Colorectal Cancer: A Review of Carcinogenesis, Global Epidemiology, Current Challenges, Risk Factors, Preventive and Treatment Strategies

An overview of potential of natural compounds to regulate epigenetic modifications in colorectal cancer: a recent update

Colorectal cancer (CRC) remains an alarming global health concern despite advancements in treatment modalities over recent decades. Among the various factors contributing to CRC, this review emphasizes the critical role of epigenetic mechanisms in its pathogenesis and progression. This review also describes the potential role of natural compounds in altering the epigenetic landscape, focused mainly on DNA methylation, histone modification, and non-coding RNAs. Publications from the previous five years were searched and retrieved using well-known search engines and databases like PubMed, Google Scholar, and ScienceDirect. Keywords like CRC/colorectal cancer, CAC/Colitis associated CRC, inflammasomes, epigenetic modulation, genistein, curcumin, quercetin, resveratrol, anthocyanins, sulforaphane, and epigallocatechin-3-gallate were used in various combinations during the search. These natural compounds predominantly affect pathways such as Wnt/β-catenin, NF-κB, and PI3K/AKT to suppress CRC cell proliferation and oxidative stress and enhance anti-inflammation and apoptosis. However, their clinical use is restricted due to their low bioavailability. However, multiple methods exist to overcome challenges like this, including but not limited to structural modifications, nanoparticle encapsulations, bio-enhancers, and novel advanced delivery systems. These methods improve their potential as supportive therapies that target CRC progression epigenetically with fewer side effects. Current research focuses on enhancing epigenetic targeting to control CRC progression while minimizing side effects, emphasizing improved specificity, bioavailability, and efficacy as standalone or synergistic therapies.

The imidazoline I2 receptor agonist 2-BFI enhances cytotoxic activity of hydroxychloroquine by modulating oxidative stress, energy-related metabolism and autophagic influx in human colorectal adenocarcinoma cell lines

Recently, interest in imidazoline receptors (IRs) has been increasing. Over the years, a growing number of studies have highlighted the therapeutic potential of ligands targeting these receptors, however, the potential role of imidazoline I2 receptor agonists in cancer treatment has not been thoroughly investigated. Colorectal cancer (CRC) is among the most prevalent and lethal forms of cancer worldwide. The complexity of CRC necessitates individualized approaches. One promising area of research within CRC therapy is the regulation of autophagy. Recent studies have explored the relationship between autophagy and cancer progression, revealing that autophagy modulation could be a potential strategy for CRC treatment. However, the mechanisms underlying autophagy regulation remain poorly understood. This study aimed to evaluate the effect of the imidazoline I2 receptor agonist, namely 2-(2-benzofuranyl)-2-imidazoline hydrochloride (2-BFI), on colorectal cancer cells, HT-29 and HCT-116 cell lines, particularly its impact when co-incubated with the autophagy inhibitor, hydroxychloroquine (HCQ). The results showed that 2-BFI synergistically increased the cytotoxic effect of HCQ by inducing oxidative stress and apoptosis. Furthermore, our investigation indicated impairment autophagic influx in colon cancer cells treated by 2-BFI. The comprehensive metabolomic analysis revealed significant alterations in key metabolic pathways including MAO activity, oxidative stress responses, energy-related metabolites and amino acids metabolism. Altogether, these findings demonstrate potential a new therapeutic strategy based on autophagy regulation and the selective induction of oxidative stress in colorectal cancer cells. Moreover, this study provides a foundation for further investigation into the therapeutic potential of imidazoline receptor agonists in cancer therapy.

In vitro effects of crocin on the possible anticancer properties of Lactococcus lactis against colorectal adenocarcinoma cells

Probiotics have been suggested to contribute to cancer prevention through various mechanisms. Additionally, recent studies have established a connection between diet, microbiota, and overall health. In this respect, the current study aims to understand the impact of crocin on possible anti-cancer and antibacterial effects of Lactococcus lactis (L. lactis) in colorectal cancer cells and pathogenic bacteria. The study involved collecting cell-free supernatants (CFSs) from untreated bacteria as a control group and bacteria treated with crocin, and then examining their ability to prevent the growth of HCT-116 colon cancer cells. It was demonstrated that L. lactis, when treated with crocin, can effectively combat against various types of pathogenic bacteria and can survive in acidic conditions. Both CFS and cro-CFS exhibited a dose-dependent inhibition of HCT-116 cell growth but crocin-treated bacteria showed more significant effects. The half-maximal inhibitory concentration (IC50) for cell growth inhibition was 97.41 µL/mL in CSF group and 72.07 µL/mL in cro-CFS group. The results of flow cytometry tests confirmed the MTT assay findings, showing that cro-CFS group had a significantly higher rate of apoptosis compared to CFS of control group. The results obtained from qPCR also showed that the Caspase 9 and BAX genes were upregulated, and the BCL-2 expression level was reduced in cells treated with cro-CFS compared to the CFS group. Overall, these findings suggest that crocin may alter the composition of CFS from probiotics that are present in the gut, potentially impacting their ability to combat cancer.

Leveraging machine learning for integrative analysis of T-cell receptor repertoires in colorectal cancer: Insights into MAIT cell dynamics and risk assessment

This study investigates the T-cell receptor (TCR) repertoires in colorectal cancer (CRC) patients by analyzing three distinct datasets: one bulk sequencing dataset of 205 patients with various tumor stages, all newly diagnosed at Sheba Medical Center between 2017 and 2022, with minimal recruitment in 2014 and 2016, and two (public) single-cell sequencing datasets of 10 and 12 patients. Despite the significant variability in the TCR repertoire and the low likelihood of sequence overlap, our analysis reveals an interesting set of TCR sequences across these data. Notably, we observe elevated presence of mucosal-associated invariant T (MAIT) cells in both metastatic and non-metastatic patients. Furthermore, we identify nine identical TCR alpha and TCR beta pairs that appear in both single-cell datasets, with 13 out of 18 sequences from these sequences also appearing in the bulk data. Clinical risk analysis over the bulk dataset, using a subset of these unique sequences, demonstrates a correlation between TCR repertoire disease stage and risk. These findings enhance our understanding of the TCR landscape in CRC and underscore the potential of TCR sequences as biomarkers for disease outcome.

Optimizing prediction of metastasis among colorectal cancer patients using machine learning technology

BACKGROUND AND AIM

Colorectal cancer is among the most prevalent and deadliest cancers. Early prediction of metastasis in patients with colorectal cancer is crucial in preventing it from the advanced stages and enhancing the prognosis among these patients. So far, previous studies have been conducted to predict metastasis in colorectal cancer patients using clinical data. The current research attempts to leverage a combination of demographic, lifestyle, nutritional, and clinical factors, such as diagnostic and therapeutical factors, to construct an ML model with more predictive insights and generalizability than previous ones.

MATERIALS AND METHODS

In this retrospective study, we used 1156 CRC patients referred to the Masoud internal clinic in Tehran City from January 2017 to December 2023. The chosen machine learning algorithms, including LightGBM, XG-Boost, random forest, artificial neural network, support vector machine, decision tree, K-Nearest Neighbor and logistic regression, were utilized to establish prediction models for predicting metastasis among colorectal cancer patients. We also assessed features based on the best-performing model to improve clinical usability. To show the generalizability of the established prediction model for predicting CRC metastasis, we leveraged the data of 115 CRC patients from Imam Khomeini Hospital in Sari City. We assessed the predictive ability of LightGBM as the best-performing model based on external data.

RESULTS

The LightGBM model with a PPV of 97.32%, NPV of 84.67%, sensitivity of 83.14%, specificity of 93.14%, accuracy of 88.14%, F1-score of 87.51%, and an AU-ROC of 0.9 [Formula: see text]0.01 obtained satisfactory performance for prediction purposes on this topic. Factors including the history of IBD, family history of CRC, number of lymph nodes involved, fruit intake, and tumor size were considered as more strengthful predictors for metastasis in colorectal cancer and clinical usability. The external validation cohort showed a PPV of 0.8, NPV of 0.85, sensitivity of 0.78, specificity of 0.86, accuracy of 0.834, F1-score of 0.795, and AU-ROC of 0.77[Formula: see text]0.03, demonstrating satisfactory generalizability when leveraging external data from other clinical settings.

CONCLUSION

The current empirical results indicated that LighGBM has predictive competency that can be leveraged by physicians in clinical environments for early prediction of metastasis and enhanced prognosis in patients with colorectal cancer.

CLINICAL TRIAL NUMBER

Not applicable.

A novel tubulin inhibitor, No.07, shows anti-cancer and anti-metastatic effects in colon cancer and tumoroids

Colorectal cancer is a highly metastatic disease and the second leading cause of cancer-related death worldwide. Despite the use of various treatment strategies, including chemotherapy and targeted therapy, challenges such as toxicity, drug resistance, and poor response indicate the critical need for new therapeutic agents. Microtubule target agents are one of the major treatment options for chemotherapy in various cancer patients. However, most of these agents are substrates of the MDR1 protein, which leads to the development of multidrug resistance, significantly limiting their effectiveness. Therefore, the development of new drugs is being actively pursued. In this study, we synthesized a novel compound, No.07, which demonstrates significant anti-cancer activity in 3D spheroid models, patient-derived colon cancer organoid models, and mice xenograft models. No.07 directly binds to tubulin dimers, interfering with microtubule polymerization and thereby disrupting tubulin dynamics, ultimately inducing mitotic arrest. Furthermore, No.07 increases mitochondria reactive oxygen species level, leading to the inactivation of the RAF-MEK-ERK signaling cascade, which consequently inhibits metastasis. Notably, Swiss ADME predictions suggest that No.07 is not a substrate of MDR1 and can cross the blood-brain barrier, unlike other microtubule target agents that are limited by MDR1-mediated drug resistance and poor brain penetration. Additionally, experiments using multidrug-resistant cell lines confirmed that No.07 effectively overcomes multidrug resistance, providing a significant improvement over traditionally used chemotherapy agents. In conclusion, No.07 has the potential to address the limitations of existing treatments as a novel therapeutic option.

