Ganglioside GM3-Functionalized Reconstituted High-Density Lipoprotein (GM3-rHDL) as a Novel Nanocarrier Enhances Antiatherosclerotic Efficacy of Statins in apoE-/- C57BL/6 Mice

Previously, we found that exogenous ganglioside GM3 had an antiatherosclerotic efficacy and that its antiatherosclerotic efficacy could be enhanced by reconstituted high-density lipoprotein (rHDL). In this study, we hypothesized that GM3-functionalized rHDL (i.e., GM3-rHDL) as a nanocarrier can promote the efficacy of traditional antiatherosclerotic drugs (e.g., statins). To test this hypothesis, lovastatin (LT) was used as a representative of statins, and LT-loaded GM3-rHDL nanoparticle (LT-GM3-rHDL or LT@GM3-rHDL; a mean size of ~142 nm) and multiple controls (e.g., GM3-rHDL without LT, LT-loaded rHDL or LT-rHDL, and other nanoparticles) were prepared. By using two different microsphere-based methods, the presences of apolipoprotein A-I (apoA-I) and/or GM3 in nanoparticles and the apoA-I-mediated macrophage-targeting ability of apoA-I/rHDL-containing nanoparticles were verified in vitro. Moreover, LT-GM3-rHDL nanoparticle had a slowly sustained LT release in vitro and the strongest inhibitory effect on the foam cell formation of macrophages (a key event of atherogenesis). After single administration of rHDL-based nanoparticles, a higher LT concentration was detected shortly in the atherosclerotic plaques of apoE^-/- mice than non-rHDL-based nanoparticles, suggesting the in vivo plaque-targeting ability of apoA-I/rHDL-containing nanoparticles. Finally, among all nanoparticles LT-GM3-rHDL induced the largest decreases in the contents of blood lipids and in the areas of atherosclerotic plaques at various aortic locations in apoE^-/- mice fed a high-fat diet for 12 weeks, supporting that LT-GM3-rHDL has the best in vivo antiatherosclerotic efficacy among the tested nanoparticles. Our data imply that GM3-functionalized rHDL (i.e., GM3-rHDL) can be utilized as a novel nanocarrier to enhance the efficacy of traditional antiatherosclerotic drugs (e.g., statins).

Enhanced Anti-Atherosclerotic Efficacy of pH-Responsively Releasable Ganglioside GM3 Delivered by Reconstituted High-Density Lipoprotein

Recently, the atheroprotective role of endogenous GM3 and an atherogenesis-inhibiting effect of exogenous GM3 suggested a possibility of exogenous GM3 being recruited as an anti-atherosclerotic drug. This study seeks to endow exogenous GM3 with atherosclerotic targetability via reconstituted high-density lipoprotein (rHDL), an atherosclerotic targeting drug nanocarrier. Unloaded rHDL, rHDL loaded with exogenous GM3 at a low concentration (GM3_L-rHDL), and rHDL carrying GM3 at a relatively high concentration (GM3_H-rHDL) were prepared and characterized. The inhibitory effect of GM3-rHDL on lipid deposition in macrophages was confirmed, and GM3-rHDL did not affect the survival of red blood cells. In vivo experiments using ApoE^-/- mice fed a high fat diet further confirmed the anti-atherosclerotic efficacy of exogenous GM3 and demonstrated that GM3 packed in HDL nanoparticles (GM3-rHDL) has an enhanced anti-atherosclerotic efficacy and a reduced effective dose of GM3. Then, the macrophage- and atherosclerotic plaque-targeting abilities of GM3-rHD, most likely via the interaction of ApoA-I on GM3-rHDL with its receptors (e.g., SR-B1) on cells, were certified via a microsphere-based method and an aortic fragment-based method, respectively. Moreover, we found that solution acidification enhanced GM3 release from GM3-rHDL nanoparticles, implying the pH-responsive GM3 release when GM3-rHDL enters the acidic atherosclerotic plaques from the neutral blood. The rHDL-mediated atherosclerotic targetability and pH-responsive GM3 release of GM3-rHDL enhanced the anti-atherosclerotic efficacy of exogenous GM3. The development of the GM3-rHDL nanoparticle may help with the application of exogenous GM3 as a clinical drug. Moreover, the data imply that the GM3-rHDL nanoparticle has the potential of being recruited as a drug nanocarrier with atherosclerotic targetability and enhanced anti-atherosclerotic efficacy.

