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Chronopharmacodynamics of hematopoietic growth factors and antitumor cytokines
... The biological effects of cytokine exogenous administration have been proven to change during the 24-hour period of the day. In particular, it has been demonstrated that reticulocyte response to erythropoietin [3], neutrophil increase in response to granulocyte-colony-stimulating factor [4] and lymphocyte proliferative response to IL-2 [5] are maximal during the night. In addition, recent advances in psychoneuroimmunology have shown that cytokine secretion and activity are under central neuroendocrine control [6], and in particular it has been shown that the pineal gland plays a fundamental role in the neuroendocrine regulation of immunity through the light/dark secretion of its main hormone melatonin (MLT) [7]. ...
It has been demonstrated that cytokine activities are under neuroendocrine control, recently mainly exerted by the pineal gland through the circadian secretion of its main hormone melatonin (MLT). It is mainly released during the night, but at present it is still unclear which relation exists between MLT and the circadian secretion of cytokines. This study was performed to evaluate the circadian secretion of IL-2, IL-6, IL-10 and IL-12 in relation to that of MLT. The study included 10 healthy volunteers whose venous blood samples were collected at 8 a.m., noon, 4 p.m., 8 p.m., 1 a.m. and 4 a.m. The mean levels of MLT were significantly higher during the night than during the light phase of the day. Similarly, IL-2 mean levels significantly increased during the night. IL-6 mean values were higher during the light period of the day without, however, any significant differences with respect to the nocturnal mean levels. Finally, no substantial circadian variation was seen in IL-10 and IL-12 mean concentrations. These results show that IL-2 secretion increases during the night, concomitantly to that of the pineal hormone MLT, whereas there is no evidence of a circadian secretion for the other cytokines. Since the pineal gland has been proven to stimulate IL-2 endogenous production, the nocturnal increase in IL-2 blood concentrations could depend at least in part on the promoting action of MLT, whose release increases during the dark period of the day.
... The biological effects of cytokine exogenous administration have been proven to change during the 24-hour period of the day. In particular, it has been demonstrated that reticulocyte response to erythropoietin [3], neutrophil increase in response to granulocyte-colony-stimulating factor [4] and lymphocyte proliferative response to IL-2 [5] are maximal during the night. In addition, recent advances in psychoneuroimmunology have shown that cytokine secretion and activity are under central neuroendocrine control [6], and in particular it has been shown that the pineal gland plays a fundamental role in the neuroendocrine regulation of immunity through the light/dark secretion of its main hormone melatonin (MLT) [7]. ...
Since hematologic examination during cancer chemotherapy is generally limited to the evaluation of neutrophil and platelet numbers, at present there are no clear data about the possible prognostic significance of changes in lymphocyte number in relation to the clinical efficacy of chemotherapy itself. To obtain some preliminary data about this issue, we have evaluated changes in lymphocyte number and percentage in a group of 50 advanced non-small cell lung cancer patients treated with three cycles of cisplatin (20 mg/m2/day) plus etoposide (100 mg/m2/day) i.v. for three days every 21 days. The clinical response consisted of partial response (PR) in nine (18%), stable disease (SD) in 18 (36%) and progressive disease (PD) in the remaining 23 (46%) patients. The lymphocyte percentage increased during chemotherapy, without, however, a significant difference with respect to the pretreatment values. In contrast, the mean number of lymphocytes observed after the first chemotherapeutic cycle significantly decreased in patients with PD, whereas it increased in patients with PR or SD, even though the difference did not reach statistical significance. These preliminary data, which have to be confirmed in a large number of patients and in patients treated with other chemotherapeutic schedules for different tumor types, seem to suggest that a chemotherapy-induced decline in lymphocyte number may be associated with a lack of efficacy of chemotherapy itself.
Die Rationale für dosiseskalierte Therapien bei soliden Tumoren begründet sich in der Annahme, daß eine Beziehung besteht zwischen der verabfolgten Dosis und dem Ausmaß der Tumorzellzerstörung und daß es daher möglich sein muß, eine Tumorzellpopulation durch entsprechende Erhöhung der Zytostatikadosierungen komplett zu zerstören. Nach Schätzungen von Frei et al. (1989) liegt die Tumorzellzahl bei einem Patienten mit klinisch evidenter, metastasierter Erkrankung bei ca. 1011 Zellen; ca. 1–0,1%, also 108–107 Zellen sind Tumorstammzellen. Unter der Annahme, daß eine konventionelle Chemotherapie in einer hypothetischen Situation in der Lage ist, eine gute partielle oder kurzanhaltende komplette Remission zu induzieren — entsprechend einer Tumorzellreduktion von ca. 1–2 log -, ist im idealen Fall eine Dosiseskalation um den Faktor 5–8 notwendig, um kurativ sein zu können. Diese Annahme hat allerdings nur Gültigkeit, wenn man davon ausgeht, daß für die verwendeten Substanzen eine log-lineare Dosis-Wirkungs-Beziehung über mehrere Zehnerpotenzen der Tumorzellreduktion vorliegt. Viele Substanzen, v. a. die Antimetaboliten und die Vincaalkaloide, weisen in experimentellen Systemen ein Plateau nach 1–2 log Tumorzellzerstörung auf und scheinen schon aufgrund dieser Charakteristika nicht besonders geeignet für Hochdosistherapien zu sein.
