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Rajkovic J, Novakovic R, Grujic-Milanovic J, Ydyrys A, Ablaikhanova N, Calina D, Sharifi-Rad J, Al-Omari B. An updated pharmacological insight into calotropin as a potential therapeutic agent in cancer. Front Pharmacol 2023; 14:1160616. [PMID: 37138852 PMCID: PMC10149670 DOI: 10.3389/fphar.2023.1160616] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/05/2023] [Indexed: 05/05/2023] Open
Abstract
Calotropin is a pharmacologically active compound isolated from milkweed plants like Calotropis procera, Calotropis gigantea, and Asclepias currasavica that belong to the Asclepiadaceae family. All of these plants are recognised as medical traditional plants used in Asian countries. Calotropin is identified as a highly potent cardenolide that has a similar chemical structure to cardiac glycosides (such as digoxin and digitoxin). During the last few years, cytotoxic and antitumor effects of cardenolides glycosides have been reported more frequently. Among cardenolides, calotropin is identified as the most promising agent. In this updated and comprehensive review, we aimed to analyze and discuss the specific mechanisms and molecular targets of calotropin in cancer treatment to open new perspectives for the adjuvant treatment of different types of cancer. The effects of calotropin on cancer have been extensively studied in preclinical pharmacological studies in vitro using cancer cell lines and in vivo in experimental animal models that have targeted antitumor mechanisms and anticancer signaling pathways. The analyzed information from the specialized literature was obtained from scientific databases until December 2022, mainly from PubMed/MedLine, Google Scholar, Scopus, Web of Science, and Science Direct databases using specific MeSH search terms. The results of our analysis demonstrate that calotropin can be a potential chemotherapeutic/chemopreventive adjunctive agent in cancer pharmacotherapeutic management.
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Affiliation(s)
- Jovana Rajkovic
- Institute for Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Radmila Novakovic
- Institute for Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelica Grujic-Milanovic
- Institute for Medical Research, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Alibek Ydyrys
- Biomedical Research Centre, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Nurzhanat Ablaikhanova
- Department of Biophysics, Biomedicine and Neuroscience, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, Craiova, Romania
- *Correspondence: Daniela Calina, ; Javad Sharifi-Rad, ; Basem Al-Omari,
| | - Javad Sharifi-Rad
- Facultad de Medicina, Universidad del Azuay, Cuenca, Ecuador
- *Correspondence: Daniela Calina, ; Javad Sharifi-Rad, ; Basem Al-Omari,
| | - Basem Al-Omari
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- *Correspondence: Daniela Calina, ; Javad Sharifi-Rad, ; Basem Al-Omari,
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Docter S, Lukacs MJ, Fathalla Z, Khan MCM, Jennings M, Liu SH, Dong S, Getgood A, Bryant DM. Inconsistencies in the Methodological Framework Throughout Published Studies in High-Impact Orthopaedic Journals: A Systematic Review. J Bone Joint Surg Am 2022; 104:181-188. [PMID: 34648473 DOI: 10.2106/jbjs.21.00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Both the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and Consolidated Standards of Reporting Trials (CONSORT) guidelines recommend that clinical trials follow a study framework that aligns with their objective to test the relative efficacy or safety (equality) or effectiveness (superiority, noninferiority, or equivalence) between interventions. We conducted a systematic review to assess the proportion of studies that demonstrated inconsistency between the framing of their research question, sample size calculation, and conclusion and those that should have framed their research question differently based on the compared interventions. METHODS We included studies from 5 high-impact-factor orthopaedic journals published in 2017 and 2019 that compared at least 2 interventions using patient-reported outcome measures. RESULTS We included 228 studies. The sample size calculation was reported in 60.5% (n = 138) of studies. Of these, 52.2% (n = 72) were inconsistent between the framing of their research question, sample size calculation, and conclusion. The majority (n = 137) of sample size calculations were for equality, but 43.8% of these studies concluded superiority, noninferiority, or equivalence. Studies that framed their research question as equality (n = 186) should have been framed as superiority (n = 129), equivalence (n = 52), or noninferiority (n = 3). Only 2 studies correctly framed their research question as equality. CONCLUSIONS Studies published in high-impact journals were inconsistent between the framing of their research question, sample size calculation, and conclusion. Authors may be misinterpreting research findings and making clinical recommendations solely based on p values. Researchers are encouraged to state and justify their methodological framework and choice of margin(s) in a publicly published protocol as they have implications for sample size and the applicability of conclusions. CLINICAL RELEVANCE The results of clinical research must be interpreted using confidence intervals, with careful consideration as to how the confidence intervals relate to clinically meaningful differences in outcomes between treatments. The more typical practice of relying on p values leaves the clinician at high risk of erroneous interpretation, recommendation, and/or action.
