Epidermal Stem Cell Derived Exosomes Alleviate Excessive Autophagy Induced Endothelial Cell Apoptosis by Delivering miR200b-3p to Diabetic Wounds

The dysfunction of endothelial cells caused by hyperglycemia is observed as a decrease in neovascularization in diabetic wound healing. Studies have found that epidermal stem cells (EpiSCs) can promote the angiogenesis of full-thickness wounds. To further explain the therapeutic effect of EpiSCs, EpiSC-derived exosomes (EpiSC-EXOs) are considered the main substance contributing to stem cell effectivity. In our study, EpiSCs and EpiSC-EXOs were supplied to the dorsal wounds of db/db mice. Results showed that EpiSCs could colonize in the wound area and both EpiSCs and EpiSC-EXOs could accelerate diabetic wound healing by promoting angiogenesis. In vitro, persistent high glucose led to the malfunction and apoptosis of endothelial cells. The apoptosis induced by high glucose is due to excessive autophagy and was alleviated by EpiSC-EXOs. RNA sequencing of EpiSC-EXOs showed that miR200b-3p was enriched in EpiSC-EXOs and alleviated the apoptosis of endothelial cells. Synapse defective rho GTPase homolog 1 was identified the target of miR200b-3p and affected the phosphorylation of ERK to regulate intracellular autophagy and apoptosis. Furthermore, animal experiments validated the angiogenic effect of miR200b-3p. Collectively, our results verified the effect of EpiSC-EXOs on apoptosis caused by hyperglycemia in endothelial cells through the miR200b-3p/synapse defective rho GTPase homolog 1 /RAS/ERK/autophagy pathway, providing a theoretical basis for EpiSC in treating diabetic wounds.

The naringin/carboxymethyl chitosan/sodium hyaluronate/silk fibroin scaffold facilitates the healing of diabetic wounds by restoring the ROS-related dysfunction of vascularization and macrophage polarization

Chronic diabetic wounds remain a globally recognized clinical challenge, which occurs mainly due to the disturbances of wound microenvironmental induced by high concentrations of reactive oxygen species (ROS). Impairments in angiogenesis and inflammation in the wound microenvironment ultimately impede the normal healing process. Therefore, targeting macrophage and vascular endothelial cell dysfunction is a promising therapeutic strategy. In our study, we fabricated artificial composite scaffolds composed of naringin/carboxymethyl chitosan/sodium hyaluronate/silk fibroin (NG/CMCS/HA/SF) to promote wound healing. The NG/CMCS/HA/SF scaffold demonstrated favorable anti-inflammatory, anti-oxidative, and pro-angiogenic properties in both in vitro and in vivo experiments, effectively promoting the healing of diabetic wounds. The positive therapeutic effects observed indicate that the composite scaffolds have great potential in clinical wound healing applications.

Melatonin inhibits fibroblast cell functions and hypertrophic scar formation by enhancing autophagy through the MT2 receptor-inhibited PI3K/Akt /mTOR signaling

Hypertrophic scar (HS) is a fibrotic skin condition and characterized by abnormal proliferation of myofibroblasts and accumulation of extracellular matrix. Melatonin, an endogenous hormone, can alleviate fibrosis in multiple models of diseases. This study examined the effect of melatonin on fibrosis in primary fibroblasts from human HS (HSFs) and a rabbit ear model and potential mechanisms. Melatonin treatment significantly decreased the migration and contraction capacity, collagen and α-smooth muscle actin (α-SMA) production in HSFs. RNA-sequencing and bioinformatic analyses indicated that melatonin modulated the expression of genes involved in autophagy and oxidative stress. Mechanistically, melatonin treatment attenuated the AKT/mTOR activation through affecting the binding of MT2 receptor with PI3K to enhance autophagy, decreasing fibrogenic factor production in HSFs. Moreover, melatonin treatment inhibited HS formation in rabbit ears by enhancing autophagy. The anti-fibrotic effects of melatonin were abrogated by treatment with an autophagy inhibitor (3-methyladenine, 3-MA), an Akt activator (SC79), or an MT2 selective antagonist (4-phenyl-2propionamidotetralin, 4-P-PDOT). Therefore, melatonin may be a potential drug for prevention and treatment of HS.

Myokines and Biomarkers of Frailty in Older Inpatients with Undernutrition: A Prospective Study

BACKGROUND

Population aging might increase the prevalence of undernutrition in older people, which increases the risk of frailty. Numerous studies have indicated that myokines are released by skeletal myocytes in response to muscular contractions and might be associated with frailty. This study aimed to evaluate whether myokines are biomarkers of frailty in older inpatients with undernutrition.

METHODS

The frailty biomarkers were extracted from the Gene Expression Omnibus and Genecards datasets. Relevant myokines and health-related variables were assessed in 55 inpatients aged ≥ 65 years from the Peking Union Medical College Hospital prospective longitudinal frailty study. Serum was prepared for enzyme-linked immunosorbent assay using the appropriate kits. Correlations between biomarkers and frailty status were calculated by Spearman's correlation analysis. Multiple linear regression was performed to investigate the association between factors and frailty scores.

RESULTS

The prevalence of frailty was 13.21%. The bioinformatics analysis indicated that leptin, adenosine 5'-monophosphate-activated protein kinase (AMPK), irisin, decorin, and myostatin were potential biomarkers of frailty. The frailty group had significantly higher concentrations of leptin, AMPK, and MSTN than the robust group (p < 0.05). AMPK was significantly positively correlated with frailty (p < 0.05). The pre-frailty and frailty groups had significantly lower concentrations of irisin than the robust group (p < 0.05), whereas the DCN concentration did not differ among the groups. Multiple linear regression suggested that the 15 factors influencing the coefficients of association, the top 50% were the ADL score, MNA-SF score, serum albumin concentration, urination function, hearing function, leptin concentration, GDS-15 score, and MSTN concentration.

