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1.
Int J Mol Sci ; 22(11)2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34071200

RESUMO

In the tumor microenvironment, mesenchymal stromal cells (MSCs) are key modulators of cancer cell behavior in response to several stimuli. Intratumoral acidosis is a metabolic trait of fast-growing tumors that can induce a pro-tumorigenic phenotype in MSCs through the activation of the NF-κB-mediated inflammatory pathway, driving tumor clonogenicity, invasion, and chemoresistance. Recent studies have indicated that curcumin, a natural ingredient extracted from Curcuma longa, acts as an NF-κB inhibitor with anti-inflammatory properties. In this work, highly proliferating osteosarcoma cells were used to study the ability of curcumin to reduce the supportive effect of MSCs when stimulated by acidosis. Due to the poor solubility of curcumin in biological fluids, we used spherical polymeric nanoparticles as carriers (SPN-curc) to optimize its uptake by MSCs. We showed that SPN-curc inhibited the release of inflammatory cytokines (IL6 and IL8) by acidity-stimulated MSCs at a higher extent than by free curcumin. SPN-curc treatment was also successful in blocking tumor stemness, migration, and invasion that were driven by the secretome of acid-stressed MSCs. Overall, these data encourage the use of lipid-polymeric nanoparticles encapsulating NF-κB inhibitors such as curcumin to treat cancers whose progression is stimulated by an activated mesenchymal stroma.


Assuntos
Curcumina/farmacologia , Células-Tronco Mesenquimais/metabolismo , Nanopartículas/química , Osteossarcoma/metabolismo , Anti-Inflamatórios/farmacologia , Linhagem Celular Tumoral , Citocinas/metabolismo , Humanos , Proteínas I-kappa B , Células-Tronco Mesenquimais/efeitos dos fármacos , NF-kappa B/metabolismo , Osteossarcoma/tratamento farmacológico , Microambiente Tumoral/efeitos dos fármacos
2.
RSC Appl Polym ; 1(1): 19-29, 2023 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-38013908

RESUMO

Interactive materials are an emerging class of systems that can offer control over response and adaptivity in polymer structures towards the meso- and macroscale. Here, we use enzyme regulated cleavage of peptide crosslinkers in polymer hydrogels to release a cytotoxic therapeutic nanoparticle with an adaptable mechanism. Hydrogel microplates were formed through polyethylene glycol/peptide photoinitiated thiol-ene chemistry in a soft-lithography process to give square plates of 20 by 20 µm with a height of 10 µm. The peptide was chosen to be degradable in the presence of matrix metalloproteinase 2/9 (MMP-2/9). The hydrogel material's mechanical properties, swelling, and protease degradation were characterised. The microfabricated hydrogels were loaded with docetaxel (DTXL) containing poly(dl-lactide-co-glycolide) (PLGA) nanoparticles, and characterised for enzyme responsivity, and toxicity to MMP-2/9 overexpressing brain cancer cell line U87-MG. A 5-fold decrease in EC50 was seen compared to free DTXL, and a 20-fold decrease was seen for the MMP responsive microplates versus a non-degradable control microplate. Potential applications of this system in post-resection glioblastoma treatment are envisioned.

3.
Drug Deliv Transl Res ; 12(8): 1829-1842, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-34973133

RESUMO

Schizophrenia is a disorder characterized by cognitive impairment and psychotic symptoms that fluctuate over time and can only be mitigated with the chronic administration of antipsychotics. Here, we propose biodegradable microPlates made of PLGA for the sustained release of risperidone over several weeks. Two microPlate configurations - short: 20 × 20 × 10 µm; tall: 20 × 20 × 20 µm - are engineered and compared to conventional ~ 10 µm PLGA microspheres in terms of risperidone loading and release. Tall microPlates realize the slowest release documenting a 35% risperidone delivery at 100 days with a residual rate of 30 ng/ml. Short microPlates and microspheres present similar release profiles with over 50% of the loaded risperidone delivered within the first 40 days. Then, the therapeutic efficacy of one single intraperitoneal injection of risperidone microPlates is compared to the daily administration of free risperidone in heterozygous knockout mice for dysbindin-1, a clinically relevant mouse model of cognitive and psychiatric liability. In temporal order object recognition tasks, mice treated with risperidone microPlates outperform those receiving free risperidone up to 2, 4, 8, and 12 weeks of observation. This suggests that the sustained release of antipsychotics from one-time microPlate deposition can rescue cognitive impairment in dysbindin mice for up to several weeks. Overall, these results demonstrate that risperidone-loaded microPlates are a promising platform for improving cognitive symptoms associated to schizophrenia. Moreover, the long-term efficacy with one single administration could be of clinical relevance in terms of patient's compliance and adherence to the treatment regimen. Single injection of long-acting risperidone-loaded µPL ameliorates the dysbindin-induced deficit in a clinically relevant mouse model of cognitive and psychiatric liability for up to 12 weeks.


