Single‑cell multi‑omics advances in lymphoma research (Review)

The evolution of lymphoma is a multifactorial process that leads to unavoidable lymphoma heterogeneity in the form of genetic mutations, chromosomal translocations and other variations. Multi‑omics analyses based on single‑cell assays can reveal and characterize tumor components, enabling us to determine the timing of mutations and to profile disease progression. Increasing numbers of studies are using single‑cell transcriptomics to unravel the mechanisms of lymphoma evolution, drug resistance and therapeutic approaches. Various single‑cell multi‑omics measurements involving genomics, transcriptomics and epigenomics have improved knowledge of the complex lymphatic system and made it possible to obtain individualized and precise tumor biological characteristics, which cannot be accessed from bulk cell analysis, and this can facilitate individualized treatment. In the present review, the advances in multi‑omics analysis based on single‑cell assays of lymphoma specimens were systematically discussed, including the sequencing of the single‑cell from genomic and transcriptomic perspectives, the landscape of the lymphoma microenvironment, the development of single‑cell histology biomarkers, the identification of lymphoma origin and evolution, as well as the current challenges and future prospects of single‑cell multi‑omics. The authors' insights may contribute to the exploration of novel lymphoma biomarkers and the discovery of efficient treatment combinations that target immunological checkpoints and underlying molecular mechanisms.

Clinical and genetic characteristics in lymphoma patients with a second solid malignancy

Diagnosis and treatment of multiple primary malignancies are becoming a new challenge in clinical practice worldwide. The present study aimed to characterize the clinical and genetic features of multiple primary malignancies in patients with synchronous or metachronous lymphoma and another solid tumor. We retrospectively analyzed 11 cases with lymphoma and another solid tumor. The germline mutations in plasma cell-free DNA samples and somatic mutations in lymphoma and solid tumor tissue samples were identified using targeted next-generation sequencing. In the 11 lymphoma patients, the most common type of concurrent solid tumor was colon adenocarcinoma (case 3, 5, 9 11) followed by papillary thyroid carcinoma (case 1, 7, 10). Metachronous lymphoma and solid tumor in 6 patients were treated with corresponding standard therapy asynchronously. Chemotherapy for colon adenocarcinoma during the interval of lymphoma chemotherapy led to excellent outcome in two patients. Immediate chemotherapy for lymphoma plus elective surgery for synchronous papillary thyroid carcinoma also yielded good prognosis in two patients with synchronous double primaries. Interestingly, we found that 10 of 11 patients with lymphoma and another solid tumor harbored germline mutations in Fanconi anemia complementation group (FANC) genes, including FANCI, FANCA, FANCG, FANCL, FANCD1, FANCF, FANCJ, and FANCS. In summary, comprehensive study of the clinical and genetic features of patients with multiple primary malignancies may improve diagnosis and treatment in the future. Mutations in FANC genes might be a predisposition to tumorigenesis of lymphoma patients with a second solid malignancy.

Biophysical cues to improve the immunomodulatory capacity of mesenchymal stem cells: The progress and mechanisms

Mesenchymal stem cells (MSCs) can maintain immune homeostasis and many preclinical trials with MSCs have been carried out around the world. In vitro culture of MSCs has been found to result in the decline of immunomodulatory capacity, migration and proliferation. To address these problems, simulating the extracellular environment for preconditioning of MSCs is a promising and inexpensive method. Biophysical cues in the external environment that MSCs are exposed to have been shown to affect MSC migration, residency, differentiation, secretion, etc. We review the main ways in which MSCs exert their immunomodulatory ability, and summarize recent advances in mechanical preconditioning of MSCs to enhance immunomodulatory capacity and related mechanical signal sensing and transduction mechanisms.

Piezo protein determines stem cell fate by transmitting mechanical signals

Piezo ion channel is a mechanosensitive protein on the cell membrane, which contains Piezo1 and Piezo2. Piezo channels are activated by mechanical forces, including stretch, matrix stiffness, static pressure, and shear stress. Piezo channels transmit mechanical signals that cause different downstream responses in the differentiation process, including integrin signaling pathway, ERK1/2 MAPK signaling pathway, Notch signaling, and WNT signaling pathway. In the fate of stem cell differentiation, scientists found differences in Piezo channel expression and found that Piezo channel expression is related to developmental diseases. Here, we briefly review the structure and function of Piezo channels and the relationship between Piezo and mechanical signals, discussing the current understanding of the role of Piezo channels in stem cell fate and associated molecules and developmental diseases. Ultimately, we believe this review will help identify the association between Piezo channels and stem cell fate.

Patient-derived intrafemoral orthotopic xenografts of peripheral blood or bone marrow from acute myeloid and acute lymphoblastic leukemia patients: clinical characterization, methodology, and validation

Acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) are malignant clonal diseases of the hematopoietic system with an unsatisfactory overall prognosis. The main obstacle is the increased resistance of AML and ALL cells to chemotherapy. The development and validation of new therapeutic strategies for acute leukemia require preclinical models that accurately recapitulate the genetic, pathological, and clinical features of acute leukemia. A patient-derived orthotopic xenograft (PDOX) model is established using surgical orthotopic implantation. They closely resemble human tumor progression and microenvironment and are more reliable translational research tools than subcutaneous-transplant models. In this study, we established PDOX models by direct intrafemoral injection of bone marrow and peripheral blood cells from AML and ALL patients, characterized their pathology, cytology, and genetics, and compared the model's characteristics and drug responsiveness with those of the corresponding patients.

Abstract 3103: Liquid tumor orthotopic PDX models of acute leukemia

Liquid tumor orthotopic xenograft models were established by intra femoral injection on NCG mice using freshly prepared leukemia cells from peripheral blood (PB) or bone marrow (BM) of AML/ALL patient samples. The establishment of the orthotopic models were monitored by the flow cytometry analysis of peripheral blood of engrafted mice:CD45+/CD33+ for AML and CD45+/CD19+ for B-ALL. The double positive cells in the peripheral blood of the successfully transplanted model can reach 5-15%. Typically, it takes 120 -170 days to establish the P0 AML orthotopic model. It takes 45-60 days to establish the P0 ALL orthotopic model. Spleen from engrafted P0 mice was used for P1-P3 reconstitution of the orthotopic model. On these orthotopic models, we tested whether medicines such as etoposide, cytarabine, vincristine, ibrutinib and imatinib are sensitive. And anti-CD47 antibody was also tested on these models. NGS profiling was used to confirm the genotype of established orthotopic PDX.

