Mesenchymal stem cells and immunomodulation: current status and future prospects

The unique immunomodulatory properties of mesenchymal stem cells (MSCs) make them an invaluable cell type for the repair of tissue/ organ damage caused by chronic inflammation or autoimmune disorders. Although they hold great promise in the treatment of immune disorders such as graft versus host disease (GvHD) and allergic disorders, there remain many challenges to overcome before their widespread clinical application. An understanding of the biological properties of MSCs will clarify the mechanisms of MSC-based transplantation for immunomodulation. In this review, we summarize the preclinical and clinical studies of MSCs from different adult tissues, discuss the current hurdles to their use and propose the future development of pluripotent stem cell-derived MSCs as an approach to immunomodulation therapy.

Mesenchymal stem cells derived from human induced pluripotent stem cells modulate T-cell phenotypes in allergic rhinitis

Background

Human induced pluripotent stem cells (iPSCs) possess remarkable self-renewal capacity and the potential to differentiate into novel cell types, such as mesenchymal stem cells (MSCs). iPSC-MSCs have been shown to enhance tissue regeneration and attenuate tissue ischaemia; however, their contribution to the immune regulation of Th2-skewed allergic rhinitis (AR) and asthma remains unclear.

Objective

This study compared the immunomodulatory effects of iPSC-MSCs and bone marrow-derived MSCs (BM-MSCs) on lymphocyte proliferation, T-cell phenotypes and cytokine production in peripheral blood mononuclear cells (PBMCs) in patients with AR, and investigated the possible molecular mechanisms underlying the immunomodulatory properties of iPSC-MSCs.

Methods

In co-cultures of PBMCs with iPSC-MSCs or BM-MSCs, lymphocyte proliferation was evaluated using 3H-thymidine (3H-TdR) uptake, carboxyfluorescein diacetate, succinimidyl ester (CFDA-SE) assays; the regulatory T-cell (Treg) phenotype was determined by flow cytometry, and cytokine levels were measured using an enzyme-linked immunosorbent assay. The immunomodulatory properties of both MSCs were further evaluated using NS398 and transwell experiments.

Results

Similar to BM-MSCs, we determined that iPSC-MSCs significantly inhibit lymphocyte proliferation and promote Treg response in PBMCs (P < 0.05). Accordingly, the cytokine milieu (IFN-γ, IL-4, IL-5, IL-10 and IL-13) in the supernatants of PBMCs changed significantly (P < 0.05). The immunomodulatory properties of iPSC-MSCs and BM-MSCs were associated with prostaglandin E2 (PGE2) production and cell–cell contact.

Conclusions

These data demonstrate that iPSC-MSCs are capable of modulating T-cell phenotypes towards Th2 suppression through inducing Treg expansion, suggesting that iPSC-MSCs can be used as an alternative candidate to adult MSCs to treat allergic airway diseases.

Mesenchymal stem cells derived from human induced pluripotent stem cells modulate T-cell phenotypes in allergic rhinitis

BACKGROUND

Human induced pluripotent stem cells (iPSCs) possess remarkable self-renewal capacity and the potential to differentiate into novel cell types, such as mesenchymal stem cells (MSCs). iPSC-MSCs have been shown to enhance tissue regeneration and attenuate tissue ischaemia; however, their contribution to the immune regulation of Th2-skewed allergic rhinitis (AR) and asthma remains unclear.

OBJECTIVE

This study compared the immunomodulatory effects of iPSC-MSCs and bone marrow-derived MSCs (BM-MSCs) on lymphocyte proliferation, T-cell phenotypes and cytokine production in peripheral blood mononuclear cells (PBMCs) in patients with AR, and investigated the possible molecular mechanisms underlying the immunomodulatory properties of iPSC-MSCs.

METHODS

In co-cultures of PBMCs with iPSC-MSCs or BM-MSCs, lymphocyte proliferation was evaluated using 3H-thymidine (3H-TdR) uptake, carboxyfluorescein diacetate, succinimidyl ester (CFDA-SE) assays; the regulatory T-cell (Treg) phenotype was determined by flow cytometry, and cytokine levels were measured using an enzyme-linked immunosorbent assay. The immunomodulatory properties of both MSCs were further evaluated using NS398 and transwell experiments.

