Activation of the PI3K/AKT signaling pathway by ARNTL2 enhances cellular glycolysis and sensitizes pancreatic adenocarcinoma to erlotinib

BACKGROUND

Pancreatic adenocarcinoma (PC) is an aggressive malignancy with limited treatment options. The poor prognosis primarily stems from late-stage diagnosis and when the disease has become therapeutically challenging. There is an urgent need to identify specific biomarkers for cancer subtyping and early detection to enhance both morbidity and mortality outcomes. The addition of the EGFR tyrosine kinase inhibitor (TKI), erlotinib, to gemcitabine chemotherapy for the first-line treatment of patients with advanced pancreatic cancer slightly improved outcomes. However, restricted clinical benefits may be linked to the absence of well-characterized criteria for stratification and dependable biomarkers for the prediction of treatment effectiveness.

METHODS AND RESULTS

We examined the levels of various cancer hallmarks and identified glycolysis as the primary risk factor for overall survival in PC. Subsequently, we developed a glycolysis-related score (GRS) model to accurately distinguish PC patients with high GRS. Through in silico screening of 4398 compounds, we discovered that erlotinib had the strongest therapeutic benefits for high-GRS PC patients. Furthermore, we identified ARNTL2 as a novel prognostic biomarker and a predictive factor for erlotinib treatment responsiveness in patients with PC. Inhibition of ARNTL2 expression reduced the therapeutic efficacy, whereas increased expression of ARNTL2 improved PC cell sensitivity to erlotinib. Validation in vivo using patient-derived xenografts (PDX-PC) with varying ARNTL2 expression levels demonstrated that erlotinib monotherapy effectively halted tumor progression in PDX-PC models with high ARNTL2 expression. In contrast, PDX-PC models lacking ARNTL2 did not respond favorably to erlotinib treatment. Mechanistically, we demonstrated that the ARNTL2/E2F1 axis-mediated cellular glycolysis sensitizes PC cells to erlotinib treatment by activating the PI3K/AKT signaling pathway.

CONCLUSIONS

Our investigations have identified ARNTL2 as a novel prognostic biomarker and predictive indicator of sensitivity. These results will help to identify erlotinib-responsive cases of PC and improve treatment outcomes. These findings contribute to the advancement of precision oncology, enabling more accurate and targeted therapeutic interventions.

The Role of Bile Acids in Pancreatic Cancer

Bile acids are well known to promote the digestion and absorption of fat, and at the same time, they play an important role in lipid and glucose metabolism. More studies have found that bile acids such as ursodeoxycholic acid also have anti-inflammatory and immune-regulating effects. Bile acids have been extensively studied in biliary and intestinal tumors but less in pancreatic cancer. Patients with pancreatic cancer, especially pancreatic head cancer, are often accompanied by biliary obstruction and elevated bile acids caused by tumors. Elevated total bile acid levels in pancreatic cancer patients usually have a poor prognosis. There has been controversy over whether elevated bile acids are harmful or beneficial to pancreatic cancer. Still, there is no doubt that bile acids are important for the occurrence and development of pancreatic cancer. This article summarizes the research on bile acid as a biomarker and regulation of the occurrence, development and chemoresistance of pancreatic cancer, hoping to provide some inspiration for future research.

Cuproptosis-related lncRNAs are correlated with tumour metabolism and immune microenvironment and predict prognosis in pancreatic cancer patients

Cuproptosis is a novel cell death pathway, and the regulatory mechanism in pancreatic cancer (PC) is unclear. The authors aimed to figure out whether cuproptosis-related lncRNAs (CRLs) could predict prognosis in PC and the underlying mechanism. First, the prognostic model based on seven CRLs screened by the least absolute shrinkage and selection operator Cox analysis was constructed. Following this, the risk score was calculated for pancreatic cancer patients and divided patients into high and low-risk groups. In our prognostic model, PC patients with higher risk scores had poorer outcomes. Based on several prognostic features, a predictive nomogram was established. Furthermore, the functional enrichment analysis of differentially expressed genes between risk groups was performed, indicating that endocrine and metabolic pathways were potential regulatory pathways between risk groups. TP53, KRAS, CDKN2A, and SMAD4 were dominant mutated genes in the high-risk group and tumour mutational burden was positively correlated with the risk score. Finally, the tumour immune landscape indicated patients in the high-risk group were more immunosuppressive than that in the low-risk group, with lower infiltration of CD8+ T cells and higher M2 macrophages. Above all, CRLs can be applied to predict PC prognosis, which is closely correlated with the tumour metabolism and immune microenvironment.

Chemotherapeutic drugs-induced pyroptosis mediated by gasdermin E promotes the progression and chemoresistance of pancreatic cancer

Pyroptosis is closely associated with cancer development; however, the role of pyroptosis in pancreatic ductal adenocarcinoma (PDAC), a fatal malignant tumour with a poor overall survival rate, remains elusive. Here, we explored the mechanism of chemotherapy-induced pyroptosis and elucidated the role of pyroptosis in mediating PDAC progression and chemoresistance. The results demonstrated first- and second-line chemotherapeutic drugs against PDAC, including gemcitabine, irinotecan, 5-fluorouracil, paclitaxel, and cisplatin, induced concurrent pyroptosis and apoptosis. During this process, gasdermin E (GSDME) was cleaved by activated caspase-3, which was accompanied by pro-apoptotic caspase-7/8 activation. GSDME knockdown switched pyroptosis to apoptosis, decreased invasion and migration, and enhanced the sensitivity of PDAC cells to chemotherapy in vitro and in vivo. GSDME was highly expressed in PDAC tissues and positively correlated with histological differentiation and vascular invasion. Furthermore, cells that survived pyroptosis promoted proliferation and invasion and impaired the chemosensitivity of PDAC cells, which was attenuated by the GSDME knockdown. Our findings demonstrated that chemotherapeutics against PDAC induce GSDME-dependent pyroptosis, and GSDME expression positively correlated with PDAC progression and chemoresistance. Targeting GSDME may be a novel approach to overcoming chemoresistance in PDAC.

