A Deep Learning-Based Assay for Programmed Death Ligand 1 Immunohistochemistry Scoring in Non-Small Cell Lung Carcinoma: Does it Help Pathologists Score?

Several studies have developed various artificial intelligence (AI) models for immunohistochemical analysis of programmed death ligand 1 (PD-L1) in patients with non-small cell lung carcinoma; however, none have focused on specific ways by which AI-assisted systems could help pathologists determine the tumor proportion score (TPS). In this study, we developed an AI model to calculate the TPS of the PD-L1 22C3 assay and evaluated whether and how this AI-assisted system could help pathologists determine the TPS and analyze how AI-assisted systems could affect pathologists' assessment accuracy. We assessed the 4 methods of the AI-assisted system: (1 and 2) pathologists first assessed and then referred to automated AI scoring results (1, positive tumor cell percentage; 2, positive tumor cell percentage and visualized overlay image) for final confirmation, and (3 and 4) pathologists referred to the automated AI scoring results (3, positive tumor cell percentage; 4, positive tumor cell percentage and visualized overlay image) while determining TPS. Mixed-model analysis was used to calculate the odds ratios (ORs) with 95% CI for AI-assisted TPS methods 1 to 4 compared with pathologists' scoring. For all 584 samples of the tissue microarray, the OR for AI-assisted TPS methods 1 to 4 was 0.94 to 1.07 and not statistically significant. Of them, we found 332 discordant cases, on which the pathologists' judgments were inconsistent; the ORs for AI-assisted TPS methods 1, 2, 3, and 4 were 1.28 (1.06-1.54; P = .012), 1.29 (1.06-1.55; P = .010), 1.28 (1.06-1.54; P = .012), and 1.29 (1.06-1.55; P = .010), respectively, which were statistically significant. For discordant cases, the OR for each AI-assisted TPS method compared with the others was 0.99 to 1.01 and not statistically significant. This study emphasized the usefulness of the AI-assisted system for cases in which pathologists had difficulty determining the PD-L1 TPS.

Downregulation of the spinal dorsal horn clock gene Per1 expression leads to mechanical hypersensitivity via c-jun N-terminal kinase and CCL2 production in mice.

Disturbances of circadian rhythm and dysregulation of clock gene expression are involved in the induction of various neurological disorder states, including chronic pain. However, the relationship between the CNS circadian-clock gene system and nociception remains poorly defined. Significant circadian oscillations of Period (Per1, Per2), Bmal1 and Cryptochrome 1 (Cry1) mRNA expression have been observed in the lumbar spinal dorsal horn of naïve mice. The current study examined the expression of clock genes in the lumbar spinal dorsal horn of mice with neuropathic pain due to a partial sciatic nerve ligation (PSNL). Seven days after PSNL, the mice displayed a robust unilateral hind paw mechanical hypersensitivity. The normal circadian oscillations of Per1, Per2 and Cry1, but not Bmal1, mRNA expression were significantly suppressed in the ipsilateral lumbar spinal dorsal horn of PSNL mice 7days following surgery. The circadian expression of PER1 protein, in particular, was also significantly suppressed in the ipsilateral spinal dorsal horn of PSNL mice. Double-labeling immunohistochemistry revealed downregulation of PER1 in neurons and astrocytes, but not microglia. Knockdown of Per1 expression by intrathecal treatment with Per1 siRNA also induced mechanical hypersensitivity, phosphorylation of c-jun N-terminal kinase (JNK) and the upregulation of chemokine (C-C motif) ligand 2 (CCL2) production in the lumbar spinal dorsal horn. Per1 siRNA-induced mechanical hypersensitivity was attenuated with intrathecal treatment of either the JNK inhibitor SP600125 or the selective CCL2 receptor (CCR2) antagonist RS504393, indicating that these intracellular messengers are crucial in mediating the mechanical hypersensitivity following the downregulation of PER1 expression. These results suggest that the downregulation of the spinal dorsal horn clock genes such as Per1 expressed could be crucial in the induction of neuropathic pain following peripheral nerve injury. Modulating clock gene Per1 expression could be a novel therapeutic strategy in alleviating neuropathic pain.

The induction of Per1 expression by the combined treatment with glutamate, 5-hydroxytriptamine and dopamine initiates a ripple effect on Bmal1 and Cry1 mRNA expression via the ERK signaling pathway in cultured rat spinal astrocytes.

