Introdução: A cardiotoxicidade aguda e subaguda pode ser caracterizada pelo prolongamento do intervalo QT corrigido (QTc) e demais medidas derivadas do intervalo QTc, como: a dispersão do intervalo QTc (QTdc) e a dispersão transmural da repolarização (DTpTe). No entanto, ainda não foi determinado se pacientes com neoplasia de mama submetidas ao esquema quimioterápico com antraciclina, ciclofosfamida e taxano (ACT) podem apresentar prolongamento do intervalo QTc, da QTdc e da DTpTe. Os objetivos deste estudo foram 1. avaliar o efeito da quimioterapia ACT no intervalo QTc, 2. avaliar o efeito da quimioterapia ACT na QTdc e na DTpTe, 3.avaliar os biomarcadores cardioespecíficos como a troponina e o peptídeo natriurético do tipo B (BNP), e 4. avaliar manifestações clínicas de cardiotoxicidade, como a presença de: arritmias cardíacas, insuficiência cardíaca (ICC), angina e morte cardiovascular em pacientes com neoplasia de mama. Métodos: Trata-se de um estudo de coorte prospectivo em que 23 pacientes com neoplasia de mama não metastática foram acompanhadas durante o tratamento quimioterápico com o esquema ACT. As medidas do intervalo QTc, da QTdc e da DTpTe foram determinadas pelo eletrocardiograma (ECG) de 12 derivações antes do início da quimioterapia (basal), após a primeira fase com antraciclina e ciclofosfamida (AC), e ao final do tratamento com taxano (T). Biomarcadores como troponina e BNP também foram analisados. Resultados: Quando comparado aos valores basais, houve prolongamento do intervalo QTc após a primeira fase da quimioterapia - AC, 439,7 ms ± 33,2 vs 472,5 ms ± 36,3, (p = 0,001) e ao final do tratamento com taxano, 439,7 ms ± 33,2 vs 467,9 ms ± 42,6, (p < 0,001). A dosagem média de troponina sérica, quando comparada aos valores basais, apresentou elevação após o término da primeira fase da quimioterapia - AC, 6,0 pg/mL [min-max. 6,0 - 22,0] vs 23,0 pg/mL [min-max. 6,0 - 85,0], (p < 0,001) e ao final do tratamento com taxano, 6,0 pg/mL [min-max. 6,0 - 22,0] vs 25,0 pg/mL [min-max. 6,0 - 80,0], (p < 0,001). A QTdc, a DTpTe e os níveis séricos de BNP não mostraram diferenças com significância estatística. Durante o seguimento clínico não houve nenhum óbito e nenhuma constatação de angina, ICC e arritmias cardíacas. Conclusão: Em pacientes com neoplasia de mama não metastática submetidas à quimioterapia com esquema ACT, houve prolongamento do intervalo QTc e elevação dos níveis séricos de troponina / Background: Acute and subacute cardiotoxicity are characterized by prolongation of the corrected QT interval (QTc) and other measures derived from the QTc interval, such as the QTc dispersion (QTdc) and the transmural dispersion of repolarization (DTpTe). Although anthracyclines prolong the QTc interval, it is unknown whether breast cancer patients who undergo a chemotherapy regimen with anthracycline (A; doxorubicin), cyclophosphamide (C) and taxane (T; ACT regimen) may present with QTc, QTdc and DTpTe prolongation. Methods: Twenty-three patients with breast cancer were followed up in a prospective study during ACT chemotherapy. QTc, QTdc and DTpTe measurements were determined by a 12-lead electrocardiogram (EKG) prior to chemotherapy (baseline), after the first phase of anthracycline and cyclophosphamide (AC), and after T treatment. Biomarkers such as troponin and B-type natriuretic peptide (BNP) were also measured. Results: When compared to baseline values, the QTc interval showed a statistically significant prolongation after the AC phase (439.7 ± 33.2 msec vs 472.5 ± 36.3 msec, p = 0.001) and after T treatment (439.7 ± 33.2 msec vs 467.9 ± 42.6 msec, p < 0.001). Troponin levels were elevated after the AC phase (23.0 pg/mL [min-max: 6.0 - 85.0] vs 6.0 pg/mL [min-max: 6.0 - 22.0], p < 0.001) and again after T treatment (25.0 pg/mL [min-max: 6.0 - 80.0] vs 6.0 pg/mL [min-max: 6.0 - 22.0], p < 0.001) compared to the baseline values. Conclusion: In patients with non-metastatic breast cancer who underwent ACT chemotherapy, a statistically significant QTc prolongation and an elevation in serum troponin levels were observed