PLA2G2A+ cancer-associated fibroblasts mediate pancreatic cancer immune escape via impeding antitumor immune response of CD8+ cytotoxic T cells

Our previous research defined a novel metabolic cancer associated fibroblasts subset (meCAFs) enriched in loose-type pancreatic ductal adenocarcinoma (PDAC) and related to CD8⁺ T cells accumulation. Consistently, the abundance of meCAFs was associated with poor prognosis but better immunotherapy responses in PDAC patients. However, the metabolic characteristic of meCAFs and its cross-talk with CD8⁺ T cells remain to be elucidated. In this study, we identified PLA2G2A as a marker of meCAFs. In particular, the abundance of PLA2G2A⁺ meCAFs was positively related to the accumulation of total CD8⁺ T cells and negatively correlated with clinical outcomes of PDAC patients and infiltration of intratumoral CD8⁺ T cells. We demonstrated that PLA2G2A⁺ meCAFs substantially attenuated the antitumor ability of tumor infiltrating CD8⁺ T cells and facilitated tumor immune escape in PDAC. Mechanistically, PLA2G2A regulated the function of CD8⁺ T cells as a pivotal soluble mediator via MAPK/Erk and NF-κB signaling pathways. In conclusion, our study identified the unrecognized role of PLA2G2A⁺ meCAFs in promoting tumor immune escape by impeding the antitumor immune function of CD8⁺ T cells, and strongly suggested PLA2G2A as a promising biomarker and therapeutic target for immunotherapy in PDAC.

HDACs/mTOR inhibitor synergizes with pyrotinib in HER2-positive pancreatic cancer through degradation of mutant P53

BACKGROUND

Pancreatic ductal adenocarcinoma (PDAC), as a highly lethal malignancy with high mortality, lacks of effective treatment. Canonical therapeutic targets in PDAC demand further verification among which HER2 receptor tyrosine kinase inhibitor pyrotinib as treatment targets has not be decided.

METHODS

Anti-PDAC efficacy of pyrotinib was evaluated both in vitro and in vivo using both cell lines and patient-derived xenografts. By screening a large-scale library of 1453 compounds, we identified HDACs/mTOR inhibitor 1 as a promising candidate to synergize with pyrotinib. The combination therapy was evaluated in vitro and in vivo in multiple cell lines and animal models. Furthermore, RNA-seq analysis was performed to reveal the latent molecular mechanism of combination therapy.

RESULTS

In our study, pyrotinib monotherapy was found to be inefficient to anti-PDAC which exhibited limited anti-proliferation effect in vitro and in vivo. Through therapy combined with HDACs/mTOR inhibitor 1, pyrotinib triggered intense apoptosis in PDAC both in cell lines and animal models. Mechanistic analyses revealed that mutant P53 degradation mediated by HDAC inhibition synergized with HER2 and mTOR inhibition.

CONCLUSIONS

In conclusion, identification of HDACs/mTOR inhibitor as a synergistic inhibitor, provides a potent therapeutic strategy that targets HER2-positive pancreatic cancer.

A novel angiogenesis-based molecular signature related to prognosis and tumor immune interactions of pancreatic cancer

Angiogenesis, a hallmark of cancer, is related to prognosis, tumor progression, and treatment response. Nevertheless, the correlation of angiogenesis-based molecular signature with clinical outcome and immune cell infiltration has not been thoroughly studied in pancreatic cancer. In this study, multiple bioinformatics methods were combined to evaluate prognosis, immune cell infiltration, and the alterations of angiogenesis-related genes (ARGs) in PC samples, and further establish a novel angiogenesis-related gene signature. Moreover, the protein and mRNA expression levels of four angiogenesis risk genes were determined by Human Protein Atlas (HPA) database and qPCR analysis, respectively. Here, we recognized two distinct angiogenesis subtypes and two gene subtypes, and revealed the critical roles of ARGs in the tumor immune microenvironment (TIME), clinical features, and prognosis. Consequently, we established an ARGs score to predict prognosis and therapeutic response of PC patients, and validated its robust predictive ability. Additionally, the ARGs score was markedly associated with clinical outcomes, tumor mutation burden (TMB), and chemotherapeutic drug sensitivity. In brief, our findings imply that the ARGs score is a robust prognostic indicator and may contribute to the development of effective individualized therapies for PC.

Association of aging-related genes with prognosis and immune infiltration in pancreatic adenocarcinoma

Pancreatic adenocarcinoma (PAAD) is one of the deadliest malignancies. Aging is described as the degeneration of physiological function, which is complexly correlated with cancer. It is significant to explore the influences of aging-related genes (ARGs) on PAAD. Based on The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx) datasets, we used univariate Cox regression analysis and acquired eight differentially expressed ARGs with prognostic values. Two molecular subtypes were identified based on these ARGs to depict PAAD patients’ overall survival (OS) and immune microenvironments preliminarily. Cluster 1 had a poor OS as well as a worse immune microenvironment. Through least absolute shrinkage and selection operator (LASSO) regression analysis, we constructed a seven-ARG risk signature based on the TCGA dataset and verified it in Gene Expression Omnibus (GEO) and International Cancer Genome Consortium (ICGC) to predict the prognoses, immune microenvironments, signal pathways, tumor mutations, and drug sensitivity of PAAD patients. The high-risk group possessed an unfavorable OS compared with that of the low-risk group. We also verified the independence and clinical availability of the risk signature by Cox regression analyses and the establishment of a nomogram, respectively. The higher risk score was associated with several clinical factors such as higher grade and advanced tumor stage as well as lower immunoscore and cluster 1. The negative associations of risk scores with immune, stroma, and estimate scores proved the terrible immune microenvironment in the high-risk group. Relationships between risk score and immune checkpoint gene expression as well as signal pathways provided several therapeutic targets. PAAD patients in the low-risk group possessed lower tumor mutations as well as a higher susceptibility to axitinib and vorinostat. The high-risk group bore a higher TMB and cisplatin and dasatinib may be better options. We used immunohistochemistry and qPCR to confirm the expression of key ARGs with their influences on OS. In conclusion, we identified two ARG-mediated molecular subtypes and a novel seven-ARG risk signature to predict prognoses, immune microenvironments, signal pathways, tumor mutations, and drug sensitivity of PAAD patients.

