[Health-related quality of life and its associated variables in Chinese patients with Philadelphia-negative myeloproliferative neoplasms]

Objectives: To explore health-related quality of life (HRQoL) and identify its associated variables in Chinese patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) . Methods: In this cross-sectional study, anonymous questionnaires were distributed to adult patients with MPNs to assess symptom burden measured by MPN-10 and HRQoL measured by Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) . Results: The data from 1405 respondents with MPNs, including 645 (45.9%) with essential thrombocythemia (ET) , 297 (21.1%) with polycythemia vera (PV) , and 463 (33.0%) with myelofibrosis (MF) , were analyzed. 646 (46.0%) respondents were male. The median age was 56 (range, 18-99) years. The mean MPN-10 scores were 13.0±12.7, 15.0±14.7, and 21.0±16.6 (P<0.001) , and the physical component summary (PCS) and mental component summary (MCS) scores were 48.0±8.5, 47.0±9.0, and 42.0±10.0 (P<0.001) and 51.0±11.0, 50.0±10.8, and 49.0±11.1 (P=0.002) for respondents with ET, PV, and MF, respectively. Respondents with MF reported the lowest score of physical functioning, role functioning, emotional functioning, cognitive functioning, social function, and global health status (all P<0.01) and the highest score of fatigue, pain, dyspnea, appetite loss, diarrhea, and financial problems (all P<0.05) in EORTC QLQ-C30. Multivariate analyses revealed that higher MPN-10 scores were significantly associated with lower PCS (-0.220 to -0.277, P<0.001) and MCS (-0.244 to -0.329, P<0.001) scores; increasing age (-1.923 to -4.869; all P<0.05) , lower PCS score. Additionally, comorbidity (ies) , symptom at diagnosis, splenomegaly, anemia, unknown driver gene, and higher annual out-of-pocket cost were significantly associated with lower PCS and/or MCS scores. However, age ≥ 60 years, urban household registration, concomitant medication, and receiving ruxolitinib therapy in respondents with MF were associated with higher MCS scores. Weak correlations were found between MPN-10 score (except the subscale of appetite loss and constipation) and EORTC QLQ-C30 score in majority of subscales in respondents with ET (|r| = 0.193-0.457, all P<0.001) , PV (|r| = 0.192-0.529, all P<0.01) , and MF (|r| = 0.180-0.488, all P<0.001) , respectively. Conclusions: HRQoL in patients with MPN was significantly reduced, especially in patients with MF. Sociodemographic and clinical variables were significantly associated with the HRQoL in patients with MPNs.

Influence of tissue and geographic locality on culturable endophytic bacteria of Atractylodes macrocephala

The endophytic bacterial community and their diversity are closely related to the host's growth and development. This paper explores the culturable endophytic bacteria in the stems, leaves, roots and rhizomes of Atractylodes macrocephala (AM) of four localities (Yuqian, Wenxian, Pan'an and Pingjiang) and the potential correlation between the bacteria and plant bioactive compounds. A total of 118 endophytic bacteria belonging to 3 phyla, 5 classes, 11 orders, 26 families and 48 genera were isolated and identified from the four AM tissues. Among them, Bacillus was the dominant genus. In AM, the tissue type and locality influenced the endophytic bacterial community. Approximately 29.7 and 28.8% of the endophytic bacteria exhibited tissue specificity and geographic specificity, respectively. Furthermore, high-performance liquid chromatography revealed that the sesquiterpenoid (atractylenolide I, atractylenolide Ⅱ and atractylon) content was more in the rhizomes of Wenxian than in those of Pingjiang, Yuqian and Pan'an. The multiple linear regression was used to screen the bacterial strains related to the bioactive compounds of AM. The relative frequency of Microbacterium positively correlated with atractylenolide I and atractylon content in AM but negatively correlated with atractylenolide Ⅱ content. The study also provides a theoretical framework for future research on endophytic bacteria as alternative sources of secondary plant metabolites.

Carrier dynamics and lasing behavior of InAs/GaAs quantum dot lasers with short cavity lengths

The modulation p-doping technique has emerged as an effective way to optimize the carrier dynamics process of quantum dot (QD) structures. Here, the laser structures based on the 1.3μm multiple-layer InAs/GaAs QD were fabricated with and without modulation p-doping. The carrier relaxation rate was increased after modulation p-doping, as demonstrated by transient absorption spectroscopy. The higher relaxation rate in p-doped QDs could be explained by more rapid carrier-carrier scattering process originating from increasing of the hole quasi-Fermi-level movement that increases the probability of occupancy of the valence states. In addition, the lasing behavior of Fabry-Perot lasers with and without modulation p-doping was investigated and compared. It was found that the ground state (GS) lasing in the absence of facet coating was successfully achieved in a p-doped laser diode with short cavity length (400μm), which can be attributed to the higher GS saturation gain caused by p-doping. With assistance of a designed TiO₂/SiO₂facet coating whose central wavelength (∼1480 nm) is far beyond the lasing wavelength of 1310 nm, the GS lasing could be realized in a laser diode with short cavity lengths (300μm) under continuous wave operation at room temperature, implying great potential for the development of low-cost and high-speed directly modulated lasers.

