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Blaya-Cánovas JL, Griñán-Lisón C, Blancas I, Marchal JA, Ramírez-Tortosa C, López-Tejada A, Benabdellah K, Cortijo-Gutiérrez M, Cano-Cortés MV, Graván P, Navarro-Marchal SA, Gómez-Morales J, Delgado-Almenta V, Calahorra J, Agudo-Lera M, Sagarzazu A, Rodríguez-González CJ, Gallart-Aragón T, Eich C, Sánchez-Martín RM, Granados-Principal S. Autologous patient-derived exhausted nano T-cells exploit tumor immune evasion to engage an effective cancer therapy. Mol Cancer 2024; 23:83. [PMID: 38730475 PMCID: PMC11084007 DOI: 10.1186/s12943-024-01997-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Active targeting by surface-modified nanoplatforms enables a more precise and elevated accumulation of nanoparticles within the tumor, thereby enhancing drug delivery and efficacy for a successful cancer treatment. However, surface functionalization involves complex procedures that increase costs and timelines, presenting challenges for clinical implementation. Biomimetic nanoparticles (BNPs) have emerged as unique drug delivery platforms that overcome the limitations of actively targeted nanoparticles. Nevertheless, BNPs coated with unmodified cells show reduced functionalities such as specific tumor targeting, decreasing the therapeutic efficacy. Those challenges can be overcome by engineering non-patient-derived cells for BNP coating, but these are complex and cost-effective approaches that hinder their wider clinical application. Here we present an immune-driven strategy to improve nanotherapeutic delivery to tumors. Our unique perspective harnesses T-cell exhaustion and tumor immune evasion to develop a groundbreaking new class of BNPs crafted from exhausted T-cells (NExT) of triple-negative breast cancer (TNBC) patients by specific culture methods without sophisticated engineering. METHODS NExT were generated by coating PLGA (poly(lactic-co-glycolic acid)) nanoparticles with TNBC-derived T-cells exhausted in vitro by acute activation. Physicochemical characterization of NExT was made by dynamic light scattering, electrophoretic light scattering and transmission electron microscopy, and preservation and orientation of immune checkpoint receptors by flow cytometry. The efficacy of chemotherapy-loaded NExT was assessed in TNBC cell lines in vitro. In vivo toxicity was made in CD1 mice. Biodistribution and therapeutic activity of NExT were determined in cell-line- and autologous patient-derived xenografts in immunodeficient mice. RESULTS We report a cost-effective approach with a good performance that provides NExT naturally endowed with immune checkpoint receptors (PD1, LAG3, TIM3), augmenting specific tumor targeting by engaging cognate ligands, enhancing the therapeutic efficacy of chemotherapy, and disrupting the PD1/PDL1 axis in an immunotherapy-like way. Autologous patient-derived NExT revealed exceptional intratumor accumulation, heightened chemotherapeutic index and efficiency, and targeted the tumor stroma in a PDL1+ patient-derived xenograft model of triple-negative breast cancer. CONCLUSIONS These advantages underline the potential of autologous patient-derived NExT to revolutionize tailored adoptive cancer nanotherapy and chemoimmunotherapy, which endorses their widespread clinical application of autologous patient-derived NExT.
