Dual-Region Computed Tomography Radiomics-Based Machine Learning Predicts Subcarinal Lymph Node Metastasis in Patients with Non-small Cell Lung Cancer.

BACKGROUND: Noninvasively and accurately predicting subcarinal lymph node metastasis (SLNM) for patients with non-small cell lung cancer (NSCLC) remains challenging. This study was designed to develop and validate a tumor and subcarinal lymph nodes (tumor-SLNs) dual-region computed tomography (CT) radiomics model for predicting SLNM in NSCLC. METHODS: This retrospective study included NSCLC patients who underwent lung resection and SLNs dissection between January 2017 and December 2020. The radiomic features of the tumor and SLNs were extracted from preoperative CT, respectively. Ninety machine learning (ML) models were developed based on tumor region, SLNs region, and tumor-SLNs dual-region. The model performance was assessed by the area under the curve (AUC) and validated internally by fivefold cross-validation. RESULTS: In total, 202 patients were included in this study. ML models based on dual-region radiomics showed good performance for SLNM prediction, with a median AUC of 0.794 (range, 0.686-0.880), which was superior to those of models based on tumor region (median AUC, 0.746; range, 0.630-0.811) and SLNs region (median AUC, 0.700; range, 0.610-0.842). The ML model, which is developed by using the naive Bayes algorithm and dual-region features, had the highest AUC of 0.880 (range of cross-validation, 0.825-0.937) among all ML models. The optimal logistic regression model was inferior to the optimal ML model for predicting SLNM, with an AUC of 0.727. CONCLUSIONS: The CT radiomics showed the potential for accurately predicting SLNM in NSCLC patients. The ML model with dual-region radiomic features has better performance than the logistic regression or single-region models.

Polymer Lewis Base for Improving the Charge Transfer in Tin-Lead Mixed Perovskite Solar Cells.

The poor film stability of Sn-Pb mixed perovskite film and the mismatched interface energy levels pose significant challenges in enhancing the efficiency of tin-lead (Sn-Pb) mixed perovskite solar cells. In this study, polyvinylpyrrolidone (PVP) is introduced into the PVK perovskite precursor solution, effectively enhancing the overall stability of the film. This improvement is achieved through the formation of robust coordination bonds between the carbonyl (C=O) in the pyrrole ring and the undercoordinated SnII and PbII, thereby facilitating the passivation of defects. Furthermore, the introduction of PVP inhibits the oxidation of tin (Sn), thereby enhancing the n-type characteristics of the perovskite film. This adjustment in the energy level of the PVK perovskite film proves instrumental in reducing interface energy loss, subsequently improving interface charge transfer and mitigating device recombination. Consequently, perovskite solar cells incorporating PVP achieve an outstanding champion power conversion efficiency (PCE) of 21.31%.

Corynoxine promotes TFEB/TFE3-mediated autophagy and alleviates Aß pathology in Alzheimer's disease models.

Autophagy impairment is a key factor in Alzheimer's disease (AD) pathogenesis. TFEB (transcription factor EB) and TFE3 (transcription factor binding to IGHM enhancer 3) are nuclear transcription factors that regulate autophagy and lysosomal biogenesis. We previously showed that corynoxine (Cory), a Chinese medicine compound, protects neurons from Parkinson's disease (PD) by activating autophagy. In this study, we investigated the effect of Cory on AD models in vivo and in vitro. We found that Cory improved learning and memory function, increased neuronal autophagy and lysosomal biogenesis, and reduced pathogenic APP-CTFs levels in 5xFAD mice model. Cory activated TFEB/TFE3 by inhibiting AKT/mTOR signaling and stimulating lysosomal calcium release via transient receptor potential mucolipin 1 (TRPML1). Moreover, we demonstrated that TFEB/TFE3 knockdown abolished Cory-induced APP-CTFs degradation in N2aSwedAPP cells. Our findings suggest that Cory promotes TFEB/TFE3-mediated autophagy and alleviates Aß pathology in AD models.