Distinguishable Prognostic Signatures and Tumor Immunogenicity Between Pancreatic Head Cancer and Pancreatic Body/Tail Cancer

Background

Pancreatic head cancer and pancreatic body/tail cancer are considered to have different clinical presentations and to have altered outcomes.

Methods

Ninety cases of pancreatic adenocarcinoma (PDAC) from our institution were used as a discovery set and 166 cases of PDAC from the TCGA cohort were used as a validation set. According to the anatomical location, the cases of PDAC were divided into the pancreatic head cancer group and the pancreatic body/tail cancer group. Firstly, the different biological functions of the two groups were assessed by ssGSEA. Meanwhile, ESTIMATE and CIBERSORT were conducted to estimate immune infiltration. Then, a novel anatomical site-related risk score (SRS) model was constructed by LASSO and Cox regression. Survival and time-dependent ROC analysis was used to prove the predictive ability of our model in two cohorts. Subsequently, an integrated survival decision tree and a scoring nomogram were constructed to improve prognostic stratification and predictive accuracy for individual patients. In addition, gseaGO and gseaKEGG pathway analyses were performed on genes in the key module by the R package.

Results

Overall survival and the objective response rate (ORR) of patients with pancreatic body/tail cancer were markedly superior to those with pancreatic head cancer. In addition, distinct immune characteristics and gene patterns were observed between the two groups. Then, we screened 5 biomarkers related to the prognosis of pancreatic cancer and constructed a more powerful novel SRS model to predict prognosis.

Conclusions

Our research shed some light on the revelation of gene patterns, immune and mutational landscape characterizations, and their relationships in different PDAC locations.

Synergistic blocking of RAS downstream signaling and epigenetic pathway in KRAS mutant pancreatic cancer

BACKGROUND

Pancreatic ductal adenocarcinoma (PDAC) is a highly fatal malignancy and lacks effective therapeutic targets. Trametinib is considered to be a promising potential indirectly targeted KRAS inhibitor in PDAC. However, the clinical outcomes were poor. JQ1 displayed a significant synergistic effect when combined with chemotherapy or potential targeted therapy in pancreatic cancer. The impact of Trametinib and JQ1 combination treatment in PDAC remains to be fully elucidated.

METHODS

The efficacy of trametinib and JQ1 on cell proliferation and cytotoxicity was assayed in 7 KRAS mutant pancreatic cancer cell lines. The cytotoxic effects of drugs either alone or in combination were evaluated using a luminescent cell viability assay. Immunoblot analysis was carried out to investigate changes in p62 and autophagy.

RESULTS

We found that either trametinib or JQ1 alone inhibited the proliferation of some pancreatic cancer cell lines with KRAS alterations, irrespective of the mutational loci of KRAS and the aberrant status of the other driver genes. The synergistic effects of combination treatment of trametinib and JQ1 were observed in both trametinib-resistant and trametinib-sensitive cells. In trametinib-sensitive PDAC cells, the combined treatment definitely inhibited p62 expression compared with trametinib alone, while LC3 expression at high levels changed little. In trametinib-resistant PDAC cells, the combination of MEK/BET inhibitor dramatically decreased p62 expression compared with single agent, while p62 expression increased after anti-autophagic therapy was added.

CONCLUSIONS

Blocking RAS downstream signaling and epigenetic pathway synergistically increases the antiproliferative activity in KRAS mutant PDAC cells. Combination therapeutic synergism may induce different cell death modes in different pancreatic cancer subtypes.

Characterization of the genomic landscape in large-scale Chinese patients with pancreatic cancer

Background

Pancreatic ductal adenocarcinoma (PDAC) is a malignant tumor with an extremely poor prognosis. Effective targets for anticancer therapy confirmed in PDAC are limited. However, the characteristics of genomics have not been fully elucidated in large-scale patients with PDAC from China.

Methods

We collected both blood and tissue samples from 1080 Chinese patients with pancreatic cancer and retrospectively investigated the genomic landscape using next-generation sequencing (NGS).

Findings

We found recurrent somatic mutations in KRAS (83.2%), TP53 (70.6%), CDKN2A (28.8%), SMAD4 (23.0%), ARID1A (12.8%) and CDKN2B (8.9%) in Chinese PDAC patients. Compared with primary pancreatic cancers, more genomic alterations accumulated especially cell cycle regulatory gene variants (45.4% vs 31.6%, P < 0.001) were observed in metastatic tumors. The most common mutation site of KRAS is p.G12D (43.6%) in pancreatic cancer. Patients with KRAS mutations were significantly associated with older age and mutations in the other three driver genes, while KRAS wild-type patients contained more fusion mutations and alternative mechanisms of RTK/Ras/MAPK pathway including a number of clinically targetable mutations. KRAS mutations in Chinese cohort were significantly lower than those in Western cohorts (all P < 0.05). A total of 252 (23.3%) patients with the core DNA damage response (DDR) gene mutations were detected. ATM (n =59, 5.5%) was the most frequent mutant DDR gene in patients with pancreatic cancer from China. Patients with germline DDR gene mutations were younger (P = 0.018), while patients with somatic DDR gene mutations were more likely to accumulate in metastatic lesions (P < 0.001) and had higher TMB levels (P < 0.001). In addition, patients with mutant DDR genes and patients carrying TP53 mutation were observed mutually exclusive (P < 0.001).