CONCLUSIONS

Proinflammatory myokines, particularly leptin, myostatin, and AMPK, negatively affect muscle mass and strength in older adults. ADL and nutritional status play major roles in the development of frailty. Our results confirm that identification of frailty relies upon clinical variables, myokine concentrations, and functional parameters, which might enable the identification and monitoring of frailty.

S-Nitrosylation-mediated coupling of DJ-1 with PTEN induces PI3K/AKT/mTOR pathway-dependent keloid formation

Background

Keloids are aberrant dermal wound healing characterized by invasive growth, extracellular matrix deposition, cytokine overexpression and easy recurrence. Many factors have been implicated as pathological causes of keloids, particularly hyperactive inflammation, tension alignment and genetic predisposition. S-Nitrosylation (SNO), a unique form of protein modification, is associated with the local inflammatory response but its function in excessive fibrosis and keloid formation remains unknown. We aimed to discover the association between protein SNO and keloid formation.

Methods

Normal and keloid fibroblasts were isolated from collected normal skin and keloid tissues. The obtained fibroblasts were cultured in DMEM supplemented with 10% fetal bovine serum and 1% penicillin/streptomycin. The effects of DJ-1 on cell proliferation, apoptosis, migration and invasion, and on the expression of proteins were assayed. TurboID-based proximity labelling and liquid chromatography-mass spectrometry were conducted to explore the potential targets of DJ-1. Biotin-switch assays and transnitrosylation reactions were used to detect protein SNO. Quantitative data were compared by two-tailed Student's t test.

Results

We found that DJ-1 served as an essential positive modulator to facilitate keloid cell proliferation, migration and invasion. A higher S-nitrosylated DJ-1 (SNO-DJ-1) level was observed in keloids, and the effect of DJ-1 on keloids was dependent on SNO of the Cys106 residue of the DJ-1 protein. SNO-DJ-1 was found to increase the level of phosphatase and tensin homolog (PTEN) S-nitrosylated at its Cys136 residue via transnitrosylation in keloids, thus diminishing the phosphatase activity of PTEN and activating the PI3K/AKT/mTOR pathway. Furthermore, Cys106-mutant DJ-1 is refractory to SNO and abrogates DJ-1-PTEN coupling and the SNO of the PTEN protein, thus repressing the PI3K/AKT/mTOR pathway and alleviating keloid formation. Importantly, the biological effect of DJ-1 in keloids is dependent on the SNO-DJ-1/SNO-PTEN/PI3K/AKT/mTOR axis.

Conclusions

For the first time, this study demonstrated the effect of transnitrosylation from DJ-1 to PTEN on promoting keloid formation via the PI3K/AKT/mTOR signaling pathway, suggesting that SNO of DJ-1 may be a novel therapeutic target for keloid treatment.

Augmenting L3MBTL2-induced condensates suppresses tumor growth in osteosarcoma

Osteosarcoma is a highly aggressive cancer and lacks effective therapeutic targets. We found that L3MBTL2 acts as a tumor suppressor by transcriptionally repressing IFIT2 in osteosarcoma. L3MBTL2 recruits the components of Polycomb repressive complex 1.6 to form condensates via both Pho-binding pockets and polybasic regions within carboxyl-terminal intrinsically disordered regions; the L3MBTL2-induced condensates are required for its tumor suppression. Multi-monoubiquitination of L3MBTL2 by UBE2O results in its proteasomal degradation, and the UBE2O/L3MBTL2 axis was crucial for osteosarcoma growth. There is a reverse correlation between L3MBTL2 and UBE2O in osteosarcoma tissues, and higher UBE2O and lower L3MBTL2 are associated with poorer prognosis in osteosarcoma. Pharmacological blockage of UBE2O by arsenic trioxide can enhance L3MBTL2-induced condensates and consequently suppress osteosarcoma growth. Our findings unveil a crucial biological function of L3MBTL2-induced condensates in mediating tumor suppression, proposing the UBE2O-L3MBTL2 axis as a potential cancer therapeutic target in osteosarcoma.

GKT137831 in combination with adipose-derived stem cells alleviates high glucose-induced inflamm-aging and improves diabetic wound healing

Adipose stem cells (ADSCs) have been proven to promote healing in diabetic wounds, which are one of the most serious chronic refractory wounds. However, reactive oxygen species (ROS) induced by high glucose (HG) lead to oxidative stress and aging in ADSCs, which limits the therapeutic effect of ADSCs. In this study, we investigated the role of GKT137831, a NOX1/4 inhibitor that can reduce ROS production, in protecting ADSCs from hyperglycemia and in diabetic wound healing. In vitro, ROS levels and NOX4 expression were increased after HG treatment of ADSCs, while the oxidative stress marker malondialdehyde (MDA) was increased, mitochondrial membrane potential (MMP) was decreased, inflammatory aging-related indicators such as p16, p21, MMP1, MMP3, IL6 and β-GAL were increased, and migration was weakened. In vivo, we constructed a diabetic mouse wound model and found that the combination of ADSCs and GKT137831 synergistically promoted the 21-day wound healing rate, increased the expression of collagen and hydroxyproline, increased the number of blood vessels and the expression of CD31, and reduced the expression of IL6, MMP1, MMP3, and p21. These results suggest that GKT137831 could protect ADSCs from oxidative stress and aging induced by HG and enhance the therapeutic effect of ADSCs on diabetic wounds.

Targeting phenylpyruvate restrains excessive NLRP3 inflammasome activation and pathological inflammation in diabetic wound healing

Moderate inflammation is essential for standard wound healing. In pathological conditions, such as diabetes, protracted and refractory wounds are associated with excessive inflammation, manifested by persistent proinflammatory macrophage states. However, the mechanisms are still unclear. Herein, we perform a metabolomic profile and find a significant phenylpyruvate accumulation in diabetic foot ulcers. Increased phenylpyruvate impairs wound healing and augments inflammatory responses, whereas reducing phenylpyruvate via dietary phenylalanine restriction relieves uncontrolled inflammation and benefits diabetic wounds. Mechanistically, phenylpyruvate is ingested into macrophages in a scavenger receptor CD36-dependent manner, binds to PPT1, and inhibits depalmitoylase activity, thus increasing palmitoylation of the NLRP3 protein. Increased NLRP3 palmitoylation is found to enhance NLRP3 protein stability, decrease lysosome degradation, and promote NLRP3 inflammasome activation and the release of inflammatory factors, such as interleukin (IL)-1β, finally triggering the proinflammatory macrophage phenotype. Our study suggests a potential strategy of targeting phenylpyruvate to prevent excessive inflammation in diabetic wounds.