Chronopharmacologic effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on circulating white blood cell and differential counts as well as bone marrow granulocyte-macrophage colony-forming units (CFU-GM) counts were investigated in B6D2F1 mice. The animals were synchronized with an alternation of 12 h of light (L) and 12 h of darkness (D) (LD 12:12) for 3 weeks prior to study, then received a daily subcutaneous injection of rhG-CSF (400 µg/kg/day) for 4 consecutive days at 3, 9, 15 or 21 h ours a fter l ight o nset (HALO). Samples were obtained on the fifth day at the same circadian stage as that of rhG-CSF injection. rhG-CSF significantly increased the 24-h mean of leukocyte, neutrophil, lymphocyte and CFU-GM counts. Maximum increase in leukocyte and neutrophil counts was observed when rhG-CSF was administered in the middle of the dark span, while maximum stimulatory effect on circulating lymphocytes or on CFU-GM counts was obtained with rhG-CSF administration near the middle of the light span. The results indicate that choosing the dosing time of this cytokine may selectively orient its pharmacologic action. Appropriate chronomodulated delivery schemes of rhG-CSF may further reduce hematological toxicity following chemotherapy.
The hematologic toxicity of arabinosylcytosine (Ara-C) and carboplatin (CBDCA) as well as the stimulating effect of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on murine bone marrow vary according to their dosing time along the 24-h time scale. In the present study, we investigated whether the tolerability of Ara-C or CBDCA, given at their least toxic circadian time, could be improved further with AcSDKP, a negative regulator of hemopoiesis, rhG-CSF or both. A total of 228 B6D2F1 mice received once-daily injection of either Ara-C (42 mg/kg/d s.c.) for 7 d (d 0-6) at 8 hours after light onset - HALO) or CBDCA (40 mg/kg/d i.p.) for 5 d (d 2-6) at 16 HALO. AcSDKP (24 microg/d) was continuously infused for 7 d (d 0-6), using an osmotic minipump. rhG-CSF (400 microg/kg/d s.c.) was injected for 4 d (d 9-12) at 9 HALO. Subgroups of mice were sacrificed at 3 HALO on various days following treatment. AcSDKP significantly increased CFU-GM count on d 7 and leukocyte, neutrophil and monocyte counts on d 13 and d 16 compared to Ara-C alone. Also, rhG-CSF produced similar protective effects to those of AcSDKP with regard to leukocyte and CFU-GM counts. The combination of AcSDKP with rhG-CSF induced a further increase in total leukocytes and their subsets as compared to either agent alone, but did not alter the CFU-GM counts. Neither AcSDKP nor rhG-CSF nor their combination reduced CBD CA-induced hematological toxicity. In conclusion, AcSDKP or rhG-CSF administration further improved the tolerability of Ara-C beyond that already achieved with optimal circadian timing, while no such effect was observed in mice receiving CBDCA at the dose used. The results warrant further exploration of chronopharmacologic delivery schedules combining Ara-C with AcSDKP.
The cytokine interleukin-6 (IL-6) is a multifunctional small-peptide molecule that is produced by various types of lymphoid and nonlymphoid cells. It plays a central role in hematopoiesis, host defense mechanisms, and acute-phase reactions, including regulation of inflammatory and immune responses.
Because a circadian time structure has been shown to characterize nearly every biologic function tested in human beings, including some cytokines, we sought to investigate the 24-hour pattern of circulating IL-6 in a group of 11 clinically symptom-free men (median age, 50 years; range, 46 to 72 years). Blood samples were obtained every 3 hours for 24 hours (eight samples per subject), and serum was frozen until analysis for IL-6 with a solid-phase ELISA.
Average IL-6 values ranged from 1.66 to 5.38 pg/ml, with lowest to highest values within 24 hours ranging from 1.20 to 7.58 pg/ml (120% to 531%) between subjects. On average, values were greater than the mean throughout the night, with a peak at 01:00 hours and less than the mean throughout the day, with a nadir at 10:00 hours. A significant time effect was found by analysis of variance; and a high-amplitude circadian rhythm was described by the least-squares fit of a 24-hour cosine (p < 0.001; amplitude, 41% +/- 5%; acrophase, 02:16 +/- 00:28 hours). In addition, a positive correlation between mean IL-6 levels and age was found (r = 0.63, p = 0.037).