Qualitative insights into ecobiosocial factors influencing colorectal cancer risk in Malaysia

Introduction

Colorectal cancer (CRC) is a growing public health concern in Malaysia influenced by a complex interplay of ecological, biological, and social (EBS) factors. Despite its increasing incidence, limited research has explored how these factors interact to shape CRC risk in the Malaysian context, especially from the perspectives of affected individuals. This study explores Malaysians' perceptions and experiences regarding CRC risk within the EBS framework.

Methods

A qualitative case study approach involved in-depth interviews with twelve Malaysians aged 35-75 who had undergone colonoscopy at a university hospital. All interviews were recorded and transcribed. Data were collected until saturation was achieved. The transcripts were coded and analysed using ATLAS.ti software. The data were analysed using thematic analysis.

Results

Findings revealed key themes related to ecological factors in the physical activity environment, which included the sub-themes of type, facilitators, barriers to physical activity, and food sources. The biological factors theme revealed that a family history of CRC influences experience and perception. The subthemes of social factors were sociocultural customs, misconceptions, food preparation methods, CRC-related foods, and food affordability.

Conclusion

The findings highlighted the multifactorial nature of CRC risk. Understanding the aspects of EBS supports the development of targeted public health interventions to address modifiable CRC risk factors and promote prevention and early CRC detection in the Malaysian context.

Advancing cancer therapy: Mechanisms, efficacy, and limitations of calcium electroporation

Calcium electroporation, an innovative technique, uses high-voltage pulses to introduce calcium ions into cells, leading to cell death and tumor growth inhibition. This review explores the potential of calcium electroporation as a promising therapeutic approach in cancer treatment. We provide an in-depth analysis of the underlying mechanisms by which calcium ions function within cells and how their introduction through electroporation can effectively induce cell death in cancer cells. Furthermore, we present a comprehensive overview of the current literature, covering both preclinical and clinical studies, to highlight the safety and efficacy of calcium electroporation in various cancer types, including melanoma, head and neck cancer, and breast cancer. We also discuss the distinct advantages of calcium electroporation over traditional cancer therapies, such as its specific targeting of cancer cells while sparing healthy cells. However, we also address the challenges and limitations associated with this technique, underscoring the need for further research. By providing a comprehensive examination of calcium electroporation, this review aims to contribute to understanding this emerging field and encourage further investigation into its potential as a novel cancer treatment strategy.

Association between red and processed meat consumption and colorectal cancer risk: a comprehensive meta-analysis of prospective studies

Increasing evidence suggests that red and processed meat consumption may elevate the risk of colorectal cancer (CRC), yet the magnitude and consistency of this association remain debated. This meta-analysis aims to quantify the relationship between red and processed meat intake and the risk of CRC, colon cancer, and rectal cancer using the most comprehensive set of prospective studies to date. We conducted a comprehensive search in PubMed, Web of Science, Cochrane Library, Embase, and Google Scholar databases from 1990 to November 2024, to identify relevant prospective studies examining red, processed, and total meat consumption in relation to colorectal, colon, and rectal cancer risk. Hazard ratios (HR) and 95% confidence intervals (CI) were extracted for each study and pooled using a random-effects model to account for variability among studies. Statistical evaluation was executed using the online platform MetaAnalysisOnline.com. A total of 60 prospective studies were included. Red meat consumption was associated with a significantly increased risk of colon cancer (HR = 1.22, 95% CI 1.15-1.30), colorectal cancer (HR = 1.15, 95% CI 1.10-1.21), and rectal cancer (HR = 1.22, 95% CI 1.07-1.39). Processed meat consumption showed similar associations with increased risk for colon cancer (HR = 1.13, 95% CI 1.07-1.20), colorectal cancer (HR = 1.21, 95% CI 1.14-1.28), and rectal cancer (HR = 1.17, 95% CI 1.05-1.30). Total meat consumption also correlated with an elevated risk of colon cancer (HR = 1.22, 95% CI 1.11-1.35), colorectal cancer (HR = 1.17, 95% CI 1.12-1.22), and rectal cancer (HR = 1.28, 95% CI 1.10-1.48). This meta-analysis provides robust evidence that high consumption of red and processed meats is significantly associated with an increased risk of colorectal, colon, and rectal cancers. These findings reinforce current dietary recommendations advocating for the limitation of red and processed meat intake as part of cancer prevention strategies.

Identification of a PANoptosis-related long noncoding rna risk signature for prognosis and immunology in colon adenocarcinoma

BACKGROUND

PANoptosis, a complex programmed cell death (PCD) pathway that includes apoptosis, pyroptosis and necroptosis, is significantly involved in the progression of cancers. Long noncoding RNAs (lncRNAs) play crucial roles in PCD. However, the predictive value of PANoptosis-related lncRNAs (PRlncRNAs) for colon adenocarcinoma (COAD) has not been established.

METHODS

Gene expression data and clinical characteristics of patients with COAD were obtained from The Cancer Genome Atlas database. Differential expression analysis and Pearson correlation analysis were used to identify PRlncRNAs. In addition to least absolute shrinkage and selection operator, univariate and multivariate Cox regression analyses were employed to obtain PRlncRNAs for constructing a risk signature. Patients with COAD in the training set, testing set and entire set were stratified into high- and low-risk groups for further comparison of survival prognosis, using the median risk score as the cut-off point. Time-dependent receiver operating characteristic curves, a nomogram and multivariate Cox regression analysis were conducted to validate the risk signature in the testing set and the entire set. In addition, critical pathways, immune infiltration cells, immune checkpoint-related genes, Tumor Immune Dysfunction and Exclusion (TIDE) scores and antitumour drugs were compared between the two risk groups in the entire set. Correlations between ferroptosis, cuproptosis, disulfidptosis and the PRlncRNA risk score were evaluated. Finally, a competitive endogenous RNA (ceRNA) network was established, and enrichment analysis of the predicted mRNAs was performed using Gene Ontology (GO) analysis. The Kaplan-Meier plotter database was used as an external database to confirm the accuracy of the risk signature in predicting patient prognosis. Additionally, small interfering RNA (siRNA), a cell counting kit- 8 assay, a cell colony formation assay, quantitative polymerase chain reaction (qPCR) and an apoptosis assay were further employed to investigate the roles of AP003555.1 in colon cancer.

RESULTS

A risk signature comprising four PRlncRNAs (LINC01133, FOXD3-AS1, AP001066.1, and AP003555.1) was developed to predict the prognosis of patients with COAD. Kaplan‒Meier curves demonstrated significant differences in prognosis between the high- and low-risk groups across the three sets. Multivariate Cox regression analysis confirmed that the risk signature was an independent prognostic factor across the three sets. A nomogram, receiver operating characteristic curves and calibration curves indicated strong confidence in the risk signature. Using the CIBERSORT algorithm and gene set enrichment analysis, variations in infiltrating immune cells and immune processes were observed between the two risk groups. Furthermore, TIDE algorithm suggested that the high-risk group exhibited a lower risk of immunotherapy escape and better immunotherapy outcomes than the low-risk group. Distinct responses to various antitumour drugs were observed between the two risk groups. Additionally, we constructed a ceRNA network based on PRlncRNAs, and GO enrichment analysis of the predicted mRNAs revealed different functions. In addition, the results of the Kaplan‒Meier plotter database revealed that patients who exhibited high levels of LINC01133 and FOXD3-AS1 experienced significantly shorter overall survival than those with low levels of these lncRNAs. Specifically, in terms of functionality, AP003555.1 was found to be highly expressed in colon cancer tissue and promoted viability and proliferation while suppressing the apoptosis of colon cancer cells.

CONCLUSION

We identified a novel risk signature consisting of four PRlncRNAs, which is an independent prognostic indicator for patients with COAD. This PRlncRNA risk signature is potentially relevant for immunotherapy and could serve as a therapeutic target for COAD.

Knowledge, attitudes, and practices toward colorectal cancer lifestyle risk factors among adults in Saudi Arabia

Background

Despite an apparent increase in early-onset colorectal cancer (CRC) in Saudi Arabia, with the majority of patients being diagnosed at an advanced disease stage, no previous assessment of the knowledge, attitudes, and practices (KAP) toward its dietary and lifestyle-related risk factors has been reported. The aim of this study was to investigate the KAP levels with respect to these risk factors for CRC and examine possible associations between the studied variables among the Saudi population.

Methods

This cross-sectional study involved 1,040 participants aged 18 years or older. Data were collected by convenience sampling via a self-administered online questionnaire in Saudi Arabia between June and December 2023.

Results

A majority of participants (77.8%) displayed low knowledge about the dietary and lifestyle-related risk factors for CRC, while only 22.2% possessed high knowledge. Similarly, 78.6% of participants exhibited negative attitudes toward these risk factors, with just 21.4% having positive attitudes. Furthermore, 75.0% of participants reported engaging in poor practices, leaving only 25.0% demonstrating good practices related to CRC risk factors.

Conclusions

The findings of this study indicate insufficient KAP levels toward dietary and lifestyle-related risk factors for CRC in Saudi Arabia, highlighting the urgent need for nationwide initiatives and programs to promote improved knowledge, attitudes, and practices and reduce the effect of the risk factors contributing to CRC.

