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Ding J, Wang X, Yang H, Zhang L, Ying Y, Pi W, Deng G, Zhu Y. IGF2BP3 Triggers STAT3 Pathway by Stabilizing SRC RNA in an m6A-Dependent Manner to Promote Lymphatic Metastasis in LUAD. Cancer Sci 2025; 116:936-950. [PMID: 39805702 PMCID: PMC11967251 DOI: 10.1111/cas.16451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 12/24/2024] [Accepted: 01/03/2025] [Indexed: 01/16/2025] Open
Abstract
Lymph node metastasis significantly affects the NSCLC patients' staging, treatment strategy, and prognosis. Studies have shown that IGF2BP3, an oncofetal protein and an m6A reader, overexpresses and correlates to lymph node metastasis and worse overall survival in histopathological studies including NSCLC, but its mechanism needs further study. This study explored IGF2BP3's function and mechanism in LUAD lymphatic metastasis using public databases, a human LUAD tissue microarray, human LUAD cells, and a lymphatic metastasis model in male BALB/c nude mice. Firstly, we proved that IGF2BP3 overexpression was positively correlated to patients' lymph node metastasis and worse overall survival in bioinformatics and a human LUAD tissue microarray analysis. IGF2BP3 was knocked out or overexpressed in human LUAD cell lines. Functionally, IGF2BP3 facilitated NCI-H1299, NCI-H358, and A549 cell growth, migration, invasion, and EMT in vitro, and promoted tumorigenesis, lymphangiogenesis, and lymphatic metastasis of NCI-H1299 cells in BALB/c nude mice. Mechanically, RIP, RNA pull-down assay, MeRIP, mRNA stability assays, rescue experiments, and immunohistochemical assays were conducted. IGF2BP3 was demonstrated to bind to the m6A site of the 3'UTR region of SRC, stabilizing its mRNA and activating the downstream STAT3 signaling pathway and lymphatic growth factors such as VEGF-C, therefore affecting lymphatic metastasis. The cell migration and EMT function of IGF2BP3 were partially rescued by utilizing SRC siRNA or AZD0530, an SRC inhibitor. This study demonstrated that IGF2BP3 promotes lymphatic metastasis in LUAD via activating the m6A-SRC-STAT3-VEGFC signaling axis, indicating that IGF2BP3 is a potential therapeutic target to overcome metastasis in LUAD patients.
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Affiliation(s)
- Jiapei Ding
- Department of Radiotherapy & OncologyThe Second Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health AcademyTaizhou Hospital Affiliated to Wenzhou Medical UniversityTaizhouZhejiangChina
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang ProvinceWenzhou Medical UniversityTaizhouZhejiangChina
| | - Xuequan Wang
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health AcademyTaizhou Hospital Affiliated to Wenzhou Medical UniversityTaizhouZhejiangChina
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang ProvinceWenzhou Medical UniversityTaizhouZhejiangChina
| | - Haihua Yang
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health AcademyTaizhou Hospital Affiliated to Wenzhou Medical UniversityTaizhouZhejiangChina
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang ProvinceWenzhou Medical UniversityTaizhouZhejiangChina
| | - Lele Zhang
- School of Laboratory MedicineNingxia Medical UniversityYinchuanChina
| | - Yongquan Ying
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang ProvinceWenzhou Medical UniversityTaizhouZhejiangChina
| | - Wenhu Pi
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health AcademyTaizhou Hospital Affiliated to Wenzhou Medical UniversityTaizhouZhejiangChina
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang ProvinceWenzhou Medical UniversityTaizhouZhejiangChina
| | - Guozhong Deng
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health AcademyTaizhou Hospital Affiliated to Wenzhou Medical UniversityTaizhouZhejiangChina
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang ProvinceWenzhou Medical UniversityTaizhouZhejiangChina
| | - Yaqun Zhu
- Department of Radiotherapy & OncologyThe Second Affiliated Hospital of Soochow UniversitySuzhouJiangsuChina
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Krešić T, Klarić M, Eminović S, Kolobarić A, Dugandžić Šimić A, Bošković A. Prognostic Value of IMP3 Expression in Squamous Cervical Cancer. Appl Immunohistochem Mol Morphol 2024; 32:412-416. [PMID: 39351768 PMCID: PMC11451927 DOI: 10.1097/pai.0000000000001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 08/28/2024] [Indexed: 10/06/2024]
Abstract
Cervical cancer remains one of the leading causes of death from malignant diseases in women worldwide. Primary and secondary prevention have led to better outcomes in developed countries, whereas in developing countries, cervical cancer continues to be responsible for an unjustifiably high number of fatalities. The discovery of new tumor biomarkers can lead to earlier diagnosis, better therapeutic decisions, and improved treatment methods. IMP3 is a protein responsible for invasiveness and other aggressive characteristics of tumor processes. Its highly specific expression has been proven in various malignant processes. The level of IMP3 expression in cervical cancer cells could be used as a prognostic factor for a worse disease course. In this study, IMP3 expression was examined in 80 patients who underwent surgery for squamous cell cervical cancer in the first FIGO stage of the disease, and its association with disease-free period and overall survival was investigated. Data analysis did not show a statistically significant association between IMP3 expression and the mentioned primary outcomes, despite its association with clinical-pathological indicators of advanced disease. In conclusion, the analysis of IMP3 protein expression in patients with early-stage cervical cancer is of limited utility.