Isolated cell-bound membrane vesicles (CBMVs) as a novel class of drug nanocarriers

BACKGROUND

Cell-bound membrane vesicles (CBMVs) are a type of membrane vesicles different from the well-known extracellular vesicles (EVs). In recent years, the applications of EVs as drug delivery systems have been studied widely. A question may arise whether isolated CBMVs also have the possibility of being recruited as a drug delivery system or nanocarrier?

METHODS

To test the possibility, CBMVs were isolated/purified from the surfaces of cultured endothelial cells, loaded with a putative antitumor drug doxorubicin (Dox), and characterized. Subsequently, cellular experiments and animal experiments using mouse models were performed to determine the in vitro and in vivo antitumor effects of Dox-loaded CBMVs (Dox-CBMVs or Dox@CBMVs), respectively.

RESULTS

Both Dox-free and Dox-loaded CBMVs were globular-shaped and nanometer-sized with an average diameter of ~ 300-400 nm. Dox-CBMVs could be internalized by cells and could kill multiple types of cancer cells. The in vivo antitumor ability of Dox-CBMVs also was confirmed. Moreover, Quantifications of blood cells (white blood cells and platelets) and specific enzymes (aspartate aminotransferase and creatine kinase isoenzymes) showed that Dox-CBMVs had lower side effects compared with free Dox.

CONCLUSIONS

The data show that the CBMV-entrapped Doxorubicin has the antitumor efficacy with lower side effects. This study provides evidence supporting the possibility of isolated cell-bound membrane vesicles as a novel drug nanocarrier.

[The evaluation of severity and treatment for OSAHS by acoustic pharyngometry which in different postures]

Objective: To investigate the optimal position in application of acoustic pharyngometry to detect the pharyngeal condition and to assess its therapeutic effect on obstructive sleep apnea hypopnea syndrome(OSAHS). Method: Eight adult males were assigned to the normal group, and 57 male patients with OSAHS diagnosed by polysomnograhy(PSG) were assigned to the snoring group. Of the snoring group, 11 patients who were diagnosed severe OSAHS underwent low-temperature plasma uvulopaltopharyngoplasty(UPPP) and coblationchanneling of the tongue(CCT), were assigned to the operation subgroup; 8 patients underwent continuous positive airway pressure(CPAP), which was assigned to the CPAP subgroup. And remainders underwent conservative treatment, including weight loss and position change. Acoustic pharyngometry (three positions including sitting position, supine position and lateral position) and PSG exam were performed in all participants. Additionally, acoustic pharyngometry under three positions was conducted again in patients in the operation and CPAP subgroups three months after treatment. Result: The minimum cross-sectional area was negatively associated with both AHI and the percentage of time with oxygen saturation below 90%(SIT90)( P<0.01). The correlation coefficient of the minimum crosssectional area insupine position with AHI and SIT90 were r=-0.569,r=-0.478, respectively. Under supine position, the minimum crosssectional area was negatively correlated with body mass index(BMI)(r=-0.265, P=0.033), and the minimum crosssectional area was negatively associated with neck circumference(r=-0.309, P=0.012). The minimum cross-sectional area was significantly increased after treatment of OSAHS(both operation and CPAP), which was statistically different before and after treatment compared to the control group(P<0.01). Conclusion: ①The minimum cross-sectional area is significantly correlated with AHI and SIT90, respectively. The acoustic pharyngometry can be used to screen OSAHS patients. ②In this study, the minimum cross-sectional area under supine position is significantly smaller than that under sitting position. In addition, the minimum cross-sectional area under supine position harbored a better correlation with AHI and SIT90, which could better reflect the narrowness of pharyngeal cavity during sleep. ③Acoustic pharyngometry could be a simple, rapid and non-invasive technique that can objectively evaluate the efficacy of surgical and CPAP methods, and provided a more favorable basis for future clinical work..

