Serum cytokines and creatinine/cystatin C ratio as prognostic biomarkers in advanced cancer patients treated with anti-PD-1/PD-L1 therapy.

OBJECTIVE: Immune checkpoint inhibitors (ICIs), specifically targeting the programmed cell death protein-1 or its ligand (PD-1/PD-L1), have been extensively used in the treatment of a spectrum of malignancies, although the predictive biomarkers remain to be elucidated. This study aims to investigate the association between baseline circulating levels of cytokines and the creatinine/cystatin C ratio (CCR) with the treatment outcomes of ICIs in patients with advanced cancer. METHODS: The pre-treatment circulating levels of 10 cytokines (PD-L1, CTLA4, CXCL10, LAG3, HGF, CCL2, MIG, GRANB, IL-18, and IL-6) were measured via automated capillary-based immunoassay platform in the serum of 65 advanced cancer patients treated with anti-PD-1/PD-L1-based systemic therapy and 10 healthy volunteers. The levels of cytokines and CCR were quantified and categorized into high and low groups based on the median value. The associations of serum cytokines and CCR with response to treatment, survival, and immune-related adverse events were assessed. RESULTS: Elevated circulating levels of 6 cytokines (PD-L1, CXCL10, HGF, CCL2, MIG, and IL-6) were observed in cancer patients compared with that in healthy volunteers. The correlation coefficients between cytokines, CCR and nutritional risk index were also calculated. In the cancer cohort (N = 65), low circulating HGF (P = 0.023, P = 0.029), low IL-6 (P = 0.002, P < 0.001), and high CCR (P = 0.031, P = 0.008) were associated with significantly improved progression-free survival (PFS) and overall survival (OS). Multi-variable COX analyses adjusted for clinicopathological factors revealed that low HGF, low IL-6, and high CCR were independent favorable prognostic factors for PFS (P = 0.028, P = 0.010, and P = 0.015, respectively) and OS (P = 0.043, P = 0.003, and P = 0.026, respectively). Grade 2 irAEs occurred more frequently in patients with low levels of circulating CCL2 and LAG3. CONCLUSIONS: Pre-treatment circulating levels of serum IL-6, HGF, and CCR may serve as independent predictive and prognostic biomarkers in advanced cancer patients treated with ICIs-based systemic therapy. These findings might help to identify potential patients who would benefit from these therapies.

Inhibition of CD8+ T cells and elimination of myeloid cells by CD4+ Foxp3- T regulatory type 1 cells in acute respiratory distress syndrome.

Acute lung injury and acute respiratory distress syndrome (ARDS) are caused by rapid-onset bilateral pulmonary inflammation. We therefore investigated the potential role of interleukin (IL)-10+ CD4+ Tr1 cells, a regulatory T cell subset with previously identified immunosuppressive functions, in ARDS patients. We first showed that circulating Tr1 cells were upregulated in active and resolved ARDS patients compared to healthy controls and pneumonia patient controls. A significant fraction of these Tr1 cells expressed granzyme B and perforin, while most Tr1 cells did not express interferon gamma (IFN-γ), IL-4, IL-17 or FOXP3, suggesting that the effector functions of these Tr1 cells were primarily mediated by IL-10, granzyme B, and perforin. Indeed, Tr1 cells effectively suppressed CD8+ T cell IFN-γ production and induced lysis of monocytes and dendritic cells in vitro. The elimination of myeloid antigen-presenting cells depended on granzyme B production. We also discovered that Tr1 cells could be identified in the bronchoalveolar lavage fluid collected from ARDS patients. All these results suggested that Tr1 cells possessed the capacity to downregulate inflammation in ARDS. In support of this, we found that ARDS patients who resolved the inflammation and survived the syndrome contained significantly higher levels of Tr1 cells than ARDS patients who succumbed to the syndrome. Overall, this report added a novel piece of evidence that ARDS could be intervened by regulatory T cell-mediated suppressive mechanisms.

