Changes in Gene Expression of Selected Genes in Patients with Type 1 Diabetes and Pancreas Transplant in Peripheral Blood

BackgroundDiabetes is an autoimmunologic disease that may have a different background. The aim of our study was to show that type 1 diabetes is accompanied by changes in gene expression in peripheral blood mononuclear cells. We analyzed the genes characteristic of pancreatic islet cells and genes playing a big part in autoimmune diseases and cancer.DesignThe study included 21 patients and was performed to examine the expression of 9 genes. The patients were divided into 3 research groups: people with type 1 diabetes, people with diabetes after pancreas transplant, and a control group of healthy patients. To assess the level of expression, RNA material was obtained from peripheral blood collected from individuals qualified for the study.ResultsThe results of the study showed many interesting changes in the expression level of the analyzed genes. It was demonstrated that CASR gene expression was significantly higher in transplant patients than in diabetic patients. Differences in the level of activity are also noted in genes that take part in autoimmune diseases.ProposalProfiling gene expression in peripheral blood samples may be a useful and noninvasive diagnostic tool that allows early detection of changes leading to the onset or resumption of diabetes.     

Efficacy and Safety of Two Neoadjuvant Strategies With Bevacizumab in MRI-Defined Locally Advanced T3 Resectable Rectal Cancer: Final Results of a Randomized,Noncomparative Phase 2 INOVA Study

BackgroundRecurrence and distant metastases remain a significant issue in locally advanced rectal cancer (LARC). Several multimodal strategies are assessed in clinical trials.Patients and MethodsPatients with mid/low magnetic resonance imaging–defined high-risk LARC were randomized to arm A (12-week bevacizumab + FOLFOX-4 then bevacizumab–5-fluorouracil [5-FU]–radiotherapy [RT] before total mesorectal excision [TME]) or arm B (bevacizumab-5-FU–RT then TME). Long-term efficacy and safety up to 5 years’ follow-up are reported. No comparison between arms was planned.ResultsOverall, 91 patients (46 in arm A and 45 in arm B) were included. Main results have been presented previously. During the late follow-up period (> 4 weeks after surgery), 4 patients (8.7%) in arm A and 4 (8.9%) in arm B experienced grade 3/4 adverse events related to bevacizumab; the most frequent were 2 anastomotic fistulas (both in arm A) and abscesses (1 in arm A and 2 in arm B). At 5 years’ follow-up, 9 (19.6%) and 11 (24.4%) patients in arms A and B developed a fistula in the year after surgery, and 2 (4.3%) in arm A at > 1 year after surgery. Most resolved before study end. Five-year disease-free survival was 70% and 64.3% in arms A and B, respectively. Five-year overall survival was 90.5% (95% confidence interval, 76.7, 96.3) in arm A and 72.7% (95% confidence interval, 56.0, 83.9) in arm B.ConclusionNeoadjuvant bevacizumab + FOLFOX-4 may have the potential to increase survival outcomes when followed by bevacizumab–5-FU–RT and TME in LARC. Bevacizumab–5-FU–RT then TME was associated with a higher-than-projected rate of anastomotic fistulas. Further research of neoadjuvant strategies in LARC is encouraged.     

Preoperative versus intraoperative diagnosis of hiatal hernia in bariatric population

BackgroundHiatal hernia is frequently encountered intraoperatively during bariatric surgery. There is scarce research pertaining to the diagnostic accuracy of a preoperative diagnostic modality in comparison to intraoperative diagnosis, along with patient characteristics and related factors contributing to hiatal hernia.ObjectiveTo identify the prevalence and associations of hiatal hernia in the bariatric patient population, we compared the diagnostic accuracy of upper gastrointestinal series and esophagogastroduodenoscopy with the intraoperative findings across various patient characteristics.SettingMetabolic and Bariatric Surgery Accreditation and Quality Improvement Program, Teaching Hospital, New York, USA.MethodsRetrospective study of patients from 2015 to 2018 who met National Institutes of Health criteria for bariatric surgery.ResultsThere were 1094 patients included (135 males, 959 females), with an age range of 18 to 74 years. The diagnostic accuracy was determined by a sensitivity of 64.71% (95% confidence interval [CI] .55–.70), specificity of 74.38% (95% CI .71–.70), positive predictive value of 29.86% (95% CI .24–.30), negative predictive value of 92.59% (95%CI .89–90), likelihood ratio of 2.526, and P value < .0001 for esophagogastroduodenoscopy; a sensitivity of 14.02% (95% CI .08–0), specificity of 98.23% (95% CI .96–.90), positive predictive value of 71.43% (95% CI .50–.80), negative predictive value of 78.35% (95% CI .74–.80), likelihood ratio 7.921, and P value < .0001 were used for upper gastrointestinal series. Hiatal hernia with age <60 years was 17.09% versus 48.44% at >60 years (P < .0001). Hiatal hernia incidence was 17% in Hispanics, 22.5% in Caucasians, and 23.10% in blacks.ConclusionThe prevalence of hiatal hernia is 18.92%. There is strong association between hiatal hernia and age and ethnicity and no association based on sex and body mass index. The diagnostic accuracy of upper gastrointestinal series is very low compared with that of esophagogastroduodenoscopy for hiatal hernia. Preoperative diagnosis of hiatal hernia in the bariatric population is not required based on our study. Not only does it lessen the economic burden, patient wait time, and discomfort of an additional study, but preoperative diagnosis does not change, alter, or aid in the intraoperative management of hiatal hernia considering the suboptimal accuracy of preoperative diagnostics, thus deeming them unwarranted.     

