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Dessai A, Nayak UY, Nayak Y. Precision nanomedicine to treat non-small cell lung cancer. Life Sci 2024; 346:122614. [PMID: 38604287 DOI: 10.1016/j.lfs.2024.122614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
Lung cancer is a major cause of death worldwide, being often detected at a later stage due to the non-appearance of early symptoms. Therefore, specificity of the treatment is of utmost importance for its effective treatment. Precision medicine is a personalized therapy based on the genomics of the patient to design a suitable drug approach. Genetic mutations render the tumor resistant to specific mutations and the therapy is in vain even though correct medications are prescribed. Therefore, Precision medicine needs to be explored for the treatment of Non-small cell lung cancer (NSCLC). Nanoparticles are widely explored to give personalized interventions to treat lung cancer due to their various advantages like the ability to reach cancer cells, enhanced permeation through tissues, specificity, increased bioavailability, etc. Various nanoparticles (NPs) including gold nanoparticles, carbon nanotubes, aptamer-based NPs etc. were conjugated with biomarkers/diagnostic agents specific to cancer type and were delivered. Various biomarker genes have been identified through precision techniques for the diagnosis and treatment of NSCLC like EGFR, RET, KRAS, ALK, ROS-1, NTRK-1, etc. By incorporating of drug with the nanoparticle through bioconjugation, the specificity of the treatment can be enhanced with this revolutionary treatment. Additionally, integration of theranostic cargos in the nanoparticle would allow diagnosis as well as treatment by targeting the site of disease progression. Therefore, to target NSCLC effectively precision nanomedicine has been adopted in recent times. Here, we present different nanoparticles that are used as precision nanomedicine and their effectiveness against NSCLC disease.
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Affiliation(s)
- Akanksha Dessai
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
| | - Usha Yogendra Nayak
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
| | - Yogendra Nayak
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
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Wu W, Li J, Yin Y, Zhou Y, Huang X, Cao Y, Chen X, Zhou Y, Du J, Xu Z, Yang B, He Q, Yang X, Hu Y, Yan H, Luo P. Rutin attenuates ensartinib-induced hepatotoxicity by non-transcriptional regulation of TXNIP. Cell Biol Toxicol 2024; 40:38. [PMID: 38789868 PMCID: PMC11126486 DOI: 10.1007/s10565-024-09883-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
Ensartinib, an approved ALK inhibitor, is used as a first-line therapy for advanced ALK-positive non-small cell lung cancer in China. However, the hepatotoxicity of ensartinib seriously limits its clinical application and the regulatory mechanism is still elusive. Here, through transcriptome analysis we found that transcriptional activation of TXNIP was the main cause of ensartinib-induced liver dysfunction. A high TXNIP level and abnormal TXNIP translocation severely impaired hepatic function via mitochondrial dysfunction and hepatocyte apoptosis, and TXNIP deficiency attenuated hepatocyte apoptosis under ensartinib treatment. The increase in TXNIP induced by ensartinib is related to AKT inhibition and is mediated by MondoA. Through screening potential TXNIP inhibitors, we found that the natural polyphenolic flavonoid rutin, unlike most reported TXNIP inhibitors can inhibit TXNIP by binding to TXNIP and partially promoting its proteasomal degradation. Further studies showed rutin can attenuate the hepatotoxicity of ensartinib without antagonizing its antitumor effects. Accordingly, we suggest that TXNIP is the key cause of ensartinib-induced hepatotoxicity and rutin is a potential clinically safe and feasible therapeutic strategy for TXNIP intervention.
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Affiliation(s)
- Wentong Wu
- Center for Drug Safety Evaluation and Research of Zhejiang University, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Zijingang Campus, Zhejiang, 310058, Hangzhou, China
| | - Jinjin Li
- Center for Drug Safety Evaluation and Research of Zhejiang University, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Zijingang Campus, Zhejiang, 310058, Hangzhou, China
| | - Yiming Yin
- Center for Drug Safety Evaluation and Research of Zhejiang University, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Zijingang Campus, Zhejiang, 310058, Hangzhou, China
| | - Yourong Zhou
- Center for Drug Safety Evaluation and Research of Zhejiang University, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Zijingang Campus, Zhejiang, 310058, Hangzhou, China
| | - Xiangliang Huang
- Center for Drug Safety Evaluation and Research of Zhejiang University, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Zijingang Campus, Zhejiang, 310058, Hangzhou, China
| | - Yashi Cao
- Center for Drug Safety Evaluation and Research of Zhejiang University, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Zijingang Campus, Zhejiang, 310058, Hangzhou, China
| | - Xueqin Chen
- Department of Oncology, Affiliated Hangzhou Cancer Hospital, Zhejiang University School of Medicine, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Hangzhou, 310002, China
- Cancer Center, Zhejiang University, Hangzhou, 310058, China
| | - Yunfang Zhou
- The Laboratory of Clinical Pharmacy, the Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui, 323020, China
| | - Jiangxia Du
- Center for Medical Research and Innovation in Digestive System Tumors, Ministry of Education, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310017, China
| | - Zhifei Xu
- Center for Drug Safety Evaluation and Research of Zhejiang University, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Zijingang Campus, Zhejiang, 310058, Hangzhou, China
| | - Bo Yang
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China
- School of Medicine, Hangzhou City University, Hangzhou, 310015, China
| | - Qiaojun He
- Center for Drug Safety Evaluation and Research of Zhejiang University, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Zijingang Campus, Zhejiang, 310058, Hangzhou, China
- School of Medicine, Hangzhou City University, Hangzhou, 310015, China
- Innovation Institute for Artificial Intelligence in Medicine of Zhejiang University, Hangzhou, 310018, China
| | - Xiaochun Yang
- Center for Drug Safety Evaluation and Research of Zhejiang University, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Zijingang Campus, Zhejiang, 310058, Hangzhou, China
| | - Yuhuai Hu
- Innovation Institute of Hangzhou Yuhong Pharmatech Co.,LTD, Hangzhou, 310018, China
| | - Hao Yan
- Center for Drug Safety Evaluation and Research of Zhejiang University, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Zijingang Campus, Zhejiang, 310058, Hangzhou, China.
