A phase II dose‑escalation trial of perioperative desmopressin (1‑desamino‑8‑D‑arginine vasopressin) in breast cancer patients

Desmopressin (dDAVP) is a well-known peptide analog of the antidiuretic hormone vasopressin, used to prevent excessive bleeding during surgical procedures. dDAVP increases hemostatic mediators, such as the von Willebrand factor (vWF), recently considered a key element in resistance to metastasis. Studies in mouse models and veterinary trials in dogs with locally-advanced mammary tumors demonstrated that high doses of perioperative dDAVP inhibited lymph node and early blood-borne metastasis and significantly prolonged survival. We conducted a phase II dose-escalation trial in patients with breast cancer, administering a lyophilized formulation of dDAVP by intravenous infusion in saline, 30–60 min before and 24 h after surgical resection. Primary endpoints were safety and tolerability, as well as selection of the best dose for cancer surgery. Secondary endpoints included surgical bleeding, plasma levels of vWF, and circulating tumor cells (CTCs) as measured by quantitative PCR of cytokeratin-19 transcripts. Only 2 of a total of 20 patients experienced reversible adverse events, including hyponatremia (grade 4) and hypersensitivity reaction (grade 2). Reactions were adequately managed by slowing the infusion rate. A reduced intraoperative bleeding was noted with increasing doses of dDAVP. Treatment was associated with higher vWF plasma levels and a postoperative drop in CTC counts. At the highest dose level evaluated (2 μg/kg) dDAVP appeared safe when administered in two slow infusions of 1 μg/kg, before and after surgery. Clinical trials to establish the effectiveness of adjunctive perioperative dDAVP therapy are warranted. This trial is registered on www.clinicaltrials.gov (NCT01606072).Facultad de Ciencias Médica

A phase II dose-escalation trial of perioperative desmopressin (1-desamino-8-d-arginine vasopressin) in breast cancer patients

Desmopressin (dDAVP) is a well-known peptide analog of the antidiuretic hormone vasopressin, used to prevent excessive bleeding during surgical procedures. dDAVP increases hemostatic mediators, such as the von Willebrand factor (vWF), recently considered a key element in resistance to metastasis. Studies in mouse models and veterinary trials in dogs with locally-advanced mammary tumors demonstrated that high doses of perioperative dDAVP inhibited lymph node and early blood-borne metastasis and significantly prolonged survival. We conducted a phase II dose-escalation trial in patients with breast cancer, administering a lyophilized formulation of dDAVP by intravenous infusion in saline, 30–60 min before and 24 h after surgical resection. Primary endpoints were safety and tolerability, as well as selection of the best dose for cancer surgery. Secondary endpoints included surgical bleeding, plasma levels of vWF, and circulating tumor cells (CTCs) as measured by quantitative PCR of cytokeratin-19 transcripts. Only 2 of a total of 20 patients experienced reversible adverse events, including hyponatremia (grade 4) and hypersensitivity reaction (grade 2). Reactions were adequately managed by slowing the infusion rate. A reduced intraoperative bleeding was noted with increasing doses of dDAVP. Treatment was associated with higher vWF plasma levels and a postoperative drop in CTC counts. At the highest dose level evaluated (2 μg/kg) dDAVP appeared safe when administered in two slow infusions of 1 μg/kg, before and after surgery. Clinical trials to establish the effectiveness of adjunctive perioperative dDAVP therapy are warranted. This trial is registered on www.clinicaltrials.gov (NCT01606072).Fil: Weinberg, Ruth S.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Grecco, Marcelo O.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Ferro, Gimena S.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Seigelshifer, Debora Judith. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Perroni, Nancy V.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Terrier, Francisco J.. Instituto Universitario del Hospital Italiano de Buenos Aires; ArgentinaFil: Sánchez Luceros, Analía Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Medicina Experimental. Academia Nacional de Medicina de Buenos Aires. Instituto de Medicina Experimental; Argentina. Academia Nacional de Medicina de Buenos Aires; ArgentinaFil: Maronna, Esteban. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; ArgentinaFil: Sánchez Marull, Ricardo. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; ArgentinaFil: Frahm, Isabel. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; ArgentinaFil: Guthmann, Marcelo D.. Laboratorio Elea; ArgentinaFil: Di Leo, Daniela. Laboratorio Elea; ArgentinaFil: Spitzer, Eduardo. Laboratorio Elea; ArgentinaFil: Ciccia, Graciela Noemi. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Garona, Juan. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Quilmes; ArgentinaFil: Pifano, Marina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Quilmes; ArgentinaFil: Torbidoni, Ana Vanesa. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Quilmes; ArgentinaFil: Gomez, Daniel Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Quilmes; ArgentinaFil: Ripoll, Giselle Vanina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Quilmes; ArgentinaFil: Gomez, Roberto E.. Laboratorio Elea; ArgentinaFil: Demarco, Ignacio A.. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Alonso, Daniel Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Quilmes; Argentin

The functional interaction between Acyl-CoA synthetase 4, 5-lipooxygenase and cyclooxygenase-2 controls tumor growth: a novel therapeutic target.

