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PubMed2002

Phase I study of docetaxel in combination with cyclophosphamide as first-line chemotherapy for metastatic breast cancer.

This phase I was study conducted to establish the maximum tolerated dose, dose-limiting toxicity, and recommended dose of docetaxel in combination with cyclophosphamide as first-line chemotherapy for metastatic breast cancer. Twenty-six patients were treated with cyclophosphamide (600 mg m(-2), intravenous bolus) followed by docetaxel (60, 75 or 85 mg m(-2), 1-h intravenous infusion) every 3 weeks. The maximum tolerated dose was docetaxel 85 mg m(-2) with cyclophosphamide 600 mg m(-2), the dose-limiting toxicity being febrile neutropenia. Grade 4 neutropenia was experienced by all patients, but was generally brief. Otherwise, the combination was well tolerated with few acute and no chronic non-haematological toxicities of grade 3/4. Activity was observed at all dose levels and disease sites, and the overall response rate was 42% (95% confidence interval 22-61%). The pharmacokinetics of docetaxel were not modified by cyclophosphamide coadministration. These findings establish a recommended dose of docetaxel 75 mg m(-2) in combination with cyclophosphamide 600 mg m(-2) every three weeks for phase II evaluation.

Adult↗

PubMed1999

Evaluation of uroprotective efficacy of amifostine against cyclophosphamide induced hemorrhagic cystitis.

The role of amifostine in the prevention of cyclophosphamide-induced hemorrhagic cystitis (HC) was evaluated in the rat model. Urinary bladders from control rats that received no drugs (group I) were compared with those from rats receiving cyclophosphamide alone at a dose of 150 mg/kg (group II), and two other groups receiving amifostine at 100 mg/kg (group III) and 200 mg/kg (group IV), 15 min prior to cyclophosphamide. Bladders were assessed macroscopically and histologically at 24 h and after 7 days. All the animals that received cyclophosphamide alone developed severe HC. On the basis of the scores of macroscopic and histologic changes, animals that received amifostine showed excellent uroprotection. Only 2/6 rats in group III and 1/6 rats in group IV developed mild HC at 24 h. None of the rats in either of these groups showed any evidence of HC at 7 days. It is concluded that amifostine protects the urothelium against cyclophosphamide-induced HC.

Amifostine↗

PubMed2000

The effect of busulphan on the pharmacokinetics of cyclophosphamide and its 4-hydroxy metabolite: time interval influence on therapeutic efficacy and therapy-related toxicity.

Busulphan and cyclophosphamide (Bu/CP) are widely used in preparative regimens for bone marrow transplantation. Many studies have shown a wide variation in busulphan pharmacokinetics. Moreover, higher rates of liver toxicity were reported in Bu/CP protocols than in a total body irradiation (TBI)-containing regimen. In the present paper we investigated the effect of the time interval between the last dose of busulphan and the first dose of cyclophosphamide on the pharmacokinetics of CP and its cytotoxic metabolite 4-hydroperoxycyclophosphamide (4-OHCP). Thirty-six patients undergoing bone marrow transplantation (BMT) were included in the study. We also investigated the occurrence of veno-occlusive disease, mucositis and graft-versus-host disease. Ten patients conditioned with CP followed by TBI served as a control group (TBI). Twenty-six patients were conditioned with Bu/CP. The patients received Bu (1 mg/kg x 4 for 4 days), followed by CP (60 mg/kg for 2 days) administered as a 1-h infusion. Patients received their CP therapy either 7-15 h (group A, n = 12) or 24-50 h (group B, n = 14) after the last dose of Bu. None of the patients were given phenytoin or any other drug known to enhance CP metabolism. The administration of CP less than 24 h after the last dose of Bu resulted in: (1) a significantly (P = 0.003) lower clearance for cyclophosphamide was observed in group A (0.036 l/h/kg) compared to 0.055 and 0.055 l/h/kg, in the B and TBI groups, respectively; (2) significantly (P = 0.002) longer elimination half-life in group A (10.93 h) than in groups B and TBI (6.87 and 7.52 h, respectively); (3) significantly (P < 0.001) lower exposure to the cytotoxic metabolite (4-OHCP), expressed as the ratio AUC4-OHCP/AUCCP, in group A (0.0053) than that obtained in group B (0.013) and group TBI (0.012); (4) the patients in group A had a significantly (P < 0.05) higher incidence of VOD (seven of 12) than the other groups, B and TBI (2/14 and 1/10, respectively); and (5) mucositis was significantly higher in group A patients (8/12), being seen in only one patient in group B and none in the TBI group. The present study has shown that the interval between busulphan and cyclophosphamide administration can negatively affect the pharmacokinetics of cyclophosphamide and its cytotoxic metabolite. We conclude that the timing of CP administration must be considered in order to improve drug efficacy and reduce conditioning-related toxicity.

