Karsinoma payudara (KPD) merupakan kanker terbanyak pada perempuan dan lebih dari 90%
kematian akibat kanker diebabkan oleh adanya metastasis. Diperlukan terapi yang tidak hanya
fokus pada proliferasi, tetapi juga fokus pada proses metastasis. Jalur Rho/ROCK diketahui
memengaruhi invasi dan metastasis. Studi terbaru menunjukkan bahwa jalur Rho/ROCK
berperan penting pada regulasi migrasi dan proliferasi sel, sehingga dapat dijadikan target
terapi. Selain mereduksi biosintesis kolesterol melalui inhibisi 3-hydroxy-3-methylglutaryl
coenzyme A reductase, statin juga mengurangi formasi isoprenoid intermediates yang
diperlukan untuk mediasi pensinyalan melalui jalur Rho/ROCK. Statin diduga dapat
menghambat jalur Rho/ROCK dan aman digunakan dalam jangka panjang. Penelitian ini
bertujuan untuk mengetahui efek antimetastasis (migrasi dan proliferasi) simvastatin terhadap
KPD melalui jalur Rho/ROCK.
Penelitian ini merupakan uji intervensi perioperative “window”, parallel unmatching,
randomized, double-blinded, dan placebo-controlled yang berlangsung sejak November 2014
hingga Juli 2015. Sebanyak 30 pasien KPD diberikan terapi simvastatin 40 mg/hari dan plasebo
selama 4-6 minggu lalu dilakukan mastektomi di RSCM, RSPAD Gatot Subroto, RS
Persahabatan, dan RSUD Koja. Perubahan migrasi (indeks migrasi, aktivitas ROCK dan kadar
mRNA RhoC, CXCR4, dan CD44) dan reduksi proliferasi (ekspresi Ki67) yang didapat dari
jaringan biopsi dan mastektomi dievaluasi sebelum dan sesudah terapi. Kemudian karakteristik
yang berbeda bermakna dianalisis juga hubungannya dengan kadar kolesterol darah, grade,
status ER/PR, dan status HER-2.
Simvastatin 40 mg/harimenurunkan indeks migrasi (p=0,006), aktivitas ROCK (p=0,002), kadar
mRNA CXCR4 (p=0,045) dan ekspresi Ki67 (p<0,001) secara bermakna. Terdapat tren
penurunan kadar mRNA RhoC (p=0,163) dan CD44 (p=0,094). Penurunan aktivitas ROCK
berhubungan dengan kolesterol tinggi (p=0,008), grade rendah (p=0,019) dan amplifikasi HER-
2 (p=0,009). Penurunan kadar mRNA CXCR4 berhubungan dengan kolesterol tinggi (p=0,024),
ER/PR positif (p=0,013), dan amplifikasi HER-2 (p=0,018). Penurunan ekspresi Ki67
berhubungan dengan kolesterol tinggi (p=0,001), grade rendah (p=0,017) dan tinggi (p=0,018),
HER-2 (p=0,002) dan negatif (p=0,034), serta ER/PR positif (p=0,007) dan negatif (p=0,042).
Simvastatin dapat menginhibisi migrasi dan menyupresi proliferasi pada KPD melalui jalur
Rho/ROCK, sehingga dapat digunakan sebagai terapi pencegahan metastasis kanker payudara.
Breast cancer is the most common cancer among women and more than 90% of cancer
deaths are caused by metastasis. There is an urgent need for the development of therapeutic
intervention specifically targeted to the metastatic process. The Rho/ROCK pathway is
found to be involved in invasion and metastasis. Recent studies have revealed that the
Rho/ROCK pathway plays a critical role in regulation of cancer cell migration and
proliferation, making it a potential therapy target. Besides reducing cholesterol biosynthesis
by inhibiting 3-hydroxy-3-methylglutaryl coenzyme A reductase, statins also decrease the
formation of isoprenoids intermediates essential for mediating the Rho/ROCK signalling.
Statin is thought to inhibit the Rho/ROCK pathway and is safe for long-term use. This study
aimed to determine the antimetastasis (migration and proliferation) effect of simvastatin on
breast cancer through the Rho/ROCK pathway.