Chemotherapy persists as one of the mainstays of breast cancer treatment, particularly for triple-negative breast cancer which currently has no targeted treatment methods. While chemotherapy is beneficial for killing the malignant tumor cells, it leads to the release of damage-associated molecular patterns into the tumor microenvironment. Damage-associated molecular patterns are a contributing factor to cancer-related inflammation which can potentiate metastatic spread through several mechanisms such as the development of tumor microenvironments at metastastic sites. These damage-associated molecular patterns include nucleic acids, nucleic acid-associated lipids and vesicles, cytokines, and proteins such as high mobility group protein B1. Polyamidoamine (PAMAM) is a biodegradable, water-soluble dendrimer polymer with the ability to possess different charges and sizes depending on its terminal branches and degree of branching (i.e. generation number), respectively. Amine-terminated PAMAM-NH2 is positively charged and can bind to circulating DNA and RNA. Since most DAMP molecules are negatively charged, I hypothesized that a polycation such as PAMAM-NH2 would be an efficient nanomaterial to remove pathogenic NA DAMPs generated by chemotherapy. Building on this dendrimer, we synthesized modified cationic PAMAM-generation 3 derivatives with an aim to balance toxicity with NA-binding affinity and capacity to encapsulate chemodrugs. Our results found that these soluble and nanoparticle PAMAM materials can bind to both cell-free DNA and RNA released as a result of treating triple-negative breast cancer cells with chemotherapy drugs such as doxorubicin and paclitaxel. These PAMAM-G3 materials are termed as nucleic acid binding polymers and nucleic-acid binding polymeric nanoparticles.My thesis dissertation explores the anti-metastatic effects of nucleic-acid binding polymeric nanoparticles delivering the chemotherapy drug paclitaxel using in-vitro and in-vivo models. Two murine metastatic breast cancer models served as the basis for assessing the effects of conventional paclitaxel delivery compared to paclitaxel delivery from within PAMAM nucleic-acid binding polymeric nanoparticles with respect to primary tumor growth, extent of lung metastasis, and the systemic inflammatory response reflected in murine serum. Compared to treatment with unencapsulated paclitaxel, delivery of paclitaxel within the PAMAM nucleic-acid binding polymeric nanoparticles resulted in significantly decreased serum cell-free DNA levels, decreased inflammatory cytokines, and a lower degree of lung metastasis in the mice. The decrease in the degree of lung metastasis in mice receiving paclitaxel within the PAMAM nanoparticles was confirmed by assessing the photon flux signal of 4T1-luciferase breast cancer cells invading the murine lungs in both in-vivo and ex-vivo imaging and by using a machine learning method to quantify the degree of metastasis in H&E- stained sections of the lungs. The ability to mitigate the phenomenon of chemotherapy-induced cancer metastasis while effectively delivering the chemotherapy to the tumor microenvironment could help improve the outcomes of patients being treated with chemotherapy. This work developed a therapeutic cationic PAMAM nanocarrier-based strategy to inhibit paclitaxel-induced metastasis by scavenging cell-free nucleic acids and mitigating cell-free nucleic acid-induced inflammation.