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Grants
- PRDJA19001BLAY Fundación Científica Asociación Española Contra el Cáncer
- POSTDOC_21_638 Consejería de Economía, Innovación, Ciencia y Empleo, Junta de Andalucía
- RTI2018.101309B-C22 Ministerio de Ciencia, Innovación y Universidades
- FPU19/04450 Ministerio de Ciencia, Innovación y Universidades
- DOC_01686 Consejería de Transformación Económica, Industria, Conocimiento y Universidades
- PI19/01533 Instituto de Salud Carlos III
- P29/22/02 Consejería de Economía, Conocimiento, Empresas y Universidad, Junta de Andalucía, Spain
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Affiliation(s)
- José L Blaya-Cánovas
- UGC de Oncología Médica, Hospital Universitario de Jaén, Jaén, 23007, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, University Hospitals of Granada- University of Granada, Granada, 18100, Spain
- Centre for Genomics and Oncological Research, GENYO, Pfizer/University of Granada/Andalusian Regional Government, Granada, 18016, Spain
| | - Carmen Griñán-Lisón
- Instituto de Investigación Biosanitaria ibs.GRANADA, University Hospitals of Granada- University of Granada, Granada, 18100, Spain
- Centre for Genomics and Oncological Research, GENYO, Pfizer/University of Granada/Andalusian Regional Government, Granada, 18016, Spain
- Department of Biochemistry and Molecular Biology 2, Faculty of Pharmacy, University of Granada, Campus de Cartuja s/n, Granada, 18071, Spain
- Excellence Research Unit "Modeling Nature" (MNat), University of Granada, Granada, 18100, Spain
| | - Isabel Blancas
- Instituto de Investigación Biosanitaria ibs.GRANADA, University Hospitals of Granada- University of Granada, Granada, 18100, Spain
- UGC de Oncología, Hospital Universitario San Cecilio, Granada, 18016, Spain
- Department of Medicine, University of Granada, Granada, 18016, Spain
| | - Juan A Marchal
- Instituto de Investigación Biosanitaria ibs.GRANADA, University Hospitals of Granada- University of Granada, Granada, 18100, Spain
- Excellence Research Unit "Modeling Nature" (MNat), University of Granada, Granada, 18100, Spain
- Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research, (CIBM), University of Granada, Granada, 18100, Spain
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Granada, Granada, 18016, Spain
| | - César Ramírez-Tortosa
- Instituto de Investigación Biosanitaria ibs.GRANADA, University Hospitals of Granada- University of Granada, Granada, 18100, Spain
- UGC de Anatomía Patológica, Hospital San Cecilio, Granada, 18016, Spain
| | - Araceli López-Tejada
- Instituto de Investigación Biosanitaria ibs.GRANADA, University Hospitals of Granada- University of Granada, Granada, 18100, Spain
- Centre for Genomics and Oncological Research, GENYO, Pfizer/University of Granada/Andalusian Regional Government, Granada, 18016, Spain
- Department of Biochemistry and Molecular Biology 2, Faculty of Pharmacy, University of Granada, Campus de Cartuja s/n, Granada, 18071, Spain
| | - Karim Benabdellah
- Centre for Genomics and Oncological Research, GENYO, Pfizer/University of Granada/Andalusian Regional Government, Granada, 18016, Spain
| | - Marina Cortijo-Gutiérrez
- Centre for Genomics and Oncological Research, GENYO, Pfizer/University of Granada/Andalusian Regional Government, Granada, 18016, Spain
| | - M Victoria Cano-Cortés
- Instituto de Investigación Biosanitaria ibs.GRANADA, University Hospitals of Granada- University of Granada, Granada, 18100, Spain
- Centre for Genomics and Oncological Research, GENYO, Pfizer/University of Granada/Andalusian Regional Government, Granada, 18016, Spain
- Department of Medicinal & Organic Chemistry and Excellence Research Unit of "Chemistry Applied to Biomedicine and the Environment", Faculty of Pharmacy, University of Granada, Campus de Cartuja s/n, Granada, 18071, Spain
| | - Pablo Graván
- Instituto de Investigación Biosanitaria ibs.GRANADA, University Hospitals of Granada- University of Granada, Granada, 18100, Spain
- Excellence Research Unit "Modeling Nature" (MNat), University of Granada, Granada, 18100, Spain
- Department of Applied Physics, Faculty of Science, University of Granada, Granada, 18071, Spain
| | - Saúl A Navarro-Marchal
- Instituto de Investigación Biosanitaria ibs.GRANADA, University Hospitals of Granada- University of Granada, Granada, 18100, Spain
- Excellence Research Unit "Modeling Nature" (MNat), University of Granada, Granada, 18100, Spain
- Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research, (CIBM), University of Granada, Granada, 18100, Spain
- Department of Applied Physics, Faculty of Science, University of Granada, Granada, 18071, Spain
| | - Jaime Gómez-Morales
- Laboratorio de Estudios Cristalográficos IACT-CSIC-UGR, Armilla, 18100, Spain
| | - Violeta Delgado-Almenta
- Centre for Genomics and Oncological Research, GENYO, Pfizer/University of Granada/Andalusian Regional Government, Granada, 18016, Spain