Citation Format: Hongkui Chen, Lintao Bi, Shizhu Zhao, Shuai Wang, Wenqiang Huang, Josh Caggiula, Loc Van, Danyi Wen. Liquid tumor orthotopic PDX models of acute leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3103.

Dual Functions of MDP Monomer with De- and Remineralizing Ability

Methacryloyloxydecyl dihydrogen phosphate (MDP) has been speculated to induce mineralization, but there has been no convincing evidence of its ability to induce intrafibrillar mineralization. Polymers play a critical role in biomimetic mineralization as stabilizers/inducers of amorphous precursors. Hence, MDP-induced biomimetic mineralization without polymer additives has not been fully verified or elucidated. By combining 3-dimensional stochastic optical reconstruction microscopy, surface zeta potentials, contact angle measurements, inductively coupled plasma-optical emission spectroscopy, transmission electron microscopy, atomic force microscopy, and Fourier transform infrared spectroscopy with circular dichroism, we show that amphiphilic MDP can not only demineralize dentin by releasing protons as an acidic functional monomer but also infiltrate collagen fibrils (including dentin collagen), unwind the triple helical structure by breaking hydrogen bonds, and finally immobilize within collagen. MDP-bound collagen functions as a huge collagenous phosphoprotein (HCPP), in contrast to chemical phosphorylation modifications. HCPP can induce biomimetic mineralization itself without polymer additives by alternatively attracting calcium and phosphate through electrostatic attraction. Therefore, we herein propose the dual functions of amphiphilic MDP monomer with de- and remineralizing ability. MDP in the free state can demineralize dentin substrates by releasing protons, whereas MDP in the collagen-bound state as HCPP can induce intrafibrillar mineralization. The dual functions of MDP monomer with de- and remineralization properties might create a new epoch in adhesive dentistry and preventive dentistry.

POS0664 A MULTICENTER RANDOMIZED STUDY IN RHEUMATOID ARTHRITIS TO COMPARE IGURATIMOD, METHOTREXATE, OR COMBINATION: 52 WEEK EFFICACY AND SAFETY RESULTS OF THE SMILE TRIAL

Background:

Iguratimod (IGU) has demonstrated efficacy and safety for active rheumatoid arthritis (RA) patients in double-blind clinical trials in China and Japan as a new disease-modifying anti-rheumatic drug (DMARD). There are no studies evaluating the radiographic progression of structural joint damage of IGU for the treatment of RA using the mTSS as the primary endpoint.

Objectives:

Our study was to evaluate the efficacy and safety of IGU monotherapy and IGU combined methotrexate (MTX) compared with MTX monotherapy, including the inhibitory effects of joint destruction.

Methods:

This randomized, double-blind, parallel-controlled, multicenter study in patients with active RA who have not previously used MTX and biological DMARDs (bDMARDs) (ClinicalTrials.gov Identifier NCT01548001) was carried out in China. Patients were randomized 1:1:1 to receive IGU 25 mg twice a day (bid), MTX 10mg once a week(qw) for the first 4 weeks and 15 mg once a week(qw) for week 5 to 52, or IGU combined MTX (IGU+MTX) for 52 weeks. The primary endpoints were to assess and compare American College of Rheumatology 20% (ACR20) response and the change of modified total Sharp scoring (mTSS) score over 52 weeks (Intention-to-treat, ITT analysis). The non-inferiority test was used to analyze the difference of ACR20 response at 52 weeks between the IGU monotherapy and the MTX monotherapy arms, and the non-inferiority limit value was 10%. The difference test was used for the comparison between the IGU+MTX and MTX monotherapy arms. Two-way ANOVA was used to analyze the difference of the changes of mTSS score of each arm compared with baseline value (0 week).

Results:

A total of 895 patients were randomized to IGU 25mg bid (n =297), MTX 10-15mg qw(n=293), and IGU+MTX (n=305). Baseline characteristics were comparable between the arms (Table 1).

Table 1.

Demographic and Other Baseline Characteristics (SAS)

IGUMTXIGU+MTXNumber of Subjects297293305Age, mean (SD) years46.87(10.67)47.63(10.70)48.37(10.69)Female/male, %77.44/22.5679.18/20.8278.03/21.97Duration of RA, mean(SD) years11.67±7.1611.60±7.9811.67±7.27CRP, mean(SD) mg/L222.32±35.4720.67±26.6119.74±31.38Tender joint count, mean (SD)14.59±9.1614.83±9.3014.93±9.88Swollen joint count, mean (SD)9.81±6.639.73±7.209.51±6.22DAS28-CRP, mean (SD)5.084±0.9945.102±0.9795.103±0.956HAQ score, mean (SD)15.82±11.2515.24±10.9316.06±10.92

SAS: Safety Analysis Set; CRP: C-reactive protein;

DAS28: disease activity score; HAQ: Health Assessment Questionnaire

The study met its primary endpoints. More concretely, IGU monotherapy and IGU+MTX were found to be superior to MTX at week 52 with a higher ACR20 response of 77.44%(230/297, P=0.0019) and 77.05%(235/305, P=0.0028) versus 65.87%(193/293) (fig 1). As shown in fig 1, the structural remission (ΔmTSS≤0.5) was statistically significant for IGU monotherapy (57.4%, P=0.0308) but not for IGU+MTX arm (55%) versus MTX monotherapy (47.8%).

Overall incidence of the adverse events (AEs) leading to study discontinuation were reported in 13.8% (41/297) in IGU monotherapy arm, 11.26% (33/293) in MTX monotherapy arm and 11.51% (35/305) patients in IGU+MTX arm. The incidence of adverse drug reactions (ADR) leading to study discontinuation were 11.45% (34/297), 8.53% (25/293) and 9.21% (28/305), respectively. There was no one death and no significant difference in all the safety indicators among the three arms.