Additionally, we showed that SeC induced S-phase arrest in MCF-7 cells associated with a marked decrease in the protein expression of cyclin A, D1 and D3 and cyclin-dependent kinases (CDK) 4 and 6, with concomitant induction of p21waf1/Cip1, p27Kip1 and p53. Expose of MCF-7 cells to SeC resulted in delayed onset of apoptosis as evidenced by caspase activation, PARP cleavage and DNA fragmentation. SeC treatment also triggered the activation of JNK, p38 MAPK, ERK and Akt phosphorylation. Inhibitors of ERK (U0126) or Akt (LY294002), but not JNK (SP600125) and p38 MAPK (SB203580), significantly suppressed SeC-induced S-phase arrest and apoptosis in MCF-7 cells. In conclusion, our findings establish a mechanistic link between the PI3K/Akt pathway, MAPK pathway and SeC-induced cell cycle arrest and apoptosis in human breast cancer cells. (Abstract shortened by UMI.) / The role of selenium as potential cancer chemopreventive and chemotherapeutic agents has been supported by epidemiological, preclinical and clinical studies. Although cell apoptosis has been evidenced as a critical mechanism mediating the anticancer activity of selenium, the underlying molecular mechanisms remain elusive. In the present study, selenocystine (SeC), a novel organic selenocompound, is identified as a novel antiproliferative agent with a broad spectrum of inhibition against eight human cancer cell lines with the IC50 values ranged from 3.6 to 37.0 muM. Despite this potency, SeC was relatively nontoxic toward HS68 human fibroblasts with an IC 50 value exceeded 400 muM. Further investigation on the molecular mechanisms indicated that SeC induced caspase-independent apoptosis in MCF-7 breast carcinoma cells, which was accompanied by poly(ADP-ribose) polymerase (PARP) cleavage, caspase activation, DNA fragmentation, phosphatidylserine exposure and nuclear condensation. Moreover, SeC induced the loss of mitochondrial membrane potential (DeltaPsim) by regulating the expression and phosphorylation of pro-surivival and pro-apoptotic Bcl-2 family members. Loss of DeltaPsim led to the mitochondrial release of cytochrome c and apoptosis-inducing factor (AIF) which subsequently translocated into the nucleus and induced chromatin condensation and DNA fragmentation. MCF-7 cells exposed to SeC shown increase in total p53 and phosphorylated p53 on serine residues of Ser15, Ser20, and Ser392 prior to mitochondrial dysfunction. Silencing and attenuation of p53 expression with RNA interference and pifithrin-alpha treatment respectively, partially suppressed SeC-induced cell apoptosis. Furthermore, generation of reactive oxygen species (ROS) and subsequent induction of DNA strand breaks were found to be upstream cellular events induced by SeC. The thiol-reducing antioxidants, N-acetylcysteine and glutathione, completely blocked the initiation and execution of cell apoptosis. Taken together, these results suggest that SeC, as a promising anticancer selenocompound, induces caspase-independent apoptosis in MCF-7 cells mediated by ROS generation and p53 phosphorylation through regulating the mitochondrial membrane permeability. / Chen, Tianfeng. / Adviser: Yun-Shing Wong. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3260. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 124-136). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

A breast cancer cell line stably transfected with the CYP19 gene had been employed for aromatase inhibition. Among the phytochemicals tested, the major dietary flavonoids, such as genistein and daidzein, produced very weak inhibition. On the other hand, the red clover isoflavone biochanin A, the hydroxychalcone butein and the red grape phytoalexin resveratrol were found to be effective aromatase inhibitors. Cell proliferation assay had shown that they could inhibit ER-positive cell proliferation induced by testosterone, and the inhibitory effect was specifically attributed to the reduction of estrogen synthesis. In another breast cancer cell line SK-BR-3, resveratrol, biochanin A and genistein inhibited CYP19 both in enzyme and promoter I.3/II transcriptional levels. The element responsible for the inhibition of aromatase by these phytoestrogens should fall within the region between -556 to -446 by upstream of exon II. / Breast cancer is one of the most common cancers affecting women. Estrogen plays an important role in breast cancer initiation and development. The majority of breast tumors are initially dependent upon estrogen to support their growth. Most breast cancers occur in the postmenopausal period. However, the intra-tumoral estradiol (E2) is maintained at a high level equivalent to the pre-menopausal status. High intra-tumoral E2 level in postmenopausal women is sustained by the biosynthesis of estrogens in the tumorous tissue. / Genistein and Biochanin A, ranged from 0.1 to 10 muM, might act as estrogen agonist and induced aromatase activity and promoter I.1 transactivation in ERalpha-transfected SK-BR-3 cells. (Abstract shortened by UMI.) / The aromatase enzyme, CYP19, belongs to a family of P450 enzyme. As a final rate-limiting step in estrogen biosynthesis, it catalyzes the conversion of C 19 steroids to estrogens. The expression of CYP19 is tissue-specific, and is regulated by alternate promoter usage. The use of aromatase inhibitors for breast cancer treatment has become a major therapeutic approach. / The consumption of some phytochemicals protects against breast cancer. Yet the mechanisms are far from clear. In my present study, various phytochemicals, including phytoestrogens, monoterpenes and carotenoids, were evaluated for their effect on aromatase. / Wang Yun. / "July 2005." / Adviser: Lai-Kwok Leung. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3716. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 145-169). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