RESULTS

Similar to BM-MSCs, we determined that iPSC-MSCs significantly inhibit lymphocyte proliferation and promote Treg response in PBMCs (P < 0.05). Accordingly, the cytokine milieu (IFN-γ, IL-4, IL-5, IL-10 and IL-13) in the supernatants of PBMCs changed significantly (P < 0.05). The immunomodulatory properties of iPSC-MSCs and BM-MSCs were associated with prostaglandin E2 (PGE2) production and cell-cell contact.

CONCLUSIONS

These data demonstrate that iPSC-MSCs are capable of modulating T-cell phenotypes towards Th2 suppression through inducing Treg expansion, suggesting that iPSC-MSCs can be used as an alternative candidate to adult MSCs to treat allergic airway diseases.

Selective changes of calcineurin (protein phosphatase 2B) activity in Alzheimer's disease cerebral cortex

Neurofibrillary tangles, which contain abnormally hyperphosphorylated forms of tau protein, are one of the neuropathological hallmarks of Alzheimer's disease (AD). This altered phosphorylation state of tau protein may be due to increased kinase activity or/and decreased phosphatase activity. In the present study, we characterized human calcineurin phosphatase activity in postmortem superior frontal cortex and sensorimotor cortex and measured calcineurin phosphatase activity in samples from individuals with moderate to severe AD (n = 7) and age-matched controls (n = 5). Basal phosphatase activity was reduced by 25% (P < 0.05) in AD frontal cortex. Nickel-stimulated calcineurin activity was decreased by 52% (P < 0.05) and 30% (P < 0.05) in P2 and total cell homogenate, respectively, compared to age-matched controls. No differences in phosphatase activities were detected in the sensorimotor cortex. The decrease in nickel-stimulated calcineurin phosphatase activity in frontal lobe correlated with the neurofibrillary tangle pathology (total cell homogenate, r = -0.77, P < 0.05; P2 fraction, r = -0.76, P < 0.02), but not with diffuse or neuritic plaques. Despite the changes in calcineurin phosphatase activity in the superior frontal cortex, calcineurin protein levels determined by immunoblot were similar in control and AD cases. In addition, no changes in calcineurin regulatory proteins (cyclophilin A and FKBP12) levels were observed. These studies suggest that decrease of calcineurin activity may play a role in paired-helical filament formation and/or stabilization, and the decrease of activity was not accompanied by a decrease of calcineurin protein expression.

Comparison of laparoscopically assisted and open radical distal gastrectomy with extended lymphadenectomy for gastric cancer management

BACKGROUND

The feasibility and safety of laparoscopically assisted gastrectomy with extended lymphadenectomy for advanced gastric cancer has rarely been studied. This study aimed to investigate the feasibility, safety, and cancer clearance of laparoscopically assisted distal gastrectomy with D2 lymphadenectomy.

METHODS

Of the 44 patients with distal gastric cancer who underwent radical distal gastrectomy from March 2004 to May 2005, 35 were treated with D2/D2(+) lymphadenectomy. These patients were compared with 58 patients who, during the same period, underwent a conventional open radical distal gastrectomy.

RESULTS

The mean total number of retrieved lymph nodes (30.11 +/- 16.97) and the mean tumor margin were comparable with those in the open group. The mean operative time for laparoscopically assisted distal gastrectomy was significantly longer than for open surgery (282.84 +/- 32.81 min vs 223.75 +/- 23.25 min). The patients in the laparoscopic surgery group had less blood loss, shorter times of analgesic injection, and a faster recovery. The rates of complications were comparable between two groups.

CONCLUSIONS

Although laparoscopically assisted radical gastrectomy with D2 lymphadenectomy is more time consuming than open surgery, it is a safe, feasible procedure that achieves cancer clearance similar to open surgery and leads to a quick postoperative recovery.

S-nitrosocysteine, but not sodium nitroprusside, produces apamin-sensitive hyperpolarization in rat gastric fundus