| | - Peihua Luo
- Center for Drug Safety Evaluation and Research of Zhejiang University, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Zijingang Campus, Zhejiang, 310058, Hangzhou, China.
- Department of Pharmacology and Toxicology, Hangzhou Institute of Innovative Medicine, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310018, China.
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou Cancer Hospital, Zhejiang University School of Medicine, Hangzhou, 310002, China.
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Yuan X, Wang Y, Yang M, Wu P, Chen H, Yun Y, Shen Z, Ji D, Ma Y, Ding L. A retrospective study of ensartinib-treated ALK-positive locally advanced or metastatic NSCLC patients in China. Lung Cancer Manag 2023; 12:LMT61. [PMID: 38239813 PMCID: PMC10793637 DOI: 10.2217/lmt-2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/27/2023] [Indexed: 01/22/2024] Open
Abstract
Aim This retrospective study aimed to assess the efficacy and safety of ensartinib in Chinese patients with ALK-positive advanced NSCLC in real-world clinical practice. Methods Clinical data from ALK-positive NSCLC patients treated with ensartinib in China were collected and analyzed. Efficacy end points included objective response rate and progression-free survival. Safety profiles were also evaluated. Results A total of 682 patients were included in this study. The study demonstrated promising efficacy with an objective response rate of 54.0%, and the median progression-free survival was not estimable. Ensartinib exhibited a manageable safety profile with treatment-related adverse events (TRAEs) consistent with prior clinical trials. The most common TRAE was rash (21.1%) and no TRAE led to death. Conclusion Ensartinib is active and well tolerated for ALK-positive NSCLC patients in real-world clinical settings.
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Affiliation(s)
- Xiaobin Yuan
- Betta Pharmaceuticals Co., Ltd, Hangzhou, Zhejiang, 311100, China
| | - Yang Wang
- Betta Pharmaceuticals Co., Ltd, Hangzhou, Zhejiang, 311100, China
| | - Min Yang
- Betta Pharmaceuticals Co., Ltd, Hangzhou, Zhejiang, 311100, China
| | - Pengxiang Wu
- Betta Pharmaceuticals Co., Ltd, Hangzhou, Zhejiang, 311100, China
| | - Hui Chen
- Betta Pharmaceuticals Co., Ltd, Hangzhou, Zhejiang, 311100, China
| | - Yu Yun
- Betta Pharmaceuticals Co., Ltd, Hangzhou, Zhejiang, 311100, China
| | - Zhilin Shen
- Betta Pharmaceuticals Co., Ltd, Hangzhou, Zhejiang, 311100, China
| | - Dong Ji
- Betta Pharmaceuticals Co., Ltd, Hangzhou, Zhejiang, 311100, China
| | - Yongbin Ma
- Betta Pharmaceuticals Co., Ltd, Hangzhou, Zhejiang, 311100, China
| | - Lieming Ding
- Betta Pharmaceuticals Co., Ltd, Hangzhou, Zhejiang, 311100, China
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Wang X, Yu Y, Liu H, Bu F, Shen C, He Q, Zhu X, Jiang P, Han B, Xiang X. Prediction of Drug-Drug Interactions with Ensartinib as a Time-Dependent CYP3A Inhibitor Using Physiologically Based Pharmacokinetic Model. Drug Metab Dispos 2023; 51:1515-1526. [PMID: 37643879 DOI: 10.1124/dmd.123.001373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
Ensartinib (X-396) is a second-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor (TKI) indicated for the treatment of ALK-positive patients with locally advanced or metastatic non-small cell lung cancer. Although in vitro experiments and molecular docking suggested its potential as a cytochrome P450 inhibitor, no further investigation or clinical trials have been conducted to assess its drug-drug interaction (DDI) risk. In this study, we conducted a series of in vitro experiments to elucidate the inhibition mechanism of ensartinib. Furthermore, a physiologically-based pharmacokinetic (PBPK) model was developed based on in vitro, in silico, and in vivo parameters, verified using clinical data, and applied to predict the clinical DDI mediated by ensartinib. The in vitro incubation experiments suggested that ensartinib exhibited strong time-dependent inhibition. Simulation results from the PBPK model indicated a significant increase in the exposure of CYP3A substrates in the presence of ensartinib, with the maximal plasma concentration and area under the plasma concentration-time curve increasing up to 12-fold and 29-fold for sensitive substrates. Based on these findings, it is evident that co-administration of ensartinib and CYP3A substrates requires careful regulatory consideration. SIGNIFICANCE STATEMENT: Ensartinib was found to be a strong time-dependent inhibitor of CYP3A for the first time based on in vitro experiments, but there was no research conducted to estimate the risk of drug-drug interaction (DDI) of ensartinib in clinic. Therefore, the first ensartinib physiologically based pharmacokinetic model was developed and applied to predict various untested scenarios. The simulation result indicated that the exposure of CYP3A substrate increased significantly and urged the further clinical DDI study.
