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Roy Moulik N, Keerthivasagam S, Pandey A, Agiwale J, Hegde K, Chatterjee G, Dhamne C, Prasad M, Chichra A, Srinivasan S, Mohanty P, Jain H, Shetty D, Tembhare P, Patkar N, Narula G, Subramanian PG, Banavali S. Treatment and follow-up of children with chronic myeloid leukaemia in chronic phase (CML-CP) in the tyrosine kinase inhibitor (TKI) era-Two decades of experience from the Tata Memorial Hospital paediatric CML (pCML) cohort. Br J Haematol 2024; 204:1249-1261. [PMID: 38098201 DOI: 10.1111/bjh.19251] [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: 09/21/2023] [Revised: 11/04/2023] [Accepted: 11/28/2023] [Indexed: 04/11/2024]
Abstract
Tyrosine kinase inhibitors (TKIs) have drastically improved the outcomes of pCML (paediatric CML) but data on long-term off-target toxicities of TKIs in children are scarce. In this single-centre, retrospective cum prospective study of pCML in chronic phase, we report our experience of treating 173 children with imatinib and following them for long-term toxicities. Mean (SD) time to attain CHR, CCyR and MMR were 3.05 (2.1), 10.6 (8.4) and 43.4 (31.8) months respectively. DMR was not attained in 59 (34%) patients at last follow-up. Ten patients were switched to second-generation TKIs (2G-TKIs; nilotinib = 1/dasatinib = 9) due to poor/loss in response, of which seven had kinase domain mutations. Three patients progressed to the blastic phase. At a median follow-up of 84 (3-261) months, the 5-year EFS and OS for the entire cohort were 96.9% (95% CI: 93.4-100) and 98.7% (95% CI: 96.9-100) respectively. Screening for long-term toxicities revealed low bone density and hypovitaminosis D in 70% and 80% respectively. Other late effects included short stature (27%), delayed puberty (15%), poor sperm quality (43%) and miscellaneous endocrinopathies (8%). Children younger than 5 years at diagnosis were more susceptible to growth and endocrine toxicities (p = 0.009). Regular monitoring for long-term toxicities, timely intervention and trial of discontinuation whenever feasible are likely to improve the long-term outlook of pCML.
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Affiliation(s)
- Nirmalya Roy Moulik
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | | | - Ankita Pandey
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Jayesh Agiwale
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Kriti Hegde
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Gaurav Chatterjee
- Homi Bhabha National Institute, Mumbai, India
- Hematopathology, Tata Memorial Hospital, Mumbai, India
| | - Chetan Dhamne
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Maya Prasad
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Akanksha Chichra
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Shyam Srinivasan
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Purvi Mohanty
- Homi Bhabha National Institute, Mumbai, India
- Cancer Cytogenetics, Tata Memorial Hospital, Mumbai, India
| | - Hemani Jain
- Homi Bhabha National Institute, Mumbai, India
- Cancer Cytogenetics, Tata Memorial Hospital, Mumbai, India
| | - Dhanlaxmi Shetty
- Homi Bhabha National Institute, Mumbai, India
- Cancer Cytogenetics, Tata Memorial Hospital, Mumbai, India
| | - Prashant Tembhare
- Homi Bhabha National Institute, Mumbai, India
- Hematopathology, Tata Memorial Hospital, Mumbai, India
| | - Nikhil Patkar
- Homi Bhabha National Institute, Mumbai, India
- Hematopathology, Tata Memorial Hospital, Mumbai, India
| | - Gaurav Narula
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Papagudi G Subramanian
- Homi Bhabha National Institute, Mumbai, India
- Hematopathology, Tata Memorial Hospital, Mumbai, India
| | - Shripad Banavali
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
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Naples JG, Rice-Narusch W, Watson NW, Ghulam-Smith M, Holmes S, Li D, Jalisi S. Ototoxicity Review: A Growing Number of Non-Platinum-Based Chemo- and Immunotherapies. Otolaryngol Head Neck Surg 2023; 168:658-668. [PMID: 35439087 DOI: 10.1177/01945998221094457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/14/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To raise awareness of the growing list of non-platinum-based chemo- and immunotherapeutic agents that have been associated with ototoxicity and to introduce the possible mechanism of ototoxicity of these agents. DATA SOURCES PubMed, Embase, and Web of Science. REVIEW METHODS A systematic review was performed following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). PubMed, Embase, and Web of Science databases were searched for published reports of ototoxicity from non-platinum-based chemo- and immunotherapeutic agents in adult and pediatric patients. Therapies that utilized any platinum-based agent were excluded. CONCLUSIONS Ototoxicity from non-platinum-based chemo- and immunotherapies is an evolving problem. There were 54 reports-39 case reports and 15 cohort studies-documenting ototoxicity from 7 agents/combination therapies. Of these reports, 37 (69%) were published within the last 15 years (after 2005). No recovery of hearing was documented in 21 of 56 cases (38%). Pretreatment audiograms were uncommon (19/54 studies, 35%), despite documented ototoxic associations. IMPLICATIONS FOR PRACTICE There is a growing number of novel, ototoxic, non-platinum-based chemo- and immunotherapeutic agents with various potential mechanisms of action. Otolaryngologists will need to prioritize awareness of these agents. This growing list of agents, many of which have reversible effects, suggest a need for standardized ototoxicity monitor protocols so that appropriate and timely management options can be implemented.