1. To investigate the pharmacological properties of the membrane hyperpolarization induced by electrical field stimulation (EFS), sodium nitroprusside (SNP) and S-nitrosocysteine (NO-Cys) in circular smooth muscle cells of the rat gastric fundus (forestomach), the effects of various potassium channel blockers on these hyperpolarizations were investigated. 2. EFS (50 microseconds, 20 Hz, 3 pulses, 10-50 V) produced inhibitory junction potentials (i.j.ps), in the presence of atropine (1 microM) and guanethidine (1 microM). NO-Cys and SNP produced hyperpolarization of the membrane in the rat gastric fundus. L-NG-nitroarginine (L-NNA) inhibited the i.j.ps, but not the hyperpolarization induced by NO-Cys and SNP. This inhibitory action of L-NNA on the i.j.ps was partly reversed by subsequent application of L-arginine (1 mM) but not by D-arginine. 3. Oxyhaemoglobin (Oxy-Hb; 5 microM) inhibited these hyperpolarizations, although a higher concentration of Oxy-Hb was required to inhibit the SNP-induced hyperpolarization. Hydroquinone (50 microM) inhibited only the hyperpolarization induced by NO-Cys. 4. Apamin (1 microM) partly inhibited i.j.ps and NO-Cys-induced hyperpolarization, but not the SNP-induced hyperpolarization. Tetraethylammonium (TEA; 1 mM), 4-aminopyridine (4-AP; 1 mM) or glibenclamide (1 microM) did not affect hyperpolarization induced by NO-Cys and SNP. 5. 8-Bromo cyclic guanosine 3':5'-monophosphate (1 mM) also produced hyperpolarization. Apamin (1 microM), TEA (1 mM) and glibenclamide (5 microM) all failed to inhibit this hyperpolarization. 6. These results indicate that NO-Cys and EFS hyperpolarize the membrane by activating apaminsensitive and TEA-resistant K+ channels and favour the hypothesis that a NO-liberating substance may act as a neurotransmitter in non-adrenergic, non-cholinergic (NANC) neurones in the rat forestomach.Our results also suggest that increase in cyclic GMP may cause apamin-resistant hyperpolarization but the apamin-sensitive hyperpolarization is mediated by another mechanism.

Consequences of missense mutations for dimerization and turnover of alanine:glyoxylate aminotransferase: study of a spectrum of mutations

Alanine:glyoxylate aminotransferase (AGT) is a liver peroxisomal enzyme, deficiency of which results in primary hyperoxaluria type 1 (PH1). More than 65 PH1-related mutations are now documented in the AGT gene (AGXT), of which about 50% are missense. We have generated a spectrum of 15 missense changes including the most common PH1 mutation, G170R, and expressed them on the appropriate background of the major or minor allele, in an Escherichia coli overexpression system and in a rabbit reticulocyte transcription/translation system. We have investigated their effects on enzyme activity, dimerization, aggregation, and turnover. The effect of pyridoxal phosphate (PLP) on dimerization and stability was also investigated. Although all 15 mutant AGTs were expressed as intact proteins in E. coli, only three: G41R and G41V on the major allele, and the common mutation G170R, resulted in significant amounts of enzymatic activity. Dimerization failure was a frequent observation (13/15) except for G41V and D183N. Dimerization was poor with S187F but was substantially improved with PLP. Proteasome-mediated protein degradation was observed for all the mutations except G41R on the major allele, G41V, D183N, G170R, and S218L. Increases in the stability of the mutant enzymes in the presence of PLP were small; however, G41R on the minor allele showed a direct relationship between its half life and the concentration of PLP. The minor allele AGT product and many of the mutants were subject to a limited non-proteasomal proteolytic cleavage when ATP was depleted.

Mechanical properties and in-vivo performance of calcium phosphate cement—chitosan fibre composite

Self-hardened calcium phosphate cement (CPC) sets to form hydroxyapatite and possesses excellent osteoconductivity. However, lack of macroporosity and low strength constrain its application in bone tissue engineering. Recent studies have incorporated various fibres into CPC to improve its mechanical strength. The present approach focused on the reinforcement of CPC with chitosan fibres and then the effects of the fibre structure on the mechanical properties and macrochannels formation characteristics of CPC—fibre composite were investigated. Chitosan fibres of diameter 200 μm were used to fabricate two types of three-dimensional structure, which were then coated with collagen and incorporated into CPC to fabricate CPC—fibre implants with a fibre volume content of 5 per cent. The compressive strength of the CPC—fibre implant was 33 MPa when the strain was 2.4 per cent, which is fourfold higher than that of the CPC control. Nine cylindrical implants including six CPC—fibre implants were implanted in the bone defects of nine dogs and were then post-operatively observed. After 20 weeks in vivo, new callus from the healthy tissue of the defect entirely integrated with the CPC—fibre implant and new bone was formed as the implant degraded. Scanning electronic microscopy images indicated that macrochannels were formed in the CPC—fibre implants with the degradation of fibres, but only micropores with a scale of less than 50 μm could be observed in the CPC control. Briefly, the incorporation of a suitable chitosan-fibre structure into a CPC implant not only could improve its mechanical properties but also facilitated the bone repair process in vivo.

