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Guo X, Zhang Y, Liu Q, Xu M, Pang J, Yang B, Rong S, Yang X. Progress on liposome delivery systems in the treatment of bladder cancer. RSC Adv 2025; 15:14315-14336. [PMID: 40330044 PMCID: PMC12053965 DOI: 10.1039/d5ra00746a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Accepted: 04/08/2025] [Indexed: 05/08/2025] Open
Abstract
Bladder cancer (BC) in the urinary system remains one of the most prevalent malignancies with high recurrence rate globally. Current treatment schemes against BC such as surgery, chemotherapy, and radiotherapy have substantial limitations including side effects, drug resistance, and poor tumor targeting. Considering the above-mentioned challenges, nanotechnology has become a current research hotspot, particularly liposome-based drug delivery systems, which offer promising novel therapeutic strategies aimed at reducing systemic toxicity, overcoming drug resistance, and enhancing drug targeting. This review systematically elaborates the current research progress on liposomal drug delivery systems in BC treatment, focusing on their application in chemotherapy, immunotherapy, and gene therapy. Additionally, we provide a comprehensive assessment of the benefits and limitations of liposome nanocarriers used in BC treatment. The advanced targeting strategies and combination treatments via liposomal therapies are also discussed, demonstrating that liposomal formulations have great potential application value in the treatment of BC owing to their superior bioavailability, stability, and targeting and minimal adverse effects.
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Affiliation(s)
- Xinyu Guo
- Department of Urology Surgery, First Hospital of Shanxi Medical University Taiyuan Shanxi 030001 China
- The First Clinical Medical College of Shanxi Medical University Taiyuan Shanxi 030001 China
| | - Yan Zhang
- School of Optoelectronic Engineering, Xi'an Technological University Xi'an 710021 China
| | - Quanyong Liu
- Department of Urology Surgery, First Hospital of Shanxi Medical University Taiyuan Shanxi 030001 China
- The First Clinical Medical College of Shanxi Medical University Taiyuan Shanxi 030001 China
| | - Mingquan Xu
- Department of Urology Surgery, First Hospital of Shanxi Medical University Taiyuan Shanxi 030001 China
- The First Clinical Medical College of Shanxi Medical University Taiyuan Shanxi 030001 China
| | - Jianzhi Pang
- The First Clinical Medical College of Shanxi Medical University Taiyuan Shanxi 030001 China
| | - Bin Yang
- Department of Urology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital Taiyuan 030032 China
| | - Shuo Rong
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital Taiyuan 030032 China
| | - Xiaofeng Yang
- Department of Urology Surgery, First Hospital of Shanxi Medical University Taiyuan Shanxi 030001 China
- The First Clinical Medical College of Shanxi Medical University Taiyuan Shanxi 030001 China
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Konety BR, Lotan Y, Myers A. Safety of nadofaragene firadenovec-vncg: review of data from phase 2 and phase 3 studies. THE CANADIAN JOURNAL OF UROLOGY 2025; 32:29-36. [PMID: 40194933 DOI: 10.32604/cju.2025.064710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Accepted: 02/21/2024] [Indexed: 04/09/2025]
Abstract
INTRODUCTION Non-muscle-invasive bladder cancer (NMIBC) is a common malignancy worldwide. While Bacillus Calmette-Guérin (BCG) is standard of care for treatment for most patients with high-risk NMIBC, many will either not respond to BCG initially or will eventually develop BCG-unresponsive disease. A treatment option in BCG-unresponsive disease is nadofaragene firadenovec-vncg (Adstiladrin), a nonreplicating adenoviral vector-based gene therapy approved by the US Food and Drug Administration (FDA) for the treatment of adults with high-risk BCG-unresponsive NMIBC with carcinoma in situ with or without papillary tumors. OBJECTIVE To review safety outcomes of participants who received the FDA-approved dose of nadofaragene firadenovec (3 × 1011 vp/mL) across phase 2 (NCT01687244) and phase 3 (NCT02773849) studies. METHODS Data from the phase 2 and phase 3 studies were collected and analyzed. The findings were reported using descriptive statistics to summarize the key outcomes observed across studies. RESULTS Common adverse events (AEs) among nadofaragene firadenovec recipients were leakage of fluid around the urinary catheter, fatigue, bladder spasm, chills, dysuria, and micturition urgency. Most study drug-related AEs were mild and localized, with no grade 4 or 5 study drug-related AEs observed in either study. Study drug-related AEs were generally transient, with most study drug-related AEs having a median duration of ≤2.0 days in the phase 3 study. Discontinuation rates due to study drug-related AEs were low, with none (0%) in the phase 2 study and three (1.9%) in the phase 3 study. No specific postmarketing surveillance was required by the FDA besides routine pharmacovigilance monitoring; no new real-world safety signals have been observed. CONCLUSION Nadofaragene firadenovec demonstrated a favorable and tolerable safety profile across its clinical study program, allowing for broad patient selection among those with high-risk BCG-unresponsive NMIBC.