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Affiliation(s)
- Tanja Krešić
- Department of Gynecology and obstretics, University Hospital Mostar
- Faculty of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | | | - Senija Eminović
- Department of Pathology, Clinical Hospital Centar Rijeka, Rijeka, Republic Croatia
| | - Anita Kolobarić
- Department of Pediatrics, University Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Ana Dugandžić Šimić
- Department of Gynecology and obstretics, University Hospital Mostar
- Faculty of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Ana Bošković
- Department of Gynecology and obstretics, University Hospital Mostar
- Faculty of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
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Wang M, Meng J, Wang H, Hu H, Hong Y. Atractylodes macrocephala III suppresses EMT in cervical cancer by regulating IGF2BP3 through ETV5. J Cell Mol Med 2024; 28:e18081. [PMID: 38358034 PMCID: PMC10868144 DOI: 10.1111/jcmm.18081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 02/16/2024] Open
Abstract
Atractylodes macrocephala III (ATL III), with anti-inflammatory and antitumor effects, is the main compound of Atractylodes macrocephala. Whether ATL III has an effect on cervical cancer and the specific mechanism are still unclear. Here, we investigated the effects of ATL III on cervical cancer cells at different concentrations and found that ATL III downregulates insulin-like growth factor 2 mRNA-binding protein 3 (IGF2BP3), which was found to be highly expressed in cervical cancer tissue by RNA-Seq. In this study, we found that ATL III promotes apoptosis and regulates epithelial-mesenchymal transition (EMT) in cervical cancer cells (HeLa and SiHa cells) and that IGF2BP3 is a common target gene of ATL III in HeLa and SiHa cells. The expression level of IGF2BP3 in cervical cancer cells was proportional to their migration and invasion abilities. This was verified by transfection of cells with a small interfering RNA and an IGF2BP3 overexpression plasmid. After ATL III treatment, the migration and invasion abilities of cervical cancer cells were obviously reduced, but these effects were attenuated after overexpression of IGF2BP3. In addition, the transcription factor IGF2BP3 was predicted by the JASPAR system. After intersection with our sequencing results, we verified the promotional effect of ETV5 (ETS translocation variant 5) on IGF2BP3 and found that ALT III inhibited ETV5. In general, our research showed that ATL III inhibits the migration and invasion of cervical cancer cells by regulating IGF2BP3 through ETV5.
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Affiliation(s)
- Meixia Wang
- Department of Gynecology and ObstetricsNanjing Drum Tower Hospital, Clinical College of Nanjing University of Chinese MedicineNanjingChina
- Department of Gynecology and ObstetricsWenzhou Hospital of Integrated Traditional Chinese and Western MedicineWenzhouChina
| | - Jingwen Meng
- Department of Gynecology and ObstetricsNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Hongyun Wang
- Department of Gynecology and ObstetricsNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Huijuan Hu
- Department of Gynecology and ObstetricsWenzhou Hospital of Integrated Traditional Chinese and Western MedicineWenzhouChina
| | - Ying Hong
- Department of Gynecology and ObstetricsNanjing Drum Tower Hospital, Clinical College of Nanjing University of Chinese MedicineNanjingChina
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Sun X, Ye G, Li J, Shou H, Bai G, Zhang J. Parkin regulates IGF2BP3 through ubiquitination in the tumourigenesis of cervical cancer. Clin Transl Med 2023; 13:e1457. [PMID: 37877353 PMCID: PMC10599278 DOI: 10.1002/ctm2.1457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Insulin-like growth Factor 2 mRNA-binding protein 3 (IGF2BP3) is a highly conserved RNA-binding protein and plays a critical role in regulating posttranscriptional modifications. METHODS Immunoprecipitation was used to examine the interaction of Parkin and IGF2BP3. Mass spectrometry was performed to identify the ubiquitination sites of IGF2BP3. RNA-immunoprecipitation was conducted to examine the target genes of IGF2BP3. Xenograft mouse model was constructed to determine the tumorigenesis of IGF2BP3. RESULTS IGF2BP3 expression is negatively correlated with Parkin expression in human cervical cancer cells and tissues. Parkin directly interacts with IGF2BP3, and overexpression of Parkin causes the proteasomal degradation of IGF2BP3, while knockdown of PARK2 increases the protein levels of IGF2BP3. Mechanistically, in vivo and in vitro ubiquitination assays demonstrated that Parkin is able to ubiquitinate IGF2BP3. Moreover, the ubiquitination site of IGF2BP3 was identified at K213 in the first KH domain of IGF2BP3. IGF2BP3 mutation results in the loss of its oncogenic function as an m6A reader, resulting in the inactivation of the phosphoinositide 3-kinase (PI3K) and mitogen-activated protein kinase (MAPK) signalling pathways. In addition, IGF2BP3 mutation results in the attenuation of Parkin-mediated mitophagy, indicating its inverse role in regulating Parkin. Consequently, the tumourigenesis of cervical cancer is also inhibited by IGF2BP3 mutation. CONCLUSION IGF2BP3 is ubiquitinated and regulated by the E3 ubiquitin ligase Parkin in human cervical cancer and ubiquitination modification plays an important role in modulating IGF2BP3 function. Thus, understanding the role of IGF2BP3 in tumourigenesis could provide new insights into cervical cancer therapy.
