Epithelial-mesenchymal transition classification of circulating tumor cells predicts clinical outcomes in progressive nasopharyngeal carcinoma

Background

Liquid biopsy facilitates the enrichment and isolation of circulating tumor cells (CTCs) in various human cancers, including nasopharyngeal carcinoma (NPC). Characterizing CTCs allows observation of the evolutionary process of single tumor cells undergoing blood-borne dissemination, such as epithelial-mesenchymal transition. However, the prognostic value of phenotypic classification of CTCs in predicting the clinical outcomes of NPC remains poorly understood.

Patients and methods

A total of 92 patients who met the inclusion criteria were enrolled in the present study. The CanPatrol™ CTC technology platform was employed to isolate CTCs, and an RNA in situ hybridization-based system was used for phenotypic classification. Kaplan–Meier survival curves were used for univariate survival analysis, and the log-rank test was performed for between-group comparisons of the survival curves.

Results

CTCs were detected in 88.0% (81/92) of the enrolled patients with NPC. The total CTC number did not vary between the T and N stages or between Epstein–Barr virus DNA-positive and -negative cases. The numbers of total CTCs and epithelial/mesenchymal (E/M) hybrid CTCs decreased significantly at 3 months post concurrent chemoradiotherapy (P=0.008 and P=0.023, respectively), whereas the numbers of epithelial or mesenchymal CTCs did not decrease. E/M hybrid-predominant cases had lower disease-free survival (P=0.043) and distant metastasis-free survival (P=0.046) rates than non-E/M hybrid-predominant cases.

Conclusion

CTC classification enables a better understanding of the cellular phenotypic alterations responsible for locoregional invasion and distant metastasis in NPC. E/M hybrid-predominant CTC distribution predicts unfavorable clinical outcomes in patients with progressive NPC.

A two-in-one Janus NIR-II AIEgen with balanced absorption and emission for image-guided precision surgery

Fluorescence imaging in the near-infrared II (NIR-II, 1000-1700 nm) region opens up new avenues for biological systems due to suppressed scattering and low autofluorescence at longer-wavelength photons. Nonetheless, the development of organic NIR-II fluorophores is still limited mainly due to the shortage of efficient molecular design strategy. Herein, we propose an approach of designing Janus NIR-II fluorophores by introducing electronic donors with distinct properties into one molecule. As a proof-of-concept, fluorescent dye 2 TT-m, oC6B with both twisted and planar electronic donors displayed balanced absorption and emission which were absent in its parent compound. The key design strategy for Janus molecule is that it combines the merits of intense absorption from planar architecture and high fluorescence quantum yield from twisted motif. The resulting 2 TT-m, oC6B nanoparticles exhibit a high molar absorptivity of 1.12 ⨯104 M-1 cm-1 at 808 nm and a NIR-II quantum yield of 3.7%, displaying a typical aggregation-induced emission (AIE) attribute. The highly bright and stable 2 TT-m, oC6B nanoparticles assured NIR-II image-guided cancer surgery to resect submillimeter tumor nodules. The present study may inspire further development of molecular design philosophy for highly bright NIR-II fluorophores for biomedical applications.

Bleomycin A5 suppresses Drp1‑mediated mitochondrial fission and induces apoptosis in human nasal polyp‑derived fibroblasts

Intralesional injection of bleomycin-A5 (BLE-A5) is a novel treatment for nasal polyps. Our previous study clarified that BLE-A5 could induce nasal polyp-derived fibroblast (NPDF) apoptosis in nasal polyps. However, the detailed mechanisms are still unclear. The present study aimed to determine the effects of BLE-A5 on NPDF mitochondrial dynamics and provide a theoretical basis for the local application of BLE-A5 to treat nasal polyps. In the present study, an in vitro nasal polyp tissue culture model was used to define the BLE-A5 target cell type in nasal polyps. NPDF primary cell culture was used to study the effects of BLE-A5 on the mitochondrial dynamic-related mechanism. The results showed that BLE-A5 treatment of NPDFs caused mitochondrial-mediated apoptosis. Dynamin-related protein 1 (Drp1) was shown to be altered in BLE-A5-treated NPDFs. Drp1 knockdown increased the sensitivity of NPDFs to BLE-A5 and exacerbated mitochondrial dysfunction. BLE-A5 decreased cyclin B1-CDK1 complex-mediated phosphorylation of Drp1 and inhibited Drp1-mediated mitophagy in NPDFs. Overall, the present study concluded that BLE-A5 mainly induces NPDF apoptosis in nasal polyps. BLE-A5 regulates the mitochondria by inhibiting Drp1 activation, resulting in NPDF mitochondrial dynamic disorder and apoptosis.

