Determination of eleven components in rat plasma by UPLC-MS/MS and GC-MS for pharmacokinetic studies after oral administration of Citri Reticulatae Pericarpium extract.

Citri Reticulatae Pericarpium (CRP) is used as common health-care food and traditional Chinese medicine (TCM), which exerts pharmacological effects, such as anti-cardiovascular, anti-tumor, anti-oxidant, anti-inflammatory, anti-virus, hepatoprotective, blood pressure-lowering and neuroprotective. In this study, reliable, and sensitive ultra-high performance liquid chromatography/tandem mass spectrometry (UPLC-MS/MS) and gas chromatography-mass spectrometry (GC-MS) methods were developed and validated for the determination of eleven active components in rat plasma after oral administration of the CRP extract. The results of this method exhibited that the specificity, linearity (r > 0.999), precision and accuracy (the coefficient of variation (CV) < 11.5 %), recovery (52.9-107.9 %), matrix effects (63.8-107.5 %), and stability (CV < 10.8 %) met all requirements for the quantitation of plasma samples. The pharmacokinetic results showed that the Tmax of flavone glycosides was less than 0.7 h, and that of polymethoxyflavones and volatile components were within 1-7 h. Meanwhile, the area-under-the-curve (AUC) and concentration maximum (Cmax) of hesperidin, nobiletin, tangeretin, and D-limonene were higher than those of the other components, suggesting that the plasma exposure levels of these constituents were higher in CRP. The present research lays a foundation for elucidating the therapeutic material basis and provides a reference for further scientific research and clinical application of CRP.

Gliotransmission and adenosine signaling promote axon regeneration.

How glia control axon regeneration remains incompletely understood. Here, we investigate glial regulation of regenerative ability differences of closely related Drosophila larval sensory neuron subtypes. Axotomy elicits Ca2+ signals in ensheathing glia, which activates regenerative neurons through the gliotransmitter adenosine and mounts axon regenerative programs. However, non-regenerative neurons do not respond to glial stimulation or adenosine. Such neuronal subtype-specific responses result from specific expressions of adenosine receptors in regenerative neurons. Disrupting gliotransmission impedes axon regeneration of regenerative neurons, and ectopic adenosine receptor expression in non-regenerative neurons suffices to activate regenerative programs and induce axon regeneration. Furthermore, stimulating gliotransmission or activating the mammalian ortholog of Drosophila adenosine receptors in retinal ganglion cells (RGCs) promotes axon regrowth after optic nerve crush in adult mice. Altogether, our findings demonstrate that gliotransmission orchestrates neuronal subtype-specific axon regeneration in Drosophila and suggest that targeting gliotransmission or adenosine signaling is a strategy for mammalian central nervous system repair.

A Non-Immunized and BSA-Template Aggregation-Induced Emission Sensor for Noninvasive Detection of Cystatin C in the Clinical Diagnosis of Diabetes Nephropathy.

Diabetes nephropathy (DN) is one of the main causes of death in patients with diabetes. Cystatin C (Cys C) is a reliable indicator of glomerular filtration function. Therefore, it is urgent and meaningful to obtain early warning of DN by noninvasive measurement of Cys C. In this investigation, a novel fluorescence sensor (BSA-AIEgen sensor) was synthesized by cross-linking the aggregation-induced emission (AIE) characteristics of 2-(4-bromophenyl)-3-(4-(4-(diphenylamino) styryl) phenyl) fumaronitrile (TPABDFN) and bovine serum albumin (BSA), which exhibited the "On" state owing to the restriction of the intramolecular motions (RIM) phenomenon of TPABDFN. Intriguingly, a decrease in fluorescence of BSA-AIEgen sensors could be found owing to BSA on the surface of BSA-AIEgen sensor hydrolyzed by papain, but a reverse phenomenon emerged with the increase of Cys C content as the inhibitor of papain. Hence, Cys C was successfully detected by employing the fluorescent differential display and the linear range was from 12.5 ng/mL to 800 ng/mL (R2 = 0.994) with the limit of detection (LOD) of 7.10 ng/mL (S/N = 3). Further, the developed BSA-AIEgen sensor successfully differentiates patients with diabetes nephropathy from volunteers with the advantages of high specificity, low cost, and simple operation. Accordingly, it is expected to become a non-immunized method to monitor Cys C for the early warning, noninvasive diagnosis, and drug efficacy evaluation of diabetes nephropathy.