Assessing the impact of cardiovascular events on health-related quality of life outcomes in DAPA-HF

Background

Heart failure (HF) patients are at increased risk of cardiovascular (CV) events, including hospitalisation for HF (hHF), myocardial infarction (MI) and stroke, imposing a significant burden on health related quality of life (HRQoL). DAPA-HF was a multinational clinical trial (NCT03036124) investigating the efficacy and safety of dapagliflozin for the treatment of HF with reduced ejection fraction. Patient reported outcomes were collected. The objective of this study was to estimate the impact of CV events on patient HRQoL over time, as assessed through EQ-5D-5L and Kansas City Cardiomyopathy Questionnaire (KCCQ) total symptom score (TSS) and clinical symptom score (CSS).

Methods

Mixed effects regression models were developed based on pooled individual patient data from DAPA-HF to estimate the impact of hHF, MI and stroke on patient utility (EQ-5D-5L questionnaire responses weighted according to the societal value placed on given health states), and KCCQ TSS score. Utility was estimated using UK-specific tariffs after mapping EQ-5D-5L to EQ-5D-3L values in line with NICE guidance. A subject-specific intercept was incorporated, and estimates were adjusted for the incidence of events occurring within one month prior, two to four months prior, and 4 to 12 months prior to questionnaire completion.

Results

Mean patient baseline utility was 0.716 (95% CI: 0.711, 0.722), with KCCQ TSS 73.6 (73.0, 74.2). The incidence of CV events was consistently associated with reduced patient HRQoL, assessed through either EQ-5D or KCCQ TSS. In the first month following the event, hHF was associated with a 0.083 (0.06, 0.107) reduction in patient utility, and 16.9 (14.5, 19.4) reduction in KCCQ TSS (Fig. 1). Comparing measures, the disease specific measure KCCQ appeared more sensitive than EQ-5D to changes in HRQoL following hHF events and less sensitive to changes following MI and stroke events. Comparing events using the generic EQ-5D measure, at two months post-event, patients with MI and stroke returned to baseline utility; patients with hHF remained below baseline utility at each assessment point for 12 months (Fig. 2); where patients had a mean reduction of 0.02 (0.005, 0.035) utility and 0.5 (−1.1, 2.1) KCCQ-TSS compared to those without an hHF event.

Conclusion

The incidence of cardiovascular events imposes a considerable burden on HRQoL in patients with HFrEF. HF specific events may be better characterised with a disease specific tool, whereas for wider CV events a generic tool may be preferable. The impact of hHF on HRQoL was noteworthy in its persistence across the measures used up to one year. Interventions that reduce the risk of these events have the potential to significantly improve patient quality of life.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): AstraZeneca

Evaluating the key predictors of health-related quality of life in patients with heart failure and reduced ejection fraction: results from the DAPA-HF trial

Background

The DAPA-HF trial demonstrated that dapagliflozin was superior to placebo at preventing cardiovascular death and hospitalisation for heart failure (hHF) events in patients with chronic heart failure with reduced ejection fraction (HFrEF). The trial also demonstrated a clinically important benefit of dapagliflozin on health-related quality of life (HRQoL). However, key predictors of HRQoL in HFrEF patients remain uncertain. The objective of this study was to determine, using DAPA-HF trial data, the patient characteristics and disease-related events associated with patient HRQoL, measured by health state utility values.

Methods

Mixed effects regression models were developed based on pooled individual patient data from DAPA-HF to determine patient utility estimated from responses to the EQ-5D-5L questionnaire, incorporating a subject specific random intercept. In line with NICE guidance, utility estimates were derived using UK-specific utility tariffs after mapping EQ-5D-5L data to EQ-5D-3L values. Univariable analysis was first undertaken to assess candidate predictors of utility; followed by a multivariable model including statistically significant predictors, e.g. Kansas City Cardiomyopathy Questionnaire Total Symptom Score (KCCQ-TSS) and the incidence hHF events, and controlling for differences in baseline characteristics. All variables were included in a single model to provide independent (adjusted) estimates for each covariable.

Results

19,983 EQ-5D-5L questionnaires from 4,744 patients were included. Mean patient utility at baseline was 0.716 (95% CI: 0.711, 0.722). Univariable analysis demonstrated NYHA, KCCQ-TSS, T2DM, BMI, age, geographic location, non-ischaemic/unknown aetiology and atrial fibrillation were statistically significant in their association with patient utility while prior hHF, race, eGFR and left ventricular ejection fraction were not.

Multivariable analysis results are summarised in Fig. 1. The baseline characteristic with the greatest impact on EQ-5D was KCCQ-TSS quartile, with EQ-5D increasing with KCCQ-TSS and the difference in utility between patients in quartile 1 (lowest score) and quartile 4 (highest score) estimated at 0.233 (0.226, 0.240).

When controlled for baseline characteristics, being post-event was significantly associated with HRQoL; patients who experienced hospitalisation for HF had 0.036 (0.014, 0.058) lower utility on average within one month of the event and 0.025 (0.011, 0.039) lower utility up to one-year after the event. For patients who had stroke or myocardial infarction events there were reductions in utility of 0.206 (0.141, 0.272) and 0.108 (0.039, 0.177) respectively at 1 month.

