Pathogenicity and virulence of Helicobacter pylori: A paradigm of chronic infection

Infection with Helicobacter pylori is one of the most common infections of mankind. Infection typically occurs in childhood and persists for the lifetime of the host unless eradicated with antimicrobials. The organism colonizes the stomach and causes gastritis. Most infected individuals are asymptomatic, but infection also causes gastric and duodenal ulceration, and gastric cancer. H. pylori possesses an arsenal of virulence factors, including a potent urease enzyme for protection from acid, flagella that mediate motility, an abundance of outer membrane proteins that can mediate attachment, several immunomodulatory proteins, and an ability to adapt to specific conditions in individual human stomachs. The presence of a type 4 secretion system that injects effector molecules into gastric cells and subverts host cell signalling is associated with virulence. In this review we discuss the interplay of H. pylori colonization and virulence factors with host and environmental factors to determine disease outcome in infected individuals.

Hypoxia-regulated miR-103-3p/FGF2 axis in adipose-derived stem cells promotes angiogenesis by vascular endothelial cells during ischemic tissue repair

BACKGROUND

Identifying factors mediating adipose-derived stem cells (ADSCs)-induced endothelial cell angiogenesis in hypoxic skin flap tissue is critical for reconstruction. While the paracrine action of VEGF by adipose-derived stem cells (ADSCs) is established in promoting endothelial cell angiogenesis, the role of FGF2 and its regulatory mechanisms in ADSCs paracrine secretion remains unclear.

METHODS

We induced hypoxia and examined the expression level of FGF2 in ADSCs using ELISA, qRT-PCR, and western blotting. Proliferation of ADSCs under hypoxia was assessed using a CCK-8 assay. Co-culture experiments of hypoxia-induced ADSCs with vascular endothelial cells were conducted, and migration and tube formation abilities were evaluated through wound healing assays, transwell cell migration, and tube formation experiments.

RESULTS

Hypoxia treatment induced significant upregulation of FGF2 expression in ADSCs, along with enhanced cell proliferation. Co-culture of hypoxia-induced ADSCs with vascular endothelial cells showed increased migration and tube formation abilities of endothelial cells. Knockdown of FGF2 inhibited these processes, while overexpression of miR-103-3p mimics in ADSCs suppressed endothelial cell migration and tube formation. FGF2 is a direct target of miR-103-3p in ADSCs. miR-103-3p/FGF2 axis regulates ADSCs on the biological activity of co-cultured vascular endothelial cells. Moreover, in the ischemic skin flap nude mouse model, ADSCs injection showed increased blood vessel formation and reduced flap necrosis, with the most significant improvement observed with ADSCs of miR-103-3p inhibitor overexpressed.

CONCLUSION

Hypoxia induces paracrine secretion of FGF2 from ADSCs, which enhances endothelial cell angiogenesis. FGF2 expression is regulated by miR-103-3p in ADSCs. The miR-103-3p/FGF2 axis induces endothelial cell migration and angiogenesis and finally modulates ischemic skin flap repair in nude mice in vivo.

Influence of antiplatelet drugs on gastric ulcer healing after endoscopic submucosal dissection in patients with early gastric cancer

Objectives

The causes of drug-induced gastroduodenal injuries primarily include antithrombotic drugs, including low-dose aspirin, non-steroidal anti-inflammatory drugs, and corticosteroids. These drugs are suspected to affect gastric ulcer healing after endoscopic submucosal dissection (ESD). This study aimed to investigate the effects of these drugs on post-ESD ulcer healing.

Methods

This study included 170 lesions (149 patients) who had undergone ESD for early gastric cancer. Post-ESD ulcers were endoscopically measured on the 1st, 28th, and 56th days after ESD and were analyzed to identify potential risk factors for delayed ulcer healing among patients taking antiplatelet drugs, anticoagulant drugs, non-steroidal anti-inflammatory drugs, corticosteroids, and no drugs.

Results

Multivariate analysis for the frequency of scarring on the 56th day after ESD showed that antiplatelet drugs (odds ratio [OR], 3.905; p = 0.017), ulcer size of ≥40 mm on the first day (OR, 4.903; p = 0.006), hemoglobin A1c ≥6.5% (OR 7.659, p = 0.012), and age of ≥75 (OR, 5.227; p = 0.007) were independent risk factors of delayed ulcer healing. Anticoagulant drugs, non-steroidal anti-inflammatory drugs, and corticosteroids were not significant factors. Among antiplatelet drugs, the ulcer reduction ratio for clopidogrel on the 28th day after ESD was 84.8%, which was significantly lower than the ulcer reduction ratio of 92.8% for no drug (p < 0.05).

Conclusions

As antiplatelet drugs, particularly clopidogrel, may delay gastric ulcer healing after ESD, careful endoscopic follow-up and drug therapy are suggested for patients taking these drugs.

Management of gastrointestinal bleed in the intensive care setting, an updated literature review

Gastrointestinal (GI) bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit (ICU). This literature review consolidates current insights on the epidemiology, etiology, management, and outcomes of GI bleeding in critically ill patients. GI bleeding remains a significant concern, especially among patients with underlying risk factors such as coagulopathy, mechanical ventilation, and renal failure. Managing GI bleeding in the ICU requires a multidisciplinary approach, including resuscitation, endoscopic intervention, pharmacologic therapy, and sometimes surgical procedures. Even with enhanced management strategies, GI bleeding in the ICU is associated with considerable morbidity and mortality, particularly when complicated by multi-organ failure. This review reiterates the need for adequate resuscitation and interventions in managing GI bleeding in critically ill patients, aiming to enhance survival rates and improve the quality of care within the ICU setting.

Traditional Chinese medicine for chronic atrophic gastritis: Efficacy, mechanisms and targets

Chronic atrophic gastritis (CAG) is an important stage of precancerous lesions of gastric cancer. Effective treatment and regulation of CAG are essential to prevent its progression to malignancy. Traditional Chinese medicine (TCM) has shown multi-targeted efficacy in CAG treatment, with advantages in enhancing gastric mucosal barrier defense, improving microcirculation, modulating inflammatory and immune responses, and promoting lesion healing, etc. Clinical studies and meta-analyses indicate that TCM provides significant benefits, with specific Chinese herbal compounds and monomers demonstrating protective effects on the gastric mucosa through mechanisms including anti-inflammation, anti-oxidation, and regulation of cellular proliferation and apoptosis, etc. Finally, it is pointed out that the efficacy of TCM in the treatment of CAG requires standardized research and unified standards, and constantly clarifies and improves the evaluation criteria of each dimension of gastric mucosal barrier function.

Protective effects of vincamine against ethanol-induced gastric ulcer by attenuation of IL-6, IL-1β, and TNF-α mRNA expression levels in the gastric mucosa of BALB/c mice

Vincamine, a monoterpenoid alkaloid, and an active constituent of plant Catharanthus roseus Linn, has been proclaimed for antioxidant and anti-inflammatory activities. This study was designed to evaluate the gastroprotective activity of Vincamine by ameliorating gastric ulcer in BALB/c mice. The study was also designed to find the possible mechanism of gastric protection by exploring the impact of Vincamine on gastric pH, acidic content, observing histopathology and molecular expression of inflammatory mediators like Interleukin- β (IL-1β), Interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF- α) and oxidative stress markers in the gastric tissue. A total number of 36 BALB/c mice were divided into 6 groups mainly normal control (NC) treated with normal saline, disease control (DC) treated with high dose of absolute ethanol (5ml/kg) while treatment groups involved pretreatment with low- dose Vincamine (VLD) at 10mg/kg body weight, medium-dose vincamine (VMD) at 20mg/kg body weight and high- dose vincamine (VHD) at 40mg/kg body weight before ethanol high dose administration and reference drug control, omeprazole (OMT) at the dose of 20 mg/kg body weight. Molecular expression levels of mRNA expressions of inflammatory cytokines like IL-1β, IL-6 and TNF- α were evaluated by using reverse transcription real time polymerase chain reaction method (RT-PCR). Pre-treatment of DC group with low (VLD), medium (VMD) and high doses (VHD) of vincamine improved gastric ulcer score and ameliorated histopathological parameter such as, infiltration of inflammatory cells, edema, fibrinoid necrosis, hemorrhage, and erosion score when compared to DC group. Induction of gastric model significantly increased (all P < 0.05) the mRNA expression of IL-1β, IL-6 and TNF- α in the gastric tissue when same was compared to normal control group (NC). Pretreatment of DC group with different doses of vincamine (VLD, VMD and VHD) significantly downregulated (all P < 0.05) the mRNA expressions of IL-1β, IL-6 and TNF- α and ameliorated oxidative stress marker MDA and increased antioxidant markers like SOD and GSH in the gastric tissue when same was compared to the DC group. In a nutshell, vincamine provide gastric protection in the BALB/c mice of gastric ulcer group by increasing the gastric pH, attenuated total acidity of the stomach and modulated infiltration of inflammatory cells, edema, fibrinoid necrosis, hemorrhage, and erosion score when compared to the DC group. Furthermore, vincamine possesses antiulcer and gastroprotective activity which may be ascribed to down-regulation the mRNA expression of IL-1β, IL-6 and TNF- α in the gastric tissue of disease control group. Vincamine also provide gastroprotective role by increasing the concentration of SOD and GSH while decreasing the MDA in gastric tissue.