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Affiliation(s)
- Xiaowen Wang
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China (X.W., Q.H., X.Z., P.J., X.X.); Department of Pharmacy, Minhang Hospital, Fudan University, Shanghai, China (X.W., Y.Y., H.L., C.S., B.H.); Department of Pharmacy, Eye and ENT Hospital, Fudan University, Shanghai, China (F.B.); and Shanghai Medicilon Inc., Shanghai, China (P.J.)
| | - Yiqun Yu
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China (X.W., Q.H., X.Z., P.J., X.X.); Department of Pharmacy, Minhang Hospital, Fudan University, Shanghai, China (X.W., Y.Y., H.L., C.S., B.H.); Department of Pharmacy, Eye and ENT Hospital, Fudan University, Shanghai, China (F.B.); and Shanghai Medicilon Inc., Shanghai, China (P.J.)
| | - Hongrui Liu
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China (X.W., Q.H., X.Z., P.J., X.X.); Department of Pharmacy, Minhang Hospital, Fudan University, Shanghai, China (X.W., Y.Y., H.L., C.S., B.H.); Department of Pharmacy, Eye and ENT Hospital, Fudan University, Shanghai, China (F.B.); and Shanghai Medicilon Inc., Shanghai, China (P.J.)
| | - Fengjiao Bu
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China (X.W., Q.H., X.Z., P.J., X.X.); Department of Pharmacy, Minhang Hospital, Fudan University, Shanghai, China (X.W., Y.Y., H.L., C.S., B.H.); Department of Pharmacy, Eye and ENT Hospital, Fudan University, Shanghai, China (F.B.); and Shanghai Medicilon Inc., Shanghai, China (P.J.)
| | - Chunying Shen
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China (X.W., Q.H., X.Z., P.J., X.X.); Department of Pharmacy, Minhang Hospital, Fudan University, Shanghai, China (X.W., Y.Y., H.L., C.S., B.H.); Department of Pharmacy, Eye and ENT Hospital, Fudan University, Shanghai, China (F.B.); and Shanghai Medicilon Inc., Shanghai, China (P.J.)
| | - Qingfeng He
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China (X.W., Q.H., X.Z., P.J., X.X.); Department of Pharmacy, Minhang Hospital, Fudan University, Shanghai, China (X.W., Y.Y., H.L., C.S., B.H.); Department of Pharmacy, Eye and ENT Hospital, Fudan University, Shanghai, China (F.B.); and Shanghai Medicilon Inc., Shanghai, China (P.J.)
| | - Xiao Zhu
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China (X.W., Q.H., X.Z., P.J., X.X.); Department of Pharmacy, Minhang Hospital, Fudan University, Shanghai, China (X.W., Y.Y., H.L., C.S., B.H.); Department of Pharmacy, Eye and ENT Hospital, Fudan University, Shanghai, China (F.B.); and Shanghai Medicilon Inc., Shanghai, China (P.J.)
| | - Pin Jiang
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China (X.W., Q.H., X.Z., P.J., X.X.); Department of Pharmacy, Minhang Hospital, Fudan University, Shanghai, China (X.W., Y.Y., H.L., C.S., B.H.); Department of Pharmacy, Eye and ENT Hospital, Fudan University, Shanghai, China (F.B.); and Shanghai Medicilon Inc., Shanghai, China (P.J.)
| | - Bing Han
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China (X.W., Q.H., X.Z., P.J., X.X.); Department of Pharmacy, Minhang Hospital, Fudan University, Shanghai, China (X.W., Y.Y., H.L., C.S., B.H.); Department of Pharmacy, Eye and ENT Hospital, Fudan University, Shanghai, China (F.B.); and Shanghai Medicilon Inc., Shanghai, China (P.J.)
| | - Xiaoqiang Xiang
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China (X.W., Q.H., X.Z., P.J., X.X.); Department of Pharmacy, Minhang Hospital, Fudan University, Shanghai, China (X.W., Y.Y., H.L., C.S., B.H.); Department of Pharmacy, Eye and ENT Hospital, Fudan University, Shanghai, China (F.B.); and Shanghai Medicilon Inc., Shanghai, China (P.J.)
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