[Efficacy and safety analysis of a combination regimen with BCL-2 inhibitor in relapsed/refractory primary systemic light chain amyloidosis with t(11;14) from a single center]

Objective: To explore the efficacy and safety of BCL-2 inhibitor-based treatment in patients with relapsed/refractory t (11; 14) primary systemic light chain amyloidosis. Methods: This was a retrospective case series study. Ten patients with relapsed/refractory t(11;14) primary systemic light chain amyloidosis who had all received treatment with a combination regimen including the BCL-2 inhibitor venetoclax from January 2018 to November 2022 at the Hematology Department of Peking University People's Hospital were included. Adverse events, and hematological and organ responses were evaluated. Results: The median age of the ten enrolled patients was 59 (range 41-78) years, and the male to female ratio was 8∶2. Except for one patient, a very good partial or better response was achieved in 8/9 patients and one patient obtained a partial response. The overall response rate was 100%. The median time to achieve a hematological response was 60 (range 24-236) days. At least one organ response was observed in 7/9 patients. With a median follow-up of 18 months, one patient experienced hematological progression and one patient died. Grade 3 adverse events included lymphocytopenia (3 cases), anemia (1 case), diarrhea (1 case), and appendicitis (1 case). One patient died of pulmonary fungal infection two months after completion of treatment, which was not excluded as being treatment related. Conclusion: A combination regimen including BCL-2 inhibitors in patients with relapsed/refractory t(11;14) primary systemic light chain amyloidosis is a potentially safe and effective treatment option that warrants further investigation.

Nanoarray Enabled Size-Dependent Isolation and Proteomics Profiling of Small Extracellular Vesicle Subpopulations toward Accurate Cancer Diagnosis and Prognosis

Small extracellular vesicles (sEVs) have emerged as noninvasive biomarkers in liquid biopsy due to their significant function in pathology and physiology. However, the phenotypic heterogeneity of sEVs presents a significant challenge to their study and has significant implications for their applications in liquid biopsies. In this study, anodic aluminum oxide films with different pore sizes (AAO nanoarray) were introduced to enable size-based isolation and downstream proteomics profiling of sEV subpopulations. The adjustable pore size and abundant Al3+ on the framework of AAOs allowed size-dependent isolation of sEV subpopulations through nanoconfined effects and Lewis acid-base interaction between AAOs and sEVs. Benefiting from the strong concerted effect, the simple AAO nanoarray enabled specific isolation of three sEV subpopulations, termed "50", "90", and "150 nm" groups, from 10 μL of complex biological samples within 10 min with high capture efficiencies and purities. Moreover, the nanopores of AAOs also acted as nanoreactors for comprehensive proteomic profiling of the captured sEV subpopulations to reveal their heterogeneity. The AAO nanoarray was first investigated on sEVs from a cell culture medium, where sEV subpopulations could be clearly distinguished, and three traditional sEV-specific proteins (CD81, CD9, and FLOT1) could be identified by proteomic analysis. A total of 3946, 3951, and 3940 proteins were identified from 50, 90, and 150 nm sEV subpopulations, respectively, which is almost twice the number compared to those obtained from the conventional approach. The concept was further applied to complex real-case sample analysis from prostate cancer patients. Machine learning and gene ontology (GO) information analysis of the identified proteins indicate that different-sized sEV subpopulations contain unique protein cargos and have distinct cellular components and molecular functions. Further receiver operating characteristic curve (ROC) analysis of the top five differential proteins from the three sEV subpopulations demonstrated the high accuracy of the proposed approach toward prostate cancer diagnosis (AUC > 0.99). More importantly, several proteins involved in focal adhesion and antigen processing and presentation pathways were found to be upregulated in prostate cancer patients, which may serve as potential biomarkers of prostate cancer. These results suggest that the sEV subpopulation-based AAO nanoarray is of great value in facilitating the early diagnosis and prognosis of cancer and opens a new avenue for sEVs in liquid biopsy.

Overcoming Radio-Immunotherapy Treatment Resistance through ILT4 Blockade and Reversal of HFRT Induced CXCL1-CXCR2 Axis Activation and Tumor-Associated Macrophage Immunosuppression

PURPOSE/OBJECTIVE(S)

Immunotherapy combined with radiotherapy (iRT) has unlimited potential, but up to 60% of cancer patients do not benefit from it. Enhancing the anti-tumor immune stimulatory effect triggered by radiotherapy is the key to overcome iRT resistance. Immunoglobulin-like transcript (ILT) 4 is a potential immune checkpoint molecule, highly expressed in various tumor cells, but its role in radiotherapy is still unknown. This study confirmed the role and molecular mechanism of ILT4 in suppressing radiotherapy immunosuppressive microenvironment formation and promoting tumor radiotherapy resistance. We propose a new therapeutic strategy that block ILT4 to enhance the efficacy of radiotherapy, and cooperate with radiotherapy to reverse immunotherapy resistance.

MATERIALS/METHODS

Using multiplex immunohistochemistry, we analyzed ILT4 expression, tumor-associated macrophage (TAM) /T cell phenotype and quantity in tumor patient treated with SBRT. Using mice subcutaneous tumor models, Single-cell RNA sequencing and multiplex flowcytometry, we assessed the role of ILT4 inhibition and hyper-fractionated radiotherapy (HFRT) on preventing tumor growth and immune escape. The molecular signaling and cytokines regulated by ILT4 under HFRT were analyzed by transcriptome sequencing and further verified by molecular experiments. By establishing cancer cell/TAM co-culture system in vitro, using CXCL1 protein or CXCR2 inhibitor and macrophage/CD8+ T cell deletion antibody in vivo, we identified the downstream pathway and cytokine of ILT4 to enhancing HFRT -induced TAM immune response.