Because monitoring of endogenous cytokine levels is suggested for assessing immune function and pathologic condition, clinical decisions and immunotherapies may be significantly influenced by the large and predictable day-night variations in endogenous cytokine production and bioactivity.
In all of its components, the immune system shows regularly recurring, rhythmic variations in numerous frequencies; the circadian (about 24 h) rhythms are the best explored. The circadian variations in immunocompetent cells circulating in the peripheral blood are of a magnitude to require attention in medical diagnostics. Both the humoral arm and the delayed (cellular) arm of the immune system function in a rhythmic manner. The response of the immune system to introduction of an antigen and to challenge of the sensitized organism varies in extent in the circadian frequency range and also in lower frequencies, for example, of about a week (circaseptan) or seasonally (circannual). The medical application of the biologic rhythms of the immune system extends to diagnostic measures, as well as treatment.
Melatonin (MLT) has been proven to counteract chemotherapy toxicity, by acting as an anti-oxidant agent, and to promote apoptosis of cancer cells, so enhancing chemotherapy cytotoxicity. The aim of this study was to evaluate the effects of concomitant MLT administration on toxicity and efficacy of several chemotherapeutic combinations in advanced cancer patients with poor clinical status. The study included 250 metastatic solid tumour patients (lung cancer, 104; breast cancer, 77; gastrointestinal tract neoplasms, 42; head and neck cancers, 27), who were randomized to receive MLT (20 mg/day orally every day) plus chemotherapy, or chemotherapy alone. Chemotherapy consisted of cisplatin (CDDP) plus etoposide or gemcitabine alone for lung cancer, doxorubicin alone, mitoxantrone alone or paclitaxel alone for breast cancer, 5-FU plus folinic acid for gastro-intestinal tumours and 5-FU plus CDDP for head and neck cancers. The 1-year survival rate and the objective tumour regression rate were significantly higher in patients concomitantly treated with MLT than in those who received chemotherapy (CT) alone (tumour response rate: 42/124 CT + MLT versus 19/126 CT only, P < 0.001; 1-year survival: 63/124 CT + MLT versus 29/126 CT only, P < 0.001). Moreover, the concomitant administration of MLT significantly reduced the frequency of thrombocytopenia, neurotoxicity, cardiotoxicity, stomatitis and asthenia. This study indicates that the pineal hormone MLT may enhance the efficacy of chemotherapy and reduce its toxicity, at least in advanced cancer patients of poor clinical status.
Circadian rhythms in plasma concentrations of many hormones and cytokines determine their effects on target cells.
Circadian variations were studied in cortisol, melatonin, cytokines (basic fibroblast growth factor IbFGF], EGF, insulin-like growth factor-1 [IGF-1]), and a cytokine receptor (insulin-like growth factor binding protein-3 [IGFBP-3]) in the plasma of 28 patients with metastatic breast cancer. All patients followed a diurnal activity pattern. Blood was drawn at 3h intervals during waking hours and once during the night, at 03:00. The plasma levels obtained by enzyme-linked immunoassay (ELISA) or radioimmunoassay (RIA) were evaluated by population mean cosinor (using local midnight as the phase reference) and by one-way analysis of variance (ANOVA).
Cortisol and melatonin showed a high-amplitude circadian rhythm and a superimposed 12h frequency. bFGF showed a circadian rhythm with an acrophase around 13:00 with a peak-to-trough interval (double amplitude) of 18.2% and a superimposed 12h frequency. EGF showed a circadian rhythm with an acrophase around 14:20, a peak-to-trough interval of 25.8%, and a superimposed 12h frequency. IGF-1 showed a high value in the morning, which is statistically different (t test) from the low value at 10:00, but a regular circadian or ultradian rhythm was not recognizable as a group phenomenon. IGFBP-3 showed a low-amplitude (peak-to-trough difference 8.4%) circadian rhythm with the acrophase around 11:00 and low values during the night.
(1) Circadian periodicity is maintained in hospitalized patients with metastatic breast cancer. (2) Ultradian (12h) variations were superimposed on the circadian rhythms of the hormones and several of the cytokines measured. (3) Studies of hormones and cytokines in cancer patients have to take their biologic rhythms into consideration. (4) The circadian periodicity of tumor growth stimulating or restraining factors raises questions about circadian and/or ultradian variations in the pathophysiology of breast cancer.
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