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Affiliation(s)
- Shgufta Docter
- Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Michael J Lukacs
- Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Zina Fathalla
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michaela C M Khan
- Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Morgan Jennings
- Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Shu-Hsuan Liu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Susan Dong
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Alan Getgood
- Bone and Joint Institute, Western University, London, Ontario, Canada.,Division of Orthopaedics, Department of Surgery, Fowler Kennedy Sport Medicine, Western University, London, Ontario, Canada
| | - Dianne M Bryant
- Faculty of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.,Bone and Joint Institute, Western University, London, Ontario, Canada.,Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Division of Orthopaedics, Department of Surgery, Fowler Kennedy Sport Medicine, Western University, London, Ontario, Canada
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Hashim M, Vincken T, Kroi F, Gebregergish S, Spencer M, Wang J, Kampfenkel T, Lam A, He J. A systematic review of noninferiority margins in oncology clinical trials. J Comp Eff Res 2021; 10:443-455. [PMID: 33728935 DOI: 10.2217/cer-2020-0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: A systematic literature review was conducted to identify and characterize noninferiority margins for relevant end points in oncology clinical trials. Materials & methods: Randomized, controlled, noninferiority trials of patients with cancer were identified in PubMed and Embase. Results: Of 2284 publications identified, 285 oncology noninferiority clinical trials were analyzed. The median noninferiority margin was a hazard ratio of 1.29 (mean: 1.32; range: 1.05-2.05) for studies that reported time-to-event end points (n = 192). The median noninferiority margin was 13.0% (mean: 12.7%; range: 5.0-20.0%) for studies that reported response end points as absolute rate differences (n = 31). Conclusion: Although there was consistency in the noninferiority margins' scale, variability was evident in noninferiority margins across trials. Increased transparency may improve consistency in noninferiority margin application in oncology clinical trials.
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Affiliation(s)
| | | | | | | | - Mike Spencer
- Janssen Global Services, LLC, Raritan, NJ 08869, USA
| | - Jianping Wang
- Janssen Global Services, LLC, Raritan, NJ 08869, USA
| | | | - Annette Lam
- Janssen Global Services, LLC, Raritan, NJ 08869, USA
| | - Jianming He
- Janssen Global Services, LLC, Raritan, NJ 08869, USA
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Marini W, Moher D, McCready D, Parsyan A. ASO Author Reflections: Current Issues in Conduct and Reporting of Noninferiority Randomized Controlled Trials in the Surgical Management of Cancer Patients. Ann Surg Oncol 2020; 27:751-752. [PMID: 32436188 DOI: 10.1245/s10434-020-08589-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Wanda Marini
- Department of Surgery, University Health Network, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - David Moher
- Centre for Journalology, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - David McCready
- Department of Surgery, University Health Network, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Armen Parsyan
- Departments of Surgery and Oncology, London Regional Cancer Program, St. Joseph's Health Care and London Health Sciences Centre, Western University, London, ON, Canada.
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Parsyan A, Marini W, Fazelzad R, Moher D, McCready D. Current Issues in Conduct and Reporting of Noninferiority Randomized Controlled Trials in Surgical Management of Cancer Patients. Ann Surg Oncol 2020; 28:39-47. [PMID: 32430749 DOI: 10.1245/s10434-020-08575-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Serious concerns regarding quality of conduct and reporting of noninferiority trials (NITs) have been raised. Systematic analysis of the quality of the surgical NITs is lacking. Assessing the quality of conduct, reporting, and interpretation of surgical NITs in cancer patients is critical given their potential clinical impact. We aim to assess the quality of conduct, reporting, and interpretation of NITs that investigate the effects of surgical management in cancer patients. METHODS A cross-sectional analysis of papers identified through a comprehensive literature database search was performed. Forty papers employing a phase III noninferiority (NI) randomized trial design to study effects of surgical methodology or sequencing of surgery in patients with solid cancers were included. Papers were assessed for type of analysis, justification of the noninferiority margin (NIM), consistency of type I error with confidence intervals (CIs), ability to achieve the predefined sample size, and interpretations regarding NI. RESULTS Only half of the papers used both intention-to-treat and per protocol analyses; 62.5% provided no or poor justification for the NIM; 42.5% showed inconsistency of the type I error rate with CIs; 52.5% were deemed poor or fair quality, and 60.0% did not achieve the predefined sample size. One-fifth of the papers provided interpretation of the NI hypothesis that was not in concordance with the CONSORT guidelines. CONCLUSIONS The quality of conduct, reporting, and interpretation of surgical NITs is suboptimal, requiring further improvements through adherence to guidelines and rigorous assessment at the stages of the study approval, funding, and the peer-review process.
