Duodenal neuroendocrine tumor-tertiary care centre experience: A case report

BACKGROUND

Neuroendocrine neoplasms (NENs) are a heterogeneous group of neoplasms arising from neuroendocrine cells, which contribute a small fraction of gastrointestinal malignancies. Duodenal neuroendocrine tumors (dNETs) represent 2% of all gastroenteropancreatic NENs. NENs are heterogeneous in terms of clinical symptoms, location, and prognosis. Non-functional NETs are mostly asymptomatic and need a high degree of clinical suspicion. Diagnosis of NETs is by endoscopic, endosonographic biopsy, and histopathological examination with immunohistochemistry staining for synaptophysin and chromogranin A.

CASE SUMMARY

We present case reports of 5 patients obtained over a period of 10 years in our center with dNETs. One patient had moderately differentiated NET and the remaining four had well-differentiated NET. Surveillance endoscopy was recommended in all the patients and is kept under regular follow-up after performing endoscopic therapy using endoscopic mucosal resection in 4 of them and one patient was advised to undergo a Whipple procedure.

CONCLUSION

Recently, the number of reported cases of NETs has increased due to advancements in diagnostic modalities and prevalence because of longer survival duration. The management differs based on the site, size, proliferation grade, and locally invasive pattern. They are slow-growing tumors with a good overall prognosis. The prognosis correlates with local lymph node status and metastasis.

Photobiomodulation therapy for osteoarthritis: Mechanisms of action

Photobiomodulation (PBM) is a non-invasive therapeutic modality with demonstrated effects in many fields related to regenerative medicine. In the field of orthopedics, in particular, PBM at various wavelengths has demonstrated the capacity to trigger multiple biological effects associated with protective mechanisms in musculoskeletal tissues. The articles cited in this review show that devices operating close to or within the near infrared range at low intensities can provoke responses which favor the shift in the predominant catabolic microenvironment typically seen in degenerative joint diseases, especially osteoarthritis (OA). These responses include proliferation, differentiation and expression of proteins associated with stable cell cycles. Additionally, PBM can also modulate oxidative stress, inflammation and pain by exerting regulatory effects on immune cells and blocking the transmission of pain through sensory neuron fibers, without adverse events. Collectively, these effects are essential in order to control the progression of OA, which is in part attributed to exacerbated inflammation and degradative enzymatic reactions which gradually contribute to the destruction of joint tissues. PBM may offer medical experts ease of application, financial viability, efficacy and lack of serious adverse events. Therefore, it may prove to be a suitable ally in the management of mild to moderate degrees of OA. This review explores and discusses the principal biological mechanisms of PBM and how the produced effects may contribute to the amelioration of osteoarthritic progression. Literature was reviewed using PubMed and Google Scholar in order to find studies describing the mechanisms of PBM. The investigation included a combination of nomenclature such as: “photobiomodulation”, “phototherapy”, “laser therapy”, “PBM”, “osteoarthritis”, low level light therapy”, “inflammation” and “cartilage”. We considered only articles written in English, with access to the full text.

Cell-free mitochondrial DNA quantification in ischemic stroke patients for non-invasive and real-time monitoring of disease status

BACKGROUND

Acute ischemic stroke (AIS) is one of the major causes of the continuous increasing rate of global mortality due to the lack of timely diagnosis, prognosis, and management. This study provides a primitive platform for non-invasive and cost-effective diagnosis and prognosis of patients with AIS using circulating cell-free mitochondrial DNA (cf-mtDNA) quantification and validation.

AIM

To evaluate the role of cf-mtDNA as s non-invasive, and affordable tool for real-time monitoring and prognosticating AIS patients at disease onset and during treatment.

METHODS

This study enrolled 88 participants including 44 patients with AIS and 44 healthy controls with almost similar mean age group at stroke onset, and at 24 h and 72 h of treatment. Peripheral blood samples were collected from each study participant and plasma was separated using centrifugation. The cf-mtDNA concentration was quantified using nanodrop reading and validated through real-time quantitative polymerase chain reaction (RT-qPCR) of NADH-ubiquinone oxidoreductase chain 1 (ND1) relative transcript expression levels.