Rebamipide in gastric mucosal protection and healing: An Asian perspective

This review emphasizes the exemplary safety and efficacy of rebamipide in the treatment of gastric ulcers and other mucosa-related disorders, positioning it as a viable candidate for inclusion in treatment guidelines across India and globally. An in-depth literature review of rebamipide was carried out on PubMed and Google Scholar. Rebamipide has a multifaceted mechanism of action, including prostaglandin synthesis, scavenging free radicals, and enhancing mucin production, leading to enhanced mucosal protection and ulcer healing. Rebamipide serves as a highly effective and safe treatment option for gastric ulcers and gastroesophageal reflux disease. The efficacy of this drug in treating ulcers often surpasses that of routinely used agents such as pantoprazole, sucralfate, misoprostol, famotidine, lansoprazole, and esomeprazole. This superiority of rebamipide can be attributed to the low rate of adverse events associated with it and its mild side effects, contributing to its widespread adoption across Southeast Asia and Russia. This popularity extends to its application beyond gastrointestinal ailments. Notably, it has been successfully employed in the treatment of ophthalmological, oncological, and bone regeneration-related issues. Rebamipide's exemplary safety and efficacy in treating gastric ulcers and other mucosa-related disorders support its potential for inclusion in treatment guidelines, not only in India but also globally.

Skin-Integrated Electrogenetic Regulation of Vasculature for Accelerated Wound Healing

Neo-vascularization plays a key role in achieving long-term viability of engineered cells contained in medical implants used in precision medicine. Moreover, strategies to promote neo-vascularization around medical implants may also be useful to promote the healing of deep wounds. In this context, a biocompatible, electroconductive borophene-poly(ε-caprolactone) (PCL) 3D platform is developed, which is called VOLT, to support designer cells engineered with a direct-current (DC) voltage-controlled gene circuit that drives secretion of vascular endothelial growth factor A (VEGFA). The VOLT platform consists of a 3D-printed borophene-PCL honeycomb-shaped matrix decorated with borophene-PCL nanofibers by electrospinning. The honeycomb structure provides mechanical stability, while the nanofibers facilitate the adhesion, migration, and proliferation of the engineered cells. The cells incorporate a DC-powered reactive oxygen species (ROS)-sensing gene circuit wired to an engineered synthetic promoter that triggers secretion of VEGFA to promote vascularization in the adjacent extracellular matrix. Cells engineered with this gene circuit and enclosed in the VOLT matrix, termed the VOLTVEGFA system, can be simply triggered using off-the-shelf AA batteries, utilizing the established ability of a brief DC bias to generate non-cytotoxic levels of ROS. For proof-of-concept, a subcutaneous wound-healing model in rats is chosen. Electrostimulation of a VOLTVEGFA implant (5 V, 20 s per day) induced secretion of VEGFA, and significantly accelerated neovascularization and granulation tissue formation, resulting in faster wound closure compared with non-stimulated controls. Complete re-epithelialization and dermal regeneration are observed within 15 days of application.

Emerging role of bile acids in colorectal liver metastasis: From molecular mechanism to clinical significance (Review)

Liver metastasis is the leading cause of colorectal cancer (CRC)‑related mortality. Microbiota dysbiosis serves a role in the pathogenesis of colorectal liver metastases. Bile acids (BAs), cholesterol metabolites synthesized by intestinal bacteria, contribute to the metastatic cascade of CRC, encompassing colorectal invasion, migration, angiogenesis, anoikis resistance and the establishment of a hepatic pre‑metastatic niche. BAs impact inflammation and modulate the immune landscape within the tumor microenvironment by activating signaling pathways, which are used by tumor cells to facilitate metastasis. Given the widespread distribution of BA‑activated receptors in both tumor and immune cells, strategies aimed at restoring BA homeostasis and blocking metastasis‑associated signaling are of importance in cancer therapy. The present study summarizes the specific role of BAs in each step of colorectal liver metastasis, elucidating the association between BA and CRC progression to highlight the potential of BAs as predictive biomarkers for colorectal liver metastasis and their therapeutic potential in developing novel treatment strategies.

Machine Learning-Based Pathomics Model Predicts Angiopoietin-2 Expression and Prognosis in Hepatocellular Carcinoma

Angiopoietin-2 (ANGPT2) shows promise as prognostic marker and therapeutic target in hepatocellular carcinoma (HCC). However, assessing ANGPT2 expression and prognostic potential using histopathology images viewed with naked eye is challenging. Herein, machine learning was employed to develop a pathomics model for analyzing histopathology images to predict ANGPT2 status. HCC cases obtained from The Cancer Genome Atlas (TCGA-HCC; n = 267) were randomly assigned to the training or testing set, and cases from a single center were employed as a validation set (n = 91). In the TCGA-HCC cohort, the group with high ANGPT2 expression had a significantly lower overall survival compared with the group with low ANGPT2. Histopathologic features in the training set were extracted, screened, and incorporated into a gradient-boosting machine model that generated a pathomics score, which successfully predicted ANGPT2 expression in the three data sets and showed remarkable risk stratification for overall survival in both the TCGA-HCC (P < 0.0001) and single-center cohorts (P = 0.001). Multivariate analysis suggested that the pathomics score could serve as a predictor of prognosis (P < 0.001). Bioinformatics analysis illustrated a distinction in tumor growth and development related gene-enriched pathways, vascular endothelial growth factor-related gene expression, and immune cell infiltration between high and low pathomics scores. This study indicates that the use of histopathology image features can enhance the prediction of molecular status and prognosis in HCC. The integration of image features with machine learning may improve prognosis prediction in HCC.

Bletilla ochracea Schltr. protects against ethanol-induced acute gastric ulcers by alleviating oxidative stress and inflammation and modulating gut microbiota

Gastric ulcers (GUs) are superficial diffuse lesions of the gastric mucosa that are characterised by being vulnerable to infection, difficult to cure and liable to recur. Bletilla ochracea Schltr. (BO) has the effects of astringent hemostasis, muscle growth and pain relief. We examined the effects of BO on acute GUs and their potential mechanisms from the perspectives of inflammation, oxidative stress and gut microbiota. Results indicated that BO alleviated pathological injury to the gastric mucosa and markedly alleviated oxidative stress and inflammation. In addition, BO significantly upregulated the levels of Nrf2, HO-1, NQO1 protein, and downregulated the levels of NF-κB p65, TLR4 protein. Moreover, BO significantly increased promoting the nuclear transfer of Nrf2 and markedly reduced the nuclear translocation of NF-κB p65. Furthermore, BO effectively modulated gut microbiota by increasing the diversity of species and relative abundance. Our study provided evidence that BO alleviated ethanol-induced acute GUs by activating the Nrf2/HO-1 and inhibiting the NF-κB p65/TLR4 signalling pathway, regulating dysbiosis of gut microbiota.

De-coding the complex role of microbial metabolites in cancer

The human microbiome, an intricate ecosystem of trillions of microbes residing across various body sites, significantly influences cancer, a leading cause of morbidity and mortality worldwide. Recent studies have illuminated the microbiome's pivotal role in cancer development, either through direct cellular interactions or by secreting bioactive compounds such as metabolites. Microbial metabolites contribute to cancer initiation through mechanisms such as DNA damage, epithelial barrier dysfunction, and chronic inflammation. Furthermore, microbial metabolites exert dual roles on cancer progression and response to therapy by modulating cellular metabolism, gene expression, and signaling pathways. Understanding these complex interactions is vital for devising new therapeutic strategies. This review highlights microbial metabolites as promising targets for cancer prevention and treatment, emphasizing their impact on therapy responses and underscoring the need for further research into their roles in metastasis and therapy resistance.

Early-stage immunoexpression of inflammatory, angiogenic, and survival markers in tongue epithelium of mice exposed to hookah smoke

OBJECTIVE

The objective was to evaluate the early-stage immunoexpression of markers (COX-2, NF-kB, VEGFR-1 and apoptotic index) related to inflammation, angiogenesis, and cell survival in the tongue dorsum epithelium of mice exposed to hookah smoke.

MATERIALS AND METHODS

The sample consisted of Swiss mice (N = 20), female gender, aged 2 months, and approximately 25g each, four groups (n = 5) mice: group exposed to fresh air and groups exposed to hookah smoke for 7, 15, and 30 days. Tongues were embedded in paraffin. A tissue microarray was constructed, and immunohistochemistry was performed for Cyclooxygenase 2, NF-kappa B, Vascular Endothelial Growth Factor Receptor 1, and terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) for apoptotic analysis. The positive and negative cells were quantified in the epithelium of the mid-dorsal tongue region. Kruskal-Wallis and Dunn tests was made.

RESULTS

The apoptotic index was higher at 30 days of smoke exposure (20.38% basal/ 19.63%/ suprabasal) compared to the group exposed to air (9.55%/ 11.88%), The expression of Vascular Endothelial Growth Factor Receptor 1 was higher at 30 days of smoke exposure (30.15%/ 38.15%) compared to the group exposed to air (18.25%/ 3.60%).

CONCLUSION

Hookah smoke induced greater apoptosis and increased expression of Vascular Endothelial Growth Factor Receptor 1 in the epithelium of the tongue at 30 days, potentially playing a role in the initial stages of carcinogenesis, in the early stages of hookah use.