| | - Jesús Calahorra
- UGC de Oncología Médica, Hospital Universitario de Jaén, Jaén, 23007, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, University Hospitals of Granada- University of Granada, Granada, 18100, Spain
- Centre for Genomics and Oncological Research, GENYO, Pfizer/University of Granada/Andalusian Regional Government, Granada, 18016, Spain
| | - María Agudo-Lera
- Centre for Genomics and Oncological Research, GENYO, Pfizer/University of Granada/Andalusian Regional Government, Granada, 18016, Spain
| | - Amaia Sagarzazu
- Centre for Genomics and Oncological Research, GENYO, Pfizer/University of Granada/Andalusian Regional Government, Granada, 18016, Spain
| | | | - Tania Gallart-Aragón
- Department of Medicine, University of Granada, Granada, 18016, Spain
- UGC de Cirugía General y del Aparato Digestivo, Hospital Universitario San Cecilio, Granada, 18016, Spain
| | - Christina Eich
- Translational Nanobiomaterials and Imaging, Department of Radiology, Leiden University Medical Center, Leiden, 2333, The Netherlands
| | - Rosario M Sánchez-Martín
- Instituto de Investigación Biosanitaria ibs.GRANADA, University Hospitals of Granada- University of Granada, Granada, 18100, Spain
- Centre for Genomics and Oncological Research, GENYO, Pfizer/University of Granada/Andalusian Regional Government, Granada, 18016, Spain
- Department of Medicinal & Organic Chemistry and Excellence Research Unit of "Chemistry Applied to Biomedicine and the Environment", Faculty of Pharmacy, University of Granada, Campus de Cartuja s/n, Granada, 18071, Spain
| | - Sergio Granados-Principal
- Instituto de Investigación Biosanitaria ibs.GRANADA, University Hospitals of Granada- University of Granada, Granada, 18100, Spain.
- Centre for Genomics and Oncological Research, GENYO, Pfizer/University of Granada/Andalusian Regional Government, Granada, 18016, Spain.
- Department of Biochemistry and Molecular Biology 2, Faculty of Pharmacy, University of Granada, Campus de Cartuja s/n, Granada, 18071, Spain.
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2
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Lopez-Garzon M, Cantarero-Villanueva I, Legerén-Alvarez M, Gallart-Aragón T, Postigo-Martin P, González-Santos Á, Lozano-Lozano M, Martín-Martín L, Ortiz-Comino L, Castro-Martín E, Ariza-García A, Fernández-Lao C, Arroyo-Morales M, Galiano-Castillo N. Prevention of Chemotherapy-Induced Peripheral Neuropathy With PRESIONA, a Therapeutic Exercise and Blood Flow Restriction Program: A Randomized Controlled Study Protocol. Phys Ther 2022; 102:6497838. [PMID: 35079838 DOI: 10.1093/ptj/pzab282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/27/2021] [Accepted: 10/25/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVE This trial will analyze the acute and cumulative effects of a tailored program called PRESIONA that combines therapeutic exercise and blood flow restriction to prevent chemotherapy-induced peripheral neuropathy (CIPN) in individuals with early breast cancer undergoing neoadjuvant chemotherapy. METHODS PRESIONA will be a physical therapist-led multimodal exercise program that uses blood flow restriction during low-load aerobic and strength exercises. For the acute study, only 1 session will be performed 1 day before the first taxane cycle, in which 72 women will be assessed before intervention and 24 hours post intervention. For the cumulative study, PRESIONA will consist of 24 to 36 sessions for 12 weeks following an undulatory prescription. At least 80 women will be randomized to the experimental group or control group. Feasibility will be quantified based on the participant recruitment to acceptance ratio; dropout, retention, and adherence rates; participant satisfaction; tolerance; and program security. In the efficacy study, the main outcomes will be CIPN symptoms assessed with a participant-reported questionnaire (EORTC QLQ-CIPN20). In addition, to determine the impact on other participant-reported health and sensorimotor and physical outcomes, the proportion of completed scheduled chemotherapy sessions will be examined at baseline (t0), after anthracycline completion (t1), after intervention (t2), and at the 2-month (t3) and 1-year follow-ups (t4). CONCLUSION The proposed innovative approach of this study could have a far-reaching impact on therapeutic options, and the physical therapist role could be essential in the oncology unit to improve quality of life in individuals with cancer and reduce side effects of cancer and its treatments. IMPACT Physical therapists in the health care system could be essential to achieve the planned doses of chemotherapy to improve survival and decrease the side effects of individuals with breast cancer. The prevention of CIPN would have an impact on the quality of life in these individuals, and this protocol potentially could provide an action guide that could be implemented in any health care system.