Single-stage transplantation combined with epidermal stem cells promotes the survival of tissue-engineered skin by inducing early angiogenesis

BACKGROUND

The composite transplantation of a split-thickness skin graft (STSG) combined with an acellular dermal matrix (ADM) is a promising repair method for full-thickness skin defects. Due to delayed vascularization of the ADM, no currently available engineered skin tissue is able to permanently cover full-thickness skin defects via a single-stage procedure. Epidermal stem cells (EpSCs) have been found to promote angiogenesis in the wound bed. Whether EpSCs can induce early angiogenesis of dermal substitutes and promote the survival of single-stage tissue-engineered skin transplantation needs to be further studied.

METHODS

In vitro, rat vascular endothelial cells (RVECs) were treated with the supernatant of EpSCs cultured in ADM and stimulated for 48 h. RVECs were analysed by RNA sequencing and tube formation assays. For the in vivo experiment, 75 rats were randomly divided into five groups: ADM, ADM + EpSCs (AE), STSG, ADM + STSG (AS), and ADM + STSG + EpSCs (ASE) groups. The quality of wound healing was estimated by general observation and H&E and Masson staining. The blood perfusion volume was evaluated using the LDPI system, and the expression of vascular markers was determined by immunohistochemistry (IHC).

RESULTS

The active substances secreted by EpSCs cultured in ADM promoted angiogenesis, as shown by tube formation experiments and RNA-seq. EpSCs promoted epithelialization of the ADM and vascularization of the ADM implant. The ASE group showed significantly increased skin graft survival, reduced skin contraction, and an improved cosmetic appearance compared with the AS group and the STSG control group.

CONCLUSIONS

In summary, our findings suggest that EpSCs promote the formation of new blood vessels in dermal substitutes and support one-step transplantation of tissue-engineered skin, and thereby provide new ideas for clinical application.

Analysis of miR-203a-3p/SOCS3-mediated induction of M2 macrophage polarization to promote diabetic wound healing based on epidermal stem cell-derived exosomes

BACKGROUND

The development of therapeutic strategies to improve wound healing in individual diabetic patients remains challenging. Stem cell-derived exosomes represent a promising nanomaterial, and microRNAs (miRNAs) can be isolated from them. It is important to identify the potential therapeutic role of specific miRNAs, given that miRNAs can play a therapeutic role.

METHODS

qPCR, flow cytometry, and western blotting were used to verify the effect of epidermal stem cell-derived exosomes (EpiSC-EXOs) on M2 macrophage polarization and SOCS3 expression. By screening key miRNAs targeting SOCS3 in EpiSC-EXOs by high-throughput sequencing, we verified the mechanism in vitro. Finally, an animal model was used to verify the effect of promoting healing.

RESULTS

The use of EpiSC-EXOs reduced SOCS3 expression and promoted M2 macrophage polarization. The abundant miR-203a-3p present in the EpiSC-EXOs specifically bound to SOCS3 and activated the JAK2/STAT3 signaling pathway to induce M2 macrophage polarization. Treatment of the db/db mouse wound model with miR-203a-3p agomir exerted a pro-healing effect.

CONCLUSIONS

Our results demonstrated that the abundant miR-203a-3p present in EpiSC-EXOs can promote M2 macrophage polarization by downregulating SOCS3 and suggested that diabetic wounds can obtain better healing effects through this mechanism.

Transcriptome profiles of fatty acid metabolism-related genes and immune infiltrates identify hot tumors for immunotherapy in cutaneous melanoma

Background: Immunotherapy with checkpoint inhibitors usually has a low response rate in some cutaneous melanoma (CM) cases due to its cold nature. Hence, identification of hot tumors is important to improve the immunotherapeutic efficacy and prognoses of CMs.

Methods: Fatty acid (FA) metabolism-related genes were extracted from the Gene Set Enrichment Analysis and used in the non-negative matrix factorization (NMF), copy number variation frequency, tumor mutation burden (TMB), and immune-related analyses, such as immunophenoscore (IPS). We generate a risk model and a nomogram for predicting patient prognoses and predicted the potential drugs for therapies using the Connectivity Map. Moreover, the NMF and the risk model were validated in a cohort of cases in the GSE65904 and GSE54467. At last, immunohistochemistry (IHC) was used for further validation.

Results: Based on the NMF of 11 FA metabolism-related DEGs, CM cases were stratified into two clusters. Cluster 2 cases had the characteristics of a hot tumor with higher immune infiltration levels, higher immune checkpoint (IC) molecules expression levels, higher TMB, and more sensitivity to immunotherapy and more potential immunotherapeutic drugs and were identified as hot tumors for immunotherapy. The risk model and nomogram displayed excellent predictor values. In addition, there were more small potential molecule drugs for therapies of CM patients, such as ambroxol. In immunohistochemistry (IHC), we could find that expression of PLA2G2D, ACOXL, and KMO was upregulated in CM tissues, while the expression of IL4I1, BBOX1, and CIDEA was reversed or not detected.

Conclusion: The transcriptome profiles of FA metabolism-related genes were effective for distinguishing CM into hot–cold tumors. Our findings may be valuable for development of effective immunotherapy for CM patients and for proposing new therapy strategies.