Nociceptive neurons promote gastric tumour progression via a CGRP-RAMP1 axis

Cancer cells have been shown to exploit neurons to modulate their survival and growth, including through the establishment of neural circuits within the central nervous system1-3. Here we report a distinct pattern of cancer-nerve interactions between the peripheral nervous system and gastric cancer. In multiple mouse models of gastric cancer, nociceptive nerves demonstrated the greatest degree of nerve expansion in an NGF-dependent manner. Neural tracing identified CGRP+ peptidergic neurons as the primary gastric sensory neurons. Three-dimensional co-culture models showed that sensory neurons directly connect with gastric cancer spheroids. Chemogenetic activation of sensory neurons induced the release of calcium into the cytoplasm of cancer cells, promoting tumour growth and metastasis. Pharmacological ablation of sensory neurons or treatment with CGRP inhibitors suppressed tumour growth and extended survival. Depolarization of gastric tumour membranes through in vivo optogenetic activation led to enhanced calcium flux in jugular nucleus complex and CGRP release, defining a cancer cell-peptidergic neuronal circuit. Together, these findings establish the functional connectivity between cancer and sensory neurons, identifying this pathway as a potential therapeutic target.

Human milk as a complex natural product

Covering: up to the end of 2024Breastfeeding is one of the most effective ways to promote child health. However, characterizing the chemistry that fortifies the benefits of breastfeeding remains a grand challenge. Current efforts in the community are focused on characterizing the roles of the different carbohydrates, proteins, and fats in milk. The goal of this review is to highlight and describe current knowledge about the major classes of macromolecules in human milk and their potential role in infant health and wellness.

Relationship between gastric mucosal atrophy, cystic dilatation, and histopathological characteristics

OBJECTIVE

This study aims to elucidate the relationship between gastric mucosal atrophy, cystic dilatation, and their associated histopathological characteristics.

METHODS

A comprehensive analysis was conducted on endoscopic biopsy specimens from 527 cases exhibiting gastric mucosal cystic dilatation. Detailed histological observations and immunohistochemical analysis were performed.

RESULTS

This study included 527 endoscopic biopsy and ESD samples, with a male predominance of 313 cases (59.4%) and 214 female cases (40.6%). The age distribution was as follows: 207 cases (39.3%) were ≤ 60 years, while 320 cases (60.7%) were > 60 years. Regarding cystic dilatation types, 287 cases (54.5%) were identified as simple cystic dilatation, and 240 cases (45.5%) were classified as compound cystic dilatation. Gastric mucosal atrophy was observed in all cases of cystic dilatation, with the atrophic process initially disrupting the structural integrity of the gastric glands. This led to increased interstitial tissue and widening of glandular septa, followed by compensatory hyperplasia and cystic cavity formation. Simple cystic dilatation (54.5%) and compound cystic dilatation (45.5%) were distinguished based on the extent of cellular and structural changes. Simple cystic dilatation could progress to early gastric cancer, presenting as gastric papillary cystadenocarcinoma, while compound cystic dilatation could lead to tubular papillary adenocarcinoma. The progression from simple to complex lesions involved low- and high-grade intraepithelial neoplasia, ultimately resulting in mixed cystadenocarcinoma-glandular tube papillary carcinoma, indicative of early-stage gastric cancer.

CONCLUSION

The classification, grading, and histopathological characteristics of cystic dilatation in the gastric mucosa are crucial for guiding clinicians in precise treatment and vigilant monitoring of malignant transformation. This approach is significant for the prevention and control of gastric cancer progression.

In situ albumin tagging for targeted imaging of endothelial barrier disruption

The endothelial barrier (EB) is a critical component of the body's homeostatic mechanisms, thus developing effective imaging techniques to visualize its integrity is essential. The EB disruption is accompanied by the alternations in permeability and even the breakdown of tight junctions (TJs), leading to the leakage of albumin; thus, albumin can serve as a biomarker for EB disruption. Herein, we develop an albumin-specific, covalently tagged near-infrared II (NIR-II) dye, with its high selectivity for endogenous albumin, for targeted imaging EB disruption. Our albumin-tagging dye serves as a chromophore to construct NIR-II fluorescent proteins in situ, with substantially improved brightness. Thus, through in situ dye tagging of endogenous albumin as the efficient "targeting agent," we can precisely image disruptions in various endothelial barriers. Unlike the traditional exogenous targeting agents (e.g., dye-labeled antibodies) with enzymatic degradation or immune system capture issues, in situ albumin tagging demonstrates superhigh performance for targeted imaging.

Rapid-release and user-friendly costunolide/dehydrocostuslactone hydrophilic nanofibers: Therapeutic effects on acute gastric ulcers

Gastric ulcers often cause postprandial epigastric pain, especially in acute cases. Abnormal motility, with about 50 % of patients having delayed gastric emptying, contributes to ulcer development. Costunolide (COS) and dehydrocostuslactone (DEH), derived from "Mu xiang" herbs, show potential in treating ulcers and regulating gastrointestinal motility. However, their poor solubility and bioavailability limit in vivo use. This study uses electrospinning to develop hydrophilic nanofibers loaded with COS and DEH in a polyvinylpyrrolidone (PVP) matrix for treating acute gastric ulcers. The production process for costunolide / dehydrocostuslactone nanofibers (COS/DEH/NFs) was optimized, characterized, and tested in pharmacodynamic studies. The results showed that COS and DEH remained in a non-crystalline state within COS/DEH/NFs, enhancing their in vitro release. With 21 % drug incorporation, COS/DEH/NFs released over 70 % of COS and more than 50 % of DEH within 20 min in body fluids. In treatment, COS/DEH/NFs suppressed pro-inflammatory cytokines, resisted oxidative stress, promoted gastric mucosal repair, and enhanced gastrointestinal motility. In a mouse model of acute gastric ulcer, high-dose COS/DEH/NFs achieved a 77.09 % ulcer inhibition rate, and low-dose COS/DEH/NFs resulted in gastric residual and intestinal propulsion rates of 73.55 % and 69.89 %, respectively. The drug loading of COS/DEH/NFs is 14.76 ± 0.26 %, with an encapsulation efficiency of 68.77 ± 1.14 %. COS/DEH/NFs is a new choice for treating acute gastric ulcers with gastrointestinal bloating due to its convenience and swallow-free use, providing rapid symptom relief.

Antarctic Krill Protein Amyloid Fibrils as a Novel Iron Carrier for the Improvement of Iron Deficiency

Iron fortification with food supplements remains the primary dietary strategy for improving iron deficiency anemia (IDA). This study used Antarctic krill protein for fibrillar design to form an Antarctic krill protein amyloid fibril (AKAF). The results indicated that peptides generated by proteolysis were a prerequisite for fibril assembly, forming elongated fibril structures and cross-linking upon heating. During this process, hydrogen bonds were rearranged, forming ordered β-sheet conformations (49.36 ± 0.21%); π-π stacking interactions among aromatic residues contributed to fibril formation. Further studies showed that AKAF effectively maintained iron in a bioavailable state and exhibited a high binding capacity (60.67 ± 0.69%). Moreover, the AKAF-iron complex markedly ameliorated hematological abnormalities in IDA mice, enhanced iron storage in the liver and spleen, and positively influenced the expression of iron homeostasis genes. This complex was also effective in alleviating gastric inflammatory responses induced by IDA. Overall, AKAF holds promise as an efficient iron delivery carrier.

Targeting Helicobacter pylori Through the "Muco-Microbiotic Layer" Lens: The Challenge of Probiotics and Microbiota Nanovesicles

The muco-microbiotic layer represents a critical biological frontier in gastroenterology, emphasizing the intricate interplay between the protective mucus, its resident microbiota, and extracellular vesicles. This review explores the functional morphology of the gastric mucosa, focusing on the gastric muco-microbiotic layer, its role as a protective barrier, and its dynamic interaction with some of the most insidious pathogens such as Helicobacter pylori (H. pylori). Highlighting the multifaceted mechanisms of H. pylori pathogenesis, we have delved into bacterial virulence factors, host immune responses, and the microbiota's regulatory effects. Novel therapeutic strategies for H. pylori eradication, including traditional antibiotic therapies and emerging adjuvant treatments like probiotics and probiotic-derived extracellular vesicles, are critically examined. These findings underscore the potential of targeting nanovesicular interactions in the gastric mucosa, proposing a paradigm shift in the management of H. pylori infections to improve patient outcomes while mitigating antibiotic resistance.

Gastroprotective effect of fucoidan from Sargassum siliquastrum against ethanol-induced gastric mucosal injury

The ethanol-induced BALB/c mice and human gastric epithelial cell (Ges-1 cell) models were used to investigate the Sargassum siliquastrum fucoidan (SFuc) gastroprotective capability. The injury score and histopathological sections of the stomach were used to evaluate the gastroprotective capability. The western blotting and RT-PCR methods determined the signaling mechanism of mice's gastric injury. SFuc is fucoidan with a molecular weight of 300.7 and 25.1 kDa. The injury score and ulcer index of the SFuc-200 group decreased by 3.85 and 2.06 folds in contrast with the Model group, respectively. The findings indicated that SFuc reduced oxidative stress and inflammatory factor expression in the gastric mucosa by downregulating the levels of associated genes within the TLR-4, MyD88, and MAPK/NF-κB signaling pathways. Meanwhile, the SFuc-200 group promoted the expressions of EGF and PGE 2 by 1.53 and 1.52 folds, respectively. Together with the expression inhibition of p38, ERK, JNK, and NF-κB proteins in gastric tissue to help for differentiation of gastric cells. In addition, SFuc significantly reduced apoptosis occurrence in mice and Ges-1 cells. Our study provides potential mechanism clues of the SFuc's resistance to ethanol-induced gastric mucosal damage, suggesting its potential functional food for gastric protection.

