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Lesmana R, Tandean S, Christoper A, Suwantika AA, Wathoni N, Abdulah R, Fearnley J, Bankova V, Zulhendri F. Propolis as an autophagy modulator in relation to its roles in redox balance and inflammation regulation. Biomed Pharmacother 2024; 175:116745. [PMID: 38761422 DOI: 10.1016/j.biopha.2024.116745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024] Open
Abstract
Autophagy is a degradation process that is evolutionarily conserved and is essential in maintaining cellular and physiological homeostasis through lysosomal removal and elimination of damaged peptides, proteins and cellular organelles. The dysregulation of autophagy is implicated in various diseases and disorders, including cancers, infection-related, and metabolic syndrome-related diseases. Propolis has been demonstrated in various studies including many human clinical trials to have antimicrobial, antioxidant, anti-inflammatory, immune-modulator, neuro-protective, and anti-cancer. Nevertheless, the autophagy modulation properties of propolis have not been extensively studied and explored. The role of propolis and its bioactive compounds in modulating cellular autophagy is possibly due to their dual role in redox balance and inflammation. The present review attempts to discuss the activities of propolis as an autophagy modulator in biological models in relation to various diseases/disorders which has implications in the development of propolis-based nutraceuticals, functional foods, and complementary therapies.
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Affiliation(s)
- R Lesmana
- Physiology Division, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Indonesia; Biological Activity Division, Central Laboratory, Universitas Padjadjaran, Indonesia.
| | - S Tandean
- Department of Neurosurgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara 20222, Indonesia.
| | - A Christoper
- Postgraduate Program of Medical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia.
| | - A A Suwantika
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung 45363, Indonesia; Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung 45363, Indonesia.
| | - N Wathoni
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45363, Indonesia; Research Center of Biopolymers for Drug and Cosmetic Delivery, Bandung 45363, Indonesia.
| | - R Abdulah
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung 45363, Indonesia; Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung 45363, Indonesia.
| | - J Fearnley
- Apiceutical Research Centre, Unit 3b Enterprise Way, Whitby, North Yorkshire YO18 7NA, UK.
| | - V Bankova
- Institute of Organic Chemistry with Centre of Phytochemistry, Bulgarian Academy of Sciences, Acad. G. Bonchev str., bl. 9, Sofia 1113, Bulgaria.
| | - F Zulhendri
- Kebun Efi, Kabanjahe, North Sumatra 22171, Indonesia; Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Indonesia.
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Chavda VP, Vuppu S, Balar PC, Mishra T, Bezbaruah R, Teli D, Sharma N, Alom S. Propolis in the management of cardiovascular disease. Int J Biol Macromol 2024; 266:131219. [PMID: 38556227 DOI: 10.1016/j.ijbiomac.2024.131219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Propolis is a resinous compound that is obtained from honey bees. It consists of numerous chemical constituents that impart different therapeutic action. The heart is the core of the body and cardiovascular disease (CVD) is a burden for the human being. This article emphasizes how propolis is fruitful in the management of various CVDs. SCOPE AND APPROACH This review focuses on how various constituents of the propolis (such as terpenes, flavonoids, phenolics, etc.) impart cardio protective actions. KEY FINDING AND CONCLUSION With the support of various clinical trials and research outcomes, it was concluded that propolis owns niche cardio protective properties that can be a boon for various cardiac problems (both in preventive and therapeutic action) such as atherosclerosis, excessive angiogenesis, hypertension, and many more.
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Affiliation(s)
- Vivek P Chavda
- Department of Pharmaceutics and Pharmaceutical Technology, LM College of Pharmacy, Ahmedabad 380009, Gujarat, India.
| | - Suneetha Vuppu
- Department of Biotechnology, Science, Innovation, Society Research lab 115, Hexagon (SMV), Vellore Institute of Technology, Vellore, Tamil Nadu 632014, India.