Impact of metabolic syndrome on the survival of Chinese patients with resectable esophageal squamous cell carcinoma

Metabolic syndrome (MetS) is associated with the risk of esophageal squamous cell carcinoma (ESCC). However, the impact of MetS on survival has not been evaluated. A retrospective review was performed on 596 consecutive Chinese patients with esophageal squamous cell carcinoma who received surgery between January 2005 and October 2007. The clinical data and pretreatment information related to MetS were reviewed. The impact of MetS on overall survival (OS) was estimated by Kaplan-Meier and Cox proportional hazards analyses. MetS was a significant and independent predictor for better survival in patients with resectable ESCC. The 3-year OS and 5-year OS for patients with and without MetS were 75.0% versus 57.8% and 65.1% versus 44.6%, respectively (P = 0.005 in the univariate analysis, P = 0.010 in multivariate analysis). However, there was no apparent influence of any single component of MetS on OS. The other independent prognostic factors identified in the univariate analysis included the following: gender, smoking status, alcohol use, the extent of radical surgical resection, T and N stage, and tumor differentiation. The results of the multivariate analysis included the extent of radical surgery resection, T and N stage, and tumor differentiation. MetS was also associated with greater tumor cell differentiation (P = 0.036). There was no association found between MetS status and postoperative complications. MetS is an independent prognostic factor for OS in patients with ESCC and is associated with better tumor cell differentiation.

A novel multivariate scoring system for determining the prognosis of lymph node-negative esophageal squamous cell carcinoma following surgical therapy: an observational study

BACKGROUND

Identifying patients with esophageal squamous cell carcinoma (ESCC) with negative prognostic factors, which have an extremely low survival rate, has been problematic.

METHODS

We retrospectively collected clinical data for 648 patients with lymph node-negative ESCC who were treated at the Sun Yat-Sen University Cancer Center from 1990 to 2005. Survival difference was compared using Kaplan-Meier analysis and multivariate Cox regression analysis.

RESULTS

We identified advancing age, smoking history, alcohol consumption history, decreased forced expiratory volume in 1 s (FEV1), surgical procedure, tumor location, number of resected lymph nodes, poor tumor differentiation, and surgical stage as independent prognostic risk factors. Furthermore, based on the results of multivariate analysis, we constructed a novel scoring system that included the factors of age, smoking history, alcohol consumption history, number of resected lymph nodes, tumor differentiation, and surgical stage. Risk score (RS) was computed with the scoring system, and patients were divided into Class A (RS: 0-5) and Class B (RS: 6-10). P < 0.001 indicated statistical significance. A significant difference (p < 0.001) demonstrated that Class B was strongly related to a low survival rate and poor prognosis.

CONCLUSION

We developed a new simple flexible scoring system of high prognostic significance, which has the potential to guide postoperative therapeutic strategies and follow-up frequency and to provide better prognostic information for patients and their families.

Combined detection of p53, p16, Rb, and EGFR mutations in lung cancer by suspension microarray

Mutations of some contributing factors (p53, p16, Rb, and EGFR) are believed to affect diagnosis and drug resistance of lung cancer. We evaluated the efficacy of a multimarker panel for molecular diagnosis of lung cancer, using a high-throughput suspension microarray. One hundred and twenty-five lung cancer specimens and 30 tumor-free lung tissue samples were assayed by multiplex polymerase chain reaction with specific probes designed to detect hot-spot mutations in p53, p16, Rb, and EGFR. The mutation rates of p53, p16, Rb, or EGFR in the lung cancer specimens were 36.8, 15.2, 11.2, and 18.4%, respectively. Inclusion of four markers elevated sensitivity to 68.0%. The specificity and accuracy of four-marker detection were 90.0 and 72.3%, and the mutation rates of this panel in stage I, stage II and stage III disease were 62.2, 65.9 and 75.0%, respectively. Mutation at p16 occurred more frequently in non-small cell lung cancer (19.3%) than in small cell lung cancer (5.4%); while the mutation rate of Rb was 32.4% in small cell lung cancer versus 2.3% in non-small cell lung cancer. We conclude that simultaneous detection of p53, Rb, p16, and EGFR in a suspension microarray facilitates rapid diagnosis of lung cancer.

