苯海索对铂诱导的周围神经病变和肿瘤生长的预防作用。

Preventive action of benztropine on platinum-induced peripheral neuropathies and tumor growth.

机构信息

Department "Development, Reproduction and Cancer", Institut Cochin, Paris Descartes University, Sorbonne Paris City, INSERM U1016, Paris, France.

Molecular engineering of proteins unit (SIMOPRO), CEA of Saclay, and Paris-Saclay Institute of Neuroscience (Neuro-PSI), UMR CNRS 9197, Paris-Saclay University, Gif-sur-Yvette, France.

出版信息

Acta Neuropathol Commun. 2019 Jan 18;7(1):9. doi: 10.1186/s40478-019-0657-y.

Abstract

The endogenous cholinergic system plays a key role in neuronal cells, by suppressing neurite outgrowth and myelination and, in some cancer cells, favoring tumor growth. Platinum compounds are widely used as part of first line conventional cancer chemotherapy; their efficacy is however limited by peripheral neuropathy as a major side-effect. In a multiple sclerosis mouse model, benztropine, that also acts as an anti-histamine and a dopamine re-uptake inhibitor, induced the differentiation of oligodendrocytes through M1 and M3 muscarinic receptors and enhanced re-myelination. We have evaluated whether benztropine can increase anti-tumoral efficacy of oxaliplatin, while preventing its neurotoxicity.We showed that benztropine improves acute and chronic clinical symptoms of oxaliplatin-induced peripheral neuropathies in mice. Sensory alterations detected by electrophysiology in oxaliplatin-treated mice were consistent with a decreased nerve conduction velocity and membrane hyperexcitability due to alterations in the density and/or functioning of both sodium and potassium channels, confirmed by action potential analysis from ex-vivo cultures of mouse dorsal root ganglion sensory neurons using whole-cell patch-clamp. These alterations were all prevented by benztropine. In oxaliplatin-treated mice, MBP expression, confocal and electronic microscopy of the sciatic nerves revealed a demyelination and confirmed the alteration of the myelinated axons morphology when compared to animals injected with oxaliplatin plus benztropine. Benztropine also prevented the decrease in neuronal density in the paws of mice injected with oxaliplatin. The neuroprotection conferred by benztropine against chemotherapeutic drugs was associated with a lower expression of inflammatory cytokines and extended to diabetic-induced peripheral neuropathy in mice.Mice receiving benztropine alone presented a lower tumor growth when compared to untreated animals and synergized the anti-tumoral effect of oxaliplatin, a phenomenon explained at least in part by benztropine-induced ROS imbalance in tumor cells.This report shows that blocking muscarinic receptors with benztropine prevents peripheral neuropathies and increases the therapeutic index of oxaliplatin. These results can be rapidly transposable to patients as benztropine is currently indicated in Parkinson's disease in the United States.

摘要

内源性胆碱能系统在神经元细胞中发挥关键作用,通过抑制轴突生长和髓鞘形成,并且在一些癌细胞中促进肿瘤生长。铂化合物被广泛用作一线常规癌症化疗的一部分;然而,它们的疗效受到周围神经病变这一主要副作用的限制。在多发性硬化症小鼠模型中,苯扎托品通过 M1 和 M3 毒蕈碱受体诱导少突胶质细胞分化,并增强髓鞘再生,苯扎托品还具有抗组胺和多巴胺再摄取抑制剂的作用。我们评估了苯扎托品是否可以提高奥沙利铂的抗肿瘤疗效,同时预防其神经毒性。我们发现苯扎托品可改善奥沙利铂诱导的周围神经病变小鼠的急性和慢性临床症状。电生理学检测到的奥沙利铂处理小鼠的感觉改变与神经传导速度降低和膜过度兴奋一致,这是由于钠和钾通道的密度和/或功能改变引起的,从使用全细胞膜片钳的小鼠背根神经节感觉神经元的离体培养物中分析动作电位得到证实。这些改变均被苯扎托品所预防。在奥沙利铂处理的小鼠中,MBP 表达、坐骨神经的共聚焦和电子显微镜显示脱髓鞘,并证实与注射奥沙利铂加苯扎托品的动物相比,髓鞘化轴突形态发生改变。苯扎托品还可预防奥沙利铂注射小鼠足爪中神经元密度的降低。苯扎托品对化疗药物的神经保护作用与炎症细胞因子表达降低有关,并扩展到小鼠的糖尿病诱导的周围神经病变。与未治疗的动物相比,单独接受苯扎托品的小鼠肿瘤生长速度降低,并且与奥沙利铂的抗肿瘤作用协同作用,这种现象至少部分解释为苯扎托品在肿瘤细胞中引起的 ROS 失衡。本报告表明,用苯扎托品阻断毒蕈碱受体可预防周围神经病变并增加奥沙利铂的治疗指数。这些结果可以迅速转化为患者,因为苯扎托品目前在美国被用于帕金森病。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1fcc/6337872/d7a8470e6fda/40478_2019_657_Fig1_HTML.jpg

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