The Attenuation of Diabetic Nephropathy by Annexin A1 via Regulation of Lipid Metabolism Through the AMPK/PPARα/CPT1b Pathway

Inflammation and abnormal metabolism play important roles in the pathogenesis of diabetic nephropathy (DN). Annexin A1 (ANXA1) contributes to inflammation resolution and improves metabolism. In this study, we assess the effects of ANXA1 in diabetic mice and proximal tubular epithelial cells (PTECs) treated with high glucose plus palmitate acid (HGPA) and explore the association of ANXA1 with lipid accumulation in patients with DN. It is found that ANXA1 deletion aggravates renal injuries, including albuminuria, mesangial matrix expansion, and tubulointerstitial lesions in high-fat diet/streptozotocin-induced diabetic mice. ANXA1 deficiency promotes intrarenal lipid accumulation and drives mitochondrial alterations in kidneys. In addition, Ac2-26, an ANXA1 mimetic peptide, has a therapeutic effect against lipid toxicity in diabetic mice. In HGPA-treated human PTECs, ANXA1 silencing causes FPR2/ALX-driven deleterious effects, which suppress phosphorylated Thr¹⁷² AMPK, resulting in decreased peroxisome proliferator-activated receptor α and carnitine palmitoyltransferase 1b expression and increased HGPA-induced lipid accumulation, apoptosis, and elevated expression of proinflammatory and profibrotic genes. Last but not least, the extent of lipid accumulation correlates with renal function, and the level of tubulointerstitial ANXA1 expression correlates with ectopic lipid deposition in kidneys of patients with DN. These data demonstrate that ANXA1 regulates lipid metabolism of PTECs to ameliorate disease progression; hence, it holds great potential as a therapeutic target for DN.

Characterization of the diastaphenazine/izumiphenazine C biosynthetic gene cluster from plant endophyte Streptomyces diastaticus W2

Two phenazine compounds, diastaphenazine and izumiphenazine C, with complex structures and promising antitumour activity have been isolated from the plant endophytic actinomycete Streptomyces diastaticus W2. Their putative biosynthetic gene cluster (dap) was identified by heterologous expression and gene knockout. There are twenty genes in the dap cluster. dap14‐19 related to shikimic pathway were potentially involved in the precursor chorismic acid biosynthesis, and dapBCDEFG were confirmed to be responsible for the biosynthesis of the dibenzopyrazine ring, the nuclear structure of phenazines. Two transcriptional regulatory genes dapR and dap4 played the positive regulatory roles on the phenazine biosynthetic pathway. Most notably, the dimerization of the dibenzopyrazine ring in diastaphenazine and the loading of the complex side chain in izumiphenazine C could be catalysed by the cyclase homologous gene dap5, suggesting an unusual modification strategy tailoring complex phenazine biosynthesis. Moreover, metabolite analysis of the gene deletion mutant strain S. albus::23C5Δdap2 and substrate assay of the methyltransferase Dap2 clearly revealed the biosynthetic route of the complex side chain in izumiphenazine C.

α-C(sp3)-H Arylation of Cyclic Carbonyl Compounds

α-C(sp3)-H arylation is an important type of C-H functionalization. Various biologically significant natural products, chemical intermediates, and drugs have been effectively prepared via C-H functionalization. Cyclic carbonyl compounds comprise of cyclic ketones, enones, lactones, and lactams. The α-C(sp3)-H arylation of these compounds have been exhibited high efficiency in forming C(sp3)-C(sp2) bonds, played a crucial role in organic synthesis, and attracted majority of interests from organic and medicinal communities. This review focused on the most significant advances including methods, mechanism, and applications in total synthesis of natural products in the field of α-C(sp3)-H arylations of cyclic carbonyl compounds in recent years.

