Federica Avezza

Bortezomib-induced painful neuropathy in rats: a behavioral, neurophysiological and pathological study in rats

Bortezomib is a proteasome inhibitor showing strong antitumor activity against many tumors, primarily multiple myeloma. Bortezomib‐induced neuropathic pain is the main side effect and the dose‐limiting factor of the drug in clinical practice. In order to obtain a pre‐clinical model to reproduce the characteristic pain symptoms in bortezomib‐treated patients, we developed an animal model of bortezomib‐induced nociceptive sensory neuropathy. In this study, bortezomib (0.15 or 0.20mg/kg) was administered to Wistar rats three times/week for 8 weeks, followed by a 4 week follow‐up period. At the end of the treatment period a significant decrease in weight gain was observed in the treated groups vs. controls, and hematological and histopathological parameters were evaluated. After the treatment period, both doses of bortezomib induced a severe reduction in nerve conduction velocity and demonstrated a dose‐cumulative effect of the drug. The sensory behavioral assessment showed the onset of mechanical allodynia, while no effect on thermal perception was observed.

CR4056, a new analgesic I2 ligand, is highly effective against bortezomib-induced painful neuropathy in rats

Although bortezomib (BTZ) is the frontline treatment for multiple myeloma, its clinical use is limited by the occurrence of painful peripheral neuropathy, whose treatment is still an unmet clinical need. Previous studies have shown chronic BTZ administration (0.20 mg/kg intravenously three times a week for 8 weeks) to female Wistar rats induced a peripheral neuropathy similar to that observed in humans. In this animal model of BTZ-induced neurotoxicity, the present authors evaluated the efficacy of CR4056, a novel I2 ligand endowed with a remarkable efficacy in several animal pain models. CR4056 was administered in a wide range of doses (0.6–60 mg/kg by gavage every day for 2–3 weeks) in comparison with buprenorphine (Bupre) (28.8 μg/kg subcutaneously every day for 2 weeks) and gabapentin (Gaba) (100 mg/kg by gavage every day for 3 weeks). Chronic administration of BTZ reduced nerve conduction velocity and induced allodynia. CR4056, Bupre, or Gaba did not affect the impaired nerve conduction velocity. Conversely, CR4056 dose-dependently reversed BTZ-induced allodynia (minimum effective dose 0.6 mg/kg). The optimal dose found, 6 mg/kg, provided a constant pain relief throughout the treatment period and without rebound after suspension, being effective when coadministered with BTZ, starting before or after allodynia was established, or when administered alone after BTZ cessation. A certain degree of tolerance was seen after 7 days of administration, but only at the highest doses (20 and 60 mg/kg). Bupre was effective only acutely, since tolerance was evident from the fourth day onwards. Gaba showed a significant activity only at the fourth day of treatment. CR4056, over the range of concentrations of 3–30 μM, was unable to hinder BTZ cytotoxicity on several tumor cell lines, which could indicate that this substance does not directly interfere with BTZ antitumor activity. Therefore, CR4056 could represent a new treatment option for BTZ-induced neuropathic pain.

Therapeutic potential of Mesenchymal Stem Cells for the treatment of diabetic peripheral neuropathy.

ABSTRACT Type‐1 Diabetes is generally treated with exogenous insulin administration. Despite treatment, a very common long term consequence of diabetes is the development of a disabling and painful peripheral neuropathy. The transplantation of pancreatic islets is an advanced alternative therapeutic approach, but its clinical application is still very limited, mainly because of the great number of islets required to complete the procedure and of their short‐term survival. An intriguing method to improve the performance of pancreatic islets transplantation is the co‐transplantation of Mesenchymal Stem Cells (MSCs), adult stem cells already known to support the survival of different cellular populations. In this proof‐of‐concept study, we demonstrated using an in vivo model of diabetes, the ability of allogenic MSCs to reduce the number of pancreatic islets necessary to achieve glycemic control in diabetic rats, and overall their positive effect on diabetic neuropathy, with the reduction of all the neuropathic signs showed after disease induction. The cutback of the pancreatic islet number required to control glycemia and the regression of the painful neuropathy make MSC co‐transplantation a very promising tool to improve the clinical feasibility of pancreatic islet transplantation for diabetes treatment. HighlightsMSCs reduce the number of Pancreatic Islets necessary to control blood glucose level.MSCs co‐transplanted with Pancreatic Islets ameliorate diabetic neuropathy.MSCs co‐transplanted with Pancreatic Islets reduce nephrotoxicity.

Islet transplantation and insulin administration relieve long-term complications and rescue the residual endogenous pancreatic β cells.

