[Efficacy and safety of first-line treatment with anti-CD38 monoclonal antibody-based regimen for primary plasma cell leukemia]

Objective: To analyze the efficacy and safety of first-line treatment with an anti-CD38 monoclonal antibody regimen for primary plasma cell leukemia (pPCL). Methods: Patients diagnosed with pPCL from December 1st, 2018 to July 26th, 2023, receiving first-line treatment of anti-CD38 monoclonal antibody-based regimens across multiple centers including Peking University People's Hospital, Fuxing Hospital of Capital Medical University, Qingdao Municipal Hospital, Shengjing Hospital of China Medical University, Handan Central Hospital, the First Affiliated Hospital of Harbin Medical University, the Fourth Hospital of Hebei Medical University and General Hospital of Ningxia Medical University were consecutively included. A total of 24 pPCL patients were included with thirteen being male and eleven being female. The median age [M(Q1, Q3)] was 60 (57, 70) years. Patients were grouped according to peripheral blood plasma cell (PBPC) percentage [5%-19% (n=14) vs ≥20% (n=10)]. Last follow-up date was September 26th, 2023. The median follow-up period was 9.1 (4.2, 15.5) months. Patients' data related with clinical baseline characteristics, efficacy, survival and safety were retrospectively collected. Cox proportional hazards regression model was used to analyze risk factors associated with survival. Results: Among 24 pPCL patients, 16 (66.7%) patients had anemia at diagnosis, 13(54.2%) patients had thrombocytopenia, 8 (33.3%) patients had a baseline estimated glomerular filtration rate (eGFR)<40 ml·min-1·(1.73m2)-1, 13 (54.2%) patients had elevated lactate dehydrogenase (LDH) levels. The median PBPC percentage was 16% (8%, 26%) . Fluorescence in situ hybridization testing indicated that patients harboring 17p deletion, t(4;14) or t(14;16) were 6 (25.0%), 4 (16.7%) and 4 (16.7%), respectively. The overall response rate was 83.3% (20/24). The median progression-free survival (PFS) was 20.5 (95%CI: 15.8-25.2) months, and the median overall survival (OS) was not reached. Estimated 1-year and 2-year PFS and OS rates were 75.0% and 89.1%, 37.5% and 53.4%, respectively. The median PFS and OS for patients with PBPC percentages 5%-19% and≥20% were not reached and 20.5 (95%CI:15.7-25.3) months, 17.8 months and not reached, respectively. There was no significant statistical difference of PFS and OS between two groups (all P>0.05). Multivariate Cox regression analysis showed that 1p32 deletion was the risk factor associated with PFS (HR=7.7, 95%CI: 1.1-54.9, P=0.043). Seventeen patients (70.8%) developed grade 3-4 hematologic toxicities. Twelve patients (50.0%) developed grade 3-4 thrombocytopenia. Sixteen patients (66.7%) developed infection. All hematologic toxicities and infections were improved after supportive treatment. Conclusion: First-line treatment with anti-CD38 monoclonal antibody-based therapy for pPCL is effective and safe.

Efficacy and safety of keverprazan compared to lansoprazole in the treatment of duodenal ulcer: a phase III, randomised, double-blind, multicentre trial

INTRODUCTION

Keverprazan is a novel potassium-competitive acid blocker for the treatment of acid-related disorders requiring potent acid inhibition. This study aimed to establish the non-inferiority of keverprazan to lansoprazole in treatment of patients with duodenal ulcer (DU).

METHODS

In this phase III, double-blind, multicentre study, 360 Chinese patients with endoscopically confirmed active DU were randomised 1:1 to take either keverprazan (20 mg) or lansoprazole (30 mg) treatment for up to 6 weeks. The primary endpoint was DU healing rate at week 6. The secondary endpoints were DU healing rate at week 4. Symptom improvement and safety were also assessed.

RESULTS

Based on full analysis set, the cumulative healing rates at week 6 were 94.4% (170/180) and 93.3% (166/178) for keverprazan and lansoprazole, respectively (difference: 1.2%; 95% CI: -4.0% to 6.5%). At week 4, the respective healing rates were 83.9% (151/180) and 80.3% (143/178). In per-protocol set, the 6-week healing rates in keverprazan and lansoprazole groups were 98.2% (163/166) and 97.6% (163/167), respectively (difference: 0.6%; 95% CI: -3.1% to 4.4%); the 4-week healing rates were respectively 86.8% (144/166) and 85.6% (143/167). Keverprazan was non-inferior to lansoprazole in DU healing after the treatment for 4 and 6 weeks. The incidence of treatment- emergent adverse events was comparable among groups.

CONCLUSIONS

Keverprazan 20 mg had a good safety profile and was non-inferior to lansoprazole 30 mg once daily for DU healing.

Efficacy of keverprazan for duodenal ulcer: A phase II randomized, double-blind, parallel-controlled trial

BACKGROUND AND AIM

Considering the limitation of varying acid suppression of proton pump inhibitors, this study was aimed to assess the efficacy, safety, and dose-effect relationship of keverprazan, a novel potassium-competitive acid blocker, in the treatment of duodenal ulcer (DU) compared with lansoprazole.

METHODS

A randomized, double-blind, double-dummy, multicenter, low-dose, high-dose, and positive-drug parallel-controlled study was conducted to verify the non-inferiority of keverprazan (20 or 30 mg) to lansoprazole of 30 mg once daily for 4 to 6 weeks and dose-effect relationship of keverprazan in the treatment of patients with active DU confirmed by endoscopy.

RESULTS

Of the 180 subjects randomized, including 55 cases in the keverprazan_20 mg group, 61 cases in the keverprazan_30 mg group, and 64 cases in the lansoprazole_30 mg group, 168 subjects (93.33%) completed the study. The proportions of healed DU subjects in the keverprazan_20 mg, keverprazan_30 mg, and lansoprazole_30 mg groups were respectively 87.27%, 90.16%, and 79.69% at week 4 (P = 0.4595) and were respectively 96.36%, 98.36%, and 92.19% at week 6 (P = 0.2577). The incidence of adverse events in the keverprazan_20 mg group was lower than that in the lansoprazole_30 mg (P = 0.0285) and keverprazan_30 mg groups (P = 0.0398).