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Affiliation(s)
- Badrinath R Konety
- Department of Urology, University of Minnesota and Allina Health Cancer Institute, Minneapolis, MN 55407, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Amanda Myers
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Akbulut I, Ödemiş İ, Atalay S. Analysis of local and systemic side effects of bacillus Calmette-Guérin immunotherapy in bladder cancer: a retrospective study in Türkiye. PeerJ 2025; 13:e18870. [PMID: 39959825 PMCID: PMC11829628 DOI: 10.7717/peerj.18870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 12/24/2024] [Indexed: 02/18/2025] Open
Abstract
Background Bladder cancer is a growing health concern, especially in developing countries like Türkiye. Intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is essential for reducing recurrence and progression in non-muscle invasive bladder cancer (NMIBC). However, it can cause local and systemic adverse effects linked to bacterial virulence, allergic reactions, or nosocomial infections. Data from randomized studies on BCG side effects are limited, with severe cases often reported in case studies. This study investigates the association between intravesical BCG immunotherapy and its adverse effects. Methods A retrospective analysis was conducted on 239 patients who underwent BCG immunotherapy between 2017 and 2024. Detailed demographic, clinical, and laboratory data were collected, and the adverse effects that developed following BCG therapy were evaluated. Descriptive statistics, including medians, counts, and percentage distributions, were calculated, and logistic regression analysis was performed to identify factors influencing the development of adverse effects. Results Adverse effects related to BCG immunotherapy were observed in 63.1% of the patients. The most common minor adverse effects were hematuria, dysuria, and cystitis, while major adverse effects included sepsis and lymphadenopathy. The analyses revealed that elevated aspartate aminotransferase (AST) levels and the presence of Escherichia coli and Enterococcus faecalis in urine cultures were significant risk factors for the development of adverse effects. Additionally, patients who underwent the 6th cycle of BCG therapy were found to have a higher risk of developing adverse effects compared to those who received fewer cycles. Conclusion BCG immunotherapy is an effective treatment method for NMIBC; however, the adverse effects that occur during treatment must be closely monitored. Elevated AST levels, the presence of specific pathogens in urine cultures, and the number of BCG doses administered are significant factors that increase the risk of adverse effects. These findings highlight the necessity for more careful monitoring throughout the treatment process.
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Affiliation(s)
- Ilkay Akbulut
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - İlker Ödemiş
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Sabri Atalay
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
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Peng Y, Song Y, Du Y, Qin C, Xu T. Comparative analysis of adverse events among intravesical drugs in bladder cancer: a real-world study on FAERS database. Expert Opin Drug Saf 2024; 23:1207-1214. [PMID: 38946478 DOI: 10.1080/14740338.2024.2374921] [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: 04/29/2024] [Accepted: 06/20/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Intravesical therapy is a commonly utilized treatment for non-muscle invasive bladder cancer (NMIBC). This study focuses on summarizing the signals of all intravesical drugs and aims to highlight the comprehensive differences in adverse events (AEs) between these drugs. RESEARCH DESIGN AND METHODS We conducted pharmacovigilance data analysis based on the real-world big data from the Food and Drug Administration Adverse Event Reporting System (FAERS) database. RESULTS We elucidated all signals compared with the overall FAERS database or other administration routes for Bacillus Calmette-Guerin (BCG), mitomycin, gemcitabine, valrubicin, and epirubicin. Notably, the distribution of reported AEs associated with intravesical therapy exhibited a noticeable inclination toward male patients. Furthermore, all five drugs demonstrated a disproportionate distribution in local AEs, particularly in renal and urinary disorders. Additionally, specific signals and findings were summarized for each individual drug. Finally, we highlighted the AEs that resulted in serious outcomes for each drug. CONCLUSION We have compiled an overview of the AEs tied to intravesical drugs whilst considering their individual distinctions. These insightful findings serve to enrich our comprehension of the safety profiles and potential risks linked to intravesical therapy.
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Affiliation(s)
- Yun Peng
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Yuxuan Song
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Yiqing Du
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Caipeng Qin
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing, China
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Salif A, Bigirimana F, Willems S, Reichman G, Noels J, Wijngaert SVD, Lecomte S, Maillart E, Clevenbergh P. Bacillus Calmette-Guérin (BCG) prostato-epididymitis in a patient treated for a non-invasive urothelial cancer: A case report. IDCases 2024; 36:e01967. [PMID: 38699528 PMCID: PMC11064455 DOI: 10.1016/j.idcr.2024.e01967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/26/2024] [Accepted: 04/14/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction The Bacillus Calmette-Guérin (BCG) used as anti-tuberculous vaccine is also a well-known therapy for superficial urothelial cancer. Local or general side effects can occur, although it is generally well tolerated. Case We present the case of a 65 year-old caucasian man consulting for gross hematuria and lower urinary tract symptoms. Magnetic resonance imaging (MRI) demonstrated a non-invasive urothelial carcinoma (NMIBC) and Prostate Imaging-Reporting and Data System (PIRADS) IV lesions. Transurethral resection of the bladder tumor revealed a non-invasive transitional cell carcinoma. Intravesical Bacillus Calmette Guerin (BCG) therapy was provided. After 6 intravesical instillations, the patient presented with prostato-epididymitis. Forthcoming BCG instillations were canceled, and cancer treatment was switched to epirubicine. Treatment with ethambutol, rifampicin and isoniazid was started with rapid resolution of the symptoms. Urinary and semen cultures grew Mycobacterium tuberculosis complex strain BCG. As prostate specific antigen (PSA) rose, prostate's biopsies were performed showing extensive necrosis boarded by granulomas without signs of malignancy. Discussion BCGitis is a rare complication in patients treated for non-invasive urothelial cancer. Several risk factors, local and systemic, should be considered prior to this immunotherapy. BCGitis (local or disseminated) or hypersensitivity reactions to BCG must be included in the differential diagnosis even if therapy was administered several years before the symptoms. Adequate treatment must be started as fast as possible to avoid serious complications.