Conclusion

HF symptoms, measured by the KCCQ, were strongly associated with patient health utility. Therapeutic interventions that can improve HF symptoms have the potential to improve HRQoL and reduce the burden of HF.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): AstraZeneca

Traditional Uses, Phytochemistry, Pharmacology, and Quality Control of Dendrobium officinale Kimura et. Migo

Dendrobium officinale, a well-known plant used as a medicinal and food homologous product, has been reported to contain various bioactive components, such as polysaccharides, bibenzyls, phenanthrenes, and flavonoids. It is also widely used as a traditional medicine to strengthen “Yin”, nourish heart, tonify five viscera, remove arthralgia, relieve fatigue, thicken stomach, lighten body, and prolong life span. These traditional applications are in consistent with modern pharmacological studies, which have demonstrated that D. officinale exhibits various biological functions, such as cardioprotective, anti-tumor, gastrointestinal protective, anti-diabetes, immunomodulatory, anti-aging, and anti-osteoporosis effects. In this review, we summarize the research progress of D. officinale from November 2016 to May 2021 and aim to better understand the botany, traditional use, phytochemistry, and pharmacology of D. officinale, as well as its quality control and safety. This work presents the development status of D. officinale, analyzes gaps in the current research on D. officinale, and raises the corresponding solutions to provide references and potential directions for further studies of D. officinale.

Differentiated activities of decorin and biglycan in the progression of post-traumatic osteoarthritis

OBJECTIVE

To delineate the activities of decorin and biglycan in the progression of post-traumatic osteoarthritis (PTOA).

DESIGN

Three-month-old inducible biglycan (BgniKO) and decorin/biglycan compound (Dcn/BgniKO) knockout mice were subjected to the destabilization of the medial meniscus (DMM) surgery to induce PTOA. The OA phenotype was evaluated by assessing joint structure and sulfated glycosaminoglycan (sGAG) staining via histology, surface collagen fibril nanostructure and calcium content via scanning electron microscopy, tissue modulus via atomic force microscopy-nanoindentation, as well as subchondral bone structure and meniscus ossification via micro-computed tomography. Outcomes were compared with previous findings in the inducible decorin (DcniKO) knockout mice.

RESULTS

In the DMM model, BgniKO mice developed similar degree of OA as the control (0.44 [-0.18 1.05] difference in modified Mankin score), different from the more severe OA phenotype observed in DcniKO mice (1.38 [0.91 1.85] difference). Dcn/BgniKO mice exhibited similar histological OA phenotype as DcniKO mice (1.51 [0.97 2.04] difference vs control), including aggravated loss of sGAGs, salient surface fibrillation and formation of osteophyte. Meanwhile, Dcn/BgniKO mice showed further cartilage thinning than DcniKO mice, resulting in the exposure of underlying calcified tissues and aberrantly high surface modulus. BgniKO and Dcn/BgniKO mice developed altered subchondral trabecular bone structure in both Sham and DMM groups, while DcniKO and control mice did not.

CONCLUSION

In PTOA, decorin plays a more crucial role than biglycan in regulating cartilage degeneration, while biglycan is more important in regulating subchondral bone structure. The two have distinct activities and modest synergy in the pathogenesis of PTOA.

Curculigoside attenuates oxidative stress and osteoclastogenesis via modulating Nrf2/NF-κB signaling pathway in RAW264.7 cells

ETHNOPHARMACOLOGICAL RELEVANCE

Curculigo orchioides Gaertn is used for the treatment of impotence, atrophic debility of bones (osteoporosis), limb limpness, and arthritis of the lumbar and knee joints in traditional Chinese medicine and Ayurvedic medical system. Curculigoside (Cur) from Curculigo orchioides Gaertn has been shown to have regulatory effects on bone metabolism via anti-oxidative activities in rats and osteoblasts. However, little is known about the molecular pharmacological activity of Cur in osteoclastic bone resorption.

AIM

The aim of this work is to investigate the inhibitory effect of Cur against osteoclasts (OCs) under the oxidative stress status, and explore the possible underlying mechanism.

MATERIALS AND METHODS

OCs were induced from RAW264.7 cells using RANKL and H₂O₂. The number of OCs was measured by tartrate-resistant acid phosphatase (TRAP) staining. F-Actin and nuclear translocation of P65 and Nrf2 were stained with immunofluorescence assay and observed under a laser confocal microscope. The biochemical parameters of OCs were detected with an ELISA kit. The expression of Nrf2 and NF-κB pathway-related proteins was analyzed by Western Blot.

RESULTS

Cur inhibited the TRAP activity, release of degrading products from bone slices and the expression of NFATc1, c-Fos, Cathepsin K (Ctsk) and matrix metallopeptidase 9 (MMP9) of OCs induced with RANKL and H₂O₂. In addition, Cur suppressed the ROS level and NADPH oxidase 1(NOX1) and NADPH oxidase 4 (NOX4) activities of OCS. More importantly, Cur enhanced the expression and nucleus translocation of Nrf2 and activities of its regulatory cytoprotective enzymes, and reduced the NF-κB expression and phosphorylation and nucleus translocation of p65 in OCs. Furthermore, the Nrf2 inhibitor ML385 and NF-κB inhibitor Bay11-7082 counteracted the effect of Cur in OCs.

CONCLUSION

Cur mitigated oxidative stress and osteoclastogenesis by activating Nrf2 and inhibiting the NF-κB pathway, suggesting that Cur may prove to be a promising candidate for the treatment of osteoporosis. Our findings may also help partially explain the rationale behind the traditional use of Curculigo orchioides Gaertn.

POS0094 EFFECTS OF RANKL INHIBITION ON PROMOTING HEALING OF BONE EROSION IN RHEUMATOID ARTHRITIS USING HR-pQCT: A 2-YEAR, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL

Background:

Partial repair of bone erosions in rheumatoid arthritis (RA) is known from high-resolution peripheral quantitative computer tomography (HR-pQCT) studies in patients with moderate to high disease activity using biologics [1]. Whether RANKL inhibition by denosumab is efficacious in healing existing erosions in RA patients with low disease activity or in remission on conventional synthetic DMARDs is uncertain.