Assuntos
Antipsicóticos , Disfunção Cognitiva , Esquizofrenia , Animais , Disfunção Cognitiva/tratamento farmacológico , Preparações de Ação Retardada/uso terapêutico , Disbindina , Camundongos , Risperidona , Esquizofrenia/tratamento farmacológico
4.
Drug Deliv Transl Res ; 12(8): 2019-2037, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35284984

RESUMO

The storied history of controlled the release systems has evolved over time; from degradable drug-loaded sutures to monolithic zero-ordered release devices and nano-sized drug delivery formulations. Scientists have tuned the physico-chemical properties of these drug carriers to optimize their performance in biomedical/pharmaceutical applications. In particular, particle drug delivery systems at the micron size regime have been used since the 1980s. Recent advances in micro and nanofabrication techniques have enabled precise control of particle size and geometry-here we review the utility of microplates and discoidal polymeric particles for a range of pharmaceutical applications. Microplates are defined as micrometer scale polymeric local depot devices in cuboid form, while discoidal polymeric nanoconstructs are disk-shaped polymeric particles having a cross-sectional diameter in the micrometer range and a thickness in the hundreds of nanometer range. These versatile particles can be used to treat several pathologies such as cancer, inflammatory diseases and vascular diseases, by leveraging their size, shape, physical properties (e.g., stiffness), and component materials, to tune their functionality. This review highlights design and fabrication strategies for these particles, discusses their applications, and elaborates on emerging trends for their use in formulations.


Assuntos
Portadores de Fármacos , Sistemas de Liberação de Medicamentos , Portadores de Fármacos/química , Composição de Medicamentos , Sistemas de Liberação de Medicamentos/métodos , Tamanho da Partícula , Polímeros/química
5.
J Control Release ; 329: 16-35, 2021 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-33259851

RESUMO

The central nervous system (CNS), consisting of the brain, spinal cord, and retina, superintends to the acquisition, integration and processing of peripheral information to properly coordinate the activities of the whole body. Neurodegenerative and neurodevelopmental disorders, trauma, stroke, and brain tumors can dramatically affect CNS functions resulting in serious and life-long disabilities. Globally, the societal and economic burden associated with CNS disorders continues to grow with the ageing of the population thus demanding for more effective and definitive treatments. Despite the variety of clinically available therapeutic molecules, medical interventions on CNS disorders are mostly limited to treat symptoms rather than halting or reversing disease progression. This is attributed to the complexity of the underlying disease mechanisms as well as to the unique biological microenvironment. Given its central importance, multiple barriers, including the blood brain barrier and the blood cerebrospinal fluid barrier, protect the CNS from external agents. This limits the access of drug molecules to the CNS thus contributing to the modest therapeutic successes. Loco-regional therapies based on the deposition of thermoresponsive hydrogels loaded with therapeutic agents and cells are receiving much attention as an alternative and potentially more effective approach to manage CNS disorders. In this work, the current understanding and challenges in the design of thermoresponsive hydrogels for CNS therapy are reviewed. First, the biological barriers that hinder mass and drug transport to the CNS are described, highlighting the distinct features of each barrier. Then, the realization, characterization and biomedical application of natural and synthetic thermoresponsive hydrogels are critically presented. Advantages and limitations of each design and application are discussed with the objective of identifying general rules that could enhance the effective translation of thermoresponsive hydrogel-based therapies for the treatment of CNS disorders.