| | - Pankti C Balar
- Pharmacy Section, LM College of Pharmacy, Ahmedabad 380009, Gujarat, India
| | - Toshika Mishra
- Department of Biotechnology, Science, Innovation, Society Research lab 115, Hexagon (SMV), Vellore Institute of Technology, Vellore, Tamil Nadu 632014, India
| | - Rajashri Bezbaruah
- Institute of Pharmacy, Assam medical College and hospital, Dibrugarh, Assam, India
| | - Divya Teli
- Department of Pharmaceutics and Pharmaceutical Technology, LM College of Pharmacy, Ahmedabad 380009, Gujarat, India
| | - Nikita Sharma
- Department of Biotechnology, Science, Innovation, Society Research lab 115, Hexagon (SMV), Vellore Institute of Technology, Vellore, Tamil Nadu 632014, India
| | - Shahnaz Alom
- Girijananda Chowdhury Institute of Pharmaceutical Science, Girijananda Chowdhury University, Tezpur, Sonitpur, Assam, India
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Gheflati A, Dehnavi Z, Ghannadzadeh Yazdi A, Khorasanchi Z, Raeisi-Dehkordi H, Ranjbar G. The effects of propolis supplementation on metabolic parameters: A systematic review and meta-analysis of randomized controlled clinical trials. AVICENNA JOURNAL OF PHYTOMEDICINE 2021; 11:551-565. [PMID: 34804893 PMCID: PMC8588957 DOI: 10.22038/ajp.2021.18046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 12/16/2022]
Abstract
Objective: Propolis is a sticky, resinous substance produced by honeybees from various plants. Various biological properties of propolis and its extracts have been recognized in previous studies including the antiseptic, anti-inflammatory, antioxidant, antiviral, hepatoprotective, antitumor, antibacterial and antimycotic properties. This study aimed to summarize the effect of propolis on metabolic parameters in human adults using systematic review and meta-analysis. Materials and Methods: A comprehensive systematic search was performed in ISI Web of Science, PubMed, Scopus, and Google Scholar up to July 2020 for controlled clinical trials evaluating the impact of propolis on lipid profile and liver enzyme biomarkers. A random effects model was used to calculate the weighted mean difference (WMD) and 95% confidence interval (CI) as the difference between the mean for the intervention and control groups. Results: The present meta-analysis included six randomized controlled trials. There was significant reduction in Aspartate Aminotransferase (AST) in comparison to the control groups (WMD=-2.01; 95% CI: -3.93--0.10; p=0.039). However, a non-significant effect was observed in Triglycerides (TG), Total cholesterol (TC), low-density lipoprotein (LDL), High-density lipoprotein (HDL) (WMD=-0.05 mg/dl; 95% CI: -0.27-0.18; p=0.688; WMD=7.08 mg/dl; 95% CI: -37.31-51.46; p=0.755; WMD=-0.94 mg/dl; 95% CI: -6.64-4.77; p=0.747; WMD=3.14 mg/dl; 95% CI: -1.84-8.13; p=0.216, respectively). Conclusion: Current meta-analysis revealed that propolis supplementation can reduce AST; nevertheless, there was no significant effect on lipid profile indices and ALT.
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Affiliation(s)
- Alireza Gheflati
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Dehnavi
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Zahra Khorasanchi
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamidreza Raeisi-Dehkordi
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Golnaz Ranjbar
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Ji C, Pan Y, Xu S, Yu C, Ji J, Chen M, Hu F. Propolis ameliorates restenosis in hypercholesterolemia rabbits with carotid balloon injury by inhibiting lipid accumulation, oxidative stress, and TLR4/NF-κB pathway. J Food Biochem 2021; 45:e13577. [PMID: 33729587 DOI: 10.1111/jfbc.13577] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/24/2022]
Abstract
Neointima formation and atherosclerosis are the main complications after the endovascular intervention and vascular surgery, and there are no effective drugs. Propolis is a kind of resin substance produced by honeybees and has numerous health-beneficial effects. In this study, we evaluated the effects of propolis (125 and 250 mg·kg-1 ·day-1 , 6 weeks) on carotid restenosis in hypercholesterolemia rabbits. Propolis significantly ameliorated the degree of carotid restenosis, inhibited neointima hyperplasia, reduced serum lipids profile, and enhanced the anti-oxidative activities in hypercholesterolemia rabbits. Furthermore, propolis reduced the plasma levels of C-reactive protein, interleukin-6, and tumor necrosis factor-α (TNF-α), and inhibited the expression of CD68, TLR4, NF-κB p65, MMP-9, and TNF-α in the carotid arteries. The results indicate that propolis has a protective effect on carotid restenosis in rabbits, which is associated with regulating blood lipids, inhibiting oxidative stress and inflammation, and its anti-inflammatory activity may be related to inhibit TLR4-mediated NF-κB signaling pathway. PRACTICAL APPLICATIONS: Restenosis is a primary challenge in angioplasty and atherosclerotic treatment. Hyperlipidemia can induce inflammation and accelerate the formation of restenosis. Recently, natural products have been widely used to prevent intimal hyperplasia of common cardiovascular diseases. Propolis is currently a popular functional food, but the role of propolis on carotid restenosis after angioplasty and its underlying mechanism remains unclear. This study showed that propolis inhibits the effect of carotid restenosis in hypercholesterolemia rabbits. The results of this study may provide a basis for propolis to prevent and treat vascular restenosis.