Longitudinal wastewater surveillance of four key pathogens during an unprecedented large-scale COVID-19 outbreak in China facilitated a novel strategy for addressing public health priorities-A proof of concept study.

Wastewater-based epidemiology (WBE) is a promising tool for monitoring the spread of SARS-CoV-2 and other pathogens, providing a novel public health strategy to combat disease. In this study, we first analysed nationwide reports of infectious diseases and selected Salmonella, norovirus, and influenza A virus (IAV) as prioritized targets apart from SARS-CoV-2 for wastewater surveillance. Next, the decay rates of Salmonella, norovirus, and IAV in wastewater at various temperatures were established to obtain corrected pathogen concentrations in sewage. We then monitored the concentrations of these pathogens in wastewater treatment plant (WWTP) influents in three cities, establishing a prediction model to estimate the number of infected individuals based on the mass balance between total viral load in sewage and individual viral shedding. From October 2022 to March 2023, we conducted multipathogen wastewater surveillance (MPWS) in a WWTP serving one million people in Xi'an City, monitoring the concentration dynamics of SARS-CoV-2, Salmonella, norovirus, and IAV in sewage. The infection peaks of each pathogen were different, with Salmonella cases and sewage concentration declining from October to December 2022 and only occasionally detected thereafter. The SARS-CoV-2 concentration rapidly increased from December 5th, peaked on December 26th, and then quickly decreased until the end of the study. Norovirus and IAV were detected in wastewater from January to March 2023, peaking in February and March, respectively. We used the prediction models to estimate the rate of SARS-CoV-2 infection in Xi'an city, with nearly 90 % of the population infected in urban regions. There was no significant difference between the predicted and actual number of hospital admissions for IAV. We also accurately predicted the number of norovirus cases relative to the reported cases. Our findings highlight the importance of wastewater surveillance in addressing public health priorities, underscoring the need for a novel workflow that links the prediction results of populations with public health interventions and allocation of medical resources at the community level. This approach would prevent medical resource panic squeezes, reduce the severity and mortality of patients, and enhance overall public health outcomes.

Remote sensing algorithm for retrieving global-scale sea surface solar irradiance.

This paper presents a new remote sensing (RS) algorithm for retrieving instantaneous sea surface solar irradiance (SR) by using the XGBoost (XGB) package in RStudio and available remote sensing data along with ground-truth solar irradiance data. By means of XGB, the new RS algorithm, called LSU model, was structurally built with nine key RS parameters, including photosynthetically available radiation (PAR); instantaneous PAR (iPAR); water leaving reflectance Rrs at wavelengths 412, 443, 469, and 488 nm; angstrom; aerosol optical thickness (aot_869); and latitude that represent major sources and sinks of solar irradiance, as model input variables. Among the nine parameters, the most important four parameters are PAR, iPAR, latitude, and aot_869. It was found that the sea surface SR is highly affected by conditions in both the atmosphere and the seawater. The aot_869 is by far the most important factor describing the effects of the atmospheric absorption and scattering of SR before reaching the sea surface. The most important factors describing the effects of seawater characteristics on solar irradiance are PAR, iPAR, and latitude. Comparisons with existing SR models indicate that LSU model is scientifically sound due to the use of major source and sink factors of SR as model input variables. LSU model is also technically accurate due to its fine resolution (1×1 km) and overall best performance in predicting instantaneous SR. More importantly, LSU model is globally applicable as it can be utilized to obtain global-scale SR data for any day, any time, and anywhere in the world.

PPARɑ Ligand Caudatin Improves Cognitive Functions and Mitigates Alzheimer's Disease Defects By Inducing Autophagy in Mice Models.