CONCLUSIONS

Keverprazan was effective and non-inferior to lansoprazole in healing DU. Based on the comparable efficacy and safety data, keverprazan of 20 mg once daily is recommended for the follow-up study of acid-related disorders. (Trial registration number: ChiCTR2100043455.).

Efficacy and safety of pomalidomide and low-dose dexamethasone in Chinese patients with relapsed or refractory multiple myeloma: a multicenter, prospective, single-arm, phase 2 trial

Background

Pomalidomide in combination with dexamethasone has demonstrated positive results in patients with relapsed or refractory multiple myeloma (RRMM), but no data are available in China. We conducted a multicenter, single-arm trial to examine the efficacy and safety of bioequivalent generic pomalidomide plus low-dose dexamethasone in Chinese RRMM patients.

Methods

Adult (≥ 18 years of age) RRMM patients who progressed after at least two previous treatments, including bortezomib and lenalidomide, were eligible. Pomalidomide was given orally at 4 mg/day on days 1 to 21 of a 28-day cycle. Dexamethasone was given at 40 mg/day (either orally or intravenously; 20 mg/day at 75 years or older) on days 1, 8, 15, and 22 of each cycle. Treatment continued until disease progression or intolerable adverse events (AEs). The primary end point was objective response rate (ORR).

Results

Seventy-four patients were enrolled between February 2017 and February 2019. All patients had progressed within 60 days of their last therapy. 74.3% of the patients were resistant to lenalidomide, 31.1% had renal insufficiency and 33.8% had high-risk cytogenetic RRMM. The median follow-up duration was 33.0 months (range 31.1–34.8 months). The ORR was 37.8% in the overall analysis, 32.7% in lenalidomide-refractory patients, 36.0% in patients with high-risk cytogenetics and 34.8% in RRMM patients with renal impairment. The median progression-free survival was 5.7 months (95% CI 3.7–8.8 months). The median overall survival was 24.3 months (95% CI 14.4–41.1 months). The most common grade 3 and 4 treatment-emergent adverse events (TEAEs) were neutropenia (63.5%), leukopenia (37.8%), thrombocytopenia (28.4%), and anemia (31.1%). Pulmonary infection (27.0%) was the most frequent grade 3 and 4 nonhematologic TEAE. No previously unreported AEs were observed. No venous thromboembolism was reported.

Conclusions

Pomalidomide in combination with low-dose dexamethasone is effective and safe in Chinese RRMM patients.

Trial registration

The study is registered at Chinese Clinical Trial Registry (ChiCTR) (ChiCTR-OIC-17013234, first registered on 03/11/2017).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-09802-y.

Comprehensive geriatric assessment in newly diagnosed older myeloma patients: a multicentre, prospective, non-interventional study

BACKGROUND

Multiple myeloma is a disease of the older people, whose prognoses are highly heterogeneous. The International Myeloma Working Group (IMWG) proposed a geriatric assessment (GA) based on age, functional status and comorbidities to discriminate between fit and frail patients. Given the multidimensional nature of frailty and the relatively recent exploration of frailty in the field of MM, reaching a consensus on the measurement of frailty in MM patients remains challenging.

OBJECTIVE

We sought to assess the feasibility of performing a comprehensive GA (CGA) in older MM patients in a real-world and multicentre setting and to evaluate their baseline CGA profiles.

RESULTS

We studied 349 older patients with newly diagnosed MM (age range, 65-86 years). Our results showed that a CGA is feasible for older MM patients. Using the IMWG-GA criteria, we identified significantly more frail patients in our cohort comparing to in the IMWG cohort (43% vs 30%, P = 0.002). In the IMWG-GA 'fit' group, risk of malnutrition, depression and cognitive impairment remains. The median follow-up time was 26 months (range 1-38). The median overall survival (OS) was 34.7 months, and the estimated 3-year OS rate was 50%. A high MNA-SF score (MNA-SF ≥ 12), low GDS score (GDS ≤ 5) and high CCI score (CCI ≥ 2) can be used to predict the OS of older patients with newly diagnosed MM. This study is registered at www.clinicaltrials.gov (NCT03122327).

CONCLUSIONS

Our study justifies the need for a CGA in older patients with newly diagnosed MM.

Watch-and-wait or immediate immunotherapy/immunochemotherapy in patients with phase IE primary pulmonary MALT lymphoma? A multicenter retrospective study

Primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is rare, and the optimal frontline treatment has not taken shape so far. It is still debatable whether the watch-and-wait (W&W) policy is beneficial to patients, especially in the early stage. This study was to compare the efficacy of W&W with rituximab single agent or combined chemotherapy (R/R-Chemo) on primary pulmonary MALT patients with localized disease. Clinical characters and effect on 28 patients with primary pulmonary MALT (IE phase) were analyzed. Among the 28 patients, 14 were grouped into W&W cohort, and 14 were immediately treated with R/R-Chemo. The median follow-up duration was 62 months. The estimated median time to treatment failure (TTF) in the W&W cohort and immediate R/R-Chemo cohort was 29 months and 59 months, which were not significantly different (P = 0.667). The estimated median time of overall survival (OS) in the W&W cohort and immediate R/R-Chemo cohort was 78 months and 76 months, which were also not statistically significant (P = 0.696). Concerning prognosis, there is no difference between patients with primary pulmonary MALT (IE phase) treated with W&W and with timely R/R-Chemo.

[A retrospective study of the BiRd regimen in the treatment of relapsed/ refractory multiple myeloma]

Objective: To evaluate efficacy of the BiRd regimen, a combination of clarithromycin, lenalidomide, and dexamethasone, in the treatment of patients with relapsed/refractory multiple myeloma (RRMM) . Methods: Patients with RRMM treated with BiRd between September 11, 2013 and August 1, 2016 at six centers were included to evaluate overall survival rate (ORR) , clinical benefit rate (CBR) , progression-free survival (PFS) , overall survival (OS) , as well as adverse events. Results: Of 30 patients with RRMM, 27 patients were evaluable, and ORR and CBR were 51.9% (14/27) and 66.7% (18/27) respectively, including 1 sCR (3.7%) , 3 CR (11.1%) , 3 VGPR (11.1%) , and 7 PR (25.6%) . In 13 patients with prior Rd, ORR and CBR were 38.5% (5/13) and 61.5% (8/13) respectively, of which 5 patients with ≥MR carried high-risk cytogenetic[ (e.g.17p- or t (4;14) ] together with at least one of other adverse-prognostic cytogenetic (e.g.13q- and/or 1q21+) . In 24 patients with prior bortezomib-based therapy, ORR and CBR were 45.8 and 62.5%, respectively. With a median follow-up time of 14.9 (range 1.0-33.8) months, the median PFS and OS were 12.0 (95%CI 11.6-12.4) and 27.6 (95%CI 15.1-40.1) months, respectively. The BiRd regimen was well tolerated. Conclusion: The BiRd regimen is an effective and safety protocol for RRMM, including those carrying high-risk cytogenetic markers.

