Folic acid-decorated polyamidoamine dendrimer exhibits high tumor uptake and sustained highly localized retention in solid tumors: Its utility for local siRNA delivery

The utility of folic acid (FA)-decorated polyamidoamine dendrimer G4 (G4-FA) as a vector was investigated for local delivery of siRNA. In a xenograft HN12 (or HN12-YFP) tumor mouse model of head and neck squamous cell carcinomas (HNSCC), intratumorally (i.t.) injected G4-FA exhibited high tumor uptake and sustained highly localized retention in the tumors according to near infrared (NIR) imaging assessment. siRNA against vascular endothelial growth factor A (siVEGFA) was chosen as a therapeutic modality. Compared to the nontherapeutic treatment groups (PBS solution or dendrimer complexed with nontherapeutic siRNA against green fluorescent protein (siGFP)), G4-FA/siVEGFA showed tumor inhibition effects in single-dose and two-dose regimen studies. In particular, two doses of G4-FA/siVEGFA i.t. administered eight days apart resulted in a more profound inhibition of tumor growth, accompanied with significant reduction in angiogenesis, as judged by CD31 staining and microvessel counts. Tumor size reduction in the two-dose regimen study was ascertained semi-quantitatively by live fluorescence imaging of YFP tumors and independently supported antitumor effects of G4-FA/siVEGFA. Taken together, G4-FA shows high tumor uptake and sustained retention properties, making it a suitable platform for local delivery of siRNAs to treat cancers that are readily accessible such as HNSCC.

STATEMENT OF SIGNIFICANCE

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide and is difficult to transfect for gene therapy. We developed folate receptor (FR)-targeted polyamidoamine (PAMAM) dendrimer for enhanced delivery of genes to HNSCC and gained in-depth understanding of how gene delivery and transfection in head and neck squamous cancer cells can be enhanced via FR-targeted PAMAM dendrimers. The results we report here are encouraging and present latest advances in using dendrimers for cancer therapies, in particular for HNSCC. Our work has demonstrated that localized delivery of FR-targeted PAMAM dendrimer G4 complexed with siVEGFA resulted in pronounced tumor suppression in an HN12 xenograft tumor model. Tumor suppression was attributed to enhanced tumor uptake of siRNA and prolonged nanoparticle retention in the tumor. Taken together, G4-FA shows high tumor uptake and sustained highly localized retention properties, making it a suitable platform for local delivery of siRNAs to treat cancers that are readily accessible such as HNSCC.

The diagnostic and prognostic values of Ki-67/MIB-1 expression in thyroid cancer: a meta-analysis with 6,051 cases

BACKGROUND

Growing evidence has demonstrated that Ki-67/MIB-1 has an effect on the clinical progression and prognosis in cancers. However, the diagnostic and prognostic values of Ki-67/MIB-1 in thyroid cancer remain unclear.

MATERIALS AND METHODS

The meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were retrieved from PubMed, EBSCO, EMBASE, ISI Web of Science, China National Knowledge Infrastructure, WanFang and Chinese VIP databases. MetaDiSc and STATA12.0 were used to analyze the meta-analysis. Fixed-effect analysis and random-effect analysis were applied to pool the relative ratio based on heterogeneity in this meta-analysis.

RESULTS

In the meta-analysis, 51 eligible studies were included. The pooled sensitivity of Ki-67/MIB-1 was 0.61 (95% confidence interval [CI]: 0.59-0.63) and specificity was 0.75 (95% CI: 0.74-0.77) in thyroid cancer. The pooled positive likelihood ratio was 3.19 (95% CI: 2.30-4.42) and negative likelihood ratio was 0.43 (95% CI: 0.35-0.54). In the diagnosis of thyroid cancer, the pooled diagnostic odds ratio of Ki-67/MIB-1 was 8.54 (95% CI: 5.03-14.49). The area under the symmetric receiver operating characteristic curve was 0.804 (standard error =0.031). Our results showed that there were statistical associations between Ki-67/MIB-1 and age (odds ratio [OR] =1.71, 95% CI: 1.14-2.57, P=0.010), tumor size (OR =1.86, 95% CI: 1.17-2.96, P=0.008), lymph node metastasis (OR =2.49, 95% CI: 1.42-4.39, P=0.002), metastasis status (OR =6.96, 95% CI: 2.46-19.69, P<0.001), tumor node metastasis stage (OR =6.56, 95% CI: 3.80-11.34, P<0.001) and extrathyroid extension (OR =1.91, 95% CI: 1.27-2.87, P=0.002). Furthermore, thyroid cancer patients with a high level of Ki-67/MIB-1 had a worse disease-free survival as compared to patients with a low level of Ki-67/MIB-1 (hazard ratio =5.19, 95% CI: 3.18-8.46, P<0.001). Also, Ki-67/MIB-1 was found to be associated with increased risk of mortality (hazard ratio =3.56, 95% CI: 1.17-10.83, P=0.025).

CONCLUSION

Our results demonstrated that Ki-67/MIB-1 might act as a potential factor in diagnosing thyroid cancer in Chinese. Also, the meta-analysis indicated that Ki-67/MIB-1 might have an effect on prognosis in non-Chinese thyroid cancer patients.