[Preventive effect of low-dose carvedilol combined with candesartan on the cardiotoxicity of anthracycline drugs in the adjuvant chemotherapy of breast cancer].

OBJECTIVE: To investigate the effect of low-dose carvedilol combined with candesartan in the prevention of acute and chronic cardiotoxicity of anthracycline drugs in adjuvant chemotherapy of breast cancer. METHODS: Forty patients were randomly divided into two groups: the experimental group with chemotherapy plus low-dose carvedilol combined with candesartan (20 cases) and control group with chemotherapy alone (20 cases). The same chemotherapy was given to the two groups. All the 40 patients had no contraindication for carvedilol and candesartan. Patients of the experimental group received low-dose carvedilol from 2.5 mg orally twice a day at first cycle to 5 mg twice a day gradually if no side reactions, and candesartan 2.5 mg orally once a day. Electrocardiogram, ultrasonic cardiogram, arrhythmia, troponin and non-hematologic toxicity were recorded and compared after the second, forth and sixth cycle of chemotherapy. Each cycle included 21 days. RESULTS: LVEF was decreased along with the prolongation of chemotherapy in the experimental group and control group. LVEDD and LVESD showed no significant changes in the experimental group, but gradually increased in the control group. After four and six cycles of chemotherapy, LVEF were (57.00 ± 5.13)% and (45.95 ± 3.68)%, respectively, in the control group, significantly lower than that of (67.00 ± 5.13)% and (57.50 ± 2.57)%, respectively, in the experimental group (P < 0.05). After six cycles of chemotherapy, LVEDD and LVESD were (50.00 ± 10.48) mm and (35.01 ± 2.99) mm, respectively, in the control group, significantly higher than those before chemotherapy (P < 0.05) and experimental group (P < 0.001). The rate of ST segment and T wave abnormalities was 80.0% in the control group after six cycles of chemotherapy, significantly higher than that of 25.0% after four cycles of chemotherapy (P = 0.001) and 10.0% after two cycles of chemotherapy (P < 0.001). The reduction of QRS voltage, arrhythmia and abnormal troponin were 55.0%, 45.0% and 45.0%, respectively, in the control group, significantly higher than those in the experimental group (20.0%, P < 0.05), (10.0%, P = 0.010) and (10.0%, P < 0.05), respectively. The rate of abnormal expression of troponin was 45.0% in the control group, significantly higher than the 10.0% in the experimental group (P < 0.05). CONCLUSIONS: The use of low-dose carvedilol combined with candesartan can reduce the acute and chronic cardiotoxicity of anthracycline drugs, and with tolerable toxicities. This may provide a new approach to prevent cardiotoxicity of anthracycline drugs in adjuvant chemotherapy of breast cancer.

[Clinical controlled trial of first-line treatment for advanced kidney cancer].

OBJECTIVE: To estimate the efficacies of different first-line treatments for advanced stage kidney cancer. METHODS: For this observation controlled trial, a total of 82 cases with advanced stage kidney cancer from 2006 to 2011 were recruited. They were divided into 3 groups and accepted gemcitabine plus interleukin-2 (IL-2) (Group A), oxaliplatin plus capecitabine (Group B) or sorafenib alone (Group C). RESULTS: Among them, 76 patients had complete data. The overall response rates of A-C groups were 39.3% (11/28), 37.0% (10/27) and 38.1% (8/21) respectively. And there was no significant difference (χ(2) = 0.029, P = 0.986). And their progression-free survival (PFS) rates were 9.1 (95%CI: 7.9 - 10.3), 7.5(95%CI: 5.5 - 9.5) and 10.9 (95%CI: 10.5 - 11.3) months respectively. And there were significant differences (P = 0.013). Average daily treatment costs were 490, 498 and 501 Chinese yuan respectively. And there was no significant difference (P = 1.240). Because of toxicity, 2 and 3 cases withdrew in Groups A and B respectively. CONCLUSION: Gemcitabine plus IL-2 and oxaliplatin plus capecitabine have similar early efficacies and tolerance profiles for the patients who can not accept sorafenib as first-line treatment.