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Affiliation(s)
- Xin Sun
- Department of Medical OncologyCancer CenterKey Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang ProvinceZhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)HangzhouChina
| | - Guiqin Ye
- Basic Medical SciencesHangzhou Medical CollegeHangzhouChina
| | - Jiuzhou Li
- Department of NeurosurgeryBinzhou People's HospitalBinzhouChina
| | - Huafeng Shou
- Department of GynecologyZhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)BinzhouChina
| | - Gongxun Bai
- Key Laboratory of Rare Earth Optoelectronic Materials and Devices of Zhejiang Province, College of Optical and Electronic TechnologyChina Jiliang UniversityHangzhouChina
| | - Jianbin Zhang
- Department of Medical OncologyCancer CenterKey Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang ProvinceZhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)HangzhouChina
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Klein M, Wefers M, Hallermann C, Fischer HJ, Hölzle F, Wermker K. IMP3 Expression as a Potential Tumour Marker in High-Risk Localisations of Cutaneous Squamous Cell Carcinoma: IMP3 in Metastatic cSCC. Cancers (Basel) 2023; 15:4087. [PMID: 37627115 PMCID: PMC10452512 DOI: 10.3390/cancers15164087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/01/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND High IMP3 expression is correlated with a worse outcome. Until now, there have been no data about IMP3 expression and clinical outcome for high-risk localisation of squamous cell carcinoma of the skin (cSCC). METHODS One-hundred twenty-two patients with cSCC of the lip and ear were included, and IMP3 expression in the tumours was immunohistochemically assessed in different evaluation approaches. Subsequently, subgroups were analysed in a matched pair approach and correlated with clinical pathologic parameters. In the following, different IMP3 analysis methods were tested for clinical suitability. RESULTS We found a significant correlation between IMP3 expression and risk for lymph node metastasis, local relapse, and progression-free survival. CONCLUSIONS On basis of our data, we suggest a prognostic benefit cutoff value for high (>50%) and low (<50%) IMP3 expression. Thus, IMP3 expression has a high scientific potential for further studies and could potentially be used as a prognostic marker in diagnostic and therapeutic decision-making.
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Affiliation(s)
- Maurice Klein
- Department of Oral, Maxillofacial and Facial Plastic Surgery, School of Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany;
| | - Merle Wefers
- Orthodontics Meyer, Kurze Straße 6, 48151 Muenster, Germany;
| | - Christian Hallermann
- Laboratory for Dermatopathology and Pathology Hamburg-Niendorf, Tibarg 7, 22459 Hamburg, Germany;
- Department of Dermatology and Histopathology, Fachklinik Hornheide, Dorbaumstrasse 300, 48157 Muenster, Germany
| | - Henrike J. Fischer
- Department of Immunology, School of Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany;
| | - Frank Hölzle
- Department of Oral, Maxillofacial and Facial Plastic Surgery, School of Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany;
| | - Kai Wermker
- Department of Oral and Cranio-Maxillofacial Surgery, Klinikum Osnabrueck GmbH, Am Finkenhuegel 1, 49076 Osnabrueck, Germany;
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Immunohistochemical comparative analysis of IMP-3 and KI-67 in actinic cheilitis and lower lip squamous cell carcinoma. Oral Maxillofac Surg 2022; 26:587-593. [PMID: 34817714 DOI: 10.1007/s10006-021-00990-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/18/2021] [Indexed: 12/31/2022]
Abstract
Actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC) exhibit epithelial alterations mainly associated with chronic ultraviolet ray exposure. Currently, it is impossible to predict which AC cases will progress to LLSCC; thus, biomolecular markers have been studied. The aim of this study was to evaluate the immunoexpression of IMP-3 and KI-67 in AC and LLSCC. Forty AC and 40 LLSCC cases were submitted to peroxidase method and quantitatively analyzed, using the following scores: 0 (0% positive cells), + 1(≤ 30%), + 2 (> 30% to ≤ 60%), and + 3 (> 60%). Results were submitted to non-parametric Mann-Whitney (U) test. A p value < 0.05 was considered to indicate statistical significance. IMP-3 immunoexpression was observed in 26 AC cases, with predominance of the score 1 (35% of cases). This protein was also positive in 22 LLSCC cases, with predominance of the score 3 (37.5% of cases). Immunoexpression of KI-67 was observed in all studied cases, with predominance of the score 2 (70% of AC cases and 57.5% LLSCC cases). The association between IMP-3 and Ki-67 immunoexpression, AC dysplastic severity and LLSCC tumoral grade revealed no significant differences. The present results demonstrate that IMP-3 and Ki-67 immunoexpression are frequent in AC and in LLSCC. Moreover, these proteins could be involved in lower lip carcinogenesis process.
