Sorafenib plus triplet therapy with venetoclax, azacitidine and homoharringtonine for refractory/relapsed acute myeloid leukemia with FLT3-ITD: A multicenter phase 2 study.

BACKGROUND: Patients with relapsed or refractory acute myeloid leukemia (R/R AML) and FLT3-internal tandem duplication (FLT3-ITD) respond infrequently to salvage chemotherapy. OBJECTIVE: To investigate the efficacy of sorafenib plus triplet therapy with venetoclax, azacitidine, and homoharringtonine (VAH) as a salvage therapy in this population. METHODS: This multicenter, single-arm, phase 2 study was conducted at 12 hospitals across China. Eligible patients had R/R AML with FLT3-ITD (aged 18-65 years) who were treated with VAH. The primary endpoint was composite complete remission (CRc) after two cycles. Secondary outcomes included the overall response rate (ORR), safety, and survival. RESULTS: Between July 9, 2020, and March 19, 2022, 58 patients were assessed for eligibility, 51 of whom were enrolled. The median patient age was 47 years (interquartile range [IQR] 31-57). CRc was 76.5% with ORR of 82.4%. At a median follow-up of 17.7 months (IQR, 8.7-24.7), the median duration of CRc was not reached (NR), overall survival was 18.1 months (95% confidence interval [CI], 11.8-NR) and event-free survival was 11.4 months (95% CI, 5.6-NR). Grade 3 or 4 adverse events occurring in ≥10% of patients included neutropenia in 47 (92.2%), thrombocytopenia in 41 (80.4%), anemia in 35 (68.6%), febrile neutropenia in 29 (56.9%), pneumonia in 13 (25.5%), and sepsis in 6 (11.8%) patients. Treatment-related death occurred in two (3.9%) patients. CONCLUSIONS: The sorafenib plus VAH regimen was well tolerated and highly active against R/R AML with FLT3-ITD. This regimen may be a suitable therapeutic option for this population, but larger population trials are needed to be explored. TRIAL REGISTRATION: Clinical Trials Registry: NCT04424147.

Transcriptomics and metabolomics revealed the pulmonary protective mechanism of Xixin-Ganjiang Herb Pair for warming the lungs to dissolve phlegm in COPD rats.

Xixin-Ganjiang Herb Pair (XGHP), a classic combination treatment to warm the lungs and dissolve phlegm, is widely used in the treatment of various pulmonary diseases. Chronic obstructive pulmonary disease (COPD) refers to a group of chronic obstructive airway diseases that can seriously harm human health. However, the effective components, targets, and pathways that underlie XGHP in the treatment of COPD remain unclear. Therefore, this study initially identified the effective components of XGHP through the use of UPLC-MS/MS and pharmacologic methods of traditional Chinese medicine. Secondly, transcriptomic analysis of the lung tissues of rats revealed the pharmacodynamic transcripts of each group, and metabolomics analysis revealed the differential metabolites associated with XGHP treatment. Finally, molecular docking of effective components with transcriptome genes was performed and western blotting was performed in order to determine the expression of related proteins in rat lung tissue. Overall, 30 effective components of XGHP were identified, including L-asarinin, 6-gingerol, sesamin, kaempferol, and quercetin. Transcriptomic studies demonstrated that expression of 386 genes recovered after XGHP treatment, and that they were mainly enriched in the oxidative phosphorylation and AMPK signaling pathways. According to the metabolomics studies, expression of eight metabolites differed between the COPD and the XGHP groups. These metabolites were mainly involved the biosynthesis of unsaturated fatty acids. Finally, the transcriptomic and metabolomics data were integrated. FASN and SCD in AMPK signaling pathway were directly linked to certain metabolites, including linoleic acid, palmitic acid, and oleic acid. These results indicate that XGHP can inhibit pAMPK expression and negatively regulate FASN and SCD expression during treatment of COPD in order to enhance the biosynthesis of unsaturated fatty acids and maintain energy homeostasis.

Co-occurrence network in core microorganisms driving the transformation of phosphorous fractionations during phosphorus recovery product used as soil fertilizer.

Phosphorus recovery from water and the subsequent reuse of its products can solve both water eutrophication and phosphorus resource waste issues. However, the potential use of the final recovered products as crop phosphorus fertilizers and the transformation of phosphorus fractions in soils have rarely been analyzed. In this study, the effects of a phosphorus recovery product (w-HC/CSH/P) obtained from our previous phosphorus recovery study on pepper growth were investigated. The association between soil phosphorus fraction transformation and the microbial co-occurrence network was investigated using high-throughput sequencing. The results showed that amendment with w-HC/CSH/P could promote the growth and chlorophyll content of pepper, which exhibited high phosphorus fertilizer efficiency. In addition, applying w-HC/CSH/P in soils could increase the microbial alpha-diversity during pepper cultivation and induce changes in the microbial community, leading to an increase in the relative abundance of Povalibacter, Lysobacter, and GP10 and a decrease in GP17. The proportion of Resin-P and NaHCO3-Po decreased, whereas that of NaOH-Po increased during pepper cultivation. psOTU331 (g_Latescibacteria), psOTU377 (g_Lysobacter), and psOTU461 (g_Pseudoxanthomonas) were the key microorganisms driving the transformation of phosphorus fractionation in the microbial co-occurrence network. Latescibacteria and Lysobacter were closely correlated with the transformation of NaHCO3-Po to NaOH-Po, and Pseudoxanthomonas was significantly correlated with a decrease in Resin-P. These observations highlight the potential of phosphorus recovery products as fertilizer for pepper and provide new insights into the transformation of phosphorus fractions corresponding to the microbiome in soils.