Colorectal cancer statistics, 2023

A targeted MAVS fusion protein for controlled innate immune activation and antitumor therapy

Targeted therapies leveraging the innate immune system are emerging as promising cancer treatments. The mitochondrial antiviral signaling protein (MAVS) plays a crucial role in initiating innate immune responses, but its clinical use is limited by the risk of uncontrolled activation and systemic toxicity. To address this, we developed a novel therapeutic agent, the truncated interferon activation switch (TRIAS), combining MAVS truncates with a tumor antigen-targeting single-chain variable fragment (scFv). This design ensures antigen-dependent, controlled activation. Lentiviral delivery of TRIAS induced significant antitumor responses, including complete tumor regression in some cases. Flow cytometry (FCM) analysis further confirmed that tumor cells were the predominant population expressing the transgene. TRIAS-expressing tumor cells exhibited enhanced antitumor activity, likely due to increased cytokine release and upregulated major histocompatibility complex (MHC) expression, enabling tumor cells to function as antigen-presenting cells. This activated other immune cells, driving adaptive immune responses. Additionally, TRIAS promoted a proinflammatory shift in the tumor microenvironment (TME). In conclusion, TRIAS was validated as an innovative immunotherapeutic agent with MAVS-like immune-activating properties and tightly controlled mechanisms, offering a safer and more effective approach for clinical cancer immunotherapy.

Desulfovibrio vulgaris flagellin exacerbates colorectal cancer through activating LRRC19/TRAF6/TAK1 pathway

The initiation and progression of colorectal cancer (CRC) are intimately associated with genetic, environmental and biological factors. Desulfovibrio vulgaris (DSV), a sulfate-reducing bacterium, has been found excessive growth in CRC patients, suggesting a potential role in carcinogenesis. However, the precise mechanisms underlying this association remain incompletely understood. We have found Desulfovibrio was abundant in high-fat diet-induced Apcmin/+ mice, and DSV, a member of Desulfovibrio, triggered colonocyte proliferation of germ-free mice. Furthermore, the level of DSV progressively rose from healthy individuals to CRC patients. Flagella are important accessory structures of bacteria, which can help them colonize and enhance their invasive ability. We found that D. vulgaris flagellin (DVF) drove the proliferation, migration, and invasion of CRC cells and fostered the growth of CRC xenografts. DVF enriched the epithelial-mesenchymal transition (EMT)-associated genes and characterized the facilitation of DVF on EMT. Mechanistically, DVF induced EMT through a functional transmembrane receptor called leucine-rich repeat containing 19 (LRRC19). DVF interacted with LRRC19 to modulate the ubiquitination of tumor necrosis factor receptor-associated factor (TRAF)6, rather than TRAF2. This interaction drove the ubiquitination of pivotal molecule TAK1, further enhancing its autophosphorylation and ultimately contributing to EMT. Collectively, DVF interacts with LRRC19 to activate the TRAF6/TAK1 signaling pathway, thereby promoting the EMT of CRC. These data shed new light on the role of gut microbiota in CRC and establish a potential clinical therapeutic target.

Microbiota and metabolite-based prediction tool for colonic polyposis with and without a known genetic driver

Despite extensive investigations into the microbiome and metabolome changes associated with colon polyps and colorectal cancer (CRC), the microbiome and metabolome profiles of individuals with colonic polyposis, including those with (Gene-pos) and without (Gene-neg) a known genetic driver, remain comparatively unexplored. Using colon biopsies, polyps, and stool from patients with Gene-pos adenomatous polyposis (N = 9), Gene-neg adenomatous polyposis (N = 18), and serrated polyposis syndrome (SPS, N = 11), we demonstrated through 16S rRNA sequencing that the mucosa-associated microbiota in individuals with colonic polyposis is representative of the microbiota associated with small polyps, and that both Gene-pos and SPS cohorts exhibit differential microbiota populations relative to Gene-neg polyposis cohorts. Furthermore, we used these differential microbiota taxa to perform linear discriminant analysis to differentiate Gene-neg subjects from Gene-pos and from SPS subjects with an accuracy of 89% and 93% respectively. Stool metabolites were quantified via 1H NMR, revealing an increase in alanine in SPS subjects relative to non-polyposis subjects, and Partial Least Squares Discriminant Analysis (PLS-DA) analysis indicated that the proportion of leucine to tyrosine in fecal samples may be predictive of SPS. Use of these microbial and metabolomic signatures may allow for better diagnostric and risk-stratification tools for colonic polyposis patients and their families as well as promote development of microbiome-targeted approaches for polyp prevention.

In situ forming AIEgen-alginate hydrogel for remodeling tumor microenvironment to boost FLASH immunoradiotherapy

FLASH radiotherapy, which involves the delivery of an ultra-high radiation dose rate exceeding 40 Gy/s, has emerged as a promising tumor ablation strategy. While this approach generally spares normal tissues, the incomplete killing of tumors may sometimes lead to recurrence due to the immunosuppressive tumor microenvironment (TME). Herein, an aggregation-induced-emission luminogen (AIEgen)-alginate hydrogel was used to sensitize colon cancer via photodynamic therapy (PDT). Flower-like calcium carbonate nanoparticles, doped with an AIEgen termed CQu, were designed and applied as a cocktail with sodium alginate. When exposed to the acidic TME, Ca2+ is released from this structure, resulting in sodium alginate termed FA forming a hydrogel in situ within the TME. This hydrogel also captures high concentrations of CQu in the local TME. Under laser irradiation, the CQu can generate sustained reactive oxygen species (ROS) production, thereby facilitating Ca2+ influx and causing mitochondrial damage. Through a single injection of established FA hydrogel, followed by PDT and FLASH radiotherapy, immunogenic tumor cell death was induced which promoted antitumor immunity, thereby protecting against tumor recurrence while realizing abscopal effect. The results highlight the potential to improve the sensitivity of tumor cells to FLASH radiotherapy through sustained ROS production and Ca2+ overload, thereby yielding optimal immunotherapy outcomes.

Novel 6xHis/HaloTag mammalian expressed autoantigens for the detection of humoral response with multiplexed electrochemical biosensors: A breakthrough in colorectal cancer and Alzheimer's disease personalized diagnostics

The integration of autoantibody detection with electrochemical biosensors allows the development of a novel strategy for managing colorectal cancer (CRC) and Alzheimer's disease (AD). This work reports the use, for the first time, of sustainable receptors, autoantigens expressed in mammalian cells, fused to 6xHis at the N-terminus and HaloTag at the C-terminus, immobilized on chloroalkane-modified magnetic beads (MBs) to selectively capture plasma autoantibodies. Detection was based on amperometric measurements using disposable multiplexed screen-printed carbon electrodes (x8 sensing surfaces), horseradish peroxidase (HRP)-conjugated secondary antibodies, and the HQ/H2O2 system. HaloTag immobilization gave rise to a great sensitivity allowing discrimination between patients and healthy individuals in comparison with HisTag or -COOH immobilization. The CRC biosensor integrated seven CRC-specific full-length autoantigens, while the AD bioplatform combined three AD-specific full-length proteins and four AD-specific peptides, which allowed a robust diagnostic performance validated by ROC analyses. These multiplexed biosensors provide minimally invasive, cost-effective, and sustainable alternatives to traditional diagnostic methods, and show ideal for discovery of new targets and for mass screening and early disease detection, supporting personalized medicine approaches.

HNRNPC stabilizes m6A-modified AC145207.5 to accelerate tumorigenesis in colorectal cancer by impeding the Nrf2/GPX4 axis-mediated ferroptosis

Ferroptosis is an apoptosis-independent cell death pathway characterized by heightened lipid peroxidation, which shows promise for tumor suppression. Despite extensive research on long non-coding RNAs (LncRNAs) in ferroptosis, their role in colorectal cancer (CRC) remains underexplored. We investigated the upregulation of AC145207.5 and HNRNPC expression in CRC tissues through public dataset analysis and in-house validation, identifying them as having significant diagnostic potential. In vitro experiments including MTS assay, transwell, and colony formation, alongside in vivo studies using xenograft models, elucidated the synergistic carcinogenic role of the HNRNPC/AC145207.5 axis in promoting the malignant characteristics of CRC. Mechanistically, the m6A reader HNRNPC stabilized m6A-modified AC145207.5, contributing to its stabilization and upregulation. Consequently, AC145207.5 activated the Nrf2/GPX4 axis, resulting in increased GPX4 expression, inhibition of GPX4-mediated ferroptosis, and facilitation of CRC progression. Our findings underscore the clinical relevance of the HNRNPC/AC145207.5 axis in CRC and illuminate its regulatory role in ferroptosis, suggesting implications for targeted precision medicine in CRC.

Intestinal estrogen receptor beta modulates the murine colon tumor immune microenvironment

Chronic inflammation contributes to the development of colorectal cancer, partly through its regulation of the microenvironment and antitumor immunity. Interestingly, women have a lower incidence of colorectal cancer, and estrogen treatment has been shown to reduce the occurrence of colorectal tumors. While intestinal estrogen receptor beta (ERβ, Esr2) can protect against colitis and colitis-induced cancer in mice, its role in shaping the tumor microenvironment remains unknown. In this study, we performed RNA sequencing to analyze the transcriptome of colonic epithelia and tumors from azoxymethane/dextran sulfate sodium-treated wild-type and intestinal ERβ knockout (ERβKOVil) mice and vehicle-treated controls. This revealed significant differences in gene expression and enriched biological processes influenced by sex and genotype, with immune-related responses being overrepresented. Deconvolution supported differential immune cell abundance and immunostaining showed that tumors from ERβKOVil mice displayed significantly increased macrophage infiltration, decreased T cell infiltration, and impaired natural killer cell infiltration. Further, ERβ mRNA levels in clinical colorectal tumors correlated with immune signaling profiles and better survival. Our findings indicate that intestinal ERβ promotes an antitumor microenvironment and could potentially affect the effectiveness of immunotherapy. These insights highlight the importance of ERβ in modulating antitumor immunity and underscore its therapeutic potential in colorectal cancer.