The autophagy-lysosomal pathway (ALP) is a major cellular machinery involved in the clearance of aggregated proteins in Alzheimer disease (AD). However, ALP is dramatically impaired during AD pathogenesis via accumulation of toxic amyloid beta (Aß) and phosphorylated-Tau (phospho-Tau) proteins in the brain. Therefore, activation of ALP may prevent the increased production of Aß and phospho-Tau in AD. Peroxisome proliferator-activated receptor alpha (PPARα), a transcription factor that can activate autophagy, and transcriptionally regulate transcription factor EB (TFEB) which is a key regulator of ALP. This suggests that targeting PPARα, to reduce ALP impairment, could be a viable strategy for AD therapy. In this study, we investigated the anti-AD activity of Caudatin, an active constituent of Cynanchum otophyllum (a traditional Chinese medicinal herb, Qing Yang Shen; QYS). We found that Caudatin can bind to PPARα as a ligand and augment the expression of ALP in microglial cells and in the brain of 3XTg-AD mice model. Moreover, Caudatin could activate PPARα and transcriptionally regulates TFEB-augmented lysosomal degradation of Aß and phosphor-Tau aggregates in AD cell models. Oral administration of Caudatin decreased AD pathogenesis and ameliorated the cognitive dysfunction in 3XTg-AD mouse model. Conclusively, Caudatin can be a potential AD therapeutic agent via activation of PPARα-dependent ALP.

Low Pi stress enhances the sensitivity of hepatocellular carcinoma to sorafenib.

Sorafenib is a tyrosine kinase inhibitor for the treatment of advanced-stage HCC; however, clinical trials of sorafenib failed to demonstrate long-term survival benefits due to drug resistance. Low Pi stress has been shown to inhibit tumor growth and the expression of multidrug resistance-associated proteins. In this study, we investigated the sensitivity of HCC to sorafenib under conditions of low Pi stress. As a result, we found that low Pi stress facilitated sorafenib-mediated suppression of migration and invasion of HepG-2 and Hepa1-6 cells by decreasing the phosphorylation or expression of AKT, Erk and MMP-9. Angiogenesis was inhibited due to decreased expression of PDGFR under low Pi stress. Low Pi stress also decreased the viability of sorafenib-resistant cells by directly regulating the expression of AKT, HIF-1a and P62. In vivo drug sensitivity analysis in the four animal models showed a similar tendency that low Pi stress enhances sorafenib sensitivity in both the normal and drug-resistant models. Altogether, low Pi stress enhances the sensitivity of hepatocellular carcinoma to sorafenib and expands the indications for sevelamer.

The application of radiomics in esophageal cancer: Predicting the response after neoadjuvant therapy.

Esophageal cancer (EC) is one of the fatal malignant neoplasms worldwide. Neoadjuvant therapy (NAT) combined with surgery has become the standard treatment for locally advanced EC. However, the treatment efficacy for patients with EC who received NAT varies from patient to patient. Currently, the evaluation of efficacy after NAT for EC lacks accurate and uniform criteria. Radiomics is a multi-parameter quantitative approach for developing medical imaging in the era of precision medicine and has provided a novel view of medical images. As a non-invasive image analysis method, radiomics is an inevitable trend in NAT efficacy prediction and prognosis classification of EC by analyzing the high-throughput imaging features of lesions extracted from medical images. In this literature review, we discuss the definition and workflow of radiomics, the advances in efficacy prediction after NAT, and the current application of radiomics for predicting efficacy after NAT.

Characterisation of a laccase isolated from Trametes hirsuta and its application in the oligomerisation of phenolic compounds.

Phenolic compounds are widely distributed in nature and industrial environment, and their detoxification or bioactive enhancement is of great value to environmental protection and industrial development. Laccases are multicopper oxidases that catalyse the oligo- or polymerisation of phenolic compounds. Identifying new laccase producers and investigating their application potential are of great importance. In this study, a white-rot fungus, Trametes hirsuta EZ1, with significantly high laccase productivity was isolated. The optimum conditions were studied for the maximum fermentation of extracellular laccase, which was achieved at 150 U/mL with a medium containing 10% strain EZ1, 7% maltodextrin, 1.5% peptone, and 0.5 mM Cu2+, and incubation at initial pH 6.0, 32 °C, and 180 rpm for nine days. Subsequently, a 70-kDa laccase was purified that showed activity over a wide range of temperature and pH, sensitivity to many metal ions and sodium dodecyl sulphate, and high tolerance to organic solvents. Purified laccase showed a significant unreported effect by catalysing catechol or ferulic acid into dimers, trimers, and tetramers or caffeic acid into dimers, trimers, tetramers, and pentamers. The oligomeric mixtures exhibited increased antioxidative capacity compared to that of each parent monomer, except for caffeic acid derivatives. Our study offers a novel strain source for laccase production and broadens its application in the enhancement of bioactive compounds.