Interleukin-4-induced posttranscriptional gene regulation of CCL26 by the RNA-binding protein HuR in primary human nasal polyp-derived epithelial cells

BACKGROUND

Much attention on the pathophysiology of nasal polyp (NP) has focused on eosinophils. Interleukin (IL)-4 and eotaxin-3 (C-C motif chemokine ligand 26, or CCL26) levels have been reported to be increased in eosinophilic nasal polyps. The aim of this study was to characterize CCL26 posttranscriptional regulation by the RNA-binding protein HuR in primary human nasal polyp-derived epithelial cells (hNPDECs) challenged with IL-4.

METHODS

A prospective, observational study was conducted. Nasal polyp tissues were obtained from eosinophilic (n = 12) and non-eosinophilic (n = 10) NP patients, and inferior turbinate (IT) tissues were taken from control subjects (n = 9) and cultured into hNPDECs. Expression of HuR and CCL26 were measured by immunohistochemistry, Western blot analysis, enzyme-linked immunoassay, and real-time polymerase chain reaction (PCR). The nucleocytoplasmic shuttling of HuR in hNPDECs was detected by immunofluorescence. Posttranscriptional regulation of CCL26 by HuR was tested by ribonucleoprotein immunoprecipitation assay (RIP) and dual-luciferase reporter assay. CCL26 mRNA stabilization was measured by quatititative PCR after treatment with actinomycin D. Student's t test and one-way analysis of variance were used.

RESULTS

Immunohistochemical data show that both HuR and CCL26 were highly expressed in NP tissues, especially eosinophilic NP tissues (p < 0.05). IL-4 stimulation increased CCL26 mRNA stability, and overexpression and knockdown of HuR affected CCL26 expression. Immunofluorescence data indicate that IL-4 altered the subcellular distribution of HuR. The RIP and dual-luciferase reporter assay results supply strong evidence for HuR binding to CCL26.

CONCLUSION

Our results provide strong support for the hypothesis that IL-4-induced expression of CCL26 in hNPDECs relies partly on CCL26 mRNA stabilization mediated by the interaction of HuR with CCL26 3'UTR.

Reactive Oxygen Species Are Necessary for Bleomycin A5-Induced Apoptosis and Extracellular Matrix Elimination of Nasal Polyp-Derived Fibroblasts

BACKGROUND:

The pathology of chronic rhinosinusitis with nasal polyp (CRSwNP) is characterized by the infiltration of a large number of fibroblasts, resulting in extracellular matrix (ECM) deposition. Intralesional bleomycin A5 (BLE) injection has proved to be effective and safe, providing a novel treatment for CRSwNP. However, the mechanism is not clearly understood.

OBJECTIVES:

The aim of this study is to explore the possible mechanism of BLE-induced apoptosis in nasal polyp-derived fibroblasts (NPDFs).

MATERIAL AND METHODS:

Dichloro-dihydro-fluorescein diacetate probe, cell migration assays, and cell cycle analysis were used to detect the growth characteristics and basal reactive oxygen species (ROS) traits of NPDFs. Annexin V/propidium iodide and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assay was used to detect BLE-induced apoptosis. As a control, the antioxidant glutathione (GSH) was used to abrogate ROS induced by BLE. Western blot analysis was used to evaluate the effects of BLE on apoptosis and the ECM proteins of NPDFs.

