Eomes expression identifies the early bone marrow precursor to classical NK cells.

Natural killer (NK) cells traffic through the blood and mount cytolytic and interferon-γ (IFNγ)-focused responses to intracellular pathogens and tumors. Type 1 innate lymphoid cells (ILC1s) also produce type 1 cytokines but reside in tissues and are not cytotoxic. Whether these differences reflect discrete lineages or distinct states of a common cell type is not understood. Using single-cell RNA sequencing and flow cytometry, we focused on populations of TCF7+ cells that contained precursors for NK cells and ILC1s and identified a subset of bone marrow lineage-negative NK receptor-negative cells that expressed the transcription factor Eomes, termed EomeshiNKneg cells. Transfer of EomeshiNKneg cells into Rag2-/-Il2rg-/- recipients generated functional NK cells capable of preventing metastatic disease. By contrast, transfer of PLZF+ ILC precursors generated a mixture of ILC1s, ILC2s and ILC3s that lacked cytotoxic potential. These findings identified EomeshiNKneg cells as the bone marrow precursor to classical NK cells and demonstrated that the NK and ILC1 lineages diverged early during development.

γδ T cells suppress Plasmodium falciparum blood-stage infection by direct killing and phagocytosis.

Activated Vγ9Vδ2 (γδ2) T lymphocytes that sense parasite-produced phosphoantigens are expanded in Plasmodium falciparum-infected patients. Although previous studies suggested that γδ2 T cells help control erythrocytic malaria, whether γδ2 T cells recognize infected red blood cells (iRBCs) was uncertain. Here we show that iRBCs stained for the phosphoantigen sensor butyrophilin 3A1 (BTN3A1). γδ2 T cells formed immune synapses and lysed iRBCs in a contact, phosphoantigen, BTN3A1 and degranulation-dependent manner, killing intracellular parasites. Granulysin released into the synapse lysed iRBCs and delivered death-inducing granzymes to the parasite. All intra-erythrocytic parasites were susceptible, but schizonts were most sensitive. A second protective γδ2 T cell mechanism was identified. In the presence of patient serum, γδ2 T cells phagocytosed and degraded opsonized iRBCs in a CD16-dependent manner, decreasing parasite multiplication. Thus, γδ2 T cells have two ways to control blood-stage malaria-γδ T cell antigen receptor (TCR)-mediated degranulation and phagocytosis of antibody-coated iRBCs.

A Gata3 enhancer necessary for ILC2 development and function.

The type 2 helper effector program is driven by the master transcription factor GATA3 and can be expressed by subsets of both innate lymphoid cells (ILCs) and adaptive CD4+ T helper (Th) cells. While ILC2s and Th2 cells acquire their type 2 differentiation program under very different contexts, the distinct regulatory mechanisms governing this common program are only partially understood. Here we show that the differentiation of ILC2s, and their concomitant high level of GATA3 expression, are controlled by a Gata3 enhancer, Gata3 +674/762, that plays only a minimal role in Th2 cell differentiation. Mice lacking this enhancer exhibited defects in several but not all type 2 inflammatory responses, depending on the respective degree of ILC2 and Th2 cell involvement. Our study provides molecular insights into the different gene regulatory pathways leading to the acquisition of the GATA3-driven type 2 helper effector program in innate and adaptive lymphocytes.

Linking Endoplasmic Reticular Stress and Alternative Splicing.

RNA splicing patterns in antibody-secreting cells are shaped by endoplasmic reticulum stress, ELL2 (eleven-nineteen lysine-rich leukemia gene 2) induction, and changes in the levels of snRNAs. Endoplasmic reticulum stress induces the unfolded protein response comprising a highly conserved set of genes crucial for cell survival; among these is Ire1, whose auto-phosphorylation drives it to acquire a regulated mRNA decay activity. The mRNA-modifying function of phosphorylated Ire1 non-canonically splices Xbp1 mRNA and yet degrades other cellular mRNAs with related motifs. Naïve splenic B cells will activate Ire1 phosphorylation early on after lipopolysaccharide (LPS) stimulation, within 18 h; large-scale changes in mRNA content and splicing patterns result. Inhibition of the mRNA-degradation function of Ire1 is correlated with further differences in the splicing patterns and a reduction in the mRNA factors for snRNA transcription. Some of the >4000 splicing changes seen at 18 h after LPS stimulation persist into the late stages of antibody secretion, up to 72 h. Meanwhile some early splicing changes are supplanted by new splicing changes introduced by the up-regulation of ELL2, a transcription elongation factor. ELL2 is necessary for immunoglobulin secretion and does this by changing mRNA processing patterns of immunoglobulin heavy chain and >5000 other genes.