[Efficacy and safety of IA regimen containing different doses of idarubicin in de-novo acute myeloid leukemia for adult patients]

目的

探讨含不同剂量去甲氧柔红霉素（IDA 8、10、12 mg/m²）的IA方案诱导治疗成人初发急性髓系白血病（AML）（非急性早幼粒细胞白血病）的临床疗效和安全性。

方法

采用多中心、单盲、非随机、临床对照研究，纳入2011年5月至2015年3月苏州大学附属第一医院及其他36家单位收治的1 215例成人初发AML患者，根据诱导化疗方案中IDA的剂量对患者进行分组，分析不同剂量IDA联合阿糖胞苷（100 mg/m²）组成的IA方案在成人初发AML诱导治疗中的完全缓解（CR）率、血液学及非血液学不良事件。

结果

可纳入缓解率分析的AML患者共1 207例，IDA 8 mg/m²、10 mg/m²和12 mg/m²组的CR率分别为73.6%（215/292）、84.1%（662/787）和86.7%（111/128），差异有统计学意义（P<0.001）；以IDA 8 mg/m²组为参照组，在调整了年龄、骨髓原始细胞比例、FAB分型、危险度分层后，IDA 10 mg/m²和IDA 12 mg/m²为影响患者CR的有利因素[OR=0.49（95% CI 0.34~0.70），P<0.001；OR=0.36（95%CI 0.18~0.71），P=0.003]。在中、低危组中三组CR率分别为76.5%（163/213）、86.9%（506/582）和86.1%（68/79），差异有统计学意义（P=0.007）；在调整了年龄、骨髓原始细胞比例、FAB分型因素后，IDA 10 mg/m²为影响患者CR的有利因素[OR=0.47（95% CI 0.31~0.71），P<0.001]。在高危组中，三组CR率分别为50.0%（18/36）、60.6%（43/71）和81.8%（18/22），差异无统计学意义（P=0.089），但在调整了年龄、骨髓原始细胞比例、FAB分型因素后，IDA 12 mg/m²为影响患者CR的有利因素[OR=0.22（95% CI 0.06~0.80），P=0.022]。8 mg/m²、10 mg/m²和12 mg/m²组中性粒细胞≤0.5×10⁹/L的中位持续时间分别为14（11~18）、15（11~20）和18（14~22）d，差异有统计学意义（P=0.012）；三组PLT≤20×10⁹/L的中位持续时间分别为14（7~17）、15（11~20）和17（15~21）d，差异有统计学意义（P=0.001）；三组肺部感染发生率分别为9.8%、13.5%和25.2%，差异有统计学意义（P<0.001）。

结论

在中国成人（18~60岁）初发AML中，建议中、低危组患者采用含IDA 10 mg/m²的IA方案进行诱导治疗；而高危组AML建议选择含IDA 12 mg/m²的IA方案进行诱导治疗。

Inhibition of epithelial‑mesenchymal transition in gastric cancer cells by miR‑711‑mediated downregulation of CD44 expression

Gastric cancer is a common malignancy worldwide. The prognosis of early stage gastric cancer patients has significantly improved in recent years. However, in progressive stage gastric cancer patients, the prognosis remains relatively poor due to tumor metastases. In our previous study, we showed that the expression of miR‑711 in gastric cancer tissues is low, and restoration of miR‑711 inhibited the invasion and migration and the occurrence of epithelial‑mesenchymal transition (EMT) in gastric cancer cells. Yet, the mechanisms involved in these processes remain unknown. In the present study, we demonstrated that miR‑711‑mediated downregulation of CD44 expression inhibited EMT of gastric cancer cells in vitro and in vivo by downregulating vimentin protein expression and upregulating E‑cadherin protein expression through transfection, qRT‑PCR and western blotting. Therefore, miR‑711 may provide a promising target for EMT‑related therapy for gastric cancer.

[Impact of KIT D816 mutation on salvage therapy in relapsed acute myeloid leukemia with t(8;21) translocation]

Objective: To evaluate the impact of KIT D816 mutation on the salvage therapy in relapsed acute myeloid leukemia (AML) with t(8;21) translocation. Method: The characteristics of the first relapsed AML with t(8;21) translocation from 10 hospitals were retrospectively collected, complete remission (CR(2)) rate after one course salvage chemotherapy and the relationship between KIT mutation and CR(2) rate was analyzed. Results: 68 cases were enrolled in this study, and 30 cases (44.1%) achieved CR(2). All patients received KIT mutation detection, and KIT D816 mutation was identified in 26 cases. The KIT D816 positive group had significantly lower CR(2) compared with non-KIT D816 group (23.1% vs 57.1%, χ(2)=7.559, P=0.006), and patients with longer CR(1) duration achieved significantly higher CR(2) than those with CR(1) duration less than 12 months (74.1% vs 31.9%, χ(2)=9.192, P=0.002). KIT D816 mutation was tightly related to shorter CR(1) duration. No significant difference of 2 years post relapse survival was observed between KIT D816 mutation and non-KIT D816 mutation group. Conclusion: KIT D816 mutation at diagnosis was an adverse factor on the salvage therapy in relapsed AML with t(8;21) translocation, significantly related to shorter CR1 duration, and can be used for prediction of salvage therapy response. KIT D816 mutation could guide the decision-making of salvage therapy in relapsed AML with t(8;21) translocation.