RESULTS:

The results showed that NPDFs had more active growth characteristics and higher basal ROS levels than normal nasal mucosa fibroblasts (NMFCs). NPDFs were more sensitive to BLE-induced apoptosis and ROS accumulation. GSH abrogation inhibits BLE-induced ECM degradation and apoptosis in NPDFs through a mitochondrial-mediated pathway.

CONCLUSIONS:

BLE induced NPDF apoptosis and ECM degradation through a mitochondrial-mediated pathway and in a ROS-dependent manner.

Intralesional bleomycin A5 injection for the treatment of nasal polyps through inducing apoptosis

CONCLUSION

An intralesional bleomycin A5 (BLE) injection might be used as an alternative therapy for eosinophilic-type nasal polyps (NPs). BLE-induced apoptosis might play an important role in shrinkage of NPs.

OBJECTIVES

The aim of this study is to determine the effect and explore the possible role of apoptosis in shrinkage of NPs.

METHODS

Twenty-nine patients with eosinophilic-type NPs experienced repeated local injection of BLE. The recurrence rate of this group was obtained. The mechanism of BLE treatment was investigated through an in vitro experiment. Nasal polyp tissues were treated with BLE. The apoptotic activity was detected by the presence of DNA smear and test of terminal deoxynucleotidyl transferase dUTP nick end labeling. The caspase-8 and PARP were examined through immunohistochemistry and Western blotting.

RESULTS

After several local injections of BLE, the nasal polyp tissues decreased and then disappeared. During follow-up of 3 years the recurrence rate of this group was significantly lower than another one treated with operation plus medicine treatment. Apoptosis in BLE-treated tissue was prominently detected in the infiltrating inflammatory cells. The expression of PARP and casp-8 were increased in BLE-treated nasal polyp tissue compared with PBS-treated tissue.

Induction of apoptosis in nasal polyp-derived fibroblasts by bleomycin A5 in vitro

The present study aimed to evaluate the pro-apoptotic effects of bleomycin A5 on nasal polyp‑derived fibroblasts (NPDFs) and the underlying molecular mechanisms. Nasal polyp tissue was acquired from 10 patients during surgery and NPDFs were isolated from surgical tissues. Fibroblasts were identified using immunohistochemistry. Bleomycin A5 was used to treat NPDFs along a concentration gradient. Cell viability was evaluated using a Cell Counting Kit‑8 assay. A flow cytometric Annexin V‑fluorescein isothiocyanate/propidium iodide assay was used to determine the percentage of apoptotic NPDFs. The mRNA expression levels of apoptotic genes were determined by reverse transcription‑quantitative polymerase chain reaction and levels of proteins associated with apoptosis were determined by western blotting. The results indicated that bleomycin A5 was able to induce apoptosis in NPDFs in a dose‑dependent manner. NPDFs treated with bleomycin A5 were identified to contain significantly high amounts of the active forms of caspase‑3 and showed considerable cleavage of poly(ADP‑ribose) polymerase. The mRNA and protein expression levels of the pro‑apoptotic molecule Bcl‑2‑associated X protein were significantly higher in treated NPDFs than in untreated NPDFs. In contrast, the mRNA and protein expression of the anti‑apoptotic molecule B‑cell lymphoma 2 (Bcl‑2) was significantly lower in treated NPDFs. These results indicated that bleomycin A5 could induce apoptosis in primary NPDFs through activation of the Bcl‑2 family and caspase cascades in a time-, and concentration-dependent manner.

[Effects of combination therapy with aspirin, prednisone, and Elevit in patients with unexplained recurrent early pregnancy loss]