Objectives:

To evaluate the effects of denosumab on erosion healing at 2-4 metacarpophalangeal head as determined by HR-pQCT in patients with RA with stable disease.

Methods:

This was a randomized, placebo-controlled, double-blind study. RA patients with disease activity score 28 joints (DAS28) ≤5.1 were randomized (1:1) to subcutaneous denosumab 60 mg or placebo once every six months for 24 months. The primary outcome was erosion healing at MCP 2-4 on HR-pQCT at 12 months. The effects of denosumab on erosion and joint space parameters on HR-pQCT and radiographs, disease activity and health assessment questionnaire-disability index (HAQ-DI) were also examined.

Results:

At 24 months, HR-pQCT images were analyzed in 98 patients. Baseline demographic, clinical characteristics and imaging parameters were comparable between the two treatment groups (table 1). Seventeen patients in each group (placebo group: 17/52, 32.6%; denosumab group: 17/50, 34.0%) achieved sustained low disease activity (DAS28 ≤ 3.2) throughout the 24 months. At 12 months, changes in erosion parameters on HR-pQCT were similar between the two groups. At 24 months, new erosions (19% vs 9%, p=0.009) and erosion progression (34% vs 16%, p<0.001) were more common in the placebo group than the denosumab group. Erosion healing was seen in a significantly higher proportion of patients in the denosumab group (20% vs 6%, p=0.045) at 24 months. The details of the changes in HR-pQCT erosion parameters are shown in figure 1. No significant differences in the changes in joint space parameters on HR-pQCT, van der Heijde-Sharp erosion score, DAS28 and HAQ-DI were observed between the two groups at 12 and 24 months.

Table 1.

Baseline clinical, demographic, disease activity parameters and medications

Placebo (n=55)Denosumab (n=55)Total (n=110)Age56.5 ± 7.157.2 ± 8.556.8 ± 7.8Gender (Female)47 (86)41 (75)88 (80)Disease duration (years)8.5 ± 6.87.3 ± 6.97.9 ± 6.8Rheumatoid factor positive40 (72)38 (69)78 (71)ACPA positive43 (78)44 (80)87 (79)DAS28-CRP2.43 ± 0.832.6 ± 0.922.51 ± 0.88DAS28-CRP>3.28 (15)13 (24)21 (19)HAQ-DI (0-3)0.31 ± 0.380.46 ± 0.470.39 ± 0.43csDMARDs49 (89)52 (95)101 (92)Combination csDMARDs26 (47)33 (60)59 (54)Glucocorticoids5 (10)5 (9)10 (9)vdH- Sharp erosion score10.4 ± 18.48.9 ± 13.89.6 ± 16.2vdH- Sharp JSN score12.4 ± 17.711.5 ± 17.211.9 ± 17.4Lumbar spine aBMD, g/cm20.914 ± 0.1470.930 ± 0.1430.922 ± 0.145Total hip aBMD, g/cm20.837 ± 0.1020.847 ± 0.1460.841 ± 0.125Femoral neck aBMD, g/cm20.681 ± 0.0990.695 ± 0.1280.687 ± 0.114

Data are reported as mean ± SD or number (%). ACPA: Anti-cyclic citrullinated peptide antibody; DAS28: disease activity score 28; csDMARDs: conventional synthetic disease modifying anti-rheumatic drug. HAQ-DI: health assessment questionnaire disability index; vdH- Sharp score: Van der Heijde- Sharp score; aBMD: areal bone mineral density

Conclusion:

Although no differences in erosion parameters were observed at 12 months, denosumab was more efficacious than placebo in erosion repair on HR-pQCT after 24 months.

References:

[1]Finzel S, Rech J, Schmidt S, et al. Interleukin-6 receptor blockade induces limited repair of bone erosions in rheumatoid arthritis: a micro CT study. Ann Rheum Dis 2013;72:396-400.

Figure 1.

Changes in erosion parameters by HR-pQCT. (A) Percentage of patients with overall erosion healing; (B) Outcome of individual erosion with healing, progression and new erosion detected across study period; change in (C) mean erosion volume; (D) total erosion volume; (E) erosion width; (F) erosion depth and (G) marginal osteosclerosis per patient.

Disclosure of Interests:

Ho SO: None declared, Isaac T. Cheng: None declared, Sze-Lok Lau: None declared, Evelyn Chow: None declared, Tommy Lam: None declared, Vivian W Hung: None declared, Edmund Li: None declared, James F Griffith: None declared, Vivian WY Lee: None declared, Lin Shi: None declared, Junbin Huang: None declared, Yan Kitty Kwok: None declared, Isaac C Yim: None declared, Tena K. Li: None declared, Vincent Lo: None declared, Jolly M Lee: None declared, Jack Jock Wai Lee: None declared, Ling Qin: None declared, Lai-Shan Tam Grant/research support from: Grants from Novartis and Pfizer

Single Standard Substance for the Simultaneous Determination of Eleven Components in the Extract of Paeoniae Radix Alba (Root of Paeonia lactiflora Pall.)

