Obesity and Cancer Mechanisms: Tumor Microenvironment and Inflammation

The effect of body mass index on breast cancer stage and breast cancer specific survival

PURPOSE

Underweight women and those with obesity, defined as having a body mass index (BMI) ≥ 30 kg/m2, diagnosed with breast cancer (BC) are known to have worse prognosis. Whether BMI impacts BC stage at diagnosis and BC specific survival (BCSS) is not understood. We aim to better understand the relationship between BMI with stage at BC diagnosis and BCSS.

METHODS

Women age ≥ 15 years old diagnosed with BC between 2014 and 2019 were identified from the California Cancer Registry. BMI at diagnosis was classified as underweight (< 18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obesity class 1-2 (30-39.9 kg/m2), and obesity class 3 (≥ 40 kg/m2). BC late stage of diagnosis was defined as American Joint Committee on Cancer stage 3 and 4. Multivariate logistic regression was performed to compare sociodemographic and clinical factors associated with late stage. Multivariable cox proportional hazards regression models assessed association of BMI and BCSS.

RESULTS

Of 159,248 patients: 2.2% were underweight, 34.6% normal weight, 30.5% overweight, 26.7% obesity class 1-2, and 6.0% obesity class 3. Compared to normal weight, patients who were underweight [Hazard Ratio (HR) 1.54, 95% Confidence Interval (CI) 1.51-1.57], obesity class 1-2 [HR 1.06, 1.05-1.07], and obesity class 3 [HR 1.14, 1.12-1.16] were more likely to be diagnosed with late-stage BC. In models stratified by age, patients ≥ 40 years who were underweight had worse BCSS, while patients ≥ 51 years with obesity class 1-2 had better BCSS.

CONCLUSION

Patients with obesity class 1-2 were more likely to be diagnosed with a later stage, but had improved BCSS, supporting an "obesity paradox" in BC and suggesting that other measures are needed to better assess body composition, adipose distribution, and metabolic health of patients. Patients who were underweight had worse survival, suggesting this high-risk group may benefit from being assessed and treated for possible sarcopenia and malnourishment.

Apoptotic vesicles inhibit bone marrow adiposity via wnt/β-catenin signaling

Background

There is currently increasing focus on aging-related diseases. Osteoporosis is a common disease the incidence of which increases with age. In older patients with osteoporosis, bone marrow mesenchymal stem cells (BMMSCs) have a decreased capacity for osteogenesis and an increased capacity for adipogenesis, causing excessive accumulation of adipose tissue in the bone marrow. Therefore, means of reducing bone marrow adiposity may have therapeutic potential for osteoporosis. Apoptotic vesicles (apoVs) participate in a wide range of physiological processes and have been shown to have therapeutic effects in a variety of diseases. The principal objective of this study was to examine the special properties and regulatory mechanisms of BMMSC-derived apoVs in the treatment of bone marrow adiposity.

Results

The results showed that apoVs could decrease bone marrow adiposity in osteoporotic mice and prevent adipogenic differentiation of MSCs by activating the Wnt/β-catenin pathway.

Conclusion

New apoV-based therapies have potential for the treatment of bone marrow adiposity in patients with aging-related osteoporosis and may be further applicable to the treatment of obesity and aging-related diseases.

Chinese visceral adiposity index outperforms other obesity indexes in association with increased overall cancer incidence: findings from prospective MJ cohort study

BACKGROUND

We assessed the associations of visceral adiposity indexes such as Chinese Visceral Adiposity Index (CVAI), Visceral Adiposity Index (VAI), Lipid Accumulation Product (LAP), waist circumference (WC), and waist-hip ratio (WHR) with overall and specific cancer incidence in a Chinese population.

METHODS

332,297 individuals from the Taiwan MJ cohort (1996-2007) were included. We utilized multivariable Cox proportional hazards models to examine associations of baseline visceral adiposity indexes and cancer incidences. Sex-specific CVAI, VAI, and LAP were calculated, incorporating WC and triglycerides levels. CVAI and VAI also included body mass index and high-density lipoprotein, with CVAI further incorporating age.

RESULTS

Higher CVAI was consistently associated with higher overall cancer incidence, with HRs of 1.45 (95% CI: 1.2-1.76) and 2.03 (95% CI: 1.52-2.72) for males and females, respectively, comparing the fifth quintile to the first. The HRs for WC were 1.27 (95% CI: 1.08-1.49) and 1.19 (95% CI: 1.01-1.40) for males and females, WHR was significantly associated with cancer risk in males (HR:1.28; 95% CI: 1.13-1.45), and LAP was significantly associated with cancer risk in females (HR: 1.25; 95% CI: 1.04-1.5). VAI was not associated with overall cancer incidence.

DISCUSSION

CVAI is a superior clinical biomarker for predicting cancer incidence in the Chinese population compared to traditional visceral obesity indices.

The relationship between renal cell carcinoma pathological types and perirenal fat area

INTRODUCTION

To explore whether there is a relationship between perirenal fat area (PFA) and the pathological types of renal cell carcinoma (RCC).

METHODS

Two hundred ninety-seven cases of RCC patients were included in our study, which is a retrospective analysis. Based on pathological type, we divided the 297 RCC patients into two groups: the clear cell renal cell carcinoma (ccRCC) group (236 cases) and the non-clear cell renal cell carcinoma (non-ccRCC) group (61 cases). Computed tomography (CT) images at the renal vein level were used to measure PFA. A multivariate logistic regression model was employed to examine the connection between various pathological types of RCC and PFA.

RESULTS

Significant differences were observed between ccRCC and non-ccRCC patients in PFA (P = 0.007), contralateral PFA (P = 0.011), weight (P = 0.002), BMI (P < 0.001), pathological stage 1 (P = 0.010), and pathological stage 2 (P = 0.002). To study the link between pathological subtypes and PFA, a multivariate logistic regression model was employed. Stratifying patients by tumor location in the kidney, the multivariate logistic regression analysis showed that when the tumor is located outside the polar lines of the kidney (OPLK), for every 1 cm2 increase in PFA, the probability of developing ccRCC increases by 5% [1.05 (1.01, 1.10) P = 0.0153]. Furthermore, after stratifying patients by tumor location and pathological stage, it was found that in T1 stage patients with tumors located OPLK, for every 1 cm2 increase in PFA, the probability of developing ccRCC increases by 6% [1.06 (1.01, 1.11) P = 0.0300].

CONCLUSION

When the tumor is located OPLK in T1 stage patients, PFA is positively correlated with ccRCC. Perirenal adipose tissue may be a risk factor for ccRCC.

Single-Cell and Single-Nuclei transcriptomics profiling reveals dynamic cellular features in tumor-related adipose microenvironment of breast cancer patients with high BMI

OBJECTIVES

High body mass index (BMI), encompassing overweight and obesity, is a well-established risk factor for developing breast cancer (BC). The underlying mechanisms linking elevated BMI to increased BC risk involve metabolic reprogramming and chronic inflammatory microenvironments regulated by cellular networks within breast white adipose tissue (WAT). However, the complicated landscape and specific cell chat leading to BC-related adipose microenvironment remained unclear.

MATERIALS AND METHODS

We unveiled a comprehensive cell atlas by employing single-cell (N = 27) and single-nuclei (N = 6) transcriptomics to address dynamic changes of immune and stromal cell components within WAT in high BMI population. Bulk RNA-seq data sets were used for validation.

RESULTS

Characteristics of adipose-infiltrating tissue-resident macrophages (PVMs), APOD+γδ T cells, and mature FKBP5+ adipocytes in breast cancer women with high BMI were revealed, in terms of transcriptional genes, metabolism features, developmental trajectories and gene set enrichment analysis (GSEA). PVMs upregulated c-Maf combined with its co-activator CREB1 to increase TCA cycles. APOD+γδ T cells were found to elevate intracellular lipid metabolism, leading to poor clinical prognosis. Mature FKBP5+adipocytes served as an advanced adipogenesis mediator to promote tumor aggressiveness. In-depth analysis of cell-cell interactions uncovered a remodeling trend towards metabolic dysfunction and chronic inflammation in WAT with weight gain via EGF, CXCL, and CCL signalings.

CONCLUSION

These results provided a novel understanding of detailed and unbiased cellular landscape of WAT in breast cancer with high BMI from single-cell atlas perspective, uncovering interplays between breast adipose-infiltrating immune cells and stromal cells that promote progression of BC under high BMI conditions.

Preoperative immune prognostic index predicts the prognosis and postoperative adjuvant chemotherapy benefits of esophageal squamous cell carcinoma after minimally invasive esophagectomy

BACKGROUND

The utility of the immune prognostic index (IPI) for esophageal squamous cell carcinoma (ESCC) has yet to be established after minimally invasive esophagectomy (MIE). The purpose of this study was to investigate the value of IPI in predicting the prognosis and postoperative adjuvant chemotherapy (AC) benefits of ESCC patients.

METHODS

Between January 2011 and December 2018, 613 ESCC patients underwent MIE at our center and were divided into two groups: low IPI and high IPI.Log-rank tests were used to compare the overall survival (OS) and disease-free survival (DFS) of patients in different groups based on Kaplan-Meier survival analysis. Differences in clinical characteristics between groups were eliminated by propensity score matching (PSM) analysis. To identify independent risk factors influencing OS and DFS, the Cox proportional risk model was used.

RESULTS

In comparison to the high IPI group, the low IPI group had a better 5-year OS and DFS in both the entire and matched cohorts (P < 0.05). IPI was found to be an independent prognostic factor for OS and DFS in a multivariate analysis of the entire cohort and the matched cohort (P < 0.05). In subgroup analyses of most clinicopathological factors, high IPI was associated with a higher risk of death or recurrence in the matched cohorts. When combined with 8th TNM staging, the 5-year OS and DFS of stage II or III patients with low IPI in the AC group were not different from those in the non-AC group (P > 0.05), and AC of stage III patients with high IPI significantly prolonged 5-year OS and DFS (OS: 37.4% vs 26.2%, P = 0.018; DFS: 33.6% vs 19.8%, P = 0.042).