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Qin R, Cao L, Ye C, Wang J, Sun Z. Screening of genes related to survival prognosis of cervical squamous cell carcinoma and construction of prognosis prediction model. J Obstet Gynaecol Res 2021; 47:3310-3321. [PMID: 34219322 DOI: 10.1111/jog.14827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 04/01/2021] [Accepted: 04/30/2021] [Indexed: 12/09/2022]
Abstract
AIM We aimed to screen for the genes related to survival prognosis of cervical squamous cell carcinoma (CSCC) and then constructed a prognosis prediction model. METHODS The GSE63514 dataset was obtained from the National Center for Biotechnology Information (NCBI) Gene Expression Omnibus (GEO). The CSCC gene dataset and the GSE44001 dataset were obtained from The Cancer Genome Atlas and NCBI GEO, respectively. The Kaplan-Meier (KM) curve was used to evaluate the association between high and low prognosis that was with the actual survival prognosis information. The Cox proportional hazards model was used to screen out the optimized prognostic-related signature differentially expressed gene (DEG) combinations. Gene set enrichment analysis was used to perform pathway enrichment annotation analysis for DEGs that were related to risk grouping. RESULTS In total, 16 399 DEGs were obtained and 23 gene ontology biological processes and 8 Kyoto Encyclopedia of Genes and Genomes pathways were screened. Nine optimized DEG groups related to independent prognosis were selected. The KM curves of pathologic N0 and N1 showed that low-risk group were associated with a better overall survival (p = 1.518e; p = 1.704e-01). The pathways related to risk grouping were cytokine-cytokine receptor interaction, JAK stat signaling pathway, and glycolysis-gluconeogenesis. CONCLUSION On the basis of this study, we established a prognostic risk model, which provided a reliable prognostic tool and was of great significance for locating the biomarkers related to survival prognosis in CSCC.
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Affiliation(s)
- Rui Qin
- Department of Obstetrics and Gynecology, The Third Hospital of Jilin University, Changchun, Jilin, P.R. China
| | - Lu Cao
- Department of Obstetrics and Gynecology, The Third Hospital of Jilin University, Changchun, Jilin, P.R. China
| | - Cong Ye
- Department of Obstetrics and Gynecology, The Third Hospital of Jilin University, Changchun, Jilin, P.R. China
| | - Junrong Wang
- Department of Obstetrics and Gynecology, The Third Hospital of Jilin University, Changchun, Jilin, P.R. China
| | - Ziqian Sun
- Department of Obstetrics and Gynecology, The Third Hospital of Jilin University, Changchun, Jilin, P.R. China
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Bevanda Glibo D, Bevanda D, Vukojević K, Tomić S. IMP3 protein is an independent prognostic factor of clinical stage II rectal cancer. Sci Rep 2021; 11:10844. [PMID: 34035433 PMCID: PMC8149387 DOI: 10.1038/s41598-021-90513-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/12/2021] [Indexed: 12/24/2022] Open
Abstract
Immunohistochemical level of IMP3-protein in patients with rectal cancer in clinical stage II (141), were correlated with sociodemographic, pathohistological and clinical indicators and duration of overall-survival and progression-free-survival. Vascular invasion was associated with IMP3-positive immunostaining (p < 0.001). Vascular invasion ratio in the group of poorly-differentiated-tumors was 21 times higher than in the group of well-differentiated-tumors. IMP3-positive patients lived 2.2 times shorter than negative (p < 0.001). Patients with well-differentiated-tumors lived 1.7 times longer than the subjects with poorly-differentiated-tumors (p < 0.001). Patients without vascular invasion lived 2.7 times longer than the subjects with vascular invasion (p < 0.001). The risk of mortality was 2.3 times higher for IMP3 positive patients (p = 0.027) and 10.4 higher for the patients with vascular invasion (p < 0.001). IMP3-negative participants had 2.3 times longer free interval without disease (p < 0.001). The free interval without disease was 3.6 times longer in the group without vascular invasion (p < 0.001). The risk of disease relapse in the IMP3 positive group was 5.3 times higher (p < 0.001) and with vascular invasion was 8 times longer (p < 0.001). The risk of disease relapse was 6.8 times higher in the group with vascular invasion (p < 0.001). Patients with rectal cancer and high IMP3-protein level will have a shorter overall survival relative to patients without or with low levels of IMP3. The analysis of IMP3 expression by immunohistochemistry pointed IMP3 as an independent prognostic factor of clinical stage II rectal cancer.
