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Sunday, May 31, 2020

Cancer cells greedy for glucose

To fuel their rapid proliferation, tumor cells rely on glycolysis, a primordial metabolic pathway that is easily exploited by cancers to gain energy to grow—and spread.
Glycolysis is the oldest form of energy production in living cells. It has been around for billions of years, having emerged before oxygen accumulated on Earth, and was the type of energy production for the planet’s first primitive forms of life.
The process involves the breakdown of glucose to yield energy for cellular metabolic activities. Bacteria use glycolysis, as do more complex organisms such as plants and animals. The latter, however, have developed more sophisticated forms of energy production, despite still having glycolysis with its lower energy yield. For example, the electron transport chain produces substantially more ATP—energy molecules—than does glycolysis. Still, many types of tumor cells use glycolysis preferentially to provide sufficient energy for growth and proliferation.
High rates of glycolysis in cells remain a well-established characteristic of many human tumors, report Drs. Jeremy Blaydes and Charles N. Birts of the Cancer Sciences Unit, Faculty of Medicine, at Southampton University in England. The energy-producing process provides cancer cells with metabolites that can be used as precursors for anabolic pathways.
Writing in the journal Science Signaling, Blaydes and Birts, along with a team of cancer researchers, found that in an in vitro breast cancer model, they were able to identify something startling new—they call it a glycolytic stress response, involving p53. The p53 gene carries the DNA blueprint for a protein called tumor protein p53. The protein plays a critical role policing cellular activities, such as and cell death. Mutations in p53, studies have long shown, allow cancer cells to grow and spread.
“Constitutive aerobic glycolysis—the Warburg effect—is a hallmark of cancer cells that is commonly caused by mutations in oncogenes and tumor-suppressor genes,” Blaydes and Birst wrote in Science Signaling.
“It has multiple consequences for tumor cells, including the ability to generate adenosine 5′-triphosphate (ATP), which decreases reliance on oxygen for ATP generation, thus reducing the generation of potentially damaging reactive oxygen species (ROS) by the mitochondrial electron transport chain,” the cancer researchers concluded.
In the 1920s, Otto Warburg demonstrated that cultured cancer cells have high rates of glucose uptake and secretion of lactate, even without a need for oxygen. Those three properties—glucose uptake, lactate secretion and creating energy without oxygen, are hallmarks of the Warburg effect.
Warburg was a German scientist in the early 20th century who first studied sea urchin eggs, but turned his attention to rat tumors in 1923. That switch had a lasting impact on the discipline of cancer biology, particularly in the understanding of energy production and use in . Warburg noticed that cancer cells fueled their own growth by sucking in huge amounts of glucose from the host’s blood. Today, positron emission scans can help identify cancers by pinpointing areas of the body where enormous amounts of glucose are being consumed by cells. Those cells are easily identified as cancerous because of their unmitigated greed for glucose.
Moreover, cancer cells invariably choose the ancient metabolic pathway—glycolysis—to produce energy. Cancer cells, Warburg realized, had figured out a way to ensure their survival by exploiting the oldest form of energy production on the planet. The Warburg effect is estimated to occur in 80 percent of cancers.
Now, the University of Southampton team is shedding new light on the energy production in cancer by zeroing in on p53. The protein, the researchers found, is regulated by “aerobic glycolysis” in . This is further mediated by the CtBP family of NADH-dependent transcriptional regulators, something Warburg never would have expected. “Through the provision of glucose-6 phosphate for the oxidative pentose phosphate pathway, glycolysis also facilitates the generation of a reduced form of nicotinamide adenine dinucleotide phosphate, which provides reducing equivalents for -protective pathways,” the team wrote.

