Irisin inhibits neutrophil extracellular traps formation and protects against acute pancreatitis in mice

INTRODUCTION

Irisin is a newly discovered myokine which links exercise to inflammation and inflammation-related diseases through macrophage regulation. However, the effect of irisin on the activity of inflammation related immune cells (such as neutrophils) has not been clearly described.

OBJECTIVES

The objective of our study was to explore the effect of irisin on the neutrophil extracellular traps (NETs) formation.

METHODS

Phorbol-12-myristate-13-acetate (PMA) was used to construct a classic neutrophil inflammation model that was used to observe the formation of NETs in vitro. We studied the effect of irisin on NETs formation and its regulation mechanism. Subsequently, acute pancreatitis (AP) was used to verify the protective effect of irisin in vivo, which was an acute aseptic inflammatory response disease model closely related to NETs.

RESULTS

Our study found that addition of irisin significantly reduced the formation of NETs via regulation of the P38/MAPK pathway through integrin αVβ5, which might be the one of key pathways in NETs formation, and which could theoretically offset the immunoregulatory effect of irisin. Systemic treatment with irisin reduced the severity of tissue damage common in the disease and inhibited the formation of NETs in pancreatic necrotic tissue of two classical AP mouse models.

CONCLUSION

The findings confirmed for the first time that irisin could inhibit NETs formation and protect mice from pancreatic injury, which further elucidated the protective effect of exercise on acute inflammatory injury.

Elevated serum HbA1c level, rather than previous history of diabetes, predicts the disease severity and clinical outcomes of acute pancreatitis

INTRODUCTION

The aim of our study is to explore the value of serum glycosylated hemoglobin A1c (HbA1c) in disease severity and clinical outcomes of acute pancreatitis (AP).

RESEARCH DESIGN AND METHODS

Patients with AP were included from January 2013 to December 2020, retrospectively, dividing into normal serum HbA1c level (N-HbA1c) group and high serum HbA1c level (H-HbA1c) group according to the criteria HbA1c <6.5%. We compared patient characteristics, biochemical parameters, disease severity, and clinical outcomes of patients with AP in two groups. Besides, we evaluated the efficacy of serum HbA1c to predict organ failure (OF) in AP patients by receiver operating curve (ROC).

RESULTS

We included 441 patients with AP, including 247 patients in N-HbA1c group and 194 patients in H-HbA1c group. Serum HbA1c level was positively correlated with Atlanta classification, systemic inflammatory response syndrome, local complication, and OF (all p<0.05). Ranson, BISAP (bedside index of severity in acute pancreatitis), and CT severity index scores in patients with H-HbA1c were markedly higher than those in patients with N-HbA1c (all p<0.01). ROC showed that the best critical point for predicting the development of OF in AP with serum HbA1c is 7.05% (area under the ROC curve=0.79). Logistic regression analysis showed H-HbA1c was the independent risk factor for the development of OF in AP. Interestingly, in patients with presence history of diabetes and HbA1c <6.5%, the severity of AP was significantly lower than that in H-HbA1c group. Besides, there was no significant difference between with and without history of diabetes in N-HbA1c group.

CONCLUSIONS

Generally known, diabetes is closely related to the development of AP, and strict control of blood glucose can improve the related complications. Thus, the level of glycemic control before the onset of AP (HbA1c as an indicator) is the key to poor prognosis of AP, rather than basic history of diabetes. Elevated serum HbA1c level can become the potential indicator for predicting the disease severity of AP.

Elevated serum ferritin levels are associated with severity and prognosis of severe acute pancreatitis: a preliminary cohort study

Background

Serum ferritin (SF), as an acute-phase response protein, is used to reflect the degree of oxidative stress and systemic inflammatory responses. This study was designed to assess the effect of elevated SF levels on the severity of acute pancreatitis (AP).

Methods

From January 2013 to December 2020, 200 consecutive patients with AP were retrospectively reviewed to analyze the relationships among the etiologies of pancreatitis, the severity of the disease and SF levels. The receiver operating characteristic (ROC) curve and logistic regression analysis were used to assess whether elevated SF levels could predict the onset of organ failure in AP.

Results

92 (46%) had high SF levels (> 275 ng/ml). SF levels were not associated with the etiology of AP disease. Among patients with high SF levels, there was a significant increase in the proportion of patients with severe AP (23.1% vs. 76.9%) and a higher proportion of systemic inflammatory response scores (25.9% vs. 44.6%) in comparison to patients with normal SF levels. The area under the ROC curve for SF in predicting persistent organ failure was 0.812 [95% confidence interval 0.721–0.904].

Conclusions

F concentrations were positively correlated with the severity of AP, and quantitative assessment of SF can predict disease severity and organ failure in patients with AP.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-022-02446-z.

Expression of mismatch repair proteins, CDX-2, and p53 in colorectal adenocarcinoma and their association with clinicopathological characteristics

BACKGROUND

Microsatellite instability is caused by loss of expression of DNA mismatch repair (MMR) proteins, which are involved in one of significant pathways that lead to colorectal cancer development and progression. Both Cdx-2 and p53 play an inhibitory role in colorectal cancer and are related to some clinicopathological features.

