RESUMEN
OBJECTIVE: VEGF-D is a potential biomarker for lymphangioleiomyomatosis (LAM); however, its diagnostic performance has yet to be systematically studied. METHODS: We searched PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library to identify primary studies on VEGF-D in relation to the diagnosis of LAM. The quality of the studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Summary estimates of diagnostic accuracy were pooled using a bivariate random effects model. Subgroup and sensitivity analyses were performed to explore possible heterogeneity. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was applied to rate the quality of evidence and indicate the strength of recommendations. RESULTS: Ten studies involving 945 patients were of high risk in quality, as assessed using the QUADAS-2. The pooled diagnostic parameters were indicated as follows: sensitivity = 0.82 (95% CI, 0.71-0.90); specificity = 0.98 (95% CI, 0.94-0.99); and diagnostic OR = 197 (95% CI, 66-587). The AUC of summary ROC analysis was 0.98. The subgroup and sensitivity analyses revealed that the overall performance was not substantially affected by the composition of the control group, prespecified cutoff value, the country of origin, or different cutoff values (p > 0.05 for all). A strong recommendation for serum VEGF-D determination to aid in the diagnosis of LAM was made according to the GRADE. CONCLUSIONS: VEGF-D seems to have great potential implications for the diagnosis of LAM in clinical practice due to its excellent specificity and suboptimal sensitivity.
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Linfangioleiomiomatosis , Biomarcadores , Humanos , Linfangioleiomiomatosis/diagnóstico , Curva ROC , Sensibilidad y Especificidad , Factor D de Crecimiento Endotelial VascularRESUMEN
ABSTRACT Objective: VEGF-D is a potential biomarker for lymphangioleiomyomatosis (LAM); however, its diagnostic performance has yet to be systematically studied. Methods: We searched PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library to identify primary studies on VEGF-D in relation to the diagnosis of LAM. The quality of the studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Summary estimates of diagnostic accuracy were pooled using a bivariate random effects model. Subgroup and sensitivity analyses were performed to explore possible heterogeneity. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was applied to rate the quality of evidence and indicate the strength of recommendations. Results: Ten studies involving 945 patients were of high risk in quality, as assessed using the QUADAS-2. The pooled diagnostic parameters were indicated as follows: sensitivity = 0.82 (95% CI, 0.71-0.90); specificity = 0.98 (95% CI, 0.94-0.99); and diagnostic OR = 197 (95% CI, 66-587). The AUC of summary ROC analysis was 0.98. The subgroup and sensitivity analyses revealed that the overall performance was not substantially affected by the composition of the control group, prespecified cutoff value, the country of origin, or different cutoff values (p > 0.05 for all). A strong recommendation for serum VEGF-D determination to aid in the diagnosis of LAM was made according to the GRADE. Conclusions: VEGF-D seems to have great potential implications for the diagnosis of LAM in clinical practice due to its excellent specificity and suboptimal sensitivity.
RESUMO Objetivo: O VEGF-D é um potencial biomarcador para linfangioleiomiomatose (LAM); entretanto, seu desempenho diagnóstico ainda não foi sistematicamente estudado. Métodos: Foram realizadas buscas nos bancos de dados PubMed, EMBASE, Scopus, Web of Science e Cochrane Library para identificar estudos primários sobre o VEGF-D com relação ao diagnóstico de LAM. A qualidade dos estudos foi avaliada por meio da ferramenta Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). As estimativas sumárias de acurácia diagnóstica foram combinadas utilizando um modelo bivariado de efeitos aleatórios. Análises de subgrupo e de sensibilidade foram realizadas para explorar possíveis heterogeneidades. O sistema Grading of Recommendations Assessment, Development, and Evaluation (GRADE) foi aplicado para avaliar a qualidade das evidências e indicar a força das recomendações. Resultados: Dez estudos envolvendo 945 pacientes eram de alto risco em qualidade, segundo a ferramenta QUADAS-2. Os parâmetros diagnósticos combinados foram indicados da seguinte forma: sensibilidade = 0,82 (IC95%: 0,71-0,90); especificidade = 0,98 (IC95%: 0,94-0,99); e OR diagnóstica = 197 (IC95%: 66-587). A ASC da análise summary ROC foi de 0,98. As análises de subgrupo e de sensibilidade revelaram que o desempenho global não foi substancialmente afetado pela composição do grupo controle, valor de corte pré-especificado, país de origem ou diferentes valores de corte (p > 0,05 para todos). Uma forte recomendação para a dosagem de VEGF-D sérico para auxiliar no diagnóstico de LAM foi feita de acordo com o sistema GRADE. Conclusões: O VEGF-D parece ter grandes implicações potenciais para o diagnóstico de LAM na prática clínica em virtude da excelente especificidade e sensibilidade subótima.