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Affiliation(s)
- Maria Lopez-Garzon
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Irene Cantarero-Villanueva
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
| | - Marta Legerén-Alvarez
- FEA Oncología Médica, San Cecilio University Hospital, Andalusian Health Service, Granada, Spain
| | | | - Paula Postigo-Martin
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
| | - Ángela González-Santos
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Mario Lozano-Lozano
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
| | - Lydia Martín-Martín
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
| | | | - Eduardo Castro-Martín
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
| | - Angélica Ariza-García
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
| | - Carolina Fernández-Lao
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
| | - Manuel Arroyo-Morales
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
| | - Noelia Galiano-Castillo
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
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3
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González-Santos Á, Postigo-Martin P, Gallart-Aragón T, Esteban-Cornejo I, Lopez-Garzon M, Galiano-Castillo N, Arroyo-Morales M, Illescas-Montes R, Artacho-Cordón F, Martín-Martín L, Forneiro-Pérez R, Lozano-Lozano M, Fernández-Lao C, Ruiz-Vozmediano J, Sánchez-Salgado C, Cantarero-Villanueva I. Neurotoxicity prevention with a multimodal program (ATENTO) prior to cancer treatment versus throughout cancer treatment in women newly diagnosed for breast cancer: Protocol for a randomized clinical trial. Res Nurs Health 2021; 44:598-607. [PMID: 33963594 DOI: 10.1002/nur.22136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 01/22/2023]
Abstract
A current challenge in breast cancer (BC) patients is how to reduce the side effects of cancer and cancer treatments and prevent a decrease in quality of life (QoL). Neurotoxic side effects, especially from chemotherapy, are present in up to 75% of women with BC, which implies a large impact on QoL. There is a special interest in the preventive possibilities of therapeutic exercise (TE) for these neurological sequelae, and the benefits of TE could be improved when it is combined with vagal activation techniques (VATs). This superiority randomized controlled trial aims to examine the feasibility and efficacy of an 8-week multimodal intervention (ATENTO) based on moderate-vigorous intensity and individualized TE (aerobic and strength exercises) and VAT (myofascial and breathing exercises), on neurotoxicity prevention in women with BC before starting adjuvant chemotherapy (ATENTO-B) versus throughout adjuvant chemotherapy (ATENTO-T). A sample of 56 women newly diagnosed with BC, as calculated with a power of 85%, will be randomly allocated into these two groups. This study could provide an impetus for the introduction of early multimodal intervention methods to prevent neurotoxicity and consequently avoid the QoL deterioration that BC patients presently suffer throughout their treatments.