In a parallel unmatching, randomized, double-blinded, placebo-controlled, perioperative
“window” interventional trial conducted from November 2014 until July 2015, 30 breast
cancer subjects were treated with simvastatin 40 mg/day or placebo for 4–6 weeks
followed by mastectomy (n=15 in each arm) at Cipto Mangunkusumo Hospital, Gatot
Subroto Army Hospital, Persahabatan Hospital and Koja Hospital. Changes in
migration (migration index, ROCK activity, mRNA RhoC, CXCR4 and CD44 level)
and proliferation (Ki67 expression) from biopsy and final surgical specimen were
obtained before and after intervention. The relationships of significant factors with
blood cholesterol level, grade, ER/PR and HER-2 status were analyzed.
Simvastatin 40 mg/d significantly reduced migration index (p = 0.006), ROCK activity
(p = 0.002), mRNA CXCR4 level (p = 0.045) and reduced Ki67 expression (p < 0.001).
Decreased was also observed for mRNA RhoC (p = 0.163) and CD44 level (p = 0.094).
Reduced ROCK activity was related to high cholesterol level (p = 0.008), low grade (p
= 0.019) and HER-2 amplification (p = 0.009). Reduced CXCR4 transcription was
related to high cholesterol level (p = 0.024), positive ER/PR (p = 0.013) and HER-2
amplification (p = 0.018). Ki67 expression was related to high cholesterol level (p =
0.001), low (p = 0.017) and high grade (p= 0.018), with (p = 0.002) and without HER-2
amplification (p = 0.034), and positive (p = 0.007) and negative (p = 0.042) ER/PR
status.
Simvastatin inhibits the migration and proliferation in breast cancer through Rho/ROCK
pathway, hence holds a promising potential as prophylaxis for breast cancer metastasis
Latar belakang:Penyebab utama kematian pasien penyakit ginjal kronis (PGK) adalah penyakit kardiovaskular. Stres oksidatif merupakan mediator dalam patogenesis sindrom kardiorenal. Terapi kombinasi penghambat reseptor angiotensin dan statin dapat dipertimbangkan dalam manajemen pasien PGK karena pendekatannya berbeda dalam menekan stres oksidatif.
Tujuan:Penelitian ini bertujuan untuk mengetahui efek irbesartan dan simvastatin terhadap penurunan stres oksidatif melalui pengamatan kadar malondialdehid (MDA) jantung dan serum tikus PGK.
Metode:Penelitian ini menggunakan jantung dan serum tersimpan dari tikus jantan galur Sprague-Dawley yang telah diberikan perlakuan pada penelitian sebelumnya. Terdapat 3 kelompok yakni kontrol normal (sham; n=4), nefrektomi 5/6 (Nx; n=4), dan nefrektomi 5/6 + terapi irbesartan 20mg/kgBB/hari dan simvastatin 10mg/kgBB/hari selama 4 minggu (Nx + Ir-Si; n=4). Kadar MDA sampel jantung dan serum tersimpan diukur dengan metode TBARS. Data dianalisis dengan SPSS menggunakan uji One-Way Anova. Nilai p ≤0.05 dianggap bermakna secara statistik.
Hasil:Pemberian irbesartan 20mg/kgBB/hari dan simvastatin 10mg/kgBB/hari selama 4 minggu menyebabkan kadar MDA yang cenderung meningkat namun tidak bermakna pada organ jantung (p=0,069) dan serum (p=0,091) tikus PGK.
Simpulan:Tidak terdapat perbedaan yang bermakna antara kelompok tikus PGK yang diberi terapi kombinasi irbesartan dan simvastatin dengan kelompok tikus PGK tanpa terapi terhadap hasil rerata kadar MDA jantung dan serum tikus.
Background:Cardiovascular disease is the main cause of mortality in chronic kidney disease(CKD). Oxidative stress is one of the mediators in cardiorenal syndrome. Combined angiotensin-receptor blockers and statins can be considered in CKDmanagement.
Purpose:This study aims to determine the effect of irbesartan-simvastatin on reducing oxidative stress by observing malondialdehyde (MDA)levels in the heart and serum of CKD rats model.
Methods:This study uses stored heart tissue and serum from male Sprague-Dawley rats, those had been given treatment in previous study. There are 3 groups which are normal control (sham; n=4), untreated 5/6 nephrectomy (Nx; n=4), and 5/6 nephrectomy + irbesartan 20mg/kgBW/day and simvastatin 10mg/kgBW/day (Nx + Ir-Si; n=4).MDAlevels were measured using TBARS methods. Data were analyzed with SPSSusing One-Way Anova test. p value ≤0.05 is considered statistically significant.