CONCLUSION

Preoperative IPI is a promising predictor of ESCC after MIE. For stage III ESCC patients with high IPI, AC can significantly reduce the risk of death or recurrence.

Perceived discrimination, trust in physicians, and their associations with ovarian cancer mortality among women in the African American Cancer Epidemiology Study

PURPOSE

Black women are 30% more likely to die of ovarian cancer than White women. Discrimination may affect cancer health disparities through pathways including socioeconomic disadvantage, chronic stress, and access to care. In this study, we evaluated associations of discrimination and trust in physicians with all-cause mortality among Black women with ovarian cancer.

METHODS

Using data from the African American Cancer Epidemiology Study (AACES), we included 592 Black ovarian cancer patients who completed an interview. Discrimination and trust in physicians were measured using the Everyday Discrimination, Major Experiences of Discrimination, and Trust in Physicians scales, respectively. We used Cox proportional hazard models to compute multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CIs) associating everyday discrimination, major experiences of discrimination, and trust in physicians with all-cause mortality.

RESULTS

Approximately 43% reported experiencing at least one major experience of discrimination, 16% reported high everyday experiences of discrimination, and the median trust in physician score was 35. The association between higher experiences of everyday discrimination was HR = 0.84 (95% CI: 0.63, 1.11), compared with low experiences of everyday discrimination. We observed that more major experiences of discrimination had 1.25-times the mortality rate compared with low experiences of major discrimination (95% CI: 0.84, 2.20). Higher trust in physicians was associated with slightly lower mortality rates (HR = 0.91, 95% CI: 0.74, 1.14).

CONCLUSION

We observed complexities in the relationships of everyday discrimination, major experiences of discrimination, and trust in physicians with mortality among Black women with ovarian cancer. Future work to understand the these relationships is likely warranted.

Novel metabolic and inflammatory stratification of overweight/obesity to characterize risks of adverse outcomes: A large population-based cohort study

AIMS

The growing epidemic of overweight and obesity elevates disease risks, with metabolic disorders and inflammation critically involved in the pathogenic mechanisms. This study refines the subtyping of overweight and obesity using metabolic and inflammatory markers to enhance risk assessment and personalized prevention.

MATERIALS AND METHODS

Based on the UK Biobank, this retrospective study included participants classified as overweight or obese (BMI ≥25 kg/m2). K-means clustering was performed using metabolic and inflammatory biomarkers. Multivariate Cox regression analysis assessed the risk of complications and mortality over a follow-up period of 13.5 years. Genome-Wide Association Studies (GWAS) and Phenome-Wide Association Studies (PheWAS) explored cluster-specific genetic traits.

RESULTS

Among 126 145 participants (mean [IQR] age: 55.0 [14.0] years; 61 983 males [49.1%]), five clusters were identified: (1) Low Metabolic Risk-related, (2) Hypertension-Related, (3) Mixed Hyperlipidemia-Related, (4) Elevated Lipoprotein(a)-Related and (5) High BMI and Inflammation-Related. Cluster 1 exhibited a lower risk of complications than other clusters. Cluster 2 had the highest incidence of stroke, linked to variants affecting blood circulation. Cluster 3 showed the highest risks for ischaemic heart disease, characterized by variants enriched in cholesterol metabolism pathways. Cluster 4 was associated with high cardiovascular risks. Cluster 5 had the highest risks for diabetes, asthma, chronic obstructive pulmonary disease, osteoarthritis and mortality, linked to obesity-related genetic variants. We also proposed a method for applying this classification in clinical settings.

CONCLUSIONS

This classification provides insights into the heterogeneity of individuals with overweight and obesity, aiding in the identification of high-risk patients who may benefit from targeted interventions.

The association between life's crucial 9 and all-cause, cancer-specific and cardiovascular mortality in US cancer survivors: a cohort study of NHANES

BACKGROUND

Life's Crucial 9 (LC9) is a recently proposed cardiovascular health (CVH) scoring system that integrates psychological well-being with Life's Essential 8 (LE8). However, its prognostic value remains unclear. This study aims to investigate the association between LC9 and outcomes among cancer survivors.

METHODS

A total of 2,558 cancer survivors from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 were included in this study. LC9, representing a dimension of psychological health, was calculated as the average of the LE8 score and the depression score. Cox proportional hazards regression, restricted cubic spline (RCS) analysis, subgroup analysis, and Kaplan-Meier survival curves were employed to evaluate the association between LC9 and mortality risk, with adjustments for potential confounders.

RESULTS

During an average follow-up period of 80 months, 640 deaths occurred, including 205 from cancer and 128 from cardiovascular disease. After adjusting for all covariates using Cox regression, a 10-point increase in the LC9 score was associated with a 24% reduction in all-cause mortality (HR: 0.76; 95% CI: 0.68-0.84), a 19% reduction in cancer-specific mortality (HR: 0.81; 95% CI: 0.68-0.97), and a 28% reduction in cardiovascular mortality (HR: 0.72; 95% CI: 0.58-0.90). Kaplan-Meier survival curves indicated lower rates of all-cause, cancer-specific, and cardiovascular mortality among participants with higher LC9 scores. RCS analysis revealed a linear inverse association between LC9 and all-cause and cancer-specific mortality and a nonlinear inverse association with cardiovascular mortality.

CONCLUSION

Among cancer survivors in the United States, higher LC9 scores were independently associated with lower risks of all-cause, cancer-specific, and cardiovascular mortality. This finding highlights the potential link between cardiovascular health and survival outcomes in cancer survivors, suggesting that improving cardiovascular health may serve as an important preventive strategy to enhance survival rates in this population.

Impact of exercise on health outcomes in people with cancer: an umbrella review of systematic reviews and meta-analyses of randomised controlled trials

OBJECTIVE

To examine the comprehensive health impacts of exercise on people with cancer by systematically summarising existing evidence and assessing the strength and reliability of the associations.

DESIGN

Umbrella review of meta-analyses.

DATA SOURCE

PubMed, Embase, Cochrane and Web of Science databases were searched from their inception to 23 July 2024.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Meta-analyses of randomised controlled trials that investigated the associations between exercise and health outcomes among people with cancer.

RESULTS

This umbrella review identified 485 associations from 80 articles, all evaluated as moderate to high quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR). Two hundred and sixty (53.6%) associations were statistically significant (p<0.05), 81/485 (16.7%) were supported by high-certainty evidence according to the Grading of Recommendations Assessment, Development, and Evaluation criteria. Compared with usual care or no exercise, moderate- to high-certainty evidence supported the view that exercise significantly mitigates adverse events associated with cancer and its treatments (eg, cardiac toxicity, chemotherapy-induced peripheral neuropathy, cognitive impairment and dyspnoea). Exercise also modulates body composition and biomarkers (eg, insulin, insulin-like growth factor-1, insulin-like growth factor-binding protein-1 and C-reactive protein) in people with cancer, and enhances sleep quality, psychological well-being, physiological functioning and social interaction, while improving overall quality of life.

CONCLUSION

Exercise reduces adverse events and enhances well-being through a range of health outcomes in people with cancer.

The best anthropometric indices to predict colon cancer

BACKGROUND

Colon cancer is one of the most prevalent malignancies globally. Anthropometric data are widely accessible. However, numerous anthropometric indicators exist, and no study has identified the most reliable predictor for colon cancer. This study aims to identify the most effective anthropometric indicators for predicting colon cancer.

RESULTS

Significant differences were observed in age, race, smoking, diabetes, hypertension, waist circumference, a body shape index (ABSI), Body Roundness Index (BRI), Conicity Index (ConI), Waist-to-Height Ratio(WHtR), and Weight-adjusted Waist Index(WWI) between colon cancer patients and controls (P < 0.05). ABSI (AUC: 0.68, 95% CI: 0.64-0.71), ConI (AUC: 0.68, 95% CI: 0.64-0.71), and WWI (AUC: 0.67, 95% CI: 0.63-0.70) were the most accurate anthropometric indices for predicting colon cancer. ABSI, ConI, and WWI demonstrated a strong correlation.

CONCLUSION

Analysis of NHANES data (2005-2018) identified ABSI, ConI, and WWI (AUC:0.67-0.68) as optimal anthropometric predictors of colon cancer, emphasizing abdominal obesity's clinical relevance. These cost-effective indices could enhance early screening in resource-limited settings.

Body Mass Index, Height, and Head and Neck Cancer Risk: The Japan Public Health Center-based Prospective Study

BACKGROUND

Although both a lower and a higher body mass index (BMI) are reportedly associated with head and neck cancer (HNC), reports from Asia are scarce. Moreover, evidence regarding the association between height and HNC is limited.

METHODS

We investigated associations between BMI, height, and the incidence of HNC among 102,668 participants (49,029 men and 53,639 women) aged 40-69 years in the Japan Public Health Center-based Prospective Study. We followed participants from 1990 to 2013. We conducted a Cox proportional hazards regression analysis, which included adjustment for potential confounders, such as smoking status. Baseline weight and height information were self-reported.

RESULTS

Over an average follow-up of 18.7 years, 311 HNC cases were newly diagnosed. Lower BMI was significantly associated with HNC, with hazard ratios (HR) of 2.75 (95% confidence interval [CI], 1.63-4.64) for <18.5 kg/m2 and 1.63 (95% CI, 1.15-2.30) for 18.5-20.9 kg/m2 compared to 23-24.9 kg/m2. Increased risk was suggested for higher BMI, with an HR of 1.30 (95% CI, 0.84-2.00) for ≥27.5 kg/m2. This trend was also observed in quadratic models. Results were similar among never-smokers. Meanwhile, only lower BMI showed a strong association with HNC risk among former and current smokers (HR 3.09; 95% CI, 1.54-6.20 for <18.5 kg/m2 compared to 23-24.9 kg/m2). Height showed no association with HNC.