RESULTS

Comparative analysis of cf-mtDNA concentration in patients at disease onset showed significantly increased levels compared to control individuals for both nanodrop reading, as well as ND1 relative expression levels (P < 0.0001). Intergroup analysis of cf-mtDNA concentration using nanodrop showed significantly reduced levels in patients at 72 h of treatment compared to onset (P < 0.01). However, RT-qPCR analysis showed a significant reduction at 24 h and 72 h of treatment compared to the disease onset (P < 0.001). The sensitivity and specificity were relatively higher for RT-qPCR than nanodrop-based cf-mtDNA quantification. Correlation analysis of both cf-mtDNA concentration as well as ND1 relative expression with National Institute of Health Stroke Scale score at baseline showed a positive trend.

CONCLUSION

In summary, quantitative estimation of highly pure cf-mtDNA provides a simple, highly sensitive and specific, non-invasive, and affordable approach for real-time monitoring and prognosticating AIS patients at onset and during treatment.

Current progress and emerging technologies for generating extrapancreatic functional insulin-producing cells

Diabetes has been one of the major concerns in recent years, due to the increasing rate of morbidity and mortality worldwide. The available treatment strategies for uncontrolled diabetes mellitus (DM) are pancreas or islet transplantation. However, these strategies are limited due to unavailability of quality pancreas/ islet donors, life-long need of immunosuppression, and associated complications. Cell therapy has emerged as a promising alternative options to achieve the clinical benefits in the management of uncontrolled DM. Since the last few years, various sources of cells have been used to convert into insulin-producing β-like cells. These extrapancreatic sources of cells may play a significant role in β-cell turnover and insulin secretion in response to environmental stimuli. Stem/progenitor cells from liver have been proposed as an alternative choice that respond well to glucose stimuli under strong transcriptional control. The liver is one of the largest organs in the human body and has a common endodermal origin with pancreatic lineages. Hence, liver has been proposed as a source of a large number of insulin-producing cells. The merging of nanotechnology and 3D tissue bioengineering has opened a new direction for producing islet-like cells suitable for in vivo transplantation in a cordial microenvironment. This review summarizes extrapancreatic sources for insulin-secreting cells with reference to emerging technologies to fulfill the future clinical need.

Machine intelligence for precision oncology

Despite various advances in cancer research, the incidence and mortality rates of malignant diseases have remained high. Accurate risk assessment, prevention, detection, and treatment of cancer tailored to the individual are major challenges in clinical oncology. Artificial intelligence (AI), a field of applied computer science, has shown promising potential of accelerating evolution of healthcare towards precision oncology. This article focuses on highlights of the application of data-driven machine learning (ML) and deep learning (DL) in translational research for cancer diagnosis, prognosis, treatment, and clinical outcomes. ML-based algorithms in radiological and histological images have been demonstrated to improve detection and diagnosis of cancer. DL-based prediction models in molecular or multi-omics datasets of cancer for biomarkers and targets enable drug discovery and treatment. ML approaches combining radiomics with genomics and other omics data enhance the power of AI in improving diagnosis, prognostication, and treatment of cancer. Ethical and regulatory issues involving patient confidentiality and data security impose certain limitations on practical implementation of ML in clinical oncology. However, the ultimate goal of application of AI in cancer research is to develop and implement multi-modal machine intelligence for improving clinical decision on individualized management of patients.

Inflammation and cardiovascular disease

Cardiovascular disease (CVD) has been associated with the so-called traditional risk factors, such as hypertension, hypercholesterolemia and cigarette smoking. Chronic inflammation, exemplified by elevated high sensitivity C-reactive protein, has been added to these risk factors for CVD as non-traditional risk factor. There are two aspects in this association. The first is whether inflammation plays a pathogenic role in traditional risk factors-mediated CVD or it is just an epiphenomenon. The second is whether chronic inflammation caused by an inflammatory disease has any impact on CVD. Accumulated data have shown that inflammation has a central and inciting role in the development of atherosclerosis leading to increased CVD risk. How inflammation contributes to CVD is a topic of continuous research where mechanisms involving both innate and adaptive immune pathways are involved. Endothelial dysfunction, oxidative stress in vascular endothelial cells, macrophage accumulation, formation of inflammasome, production of tumor necrosis factor (TNF)-a, IL-1 and IL-6 characterize the inflammatory process leading to atherogenesis. Recently clonal hematopoiesis of indeterminate potential represents a surprising and novel mechanism underlying atherogenesis. Data from chronic rheumatic inflammatory diseases exemplify the complexity of mechanisms leading to increased CVD, while they also provide evidence that anti-inflammatory biologic drugs, such as anti-TNF and anti-IL6 agents, could control atherogenesis and ameliorate CVD risk. Recent groundbreaking work using biologic anti-IL-1b therapy to treat men and women who have had a prior heart attack provides the best proof of the pathogenic contribution of inflammation in the development of CVD.