Conclusion:

Iguratimod alone or in combination with MTX demonstrated superior efficacy with acceptable safety compared to MTX for patients with active RA who have not previously used MTX bDMARDs.

Disclosure of Interests:

None declared

Blastic plasmacytoid dendritic cell neoplasm with genetic mutations in multiple epigenetic modifiers: a case report

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive hematodermic malignancy derived from plasmacytoid dendritic cell precursors. Despite advances in our understanding of tumor cell surface markers, the pathogenesis of BPDCN remains largely unknown. No standard or optimal treatments are available for BPDCN, and the prognosis is usually poor. We report herein a case of BPDCN that harbored multiple genetic mutations in epigenetic modifiers such as TET2 and ZRSR2. Genetic studies in patients with BPDCN may provide insights into the underlying pathogenesis, prediction of clinical prognosis, and development of better targeted therapeutics for this rare clinical entity.

Effects of dexmedetomidine on sepsis-induced liver injury in rats

OBJECTIVE

To explore the effect of dexmedetomidine (DEX) on sepsis-induced liver injury in rats and the mechanism of action, providing certain references for the prevention and treatment of sepsis-induced liver injury in clinical practice.

MATERIALS AND METHODS

A total of 60 male Sprague Dawley (SD) rats were randomly divided into 3 groups, namely sham operation group (Sham group, n=20), sepsis-induced liver injury group [lipopolysaccharides (LPS) group, n=20], and sepsis-induced liver injury + DEX group (LPS + DEX group, n=20) using a random number table. Rat models of sepsis-induced liver injury were established by intraperitoneal injection of LPS (10 mg/kg), and at the same time, DEX was intragastrically injected at a dose of 50 μg/kg. After 24 h, the survival analysis curves of each group of rats were plotted. Meanwhile, the levels of liver function indexes and oxidative stress markers were measured at 12 h in each group of rats. Hematoxylin-eosin (H&E) staining assay was carried out to detect the morphological changes of rat liver cells in each group. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling (TUNEL) staining assay was performed to detect the apoptosis level in rat liver tissues in each group. In addition, the expression level of Caspase 3 in three groups of rats was measured through immunohistochemical staining assay. Lastly, the effect of DEX on the protein expression of extracellular signal-regulated kinases 1/2 (ERK1/2) in liver tissues was detected via Western blotting.

RESULTS

DEX significantly improved liver dysfunction induced by LPS and raised the 24 h-survival rates of rats (p<0.05). Besides, H&E staining results showed that DEX clearly relieved the pathological damage of rat liver cells caused by LPS. In comparison with LPS group, LPS + DEX group displayed more neatly arranged liver cells, less degradation and necrosis, and evidently attenuated cellular edema. Immunohistochemistry results revealed that DEX significantly reversed the increase in Caspase 3 expression resulting from LPS. The results of the TUNEL staining assay showed that DEX clearly inhibited the apoptosis of rat liver cells induced by LPS. The results of Western blotting revealed that DEX notably reversed the decrease of phosphorylated ERK1/2 (p-ERK1/2) in rat liver tissues compared with LPS group.

CONCLUSIONS

DEX is able to markedly relieve LPS-induced liver injury in rats and the underlying mechanism may be related to the activation of the ERK1/2 signaling pathway.

A comparison of open, laparoscopic and robotic total mesorectal excision: trial sequential analysis and network meta-analysis

AIM

Total mesorectal excision (TME) for rectal cancer can be achieved by employing open (OpTME), laparoscopic (LaTME) and robotic (RoTME) approaches but which of these has the best outcome? The aim of present study is to identify the most effective technique for rectal cancer by comparing all outcomes.

METHODS

Randomized controlled trials (RCTs) which compared at least two TME strategies were identified by literature search of electronic databases of articles published to June 2018. Network meta-analysis with trial sequential analysis was performed using a frequentist approach with random-effects meta-analysis. Data collection and analysis We conducted a systematic search of PubMed, EmBase, the Cochrane Library, CNKI, and Web of Science. Titles and abstracts of the retrieved publications were independently and blindly assessed by two authors.

RESULTS

Twenty-two RCTs with 4882 rectal cancer patients were included in this analysis. The trial sequential analysis demonstrated that the cumulative Z-curve crossed either the traditional boundary or the trial sequential monitoring boundaries, suggesting that OpTME resulted in a more complete TME specimen than LaTME (relative risk 1.05, 95% confidence interval 1.01-1.08). Network meta-analysis showed there was no significant difference in the other comparisons. Based on the P score of completeness of the TME specimen and circumferential resection margin positivity, the best technique was OpTME, followed by RoTME and then LaTME. However, this order was reversed when complications and mortality were considered. RoTME led to better lymph node harvest.

CONCLUSIONS

Although OpTME may give better pathological specimens, minimally invasive techniques may have advantages when considering lymph node harvest, complications and mortality. More RCTs are needed to determine which technique actually gives the best chance of survival.

Molecular signatures of multiple myeloma progression through single cell RNA-Seq

We used single cell RNA-Seq to examine molecular heterogeneity in multiple myeloma (MM) in 597 CD138 positive cells from bone marrow aspirates of 15 patients at different stages of disease progression. 790 genes were selected by coefficient of variation (CV) method and organized cells into four groups (L1–L4) using unsupervised clustering. Plasma cells from each patient clustered into at least two groups based on gene expression signature. The L1 group contained cells from all MGUS patients having the lowest expression of genes involved in the oxidative phosphorylation, Myc targets, and mTORC1 signaling pathways (p < 1.2 × 10⁻¹⁴). In contrast, the expression level of these pathway genes increased progressively and were the highest in L4 group containing only cells from MM patients with t(4;14) translocations. A 44 genes signature of consistently overexpressed genes among the four groups was associated with poorer overall survival in MM patients (APEX trial, p < 0.0001; HR, 1.83; 95% CI, 1.33–2.52), particularly those treated with bortezomib (p < 0.0001; HR, 2.00; 95% CI, 1.39–2.89). Our study, using single cell RNA-Seq, identified the most significantly affected molecular pathways during MM progression and provided a novel signature predictive of patient prognosis and treatment stratification.