Results:Combined therapy of irbesartan 20mg/kgBW/day and simvastatin 10mg/kgBW/day for 4 weeks caused a tendency in malondialdehyde levels to increase but not statistically significant in heart (p=0.069) and serum (p=0.091)of CKD rats model.
Conclusion:There were no significant differences between group of CKD rats with combined therapy of irbesartan-simvastatin and group of CKD rats without therapy on the MDA levels in heart and serum.
Latar belakang: Riset Kesehatan Dasar 2018 menemukan bahwa 38/10.000 penduduk Indonesia berusia >15 tahun menderita penyakit ginjal kronis (PGK). Morbiditas dan mortalitas utama pada penderita PGK disebabkan karena sindrom kardiorenal tipe 4. Toksin urea pada penderita PGK dapat menyebabkan inflamasi sistemis serta perburukkan stres oksidatif, mengakibatkan disfungsi endotel dan aterosklerosis yang bisa berujung pada penyakit kardiovaskuler. Sejumlah studi menemukan bahwa simvastatin memiliki efek antiinflamasi dan antioksidan yang ditunjukkan dengan penurunan malondialdehid (MDA), penanda tidak langsung inflamasi dan stres oksidatif.
Tujuan: Penelitian ini bertujuan untuk mengetahui efek pemberian simvastatin dan pengaruhnya terhadap stres oksidatif pada tikus model PGK melalui pengamatan kadar MDA di jantung dan serum.
Metode: Tikus Sprague-Dawley (n=12) dibagi secara acak menjadi 3 kelompok: kelompok sham (S), model PGK melalui metode 5/6 nefrektomi (N), dan model PGK dengan pemberian simvastatin 10 mg/kgBB selama 4 minggu (NS). Pengukuran kadar MDA jantung dan serum dilakukan melalui Thiobarbituric Acid Reactive Substance Assay. Data selanjutnya diolah melalui uji One-Way Anova.
Hasil: Ditemukan rerata kadar MDA jantung sebagai berikut: S=1,3708 nmol/mg protein; NS=1,2574 nmol/mg protein; dan N=0,4129 nmol/mg protein. Ditemukan rerata kadar MDA serum sebagai berikut: NS=1,5924 nmol/ml; N=1,2667 nmol/ml; dan S=1,2171 nmol/ml. Temuan pada penelitian ini bertentangan dengan teori yang sudah ada. Meski demikian, perbedaan kadar MDA antarkelompok pada penelitian ini tidak bermakna secara statistik (p>0,05).
Simpulan: Tidak terdapat perbedaan kadar MDA yang bermakna secara statistik baik pada kelompok S, kelompok N, dan kelompok NS.
Introduction: Riset Kesehatan Dasar 2018 found that 38/10.000 Indonesian population aged >15 years were suffering from Chronic Kidney Disease (CKD). CKD patients’ morbidity and mortality are majorly caused by type 4 cardiorenal syndrome. Urea toxin in CKD patients can cause systemic inflammation and oxidative stress, causing endothelial dysfunction and atherosclerosis that can lead to cardiovascular diseases. Several studies found that simvastatin had antiinflammatory and antioxidant effects, shown by the reduction of malondyaldehyde (MDA), an indirect inflammatory and oxidative stress marker.
Objective: This research aims to determine the effects of simvastatin administration on oxidative stress in CKD rat model by measuring cardiac and serum MDA levels.
Method: Sprague-Dawley rats (n=12) were randomly divided into 3 groups: sham (S), CKD model by 5/6 nephrectomy (N), and CKD model with 10 mg/kgBB simvastatin administration for 4 weeks (NS). Cardiac and serum MDA levels were measured using Thiobarbituric Acid Reactive Substance Assay. Data collected were analyzed using One-Way Anova test.
Results: The average cardiac MDA levels found were as followed: S=1.3708 nmol/mg protein; NS=1.2754 nmol/mg protein; and N=0.4129 nmol/mg protein. The average serum MDA levels found were as followed: NS=1.5924 nmol/ml; N=1.2667 nmol/ml; and S=1.2171 nmol/ml. These findings contradict existing theories. However, the differences among treatments and MDA levels are not statistically significant (p>0.05).
Conclusion: There isn’t statistically significant difference among the MDA levels in the S, the N, and the NS group