DNTTIP1 promotes nasopharyngeal carcinoma metastasis via recruiting HDAC1 to DUSP2 promoter and activating ERK signaling pathway

Background

Distant metastasis remains the leading cause of treatment failure in patients with nasopharyngeal carcinoma (NPC), making it critical to identify efficient therapeutic targets for metastatic NPC. Previous studies have demonstrated that deoxynucleotidyltransferase terminal-interacting protein 1 (DNTTIP1) is associated with the development of various types of cancer. However, its role and mechanism in NPC have not been explored.

Methods

RNA-seq profiling was performed for three pairs of NPC and normal nasopharynx tissues. DNTTIP1 expression in NPC specimens was detected by immunohistochemistry. In vitro and in vivo assays were used to investigate the function of DNTTIP1. The molecular mechanism was determined using RT-qPCR, western blotting, RNA-seq, luciferase reporter assays, ChIP assays, and co-IP assays.

Findings

DNTTIP1 was found to be significantly upregulated in NPC tissues. Furthermore, DNTTIP1 promoted NPC growth and metastasis in vitro and in vivo. Upregulation of DNTTIP1 in NPC indicated poor clinical outcomes. Mechanistically, DNTTIP1 suppressed DUSP2 gene expression via recruiting HDAC1 to its promoter and maintaining a deacetylated state of histone H3K27. The downregulation of DUSP2 resulted in aberrant activation of the ERK signaling and elevated MMP2 levels, promoting NPC metastasis. Chidamide, an HDAC inhibitor, was shown to suppress NPC metastasis by regulating the DNTTIP1/HDAC1-DUSP2 axis.

Interpretation

Our findings demonstrate that DNTTIP1 not only regulates NPC metastasis but also independently predicts NPC prognosis. Furthermore, targeting DNTTIP1/HDAC1 by Chidamide may benefit NPC patients with metastasis.

Funding

This work was supported by the National Natural Science Foundation of China (No. 81872464, 82073243).

Lycorine Inhibits Hypertrophic Scar Formation by Inducing ROS-Mediated Apoptosis

Background: Hypertrophic scar (HS) is a fibrotic cutaneous disease with few effective therapies. Lycorine is a drug with pro-apoptotic ability and anti-fibrosis potential. This study aimed to test whether lycorine could trigger the apoptosis of hypertrophic scar fibroblasts (HSFs) to inhibit HS formation.

Methods: The proapoptotic and anti-fibrosis effects of lycorine on the viability and apoptosis of human primary HSFs and their reactive oxygen species (ROS) production as well as a rabbit ear model of HS were determined by CCK-8, flow cytometry, Western blot, immunofluorescence, transwell migration, collagen gel contraction assays.

Results: Lycorine treatment selectively decreased the viability of HSFs, and induced their apoptosis, but not normal fibroblasts (NFs). Lycorine treatment increased the relative levels of Bax and cleaved PARP expression, cytochrome C cytoplasm translocation, but decreased Bcl-2, caspase-3 and caspase-9 expression, the mitochondrial membrane potential (MMP) in HSFs. Lycorine inhibited the migration and contraction of HSFs, and reduced the expression of collagen I, collagen III and α-SMA. Mechanistically, lycorine treatment stimulated high levels of ROS production, leading to apoptosis of HSFs while treatment with NAC, a ROS inhibitor, significantly mitigated or abrogated the pro-apoptotic and antifibrotic activity of lycorine in HSFs. Moreover, lycorine treatment mitigated the severity of HS in rabbit ears by inducing fibroblast apoptosis.

Conclusion: These results indicate that lycorine has a potent anti-fibrotic activity and is a potential drug for intervention of HS.

M6A demethylase FTO-mediated downregulation of DACT1 mRNA stability promotes Wnt signaling to facilitate osteosarcoma progression

Despite advances in clinical diagnosis and treatment, the prognosis of patients with osteosarcoma (OS) remains poor, and the treatment efficacy has plateaued. Therefore, it is important to identify new therapeutic targets for OS. N⁶-methyladenosine (m⁶A) modification has been reported to participate in tumor malignancy. In this study, functional screening showed that the m⁶A demethylase FTO could be a candidate therapeutic target for OS. Upregulated FTO in OS could predict a poorer prognosis. FTO promoted the growth and metastasis of OS in vitro and in vivo. Methylated RNA immunoprecipitation sequencing (MeRIP-seq) and RNA sequencing (RNA-seq) were performed to identify DACT1 as a potential target of FTO. In vitro assays demonstrated that FTO could reduce the mRNA stability of DACT1 via m⁶A demethylation, which decreased DACT1 expression and further activated the Wnt signaling pathway. The oncogenic effect of FTO on OS was dependent on DACT1. In addition, the m⁶A reader IGF2BP1 was validated to participate in the regulation of DACT1. Entacapone, a conventional drug for Parkinson's disease, was confirmed to suppress OS via m⁶A-mediated regulation through the FTO/DACT1 axis. Our findings demonstrate that FTO may be a novel therapeutic target and that entacapone has preclinical value to be repurposed for OS.

EBF3 reactivation by inhibiting the EGR1/EZH2/HDAC9 complex promotes metastasis via transcriptionally enhancing vimentin in nasopharyngeal carcinoma

Metastasis is the major reason for treatment failure and accounts for cancer-related death in patients with nasopharyngeal carcinoma. However, the genetic alterations and molecular mechanisms that cause nasopharyngeal carcinoma metastasis are elusive. Herein, we performed RNA sequencing in patients with or without metastasis, and found that the early B-cell factor 3 (EBF3) was significantly elevated in the samples with metastasis. Mechanistically, EBF3 promoted metastasis by directly combining with the promoter of Vimentin and transcriptionally upregulating it. In addition, EBF3 was epigenetically silenced by EGR1/EZH2/HDAC9 complexes via sustaining the high level of H3K27-Me3 at its promoter. Clinically, there was a positive correlation between EBF3 and Vimentin in nasopharyngeal carcinoma tissues. Moreover, high expression of EBF3 or Vimentin was correlated with poor overall survival, while the combination of high EBF3 and Vimentin expression was associated with more significant poor prognosis. Therefore, specific agents targeting EBF3 or stabilizing the EGR1/EZH2/HDAC9 complex could be novel therapeutic strategies for cancer metastasis.