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Affiliation(s)
- Chao Ji
- Huai'an Bee Products Engineering Research Center, Huai'an, China
| | - Yongming Pan
- Comparative Medical Research Institute, Zhejiang Chinese Medical University, Hangzhou, China
| | - Songtao Xu
- Comparative Medical Research Institute, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chen Yu
- Comparative Medical Research Institute, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jian Ji
- Huai'an Bee Products Engineering Research Center, Huai'an, China
| | - Minli Chen
- Comparative Medical Research Institute, Zhejiang Chinese Medical University, Hangzhou, China
| | - Fuliang Hu
- College of Animal Sciences, Zhejiang University, Hangzhou, China
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Silva H, Francisco R, Saraiva A, Francisco S, Carrascosa C, Raposo A. The Cardiovascular Therapeutic Potential of Propolis-A Comprehensive Review. BIOLOGY 2021; 10:biology10010027. [PMID: 33406745 PMCID: PMC7823408 DOI: 10.3390/biology10010027] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023]
Abstract
Simple Summary Propolis, also described as bee glue, is a natural component made up of a resinous mixture of honeybee compounds from multiple botanical sources. The literature has demonstrated a variety of medicinal properties attributed to propolis due to its chemical complexity. However, the positive effects of propolis on cardiovascular health have gained little coverage. Therefore, we aimed to provide an accurate and up-to-date review of the main cardiovascular health benefits of propolis. In particular, we intend to establish the key varieties of propolis and pharmacological compounds with the therapeutic effects that are most encouraging, as well as the physiological processes by which those advantages are accomplished. The Brazilian green and red varieties reveal the greatest number of beneficial activities among the varieties of propolis studied. While much of the cardiovascular beneficial effects appear to derive from the cumulative actions of several compounds working via multiple signaling mechanisms, some individual compounds that may enhance the existing therapeutic arsenal have also shown significant results. It is also worth exploring the prospect of using propolis as food supplements. Abstract Owing to its chemical richness, propolis has a myriad of therapeutic properties. To the authors’ knowledge, this is the first comprehensive review paper on propolis to focus exclusively on its major effects for cardiovascular health. The propolis compound varieties with the most promising therapeutic benefits and their respective physiological mechanisms will be discussed. Propolis displays an anti-atherosclerotic activity, attained through modulation of the plasma lipid profile and through stabilization of the fatty plaque by inhibiting macrophage apoptosis, vascular smooth muscle proliferation and metalloproteinase activity. The antihypertensive effects of propolis probably arise through the combination of several mechanisms, including the suppression of catecholamine synthesis, stimulation of endothelium-dependent vasorelaxation and vascular anti-inflammatory activity. The anti-hemostatic activity of propolis is attributed to the inhibition of platelet plug formation and antifibrinolytic activity. By inhibiting the secretion of proangiogenic factors, propolis suppresses endothelial cell migration and tubulogenesis, exerting antiangiogenic activity. The antioxidant and anti-inflammatory activities are responsible for protection against vascular endothelial and cardiomyocyte dysfunction, mostly by the prevention of oxidative stress. Among the reviewed propolis varieties, the Brazilian green and red varieties show the largest number of beneficial activities. Further research, especially preclinical, should be conducted to assess the cardiovascular benefits of the given varieties with different compositions.