Visfatin as a therapeutic target for rheumatoid arthritis

Introduction: The rising prevalence of musculoskeletal pathologies in developed countries has caused a dramatic impact on social welfare. Amidst these musculoskeletal pathologies is Rheumatoid arthritis (RA), a chronic systemic autoimmune disease that mostly affects the synovium. RA metabolic-associated alterations, including distorted adipokine production, enhance RA inflammatory environment. Among the altered adipokines, visfatin is particularly involved in RA inflammation and catabolism and stands out as an essential enzyme linked to critical cell features.

Areas covered: We discuss the potential mechanism supporting the contribution of visfatin to RA and the association between RA and obesity. We discuss the repurposing of cancer-tested drugs to inhibit visfatin in the context of RA. Additionally, we address the possibility of combining these drugs with current RA therapy. Finally, we explore the future of visfatin as an RA biomarker or therapeutic target.

Expert opinion: Inhibition of visfatin has become an interesting therapeutic approach for RA pathology. Such a feat has already been attained in oncology using small molecule inhibitors, which suggest that a similar course of action would be worth pursuing in the RA context. Visfatin will become an important biomarker and therapeutic target for RA.     

lncRNA FOXD2-AS1通过靶向miR-506-5p调控宫颈癌细胞增殖与凋亡

[摘要] 目的: 探讨长链非编码RNA（lncRNA）FOXD2-AS1 是否通过靶向miR-506-5p 调控宫颈癌细胞增殖和凋亡。方法:体外培养人宫颈癌细胞系HeLa、Siha、Caski 与正常宫颈细胞株Ect1/E6E7，用qPCR检测细胞中FOXD2-AS1 和miR-506-5p 的表达水平。用脂质体转染技术分别构建抑制FOXD2-AS1 表达和过表达miR-506-5p 的宫颈癌细胞，用MTT实验和流式细胞术检测细胞的增殖和凋亡情况，WB实验检测细胞中增殖相关蛋白CyclinD1、p21 和p27 及凋亡相关蛋白Bcl-2、BAX和cleaved-capase-3的表达。用双荧光素酶报告基因实验验证FOXD2-AS1 是否靶向miR-506-5p，并分析同时抑制FOXD2-AS1 和miR-506-5p 表达对宫颈癌细胞增殖与凋亡的影响。结果：与Ect1/E6E7 细胞比较，宫颈癌HeLa、Siha 和Caski 细胞中FOXD2-AS1 表达水平显著升高，miR-506-5p 表达水平降低（均P<0.01）。抑制FOXD2-AS1 表达可显著抑制宫颈癌细胞中CyclinD1 蛋白和Bcl-2 蛋白表达，并促进p21、p27 和BAX、cleaved-capase-3 蛋白的表达，抑制细胞增殖并促进细胞凋亡（均P<0.01）。过表达miR-506-5p 可显著抑制宫颈癌细胞中CyclinD1 和Bcl-2 蛋白表达，促进p21 和BAX蛋白表达，抑制细胞增殖并促进细胞凋亡（均P<0.01）。双荧光素酶报告基因实验证实宫颈癌细胞中FOXD2-AS1 靶向负调控miR-506-5p 的表达（P<0.01）。抑制miR-506-5p 表达逆转了抑制FOXD2-AS1 表达对宫颈癌细胞增殖和凋亡的作用（P<0.01）。结论: FOXD2-AS1 通过靶向miR-506-5p 的表达调控宫颈癌细胞的增殖和凋亡。     