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Humanos , Linfangioleiomiomatosis/diagnóstico , Biomarcadores , Curva ROC , Sensibilidad y Especificidad , Factor D de Crecimiento Endotelial VascularRESUMEN
BACKGROUND There is growing concern about the clinical course of certain diseases in patients who are simultaneously infected by SARS-CoV-2. This report is of a 34-year-old woman from Brazil with a recent diagnosis of pulmonary lymphangioleiomyomatosis (LAM) diagnosed by raised serum VEGF-D levels and the finding of lung cysts on computed tomography (CT) imaging, who presented with COVID-19 pneumonia. CASE REPORT Five months after the diagnosis of pulmonary LAM, which was based on the presence of diffuse and bilateral cystic lesions on CT scan associated with high serum VEGF-D levels, the patient presented with worsening dyspnea, drop in peripheral oxygen oxygenation, fever, and diffuse myalgia. She was using Sirolimus because it inhibits the development of LAM cells. A worsening of lung abnormalities was demonstrated in a chest CT examination, with the appearance of areas of consolidation and ground-glass abnormalities. A nasal swab sample tested positive for SARS-CoV-2 infection using reverse-transcription polymerase chain reaction. Thus, Sirolimus was suspended because of concern about its immunosuppressive action. She received hospital support following the institutional protocol in force at the time, without the need for invasive mechanical ventilation. After 2 weeks, she was discharged from the hospital, with supplemental oxygen at home and return of Sirolimus. CONCLUSIONS This report has described the presentation of COVID-19 pneumonia due to SARS-CoV-2 infection in a 34-year-old woman with a recent diagnosis of LAM involving the lungs.
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COVID-19 , Quistes , Enfermedades Pulmonares Intersticiales , Linfangioleiomiomatosis , Adulto , Brasil , Femenino , Humanos , Pulmón/diagnóstico por imagen , Linfangioleiomiomatosis/diagnóstico por imagen , SARS-CoV-2 , Tomografía Computarizada por Rayos X , Factor D de Crecimiento Endotelial VascularRESUMEN
OBJECTIVE: The aim of this study was to assess vascular endothelial growth factor C (VEGF-C) and VEGF-D expressions, tumor lymphatic density (D2-40) and endothelial lymphatic proliferation (D2-40/Ki-67 double labeling) in a series of salivary gland neoplasm cases. MATERIALS AND METHODS: Twenty pleomorphic adenomas (PA), 20 adenoid cystic carcinomas (ACC) and 20 mucoepidermoid carcinomas (MEC) were assessed, as well as 10 normal minor salivary gland (SG) tissues for comparison. RESULTS: All cases presented positive VEGF-C expression in the peritumoral and intratumoral regions, and no differences in immunoexpression were detected between groups. However, the ACC group presented a significant difference in VEGF-C immunoexpression according to the predominant histological pattern. Most cases presented poor VEGF-D labeling in the peritumoral and intratumoral regions. Concerning peritumoral, intratumoral and total lymphatic endothelial density, the assessed groups revealed an increasing gradient, with lower values for PA, followed by MEC and ACC. CONCLUSION: No correlation was detected between VEGF-C and VEGF-D immunoexpression in relation to lymphatic tumor density and endothelial lymphatic proliferation. Western blotting (WB) revealed no difference between VEGF-C and VEGF-D expression among the lesions, corroborating the immunohistochemistry findings.