Adolescent↗

PubMed2001

High-dose mitoxantrone and cyclophosphamide without stem cell support in high-risk and advanced solid tumors: a phase I trial.

This phase I study was designed to develop a high-dose combination of two cycles of mitoxantrone and cyclophosphamide in patients with solid tumors, as an alternative to single-cycle high-dose regimens that use only alkylating agents. Treatment was delivered with granulocyte colony-stimulating factor (G-CSF), but without stem cell support, in order to avoid potential tumor cell reinfusion. Thirty-one patients with advanced solid tumors received two cycles of high-dose mitoxantrone (20-30 mg/m2) plus high-dose cyclophosphamide (3000-4000 mg/m2). All patients received G-CSF until hematologic recovery. Dose-escalation was performed when less than 50% of cycles per level had dose-limiting toxicity (DLT). The maximum tolerated dose (MTD) achieved was mitoxantrone 25 mg/m2 and cyclophosphamide 4000 mg/m2. Main dose-limiting toxicities (DLTs) were hematological: grade IV neutropenia lasting more than 7 days and thrombopenia below 20 x 10(9)/l requiring more than one platelet transfusion. Non-hematological DLT consisted predominantly of grade III emesis and asthenia. Follow-up after each cycle was performed in an outpatient setting and there were no toxic deaths. In conclusion, the administration of two cycles of high-dose mitoxantrone and cyclophosphamide with G-CSF support is safe and feasible. MTD was mitoxantrone 25 mg/m2 and cyclophosphamide 4000 mg/m2. Evaluation of this regimen is being done in a phase II trial.

Adolescent↗

PubMed2004

High-dose cyclophosphamide with or without etoposide for mobilization of peripheral blood progenitor cells in patients with multiple myeloma: efficacy and toxicity.

The purpose of the study was to examine the yield of CD34(+) cells, response rates, and toxicity of high-dose cyclophosphamide with or without etoposide in patients with multiple myeloma. In total, 77 myeloma patients received either cyclophosphamide 4.5 g/m(2) (n=28) alone or with etoposide 2 g/m(2) (n=49) in a nonrandomized manner, followed by G-CSF 10 microg/kg/day for the purpose of stem cell mobilization. The effects of various factors on CD34(+) cell yield, response rate and engraftment were explored. A median of 22.39 x 10(6) CD34(+) cells/kg were collected on the first day of leukapheresis (range 0.59-114.71 x 10(6)/kg) in 71 (92%) of patients. Greater marrow plasma cell infiltration (P=0.02) or prior radiation therapy (P=0.02) adversely affected CD34(+) cell yield. In total, 45% of patients receiving cyclophosphamide and 56% of those receiving cyclophosphamide/etoposide had at least a minimum response by EBMT criteria. In all, 25% of patients who received cyclophosphamide alone vs 75.5% of patients who received combined chemotherapy required hospitalization mainly for treatment of neutropenic fever. Cyclophosphamide alone is associated with impressive CD34(+) cell yields and clear antimyeloma activity. The addition of etoposide resulted in increased toxicity without significant improvement in CD34(+) cell yield or response rates.

Adult↗

PubMed2001

The superoxide dismutase content in erythrocytes predicts short-term toxicity of high-dose cyclophosphamide.