AIM

To analyze the significance of expression of MMR proteins (MLH1, MSH2, PMS2, and MSH6), CDX-2, and p53 in colorectal adenocarcinoma.

METHODS

A total of 175 patients with colorectal adenocarcinoma who were operated at the Affiliated Hospital of Yangzhou University from January 2017 to March 2021 were selected. The expression levels of MLH1, MSH2, PMS2, MSH6, CDX-2, and p53 in colorectal cancer were detected by immunohistochemical method. The association of the expression of the above proteins with clinicopathological features of colorectal adenocarcinoma was explored by chi-square test, and Spearman rank correlation was used for correlation analysis.

RESULTS

Among 175 colorectal adenocarcinoma patients, there were 39 patients with negative expression of all four MMR proteins (22.3%). The negative expression of MSH2, MSH6, MLH1, and PMS2 was found in 12 (6.9%), 1 (0.6%), 17 (9.7%), and 28 (16.0%) cases, respectively. Among 91 colorectal adenocarcinoma patients, 34 (35.1%) had negative expression of CDX-2, and 7 (25%) had negative expression of p53 in colorectal adenocarcinoma. The negative expression of MMR proteins was significantly correlated with the age of onset, tumor site, and degree of differentiation in colorectal adenocarcinoma patients (P < 0.05), but had no significant correlation with patient gender, tumor invasion depth, or lymph node metastasis (P > 0.05). There was no correlation between the expression of MMRs protein and that of CDX-2 and p53 (P > 0.05).

CONCLUSION

The expression of MMR proteins is related to the age of onset, tumor site, and degree of differentiation. The detection of MMR proteins has important clinical significance for the early diagnosis of colorectal adenocarcinoma, the formulation of therapeutic plan, and the assessment of prognosis.

Impact of Fatty Pancreas on Postoperative Pancreatic Fistulae: A Meta-Analysis

Background

Soft pancreas is widely recognized as an important risk factor for the development of postoperative pancreatic fistula (POPF). Although fatty pancreas (FP) has not been formally defined as a cause of pancreatic fistula, existing research has shown that it can increase the incidence of POPF by increasing pancreatic tenderness; therefore, it may be a potential risk factor. This study aimed to discern whether FP was associated with POPF.

Method

Two reviewers independently performed literature searches from five electronic databases. According to the established inclusion criteria, we extracted necessary data from the studies that met the criteria for further analysis. We pooled the odds ratios (ORs) from individual studies using a random-effects model to investigate the associations between POPF and the prognosis of FP.

Result

A total of 11 studies involving 2484 individuals were included. The pooled prevalence of POPF was 18% (95% CI: 12-24%). Body mass index (BMI) was associated with a significantly increased risk of POPF (OR=3.55; 95% CI: 1.83, 6.86; P=0.0002; I²=0). FP was obviously associated with the occurrence of POPF (OR=3.75; 95% CI: 1.64, 8.58; P=0.002; I²=78).

Conclusion

FP is closely associated with the development of POPF, and the early identification of these high-risk patients can help to reduce the incidence of POPF.

Systematic Review Registration

The Registration URL link is (https://www.crd.york.ac.uk/PROSPERO/). The ID is "CRD42021265141".

Meta-analysis of risk factors for recurrent acute pancreatitis

BACKGROUND

With the continuous improvement of living standards, the incidence of recurrent acute pancreatitis is also increasing year by year, and this disease has become a hot research topic in recent years. Understanding the etiology of recurrent acute pancreatitis has become an urgent problem to be solved in clinical practice.

AIM

To explore the risk factors for recurrent acute pancreatitis (RAP) by means of systematic evaluation, and provide evidence for better prevention of RAP.

METHODS

We searched CNKI, CBM, VIP, Wanfang, The Cochrane Library, PubMed, Embase, and Web of Science databases to collect case-control and cohort studies on the risk factors associated with RAP from January 1, 2000 to February 29, 2020. "Pancreatitis", "recurrence", "risk factors", and their free words were selected as keywords. The retrieved articles were evaluated and filtrated using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed based on the articles scored above 6 by using Revman5.3 software.

RESULTS

A total of 15 articles were included, with the cumulative number of cases and controls reaching 2258 and 8482, respectively. The results of meta-analysis showed that alcohol consumption [odds ratio [OR] = 1.83, 95%CI (1.30, 2.59), P = 0.0006], smoking [OR = 2.09, 95%CI (1.61, 2.73), P < 0.00001], biliary AP [OR = 1.82, 95%CI (1.28, 2.57), P = 0.0008], hypertriacylglyceremic AP [OR = 2.24, 95%CI (1.76, 2.85), P < 0.00001], alcoholic AP [OR = 2.68, 95%CI (2.03, 3.55), P < 0.00001], diabetes [OR = 1.57, 95%CI (1.48, 1.66), P < 0.00001], fatty liver [OR = 2.05, 95%CI (1.22, 3.47), P = 0.007], and CT score [OR = 3.52, 95%CI (2.28, 5.43), P < 0.00001] were statistically significant risk factors for RAP.