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Affiliation(s)
- James G Naples
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Wyatt Rice-Narusch
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Sean Holmes
- Louisiana State University-Shreveport, Shreveport, Louisiana, USA
| | - Daqing Li
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scharukh Jalisi
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
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Coffin AB, Dale E, Doppenberg E, Fearington F, Hayward T, Hill J, Molano O. Putative COVID-19 therapies imatinib, lopinavir, ritonavir, and ivermectin cause hair cell damage: A targeted screen in the zebrafish lateral line. Front Cell Neurosci 2022; 16:941031. [PMID: 36090793 PMCID: PMC9448854 DOI: 10.3389/fncel.2022.941031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
The biomedical community is rapidly developing COVID-19 drugs to bring much-need therapies to market, with over 900 drugs and drug combinations currently in clinical trials. While this pace of drug development is necessary, the risk of producing therapies with significant side-effects is also increased. One likely side-effect of some COVID-19 drugs is hearing loss, yet hearing is not assessed during preclinical development or clinical trials. We used the zebrafish lateral line, an established model for drug-induced sensory hair cell damage, to assess the ototoxic potential of seven drugs in clinical trials for treatment of COVID-19. We found that ivermectin, lopinavir, imatinib, and ritonavir were significantly toxic to lateral line hair cells. By contrast, the approved COVID-19 therapies dexamethasone and remdesivir did not cause damage. We also did not observe damage from the antibiotic azithromycin. Neither lopinavir nor ritonavir altered the number of pre-synaptic ribbons per surviving hair cell, while there was an increase in ribbons following imatinib or ivermectin exposure. Damage from lopinavir, imatinib, and ivermectin was specific to hair cells, with no overall cytotoxicity noted following TUNEL labeling. Ritonavir may be generally cytotoxic, as determined by an increase in the number of TUNEL-positive non-hair cells following ritonavir exposure. Pharmacological inhibition of the mechanotransduction (MET) channel attenuated damage caused by lopinavir and ritonavir but did not alter imatinib or ivermectin toxicity. These results suggest that lopinavir and ritonavir may enter hair cells through the MET channel, similar to known ototoxins such as aminoglycoside antibiotics. Finally, we asked if ivermectin was ototoxic to rats in vivo. While ivermectin is not recommended by the FDA for treating COVID-19, many people have chosen to take ivermectin without a doctor’s guidance, often with serious side-effects. Rats received daily subcutaneous injections for 10 days with a clinically relevant ivermectin dose (0.2 mg/kg). In contrast to our zebrafish assays, ivermectin did not cause ototoxicity in rats. Our research suggests that some drugs in clinical trials for COVID-19 may be ototoxic. This work can help identify drugs with the fewest side-effects and determine which therapies warrant audiometric monitoring.