Patients receiving high-dose cyclophosphamide as a conditioning regimen for peripheral stem cell collection are subjected over a short period of time to significant exposure to reactive oxygen species (ROS). All these patients undergo profound leucopenia. Various other short-term toxicities are observed in a fraction of the patients, including febrile aplasia requiring hospitalization, thrombocytopenia and mucositis. Although stem cell collection is feasible in the majority of patients stimulated with haematopoietic growth factors, in some instances, graft collection cannot be performed because of insufficient concentrations of stem cells in peripheral blood. There is currently no predictive assay to determine which patients treated with high-dose cyclophosphamide have a high risk of febrile aplasia or will successfully undergo cytaphereses for stem cell collection. In order to identify such predictive factors, we analysed the level of expression before treatment of various ROS detoxification mechanisms in the peripheral blood of 37 patients receiving high-dose cyclophosphamide for lymphoproliferative diseases. Various parameters involved in the metabolism of ROS were measured in plasma and/or erythrocytes, including superoxide dismutase, glutathione, glutathione peroxidase, glutathione reductase and malondialdehyde. High levels of erythrocyte superoxide dismutase before cyclophosphamide therapy were correlated with an increased risk of hospitalization for febrile aplasia (65% vs. 29%, P = 0.013). High superoxide dismutase and low erythrocyte glutathione reductase were associated with lower CD34 yields. These data suggest that components of the ROS detoxification system modulate the degree of short-term toxicity of cyclophosphamide and could be used as predictive markers in individual patients.

Adult↗

PubMed2002

Involvement of N-methyl-D-aspartate receptors in nociception in the cyclophosphamide-induced vesical pain model in the conscious rat.

We previously showed that the intraperitoneal (i.p.) administration of 200mg/kg cyclophosphamide, an antitumoral agent, modified the behaviour of rats with cystitis induced by acrolein, a toxic urinary by-product of cyclophosphamide. This behaviour, (namely decreased breathing rate, closing of the eyes, and specific postures), was scored to indirectly assess the nociception elicited by the cystitis and to use this experimental model as a vesical pain model. Here we investigated the involvement of the N-methyl-D-aspartate (NMDA) receptors and thus of the excitatory amino acid system in this model. We administered dizocilpine (0.01 to 0.1mg/kg intravenously (i.v.) and 1 to 20 microg/rat intrathecally (i.t.)) and ketamine (5 and 10mg/kg i.v. and 50 to 1000 microg/rat i.t.), two non-competitive NMDA receptor antagonists that bind to the channel site, and AP-5 (0.01 to 1mg/kg i.v. and 20 to 500 microg/rat i.t), a competitive antagonist that binds to the glutamate site. Whichever the route of administration (i.v. or i.t.), dizocilpine dose-relatedly reduced the behavioural disorders induced by cyclophosphamide. Systemic ketamine also dose-dependently, though transiently, reduced the effects of cyclophosphamide, but ketamine i.t. and AP-5 i.v. and i.t. did not induce any reduction of these effects.These results (i) demonstrate that in the cyclophosphamide-induced vesical pain model NMDA receptors are involved in the nociception, as shown by the effects of dizocilpine and systemic ketamine, (ii) reveal marked differences in the data obtained with various NMDA receptor antagonists, possibly due to their physicochemical properties, to the animal pain model used, to the noxious stimulus applied or to any combination of these factors.

Acrolein↗

PubMed2000

ESHAP and G-CSF is a superior blood stem cell mobilizing regimen compared to cyclophosphamide 1.5 g m(-2) and G-CSF for pre-treated lymphoma patients: a matched pairs analysis of 78 patients.