Open Arthrolysis for Chronic Elbow Dislocation with Extremely Severe Stiffness in Children.

OBJECTIVE: Studies on extremely severe elbow stiffness after chronic dislocation in children are scarce. This study aims to investigate the choice of surgical treatment modalities and to analyze their treatment efficacy in children with chronic elbow dislocation with extremely severe periarticular stiffness. METHODS: Data of 21 children with chronic elbow dislocation with extremely severe periarticular stiffness diagnosed and treated in our department between February 2015 and February 2021 were retrospectively analyzed. Twenty boys and one girl were included in the study, their mean age was 11 ± 2.5 years, and they had concomitant distal humerus fractures. For the treatment protocol, all children with extremely severe elbow stiffness were treated with open arthrolysis, and elbow joint stability was intraoperatively assessed. All children performed passive functional exercises the day after surgery. The elbow flexion and extension angles, range of motion (ROM), and Mayo score were evaluated preoperatively and at the final follow-up. RESULTS: Of the 21 children, only one had recurrent severe stiffness of the elbow joint after surgery; nevertheless, the function was still improved compared with that before surgery. Preoperatively, the mean elbow extension and flexion angles were 72.2° ± 12.7° and 93.6° ± 11.1°, respectively, and the range of motion (ROM) of the elbow joint was 17.8° ± 8.3°. At the final follow-up, the mean elbow extension and flexion angles were 22.7° ± 18.6° and 118.8° ± 15.4°, respectively, and the elbow joint ROM was 96.1° ± 17.4°. The differences in the preoperative and postoperative ROMs, flexion angles, and extension angles of the elbow joint were significant (p < 0.01). The MEPS at the final follow-up was 78.57 ± 14.24, which was significantly higher than preoperative (29.76 ± 10.89), and the excellent rate was 81%. CONCLUSION: Open arthrolysis and open reduction and internal fixation of the elbow joint are effective in treating chronic elbow dislocation with extremely severe stiffness in children.

Optimum environmental conditions controlling prevalence of vibrio parahaemolyticus in marine environment.

This literature review presents major environmental indicators and their optimum variation ranges for the prevalence of Vibrio parahaemolyticus in the marine environment by critically reviewing and statistically analyzing more than one hundred studies from countries around the world. Results of this review indicated that the prevalence of Vibrio parahaemolyticus in the marine environment is primarily responsive to favorable environmental conditions that are described with environmental indicators. The importance of environmental indicators to the prevalence of Vibrio parahaemolyticus can be ranked from the highest to lowest as Sea Surface Temperature (SST), salinity, pH, chlorophyll a, and turbidity, respectively. It was also found in this study that each environmental indicator has an optimum variation range favoring the prevalence of Vibrio parahaemolyticus. Specifically, the SST range of 25.67 ± 2 °C, salinity range of 27.87 ± 3 ppt, and pH range of 7.96 ± 0.1 were found to be the optimum conditions for the prevalence of Vibrio parahaemolyticus. High vibrio concentrations were also observed in water samples with the chlorophyll a range of 16-25 µg/L. The findings provide new insights into the importance of environmental indicators and their optimum ranges, explaining not only the existence of both positive and negative associations reported in the literature but also the dynamic associations between the Vibrio presence and its environmental drivers.

Effects of digital elevation model data source on HSPF-based watershed-scale flow and water quality simulations.

