Si-Wu-Tang attenuates hepatocyte PANoptosis and M1 polarization of macrophages in non-alcoholic fatty liver disease by influencing the intercellular transfer of mtDNA

ETHNOPHARMACOLOGICAL RELEVANCE

Non-alcoholic fatty liver disease (NAFLD) represents a burgeoning challenge for public health with potential progression to malignant liver diseases. PANoptosis, an avant-garde conceptualization of cell deaths, is closely associated with mitochondrial damage and linked to multiple liver disorders. Si-Wu-Tang (SWT), a traditional Chinese herbal prescription renowned for regulating blood-related disorders and ameliorating gynecological and hepatic diseases, has been demonstrated to alleviate liver fibrosis by regulating bile acid metabolism and immune responses.

AIM OF THE STUDY

However, the mechanisms by which mtDNA is released from PANoptotic hepatocytes, triggering macrophage activation and hepatitis and whether this process can be reversed by SWT remain unclear.

MATERIALS AND METHODS

Here, sophisticated RNA-sequencing complemented by molecular approaches were applied to explore the underlying mechanism of SWT against NAFLD in methionine/choline-deficient diet (MCD)-induced mice and relative in vitro models.

RESULTS

We revealed that SWT profoundly repaired mitochondrial dysfunction, blocked mitochondrial permeability transition and mtDNA released to the cytoplasm, subsequently reversing hepatocyte PANoptosis and macrophage polarization both in MCD-stimulated mice and in vitro. Mechanically, loaded lipids dramatically promoted the opening of mPTP and oligomerization of VDAC2 to orchestrate mtDNA release, which was combined with ZBP1 to promote hepatocyte PANoptosis and also taken by macrophages to trigger M1 polarization via the FSTL1 and PKM2 combination. SWT effectively blocked NOXA signaling and reversed all these detrimental outcomes.

CONCLUSION

Our findings show that SWT protects against hepatitis-mediated hepatocyte PANoptosis and macrophage M1 polarization by influencing intrahepatic synthesis, release and intercellular transfer of mtDNA, suggesting a potential therapeutic strategy for ameliorating NAFLD.

Neuroprotection of low dose carbon monoxide in Parkinson's disease models commensurate with the reduced risk of Parkinson's among smokers

Paradoxically, cigarette smoking is associated with a reduced risk of Parkinson's disease (PD). This led us to hypothesize that carbon monoxide (CO) levels, which are constitutively but modestly elevated in smokers, might contribute to neuroprotection. Using rodent models of PD based on α-synuclein (αSyn) accumulation and oxidative stress, we show that low-dose CO mitigates neurodegeneration and reduces αSyn pathology. Oral CO administration activated signaling cascades mediated by heme oxygenase-1 (HO-1), which have been implicated in limiting oxidative stress, and in promoting αSyn degradation, thereby conferring neuroprotection. Consistent with a neuroprotective effect of smoking, HO-1 levels in cerebrospinal fluid were higher in human smokers compared to nonsmokers. Moreover, in PD brain samples, HO-1 levels were higher in neurons without αSyn pathology. Thus, CO in rodent PD models reduces pathology and increases oxidative stress responses, phenocopying possible protective effects of smoking evident in PD patients. These data highlight the potential for low-dose CO modulated pathways to slow symptom onset and limit pathology in PD patients.

Salvianolic acid B protects against pulmonary fibrosis by attenuating stimulating protein 1-mediated macrophage and alveolar type 2 cell senescence

Idiopathic pulmonary fibrosis (IPF), as the most common idiopathic interstitial pneumonia, is caused by a complex interaction of pathological mechanisms. Interestingly, IPF frequently occurs in the middle-aged and elderly populations but rarely affects young people. Salvianolic acid B (SAB) exerts antioxidant, antiinflammatory, and antifibrotic bioactivities and is considered a promising drug for pulmonary disease treatment. However, the pharmacological effects and mechanisms of SAB on cellular senescence of lung cells and IPF development remain unclear. We used bleomycin (BLM)-induced pulmonary fibrosis mice and different lung cells to investigate the antisenescence impact of SAB and explain its underlying mechanism by network pharmacology and the Human Protein Atlas database. Here, we found that SAB significantly prevented pulmonary fibrosis and cellular senescence in mice, and reversed the senescence trend and typical senescence-associated secretory phenotype (SASP) factors released from lung macrophages and alveolar type II (AT2) epithelial cells, which further reduced lung fibroblasts activation. Additionally, SAB alleviated the epithelial-mesenchymal transition process of AT2 cells induced by transforming growth factor beta. By predicting potential targets of SAB that were then confirmed by chromatin immunoprecipitation-qPCR technology, we determined that SAB directly hampered the binding of transcription factor stimulating protein 1 to the promoters of SASPs (P21 and P16), thus halting lung cell senescence. We demonstrated that SAB reduced BLM-induced AT2 and macrophage senescence, and the subsequent release of SASP factors that activated lung fibroblasts, thereby dual-relieving IPF. This study provides a new scientific foundation and perspective for pulmonary fibrosis therapy.

Si-Wu-Tang attenuates liver fibrosis via regulating lncRNA H19-dependent pathways involving cytoskeleton remodeling and ECM deposition

Liver fibrosis is a dynamic wound-healing response characterized by the agglutination of the extracellular matrix (ECM). Si-Wu-Tang (SWT), a traditional Chinese medicine (TCM) formula, is known for treating gynecological diseases and liver fibrosis. Our previous studies demonstrated that long non-coding RNA H19 (H19) was markedly upregulated in fibrotic livers while its deficiency markedly reversed fibrogenesis. However, the mechanisms by which SWT influences H19 remain unclear. Thus, we established a bile duct ligation (BDL)-induced liver fibrosis model to evaluate the hepatoprotective effects of SWT on various cells in the liver. Our results showed that SWT markedly improved ECM deposition and bile duct reactions in the liver. Notably, SWT relieved liver fibrosis by regulating the transcription of genes involved in the cytoskeleton remodeling, primarily in hepatic stellate cells (HSCs), and influencing cytoskeleton-related angiogenesis and hepatocellular injury. This modulation collectively led to reduced ECM deposition. Through extensive bioinformatics analyses, we determined that H19 acted as a miRNA sponge and mainly inhibited miR-200, miR-211, and let7b, thereby regulating the above cellular regulatory pathways. Meanwhile, SWT reversed H19-related miRNAs and signaling pathways, diminishing ECM deposition and liver fibrosis. However, these protective effects of SWT were diminished with the overexpression of H19 in vivo. In conclusion, our study elucidates the underlying mechanisms of SWT from the perspective of H19-related signal networks and proposes a potential SWT-based therapeutic strategy for the treatment of liver fibrosis.

Inhibiting autophagy to boost antitumor immunity with tetramethylpyrazine-loaded and PD-L1-targeting liposomal nanoparticles

Cancer immunotherapy has been recognized as a revolutionary breakthrough and has yielded impressive results. However, a major challenge facing immunotherapy is its limited efficacy, which may be largely due to the inadequate infiltration of immune cells into the tumor microenvironment (TME). Autophagy inhibition has been identified to enhance the recruitment of immune cells into the tumor by upregulating the expression and secretion of chemokines. Here, we verified a novel autophagy inhibitor tetramethylpyrazine (TMP) from natural products using a mCherry-GFP-LC3 probe-based autophagy flux reporter system. We then devised a liposomal system capable of co-delivering DOX and TMP using the thin-film dispersion method and modified the liposome with PD-L1 binding peptide JY4 (DOX-TMP-JY4LIPO). We found that DOX-TMP-JY4LIPO exhibited potent antitumor efficacy in vitro. In addition, DOX-TMP-JY4LIPO could effectively inhibit the autophagic flux to enhance the recruitment of immune cells into the tumor by upregulating CCL5 and CXCL10. The liposome exhibited favorable biocompatibility and safety while facilitating the accumulation of therapeutic drugs in tumors. DOX-TMP-JY4LIPO significantly inhibited tumor growth in LLC xenograft mice, accompanied by increased granzymes- and perforin-mediated cytotoxic immune responses. Our findings demonstrate that the TMP-loaded and PD-L1-targeting liposomal nanoparticles can significantly boost antitumor immunity by inhibiting autophagy, suggesting a novel natural product-based nanomedicine for immunotherapy.