RESULTS

In the tumor specimens of NSCLC patients treated with SBRT, we found that high ILT4 expression predicted poor progression-free survival and more M2-TAM recruitment. Among the C57BL/6 mice model, ILT4 inhibition in cancer cells reduced HFRT mediated M2-TAMs accumulation, and to sustain activation and proliferation of CD8+ T cells, and eventually suppressed tumor progression. Mechanistically, RT promoted ILT4 expression, which subsequently induced NF-κB pathway activation and CXCL1 secretion to enhance M2-TAMs migration in vitro. Using CXCL1 protein or CXCR2 inhibitor administration, inferring that ILT4 promotes TAMs migration via NF-κB-CXCL1-CXCR2 axis. Consistently, depletion of TAMs blocked the T cell function impairment and radiotherapy resistance induced by ILT4 in vivo. Importantly, targeting ILT4 potentiated the effect of radiotherapy, overcomes radio-immunotherapy treatment resistance.

CONCLUSION

ILT4 mediates HFRT-induced M2-like TAMs recruitment and subsequently T cell response impairment by regulating NF-κB-CXCL1-CXCR2 axis. ILT4 is an attractive drug target for enhancing radiotherapy and overcomes radio-immunotherapy treatment resistance.

RUNX1 as a Potential Target for Combined Radioimmunotherapy of Lung Adenocarcinoma

PURPOSE/OBJECTIVE(S)

Radioimmunotherapy for non-small cell lung cancer has good clinical application prospects. The role and mechanism of RUNX1 in DNA damage repair were explored for its potential role in lung adenocarcinoma radioimmunotherapy.

MATERIALS/METHODS

To study the effect of RUNX1 expression level on the expression of DNA damage repair system related factors and radiation sensitivity of lung adenocarcinoma cells. As an important nuclear transcription factor, RUNX1 was explored whether directly regulating the expression of Nrf2, Rad51, BRCA1, and verifying their respective DNA binding sites in the promoter region through relevant databases. To observe the effect of RUNX1 knockout and overexpression on the expression level of PD-L1 in tumor cells at the cell level; The effect of RUNX1 expression level on the sorting and presentation of PD-L1 cells was investigated by the method of nucleocytoplasmic separation. According to literature reports, CMTM6 and ALIX play a key role in the process of PD-L1 cell sorting and presentation, and explore whether RUNX1 plays a role through this factor. The effect of phosphorylation level of different splicing bodies of RUNX1 (RUNX1a/b/c) on the expression level and DNA damage repair system related factors on tumor radiosensitivity were also explored.

RESULTS

According to TCGA database, RUNX1 is highly expressed and phosphorylated in lung adenocarcinoma. Through gene comparison with the database, it was found that RUNX1 binding sites existed in the promoter region of several factors related to this study, including ALIX, Nrf2, BRCA1, RAD51, ATM, H2AX, etc. After being activated by MAPKp38 phosphorylation, RUNX1a can positively regulate Nrf2 signal pathway. The expression of RUNX1 and p-RUNX1 is time-dependent on ionizing radiation. At the same time, it was found that the expression of RUNX1 and p-RUNX1 was dose-dependent on ionizing radiation, and the expression trend of Nrf2 signal pathway related factors was consistent with RUNX1. RUNX1 regulates the expression of PD-L1, BRCA1, ALIX and Nrf2. Bioinformatics analysis and flow cytometry data show that RUNX1 has inhibitory effect on tumor microenvironment of lung adenocarcinoma.

CONCLUSION

RUNX1 regulates DNA damage repair system and has inhibitory effect on tumor immunity. Inhibiting the expression of RUNX1 in lung adenocarcinoma cells can enhance the effect of radioimmunotherapy.

IKBKE Promotes Radioresistance of Glioblastoma through AKT/FOXO3a Pathway

PURPOSE/OBJECTIVE(S)

Glioblastoma is an intracranial highly malignant primary tumor, and postoperative radiotherapy is a common treatment of glioblastoma. While radiotherapy resistance of glioblastoma is an important reason for treatment failure. IKBKE is overexpressed in gliomas, but its role in radiotherapy is unknown. This study confirmed that IKBKE can directly phosphorylate AKT protein to regulate FOXO3a, thus promoting the radioresistance of glioblastoma, and proposed a new therapeutic strategy to enhance the efficacy of radiotherapy.

MATERIALS/METHODS

We used flow cytometry, tunel staining, plate cloning, a cell counting kit and WB to confirm the effects of IKBKE and FOXO3a on radioresistance of glioblastoma, and immunofluorescence and WB were used to detect the expression of γ-H2AX. Subcutaneous tumor formation in mice and immunohistochemical staining was performed. IP combined with mass spectrometry, immunofluorescence, endogenous and exogenous IP were used to confirm the interaction between IKBKE and AKT. Point mutation, IP and WB were used to confirm the phosphorylation site of AKT. IP and some small molecule inhibitors were used to confirm the relationship between IKBKE, AKT and PI3K. The effect of IKBKE on FOXO3a was confirmed by WB and qPCR. The protein relationship among IKBKE, FOXO3a and 14-3-3 was confirmed by CHX, MG132, ubiquitin test, immunofluorescence and IP. The above experiments were carried out to verify the effect of Amlexanox, an IKBKE inhibitor, on glioblastoma. And its pharmacokinetics in the brain was determined by LC-MS to provide a theoretical basis for further clinical use.

RESULTS

It was found that IKBKE could increase the radioresistance of glioblastoma in vitro and in vivo. IKBKE could directly phosphorylate AKT, and its phosphorylation sites were Ser473 and Thr308. We also certified that IKBKE activated AKT independent of PI3K. IKBKE inhibited the expression of FOXO3a on protein level, promoted its ubiquitin degradation, enhanced its interaction with 14-3-3, and inhibited its transportation into the nucleus. FOXO3a can increase the radiosensitivity of glioblastoma. Amlexanox, an IKBKE inhibitor, can inhibit the radiosensitivity of glioblastoma and partially pass through the blood-brain barrier to enhance the radiosensitivity of intracranial tumors.

CONCLUSION

IKBKE can activate AKT independent of PI3K by directly phosphorylating AKT Ser473 and Thr308, thus increasing the phosphorylation of FOXO3a. Phosphorylated FOXO3a promoted its ubiquitin degradation, and inhibited its transportation into the nucleus, causing radioresistance in glioblastoma. IKBKE inhibitor Amlexanox can pass through the blood-brain barrier and increase the radiosensitivity of intracranial tumor cells.