Assuntos
Doenças do Sistema Nervoso Central , Hidrogéis , Barreira Hematoencefálica , Sistema Nervoso Central , Doenças do Sistema Nervoso Central/tratamento farmacológico , Sistemas de Liberação de Medicamentos , Humanos , Hidrogéis/uso terapêutico
6.
Biomedicines ; 9(9)2021 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-34572461

RESUMO

Chemotherapeutics represent the standard treatment for a wide range of cancers. However, these agents also affect healthy cells, thus leading to severe off-target effects. Given the non-selectivity of the commonly used drugs, any increase in the selective tumor tissue uptake would represent a significant improvement in cancer therapy. Recently, the use of gene therapy to completely remove the lesion and avoid the toxicity of chemotherapeutics has become a tendency in oncotherapy. Ideally, the genetic material must be safely transferred from the site of administration to the target cells, without involving healthy tissues. This can be achieved by encapsulating genes into non-viral carriers and modifying their surface with ligands with high selectivity and affinity for a relevant receptor on the target cells. Hence, in this work we evaluate the use of terpolymer-based nanocapsules for the targeted delivery of DNA toward cancer cells. The surface of the nanocapsules is decorated with folic acid to actively target the folate receptors overexpressed on a variety of cancer cells. The nanocapsules demonstrate a good ability of encapsulating and releasing DNA. Moreover, the presence of the targeting moieties on the surface of the nanocapsules favors cell uptake, opening up the possibility of more effective therapies.

7.
ACS Appl Mater Interfaces ; 13(27): 31379-31392, 2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34197081

RESUMO

Osteoarthritis (OA) is treated with the intra-articular injection of steroids such as dexamethasone (DEX) to provide short-term pain management. However, DEX treatment suffers from rapid joint clearance. Here, 20 × 10 µm, shape-defined poly(d,l-lactide-co-glycolide)acid microPlates (µPLs) are created and intra-articularly deposited for the sustained release of DEX. Under confined conditions, DEX release is projected to persist for several months, with only ∼20% released in the first month. In a highly rigorous murine knee overload injury model (post-traumatic osteoarthritis), a single intra-articular injection of Cy5-µPLs is detected in the cartilage surface, infrapatellar fat pad/synovium, joint capsule, and posterior joint space up to 30 days. One intra-articular injection of DEX-µPL (1 mg kg-1) decreased the expression of interleukin (IL)-1ß, tumor necrosis factor (TNF)-α, IL-6, and matrix metalloproteinase (MMP)-13 by approximately half compared to free DEX at 4 weeks post-treatment. DEX-µPL also reduced load-induced histological changes in the articular cartilage and synovial tissues relative to saline or free DEX. In sum, the µPLs provide sustained drug release along with the capability to precisely control particle geometry and mechanical properties, yielding long-lasting benefits in overload-induced OA. This work motivates further study and development of particles that provide combined pharmacological and mechanical benefits.


Assuntos
Cartilagem Articular/metabolismo , Dexametasona/química , Dexametasona/metabolismo , Portadores de Fármacos/química , Osteoartrite/tratamento farmacológico , Osteoartrite/metabolismo , Animais , Biomarcadores/metabolismo , Preparações de Ação Retardada , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Regulação da Expressão Gênica/efeitos dos fármacos , Injeções Intra-Articulares , Camundongos , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/química , Estresse Mecânico
8.
ACS Appl Mater Interfaces ; 13(45): 53618-53629, 2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34751556

RESUMO

Type-1 diabetes (T1DM) is a chronic metabolic disorder resulting from the autoimmune destruction of ß cells. The current standard of care requires multiple, daily injections of insulin and accurate monitoring of blood glucose levels (BGLs); in some cases, this results in diminished patient compliance and increased risk of hypoglycemia. Herein, we engineered hierarchically structured particles comprising a poly(lactic-co-glycolic) acid (PLGA) prismatic matrix, with a 20 × 20 µm base, encapsulating 200 nm insulin granules. Five configurations of these insulin-microPlates (INS-µPLs) were realized with different heights (5, 10, and 20 µm) and PLGA contents (10, 40, and, 60 mg). After detailed physicochemical and biopharmacological characterizations, the tissue-compliant 10H INS-µPL, realized with 10 mg of PLGA, presented the most effective release profile with ∼50% of the loaded insulin delivered at 4 weeks. In diabetic mice, a single 10H INS-µPL intraperitoneal deposition reduced BGLs to that of healthy mice within 1 h post-implantation (167.4 ± 49.0 vs 140.0 ± 9.2 mg/dL, respectively) and supported normoglycemic conditions for about 2 weeks. Furthermore, following the glucose challenge, diabetic mice implanted with 10H INS-µPL successfully regained glycemic control with a significant reduction in AUC0-120min (799.9 ± 134.83 vs 2234.60 ± 82.72 mg/dL) and increased insulin levels at 7 days post-implantation (1.14 ± 0.11 vs 0.38 ± 0.02 ng/mL), as compared to untreated diabetic mice. Collectively, these results demonstrate that INS-µPLs are a promising platform for the treatment of T1DM to be further optimized with the integration of smart glucose sensors.


