Prospects in the application of ultrasensitive chromosomal aneuploidy detection in precancerous lesions of gastric cancer

Gastric cancer (GC) is a prevalent malignant tumor within the digestive system, with over 40% of new cases and deaths related to GC globally occurring in China. Despite advancements in treatment modalities, such as surgery supplemented by adjuvant radiotherapy or chemotherapeutic agents, the prognosis for GC remains poor. New targeted therapies and immunotherapies are currently under investigation, but no significant breakthroughs have been achieved. Studies have indicated that GC is a heterogeneous disease, encompassing multiple subtypes with distinct biological characteristics and roles. Consequently, personalized treatment based on clinical features, pathologic typing, and molecular typing is crucial for the diagnosis and management of precancerous lesions of gastric cancer (PLGC). Current research has categorized GC into four subtypes: Epstein-Barr virus-positive, microsatellite instability, genome stability, and chromosome instability (CIN). Technologies such as multi-omics analysis and gene sequencing are being employed to identify more suitable novel testing methods in these areas. Among these, ultrasensitive chromosomal aneuploidy detection (UCAD) can detect CIN at a genome-wide level in subjects using low-depth whole genome sequencing technology, in conjunction with bioinformatics analysis, to achieve qualitative and quantitative detection of chromosomal stability. This editorial reviews recent research advancements in UCAD technology for the diagnosis and management of PLGC.

Elian granules alleviate precancerous lesions of gastric cancer in rats by suppressing M2-type polarization of tumor-associated macrophages through NF-κB signaling pathway

BACKGROUND

Precancerous lesions of gastric cancer (PLGC) refer to a kind of histopathological changes in the gastric mucosa that can progress to gastric cancer. Elian granules (ELG), a Chinese medicinal prescription, have achieved satisfactory results in the treatment of PLGC. However, the exact mechanism underlying the therapeutic effect of ELG remains unclear. Here, this study aims to explore the mechanism of ELG alleviating PLGC in rats.

METHODS

The chemical ingredients of ELG were analyzed using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS). Specific Pathogen Free SD rats were randomly assigned to 3 groups: the control, model, and ELG groups. The 1-Methyl-3-nitro-1-nitrosoguanidine (MNNG) integrated modeling method was adopted to construct the PLGC rat model in groups except for the control group. Meanwhile, normal saline was used as an intervention for the control and model groups, and ELG aqueous solution for the ELG group, lasting 40 weeks. Subsequently, the stomach of rats was harvested for further analysis. Hematoxylin-eosin staining of the gastric tissue was conducted to assess the pathological changes. Immunofluorescence was carried out for the expression of CD68, and CD206 proteins. Real-time quantitative PCR combined with Western blot was conducted to analyze the expression of arginase-1(Arg-1), inducible nitric oxide synthase (iNOS), p65, p-p65, nuclear factor inhibitor protein-α (IκBα), and p-IκBα in gastric antrum tissue.

RESULTS

Five chemical ingredients including Curcumol, Curzerenone, Berberine, Ferulic Acid, and 2-Hydroxy-3-Methylanthraquine were identified in ELG. The gastric mucosal glands of rats treated with ELG were orderly arranged, with no intestinal metaplasia and no dysplasia. Furthermore, ELG decreased the percentage of M2-type TAMs marked with CD68 and CD206 proteins, and the ratio of Arg-1 to iNOS in the gastric antrum tissue of rats with PLGC. In addition, ELG could also down-regulate the protein and mRNA expression of p-p65, p65, and p-IκBα, but up-regulate the expression of IκBα mRNA in rats with PLGC.

CONCLUSIONS

The results showed that ELG attenuates PLGC in rats by suppressing the M2-type polarization of tumor-associated macrophages (TAMs) through NF-κB signaling pathway.