Anticancer signal transduction pathways of selenium nanoparticles in mouse colorectal cancer model

Despite significant advances in the treatment of colon cancer, this disease is extremely common, often requiring serious surgery followed by long-term drug treatment. Colon and rectal cancer remain dangerous forms of cancer due to the high degree of metastasis. The development and study of the effectiveness of anticancer drugs based on nanoparticles is an urgent task of modern biomedicine. Of particular interest are attempts to move research from the in vitro level to the in vivo level of preclinical studies. In the presented study, mice were subcutaneously implanted with MC-38 cell line, a tumor was grown, and selenium nanoparticles (SeNPs) with a diameter of 100 nm obtained using the laser ablation method were administered intraperitoneally. Using morphometric measurements, it was found that injections of 1 μg/g or 10 μg/g SeNPs inhibited weight loss of mice during cancer development, reduced tumor size by 2-2.5 times, and suppressed metastasis by 1.5-3 times. Analysis of selenium levels in mouse blood, liver and tumor samples by atomic absorption spectrometry after the end of SeNPs treatment showed that the nanoparticles increased selenium levels in the blood and liver of mice without a significant dose-dependence, whereas in tumors a dose-dependent increase in selenium concentration was detected from the concentration of nanoparticles, with 10 μg/g SeNPs causing a more pronounced increase in selenium concentration. Using PCR and Western blot analysis, it was possible to establish that SeNPs injections led to an increase in the expression of genes encoding anti-inflammatory and anti-hypoxic proteins, but reduced the expression of antioxidant selenium-containing proteins and proteins responsible for the proliferation of cancer cells. Both concentrations of SeNPs led to similar effects, but increasing the concentration of nanoselenium to 10 μg/g affected the expression of a larger number of genes and the effects on expression were more "bright". Thus, the complex of presented experiments showed that injections of selenium nanoparticles in concentrations of 1 μg/g or 10 μg/g are capable to transport by the bloodstream and accumulating in the highest concentration in colon adenocarcinoma, compared with liver, which indicates the targeting of SeNPs in relation to tumors even without functionalization by specific molecules. As a result, there was a change in the expression patterns of genes and a number of proteins, and as a result, there was a decrease in tumor volume, normalization of mouse weight and maintenance of positive dynamics throughout the entire observation period.

Prognostic gene expression profile of colorectal cancer

Colorectal cancer is a major global health burden, with significant heterogeneity in clinical outcomes among patients. Identifying robust prognostic gene expression signatures can help stratify patients, guide treatment decisions, and improve clinical management. This review provides an overview of current prognostic gene expression profiles in colorectal cancer research. We have synthesized evidence from numerous published studies investigating the association between tumor gene expression patterns and patient survival outcomes. The reviewed literature reveals several promising gene signatures that have demonstrated the ability to predict disease-free survival and overall survival in CRC patients, independent of standard clinicopathological risk factors. These genes are crucial in fundamental biological processes, including cell cycle control, epithelial-mesenchymal transition, and immune regulation. The implementation of prognostic gene expression tests in clinical practice holds great potential for enabling more personalized management strategies for colorectal cancer.

Accuracy of CT colonography with mannitol preparation for detecting synchronous lesions in obstructive colorectal cancer

OBJECTIVE

Preoperative detection of advanced neoplasms is essential for surgical planning in colorectal cancer (CRC). CT colonography (CTC) has emerged as a reliable alternative when obstructive CRC prevents complete optical colonoscopy (OC). Mannitol, commonly used for OC preparation in some countries, offers potential advantages over polyethylene glycol (PEG), including low cost, reduced ingestion volume, fast action, and a more palatable sweet taste. We evaluated the diagnostic accuracy of mannitol-based CTC for detecting synchronous lesions in CRC, hypothesizing that this low-volume preparation could maintain high accuracy while improving patient tolerability.

METHODS

Of 150 CRC patients with incomplete OC who underwent preoperative CTC following cathartic preparation with mannitol, 62 were retrospectively analyzed. Their CTC findings were compared with postoperative surgical and pathological results and follow-up OC. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed for lesions ≥6 mm. In addition, the quality of bowel preparation with mannitol (amount of liquid and solid residue) was compared with historical data from published studies.

RESULTS

In 62 patients (372 segments), 26 synchronous lesions were identified (9 ≥ 10 mm, 17 sized 6-9 mm). For lesions ≥6 mm, CTC achieved a sensitivity of 92.3 % (95 % CI: 74.9-99.1 %), specificity of 99.1 % (95 % CI: 97.5-99.8 %), PPV of 88.9 % (95 % CI: 70.8-97.6 %), and NPV of 99.4 % (95 % CI: 97.9-99.9 %). Bowel cleansing was adequate, with 82.8 % of segments showing no or minimal residual fluid and 96.3 % with no or minimal solid residue.

CONCLUSION

CTC with a mannitol-based preparation demonstrated high accuracy in detecting synchronous neoplasms among patients with obstructive CRC and incomplete OC. These findings suggest that mannitol is a feasible alternative to PEG, maintaining excellent diagnostic performance while possibly improving tolerability. Additionally, it could streamline surgical planning and improve overall outcomes in modern CRC management.

The BMI1-Angiopoietin-2 axis as an independent prognostic factor in colorectal cancer

BACKGROUND

The polycomb group protein B-lymphoma Moloney murine leukemia virus Insertion region-1 (BMI1), a transcriptional repressor, has been implicated in colorectal cancer (CRC) progression. This study investigated the role of BMI1 in the regulation of angiogenesis and its association with angiopoietin 2 (ANGPT2) in CRC.

METHODS

The highly metastatic CRC cell line SW620, known for its high BMI1 expression, was used to examine the effects of BMI1 knockdown and pharmacological inhibition using PTC209. Angiogenesis was assessed by tube formation and transendothelial migration assays. Quantitative real-time polymerase chain reaction (RT-qPCR) arrays were conducted to identify angiogenesis-related genes, and bioinformatics analysis using the TIMER database (version 2.0) was used to validate the correlation between BMI1 and angiogenic factors. Western blotting and immunohistochemistry confirmed protein-level interactions in cell and tissue samples. Clinicopathological associations were analyzed in 44 patients with advanced CRC, using survival analysis and multivariate regression models.

RESULTS

BMI1 knockdown significantly reduced tube formation and endothelial cell adhesion in SW620 cells. RT-qPCR and database analyses revealed a strong positive correlation between BMI1 and ANGPT2 expression (r = 0.366, p < 0.05). Protein-level analysis confirmed that BMI1 is essential for ANGPT2 expression, which was further validated in CRC clinical specimens and showed a significant correlation (p = 0.039). Survival analysis indicated that high BMI1 and ANGPT2 expression levels were significantly associated with poor overall survival and progression-free survival (p < 0.05).

CONCLUSION

BMI1 promotes angiogenesis in CRC by upregulating ANGPT2 expression. High BMI1 and ANGPT2 levels served as independent prognostic factors for tumor progression, highlighting their potential as therapeutic targets for CRC management.

Nanobody-based immunotoxins: A precision tool in the treatment of solid tumors

Solid tumors, the main cause of cancer-related death, represent a significant therapeutic challenge due to the high-density microenvironment and intolerance to conventional treatments. Nanobody-based immunotoxins (NbITs) are an exciting candidate, combining the ultimate specificity of nanobodies (single-domain antibody fragments of camelid antibodies) and detrimental effects of the toxin. These nanobodies are small (one-tenth of conventional antibody size), thermostable with high specificity, high antigen binding affinity which give it the ability to penetrate into solid tumors. Specific delivery to tumor cells is achieved through conjugating nanobodies with cytotoxic agents of bacterial origin or synthetic drugs. This phenomenon is initially attracted to the cells by the antigen-antibody interaction that is further enhanced by receptor-mediated internalization and cytotoxic payload release that subdues essential cellular processes and, as a consequence, damages the cells. This review discusses the mechanisms that underlie the effectiveness of NbITs, such as tumor antigen recognition, toxin release, and cellular signaling pathways elicited by the internalized toxins. We also discuss the application of NbITs in treating cancers such as HER2-positive breast cancer and EGFR-overexpressing lung cancer, and other cancers, highlighting their ability to address limitations of conventional therapies. Key challenges in NbIT development, including stability, immunogenicity, and efficient delivery, are critically evaluated. Current advances such as the creation of bispecific nanobody constructs, optimization of linker strategies, as well as the incorporation of nanoparticle-based delivery systems are maximizing the therapeutic potential of these molecules. This review synthesizes recent progress and addresses current obstacles in NbIT development, showcasing their transformative potential as a targeted therapeutic approach for solid tumors. It also covers future opportunities to develop and advance this emerging treatment strategy.

Stage-specific characterization of "early-onset colorectal cancer": Localized and synchronous metastatic disease

Early-onset colorectal cancer (EOCRC) is an alarming entity worldwide. Yet, stage-specific characteristics and prognosis in localized and synchronous metastatic EOCRC are not well-defined. Two cohorts of CRC patients (localized and synchronous metastatic) were evaluated, defining EOCRC as the diagnosis <50 years old. Five hundred sixty-eight patients were included (n = 432 localized, 14.4% [n = 62] EOCRC and n = 136 synchronous metastatic, 20.6% [n = 28] EOCRC). 93.5% of localized and 96.5% of synchronous metastatic EOCRC patients were symptomatic at diagnosis. Among localized patients, female gender (58.1% vs. 40%, p = .008), perineural invasion (41.9% vs. 24.9%, p = .005), folinic acid, 5-fluorouracil, and oxaliplatin chemotherapy (45.2% vs. 25.2%, p = .003), and perioperative chemotherapy cycles (9.21 [± 3.10] vs. 7.98 [± 2.92], p = .006) were higher in EOCRC compared with ≥50-year. Median recurrence-free survival (RFS) and overall survival were not reached in either group (p = .234 and p = .831). Only RAS mutant status was associated with RFS (Hazard ratio: 7.09 [95% confidence interval (CI): 1.87-26.76], p < .001) in EOCRC. Among synchronous metastatic patients, urgent surgery (32.1% vs. 11.1%, p = .014) and local treatments (39.3% vs. 20.4%, p = .037) were more frequent in EOCRC. Median progression-free survival and overall survival in the EOCRC and ≥50 years were 8.07 months (95% CI: 5.03-12.97) vs. 10.03 months (95% CI, 8.40-13.10) (p = .450) and 18.57 months (95% CI, 13.33-43.03) vs. 19.83 months (95% CI, 16.07-27.30) (p = .833), respectively. Synchronous metastatic EOCRC more frequently underwent urgent surgery (32.1% vs. 8%, p = .008) and had RAS mutation (43.5% vs. 16.7%, p = .032) than localized EOCRC. This study suggests that localized and synchronous metastatic EOCRC patients may have different characteristics than average onset, without survival differences. Implementation of stage-specific characteristics into daily practice is necessary for decision-making processes in these young patients.