Cyclophosphamide 1.5 g m(-2) followed by granulocyte colony-stimulating factor (G-CSF) is an effective peripheral blood stem cell (PBSC) mobilizing regimen, but has limited anti-lymphoma activity. We therefore assessed the mobilizing potential of ESHAP (etoposide, ara-C, methylprednisolone and cisplatin), a potent second-line lymphoma regimen followed by G-CSF. The results were compared in 78 patients with relapsed or resistant lymphomas with the use of cyclophosphamide 1.5 g m(-2) followed by G-CSF in a matched pairs analysis, matching the ESHAP recipients (for predetermined prognostic factors) from a cohort of 178 lymphoma patients mobilized with cyclophosphamide and G-CSF. The total numbers of mononuclear cells collected at apheresis was similar with both regimens but ESHAP plus G-CSF resulted in a significantly higher percentage of CD34+ cells, absolute number of CD34+ cells and GM-CFC (all with P-values < 0.001). The number of patients requiring only one apheresis harvest to achieve a CD34+ cell yield of > 2.0 x 10(6) kg(-1) was greatly increased in the ESHAP recipients (56/78 vs 17/78, P < 0.001). The total number of progenitor cells collected was not significantly different with the two mobilization regimens because of this higher number of apheresis in the cyclophosphamide group. The proportion of patients who failed to achieve a minimum CD34+ cell target of 1 x 10(6) kg(-1) with the pooled harvests was less in the ESHAP arm (four patients vs nine patients) despite an increased number of aphereses in the cyclophosphamide recipients. ESHAP plus G-CSF is well tolerated and is an excellent mobilization regimen in patients with pre treated lymphoma.

Adult↗

PubMed1999

Unique alterations of thyroid function parameters after i.v. administration of alkylating drugs (cyclophosphamide and ifosfamide).

Alkylating drugs (cyclophosphamide and ifosfamide) have been in clinical use for the treatment of malignant diseases in the past. They are most useful anticancer agents and cyclophosphamide is also widely used for its immunosuppressive properties. However the effect of alkylating drugs on thyroid hormone parameters have not been evaluated so far. Three groups of patients were prospectively evaluated: Group I: 15 patients with Wegener's granulomatosis and 4 patients with severe scleritis received a single dose cyclophosphamide (15 mg/kg bw/day) and 250 mg prednisone i.v. Group II: 9 patients with malignant lymphomas were treated according to the IMVP 16-protocol. Patients received daily ifosfamide 1000 mg/m2 from day 0 to 4 and vepesid from day 0 to 2. Patients did not receive corticosteroids additionally. Group III: 6 patients with a relapse of malignant lymphomas received ifosfamide 1.500 mg/m2/day from day 0 to 4 i.v. and dexamethasone 40 mg/m2 as well as ara-c and etoposid. All patients received mesna to prevent hemorrhagic cystitis and odansetran or metoclopramide as antiemetic drugs. Alkylating drugs were given as a one hour infusion. Thyroid hormone parameters were determined before and on day 1, 2, 3, 4 after drug administration. We observed a significant increase in T4 and fT4 concentrations and a concomitant fall in TSH in either group one day after the administration of alkylating drugs. The effect was most pronounced in group III: T4 increased from 113 +/- 8 nmol/L to 175 +/- 8 (normal: 58-154) and fT4 from 14.0 +/- 0.8 to 24.8 +/- 2.5 pmol/L (normal 10-25). TSH dropped from 1.27 +/- 0.16 to 0.33 +/- 0.07 mU/L (normal 0.3-4). All changes were significant: p < 0.001. Two of the six patients displayed biochemical hyperthyroidism. Also reverse T3 increased significantly. Two days after drug administration a gradual normalization occurred. However, T3, Tg, TBG, Transthyretin and albumin levels did not change throughout the study period. One patient with coexisting hypothyroidism, who received his last thyroxine substitution therapy one day before the administration of cyclophosphamide (as in group I), also demonstrated an increase in T4, fT4 and rT3 and a fall in TSH concentrations. I.v. administrations of cyclophosphamide and ifosfamide induce a transient increase in T4 and fT4 concentrations and a concomitant fall of TSH in the presence of normal Tg, T3 and thyroid binding protein concentrations. These data suggest, that the changes are not due to a release of thyroid hormones from the thyroid itself, but is likewise related to a release of thyroxine from cellular pools such as the liver.

Adult↗

PubMedDate not supplied

[The modification of fracture healing by the cytostatic agent cyclophosphamide - an experimental interdisciplinary study].

