Talc mediates angiostasis in malignant pleural effusions via endostatin induction

Nasreen, Najmunnisa; Mohammed, Kamal A.; Brown, Scott C.; Su, Yunchao; Pothapregada, Sriram; Moudgil, Brij M.; Loddenkemper, R.; Antony, Veena B.

doi:10.1183/09031936.00061606

Cited by 52 publications

(16 citation statements)

References 39 publications

(54 reference statements)

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“…In addition to inducing the best results in pleurodesis, recent studies seem to show a local antitumor effect of talc by triggering apoptosis in cancer cells [40] and by altering the angiostatic balance via endostatin [41]. Defective apoptotic signalling pathways have an important role in the initiation and progression of cancer, and they are related with tumor aggressiveness and short survival.…”

Section: The Choice Of Sclerosants For Pleurodesismentioning

confidence: 99%

Mechanisms of Pleurodesis

2012

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Pleurodesis aims to obliterate the pleural space by producing extensive adhesion of the visceral and parietal pleura, in order to control relapse of either pleural effusions (mostly malignant) or pneumothorax. A tight and complete apposition between the two pleural layers is a necessary condition to obtain a successful pleurodesis, but – besides this mechanical aspect – there are many biological mechanisms that appear to be common to most of the sclerosing agents currently used. Following intrapleural application of the sclerosing agent, diffuse inflammation, pleural coagulation-fibrinolysis imbalance (favoring the formation of fibrin adhesions), recruitment and subsequent proliferation of fibroblasts, and collagen production are findings in the pleural space. The pleural mesothelial lining is the primary target for the sclerosant and plays a pivotal role in the whole pleurodesis process, including the release of several mediators like interleukin-8, transforming growth factor-β and basic fibroblast growth factor. When the tumor burden is high, normal mesothelial cells are scarce, and consequently the response to the sclerosing agent is decreased, leading to failure of pleurodesis. Also, the type of tumor in the pleural cavity may also affect the outcome of pleurodesis (diffuse malignant mesothelioma and metastatic lung carcinomas have a poorer response). There is general agreement that talc obtains the best results, and there are also preliminary experimental studies suggesting that it can induce apoptosis in tumor cells and inhibit angiogenesis, thus contributing to a better control of the malignant pleural effusion. There is concern about complications (possibly associated with talc but other agents as well) related to systemic inflammation and possible activation of the coagulation cascade. In order to prevent extrapleural talc dissemination, large-particle talc is recommended. Although it could – to some degree – interfere with the mechanisms leading to pleurodesis and a carefully balanced clinical decision has therefore to be made, prophylactic treatment with subcutaneous heparin is recommended during hospitalization (immediately before and after the pleurodesis procedure).

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Section: The Choice Of Sclerosants For Pleurodesismentioning

confidence: 99%

Mechanisms of Pleurodesis

2012

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“…Talc insufflation has been noted to induce pleural mesothelial cells to release endostatin [52]. The biological effects of pleural fluids and conditioned media from talc-activated pleural mesothelial cells on endothelial cells were evaluated by performing proliferation, invasion, tube formation and apoptosis assays.…”

Section: Malignant Pleural Effusionsmentioning

confidence: 99%

Pathophysiology of the Pleura

Jantz

Antony²

2008

Respiration

108

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The pleural mesothelial cell is an essential cell in maintaining the normal homeostasis of the pleural space and it is also a central component of the pathophysiologic processes affecting the pleural space. In this review, we will review the defense mechanisms of the pleural mesothelium and changes in pleural physiology as a result of inflammatory, infectious, and malignant conditions with a focus on cytokine and chemokine networks. We will also review the processes involved in the pathogenesis of pleural fibrosis.

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“…Its mechanism of action is, as yet, incompletely understood. This is demonstrated by NAJMUNNISA et al [30] in the current issue of the European Respiratory Journal (ERJ ), in that talc mediates a dramatic decrease of angiogenic activity within the pleural space in patients with malignant effusions, which supports the use of talc as a sclerosant agent in these patients.…”

Section: The Long-term Safety Of Talcmentioning

confidence: 63%

Who's (still) afraid of talc?

Noppen¹

2007

European Respiratory Journal

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Talc mediates angiostasis in malignant pleural effusions via endostatin induction

Cited by 52 publications

References 39 publications

Mechanisms of Pleurodesis

Mechanisms of Pleurodesis

Pathophysiology of the Pleura

Who's (still) afraid of talc?

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