Genetic analysis of the septal peptidoglycan synthase FtsWI complex supports a conserved activation mechanism for SEDS-bPBP complexes

SEDS family peptidoglycan (PG) glycosyltransferases, RodA and FtsW, require their cognate transpeptidases PBP2 and FtsI (class B penicillin binding proteins) to synthesize PG along the cell cylinder and at the septum, respectively. The activities of these SEDS-bPBPs complexes are tightly regulated to ensure proper cell elongation and division. In Escherichia coli FtsN switches FtsA and FtsQLB to the active forms that synergize to stimulate FtsWI, but the exact mechanism is not well understood. Previously, we isolated an activation mutation in ftsW (M269I) that allows cell division with reduced FtsN function. To try to understand the basis for activation we isolated additional substitutions at this position and found that only the original substitution produced an active mutant whereas drastic changes resulted in an inactive mutant. In another approach we isolated suppressors of an inactive FtsL mutant and obtained FtsW^E289G and FtsI^K211I and found they bypassed FtsN. Epistatic analysis of these mutations and others confirmed that the FtsN-triggered activation signal goes from FtsQLB to FtsI to FtsW. Mapping these mutations, as well as others affecting the activity of FtsWI, on the RodA-PBP2 structure revealed they are located at the interaction interface between the extracellular loop 4 (ECL4) of FtsW and the pedestal domain of FtsI (PBP3). This supports a model in which the interaction between the ECL4 of SEDS proteins and the pedestal domain of their cognate bPBPs plays a critical role in the activation mechanism.

Bacterial cell division requires the synthesis of septal peptidoglycan by the widely conserved SEDS-bPBP protein complex FtsWI, but how the complex is activated during cell division is still poorly understood. Previous studies suggested that FtsN initiates a signaling cascade in the periplasm to activate FtsWI. Here we isolated and characterized activated FtsW and FtsI mutants and confirmed that the signaling cascade for FtsW activation goes from FtsN to FtsQLB to FtsI and then to FtsW. The residues corresponding to mutations affecting FtsWI activation are clustered to a small region of the interaction interface between the pedestal domain of FtsI and the extracellular loop 4 of FtsW, suggesting that this interaction mediates activation of FtsW. This is strikingly similar to the proposed activation mechanism for the RodA-PBP2 complex, another SEDS-bPBP complex required for cell elongation. Thus, the two homologous SEDS-bPBP complexes are activated similarly by completely unrelated activators that modulate the interaction interface between the SEDS proteins and the bPBPs.

The correlation between hepatic fat fraction evaluated by dual-energy computed tomography and high-risk coronary plaques in patients with non-alcoholic fatty liver disease

PURPOSE

To determine the relationship between non-alcoholic fatty liver disease (NAFLD) evaluated by a hepatic fat fraction (HFF) using dual-energy computed tomography (DECT) and high-risk coronary plaques (HRP) in NAFLD patients.

METHODS

We conducted a matched case-control study involving 172 NAFLD individuals recruited from August 2019 to September 2020. They underwent dual-energy coronary computed tomographic angiography and were classified as no-plaque, HRP negative and HRP positive groups. HFF values were measured using multimaterial decomposition algorithm of DECT, and the differences among three groups were compared. Multiple logistic regression analysis was performed to determine the independent correlation between HFF and HRP. Spearman rank correlation was used to assess the correlations between HFF and multiple variables.

RESULTS

HRP positive group (15.3%) had higher HFF values than no-plaque (6.9%) and HRP negative groups (8.9%) (P < 0.001). After adjusting for confounding variables, the results indicated that HFF was an independent risk factor for HRP (OR 1.93, P < 0.001). Additionally, HFF significantly correlated with coronary artery calcium score, hepatic CT attenuation, epicardial and pericoronary adipose tissue volume, and CT attenuation (all P < 0.001).

CONCLUSIONS

As a new imaging marker for the quantification of liver fat, HFF was independently associated with HRP.

Annexin A1 alleviates kidney injury by promoting the resolution of inflammation in diabetic nephropathy

Since failed resolution of inflammation is a major contributor to the progression of diabetic nephropathy, identifying endogenously generated molecules that promote the physiological resolution of inflammation may be a promising therapeutic approach for this disease. Annexin A1 (ANXA1), as an endogenous mediator, plays an important role in resolving inflammation. Whether ANXA1 could affect established diabetic nephropathy through modulating inflammatory states remains largely unknown. In the current study, we found that in patients with diabetic nephropathy, the levels of ANXA1 were upregulated in kidneys, and correlated with kidney function as well as kidney outcomes. Therefore, the role of endogenous ANXA1 in mouse models of diabetic nephropathy was further evaluated. ANXA1 deficiency exacerbated kidney injuries, exhibiting more severe albuminuria, mesangial matrix expansion, tubulointerstitial lesions, kidney inflammation and fibrosis in high fat diet/streptozotocin-induced-diabetic mice. Consistently, ANXA1 overexpression ameliorated kidney injuries in mice with diabetic nephropathy. Additionally, we found Ac2-26 (an ANXA1 mimetic peptide) had therapeutic potential for alleviating kidney injuries in db/db mice and diabetic Anxa1 knockout mice. Mechanistic studies demonstrated that intracellular ANXA1 bound to the transcription factor NF-κB p65 subunit, inhibiting its activation thereby modulating the inflammatory state. Thus, our data indicate that ANXA1 may be a promising therapeutic approach to treating and reversing diabetic nephropathy.

