1
|
Goldman M, Lucke-Wold B, Katz J, Dawoud B, Dagra A. Respiratory Patterns in Neurological Injury, Pathophysiology, Ventilation Management, and Future Innovations: A Systematic Review. EXPLORATORY RESEARCH AND HYPOTHESIS IN MEDICINE 2023; 8:338-349. [PMID: 38130817 PMCID: PMC10735242 DOI: 10.14218/erhm.2022.00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Traumatic brain injuries (TBI), ischemic stroke, hemorrhagic stroke, brain tumors, and seizures have diverse and sometimes overlapping associated breathing patterns. Homeostatic mechanisms for respiratory control are intertwined with complex neurocircuitry, both centrally and peripherally. This paper summarizes the neurorespiratory control and pathophysiology of its disruption. It also reviews the clinical presentation, ventilatory management, and emerging therapeutics. This review additionally serves to update all recent preclinical and clinical research regarding the spectrum of respiratory dysfunction. Having a solid pathophysiological foundation of disruptive mechanisms would permit further therapeutic development. This novel review bridges experimental/physiological data with bedside management, thus allowing neurosurgeons and intensivists alike to rapidly diagnose and treat respiratory sequelae of acute brain injury.
Collapse
Affiliation(s)
| | | | | | - Bavly Dawoud
- Neurosurgical Resident, University of Illinois, Peoria Illinois, United States
| | - Abeer Dagra
- Research Assistant, University of Florida, Gainesville, United States
| |
Collapse
|
2
|
Korde A, Haslip M, Pednekar P, Khan A, Chioccioli M, Mehta S, Lopez-Giraldez F, Bermejo S, Rojas M, Dela Cruz C, Matthay MA, Pober JS, Pierce RW, Takyar SS. MicroRNA-1 protects the endothelium in acute lung injury. JCI Insight 2023; 8:e164816. [PMID: 37737266 PMCID: PMC10561733 DOI: 10.1172/jci.insight.164816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 08/10/2023] [Indexed: 09/23/2023] Open
Abstract
Acute lung injury (ALI) and its most severe form, acute respiratory distress syndrome (ARDS), cause severe endothelial dysfunction in the lung, and vascular endothelial growth factor (VEGF) is elevated in ARDS. We found that the levels of a VEGF-regulated microRNA, microRNA-1 (miR-1), were reduced in the lung endothelium after acute injury. Pulmonary endothelial cell-specific (EC-specific) overexpression of miR-1 protected the lung against cell death and barrier dysfunction in both murine and human models and increased the survival of mice after pneumonia-induced ALI. miR-1 had an intrinsic protective effect in pulmonary and other types of ECs; it inhibited apoptosis and necroptosis pathways and decreased capillary leak by protecting adherens and tight junctions. Comparative gene expression analysis and RISC recruitment assays identified miR-1 targets in the context of injury, including phosphodiesterase 5A (PDE5A), angiopoietin-2 (ANGPT2), CNKSR family member 3 (CNKSR3), and TNF-α-induced protein 2 (TNFAIP2). We validated miR-1-mediated regulation of ANGPT2 in both mouse and human ECs and found that in a 119-patient pneumonia cohort, miR-1 correlated inversely with ANGPT2. These findings illustrate a previously unknown role of miR-1 as a cytoprotective orchestrator of endothelial responses to acute injury with prognostic and therapeutic potential.
Collapse
Affiliation(s)
- Asawari Korde
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Maria Haslip
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Prachi Pednekar
- Department of Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | | | - Maurizio Chioccioli
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sameet Mehta
- Department of Genetics, Yale University School Medicine, New Haven, Connecticut, USA
| | | | - Santos Bermejo
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mauricio Rojas
- Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Charles Dela Cruz
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael A. Matthay
- Cardiovascular Research Institute, Department of Medicine and Anesthesiology, UCSF, San Francisco, California, USA
| | | | | | - Shervin S. Takyar
- Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
3
|
Hussain M, Khurram Syed S, Fatima M, Shaukat S, Saadullah M, Alqahtani AM, Alqahtani T, Bin Emran T, Alamri AH, Barkat MQ, Wu X. Acute Respiratory Distress Syndrome and COVID-19: A Literature Review. J Inflamm Res 2022; 14:7225-7242. [PMID: 34992415 PMCID: PMC8710428 DOI: 10.2147/jir.s334043] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is an overwhelming inflammatory disorder of the lung due to direct and indirect insults to the lungs. ARDS is characterized by increased vascular permeability, protein-rich edema, diffuse alveolar infiltrate, and loss of aerated lung tissue, leading to decreased lung compliance, tachypnea, and severe hypoxemia. COVID-19 is generally associated with ARDS, and it has gained prime importance since it started. The mortality rate is alarmingly high in COVID-19-related ARDS patients regardless of advances in mechanical ventilation. Several pharmacological agents, including corticosteroids, nitric oxide, neuromuscular blocker, anti-TNF, statins, and exogenous surfactant, have been studied and some are under investigation, like ketoconazole, lisofylline, N-acetylcysteine, prostaglandins, prostacyclin, and fish oil. The purpose of this review is to appraise the understanding of the pathophysiology of ARDS, biomarkers, and clinical trials of pharmacological therapies of ARDS and COVID-19-related ARDS.