Using β-Elemene to reduce stemness and drug resistance in osteosarcoma: A focus on the AKT/FOXO1 signaling pathway and immune modulation

Objective

Osteosarcoma, a highly malignant bone tumor, poses significant treatment challenges due to its propensity for stemness and drug resistance, particularly against doxorubicin (DOX). This study aims to investigate the mechanism by which β-elemene reduces the stemness of osteosarcoma stem cells and ultimately decreases DOX resistance by inhibiting the Akt/FoxO1 signaling pathway and activating a macrophage-mediated inflammatory microenvironment.

Methods

Osteosarcoma stem cells were isolated and induced for DOX resistance. In vitro and in vivo models were employed to assess β-elemene's impact on cell viability, stemness, and drug resistance. Bioinformatics analysis, flow cytometry, and immunofluorescence staining were used to evaluate signaling pathway activity and macrophage polarization. Additionally, an osteosarcoma xenograft mouse model was established to confirm the therapeutic effects of β-elemene.

Results

In vivo animal experiments demonstrated that β-elemene reduces osteosarcoma resistance. Bioinformatics analysis revealed that AKT1 is a key core gene in osteosarcoma progression, acting through the FOXO signaling pathway. Additionally, AKT inhibits immune cell infiltration in osteosarcoma and suppresses immune responses during osteosarcoma progression. β-elemene may influence osteosarcoma progression by mediating TP53 to regulate PTEN and subsequently AKT1. In vitro experiments showed that β-elemene promotes M1 macrophage activation by inhibiting the Akt/FoxO1 signaling axis, thereby reducing the stemness of osteosarcoma stem cells. Finally, in vivo animal experiments confirmed that β-elemene reduces osteosarcoma resistance by promoting M1 macrophage activation through inhibition of the Akt/FoxO1 signaling axis.

Conclusion

β-Elemene demonstrates promising potential in reducing osteosarcoma stemness and drug resistance via dual mechanisms: targeting the AKT/FOXO1 pathway and modulating the tumor immune microenvironment. These findings suggest β-elemene as a potential adjunct therapy for osteosarcoma, providing novel therapeutic strategies to overcome chemotherapy resistance and improve patient outcomes.

High paracrine activity of hADSCs cartilage microtissues inhibits extracellular matrix degradation and promotes cartilage regeneration

Due to its unique structure, articular cartilage has limited self-repair capacity. Microtissues are tiny tissue clusters that can mimic the function of target organs or tissues. Using cells alone for microtissue construction often results in the formation of necrotic cores. However, the extracellular matrix (ECM) of native cartilage can provide structural support and is an ideal source of microcarriers. Autologous adipose-derived mesenchymal stem cells (ADSCs) and bone marrow mesenchymal stem cells (BMSCs) are widely used in cartilage tissue engineering. In this study, we fabricated microcarriers and compared the behavior of two homologous cell types in the microcarrier environment. The microcarrier environment highlighted the advantages of ADSCs and promoted the proliferation and migration of these cells. Then, ADSCs microtissues (ADSCs-MT) and BMSCs microtissues (BMSCs-MT) were fabricated using a three-dimensional dynamic culture system. In vitro and in vivo experiments verified that the cartilage regeneration ability of ADSCs-MT was significantly superior to that of BMSCs-MT. Transcriptomics revealed that ADSCs-MT showed significantly lower expression levels of ECM degradation, osteogenesis, and fibrocartilage markers. Finally, the protective effect of microtissues on inflammatory chondrocytes was validated. Overall, the ADSCs-MT constructed in this study achieved excellent cartilage regeneration and could be promising for the autologous application of cartilage microtissues.

Organoids, tissue slices and organotypic cultures: Advancing our understanding of pancreatic ductal adenocarcinoma through in vitro and ex vivo models

Pancreatic ductal adenocarcinoma (PDAC) has one of the worst prognoses of all common solid cancers. For the large majority of PDAC patients, only systemic therapies with very limited efficacy are indicated. In addition, immunotherapies have not brought the advances seen in other cancer types. Several key characteristics of PDAC contribute to poor treatment outcomes, and in this review, we will discuss how these characteristics are best captured in currently available ex vivo or in vitro model systems. For instance, PDAC is hallmarked by a highly desmoplastic and immune-suppressed tumor microenvironment that impacts disease progression and therapy resistance. Also, large differences in tumor biology exist between and within tumors, complicating treatment decisions. Furthermore, PDAC has a very high propensity for locally invasive and metastatic growth. The use of animal models is often not desirable or feasible and several in vitro and ex vivo model systems have been developed, such as organotypic cocultures and tissue slices, among others. However, the absence of a full host organism impacts the ability of these models to accurately capture the characteristics that contribute to poor outcomes in PDAC. We will discuss the caveats and advantages of these model systems in the context of PDAC's key characteristics and provide recommendations on model choice and the possibilities for optimization. These considerations should be of use to researchers aiming to study PDAC in the in vitro setting.

Pomegranate as a natural remedy for gastric ulcers prevention: a review of its gastroprotective mechanisms and pharmacological benefits

Gastric ulcers (GUs) represent a common gastrointestinal disorder characterized by mucosal damage and inflammation, often precipitated by factors such as Helicobacter pylori infection and the consumption of COX inhibitors. This comprehensive review investigates the role of oxidative stress and inflammation in the pathogenesis of GUs and assesses the potential therapeutic effects of Punica granatum (pomegranate, Pg) supplementation. Utilizing a series of experimental models, including indomethacin, aspirin, and alcohol-induced ulcers, we demonstrate that Pg extracts possess significant gastroprotective properties. The antioxidant activity of Pg is ascribed to its capacity to neutralize reactive oxygen species (ROS), enhance the activity of endogenous antioxidants such as superoxide dismutase (SOD) and catalase (CAT), and diminish lipid peroxidation. Furthermore, the anti-inflammatory effects of Pg are mediated through the suppression of pro-inflammatory cytokines such as TNF-α and IL-1β, in conjunction with the promotion of gastric mucosal protective agents. Histological analyses indicate that Pg extract preserves the architecture of gastric tissue and alleviates ulcer severity. These findings highlight the potential of Pg as a natural remedy for GUs, thereby necessitating further investigation into its mechanisms of action and optimal therapeutic formulations.

A Non-Pharmacological Paradigm Captures the Complexity in the Mechanism of Action of Poliprotect Against Gastroesophageal Reflux Disease and Dyspepsia

When the protective mechanisms of the gastroesophageal mucosa are overwhelmed by injurious factors, the structural and functional mucosal integrity is compromised, resulting in a wide spectrum of disorders. Poliprotect has recently been shown to be non-inferior to standard-dose omeprazole for the treatment of endoscopy-negative patients with heartburn and/or epigastric pain or burning. Here, we provide preclinical data describing the mechanism of action of the Poliprotect formulation, a 100% natural, biodegradable, and environmental friendly medical device according to EU 2017/745 and containing UVCB (unknown or variable composition, complex-reaction products, or biological materials) substances of botanical and mineral origin, according to the REACH and European Chemical Agency definitions. Different in vitro assays demonstrated the capability of Poliprotect to adhere to mucus-secreting gastric cells and concomitantly deliver a local barrier with buffering and antioxidant activity. In studies conducted in accordance with systems biology principles, we evaluated the effects of this barrier on human gastric cells exposed to acidic stress. Biological functions identified via Ingenuity Pathway Analysis highlighted the product's ability to create a microenvironment that supports the mucosal structural and functional integrity, promotes healing, and restores a balanced mucosal inflammatory status. Additionally, transepithelial electrical resistance and an Ussing chamber showed the product's capability of preserving the integrity of the gastric and esophageal epithelial barriers when exposed to an acid solution. Two in vivo models of erosive gastropathy further highlighted its topical protection against ethanol- and drug-induced mucosal injury. Overall, our findings sustain the feasibility of a paradigm shift in therapeutics R&D by depicting a very innovative and desirable mode of interaction with the human body based on the emerging biophysical, rather than the pharmacological properties of these therapeutic agents.

SARS-CoV-2 S-protein expression drives syncytia formation in endothelial cells

SARS-CoV-2 is a viral infection, best studied in the context of epithelial cell infection. Epithelial cells, when infected with SARS-CoV-2 express the viral S-protein, which causes host cells to fuse together into large multi-nucleated cells known as syncytia. Because SARS-CoV-2 infections also frequently present with cardiovascular phenotypes, we sought to understand if S-protein expression would also result in syncytia formation in endothelial cells. S-protein expression in endothelial cells was sufficient to induce the formation of multi-nucleated cells, with an average of 10% of all cells forming syncytia with an average of 6 nuclei per syncytia after 72 h of S-protein expression. Formation of syncytia was associated with the formation of gaps between cells, suggesting the potential for syncytia formation to compromise barrier function. Inhibition of myosin light chain kinase (MLCK), but not Rho-associated protein kinase, inhibited the formation of syncytia, suggesting a role for MLCK in syncytia formation. Further supporting the role of cellular contractility in syncytia formation, we also observed a reduction in the occurrence of syncytia for endothelial cells grown on substrates with reduced stiffness. Because endothelial cells are exposed to physiological forces due to blood flow, we examined the effects of cyclic biaxial stretch and fluid shear stress. While biaxial stretch did not affect syncytia formation, endothelial cells exposed to fluid shear stress were more resistant to syncytia formation. Finally, we observed that endothelial cells are suitable host cells for SARS-CoV-2 viral infection and replication, and that viral infection also causes syncytia formation. Our studies indicate that endothelial cells, in addition to epithelial cells, should also be considered a target for SARS-CoV-2 infection and a driver of COVID-19-associated pathology.