Potential for enhancing efficacy of screening colonoscopy by lowering starting ages and extending screening intervals: A modelling study for Germany

Studies aimed to evaluate the expected impact of alternative screening strategies are essential for optimizing colorectal cancer (CRC) screening offers, but such studies are lacking in Germany, where two screening colonoscopies (CS) 10 years apart are offered for men from age 50 and women from age 55. Our aim was to explore whether and to what extent the efficacy of utilizing two CS could be enhanced by alternative starting ages and screening intervals. We modeled the expected numbers of CRC cases, CRC deaths, years of potential life lost (YPLL), and disability-adjusted life years (DALYs) due to CRC in hypothetical cohorts of 100,000 men and women aged 45-85 using COSIMO, a validated Markov-based multi-state simulation model. Modeled strategies included combinations of starting ages (45/50/55/60) and CS (10/15/20 years). For men, CRC deaths could be slightly reduced by extending the interval to 15 years, with a second CS at 65. YPLL and DALYs would be reduced by decreasing starting age to 45 when combined with a 15-year screening interval. For women, use of two CS at ages 50 and 65 would reduce all CRC burden parameters compared to the current earliest-use offer at 55 and 65 years. Our results suggest that lowering the starting age of screening colonoscopy to 45 for men and 50 for women, combined with extending the CS screening interval to 15 years would have the potential to enable significant reductions in years of potential life lost, and disability-adjusted life years compared to current screening offers in Germany.

Therapeutic efficacy of baicalein and 6-(methylsulfinyl)hexyl isothiocyanate, alone or in combination with 5-fluorouracil, in the treatment of colorectal cancer

Colorectal cancer (CRC) is the third most common malignancy worldwide. 5-fluorouracil (5-FU) remains the first-line drug for treatment of the metastatic stage despite the limits of its efficacy. Here, we investigated the anti-tumor effect of two phytochemicals, baicalein and 6-(methylsulfinyl)hexyl isothiocyanate (6-MITC), on colorectal cancer cells (HCT-116 and RKO) and determined whether these individual agents, when used alone or in combination with 5-FU, could enhance treatment efficacy. The evaluations included assays that measure cell viability and proliferation (MTT), apoptosis, cell migration, cell cycle, gelatin zymography, and combination index analyses. In both cell lines, baicalein [HCT-116 cells; IC50 = 40.82 ± 7.77 μM (24 h) and 33.83 ± 1.99 μM (48 h), and RKO cells; IC50 = 55.84 ± 3.12 μM (24 h) and 45.11 ± 3.05 μM (48 h)] and 6-MITC [HCT-116 cells; IC50 = 24.66 ± 1.57 μM (24 h) and 8.28 ± 0.56 μM (48 h), and RKO cells; IC50 = 45.74 ± 1.63 μM (24 h) and 9.85 ± 1.42 (48 h) μM] suppressed cancer cell proliferation in a dose-dependent manner at 24 and 48 h, while 5-FU was cytotoxic only after 48 h [HCT-116 cells; IC50 18.43 ± 3.82, and RKO cells; IC50 = 30.57 ± 8.34 μM]. Compared with 5-FU treatment only, the combined treatments induced significant increases in the pre-G1 phase and decreases in the G1 and S phases in both cell lines. In HCT-116 cells, combined treatments induced significantly greater apoptosis compared to 5-FU alone. Single and combination treatments with baicalein or 6-MITC significantly lowered the migration of cells compared to 5-FU alone in both cell lines. In conclusion, our study showed that both baicalein and 6-MITC induced similar anti-tumor effects compared to 5-FU alone in both cell lines, however, the combined treatments were more efficient.

Low Carbohydrate Diet Containing Soy Protein and Fish Oil Reduces AOM/DSS-Induced Colon Cancer, in Part, by an Acetate-Mediated Reduction in TH17 Cell Differentiation

Since our previous studies found a low-carbohydrate (CHO) diet containing soy protein and fish oil (i.e., 15%Amylose/Soy/FO) significantly reduced tobacco carcinogen-induced lung nodules in A/J mice, breast tumors in C3(1)/Tag mice, and myelomalignancy in miR-146a knockout mice, we asked herein if this CHO diet could also reduce colorectal cancer. We tested the efficacy of the 15%Amylose/Soy/FO diet in preventing colitis-induced colorectal cancer using an azoxymethane/dextran sodium sulfate BALB/c mouse model. The 15%Amylose/Soy/FO diet significantly reduced colon tumor numbers compared to a Western diet and this was associated with a reduction in blood glucose, and a trend towards an increase in plasma β-hydroxybutyrate and an increase in liver fatty acid synthase, suggesting a systemic metabolic shift from glucose to fatty acids as an energy source. In addition, our CHO diet reduced proinflammatory cytokines, induced a marked change in the fecal microbiome, an increase in cecal and fecal acetate, and a reduction in interleukin-17A expressing cells in the colonic tumors of mice on the 15%Amylose/Soy/FO diet. Taken together, our results suggest the 15%Amylose/Soy/FO diet ameliorates colitis and prevents the subsequent development of colorectal cancer, in part by an acetate-mediated reduction in TH17 cell development.

Integrative multi-omics analysis reveals the LncRNA 60967.1-PLCD4-ATRA axis as a key regulator of colorectal cancer progression and immune response

Colorectal cancer (CRC) is a major global health concern, characterized by high morbidity and mortality rates. CRC progression involves intricate molecular networks that remain incompletely understood. In this study, we conducted an integrative multi-omics analysis of transcriptomic, proteomic, and metabolomic profiles from CRC tissues and matched normal adjacent tissues (NATs). Our analysis revealed 1,394 differentially expressed long non-Coding RNAs (lncRNAs), 2,788 genes, 548 proteins, and 91 metabolites. A significant interaction network comprising 22 lncRNAs, 14 mRNAs/proteins, and 9 metabolites was identified, among which lncRNA 60967.1 emerged as a pivotal regulator. Functional validation demonstrated that lncRNA 60967.1 is markedly downregulated in CRC cell lines and patient tissues. Overexpression of lncRNA 60967.1 restored expression of the tumor suppressor PLCD4 and increased levels of all-trans retinoic acid (ATRA). This modulation enhanced IFN-γ-induced apoptosis and increased expression of the IFN-γ receptor subunit IFNGR1, thereby partially reversing IFN-γ resistance. In murine models, lncRNA 60967.1 overexpression promoted immune cell infiltration and synergized with anti-PD-1 therapy to inhibit tumor growth. Collectively, our findings uncover a novel lncRNA-mRNA/protein-metabolite network, the lncRNA 60967.1-PLCD4-ATRA axis, that plays a critical role in CRC progression and immune modulation, offering promising therapeutic targets for improved treatment efficacy.

Preparation of mitochondria-targeted camptothecin derivatives for the imaging and antiproliferation of colorectal cancer

Colorectal cancer ranks among the top causes of both cancer incidence and mortality, posing a severe threat to global health. Currently, chemotherapeutic drugs used for treating colorectal cancer, such as camptothecin (CPT) and its derivatives, are limited in their application due to gastrointestinal reactions and myelosuppression. Mitochondria-targeted therapy aims to deliver active drug molecules into the mitochondria via electrostatic adsorption, allowing them to exert their effects directly within the mitochondria while reducing side effects during treatment. In this work, we used camptothecin as the parent compound, then we synthesized three series of 13 camptothecin derivatives by attaching alkyl chains of different length to delocalized lipophilic cations such as triphenylphosphonium, F16 and rhodamine B. The in vitro cytotoxicity screening revealed that compounds 8a and 8c, which are connected to rhodamine B, showed significantly higher antiproliferative activity against HCT116 colorectal cancer cells than CPT. Furthermore, compound 8a exhibited lower toxicity towards normal liver cells. Cellular imaging experiments demonstrated excellent mitochondria-targeted abilities of compounds 8a and 8c. Flow cytometry analysis indicated that compound 8a can induce apoptosis in a concentration-dependent manner. Overall, compound 8a can be a potential anti-cancer agent for colorectal cancer.

Mesenteric benign lymph node enlargement in colorectal cancer: Friend or foe?

INTRODUCTION

Benign lymph node enlargement (BLNE) is common in colorectal cancer; however, few studies have investigated its influence on prognosis, clinicopathological features, and pathogenesis.

METHODS

A cohort study was conducted to analyze the clinicopathologic features and prognosis of colorectal cancer patients, categorized based on the presence or absence of BLNE. Given the correlation between lymph nodes and immune response, immunohistochemistry, transcriptome analysis, and exon sequencing were employed to further investigate the differences in the immune microenvironment of primary tumors.

RESULTS

Overall, 630 AJCC stage I/II patients were included in the study, with 131 in the BLNE group and 499 in the Non-BLNE (NBLNE) group. Patients in the BLNE group were found to have a significantly better disease-free survival (DFS) (hazard ratio [HR] 0.44, P = 0.016) and overall survival (OS) (HR 0.46, P = 0.011) than those in the NBLNE group. Pathologically, compared with the NBLNE group, the BLNE group had more mature tertiary lymphoid structures (66.7 % vs. 36.5 %, P = 0.002) and higher immunoscores (18.8 % vs. 2.1 %, P = 0.004) in primary tumor tissue. Also, transcriptome analysis showed that, compared with NBLNE, the genes upregulated in BLNE were enriched in immune-related pathways, such as adaptive immune response and immuno-regulatory interactions. Whole-exon sequencing analysis revealed a higher tumor mutation burden (TMB) in the BLNE group [6.03 (5.59, 7.59) vs. 5.33 (4.62, 6.34), P = 0.025].

CONCLUSION

BLNE is positively associated with the prognosis of colorectal cancer, possibly because patients with BLNE have a stronger anti-tumor immune response.

Unmet Care Needs of Colorectal Cancer Survivors in Taiwan and Related Predictors

BACKGROUND

Despite advancements in medical technology and early cancer detection, many colorectal cancer (CRC) survivors report unmet care needs after completion of their cancer treatment that compromise their quality of life (QoL). Previous studies on the care needs of cancer survivors have yielded inconsistent results, and few studies have been conducted on survivors of CRC in Taiwan or on predictors of their unmet care needs.

PURPOSE

The purpose of this study was to examine the unmet care needs, psychological distress, and QoL of Taiwanese CRC survivors ( n = 100) as well as to assess the mean differences by sociodemographic characteristics in their unmet care needs and other related predictors after treatment completion.

METHODS

This cross-sectional study using a purposive sampling method was conducted at a regional hospital in northern Taiwan between October 2019 and February 2020. The measurements used in this study included Chinese Cancer Survivors' Unmet Needs, Hospital Anxiety and Depression Scale, and European Organization for Research and Treatment Quality of Life Questionnaire-Core 30 and Quality of Life Questionnaire-Colorectal Cancer Module 29. The independent t test and one-way analysis of variance were employed to assess sociodemographic differences in unmet care needs, and multivariate linear regression was used to identify significant predictors.