Gut microbiota protect against colorectal tumorigenesis through lncRNA Snhg9

The intestinal microbiota is a key environmental factor in the development of colorectal cancer (CRC). Here, we report that, in the context of mild colonic inflammation, the microbiota protects against colorectal tumorigenesis in mice. This protection is achieved by microbial suppression of the long non-coding RNA (lncRNA) Snhg9. Snhg9 promotes tumor growth through inhibition of the tumor suppressor p53. Snhg9 suppresses p53 activity by dissociating the p53 deacetylase sirtuin 1 (SIRT1) from the cell cycle and apoptosis regulator 2 (CCAR2). Consequently, the depletion of the microbiota by antibiotics causes upregulation of Snhg9 and accelerates CRC progression. Moreover, Snhg9 is functionally conserved. Human SNHG9 promotes tumor growth via the same mechanism as mouse Snhg9, despite their low sequence similarity.

Polymer-lipid hybrid microcarriers for oral codelivery of paclitaxel and tributyrin: development, optimization, and cytotoxicity in cells and spheroids of colorectal cancer

Colorectal cancer (CRC) is the third most frequent cancer worldwide. Despite advances in treatment, conventional chemotherapy suffers from severe side effects and limited drug selectivity, highlighting the importance of alternative therapies. In this study, a polymer-lipid hybrid microcarrier was developed for oral co-administration of paclitaxel (PTX) and tributyrin (TB) as a novel approach for CRC therapy. The microcarrier was designed with a pH-sensitive polymeric shell that encapsulates drug-loaded nanostructured lipid carriers (NLC); shell dissolution at intestinal pH enables localized release of the NLC. The methodological approach employed an emulsion of vegetable oil and NLC as a template for polymer deposition. Multiple parameters were optimized, including polymers ratios, NLC dilution, acid concentration, and sonication time. Spherical hybrid particles with smooth surface and mean size of 1000 nm were obtained; PTX encapsulation efficiency was 99.9 ± 0.2 %, with a production yield of 97.2 ± 0.08 %. Drug release followed the Korsmeyer-Peppas kinetic model. Cytotoxic evaluation in human colorectal adenocarcinoma HCT-116 monolayers showed that PTX encapsulation increased cytotoxicity, lowering IC50 to 83.7 nM compared to 199.5 nM for free PTX. The addition of TB further improved cytotoxicity, reducing the IC50 to 60.8 nM. A similar potentiation cytotoxicity was observed in spheroids. The microcarrier induced reductions in colony formation, alterations in cell cytoskeleton, and led to a significant reduction in P-glycoprotein expression compared to its free form, suggesting its potential to help to overcome drug resistance. These results point to the promising applicability of the hybrid microcarrier as an innovative delivery system for oral administration of cytotoxic agents.

Blocking lncRNA NOP14-AS1 overcomes 5-Fu resistance of colon cancer cells by modulating miR-30a-5p-LDHA-glucose metabolism pathway

Colorectal cancer (CRC) is a malignant digestive tumor associated with high mortality rate. Currently, 5-Fu therapy is a frequently used treatment approach for CRC. Yet, acquirement of 5-Fu resistance ultimately leads to therapeutic failure in CRC patients. LncRNA NOP14-AS1 was upregulated in cancers, but its biological functions and mechanisms in 5-Fu resistant colorectal cancer remain elusive. We discovered that NOP14-AS1 was high-expressed in colorectal tumors and cancer cells. Silencing NOP14-AS1 sensitized CRC cells to 5-Fu. By creating a 5-Fu resistant CRC cell line (HT-29 5-Fu R) and observed that expression of NOP14-AS1 was remarkedly elevated in 5-Fu resistant cells compared to parental cells. Additionally, we found that miRNA-30a-5p was a target of NOP14-AS1 and directly affected its function. miR-30a-5p overexpression sensitized CRC cells to 5-Fu treatment and targeted the glycolysis key enzyme, LDHA. Rescue experiments showed that restoring LDHA in CRC cells which were overexpressing miR-30c-5p successfully overridden 5-Fu resistance. Importantly, restoring miR-30a-5p in NOP14-AS1-overexpressing cells effectively restored 5-Fu sensitivity in HT-29 5-Fu R cells by targeting the LDHA-mediated glucose metabolism. In summary, our results revealed that lncRNA NOP14-AS1 promotes 5-Fu resistance by mediating the miR-30a-5p-LDHA axis.

Dynamic spectrum-driven hierarchical learning network for polyp segmentation

Accurate automatic polyp segmentation in colonoscopy is crucial for the prompt prevention of colorectal cancer. However, the heterogeneous nature of polyps and differences in lighting and visibility conditions present significant challenges in achieving reliable and consistent segmentation across different cases. Therefore, this study proposes a novel dynamic spectrum-driven hierarchical learning model (DSHNet), the first to specifically leverage image frequency domain information to explore region-level salience differences among and within polyps for precise segmentation. A novel spectral decoupler is advanced to separate low-frequency and high-frequency components, leveraging their distinct characteristics to guide the model in learning valuable frequency features without bias through automatic masking. The low-frequency driven region-level saliency modeling then generates dynamic convolution kernels with individual frequency-aware features, which regulate region-level saliency modeling together with the supervision of the hierarchy of labels, thus enabling adaptation to polyp heterogeneous and illumination variation simultaneously. Meanwhile, the high-frequency attention module is designed to preserve the detailed information at the skip connections, which complements the focus on spatial features at various stages. Experimental results demonstrate that the proposed method outperforms other state-of-the-art polyp segmentation techniques, achieving robust and superior results on five diverse datasets. Codes are available at https://github.com/gardnerzhou/DSHNet.

Mitochondria-targeted photothermal-chemodynamic therapy enhances checkpoint blockade immunotherapy on colon cancer

Immunotherapy has emerged as a hotspot for cancer treatment. However, the response rate of monotherapy remains relatively low in clinical settings. Photothermal therapy (PTT), which employs light energy to ablate tumors, can also activate tumor-specific immune responses. This effect has been attributed in several studies to the release of damage-associated molecular patterns (DAMPs) triggered by mitochondrial injury. We propose that mitochondria-targeted PTT may better synergize with immunotherapy. Herein, we constructed a multifunctional nanoplatform that enables mitochondria-targeted photothermal-chemodynamic combination therapy by conjugating indocyanine green-thiol (ICG-SH) and mercaptoethyl-triphenylphosphonium (TPP-SH) onto polyvinyl pyrrolidone (PVP)-coated gold-copper nanoparticles (AIT). Upon near-infrared light (NIR) irradiation, AIT ablates cancer cells and amplifies the effect of chemodynamic therapy (CDT), thereby inducing apoptosis in the tumor. The combination of CDT and PTT promotes immunogenic cell death, which could synergize with checkpoint blockade immunotherapy. In a bilateral mouse colon cancer model, we observed complete eradication of light-irradiated primary tumors and significant inhibition of distant untreated tumors in the group treated with AIT plus anti-PD-1 (αPD-1). We found a significant increase in serum levels of pro-inflammatory factors, including interleukin-6 (IL-6), interferon-γ (IFN-γ), and tumor necrosis factor-α (TNF-α), following PTT/CDT/immunotherapy treatment, suggesting effective activation of the immune response. The enhanced immunogenicity caused by AIT with αPD-1 treatment resulted in efficient antigen presentation, as indicated by the increased infiltration of dendritic cells (DCs) into the tumor-draining lymph nodes (LNs). We also observed enhanced infiltration of CD8+ T cells in distant tumors in the AIT with αPD-1 group compared to αPD-1 alone. Hence, mitochondria-targeting represents an effective strategy to potentiate the combination of photothermal, chemodynamic, and immune checkpoint blockade therapies for the treatment of metastatic cancer.

Mechanistic insights into SENP1 and OCT4 interaction in promoting drug resistance and stem cell features in colon cancer

This study explores the molecular mechanism by which sentrin/SUMO-specific protease 1 (SENP1) promotes cisplatin (Cis) resistance and tumor stem cell characteristics in colon adenocarcinoma (COAD) through deSUMOylation-mediated modification of octamer-binding transcription factor 4 (OCT4). By analyzing single-cell and transcriptome sequencing datasets, we identified key genes and regulatory pathways in both resistant and sensitive COAD cells. Malignant cells were isolated and evaluated for stemness using the infercnv package, and differential genes between Cis-resistant and -sensitive groups were identified. Machine learning algorithms highlighted essential genes, and databases predicted interaction sites between OCT4 and SENP1. In vitro experiments using enriched HCT116 stem cells revealed that SENP1 and OCT4 expression significantly elevated CD44 and CD133 levels, enhancing stemness. Functional assays showed that SENP1's deSUMOylation of OCT4 intensified Cis resistance, migration, and invasion in cisplatin-resistant cell line 116 (Cis-116) cells. In vivo, SENP1 knockdown reduced tumor growth and stem cell markers, whereas OCT4 overexpression escalated tumor metastasis and structural damage. These findings demonstrate that SENP1's modulation of OCT4 is central to COAD's resistance and stem cell properties, offering a novel target for COAD therapy.NEW & NOTEWORTHY This study uncovers the critical role of SENP1 in regulating OCT4 through deSUMOylation, driving Cis resistance and tumor stemness in COAD. Targeting this pathway may provide novel therapeutic strategies for COAD management.

Risk Model for Predicting Gaps in Surgical Oncology Care Among Patients With Stage I-III Rectal Cancer From KwaZulu-Natal, South Africa

PURPOSE

Gaps in surgical oncology care (GISOC), including delayed or nonreceipt of surgery, are detrimental to cancer control. This research sought to develop a risk model for predicting GISOC in South African rectal cancer (RC) patients with localized disease.

METHODS

This retrospective cohort study analyzed data from an existing colorectal cancer patient registry. GISOC was defined as surgery received >62 days after diagnosis with stage I-III RC or nonreceipt of surgery for stage I-III RC. Patient demographics, comorbidity, disease staging, and neoadjuvant therapy receipt were included as covariates in the analysis. A supervised logistic regression machine learning algorithm was used to train and test an appropriate risk model, which was translated into a nomogram. Receiver operating characteristic curve analyses and AUC assessments were used to establish the nomogram's performance.