Post-pandemic insights on COVID-19 and premature ovarian insufficiency

The COVID-19 pandemic has raised concerns regarding its potential impact on premature ovarian insufficiency (POI). This overview examines the possible interactions between COVID-19 and POI, while also suggesting preventive measures. The viral infection's inflammatory response and immune dysregulation may adversely affect ovarian tissues, leading to inflammation and damage. Additionally, alterations in vascular function could impair ovarian blood flow and hormonal imbalances may disrupt normal ovarian function. Long-term health effects, such as "long COVID," may exacerbate these issues through chronic inflammation and immune dysfunction. Public health measures, such as vaccination and home isolation, may indirectly protect ovarian health by reducing systemic inflammation. Vaccines could mitigate the severity of COVID-19's impact on ovarian function, while isolation may reduce stress and inflammation. However, further research is needed to validate these mechanisms.

Mucosal snare resection-endoscopic submucosal excavation for gastric submucosal tumors: a retrospective study (with video)

Aims

This study aimed to compare the clinical outcomes of patients with submucosal tumors treated with endoscopic submucosal excavation (ESE) and those treated with mucosal snare resection-endoscopic submucosal excavation (MSR-ESE).

Methods

We retrospectively analyzed clinical data from patients who underwent ESE or MSR-ESE at the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2023 and January 2024. Factors such as operation time, intraoperative perforation, postoperative adverse events, postoperative fasting time, antibiotic use, hospitalization duration, costs, and pathological diagnosis were compared between the two procedures.

Results

A total of 180 patients with submucosal tumors were included in this study. The MSR-ESE group consisted of 75 patients (41.7%), while the ESE group had 105 patients (58.3%). Propensity score matching (PSM) showed no significant differences in postoperative antibiotic use, fasting time, or intraoperative perforation between the two groups (P>0.05). However, the MSR-ESE group demonstrated shorter operation and hospitalization times, lower hospitalization costs, and a reduced incidence of postoperative peritonitis (P<0.05). Multivariate logistic regression analysis identified operation time as an independent risk factor for unplanned intraoperative perforation, with the likelihood of perforation increasing significantly as operation time increased (P=0.007, OR=1.015, 95% CI, 1.004 to 1.026).

Conclusion

MSR-ESE outperforms ESE with shorter operation times, lower costs, and fewer postoperative complications, making it a safe and effective treatment for gastric submucosal tumors.

Mechanobiological Approach for Intestinal Mucosal Immunology

The intestinal area is composed of diverse cell types that harmonize gut homeostasis, which is influenced by both endogenous and exogenous factors. Notably, the environment of the intestine is exposed to several types of mechanical forces, including shear stress generated by fluid flow, compression and stretch generated by luminal contents and peristaltic waves of the intestine, and stiffness attributed to the extracellular matrix. These forces play critical roles in the regulation of cell proliferation, differentiation, and migration. Many efforts have been made to simulate the actual intestinal environment in vitro. The three-dimensional organoid culture system has emerged as a powerful tool for studying the mechanism of the intestinal epithelial barrier, mimicking rapidly renewing epithelium from intestinal stem cells (ISCs) in vivo. However, many aspects of how mechanical forces, such as shear stress, stiffness, compression, and stretch forces, influence the intestinal area remain unresolved. Here, we review the recent studies elucidating the impact of mechanical forces on intestinal immunity, interaction with the gut microbiome, and intestinal diseases.

COX-2 Inhibitor Prediction With KNIME: A Codeless Automated Machine Learning-Based Virtual Screening Workflow

Cyclooxygenase-2 (COX-2) is an enzyme that plays a crucial role in inflammation by converting arachidonic acid into prostaglandins. The overexpression of enzyme is associated with conditions such as cancer, arthritis, and Alzheimer's disease (AD), where it contributes to neuroinflammation. In silico virtual screening is pivotal in early-stage drug discovery; however, the absence of coding or machine learning expertise can impede the development of reliable computational models capable of accurately predicting inhibitor compounds based on their chemical structure. In this study, we developed an automated KNIME workflow for predicting the COX-2 inhibitory potential of novel molecules by building a multi-level ensemble model constructed with five machine learning algorithms (i.e., Logistic Regression, K-Nearest Neighbors, Decision Tree, Random Forest, and Extreme Gradient Boosting) and various molecular and fingerprint descriptors (i.e., AtomPair, Avalon, MACCS, Morgan, RDKit, and Pattern). Post-applicability domain filtering, the final majority voting-based ensemble model achieved 90.0% balanced accuracy, 87.7% precision, and 86.4% recall on the external validation set. The freely accessible workflow empowers users to swiftly and effortlessly predict COX-2 inhibitors, eliminating the need for any prior knowledge in machine learning, coding, or statistical modeling, significantly broadening its accessibility. While beginners can seamlessly use the tool as is, experienced KNIME users can leverage it as a foundation to build advanced workflows, driving further research and innovation.

Advanced dressings based on novel biological targets for diabetic wound healing: A review

The diabetic wound is one of the most common complications of diabetes in clinic. The existing diabetic wound dressings all have bottlenecks in decreasing inflammation, stopping peripheral neuropathy, relieving local ischemia and hypoxia in diabetic wounds. These challenges are intricately linked to the roles of various growth factors, as well as matrix metalloproteinases. Thus, a comprehensive understanding of growth factors-particularly their dynamic interactions with the extracellular matrix (ECM) and cellular components-is essential. Cells and proteins that influence the synthesis of growth factors and matrix metalloproteinases emerge as potential therapeutic targets for diabetic wound management. This review discusses the latest advancements in the pathophysiology of diabetic wound healing, highlights novel biological targets, and evaluates new wound dressing strategies designed for the treatment of diabetic wounds.

Chemical Composition of Mexicali Propolis and Its Effect on Gastric Repair in an Indomethacin-Induced Gastric Injury Murine Model

Propolis is a resinous substance produced by bees that has several biomedical properties that could contribute to the repair process of the gastric mucosa, such as antioxidant, anti-inflammatory, healing, and gastroprotective properties. Thus, this study aimed to determine the chemical composition of Mexicali propolis, its antioxidant capacity, and its effect on gastric repair. Three polarity-directed extracts were obtained: the ethanolic extract, the ethyl acetate extract, and the hexane extract. The antioxidant activity, total phenolic content (TPC), and flavone/flavonol content were determined for each extract. The chemical composition was analysed using HPLC-TOF-MS (High-Performance Liquid Chromatography-Time-Of-Flight Mass Spectrometry) and GC-MS (Gas Chromatography-Mass Spectrometry), and a total of 52 compounds were identified. The results revealed that the ethanolic extract had the greatest effect on free radical scavenging and the content of bioactive compounds. On the basis of these results, the effect of the Mexicali ethanolic extract of propolis (MeEEP) on gastric repair was subsequently evaluated. Prior to the evaluation, MeEEP was found to exhibit low oral toxicity, as determined under the Organisation for Economic Co-operation and Development (OECD) 425 guidelines. Gastric injury was induced in male C57BL/6 mice by intragastric administration of indomethacin (10 mg/kg). MeEEP (300 mg/kg) was administered 6 h after the induction of injury using indomethacin and daily thereafter. The mice were sacrificed at 12, 24, and 48 h to assess the effect. As a result, MeEEP enhanced the repair of the gastric lesion by decreasing the percentage of the bleeding area and attenuating the severity of histological damage, as demonstrated by H&E staining. This effect was associated with a reduction in MPO enzyme activity and in the levels of the proinflammatory cytokines TNF-α, IL-1β, and IL-6, maintaining controlled inflammation in gastric tissue. Furthermore, the administration of the extract increased SOD enzymatic activity and GSH levels, reducing the degree of oxidative damage in the gastric tissue, as demonstrated by low MDA levels. Finally, after evaluating the effect on apoptosis via immunohistochemistry, MeEEP was shown to reduce the expression of the proapoptotic marker Bax and increase the expression of the antiapoptotic marker Bcl-2. In conclusion, these findings suggest that MeEEP may enhance gastric repair through a cytoprotective mechanism by controlling inflammation exacerbation, reducing oxidative stress, and regulating apoptosis. These mechanisms are primarily attributed to the presence of pinocembrin, tectochrysin, chrysin, apigenin, naringenin, acacetin, genistein, and kaempferol. It is important to highlight that this study provides a preliminary exploration of the reparative effect of Mexican propolis, describing the potential mechanisms of action of the compounds present in Mexicali propolis.