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Células Endoteliales/metabolismo , Células Endoteliales/patología , Vasos Linfáticos/patología , Neoplasias de las Glándulas Salivales/patología , Factor C de Crecimiento Endotelial Vascular/metabolismo , Factor D de Crecimiento Endotelial Vascular/metabolismo , Proliferación Celular , HumanosRESUMEN
Red and processed meat consumption has been strongly related to increase the risk of colorectal cancer (CRC), although its impact is largely unknown. Hemin, an iron-containing porphyrin, is acknowledged as a putative factor of red and processed meat pro-carcinogenic effects. The aim of this study was to investigate the effects of high dietary hemin on the promotion/progression stages of 1,2-dimethylhydrazine (1,2-DMH)-induced colon carcinogenesis. Twenty-four Wistar male rats were given four subcutaneous 1,2-DMH injections and received either balanced diet or balanced diet supplemented with hemin 0.5â¯mmol/kg for 23 weeks. Colon specimens were analyzed for aberrant crypt foci (ACF) and tumor development. Dietary hemin significantly increased ACF number and fecal water cytotoxicity/genotoxicity in Caco-2 cells when compared to 1,2-DMH control group. However, tumor incidence, multiplicity and cell proliferation did not differ between 1,2-DMHâ¯+â¯hemin and 1,2-DMH control group. Gene expression analysis of 91 target-genes revealed that only three genes (Figf, Pik3r5 and Tgfbr2) were down-regulated in the tumors from hemin-fed rats compared to those from 1,2-DMH control group. Therefore, the findings of this study show that high hemin intake promotes mainly DNA damage and ACF development and but does not change the number nor incidence of colon tumors induced by 1,2-DMH in male rats.
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Focos de Criptas Aberrantes/inducido químicamente , Neoplasias del Colon/inducido químicamente , Daño del ADN , Hemina/toxicidad , Lesiones Precancerosas/inducido químicamente , 1,2-Dimetilhidrazina , Alimentación Animal , Animales , Células CACO-2 , Cocarcinogénesis , Ensayo Cometa , Regulación hacia Abajo/efectos de los fármacos , Heces , Humanos , Masculino , Fosfatidilinositol 3-Quinasa/genética , Ratas , Ratas Wistar , Receptor Tipo II de Factor de Crecimiento Transformador beta/biosíntesis , Receptor Tipo II de Factor de Crecimiento Transformador beta/genética , Carne Roja , Factores de Tiempo , Factor D de Crecimiento Endotelial Vascular/biosíntesis , Factor D de Crecimiento Endotelial Vascular/genéticaRESUMEN
INTRODUCTION: Serum vascular endothelial growth factor-D (VEGF-D) is a lymphangiogenic growth factor that is considered a valuable tool in the diagnosis of lymphangioleiomyomatosis (LAM). Previous studies have reported a wide variability in VEGF-D serum levels in LAM patients and it seems to be associated with pulmonary impairment and lymphatic involvement. METHODS: We conducted a cross-sectional study from 2009 to 2017 that evaluated VEGF-D serum levels in a cohort of LAM patients who were never treated with mTOR inhibitors and compared them to healthy age-matched volunteers. Clinical and functional parameters were assessed and correlated with their respective serum VEGF-D levels. RESULTS: One hundred and four patients were included in the analysis. Serum VEGF-D levels were higher in LAM patients compared to healthy controls: 796 (404-1588) versus 162 (117-232) pg/mL, respectively (p < 0.001). Patients with tuberous sclerosis complex-LAM, TSC-LAM (20%), had higher levels of VEGF-D when compared to patients with sporadic LAM (80%) [1005 (641-2732) vs. 772 (370-1383), p = 0.05]. Serum VEGF-D levels were weakly correlated with DLCO (r = - 0.26, p = 0.001) and lymphatic involvement was more frequent in those with serum VEGF-D levels equal or above 800 pg/mL (35% vs. 13%, p = 0.02). CONCLUSIONS: In LAM, serum VEGF-D is weakly associated with lung function impairment and strongly associated with lymphatic involvement. VEGF-D is validated for use in Brazilian patients with LAM whose characteristics must be accounted for when evaluating their serum VEGF-D levels.