Effects of energy restriction during growing phase on the productive performance of Hyline Brown laying hens aged 6 to 72 wk

The aim of this study was to assess the effects of energy-restricted feeding during growing phase on the productive performance of Hyline Brown laying hens aged 6 to 72 wk. A total of 720 six-week-old layer chicks were allocated equally to 3 groups with 6 replicates of 40 pullets each, and were fed 1 of 3 diets that were nutritionally similar except for the apparent metabolizable energy corrected for nitrogen (AMEn) content. At the age of 6 to 17 wk, the pullets in the control group were given diet with 2,850 kcal/kg AMEn, and were fed ad libitum. The levels of AMEn in diet of pullets in the experimental groups were 90% (2,565 [2,850 × 90%] kcal/kg) and 80% (2,280 [2,850 × 80%] kcal/kg) of that in control group, and the daily amount of feed was restricted to the absolute quantity of the diet consumed by pullets in control group. At the age of 18 to 72 wk, all the hens were fed with the same diets ad libitum. As energy restriction increased in the growing phase, body weight (BW) dropped at the ages of 12 and 15 to 23 wk (at 23 wk: P = 0.001; at other ages: P < 0.001), but it showed no significant difference at 24 wk (P = 0.071). At 20 wk, restricting energy induced a delay in the development of sexual organs, including the ovary stroma, oviduct, and small yellow follicle (P < 0.05), as well as a delay in sexual maturity (P < 0.05). Consequently, the laying rate in the first and second periods dropped linearly (P = 0.046, 0.030, and 0.038, P < 0.001, respectively). The coefficient of variation (CV) in the BW at 19, 20, and 21 wk (P = 0.040, 0.023, and 0.042, respectively), the CV of age at first egg (P < 0.001), and CV of individual egg number at age 18 to 72 wk (P < 0.001) decreased linearly. There was a linear increase in the laying rate of hens in the later periods (at age 32-72 wk, P < 0.05), as well as in the average total egg number per hen and average laying rate at the age of 18 to 72 wk (P = 0.006). The average egg mass also showed a linear increase with increasing levels of energy restriction (P < 0.001). In summary, although appropriate energy restriction during growing phase delayed sexual maturity and sexual organ development in early-laying Hyline Brown pullets, it improved uniformity of BW, age at first egg laying, and individual egg number, and increased egg number per hen, laying rate, average egg mass, and number of settable eggs from 18 to 72 wk of age.

MiR-222-3p suppresses C2C12 myoblast proliferation and differentiation via the inhibition of IRS-1/PI3K/Akt pathway

Numerous studies have revealed the profound impact of microRNAs on regulating skeletal muscle development and regeneration. However, the biological function and regulation mechanism of miR-222-3p in skeletal muscle remains largely unknown. In this study, miR-222-3p was found to be abundantly expressed in the impaired skeletal muscles, indicating that it might have function in the development and regeneration process of the skeletal muscle. MiR-222-3p overexpression impeded C2C12 myoblast proliferation and myogenic differentiation, whereas inhibition of miR-222-3p got the opposite results. The dual-luciferase reporter assay showed that insulin receptor substrate-1 (IRS-1) was the target gene of miR-222-3p. We next found that knockdown of IRS-1 could obviously suppress C2C12 myoblast proliferation and differentiation. Additionally, miR-222-3p-induced repression of myoblast proliferation and differentiation was verified to be associated with a decrease in phosphoinositide 3-kinase (PI3K)-Akt signaling. Overall, we demonstrated that miR-222-3p inhibited C2C12 cells myogenesis via IRS-1/PI3K/Akt pathway. Therefore, miR-222-3p may be used as a therapeutic target for alleviating muscle loss caused by inherited and nonhereditary diseases.

Endurance Exercise-Induced Fgf21 Promotes Skeletal Muscle Fiber Conversion through TGF-β1 and p38 MAPK Signaling Pathway

Fgf21 has been identified as playing a regulatory role in muscle growth and function. Although the mechanisms through which endurance training regulates skeletal muscle have been widely studied, the contribution of Fgf21 remains poorly understood. Here, muscle size and function were measured, and markers of fiber type were evaluated using immunohistochemistry, immunoblots, or qPCR in endurance-exercise-trained wild-type and Fgf21 KO mice. We also investigated Fgf21-induced fiber conversion in C2C12 cells, which were incubated with lentivirus and/or pathway inhibitors. We found that endurance exercise training enhanced the Fgf21 levels of liver and GAS muscle and exercise capacity and decreased the distribution of skeletal muscle fiber size, and fast-twitch fibers were observed converting to slow-twitch fibers in the GAS muscle of mice. Fgf21 promoted the markers of fiber-type transition and eMyHC-positive myotubes by inhibiting the TGF-β1 signaling axis and activating the p38 MAPK signaling pathway without apparent crosstalk. Our findings suggest that the transformation and function of skeletal muscle fiber types in response to endurance training could be mediated by Fgf21 and its downstream signaling pathways. Our results illuminate the mechanisms of Fgf21 in endurance-exercise-induced fiber-type conversion and suggest a potential use of Fgf21 in improving muscle health and combating fatigue.

Early strategy vs. late initiation of renal replacement therapy in adult patients with acute kidney injury: an updated systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

The optimal time to start renal replacement therapy (RRT) for acute kidney injury (AKI) remains controversial. We aim to compare the effects of early vs. delayed RRT initiation on clinical outcomes in adult patients with AKI.

MATERIALS AND METHODS

PubMed, Embase, Cochrane Library, Web of Science, Chinese Biomedical Literature Database, ClinicalTrials.gov, and the International Clinical Trial registry platform were systematically searched from inception to 7 August 2022. The review included randomized clinical trials (RCTs) comparing early and delayed initiation of RRT in AKI patients. The selected primary outcomes were short-term and long-term mortality. Secondary outcomes included RRT dependency, intensive care unit (ICU) length of stay, hospital length of stay, mechanical ventilator-free days, vasoactive agents-free days, RRT-free days, and adverse events.