[A prospective multi-center trial of non-interventional and observational study of lenalidomide in Chinese patients with multiple myeloma]

Objective: To evaluate the efficacy and safety of lenalidomide in a real-world clinical practice in Chinese patients with multiple myeloma (MM). Methods: It was a prospective, multi-center, observational study. A total of 165 consecutive patients with MM treated with lenalidomide-based regimens were enrolled in 12 hospitals from June 2013 to November 2015. Relevant information was recorded, such as baseline clinical data, cytogenetic abnormalities, treatment regimens, and duration of treatment, safety, and survival. Results: (1)There were 126 relapsed and refractory MM (RRMM) patients, 25 newly diagnosed patients and 19 maintenance patients. The evaluable RRMM patients accounted for 120 cases, among which 74 cases(61.7%) reached the partial response (PR) or above, and a very good partial response (VGPR) in 16 patients (13.3%), a complete response (CR) in 14 cases (11.7%), a strictly complete response (sCR) in 4 cases (3.3%). Thus, a VGPR or above in 34 patients accounted for 28.3%. (2)The median follow-up was 13 months, the median time to progression 12 months. The median survival after receiving lenalidomide was 19 months, and the median overall survival (OS) was 62 months. (3) The univariate analysis in 120 RRMM patients suggested that prognostic factors for significant improvement in PFS included normal karyotype, international staging system (ISS) Ⅰ-Ⅱ, t(4; 14) negative (detected by fluorescence in situ hybridization), non-bortezomib resistance and response to previous regimens. As to OS, non-bortezomib resistance, response to previous regimens and non-primary refractoriness were positive factors. Multivariate analysis showed that the response to previous regimens (PR or better) was an independent good prognostic factor for progress-free survival(PFS), non-bortezomib resistance and non-primary refractoriness for OS. (4) Grade 3 or 4 adverse events that occurred in more than 10% of all enrolled patients were neutropenia (12.7%), leukocytosis(11.5%) and thrombocytopenia (12.7%). Owing to intolerance of toxic side effects, 7 cases withdrew lenalidomide. Conclusions: No matter what combination, regimens containing lenalidomide are effective to RRMM patients with overall response rate 61.7%, a time to progression 12 months and an overall survival 62 months.The toxicity is quite tolerable and manageable. In addition, the response to previous treatment (reached PR or above) is the independent good prognostic factor for PFS, non-bortezomib resistance and non-primary refractoriness for OS. Clinical trail registration: Clinicaltrials.gov, NCT01947309.

Geriatric Assessment to Predict Survival and Risk of Serious Adverse Events in Elderly Newly Diagnosed Multiple Myeloma Patients: A Multicenter Study in China

BACKGROUND

Elderly multiple myeloma (MM) patients often tend to suffer a variety of diseases, so the treatment of choice is very difficult for the elderly myeloma patients. The overall survival (OS) time and side effects with elderly patients are unclear in China. The study tried to find out the role of geriatric assessment in the Chinese elderly MM.

METHODS

We retrospectively analyzed the data of 628 newly diagnosed patients from six hospitals from June 2011 to June 2013. A geriatric assessment had been performed to assess comorbidities, cognitive, and physical status for these patients. The primary endpoint was to evaluate different physical states of elderly patients with OS time and treatment-related side effects.

RESULTS

An additive scoring system (range: 0-5), based on age, Katz's Activity of Daily Living (ADL) and Lawton's Instrumental Activity of Daily Living (IADL) ≤5 and Charlson Comorbidity Index (CCI) was developed to identify three groups: fit (score = 0); intermediate-fitness (score = 1); and frail (score ≥2). The 3-year OS was 63% in fit patients, 63% in intermediate-fitness patients, and 49% in frail patients ≥3 hematologic adverse events (AEs) were documented in 45 (35.4%) fit, 34 (34%) intermediate-fitness, and 121 (30.2%) frail patients. The risk of a grade ≥3 hematologic AEs was not significantly increase in intermediate-fitness (hazard ratios [HR]: 0.99, 95% confidence interval [CI]: 0.54-1.47, P = 1.000) and in frail patients (HR: 1.16, 95% CI: 0.70-1.93, P = 0.558) compared with fit ones.

CONCLUSIONS

MM occurs earlier in life and being advanced when the diagnosis is made in the mainland of China. The overall survival in frailty with International Staging System (ISS) II/III was the worst in all patients.

[Mechanisms of Apoptosis Induced by FTY720 in Multiple Myeloma Cell Line U266]

OBJECTIVE

To investigate the effects of FTY720 on apoptosis in multiple myeloma cell line U266 and to clarify the molecular mechanism of apoptosis induced by FTY720.

METHODS

U266 cells were treated with 2.5, 5, 10 and 20 µmol/L of FTY720 for 24 hours, the apoptotic rates were tested by flow cytometry with Annexin-V-FITC/PI staining. Then U266 cells were treated with 20 µmol/L FTY720 for 0, 6, 16 and 24 hours, the apoptotic rates were tested. U266 cells were treated with DMSO and FTY720 separately and then were stained with DAPI for 5 min. Drop the cells to the slides and cover the slide with the glass. The cells were observed by fluorescence microscopy. U266 cells were treated with 5 µmol/L FTY720 or together with different doses of Z-VAD-fmk (12.5, 25, 50 µmol/L), a pancaspase inhibitor, for 24 hours, then the cell viability was tested by CCK-8. U266 cells were treated with 2.5, 5, 10 and 20 µmol/L of FTY720 for 24 hours, the expression of cleaved caspase-3 was tested by Western blot. U266 cells were treated with 0, 5, 10 and 20 µmol/L of FTY720 for 24 hours, the expressions of MCL-1, survivin, BCL-2, BID, BAX, BAK, P-ERK were tested by Western blot.

RESULTS

The apoptotic rate increased in U266 cells treated with FTY720 and showed the characteristic of time-dependent and dose-dependent manner. Karyopyknosis and nuclearfragmentation could be observed in U266 cells treated with FTY720 after being stained with DAPI under fluorescent microscope. The same effect was not observed in the cells treated with DMSO. Z-VAD-fmk could rescue the apoptosis in U266 cells treated with FTY720 in dose-dependent manner. The expression of MCL-1, survivin and BCL-2 decreased in U266 cells treated with FTY720. The cleavage of BID could be observed in U266 cells treated with FTY720. FTY720 had no effect on the expression of BAX, BAK and P-ERK.