Interpretation

We demonstrated the real-world genomic characteristics of large-scale patients with pancreatic cancer from China which may have promising implications for further clinical significance and drug development.

Funding

The funders are listed in the Acknowledgement.

A phase I study of the safety and activity of K-001 in patients with advanced pancreatic ductal adenocarcinoma

Background

Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease that lack of effective therapeutic drugs. K-001 is an oral antitumor drug made from active ingredients of marine microorganisms. The current study aimed to evaluate safety and antitumor activity of K-001 in patients with advanced PDAC.

Methods

In this phase I, open-label trial, patients with advanced PDAC were recruited to a dose-escalation study in a standard 3 + 3 design. K-001 was administered twice daily in four-week cycles, and dose escalation from 1350 mg to 2160 mg was evaluated twice daily. Physical examination and laboratory tests were done at screening and then weekly. The safety, dose-limiting toxicity (DLT), and maximum tolerated dose (MTD) of K-001 were assessed while tumor response was estimated by Response Evaluation Criteria in Solid Tumor (RECIST).

Results

Eighteen patients with advanced PDAC were screened, and twelve eligible patients were analyzed in the study. No DLT was observed. Totally, 47 adverse events (AEs) presented, and 14 drug-related AEs were reported in 7 patients, including 8 grade 1 events (57.1%) and 6 grade 2 events (42.9%). There was no grade 3 or 4 drug-related AE. In these 14 drug-related AEs, the most frequent ones were dyspepsia (21.4%), followed by flatulence, constipation, and hemorrhoid bleeding (above 10% of each). Among all 12 patients, 10 patients (83.3%) maintained stable disease (SD), and 2 patients (16.7%) had progressive disease (PD). The objective response rate (ORR) was 0% and the disease control rate (DCR) was 83.3%.

Conclusions

K-001 manifests satisfactory safety and tolerability, as well as meaningful antitumor activity in advanced PDAC patients. Further evaluation of K-001 in phase II/III appears warranted.

Trial registration

NCT02720666. Registered 28 Match 2016 - Retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08375-6.

Single-cell analysis of pancreatic ductal adenocarcinoma identifies a novel fibroblast subtype associated with poor prognosis but better immunotherapy response

The current pathological and molecular classification of pancreatic ductal adenocarcinoma (PDAC) provides limited guidance for treatment options, especially for immunotherapy. Cancer-associated fibroblasts (CAFs) are major players of desmoplastic stroma in PDAC, modulating tumor progression and therapeutic response. Using single-cell RNA sequencing, we explored the intertumoral heterogeneity among PDAC patients with different degrees of desmoplasia. We found substantial intertumoral heterogeneity in CAFs, ductal cancer cells, and immune cells between the extremely dense and loose types of PDACs (dense-type, high desmoplasia; loose-type, low desmoplasia). Notably, no difference in CAF abundance was detected, but a novel subtype of CAFs with a highly activated metabolic state (meCAFs) was found in loose-type PDAC compared to dense-type PDAC. MeCAFs had highly active glycolysis, whereas the corresponding cancer cells used oxidative phosphorylation as a major metabolic mode rather than glycolysis. We found that the proportion and activity of immune cells were much higher in loose-type PDAC than in dense-type PDAC. Then, the clinical significance of the CAF subtypes was further validated in our PDAC cohort and a public database. PDAC patients with abundant meCAFs had a higher risk of metastasis and a poor prognosis but showed a dramatically better response to immunotherapy (64.71% objective response rate, one complete response). We characterized the intertumoral heterogeneity of cellular components, immune activity, and metabolic status between dense- and loose-type PDACs and identified meCAFs as a novel CAF subtype critical for PDAC progression and the susceptibility to immunotherapy.

Anti-PD-1 antibody combined with albumin-bound paclitaxel and gemcitabine (AG) as first-line therapy and Anti-PD-1 monotherapy as maintenance in metastatic pancreatic ductal adenocarcinoma (PDAC)

e16218

Background: Two studies in ASCO 2018 showed the preliminary efficacy of PD-1 inhibitor and AG as first-line therapy for advanced pancreatic cancer, the disease control rate (DCR) was up to 100%. However, in a phase 1 study of nivolumab plus nab-paclitaxel and gemcitabine in advanced PDAC, the objective response rate (ORR) was only 18%, and the progression-free survival (PFS)/overall survival (OS) were 5.5/9.9 months, which was quite different from what had been reported before in ASCO. All the patients received continuous chemotherapy, and the tolerance was poor. Recently, maintenance therapy on pancreatic cancer was widely investigated in clinical trials. The present study explored the camrelizumab (anti-PD-1 antibody) combined with AG as the first-line treatment, and camrelizumab as maintenance therapy for metastatic PDAC (mPDAC) among Chinese patients. Methods: In this single-arm, single-center, exploratory study, patients who were pathologically or cytologically diagnosed as mPDAC and had not received systemic treatment before, with an ECOG performance status of 0-1 would receive: albumin-bound paclitaxel 125 mg/m2 plus gemcitabine 1000 mg/m2 (days 1, 8), and camrelizumab, 200mg (day 1) for a 21-day cycle. After six cycles, if there was no evidence of disease progression, camrelizumab (200mg, every 21 days) monotherapy as maintenance therapy would be given. Primary endpoint was ORR assessed according to RECIST 1.1. The secondary endpoint was DCR, PFS, OS, etc. Safety was also assessed. Results: From July 3, 2019 to July 1, 2020, twenty patients were enrolled and received the study treatment. The median age was 63 years (range 33-78). Sixteen participants (80%) were male. Eleven patients (55%) received six cycles of camrelizumab combined with AG and subsequential maintenance therapy. Nineteen patients received at least one imaging evaluation, one patient (5%) achieved complete response, eleven (55%) patients achieved partial response, five (25%) patients were assessed as stable disease, and progressive disease was observed in two patients (10%) who died within 2 months. The ORR (primary endpoint) and DCR were 60% and 85%, respectively. The data of PFS and OS were immature. The most common AEs (all grade, grade≥3) were erythropenia (55%, 0%), leukopenia (45%, 10%), neutropenia (40%, 15%), anemia (30%, 5%), thrombocytopenia (30%, 5%). One patient received day 1 camrelizumab plus AG, and the day 8 therapy was skipped due to thrombocytopenia. During the second cycle, he presented with jaundice due to disease progression and died rapidly. Conclusions: The ORR and DCR of chemotherapy-naive mPDAC patients receiving camrelizumab plus AG were high. Safety findings were consistent with previous data observed from camrelizumab or AG treatment; with no unexpected safety signals. Clinical trial information: NCT04181645.