Smac mimetic LCL161 overcomes protective ER stress induced by obatoclax, synergistically causing cell death in multiple myeloma

Bcl2 and IAP families are anti-apoptotic proteins deregulated in multiple myeloma (MM) cells. Pharmacological inhibition of each of these families has shown significant activity only in subgroups of MM patients. Here, we have examined a broad-spectrum Bcl2 family inhibitor Obatoclax (OBX) in combination with a Smac mimetic LCL161 in MM cell lines and patient cells. LCL161/OBX combination induced synergistic cytotoxicity and anti-proliferative effects on a broad range of human MM cell lines. The cytotoxicity was mediated through inhibition of the IAPs, activation of caspases and up regulation of the pro-apoptotic proteins Bid, Bim, Puma and Noxa by the drug combination. In addition, we observed that OBX caused ER stress and activated the Unfolded Protein Response (UPR) leading to drug resistance. LCL161, however inhibited spliced Xbp-1, a pro-survival factor. In addition, we observed that OBX increased GRP78 localization to the cell surface, which then induced PI3K dependent Akt activation and resistance to cell death. LCL161 was able to block OBX induced Akt activation contributing to synergistic cell death. Our results support clinical evaluation of this combination strategy in relapsed refractory MM patients.

Primary pulmonary intravascular large B-cell lymphoma: A report of three cases and literature review

The present study aimed to investigate the clinicopathological features of primary intravascular large B-cell lymphoma (IVLBCL) of the lung. The clinical and histopathological data of three patients, and the literature was reviewed. The Ethics Committees of Drum Tower Hospital approved the current study based on the three cases. Fever and respiratory symptoms were the main presenting symptoms. Serum lactate dehydrogenase and C-reactive protein were significantly increased. Diffuse ground glass opacities or nodular consolidations were seen on high resolution computed tomography. Lung biopsy revealed lymphoma cells in the lumen of small blood vessels. Tumor cells expressed cluster of differentiation 20 and melanoma associated antigen (mutated) 1. Primary pulmonary IVLBCL is extremely rare and its prognosis is poor. Full recognition of its clinical character and improvement of the diagnostic awareness may help to reduce missed diagnosis, and facilitate appropriate treatment.

Efficacy and safety of duloxetine in Chinese patients with chronic pain due to osteoarthritis: a randomized, double-blind, placebo-controlled study

OBJECTIVE

We assessed the efficacy and safety of duloxetine (60 mg, once daily), compared with placebo, during a 13-week treatment period in Chinese patients with chronic pain due to osteoarthritis (OA).

DESIGN

Patients were at least 40 years old (male or female) who met American College of Rheumatology clinical and radiographic criteria for the diagnosis of OA of the knee or hip. The primary efficacy measure in this phase 3, randomized, double-blind, placebo-controlled clinical trial was assessment of pain severity by the Brief Pain Inventory (BPI) 24-h Average Pain rating. The clinical trial was conducted at 17 study centers. Statistical approaches included mixed-effects model repeated measures and analysis of covariance. A Fisher exact test was applied to categorical variables.

RESULTS

Of 407 patients randomized (duloxetine: N = 205; placebo: N = 202), 166 (81.0%) patients from the duloxetine group and 176 (87.1%) patients from the placebo group completed the 13-week treatment phase. The majority (76.4%) of patients was female; mean age was 60.5 years. Duloxetine-treated patients reported significant pain reduction, compared with placebo treatment, on the BPI 24-h Average Pain rating (least-squares mean (LS Mean) change from baseline to endpoint [95% confidence interval (CI)], duloxetine: -2.23; placebo: -1.73; difference = -0.50 [-0.80, -0.20]; P = 0.001). The incidence of discontinuations due to adverse events was 9.0% in duloxetine-treated patients and 4.5% in placebo-treated patients (P = 0.109).

CONCLUSIONS

This study demonstrated the efficacy of duloxetine in Chinese patients with chronic pain due to OA. The safety profile of duloxetine observed in this study was consistent with that in previous duloxetine trials. This trial is registered with ClinicalTrials.gov (NCT01931475).

Epithelial Microvesicles Promote an Inflammatory Phenotype in Fibroblasts

Microvesicles (MVs) are extracellular vesicles secreted by various cell types that are involved in intercellular communication. We hypothesized that in human periodontal disease, the pocket epithelium releases MVs, which then modulate gene expression in the underlying fibroblasts to control periodontal inflammation. MVs were isolated from culture medium of gingival epithelial cells (GECs) treated with oral bacterial biofilm extract or left untreated. Biofilm treatment significantly increased MV release from the GECs. Mass spectrometry of GEC-MVs identified a total of 2,173 proteins, of which about 80% were detected in MVs from both control and biofilm-treated GECs. Among 80 signature genes of human gingival fibroblasts, 20 were significantly regulated ( P < 0.05) by MVs from control and biofilm-treated GECs in a similar manner. Matrix metalloproteinase 1 and 3 and interleukin 6 and 8 showed the strongest regulation at the mRNA and protein levels. Several cellular signaling pathways were activated by GEC-MVs in human gingival fibroblasts, including Smad and mitogen-activated protein kinase–associated pathways ERK1/2, JNK, and p38. However, ERK1/2 signaling dominated in the MV-induced gene expression changes. The results demonstrate that GEC-MVs have a strong regulatory effect on the expression of fibroblast genes associated with inflammation and matrix degradation and that bacterial biofilm stimulates the generation of GEC-MVs. This suggests that bacterial biofilms can contribute to the initiation and progression of periodontal disease by promoting a tissue-destructive phenotype in gingival fibroblasts via the enhanced secretion of epithelial MVs.

Mutations of glucocerebrosidase gene and susceptibility to Parkinson's disease: An updated meta-analysis in a European population

This meta-analysis aims to investigate the association between mutations of glucocerebrosidase (GBA) gene and susceptibility to Parkinson's disease (PD) in a European population. Several electronic databases were extensively searched. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the association. In total, fourteen published papers screening L444P, N370S and other GBA variants were identified. The GBA mutations were significantly associated with PD in the European population. Subgroup analysis stratified by the age of onset (AAO) revealed that the association between GBA mutations and PD existed in the patients with age at onset ⩽50 years but did not exist in the patients with age at onset >50 years. Furthermore, the associations between N370S, and L444P with PD were also analyzed to explore the roles of the two most frequent GBA mutations in the development of PD. The results showed that significant associations between N370S, and L444P with PD were observed, respectively. Overall, the study supported that GBA mutations were a risk factor for PD in the European population. Patients with early-onset were more likely to carry GBA mutations than those with late-onset. Moreover, both L444P and N370S were associated with increased PD risk.