Correlation Between TNFAIP2 Gene Polymorphism and Prediction/Prognosis for Gastric Cancer and Its Effect on TNFAIP2 Protein Expression.

Objective: TNFAIP2 is a novel gene induced by TNF-α and participates in inflammatory reaction and tumor angiogenesis. This study aims to understand the correlation between TNFAIP2 gene polymorphism and prediction as well as prognosis of gastric cancer (GC) in a Chinese population. Methods: One thousand two hundred seventy-nine cases were enrolled, including 640 GC and 639 non-cancer cases. The functional tagSNPs of the TNFAIP2 gene were screened by Haploview software and NIH Snpinfo website. Human whole-blood genomic DNA was extracted by phenol chloroform method and analyzed by KASP SNP typing and sequencing method. ELISA was used to determine the expression of TNFAIP2 protein in serum samples. The miRNAs bound to TNFAIP2 3' UTR rs8126 were predicted by MirSNP and TargetScan database. SPSS 22.0 software was used for statistical analysis, and P < 0.05 showed statistical difference. Results: Four functional TNFAIP2 tagSNPs were found by bioinformatics analysis. TNFAIP2 rs8126 T>C polymorphism increased GC risk, and the risk in TC genotype cases was higher than that in TT genotype cases (P = 0.001, OR = 1.557). In the dominant model, the TNFAIP2 rs8126 polymorphic carrier was 1.419 times higher (P = 0.007). TNFAIP2 rs710100 C>T polymorphism, TNFAIP2 rs3759571 G>A polymorphism, and TNFAIP2 rs3759573 A>G polymorphism were not correlated with GC risk. In the subgroup analysis, TNFAIP2 rs8126 TC genotype cases had a higher GC risk in male, aged 60 years or older, Helicobacter pylori-negative, non-smoking, and non-drinking. However, there was no correlation between TNFAIP2 SNPs and GC prognosis. The TNFAIP2 protein concentration in GC patients was significantly different from that in healthy persons (P = 0.029), but it was not associated with GC prognosis. The high or low expression of TNFAIP2 protein had no significant difference with gender, age, H. pylori infection, smoking, and drinking in GC patients. The serum TNFAIP2 protein expression in rs8126 TT genotype carriers was significantly higher than that in rs8126 CC genotype carriers (P < 0.001). Conclusion: TNFAIP2 3' UTR rs8126 T>C polymorphism was associated with GC risk in a Chinese population, especially in cases with males aged 60 years or older, H. pylori negative, non-smoking and non-drinking. Compared with healthy persons, serum TNFAIP2 protein expression was higher in Chinese GC patients, and TNFAIP2 3' UTR rs8126 T>C polymorphism might affect TNFAIP2 protein expression.

Small breast epithelial mucin promotes the invasion and metastasis of breast cancer cells via promoting epithelial­to­mesenchymal transition.

The aim of the present study was to observe the influence of the small breast epithelial mucin (MUCL1) (also known as SBEM) gene on migration and invasion ability of breast cancer cells and to explore the potentially involved mechanism. SBEM­interference plasmid and SBEM­overexpressing plasmid were constructed. SBEM­knockdown or SBEM­â€‹overexpressing MCF­7 and MDA­MB­231 breast cancer cells were established by lentivirus­mediated stable transfection method. The scratch wound­healing assay and Transwell chamber experiment were used to detect the influence of the SBEM gene on the migration and invasion abilities of MCF­7 and MDA­MB­231 cells. Real­time PCR (polymerase chain reaction) and western blotting were used to detect the expression of epithelial­to­mesenchymal transition (EMT)­related markers and regulators. The cell morphology was observed after transfection. The SBEM­knockdown or SBEM­overexpressing MCF­7 and MDA­MB­231 cells were established successfully. The migration and invasion abilities were decreased after SBEM was downregulated, and were increased after SBEM was overexpressed both in MCF­7 and MDA­MB­231 cell lines. The mRNA and protein expressions of N­cadherin, Twist and vimentin were elevated following SBEM overexpression, while the expression of E­cadherin and claudin­1 were found to be decreased following SBEM overexpression. In conclusion, SBEM has the potential to promote migration and invasion ability of breast cancer cells via promoting epithelial­to­mesenchymal transition.

