Risk factors for severe bronchopulmonary dysplasia in a Chinese cohort of very preterm infants

OBJECTIVES

To examine the risk factors for severe bronchopulmonary dysplasia (BPD) in a cohort of very preterm infants (VPIs) in China, as BPD is common among VPIs and associated with a high mortality rate.

METHODS

In this multicenter retrospective study, medical records from infants with BPD born at gestation age (GA) of <32 weeks with birth weight (BW) of <1,500 grams (g) in 7 regions of China were included. The cohort was stratified into different BPD severity groups based on their fraction of inspired oxygen requirement at a modified GA of 36 weeks or post discharge. Risk factors were identified using logistic regression analysis.

RESULTS

A significant inverse correlation was revealed between BPD severity and both GA and BW (p<0.001). Independent risk factors for severe BPD (sBPD) were identified as invasive mechanical ventilation (≥7d), multiple blood transfusion (≥3), nosocomial infection (NI), hemodynamically significant patent ductus arteriosus (hsPDA), delayed initiation of enteral nutrition, and longer time to achieve total caloric intake of 110 kcal/kg. Conversely, administration of antenatal steroids was associated with reduced risk of sBPD.

CONCLUSION

Our study not only reaffirmed the established risk factors of low GA and BW for sBPD in VPIs, but also identified additional, potentially modifiable risk factors. Further research is warranted to explore whether intervention in these modifiable factors might reduce the risk of sBPD.Clinical Trial Reg. No.: ChiCTR1900023418.

[Peripheral sterile corneal infiltrates after small incision lenticule extraction]

A 31-year-old female patient with refractive error in both eyes underwent small incision lenticule extraction. On the 4th day after surgery, arc-shaped peripheral corneal infiltrates appeared in the right eye. Tobramycin and dexamethasone eye drops, 0.3% gatifloxacin eye drops, and a corneal bandage lens were applied to the eye. After bacterial infection was ruled out, dexamethasone sodium phosphate was injected subconjunctivally near the corneal lesion. The symptoms improved and the corneal lesion subsided afterwards.

Protective Effects of Aspirin Supplemented With Quercetin in L-NAME-Induced Preeclampsia-Like Rats

Aspirin supplemented with quercetin was reported to enhance the therapeutic effects of aspirin in a rat model of preeclampsia. In this study, the underlying mechanisms were further explored. Preeclampsia was induced by L-NAME (50 mg/kg/day) via oral gavage from gestation day (GD)14 to GD19. Aspirin (1.5 mg/kg/day) administration was performed using aspirin mixed with rodent dough from GD0 to GD19. The administration of quercetin (2 mg/kg/day) was performed by intraperitoneal infusion from GD0 to GD19. Protein levels were evaluated using ELISA or Western blot, and microRNA (miRNA) level was evaluated by RT-PCR. Aspirin supplemented with quercetin ameliorated the increase of systolic blood pressure (SBP), proteinuria, tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) levels, and improved the pregnancy outcomes in preeclampsia rats. Aspirin supplemented with quercetin inhibited miR-155 expression in preeclampsia rats. The decreased miR-155 level in placenta further increased the protein level of SOCS1 and inhibited the phosphorylation of p65. In this study, we demonstrated that aspirin supplemented with quercetin enhanced the effects of aspirin for the treatment of preeclampsia.

[Effects of nasal valve on subjective nasal patency and nasal resistance: a correlation study on numerical simulation of nasal airflow]

Objective: To investigate the correlations between subjective nasal patency, nasal valve area size and aerodynamic parameters in normal nasal cavity by means of numerical simulation, and to explore the effect of nasal valve on nasal subjective sensation and nasal airflow regulation. Methods: A total of 52 healthy participants (31 males and 21 females) with the average age of 37.8 years, were recruited from the outpatient Department of Otorhinolaryngology Head and Neck Surgery, the Ninth People's Hospital Affiliated to the Medical College of Shanghai Jiao Tong University between January and August 2023. Visual Analog Scale (VAS) scores for unilateral nasal subjective sensation were obtained from all participants. Additionally, the aerodynamic characteristics of inspiratory airflow were simulated. A correlation matrix analysis was conducted to identify the correlation strength between these subjective and objective parameters. Results: VAS scores showed negative correlations with unilateral nasal valve cross-sectional area (r=-0.85, P<0.01) and unilateral intranasal airflow (r=-0.57, P<0.01), and was a positive correlation with unilateral nasal resistance (NR) at the front-end of inferior turbinate (r=0.61, P<0.01). The average cross-sectional area of unilateral nasal valve was (0.85±0.35) cm2. The cross-sectional area of unilateral nasal valve was negatively correlated with unilateral NR (r=-0.50, P<0.01), and positively correlated with unilateral nasal airflow (r=0.61, P<0.01). The NR at the nasal valve area accounted for (40.41±23.54)% of the total unilateral NR. Nearly half of the unilateral NR [(46.74±21.38)%] and air warming [(49.96±10.02)%] occurring before the front end of inferior turbinate were achieved. Conclusions: The nasal valve area plays a crucial role in influencing nasal NR, unilateral nasal airflow, and changes in nasal airflow temperature. Moreover, it is associated with subjective perception of nasal patency.

Machine-learning-guided Directed Evolution for AAV Capsid Engineering

Target gene delivery is crucial to gene therapy. Adeno-associated virus (AAV) has emerged as a primary gene therapy vector due to its broad host range, long-term expression, and low pathogenicity. However, AAV vectors have some limitations, such as immunogenicity and insufficient targeting. Designing or modifying capsids is a potential method of improving the efficacy of gene delivery, but hindered by weak biological basis of AAV, complexity of the capsids, and limitations of current screening methods. Artificial intelligence (AI), especially machine learning (ML), has great potential to accelerate and improve the optimization of capsid properties as well as decrease their development time and manufacturing costs. This review introduces the traditional methods of designing AAV capsids and the general steps of building a sequence-function ML model, highlights the applications of ML in the development workflow, and summarizes its advantages and challenges.

Quantitative Proteomic and Phosphoproteomic Analyses Reveal a Role of Death-Associated Protein Kinase 1 in Regulating Hippocampal Synapse

Death-associated protein kinase 1 (DAPK1) is a stress-responsive calcium/calmodulin (CaM)-regulated serine/threonine protein kinase that is actively involved in stress-induced cell death. The dysregulation of DAPK1 has been established in various neurological disorders such as epilepsy, Alzheimer's disease (AD), and Parkinson's disease (PD). Recent research indicates a synaptic localization of DAPK1 in neurons, suggesting a potential role of DAPK1 in modulating synaptic structure and function. However, the key molecules and pathways underlying the influence of DAPK1 on synapses remain elusive. We utilized quantitative proteomic and phosphoproteomic analyses to compare the differences in protein expression and phosphorylation in hippocampal tissues of wild-type (WT) and DAPK1-knockout (KO) mice. Bioinformatic analysis of differentially expressed proteins and phosphoproteins revealed a preferential enrichment of proteins involved in regulating synaptic function, cytoskeletal structure, and neurotransmission. Gene set enrichment analysis (GESA) highlighted altered presynaptic functions including synaptic vesicle priming and glutamate secretion in KO mice. Besides, we observed that proteins with potential phosphorylation motifs of ERK and DAPK1 were overrepresented among the differential phosphoproteins and were highly enriched in neuronal function-related pathways. Furthermore, Western blot analysis validated differences in the expression of several proteins closely associated with presynaptic organization, dendrites and calcium transmembrane transport between KO and WT mice, further corroborating the potential involvement of DAPK1 in the regulation of synaptic functions. Overall, our data provide molecular evidence to elucidate the physiological links between DAPK1 and neuronal functions and help clarify the role of DAPK1 in the pathogenesis of neurodevelopmental and neurodegenerative diseases.

Activation of transient receptor potential vanilloid 1 ameliorates tau accumulation-induced synaptic damage and cognitive dysfunction via autophagy enhancement

AIMS

The autophagy-lysosomal pathway is important for maintaining cellular proteostasis, while dysfunction of this pathway has been suggested to drive the aberrant intraneuronal accumulation of tau protein, leading to synaptic damage and cognitive impairment. Previous studies have demonstrated that the activation of transient receptor potential vanilloid 1 (TRPV1) by capsaicin has a positive impact on cognition and AD-related biomarkers. However, the effect and mechanism of TPRV1 activation on neuronal tau homeostasis remain elusive.

METHODS

A mouse model of tauopathy was established by overexpressing full-length human tau in the CA3 area. Mice were fed capsaicin diet (0.0125%) or normal diet for 9 weeks. The cognitive ability, synaptic function, tau phosphorylation levels, and autophagy markers were detected. In vitro, capsaicin-induced alterations in cellular autophagy and tau degradation were characterized using two cell models. Besides, various inhibitors were applied to validate the role of TRPV1-mediated autophagy enhancement in tau clearance.

RESULTS

We observed that TRPV1 activation by capsaicin effectively mitigates hippocampal tau accumulation-induced synaptic damages, gliosis, and cognitive impairment in vivo. Capsaicin promotes the degradation of abnormally accumulated tau through enhancing autophagic function in neurons, which is dependent on TRPV1-mediated activation of AMP-activated protein kinase (AMPK) and subsequent inhibition of the mammalian target of rapamycin (mTOR). Blocking AMPK activation abolishes capsaicin-induced autophagy enhancement and tau degradation in neurons.

CONCLUSION

Our findings reveal that capsaicin-induced TRPV1 activation confers neuroprotection by restoring neuronal tau homeostasis via modulating cellular autophagy and provides additional evidence to support the potential of TRPV1 as a therapeutic target for tauopathies.

Efficacy of the traditional Chinese medicine, Buyang Huanwu Decoction, at preventing taxane-induced peripheral neuropathy in breast cancer patients: A prospective, randomized, controlled study

BACKGROUND

Buyang Huanwu Decoction (BYHWD) is a traditional Chinese prescription, originally derived from Yi Lin Gai Cuo during the Qing Dynasty. This study aimed to evaluate the efficacy and safety of BYHWD in the prevention of taxane-induced peripheral neuropathy (TIPN) in patients with breast cancer.

METHODS

This single-center, statistician-blinded, parallel-group, simple randomized, no-treatment controlled study was conducted at the China-Japan Friendship Hospital in Beijing. Sixty breast cancer patients scheduled to receive nab-paclitaxel-based chemotherapy were randomly assigned to either the BYHWD group (N = 30) or the control group (N = 30) using simple randomization procedures. The data analysts were unaware of the treatment allocation. The primary efficacy endpoints were the incidence and severity of TIPN in the 2 groups, assessed using the Common Terminology Criteria for Adverse Events (CTCAE) and Patients' Neurotoxicity Questionnaire (PNQ). The secondary efficacy endpoint was the score of Functional Assessment of Cancer Therapy-Breast for both groups. The primary safety endpoints were routine blood test results and liver and renal functions. Both groups were subjected to 4 chemotherapy cycles. Efficacy and safety analyses were conducted on an intention-to-treat basis.

RESULTS

The incidence of TIPN in the BYHWD group was 50.0%, which was lower than the 80.0% incidence in the control group (β = -1.881 [95%CI -3.274, -.488]; P = .008, adjusted). The probability of TIPN in the BYHWD group was 15.2% of that in the control group, representing a significant reduction in incidence (odds ratio = .152, [95%CI .038, 0.614]; P = .008, adjusted). The CTCAE and PNQ grades of the BYHWD group were 1.527 and 1.495 points lower than those of the control group at the same cycle, respectively (CTCAE: β = -1.527 [95%CI -2.522, -.533]; P = .003, adjusted; PNQ: β = -1.495 [95%CI -2.501, -.489]; P = .004, adjusted, respectively). After treatment, the Functional Assessment of Cancer Therapy-Breast scores in the BYHWD group were significantly better than those in the control group (P = .003), especially in the physiological, functional, and additional concerns domains.