A comprehensive review of the botany, ethnopharmacology, phytochemistry, pharmacology, toxicity and quality control of Perillae Fructus.

ETHNOPHARMACOLOGICAL RELEVANCE: Perilla frutescens (Linnaeus) Britton, Mem. Torrey Bot. Club 5: 277. 1894., is famous as a worldwide plant with multiple medical parts, including leaves, stems, fruits, etc. Perillae Fructus, the desiccative ripe fruit of P. frutescens, is locally called Zisuzi in Chinese Pharmacopoeia. It is a popularly used herb for relieving cough and asthma, dissipating phlegm and treating constipation in some Asian countries, such as China, Japan, India, South Korea, etc. Various chemical compounds were isolated and identified from Perillae Fructus. THE AIM OF THE REVIEW: This review aims to summarize the botany, ethnopharmacological applications, phytochemistry, pharmacology, toxicity and quality control of Perillae Fructus to provide scientific evidence for development and utilization Perillae Fructus. MATERIALS AND METHODS: Relevant information about Perillae Fructus was collected from ScienceDirect, PubMed, Web of science, CNKI, WanFang data, ancient classics and clinical reports. Some electronic databases were also retrieved. RESULTS: Perillae Fructus was exerted to treat cough and asthma in traditional application. It also had the effect on moistening intestine to relieve constipation for tremendous lipid substances. Up to now, 193 compounds have been isolated and identified from Perillae Fructus, mainly including fatty acids, flavonoids, phenolic acids, phytosterols, triterpenoids and volatile oils. As for its pharmacological activities, prevalent traditional applications of Perillae Fructus have been supported by modern pharmacological experiments in vivo or in vitro, such as anti-inflammatory and anti-oxidant effects. Besides, Perillae Fructus also has hypolipidemic, anti-tumor, antibacterial effects, etc. This review will provide a scientific basis for further studies and rational applications of Perillae Fructus in the future. CONCLUSIONS: According to its traditional applications, phytochemicals and pharmacological activities, Perillae Fructus was regarded as a valuable herb for application in medicine and food fields. Although some ingredients have been confirmed to have multiple pharmacological activities, their mechanisms of action are still unclear. Further studies on the material basis and mechanism of action are clearly warranted.

The Relationship Between Short-Term Surrogate Endpoint Indicators and mPFS and mOS in Clinical Trials of Malignant Tumors: A Case Study of Approved Molecular Targeted Drugs for Non-Small-Cell Lung Cancer in China.

Objective: Due to the initiation of the priority review program in China, many antitumor drugs have been approved for marketing based on phase II clinical trials and short-term surrogate endpoint indicators. This study used approved targeted drugs for the treatment of non-small-cell lung cancer (NSCLC) in China as an example to evaluate the association between short-term surrogate endpoints [objective response rate (ORR) and disease control rate (DCR)] and median progression-free survival (mPFS) and median overall survival (mOS). Methods: Five databases, i.e., MEDLINE, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched, for phase II or phase III clinical trials of all molecular targeted drugs that have been marketed in China for the treatment of NSCLC. After screening the literature and extracting information, both univariate and multivariate linear regression were performed on the short-term surrogate indicators and mPFS and mOS to explore the relationship. Results: A total of 63 studies were included (25 studies with only ORR, DCR, and mPFS and 39 studies with ORR, DCR, mPFS, and mOS). In terms of the targeted drugs for the treatment of NSCLC, in addition to the good but not excellent linear relationship between DCR and mOS (0.4 < R2 adj = 0.5653 < 0.6), all other short-term surrogate endpoint indicators had excellent linear relationships with mPFS and mOS (R2 adj≥0.6), while mPFS and mOS had the most excellent linear relationships (R2 adj = 0.8036). Conclusion: For targeted drugs for the treatment of NSCLC, short-term surrogate endpoint indicators such as ORR and DCR may be reliable surrogate indicators for mPFS and mOS. However, whether short-term surrogate endpoint indicators can be used to predict final endpoints remains to be verified.