Study on the mechanism of Fufang E'jiao Jiang on precancerous lesions of gastric cancer based on network pharmacology and metabolomics

ETHNOPHARMACOLOGICAL RELEVANCE

Fufang E'jiao Jiang (FEJ) is a prominent traditional Chinese medicine prescription, which consists of Asini Corii Colla (Donkey-hide gelatin prepared by stewing and concentrating from the hide of Equus asinus Linnaeus., ACC), Codonopsis Radix (the dried roots of Codonopsis pilosula (Franch.) Nannf., CR), Ginseng Radix et Rhizoma Rubra (the steamed and dried root of Panax ginseng C.A. Mey., GRR), Crataegi Fructus (the mature fruits of Crataegus pinnatifida Bunge., CF), and Rehmanniae Radix Praeparata (the steamed and sun dried tuber of Rehmannia glutinosa (Gaertn.) Libosch. ex Fisch. & C.A. Mey., RRP). It is a popularly used prescription for "nourishing Qi and nourishing blood".

AIM OF THE STUDY

To explore the potential mechanism of FEJ on precancerous lesion of gastric cancer in rats by combining network pharmacology and metabolomics.

METHODS

Traditional Chinese Medicine Systems Pharmacology and Bioinformatics Analysis Tool for Molecular mechanism of Traditional Chinese Medicine were used to identify the ingredients and potential targets of FEJ. GeneCards database was used to define PLGC-associated targets. We built a herb-component-disease-target network and analyzed the protein-protein interaction network. Underlying mechanisms were identified using Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis. In addition, 40% ethanol, N-methyl-N'-nitro-N-nitroguanidine and irregular eating were used to establish PLGC rats model. We also evaluated the efficacy of FEJ on MNNG-induced PLGC rats by body weight, histopathology, blood routine and cytokine levels, while the predicted pathway was determined by the Western blot. Ultra-performance liquid chromatography-tandem mass spectrometry-based serum non-targeted metabolomics was used to select potential biomarkers and relevant pathways for FEJ in the treatment of PLGC.

RESULTS

Network pharmacology showed that FEJ exhibited anti-PLGC effects through regulating ALB, TNF, VEGFA, TP53, AKT1 and other targets, and the potential pathways mainly involved cancer-related, TNF, PI3K-AKT, HIF-1, and other signaling pathways. Animal experiments illustrated that FEJ could suppress inflammation, regulate gastrointestinal hormones, and inhibit the expression of PI3K/AKT/HIF-1α pathway-related proteins. Based on serum non-targeted metabolomics analysis, 12 differential metabolites responding to FEJ treatment were identified, and metabolic pathway analysis showed that the role of FEJ was concentrated in 6 metabolic pathways.

CONCLUSION

Based on network pharmacology, animal experiments and metabolomics, we found that FEJ might ameliorate gastric mucosal injury in PLGC rats by regulating gastrointestinal hormones and inhibiting inflammation, and its mechanism of action is related to the inhibition of excessive activation of PI3K/AKT/HIF-1α signaling pathway and regulation of disorders of body energy metabolism. This comprehensive strategy also provided a reasonable way for unveiling the pharmacodynamic mechanisms of multi-components, multi-targets, and multi-pathways in Traditional Chinese Medicine.

The therapeutic effect of Huazhuojiedu decoction on precancerous lesions in a gastric cancer model via the regulation of lnc 517368

ETHNOPHARMACOLOGICAL RELEVANCE

Huazhuojiedu decoction, a Chinese herbal preparation, has been proven to be clinically effective in treating precancerous lesions in gastric cancer (PLGC). This formula is optimized from a classic formula called "Ganluxiaodu Dan." Although some experiments have shown that Huazhuojiedu decoction is effective against PLGC, the mechanism remains unclear.

AIM OF THE STUDY

To investigate the treatment of PLGC with Huazhuojiedu decoction from the perspective of lncRNA in vitro and in vivo.