Multimodal Risk-Adapted Treatment in Surgical Patients With Synovial Sarcoma: A Preoperative Nomogram-Guided Adjuvant Treatment Strategy

Background: Synovial sarcoma is characterized by heterogeneous clinical manifestations, making it difficult to evaluate individual patients' prognoses and design personal treatment schemes. We established an effective preoperative nomogram to predict cancer-specific survival (CSS) and present a risk-adapted adjuvant treatment strategy in surgical patients with synovial sarcoma. Methods: This retrospective study included patients from the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with synovial sarcoma between 1996 and 2015. The patients were randomly divided into training and validation groups. The predictors were selected using univariate and multivariate Cox hazards models. The nomogram performance was verified for its discriminatory ability and calibration. We further stratified the patients into different risk groups according to the nomogram scores and compared the efficacy of chemotherapy, radiotherapy, and combination of radiotherapy and chemotherapy. Results: There were 915 patients enrolled in our study, with 874 patients either alive or dead due to synovial sarcoma. We established a nomogram to predict 5-year CSS based on independent factors, including sex, age, grade, tumor size, location, and extent (all p < 0.05). Our model showed a consistently good discriminatory ability and calibration for predicting 5-year CSS in both the training (c-index = 0.78, 95% CI 0.75-0.81) and validation (c-index = 0.73, 95% CI 0.68-0.78). Based on their nomogram scores, we divided patients into 5 groups. Compared to patients without adjuvant treatment, nomogram I patients with adjuvant treatment had no improvements in 5-year CSS (100.0% vs. 100.0%), nomogram II patients had higher 5-year CSS with radiotherapy or chemotherapy (92.9% vs. 72.2%, p = 0.015), nomogram III patients had higher 5-year CSS with combination of chemotherapy and radiotherapy (70.1% vs. 47.2%, p = 0.004), nomogram IV patients had higher 5-year CSS with radiotherapy (41.3% vs. 15.6%, p = 0.015), and nomogram V patients had no improvements in 5-year CSS rates with adjuvant treatment (28.9% vs. 16.9%, p = 0.18). Conclusion: The nomogram showed a satisfactory discriminatory ability and calibration for predicting 5-year CSS in synovial sarcoma patients. Based on this nomogram, we stratified synovial sarcoma patients according to risk levels, which enabled us to provide a useful grouping scheme that can inform multimodal risk-adapted treatment in synovial sarcoma.

Comprehensive metabolomic profiling of osteosarcoma based on UHPLC-HRMS

INTRODUCTION

Osteosarcoma (OS) is the most common primary malignant bone tumor in children and adolescents. An increasing number of studies have demonstrated that tumor proliferation and metastasis are closely related to complex metabolic reprogramming. However, there are limited data to provide a comprehensive metabolic picture of osteosarcoma.

OBJECTIVES

Our study aims to identify aberrant metabolic pathways and seek potential adjuvant biomarkers for osteosarcoma.

METHODS

Serum samples were collected from 65 osteosarcoma patients and 30 healthy controls. Nontargeted metabolomic profiling was performed by liquid chromatography-mass spectrometry (LC-MS) based on univariate and multivariate statistical analyses.

RESULTS

The OPLS-DA model analysis identified clear separations among groups. We identified a set of differential metabolites such as higher serum levels of adenosine-5-monophosphate, inosine-5-monophosphate and guanosine monophosphate in primary OS patients compared to healthy controls, and higher serum levels of 5-aminopentanamide, 13(S)-HpOTrE (FA 18:3 + 2O) and methionine sulfoxide in lung metastatic OS patients compared to primary OS patients, revealing aberrant metabolic features during the proliferation and metastasis of osteosarcoma. We found a group of metabolites especially lactic acid and glutamic acid, with AUC values of 0.97 and 0.98, which could serve as potential adjuvant diagnostic biomarkers for primary osteosarcoma, and a panel of 2 metabolites, 5-aminopentanamide and 13(S)-HpOTrE (FA 18:3 + 2O), with an AUC value of 0.92, that had good monitoring ability for lung metastases.

CONCLUSIONS

Our study provides new insight into the aberrant metabolic features of osteosarcoma. The potential biomarkers identified here may have translational significance.

Regional lymph node involvement is associated with poorer survivorship in patients with upper extremity osteosarcoma than with lower extremity osteosarcoma: a SEER analysis

Background

Although the upper limb is the second most common site of osteosarcoma, investigations into clinical manifestation differences between upper and lower limb patients are still sporadic. We retrospectively investigated the characteristics of these patients to gain a better understanding of the differences between upper and lower limb osteosarcoma patients.

Methods

This retrospective study involved patients diagnosed with extremity osteosarcoma between 1997 and 2016 collected from the Surveillance, Epidemiology, and End Results (SEER) database. Patient characteristics were analyzed with t-tests, rank sum tests and chi-square tests. Log-rank tests were applied to evaluate univariate significance, and Cox hazards models were performed in multivariate analysis. A binary logistics regression model was used to screen the risk factors related to lymph node involvement.

Results

In total, 1,882 patients, 1,588 (84.4%) with lower limb lesions and 294 (15.6%) with upper limb lesions were enrolled in our study. The patients with upper limb osteosarcoma exhibited poorer 5-year overall survival (OS) than patients with lower limb osteosarcoma (54.8% vs. 63.2%, P=0.02). The upper limb patients had more lymph node involvement (5.6% vs. 2.7%, P=0.03), which was found to be an independent prognostic factor (P=0.000). Tumors located in the upper limbs and the presence of distal metastasis were risk factors related to lymph node involvement in the extremity (P<0.05). The upper limb patients were tended to suffer greater risk of being affected by both metastasis and lymph node involvement (15.7% vs. 9.4%, P=0.18).

Conclusions

Upper limb osteosarcoma patients are characterized by more lymph node involvement than lower limb patients, leading to poorer OS. In addition, upper limb patients are at greater risk for both lymph node involvement and distal metastasis. Our results suggest that upper limb patients should be screened more thoroughly for regional lymph node involvement.