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Affiliation(s)
- Ángela González-Santos
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Paula Postigo-Martin
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | | | - Irene Esteban-Cornejo
- Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain.,PROFITH "PROmoting FITness and Health through physical activity" Research Group, Granada, Spain
| | - Maria Lopez-Garzon
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Noelia Galiano-Castillo
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Manuel Arroyo-Morales
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Rebeca Illescas-Montes
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Department of Nursing, Biomedical Group (BIO277), Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Francisco Artacho-Cordón
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Department of Radiology and Physical Medicine, University of Granada, Granada, Spain
| | - Lydia Martín-Martín
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | | | - Mario Lozano-Lozano
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Carolina Fernández-Lao
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | | | | | - Irene Cantarero-Villanueva
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
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4
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Postigo-Martin P, Peñafiel-Burkhardt R, Gallart-Aragón T, Alcaide-Lucena M, Artacho-Cordón F, Galiano-Castillo N, Fernández-Lao C, Martín-Martín L, Lozano-Lozano M, Ruíz-Vozmediano J, Moreno-Gutiérrez S, Illescas-Montes R, Arroyo-Morales M, Cantarero-Villanueva I. Attenuating Treatment-Related Cardiotoxicity in Women Recently Diagnosed With Breast Cancer via a Tailored Therapeutic Exercise Program: Protocol of the ATOPE Trial. Phys Ther 2021; 101:6124131. [PMID: 33528004 DOI: 10.1093/ptj/pzab014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/09/2020] [Accepted: 12/01/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Therapeutic exercise is already used to ameliorate some of the side effects of cancer treatment. Recent studies examined its preventive potential regarding treatment-related toxicity, which can increase the risk of functional decline and lead to disease recurrence and death. This trial will examine whether the Tailored Therapeutic Exercise and Recovery Strategies (ATOPE) program, performed before treatment, can mitigate the onset and extent of cardiotoxicity beyond that achieved when the program is followed during treatment in recently diagnosed breast cancer patients. METHODS The intervention has a preparatory phase plus 12 to 18 sessions of tailored, high-intensity exercise, and post-exercise recovery strategies. A total of 120 women recently diagnosed with breast cancer, at risk of cardiotoxicity due to anticancer treatment awaiting surgery followed by chemotherapy and/or radiotherapy, will be randomized to either group. In a feasibility study, measurements related to recruitment rate, satisfaction with the program, adherence to them, the retention of participants, safety, and adverse effects will be explored. In the main trial, the efficacy of these interventions will be examined. The major outcome will be cardiotoxicity, assessed echocardiographically via the left ventricular ejection fraction. Other clinical, physical, and anthropometric outcomes and biological and hormonal variables will also be assessed after diagnosis, after treatment, 1 year after treatment ends, and 3 years after treatment ends. CONCLUSION Given its potential effect on patient survival, the mitigation of cardiotoxicity is a priority, and physical therapists have an important role in this mitigation. If the ATOPE intervention performed before treatment returns better cardioprotection results, it may be recommendable that patients recently diagnosed follow this program. IMPACT The ATOPE program will highlight the need for a physical therapist intervention from the moment of diagnosis, in the prevention or mitigation of cardiotoxicity, in women with breast cancer. It could help physical therapists to establish an adequate therapeutic exercise dose adapted to breast cancer patients and to propose correct therapeutic exercise prescription according to the assimilation of the sessions.
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Affiliation(s)
- Paula Postigo-Martin
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain
| | | | | | | | - Francisco Artacho-Cordón
- Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Department of Radiology and Physical Medicine, University of Granada, Granada, Spain
| | - Noelia Galiano-Castillo
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Carolina Fernández-Lao
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Lydia Martín-Martín
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Mario Lozano-Lozano
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | | | - Salvador Moreno-Gutiérrez
- Department of Computer Architecture and Technology, Information and Communication Technologies Research Center (CITIC), University of Granada, Spain
| | | | - Manuel Arroyo-Morales
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Irene Cantarero-Villanueva
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
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Cruz-Fernández M, Achalandabaso-Ochoa A, Gallart-Aragón T, Artacho-Cordón F, Cabrerizo-Fernández MJ, Pacce-Bedetti N, Cantarero-Villanueva I. Quantity and quality of muscle in patients recently diagnosed with colorectal cancer: a comparison with cancer-free controls. Support Care Cancer 2020; 28:4745-4752. [PMID: 31970516 DOI: 10.1007/s00520-020-05314-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/16/2020] [Indexed: 12/27/2022]
Abstract
This cross-sectional study compares the muscle mass, core strength and physical fragility of patients recently diagnosed with colorectal cancer (pRD-CRC) with those of healthy subjects and identifies variables to be considered when designing pre-treatment physical interventions for such patients. Body composition, anthropometric variables, the muscle architecture of the lumbopelvic region, physical fitness and frailty were assessed in 32 pRD-CRC and 29 healthy control subjects. The patients showed a reduction in muscle mass (F = 10.059; P = 0.003), in the width of the lumbar multifidus (F = 21.869; P < 0.001), in the transverse abdominal muscle (U = 323.00; P = 0.042) and in the abdominal strength resistance (F = 12.264; P = 0.001). They were also frailer (P = 0.002) than the controls. These results suggest that pRD-CRC are affected by reduced strength and myopenia, leading to frailty. The early incorporation of these patients into strength-enhancing programs may be advisable.