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Linfangioleiomiomatosis/sangre , Factor D de Crecimiento Endotelial Vascular/sangre , Adulto , Biomarcadores/sangre , Brasil , Estudios de Casos y Controles , Estudios Transversales , Progresión de la Enfermedad , Tolerancia al Ejercicio , Femenino , Volumen Espiratorio Forzado , Humanos , Pulmón/fisiopatología , Linfangioleiomiomatosis/diagnóstico , Linfangioleiomiomatosis/fisiopatología , Sistema Linfático/fisiopatología , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Capacidad de Difusión Pulmonar , Regulación hacia ArribaRESUMEN
SummaryThe mammalian oviduct plays a pivotal role in the success of early reproductive events. The urokinase plasminogen activator system (uPAS) is present in the bovine oviduct and is involved in extracellular matrix remodelling through plasmin generation. This system can be regulated by several members of the vascular endothelial growth factors (VEGF) and their receptors. In this study, the VEGF-D effect on the regulation of uPAS was evaluated. First, RT-polymerase chain reaction (PCR) analyses were used to evidence the expression of VEGF-D and its receptors in oviductal epithelial cells (BOEC). VEGF-D, VEGFR2 and VEGFR3 transcripts were found in ex vivo and in vitro BOEC, while only VEGFR2 mRNA was present after in vitro conditions. VEGF-D showed a regulatory effect on uPAS gene expression in a dose-dependent manner, inducing an increase in the expression of both uPA and its receptor (uPAR) at 24 h post-induction and decreases in the expression of its inhibitor (PAI-1). In addition, the regulation of cell migration induced by VEGF-D and uPA in BOEC monolayer cultures was analyzed. The wound areas of monolayer cultures incubated with VEGF-D 10 ng/ml or uPA 10 nM were modified and significant differences were found at 24 h for both stimulations. These results indicated that uPAS and VEGF-D systems can modify the arrangement of the bovine oviductal epithelium and contribute to the correct maintenance of the oviductal microenvironment.
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Trompas Uterinas/fisiología , Activador de Plasminógeno de Tipo Uroquinasa/metabolismo , Factor D de Crecimiento Endotelial Vascular/metabolismo , Animales , Bovinos , Células Cultivadas , Células Epiteliales/fisiología , Trompas Uterinas/citología , Trompas Uterinas/efectos de los fármacos , Femenino , Regulación de la Expresión Génica , Inhibidor 1 de Activador Plasminogénico/genética , Receptores del Activador de Plasminógeno Tipo Uroquinasa/genética , Activador de Plasminógeno de Tipo Uroquinasa/genética , Factor D de Crecimiento Endotelial Vascular/genética , Factor D de Crecimiento Endotelial Vascular/farmacología , Receptor 2 de Factores de Crecimiento Endotelial Vascular/genética , Receptor 2 de Factores de Crecimiento Endotelial Vascular/metabolismo , Receptor 3 de Factores de Crecimiento Endotelial Vascular/genética , Receptor 3 de Factores de Crecimiento Endotelial Vascular/metabolismoRESUMEN
Fatty acid synthase (FASN) is responsible for the endogenous production of fatty acids from acetyl-CoA and malonyl-CoA. Its overexpression is associated with poor prognosis in human cancers including melanomas. Our group has previously shown that the inhibition of FASN with orlistat reduces spontaneous lymphatic metastasis in experimental B16-F10 melanomas, which is a consequence, at least in part, of the reduction of proliferation and induction of apoptosis. Here, we sought to investigate the effects of pharmacological FASN inhibition on lymphatic vessels by using cell culture and mouse models. The effects of FASN inhibitors cerulenin and orlistat on the proliferation, apoptosis, and migration of human lymphatic endothelial cells (HDLEC) were evaluated with in vitro models. The lymphatic outgrowth was evaluated by using a murine ex vivo assay. B16-F10 melanomas and surgical wounds were produced in the ears of C57Bl/6 and Balb-C mice, respectively, and their peripheral lymphatic vessels evaluated by fluorescent microlymphangiography. The secretion of vascular endothelial growth factor C and D (VEGF-C and -D) by melanoma cells was evaluated by ELISA and conditioned media used to study in vitro lymphangiogenesis. Here, we show that cerulenin and orlistat decrease the viability, proliferation, and migration of HDLEC cells. The volume of lymph node metastases from B16-F10 experimental melanomas was reduced by 39% in orlistat-treated animals as well as the expression of VEGF-C in these tissues. In addition, lymphatic vessels from orlistat-treated mice drained more efficiently the injected FITC-dextran. Orlistat and cerulenin reduced VEGF-C secretion and, increase production of VEGF-D by B16-F10 and SK-Mel-25 melanoma cells. Finally, reduced lymphatic cell extensions, were observed following the treatment with conditioned medium from cerulenin- and orlistat-treated B16-F10 cells. Altogether, our results show that FASN inhibitors have anti-metastatic effects by acting on lymphatic endothelium and melanoma cells regardless the increase of lymphatic permeability promoted by orlistat.