More than boric acid: Increasing relevance of boron in medicine

Although boron has been a chemical element of interest since the ancient times, only a few boron-containing compounds (BCCs) had been used for medicinal purposes before the 21^st century. Among these, only boric acid has been explored in multiple therapeutic applications. Hence, it is common to extrapolate from boric acid to all BCCs, supposing a similar biological effect. However, boric acid is just one of dozens of BCCs in nature and thousands available from chemical synthesis. Nowadays, there is a boom in research on new BCCs as potential tools in the prevention, diagnosis and therapy of human disease. We herein discuss the new role of BCCs in drug development, with emphasis on the compounds for which a mechanism of action has been proposed or demonstrated. Because of data gathered in recent years, BCCs have expanded beyond the well-known fields of antimicrobial and antineoplastic agents, now being explored for their possible use as enzyme inhibitors, regulators of protein expression and modulators of the immune response, as well as in biomaterials. We suggest that translational medicine can accelerate the medicinal applications of BCCs, which is especially important for the human diseases that are generating a high global burden.

Scope of translational medicine in developing boron-containing compounds for therapeutics

The ubiquitousness of naturally occurring boron-containing compounds (BCCs) has led to their constant contact with humankind. Recently, many synthetic BCCs have been elaborated for a broad spectrum of purposes, especially boric, boronic and borinic acids. Although BCCs were once employed primarily as antiseptics and later as antibiotics, they have become an increasingly relevant therapeutic tool. Nevertheless, this potential of BCCs has been drastically limited due to some unfortunate intra-hospital accidents in the 1940s and 1950s. The increasing use of BCCs as insecticides, antimicrobials, and other agents is providing new insights into their role in the physiology of several living species and in the pathophysiology of humans. It is becoming clear that BCCs act through a wide range of mechanisms, as do their corresponding boron-free counterparts. When comparing BCCs and similar boron-free compounds, in many cases the former show advantages in the medical field. The current mini-review focuses on how BCCs have been developed by means of translational medicine, a process connecting biomedical research with clinical applications. This process of discovery is currently in an exponential stage.

Sphingolipid metabolism affects the anticancer effect of cisplatin

Cisplatin, a DNA crosslinking agent, is widely used for the treatment of a variety of solid tumors. Numerous studies have demonstrated that sphingolipid metabolism, which acts as a target for cisplatin treatment, is a highly complex network that consists of sphingolipid signaling molecules and related catalytic enzymes. Ceramide (Cer), which is the central molecule of this network, has been established to induce apoptosis. However, another molecule, sphingosine-1-phosphate (S1P), exerts the opposite function, i.e., serves as a regulator of pro-survival. Other sphingolipid molecules, including dihydroceramide, ceramide-1-phosphate, glucosylceramide (GluCer), and sphingosine (Sph), or sphingolipid catalytic enzymes such as Sph kinase (SphK), Cer synthase (CerS), and S1P lyase, have also attracted considerable attention, particularly Cer, GluCer, SphK, CerS, and S1P lyase, which have been implicated in cisplatin resistance. This review summarizes specific molecules involved in sphingolipid metabolism and related catalytic enzymes affecting the anticancer effect of cisplatin, particularly in relation to induction of apoptosis and drug resistance.