Clock genes contribute to the regulation of spinal cord astrocytic function. Although it was previously found that noradrenaline has a pivotal role in the regulation of clock genes expression in cultured rat spinal astrocytes, it is still unknown whether other neurotransmitters might affect clock gene expression. Thus, the effect of spinal neurotransmitters glutamate (Glu), 5-hydroxytriptamine (5-HT) and dopamine (DA) on clock genes expression was examined in cultured rat spinal astrocytes. Simultaneous treatment with Glu (100 µM), 5-HT (10 µM) and DA (10 µM) led to a transient induction of Per1 expression, and a delayed increase of Bmal1 expression and a decrease of Cry1 expression. By contrast, treatment with either Glu, 5-HT or DA alone increased only Per1 expression. The increase in Per1 mRNA by simultaneous treatment with Glu, 5-HT and DA was dependent on extracellular signal-regulated kinase (ERK) activation, since pretreatment with ERK inhibitor U0126 (3 µM) blocked Per1 expression. Second messengers p38 and c-jun N-terminal kinase were not involved in the neurotransmitter effect on Per1 expression, since pretreatment with SB202190 (3 µM) and SP600125 (10 µM), a p38 inhibitor and c-jun N-terminal kinase inhibitor, respectively, had no effect. Blockade of ERK signaling also prevented changes in Bmal1 and Cry1 mRNA expression induced by co-treatment with Glu, 5-HT and DA. In addition to modulating clock gene expression, co-treatment with Glu, 5-HT and DA significantly increased ERK1/2 phosphorylation. Per1 expression itself modulates the expression of other clock gene as knockdown of Per1 expression by using short interference RNA significantly blocked the increase of Bmal1 mRNA expression and the decrease of Cry1 mRNA expression. Thus, neurotransmitters Glu, 5-HT and DA regulate spinal astrocytic clock genes mRNA expression through the ERK pathway and Per1 is a key clock gene that likely modulates the oscillation of clock genes thereby regulating astrocytic function.

Clock gene Per1 regulates the production of CCL2 and interleukin-6 through p38, JNK1 and NF-κB activation in spinal astrocytes.

It has been previously reported that spinal clock genes controlled under circadian rhythm contribute to the regulation of astrocytic function, which in turn is involved in diverse processes such as nociceptive transduction and the induction of inflammation. However, how clock genes expressed in spinal cord astrocytes are associated with the modulation of the inflammatory response is poorly understood. In the current study, the role of Period1 (Per1), one of clock genes, in the expression of chemokine (C-C motif) ligand 2 (CCL2) and interleukin-6 (IL-6), which are typical pro-inflammatory mediators produced by spinal astrocytes, was investigated. It was found that the knockdown of Per1 by using RNA interference led to a significant increase of the expression of CCL2 and IL-6 in cultured rat spinal astrocytes. Moreover, the silencing of the Per1 gene also increased the phosphorylation of p38, c-Jun N-terminal kinase (JNK) 1 and IκBα, and led to the translocation of p65 from the cytosol to the nucleus. The induction of CCL2 and IL-6 was significantly inhibited by treatment with the inhibitors of p38, JNK, and NF-κB. By contrast, the overexpression of PER1 by transfection vector significantly blocked the expression of CCL2 and IL-6, and the activation of p38, JNK, and NF-κB. Together, these results suggest that down-regulation of Per1 induced the phosphorylation of p38 and JNK1 and the subsequent activation of NF-κB, and that these events contribute to neuroinflammatory state in the spinal cord via the induction of the release of inflammatory mediators.

Spinal astrocytes contribute to the circadian oscillation of glutamine synthase, cyclooxygenase-1 and clock genes in the lumbar spinal cord of mice.

Spinal astrocytes have key roles in the regulation of pain transmission. However, the relationship between astrocytes and the circadian system in the spinal cord remains poorly defined. In the current study, the circadian variations in the expression of several clock genes in the lumbar spinal cord of mice were examined by using real-time PCR. The expression of Period1, Period2 and Cryptochrome1 showed significant circadian oscillations, each gene peaking in the early evening. The expression of Bmal1 mRNA also exhibited a circadian pattern, peaking from around midnight to early morning. The mRNA levels of Cryptochrome2 were slightly, but not significantly altered. Molecules related to pain transmission were also investigated. The mRNA expression of glutamine synthase (GS), and cyclooxygenases (COXs), known to be involved in various spinal sensory functions, showed rhythmicity with a peak in the early evening, although the expression of the neurokinin-1 receptor, subunits of the N-methyl-d-aspartate receptor, and glutamate transporters did not change. In addition, we found that protein levels of GS and COX-1 were also high at midnight compared with midday. Furthermore, we examined the effect of intrathecal fluorocitrate (100pmol), an inhibitor of astrocytic metabolism, on the expression of oscillating genes in lumbar spinal cord. Fluorocitrate significantly suppressed astrocyte function. Furthermore, the circadian oscillation of clock gene expression and GS and COX-1 expression were suppressed. Together, these results suggest that a significant circadian rhythmicity of the expression of clock genes is present in the spinal cord and that the components of the circadian clock timed by astrocytes might contribute to spinal functions, including nociceptive processes.