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Affiliation(s)
- Daniela Bevanda Glibo
- Department of Internal Medicine, University Hospital Center Mostar, 88000, Mostar, Bosnia and Herzegovina
| | - Danijel Bevanda
- Department of Internal Medicine, University Hospital Center Mostar, 88000, Mostar, Bosnia and Herzegovina
| | - Katarina Vukojević
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia. .,Department of Medical Genetics, School of Medicine, University of Mostar, 88000, Mostar, Bosnia and Herzegovina.
| | - Snježana Tomić
- Department of Pathology, Citology and Forensic Medicine, University Hospital Center Split, 21000, Split, Croatia
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Richey JD, Deng AC, Dresser K, O'Donnell P, Cornejo KM. Distinguishing between irritated seborrheic keratosis and squamous cell carcinoma in situ using BCL-2 and IMP3 immunohistochemistry. J Cutan Pathol 2018; 45:603-609. [DOI: 10.1111/cup.13269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/23/2018] [Accepted: 05/01/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Justin D. Richey
- Department of Pathology; University of Massachusetts Medical School, UMass Memorial Medical Center; Worcester Massachusetts
| | - April C. Deng
- Department of Pathology; University of Massachusetts Medical School, UMass Memorial Medical Center; Worcester Massachusetts
| | - Karen Dresser
- Department of Pathology; University of Massachusetts Medical School, UMass Memorial Medical Center; Worcester Massachusetts
| | - Patrick O'Donnell
- Department of Pathology; University of Massachusetts Medical School, UMass Memorial Medical Center; Worcester Massachusetts
| | - Kristine M. Cornejo
- Department of Pathology; University of Massachusetts Medical School, UMass Memorial Medical Center; Worcester Massachusetts
- Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
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Chen L, Xie Y, Li X, Gu L, Gao Y, Tang L, Chen J, Zhang X. Prognostic value of high IMP3 expression in solid tumors: a meta-analysis. Onco Targets Ther 2017; 10:2849-2863. [PMID: 28652767 PMCID: PMC5476767 DOI: 10.2147/ott.s128810] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Accumulated studies have investigated the prognostic role of insulin-like growth factor II mRNA-binding protein 3 (IMP3) in various cancers, but inconsistent and controversial results were obtained. Therefore, we performed a systematic review and meta-analysis to investigate the potential value of IMP3 in the prognostic prediction of human solid tumors. MATERIALS AND METHODS A systematic literature search in the electronic databases PubMed, Embase, Web of Science, and Cochrane library (updated to April 2016) was conducted to identify eligible studies. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) for survival outcomes were calculated and gathered using STATA 12.0 software. RESULTS A total of 53 studies containing 8,937 patients with solid tumors were included in this meta-analysis. High IMP3 expression was significantly associated with worse overall survival (OS) of solid tumors (HR =2.08, 95% CI: 1.80-2.42, P<0.001). Similar results were observed in cancer-specific survival (CSS), disease-free survival (DFS), recurrence-free survival (RFS), progression-free survival (PFS), and metastasis-free survival (MFS). Further subgroup analysis stratified by tumor type showed that elevated IMP3 expression was associated with poor OS in renal cell carcinoma (RCC), lung cancer, oral cancer, urothelial carcinoma, hepatocellular carcinoma (HCC), colorectal cancer, pancreatic cancer, gastric cancer, and intrahepatic cholangiocarcinoma (ICC). CONCLUSION The current evidence suggests that high IMP3 expression is associated with poor prognosis in most solid tumors. IMP3 is a potential valuable prognostic factor and might serve as a promising biomarker to guide clinical decisions in human solid tumors.