Tissue-Specific Analysis of Secondary Metabolites Creates a Reliable Morphological Criterion for Quality Grading of Polygoni Multiflori Radix.

In commercial herbal markets, Polygoni Multiflori Radix (PMR, the tuberous roots of Polygonum multiflorum Thunb.), a commonly-used Chinese medicinal material, is divided into different grades based on morphological features of size and weight. While more weight and larger size command a higher price, there is no scientific data confirming that the more expensive roots are in fact of better quality. To assess the inherent quality of various grades and of various tissues in PMR and to find reliable morphological indicators of quality, a method combining laser microdissection (LMD) and ultra-performance liquid chromatography triple-quadrupole mass spectrometry (UPLC-QqQ-MS/MS) was applied. Twelve major chemical components were quantitatively determined in both whole material and different tissues of PMR. Determination of the whole material revealed that traditional commercial grades based on size and weight of PRM did not correspond to any significant differences in chemical content. Instead, tissue-specific analysis indicated that the morphological features could be linked with quality in a new way. That is, PMR with broader cork and phloem, as seen in a transverse section, were typically of better quality as these parts are where the bioactive components accumulate. The tissue-specific analysis of secondary metabolites creates a reliable morphological criterion for quality grading of PMR.

Tissue-specific metabolite profiling of benzylisoquinoline alkaloids in the root of Macleaya cordata by combining laser microdissection with ultra-high-performance liquid chromatography/tandem mass spectrometry.

RATIONALE: Tissue-specific metabolite profiling helps to find trace alkaloids masked during organ analysis, which contributes to understanding the alkaloid biosynthetic pathways in vivo and evaluating the quality of medical plants by morphology. As Macleaya cordata contains diverse types of benzylisoquinoline alkaloids (BIAs), the alkaloid metabolite profiling was carried out on various tissues of the root. METHODS: Laser microdissection with fluorescence detection was used to recognize and dissect different tissues from the root of M. cordata. Ultra-high-performance liquid chromatography/quadrupole time-of-flight mass spectrometry was applied to analyze the trace alkaloids in tissues. These detected alkaloids were elucidated using their accurate molecular weights, MS/MS data, MS fragmentation patterns and the known biosynthetic pathways of BIAs. Finally, the distribution of alkaloids in dissected tissues and whole sections was mapped. RESULTS: Forty-nine alkaloids were identified from five microdissected tissues, and 24 of them were detected for the first time in M. cordata. Some types of alkaloids occurred specifically in dissected tissues. More alkaloids were detected in the cork and xylem vascular bundles which emit strong fluorescence under fluorescence microscopy. Some of the screened alkaloids were intermediates in sanguinarine and chelerythrine biosynthetic pathways, and others were speculated to be involved in the new branches of biosynthetic pathways. CONCLUSIONS: The integrated method is sensitive, specific and reliable for determining trace alkaloids, which is also a powerful tool for metabolite profiling of tissue-specific BIAs in situ. The present findings should contribute to a better understanding of the biosynthesis of BIAs in M. cordata root and provide scientific evidence for its quality evaluation based on morphological characteristics. Copyright © 2016 John Wiley & Sons, Ltd.

Comparison of chemical profiles between the root and aerial parts from three Bupleurum species based on a UHPLC-QTOF-MS metabolomics approach.

BACKGROUND: Bupleuri Radix (Chaihu) represents one of the most successful and widely used herbal medicines in Asia for the treatment of many diseases such as inflammatory disorders and infectious diseases over the past 2000 years. In the Chinese Pharmacopoeia, Chaihu is recorded as the dried roots of Bupleurum chinense DC. and B. scorzonerifolium Willd. (Umbelliferae). However, the widespread demand for the herb has tended to far outstrip the supply. Whether the aerial parts, which account for 70 ~ 85% of the dry weights of Bupleurum species, could be used as an alternative for the root has become an important scientific issue for the sustainable utilization of Bupleurum species. On the other hand, in some areas including the southeast of China as well as in Spain, the aerial parts of Bupleurum species have already been used in the folk medications. Therefore, to clarify whether the root and aerial parts of Bupleurum species are "equivalent" in the types and quantities of chemical constituents which subsequently influence their biological activities and therapeutic effects is of great importance for both the rational and sustainable use of this herb. METHODS: In the present study, the chemical profiles between the root and aerial parts of Bupleurum species from different species and collected from various locations were analyzed and compared by the ultra-high performance liquid chromatography quadrupole/time of flight-mass spectrometry (UHPLC-QTOF-MS). RESULTS: A total of 56 peaks were identified in the root and/or aerial parts from different batches of Bupleurum species, by comparison of references standards or with those reported in the literature. Principal Component Analysis (PCA) was conducted for displaying the differentiating clustering between these two parts. CONCLUSION: The results disclosed the distinct variations between them, which indicated that the aerial parts could not be used as an alternative of root from a chemodiversity perspective. The differentiating markers resulted from the PCA analysis could also be utilized for the differentiation between them. Further validation of their biological differences is anticipated in the future study.