Potential therapeutic targets from genetic and epigenetic approaches for asthma

Asthma is a complex disorder characterised by inflammation of airway and symptoms of wheeze and shortness of breath. Allergic asthma, atopic dermatitis and allergic rhinitis are immunoglobulin E (IgE) related diseases. Current therapies targeting asthma rely on non-specific medication to control airway inflammation and prevent symptoms. Severe asthma remains difficult to treat. Genetic and genomic approaches of asthma and IgE identified many novel loci underling the disease pathophysiology. Recent epigenetic approaches also revealed the insights of DNA methylation and chromatin modification on histones in asthma and IgE. More than 30 microRNAs have been identified to have regulating roles in asthma. Understanding the pathways of the novel genetic loci and epigenetic elements in asthma and IgE will provide new therapeutic means for clinical management of the disease in future.

Gene editing for corneal disease management

Gene editing has recently emerged as a promising technology to engineer genetic modifications precisely in the genome to achieve long-term relief from corneal disorders. Recent advances in the molecular biology leading to the development of Clustered Regularly Interspaced Short Palindromic Repeats (CRISPRs) and CRISPR-associated systems, zinc finger nucleases and transcription activator like effector nucleases have ushered in a new era for high throughput in vitro and in vivo genome engineering. Genome editing can be successfully used to decipher complex molecular mechanisms underlying disease pathophysiology, develop innovative next generation gene therapy, stem cell-based regenerative therapy, and personalized medicine for corneal and other ocular diseases. In this review we describe latest developments in the field of genome editing, current challenges, and future prospects for the development of personalized gene-based medicine for corneal diseases. The gene editing approach is expected to revolutionize current diagnostic and treatment practices for curing blindness.

Prednisolone inhibits SaOS2 osteosarcoma cell proliferation by activating inducible nitric oxide synthase

AIM: To investigate the effect of prednisolone, a synthetic glucocorticoid used in inflammatory diseases, on the growth of cultured osteosarcoma cells.

METHODS: Two osteosarcoma cell lines with different degree of differentiation were used. SaOS2 show a rather mature phenotype, while U2OS are negative for almost all osteoblastic markers. The cells were exposed to different concentrations of prednisolone (1-9 μmol/L) with or without antioxidants or the inhibitor of inducible nitric oxide synthase (iNOS) l-N⁶-(iminoethyl)-lysine-HCl (L-NIL). Cell growth was assessed by counting viable cells. The production of nitric oxide (NO) was measured in the conditioned media by the Griess method. The production of reactive oxygen species was quantified using 2’-7’-dichlorofluorescein diacetate. Western blot with specific antibodies against NOSs was performed on cell extracts.

RESULTS: Prednisolone inhibited SaOS2 cell growth in a dose dependent manner. No significant effects were observed in U2OS. The inhibition of SaOS2 growth is not due to oxidative stress, because antioxidants do not rescue cell proliferation. Since high concentrations of NO inhibit bone formation, we also measured NO and found it induced in SaOS2, but not in U2OS, exposed to prednisolone, because of the upregulation of iNOS as detected by western blot. Therefore, we treated SaOS2 with prednisolone in the presence or in the absence of L-NIL. L-NIL prevented NO release induced by prednisolone at all the concentrations apart from 9 μmol/L. At the same concentrations, we found that L-NIL rescued SaOS2 growth after exposure to prednisolone. In U2OS cells, prednisolone did not induce NO production nor affected cell growth. All together, these data indicate that a link exists between increased amounts of NO and growth inhibition in response to prednisolone in SaOS2.

CONCLUSION: Prednisolone inhibited SaOS2 proliferation by increasing the release of NO through the upregulation of iNOS, while no effect was exerted on U2OS.

Naked DNA in cells: An inducer of major histocompatibility complex molecules to evoke autoimmune responses?

The major histocompatibility complex (MHC) is the exclusive chaperone that presents intracellular antigens, either self or foreign to T cells. Interestingly, aberrant expression of MHC molecules has been reported in various autoimmune target tissues such as thyroid follicular cells in Grave’s disease. Herein, we review the discovery of an unexpected effect of cytosolic double-stranded DNA (dsDNA), despite its origins, to induce antigen processing and presenting genes, including MHC molecules, in non-immune cells. Moreover, we highlight several recent studies that suggest cell injury endows thyroid epithelial cells with a phenotype of mature antigen presenting cells by inducing multiple antigen processing and presenting genes via releasing genomic DNA fragments into the cytosol. We discuss the possibility that such cytosolic dsDNA, in naked form without binding to histone proteins, might be involved in the development of cell damage-triggered autoimmune responses. We also discuss the possible molecular mechanism by which cytosolic dsDNA can induce MHC molecules. It is reasonable to speculate that cytosolic dsDNA-induced MHC class I is partially due to an autocrine/paracrine effect of type I interferon (IFN). While the mechanism of cytosolic dsDNA-induced MHC class II expression appears, at least partially, distinct from that mediated by IFN-γ. Further in-depth are required to clarify this picture.