RESULTS

Overall, 15 RCTs, including 5,625 patients, were analyzed. Early RRT showed no survival benefit when compared to the delayed therapy (28-or 30-day mortality: RR, 1.01, 95% CI: 0.94-1.08, p = 0.87; 60-day mortality: RR, 0.87, 95% CI: 0.71-1.06, p = 0.16; 90-day mortality: RR, 1.00, 95% CI: 0.88-1.13, p = 0.97; in-hospital mortality: RR, 1.05, 95% CI: 0.88-1.24, p = 0.58; ICU mortality: RR, 1.00, 95% CI: 0.91-1.10, p = 0.98). The delayed RRT did not lead to a higher risk of RRT dependency, ICU, or hospital length of stay than the early RRT. Similarly, early initiation of RRT did not lead to longer ventilator-free, vasoactive agent-free, and RRT-free days. However, early RRT initiation was associated with more adverse events.

CONCLUSIONS

Our study suggested that early RRT initiation was not associated with survival benefits or better clinical outcomes and increased the risk of RRT-associated adverse events. Current evidence does not support the use of early RRT for AKI patients without urgent indications.

[Epidemiologic characteristics and influencing factors of influenza outbreaks in Guangdong Province, 2015-2022]

Objective: To grasp the epidemiological characteristics of influenza outbreaks in Guangdong Province by analyzing the outbreaks of influenza-like cases reported in Guangdong Province from January 2015 to the end of August 2022. Methods: In response to the outbreak of epidemics in Guangdong Province from 2015 to 2022, information on on-site epidemic control was collected, and epidemiological analysis was conducted to describe the characteristics of the epidemics. The factors that influence the intensity and duration of the outbreak were determined through a logistic regression model. Results: A total of 1 901 influenza outbreaks were reported in Guangdong Province, with an overall incidence of 2.05%. Most outbreak reports occurred from November to January of the following year (50.24%, 955/1 901) and from April to June (29.88%, 568/1 901). A total of 59.23% (1 126/1 901) of the outbreaks were reported in the Pearl River Delta region, and primary and secondary schools were the main places where outbreaks occurred (88.01%, 1 673/1 901). Outbreaks with 10-29 cases were the most common (66.18%, 1 258/1 901), and most outbreaks lasted less than seven days (50.93%,906/1 779). The size of the outbreak was related to the nursery school (aOR=0.38, 95%CI:0.15-0.93), the Pearl River Delta region (aOR=0.60, 95%CI:0.44-0.83), the time interval between the onset of the first case and the time of report (>7 days compared with ≤3 days: aOR=3.01, 95%CI:1.84-4.90), the influenza A(H1N1) (aOR=2.02, 95%CI:1.15-3.55) and the influenza B (Yamagata) (aOR=2.94, 95%CI: 1.50-5.76). The duration of outbreaks was related to school closures (aOR=0.65, 95%CI: 0.47-0.89), the Pearl River Delta region (aOR=0.65, 95%CI: 0.50-0.83) and the time interval between the onset of the first case and the time of report (>7 days compared with ≤3 days: aOR=13.33, 95%CI: 8.80-20.19; 4-7 days compared with ≤3 days: aOR=2.56, 95%CI: 1.81-3.61). Conclusions: An influenza outbreak in Guangdong Province exhibits two peaks, one in the winter and spring seasons and the other in the summer. Primary and secondary schools are high-risk areas, and early reporting of outbreaks is critical for controlling influenza outbreaks in schools. Furthermore, comprehensive measures should be taken to prevent the spread of the epidemic.

A randomized trial of eribulin monotherapy versus eribulin plus anlotinib in patients with locally recurrent or metastatic breast cancer

BACKGROUND

Eribulin mesylate is a novel, nontaxane, microtubule dynamics inhibitor. In this study, we assessed the efficacy and safety of eribulin versus eribulin plus the oral small-molecule tyrosine kinase inhibitor anlotinib in patients with locally recurrent or metastatic breast cancer.

PATIENTS AND METHODS

In this single-center, open-label, phase II clinical study (NCT05206656) conducted in a Chinese hospital, patients with human epidermal growth factor receptor 2 (HER2)-negative, locally recurrent or metastatic breast cancer previously treated with anthracycline- or taxane-based chemotherapy were randomized (1 : 1) to receive eribulin alone or in combination with anlotinib. The primary efficacy endpoint was investigator-assessed progression-free survival (PFS).

RESULTS

From June 2020 to April 2022, a total of 80 patients were randomly assigned to either eribulin monotherapy or eribulin plus anlotinib combination therapy, with 40 patients in each group. The data cut-off was 10 August 2022. The median PFS was 3.5 months [95% confidence interval (CI) 2.8-5.5 months] for eribulin and 5.1 months (95% CI 4.5-6.9 months) for eribulin plus anlotinib (hazard ratio = 0.56, 95% CI 0.32-0.98; P = 0.04). The objective response rates were 32.5% versus 52.5% (P = 0.07), respectively, and disease control rates were 67.5% versus 92.5% (P = 0.01), respectively. Patients <50 years of age, with an Eastern Cooperative Oncology Group performance status score of 0, visceral metastasis, number of treatment lines of four or more, hormone receptor negative (triple-negative), and HER2 low expression appeared to benefit more from combined treatment. The most common adverse events in both groups were leukopenia (n = 28, 70.0%, patients in the eribulin monotherapy group versus n = 35, 87.5%, patients in the combination therapy group), aspartate aminotransferase elevations (n = 28, 70.0%, versus n = 35, 87.5%), neutropenia (n = 25, 62.5%, versus n = 31, 77.5%), and alanine aminotransferase elevations (n = 25, 62.5%, versus n = 30, 75.0%).

CONCLUSION

Eribulin plus anlotinib can be considered an alternative treatment option for HER2-negative locally advanced or metastatic breast cancer.