A Thermosensitive Heparin-Poloxamer Hydrogel Bridges aFGF to Treat Spinal Cord Injury

Acidic fibroblast growth factor (aFGF) exerts a protective effect on spinal cord injury (SCI) but is limited by the lack of physicochemical stability and the ability to cross the blood spinal cord barrier (BSCB). As promising biomaterials, hydrogels contain substantial amounts of water and a three-dimensional porous structure and are commonly used to load and deliver growth factors. Heparin can not only enhance growth factor loading onto hydrogels but also can stabilize the structure and control the release behavior. Herein, a novel aFGF-loaded thermosensitive heparin-poloxamer (aFGF-HP) hydrogel was developed and applied to provide protection and regeneration after SCI. To assess the effects of the aFGF-HP hydrogel, BSCB restoration, neuron and axonal rehabilitation, glial scar inhibition, inflammatory response suppression, and motor recovery were studied both in vivo and in vitro. The aFGF-HP hydrogels exhibited sustained release of aFGF and protected the bioactivity of aFGF in vitro. Compared to groups intravenously administered either drug-free HP hydrogel or aFGF alone, the aFGF-HP hydrogel group revealed prominent and attenuated disruption of the BSCB, reduced neuronal apoptosis, reactive astrogliosis, and increased neuron and axonal rehabilitation both in vivo and in vitro. This work provides an effective approach to enhance recovery after SCI and provide a successful strategy for SCI protection.

EZH2 overexpression is associated with poor prognosis in patients with glioma

Previous studies have investigated the prognostic value of enhancer of zeste homolog 2 (EZH2) expression in patients with glioma but conclude contradictory results. We aimed to comprehensively evaluate the prognostic role of EZH2 in glioma by meta-analysis. The databases of PubMed, Embase and Web of Science were searched. Hazard ratio (HR) and 95% confidence interval (CI) were combined to assess the association between EZH2 and overall survival (OS) as well as progression-free survival (PFS). Odd ratio (OR) and 95% CI were calculated to investigate the relevance of EZH2 on clinical factors. Six studies with 575 patients were included for meta-analysis. The results showed that EZH2 overexpression was correlated with poor OS (n = 6, HR = 2.23, 95% CI: 1.56-3.19, p < 0.001) and PFS (n = 3, HR = 2.23, 95% CI: 1.56-3.19, p < 0.001). Subgroup analysis showed that EZH2 had enhanced prognostic value in Asian patients, for WHO grade I-IV and when using immunohistochemistry (IHC) method. In addition, EZH2 was associated with KPS score < 80. No evidence of publication bias was found in this meta-analysis. In conclusion, the present study showed that EZH2 was a potential prognostic marker for poor OS, PFS and lower KPS score in glioma patients.

Enhanced neuroprotection with decellularized brain extracellular matrix containing bFGF after intracerebral transplantation in Parkinson's disease rat model

Extracellular matrix-based biomaterials have many advantages over synthetic polymer materials for regenerative medicine applications. In central nervous system (CNS), basic fibroblast growth factor (bFGF) is widely studied as a potential agent for Parkinson's disease (PD). However, the poor stability of bFGF hampered its clinical use. In this study, CNS-derived biologic scaffold containing bFGF was used to enhance and extend the neuroprotective effect of bFGF on PD targeted therapy. Decellularized brain extracellular matrix (dcBECM) was prepared by chemical extraction. The biocompatibility of dcBECM was evaluated using CCK-8 assay and magnetic resonance imaging (MRI). The controlled-release behavior of dcBECM containing bFGF (bFGF+dcBECM) was confirmed by ELISA assay. Furthermore, the cytocompatibility and neuroprotective effect of bFGF+dcBECM was evaluated in vitro and in vivo. From results, dcBECM showed a three-dimensional network structure with high biocompatibility. MRI of dcBECM implanted rats showed nearly seamless fusion of dcBECM with the adjoining tissues. The cumulative release rate of bFGF+dcBECM in vitro reached to 75.88% at 10h and maintained sustained release trend during the observation. ELISA results in vivo further confirmed the sustained-release behavior (from 12h to 3d) of bFGF+dcBECM in brain tissues. Among the experimental groups, bFGF+dcBECM group showed the highest cell survival rate of PD model cells, improved behavioral recovery and positive expressions of neurotrophic proteins in PD recovered rats. In conclusion, sustained neuroprotection in PD rats was achieved by using bFGF+dcBECM. The combination of dcBECM and bFGF would be a promising therapeutic strategy to realize an effective and safe alternative for CNS disease treatment.

Relationship of cubitus varus and ulnar varus deformity in supracondylar humeral fractures according to the age at injury

BACKGROUND

We investigated the relationships of ulnar varus deformity and the degree of cubitus varus according to the age at injury in patients with cubitus varus.

METHODS

Basic demographic factors were investigated in group 1 (injured at age younger than 5 years) and group 2 (injured at age 5-10 years). The uninjured side ulnar angle (UA) at the time of injury and final follow-up and the humeral-elbow-wrist angle (HEW-A) at final follow-up were measured. ΔUA (injured side - uninjured side UA at final follow-up) and ΔHEW-A (injured side - uninjured side HEW-A at final follow-up) were calculated and compared between the 2 groups. The correlation between ΔUA and ΔHEW-A was analyzed, and the degree of correlation was compared between the groups.

RESULTS

Final UA and HEW-A on the injured side were increased more in group 1. ΔUA and ΔHEW-A were also more definitive in group 1. Positive correlations were found in both groups between ΔUA and ΔHEW-A, and the degree of correlation was similar in both groups. Distinct negative correlations were observed in both groups between the uninjured side UA at the time of injury and the ΔUA, but the degree of correlation differed significantly.

CONCLUSIONS

The degree of ulnar varus correlated well with the degree of cubitus varus. A straighter ulna at the time of injury could become more bowed if cubitus varus deformity occurred and progressed. This may be evidence suggesting that the earlier correction of cubitus varus would be more effective under a less deformed varus of the ulna.

LEVEL OF EVIDENCE

Level III; Retrospective Cohort Design; Treatment Study.