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Affiliation(s)
- Henrique Silva
- Informetrics Research Group, Ton Duc Thang University, Ho Chi Minh City 758307, Vietnam
- Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City 758307, Vietnam
- Correspondence: (H.S.); (A.R.)
| | - Rafaela Francisco
- Pharmacological Sciences Department, Faculty of Pharmacy, Universidade de Lisboa, Av Prof Gama Pinto, 1649-003 Lisboa, Portugal;
| | - Ariana Saraiva
- Department of Animal Pathology and Production, Bromatology and Food Technology, Faculty of Veterinary, Universidad de Las Palmas de Gran Canaria, Trasmontaña s/n, 35413 Arucas, Spain; (A.S.); (C.C.)
| | - Simone Francisco
- Faculty of Medicine, Nutrition Lab—Universidade de Lisboa, 1649-028 Lisboa, Portugal;
| | - Conrado Carrascosa
- Department of Animal Pathology and Production, Bromatology and Food Technology, Faculty of Veterinary, Universidad de Las Palmas de Gran Canaria, Trasmontaña s/n, 35413 Arucas, Spain; (A.S.); (C.C.)
| | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal
- Correspondence: (H.S.); (A.R.)
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Hesami S, Hashemipour S, Shiri-Shahsavar MR, Koushan Y, Khadem Haghighian H. Administration of Iranian Propolis attenuates oxidative stress and blood glucose in type II diabetic patients: a randomized, double-blind, placebo-controlled, clinical trial. CASPIAN JOURNAL OF INTERNAL MEDICINE 2019; 10:48-54. [PMID: 30858941 PMCID: PMC6386327 DOI: 10.22088/cjim.10.1.48] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/28/2018] [Accepted: 09/29/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hyperglycemia in diabetic people resulted in oxidative conditions. Propolis is the third most important component of bee products which has various functional properties such as anti-oxidant due to its components. The aim of this study was to evaluate the propolis effect on fructosamine level, the catalase activity, and the level of oxidized LDL changes in type 2 diabetic patients. METHODS In this double-blind, randomized controlled trial study, 62 type 2 diabetic patients, attending Endocrine clinic in Velayat Hospital (Qazvin, Iran) in 2017, were randomly assigned to one of intervention and placebo (n=31) groups. Participants in intervention group took propolis capsule (500 mg) 3 times a day and those in placebo group took placebo capsules for 8-week. Fructosamine level, catalase activity and the level of oxidized-LDL were measured at the baseline and at the end of the study. Statistical analysis was performed using SPSS software. RESULTS At the end of the study, significant differences were seen within groups and in-between groups. In Propolis group compared to the placebo, fructosamine (p<0.05), and the level of oxidized LDL (p<0.05) decreased, and catalase activity (p<0.05) improved. However, there were no significant changes in the placebo group at the end of trial. CONCLUSION Eight weeks intake of propolis as a supplement in type II diabetic patients could improve anti-oxidant defense and decline production of hyperglycemia induced products such as fructosamine.
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Affiliation(s)
- Sepideh Hesami
- Department of Nutrition, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Sima Hashemipour
- Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Yaghob Koushan
- Medical Plant Research Center of Islamic Azad University of Tabriz, Researcher in Traditional Medicine, Tabriz, Iran
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Chang H, Yuan W, Wu H, Yin X, Xuan H. Bioactive components and mechanisms of Chinese poplar propolis alleviates oxidized low-density lipoprotein-induced endothelial cells injury. Altern Ther Health Med 2018; 18:142. [PMID: 29724195 PMCID: PMC5934819 DOI: 10.1186/s12906-018-2215-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/20/2018] [Indexed: 01/21/2023]
Abstract