Collapse
Affiliation(s)
- Musaddique Hussain
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, 63100, Pakistan
| | - Shahzada Khurram Syed
- Department of Basic Medical Sciences, School of Health Sciences, University of Management and Technology Lahore, Lahore, 54000, Pakistan
| | - Mobeen Fatima
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, 63100, Pakistan
| | - Saira Shaukat
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, 63100, Pakistan
| | - Malik Saadullah
- Department of Pharmaceutical Chemistry, Government College University, Faisalabad, 38000, Pakistan
| | - Ali M Alqahtani
- Department of Pharmacology, College of Pharmacy, King Khalid University, Abha, 62529, Saudi Arabia
| | - Taha Alqahtani
- Department of Pharmacology, College of Pharmacy, King Khalid University, Abha, 62529, Saudi Arabia
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4381, Bangladesh
| | - Ali H Alamri
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Abha, 62529, Saudi Arabia
| | - Muhammad Qasim Barkat
- Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou City, 310000, People's Republic of China
| | - Ximei Wu
- Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou City, 310000, People's Republic of China
| |
Collapse
|
4
|
Prasanna P, Rathee S, Upadhyay A, Sulakshana S. Nanotherapeutics in the treatment of acute respiratory distress syndrome. Life Sci 2021; 276:119428. [PMID: 33785346 PMCID: PMC7999693 DOI: 10.1016/j.lfs.2021.119428] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/12/2021] [Accepted: 03/20/2021] [Indexed: 01/08/2023]
Abstract
Acute respiratory distress syndrome (ARDS) is a form of oxygenation failure primarily characterized by rapid inflammation resulting from a direct pulmonary or indirect systemic insult. ARDS has been a major cause of death in the recent COVID-19 outbreak wherein asymptomatic respiratory tract infection progresses to ARDS from pneumonia have emphasized the need for a reliable therapy for the disease. The disease has a high mortality rate of approximately 30-50%. Despite the high mortality rate, a dearth of effective pharmacotherapy exists that demands extensive research in this area. The complex ARDS pathophysiology which remains to be understood completely and the multifactorial etiology of the disease has led to the poor diagnosis, impeded drug-delivery to the deeper pulmonary tissues, and delayed treatment of the ARDS patients. Besides, critically ill patients are unable to tolerate the off-target side effects. The vast domain of nanobiotechnology presents several drug delivery systems offering numerous benefits such as targeted delivery, prolonged drug release, and uniform drug-distribution. The present review presents a brief insight into the ARDS pathophysiology and summarizes conventional pharmacotherapies available to date. Furthermore, the review provides an updated report of major developments in the nanomedicinal approaches for the treatment of ARDS. We also discuss different nano-formulations studied extensively in the ARDS preclinical models along with underlining the advantages as well as challenges that need to be addressed in the future.
Collapse
Affiliation(s)
- Pragya Prasanna
- Department of Biotechnology, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Bihar 844102, India
| | - Shweta Rathee
- Department of Food Science and Technology, National Institute of Food Technology Entrepreneurship and Management, Sonipat, Haryana 131028, India
| | - Arun Upadhyay
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Sulakshana Sulakshana
- Department of Anesthesiology and Critical Care, Sri Ram Murti Smarak Institute of Medical Sciences (SRMS-IMS), Bareilly, Uttar Pradesh 243202, India.
| |
Collapse
|
5
|
Pang J, Xu F, Aondio G, Li Y, Fumagalli A, Lu M, Valmadre G, Wei J, Bian Y, Canesi M, Damiani G, Zhang Y, Yu D, Chen J, Ji X, Sui W, Wang B, Wu S, Kovacs A, Revera M, Wang H, Jing X, Zhang Y, Chen Y, Cao Y. Efficacy and tolerability of bevacizumab in patients with severe Covid-19. Nat Commun 2021; 12:814. [PMID: 33547300 PMCID: PMC7864918 DOI: 10.1038/s41467-021-21085-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 01/08/2021] [Indexed: 01/08/2023] Open
Abstract
On the basis of Covid-19-induced pulmonary pathological and vascular changes, we hypothesize that the anti-vascular endothelial growth factor (VEGF) drug bevacizumab might be beneficial for treating Covid-19 patients. From Feb 15 to April 5, 2020, we conducted a single-arm trial (NCT04275414) and recruited 26 patients from 2-centers (China and Italy) with severe Covid-19, with respiratory rate ≥30 times/min, oxygen saturation ≤93% with ambient air, or partial arterial oxygen pressure to fraction of inspiration O2 ratio (PaO2/FiO2) >100 mmHg and ≤300 mmHg, and diffuse pneumonia confirmed by chest imaging. Followed up for 28 days. Among these, bevacizumab plus standard care markedly improves the PaO2/FiO2 ratios at days 1 and 7. By day 28, 24 (92%) patients show improvement in oxygen-support status, 17 (65%) patients are discharged, and none show worsen oxygen-support status nor die. Significant reduction of lesion areas/ratios are shown in chest computed tomography (CT) or X-ray within 7 days. Of 14 patients with fever, body temperature normalizes within 72 h in 13 (93%) patients. Relative to comparable controls, bevacizumab shows clinical efficacy by improving oxygenation and shortening oxygen-support duration. Our findings suggest bevacizumab plus standard care is highly beneficial for patients with severe Covid-19. Randomized controlled trial is warranted. In this single-arm clinical trial, the authors show that treatment of COVID-19 patients with bevacizumab, an anti-vascular endothelial growth factor drug, can improve PaO2/FiO2 ratios and oxygen-support status. Relative to an external control group, bevacizumab shows clinical efficacy by improving oxygenation.