ICAM-1 Activates Platelets and Promotes Endothelial Permeability through VE-Cadherin after Insufficient Radiofrequency Ablation

Radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) often leads to aggressive local recurrence and increased metastasis, and vascular integrity and platelets are implicated in tumor metastasis. However, whether interactions between endothelial cells and platelets induce endothelial permeability in HCC after insufficient RFA remains unclear. Here, significantly increased CD62P-positive platelets and sP-selectin in plasma are observed in HCC patients after RFA, and tumor-associated endothelial cells (TAECs) activate platelets and are susceptible to permeability after heat treatment in the presence of platelets in vitro. In addition, tumors exhibit enhanced vascular permeability after insufficient RFA in mice; heat treatment promotes platelets-induced endothelial permeability through vascular endothelial (VE)-cadherin, and ICAM-1 upregulation in TAECs after heat treatment results in platelet activation and increased endothelial permeability in vitro. Moreover, the binding interaction between upregulated ICAM-1 and Ezrin downregulates VE-cadherin expression. Furthermore, platelet depletion or ICAM-1 inhibition suppresses tumor growth and metastasis after insufficient RFA in an orthotopic tumor mouse model, and vascular permeability decreases in ICAM-1-/- mouse tumor after insufficient RFA. The findings suggest that ICAM-1 activates platelets and promotes endothelial permeability in TAECs through VE-cadherin after insufficient RFA, and anti-platelet and anti-ICAM-1 therapy can be used to prevent progression of HCC after insufficient RFA.

Expression of CDK13 Was Associated with Prognosis and Expression of HIF-1α and beclin1 in Breast Cancer Patients

OBJECTIVE

To investigate role and clinical significance of CDK13 in breast cancer patients.

METHODS

A total of 189 cases of breast cancer were enrolled during March 2013 to March 2015. Immunohistochemistry (IHC) was used for measurement of CDK13, HIF-1α and beclin1. Clinical characteristics of age, BMI, TNM stage, pathological types, and tumor diameter, were recorded. Patients' 5-year overall survival and recurrence were followed up. All patients were followed up for 5 years or to the last follow-up.

RESULTS

The expression levels of CDK13 and HIF-1αin breast cancer tissues were up-regulated and beclin1 was down-regulated than in the paracancerous non-tumor tissues. CDK13 was positively correlated with HIF-1α and negatively correlated with beclin1 in breast cancer tissues. The patients with higher expression of CDK13 showed significantly higher rates of TNM III-IV, higher rates of lymph node metastasis, distant metastasis and larger tumor size. The mortality and recurrence rates were higher in high expression CDK13 patients than in low CDK13 expression patients, however with no significant difference. K-M curve showed patients with higher CDK13 showed lower 5-year overall survival and lower disease-free survival time, however with no significant difference.

CONCLUSION

CDK13 was overexpressed in breast cancer tissues, and patients with higher CDK13 had poorer clinical outcomes. Further studies are still needed to reveal the clinical significance of CDK13 in breast cancer.

A Non-Invasive Nanoprobe for In Vivo Photoacoustic Imaging of Vulnerable Atherosclerotic Plaque