CONCLUSION

Buyang Huanwu decoction (BYHWD) can effectively prevent TIPN and improve the quality of life in patients with breast cancer.

Progress of stimulus responsive nanosystems for targeting treatment of bacterial infectious diseases

In recent decades, due to insufficient concentration at the lesion site, low bioavailability and increasingly serious resistance, antibiotics have become less and less dominant in the treatment of bacterial infectious diseases. It promotes the development of efficient drug delivery systems, and is expected to achieve high absorption, targeted drug release and satisfactory therapy effects. A variety of endogenous stimulation-responsive nanosystems have been constructed by using special infection microenvironments (pH, enzymes, temperature, etc.). In this review, we firstly provide an extensive review of the current research progress in antibiotic treatment dilemmas and drug delivery systems. Then, the mechanism of microenvironment characteristics of bacterial infected lesions was elucidated to provide a strong theoretical basis for bacteria-targeting nanosystems design. In particular, the discussion focuses on the design principles of single-stimulus and dual-stimulus responsive nanosystems, as well as the use of endogenous stimulus-responsive nanosystems to deliver antimicrobial agents to target locations for combating bacterial infectious diseases. Finally, the challenges and prospects of endogenous stimulus-responsive nanosystems were summarized.

Rapid detection of Pseudomonas syringae pv. actinidiae by electrochemical surface-enhanced Raman spectroscopy

Bacterial cancer caused by Pseudomonas syringae pv. actinidiae (Psa) is a major threat to kiwifruit in the world, and there is still a lack of effective control measures. The field of bacterial detection needs a fast, easy-to-use and sensitive identification platform. The current bacterial identification methods are lack of time efficiency, which brings problems to many sectors of society. Surface-enhanced Raman spectroscopy (SERS) and electrochemistry (EC) have been studied as possible candidates for bacterial detection because of their high sensitivity for the detection of biomolecules. In this work, SERS, EC and electrochemical surface-enhanced Raman spectroscopy (EC-SERS) were used for the first time to study the adsorption and EC behavior of Psa on the surface of nanostructured silver electrodes. Two different Raman spectra of a single analyte were obtained, and this dual detection was realized. Silver nanoparticles with iodide and calcium ions (Ag@ICNPs) were synthesized as SERS substrates significantly enhanced the characteristic signal peaks of Psa, and the limit of detection (LOD) is as low as 1.0 × 102 cfu/mL. Chemical imaging results show that the application of negative voltage can significantly improve the spectrum quality, showing a higher signal at -0.8 V, indicating that Psa molecules may have potential-induced reorientation on the electrode surface. Therefore, EC-SERS has the ability to greatly improve the SERS performance of bacteria in terms of peak intensity and spectral richness.

Comparison of clinical data between the proximal femoral bionic nail (PFBN) and hip replacement for the treatment of femoral intertrochanteric fracture

OBJECTIVE

The aim of this study was to compare the difference between proximal femoral bionic nail (PFBN) and hip replacement (HR) for femoral intertrochanteric fracture.

MATERIALS AND METHODS

A retrospective analysis of the differences in operative time, length of stay, postoperative Harris score, and postoperative mortality between patients with femoral intertrochanteric fracture treated by PFBN and HR admitted to Jinzhai County People's Hospital from October 2020 to September 2022 was performed.

RESULTS

A total of 56 patients with femoral intertrochanteric fracture, 26 with PFBN and 30 with HR, were included in the study. There were no differences in the length of surgery, pre- and post-operative hemoglobin, or post-operative Harris score at 3 months between the two groups. Compared to the HR group, the PFBN group had a lower total cost, shorter hospital stays, and lower mortality but a longer ambulation time, with a difference of 3.36 weeks.

CONCLUSIONS

PFBN may be a promising new treatment for femoral intertrochanteric fracture.

The efficacy and safety of continuous blood purification in neonates with septic shock and acute kidney injury: a two-center retrospective study

To investigate the efficacy and safety of continuous blood purification (CBP) in neonates with septic shock and acute kidney injury (AKI). This retrospective study was conducted at two tertiary care children's hospitals between January 2015 and May 2022. A total of 26 neonates with septic shock and AKI were included in this study, with a mortality rate of 50%. Fourteen neonates (53.8%) received continuous veno-venous hemodiafiltration, and 12 (46.2%) received continuous veno-venous hemofiltration. Compared with the indices before CBP, urine output increased 12 h after CBP initiation (P = 0.003) and serum creatinine decreased (P = 0.019). After 24 h of CBP, blood urea nitrogen had decreased (P = 0.006) and mean arterial pressure had increased (P = 0.007). At the end of CBP, the vasoactive-inotropic score and blood lactate were decreased (P = 0.035 and 0.038, respectively) and PH was increased (P = 0.015). Thrombocytopenia was the most common complication of CBP.  Conclusion: CBP can efficiently maintain hemodynamic stability, improve renal function, and has good safety in neonates with septic shock and AKI. However, the mortality rate remains high, and whether CBP improves the prognosis of neonates with septic shock and AKI remains unclear. What is Known: • Over 50% of children with septic shock have severe AKI, of which 21.6% required CBP. • The clinical application of CBP in septic shock has attracted increasing attention. What is New: • CBP can efficiently maintain hemodynamic stability, improve renal function, and has good safety in neonates with septic shock and AKI. • The mortality rate in neonates with septic shock and AKI receiving CBP remains high.

Newborn screening for fatty acid oxidation disorders in a southern Chinese population

Background and aims

Fatty acid oxidation disorders (FAODs) are a group of autosomal recessive metabolic diseases included in many newborn screening (NBS) programs, but the incidence and disease spectrum vary widely between ethnic groups. We aimed to elucidate the incidence, disease spectrum, and genetic features of FAODs in a southern Chinese population.

Materials and methods

The FAODs screening results of 643,606 newborns from 2014 to 2022 were analyzed.

Results

Ninety-two patients were eventually diagnosed with FAODs, of which 61 were PCD, 20 were MADD, 5 were SCADD, 4 were VLCADD, and 2 were CPT-IAD. The overall incidence of FAODs was 1:6996 (95 % CI: 1:5814-1:8772) newborns. All PCD patients had low C0 levels during NBS, while nine patients (14.8 %) had normal C0 levels during the recall review. All but one MADD patients had elevated C8, C10, and C12 levels during NBS, while eight patients (40 %) had normal acylcarnitine levels during the recall review. The most frequent SLC22A5 variant was c.760C > T (p.R254*) with an allele frequency of 29.51 %, followed by c.51C > G (p.F17L) (17.21 %) and c.1400C > G (p.S467C) (16.39 %). The most frequent ETFDH variant was c.250G > A (p.A84T) with an allelic frequency of 47.5 %, followed by c.524G > A (R175H) (12.5 %), c.998A > G (p.Y333C) (12.5 %), and c.1657T > C (p.Y553H) (7.5 %).

Conclusion

The prevalence, disease spectrum, and genetic characteristics of FAODs in a southern Chinese population were clarified. PCD was the most common FAOD, followed by MADD. Hotspot variants were found in SLC22A5 and ETFDH genes, while the remaining FAODs showed great molecular heterogeneity. Incorporating second-tier genetic screening is critical for FAODs.

BME-free primary patient-specific organoids obtained with a one-day mimicking method to replicate the corresponding tumor for personalized treatment options

Introduction

In cancer treatment, every minute counts. Due to the unpredictable behavior of cancer cells caused by continuous mutations, each cancer patient has a unique situation and may or may not respond to a specific drug or treatment. The process of finding an effective therapy can be time-consuming, but cancer patients do not have the luxury of time for trial and error. Therefore, a novel technology to fast generate a patient relevant organoid for the therapies selecting is urgently needed.

Methods

Utilizing the new organoid technology by specially dissolving the mesenchyme in tumor tissues acquired from cancer patients, we realized the work of creating patient-specific organoids (PSO) within one day.

Results

PSO properties reflect those of its respective original in vivo tumor tissue and can be utilized to perform various in vitro drug sensitivity tests to identify the most effective clinical treatment for patients. Additionally, PSO can aid in assessing the efficacy of immune cell therapies.

Discussion

Organoid technology has advanced significantly in recent years. However, current cancer organoid methods involve creating 3D tumor tissue from 2D cancer cells or cell clusters, primarily for cancer research purposes aimed at investigating related molecular and cellular mechanisms of tumor development. These methods are research-driven, not tailored towards clinical applications, and cannot provide personalized information for individual patients. PSO filled the gap of clinic-driven and time-saving method for the personalized therapies selecting to the cancer patients.

Design and Synthesis of Novel Near-Infrared Fluorescence Probes Based on an Open Conformation of a Cytochrome P450 1B1 Complex for Molecular Imaging of Colorectal Tumors

Cytochrome P450 1B1 (CYP1B1) is induced during the early stage of cancer and is universally overexpressed in tumors. Thus, it was considered as a potential biomarker for the monitoring of cancer. In this study, we designed and synthesized CYP1B1-targeted near-infrared (NIR) fluorescence molecular probes based on the latest reported open conformation of the CYP1B1-α-naphthoflavone (ANF) complex. According to the architecture of the open channel, we introduced linkers and a Cy5.5 fragment at the 5' position of ANF derivatives with strong CYP1B1 inhibitory activity to obtain probes 19-21. Then, in vitro cell-based studies showed that the probes could be enriched in tumor cells by binding to CYP1B1. During in vivo and ex vivo imaging in a xenograft mouse model, probe 19 with the best binding affinity was proven to be able to identify tumor sites in both fluorescence imaging and photoacoustic imaging modes.

Serum levels of Vanin-2 increase with obesity in relation to inflammation of adipose tissue and may be a predictor of bariatric surgery outcomes

Objective

Excessive obesity can lead to dysfunction in adipose tissue, which contributes to the development of comorbidities associated with obesity, such as type 2 diabetes (T2D), cardiovascular and cerebrovascular disease, among others. Previous research has mainly focused on the Vanin family in systemic inflammatory diseases or predicting its role in tumor prognosis, while neglecting its role as a secretory protein in adipose tissue inflammation and metabolism. The objective of this study was to compare the changes in Vanin-2 levels in the circulating blood of normal and obese individuals, and to assess its correlation with inflammatory factors in vivo. Furthermore, the study aimed to systematically evaluate its effectiveness in human weight loss surgery.

Methods

Serum concentrations of Vanin-2 and inflammatory indicators were measured in 518 volunteers. Furthermore, the concentrations of Vanin-2 were measured both before and after weight loss through a dietetic program or laparoscopic sleeve gastrectomy (LSG). Additionally, we assessed the levels of insulin, adiponectin, and inflammation-related factors. The hormonal profile and changes in body weight were evaluated at baseline and 3 months after surgery.

Results

Serum levels of Vanin-2 were found to be significantly increased in individuals with overweight/obesity (OW/OB) group (controls 438.98 ± 72.44, OW/OB 530.89 ± 79.39 ug/L; p < 0.001). These increased levels were associated with IL-18, BMI, FAT%, and HOMA-IR. However, levels of Vanin-2 remained unchanged after conventional dietary treatment. On the other hand, weight loss induced by LSG resulted in a significant decrease in Vanin-2 concentrations from 586.44 ± 48.84 to 477.67 ± 30.27 ug/L (p < 0.001), and this decrease was associated with the Vanin-2 concentrations observed before the operation.

Conclusion

Serum Vanin-2 is a highly effective biomarker for assessing adipose tissue inflammation in obesity and has the potential to serve as a predictor of bariatric surgery outcomes.