Collapse
Affiliation(s)
- Jiaojiao Pang
- Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Feng Xu
- Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, Shandong, China.,Clinical Research Center of Shandong University, Jinan, Shandong, China.,Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Jinan, Shandong, China
| | - Gianmarco Aondio
- Department of Medicine and Oncology, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Gravedona, Italy
| | - Yu Li
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Alberto Fumagalli
- Department of Medicine and Oncology, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Gravedona, Italy
| | - Ming Lu
- Clinical Research Center of Shandong University, Jinan, Shandong, China
| | - Giuseppe Valmadre
- Department of Medicine and Oncology, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Gravedona, Italy
| | - Jie Wei
- Department of Emergency Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yuan Bian
- Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Margherita Canesi
- Department of Neurological Rehabilitation, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Gravedona, Italy
| | - Giovanni Damiani
- Department of Radiology, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Gravedona, Italy
| | - Yuan Zhang
- Clinical Research Center of Shandong University, Jinan, Shandong, China
| | - Dexin Yu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Jun Chen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiang Ji
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Wenhai Sui
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Jinan, Shandong, China
| | - Bailu Wang
- Clinical Research Center of Shandong University, Jinan, Shandong, China
| | - Shuo Wu
- Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Attila Kovacs
- Department of Intensive Care Unit, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Gravedona, 22015, Italy
| | - Miriam Revera
- Department of Cardiology, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Gravedona, 22015, Italy
| | - Hao Wang
- Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Xu Jing
- Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Ying Zhang
- Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yuguo Chen
- Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, Shandong, China. .,Clinical Research Center of Shandong University, Jinan, Shandong, China. .,Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Jinan, Shandong, China.
| | - Yihai Cao
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, 17177, Sweden.
| |
Collapse
|
6
|
Vassiliou AG, Kotanidou A, Dimopoulou I, Orfanos SE. Endothelial Damage in Acute Respiratory Distress Syndrome. Int J Mol Sci 2020; 21:ijms21228793. [PMID: 33233715 PMCID: PMC7699909 DOI: 10.3390/ijms21228793] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/14/2020] [Accepted: 11/18/2020] [Indexed: 01/01/2023] Open
Abstract
The pulmonary endothelium is a metabolically active continuous monolayer of squamous endothelial cells that internally lines blood vessels and mediates key processes involved in lung homoeostasis. Many of these processes are disrupted in acute respiratory distress syndrome (ARDS), which is marked among others by diffuse endothelial injury, intense activation of the coagulation system and increased capillary permeability. Most commonly occurring in the setting of sepsis, ARDS is a devastating illness, associated with increased morbidity and mortality and no effective pharmacological treatment. Endothelial cell damage has an important role in the pathogenesis of ARDS and several biomarkers of endothelial damage have been tested in determining prognosis. By further understanding the endothelial pathobiology, development of endothelial-specific therapeutics might arise. In this review, we will discuss the underlying pathology of endothelial dysfunction leading to ARDS and emerging therapies. Furthermore, we will present a brief overview demonstrating that endotheliopathy is an important feature of hospitalised patients with coronavirus disease-19 (COVID-19).
Collapse
Affiliation(s)
- Alice G. Vassiliou
- 1st Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.G.V.); (A.K.); (I.D.)
| | - Anastasia Kotanidou
- 1st Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.G.V.); (A.K.); (I.D.)
| | - Ioanna Dimopoulou
- 1st Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.G.V.); (A.K.); (I.D.)
| | - Stylianos E. Orfanos
- 1st Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.G.V.); (A.K.); (I.D.)
- 2nd Department of Critical Care, School of Medicine, National and Kapodistrian University of Athens, Attikon Hospital, 124 62 Athens, Greece
- Correspondence: or ; Tel.: +30-2107-235-521
| |
Collapse
|
7
|
Horie S, McNicholas B, Rezoagli E, Pham T, Curley G, McAuley D, O'Kane C, Nichol A, Dos Santos C, Rocco PRM, Bellani G, Laffey JG. Emerging pharmacological therapies for ARDS: COVID-19 and beyond. Intensive Care Med 2020; 46:2265-2283. [PMID: 32654006 PMCID: PMC7352097 DOI: 10.1007/s00134-020-06141-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023]
Abstract
ARDS, first described in 1967, is the commonest form of acute severe hypoxemic respiratory failure. Despite considerable advances in our knowledge regarding the pathophysiology of ARDS, insights into the biologic mechanisms of lung injury and repair, and advances in supportive care, particularly ventilatory management, there remains no effective pharmacological therapy for this syndrome. Hospital mortality at 40% remains unacceptably high underlining the need to continue to develop and test therapies for this devastating clinical condition. The purpose of the review is to critically appraise the current status of promising emerging pharmacological therapies for patients with ARDS and potential impact of these and other emerging therapies for COVID-19-induced ARDS. We focus on drugs that: (1) modulate the immune response, both via pleiotropic mechanisms and via specific pathway blockade effects, (2) modify epithelial and channel function, (3) target endothelial and vascular dysfunction, (4) have anticoagulant effects, and (5) enhance ARDS resolution. We also critically assess drugs that demonstrate potential in emerging reports from clinical studies in patients with COVID-19-induced ARDS. Several therapies show promise in earlier and later phase clinical testing, while a growing pipeline of therapies is in preclinical testing. The history of unsuccessful clinical trials of promising therapies underlines the challenges to successful translation. Given this, attention has been focused on the potential to identify biologically homogenous subtypes within ARDS, to enable us to target more specific therapies ‘precision medicines.’ It is hoped that the substantial number of studies globally investigating potential therapies for COVID-19 will lead to the rapid identification of effective therapies to reduce the mortality and morbidity of this devastating form of ARDS.