Explore further
PGK1 protein promotes brain tumor formation and cancer metabolism

More information: Charles N. Birts et al. p53 is regulated by aerobic glycolysis in cancer cells by the CtBP family of NADH-dependent transcriptional regulators, Science Signaling (2020). DOI: 10.1126/scisignal.aau9529

COVID-19 Effect: Prescription Fills Mostly Down for Leading Drugs

Prescription fills for hydroxychloroquine/chloroquine spiked right after COVID-19 was declared a national emergency in March, but use of the drugs still remains well above 2019 levels, based on data from more than 58,000 U.S. pharmacies.
Hydroxychloroquine/chloroquine are also doing better than any of the prescription drugs in the top 10 based on total claims in 2019, Muthiah Vaduganathan, MD, MPH, of Brigham and Women’s Hospital, Boston, and associates reported May 28 in a research letter in JAMA.
Prescription fills for hydroxychloroquine/chloroquine have been above 2019 levels every week since the national emergency was declared on March 13, with the high occurring during the week of March 15-21, when fills were 214% higher than the corresponding week in 2019. The lowest level in that time came during the week of April 12-18, with growth of 14.6% over 2019, the investigators said.
The drugs occupying the top 10 — amlodipine, amoxicillin, atorvastatin, gabapentin, hydrocodone-acetaminophen, levothyroxine, lisinopril, losartan, omeprazole, and sertraline — have not done as well. Losartan, the only one that hasn’t lost ground in any week since March 13, rose by almost 49% during March 15-21, but was down to a 1.7% rise by the end of the study period, they reported.
Meanwhile, the other drug touted as a treatment for COVID-19, azithromycin, has fallen farther than most of the top 10. By April 19-25, the last week of the study period, fills for the antibiotic were down 62.7%, compared with last year, the analysis showed. Only amoxicillin had dropped more (64.4%).
The modest decline for most common long-term therapies after peak could represent reduced contact with prescribing clinicians, restricted access to pharmacies, pharmacist rationing, loss of insurance from unemployment, or replete supplies from early stockpiling, Dr. Vaduganathan and associates wrote.
The investigators used all-payer U.S. pharmacy data from 58,332 chain, independent, and mail-order pharmacies across 14,421 zip codes in 50 states, reflecting approximately 17 million deidentified claims, to estimate national prescription fills, they explained.
https://www.medscape.com/viewarticle/931443

New coronavirus losing potency, top Italian doctor says

The new coronavirus is losing its potency and has become much less lethal, a senior Italian doctor said on Sunday.
“In reality, the virus clinically no longer exists in Italy,” said Alberto Zangrillo, the head of the San Raffaele Hospital in Milan in the northern region of Lombardy, which has borne the brunt of Italy’s coronavirus contagion.
“The swabs that were performed over the last 10 days showed a viral load in quantitative terms that was absolutely infinitesimal compared to the ones carried out a month or two months ago,” he told RAI television.
Italy has the third highest death toll in the world from COVID-19, with 33,415 people dying since the outbreak came to light on Feb. 21. It has the sixth highest global tally of cases at 233,019.
However new infections and fatalities have fallen steadily in May and the country is unwinding some of the most rigid lockdown restrictions introduced anywhere on the continent.

Zangrillo said some experts were too alarmist about the prospect of a second wave of infections and politicians needed to take into account the new reality.
“We’ve got to get back to being a normal country,” he said. “Someone has to take responsibility for terrorizing the country.”
The government urged caution, saying it was far too soon to claim victory.
“Pending scientific evidence to support the thesis that the virus has disappeared … I would invite those who say they are sure of it not to confuse Italians,” Sandra Zampa, an undersecretary at the health ministry, said in a statement.
“We should instead invite Italians to maintain the maximum caution, maintain physical distancing, avoid large groups, to frequently wash their hands and to wear masks.”

A second doctor from northern Italy told the national ANSA news agency that he was also seeing the coronavirus weaken.
“The strength the virus had two months ago is not the same strength it has today,” said Matteo Bassetti, head of the infectious diseases clinic at the San Martino hospital in the city of Genoa.
“It is clear that today the COVID-19 disease is different.”
https://www.reuters.com/article/us-health-coronavirus-italy-virus/new-coronavirus-losing-potency-top-italian-doctor-says-idUSKBN2370OQ

Retailers already hit by coronavirus board up as U.S. protests rage

Retail giant Target Corp said on Sunday it shuttered stores across the United States as retailers already reeling from closures because of the coronavirus pandemic shut outlets amid protests that included looting in many U.S. cities.
Protests turned violent in places including New York and Chicago following the death in Minneapolis of a black man, George Floyd, seen on video gasping for breath as a white police officer knelt on his neck.
In Los Angeles, protests led to the looting of the Alexander McQueen clothing store on Rodeo Drive, and a Gucci store on the vaunted strip was marked with the graffiti slogan: “Eat the rich,” according to local media reports.