CONCLUSION

Current evidence shows that the risk factors for RAP include disease factors (biliary, alcoholic, and hypertriacylglyceremic AP, fatty liver, and diabetes), behavioral factors (alcohol consumption and smoking), and related indicators (CT score). Due to the limited quantity and quality of included studies, more prospective high-quality clinical studies are needed to verify the above conclusion.

Diabetes aggravates acute pancreatitis possibly via activation of NLRP3 inflammasome in db/db mice

Clinical studies have confirmed that patients with diabetes had an elevated risk of acute pancreatitis (AP) and diabetes was associated with increased severity and mortality in patients with AP. However, these studies failed to prove a cause-and-effect relationship between diabetes and AP. In the present study, we for the first time have evaluated the effects of diabetes on AP by adopting a type 2 diabetes animal model db/db mice and investigated the possible underlying mechanisms. The results showed that in comparison to wide type (WT) mice, db/db mice showed exacerbated pancreatic and pulmonary injuries, elevated serum amylase and lipase levels, increased myeloperoxidase (MPO) expressions in pancreatic and pulmonary tissues as well as increased apoptotic acinar cells after AP induction. Furthermore, we observed that NLRP3 inflammasome in pancreatic tissues was remarkably activated in db/db mice compared with WT mice. In addition, we also found that diabetes could increase the susceptibility of mice to AP. Taken together, our results indicated that diabetes could predispose and aggravate the disease severity of AP potentially via promoting the activation of NLRP3 inflammasome pathway.

Establishment of oral bacterial communities in germ-free mice and the influence of recipient age

The acquisition of the oral microbiome is a complex process. We examined how the timing of microbial exposure alters bacterial colonization of the tooth surface. Germ-free mice were conventionalized by exposure to specific pathogen-free (SPF) mice to acquire a commensal microbiome over three distinct 4-week periods, 0-4 weeks of age (Conv0-4w), 4-8 weeks (Conv4-8w), or 8-12 weeks (Conv8-12w). Bacterial DNA was extracted from the tooth surface and analyzed by 16S rDNA sequencing. Total bacteria and inflammatory cytokine expression in gingiva were determined by quantitative real-time polymerase chain reaction. After co-housing with SPF mice, Conv0-4w and Conv4-8w mice had low bacterial diversity, whereas Conv8-12w mice had high bacterial diversity that was similar to that of SPF donor mice, as determined by both operational taxonomic units and the Shannon Index. Cluster analysis with unweighted Unifrac distance also supported these trends. This was surprising as the amount of maturation time, 4 weeks, was equal in all conventionalized mice and tooth eruption was largely completed by 4 weeks. This suggests that host factors that occur after tooth eruption have a significant effect on the microbial tooth colonization.

Case report: successful resection of a leiomyoma causing pseudoachalasia at the esophagogastric junction by tunnel endoscopy

Background

Pseudoachalasia is a rare disorder whose presentation strongly resembles idiopathic achalasia.

Case presentation

Here, we present a case of a 42-year-old female patient with esophageal leiomyoma who was initially diagnosed with achalasia. On endoscopical investigation, however, it became apparent that she had pseudoachalasia as consequence of a leiomyoma at the esophagogastric junction (EGJ). The condition was successfully treated through submucosal tunneling endoscopic resection.

Conclusion

This case suggests that submucosal tunneling endoscopic resection is a therapeutic u option for the treatment of pseudoachalasia caused by leiomyoma of EGJ.

[Advance in studies on antitumor and immunomodulatory effects of wogonin]

Wogonin is a kind of natural flavonoid compound. According to findings in the latest studies, wogonin shows a wide range of antitumor effects, with the characteristics of multi-pathway, multi-link and multi-target, such as promoting tumor cell apoptosis through ROS or Ca(2+)-mediated signal paths, enhancing tumor cytotoxicity by TNF-α and TRAIL, blocking tumor cell cycle, inhibiting tumor angiogenesis and resisting cancer synergistically with chemotherapeutic drugs. Moreover, Wogonin could enhance body immune function by enhancing immune cell infiltration, regulating the immune cell phenotype and promoting relevant cytokine secretion. In this paper, the authors summarized the advance in studies on wogonin's antitumor and immunomodulatory effects.

Clinical characteristics of adenomatous polyps in colorectal cancer

AIM: To evaluate the morphological and pathologic features of polyps in colorectal cancer (CRC) patients.

METHODS: A total of 3166 patients underwent colonoscopy between April 2009 and August 2012 at the First People's Hospital of Yangzhou. These patients were divided into two groups: CRC and non-CRC. Sex, age, characteristics of adenomatous polyps (location, number, size, morphology and pathology), and CRC were recorded. The morphological and pathologic features of polyps in the two groups were analyzed.

RESULTS: Of 3022 cases who underwent total colonoscopy, 142 were diagnosed with CRC (4.7%), and 2880 had non-CRC diseases. CRC patients had higher prevalences of polyps, multiple polyps and high-risk adenomas than non-CRC patients (P = 0.017, 0.02, 0.002). Although CRC patients had a higher frequency of tubular or villous adenomas (P < 0.05), no significant differences in size of the lesion or pathological type were observed between the two groups. The frequency of right colonic lesions in CRC patients was significantly higher than that in non-CRC patients (37.4% vs 27.5%, P = 0.007).

