Effect of long-chain omega-3 polyunsaturated fatty acids on cardiometabolic factors in children with acute lymphoblastic leukemia undergoing treatment: a secondary analysis of a randomized controlled trial

n-3 polyunsaturated fatty acids enhanced efficacy of cytarabine in iron-overloaded NALM-6 cells via apoptotic and oxidative pathways

Despite progress in treating acute lymphoblastic leukemia (ALL), the adverse effects of chemotherapy toxicity and iron overload from transfusions continue to affect patients' quality of life. Polyunsaturated fatty acids (PUFAs) exhibit both antitumor and anti-inflammatory properties in leukemia. This study investigated the influence of n-3 PUFA on the efficacy of cytarabine in cells with iron overload. Iron overload was induced in NALM-6 cells using ferric ammonium citrate (FAC) and quantified through atomic absorption spectroscopy (AAS). The impact of n-3 PUFA on NALM-6 cells' response to cytarabine was evaluated using MTT, lactate dehydrogenase (LDH), apoptosis, and cell cycle assays. Additionally, gene expression analyses were performed on apoptotic, anti-apoptotic, and inflammatory genes, along with oxidative stress markers such as reactive oxygen species (ROS) and malondialdehyde (MDA) levels. The administration of n-3 PUFA significantly enhanced the effectiveness of cytarabine in iron-overloaded NALM-6 cells, leading to increased LDH secretion, elevated apoptosis rates, and G1 phase cell cycle arrest. These effects were associated with the upregulation of apoptotic genes such as P53 and caspase-8, the downregulation of the anti-apoptotic gene Bcl2, and a decrease in the inflammatory gene TNF-α. Furthermore, there was a notable increase in ROS and MDA levels. Overall, n-3 PUFA treatment improved cytarabine's efficacy in iron-overloaded NALM-6 cells by activating apoptotic processes and oxidative stress pathways.

The impact of n-3 polyunsaturated fatty acids in patients with cancer: emerging themes

PURPOSE OF REVIEW

This review summarizes recent literature falling broadly under the topic of n-3 polyunsaturated fatty acids (PUFAs) in the oncology setting, highlighting emerging themes and emphasizing novel explorations.

RECENT FINDINGS

Meta-analyses continue to confirm safety and efficacy of n-3 PUFA supplementation on reducing inflammation and improving survival in people with cancer. Common themes in recent studies emphasize improving tumor-directed efficacy and reducing toxicities of common cancer therapies. New areas of interest include the impact of n-3 PUFA when combined with immunotherapies and applications in pediatric acute lymphoid leukemia. Novel assessments include specialized pro-resolving lipid mediators, the intestinal microbiome and psychological well being. A variety of clinically relevant outcomes including nutritional status, toxicities and survival are being explored in ongoing clinical studies.

SUMMARY

Evidence confirms the safety of n-3 PUFA for patients with cancers, as well as benefits in some, but not all areas of exploration. Larger, well designed trials with biological assessment of compliance compared to the prescribed n-3 PUFA dose would strengthen the evidence needed to integrate n-3 PUFA recommendations into clinical practice for patients with cancer.

The Use of Dietary Supplements for the Management of Adverse Effects of Treatment in Children and Adolescents with Leukemia: A Scoping Review

Acute lymphoblastic leukemia is the most prevalent form of leukemia in children and adolescents. Despite high survival rates due to advanced treatments, these therapies often result in significant treatment-related adverse effects. This scoping review explores dietary supplementation strategies for managing these adverse effects in pediatric leukemia patients. Twelve studies were included, involving participants aged between 0.8 and 21 years, all undergoing chemotherapy at various treatment phases. Chemotherapy-related adverse effects identified in this review included gastrointestinal symptoms, cardiometabolic risk factors, hepatotoxicity, osteopathies, neuro-psychiatric effects, hematological disorders, and changes in body composition. The dietary supplements evaluated for managing these effects were probiotics, ginger, glutamine, omega-3, vitamin D, calcium, potassium, honey, chamomile, and medium-chain triglyceride. Most of these supplements showed promising outcomes in reducing or preventing adverse effects. However, there is a demand for more rigorous clinical trials with larger sample sizes and standardized protocols to validate the efficacy of these interventions. Further research to identify optimal dosages, better understand long-term effects, and develop evidence-based guidelines for the use of dietary supplements in managing treatment-related adverse effects in children and adolescents with leukemia is needed.