Comparison of local control and survival outcomes between surgical and non-surgical local therapy on pelvic Ewing’s sarcoma patients: a meta-analysis

Background

The efficacy of surgical therapy to nonsurgical therapy is still a controversial topic in pelvic Ewing’s sarcoma (ES) management. We perform a systemic review and meta-analysis to compare the effect of local control (LC) and survival outcomes between surgical and nonsurgical local therapy on pelvic ES patients with systemic chemotherapy.

Methods

Published retrospective studies searched from PubMed, Embase, Cochrane and Web of Science databases that investigated the effects of surgical and nonsurgical local therapy on the LC and survival outcomes of patients with pelvic ES treated with chemotherapy were included in our study. Our primary outcome was the LC rate and progression-free survival (PFS) rate. The effect of confounders of extend of disease, surgical margin and chemotherapy respond on PFS was analyzed in subgroups.

Results

Ten studies with 782 pelvic ES patients were included in our analysis. Surgical patients showed higher LC and PFS rate comparing to nonsurgical patients [LC: risk ratio (RR) 0.72, 95% CI: 0.52–1.00, P=0.05, I²=0%; PFS: RR 0.72, 95% CI: 0.61–0.86, P=0.000, I²=15%]. Localized patients showed higher PFS with surgical therapy than nonsurgical patients (RR 0.67, 95% CI: 0.51–0.88, P=0.003).Patients with adequate resection and good chemotherapy respond improved PFS comparing to nonsurgical patients (adequate resection vs. nonsurgical: RR 0.59, 95% CI: 0.46–0.76, P<0.001, I²=0%; good respond vs. nonsurgical: RR 0.56, 95% CI: 0.41–0.77, P<0.001, I²=21%). But patients with inadequate resection and poor chemotherapeutic respond shows no statistical different PFS comparing to nonsurgical patients (inadequate resection vs. nonsurgical: RR 1.11, 95% CI: 0.87–1.41, P=0.41, I²=0%; poor respond vs. nonsurgical: RR 1.17, 95% CI: 0.90–1.52, P=0.25, I²=0%).

Conclusions

Surgical therapy is primarily recommended in localized, resectable, good chemotherapeutic respond pelvic ES. Inadequate resection and poor chemotherapeutic respond are negative prognostic factors in surgical patients and their surviving are not improved comparing with nonsurgical patients.

Systematic review registration

PROSPERO CRD42020149224.

Long noncoding RNA PCAT-1 promoted ovarian cancer cell proliferation and invasion by suppressing KLF6

OBJECTIVE

Recently, the role of long noncoding RNAs (lncRNAs) in tumor progression has caught attention in numerous researchers. In our investigation, lncRNA PCAT-1 was studied to identify how it functioned in the progression of ovarian cancer.

PATIENTS AND METHODS

LncRNA PCAT-1 expression was detected by quantitative Real-time polymerase chain reaction (qRT-PCR) in both ovarian cancer cells and tissue samples. Furthermore, to identify the function of PCAT-1 in ovarian cancer, cell proliferation, transwell assay and Matrigel assay were conducted. In addition, by performing qRT-PCR and Western blot assay, the underlying mechanism was explored.

RESULTS

PCAT-1 expression was remarkably higher in ovarian cancer samples when compared with that in corresponding ones. Moreover, cell proliferation, migration and invasion were inhibited after PCAT-1 was knocked down in ovarian cancer cells. Moreover, the mRNA and protein expression of KLF6 (Krüppel-like factor 6) was upregulated after PCAT-1 was knocked down. Furthermore, the KLF6 expression level was negatively related to the PCAT-1 expression level in ovarian cancer samples.

CONCLUSIONS

We showed that PCAT-1 promotes the progression of ovarian cancer through enhancing cell metastasis and proliferation via suppressing KLF6, which might be a novel therapeutic strategy in ovarian cancer.

Long noncoding RNA PCAT-1 promoted ovarian cancer cell proliferation and invasion by suppressing KLF6

Since this article has been suspected of research misconduct and the corresponding authors did not respond to our request to prove originality of data and figures, "Long noncoding RNA PCAT-1 promoted ovarian cancer cell proliferation and invasion by suppressing KLF6, by H.-P. Liu, D. Lv, J.-Y. Wang, Y. Zhang, J.-F. Chang, Z.-T. Liu, N. Tang, published in Eur Rev Med Pharmacol Sci 2019; 23 (11): 4650-4655-DOI: 10.26355/eurrev_201906_18044-PMID: 31210290" has been withdrawn. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/18044.

Neuropilin1, a novel independent prognostic factor and therapeutic target in triple-negative breast cancer

Triple-negative breast cancer (TNBC) is the most aggressive breast cancer, and thus, has limited treatment options. Neuropilin1 (NRP1) is a multi-functional transmembrane protein that interacts with a number of signaling receptors and plays an important role in cancer progression. Previous studies demonstrated that the expression of NRP1 is activated and promotes the progression of breast cancer particularly in TNBC compared to other molecular subtypes; however, whether or not the level of NRP1 expression is related to the progression of TNBC warrants further study. In the current study, we determined the expression and function of NRP1 and evaluated the clinical significance of NRP1 in patients with TNBC. In addition, we determined whether or not an NRP1 antagonist potentiates the inhibitory effects of paclitaxel (PTX) in patients with TNBC. In our clinical study, NRP1 had higher expression in TNBC tissues than non-TNBC tissues at the same stage, and NRP1 was an independent prognostic factor. Specifically, the high expression of NRP1 was associated with shorter survival in TNBC patients. In addition, TNBC cells treated with NRP1 antagonist significantly potentiated the effect of PTX on cell proliferation, cell migration, and apoptosis. Our findings suggest that NRP1 expression can act as an independent prognostic factor for TNBC patients, and the combination of PTX and an NRP1 antagonist may be an effective treatment regimen for TNBC.