Partial trypsin digestion as an indicator of mis-folding of mutant alanine:glyoxylate aminotransferase and chaperone effects of specific ligands. Study of a spectrum of missense mutants

Alanine:glyoxylate aminotransferase (AGT) is a liver peroxisomal enzyme whose deficiency results in primary hyperoxaluria type 1 (PH1). More than 75 PH1 mutations are now documented in the AGT gene (AGXT), of which about 50% are missense. We have previously demonstrated that many such mutants expressed by transcription/translation are subject to generalized degradation by the proteasome and a specific limited trimming by an endogenous ATP-independent protease activity. Here, we report the results of partial digestion using trypsin as a mimic for the endogenous non-proteasomal protease and the use of N-terminal protein sequencing to determine the sensitive site. Partial trypsin digestion also provided an indicator of proper folding of the mutant enzyme. For selected mutations the sensitivity to trypsin could be ameliorated by addition of pyridoxal phosphate or aminooxy acetic acid as specific pharmacological chaperones.

Single-cell RNA sequencing identifies molecular targets associated with poor in vitro maturation performance of oocytes collected from ovarian stimulation

STUDY QUESTION

What is the transcriptome signature associated with poor performance of rescue IVM (rIVM) oocytes and how can we rejuvenate them?

SUMMARY ANSWER

The GATA-1/CREB1/WNT signalling axis was repressed in rIVM oocytes, particularly those of poor quality; restoration of this axis may produce more usable rIVM oocytes.

WHAT IS KNOWN ALREADY

rIVM aims to produce mature oocytes (MII) for IVF through IVM of immature oocytes collected from stimulated ovaries. It is not popular due to limited success rate in infertility treatment. Genetic aberrations, cellular stress and the absence of cumulus cell support in oocytes could account for the failure of rIVM.

STUDY DESIGN, SIZE, DURATION

We applied single-cell RNA sequencing (scRNA-seq) to capture the transcriptomes of human in vivo oocytes (IVO) (n = 10) from 7 donors and rIVM oocytes (n = 10) from 10 donors. The effects of maternal age and ovarian responses on rIVM oocyte transcriptomes were also studied. In parallel, we studied the effect of gallic acid on the maturation rate of mouse oocytes cultured in IVM medium with (n = 84) and without (n = 85) gallic acid.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Human oocytes were collected from donors aged 28-41 years with a body mass index of <30. RNA extraction, cDNA generation, library construction and sequencing were performed in one preparation. scRNA-seq data were then processed and analysed. Selected genes in the rIVM versus IVO comparison were validated by quantitative real-time PCR. For the gallic acid study, we collected immature oocytes from 5-month-old mice and studied the effect of 10-μM gallic acid on their maturation rate.

MAIN RESULTS AND THE ROLE OF CHANCE

The transcriptome profiles of rIVM/IVO oocytes showed distinctive differences. A total of 1559 differentially expressed genes (DEGs, genes with at least 2-fold change and adjusted P < 0.05) were found to be enriched in metabolic processes, biosynthesis and oxidative phosphorylation. Among these DEGs, we identified a repression of WNT/β-catenin signalling in rIVM when compared with IVO oocytes. We found that oestradiol levels exhibited a significant age-independent correlation with the IVO mature oocyte ratio (MII ratio) for each donor. rIVM oocytes from women with a high MII ratio were found to have over-represented cellular processes such as anti-apoptosis. To further identify targets that contribute to the poor clinical outcomes of rIVM, we compared oocytes collected from young donors with a high MII ratio with oocytes from donors of advanced maternal age and lower MII ratio, and revealed that CREB1 is an important regulator. Thus, our study identified that GATA-1/CREB1/WNT signalling was repressed in both rIVM oocytes versus IVO oocytes and in rIVM oocytes of lower versus higher quality. Consequently we investigated gallic acid, as a potential antioxidant substrate in human rIVM medium, and found that it increased the mouse oocyte maturation rate by 31.1%.

LARGE SCALE DATA

Raw data from this study can be accessed through GSE158539.