RESULTS

The analysis included 490 patients (training data set = 245, testing data set = 245). Overall, there were 242 patients who experienced GISOC (49.4%), of whom 33 (13.6%) did not receive surgery and 209 (86.4%) had a delay in receiving surgery. The trained risk model consisted of patient race (Indian, odds ratio [OR] = 0.24; White, OR = 0.23; v Black), comorbidity (OR = 2.29 v no comorbidity), and neoadjuvant therapy receipt (OR = 18.40 v nonreceipt). AUCs for the risk model were >0.800.

CONCLUSION

An accurate, setting-specific risk model and nomogram was developed for predicting GISOC in patients with RC. The nomogram can be implemented without the use of technology to identify patients at high risk for GISOC, who can then be targeted with risk-reduction interventions. The impact of the nomogram on existing surgical unit workflows requires further investigation.

Clinical Prediction Models for Contact X-Ray Brachytherapy in Managing Rectal Cancers: A Scoping Review

BACKGROUND

Currently, there are no clinically predictive models that can prognosticate the response of rectal cancers to Contact X-ray brachytherapy (CXB). This review aims to critically evaluate existing models that have attempted to predict the response of rectal cancer to external beam radiotherapy, with the objective of laying the foundation for the development of a CXB-specific prediction model.

METHODS

A random-effects meta-analysis was employed to calculate pooled estimates of the discriminative ability of published models. Using the Prediction Model Risk Of Bias Assessment Tool (PROBAST), each model was evaluated for its risk of bias and applicability. Additionally, the frequency of commonly utilised predictive factors was documented.

RESULTS

Twelve papers discussed fifteen models based on pre-treatment factors. Models predicting response based on the Tumour regression grade (TRG) classified responders as patients who achieved a complete response or near complete response and achieved a pooled AUC of 0.82 (95% CI 0.74-0.89). Models that predicted pathologic complete response (pCR) had a pooled AUC of 0.76 (95% CI 0.71-0.82). The most utilised predictive parameters were age, tumour grade and T stage. However, these models were prone to significant risk of bias and had limited applicability to the general population.

CONCLUSIONS

Although the existing models were statistically robust, they lacked broad applicability. This was primarily due to a lack of external validation, which limits their clinical utility. A future CXB-specific model should prioritise dedicated data collection based on pre-calculated sample size and include the predictive factors identified in this review.

Development and validation of nomograms for predicting the prognosis of colorectal cancer patients

Background

Accurate prognosis prediction is essential in colorectal cancer (CRC) for guiding treatment decisions, yet the traditional tumor-node-metastasis (TNM) staging system often lacks precision. This study aimed to develop improved prognostic tools for CRC patients.

Methods

Prognostic nomogram models were developed using data from 2,435 CRC patients who underwent curative resection. Parameters were selected via least absolute shrinkage and selection operator (LASSO) regression to include overall survival (OS) and disease-free survival (DFS) nomograms. The performance of these nomograms was evaluated against the TNM staging system using ROC analysis, calibration curves, and decision curve analysis (DCA).

Results

Critical prognostic factors identified included tumor invasion depth, distant metastasis, tumordifferentiation grade, extranodal tumor deposits (ENTD), R1 resection, and log odds of positive lymph nodes (LODDS). The OS nomogram demonstrated area under the curve (AUC) values of 0.786, 0.776, and 0.803 for predicting 1-, 3-, and 5-year survival, respectively, compared to 0.768, 0.750, and 0.782 for TNM staging. The DFS nomogram predicted 1-, 3-, and 5-year DFS with AUCs of 0.764, 0.777, and 0.789, respectively, compared to 0.762, 0.761, and 0.770 for TNM staging. Calibration plots indicated strong predictive capabilities, and DCA confirmed greater net benefits over TNM staging.

Conclusions

Our developed prognostic nomogram models offer enhanced accuracy over traditional TNM staging in predicting CRC prognosis. Integrating these models into clinical practice can potentially improve personalized treatment strategies for postoperative CRC patients, enhancing overall clinical outcomes.

Apelin/APJ: Another Player in the Cancer Biology Network

The apelinergic system exerts multiple biological activities in human pathologies, including cancer. Overactivation of apelin/APJ, which has been detected in many malignant tumors, and the strong correlation with progression-free and overall survival, suggested the role of an oncogene for the apelin gene. Emerging evidence sheds new light on the effects of apelin on cellular functions and homeostasis in cancer cells and supports a direct role for this pathway on different hallmarks of cancer: "sustaining proliferative signaling", "resisting cell death", "activating invasion and metastasis", "inducing/accessing vasculature", "reprogramming cellular metabolism", "avoiding immune destruction" and "tumor-promoting inflammation", and "enabling replicative immortality". This article reviews the currently available literature on the intracellular processes regulated by apelin/APJ, focusing on those pathways correlated with tumor development and progression. Furthermore, the association between the activity of the apelinergic axis and the resistance of cancer cells to oncologic treatments (chemotherapy, immunotherapy, radiation) suggests apelin/APJ as a possible target to potentiate traditional therapies, as well as to develop diagnostic and prognostic applications. This issue will be also covered in the review.

Sprayed hyaluronic acid based multidrug composite hydrogel for postoperative colorectal cancer ultra-efficient long-lasting multi-stage immuno-chemo synergistic therapy

To enhance the therapeutic efficacy of postoperative colorectal cancer treatment and prevent peritoneal metastasis, we propose a strategy utilizing the photothermal-induced ultra-efficient and long-lasting multi-stage immuno-chemo synergistic therapy. To implement this strategy, oxaliplatin (OXA), curcumin (Cur), and Mn2+ were coordinated to form infinite coordination polymer nanoparticles (OXA-Mn(II)-Cur ICP NPs). These nanoparticles are encapsulated with polydopamine (PDA) to create OXA-Mn(II)-Cur ICP@PDA NPs, which are subsequently embedded in a sprayable hyaluronic acid-based hydrogel. The resulting ICP@PDA NPs@composite hydrogel exhibits strong tissue adhesion and segmented pH-responsive drug release properties. Notably, the hydrogel can sustainably release drugs for over 20 days in vivo, maximizing local drug concentration while minimizing systemic toxic side effects. Each component of the composite hydrogel serves multiple functions, and its application to postoperative tumor sites enables long-term, dual-pathway, multi-stage immune activation. This immune response synergizes with chemotherapy to achieve a highly effective therapeutic outcome. In vivo experiments demonstrated that the composite hydrogel effectively eliminates residual tumors, ensuring a 100% survival rate without recurrence for 80 days in treated mice. Furthermore, it inhibits peritoneal metastasis and completely eradicates intraperitoneal tumors within 20 days. The ICP@PDA NPs@composite hydrogel represents a promising therapeutic platform for postoperative colorectal cancer treatment and metastasis prevention.

Pathological expression of mitochondrial genome-derived circRNA SCAR/mc-COX2 and its ceRNA network in colorectal cancer: implications for clinical significance

BACKGROUND

Mitochondrial-encoded circular RNAs (mecciRNAs) are a newly discovered class of mitochondrial-encoded non-coding RNAs (mt-ncRNAs) that play important biological roles in the cell. This study aimed to examine the expression profile of SCAR/mc-COX2 (has_circ_0089762) in colorectal cancer (CRC) and its relationship with clinicopathological variables. Furthermore, to better understand SCAR/mc-COX2's functional role in CRC, we constructed a competing endogenous RNA (ceRNA) network.

METHODS

Quantitative real-time PCR (qRT-PCR) was employed to analyze the expression levels of SCAR/mc-COX2 in 40 pairs of CRC samples, consisting of 40 tumor samples and 40 adjacent non-tumoral samples from patients. The ceRNA regulatory network was constructed using online bioinformatics tools. Furthermore, the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis and Gene Ontology (GO) enrichment analysis were conducted using the Enrichr database.

RESULTS

The results demonstrated a significant decrease in SCAR/mc-COX2 expression in tumor tissues compared to adjacent non-tumoral tissues (p-value<0.05). In another finding, a significant relationship was observed between pathological T staging and the expression status of SCAR/mc-COX2 (p-value=0.02). Additionally, the Receiver Operating Characteristic (ROC) curve analysis revealed that SCAR/mc-COX2 had an area under the curve (AUC) of 0.77, with 80% sensitivity and 75% specificity. Finally, a ceRNA regulatory network including SCAR/mc-COX2, 5 miRNA, and 9 mRNAs was found.

CONCLUSION

These findings suggest that SCAR/mc-COX2 may act as a tumor suppressor in CRC, and its dysregulation could play a crucial role in the pathophysiology of this cancer. The significant association with pathological T staging and its robust diagnostic performance (AUC = 0.77, sensitivity = 80%, specificity = 75%) highlight its potential as a novel biomarker for CRC detection and prognosis. Further functional studies are required to elucidate its precise role in CRC tumorigenesis and clinical applicability.

Early Detection and Age-Comparative Analysis of Colorectal Cancer Screening: Insights from the Turkish Population

BACKGROUND

This study aimed to evaluate the diagnostic yield of colonoscopy in asymptomatic individuals aged 45-49 years compared with those aged 50-54 years in a Turkish population, providing insights into region-specific screening strategies.

METHODS

This retrospective multicenter study was conducted across three tertiary endoscopy units in Turkey. Screening colonoscopy data from 3943 asymptomatic individuals aged 45-54 years between 2018 and 2023 were analyzed. The patients were stratified into two groups: 45-49 years (Group 1) and 50-54 years (Group 2). Demographic characteristics, polyp size, histological features, and prevalence of early-onset advanced colorectal neoplasia (EAO-aCRN) were assessed.