RESULTS

More than half of the participants (63.2%) reported at least one unmet care need, with the highest categories including information needs ("signs and symptoms of cancer recurrence" 31.7% and "information related to health promotion" 31.7%), "medical care needs" ("managing health with the medical team" 13.9%), and "physical/psychological effect needs ("concerns about cancer recurrence" 23.8%). Also, 7%-57% of the participants experienced differing degrees of distress symptoms including fatigue, intestinal and urogenital dysfunctions, and anxiety or depression. The results of the univariate analyses showed unmet needs to differ significantly by age ( p = .021), employment status ( p = .007), and chronic disease status ( p = .025). The findings revealed being of older age (β = 0.23, p = .049), being employed (β = 0.26, p = .014), and having a lower functional level (β = -0.31, p = .012) to be associated with significantly higher levels of unmet care needs, collectively accounting for nearly 27.3% of the variance (adjusted R2 = .273).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

CRC survivors continue to experience unmet care needs and various forms of physical-psychological distress for an average of almost 2 years after their completion of CRC treatment. The findings of this study may assist healthcare providers in identifying the major risk factors that interfere with survivor care needs following treatment, thus facilitating the development of timely interventions to mitigate the impact of cancer on this vulnerable population.

Yield and Effectiveness of 2-Sample Fecal Immunochemical Test-Based Screening Program for Colorectal Cancer

BACKGROUND AND AIMS

Colorectal cancer (CRC) incidence and mortality of China account for nearly 30% of the global attributable fraction. We aimed to estimate the yield and effectiveness of a 2-sample fecal immunochemical test (FIT)-based screening program in China.

METHODS

Eligible individuals were invited for 2-sample FIT between 2007 and 2021, with positive ones (cutoff 40 μg/g before 2013 and 20 μg/g thereafter) referred for colonoscopy. Participation rates, detection rates, and positive predictive values were calculated. Participants were classified into: FIT+/colonoscopy compliers, FIT+/colonoscopy noncompliers, and FIT- as control subjects. We compared CRC incidence and mortality and calculated the age reaching comparable risk.

RESULTS

Among 246,349 invitees, 150,524 (61.10%) participated in 2-sample FIT, with 16,994 (11.29%) identified as FIT+; 12,816 (75.41%) underwent colonoscopy, yielding a detection rate and positive predictive value of 0.57% and 6.70% for advanced neoplasia, respectively. Median follow-up was 10.58 years. Compared with FIT- participants, CRC incidence and mortality were relatively similar among FIT+/colonoscopy compliers with hazard ratios of 0.94 (95% confidence interval [CI], 0.75-1.19) and 1.62 (95% CI, 1.09 to 2.41) but higher among noncompliers, with hazard ratios of 3.52 (95% CI, 2.85-4.34) and 4.41 (95% CI, 2.96-6.55). Taking CRC incidence and mortality risk of FIT- participants at 50.0 years of age as the benchmark, FIT+/colonoscopy compliers reached same risk at 50.6 and 46.1 years of age, while noncompliers reached the same risk at 38.0 and 37.9 years of age, respectively.

CONCLUSIONS

Two-sample FIT could effectively identify high-risk populations, and colonoscopy compliance is associated with a lower risk of CRC incidence and mortality. This strategy might facilitate CRC screening practice in countries with large populations.

From Function to Mechanism: Unveiling the Role of Small Nucleolar Ribonucleic Acids in Digestive Tumours

Small nucleolar ribonucleic acids (snoRNAs) have emerged as crucial regulators in various biological processes and have garnered significant attention for their potential roles in cancer. These noncoding ribonucleic acids (RNAs) primarily guide ribosomal RNA (rRNA) pseudouridylation and 2'-O-methylation modifications and exhibit stable expression in the serum, making them promising biomarkers and therapeutic targets. Digestive tract cancer poses a severe global health threat due to its high mortality rate and difficulty in early detection. Understanding the molecular mechanisms underlying tumor development is critical for improving diagnostic and therapeutic strategies. Small nucleolar RNAs, with their diverse functions and stable presence in biological fluids, offer a unique opportunity to address these challenges. Small nucleolar RNAs are a class of small noncoding RNAs mainly located in the nucleolus of eukaryotic cells. They play essential roles in the maturation and modification of rRNAs, transfer RNAs, and small nuclear RNAs. They also participate in alternative splicing regulation and exhibit microRNA-like functions, influencing various cellular processes. Abnormal expression of snoRNAs has been closely linked to the development, invasion, and metastasis of digestive system tumors. Given their stable expression in serum and the ability to function independently of host genes, snoRNAs hold great potential as biomarkers for early screening, prognosis prediction, and therapeutic targets in digestive system tumors. Their involvement in key signaling pathways and molecular mechanisms provides a foundation for developing targeted therapies and improving patient outcomes. This review highlights the significance of snoRNAs in digestive system tumors, their biological roles, connections to cancer progression, and potential clinical applications. Further exploration of snoRNAs is expected to provide new insights into the diagnosis and treatment of digestive system tumors.

Emerging roles of EGFL family members in neoplastic diseases: Molecular mechanisms and targeted therapies

Epidermal growth factor-like proteins (EGFLs) contain more than a single EGF/EGF-like domain within their protein structure. To date, ten EGFL family members (EGFL1-10) have been characterized across diverse tissues and developmental stages under different conditions. In this review, we conclude that EGFLs are instrumental in regulating biological activities and pathological processes. Under physiological conditions, EGFLs participate in angiogenesis, neurogenesis, osteogenesis, and other processes. Under pathological conditions, EGFLs are linked with different diseases, particularly cancers. Furthermore, we highlight recent advancements in the study of EGFLs in biological conditions and cancers. In addition, the regulatory role and key underlying mechanism of EGFLs in mediating tumorigenesis are discussed. This paper also examines potential antagonists that target EGFL family members in cancer therapeutics. In summary, this comprehensive review elucidates the critical role of EGFLs in neoplastic diseases and highlights their potential as therapeutic targets.

Preoperative tumor marker elevations in colorectal cancer patients with peritoneal metastases should be used to help select patients for cytoreductive surgery

BACKGROUND

Tumor markers are used routinely for surveillance in patients treated for colorectal cancer (CRC). However, the prognostic implications of elevated preoperative tumor markers in patients treated for CRC and peritoneal metastases (PM) has not been well defined. The utility of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and cancer antigen 125 (CA125) to predict outcome for these patients is reported.

METHODS

Clinical and histologic features plus preoperative tumor markers were recorded within 1 week prior to CRS. Impact on overall survival of these factors was analyzed by univariate and multivariate analysis.

RESULTS

Two hundred and four patients were in our database and 140 patients (75.3 %) had at least a single elevated preoperative tumor marker. In an analysis of clinical and histologic parameters preoperatively, a poorly differentiated tumor, signet ring morphology, a peritoneal cancer index (PCI) of ≥16 and an incomplete cytoreduction had a negative impact on median survival. In a multivariate analysis of clinical and histologic features together with tumor markers, an elevated CA19-9 and CA125 was independently associated with reduced overall survival (HR 2.7, p < 0.0001 and HR 2.2, p = 0.005), respectively. Quantitative assessment of CEA (HR 0.5, p = 0.0094) and CA19-9 (HR 4.9, p < 0.001) greater than x10 ULN showed reduced survival.

CONCLUSION

Preoperative assessment of symptoms and histopathology, PCI and a complete CRS combined with tumor markers CEA, CA19-9 and CA125 are independent prognostic indicators for selection by the multidisciplinary team of CRC PM patients for CRS and HIPEC. All three tumor markers are needed for a meaningful assessment.

[Early-onset colorectal cancer : When should we start with screening?]

BACKGROUND

In recent years, the number of new cases of colorectal cancer in people under the age of 50 (early-onset colorectal cancer, EOCRC) has increased, and extension of colorectal cancer screening for younger age groups is currently being discussed.

OBJECTIVES

To discuss whether the age for population-wide colorectal cancer screening should be lowered?

RESULTS

Extension of population-wide screening to younger age groups particularly to those under the age of 40 would be highly inefficient due to the low colorectal cancer incidence. Still, it could be considered for people at increased risk, including young adults with familial risk. Implementation of primary prevention measures would already be possible.

CONCLUSIONS

More targeted risk-adapted prevention and screening strategies are needed to reverse the rising trend of EOCRC and to detect colorectal cancer more frequently at an early stage.

De novo colorectal cancer after kidney transplantation: a systematic review and meta-analysis

BACKGROUND

Kidney transplant (KT) patients have higher risks of developing de novo colorectal cancer (CRC) compared to the general population. However, there is still a knowledge gap in their clinical characteristics, as most single- or multi-center efforts are underpowered and lack generalizability.

METHODS

PubMed, Web of Science, Cochrane CENTRAL, and Scopus databases were queried for studies published until July 22nd, 2024. Studies reporting the clinicopathologic characteristics and outcomes of de novo CRC among KT recipients were included.

RESULTS

There were 49 articles included involving 1855 KT patients who developed CRC. The mean time from transplantation to CRC diagnosis was 8·7 years (95%CI 7·2, 10·3 years; I2 = 98·3%). De novo CRC was most commonly located in the ascending colon (43·6%; 95%CI 29·5%, 58·9%; I2 = 55·3%), and 37·1% had advanced CRC at diagnosis (95%CI 22·3%, 54·8%; I2 = 64·1%). Although 68·8% underwent curative intent treatment (95%CI 45·4%, 85·4%; I2 = 65·4%), pooled 5-year survival rate was 31·8% (95%CI 10·5%, 65·1%; I2 = 82·5%).

CONCLUSIONS

De novo CRC was diagnosed in under 10 years after KT, and nearly 40% of patients already have advanced stage disease at diagnosis. The pooled rate of 5-year survival was 31.8%. However, there was wide heterogeneity between studies and further research is required. PROSPERO Registration: CRD42023415767.

Association Between Colorectal Cancer Primary Features and Liver Metastases Histological Growth Patterns: Inflammation on the Primary Tumor is Associated with Desmoplastic Growth Pattern

BACKGROUND

More than 50% of patients diagnosed with colorectal cancer (CRC) will develop liver metastases (CRCLM), which is the main cause of death for more than 60% of these patients. The aim of this study was to correlate the clinical and pathological characteristics of the primary CRC and CRCLM, with emphasis in predicting the histological growth pattern of the CRCLM.

METHODS

Cohort of 73 patients with CRC. Analysis of clinical data and blinded pathological review was performed related with primary tumor and CRCLM features. The analysis was performed in SPSS (version 27) with a significance level of 5%.

