Academic literature on the topic 'Fluorouracil – Toxicology'

Introduction Capecitabine is an orally bioavailable prodrug of the chemotherapeutic agent, fluorouracil. Fluorouracil is converted to several active metabolites that induce a cytotoxic effect. Capecitabine toxicity can be life-threatening with a delayed presentation from ingestion. An oral antidote, uridine triacetate, exists but requires the administration of 20 total doses over a course of five days. Case report In this report, we describe a case where timely coordination with a clinical toxicology laboratory was utilized to drive clinical decision making and management. Two children were brought to the emergency department shortly after suspected capecitabine ingestion. Management and outcome Patients were admitted to the hospital and started on uridine triacetate. Real-time comprehensive toxicology testing of the children’s blood was used to rule out capecitabine toxicity and prevent several unnecessary days of hospitalization and doses of antidote. Patients were discharged safely. Discussion Real-time comprehensive toxicology testing on a patient’s blood may be a valuable resource in ruling out or confirming toxic exposure in accidental pediatric ingestion of chemotherapeutic agents like capecitabine when performed in a timely manner.

Naringin is a citrus flavonoid recently studied for anti-inflammatory activity in numerous cancer cells. In this study, the anti-inflammatory properties of naringin along with 5-fluorouracil in human skin cancer cell lines A375 was analyzed. A375 cells were treated with naringin, 5-fluorouracil alone, and combination. MTT assay and cell viability assays was demonstrated to detect the inhibitory effects of naringin or 5-fluorouracil on cell proliferation. mRNA expression of TNFα, IL-6, IL-1β, and NFκB were determined using quantitative RT-PCR. The effect of naringin and 5-fluorouracil combination significantly inhibited the growth and proliferation of the A375 cells in a concentration dependent manner with the IC50 values of naringin (24.75 μM) 5-fluorouracil (2.5 μM). The combination of naringin+5-fluorouracil on A375 cell lines at a concentration of half IC50 values (12µM+1 μM). Naringin and 5-fluorouracil combination also decreased the level of TNFα, IL-6, IL-1β, and NFκB mRNA in the A375 cell line. Naringin and 5-fluorouracil exerted anti-inflammatory effect through the suppression of NF-kB, IL-1β, TNFα, IL-6 in A375 cells. Taken together, our results suggested that treating A375 with naringin and 5-fluorouracil combination may have future applications in treating skin cancers through its anti-inflammatory effect.

Spontaneous and chemotherapy-induced sister chromatid exchanges (SCES) and lymphocyte proliferation rate index (PRI) in cultured peripheral lymphocytes were evaluated in 30 patients with diagnosed breast cancer before and after adjuvant chemotherapy and in 30 healthy women with no known familial history of breast cancer. Before chemotherapy, the breast cancer patients had a significantly increased background level of SCE, and lowered PRI as compared with the healthy women. Marked inter-individual variations were observed in both endpoints among the patients. Significantly elevated frequency of SCE and depressed PRI were recorded in blood samples collected after the first cycle of chemotherapy, with high inter-individual variations in the responses to the chemotherapy. FAC (5-fluorouracil, adriamycin and cyclophosphamide) protocol was the most genotoxic of the protocols studied, but also AC (adriamycin, cyclophosphamide) and CMF (cyclophosphamide, methotrexate and 5-fluorouracil) clearly increased SCE. All protocols significantly retarded lymphocyte proliferation in vitro. Our findings indicate that both SCE and PRI may serve as sensitive biomarkers for the routine detection of critical lesions produced by the administration of antineoplastic drugs in the clinical setting, as well as for possible screening of high-risk individuals among patients who have successfully completed chemotherapy. Human & Experimental Toxicology (2007) 26 , 391—399