CONCLUSION

Lower BMI was significantly associated with HNC risk, while increased HNC risk was suggested in higher BMI among never-smokers. Among former and current smokers, only lower BMI was associated with HNC risk.

Exposomal determinants of non-genetic plasticity in tumor initiation

The classical view of cancer as a genetically driven disease has been challenged by recent findings of oncogenic mutations in phenotypically healthy tissues, refocusing attention on non-genetic mechanisms of tumor initiation. In this context, gene-environment interactions take the stage, with recent studies showing how they unleash and redirect cellular and tissue plasticity towards protumorigenic states in response to the exposome, the ensemble of environmental factors impinging on tissue homeostasis. We conceptualize tumor-initiating plasticity as a phenotype-transforming force acting at three levels: cell-intrinsic, focusing on mutant epithelial cells' responses to environmental variation; reprogramming of non-neoplastic cells of the host, leading to protumor micro- and macroenvironments; and microbiome ecosystem dynamics. This perspective highlights cell, tissue, and organismal plasticity mechanisms underlying tumor initiation that are shaped by the exposome, and how their functional investigation may provide new opportunities to prevent, detect, and intercept cancer-promoting plasticity.

Sex differences in the obesity paradox of body compositions in non-small cell lung cancer

OBJECTIVES

This study investigated the correlation between body mass index (BMI), bioelectrical impedance analysis (BIA)-derived specific body compositions, and the obesity paradox, with a focus on sex differences in non-smallcell lung cancer (NSCLC).

METHODS

This study is a multicenter prospective cohort. Association with survival was determined using Cox proportional hazard regression analysis. The mediating effect of systemic inflammation on the association between body composition and survival rate was determined using mediation analysis.

RESULTS

Fat mass had a strong positive correlation with BMI, but a weak positive correlation with other BIA-derived body compositions. Obese, overweight, and normal weight patients had significantly longer median survival than patients with BMI <18.5 ([23.2 versus 18.5 versus 17.5 versus 15.8] months, P < 0.001). Increased BMI and BIA-derived body composition indicators were associated with decreased all-cause mortality. Multivariable-adjusted analysis demonstrated that BMI, fat mass (FM), fat-free mass, muscle mass, bone mass, protein mass, total body water, extracellular water, and intracellular water were independent protective factors affecting the prognosis of patients with NSCLC. A difference in body compositions performance in the prognostic assessment of the different sexes was observed. Fat-related body compositions exhibited a significant obesity paradox in females compared to in males. Systemic inflammation played a crucial role in the relationship between body compositions and disease prognosis, with a mediating effect on body fat in males (31%) and females (19.7%).

CONCLUSIONS

The obesity paradox exists among patients with NSCLC and is not influenced by specific body compositions. In addition, this paradox is notably more common in female patients.

TRIAL REGISTRATION

Registration number: ChiCTR1800020329.

Non-steroidal anti-inflammatory drug use and inflammatory markers associated with gallbladder dysplasia: A case-control analysis within a series of patients undergoing cholecystectomy

Inflammation has been associated with the development of gallbladder cancer (GBC). However, little is known about the associations of both, inflammation and the use of non-steroidal anti-inflammatory drugs (NSAIDs), with preneoplastic lesions. We analyzed the association of NSAIDs and gallbladder dysplasia in 82 patients with dysplasia and 1843 patients with gallstones among symptomatic patients from a high-risk population. We also analyzed associations for 33 circulating immune-related proteins in a subsample of all 68 dysplasia cases diagnosed at the time of sample selection and 136 gallstone controls. We calculated age- and sex-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). Biliary colic was reported among most cases (97.6%) and controls (83.9%). NSAID use was inversely associated with gallbladder dysplasia (OR: 0.48, 95%CI: 0.26-0.83). Comparing the highest versus lowest category of each immune-related protein, eight proteins were inversely associated with dysplasia with sex- and age-adjusted ORs ranging from 0.30 (95%CI: 0.12-0.77) for IL-33 to 0.76 (95%CI: 0.59-0.99) for MIP-1B. Of those, GRO remained associated with dysplasia (OR: 0.64, 95%CI: 0.45-0.91) and BCA-1 was borderline associated (OR: 0.74, 95%CI: 0.54-1.01) after adjusting the logistic regression model for sex, age, and NSAIDs. In conclusion, NSAID users were less likely to have gallbladder dysplasia, suggesting that NSAIDs might be beneficial for symptomatic gallstones patients. The inverse association between immune-related markers and dysplasia requires additional research, ideally in prospective studies with asymptomatic participants, to understand the role of the inflammatory response in the natural history of GBC and to address the biological effect of NSAIDs.

Beneath the Surface: The Emerging Role of Ultra-Processed Foods in Obesity-Related Cancer

PURPOSEOF REVIEW

Ultra-processed foods (UPFs) are becoming more and more important in daily diets around the world; in some cases, they can account for as much as 60% of daily energy intake. Epidemiological evidence suggests that this shift toward high levels of food processing may be partially responsible for the global obesity epidemic and the rise in the prevalence of chronic diseases.

RECENT FINDINGS

Few prospective studies have examined the relationship between UPF consumption and cancer outcomes. According to currently available information, UPFs may increase the risk of cancer due to their obesogenic properties and exposure to substances that can cause cancer, such as certain food additives and pollution from product processing. The complex relationship between obesity and cancer involves factors such as immune dysregulation, altered adipokine and sex hormone levels, abnormal fatty acid metabolism, extracellular matrix remodeling, and chronic inflammation. Addressing cancer risk associated with UPF consumption could involve a multifaceted approach, including consumer behavior modification programs and robust public health regulations aimed at enhancing food environments. Improved knowledge of the potential dual negative impacts of UPFs on the environment and cancer risk is one of the priority areas we identify for future research and policy implications. Various approaches could be used to prevent cancers associated with UPF consumption, such as consumer behavior change programs and stricter public health regulations needed to improve the food environment. This review examines for the first time the potential role of UPFs in cancer risk associated with obesity, exploring underlying biological mechanisms and identifying key areas for future research and policy action, including the dual environmental and health impact of UPFs.

Rapid indirect detection of N-lactoyl-phenylalanine using dual DNA biosensors based on solution-gated graphene field-effect transistor

As obesity rates continue to rise, there is an increasing focus on reducing obesity through exercise. People are becoming more aware of the importance of weight loss through physical activity. However, the effectiveness of exercise can vary significantly among individuals, making it challenging to evaluate its impact. Therefore, establishing a reliable method for assessing exercise effectiveness is crucial for enhancing exercise quality and reducing obesity risk. It is noteworthy that the relationship between N-lactoyl-phenylalanine (N-Lac-Phe) and energy metabolism has garnered considerable attention. In this study, we developed a N-Lac-Phe biosensor by detecting L-lactic acid (L-Lac) and L-phenylalanine (L-Phe) based on Solution-Gated Graphene Field-Effect Transistors (SGGT). Our findings showed that the L-Lac and L-Phe biosensors exhibited excellent linearity within concentration ranges of 300 pM to 300 nM for L-Lac and 3 nM-1000 nM for L-Phe, with R2 values of 0.9934 and 0.9897, respectively. The detection accuracies for these two types of SGGT biosensors were 91.63 ± 6.97% and 99.39 ± 8.53%, respectively. Using the established N-Lac-Phe, L-Lac, and L-Phe relationship model (NLL model), we could calculate the concentration of N-Lac-Phe in the RAW264.7 culture medium based on the concentrations of L-Lac and L-Phe. The biosensors demonstrated excellent accuracy and selectivity, indicating their potential for rapidly evaluating the effectiveness of exercise.

The Role of Perirenal Adipose Tissue in Carcinogenesis-From Molecular Mechanism to Therapeutic Perspectives

Perirenal adipose tissue (PRAT) exhibits particular morphological features, with its activity being mainly related to thermogenesis. However, an expanded PRAT area seems to play a significant role in cardiovascular diseases, diabetes mellitus, and chronic kidney disease pathogenesis. Numerous studies have demonstrated that PRAT may support cancer progression and invasion, mainly in obese patients. The mechanism underlying these processes is of dysregulation of PRAT's secretion of adipokines and pro-inflammatory cytokines, such as leptin, adiponectin, chemerin, apelin, omentin-1, vistatin, nesfatin-1, and other pro-inflammatory cytokines, modulated by tumor cells. Cancer cells may also induce a metabolic reprogramming of perirenal adipocytes, leading to increased lipids and lactate transfer to the tumor microenvironment, contributing to cancer growth in a hypoxic milieu. In addition, the PRAT browning process has been specifically detected in renal cell carcinoma (RCC), being characterized by upregulated expression of brown/beige adipocytes markers (UCP1, PPAR-ɣ, c/EBPα, and PGC1α) and downregulated white fat cells markers, such as LEPTIN, SHOX2, HOXC8, and HOXC9. Considering its multifaceted role in cancer, modulation of PRAT's role in tumor progression may open new directions for oncologic therapy improvement. Considering the increasing evidence of the relationship between PRAT and tumor cells, our review aims to provide a comprehensive analysis of the perirenal adipocytes' impact on tumor progression and metastasis.

Effect of subcutaneous fat on long-term survival after surgery for stage I-III breast cancer as determined by computed tomography

Introduction

Monitoring body composition through Computed Tomography (CT) scans, including muscle and adipose tissue, plays a key role in the prognosis of various cancers. However, abdominal CT is impractical for patients with breast cancer (BC), making chest CT an essential tool for postoperative surveillance. This study aims to evaluate the effect of subcutaneous fat tissue at the 11th thoracic vertebral plane on the postoperative prognosis of BC patients by analyzing chest CT images, providing evidence for postoperative nutritional and rehabilitation guidance.