A Ferroptosis Microneedle Integrated Wireless Implanted Photodynamic Therapy Pellet for Cancer Treatment

PURPOSE/OBJECTIVE(S)

Effective, non-toxic, and targeted induction of lung cancer cell death is urgently needed. The goal of this research is to create a new implantable battery-free therapeutic pellet with integrated drug microneedles that allows for wireless photodynamic therapy (PDT) and targeted release of a ferroptosis inducer (Imidazole ketone erastin, IKE) into tumor tissue.

MATERIALS/METHODS

A wireless power unit, μ-LED illuminant, a flexible control circuit, and an IKE-stored biodegradable microneedle enclosed in polydimethylsiloxane (PDMS) were all built into an integrated therapeutic pellet. Lung cancer cells were used to illustrate the in vitro viability and molecular biological processes of this system. Therapeutic pellet implanted into the LLC xenograft C57BL/6 model. PDT was conducted by 660 nm laser irradiation after injecting a photosensitizer (Chlorin e6, Ce6) and targeted IKE released into the tumor. Systematically analyzing the therapeutic effects on lung cancer and toxic side-effects.

RESULTS

The PDT-IKE group reduced cellular viability by 90% compared to the control group at the cellular level. In mouse model studies, the PDT-IKE group suppressed tumors at 78.8%, three or four times greater than the PDT (26.6%) or IKE (19.2%) group alone. The PDT-IKE group also controlled IKE release more precisely with heated electrodes, reducing nephrotoxicity and improving safety. Moreover, the combination of PDT and IKE can effectively cause ferroptosis in tumor cells, both in vivo and in vitro.

CONCLUSION

A new implantable battery-free therapeutic pellet was designed for wireless PDT with integrated IKE microneedles to induce obvious ferroptosis in lung cancer. The proposed pellet would provide a promising strategy for cancer treatment.

Chuanxiong Rhizoma extracts prevent cholestatic liver injury by targeting H3K9ac-mediated and cholangiocyte-derived secretory protein PAI-1 and FN

Chuanxiong Rhizoma (CX, the dried rhizome of Ligusticum wallichii Franch.), a well-known traditional Chinese medicine, is clinically used for treating cardiovascular, cerebrovascular and hepatobiliary diseases. Cholestatic liver damage is one of the chronic liver diseases with limited effective therapeutic strategies. Currently, little is known about the mechanism links between CX-induced anti-cholestatic action and intercellular communication between cholangiocytes and hepatic stellate cells (HSCs). The study aimed to evaluate the hepatoprotective activity of different CX extracts including the aqueous, alkaloid, phenolic acid and phthalide extracts of CX (CXAE, CXAL, CXPA and CXPHL) and investigate the intercellular communication-related mechanisms by which the most effective extracts work on cholestatic liver injury. The active compounds of different CX extracts were identified by UPLC-MS/MS. A cholestatic liver injury mouse model induced by bile duct ligation (BDL), and transforming growth factor-β (TGF-β)-treated human intrahepatic biliary epithelial cholangiocytes (HIBECs) and HSC cell line (LX-2 cells) were used for in vivo and in vitro studies. Histological and other biological techniques were also applied. The results indicated that CXAE, CXAL and CXPHL significantly reduced ductular reaction (DR) and improved liver fibrosis in the BDL mice. Meanwhile, both CXAE and CXPHL suppressed DR in injured HIBECs and reduced collagen contraction force and the expression of fibrosis biomarkers in LX-2 cells treated with TGF-β. CXPHL suppressed the transcription and transfer of plasminogen activator inhibitor-1 (PAI-1) and fibronectin (FN) from the 'DR-like' cholangiocytes to activated HSCs. Mechanistically, the inhibition of PAI-1 and FN by CXPHL was attributed to the untight combination of the acetyltransferase KAT2A and SMAD3, followdd by the suppression of histone 3 lysine 9 acetylation (H3K9ac)-mediated transcription in cholangiocytes. In conclusion, CXPHL exerts stronger anti-cholestatic activity in vivo and in vitro than other CX extracts, and its protective effect on the intracellular communication between cholangiocytes and HSCs is achieved by reducing KAT2A/H3K9ac-mediated transcription and release of PAI-1 and FN.

[Electroencephalographic microstates in vestibular schwannoma patients with tinnitus]

OBJECTIVE

To explore the biomarkers of tinnitus in vestibular schwannoma patients using electroencephalographic (EEG) microstate technology.

METHODS

The EEG and clinical data of 41 patients with vestibular schwannoma were collected. All the patients were evaluated by SAS, SDS, THI and VAS scales. The EEG acquisition time was 10-15 min, and the EEG data were preprocessed and analyzed using MATLAB and EEGLAB software package.

RESULTS

Of the 41 patients with vestibular schwannoma, 29 patients had tinnitus and 12 did not have tinnitus, and their clinical parameters were comparable. The average global explanation variances of the non-tinnitus and tinnitus groups were 78.8% and 80.1%, respectively. The results of EEG microstate analysis showed that compared with those without tinnitus, the patients with tinnitus had an increased frequency (P=0.033) and contribution (P=0.028) of microstate C. Correlation analysis showed that THI scale scores of the patients were negatively correlated with the duration of microstate A (R=-0.435, P=0.018) and positively with the frequencies of microstate B (R=0.456, P=0.013) and microstate C (R=0.412, P=0.026). Syntax analysis showed that the probability of transition from microstate C to microstate B increased significantly in vestibular schwannoma patients with tinnitus (P=0.031).

CONCLUSION

EEG microstate features differ significantly between vestibular schwannoma patients with and without tinnitus. This abnormality in patients with tinnitus may reflect the potential abnormality in the allocation of neural resources and the transition of brain functional activity.

[Comparison of the therapeutic effects of optic nerve sheath fenestration and medication on papilledema due to cerebral venous thrombosis]

Objective: To compare the therapeutic effects of optic nerve sheath fenestration (ONSF) and medication on papilledema induced by cerebral venous thrombosis (CVT). Methods: Patients with papilledema induced by CVT in Beijing Tiantan Hospital and Xuanwu Hospital from January 2017 to July 2022 were retrospectively enrolled and were divided into two groups according to the treatment strategies they underwent, with 76 cases (107 eyes) in ONSF group and 35 cases (69 eyes) in medication group. The degree of papilledema was evaluated by the modified Frisén's grading (grade 0-1 was defined as mild, grade 2-3 was moderate, and grade 4-5 was severe edema). The mean defect (MD) of visual field, the degree of papilledema, and the mean retinal nerve fiber layer (RNFL) thickness in different subgroups were compared between baseline versus 1 month after ONSF or medication. Results: There were 76 cases in ONSF group (26 males and 50 females), and aged (35.3±11.4) years. Meanwhile, there were 35 cases in medication group (22 males and 13 females), and aged (35.2±11.0) years. Compared with baseline, MD were improved in both moderate [(-8.4±6.6) vs (-11.8±8.6) db, P=0.021] and severe [(-8.1±5.3) vs (-11.4±6.9) db, P<0.001] papilledema subgroups after ONSF, while there was an improvement in mild papilledema subgroup [(-1.5±5.3) vs (-3.4±5.1) db, P<0.001] after medication. The papilledema (Frisén's scores) in both ONSF group (P<0.001) and medication group (P=0.010) was improved. Compared with baseline, the mean RNFL decreased in mild [(78.5±13.5) vs (91.0±17.4) μm, P=0.002], moderate [(126.6±67.6) vs (154.8±77.9) μm, P=0.011] and severe [(179.0±70.9) vs (230.6±89.7) μm, P=0.001] papilledema subgroups after ONSF, while the mean RNFL decreased [(142.0±29.3) vs (158.8±22.7) μm, P=0.020] in moderate papilledema subgroup after medication. Conclusions: ONSF might attenuate CVT-mediated papilledema, and improve the visual function in patients with moderate and severe papilledema. Likewise, patients with mild papilledema could also get benefit from medication.

A Novel Tri-Functional Liposome Re-Educates "Cold Tumor" and Abrogates Tumor Growth by Synergizing Autophagy Inhibition and PD-L1 Blockade

Immunotherapy has been regarded as a breakthrough in cancer treatment and achieved great success. However, the poor response rate is still a formidable challenge of current immunotherapies, especially in solid tumors without sufficient infiltration of immune cells, also known as "cold tumor." SAR405 is a highly specific VPS34 inhibitor and has been suggested as a potential approach converting "cold tumor" into "hot tumor" by inhibiting autophagy. In this study, a tri-functional doxorubicin (DOX) plus SAR405 liposome system is established and further modified with a novel anti-PD-L1 peptide JY4 for targeted delivery (DOX-SAR-JY4_LIPO ). The data here demonstrate that in a lung cancer xenograft mouse model, by facilitating the tumoral enrichment of both SAR405 and DOX, DOX-SAR-JY4_LIPO effectively increases the infiltration of cytotoxic lymphocytes in the tumor by synergizing DOX-induced immunogenic cell death (ICD) and SAR405-mediated upregulation of chemokines including CCL5 and CXCL10. As results, DOX-SAR-JY4_LIPO significantly inhibits tumor growth, metastasis, and resurrection by re-educating immunosuppressive tumor microenvironment. In conclusion, this study not only proves the concept of inhibiting autophagy for better immune infiltration in the tumor but also presents a novel tri-functional liposomal system that overcomes the deficiencies of current therapies and holds great promise in cancer immunotherapy.