Islet transplantation is a poorly investigated long-term strategy for insulin replacement and for treatment of complications in patients with diabetes. We investigated whether islet transplantation and insulin treatment can relieve diabetic neuropathy and rescue the residual endogenous pancreatic β cells. We used a multimodal approach, with five groups of Sprague-Dawley rats studied for 8 months: control rats, diabetic rats, insulin-treated diabetic rats with moderate or mild hyperglycemia, and diabetic rats transplanted with microencapsulated islets. Islet transplantation normalized glycemia and increased body and muscle weight; it was also effective in reducing proteinuria and altered liver function. Transplantation significantly improved tail nerve conduction velocity, Na(+)-K(+)-ATPase activity, and morphological alterations in the sciatic nerve as evidenced by decrease in g-ratio; it also restored thermal and ameliorated mechanical nociceptive thresholds. Morphometric analysis of pancreas indicated a significant β-cell volume increase in transplanted rats, compared with mildly and moderately hyperglycemic rats. Thus, allogeneic islet transplantation had a positive systemic effect in diabetic rats and induced regression of the established neuropathy and restitution of the typical characteristics of the islets. These findings strongly reinforce the need for improving glycemic control, not only to reverse established diabetic complications but also to improve β-cell status in diabetic pancreas.

Chemotherapy-induced peripheral neuropathy in immunodeficient mice: new useful ready-to-use animal models

Cisplatin, paclitaxel, and bortezomib represent the most employed chemotherapy regimens for the treatment of genitourinary cancers, breast and lung cancers and multiple myeloma. Nevertheless, their clinical use is often associated to the development of peripheral neuropathies characterized mostly by sensory alterations and pain (Argyriou et al., 2012). Several rat models of chemotherapy-induced peripheral neuropathy (CIPN) had been established in the past to describe the mechanisms of its development and pathogenesis. However, only few cancer cell lines induce the development of cancer in the rat, while immunodeficient mice best allowed human cancers xenografts to study at the same time, the antineoplastic and neurotoxic effects of chemotherapy. Here we characterized neuropathic pain, neurophysiological and neuropathological alterations induced by chronic chemotherapy in immunodeficient nude mice. Mice were treated with effective doses of cisplatin (4 mg/Kg, i.p), paclitaxel (80 mg/Kg, i.v) and bortezomib (0.8 mg/Kg, i.v) for a 4-6 weeks period. At the end of the 6th week all chemotherapy regimens determined a significant impairment of neurophysiologic parameters, mechanical allodynia and thermal hypo-or hyperalgesia. Light microscopy analysis of dorsal root ganglia (DRG) showed that bortezomib induced morphological alterations in the sensory neurons and satellite cells as dark inclusions and clear vacuolation throughout the cytoplasm. Moreover, sporadic episodes of neuronal degeneration were evident. DRG of cisplatin-treated animals showed severe neuronal atrophy. Moreover bortezomib induced moderate to severe axonal degeneration of the myelinated fibers in the sciatic nerves. More severe changes were induced by paclitaxel where also areas of fibers loss were frequently observed and rare pathological abnormalities were present in unmyelinated fibers. Similar changes were evident in paclitaxel-treated mice (degeneration at different stage of severity in myelinated fibers, enlargement of Schwann cells, fibers loss and dark inclusions in the unmyelinated fibers). These schedules demonstrated to be effective in mimicking clinical features of painful neuropathies and allows to combine the study of peripheral neurotoxicity of chemotherapy drugs to their anti-tumour activity against cancers of human origin.

Evaluation of the Profile and Mechanism of Neurotoxicity of Water-Soluble [Cu(P)4]PF6 and [Au(P)4]PF6 (P = thp or PTA) Anticancer Complexes