The acyl-CoA synthetase 4 (ACSL4), which esterify mainly arachidonic acid (AA) into acyl-CoA, is increased in breast, colon and hepatocellular carcinoma. The transfection of MCF-7 cells with ACSL4 cDNA transforms the cells into a highly aggressive phenotype and controls both lipooxygenase-5 (LOX-5) and cyclooxygenase-2 (COX-2) metabolism of AA, suggesting a causal role of ACSL4 in tumorigenesis. We hypothesized that ACSL4, LOX-5 and COX-2 may constitute potential therapeutic targets for the control of tumor growth. Therefore, the aim of this study was to use a tetracycline Tet-Off system of MCF-7 xenograft model of breast cancer to confirm the effect of ACSL4 overexpression on tumor growth in vivo. We also aim to determine whether a combinatorial inhibition of the ACSL4-LOX-COX-2 pathway affects tumor growth in vivo using a xenograft model based on MDA-MB-231 cells, a highly aggressive breast cancer cell line naturally overexpressing ACSL4. The first novel finding is that stable transfection of MCF-7 cells with ACSL4 using the tetracycline Tet-Off system of MCF-7 cells resulted in development of growing tumors when injected into nude mice. Tumor xenograft development measured in animals that received doxycycline resulted in tumor growth inhibition. The tumors presented marked nuclear polymorphism, high mitotic index and low expression of estrogen and progesterone receptor. These results demonstrate the transformational capacity of ACSL4 overexpression. We examined the effect of a combination of inhibitors of ACSL4, LOX-5 and COX-2 on MDA-MB-231 tumor xenografts. This treatment markedly reduced tumor growth in doses of these inhibitors that were otherwise ineffective when used alone, indicating a synergistic effect of the compounds. Our results suggest that these enzymes interact functionally and form an integrated system that operates in a concerted manner to regulate tumor growth and consequently may be potential therapeutic targets for the control of proliferation as well as metastatic potential of cancer cells

ERα and PR receptor expression in MCF-7 Tet-Off empty vector and MCF-7 Tet-Off/ACSL4 human breast cancer cells.

<p>MCF-7 Tet-Off/ACSL4 cells were incubated with or without docicycline. After 96 h of doxycycline treatment, total RNA and cellular proteins from MCF-7 Tet-Off empty vector and MCF-7 Tet-Off/ACSL4 cells were extracted and subjected to RT-PCR analysis for ERα and PR and L19 mRNA expression and SDS-PAGE and Western blot analysis respectively. Semiquantitive RT-PCR of ERα and PR (panel A and B respectively). were performed as described in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0040794#s4" target="_blank">Materials and Methods</a>. The integrated optical density of PCR products was normalized with the corresponding L19 mRNA bands. Data represent mean ± SD of three independent experiments. Western blot analysis of ERα and PR (panel C and D respectively) were performed as described in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0040794#s4" target="_blank">Materials and Methods</a>. Using anti ERα and PR - and anti-β-tubulin antibodies, specific protein bands were detected in immunoblots by enhanced chemiluminescence. The integrated optical density of protein levels was quantified and normalized with the corresponding -tubulin signal. Data represent the means ± SD of three independent experiments. The asterisk indicates significant differences analyzed by Student’s test comparing MCF-7 Tet-Off empty vector and MCF-7 Tet-Off/ACSL4 cells, (**) <i>P</i>≤0.05.</p

Tumor xenograft development measured in animals that received doxycycline.

<p>Comparison of average tumor volume (A) and tumor growth rate (B) of MCF-7 Tet-Off/ACSL4 tumor xenografts after injection of 5×10⁶ cells into the right flank of female Balb/c nu/nu mice, aged 6–8 weeks treated with or without doxycycline and average tumor volume of MCF-7 Tet-Off empty vector tumor xenografts 70 days after injection of 5×10⁶ cells into the right flank of female Balb/c nu/nu mice, aged 6–8 weeks. Values are mean ± SD, n = 5. The asterisk indicates significant differences between the tumor volumes and rate of tumor growth by one-way ANOVA post test Student-Newman-Keuls (*) <i>P</i>≤0.05 and (***) <i>P</i>≤0.001.</p

Two-way ANOVA analysis of tumor growth inhibition by different treatments on MDA-MB-231 tumor xenografts.

<p>GraphPad Prism Software was used to perform a two-way ANOVA of tumor growth data after treatment (data is graphed as tumor volume from day 11 to 30 post injection in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0040794#pone-0040794-g005" target="_blank">figure 5A</a>). Treatment A (first column) was compared to treatment B (second column) and the time it took (in days-post injection) to reach a significant level at <i>P</i><0.05, <i>P</i><0.01 or <i>P</i><0.001 as indicated in columns 3, 4 and 5 respectively.</p