The Anti-Inflammatory Effect of miR-140-3p in BMSCs-Exosomes on Osteoarthritis

PURPOSE OF THE STUDY Articular cartilage injury is a common disease in daily life, with a high incidence. The aim of this study was to investigate the effect and mechanism of miRNA-140-3p in bone mesenchymal stem cells (BMSCs)-derived exosomes under hypoxia on inflammatory articular chondrocytes. MATERIAL AND METHODS To simulate the pathological status of arthritis, rat chondrocytes were used to establish the osteoarthritis (OA) model by IL-1β (10 μg/ml) as a modulating in vitro, and exosomes were isolated by differential ultra-high speed centrifugation. The cell counting kit-8, wound healing and flow cytometry assays were utilized to assess proliferation, migration and apoptosis of chondrocytes, respectively. Lipogenic and chondrogenic differentiation of chondrocytes were detected by oil red O staining and toluidine blue staining individually. The expressions of miR-140-3p and chondrocyte-specific gene mRNA were investigated using qRT-PCR. Western blot was applied to assess chondrocyte associated proteins and BMSC-Exo surface protein markers, and immunohistochemistry was adopted to detect the staining of collagen I and II. RESULTS Under scanning electronic microscope, the shape of exosomes was almost round. Exosome treatment prominently impaired the inhibition of chondrocytes' proliferative and migrative ability by IL-1β. It was found hypoxia had a more marked impact on proliferation, expression of collagen II and apoptosis in OA chondrocytes than normoxia, as well as a stronger effect on weakening adipose differentiation and enhancing chondrogenic differentiation in inflammatory chondrocytes. Furthermore, incubation with BMSC-Exo overexpressing miR-140-3p can remarkably increase the survival rate and migration in inflammatory chondrocytes. In addition, overexpression of miR-140-3p was found to enhance the chondrogenic differentiation of inflammatory chondrocytes. Furthermore, we found that the healing effect of exosomes on inflammatory chondrocytes under hypoxic conditions was produced by a rise in miR-140-3p expression within them and that hypoxia-mediated upregulation of miR-140-3p expression occurred through HIF-1α. CONCLUSIONS Under hypoxia, BMSC-Exo enhanced the chondrogenic phenotype, increased the viability of inflammatory chondrocytes. The overexpression of miR-140-3p in BMSC-Exo is beneficial to protect joints and delaying the pathogenesis in OA. Key words: HIF-1α, apoptosis, lipogenic differentiation, chondrogenic differentiation.

[Analysis of epidemiological characteristics of pulmonary tuberculosis patients in Fengtai District, Beijing City from 2011 to 2021]

Objective: To analyze the epidemiological characteristics of pulmonary tuberculosis (PTB) in Fengtai District from 2011 to 2021. Methods: A retrospective study was conducted, the data of PTB patients in Fengtai District from 2011 to 2021 were collected in Chinese disease prevention and Control Information System, which included etiological classification, gender, age, occupation, onset time, demographic information etc. the epidemiological characteristics of reported PTB patients was analysis. Results: A total of 10 342 cases of PTB were reported from 2011 to 2021 in Fengtai District, with an average annual reported incidence rate of 42.87/ 100 000. The incidence rate was the highest in 2012(75.89/100 000), and significantly declined from 2013, which declined to 29.70/100 000 in 2017. It showed a slow rise from 2018 to 2021. The difference was statistically significant (χ²=1 471.77,P<0.001).There were 2 975 cases of etiologic positive PTB from 2011 to 2021, and 76 cases of Rifampicin-resistant PTB from 2017 to 2021. The ratio of male cases to female was 1.75, the average annual incidence rate of male (53.94/100 000) was higher, than female(31.57/100 000).(χ²=704.01,P<0.001). Among all age groups, 25-29 years group, 20-24 years group and 30-34 years group had the highest proportion, which were 1 506 cases (14.56%) , 1 292 cases (12.49%) and 1 024 cases (9.90%) respectively. The average annual incidence rate was the lowest in the group less than 10 years old (1.43/100 000), and the highest in the group 85 years old and over (195.20/100 000), the difference was statistically significant(χ²=3164.24, P<0.001). The top occupations from high to low were housework and unemployment (2 917 cases, 28.21%), retirees (2 308 cases, 22.32%), workers (1 047 cases, 10.12%), cadres and staff (950 cases, 9.19%), farmers (860 cases, 8.32%), business services (698 cases, 6.75%), teachers and students (455 cases, 4.40%). Conclusion: From 2011 to 2021, the incidence rate of PTB was decreased from 2012 to 2017, and slowly increased lately in Fengtai District. The epidemiological characteristics of PTB vary in different age and gender.

Multi-elements characteristic and potential risk of heavy metals in MOUTAN CORTEX from Anhui Province, China

To ensure the quality and safety of herbs, the content of 54 elements in MOUTAN CORTEX (MC) was determined by the ICP-AES and ICP-MS, and the health risks of Cu, As, Cd, Pb, Hg and rare earth elements (REEs) were assessed. These herbs were collected from 5 producing areas in Anhui Province, China, namely Wuhu, Tongling, Bozhou, Xuancheng and Chizhou. The multi-elements fingerprint identification of MC in Anhui Province was established. The total amount of macro-elements from Wuhu and Tongling is significantly lower than Bozhou. Among all MC from 5 producing areas, the highest content is Ca. Except for Bozhou, the content of macro-elements and REES in the other 4 origins of MC is from highest to lowest: Ca > K > Mg > Al > Fe > Na and Ce > La > Nd > Y > Pr > Er > Yb > Eu > Ho > Tb > Tm > Lu. The chemical forms of Cd in MC from Bozhou with the highest percentage were PH2O of high toxicity and migration, while the other 4 regions were PNaCl of low activity and mobility. There was a great difference in the content of inorganic elements and chemical forms of Cd between the MC produced from the plain (Bozhou) and the hilly areas (Wuhu, Tongling, Chizhou and Xuancheng). Except for Cd, the content of Cu, As, Pb and Hg in MC did not exceed the limit. The results of PTWIFact and ADI for Cd and REEs showed that MC herbs did not pose a risk to human health.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13762-022-04402-6.

Probabilistic Circuit Implementation Based on P-Bits Using the Intrinsic Random Property of RRAM and P-Bit Multiplexing Strategy

Probabilistic computing is an emerging computational paradigm that uses probabilistic circuits to efficiently solve optimization problems such as invertible logic, where traditional digital computations are difficult to solve. This paper proposes a true random number generator (TRNG) based on resistive random-access memory (RRAM), which is combined with an activation function implemented by a piecewise linear function to form a standard p-bit cell, one of the most important parts of a p-circuit. A p-bit multiplexing strategy is also applied to reduce the number of p-bits and improve resource utilization. To verify the superiority of the proposed probabilistic circuit, we implement the invertible p-circuit on a field-programmable gate array (FPGA), including AND gates, full adders, multi-bit adders, and multipliers. The results of the FPGA implementation show that our approach can significantly save the consumption of hardware resources.