New insights in sperm biology: How benchside results in the search for molecular markers may help understand male infertility

The male factor is responsible for about 40% of couple infertility cases and such percentage is expected to increase in the future because of several likely factors including the presence of endocrine disruptors in the environment, changes in lifestyle habits and advanced couple aging. How such factors affect male fertility status, however, should be clarified. Most studies on male fertility status have focused on parameters analyzed using a spermiogram test, the primary diagnostic tool in the routine assessment of male infertility, which is, however, poorly predictive of both natural and medically assisted conception. For these reasons it is mandatory for the scientific community to identify new molecular markers to incorporate into the existing diagnostic tests of male fertility. Ideally, such markers would be detected in mature spermatozoa to avoid invasive procedures for the patient. This review summarizes the recent advancements in benchside approaches that appear most promising for the development of new diagnostic sperm fertility tests, or identification of therapeutic targets, and, illustrates their advantages and limits.

Role of nestin in glioma invasion

AIM: To determine the role for the intermediate filament protein nestin in glioma invasion.

METHODS: We examined the expression and function of nestin in gliomas (Grades II-IV as defined by the World Health Organization). We determined nestin expression using Immunohistochemical methods. To elucidate nestin’s biological function(s), we reduced mRNA levels by 61% and 87% in two glioblastoma-derived neurosphere lines using short hairpin RNAs and determined the effect of reduced nestin expression on glioma cell proliferation and invasion using MTS and matrigel migration assays, respectively. We also utilized quantitative real time polymerase chain reaction assays to determine the effect of reduced nestin expression on the expression of other markers associated with glioma stem cells and their differentiated progenies.

RESULTS: We found a significant correlation between nestin immunoreactivity and astrocytoma tumor grade, with 36% of grade II, 75% of grade III, and 100% of grade IV tumors expressing significant levels of the protein when assessed using immunohistochemistry. Reduction in nestin expression had no effect on cell growth in culture, but did retard the capacity of one line to migrate in-vitro on matrigel. Interestingly, in the line whose migration was not affected, mRNA levels of a second intermediate filament, synemin (also knowns as desmuslin), were elevated following introduction of shRNA targeting nestin. As synemin was not induced in the line which required nestin for migration, it is a possibility that synemin may compensate for the loss of nestin in this process.

CONCLUSION: Nestin expression is prominent in high-grade astrocytomas. Nestin is not required for cell growth but it may, however, be required for cell motility.

Contributions of neutrophils to the adaptive immune response in autoimmune disease

Neutrophils are granulocytic cytotoxic leukocytes of the innate immune system that activate during acute inflammation. Neutrophils can also persist beyond the acute phase of inflammation to impact the adaptive immune response during chronic inflammation. In the context of the autoimmune disease, neutrophils modulating T and B cell functions by producing cytokines and chemokines, forming neutrophil extracellular traps, and acting as or priming antigen presentation cells. Thus, neutrophils are actively involved in chronic inflammation and tissue damage in autoimmune disease. Using rheumatoid arthritis as an example, this review focuses on functions of neutrophils in adaptive immunity and the therapeutic potential of these cells in the treatment of autoimmune disease and chronic inflammation.

Pro- vs anti-stenotic capacities of type-I vs type-II human induced pluripotent-derived endothelial cells

AIM: To verify in vivo relevance of the categorization of human vascular endothelial cells (VECs) into type-I (pro-proliferative) and type-II (anti-proliferative).