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Affiliation(s)
- Luyao Chen
- Department of Urology, Chinese PLA General Hospital, Beijing.,Department of Urology, First Affiliated Hospital of Nanchang University, Nanchang
| | - Yongpeng Xie
- School of Medicine, Nankai University, Tianjin, People's Republic of China
| | - Xintao Li
- Department of Urology, Chinese PLA General Hospital, Beijing
| | - Liangyou Gu
- Department of Urology, Chinese PLA General Hospital, Beijing
| | - Yu Gao
- Department of Urology, Chinese PLA General Hospital, Beijing
| | - Lu Tang
- Department of Urology, Chinese PLA General Hospital, Beijing
| | - Jianwen Chen
- Department of Urology, Chinese PLA General Hospital, Beijing
| | - Xu Zhang
- Department of Urology, Chinese PLA General Hospital, Beijing
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IMP3 contributes to poor prognosis of patients with metaplastic breast carcinoma: A clinicopathological study. Ann Diagn Pathol 2017; 31:30-35. [PMID: 29146055 DOI: 10.1016/j.anndiagpath.2017.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 12/26/2022]
Abstract
Metaplastic breast carcinoma (MBC) is a rare type of tumor with heterogenous histological patterns. We investigated the immunohistochemical expression of IMP3, an oncofetal protein, in 31 MBC patients in association with histological subtypes and clinical outcomes. The cohort consisted of spindle cell carcinoma (SPC) (n=11), squamous cell carcinoma (SCC) (n=14), matrix-producing carcinoma (MPC) (n=4), carcinoma with osteocartilaginous elements (COC) (n=1), and low grade adenosquamous cell carcinoma (ASC) (n=1). IMP3 expression was identified in 7 cases of SPC (64%) and 6 patients of all the other subtypes (p=0.051). In comparison between IMP3 high (n=13) and low (n=18) groups, a large-sized tumor (≥4.0cm) was identified in 9 IMP3 high patients, and 14 IMP3 low patients had a small-sized tumor (p=0.01). High Ki67 positivity was detected in all of the IMP3 high patients and in 7 of the IMP3 low patients (p=0.002). During the follow-up period, 9 IMP3 high patients died, whereas 15 of the 18 IMP3 low patients remained alive (p=0.004). A univariate analysis revealed that IMP3 expression and tumor size were significantly associated with poor clinical outcomes (p=0.03 and <0.001, respectively). The IMP3 high group was likely to be associated with reduced overall survival compared to the IMP3 low group (p=0.06). These findings indicate that IMP3 may contribute to the aggressive behavior of MBC, and that this expression could potentially be a prognostic marker of MBC.
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Tan SC, Ismail MP, Duski DR, Othman NH, Bhavaraju VMK, Ankathil R. Identification of Optimal Reference Genes for Normalization of RT-qPCR Data in Cancerous and Non-Cancerous Tissues of Human Uterine Cervix. Cancer Invest 2017; 35:163-173. [DOI: 10.1080/07357907.2017.1278767] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Shing Cheng Tan
- Human Genome Centre, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Pazudin Ismail
- Department of Obstetrics and Gynecology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Daniel Roza Duski
- Department of Obstetrics and Gynecology, Hospital Sultan Ismail, Johor, Malaysia
| | - Nor Hayati Othman
- Department of Pathology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Venkata Murali Krishna Bhavaraju
- Department of Nuclear Medicine, Radiotherapy and Oncology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ravindran Ankathil
- Human Genome Centre, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
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Bi R, Shen X, Zhang W, Cheng Y, Feng Z, Cai X, Yang W. Clear cell carcinomas of the ovary: a mono-institutional study of 73 cases in China with an analysis of the prognostic significance of clinicopathological parameters and IMP3 expression. Diagn Pathol 2016; 11:17. [PMID: 26837693 PMCID: PMC4736169 DOI: 10.1186/s13000-016-0467-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/14/2016] [Indexed: 01/07/2023] Open
Abstract
Background Ovarian clear cell carcinoma (CCC) is an uncommon subtype of ovarian epithelial tumor. The prognostic significance of its clinicopathological parameters is discordant, with the exception of stage as the adverse prognostic factor. The present study aimed to evaluate the prognostic significance of its clinicopathological characteristics and the expression of IMP3 (Insulin-like growth factor-II mRNA-binding protein 3, IMP3 or IGF2BP3) in Chinese patients with primary pure CCC. Methods We collected clinicopathological data from 73 cases with a minimum of 5 years of follow-up and evaluated the expression of IMP3 by immunohistochemistry. Results In total, 49.3 % of the patients were in stage I. Advanced stages were closely related to poor prognosis of disease-free survival (DFS) and overall survival (OS) (P < 0.005). Patients with CCC coexisting with endometriosis tended to be younger and to have unilateral involvement but did not exhibit differences in prognosis compared with patients with CCC without endometriosis. Other histological features such as growth pattern, mitosis, and necrosis did not have prognostic significance. IMP3 was positive in 63 % of patients (46 of 73 cases); Thus, positive expression of IMP3 is an adverse prognostic marker in terms of OS (P = 0.012), even in stage I patients (P = 0.038). Conclusions The present study demonstrates that IMP3 expression is a prognostic marker, with the exception of stage. IMP3 represents a biomarker of unfavorable prognosis even in stage I patients.
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Affiliation(s)
- Rui Bi
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Xuxia Shen
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Weiwei Zhang
- Psycho-Oncology Research & Training (CePORT), School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong.