Assuntos
Materiais Biocompatíveis/farmacologia , Glicemia/análise , Diabetes Mellitus Experimental/tratamento farmacológico , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemiantes/farmacologia , Insulina/farmacologia , Ácido Poliglicólico/farmacologia , Animais , Materiais Biocompatíveis/síntese química , Materiais Biocompatíveis/química , Diabetes Mellitus Experimental/induzido quimicamente , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Tipo 1/induzido quimicamente , Diabetes Mellitus Tipo 1/metabolismo , Relação Dose-Resposta a Droga , Hipoglicemia/induzido quimicamente , Hipoglicemia/tratamento farmacológico , Hipoglicemia/metabolismo , Hipoglicemiantes/síntese química , Hipoglicemiantes/química , Insulina/química , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Tamanho da Partícula , Ácido Poliglicólico/química , Estreptozocina
9.
J Mater Chem B ; 7(8): 1276-1283, 2019 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-30931126

RESUMO

Low patient compliance and poor bioavailability of ophthalmic medications are the main limitations of topical eye drops. A potential solution to these disadvantages could be provided by thermoresponsive hydrogels, which could be used as the basis for a gelling eye drop for long-term release of therapeutics. We previously reported such a system capable of being retained in the lower fornix of rabbits, continuously releasing an anti-glaucoma drug for one month. Here, we sought to improve the properties of the existing gels as most relevant to patient use without altering the drug release profile. Specifically, we optimized the sol-to-gel transition temperature and de-swelling kinetics of pNIPAAm gels to avoid risk of the gelled drop reverting to liquid during cold or windy weather, and ensure quick gelation upon administration. A reduction of the gel LCST, faster gelation kinetics, and suitable viscosity for the administration as an eye drop were successfully achieved through modification of the poly(ethylene glycol) content in the water phase and its molecular weight. Our data suggest that drug release is not affected by these changes, with representative drug concentration profiles of the previous and new formulations demonstrating comparable anti-glaucoma release kinetics.


Assuntos
Resinas Acrílicas/química , Portadores de Fármacos/química , Hidrogéis/química , Administração Tópica , Sobrevivência Celular/efeitos dos fármacos , Túnica Conjuntiva/citologia , Liberação Controlada de Fármacos , Módulo de Elasticidade , Células Epiteliais/citologia , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/metabolismo , Hidrogéis/farmacologia , Cinética , Soluções Oftálmicas/química , Soluções Oftálmicas/metabolismo , Temperatura de Transição , Viscosidade
10.
J Tissue Eng Regen Med ; 13(7): 1253-1264, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31050859

RESUMO

The protection from ischaemia-reperfusion-associated myocardial infarction worsening remains a big challenge. We produced a bioartificial 3D cardiac patch with cardioinductive properties on stem cells. Its multilayer structure was functionalised with clinically relevant doses of adenosine. We report here the first study on the potential of these cardiac patches in the controlled delivery of adenosine into the in vivo ischaemic-reperfused pig heart. A Fourier transform infrared chemical imaging approach allowed us to perform a characterisation, complementary to the histological and biochemical analyses on myocardial samples after in vivo patch implantation, increasing the number of investigations and results on the restricted number of pigs (n = 4) employed in this feasibility step. In vitro tests suggested that adenosine was completely released by a functionalised patch, a data that was confirmed in vivo after 24 hr from patch implantation. Moreover, the adenosine-loaded patch enabled a targeted delivery of the drug to the ischaemic-reperfused area of the heart, as highlighted by the activation of the pro-survival signalling reperfusion injury salvage kinases pathway. At 3 months, though limited to one animal, the used methods provided a picture of a tissue in dynamic conditions, associated to the biosynthesis of new collagen and to a non-fibrotic outcome of the healing process underway. The synergistic effect between the functionalised 3D cardiac patch and adenosine cardioprotection might represent a promising innovation in the treatment of reperfusion injury. As this is a feasibility study, the clinical implications of our findings will require further in vivo investigation on larger numbers of ischaemic-reperfused pig hearts.