Paeoniae Radix Alba (PRA), an herbal drug produced from the root of Paeonia lactiflora Pall., is widely used in many herbal medicine prescriptions/preparations. Since the pharmacological effects of PRA come from multiple chemical components, it is important to establish a method for the determination of those components in PRA extracts with simple operation and low cost, which is more suitable to evaluate the quality of PRA extracts and optimize the extraction process. This work introduced the quantitative analysis of multicomponents with a single-marker (QAMS) method for the simultaneous determination of eleven bioactive components in PRA extracts, including gallic acid, oxypaeoniflorin, catechin, albiflorin, paeoniflorin, ethyl gallate, galloylpaeoniflorin, pentagalloylglucose, benzoic acid, benzoylpaeoniflorin, and paeonol. In the QAMS method established based on high performance liquid chromatography with diode array detection, only the reference substance of paeoniflorin was needed, and the other ten components were determined based on their relative correction factors (RCFs) to paeoniflorin. Moreover, the repeatability and robustness of the RCFs were studied with different column temperatures, detection wavelengths, flow rates, column types, and instruments. In method validation, good linearity (r > 0.999), stability, repeatability (RSD < 1.9%), and accuracy (recoveries within 96.1%-105.5%) were shown. Sample analyses showed that the QAMS method was consistent with the conventional external standard method. The established method provided a comprehensive, efficient, and low-cost tool for the routine quality evaluation of PRA extracts.

Beneficial Relationships Between Endophytic Bacteria and Medicinal Plants

Plants benefit extensively from endophytic bacteria, which live in host plant tissues exerting no harmful effects. Bacterial endophytes promote the growth of host plants and enhance their resistance toward various pathogens and environmental stresses. They can also regulate the synthesis of secondary metabolites with significant medicinal properties and produce various biological effects. This review summarizes recent studies on the relationships between bacterial endophytes and medicinal plants. Endophytic bacteria have numerous applications in agriculture, medicine, and other industries: improving plant growth, promoting resistance toward both biotic and abiotic stresses, and producing metabolites with medicinal potential. Their distribution and population structure are affected by their host plant's genetic characteristics and health and by the ecology of the surrounding environment. Understanding bacterial endophytes can help us use them more effectively and apply them to medicinal plants to improve yield and quality.

Salchaetoglobosins A and B: Cytochalasan alkaloids from Chaetomium globosum D38, a fungus derived from Salvia miltiorrhiza

Chemical investigation on the solid rice culture of Chaetomium globosum D38, an endophytic fungus derived from Salvia miltiorrhiza, has afforded two new 19,20-seco-chaetoglobosins, salchaetoglobosins A (1) and B (2), along with three known analogues, chaetoglobosins E (3), Fex (4), and V_b (5). Their structures and absolute configurations were elucidated by a set of spectroscopy and single-crystal X-ray crystallography. Compounds 1-5 were evaluated for their cytotoxic activities against HCT-116 (colorectal carcinoma) and PC3 (prostate cancer) cells, as well as the NO production inhibitory effects in LPS-stimulated RAW264.7 cells.

Connectivity map analysis identifies fisetin as a treatment compound for osteoporosis through activating the PI3K-AKT signaling pathway in mouse pre-osteoblastic MC3T3-E1 cells

AIMS

This research aimed at exploring potential new compound in the treatment of osteoporosis by Connectivity Map (CMap) and determining the role of fisetin on osteoporosis according to its effects on PI3K-AKT signaling pathway in MC3T3-E1 pre-osteoblastic cells.

METHODS

Microarray analysis was used to obtain the differentially expressed genes in published gene expression data. Potent compounds for osteoporosis therapy were discovered by CMap analysis. DAVID and gene set enrichment analysis (GSEA) were used to discover signaling pathways that connected to osteoporosis disease. Cell viability was evaluated by a CCK-8 assay. Quantitative real-time polymerase chain reaction (qRT-PCR) and western blot analysis were used to test the mRNA and protein expressions related to PI3K-AKT signaling pathway in MC3T3-E1 cells respectively.

RESULTS

CMap analysis identified fisetin as a promising compound for anti-osteoporosis treatment. DAVID and GSEA analysis showed that the PI3K-AKT signaling pathway was inactivated in osteoporosis. Cell experiments revealed that fisetin caused an elevation of cell viability, up-regulated the mRNA levels of the runt-related transcription factor-2 (Runx2), osterix (Osx), collagen type I 1 (Col1a1) and osteoprotegerin (OPG) while down-regulated the nuclear factor-κB ligand (RANKL) mRNA level.

DISCUSSION

The protein levels of Runx2, Col1a1 and osteocalcin(OCN) were also increased by fisetin. Furthermore, fisetin activated the phosphoinositide-3-kinase/protein kinase B (PI3K-AKT) signaling pathway, and blocking this pathway by the inhibitor LY-294002 could impair fisetin's functions on proliferation, differentiation and OPG/RANKL expression ratio in the MC3T3-E1 cells.

CONCLUSION

Our results demonstrated that fisetin could promote MC3T3-E1 cell proliferation, differentiation, and increase OPG/RANKL expression ratio through activating the PI3K-AKT pathway, which has potential in the treatment of osteoporosis.

Transcription Factor: A Powerful Tool to Regulate Biosynthesis of Active Ingredients in Salvia miltiorrhiza

Salvia miltiorrhiza Bunge is a common Chinese herbal medicine, and its major active ingredients are phenolic acids and tanshinones, which are widely used to treat vascular diseases. However, the wild form of S. miltiorrhiza possess low levels of these important pharmaceutical agents; thus, improving their levels is an active area of research. Transcription factors, which promote or inhibit the expressions of multiple genes involved in one or more biosynthetic pathways, are powerful tools for controlling gene expression in biosynthesis. Several families of transcription factors have been reported to participate in regulating phenolic acid and tanshinone biosynthesis and influence their accumulation. This review summarizes the current status in this field, with focus on the transcription factors which have been identified in recent years and their functions in the biosynthetic regulation of phenolic acids and tanshinones. Otherwise, the new insight for further research is provided. Finally, the application of the biosynthetic regulation of active ingredients by the transcription factors in S. miltiorrhiza are discussed, and new insights for future research are explored.