Protective role of perivascular adipose tissue in the cardiovascular system

This review provides an overview of the key role played by perivascular adipose tissue (PVAT) in the protection of cardiovascular health. PVAT is a specific type of adipose tissue that wraps around blood vessels and has recently emerged as a critical factor for maintenance of vascular health. Through a profound exploration of existing research, this review sheds light on the intricate structural composition and cellular origins of PVAT, with a particular emphasis on combining its regulatory functions for vascular tone, inflammation, oxidative stress, and endothelial function. The review then delves into the intricate mechanisms by which PVAT exerts its protective effects, including the secretion of diverse adipokines and manipulation of the renin-angiotensin complex. The review further examines the alterations in PVAT function and phenotype observed in several cardiovascular diseases, including atherosclerosis, hypertension, and heart failure. Recognizing the complex interactions of PVAT with the cardiovascular system is critical for pursuing breakthrough therapeutic strategies that can target cardiovascular disease. Therefore, this review aims to augment present understanding of the protective role of PVAT in cardiovascular health, with a special emphasis on elucidating potential mechanisms and paving the way for future research directions in this evolving field.

Genetic spectrums and clinical profiles of critically ill neonates with congenital auricular deformity in the China Neonatal Genomes Project

Congenital auricular deformity (CAD) is a complex phenotype that may occur as a single malformation or part of a congenital syndrome. The genetic architecture and utility of next-generation sequencing (NGS) in a sizable cross-sectional study of critically ill neonates with CAD have not yet been systematically investigated. This cross-sectional study investigated the genetic spectrum in critically ill neonates with CADs. Critically ill neonates with CADs (n = 251) were enrolled between August 8, 2016 and October 1, 2022. All neonates underwent NGS. The outcomes were molecular diagnostic yield, spectrum of genetic events, and clinical findings. Genetic findings were obtained in 107 neonates (42.6%), of which 67.3% (72/107) had pathogenic/likely pathogenic/variants of uncertain significance (P/LP/VUS) gene variations and 32.7% (35/107) had P/LP/VUS copy number variations (CNVs). The diagnostic rates of clinical exome sequencing were similar to those of exome sequencing. The logistic regression model revealed that CAD neonates with craniofacial abnormalities (OR = 4.15, 95% CI 2.29-7.53) or cardiovascular malformation (OR = 2.09, 95% CI 1.14-3.84) are more likely to be attributed to genetic causes. Follow-up analysis revealed that, compared to those in the undiagnosed group, the number of neonates whose care was withdrawn or who died was higher in the genetically diagnosed group (P < 0.05). This study identified a high incidence of genetic causes in critically ill neonates with CADs, with a combination of single-nucleotide variations and CNVs among the genetic causes of CAD. These findings highlight potential of NGS in the genetic testing of critically ill neonates with CADs.

Enhancing the Focus: How Does Parental Incarceration Fit into the Overall Picture of Adverse Childhood Experiences (ACEs) and Positive Childhood Experiences (PCEs)?

Despite the five million children in the U.S. with an incarcerated parent, there is limited research on risk and protective factors for this population. We analyzed data from the National Survey for Children's Health (2018) to: (1) examine associations among parental incarceration and other adverse childhood experiences (ACEs), (2) characterize the association between parental incarceration and youth mental health outcomes, (3) examine differences in positive childhood experiences (PCEs; collective socialization, community engagement, neighborhood amenities, and family problem solving) by parental incarceration status, (4) examine whether PCEs were protective against mental health problems and if there was an interaction with parental incarceration status, and (5) examine the interaction between PCEs, parental incarceration, and ACEs on mental health problems. Results revealed that children with incarcerated parents had higher odds of experiencing other ACEs, higher odds of having mental health problems, and experienced fewer PCEs compared to children without incarcerated parents. Further, although PCEs were associated with a lower odds of mental health problems for both children with and without incarcerated parents, they did not mitigate the negative impact of parental incarceration on mental health outcomes. While PCEs attenuated the association between ACEs and mental health, parental incarceration status did not significantly moderate the interaction. These results highlight vulnerabilities and potential protective factors for children with incarcerated parents and have important implications for the development of multilevel intervention strategies that seek to promote resilience and reduce risk for this population.

Death-associated protein kinase 1 phosphorylates MDM2 and inhibits its protein stability and function

Breast cancer is one of the major malignancies in women, and most related deaths are due to recurrence, drug resistance, and metastasis. The expression of the mouse double minute 2 (MDM2) oncogene is upregulated in breast cancer; however, its regulatory mechanism has yet to be fully elucidated. Herein, we identified the tumor suppressor death-associated protein kinase 1 (DAPK1) as a novel MDM2 regulator by unbiased peptide library screening. DAPK1 is directly bound to MDM2 and phosphorylates it at Thr419. DAPK1-mediated MDM2 phosphorylation promoted its protein degradation via the ubiquitin-proteasome pathway, resulting in upregulated p53 expression. DAPK1 overexpression, but not its kinase activity-deficient form, decreased colony formation and increased doxorubicin-induced cell death; however, DAPK1 knockdown produced the opposite effects in human breast cancer cells. In a xenograft tumorigenesis assay, DAPK1 overexpression significantly reduced tumor formation, whereas inhibition of DAPK1 kinase activity reduced its antitumorigenic effect. Finally, DAPK1 expression was negatively correlated with MDM2 levels in human breast cancer tissues. Thus, these results suggest that DAPK1-mediated MDM2 phosphorylation and its protein degradation may contribute to its antitumorigenic function in breast cancer.

KCNH2A561V Heterozygous Mutation Inhibits KCNH2 Protein Expression via The Activation of UPR Mediated by ATF6

The potassium channel protein KCNH2 is encoded by KCNH2 gene, and there are more than 300 mutations of KCNH2. Unfolded protein response (UPR) is typically initiated in response to an accumulation of unfolded and/or misfolded proteins in the endoplasmic reticulum (ER). The present study aimed to explore the UPR process and the role of activating transcription factor 6 (ATF6) in the abnormal expression of potassium voltage-gated channel subfamily H member 2 (KCNH2)A561V. The wild-type (wt) KCNH2 and A561V mutant KCNH2 was constructed with his-tag. The 293 cells were used and divided into KCNH2wt+KCNH2A561V, KCNH2wt and KCNH2A561V groups. The expression levels of ATF6 and KCNH2 in different groups were detected by Western blotting, reverse transcription-quantitative PCR, immunofluorescence and immuno-coprecipitation assays. The protein types and abundance of immuno-coprecipitation samples were analyzed by mass spectrometry. The proteomic analysis of the mass spectrometry results was carried out by using the reactome database and GO (Gene Ontology) tool. The mRNA expression levels of KCNH2 and ATF6 in the KCNH2wt+KCNH2A561V group were higher compared with the KCNH2A561V group. However, the full-length protein expression of ATF6 was inhibited, indicating that ATF6 was highly activated and a substantial number of ATF6 was sheared in KCNH2wt+KCNH2A561V group compared with control group. Furthermore, A561V-KCNH2 mutation leading to the accumulation of the immature form of KCNH2 (135 kDa bands) in ER, resulting in the reduction of the ratio of 155 kDa/135 kDa. In addition, the abundance of UPR-related proteins in the KCNH2A561V group was higher compared with the KCNH2wt+KCNH2A561V group. The 'cysteine biosynthetic activity' of GO:0019344 process and the 'positive regulation of cytoplasmic translation activity' of GO:2000767 process in the KCNH2A561V group were higher compared with the KCNH2wt+KCNH2A561V group. Hence, co-expression of wild-type and A561V mutant KCNH2 in 293 cells activated the UPR process, which led to the inhibition of protein translation and synthesis, in turn inhibiting the expression of KCNH2. These results provided a theoretical basis for clinical treatment of Long QT syndrome.

[Molecular detection and subtyping of Blastocystis sp. in pigs in Anhui Province]

OBJECTIVE

To investigate the prevalence and subtype distribution of Blastocystis sp. in pigs in Anhui Province.

METHODS

A total of 500 stool samples were collected from large-scale pig farms in Bozhou, Anqing, Chuzhou, Hefei, Fuyang, and Lu'an cities in Anhui Province from October to December 2015. Blastocystis was detected in pig stool samples using a PCR assay based on the small subunit ribosomal RNA (SSU rRNA) gene, and positive samples were subjected to sequencing and sequence analysis. Blastocystis subtypes were characterized in the online PubMLST database, and verified using phylogenetic tree created with the neighbor-joining algorithm in the Meta software.

RESULTS

The prevalence of Blastocystis infection was 43.2% (216/500) in pigs in 6 cities of Anhui Province, and all pig farms were tested positive for Blastocystis. There was a region-specific prevalence rate of Blastocystis (17.2% to 50.0%) (χ2 = 26.084, P < 0.01), and there was a significant difference in the prevalence of Blastocystis sp. among nursery pigs (39.6%), preweaned pigs (19.1%), and growing pigs (62.3%) (χ2 = 74.951, P < 0.01). Both online inquiry and phylogenetic analysis revealed ST1, ST3, and ST5 subtypes in pigs, with ST5 as the predominant subtype.

CONCLUSIONS

The prevalence of Blastocystis sp. is high in pigs in Anhui Province, with three zoonotic subtypes identified, including ST1, ST3, and ST5.

Hyperon Polarization along the Beam Direction Relative to the Second and Third Harmonic Event Planes in Isobar Collisions at sqrt[s_{NN}]=200 GeV

The polarization of Λ and Λ[over ¯] hyperons along the beam direction has been measured relative to the second and third harmonic event planes in isobar Ru+Ru and Zr+Zr collisions at sqrt[s_{NN}]=200  GeV. This is the first experimental evidence of the hyperon polarization by the triangular flow originating from the initial density fluctuations. The amplitudes of the sine modulation for the second and third harmonic results are comparable in magnitude, increase from central to peripheral collisions, and show a mild p_{T} dependence. The azimuthal angle dependence of the polarization follows the vorticity pattern expected due to elliptic and triangular anisotropic flow, and qualitatively disagrees with most hydrodynamic model calculations based on thermal vorticity and shear induced contributions. The model results based on one of existing implementations of the shear contribution lead to a correct azimuthal angle dependence, but predict centrality and p_{T} dependence that still disagree with experimental measurements. Thus, our results provide stringent constraints on the thermal vorticity and shear-induced contributions to hyperon polarization. Comparison to previous measurements at RHIC and the LHC for the second-order harmonic results shows little dependence on the collision system size and collision energy.

Blockage of CacyBP inhibits macrophage recruitment and improves anti-PD-1 therapy in hepatocellular carcinoma

BACKGROUND

Despite remarkable advancements in cancer immunotherapy, the overall response rate to anti-programmed cell death-1 (anti-PD-1) therapy in hepatocellular carcinoma (HCC) patients remains low. Our previous study has demonstrated the critical role of CacyBP/SIP (Calcyclin-Binding Protein and Siah-1 Interacting Protein) as a regulator of HCC development and progression. However, the possible impact of CacyBP on the tumor immune microenvironment has not yet been clarified.

METHODS

The expressions of CacyBP and Myd88 in HCC cell lines and tissues was detected by bioinformatics analysis, real-time quantitative PCR, western blotting and immunohistochemistry. The interaction between CacyBP and Myd88 was measured using co-immunoprecipitation and immunofluorescence. In vitro and in vivo assays were used to investigate the regulation of CacyBP on tumor-associated macrophages (TAMs).

RESULTS

We identified that CacyBP was positively correlated with Myd88, a master regulator of innate immunity, and Myd88 was a novel binding substrate downstream of CacyBP in HCC. Additionally, CacyBP protected Myd88 from Siah-1-mediated proteasome-dependent degradation by competitively binding to its Toll/interleukin-1 receptor (TIR) domain. Inhibition of CacyBP-Myd88 signaling subsequently diminished HDAC1-mediated H3K9ac and H3K27ac modifications on the CX3CL1 promoter and reduced its transcription and secretion in HCC cells. Moreover, by using in vitro and in vivo strategies, we demonstrated that depletion of CacyBP impaired the infiltration of TAMs and the immunosuppressive state of the tumor microenvironment, further sensitizing HCC-bearing anti-PD-1 therapy.