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Cerulenina/farmacología , Ácido Graso Sintasas/antagonistas & inhibidores , Lactonas/farmacología , Vasos Linfáticos/efectos de los fármacos , Melanoma Experimental/prevención & control , Animales , Apoptosis/efectos de los fármacos , Western Blotting , Línea Celular , Línea Celular Tumoral , Movimiento Celular/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Ácido Graso Sintasas/genética , Ácido Graso Sintasas/metabolismo , Inhibidores de la Síntesis de Ácidos Grasos/farmacología , Humanos , Linfangiogénesis/efectos de los fármacos , Metástasis Linfática , Vasos Linfáticos/metabolismo , Melanoma/genética , Melanoma/metabolismo , Melanoma/patología , Melanoma Experimental/genética , Melanoma Experimental/metabolismo , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Orlistat , Interferencia de ARN , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factor C de Crecimiento Endotelial Vascular/metabolismo , Factor D de Crecimiento Endotelial Vascular/metabolismoRESUMEN
OBJECTIVE: The present study was carried out to analyze the interstitial fluid pressure (IFP) values in patients with oral squamous cell carcinoma and identify the relationship between the IFP and tumor prognosis. METHODS: We investigated tumor lymphatic metastasis-related protein (VEGFC, VEGFD and VEGFR3) expressions change on SCC-4 and SCC-9 cells subjected to increased extracellular pressure in vitro and analyzed the relationship between these proteins and IFP, and prognosis of patients with oral squamous cell carcinoma. RESULTS: The results showed that the elevated extracellular pressure significantly resulted in a dramatic increase of VEGFC, VEGFD and VEGFR3 protein expressions in OSCC. More important, the activation of VEGFC, VEGFD and VEGFR3 proteins through IFP elevation contributed to poor prognosis for patients with OSCC. CONCLUSIONS: These results suggest an important potential clinical application of measuring IFP, which can be used as a generic marker of prognosis evaluation and response to therapy. Furthermore, VEGFC, VEGFD and VEGFR3 may be useful targets in developing novel and specific therapeutic tool for OSCC patients with high IFP.