Activation of the neurokinin-1 receptor in rat spinal astrocytes induces Ca2+ release from IP3-sensitive Ca2+ stores and extracellular Ca2+ influx through TRPC3.

Substance P (SP) plays an important role in pain transmission through the stimulation of the neurokinin (NK) receptors expressed in neurons of the spinal cord, and the subsequent increase in the intracellular Ca(2+) concentration ([Ca(2+)](i)) as a result of this stimulation. Recent studies suggest that spinal astrocytes also contribute to SP-related pain transmission through the activation of NK receptors. However, the mechanisms involved in the SP-stimulated [Ca(2+)](i) increase by spinal astrocytes are unclear. We therefore examined whether (and how) the activation of NK receptors evoked increase in [Ca(2+)](i) in rat cultured spinal astrocytes using a Ca(2+) imaging assay. Both SP and GR73632 (a selective agonist of the NK1 receptor) induced both transient and sustained increases in [Ca(2+)](i) in a dose-dependent manner. The SP-induced increase in [Ca(2+)](i) was significantly attenuated by CP-96345 (an NK1 receptor antagonist). The GR73632-induced increase in [Ca(2+)](i) was completely inhibited by pretreatment with U73122 (a phospholipase C inhibitor) or xestospongin C (an inositol 1,4,5-triphosphate (IP(3)) receptor inhibitor). In the absence of extracellular Ca(2+), GR73632 induced only a transient increase in [Ca(2+)](i). In addition, H89, an inhibitor of protein kinase A (PKA), decreased the GR73632-mediated Ca(2+) release from intracellular Ca(2+) stores, while bisindolylmaleimide I, an inhibitor of protein kinase C (PKC), enhanced the GR73632-induced influx of extracellular Ca(2+). RT-PCR assays revealed that canonical transient receptor potential (TRPC) 1, 2, 3, 4 and 6 mRNA were expressed in spinal astrocytes. Moreover, BTP2 (a general TRPC channel inhibitor) or Pyr3 (a TRPC3 inhibitor) markedly blocked the GR73632-induced sustained increase in [Ca(2+)](i). These findings suggest that the stimulation of the NK-1 receptor in spinal astrocytes induces Ca(2+) release from IP(3-)sensitive intracellular Ca(2+) stores, which is positively modulated by PKA, and subsequent Ca(2+) influx through TRPC3, which is negatively regulated by PKC.

Noradrenaline induces clock gene Per1 mRNA expression in C6 glioma cells through beta(2)-adrenergic receptor coupled with protein kinase A - cAMP response element binding protein (PKA-CREB) and Src-tyrosine kinase - glycogen synthase kinase-3beta (Src-GSK-3beta).

Astrocytes in the hypothalamic suprachiasmatic nucleus, site of the master circadian pacemaker, play an essential role in the regulation of systemic circadian rhythms. To evaluate involvement of noradrenergic systems in regulation of circadian variation of clock-genes in astrocytes, we investigated effects of noradrenaline (NA) on expression of several clock genes in C6 glioma cells by using real-time PCR analysis. Treatment with NA (10 microM) induced transient expression of Per1 mRNA, but not of Per2, Bmal1, Clock, Cry1, or Cry2 mRNA, through activation of beta(2) adrenoceptors. Action of NA was partially blocked by H-89 [protein kinase A (PKA) inhibitor] or KG-501 [inhibitor of cAMP response element binding protein (CREB)]. We found that pretreatment with genistein or PP2 (general or Src tyrosine kinase inhibitors, respectively) or LiCl [inhibitor of glycogen synthase kinase-3beta (GSK-3beta)] significantly inhibited NA-induced Per1 mRNA expression. In addition, treatment with H-89 and either genistein or LiCl completely blocked NA stimulatory effects. NA markedly induced tyrosine phosphorylation of Src and GSK-3beta via activation of beta(2) adrenoceptors. Phosphorylation of GSK-3beta by NA was completely eliminated by genistein or PP2. These results primarily suggest that two distinct NA-mediating pathways, PKA-CREB and Src-GSK-3beta, play crucial roles in regulation of Per1 expression in astroglial cells.