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Li J, Li XL, Li CQ. Immunoregulation mechanism of VEGF signaling pathway inhibitors and its efficacy on the kidney. Am J Med Sci 2023; 366:404-412. [PMID: 37699444 DOI: 10.1016/j.amjms.2023.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 05/10/2023] [Accepted: 09/07/2023] [Indexed: 09/14/2023]
Abstract
Angiogenesis and immunosuppression are closely related pathophysiologic processes. Widely prescribed in malignant tumor and proliferative retinal lesions, VEGF signaling pathway inhibitors may cause hypertension and renal injury in some patients, presenting with proteinuria, nephrotic syndrome, renal failure and thrombotic microangiopathy. VEGF signaling pathway inhibitors block the action of both VEGF-A and VEGF-C. However, VEGF-A and VEGF-C produced by podocytes are vital to maintain the physiological function of glomerular endothelial cells and podocytes. There is still no effective treatment for kidney disease associated with VEGF signaling pathway inhibitors and some patients have progressive renal failure even after withdrawal of the drug. Recent studies reveal that blocking of VEGF-A and VEGF-C can activate CD4 +and CD8+ T cells, augment antigen-presenting function of dendritic cells, enhance cytotoxicity of macrophages and initiate complement cascade activation. VEGF and VEGFR are expressed in immune cells, which are involved in the immunosuppression and cross-talk among immune cells. This review summarizes the expression and function of VEGF-A and VEGF-C in the kidney. The current immunoregulation mechanisms of VEGF signaling pathway inhibitors are reviewed. Finally, combinate strategies are summarized to highlight the proposal for VEGF signaling pathway inhibitors.
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Affiliation(s)
- Jun Li
- Department of Nephrology, Affiliated Hospital of Jiangnan University, Jiangsu, China; Wuxi School of Medicine, Jiangnan University, Jiangsu, China.
| | - Xiao-Lin Li
- Wuxi School of Medicine, Jiangnan University, Jiangsu, China
| | - Chun-Qing Li
- Department of Nephrology, Affiliated Hospital of Jiangnan University, Jiangsu, China
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2
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Hayashi Y, Kaneko R, Ogino H, Uekusa T, Kitajima M, Ikehara T, Nagai H, Matsuda T. A case of multiple hepatocellular carcinoma experiencing complete responses to sorafenib and atezolizumab-bevacizumab and developing severe, refractory venous congestive cutaneous ulcers on either regimen. Clin J Gastroenterol 2023; 16:229-236. [PMID: 36624210 DOI: 10.1007/s12328-023-01756-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
A man in his eighties presented with a history of bilateral leg congestive phlebitis, and multiple hepatocellular carcinoma (HCC) treated with sorafenib. When the dose was increased to 400 mg, ulcers appeared under both knees, which worsened, and the drug was discontinued 2 months after administration. However, the ulcers to 30 mm in diameter, requiring debridement and antibiotics. The HCC showed a complete response (CR) based on modified-RECIST criteria; however, after several rounds of locoregional therapy for recurrence, multiple HCCs and metastatic lesions in the Morrison's fossa were detected. Therefore, atezolizumab 1200 mg-bevacizumab 900 mg was started. After the first course, the patient complained of pain below both knees, and when the second course was administered, leg ulcers re-appeared and rapidly worsened. The ulcers were circular and multiple and progressed to deep digging, leading to tendon exposure. Bevacizumab-induced congestive venous ulcer was diagnosed, requiring skin grafts to heal. HCC then showed a CR based on m-RECIST criteria. Initially, the cause of the ulcer was thought to be immune-related adverse effects due to atezolizumab, but experience with sorafenib led us to conclude that the cause was stagnant venous ulcers due to vascular endothelial growth factor receptor inhibitor, which inhibited angiogenesis.
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Affiliation(s)
- Yorihito Hayashi
- Department of Gastroenterology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Rena Kaneko
- Department of Gastroenterology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan.
| | - Hiroki Ogino
- Department of Plastic Surgery, Kanto Rosai Hospital, Kawasaki, Japan
| | - Toshimasa Uekusa
- Department of Pathology and Diagnostics, Kanto Rosai Hospital, Kawasaki, Japan
| | - Mayako Kitajima
- Department of Dermatology, Kanto Rosai Hospital, Kawasaki, Japan
| | - Takashi Ikehara
- Department of Gastroenterology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8510, Japan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Hidenari Nagai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
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Gore Karaali M, Karaali S, Demir D, Yazıcı GN, Coban A, Mammadov R, Suleyman B, Suleyman H. The protective effect of carvacrol on bevacizumab-related skin injury in rats: A biochemical and histopathological evaluation. Cutan Ocul Toxicol 2022; 41:285-290. [DOI: 10.1080/15569527.2022.2124413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Muge Gore Karaali
- Department of Dermatology, Erzincan Binali Yıldırım University, Mengücek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Soner Karaali
- Department of Plastic, Reconsctructive and Aesthetic Surgery, Erzincan Binali Yıldırım University, Mengücek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Damla Demir
- Department of Dermatology, Istinye University Faculty of Medicine, Istanbul, Turkey
| | - Gulce Naz Yazıcı
- Department of Histology and Embryology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Abdulkadir Coban
- Department of Biochemistry, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Renad Mammadov
- Department of Pharmacology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Bahadır Suleyman
- Department of Pharmacology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Halis Suleyman
- Department of Pharmacology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
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İnözü M, Özlü SG, Özyörük D, Kiremitçi S, Çakmakçı S, Avcı B, Özdemir Sİ, Bayrakçı US. Will eculizumab be used in bevacizumab induced thrombotic microangiopathy: Case report. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2022. [DOI: 10.1016/j.phoj.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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5