Collapse
Affiliation(s)
- Shahd Horie
- Lung Biology Group, Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, Biomedical Sciences Building, National University of Ireland, Galway, Ireland
| | - Bairbre McNicholas
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Galway, Ireland
| | - Emanuele Rezoagli
- Lung Biology Group, Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, Biomedical Sciences Building, National University of Ireland, Galway, Ireland.,Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.,Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy
| | - Tài Pham
- Service de médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Ger Curley
- Department of Anaesthesiology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Danny McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK.,Department of Intensive Care Medicine, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - Cecilia O'Kane
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Alistair Nichol
- Clinical Research Centre at St Vincent's University Hospital, University College Dublin, Dublin, Ireland.,Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.,Intensive Care Unit, Alfred Hospital, Melbourne, Australia
| | - Claudia Dos Santos
- Keenan Research Centre and Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Giacomo Bellani
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.,Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy
| | - John G Laffey
- Lung Biology Group, Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, Biomedical Sciences Building, National University of Ireland, Galway, Ireland. .,Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Galway, Ireland.
| |
Collapse
|
8
|
Chastain DB, Stitt TM, Ly PT, Henao-Martínez AF, Franco-Paredes C, Osae SP. Countermeasures to Coronavirus Disease 2019: Are Immunomodulators Rational Treatment Options-A Critical Review of the Evidence. Open Forum Infect Dis 2020; 7:ofaa219. [PMID: 32691007 PMCID: PMC7313774 DOI: 10.1093/ofid/ofaa219] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/02/2020] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 is associated with higher concentrations of proinflammatory cytokines that lead to lung damage, respiratory failure, and resultant increased mortality. Immunomodulatory therapy has the potential to inhibit cytokines and quell the immune dysregulation. Controversial data found improved oxygenation after treatment with tocilizumab, an interleukin-6 inhibitor, sparking a wave of interest and resultant clinical trials evaluating immunomodulatory therapies. The purpose of this article is to assess potential proinflammatory targets and review the safety and efficacy of immunomodulatory therapies in managing patients with acute respiratory distress syndrome associated with coronavirus disease 2019.
Collapse
Affiliation(s)
| | - Tia M Stitt
- University of Georgia College of Pharmacy, Albany, Georgia, USA
- Phoebe Putney Memorial Hospital, Albany, Georgia, USA
| | - Phong T Ly
- University of Georgia College of Pharmacy, Albany, Georgia, USA
- Phoebe Putney Memorial Hospital, Albany, Georgia, USA
| | - Andrés F Henao-Martínez
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Carlos Franco-Paredes
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Hospital Infantil de México, Federico Gómez, México City, México
| | - Sharmon P Osae
- University of Georgia College of Pharmacy, Albany, Georgia, USA
| |
Collapse
|
9
|
VEGF (Vascular Endothelial Growth Factor) and Fibrotic Lung Disease. Int J Mol Sci 2018; 19:ijms19051269. [PMID: 29695053 PMCID: PMC5983653 DOI: 10.3390/ijms19051269] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/10/2018] [Accepted: 04/18/2018] [Indexed: 01/01/2023] Open
Abstract
Interstitial lung disease (ILD) encompasses a group of heterogeneous diseases characterised by varying degrees of aberrant inflammation and fibrosis of the lung parenchyma. This may occur in isolation, such as in idiopathic pulmonary fibrosis (IPF) or as part of a wider disease process affecting multiple organs, such as in systemic sclerosis. Anti-Vascular Endothelial Growth Factor (anti-VEGF) therapy is one component of an existing broad-spectrum therapeutic option in IPF (nintedanib) and may become part of the emerging therapeutic strategy for other ILDs in the future. This article describes our current understanding of VEGF biology in normal lung homeostasis and how changes in its bioavailability may contribute the pathogenesis of ILD. The complexity of VEGF biology is particularly highlighted with an emphasis on the potential non-vascular, non-angiogenic roles for VEGF in the lung, in both health and disease.
Collapse
|
10
|
Hollevoet K, Declerck PJ. State of play and clinical prospects of antibody gene transfer. J Transl Med 2017; 15:131. [PMID: 28592330 PMCID: PMC5463339 DOI: 10.1186/s12967-017-1234-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/31/2017] [Indexed: 12/31/2022] Open
Abstract
Recombinant monoclonal antibodies (mAbs) are one of today's most successful therapeutic classes in inflammatory diseases and oncology. A wider accessibility and implementation, however, is hampered by the high product cost and prolonged need for frequent administration. The surge in more effective mAb combination therapies further adds to the costs and risk of toxicity. To address these issues, antibody gene transfer seeks to administer to patients the mAb-encoding nucleotide sequence, rather than the mAb protein. This allows the body to produce its own medicine in a cost- and labor-effective manner, for a prolonged period of time. Expressed mAbs can be secreted systemically or locally, depending on the production site. The current review outlines the state of play and clinical prospects of antibody gene transfer, thereby highlighting recent innovations, opportunities and remaining hurdles. Different expression platforms and a multitude of administration sites have been pursued. Viral vector-mediated mAb expression thereby made the most significant strides. Therapeutic proof of concept has been demonstrated in mice and non-human primates, and intramuscular vectored mAb therapy is under clinical evaluation. However, viral vectors face limitations, particularly in terms of immunogenicity. In recent years, naked DNA has gained ground as an alternative. Attained serum mAb titers in mice, however, remain far below those obtained with viral vectors, and robust pharmacokinetic data in larger animals is limited. The broad translatability of DNA-based antibody therapy remains uncertain, despite ongoing evaluation in patients. RNA presents another emerging platform for antibody gene transfer. Early reports in mice show that mRNA may be able to rival with viral vectors in terms of generated serum mAb titers, although expression appears more short-lived. Overall, substantial progress has been made in the clinical translation of antibody gene transfer. While challenges persist, clinical prospects are amplified by ongoing innovations and the versatility of antibody gene transfer. Clinical introduction can be expedited by selecting the platform approach currently best suited for the mAb or disease of interest. Innovations in expression platform, administration and antibody technology are expected to further improve overall safety and efficacy, and unlock the vast clinical potential of antibody gene transfer.
