Cancer drugs and the heart: importance and management

Progress in the detection and treatment of cancer has led to an impressive reduction in both mortality and morbidity. Due to their mechanism of action, however, conventional chemotherapeutics and some of the newer anti-cancer signaling inhibitors carry a substantial risk of cardiovascular side effects that include cardiac dysfunction and heart failure, arterial hypertension, vasospastic and thromboembolic ischaemia, dysrhythmia, and QT prolongation. While some of these side effects are irreversible and cause progressive cardiovascular disease, others induce only temporary dysfunction with no apparent long-term sequelae for the patient. The challenge for the cardiovascular specialist is to balance the need for life-saving cancer treatment with the assessment of risk from cancer drug-associated cardiovascular side effects to prevent long-term damage. This review discusses concepts for timely diagnosis, intervention, and surveillance of cancer patients undergoing treatment, and provides approaches to clinical uncertaintie

Pathophysiology and diagnosis of cancer drug induced cardiomyopathy

The clinical manifestations of anti-cancer drug associated cardiac side effects are diverse and can range from acutely induced cardiac arrhythmias to Q-T interval prolongation, changes in coronary vasomotion with consecutive myocardial ischemia, myocarditis, pericarditis, severe contractile dysfunction, and potentially fatal heart failure. The pathophysiology of these adverse effects is similarly heterogeneous and the identification of potential mechanisms is frequently difficult since the majority of cancer patients is not only treated with a multitude of cancer drugs but might also be exposed to potentially cardiotoxic radiation therapy. Some of the targets inhibited by new anti-cancer drugs also appear to be important for the maintenance of cellular homeostasis of normal tissue, in particular during exposure to cytotoxic chemotherapy. If acute chemotherapy-induced myocardial damage is only moderate, the process of myocardial remodeling can lead to progressive myocardial dysfunction over years and eventually induce myocardial dysfunction and heart failure. The tools for diagnosing anti-cancer drug associated cardiotoxicity and monitoring patients during chemotherapy include invasive and noninvasive techniques as well as laboratory investigations and are mostly only validated for anthracycline-induced cardiotoxicity and more recently for trastuzumab-associated cardiac dysfunctio

Characterisation of the tetrahalophosphonium cations PBrnI4 − n+ (0 ≤ n ≤ 4) by 31P MAS NMR, IR and Raman spectroscopy and the crystal structures of PI4+AlCl4−, PI4+AlBr4− and PI4+GaI4−

The novel tetrahalophosphonium salts PBr4+AsF6−, PI4+AlCl4− and PI4+EBr4− (E = Al, Ga) have been synthesised. A variety of solid complexes containing PBr4+ (e.g. PBr4+AsF6−, PBr4+AlBr4− PBr4+GaBr4−), PI4+ (e.g. PI4+AlCl4−, PI4+AlBr4−, PI4+GaBr4−) or the mixed species PBrnI4 − n+ (0 ≤ n ≤ 4, containing AlBr4−, GaBr4−, AsF6− or SbF6−) have been studied by solid-state 31P MAS NMR and vibrational spectroscopy. The influence of the counter-ion on the chemical shift and the vibrational frequencies are discussed. The crystal structures of PI4+AlCl4−, PI4+AlBr4− and PI4+GaI4− are reported. Evidence for the existence of the hitherto unknown mixed bromoiodophosphonium cations PBr3I+, PBr2I2+ and PBrI3+ has been confirmed by spin–orbit corrected density functional calculations of isotropic 31P chemical shifts for PBrnI4 − n+

A Sustained Dietary Change Increases Epigenetic Variation in Isogenic Mice

Epigenetic changes can be induced by adverse environmental exposures, such as nutritional imbalance, but little is known about the nature or extent of these changes. Here we have explored the epigenomic effects of a sustained nutritional change, excess dietary methyl donors, by assessing genomic CpG methylation patterns in isogenic mice exposed for one or six generations. We find stochastic variation in methylation levels at many loci; exposure to methyl donors increases the magnitude of this variation and the number of variable loci. Several gene ontology categories are significantly overrepresented in genes proximal to these methylation-variable loci, suggesting that certain pathways are susceptible to environmental influence on their epigenetic states. Long-term exposure to the diet (six generations) results in a larger number of loci exhibiting epigenetic variability, suggesting that some of the induced changes are heritable. This finding presents the possibility that epigenetic variation within populations can be induced by environmental change, providing a vehicle for disease predisposition and possibly a substrate for natural selection.This work was supported by the Australian Research Council (DP0771859) and the National Health and Medical Research Council (#459412, #635510)