The influence of the cytotoxic agent cyclophosphamide (Endoxan) on the course of fracture healing has been investigated in rats. -- In 200 rats the right femur was osteotomized and stabilized by intramedullar nailing. The rats were distributed to 4 groups (n = 50) and submitted to the following scheme of treatment: group I had no further treatment after operation, group II was injected intraperitoneally daily for 14 days with 10 mg cyclophosphamide per kg body-weight beginning at the 3rd day after operation, group III was treated the same dose as group II but until 2 days before operation, group IV was injected the same dose as group II but beginning 20 days after operation. Beside continuous check of body weight and white blood cells as well as x-ray of the hind-limbs, 10, 20, 30, 50 and 70 days after operation both femora were excised and investigated by means of radiologic, scintigraphic, biomechanic as well as histomorphologic methods. The results obtained indicate that cyclophosphamide significantly retards the course of fracture reparation. The degree of retardation was directly depended on the phase of fracture healing process during cyclophosphamide treatment. The retarding effect was supreme in case of coincidence of the beginning of fracture healing and cytotoxic treatment (group II) and diminished relatively in case of cyclophosphamide treatment before (group III) or after (group IV) operation.

Animals↗

PubMed1984

Modulation of cellular immune function by cyclophosphamide in children with minimal-change nephropathy.

Cyclophosphamide is widely used to induce a remission of minimal-change nephropathy, but concerns have been raised about whether its effects on cellular immunity persist after treatment is discontinued. We studied functional and numerical measures of cellular immunity in children who had minimal-change nephropathy with frequent steroid-responsive relapses and were receiving cyclophosphamide (2.5 mg per kilogram of body weight per day for eight weeks). Sequential studies during such treatment showed that cyclophosphamide caused lymphopenia, particularly among T helper cells, resulting in a significant fall in the immunoregulatory (helper/suppressor) cell ratio. This change persisted 1 to 3 months after cyclophosphamide was discontinued, but measures of immune function reverted to normal after 6 to 12 months. Children with minimal-change nephropathy in long-term remission had no difference in T-cell subpopulations, lymphocyte responses to mitogens, or suppressor-cell function that could be attributed to the disease itself or to the previous use of cyclophosphamide.

Child↗

PubMed2003

Oral cyclophosphamide for treatment of pemphigus vulgaris and foliaceus.

BACKGROUND: Cyclophosphamide is an alkylating adjuvant used in refractory cases of pemphigus. OBJECTIVE: We sought to evaluate the effectiveness and safety of oral cyclophosphamide in the treatment of patients with pemphigus vulgaris (PV) and pemphigus foliaceus (PF) with refractory disease. PATIENTS: We studied 23 patients with pemphigus (20 with PV; 3 with PF) who failed to achieve clinical remissions with the use of prednisone and antimetabolites. RESULTS: Complete remission was achieved in 17 patients with PV and 2 with PF. A total of 3 patients with PV failed therapy. A partial remission was achieved in 1 patient with PF. The treatment was administered for a median duration of 17 months with a follow-up period of 27 months. The median time to complete remission was 8.5 months. A total of 9 patients who were severely affected received concomitant plasma exchange. Adverse reactions included 5 cases of hematuria, 6 nonlife-threatening infections, and the development of transitional cell carcinoma of the bladder 15 years after discontinuation of cyclophosphamide in 1 patient. No death was associated with cyclophosphamide treatment. CONCLUSION: Oral cyclophosphamide is an effective adjuvant in the treatment of severe and refractory PV and PF, but requires close monitoring.

Administration, Oral↗

PubMedDate not supplied

Environmental contamination and assessment of exposure to antineoplastic agents by determination of cyclophosphamide in urine of exposed pharmacy technicians: is skin absorption an important exposure route?

In the Netherlands, special guidelines and safety precautions were introduced about 10 y ago for preparation and administration of antineoplastic agents. However, little is known about the effectiveness of these measures. In this study, occupational exposure to antineoplastic agents of nine pharmacy technicians who were involved in drug preparation was investigated. Cyclophosphamide, 5-fluorouracil, and methotrexate accounted for 95% of the antineoplastic agents prepared; therefore, the presence of these compounds was monitored. During preparation, cyclophosphamide was detected in the air of the work environment (< 0.04-10.1 micrograms/m3). Contamination of and permeation through latex gloves were found for each of the three compounds. The uptake of cyclophosphamide was assessed by the determination of cyclophosphamide in urine. The drug was found in urine samples of six pharmacy technicians, including three persons who were not directly involved in the preparation of cyclophosphamide. The amounts excreted ranged from 0.2 to 19.4 micrograms/24 h. The results strongly suggest that inhalation is of minor importance for internal exposure, compared with other, presumably dermal, routes.