Change in the active component of processed Tetradium ruticarpum extracts leads to improvement in efficacy and toxicity attenuation

ETHNOPHARMACOLOGICAL RELEVANCE

The dried and nearly ripe fruits of Tetradium ruticarpum (A. Juss.) T.G. Hartley (TR) have long been used in treating headache and gastrointestinal disorders in oriental medicine. TR is usually processed by stir-frying with licorice extract before use. Although processing procedure is considered as the way to relieve pungent smell, reduce toxicity, and improve efficacy, its effects on TR's toxicity and efficacy and bioactive compound profiles are largely unknown.

AIM OF THE STUDY

The purposes of the study are to evaluate the acute toxicity, efficacy and variation of toxic and effective components of TR before and after processing, and to explore the possible mechanism of how the processing procedure affect the quality of TR as a herbal medicine.

MATERIALS AND METHODS

Volatile oil, aqueous extract and ethanol extract of raw and processed TR were tested for their acute toxicity, analgesic, and anti-inflammatory effects in mouse models, respectively. To identify potential toxic and effective components, the extracts were analyzed with gas chromatography-mass spectrometry and ultra-performance liquid chromatography - quadrupole time-of-flight mass spectrometry, followed by fold-change-filtering analysis.

RESULTS

LD₅₀ and LD₅ tests indicated that although the aqueous extract has higher toxicity than volatile oil and ethanol extract, the use of TR is safe under the recommended does. The processing procedure could effectively decrease the toxicity of all three extracts with the largest decrease in volatile oil, which is likely due to the loss of volatile compounds during processing. Analgesic and anti-inflammatory studies suggested that volatile oil and ethanol extract of TR have better efficacy than the aqueous extract and the processing procedure significantly enhanced the efficacy of these two former extracts, whereas processing showed no substantially effects on the bioactivities of aqueous extract. Integrated analysis of animal trial and chromatographic analyses indicated that indole and quinolone type alkaloids, limonoids, amides and 18β-glycyrrhetinic acid were identified as the potential main contributors of TR's efficacy, whereas hydroxy or acetoxy limonoid derivates and coumarins could be the major causes of toxicity. Moreover, the reduced toxicity and improved efficacy of the processed TR are liked due to the licorice ingredients and altered alkaloids with better solubility.

CONCLUSIONS

In summary, the integrated toxicity and efficacy analyses of volatile, aqueous and ethanol extracts of TR indicated that the processing procedure could effectively reduce its acute toxicity in all three extracts and enhance its analgesic and anti-inflammatory effects in volatile and ethanol extracts. The promising candidate compounds related to the toxicity and efficacy of TR were also identified. The results could expand our understanding of the value of the standard processing procedure of TR, be valuable to the quality control of TR manufacturing and administration, as well as support clinical rational and safety applications of this medicinal plant.

MiRNA-7b-5p attenuates the progression of osteoporosis by inhibiting adipose differentiation of hMSCs via regulating IRS2

OBJECTIVE

To elucidate whether microRNA-7b-5p (miRNA-7b-5p) could inhibit adipose differentiation of human bone marrow-derived mesenchymal stem cells (hMSCs) through regulating IRS2, thereby alleviating the progression of osteoporosis.

MATERIALS AND METHODS

Expression levels of miRNA-7b-5p and IRS2 in hMSCs at different stages of adipogenic differentiation and osteogenic differentiation were detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) and Western blot. After transfection of miRNA-7b-5p mimic or pcDNA-IRS2 in hMSCs, lipid droplet formation in cells was observed by oil red O staining. Expressions of C/EBPα and PPARγ were detected by qRT-PCR and Western blot. The potential target gene of miRNA-7b-5p was predicted by bioinformatics and verified by dual-luciferase reporter gene assay. Finally, expressions of IRS2 in hMSCs transfected with miRNA-7b-5p-NC, miRNA-7b-5p mimic or co-transfected with miRNA-7b-5p mimic and pcDNA-IRS2 were examined.

RESULTS

Expressions of miRNA-7b-5p and IRS2 gradually decreased with the prolongation of adipogenic differentiation, but increased during osteogenic differentiation of hMSCs. Transfection of miRNA-7b-5p mimic reduced oil red O staining after adipogenic differentiation and downregulated mRNA and protein levels of C/EBPα and PPARγ. Transfection of pcDNA-IRS2 increased oil red O staining after osteogenic differentiation and upregulated mRNA and protein levels of C/EBPα and PPARγ. Dual-luciferase reporter gene results showed that miRNA-7b-5p could bind to IRS2. Overexpression of IRS2 reversed the downregulated mRNA and protein levels of adipogenic-related genes C/EBPα and PPARγ due to the overexpression of miRNA-7b-5p.

CONCLUSIONS

MiRNA-7b-5p inhibits the adipogenic differentiation of hMSCs through IRS2, thus alleviating the development of osteoporosis.