RESULTS

A total of 3943 patients were included, with 862 in Group 1 (45-49 years) and 3081 in Group 2 (50-54 years). The polyp detection rate was 16.6% in Group 1 and 22.9% in Group 2 (p < 0.001). The adenoma detection rates were 10.8% and 13.9% in Groups 1 and 2, respectively (p = 0.018). The advanced polyp detection rates were 3.2% and 7.3% in Groups 1 and 2, respectively (p < 0.001). Mean polyp size was 6.5 ± 5.1 mm in Group 1 and 8.8 ± 8.4 mm in Group 2 (p < 0.001). The mean number of polyps per patient was 1.5 ± 0.8 in Group 1 and 1.9 ± 1.6 in Group 2 (p = 0.023). Advanced neoplasia was detected in 16.6% of Group 1 patients compared with 22.9% of Group 2 patients (p < 0.001).

CONCLUSIONS

While CRC screening at age 45 demonstrated lower detection rates of polyps and advanced neoplasia than at age 50, the higher prevalence of EAO-CRN among 45-49-year-olds in Turkey underscores the importance of early screening in high-risk populations. Tailored regional strategies incorporating individual risk factors are crucial for optimizing CRC prevention policies.

Mechanism of Guishao Yigong decoction in treating colorectal cancer based on network pharmacology and experimental validation

OBJECTIVES

To explore the effective components of Guishao Yigong decoction (GYD) in the treatment of colorectal cancer and reveal its potential mechanism of action.

METHODS

Through network pharmacology, the main target and signaling pathway of GYD therapy for colorectal cancer (CRC) were found. Subsequently, the effect of GYD was verified by in vitro cell viability measurements, colony formation, and scratch healing tests. The effects of GYD on metabolic pathways in vivo were found through plasma metabolomics. Finally, flow cytometry and qPCR experiments were used to verify the cycle-blocking effect of GYD on CRC cells.

KEY FINDINGS

Based on the network pharmacological analysis and molecular docking technology, it was found that GYD could restrain the growth of CRC cells by affecting lipid metabolic pathways and mitogen-activated protein kinase (MAPK) signaling pathways. A series of cell experiments showed that GYD could inhibit the proliferation, migration and clonogenic ability of CRC cells. Furthermore, the plasma metabolomics results showed that GYD could affect the production of unsaturated fatty acids in mice. Flow cytometry and qPCR experiments further proved that GYD blocked the CRC cells in the G1 phase and modulated the expression of cell cycle-related targets, such as AKT, TP53, CDKN1A, and CDK2.

CONCLUSIONS

All the results indicated that GYD could regulate the related metabolism of unsaturated fatty acids. Thus, the cell cycle was blocked and the expressions of the key proteins such as AKT and TP53 were regulated, which achieved the purpose of intervention in colorectal cancer.

Virtual Colonoscopy: Retrospective Comparison of the Findings in Supine and Prone Positions

BACKGROUND

Early detection of colorectal cancer (CRC) is significantly associated with reduced morbidity and mortality. Virtual colonoscopy (VC) is a minimally invasive, safe and well-tolerated alternative procedure to traditional colonoscopy. Therefore, we aimed to evaluate the findings of VC particularly in supine and prone positions as well as to contribute to the practical challenges of procedure.

METHODS

Total number of 20 patients who underwent VC were included in this retrospective study. After proper bowel cleansing was achieved, intestinal dilatation was performed by injecting air into the rectum. Two different shots were performed in the supine and prone positions. Additionally, intestinal diameters were measured from the cecum to the rectum at their widest point via 2-dimensional coronal reformat.

RESULTS

Polyps were detected in 3 patients which were confirmed by optical colonoscopy. The mean cecum diameter was detected as the largest diameter in the supine and prone examinations. In both supine and prone examinations, the distal descending colon was the most challenging site. Additionally, the mean descending colon diameter calculated in the prone position (40.9 ± 6.4 mm) was found to be statistically larger than descending colon diameter calculated in the supine position (36.1 ± 5.3 mm) (P = 0.001).

CONCLUSIONS

Our findings clearly demonstrated that combination of prone and supine scanning provides clear field of vision on narrow parts of the colon which improves accurate estimation for polyp detection. Furthermore, VC appears to be more comfortable, safe, fast, and cost-efffective procedure for CRC screening with advantages of low radiation exposure, extracolonic findings and lack of sedation requirements.

Evaluation of active substances in gamboge and their mechanisms for the treatment of colorectal cancer by UPLC-MS/MS integrated with network pharmacology

Gamboge exhibits anti-colorectal cancer (CRC) activity, however, its active compounds and the underlying mechanisms remain unclear. Herein, a liquid chromatography tandem mass spectrometry (UPLC-MS/MS) method for determining gambogellic acid, β-morellic acid, isogambogenic acid, gambogenic acid, R-gambogic acid, S-gambogic acid, and hydroxygambogic acid in gamboge was established. The key parameters including ion transitions, voltages, LOD, and LOQ were determined, with LOD ranging from 0.8 to 2.0 ng mL-1 and LOQ from 2.7 to 6.7 ng mL-1. The recovery rates were found to be between 95.6 % and 103.5 %. Furthermore, the active compounds were successfully determined, and molecular mechanisms of gamboge in treating CRC were explored. Network pharmacology revealed a "compound-target-pathway" network where the seven compounds could target key proteins, modulate PI3K-Akt and JAK-STAT pathways, and inhibit CRC development. Molecular docking validated SRC, SATA3, PIK3CA, among others, as potential targets for the active compounds in CRC intervention. In conclusion, this method significantly reduces analysis time and improves efficiency relative to existing approaches, making it highly suitable for the effective determination of multiple compounds in the quality control of gamboge materials.

An updated landscape on nanopharmaceutical delivery for mitigation of colon cancer

Globally, colorectal cancer (CRC) continues to rank among the leading causes of cancer-related death. Systemic toxicity, multidrug resistance, and nonspecific targeting often pose challenges to conventional therapy for CRC. Because it is a complex disease with a complex genetic and environmental pathophysiology, advanced therapeutic strategies are needed. Nanotechnology presents a potential solution that may maximize therapeutic efficacy while minimizing negative effects by enabling personalized delivery of anticancer drugs. This review focuses on recent developments in colorectal drug delivery systems based on nanotechnology. Numerous nanomaterials, including liposomes, dendrimers, micelles, exosomes, and gold nanoparticles, are developed and used. Distinctive characteristics of mentioned nanocarriers are discussed along with strategies that can be employed for enhancing the delivery of drugs to colorectal cancer cells. The review also quotes the most relevant preclinical and clinical studies that show how these nanomaterials improve drug solubility, stability, and targeted delivery while overcoming the shortcomings of conventional therapies. Nanotechnology has made CRC treatment very efficient and advanced, which has opened up new possibilities for targeted drug delivery. Preclinical and clinical studies have also proved that the use of nano-formulations in colon-specific delivery systems have significant results, indicating potential for better patient outcomes. Future research can be done in order to overcome the hurdles regarding biocompatibility, expansion, and regulatory challenges. Large-scale clinical trials and nanomaterial formulation optimization should be the main goals of future research to confirm the efficacy and safety of these novel treatments.

Investigation of GSTP1 and PTEN gene polymorphisms and their association with susceptibility to colorectal cancer

BACKGROUND

This study investigates the association of single nucleotide polymorphism in glutathione S transferase P1 (rs1695 and rs1138272) and phosphatase and TENsin homolog (rs701848 and rs2735343) with the risk of colorectal cancer (CRC).

PATIENTS AND METHODS

In this case-control study, 250 healthy controls and 200 CRC patients were enrolled. All subjects were divided into 3 groups: healthy control, patients, and overall (control + patients). Genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The demographic information, including age, gender, location, smoking status, cancer stage, and node involvement, were collected.

RESULTS

The allele frequencies of PTEN rs701848 in overall subjects were 0.78 for C and 0.22 for T. Similarly, in overall individuals, allele frequencies for PTEN rs2735343 were 0.65 and 0.35 for G and C alleles, respectively. The CC genotype or C allele of rs701848 and CG/GG genotype of rs2735343 were observed to be a risk factor for CRC. In overall individuals, a significant (p ≤ 0.05)) association was observed between rs701848 and rs2735343 polymorphisms CRC. Allele frequencies for GSTP1 rs1695 were 0.68 and 0.32 for the A and G alleles, respectively. Allele frequencies for GSTP1 rs1138272 were 0.68 and 0.32 for C and T alleles, respectively. However, a significant (p < 0.05) association was found in males for rs1695, while a non-significant difference was observed for the distribution of any genotypes or alleles at GSTP1 (rs1138272).

CONCLUSIONS

Both SNPs of PTEN rs701848 and rs2735343 polymorphisms were significantly associated with CRC. However, in GSTP1, rs1695 was significantly associated with CRC risk in males, and rs1138272 showed a non-significant association with colorectal cancer risk.

Community pharmacist-led point-of-care colorectal cancer screening program: Early detection of colorectal cancer in high-risk patients

BACKGROUND

The prevalence of colorectal cancer (CRC) is on the rise among the younger population, with an anticipated increase in new cases for individuals aged 20-49 years by 2030. The accessibility of community pharmacists and their strong community connections present unique opportunities to enhance patient engagement in a population-based CRC screening program.

OBJECTIVES

This study seeks to assess the effectiveness of a community pharmacist-led point-of-care CRC screening program utilizing fecal immunochemical test (FIT) kits to identify CRC prevalence in high-risk individuals.

METHODS AND MATERIALS

Over the course of a 10-month prospective intervention conducted in UAE community pharmacies, we evaluated the impact of a pharmacist-led point-of-care colorectal cancer screening program. Six pharmacies were selected based on their services and capabilities. Eligible participants were those identified during medication reviews as exhibiting colorectal cancer risk factors. Pharmacists provided communication materials, distributed FIT kits, and implemented reminders. Participants collected samples for hemoglobin analysis, which served as an indicator of colorectal bleeding. Collected data encompassed demographics, lifestyle, and health-related characteristics. Pharmacists performed medication reviews and offered recommendations.