MATERIALS AND METHODS

A PLGC rat model was prepared and randomly divided into a Huazhuojiedu decoction group (HG), a vitacoenzyme group (VG), a model group (MG), and a normal group (CG). Each group was given a corresponding concentration of medicine and distilled water for 10 weeks. The pathological changes in the gastric mucosa were observed by hematoxylin-eosin staining (HE). High-throughput sequencing was performed to detect the differentially expressed lncRNAs in the HG, MG, and CG. Quantitative real-time reverse transcription-polymerase chain reaction (RT-qPCR) was used to verify differentially expressed lncRNAs, and rat-human homology information was obtained from the University of California, Santa Cruz (UCSC) Genome Database. Human gastric mucosal epithelial cells (GES-1) were used to prepare precancerous lesions of gastric cancer cells (MC). A Huazhuojiedu decoction drug-containing serum was prepared to treat the MC cells. The effects of the Huazhuojiedu decoction and the lncRNA ENST00000517368 (lnc 517368) knockdown or overexpression on PLGC cell proliferation and apoptosis were evaluated in vitro using CCK-8, flow cytometry, and RT-qPCR.

RESULTS

The HE results showed that gastric mucosal pathology was significantly improved in the HG. High-throughput sequencing results showed that compared with the CG, 91 lncRNAs upregulated in the MG were restored and downregulated in the HG (P < 0.05), and 115 lncRNAs downregulated in the MG were restored and upregulated in the HG (P < 0.05). The results of RT-qPCR were consistent with the sequencing results. The differentially expressed genomic rat lncRNA ENSRNOT00000079699 is homologous to human lnc 517368. In cell experiments, high expression of lnc 517368 promoted proliferation and reduced apoptosis in PLGC cells, while the Huazhuojiedu decoction reduced the expression of lnc 517368 and improved cell morphology.

CONCLUSIONS

Huazhuojiedu decoction inhibited cell proliferation and promoted apoptosis in PLGC cells, and its effect may be partially dependent on the downregulation of lnc 517368.

Traditional Chinese medicine for precancerous lesions of gastric cancer: A review

Gastric cancer (GC) is the fifth most common type of cancer and the third leading cause of death due to cancer worldwide. The gastric mucosa often undergoes many years of precancerous lesions of gastric cancer (PLGC) stages before progressing to gastric malignancy. Unfortunately, there are no effective Western drugs for patients with PLGC. In recent years, traditional Chinese medicine (TCM) has been proven effective in treating PLGC. Classical TCM formulas and chemical components isolated from some Chinese herbal medicines have been administered to treat PLGC, and the main advantage is their comprehensive intervention with multiple approaches and multiple targets. In this review, we focus on recent studies using TCM treatment for PLGC, including clinical observations and experimental research, with a focus on targets and mechanisms of drugs. This review provides some ideas and a theoretical basis for applying TCM to treat PLGC and prevent GC.

A correlational study of Weifuchun and its clinical effect on intestinal flora in precancerous lesions of gastric cancer

Background

Weifuchun (WFC), a Chinese herbal prescription consisting of Red Ginseng, Isodon amethystoides and Fructus Aurantii, is commonly used in China to treat a variety of chronic stomach disorders. The aim of the paper was to determine the effect of WFC on intestinal microbiota changes in precancerous lesions of gastric cancer (PLGC) patients.

Methods

PLGC patients of H. pylori negative were randomly divided into two groups and received either WFC tablets for a dose of 1.44 g three times a day or vitacoenzyme (Vit) tablets for a dose of 0.8 g three times a day. All patients were treated for 6 months consecutively. Gastroscopy and histopathology were used to assess the histopathological changes in gastric tissues before and after treatment. 16S rRNA gene sequencing was carried out to assess the effects WFC on intestinal microbiota changes in PLGC patients. Receiver Operating Characteristics (ROC) analysis was used to assess the sensitivity and specificity of different intestinal microbiota in distinguishing between PLGC patients and healthy control group.

Results

Gastroscopy and histopathological results indicated that WFC could improve the pathological condition of PLGC patients, especially in the case of atrophy or intestinal metaplasia. The results of 16S rRNA gene sequencing indicated that WFC could regulate microbial diversity, microbial composition, and abundance of the intestinal microbiota of PLGC patients. Following WFC treatment, the relative abundance of Parabacteroides decreased in WFC group when compared with the Vit group. ROC analysis found that the Parabacteroides could effectively distinguish PLGC patients from healthy individuals with sensitivity of 0.79 and specificity of 0.8.