CONCLUSION: There are high detection rates of colon polyps and high-risk adenomas in CRC patients. The quality of colonoscopy should be stressed in CRC patients.

Intratumor hypoxia promotes immune tolerance by inducing regulatory T cells via TGF-β1 in gastric cancer

Regulatory T cell (Treg)-mediated immunosuppression represents one of the crucial tumor immune evasion mechanisms and is a main obstacle for successful tumor immunotherapy. Hypoxia, a common feature of solid tumors, has been associated with potentiated immunosuppression, decreased therapeutic response, malignant progression and local invasion. Unfortunately, the link between hypoxia and Treg-mediated immune tolerance in gastric cancer remains poorly understood. In our study, Tregs and hypoxia inducible factor-1α were found to be positively correlated with each other and were increased with the tumor progression. A subsequent in vitro study indicated that supernatants derived from gastric cancer cells under hypoxic condition, could induce the expression of Foxp3 via TGF-β1. These findings confirmed the crucial role of Tregs as a therapeutic target in gastric cancer therapy and provided helpful thoughts for the design of immunotherapy for gastric cancer in the future.

Synchronous vs sequential laparoscopic cholecystectomy for cholecystocholedocholithiasis

AIM: To compare synchronous laparoscopic cholecystectomy (LC) combined with endoscopic sphincterotomy (EST) and sequential LC combined with EST for treating cholecystocholedocholithiasis.

METHODS: A total of 150 patients were included and retrospectively studied. Among these, 70 were selected for the synchronous operation, in which the scheme was endoscopic retrograde cholangiopancreatography combined with EST during LC. The other 80 patients were selected for the sequential operation, in which the scheme involved first cutting the papillary muscle under endoscopy and then performing LC. The indexes in the two groups, including the operation time, the success rate, the incidence of complications, and the length of the hospital stay, were observed.

RESULTS: There were no significant differences between the groups in terms of the numbers of patients, sex distribution, age, American Society of Anesthesiologists score, serum bilirubin, γ-glutamyl transpeptidase, mean diameter of common bile duct stones, and previous medical and surgical history (P = 0.54, P = 0.18, P = 0.52, P = 0.22, P = 0.32, P = 0.42, P = 0.68, P = 0.70, P = 0.47 and P = 0.57). There was no significant difference in the surgical operation time between the two groups (112.1 ± 30.8 min vs 104.9 ± 18.2 min). Compared with the sequential operation group, the incidence of pancreatitis was lower (1.4% vs 6.3%), the incidence of hyperamylasemia (1.4% vs 10.0%, P < 0.05) was significantly reduced, and the length of the hospital stay was significantly shortened in the synchronous operation group (3 d vs 4.5 d, P < 0.001).

CONCLUSION: For treatment of cholecystocholedocholithiasis, synchronous LC combined with EST reduces incidence of complications, decreases length of hospital stay, simplifies the surgical procedure, and reduces operation time.

Clinical features of hyperlipidemic acute pancreatitis: An analysis of 130 cases

AIM: To summarize and analyze the clinical features of hyperlipidemic acute pancreatitis (HLAP).

METHODS: Clinical data for patients with HLAP treated at our hospital from January 2006 to September 2012 were analyzed retrospectively. The clinical characteristics of HLAP were statistically analyzed. One hundred patients with acute biliary pancreatitis (ABP) were enrolled as controls.

RESULTS: A total of 102 HLPA patients (130 onsets) were enrolled in this study, accounting for 17.4 % of all AP patients. Patients with severe HLAP accounted for 23.1% of all HLAP patients. The mean age and percentage of patients with a serum amylase level greater than 3 times the upper limit of normal were significantly lower in HLAP patients than in ABP patients (both P < 0.05); however, HLAP patients were more likely to be associated with underlying metabolism syndrome and history of acute pancreatitis (both P < 0.05). The percentage of patients with a serum amylase level greater than 3 times the upper limit of normal was lower in HLAP patients with a TG level greater than or equal to 11.30 mmol/L than in HLAP patients with a TG level between 5.65-11.30 mmol/L (23.4% vs 41.5%, P < 0.05), but there were no significant differences in the proportion of severe cases (21.7% vs 28.6%, P > 0.05), hospitalization time (13.1 d ± 6.2 d vs 14.4 d ± 7.9 d, P > 0.05), and duration of abdominal pain (2.43 d ± 1.6 d vs 2.08 d ± 1.8 d, P > 0.05) between HLAP patients with different TG levels.

CONCLUSION: Low age of disease onset, male predominance, close relationship with metabolism syndrome, easy to recur, and unobvious increase in serum amylase are main clinical features of HLAP. Serum TG levels do not correlate with the severity of HLAP.

Clinical features of adult patients with esophageal foreign bodies: An analysis of 256 cases

AIM: To summarize and analyze the clinical features of adult patients with esophageal foreign bodies.