CONCLUSION

FTY720 can induce the apoptosis in U266 cells, the apoptosis was Caspase-3-depended. The apoptosis induced by FTY720 is due to the decrease of MCL-1, survivin and BCL-2, which are the inhibitors of apoptosis. Meanwhile, the apoptosis was also due to the activation of BID, which is pro-apoptotic protein.

Effect of TIEG1 on apoptosis and expression of Bcl-2/Bax and Pten in leukemic cell lines

We examined the effect of transforming growth factor-b inducible early gene-1 (TIEG1) on the apoptosis of leukemic cell lines and expression of B-cell lymphoma 2 (Bcl-2) and phosphatase and tensin homolog (Pten). Four leukemic cell lines (HL-60, U937, Raji, and K562) were treated with 0, 1, 5, 10, and 20 ng/mL TIEG1, respectively. The cell growth inhibitory ratio was assessed using the MTT assay. An inhibitory curve was drawn, and half-maximal inhibitory concentration was calculated. Additionally, 1640 culture medium containing 10 ng/mL TIEG1 was used to culture leukemic cell lines for 0, 6, 12, 24, and 48 h. The apoptosis of each cell line at different time points was detected by flow cytometry. Total RNA was extracted before reverse transcription-polymerase chain reaction. The products of this reaction were analyzed by electrophoresis, and the expression of Bcl-2/Bcl-2-associated X protein (Bax) and Pten were detected. After treatment with TIEG1, proliferation of the 4 leukemic cell lines was inhibited both time- and dose-dependently. During apoptosis induction, the expression of Bcl-2 was decreased and the expressions of Bax and Pten were increased in the 4 leukemic cell lines induced by TIEG1 (P < 0.05). TIEG1 can inhibit the proliferation of leukemic cells and induce their apoptosis in a time- and dose-dependent manner. A close relationship exists between Bcl-2/Bax and Pten expression and cell apoptosis induced by TIEG1.

Expression of miR-181a and miR-181b in human gastric cancer cells and tissues

AIM: To investigate the expression of miR-181a and miR-181b in human gastric cancer cell lines and tissues, and to explore their role in the development and progression of gastric cancer.

METHODS: Three gastric cancer cell lines with different degrees of differentiation (AGS, SGC-7901, MGC-803) and normal gastric mucosa cell line GES-1 were cultured in vitro, and gastric cancer tissue and normal tissue samples from 28 patients who underwent surgical operation were collected. The expression levels of miR-181a and miR-181b in the above cell lines and tissues were detected by quantitative real-time polymerase chain reaction (qRT-PCR) and compared among different groups.

RESULTS: The expression of miR-181a and miR-181b in AGS, SGC-7901 and MGC-803 cells was significantly higher than that in GES-1 cells (P < 0.05), but had no significant difference among the three gastric cancer cell lines (P > 0.05). Compared with normal gastric tissues, the expression of miR-181a and miR-181b in gastric cancer tissues was significantly higher (P < 0.05). The expression of miR-181a and miR-181b was significantly higher in stage Ⅲ/Ⅳ gastric cancer tissues than in stage Ⅰ/Ⅱ (P < 0.05), and in gastric cancer patients with lymph node metastasis than in patients without (P < 0.05). There was no significant correlation between the expression of miR-181a/miR-181b and age, gender, or degree of tumor differentiation (P > 0.05).

CONCLUSION: MiR-181a and miR-181b are highly expressed in gastric cancer cell lines and tissues, and their expression levels in gastric cancer are associated with tumor stage and lymph node metastasis. They might play a role as oncogenes in gastric carcinogenesis.

[Effects of TIEG1 on K562 cell apoptosis and expression of BCL-2/BAX, PTEN]

The aim of this study was to investigate the effect of TIEG1 on K562 cell apoptosis and expression of BCL-2/BAX, PTEN. The different concentration(0, 1, 5, 10, 20 ng/ml) of TIEG1 were used to treat K562 cells, the cell growth inhibition rate was detected by using MTT method. After treating K562 cells with 10.00 ng/ml TIEG1, the cell apoptosis was detected with flow cytometry. The RT-PCR was used to detected the expression levels of BCL-2 /BAX and PTEN. The results showed that TIEG1 displays inhibitory effect on proliferation of K562 cells in time-and dose-dependent manner (r = 0.52, P < 0.05) ; after K562 cells were treated for 6, 12, 24 and 48 h, the IC50 of TIEG1 were 48.19, 18.72, 9.5 and 3.85 ng/ml respectively. After treating K562 cells with 10.00 ng/ml TIEG1 for 0, 6, 12, 24, 48 h, the apoptosis rate were (2.13 ± 0.42)%, (7.79 ± 0.71)%, (11.17 ± 1.37)%, (24.66 ± 0.29)% and (48.60 ± 1.38)% respectively, and there was significant difference between groups(P < 0.05). In process of K562 cell apoptosis, the expression level of BCL-2 gradually decreased (r = 0.48, P < 0.05), meanwhile the expression levels of BAX (r = 0.69, P < 0.05) and PTEN (r = 0.57, P < 0.05) gradually increased. It is concluded that TIEG1 can indue apoptosis of K562 cells and inhibit K562 cell proliferation in time-and dose-dependent manner. In apoptosis process of K562 cells induced by TIEG1, the expression changes of BCL-2/BAX and PTEN associate with the K562 cell apoptosis.

[Mechanisms of ROS in U266 cell death induced by FTY720]

This study was purpose to investigate the role of reactive oxygen species (ROS) in apoptosis and autophagy induced by FTY720 in multiple myeloma cell line U266. U266 cells were treated by different concentrations of FTY720 for 24 h, the apoptotic rates were detected by flow cytometry, and the expression of LC3B was detected by Western blot. The results indicated that apoptosis and autophagy were induced by FTY720 in U266 cells. Autophagy induced by FTY720 could lead to cell death. Bafilomycin A1, the inhibitor of autophagy, could enhance the cell viability in U266 cells treated with FTY720. NAC or Tiron, ROS scavenger, could decrease the FTY720 induced apoptosis and the expression of LC3B-II was reduced in combination of FTY720 with NAC or Tiron as compared with treatment with FTY720 only. It is concluded that FTY720 can induce U266 cell apoptosis and autophagy. ROS is the mediator that regulates both the apoptosis and autophagy in multiple myeloma cells.