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Affiliation(s)
- Allison B. Coffin
- Department of Integrative Physiology and Neuroscience, Washington State University, Vancouver, WA, United States
- College of Arts and Sciences, Washington State University, Vancouver, WA, United States
- *Correspondence: Allison B. Coffin,
| | - Emily Dale
- College of Arts and Sciences, Washington State University, Vancouver, WA, United States
| | - Emilee Doppenberg
- College of Arts and Sciences, Washington State University, Vancouver, WA, United States
| | - Forrest Fearington
- College of Arts and Sciences, Washington State University, Vancouver, WA, United States
| | - Tamasen Hayward
- College of Arts and Sciences, Washington State University, Vancouver, WA, United States
| | - Jordan Hill
- College of Arts and Sciences, Washington State University, Vancouver, WA, United States
| | - Olivia Molano
- College of Arts and Sciences, Washington State University, Vancouver, WA, United States
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Coffin AB, Boney R, Hill J, Tian C, Steyger PS. Detecting Novel Ototoxins and Potentiation of Ototoxicity by Disease Settings. Front Neurol 2021; 12:725566. [PMID: 34489859 PMCID: PMC8418111 DOI: 10.3389/fneur.2021.725566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022] Open
Abstract
Over 100 drugs and chemicals are associated with permanent hearing loss, tinnitus, and vestibular deficits, collectively known as ototoxicity. The ototoxic potential of drugs is rarely assessed in pre-clinical drug development or during clinical trials, so this debilitating side-effect is often discovered as patients begin to report hearing loss. Furthermore, drug-induced ototoxicity in adults, and particularly in elderly patients, may go unrecognized due to hearing loss from a variety of etiologies because of a lack of baseline assessments immediately prior to novel therapeutic treatment. During the current pandemic, there is an intense effort to identify new drugs or repurpose FDA-approved drugs to treat COVID-19. Several potential COVID-19 therapeutics are known ototoxins, including chloroquine (CQ) and lopinavir-ritonavir, demonstrating the necessity to identify ototoxic potential in existing and novel medicines. Furthermore, several factors are emerging as potentiators of ototoxicity, such as inflammation (a hallmark of COVID-19), genetic polymorphisms, and ototoxic synergy with co-therapeutics, increasing the necessity to evaluate a drug's potential to induce ototoxicity under varying conditions. Here, we review the potential of COVID-19 therapies to induce ototoxicity and factors that may compound their ototoxic effects. We then discuss two models for rapidly detecting the potential for ototoxicity: mammalian auditory cell lines and the larval zebrafish lateral line. These models offer considerable value for pre-clinical drug development, including development of COVID-19 therapies. Finally, we show the validity of in silico screening for ototoxic potential using a computational model that compares structural similarity of compounds of interest with a database of known ototoxins and non-ototoxins. Preclinical screening at in silico, in vitro, and in vivo levels can provide an earlier indication of the potential for ototoxicity and identify the subset of candidate therapeutics for treating COVID-19 that need to be monitored for ototoxicity as for other widely-used clinical therapeutics, like aminoglycosides and cisplatin.
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Affiliation(s)
| | | | - Jordan Hill
- Washington State University Vancouver, Vancouver, WA, United States
| | - Cong Tian
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE, United States
| | - Peter S. Steyger
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE, United States
- National Center for Rehabilitative Auditory Research, Portland, OR, United States
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Güler İ, Kuzucu İ, Baklacı D, Kum RO, Özhamam Uçaryılmaz E, Özcan M. Evaluation of Nivolumab for Ototoxic Effects: An Animal Study in Rats. J Int Adv Otol 2021; 16:218-221. [PMID: 32510456 DOI: 10.5152/iao.2020.7123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess whether nivolumab is ototoxic in rats and whether this ototoxicity is dose-dependent. MATERIALS AND METHODS Twelve rats were divided into two groups: Group 1 (control group, 6 rats, 12 ears) received intraperitoneal saline for 14 days. Group 2 (study group, 6 rats, 12 ears) and received two doses of 3 mg/kg intraperitoneal nivolumab within 14 days. Auditory brainstem responses (ABRs) were performed preoperatively and 4 and 8 weeks postoperatively. We compared between the groups, morphologic appearance of spiral ganglion cells and organ of Corti and density of spiral ganglion cells (measured with conventional light microscope connected to a personal computer). RESULTS In our control group, both spiral ganglion and organ of corti had a normal morphological appearance. In our study group, spiral ganglion cells had a normal morphological appearance. However, some sections showed possibly mild degenerative changes in the organ of corti. Of 12 samples in the study group, four had a significant loss of density of spiral ganglion cells compared to the control group. The baseline ABR thresholds did not significantly differ between the groups (p=0.713). There was no statistically significant difference between the groups regarding ABR thresholds at week 4 (p=0.347). However, a statistically significant difference was observed in the ABR thresholds at week 8 (p=0.045). CONCLUSION The results of our study showed that nivolumab treatment has ototoxic effects. Based on our results, we recommend monitoring the changes in the hearing ability of chemotherapy patients.