Clinical Significance of the Radiological Relationship between the Tumor and the main blood vessels in Enneking IIB Osteosarcoma of the extremities

Aim: Osteosarcoma is one of the most prevalent primary bone malignancies in children and adolescents. Magnetic resonance imaging (MRI) has been considered a very critical tool to provide anatomical information of tumor and surrounding main blood vessels. To evaluate the prognostic significance of the radiological vascular involvement according to the pre-treatment MRI in patients with Enneking IIB osteosarcoma. Methods: In this retrospective study, we included 482 patients younger than 50 years old with Enneking IIB primary osteosarcoma of the extremities with complete clinical records from 2005 to 2015.Univariate and multivariable analyses were conducted to identify the risk factors for OS (Overall survival) and EFS (Event-free survival). The correlations between the risk factors was performed using Spearman analysis. The Kaplan-Meier method was used to calculate survival curves. Based on the radiological relationship between the tumor lesion and the surrounding reactive area with the main blood vessels as shown on pretreatment MRI findings. Results: Radiological vascular involvement assessed via pretreatment MRI is an important risk factor for Enneking IIB primary patients with osteosarcoma (HR_OS=2.32/HR_EFS=1.81 P<0.01) according to the univariate and multivariable analyses. Enneking IIB patients with osteosarcoma were assigned to three subtypes based on the radiological relationship between the main blood vessels and the lesion or reactive area. The 5-year cumulative OS of patients classified by the three types were 81.6% (type I), 67.1% (type II) and 44.8% (type III)(P<0.01). The 5-year cumulative EFS of the three types were 60.2% (type I), 46.7% (type II) and 30.2% (type III)(P<0.05). The total 5-year cumulative OS and EFS for all patients were 68.3% and 48.3%, respectively. Conclusion: Vascular involvement according to radiological findings from pretreatment MRI is an independent risk factor for cumulative OS and EFS in patients with Enneking IIB primary osteosarcoma of the extremities. The new subtyping based on the relationship between the tumors and surrounding reactive area with the main blood vessels based on pretreatment MRI can predict the prognosis of patients with osteosarcoma and provide certain directive information for selecting the appropriate surgical procedure for individual patients.

Identification of differential gene expression related to epirubicin-induced cardiomyopathy in breast cancer patients

BACKGROUND

Epirubicin is a potent chemotherapeutic agent for the treatment of breast cancer. However, it may lead to cardiotoxicity and cardiomyopathy, and no reliable biomarker was available for the early prediction of epirubicin-induced cardiomyopathy.

METHODS

Global gene expression changes of peripheral blood cells were studied using high-throughput RNA sequencing in three pair-matched breast cancer patients (patients who developed symptomatic cardiomyopathy paired with patients who did not) before and after the full session of epirubicin-based chemotherapy. Functional analysis was conducted using gene ontology and pathway enrichment analysis.

RESULTS

We identified 13 significantly differentially expressed genes between patients who developed symptomatic epirubicin-induced cardiomyopathy and their paired control who did not. Among them, the upregulated Bcl-associated X protein was related to "apoptosis," while the downregulated 5'-aminolevulinate synthase 2 (ALAS2) was related to both "glycine, serine, and threonine metabolism" and "porphyrin and chlorophyll metabolism" in pathway enrichment analysis.

CONCLUSIONS

ALAS2 and the metabolic pathways which were involved may play an important role in the development of epirubicin-induced cardiomyopathy. ALAS2 may be useful as an early biomarker for epirubicin-induced cardiotoxicity detection.

Features and clinical significance of the ossification centres in the odontoid process based on micro-computed tomography

BACKGROUND

Microscopic structures of the ossification centres of the odontoid process were studied from the micro-computed tomography (CT) images of the axis, and the potential influence of the ossification centres with different microscopic structures on odontoid process fractures was analysed.

MATERIALS AND METHODS

Eighteen odontoid process specimens were randomly collected and scanned by micro-CT. The obtained images were then input into the software for further observation and measurement. Incomplete absorption of the ossification centres in the base was observed, along with the anatomic structure of the regions with incomplete ossification and structural parameters of the trabecular bones.

RESULTS

The microscopic structures of the trabecular bones in the ossification centres in the base of the odontoid process could be clearly visualised from the micro-CT images. Among the 18 odontoid process specimens, 11 specimens were found with incomplete absorption of the ossification centres in the axis, the prevalence reaching up to 61%. Regions with incomplete ossification varied in size and morphology, and their three-dimensional morphology was predominantly oval. Of all structural parameters examined for the trabecular bones, there were only significant differences in the degree of anisotropy between the regions with incomplete absorption of ossification centres and the average vertebral trabecular bones (p < 0.05).

CONCLUSIONS

Incomplete absorption of the ossification centres in the base of the odontoid process is a relatively prevalent condition. The cavitation effect of the trabecular bones may be the primary cause for odontoid process fractures.

[The application of parental version of pediatric voice-related quality of life in children with voice disorders]

Objective:To evaluate the influence of voice disorders on children's quality of life through the parental version of pediatric voice-related quality of life（pVRQOL）. Method:Three hundred and eighty-six children from August 2017 to December 2018 were enrolled in this study. A total of 214 parents of children had voice disorders（dysphonic group）, and 172 parents of children were without voice disorders（control group）. Both groups were filled out the questionnaire containing the parental version of pVRQOL. Result:① The most common disease in children with voice disorder was vocal fold nodule, and boys were more susceptible to voice disorder than girls（71.5%, 28.5%）; ②In dysphonic group, the scores of total（91.40±8.63, 97.94±4.23）, physiology and function（87.55±10.98, 96.99±6.10）, social emotion（98.86 ±3.29, 99.73±1.08） were lower than those in control group（P<0.01）; ③In dysphonic group, there was a correlation between the parents' overall evaluation of the children's voice quality and the three dimensions of the parental version of pVRQOL（total: r=-0.398, P<0.01, physical function: r=-0.448, P<0.01, social-emotion: r=-0.125, P<0.05）. Conclusion:Voice disorders could cause a negative impact on children's voice related quality of life. pVRQOL could be applied to assess the voice-related quality of life in children with voice disorders.