Depth-resolved measurements of the Meissner screening profile in surface-treated Nb

We report depth-resolved measurements of the Meissner screening profile in several surface-treated Nb samples using low-energy muon spin rotation (LE-$\mu$SR). In these experiments, implanted positive muons, whose stopping depths below Nb's surface were adjusted between ~10 nm to ~150 nm, reveal the field distribution inside the superconducting element via their spin-precession (communicated through their radioactive decay products). We compare how the field screening is modified by different surface treatments commonly employed to prepare superconducting radio frequency (SRF) cavities used in accelerator beamlines. In contrast to an earlier report [A. Romanenko et al., Appl. Phys. Lett. 104 072601 (2014)], we find no evidence for any "anomalous" modifications to the Meissner profiles, with all data being well-described by a London model. Differences in screening properties between surface treatments can be explained by changes to the carrier mean-free-paths resulting from dopant profiles near the material's surface.Comment: 15 pages, 5 figures, 2 table

Spectroscopic perspective on the interplay between electronic and magnetic properties of magnetically doped topological insulators

We combine low energy muon spin rotation (LE-$\mu$SR) and soft-X-ray angle-resolved photoemission spectroscopy (SX-ARPES) to study the magnetic and electronic properties of magnetically doped topological insulators, (Bi,Sb)$_2$Te$_3$. We find that one achieves a full magnetic volume fraction in samples of (V/Cr)$_x$(Bi,Sb)$_{2-x}$Te$_3$ at doping levels x $\gtrsim$ 0.16. The observed magnetic transition is not sharp in temperature indicating a gradual magnetic ordering. We find that the evolution of magnetic ordering is consistent with formation of ferromagnetic islands which increase in number and/or volume with decreasing temperature. Resonant ARPES at the V $L_3$ edge reveals a nondispersing impurity band close to the Fermi level as well as V weight integrated into the host band structure. Calculations within the coherent potential approximation of the V contribution to the spectral function confirm that this impurity band is caused by V in substitutional sites. The implications of our results on the observation of the quantum anomalous Hall effect at mK temperatures are discussed

Supervised exercise training in patients with cancer during anthracycline-based chemotherapy to mitigate cardiotoxicity: a randomized-controlled-trial

Background: Exercise training (ET) has been shown to mitigate cardiotoxicity of anthracycline-based chemotherapies (AC) in animal models. Data from randomized controlled trials in patients with cancer are sparse. Methods: Patients with breast cancer or lymphoma receiving AC were recruited from four cancer centres and randomly assigned to 3 months supervised ET. Primary outcome was change in left ventricular global longitudinal strain (GLS) from baseline (before AC) to post AC (AC-end) compared between the EXduringAC group, who participated in an exercise intervention during AC including the provision of an activity tracker, and the control group EXpostAC, who received an activity tracker only. Secondary outcome parameters were changes in high sensitivity Troponin T (hsTnT), NT-pro-brain natriuretic peptide (NT-proBNP), peak oxygen consumption (peak VO2) and objectively measured physical activity (PA) during this same time-period. All assessments were repeated at a 12-week follow-up from AC-end, when also the EXpostAC group had completed the ET, that started after AC. In exploratory analyses, robust linear models were performed to assess the association of PA with changes in echocardiographic parameters and biomarkers of LV function. Results: Fifty-seven patients (median age 47 years; 95% women) were randomized to EXduringAC (n = 28) and EXpostAC (n = 29) group. At AC-end, GLS deteriorated in both study groups (albeit insignificantly) with 7.4% and 1.0% in EXduringAC (n = 18) and EXpostAC (n = 18), respectively, and hsTnT and NT-proBNP significantly increased in both groups, without difference between groups for any parameter. Change in peak VO2 (−1.0 and −1.1 ml/kg/min) at AC-end was also similar between groups as was duration of moderate-to-vigorous PA (MVPA) with a median of 33 [26, 47] min/day and 32 [21, 59] min/day in the EXduringAC and EXpostAC group, respectively. In the robust linear model including the pooled patient population, MVPA was significantly associated with a more negative GLS and lesser increase in hsTnT at AC-end. Conclusion: In this small scale RCT, supervised ET during AC was not superior to wearing a PA tracker to mitigate cardiotoxicity. The dose-response relationship between PA and cardioprotective effects during AC found in our and previous data supports the notion that PA should be recommended to patients undergoing AC. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT03850171