Mediastinal lymph node dissection affects survival in patients with stage I non-small cell lung cancer

BACKGROUND

The therapeutic value of mediastinal lymph node dissection (LND) for early-stage non-small cell lung cancer (NSCLC) remains controversial. We conducted a retrospective study to investigate the impact of mediastinal LND on survival in patients with stage I NSCLC.

METHODS

Clinical data of patients with stage I NSCLC who were treated with surgical resection during a period of ten years were reviewed. The patients were categorized into lobectomy (or pneumonectomy) combined with mediastinal LND or lymph node sampling (LNS) according to the record of their operative procedures. The Kaplan-Meier method was used for survival analysis. Cox proportional hazards model was used for multivariate analysis.

RESULTS

Of the 319 patients who were included in the study, 139 patients received mediastinal LND, while 180 underwent LNS. There was a significant difference in overall survival (OS) between the group with LND and the group with LNS (5-year survival rate: 76.4 % vs. 65.9 %, P = 0.015 by log rank test). Multivariate analysis showed that lymph node dissection (RR = 0.548, 95 %CI: 0.350 - 0.858, P = 0.009), together with the stage, significantly influenced overall survival.

CONCLUSIONS

Lobectomy combined with mediastinal LND can improve survival in patients with stage I NSCLC. It should be performed in all patients with clinical stage I NSCLC.

[Clinical value of modified thoracotomy for thoracic tumors]

BACKGROUND

To minimize the morbidity of thoracotomy for thoracic tumors.

METHODS

From Oct. 2000 to Sept. 2001, 40 patients ( male 26, female 14, with age of 20-79 years old) underwent thoracotomies, in which 15 had lung cancer, 1 carcinoid, 1 infectious cyst of lung, 2 pulmonary inflammatory pseudotumor, 2 thymoma, and 19 esophageal carcinoma. Inframammary incision, muscle-sparing thoracotomy and serratuas-sparing posterolateral thracotomy were done to conduct lobectomy or bilobectomy in 17, segmentectomy in 1, middle lobectomy plus sleeve resection of bronchus media in 1, resection of thymoma in 2 and esophagectomy in 19. A conventional posterolateral thoracotomy group was set as control. Comparative parameters included postoperative pain and shoulder function. The lobectomy cases in study group were even compared the preoperative and postoperative FEV1 and length of hospitalization with conventional posterolateral thoracotomies. Statistic t test and Chi-Square test were used to exam the data.

RESULTS

Compared with the conventional posterolateral thoracotomy, the acute and chronic postoperative pain and shoulder function in study group were remarkablely improved on clinical observation. Length of hospitalization was shortened and early pulmonary function was significantly improved when adjusted with age, number of resected lobe and the operated side.

CONCLUSIONS

The morbidity of thoracotomy for thoracic tumors can be minimized by reasonable incision-designing based on the stage of disease and topical anatomy.

[Bronchioloalveolar carcinoma: a retrospective analysis of 52 patients]

OBJECTIVE

To present the treatment and prognosis of bronchioloalveolar carcinoma (BAC).

METHODS

A retrospective study was conducted on 52 bronchioloalveolar carcinoma patients admitted from April 1990 to April 2000 with emphasis on clinical manifestations, treatment and survival. All lesions were pathologically proved as either localized or diffused type.