Collapse
Affiliation(s)
- Kevin Hollevoet
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Campus Gasthuisberg O&N 2, P.B. 820, Herestraat 49, 3000 Leuven, Belgium
| | - Paul J. Declerck
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Campus Gasthuisberg O&N 2, P.B. 820, Herestraat 49, 3000 Leuven, Belgium
| |
Collapse
|
11
|
Seno A, Takeda Y, Matsui M, Okuda A, Nakano T, Nakada Y, Kumazawa T, Nakagawa H, Nishida T, Onoue K, Somekawa S, Watanabe M, Kawata H, Kawakami R, Okura H, Uemura S, Saito Y. Suppressed Production of Soluble Fms-Like Tyrosine Kinase-1 Contributes to Myocardial Remodeling and Heart Failure. Hypertension 2016; 68:678-87. [PMID: 27480835 DOI: 10.1161/hypertensionaha.116.07371] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/26/2016] [Indexed: 01/17/2023]
Abstract
Soluble fms-like tyrosine kinase-1 (sFlt-1), an endogenous inhibitor of vascular endothelial growth factor and placental growth factor, is involved in the pathogenesis of cardiovascular disease. However, the significance of sFlt-1 in heart failure has not been fully elucidated. We found that sFlt-1 is decreased in renal failure and serves as a key molecule in atherosclerosis. In this study, we aimed to investigate the role of the decreased sFlt-1 production in heart failure, using sFlt-1 knockout mice. sFlt-1 knockout mice and wild-type mice were subjected to transverse aortic constriction and evaluated after 7 days. The sFlt-1 knockout mice had significantly higher mortality (52% versus 15%; P=0.0002) attributable to heart failure and showed greater cardiac hypertrophy (heart weight to body weight ratio, 8.95±0.45 mg/g in sFlt-1 knockout mice versus 6.60±0.32 mg/g in wild-type mice; P<0.0001) and cardiac dysfunction, which was accompanied by a significant increase in macrophage infiltration and cardiac fibrosis, than wild-type mice after transverse aortic constriction. An anti-placental growth factor-neutralizing antibody prevented pressure overload-induced cardiac hypertrophy, fibrosis, and cardiac dysfunction. Moreover, monocyte chemoattractant protein-1 expression was significantly increased in the hypertrophied hearts of sFlt-1 knockout mice compared with wild-type mice. Monocyte chemoattractant protein-1 inhibition with neutralizing antibody ameliorated maladaptive cardiac remodeling in sFlt-1 knockout mice after transverse aortic constriction. In conclusion, decreased sFlt-1 production plays a key role in the aggravation of cardiac hypertrophy and heart failure through upregulation of monocyte chemoattractant protein-1 expression in pressure-overloaded heart.
Collapse
Affiliation(s)
- Ayako Seno
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Yukiji Takeda
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Masaru Matsui
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Aya Okuda
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Tomoya Nakano
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Yasuki Nakada
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Takuya Kumazawa
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Hitoshi Nakagawa
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Taku Nishida
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Kenji Onoue
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Satoshi Somekawa
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Makoto Watanabe
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Hiroyuki Kawata
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Rika Kawakami
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Hiroyuki Okura
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Shiro Uemura
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Yoshihiko Saito
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.).
| |
Collapse
|
12
|
Leuci V, Maione F, Rotolo R, Giraudo E, Sassi F, Migliardi G, Todorovic M, Gammaitoni L, Mesiano G, Giraudo L, Luraghi P, Leone F, Bussolino F, Grignani G, Aglietta M, Trusolino L, Bertotti A, Sangiolo D. Lenalidomide normalizes tumor vessels in colorectal cancer improving chemotherapy activity. J Transl Med 2016; 14:119. [PMID: 27149858 PMCID: PMC4857418 DOI: 10.1186/s12967-016-0872-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 04/20/2016] [Indexed: 12/19/2022] Open
Abstract
Background Angiogenesis inhibition is a promising approach for treating metastatic colorectal cancer (mCRC). Recent evidences support the seemingly counterintuitive ability of certain antiangiogenic drugs to promote normalization of residual tumor vessels with important clinical implications. Lenalidomide is an oral drug with immune-modulatory and anti-angiogenic activity against selected hematologic malignancies but as yet little is known regarding its effectiveness for solid tumors. The aim of this study was to determine whether lenalidomide can normalize colorectal cancer neo-vessels in vivo, thus reducing tumor hypoxia and improving the benefit of chemotherapy. Methods We set up a tumorgraft model with NOD/SCID mice implanted with a patient-derived colorectal cancer liver metastasis. The mice were treated with oral lenalidomide (50 mg/Kg/day for 28 days), intraperitoneal 5-fluorouracil (5FU) (20 mg/Kg twice weekly for 3 weeks), combination (combo) of lenalidomide and 5FU or irrelevant vehicle. We assessed tumor vessel density (CD146), pericyte coverage (NG2; alphaSMA), in vivo perfusion capability of residual vessels (lectin distribution essay), hypoxic areas (HP2-100 Hypoxyprobe) and antitumor activity in vivo and in vitro. Results Treatment with lenalidomide reduced tumor vessel density (p = 0.0001) and enhanced mature pericyte coverage of residual vessels (p = 0.002). Perfusion capability of tumor vessels was enhanced in mice treated with lenalidomide compared to controls (p = 0.004). Accordingly, lenalidomide reduced hypoxic tumor areas (p = 0.002) and enhanced the antitumor activity of 5FU in vivo. The combo treatment delayed tumor growth (p = 0.01) and significantly reduced the Ki67 index (p = 0.0002). Lenalidomide alone did not demonstrate antitumor activity compared to untreated controls in vivo or against 4 different mCRC cell lines in vitro. Conclusions We provide the first evidence of tumor vessel normalization and hypoxia reduction induced by lenalidomide in mCRC in vivo. This effect, seemingly counterintuitive for an antiangiogenic compound, translates into indirect antitumor activity thus enhancing the therapeutic index of chemotherapy. Our findings suggest that further research should be carried out on synergism between lenalidomide and conventional therapies for treating solid tumors that might benefit from tumor vasculature normalization.