On the basis of clinical studies, some researchers have advocated that the neurohormone and antioxidant melatonin, shown to possess intrinsic anticancer properties, be used as co-therapy in cancer patients being treated with the antineoplastic agent 5-fluorouracil, as increased patient survival times and enhanced quality of life have been observed. The focus of this research was thus to investigate the mechanisms of this seemingly beneficial drug interaction between 5-fluorouracil and melatonin. Metabolism studies were undertaken, in which it was established that there is no hepatic metabolic drug interaction between these agents by cytochrome P450, and that neither agent alters the activity of this enzyme system. Co-therapy with melatonin is thus unlikely to alter plasma levels of 5-fluorouracil by this mechanism. Novel mechanisms by which 5-fluorouracil is toxic were elucidated, such as the induction of lipid peroxidation, due to the formation of reactive oxygen species; decreases in brain serotonin, dopamine and norepinephrine levels, possibly leading to depression; hippocampal shrinkage and morphological alterations and lysis of hippocampal cells, which may underlie cognitive impairment; and a reduction in the nociceptive threshold when administered acutely. All these deleterious effects are attenuated by the co-administration of melatonin, suggesting that the agent exhibits antidepressive and analgesic properties, in addition to its known antioxidative and free radical-scavenging abilities. This suggests that melatonin cotherapy can significantly decrease 5-fluorouracil-induced toxicity, but this may also exert a protective effect on cancer cells and thus compromise the anticancer efficacy of 5-fluorouracil. It was, furthermore, found that stimulation of indoleamine 2,3-dioxygenase activity, mediated by increases in superoxide anion and interferon-γ levels, may underlie resistance to 5-fluorouracil therapy. Melatonin was shown to increase superoxide anion levels in vivo, and this is believed to be by conversion to the metabolite and known oxidant 6- hydroxymelatonin. This highlights that the possible deleterious effects of melatonin metabolites should be studied further. Serum corticosterone levels and cytokine profiles are unaltered by both 5-FU and melatonin, suggesting that these agents may be used by HIV infected individuals without promoting the progression to AIDS. It can thus be concluded that melatonin co-therapy is potentially useful in countering 5-fluorouracil toxicity.

Les ARNm codent pour les protéines, tandis qu'un grand nombre d'ARNs nommés longues ARNs non codants (ARNlnc) ne sont pas traduites en protéines. Les deux types d’ARNs existent en isoforms qui se distinguent à cause de l’épissage alternatif. Certains des ARNlnc jouent des rôles importants dans la croissance et différentiation cellulaire. Cependant, leurs fonctions dans la cytotoxicité de la chimiothérapie anti-cancéreuse médicamenteuse utilisant le 5-fluorouracile (5-FU) sont encore inconnues. Pendant mes travaux j'ai trouvé que le traitement par le 5-FU cause l’accumulation des ARNlnc. Ce phénomène est parfois, sous forme d’ARN double brin (ARNds) formé par une paire de transcrits chevauchant, corrélé négativement avec le niveau de la protéine codée par l'ARNm. Cette inhibition potentielle de la traduction des régulateurs du cycle cellulaire clés et les gènes essentiels en formant des l'ARNds peut éventuellement empêcher la progression du cycle cellulaire. Nos analyses prometteuses devraient inspirer des études approfondies des ARNlnc dans la cytotoxicité du 5-FU chez la levure et l’homme afin d’'améliorer la chimiothérapie. J'ai trouvé que la surexpression de RRP6, peut conduire à une résistance accrue au traitement par le 5-FU. Je démontre ensuite que l’ARNlnc MUT1312 forme des ARNds avec RRP6 qui sont négativement corrélés avec le niveau de la protéine Rrp6. Par ailleurs, la surexpression de MUT1312 pendant la mitose et associé avec une diminution d’Rrp6. Ainsi, mon étude suggère que MUT1312 soit impliqué dans la régulation de Rrp6 pendant la differentiation cellulaire. Mes recherches de MUT477/SWI4 indiquent la function importante de la méiose induite à long ARN non codantes en tant que forme d'ARN double brin potentiellement réguler la traduction. J'ai trouvé que SUT200 pourrait inhiber la transcription de CDC6 durant la méiose par