LIMITATIONS, REASONS FOR CAUTION

In the rIVM oocytes of the high- and low-quality comparison, the number of samples was limited after data filtering with stringent selection criteria. For the oocyte stage identification, we were unable to predict the presence of oocyte spindle, so polar body extrusion was the only indicator.

WIDER IMPLICATIONS OF THE FINDINGS

This study showed that GATA-1/CREB1/WNT signalling was repressed in rIVM oocytes compared with IVO oocytes and was further downregulated in low-quality rIVM oocytes, providing us the foundation of subsequent follow-up research on human oocytes and raising safety concerns about the clinical use of rescued oocytes.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by the Collaborative Research Fund, Research Grants Council, C4054-16G, and Research Committee Funding (Research Sustainability of Major RGC Funding Schemes), The Chinese University of Hong Kong. The authors have no conflicts of interest to declare.

The Effect of Stem Structure on Stress Distribution of a Custom-Made Hip Prosthesis

A custom-made hip is essential for the initial stability and longevity which correspond to an optimal stress distribution, since a standard hip cannot always satisfy every patient's need. In order to find out the designing principles of a custom-made hip, a patient's personal features on which the design was based were acquired. In this study, an integrated finite element model of the hip (including ilium, acetabular cup, femoral head, femoral stem, and femur) was created based on the computed tomography (CT) images of this patient. A series model with different stem length, cross-section, and collodiaphyseal angle were analysed under both static and quasi-static loading conditions. Comparing the stress distribution on each part of the hip prosthesis with that of the natural hip before replacement, the optimal stem structure for this patient was found. In addition, the changes of interspace between acetabular cup and femoral head were measured according to dynamic CT images on the healthy side of this patient during a gait cycle. Results correspond to the trail of the maximum contact stress sites, which were mainly located on the superolateral surface of the acetabular cup. This custom-design method can also be adopted for other patients.

Fabrication of porous beta-tricalcium phosphate with microchannel and customized geometry based on gel-casting and rapid prototyping

The tissue engineering scaffolds with three-dimensional porous structure are regarded to be beneficial to facilitate a sufficient supply of nutrients and enable cell ingrowth in bone reconstruction. However, the pores in scaffolds tend to be blocked by the cell ingrowth and result in a restraint of nutrient supply in the further side of the scaffold. An indirect approach of combining the rapid prototyping and gel-casting technique is introduced in this study to fabricate beta-tricalcium phosphate (beta-TCP) scaffolds which not only have interconnected porous structure, but also have a microchannel network inside. The scaffold was designed with customized geometry that matches the defect area, and a double-scale (micropores-microchannel) porous structure inside that is beneficial for cell ingrowth. The scaffolds fabricated have an open, uniform, and interconnected porous architecture with a pore size of 200-400 microm, and posses an internal channel network with a diameter of 600 microm. The porosity was controllable. The compressive yield strength was 4.5 MPa with a porosity of 70 per cent. X-ray diffraction analysis shows that these fabrication processes do not change the crystal structure and chemical composition of beta-TCP. With this technique, it was also possible to fabricate porous scaffolds with desired pore size, porosity, and microchannel, as well as customized geometries by other bioceramics.

JAK2 tyrosine kinase inhibitor AG490 suppresses cell growth and invasion of gallbladder cancer cells via inhibition of JAK2/STAT3 signaling

The Janus kinase-signal transducers and activators of transcription signaling pathway (JAK/STAT pathway) have displayed a critical role in tumor development and progression in multiple malignancies. Previous studies showed that inhibition of JAK/STAT signaling blocked cell growth and metastasis in cancer cells, however, the antitumor effects of JAK inhibitor AG490 on gallbladder cancer (GBC) have not been reported. Our present study aimed to investigate the effects and associated mechanisms of JAK inhibitor AG490 on cell growth, invasive potential and apoptosis in GBC cells (GBC-SD and SGC-996) indicated by MTT, cell colony formation, Transwell and flow cytometry. As a consequence, we found that JAK2 inhibitor AG490 inhibited cell growth and invasion, and induced cell apoptosis and cycle arrest in GBC-SD and SGC-996 cells. Furthermore, the expression levels of p-JAK2, p-STAT3, VEGFC-/-D and cyclinD1 were downregulated, while p53 expression was upregulated in AG490-treated GBC cells indicated by Western blot assay. Therefore, our findings demonstrate that JAK inhibitor AG490 inhibits growth and invasion of GBC cells via blockade of JAK2/STAT3 signaling and provides the potential therapeutic strategy for the treatment of GBC patients.