In the nearby Grove Shopping Center, which houses 51 upscale stores, Nordstrom, Ray Ban and Apple were broken into. Nordstrom Inc temporarily closed all its stores on Sunday, it told Reuters in an emailed statement.
“We hope to reopen our doors as soon as possible,” the statement said. “We had impacts at some of them and are in the process of assessing any damage so we can resume serving customers.”
The violence was widespread, and Target said it was closing or limiting hours at more than 200 stores. It did not specify how long the closures would last.

The company told Reuters it was beginning to board up its Lake Street store in Minneapolis, near where Floyd was killed, for safety and to begin recovery efforts. The company said in a statement that it would plan to reopen the store late this year.
“There is certainly potential for the resulting social unrest to hurt certain businesses like retailers and restaurants, and for it to further dent consumer and business sentiment,” said Robert Phipps, director at Per Stirling. “It is even possible, particularly if the unrest continues and spreads, that it would, all other things being equal, have a significant impact on investor psychology and the markets.”
U.S. retail sales have posted record declines as the novel coronavirus pandemic kept Americans at home, putting the economy on track for its biggest contraction in the second quarter since the Great Depression in the 1930s.
https://www.reuters.com/article/us-minneapolis-police-protests-retail/retailers-already-hit-by-coronavirus-board-up-as-u-s-protests-rage-idUSKBN2370Q0

U.S. sends Brazil 2 million doses of hydroxychloroquine

The United States has supplied Brazil with 2 million doses of hydroxychloroquine for use against the coronavirus, the two governments said on Sunday, despite medical warnings about risks associated with the anti-malaria drug.
The White House released a joint announcement on the drug, whose use has been touted both by U.S. President Donald Trump and Brazilian President Jair Bolsonaro, just days after the World Health Organization suspended testing it in COVID-19 patients because of safety concerns.
Trump himself said in mid-May that he was on a regimen of hydroxychloroquine as a preventive measure, even though the U.S. Food and Drug Administration had issued a warning about its use for the coronavirus.

Bolsonaro, a right-wing leader who has forged personal ties with Trump, said recently he kept a box of the drug in case his 93-year-old mother needed it.
“The American and Brazilian people stand in solidarity in the fight against the coronavirus,” the statement said. “We are announcing the United States Government has delivered two million doses of hydroxychloroquine (HCQ) to the people of Brazil.”
“HCQ will be used as a prophylactic to help defend Brazil’s nurses, doctors and healthcare professionals against the virus. It will also be used as a therapeutic to treat Brazilians who become infected,” it said.

The two countries will also conduct a joint research effort that will include “randomized controlled clinical trials,” the statement said, adding that the United States would soon send 1,000 ventilators to Brazil.
Brazil reported a record 33,274 new cases of the novel coronavirus on Saturday, its Health Ministry said, and the death toll surpassed that of France and now ranks only below the United States, Britain and Italy.
Demand for the decades-old hydroxychloroquine has surged as Trump repeatedly promoted its use against the coronavirus despite a lack of scientific evidence.
https://www.reuters.com/article/us-health-coronavirus-usa-brazil/u-s-sends-brazil-2-million-doses-of-hydroxychloroquine-drug-touted-by-trump-idUSKBN2370RU?il=0