[Relation of lymphatic microvessel density detected by monoclonal antibody D2-40 with VEGF-C expression in breast cancer].

OBJECTIVE: To investigate the relationship of lymphatic micovessel density (LMVD) detected by monoclonal antibody D2-40) with the VEGF-C expression in human breast cancer. METHODS: Tissue samples of 102 breast cancers, 25 breast fibroadenomas and 10 normal breasts were collected. Immunohistochemical staining was used to detected the lymphatic micovessels with monoclonal antibody D2-40. The expression of VEGF-C was detect by SP immunohistochemistry, and VEGF-C mRNA by hybridization in situ. RESULTS: In 102 breast cancers, the positive rate of D2-40 was 76.5% (78/102), higher than that in the breast fibroadenomas. LMVD in the periphery of breast cancer was 30.1 lymphatic microvessels per x 100 field of vision, which was significantly higher than that in the central area of the tumors (P = 0.000). The LMVD in the periphery of the breast cancers was correlated with the number of metastatic lymph nodes (r = 0.964, P < 0.01). The positive rates of VEGF-C protein and mRNA were 55.9% (57/102) and 59.8% (61/102), respectively, significantly higher than that in the breast fiberoadenomas and normal breast tissues (chi2 = 11.653, P = 0.003; chi2 = 10.345, P = 0.006), and were significantly correlated with the status of lymph node metastasis, clinical stage and the expressions of c-erbB-2 and p53 protein (P < 0.05). Both of VEGF-C protein and mRNA were significantly correlated with LMVD detected by D2-40 (P < 0.05), especially with the LMVD in the periphery of breast cancers (P < 0.05). CONCLUSION: The monoclonal antibody D240 can be used to detect the lymphatic endothelium in human breast cancer. The lymphatic microvessel density in the periphery of breast cancer is correlated with the lymph node metastasis and expression of VEGF-C. Therefore, VEGF-C may play a significant role in the lymphangiogenesis leading to metastasis of breast cancer.

DDX5 promotes gastric cancer cell proliferation in vitro and in vivo through mTOR signaling pathway.

DEAD (Asp-Glu-Ala-Asp) box helicase 5 (DDX5) is an ATP-dependent RNA helicase that is overexpressed in various malignancies. Increasing evidence suggests that DDX5 participates in carcinogenesis and cancer progression via promoting cell proliferation and metastasis. However, the functional role of DDX5 in gastric cancer is largely unknown. In this study, we observed that DDX5 was significantly up-regulated in gastric cancer tissues compared with the paired adjacent normal tissues. The expression of DDX5 correlated strongly with Ki67 index and pathological stage of gastric cancer. In vitro and in vivo studies suggested that knockdown of DDX5 inhibited gastric cancer cell proliferation, colony formation and xenografts growth, whereas ectopic expression of DDX5 promoted these cellular functions. Mechanically, DDX5 induced gastric cancer cell growth by activating mTOR/S6K1. Treatment of everolimus, the specific mTOR inhibitor, significantly attenuated DDX5-mediated cell proliferation. Interestingly, the expression of DDX5 and p-mTOR in gastric cancer tissues demonstrated a positive correlation. Taken together, these results revealed a novel role of DDX5 in gastric cancer cell proliferation via the mTOR pathway. Therefore, DDX5 may serve as a therapeutic target in gastric cancer.

[Effects of Nasea on prevention of gastrointestinal side effects caused by chemotherapeutic drugs].