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Affiliation(s)
- İsmail Güler
- Deparment of Otorhinolaryngology, Ankara Medipol University School of Medicine, Ankara, Turkey
| | - İhsan Kuzucu
- Department of Otorhinolaryngology, Aksaray University School of Medicine, Aksaray, Turkey
| | - Deniz Baklacı
- Clinic of Otorhinolaryngology, Kahramankazan State Hospital, Ankara, Turkey
| | - Rauf Oğuzhan Kum
- Clinic of Otorhinolaryngology, Ankara City Hospital, Ankara, Turkey
| | | | - Müge Özcan
- Clinic of Otorhinolaryngology, Ankara City Hospital, Ankara, Turkey
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Bora A, Durmuş K, Terzi H, Altuntaş EE. Examining the Early Period Effect of Nilotinib on Hearing: An Experimental Study. J Int Adv Otol 2020; 16:77-86. [PMID: 31287435 PMCID: PMC7224425 DOI: 10.5152/iao.2019.5908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Nilotinib has very few side effects, including neutropenia, thrombocytopenia, cardiotoxicity, high pancreatic lipase, ischemia, and vascular occlusion. We aimed to investigate whether short-term administration of nilotinib had ototoxic effects in rats. MATERIALS AND METHODS Wistar-albino rats were categorized into three groups: group C (administered 0.25 mL of distilled water, no nilotinib), group N-20 (administered 20 mg/kg/day of nilotinib dissolved in distilled water), and group N-50 (administered 50 mg/kg/day of nilotinib dissolved in distilled water). A single dose was administered once per day, at the same hour, over 21 days. Auditory brainstem response (ABR) thresholds were recorded on day 0 and day 21. RESULTS There were no changes in ABR threshold values obtained on day 0 (baseline) and on day 21 across all three groups. A statistically significant difference was not found in terms of the mean latency of waves V and III, interpeak latency values of waves III-V, and amplitude ratios of waves III-V and V/Va at baseline and on day 21 across all three groups on within-group or between-group evaluation. CONCLUSION Consequently, further studies are needed that involve different drug doses, prolonged administration of drugs, as well as distortion otoacoustic emission test for the evaluation of cochlear activation and ABR. Furthermore, histopathological studies are needed to indicate whether the cochlea is affected to prove that nilotinib has definitively no ototoxic effect.
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Affiliation(s)
- Adem Bora
- Department of Otolaryngology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Kasım Durmuş
- Department of Otolaryngology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Hatice Terzi
- Department of Internal Medicine, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Emine Elif Altuntaş
- Department of Otolaryngology, Cumhuriyet University School of Medicine, Sivas, Turkey
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7
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Favrelière S, Delaunay P, Lebreton JP, Rouby F, Atzenhoffer M, Lafay-Chebassier C, Pérault-Pochat MC. Drug-induced hearing loss: a case/non-case study in the French pharmacovigilance database. Fundam Clin Pharmacol 2020; 34:397-407. [PMID: 31912913 DOI: 10.1111/fcp.12533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 12/06/2019] [Accepted: 01/06/2020] [Indexed: 11/29/2022]
Abstract
Hearing loss is defined as a decrease in the ability to perceive sounds which can occur suddenly or gradually and affects one ear or both. It is related to various etiologies, in particular drugs. The identification of all drugs that could be associated with hearing loss is essential for the patients' life quality. The objective of our study was to identify signals of hearing loss involving drugs approved in the last 20 years. The occurrence in association with drugs known for their ototoxicity was also analyzed. We used a case/non-case method in the French Pharmacovigilance Database (FPVD). The cases were reports of hearing loss in the FPVD between January 2007 and August 2017. Non-cases were all reports over the same period. We calculated the reporting odds ratio (ROR) with 95% confidence intervals. Among the 555 reports of hearing loss, significant RORs were found for 68 drugs. The main therapeutic classes implicated were antineoplastic agents (n = 240), systemic anti-infective agents (n = 182), immunosuppressants (n = 42) loop diuretics (n = 26), and salicylate analgesics (n = 26). We found signals of hearing loss with azacitidine, vaccines and nevirapine, immunosuppressants such as leflunomide, and biotherapies such as panitumumab and vandetanib. Prescribers should be informed about the potential associations with all these drugs. The role of the pathology itself and the known ototoxic drugs that can be associated do not allow to conclude definitively. Audiograms for the early detection of hearing loss induced by drugs known to be ototoxic are rarely carried out. Preventive treatments exist and must be considered.