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Carcinoma de Células Escamosas/secundario , Líquido Extracelular/metabolismo , Neoplasias de la Boca/patología , Presión , Factor C de Crecimiento Endotelial Vascular/metabolismo , Factor D de Crecimiento Endotelial Vascular/metabolismo , Receptor 3 de Factores de Crecimiento Endotelial Vascular/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/metabolismo , Western Blotting , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/mortalidad , Líquido Extracelular/química , Femenino , Estudios de Seguimiento , Neoplasias Gingivales/metabolismo , Neoplasias Gingivales/mortalidad , Neoplasias Gingivales/patología , Humanos , Técnicas para Inmunoenzimas , Metástasis Linfática , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/metabolismo , Neoplasias de la Boca/mortalidad , Clasificación del Tumor , Estadificación de Neoplasias , Pronóstico , Tasa de Supervivencia , Neoplasias de la Lengua/metabolismo , Neoplasias de la Lengua/mortalidad , Neoplasias de la Lengua/patologíaRESUMEN
PURPOSE: Neuroblastoma is a common pediatric neoplasm with variable histopathological features that carry an inherent risk of developing distant metastases, in particular bone marrow metastasis. Nestin, X-linked inhibitor of apoptosis (XIAP) and vascular growth factors (VEGF) are biomarkers that are implicated in the tumorigenesis of various cancers. We studied the expression of these biomarkers in neuroblastoma, in relation to bone marrow (BM) metastasis and other histologic parameters. METHODS: Patients with neuroblastoma included seven with BM metastasis and 12 with non-metastatic tumors. Slides from the primary tumors were immunostained with antibodies against nestin, XIAP, VEGF-A, VEGF-B, VEGF-D, VEGF-R1, and VEGF-R2. Immunostaining results were evaluated by two pathologists, graded and statistically correlated with the risk of developing BM metastasis. RESULTS: Nestin was expressed in 16/19 cases with no significant difference between patients with BM metastasis and those without BM metastasis. XIAP was identified in 18/19 tumor cases; the staining density was significantly lower in patients with bone marrow metastasis and those with unfavorable histology. VEGF-R1, VEGF-R2, and VEGF-B were expressed while VEGF-A and VEGF-D were not. Significantly, higher expression of VEGF-B was noted in patients with BM metastasis. CONCLUSION: Expression of VEGF-B and XIAP in neuroblastoma may play a role in the development of bone marrow metastasis. Given the limited number of patients in this study, a larger cohort is needed to validate these findings.
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Biomarcadores de Tumor/metabolismo , Neoplasias de la Médula Ósea/metabolismo , Neuroblastoma/metabolismo , Adolescente , Neoplasias de la Médula Ósea/secundario , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Técnicas para Inmunoenzimas , Lactante , Recién Nacido , Masculino , Nestina/metabolismo , Neuroblastoma/patología , Pronóstico , Factor A de Crecimiento Endotelial Vascular/metabolismo , Factor B de Crecimiento Endotelial Vascular/metabolismo , Factor D de Crecimiento Endotelial Vascular/metabolismo , Receptor 1 de Factores de Crecimiento Endotelial Vascular/metabolismo , Receptor 2 de Factores de Crecimiento Endotelial Vascular/metabolismo , Proteína Inhibidora de la Apoptosis Ligada a X/metabolismoRESUMEN
A Linfangioleiomiomatose (LAM) é uma rara afecção, caracterizada pela substituição do parênquima pulmonar por cistos, resultando em prejuízo na troca gasosa e progressiva piora funcional. A patogênese da formação dos cistos permanece incerta, mas tem sido associada à hiperreatividade de metaloproteinases (MMP), principalmente MMP-2 e -9. Neste estudo foram avaliados os efeitos da doxiciclina, um potente inibidor de MMP, sobre a eficácia no bloqueio dos níveis sérico e urinário das MMP-2 e -9 após 12 meses de tratamento, bem como sobre os parâmetros funcionais das pacientes com LAM. Foi delineado um ensaio clínico prospectivo, não randomizado e não controlado, no qual as pacientes com LAM receberam doxiciclina (100 mg/dia) por 12 meses, realizando avaliações nos meses basal, 6 e 12 mês, através de prova de função pulmonar completa, teste de caminhada de seis minutos (TC6M), questionário de qualidade de vida (SF-36) e coleta de amostras de urina e sangue para dosagem das MMP-2 e -9. No total, 31 pacientes, com idade média (DP) de 43 (8) anos e diagnóstico estabelecido de LAM, receberam doxiciclina durante 12 meses. Após análise, observou-se bloqueio efetivo sobre a MMP-9 urinária, sendo a mediana (IQ) pré-doxiciclina de 10.487 pg/mL (4.565-20.963) e de 4.061 pg/mL (712-9.985) após 12 meses de doxiciclina (p<0,001). A MMP-2 sérica foi igualmente bloqueada, sendo a mediana (IQ) basal de 0 pg/mL (0-833) e de 0 pg/mL (0-179) após 12 meses (p=0,005). Não houve mudança significativa na MMP-9 sérica e os níveis urinários de MMP-2 não foram detectados nas pacientes. Na análise funcional, apesar de ter havido declínio de 70 mL na média do VEF1 das 31 pacientes, após 12 meses de tratamento, observou-se dois grupos distintos funcionalmente e em relação à qualidade de vida. Estes grupos foram obtidos de acordo com a variação do VEF1, sendo o primeiro grupo compreendido por 13 pacientes, em que o VEF1 permaneceu estável ou aumentou (G1), e o segundo com 18...