Conclusions

WFC could slow down the progression of PLGC by regulating intestinal microbiota abundance.

Trial registration NCT03814629. Name of registry: Randomized Clinical Trial: Weifuchun Treatment on Precancerous Lesions of Gastric Cancer. Registered 3 August 2018-Retrospectively registered, https://register.clinicaltrials.gov/ NCT03814629.

Discussion on action mechanism of traditional Chinese medicine on chronic atrophic gastritis from the perspective of gene regulation

At present, research on tumor genes related to chronic atrophic gastritis (CAG), a form of precancerous lesion of gastric cancer, has become a hot topic. In this paper, we discuss the mechanism of action of traditional Chinese medicine treatment on CAG from the aspects of protooncogenes, tumor suppressor genes, and apoptosis-related genes, with an aim to provide new ideas for clinical treatment and prevention of CAG.

Effect of Huatan Xiaoyu decoction on serum tumor markers in patients with precancerous lesions of gastric cancer

AIM: To observe the clinical efficacy of Huatan Xiaoyu decoction (HXD) in the treatment of precancerous lesions of gastric cancer (PLGCs), and its effect on tumor markers in serum.

METHODS: Two hundred patients with PLGCs were orally given HXD twice per day. The therapeutic course for all patients was six months. The therapeutic efficacy was assessed, and pathological changes were evaluated after electronic gastroscopy and biopsy. Serum levels of tumor markers were determined using electrochemical luminescence immunoassay.

RESULTS: Total effective rate was 88%. Symptom improvement, endoscopic and pathologic changes after treatment were significantly better than those before treatment (P < 0.05). The contents of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), CA72-4, and CA125 in serum were significantly lower after treatment than before treatment (P < 0.05).

CONCLUSION: HXD could prevent the progression of PLGCs by lowering serum CEA, CA19-9, CA72-4 and CA125 levels. Our findings provide an objective basis for the treatment of PLGCs to reduce the risk of cancer.

Effect of Huatan Xiaoyu Fang on expression of Notch1, β-catenin and PTEN in precancerous lesions of gastric cancer in rats

AIM: To observe the effect of Huatan Xiaoyu Fang (HTXY) on the expression of Notch1, β-catenin and PTEN in precancerous lesions of gastric cancer (PLGC) in rats.

METHODS: PLGC was induced by a complex method, in which N-methyl-N-nitro-N-nitrosoguanidine was mainly used. After successful modeling, the model rats were randomly divided into a model group, low-, medium- and high-dose HTXY groups, and a vitacoenzyme group, with 15 rats in each group. Fifteen normal rats comprised a blank control group. Eight weeks later, the rats' general conditions, the pathological changes in the gastric mucosa, and the expression of Notch1, β-catenin and PTEN were assessed.

RESULTS: Compared with the blank control group, the expression of Notch1 and β-catenin significantly decreased (P<0.01) and that of PTEN increased (P<0.05) in the model group. Compared with the model group, the expression of Notch1 and β-catenin significantly increased (P<0.05) and that of PTEN decreased (P<0.01) in each HTXY group and the vitacoenzyme group. Compared with the vitacoenzyme group, the expression of Notch1 and β-catenin decreased more significantly in the high-dose HTXY group (P<0.05, P<0.01).

CONCLUSION: HTXY can significantly improve the pathological changes in the gastric mucosa of rats with PLGC possibly by up-regulating the expression of Notch1 and β-catenin and down-regulating the expression of PTEN.

Expression of Survivin and Livin in precancerous lesions of gastric cancer in rats: Implications for therapeutic effects of Huatanxiaoyu decoction

AIM: To explore whether Huatanxiaoyu decoction exerts therapeutic effects against precancerous lesions of gastric cancer (PLGC) by suppressing Survivin and Livin expression in rats.