OBJECTIVE: To investigate the effects of Nasea on prevention of gastrointestinal side effects caused by chemotherapeutic drugs. METHODS: Eighty-five in-patients with cancer undergoing chemotherapy were randomly divided into 2 groups: Nasea group (group A, n = 43, Nasea, ramosetron hydrochloride was injected intravenously 30 minutes before chemotherapy) and ondansetron group (group B, n = 42, ondamsetron was injected intravenously 30 minutes before chemotherapy). The side effects of chemotherapy, including nausea, vomiting, anorexia, etc, were observed during the 3 days after chemotherapy. RESULTS: The complete effective rate and effective rate of prevention of nausea, vomiting, and anorexia during the periods 0 - 6 hours, 6 - 12 hours, 24 - 48 hours, and 48 - 62 hours after chemotherapy were similar in these 2 groups. However, these rates during the period 12 approximately 24 hours after chemotherapy were significantly higher in group A than in group B (all P < 0.05). The side effects of these 2 drugs included carebarja, headache, fatigue, etc, all being mild and not significantly different between these 2 groups. CONCLUSION: Effectively preventing the gastrointestinal side effects caused by chemotherapeutic drugs with an efficacy similar to that of ondansetron and seemingly lasting longer, Nasea is a promising drug.

Small breast epithelial mucin (SBEM) has the potential to be a marker for predicting hematogenous micrometastasis and response to neoadjuvant chemotherapy in breast cancer.

To investigate the potential role of small breast epithelial mucin (SBEM) as a marker for detecting hematogenous micrometastasis in breast cancer and explore its clinical significance in neoadjuvant chemotherapy. SBEM protein expression in 82 tissue specimens of primary breast cancer was detected using immunohistochemistry (IHC), and SBEM expression in peripheral blood (PB) samples of 109 primary breast cancer patients (94 cases at stage I-III, 15 cases at stage IV) was detected by flow cytometry (FCM) and reverse transcription polymerase chain reaction (RT-PCR). Moreover, SBEM mRNA expression was monitored by quantification real-time PCR (QPCR) before and after 3 cycles' neoadjuvant chemotherapy. SBEM expression correlated with tumor node metastasis (TNM) staging and lymph node metastasis at both mRNA and protein levels. SBEM expression in PB of breast cancer patients was markedly higher than that of healthy donors and other cancer patients. SBEM was found expressed in PB of 50 cases among 94 cases at stage I-III and expressed in PB of 11 cases among 15 cases at stage IV. After 3 cycles' neoadjuvant chemotherapy, SBEM expression levels were significantly down-regulated in up to 58% breast cancer patients. SBEM has the potential to be a specific marker for predicting hematogenous micrometastasis and response to neoadjuvant chemotherapy in breast cancer.

Study on relationship between angiogenesis and micrometastases of peripheral blood in breast cancer.

PURPOSE: To investigate the relationship between microvessel density, expression of vascular endothelial growth factor A (VEGF-A) and micrometastases in peripheral blood of patients with breast cancer. METHOD: Microvessel density (MVD) and expression of VEGF-A were detected by immunohistochemistry S-P. Nested RT-PCR was introduced to detect the expression of hMAM mRNA in peripheral blood of all cases. RESULT: Average MVD was 28.95 +/- 6.95 microvessels/100x and positive rate of VEGF-A was 64.0% (32/50) in 50 cases with breast cancer. MVD count and expression of VEGF-A were related to tumor size, metastasis of axillary lymph nodes and clinical stages (P < 0.05), independent of age and histological classification (P > 0.05). The positive rate of hMAM mRNA in peripheral blood was 34.0% (17/50), which correlated with lymphatic metastasis and clinical stages (P < 0.05), independent of pathological category, menopause and hormone receptor (P > 0.05). MVD count and positive rate of VEGF-A in breast cancer with positive expression of hMAM mRNA was obviously higher than those without hMAM mRNA expression (chi (2) = 5.766, P = 0.032; t = 5.37, P = 0.002). CONCLUSIONS: MVD count and positive expression of VEGF-A closely correlated to hMAM mRNA released from tumor cells in the circulation. hMAM mRNA is expected to become a valuable marker for further study on micrometastases of breast cancer.