Downregulation of EZH2 in Trophoblasts Induces Decidual M1 Macrophage Polarization: a Potential Cause of Recurrent Spontaneous Abortion.

Macrophages are known to be pivotal for ensuring the establishment of the immune tolerance microenvironment at the maternal-fetal interface. In particular, trophoblasts stay in close contact with decidual macrophages (DMs), which have been reported to play an active role in the modulation of the polarization of DMs. Thus, any dysfunction of trophoblasts might be associated with certain pregnancy-related complications, such as recurrent spontaneous abortion (RSA). Enhancer of zeste homolog 2 (EZH2) is an important epigenetic regulatory gene that has been previously shown to be related to immune regulation. The present study assessed the expression of EZH2 in villi tissue obtained from healthy controls and RSA patients. Trophoblasts conditioned medium was collected to incubate macrophages differentiated from the THP-1 cell line. The expression and function of EZH2 in trophoblasts were knocked down either by the use of siRNA or GSK126 as an inhibitor. Our results show a significant decrease in the expression of EZH2 in villi tissue from RSA patients as compared to healthy controls. Further, the inhibition of expression or function of EZH2 in trophoblasts promoted M1 macrophage polarization, which might be involved in the pathogenesis of RSA. Moreover, the suppression of EZH2 was found to affect the secretion of immune and inflammatory cytokines in trophoblasts. Altogether, these results indicated the importance of EZH2 in the regulation of immune functions of trophoblasts and thus highlighted its potential to be explored as a therapeutic target to prevent and treat pregnancy loss.

Will the Inducing and Maintaining Remission of Non-biological Agents and Biological Agents Differ for Crohn's Disease? The Evidence From the Network Meta-Analysis.

Background: Several drugs currently are available for the treatment of Crohn's disease, including non-biological agents such as anti-inflammatory agents, steroids, immunosuppressive agents, and biologic agents such as anti-tumor necrosis factor (TNF), anti-α4ß7 integrin, anti-alpha-4 integrin and anti-interleukin 12/23. However, the choice of treatments for induction and maintenance is still a challenge. The relevant comparison between non-biologic agents and biologic agents is few. In our research, we aimed to help making decisions, as well as providing clinicians and patients with medication references. Methods: We searched MEDLINE, Embase, and the Cochrane Central Register of controlled trials for relevant randomized controlled trials published through to July 2020 and systematic reviews published from January 2011 to December 2020. Search results were screened by 2 independent reviewers first by title and abstract and then by full text. Disagreements were resolved through discussion with a third reviewer. Results: 54 randomized controlled trials were included in our analysis. For induction of remission, azathioprine (OR, 3.5; 95% Crl, 1.4-8.9), infliximab (OR, 4.1; 95% Crl, 1.2-16.0), infliximab + azathioprine (OR, 7.0; 95% Crl, 1.2-41.0) and infliximab+ methotrexate (OR, 7.8; 95% Crl, 1.2-65.0) were more effective in first-line therapy than placebo. Adalimumab showed superiority to placebo in second-line therapy, but the range of SD was wide. For maintenance of remission, adalimumab (OR,2.24;95% Crl,1.17-4.76) and azathioprine (OR,2.05; 95% Crl,1.14-3.96) were more effective than placebo. Adalimumab (OR,0.56; 95%Crl,0.27-1.2), budesonide (OR,0.63; 95%Crl,0.26-1.6) and natalizumab (OR,0.65; 95%Crl,0.30-1.4) was associated with less risk of withdrawals when compared with placebo. Conclusion: For induction of remission, azathioprine, infliximab, and infliximab + azathioprine were more effective in first-line therapy. In second-line therapy, adalimumab was more effective but should be interpreted carefully. For maintenance of remission, adalimumab and azathioprine were more effective. Besides, adalimumab, budesonide, natalizumab had lower withdrawals. Therefore, biological agents were not always better than non-biological agents and they have their own advantages in different treatment methods of Crohn's disease.