Background Propolis, a polyphenol-rich natural product, has been used as a functional food in anti-inflammation. However, its bioactive components and mechanisms have not been fully elucidated. To discover the bioactive components and anti-inflammatory mechanism, we prepared and separated 8 subfractions from ethyl acetate extract of Chinese propolis (EACP) and investigated the mechanism in oxidized low density lipoprotein (ox-LDL) induced human umbilical vein endothelial cells (HUVECs) damage. Methods Eight subfractions were prepared and separated from ethyl acetate extract of Chinese propolis (EACP) with different concentrations of methanol-water solution, and analysed its chemical constituents by HPLC-DAD/Q-TOF-MS. Then 80% confluent HUVECs were stimulated with 40 μg/mL ox-LDL. Cell viability and apoptosis were evaluated by Sulforhodamine B (SRB) assay and Hoechst 33,258 staining, respectively. Levels of caspase 3, PARP, LC3B, p62, p-mTOR, p-p70S6K, p-PI3K, p-Akt, LOX-1 and p-p38 MAPK were assessed by western blotting and immunofluorescence assay, respectively. Reactive oxygen species (ROS) and mitochondrial membrane potential (MMP) were measured with fluorescent probes. Results Each subfraction exhibited similar protective effect although the contents of chemical constituents were different. EACP attenuated ox-LDL induced HUVECs apoptosis, depressed the ratio of LC3-II/LC3-I and enhanced the p62 level. In addition, treatment with EACP also activated the phosphorylation of PI3K/Akt/mTOR, and deactivated the level of LOX-1 and phosphorylation of p38 MAPK. The overproduction of ROS and the damage of MMP were also ameliorated after ECAP treatment. Conclusions These findings indicated that the bioactive component of propolis on anti-inflammatory activity was not determined by a single constituent, but a complex interaction including flavonoids, esters and phenolic acids. EACP attenuated ox-LDL induced HUVECs injury by inhibiting LOX-1 level and depressed ROS production against oxidative stress in ox-LDL induced HUVECs, further to activate PI3K/Akt/mTOR pathway and deactivate p38 MAPK to inhibit apoptosis and autophagy, which provide novel insights into the potential application of propolis on modulating chronic inflammation.
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Chang H, Wang Y, Yin X, Liu X, Xuan H. Ethanol extract of propolis and its constituent caffeic acid phenethyl ester inhibit breast cancer cells proliferation in inflammatory microenvironment by inhibiting TLR4 signal pathway and inducing apoptosis and autophagy. Altern Ther Health Med 2017; 17:471. [PMID: 28950845 PMCID: PMC5615448 DOI: 10.1186/s12906-017-1984-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/22/2017] [Indexed: 12/19/2022]
Abstract
Background Propolis and its major constituent – caffeic acid phenethyl ester (CAPE) have good abilities on antitumor and anti-inflammation. However, little is known about the actions of propolis and CAPE on tumor in inflammatory microenvironment, and inflammatory responses play decisive roles at different stages of tumor development. To understand the effects and mechanisms of ethanol-extracted Chinese propolis (EECP) and its major constituent - CAPE in inflammation-stimulated tumor, we investigated their effects on Toll-like receptor 4 (TLR4) signaling pathway which plays a crucial role in breast cancer MDA-MB-231 cell line. Methods 80% confluent breast cancer MDA-MB-231 cells were stimulated with 1 μg/mL lipopolysaccaride (LPS). Then the cells were divided for treatment by CAPE (25 μg/mL) and EECP (25, 50 and 100 μg/mL), respectively. Cell viability, nitric oxide (NO) production and cell migration were measured by sulforhodamine B assay, chemical method and scratch assay. The levels of TLR4, MyD88, IRAK4, TRIF, caspase 3, PARP, LC3B and p62 were investigated through western blotting. The expression of TLR4, LC3B and nuclear factor-κB p65 (NF-κB p65) were tested by immunofluorescence microscopy assay. Results Treatment of different concentrations of EECP (25, 50 and 100 μg/mL) and CAPE (25 μg/mL) significantly inhibited LPS-stimulated MDA-MB-231 cell line proliferation, migration and NO production. Furthermore, EECP and CAPE activated caspase3 and PARP to induce cell apoptosis, and also upregulated LC3-II and decreased p62 level to induce autophagy during the process. TLR4 signaling pathway molecules such as TLR4, MyD88, IRAK4, TRIF and NF-κB p65 were all down-regulated after EECP and CAPE treatment in LPS-stimulated MDA-MB-231 cells. Conclusions These findings indicated that EECP and its major constituent - CAPE inhibited breast cancer MDA-MB-231 cells proliferation in inflammatory microenvironment through activating apoptosis, autophagy and inhibiting TLR4 signaling pathway. EECP and CAPE may hold promising prospects in treating inflammation-induced tumor.
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