Abstract[Cu(thp)4]PF6, [Cu(PTA)4]PF6, [Au(thp)4]PF6 and [Au(PTA)4]PF6 are phosphane (thp = tris(hydroxymethyl)phosphane; PTA = 1,3,5-triaza-7-phosphaadamantane) copper(I) and gold(I) water-soluble complexes characterized by high anticancer activity in a wide range of solid tumors, often able to overcome drug resistance of platinum-based compounds. For these reasons, they have been proposed as a valid alternative to platinum-based chemotherapeutic drugs (e.g., cisplatin and oxaliplatin). In vitro experiments performed on organotypic cultures of dorsal root ganglia (DRG) from 15-day-old rat embryos revealed that copper-based compounds were not neurotoxic even at concentrations higher than the IC50 obtained in human cancer cells while [Au(PTA)4]PF6 was neurotoxic at lower concentration than IC50 in cancer cell lines. The ability of these compounds to hinder the proteasome machinery in DRG neurons was tested by fluorimetric assay showing that the non-neurotoxic copper-based complexes do not inhibit proteasome activity in DRG primary neuron cultures. On the contrary, the neurotoxic complex [Au(PTA)4]PF6, induced a significant inhibition of proteasome activity even at concentrations lower than the IC50 in cancer cells. The proteasome inhibition induced by [Au(PTA)4]PF6 was associated with a significant increase in α-tubulin polymerization that was not observed following the treatment with copper-based compounds. Uptake experiments performed by atomic absorption spectrometry showed that both copper-based complexes and [Au(PTA)4]PF6 are internalized in neuron cultures. In vitro and in vivo preliminary data confirmed copper-based complexes as the most promising compounds, not only for their anticancer activity but also concerning the peripheral neurotoxicity profile.

Oxaliplatin-Induced Peripheral Neurotoxicity: Morphological Characterization In Different Mouse Strains

Oxaliplatin is one of the most effective anticancer drug, particularly employed in the treatment of colorectal cancer, but one of the major limitation in its use is peripheral neurotoxicity. Oxaliplatin induced peripheral neurotoxicity (OIPN) has a high incidence and is frequently long lasting or permanent. Neuropathy is characterized by distal sensory impairment initially in the legs, then extending to the arms. A prominent manifestation of sensitive damage is ataxia. Besides chronic neurotoxicity, many patients experience an acute, rapidly developing cold-induced sensory neuropathy, usually resolving within one week. OIPN clinical manifestations reflect the involvement of dorsal root ganglia (DRG) as primary target of the drug toxicity. Although this assumption is largely accepted and some pathogenetic hypothesis have been proposed, mechanisms at the basis of OIPN need to be clearly defined. OIPN may vary in frequency and severity among different cancer patients despite equal treatment schedules. A genetic susceptibility for more severe oxaliplatin-induced peripheral neurotoxicity (OIPN) has been suggested but never confirmed. Therefore we designed a study to assess the phenotypic differences induced by oxaliplatin treatment in six different mice strains (Balb c, AJ, C57Bl6, FVB, DBA, CD1) aiming at identifying the more and less severely affected. Animals were treated with OHP 3.5 mg/Kg/iv twice weekly x 4 weeks and evaluated before and after treatment. In all strains we performed a multimodal characterization of its neurotoxicity through morphological and morphometrical assessment in caudal nerve and DRG at light and electron microscopy, intra-epidermal nerve fibers density quantification, evaluation of mechanical and cold allodynia/hypoaesteshesia, caudal and digital nerve conduction velocity, activity of wide dynamic range (WDR) neurons of the spinal dorsal horn. Our preliminary data suggest that all the strains show signs of OIPN but not the same modifications in the parameters examined. We will show these results with particular attention to morphological data. This study suggests that genetic variability might have a role in the type and severity of OHP-induced peripheral damage.

A new animal model of chemotherapy induced peripheral neurotoxicity: the immune-deficient mouse

Cisplatin, paclitaxel and bortezomib are anticancer drugs widely employed in the treatment of different solid tumours even though peripheral neurotoxicity represents a major limitation in their clinical use. During the last decades many rat and mouse models of chronic chemotherapyinduced peripheral neurotoxicity (CIPN) have been characterized from the clinical, pathological, neurophysiological and behavioural point of view. These models were based on immune-competent animals, however in preclinical oncology immune-deficient mice are mainly used. In this respect, the development of immune-deficient mice models could represent a basis for the concurrent investigation of both anticancer drug efficacy and neurotoxicity in animals implanted with human-derived cancer. Moreover, in the same model, neuroprotective effects and non-interference with anticancer activity could be better studied. In this study we established the feasibility of new immune-deficient murine models of peripheral neurotoxicity induced by three anticancer drugs. Forty-eight athymic nude mice were randomized in 4 groups of 12 animals, three were treated respectively with cisplatin, paclitaxel and bortezomib, and one was left untreated. All animals were followed up for 6 weeks. They were examined at baseline, week 4 and 6 for neurophysiological functions and behavioural tests, whilst morphological and morphometric analysis were performed on dorsal root ganglia (DRG) and peripheral nerves collected after 4 and 6 weeks of treatment. The results of the study demonstrate that athymic nude mice show CIPN features similar to those observed in conventional models even if some differences must be remarked as the prolonged time of treatment required to develop a chronic neuropathy. The characterization of this new mice model of CIPN will allow studies of antineoplastic and neurotoxic effects in the same animal.