Methods

We conducted a retrospective analysis of the medical records of 188 BC patients treated and discharged from the Second Affiliated Hospital of Wenzhou Medical University between January 1, 2013, and December 31, 2013. The subcutaneous fat area (SFA) at the 11th thoracic vertebra (T11) was measured using chest CT images, and the subcutaneous fat index (SFI, area/height2) was calculated. Using multivariate Cox proportional hazards models and propensity score matching (PSM), the relationships between the SFI and overall survival (OS), as well as recurrence-free survival (RFS), were assessed. Additionally, Kaplan-Meier survival curves were applied to compare prognostic differences between the groups.

Results

The median follow-up duration was 128 months (range: 27-188 months). Of the 188 patients included in the study, the optimal cutoff value for the SFI was determined to be 49.31 cm²/m². Multivariate analysis indicated that SFI was an independent prognostic factor for both OS (HR 2.50, 95% CI 1.07-5.83, P = 0.034) and RFS (HR 2.04, 95% CI 1.10-3.78, P = 0.024). After PSM, Kaplan-Meier survival curve analysis revealed significant differences in both RFS and OS between the two groups (P = 0.025 and P = 0.018, respectively). All the results showed that the prognosis of BC with more subcutaneous fat was poor.

Discussion

The findings demonstrated that the SFI at T11 was negatively correlated with patient survival. This offers a new perspective on personalized management for BC patients, suggesting that future research should validate these results and investigate combining imaging assessments with lifestyle interventions, such as exercise, nutrition, and diet, to optimize patient outcomes.

Systemic aging and aging-related diseases

Aging is a biological process along with systemic and multiple organ dysfunction. It is more and more recognized that aging is a systemic disease instead of a single-organ functional disorder. Systemic aging plays a profound role in multiple diseases including neurodegenerative diseases, cardiovascular diseases, and malignant diseases. Aged organs communicate with other organs and accelerate aging. Skeletal muscle, heart, bone marrow, skin, and liver communicate with each other through organ-organ crosstalk. The crosstalk can be mediated by metabolites including lipids, glucose, short-chain fatty acids (SCFA), inflammatory cytokines, and exosomes. Metabolic disorders including hyperglycemia, hyperinsulinemia, and hypercholesterolemia caused by chronic diseases accelerate hallmarks of aging. Systemic aging leads to the destruction of systemic hemostasis, causes the release of inflammatory cytokines, senescence-associated secretory phenotype (SASP), and the imbalance of microbiota composition. Released inflammatory factors further aggregate senescence, which promotes the aging of multiple solid organs. Targeting senescence or delaying aging is emerging as a critical health strategy for solving age-related diseases, especially in the old population. In the current review, we will delineate the mechanisms of organ crosstalk in systemic aging and age-related diseases to provide therapeutic targets for delaying aging.

Cancer screening in patients with acromegaly: a plea for a personalized approach and international registries

Acromegaly is a rare condition, and often diagnosis is delayed by several years, for most patients. Acromegaly is characterized by short and long-term respiratory, cardiovascular and metabolic comorbidities, with possible impact on mortality. In the last two decades, life expectancy has progressively increased in part due to a reduction in biochemically active disease, multidisciplinary treatment approaches and a reduction in complications, and the availability of new drugs. Of note, a leading cause of mortality, cardiovascular comorbidity, has been replaced by cancer(s). As such, neoplasms more frequently observed (colon, thyroid, breast, prostate, and stomach) in patients with acromegaly are receiving increased attention. Chronic exposure to increased growth hormone serum levels may contribute to an increase in the occurrence and progression of cancers. Various efforts have been made to determine the pathogenetic mechanisms involved. However, there are no clear medical-related societal agreement(s) in relation to screening methods or timing regarding neoplasm(s) diagnosis in patients with acromegaly. Additionally, independent and dependent risk factor data in patients with acromegaly is lacking. International/national registries could help lay the groundwork to better study the impact of cancer(s) in patients with acromegaly and subsequently lead to and validate the most appropriate diagnostic and therapeutic path forward.

Lanatoside C Inhibits Proliferation and Induces Apoptosis in Human Prostate Cancer Cells Through the TNF/IL-17 Signaling Pathway

Prostate cancer remains a leading cause of cancer-related morbidity and mortality among men globally, with limited therapeutic options for advanced and metastatic disease. The therapeutic potential of natural compounds has attracted increasing attention in cancer treatment. Lanatoside C (Lan C), a cardiac glycoside derived from Digitalis lanata, has demonstrated promising anticancer activity across various cancer types. However, its role and mechanisms in prostate cancer remain underexplored. In this study, evidence shows that Lan C significantly inhibits the proliferation of prostate cancer cells, as demonstrated by reduced cell viability, suppressed colony formation, and G2/M cell cycle arrest. Additionally, Lan C promotes apoptosis and inhibits the migration and invasion of prostate cancer cells. Mechanistically, transcriptomic analysis identified differentially expressed genes, which were further validated at both the mRNA and protein levels. Our findings suggest that Lan C exerts its effects by modulating the TNF/IL-17 signaling pathway, influencing the tumor microenvironment and regulating key processes involved in tumor progression, immune response, and apoptosis.

Obesity promotes immunotherapy efficacy by up-regulating the glycolytic-mediated histone lactacylation modification of CD8+ T cells

The response rate of immune checkpoint blockade (ICB) therapy for non-small-cell lung cancer (NSCLC) remains limited. Recent evidence suggests that obese cancer patients are more likely to benefit from ICB therapy, however, the specific mechanism needs further research. In this study, we found that anti-PD-1 therapy was more effective in obese NSCLC patients compared to normal weight patients and this was verified in mouse NSCLC model. Further bioinformatics analysis indicated that the glycolytic metabolism was markedly elevated in obese NSCLC patients. In vitro co-culture experiment showed that both increased glycolysis of tumor cells and external addition of lactate promoted T cell PD-1 expression. And, PD-1 upregulation was related to monocarboxylate transporter 1 (MCT1)-mediated lactate transport and subsequent lysine lactylation of histones in T cells. Based on the aforementioned data, our study contributes to better application of anti-PD-1 therapy in NSCLC.

Omentin-General Overview of Its Role in Obesity, Metabolic Syndrome and Other Diseases; Problem of Current Research State

Background: Omentin (omentin-1, intelectin-1, ITLN-1) is an adipokine considered to be a novel substance. Many chronic, inflammatory, or civilization diseases are linked to obesity, in which omentin plays a significant role. Methods: MEDLINE and SCOPUS databases were searched using the keywords "omentin" or "intelectin-1". Then the most recent articles providing new perspectives on the matter and the most important studies, which revealed crucial insight, were selected to summarize the current knowledge on the role of omentin in a literature review. Results and Conclusions: The valid role of this adipokine is evident in the course of metabolic syndrome. In most cases, elevated omentin expression is correlated with the better course of diseases, including: type 2 diabetes mellitus, polycystic ovary syndrome, rheumatoid arthritis, metabolic dysfunction-associated steatotic liver disease, Crohn's disease, ulcerative colitis, atherosclerosis, or ischemic stroke, for some of which it can be a better marker than the currently used ones. However, results of omentin studies are not completely one-sided. It was proven to participate in the development of asthma and atopic dermatitis and to have different concentration dynamics in various types of tumors. All of omentin's effects and properties make it an attractive subject of research, considering still unexplored inflammation mechanisms, in which it may play an important role. Omentin was proven to prevent osteoarthritis, hepatocirrhosis, and atherosclerosis in mouse models. All of the above places omentin among potential therapeutic products, and not only as a biomarker. However, the main problems with the omentin's research state are the lack of standardization, which causes many contradictions and disagreements in this field.

Elemental evaluation, nutritional analysis, GC-MS analysis and ameliorative effects of Artocarpus communis J.R.Forst. & G.Forst. seeds' phytoconstituents on metabolic syndrome via in silico approach

The nutritional as well as beneficial effects of the Artocarpus communis seed on metabolic syndrome complications have not been studied. In this research, the aim was to investigate the nutritional composition and beneficial effects of Artocarpus communis seeds' phytoconstituents on the p53 core, fat mass and obesity-associated (FTO) protein and cytochrome P450 CYP11A1 domains. The elements and phytochemicals in the seed were determined through atomic absorption spectroscopy assay and gas chromatography-mass spectrometry (GC-MS) analysis, respectively. Also, the compounds detected were docked to the p53 core, FTO protein and cytochrome P450 CYP11A1 domains protein. Artocarpus communis seed contains sodium (7.824 ± 0.0134 ppm), magnesium (10.187 ± 0.0239 ppm) and iron (1.924 ± 0.0017), while zinc and cadmium were undetected. Phenolics and flavonoids were the most abundant phytochemicals in the seed. Phytoconstituents, such as pentadecanoic acid, hexadecanoic acid and methyl ester, possessing different therapeutic effects were identified via GC-MS analysis. In A. communis seed, 3-methyl-4-nitro-5-(1-pyrazolyl) pyrazole and phenanthrene were able to bind more peculiarly and specifically to the p53 core, FTO protein and cytochrome P450 CYP11A1 domains. One of the important processes that were hypothesized for the recovery of metabolic syndrome in affected victims is shown by the molecular dynamics analysis, which shows that the binding of these chemicals to the targeted structure stabilized the proteins. Therefore, Artocarpus communis seeds could be a new strategy for the management of metabolic syndrome.Communicated by Ramaswamy H. Sarma.