METHODS: Adult patients with esophageal foreign bodies who underwent endoscopy from January 2004 to January 2012 were analyzed retrospectively and their clinical characteristics were statistically analyzed.

RESULTS: A total of 256 patients were enrolled in this study. Food bolus is the main type of foreign body (95.7%). The top three symptoms were sensation of obstruction, dysphagia, and swallowing pain. Elderly patients (≥ 65 years old) were more likely to be associated with underlying esophageal diseases than patients between 18-65 years old (27.6% and 14.8%, P < 0.05). The major foreign body type was food boluses in patients with underlying esophageal diseases (65.3%) and bones (fish or chicken) in patients without underlying diseases (68.5%). The success rate for foreign body removal by endoscopic management was 98.4% (252/256).

CONCLUSION: Esophageal foreign body is a clinically common disease. More attention should be paid to elderly patients or/and patients with underlying esophageal diseases. Endoscopic management of esophageal foreign bodies is safe and effective.

[Correlation of Helicobacter pylori infection with the expression of COX-2 and EGFR and VEGF in human gastric carcinoma]

OBJECTIVE

To investigate the correlation of Helicobactor pylori (Hp) infection with the expression of COX-2, EGFR and VEGF in human gastric carcinoma.

METHODS

The expression of COX-2, EGFR and VEGF was detected by immunohistochemistry in samples of 61 gastric cancers and 20 cancer-adjacent tissues. Western blotting was performed in samples of 10 gastric cancers and corresponding cancer-adjacent tissues. Hp infection was detected in 47 patients by fast urea enzyme test and (13)C breath test.

RESULTS

The results of immunohistochemistry showed that the positive expressions of COX-2, EGFR and VEGF in gastric carcinoma were 59.02%, 36.07% and 60.66%, respectively, significantly higher than that in the normal mucosa (25.00%, 0 and 30.00%, respectively). There was a positive correlation between the expression of COX-2, EGFR and VEGF and gastric carcinoma. The expression of COX-2 and EGFR was 75.76% and 45.45% in the gastric carcinomas with Hp infection, significantly higher than that in those without (28.57% and 14.29%). The protein expression of COX-2, EGFR and VEGF detected by Western blot in gastric carcinomas was also significantly higher than that in normal mucosa.

CONCLUSION

COX-2, EGFR and VEGF are overexpressed in gastric carcinoma, and there is a positive correlation among them. Hp infection may upregulate the expression of COX-2 and EGFR in gastric cancer tissues.

Treatment of 64 cases severe acute pancreatitis with early enteral nutrition and intestinal barrier protective agents

AIM: To evaluate the efficacy of early enteral nutrition and intestinal barrier protective agents on severe acute pancreatitis (SAP).

METHODS: Sixty-four patients with SAP were randomly divided into groups A, B and C. Group A was given conventional therapy, group B enteral nutrition by nasogastric feeding, and group C enteral nutrition and intestinal barrier protective agents by nasogastric feeding. We measured the recovery time from symptoms, physical signs and laboratory parameters [white blood cell count (WBC), C-reactive protein (CRP) and serum amylase], changes in body weight and serum albumin, cost of hospitalization and length of stay.

RESULTS: Recovery time from symptoms, physical signs and laboratory parameters in group B was significantly shorter than that in group A (P < 0.05). Cost of hospitalization and length of stay in group B were better than those in group A (P < 0.05). Recovery time of CRP and WBC in group C was significantly shorter than that in group B (P < 0.05). Average daily hospitalization cost was comparable in the three groups.

CONCLUSION: Treatment of SAP with early enteral nutrition and intestinal barrier protective agents can improve nutrition, speed up symptom recovery, shorten length of stay and reduce medical costs.

Treatment of severe acute pancreatitis by different administration route: a comparative analysis

AIM: To compare the efficacy of rude rhubarb in the treatment of severe acute pancreatitis (SAP) by nasogastric or nasojejunal feeding.

METHODS: SAP patients were divided into group A (n = 20) and B (n = 23) randomly. Based on comprehensive treatment, the patients in group A were given rude rhubarb by nasogastric feeding, while those in group B were given rude rhubarb by nasojejunal feeding. The APACHE-Ⅱ score and Balthazar CT score on the 7th and 14th day were observed, and the level of serum C-reactive protein (CRP) and amylase and the intestinal function were also detected.

RESULTS: On day 7, the APACHE-Ⅱ score in group B was significantly lower than that in group A (3.76 ± 2.82 vs 4.58 ± 2.07, P < 0.05), but Balthazar CT score had no marked difference between the two groups (P > 0.05). On day 14, both the APACHE-Ⅱ score and Balthazar CT score were not notably different between group A and B (P > 0.05). The recovery time of CRP and intestinal function had significant differences between group B and A (8.3 ± 1.7 vs 9.1 ± 3.6, P < 0.05; 6.2 ± 2.9 vs 8.5 ± 2.3, P < 0.01).

CONCLUSION: Application of rude rhubarb by nasojejunal feeding can more effectively control the systemic inflammation in SAP and shorten the course of disease.