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Affiliation(s)
- Ayemane Salif
- Department of Surgery, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Ferdinand Bigirimana
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Sophie Willems
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Gina Reichman
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Johanna Noels
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Sigi Van Den Wijngaert
- Department of Microbiology, University Laboratory of Brussels, LHUB-ULB, Free University of Brussels, Brussels, Belgium
| | - Sophie Lecomte
- Pathology department, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Evelyne Maillart
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Philippe Clevenbergh
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
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Grabe-Heyne K, Henne C, Mariappan P, Geiges G, Pöhlmann J, Pollock RF. Intermediate and high-risk non-muscle-invasive bladder cancer: an overview of epidemiology, burden, and unmet needs. Front Oncol 2023; 13:1170124. [PMID: 37333804 PMCID: PMC10272547 DOI: 10.3389/fonc.2023.1170124] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023] Open
Abstract
Bladder cancer ranks among the most common cancers globally. At diagnosis, 75% of patients have non-muscle-invasive bladder cancer (NMIBC). Patients with low-risk NMIBC have a good prognosis, but recurrence and progression rates remain high in intermediate- and high-risk NMIBC, despite the decades-long availability of effective treatments for NMIBC such as intravesical Bacillus Calmette-Guérin (BCG). The present review provides an overview of NMIBC, including its burden and treatment options, and then reviews aspects that counteract the successful treatment of NMIBC, referred to as unmet treatment needs. The scale and reasons for each unmet need are described based on a comprehensive review of the literature, including insufficient adherence to treatment guidelines by physicians because of insufficient knowledge, training, or access to certain therapy options. Low rates of lifestyle changes and treatment completion by patients, due to BCG shortages or toxicities and adverse events as well as their impact on social activities, represent additional areas of potential improvement. Highly heterogeneous evidence for the effectiveness and safety of some treatments limits the comparability of results across studies. As a result, efforts are underway to standardize treatment schedules for BCG, but intravesical chemotherapy schedules remain unstandardized. In addition, risk-scoring models often perform unsatisfactorily due to significant differences between derivation and real-world cohorts. Reporting in clinical trials suffers from a lack of consistent outcomes reporting in bladder cancer clinical trials, paired with an under-representation of racial and ethnic minorities in many trials.
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Affiliation(s)
| | | | - Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, United Kingdom
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Borówka M, Łącki-Zynzeling S, Nicze M, Kozak S, Chudek J. Adverse Renal Effects of Anticancer Immunotherapy: A Review. Cancers (Basel) 2022; 14:4086. [PMID: 36077623 PMCID: PMC9454552 DOI: 10.3390/cancers14174086] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Modern oncological therapy utilizes various types of immunotherapy. Immune checkpoint inhibitors (ICIs), chimeric antigen receptor T cells (CAR-T) therapy, cancer vaccines, tumor-targeting monoclonal antibodies (TT-mAbs), bispecific antibodies and cytokine therapy improve patients' outcomes. However, stimulation of the immune system, beneficial in terms of fighting against cancer, generates the risk of harm to other cells in a patient's body. Kidney damage belongs to the relatively rare adverse events (AEs). Best described, but still, superficially, are renal AEs in patients treated with ICIs. International guidelines issued by the European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO) cover the management of immune-related adverse events (irAEs) during ICI therapy. There are fewer data concerning real occurrence and possible presentations of renal adverse drug reactions of other immunotherapeutic methods. This implies the need for the collection of safety data during ongoing clinical trials and in the real-life world to characterize the hazard related to the use of new immunotherapies and management of irAEs.
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Affiliation(s)
| | - Stanisław Łącki-Zynzeling
- Department of Internal Medicine and Oncological Chemotherapy, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Reymonta 8, 40-027 Katowice, Poland
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Xu Y, Luo C, Wang J, Chen L, Chen J, Chen T, Zeng Q. Application of nanotechnology in the diagnosis and treatment of bladder cancer. J Nanobiotechnology 2021; 19:393. [PMID: 34838048 PMCID: PMC8626998 DOI: 10.1186/s12951-021-01104-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/26/2021] [Indexed: 01/03/2023] Open
Abstract
Bladder cancer (BC) is a common malignancy in the genitourinary system and the current theranostic approaches are unsatisfactory. Sensitivity and specificity of current diagnosis methods are not ideal and high recurrence and progression rates after initial treatment indicate the urgent need for management improvements in clinic. Nanotechnology has been proposed as an effective method to improve theranosis efficiency for both non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC). For example, gold nanoparticles (AuNPs) have been developed for simple, fast and sensitive urinary sample test for bladder cancer diagnosis. Nanoparticles targeting bladder cancers can facilitate to distinguish the normal and abnormal bladder tissues during cystoscopy and thus help with the complete removal of malignant lesions. Both intravenous and intravesical agents can be modified by nanotechnology for targeted delivery, high anti-tumor efficiency and excellent tolerability, exhibiting encouraging potential in bladder cancer treatment. Photosensitizers and biological agents can also be delivered by nanotechnology, intermediating phototherapy and targeted therapy. The management of bladder cancer remained almost unchanged for decades with unsatisfactory effect. However, it is likely to change with the fast-developed nanotechnology. Herein we summarized the current utility of nanotechnology in bladder cancer diagnosis and treatment, providing insights for the future designing and discovering novel nanoparticles for bladder cancer management. ![]()
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Affiliation(s)
- Yadong Xu
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Cheng Luo
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Jieqiong Wang
- Department of Urology, Guangzhou First People's Hospital, Guangzhou, China
| | - Lingwu Chen
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Junxing Chen
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Tianfeng Chen
- Department of Chemistry, Jinan University, Guangzhou, 510632, China.
| | - Qinsong Zeng
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China.