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Affiliation(s)
- Sylvie Favrelière
- Department of Clinical Pharmacology and Pharmacovigilance, University Hospital of Poitiers, 2 rue de la Milètrie, BP 577, 86021, Poitiers Cedex, France
| | - Paul Delaunay
- Department of Clinical Pharmacology and Pharmacovigilance, University Hospital of Poitiers, 2 rue de la Milètrie, BP 577, 86021, Poitiers Cedex, France
| | - Jean-Pascal Lebreton
- Department of Otorhinolaryngology - Head & Neck Surgery, University Hospital of Poitiers, 2, rue de la Milètrie, BP 577, 86021, Poitiers Cedex, France
| | - Franck Rouby
- Department of Clinical Pharmacology and Pharmacovigilance, University Hospital of Marseille, 270 Boulevard Sainte Marguerite, 13009, Marseille, France
| | - Martine Atzenhoffer
- Department of Clinical Pharmacology and Pharmacovigilance, Hospices civils de Lyon, 69424, Lyon, France
| | - Claire Lafay-Chebassier
- Department of Clinical Pharmacology and Pharmacovigilance, University Hospital of Poitiers, 2 rue de la Milètrie, BP 577, 86021, Poitiers Cedex, France.,INSERM, U1084, Laboratoire de Neurosciences Expérimentales et Cliniques - LNEC, Université de Poitiers, Batiment B36, 1 rue Georges Bonnet, BP633, 86022, Poitiers Cedex, France
| | - Marie Christine Pérault-Pochat
- Department of Clinical Pharmacology and Pharmacovigilance, University Hospital of Poitiers, 2 rue de la Milètrie, BP 577, 86021, Poitiers Cedex, France.,INSERM, U1084, Laboratoire de Neurosciences Expérimentales et Cliniques - LNEC, Université de Poitiers, Batiment B36, 1 rue Georges Bonnet, BP633, 86022, Poitiers Cedex, France
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Altuntas E, Durmus K, Bora A, Turgut N, Terzi H, Kutluhan A. Examination of ototoxicity induced by imatinib, being a tyrosine kinase inhibitor: An experimental study. INDIAN JOURNAL OF OTOLOGY 2020. [DOI: 10.4103/indianjotol.indianjotol_129_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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9
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Ryals M, Pak K, Jalota R, Kurabi A, Ryan AF. A kinase inhibitor library screen identifies novel enzymes involved in ototoxic damage to the murine organ of Corti. PLoS One 2017; 12:e0186001. [PMID: 29049311 PMCID: PMC5648133 DOI: 10.1371/journal.pone.0186001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/22/2017] [Indexed: 11/25/2022] Open
Abstract
Ototoxicity is a significant side effect of a number of drugs, including the aminoglycoside antibiotics and platinum-based chemotherapeutic agents that are used to treat life-threatening illnesses. Although much progress has been made, the mechanisms that lead to ototoxic loss of inner ear sensory hair cells (HCs) remains incompletely understood. Given the critical role of protein phosphorylation in intracellular processes, including both damage and survival signaling, we screened a library of kinase inhibitors targeting members of all the major families in the kinome. Micro-explants from the organ of Corti of mice in which only the sensory cells express GFP were exposed to 200 μM of the ototoxic aminoglycoside gentamicin with or without three dosages of each kinase inhibitor. The loss of sensory cells was compared to that seen with gentamicin alone, or without treatment. Of the 160 inhibitors, 15 exhibited a statistically significant protective effect, while 3 significantly enhanced HC loss. The results confirm some previous studies of kinase involvement in HC damage and survival, and also highlight several novel potential kinase pathway contributions to ototoxicity.