RESULTS

A statistically significant association was found between tumor size and metastasis growth pattern (P = .002), with larger tumors giving rise to metastases with a nondesmoplastic growth pattern. Lymphovascular invasion (LVI) was associated with metachronous CRCLM (P = .043). In the absence of LVI, the time required for CRCLM to appear was significantly longer (P = .011). The number of metastases was significantly higher (P = .049) in tumors without LVI when compared to tumors with LVI. There was a statistically significant association between CRC high-grade inflammation and the desmoplastic metastases growth pattern of the CRCLM (P = .017).

CONCLUSION

The possibility of predicting the CRCLM histological growth pattern resorting to primary CRC characteristics would be useful for proper patient selection for surgery and adapting biological therapies.

Environmental Levels of Volatile Organic Compounds, Race, and Socioeconomic Markers Correlate with Areas of High Colorectal Cancer Incidence

BACKGROUND

Ambient levels of volatile organic compounds (VOCs) released from nearby industrial plants have shown positive associations with increased colorectal cancer (CRC) rates. The objective of this study is to analyze the distribution of CRC in the context of socioeconomic status and its correlation with community environmental data.

METHODS

A retrospective study analyzed CRC patients from 2021 to 2023. The census tracts of the patients' residential addresses were obtained, and CRC rates were calculated for each census tract. Socioeconomic data was gathered on these communities. Environmental VOC measurements were obtained from the National Scale Air Toxics Assessment. All datapoints were compared to statewide levels.

RESULTS

Three census tracts in the county had higher CRC cases comparatively. These areas exhibited higher incidence rates and localized clusters of CRC cases, higher distribution of Black or African Americans, lower household incomes, lower home values, and lower educational attainment. VOC measurements in these census tracts had higher levels compared to county and state averages: specifically, 10.68% higher than county and 48.07% higher than state benzene levels (0.52 µg/m3 clusters vs 0.47µg/m3 county vs 0.35 µg/m3 state), 10.84% and 129.15% higher toluene (1.65 µg/m3 vs 1.49 vs 0.72 µg/m3), and 15.64% and 141.87% higher butadiene (0.048 µg/m3 vs 0.041 µg/m3 vs 0.020 µg/m3).

CONCLUSION

This study illustrates a positive correlation between higher ambient exposure to VOCs with increased CRC incidence. These findings underscore the potential interplay of environmental factors, socioeconomic determinants, and environmental injustice when considering strategies to address health disparities and CRC incidence.

KRAS/NRAS/BRAF mutational profile and association with clinicopathological characteristics in patients with metastatic colorectal cancer

Colorectal cancer (CRC) is increasingly prevalent in Jordan and poses a significant public health challenge. The presence of Kirsten rat sarcoma viral oncogene homolog (KRAS), neuroblastoma RAS viral oncogene homolog (NRAS) and v-Raf Murine Sarcoma Viral Oncogene Homolog B (BRAF) mutations is key in CRC diagnostics, as these mutations are associated with resistance to monoclonal antibodies targeting the epidermal growth factor receptor. The present study aimed to identify these mutations in patients with CRC and assess their associations with clinicopathological characteristics. A retrospective analysis was conducted using data from 262 patients with metastatic CRC (mCRC) at the Jordanian Military Cancer Center-Royal Medical Services (Amman, Jordan). Variables such as age, sex, tumor differentiation and the mutational status of KRAS, NRAS and BRAF, along with tumor location, were analyzed statistically to explore associations between mutations and tumor characteristics. Among the included patients, 48.5% had KRAS mutations, 3.8% had NRAS mutations and 0.8% had BRAF mutations. The majority of KRAS mutations were in exon 2 at codons 12 and 13, with the highest mutational rate at 45.8%. In the univariate model, NRAS mutations were significantly associated with moderately differentiated tumors and the multivariate hierarchical regression analysis established that KRAS mutations were significantly associated with histological subtypes [mucinous adenocarcinoma, tubular adenocarcinoma, signet adenocarcinoma and adenocarcinoma (not specified)]. These results highlighted the molecular profiles and clinicopathological characteristics of patients with mCRC, which demonstrated the associations between mutational status and the varying clinicopathological aspects based on the type of RAS mutation. Thus, these specific traits (patient's age, sex, CRC site, histological subtypes and tumor grade) may be taken into account when evaluating the predictive significance of RAS and BRAF status in CRC and tailored treatment strategies.

Exploring colorectal cancer patients' diagnostic pathways and general practitioners' assessment of the diagnostic processes: a Danish survey study

INTRODUCTION

Colorectal cancer (CRC) is among the most common cancers and the prognosis of CRC is highly dependent on stage at diagnosis. Although many cases are diagnosed swiftly, there is still room for improvement.

AIM

We aimed to explore CRC diagnostic pathways, encompassing (1) place of initial contact; (2) associations with symptom presentations, sex, and age with events in the diagnostic process and initial referrals and (3) the general practitioner's (GP's) evaluation of the diagnostic processes.

METHODS

All GPs in North-, Central-, and Southern Denmark were invited to fill in questionnaires for their listed patients diagnosed with cancer during the past two years.

RESULTS

Among 1,032 recorded CRC patients, 65% had their initial contact in general practice, 5% within the out-of hours service, 10% in the hospital, and 20% were diagnosed based on screening. A total of 27% of CRC patients over 40 who initially presented in general practice were treated or referred on suspicion of another disease first, and 9% were reported to have had hesitated in seeking medical attention. Some 37% presented solely non-specific symptoms, increasing the odds of the GP advising watchful waiting (OR 2.48; 95% CI 1.06-5.81), treating or referring on the suspicion of another illness first (OR 2.57; 95% CI 1.76-3.75), wait due to normal findings (OR 2.11; 95% CI 1.16-3.85), or referring to diagnostic imaging (OR 3.07; 95% CI 1.63-5.79). The GPs assessed nearly one fifth of the diagnostic processes as poor.

CONCLUSION

Most CRC patients are diagnosed with initial presentation in general practice. Having non-specific symptoms is common and challenges timely diagnosis.

Effect of laxative use and laxative type on colorectal cancer risk: A pooling up analysis and evidence synthesis

Colorectal cancer (CRC) is the third most common cancer worldwide and there is a controversy regarding the influence of laxative use on the incidence of CRC. Therefore, the present study aimed to investigate the effects of laxative use and different subtypes of laxatives on the incidence of CRC. To this aim, a comprehensive search of three databases (PubMed, Embase and the Cochrane Library) was conducted on April 12, 2022, using key words that included 'laxative' and 'CRC', which initially retrieved 305 records. Ultimately, 12 studies involving 415,313 patients met all eligibility criteria and were included in a meta-analysis. Subsequently, patients were categorized into the laxative use and non-laxative use groups. Stata 16.0 software was used for all data analyses. The results indicated that laxative use was not significantly associated with CRC risk [odds ratio (OR), 0.95; 95% confidence interval (CI), 0.75-1.20; P=0.65; I2=94.63%]. In the subgroup analyses, the effects of different laxative types were further examined. Notably, all types of laxatives except for fiber laxatives showed no significant influence on CRC risk (P>0.1). By contrast, fiber laxatives were associated with a reduced risk of CRC (OR, 0.74; 95% CI, 0.59-0.93; P=0.01; I2=32.15%), suggesting a potential protective effect of this medication. In conclusion, the findings of the present study suggest that the use of laxatives does not increase the risk of CRC. Moreover, the use of fiber laxatives may have a protective effect by reducing CRC incidence.

Volumetric histogram analysis of amide proton transfer-weighted imaging for predicting complete tumor response to neoadjuvant chemoradiotherapy in locally advanced rectal adenocarcinoma

OBJECTIVES

To investigate the potential of histogram analysis applied to pre-treatment amide proton transfer-weighted (APTw) imaging in predicting complete pathological regression (pCR) in patients with locally advanced rectal cancer (LARC) undergoing neoadjuvant chemoradiotherapy (nCRT).

MATERIALS AND METHODS

This retrospective study enrolled LARC patients who underwent preoperative rectal magnetic resonance imaging (MRI). Based on histologic assessment, the patients were divided into a pathological complete response (pCR) group or a non-pCR group. APTw histogram features, apparent diffusion coefficient (ADC), and clinical parameters were analyzed. Mann-Whitney U-test, Spearman rank correlation, and univariate and multivariate logistic regression were used for statistical analysis. The predictive performances of different models were evaluated by the receiver operating characteristic curve (ROC).

RESULTS

One-hundred forty-five patients were included (mean age, 61.6 years ± 11.8 [SD]; 87 men). pCR patients exhibited lower pre-treatment ADC value, higher pre-treatment APTw-10%, APTw-90%, minimum, maximum, median, mean, range, and root mean square (RMS) of the primary tumor compared to non-pCR patients (all p < 0.05). APTw-10%, APTw-90%, maximum, mean, median, minimum, range, and RMS showed negative correlations with the tumor regression grade (TRG) category (r ranged between -0.457 and -0.173; all p < 0.005). Skewness, kurtosis, and entropy exhibited positive correlations with the TRG category (r = 0.278, 0.319, and 0.324, respectively; all p < 0.05). The combined model had a higher AUC of 0.930, with 93.9% sensitivity and 83.9% specificity.

CONCLUSION

Histogram analysis of pre-treatment APTw may hold promise as a novel approach for predicting the response of LARC patients to nCRT.

KEY POINTS

Question Predicting response to nCRT is crucial for early stratified management of LARC patients; however, current radiological studies remain inconclusive. Finding LARC patients with pCR is correlated with higher pre-treatment APTw intensity-related and lower shape-related histogram features. Clinical relevance The APTw-histogram model and the APTw-clinical combined model demonstrated strong diagnostic efficacy and clinical practicality in predicting LARC patients' responsiveness to nCRT, offering new insights for early clinical decision-making.

Cancer Screening in Women

Cancer is the second leading cause of death in US women. Lung cancer has the highest mortality rate in the United States, followed by breast cancer, colorectal cancer, and pancreatic cancer. The incidence of new cancer cases per year in the United States is highest for breast cancer, followed by lung cancer, colorectal cancer, and uterine cancer. Cancer incidence and mortality rates are higher for many under-resourced communities. Cancers with effective screening programs include lung, breast, colorectal and cervical cancers. Clinicians should offer screening for these cancers to all women who meet criteria.

