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.

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.

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.

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.

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.

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 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.

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.

Development of an artificial intelligent model for pre-endoscopic screening of precancerous lesions in gastric cancer

BACKGROUND

Given the high cost of endoscopy in gastric cancer (GC) screening, there is an urgent need to explore cost-effective methods for the large-scale prediction of precancerous lesions of gastric cancer (PLGC). We aim to construct a hierarchical artificial intelligence-based multimodal non-invasive method for pre-endoscopic risk screening, to provide tailored recommendations for endoscopy.

METHODS

From December 2022 to December 2023, a large-scale screening study was conducted in Fujian, China. Based on traditional Chinese medicine theory, we simultaneously collected tongue images and inquiry information from 1034 participants, considering the potential of these data for PLGC screening. Then, we introduced inquiry information for the first time, forming a multimodality artificial intelligence model to integrate tongue images and inquiry information for pre-endoscopic screening. Moreover, we validated this approach in another independent external validation cohort, comprising 143 participants from the China-Japan Friendship Hospital.

RESULTS

A multimodality artificial intelligence-assisted pre-endoscopic screening model based on tongue images and inquiry information (AITonguequiry) was constructed, adopting a hierarchical prediction strategy, achieving tailored endoscopic recommendations. Validation analysis revealed that the area under the curve (AUC) values of AITonguequiry were 0.74 for overall PLGC (95% confidence interval (CI) 0.71-0.76, p < 0.05) and 0.82 for high-risk PLGC (95% CI 0.82-0.83, p < 0.05), which were significantly and robustly better than those of the independent use of either tongue images or inquiry information alone. In addition, AITonguequiry has superior performance compared to existing PLGC screening methodologies, with the AUC value enhancing 45% in terms of PLGC screening (0.74 vs. 0.51, p < 0.05) and 52% in terms of high-risk PLGC screening (0.82 vs. 0.54, p < 0.05). In the independent external verification, the AUC values were 0.69 for PLGC and 0.76 for high-risk PLGC.

CONCLUSION

Our AITonguequiry artificial intelligence model, for the first time, incorporates inquiry information and tongue images, leading to a higher precision and finer-grained pre-endoscopic screening of PLGC. This enhances patient screening efficiency and alleviates patient burden.

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.

Mechanism of Yinxu Weitong Capsule in the treatment of precancerous lesions of gastric cancer based on network pharmacology and experimental validation

ETHNOPHARMACOLOGICAL RELEVANCE

Yinxu Weitong Capsule (YXWTC) is a Chinese patent medicine used to treat chronic gastritis. However, its efficacy and mechanisms of action in treating precancerous lesions of gastric cancer (PLGC) remain unclear.

AIM OF THE STUDY

To evaluate the effects of YXWTC on PLGC and explore the underlying mechanisms.

MATERIALS AND METHODS

YXWTC components were identified using ultra-high-performance liquid chromatography coupled with electrospray ionization quadrupole-exactive orbitrap mass spectrometry. A PLGC animal model was established and the protective effects of YXWTC on the gastric mucosa in PLGC rats were evaluated using hematoxylin and eosin (H&E), Alcian blue-periodic acid-Schiff and Alcian blue-high iron diamine staining, and transmission electron microscopy (TEM). The vital organs of the rats were examined using H&E staining to evaluate biosafety. Network pharmacology identified potential targets and pathways of YXWTC in PLGC treatment, followed by molecular docking validation. Various techniques, including enzyme-linked immunosorbent assay, real-time quantitative reverse transcription PCR, Western blotting, immunohistochemistry, apoptosis detection, and reactive oxygen species fluorescence staining were employed to elucidate the underlying mechanisms.

RESULTS

In total, 340 YXWTC components were identified. YXWTC effectively improves gastric mucosal pathology in rats with PLGC. Network pharmacology identified 403 targets common to PLGC and YXWTC. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses identified 2,323 biological processes and 206 signaling pathways, respectively. Molecular docking revealed that the primary target proteins and major drug molecules exhibited strong binding affinities. Animal studies demonstrated that YXWTC inhibited the IL-6/STAT3 pathway, promoted mitochondrial apoptosis, and induced ROS release.

CONCLUSIONS

We verified the pharmacodynamic effects of YXWTC in PLGC. In summary, the effects are mediated by inhibition of the IL-6/STAT3 pathway, promotion of mitochondrial apoptosis, and induction of ROS release.

Huopuxialing Decoction: A Promising Candidate for Precancerous Lesions of Gastric Cancer Treatment Based on Bioinformatics and Experimental Verification

BACKGROUND

The Precancerous Lesion of Gastric Cancer (PLGC) is an early stage in the development of gastric cancer. The clinical application of HPXLD has been found to be effective in treating PLGC, but the mechanism of how HPXLD acts on PLGC is still unclear.

