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Wang X, Fukumoto T, Noma KI. Therapeutic strategies targeting cellular senescence for cancer and other diseases. J Biochem 2024; 175:525-537. [PMID: 38366629 PMCID: PMC11058315 DOI: 10.1093/jb/mvae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 02/18/2024] Open
Abstract
Cellular senescence occurs in response to endogenous or exogenous stresses and is characterized by stable cell cycle arrest, alterations in nuclear morphology and secretion of proinflammatory factors, referred to as the senescence-associated secretory phenotype (SASP). An increase of senescent cells is associated with the development of several types of cancer and aging-related diseases. Therefore, senolytic agents that selectively remove senescent cells may offer opportunities for developing new therapeutic strategies against such cancers and aging-related diseases. This review outlines senescence inducers and the general characteristics of senescent cells. We also discuss the involvement of senescent cells in certain cancers and diseases. Finally, we describe a series of senolytic agents and their utilization in therapeutic strategies.
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Affiliation(s)
- Xuebing Wang
- Institute for Genetic Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-Ku, Sapporo 060-0815, Japan
| | - Takeshi Fukumoto
- Division of Dermatology, Department of Internal Related, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Ken-ichi Noma
- Institute for Genetic Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-Ku, Sapporo 060-0815, Japan
- Institute of Molecular Biology, University of Oregon, 1370 Franklin Blvd, Eugene, OR 97403, USA
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Ji J, Ding K, Cheng B, Zhang X, Luo T, Huang B, Yu H, Chen Y, Xu X, Lin H, Zhou J, Wang T, Jin M, Liu A, Yan D, Liu F, Wang C, Chen J, Yan F, Wang L, Zhang J, Yan S, Wang J, Li X, Chen G. Radiotherapy-Induced Astrocyte Senescence Promotes an Immunosuppressive Microenvironment in Glioblastoma to Facilitate Tumor Regrowth. Adv Sci (Weinh) 2024; 11:e2304609. [PMID: 38342629 PMCID: PMC11022718 DOI: 10.1002/advs.202304609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/24/2024] [Indexed: 02/13/2024]
Abstract
Accumulating evidence suggests that changes in the tumor microenvironment caused by radiotherapy are closely related to the recurrence of glioma. However, the mechanisms by which such radiation-induced changes are involved in tumor regrowth have not yet been fully investigated. In the present study, how cranial irradiation-induced senescence in non-neoplastic brain cells contributes to glioma progression is explored. It is observed that senescent brain cells facilitated tumor regrowth by enhancing the peripheral recruitment of myeloid inflammatory cells in glioblastoma. Further, it is identified that astrocytes are one of the most susceptible senescent populations and that they promoted chemokine secretion in glioma cells via the senescence-associated secretory phenotype. By using senolytic agents after radiotherapy to eliminate these senescent cells substantially prolonged survival time in preclinical models. The findings suggest the tumor-promoting role of senescent astrocytes in the irradiated glioma microenvironment and emphasize the translational relevance of senolytic agents for enhancing the efficacy of radiotherapy in gliomas.