Assuntos
Adenosina , Gelatina , Traumatismo por Reperfusão Miocárdica/tratamento farmacológico , Miocárdio , Copolímero de Ácido Poliláctico e Ácido Poliglicólico , Adenosina/química , Adenosina/farmacologia , Animais , Modelos Animais de Doenças , Implantes de Medicamento/química , Implantes de Medicamento/farmacologia , Feminino , Gelatina/química , Gelatina/farmacologia , Traumatismo por Reperfusão Miocárdica/metabolismo , Traumatismo por Reperfusão Miocárdica/patologia , Miocárdio/metabolismo , Miocárdio/patologia , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/química , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/farmacologia , Suínos
11.
Adv Healthc Mater ; 6(23)2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29034584

RESUMO

Dry eye disease, age-related macular degeneration, and uveitis are ocular diseases that significantly affect the quality of life of millions of people each year. In these diseases, the action of chemokines, proinflammatory cytokines, and immune cells drives a local inflammatory response that results in ocular tissue damage. Multiple therapeutic strategies are developed to either address the symptoms or abate the underlying cause of these diseases. Herein, the challenges to deliver drugs to the relevant location in the eye for each of these diseases are reviewed along with current and innovative therapeutic approaches that attempt to restore homeostasis within the ocular microenvironment.


Assuntos
Degeneração Macular/terapia , Uveíte/terapia , Animais , Quimiocinas/imunologia , Humanos , Inflamação/imunologia , Degeneração Macular/imunologia , Degeneração Macular/patologia , Uveíte/imunologia , Uveíte/patologia
13.
J Appl Biomater Funct Mater ; 14(2): e129-36, 2016 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-27056481

RESUMO

BACKGROUND: The accumulation of amyloid beta protein in the brain causes the cognitive impairment observed in neurodegenerative pathologies such as Alzheimer's disease. The present study aimed to test the hypothesis that a rapid removal of amyloid beta protein peptides from the blood by an extracorporeal purification system could represent an alternative solution for the treatment of patients suffering from this neurodegenerative disease. METHODS: In this regard, we investigated the specific recognition properties of a molecularly imprinted membrane based on poly(ethylene-co-vinyl alcohol) toward the amyloid beta protein fragment 25-35 (AbP), the more neurotoxic domain of amyloid beta protein. A chemical modification of the copolymer backbone using succinic anhydride was also performed to favor the formation of carboxylic groups and thus improve imprinting performance. RESULTS: The physico-chemical, morphological, mechanical and functional characterisations gave interesting results confirming the ability of imprinted membranes to in vitro rebind AbP. CONCLUSIONS: This work represents a proof of concept regarding the development of a biocompatible polymer membrane capable of selectively removing amyloid beta peptide from the blood and consequently from the cerebrospinal fluid.


Assuntos
Peptídeos beta-Amiloides/química , Membranas Artificiais , Impressão Molecular , Fragmentos de Peptídeos/química , Polivinil/química , Doença de Alzheimer/metabolismo , Peptídeos beta-Amiloides/metabolismo , Humanos , Fragmentos de Peptídeos/metabolismo
14.
Stem Cells Int ; 2016: 7176154, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27822229

RESUMO

The biomaterial scaffold plays a key role in most tissue engineering strategies. Its surface properties, micropatterning, degradation, and mechanical features affect not only the generation of the tissue construct in vitro, but also its in vivo functionality. The area of myocardial tissue engineering still faces significant difficulties and challenges in the design of bioactive scaffolds, which allow composition variation to accommodate divergence in the evolving myocardial structure. Here we aimed at verifying if a microstructured bioartificial scaffold alone can provoke an effect on stem cell behavior. To this purpose, we fabricated microstructured bioartificial polymeric constructs made of PLGA/gelatin mimicking anisotropic structure and mechanical properties of the myocardium. We found that PLGA/gelatin scaffolds promoted adhesion, elongation, ordered disposition, and early myocardial commitment of human mesenchymal stem cells suggesting that these constructs are able to crosstalk with stem cells in a precise and controlled manner. At the same time, the biomaterial degradation kinetics renders the PLGA/gelatin constructs very attractive for myocardial regeneration approaches.