CONCLUSIONS

Our findings suggest that targeting CacyBP may be a novel treatment strategy for improving the efficacy of anti-PD-1 immunotherapy in HCC.

The impact of SARS-COV-2 infection on menstruation

BACKGROUND

Recent study has demonstrated that the GnRH system in patients with post-COVID syndrome may be influenced by SARS-CoV-2. However, the impact of COVID-19 infection on women's menstruation is still unknown.

OBJECTIVE

We aimed to investigate the the relationship between coronavirus disease 2019 (COVID-19) and menstruation in premenopausal women.

METHODS

This was a retrospective cohort study. Pre-menopausal women were invited to participate in the online questionnaire on wechat. Participants were divided into four groups according to whether they were infected with severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) and whether they had menstrual changes during the pandemic. Sociodemographic characteristics, history of COVID-19, menstruation and menstrual changes of the participants were collected. Statistical analyses were performed using SPSS, version 25.0 (SPSS Inc., Chicago, IL, USA).

RESULTS

A total of 1946 women were included in the study. 1800 participants had been or were currently infected with SARS-COV-2, and 146 people had not been infected. Among 1800 patients with COVID-19, 666 (37.0%) had changes in menstruation, and 1134 (63.0%) did not, which was significantly higher than the uninfected participants (c2 = 12.161, P = 0.000). The proportion of participants with menstrual cycle changes (450/67.6%) is larger than that of uninfected participants (c2 = 6.904, P = 0.009). COVID-19 vaccination was associated with lower odds of menstrual cycle change (OR, 0.855; 95% CI, 0.750-0.976). Participants who reported chest pain (OR, 1.750, 95% CI, 1.209-2.533) and dyspnea (OR, 1.446; 95% CI, 1.052-1.988) during infection had greater odds of changes to their menstrual cycle compared with the participants who did not.

CONCLUSIONS

The association between the COVID-19 and increased prevalence of menstrual cycle irregularity. COVID-19 vaccination is a protective factor in the long term, and participants with chest pain and dyspnea are more likely to develop AUB.

The relationship between central obesity and risk of breast cancer: a dose-response meta-analysis of 7,989,315 women

Purpose

Central obesity may contribute to breast cancer (BC); however, there is no dose-response relationship. This meta-analysis examined the effects of central obesity on BC and their potential dose-response relationship.

Methods

In the present study, PubMed, Medline, Embase, and Web of Science were searched on 1 August 2022 for published articles. We included the prospective cohort and case-control studies that reported the relationship between central obesity and BC. Summary effect size estimates were expressed as risk ratios (RRs) or odds ratios (ORs) with 95% confidence intervals (95% CI) and were evaluated using random-effect models. The inconsistency index (I2) was used to quantify the heterogeneity magnitude derived from the random-effects Mantel-Haenszel model.

Results

This meta-analysis included 57 studies (26 case-control and 31 prospective cohort) as of August 2022. Case-control studies indicated that waist circumference (WC) (adjusted OR = 1.18; 95% CI: 1.00-1.38; P = 0.051) and waist-to-hip ratio (WHR) (adjusted OR = 1.28; 95% CI: 1.07-1.53; P = 0.008) were significantly positively related to BC. Subgroup analysis showed that central obesity measured by WC increased the premenopausal (adjusted OR = 1.15; 95% CI: 0.99-1.34; P = 0.063) and postmenopausal (adjusted OR = 1.18; 95% CI: 1.03-1.36; P = 0.018) BC risk and the same relationship appeared in WHR between premenopausal (adjusted OR = 1.38; 95% CI: 1.19-1.59; P < 0.001) and postmenopausal (adjusted OR = 1.41; 95% CI: 1.22-1.64; P < 0.001). The same relationship was observed in hormone receptor-positive (HR+) (adjusted ORWC = 1.26; 95% CI: 1.02-1.57; P = 0.035, adjusted ORWHR = 1.41; 95% CI: 1.00-1.98; P = 0.051) and hormone receptor-negative (HR-) (adjusted ORWC = 1.44; 95% CI: 1.13-1.83; P = 0.003, adjusted ORWHR = 1.42; 95% CI: 0.95-2.13; P = 0.087) BCs. Prospective cohort studies indicated that high WC (adjusted RR = 1.12; 95% CI: 1.08-1.16; P < 0.001) and WHR (adjusted RR = 1.05; 95% CI: 1.018-1.09; P = 0.017) may increase BC risk. Subgroup analysis demonstrated a significant correlation during premenopausal (adjusted RR = 1.08; 95% CI: 1.02-1.14; P = 0.007) and postmenopausal (adjusted RR = 1.14; 95% CI: 1.10-1.19; P < 0.001) between BC and central obesity measured by WC, and WHR was significantly positively related to BC both premenopausal (adjusted RRpre = 1.04; 95% CI: 0.98-1.11; P = 0.169) and postmenopausal (adjusted RRpost = 1.04; 95% CI: 1.02-1.07; P = 0.002). Regarding molecular subtype, central obesity was significantly associated with HR+ (adjusted ORWC = 1.13; 95% CI: 1.07-1.19; P < 0.001, adjusted ORWHR = 1.03; 95% CI: 0.98-1.07; P = 0.244) and HR- BCs (adjusted ORWC =1.11; 95% CI: 0.99-1.24; P = 0.086, adjusted ORWHR =1.01; 95% CI: 0.91-1.13; P = 0.808). Our dose-response analysis revealed a J-shaped trend in the relationship between central obesity and BC (measured by WC and WHR) in case-control studies and an inverted J-shaped trend between BMI (during premenopausal) and BC in the prospective cohort.

Conclusion

Central obesity is a risk factor for premenopausal and postmenopausal BC, and WC and WHR may predict it. Regarding the BC subtype, central obesity is proven to be a risk of ER+ and ER- BCs. The dose-response analysis revealed that when BMI (during premenopausal) exceeded 23.40 kg/m2, the risk of BC began to decrease, and WC higher than 83.80 cm or WHR exceeded 0.78 could efficiently increase the BC risk.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022365788.

Genetic Spectrum of Congenital Anomalies of the Kidney and Urinary Tract in Chinese Newborn Genome Project

Introduction

Congenital anomalies of the kidney and urinary tract (CAKUT) corresponds to a spectrum of defects. Several large-cohort studies have used high-throughput sequencing to investigate the genetic risk of CAKUT during antenatal, childhood, and adulthood period. However, our knowledge of newborns with CAKUT is limited.

Methods

This multicenter retrospective cohort study explored the genetic spectrum of CAKUT in a Chinese neonatal cohort. Clinical data and whole exome sequencing (WES) data of 330 newborns clinically diagnosed with CAKUT were collected. WES data were analyzed for putative deleterious single nucleotide variants (SNVs) and potential disease-associated copy number variants (CNVs).

Results

In this study, pathogenic variants were identified in 61 newborns (18.5%, 61/330), including 35 patients (57.4%) with SNVs, 25 patients (41%) with CNVs, and 1 patient with both an SNV and a CNV. Genetic diagnosis rates were significantly higher in patients with extrarenal manifestations (P＜0.001), especially in those with cardiovascular malformations (P＜0.05). SNVs in genes related to syndromic disorders (CAKUT with extrarenal manifestations) were common, affecting 20 patients (57.1%, 20/35). KMT2D was the most common gene (5 patients) and 17q12 deletion was the most common CNV (4 patients). Patient 110 was detected with both a CNV (17q12 deletion) and an SNV (a homozygous variant of SLC25A13). Among the newborns with positive genetic results, 22 (36.1%, 22/61) patients may benefit from a molecular diagnosis and change in clinical management (including early multidisciplinary treatment, disease-specific follow-up, and familial genetic counseling).

Conclusion

This study shows the heterogeneous genetic etiologies in a Chinese CAKUT neonatal cohort by using WES. Patients with CAKUT who have extrarenal manifestations are more likely to harbor genetic diagnoses. Kabuki syndrome and 17q12 deletion syndrome were the most common genetic findings. Approximately 36.1% of the patients may benefit from molecular diagnoses and a change in clinical management.

Overcoming Radio-Immunotherapy Treatment Resistance through ILT4 Blockade and Reversal of HFRT Induced CXCL1-CXCR2 Axis Activation and Tumor-Associated Macrophage Immunosuppression

PURPOSE/OBJECTIVE(S)

Immunotherapy combined with radiotherapy (iRT) has unlimited potential, but up to 60% of cancer patients do not benefit from it. Enhancing the anti-tumor immune stimulatory effect triggered by radiotherapy is the key to overcome iRT resistance. Immunoglobulin-like transcript (ILT) 4 is a potential immune checkpoint molecule, highly expressed in various tumor cells, but its role in radiotherapy is still unknown. This study confirmed the role and molecular mechanism of ILT4 in suppressing radiotherapy immunosuppressive microenvironment formation and promoting tumor radiotherapy resistance. We propose a new therapeutic strategy that block ILT4 to enhance the efficacy of radiotherapy, and cooperate with radiotherapy to reverse immunotherapy resistance.

MATERIALS/METHODS

Using multiplex immunohistochemistry, we analyzed ILT4 expression, tumor-associated macrophage (TAM) /T cell phenotype and quantity in tumor patient treated with SBRT. Using mice subcutaneous tumor models, Single-cell RNA sequencing and multiplex flowcytometry, we assessed the role of ILT4 inhibition and hyper-fractionated radiotherapy (HFRT) on preventing tumor growth and immune escape. The molecular signaling and cytokines regulated by ILT4 under HFRT were analyzed by transcriptome sequencing and further verified by molecular experiments. By establishing cancer cell/TAM co-culture system in vitro, using CXCL1 protein or CXCR2 inhibitor and macrophage/CD8+ T cell deletion antibody in vivo, we identified the downstream pathway and cytokine of ILT4 to enhancing HFRT -induced TAM immune response.

RESULTS

In the tumor specimens of NSCLC patients treated with SBRT, we found that high ILT4 expression predicted poor progression-free survival and more M2-TAM recruitment. Among the C57BL/6 mice model, ILT4 inhibition in cancer cells reduced HFRT mediated M2-TAMs accumulation, and to sustain activation and proliferation of CD8+ T cells, and eventually suppressed tumor progression. Mechanistically, RT promoted ILT4 expression, which subsequently induced NF-κB pathway activation and CXCL1 secretion to enhance M2-TAMs migration in vitro. Using CXCL1 protein or CXCR2 inhibitor administration, inferring that ILT4 promotes TAMs migration via NF-κB-CXCL1-CXCR2 axis. Consistently, depletion of TAMs blocked the T cell function impairment and radiotherapy resistance induced by ILT4 in vivo. Importantly, targeting ILT4 potentiated the effect of radiotherapy, overcomes radio-immunotherapy treatment resistance.

CONCLUSION

ILT4 mediates HFRT-induced M2-like TAMs recruitment and subsequently T cell response impairment by regulating NF-κB-CXCL1-CXCR2 axis. ILT4 is an attractive drug target for enhancing radiotherapy and overcomes radio-immunotherapy treatment resistance.

Metformin Antagonizes Radiotherapy-Induced Anti-Tumor Effects via Inhibition of cGAS-STING Pathway Mediated Immune Responses

PURPOSE/OBJECTIVE(S)

Radiotherapy induced anti-tumor effects depend on both direct tumor cell death caused by radiation and immune activation mediated by cGAS-STING pathway. Metformin (MTF), which could augment the tumoricidal efficiency of radiation, is indicated to be a radiosensitizer by basic research. However, several large prospective clinical trials proved otherwise. In present study, we intend to interrogate the effects of MTF on radiotherapy-induced anti-tumor immune responses and try to explain the inconsistent outcomings of radiotherapy combined with MTF in basic research and clinical practice.