[Investigation of genus Ardisia in Bencao literature].

Based on a systematic review of morphology and distribution of plants, alternate names, actions, and properties of herbs recorded in ancient and modern literatures, in combination of field investigation, 18 Chinese herbal medicines recorded in ancient bencao literature were regarded to be derived from 7 species in the Ardisia genus. Among them, the variety Ardisia crenata f. hortensis was identified as the source of Zhushagen and Zijinniu. A. hanceana is referenced as Tiesan in the illustrated atlas of Botanical Nomenclature (Zhiwu Mingshi Tukao). The name Pingdimu refers to a different substance in the illustrated atlas of Botanical Nomenclature and the Flower Mirror (Huajing). The medicinals named Yedihong, Aicha, and Duanjiao sanlangare all derived from A. japonica. The origin of the herb Xiaoqing referenced in the Illustrated Classic of the Materia Medica (Bencao Tujing) is A. pusilla. The medicinals Bailiangjin, Jiuguanxue and Zoumatai are derived from A. crispa, A. brevicaulis, and A. gigantifolia, respectively. This investigation clarifies the botanical sources and actions of related Chinese medicinal materials in the genus Ardisia, and provides clues and evidence for utilizing and developing their medicinal plant resources.

Distributive and Quantitative Analysis of the Main Active Saponins in Panax notoginseng by UHPLC-QTOF/MS Combining with Fluorescence Microscopy and Laser Microdissection.

The distribution of the secondary metabolites in different tissues of Panax notoginseng has not yet been investigated. Furthermore, there is no scientific evidence available for the quality assessment of P. notoginseng. This is the first study on the tissue-specific chemicals to identify and determinate the main secondary metabolite profiling of P. notoginseng in order to provide more information for quality evaluation. In this study, the ultrahigh-performance liquid chromatography quadrupole time-of-flight mass spectrometry approach combined with fluorescence microscopy and laser microdissection was developed and validated for distributive and quantitative analyses of the main active saponins of different tissues from P. notoginseng. The results showed that the total content of notoginsenoside R1, ginsenoside Rg1, ginsenoside Rb1, and ginsenoside Rd in the xylem were higher than those in the cork, phloem, and cortex. There was no significant difference in the distribution of saponins between the main roots and the branch roots of the fresh unprocessed materials, nor was there a significant difference in their distribution between the main roots from the fresh unprocessed vs. the dried processed commercial materials. This method illustrated the distribution pattern of the main saponins in the tissues of P. notoginseng, which could help to explain the relationship between its anatomical structures, morphological characteristics, and quality. In summary, this study has significance for the procurement, collection, cultivation, effective management, and quality control of P. notoginseng.

[Chemical variation in Aurantii Fructus before and after processing based on UHPLC-Q-TOF-MS].

To explore the processing mechanism of Aurantii Fructus decoction pieces used in Guangdong province and Hong Kong by analysing the chemical variation between raw and processed Aurantii Fructus with different methods based on UHPLC-Q-TOF-MS. The total ion chromatograms detected in positive and negative ion modes, and ion peak area ratio before and after processing were taken as variation indexes in the comparison. The results indicated that fermented Aurantii Fructus could produce three new ingredients, namely eriodictyol-7-glucoside, hesperetin-7-O-glucoside and 5-demethylnobiletin. At the same time, it could significantly increase the content of naringenin and hesperetin components, and could increase the content of such limonin derivatives as sudachinoid A, obacunoic acid and limoninand nomilinic acid. This suggests that the fermentation processing method of Aurantii Fructus decoction pieces used in Guangdong province and Hong Kong is of important significance for enhancing biological activity and bioavailability, and improving the clinical efficacy of Aurantii Fructus decoction pieces, and so is worth further protection and promotion.