Collapse
Affiliation(s)
- V Leuci
- Department of Oncology, University of Torino, Turin, Italy.,Laboratory of Medical Oncology-Experimental Cell Therapy, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - F Maione
- Laboratory of Transgenic Mouse Models, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - R Rotolo
- Department of Oncology, University of Torino, Turin, Italy.,Laboratory of Medical Oncology-Experimental Cell Therapy, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - E Giraudo
- Laboratory of Transgenic Mouse Models, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy.,Department of Science and Drug Technology, University of Torino, Turin, Italy
| | - F Sassi
- Laboratory of Translational Cancer Medicine, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - G Migliardi
- Laboratory of Translational Cancer Medicine, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - M Todorovic
- Laboratory of Medical Oncology-Experimental Cell Therapy, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - L Gammaitoni
- Laboratory of Medical Oncology-Experimental Cell Therapy, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - G Mesiano
- Laboratory of Medical Oncology-Experimental Cell Therapy, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - L Giraudo
- Laboratory of Medical Oncology-Experimental Cell Therapy, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - P Luraghi
- Laboratory of Cancer Stem Cell Research, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - F Leone
- Department of Oncology, University of Torino, Turin, Italy.,Division and Laboratory of Medical Oncology, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - F Bussolino
- Department of Oncology, University of Torino, Turin, Italy.,Laboratory of Vascular Oncology, Candiolo Cancer Institute, Candiolo, Turin, Italy
| | - G Grignani
- Division and Laboratory of Medical Oncology, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - M Aglietta
- Department of Oncology, University of Torino, Turin, Italy.,Division and Laboratory of Medical Oncology, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - L Trusolino
- Department of Oncology, University of Torino, Turin, Italy.,Laboratory of Translational Cancer Medicine, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - A Bertotti
- Department of Oncology, University of Torino, Turin, Italy.,Laboratory of Translational Cancer Medicine, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - D Sangiolo
- Department of Oncology, University of Torino, Turin, Italy. .,Laboratory of Medical Oncology-Experimental Cell Therapy, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy.
| |
Collapse
|
13
|
Wimmer T, Lorenz B, Stieger K. Functional Characterization of AAV-Expressed Recombinant Anti-VEGF Single-Chain Variable Fragments In Vitro. J Ocul Pharmacol Ther 2015; 31:269-76. [PMID: 25867736 DOI: 10.1089/jop.2014.0125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Most retinal neovascular disorders are caused by upregulation of vascular endothelial growth factor (VEGF) expression. These disorders are treated with repeated injections of anti-VEGF molecules, which may have severe side effects. The expression of anti-VEGF molecules by the retina itself in a controlled manner following adeno-associated viral (AAV) gene transfer could be a replacement of this therapy. METHODS The open reading frames (orf) of the light and the heavy chain of ranibizumab were cloned into an expression plasmid separated by an internal ribosomal entry site (IRES). The construct was mutated to generate ranibizumab single-chain variable fragments (scFv). Expression was verified by western blotting and the concentrations were measured with a custom-made ranibizumab ELISA. Biological activity, VEGF-binding properties, and the doxycycline-dependent induction of anti-VEGF expression were tested. An AAV2/5 vector was generated containing the optimal variant Ra02. RESULTS Ra01-Ra05 molecules were detected in the cell culture medium. While the VEGF-binding affinity was significantly lower for Ra01 and Ra02 compared to Lucentis(®), the inhibition of cell migration was comparable and the maximum inhibition of Ra01 and Ra02 was reached at lower doses. The expression of Ra01 and Ra02 was shown to be regulable with the TetOn-system(®) as plasmid (Ra01, Ra02) and AAV vector construct (Ra02). CONCLUSION Ra01 and Ra02 can be produced in eukaryotic cells after AAV-mediated gene transfer in a regulable manner in vitro and display comparable biological activity as Lucentis. These results are the basis for in vivo studies in human VEGF-overexpressing mice, a model for human neovascular disorders.