MATERIALS/METHODS

To explore the effects of MTF on radiotherapy induced anti-tumor effects, tumor models were established using E0771, B16F10 and LLC cell lines in both immunocompetent and immunodeficient mice. To investigate the composition and function of immune cells in tumor microenvironments, single-cell transcriptome sequencing of CD45+ cells sorted from tumor microenvironments were carried out, and flow cytometry and multiple immunofluorescence analysis were then performed for validation. To reveal the possible mechanisms, tumor cells were subjected to radiotherapy in the presence or absence of MTF in vitro, and RNA-sequencing was then employed followed by subsequent validation with western blotting, real-time qPCR and flow cytometry.

RESULTS

We found that systematic administration of MTF could significantly inhibit radiotherapy-induced anti-tumor effects in immunocompetent mouse models. Single cell sequencing of CD45+ cells sorted from tumor microenvironments and further validation showed that administration of MTF dramatically attenuated the infiltration and cytotoxic capacity of CD8+ T cells after radiotherapy. cGAS-STING pathway in tumor cells was required for maximum efficiency of radiotherapy, while MTF curbed cGAS-STING pathway after radiotherapy in a dose-dependent pattern by enhancing autophagy and reducing cytoplasmic mitochondrial DNA accumulation, which contributed to compromised anti-tumor effects.

CONCLUSION

Our findings indicated that MTF could antagonize radiotherapy-mediated anti-tumor effects by inhibiting the activation of cGAS-STING pathway and subsequent immune responses, which may partially explain the unsatisfied outcomes of radiotherapy combined with MTF in clinical practices. Since the anti-tumor effects of radiotherapy rely not only on the tumor-killing efficiency of radiation but also on systematic immune responses, our findings suggest that cautions are needed when MTF is administrated with radiotherapy in clinical practice.

Efficacy of Postoperative Radiotherapy for Patients with New N2 Descriptors of Subclassification in Completely Resected Non-Small Cell Lung Cancer: A Real-World Study

PURPOSE/OBJECTIVE(S)

Patients with N2 non-small cell lung cancer (NSCLC) were heterogeneous groups and required further stratification. The International Society for the Study of Lung Cancer (IASLC) added new descriptors of three sub-stages for stage N2 NSCLC: N2 at a single station without N1 involvement (N2a1), N2 at a single station with N1 involvement (N2a2), and N2 at multiple stations (N2b). This study aimed to investigate the efficacy of postoperative radiotherapy (PORT) for patients with these N2 descriptors.

MATERIALS/METHODS

Patients with histologically confirmed NSCLC after complete resection and divided into PORT group and non-PORT group. The primary endpoint was DFS. The second endpoints were overall survival (OS) and locoregional recurrence-free survival (LRFS). Propensity-score matching (PSM) of baseline characteristics between the PORT and non-PORT groups was used for validation.

RESULTS

Totally 1832 patients were enrolled, including 308 N2a1 patients, 682 N2a2 patients, and 842 N2b patients. The median follow-up time was 50.1 months. The survival outcomes of the PORT and non-PORT groups before PSM were shown in Table 1. For patients with N2a1, PORT could not improve the DFS (median DFS of the PORT group and the non-PORT group: not reached vs. 46.8 months, P = 0.41), OS (P = 0.85), or LRFS (P = 0.32), which were consistent with the multivariate analysis and data after the PSM. For patients with N2a2, PORT significantly improved the DFS (median DFS 29.7 vs. 22.2 months, P = 0.02), OS (P = 0.03), and LRFS (P = 0.01). The multivariate analysis and data after the PSM confirmed the benefits in DFS and LRFS, but no benefit was observed in OS (multivariate analysis: HR 0.79, P = 0.18; median OS after PSM: 103.7 vs. 63.1 months, P = 0.34). For patients with N2b, PORT could not improve the DFS (median DFS 20.6 vs. 21.2 months, P = 0.39) but significantly improved the OS (P<0.001) and LRFS (P<0.001). However, the multivariate analysis showed that PORT significantly improved DFS (HR 0.81, P = 0.03), consistent with the data after the PSM (median DFS 20.6 and 17.6 months, P = 0.04).

CONCLUSION

PORT significantly improved the DFS and LRFS in patients with N2a2 and significantly improved the DFS, LRFS, and OS in patients with N2b. Patients with N2a1 could not benefit from PORT.

Targeting XPO1 Combined with Radiotherapy to Enhance Systemic Anti-tumor Effects in Non-Small Cell Lung Cancer

PURPOSE/OBJECTIVE(S)

The combination of radiation and radiosensitizing chemotherapeutic agents have shown promising anti-tumor effects in NSCLC. Acting as an oncogenic driver, XPO1 is frequently overexpressed and/or mutated in lung cancer. Thus, suppression of XPO1-mediated nuclear export presents a unique therapeutic strategy. We hypothesize that XPO1 inhibition combined with radiotherapy (XRT) may remodel the tumor immune microenvironment (TIME) and reduce radioresistance, thus enhance systemic anti-tumor effects.

MATERIALS/METHODS

Herein, we optimized a small molecule inhibitor, WJ01024, which can bind to XPO1 and antagonize its activity to inhibit nuclear export. In the C57BL/6 mouse subcutaneous tumor model, we evaluated the ability of different treatment regimens containing oral WJ01014 single or combined with XRT (one fractions of 15 Gy) in tumor control and tumor recurrence inhibition. The effects of each treatment regimen on the alterations of immunophenotypes, including the quantification, activation, proliferative capacity, exhaustion marker expression, and memory status, were evaluated by flow cytometry.

RESULTS

In our study, we found that the overexpression of XPO1 was associated with poor prognosis and survival in radioresistant patients with NSCLC. The combination therapy of WJ01024 and XRT resulted in an increase of apoptosis and a decrease of proliferation compared to monotherapy, which was closely correlated with tumor regression and improved survival in the C57BL/6 mouse subcutaneous tumor model. Notably, we found that WJ01024 were shown to enhance the therapeutic effect of XRT by remodeling TIME. Compared with XRT, the addition of WJ01024 increased the infiltration and proliferation of radiation-stimulated CD8+ T cells, which especially promoted the production of interferon-γ and granzyme B. Moreover, the combination therapy also reversed the immunosuppressive effect of radiation on the percentage of Tregs and exhausted T cells in mouse xenografts. Thus, the TIME was significantly improved in combination therapy. Strikingly, mechanistic studies suggested that the activation of cyclic GMP-AMP synthase/stimulator of interferon genes (cGAS/STING) signaling pathway is required to reshape TIME and produce synergistic anti-tumor effect with the combination of WJ01024 and XRT.

CONCLUSION

Our findings suggest that WJ01024 might be a potential synergistic treatment for radiotherapy to control the proliferation of NSCLC cells, promote tumor regression and prolong survival in mouse model of NSCLC by activating cGAS/STING signaling, and this in turn potentiate the immune microenvironment.

Single-Cell RNA Sequencing Reveals a Subset of cMAS can Aggravate RIHD through CXCL1-CXCR2 Axis

PURPOSE/OBJECTIVE(S)

Radiation induced heart disease (RIHD) is any form of cardiac toxicity induced by radiation therapy (RT) for thoracic cancers. Our previous studies have shown that RT obviously contributed to cardiovascular diseases-specific death over 3 years while RT became protective in the short term within 2 years survival in non-small cell lung cancer patients. Here, single cell RNA sequencing (scRNA-seq) was performed to identify various cell subsets and investigate their functions and dynamics in RIHD which offered several targets for early clinical interventions to alleviate RIHD.

MATERIALS/METHODS

Based on evaluation of histopathological characteristics, ejection fraction and serum levels of cardiac injury biomarkers, we have established mouse models during different stages to simulate clinical RIHD progression. Hence, we performed single cell RNA-sequencing of RIHD models to characterize the diversity within specific cell types and obtain basic information of differently expressed genes (DEGs). We investigated the role of several cell clusters and DEGs in RIHD through bioinformatics analysis and experimental verification. In vivo, mouse models were given intraperitoneal injection of CXCR2 inhibitor. Bone marrow macrophages and primary cardiac fibroblasts were extracted for in vitro experiments.

RESULTS

RIHD processes were divided into acute injury, compensation and decompensation stage. Transcriptomes of 31769 single cells from cardiac suspension have been profiled. Analysis of scRNA-seq revealed that there were 30 cell clusters participating in RIHD. The fraction of cell populations varied greatly at three stages which indicated RIHD was a dynamic process and each cell cluster functioned differently at different stages. Notably, we observed cardiac resident macrophages (cMAS) subset accounted for the highest fraction during the compensatory period and decreased in decompensation period. Pseudotime analysis showed cMAS had a different developmental trajectory compared to myeloid derived cells. Moreover, CXCR2 was significantly expressed in cMAS cluster. Ligand-receptor interaction results suggested that CXCL1 secreted by cardiac fibroblasts bind primarily to CXCR2+ cMAS and participated in the formation of the extracellular matrix (ECM) related to cardiac fibrosis. Moreover, cardiac fibrosis of RIHD models were relieved after CXCR2 inhibitor treatment. CXCL1 expression in primary cardiac fibroblast elevated after RT.

CONCLUSION

The identification of main cell clusters provided a new insight to investigate RIHD through dynamics of cell phenotypes and cell-cell communications during RIHD processes. In compensation stage, CXCR2+ cMAS could be activated by CXCL1 secreted by cardiac fibroblasts. Both were associated with ECM and contribute to the decompensation stage.

IL-1β+ Tumor Associated Macrophages Induced by Type I Interferon Initiates Radiotherapy-Mediated Abscopal Effect

PURPOSE/OBJECTIVE(S)

Both experimental and clinical studies have proved that radiotherapy can lead to not only local control of irradiated tumors, but also tumor regression of non-irradiated area, termed as abscopal effect. Abscopal effect has been attributed to radiotherapy-induced innate and adaptive anti-tumor immune responses. However, the detailed molecular mechanisms and key cellular components are still unclear. So, the purpose of this study is to reveal the key molecular mechanisms and essential cells in inducing abscopal effect.

MATERIALS/METHODS

Bilateral MC38 subcutaneous tumor mouse models were established, and primary tumors were subjected to one fraction of 15Gy. CD45+ cells were sorted from both primary and abscopal tumors 3-, 7-, 17- and 24-day post radiotherapy respectively and subjected to single-cell RNA sequencing followed by standard bioinformatic analysis with R studio. To verify the findings, flow cytometry, mIHC and real-time qPCR were carried out to analyze the cellular and molecular components in tumor microenvironments. Cellular depletion experiments and conditional knockout mice were finally employed to confirm key mechanisms that contribute to abscopal effect.

RESULTS

The primary and abscopal immune microenvironments showed different repertoires time-dependently. Radiotherapy induced durable type I interferon (IFN-I) responses with dramatic infiltration and activation of CD8+ T cells and tumor associated macrophages (TAMs) in primary tumors. However, in abscopal tumors, we found that TAMs rather than CD8+ T cells were the predominant population activated in early stages (3- and 7-day post radiotherapy), and functional CD8+ T cells enriched until late stages (24-day post radiotherapy). Thorough analysis of scRNA-seq and experimental validation discovered a unique subset of TAMs characterized by high expression of IL-1β emerged as early as 3-day post radiotherapy in both primary and secondary tumor immune microenvironments, termed as IL-1β+ TAMs herein. IL-1β+ TAMs were the main activated component in abscopal tumors in early stage, and strongest respondent to IFN-I pathway. Abscopal effect was significantly attenuated when IFN-I response was abolished in either primary or abscopal tumors or TAMs were depleted from abscopal tumors.

CONCLUSION

Our data identified a subset of immune cells, IL-1β+ TAMs, and IFN-I as the essential cellular and molecular components that contribute to abscopal effect. Mechanically, radiotherapy-induced dramatical IFN-I response in primary tumors lead to enrichment of IL-1β+ TAMs, which initiated the anti-tumor immune response in abscopal tumors. All these findings provided theoretical basis for understanding and improving radiotherapy-induced abscopal effect.