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Affiliation(s)
- Jianxiong Ji
- Department of Neurosurgerythe Second Affiliated Hospital of Zhejiang University School of MedicineKey Laboratory of Precise Treatment and Clinical Translational Research of Neurological DiseasesHangzhouZhejiang310000P. R. China
- Department of NeurosurgeryQilu Hospital of Shandong University and Brain Science Research InstituteCheeloo College of MedicineShandong University107 Wenhua Xi RoadJinanShandong250012P. R. China
- Key Laboratory of Brain Functional RemodelingShandong University107 Wenhua Xi RoadJinanShandong250012P. R. China
- Department of Radiation OncologyMayo ClinicRochesterMN55905USA
| | - Kaikai Ding
- Department of NeurosurgeryQilu Hospital of Shandong University and Brain Science Research InstituteCheeloo College of MedicineShandong University107 Wenhua Xi RoadJinanShandong250012P. R. China
- Key Laboratory of Brain Functional RemodelingShandong University107 Wenhua Xi RoadJinanShandong250012P. R. China
- Department of Radiation Oncologythe First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouZhejiang310000P. R. China
| | - Bo Cheng
- Department of Radiation OncologyQilu Hospital of Shandong UniversityCheeloo College of MedicineShandong UniversityJinanShandong250012P. R. China
| | - Xin Zhang
- Department of NeurosurgeryQilu Hospital of Shandong University and Brain Science Research InstituteCheeloo College of MedicineShandong University107 Wenhua Xi RoadJinanShandong250012P. R. China
- Key Laboratory of Brain Functional RemodelingShandong University107 Wenhua Xi RoadJinanShandong250012P. R. China
| | - Tao Luo
- Department of NeurosurgeryQilu Hospital of Shandong University and Brain Science Research InstituteCheeloo College of MedicineShandong University107 Wenhua Xi RoadJinanShandong250012P. R. China
- Key Laboratory of Brain Functional RemodelingShandong University107 Wenhua Xi RoadJinanShandong250012P. R. China
| | - Bin Huang
- Department of NeurosurgeryQilu Hospital of Shandong University and Brain Science Research InstituteCheeloo College of MedicineShandong University107 Wenhua Xi RoadJinanShandong250012P. R. China
- Key Laboratory of Brain Functional RemodelingShandong University107 Wenhua Xi RoadJinanShandong250012P. R. China
| | - Hao Yu
- Department of Radiation Oncologythe First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouZhejiang310000P. R. China
| | - Yike Chen
- Department of Neurosurgerythe Second Affiliated Hospital of Zhejiang University School of MedicineKey Laboratory of Precise Treatment and Clinical Translational Research of Neurological DiseasesHangzhouZhejiang310000P. R. China
| | - Xiaohui Xu
- Department of Neurosurgerythe Second Affiliated Hospital of Zhejiang University School of MedicineKey Laboratory of Precise Treatment and Clinical Translational Research of Neurological DiseasesHangzhouZhejiang310000P. R. China
| | - Haopu Lin
- Department of Neurosurgerythe Second Affiliated Hospital of Zhejiang University School of MedicineKey Laboratory of Precise Treatment and Clinical Translational Research of Neurological DiseasesHangzhouZhejiang310000P. R. China
| | - Jiayin Zhou
- Department of Neurosurgerythe Second Affiliated Hospital of Zhejiang University School of MedicineKey Laboratory of Precise Treatment and Clinical Translational Research of Neurological DiseasesHangzhouZhejiang310000P. R. China
| | - Tingtin Wang
- Department of Neurosurgerythe Second Affiliated Hospital of Zhejiang University School of MedicineKey Laboratory of Precise Treatment and Clinical Translational Research of Neurological DiseasesHangzhouZhejiang310000P. R. China
| | - Mengmeng Jin
- Department of Reproductive EndocrinologyWomen's HospitalZhejiang University School of MedicineHangzhouZhejiang310000P. R. China
| | - Aixia Liu
- Department of Reproductive EndocrinologyWomen's HospitalZhejiang University School of MedicineHangzhouZhejiang310000P. R. China
| | - Danfang Yan
- Department of Radiation Oncologythe First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouZhejiang310000P. R. China
| | - Fuyi Liu