15.
J Appl Biomater Funct Mater ; 13(4): e340-5, 2015 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-26391865

RESUMO

PURPOSE: Nano-drug delivery systems based on polymeric biomaterials have received considerable interest as drug delivery vehicles. In this work, radical polymerization was carried out in order to obtain nanoparticles based on a new acrylate terpolymer (PBMA-(PEG)MEMA-PDMAEMA). METHODS: Nanoparticles were developed in the form both of nanospheres and nanocapsules, an innovative kind of hollow nanoparticles with a great potential because of their low effective density and high specific surface area. The ability of the nanoparticles to load and then release a nucleic acid (DNA) to be used in cancer treatment was also investigated. RESULTS: Scanning electron microscopy analysis showed a spherical shape, nanometric dimensions, and a homogeneous distribution of the nanoparticles, also confirmed by dynamic light scattering measurements. Fourier-transform infrared spectroscopy chemical imaging analysis carried out on the nanocapsules before and after removal of the core demonstrated the presence of the cavity. High-performance liquid chromatography analysis confirmed good encapsulation efficiency of DNA both for nanospheres and nanocapsules. Drug release tests showed controlled release kinetics for both the systems with a high release of DNA in the first hours. In vitro MTT assay showed that the particles do not have cytotoxic effects on the cells. CONCLUSIONS: The preliminary investigation showed that the terpolymer-based nanoparticles developed in this study could be good candidates to be used as innovative and versatile gene delivery systems.


Assuntos
DNA/metabolismo , Nanopartículas/química , Polímeros/química , Células 3T3 , Adsorção , Animais , Sobrevivência Celular/efeitos dos fármacos , DNA/química , Portadores de Fármacos/química , Portadores de Fármacos/toxicidade , Camundongos , Nanopartículas/toxicidade , Nanopartículas/ultraestrutura , Tamanho da Partícula , Espectroscopia de Infravermelho com Transformada de Fourier
16.
Tumori ; 98(1): 1-18, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22495696

RESUMO

AIMS AND BACKGROUND: The DIANA (Diet and Androgens)-5 study is a multi-institutional randomized controlled trial of the effectiveness of a diet based on Mediterranean and macrobiotic recipes and principles, associated with moderate physical activity, in reducing additional breast cancer events in women with early stage invasive breast cancer at high risk of recurrence because of metabolic or endocrine milieu. The intervention is expected to reduce serum insulin and sex hormones, which were associated with breast prognosis in previous studies. METHODS: Between 2008 and 2010, the study randomly assigned 1208 patients to an intensive diet and exercise intervention or to a comparison group, to be followed-up through 2015. General lifestyle recommendations for the prevention of cancer are given to both groups, and the intervention group is being offered a comprehensive lifestyle intervention, including cooking classes, conferences, common meals and exercise sessions. Adherence assessments occurred at baseline and at 12 months and are planned at 36 and 60 months. They include food frequency diaries, anthropometric measures, body fat distribution assessed with impedance scale, one week registration of physical activity with a multisensor arm-band monitor, metabolic and endocrine blood parameters. Outcome breast cancer events are assessed through self report at semi annual meetings or telephone interview and are validated through medical record verification. RESULTS: The randomized groups were comparable for age (51.8 years), proportion of ER-negative tumors (22%), axillary node metastasis (42%), reproductive variables, tobacco smoking, blood pressure, anthropometric measurements and hormonal and metabolic parameters. CONCLUSIONS: DIANA-5 has the potential to establish whether a Mediterranean-macrobiotic lifestyle may reduce breast cancer recurrences. We will assess evidence of effectiveness, first by comparing the incidence of additional breast cancer events (local or distant recurrence, second ipsilateral or contralateral cancer) in the intervention and in the control group, by an intention-to-treat analysis, and second by analyzing the incidence of breast cancer events in the total study population by compliance assessment score.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/prevenção & controle , Dieta Mediterrânea , Exercício Físico , Estilo de Vida , Comportamento de Redução do Risco , Prevenção Secundária/métodos , Adulto , Idoso , Biomarcadores/sangue , Distribuição da Gordura Corporal , Neoplasias da Mama/sangue , Neoplasias da Mama/etiologia , Neoplasias da Mama/patologia , Restrição Calórica , Registros de Dieta , Metabolismo Energético , Feminino , Hormônios Esteroides Gonadais/sangue , Humanos , Insulina/sangue , Fator de Crescimento Insulin-Like I/metabolismo , Itália/epidemiologia , Metástase Linfática , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Cooperação do Paciente , Prognóstico , Projetos de Pesquisa , Medição de Risco , Fatores de Risco
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