therapy an attractive therapeutic candidate. Nevertheless, very limited clinical trials on bacteriophage therapy were performed and completed as of presence. Bacteriophage therapy alludes to infecting bacteria with a virus, this often results in a bactericidal effect. The compiled studies support the feasibility of treating AMR with bacteriophage. However, the efficacy of specific bacteriophage strains and the accurate dosage have to be further studied and tested rigorously.

Levels of Trace Elements in the Aqueous Humor of Cataract Patients Measured by the Inductively Coupled Plasma Optical Emission Spectrometry

Trace elements play an important role in the pathogenesis of several serious ophthalmological disorders, such as glaucoma, age-related macular degeneration (AMD), diabetic retinopathy, cataract, etc. This study aimed to measure alterations of chemical elements' (67) levels in the aqueous humor of patients undergoing cataract surgery. The pilot study included 115 patients, (age 74 ± 7.27, female 64.35%, male 35.65%). The aqueous levels of elements were measured by the use of the inductively coupled plasma optical emission spectrometry (ICP-OES), quality controlled with certified standards. The classification of elements based on their concentration was achieved by hierarchical cluster analysis. This is the first screening study that quantifies over 60 elements which are present in the fluid from the anterior chamber of the eye of cataract patients. The obtained results can be suitable for understanding and identifying the causes that may play a role in the initiation and progression of lens opacity.

Anticancer drugs-related QTc prolongation, torsade de pointes and sudden death: current evidence and future research perspectives

Anticancer drugs may have proarrhythmic effects including drug-induced QT interval prolongation, which is of particular importance because it can lead to a fatal polymorphic ventricular tachycardia termed torsade de pointes (TdP). QT interval prolongation and TdP are rare life-threatening untoward effects of anticancer therapy, particularly with arsenic trioxides and anthracyclines, and even some novel molecular targeted drugs touted as 'tumor specific'. Several factors that affect myocardial repolarization can further increase the risk of TdP. This article reviews the mechanism of QT interval prolongation, risk factors for TdP and the QT toxicity of anticancer drugs as well as its management. Specific attention should be paid to high-risk populations such as patients with underlying heart diseases, electrolyte imbalance and bradycardia. To minimize the occurrence of QT interval prolongation and TdP, it is advisable to conduct a careful risk factor assessment before antitumor therapy. To this end, several new biomarkers have been introduced to predict TdP triggering and recent studies have pointed out the potential clinical relevance of genetic testing.

Cesium-associated hypokalemia successfully treated with amiloride

Self-treatment of cancer with cesium chloride, despite proven lack of efficacy, continues to produce serious adverse effects. Among these is hypokalemia predisposing to life-threatening arrhythmia. The mechanism of cesium-associated hypokalemia (CAH) has not been described. We report urinary potassium wasting responsive to amiloride therapy in a cancer patient with CAH, and discuss possible mechanisms.