Texas issues disaster declaration over George Floyd protests

Texas Gov. Greg Abbott issued a disaster declaration for the entire state Sunday in response to violent protests over the death of George Floyd.
The governor’s announcement came after violent clashes between police and demonstrators on Saturday in some of the Lone Star State’s largest cities, including Austin, Dallas, Houston and San Antonio, the Texas Tribune reported.
“Every Texan and every American has the right to protest and I encourage all Texans to exercise their First Amendment rights,” Abbott said in a statement. “However, violence against others and the destruction of property is unacceptable and counterproductive.”
The declaration, which allows the governor to designate federal law enforcement officials as Texas peace officers, comes one day after Abbott activated the Texas National Guard to help quell the protests.
The Texas Department of Public Safety has also dispatched more than 1,500 officers to help besieged local police departments deal with the demonstrations, the Tribune said.
More than a dozen cities throughout the US have been besieged by massive protests in response to the Memorial Day police custody death of George Floyd in Minneapolis.
Floyd, 46, was suspected of passing a counterfeit $20 bill when police pinned him to the ground for nearly four minutes despite his pleas that he couldn’t breathe.
Demonstrators from Los Angeles to New York, Chicago to Miami have seen widespread looting, vandalism and arson fires.
https://nypost.com/2020/05/31/texas-issues-disaster-declaration-over-george-floyd-protests/

ASCO 2020: Looking Back on COVID-19 in Order to Move Forward

At the virtual ASCO 2020 annual meeting, Giuseppe Curigliano, MD, PhD summarized and reviewed the previous two presentations in this session, on the TERAVOLT and COVID-19 Cancer Consortium (CCC-19) initiatives.
The CCC19 study included 928 patients with various types of cancers. In contrast, the TERAVOLT study included 400 patients with thoracic malignancies only. Another important difference was that in the CCC19, all patients had confirmed Real-time PCR COVID-19 infection, while in the TERAVOLT study, patients had either confirmed COVID-19 infection or had clinically suspected or radiologically suspected infection.
Dr. Curigliano also assessed the mortality rate in the CCC19 study. With a median of 21 days of follow up, 121 patients — representing 13% of the entire cohort — had died. In the TERAVOLT study, the median follow-up was 33 days, and 35.5% had died. There are many hypotheses for why patients with thoracic malignancies have a higher death rate, but one of these hypothesis states that these patients are prone to develop microvascular obstruction of lung vessels with the formation of microclots, manifesting as the thrombo-inflammatory syndrome (Figure 1).
Figure 1 – Thrombo-inflammatory syndrome:
Figure1_ThromboInflammatorySyndrome_ASCO2020.png