read-through. Un cas comparable est MUT1465 et CLN2. J’ai fait un criblage in silico pour trouver des facteurs de transcription qui activent des MUTs durant la méiose. J’ai trouvé que la plupart des MUTs sont induites par Ndt80. MUT1465 est parmi eux : il pourrait être induite par Ndt80 ce qui inhiberait l’expression de CLN2 après l’initiation de la méiose. J’ai trouvé que la répression de certains MUTs par le complexe Ume6/Rpd3 en mitose est différemment régulée entre JHY222 et SK1. MUT100 qui ne possède pas l'élément USR1 fixé par Ume6, et qui est donc une cible indirecte, est déréprimé dans JHY22 ume6 mais pas dans SK1 ume6. Pour la régulation de l'étude de isoforme méiose, Nous avons trouvé que le complexe histone déacétylase Rpd3/Sin3/Ume6, empêche également l'induction de l'isoforme longue de BOI1 dans la mitose par liaison directe de liaison Ume6 à sa cible de URS1. Orc1 est importante pour la réplication de l'ADN. J’ai démontré que mORC1 est une cible directe de l'activateur Ndt80 et que son motif de fixation (MSE) est nécessaire pour l'induction de l’isoforme mORC1 et du gene méiotique SMA2 transcrit de façon divergente. J’ai trouvé qu'une souche incapable d’induire mORC1, contient des niveaux anormalement élevés d’Orc1 pendant la gamétogenèse, ce qui corréle mORC1 avec la baisse de la protéine Orc1. En conclusion, mes études au cours du doctorat révèlent des nouvelles cibles et ainsi offrent des nouvelles perspectives de l’amélioration de la chimiothérapie par le 5-FU. Les mécanismes incluent la formation d'un ARN double brin avec son ARNm anti-sens pour potentiellement inhiber la traduction de l'ARNm, et inhibition en aval de l'ARNm par transcription read-through d’une ARNlnc. Mon travail a également révélé un mécanisme de régulation des ARNlnc et les isoforms d’ARN pendent la croissance et la différentiation cellulaire
RNAs are molecules with important functions in diverse cellular processes. mRNAs encode proteins, while a large number of RNAs called long noncoding RNAs (lncRNAs) are not translated into proteins. Both types of RNAs exist in various isoforms due to alternative splicing.Some of lncRNA play important roles in cell growth and differentiation. However, their functions in the cytotoxicity of the drug anticancer chemotherapy using 5-fluorouracil (5-FU) are still unknown. During my research I found that treatment with 5-FU causes accumulation of lncRNA. Acuumulated antisense lncRNA form double stranded RNA with the mRNAs , negatively correlated with the level of the protein encoded by the mRNA. This potential inhibition of translation of key cell cycle regulators and essential genes by forming dsRNA may possibly prevent the progression of the cell cycle. My results suggest that lncRNA are likely to play an important role in the cytotoxicity of 5-FU. Our promising testing should inspire in-depth studies of lncRNA in the cytotoxicity of 5-FU in yeast and humans to improve chemotherapy.Rrp6 is a 3'-5 'exoribonuclease, which plays an important role in the regulation and modification of rRNA, mRNA and lncRNA. I found that overexpression of RRP6, the homologue of the yeast EXOSC10 gene in mammals, can lead to increased resistance to treatment with 5-FU. I found that the lncRNA MUT1312 form dsRNA with RRP6 that are negatively correlated with the level of Rrp6 protein. Furthermore, overexpression of MUT1312 during mitosis and associated with a decrease of Rrp6. Thus, my study suggests that MUT1312 may involved in the regulation of Rrp6 during cell differentiation. I further explored the function of the double-stranded RNA in meiosis. My research about SWI4/MUT477 indicates the important function of meiosis induced long noncoding RNA as a form of double-stranded RNA potentially regulate translation. Another aspect of the function of lncRNA is to regulate the transcription of downstream mRNA. I found SUT200 could inhibit transcription of CDC6 during meiosis by read-through. A similar case is CLN2/MUT1465. I did an in silico screening to find transcription factors that activate MUTs during meiosis. I found that most MUTs are induced by Ndt80. MUT1465 is among them: it could be induced by Ndt80 which inhibit the expression of CLN2 after initiation of meiosis. I found that repression