- Department of Neurosurgerythe Second Affiliated Hospital of Zhejiang University School of MedicineKey Laboratory of Precise Treatment and Clinical Translational Research of Neurological DiseasesHangzhouZhejiang310000P. R. China
| | - Chun Wang
- Department of Neurosurgerythe Second Affiliated Hospital of Zhejiang University School of MedicineKey Laboratory of Precise Treatment and Clinical Translational Research of Neurological DiseasesHangzhouZhejiang310000P. R. China
| | - Jingsen Chen
- Department of Neurosurgerythe Second Affiliated Hospital of Zhejiang University School of MedicineKey Laboratory of Precise Treatment and Clinical Translational Research of Neurological DiseasesHangzhouZhejiang310000P. R. China
| | - Feng Yan
- Department of Neurosurgerythe Second Affiliated Hospital of Zhejiang University School of MedicineKey Laboratory of Precise Treatment and Clinical Translational Research of Neurological DiseasesHangzhouZhejiang310000P. R. China
| | - Lin Wang
- Department of Neurosurgerythe Second Affiliated Hospital of Zhejiang University School of MedicineKey Laboratory of Precise Treatment and Clinical Translational Research of Neurological DiseasesHangzhouZhejiang310000P. R. China
| | - Jianmin Zhang
- Department of Neurosurgerythe Second Affiliated Hospital of Zhejiang University School of MedicineKey Laboratory of Precise Treatment and Clinical Translational Research of Neurological DiseasesHangzhouZhejiang310000P. R. China
| | - Senxiang Yan
- Department of Radiation Oncologythe First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouZhejiang310000P. R. China
| | - Jian Wang
- Department of NeurosurgeryQilu Hospital of Shandong University and Brain Science Research InstituteCheeloo College of MedicineShandong University107 Wenhua Xi RoadJinanShandong250012P. R. China
- Key Laboratory of Brain Functional RemodelingShandong University107 Wenhua Xi RoadJinanShandong250012P. R. China
- Department of BiomedicineUniversity of BergenJonas Lies vei 91BergenNorway5009
| | - Xingang Li
- Department of NeurosurgeryQilu Hospital of Shandong University and Brain Science Research InstituteCheeloo College of MedicineShandong University107 Wenhua Xi RoadJinanShandong250012P. R. China
- Key Laboratory of Brain Functional RemodelingShandong University107 Wenhua Xi RoadJinanShandong250012P. R. China
| | - Gao Chen
- Department of Neurosurgerythe Second Affiliated Hospital of Zhejiang University School of MedicineKey Laboratory of Precise Treatment and Clinical Translational Research of Neurological DiseasesHangzhouZhejiang310000P. R. China
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Dańczak‐Pazdrowska A, Gornowicz‐Porowska J, Polańska A, Krajka‐Kuźniak V, Stawny M, Gostyńska A, Rubiś B, Nourredine S, Ashiqueali S, Schneider A, Tchkonia T, Wyles SP, Kirkland JL, Masternak MM. Cellular senescence in skin-related research: Targeted signaling pathways and naturally occurring therapeutic agents. Aging Cell 2023; 22:e13845. [PMID: 37042069 PMCID: PMC10265178 DOI: 10.1111/acel.13845] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/13/2023] Open
Abstract
Despite the growing interest by researchers into cellular senescence, a hallmark of cellular aging, its role in human skin remains equivocal. The skin is the largest and most accessible human organ, reacting to the external and internal environment. Hence, it is an organ of choice to investigate cellular senescence and to target root-cause aging processes using senolytic and senomorphic agents, including naturally occurring plant-based derivatives. This review presents different aspects of skin cellular senescence, from physiology to pathology and signaling pathways. Cellular senescence can have both beneficial and detrimental effects on the skin, indicating that both prosenescent and antisenescent therapies may be desirable, based on the context. Knowledge of molecular mechanisms involved in skin cellular senescence may provide meaningful insights for developing effective therapeutics for senescence-related skin disorders, such as wound healing and cosmetic skin aging changes.