Indiana University-Purdue University Indianapolis (IUPUI) / The time course and biological mechanisms by which breast cancer (BC) and/or alterations in estrogen status lead to cognitive and brain changes remain unclear. The studies presented here use neuroimaging, cognitive testing, genetics, and biomarkers to investigate how post-chemotherapy interval (PCI), chemotherapy-induced amenorrhea (CIA), and genetic variation in the estrogen pathway affect the brain. Chapter 1 examines the association of post-chemotherapy interval (PCI) with gray matter density (GMD) and working memory-related brain activation in BC survivors (mean PCI 6.4, range 3-10 years). PCI was positively associated with GMD and activation in the right frontal lobe, and GMD in this region was correlated with global neuropsychological function. In regions where BC survivors showed decreased GMD compared to controls, this was inversely related to oxidative DNA damage and learning and memory scores. This is the first study to show neural effects of PCI and relate DNA damage to brain alterations in BC survivors. Chapter 2 demonstrates prospectively, in an independent cohort, decreased combined magnitudes of brain activation and deactivation from pre-to post-chemotherapy in patients undergoing CIA compared to both postmenopausal BC patients undergoing chemotherapy and healthy controls. CIA’s change in activity magnitude was strongly correlated with change in processing speed, suggesting this activity increase reflects effective cognitive compensation. These results demonstrate that the pattern of change in brain activity from pre- to post-chemotherapy varies according to pre-treatment menopausal status. Chapter 3 presents the effects of variation in ESR1, the gene that codes for estrogen receptor-α, on brain structure in healthy older adults. ESR1 variation was associated with hippocampus and amygdala volumes, particularly in females. Single nucleotide polymorphism (SNP) rs9340799 influenced cortical GMD and thickness differentially by gender. Apolipoprotein E (APOE)-ε4 carrier status modulated the effect of SNP rs2234693 on amygdala volumes in women. This study showed that genetic variation in estrogen relates to brain morphology in ways that differ by sex, brain region and APOE-ε4 carrier status. The three studies presented here explore the interplay of BC, estrogen, and cognition, showing that PCI, CIA, and ESR1 genotype influence brain phenotypes. Cognitive correlates of neuroimaging findings indicate potential clinical significance of these results.

Indiana University-Purdue University Indianapolis (IUPUI) / Aromatase inhibitors (AIs) are the current standard of care for the treatment of hormone receptor positive breast cancer in postmenopausal women. Nearly one-half of patients receiving AI therapy develop musculoskeletal toxicity that is characterized by joint and/or muscle pain and approximately one-fourth of patients discontinue their therapy as a result of musculoskeletal pain. Since there are no effective strategies for prevention or treatment, insight into the mechanisms of AI-induced pain is critical to improve treatment. However, there are few studies of AI effects in animal models of nociception. To determine whether AIs produce hypersensitivity in animal models of pain, I examined the effects of AI administration on mechanical, thermal, and chemical sensitivity in rats. The results demonstrate that (1) repeated injection of 5 mg/kg letrozole in male rats produces mechanical, but not thermal, hypersensitivity that extinguishes when drug dosing is stopped; (2) administering a single dose of 1 or 5 mg/kg letrozole in ovariectomized (OVX) rats also induces mechanical hypersensitivity, without altering thermal sensitivity and (3) a single dose of 5 mg/kg letrozole or daily dosing of letrozole or exemestane in male rats augments flinching behavior induced by intraplantar ATP injection. To determine whether the effects of AIs on nociceptive behaviors are mediated by activation or sensitization of peptidergic sensory neurons, I determined whether letrozole exposure alters release of calcitonin gene-related peptide (CGRP) from isolated rat sensory neurons and from sensory nerve endings in rat spinal cord slices. No changes in basal, capsaicin-evoked or high extracellular potassium-evoked CGRP release were observed in sensory neuronal cultures acutely or chronically exposed to letrozole. Furthermore, letrozole exposure did not alter the ability of ATP to augment CGRP release from sensory neurons in culture. Finally, chronic letrozole treatment did not augment neuropeptide release from spinal cord slices. Taken together, these results do not support altered release of this neuropeptide into the spinal cord as mediator of letrozole-induced mechanical hypersensitivity and suggest the involvement of other mechanisms. Results from this dissertation provide a new experimental model for AI-induced hypersensitivity that could be beneficial in delineating mechanisms mediating pain during AI therapy.