METHODS: Ninety-six 6-8-week-old male SD rats were randomly divided into either a normal group or a model group. N-methyl-N'-nitro-N-nitrosoguanidine (MNNG), ranitidine and irregular diet were used for preparing PLGC animal models. After successful modeling, the model rats were randomly divided into a model group, low-, medium- and high-dose Chinese medicine groups, and a western medicine (folie acid tablets) group. After 8 wk of treatment, gastric body and antrum mucosal specimens were taken for observing pathological changes of the gastric mucosa after HE staining, or for detecting the expression of Survivin and Livin by immunohistochemistry.

RESULTS: The normal group showed no PLGC changes, while all the other groups had PLGC changes. Medium- and high-dose Huatanxiaoyu decoction significantly improved PLGC changes (P < 0.05), and the improvement was better in the high-dose group than in the other treatment groups (P < 0.05). Treatment with folie acid tablets also significantly improved PLGC pathology compared with the model group (P < 0.05). The expression of Survivin and Livin proteins in the model group was significantly higher than that in the normal group (P < 0.01). Compared with the model group, Huatanxiaoyu decoction significantly decreased the Survivin and Livin expression in a dose-dependent manner (P < 0.05), and the decrease was more significant in the high-dose group than in the other groups (P < 0.05).

CONCLUSION: Huatanxiaoyu decoction is superior to folie acid in treating PLGC, and the therapeutic effects may be closely related to the inhibition of Survivin and Livin expression.

Effect of Jianpi Huoxue decoction on CD44V6, MLH1 and MSH2 expression in precancerous lesions of gastric cancer in rats

AIM: To investigate the effects of Jianpi Huoxue decoction on CD44V6, mutL homolog 1 (MLH1) and mutS homologue 2 (MSH2) expression in precancerous lesions of gastric cancer (PLGC) in rats.

METHODS: PLGC was induced in rats with N-methyl-N-nitro N-nitrosoguanidine (MNNG) together with 0.3 g/L ranitidine, 400 mL/L alcohol and irregular diet. Forty model rats were randomly and equally divided into a model control group (0.9% normal saline, NS), a Weifuchun group (0.86 g/kg), and high-, medium- and low-dose Jianpi Huoxue decoction groups (32, 16, and 8 g/kg). Untreated normal rats comprised the normal control group. Each group was given corresponding medicine (10 mL/kg) once a day for 10 wk. All of the rats were sacrificed at the end of the experiment. The expression of CD44V6, MLH1 and MSH2 was detected by rapid immunohistochemistry.

RESULTS: In comparison with the normal control group, CD44V6 expression was significantly increased in the model control group (5.12 ± 1.96 vs 0.25 ± 0.46, P < 0.01). In comparison with the model group, CD44V6 expression was significantly decreased in the high- and medium-dose Jianpi Huoxue decoction groups (2.25 ± 0.71, 3.25 ± 0.31 vs 5.12 ± 1.96, P < 0.01 or < 0.05), although there was no significant difference between the low-dose Jianpi Huoxue decoction group and the model group (P > 0.05). In comparison with the Weifuchun group, CD44V6 expression was decreased in the high-dose Jianpi Huoxue decoction group (2.25 ± 0.71 vs 4.62 ± 1.19, P < 0.01), but there were no significant differences between the Weifuchun group, the medium- and low-dose Jianpi Huoxue decoction groups (P > 0.05 for both). In comparison with the normal group, MLH1 and MSH2 expression was significantly decreased in the model group (3.75 ± 1.04 vs 8.00 ± 0.926, 3.62 ± 1.69 vs 7.25 ± 2.12, P < 0.01 for both). In comparison with the model group, MLH1 and MSH2 expression was significantly increased in the high-, medium- and low-dose Jianpi Huoxue decoction groups (6.50 ± 0.93, 5.25 ± 1.49, 5.12 ± 1.25 vs 3.75 ± 1.04; 6.62 ± 2.13, 6.00 ± 1.51, 5.50 ± 1.41 vs 3.62 ± 1.69, P < 0.01 or < 0.05 for all). In comparison with the Weifuchun group, MLH1 expression was increased in the high-dose Jianpi Huoxue decoction group (6.50 ± 0.93 vs 4.88 ± 1.25, P < 0.05), but there were no significant differences between the Weifuchun group, the medium- and low-dose Jianpi Huoxue decoction groups (P > 0.05 for both). As for MSH2 expression, there were no significant differences between the Weifuchun group and all Jianpi Huoxue decoction groups (P > 0.05 for all).