Tumor Metastasis: Mechanistic Insights and Therapeutic Intervention

Metastasis remains a leading cause of cancer‐related deaths, defined by a complex, multi‐step process in which tumor cells spread and form secondary growths in distant tissues. Despite substantial progress in understanding metastasis, the molecular mechanisms driving this process and the development of effective therapies remain incompletely understood. Elucidating the molecular pathways governing metastasis is essential for the discovery of innovative therapeutic targets. The rapid advancements in sequencing technologies and the expansion of biological databases have significantly deepened our understanding of the molecular drivers of metastasis and associated drug resistance. This review focuses on the molecular drivers of metastasis, particularly the roles of genetic mutations, epigenetic changes, and post‐translational modifications in metastasis progression. We also examine how the tumor microenvironment influences metastatic behavior and explore emerging therapeutic strategies, including targeted therapies and immunotherapies. Finally, we discuss future research directions, stressing the importance of novel treatment approaches and personalized strategies to overcome metastasis and improve patient outcomes. By integrating contemporary insights into the molecular basis of metastasis and therapeutic innovation, this review provides a comprehensive framework to guide future research and clinical advancements in metastatic cancer.

Unveiling the link between chronic inflammation and cancer

The highly nuanced transition from an inflammatory process to tumorigenesis is of great scientific interest. While it is well known that environmental stimuli can cause inflammation, less is known about the oncogenic modifications that chronic inflammation in the tissue microenvironment can bring about, as well as how these modifications can set off pro-tumorigenic processes. It is clear that no matter where the environmental factors come from, maintaining an inflammatory microenvironment encourages carcinogenesis. In addition to encouraging angiogenesis and metastatic processes, sustaining the survival and proliferation of malignant transformed cells, and possibly altering the efficacy of therapeutic agents, inflammation can negatively regulate the antitumoral adaptive and innate immune responses. Because chronic inflammation has multiple pathways involved in tumorigenesis and metastasis, it has gained recognition as a marker of cancer and a desirable target for cancer therapy. Recent advances in our knowledge of the molecular mechanisms that drive cancer's progression demonstrate that inflammation promotes tumorigenesis and metastasis while suppressing anti-tumor immunity. In many solid tumor types, including breast, lung, and liver cancer, inflammation stimulates the activation of oncogenes and impairs the body's defenses against the tumor. Additionally, it alters the microenvironment of the tumor. As a tactical approach to cancer treatment, these findings have underscored the importance of targeting inflammatory pathways. This review highlights the role of inflammation in cancer development and metastasis, focusing on its impact on tumor progression, immune suppression, and therapy resistance. It examines current anti-inflammatory strategies, including NSAIDs, cytokine modulators, and STAT3 inhibitors, while addressing their potential and limitations. The review emphasizes the need for further research to unravel the complex mechanisms linking inflammation to cancer progression and identify molecular targets for specific cancer subtypes.

Targeting obesity, metabolic syndrome, and prostate cancer: GLP-1 agonists as emerging therapeutic agents

Prostate cancer (PCa) is known as the second most common cancer and has one of the highest incidences among male cancers in the United States. In addition, obesity and metabolic syndrome are a rising and continuous issue in the United States, with 41.9% of individuals as obese. The importance of highlighting these figures is the possibility of PCa having a progressive relationship with obesity and metabolic syndromes. The drugs developed for treating obesity and diabetes pose an exciting possibility of therapeutic application for cancer in efforts to relieve the population's rising numbers. Although this connection has not been established in detail, there are some PCa key biomarkers, and their interactions with metabolic products found in obese, diabetic, and PCa patients can provide good starting points for further investigation. One of the significant links between PCa, obesity, and metabolic disease may be due to insulin metabolism. A downstream target identified that could be the link between PCa, metabolic syndromes, and obesity is the forkhead box C2 (FOXC2). FOXC2 has been known to inhibit some insulin-resistant genes and cause the proliferation of PCa. The relationships of FOXC2, insulin resistance, and GLP-1 receptor agonists as potential therapeutic applications have not been thoroughly explored. This review covers a broad relationship of PCa, obesity, metabolic syndromes, possible drugs, and therapeutic targets.

Maternal weight during pregnancy and risk of childhood acute lymphoblastic leukemia in offspring

In addition to biological factors, maternal exposures during pregnancy can contribute to leukemogenesis in offspring. We conducted a population-based cohort study in Sweden to investigate the association between risk of acute lymphoblastic leukemia (ALL) in offspring and maternal anthropometrics during pregnancy. A total of 2,961,435 live-born singletons during 1983-2018 were followed from birth to ALL diagnosis, end of age 18, or end of 2018. 1388 children were diagnosed with ALL (55.6% boys). We observed an increased risk of ALL among daughters of overweight/obese mothers in early pregnancy [Body mass index (BMI) ≥ 25 kg/m2; Standardized incidence ratio (SIR) = 1.4, 95% CI: 1.2-1.6] compared with the risk in daughters of mothers with normal BMI. This association was not found in their sons (SIR = 1.0, 95% CI: 0.9-1.1). Similar results were found for the association between ALL and maternal BMI before delivery. We did not find an association between low or high gestational weight gain (GWG) and risk of ALL (both SIRs = 1.0) in male/female offspring. These suggest that maternal overweight/obesity are important risk factors for childhood ALL in daughters, whereas GWG is not associated with risk of ALL. Further research on this mother-daughter association may shed light on a possible sex hormone/chromosome-related etiology of ALL.

Neutrophils in colorectal cancer: mechanisms, prognostic value, and therapeutic implications

Neutrophils, the most abundant myeloid cells in human peripheral blood, serve as the first defense line against infection and are also significantly involved in the initiation and progression of cancer. In colorectal cancer (CRC), neutrophils exhibit a dual function by promoting tumor events and exerting antitumor activity, which is related to the heterogeneity of neutrophils. The neutrophil extracellular traps (NETs), gut microbiota, and various cells within the tumor microenvironment (TME) are involved in shaping the heterogeneous function of neutrophils. This article provides an updated overview of the complex functions and underlying mechanisms of neutrophils in CRC and their pivotal role in guiding prognosis assessment and therapeutic strategies, aiming to offer novel insights into neutrophil-associated treatment approaches for CRC.

Relationship of obesity, body fat, benign adrenal tumors and the mediating mechanism: a two-step mendelian randomization study

BACKGROUND

Benign adrenal tumors comprise the majority of asymptomatic adrenal masses and are often associated with cortisol secretion, which increases the risk of obesity and metabolic syndrome. Hormone secretion by these tumors may confound prevailing epidemiologic findings, and the causal relationships among obesity, body fat, and benign adrenal tumors remain uncertain. Mendelian randomization (MR) uses genetic variation as an instrumental variable to simulate randomized controlled trials, thereby reducing confounding and supporting causal relationships. Therefore, we aim to use MR methods to investigate causal relationships between obesity, body fat, and benign adrenal tumors. And use two-step MR to evaluate potential mediating mechanisms and their mediation proportions.

METHOD

Single nucleotide polymorphisms significantly associated with obesity, body fat and possible mediators were selected as instrumental variables from published genome-wide association studies (GWAS). GWAS data for benign adrenal tumor cases (n = 1,790) and controls (n = 390,633) were obtained from the Finngen database. Univariable MR analysis was performed to evaluate the causal associations of obesity and body fat with benign adrenal tumors, with obesity and body fat quantified using ten anthropometric indicators. In addition, two-step MR was used to examine four categories of possible mediators (metabolic indicators, hormone indicators, inflammation and oxidation indicators, and diseases) to explore potential mechanisms between obesity, body fat, and benign adrenal tumors and to calculate mediation proportions.

RESULT

Our results show that all anthropometric indicators are risk factors for benign adrenal tumors (OR range from 1.59 to 2.49 with FDR < 0.05). In addition, two-step MR analysis shows that both total and bioavailable testosterone levels significantly mediate body fat percentage, trunk fat percentage, and trunk fat mass on benign adrenal tumors in women (mediation proportion: 4.07%-15.58%). In addition, bioavailable testosterone levels mediate whole body fat mass (10.95%) and body mass index (17.04%), while total testosterone levels mediate hip circumference (7.27%) in women.

CONCLUSION

Our study demonstrates that obesity and elevated body fat may serve as risk factors for benign adrenal tumors. Furthermore, we identify the mediating role of total/bioavailable testosterone levels in women, suggesting its potential target for prevention and intervention of benign adrenal tumors in individuals with obesity or high body fat.

Crosstalk between gut microbiotas and fatty acid metabolism in colorectal cancer

Colorectal cancer (CRC) is the third most common malignancy globally and the second leading cause of cancer-related mortality. Its development is a multifactorial and multistage process influenced by a dynamic interplay between gut microbiota, environmental factors, and fatty acid metabolism. Dysbiosis of intestinal microbiota and abnormalities in microbiota-associated metabolites have been implicated in colorectal carcinogenesis, highlighting the pivotal role of microbial and metabolic interactions. Fatty acid metabolism serves as a critical nexus linking dietary patterns with gut microbial activity, significantly impacting intestinal health. In CRC patients, reduced levels of short-chain fatty acids (SCFAs) and SCFA-producing bacteria have been consistently observed. Supplementation with SCFA-producing probiotics has demonstrated tumor-suppressive effects, while therapeutic strategies aimed at modulating SCFA levels have shown potential in enhancing the efficacy of radiation therapy and immunotherapy in both preclinical and clinical settings. This review explores the intricate relationship between gut microbiota, fatty acid metabolism, and CRC, offering insights into the underlying mechanisms and their potential translational applications. Understanding this interplay could pave the way for novel diagnostic, therapeutic, and preventive strategies in the management of CRC.

Machine learning model using immune indicators to predict outcomes in early liver cancer

BACKGROUND

Patients with early-stage hepatocellular carcinoma (HCC) generally have good survival rates following surgical resection. However, a subset of these patients experience recurrence within five years post-surgery.

