The negative effect of concomitant medications on immunotherapy in non-small cell lung cancer: An umbrella review

Differences in the effectiveness of leukocyte-rich platelet-rich plasma compared with leukocyte-poor platelet-rich plasma in the treatment of rotator cuff surgery: an umbrella review of meta-analyses

BACKGROUND

An umbrella review of meta-analyses was conducted to evaluate the use of platelet-rich plasma (PRP) in arthroscopic surgeries of rotator cuff injury. The effectiveness of leukocyte-poor PRP and leukocyte-rich PRP in the treatment of rotator cuff surgery was also compared.

METHODS

Web of Science, Embase, PubMed/MEDLINE, and the Cochrane Library were searched from inception to May 2024. Literature screening, quality evaluation, and data extraction were performed according to the inclusion and exclusion criteria. The Jadad decision algorithm was used to ascertain which meta-analysis represented the best evidence.

RESULTS

A total of 11 meta-analyses with evidence level ranging from level 1 to 2 were included in this umbrella review. Leukocyte-poor PRP was effective in reducing rotator cuff retear rates, alleviating pain, and increasing Constant scores compared with non-PRP treatments. However, it did not show improvement on the University of California Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) score, and the Simple Shoulder Test (SST) compared with the non-PRP treatment group. Meanwhile, the leukocyte-rich PRP group improved the SST but showed no different results when compared with the non-PRP treatment group.

CONCLUSION

Compared with no use of PRP, leukocyte-poor PRP was able to alleviate postoperative pain, reduce the retear rate, and improve the postoperative Constant score. Leukocyte-rich PRP could effectively enhance postoperative SST outcomes, leading to improvement of patient satisfaction and quality of life. Future researches should prioritize long-term follow-up studies and evaluate the durability of these results.

Prognostic impact of metformin in solid cancer patients receiving immune checkpoint inhibitors: novel evidences from a multicenter retrospective study

Objective: Metformin as a common antidiabetic drug, has recently found to exert its anti-cancer and immunomodulatory effect in numerous preclinical studies. This study aims to clarify the prognostic impact of metformin use in solid cancer patients receiving immune checkpoint inhibitors (ICIs). Methods: A retrospective cohort enrolling 516 solid cancer patients who received ICI-based therapy between 2018 and 2023 at three hospitals was analyzed. The primary endpoints included overall survival (OS) and progression-free survival (PFS). In addition, a bioinformatics analysis based on TCGA and GSE cohort was performed to investigate the prognostic significance of metformin target genes (MTGs) and their correlation with immune infiltration in non-small cell lung cancer (NSCLC) patients. Results: In the entire cohort, a total of 76 patients received metformin before and/or during ICI therapy. The global analysis demonstrated that metformin use was unrelated with the OS (p = 0.064) and PFS (p = 0.059) of ICI-treated cancer patients, which was confirmed in the subgroups of esophagus, hepatobiliary or pancreatic cancer (all p > 0.05). However, metformin use was significantly correlated with better OS (p = 0.012) and PFS (p = 0.005) in ICI-treated lung cancer patients. Metformin use was also identified as an independent favorable prognostic factor for these patients. The bioinformatics analysis identified five favorable prognostic MTGs (RPS6KA5, RORA, SH3BP5, NUPR1, and CD40LG) for NSCLC patients, all of which was downregulated in lung cancer tissues as compared with normal tissues. The expressions of five MTGs not only could effectively stratify the OS of NSCLC patients, but also was correlated with infiltration of immune cells such as CD4+ and CD8+ T cells. Conclusion: Metformin use was significantly correlated with better OS and PFS in ICI-treated lung cancer patients. MTGs has the potential to serve as novel clinical biomarkers or druggable targets for cancer immunotherapy. Considering study limitations, the actual impact of metformin use on ICI therapy needs to be clarified by more clinical trials.

Fluorescence Super-Resolution Imaging Chip for Gene Silencing Exosomes

Tumor cell-derived extracellular vesicles and their cargo of bioactive substances have gradually been recognized as novel biomarkers for cancer diagnosis. Meanwhile, the PD-L1 (Programmed Death-Ligand 1) protein, as an immune checkpoint molecule, is highly expressed on certain tumor cells and holds significant potential in immune therapy. In comparison to PD-L1 monoclonal antibodies, the inhibitory effect of PD-L1 siRNA (small interfering RNA) is more advantageous. In this article, we introduced a microfluidic chip integrating cell cultivation and exosome detection modules, which were intended for the investigation of the gene silencing effect of PD-L1 siRNA. Basically, cells were first cultured with PD-L1 siRNA in the chip. Then, the secreted exosomes were detected via super-resolution imaging, to validate the inhibitory effect of siRNA on PD-L1 expression. To be specific, a "sandwich" immunological structure was employed to detect exosomes secreted from HeLa cells. Immunofluorescence staining and DNA-PAINT (DNA Point Accumulation for Imaging in Nanoscale Topography) techniques were utilized to quantitatively analyze the PD-L1 proteins on HeLa exosomes, which enabled precise structural and content analysis of the exosomes. Compared with other existing PD-L1 detection methods, the advantages of our work include, first, the integration of microfluidic chips greatly simplifying the cell culture, gene silencing, and PD-L1 detection procedures. Second, the utilization of DNA-PAINT can provide an ultra-high spatial resolution, which is beneficial for exosomes due to their small sizes. Third, qPAINT could allow quantitative detection of PD-L1 with better precision. Hence, the combination of the microfluidic chip with DNA-PAINT could provide a more powerful integrated platform for the study of PD-L1-related tumor immunotherapy.