他克莫司和雷帕霉素对肝癌肝移植患者Foxp3+ Treg的影响及防治排斥反应的研究

目的 探讨免疫抑制剂他克莫司和雷帕霉素对肝癌肝移植受者Foxp3+ Treg产生的影响及其防治排斥反应的疗效.方法 自移植后第2个月到第12个月,每月采血,采用实时荧光定量PCR法检测他克莫司组和雷帕霉素组肝癌肝移植受者新鲜外周血单个核细胞中Foxp3 mRNA的表达水平,通过同期术后观察和实验室检查,比较两组受者间Foxp3 mRNA表达水平和急性排斥反应发生率的差异.结果 他克莫司组受者的外周血单个核细胞中Foxp3 mRNA表达水平(0.1032±0.0943)明显低于雷帕霉素组受者(1.2136±0.6738),差异有统计学意义(t=5.1610,P＜0.01);雷帕霉素组患者比同期他克莫司组受者术后急性排斥反应发生率明显减低,差异有统计学意义(x2=2.2222,P＜0.05).结论 他克莫司抑制了肝癌肝移植术后免疫耐受的诱导,而雷帕霉素可能参与了免疫耐受的诱导和维持;雷帕霉素对肝癌肝移植受者防治排斥反应的效果更好.     

EFFECTS OF NITRIC OXIDE SYNTHESIS INHIBITION ON FK506-INDUCED NEPHROTOXICITY IN RATS

This study was designed to evaluate the role of nitric oxide (NO) in FK506-induced nephrotoxicity by administering an inhibitor of NO synthesis, Nω-nitro-L-arginine methyl ester (L-NAME) to rats treated with FK506. After one week of treatment with FK506 (3.2 mg/kg/day, intramuscularly) and/or L-NAME (5 mg/100 mL of L-NAME in the drinking water), the arterial pressure, urinary NOx, and parameters for renal function were measured, and histological analysis of the kidney was made. In the L-NAME without FK506 group, L-NAME administration effectively inhibited urinary NOx excretion and increased mean arterial pressure (MAP) without any change in renal function. In the FK506 without L-NAME group, FK506 treatment showed increase in urinary NOx excretion and mild renal dysfunction. In the FK506 with L-NAME group, urinary NOx excretion was decreased by L-NAME administration and renal function was significantly worsened than FK506 without L-NAME group. The plasma creatinine, BUN and urinary N-acetyl-β-D-glucosaminidase increased 2-, 3-, and 3-fold, respectively and the creatinine clearance was reduced by 50% as compared with that in the FK506 without L-NAME group. Histological analysis revealed severe interstitial fibrosis and tubular atrophy in the FK506 + L-NAME treatment group. Thus, results suggest that NO synthesis is enhanced in the kidney during FK506-induced nephrotoxicity and that NO synthesis inhibition aggravates FK506-induced nephrotoxicity. NO may play a protective role attributable to the balance of vasoactive substances in FK506-induced nephrotoxicity.     

Targeting the PI3K/AKT/mTOR pathway in biliary tract cancers: A review of current evidences and future perspectives

Biliary tract cancers (BTCs) are a group of invasive neoplasms, with increasing incidence and dismal prognosis. In advanced disease, the standard of care is represented by first-line chemotherapy with cisplatin and gemcitabine. In subsequent lines, no clear recommendations are currently available, highlighting the need for novel therapeutic approaches.The PI3K/AKT/mTOR pathway is a core regulator of cell metabolism, growth and survival, and is involved in BTCs carcinogenesis and progression. Mutations, gene copy number alterations and aberrant protein phosphorylation of PI3K, AKT, mTOR and PTEN have been thoroughly described in BTCs and correlate with poor survival outcomes.Several pre-clinical evidences state the efficacy of PI3K/AKT/mTOR pathway inhibitors in BTCs, both in vitro and in vivo. In the clinical setting, initial studies with rapamycin analogs have shown interesting activity with an acceptable toxicity profile. Novel strategies evaluating AKT and PI3K inhibitors have risen serious safety concerns, pointing out the need for improved patient selection and increased target specificity for the clinical development of these agents, both alone and in combination with chemotherapy.This review extensively describes the role of the PI3K/AKT/mTOR pathway in BTCs and examines the rationale of its targeting in these tumors, with particular focus on clinical activity, toxicities and perspectives on further development of PI3K/AKT/mTOR pathway inhibitors.