Fish Oil Supplementation Modifies the Proteome, Lipidome, and Function of High-Density Lipoprotein: Findings from a Trial in Young Healthy Adults

BACKGROUND

Fish oil with the ω-3 fatty acids EPA and DHA is an FDA-approved treatment of patients with severe hypertriglyceridemia. Furthermore, EPA is an FDA-approved treatment of patients with high risk of cardiovascular disease (CVD); however, the cardioprotective mechanisms are unclear.

OBJECTIVES

We aimed to determine if fish oil supplementation is cardioprotective due to beneficial modifications in HDL particles.

METHODS

Seven fish oil naïve subjects without a history of CVD were recruited to take a regimen of fish oil (1125 mg EPA and 875 mg DHA daily) for 30 d, followed by a 30-d washout period wherein no fish oil supplements were taken. HDL isolated from fasting whole blood at each time point via 2-step ultracentrifugation (ucHDL) was assessed for proteome, lipidome, cholesterol efflux capacity (CEC), and anti-inflammatory capacity.

RESULTS

Following fish oil supplementation, the HDL-associated proteins immunoglobulin heavy constant γ1, immunoglobulin heavy constant α1, apolipoprotein D, and phospholipid transfer protein decreased compared to baseline (P < 0.05). The HDL-associated phospholipid families sphingomyelins, phosphatidylcholines, and phosphatidylserines increased after fish oil supplementation relative to baseline (P < 0.05). Compared to baseline, fish oil supplementation increased serum HDL's CEC (P = 0.002). Fish oil-induced changes (Post compared with Baseline) in serum HDL's CEC positively correlated with plasma EPA levels (R2 = 0.7256; P = 0.015). Similarly, fish oil-induced changes in ucHDL's CEC positively correlated with ucHDL's ability to reduce interleukin 10 (R2 = 0.7353; P = 0.014) and interleukin 6 mRNA expression (R2 = 0.6322; P =0.033) in a human macrophage cell line.

CONCLUSIONS

Overall, fish oil supplementation improved HDL's sterol efflux capacity through comprehensive modifications to its proteome and lipidome.

Hyperlipidemia in children and adolescents with acute lymphoblastic leukemia: A systematic review and meta-analysis

BACKGROUND

The established association between acute lymphoblastic leukemia (ALL) and hyperlipidemia has, in some studies, been linked to toxicities such as pancreatitis, thrombosis, and osteonecrosis. However, a systematic review investigating the incidence, management, and clinical implications of hyperlipidemia during childhood ALL treatment is lacking.

OBJECTIVES

Systematically assess the incidence of hyperlipidemia during ALL treatment, explore associations with risk factors and severe toxicities (osteonecrosis, thrombosis, and pancreatitis), and review prevalent management strategies.

METHODS

A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Data synthesis was descriptive, and a meta-analysis of hypertriglyceridemia and risk of severe toxicities was performed.

RESULTS

We included 13 studies with 3,425 patients. Hyperlipidemia incidence varied widely (6.7%-85%) but with inconsistent definitions and screening strategies across studies. Evidence regarding risk factors was conflicting, but age (> 10 years) and treatment with asparaginase and glucocorticosteroids seem to be associated with hyperlipidemia. Hypertriglyceridemia (grade 3/4) increased the risk for osteonecrosis (odds ratio (OR): 4.27, 95% confidence interval (CI): 2.77-6.61). No association could be established for pancreatitis (OR: 1.60, 95% CI: 0.53-4.82) or thrombosis (OR: 2.45, 95% CI: 0.86-7.01), but larger studies are needed to confirm this.

CONCLUSION

The overall evidence of this systematic review is limited by the small number of studies and risk of bias. Our review suggests that hypertriglyceridemia increases the risk for osteonecrosis. However, larger studies are needed to explore the clinical implications of hyperlipidemia and randomized trials investigating hyperlipidemia management and its impact on severe toxicities.