Vulnerable atherosclerotic (AS) plaque is the major cause of cardiovascular death. However, clinical methods cannot directly identify the vulnerable AS plaque at molecule level. Herein, osteopontin antibody (OPN Ab) and NIR fluorescence molecules of ICG co-assembled Ti₃ C₂ nanosheets are reported as an advanced nanoprobe (OPN Ab/Ti₃ C₂ /ICG) with enhanced photoacoustic (PA) performance for direct and non-invasive in vivo visual imaging of vulnerable AS plaque. The designed OPN Ab/Ti₃ C₂ /ICG nanoprobes successfully realize obvious NIR fluorescence imaging toward foam cells as well as the vulnerable AS plaque slices. After intravenous injection of OPN Ab/Ti₃ C₂ /ICG nanoprobes into AS model mice, in vivo imaging results show a significantly enhanced PA signal in the aortic arch accumulated with vulnerable plaque, well indicating the remarkable feasibility of OPN Ab/Ti₃ C₂ /ICG nanoprobes to distinguish the vulnerable AS plaque. The proposed OPN Ab/Ti₃ C₂ /ICG nanoprobes not only overcome the clinical difficulty to differentiate vulnerable plaque, but also achieve the non-invasively specific in vivo imaging of vulnerable AS plaque at molecule level, greatly promoting the innovation of cardiovascular diagnosis technology.

Molecular characterization and functional analysis of a Rel gene in the Pacific oyster

The nuclear factor-κB (NF-κB) signaling pathway plays a crucial role in regulating many physiological processes such as development, inflammation, apoptosis, cell proliferation, differentiation and immune responses. And the NF-κB/Rel family members were considered as the most important transcription factors in the NF-κB signaling pathway. In this study, we cloned a Rel homolog gene (named as CgRel2) from the Pacific oyster, Crassostrea gigas. The 2115-bp open reading frame (ORF) encodes 704 amino acids and CgRel2 possesses a conserved Rel Homology Domain (RHD) at the N-terminus. Phylogenetic analysis revealed that CgRel2 is most closely related to Pinctada fucata dorsal protein. CgRel2 transcripts are widely expressed in all tested tissues, with the highest expression observed in the labial palp and the gill. Moreover, the expression of CgRel2 is significantly upregulated after lipopolysaccharide (LPS), peptidoglycan (PGN), and polyinosinic-polycytidylic acid [poly(I:C)] challenge. CgRel2 transfection into human cell lines activated NF-κB, TNFα and oyster IL-17 (CgIL-17) reporter genes in a dose-dependent manner, while CgRel2 overexpression cannot induce ISRE (Interferon stimulation response element) reporter gene's transcriptional activity. Additionally, the results of co-immunoprecipitation showed that CgRel2 or CgRel1 could interact with oyster IκB1, IκB2 and IκB3 proteins strongly, which may be critical for the immune signaling transduction and the regulation of its immune functions. Together, these results suggest that CgRel2 could respond to pathogenic infection, participate in the immune signal transduction and activate NF-κB, TNFα and CgIL-17 reporter genes. Thus, CgRel2 could play an important role in the oyster immune system.

Effects of epicardial adipose tissue volume and density on cardiac structure and function in patients free of coronary artery disease

PURPOSE

To determine the association of epicardial adipose tissue (EAT) volume and density with cardiac geometry and function.

METHODS

We included 178 consecutive patients who performed coronary computed tomography angiography but were not diagnosed with coronary artery disease (CAD). The EAT volume, density, and following cardiac structure and function parameters were measured: left ventricular ejection fraction, left ventricular mass (LVM), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular stroke volume (LVSV), left ventricular end-diastolic diameter (LVEDD), interventricular septal thickness (IVST) and posterior wall thickness (PWT). All the parameters were standardized using the height^2.7.

RESULTS

A significant correlation was found between larger EAT volume and increased LVM, LVEDV, LVESV, LVSV, LVEDD, IVST and corresponding standardized indexes (P < 0.05 for all). Higher EAT density significantly correlated with increased LVM, LVEDV, LVESV, LVSV, LVEDD, IVST, PWT and corresponding standardized indexes (P < 0.05 for all). The largest cardiac structure and function parameters were observed in the population with above-median EAT volume and density.

CONCLUSION

Both large EAT volume and high EAT density were associated with cardiac structure and function in patients with no CAD. The EAT density may render complementary information to EAT volume regarding cardiac geometry changes.

Preliminary investigation demonstrating the GHITM gene probably involved in apoptosis and growth of the golden apple snail (Pomacea canaliculata)

Background

Growth hormone inducible transmembrane protein (GHITM) is a highly conserved transmembrane protein. This study was conducted to investigate the role of GHITM gene in the apoptosis and growth of the golden apple snail Pomacea canaliculate.