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Wang Y, Cui C, Liu X, Deng L, Yang K, Li B, Xue J, Xie J, Cui W. Conditional catheter-related thrombosis free probability and risk-adapted choices of catheter for lung cancer. Thorac Cancer 2022; 13:1814-1821. [PMID: 35567315 PMCID: PMC9200883 DOI: 10.1111/1759-7714.14460] [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: 02/28/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Current predictive tools assess catheter‐related thrombosis (CRT) in patients with lung cancer in a static manner at a single time point of catheterization. The subsequent hazard changes over time are unknown. The conditional catheter‐related thrombosis‐free probability (CCFP) can provide dynamic information on continual CRT‐free expectations. This study aimed to assess the CCFP and hazard rates based on risk categories and various venous access devices (VADs). Methods This retrospective study reviewed 939 patients with lung cancer with peripherally inserted central venous catheters (PICCs) or central venous catheters (CVCs) identified at the National Clinical Research Center for Cancer between January 1, 2015 and December 31, 2018. The incidence of CRT has also been reported. Patients were stratified into low‐ and high‐risk groups according to multivariate Cox regression analyses. CCFP is defined as the CRT‐free probability given that patients have no CRT for a definite time. Results A total of 507 patients with PICCs and 432 patients with CVCs were included in this study. The 3‐month CCFP increased from 74.2% at catheter insertion to 93.6% at 3 months. The hazards of CRT in the first month were highest (16.4%) and slightly thereafter. The high‐risk group initially had a higher (21.4%) but significantly decreased CRT hazard after 2 months (8.3%), whereas the low‐risk group maintained a comparable lower risk hazard of less than 5% after 1 month. In the overall cohort, patients with CVCs had lower CRT probability than those with PICCs (HR, 1.76; 95% CI: 1.28–2.41; p < 0.01). Further analysis demonstrated that compared with PICCs, CVCs provided a CRT‐free benefit in low‐risk patients (p = 0.02) but not in high‐risk patients (p = 0.06). Conclusions CCFP increased, and the hazards of CRT decreased over time in a risk‐dependent manner in patients with lung cancer. These valuable dynamic data may help optimize risk‐adjusted choices of VADs and risk‐adjusted prophylactic anticoagulation strategies for patients.
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Affiliation(s)
- Yanfeng Wang
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chanjuan Cui
- Department of Laboratory Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Liu
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Deng
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ke Yang
- Department of Medical Oncology, Cancer Hospital of Huanxing, Beijing, China
| | - Bin Li
- Department of Management Center, Cancer Hospital of Huanxing, Beijing, China
| | - Jie Xue
- Department of Management Center, Cancer Hospital of Huanxing, Beijing, China
| | - Junying Xie
- Department of Management Center, Cancer Hospital of Huanxing, Beijing, China
| | - Wei Cui
- Department of Laboratory Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Vakiti A, Singh D, Pilla R, Alhaj-Moustafa M, Fitzpatrick KW. Bevacizumab-induced atypical hemolytic uremic syndrome and treatment with eculizumab. J Oncol Pharm Pract 2018; 25:1011-1015. [PMID: 29768958 DOI: 10.1177/1078155218774895] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Bevacizumab (Avastin) is a recombinant humanized monoclonal antibody used for the management of various solid malignancies including colorectal, lung, brain, renal, and ovarian cancers as well as age-related macular degeneration of the eye. It is a vascular endothelial growth factor inhibitor which exhibits its action by blocking the growth of blood vessels in cancerous tissue. Common side effects include hypertension, fatigue, headaches, and increased risk of infections. Atypical hemolytic uremic syndrome is a serious side effect associated with bevacizumab due to its anti-angiogenic effect. It encompasses the clinical triad of thrombocytopenia, microangiopathic hemolytic anemia, and acute renal failure, without any association with Shiga toxins. Eculizumab is a terminal complement inhibitor used in the treatment of atypical hemolytic uremic syndrome. Herein, we present three cases of bevacizumab-induced atypical hemolytic syndrome treated successfully with eculizumab.
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Affiliation(s)
- Anusha Vakiti
- 1 Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Daulath Singh
- 2 Department of Hematology and Oncology, Loyola University Medical Center, Maywood, IL, USA
| | - Ravi Pilla
- 1 Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Muhamad Alhaj-Moustafa
- 1 Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Kelly W Fitzpatrick
- 3 Division of Hematology and Oncology, Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
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Mizutani H, Inatomi Y, Singu T, Nakajima M, Yonehara T, Ando Y. [Embolic stroke immediately after initial administration of intravitreal aflibercept]. Rinsho Shinkeigaku 2018; 58:314-319. [PMID: 29710026 DOI: 10.5692/clinicalneurol.cn-001162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 72-year-old man was admitted to our hospital because of right upper limb monoplegia 8 hours after the initial intravitreal injection of aflibercept, which is an inhibitor of vascular endothelial growth factor. Magnetic resonance diffusion-weighted images showed recent ischemic lesions in the left corona radiata and the right superior frontal gyrus. Laboratory findings showed mild hyperfibrinolysis. A patent foramen ovale was diagnosed on transesophageal echocardiography; however, lower-extremity ultrasonography did not detect deep vein thrombosis. The source of embolism remained unknown. A possible mechanism of cerebral emboli in the present case was a rapidly induced hypercoagulative state due to transfer of aflibercept from the vitreous body to the systemic circulation.
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Affiliation(s)
- Hironori Mizutani
- Department of Neurology, Saiseikai Kumamoto Hospital.,Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
| | | | - Takaomi Singu
- Department of Neurology, Saiseikai Kumamoto Hospital
| | - Makoto Nakajima
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
| | | | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University
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