Peripheral neuropathy induced by paclitaxel: in vitro study

Peripheral neuropathy induced by paclitaxel: in vitro study

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Peripheral neuropathy induced by paclitaxel: in vitro study

Zuzana Michalová1,2 , Zuzana Dzurjašková , Eva Szekiová , Ivo Vanický ,
1 Institute of Neurobiology, Biomedical Research Center, Slovak Academy of Sciences, Šoltésovej 4-6, 040 01 Košice, Slovakia
2 Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Trieda SNP 1, 040 11, Košice, Slovakia
zuzanamichalov@gmail.com

Paclitaxel induced peripheral neuropathy (PIPN) is a severe adverse effect observed in most cancer patients receiving paclitaxel for the treatment of breast, ovarian or lung cancer (1). In cancer cells, paclitaxel induces cell death via microtubule stabilization interrupting cell mitosis. Although highly effective in blocking tumor progression, a major dose-limiting side effect of paclitaxel can persist for up to two years after completing treatment, greatly affecting both the course of chemotherapy and patients' quality of life. The main symptoms of PIPN are numbness, paresthesia and burning pain in a glove-and-stocking distribution. Recent studies have aimed at defining the underlying mechanisms of PIPN. In vitro models using dorsal root ganglion (DRG) neurons have revealed a number of molecular pathways affected by paclitaxel within axons of sensory neurons, such as altered calcium signaling, neuropeptide and growth factor release, mitochondrial damage, reactive oxygen species formation, activated ion channels that mediate responses to extracellular cues and role for the matrix-metalloproteinase 13 in mediating neuropathy (2, 3). In this study, DRG derived sensory neuron culture system obtained from adult rats as a useful in vitro model, has been used to recapitulate the pathophysiological features of peripheral neuropathy and axonal degeneration. One of the most notable effects of paclitaxel neurotoxicity in DRG in vitro models is the reduction of neurite length. DRG dissociated primary cultures have been used as a neurotoxicity-screening model to evaluate the effect of paclitaxel on the neurite elongation.  The neurotoxic effect of this drug was analyzed by measuring the neurite length of post-mitotic, non-dividing cells, such as neurons. Paclitaxel-induced tubulin polymerization in these cells is thought to interfere with axonal transport, causing peripheral neuropathy. The neurotoxic effect of paclitaxel is dose and time dependent. Moreover, in DRG dissociated post-mitotic neurons, the morphological features of paclitaxel-induced cellular death were studied and the DRG neurons were observed to die by necrosis. DRG derived sensory neurons, as well as DRG explants are a good, simple and well-accepted model for studying peripheral neuropathy induced by various antineoplastic agents. Drug neurotoxicity assessment in vitro is based on the ability of post-mitotic cells to outgrow and prolong neurites when exposed to toxic substances. Currently, there are no therapeutic options available for the prevention or successful therapy of PIPN and only few drugs are recommended for the treatment of existing neuropathies because the mechanisms of PIPN remain unclear. Our findings demonstrate a previously known neurotoxic effect of paclitaxel in DRG derived sensory neuron culture system and suggest advantages of this in vitro model, as high efficiency and reproducibility of cell culture studies in the field of toxic neuropathy induced by paclitaxel.

 

Poďakovanie: 

This project was supported by research grants: VEGA 2/0109/21, VEGA 2/0123/20.

Zdroje: 

(1) Kampan NC, Madondo MT, McNally OM, Quinn M, Plebanski M. Paclitaxel and Its Evolving Role in the Management of Ovarian Cancer. Biomed Res Int. 2015;2015:413076. doi:10.1155/2015/413076

(2) Sisignano M, Baron R, Scholich K, Geisslinger G. Mechanism-based treatment for chemotherapy-induced peripheral neuropathic pain. Nat Rev Neurol. 2014 Dec;10(12):694-707. doi: 10.1038/nrneurol.2014.211. Epub 2014 Nov 4. PMID: 25366108.

(3) Makker PG, Duffy SS, Lees JG, Perera CJ, Tonkin RS, Butovsky O, Park SB, Goldstein D, Moalem-Taylor G. Characterisation of Immune and Neuroinflammatory Changes Associated with Chemotherapy-Induced Peripheral Neuropathy. PLoS One. 2017 Jan 26;12(1):e0170814. doi: 10.1371/journal.pone.0170814. PMID: 28125674; PMCID: PMC5268425.

Diskusia

Greetings,

congratulations to nice study. I would like to ask about statistics: what method did you use within evaluation processs with acquired data. I didin´t find that information. On Fig.3. there some significancies marked, however no SEM or SD abscisses are visible. Thanks in advance for your reply, ZB

Hello Zuzana, thank you for your interest!

In order to established the statistical significants of differences observed between groups, the non-parametric Mann- Whitney U-test was used. Statistical significance was considered to be present once p-values were lower than 0.05. The data from the neurite lenght measurements are expressed as the mean±standard deviation. For CTRL samples and 48 hours after incubation, the neurite length did not significantly differ (p>0.05). However, when compared to 2 hours and 24 hours after incubation, results showed significantly decreased neurite length in both 2h samples and 24h samples (185,27±77,97 vs. 36,47±12,21, respectively, p< 0.001; 185,27±77,97 vs. 104,60±56,46, respectively, p< 0.01)

Thank you for your reply, all the best! Cordially, ZB 

Hello Zuzana, very nice work. I have noticed that you use dorsal root ganglia obtained from adult rats in your in vitro model. I would like to ask why you chose adult animals? Would be the same difference also observed if you used younger animals, resp. embryos?

Hello Erika, thank you for your interest!

DRG neurons derived from adult animals are more suitable for modeling CIPN, which also primarily affects adults whose sensory neurons are fully mature.

Hello Zuzana, in your study you have mentioned that there are no therapeutic options available for the prevention or successful therapy of PIPN and only few drugs are recommended for the treatment of existing neuropathies. I was wondering, can you mention some of them?

Hello, thank you for your interest. Systemic treatment options for neuropathic pain include antidepressants, antiepileptics, as well as opioids. However, according to existing recommendations, only the selective serotonin and norepinephrine reuptake inhibitor (SNRI) duloxetine is recommended for the treatment of peripheral neuropathies, as well as chemotherapy-induced peripheral neuropathy. For all other systemic treatment options and drugs, the clinical evidence for CIPN is still inconclusive and is used in an out-of-approval manner.