RESULTS

These 52 cases comprised 2.5% lung tumors treated in the same period. Its clinical symptoms were similar to those of the other lung cancers. Short of breath and positive physical chest findings were more common in the diffused type. Forty-seven of these 52 patients underwent surgery and 5, chemotherapy. Follow-up showed that 28 (53.8%) patients have died; 10 (19.2%) of recurrence and 18 (34.6%) of metastasis with a median survival of 24.3 months for the localized type and 5.3 months for the diffused type (P < 0.05), The median survival of stage II BAC was 26.8 months in contrast of 42.5 months of stage II non-BAC adenocarcinoma group(P < 0.05). However, there was no significant difference in the overall survival rates of BAC and non-BAC squamous carcinoma (P > 0.05). Even though, trend analysis still showed that there is a tendency of decline in the survival rates from squamous cancer, non-BAC and BAC though (P < 0.05).

CONCLUSION

Localized BAC gives a better prognosis than diffused BAC of which the biological characteristics are different from those of the non-BAC. Compared with the non-BAC, a more active postoperative treatment should be considered for the BAC patients, such as postoperative chemotherapy and or radiotherapy, especially for stage II BAC lesions.

Adjuvant chemotherapy following radical surgery for non-small-cell lung cancer: a randomized study on 70 patients

OBJECTIVE

To evaluate the efficacy of adjuvant chemotherapy after radical surgery for non-small-cell lung cancer (NSCLC).

METHODS

Seventy patients with NSCLC (stages I-III) undergoing radical surgery were randomized into two groups. Group 1 (n = 35): combination group, which received adjuvant chemotherapy with cyclophosphamide 300 mg/m2, vincristine 1.4 mg/m2, adriamycin 50 mg/m2, and lomustine 50 mg/m2 on day 1, and cisplatin 20 mg/m2 on days 1-5. The treatment was repeated every 4-6 weeks for 4 cycles, followed by oral administration of ftorafur (FT-207) 600-900 mg/d for 1 year. Group 2 (n = 35): surgery group, which received surgical treatment only.

RESULTS

The overall 5-year survival rate was 48.6% in the combination group versus 31.4% in the surgery group, and difference between the two groups was not statistically significant (chi 2 = 3.09, P > 0.05). The 5-year survival rate for patients with stage III disease was 44% and 20.8% in the combination and surgery groups, respectively, showing a statistically significant difference (chi 2 = 5.28, P < 0.025). The 5-year survival rates of patients in stages I-II in the two groups were 60.0% and 54.5%, respectively, and were not significantly different (chi 2 = 0.03, P > 0.75).

CONCLUSION

Postoperative adjuvant chemotherapy provides statistically significant improvement in the 5-year survival rate only in patients with stage III NSCLC.

[Post-operative staging and survival based on the revised TNM staging system for non-small cell lung cancer]

OBJECTIVE

To study the factors affecting post-operative staging and survival in non-small cell lung cancer (NSCLC) patients based on the revised TNM staging system adopted by the UICC in 1997.

METHODS

Data were collected from 1757 consecutively operated NSCLC patients, including those receiving complete tumor excision, tumor debulking and exploratory thoracotomy from April 1969 through Dec. 1993. The end point of follow-up was Nov. 30, 1998. Cumulative survival and its influencing factors were analyzed by Kaplan-Meier and Cox model of SPSS software.

RESULTS

In this series, 30 patients (1.71%) were lost from follow-up. The 5-year cumulative survival rate was 88.0% for patients in stage IA, 53.9% in stage IB, 33.5% in stage II, 14.7% in stage IIIA, 5.5% in stage IIIB and 7.0% in stage IV. The overall 5-year survival rate was 28.2%. The 5-year survival rate was 39.8%, 14.4% and 4.2% in patients treated with complete tumor resection, tumor debulking and exploratory thoracotomy, respectively. The 10-year survival rate was 31.4%, 9.5% and 0%, respectively. Factors affecting long-term cumulative survival, in the order of decreasing significance, were the type of operation, lymph node status, staging, size and pathologic type of the primary tumor.