RESULTS

A total of four hundred and one recruited int the study. The mean age of study cohort at baseline was 66.6 ± 11.3 years. In our study with 401 participants, 36.4 % had undiagnosed colorectal cancer (CRC). Univariate logistic regression identified older age, a history of Type 2 diabetes mellitus (DM), and inflammatory bowel disease (IBD) as significant factors associated with increased CRC prevalence, while aspirin users exhibited a lower likelihood of CRC. In the multivariate regression model, the history of Type 2 DM and IBD remained significant predictors for heightened CRC risk.

CONCLUSION

This study strengthens the plausibility of cause-and-effect relationships between colorectal cancer and demographic variables using epidemiological evidence. The significant relationships found between prevalence of CRC and age, type 2 diabetes, IBD and aspirin use support the effectiveness of using FIT kits in community pharmacist-led point-of-care CRC screening program to identify high-risk individuals. The finding highlights the significance of improving efforts on colorectal cancer prevention and control.

Thiazepine-Based Hybrids as Promising Anti-Colon Cancer Agents: Design, Synthesis, Computational and In Vitro Screening

Novel thiazepine-based hybrids (9 a-d) were designed and synthesized to create lead molecules with exceptional anti-colon cancer efficacy. Analytical methods, including IR, NMR, and HR-MS, characterized the synthesized compounds. The in vitro colorectal study was carried out to compare the biological activity of newly developed compounds with the computational data. The tested compounds induced cytotoxicity in HT-29 cells for both 24 h and 48 h in a dose-dependent manner. However, compound 9 a induced cytotoxicity at much higher concentrations compared to the rest of the compounds. 9 b and 9 c caused 50 % cell death (compared to the untreated cells) at a dose of ~50 μM and 40 μM in case of 24-hour exposure, respectively. On the contrary, for 48 h exposure, both 9 b and 9 c induced 50 % cell death concerning untreated cells at a dose of around ~20 μM, whereas 9 d exhibited 50 % cell death at 5 μM in the case of 48 h exposure. In silico ADMET was also carried out to understand the pharmacokinetics and safety profiles of the drug candidates. We found some of the critical targets of these compounds, which eventually will be integral to exploring the mechanistic actions of these compounds in colon cancer.

Risk of malignancy in adult patients with congenital heart disease: a clinical practice review

This paper presents case studies of adult patients with congenital heart disease (CHD) who developed cancer and also discusses relevant epidemiological studies, risk factors, and reports on early detection. Herein, we describe three cases: a 63-year-old man with an atrial septal defect and multiple myeloma; a 48-year-old man with tetralogy of Fallot and colorectal cancer; and a 25-year-old man with Fontan circulation and hepatocellular carcinoma (HCC). Previous studies have found that the incidence of cancer in adult patients with CHD is higher than that in the general population. The management of adult patients with CHD complicated by cancer requires careful attention because cancer treatment alone can affect the survival prognosis and quality of life, as well as the pathophysiology and treatment of underlying heart disease. Apart from known risk factors in the non-CHD population, specific risk factors have been reported, such as genetic abnormalities, low-dose ionizing radiation exposure, early thymectomy, Fontan-associated liver disease, and hypoxia. Encouraging patients to participate in cancer screening and avoid known risk factors is essential in daily practice for the early diagnosis and prevention of cancer. It is also important to be vigilant for initial signs that are indicative of cancer as well as avoidable risk factors.

Comprehensive genomic analysis in sporadic early-onset colorectal adenocarcinoma patients

BACKGROUND

The incidence of colorectal cancer (CRC) in young adults has increased worldwide. Our study aimed to evaluate genomic alterations in early-onset (aged 15-39 years) sporadic CRC.

METHODS

Formalin-fixed, paraffin-embedded tissue samples from 90 patients with histologically confirmed colorectal adenocarcinoma with proficient mismatch repair status from Siriraj Hospital (Bangkok, Thailand) were extracted. Patients with clinically suspected familial adenomatous polyposis were excluded. A 517-gene mutational analysis was performed by next-generation sequencing using the Oncomine Comprehensive Assay Plus kit. The previously reported molecular data in adult-onset CRC from our group were used as a comparator group.

RESULTS

The five most frequently mutated genes were APC (66%), TP53 (51%), KRAS (47%), ARID1A (31%), and KMT2B (31%). When compare with adult-onset, NOTCH1 (11.1% vs. 1.9%), FBXW7 (23.3% vs. 14.8%), PIK3CA (20% vs. 12.1%), and FGFR3 (8.9% vs. 3.7%) mutations were more prevalent in early-onset. No differences were observed in other common mutations, such as TP53, EGFR, KRAS, NRAS and BRAF mutations. An increased prevalence in KRAS codon 12 mutations was also observed in early-onset patients compared to the adult-onset group (38.9% vs. 29.6%).

CONCLUSIONS

Overall, the genomic landscape between early- and adult-onset CRC appears similar. However, our study revealed the enrichment of NOTCH1, FBXW7, PIK3CA, and FGFR3 along with KRAS G12 mutations, were more frequent in early-onset compared to adult-onset cases. Further studies with a larger cohort of patients on the comprehensive analysis of genetic/epigenetic signatures are required.

Mechanisms and Strategies to Overcome Drug Resistance in Colorectal Cancer

Colorectal cancer (CRC) is a major cause of cancer-related mortality worldwide, with a significant impact on public health. Current treatment options include surgery, chemotherapy, radiotherapy, molecular-targeted therapy, and immunotherapy. Despite advancements in these therapeutic modalities, resistance remains a significant challenge, often leading to treatment failure, poor progression-free survival, and cancer recurrence. Mechanisms of resistance in CRC are multifaceted, involving genetic mutations, epigenetic alterations, tumor heterogeneity, and the tumor microenvironment. Understanding these mechanisms at the molecular level is crucial for identifying novel therapeutic targets and developing strategies to overcome resistance. This review provides an overview of the diverse mechanisms driving drug resistance in sporadic CRC and discusses strategies currently under investigation to counteract this resistance. Several promising strategies are being explored, including targeting drug transport, key signaling pathways, DNA damage response, cell death pathways, epigenetic modifications, cancer stem cells, and the tumor microenvironment. The integration of emerging therapeutic approaches that target resistance mechanisms aims to enhance the efficacy of current CRC treatments and improve patient outcomes.

Folic acid-targeted β-lactoglobulin nanocarriers for enhanced delivery of 5-fluorouracil and sodium butyrate in colorectal cancer treatment

Colorectal cancer (CRC) remains a significant public health concern, emphasizing the need for innovative therapeutic strategies to improve patient outcomes. This study aimed to develop a highly efficient nanocarrier for targeted drug delivery, enhancing drug efficacy while minimizing concentrations and limiting adverse effects. We synthesized protein-based β-lactoglobulin (βlg) nanoparticles (NPs), loaded with 5-fluorouracil (5-FU) and sodium butyrate (NaB), and further functionalized with folic acid (FA) for specific targeting of folate receptor-positive CRC cells. The βlg-5-FU-NaB-FA nanoplatforms exhibited a well-defined size of 208 nm with a narrow size distribution (PDI ≈ 0.5). Zeta potential measurements showed a value of -11.4 mV, indicating stability and suitability for drug delivery. Scanning electron microscopy (SEM) and atomic force microscopy (AFM) confirmed the nanocarrier's spherical morphology and efficient distribution. Drug release profiles demonstrated that the NPs released more drugs at neutral to alkaline pH levels, attributed to pectin's ionization properties. The efficacy of the prepared βlg-5-FU-NaB-FA nanoplatforms was investigated on HCT116 and Caco2 CRC cells, along with the normal cell line CRL-1831. The βlg-5-FU-NaB-FA nanoplatforms exhibited remarkable cytotoxicity against both HCT116 and Caco2 CRC cells compared to free drugs, highlighting the efficacy of targeted delivery in folate receptor-positive cells. These NPs induce cell apoptosis and cell cycle arrest more effectively than free drugs, demonstrating their potential for targeted cancer therapy. Furthermore, a decrease in the expression of crucial genes involved in the Wnt signaling pathway was observed, which offers a valuable understanding of their underlying mechanism. Collectively, our results suggest that the FA-targeted βlg nanocarriers represent a promising platform for the efficient and targeted delivery of 5-FU and NaB in folate receptor-positive CRC. This novel nanocarrier holds the potential to enhance therapeutic outcomes while minimizing side effects, providing a new avenue for the treatment of CRC.

Preoperative tumor marker elevations in colorectal cancer patients with peritoneal metastases should be used to help select patients for cytoreductive surgery

BACKGROUND

Tumor markers are used routinely for surveillance in patients treated for colorectal cancer (CRC). However, the prognostic implications of elevated preoperative tumor markers in patients treated for CRC and peritoneal metastases (PM) has not been well defined. The utility of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and cancer antigen 125 (CA125) to predict outcome for these patients is reported.

METHODS

Clinical and histologic features plus preoperative tumor markers were recorded within 1 week prior to CRS. Impact on overall survival of these factors was analyzed by univariate and multivariate analysis.

RESULTS

Two hundred and four patients were in our database and 140 patients (75.3 %) had at least a single elevated preoperative tumor marker. In an analysis of clinical and histologic parameters preoperatively, a poorly differentiated tumor, signet ring morphology, a peritoneal cancer index (PCI) of ≥16 and an incomplete cytoreduction had a negative impact on median survival. In a multivariate analysis of clinical and histologic features together with tumor markers, an elevated CA19-9 and CA125 was independently associated with reduced overall survival (HR 2.7, p < 0.0001 and HR 2.2, p = 0.005), respectively. Quantitative assessment of CEA (HR 0.5, p = 0.0094) and CA19-9 (HR 4.9, p < 0.001) greater than x10 ULN showed reduced survival.