Absorption↗

PubMed1990

Chemoprotection of garlic extract toward cyclophosphamide toxicity in mice.

The effect of the administration of an extract of garlic (Allium sativum) was studied in mice that were treated with a chronic lethal dose of cyclophosphamide (50 mg/kg body wt, 14 days). The intraperitoneal administration of garlic (50 mg/animal, 14 days) along with cyclophosphamide reduced the toxicity of the latter considerably with an increase in life span of more than 70%. The administration of garlic extract did not improve the lymphopenia produced by cyclophosphamide or liver alkaline phosphatase, but there was a significant reduction in liver glutamic-pyruvic transaminase. Moreover, garlic extract reduced the level of lipid peroxidation induced in the liver by cyclophosphamide administration. Administration of garlic extract did not interfere with the tumor-reducing activity of cyclophosphamide.

Alanine Transaminase↗

PubMed2002

Protective role of alpha-tocopherol-succinate (provitamin-E) in cyclophosphamide induced testicular gametogenic and steroidogenic disorders: a correlative approach to oxidative stress.

The present study was undertaken to find out the adverse effects of cyclophosphamide on testicular activities along with testicular oxidative stress at its therapeutic dose and the protective effects of alpha-tocopherol succinate on testicular dysfunctions induced by cyclophosphamide in mature albino rats. A significant diminution in the activities of testicular delta 5, 3 beta-hydroxysteroid dehydrogenase (HSD) and 17 beta-hydroxysteroid dehydrogenase (HSD) along with significant reduction in the plasma level of testosterone and number of spermatogonia-A (ASg), preleptotene spermatocytes (pLSc), midpachytene spermatocytes (mPSc) and step 7 spermatids (7Sd) at stage VII of spermatogenic cycle were observed following cyclophosphamide treatment. Oxidative stress was also noted in testis, which was enlightened by significant elevation in the level of malondialdehyde (MDA) and conjugated dienes along with significant reduction in the activities of testicular peroxidase and catalase. Co-administration of alpha-tocopherol succinate in cyclophosphamide-treated rats resulted a significant restoration of all the above-mentioned parameters to the control level. The results of our experiment suggest that cyclophosphamide treatment at its clinical dose is associated with antigonadal activities as well as induction of oxidative stress in gonad that can be ameliorated significantly by alpha-tocopherol succinate co-administration. So, our data have some potential clinical implications.

17-Hydroxysteroid Dehydrogenases↗

PubMed1985

Evaluation of the immunotoxic potential of chlordecone with comparison to cyclophosphamide.

The immunotoxic potential of chlordecone was evaluated in male Fischer-344 rats following 10 d of acute dosing by oral gavage. These results were compared with those obtained following a comparable dosing regimen with the known immunosuppressive drug cyclophosphamide. Significant changes in ratios of spleen and thymus to body weight, blastogenic responsiveness of lymphocytes to concanavalin A, and natural killer (NK) cell activity against allogeneic W/Fu-G1 rat lymphoma target cells and xenogeneic YAC-1 mouse lymphoma target cells were observed only at the highest chlordecone dosage (10 mg/kg . d). A significant decrement in body weight also occurred at this dosage which suggests that the observed changes in the immune parameters measured were most likely due to the overt toxicity of chlordecone. In contrast, rats dosed over 10 d by oral gavage with cyclophosphamide showed significant decreases in spleen and thymus to body weight ratios at a dosage as low as 1.5 mg/kg . d. Body weight decrements were observed only at dosages of 12 mg/kg . d or greater. At dosages of 1.5 mg/kg . d or greater, cyclophosphamide caused a significant decrease in the total leukocyte and absolute lymphocyte counts in peripheral blood, and a decrease in the lymphoproliferative responses to both T- and B-lymphocyte mitogens. Significant suppression of NK cell activity was observed at dosages of 6 mg/kg . d or greater. These results suggest that T and B lymphocytes are more sensitive than are NK lymphocytes to the immunosuppressive effects of cyclophosphamide. The results of these two studies indicate that the failure to detect chlordecone-induced immunotoxic effects in the absence of overt toxicity is not due to the possible insensitivity of the parameters examined. Instead, since cyclophosphamide affected all of the parameters tested, these results indicate that the endpoints examined here are capable of detecting immunotoxicity with sufficient sensitivity to permit distinction between probable indirect immunosuppression due to overt toxicity and subtle, direct impairment of the immune system.