Bajitianwan attenuates D-galactose-induced memory impairment and bone loss through suppression of oxidative stress in aging rat model

ETHNOPHARMACOLOGICAL RELEVANCE

Osteoporosis and Alzheimer's disease (AD) are both senile diseases, which are closely related to oxidative stress. Bajitianwan (BJTW) is a classic Chinese formulation consisting of seven herbal drugs: the root of Morinda officinalis F.C.How., root and rhizome of Acorus tatarinowii Schott, the root bark of Lycium chinense Mill., the sclerotium of Poria cocos (Schw.) Wolf, the root of Polygala tenuifolia Willd., sclerotium with host wood of Poria cocos (Schw.) Wolf and root and rhizome of Panax ginseng C. A. Mey. BJTW has been used for the treatment of osteoporosis and AD for hundreds of years.

AIM OF THE STUDY

This study aimed to investigate the protective effects of BJTW in the amelioration of memory impairment and bone loss induced by D-galactose and to explore the underlying mechanism.

MATERIALS AND METHODS

The aging model was established in male Wistar rats by subcutaneous injection of D-galactose (100 mg/kg), and the rats were treated with huperzine-A, alendronate sodium, or the aqueous extract of BJTW for 4 months. Cognitive performance was evaluated with the Morris water maze. Rat femurs were scanned using microcomputed tomography to obtain three-dimensional imagery of bone microstructure. The impact of D-galactose on the expression of Forkhead box O1 and superoxide dismutase 2 in femur tissue was also evaluated.

RESULTS

For the model group, BJTW treatment significantly reduced the latency time for finding the target platform in the directional swimming test and increased time spent swimming in the target quadrant with the probe test. Additionally, BJTW treatment alleviated D-galactose-induced bone loss through regulation of levels of alkaline phosphatase, osteocalcin, osteoprotegerin, and receptor activator of nuclear factor kappa B ligand. Furthermore, BJTW treatment increased catalase and glutathione peroxidase levels in serum, reduced malondialdehyde content in hippocampus, and upregulated expression of Forkhead O1, which upregulated superoxide dismutase 2 in the femur.

CONCLUSIONS

BJTW had positive effects on age-related memory impairments and bone loss. It may be a promising antioxidant candidate for treatment of Alzheimer's disease and osteoporosis.

MicroRNA-330-5p promotes the development of osteosarcoma by regulating SPRY2

OBJECTIVE

MicroRNA is an endogenous, non-coding small RNA that has a significant role in regulating organisms and pathology. Previous studies have demonstrated that microRNA-330-5p was a cancer-promoting gene. However, the role of microRNA-330-5p in osteosarcoma (OS) has not been reported. The aim of this work was to explore the characteristics of microRNA-330-5p expression in OS, and to further study its expression in OS and its relationship with clinicopathological parameters and prognosis.

PATIENTS AND METHODS

Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was performed to investigate the expression of microRNA-330-5p in 48 pairs of OS tissues and paracancer tissues, and to analyze the relationship between the expression of microRNA-330-5p and OS clinical indicators and patient prognosis. Meanwhile, qRT-PCR was performed to verify the microRNA-330-5p expression in OS cells. In addition, the microRNA-330-5p knockdown expression model was constructed using lentivirus in OS cell lines U2OS and MG63. The effects of microRNA-330-5p on the biological function of OS cells were analyzed by Cell Counting Kit-8 (CCK-8) and transwell experiments. The potential mechanism was explored by Western blot.

RESULTS

In this paper, qRT-PCR results showed that the expression of microRNA-330-5p in OS was higher than that in paracancer tissues, and the difference was statistically significant. Compared with microRNA-330-5p low expression group, patients with high expression of microRNA -330-5p had a higher prevalence of distant metastasis and a lower overall survival rate. In vitro experiment showed that the proliferation, invasion and metastasis abilities of the cells in the microRNA-330-5p silencing group were markedly decreased compared with the negative control group (NC group). Western blot results demonstrated that microRNA-330-5p inhibitor can activate SPRY2 and regulate the expression of key proteins, such as p-Smad2, p-Smad3, TGF-β1, MMP9 and Vimentin in the TGF-β1/Smad signaling pathway. It was found that there was a mutual regulation between microRNA-330-5p and SPRY2, which promoted the malignant progression of OS.

CONCLUSIONS

The expression of microRNA-330-5p was markedly increased in OS, which was associated with distant metastasis and poor prognosis. Furthermore, we found that microRNA-330-5p may promote the vicious progression of OS by inter-modulating SPRY2 and the TGF-β1/Smad signaling pathways.

Novel Insight into Utilization of Flavonoid Glycosides and Biological Properties of Saffron (Crocus sativus L.) Flower Byproducts

Saffron (Crocus sativus L.) byproducts are considered as a cheap source of bioactive polyphenolics endowed with potential antioxidant effects. The saffron biowaste is utilized for extraction of flavonoid glycosides and their potential biological properties. The total amount of polyphenolics and polysaccharides was found to be higher in the tepal than in the stamen. The bioactive compounds quercetin-3-O-sophoroside (Q-3-sop) and kaempferol-3-O-sophoroside (K-3-sop) were analyzed using high-performance liquid chromatography equipped with a photodiode array detector (HPLC-PDA) and identified by high-resolution mass spectrometry (HRMS) and nuclear magnetic resonance (NMR). The antioxidant effects were studied using 2,2 diphenyl-2-picrylhydrazyl (DPPH), 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS), ferric ion reducing antioxidant power (FRAP), and oxygen radical absorbance capacity (ORAC); Q-3-sop showed stronger antioxidant effects compared to K-3-sop, crocin-I, and crocin-II. Furthermore, Q-3-sop also inhibited cell apoptosis caused by H₂O₂ by reducing the levels of cellular reactive oxygen species (ROS). In terms of cytogenetic effects, Q-3-sop revealed no cytogenic effects on onion root meristem cells but chromosomal aberration was observed at the highest dose (200 ppm). Thus, saffron byproducts and its flavonoids could be utilized as natural antioxidant agents with no cytogenetic effects.