A narrative review of Safety management of 1 L platinum-based chemotherapy and maintenance olaparib in BRCA mutated advanced pancreatic cancer

OBJECTIVE

We aimed to review the safety management and efficacy of a modified FOLFIRINOX regimen to help clinicians improve first-line platinum-based chemotherapy and maintenance olaparib to treat patients with advanced PC with BRCA mutations.

BACKGROUND

FOLFIRINOX has relatively high efficacy among all the chemotherapy regimens for advanced pancreatic carcinoma (PC) patients. However, the combination of drugs is often associated with a high incidence of adverse reactions, and safety concerns are the primary reasons limiting its clinical use. In recent years, through the adjustment of drug dosage and administration route, the toxicity of FOLFIRINOX has been reduced while its clinical effect has been maintained. Also, the empirical use of prophylactics in the chemotherapy cycle can reduce chemotherapy-related serious adverse reactions. All these methods have established a good foundation for the maintenance of olaparib.

METHODS

Pubmed, Embase, and the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) were searched using the terms' pancreatic cancer', 'folfirinox', 'parp inhibitor', 'chemotherapy', and 'adverse reaction' from 2005 through to March 2021.

CONCLUSIONS

The historical evidence suggested that modified FOLFIRINOX and maintenance olaparib could significantly improve the therapeutic effect and reduce the toxicity. It also provides some insights for clinicians to choose the most suitable regimen for each patient.

CSE1L, as a novel prognostic marker, promotes pancreatic cancer proliferation by regulating the AKT/mTOR signaling pathway

Pancreatic cancer is one of the most aggressive tumors with poor prognosis and new targetable therapies are urgently required. CSE1L (chromosome segregation 1 like) is thought to play an important role in tumorigenesis and acts as a cancer therapeutic target. However, the biological function and the underlying mechanism of CSE1L in pancreatic cancer are still not fully explicit. In the present study, we found that high CSE1L expression was related to a worse prognosis in patients with pancreatic cancer according to data from the Cancer Genome Atlas (TCGA) database. Additionally, we found that CSE1L knockdown inhibited the proliferation of pancreatic cancer cells and promoted apoptosis, while CSE1L overexpression demonstrated the opposite phenomenon. Furthermore, we discovered that CSE1L might regulate pancreatic cancer proliferation through AKT signaling pathway. In summary, we reveal that CSE1L plays a crucial role in tumor growth and may serve as a potential prognostic and therapeutic target for pancreatic cancer.

[Preliminary results of Chinese magnetic sphincter augmentation in treating gastroesophageal reflux disease]

Objective: To examine the preliminary clinical efficacy of Chinese magnetic sphincter augmentation (MSA) in the treatment of gastroesophageal reflux disease (GERD). Methods: According to the enrollment criteria for the MSA developed by ShengJieKang Co. and Shanghai Chest Hospital (SS-MSA) clinical trial, a total of 19 GERD patients were treated with SS-MSA from August 2018 to January 2020 at Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University. The majority of registered cases were male patients with age of (32.2±7.3) years (range: 22 to 50 years), height of (170.7±6.2) cm (range: 160 to 179 cm) and weight of (65.2±10.3) kg (range: 47.5 to 90.0 kg). SS-MSA was implanted via laparoscopy. The major evaluation indexs of postoperative efficacy were the total time of acid exposure within 24 hours and the total number of reflux. Secondary efficacy indicators included: (1) evaluation of the average daily dose of proton pump inhibitor medications; (2) the score of GERD health related quality of life questionnaire (GERD-Q) before and after MSA implantation. Paired design t-test was used to evaluate the efficacy of the SS-MSA. Results: A total of 19 patients underwent SS-MSA surgery successfully. The history of the GERD were 19 (54) months (M(Q(R))). The operation time was 63 (22) minutes and the in-hospital stay was 3 (2) days. No obvious surgical complications occurred. Postoperative adverse events included 14 cases with mild to moderate dysphagia exited after surgery, gradually eased within 1 to 3 months, 1 case with the removal of the device after 1 month of severe swallowing difficulties, 1 case of diarrhea. No corrosion, perforation, displacement occurred. The GERD-Q score (11.0(4.5) vs. 6(1.0), t=4.274, P=0.013), 24-hour acid exposure time (6.2(4.8)% vs. 0.1(0.9)%, t=5.814, P=0.004), and Demeester score (23.72(16.20) vs. 0.96(3.10), t=6.678, P=0.003) were significantly decreased 1 year after surgery(n=5). Proton pump inhibitor reuse rates were 6/18, 5/15, 3/10, and 1/5 in 1, 3, 6 and 12 months after the operation, respectively. Conclusions: SS-MSA implantation is feasible and safe with short hospital stay and rare perioperative complications. The preliminary results is good after 1 year follow-up. It could be expected to be an ideal substitutive for future GERD treatment.