Metabolite profiling of tissues of Acorus calamus and Acorus tatarinowii rhizomes by using LMD, UHPLC-QTOF MS, and GC-MS.

Acorus calamus and its related species are of significant importance to the food and fragrance industries due to their varied applications. They are also a cause of critical concern due to their toxic ß-asarone content. Several toxicity cases have occurred due to high ß-asarone compositions in food products. Hence, limits for their use are strictly regulated by the Food and Drug Administration, the European Union, and legislations of different countries. The identification of species with a lower ß-asarone content is of great significance. In this report, the metabolite profiles and essential oil content of A. calamus and Acorus tatarinowii rhizomes were analysed and compared using UHPLC-QTOF-MS and GC-MS techniques. The metabolite profiles were similar; however, ß-asarone content was higher in A. calamus rhizomes. The developed methods can be applied for microscopic and macroscopic identification, and quality control of food products containing ß-asarone.

Chemical differentiation and quality evaluation of commercial Asian and American ginsengs based on a UHPLC-QTOF/MS/MS metabolomics approach.

INTRODUCTION: Asian and American ginsengs are widely used medicinal materials and are being used more and more in health products. The two materials look alike but function differently. Various forms of both types of ginseng are found in the market, causing confusion for consumers in their choice. OBJECTIVE: To evaluate the overall quality of commercial Asian and American ginsengs and investigate the characteristic chemical markers for differentiating between them. METHODS: This article investigated 17 Asian and 21 American ginseng samples using an ultra-HPLC combined with quadrupole time-of-flight MS/MS technique. The data were processed by principal component analysis and orthogonal partial least squared discriminant analysis. RESULTS: In the chromatograms, a total of 40 peaks were detected. Among them, six were positively identified, and all of the remainder were tentatively identified. According to statistical results, ginsenosides Rf, Rb2 and Rc together with their isomers and derivatives were more likely to be present in Asian ginsengs, whereas ginsenoside Rb1 , pseudoginsenoside F11 and ginsenoside Rd together with their isomers and derivatives tended to be present in American ginsengs. For Asian ginsengs, ginsenoside Ra3 and 20-ß-D-glucopyranosyl-ginsenoside-Rf were more likely to be present in forest samples, whereas contents of floralquinquenoside B, ginsenosides Ro and Rc, and zingibroside R1 were higher in sun-dried ginsengs. For American ginseng, wild samples often had more of the notoginsenosides R1 and Rw2 and less of the ginsenosides Rd, Rd isomer and 20 (S)-Rg3 than cultivated samples. CONCLUSION: The method provided important fingerprint information for authentication and evaluation of Asian and American ginsengs from various commercial products.

[Inheritance and innovation of traditional Chinese medicinal authentication].

Chinese medicinal authentication is fundamental for the standardization and globalization of Chinese medicine. The discipline of authentication addresses difficult issues that have remained unresolved for thousands of years, and is essential for preserving safety. Chinese medicinal authentication has both scientific and traditional cultural connotations; the use of scientific methods to elucidate traditional experience-based differentiation carries the legacy of Chinese medicine forward, and offers immediate practical significance and long-term scientific value. In this paper, a path of inheritance and innovation is explored through the scientific exposition of Chinese medicinal authentication, featuring a review of specialized publications, the establishment of a Chinese medicine specimen center and Chinese medicinal image databases, the expansion of authentication technologies, and the formation of a cultural project dedicated to the Compedium of Materia Medica.

Tissue-specific metabolite profiling of Turmeric by using laser micro-dissection, ultra-high performance liquid chromatography-quadrupole time of fight-mass spectrometry and liquid chromatography-tandem mass spectrometry.

Curcuma longa L. is recognized for its therapeutic and culinary uses both in Ayurveda and traditional Chinese medicine and is considered to be a boon to mankind. It has been extensively studied for its benefits and still continues to be an important drug with continued potential for further exploration and research. We studied the tissue-specific distribution of secondary metabolites to establish the validity of the use of rhizome samples from India and China, as substitutes for each other, based upon their metabolite profiles and curcumin contents. Laser microdissection was used for the isolation of microscopic tissues, such as cork, cortex and leaf-trace vascular bundles from rhizomes. Metabolite profiling was carried out by ultra-high performance liquid chromatography-quadrupole time of fight-mass spectrometry and curcumin content was estimated by a method validated as per the Harmonized Tripartite Guidelines. The cortex and cork revealed the presence of a higher number of secondary metabolites than in the leaf-trace vascular bundles. The curcumin contents in rhizome samples from both the countries, estimated with the help of a precise and accurate validated method, were found to be comparable. Based on the results, we conclude that turmeric rhizomes grown in India and China are qualitatively and quantitatively indistinguishable and therefore can be used as substitutes. The developed method can be widely applied for microscopic identification, authentication and analysis of the distribution of phytoconstituents in other botanical species of interest or of species with a significant commercial and therapeutic value.

