1
|
Du B, Zhang Y, Zhang P, Zhang M, Yu Z, Li L, Hou L, Wang Q, Zhang X, Zhang W. Joint metabolomics and transcriptomics analysis systematically reveal the impact of MYCN in neuroblastoma. Sci Rep 2024; 14:20155. [PMID: 39215128 PMCID: PMC11364762 DOI: 10.1038/s41598-024-71211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
The limited understanding of the molecular mechanism underlying MYCN-amplified (MNA) neuroblastoma (NB) has hindered the identification of effective therapeutic targets for MNA NB, contributing to its higher mortality rate compared to MYCN non-amplified (non-MNA) NB. Therefore, a comprehensive analysis integrating metabolomics and transcriptomics was conducted to systematically investigate the MNA NB. Metabolomics analysis utilized plasma samples from 28 MNA NB patients and 68 non-MNA NB patients, while transcriptomics analysis employed tissue samples from 15 MNA NB patients and 37 non-MNA NB patients. Notably, joint metabolomics and transcriptomics analysis was performed. A total of 46 metabolites exhibited alterations, with 21 displaying elevated levels and 25 demonstrating reduced levels in MNA NB. In addition, 884 mRNAs in MNA NB showed significant changes, among which 766 mRNAs were higher and 118 mRNAs were lower. Joint-pathway analysis revealed three aberrant pathways involving glycerolipid metabolism, purine metabolism, and lysine degradation. This study highlights the substantial differences in metabolomics and transcriptomics between MNA NB and non-MNA NB, identifying three abnormal metabolic pathways that may serve as potential targets for understanding the molecular mechanisms underlying MNA NB.
Collapse
Affiliation(s)
- Bang Du
- Health Commission of Henan Province Key Laboratory for Precision Diagnosis and Treatment of Pediatric Tumor, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China
| | - Yingyu Zhang
- The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Henan Key Laboratory of Rare Diseases, Endocrinology and Metabolism Center, Luoyang, 471003, China
| | - Pin Zhang
- Health Commission of Henan Province Key Laboratory for Precision Diagnosis and Treatment of Pediatric Tumor, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China
| | - Mengxin Zhang
- Health Commission of Henan Province Key Laboratory for Precision Diagnosis and Treatment of Pediatric Tumor, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China
| | - Zhidan Yu
- Health Commission of Henan Province Key Laboratory for Precision Diagnosis and Treatment of Pediatric Tumor, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China
| | - Lifeng Li
- Health Commission of Henan Province Key Laboratory for Precision Diagnosis and Treatment of Pediatric Tumor, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China
| | - Ligong Hou
- Henan International Joint Laboratory for Prevention and Treatment of Pediatric Disease, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China
| | - Qionglin Wang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China.
| | - Xianwei Zhang
- Health Commission of Henan Province Key Laboratory for Precision Diagnosis and Treatment of Pediatric Tumor, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China.
| | - Wancun Zhang
- Health Commission of Henan Province Key Laboratory for Precision Diagnosis and Treatment of Pediatric Tumor, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China.
- Henan International Joint Laboratory for Prevention and Treatment of Pediatric Disease, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China.
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450018, China.
| |
Collapse
|
2
|
Somasundaram DB, Aravindan S, Gupta N, Yu Z, Baker A, Aravindan N. ALK expression, prognostic significance, and its association with MYCN expression in MYCN non-amplified neuroblastoma. World J Pediatr 2022; 18:285-293. [PMID: 35132576 DOI: 10.1007/s12519-022-00517-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Dinesh Babu Somasundaram
- Department of Radiation Oncology, BMSB 311C, Radiation Biology Laboratory, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Boulevard, Oklahoma City, OK, 73104, USA
| | | | | | - Zhongxin Yu
- Department of Pathology, BMSB 311C, Radiation Biology Laboratory, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Boulevard, Oklahoma City, OK, 73104, USA
| | - Ashley Baker
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Natarajan Aravindan
- Department of Radiation Oncology, BMSB 311C, Radiation Biology Laboratory, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Boulevard, Oklahoma City, OK, 73104, USA.
- Stephenson Cancer Center, Oklahoma City, OK, USA.