PD-1 antibody combined with paclitaxel (albumin bound) and gemcitabine as first-line therapy in patients with metastatic pancreatic cancer

TPS4665

Background: Pancreatic cancer is a malignant tumor with limited therapeutic strategies and poor prognosis. About 60% of the patients have metastasis disease at time of diagnosis and lose the opportunity for surgery. Thus, therapy based on drugs becomes a vital part in pancreatic cancer. In 2013, MPACT showed that albumin-bound paclitaxel combined with gemcitabine in the treatment of metastatic pancreatic cancer could increase the mOS from 6.6 months to 8.7 months (HR = 0.72, 95% CI: 0.62-0.83; P < 0.001). Nowadays, the immunosuppressive checkpoint inhibitors acting on PD-1/PD-L1 pathway have shown a significant efficacy in enhancing tumor immune surveillance and anti-tumor immune response. In 2018, two studies reported in ASCO showed the preliminary efficacy of albumin paclitaxel, gemcitabine and PD-1 inhibitor in the treatment of advanced pancreatic cancer. Among patients who have not received treatment before, the disease control rate was even up to 100%. Therefore, this study will further explore the domestic PD-1 antibody combined with albumin-bound paclitaxel and gemcitabine as the first-line treatment of advanced pancreatic cancer among Chinese pancreatic cancer patients. Methods: This is a prospective, single-armed, exploratory, investigator initiated trial to explore the efficacy and safety of PD-1 antibody combined with albumin-bound paclitaxel and gemcitabine as first-line treatment of metastatic pancreatic cancer. This study is, to our knowledge, the first one to test the efficacy and safety of PD-1 antibody on metastatic pancreatic cancer patients among Chinese population. Survival index is median survival estimated by Kaplan-Meier and draw the survival curve. The response rate was compared by χ 2 test / Fisher test. All primary and secondary outcomes will be analyzed on the full analysis set. PD-1 antibody, 200mg, D1 administration; paclitaxel (albumin binding type), 125mg/m2, D1, 8 days administration; gemcitabine, 1000mg/m2, D1, 8 days administration, every 21 days as a cycle and PD-1 antibody (200mg, D1, every 21 days) single drug maintenance treatment is given after the completion of 6 cycle chemotherapy. Major eligibility criteria is that each participant must have metastatic pancreatic cancer confirmed by histology or cytology and has never received systemic anti-tumor therapy before. So far, 11 of planned 20 patients have been enrolled. Clinical trial information: NCT04181645 .

[Experiences of esophageal replacement with ileocolon graft: a series of 34 cases]

Objective: To evaluate the safety and effectiveness of esophageal replacement with ileocolon graft. Methods: Totally 34 cases of esophageal replacement with ileocolon graft from July 2015 to November 2017 at Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University were analyzed retrospectively, including 24 male and 10 female, aging from 7 to 72 years old. Esophageal replacement with ileocolon graft by right and/or middle colic artery as a blood supply using retrosternal route except one subcutaneous route. The primary esophageal disease, postoperative complication rate and quality of life were analyzed. Results: The overall postoperative complication rate was 23.5% (8/34), cervical anastomotic leakage rate of 5.9% (2/34), necrosis of colon graft of 5.9% (2/34). There were 3 patients experienced re-operation including 2 patients with colon graft necrosis and 1 patient with intestinal obstruction after ERC. One patient with colon graft necrosis died of septic shock after reoperation. Six cases of cervical esophago-jejunal anastomosis stenosis and 1 case of diarrhea occurred in the later time. All patients were followed up for a median time of 9 months (range: 1 to 28 months), 32 cases survived but 1 patient died until last follow-up by the end of December 2017. Conclusion: Esophageal replacement with ileocolon graft by right and/or middle colic artery as a blood supply using retrosternal route was safe and effective.

Classification of water contamination developed by 2-D Gabor wavelet analysis and support vector machine based on fluorescence spectroscopy

The identification of the specific categories of pollutants in the urban water supply system is necessary. Traditional detection methods are based mainly on common water quality indicators. However, inspecting these water quality indicators is made difficult by issues such as long analysis time, insufficient sensitivity, need for reagents, and generation of waste liquid. These problems hinder high-frequency water detection and monitoring. In this study, three-dimensional (3D) fluorescence spectroscopy is adopted as a monitoring method for water quality. An identification method based on two-dimensional (2D) Gabor wavelets and support vector machine (SVM) multi-classification is also proposed. The Delaunay triangulation method for interpolation is used to pre-process 3D fluorescence spectra and thereby eliminate Rayleigh scattering and Raman scattering. A 2D Gabor wavelet function generated by filters of different scales and rotation angles is proposed to extract the features of the spectra. The block statistics method, based on Gabor feature description, is employed to enhance the efficiency in describing spectra features. Then, multiple SVM classifiers are used in pollutant classification and recognition. By comparing the proposed method with principal component analysis, which is a commonly used feature extraction method, this study finds that the application of 2D Gabor wavelets and block statistics can effectively describe the characteristics of 3D fluorescence spectra. Moreover, 2D Gabor wavelets achieve high classification accuracy, especially for substances with closely positioned or overlapping characteristic peaks.

Experimental study on TGF-β1-mediated CD147 expression in oral submucous fibrosis

OBJECTIVE

Although previous evidence indicates that CD147 is closely involved in the progression of organ fibrosis and various signaling pathways have been proven to regulate its expression, the role of CD147 in oral submucous fibrosis (OSF) remains largely unknown.

METHODS

In this study, we investigated the expression of CD147 and transforming growth factor β1 (TGF-β1) in human samples of an OSF tissue array by immunohistopathology. Pearson's correlation analysis was conducted to explore the correlation between CD147 and TGF-β1. Immunofluorescence and Western blotting were used to investigate to levels of CD147 in Human Oral Keratinocytes (HOKs) followed by TGF-β1 or LY2157299, an inhibitor of TGF-β1 receptor and arecoline stimulation.