Ferulic acid ameliorates acetaminophen-induced acute liver injury by promoting AMPK-mediated protective autophagy

Acetaminophen (APAP), one of the most widely used antipyretics and analgesics, principally results in acute liver injury (ALI) in developed countries when taken overdose. Ferulic acid (FA) is a natural polyphenol compound existing in many plants that has free radical scavenging, anti-inflammatory and liver-protective properties. However, the effect and underlying mechanism of FA in treating APAP-induced ALI have not been fully elucidated. Herein, we established a mouse model of APAP-induced ALI and used APAP-stimulated mouse primary hepatocytes for biochemical assessment of molecular parameters. After constructing networks and obtaining predicted targets from public databases, we further verified the putative pathways using immune-blotting assays both in vivo and in vitro. The reign of liver necrosis, serum levels of ALT and AST and oxidative stress in livers significantly elevated after APAP treatment, which were almost recovered back to normal levels by FA administration. In addition, FA significantly upregulated the APAP-induced downregulation of hepatic specific markers, including HNF4a, Foxa2 and ALB. Then, the results of functional enrichment indicated the possible signaling pathways of FA against APAP challenge, mainly including AMPK, autophagy, apoptosis and other metabolic process. Furthermore, FA markedly reversed the APAP-induced decline of mitochondria membrane potential, increased ratio of BAX/BCL2 and CASPASE 3 expression, and promoted autophagy flux of hepatocytes by upregulating AMPK phosphorylation, which were abrogated by a specific AMPK inhibitor, compound C. Overall, the hepatoprotective effect of FA on APAP-induced ALI might be associated with anti-oxidant and anti-apoptosis, which were at least partly attributed to AMPK-mediated protective autophagy.

Muscle Area and Density Assessed by Abdominal Computed Tomography in Healthy Adults: Effect of Normal Aging and Derivation of Reference Values

BACKGROUND

A growing body of evidence has demonstrated the prognostic value of skeletal muscle area and quality measured by computed tomography (CT) as biomarkers of sarcopenia and frailty. However, there exists little data in normal healthy subjects to inform reference values and determine the effects of advancing age and sex on CT muscle parameters.

METHODS

Abdominal CT images of patients (20-80 years of age) presenting to the emergency department with benign abdominal symptoms and no significant medical comorbidities were retrospectively collected from 2014 to 2017. Psoas and abdominal wall muscle area (PMA, WMA) and density (PMD, WMD) at the level of the L4 vertebrae were measured with the CoreSlicer.com web app. The normal reference range was computed by non-parameteric 2.5th and 97.5th percentiles stratified by sex and restricted by age to the younger subgroup (20-39 years of age).

RESULTS

The cohort consisted of 390 otherwise healthy patients (162 males, 228 females). The lower reference range for PMA was <22.0 cm2 in males and <11.1 cm2 in females, and for WMA was <112.2 cm2 in males and <75.6 cm2 in females. There was a graded decline observed in PMA and WMA among older compared to younger adults (especially ≥60 years of age) (P<0.001) and among females compared to males (P<0.001). There was also a graded decline observed in PMD and WMD among older compared to younger adults (P<0.001), irrespective of sex.

CONCLUSION

This study has defined the normal reference values and age-associated down-trend for CT muscle parameters at L4 in a healthy population using an accessible web-based software, which help contextualize and interpret these imaging biomarkers of sarcopenia in clinical care.

Compute-in-Memory for Numerical Computations

In recent years, compute-in-memory (CIM) has been extensively studied to improve the energy efficiency of computing by reducing data movement. At present, CIM is frequently used in data-intensive computing. Data-intensive computing applications, such as all kinds of neural networks (NNs) in machine learning (ML), are regarded as ‘soft’ computing tasks. The ‘soft’ computing tasks are computations that can tolerate low computing precision with little accuracy degradation. However, ‘hard’ tasks aimed at numerical computations require high-precision computing and are also accompanied by energy efficiency problems. Numerical computations exist in lots of applications, including partial differential equations (PDEs) and large-scale matrix multiplication. Therefore, it is necessary to study CIM for numerical computations. This article reviews the recent developments of CIM for numerical computations. The different kinds of numerical methods solving partial differential equations and the transformation of matrixes are deduced in detail. This paper also discusses the iterative computation of a large-scale matrix, which tremendously affects the efficiency of numerical computations. The working procedure of the ReRAM-based partial differential equation solver is emphatically introduced. Moreover, other PDEs solvers, and other research about CIM for numerical computations, are also summarized. Finally, prospects and the future of CIM for numerical computations with high accuracy are discussed.

A195 GEOEPIDEMIOLOGICAL CHANGES DUE TO ALTERATIONS IN DIAGNOSTIC ROME CRITERIA FOR IRRITABLE BOWEL SYNDROME

Background

Irritable bowel syndrome (IBS) is a positive diagnosis based on consensus opinions. The Rome (R) criteria, have gone through 4 rounds. R4 restricted diagnosis of IBS over R3, reducing global prevalence. Previously, there were no correlations of world distributions of IBS and Inflammatory Bowel Disease [IBD](Lovell). There are also epidemiological studies showing relationships between IBD and national wealth.

Aims

We reevaluate relationships among different R criteria and latitude(Lat), lactose digestion status (LNP), human development index(HDI), gross domestic product/capita(GDP/c), Crohn’s disease (CD and ulcerative colitis (UC) incidence(i) and prevalence(p).

Methods

Literature on world prevalence of national IBS (Oka,Sperber), IBD rates (Ng), and GDP (Lopez Ruiz) (4) were sought on PubMed and Google Scholar.National HDI(08 or 2016) were available on the internet (http://hdr.undp.org/en/data). National lactase distributions and latitudes were quoted (Szilagyi). Target dates were for the year 2008±8yrs. After log transformation of IBD incidence, Pearson’s correlations were carried out.(strong at; r ≥0.7, moderate ≥0.5, weak ≤ 0.49, negligible ≤ 0.3). (significance was p&lt;0.05).

Results

Correlations of HDI08 and HDI16 was 0.98. Comparisons of R2 and a composite based on Manning, R 1 and 2 (Lovell) was r = 0.96 (N21 countries), Correlation of R 3 and 4 were r = 0.85 (N17). Correlations of R2 and R3 or R4 were negligible (r = -0.2 (n15) and -0.12 (N22). Correlations of R2 and both economic metrics were weak but significant (r = 0.42 – r = 0.49, p &lt; 0.03 - &lt; 0.001). However, correlations of metrics with R3 were non significant and negligible with R4. Comparisons of R2 with LNP or Lat were negligible, but those of R3 or R4 with Lat were significant. Comparisons of R3 with CDp showed a strong correlation while R4 showed a weak but significant correlation with UCi. R2 had negligible correlations with IBD.

Conclusions

Although, these results are based on limited data variations in R criteria have changed relations with IBS prevalence.Earlier R criteria showed increased IBS in poorer nations. The recent R3 and R4 criteria are independent of national economy, but show more relations with increasing latitudes. Consequences of the change include R3 and 4 reflecting western society symptoms perhaps linking it more with IBD.It is unclear if this new relationship incorporates an irritable inflammatory bowel syndrome (Gajula).The generalizability therefore of the new R4 criteria may still be limited.

Table: Rome criteria compared to variables.

Statistical significance * &lt; 0.03, ** ≤ 0.05

Funding Agencies

None

All-Electrical Control of Compact SOT-MRAM: Toward Highly Efficient and Reliable Non-Volatile In-Memory Computing

Two-dimensional van der Waals (2D vdW) ferromagnets possess outstanding scalability, controllable ferromagnetism, and out-of-plane anisotropy, enabling the compact spintronics-based non-volatile in-memory computing (nv-IMC) that promises to tackle the memory wall bottleneck issue. Here, by employing the intriguing room-temperature ferromagnetic characteristics of emerging 2D Fe₃GeTe₂ with the dissimilar electronic structure of the two spin-conducting channels, we report on a new type of non-volatile spin-orbit torque (SOT) magnetic tunnel junction (MTJ) device based on Fe₃GeTe₂/MgO/Fe₃GeTe₂ heterostructure, which demonstrates the uni-polar and high-speed field-free magnetization switching by adjusting the ratio of field-like torque to damping-like torque coefficient in the free layer. Compared to the conventional 2T1M structure, the developed 3-transistor-2-MTJ (3T2M) cell is implemented with the complementary data storage feature and the enhanced sensing margin of 201.4% (from 271.7 mV to 547.2 mV) and 276% (from 188.2 mV to 520 mV) for reading “1” and “0”, respectively. Moreover, superior to the traditional CoFeB-based MTJ memory cell counterpart, the 3T2M crossbar array architecture can be executed for AND/NAND, OR/NOR Boolean logic operation with a fast latency of 24 ps and ultra-low power consumption of 2.47 fJ/bit. Such device to architecture design with elaborated micro-magnetic and circuit-level simulation results shows great potential for realizing high-performance 2D material-based compact SOT magnetic random-access memory, facilitating new applications of highly reliable and energy-efficient nv-IMC.