METHODS: Endothelial layers of murine femoral arteries were removed by wire injury (WI) operation, a common technique to induce arteriostenosis. Type-I and type-II VECs produced from human induced pluripotent stem cells (iPSCs), whose characters were previously determined by their effects on the proliferation of vascular smooth muscle cells in in vitro co-culture experiments, were mixed with Matrigel^® Matrix. The mixtures were injected into subcutaneous spaces around WI-operated femoral arteries for the transplanted human iPSC-derived VECs (iPSdECs) to take a route to the luminal surface via vasa vasorum, a nutrient microvessel for larger arteries. Histologies of the femoral arteries were examined over time. The presence of human iPSdECs was checked by immunostaining studies using an antibody that specifically recognizes human VECs. Degrees of stenosis of the femoral arteries were calculated after three weeks. To determine the optimal experimental condition, xenotransplantation experiments were performed under various conditions using immunocompromised mice as well as immunocompetent mice with or without administration of immunosuppressants.

RESULTS: Because immunocompromised mice showed unexpected resistance to WI-induced arteriostenosis, we performed xenotransplantation experiments using immunocompetent mice along with immunosuppressant administrations. After one week, luminal surfaces of the WI-operated arteries were completely covered by human iPSdECs, showing the efficacy of our novel transplantation technique. After three weeks, type-I-iPSdECs-transplanted arteries underwent total stenosis, while type-II-iPSdECs-transplanted arteries remained intact. However, untransplanted arteries of immunosuppressant-treated mice also remained intact by unknown reasons. We found that transplanted human VECs had already been replaced by murine endothelial cells by this time, indicating that a transient existence of human type-II-iPSdECs on arterial luminal surfaces can sufficiently prevent the development of stenosis. Thus, we re-performed xenotransplantation experiments using immunocompetent mice without administrating immunosuppressants and found that arteriostenosis was accelerated or prevented by transplantation of type-I or type-II iPSdECs, respectively. Similar results were obtained from the experiments using human embryonic stem cell-derived VECs at early passages (i.e., type-II) and late passages (i.e., type-I).

CONCLUSION: Pro- and anti-stenosis capacities of type-I and type-II human iPSdECs were verified, respectively, promising a therapeutic application of allogenic iPSdECs.

p38 mitogen-activated protein kinase regulates type-I vs type-II phenotyping of human vascular endothelial cells

AIM: To identify kinases involved in phenotype regulation of vascular endothelial cells (VECs): Pro-proliferative G-protein signaling 5 (RGS5)^high (type-I) vs anti-proliferative RGS5^low (type-II) VECs.

METHODS: Proteomic kinase assays were performed to identify the crucial kinase involved in the phenotype regulation of human VECs using type-I VECs, which promotes the proliferation of human vascular smooth muscle cells (VSMCs), and type-II VECs, which suppress the proliferation of human VSMCs. The assays were performed using multiple pairs of type-I and type-II VECs to obtain the least number of candidates. The involvement of the candidate kinases was verified by evaluating the effects of their specific inhibitors on the phenotype regulation of human VECs as well as the expression levels of regulator of RGS5, which is the causative gene for the “type-II to type-I” phenotype conversion of human VECs.

RESULTS: p38α mitogen-activated protein kinase (p38α MAPK) was the only kinase that showed distinctive activities between type-I and type-II VECs: p38α MAPK activities were low and high in type-I and type-II VECs, respectively. We found that an enforced expression of RGS5 indeed lowered p38α MAPK activities in type-II VECs. Furthermore, treatments with a p38α MAPK inhibitor nullified the anti-proliferative potential in type-II VECs. Interestingly, MAPK inhibitor treatments enhanced the induction of RGS5 gene. Thus, there is a vicious cycle between “RGS5 induction” and “p38α MAPK inhibition”, which can explain the unidirectional process in the stress-induced “type-II to type-I” conversions of human VECs. To understand the upstream signaling of RGS5, which is known as an inhibitory molecule against the G protein-coupled receptor (GPCR)-mediated signaling, we examined the effects of RGS5 overexpression on the signaling events from sphingosine-1-phosphate (S1P) to N-cadherin, because S1P receptors belong to the GPCR family gene and N-cadherin, one of their downstream effectors, is reportedly involved in the regulation of VEC-VSMC interactions. We found that RGS5 specifically bound with S1P₁. Moreover, N-cadherin localization at intercellular junctions in type-II VECs was abolished by “RGS5 overexpression” and “p38α MAPK inhibition”.