Binary Eluent Based Vortex-Assisted Matrix Solid-Phase Dispersion for the Extraction and Determination of Multicomponent from Musk by Gas Chromatography-Mass Spectrometry.

A green, flexible, and effective strategy was proposed to quantify four target compounds (muscone, ethyl palmitate, ethyl oleate, and ethylparaben) from musk by binary eluent based vortex-assisted matrix solid-phase dispersion (MSPD) extraction coupled with GC/MS. Single-factor tests and orthogonal design were employed to optimize the MSPD parameters. In addition, the binary eluent system, methanol, and ethyl acetate 3 : 7 (v/v) were used to extract the target analytes. Finally, C 18 was applied as the easily available dispersant and the sample powder was ground for 2 min. Thereafter, the mixture was rapidly extracted with the binary eluents under whirling for 3 min. Eventually, the analysis of the samples was completed within 12 min by GC/MS. All correlation coefficients (r) of four targets were more than 0.9991. The recoveries of all target compounds ranged from 92.8% to 101% while their RSDs were less than 6.94%. There was no significant matrix interference for the analysis. Thus, the combination of vortex-assisted MSPD with GC/MS was considered as a novel, rapid, and environmentally friendly quantitative approach for musk samples.

Chaihu Guizhi Ganjiang Decoction Ameliorates Pancreatic Fibrosis via JNK/mTOR Signaling Pathway.

Pancreatic fibrosis is a pathological characteristic of chronic pancreatitis (CP) and pancreatic cancer. Chaihu Guizhi Ganjiang Decoction (CGGD) is a traditional Chinese medicine, which is widely used in the clinical treatment of digestive diseases. However, the potential anti-fibrosis mechanism of CGGD in treating CP remains unclear. Here, we conducted a series of experiments to examine the effect of CGGD on the CP rat model and primary isolated pancreatic stellate cells (PSCs). The results revealed that CGGD attenuated pancreatic damage, decreased collagen deposition, and inhibited PSC activation in the pancreas of CP rats. However, compared with the CP group, CGGD had no effect on body weight and serum amylase and lipase. In addition, CGGD suppressed autophagy by downregulating Atg5, Beclin-1, and LC3B and facilitated phosphorylation of mTOR and JNK in pancreatic tissues and PSCs. Moreover, the CGGD-containing serum also decreased LC3B or collagen I expression after rapamycin (mTOR inhibitor) or SP600125 (JNK inhibitor) treatment in PSCs. In conclusion, CGGD attenuated pancreatic fibrosis and PSC activation, possibly by suppressing autophagy of PSCs through the JNK/mTOR signaling pathway.

Economic Evaluation of First-Line Atezolizumab for Extensive-Stage Small-Cell Lung Cancer in the US.

Introduction: This study evaluated the cost-effectiveness of atezolizumab + chemotherapy vs. chemotherapy as first-line treatment for extensive-stage small-cell lung cancer (SCLC) in the United States (US). Methods: The three health states partitioned survival (PS) model was used over the lifetime. Effectiveness and safety data were derived from the IMpower133 trial. The parametric survival model and mixture cure model were used for the atezolizumab + chemotherapy group to explore the long-term uncertainty of the effect of immunotherapy, and the parametric survival model was used for the chemotherapy group. Costs were derived from the pricing files of Medicare and Medicaid Services, and utility values were derived from previous studies. Sensitivity analyses were performed to observe model stability. Results: If the mixture cure model was considered for the intervention group, compared with chemotherapy alone, atezolizumab + chemotherapy yielded an additional 0.11 quality-adjusted life-years (QALYs), with an incremental cost of US$84,257. The incremental cost-utility ratio (ICUR) was US$785,848/QALY. If the parametric survival model was considered for the intervention group, atezolizumab + chemotherapy yielded an additional 0.10 QALYs, with an incremental cost of US$84,257; the ICUR was US$827,610/QALY. In the one-way sensitivity analysis, progression-free (PF) and postprogression (PP) utilities were the main drivers. In the scenario analysis (PF utility = 0.673, PP utility = 0.473), the results showed that the ICUR was US$910,557/QALY and US$965,607/QALY when the mixture cure model and parametric survival model was considered for the intervention group, respectively. In the PSA, the probabilities that atezolizumab + chemotherapy would not be cost-effective were 100% if the willingness-to-pay threshold was US$100,000/QALY. Conclusions: The findings of the present analysis suggest that atezolizumab + chemotherapy is not cost-effective in patients receiving first-line treatment for extensive-stage SCLC in the US.