Objective: To investigate the effect of triple therapy with aspirin, prednisone and Elevit in patients with unexplained recurrent early pregnancy loss. Methods: From January 1, 2013 to December 31, 2016, a total of 353 women of childbearing age were enrolled in Peking Union Medical College Hospital, including blood, urine and vaginal swabs. One hundred and fifty-five patients were observed normal results of blood test, urine test and vaginal swabs. According to the treatment regimen, 155 patients were divided into two groups, 89 patients (57.42%) treated with (aspirin, prednisone, and Elevit) as experimental group, and the other 66 cases (42.58%) taking folic acid as control group. The fetal bud, fetal heart and neck hyaline layer thickness were examined by ultrasonography at 12 weeks. Visible fetal bud, fetal heart, and nuchal translucency thickness <0.3 cm were used as indicators of successful treatment. t test and χ(2) test were used to analyze and compare the statistical significance of the differences between the two groups of patients, and the Logistic method was used to analyze the data and observe the effect of medication. Results: There were 67 patients successfully treated in the experimental group, the successful rate was 83.75% (67/80), and 33 patients in the control group were successfully treated, the successful rate was 54.10% (33/61). There were significant statistical differences in two groups (P<0.05). Conclusion: The effect of triple therapy with aspirin, prednisone and Elevit in patients with unexplained recurrent early pregnancy loss is significant.

[Analysis of the influence of iron overload in glucose metabolism in thalassemia major patients]

Objective: This study aimed at determining the characteristics of the glucose homeostasis and its relationship with iron overload of the patients with β-thalassemia major (β-TM). Method: From Sun Yat-sen Memorial Hospital between January 2014 and December 2015, a total of 57 transfusion-dependent β-TM patients with 5-18 years old were enrolled in this study and fasting blood glucose(FBG) and insulin level, serum ferritin (SF), serum iron, transferrin, total iron binding capacity, unsaturated iron binding capacity were determined.Insulin resistance index (IRI), insulin sensitivity index and β-cell function index (BFI) were also estimated. Besides, in 36 patients cardiac T2* and liver T2* were estimated. Result: (1) Four patients(7%) with β-TM were diagnosed diabetes mellitus, and 14(24%) had impaired fasting glucose. (2) The incidence of abnormal glucose metabolism was significantly different according to levels of SF and degrees of the cardiac iron overload(χ(2)=9.737, P<0.05; χ(2)=17.027, P<0.05). It rose while the level of SF increased and the degree of cardiac iron overload aggravated. (3) The incidence of abnormal glucose level was not significantly different in cases with different degree of liver iron overload.The severe group of liver iron overload had significantly higher levels of INS, HOMA-βFI, HOMA-ISI, HOMA-βFI than the non-severe group (Z=-2.434, -2.515, F=8.658, all P<0.05), while no differences were found in the level of FBG, HOMA-βFI between two groups. (4) The result of logistic regression analysis indicated that the cardiac T2* was a significant predictor for the incidence of abnormal glucose metabolism in TM patients (P=0.035, OR=1.182%, 95%CI=1.048 to 1.332). Conclusion: The high prevalence of abnormal glucose metabolism in β-TM patients was mainly closely related with the internal iron overload, especially in organs.The cardiac T2* was an independent risk factor for the incidence of abnormal glucose metabolism in TM patients.

Retinoic acid-induced tissue transglutaminase and apoptosis in vascular smooth muscle cells

Retinoids exert antiproliferative and prodifferentiating effects in vascular smooth muscle cells (SMCs) and reduce neointimal mass in balloon-injured blood vessels. The mechanisms through which retinoids carry out these effects are unknown but likely involve retinoid receptor-mediated changes in gene expression. Here we report the cloning, chromosomal mapping, and biological activity of the retinoid-response gene rat tissue transglutaminase (tTG). Northern blotting studies showed that tTG is rapidly and dose-dependently induced in a protein synthesis-independent manner after stimulation with the natural retinoid all-trans retinoic acid (atRA). The induction of tTG was selective for atRA and its stereoisomers 9-cis and 13-cis RA, because little or no elevation in mRNA expression was observed with a panel of growth factors. Western blotting and immunofluorescence confocal microscopy showed an accumulation of cytosolic tTG protein after atRA stimulation. Radiolabeled cross-linking studies revealed a corresponding elevation in in vitro tTG activity. The increase in tTG activity was reduced in the presence of 2 distinct inhibitors of tTG (monodansylcadaverine and cystamine). atRA-induced tTG mRNA and protein expression were followed by a significant elevation in SMC apoptosis. Such retinoid-induced programmed cell death could be partially inhibited with each tTG inhibitor and was completely blocked when both inhibitors were used simultaneously. These results establish a role for atRA in the sequential stimulation of tTG and apoptosis in cultured SMCs. atRA-mediated apoptosis in SMCs seems to require the participation of active tTG, suggesting a potential mechanistic link between this retinoid-inducible gene and programmed cell death.

