The pro-inflammatory and anti-inflammatory role of hyaluronic acid in endometriosis

Comparative analysis of in vivo bio-integration of three hyaluronic acid-based fillers for 26 weeks: a histological study

Stabilized hyaluronic acid (HA), produced through diverse cross-linking technology and formulated as an injectable gel, has found widespread utilization in aesthetic industry. Cross-linked HA essentially constitutes a gel particle composition formed by numerous viscoelastic particulates. Various product formulations yield HA gels with distinct properties, including particle size, viscoelasticity, and interaction forces between particles. While previous studies have primarily concentrated on the biological safety and macroscopic expression of fillers, limited research exists on the internal mechanisms governing their macro-performance. This study selected three common dermal fillers for analysis, establishing an animal model to assess their in vivo interaction with surrounding tissues and explore their internal mechanisms. The findings revealed that particle size plays a crucial role in tissue integration.

Prediction of short-term mortality in elderly patients with sepsis using immunoglobulin G2: An observational study

Background

Sepsis is a global healthcare issue and continues to cause high mortality especially in elderly patients. The humoral immune system plays an important role in protecting from microbial contamination. The goal of this study is to investigate the immune status and prognostic evaluation of elderly patients with sepsis.

Methods

A single-center, prospective observational study has been conducted, with the endpoint being the 28-day mortality. Patients 65 years and older who met the diagnostic criteria of Sepsis-3 in the Emergency Department of Beijing Chao-Yang Hospital were divided into survivors and non-survivors groups. Levels of immunoglobulin (Ig) A, IgG, IgM and their subclasses as well as clinical indicators were collected upon enrollment, and the results were statistically analyzed.

Results

This study finally enrolled 106 elderly patients, including 68 survivors and 38 non-survivors. Compared with survivors, IgG2 level and IgG4 level were lower in non-survivors ( P < 0.05 ). IgG2 could be regarded as an independent predictor of the 28-day mortality in elderly septic patients. IgG2 had a higher predictive value than other immunoglobulins, lactate, procalcitonin, SOFA score and APACHE II score for mortality in elderly septic patients, and the ratio of IgG2 to IgG had a slightly larger area under the ROC curve compared to IgG2 only (AUC: 0.776 v.s. 0.741).

Conclusion

IgG subclasses play important roles in the prognosis of elderly septic patients, with IgG2 being the main component. IgG2 was found to outperform other immunoglobulins, lactate, procalcitonin, SOFA score and APACHE II score in terms of predicting the mortality. A complete immunological evaluation is helpful to guide the prognosis and treatment of patients with age-related infection.

Emerging Drug Targets for Endometriosis

Endometriosis is a chronic inflammatory disease causing distressing symptoms and requiring a life-long management strategy. The objective of this review is to evaluate endometriosis-related pathways and identify novel therapies to treat it. We focused on the crucial role of inflammation and inflammatory molecules in order to define new perspectives for non-hormonal treatment of the disease by targeting inflammation, nuclear factor kappa B and cytokines, or reactive oxygen species, apoptotic and autophagic pathways, regulators of epithelial-mesenchymal transition, and angiogenesis and neuroangiogenesis. Novel non-steroidal therapies targeting these pathways for endometriosis were explored, but multiple challenges remain. While numerous agents have been investigated in preclinical trials, few have reached the clinical testing stage because of use of inappropriate animal models, with no proper study design or reporting of preclinical strategies. Targeting estrogens is still the best way to control endometriosis progression and inflammation.

Ectopic Endometrial Cell-Derived Exosomal Moesin Induces Eutopic Endometrial Cell Migration, Enhances Angiogenesis and Cytosolic Inflammation in Lesions Contributes to Endometriosis Progression

Background: Endometriosis (EMs) is the most common gynaecological disorder with its etiology and/or pathophysiology remains enigmatic. Recent studies showed that extracellular vesicles (EVs), exosomes in particular, play a critical role in developing various clinical disorders. However, the implication of exosomes in endometriosis progression has not been well elucidated.

Method: The ectopic stromal cellular exosomes (eEVs) were assessed by transwell assay, scratch tests, tube formation assay, western blot, and qRT-PCR analysis. Protein expression profiles of exosomes in endometrial tissue and vaginal discharge collected from patients with EMS and healthy donors were analysed by Mass spectrometry. siRNA interference technology was used to inhibit the expression of exosomal protein for the functional analysis in in-vivo. Finally, in-vitro experiments were performed to validate the results that we observed in EMs mouse model.

Results:In vitro, we discovered that eEVs improved NSC migratory potential by upregulating MMP9 expression and activity. eEVs also aided angiogenesis and elevated the expression of inflammatory cytokines in ovarian epithelial cells, according to our findings. Moesin (MSN) levels in ESC exosomes were substantially greater than in NSC exosomes (1.22e⁸±5.58e⁶ vs. 6.605e⁷±4.574e⁶, LFQ intensity), as shown by protein mass spectrometry and bioinformatics analysis. In ectopic stromal cells, ERa receptors stimulated the RhoA/Rock-2/MSN pathway. We discovered that downregulating exosomal moesin reduced NSC migration (about 3-fold change) and MMP9 expression (about 2-fold change). On the other hand, Exomsni inhibited angiogenesis and inflammatory cytokine release. In vivo the result of immunohistochemistry and immunofluorescence demonstrated that exosomal MSN substantially modified the expression of MM9, VEGFR and p-VEGFR in polyclonal lesions. In addition, we discovered an elevation in the expression of proinflammatory factors in the surrounding tissue.

Conclusion: Exosomal MSN derived from ectopic stromal cells can contribute to endometriosis progression by mediating the construction of a “migration-vascularization-inflammation” loop in the ectopic environment.