- Department of Pathology, BMSB 311C, Radiation Biology Laboratory, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Boulevard, Oklahoma City, OK, 73104, USA.
| |
Collapse
|
3
|
Teo AKJ, Singh SR, Prem K, Hsu LY, Yi S. Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis. Respir Res 2021; 22:251. [PMID: 34556113 PMCID: PMC8459488 DOI: 10.1186/s12931-021-01841-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Thirty countries with the highest tuberculosis (TB) burden bear 87% of the world's TB cases. Delayed diagnosis and treatment are detrimental to TB prognosis and sustain TB transmission in the community, making TB elimination a great challenge, especially in these countries. Our objective was to elucidate the duration and determinants of delayed diagnosis and treatment of pulmonary TB in high TB-burden countries. METHODS We conducted a systematic review and meta-analysis of quantitative and qualitative studies by searching four databases for literature published between 2008 and 2018 following PRISMA guidelines. We performed a narrative synthesis of the covariates significantly associated with patient, health system, treatment, and total delays. The pooled median duration of delay and effect sizes of covariates were estimated using random-effects meta-analyses. We identified key qualitative themes using thematic analysis. RESULTS This review included 124 articles from 14 low- and lower-middle-income countries (LIC and LMIC) and five upper-middle-income countries (UMIC). The pooled median duration of delays (in days) were-patient delay (LIC/LMIC: 28 (95% CI 20-30); UMIC: 10 (95% CI 10-20), health system delay (LIC/LMIC: 14 (95% CI 2-28); UMIC: 4 (95% CI 2-4), and treatment delay (LIC/LMIC: 14 (95% CI 3-84); UMIC: 0 (95% CI 0-1). There was consistent evidence that being female and rural residence was associated with longer patient delay. Patient delay was also associated with other individual, interpersonal, and community risk factors such as poor TB knowledge, long chains of care-seeking through private/multiple providers, perceived stigma, financial insecurities, and poor access to healthcare. Organizational and policy factors mediated health system and treatment delays. These factors included the lack of resources and complex administrative procedures and systems at the health facilities. We identified data gaps in 11 high-burden countries. CONCLUSIONS This review presented the duration of delays and detailed the determinants of delayed TB diagnosis and treatment in high-burden countries. The gaps identified could be addressed through tailored approaches, education, and at a higher level, through health system strengthening and provision of universal health coverage to reduce delays and improve access to TB diagnosis and care. PROSPERO registration: CRD42018107237.
Collapse
Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, #10-01, 12 Science Drive 2, Singapore, 117549, Singapore.
| | - Shweta R Singh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Touro University California, Vallejo, USA
| |
Collapse
|
4
|
Islam MZ, Efa SS, Farjana S. Patient factors related to pre-treatment delay of pulmonary tuberculosis: A retrospective cohort study in Bangladesh. Indian J Tuberc 2020; 67:472-478. [PMID: 33077046 DOI: 10.1016/j.ijtb.2020.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Burden of tuberculosis (TB) is still high in Bangladesh. Pre-treatment delay is a hindrance in reducing this burden by early diagnosis and prompt treatment of TB. The study was conducted to identify the patient factors related to pre-treatment delay of pulmonary TB. METHODS This retrospective cohort study was performed during January to June 2018 in a cohort of 240 consecutively enrolled; newly detected adult pulmonary TB (PTB) patients initiated anti-TB therapy during the study period. Two DOTS were selected randomly using cluster sampling and all the PTB patients enrolled in the DOTS centres formed the study population. Informed written consent was obtained from the patients, prior to data collection. Data were collected by face-to-face interview and reviewing medical records using a semi-structured questionnaire and checklist respectively. RESULTS Age of the patients was associated with pre-treatment delay of TB (p < 0.05) with predominance in elderly (75.0%). Delay in care seeking was associated with inability to make decision (RR = 1.84; AR: 35.84%) and awareness of patients (RR = 0.33; AR = -40.0%). Delay in diagnosis was associated with economic problem (RR: 1.63; AR: 28.85%); work barrier (RR: 1.75; AR: 35.03%); inability to make decision (RR: 1.93; AR: 40.65%); delayed investigation (RR: 2.88; AR: 56.17%); others' assistance (RR: 1.77; AR: 28.53%); and symptomatic treatment (RR: 6.43; AR: 65.14%). Delay in treatment initiation was associated with repeated investigations (RR = 1.52; AR: 23.29%) and smear positivity (RR: 0.64; AR: 23.11%). Awareness of patients regarding symptoms and smear positivity were revealed as protective factors for pre-treatment delay of TB. CONCLUSION Delay in care seeking, diagnosis, and treatment initiation contribute substantially to pre-treatment delay of PTB. Considerable reduction in pre-treatment delay may be achieved through changes in awareness of patients and ensuring early diagnosis and prompt treatment of PTB under DOTS programme.