Aurantio-Obtusin Attenuates Non-Alcoholic Fatty Liver Disease Through AMPK-Mediated Autophagy and Fatty Acid Oxidation Pathways

Nonalcoholic fatty liver disease (NAFLD), manifested as the aberrant accumulation of lipids in hepatocytes and inflammation, has become an important cause of advanced liver diseases and hepatic malignancies worldwide. However, no effective therapy has been approved yet. Aurantio-obtusin (AO) is a main bioactive compound isolated from Cassia semen that has been identified with multiple pharmacological activities, including improving adiposity and insulin resistance. However, the ameliorating effects of AO on diet-induced NAFLD and underlying mechanisms remained poorly elucidated. Our results demonstrated that AO significantly alleviated high-fat diet and glucose-fructose water (HFSW)-induced hepatic steatosis in mice and oleic acid and palmitic acid (OAPA)-induced lipid accumulation in hepatocytes. Remarkably, AO was found to distinctly promote autophagy flux and influence the degradation of lipid droplets by inducing AMPK phosphorylation. Additionally, the induction of AMPK triggered TFEB activation and promoted fatty acid oxidation (FAO) by activating PPARα and ACOX1 and decreasing the expression of genes involved in lipid biosynthesis. Meanwhile, the lipid-lowing effect of AO was significantly prevented by the pretreatment with inhibitors of autophagy, PPARα or ACOX1, respectively. Collectively, our study suggests that AO ameliorates hepatic steatosis via AMPK/autophagy- and AMPK/TFEB-mediated suppression of lipid accumulation, which opens new opportunities for pharmacological treatment of NAFLD and associated complications.

MSPAN: A Memristive Spike-Based Computing Engine With Adaptive Neuron for Edge Arrhythmia Detection

In this work, a memristive spike-based computing in memory (CIM) system with adaptive neuron (MSPAN) is proposed to realize energy-efficient remote arrhythmia detection with high accuracy in edge devices by software and hardware co-design. A multi-layer deep integrative spiking neural network (DiSNN) is first designed with an accuracy of 93.6% in 4-class ECG classification tasks. Then a memristor-based CIM architecture and the corresponding mapping method are proposed to deploy the DiSNN. By evaluation, the overall system achieves an accuracy of over 92.25% on the MIT-BIH dataset while the area is 3.438 mm2 and the power consumption is 0.178 μJ per heartbeat at a clock frequency of 500 MHz. These results reveal that the proposed MSPAN system is promising for arrhythmia detection in edge devices.

Si-Wu-Tang ameliorates fibrotic liver injury via modulating intestinal microbiota and bile acid homeostasis

Background

Fibrotic liver injury is a progressive scarring event, which may permanently affect liver function and progress into devastating end-stage liver diseases due to the absence of effective therapies. Si-Wu-Tang (SWT), a traditional Chinese medicine formula used in clinic to treat gynecological disorders for centuries, has been investigated in recent preliminary findings for its role in alleviating chronic liver diseases. Here we aim to elucidate the therapeutic effects and possible mechanisms of SWT against fibrotic liver injury.

Methods

UHPLC-MS/MS was performed to investigate the chemical characterization of SWT. After intragastrically administered with carbon tetrachloride (CCl₄) every 3 days for 1-week, C57BL/6 mice were orally administered with SWT (5.2, 10.4 and 20.8 g/kg) once daily for 3 weeks along with CCl₄ challenge. Liver function was determined by the measurement of serum biomarkers, hematoxylin and eosin (H&E) and Masson’s trichrome staining. Intestinal inflammatory infiltration and the disruption of intestinal barrier were examined by H&E and E-cadherin immunohistochemical staining. The microbial composition of intestinal content was determined by 16S rRNA sequencing. Serum bile acids (BAs) profiling was analyzed by LC–MS/MS. Simultaneously, the expression of genes of interest was determined by qPCR and western blot.

Results

SWT exhibited remarkable therapeutic effects on CCl₄-induced liver fibrosis, as indicated by improved collagen accumulation in livers, intestinal barrier injury and hepatic and intestinal inflammatory response. Results of 16S rRNA sequencing revealed that SWT treatment strikingly restructured intestinal microbiota in fibrotic mice by increasing the relative abundances of Bacteroides and Lachnoclostridium and decreasing the relative abundances of Alistipes and Rikenellaceae. UHPLC-MS/MS data suggested that SWT altered the composition of BAs in circulation as evidenced by increased unconjugated BAs like cholic acid and chenodeoxycholic acid but decreased conjugated BAs including taurocholic acid and taurodeoxycholic acid, compared to that in CCl₄ mice. Notably, SWT efficiently improved the imbalance of BA homeostasis in livers caused by CCl₄ via activating farnesoid X receptor (FXR)-fibroblast growth factor 15 enterohepatic and FXR-small heterodimer partner hepatic pathways.

Conclusion

SWT decreased inflammatory response, reconstructed gut microbiota-mediated BA homeostasis as well as activated FXR pathways, which eventually protected against CCl₄-induced fibrotic liver injury.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13020-021-00524-0.

Ferulic Acid Ameliorates Hepatic Inflammation and Fibrotic Liver Injury by Inhibiting PTP1B Activity and Subsequent Promoting AMPK Phosphorylation

Chronic inflammation in response to persistent exogenous stimuli or damage results in liver fibrosis, which subsequently progresses into malignant liver diseases with high morbidity and mortality. Ferulic acid (FA) is a phenolic acid widely isolated from abundant plants and exhibits multiple biological activities including anti-oxidant, anti-inflammation and enhancement of immune responses. Adenosine monophosphate-activated protein kinase (AMPK) functions as a critical energy sensor and is regulated through the phosphorylation of liver kinases like LKB1 or dephosphorylation by protein tyrosine phosphatases (PTPs). However, the role of FA in carbon tetrachloride (CCl₄)-induced chronic inflammation and liver fibrosis and AMPK activation has not been elucidated. Here we reported that FA ameliorated CCl₄-induced inflammation and fibrotic liver damage in mice as indicated by reduced levels of serum liver function enzyme activities and decreased expression of genes and proteins associated with fibrogenesis. Additionally, FA inhibited hepatic oxidative stress, macrophage activation and HSC activation via AMPK phosphorylation in different liver cells. Mechanically, without the participation of LKB1, FA-induced anti-inflammatory and anti-fibrotic effects were abrogated by a specific AMPK inhibitor, compound C. Combining with the results of molecular docking, surface plasmon resonance and co-immunoprecipitation assays, we further demonstrated that FA directly bound to and inhibited PTP1B, an enzyme responsible for dephosphorylating key protein kinases, and eventually leading to the phosphorylation of AMPK. In summary, our results indicated that FA alleviated oxidative stress, hepatic inflammation and fibrotic response in livers through PTP1B-AMPK signaling pathways. Taken together, we provide novel insights into the potential of FA as a natural product-derived therapeutic agent for the treatment of fibrotic liver injury.

The associations of CD4 count, CD4/CD8 ratio, and HIV viral load with survival from non-small cell lung cancer in persons living with HIV

HIV status may influence survival from non-small cell lung cancer (NSCLC). Among NSCLC patients in the Bronx, NY, we assessed (1) associations of CD4 count, CD4/CD8 ratio and HIV viral load (VL) with survival and (2) prognostic factors among persons living with HIV (PLWH). We compared survival from NSCLC diagnosis (2004-2017) between HIV-negative persons (HIV-, n=2,881) and PLWH (n=88) accounting for clinical and sociodemographic factors. HIV-survival was also compared with PLWH, dichotomized by CD4 (<200 vs. ≥200cells/µL), CD4/CD8 (median, <0.43 vs. ≥0.43) and VL (<75 vs. ≥75copies/mL) at NSCLC diagnosis. Among PLWH, we assessed the relationships of CD4, CD4/CD8, and VL with survival, adjusting for age, sex, and cancer stage. PLWH with CD4< 200cells/µL had lower survival than HIV- [hazard ratio, 95% confidence interval [HR(95%CI)]=1.86(0.98-3.55)]. Survival was similar between PLWH with CD4≥ 200cells/µL and HIV- [HR(95%CI) = 0.90(0.61-1.33)]. Results were similar when categorizing PLWH by CD4/CD8 [vs. HIV-: low CD4/CD8: HR(95%CI) = 1.74(1.07-3.89); high CD4/CD8: HR(95%CI) = 0.63(0.37-1.07)] and VL [vs. HIV-: <75copies/mL: HR(95%CI) = 0.74(0.46-1.21), ≥75copies/mL: HR(95%CI) = 1.41(0.88-2.27)]. Among PLWH, CD4< 200cells/µL was associated with worse survival [vs. CD4≥ 200cells/µL: HR(95%CI) = 2.37(1.14-4.92)]. CD4, CD4/CD8, and VL may be prognostic markers for PLWH with NSCLC, suggesting immune status may be important in NSCLC survival among PLWH.