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Evaluation and Management of Genitourinary Emergencies in Patients with Cancer. Emerg Med Int 2021; 2021:4511968. [PMID: 34367695 PMCID: PMC8337163 DOI: 10.1155/2021/4511968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/10/2021] [Accepted: 07/17/2021] [Indexed: 02/03/2023] Open
Abstract
Background Genitourinary emergencies in cancer patients are common. Most cancer treatments are administered in the outpatient setting, and patients with complications often visit the emergency department. However, there is no recent emergency medicine literature review focusing on genitourinary emergencies in the oncologic population. Objective of the review. To increase awareness of common genitourinary emergencies in patients with cancer and enable the prompt recognition and appropriate management of these conditions. Discussion. Genitourinary emergencies in patients with cancer require a multidisciplinary approach to treatment. The most common genitourinary emergencies in patients with cancer are related to infection, obstructive uropathy, hemorrhagic cystitis, and complications associated with urinary diversions. The treatment approach in patients with infections, including viral infections, is similar to those without cancer. Understanding the changes in the anatomy of patients with urinary diversions or fistulas can help with the management of genitourinary emergencies. Conclusions Familiarization with the uniqueness of genitourinary emergencies in patients with cancer is important for emergency physicians.
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Cytokine/Chemokine Release Patterns and Transcriptomic Profiles of LPS/IFNγ-Activated Human Macrophages Differentiated with Heat-Killed Mycobacterium obuense, M-CSF, or GM-CSF. Int J Mol Sci 2021; 22:ijms22137214. [PMID: 34281268 PMCID: PMC8268300 DOI: 10.3390/ijms22137214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 01/15/2023] Open
Abstract
Macrophages (Mφs) are instrumental regulators of the immune response whereby they acquire diverse functional phenotypes following their exposure to microenvironmental cues that govern their differentiation from monocytes and their activation. The complexity and diversity of the mycobacterial cell wall have empowered mycobacteria with potent immunomodulatory capacities. A heat-killed (HK) whole-cell preparation of Mycobacterium obuense (M. obuense) has shown promise as an adjunctive immunotherapeutic agent for the treatment of cancer. Moreover, HK M. obuense has been shown to trigger the differentiation of human monocytes into a monocyte-derived macrophage (MDM) type named Mob-MDM. However, the transcriptomic profile and functional properties of Mob-MDMs remain undefined during an activation state. Here, we characterized cytokine/chemokine release patterns and transcriptomic profiles of lipopolysaccharide (LPS)/interferon γ (IFNγ)-activated human MDMs that were differentiated with HK M. obuense (Mob-MDM(LPS/IFNγ)), macrophage colony-stimulating factor M-MDM(LPS/IFNγ)), or granulocyte/macrophage colony-stimulating factor (GM-MDM(LPS/IFNγ)). Mob-MDM(LPS/IFNγ) demonstrated a unique cytokine/chemokine release pattern (interleukin (IL)-10low, IL-12/23p40low, IL-23p19/p40low, chemokine (C-x-C) motif ligand (CXCL)9low) that was distinct from those of M-MDM(LPS/IFNγ) and GM-MDM(LPS/IFNγ). Furthermore, M-MDM(LPS/IFNγ) maintained IL-10 production at significantly higher levels compared to GM-MDM(LPS/IFNγ) and Mob-MDM(LPS/IFNγ) despite being activated with M1-Mφ-activating stimuli. Comparative RNA sequencing analysis pointed to a distinct transcriptome profile for Mob-MDM(LPS/IFNγ) relative to both M-MDM(LPS/IFNγ) and GM-MDM(LPS/IFNγ) that comprised 417 transcripts. Functional gene-set enrichment analysis revealed significant overrepresentation of signaling pathways and biological processes that were uniquely related to Mob-MDM(LPS/IFNγ). Our findings lay a foundation for the potential integration of HK M. obuense in specific cell-based immunotherapeutic modalities such as adoptive transfer of Mφs (Mob-MDM(LPS/IFNγ)) for cancer treatment.
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Plasek J, Weissert J, Downs T, Richards K, Ravvaz K. Clinicopathological Criteria Predictive of Recurrence Following Bacillus Calmette-Guérin Therapy Initiation in Non-Muscle-Invasive Bladder Cancer: Retrospective Cohort Study. JMIR Cancer 2021; 7:e25800. [PMID: 34156341 PMCID: PMC8277393 DOI: 10.2196/25800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 01/31/2023] Open
Abstract
Background Bacillus Calmette-Guérin (BCG) is currently the most clinically effective intravesical treatment for non–muscle-invasive bladder cancer (NMIBC), particularly for patients with high-risk NMIBC such as those with carcinoma in situ. BCG treatments could be optimized to improve patient safety and conserve supply by predicting BCG efficacy based on tumor characteristics or clinicopathological criteria. Objective The aim of this study is to assess the ability of specific clinicopathological criteria to predict tumor recurrence in patients with NMIBC who received BCG therapy along various treatment timelines. Methods A total of 1331 patients (stage Ta, T1, or carcinoma in situ) who underwent transurethral resection of a bladder tumor between 2006 and 2017 were included. Univariate analysis, including laboratory tests (eg, complete blood panels, creatinine levels, and hemoglobin A1c levels) within 180 days of BCG therapy initiation, medications, and clinical and demographic variables to assess their ability to predict NMIBC recurrence, was completed. This was followed by multivariate regression that included the elements of the Club Urológico Español de Tratamiento Oncológico (CUETO) scoring model and variables that were significant predictors of recurrence in univariate analysis. Results BCG was administered to 183 patients classified as intermediate or high risk, and 76 (41.5%) experienced disease recurrence. An abnormal neutrophil-to-lymphocyte ratio measured within 180 days of induction BCG therapy was a significant predictor (P=.047) of future cancer recurrence and was a stronger predictor than the CUETO score or the individual variables included in the CUETO scoring model through multivariate analysis. Conclusions An abnormal neutrophil-to-lymphocyte ratio within 180 days of BCG therapy initiation is predictive of recurrence and could be suggestive of additional or alternative interventions.