| | - Yufan Cheng
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Zheng Feng
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. .,Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
| | - Xu Cai
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Wentao Yang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Vidal MTA, Lourenço SV, Soares FA, Gurgel CA, Studart EJB, Valverde LDF, Araújo IBDO, Ramos EAG, Xavier FCDA, dos Santos JN. The sonic hedgehog signaling pathway contributes to the development of salivary gland neoplasms regardless of perineural infiltration. Tumour Biol 2016; 37:9587-601. [DOI: 10.1007/s13277-016-4841-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/12/2016] [Indexed: 12/16/2022] Open
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Kanzaki A, Kudo M, Ansai SI, Peng WX, Ishino K, Yamamoto T, Wada R, Fujii T, Teduka K, Kawahara K, Kawamoto Y, Kitamura T, Kawana S, Saeki H, Naito Z. Insulin-like growth factor 2 mRNA-binding protein-3 as a marker for distinguishing between cutaneous squamous cell carcinoma and keratoacanthoma. Int J Oncol 2016; 48:1007-15. [PMID: 26782292 PMCID: PMC4750532 DOI: 10.3892/ijo.2016.3323] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/08/2015] [Indexed: 12/28/2022] Open
Abstract
In the histopathological diagnosis of cutaneous tumors, the differential diagnosis of squamous cell carcinoma (SCC) with crateriform architecture and keratoacanthoma (KA) is often difficult so an accurate understanding of the biological features and the identification of reliable markers of SCC and KA are crucial issues. Insulin-like growth factor 2 mRNA-binding protein-3 (IGF2BP3, also known as IMP3) is thought of as a bona fide oncofetal protein, which is overexpressed and is involved in cell proliferation, migration, and invasion in several kinds of tumors. However, the role of IMP3 in cutaneous SCC and KA has not been well studied. Therefore, we focused on studying the biological functions of IMP3 in SCC and KA. In human skin SCC cell lines, HSC-1 and HSC-5, and the human keratinocyte cell line, HaCaT, IMP3 mRNA levels were significantly higher than that of normal human skin. The knockdown of IMP3 expression reduced the proliferation of HSC-1, and significantly reduced invasion by HSC-1 and HSC-5. In contrast, the knockdown of IMP3 did not significantly affect invasion by HaCaT cells. In immunohistochemical studies of SCC and KA tissues, the Ki-67 labeling index (LI) of the suprabasal cell layer was significantly higher in SCC, compared with KA tissues and the tumor-free margin (TFM) adjacent to SCC and KA. Most SCC tissues stained strongly positive for IMP3, but KA tissues and TFM were mostly negative for IMP3. The Ki-67 LI of the IMP3-positive group was significantly higher than that of the IMP3-negative group in the suprabasal cell layer of SCC. These results suggest that IMP3 plays an important role in proliferation and, more significantly, in the invasion of SCC, and may be a suitable marker for the histopathological diagnosis of SCC with a crateriform architecture and KA. Furthermore, IMP3 may potentially be a new therapeutic target for SCC.
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Affiliation(s)
- Akiko Kanzaki
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Mitsuhiro Kudo
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Shin-Ichi Ansai
- Department of Dermatology, Nippon Medical School Musashikosugi Hospital, Tokyo, Japan
| | - Wei-Xia Peng
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Kousuke Ishino
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | | | - Ryuichi Wada
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Takenori Fujii
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Kiyoshi Teduka
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Kiyoko Kawahara
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Yoko Kawamoto
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Taeko Kitamura
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Seiji Kawana
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Zenya Naito
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
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Zhang H, Zhang T, You Z, Zhang Y. Positive Surgical Margin, HPV Persistence, and Expression of Both TPX2 and PD-L1 Are Associated with Persistence/Recurrence of Cervical Intraepithelial Neoplasia after Cervical Conization. PLoS One 2015; 10:e0142868. [PMID: 26624896 PMCID: PMC4666599 DOI: 10.1371/journal.pone.0142868] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/27/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To determine the clinicopathologic and immunohistochemical predictors of the persistence/recurrence of cervical intraepithelial neoplasia (CIN) after cervical conization. Methods Medical records of 502 patients who received cervical conization treatment of CIN between 2005 and 2012 were reviewed. The clinicopathologic parameters were analyzed using Cox hazard regression. Fifty patients with CIN persistence/recurrence were matched to 50 cases without CIN persistence/recurrence. These 100 cervical specimens were assessed for expression of insulin-like growth factor II messenger RNA (mRNA)-binding protein 3 (IMP3), targeting protein for xenopus kinesin-like protein 2 (TPX2), and programmed cell death-1 ligand-1 (PD-L1) using immunohistochemical staining. Results Multivariate analysis found that the independent predictors of CIN persistence/recurrence were positive surgical margin (hazard ratio 5.777, 95% confidence interval 2.334–14.301, p < 0.001) and human papilloma virus persistence for 6 months (hazard ratio 20.685, 95% confidence interval 7.350–57.657, p < 0.001). Co-expression of TPX2 and PD-L1 was significantly higher in CIN persistence/recurrence group than the group without CIN persistence/recurrence (p = 0.013). The depth of glandular involvement (GI) was less than 3mm in about 86.8% (59/68) CIN2-3 lesions, However, No statistically significant associations between GI and persistence/recurrence were observed (P = 0.58). Conclusion Positive surgical margin, HPV persistence, and expression of both TPX2 and PD-L1 are associated with persistence/recurrence of cervical intraepithelial neoplasia after cervical conization.
