Implications of inappropriate prescription of oral nutritional supplements on the quality of life of cancer outpatients: a cross-sectional comparative study.

BACKGROUND AND AIMS: Oral nutritional supplements (ONS) are considered a cornerstone in the treatment plan of malnutrition in cancer patients. However, the prevalence of inappropriate prescription of ONS is high. In this study, we aim to investigate the effect of inappropriate oral nutritional supplementation (consisting of prescription of ONS without evident clinical indication, or the absence of ONS when at risk of malnutrition) on the quality of life of cancer outpatients. METHODS: A cross-sectional comparative study was conducted in 104 cancer outpatients, receiving ONS without prior malnutrition risk screening (n = 51), and patients not receiving ONS (n = 53). Nutritional risk screening was performed using the abridged patient-generated subjective global assessment (ab-PG-SGA). The quality of life was assessed using EORTC QLQ-C30 version 3.0 questionnaire. Multivariate analysis was conducted to determine the predictors of quality-of-life scales. Age (years), malnutrition (ab-PG-SGA scores), BMI (kg/m2), TSF (mm), MUAC (cm), ONS (yes, no) were entered into the linear regression analysis as predictors (backward stepwise linear regression analysis). RESULTS: The prevalence of malnutrition risk (ab-PG-SGA ≥ 6) was 74%. The median score of the ab-PG-SGA for ONS receiving group was significantly higher (p = 0.045). Furthermore, univariate analysis showed that the scores of the global health status (QoL) and the role functioning (RF) scales were significantly lower for the ONS receiving group (p = 0.020 and p = 0.016, respectively). Multivariately, malnutrition, inappropriate ONS prescription, and triceps skin fold were found to be predictors of the RF scale, while malnutrition was the only predictor for the QoL. CONCLUSION: The inappropriate ONS prescription does not improve nutritional status or quality of life of cancer outpatients.

Recent advances in nanomedicine-based delivery of histone deacetylase inhibitors for cancer therapy.

Histone deacetylase inhibitors (HDACi) are cancer therapeutics that operate at the epigenetic level and which have recently gained wide attention. However, the applications of HDACi are generally hindered by their poor physicochemical characteristics and unfavorable pharmacokinetic profile. Inspired by the approved nanomedicine-based drugs in the market, nanocarriers could provide a resort to circumvent the limitations imposed by HDACi. Enhanced tumor targeting, improved cellular uptake and reduced toxicity are major advantages offered by HDACi-loaded nanoparticles. More importantly, site-specific drug delivery can be achieved via engineered stimuli-responsive nanosystems. In this review we elucidate the anticancer mechanisms of HDACi and their structure-activity relationships, with a special focus on their nanomedicine-based delivery, different drug loading concepts and their implications.

Malnutrition score and Body Mass Index as nutritional screening tools for hemodialysis patients.

BACKGROUND AND AIMS: Malnutrition is highly prevalent in the hemodialysis population. Nutritional screening is important to identify patients at risk of malnutrition. This study aimed to investigate the concurrent validity of BMI cut-offs (BMI < 23 kg/m2 and BMI < 18.5 kg/m2) and DMS, as simple nutritional screening tools, compared to PG-SGA, as the reference standard, in detecting the risk of malnutrition in hemodialysis patients. DESIGN: A Single-centered cross-sectional study design. METHODS: A total of 98 patients on maintenance hemodialysis, who were at least 18 years old (mean age: 51.33 ± 14.12) and subjected to hemodialysis for at least 3 months, were screened. Concurrent validity was assessed using receiver operating characteristic (ROC) curve analysis as well as sensitivity, specificity, accuracy, PPV, NPV, LR+ and LR-, against diagnosed malnutrition. RESULTS: The patients considered malnourished were 71.4% (n = 70), with the majority being females (60%), and possessed a BMI distribution of 28.2 ± 6.3 kg/m2. DMS (score ≥ 14) agreed with diagnosed malnutrition (κ = 0.450 (95% CI 0.26-0.64) <0.0005). Furthermore, DMS (score ≥ 14) showed a sensitivity and a specificity of 84.3% and 60.7%, respectively. However, BMI cut-offs (<23 kg/m2 or < 18.5 kg/m2) did not show any agreement with diagnosed malnutrition. CONCLUSION: DMS is a useful screening tool for detecting the risk of malnutrition in hemodialysis patients. On the contrary, BMI <23 kg/m2 and BMI <18.5 kg/m2 were not valid tools for identifying the risk of malnutrition in hemodialysis patients.

Self-assembled non-covalent protein-drug nanoparticles: an emerging delivery platform for anti-cancer drugs.

INTRODUCTION: Protein nanocarriers offer advantageous delivery platforms for anti-cancer drugs, provided by their biocompatibility, high drug loading capacity, and their ability to encapsulate hydrophobic active therapeutics. However, the conventional fabrication techniques of protein nanoparticles (NPs) often suffer from incorporation of considerable amounts of toxic solvents and crosslinking agents which may result in significant toxicity or compromise the drug stability. Therefore, novel strategies were proposed to induce non-covalent self-assembly of proteins by exploiting hydrophobic interactions or manipulation of disulfide bonds to produce nontoxic crosslinker-free drug-loaded protein NPs. Thermal mediated unfolding, the use of reducing agents, modulation of pH and ionic strength, chemical-induced denaturation as well as photochemical methods can be efficiently utilized to induce the protein self-assembly process. AREAS COVERED: In this review, we highlight the novel approaches used in the development of non-covalent protein-drug nano-assemblies, formulation factors, their implications, limitations, and treatment outcomes as well as future challenges. EXPERT OPINION: Formulation of protein-drug nanocarriers via non-covalent self-assembly can be advantageous as a promising strategy for efficient and safe tumor-targeted delivery of anti-cancer drugs compared to the conventional nano-fabrication technologies.

Lactoferrin, a multi-functional glycoprotein: Active therapeutic, drug nanocarrier & targeting ligand.

Recent progress in protein-based nanomedicine, inspired by the success of Abraxane® albumin-paclitaxel nanoparticles, have resulted in novel therapeutics used for treatment of challenging diseases like cancer and viral infections. However, absence of specific drug targeting, poor pharmacokinetics, premature drug release, and off-target toxicity are still formidable challenges in the clinic. Therefore, alternative protein-based nanomedicines were developed to overcome those challenges. In this regard, lactoferrin (Lf), a glycoprotein of transferrin family, offers a promising biodegradable well tolerated material that could be exploited both as an active therapeutic and drug nanocarrier. This review highlights the major pharmacological actions of Lf including anti-cancer, antiviral, and immunomodulatory actions. Delivery technologies of Lf to improve its pries and enhance its efficacy were also reviewed. Moreover, different nano-engineering strategies used for fabrication of drug-loaded Lf nanocarriers were discussed. In addition, the use of Lf for functionalization of drug nanocarriers with emphasis on tumor-targeted drug delivery was illustrated. Besides its wide application in oncology nano-therapeutics, we discussed the recent advances of Lf-based nanocarriers as efficient platforms for delivery of anti-parkinsonian, anti-Alzheimer, anti-viral drugs, immunomodulatory and bone engineering applications.