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Affiliation(s)
- Joseph Plasek
- Advocate Aurora Research Institute, Milwaukee, WI, United States
| | - John Weissert
- Advocate Aurora Research Institute, Milwaukee, WI, United States
| | - Tracy Downs
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Kyle Richards
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Kourosh Ravvaz
- Advocate Aurora Research Institute, Milwaukee, WI, United States
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Samaddar S, Mazur J, Sargent J, Thompson DH. Immunostimulatory Response of RWFV Peptide-Targeted Lipid Nanoparticles on Bladder Tumor Associated Cells. ACS APPLIED BIO MATERIALS 2021; 4:3178-3188. [PMID: 35014405 PMCID: PMC11752680 DOI: 10.1021/acsabm.0c01572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bladder carcinoma is the most expensive tumor type to treat on a cost-per-patient basis from diagnosis to death. Treatment with Bacillus Calmette Guerin (BCG) instillation is the only approved immunotherapy in the clinic for the remission of superficial bladder carcinoma. Unfortunately, frequent relapses, high local morbidity, risk of systemic mycobacterial infection, and occasional supply chain interruptions limit the utility of BCG for bladder cancer treatment. It is well known that BCG utilizes an adhesin protein known as fibronectin attachment protein that possesses a crucial RWFV peptide sequence for binding to the bladder tumor microenvironment prior to the initiation of the immunotherapeutic response. We report a RWFV-targeted, pH-responsive stabilized lipid nucleic acid nanoparticle (LNP) vehicle for the effective delivery of an immunotherapeutic oligonucleotide, CpG, that is assembled using a glass microfluidic Chemtrix 3221 reactor. Our small-angle X-ray scattering studies revealed a layer-by-layer assembly of the oligonucleotides with a repeat distance of 6.04 nm within the LNP. Using flow cytometry to evaluate the different cell types found in the bladder tumor microenvironment, RWFV-targeted LNPs were found to attach specifically to fibronectin-secreting cells in culture during a 2 h incubation period. The trafficking and cellular fate of these targeted LNPs were revealed by confocal microscopy of RAW264.7 macrophages to enter the endocytotic pathway within 4 h post treatment. Importantly, control studies reveal that only the pH-sensitive LNP formulation is capable of efficiently releasing the payload within 12 h. As a result, the targeted pH-sensitive LNP resulted in higher expression levels of costimulatory molecules CD83, CD 86, and MHC II, while also inducing higher levels of TNF-α secretion from macrophages. These results demonstrate that RWFV-targeted, pH-sensitive LNP formulations are capable of maximum immunotherapeutic response, potentially making them a highly efficient, lower risk, and readily manufactured alternative to BCG immunotherapy.
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Affiliation(s)
- Shayak Samaddar
- Multi-disciplinary Cancer Research Facility, Bindley Bioscience Center, Department of Chemistry, Purdue University, West Lafayette, IN 47907
| | - Joshua Mazur
- Multi-disciplinary Cancer Research Facility, Bindley Bioscience Center, Department of Chemistry, Purdue University, West Lafayette, IN 47907
| | | | - David H. Thompson
- Multi-disciplinary Cancer Research Facility, Bindley Bioscience Center, Department of Chemistry, Purdue University, West Lafayette, IN 47907
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First time intravesically administered trifunctional antibody catumaxomab in patients with recurrent non-muscle invasive bladder cancer indicates high tolerability and local immunological activity. Cancer Immunol Immunother 2021; 70:2727-2735. [PMID: 33837852 PMCID: PMC8360869 DOI: 10.1007/s00262-021-02930-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/26/2021] [Indexed: 11/30/2022]
Abstract
Transurethral resection of the tumor (TUR-B) followed by adjuvant intravesical treatment with cytostatic drugs or Bacillus Calmette–Guérin (BCG) as standard therapy of non-muscle-invasive bladder cancer (NMIBC) is associated with a high recurrence rate of about 60–70%, considerable side effects and requires close monitoring. Alternative treatment options are warranted. Two patients with epithelial cell adhesion molecule (EpCAM)-positive recurrent non-muscle invasive bladder cancer were treated the first time by an intravesical administration of the trifunctional bispecific EpCAM targeting antibody catumaxomab (total dosage of 470 and 1120 µg, respectively). The binding and killing activity of catumaxomab in urine milieu was evaluated in vitro. In contrast to its previous systemic application catumaxomab was well tolerated without any obvious signs of toxicity. Relevant cytokine plasma levels were not detected and no significant systemic drug release was observed. The induction of a human anti-mouse-antibody (HAMA) reaction was either absent or untypically weak contrary to the high immunogenicity of intraperitoneal applied catumaxomab. Tumor cells that were detectable in urine patient samples disappeared after catumaxomab therapy. Endoscopically confirmed recurrence-free intervals were 32 and 25 months. Our data suggest that intravesical administration of catumaxomab in NMIBC is feasible, safe and efficacious, thus arguing for further clinical development of catumaxomab in this indication.