AIM

To develop predictive models utilizing machine learning (ML) methods to detect early-stage patients at a high risk of mortality.

METHODS

Eight hundred and eight patients with HCC at Beijing Ditan Hospital were randomly allocated to training and validation cohorts in a 2:1 ratio. Prognostic models were generated using random survival forests and artificial neural networks (ANNs). These ML models were compared with other classic HCC scoring systems. A decision-tree model was established to validate the contribution of immune-inflammatory indicators to the long-term outlook of patients with early-stage HCC.

RESULTS

Immune-inflammatory markers, albumin-bilirubin scores, alpha-fetoprotein, tumor size, and International Normalized Ratio were closely associated with the 5-year survival rates. Among various predictive models, the ANN model generated using these indicators through ML algorithms exhibited superior performance, with a 5-year area under the curve (AUC) of 0.85 (95%CI: 0.82-0.88). In the validation cohort, the 5-year AUC was 0.82 (95%CI: 0.74-0.85). According to the ANN model, patients were classified into high-risk and low-risk groups, with an overall survival hazard ratio of 7.98 (95%CI: 5.85-10.93, P < 0.0001) between the two cohorts.

CONCLUSION

A non-invasive, cost-effective ML-based model was developed to assist clinicians in identifying high-risk early-stage HCC patients with poor postoperative prognosis following surgical resection.

Systemic immune-inflammation index mediates the association between abdominal obesity and serum klotho levels

The weight-adjusted waist index (WWI) has emerged as a reliable indicator of abdominal obesity. α-Klotho, a transmembrane protein, functions as a suppressor of aging. However, the relationship between these two factors remains underexplored. This study aims to investigate the association between WWI and serum α-Klotho levels in middle-aged and elderly Americans, with a focus on exploring the potential mediating role of the systemic immune inflammation index (SII). A cross-sectional study was conducted using data from 6997 middle-aged and elderly Americans participating in the National Health and Nutrition Examination Surveys (NHANES) between 2011 and 2016. Multiple linear regression analysis was employed to assess the relationship between WWI and serum α-Klotho concentrations. Additionally, mediation analysis was performed to investigate the mediating effect of SII on the relationships. Our analysis revealed a significant negative correlation between WWI and serum α-Klotho levels in the survey-weighted multiple linear regression models (adjusted percent change: -7.79; 95% CI: -10.15, -5.37). Mediation analysis demonstrated that the association between WWI and α-Klotho levels was partially mediated by SII (adjusted percent change: -0.88; 95% CI: -1.24, -0.45), with the proportion of mediation amounting to 11.6%. Further age-stratified results showed that the mediating role of SII was more pronounced among individuals aged ≥ 60 years, exhibiting a mediating effect of 26.3%, in contrast to 4.2% for those < 60 years. The findings suggest that WWI is inversely associated with serum α-Klotho concentrations and that this association is partially mediated by SII, especially in older people.

Global, regional, and national burden of pancreatic cancer from 1990 to 2021, its attributable risk factors, and projections to 2050: a systematic analysis of the global burden of disease study 2021

BACKGROUND

The incidence and mortality rates of pancreatic cancer are rising globally. This study examines global and regional trends in pancreatic cancer incidence, Disability Adjusted Life Years (DALYs), and mortality from 1990 to 2021, utilizing data from the most recent Global Burden of Disease (GBD) 2021 database.

METHODS

Data were sourced from the GBD database over the period from 1990 to 2021. Age-standardized rates for incidence, DALYs, and mortality were calculated per 100,000 population. We also calculated the proportion of DALYs and mortality attributable to risk factors. The Bayesian age-period-cohort model was applied to project future trends until 2050.

RESULTS

Between 1990 and 2021, the global incidence of pancreatic cancer increased significantly, with the number of cases rising from approximately 207,905 to 508,533 and the age-standardized incidence rate (ASIR) increasing from 5.47 to 5.96 per 100,000 population. The global burden of pancreatic cancer, measured in DALYs, rose from 5.21 million to 11.32 million. Mortality rates showed a similar upward trend, with the number of deaths increasing from around 211,613 to 505,752, and the age-standardized mortality rate (ASMR) rising from 5.655 to 5.948 per 100,000 population. Notable increases in ASIR and ASMR were observed in low-middle and low sociodemographic index regions with males experienced higher rates compared to females. Age-standardized DALYs rate (ASDR) and ASMR worldwide were attributable to tobacco smoking, high BMI, and high fasting plasma glucose. Furthermore, our projection model estimates that the ASIR and ASMR of pancreatic cancer will significantly decline, while the ASDR is anticipated to maintain a steady downward trend by 2050.

CONCLUSION

This study offers a comprehensive analysis of pancreatic cancer trends, providing crucial insights for public health planning and policy-making. Addressing identified risk factors and targeting high-risk populations are essential for effective strategies to reduce the global burden of pancreatic cancer.

Obesity correlates to the microsatellite instability of endometrial cancer: A retrospective observational study

OBJECTIVE

To investigate the relationship between obesity and Microsatellite Instability (MSI) in endometrial cancer (EC), determine which mismatch repair (MMR) protein loss is influenced by obesity, and assess the correlation between BMI and MSI probability.

METHODS

This retrospective cohort study included 89 endometrial cancer patients treated at the Gynaecologic oncology unit of the University of Campania "Luigi Vanvitelli" from August 2023 to October 2024, and stratified by BMI: normal weight (n = 26), overweight (n = 31), obese (n = 26), and severely obese (n = 6). Microsatellite instability (MSI) was determined through immunohistochemical assessment of mismatch repair (MMR) protein expression: MLH1, PMS2, MSH2, and MSH6. Tumors were considered MSI if at least one of the four MMR proteins showed loss of expression. Univariate and multivariate logistic regression models were constructed to evaluate the correlation between BMI and MSI RESULTS: 89 patients were enrolled. Obese and severely obese groups showed significantly higher MSI rates (50 % each) compared to normoweight (12 %) and overweight (29 %) groups (P = .013). MLH1 and PMS2 loss of expression were significantly higher in obese and severely obese women (MLH1: P = .003; PMS2: P = .014). Univariate logistic regression showed a significant positive correlation between BMI and MSI (OR 1.02, 95 % CI 1.01-1.04, P = .007). In multivariate analysis, adjusting for grading, stage, histotype, and age, BMI maintained a significant positive correlation with MSI (OR 1.02, 95 % CI 1.01-1.04, P = .048).

CONCLUSIONS

This study demonstrates a significant association between obesity and MSI in EC, particularly affecting MLH1 and PMS2 expression. The findings suggest that obesity may contribute to EC development also through MMR deficiency.

High prediagnostic dietary intake of vitamin B2 and vitamin B6 is associated with favorable prognosis of colorectal cancer among Chinese colorectal cancer patients

The potential impact of one-carbon metabolism (OCM)-related B vitamins (vitamin B2, B6, B12, and folate) on colorectal cancer survival warrants investigation but research is sparse. This cohort study examined the association between the prediagnostic dietary intakes of OCM-related B vitamins and colorectal cancer survival. A total of 2799 colorectal cancer patients from the Guangdong Colorectal Cancer Cohort, enrolled at baseline in 2010, were followed for mortality outcomes through 2023. Dietary data were collected from patients using a food frequency questionnaire for the year prior to their diagnosis. Multivariable Cox proportional hazards regression models were applied to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) to examine the association between OCM-related B vitamins and colorectal cancer survival. Restricted cubic spline analyses and stratified analysis were performed. During the follow-up period of approximately 60.33 months, 639 deaths were documented, of which 574 were colorectal cancer-specific deaths. Dietary vitamin B2 and B6 intake was significantly associated with survivals. The adjusted HRs in the highest versus the lowest quartile of vitamin B2 intake were 0.77 (0.62-0.97) for overall survival and 0.71 (0.55-0.90) for colorectal cancer-specific survival, and vitamin B6 intake were 0.79 (0.64-0.99) for overall survival and 0.75 (0.59-0.94) for colorectal cancer-specific survival. Nonlinear associations were observed between vitamin B6 intake and both overall survival and colorectal cancer-specific survival. However, no significant association was found between vitamin B12 or folate intake and survivals. These results suggest that high prediagnostic intake of vitamin B2 and B6 may be associated with improved survivals in colorectal cancer patients.

Unraveling molecular interconnections and identifying potential therapeutic targets of significance in obesity-cancer link

Obesity, a global health concern, is associated with severe health issues like type 2 diabetes, heart disease, and respiratory complications. It also increases the risk of various cancers, including melanoma, endometrial, prostate, pancreatic, esophageal adenocarcinoma, colorectal carcinoma, renal adenocarcinoma, and pre-and post-menopausal breast cancer. Obesity-induced cellular changes, such as impaired CD8+ T cell function, dyslipidemia, hypercholesterolemia, insulin resistance, mild hyperglycemia, and fluctuating levels of leptin, resistin, adiponectin, and IL-6, contribute to cancer development by promoting inflammation and creating a tumor-promoting microenvironment rich in adipocytes. Adipocytes release leptin, a pro-inflammatory substance that stimulates cancer cell proliferation, inflammation, and invasion, altering the tumor cell metabolic pathway. Adiponectin, an insulin-sensitizing adipokine, is typically downregulated in obese individuals. It has antiproliferative, proapoptotic, and antiangiogenic properties, making it a potential cancer treatment. This narrative review offers a comprehensive examination of the molecular interconnections between obesity and cancer, drawing on an extensive, though non-systematic, survey of the recent literature. This approach allows us to integrate and synthesize findings from various studies, offering a cohesive perspective on emerging themes and potential therapeutic targets. The review explores the metabolic disturbances, cellular alterations, inflammatory responses, and shifts in the tumor microenvironment that contribute to the obesity-cancer link. Finally, it discusses potential therapeutic strategies aimed at disrupting these connections, offering valuable insights into future research directions and the development of targeted interventions.