A microfluidic electrochemical immunosensor for detection of CEA and Ki67 in 3D tumor spheroids

Microfluidic chip-based electrochemical sensors have been developed to detect cancer biomarkers and monitor changes in the tumor microenvironment. However, the limitation of detecting only a single biomarker restricts their utility as accurate diagnostic tools. Simultaneous detection of multiple tumor biomarkers is important for early diagnosis of cancer. In this work, we report the development of a microfluidic-based electrochemical immunosensor platform capable of simultaneously observing multiple biomarkers expressed by three dimensions (3D) cell spheroids. The sensor platform employs a nanocomposite electrode material consisting of gold nanoparticles and carbon nanotubes, which enables sensitive and selective detection. The sensor was fabricated using 3D and printed circuit boards (PCB) printing techniques, demonstrating the feasibility of cost-effective manufacturing. The developed platform was able to quantitatively detect two key cancer biomarkers, carcinoembryonic antigen (CEA) and Ki67, with limits of detection of 0.97 ng/mL for each. Furthermore, the sensor was successfully utilized to observe the knockdown of these biomarkers, showcasing its potential for both diagnostic and therapeutic monitoring applications. These results suggest that the presented electrochemical sensor platform provides a promising lab-on-a-chip technology for comprehensive 3D cell spheroid-based cancer biomarker analysis, which could have significant implications for future clinical diagnostics and personalized medicine.

miR-145-enriched BMSCs-derived exosomes ameliorate neurogenic erectile dysfunction in aged rats via TGFBR2 inhibition

Background

Neurogenic erectile dysfunction (ED) is a prevalent complication following radical prostatectomy in elderly patients, primarily resulting from the apoptosis of corpus cavernosum smooth muscle cells (CCSMCs) and the subsequent excessive fibrosis of the corpus cavernosum.

Aim

This study aimed to compare the therapeutic effects of exosomes derived from lentivirus-transfected miR-145 bone marrow mesenchymal stem cells (Exo-145) and unmodified BMSCs-derived exosomes (Exo) in aged rats with bilateral cavernous nerve injury (BCNI) and investigate the underlying mechanisms.

Methods

Twenty-four-month-old male rats were assigned to four groups, namely Sham, BCNI, Exo, and Exo-145. Three weeks after treatment, erectile function was assessed by measuring the maximal intracavernosal pressure to mean arterial pressure (ICP/MAP) ratio. Apoptosis and fibrosis were semi-quantitatively analyzed using TUNEL and Masson's trichrome staining, respectively. In vitro, CCSMCs were subjected to H2O2-induced oxidative stress, and the protective effects of Exo-145 were evaluated through flow cytometry and Western blot. Lastly, the targets and mechanisms of miR-145 were further validated using dual-luciferase reporter assays and rescue experiments.

Results

Exo-145 significantly outperformed Exo in restoring erectile function in aged BCNI rats, as evidenced by the significantly higher maximal ICP/MAP ratio, a marked reduction in TUNEL-positive cell count, and marked suppression of fibrosis in cavernous tissue. Moreover, Masson's trichrome staining displayed a substantial decrease in collagen deposition. In vitro, Exo-145 alleviated H2O2-induced apoptosis in CCSMCs by downregulating Cleaved Caspase-3 expression and Bax while concurrently upregulating Bcl-2 expression. TGFBR2 was identified as a direct target of miR-145 through dual-luciferase reporter assays, with its overexpression partially reversing the protective effects of Exo-145.

Conclusion

Exo-145 demonstrates superior efficacy compared to Exo in treating aged neurogenic ED by targeting TGFBR2 to alleviate apoptosis and fibrosis. It may represent a promising cell-free therapeutic option for neurogenic erectile dysfunction in elderly patients and could offer new perspectives for improving their prognosis.

A Multimodal Intervention to Increase Total Mesorectal Excision Grading for Rectal Cancer in Michigan: A Randomized Controlled Trial

BACKGROUND

The total mesorectal excision technique is associated with improved outcomes for rectal cancer, and grading the total mesorectal excision specimen is recommended. We implemented a multimodal intervention in Michigan Surgical Quality Collaborative hospitals to increase total mesorectal excision grading.

OBJECTIVE

To compare total mesorectal excision grading rates over time between hospitals that received the intervention early and late in the study.

DESIGN

Stepped wedge randomized controlled trial with hospitals randomly assigned to receive the education intervention early in the trial or 1 year later. We used a generalized linear mixed model to compare rates of total mesorectal excision grading over time between groups, adjusting for hospital characteristics.

SETTING

Twelve hospitals within the Michigan Surgical Quality Collaborative.

PATIENTS

Adult patients undergoing total mesorectal excision for rectal cancer from 2014 to 2021 were included.

INTERVENTION

A multimodal educational intervention consisting of a webinar about total mesorectal excision grading, a pre- and postwebinar quiz, and site visits.

MAIN OUTCOME MEASURES

Total mesorectal excision grading rate for each hospital over time.

RESULTS

From 2014 to 2021, 560 patients underwent total mesorectal excision in participating hospitals: 350 in early intervention hospitals and 210 in late intervention hospitals. The early intervention began in August 2018, and the late intervention began in June 2019. Based on the mixed model, grading in early hospitals increased from 8.1% to 99.7% at the end of the study ( p < 0.001). In the late group, grading increased from 47.8% to 94.0% ( p < 0.001). The intervention was not associated with a change in total mesorectal excision grading in either group; rather, the increase in grading corresponded with a statewide collaborative presentation on this topic in December 2016.

LIMITATIONS

Selection bias, as hospitals recruited to participate were already participating in colorectal cancer quality improvement and may reflect greater commitment to high-quality rectal cancer care.

CONCLUSIONS

Our findings show an increase in total mesorectal excision grading in Michigan from 2014 to 2021 that preceded the dates of our intervention. These results highlight the importance of accounting for secular trends in measuring health care quality improvement interventions. See Video Abstract .

AUMENTO DE GRADACION POR INTERVENCION MULTIMODAL EN LA CLASIFICACIN DE LA EXCISIN TOTAL DEL MESORRECTO EN CASOS DE CNCER DE RECTO EN MICHIGAN ESTUDIO RANDOMIZADO Y CONTROLADO

ANTECEDENTES:La técnica de excisión total del mesorrecto se asocia con mejores resultados en los casos de cáncer recto, y se recomienda aumentar la clasificación de la muestra de excisión mesorrectal total. Implementamos la intervención multimodal en los hospitales de la Colaboración para la Calidad Quirúrgica de Michigan para aumentar la clasificación de la excisión mesorrectal total.OBJETIVO:Comparar los grados en la clasificación de la excisión total del mesorrecto a lo largo del tiempo entre los hospitales que recibieron la intervención al principio y al final del estudio.DISEÑO:Estudio controlado aleatorio y escalonado con hospitales asignados al azar para recibir la intervención educativa al principio del estudio o un año después. Utilizamos un modelo lineal mixto generalizado para comparar las tasas de clasificación en la excisión total del mesorrecto a lo largo del tiempo entre los grupos, ajustando las características del hospital.CONTEXTO:Doce hospitales dentro de la Colaboración de Calidad Quirúrgica de Michigan.PACIENTES:Pacientes adultos sometidos a excisión total del mesorrecto por cáncer de recto entre 2014 y 2021.INTERVENCIÓN:Intervención educativa multimodal que consiste en un seminario - web sobre la clasificación de la excisión total del mesorrecto, un cuestionario previo y otro posterior al seminario - web y visitas al centro.PRINCIPALES MEDIDAS DE RESULTADOS:Los grados de clasificación de la excisión total del mesorrecto para cada hospital a lo largo del tiempo.RESULTADOS:De 2014 a 2021, 560 pacientes se sometieron a una excisión total del mesorrecto en hospitales participantes, 350 en hospitales de intervención temprana y 210 en hospitales de intervención tardía. La intervención temprana comenzó en agosto de 2018 y la intervención tardía comenzó en junio de 2019. Según el modelo mixto, la clasificación en los hospitales que participaron en la intervención temprana aumentó del 8,1 % al 99,7 % al final del estudio ( p < 0,001). En el grupo de intervención tardía, la clasificación aumentó del 47,8 % al 94,0 % ( p < 0,001). La intervención no se asoció con un cambio en la clasificación de la excisión total del mesorrecto en ninguno de los grupos; más bien, el aumento de la clasificación correspondió con la presentación colaborativa a nivel estatal sobre este tema en diciembre de 2016.LIMITACIONES:Sesgo de selección, ya que los hospitales reclutados para participar ya estaban participando en la mejora de la calidad del cáncer colorrectal y podrían reflejar un mayor compromiso con la atención de alta calidad del cáncer rectal.CONCLUSIONES:Nuestros hallazgos muestran un aumento en la clasificación de la excisión total del mesorrecto en Michigan entre 2014 y 2021 precediendo a las fechas de nuestra intervención. Estos resultados destacan la importancia de tener en cuenta las tendencias seculares en la medición de las intervenciones de mejora de la calidad de la atención sanitaria . (Traducción-Dr. Xavier Delgadillo ).

Long-term prognostic value of apoptotic index in colorectal cancer: a 5-year multicentre cohort study

Despite TNM (Tumour, Node, Metastasis) classification being the gold standard for estimating the prognosis of early-stage colorectal cancer, significant variability in long-term survival persists among patients within the same TNM stage, underscoring the importance of the disease's biological heterogeneity and the need for novel markers. This study investigates the determinants of 5-year mortality in patients with colon or rectal cancer through the analysis of 448 diagnostic tumour samples from a prospective multicentre cohort. We assessed sociodemographic, clinical, and pathological data, as well as the apoptotic index (AI) measured by the terminal deoxynucleotidyl transferase dUTP nick-end labelling (TUNEL) technique. Overall survival was the primary outcome, and Cox regression was used to estimate the hazard ratio (HR). Multivariate 5-year survival analysis identified the highest risk associated with TNM stages IV [p<0.001, HR 12.06, confidence interval (CI) 5.75-25.31] and III (p<0.001, HR 3.52, CI 1.88-6.62), followed by an AI >1.8% (p<0.001, HR 2.16, CI 1.46-3.20), male biological sex (p<0.05, HR 1.58, CI 1.05-2.37), tumour location on the right colon (p<0.024, HR 1.55, CI 1.06-2.27), and age (p<0.001, HR 1.05, CI 1.04-1.07). Our findings underscore the long-term prognostic value of a high AI as a determinant of poor prognosis in colorectal cancer and highlight the need to refine conventional prognostic markers to enable more precise risk stratification.

