Effect of low-protein diet on anthracycline pharmacokinetics and cardiotoxicity

El‐Demerdash, Ebtehal; Ali, Azza A.; El-Taher, Dalia E M; Hamada, Farid M.A.

doi:10.1111/j.2042-7158.2011.01413.x

Cited by 15 publications

(8 citation statements)

References 29 publications

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“…Protein malnutrition is prevalent in cancer patients and occurs as a consequence of an imbalance between nutritional needs of the patient, demands of the tumor and availability of nutrients in the body [ 26 ]. Main immunological anti-cancer defenses in the organism include lymphocytes CD8+ and NK cells.…”

Section: Discussionmentioning

confidence: 99%

Experimental immunology The influence of vitamin B 12 supplementation on the level of white blood cells and lymphocytes phenotype in rats fed a low-protein diet

Lewicki¹,

Lewicka²,

Kalicki³

et al. 2014

cejoi

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Protein malnutrition has a negative effect on body composition and some blood parameters, especially in the young growing organism. One of nutritional factors which could protect against negative consequences of protein deficiency may be B group vitamins. The aim of the study was to investigate the effect of vitamin B12 supplementation on the immune system in rats fed a standard and a low-protein diet. Rats were fed a control (20% of energy from protein) or a protein-deficient diet (4.5% of energy from protein). Half of animals in each group were additionally supplemented with vitamin B12 (300% of the daily intake). The white blood cells analysis and lymphocytes immunophenotyping (number and percentage) were performed. Low-protein diets caused disturbances in WBC and lymphocyte subpopulations in both short- (30-day) as well as long-term periods (90-day). Vitamin B12 supplementation significantly reduced the negative impact of protein malnutrition after 30 days, however had no effect on long-term malnutrition. Furthermore, vitamin B12 addition in rats fed a control diet did not affect the studied parameters. This observation opens the promise of use of vitamin B12 supplementation to improve immune system parameters in protein malnourished organisms.

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Section: Discussionmentioning

confidence: 99%

Experimental immunology The influence of vitamin B 12 supplementation on the level of white blood cells and lymphocytes phenotype in rats fed a low-protein diet

Lewicki¹,

Lewicka²,

Kalicki³

et al. 2014

cejoi

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“…39 In another study using a rat and rabbit model, protein malnutrition, lower body weight, and hypoalbuminemia alter pharmacokinetics of doxorubicin with a significant decrease in drug elimination. 39,40 It is unclear whether similar findings are seen in patients who are cachectic or sarcopenic but the findings in animal models could provide an explanation for the increased toxicities observed in older adults. Figure 1.…”

Section: Other Risk Factors For Arlvdmentioning

confidence: 99%

Anthracycline-related cardiotoxicity in older patients with acute myeloid leukemia: a Young SIOG review paper

et al. 2020

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The incidence of acute myeloid leukemia (AML) increases with age. Intensive induction chemotherapy containing cytarabine and an anthracycline has been part of the upfront and salvage treatment of AML for decades. Anthracyclines are associated with a significant risk of cardiotoxicity (especially anthracycline-related left ventricular dysfunction [ARLVD]). In the older adult population, the higher prevalence of cardiac comorbidities and risk factors may further increase the risk of ARLVD. In this article of the Young International Society of Geriatric Oncology group, we review the prevalence of ARLVD in patients with AML and factors predisposing to ARLVD, focusing on older adults when possible. In addition, we review the assessment of cardiac function and management of ARLVD during and after treatment. It is worth noting that only a minority of clinical trials focus on alternative treatment strategies in patients with mildly declined left ventricular ejection fraction or at a high risk for ARLVD. The limited evidence for preventive strategies to ameliorate ARLVD and alternative strategies to anthracycline use in the setting of cardiac comorbidities are discussed. Based on extrapolation of findings from younger adults and nonrandomized trials, we recommend a comprehensive baseline evaluation of cardiac function by imaging, cardiac risk factors, and symptoms to risk stratify for ARLVD. Anthracyclines remain an appropriate choice for induction although careful risk-stratification based on cardiac disease, risk factors, and predicted chemotherapy-response are warranted. In case of declined left ventricular ejection fraction, alternative strategies should be considered.

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“…Therefore, GH therapy may prevent AIC [ 29 ]. Protein malnutrition is also a risk factor for development of ANT cardiotoxicity, being frequently found in cancer patients [ 30 ]. Furthermore, cigarette smoking was found to have a negative effect on longitudinal strain in asymptomatic breast cancer survivors [ 31 ].…”

Section: Risk Factorsmentioning

confidence: 99%

Cardiotoxicity of anthracycline therapy: current perspectives

Valcovici¹,

Andrica²,

Şerban³

et al. 2016

aoms

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Anthracyclines, especially doxorubicin and daunorubicin, are the drugs of first choice in the treatment of patients with hematologic malignancies, soft-tissue sarcomas, and solid tumors. Unfortunately, the use of anthracyclines is limited by their dose-dependent and cumulative cardiotoxicity. The molecular mechanism responsible for anthracycline-induced cardiotoxicity remains poorly understood, although experimental and clinical studies have shown that oxidative stress plays the main role. Hence, antioxidant agents, especially dexrazoxane, and also other drug classes (statins, β-blockers) proved to have a beneficial effect in protecting against anthracycline-induced cardiotoxicity. According to previous clinical trials, the major high-risk factors for anthracycline-induced cardiotoxicity are age, body weight, female gender, radiotherapy, and other diseases such as Down syndrome, familial dilated cardiomyopathy, diabetes and hypertension. Consequently, further studies are needed to elucidate the molecular pathogenesis of anthracycline-induced cardiotoxicity and also to discover new cardioprotective agents against anthracycline-induced cardiotoxicity.

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Effect of low-protein diet on anthracycline pharmacokinetics and cardiotoxicity

Abstract: If similar alteration in anthracyclines' pharmacokinetics occurs in malnourished cancer patients, protein malnutrition will be a risk factor for development of anthracycline cardiotoxicity and dose adjustment will be required in nutritionally deprived patients.

Cited by 15 publications

References 29 publications

Experimental immunology The influence of vitamin B 12 supplementation on the level of white blood cells and lymphocytes phenotype in rats fed a low-protein diet

Experimental immunology The influence of vitamin B 12 supplementation on the level of white blood cells and lymphocytes phenotype in rats fed a low-protein diet

Anthracycline-related cardiotoxicity in older patients with acute myeloid leukemia: a Young SIOG review paper

Cardiotoxicity of anthracycline therapy: current perspectives

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