CONCLUSION

Preoperative assessment of symptoms and histopathology, PCI and a complete CRS combined with tumor markers CEA, CA19-9 and CA125 are independent prognostic indicators for selection by the multidisciplinary team of CRC PM patients for CRS and HIPEC. All three tumor markers are needed for a meaningful assessment.

Comprehensive analysis of mitochondrial-related gene signature for prognosis, tumor immune microenvironment evaluation, and candidate drug development in colon cancer

Colon adenocarcinoma (COAD), a common digestive system malignancy, involves crucial alterations in mitochondria-related genes influencing tumor growth, metastasis, and immune evasion. Despite limited studies on prognostic models for these genes in COAD, we established a mitochondrial-related risk prognostic model, including nine genes based on available TCGA and MitoCarta 3.0 databases, and validated its predictive power. We investigated the tumor microenvironment (TME), immune cell infiltration, complex cell communication, tumor mutation burden, and drug sensitivity of COAD patients using R language, CellChat, and additional bioinformatic tools from single-cell and bulk-tissue sequencing data. The risk model revealed significant differences in immune cell infiltration between high-risk and low-risk groups, with the strongest correlation found between tissue stem cells and macrophages in COAD. The risk score exhibited a robust correlation with TME signature genes and immune checkpoint molecules. Integrating the risk score with the immune score, microsatellite status, or TMB through TIDE analysis enhanced the accuracy of predicting immunotherapy benefits. Predicted drug efficacy offered options for both high- and low-risk group patients. Our study established a novel mitochondrial-related nine-gene prognostic signature, providing insights for prognostic assessment and clinical decision-making in COAD patients.

Long-Term Outcomes of Patients with Poor Prognostic Factors Following Transanal Endoscopic Microsurgery (TEMS) for Early Rectal Cancer

Background: Transanal endoscopic microsurgery (TEMS) is an organ-preserving approach for treatment of early rectal cancer (ERC). However, adverse histopathological features identified post-TEMS often necessitate adjuvant therapy. This study aims to compare the long-term oncological outcomes of patients who underwent TEMS and were offered adjuvant treatments with total mesorectal excision (TME), chemoradiotherapy (CRT), radiotherapy (RT), active surveillance, or dose escalation with contact X-ray brachytherapy (CXB). Methods: This study included patients treated with TEMS for ERC between September 2012 and December 2022, with follow-up until December 2023. Patients with adverse histopathological features (extra-mural venous invasion, lympho-vascular invasion, R1 margins, tumour budding) were assigned to adjuvant treatments. Inverse probability of treatment weighting (IPTW) was applied to mitigate selection bias. Results: Of the 117 patients, 24 underwent TME, 17 received CRT, 25 received RT, 14 underwent active surveillance, and 37 patients received CXB boost along with CRT. The median follow-up was 60 months (IQR 52-73). During this time, 29 patients developed recurrence, and 15 died. The 5-year overall survival (OS) was 78.6%, and disease-free survival (DFS) was 70.9%. Compared to CXB, the mortality risk for CRT (HR = 0.81; 95% CI: 0.20-3.28; p = 0.77) and TME (HR = 3.68; 95% CI: 0.46-29.79; p = 0.22) was not significantly different. However, TME was associated with a significantly higher recurrence risk compared to CXB (HR = 7.57; 95% CI: 1.23-46.84; p = 0.029). Conclusions: An organ-preserving strategy with CRT or CRT combined with a CXB boost may offer comparable long-term outcomes and reduced recurrence risks for patients undergoing TEMS for ERC with poor prognostic features. Further research with larger cohorts is needed to validate these results.

Cannabidiol Targets Colorectal Cancer Cells via Cannabinoid Receptor 2, Independent of Common Mutations

Cannabidiol (CBD) is a non-neurotoxic, phytocannabinoid from cannabis with reported medicinal properties, including antiepileptic and anti-inflammatory activity. Several in vitro and in vivo studies have shown that CBD has antitumor potential against colorectal cancer (CRC), the third deadliest cancer in the world. However, as different mutations influence the antitumor effects and CBD can bind a variety of receptors, it is yet to be determined whether specific CRC mutations affect CBD's efficacy in treatment of CRC. To investigate this, we selected four CRC cell lines, including HCT116, HT-29, LS174T, and LS153, which harbor distinct mutations. Cells were treated with a range of concentrations of CBD to evaluate its cytotoxic effects and impact on cell proliferation, migration, and invasion by using a live-cell imaging system. IC50 values were then calculated for each parameter. The level of endoplasmic reticulum (ER) stress pathway markers was also measured using qRTPCR. The requirements for CB1 or CB2 receptor-medicated signaling were investigated using the selective inhibitors AM251 and SR144528, respectively. Our results demonstrate that CBD induces apoptosis and halts proliferation, migration, and invasion of CRC cell lines in a concentration-dependent manner. CBD showed potent antitumor effects in the tested cell lines with no obvious effect from different mutations such as KRAS, BRAF, APC, PTEN, etc. CBD also induced ER stress in CRC cells but not in healthy intestinal organoids. Cotreatment with SR144528 inhibited the effects of indicating involvement of CB2 receptor activation in the anticancer effects of CBD. Together, these results demonstrated that CBD could be effective for CRC regardless of the underlying mutation through CB2 receptor activation.

Nano-Radiopharmaceuticals in Colon Cancer: Current Applications, Challenges, and Future Directions

Colon cancer remains a significant global health challenge; however, the treatment outcome for colon patients can be improved through early detection and effective treatment. Nano-radiopharmaceuticals, combining nanotechnology with radiopharmaceuticals, are emerging as a revolutionary approach in both colon cancer diagnostic imaging and therapy, playing a significant role in the management of colon cancer patients. This review examines the use of nano-radiopharmaceuticals in the diagnosis and treatment of colon cancer, highlighting current applications, challenges, and future directions. Nanocarriers of radionuclides have shown potential in improving cancer treatment, including liposomes, microparticles, nanoparticles, micelles, dendrimers, and hydrogels, which are approved by the FDA. These nanocarriers can deliver targeted drugs into malignant cells without affecting normal cells, reducing side effects. Antibody-guided systemic radionuclide-targeted therapy has shown potential for treating cancer. Novel cancer nanomedicines, like Hensify and 32P BioSilicon, are under clinical development for targeted radiation delivery in percutaneous intratumoral injections. Although using nano-radiopharmaceuticals is a superior technique for diagnosing and treating colon cancer, there are limitations and challenges, such as the unintentional accumulation of nanoparticles in healthy tissues, which leads to toxicity due to biodistribution issues, as well as high manufacturing costs that limit their availability for patients. However, the future direction is moving toward providing more precise radiopharmaceuticals, which is crucial for enhancing the diagnosis and treatment of colon cancer and reducing production costs.

Comprehensive Bioinformatics Analysis of Glycosylation-Related Genes and Potential Therapeutic Targets in Colorectal Cancer

Colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide, characterized by high incidence and poor survival rates. Glycosylation, a fundamental post-translational modification, influences protein stability, signaling, and tumor progression, with aberrations implicated in immune evasion and metastasis. This study investigates the role of glycosylation-related genes (Glycosylation-RGs) in CRC using machine learning and bioinformatics. Data from The Cancer Genome Atlas (TCGA) and the Molecular Signatures Database (MSigDB) were analyzed to identify 67 differentially expressed Glycosylation-RGs. These genes were used to classify CRC patients into two subgroups with distinct survival outcomes, highlighting their prognostic value. Weighted gene coexpression network analysis (WGCNA) revealed key modules associated with CRC traits, including pathways like glycan biosynthesis and PI3K-Akt signaling. A machine-learning-based prognostic model demonstrated strong predictive performance, stratifying patients into high- and low-risk groups with significant survival differences. Additionally, the model revealed correlations between risk scores and immune cell infiltration, providing insights into the tumor immune microenvironment. Drug sensitivity analysis identified potential therapeutic agents, including Trametinib, SCH772984, and Oxaliplatin, showing differential efficacy between risk groups. These findings enhance our understanding of glycosylation in CRC, identifying it as a critical factor in disease progression and a promising target for future therapeutic strategies.

Green Tea Components: In Vitro and In Vivo Evidence for Their Anticancer Potential in Colon Cancer

Green tea consumption has been implicated in various biological activities, with particular emphasis on its anticancer properties. The antineoplastic effects of green tea are primarily attributed to its rich polyphenol content, among which, epigallocatechin-3-gallate (EGCG) is recognized as the most bioactive and potent catechin, responsible for the majority of its anticancer activity. This review provides a detailed examination of the in vitro and in vivo effects of green tea components, focusing on their potential therapeutic implications in colorectal cancer. The molecular mechanisms of action and bioactive constituents of green tea are systematically discussed, alongside an evaluation of experimental evidence supporting their efficacy. Furthermore, insights into the relationship between green tea dietary intake and colorectal cancer risk are analyzed, with a particular emphasis on clinical data and findings from meta-analyses involving patients diagnosed with colon cancer. The aggregated evidence underscores the necessity for well-designed randomized controlled trials and longitudinal cohort studies to substantiate the role of green tea as a chemopreventive agent. Additionally, future investigations should prioritize determining the optimal dosages, the appropriate durations of consumption, and the potential modulatory effects of dietary or lifestyle factors on green tea's anticancer efficacy.

Optimal timing of surgery after neoadjuvant chemoradiotherapy in rectal cancer: A retrospective analysis

BACKGROUND

Determining the optimal interval between neoadjuvant chemoradiotherapy (NCRT) and surgery in patients with locally advanced rectal cancer (LARC) remains crucial for improving treatment outcomes. Extending the interval may increase rates of pathological complete response (pCR), potentially enhancing survival and reducing recurrence.