Table 1 compares the morbidity and mortality in the TERAVOLT and CCC19 studies and demontrates a higher mortality and hospitalization rate in the TERAVOLT study, but a lower ICU admission rate, and rate of mechanical ventilation. Table 2 demonstrates the independent factors for mortality in both studies, showing very similar risk factors. Table 3 shows important data as it presents the main differences between the two studies, including smoking status, gender, previous steroid use, cancer stage, and the region of patient residence. The data shown in Table 4 attempts to explain some of the presented differenced between these studies, which include the different accrual timeframe, the type of national and local government response to the COVID-19 pandemic, and the rate of critical care bed per capita, which was different in a staggering manner.
Table 1 – Morbidity and mortality in the TERAVOLT and CCC19 studies:
Table1_Morbitity_Mortality_ASCO2020.png
Table 2 – independent factors for mortality in the TERAVOLT and CCC19 studies:
Table2_IndependentFactorsforMortality_ASCO2020.png
Table 3 – CCC19 and TERAVOLT main differences:
Table3_CCC19_Teravolt_ASCO2020.png
Table 4 – CCC19 and TERAVOLT possible explanations for the major differences between the studies:
Table4_CCC19_Teravolt_ASCO2020.png
Dr. Curigliano moved on to discuss the mortality rates of COIVD-19 in cancer patients in areas that were hit with COVID-19 quite substantially. The mortality rate of patients with cancer and COVID-19 in New York City was markedly increased compared to non-cancer patients, and compared to all New York City COVID-19 patients. The mortality rate in cancer patients with COVID-19 was significantly higher when compared to all patients with COVID-19 in New York City (25% vs. 14%). Specifically, there was a 50% mortality rate among lung cancer patients, 40% mortality rate for breast cancer patients, 50% mortality rate for genitourinary cancer patients, and 38% mortality rate for gastrointestinal cancer patients.
When assessing the case fatality rate in cancer patients in Milan, Italy, cancer patients demonstrated markedly increased COVID-19 mortality rate compared to non-cancer patients admitted to the ICU. The case fatality rates in cancer patients with COVID-19 was 19% in elderly patients )>75 years old), while the overall mortality rate in cancer patients was 8%.
Dr. Curigliano moved on to discuss the major limitations of both the TERAVOLT and CCC19 studies. These included:
  • COVID-19 case definition in the TERAVOLT trial that was not standardized.
  • In the European centers the pandemic scenario resulted in very difficult triage decisions (TERAVOLT study).
  • The patient selection in the TERAVOLT study was problematic as well.
  • There was a high proportion of stage four non-small cell lung carcinoma in the TERAVOLT study.
  • In contrast, there was a high proportion of patients in remission in the CCC19 study.
  • There was no data presented on the occurrence of deep vein thrombosis or pulmonary embolism in both studies
  • There was no clear definition for eligibility to ICU.
  • Both studies were cross-sectional studies with no real-time data capture, no auditing, and no standardized outcome definitions.
  • In both studies, there are multiple biases, including selection bias, recall bias, confounding by indication, and changes in practice and or disease evolution.
  • Lastly, there was no propensity score adjustment, no control with non-cancer patients, and there was no stratification for the stage and lines of previous therapies.
  • In both studies, serious confounding may remain due to the impact of unmeasured confounders and unmeasured risks on treatment decisions.
The strengths of the studies include the fact that that these studies represent a real-world data set which investigates the risks for hospitalization and death in cancer patients. Importantly, these studies represent an unprecedented global effort to collect data of patients with cancer affected by COVID-19. Lastly, in both studies, similar independent factors were associated with increased mortality after adjustment, which included older age, increased number of comorbidities, worse performance status, active cancer, and chemotherapy alone or in combination with other treatments.
There are still many questions that remain regarding cancer care prioritization and care intensity optimization. It is not clear if cancer patients should be prioritized for the ICU triage for admission based on the disease stage. It is also unclear whether immunotherapy provides any kind of protective effect from COVID-19 infection and outcome.
In conclusion, older age, increased number of comorbidities, worse performance status, active cancer, and chemotherapy alone or in combination with other treatments, have been shown to increase the risk of mortality in cancer patients with COVID-19. It is important for centers to prepare for the treatment not only of suspected and confirmed cases of COVID-19, but also to consider the treatment of cancer patients with COVID-19 and prepare accordingly. Lastly, cancer treatment prioritization should balance interventions based on the magnitude of benefit in the clinical setting.
Before ending his talk, Dr. Curigliano discussed some research priorities in cancer patients. According to him, it is important to understand the utility of PCR testing in these patients. Longitudinal serological studies are urgently needed to determine the extent and duration of immunity to COVID-19. It is critical that we develop an epidemiological model to estimate the cumulative incidence of COVID-19 within a specific timeframe and pandemic scenario. We need to identify viral, environmental, and immunological factors that, in combination, will determine the dynamics of COVID-19. It is also critical to determine the morbidity and mortality associated with COVID-19 according to the specific treatment that is given to cancer patients (chemotherapy, targeted therapy, and immune checkpoint blockade).
To conclude his talk, Dr. Curigliano reiterated three important principles that continue to guide us through this pandemic:
  1. Transparency is the best policy.
  2. During this pandemic, there was an unprecedented collaboration among clinicians and scientists globally to work together and generate data for patients with cancer.
  3. Surprisingly, 21st-century science played a relatively small role in dealing and controlling the COVID-19 pandemic, while 19th-century methodology continued to prove it’s value, with early implementation of social distancing, personal protective equipment, and handwashing.
Presented by: Giuseppe Curigliano, MD, PhD, Associate Professor of Medical Oncology at the University of Milano, Head of the Division of Early Drug Development at European Institute of Oncology, Italy
https://www.urotoday.com/conference-highlights/asco-2020/asco-2020-prostate-cancer/121908-asco-2020-looking-back-on-covid-19-in-order-to-move-forward.html