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Affiliation(s)
- Armen Parsyan
- Department of Surgery and Oncology, London Regional Cancer Program, St Joseph's Health Care and London Health Sciences Centre, Western University, London, ON, Canada.
| | - Wanda Marini
- Department of Surgery, University Health Network, Princess Margaret Hospital, University of Toronto, Toronto, Canada
| | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - David Moher
- Centre for Journalology, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - David McCready
- Department of Surgery, University Health Network, Princess Margaret Hospital, University of Toronto, Toronto, Canada
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Tian L, Xie XH, Zhu ZH. Calotropin regulates the apoptosis of non‑small cell cancer by regulating the cytotoxic T‑lymphocyte associated antigen 4‑mediated TGF‑β/ERK signaling pathway. Mol Med Rep 2018; 17:7683-7691. [PMID: 29620207 PMCID: PMC5983968 DOI: 10.3892/mmr.2018.8853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/09/2018] [Indexed: 01/27/2023] Open
Abstract
Non-small-cell lung cancer (NSCLC) is one of the most common malignancies that is responsible for a high level of cancer-associated mortalities worldwide. Previous evidence has shown that Calotropin is an upstream activator of protein kinase B, which can further inhibit the growth and promote the apoptosis of NSCLC cells. In the present study, the efficacy of Calotropin on growth, aggressiveness and apoptosis of NSCLC cells was investigated, as well as the potential underlying mechanism. The results demonstrated that Calotropin inhibited H358 cell growth, migration and invasion. Flow cytometry assay showed that Calotropin promoted the apoptosis of H358 cells in vitro. Western blot analysis demonstrated that Calotropin inhibited fibronectin (FN), Vimentin (VIM) and E-cadherin (Eca) protein expression levels in H358 cells in vitro. In addition, Calotropin treatment upregulated pro-apoptosis gene expression, including caspase-3, caspase-8 and apoptotic protease activating factor-1, and downregulated anti-apoptosis gene expression, including P53, B-cell lymphoma (Bcl) 2 and Bcl-2-like protein 2 in H358 cells. The results also revealed that the expression levels of cytotoxic T-lymphocyte associated antigen 4 (CTLA-4) were decreased by Calotropin treatment in H358 cells. Analyses of the underlying mechanism indicated that Calotropin inhibited transforming growth factor-β (TGF-β) and extracellular signal-regulated kinase (ERK) expression. Overexpression of CTLA-4 inhibited Calotropin-mediated downregulation of TGF-β and ERK expression in H358 cells. In vivo assay revealed that Calotropin administration significantly inhibited tumor growth and prolonged animal survival over the 120-day observation period. Immunohistochemistry demonstrated that the number of apoptotic cells increased and the expression levels of CTLA-4 were decreased in the Calotropin-treated tumor group when compared with control. In addition, the expression levels of TGF-β and ERK were downregulated in the Calotropin-treated tumor group compared with control. In conclusion, the results of the present study indicated that Calotropin administration regulated NSCLC apoptosis by downregulating the CTLA-4-mediated TGF-β/ERK signaling pathway, suggesting that Calotropin may be a potential anti-cancer agent for the treatment of NSCLC.
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Affiliation(s)
- Lu Tian
- Department of Respiratory Medicine, The Fourth People's Hospital of Guiyang, Guiyang, Guizhou 550002, P.R. China
| | - Xiao-Hong Xie
- Department of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, P.R. China
| | - Ze-Hao Zhu
- Department of Respiratory Medicine, The Affiliated Zhoushan Hospital of Wenzhou Medical University, Zhoushan, Zhejiang 316000, P.R. China
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