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Affiliation(s)
- Mayra Cruz-Fernández
- "Cuídate" Support Unit for Oncology Patients (UAPO), Sport and Health University Research Institute (iMUDS, University of Granada, Granada, Spain
- Department of Physiotherapy, University of Granada, Granada, Spain
| | | | - Tania Gallart-Aragón
- Unit of Mammary Pathology, General Surgery Services, "Campus de la Salud" Hospital, Granada, Spain
| | - Francisco Artacho-Cordón
- "Cuídate" Support Unit for Oncology Patients (UAPO), Sport and Health University Research Institute (iMUDS, University of Granada, Granada, Spain
- Department of Physiotherapy, University of Granada, Granada, Spain
- Department of Radiology and Physical Medicine, University of Granada, Granada, Spain
- Biohealth Research Institute in Granada (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain
| | | | | | - Irene Cantarero-Villanueva
- "Cuídate" Support Unit for Oncology Patients (UAPO), Sport and Health University Research Institute (iMUDS, University of Granada, Granada, Spain.
- Department of Physiotherapy, University of Granada, Granada, Spain.
- Biohealth Research Institute in Granada (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.
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Gallart-Aragón T, Fernández-Lao C, Cózar-Ibañez A, Cantarero-Villanueva I, Cambil-Martín J, Jiménez Ríos JA, Arroyo-Morales M. Relationship between changes in hemoglobin glycosilated and improvement of body composition in patients with morbid obesity after tubular laparoscopic gastrectomy. Med Clin (Barc) 2018; 151:131-135. [PMID: 29292099 DOI: 10.1016/j.medcli.2017.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 10/09/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective of our study is to analyze the possible relationship between changes in glycemic profile and body composition parameters in morbid obesity patients after tubular laparoscopic gastrectomy. MATERIAL AND METHODS A prospective observational cohort study with 69 patients was performed. The variables analyzed were body weight, blood glucose, hemoglobin, glycosylated, high density lipoprotein, low density lipoprotein, triglycerides, and waist and hip circumference. An analysis of variance of repeated measurements (ANOVA) and a correlation analysis through the Pearson test were carried out. RESULTS A significant reduction in weight (p<.001 after surgery) and in glycosylated hemoglobin (p<.036) and waist hip (p<.001) were found at 6 months after surgery. There was no significant difference in the rest of the variables studied. In correlation analysis, a significant positive correlation was found between the change in concentration of hemoglobin glycosylated and hip circumference (p=.047; r=0.237), the smaller the hip circumference, the lower the concentration of glycosylated hemoglobin. CONCLUSIONS Tubular laparoscopic gastrectomy is an effective technique for the treatment of morbidly obese patients with type 2 diabetes mellitus. The reduction in the perimeter of hip is related to glycosylated hemoglobin reduction 6 months after intervention.
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Gallart-Aragón T, Fernández-Lao C, Galiano-Castillo N, Cantarero-Villanueva I, Lozano-Lozano M, Arroyo-Morales M. Improvements in Health-Related Quality of Life and Pain: A Cohort Study in Obese Patients After Laparoscopic Sleeve Gastrectomy. J Laparoendosc Adv Surg Tech A 2017; 28:53-57. [PMID: 28850292 DOI: 10.1089/lap.2017.0415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The principal aim of the study was to investigate the effect of the sleeve gastrectomy (SG) in the quality of life (QoL) and pain in a population of morbidly obese patients. METHODS Seventy-two SG patients were assessed in this descriptive observational study, before the surgery and 6 months after that. We evaluated health-related QoL (Gastrointestinal Quality of Life Index [GIQLI]) and pain (spontaneous low back pain by Numerical Point Rate Scale [NPRS] and pressure pain thresholds [PPTs]). RESULTS The results of the analysis of variance (ANOVA) revealed significant improvements in nearly all of the subscales of GIQLI questionnaire after 6 months: gastrointestinal symptoms (P = .01), physical well-being (P < .001), social well-being (P = .03), and total GIQLI score (P < .001), but not for the emotional condition (P = .20). Patients also had improvements in spontaneous low back pain (P = .002), but not in the PPTs in all the body areas explored, including the cervical area, low back, and hands (P > .05). CONCLUSION Patients receiving SG improved their health-related QoL and low back pain 6 months after the intervention, but this improvement was not so important for pressure pain thresholds in different body areas.