[Efficacy of decitabine combined with low dose chemotherapy on children with acute myeloid leukemia]

Objective: To evaluate the efficacy of decitabine combined with low dose chemotherapy (LDC) in the treatment of high-risk, refractory and relapsed pediatric acute myeloid leukemia (AML). Methods: Clinical data of 19 AML children treated with decitabine combined with LDC in the Department of Hematology, Children's Hospital of Soochow University from April 2017 to November 2019 were analyzed retrospectively. The therapeutic response, adverse effects and survival status were analyzed,and the outcomes of patients were followed up. Results: Among 19 AML cases, there were 10 males and 9 females. Five cases were high-risk AML, 7 cases were refractory AML, and 7 cases were relapsed AML. After one course of decitabine+LDC treatment, 15 cases achieved complete remission, 3 cases got partial remission, and only 1 case didn't get remission. All patients received allogeneic hematopoietic stem cell transplantation as consolidation therapy. The follow-up time of all cases was 46 (37, 58) months, 14 children had survived. The cumulative three-year overall survival rate was (79±9) %, events free survival rates was (68±11) %, and recurrence free survival rate was (81±10) %. The most common adverse effects related to the induction treatment were cytopenia (19 cases) and infection (16 cases).There were no treatment-related death during the therapy. Conclusion: Decitabine combined with LDC is a safe and effective option for high-risk, refractory and relapsed AML children, which provides an opportunity for HSCT.

Vital pulp therapy for permanent teeth with diagnosis of irreversible pulpitis: biological basis and outcome

Root canal treatment (RCT) has been considered the conventional standard for the management of teeth with carious pulp exposure, particularly in mature teeth presenting with symptoms. Following a better understanding of the histopathology of deep carious lesions, the histology of the cariously exposed pulp and the healing potential of the inflamed pulp, vital pulp therapy (VPT) is increasingly adopted around the world for the management of permanent teeth with clinical signs and symptoms indicative of irreversible pulpitis. Furthermore, VPT became a recognized treatment modality by the European Society of Endodontology (ESE) and the American Association of Endodontists (AAE) by virtue of its high success rates reported in outcome studies using contemporary hydraulic calcium silicate-based cements. However, proper case selection, strict asepsis, capping materials and good coronal seal are mandatory for success. The aim of this paper is to review the biological basis for VPT in symptomatic teeth with carious pulp exposure and to report on the outcome of pulpotomy in teeth with clinical diagnosis of irreversible pulpitis.

Brain Activation Evoked by Motor Imagery in Pediatric Patients with Complete Spinal Cord Injury

BACKGROUND AND PURPOSE

Currently, there is no effective treatment for pediatric patients with complete spinal cord injury. Motor imagery has been proposed as an alternative to physical training for patients who are unable to move voluntarily. Our aim was to reveal the potential mechanism of motor imagery in the rehabilitation of pediatric complete spinal cord injury.

MATERIALS AND METHODS

Twenty-six pediatric patients with complete spinal cord injury and 26 age- and sex-matched healthy children as healthy controls were recruited. All participants underwent the motor imagery task-related fMRI scans, and additional motor execution scans were performed only on healthy controls. First, we compared the brain-activation patterns between motor imagery and motor execution in healthy controls. Then, we compared the brain activation of motor imagery between the 2 groups and compared the brain activation of motor imagery in pediatric patients with complete spinal cord injury and that of motor execution in healthy controls.

RESULTS

In healthy controls, compared with motor execution, motor imagery showed increased activation in the left inferior parietal lobule and decreased activation in the left supplementary motor area, paracentral lobule, middle cingulate cortex, and right insula. In addition, our results revealed that the 2 groups both activated the bilateral supplementary motor area, middle cingulate cortex and left inferior parietal lobule, and supramarginal gyrus during motor imagery. Compared with healthy controls, higher activation in the bilateral paracentral lobule, supplementary motor area, putamen, and cerebellar lobules III-V was detected in pediatric complete spinal cord injury during motor imagery, and the activation of these regions was even higher than that of healthy controls during motor execution.

CONCLUSIONS

Our study demonstrated that part of the motor imagery network was functionally preserved in pediatric complete spinal cord injury and could be activated through motor imagery. In addition, higher-level activation in sensorimotor-related regions was also found in pediatric complete spinal cord injury during motor imagery. Our findings may provide a theoretic basis for the application of motor imagery training in pediatric complete spinal cord injury.

Temporal proteomic profiling reveals functional pathways in vaccinia virus-induced cell migration

Introduction

Viral diseases have always been intricate and persistent issues throughout the world and there is a lack of holistic discoveries regarding the molecular dysregulations of virus-host interactions. The temporal proteomics strategy can identify various differentially expressed proteins and offer collaborated interaction networks under pathological conditions.

Method

Herein, temporal proteomics at various hours post infection of Vero cells were launched to uncover molecular alternations during vaccinia virus (VACV)-induced cell migration. Different stages of infection were included to differentiate gene ontologies and critical pathways at specific time points of infection via bioinformatics.

Results

Bioinformatic results showed functional and distinct ontologies and pathways at different stages of virus infection. The enrichment of interaction networks and pathways verified the significances of the regulation of actin cytoskeleton and lamellipodia during VACV-induced fast cell motility.

Discussion

The current results offer a systematic proteomic profiling of molecular dysregulations at different stages of VACV infection and potential biomedical targets for treating viral diseases.

Bone marrow mesenchymal stem cell-derived exosomes reduce insulin resistance and obesity in mice via the PI3K/AKT signaling pathway

Obesity is a common chronic metabolic disease that induces chronic systemic inflammation in the body, eventually leading to related complications such as insulin resistance (IR), type 2 diabetes mellitus (T2DM), and metabolic syndromes such as cardiovascular disease. Exosomes transfer bioactive substances to neighboring or distal cells through autosomal, paracrine, or distant secretion, regulating the gene and protein expression levels of receptor cells. In this study, we investigated the effect of mouse bone marrow mesenchymal stem cell-derived exosomes (BMSC-Exos) on high-fat diet (HFD) obese mice and mature 3T3-L1 adipocyte models of IR. BMSC-Exo treatment of obese mice promoted their metabolic homeostasis, including reduction of obesity, inhibition of M1-type pro-inflammatory factor expression, and improvement of insulin sensitivity. In vitro analysis revealed that BMSC-Exos improved IR and lipid droplet accumulation in mature 3T3-L1 adipocytes treated with palmitate (PA). Mechanistically, BMSC-Exos cause increased glucose uptake and improved IR in high-fat chow-fed mice and PA-acting 3T3-L1 adipocytes by activating the phosphoinositide 3-kinases/protein kinase B (PI3K/AKT) signaling pathway and upregulating glucose transporter protein 4 (GLUT4) expression. This study offers a new perspective for development of treatments for IR in obese and diabetic patients.