Mycoplasma pneumoniae lipids license TLR-4 for activation of NLRP3 inflammasome and autophagy to evoke a proinflammatory response

Mycoplasma pneumoniae is an obligate pathogen that causes pneumonia, tracheobronchitis, pharyngitis and asthma in humans. It is well recognized that membrane lipoproteins are immunostimulants exerting as lipopolysaccharides (LPS) and play a crucial role in the pathogenesis of inflammatory responses upon M. pneumoniae infection. Here, we report that the M. pneumoniae-derived lipids are another proinflammatory agents. Using an antibody-neutralizing assay, RNA interference or specific inhibitors, we found that Toll-like receptor 4 (TLR-4) is essential for M. pneumoniae lipid-induced tumour necrosis factor (TNF)-α and interleukin (IL)-1β production. We also demonstrate that NLR family pyrin domain containing 3 inflammasome (NLRP3) inflammasome, autophagy and nuclear factor kappa B (NF-κB)-dependent pathways are critical for the secretion of proinflammatory cytokines, while inhibition of TLR-4 significantly abrogates these events. Further characterization revealed that autophagy-mediated inflammatory responses involved the activation of NF-κB. In addition, the activation of NF-κB promoted lipid-induced autophagosome formation, as revealed by assays using pharmacological inhibitors, 3-methyladenine (3-MA) and Bay 11-7082, or silencing of atg5 and beclin-1. These findings suggest that, unlike the response to lipoprotein stimulation, the inflammation in response to M. pneumoniae lipids is mediated by the TLR-4 pathway, which subsequently initiates the activation of NLRP3 inflammasome and formation of a positive feedback loop between autophagy and NF-κB signalling cascade, ultimately promoting TNF-α and Il-1β production in macrophages.

[Burden of disease attributed to high level serum low-density lipoprotein cholesterol in China in 2017]

Objective: To quantitatively analyze the death and disability-adjusted life years (DALY) attributed to high level serum LDL-C in Chinese population in 2017. Methods: Data were obtained from the '2017 Global Burden of Disease Study (GBD2017)'. Population attributable fraction (PAF), number and rate of deaths and DALY attributable to high LDL-C were used to describe the burden of disease by gender, age groups, diseases and provinces in China. Both rates on mortality and DALY were standardized by GBD world population. Results: In 2017, 862 759 deaths were caused by high level serum LDL-C in China, that accounting for 8.25% of the total deaths. Of the attributable deaths, 705 355 (81.76%) persons died from ischemic heart disease (IHD), while the remaining 18.24% from ischemic stroke (IS). High LDL-C accounted for 40.30% of the total deaths from ischemic heart disease and 18.49% from ischemic stroke. The highest PAF of death (13.70%) appeared in Jilin province and the lowest in Zhejiang province (4.65%). PAF of death was seen higher in females than in males, while both age-standardized rates of mortality and DALY appeared higher in males than in females. High LDL-C attributed mortality rate appeared as 61.08/100 000 after standardization in Chinese population. High LDL-C attributed DALYs were 18.16 million person years, among which 76.76% were caused by IHD (13.94 million person years), with DALY rate as 1285.83/100 000. Among provinces, Heilongjiang showed the highest standardized DALY rate, and Zhejiang the lowest. The PAF, number of deaths, rates on mortality and DALY caused by high LDL-C were high among residents above 70 years old, with the DALY number as 8.56 million person years, highest seen in the age group from 50 to 69 years old. Conclusion: The burden of disease attributed to high level LDL-C was quite high and with gender, age group and interprovincial differences, in China in 2017.

A natural compound (LCA) isolated from Litsea cubeba inhibits RANKL-induced osteoclast differentiation by suppressing Akt and MAPK pathways in mouse bone marrow macrophages

ETHNOPHARMACOLOGICAL RELEVANCE

Litsea cubeba (Lour.) Pers. has been traditionally used as a folk prescription for treating rheumatic diseases in China.

AIM OF THE STUDY

This study aimed to investigate the effects and underlying mechanism of LCA, a new type of dibenzyl butane lignin compound extracted from L. cubeba, on macrophage colony stimulating factor (M-CSF) plus receptor activator of NF-κB ligand (RANKL)-induced osteoclast differentiation in mouse-derived bone marrow macrophages (BMMs).

MATERIAL AND METHODS

TRAP staining, TRAP enzyme activity assay and actin ring staining were applied to identify the effects of LCA on osteoclast differentiation. Protein expression of NFATc1, c-Fos and MMP-9, and phosphorylation of p65, Akt, JNK, ERK and p38 in RANKL-induced osteoclasts was determined using western blotting to investigate the underlying mechanism.

RESULTS

LCA significantly suppressed RANKL-induced osteoclast differentiation by inhibiting TRAP activity, decreasing the number of TRAP⁺ multinuclear osteoclasts and reducing the formation of F-actin ring without obvious cytotoxicity in BMMs. Moreover, LCA treatment strongly reduced protein expression of NFATc1, c-Fos and MMP-9, and attenuated the phosphorylation of p65, Akt, JNK, ERK and p38 in RANKL-stimulated BMMs.

CONCLUSIONS

LCA ameliorated RANKL-induced osteoclast differentiation via inhibition of Akt and MAPK signalings in BMMs, and may serve as a potential pro-drug for bone destruction prevention.