[Effect of valproic acid sodium on proliferation and apoptosis of acute T-lymphoblastic leukemia Jurkat cells]

This study was aimed to investigate the effects of valproic acid sodium (VPA) on the proliferation and apoptosis of acute T-lymphoblastic leukemia Jurkat cells. Jurkat cells were treated with different concentration of VPA. Proliferation-inhibition curve was assayed and plotted by CCK-8 method and the cell apoptosis was detected by flow cytometry with Annexin V/PI double staining. The expression level of anti-apoptotic gene BCL-2 and pro-apoptosis gene Bak1 were detected by semi-quantitative RT-PCR. The results showed that the VPA inhibited the proliferation of Jurkat cells in concentration-dependent manner. As compared with the control group, the apoptosis of cells increased along with adding concentration of VPA; VPA could decrease the expression of BCL-2 gene, but did not show obvious effect on the expression of Bak1. It is concluded that the VPA can inhibit proliferation of Jurkat cells which possibly associates with the decrease of BCL-2 expression.

[Influence of TIEG1 on apoptosis of HL-60 cells and expression of Bcl-2/Bax]

This study was aimed to investigate the influence of TIEG1 on apoptosis of HL-60 cells and the expression of Bcl-2/Bax. Different concentration of TIEG1 were used to treat HL-60 cells, the cell growth inhibition rate was detected by MTT method. After treating HL-60 cells with 12.03 ng/ml TIEG1, cell apoptosis was detected with flow cytometry. Bcl-2 and Bax was detected with RT-PCR. The results showed that TIEG1 had inhibitory effect on HL-60 cell proliferation, and in time-and dose-dependent manners. The more obvious inhibitory effect was observed in HL-60 cells treated with TIEG1 of 12.03 ng/ml. During the course of cell apoptosis, Bax expression increased, but Bcl-2 expression decreased (P < 0.05). It is concluded that TIEG1 inhibits HL-60 cell proliferation and induces apoptosis in time and dose-dependent manners. During the course of HL-60 cells apoptosis induced by TIEG1, Bcl-2/Bax are associated with HL-60 cell apoptosis induced by TIEG1.

Reversion of Multidrug-Resistance by Proteasome Inhibitor Bortezomib in K562/DNR Cell Line

OBJECTIVE

To observe the reversion of multi-drug resistance by proteasome inhibitor bortezomib in K562/DNR cell line and to analyze the possible mechanism of reversion of multidrug-resistance.

METHODS

MTT method was used to determine the drug resistance of K562/DNR cells and the cellular toxicity of bortezomib. K562/DNR cells were cultured for 12 hours, 24 hours and 36 hours with 100 μg/ml DNR only or plus 4 μg/L bortezomib. The expressions of NF-κB, IκB and P-gp of K562/DNR were detected with Western blot method, the activity of NF-κB was tested by ELISA method and the apoptosis rate was observed in each group respectively.

RESULTS

The IC50 of DNR on cells of K562/S and K562/DNR groups were 1.16 μg/ml and 50.43 μg/mL, respectively. The drug-resistant fold was 43.47. The IC10 of PS-341 on Cell strain K562/DNR was 4 μg/L. Therefore, 4 μg/L was selected as the concentration for PS-341 to reverse drug-resistance in this study. DNR induced down-regulation of IκB expression, up-regulation of NF-κB and P-gp expression. After treatment with PS-341, a proteasome inhibitor, the IκB degradation was inhibited, IκB expression increased, NF-κB and P-gp expression decreased in a time dependent manner. Compared to DNR group, the NF-κB p65 activity of DNR+PS-341 group was decreased. Compared to corresponding DNR group, DNR induced apoptosis rate increases after addition of PS-341 in a time dependent manner.

CONCLUSION

Proteasome inhibitor bortezomib can convert the leukemia cell drug resistance. The mechanism may be that bortezomib decreases the degradation of IκB and the expression of NF-κB and P-gp, therefore induces the apoptosis of multi-drug resistant cells.

[Ki-67 proliferative index in non-Hodgkin's lymphoma and its clinical significance]

This study was aimed to investigate the relationship of Ki-67 proliferation index (Ki-67 PI) with non-Hodgkin's lymphoma(NHL) typing and biological behavior, as well as its significance in clinical characters and prognosis of diffuse large B-cell lymphoma(DLBCL). A total of 542 cases of NHL in our hospital from 1st January 2001 to 31st December 2010 were retrospectively analyzed, and Ki-67 PI was all assayed immunohistochemically, and a total of 82 cases of newly-diagnosed DLBCL with more clinical records were investigated. The results indicated that according to the World Health Organization (WHO) histopathological classification of lymphoma, Ki-67 PI was different as classification for NHL subgroups was different. The Ki-67 PI increased with aggressive progression of NHL. The mean Ki-67 PI ranged from 25.5% in indolent lymphoma to 98.4% in very aggressive lymphoma. ROC curve analysis demonstrated that the 50% was the cut-off value distinguishing indolent from aggressive disease. On ROC curve analysis, Ki-67 PI of 75% was found to significantly discriminate patients with DLBCL who had a good or bad prognosis. There was a significant correlation of Ki-67 PI with Ann Arbor stage and LDH level. When the DLBCL cases were divided by Ann Arbor stage and IPI score, the 3-year overall survival (OS) of patients with a low Ki-67 PI (≤ 75%) in the group of Ann Arbor stage III-IV and high LDH level was higher than those with a high Ki-67 PI (> 75%) among the patients with B symptoms and IPI 3.0-5. 3-year OS in those with a low Ki-67 PI (≤ 75%) in the group of Ann Arbor stage III-IV and normal LDH level was higher than those with a high Ki-67 PI (> 75%) among the patients with B symptoms. 3-year OS of patients with a low Ki-67 PI (≤ 75%) in the group at III-IV stage and a high LDH level was higher than those with a high Ki-67 PI (> 75%). It is concluded that a cut-off value of 50% can be helpful to differentiate indolent from aggressive NHL. In DLBCL, a cut-off value of 75% can distinguish patients with a good or bad prognosis when combined with other prognostic factors, i.e. B symptoms, Ann Arbor stage, IPI score and lactate dehydrogenase (LDH) level.