Spatial Proteome Analysis Identifies Lymphocyte CD44 as a Biomarker Associated with SBRT Resistance in Early-Stage Non-Small Cell Lung Cancer

PURPOSE/OBJECTIVE(S)

To discover and validate spatially-resolved protein markers associated with resistance to SBRT in early-stage NSCLC patients.

MATERIALS/METHODS

We initially evaluated a discovery cohort of 44 early-stage NSCLC patients treated with SBRT as first-line treatment at the Shandong cancer hospital. Using the GeoMx DSP system, 71 proteins were measured in five molecular compartments (tumor, leukocyte, lymphocyte, macrophage, and stroma) on pre-treatment samples. Candidate biomarkers were orthogonally validated with the Gem AQUA method of quantitative immunofluorescence (QIF). For internal independent cohort validation, we assessed pre-treatment samples derived from 150 NSCLC patients who receive radiotherapy. We further analyzed 100 radiotherapy untreated patients with operable NSCLC to address prognostic significance.

RESULTS

Using continuous log-scaled data, we identified CD44 expression in the lymphocyte compartment (CD3+) as a novel predictor of poor progression-free survival (PFS) (multivariate HR = 7.323, p = 0.0079) and overall survival (OS) (multivariate HR = 8.65, p = 0.028) in the discovery set. High CD44 expression in the tumor compartment (pan-cytokeratin, CK+) predicted significantly shorter OS (multivariate HR = 2.208, p = 0.0212), with no significant difference in PFS. We validated by QIF that lymphocyte CD44 levels were associated with resistance to SBRT therapy and prognostic for poor outcomes. Using QIF in an independent radiotherapy treated cohort, we validated that CD44 levels in the lymphocyte compartment were associated with poor PFS and OS. High lymphocyte cell CD44 was not prognostic in non-radiotherapy-treated cohort. Using DSP data, intratumoral regions with elevated lymphocyte cell CD44 expression showed prominent upregulation of CD127, ARG1 and VISTA in the discovery Cohort.

CONCLUSION

In conclusion, we identified and validated lymphocyte cell CD44 as a biomarker indicative of resistance to SBRT or radiotherapy in patients with NSCLC. Further evaluation is warranted to address the predictive value of lymphocyte cell CD44 in multi-institutional studies and clinical trials.

Irradiated Tumor Cells-Derived Exosomes Modulate Macrophage Polarization by Targeting SHP-2 Mediated Metabolic Reprogramming

PURPOSE/OBJECTIVE(S)

Tumor-associated macrophages (TAMs) constitute a plastic and heterogeneous cell population of the tumor microenvironment (TME) that can regulate tumor proliferation and support resistance to therapy, constituting promising targets for the development of novel anticancer agents. The efficacy of radiotherapy, a mainstay of cancer treatment, can strongly influence TAMs recruitment and phenotype. Our previous results demonstrated that SHP-2 and PD-L1 inhibition combined with radiotherapy enhances systemic antitumor effects in non-small cell lung cancer (NSCLC). Especially, SHP-2 has an important effect on the polarization of TAM in the context of radiotherapy. However, the immune mechanisms of SHP-2 in TAM remain largely unknown, and this leads us to implement this project.

MATERIALS/METHODS

Transmission electron microscopy and differential ultracentrifugation were used to verify the existence of exosomes. The bone marrow-derived macrophages (BMDM) and peritoneal macrophages (PM) were derived from C57BL/6 mice for vitro tests. In vivo and in vitro assays were used to identify roles of exosomal miRNA targeting SHP-2. To investigate the regulating function of SHP-2 in TAMs, co-culture experiments, qPCR, Western Blot, Flow Cytometry and Oxygraph-2k were employed. And we also explore tumor growth and tumor environment changes in SHP-2 flox/floxLyz-Cre+/- (CKO) mice.

RESULTS

We found that irradiated tumor cells-derived exosomes reprogramed their energy metabolism and polarized primary macrophages to an anti-inflammatory phenotype. Furthermore, SHP-2 in macrophages was a direct target of exosomal miR-138-5p from irradiated tumor cells. In vitro study also demonstrates that miR-138-5p can down-regulate SHP-2 in the BMDMs and PMs. Further research has shown that SHP-2 negatively regulated glycolysis through dephosphorylating Pyruvate kinase M2 (PKM2) at the Tyr105 site. In addition, SHP-2 can inhabit PKM2 translocation to the nucleus by dephosphorylating PKM2 at the Ser37 site. Thus, the SHP099 (a SHP-2 inhibitor) can uptake and utilization of glucose by SHP-2/PKM2(Tyr105) (Ser37)/β-catenin/LDHA/Glut-1 axis, suggesting that SHP099 plays positive roles on glycolysis and M1-polarized. In vivo study showed that SHP-2 flox/floxLyz-Cre+/- (CKO) mice display enhanced control of solid tumor growth, accompanied by increased the proportion of M1-like macrophages.

CONCLUSION

Our study demonstrates that exosomal miR-138-5p from irradiated tumor cells can modulate macrophage polarization by targeting SHP-2. And SHP-2 negatively regulates glycolysis and polarize macrophage to an M2 phenotype by SHP-2/PKM2(Tyr105) (Ser37)/β-catenin/LDHA/Glut-1 axis.

Carm1 Inhibition Potentiates Irradiation-Induced Antitumor Immunity via Tumor Intrinsic STING Pathway Activation

PURPOSE/OBJECTIVE(S)

Radiotherapy is commonly applied in multiple cancer types. Besides irradiation induced direct cell death, radiotherapy stimulated significant immune responses for tumor control. Intact and functional cGAS-STING pathway in both tumor cells and host cells is indispensable for efficient irradiation-induced anti-tumor effects. Coactivator-associated arginine methyltransferase 1 (Carm1) is emerging as an attractive therapeutic target and a biomarker for prognosis in various types of cancer. It has been reported that Carm1 inhibition could improve immunotherapy induced anti-tumor effects. However, it remains unclear how tumor cell intrinsic Carm1 affects irradiation-induced anti-tumor immunity.

MATERIALS/METHODS

Carm1 deficient cell lines were established in MC38 and B16F10 murine cancer cells using the CRISPR/Cas9 technology. To verify the effects of tumor `subcutaneous tumor mouse models were established and one fraction of 15Gy was administrated when the tumor volume reached 200mm3, followed by flow cytometry assays. Transcriptome sequencing, protein mass spectrometry, single-cell sequencing, Digital Spatial Profiling (DSP), real-time qPCR, western blotting, immunofluorescence and co-immunoprecipitation were carried out to explore and verify possible molecular mechanisms.

RESULTS

Here we found Carm1 deficiency in tumor cells dramatically enhanced irradiation-induced anti-tumor immune responses. Transcriptome sequencing of irradiated tumor cells and further experiments then validated that cGAS-STING pathway was significantly activated after irradiation in the absence of Carm1 in tumor cells, which contributed to enhance anti-tumor immunity after irradiation. Mechanistically, Carm1 deficiency in tumor cells attenuated autophagy, resulting in increased cytoplasmic mtDNA enrichment and enhanced cGAS-STING pathway activation. On the other hand, we also found that Carm1 caused asymmetric arginine methylation (ADMA) modification of TBK1 with reduced phosphorylation level, and Carm1 deficiency could activate cGAS-STING pathway by reducing AMDA modification and enhancing phosphorylation of TBK1. Finally, Carm1 inhibitor EZM2302 was applied in combination with radiotherapy in vitro, and it's indicated that combination therapy resulted in intensive anti-tumor immunity and prominent abscopal effects.

CONCLUSION

In this study, we identified that Carm1 ablation in tumor cells could promote irradiation-induced antitumor immunity through tumor cell intrinsic STING pathway activation. Mechanically, Carm1 deficiency directly activated the cGAS-STING pathway by interacting with TBK1 and increased mtDNA accumulation in cytoplasm by inhibiting autophagy. These findings provided new strategies for targeting Carm1 to boost the efficacy of radiotherapy.

RUNX1 as a Potential Target for Combined Radioimmunotherapy of Lung Adenocarcinoma

PURPOSE/OBJECTIVE(S)

Radioimmunotherapy for non-small cell lung cancer has good clinical application prospects. The role and mechanism of RUNX1 in DNA damage repair were explored for its potential role in lung adenocarcinoma radioimmunotherapy.

MATERIALS/METHODS

To study the effect of RUNX1 expression level on the expression of DNA damage repair system related factors and radiation sensitivity of lung adenocarcinoma cells. As an important nuclear transcription factor, RUNX1 was explored whether directly regulating the expression of Nrf2, Rad51, BRCA1, and verifying their respective DNA binding sites in the promoter region through relevant databases. To observe the effect of RUNX1 knockout and overexpression on the expression level of PD-L1 in tumor cells at the cell level; The effect of RUNX1 expression level on the sorting and presentation of PD-L1 cells was investigated by the method of nucleocytoplasmic separation. According to literature reports, CMTM6 and ALIX play a key role in the process of PD-L1 cell sorting and presentation, and explore whether RUNX1 plays a role through this factor. The effect of phosphorylation level of different splicing bodies of RUNX1 (RUNX1a/b/c) on the expression level and DNA damage repair system related factors on tumor radiosensitivity were also explored.

RESULTS

According to TCGA database, RUNX1 is highly expressed and phosphorylated in lung adenocarcinoma. Through gene comparison with the database, it was found that RUNX1 binding sites existed in the promoter region of several factors related to this study, including ALIX, Nrf2, BRCA1, RAD51, ATM, H2AX, etc. After being activated by MAPKp38 phosphorylation, RUNX1a can positively regulate Nrf2 signal pathway. The expression of RUNX1 and p-RUNX1 is time-dependent on ionizing radiation. At the same time, it was found that the expression of RUNX1 and p-RUNX1 was dose-dependent on ionizing radiation, and the expression trend of Nrf2 signal pathway related factors was consistent with RUNX1. RUNX1 regulates the expression of PD-L1, BRCA1, ALIX and Nrf2. Bioinformatics analysis and flow cytometry data show that RUNX1 has inhibitory effect on tumor microenvironment of lung adenocarcinoma.

CONCLUSION

RUNX1 regulates DNA damage repair system and has inhibitory effect on tumor immunity. Inhibiting the expression of RUNX1 in lung adenocarcinoma cells can enhance the effect of radioimmunotherapy.

Safety and Efficacy Analysis of Patients with Extensive-Stage Small Cell Lung Cancer (ES-SCLC) Treated with SHR-1316 Plus Chemotherapy and Sequential Chest Radiotherapy as First-Line Therapy from a Phase II Trial

PURPOSE/OBJECTIVE(S)

CAPSTONE-1, a phase 3 trial, showed that SHR-1316 (PD-L1 antibody) combined with standard first-line chemotherapy could prolong overall survival (OS) in patients (pts) with ES-SCLC. The CREST trial reported consolidative thoracic radiotherapy (TRT) of 30 Gy in 10 fractions provided a 10% 2-year OS benefit and more intensive TRT should be investigated in ES-SCLC. In the era of immunotherapy, the role of TRT also needs further exploration. Therefore, we designed this clinical trial to investigate the efficacy and safety of SHR-1316 plus first-line chemotherapy followed by TRT combined with SHR-1316.

MATERIALS/METHODS

Key inclusion criteria were pts aged 18-75 years, with previously untreated histologically or cytologically confirmed ES-SCLC, and an ECOG performance status of 0-1. Eligible pts would receive 4∼6 cycles of SHR-1316 (20mg/kg, D1, q3w) combined with EP/EC (etoposide, 100mg/m2, D1-5, q3w and cisplatin, 75mg/m², D1-3, q3w or carboplatin, AUC = 5, D1, q3w), followed by SHR-1316 combined with TRT (≥3 Gy*10 f or ≥2 Gy*25 f, involved-field irradiation), and then the maintenance therapy with SHR-1316 until disease progression or intolerable adverse events (AEs). The main endpoints included ORR, PFS and safety.