Digital elevation models (DEMs) from different sources have been widely utilized in watershed modeling and environment management. Yet, little is known about how DEMs from different data sources affect modeling results and management decisions. This paper presents new insights into how the DEMs from three different sources affect model-simulated flow, nitrate (NO3), phosphorus (P), and sediment by using the BASINS/HSPF watershed modeling system. It was found that DEM source-induced uncertainties in simulation results are higher than the DEM resolution-induced uncertainties regardless of watershed slope or delineation method. Moreover, DEM source introduces higher uncertainties in simulation results for automatically delineated low-gradient watersheds than high gradient watersheds. Sediment and NO3 concentrations were the most and the least sensitive water quality parameters, respectively, to DEM sources. The uncertainties in simulation results may be reduced by using the manual method for watershed delineation but they cannot be completely eliminated. It is recommended that high precision (such as NED) DEMs be employed especially for flat watersheds. The findings provide guidelines for selection of DEM source based on available resources.

Evaluation of the safety and efficacy of transarterial sevelamer embolization in a rabbit liver cancer model: A challenge on the size rule for vascular occlusion.

As the most efficient method to treat hepatocellular carcinoma in the immediate or advanced stage, transarterial chemoembolization (TACE) is coming into the era of microsphere (MP). Drug-eluting beads have shown their huge potential as an embolic agent and drug carrier for chemoembolization, but their sizes are strictly limited to be above 40 µm, which was considered to occlude vessels in a safe mode. microsphere smaller than 40 µm is easy to be washed out and transported to the normal liver lobe or other organs, causing severe adverse events and failed embolization. To determine whether sevelamer ultrafine particle (0.2-0.5 µm) is qualified as a safe and efficient embolic agent, we investigated the safety and therapeutic efficiency of transarterial sevelamer embolization (TASE) in the VX2 rabbit liver cancer model, aiming to challenge the "40 µm" rule on the selection criteria of the MP. In a four-arm study, blank bead (Callisphere, 100-300 µm), luminescent polystyrene microsphere (10, 100 µm), and sevelamer particle were transarterially administered to evaluate the threshold size of the MP size for intrahepatic or extrahepatic permeability. Another four-arm study was designed to clarify the safety and efficiency of preclinical transarterial sevelamer embolizationTASE tests over other techniques. Sham (saline), TASE, C-TACE, and D-TACE (n = 6) were compared in terms of serum chemistry, histopathology, and tumor necrosis ratio. In the first trials, the "40 µm" rule was detectable on the VX2 cancer model, but the regulation has no application to the new embolic agent as sevelamer ultrafine particles have not been found to leak out from the VX2 lesions, only found in the embolized vessels. Pathology proves that less viable tumor residue was found 2 weeks after the procedure, evidencing a better therapeutic outcome. No adverse events were found except for a short stress response. These results indicate that sevelamer is a safe and efficient embolic as an alternative to the current MP-based embolization therapy techniques.

Deep learning-based ensemble modeling of Vibrio parahaemolyticus concentration in marine environment.

Vibrio parahaemolyticus (V.p) is a marine pathogenic bacterium that poses a high risk to human health and shellfish industry, yet an effective regional-scale nowcasting model for managing the risk remains lacking. This study presents the first regional-scale model for nowcasting the level of V.p in oysters in the marine environment by developing an ensemble modeling approach. The ensemble modeling approach involves the integration of genetic programming (GP) and deep artificial neural networks (DNN)-based modeling. The new approach was demonstrated by developing three GP-DNN ensemble models for predicting the V.p level in North Carolina, New Hampshire, and the combined region. Specifically, GP was employed to establish nonlinear functions between the V.p level and antecedent conditions of environmental variables. The nonlinear GP functions and current conditions of individual environmental variables were then utilized as inputs into a DNN model, forming a GP-DNN ensemble model. Modeling results indicated that the GP-DNN ensemble models were capable of predicting the V.p level with the correlation coefficient of 0.91, 0.90, and 0.80 for North Carolina, New Hampshire, and the combined region, respectively, demonstrating the impact of distinct environmental conditions in the local areas on accuracy of the combined regional-scale model. Sensitivity analysis results showed that sea surface temperature and sea surface salinity are the two most important environmental predictors for the abundance of V.p in oysters, followed by water level, pH, chlorophyll-a, and turbidity. The findings suggested that the GP-DNN ensemble models could be utilized as effective predictive tools for mitigating the V.p risk.