of certain MUTs by the Ume6 / Rpd3 complex in mitosis is regulated differently between JHY222 and SK1. MUT100 which does not have the Ume6 binding site URS1 element, and is therefore an indirect target is derepressed in JHY22 ume6 but not in SK1 ume6. For the study about regulation of meiosis isoform, we have found that the histone deacetylase complex Rpd3 / Sin3 / Ume6 prevents the induction of long isoform BOI1 in mitosis by direct binding Ume6 binding to its target URS1.Orc1 is important for DNA replication. I have demonstrated that mORC1 is a direct target of the Ndt80 activator and its binding motif (MSE) is required for induction of isoform mORC1 and meiotic gene SMA2 divergently transcribed. I found that a strain incapable of inducing mORC1 contains abnormally high levels of Orc1 during gametogenesis, which correlates with mORC1 declining Orc1 protein. Since eukaryotic genes often encode multiple transcripts with 5'-UTR of variable length, the findings are likely relevant to gene expression during development and disease in higher eukaryotes. In conclusion, my studies during PhD reveal new targets and thus offer new prospects for improving chemotherapy with 5-FU. Mechanisms include (1) the formation of a double strand with its antisense mRNAs to potentially inhibit translation of mRNA, and (2) downstream inhibition of mRNA transcription read-through of a lncRNA. My work also revealed a lncRNA regulatory mechanism and RNA isoforms dangling growth and cell differentiation

Mestrado em Toxicologia e Ecotoxicologia
Atualmente, as terapias anticancerígenas normalmente consistem na combinação de fármacos e também em outras abordagens terapêuticas como a radioterapia, a cirurgia, entre outras, contribuindo para um prognóstico mais favorável dos doentes com cancro, bem como para a melhoria da sua qualidade de vida. Em contrapartida, o aumento da eficácia clínica é acompanhado por uma elevada incidência de efeitos secundários graves. Os efeitos secundários da quimioterapia são uma das grandes limitações à sua utilização e a cardiotoxicidade é considerada um dos efeitos secundários mais graves da quimioterapia. Esta dissertação teve como objetivo avaliar e comparar a toxicidade da doxorrubicina (DOX), do 5-fluorouracilo (5-FU), da ciclofosfamida (CIC) e da sua mistura (Cyclophosphamide+Adriamycin+5-Fluorouracil, doravante designada CAF) em células H9c2 diferenciadas. Para tal, as células H9c2 diferenciadas foram incubadas com DOX, 5-FU e CIC numa gama de concentrações entre 0-5 μM, durante 24 ou 48 horas. As células H9c2 foram também expostas a concentrações de 10, 25 e 50 μM de 5-FU ou CIC, durante 48 horas. Além disso, as células H9c2 diferenciadas foram incubadas com a mistura CAF nas concentrações de 0,2; 1 ou 5 μM de cada fármaco durante 48 horas. Após o tempo de incubação, foram realizados os seguintes testes de citotoxicidade: teste de redução do brometo de 3-(4,5-dimetil-tiazol-2-il)-2,5-difenil tetrazólio (MTT) e o teste de incorporação do vermelho neutro. A DOX no teste de redução do MTT demonstrou causar citotoxicidade em todas as concentrações testadas, quando comparado com as células controlo, sendo esta citotoxicidade dependente da concentração e mais acentuada para o maior tempo de exposição. No teste de incorporação do vermelho neutro, a DOX provocou citotoxicidade significativa nas concentrações de 0,5; 1; 2,5 e 5 μM, quando comparado com o controlo, sendo a citotoxicidade dependente do tempo de incubação.Relativamente ao 5-FU, após 24 horas de exposição observou-se citotoxicidade no teste de redução do MTT apenas na concentração de 5 μM. Quando as células foram expostas 48 horas ao 5-FU, verificou-se citotoxicidade significativa nas concentrações de 0,5; 1; 2,5 e 5 μM, em comparação com o controlo. No teste de incorporação do vermelho neutro, apenas as concentrações 1; 2,5 e 5 μM de 5-FU causaram toxicidade às células H9c2 diferenciadas. Quando as células foram incubadas com 10, 25 e 50 μM de 5-FU, todas as concentrações testadas causaram citotoxicidade quer esta tenha sido avaliada pelo ensaio de redução do MTT, quer pelo ensaio de incorporação do vermelho neutro. No que diz respeito à CIC, no teste de redução do MTT e às 24 horas, apenas a concentração de 1 μM causou