[A cmparative study of the voice function change in patients who underwent total thyroidectomy between preoperative and postoperative]

Objective:The aim of this study is to investigate the voice function change in patients who underwent total thyroidectomy between preoperative and the third day postoperative, Taking the result data to explore methods for voice protection and be valuable for clinical diagnose and treatment. Method:Three hundred and fifth-three patients with thyroid papillary carcinoma without preoperative vocal dysfunction were treated with total thyroidectomy and single or bilateral central cervical lymph node dissection. At preoperative and the third day postoperative, videostroboscopic, acoustic analysis, voice handicap index 10（VHI-10）are measured. Result: At the third day postoperative, 294 （83.29%）patients have voice symptoms，the most common voice disorder is hoarseness in 105 cases （35.71%），phonasthenia in 78 cases（26.53%），unable speak louderly in 53 cases （18.03%）, unable speak high-pitch in 24 cases （8.16%）, unable speak low-pitch in 29 cases （9.86%）, pronunciation leakage in 5 cases （1.70%）. Videostroboscopic examinations are normal in all patients at the third day postoperative. The total score of VHI-10, Physiology（P）, Emotion（E） dimensions in VHI-10 between preoperative and the third day postoperative are statistically significant （P<0.05）. For male patients, the acoustic analysis （fundamental frequency, Harmonicto Noise Ratio, Shimmer and Maximum phonation time） are statistically significant between preoperative and the third day postoperative （P<0.05）. For female patients, acoustic analysis （fundamental frequency, Harmonicto Noise Ratio, Shimmer, Jitter and Maximum phonation time） are statistically significant between preoperative and the third day postoperative （P<0.05）. Conclusion:These patients who underwent total thyroidectomy with bilateral or unilateral central partment lymph node dissection may develop voice complications even their recurrent laryngealnerve be undamaged during the surgery. Changes in surgery and voice may cause changes in the patient's psychology, suggesting that clinicians need to have adequate communication between doctors and patients before surgery, pay attention to the patient's voice quality and psychological changes, and give positive intervention.

Up-regulation of PCOLCE by TWIST1 promotes metastasis in Osteosarcoma

Procollagen C-proteinase enhancer protein (PCOLCE) was originally identified as an enhancer to facilitate the catalysis of procollagens by BMP1. PCOLCE participates in the reconstitution of extracellular and corneal repair. The elevation of PCOLCE in blood indicates that breast cancer has metastasized into the bones. However, direct research on PCOLCE has not been reported.

Methods: ECM candidates were identified by RNA-seq analysis from 4 normal and 16 osteosarcoma tissues. The in vitro migration and invasion abilities of osteosarcoma cells were determined by a Transwell assay. A spontaneous metastatic osteosarcoma model was established to assess osteosarcoma metastasis in vivo. The N-linked glycosylated amino acids were identified by PNGase F treatment combined with Western blotting. The mechanism of TWIST1 regulating PCOLCE transcription was elucidated by luciferase, qPCR and ChIP assays.

Results: PCOLCE was markedly up-regulated in human osteosarcoma tissues compared to its expression in noncancerous adjacent tissues; high PCOLCE expression in tissues correlated with a poor patient prognosis, and the knockdown of PCOLCE by shRNAs impaired the migration, invasion and lung metastasis of osteosarcoma cells. The overexpression of wild-type PCOLCE, but not its N29Q mutant, promoted migration, invasion and metastasis, indicating that the glycosylation of PCOLCE at Asn29 is necessary for its functions in osteosarcoma. TWIST1, a key transcription factor in metastasis, was also overexpressed in osteosarcoma tissues and positively correlated with either PCOLCE or its potential procollagen substrates, such as COL1A1, COL1A2, COL5A1, COL8A2 and COL10A1.

Conclusion: Our findings are the first to provide evidence that PCOLCE plays a critical role in promoting the lung metastasis of osteosarcoma, and this up-regulation of PCOLCE by TWIST1 may lead to a new therapeutic strategy to treat patients with metastatic osteosarcoma.

[Clinical diagnosis and treatment of adenoid cystic carcinoma of the external auditory canal]

Objective:To discuss the clinical diagnosis, therapies and prognosis of adenoid cystic carcinoma of external auditory canal.Method:Eleven patients with adenoid cystic carcinoma of external auditory canal, who had been admitted to West China hospital, Sichuan university from April 2009 to October 2015 were recruited and a retrospective analysis was performed.Result:All the 11 patients were treated with surgery except one elderly with T1 stage who was only treated with radiotherapy(RT),1 of the 10 patients treated with surgery were added on radiotherapy after surgery. Following up for 12-104 months,the patient who was treated with RT alone has survived with carcinoma for 51 months by now,among the remainder stage T1 patients,one was reoperated for local recurrence 95 months after surgery, and therefore survived without recurrence.The other 2 patients all survived with free-disease;in the stage T2 patients,one was lost to follow-up after identified local recurrence with pulmonary masses 12 months after surgery, another one committed suicide because of family problems 56 months after operation,and the other one survived without recurrence for 57 months after surgery; the stage T3 patient survived without recurrence for 26 months at present;in the T4 patients, one died after gamma knife therapy for local recurrent disease with brain metastasis 22 months after surgery, another one died from pulmonary metastasis 17 months after surgery,and the other one survived without recurrence for 56 months.Conclusion:Adenoid cystic carcinoma of external auditory canal is a rare disease with high misdiagnosis rate and progresses slowly.Surgery is the preferred therapy.The prognosis is closely related to disease clinical stage at presentation type of pathology and surgical approaches. Adenoid cystic carcinoma of external auditory canal is characteristically susceptible to local recurrence and distant metastasis,inaddition to routine re-exam of ear,the patients should be reviewed carefully to exclude of pulmonary,brain and kidney metastasis during follow-up.