Acute arrest of hematopoiesis induced by infection with Staphylococcus epidermidis following total knee arthroplasty: A case report and literature review

Infection is one of the most severe complications of total knee prosthesis implantation. The present study reported the case of a 74-year-old female that developed a Staphylococcus epidermidis infection following a cemented total knee arthroplasty. A routine blood test revealed neutropenia and anemia, while S. epidermidis was detected in the peripheral blood and bone marrow. In the present case, S. epidermidis infection led to acute arrest of hematopoiesis (AAH), also known as aplastic crisis, which is the temporary cessation of red cell production. The development of AAH secondary to S. epidermidis infection is rare and, to the best of our knowledge, this is the first case reported in the literature. The present study increased our knowledge of this rare disease and its characteristics, which will enable physicians to be aware of the development of AAH as a rare complication of S. epidermidis infection.

Chinese SLE Treatment and Research group (CSTAR) registry VII: prevalence and clinical significance of serositis in Chinese patients with systemic lupus erythematosus

Objectives

To investigate both the prevalence and clinical characteristics of serositis in Chinese patients with systemic lupus erythematosus (SLE) in a large cohort in the Chinese SLE Treatment and Research group (CSTAR) database.

Methods

A prospective cross-sectional study of patients with SLE was conducted based on the data from the CSTAR registry. Serositis was defined according to the 1999 revised American College of Rheumatology (ACR) criteria for SLE – that is, pleuritis/pleural effusion and/or pericarditis/pericardial effusion detected by echocardiography, chest X-ray or chest computerized tomography (CT) scan. Peritonitis/peritoneal effusion were confirmed by abdominal ultrasonography. We analysed the prevalence and clinical associations of serositis with demographic data, organ involvements, laboratory findings and SLE disease activity.

Results

Of 2104 patients with SLE, 345 were diagnosed with serositis. The prevalence of lupus nephritis (LN), interstitial lung disease and pulmonary arterial hypertension, as well as the presence of leukocytopenia, thrombocytopenia, hypocomplementemia and anti-dsDNA antibodies was significantly higher in patients with serositis ( P < 0.05). Significantly higher SLE disease activity scores were found in patients with serositis compared to those patients without serositis ( P < 0.05). Lupus-related peritonitis had similar clinical manifestations and laboratory profiles as serositis caused by SLE.

Conclusions

There is a significant association of nephropathy, interstitial lung disease, pulmonary arterial hypertension, hypocomplementemia, leukocytopenia, thrombocytopenia and elevated anti-dsDNA antibodies with serositis. The results suggest that higher SLE disease activity contributes to serositis development, and should be treated aggressively.

A rat model designed for the continuous intraarterial infusion of cyclosporine

BACKGROUND

Limb allotransplantation is not a life-saving treatment. However, large doses of immunosuppressive agents are needed. There is an urgent need to increase the selectivity and targeting of drugs.

METHODS

We designed a rat model for intraarterial infusion of cyclosporine (CSA) based on the hindlimb replanted model to simulate the limb allotransplantation. To investigate whether intraartery infusion could improve the drug's distribution, we infused CSA 4.0 mg/kg per day continuously into either the superficial epigastric artery (IA group) or superficial epigastric vein (IV group) of Lewis rats.

RESULTS

On day 10, CSA concentrations were measured in skin, muscle, and bone tissues of hindlimb. Samples were taken from different parts of the bilateral hindlimbs in the IA group and right hindlimb only in the IV group. Tissue concentrations of the perfusion side were much higher in IA group. Systemic concentrations of IA group were higher than IV group.

CONCLUSIONS

These results warrant further research in our next limb allotransplantation model.

Chinese SLE Treatment and Research group (CSTAR) registry: V. gender impact on Chinese patients with systemic lupus erythematosus

Introduction

Many studies have shown that differences were observed between male and female lupus patients. Although systemic lupus erythematosus (SLE) affects mostly females (female:male ratio 9:1), male SLE patients show higher mortality due to kidney and neurological disease. Currently there are limited epidemiological data concerning lupus in the Chinese population. As such, the Chinese SLE Treatment and Research group (CSTAR) developed the first online registry of Chinese lupus patients in 2009, and represents a multicenter observational study that attempts to describe and compile the major clinical characteristics of lupus in Chinese patients.

Objective

To investigate the effect of gender on the phenotypes of Chinese SLE patients.

Patients and methods

Data for 2104 SLE patients were prospectively collected and included in the CSTAR registry. Patients fulfilled the 1997 American College of Rheumatology (ACR) SLE classification criteria. We conducted a cross-sectional case-control study to analyze patient clinical and laboratory data at onset and at enrollment. SLE disease activity scores (SLEDAI) were also measured at enrollment.

Results

This study included 1914 women and 190 men. Males and females showed no differences in mean ages at onset, delay of diagnosis and disease duration. Males presented more frequently with fever ( p = 0.003), while musculoskeletal involvement ( p = 0.001) and cytopenia ( p = 0.017) was more common in females as the initial manifestation at onset of SLE. For manifestations at enrollment, males presented more frequently with fever ( p = 0.005), renal disease ( p = 0.019), vasculitis ( p = 0.032) and neuropsychiatric lupus ( p = 0.007). For cumulative manifestations at enrollment, males presented more frequently with discoid rash ( p < 0.001) and neuropsychiatric lupus ( p = 0.036), while less frequently with arthritis ( p = 0.011). However, the laboratory data showed no significant differences between the two groups at enrollment. Males also had higher SLEDAI scores at enrollment ( p = 0.002).

Conclusions

Renal disease, vasculitis and neuropsychiatric lupus are more common in male SLE patients with higher SLEDAI scores compared to female SLE patients in China.