Collapse
Affiliation(s)
- Tobias Wimmer
- Department of Ophthalmology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Birgit Lorenz
- Department of Ophthalmology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Knut Stieger
- Department of Ophthalmology, Justus-Liebig-University Giessen, Giessen, Germany
| |
Collapse
|
14
|
Abstract
The use of antibodies as a treatment for disease has it origins in experiments performed in the 1890s, and since these initial experiments, monoclonal antibodies (mAbs) have become one of the fastest growing therapeutic classes for the treatment of cancer, autoimmune disease, and infectious diseases. However, treatment with therapeutic mAbs often requires high doses given via long infusions or multiple injections, which, coupled with the prohibitively high cost associated with the production of clinical-grade proteins and the transient serum half-lives that necessitate multiple administrations to gain therapeutic benefits, makes large-scale treatment of patients, especially patients in the developing world, difficult. Due to their low-cost and rapid scalability, nucleic acid-based approaches to deliver antibody gene sequences for in situ mAb production have gained substantial traction. In this review, we discuss new approaches to produce therapeutic mAbs in situ to overcome the need for the passive infusion of purified protein.
Collapse
Affiliation(s)
- Todd J Suscovich
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | | |
Collapse
|
15
|
Barratt S, Medford AR, Millar AB. Vascular endothelial growth factor in acute lung injury and acute respiratory distress syndrome. Respiration 2014; 87:329-42. [PMID: 24356493 DOI: 10.1159/000356034] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/03/2013] [Indexed: 02/05/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is the most severe form of lung injury, characterised by alveolar oedema and vascular permeability, in part due to disruption of the alveolar capillary membrane integrity. Vascular endothelial growth factor (VEGF) was originally identified as a vascular permeability factor and has been implicated in the pathogenesis of acute lung injury/ARDS. This review describes our current knowledge of VEGF biology and summarises the literature investigating the potential role VEGF may play in normal lung maintenance and in the development of lung injury.
Collapse
Affiliation(s)
- S Barratt
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | | | | |
Collapse
|
16
|
Compte M, Nuñez-Prado N, Sanz L, Alvarez-Vallina L. Immunotherapeutic organoids: a new approach to cancer treatment. BIOMATTER 2013; 3:23897. [PMID: 23507921 PMCID: PMC3732323 DOI: 10.4161/biom.23897] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Therapeutic monoclonal antibodies have revolutionized the treatment of cancer and other diseases. However, several limitations of antibody-based treatments, such as the cost of therapy and the achievement of sustained plasma levels, should be still addressed for their widespread use as therapeutics. The use of cell and gene transfer methods offers additional benefits by producing a continuous release of the antibody with syngenic glycosylation patterns, which makes the antibody potentially less immunogenic. In vivo secretion of therapeutic antibodies by viral vector delivery or ex vivo gene modified long-lived autologous or allogeneic human mesenchymal stem cells may advantageously replace repeated injection of clinical-grade antibodies. Gene-modified autologous mesenchymal stem cells can be delivered subcutaneously embedded in a non-immunogenic synthetic extracellular matrix-based scaffold that guarantees the survival of the cell inoculum. The scaffold would keep cells at the implantation site, with the therapeutic protein acting at distance (immunotherapeutic organoid), and could be retrieved once the therapeutic effect is fulfilled. In the present review we highlight the practical importance of living cell factories for in vivo secretion of recombinant antibodies.
Collapse
Affiliation(s)
- Marta Compte
- Molecular Immunology Unit; Hospital Universitario Puerta de Hierro Majadahonda; Madrid, Spain
| | - Natalia Nuñez-Prado
- Molecular Immunology Unit; Hospital Universitario Puerta de Hierro Majadahonda; Madrid, Spain
| | - Laura Sanz
- Molecular Immunology Unit; Hospital Universitario Puerta de Hierro Majadahonda; Madrid, Spain
| | - Luís Alvarez-Vallina
- Molecular Immunology Unit; Hospital Universitario Puerta de Hierro Majadahonda; Madrid, Spain
| |
Collapse
|
17
|
Elevated VEGF Levels in Pulmonary Edema Fluid and PBMCs from Patients with Acute Hantavirus Pulmonary Syndrome. Adv Virol 2012; 2012:674360. [PMID: 22956954 PMCID: PMC3432326 DOI: 10.1155/2012/674360] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 07/11/2012] [Indexed: 12/19/2022] Open
Abstract
Hantavirus pulmonary syndrome is characterized by vascular permeability, hypoxia, and acute pulmonary edema. Vascular endothelial growth factor (VEGF) is induced by hypoxia, potently induces vascular permeability, and is associated with high-altitude-induced pulmonary edema. Hantaviruses alter the normal regulation of β3 integrins that restrict VEGF-directed permeability and hantavirus infected endothelial cells are hyperresponsive to the permeabilizing effects of VEGF. However, the role of VEGF in acute pulmonary edema observed in HPS patients remains unclear. Here we retrospectively evaluate VEGF levels in pulmonary edema fluid (PEF), plasma, sera, and PBMCs from 31 HPS patients. VEGF was elevated in HPS patients PEF compared to controls with the highest levels observed in PEF samples from a fatal HPS case. VEGF levels were highest in PBMC samples during the first five days of hospitalization and diminished during recovery. Significantly increased PEF and PBMC VEGF levels are consistent with acute pulmonary edema observed in HPS patients and HPS disease severity. We observed substantially lower VEGF levels in a severe HPS disease survivor after extracorporeal membrane oxygenation. These findings suggest the importance of patients' VEGF levels during HPS, support the involvement of VEGF responses in HPS pathogenesis, and suggest targeting VEGF responses as a potential therapeutic approach.