Study of penehyclidine for the prevention of postoperative nausea and vomiting following laparoscopic sleeve gastrectomy under general anesthesia: a randomized, prospective, double-blind trial

PURPOSE

To investigate the efficacy of penehyclidine (PHC) for preventing postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG) under general anesthesia.

MATERIALS AND METHODS

In this prospective study, 219 patients who were scheduled to undergo LSG were randomly assigned to three cohorts: the control cohort (received normal saline), the infusion cohort (administered 0.25 mg of PHC intravenously followed by an additional 0.25 mg through an intravenous analgesia pump for 48 h after LSG), and the bolus cohort (received a single intravenous dose of 0.5 mg of PHC). The study outcomes included the incidence of PONV within the first 48 h postoperatively, the severity and intensity of PONV, side effects and postoperative recovery outcomes. Univariate and multivariate logistic analyses were performed to identify independent risk factors associated with PONV.

RESULTS

Compared with the control cohort, both the infusion and bolus cohorts presented considerably lower incidences of PONV (61.64% vs. 12.33% vs. 38.36%, P < 0.05), as well as significantly decreased PONV severities (P < 0.05) and intensities (P < 0.05). There were no significant differences in side effects and postoperative recovery outcomes among the three cohorts, with the exception of dry mouthand the administration of rescue antiemetic therapy (P < 0.05). Additionally, the Apfel risk score and PHC intervention were identified as independent risk factors associated with PONV incidence following LSG (P < 0.05).

RESULTS

PHC effectively prevented PONV occurrence and reduced its severity in LSG patients without decreasing postoperative recovery outcomes, particularly in the infusion cohort.

Relative Fat Mass and Physical Indices as Predictors of Gallstone Formation: Insights From Machine Learning and Logistic Regression

Purpose

Gallstones (GS), a prevalent disorder of the biliary tract, markedly impair patients' quality of life. This study aims to construct predictive models employing diverse machine learning algorithms to elucidate risk factors linked to gallstone formation.

Patients and Methods

This study integrated data from the National Health and Nutrition Examination Survey (NHANES) with a cohort of 7868 participants from Wuxi People's Hospital and Wuxi Second People's Hospital, including 830 individuals diagnosed with gallstones. To develop our predictive model, we employed four algorithms-Logistic Regression, Gaussian Naive Bayes (GNB), Multi-Layer Perceptron (MLP), and Support Vector Machine (SVM). The models were validated internally through k-fold cross-validation and externally using independent datasets. Furthermore, we substantiated the link between relative fat mass (RFM) and gallstone formation by employing four logistic regression models, conducting subgroup analyses, and applying restricted cubic spline (RCS) curves.

Results

The logistic regression algorithm demonstrated superior predictive capability for all risk factors associated with gallstone occurrence compared to other machine learning models. SHAP analysis identified RFM, weight-to-waist index (WWI), waist circumference (WC), waist-to-height ratio (WHtR), and body mass index (BMI) as prominent predictors of gallstone occurrence, with RFM emerging as the primary determinant. A fully adjusted multivariate logistic regression analysis revealed a robust positive association between RFM and gallstones. Subgroup analysis further indicated that subgroup factors did not alter the positive relationship between RFM and gallstone prevalence.

Conclusion

Among the four algorithmic models, logistic regression proved most effective in predicting gallstone occurrence. The model developed in this study offers clinicians a valuable tool for identifying critical prognostic factors, facilitating personalized patient monitoring and tailored management.

Association between a body shape index and colorectal cancer in US population: a cross-sectional study based on NHANES

Background

Colorectal cancer (CRC) is linked to obesity, particularly visceral fat. A more accurate measure of visceral fat accumulation is offered by a body shape index (ABSI). Currently, the direct application of the ABSI to populations with varying ethnic backgrounds might be restricted. Moreover, there is less evidence about the correlation between ABSI and CRC among individuals from different ethnical backgrounds.

Methods

A total of 40,998 individuals who took part in the National Health and Nutrition Examination Survey (NHANES) spanning from 2003 to 2023 were subjected to analysis. Logistic regression was utilized to examine the associations between the ABSI and the risk of CRC. In addition, restricted cubic spline curves (RCS) were utilized, and subgroup analyses along with interaction tests were also carried out. The receiver operating characteristic curve (ROC) was employed to predict the risk of CRC relying on various anthropometric indicators.

Results

After adjusting for covariates, ABSI demonstrated a positive association with the incidence of CRC (OR = 1.03 [95% CI: 1.01-1.05], p = 0.018). Individuals in the upper quartile of ABSI exhibited a greater prevalence of CRC than those in the lower quartile (OR = 1.88 [95% CI: 1.19-2.96], p = 0.006). RCS analysis indicated a nonlinear correlation between ABSI and CRC (P for nonlinear = 0.030). Subgroup analysis indicated a notable interaction between age and BMI subgroups (interaction p < 0.05), and ROC curves indicated that the ABSI was effective in predicting CRC risk (AUC = 0.658), demonstrating good sensitivity, particularly in individuals under 60 years of age.

Conclusion

A positive correlation exists between ABSI levels and the increased incidence of CRC among U.S. adults. This is especially true for people under 60 years of age (40-60 years), with a BMI below 25 kg/m2, and those with a BMI of 30 kg/m2 or beyond. ABSI can be used as a simple anthropometric predictor of CRC.

Impact of obesity on outcome in children diagnosed with cancer in Canada: A report from Cancer in Young People in Canada

BACKGROUND

Childhood obesity can result in adverse health outcomes. The objectives of this study were to describe the prevalence of obesity and determine the association between obesity at cancer diagnosis and event-free survival (EFS) and overall survival (OS) in children diagnosed with cancer in Canada.

METHODS

The authors conducted a retrospective cohort study using the Cancer in Young People in Canada database, including all children with newly diagnosed cancer aged 2-18 years across Canada from 2001 to 2020. Obesity was defined as age-adjusted and sex-adjusted body mass index greater than or equal to the 95th percentile. Univariate and multivariable Cox proportional hazards models compared EFS and OS between patients with and without obesity at diagnosis.

RESULTS

In total, 11,291 patients were included, of whom 10.5% were obese at diagnosis. In multivariable models controlling for age, sex, ethnicity, neighborhood income quintile, treatment era, and cancer categories, obesity at diagnosis was independently associated with inferior EFS (adjusted hazard ratio [aHR], 1.16; 95% confidence interval [CI], 1.02-1.32; p = .02) and OS (aHR, 1.29; 95% CI, 1.11-1.49; p = .001). The adverse prognostic impact of obesity was particularly notable for acute lymphoblastic leukemia (ALL) and central nervous system (CNS) tumors. In children with ALL (n = 3458), obesity remained associated with inferior EFS (aHR, 1.55; p = .002) and OS (aHR, 1.75; p = .002) in multivariable analysis. In patients with CNS tumors (n = 2458), obesity was also associated with inferior EFS (aHR, 1.38; p = .008) and OS (aHR, 1.47; p = .004).

CONCLUSIONS

In this population-based study, obesity at cancer diagnosis was independently associated with inferior survival across the entire cohort, and prominently in children with ALL and CNS tumors.

Severe obesity, high inflammation, insulin resistance with risks of all-cause mortality and all-site cancers, and potential modification by healthy lifestyles

Severe obesity is often associated with inflammation and insulin resistance (IR), which expected to increase the risks of mortality and cancers. However, this relationship remains controversial, and it's unclear whether healthy lifestyles can mitigate these risks. The independent and joint associations of severe obesity (body mass index ≥ 35 m/kg2), inflammation (C-reactive protein > 10 mg/L and systemic inflammation markers > 9th decile), and IR surrogates with the risks of all-cause mortality and all-site cancers, were evaluated in 163,008 participants from the UK Biobank cohort. Further analyses were conducted to investigate how these associations were modified by lifestyle. During a median follow-up of 11.0 years, we identified 8844 deaths and 20,944 cancer cases. Severe obesity, inflammation and IR were each independently associated with increased risks of all-cause mortality [HRs(95%CIs) 1.24(1.17-1.30), 1.63(1.55-1.72) and 1.11(1.05-1.17)] and all-site cancers [1.06(1.02-1.10), 1.14(1.10-1.19) and 1.02(0.99-1.06)]. Joint analyses revealed significantly elevated risks of all-cause mortality and all-site cancers due to interaction between severe obesity, inflammation and IR, with the highest HRs(95%CIs) of 1.88(1.67-2.11) and 1.20(1.08-1.34), respectively. Further analyses showed stronger interaction between severe obesity, inflammation, IR and lifestyles, with similar associations observed in both males and females. Additionally, compared with unfavorable lifestyles, favorable lifestyles attenuated the risks of both all-cause mortality [the highest HRs(95%CIs) 2.35(1.75-3.15) vs. 3.72(2.86-4.84) for favorable vs. unfavorable lifestyles] and all-site cancers [1.16(0.89-1.53) vs. 1.63(1.26-2.10)]. Severe obesity interacts with inflammation and IR to exacerbate the risks of all-cause mortality and all-site cancers. Nonetheless, adherence to healthy lifestyles is recommended to mitigate these increased risks.