Collapse
Affiliation(s)
- M Ziaul Islam
- Dept. of Community Medicine, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka-1212, Bangladesh.
| | - S Sumaiya Efa
- Dept. of Community Medicine, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka-1212, Bangladesh
| | - S Farjana
- Dept. of Obstetrics and Gynecology, Shaheed Suhrawardy Medical College Hospital, Sher- E-Bangla Nagar, Dhaka-1207, Bangladesh
| |
Collapse
|
5
|
Zhang W, Han C, Wang MS, He Y. Characteristics and factors associated with treatment delay in pleural tuberculosis. QJM 2018; 111:779-783. [PMID: 30053223 DOI: 10.1093/qjmed/hcy167] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Current strategies for the prevention, diagnosis and treatment of pleural TB have been inadequate, several challenges and issues related with pleural TB have been reported. AIM To summarize the main features of pleural tuberculosis (TB) and determine the risk factors in treatment delay. DESIGN Retrospective analysis of hospital records. METHODS Consecutive confirmed TB patients with pleural effusion were enrolled in the study. Demographic and epidemiological data were collected from electronic medical records. Treatment delay duration was stratified into two categories: <30 days and ≥30 days. Multivariate logistic regression analysis was used to evaluate risk factors for the delay. RESULTS From July 2011 to September 2015, a total of 723 patients were enrolled, 72.1% of patients had pulmonary TB, 8.9% had empyema, 8.9% were multidrug-resistant TB (MDR-TB). Multivariate analysis revealed that MDR-TB (odds ratios (OR) = 2.485, 95% confidence interval (CI) 1.347, 4.587), pulmonary TB (OR = 1.452, 95% CI 1.010, 2.087) and empyema (OR = 4.355, 95% CI 2.185, 8.680) were significant risk factors for treatment delay, while fever (OR= 0.519, 95% CI 0.362, 0.744) as well as pleural protein (≥45 g/l) (OR=0.470, 95% CI 0.332, 0.667) were the protective factors. CONCLUSION MDR-TB, pulmonary TB and empyema were significant risk factors for treatment delay, while fever and high pleural protein were protective factors. Tuberculous empyema remains a major problem in China, adequate awareness should be created for the management.
Collapse
Affiliation(s)
- W Zhang
- Department of Rehabilitation, Linyi People's Hospital, Linyi, Shandong, China
| | - C Han
- Department of Geriatrics, Shandong Mental Health Center, Jinan, Shandong, China
| | - M-S Wang
- Department of Lab Medicine, Shandong Provincial Chest Hospital, Jinan, Shandong, China
| | - Y He
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| |
Collapse
|
6
|
Saqib SE, Ahmad MM, Amezcua-Prieto C, Virginia MR. Treatment Delay among Pulmonary Tuberculosis Patients within the Pakistan National Tuberculosis Control Program. Am J Trop Med Hyg 2018; 99:143-149. [PMID: 29761768 DOI: 10.4269/ajtmh.18-0001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Delay in diagnosis and treatment worsens the disease and clinical outcomes, which further enhances transmission of tuberculosis (TB) in the community. Therefore, this study aims to assess treatment delay and its associated factors among pulmonary TB patients in Pakistan. A cross-sectional study was conducted among 269 pulmonary TB patients in the district. Binary and multivariate logistic regressions were used to explore the factors associated with delay in TB treatment. Results reveal that most patients were from low socioeconomic backgrounds. For example, 74.7% were living in kacha houses, 54.7% were from lowest the income group (< 250 US$/month), 60.2% married, 54.3% illiterate, 62.5% rural, 56.1% had no house ownership, and 56.5% had insufficient income for daily family expenditures. Significant delays were revealed by this study: 160 patients had experienced a delay of more than 4 weeks, whereas the median delay was 5 weeks. Results show that the most important reason for patient delay was low income and poverty (42.0%) followed by unaware of TB center (41.6), stigma (felt ashamed = 38.7%), and treatment from local traditional healers. Old age (adjusted odds ratio [AOR] = 6.6; 95% confidence interval [CI] = 1.63-26.95); and rural areas patients (AOR = 2.1; 95% CI = 1.15-3.71) were more likely to have experienced delay. However, the higher income and sufficient income category (AOR = 0.5; 95% CI = 0.31-0.95) were associated factors and less likely to experience delay in patient treatment. Integrative prevention interventions, such as those involving community leaders, health extension workers such as lady health workers, and specialized TB centers, would help to reduce delay and expand access to TB-care facilities.
