{"id":6325,"date":"2019-12-05T06:44:21","date_gmt":"2019-12-05T13:44:21","guid":{"rendered":"https:\/\/amjmed.org\/?p=6325"},"modified":"2019-12-30T14:45:52","modified_gmt":"2019-12-30T21:45:52","slug":"collateral-damages-by-magic-bullets","status":"publish","type":"post","link":"https:\/\/amjmed.org\/collateral-damages-by-magic-bullets\/","title":{"rendered":"Collateral Damages by Magic Bullets"},"content":{"rendered":"<figure id=\"attachment_6331\" aria-describedby=\"caption-attachment-6331\" style=\"width: 236px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/i0.wp.com\/amjmed.org\/wp-content\/uploads\/2019\/12\/gr1.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\" wp-image-6331\" src=\"https:\/\/i0.wp.com\/amjmed.org\/wp-content\/uploads\/2019\/12\/gr1.jpg?resize=236%2C318&ssl=1\" alt=\"Graph\" width=\"236\" height=\"318\" \/><\/a><figcaption id=\"caption-attachment-6331\" class=\"wp-caption-text\">The time course of changes in platelet counts (A), hemoglobin (B), and serum creatinine levels (C). Day 0 is the day of admission. Platelet transfusion on day 4 and hemodialysis on day 5 and 7.<\/figcaption><\/figure>\n<p class=\"\">The newly approved immunotoxin, moxetumomab pasudotox, fulfills the criteria for magic bullets, a term first coined by Nobel Laureate Paul Ehrlich 100 years ago.<span class=\"bibRef\"><sup><a id=\"back-bb0005\" class=\"layerTrigger layerTriggerClick\"><\/a>1<\/sup><\/span>\u00a0It contains a portion of monoclonal antibody against CD 22 conjugated with a modified pseudomonas exotoxin (PE38) and thus targets and introduces PE38 into malignant B cells without damaging other cells.<span class=\"bibRef\"><sup><a id=\"back-bb0010\" class=\"layerTrigger layerTriggerClick\"><\/a>2<\/sup><\/span>\u00a0However, this well-designed drug seems to attack endothelial cells.<span class=\"bibRef\"><sup><a id=\"back-bb0010\" class=\"layerTrigger layerTriggerClick\"><\/a>2<\/sup><\/span><\/p>\n<p class=\"\">A 74-year-old Caucasian female with a complicated history of malignancies including variant subtype of hairy cell leukemia, squamous cell lung cancer, and ductal carcinoma in the breast. Both lung and breast cancers were in remission after surgeries and chemotherapy or radiation. Her hairy cell leukemia variant has been treated with purine analogs, rituximab, and splenectomy, but she relapsed and failed standard therapy. She was started on moxetumomab pasudomtox (0.04 mg\/kg intravenously every other day) and developed severe nausea, vomiting, and weakness 2 days following the third dose. On admission, her blood pressure was 188\/100 mm Hg, pulse rate 87\/min, and O<sub>2<\/sub>\u00a0saturation 79% on room air. She had wheezing and crackles bilaterally, and edema in lower extremities. Her platelet counts, hemoglobin, and serum creatinine levels deteriorated rapidly (<a id=\"back-gr1\" class=\"figureLink\" href=\"https:\/\/els-jbs-prod-cdn.literatumonline.com\/cms\/attachment\/edec9af9-74e3-4f15-b954-7ff35b70bb2d\/gr1.jpg\" target=\"_blank\" rel=\"noopener noreferrer\" data-link=\"modal\" data-target=\"#image-S0002934319305194gr1\" data-class=\"largeImg\">Figure<\/a>). Her urinalysis showed 3+ proteinuria, 24 red and 22 white blood cells, and some granular casts. She had schistocytes, lactate dehydrogenase 1,790 u\/L, and haptoglobin undetectable, consistent with microangiopathic hemolysis. Her albumin level was 2.9 g\/dL, international normalized ratio 1.0, and chest X-ray revealing bilateral infiltrates. Other pertinent results includes a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 level 93%, Complement 3 and 4 level 114 and 13 mg\/dL, respectively, and negative blood and urine cultures.<\/p>\n<div class=\"floatDisplay\">\n<p> <\/p>\n<div id=\"f0005\" class=\"fig-wrapper\" title=\"gr1\">\n<div><\/div>\n<\/div>\n<\/div>\n<p>To read this article in its entirety please visit our\u00a0<a href=\"https:\/\/www.amjmed.com\/article\/S0002-9343(19)30519-4\/fulltext\">website<\/a>.<\/p>\n<p>-Yeong-Hau H. Lien, MD, PhD<sup>a<\/sup><sup>,<\/sup><sup>b<\/sup>, Michael Boxer, MD<\/p>\n<div><\/div>\n<p>This article originally appeared in the December\u00a02019 issue\u00a0of<em><strong>\u00a0The American Journal of Medicine.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The newly approved immunotoxin, moxetumomab pasudotox, fulfills the criteria for magic bullets, a term first coined by Nobel Laureate Paul Ehrlich 100 years ago.1\u00a0It contains a portion of monoclonal antibody against CD 22 conjugated with a modified pseudomonas exotoxin (PE38) and thus targets and introduces PE38 into malignant B cells without damaging other cells.2\u00a0However, this […]<\/p>\n","protected":false},"author":3,"featured_media":6331,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[35,83,400],"tags":[784,797,358,564],"class_list":{"0":"post-6325","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-cancer","8":"category-drugs","9":"category-pulmonary","10":"tag-cancer","11":"tag-drugs","12":"tag-featured","13":"tag-pulmonary-2"},"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/amjmed.org\/wp-content\/uploads\/2019\/12\/gr1.jpg?fit=489%2C688&ssl=1","jetpack_sharing_enabled":true,"jetpack_likes_enabled":true,"_links":{"self":[{"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/posts\/6325","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/comments?post=6325"}],"version-history":[{"count":0,"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/posts\/6325\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/media\/6331"}],"wp:attachment":[{"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/media?parent=6325"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/categories?post=6325"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/tags?post=6325"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}