HIF-1α and VEGF Immunophenotypes as Potential Biomarkers in the Prognosis and Evaluation of Treatment Efficacy of Atherosclerosis: A Systematic Review of the Literature

BACKGROUND

Hypoxia-inducible factor 1 alpha (HIF-1α) and its related vascular endothelial growth factor (VEGF) may play a significant role in atherosclerosis and their targeting is a strategic approach that may affect multiple pathways influencing disease progression. This study aimed to perform a systematic review to reveal current evidence on the role of HIF-1α and VEGF immunophenotypes with other prognostic markers as potential biomarkers of atherosclerosis prognosis and treatment efficacy.

METHODS

We performed a systematic review of the current literature to explore the role of HIF-1α and VEGF protein expression along with the relation to the prognosis and therapeutic strategies of atherosclerosis. We used the terms {"Atherosclerosis" [OR] "Atheroma" [OR] "atheromatous plaque" [OR] "plaque atherosclerotic"} [AND] {"HIF-1α"} [AND] {"VEGF"} from 2009 up to May 2024 and the Medline/Embase/PubMed database. We used methodological approaches to assess unbiased data [ROBIS (Risk of Bias in Systematic) tool]. We used study eligibility criteria, and data were collected and evaluated from original articles by two independent teams, judged by an independent reviewer, and reported by PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020.

RESULTS

We included 34 original studies investigating 650 human specimens, 21 different cell lines, and 9 animal models. Increased HIF-1α in vascular smooth muscle cells, macrophages, or endothelial cells, under hypoxia, chronic loss of nitric oxide (NO), or reduced micro ribonucleic acid (miRNA)-17 and miR-20, is associated with the upregulation of pro-inflammatory molecules, such as interleukin-1 beta (IL-1β) or tumor necrosis factor-alpha (TNF-α), increased migration inhibitory factor of macrophages, glycolytic flux, lipid accumulation, necroptosis via miR-383, and adverse effects in atherosclerosis and plaque vulnerability. However, increased HIF-1α in lymphocytes is associated with decreased interferon-gamma (IFN-γ) and a favorable prognosis. Increased VEGF in a coronary artery, activated macrophages, or chronic exposure to methamphetamine is associated with elevated levels of serum inflammatory cells (interleukin-18; IL18), p38 mitogen-activated protein kinase (MAPK) phosphorylation, lipopolysaccharide-induced tumor necrosis factor-alpha factor (LITAF), and signal transducer and activator of transcription 6 isoform B (STAT6B) overexpression, leading to atherosclerosis progression and plaque break. However, VEGF overexpression in serum is marginally associated with an elevated risk for atherosclerosis. In contrast, stable overexpression of VEGF in macrophages correlates with reduced hyperplasia after arterial injury, reduced foam cell formation, and attenuation of atherosclerosis progression. HIF-1α/VEGF immunophenotypes reflect atherosclerosis treatment efficacy using, among others, HIF-inhibitors, statins, polyphenols, miR-497-5p, methylation modification, adenosine receptor antagonists, natural products, or glycosides.

CONCLUSION

We present an overview of HIF-1α/VEGF expression in chronic inflammatory-related atherosclerosis disease. Exploring pathogenetic mechanisms and therapeutic options, we included several studies using variable methods to evaluate HIF-1α/VEGF immunophenotypes with controversial and innovative results. Data limitations may include the use of different survival methods. Our data support HIF-1α/VEGF immunophenotypes as potential biomarkers of atherosclerosis prognosis and treatment efficacy.

A unique Helicobacter pylori strain to study gastric cancer development

Helicobacter pylori colonizes a majority of the human population worldwide and can trigger development of a variety of gastric diseases. Since the bacterium is classified as a carcinogen, elucidation of the characteristics of H. pylori that influence gastric carcinogenesis is a high priority. To this end, the Mongolian gerbil infection model has proven to be an important tool to study gastric cancer progression. However, only a small number of H. pylori strains have been evaluated in the gerbil model. Thus, to identify additional strains able to colonize and induce disease in this model, several H. pylori strains were used to infect Mongolian gerbils, and stomachs were harvested at multiple timepoints to assess colonization and gastric pathology. The USU101 strain reproducibly colonized Mongolian gerbils and induced gastric inflammation in the majority of the animals 1 month after infection. Adenocarcinoma or dysplasia was observed in the majority of gerbils by 2 months post-infection. To define the contribution of key virulence factors to this process, isogenic strains lacking cagA or vacA, along with restorant strains containing a wild-type (WT) copy of the genes, were studied. The ΔcagA USU101 strain colonized gerbils at levels similar to WT, but did not induce comparable levels of inflammation or disease. In contrast, the ΔvacA USU101 strain did not colonize gerbils, and the stomach pathology resembled that of the mock-infected animals. The restorant USU101 strains expressed the CagA and VacA proteins in vitro, and in vivo experiments with Mongolian gerbils showed a restoration of colonization levels and inflammation scores comparable to those observed in WT USU101. Our studies indicate that the USU101 strain is a valuable tool to study H. pylori-induced disease.IMPORTANCEGastric cancer is the fifth leading cause of cancer-related death globally; the majority of gastric cancers are associated with Helicobacter pylori infection. Infection of Mongolian gerbils with H. pylori has been shown to result in induction of gastric cancer, but few H. pylori strains have been studied in this model; this limits our ability to fully understand gastric cancer pathogenesis in humans because H. pylori strains are notoriously heterogenous. Our studies reveal that USU101 represents a unique H. pylori strain that can be added to our repertoire of strains to study gastric cancer development in the Mongolian gerbil model.

Pivotal role of Helicobacter pylori virulence genes in pathogenicity and vaccine development

One of the most prevalent human infections is Helicobacter pylori (H. pylori), which affects more than half of the global population. Although H. pylori infections are widespread, only a minority of individuals develop severe gastroduodenal disorders. The global resistance of H. pylori to antibiotics has reached concerning levels, significantly impacting the effectiveness of treatment. Consequently, the development of vaccines targeting virulence factors may present a viable alternative for the treatment and prevention of H. pylori infections. This review aims to provide a comprehensive overview of the current understanding of H. pylori infection, with a particular focus on its virulence factors, pathophysiology, and vaccination strategies. This review discusses various virulence factors associated with H. pylori, such as cytotoxin-associated gene A (cagA), vacuolating cytotoxin gene (vacA), outer membrane proteins (OMPs), neutrophil-activated protein (NAP), urease (ure), and catalase. The development of vaccines based on these virulence characteristics is essential for controlling infection and ensuring long-lasting protection. Various vaccination strategies and formulations have been tested in animal models; however, their effectiveness and reproducibility in humans remain uncertain. Different types of vaccines, including vector-based vaccines, inactivated whole cells, genetically modified protein-based subunits, and multiepitope nucleic acid (DNA) vaccines, have been explored. While some vaccines have demonstrated promising results in murine models, only a limited number have been successfully tested in humans. This article provides a thorough evaluation of recent research on H. pylori virulence genes and vaccination methods, offering valuable insights for future strategies to address this global health challenge.

Yeokwisan: Standardised Herbal Formula Enhancing Gastric Mucosal Protection Against Gastric Ulcers in Mice, a Preclinical Study

Background: Yeokwisan (YWS) is a standardised herbal formula for relieving functional dyspepsia symptoms. Methods: We explored the therapeutic value of YWS and its potential effects on gastritis. Its inhibitory effect on gastric mucosal damage and anti-inflammatory activity in animal models of alcohol- and restraint stress-induced gastritis were also examined. Gastric tissues of ICR mice treated with YWS (150 and 300 mg/kg) or famotidine (5 mg/kg) for 10 days were collected, and gastric lesions were quantified. The stomachs of C57BL/6 mice treated with YWS (150 and 300 mg/kg) or famotidine (5 mg/kg) for 23 days were collected, and gastric lesions were quantified. Blood samples were analysed for inflammation related factors and gastroprotective effects. Results: YWS (300 mg/kg) inhibited gastric damage by 42.33% in the EtOH-induced gastritis model and 75% in the restraint stress-induced gastritis model (compared to the control group). Pretreatment with YWS led to decreased levels of inflammatory factors (IL-1β, IL-6, and COX-2). YWS showed gastroprotective effects through histamine downregulation, while prostaglandin E2 (PGE2) and mucin were upregulated. The mRNA levels of H2R, M3R, CCK2R, and H+/K+ ATPase were significantly decreased following treatment with YWS. Conclusions: YWS provides gastric protection through its anti-inflammatory properties, reduced histamine secretion, and enhanced release of mucosal defensive factors.