citotoxicidade significativa. Porém, às 48 horas de incubação, as concentrações de 0,13; 0,2; 1 e 5 μM causaram citotoxicidade quando comparado com as células controlo. No teste de incorporação do vermelho neutro não se verificaram diferenças significativas em nenhuma concentração ou tempos de exposição testados, quando comparado com o controlo. No entanto, quando as células H9c2 diferenciadas foram incubadas com 10, 25 e 50 μM de CIC verificou-se toxicidade quando esta foi avaliada pelo teste de redução do MTT; no entanto no teste de incorporação do vermelho não se verificaram quaisquer diferenças significativas nas células expostas a CIC, quando comparado com as células do controlo. No que diz respeito à combinação de fármacos, CAF, esta na concentração de 0,2 μM (de cada fármaco da mistura), causa citotoxicidade de acordo com ambos os testes realizados em células H9c2 diferenciadas, quando comparado com as células do controlo. De facto, a mistura na concentração de 0,2 μM causa citotoxicidade no teste de redução do MTT significativamente maior do que cada um dos compostos isoladamente, quando a citotoxicidade foi avaliada pelo teste de redução do MTT. No teste de incorporação do vermelho neutro, no entanto, não existem diferenças significativas nos níveis de incorporação do corante no interior das células entre a mistura e cada um dos fármacos incubados isoladamente. Quando as células foram incubadas com 1 ou 5 μM de CAF (de cada fármaco da mistura), verificou-se que a toxicidade observada no teste de redução do MTT não era significativamente diferente entre a mistura CAF e qualquer mistura que contenha DOX, ou mesmo a DOX isoladamente. Verificaram-se diferenças significativas apenas entre a mistura e a associação de 5-FU+CIC, e os fármacos 5-FU e a CIC, isoladamente. Concluindo, a DOX, o 5-FU, a CIC e a CAF causam cardiotoxicidade em concentrações na ordem dos micromolar em células H9c2 diferenciadas, apesar dos valores encontrados serem diferentes consoante o teste de citotoxicidade utilizado. A DOX é o fármaco anticancerígeno mais tóxico no modelo celular utilizado, de acordo, com os dois testes de citotoxicidade realizados e parece contribuir de forma significativa para a toxicidade cardíaca da combinação CAF.
Currently, the most common therapeutic approaches for cancer combine drugs and also use other procedures, such as radiation therapy and surgery, among others. The use of combined therapeutics contributes both to attain a better prognosis and to improve the quality of life for people living with cancer. Unfortunately, the increased clinical efficacy of combined approaches is accompanied by a higher incidence of severe side effects. In fact, the use of chemotherapy causes severe side effects, which are major limitations for its use and with cardiotoxicity being considered one of its most serious adverse effects. This dissertation aimed to evaluate and compare the toxicity of doxorubicin (DOX), 5-fluorouracil (5-FU), cyclophosphamide (CIC), and their combination (Cyclophosphamide + Adriamycin + 5-Fluorouracil, herein after referred as CAF) in differentiated H9c2 cardiac cells. Thus, differentiated H9c2 cells were treated with several concentrations of DOX, 5-FU and CIC over a range from 0-5 μM, for 24 or 48 hours. Moreover, the cells H9c2 were treated with CAF mixtures containing 0.2; 1 or 5 μM of each drug during 48 hours. After the incubation period, the cytotoxicity was measured using the reduction of 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and neutral red incorporation assays. According to the MTT assay, the cells treated with DOX showed cytotoxicity for all concentrations tested when compared with the control, and the cytotoxicity was concentration-dependent and more notorious in the longest time of exposure. In the neutral red assay, when compared to the control, the cellular damage caused by DOX was observed for the concentrations of 0.5; 1; 2.5, and 5 μM and showed to be time-dependent. Regarding 5-FU, after an incubation time of 24 hours only the concentration of 5 μM showed significant toxicity in the MTT assay and the cytotoxicity increased in the longest incubation time. In fact, when the cells were exposed to 5-FU during 48 hours a significant cytotoxicity