Will the Markov model and partitioned survival model lead to different results? A review of recent economic evidence of cancer treatments.

Introduction: Balancing the high cost of treatment brought about by new therapies has become a problem that needs to be considered. Cost-effectiveness analysis (CEA) is a commonly used method that provides information on the potential value of new cancer treatments. The Markov and partitioned survival (PS) models are commonly used. Whether the results differ between the models in empirical research and the methodological differences remain unclear.Areas covered: A review was conducted to identify Canadian Agency for Drugs and Technologies in Health (CADTH) reports and papers published during the past 5 years that reported full economic evaluations of cancer treatments and used both models. In the included studies, most results except one obtained using the two models did not significantly differ.Expert opinion: Not enough evidence could support that there existed relevant bias in empirical studies about the PS model, and more methodological research and application of empirical research should be performed. We recommended that when individual data are available and the model structure is not complicated, the PS model is more appropriate. Both the PS and Markov models are recommended to assess model structure uncertainty.

CaMK4 promotes abortion-related Th17 cell imbalance by activating AKT/mTOR signaling pathway.

PROBLEM: The balance of the immune microenvironment along the maternal-fetal interface is closely related to pregnancy outcomes, with excessive inflammatory reactions leading to the occurrence of pathological pregnancy outcomes such as abortion. CaMK4 has been reported to play a significant role in autoimmune diseases through the regulation of Th17 cells. However, whether CaMK4 is associated with spontaneous abortion or the immune microenvironment along the maternal-fetal interface remains unclear. METHODS OF STUDY: In this study, we constructed normal pregnancy and LPS-induced abortion models in mice, and a CaMK4 inhibitor called KN-93 was administered to investigate the changes in and mechanisms of the immune response. The expression of CaMK4 was evaluated in the uteroplacental complex and spleen. Furthermore, the infiltration and function of Th17 cells were estimated in peripheral tissues and the uteroplacental complex. RESULTS: The expression of CaMK4 in the uteroplacental complex and spleen was significantly higher in the LPS-treated group than in the normal pregnancy group. KN-93, the CaMK4 inhibitor, reversed fetal resorption and excessive inflammation. In detail, KN-93 led to reduced infiltration of Th17 cells into peripheral tissues and the uteroplacental complex, and the functions of Th17 cells were inhibited. In addition, CaMK4 promoted the AKT/mTOR signaling pathway, which is one of the mechanisms that regulate the immune microenvironment. CONCLUSION: CaMK4 is a critical regulator that promotes the expansion of Th17 cells and enhances their functions through the AKT/mTOR signaling pathway. The inhibition of CaMK4 can reverse the immune imbalance along the maternal-fetal interface and improve pregnancy outcomes.

Economic Evaluation of Cisplatin Plus Gemcitabine Versus Paclitaxel Plus Gemcitabine for the Treatment of First-Line Advanced Metastatic Triple-Negative Breast Cancer in China: Using Markov Model and Partitioned Survival Model.