RESULTS

From October 2020 to January 2023, 33 pts received SHR-1316 and sequential consolidative TRT. Among them, 19 pts received high-dose TRT (>3 Gy*10 f or ≥2 Gy*25 f) and 14 pts received low-dose TRT (≤3 Gy*10 f or<2 Gy*25 f). The median age was 62 (range: 38-73). Most pts were male (28, 84.8%), former smokers (22, 66.7%) with an ECOG performance status 1 (32, 97%). Ten (30.3%) pts were diagnosed with brain metastasis and 10 (30.3%) pts had liver metastasis at baseline. At the data cutoff date, 9 pts remained on treatment, the average number of treatment cycles was 9.2. 33 pts had at least one 1 post-treatment tumor assessment. The confirmed ORR and DCR were 90.9% (30/33) and 100% (33/33) in all pts, were 89.5% (17/19) and 100% (19/19) in high-dose TRT group, and were 92.9% (13/14) and 100% (14/14) in low-dose TRT group. The median PFS was 10.2(CI: 5.8∼14.7) months in all pts, was 7 (CI: 3.8∼10.2) months in high-dose TRT group and 10.4 (CI: 8.4∼12.3) months in low-dose TRT group. AEs occurred in 27 (81.8%) pts and grade 3 or 4 AEs occurred in 20 (60.6%) pts. The most common grade 3 or 4 AEs included neutropenia (15, 45.5%), leukopenia (8, 24.2%), lymphocytopenia (5, 15.2%), pneumonia (3, 9.1%), anemia (3, 9.1%) and thrombocytopenia (2, 6.1%).

CONCLUSION

SHR-1316 plus chemotherapy and sequential TRT as first-line therapy for ES-SCLC showed promising efficacy and acceptable safety. There is no significant difference between high-dose and low-dose TRT groups in terms of safety and efficacy according to current data.

Role and Modality of Combining Radiotherapy with Immunotherapy in Stage III-IV Unresectable Small Cell Lung Cancer

PURPOSE/OBJECTIVE(S)

The combination of radiotherapy and immunotherapy was rarely reported in the management of small cell lung cancer (SCLC). We retrospectively assessed the role and modality of this combination in Stage III-IV unresectable SCLC.

MATERIALS/METHODS

Patients with stage III and IV SCLC were enrolled according to AJCC 8th edition. Both efficacy and safety of immunotherapy combined with radiotherapy were evaluated. Thereinto, patients received first-line chemo-immunotherapy and sequential thoracic consolidation radiotherapy (TCRT) were further evaluated. Survival and descriptive analyses were performed.

RESULTS

Between January 1, 2019 and December 31, 2021, 51 patients were included in our analysis. Median follow-up was 28.0 months (95% CI 22.8-33.2). Patients received radiotherapy in treatment course had a prolonged 2-year overall survival (OS). And in the first-line immunotherapy cohort of 27 patients, the addition of TCRT significantly improved 2y-OS (72.22% vs. 13.89%, p = 0.0048), 2y-locoregional recurrence free survival (LRRFS) (90.00% vs 48.00%, p = 0.011), and 2y-distance progression free survival (DPFS) (66.67% vs. 16.67%, p = 0.039). Subgroup analyses showed that TCRT rendered superior outcomes regardless of brain metastases. Dose-escalation (45 Gy/15f) and earlier radiotherapy seemed to improve the benefit. Of 70.37% (19/27) patients experienced disease progression in the TCRT evaluation cohort, 63.16% (12/19) patients failed in brain. A tendency toward better OS and superior brain metastases free survival (BMFS) were observed after receiving prophylactic cranial irradiation (PCI). Finally, the most common grade 2 or higher toxic effects were pneumonitis in all patients (11.76% of immune-related vs. 7.84% of radiation related).

CONCLUSION

Earlier addition of TCRT to immunotherapy could significantly improve survival and extracranial control for stage IIIA-IVB unresectable SCLC patients, with no increased risk of adverse events. In the era of immunotherapy, PCI may still be a recommended strategy. Further investigation is warranted.

HPK1 Inhibition Enhancing HFRT Anti-Tumor Immune Response

PURPOSE/OBJECTIVE(S)

Radiation therapy, as one of the canonical treatments for classic tumors, results in impressive clinical responses. Stereotactic body radiotherapy (SBRT) has been increasingly used as one main therapy in early-stage non-small-cell lung cancer (NSCLC). SBRT affords good local tumor control, however, recurrence and metastasis are still the main causes of treatment failure. With the continuous deepening of the relationship between radiotherapy (RT) and immunity, reversing RT induced immunosuppression is considered to be a promising strategy to improve radiotherapy efficacy. Hematopoietic progenitor kinase 1 (HPK1) is mainly expressed in immune cells while rarely expressed in tumor cells. It has been proven to play a negative regulatory role in T cell receptor (TCR) signal. Therefore, we hypothesized that the combination of HPK1 inhibitor with SBRT would boost local and systemic anti-tumor immune responses by potentiating the anti-tumor effects of SBRT.

MATERIALS/METHODS

Using Digital Spatial Profiler (DSP), we analyzed HPK1 expression in the tumor specimens of 39 NSCLC patients treated with SBRT. By establishing mice subcutaneous tumor models, we assessed the combination of a HPK1 inhibitor and local hyper-fractionated radiotherapy (HFRT) on local and systemic tumor control and mouse survival. Using Single-cell RNA sequencing, Flow cytometry and pharmacological treatment, we analyzed and verified Tumor-infiltrating lymphocytes (TILs), and excavated the specific mechanism of the HPK1 inhibitor enhancing HFRT -induced anti -tumor immune response.

RESULTS

In the tumor specimens of NSCLC patients treated with SBRT, we found that high expression HPK1 in TILs predicted poor progression-free survival (PFS). Among the C57BL/6 mice model, HFRT combined with a HPK1 inhibitor promoted local response, and improved the survival rate of mice, showing better anti-tumor curative effects. We further showed that HFRT promoted CD8+ T cell cytotoxic activity, and also aggravated CD8+ T cell exhaustion. After the intervention of HPK1 small molecular inhibitors, the proportion of exhaustion CD8+T cells was significantly reduced, while CD8+T cell cytotoxic activity was further enhanced in the later period. Single-cell RNA sequencing and pharmacological inhibition of HPK1 revealed that HPK1 mediated the exhaustion of CD8+T cells by regulating RGS16. In abscopal effects preclinical models, BGB-15025 induced obvious abscopal effect.

CONCLUSION

Thus, we demonstrate that HPK1 mediates HFRT-induced CD8+T cell exhaustion by regulating RGS16, and HPK1 is an attractive drug target for enhancing local and systemic radiotherapy.

Dosimetric Analysis of Proton Beam Therapy vs. Photon Radiotherapy for Cardiac Tumors with or without Deep Inspiratory Breath Holding: A Case Report

PURPOSE/OBJECTIVE(S)

Proton beam therapy (PBT) has been demonstrated to deliver equivalent dosimetric radiation with the benefit of improved sparing of organs at risk (OAR). Deep inspiration breath holding (DIBH) is a commonly used method for reducing the radiation dose to the heart and lungs. However, few studies have ever reported the usage of DIBH combined with proton beam therapy in cardiac tumors. The purpose of this case report is to compare the dosimetric differences between photon radiotherapy and proton radiation therapy (PBT) with or without deep inspiration breath holding.

MATERIALS/METHODS

A 66-year-old female patient with cardiac tumors was recruited, and the prescribed dose of radiotherapy for cardiac tumors was 95%PGTV 50Gy/2.5Gy/20f. Two simulation CT scans were collected during free breath (FB) and DIBH. And the target area was delineated on deep inspiratory breath holding image (DIBH-CT) and free breathing image (FB-CT). The target area of FB-CT was modified by referring to the ten-time phases of 4D-CT. Finally, IMRT, VMAT and PBT plans (DIBH-IMRT, DIBH-VAMT, DIBH-PBT, FB-IMRT, FB-VAMT, FB-PBT) were generated on the above images, and the organs at risk were limited as follows: lungs V20 ≤20%, lungs mean ≤11 Gy, heart V30 ≤40%, coronary artery mean ≤26 Gy, spinal cord ≤30 Gy, and left breast mean ≤5 Gy.

RESULTS

All of the six plans satisfied most of the treatment planning goals. DIBH resulted in a dose reduction in all organs at risk including the heart, lungs, coronary artery (CA), spinal cord and breasts, when compared with FB using IMRT, VMAT, or PBT. Compared with the FB, DIBH provided a significant reduction in the mean dose of coronary artery (CA mean for DIBH-IMRT vs FB-IMRT = 28.32 Gy vs 42.66 Gy, CA mean for DIBH-VMAT vs FB-VAMT = 26.44Gy vs 40.85Gy, CA mean for DIBH-PBT vs FB-PBT = 27.71Gy vs 39.51Gy). Similarly, when compared with IMRT or VMAT in either FB or DIBH, PBT reduced radiation doses for all of the OAR. In comparison, the difference was less significant between IMRT and VMAT technique. Pitmen compared with IMRT and VMAT, reduced significantly the max dose of spinal cord, lungs V5, breast-L/R mean. Totally, DIBH-PBT was observed sufficient dose coverage and better sparing of organs at risk.

CONCLUSION

PBT combined with DIBH technique gained an advantage in the sparing of OAR for cardiac tumors, especially in coronary protection. The possibility of broader application of PBT with DIBH in clinical practice is currently being evaluated and further studies are needed.

IKBKE Promotes Radioresistance of Glioblastoma through AKT/FOXO3a Pathway

PURPOSE/OBJECTIVE(S)

Glioblastoma is an intracranial highly malignant primary tumor, and postoperative radiotherapy is a common treatment of glioblastoma. While radiotherapy resistance of glioblastoma is an important reason for treatment failure. IKBKE is overexpressed in gliomas, but its role in radiotherapy is unknown. This study confirmed that IKBKE can directly phosphorylate AKT protein to regulate FOXO3a, thus promoting the radioresistance of glioblastoma, and proposed a new therapeutic strategy to enhance the efficacy of radiotherapy.

MATERIALS/METHODS

We used flow cytometry, tunel staining, plate cloning, a cell counting kit and WB to confirm the effects of IKBKE and FOXO3a on radioresistance of glioblastoma, and immunofluorescence and WB were used to detect the expression of γ-H2AX. Subcutaneous tumor formation in mice and immunohistochemical staining was performed. IP combined with mass spectrometry, immunofluorescence, endogenous and exogenous IP were used to confirm the interaction between IKBKE and AKT. Point mutation, IP and WB were used to confirm the phosphorylation site of AKT. IP and some small molecule inhibitors were used to confirm the relationship between IKBKE, AKT and PI3K. The effect of IKBKE on FOXO3a was confirmed by WB and qPCR. The protein relationship among IKBKE, FOXO3a and 14-3-3 was confirmed by CHX, MG132, ubiquitin test, immunofluorescence and IP. The above experiments were carried out to verify the effect of Amlexanox, an IKBKE inhibitor, on glioblastoma. And its pharmacokinetics in the brain was determined by LC-MS to provide a theoretical basis for further clinical use.

RESULTS

It was found that IKBKE could increase the radioresistance of glioblastoma in vitro and in vivo. IKBKE could directly phosphorylate AKT, and its phosphorylation sites were Ser473 and Thr308. We also certified that IKBKE activated AKT independent of PI3K. IKBKE inhibited the expression of FOXO3a on protein level, promoted its ubiquitin degradation, enhanced its interaction with 14-3-3, and inhibited its transportation into the nucleus. FOXO3a can increase the radiosensitivity of glioblastoma. Amlexanox, an IKBKE inhibitor, can inhibit the radiosensitivity of glioblastoma and partially pass through the blood-brain barrier to enhance the radiosensitivity of intracranial tumors.