was shown at the concentrations of 0.5; 1; 2.5 to 5 μM, when compared with control. In the neutral red uptake assay, only the concentrations of 1; 2.5 and 5 μM of 5-FU caused toxicity to differentiated H9c2 cells. Additionally, when the cells were incubated with 10, 25 and 50 μM of 5-FU, all tested concentrations caused cytotoxicity observed on both the MTT reduction and neutral red uptake assays. Concerning CIC, in the MTT reduction assay, cells treated for 24 hours only showed significant cytotoxicity for the concentration 1 μM. However, after 48 hours, significant of incubation the cytotoxicity was observed for the concentrations of 0.13; 0.2; 1, and 5 μM when compared to the control cells. In the neutral red uptake assay, no significant differences were observed for any of the concentrations or exposure periods tested, when compared to the control cells. When differentiated H9c2 cells were incubated with 10, 25, and 50 μM of CIC, toxicity was seen in the MTT reduction assay; whereas for the neutral red uptake assay no significant differences where observed when compared to the control cells. Finally, the combination of drugs, CAF, at a concentration of 0.2 μM (of each drug) causes toxicity in the MTT reduction and neutral red uptake assays performed. In fact, the drugs in combination exhibited a significantly higher cytotoxicity, in the MTT assay when compared with each compound alone at a concentration of 0.2 μM. In the neutral red uptake assay, however, no significant differences were observed for the mixture when compared to each drug by itself. When the cells were treated with 1 and 5 μM of CAF, a significant toxicity was seen in the MTT reduction assay when compared to the control cells. Nevertheless, there were no significant differences between the CAF mixture and any mixture containing DOX, or even DOX alone. In fact, significant differences were only observed between CAF and 5-FU, or CIC or the association 5-FU + CIC. In summary, DOX, 5-FU, CIC, and CAF cause cardiotoxicity in differentiated H9c2 cells when in micro-molar concentrations, although with the assay used show different sensitivities to demonstrate that toxicity. Moreover, according to the results, for the cell model used and with the cytotoxicity assays performed, DOX is the most toxic anticancer drug tested and appears to contribute significantly to the cardiac toxicity of the combination CAF.

Although survival rates of colorectal cancer (CRC) treated with surgery and conventional chemotherapy are high, metastatic CRC still shows acute mortality rates. Current chemotherapeutic treatment involves high doses of cytotoxic drugs, particularly adjuvant combinations of 5-Fluorouracil (5-FU) and Irinotecan (prodrug of SN-38). However, these treatments cause undesirable effects to the patients, which can negatively contribute to their survival. The use of polymer-drug conjugates (PDC) has attracted great attention in the field of controlled drug delivery for cancer treatment, improving the ratio of cytotoxic drugs in tumour tissues, taking advantage of the enhanced permeability retention effect, and consequently reducing the toxicity in healthy tissues. In this thesis the poly-(L-glutamic acid) (PGA) biodegradable polymer has been chosen as the carrier of the designed polymer-drug conjugates. By reason of the chemotherapeutic agent 5-FU is the mainstay of cytotoxic therapy against advanced CRC, in all PDC studied 5-FU has been conjugated to PGA. Three different types of PGA-based PDC have been studied: (i) PGA-5-FU conjugates; (ii) PGA-MMPpept-5FU conjugates using enzymatically-cleavable linkers, particularly MMP-sensitive peptides since some MMPs levels increase as CRC progress; and (iii) PGA-5FU-SN38 conjugates to evaluate the synergism between 5-FU and SN-38 conjugated in a single PDC. Regarding the PGA-5-FU conjugate, it was demonstrated that the conjugation of 5-FU to a PGA carrier through an ester bond showed therapeutic activity in vitro in the HCT-116.Fluc2-C9 and HT-29.FlucC4 CRC cell lines. Cellular uptake experiments performed with PGA-5-FU labelled with carboxyfluoresceine fluorescent probe indicated that the internalization of the PDC was through the endocytic pathway. In addition, in vivo biodistribution