CONCLUSION: The therapeutic effect of Jianpi Huoxue decoction for PLGC in rats is associated with decreasing CD44V6 expression and increasing MLH1 and MSH2 expression in gastric mucosa.

Roles of proinflammatory cytokines in precancerous lesions of gastric cancer

Precancerous lesions of gastric cancer, including intestinal metaplasia and dysplasia, are important stages in the evolution from normal gastric tissue to gastric cancer. Gastric cancer has a very high mortality rate, mainly due to post-metastasis diagnosis. Therefore, diagnosis of precancerous lesions of gastric cancer is of great clinical significance. In recent years, it has been reported that some proinflammatory cytokines such as interleukin 1β (IL-1β), IL-8, IL-11, tumor necrosis factor α (TNF-α) and interferon-gamma (IFN-γ) play important roles in the development of precancerous lesions of gastric cancer. A more detailed understanding of the roles of proinflammatory cytokines may provide new therapeutic targets for precancerous lesions of gastric cancer. Here, we summarize the roles of some proinflammatory cytokines in the progression of precancerous lesions of gastric cancer.

Precancerous lesions of gastric cancer: Research progress and preventive strategies

The development of precancerous lesions of gastric cancer is a critical stage of the evolution of gastric cancer. Early detection and intervention for these lesions are of considerable significance in reducing the morbidity of gastric cancer. The development of precancerous lesions of gastric cancer is controlled by multiple factors such as Helicobacter priori infection, DNA methylation, microsatellite instability, and p53 status. Because of high malignancy and unclear etiology of gastric cancer, there are certain difficulties in carrying out successful primary prevention. This review aims to review the recent advances in understanding the pathogenesis of and preventive strategies for gastric precancerous lesions.

Impact of Weikang Shuning Decoction on cytokines involved in the development of gastric precancerous lesions in rats with chronic atrophic gastritis

AIM: To investigate the impact of Weikang Shuning Decoction on cytokines involved in the development of gastric precancerous lesions in rats with chronic atrophic gastritis.

METHODS: Sixty Wistar rats were randomly divided into four groups, namely, normal control group, model control group, Vitacoenzyme group and Weikang Shuning decoction group. A rat model of gastric precancerous lesions was created by administration of N-methyl-N-nitroso-N-nitrosoguanidine (MNNG) via drinking water. After the rats were treated with Vitacoenzyme and Weikang Shuning Decoction for 12 weeks, respectively, the levels of serum EGF, TGF-α, GH, TNF-α, IGF-II and bFGF were determined by radioimmunoassay (RIA).

RESULTS: The levels of serum GH, TNF-α and IGF-II in the Weikang Shuning Decoction group were significantly higher that those in the model control group (0.24 ± 0.10 µg/L vs 0.11 ± 0.04 µg/L, 91.46 ± 7.63 µg/L vs 83.64 ± 3.75 µg/L and 0.38 ± 0.12 µg/L vs 0.27 ± 0.17 µg/L, respectively, P < 0.05 or 0.01). In contrast, the levels of serum EGF, TGF-α and bFGF in the Weikang Shuning Decoction group were significantly lower than those in the model control group (0.40 ± 0.11 µg/L vs 0.56 ± 0.15 µg/L, 0.021 ± 0.006 µg/L vs 0.029 ± 0.012 µg/L and 1.44 ± 0.37 µg/L vs 3.26 ± 0.45 µg/L, respectively; P < 0.05 or 0.01).

CONCLUSION: Weikang Shuning Decoction has a good therapeutic effect against gastric precancerous lesions in rats, and its efficacy is superior to that of Vitacoenzyme. Regulation of serum EGF, TGF-α, GH, TNF-α, IGF-II and bFGF levels may be one of the mechanisms underlying the therapeutic effect of Weikang Shuning Decoction against gastric precancerous lesions.