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Affiliation(s)
- Hui Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Department of Obstetrics and Gynecology, Affiliated Hospital of Taishan Medical College, Taian, Shandong, China
| | - Tingguo Zhang
- Department of Pathology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Zongbing You
- Department of Structural & Cellular Biology, Tulane University, New Orleans, Louisiana, United States of America
- Department of Orthopaedic Surgery, Tulane University, New Orleans, Louisiana, United States of America
- Tulane Cancer Center and Louisiana Cancer Research Consortium, Tulane University, New Orleans, Louisiana, United States of America
- Tulane Center for Stem Cell Research and Regenerative Medicine, Tulane University, New Orleans, Louisiana, United States of America
- Tulane Center for Aging, Tulane University, New Orleans, Louisiana, United States of America
- * E-mail: (YZ); or (ZY)
| | - Youzhong Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- * E-mail: (YZ); or (ZY)
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IMP3 Predicts Invasion and Prognosis in Human Lung Adenocarcinoma. Lung 2015; 194:137-46. [PMID: 26608347 DOI: 10.1007/s00408-015-9829-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/21/2015] [Indexed: 02/03/2023]
Abstract
PURPOSE Insulin-like growth factor II mRNA-binding protein 3 (IMP3) is an oncofetal protein associated with several aggressive and advanced cancers. Whether IMP3 can predict invasion, and prognosis in patients with human lung adenocarcinoma (LAC) remains unclear. METHODS Ninety-five LAC and 75 non-tumor lung tissue samples were included in a tissue microarray. IMP3 expression was assessed by immunohistochemical examination. Correlation between IMP3 expression levels, clinicopathological characteristics, and overall prognosis was evaluated. In a separate in vitro study, RNA interference method was applied for knockdown of IMP3 gene in human LAC cell lines. Invasive potential of LAC cells was then evaluated by transwell migration assay. RESULTS IMP3 immunoreactivity was observed in 39 out of 95 (41.1 %) LAC patients, but not in non-tumor lung tissues. IMP3 expression levels were closely associated with histological grade (P = 0.037), TNM stage (P = 0.034), and lymph node metastasis (P = 0.011). Patients presenting with positive IMP3 expression (P = 0.000), an advanced TNM stage (P = 0.000), and lymph node metastasis (P = 0.001) had a worse overall survival, compared to those lacking these characteristics. Both IMP3 expression (hazard ratio [HR], 2.310; 95 % confidence interval [CI] 1.192-4.476; P = 0.013) and TNM stage (HR 2.338; 95 % CI 1.393-3.925; P = 0.001) were independent predictors of poor prognosis. The invasive potential of LAC cells was significantly inhibited by IMP3 knockdown. CONCLUSION IMP3 appears to play an important role in tumor invasion in patients with LAC and may serve as a useful prognostic biomarker in these patients.
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Mizutani R, Imamachi N, Suzuki Y, Yoshida H, Tochigi N, Oonishi T, Suzuki Y, Akimitsu N. Oncofetal protein IGF2BP3 facilitates the activity of proto-oncogene protein eIF4E through the destabilization of EIF4E-BP2 mRNA. Oncogene 2015; 35:3495-502. [DOI: 10.1038/onc.2015.410] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 12/28/2022]
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Liu HQ, Wang YH, Wang LL, Hao M. P16INK4A and survivin: Diagnostic and prognostic markers in cervical intraepithelial neoplasia and cervical squamous cell carcinoma. Exp Mol Pathol 2015; 99:44-9. [PMID: 25910412 DOI: 10.1016/j.yexmp.2015.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/18/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To explore the the correlations of p16INK4A (p16) and survivin expressions with cervical intraepithelial neoplasia (CIN) and cervical squamous cell carcinoma. METHODS The p16 and survivin expressions were detected in 50 cervical squamous cell carcinoma tissues, 150 various grades of CIN tissues and 30 normal cervical tissues using immunohistochemistry. All data were analyzed applying SPSS 17.0 software. RESULTS The p16 and survivin expressions showed the presence of statistical significance in cervical cancer, CINI, CINII, CINIII and normal cervical tissues (P<0.05), and the comparison also revealed statistical significance among groups (all P<0.05); the p16 and survivin expressions were positively correlated with the grade of cervical diseases (both P<0.05). Moreover, p16 protein was associated with CIN grade and lymph node metastases in cervical cancer (all P<0.05); survivin protein was also related with clinical stages, CIN grade and lymph node metastases (all P<0.05); the p16 and survivin expressions were positively correlated with cervical cancer (r=0.854, P<0.001), and associated with poor prognosis of cervical cancer. CONCLUSION Briefly, p16 and survivin expression may be correlated with the clinico-pathological and prognosis of cervical cancer.
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Affiliation(s)
- Hui-Qiang Liu
- Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, PR China
| | - Yong-Hong Wang
- Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, PR China
| | - Lan-Lan Wang
- Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, PR China
| | - Min Hao
- Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, PR China.
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