Expression of epidermal growth factor receptor and cyclooxygenase-2 and their correlations in gastric carcinoma

AIM: To investigate the expression of epidermal growth factor receptor (EGFR) and cyclooxygenase-2 (COX-2) as well as their correlations in gastric carcinoma.

METHODS: Immunohistochemistry was performed to detect the expression of EGFR and COX-2 in 61 cases of gastric cancer and 20 cases of cancer-adjacent tissues, while Western blot was used to examine the protein expression of EGFR and COX-2 in 10 cases of gastric cancer and their corresponding cancer-adjacent tissues.

RESULTS: Immunohistochemistry showed that the expression of EGFR and COX-2 in gastric carcinoma were significantly higher than those in normal mucosa (36.07% vs 0%, χ² = 9.903, P < 0.01; 59.02% vs 25%, χ² = 6.972, P < 0.01). COX-2 expression was correlated with the depth of invasion, lymph node metastasis, TNM classification and pathologic differentiation degree (χ² = 6.333, P < 0.05; χ² = 5.588, P < 0.05; χ² = 8.826, P < 0.01; χ² = 5.653, P < 0.05). EGFR expression was correlated with lymph node metastasis, and TNM classification (χ² = 10.648, P < 0.01; χ² = 4.150, P < 0.05). There was also significant correlation between COX-2 and EGFR expression (r = 0.316, P < 0.05). Western blot also showed that the protein expression of EGFR and COX-2 in gastric carcinoma were significantly higher than those in normal mucosa (35.89 ± 12.50 vs 15.14 ± 2.15, P < 0.01; 51.29 ± 23.42 vs 27.65 ± 7.42, P < 0.05).

CONCLUSION: EGFR and COX-2 are over-expressed in gastric carcinoma, which is associated with the invasion and metastasis of gastric cancer. COX-2 expression is positively correlated with EGFR expression.

Key Words: Gastric cancinoma; Epidermal growth factor receptor; Cyclooxygenase-2; Correlation; Invasion; Metastasis

Role of prostaglandins in pathogenesis of gastrointestinal cancer

There are 2 cyclooxygenase (COX) isoforms commonly referred to COX-1 and COX-2 for the temporal order of their discovery. Although both COX-1 and COX-2 are up-regulated in a variety of circumstances, normally, COX-1 is constitutively expressed in a broad range of cells and tissues. COX-1 expression remains constant under most physiologic or pathologic conditions, and COX-1-derived prostaglandins are considered to play a role in many normal physiologic processes. COX-2, by contrast, is an immediate-early response gene normally absent from most cells but highly inducible in response to inflammatory stimuli, including endotoxin, cytokines, hormones, and tumor promoters. Prostaglandins derived from COX-1 and COX-2 are involved in a variety of physiologic and pathologic processes in the gastrointestinal tract. Recent efforts to identify the molecular mechanisms by which COX-2-derived prostanoids exert their proneoplastic effects have provided a rationale for the possible use of non-steroidal anti-inflammatory drugs alone or in combination with conventional or experimental anticancer agents for the treatment or prevention of gastrointestinal cancers.

Effects of salvia miltiorrhiza injection on coagulation function of decompensated liver cirrhosis

AIM: To evaluate the effect of salvia miltiorrhiza (SM) injection on the coagulation function of patients with decompensated liver cirrhosis.

METHODS: A total of 40 patients with decompensated liver cirrhosis were randomly and averagely divided into SM group and controls group. Besides comprehensive treatment, the patients in SM group also received SM injection for 2 wk. The indexes, including prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and fibrinogen (FIB) level were examined before and after treatment. Moreover, bleeding complication was observed in the two groups.

RESULTS: Before treatment, the values of PT, APTT and TT, and the level of FIB were 17.2 ± 5.9 s, 50.3 ± 5.1 s, 21.5 ± 2.5 s, 1.7 ± 1.2 g/L in control group, and 17.5 ± 5.7 s, 50.1 ± 5.8 s, 21.3 ± 2.7 s, 1.7 ± 1.0 g/L in SM group, respectively. After treatment, the above markers were 15.8 ± 5.0 s, 47.2 ± 5.3 s, 19.2 ± 2.1 s, 1.8 ± 1.3 g/L in control group, and 14.5 ± 4.0 s, 44.2 ± 5.6 s, 17.2 ± 2.4 s, 2.0 ± 1.5 g/L in SM group, respectively. There were significant differences before and after treatment both in control group and SM group (P < 0.05), and furthermore, marked differences also existed between the two groups after treatment (P < 0.05). The incidence rate of bleeding complication was notably lower in SM group than that in control group (25% vs 50%, P < 0.05).

CONCLUSION: SM injection can improve the coagulation function and lower the rate of bleeding complication in patients with decompensated liver cirrhosis.

Effects of prostaglandin E2 on expression of vascular endothelial growth factor in human gastric cancer cell line MKN28

AIM: To investigate the expression of vascular endothelial growth factor (VEGF) in human gastric cell line MKN28 in vitro, and identify whether exogenous prostaglandin E₂ (PGE₂) can increase the expression of VEGF.