CONCLUSION

IKBKE can activate AKT independent of PI3K by directly phosphorylating AKT Ser473 and Thr308, thus increasing the phosphorylation of FOXO3a. Phosphorylated FOXO3a promoted its ubiquitin degradation, and inhibited its transportation into the nucleus, causing radioresistance in glioblastoma. IKBKE inhibitor Amlexanox can pass through the blood-brain barrier and increase the radiosensitivity of intracranial tumor cells.

Chemoradiotherapy Combined with Nab-Paclitaxel plus Cisplatin in Patients with Locally Advanced Borderline Resectable or Unresectable Esophageal Squamous Cell Carcinoma: A Phase I/II Study

PURPOSE/OBJECTIVE(S)

To evaluate the efficacy and safety of nanoparticle albumin-bound paclitaxel (nab-PTX) plus cisplatin as the regimen of conversional chemoradiotherapy (cCRT) in locally advanced borderline resectable or unresectable esophageal squamous cell carcinoma (ESCC).

MATERIALS/METHODS

Patients with locally advanced ESCC (cT3-4, Nany, M0-1, M1 was limited to lymph node metastasis in the supraclavicular area) were enrolled. All the patients received the cCRT of nab-PTX plus cisplatin. After the cCRT, those resectable patients received esophagectomy; those unresectable patients continued to receive the definitive chemoradiotherapy (dCRT). The locoregional control (LRC), overall survival (OS), progression-free survival (PFS), distant metastasis free survival (DMFS), pathological complete response (pCR), R0 resection rate and adverse events (AEs) were calculated.

RESULTS

A total of 45 patients with ESCC treated from October 2019 to May 2021 were finally included. The median follow-up time was 30.3 months. The LRC, OS, EFS, DMFS at 1and 2 years were 81.5%, 86.6%, 64.3%, 73.2% and 72.4%, 68.8%, 44.8%, 52.7% respectively. 21 patients (46.7%) received conversional chemoradiotherapy plus surgery (cCRT+S). The pCR rate and R0 resection rate were 47.6% and 84.0%. The LRC rate at 1 and 2 years were 95.0%, 87.1% in cCRT+S patients and 69.3%, 58.7% in dCRT patients respectively (HR, 5.14; 95% CI, 1.10-23.94; P = 0.021). The OS rate at 1 and 2 years were 95.2% and 84.2% in resectable patients compared to 78.8% and 54.4% in unresectable patients (HR, 3.41; 95% CI, 1.10-10.61; P = 0.024). The toxicities during chemoradiotherapy were tolerated, the most common grade 3-4 toxicities were radiation esophagitis (15.6%).

CONCLUSION

Nab-PTX plus cisplatin were effective and safe as the regimen of conversional chemoradiotherapy of ESCC. The patients receiving conversional chemoradiotherapy plus surgery (cCRT+S) were prone to have a better survival.

The Baseline Serum Lipid Levels and Outcomes of NSCLC Patients Receiving Immunotherapy Combined or Non-Combined with Radiotherapy: A Single Center Retrospective Study

PURPOSE/OBJECTIVE(S)

In recent years, many studies have shown that lipids and lipid-like substances are key regulatory factors in tumor development and play an important role in immune regulation. However, it remains unclear whether serum lipids influence the outcome of immunotherapy. Therefore, determining the serum lipid levels of the immune treatment-beneficiary population may be valuable. The aim of this study is to evaluate the prognostic value of baseline serum lipid levels in non-small cell lung cancer (NSCLC) patients receiving immunotherapy.

MATERIALS/METHODS

We retrospectively included 294 patients with stage III-IV NSCLC who received immunotherapy continuously from December 2018 to November 2021 at our hospital, collecting their pre-treatment lipid levels, such as total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Of these, 160 receiving immunotherapy without combined radiotherapy (ICIs-nRT) and 134 combined with radiotherapy (iRT). The endpoint was the correlation between pre-treatment serum lipid levels and overall survival (OS), as well as progression-free survival (PFS). The X-tile tool was used to determine the optimal cut-off value of the indicators. The Kaplan-Meier survival curves were used to calculate OS and PFS and log rank tests were used for comparison. And the Cox proportional hazard model were used for univariate and multivariate analysis.

RESULTS

In all 294 patients, low TG, low TC, and low HDL-C predicted poor OS (P<0.001) and poor PFS (P<0.05). Low LDL-C was associated with poor OS (P = 0.0001). Among 160 patients receiving ICIs-nRT and 134 iRT patients, low levels of TG (P = 0.0134, 0.0024), TC (P = 0.0003, 0.0023), HDL-C (P = 0.0004, 0.0043), and LDL-C (P = 0.0003, 0.0419) were associated with worse OS compared to high levels of them. In the ICIs-nRT patients, low HDL-C predicted poor PFS (P = 0.0011). In 134 iRT patients, low levels of TG (P = 0.0017), TC (P = 0.0028), and LDL-C (P = 0.0330) were poor prognostic factors for PFS. In the univariate and multivariate analysis with OS in all patients, TG and HDL-C were independent risk factors, while TG was an independent risk factor in the analysis with PFS. In ICIs-nRT patients, HDL-C was an independent prognostic factor for patients' OS and PFS. In iRT patients, both TG and HDL-C were prognostic risk factors for OS.

CONCLUSION

These data confirm that higher serum lipid levels are associated with better outcomes in patients with NSCLC undergoing immunotherapy. Serum lipids may identify tumors that are more likely to respond to immunotherapy. Radiation therapy may affect lipid metabolism within the body to enhance the efficacy of immunotherapy.

Development and validation of a diagnostic model for AFP-negative hepatocellular carcinoma

PURPOSE

AFP appears to be negative in about 30% of overall hepatocellular carcinoma (HCC). Our study aimed to develop a nomogram model to diagnose AFP-negative HCC (AFPN-HCC).

PATIENTS AND METHODS

The training set included 294 AFPN-HCC patients, 159 healthy objects, 63 patients with chronic hepatitis B(CHB), and 64 patients with liver cirrhosis (LC). And the validation set enrolled 137 healthy controls objects, 47 CHB patients and 45 patients with LC. LASSO, univariate, and multivariable logistic regression analysis were performed to construct the model and then transformed into a visualized nomogram. The receiver operating characteristic (ROC) curves, the calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC) were further used for validation.

RESULTS

Four variables including age, PIVKA-II, platelet (PLT) counts, and prothrombin time (PT) were selected to establish the nomogram. The area under the curve (AUC) of the ROC to distinguish AFPN-HCC patients was 0.937(95% CI 0.892-0.938) in training set and 0.942(95% CI 0.921-0.963) in validation set. We also found that the model had high diagnostic value for small-size HCC (tumor size < 5 cm) (AUC = 0.886) and HBV surface antigen-positive AFPN-HCC (AUC = 0.883).

CONCLUSIONS

Our model was effective for discrimination of AFPN-HCC from patients with benign liver diseases and healthy controls, and might be helpful for the diagnosis for AFPN-HCC.

The Updated Landscape of Tumor Microenvironment and Pre-Metastasis Niches for Radiotherapy Resistant Tumors

PURPOSE/OBJECTIVE(S)

In the current clinical work, hypo-fractionated radiotherapy (HFRT) and conventional fractionated radiotherapy (CFRT) are considered to be completely different treatments. However, the difference between the HFRT and CFRT in reprogramming the tumor immune microenvironment (TIME) is still inconclusive. Our previous work found that compared with HFRT, CFRT is more inclined to trigger immunosuppressive phenotype, but the underlying mechanism is still unclear. Based on this, we use single-cell mRNA sequencing to describe the landscape of TIME with HFRT and CFRT, and find the key targets or pathways to combine with radiotherapy.

MATERIALS/METHODS

By simulating the in vivo radiotherapy strategy, we built recurrent murine cell lines mimicking CFRT and HFRT recurrent tumors (CFRT_R and HFRT_R tumors) with small animal radiation research platform (SARRP).

RESULTS

Based on this unique model, we found that CFRT_R tumors can promote local relapse and lung metastasis significantly compared to HFRT_R tumors. Results of single-cell mRNA sequencing and FCAS also indicate that CFRT_R tumors possess more macrophages in the tumor site and neutrophils in the metastatic site. By using quantitative proteomics of secreted proteins, we prove that CFRT_R tumors secret more Ccl2, S100a11 and Slpi. Mechanically, CFRT_R tumors influence the polarization of M2 TAMs leading to tumor growth through secretion of Ccl2 and S100a11. Meanwhile, CFRT_R tumors also augment the infiltration of neutrophils in the lung through Slpi altering the lung immune landscape to support metastasis. ChIP and EMSA results also reveal that RelB is the core transcription factor of Ccl2, S100a11 and Slpi. Furthermore, local relapse and lung metastasis can be reversed by targeting non-canonical NF-kB pathway.

CONCLUSION

The effect of CFRT_R and HFRT_R tumors in reprogramming TIME is different, CFRT_R tumors can trigger immunosuppressive phenotype compared to HFRT_R tumors by possessing more M2 TAMs in the tumor site and neutrophils in the metastatic site. The killing function of tumor infiltrated T cells can be inhibited by accumulated M2 TAMs, and abundant neutrophils in lungs contribute to the formation of the pre-metastatic niche. Targeting non-canonical NF-kB pathway can reverse local relapse and lung metastasis in CFRT_R tumors by suppressing Ccl2, S100a11 and Slpi secretion. In short, our study not only deepens the understanding of the immune landscape of CFRT and HFRT recurrence tumors, but also provides a novel therapy of CFRT recurrence patients.

A Dosimetric Study Indicates the Spinal Cord Irradiation Contributes to Acute Hematologic Toxicities in Non-Small Cell Lung Cancer Patients Receiving Radiotherapy Combined with Immunotherapy

PURPOSE/OBJECTIVE(S)

To assess the radiation therapy (RT) dose to radiation-associated hematologic toxicities (HTs) in patients with non-small cell lung cancer (NSCLC) after RT combined with immunotherapy.

MATERIALS/METHODS

Cases of NSCLC treated with RT combined with immunotherapy at Shandong Cancer Hospital in China were identified. The mean dose and the volume of the spinal cord receiving at least 5 to 40 Gy (V5-V40) were retrospectively recorded. Logistic regression was used to estimate associations between grade ≥3 HT (HT3+) and dosimetric/clinical parameters. Receiver operating characteristic analysis was used to determine dosimetric cut-points.

RESULTS

Ninety-nine patients were analyzed. The majority were male (n = 78, 78.8%) and received chemotherapy (n = 83, 83.9%). All patients received either anti-PD-1 immune checkpoint (n = 89, 89.9%) or anti-PD-L1 immune checkpoint (n = 10, 10.1%) therapy. The rate of HT3+ was 24.2% (n = 24). Spinal cord mean dose, V5 to V40 and BMI parameters associated with HT3+ were included in the multivariate analysis. On multivariate analysis, increasing mean spinal cord dose (per Gy) was associated with higher odds of developing HT3+ (odds ratio 1.053, 95% confidence interval 1.002-1.105, P = .041), as were increasing spinal cord V5 to V20 (As show in the Table below). The optimal cut-points identified were V5 = 52.5%, V10 = 47.5%, V20 = 39.4%, and mean dose = 23.3 Gy. Patients with values above these cut-points had an approximately 2-fold increased risk of HT3+.

CONCLUSION

We found that mean spinal cord dose and low-dose parameters (V5-V20) were associated with HT3+ in NSCLC patients after RT and immunotherapy. The mean dose of the spinal cord should be kept lower than 23.3 Gy for these patients. These data suggested that efforts to spare doses to the spinal cord might reduce rates of severe HT.