INHIBITORY EFFECT OF TETRAMETHYLPYRAZINE ON HEPATOCELLULAR CARCINOMA: POSSIBLE ROLE OF APOPTOSIS AND CELL CYCLE ARREST

Hepatocellular carcinoma (HCC) is the fifth most common cancer. An important approach to control HCC is chemoprevention. This study aims at investigating the antitumor effect of Tetramethylpyrazine (TMP). Rats were injected with N-Nitrosodiethylamine (DEN) to establish HCC. Tumor development was observed. Liver function was evaluated. Apoptosis and cell cycle arrest-related makers and signaling cascades were determined by Western blot, RT-PCR and flow cytometric analysis. The administration of TMP could significantly inhibit tumor development in DEN-induced HCC rats, shown by reduced incidence of tumor, decreased number of tumor nodules and reduced maximal size of tumor. DEN-induced increase of aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase and alkaline phosphatase activities were significantly inhibited by TMP. TMP exhibited inhibitory effect on HCC through induction of apoptosis and cell cycle arrest in rats. TMP induced apoptosis through increasing Bax, decreasing Bcl-2, increasing the release of cytochrome c, and activating caspase, which consisted of the mitochondrial apoptotic pathway. TMP induced G2/M cell cycle arrest through down-regulation of cyclin B1/cdc2. In addition, inhibition of Akt and ERK signaling and the antioxidant activities of TMP may also contribute to its antitumor effect. These data provide new insight into the mechanisms underlying the antitumor effect of TMP.

Langerhans cell histiocytosis with multisystem involvement in an infant: A case report

Langerhans cell histiocytosis (LCH) is a proliferative disease of histiocyte-like cells, with a wide range of clinical presentations that vary from a solitary lesion to more severe multifocal or disseminated lesions. The disease can affect any age group; however, the peak incidence rate is in infants aged between 1 and 3 years-old. Diagnosis of LCH should be based on the synthetical analysis of clinical presentations, in addition to features of imaging and histopathology. Although certain cases regress spontaneously, other patients require systemic chemotherapy together with the administration of steroids. The present study reports the case of an infant with LDH with multisystem involvement, including that of the bone, skin, orbit, spleen and lungs. The patient received chemotherapy and obtained rapid improvement in the involved systems. A total of 2.5 years after completion of the therapy, the patient still remains in follow-up and no evidence of active disease has been noted.

Pulmonary MALT lymphoma: A case report and review of the literature

Mucosa-associated lymphoid tissue (MALT) lymphoma is an extranodal low-grade B-cell lymphoma. Pulmonary MALT lymphoma is considered to originate from bronchial MALT and is also referred to as bronchial-associated lymphoid tissue lymphoma. Pulmonary MALT lymphoma is a rare disease, but it is the most frequent subset of primary pulmonary lymphoma. The median age at diagnosis of pulmonary MALT lymphoma is 50–60 years, with only few patients aged <30 years. This is the case report of a 19-year-old patient with pulmonary MALT lymphoma presenting with a multiple pulmonary consolidation pattern on computed tomography scans, who underwent successful chemotherapeutic treatment with a chlorambucil-based regimen.

Clinicopathological significance and potential drug target of p15INK4B in multiple myeloma

Multiple myeloma (MM) is a clonal malignancy characterized by the proliferation of malignant plasma cells in the bone marrow and the production of monoclonal immunoglobulin. In addition to genetic changes, gene hypermethylation is an alternative mechanism of tumor suppressor gene inactivation in MM. The cyclin-dependent kinase inhibitor 1 (CDKN2B or p15^INK4B) gene lies adjacent to the tumor suppressor gene, cyclin-dependent kinase inhibitor 2 (CDKN2A), and is frequently mutated and deleted in a wide variety of tumors, including MM. However, there is a lack of systematic analysis of p15 epigenetic modification such as methylation in MM from different studies that can provide more powerful estimation of an effect. In this study, we have systematically reviewed the studies of p15^INK4B promoter methylation in MM and quantified the association between p15^INK4B promoter methylation and MM using meta-analysis methods. We observed that the frequency of p15^INK4B methylation is significantly higher in MM patients than in normal healthy controls. The pooled odds ratio (OR) from ten studies including 394 MM and 99 normal individuals is 0.08, while confidence interval (CI) is 0.03–0.21 (P<0.00001). This indicates that p15^INK4B inactivation through methylation plays an important role in the pathogenesis of MM. In addition, the frequency of p15^INK4B methylation was significantly higher in patients with MM than in those with asymptomatic monoclonal gammopathy of undetermined significance. The pooled OR from four studies is 0.40, 95% CI =0.21–0.78 (P=0.007). These results suggest that silencing of p15^INK4B gene expression by epigenetic modification such as promoter hypermethylation plays a role not only in the initiation of MM but also in plasma cell malignant transformation, disease progression, and development.

Recurrence of histiocytic necrotizing lymphadenitis: A case report and literature review

Histiocytic necrotizing lymphadenitis (HNL) is a unique form of self-limiting lymphadenitis with an unknown cause. The majority of cases resolve within several months and the disease has a low recurrence rate of 3–4%. In the present study, a prolonged recurrent case of HNL was reported. A 44-year-old female developed recurrent HNL with generalized lymphadenopathy 14 years after the original episode.

Gene expression profile of type II spinal cord decompression sickness

STUDY DESIGN

This study was an experimental, controlled, animal study.

OBJECTIVE

This study was to determine the changes of molecular pathology in spinal cord decompression sickness (SC-DCS) based on a rabbit model of SC-DCS with the aid of an all-gene expression profile chip.

SETTING

Qingdao, Shandong Province, China.

METHODS

A gene expression profile chip containing 43 803 genes was used to compare the gene expressions in the spinal cords of four male New Zealand white rabbits in the SC-DCS and control groups, respectively. Selected differentially expressed genes were identified with quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) and immunohistochemistry.