[Exploration on parameters of TCM syndrome in acute cerebral infarction through investigating active factors of vascular endothelium cells]

OBJECTIVE

To explore the multiple parameters of TCM Syndrome-types and the acute cerebral infarction (ACI) with blood stasis type.

METHODS

Sixty-six acute cerebral infarction patients with blood stasis Syndrome, various vascular active factors such as tissue plasminogen activator (t-PA), the activity of plasminogen activator inhibitor (PAI), the concentration of prostaglandin F1 alpha (6-keto-PGF1 alpha) etc. were determined.

RESULTS

(1) In Incidental Syndrome, those "Phlegm" and "stasis" predominant, mainly manifested as Wind-Phlegm-Blood stasis (WPBS), Qi deficiency-blood stasis (QDBS) and Phlegm-Heat-bowel excess (PHBE) Syndrome all showed t-PA activity lowered, among them, QDBS Syndrome lowered more obviously (P < 0.01); and in fundamental deficiency predominant Syndrome such as Yin-deficiency and Wind-move (YDWM) Syndrome, the active t-PA content increased (P < 0.05); in Liver Yang ascending (LYA) Syndrome and YDWM Syndrome, the 6-keto-PGF1 alpha lowered very significantly. (2) Through regression analysis, although influencing the severity of acute blood stasis was related with 3 factors (t-PA activity, nervous system defect score and age growth), but single factor linear relationship analysis indicated that did not existed positive-negative relationship. (3) Through statistical analysis, the factor influencing nervous system defect scores was positively related with blood stasis score (r = 0.70, P < 0.01).

CONCLUSION

(1) The basis of WPBS, QDBS and PHBE Syndrome mainly was fibrinolytic system activity lowering, and YDWM and LYA Syndrome prostaglandin system activity lowering. Comprehensive analysis of multiple parameters would be helpful to differentiate the ACI blood stasis stage. (2) Single parameter would not help to differentiate the types of ACI blood stasis stage, its change merely denoted the existence of blood stasis, its type should be differentiated after comprehensive analysis. (3) Those influencing nervous system scoring, mainly was blood stasis score, which suggested that the importance of activating blood circulation to remove stasis in preventing and treating ACI. (4) Put forward ACI blood stasis, and the quantification for new standard of Syndrome for discussion.

Effect of the oral microbiota, blood metabolome, and inflammatory proteins on oral cavity cancer: a bidirectional two-sample Mendelian randomization study and mediation analysis

OBJECTIVE

Oral Cavity Cancer (OCC) pathogenesis is complex, extending beyond traditional risk factors. While observational studies link oral microbiome dysbiosis, metabolic disturbances, and inflammation to OCC, inherent confounding limits causal inference regarding the putative 'microbiome-metabolite-inflammation' axis in OCC. Establishing causality is crucial.

METHODS

We employed a two-sample Mendelian randomization (MR) framework using large-scale GWAS data to address this gap. We systematically evaluated causal effects of 43 oral microbial taxa, 1400 diverse circulating metabolites, and 91 inflammatory proteins on OCC risk. We performed univariable MR (UVMR) for direct effects, multivariable MR (MVMR) adjusting for interactions, and mediation MR dissecting causal pathways.

RESULTS

UVMR identified protective effects for Clostridiales (OR = 0.89) and Rothia sp. ASV0016 (OR = 0.91), and increased risk for Bacteroidales (OR = 1.09). Furthermore, 60 metabolites (e.g., glycohyocholate increasing risk; 16α-hydroxy DHEAS-3-sulfate decreasing risk) and two proteins (Cystatin D increasing risk, OR = 1.26; MCP-1 decreasing risk, OR = 0.69) showed causal links to OCC. Crucially, mediation analyses indicated protective microbial effects were partially mediated via specific metabolites, including 5α-androstan-3α,17β-diol disulfate (Clostridiales) and carboxyethyl-GABA (Rothia sp.).

CONCLUSIONS

This study provides robust genetic evidence supporting causal roles for specific oral microbes and metabolites in OCC etiology. It offers mechanistic insights into the 'oral microbiome-host metabolism' axis, providing a basis for novel microbiome/metabolite-based biomarkers for early detection and risk assessment, and identifying potential preventative or therapeutic targets.