INTRODUCTION: This study aimed to evaluate the cost-effectiveness of cisplatin plus gemcitabine vs. paclitaxel plus gemcitabine as a first-line treatment for metastatic triple-negative breast cancer in China. METHODS: The Markov model and partitioned survival (PS) model were used, and the study included three health states over the period of a lifetime. Transition probabilities and safety data were derived from the CBCSG006 trial (cisplatin plus gemcitabine vs. paclitaxel plus gemcitabine in patients who had acquired metastatic triple-negative breast cancer). Cost and utility values were derived from previous studies, the Chinese Drug Bidding Database, and healthcare documents. Sensitivity analyses were performed to observe model stability. RESULTS: In the Markov model, compared with paclitaxel plus gemcitabine, cisplatin plus gemcitabine yielded an additional 0.15 QALYs, with an incremental cost of 1976.33 USD. The incremental cost-utility ratio (ICUR) was 12,826.98 USD/QALY (quality-adjusted life year). In the PS model, cisplatin plus gemcitabine yielded an additional 0.17 QALYs with an incremental cost of 2384.63 USD; the incremental cost-utility ratio (ICUR) was 13,867.7 USD/QALY. In the first scenario analysis, in which the 3-year time horizon was used in both arms, the total QALYs in the cisplatin plus gemcitabine group were larger and the costs were lower, indicating that cisplatin plus gemcitabine was superior to paclitaxel plus gemcitabine. In the second scenario, in which the progression-free (PF) utility (during chemotherapy) was 0.76, the PF utility was 0.96, and the post-progression (PP) utility was 0.55, the result obtained with the Markov model showed that the ICUR was 11,063.68 USD/QALY. In the probabilistic sensitivity analysis (PSA) on the Markov model, the probabilities that cisplatin plus gemcitabine would be cost-effective were 48.94-78.72% if the willingness-to-pay threshold was 9776.8 to 29,330.4 USD/QALY. CONCLUSIONS: The findings of the present analysis suggest that cisplatin plus gemcitabine might be much more cost-effective than paclitaxel plus gemcitabine in patients receiving first-line treatment for metastatic triple-negative breast cancer in China.

Is there an efficacy-effectiveness gap between randomized controlled trials and real-world studies in colorectal cancer: a systematic review and meta-analysis.

BACKGROUND: To investigate whether patients with colorectal cancer (CRC) enrolled in randomized controlled trials (RCTs) and real-world studies (RWS) differ in terms of baseline characteristics, leading to an efficacy-effectiveness gap. METHODS: A systematic literature reviews was conducted to identify RCTs and RWS with CRC, treated with bevacizumab (BEV), cetuximab (CET) or oxaliplatin combined with capecitabine (XELOX). Using random-effects meta-analyses compared the baseline characteristics and treatment effects of RCTs and RWS, overall and by drug. Correlation between treatment effects and baseline characteristics and study types were estimated using meta-regression analyses. RESULTS: Two hundred and fifty-three studies were included. Compared with patients enrolled in RWS, the proportion of male patients in RCTs was 0.032 higher (P=0.004), the proportion of patients with Eastern Cooperative Oncology Group (ECOG) performance ≥2 was 0.085 less (P<0.001). No significant differences in treatment effects [progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR)] were found by overall analysis. But the OS of patients in RCTs was 4.184 higher (P=0.023) in the CET group. Meta-regression results showed that OS difference in the CET group was related to the difference in treatment lines, not related to other baseline characteristics and study types. CONCLUSIONS: No efficacy-effectiveness gap was found in CRC between RCTs and RWS. CRC treatment effects Between RCTs and RWS had high consistency.

A Delicate Balance between Bacterial Iron and Reactive Oxygen Species Supports Optimal C. elegans Development.

Iron is an essential micronutrient for all forms of life; low levels of iron cause human disease, while too much iron is toxic. Low iron levels induce reactive oxygen species (ROS) by disruption of the heme and iron-sulfur cluster-dependent electron transport chain (ETC). To identify bacterial metabolites that affect development, we screened the Keio Escherichia coli collection and uncovered 244 gene deletion mutants that slow Caenorhabditis elegans development. Several of these genes encode members of the ETC cytochrome bo oxidase complex, as well as iron importers. Surprisingly, either iron or anti-oxidant supplementation reversed the developmental delay. This suggests that low bacterial iron results in high bacterial ROS and vice versa, which causes oxidative stress in C. elegans that subsequently impairs mitochondrial function and delays development. Our data indicate that the bacterial diets of C. elegans provide precisely tailored amounts of iron to support proper development.