A comparative tissue-specific metabolite analysis and determination of protodioscin content in Asparagus species used in traditional Chinese medicine and Ayurveda by use of laser microdissection, UHPLC-QTOF/MS and LC-MS/MS.

INTRODUCTION: Asparagus is esteemed in Traditional Chinese Medicine and Ayurveda, and it is commercially one of the most important drugs in the global herbal market. Comparative metabolite profiling of different species would help in determining the similarities and ascertain their validity for being used as substitutes for each other. Laser microdissection (LMD) facilitates identification of metabolites in specific tissues, and thus it can aid in exploration of metabolic pathways in target tissues. OBJECTIVE: To compare tissue-specific metabolites and protodioscin content of Asparagus cochinchinensis (Lour.) Merr. and Asparagus racemosus Willd. used in China and India. METHODS: Metabolite analysis of laser-dissected tissues was carried out using UHPLC-QTOF/MS and LC-MS/MS. The protodioscin contents were determined and the method was validated as per the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use guidelines. RESULTS: Metabolite analysis reveals that the velamen tissue, among other tissues such as cortex, vascular bundles and pith, contained maximum components, specifically those belonging to the steroidal saponin class. Although the metabolite profiles were similar, the content of protodioscin was found to be higher in Chinese than Indian species. CONCLUSION: The study provided a suitable methodology for metabolite profiling and protodioscin content determination of Asparagus by use of LMD, UHPLC-QTOF/MS and LC-MS/MS. The similarities in metabolite profiles indicate that Asparagus species from India and China can serve as substitute for each other in various therapeutic and pharmaceutical applications.

Profiling of secondary metabolites in tissues from Rheum palmatum L. using laser microdissection and liquid chromatography mass spectrometry.

Evaluating the quality of herbal medicines by morphological features is a convenient, quick, and practical method compared with other methods that mostly depend on modern instruments. Here, laser microdissection and ultra-performance liquid chromatography are combined with mass spectrometry to map the distribution of secondary metabolites in cells or tissues of a herb itself for correlating its bioactive components and morphological features. The root and rhizome of Rheum palmatum L. were taken as research target, which is the Chinese medicine, Radix et Rhizoma Rhei. According to fluorescent microscopic characteristics, 12 herbal cells or tissues of Radix et Rhizoma Rhei were separated by laser microdissection. Thirty-eight compounds were identified or tentatively characterized in the microdissected tissues. (+)-Catechin, 1-O-galloyl-2-O-cinnamoyl-ß-D-glucose, and emodin were found to be the major components in most of the tissues. The brown ergastic substances found in rays of normal and anomalous vascular bundles as well as the parenchymatous cells of rhizome pith and the parenchymatous cells of root xylem contained higher than average amounts of these three components and more kinds of secondary metabolites. Overall, results suggest that Radix et Rhizoma Rhei of larger size and with conspicuous "brocaded patterns" and star spots are of higher quality as they tend to have greater contents of bioactive components. The study provides quantitative and specific criteria by which the quality of Radix et Rhizoma Rhei can be judged. This research also established a new, reliable, and practical method for direct profiling and imaging of secondary metabolites in any herbal tissue.

Characterization of secondary metabolites from the raphides of calcium oxalate contained in three araceae family plants using laser microdissection and ultra-high performance liquid chromatography-quadrupole/time of flight-mass spectrometry.