[Effect of different concentrations of bortezomib on the expression of ERK, JNK and P38 in daunorubicin-resistant K562 cells]

The aim of this study was to investigate the effect of proteasome inhibitor bortezomib on the expression of ERK, JNK, and P38 in daunorubicin (DNR)-resistant K562 cells and its mechanism. MTT method was used to determine the drug-resistant K562 cells and the cellular toxicity of bortezomib; Western blot was used to detect the expression of protein ERK, JNK and P38 in K562 cells after treatment with 100 nmol/L DNR alone or combined with 1 nmol/L and 10 nmol/L bortezomib for 36 hours. Flow cytometry assay was used to detect the apoptosis rate in each group cells. The results indicated that the expression of ERK and P38 were significantly suppressed (p < 0.05) and the expression of JNK was significantly enhanced (p < 0.05) in the cells treated by DNR combined with bortezomib. It is concluded that bortezomib can decrease the expressions of protein ERK and P38 and enhance the expression of JNK, the bortezomib reverses the cellular drug-resistance and promote cell apoptosis through MAPK pathway.

[Effects of oleanolic acid on apoptosis and PTEN expression of Jurkat cells]

This study was aimed to explore the effects of oleanolic acid on PTEN expression and apoptosis of Jurkat cells. The inhibitory rate was measured by Cell Counting Kit-8. The apoptotic nucleus morphous was observed by Hoechst 33258 staining. The apoptosis rate of Jurkat cells were determined by flow cytometry with Annexin V/PI double staining. PTEN mRNA and protein were detected by quantitative real-time PCR and Western blot respectively. The results showed that oleanolic acid inhibited the proliferation of Jurkat cells in time- and dose-dependent manners. The 50% growth inhibition (IC(50)) at 12, 24 and 48 hours were about 85.35 µmol/L, 53.66 µmol/L and 33.18 µmol/L respectively. Flow cytometric assay showed that the apoptotic rates of Jurkat cells treated with oleanolic acid (0, 40, 80 and 160 µmol/L) for 24 hours were 6.72%, 19.8%, 28.72% and 30.12% (p < 0.05). PTEN mRNA and protein expressions were up-regulated in Jurkat cells treated with oleanolic acid of concentration 80 µmol/L and 160 µmol/L for 24 hours. It is concluded that up-regulation of PTEN mRNA and PTEN protein may be involved in oleanolic acid-induced Jurkat cell apoptosis.

[Effect of bortezomib on MAPK signaling pathway of K562/DNR cells]

The study was aimed to investigate the effects of bortezomib (BTZ) on the expression of ERK, JNK and P38 in daunorubicin (DNR)-resistant K562 cells (K562/DNR) and to clarify the molecular mechanism of BTZ in reversing the drug-resistance in leukemic cells. The K562/DNR cells and the cellular toxicity of BTZ was determined by MTT, then 4 µg/L of BTZ was chosen to do the experiment. The expression of ERK, JNK, p38 and P-gp of K562/DNR cells treated with DNR only or DNR combined with BTZ for 12, 24 and 36 hours was detected by Western blot. The apoptosis rate in each group was assayed by flow cytometry. The results showed that as compared with DNR group, the expression of P-ERK, P-P38 and P-gp was significantly suppressed (p < 0.05) and the expression of P-JNK was significantly enhanced (p < 0.05) in the cells treated with DNR combined with BTZ. There was no change in the expression of total ERK, P38 and JNK. The effect increased with the prolonging of time. Meanwhile, the apoptosis rate in cells treated with DNR combined with BTZ increased compared with DNR only. It is concluded that the BTZ can reverse the drug resistance in K562/DNR cells by MAPK signaling pathway and increase the apoptosis of leukemic cells. The effect shows the characteristics of time-dependent manner.

Isolation and bioinformatics analysis of differentially methylated genomic fragments in human gastric cancer

AIM: To isolate and analyze the DNA sequences which are methylated differentially between gastric cancer and normal gastric mucosa.

METHODS: The differentially methylated DNA sequences between gastric cancer and normal gastric mucosa were isolated by methylation-sensitive representational difference analysis (MS-RDA). Similarities between the separated fragments and the human genomic DNA were analyzed with Basic Local Alignment Search Tool (BLAST).

RESULTS: Three differentially methylated DNA sequences were obtained, two of which have been accepted by GenBank. The accession numbers are AY887106 and AY887107. AY887107 was highly similar to the 11th exon of LOC440683 (98%), 3’ end of LOC440887 (99%), and promoter and exon regions of DRD5 (94%). AY887106 was consistent (98%) with a CpG island in ribosomal RNA isolated from colorectal cancer by Minoru Toyota in 1999.

CONCLUSION: The methylation degree is different between gastric cancer and normal gastric mucosa. The differentially methylated DNA sequences can be isolated effectively by MS-RDA.

[Screening human gastric carcinoma-associated antigens by serologic proteome analysis]

BACKGROUND & OBJECTIVE

It is urgent to find the specific or relatively specific biomarkers in the study of gastric carcinoma. This study was to screen human gastric carcinoma-associated antigens by serologic proteome analysis (SERPA).

METHODS

Total protein were isolated from 10 specimens of human gastric carcinoma by 2-dimensional electrophoresis (2-DE). The immunoblotting imaging films were obtained and the differential reacting protein spots were recognized. Then the differential reacting proteins were obtained in the replica gel by matching analysis, and identified by peptide mass fingerprint (PMF) based on matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS) and database searching.

RESULTS

Fourteen differentially expressed proteins (react only to the patient's serum) were found. Of the 14 proteins, 13 were identified as human gastric carcinoma-associated antigens, including heterogeneous nuclear ribonucleoprotein K (hnRNP K), hnRNP H1, hnRNP H2, cytokeratin 18 (CK18), crystal structure of Fkbp52 C-terminal domain complex with the C-terminal peptide meevd of hot-shock protein 90 (Hsp90), serum vitamin D-binding protein precursor (DBP), selenium-binding protein 1 (SBP1), eukaryotic translation elongation factor 1 delta (eEF-1), ACTB protein, brain creatine kinase (CKB), proteasome 26S ATPase subunit 3 (PSMC3), dimethylarginine dimethylaminohydrolase 1(DDAH-1), and NADH dehydrogenase Fe-S protein 1.