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Affiliation(s)
- Matthew Ryals
- Department of Surgery/Otolaryngology, University of California, San Diego, School of Medicine, La Jolla, California, United States of America
| | - Kwang Pak
- Department of Surgery/Otolaryngology, University of California, San Diego, School of Medicine, La Jolla, California, United States of America
| | - Rahul Jalota
- Department of Surgery/Otolaryngology, University of California, San Diego, School of Medicine, La Jolla, California, United States of America
| | - Arwa Kurabi
- Department of Surgery/Otolaryngology, University of California, San Diego, School of Medicine, La Jolla, California, United States of America
| | - Allen F. Ryan
- Department of Surgery/Otolaryngology, University of California, San Diego, School of Medicine, La Jolla, California, United States of America
- Research Service, Veterans Administration Medical Center, San Diego, California, United States of America
- * E-mail:
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10
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Audio Vestibular Status in CML Patients on Imatinib Mesylate with Review of Literature. Indian J Hematol Blood Transfus 2017; 33:175-180. [PMID: 28596647 DOI: 10.1007/s12288-015-0612-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022] Open
Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm occasionally presenting with features of leukostasis as primary symptoms. Hearing loss is occasionally reported in CML patients. Further whether Imatinib mesylate has any effect on vestibular functions is not known. We conducted a preliminary study to assess hearing pattern in patients with CML on long term TKI therapy. This is a single center, cross sectional study from northern-India. Patients of CML who were on regular Tyrosine kinase inhibitors (TKI) therapy for at least 6 months underwent audiovestibular evaluation . A total of 44 CML patients on TKI therapy were assessed over a period of 6 months. The median age of the patients was 41 years, the mean duration of TKI therapy was 36 months. Four patients were found to have otological disorder clinically. On pure tone audiometry of 88 ears normal hearing pattern were found with at low and mid frequencies. There was a down sloping type of curve at higher frequencies in PTA in most of the patients. Cold caloric tests in 42 patients were found as equal response in both ears. We conclude from this preliminary study that there are no audio vestibular dysfunctions amongst patients of CML on TKI. It's a negative study wherein we have ruled out any auditory deficits secondary to Imatinib therapy. Further studies are required to evaluate the audiometric profile in CML patients before Imatinib therapy and to be compared with the patients already on Imatinib in a large cohort.
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11
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Wasif K, Wasif N, Saif MW. Imatinib-induced Ototoxicity in a Patient with Gastrointestinal Stromal Tumor (GIST). Cureus 2016; 8:e848. [PMID: 27909636 PMCID: PMC5120973 DOI: 10.7759/cureus.848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Imatinib (Gleevec) is a biological agent that is approved for the treatment of chronic myeloid leukemia (CML) as well as gastrointestinal stromal tumor (GIST). The most frequently seen adverse effects in patients treated with imatinib include superficial edema, muscle cramps, musculoskeletal pain, rash, fatigue, headache, abdominal pain, and joint pain. Ototoxicity has rarely been reported except in two cases. We report a case of bilateral irreversible sensorineural hearing loss (SNHL) caused by imatinib in a patient receiving this agent in the adjuvant setting. This case underlines the importance of early recognition of this potential toxicity that can impact the quality of life.
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Affiliation(s)
| | | | - Muhammad W Saif
- Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine
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12
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Permanent sensorineural deafness in a patient with chronic myelogenous leukemia secondary to intracranial hemorrhage. Case Rep Hematol 2013; 2013:894141. [PMID: 24367730 PMCID: PMC3866831 DOI: 10.1155/2013/894141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 10/31/2013] [Indexed: 11/17/2022] Open
Abstract
A 52-year-old male presented with tinnitus and fullness in left ear for one day. Workup revealed a white blood cell count of 685 × 10(3)/μL with marked increase in granulocyte series and myeloid precursors on peripheral smear. The initial impression was chronic myelogenous leukemia with hyperleukocytosis, and patient was started on hydration, hydroxyurea, and allopurinol. Patient tolerated bone marrow biopsy well but continued to bleed excessively from the biopsy site. Results confirmed Philadelphia chromosome positive chronic myelogenous leukemia (chronic phase). On day three of hospitalization, patient developed sudden slurred speech along with shaking movements involving extremities. Magnetic resonance imaging revealed multiple hemorrhages throughout the brain. Hydroxyurea was continued until insurance coverage for nilotinib was getting approved. On day nine of hospitalization, patient developed sudden bilateral sensorineural deafness. Repeat magnetic resonance imaging revealed multiple new hemorrhages throughout the brain. Computer tomography of the temporal bones showed inflammatory changes in right and left mastoid cells. Nilotinib was started on day eleven of hospitalization. Patient's white blood cell count continued to decrease, but there was no improvement in hearing. Four months later, patient was treated with bilateral transmastoid cochlear implants. This case highlights permanent deafness as a hemorrhagic complication secondary to chronic myelogenous leukemia.
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