CONCLUSION

The revised staging system for NSCLC is superior to that used since 1986 as far as the end results of treatment in patients in different stage and the staging specificity are concerned. The T3N1M0 classification and the definition of M1 need to be further studied.

[Adjuvant chemotherapy following radical surgery for non-small cell lung cancer: a randomized study]

OBJECTIVE

To evaluate the efficacy of adjuvant chemotherapy after radical surgery for non-small cell lung cancer (NSCLC).

METHODS

Seventy patients with NSCLC(stage I-III) undergone radical surgery were randomized into two groups: 35 patients received adjuvant chemotherapy with cyclophosphamide (CTX) 300 mg/m2, vincristine(VCR) 1.4 mg/m2, adriamycin(ADM) 50 mg/m2, d1; cisplatin (PDD) 20 mg/m2, d1-5, for 4 cycles, and followed by oral ftorafur (FT-207) 600-900 mg/d for 1 year (adjuvant chemotherapy group). The other 35 patients received surgical treatment only (surgery group).

RESULTS

The overall 5-year survival rate was 48.6% in the adjuvant chemotherapy group, and 31.4% in the surgery group, respectively. The difference between the two groups was not statistically significant (P > 0.05). The 5-year survival rate of patients in atage III was 44.0% and 20.8% (5/24) received surgery with and without adjuvant chemotherapy, respectively. The difference between the two groups was statistically significant (P < 0.025). The 5-year survival rate of patients in stage I-II in the two group was 60.0% and 54.5%, respectively (P > 0.75).

CONCLUSION

Postoperative adjuvant chemotherapy in NSCLC improves survival but only in patients in stage III, it results in significantly higher 5-year susvival rate than surgery alone.

[Debulking operation for non-small cell lung cancer]

OBJECTIVE

To assess effectiveness and influencing factors of debulking operation for non-small cell lung cancer.

METHODS

The cumulative survival and its influencing factors were analyzed and compared by the Kaplan-Meier and Cox model of SPSS for Windows in 244 patients received debulking operation and 364 received thoracotomy.

RESULTS

The 1, 3, 5-year cumulative survival of patients treated with debulking operation was 56.9%, 20.6%, 17.5% respectively while that received thoracotomy was 41.1%, 7.8%, 5.3%, respectively (debulking vs thoracotomy, Breslow = 27.55, P < 0.0001). Multivariate analysis showed that the debulking operation or thoracotomy (B = -0.4600, P < 0.0001) and postoperative adjuvant therapies (B = -0.1059, P = 0.0216) were the most important influencing factors on the cumulative survival.

CONCLUSION

Tumor debulking operation is an important treatment for stage III, IV non-small cell lung cancer. With postoperative adjuvant chemoradiotherapy better survival can be achieved.

[Multi-operations for non-small cell lung cancer]

OBJECTIVE

Experiences and results of multi-operations in order to raise the survival rate of advanced non-small cell lung cancer are presented.

METHODS

Fifty-six operations were performed in 26 patients with recurrent, metastatic or second primary non-small cell lung cancer. The operative procedure and the postoperative complications were observed and survival was analysed with Kaplan-Meier of SPSS.

RESULTS

The postoperative complication rate of the first operation was 3.8%. The 1-, 3- and 5-year survival rates were 83.5%, 58.4% and 35.7% respectively with a median survival of 46 months. The second postoperative complication rate was 26.9% and operative mortality was 11.5%. 1-, 3- and 5-year cumulative survival rates were 55.8%, 17.1% and 17.1% respectively with a median survival of 15 months. The third for 2 cases survived 18 and 17 months respectively. The forth and fifth were carried out for the same patient all in the sixth month. The fifth operation gave a survival of 8 months.

CONCLUSION

Multi-operations for non-small cell lung cancer are still effective for recurrent, metastatic or second primary lung cancer. Simple spirometry is far from being satisfactory to evaluate pulmonary function for these patients. Meticulous attention must be paid to complication of respirative failure and infra-thoracic hemorrhage.