Association of waist circumstance with long-term all-cause mortality and cardiac death in patients with a pacemaker

Funding Acknowledgements

Type of funding sources: None.

Objective

To explore the association of abdominal obesity with long-term prognosis in patients with a pacemaker.

Methods

Patients in the Summit study were enrolled and divided into groups according to baseline waist circumference: with obesity, normal, and lean. Regular follow-up was performed. The primary endpoint was all-cause mortality, and the secondary endpoint was cardiac death.

Results

In total, 492 patients were included in the analysis. The average baseline waist circumference was 84.2 ± 12.7 cm, and abdominal obesity was observed in 37.6% of patients. During a mean follow-up of 67.2 ± 17.5 months,71 all-cause mortality (14.40%) and 24 cardiac death (4.87%) events occurred. All-cause mortality was associated with higher waist circumference (87.6 versus 83.6 cm, P = 0.014), but not body mass index (23.6 versus 23.5, P= 0.930). Multivariate Cox analysis showed compared with patients with abdominal obesity, lean patients had a significant survival benefit in both all-cause mortality (HR 0.188, 95%CI 0.070-0.505, P = 0.001) and cardiac death (HR 0.097, 95% CI 0.012-0.792, P = 0.029).

Conclusions

Waist circumference was associated with long-term all-cause mortality and cardiac death. Baseline waist circumference less than 80 cm for men and less than 75 cm for women had a significant survival benefit.

A triple-classification radiomics model for the differentiation of pleomorphic adenoma, Warthin tumour, and malignant salivary gland tumours on the basis of diffusion-weighted imaging

AIM

To develop and validate a triple-classification radiomics model for the preoperative differentiation of pleomorphic adenoma (PA), Warthin tumour (WT), and malignant salivary gland tumour (MSGT) based on diffusion-weighted imaging (DWI).

MATERIALS AND METHODS

Data from 217 patients with histopathologically confirmed salivary gland tumours (100 PAs, 68 WTs, and 49 MSGTs) from January 2015 to March 2019 were analysed retrospectively and divided into a training set (n=173), and a validation set (n=44). A total of 396 radiomic features were extracted from the DWI of all patients. Analysis of variance (ANOVA) and least absolute shrinkage and selection operator (LASSO) regression were used to select radiomic features, which were then constructed using three classification models, namely, logistic regression method (LR), support vector machine (SVM), and K-nearest neighbor (KNN). The diagnostic performance of the radiomics model was quantified by the receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) of the training and validation data sets.

RESULTS

The 20 most valuable features were investigated based on the LASSO regression. LR and SVM methods exhibited better diagnostic ability than KNN for multiclass classification. LR and SVM had the best performance and yielded the AUC values of 0.857 and 0.824, respectively, in the training data set and the AUC values of 0.932 and 0.912, respectively, in the validation data set of MSGT diagnosis.

CONCLUSION

DWI-based triple-classification radiomics model has predictive value in distinguishing PA, WT, and MSGT, which can be used for preoperative auxiliary diagnosis in clinical practice.

Synthesis of silver nanoparticles using Lactobacillus bulgaricus and assessment of their antibacterial potential

Many pathogenic strains have acquired multidrug-resistant patterns in recent a year, which poses a major public health concern. The growing need for effective antimicrobial agents as novel therapies against multidrug-resistant pathogens has drawn scientist attention toward nanotechnology. Silver nanoparticles are considered capable of killing multidrug-resistant isolates due to their oligo-dynamic effect on microorganisms. In this research study NPs were synthesized using the gram-positive bacteria Lactobacillus bulgaricus and its activity against selected pathogenic strains. Lactobacillus bulgaricus pure cultures were isolated from raw milk and grown in "De Man, Rogasa, and Sharp" broth for synthesis of nanoparticles. Lactobacillus bulgaricus culture was centrifuged and Cell- free supernatant of it was employed with aqueous silvery ions and evaluated their antibacterial activities against bacterial strains i.e. Staphylococcus aureus, Staphylococcus epidermidis and Salmonella typhi using agar well diffusion assay. Antibiotic profiling against selected pathogenic strains were also conducted using disc diffusion method. The synthesis and characterization of silver nanoparticles were monitored primarily by the conversion of the pale-yellow color of the mixture into a dark-brown color and via ultraviolet-visible absorption spectroscopy and Scanning electron microscopy respectively. The result showed that that AgNPs with size (30.65-100 nm) obtained from Lactobacillus bulgaricus were found to exhibit antibacterial activities against selected bacterial strains. Taken together, these findings suggest that Lactobacillus bulgaricus has great potential for the production of AgNPs with antibacterial activities and highly effective in comparison to tested antibiotics.

[Study on syndromic deafness caused by novel pattern of compound heterozygous variants in the CDH23 gene]

Objective: To explore the pathogenic variants of a family with syndromic deafness by high-throughput sequencing. Methods: The family was from Puyang City, Henan Province, and had four members, including two with syndromic deafness. The proband and his sister had congenital deafness, and their parents had normal phenotypes. The clinical phenotype of the family was characterized using clinical examinations and pedigree analysis. The clinical examinations included imaging examination, audiometry (pure tone audiometry, acoustic immittance, brainstem auditory evoked potential, and otoacoustic emission), vestibular function test, and ophthalmic examination (visual acuity test, visual field test, fundus examination, visual evoked potential, and electroretinogram). Target exome sequencing of 129 known deafness genes and bioinformatics analysis were used to screen suspected pathogenic variants. Sanger sequencing and minigene assay were used to verify and functionally investigate the mutation detected, respectively. According to the standards and guidelines for interpreting genetic variants proposed by the American College of Medical Genetics and Genomics, the variants c.6049G>A and c.8699A>G were classified as pathogenic/likely pathogenic, and the variant c.9856C>G was classified as variants of uncertain significance. Results: The probands and his sister had severe sensorineural hearing loss with decreased binocular vision, night blindness, decreased peripheral visual field sensitivity and partial visual field defect, and normal vestibular function. Both of them had three CDH23 mutations, including CDH23 (NM_022124.5) c.6049G>A (p.Gly2017Ser),c.9856C>G (p.His3286Asp), and c.8699A>G (p. Asp2900Gly), The first two were inherited from the father, and the last one was from the mother. The missense variants c.9856C>G and c.8699A>G were not included in the gnomad database. The missense mutation c.6049G>A was located in the last position of exon 46 and was predicted to affect splicing by bioinformatics software. The minigene experiment showed that the mutation cause exon skipping of exon 46, resulting in an abnormal protein. Conclusions: Compound heterozygous variations of the CDH23 are the leading cause of USH1D in the family. This study confirms that the compound heterozygosity of splicing and missense variants of the CDH23 gene could lead to USH1D.

Effect of condylar osteochondroma resection through an intraoral approach on the masticatory functions: a preliminary evaluation based on occlusion and temporomandibular joint functions

With this research, we aimed to evaluate the effect of condylar osteochondroma (OC) resection through an intraoral approach on the masticatory functions. Resection of condylar OC was carried out via an intraoral approach with the help of three-dimensional (3D) design, endoscope, and navigation system. The T-Scan III computerised occlusal analysis system was used to evaluate the occlusal force distribution, recorded at pre-treatment (T1) and post-treatment (T2) intervals. Records of the clinical examination of the temporomandibular joint (TMJ), including maximal interincisal opening, mandibular lateral and forward movements, were also collected. Ten patients with condylar OC were enrolled in this study. The difference of force distribution between bilateral occlusion was reduced in T2 compared with T1 (11.92% ± 4.41% vs 48.52 % ± 28.37%, p<0.05), indicating better occlusal force distribution obtained after surgery. There was no significant difference in functions of the TMJ, such as maximal interincisal opening, and mandibular lateral and forward movements between T2 and T1 (p>0.05). Accordingly, condylar OC resection through an intraoral approach would obtain a satisfactory occlusal balance with no impairment of the temporomandibular joint functions.