CONCLUSION: p38α MAPK plays crucial roles in “type-I vs type-II” phenotype regulations of human VECs at the downstream of RGS5.

Targeting apoptosis is the major battle field for killing cancers

Targeting apoptosis is one of the major strategies for cancer therapy. Essentially, most of the conventional cancer therapeutic drugs that are in the clinical use induce apoptosis and in part necrosis of malignant cells and therefore prevent cancer progression and metastasis. Although these cytotoxic anticancer drugs are important weapons for killing cancers, their toxic side effects limited their application. The molecularly targeted therapeutics that are based on the deeper understanding of the defects in the apoptotic signaling in cancers are emerging and have shown promising anticancer activity in selectively killing cancers but not normal cells. The examples of molecular targets that are under exploration for cancer therapy include the cell surface receptors such as TNFR family death receptors, the intrinsic Bcl-2 family members and some other intracellular molecules like p53, MDM2, IAP, and Smac. The advance in the high-throughput bio-technologies has greatly accelerated the progress of cancer drug discovery.

New categorization of human vascular endothelial cells by pro- vs anti-proliferative phenotypes

AIM: To integrally understand the effects of human vascular endothelial cells (VECs) on the proliferation of vascular smooth muscle cells (VSMCs).

METHODS: Various kinds of human VECs of different origins were co-cultured with human aortic smooth muscle cells, a representative of human VSMCs. To exclude the irrelevant effects due to growth competition between VECs and VSMCs, the proliferation of VECs had previously been arrested via a low-dose gamma ray irradiation. To discriminately analyze the proliferation of VSMCs from that of VECs, the former cells were labeled with red fluorescent dye while the latter cells were labeled with green fluorescent dye before performing co-culture experiments. After 4 d, total cells were harvested and subjected to flow cytometric analyses. Decrements in red fluorescence intensities due to proliferation-mediated dilutions were measured and mathematically processed using a specific software to quantitatively evaluate the proliferation of VSMCs. The findings obtained from the flow cytometry-based analyses were further validated by microscopic observations.

RESULTS: Commercially available primary cultured human VECs exclusively promoted VSMC proliferation regardless of their tissue origins and we termed these pro-proliferative VECs as “type-I”. By contrast, VECs freshly generated from human bone marrow-derived endothelial progenitors cells or human pluripotent stem cells including embryonic stem cells and induced pluripotent stem cells suppressed VSMC proliferation and we termed these anti-proliferative VECs as “type-II”. Repetitive subcultures as well as oxidative stress induced “type-II VECs to type-I” conversion along with an induction of Regulator of G-protein signaling 5 (RGS5). Compatibly, anti-oxidant treatments suppressed both the subculture-dependent “type-II to type-I” conversion and an induction of RGS5 gene. Immunostaining studies of clinical specimens indicated that RGS5 protein expressions in endothelial layers were low in normal arteries but they were up-regulated in pathological arteries including hypertension, atherosclerosis and autoimmune vasculitis in a dose-dependent manner. Overexpression and knockdown of RGS5 caused that “type-II to type-I” and “type-I to type-II” phenotype conversions of VECs, respectively.

CONCLUSION: Human VECs are categorized into two types: pro-proliferative RGS5^high VECs (type-I) and anti-proliferative RGS5^low VECs (type-II).

Nutritional determinants of anemia among adults in Eastern China

Historically, Eastern China has the highest prevalence of anemia among adults in China. It is commonly believed that iron deficiency is the main cause of anemia in China. Iron fortified soysauce is used to prevent anemia. Findings from Jiangsu Nutrition Study suggest that diet is related to anemia in this region. However, iron deficiency is not the main cause. Micronutrients other than iron (e.g., riboflavin) need to be considered in the prevention of anemia in the region.