METHODS: Human gastric cell line MKN28 was culture in vitro and then treated with 0.1, 1, 5, and 10 μmol/L PGE₂ for 3 h. Real-time polymerase chain reaction (PCR) and Western blot were used to detect the expression of VEGF mRNA and protein, respectively.

RESULTS: The transcription of VEGF mRNA increased in a dose-dependent manner after PGE₂ treatment, and the difference between the groups of 0.1, 1, 5, 10 μmol/L PGE₂ treatment and the control group had statistical significances (0.67 ± 0.093, 0.74 ± 0.13, 0.87 ± 0.07, 1.49 ± 0.15 vs 0.42 ± 0.10, P < 0.05 or P < 0.01). PGE₂ also up-regulated the expression of VEGF protein in a dose-dependent manner, and except 0.1 μmol/L PGE₂ treatment group, the difference between the groups of 1, 5, 10 μmol/L PGE₂ treatment and the control group had statistical significances (51.02 ± 2.16, 66.69 ± 9.85, 136.49 ± 6.89 vs 26.87 ± 3.98, P < 0.05 or P < 0.01).

CONCLUSION: PGE₂ can promote VEGF mRNA transcription and protein expression in human gastric cancer cell line MKN28.

PGE2 up-regulates vascular endothelial growth factor expression in MKN28 gastric cancer cells via epidermal growth factor receptor signaling system

AIM

1) To evaluate the effect of prostaglandin E2 (PGE2) on the regulation of vascular endothelial growth factor (VEGF) expression in gastric MKN28 cells, and 2) to investigate the role of the epidermal growth factor receptor (EGFR) signal transduction pathway in any effect exerted by PGE2 on VEGF expression.

METHODS

MKN28 cells were incubated with the vehicle (control) or with PGE2 in the presence or absence of AG1478, a selective inhibitor of EGFR tyrosine kinase, or PD098059, a selective inhibitor of the kinase responsible for ERK2 phosphorylation (mitogen-activated protein (MAP)/extracellular signal-regulated kinase (ERK)). Real-time quantitative polymerase chain reaction and Western blot analysis were used to evaluate VEGF mRNA and protein expression. The activity of EGFR and ERK2 was measured by Western blot analysis.

RESULTS

PGE2 significantly up-regulated VEGF mRNA and protein expression and increased the activation of EGFR and ERK2. Incubation of MKN28 cells with AG1478 significantly reduced PGE2-induced EGFR activity, ERK2 activity, and VEGF mRNA and protein expression. Meanwhile, incubation of MKN28 with PD098059 reduced PGE2-induced ERK2 activity and VEGF mRNA and protein expression, but had no effect on EGFR activity.

CONCLUSION

Our data suggested that PGE2 up-regulates VEGF expression in gastric cancer cells via transactivation of EGFR-MAPK signaling pathways, which may be mechanisms underlying the contribution of COX-2 to tumor angiogenesis in gastric cancer.

[Effects of heat shock pretreatment on the translocation and expression of alpha B-crystallin in cultured neonatal rat cardiomyocytes]

The effects of heat shock pretreatment on translocation and expression of alpha B-crystallin were evaluated in neonatal rat cardiomyocytes.

RESULTS

1. Western blot analysis demonstrated that cytosolic soluble alpha B-crystallin rapidly translocated to insoluble intracellular structure at 10 or 30 minutes and returned to cytosolic soluble compartment at about 1-2 h after heat shock. 2. Double staining of immunofluorescence showed that alpha B-crystallin redistributed in cytosol after heat shock, while HSC70 translocated from cytosol to nucleus. 3. Quantitative analysis with immunoelectronic microscopy demonstrated alpha B-crystallin translocated to cytoskeletal structure such as Z-line and nuclear envelope after heat shock. 4. Northern-blot showed that heat shock induced alpha B-crystallin mRNA expression. The rapid translocation and increasing expression of alpha B-crystallin after heat shock suggests that this small heat shock protein may play an important protective roles during the early and late phases of myocardial ischemic preconditioning.

5-hydroxylation of omeprazole by human liver microsomal fractions from Chinese populations related to CYP2C19 gene dose and individual ethnicity

It has been previously reported that omeprazole (OP) oxidation is mediated by CYP2C19 and CYP3A4 in human livers. In this study, we assessed their relative contributions with human liver microsomal fractions from Chinese populations that were genotyped by CYP2C19 and recruited from two ethnic groups, Han and Zhuang. The kinetics of 5-hydroxyomeprazole (5-OH-OP) formation was best described by the two-enzyme and single-enzyme Michaelis-Menten equations for liver microsomes from CYP2C19 extensive (EMs) and poor metabolizers, respectively. At a low substrate concentration that may be encountered in vivo, the monoclonal antibody to CYP2C8/9/19 strongly inhibited 5-OH-OP formation in EM microsomes, whereas troleandomycin (TAO) eliminated most of the formation at a high substrate concentration. In poor metabolizer microsomes, either TAO or anti-CYP3A4 could alone abolish 5-OH-OP formation. Furthermore, there were differences between homozygous and heterozygous EMs in the percentage of inhibition by TAO and the antibodies. At the low substrate concentration, OP 5-hydroxyaltion was correlated well with S-mephenytoin 4'-hydroxylation and CYP2C19 contents in liver microsomes of 34 Chinese individuals. Moreover, in these individuals, obviously genetic and somewhat ethnic differences in OP 5-hydroxylation were observed between different CYP2C19 genotypes (wt/wt > wt/m1 > m1/m1) and between Han and Zhuang (Han > Zhuang), respectively. The results indicate that CYP2C19 is a high-affinity enzyme for OP 5-hydroxylation by liver microsomes from Chinese individuals and that its contribution is CYP2C19 gene dependent and ethnically related. Similar studies indicate that OP sulfoxidation is mediated mainly by CYP3A4 and independent of CYP2C19 genotype status.