The dried stem tubers of Pinellia ternata (Thunb.) Breit, P. pedatisecta Schott and Typhonium flagelliforme (Lodd.) Blume from the Araceae family are used as Chinese medicines, namely Banxia, Zhangye Banxia and Shui Banxia, respectively. They have been reported to have a strong irritative effect on mucosa. Previous studies have indicated that the pure raphides of calcium oxalate contained in the stem tubers of three plants have attributed to this strong irritation. However, the processed products of the stem tubers of P. ternata, including Fabanxia, Qingbanxia and Jiangbanxia, have been found to have no irritative effects on mucosa. Currently, the secondary metabolites from the raphides of calcium oxalate contained in the stem tubers of P. ternata with its processed products, P. pedatisecta and T. flagelliforme were analyzed by means of laser microdissection and ultra-high performance liquid chromatography-quadrupole/ time of flight-mass spectrometry. The results indicate that the stem tubers of P. ternata P. pedatisecta and T. flagelliforme mainly contain amino acids, fatty acids, cyclic dipeptides and alkaloids. The secondary metabolite profile of the stem tuber of P. ternata was different from those of its processed products, Fabanxia, Qingbanxia and Jiangbanxia. However, the secondary metabolites from their raphides of calcium oxalate all contained beta-sitosterol, sitosterol palmitate, trigonelline, octadecenoic acid, pedatisectine A and thymidine. The raphides of calcium oxalate from P. ternata, P. pedatisecta and T. flagelliforme do not include any specific irritants. The results indicated that the irritation induced by raphides of calcium oxalate of three Araceae family plants is not relevant to the secondary metabolites but relates to the special needle shape.

Quantitative comparison of multiple components in Dioscorea nipponica and D. panthaica by ultra-high performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry.

INTRODUCTION: Dioscorea nipponica (DN) and D. panthaica (DP) have been uniquely prepared as herbal medicinal products for treating coronary heart disease (CHD) in China. However, so far there has been little discussion and no work comparing the qualitative and quantitative differences between the two herbs nor assessing whether they have similarities in chemical composition that would support their common application for treating CHD. OBJECTIVE: To develop an efficient and reliable method based on UPLC-qTOF-MS for quantitative comparison of saponins in both DN and DP. METHODS: Using electrospray ionisation and atmospheric-pressure chemical ionisation respectively, six steroidal glycosides and one aglycone were determined in 13 DN samples and 13 DP samples. The comparative analysis of chemical components in DN and DP was carried out by chromatographic fingerprint similarity evaluation, test of significance (t-test) and principle component analysis (PCA). RESULTS: The UPLC-qTOF-MS method showed limit of detection and quantitation within the range 0.02-0.2 ng and 0.08-0.5 ng, respectively, for the seven saponins studied. The intra- and interday precision (RSD) were below 5%. The recoveries for the quantified compounds were within the range of 72.79-118.31%. CONCLUSION: This UPLC-qTOF-MS assay provides a suitable method for the identification and determination of major bioactive constituents both in DN and DP. The chemical composition of all DN and DP samples studied exhibited a high level of global similarity. This chemical similarity validates their common application in the pharmaceutical industry as anti-CHD herbal drugs.

[Application and advantage of near infrared spectroscopy technology in authentication of Chinese materia medica].

This review introduced the application of near infrared spectroscopy (NIRS) in the identification of species, production area and processing method as well as quality evaluation of Chinese materia medica (CMM). By comparing with other authentication methods of CMM, the NIRS technology showed great advantages in exclusive identification of CMM, both identification and quality evaluation of CMM as well as identification of famous-region medicinal material. Finally, the future direction of the authentication of CMM by NIRS technology was suggested.

Endoscopic tightening of the cardia mucosa in gastroesophageal reflux disease: A case series of 120 patients up to 1-year follow-up.

Background and Aim: A technique of endoscopic tightening of the cardia mucosa for the treatment of gastroesophageal reflux disease (GERD) was developed and its clinical efficacy was observed. Methods: 120 patients with GERD who underwent endoscopic tightening surgery from December 2017 to December 2019 were included in this study. GERD-Q score and constitution type of patients were evaluated preoperatively and at 1 month, 3 months, 6 months, and 1 year after surgery. In addition, effectiveness and side effects of the procedure were graded based on gastroesophageal flap valve (GEFV) function. Results: GERD-Q score of 1 month, 3 months, 6 months, and 1 year after surgery were significantly decreased (P<0.01) compared with preoperative score. There were no significant differences between GERD-Q score of 1 month, 3 months, 6 months, and 1 year after surgery. The surgery proves to be effective in all GEFV grades, especially in Hill-III. Conclusion: Endoscopic tightening is an effective method for the treatment of patients with GERD, especially of Hill-III patients. Attention should be paid to cardia width, ligation ring depth, and ring number during operation. Relevance for Patients: ETCM is a safe endoscopic procedure with minimal trauma, which has been proved effective for patients who are diagnosed with GERD.