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      In vitro Paclitaxel and Radiation Effects on the Cell Types Responsible for Vascular Stenosis: A Preliminary Analysis

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          Hemodialysis vascular access dysfunction as a result of venous neointimal hyperplasia in dialysis access grafts and fistulae is currently a huge clinical problem. The aim of this study was to assess the effects of paclitaxel and radiation, both singly and in combination on the proliferation of cell types present within the lesion of venous neointimal hyperplasia (vascular smooth muscle cells, fibroblasts and endothelial cells within the neointimal microvessels). Vascular smooth muscle cells, fibroblasts and endothelial cells were plated onto 96-well plates and exposed to different concentrations and doses of paclitaxel and radiation, respectively (both individually and in combination). Growth inhibition was assessed with an MTT assay. Both paclitaxel and radiation resulted in significant growth inhibition of all three cell types. However, even small doses of paclitaxel appeared to attenuate the antiproliferative effect of radiation on these cell types. Further experiments to elucidate the mechanism behind these findings could result in a better understanding of combination antiproliferative therapies.

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          Most cited references 16

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          Hemodialysis vascular access dysfunction: a cellular and molecular viewpoint.

          Hemodialysis vascular access dysfunction is a major cause of morbidity and hospitalization in the hemodialysis population. The major cause of hemodialysis vascular access dysfunction is venous stenosis as a result of neointimal hyperplasia. Despite the magnitude of the clinical problem, however, there has been a paucity of novel therapeutic interventions in this field. This is in marked contrast to a recent plethora of targeted interventions for the treatment of arterial neointimal hyperplasia after coronary angioplasty. The reasons for this are two-fold. First there has been a relative lack of cellular and molecular research that focuses on venous neointimal hyperplasia in the specific setting of hemodialysis vascular access. Second, there have been inadequate efforts by the nephrology community to translate the recent advances in molecular and interventional cardiology into therapies for hemodialysis vascular access. This review therefore (1) briefly examines the different forms of hemodialysis vascular access that are available, (2) describes the pathology and pathogenesis of hemodialysis vascular access dysfunction in both polytetrafluoroethylene grafts and native arteriovenous fistulae, (3) reviews recent concepts about the pathogenesis of vascular stenosis that could potentially be applied in the setting of hemodialysis vascular access dysfunction, (4) summarizes novel experimental and clinical therapies that could potentially be used in the setting of hemodialysis vascular access dysfunction, and, finally, (5) offers some broad guidelines for future innovative translational and clinical research in this area that hopefully will reduce the huge clinical morbidity and economic costs that are associated with this condition.
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            An evaluation of cytotoxicity of the taxane and platinum agents combination treatment in a panel of human ovarian carcinoma cell lines.

            The objectives of this study were to determine the optimum schedule for combination of taxane and platinum agents in human ovarian carcinoma cell lines. Cell growth inhibition was determined by the standard MTT assay and an IC(50) was calculated for docetaxel, paclitaxel, cisplatin, and carboplatin in seven human ovarian cancer cell lines (CAOV-3, OVCAR-3, SKOV-3, ES-2, OV-90, TOV-112D, and TOV-21G). The IC(50) was defined as the drug concentration required for a 50% reduction in optical density. Cytotoxicity assays were performed with four sequential combinations of a taxane and a platinum compound. In each combination, cell lines were treated with the appropriate IC(50) of the drugs for varying time increments between 3 and 24 h. Controls were no drug, each agent alone and the combination of both. Results were obtained via manual cell counting with a hemocytometer. The inhibitory concentration to achieve 50% cell death (IC(50)) was determined for each compound in each cell line. The IC(50) ranged from 0.8 to 1.7 nM, 0.7 to 1.8 nM for docetaxel and paclitaxel, respectively, and 17.4 to 25.7 microM, 15.1 to 25.7 microM for cisplatin and carboplatin, respectively. In this study the combination of docetaxel plus cisplatin was considerably more active in vitro than any of the other taxane plus platinum agent combinations evaluated in the panel of human ovarian cancer cell lines. In vitro activity was similar to previously report clinical studies comparing taxane and platinum combination regimens. This suggests the combination of docetaxel with cisplatin will have enhanced clinical activity compared to the paclitaxel plus carboplatin regimen.
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              Localized intracoronary gamma-radiation therapy to inhibit the recurrence of restenosis after stenting.

              Although the frequency of restenosis after coronary angioplasty is reduced by stenting, when restenosis develops within a stent, the risk of subsequent restenosis is greater than 50 percent. We report on a multicenter, double-blind, randomized trial of intracoronary radiation therapy for the treatment of in-stent restenosis. Of 252 eligible patients in whom in-stent restenosis had developed, 131 were randomly assigned to receive an indwelling intracoronary ribbon containing a sealed source of iridium-192, and 121 were assigned to receive a similar-appearing nonradioactive ribbon (placebo). The primary end point, a composite of death, myocardial infarction, and the need for repeated revascularization of the target lesion during nine months of follow-up, occurred in 53 patients assigned to placebo (43.8 percent) and 37 patients assigned to iridium-192 (28.2 percent, P=0.02). However, the reduction in the incidence of major adverse cardiac events was determined solely by a diminished need for revascularization of the target lesion, not by reductions in the incidence of death or myocardial infarction. Late thrombosis occurred in 5.3 percent of the iridium-192 group, as compared with 0.8 percent of the placebo group (P=0.07), resulting in more late myocardial infarctions in the iridium-192 group (9.9 percent vs. 4.1 percent, P=0.09). Late thrombosis occurred in irradiated patients only after the discontinuation of oral antiplatelet therapy (with ticlopidine or clopidogrel) and only in patients who had received new stents at the time of radiation treatment. Intracoronary irradiation with iridium-192 resulted in lower rates of clinical and angiographic restenosis, although it was also associated with a higher rate of late thrombosis, resulting in an increased risk of myocardial infarction. If the problem of late thrombosis within the stent can be overcome, intracoronary irradiation with iridium-192 may become a useful approach to the treatment of in-stent restenosis.

                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                March 2007
                18 December 2006
                : 25
                : 2
                : 155-160
                Departments of aMedicine, bPharmacy, cRadiology, dSurgery, eMechanical, Industrial and Nuclear Engineering and fPathology, University of Cincinnati, Cincinnati, Ohio, USA
                98018 Blood Purif 2007;25:155–160
                © 2007 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 3, References: 28, Pages: 6
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/98018
                Original Paper

                Cardiovascular Medicine, Nephrology

                Smooth muscle cell, Radiation, Venous stenosis, Paclitaxel, Fibroblast


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