Results

The complete cDNA of this gene was cloned using the rapid amplification of cDNA ends (RACE) method and subjected to bioinformatics analysis. The full-length cDNA was 2242 bp, including an open reading frame of 1021 bp that encoded a protein of 342 amino acid residues. The mRNA expression profiles of GHITM gene in different tissues (liver, kidney, gonad and foot) and different growth phases (6-months old and 2-years old) showed that it was expressed in various tissues and different growth phases. Silencing of the GHITM gene by RNAi (RNA interference) experiments revealed that the GHITM gene possibly plays a role in inhibiting apoptosis through detecting the Caspase (Cysteine-requiring Aspartate Protease)-3 activity. In addition, the aperture width and body whorl length of the snail was significantly affected by RNAi, suggesting that this gene plays a significant role in promoting the growth of the organism.

Conclusions

These results demonstrated that the GHITM gene was involved in apoptosis and growth in golden apple snail.

Diarylpropanes from Horsfieldia kingii

Three new diarylpropanes (1-3), including two diarylpropane glycosides, and three known ones, were isolated from 70% aqueous acetone extract of the twigs and leaves of Horsfieldia kingii. Their structures were elucidated by spectroscopic analysis. Bioactive evaluation of inhibition on DDC enzyme assay showed that the new compounds were inactive.

Grain consumption and risk of gastric cancer: a meta-analysis

This study evaluated the relationship between grain consumption and the risk of gastric cancer. A total of 19 studies met the inclusion criteria. For whole grain consumption, there was a 13% reduction in the risk of gastric cancer (p = .003), and a subgroup analysis showed that a large amount of whole grain consumption reduced the risk of gastric cancer by 44% (p < .001). For refined grain consumption, there was a 36% increase in the risk of gastric cancer (p < .001); a subgroup analysis showed that a large and a moderate amount of refined grain consumption increased the risk of gastric cancer by 63% (p < .001) and 28% (p < .001), respectively. A large intake of whole grains might be protective against gastric cancer, whereas the ingestion of refined cereals may be a risk factor for gastric cancer. Moreover, the risk of cancer increases with the increase of refined grain intake.

Two new phenylpropanoid esters from Bulbophyllum retusiusculum

Two new phenylpropanoid esters bobulretulates A (1) and B (2), together with eleven known compounds, were isolated from the whole plants of Bulbophyllum retusiusculum. Their structures were elucidated by means of extensive spectroscopic analysis.

The association between vascular endothelial growth factor gene polymorphisms and stroke: A PRISMA-compliant meta-analysis

BACKGROUND

Numerous studies showed that vascular endothelial growth factor (VEGF) gene polymorphisms were linked with the regularity of stroke, but the results remained controversial. The aim of this meta-analysis was to determine the associations between VEGF gene polymorphisms and the risk of stroke.

METHODS

A systematic literature search of PubMed, Embase, Wed of Science, The Cochrane Library, Elsevier, China National Knowledge Infrastructure, China Biology Medicine disc, WanFang Data, VIP Database for Chinese Technical Periodicals, and Science paper Online was conducted. Two authors independently assessed trial quality and extracted data. The pooled odds ratio (OR) with 95% confidence interval (CI) was used to assess the strength of associations. Begger funnel plot and Egger test were used to estimate the publication bias of included studies. Heterogeneity assumption was assessed by Cochran Chi-squared-based Q-statistic test and I test.

RESULTS

Thirteen publications including 23 trails with a total of 3794 stroke patients and 3094 control subjects were enrolled. About 3747 cases and 2868 controls for +936C/T, 2134 cases and 1424 controls for -2578C/A, and 2187 cases and 1650 controls for -1154G/A were examined, respectively. The results indicated that VEGF +936C/T (T vs C, OR = 1.19, 95% CI = 1.01-1.40) or -2578C/A (A vs C, OR = 1.13, 95% CI = 1.02-1.27) was positively associated with the risk of stroke, whereas there was no association between -1154G/A (A vs G, OR = 0.99, 95% CI = 0.87-1.11) polymorphism and stroke risk in our study. Among the subgroup analyses on ethnicity, the results showed that VEGF +936C/T was an increased risk of stroke in Asian population (T vs C, OR = 1.21, 95% CI = 1.01-1.44), but not -1154G/A.

CONCLUSION

Our findings suggest that VEGF +936C/T and -2578C/A might be related to the risk of stroke, especially in the Asian population, but not -1154G/A.