Non-linear relationship between dietary vitamin E intake and cognitive performance in older adults

OBJECTIVES

This study aimed to explore the relationship between dietary vitamin E (VE) intake and cognitive function in older adults.

STUDY DESIGN

This was a cross-sectional study.

METHODS

We applied data from the National Health and Nutrition Examination Survey obtained during 2011-2014 that met our requirements. The cognitive ability assessments included the Consortium to Establish a Registry for Alzheimer's Disease Word Learning (CERAD-WL) and Delayed Recall (CERAD-DR) tests, the animal fluency test, the Digit Symbol Substitution Test, and a composite z-score calculated by summing z-scores of individual tests. We used binary logistic regression analysis to explore the relationship between VE intake and cognitive performance. The results are reported using odds ratios and 95% confidence intervals. Our study also included sex-stratified analyses and sensitivity analysis. A restricted cubic splines model was used to evaluate the dose-response relationship between dietary VE intake and cognitive function.

RESULTS

This study found that a higher intake of dietary VE was associated with a lower risk of cognitive impairment in patients. Sensitivity analysis shows stable results. The results of the gender stratification analysis showed that dietary VE intake was negatively related to the risk of cognitive disorder among females. An irregular L-shaped dose-response relationship was observed between dietary VE intake and cognitive impairment risk.

CONCLUSIONS

Dietary VE intake was negatively related to the risk of cognitive disorder in older adults, with a higher VE intake lowering the risk.

[Effect of Mycobacterium tuberculosis protein Rv0309 on intracellular survival of Mycobacterium smegmatis by inhibiting macrophage autophagy via protein STUB1]

Objective: To investigate the molecular regulatory mechanism of Mycobacterium tuberculosis (MTB) protein Rv0309 to promote the survival of Mycobacterium smegmatis (Ms) in macrophages. Methods: Using Ms as a model to study Mycobacterium tuberculosis, recombinant Ms transfected with pMV261 and PMV261-RV0309 in the control group and RAW264.7 cells were constructed. The effect of Rv0309 protein on intracellular survival of Ms was investigated by counting colony forming units (CFUs). Mass spectrometry was used to screen proteins interacting with host protein Rv0309, and immunocoprecipitate (Co-IP) was used to verify that host protein STUB1 could interact with host protein Rv0309. STUB1 gene knock-out RAW264.7 cells were infected with Ms, and CFUs were counted to explore the effect of protein Rv0309 on intracellular survival of Ms after STUB1 gene knock-out. STUB1 gene knock-out RAW264.7 cells were infected with Ms, and after obtaining samples, Western blotting assay was performed to explore the effect of protein Rv0309 on autophagy function of macrophages after STUB1 gene knock-out. Statistical analysis was performed using GraphPad Prism 8 software. T-test was selected for analysis in this experiment, with P<0.05 was considered statistically significant. Results: Western blotting showed that Rv0309 was expressed in M. smegmatis and secreted extracellularly. The CFUs of the Ms-Rv0309 group was higher than that of Ms-pMV261 group at 24 h after THP-1 macrophage infection, and the difference was statistically significant (P<0.05). The trend of infected RAW264.7 macrophages was the same as that of infected THP-1 macrophages. The Co-IP results showed that the corresponding Flag and HA bands appeared in the results of immunoprecipitation (IP):Flag and IP: HA. The level of CFUs in the experimental group with STUB1 deletion was significantly higher than that in the control group without STUB1 deletion. Compared with Ms-pMV261, the CFUs in the Ms-Rv0309 group was significantly higher than that in the Ms-pMV261 group. The gray scale of LC3Ⅱ bands of Ms-Rv0309 in experimental group was lighter than that of Ms-pMV261 in the control group at the corresponding time point, and the result was most significant at 8 h (LC3Ⅱ/β-actin: 0.76±0.05 vs 0.47±0.07), the difference being statistically significant (P<0.05). After STUB1 genome knock-out, the gray level of LC3Ⅱ bands at the corresponding time was lighter than that without STUB1 genome knock-out. Comparison of the results of Ms-pMV261 and Ms-Rv0309 strains revealed that LC3Ⅱ band gray Rv0309 group was lighter at the corresponding time compared with pMV261 group. Conclusions: MTB protein Rv0309 can be successfully expressed in M. smegmatis and secreted extracellularly, which can inhibit the autophagy process of macrophages. Protein Rv0309 interacts with host protein STUB1 to inhibit macrophage autophagy and promote intracellular survival of Ms.

[Efficacy and safety of dexcitabine combined with HAAG regimen in the treatment of recurrent acute myeloid leukemia]

Objective: To investigate the efficacy and safety of dexithabine (DAC) combined with HAAG regimen [harringtonine (HHT), cytarabine (Ara-C), aclarubicin (Acla) and recombinant human granulocyte colony stimulating factor (G-CSF)] in the treatment of acute myeloid leukemia (AML). Methods: The clinical data of 89 AML patients in People's Hospital Affiliated to Shandong First Medical University from January 2019 to January 2021 were retrospectively analyzed. The patients were divided into observation group (n=48) and control group (n=41) according to the treatment plan. The observation group included 25 males and 23 females, aged (44.4±9.3) years old, and was treated with DAC combined with HAAG. The control group included 24 males and 17 females, aged (42.2±10.1) years old, and was treated with DAC regimen. After 3 cycles of treatment, the treatment efficacy of the two groups was judged, including complete remission, partial remission and no remission. The level of serum P-glycoprotein (P-gp) in the two groups was detected by direct immunofluorescence-labeled monoclonal antibody flow cytometry. The enzyme-linked immunosorbent assay was used to detect the level of soluble urokinase-type plasminogen activator receptor (suPAR). Meanwhile, the incidence of adverse reactions such as digestive tract reaction, liver and kidney dysfunction, hemorrhage and infection during treatment were recorded. Results: After 3 cycles of treatment, the observation group had complete remission, partial remission and no remission in 10 cases, 21 cases and 17 cases, respectively, and the control group had 3 cases, 11 cases and 27 cases, respectively. The overall efficacy of the observation group was better than that of the control group (Z=-2.919, P=0.004). The levels of serum P-gp and suPAR in the observation group were (5.2±1.8) % and (464.4±103.4) ng/L, respectively, which were significantly lower than those in the control group [(8.8±1.9) % and (660.6±110.4) ng/L, respectively] (both P<0.05). During the treatment, the incidence of digestive tract reaction, liver and kidney dysfunction, hemorrhage and infection in the observation group was 29.2% (14/48), 22.9% (11/48), 16.7% (8/48) and 33.3% (16/48), respectively, while in the control group was 26.8% (11/41), 21.9% (9/41), 14.6% (6/41) and 24.4% (10/41), respectively, with no statistically significant difference (all P>0.05). Conclusions: The overall efficacy of DAC combined with HAAG in the treatment of AML is better than that of DAC alone. Moreover, the incidence of adverse reactions in DAC combined with HAAG is similar to that of DAC alone, with a high safety profile.