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Affiliation(s)
| | - Justyna Gornowicz‐Porowska
- Department and Division of Practical Cosmetology and Skin Diseases ProphylaxisPoznan University of Medical SciencesPoznanPoland
| | - Adriana Polańska
- Department of Dermatology and VenereologyPoznan University of Medical SciencesPoznanPoland
| | | | - Maciej Stawny
- Department of Pharmaceutical ChemistryPoznan University of Medical SciencesPoznanPoland
| | - Aleksandra Gostyńska
- Department of Pharmaceutical ChemistryPoznan University of Medical SciencesPoznanPoland
| | - Błażej Rubiś
- Department of Clinical Chemistry and Molecular DiagnosticsPoznan University of Medical SciencesPoznanPoland
| | - Sarah Nourredine
- Burnett School of Biomedical SciencesCollege of Medicine, University of Central FloridaOrlandoFloridaUSA
| | - Sarah Ashiqueali
- Burnett School of Biomedical SciencesCollege of Medicine, University of Central FloridaOrlandoFloridaUSA
| | | | - Tamara Tchkonia
- Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMinnesotaUSA
| | | | - James L. Kirkland
- Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMinnesotaUSA
| | - Michal M. Masternak
- Burnett School of Biomedical SciencesCollege of Medicine, University of Central FloridaOrlandoFloridaUSA
- Department of Head and Neck SurgeryPoznan University of Medical SciencesPoznanPoland
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Franzin R, Stasi A, Fiorentino M, Simone S, Oberbauer R, Castellano G, Gesualdo L. Renal Delivery of Pharmacologic Agents During Machine Perfusion to Prevent Ischaemia-Reperfusion Injury: From Murine Model to Clinical Trials. Front Immunol 2021; 12:673562. [PMID: 34295329 PMCID: PMC8290413 DOI: 10.3389/fimmu.2021.673562] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022] Open
Abstract
Donor organ shortage still remains a serious obstacle for the access of wait-list patients to kidney transplantation, the best treatment for End-Stage Kidney Disease (ESKD). To expand the number of transplants, the use of lower quality organs from older ECD or DCD donors has become an established routine but at the price of increased incidence of Primary Non-Function, Delay Graft Function and lower-long term graft survival. In the last years, several improvements have been made in the field of renal transplantation from surgical procedure to preservation strategies. To improve renal outcomes, research has focused on development of innovative and dynamic preservation techniques, in order to assess graft function and promote regeneration by pharmacological intervention before transplantation. This review provides an overview of the current knowledge of these new preservation strategies by machine perfusions and pharmacological interventions at different timing possibilities: in the organ donor, ex-vivo during perfusion machine reconditioning or after implementation in the recipient. We will report therapies as anti-oxidant and anti-inflammatory agents, senolytics agents, complement inhibitors, HDL, siRNA and H2S supplementation. Renal delivery of pharmacologic agents during preservation state provides a window of opportunity to treat the organ in an isolated manner and a crucial route of administration. Even if few studies have been reported of transplantation after ex-vivo drugs administration, targeting the biological pathway associated to kidney failure (i.e. oxidative stress, complement system, fibrosis) might be a promising therapeutic strategy to improve the quality of various donor organs and expand organ availability.
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Affiliation(s)
- Rossana Franzin
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy
| | - Alessandra Stasi
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy
| | - Marco Fiorentino
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy
| | - Simona Simone
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy
| | - Rainer Oberbauer
- Department of Nephrology and Dialysis, University Clinic for Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Giuseppe Castellano
- Nephrology, Dialysis and Transplantation Unit, Advanced Research Center on Kidney Aging (A.R.K.A.), Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy
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Kovacovicova K, Skolnaja M, Heinmaa M, Mistrik M, Pata P, Pata I, Bartek J, Vinciguerra M. Senolytic Cocktail Dasatinib+Quercetin (D+Q) Does Not Enhance the Efficacy of Senescence-Inducing Chemotherapy in Liver Cancer. Front Oncol 2018; 8:459. [PMID: 30425964 PMCID: PMC6218402 DOI: 10.3389/fonc.2018.00459] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death, which develops in the context of fibrosis and cirrhosis caused by chronic inflammation, in turn due to non-alcoholic fatty liver disease (NAFLD), alcohol consumption and/or hepatitis viral infection. An increased number of senescent cells are associated with age-related tissue degeneration during NAFLD-induced HCC, or during chemotherapeutic treatment. Senolytic agents target selectively senescent cells. A combination of the senolytic drugs dasatinib and quercetin (D+Q) reduced hepatic lipid accumulation and alleviated age-associated physical dysfunction in mice. However, whether D+Q can impact the treatment of HCC, at the end-stage of the NAFLD inflammatory spectrum, is unknown. Here, using two well-established HCC cell lines (HepG2, Huh-7), we demonstrate that the maximal cytostatic doses for D and/or Q (1 + 1 μM) lacked efficacy in removing doxorubicin-induced β-gal-positive senescent cells. Moreover, D+Q did not affect doxorubicin-dependent induction of flattened morphology, activation of p16, expression of SASP-associated genes or formation of γH2AX foci. We then investigated the antitumor efficacy of doxorubicin, D+Q, or the combination, in xenograft studies conducted with HCC cells inoculated in athymic nude mice. Doxorubicin reduced tumor growth by 30% compared to control mice, while D+Q was ineffective in synergizing with doxorubicin and in clearing doxorubicin-induced HCC senescent cells. Unexpectedly, D+Q alone appeared to have acute pro-tumorigenic effects in control mice. While our data need to be confirmed in animal models that fully recapitulate NAFLD, we demonstrate that these compounds are ineffective, alone or in synergy with senescence-inducing chemotherapy, against experimental HCC.