Probing CYP2C19 and CYP3A4 activities in Chinese liver microsomes by quantification of 5-hydroxyomeprazole and omeprazole sulphone

AIM

To develop an analytical method for simultaneous quantification of 5-hydroxyomeprazole (5-OH-OP) and omeprazole sulfone (OPS), and explore whether omeprazole (OP) is an appropriate phenotypic probe for CYP2C19 and CYP3A4 in Chinese liver microsomes.

METHODS

OP metabolism in vitro was conducted in Chinese liver microsomes, and the major metabolites 5-OH-OP and OPS were determined using high pressure liquid chromatography (HPLC). Monoclonal antibodies anti-CYP2C8/9/19 and anti-CYP3A4 were employed to conduct inhibition experiments. The protein contents of CYP2C19 and CYP3A4 were quantified using Western blot analysis and densitometric scanning.

RESULTS

5-OH-OP and OPS gave a baseline resolution in the HPLC analysis. The detection limits for both compounds were 0.01 nmol and the recovery (98%-102%) had good precision with relative standard deviation of < 9.5%. Both anti-CYP2C8/9/19 and anti-CYP3A4 had a significant inhibitory effect (P < 0.05) on the 5-OH-OP formation in a substrate concentration-dependent manner, and anti-CYP3A4 alone could almost abolish the formation of OPS (> 87%). At a substrate concentration of 2 mumol/L OP, good correlations were found between OP 5-hydroxylation and S-mephenytoin 4'-hydroxylation activities (r = 0.72, P < 0.01), OP 5-hydroxylation activities and CYP2C19 contents (r = 0.82, P < 0.01), and OP sulfoxidation activities and CYP3A4 contents (r = 0.78, P < 0.01) in Chinese liver microsomes.

CONCLUSION

OP metabolism is mediated mainly by CYP2C19 and CYP3A4, and OP can be used to probe CYP2C19 and CYP3A4 activities in Chinese liver microsomes at appropriate substrate concentrations with the HPLC method presently developed.

[Heat shock pretreatment increases alpha B-crystallin expression and protects cardiomyocytes against injury induced by hydrogen peroxide]

The protective effects of heat shock pretreatment against the injury induced by hydrogen peroxide(H2O2) were evaluated in neonatal rat cardiomyocytes. The results showed that heat shock pretreatment significantly reduced cell mortality rate, LDH release rate and increased total antioxidation of the cells. Western blot analysis demonstrated that heat shock pretreatment induced expression of alpha B-crystallin and immunoelectron microscopy demonstrated H2O2-mediated alpha B-crystallin translocation from cytoplasm to nucleus and microfilament in cardiomyocytes. The results suggest that the mechanism of protective effect of heat shock pretreatment might involve the induction and translocation of alpha B-crystallin which then protect cardiomyocytes against H2O2-induced injury by stabilizing cytoskeletal structure and increasing anti-oxidation capacity of the cells.

[The roles of alpha B-crystallin during early phase of myocardial ischemic preconditioning in rats]

OBJECTIVE

This study designed to observe intracellular translocation of alpha B-crystallin, a small heat shock protein, and its possible implication during the early phase of myocardial ischemic preconditioning in isolated Langendorff rat hearts. Eighteen male Wistar rats(180-250 g) were randomly divided into three groups: 1. Control group(Ctrl) was perfused with K-H solution throughout the experiment; 2. ischemia-reperfusion group (I-R) experienced 30 min of global ischemia and 120 min of reperfusion and 3. preconditioning and ischemia-reperfusion group(PC + I-R) was preconditioned with three cycles of short myocardial ischemia(5 min each, separated by 5 min of reperfusion) prior to 30 min of ischemia and 120 min of reperfusion. It was showed that cytosolic soluble alpha B-crystallin rapidly translocated to insoluble intracellular structure after ischemic preconditioning, then gradually returned to soluble cytosol pool and almost completely recovered at about 60 min after preconditioning. In the meanwhile, ischemic preconditioning markedly alleviated subsequent myocardial ischemia-reperfusion injury, as indicated by the improvement of LVP, + dp/dt max, coronary flow, heart rate, CPK release and malondialdehyde(MDA) production. The results suggest that the intracellular translocation of alpha B-crystallin might be important for myocardial protection during the early phase of ischemic preconditioning.