[Intravesical instillation of bacillus Calmette-Guerin for non-muscle invasive bladder cancer: outcomes of 421 patients in a single center]

OBJECTIVE

To assess the therapeutic effect and adverse effect of intravesical instillation of bacillus Calmette-Guerin (BCG) for treatment of non-muscle invasive bladder cancer (NMIBC) and analyze the independent predictors of patient survival.

METHODS

We retrospectively collected the clinical data from 421 patients (mean age 61.79±11.51 years) with NMIBC, who received intravesical instillation of BCG after surgery in Sun Yat-sen University Cancer Center from September, 2015 to September, 2021. Recurrence-free survival (RFS), progression-free survival (PFS), and disease specific survival (DSS) of the patients were analyzed, and the adverse effects were assessed using Common Terminology Criteria for Adverse Events 5.0. Kaplan-Meier analysis, univariate and multivariate COX regression analyses were used to identify the independent predictors of the patients' survival outcomes.

RESULTS

The median follow-up of the patients was 17 months, during which 88 (20.9%) patients experienced recurrence (median time to recurrence of 10 months, range 3-58 months); 40 (9.5%) patients showed tumor progression (median time to progression of 18 months, range 3-50 months); and 14 (3.3%) patients died (median survival time of 30 months, range 8-52 months). Adverse events of grade 1, 2, and 3 occurred in 69, 110, and 23 of the patients, respectively. Survival analysis indicated that an age below 67.5 years (P=0.013), first tumor onset (P < 0.001), solitary tumor (P= 0.010), time to recurrence over one year (P=0.042), low levels of neutrophils (P=0.005), monocytes (P=0.005) and neutrophil/lymphocyte ratio (NLR; P=0.014), and cytokeratin 19 fragment 21-1 (CyFra21-1; P=0.002) were all associated with a higher PFS rate. Multivariate COX analysis suggested that the time of tumor recurrence (P=0.007, HR=2.669, 95% CI: 1.316-5.414), monocyte counts (P=0.015, HR=0.376, 95% CI: 0.171-0.829), and serum CyFra21-1 level (P=0.002, HR=0.312, 95% CI: 0.151-0.647) were independent predictors of RFS; primary tumor or tumor relapse (P=0.003, HR=0.301, 95% CI: 0.138-0.660), neutrophil counts (P=0.028, HR=0.302, 95% CI: 0.103-0.882), and CyFra21-1 level (P=0.029, HR=0.358, 95% CI: 0.142-0.903) were independent predictors of PFS following BCG instillation.

CONCLUSION

Intravesical instillation of BCG is effective for treatment of intermediate or high-risk NMIBC, and the adverse effects are tolerable in most cases. The time of tumor recurrence, monocyte counts, and serum CyFra21-1 level are independent predictors of RFS, and primary tumor or tumor relapse, neutrophil counts, and CyFra21-1 level are independent predictors of PFS.

A266 DIET-BASED THERAPIES FOR INTESTINAL DYSFUNCTION INDUCED BY CLOSTRIDIOIDES DIFFICILE INFECTION

Background

Chronic gut dysfunction occurs in up to 25% of patients following antibiotic-treated C. difficile infection (CDI). We developed a humanized mouse model in which germ free mice colonized with microbiota from patients with severe constipation post-CDI developed slow colonic transit, as a result of damage to the Interstitial Cells of Cajal (ICC) network by pro-inflammatory macrophages. Colonic transit, immune activation and the ICC network normalized after fecal microbiota transplantation using samples from healthy mice, as well after treatment with psyllium fiber. Here we explored the long-term effects of psyllium and evaluated the therapeutic potential of pectin and quercetin in this model.

Purpose

1) To investigate the time course of the beneficial effect of psyllium on colonic motility.

2) To explore possible therapeutic properties of flavonoids and pectin.

Method

Germ-free mice were colonized with microbiota from the post-CDI (PCDI) patient or healthy controls (HC). After 3 weeks, the mice were fed for 4-5 weeks with a control diet or diets with 15% psyllium (PSY), 10% pectin (PCT) or 0.05% quercetin (QCT). To evaluate time course of PSY on motility, control diet was administered for 3-weeks following PSY treatment. The bead expulsion test was used to assess colonic motility. Stool samples were collected for microbial profiling, and short and branched-chain fatty acids (SCFA/BCFA) analysis. Macrophages morphology and counts, and ICC network structure were evaluated by immunohistochemistry.

Result(s)

Compared to HC microbiota, colonization with post-CDI microbiota induced slow colonic transit in recipient mice, and this was normalized by PSY (n=13; p=0.02). The benefit of PSY was transient as colonic transit slowed following discontinuation of PSY (p=0.001). The changes in colonic transit were paralleled by switch in macrophages phenotype and damage to the ICC network. Additionally, discontinuation of PSY resulted in a return of microbial diversity (p< 0.001), SCFA/BCFA levels (acetic and propionic acid/ iso-butyric and valeric acid) and specific bacterial species abundances, to values seen in untreated mice colonized with post-CDI microbiota. Microbial analysis predicted potential pathways involved in macrophage polarization, including the synthesis of SCFA/BCFA, degradation of inositol and production of acetylglucosamine.