Dorsal-ventral patterned neural cyst from human pluripotent stem cells in a neurogenic niche

Despite its importance in central nervous system development, development of the human neural tube (NT) remains poorly understood, given the challenges of studying human embryos, and the developmental divergence between humans and animal models. We report a human NT development model, in which NT-like tissues, neuroepithelial (NE) cysts, are generated in a bioengineered neurogenic environment through self-organization of human pluripotent stem cells (hPSCs). NE cysts correspond to the neural plate in the dorsal ectoderm and have a default dorsal identity. Dorsal-ventral (DV) patterning of NE cysts is achieved using retinoic acid and/or sonic hedgehog and features sequential emergence of the ventral floor plate, P3, and pMN domains in discrete, adjacent regions and a dorsal territory progressively restricted to the opposite dorsal pole. This hPSC-based, DV patterned NE cyst system will be useful for understanding the self-organizing principles that guide NT patterning and for investigations of neural development and neural disease.

Biochemical markers of bone turnover and risk of incident hip fracture in older women: the Cardiovascular Health Study

The relationships of osteocalcin (OC) and C-telopeptide of type I collagen (CTX) with long-term incidence of hip fracture were examined in 1680 post-menopausal women from a population-based study. CTX, but not OC, levels were associated with incident hip fracture in these participants, a relationship characterized by an inverted U-shape.

INTRODUCTION

We sought to investigate the relationships of OC, a marker of bone formation, and CTX, a marker of bone resorption, with long-term incidence of hip fracture in older women.

METHODS

We included 1680 women from the population-based Cardiovascular Health Study (mean [SD] age 74.5 [5.0] years). The longitudinal association of both markers with incidence of hip fracture was examined using multivariable Cox models.

RESULTS

During a median follow-up of 12.3 years, 288 incident hip fractures occurred. Linear spline analysis did not demonstrate an association between OC levels and incident hip fracture. By contrast, increasing levels of CTX up to the middle-upper range were associated with a significantly greater risk of hip fracture (HR = 1.52 per SD increment, 95% CI = 1.10-2.09), while further increases were associated with a marginally non-significant lower risk (HR = 0.80 per SD increment, 95% CI = 0.63-1.01), after full adjustment for potential confounders. In analyses of quartiles, CTX exhibited a similar inverted U-shaped relationship with incident fracture after adjustment, with a significant association observed only for the comparison of quartile 3 to quartile 1 (HR = 1.63, 95% CI = 1.10-2.43). In a subset with available measures, both OC and CTX were inversely associated with bone mineral density of the hip.

CONCLUSION

CTX, but not OC, levels were associated with incident hip fracture in post-menopausal women, a relationship characterized by an inverted U-shape. These findings highlight the complex relationship of bone turnover markers with hip fracture risk.

Abstract P2-08-18: Tumor microenvironment of metastasis (TMEM) score in residual breast carcinoma post-neoadjuvant chemotherapy as an independent prognosticator of distant recurrence

Background: Tumor microenvironment of metastasis (TMEM) is a microanatomical structure composed by 3 cells in direct contact, including a tumor cell expressing the actin-regulatory protein Mammalian-enabled (Mena), a perivascular Tie2hi/Vegfhi-expressing macrophage, and an endothelial cell. TMEM are intravasation sites that function as doorways for hematogenous tumor cell dissemination and metastases (Harney et al. Cancer Discovery 2015). TMEM may be identified and enumerated by triple immunohistochemistry in mouse and human mammary carcinomas. High TMEM score is associated with increased risk of distant metastasis in early stage breast cancer, and provides complementary prognostic information to IHC4 (Rohan et al. JNCI 2014) and Oncotype DX Recurrence Score in ER+, HER2-negative breast cancer (Sparano et al. NPJ Breast Cancer, 2017). Neoadjuvant chemotherapy (NAC) increases TMEM score in breast carcinoma in animal models and humans, indicating a previously unrecognized mechanism of resistance to cytotoxic therapy (Karagiannis et al. Science Trans Med 2017). Intravasation at TMEM sites may be inhibited using agents that block release of VEGF from TMEM-associated TIE2-hi, VEGF-hi macrophages (Harney et al. Mol Cancer Ther, 2017). Here we investigated whether TMEM score in post-NAC treated breast carcinoma is prognostic of distant recurrence in localized breast cancer after NAC, and thus provides a foundation for testing agents that block TMEM function in combination with NAC.

Methods: We determined TMEM score in 80 evaluable patients' post-NAC specimens with residual invasive ductal carcinomas of at least 0.5 cm. Approximately 60% of patients had ER+/HER2-negative, 28% had triple negative and 12% had HER2+ disease. Most of the patients received doxorubicin/cyclophosphamide + taxane and an anti-HER2 therapy if applicable. Tissue sections from residual tumors were stained for TMEM using triple immunohistochemistry for Mena-expressing cancer cells, CD31-expressing endothelial cells and CD68-expressing macrophages. The stained slides were scanned, and the images were analyzed by three pathologists, blinded to outcome, who independently determined the tissue areas appropriate for TMEM scoring. TMEM was scored within these areas using an automated algorithm.

Results: TMEM score was significantly higher in patients with distant recurrence (average TMEM=106), compared to patients without distant recurrence (average TMEM=71) (p&lt;0.01, two-sided t-test). Moreover, in a Cox proportional hazards model that included TMEM score (upper tertile vs. lower 2 tertiles), age (&gt;50 yrs. vs. &lt;50), race (black vs non-black), tumor stage (T 1-3), estrogen receptor (ER) status (+ vs -), high TMEM score was associated with a increased risk of distant recurrence (HR=2.2, 95% CI=1.0 to 4.9, p=0.05)

Conclusion: TMEM score may provide independent prognostic information for distant recurrence in patients with residual invasive carcinoma after NAC. These results support the use of agents that block TMEM function in combination with NAC, as planned in the I-SPY2 trial.

Citation Format: Oktay MH, D'Alfonso T, Ginter P, Lanjewar S, Entenberg D, Pastoriza JM, Wang Y, Lin Y, Karagiannnis GS, Lin J, Ye X, Anampa J, Xue X, Rohan TE, Sparano JA, Condeelis JS. Tumor microenvironment of metastasis (TMEM) score in residual breast carcinoma post-neoadjuvant chemotherapy as an independent prognosticator of distant recurrence [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-18.

Abstract P6-18-22: Phase Ib study of rebastinib plus antitubulin therapy with paclitaxel (P) or eribulin (E) in patients with HER2-negative metastatic breast cancer (MBC)

BACKGROUND: TMEM (Tumor Microenvironment of Metastasis) are the portal for tumor cell intravasation into the circulation and subsequent metastasis (Harney et al Cancer Discov 2015). The potent Tie2 kinase inhibitor rebastinib inhibits intravasation at TMEM sites, reduces circulating tumor cell (CTC) burden, increases angiopoietin (Ang) 1/2 levels, prevents distant metastases, and improves survival in breast cancer animal models when added to either P or E (Harney et al MCT 2017), and circumvent chemotherapy-induced pro-metastatic changes in the tumor microenvironment mediated by TMEM (Karagiannis et al STM 2017). We sought to determine the safety of rebastinib combined with antitubulin therapy (P or E) in patients with HER2- MBC. We also hypothesized that addition of rebastinib would reduce CTC burden and increase Ang levels by blocking Ang-mediated stimulation of VEGF release from TMEM-associated macrophages.

METHODS: We aimed to determine the safety and recommended phase 2 dose (RP2D) of rebastinib (2 dose levels: 50 mg or 100 mg PO BID) in combination with P (80 mg/m2 x 12 weeks) or E (1.4 mg/m2 on day 1 & 8 q 21 days) using a standard 3+3 design (1 cycle = 21 days). Secondary objectives included evaluating the effect of the P/E + rebastinib combination on CTCs (TelomeScan) and Ang levels. Dose limiting toxicity (DLT) was defined as grade 3-4 febrile neutropenia, thrombocytopenia, and non-hematologic toxicity during the first 6 weeks of therapy. Eligibility included HER2- MBC, ECOG PS 0-1, CDK4/6 inhibitor progression if ER+. Patients with ≤ 2 prior non-taxane chemotherapy regimens received P+ rebastinib, whereas those with ≥ 2 chemo regimens (including a taxane) received E+ rebastinib.

RESULTS: Of 11 treated patients, 6 received rebastinib + P and 5 received rebastinib + E (2 non-evaluable due to rapid disease progression and non-compliance). Among 11 patients who received 60 treatment cycles, only 1 patient (treated with eribulin) had grade 3 events (anemia and neuropathy after week 6) potentially related to treatment. When combined with P, the RP2D of rebastinib was 100 mg PO BID, with DLT occurring in 0/6 patients. When combined with E, 0/3 evaluable patients had a DLT at 50 mg BID of rebastinib (accrual ongoing for 100mg BID). Best response included partial response/stable disease in 4(2PR/2SD) of 6 treated with P+ rebastinib, and 1(1PR) of 5 treated with E+ rebastinib. CTCs decreased during therapy (median decrease 99.7 %) and 4/8 patients converted from CTC+ to CTC-. Ang1 levels increased during therapy in 8 patients (0.2-7.0 fold), while Ang2 levels were also increased in 8 patients (0.2-1.4 fold).