OBJECTIVE

The objectives of this study were to reveal the molecular mechanism of how HPXLD can be used to treat PLGC and investigate this mechanism through bioinformatics and experimental validation.

METHODS

PLGC-associated target genes were identified through bioinformatics analysis. A rat model of PLGC was induced using N-methyl-N'-nitro-N-nitrosoquanidine (MNNG) in combination with ranitidine, hot saline, ethanol, and intermittent fasting, with interventions by HPXLD. The pathological alterations in gastric mucosa were assessed through Hematoxylin-eosin staining (HE). Immunohistochemistry (IHC) and Western blot analyses were employed to evaluate the changes in expression levels of inflammation-related proteins.

RESULTS

After conducting bioinformatics analysis, it was found that there were 23 HPXLDPLGC crossover genes, which were significantly enriched in the IL-17 signaling pathway, TNF signaling pathway, and NF-kappa B signaling pathway. The results of HE showed that HPXLD was effective in improving gastric mucosal histopathological changes. Additionally, the IHC results demonstrated that HPXLD was able to downregulate the expression of IL-6, COX-2, MCP- 1, and MMP-9. Furthermore, Western blot analysis revealed that HPXLD was able to downregulate the expressions of IL-6, IL-17RA, ACT1, NF-κB, and TNF-α.

CONCLUSION

HPXLD has been shown to improve PLGC by reducing the expression of inflammation- related proteins. This suggests that HPXLD may potentially be a treatment option for PLGC.

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.

Acid-triggered rattan ball-like β-glucan carrier embedding doxorubicin to synergistically alleviate precancerous lesions of gastric cancer via p53 and PI3K pathways

The early intervention of precancerous lesions of gastric cancer (PLGC) is crucial for improving the survival of patients with gastric cancer. Traditional pharmaceuticals for the treatment of PLGC are limited by side effects, thus developing innovative drug carrier that are more efficient but without the undesirable side effects is required. Here, we proposed an acid-triggered mushroom-derived β-glucan carrier embedding doxorubicin (DOX) to circumvent drug cytotoxicity and synergistically alleviate PLGC based on the controlled conformational transformation. The triple helix β-glucan extracted from Dictyophora rubrovolvata (DRP) loaded doxorubicin driven by pH and DMSO regulation, forming two rattan ball-like nanoparticles (DRP-DOX(pH) and DRP-DOX(DMSO)) via its collapse and recombination of triple-helix conformation. The findings revealed that DRP-DOXs achieved acid-triggerable and sustained drug delivery with an average particle size of 500 nm and 550 nm. In vitro evaluation of GES-1 cells showed DRP-DOXs reduced reactive oxygen species (ROS) production and altered mitochondrial membrane potential. Compared to DRP-DOX(DMSO) and DRP, DRP-DOX(pH) could more effectively downregulate cellular oxidative stress and inflammation to eventually alleviate PLGC, by regulating the p53 and PI3K pathways to mitigate gastric mucosa damage. Consequently, the nature-derived β-glucan delivery nanovesicle holds great promising applications in reducing drug toxicity and suppressing the development of PLGC.

Celastrus orbiculatus Thunb. extract inhibits inflammatory metabolic adaptation in macrophages and regulates polarization via modulating PKM2

Precancerous lesions of gastric cancer (PLGC) are considered critical stages for the prevention and treatment of gastric cancer (GC), with gastric mucosal inflammation being a prerequisite for PLGC. Macrophages, integral to the immune system, typically respond to external stimuli triggering inflammation. Celastrus orbiculatus Thunb. extract (COE) has been shown to exhibit anti-inflammatory effects in treating PLGC. However, it remains unclear how COE modulates macrophage metabolic adaptation and polarization in the inflammatory response to reverse PLGC. This study utilized a composite modeling approach to establish a PLGC mouse model, assessing COE's impact on polarization and metabolic adaptation markers such as inflammatory factors in gastric mucosa and RAW264.7 macrophages. The results confirm that COE significantly reduces M1 macrophage polarization markers while increasing M2 macrophage polarization markers and lowering inflammatory factor levels. Additionally, COE effectively inhibits the expression of pyruvate kinase M2 (PKM2). Our findings suggest that COE may act through regulating PKM2 expression to modulate inflammatory responses and reverse PLGC.

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.

Construction of machine learning-based models for screening the high-risk patients with gastric precancerous lesions

BACKGROUND

The individualized prediction and discrimination of precancerous lesions of gastric cancer (PLGC) is critical for the early prevention of gastric cancer (GC). However, accurate non-invasive methods for distinguishing between PLGC and GC are currently lacking. This study therefore aimed to develop a risk prediction model by machine learning and deep learning techniques to aid the early diagnosis of GC.