RESULTS

We found that CD147 was highly expressed in both HOKs and the fibrotic oral mucosa and that this expression was correlated with TGF-β1 expression. Additionally, CD147 levels were significantly associated with the fibrosis stage. The TGF-β1 signaling pathway was found to be mainly responsible for CD147 up-regulation after arecoline treatment whereas inhibition of TGF-β1 down-regulated CD147 expression.

CONCLUSION

Our findings suggest arecoline promotes CD147 expression via the TGF-β1 signaling pathway in HOKs, whereas overexpression of CD147 may promote OSF progression.

Comparative study of functional and aesthetically outcomes of reverse digital artery and reverse dorsal homodigital island flaps for fingertip repair

This retrospective study was designed to compare functional and cosmetic outcomes of the reverse digital artery island flap and reverse dorsal homodigital island flap in fingertip repair. A total of 23 patients were followed for 24 to 30 months. The reverse digital artery island flap was used in 12 patients, and reverse dorsal homodigital island flap in another 11 patients. Flap sensibility was assessed using the Semmes-Weinstein monofilament test and static 2-point discrimination test. Patient satisfaction, active motion of the finger joints, complications and cold intolerance were evaluated. The static 2-point discrimination and Michigan Hand Outcomes Questionnaire (appearance) of the fingers treated with a reverse digital artery flap were significantly better than those with a reverse dorsal homodigital flap. The static 2-point discrimination of the skin-grafted donor sides after dorsal homodigital flap were poorer than that in the contralateral finger. No significant differences were found between the two flaps for pressure or touch sensibility, active ranges of digital motion, complications and cold intolerance.

LEVEL OF EVIDENCE

III.

Anti-CII antibody as a novel indicator to assess disease activity in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that affects a variety of organ systems. Anti-dsDNA Abs and complement factors have been used as indicators of lupus activity for more than 50 years. A novel indicator of activation in SLE is reported in this paper. Anti-collagen type II (CII) Ab was obviously elevated in patients with SLE compared to those patients with ankylosing spondylitis (AS) and healthy controls (HCs). Anti-CII-Ab-positive patients with SLE showed significantly higher levels of serum IgG and higher titers of ANA but lower levels of C3 and C4 than controls. A positive correlation was demonstrated between anti-CII Ab and serum IgG in SLE patients (r = 0.50, p < 0.0001). The negative correlations of anti-CII Ab with C3 and C4 were observed in SLE patients (r = -0.36, p = 0.0013; r = -0.37, p = 0.0006, respectively). The reduced anti-CII Ab level was accompanied by decreased level of serum IgG and increased levels of C3 and C4 after regular treatment. Therefore, anti-CII Ab could be a novel indicator for monitoring activity of SLE.

Dental Abnormalities Caused by Novel Compound Heterozygous CTSK Mutations

Cathepsin K (CTSK) is an important protease responsible for degrading type I collagen, osteopontin, and other bone matrix proteins. The mutations in the CTSK gene can cause pycnodysostosis (OMIM 265800), a rare autosomal recessive bone dysplasia. Patients with pycnodysostosis have been reported to present specific dental abnormalities; however, whether these dental abnormalities are related to dysfunctional CTSK has never been reported. Here we investigated the histologic changes of cementum and alveolar bone in a pycnodysostosis patient, caused by novel compound heterozygous mutations in the CTSK gene (c.87 G>A p.W29X and c.848 A>G p.Y283C). The most impressive manifestations in tooth were extensive periradicular high-density clumps with unclear periodontal space by orthopantomography examination and micro-computed tomography scanning analysis. Hematoxylin/eosin and toluidine blue staining and atomic force microscopy analysis showed that the cementum became significantly thickened, softened, and full of cementocytes. The disorganized bone structure was the main character of alveolar bone. The p.W29X mutation may represent the loss-of-function allele with an earlier termination codon in the precursor CTSK polypeptide. Residue Y283 is highly conserved among papain-like cysteine proteases. Three-dimensional structure modeling analysis found that the loss of the hydroxybenzene residue in the Y283C mutation would interrupt the hydrogen network and possibly affect the self-cleavage of the CTSK enzyme. Furthermore, p.Y283C mutation did not affect the mRNA and protein levels of overexpressed CTSK in COS-7 system but did reduce CTSK enzyme activity. In conclusion, the histologic and ultrastructural changes of cementum and alveolar bone might be affected by CTSK mutation via reduction of its enzyme activity (clinical trial registration: ChiCTR-TNC-10000876).

Changes and clinical significance of peripheral blood helper T lymphocyte and natural killer (NK) cells in unexplained recurrent spontaneous abortion (URSA) patients after abortion and successful pregnancy

OBJECTIVE

This study aims to investigate the number changes and the clinical significance of the peripheral blood T lymphocyte subsets and NK (natural killer) cells in unexplained recurrent spontaneous abortion (URSA) patients before and after abortion, as well as after successful pregnancy.

MATERIALS AND METHODS

Thirty-nine URSA patients (URSA-abortion group), among who 22 patients were followed up until the final successful parturition (URSA-pregnancy group), 31 normal-pregnancy (NP) cases and 25 normal non-pregnancy (NNP) control cases in which the peripheral blood T lymphocytes and subsets, B cells, and NK cells were assessed flow cytometry.

RESULTS

Compared with the URSA-pregnancy group and the NP group, the Th cells and NK cells of the URSA-abortion group increased (p < 0.05); compared with the NNP group, the total number of T cells decreased after the first, second, and third month of the URSA abortion (p < 0.05); Th cells decreased within one to six months of the URSA abortion (p < 0.05); proportion of NK cells was significantly higher in URSA patients (p < 0.05).

CONCLUSION

The abnormal numbers of the peripheral blood T cell subsets and NK cells were related with the occurrence of URSA.