RESULTS

The chip hybridization results showed that the SC-DCS group had nine upregulated and seventeen downregulated genes, compared with the control group. These genes were mainly related to inflammation, ion channels, the cell cycle, material transfer and apoptosis. The qRT-PCR results showed that parathyroid hormone and tumor necrosis factor alpha (TNF-α) genes were upregulated compared with the control group (P<0.01). However, the acyl-CoA synthetase and voltage-gated channel genes were downregulated (P<0.05). The immunohistochemical staining results confirmed that there were significantly greater expression levels of TNF-α in the spinal cord tissues of the SC-DCS group compared with the control group.

CONCLUSIONS

The spinal cord lesions of SC-DCS involve multiple gene changes in the rabbit; however, the significance of these findings needs further research. Meanwhile, the gene expression profile chip results provide us with a better understanding of the pathogenesis of DCS.

Abstract P5-03-14: Expression of ALDH1 in metastasizing axillary lymphnodes in breast cancer

Background: There is increasing evidences that a wide variety of malignancies, including breast cancer, may be driven by a small subset of ‘tumor-initiating cells’ or ‘cancer stem cells’ (CSC) which are able to form tumors in immunocompromised mice as well as to generate the phenotypic heterogeneity of the initial tumor. Enzyme aldehyde dehydrogenase (ALDH1) has been reported as a possible marker for mammary CSC. These cells are a source of tumor recurrence and metastasis, and are resistant to chemotherapy, radiotherapy and hormone therapy.

Objective: Assuming that the detection of CSC in axillary lymph nodes is more effective to predicting cancer outcome than the widely used detection of cancer cells in axillary lymph nodes, we measure ALDH1 levels to predict their presence into axillary lymph nodes on development of cancer and anticipate outcomes.

Methods: ALDH1 protein was detected by an immunohistochemical technique in 229 cases of breast cancer diagnosed from 2002 to 2011 Follow-up ranged from 11.5 months to 96.9 months, with a mean of 73.9 months. A survival assay was used to determine the relationship between distant metastatic rate and survival rate.

Results: ALDHl expression was detected in 79cases and the Positive rate in metastatic axillary lymph nodes was 34.5%. Negative ER, PR status were related to the ALDH1 positive cases(P = 0.012). See Table 1. Mortality rate between ALDH1 positive cases (50.8%) and negative cases (28.8%) were significantly different (P = 0.001). See Table 2. Further, survival analysis of recurrence-free survivals (RFS) and survival rate decreased significantly between ALDHl positive and negative cases (P = 0.001) (see table 2) and COX analysis shows that ALDH1 expression is an independent predictor of poor outcome in breast cancer(P = 0.011).

Discussion: What cancer stem cells migrate to the axillary nodes have more important prediction than that the matastesis of normal cancar cells in axillary node. It might be a role resulting in dying in breast cancer.

Mitigation of thoron exposure by application of wallpaper as a diffusion barrier

Increasing attention has been paid in recent years to the radioactive gas thoron ((220)Rn), which can cause a significant exposure and increase of lung cancer risk in some regions worldwide. Some experiments were designed to examine whether different types of wall decoration in the room, from ordinary newsprint to commercial wallpaper, can mitigate the concentrations of indoor thoron decay products. Decoration with coated paper was very effective in decreasing the thoron decay products concentration, thus reducing the effective dose by 90 %, while newsprint decoration, which is common in many rural parts of the world, was found to have a smaller but still significant effect in reducing the thoron decay products concentration when applied to the same house.

Baifuzi reduces transient ischemic brain damage through an interaction with the STREX domain of BKCa channels

Stroke is a long-term disability and one of the leading causes of death. However, no successful therapeutic intervention is available for the majority of stroke patients. In this study, we explored a traditional Chinese medicine Baifuzi (Typhonium giganteum Engl.). We show, at first, that the ethanol extract of Baifuzi exerts neuroprotective effects against brain damage induced by transient global or focal cerebral ischemia in rats and mice. Second, the extract activated large-conductance Ca(2+)-activated K(+) channel (BK(Ca)) channels, and BK(Ca) channel blockade suppressed the neuroprotection of the extract, suggesting that the BK(Ca) is the molecular target of Baifuzi. Third, Baifuzi cerebroside (Baifuzi-CB), purified from its ethanol extract, activated BK(Ca) channels in a manner similar to that of the extract. Fourth, the stress axis hormone-regulated exon (STREX) domain of the BK(Ca) channel directly interacted with Baifuzi-CB, and its deletion suppressed channel activation by Baifuzi-CB. These results indicate that Baifuzi-CB activated the BK(Ca) channel through its direct interaction with the STREX domain of the channel and suggests that Baifuzi-CB merits exploration as a potential therapeutic agent for treating brain ischemia.

Development of a new thoron progeny detector based on SSNTD and the collection by an electric field

The importance of (220)Rn (thoron) progeny for human exposure has been widely recognised in the past decades. Since no stable equilibrium factor was found between indoor thoron and its progeny, and the concentration of thoron progeny varies with time, it is necessary to develop detectors for long-term measurement that directly sample and detect thoron progeny. However, power supply of this kind of detectors has always been a problem. In this study, a set of device that is suitable for long-term measurement is introduced. A high-voltage electric field was formed for the collection of charged aerosols attached by (222)Rn (radon) and thoron progenies on solid-state nuclear track detector. Impact from radon progeny could be eliminated with a shield of Al foil of appropriate thickness. Tests were made both in an experimental house and in a thoron chamber in Helmholtz Zentrum München to determine the parameters and to verify the universality under different conditions.

Age and sex dependent inhalation doses to members of the public from indoor thoron progeny

The increased indoor thoron level in Europe, North America and Asia has shown that the exposure to thoron and its decay products cannot be ignored in some environments. The contribution of thoron and its progeny can be a significant component of the total exposure from radon and thoron. In the present paper, radiation dose assessment of members of the public of different age and sex exposed to (220)Rn progeny under different daily life activities is performed through a dosimetric approach. Dose conversion coefficients under typical indoor conditions were estimated to be in the range of 107 nSv (Bq h m(-3))(-1) for infant to 81.7 nSv (Bq h m(-3))(-1) for adult. The results of this work emphasized that small children receive a radiation dose of 25% more than adults under the same conditions, and people performing exercise receive a radiation dose 100% more than when sleeping. The results of this work are appropriate to the risk assessment of thoron exposure to members of the public who live in areas with high radon and thoron concentrations.