Gut microbiota and blood biomarkers in IBD-Related arthritis: insights from mendelian randomization

With the ongoing rise in the incidence of inflammatory bowel disease (IBD), its extraintestinal manifestations have garnered significant attention. IBD-related arthritis is notable for its insidious onset and unpredictability, presenting considerable challenges for clinical diagnosis and management. Factors such as gut microbiota, plasma proteins, inflammatory proteins, and biomarkers found in blood and urine may be closely associated with IBD-related arthritis. However, the mechanisms by which these factors influence this condition remain poorly understood and require urgent investigation. We employed the method of linkage disequilibrium and the two-sample Mendelian randomization (MR) approach, utilizing single nucleotide polymorphisms (SNPs) identified from large-scale genome-wide association studies as instrumental variables. In this scientifically rigorous manner, we explored the potential causal relationship between gut microbiota, plasma proteins, inflammatory proteins, and blood and urine biomarkers in relation to arthritis resulting from inflammatory bowel disease (IBD). This method aids in elucidating the potential roles of these biomarkers in the development of arthritis following IBD, while minimizing the confounding factors and reverse causality commonly encountered in observational studies. To further verify and strengthen our findings, we conducted subsequent sensitivity analyses. These analyses will evaluate the strength of the association between SNPs and the studied biomarkers, as well as post-IBD arthritis, while accounting for variations in SNP distribution among populations and other potential genetic influencing factors. Through these rigorous analytical steps, our objective is to enhance the robustness and credibility of the research findings and provide more reliable scientific evidence regarding the pathogenesis of post-IBD arthritis. MR analysis provides evidence for the association between genetically predicted gut microbiota, plasma proteins, inflammatory proteins, and blood and urine biomarkers with the risk of IBD-related arthritis. This analysis investigates the characteristics of the associations between specific gut microbiota, plasma proteins, inflammatory proteins, and blood and urine biomarkers in relation to IBD-related arthritis. Among the plasma proteins, pterin-4-alpha-carbinolamine dehydratase, aldo-keto reductase family 1 member C4, cathepsin L2, angiostatin, hepatocyte growth factor-like protein, hepatitis A virus cellular receptor 2, protein O-linked mannose beta-1,4-N-acetylglucosaminyltransferase 2, epididymal-specific alpha-mannosidase, and platelet-derived growth factor receptor-like protein are associated with Crohn's disease-related arthritis. In contrast, agrin, methylenetetrahydrofolate synthetase domain-containing protein, neurotrophin-3 (NT-3) growth factor receptor, and neuropilin-1 are associated with ulcerative colitis-related arthritis. Furthermore, regarding gut bacterial pathway abundance, adenosylcobalamin, N-acetylglucosamine, N-acetylmannosamine, and N-acetylneuraminic acid degradation, as well as glycolysis metabolism and degradation pathways, are associated with Crohn's disease-related arthritis. Meanwhile, gut bacterial pathway abundance (pentose phosphate pathway) and gut microbiota abundance (Bacteroidetes, Bacteroidia, Bacteroidales, Porphyromonadaceae, Faecalibacterium, Eubacterium eligens) are linked to ulcerative colitis-related arthritis. Notably, we did not identify any connections between inflammatory protein factors, blood and urine biomarkers, and IBD-related arthritis. Lastly, in the reverse MR study, the insufficient number of SNPs available for analysis precluded the detection of a reverse causal relationship. This study employs the MR method to elucidate the potential causal relationships among gut microbiota, plasma proteins, inflammatory proteins, and blood and urine biomarkers in relation to the occurrence and progression of IBD-related arthritis. This research offers a novel perspective for a deeper understanding of the pathogenesis of IBD-related arthritis and highlights future directions for the diagnosis and treatment strategies of this condition.

Deferoxamine Accelerates Mandibular Condylar Neck Fracture Early Bone Healing by Promoting Type H Vessel Proliferation

BACKGROUND

Condylar fractures (CFs) are a common type of maxillofacial trauma, especially in adolescents. Conservative treatment of CF avoids the possible complications of surgical intervention, but prolongs the patient's suffering because of the requirement for extended intermaxillary fixation. Therefore, the development of a new strategy to accelerate the rate of fracture healing to shorten the period of conservative treatment is of great clinical importance.

OBJECTIVE

To investigate the potential of deferoxamine (DFO) in promoting the healing process of CF in adolescent mice.

METHODS

Thirty-two 4-week-old male C57BL/6J mice were randomly assigned to four groups: vehicle + sham group, vehicle + CF group, DFO + sham group and DFO + CF group. After constructing the mandibular CF model, mandibular tissue samples were collected respectively at 1, 2 and 4 weeks postoperatively. Radiographic and histomorphometric analyses were employed to assess bone tissue healing and vascular formation.

RESULTS

Deferoxamine was observed to promote the early bone healing of fracture, both radiologically and histomorphometrically. Furthermore, this enhancement of condylar neck fracture healing was attributed to the upregulation of the hypoxia-inducible factor-1α (HIF-1α) signalling pathway while facilitating the formation of type H vessels. In addition, DFO did not produce significant effects on the condylar neck between vehicle + sham and DFO + sham group.

CONCLUSION

The application of the HIF-1α inducer DFO can enhance type H vessels expansion thereby accelerating condylar neck fracture healing.

Advanced Endoscopic Imaging to Predict Clinical Outcomes in Inflammatory Bowel Disease

Advanced endoscopic imaging including high-definition endoscopy, confocal laser endomicroscopy (CLE) and endocytoscopy (EC) serve as an adjunct to predict clinical outcomes in inflammatory bowel disease (IBD). CLE can identify gut barrier dysfunction which correlates with disease behavior and long-term disease outcome. EC allows the assessment of histologic activity. Future controlled studies are warranted to define a definite role of these novel technologies in the management of patients with IBD.

A Challenging Case of Giant Gastric Perforation: Insights From a Case Report

Gastric ulcer disease is a prevalent condition in the general population. The presence of giant gastric ulcers poses a challenge due to their increased risk of perforation and potential for malignancy. A giant gastric ulcer was discovered in a 43-year-old male with a history of gastric ulcer perforation and subsequent complications, including recurrent bleeding episodes despite multiple interventions. This case highlights the complexities of managing recurrent bleeding in patients with giant gastric ulcers and the need for a multifaceted approach combining medication and surgical intervention. The patient underwent initial treatment, involving exploratory laparotomy and gastrojejunostomy tube placement (which is a device that is inserted into the jejunum to provide nutrition, fluids, and medications), followed by various surgical procedures and was managed successfully. This case highlights the complex management of recurrent bleeding from a giant gastric ulcer, requiring multiple interventions and emphasizing the importance of long-term follow-up to avoid its possible complications.

Aerobic Training and Ointment Effect on range of motion, von Willebrand factor, vascular endothelial factor and Femoral Artery Hemodynamics in Joint Contracture: A Rat Model

OBJECTIVE

Using a rat model, we investigated the effect of multidisciplinary rehabilitation, including aerobic training and ointment, on the ROM, vWF, VEGF content, and femoral artery hemodynamics in rats with joint contracture.

METHODS

A total of 44 Wistar rats were divided into the normal control group (NC, eight rats) and the experimental group (EG). A joint contracture model was established for the rats in the EG group by an external fixator. After fixator removal, 32 rats are further divided into the MC, SC, RE, and SR groups (n = 8). Before and after the 42 day intervention, the ROM, vWF, VEGF, PS, ED, and RI were measured using X-ray imaging, ELISA, and color Doppler ultrasound, respectively.

RESULTS

After fixator removal, ROM for EG group was lower than that of the NC group (p < .01). After the intervention, ROM for the SR, RE, and SC groups was improved. The ROM for the SR group reached a similar value for NC group. vWF and VEGF levels in SR group were lower than in the MC, SC, and RE groups (p < .05), and had a similar value to the NC groups. PS value for SR and RE groups was higher than the MC and SC groups. The RI value for SR group was higher than that of NC and MC groups.

CONCLUSION

Multidisciplinary rehabilitation used in this study can treat joint contracture synergistically. It improves the ROM of the joint, reduces the content of vWF and VEGF, and improves the femoral artery hemodynamics.

Mechanisms of acupuncture at Zusanli (ST36) and its combinational acupoints for stress gastric ulcer based on the correlation between Zang-fu and acupoints

Gastric ulcer (GU) is a common digestive system disease. Acupuncture, as one of the external treatments of traditional Chinese medicine (TCM), has the characteristics of multi-target, multi-pathway and multi-level action in the treatment of GU. The relationship between meridian points and Zang-fu is an important part of the theory of TCM, which is crucial for the diagnosis and treatment of diseases. There is an external and internal link between acupoints and Zang-fu. The pathological reaction of Zang-fu can manifest as acupoint sensitization, while stimulation of acupoints can play a therapeutic role in the internal Zang-fu. Therefore, the acupoint has the functions of reflecting and treating diseases. This review explores the tender points on the body surface of patients with GU and the rules of acupoint selection. In addition, Zusanli (ST36), as one of the most used acupoints of the stomach meridian, was selected to show the mechanisms behind acupoint stimulation in the treatment of GU in greater detail, specifically in the well-studied model of the stress GU (SGU). Hence, the mechanisms of acupuncture at ST36 and points commonly used in combination with ST36 to treat SGU are discussed further. Treatment effects can be achieved through anti-inflammatory and antioxidant activities, gastric mucosal injury repair, and interaction with the brain-gut axis. In summary, this review provides evidence for a comprehensive understanding of the phenomena and mechanism of acupoint functions for GU. Please cite this article as: He M, Lim XY, Li J, Li L, Zhang T. Mechanisms of acupuncture at Zusanli (ST36) and its combinational acupoints for stress gastric ulcer based on the correlation between Zang-fu and acupoints. J Integr Med. 2025; 23(1): 1-11.