Effect of sonication on UV disinfectability of primary effluents

In this paper, the effect of sonication on the UV disinfection kinetics of primary effluents was investigated. Wastewater samples were collected from local municipal treatment plants and were sonicated with a 20-kHz ultrasound reactor at constant power but varying sonication times. Sonicated samples were irradiated using low-pressure UV light to obtain the UV dose-response curves (DRC). Results showed that sonication improved the UV disinfection of primary effluents by (1) increasing the initial slope of DRC (i.e., k1) and (2) decreasing the tailing level of the UV dose-response curve (i.e., beta). This improvement was confirmed to be caused by the breakage of large particles (> 60 microm) that are known to protect coliforms from UV photons. It also was found that the log reduction of the tailing level of DRC was directly proportional to the log reduction of the number of large particles (> 60 microm) present in the effluent sample. Although the number of large particles was proportional to the coliform count at high UV dosage, the proportionality constant varied from 0.05 to 0.25, depending on the sample.

Segmental bone tissue engineering by seeding osteoblast precursor cells into titanium mesh-coral composite scaffolds

The size and specific shape of bone grafts are important for jaw reconstruction. In this experiment, segmental bone grafts were engineered in a predetermined shape via seeding osteoblast precursor cells into titanium mesh-coral composite scaffolds. Titanium meshes were moulded into the shape of a column with length 12 mm and diameter 8mm. The column was filled with natural coral granules and the complex acted as a cell-seeding scaffold. About 4 x 10(7) osteoblast precursor cells in 200 microl cell-culture medium were seeded into each of six scaffolds and incubated in vitro for 2 days. Then, the composites were implanted subcutaneously into the backs of nude mice and incubated in vivo. Two months after implantation, the animals were killed and new bone formed in the scaffolds was investigated by gross inspection, X-ray examination, histological observation and mechanical testing. The results showed that newly formed tissue was red and presented the gross appearance of bone, and kept the original shape of the column. Titanium mesh was situated on the surface of the bone graft. An X-ray blocking shadow was observed in and around the titanium scaffolds; most of the coral granules had been absorbed. Histological observation demonstrated a large amount of new bone formed and integrated well with titanium mesh. Mechanical testing showed that new bone improved the mechanical property of the graft significantly. In conclusion, a titanium mesh-coral composite scaffold with osteoblast precursor cells is an efficient means to engineer segmental bone, possessing the desired shape and mechanical strength.

Performance of high-rate sludge digesters fed with sonicated sludge

A major limitation of anaerobic sludge digestion is the long hydraulic retention time (HRT) required for satisfactory stabilization which results in large digester size. This study explored a possibility of operating digesters at shortened HRTs by sonication pretreatment of secondary sludges. Four identical digesters designated D1, D2, D3 and D4 were fed with untreated and sludge sonicated at densities of 0.18 W/ml, 0.33 W/ml and 0.52 W/ml, respectively. All digesters were operated at three HRTs of 8-day, 4-day and 2-day. Comparing with the control digester (D1), total solids removal efficiencies improved by 12-19%, 17-36% and 20-39% in digesters D2, D3 and D4, respectively. The volatile solids removal was also increased by 11-21%, 17-33% and 19-36% in the respective digesters. The improved solids degradation corresponded with increase in biogas production by 1.4-2.5, 1.9-3.0 and 1.6-3.1 times, respectively. Increase in methane composition by 2-17% was also noted in all digesters fed with sonicated sludge. An analysis indicated that sonication pretreatment could enhance degradation of carbon, nitrogen and sulfur substances in the digestion. The study suggested that sonication of sludge is a possible pretreatment to shorten the digester operating HRT with improvement in solids degradation, biogas production and methane content. It can be deduced that to maintain a consistent solids loading at a desire performance, sludge digester with smaller size can be designed.

A comparison of ultrasound treatment on primary and secondary sludges

Ultrasound treatment of primary and secondary sludges was conducted to improve the qualities of sludges for the anaerobic digestion. The impacts of different sonication times, sonication densities and solids concentrations on ultrasonication efficiency were examined. The experimental results indicated that the significant reduction in particle size and increase in soluble organics could be achieved, implying that ultrasonication could offer a feasible treatment method to efficiently disintegrate sludge. The greater decrease in particle size and increase in soluble organics of sludge indicated that the secondary sludge has a more remarkable improvement after sonication over the primary sludge. With respects to the extent of disintegration and energy consumption, higher sonication density performed more effectively in terms of specific energy. There exists an optimal solids concentration range for both the sludges for optimum sonication. Within the optimal solids concentration range, efficient sonication can be effected and sludge would be disintegrated efficiently. The ultrasound would be attenuated by scattering and absorption if the solids concentration exceeds the optimal range. It appeared from the study that the mechanical shear forces caused by ultrasonic cavitation could be a key factor for sludge disintegration and collapse of cavitation bubbles could significantly alter the sludge characteristics.

Injectable bone

Temperature-dependent polymerising polyethylene oxide hydrogel was used as a vehicle to deliver bone marrow mesenchymal cells by injection in six nude mice, four mice acting as controls, to study generation of new bone in the cell-hydrogel complex. Mesenchymal cells were harvested by in vitro cell culture, and cells were seeded into polyethylene oxide solution. The density of the suspension was adjusted to 5 x 10(7)ml(-1). The hydrogel was obtained by adjusting the temperature to over 6 degrees C. Aliquots of 0.5 ml of the cell-hydrogel complexes were injected subcutaneously into the backs of the six experimental mice, and 0.5 ml of hydrogel alone was injected into the four controls. Generation of new bone was studied by gross inspection, radiographs, and histological examination. Two months after injection hard nodes had formed subcutaneously in all six mice, whereas in the control group the hydrogel had been absorbed completely and only soft tissue was present at the site of injection. A shadow could be seen on the radiographs of all cell-seeded mice. On histological examination of the nodes there was trabecular bone and some areas of neocartilage. This method of generating new bone might be of potential clinical use.