CONCLUSIONS: When combined with P x 12 weeks, the RP2D of rebastinib is 100 mg PO BID. When combined with E, the RP2D of rebastinib is at least 50mg PO BID; however, the 100 mg PO BID dose level is still accruing patients. The P/E + rebastinib combinations are associated with antitumor activity and exhibit pharmacodynamic evidence indicating blockade of Tie2 (increased Ang) and TMEM function (reduced CTCs) We plan to further evaluate the P+ rebastinib combination as neoadjuvant therapy in the I-SPY program, and continue further evaluation of P/E + rebastinib combinations in MBC.

Citation Format: Anampa JD, Xue X, Oh S-y, Kornblum N, Sadan S, Oktay MH, Condeelis J, Sparano JA. Phase Ib study of rebastinib plus antitubulin therapy with paclitaxel (P) or eribulin (E) in patients with HER2-negative metastatic breast cancer (MBC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-22.

Effects of thermal fluctuations in the fragmentation of a nanoligament

We study the effects of thermally induced capillary waves in the fragmentation of a liquid ligament into multiple nanodroplets. Our numerical implementation is based on a fluctuating lattice Boltzmann (LB) model for nonideal multicomponent fluids, including nonequilibrium stochastic fluxes mimicking the effects of molecular forces at the nanoscales. We quantitatively analyze the statistical distribution of the breakup times and the droplet volumes after the fragmentation process at changing the two relevant length scales of the problem, i.e., the thermal length scale and the ligament size. The robustness of the observed findings is also corroborated by quantitative comparisons with the predictions of sharp interface hydrodynamics. Beyond the practical importance of our findings for nanofluidic engineering devices, our study also explores a novel application of LB in the realm of nanofluidic phenomena.

Abstract OT2-06-04: Phase Ib study of rebastinib plus antitubulin therapy with paclitaxel or eribulin in patients with metastatic breast cancer

Background: Metastasis is the primary cause of death in breast cancer, yet no specific therapies are available that inhibit the metastatic process. TMEM (Tumor Microenvironment of Metastasis) are microanatomic structures formed by a Mena-expressing tumor cell, Tie2-expressing macrophage, and endothelial cell in direct content, which serve as the primary portal for tumor cell intravasation into the circulation and subsequent metastasis. High TMEM score in the primary tumor is associated with higher risk of recurrence in ER+, HER2- early breast cancer. Paclitaxel induces the formation of TMEM in the primary tumors of patients treated with neoadjuvant chemotherapy, and in the primary tumor and distant metastases in the PyMT/PDX models. Tumor cell intravasation is mediated by release of VEGF that promotes focal vascular leakiness specifically at TMEM sites, and is derived from TMEM-associated Tie2HI/VEGFHI macrophages that release VEGF upon binding of the Tie2 receptor to angiopoietin2 (ANG2), which is elaborated by TMEM-associated endothelial cells. Moreover, ANG2-stimulated release of IL-10 by tumor-associated macrophages suppresses T cell proliferation, increases the ratio of CD4+T cells to CD8+ T cells, and promotes the expansion of CD4+CD25highFOXP3+ cells. The Tie2 inhibitor rebastinib inhibits intravasation at TMEM sites, reduces circulating tumor cell (CTC) burden, prevents distant metastases, and improves survival in breast cancer animal models when added to either paclitaxel or eribulin. We therefore hypothesize that the addition of a potent Tie2 inhibitor (rebastinib) to antitubulin therapy in patients with HER2 negative metastatic breast cancer (MBC) will prevent hematogenous dissemination and distant metastasis by inhibition of TMEM function, reduction in CTC burden, and inhibition of immune-system suppression resulting in improvement in breast clinical outcomes

Methods: Primary objective of this phase Ib study (NCT02824575) is to evaluate safety and tolerability of rebastinib in two dose levels (DL) (50mg or 100mg po BID) combined with paclitaxel IV 80mg/m2 (day 1, 8 and 15) or eribulin IV 1.4mg/m2 (day1 and 8) for four 21-day cycles.

Key eligibility includes histologically confirmed HER2 negative MBC. ≤ 2 non-taxane chemotherapy regimens are allowed for rebastinib plus paclitaxel arm, while ≥ 2 chemotherapy regimens (including a taxane) are required for eribulin plus rebastinib arm. ≥ 2 endocrine regimens, including an approved CDK4/6 inhibitor, is required for ER+ disease. Patients require ECOG PS 0 or 1 and normal organ and marrow function. Exclusion criteria include significant ocular disease, significant history of cardiac disease or concomitant use drugs that prolong QTc interval.

Pharmacodynamic biomarkers to be measured during cycle 1-3 include CTCs, ANG 1/2 levels and Tie-2 expressing monocytes. Tissue biopsy after two treatment cycles in 6 patients who have accessible tumors will be performed to evaluate TMEM score and function. With two DL of rebastinib, and 3-6 patients at each DL, it is anticipated that 6-12 patients will be required.

This trial has enrolled three patients assigned paclitaxel arm (DL1) and one patient in eribulin arm(DL1).

Citation Format: Anampa JD, Xue X, Oktay M, Condeelis J, Sparano JA. Phase Ib study of rebastinib plus antitubulin therapy with paclitaxel or eribulin in patients with metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-06-04.

Abstract P6-10-02: Black race is associated with worse distant relapse-free survival in breast cancer patients treated with neoadjuvant compared to adjuvant systemic chemotherapy

Background: Compared to white women, black women with operable breast cancer treated with primary surgical therapy and adjuvant or neoadjuvant systemic chemotherapy have higher recurrence rates and breast cancer mortality. Large randomized prospective studies did not find significant differences in distant-recurrence free survival (DRFS) and overall survival (OS) between breast cancer patients treated in the adjuvant and neoadjuvant setting for predominantly white populations. However, data indicating that neoadjuvant treatment is equivalent to adjuvant treatment for black breast cancer patients are missing. Here, we first examined racial differences in DRFS among breast cancer patients treated in the neoadjuvant setting at Einstein-Montefiore Center for Cancer Care (EMCCC) in the Bronx, and then investigated if DRFS in black patients treated in the neoadjuvant setting is comparable to DRFS in the adjuvant setting.

Methods: We evaluated DRFS in 241 racially diverse patients with localized or regionally advanced breast cancer treated with neoadjuvant chemotherapy between January 2000 and December 2016. In addition, we evaluated DRFS in 474 white and 701 black patients with localized or regionally advanced breast cancer treated with systemic adjuvant (432 whites, 596 blacks) or neoadjuvant (42 whites, 105 blacks) chemotherapy. Using multivariate Cox proportional hazard models, we generated hazard ratios (HR) and 95% confidence intervals (95%CI) for risk of distant recurrence, with adjustment for age (&lt;50 vs &gt;/50 years), stage (I/II vs III), estrogen receptor (ER) status (+ vs -), HER2/neu overexpression (+ vs. -/equivocal/unknown), triple negative (TN) status (yes vs no), and type of systemic chemotherapy (adjuvant vs. neoadjuvant).

Results: Black patients treated with neoadjuvant systemic chemotherapy had significantly worse DRFS than white patients (HR=2.29; 95%CI=1.02-5.15, p=0.04). DRFS in non-black Hispanics and patients from racial backgrounds other than Hispanic or black compared to whites was not statistically different. Neoadjuvant chemotherapy was associated with worse DRFS compared to adjuvant chemotherapy in black (HR=3.72; 95%CI=4.03-5.81; p=&lt;0.0001), but not in white women.

Conclusion: Black patients with localized breast cancer treated with systemic neoadjuvant chemotherapy not only have inferior DRFS compared to white patients, but also worse DRFS when compared to black patients treated with adjuvant chemotherapy, after adjustment for clinical and pathological covariates. This observation needs to be confirmed in further prospective studies and biologic factors contributing to this finding need to be evaluated.

Citation Format: Pastoriza JM, Karagiannis GS, Xue X, Lin J, Condeelis JS, Sparanno JA, Rohan TE, Oktay MH. Black race is associated with worse distant relapse-free survival in breast cancer patients treated with neoadjuvant compared to adjuvant systemic chemotherapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-10-02.