Alkali Metal Cations Modulate the Energy Level of SnO2 via Micro-agglomerating and Anchoring for Perovskite Solar Cells.

N-type tin oxide (SnO2) films are commonly used as an electron transport layer (ETL) in perovskite solar cells (PSCs). However, SnO2 films are of poor quality due to facile agglomeration under a low-temperature preparation method. In addition, energy level mismatch between the SnO2 and perovskite (PVK) layer as well as interfacial charge recombination would cause open-circuit voltage loss. In this work, alkali metal oxalates (M-Oxalate, M = Li, Na, and K) are doped into the SnO2 precursor to solve these problems. First, it is found that the hydrolyzed alkali metal cations tend to change colloid size distribution of SnO2, in which Na-Oxalate with suitable basicity leads to most uniform colloid size distribution and high-quality SnO2-Na films. Second, the electron conductivity is enhanced by slightly agglomerated SnO2-Na, which facilitates the transmission of electrons. Third, alkali metal cations increase the conduction band level of SnO2 in the sequence of K+, Na+, and Li+ to promote band alignment between ETLs and perovskite. Based on the optimized film quality and energy states of SnO2-Na, the best PSC efficiency of 20.78% is achieved with a significantly enhanced open-circuit voltage of 1.10 V. This work highlights the function of alkali metal salts on the colloid particle distribution and energy level modulation of SnO2.

Pharmacological modulation of autophagy for Alzheimer's disease therapy: Opportunities and obstacles.

Alzheimer's disease (AD) is a prevalent and deleterious neurodegenerative disorder characterized by an irreversible and progressive impairment of cognitive abilities as well as the formation of amyloid ß (Aß) plaques and neurofibrillary tangles (NFTs) in the brain. By far, the precise mechanisms of AD are not fully understood and no interventions are available to effectively slow down progression of the disease. Autophagy is a conserved degradation pathway that is crucial to maintain cellular homeostasis by targeting damaged organelles, pathogens, and disease-prone protein aggregates to lysosome for degradation. Emerging evidence suggests dysfunctional autophagy clearance pathway as a potential cellular mechanism underlying the pathogenesis of AD in affected neurons. Here we summarize the current evidence for autophagy dysfunction in the pathophysiology of AD and discuss the role of autophagy in the regulation of AD-related protein degradation and neuroinflammation in neurons and glial cells. Finally, we review the autophagy modulators reported in the treatment of AD models and discuss the obstacles and opportunities for potential clinical application of the novel autophagy activators for AD therapy.

Colorimetric Aptasensor Based on Fe3O4-Cu2+ Nanozyme with Intrinsic Peroxidase-Like Activity in the Detection of Breast Cancer Exosomes.

