In order to identify the features of violations of free-radical processes in blood serum of 94 untreated cancer patients with different localization of the tumor (cancer of the stomach, colon, breast, ovarian, hemoblastoses) were determined selenium levels and indicators of oxidative stress (sum of metabolites of nitrogen - NOx, the level of superoxide dismutase - Cu/ZnSOD and malondiialdehyde-MDA, and the activity of catalase). In addition, 40 patients with malignant liver disease and clinical signs of liver failure in the early postoperative period was carried out a comparative evaluation of the efficacy of selenium-containing drug 'Selenaze' (sodium selenite pentahydrate). It was found that selenium levels in cancer patients by 25-30% below the norm of 110-120 mg/l at a rate of 73.0±2.6 mg/l. Low levels of NOx was detected in patients with all tumor localizations (22.1±1.1 mM, with normal range 28.4±0.9 mM). The exceptions were patients with extensive malignant process in the liver, in which the NOx levels were significantly higher than normal (p<0.001). The high level of NOx has a toxic effect on the hepatocyte, causing metabolic disorders and inflammatory-necrotic changes in the liver. Elevated levels of SOD and MDA in normal values of catalase activity was detected in all patients. The use of 'Selenaze' in postoperative patients with tumors of the liver increased selenium levels by 10-12%, which was accompanied by a decrease in the content of SOD and NOx, and contributed to earlier recovery of detoxic and synthetic liver function. These findings point to an intensification of oxidative stress and metabolic disorders in the malignant process, which is the basis for metabolic correction.
Anemic syndrome (АС) is a frequent complication of cancer that gives poor results of treatment and reduces quality of live of patients. The literature review is devoted to the role of the peptide hormone hepcidin 25 (HP25), which regulates systemic and local iron homeostasis, in the development of anemia. The main biological function of HP25 is to reduce the level of iron in the bloodstream, which realizes a decrease of the mobilization of iron from the depot and a decrease of absorption of iron in the intestine. Modern approaches to the diagnosis and treatment of anemic disease in oncological practise necessarily include an assessment of the level of HP25. It was shown that HP25 is involved in the pathogenesis of anemia in malignant neoplasms. Oncological diseases are often accompanied by high levels of pro-inflammatory cytokines, in particular interleukin-6 (IL-6), which causes an increase in the production of HP25. Under the influence of IL-6, HP25 blocks ferroportins and iron release by macrophages, which leads to the development of functional iron deficiency and iron deficiency erythropoiesis, thus, with prolonged exposure to pro-inflammatory cytokines, anemia of chronic disease develops. The treatment of АС associated with malignant neoplasms is a complex procedure. Therapeutic effect on HP25 and IL-6 is a promising prospect for the correction of anemia in cancer patients. New strategies in the pathogenetic therapy of patients with anemia are associated with the use of antihepcidin drugs that reduce the level of HP25 in the blood. However, some studies have shown that an increase in the iron content in the bloodstream increases its accessibility to the tumor and promotes its growth; therefore, further, more in-depth study of the problem of correcting АС in cancer patients is necessary
Introduction. In recent years, a separate publications have appeared indicating that interleukin 6 (IL-6) and the protein hepcidin 25 (GP25) play a significant role for the development of functional iron deficiency (FID) in oncological patients with a widespread tumor process. It is important to differentiate between FID and iron deficiency anemia (IDA), since they have the same morphological characteristics, but their treatment is fundamentally different.The aim of this study was to study the main metabolites of ferrokinetics, IL-6 and C-reactive protein (CRP) expression parameters in patients with breast cancer on the background of neoadjuvant chemotherapy to develop individual approaches to the diagnosis and treatment of anemic syndrome (AS), prediction, early detection of anemia and its adequate correction.Materials and methods. The study was conducted in 31 breast cancer patients, during of 6 cycles of chemotherapy. The main metabolites of ferrokinetics were studied: GP25, ferritin, soluble transferrin receptors, transferrin, iron, erythropoietin, IL-6 and CRP indices. The control group consisted of 29 apparently healthy women.Results. AS was detected in 14 (45.1 %) of breast cancer patients. IDA prevailed with microcytic, hypochromic characteristics of erythrocytes, a low concentration of ferritin, iron, GP25, IL-6, CRP, and a high level of transferrin and soluble transferrin receptors. A some patients were diagnosed with FID, mainly with the III and IV stages of the disease. Unlike IDA, they had a high concentration of ferritin, CRP and significant production of GP25, IL-6. Erythropoietin level was not optimal for the majority of patients with AS. A few patients on the background of treatment with recombinant erythropoietins revealed a deficiency of vitamins B12 (cyanocobalamin) and folic acid.Conclusion. Early diagnosis, a personalized approach to the prescription of iron preparations, recombinant erythropoietins, vitamins B12 and folic acid in patients with AS allowed for 6 cycles neoadjuvant chemotherapy without a significant decrease in erythrocytes, hemoglobin and hematocrit in most of them. The data obtained on IL-6, GP25, and CRP indicate relationship between them in the development of FID in breast cancer patients with a widespread tumor process and require further study.
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