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Sohrabi Y, Dos Santos JC, Dorenkamp M, Findeisen H, Godfrey R, Netea MG, Joosten LAB. Trained immunity as a novel approach against COVID-19 with a focus on Bacillus Calmette-Guérin vaccine: mechanisms, challenges and perspectives. Clin Transl Immunology 2020; 9:e1228. [PMID: 33363733 PMCID: PMC7755499 DOI: 10.1002/cti2.1228] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/03/2020] [Accepted: 11/29/2020] [Indexed: 12/13/2022] Open
Abstract
COVID-19 is a severe health problem in many countries and has altered day-to-day life in the whole world. This infection is caused by the SARS-CoV-2 virus, and depending on age, sex and health status of the patient, it can present with variety of clinical symptoms such as mild infection, a very severe form or even asymptomatic course of the disease. Similarly to other viruses, innate immune response plays a vital role in protection against COVID-19. However, dysregulation of innate immunity could have a significant influence on the severity of the disease. Despite various efforts, there is no effective vaccine against the disease so far. Recent data have demonstrated that the Bacillus Calmette-Guérin (BCG) vaccine could reduce disease severity and the burden of several infectious diseases in addition to targeting its primary focus tuberculosis. There is growing evidence for the concept of beneficial non-specific boosting of immune responses by BCG or other microbial compounds termed trained immunity, which may protect against COVID-19. In this manuscript, we review data on how the development of innate immune memory due to microbial compounds specifically BCG can result in protection against SARS-CoV-2 infection. We also discuss possible mechanisms, challenges and perspectives of using innate immunity as an approach to reduce COVID-19 severity.
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Affiliation(s)
- Yahya Sohrabi
- Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart FailureUniversity Hospital MünsterMünsterGermany
- Institute of Molecular Genetics of the Czech Academy of SciencesPragueCzech Republic
| | - Jéssica Cristina Dos Santos
- Department of Internal Medicine and Radboud Centre of Infectious Diseases (RCI)Radboud University Medical CentreNijmegenThe Netherlands
| | - Marc Dorenkamp
- Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart FailureUniversity Hospital MünsterMünsterGermany
| | - Hannes Findeisen
- Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart FailureUniversity Hospital MünsterMünsterGermany
| | - Rinesh Godfrey
- Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart FailureUniversity Hospital MünsterMünsterGermany
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Centre of Infectious Diseases (RCI)Radboud University Medical CentreNijmegenThe Netherlands
- Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES)University of BonnBonnGermany
| | - Leo AB Joosten
- Department of Internal Medicine and Radboud Centre of Infectious Diseases (RCI)Radboud University Medical CentreNijmegenThe Netherlands
- Núcleo de Pesquisa da Faculdade da Polícia Militar (FPM) do Estado de GoiásGoiâniaBrazil
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Di Bella S, Cabas P, Antonello RM, Rizzo M. Interferon: The invisible link in the physiopathology of COVID-19 and BCGitis? Scand J Immunol 2020; 92:e12939. [PMID: 32697854 PMCID: PMC7404370 DOI: 10.1111/sji.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/18/2020] [Accepted: 07/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Stefano Di Bella
- Department of Infectious DiseaseMaggiore HospitalUniversity of TriesteTriesteItaly
| | - Paolo Cabas
- Department of UrologyCattinara HospitalUniversity of TriesteTriesteItaly
| | | | - Michele Rizzo
- Department of UrologyCattinara HospitalUniversity of TriesteTriesteItaly
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16
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Comparative prostate MRI before and after chronic granulomatous prostatitis following intravesical bacillus Calmette-Guérin therapy. Future Sci OA 2020; 7:FSO637. [PMID: 33437511 PMCID: PMC7787171 DOI: 10.2144/fsoa-2020-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Granulomatous prostatitis (GnP) is an interesting complication of bacillus Calmette–Guérin (BCG) therapy as it mimics prostate cancer on clinical, biochemical and imaging examinations. In the era of multiparametric prostate MRI (mpMRI), differentiation of GnP from prostate cancer on imaging is essential. Case presentation: We report a case of post-BCG GnP in a patient with nonmuscle invasive bladder cancer, presenting with a prostate-specific antigen level of 21.6 ng/ml and prostate imaging reporting and data system (PI-RADS) 5 peripheral lesions. A mpMRI performed 6 months before showed a score 2 of PI-RADS. Conclusion: The comparison of mpMRI images before and after BCG administration gives urologists, oncologists and radiologists a precise idea of the mpMRI changes that occur following BCG administration to eventually prevent unnecessary biopsies in future patients. Granulomatous prostatitis is a bacillus Calmette–Guérin therapy complication that often mimics prostate cancer. This article gives radiologists, urologists and oncologists a clear multiparametric prostate MRI comparison of the changes that bacillus Calmette–Guérin prostatitis causes on the prostate gland.