Because breast cancer cells such as MCF-7, exhibit vital and developmental signs by exosome secretion, diagnosing them in the blood can provide a good index of the presence of breast cancer. However, accurate and inexpensive detection of exosomes in clinical practice faces challenges. Therefore, in the presents study, an aptasensor based on CD63 aptameriron oxide-copper ion nanozymes (Fe3O4-Cu2+-NZs) was designed with the ability of the CD63 aptamer to interact with the exosome and the release of the Fe3O4-Cu2+-NZs for peroxidase-like activity on the tetramethylbenzidine (TMB). After fabrication of CD63 aptamer-Fe3O4-Cu2+-NZs based on hydrothermal method, their physicochemical properties were investigated with the SEM, TEM, DLS, Zeta, XRD and magnetization. To investigate the interaction of CD63 aptamer-Fe3O4-Cu2+-NZs with exosomes, the required exosomes were extracted from cultured MCF-7 cells. The performance of CD63 aptamer-Fe3O4-Cu2+-NZs on TMB degradation in the presence and absence of exosomes was investigated through UV-vis adsorption and ocular observations based on colour changes on laboratory and real samples. The results show that the absence of exosomes significantly inhibited the peroxidase-like activity of CD63 aptamer-Fe3O4-Cu2+-NZs due to the aptamer coating. Under optimal conditions, the designed CD63 aptamer-Fe3O4-Cu2+-NZs is capable of detecting exosomes in the range of 1.4 × 104-5.6 × 105 particles/µL with a detection limit of 5.91 × 10³ particles/µL. Also, this method showed a satisfactory outcome in detection of cancer cells in real samples. Overall, this colorimetric aptasensor can be used to diagnose breast cancer cells based on a simple and inexpensive approach.

Sevelamer arsenite nanoparticle as a Pi-responsive drug carrier and embolic agent for chemoembolization.

Arsenic trioxide (As2O3, ATO) has limited therapeutic benefit to treat solid tumors, whether used alone or in combination. Nanoscale drug delivery vehicles have great potential to overcome the limitation of the utility of ATO by rapid renal clearance and dose-limiting toxicity. Polymeric materials ranging from gelatin foam to synthetic polymers such as poly(vinyl alcohol) were developed for vascular embolic or chemoembolic applications. Recently, we have introduced sevelamer, an oral phosphate binder, as a new polymeric embolic for vascular interventional therapy. In this paper, sevelamer arsenite nanoparticle with a polygonal shape and a size of 50-300 nm, synthesized by anionic exchange from sevelamer chloride, was developed as a Pi-responsive bifunctional drug carrier and embolic agent for chemoembolization therapy. At the same arsenic dosage, sevelamer arsenite-induced severer tumor necrosis than ATO on the VX2 cancer model. In vitro tests evidenced that Pi deprivation by sevelamer could enhance ATO's anticancer effect. The results showed that ATO in Pi starvation reduced cell viability, induced more apoptosis, and diminished the mitochondrial membrane potential (Δψm) of cells since Pi starvation helps ATO to further down-regulate Bcl-2 expression, up-regulate Bax expression, enhance the activation of caspase-3 and increase the release of cytochrome c, and the production of excessive reactive oxygen species (ROS). Sevelamer arsenite not only plays a Pi-activated nano-drug delivery system but also integrated anticancer drug with embolic for interventional therapy. Therefore, our results presented a new administration route of ATO as well as an alternative chemoembolization therapy.

Intratumoral Pi deprivation benefits chemoembolization therapy via increased accumulation of intracellular doxorubicin.

It is a decade-long controversy that transarterial chemoembolization (TACE) has definite priority over transarterial embolization (TAE) in treating patients with hepatocellular carcinoma (HCC), since HCC cells are regularly resistant to chemotherapy by enhanced expression of proteins that confer drug resistance, and ABC transporters pump the intracellular drug out of the cell. We addressed this issue by modulating the chemo-environment. In an animal model, sevelamer, a polymeric phosphate binder, was introduced as an embolic agent to induce intratumoral inorganic phosphate (Pi) starvation, and trans-arterially co-delivered with doxorubicin (DOX). The new type of TACE was named as DOX-TASE. This Pi-starved environment enhanced DOX tumoral accumulation and retention, and DOX-TASE thereby induced more severe tumor necrosis than that induced by conventional TACE (C-TACE) and drug-eluting bead TACE (D-TACE) at the same dose. In vitro tests showed that Pi starvation increased the cellular accumulation of DOX in an irreversible manner and enhanced cytotoxicity and cell apoptosis by suppressing the expression of ABC transporters (P-glycoprotein (P-gp), BCRP, and MRP1) and the production of intracellular ATP. Our results are indicative of an alternative interventional therapy combining chemotherapy with embolization more effectively.