Application of LSC and TLD methods for the measurement of radon and thoron decay products in air

Liquid scintillation counting (LSC) is a measuring technique, broadly applied in environmental monitoring. One of the possible applications of LSC is the measurement of radon and thoron progeny. Such a method can be stated as an absolute one. For long-term measurements, a different technique can be applied-monitors of potential alpha energy concentration (PAEC) with thermoluminescent detectors (TLDs). Such solution enables simultaneous measurements of PAEC and dust content. Moreover, the information which is stored in TLD chips is the energy of alpha particles and not the number of counted particles. Therefore, the readout of TL detector directly shows the potential alpha energy, with no dependence on equilibrium factor, etc. This technique, which had been used only for radon progeny measurements, was modified to allow simultaneous measurements of radon and thoron PAEC.

Nucleotide excision repair/TFIIH helicases RAD3 and SSL2 inhibit short-sequence recombination and Ty1 retrotransposition by similar mechanisms

Eukaryotic genomes contain potentially unstable sequences whose rearrangement threatens genome structure and function. Here we show that certain mutant alleles of the nucleotide excision repair (NER)/TFIIH helicase genes RAD3 and SSL2 (RAD25) confer synthetic lethality and destabilize the Saccharomyces cerevisiae genome by increasing both short-sequence recombination and Ty1 retrotransposition. The rad3-G595R and ssl2-rtt mutations do not markedly alter Ty1 RNA or protein levels or target site specificity. However, these mutations cause an increase in the physical stability of broken DNA molecules and unincorporated Ty1 cDNA, which leads to higher levels of short-sequence recombination and Ty1 retrotransposition. Our results link components of the core NER/TFIIH complex with genome stability, homologous recombination, and host defense against Ty1 retrotransposition via a mechanism that involves DNA degradation.

Proliferative defect and embryonic lethality in mice homozygous for a deletion in the p110alpha subunit of phosphoinositide 3-kinase

Phosphatidylinositol 3,4,5-trisphosphate is a phospholipid signaling molecule involved in many cellular functions including growth factor receptor signaling, cytoskeletal organization, chemotaxis, apoptosis, and protein trafficking. Phosphorylation at the 3 position of the inositol ring is catalyzed by many different 3-kinases (classified as types IA, IB, II, and III), but the physiological roles played by each of the different 3-kinase isozymes during embryonic development and in homeostasis in animals is incompletely understood. Mammalian type IA kinase isozymes are heterodimers that are active at 37 degrees C when the catalytic 110-kDa subunit interacts through an amino-terminal binding domain with a regulatory 85- or 55-kDa subunit. Using gene targeting in embryonic stem cells, we deleted this binding domain in the gene encoding the alpha isoform of the 110-kDa catalytic subunit (Pik3ca) of the alpha isozyme of the type IA kinases, leading to loss of expression of the p110 catalytic subunit. We show that Pik3cadel/del embryos are developmentally delayed at embryonic day (E) 9.5 and die between E9.5 and E10.5. E9. 5 Pik3cadel/del embryos have a profound proliferative defect but no increase in apoptosis. A proliferative defect is supported by the observation that fibroblasts from Pik3cadel/del embryos fail to replicate in Dulbecco's modified Eagle's medium and fetal calf serum, even with supplemental growth factors.

Inhibitor antibody development and T cell response to human factor VIII in murine hemophilia A

In order to understand better the mechanism of inhibitor formation in hemophilia A patients, we have characterized the immune response to human factor VIII in a murine model of hemophilia A. Mice with severe factor VIII deficiency caused by targeted gene disruptions in exons 16 and 17 were injected intravenously with human factor VIII. Anti-factor VIII was absent or was detected at only very low levels in hemophilic mice of both strains after a single injection of 0.2 microg factor VIII, but it was present in most mice after a second exposure. Subsequent exposures led to high titer anti-factor VIII antibodies in both ELISA and inhibitor assays. A human factor VIII-specific T cell proliferative response was detected with spleen cells obtained three days after a single injection with human factor VIII, before mice had detectable anti-factor VIII antibodies. Subsequent exposures to factor VIII were followed by an increased T cell proliferative response. These studies indicate that murine hemophilia A is a good model for the study of the immune response to human factor VIII, especially the role of the T cell in the early steps in inhibitor antibody formation.

[The clinical study on labor pain relief using two kinds of segmental block anesthesia]

OBJECTIVE

To study the pain relief effectiveness of combined subarachnoid peridural segmental block and simple peridural anesthesia, and their influences on the mothers and the infants.

METHODS

100 pregnants women were administered combined subarachnoid and peridural segmental block during labor and delivery (study group). 40 pregnant women received simple peridural anesthesia (control group). The degree of labour pain, side effects, labor course, the mode of delivery and the incidences of postpartum hemorrhage, fetal distress and neonatal asphyxia were observed in two groups respectively.

RESULTS

The pain relief effect in the study group was much better than that of the control group (P < 0.01). There were no significant differences of the mean time of labor course and the mode of delivery between the two groups (P > 0.05). The incidences of postpartum hemorrhage, fetal distress and neonatal asphyxia were similar (P > 0.05).

CONCLUSION

The analgesic delivery of combined subarachnoid and peridural segmental block is safe and effective, which has no influences on the labour course and the mothers and infants. Its pain relief effectiveness is more positive and satisfactory than that of simple peridural anesthesia. We suggest that it should be performed in the medical units under optimal conditions.

[High-level expression of human immunodeficiency virus type 1 gp120 protein in E. coli]

In order to improve protein expression and to produce good and cheap diagnostic antigen, the gene fragment (560bp) in N-terminal of gp120 of HIV-1 LAV strain was amplified by PCR. After digested by EcoR I and Sal I, the fragment was cloned into a high-level expression vector pET28a. The recombinant plasmid pET/120 transfecting BL21 (DE3) produced the protein with high-level expression in the host cell BL21(DE3), which was further proved having good antigenicity and high specificity by indirect ELISA and Western-blot assay. The protein expressed was about 50% of the total bacterial protein by SDS-PAGE electrophoresis test. It was highly expressed in the prokaryotic expression system.