PCT also normalized slow intestinal transit in mice colonized with post-CDI microbiota (p=0.003), restored phenotype of infiltrating macrophages, and improved the structural integrity of the ICC network. In contrast, QCT failed to improve gut dysfunction in PCDI mice.

Conclusion(s)

Our results suggest that the beneficial effects of psyllium in this model are transient. Dietary pectin, but not quercetin, may also serve as a novel treatment strategy to restore colonic motility and immune homeostasis in humans with severe constipation post-CDI.

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Other

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W. Garfield Weston Foundation

Disclosure of Interest

None Declared

A8 MICROBIAL ACTIVATION OF INTESTINAL DENDRITIC CELLS IS CRITICAL FOR THE ESTABLISHMENT OF NORMAL BEHAVIOR

Background

Accumulating evidence suggests that gut microbiota affects brain development and its function. It is well known that compared with conventional mice (SPF), germ-free (GF) mice display higher exploratory behavior, which normalizes after bacterial colonization. However, little is known about the underlying mechanisms and first critical steps initiating microbiota-gut-brain communication, which lead to establishment of normal behavior.

Purpose

To investigate the role of immune system in the establishment of normal behavior after bacterial colonization.

Method

We assessed behavior in GF mice before and after colonization with SPF microbiota, Altered Schaedler Flora (ASF) or the single bacterial strain E. coli JM83, and compared them to SPF mice, using the light-dark preference and tail suspension tests. Levels of brain-derived neurotrophic factor (BDNF) and c-Fos expression were measured by immunofluorescence in the hippocampus and amygdala. Colonic and brain gene expression were assessed using a NanoString technology. The immunodeficient MyD88-/- Ticam1- and SCID mice were used to study the role of the innate and adaptive immune systems. To demonstrate the role of the dendritic cells (DCs), we measured behavior before and after mono-colonization with E. coli JM83 in GF mice treated with cosalane and fingolimod, that inhibit DCs activation and migration, respectively. Brain levels of CD11b, CD11c and CD103 as DCs markers was assessed by immunofluorescence.

Result(s)

Compared to SPF mice, GF mice showed higher exploratory and less depressive-like behavior. The ex-germ-free mice colonized with ASF microbiota, or mono-colonized with E. coli JM83 showed similar normalization of behavior as those colonized with SPF microbiota. Mono-colonization with E. coli reduced both BDNF and c-fos levels in the hippocampus and amygdala. While colonization of GF SCID mice induced same change in behavior as in wild-type mice, GF MyD88-/-Ticam1-/- mice did not alter their behavior. Mono-colonization affected multiple genes in the colon and the brain, associated with innate immunity and neural plasticity. Treatment with both cosalane and fingolimod prevented behavioral changes after colonization, which was paralleled by absence of CD11b+CD103+CD11c+ cells in the brain, otherwise found in high numbers in control mono-colonized mice and absent in germ-free mice.

Conclusion(s)

The innate immune system, through activation and migration of intestinal dendritic cells into the brain, initiates the neuro-immune signaling within the gut-brain axis and leads to normalization of behavior after bacterial colonization. Our findings may impact several psychiatric conditions, in which altered innate immune signaling has been implicated.

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CIHR, Other

Please indicate your source of funding;

Balsam Family Foundation

Disclosure of Interest

None Declared

A45 FIBER-FREE DIET REDUCES BACTEROIDES ABUNDANCE AND PREVENTS MUCUS DEGRADATION IN MICE COLONIZED WITH MICROBIOTA FROM PATIENTS WITH GENERALIZED ANXIETY DISORDER

Background

Generalized anxiety disorder (GAD) is a debilitating condition with a lifetime prevalence of 4-7% worldwide. We have previously found that compared to healthy controls, GAD patients had lower reported fiber intake, increased gastrointestinal symptoms; and enrichment of Bacteroides genus as well as carbohydrate metabolism pathways (as determined by PICRUSt2, correlated to Bacteroides abundance). Bacteroides are known for its ability to degrade a wide variety of host polysaccharides, such as the intestinal mucus, which could lead to local and systemic inflammation. In this regard, GAD patients had higher C-reactive protein (CRP) compared to healthy controls (p=0.049).

Purpose

To investigate whether a fiber-free diet could decrease Bacteroides abundance and prevent damage of the mucus layer reducing anxiety-behavior in mice with GAD microbiota.

Method

Two germ-free NIH Swiss mouse breeding pairs were colonized with GAD microbiota using patients’ stool samples and kept on either fiber-free or 10 % inulin (fiber) diet. Offspring were weaned at week 3 and psychometric tests were performed at 10 weeks of age. After sacrifice, samples for histology (mucus layer thickness determination), blood (CRP ELISA determination) and stool (Illumina 16S rRNA gene sequencing) were collected. The microbiota data was analyzed following the pipelines of dada2 and by mean comparisons, correlation, AncomBC using R software (v.1.2.1335). Multiple comparison results were corrected allowing 5% of FDR.

Result(s)

Beta diversity analysis showed that parent and offspring’s (n=24 fiber-supplemented and n=14 fiber-free groups) microbiota was similar to the GAD donor. The most differentially abundant bacterial taxon was Bacteroides uniformis, which was decreased in the fiber-free group (p.adj= 0.003). Furthermore, fiber-free diet reduced the overall Bacteroides abundance by half compared to the donor and fiber-supplemented mice group. This led to a thickening (p.adj=0.027) of the mucus layer, increasing from 30 µm (fiber-supplemented diet) to 60 µm in the fiber-free diet group. B. uniformis was negatively correlated to the mucus layer thickness (R= -0.81; p.adj=0.26), although not statistically significant, likely due to a low n number (n=4). We only found a statistical trend for higher CRP levels and anxiety-like behavior in the fiber-supplemented group. This might be because fiber supplementation has several beneficial effects that can counteract the proposed increase in anxiety-like behavior fromBacteroides. Despite that, we found a significant correlation between B. uniformis and time mice spent in the dark (indicative of anxiety-like behavior) in the light preference test.

Conclusion(s)

Our data suggests that Bacteroides abundance, specifically Bacteroides uniformis, contributes to the degradation of the mucus layer and potentially triggers low grade gut inflammation and anxiety-like behavior.

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CIHR

Disclosure of Interest

None Declared