Protective Effects of Donkey Milk on Ethanol-Induced Gastric Ulcer in Rat

Gastric ulcer (GU) is the most common health concern that occurs due to an imbalance between gastric protective mucosal and aggressive factors. Ethanol-induced GU in animal models resembles the pathophysiology of human ulcers. Natural products with fewer side effects are highly requested to attenuate their GU effects. The present study was conducted to investigate the potential protective effects of donkey milk against ethanol-induced GU in rats. The male Wistar were divided into four groups, including normal control (distilled water), donkey milk (1 cm3/animal) and ranitidine (200 mg/kg). Donkey milk and ranitidine were given to rats orally daily for 10 consecutive days before induction of ulcer by ethanol. After 24 h of fasting, GU was induced by oral administration of ethanol. After an hour, the rats were sacrificed, and gastric samples were taken for pathologic analysis, malondialdehyde (MDA) and glutathione (GSH) assessments. The results showed that the severity of ethanol-induced gastric damage was significantly reduced by donkey's milk pretreatment and then ranitidine. Reduction of ulcer score and MDA level, and also increasing GSH in the gastric tissue in comparison with other groups supports our results. This study described the gastroprotective and antioxidative effects of donkey milk that were determined with ulcer inhibition percentage.

Assessment of sinapic acid's protective effects against ethanol-induced gastric ulcers in rats

This study evaluates the protective effects of sinapic acid (SA), a polyphenolic compound with diverse biological activities, against ethanol-induced gastric ulcers in rats. A gastric ulcer model was established using ethanol (ETH), and the experimental groups received either omeprazole (OMEP, 20 mg/kg) or SA at doses of 20 mg/kg and 40 mg/kg via oral gavage for 14 days. Biochemical markers, including total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), malondialdehyde (MDA), and myeloperoxidase (MPO) activity, were assessed alongside proinflammatory cytokines (tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and IL-6) using ELISA. Histopathological and immunohistochemical analyses were conducted to evaluate tissue integrity and apoptosis. Statistical analysis was performed using one-way ANOVA, followed by Tukey's HSD test for post hoc comparisons. For non-parametric data, the Kruskal-Wallis test and Mann-Whitney U test were used. A p-value < 0.05 was considered statistically significant. Results revealed that SA significantly enhanced antioxidant defenses, as evidenced by elevated TAS levels and reductions in TOS, OSI, MPO activity, and MDA levels (p < 0.05). Additionally, SA treatment mitigated inflammation and apoptosis by decreasing TNF-α, IL-1β, IL-6, and Bax expression (p < 0.05). These effects were comparable to those observed with OMEP, a widely used clinical agent. Notably, the findings underscore SA's potential as a novel therapeutic agent for managing ethanol-induced gastric ulcers. By targeting oxidative stress and inflammatory pathways, SA could complement or serve as an alternative to current treatment strategies. Future research should focus on exploring SA's molecular mechanisms, dose optimization, and long-term efficacy in clinical settings, paving the way for its integration into therapeutic regimens for gastric mucosal injuries.

Human umbilical mesenchymal stem cells ameliorate atrophic gastritis in aging mice by participating in mitochondrial autophagy through Ndufs8 signaling

BACKGROUND

Chronic atrophic gastritis (CAG) is a chronic disease of the gastric mucosa characterized by a reduction or an absolute disappearance of the original gastric glands, possibly replaced by pseudopyloric fibrosis, intestinal metaplasia, or fibrosis. CAG develops progressively into intestinal epithelial metaplasia, dysplasia, and ultimately, gastric cancer. Epidemiological statistics have revealed a positive correlation between the incidence of CAG and age. Mesenchymal stem cells (MSCs) are a type of adult stem cells derived from mesoderm, with strong tissue repair capabilities. Therefore, the restoration of the gastric mucosa may serve as an efficacious strategy to ameliorate CAG and avert gastric cancer. However, the mechanisms by which MSCs inhibit the relentless progression of aging atrophic gastritis remain to be elucidated. This study endeavored to assess a novel approach utilizing MSCs to treat CAG and forestall carcinogenics.

METHODS

In this study, we selected mice with atrophic gastritis from naturally aging mice and administered human umbilical cord-derived mesenchymal stem cells (hUMSCs) via tail vein injection to evaluate the therapeutic effects of hUMSCs on age-related chronic atrophic gastritis. Initially, we employed methods such as ELISA, immunohistochemical analysis, and TUNEL assays to detect changes in the mice post-hUMSC injection. Proteomic and bioinformatics analyses were conducted to identify differentially expressed proteins, focusing on NADH: ubiquinone oxidoreductase core subunit S8 (Ndufs8). Co-culturing hUMSCs with Ndufs8 knockout gastric mucosal epithelial cells (GMECs), we utilized flow cytometry, Western blotting, real-time quantitative PCR, and immunofluorescence to investigate the mechanisms of action of hUMSCs.

RESULTS

We observed that hUMSCs are capable of migrating to and repairing damaged gastric mucosa. Initially, hUMSCs significantly enhanced the secretion of gastric proteins PG-1 and G17, while concurrently reducing inflammatory cytokines. Furthermore, hUMSCs mitigated gastric fibrosis and apoptosis in mucosal cells. Proteomic and bioinformatic analyses revealed alterations in the protein network involved in mitochondrial autophagy, with Ndufs8 playing a pivotal role. Upon knocking out Ndufs8 in GMECs, we noted mitochondrial damage and reduced autophagy, leading to an aged phenotype in GMECs. Co-culturing Ndufs8-knockout GMECs with hUMSCs demonstrated that hUMSCs could ameliorate mitochondrial dysfunction and restore the cell cycle in GMECs.

Differentiating Sinonasal Tumor Entities with Fluorescein-Enhanced Confocal Laser Endomicroscopy: A Step Forward in Precision Diagnostics

Background/Objectives: Sinonasal malignancies are rare and highly diverse cancers that pose significant diagnostic challenges due to their variable histological features and complex anatomical locations. Accurate diagnosis is critical for guiding treatment, yet conventional methods often require multiple biopsies. This study aimed to evaluate the potential of confocal laser endomicroscopy (CLE) for real-time imaging of sinonasal tumors to characterize specific features of different entities and improve diagnostic precision. Methods: Ten patients with various sinonasal malignancies, including squamous cell carcinoma, adenocarcinoma, sinonasal undifferentiated carcinoma, olfactory neuroblastoma, sinonasal mucosal melanoma, and endonasal lymphoma, were examined using CLE during diagnostic endoscopy. CLE images were compared descriptively with histopathological cross-sections to identify unique imaging patterns for each tumor type. Results: CLE was feasible across all cases, with high-quality images obtained despite anatomical challenges in some cases. Characteristic features, such as vascular clusters in undifferentiated carcinoma, mucin-filled bubbles in adenocarcinoma, and small round cells in neuroblastoma, were identified and corresponded well with histopathological findings. CLE also helped guide biopsies by revealing areas with diagnostic relevance. Conclusions: CLE demonstrates promise as an adjunct diagnostic tool in sinonasal malignancies, offering real-time imaging that correlates with histopathological findings and aids in targeted biopsies. While this study provides preliminary insights into the utility of CLE, further research with larger cohorts and statistical validation is necessary to establish its diagnostic reliability and broader clinical application.

Risk factors for gastric mucosa lesion in critically ill patients undergoing endoscopy for percutaneous gastrostomy: a case-control study

BACKGROUND

Pharmacologic prophylaxis for gastric ulcer is commonly prescribed in patients hospitalized in the intensive care unit (ICU). The aim of the study was to assess the current prevalence and risk factors for gastric mucosa lesion in ICU patients receiving standard pharmacologic prophylaxis undergoing endoscopy for percutaneous gastrostomy implantation.

METHODS

Patients hospitalized in the mixed medical-surgical ICU undergoing percutaneous endoscopic gastrostomy (PEG) were analyzed. We excluded patients receiving either no or high doses of intravenous proton pump inhibitor (PPI), only patients receiving standard doses of PPI were included. Data retrieved from the electronic medical records included: demographics, risk factors for gastric mucosa lesion (use of stimulants, comorbidities, medications, treatment methods in the ICU, laboratory derangements) and endoscopic findings. The study compared a group of patients with gastric mucosa lesions (cases) vs. patients without gastric mucosa lesions (controls). Inter-group comparisons between cases and controls were performed. Depending on the type of distribution continuous variables were assessed using two-sample t-test or Mann-Whitney test, whereas categorical variables with Chi-squared or Fisher exact test. Odds ratio (OR) with 95% confidence interval (95% CI) were calculated. Statistical significance was assumed at p < 0.05.

RESULTS

Patients with no prophylaxis (n = 8) or receiving high doses (> 40 mg per day) of proton pump inhibitor (n = 2) were excluded. There were 182 patients receiving standard intravenous dose of PPI, 63 (34.6%) women and 119 (65.4%) men, with median age 61.5 (interquartile range IQR 46.0-70.0) years. Majority of patients (n = 169, 92.9%) were receiving pharmacological prophylaxis for venous thromboembolism. There were 53 (29.1%) patients with gastric mucosa lesion. The only risk factor that was significantly different between cases and controls was history of gastric ulcer (p = 0.04) with OR 3.8 (95% CI 1.1-12.5; p = 0.03).

CONCLUSIONS

Majority of various risk factors for gastric ulceration may not predict gastric mucosa lesion in ICU patients receiving standard pharmacological prophylaxis undergoing endoscopy for PEG implantation. We found that history of gastric ulcer may be a risk factor for gastric ulceration in the ICU patients. Patients with history of gastric ulcer might benefit from higher than standard doses of anti-ulcer medication when hospitalized in the ICU.