Collapse
Affiliation(s)
- Shahab E Saqib
- Department of Development and Sustainability, Regional and Rural Development Planning, Asian Institute of Technology, Pathum Thani, Thailand
| | - Mokbul Morshed Ahmad
- Department of Development and Sustainability, Regional and Rural Development Planning, Asian Institute of Technology, Pathum Thani, Thailand
| | - Carmen Amezcua-Prieto
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Public Health and Preventive Medicine, Faculty of Medicine, University of Granada (CTS-137) (CIBER), Granada, Spain
| | - Martínez-Ruiz Virginia
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Public Health and Preventive Medicine, Faculty of Medicine, University of Granada (CTS-137) (CIBER), Granada, Spain
| |
Collapse
|
7
|
Rifat M, Hall J, Oldmeadow C, Husain A, Milton AH. Health system delay in treatment of multidrug resistant tuberculosis patients in Bangladesh. BMC Infect Dis 2015; 15:526. [PMID: 26573825 PMCID: PMC4647619 DOI: 10.1186/s12879-015-1253-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/27/2015] [Indexed: 11/23/2022] Open
Abstract
Background Bangladesh is one of the 27 high burden countries for multidrug resistant tuberculosis listed by the World Health Organization. Delay in multidrug resistant tuberculosis treatment may allow progression of the disease and affect the attempts to curb transmission of drug resistant tuberculosis. The main objective of this study was to investigate the health system delay in multidrug resistant tuberculosis treatment in Bangladesh and to explore the factors related to the delay. Methods Information related to the delay was collected as part of a previously conducted case–control study. The current study restricts analysis to patients with multidrug resistant tuberculosis who were diagnosed using rapid diagnostic methods (Xpert MTB/RIF or the line probe assay). Information was collected by face-to-face interviews and through record reviews from all three Government hospitals providing multidrug resistant tuberculosis services, from September 2012 to April 2013. Multivariable regression analysis was performed using Bootstrap variance estimators. Definitions were as follows: Provider delay: time between visiting a provider for first consultation on MDR-TB related symptom to visiting a designated diagnostic centre for testing; Diagnostic delay: time from date of diagnostic sample provided to date of result; Treatment initiation delay: time between the date of diagnosis and date of treatment initiation; Health system delay: time between visiting a provider to start of treatment. Health system delay was derived by adding provider delay, diagnostic delay and treatment initiation delay. Results The 207 multidrug resistant tuberculosis patients experienced a health system delay of median 7.1 weeks. The health system delay consists of provider delay (median 4 weeks), diagnostic delay (median 5 days) and treatment initiation delay (median 10 days). Health system delay (Coefficient: 37.7; 95 %; CI 15.0–60.4; p 0.003) was associated with the visit to private practitioners for first consultation. Conclusions Diagnosis time for multidrug resistant tuberculosis was fast using the rapid tests. However, some degree of delay was present in treatment initiation, after diagnosis. The most effective way to reduce health system delay would be through strategies such as engaging private practitioners in multidrug resistant tuberculosis control.
Collapse
Affiliation(s)
- Mahfuza Rifat
- School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, HMRI Building Lot 1 Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia. .,BRAC, Dhaka, Bangladesh.
| | - John Hall
- School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, HMRI Building Lot 1 Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia.
| | - Christopher Oldmeadow
- School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, HMRI Building Lot 1 Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia.
| | - Ashaque Husain
- National Tuberculosis Control Programme, Directorate General of Health Services, Dhaka, Bangladesh.
| | - Abul Hasnat Milton
- School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, HMRI Building Lot 1 Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia.
| |
Collapse
|