METHODS

In this study, a total of 2229 subjects were recruited from nine tertiary hospitals between October 2022 and November 2023. We designed a comprehensive questionnaire, identified statistically significant factors, and created a web-based column chart. Then, a risk prediction model was subsequently developed by machine learning techniques. In addition, a tongue image-based risk prediction model was established by deep learning algorithms.

RESULTS

Based on logistic regression analysis, a dynamic web-based nomogram was developed and it is freely accessible at: https://yz6677.shinyapps.io/GC67/ . Then, the prediction model was established using ten different machine learning algorithms and the Random Forest (RF) model achieved the highest accuracy at 85.65%. According with the predictive results, the top 10 key risk factors were age, traditional Chinese medicine (TCM) constitution type, tongue coating color, tongue color, irregular meals, pickled food, greasy fur, over-hot eating habit, anxiety and sleep onset latency. These factors are all significant risk indicators for the progression of PLGC patients to GC patients. Subsequently, the Swin Transformer architecture was used to develop a tongue image-based model for predicting the risk for progression of PLGC. The verification set showed an accuracy of 73.33% and an area under curve (AUC) greater than 0.8 across all models.

CONCLUSIONS

Our study developed machine learning and deep learning-based models for predicting the risk for progression of PLGC to GC, which will offer the assistance to determine the high-risk patients from PLGC and improve the early diagnosis of GC.

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.

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.

Streptococcus anginosus in the development and treatment of precancerous lesions of gastric cancer

The microbiota is strongly association with cancer. Studies have shown significant differences in the gastric microbiota between patients with gastric cancer (GC) patients and noncancer patients, suggesting that the microbiota may play a role in the development of GC. Although Helicobacter pylori (H. pylori) infection is widely recognized as a primary risk factor for GC, recent studies based on microbiota sequencing technology have revealed that non-H. pylori microbes also have a significant impact on GC. A recent study discovered that Streptococcus anginosus (S. anginosus) is more prevalent in the gastric mucosa of patients with GC than in that of those without GC. S. anginosus infection can spontaneously induce chronic gastritis, mural cell atrophy, mucoid chemotaxis, and heterotrophic hyperplasia, which promote the development of precancerous lesions of GC (PLGC). S. anginosus also disrupts the gastric barrier function, promotes the proliferation of GC cells, and inhibits apoptosis. However, S. anginosus is underrepresented in the literature. Recent reports suggest that it may cause precancerous lesions, indicating its emerging pathogenicity. Modern novel molecular diagnostic techniques, such as polymerase chain reaction, genetic testing, and Ultrasensitive Chromosomal Aneuploidy Detection, can be used to gastric precancerous lesions via microbial markers. Therefore, we present a concise summary of the relationship between S. anginosus and PLGC. Our aim was to further investigate new methods of preventing and treating PLGC by exploring the pathogenicity of S. anginosus on PLGC.

Advances and global trends of precancerous lesions of gastric cancer: A bibliometric analysis

BACKGROUND

Precancerous lesions of gastric cancer (PLGC) represent a critical pathological stage in the development of intestinal gastric cancer. Early detection and diagnosis are key to reducing the incidence of gastric cancer. Substantial advancements have been made in PLGC research in recent years, making it necessary to provide updated reviews using bibliometric methods. We hypothesize that this review will identify emerging trends, key research areas, and gaps in PLGC research, providing insights that could guide future studies and enhance prevention strategies.

AIM

To comprehensively review the current state of research on PLGC, examining development trends and research hotspots.

METHODS

We conducted a bibliometric analysis of PLGC-related studies published between 2004 and 2023 using the Web of Science Core Collection database. We employed Software, including VOSviewer, CiteSpace, R software, and SCImago Graphica, to map scientific networks and visualize knowledge trends in terms of publication volume, countries/regions, institutions, journals, authors, and keywords.

RESULTS

A total of 4097 articles were included, and overall publication volume showed an increasing trend. Over the past two decades, China published the most articles, followed by the United States, Japan, South Korea, and Italy. Among the top 10 contributors, the United States ranked highest in institutions, authors, and citations and demonstrated the strongest international collaboration. Research keywords in this field were clustered into three main categories: Risk factors, pathogenesis, and diagnosis and treatment. Pathogenesis and molecular biomarkers remain key areas of focus. Future research should explore the mechanisms of gut microbiota, immune microenvironment, metabolic reprogramming, and epigenetics. Advanced technologies, including single-cell sequencing, spatially resolved analysis, multi-omics approaches, artificial intelligence, and machine learning, will likely accelerate in-depth investigations of PLGC.

CONCLUSION

PLGC research has rapidly developed in recent years, gaining considerable attention. This bibliometric analysis reveals research state and emerging trends over the past 20 years, providing insights for future studies.