Cardiovascular disease after cancer therapy

AbstractImprovements in treatment and earlier diagnosis have both contributed to increased survival for many cancer patients. Unfortunately, many treatments carry a risk of late effects including cardiovascular diseases (CVDs), possibly leading to significant morbidity and mortality. In this paper we describe current knowledge of the cardiotoxicity arising from cancer treatments, outline gaps in knowledge, and indicate directions for future research and guideline development, as discussed during the 2014 Cancer Survivorship Summit organised by the European Organisation for Research and Treatment of Cancer (EORTC).Better knowledge is needed of the late effects of modern systemic treatments and of radiotherapy to critical structures of the heart, including the effect of both radiation dose and volume of the heart exposed. Research elucidating the extent to which treatments interact in causing CVD, and the mechanisms involved, as well as the extent to which treatments may increase CVD indirectly by increasing cardiovascular risk factors is also important. Systematic collection of data relating treatment details to late effects is needed, and great care is needed to obtain valid and generalisable results.Better knowledge of these cardiac effects will contribute to both primary and secondary prevention of late complications where exposure to cardiotoxic treatment is unavoidable. Also surrogate markers would help to identify patients at increased risk of cardiotoxicity. Evidence-based screening guidelines for CVD following cancer are also needed. Finally, risk prediction models should be developed to guide primary treatment choice and appropriate follow up after cancer treatment

Direct measurement of the Meissner screening profile in superconductor-superconductor bilayers using low-energy muon spin rotation

Superconducting radio frequency (SRF) cavities, which are critical components in many particle accelerators, need to be operated in the Meissner state to avoid strong dissipation from magnetic vortices. For a defect-free superconductor, the maximum attainable magnetic field for operation is set by the superheating field, $B_{\mathrm{sh}}$, which directly depends on the surface current. In heterostructures composed of different superconductors, the current in each layer depends not only on the properties of the individual material, but also on the electromagnetic response of the adjacent layers through boundary conditions at the interfaces. Three prototypical bilayers [$\mathrm{Nb_{1-x}Ti_xN}$(50 nm)/Nb, $\mathrm{Nb_{1-x}Ti_xN}$(80 nm)/Nb, and $\mathrm{Nb_{1-x}Ti_xN}$(160 nm)/Nb] are investigated here by depth-resolved measurements of their Meissner screening profiles using low-energy muon spin rotation (LE-$\mu$SR). From fits to a model based on London theory (with appropriate boundary and continuity conditions), a magnetic penetration depth for the thin $\mathrm{Nb_{1-x}Ti_xN}$ layers of $\lambda_\mathrm{Nb_{1-x}Ti_xN} =$ 182.5(31) nm is found, in good agreement with literature values for the bulk alloy. In contrast, a simple London model without appropriate boundary conditions overestimates $\lambda_\mathrm{Nb_{1-x}Ti_xN}$ by more than a factor of two, suggesting that it is inappropriate for quantifying $\lambda_\mathrm{Nb_{1-x}Ti_xN}$ here. Using the measured $\lambda_\mathrm{Nb_{1-x}Ti_xN}$, the maximum vortex-free field, $B_{\mathrm{max}}$, of the superconductor-superconductor (SS) bilayer structure was estimated to be 610(40) mT. The strong suppression of the surface current in the $\mathrm{Nb_{1-x}Ti_xN}$ layer suggests an optimal thickness of $\sim 1.4 \lambda_{\mathrm{Nb_{1-x}Ti_xN}} =$ 261(14) nm.Comment: 13 pages and 8 figure