experiments of PGA-5-FU labelled with an AlexaFluor dye confirmed that the accumulation in tumor was maximal at 4 h post-adminstration, confirming also that the product was excreted through the kidney, but also removed by the liver in smaller amounts. In the study of a new PDC sensitive to MMP7 to deliver 5-FU we confirmed that it is of significant importance the type of link between the MMP7-sensitive peptide (AHX-RPLALWRS-AHX) and the bioactive agent 5-FU. It was confirmed through cytotoxic experiments of the peptide-drug unit that the carbamate union was too stable in vitro, opposite to the ester bond behavior, resulting as an undesirable linkage for their use in polymeric nanoconjugates designed to deliver drugs gradually. Then, in vitro therapeutic efficacy studies performed in HCT-116.Fluc2-C9 and HT-29.Fluc-C4 cells overexpressing MMP7, showed that the conjugation of 5-FU linked to AHX-RPLALWRS-AHX peptide through an ester bond to a PGA carrier, lead a PDC that adopted a conformation in solution that resulted very accessible for the MMP7 enzyme. When comparing PGA-MMP7pept-5FU with the PGA-5-FU system, it was confirmed that the nature and length of the peptide linker is of significant relevance on the final conformation of the conjugate, therefore on the kinetic release of the drug. Finally, a family of PGA-5FU-SN38 conjugates through an ester bond carrying different proportions of drugs was synthesized using PGA carrier with a molecular weight of 15 KDa. In vitro studies showed an improvement of the cytotoxic activity in the HCT-116.Fluc2-C9 and HT-29.Fluc4 CRC cells of the conjugates carrying both agents in a ratio of SN-38/5-FU of 1:40 and 1:300 in comparison with the behavior observed with the combined drugs as single agents at the same ratio. It was studied the synergy through the calculation of the Combination Index, and we confirmed that the conjugation of SN-38 and 5-FU in a single polymeric vehicle was traduced in a strong synergic interaction between both drugs when compared to the single PDC.
El agente 5-fluorouracilo (5-FU) es el tratamiento quimioterapéutico sistémico esencial para el tratamiento del cáncer colorectal. Sin embargo, la supervivencia global y superación de la enfermedad de pacientes tratados con 5-FU como primera línea de tratamiento es sólo del 10-15%. El uso de conjugados de polímero-fármaco (PDC) ha atraído gran atención en el campo de la administración controlada de fármacos para el tratamiento del cáncer. Éstos mejoran la acumulación de agentes citotóxicos en tejidos tumorales, aprovechando las características en la vascularización de los tumores, por consiguiente reduciendo la toxicidad en los tejidos sanos. Se han estudiado tres tipos diferentes de PDC basados en el polímero biodegradable ácido poly-(L-glutámico)(PGA): (i) Conjugado de PGA-5-FU; (ii) Conjugados de PGA-MMPpept-5FU utilizando enlazadores escindibles enzimáticamente, especialmente péptidos sensibles a MMP-7, ya que los niveles de algunas MMP aumentan a medida que el progresa el CRC; y (iii) conjugados de PGA-5FU-SN38 para evaluar la sinergia entre 5-FU y SN-38 conjugado en un solo vehículo. El conjugado PGA-5-FU mostró actividad terapéutica in vitro en las líneas celulares HCT-116.Fluc2-C9 y HT-29.FlucC4 e internalización mediante endocitosis, mediante la técnica de microscopía confocal. Además, experimentos de biodistribución in vivo confirmaron la acumulación en el tumor y la excreción vía renal y hepática. Con el conjugado PGA-MMP7-5FU se confirmó que la importancia del tipo de enlace entre el péptido MMP7 sensible (AHX-RPLALWRS-AHX) y el agente 5-FU; ya que se observó que la unión carbamato era demasiado estable in vitro, en comparación con la unión éster. Los estudios de citotxicidad in vitro con sobreexpresión de MMP7, confirmaron que la conformación en solución resultó muy accesible para la enzima MMP7. Finalmente, se sintetizó una familia de conjugados PGA-5FU-SN38 con diferentes proporciones de fármacos. Se estudió la sinergia entre ambos mediante el cálculo del índice de combinación, y se confirmó que la conjugación de SN-38 y 5-FU en un solo vehículo polimérico mostraba una fuerte sinérgica entre ambos fármacos en comparación con los PDC cargados con una única droga.