Two new eremophilane Sesquiterpenoides from Ligularia dictyoneura

Two new eremophilane sesquiterpenoides, 6α,9α-dihydroxyeremophilenolide (1), and 1β,10β-dihydroxyeremophilenolide (2), along with ten known eremophilane sesquiterpenoides (3-12) were isolated from the aerial parts of Ligularia dictyoneura (Franch.) Hand.-Mazz. Their structures were elucidated by means of extensive spectroscopic analysis. Compounds 3-6 were assessed for their cytotoxicity against five human cancer cell lines (HL-60, SMMC-7721, A-549, MCF-7 and SW-480), and the result showed that they had no activity.

Trimethylamine-N-oxide promotes brain aging and cognitive impairment in mice

Gut microbiota can influence the aging process and may modulate aging‐related changes in cognitive function. Trimethylamine‐N‐oxide (TMAO), a metabolite of intestinal flora, has been shown to be closely associated with cardiovascular disease and other diseases. However, the relationship between TMAO and aging, especially brain aging, has not been fully elucidated. To explore the relationship between TMAO and brain aging, we analysed the plasma levels of TMAO in both humans and mice and administered exogenous TMAO to 24‐week‐old senescence‐accelerated prone mouse strain 8 (SAMP8) and age‐matched senescence‐accelerated mouse resistant 1 (SAMR1) mice for 16 weeks. We found that the plasma levels of TMAO increased in both the elderly and the aged mice. Compared with SAMR1‐control mice, SAMP8‐control mice exhibited a brain aging phenotype characterized by more senescent cells in the hippocampal CA3 region and cognitive dysfunction. Surprisingly, TMAO treatment increased the number of senescent cells, which were primarily neurons, and enhanced the mitochondrial impairments and superoxide production. Moreover, we observed that TMAO treatment increased synaptic damage and reduced the expression levels of synaptic plasticity‐related proteins by inhibiting the mTOR signalling pathway, which induces and aggravates aging‐related cognitive dysfunction in SAMR1 and SAMP8 mice, respectively. Our findings suggested that TMAO could induce brain aging and age‐related cognitive dysfunction in SAMR1 mice and aggravate the cerebral aging process of SAMP8 mice, which might provide new insight into the effects of intestinal microbiota on the brain aging process and help to delay senescence by regulating intestinal flora metabolites.

Primary kidney malignant epithelioid angiomyolipoma: Two cases report and review of literature

RATIONALE

Epithelioid angiomyolipoma (EAML) is a subtype of angiomyolipoma with malignant potential. A diagnosis of malignant EAML of the kidney is based on extrarenal metastasis, and predicting early transformation is difficult. To propose criteria for indicators of malignant transformation, herein we report 2 cases and review 17 cases reported in the literature (2000-2017).

PATIENT CONCERNS

Tumor of the kidney was determined in 2 patients, and tissues after nephrectomy were pathologically, histologically, and immunochemically examined.

DIAGNOSIS

Malignant EAML.

INTERVENTION

The 2 present patients were treated with nephrectomy only.

OUTCOMES

Case 1 involved a 48-year-old woman with a 7.5-cm solid mass in the right kidney who underwent nephrectomy. CT detected a mass in the liver after 13 months, which was speculated to be metastasis from the kidney lesion. Case 2 involved a 62-year-old man with a 7-cm cystic solid mass in the left kidney who accepted nephrectomy and at 10 months post-surgery lived with no disease. Both cases presented a large tumor, atypical epithelioid cells, mitotic figures, and necrosis; tested positive for melanocytic markers (HMB45, MelanA).

LESSONS

The literature review of malignant EAML led to the identification of 8 malignant features: size ≥5 cm; metastasis; infiltration; necrosis; ≥50% atypical epithelioid cells; cytologic atypia; atypical mitosis; and vessel invasion. The co-existence of at least 5 of these is proposed to indicate malignant EAML. Features of our 2 new cases of primary malignant EAML of the kidney matched these criteria. Our proposal of criteria for predicting malignant feature, based on 2 new cases and 17 cases in the literature, should aid understanding and avoid misdiagnosis. Nephrectomy is currently the common treatment strategy for malignant EAML, but more effective treatment strategies are needed to provide a better prognosis for patients.