Component-resolved allergen testing: The new frontier

The discovery that allergen specific IgE (sIgE) identified individuals who were allergic to specific allergens, revolutionized allergy and immunology. Recently, component-resolved allergen testing (CRD) has shown promise in improving the field yet again. Prior to development of CRD immunoassays, whole allergen extracts were used to detect IgE mediated allergic disease either by oral, cutaneous, or conjunctival provocation. The most widely used immunoassays detect sIgE to either whole allergen sources or individual allergic components. The use of CRD micro-assay technology (not Food and Drug Administration approved in the United States) has been used to evaluate multiple allergens in parallel. This technique allows for determination of primary vs secondary sensitizations from either close sequence homology or cross-reactive carbohydrate determinants. Published studies have shown beneficial uses in hymenoptera venom immunotherapy, anaphylaxis, and food allergy. The use of component testing for aeroallergen immunotherapy has been studied, however clinical use is hampered by lack of allergen components approved for injection. Therefore, although promising in many respects, the frontier of CRD testing requires more data before it can be widely used in clinical practice.

Translating laboratory anti-aging biotechnology into applied clinical practice: Problems and obstacles

Although the use of biomedical technologies against ageing (rejuvenation biotechnologies) is considered by many as an effective way of controlling all age-related degeneration, in reality this belief cannot be justified. The human body is notoriously resistant to external perturbations and can respond in unpredictable or undesirable ways. Basic concepts of science, evolution and disease must also be considered. In this paper, I discuss some relevant problems associated with the application of any putative rejuvenation biotechnologies such as stem cell therapies, genetic engineering, tissue manipulation, as well as pharmacological approaches. I conclude that these and other biotechnologies will not be applicable to humans in the community. This is due to a wide spectrum of problems and obstacles, such as unpredictable therapeutic results, unrealistic expectations, lack of infrastructure, cellular network disruption, and many more. Even if some such technologies are developed, the totality of the problems, issues and side effects will prove an insurmountable final hurdle, rendering the development of such therapies, essentially and practically useless.

Beyond the bedside: A review of translational medicine in global health

Translational research is a broad field of medicine with several key phases moving from scientific discovery to bench research and the hospital bedside, followed by evidence-based practice and population-level policy and programming. Understanding these phases is crucial when it comes to preventing and treating illness, especially in global health. Communities around the world struggle with a variety of health problems that are at some times similar and at others quite different. Three major world health issues help to outline the phases of translational research: vaccines, human immunodeficiency virus and acquired immunodeficiency syndrome, and non-communicable diseases. Laboratory research has excelled in many of these areas and is struggling in a few. Where successful therapies have been discovered there are often problems with appropriate use or dissemination to groups in need. Also, many diseases would be better prevented from a population health approach. This review highlights successes and struggles in the arena of global health, from smallpox eradication to the impending epidemic of cardiovascular disease, in an attempt to illustrate of the various phases of translational research.

Therapeutic targets in gastrointestinal stromal tumors

Gastrointestinal stromal tumors (GISTs) are the most common type of mesenchymal tumor of the gastrointestinal tract. The tumorigenesis of GISTs is driven by gain-of-function mutations in KIT or platelet-derived growth factor receptor α (PDGFRA), resulting in constitutive activation of the tyrosine kinase and its downstream signaling pathways. Oncogenic KIT or PDGFRA mutations are compelling therapeutic targets for the treatment of GISTs, and the KIT/PDGFRA inhibitor imatinib is the standard of care for patients with metastatic GISTs. However, most GIST patients develop clinical resistance to imatinib and other tyrosine kinase inhibitors. Five mechanisms of resistance have been characterized: (1) acquisition of a secondary point mutation in KIT or PDGFRA; (2) genomic amplification of KIT; (3) activation of an alternative receptor tyrosine kinase; (4) loss of KIT oncoprotein expression; and (5) wild-type GIST. Currently, sunitinib is used as a second-line treatment for patients after imatinib failure, and regorafenib has been approved for patients whose disease is progressing on both imatinib and sunitinib. Phase II/III trials are currently in progress to evaluate novel inhibitors and immunotherapies targeting KIT, its downstream effectors such as phosphatidylinositol 3-kinase, protein kinase B and mammalian target of rapamycin, heat shock protein 90, and histone deacetylase inhibitor. Other candidate targets have been identified, including ETV1, AXL, insulin-like growth factor 1 receptor, KRAS, FAS receptor, protein kinase c theta, ANO1 (DOG1), CDC37, and aurora kinase A. These candidates warrant clinical evaluation as novel therapeutic targets in GIST.