Animals↗

PubMed1996

Cyclophosphamide diminishes inflammation and prolongs transgene expression following delivery of adenoviral vectors to mouse liver and lung.

Immune responses to adenovirus-mediated gene transfer contribute to the problems of transient recombinant gene expression, inflammation, and difficulties with vector readministration. Activation of CD4+ T cells is required for full realization of effector function of both CD8+ T cells (i.e., cytotoxic T cells) and B cells (i.e., neutralizing antibody). We evaluate in this study the effectiveness of a short course of high-dose cyclophosphamide to block immune responses in mice administered vector into lung and liver of C57BL/6 mice. Administration of cyclophosphamide with vector directed to liver blocked activation and mobilization of both CD4+ and CD8+ T cells. As a result, transgene expression was prolonged, inflammation was reduced, and, at the higher doses of cyclophosphamide, formation of neutralizing antibody was prevented and the vector was successfully readministered. Similar studies in the lung demonstrated an effective blockade of T and B cell responses. In contrast to the liver, where it was easier to stabilize transgene expression than to prevent neutralizing antibody, cyclophosphamide prevented the formation of neutralizing antibodies at all doses in the lung, whereas stabilization of transgene expression was only achieved at the highest dose. These experiments begin to define the parameters by which cyclophosphamide could be used as an adjunct in gene therapy.

Adenoviridae↗

PubMed1988

Morphological changes in the testis and epididymis of rats treated with cyclophosphamide: a quantitative approach.

Cyclophosphamide is a widely used anticancer and immunosuppressive drug that affects fertility in men. In a previous study, we found that chronic, daily treatment of male rats with low doses of cyclophosphamide had no apparent effect on the pituitary-gonadal axis, whereas it had time- and dose-dependent effects on male reproductive organ weights, the hematologic system, and on pregnancy outcome. To determine whether cyclophosphamide induces morphological changes within the male reproductive system, a detailed qualitative and quantitative evaluation of changes in the histology of the testis and epididymis was undertaken. Adult male Sprague-Dawley rats were gavage-fed for 1, 3, 6, and 9 wk with saline (control), 5.1 (low dose) or 6.8 (high dose) mg/kg/day of cyclophosphamide; the testes and epididymides were prepared for light and electron microscopy. At the light microscopic level, the orderly process of spermatogenesis in the seminiferous tubules was not affected at any time point with either dose of the drug. A number of time-dependent drug-induced changes in the histology of the epididymis, however, were apparent: 1) an increase in the relative number and a change in the distribution of halo cells in the caput epididymidis, 2) an increase in the number and size of clear cells in the caput and/or cauda epididymidis, and 3) an increase in the size of clear cells in both the caput and cauda epididymides; these changes were time dependent. At the electron microscopic level, there was a dose-dependent, two- to threefold increase in the number of spermatozoa with abnormal flagellar midpieces in the lumen of both the caput and cauda epididymides. Although the 9 plus 2 axonemal complex and the 9 outer dense fibers were present and appeared normal, the close approximation of these two structures was lost in these abnormal spermatozoa. Such abnormal flagellar midpieces were also found in the testes of control and treated rats. Electron microscopic examination of the testis revealed that both Sertoli and Leydig cells were normal in appearance. The type and timing of the effects of cyclophosphamide on the histology of the testis and epididymis suggest that the drug could be affecting germ cells by 1) inducing changes in the developing spermatozoa in the testis, some of which are seen microscopically in the epididymal lumen, and/or 2) affecting epididymal morphology and function.

Animals↗