Nitric oxide synthase/nitric oxide pathway mediates intussusception pathogenesis in rats

OBJECTIVE

To study the role of nitric oxide synthase/nitric oxide pathway in the pathophysiological process of intussusception (IN).

METHODS

The IN model of rat was induced by lipopolysaccharide (LPS). The content of NOx in plasma and the NOS activity in colic smooth muscle tissues were measured. The content of cGMP was determined by radioimmunoassay.

RESULTS

LPS (10 mg/kg, i.p.) induced IN in up to 40% of the rats 6 hours after treatment with LPS. The incidence of IN was significantly increased by 58.3% (P < 0.05) and by 66.8% (P < 0.01) in L-arginine (L-Arg)-treated rats (2% in drinking water) and in sodium nitroprusside (NSP)-treated rats (1 mg/kg, i.p.), respectively, but it is significantly decreased by 66.8% (P < 0.01) after administration of M-omega-nitro-L-arginine methyl ester (L-NAME, 15 mg/kg, i.p.), an inhibitor of nitric oxide synthase (NOS) activity. Furthermore, LPS increased total NOS activity, NOx production and cGMP levels in plasma or in colic smooth muscle tissues. These parameters in LPS-IN rats were significantly elevated by 38.8%, 50.7%, and 48.7% respectively (P < 0.01) compared with LPS-non-IN rats.

CONCLUSION

NOS/NO pathway plays an important role in the process of IN, and inhibition of NO production may serve as a possible approach to prevent IN.

Laparoscopic-assisted mini laparatomy with colectomy

PURPOSE

Laparoscopic colectomy, as many claim, is technically feasible. However, none can definitely attest to its superiority over or even equivalence to traditional open laparotomy. The goal of this study is to assess results of laparoscopic colectomy via a new approach compared with traditional colectomy.

METHODS

The study involves 12 cases of laparoscopic mini laparotomy with colectomy and another 12 cases of traditional colectomy. Laparoscopic mini laparotomy is performed with the same equipment used in laparoscopic cholecystectomy. Through a small 5-cm to 6-cm incision, the surgeon's left hand inserts into the peritoneal cavity and participates in the laparoscopic mobilization of the bowel along with other laparoscopic instruments. Mesenteric division and bowel anastomosis are performed through the same incision extracorporeally.

RESULTS

The preliminary result of the study shows that, compared with traditional surgery, laparoscopic mini laparotomy with colectomy offers reduction in the frequency of usage of intramuscular analgesics, better cosmetic results, earlier food intake, and shorter hospital stay. The only disadvantage of laparoscopic mini laparotomy with colectomy is that it takes longer operative time, which may decrease with more experience.

CONCLUSION

Laparoscopic mini laparotomy with colectomy is an alternative method of laparoscopic colectomy. It seems to offer a similar morbidity and better results compared with colectomy in open laparotomy.

Concomitant renal cell carcinoma and metastatic epithelioid angiosarcoma with microangiopathy

Epithelioid angiosarcoma is an extremely rare clinical entity. Recognized only in recent years, epithelioid angiosarcoma mimicks epithelial tumors, both morphologically and immunohistochemically. It is very aggressive, assuming a rapid, metastatic and fatal course. This is a report of a case with an unequivocal diagnosis of epithelioid angiosarcoma and concomitant renal cell carcinoma. Reports of cancer with double origins of this combination, in patients without inherited von Hippel-Lindau disease, are extremely rare in the English literature. A review of the literature encompassing all cases of epithelioid angiosarcoma since 1983 is included.

A new dissecting technique of the gallbladder in laparoscopic cholecystectomy

Laparoscopic cholecystectomy is still a challenge to most general surgeons because of the complexity and length of the procedure. We have developed a timesaving technique of dissecting the gallbladder by using a dissection forceps. This new method reduces the operative time by half.