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17
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Lillesand M, Kvikstad V, Mangrud OM, Gudlaugsson E, van Diermen-Hidle B, Skaland I, Baak JPA, Janssen EAM. Mitotic activity index and CD25+ lymphocytes predict risk of stage progression in non-muscle invasive bladder cancer. PLoS One 2020; 15:e0233676. [PMID: 32484812 PMCID: PMC7266352 DOI: 10.1371/journal.pone.0233676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/10/2020] [Indexed: 11/19/2022] Open
Abstract
In urothelial cell type non-muscle invasive urinary bladder carcinoma, TNM stage and WHO grade are widely used to classify patients into low and high‑risk groups for prognostic and therapeutic decision-making. However, stage and grade reproducibility and prediction accuracy are wanting. This may lead to suboptimal treatment. We evaluated whether proliferation features, nuclear area of the epithelial cancer cells and the composition of stromal and tumor infiltrating lymphocytes have independent prognostic value. In 183 primary non-muscle invasive bladder cancer patients with long follow-up (median for stage progression cohort: 119 months, range 5-173; median for tumor recurrence cohort: 82, range 3-165) proliferation features Ki67, PPH3 and Mitotic Activity Index (MAI), Mean Nuclear Area (MNA), lymphocyte subsets (CD8+, CD4+, CD25+) and plasma cells (CD138+) were assessed on consecutive sections. Post-resection instillation treatments (none, mitomycin, BCG) were strictly standardized during the intake period. Risk of recurrence was associated with expression of Ki67 (≤ 39 vs. > 39) and Multifocality (p = 0.01). Patients with low Ki67 had a higher recurrence rate than those with high Ki67. Lymphocyte composition did not predict recurrence. Stage progression was strongly associated with high values for MAI (>15) and CD25+ (>0.2%). In a multivariate analysis the combination of MAI and CD25+ was the single most prognostic feature (p<0.001). Validation of these results in additional, independent studies is warranted.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Transitional Cell/genetics
- Carcinoma, Transitional Cell/immunology
- Carcinoma, Transitional Cell/pathology
- Disease Progression
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Interleukin-2 Receptor alpha Subunit/metabolism
- Kaplan-Meier Estimate
- Ki-67 Antigen/metabolism
- Lymphocytes, Tumor-Infiltrating/immunology
- Lymphocytes, Tumor-Infiltrating/metabolism
- Male
- Middle Aged
- Mitotic Index
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/immunology
- Neoplasm Staging
- Prognosis
- Reproducibility of Results
- Urinary Bladder/pathology
- Urinary Bladder Neoplasms/genetics
- Urinary Bladder Neoplasms/immunology
- Urinary Bladder Neoplasms/mortality
- Urinary Bladder Neoplasms/pathology
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Affiliation(s)
- Melinda Lillesand
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
- * E-mail:
| | - Vebjørn Kvikstad
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
- Department of Mathematics and Natural Science, University of Stavanger, Stavanger, Norway
| | | | - Einar Gudlaugsson
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | | | - Ivar Skaland
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | - Jan P. A. Baak
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
- Jan Baak AS, Tananger, Norway
| | - Emiel A. M. Janssen
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
- Department of Mathematics and Natural Science, University of Stavanger, Stavanger, Norway
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18
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Oladiran O, Nwosu I, Oladunjoye A, Oladunjoye O. Disseminated BCG sepsis following intravesical therapy for Bladder Carcinoma: A case report and review of literature. J Community Hosp Intern Med Perspect 2020; 10:168-170. [PMID: 32850058 PMCID: PMC7425612 DOI: 10.1080/20009666.2020.1742475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/27/2020] [Indexed: 01/24/2023] Open
Abstract
Intravesical instillation of Bacillus-Calmette-Guerin (BCG), a live-attenuated-strain of Mycobacterium bovis, is an established treatment for superficial bladder carcinoma. Although generally well tolerated, 1/15,000 patients can develop life-threatening disseminated-BCG-infection typically soon after the procedure, a condition colloquially termed BCG-osis. Side-effects of intravesical BCG instillation including fever, chills, fatigue are common but BCG-osis is rare and severe, oftentimes requiring intensive care unit admission and triple anti-TB-therapy as in this case. It is therefore important for clinicians to recognize this possibility as the absence of specific signs and symptoms, coupled with the fastidious nature of the Mycobacteria, pose a diagnostic dilemma in the acute setting. Our case highlights this potential rare iatrogenic side effect of intravesical BCG treatment and the risk associated with non-treatment of BCG-osis.
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Affiliation(s)
- Oreoluwa Oladiran
- Department of Internal Medicine, Reading Hospital, Tower Health System, Reading, PA, USA
| | - Ifeanyi Nwosu
- Department of Internal Medicine, Leighton Hospital NHS Trust, Crewe, UK
| | - Adeolu Oladunjoye
- Division of Medical Critical Care, Boston Children’s Hospital, Boston, MA, USA
| | - Olubunmi Oladunjoye
- Department of Internal Medicine, Reading Hospital, Tower Health System, Reading, PA, USA
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19
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Effects and Complications of Intravesical Instillation of Bacillus Calmette-Guerin Therapy. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00506-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Liu Y, Lu J, Huang Y, Ma L. Clinical Spectrum of Complications Induced by Intravesical Immunotherapy of Bacillus Calmette-Guérin for Bladder Cancer. JOURNAL OF ONCOLOGY 2019; 2019:6230409. [PMID: 30984262 PMCID: PMC6431507 DOI: 10.1155/2019/6230409] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/24/2019] [Accepted: 02/12/2019] [Indexed: 12/13/2022]
Abstract
Because of its proven efficacy, intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is an important treatment for nonmuscle invasive bladder cancer at high risk of recurrence or progression. However, approximately 8% of patients have to stop BCG instillation as a result of its complications. Complications induced by BCG therapy can have a variety of clinical manifestations. These adverse reactions may occur in conjunction with BCG instillation or may not develop until months or years after BCG cessation. An essential step in the management complications arising from BCG is early establishment of diagnosis, particularly for distant, disseminated, and obscure infections. Therefore we reviewed the literature on the potential complications after intravesical BCG immunotherapy for bladder cancer and provide an overview on the incidence, diagnosis, and treatment modality of genitourinary and systemic BCG-induced complications.
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Affiliation(s)
- Yuqing Liu
- Urology Department, Peking University Third Hospital, Beijing, China
| | - Jian Lu
- Urology Department, Peking University Third Hospital, Beijing, China
| | - Yi Huang
- Urology Department, Peking University Third Hospital, Beijing, China
| | - Lulin Ma
- Urology Department, Peking University Third Hospital, Beijing, China
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21
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McGuffin SA, Trowbridge RL, O'Hare AM, Olson AP. Diagnosing the Treatment. J Hosp Med 2018; 13:577-581. [PMID: 29964279 PMCID: PMC6467279 DOI: 10.12788/jhm.2981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Sarah A McGuffin
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA.
- Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Robert L Trowbridge
- Department of Internal Medicine, Maine Medical Center, Portland, Maine, USA
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ann M O'Hare
- Division of Nephrology, VA Puget Sound Health Care System, Seattle, Washington, USA
- Division of Nephrology, University of Washington, Seattle, Washington, USA
| | - Andrew P Olson
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
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22
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Mycobacteria Bovis osteomyelitis following intravesical BCG for bladder cancer. IDCases 2017; 10:75-78. [PMID: 29034173 PMCID: PMC5635337 DOI: 10.1016/j.idcr.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 09/16/2017] [Accepted: 09/25/2017] [Indexed: 11/20/2022] Open
Abstract
Mycobacteria Bovis osteomyelitis is a rare adverse effect after Bacillus Calmette-Guerin (BCG) intravesical therapy. A 62-year-old male presented with acute spinal cord compression three months after completing his second course of therapy for bladder cancer. The first course with intravesical BCG was complicated with an episode of hematuria. He reported intermittent subjective fever for 3 weeks thereafter which resolved with Tylenol. Interferon-α2 B was added to the second cycle of intravesical BCG with the indication here being residual tumor, and was tolerated well. His complete blood count and liver function tests were unremarkable on admission. MRI showed features of osteomyelitis with cord compression at T4/T5. Biopsy of the affected bone showed caseating granuloma which was positive for acid fact bacilli, later confirmed to be Mycobacterium Bovis by PCR and pyrazinamide resistance. He was started on intravenous steroids and underwent spinal cord decompression. Rifampin, Isoniazid, and Ethambutol were then commenced. His weakness improved and after two months of therapy he was asymptomatic and back to his baseline function. Osteomyelitis is a rare but serious complication. Early diagnosis and treatment is important as the outcomes are good.
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23
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Yadav S, Singh P, Hemal A, Kumar R. Genital tuberculosis: current status of diagnosis and management. Transl Androl Urol 2017; 6:222-233. [PMID: 28540230 PMCID: PMC5422679 DOI: 10.21037/tau.2016.12.04] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Genitourinary Tuberculosis (GUTB) is the second most common extra-pulmonary manifestation of tuberculosis (Tb) and an isolated involvement of genital organs is reported in 5–30% of the cases. Genital involvement results from primary reactivation of latent bacilli either in the epididymis or the prostate or by secondary spread from the already infected urinary organs. The epididymis are the commonest involved organs affected primarily by a hematogenous mode of spread. Tb is characterized by extensive destruction and fibrosis, thus an early diagnosis may prevent function and organ loss. The gold standard for diagnosis is the isolation and culture of mycobacterium tuberculosis bacilli and in the cases of suspected GUTB, it is commonly looked for in the urinary samples. All body fluid specimens from possible sites of infection and aspirates from nodules must also be subjected to examination. Radiologic investigations including ultrasonography and contrast imaging may provide supportive evidence. Anti-tubercular chemotherapy is the first line of management for all forms of genital Tb and a 6 months course is the standard of care. Most patients with tubercular epididymo-orchitis respond to antitubercular therapy but may require open or percutaneous drainage. Infertility resulting from the tubercular affliction of the genitalia is multifactorial in origin and may persist even after successful chemotherapy. Multiple organ involvement with obstruction at several sites is characteristic and most of these cases are not amenable to surgical reconstruction. Thus, assisted reproduction is usually required. Post treatment, regular annual follow up is recommended even though, with the current multi drug therapy, the chances of relapse are low.
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Affiliation(s)
- Siddharth Yadav
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Hemal
- Baptist Medical Centre, Wake Forest University, Winston-Salem, NC, USA
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Elzein F, Albogami N, Saad M, El Tayeb N, Alghamdi A, Elyamany G. Disseminated Mycobacterium bovis Infection Complicating Intravesical BCG Instillation for the Treatment of Superficial Transitional Cell Carcinoma of the Bladder. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2016; 9:71-3. [PMID: 27559301 PMCID: PMC4988456 DOI: 10.4137/ccrep.s39904] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/29/2016] [Accepted: 05/31/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Intravesical instillation of Bacillus Calmette–Guérin (BCG) remains a first-line treatment for superficial transitional cell carcinoma of the bladder. Although its use is relatively safe, severe complications such as granulomatous hepatitis, osteomyelitis, pneumonitis, and sepsis occur in few patients. Complications of intravesical instillation of BCG can be local or systemic, with early or late presentation. CASE PRESENTATION Here, we report an 88-year-old man who developed fever, rigors, and episodes of syncope following fourth intravesical BCG instillation for the treatment of superficial transitional cell carcinoma of the bladder. Pancytopenia, disseminated intravascular coagulation, ground glass appearance on computerized tomography of the chest scan in addition to multiple bone marrow granulomas, suggested the diagnosis of disseminated BCG infection. All these features recovered on antituberculosis treatment. CONCLUSION Our case study highlights the importance of early recognition and prompt treatment of patients with disseminated BCG infection following intravesical instillation. Although isolation of mycobacterium is desirable to make the diagnosis, it is not unusual to have negative smears and cultures and this should not be used to dismiss the possibility of BCG infection.
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Affiliation(s)
- Fatehi Elzein
- Division of Infectious Diseases, Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Nada Albogami
- Division of Hematopathology, Department of Central Military Laboratory and Blood Bank, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mustafa Saad
- Division of Infectious Diseases, Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Nazik El Tayeb
- Division of Infectious Diseases, Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ghaleb Elyamany
- Division of Hematopathology, Department of Central Military Laboratory and Blood Bank, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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