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Affiliation(s)
| | - Carolina Fernández-Lao
- 2 Department of Physical Therapy, Instituto Biosanitario Granada (IBS.Granada), Instituto Mixto Deporte y Salud (iMUDS), University of Granada , Granada, Spain
| | - Noelia Galiano-Castillo
- 2 Department of Physical Therapy, Instituto Biosanitario Granada (IBS.Granada), Instituto Mixto Deporte y Salud (iMUDS), University of Granada , Granada, Spain
| | - Irene Cantarero-Villanueva
- 2 Department of Physical Therapy, Instituto Biosanitario Granada (IBS.Granada), Instituto Mixto Deporte y Salud (iMUDS), University of Granada , Granada, Spain
| | | | - Manuel Arroyo-Morales
- 2 Department of Physical Therapy, Instituto Biosanitario Granada (IBS.Granada), Instituto Mixto Deporte y Salud (iMUDS), University of Granada , Granada, Spain
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Gallart-Aragón T, Fernández-Lao C, Castro-Martín E, Cantarero-Villanueva I, Cózar-Ibáñez A, Arroyo-Morales M. Health-Related Fitness Improvements in Morbid Obese Patients After Laparoscopic Sleeve Gastrectomy: a Cohort Study. Obes Surg 2016; 27:1182-1188. [PMID: 27783365 DOI: 10.1007/s11695-016-2427-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Laparoscopic sleeve gastrectomy (LSG) has demonstrated high long-term effectiveness and major advantages over other techniques. The objective of this study was to analyze changes in physical fitness parameters in morbidly obese patients during 6 months after LSG. METHODOLOGY We conducted a descriptive observational study with 6-month follow-up in 72 LSG patients, evaluating changes in body mass index (BMI), functional capacity (6-min walking test), hand grip strength (manual dynamometry), flexibility (fingertip-to-floor test), balance (Flamingo test), physical activity level (International Physical Activity Questionnaire, IPAQ), and perception of general physical fitness (International Fitness Scale [IFIS] questionnaire). RESULTS The ANOVA revealed significant improvements in BMI, functional capacity, flexibility, balance, and physical activity level (P < 0.001) at 6 months, with an improvement in the perception of physical fitness in most cases. No significant changes were found in dominant hand (P = 0.676) or non-dominant hand (P = 0.222) dynamometry. General physical fitness was positively correlated with BMI and distance in the 6-min test, and was negatively correlated with fingertip-to-floor distance. CONCLUSION Morbidly obese patients showed major improvements at 6 months after LSG in functional capacity, balance, mobility, and physical activity, with no change in grip strength. These improvements were related to a better self-perception of general physical fitness.
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Affiliation(s)
| | - Carolina Fernández-Lao
- Department of Physical Therapy, Instituto Biosanitario Granada (IBS.Granada), Instituto Mixto Universitario Deporte y Salud (iMUDS), University of Granada, Avda. Ilustración 60, 18071, Granada, Spain.
| | - Eduardo Castro-Martín
- Department of Physical Therapy, Instituto Mixto Deporte y Salud (iMUDS), University of Granada, Granada, Spain
| | - Irene Cantarero-Villanueva
- Department of Physical Therapy, Instituto Biosanitario Granada (IBS.Granada), Instituto Mixto Universitario Deporte y Salud (iMUDS), University of Granada, Avda. Ilustración 60, 18071, Granada, Spain
| | | | - Manuel Arroyo-Morales
- Department of Physical Therapy, Instituto Biosanitario Granada (IBS.Granada), Instituto Mixto Universitario Deporte y Salud (iMUDS), University of Granada, Avda. Ilustración 60, 18071, Granada, Spain
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Calcerrada-Alises E, Martín-Piedra MÁ, Gallart-Aragón T, Sánchez-Quevedo MDC, Gómez-Valverde E, Jiménez-Ríos JA. Applications of Tissue Engineering in reparation of abdominal wall defects. ACTA ACUST UNITED AC 2015. [DOI: 10.15568/am.2015.794.re01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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