CONCLUSIONS

Thirteen human gastric carcinoma-associated antigens were found by SERPA. The results provide foundation for screening molecular biomarkers for the diagnosis, therapy, prognostic evaluation, and prevention of human gastric carcinoma.

Role of peroxisome proliferator-activated receptor-γ in resveatrol-induced proliferation inhibition of gastric cancer cell line SGC-7901

AIM: To investigate the role of peroxisome proliferator-activated receptor-γ (PPAR-γ) in the inhibitory effects of resveratrol (Res) on gastric cancer cell SGC-7901 proliferation in vitro.

METHODS: After human gastric cancer cell SGC-7901 was cultured in vitro, MTT assay was used to detect the inhibitory effect of Res and GW9662 (specific blocker of PPAR-γ) on cell proliferation. Flow cytometry was used to detect cell cycle, and PPAR-γ, Cyclin D1 mRNA was measured quantitatively by reverse transcription-polymerase chain reaction (RT-PCR). The expression of PPAR-γ protein was measured quantitatively by Western blot, and the expression of Cyclin D1 protein in gastric cancer cells was detected by immunohistochemistry.

RESULTS: Res inhibited the proliferation of SGC-7901 cells in a dose- and time-dependent manner (P < 0.05), and flow cytometry analysis revealed that the cell cycle was blocked at G₁-phase. RT-PCR and Western blot showed that both PPAR-γ mRNA and protein were expressed in SGC-7901 cells, and Res enhanced PPAR-γ mRNA expression. After SGC-7901 cells were treated by Res with the concentration of 25, 50, 75 and 100 μmol/L, the relative percentages of PPAR-γ mRNA expression were 122.2%, 195.1%, 232.9% and 277.1% of those in the controls (P < 0.05), but the expression of PPAR-γ protein didn't changed. The high levels of Cyclin D1 mRNA and protein expression were detected in SGC-7901 cells, while Res significantly decreased the expression of Cyclin D1. After SGC-7901 cells were treated by Res with the concentration of 25, 50, 75 and 100 mmol/L, the inhibitory rates of Cyclin D1 mRNA were 11.3%, 24.3%, 35.4% and 59.5%, respectively, while GW9662 markedly decreased the above effects of Res.

CONCLUSION: Res can significantly inhibit Cyclin D1 expression partly by activating PPAR-γ in gastric cancer cells SGC-7901, which results in the blockage of cell cycle at G₁ phase and inhibition of cell proliferation.

Isolation of differentially methylated DNA sequences of gastric cancer by methylation-sensitive representational difference analysis

AIM: To isolate the differentially methylated DNA sequences between gastric cancer and normal gastric mucosa.

METHODS: The differentially methylated DNA sequences between gasrtic cancer and normal gastric mucosa were isolated by methylation-sensitive representational difference analysis (MS-RDA). Similarities between the separated fragments and the human genomic DNA were analyzed with Building Loads Analysis and System Thermodynamics (BLAST) program.

RESULTS: Three differentially methylated DNA sequences, CRS1308, CRS1309, and CRS1310, were obtained. CRS1309 and CRS1310 had been accepted by GenBank. CRS1309 was highly similar to the eleventh exon of LOC440683 (98%), 3' end of LOC440887 (99%), and promoter and exon region of DRD5 (94%). CRS1310 was consistent (98%) with a CpG island, in ribosomal RNA, isolated from colorectal cancer by Minoru Toyota in 1999.

CONCLUSION: The methylation degree is different between gastric cancer and normal gastric mucosa. The differentially methylated DNA sequences can be isolated effectively by MS-RDA.

[Construction of eukaryotic expression vector of mouse alpha-fetoprotein cDNA and its expression in dendritic cells and in vitro antitumor effect on hepatoma]

BACKGROUND & OBJECTIVE

Studying the mechanism of why the abnormal protein coded by mutant gene of hepatoma carcinoma cell possesses potential antigenicity, but can not form effective immunogen, searching for specific antigen of hepatoma, and developing DNA vaccine for hepatoma treatment will have active impact on the immunotherapy of hepatoma. This study was to construct fluorescent eukaryotic expression vector of mouse alpha fetoprotein (AFP) cDNA fragment with or without the secretory signal peptide (termed AFP1 cDNA and AFP2 cDNA), and observe its expression in mouse dendritic cells (DCs) and in vitro antitumor effect on hepatoma.

METHODS

AFP1 cDNA and AFP2 cDNA were amplified from mouse hepatoma cell line H22 by reverse transcription-polymerase chain reaction (RT-PCR), and cloned into eukaryotic expression vector PEGF-N3 to form the recombinant PEGF-N3/AFP1 and PEGF-N3/AFP2. The mouse bone marrow cells were induced with recombinant granulocyte-macrophage colony-stimulating factor (rmGM-CSF) and recombinant interleukin-4 (rmIL-4) to form mature DCs. The recombinant PEGF-N3/AFP1 and PEGF-N3/AFP2 were transfected into DCs. The DCs vaccine were co-cultured with isogenous mouse spleen lymphocytes. The expression of gamma-interferon (IFN-gamma) in the spleen lymphocytes stimulated by AFP1/DCs or AFP2/DCs was measured by ELISA assay; the specific killing activity of cytotoxic T lymphocytes (CTLs) was evaluated by 51Cr release assay.

RESULTS

Sequencing analysis verified that AFP1 cDNA and AFP2 cDNA were correctly amplified from H22 cells. The recombinant PEGF-N3/AFP1 and PEGF-N3/AFP2 were stably expressed in mouse DCs. AFP2/DCs obviously stimulated proliferation of T lymphocytes; the stimulation index (SI) was significantly higher in AFP2/DCs group than in AFP1/DCs group, empty vector group, and blank control group (5.12 +/- 1.46 vs. 1.41 +/- 0.65, 1.42 +/- 0.7, and 1.41 +/- 0.55, P < 0.01); the specific killing activity of CTLs was stronger in AFP2/DCs group than in empty vector group [(88.15 +/- 16.4)% vs. (12.72 +/- 5.45)%].

CONCLUSION

The recombinant expression vectors PEGF-N3/AFP1 and PEGF-N3/AFP2 with or without signal peptide were constructed successfully. AFP2/DCs can specifically activate T lymphocytes in vitro and effectively induce antitumor immune response.