METHODS

This retrospective cohort study included 226 patients with LARC who underwent NCRT followed by surgery. ROC analysis was used to establish the optimal interval between NCRT and surgery for achieving pCR, and multivariate logistic regression assessed independent predictors of pCR. Spline regression further analyzed the relationship between surgery timing and the probability of pCR.

RESULTS

ROC analysis identified 10.5 weeks as the optimal interval, showing increased pCR rates within this period. Multivariate analysis confirmed that surgery interval (OR = 2.603, P = 0.045) significantly predicted pCR. Both ROC and spline regression indicated that a 9-11-week interval maximizes pCR probability. Notably, the comparison of postoperative complications between groups with surgery intervals ≤10 weeks and >10 weeks showed no statistically significant differences (P = 0.518).

CONCLUSION

An interval of 9-11 weeks between NCRT and surgery optimizes pCR rates without increasing postoperative risks. This timeframe may serve as a favorable window for surgical intervention to enhance outcomes in rectal cancer patients.

Decoupling chemical and mechanical signaling in colorectal cancer cell migration

Colorectal cancer metastasis is governed by a variety of chemical and mechanical signaling that are largely influenced by cancer-associated fibroblasts (CAFs) in the tumor microenvironment. Here, we deconvolute the chemical from mechanical signaling in the case of the colon cancer cell line HCT-116 and CAFs. We examined three chemoattractants (CXCL12, TGF-β, and activin A) which allegedly are secreted by CAFs and induce HCT-116 cell migration. None of the chemoattractants tested resulted in enhanced migration of HCT-116 in a 2D transwell assay, at low cell density. Similarly, CAF-conditioned media also did not lead to enhanced HCT-116 migration, while CAFs co-cultured in the transwell assay did lead to increased HCT-116 migration. This result suggests that either high cell densities are required for chemotaxis, and/or a reciprocal two-way signaling network between CAFs and HCT-116 is necessary to induce chemotaxis. Surprisingly, we find that HCT-116 cells exhibit enhanced migration along the axis of mechanical stress in a 3D collagen matrix, at very high cell densities. This migration is independent of whether the strain is induced mechanically or by CAFs. By comparing purely mechanical and purely chemical migration to a 3D co-culture of CAFs and HCT-116 containing both chemical and mechanical cues, it is concluded that HCT-116 migration is dominated by mechanical signaling, while chemical cues are less influential.

Pharmacophore-based identification and in Silico characterization of microbial metabolites as potential modulators of Wnt signaling pathway in colorectal cancer therapy

Aberrant activation of the Wnt/β-catenin signaling pathway, primarily driven by APC mutation and AXIN degradation via Tankyrase, contributes significantly to colorectal cancer (CRC) progression and metastasis. The accumulation of β-catenin, resulting from the dysregulated ubiquitination, underscores the need for alternative therapeutic strategies targeting Tankyrase and β-catenin. This present study explores microbial metabolites as a source of novel anti-cancer agents, leveraging their unique bioactivity and structural diversity, often exhibiting superior target specificity and lower toxicity than synthetic drugs. Through a computational drug discovery pipeline, a large library of 27641 microbial metabolites was initially screened based on multiple drug-likeliness criteria, resulting in the selection of 2527 compounds. Among the screened compounds, an integrated computational workflow comprising molecular docking, molecular dynamic simulations (MDS), MM/PBSA analysis, and Principal component analysis (PCA) identified Terreustoxin I (T1) as a potential Tankyrase inhibitor. In contrast, compound 10- phenyl-[12]-cytochalasin Z16 (B1) demonstrated a strong binding affinity within the β-catenin active site. Under physiological conditions, these lead compounds were evaluated for conformational stability, binding efficacy, and dynamic behavior. Additionally, ADMET profiling, physiochemical properties, and bioactivity score predictions confirmed the identified compounds' pharmacokinetic suitability and reduced toxicity profile. In silico, cytotoxicity predictions showed significant activity against SW480 and HCT90 colorectal cell lines, with additional anti-neoplastic and anti-leukemic properties, strengthening their candidacy as effective anti-cancer agents. These findings provide a foundation for further experimental validation and development of novel CRC therapies with improved safety and efficacy potential.

Ionizing Radiation May Induce Tumors Partly Through the Alteration or Regulation of Mismatch Repair Genes

Ionizing radiation is mutagenic and carcinogenic, and it is reported to induce primary and secondary tumors with intestinal tumors being one of the most commonly observed. However, the pathological and molecular mechanism(s) underlying the radiation-associated tumorigenesis remain unclear. A link between radiation and somatic tumorigenesis partly through genetic, epigenetic alteration and/or regulation of mismatch repair (MMR) genes has been hypothesized for the first time within this review. Clinical observations and experimental findings provide significant support for this association including MMR mutations as well as altered MMR RNA and protein expressions that occurred post-exposure, although existing evidence in published literature is sparse in this niche area. Some speculative mechanisms are suggested with this review to inform future research. Further studies are needed to understand the roles of the MMR system in response to radiation and to test this possible connection which could potentially provide useful and urgently needed information for clinical guidance.

Risk factors, prevention and screening of colorectal cancer: A rising problem

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer death worldwide. The leading risk factors for CRC include male gender, age over 50, family history, obesity, tobacco smoking, alcohol consumption, and unhealthy diet. CRC screening methods vary considerably between countries and depend on incidence, economic resources and healthcare structure. Important aspects of screening include adherence, which can vary significantly across ethnic and socioeconomic groups. Basic concepts of CRC screening include pre-stratification of patients by identifying risk factors and then using fecal immunochemical test or guaiac-based fecal occult blood test and/or colonoscopy or radiologic imaging techniques. Technological capabilities for CRC screening are rapidly evolving and include stool DNA test, liquid biopsy, virtual colonography, and the use of artificial intelligence. A CRC prevention strategy should be comprehensive and include active patient education along with targeted implementation of screening.

Low Phosphatidylserine+ Cells Within the CD34+/CD45dim/CD117(c-kit)+ Subpopulation Are Associated with Poor Outcomes in Metastatic Colorectal Cancer

BACKGROUND

Colorectal cancer is among the most prevalent causes of tumor-related deaths worldwide. Antiangiogenic therapy represents a cornerstone of metastatic CRC treatment, and biomarkers are advocated for the optimization of this therapeutic strategy.

METHODS

In this observational prospective study, we employed an optimized flow cytometry protocol to investigate the prognostic and predictive potential of blood circulating endothelial cells (CECs), circulating endothelial progenitor cells (CEPCs), and related subsets in a cohort of patients with metastatic colorectal cancer (n = 40).

RESULTS

Computational FC analysis revealed a differential enrichment of blood cell clusters with a CD34+/CD45dim/CD117(c-kit)+ phenotype between responders and non-responders both to antiangiogenic and non-antiangiogenic treatments. Intriguingly, our results show that a high percentage of annexin V-negative cells in a putative circulating progenitor population with a CD34+/CD45dim/CD117+ phenotype was correlated with a reduced response to systemic anticancer treatments (p = 0.015) and worse overall survival (log-rank p = 0.03). In addition, we observed increased blood concentrations of CD34+/CD45dim/CD117+/annexin V- cells in patients with a higher number of metastatic sites (p = 0.03).

CONCLUSIONS

Overall, these findings hold promise for the identification of novel circulating biomarkers to develop more personalized treatment approaches in patients with metastatic colorectal cancer.

Design, Synthesis of Flurbiprofen Based 1,3,4-Oxadiazoles and Constrained Anticancer, Antioxidant Agents: In silico Docking Analysis

Flurbiprofen, a primary component of a nonsteroidal anti-inflammatory drug (NSAID) used to relieve symptoms of arthritis, and is a considerable interest in medicinal chemistry due to its demonstrated potential as an effective agent in various therapeutic applications. In consideration of the 1,3,4-oxadiazole therapeutic potential and anticancer activity, a new series of flurbiprofen scaffolds have been prepared through a straightforward reaction between 5-(1-(2-fluoro-[1,1'-biphenyl]-4-yl)ethyl)-1,3,4-oxadiazole-2-thiol (4) and various organic active 2-chloro-N-phenyl acetamides (5). The synthesized series (6a-6k) was characterized using a combination of spectroscopic techniques, including FT-IR, mass, 1H-NMR, and 13C NMR, followed by physical data. The cytotoxicity of the newly synthesized congeners was investigated against MCF-7 (human breast cancer cell line) and A-549 (human lung carcinoma epithelial) cell lines and anti-inflammatory activity as DPPH and H2O2 radical scavenging ability. In the series, analogues 6c, 6e, 6h, and 6k showed excellent inhibitory activity against MCF-7 cells in the range of IC50 values of 9.10-13.67 μg mL-1 compared to DXN (IC50=9.24 μg mL-1). In this series, analogues 6c, 6f, 6h, and 6j show remarkable H2O2 radical scavenging inhibition IC50 of 48.25±0.21, 47.33±0.15, 51.10±0.25, and 44.40±0.07 μM by using ascorbic acid as a standard, whose IC50 is 49.90±0.27 μM. According to the docking results, the most potent cytotoxic compounds have a stronger binding affinity with the Flurbiprofen complex (PDB: 1R9O) because of their interactions with residues such as Arg416(A), Trp103(A), Phe97(A), Gly279(A), Ile188(A), Glu283(A), Thr287(A), Val462(A), Phe459(A), Leu345(A), Ile417(A), and Cys418(A). Furthermore, in silico drug-likeness prediction analysis suggested that the majority of the synthesized compounds exhibit good oral bioavailability based on their Lipinski's Rule of Five and toxicity using ADME/Tox predictions.