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Affiliation(s)
| | - Marianna Skolnaja
- Department of Chemistry and Biotechnology, Tallinn University of Technology, Tallinn, Estonia.,IVEX Lab, Tallinn, Estonia
| | - Mihkel Heinmaa
- Department of Chemistry and Biotechnology, Tallinn University of Technology, Tallinn, Estonia
| | - Martin Mistrik
- Faculty of Medicine and Dentistry, Institute of Molecular and Translational Medicine, Palacky University, Olomouc, Czechia
| | - Pille Pata
- Department of Chemistry and Biotechnology, Tallinn University of Technology, Tallinn, Estonia.,IVEX Lab, Tallinn, Estonia
| | | | - Jiri Bartek
- Faculty of Medicine and Dentistry, Institute of Molecular and Translational Medicine, Palacky University, Olomouc, Czechia.,Genome Integrity Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.,Science for Life Laboratory, Division of Translational Medicine and Chemical Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Solna, Sweden
| | - Manlio Vinciguerra
- International Clinical Research Center (FNUSA-ICRC), Brno, Czechia.,Division of Medicine, Institute for Liver and Digestive Health, University College London, London, United Kingdom
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Wang Y, Chang J, Liu X, Zhang X, Zhang S, Zhang X, Zhou D, Zheng G. Discovery of piperlongumine as a potential novel lead for the development of senolytic agents. Aging (Albany NY) 2016; 8:2915-2926. [PMID: 27913811 PMCID: PMC5191878 DOI: 10.18632/aging.101100] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/04/2016] [Indexed: 04/16/2023]
Abstract
Accumulating evidence indicates that senescent cells play an important role in many age-associated diseases. The pharmacological depletion of senescent cells (SCs) with a "senolytic agent", a small molecule that selectively kills SCs, is a potential novel therapeutic approach for these diseases. Recently, we discovered ABT-263, a potent and highly selective senolytic agent, by screening a library of rationally-selected compounds. With this screening approach, we also identified a second senolytic agent called piperlongumine (PL). PL is a natural product that is reported to have many pharmacological effects, including anti-tumor activity. We show here that PL preferentially killed senescent human WI-38 fibroblasts when senescence was induced by ionizing radiation, replicative exhaustion, or ectopic expression of the oncogene Ras. PL killed SCs by inducing apoptosis, and this process did not require the induction of reactive oxygen species. In addition, we found that PL synergistically killed SCs in combination with ABT-263, and initial structural modifications to PL identified analogs with improved potency and/or selectivity in inducing SC death. Overall, our studies demonstrate that PL is a novel lead for developing senolytic agents.
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Affiliation(s)
- Yingying Wang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Jianhui Chang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Xingui Liu
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Xuan Zhang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Suping Zhang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Xin Zhang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Daohong Zhou
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Guangrong Zheng
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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