Artificial intelligence prediction of carcinoembryonic antigen structure and interactions relevant for colorectal cancer

Carcinoembryonic antigen (CEA) is used as a biomarker for colorectal cancer. It is expressed during fetal development but in healthy adult cells the expression is low. Due to its size and the high degree of glycosylation, there are no structures available for mature CEA. By employing novel structure prediction methods, we aim to investigate CEA tertiary structure and interactions. Alphafold 3 server has increased the accuracy of structure predictions and allows for modelling of glycans in proteins and complexes. Models were created for a monomeric CEA, dimeric CEA and for CEA in complex with the antibody Tusamitamab. The structure of the monomeric glycosylated CEA exhibit two bends, one in the domain interface B1-A2 and one in the domain interface B2-A3. The dimer structure pairs in a parallel manner, with direct contacts in the N and the A2 domains of the two chains. The complex of CEA with Tusamitamab closely resembles the EM structure of the complex that was released after the training of Alphafold 3 was completed. Overall, the investigations give new angles to investigate for CEA. The predicted bend, primarily in the B2 and A3 domain interface, would allow for dimer formation of CEA from both the same cell as from adjacent cells and could help to explain the outstanding issue on how it can fulfil both tasks. The prediction of the antibody binding to CEA was accurate, the all-atom RMSD was 1.3 Å. This is encouraging for other antibody - protein complexes predictions as the complex structure was not part of the training set for Alphafold 3.

Auranofin loaded silk fibroin nanoparticles for colorectal cancer treatment

Colorectal cancer (CRC) is the second most common cause of cancer related deaths worldwide and the prevalence in young people especially is increasing annually. In the search for innovative approaches to treat the disease, drug delivery systems (DDS) are promising owing to their unique properties, which allow improved therapeutic results with lower drug concentrations, overcoming drug resistance and at the same time potentially reducing side effects. Silk fibroin is a biopolymer that can be processed to obtain biocompatible and biodegradable nanoparticles that can be efficiently loaded by surface adsorption with small-molecule therapeutics and allow their transport and sustained release by modulating their pharmacokinetics. Auranofin (AF) has recently been repurposed for its strong anticancer activity and is currently in clinical trials. Its mechanism of action is through the inhibition of thioredoxin reductase enzymes, which play an essential role in several intracellular processes and are overexpressed in some tumours. Taking into account that AF has a low solubility in water, we propose silk fibroin nanoparticles (SFN) as AF carrier in order to improve its bioavailability, increasing cellular absorption and preventing its degradation or avoiding some resistance mechanisms. Here we report the preparation and characterization of a new formulation of AF-loaded silk fibroin nanoparticles (SFN-AF), its functionalization with FITC for the analysis of cellular uptake, as well as its cytotoxic activity against cell lines of human colorectal cancer (HT29 and HCT116) in both 2D and 3D cell cultures. 3D spheroid models provide a 3D environment which mimics the 3D aspects of CRC observed in vivo and represents an effective 3D environment to screen therapeutics for the treatment of CRC. The loaded nanoparticles showed a spherical morphology with a hydrodynamic diameter of ~ 160 nm and good stability in aqueous solution due to their negative surface charges. FESEM-EDX analysis revealed a homogeneous distribution of Au clusters with high electron density on the surface of the nanoparticles. SFN-AF incubated in phosphate buffer at 37 °C released 77% of the loaded AF over 10 days, showing an initial burst and then sustained release. Flow cytometry analysis showed that FITC-SFN-AF was efficiently internalized by both cell lines, which was confirmed by confocal microscopy imaging. SFN enhanced the cytotoxicity of AF in 2D cultures in both CRC lines. Promising results were also obtained in 3D culture paving the way for future application of this strategy as a therapy for CRC.

Phloretin-nanospanlastics for targeting the Akt/PI3K signaling pathways in dimethylhydrazine-induced colon cancer in mice

Objectives

Colorectal cancer is the third most common cancer worldwide, accounting for approximately 10 % of all cancer cases. It is also the second leading cause of cancer-related deaths globally. Phloretin is a natural compound found in apples and other fruits. It has been studied for its potential health benefits, including antioxidant and anti-inflammatory properties. However, more research is needed to fully understand its impact on cancer prevention or treatment. This article aimed to prepare phloretin-nanospanlastics (Ph-NSLs) to evaluate their effects on dimethylhydrazine (DMH)-induced colon cancer in mice.

Methods

Morphology, Particle size, zeta potential, UV-vis, entrapment efficiency, polydispersity index, FT-IR spectra, and drug release of phloretin and Ph-NSLs at pH 6.8.were described. Ph-NSLs were also tested for their anti-cancer properties in DMH-induced colon cancer in mice. A 36 mice were divided into 6 groups; Normal control, DMH (20 mg/k.g.b.w.), DMH + Ph-NSLs (25 mg/k.g.b.w.), DMH + Ph-NSLs (50 mg/k.g.b.w.), DMH + 5-FU(20 mg/k.g.b.w.), DMH + Ph-NSLs (50 mg), 5-FU (20 mg). Ph-NSLs were tested for their anticancer properties in DMH-treated mice by evaluating the IC50, viability and inhibitory values of Ph-NSLs against Caco-2. Also, the effect of Ph-NSLs administration on number of surviving mice, number of tumors/mice, average of tumor size, Hb, RBCs, WBCs, C19-9, MDA, GSH, SOD, IL-2, TNF-α, TGF-β1, CEA, and P53 levels in mice treated DMH were estimated.

Results

The synthesized Ph-NSLs were uniform, spherically shaped, and well dispersed, with a size, entrapment efficiency, and polydispersity index of approximately 114.06 ± 8.35 nm, 78.60 %, and 0.05, respectively. The zeta potential value of Ph-NSLs was measured at -21.5 ± 1.47 mV. Zeta potential reflects the surface charge of nanoparticles and affects their stability and interactions. UV spectra of phloretin and Ph-NSLs showed strong absorption peaks at 225 and 285 nm. These peaks correspond to specific wavelengths where the compound absorbs light. The percentage of Ph- NSLs release was found to be 56.87 ± 2.45 %. IC50 of Ph-NSLs was recorded 15.76 ± 0.42 μg/ml and the viability and inhibitory values of Ph-NSLs against Caco-2 cell lines was resorded 2.39, and 97.61 %, respectively at 100 μg/ml as well as 10.3, and 89.7 %, respectively at 50 μg/ml.Moreover, The combination of 5-FU and Ph-NSLs resulted in a moderate increase in survival and significantly reduces tumor size and number, showing enhanced anticancer efficacy compared to individual treatments as well as attenuated levels of hemoglobin (Hb), red blood cells (RBCs), and white blood cells (WBCs). Reduced plasma cancer antigen 19-9 (CA19-9) levels as well as improved of colon malondialdehyde (MDA), reduced glutathione (GSH), superoxide dismutase (SOD), interleukine-2 (IL-2), tumor necrosis factor-alpha (TNF-α), tumor growth factor-beta1 (TGF-β1), carcinoembryonic antigen (CEA), and tumor protein (P53) levels. Also, Ph-NSLs and 5FU, either alone or together, decreased the expression of the Akt and PI3K genes in the colon. The combination of Ph-NSLs and 5FU showed more pronounced anticancer activity than Ph-NSLs administered individually.

Conclusion

The combination of 5-FU and Ph-NSLs significantly enhances anticancer efficacy, reducing both the number of tumors and average tumor size more effectively than either treatment alone. This synergistic effect leverages 5-FU's inhibition of DNA synthesis and phloretin's induction of apoptosis and inhibition of cell proliferation, offering a promising approach for improved cancer treatment outcomes.

Electrochemical biosensor based on composite of gold nanoparticle/reduced-graphene oxide/graphitic carbon nitride and a caprolactone polymer for highly sensitive detection of CEA

Carcinoembryonic antigen (CEA) is a broad-spectrum biomarker, and its accurate detection and analysis is important for early clinical diagnosis and treatment. This study aimed to develop a highly sensitive and selective sandwich-type immunosensor based on electrochemical impedance spectroscopy (EIS) for the accurate detection of CEA. A novel composite material, gold nanoparticle/reduced-graphene oxide/graphitic carbon nitride (AuNPs/rGO/g-C3N4), was synthesized with excellent electrical conductivity and a large specific surface area to immobilize biological probes. And ab1-CEA-ab2 formed a sandwich structure of 'antibody-antigen-antibody', which ensured the high selectivity of the biosensor. Furthermore, the introduction of caprolactone polymer (DMPA-PCL) significantly amplifies the impedance signal and improves the sensitivity of the analytical method. Scanning electron microscopy, x-ray diffraction, transmission electron microscopy Fourier transform infrared spectroscopy, and ultraviolet-visible spectrophotometry were used to characterise the prepared AuNPs/rGO/g-C3N4 and DMPA-PCL. Under the optimal conditions, the sensor showed good analytical performance for the detection of CEA with a linear range of 100 fg mL-1-100 ng mL-1 and a detection limit of 83.2 fg mL-1. And the sandwich-type immunosensor showed good selectivity and stability for the recognition of CEA in real samples.

A novel drug prejudice scaffold-imidazopyridine-conjugate can promote cell death in a colorectal cancer model by binding to β-catenin and suppressing the Wnt signaling pathway

INTRODUCTION

Globally, colorectal cancer (CRC) is the third most common type of cancer, and its treatment frequently includes the utilization of drugs based on antibodies and small molecules. The development of CRC has been linked to various signaling pathways, with the Wnt/β-catenin pathway identified as a key target for intervention.

OBJECTIVES

We have explored the impact of imidazopyridine-tethered chalcone-C (CHL-C) in CRC models.

METHODS

To determine the influence of CHL-C on apoptosis and autophagy, Western blot analysis, annexin V assay, cell cycle analysis, acridine orange staining, and immunocytochemistry were performed. Next, the activation of the Wnt/β-catenin signaling pathway and the anti-cancer effects of CHL-C in vivo were examined in an orthotopic HCT-116 mouse model.

RESULTS

We describe the synthesis and biological assessment of the CHL series as inhibitors of the viability of HCT-116, SW480, HT-29, HCT-15, and SNU-C2A CRC cell lines. Further biological evaluations showed that CHL-C induced apoptosis and autophagy in down-regulated β-catenin, Wnt3a, FZD-1, Axin-1, and p-GSK-3β (Ser9), and up-regulated p-GSK3β (Tyr216) and β-TrCP. In-depth analysis using structure-based bioinformatics showed that CHL-C strongly binds to β-catenin, with a binding affinity comparable to that of ICG-001, a well-known β-catenin inhibitor. Additionally, our in vivo research showed that CHL-C markedly inhibited tumor growth and triggered the activation of both apoptosis and autophagy in tumor tissues.

CONCLUSION

CHL-C is capable of inducing apoptosis and autophagy by influencing the Wnt/β-catenin signaling pathway.