The impact of diet-induced obesity on 5 fluorouracil-induced tumor and liver immune cell cytotoxicity

Obesity increases the risk for developing several cancers, including colorectal cancer (CRC), and is associated with liver perturbations, which likely impacts treatment tolerance. 5 fluorouracil (5FU) remains a first line treatment for CRC, but efficacy is hampered by interpatient variable responsiveness and off-target toxicities. The current study examined the impact of diet-induced obesity (DIO) on 5FU cytopenia and efficacy using two established CRC models: MC38 (C57BL/6) and C26 (CD2F1). DIO increased tumor size in both MC38 and C26. DIO reduced liver dihydropyrimidine dehydrogenase (dpyd) expression, the enzyme that catalyzes 5FU's catabolism to become inactive, in MC38 mice, but not in C26. 5FU remained efficacious against early MC38 and C26 tumor growth; however, 5FU-induced tumor and liver immune cell death was exacerbated following three cycles of 5FU with MC38. DIO caused dramatic changes to liver Kupffer cells (KCs), wherein there were increased prometastatic, immunosuppressive KCs in Obese Control and MC38. 5FU, however, depleted these KCs and increased inflammatory KCs in both Lean and Obese MC38. DIO yielded a milder obesity phenotype in CD2F1 mice, and 5FU-induced cytopenia was not different between Lean and Obese. DIO increased total liver KCs; however, C26 tumors increased liver KCs, which were normalized with 5FU treatment, irrespective of DIO. Although 5FU remained efficacious in both models of CRC and did not reduce survival, multiple cycles of 5FU monotherapy increased liver and tumor immune cell death in DIO mice. Altogether, obesity was not protective but rather exacerbated chemotherapy-induced cytotoxicity and promoted a prometastatic liver environment.NEW & NOTEWORTHY The current study aimed to examine the impact of obesity on tumorigenesis and 5FU safety and efficacy with two established murine models of colorectal cancer. Diet-induced obesity increased tumor burden in both models, and 5FU's antitumor efficacy remained and extended survival with both tumor models. Obese mice demonstrated increased 5FU-induced immune cell cytotoxicity following multiple cycles of 5FU with distinct changes to liver macrophages, suggesting an increased propensity for liver metastasis.

Integrin β1 in breast cancer: mechanisms of progression and therapy

The therapy for breast cancer (BC), to date, still needs improvement. Apart from traditional therapy methods, biological therapy being explored opens up a novel avenue for BC patients. Integrin β1 (ITGβ1), one of the largest subgroups in integrin family, is a key player in cancer evolution and therapy. Recent researches progress in the relationship of ITGβ1 level and BC, finding that ITGβ1 expression evidently concerns BC progression. In this chapter, we outline diverse ITGβ1-based mechanisms regarding to the promoted effect of ITGβ1 on BC cell structure rearrangement and malignant phenotype behaviors, the unfavorable patient prognosis conferred by ITGβ1, BC therapy tolerance induced by ITGβ1, and lastly novel inhibitors targeting ITGβ1 for BC therapy. As an effective biomarker, ITGβ1 undoubtedly emerges one of targeted-therapy opportunities of BC patients in future. It is a necessity focusing on scientific and large-scale clinical trials on the validation of targeted-ITGβ1 drugs for BC patients.

Metabolic syndrome and cancer risk: a two-sample Mendelian randomization study of European ancestry

BACKGROUND

The relationship between Metabolic Syndrome and cancer remains controversial. The authors aimed to assess the association between Metabolic Syndrome and cancer risk at different locations using a Mendelian randomization approach.

METHODS

The authors extracted single nucleotide polymorphisms (SNPs) of MetS and its components from public databases for populations of European ancestry. Causal effects were estimated using inverse variance weighting, MR-Egger, weighted median, and MR-PRESSO. Sensitivity analyses were performed using Cochran's Q test, MR-Egger intercept test, MR-PRESSO, leave-one-out analysis, and funnel plots. In addition, the authors calculated the Statistical power. Finally, the authors applied the False Discovery Rate (FDR) to correct our results.

RESULTS

IVW methods showed that Genetically predicted Metabolic Syndrome may be a potential risk factor for hepatocellular carcinoma ( P =0.031, P-FDR=0.093). Metabolic Syndrome was not causally associated with cancers at other sites (lung, thyroid, breast, prostate, kidney, bladder, colorectal, esophagus, and stomach). In further analyses, WC may increase the risk of lung ( P =0.003, P-FDR=0.018), and esophageal ( P =0.011, P-FDR=0.066) cancers and decrease the risk of prostate cancer ( P =0.006, P-FDR=0.001). Furthermore, hypertension may reduce the risk of Hepatic cancer ( P =0.014, P-FDR=0.084).

CONCLUSION

Our study suggests that genetically predicted Metabolic Syndrome may increase the risk of some cancers. Prevention and treatment of Metabolic Syndrome may help to prevent the development of related cancers.

Physical stimuli-responsive polymeric patches for healthcare

Many chronic diseases have become severe public health problems with the development of society. A safe and efficient healthcare method is to utilize physical stimulus-responsive polymer patches, which may respond to physical stimuli, including light, electric current, temperature, magnetic field, mechanical force, and ultrasound. Under certain physical stimuli, these patches have been widely used in therapy for diabetes, cancer, wounds, hair loss, obesity, and heart diseases since they could realize controllable treatment and reduce the risks of side effects. This review sketches the design principles of polymer patches, including composition, properties, and performances. Besides, control methods of using different kinds of physical stimuli were introduced. Then, the fabrication methods and characterization of patches were explored. Furthermore, recent applications of these patches in the biomedical field were demonstrated. Finally, we discussed the challenges and prospects for its clinical translation. We anticipate that physical stimulus-responsive polymer patches will open up new avenues for healthcare by acting as a platform with multiple functions.

A Review on In-vivo and In-vitro Models of Obesity and Obesity-Associated Co-Morbidities

BACKGROUND

Obesity is becoming a global pandemic with pandemic proportions. According to the WHO estimates, there were over 1.9 billion overweight individuals and over 650 million obese adults in the globe in 2016. In recent years, scientists have encountered difficulties in choosing acceptable animal models, leading to a multitude of contradicting aspects and incorrect outcomes. This review comprehensively evaluates different screening models of obesity and obesity-associated comorbidities to reveal the advantages and disadvantages/limitations of each model while also mentioning the time duration each model requires to induce obesity.

METHODS

For this review, the authors have gone through a vast number of article sources from different scientific databases, such as Google Scholar, Web of Science, Medline, and PubMed.

RESULTS

In-vivo models used to represent a variety of obesity-inducing processes, such as diet-induced, drug-induced, surgical, chemical, stress-induced, and genetic models, are discussed. Animal cell models are examined with an emphasis on their use in understanding the molecular causes of obesity, for which we discussed in depth the important cell lines, including 3T3-L1, OP9, 3T3-F442A, and C3H10T1/2. Screening models of obesity-associated co-morbidities like diabetes, asthma, cardiovascular disorders, cancer, and polycystic ovarian syndrome (PCOS) were discussed, which provided light on the complex interactions between obesity and numerous health problems.

CONCLUSION

Mimicking obesity in an animal model reflects multifactorial aspects is a matter of challenge. Future studies could address the ethical issues surrounding the use of animals in obesity research as well as investigate newly developed models, such as non-mammalian models. In conclusion, improving our knowledge and management of obesity and related health problems will require ongoing assessment and improvement of study models.

Role of TREM2 in immune and neurological diseases: Structure, function, and implications

Triggering Receptor Expressed on Myeloid Cells 2 (TREM2), a transmembrane receptor initially linked to neurodegenerative diseases, has recently emerged as a key player in conditions such as obesity and cancer. This review explores the structure, function, and mechanisms of TREM2 across these diverse pathological contexts, with a particular focus on its critical roles in immune regulation and neuroprotection. TREM2 primarily modulates cellular activity by binding extracellular ligands, thereby activating downstream signaling pathways and exerting immunomodulatory effects. Additionally, the therapeutic potential of targeting TREM2 is discussed, emphasizing its promise as a future treatment strategy for various diseases.

Malignant solid tumor-related spontaneous intracerebral hemorrhage: a propensity score matching study

Background

Spontaneous intracerebral hemorrhage (sICH) is a severe event with high mortality. Recently, evidence has emerged suggesting that malignant solid tumors may increase the risk of sICH through unique cancer-related factors. However, the specific risk factors and clinical characteristics of sICH in patients with malignant solid tumor remain poorly understood.

Objective

This study aimed to investigate the clinical characteristics of and identify the risk factors associated with sICH in individuals with malignant solid tumors.

Methods

This retrospective study was carried out in patients with active malignant solid tumors and sICH at the First Affiliated Hospital of Guangxi Medical University between January 2010 and December 2020. Patients were separated into control and malignant solid tumor-related spontaneous intracerebral hemorrhage (MST-sICH) groups. The control group consisted of patients presenting with malignant solid tumors alone who were matched to the MST-sICH group using a 1:1 propensity score matching (PSM) approach. Patient clinical data, laboratory findings, and imaging results were collected. Univariate analysis was carried out to determine the risk factors associated with MST-sICH. In addition, a receiver operator characteristic analysis was performed to identify potential predictors for poor prognosis.

Results

Decreased hemoglobin (HGB) levels, together with increased lymphocyte counts (LYCs), and an increased neutrophil-to-lymphocyte ratio (NLR) were found in the MST-sICH group compared to the control group. The results of the multivariate logistic regression analysis indicated a HGB levels (OR: 0.959, 95% CI [0.928-0.992]), an increased in LYCs (OR: 0.095, 95% CI [0.023-0.392]). Furthermore, there was an increased in NLR levels (OR: 2.137, 95% CI [1.427-3.200]). In the receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) with HGB, LYCs, and NLR as joint predictors was 0.955 (95% CI [0.901-1.000]), with a sensitivity of 100%, a specificity of 82.6%, and a Youden Index of 0.826.

Conclusion

Decreased HGB levels, elevated LYCs, and a higher NLR were identified as independent risk factors for sICH in patients with active solid malignancies. These markers could assist clinicians in stratifying high-risk patients, facilitating closer monitoring and informing targeted preventive strategies to mitigate the incidence of sICH in this at-risk population.