Collapse
|
18
|
Ferrarotto R, Hoff PM. Antiangiogenic drugs for colorectal cancer: exploring new possibilities. Clin Colorectal Cancer 2012; 12:1-7. [PMID: 22763196 DOI: 10.1016/j.clcc.2012.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/24/2012] [Accepted: 06/02/2012] [Indexed: 12/11/2022]
Abstract
Angiogenesis is essential to cancer development and progression, and its inhibition has been shown to benefit patients with several different malignancies. A considerable number of antiangiogenic compounds have been evaluated for the treatment of colorectal cancer, but only bevacizumab and aflibercept were able to demonstrate a survival benefit in phase III trials. In this review, we discuss important aspects of the interrelationship between tumor cells and the microenvironment leading to tumor progression, with a focus on angiogenesis. Clinical data on antiangiogenic therapies for colorectal cancer in the metastatic and adjuvant settings, as well as the potential use of antiangiogenics beyond tumor progression are analyzed. The need to identify surrogate biomarkers towards a more personalized approach in oncology is emphasized as this is becoming increasingly important in drug development.
Collapse
Affiliation(s)
- Renata Ferrarotto
- Oncology Department, Hospital Sirio Libanes, Faculdade de Medicina da Universisade de Sao Paulo, Sao Paulo, Brazil.
| | | |
Collapse
|
19
|
Abstract
Hantavirus pulmonary syndrome caused by hantaviruses in the Americas presents as a broad clinical spectrum ranging from brief febrile prodrome with only thrombocytopenia to rapidly progressive fulminant pulmonary edema and shock. This vascular leak syndrome confined almost exclusively to the lung is initiated by the noncytolytic infection of capillary endothelial cells. A number of pathogenic mechanisms have been proposed, including immune cell-mediated injury, cytokine-mediated injury and enhanced VEGF responses from intercellular junctions resulting from highly specific virus–integrin interactions. This review examines evidence for each of these potential mechanisms, with relevant references to its sister syndrome, hemorrhagic fever with renal syndrome, in Eurasia. Any mechanism or combination of mechanisms must be able to explain the massive pulmonary capillary leak at the severe extreme of the spectrum, a disease manifestation without parallel in clinical medicine.
Collapse
Affiliation(s)
- Frederick Koster
- Division of Applied Science, Lovelace Respiratory Research Institute, Albuquerque, NM, USA
| | - Erich Mackow
- Department Molecular Genetics & Microbiology, Molecular & Cellular Biology Program, Stony Brook University, Stony Brook, NY, USA
| |
Collapse
|
20
|
Sánchez-Martín D, Sanz L, Álvarez-Vallina L. Engineering human cells for in vivo secretion of antibody and non-antibody therapeutic proteins. Curr Opin Biotechnol 2011; 22:924-30. [PMID: 21435857 DOI: 10.1016/j.copbio.2011.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 02/22/2011] [Accepted: 03/01/2011] [Indexed: 01/14/2023]
Abstract
Purified proteins such as antibodies are widely used as therapeutic agents in clinical medicine. However, clinical-grade proteins for therapeutic use require sophisticated technologies and are extremely expensive to produce. In vivo secretion of therapeutic proteins by genetically engineered human cells may advantageously replace injection of highly purified proteins. The use of gene transfer methods circumvents problems related to large-scale production and purification and offers additional benefits by achieving sustained concentrations of therapeutic protein with a syngenic glycosylation pattern that make the protein potentially less immunogenic. The feasibility of the in vivo production of therapeutic proteins by diverse cells/tissues has now been demonstrated using different techniques, such as ex vivo genetically modified cells and in vivo gene transfer mediated by viral vectors.
Collapse
Affiliation(s)
- David Sánchez-Martín
- Molecular Immunology Unit, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Madrid, Spain
| | | | | |
Collapse
|
21
|
Watanabe M, Boyer JL, Crystal RG. AAVrh.10-mediated genetic delivery of bevacizumab to the pleura to provide local anti-VEGF to suppress growth of metastatic lung tumors. Gene Ther 2010; 17:1042-51. [PMID: 20596059 PMCID: PMC2921016 DOI: 10.1038/gt.2010.87] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Vascular endothelial growth factor (VEGF) produced by tumor cells has a central role in stimulating angiogenesis required for tumor growth. Humanized monoclonal anti-VEGF antibody (bevacizumab, Avastin), approved as a treatment for non-squamous, non-small cell lung cancer, requires administration every 3 weeks. We hypothesized that an intrapleural administration of an adeno-associated virus (AAV) vector expressing an anti-VEGF-A antibody equivalent of bevacizumab would result in sustained anti-VEGF-A localized expression within the lung and suppress metastatic tumor growth. The AAV vector AAVrh.10alphaVEGF encodes the light chain and heavy chain complementary DNAs of monoclonal antibody A.4.6.1, a murine antibody that specifically recognizes human VEGF-A with the same antigen-binding site as bevacizumab. A metastatic lung tumor model was established in severe combined immunodeficient mice by intravenous administration of human DU145 prostate carcinoma cells. Intrapleural administration of AAVrh.10alphaVEGF directed long-term expression of the anti-human VEGF-A antibody in lung, as shown by sustained, high-level anti-human VEGF titers in lung epithelial lining fluid for 40 weeks, which was the duration of the study. In the AAVrh.10alphaVEGF-treated animals, tumor growth was significantly suppressed (P<0.05), the numbers of blood vessels and mitotic nuclei in the tumor was decreased (P<0.05) and there was increased survival (P<0.05). Thus, intrapleural administration of an AAVrh.10 vector, encoding the murine monoclonal antibody equivalent of bevacizumab, effectively suppresses the growth of metastatic lung tumors, suggesting AAV-mediated gene transfer to the pleura to deliver bevacizumab locally to the lung as a novel alternative platform to conventional monoclonal antibody therapy.
Collapse
Affiliation(s)
- M Watanabe
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | | | | |
Collapse
|