Lymphangioleiomyomatosis (LAM) is a rare disease, characterized by substitution of lung parenchyma by cysts, resulting in impairment in the gas exchange and progressive functional worsening. The pathogenesis of development of cysts remains uncertain, but has been associated to overexpression of metalloproteinases (MMP), especially MMP-2 and -9. In this study, there have been analyzed the MMP-2 and MMP-9 blockage in the urine and blood of LAM patients, after doxycycline administration during 12 months, as well as on functional and quality of life parameters of LAM patients. A prospective clinical trial, non randomized and uncontrolled, has been designed, in which LAM patients have received doxycycline (100mg/day) for 12 months, and underwent pulmonary function tests, six-minute walk test (6MWT), quality of life assessment and blood and urine samples for MMP-2 e -9 dosage, undergoing evaluation in months basal, 6th and 12th. Overall, 31 patients mean age (SD) 43 (8) with established diagnosis of LAM have received doxycycline for 12 months. After analysis, it was observed an effective blockage over urinary MMP-9 levels, with a pre-doxycycline median (IQ) of 10,487 pg/mL (4,565-20,963), and 4,061 pg/mL (712-9,985) after 12-month doxycycline administration (p<0.001). The serum MMP-2 has been as well blocked with a basal median (IQ) of 0 pg/mL (0-833), and 0 pg/mL (0-179) after 12 months (p=0.005). There was no significant difference in serum MMP-9 levels, and urinary MMP-2 levels were untraceable. During functional parameters analysis, although there was a mean decline of 70 mL in FEV1 in the 31 patients after doxycycline treatment, we noticed two different groups concerning to the assessment of function tests and quality of life. These groups were obtained according to FEV1 variation; the first group comprised 13 patients in which the FEV1 increased or remained stable (G1), and the second group comprised 18 LAM patients in which FEV1 decreased (G2)...
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Humanos , Masculino , Femenino , Doxiciclina , Linfangioleiomiomatosis , Metaloproteinasas de la Matriz , Factor D de Crecimiento Endotelial VascularRESUMEN
This study aims to investigate MMP2 and MT1-MMP protein as well as VEGF-C and VEGF-D mRNA expression in tumor cells and distant organs considered to be targets for metastasis in a tumor spontaneous metastasis model previously described. Cultured tumor cells, able to express pro-MMP2, MMP2, pro-MMP9, and MT1-MMP, develop tumor growth and metastasis, mainly in the liver and spleen, when they are injected in the mammary pad gland of Wistar rats. Immunohistochemical studies of tumor masses showed small groups of tumor cells staining for MT1-MMP but not for MMP2. In the liver, tumor metastatic foci and a stromal positive staining for both MMP2 and MT1-MMP were shown. The spleen and lymph nodes, with only scattered metastatic cells, did not show MMPs immunostaining. Using RT-PCR, a significantly higher VEGF-C and VEGF-D gene expression was shown in the liver of tumor-bearing rats respect to normal rats, whereas spleen and lymph nodes did not show significant differences in mRNA VEGF-C/D levels. Taken together, our results suggest that the stroma microenvironment of target organs for metastasis has the ability to produce MMPs and VEGFs that facilitate the anchorage of tumor cells and promote tumor cell growth and angiogenesis.