Efficient synthesis, stability-guided optimization and anticancer evaluation of bee venom peptide Melittin

Natural cytotoxic peptides (NCPs) are emerging sources of novel anticancer chemotherapeutics. Especially, Melittin, which is the major component of bee venom and the first-in-class NCP, has been considered as a promising anticancer scaffold. Nevertheless, as a classical linear, cationic, amphipathic, and membrane-lytic peptide, Melittin may be easily degraded by proteases, suffering from poor stability, moderate anticancer durability, and severe hemolysis. In this study, applying the terminal modification and hybridization strategies, ten Melittin-based derivatives were designed, synthesized, and investigated for their anticancer potential. The robust and economic synthetic method, in vitro anticancer efficiency, time-kill kinetics, serum stability, anti-migration activity, hemolysis effects, and anticancer mechanism were explored. As expected, the Melittin-based derivatives exhibited highly potent cytotoxicity against all six tested cancer cell lines. In particular, compared with natural Melittin, the derived peptides LJ-5 containing both N-terminal acetylation and C-terminal hydrazidation, and LJ-6, the methotrexate MTX-GFLG-Melittin conjugate exhibited significantly improved proteolytic stability, more durable anticancer efficiency, higher anti-migration activity, as well as reduced hemolysis effects. Besides, it was further verified that LJ-5 and LJ-6 could efficiently disrupt the integrity of cancer cell membrane, localize to the mitochondria and rapidly reduce the mitochondrial membrane potential of cancer cells. Collectively, the economic synthetic method and stability-guided optimization were conducted on Melittin, affording hydrolysis-resistant LJ-5 and LJ-6 that may serve as anticancer candidates and useful references for further optimizations of cytotoxic peptides.

Research progress in multimodal radiomics of rectal cancer tumors and peritumoral regions in MRI

Rectal cancer (RC) is one of the most common malignant tumors of the digestive system and has an alarmingly high incidence and mortality rate globally. Compared to conventional imaging examinations, radiomics can extract quantitative features that reflect tumor heterogeneity and mine data from medical images. In this review, we discuss the potential value of multimodal MRI-based radiomics in the diagnosis and treatment of RC, with a special emphasis on the role of peritumoral tissue characteristics in clinical decision-making. Existing studies have shown that a radiomics model integrating intratumoral and peritumoral characteristics has good application prospects in RC staging evaluation, efficacy prediction, metastasis monitoring, recurrence early warning, and prognosis judgment. At the same time, this paper also objectively analyzes the existing methodological limitations in this field, including insufficient data standardization, inadequate model validation, limited sample size and poor reproducibility of results. By combining existing evidence, this review aimed to enhance the attention of clinicians and radiologists on the characteristics of peritumoral tissues and promote the translational application of radiomics technology in the individualized treatment of RC.

RUNX1/SLAMF3 Axis Drives Immunosuppression to Contribute to Colorectal Cancer Liver Metastasis by Blocking Phagocytosis and Depleting C1QC+ Tumor-Associated Macrophages

Colorectal cancer liver metastasis (CRLM) is a leading cause of death in colorectal cancer (CRC) patients and is characterized by an immunosuppressive tumor microenvironment (TME). This study employs mouse in vivo selection to isolate highly metastatic CRLM derivatives for profiling their transcriptomic, proteomic, and metabolomic alterations associated with CRLM. Notably, the expression of SLAMF3 is significantly upregulated in CRLM derivatives and its knockdown effectively suppresses CRLM in mice. RUNX1 transcriptionally upregulates SLAMF3 expression and combined targeting of the RUNX1/SLAMF3 axis synergistically suppresses liver metastasis in mice. In parallel, SLAMF3 suppresses macrophage-mediated phagocytosis of CRC cells through the SHP-1/2/mTORC1 pathway. Conversely, SLAMF3 knockdown promotes M1 polarization in liver metastases and activates the CCL signaling pathway between macrophages and CD8+ T cells. It also reduces the exhausted CD8+ T cells in liver metastases and the expression of inhibitory receptors PD-1 and TIM-3, thus alleviating the immunosuppressive TME. Clinically, activation of the RUNX1/SLAMF3 axis is closely associated with CRLM progression and correlates with a reduced proportion of clinically beneficial C1QC⁺ tumor-associated macrophages (TAMs). Collectively, these findings identify the RUNX1/SLAMF3 axis as a key driver of immunosuppressive TME remodeling and CRLM progression, highlighting its potential as a promising therapeutic target for CRLM.

Experimental and network pharmacology certify itraconazole mitigates fluorouracil-induced intestinal damage by inhibiting mTOR-mediated intestinal senescence

Fluorouracil (Fu) is one of the first-line drugs for colorectal cancer, but severe intestinal damage limits its clinical application. The intestinal damage caused by Fu is closely related to cellular senescence. Itraconazole (Itr) is primarily used to treat fungal infections. At present, the effects of Itr on intestinal senescence and damage have not been the subject of extensive study. In this study, NCM460 cells were utilized to establish a model of Fu-induced senescence and inflammation. Treatment of NCM460 cells with Fu resulted in increased senescence-associated beta-galactosidase (SA-β-Gal) activity, elevated p21 expression, and the upregulation of p16 and p53. Additionally, there was enhanced Senescence-Associated Secretory Phenotype (SASP) and an increase in inflammatory factors IL-1β and IL-6. The present study demonstrated that the treatment of Itr effectively alleviated the changes caused by Fu in NCM460 cells. Moreover, it was observed that Itr was efficacious in mitigating intestinal damage induced by Fu in Balb/c mice. Network pharmacology analysis and experimental validation identified the mTOR signaling pathway as a key target of Itr in treating Fu-induced intestinal aging and inflammation. Our findings demonstrate that Itr significantly inhibited the mTOR pathway, while the mTOR activator MHY1485 restored mTOR activity and promoted senescence. Moreover, it was observed that Itr could effectively enhance the tumor-killing effect of Fu in HCT116 and SW480 cells, as well as in Balb/c nude mice. In conclusion, Itr is a promising candidate for reducing intestinal side effects and enhancing Fu's efficacy in the treatment of colorectal cancer.

Machine Learning for Predicting Colorectal Cancer and Advanced Colorectal Polyps: A Systematic Review and Meta-Analysis

INTRODUCTION

Machine learning (ML) has become increasingly pivotal in health care, particularly in colorectal cancer (CRC) detection and diagnosis with the use of predictive models and artificial intelligence-assisted colonoscopies. This study evaluates the efficacy of ML models in predicting the risk for CRC and advanced colorectal polyps (ACP) before colonoscopy.

METHODS

A systematic literature review was conducted following PRISMA guidelines, focusing on studies using ML for CRC and ACP prediction. Data extraction regarding study type, ML methodology, quality of data, and bias assessment was in line with the CHARMS checklist. Meta-analysis was also performed to assess the performance of models for the prediction of CRC, adenoma, or both.

RESULTS

This systematic review included 14 studies with 3618 median patients (333 to 263,879). Our study demonstrated considerable heterogeneity in methodologies and outcomes, with area under the receiver operating characteristic (AUROC) ranging from 0.6 to 1. The derivation+validation cohorts showed a pooled sensitivity of 0.832 (95% CI: 0.755-0.889) and specificity of 0.802 (95% CI: 0.722-0.863), with an overall AUROC of 0.883.

CONCLUSION

The review underscores the significant role of ML in CRC and ACP diagnosis and its routine use could efficiently direct high-risk patients to timely colonoscopies and spare the low-risk ones from unnecessary procedures. Despite the promise shown, the variability in methodologies and outcomes highlights the need for standardized approaches and further investigation in this field.

Rational design of stimuli responsive nanoparticle systems for the controlled, intracellular delivery of immunotherapeutic and chemotherapeutic agents

Advanced cancer therapeutic strategies are rapidly evolving due to a better fundamental understanding of cancer cell biology and the complex tumor microenvironment. There is a need for better rational design of bioresponsive nanotherapeutics to take cues from the tumor microenvironment and better facilitate the intracellular delivery of multiple cancer therapeutic agents. Biodegradable, cationic nanogels were synthesized via a UV-initiated free radical emulsion polymerization to impart environmentally responsive behavior for the intracellular delivery of immunotherapeutic and chemotherapeutic agents. The 2-(diethylamino) ethyl methacrylate based copolymeric nanogels exhibited pH responsive behavior that was optimized for the pH gradient of the tumor microenvironment and endosomal compartments of cancer cells. Then, the cationic nanogels were assessed for their ability to load and release various chemotherapeutic and immunotherapeutic agents. Finally, the copolymeric nanoparticle system was evaluated in vitro for biocompatibility, cellular internalization, and therapeutic efficacy. This combination treatment strategy will provide an excellent foundation for the rational design and development of the next generation of drug delivery systems.

Analysis of trends in the burden of colorectal cancer in China and globally from 1990 to 2021 with projections for the next 15 years: a cross-sectional study based on the GBD database

Objective

To analyze the changes in the burden of colorectal cancer in China and globally from 1990 to 2021, and to explore the disease burden across different age groups and sexes by integrating projected data from 2022 to 2036. This study aims to provide a scientific foundation for formulating targeted prevention and control strategies.

Materials and methods

This study utilized colorectal cancer data from the Global Burden of Disease (GBD) database for the period 1990-2021. Trend analysis was conducted using Joinpoint regression, and future burden projections from 2022 to 2036 were made with an Auto-Regressive Integrated Moving Average (ARIMA) model. Key indicators analyzed included the Age-Standardized Incidence Rate (ASIR), Age-Standardized Prevalence Rate (ASPR), Age-Standardized Mortality Rate (ASMR), and Disability-Adjusted Life Years (DALYs).

Results

Between 1990 and 2021, the burden of colorectal cancer increased both in China and globally, although notable differences were observed across gender and regions. In Chinese men, the ASIR and ASMR have shown a continuous rise, reaching approximately 50 and 300 per 100,000, respectively, by 2021. Projections indicate that these rates will continue to increase through at least 2036. The ASIR in Chinese women also exhibits an upward trend, whereas the global ASIR for women has declined. From 1990 to 2021, both China and the world experienced a steady rise in ASPR, with minimal fluctuations. In contrast, while the ASDR has decreased in both China and globally, the volatility in China's ASDR is notably more pronounced than that observed worldwide.

Conclusion

The burden of colorectal cancer in China is projected to increase significantly in the coming years, particularly among males and the older adult population. This study provides critical scientific insights for the development of targeted prevention strategies and resource allocation, underscoring the urgent need to enhance early screening initiatives and health education efforts in China.