Home Screening of the best time window for MSC transplantation to treat acute myocardial infarction with SDF-1α antibody-loaded targeted ultrasonic microbubbles: An in vivo study in miniswine
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Screening of the best time window for MSC transplantation to treat acute myocardial infarction with SDF-1α antibody-loaded targeted ultrasonic microbubbles: An in vivo study in miniswine

  • Lingjie Yang , Rong Hu , Chen Yuan , Lina Guan and Yuming Mu EMAIL logo
Published/Copyright: June 21, 2023

Abstract

The present study aimed to screen the best time window for the transplantation of bone marrow mesenchymal stem cells (MSCs) after acute myocardial infarction (MI) through targeted ultrasound microbubbles loaded with SDF-1α antibody. Thirty-six MI miniswine were randomly divided into six experimental groups according to the duration after infarction (1 day, 3 days, 1 week, 2 weeks, 3 weeks, and 4 weeks after infarction). MSCs were labeled with BrdU and then injected through the coronary artery in the stem cell transplantation group to detect the number of transplanted MSCs at different time points after MI. Three miniswine were randomly selected as the control group (sham operation: open chest without ligation of the coronary artery). All SDF-1α groups and control groups were injected with a targeted microbubble ultrasound contrast agent. The values of the myocardial perfusion parameters (A, β, and A × β) were determined. A T, β T, and (A × β)T varied with time and peaked 1 week after MI (P < 0.05). The number of transplanted stem cells in the myocardium through coronary injection of MSCs at 1 week was the greatest and consistent with the changing tendency of A T, β T, and (A × β)T (r = 0.658, 0.778, 0.777, P < 0.05). β T(X), (A × β)T(X), and the number of transplanted stem cells was used to establish the regression equation as follows: Y = 36.11 + 17.601X; Y = 50.023 + 3.348X (R 2 = 0.605, 0.604, P < 0.05). The best time window for transplanting stem cells was 1 week after MI. The myocardial perfusion parameters of the SDF-1α targeted contrast agent can be used to predict the number of transplanted stem cells in the myocardial tissue.

1 Introduction

Stem cells have widely been applied in basic research and clinical trials on the regenerative repair of myocardial damage. Recent studies have confirmed that the injection of bone marrow cells is safe and effective for patients with myocardial infarction (MI) or ischemia and that there are no local or general complications [1]. In addition, there is increasing evidence indicating that mesenchymal stem cells (MSCs) also highly transferred their mitochondria to effectively protect against ischemic heart disease [2], eye diseases [3], and lung injury [4]. However, according to Henning [5], the use of different kinds of transplanted cells, different methods of transplantation, different transplanting time, different length of follow-up visits, and different evaluation methods and evaluation parameters might contribute to different effects of transplantation. Some researchers believe that transplantation of stem cells 2 weeks or more after MI has a greater curative effect in limiting the infarction area and improving the left heart function [6]. However, other researchers [7] have shown that the curative effect of transplantation is best in the early stages of MI, namely, within 7 days after MI. Other studies [8] have shown that compared with the placebo group, transplanting stem cells at different time points causes no significant improvement in cardiac function. Therefore, to further optimize and improve the therapeutic effect of stem cells on MI, it is vital to explore the best transplanting time.

Stem cell homing plays an important role in the treatment of infarcted myocardium. Stromal cell-derived factor-1alpha (SDF-1α) is a chemokine that plays a critical role in stem cell homing. SDF-1α specifically anchors CXCR4 onto the surface of the stem cell membrane and activates the SDF-1α/CXCR4 pathway, which triggers bone marrow MSCs to home to the inflammatory tissue area [9]. Experimental and clinical studies have shown that SDF-1α is upregulated in the microenvironment of the MI area and regulates stem cell migration to sites of injury [10]. Thus, the concentration of SDF-1α in infarcted myocardium is an important factor affecting the homing of stem cells. However, it is very difficult to determine the expression of SDF-1α in the infarcted area noninvasively and in vivo. Therefore, to make better use of the role of transplanted stem cells in the treatment of MI, it is necessary to study the expression of SDF-1α in the infarcted myocardium and to determine the effect of changes on stem cell homing.

Ultrasound microbubbles are widely used as carriers in drugs or gene-targeted therapies. In addition, ultrasound microbubbles are also used to carry molecular ligands with specific expression into pathological tissues to achieve the purpose of contrast-enhanced ultrasound (CEU) molecular imaging by identifying targets of molecules abnormally expressed in a pathological situation [11]. CEU molecular imaging techniques that can provide unique information on ischemia, angiogenesis, vascular inflammation, and thrombus formation have been developed. In our previous research [12], we determined the dynamic expression of SDF-1α in an acute MI (AMI) swine model by ultrasound molecular imaging via targeted microbubbles. In this study, we further explored the value of ultrasonic molecular imaging in the evaluation of stem cell homing. SDF-1α-targeted microbubbles and myocardial contrast acoustic imaging were used in the miniswine MI models to explore the best time window for stem cell transplantation after MI by analyzing the correlation between the myocardial perfusion of the targeted contrast agent and the number of transplanted stem cells.

2 Materials and methods

2.1 Preparation of targeted ultrasound microbubbles

Targestar SA (Targeson, Inc., San Diego, CA, USA) is a contrast agent with a streptavidin-coated surface to allow one-step coupling of biotinylated ligands that are suitable for molecular ultrasound imaging. There are approximately 1 × 109 microbubbles in each milliliter of the suspension. Targeted microbubbles that specifically bind with SDF-1α were prepared as previously described [13]. Briefly, streptavidin-coated microbubbles were incubated with biotinylated rabbit anti-swine SDF-1α monoclonal antibody (BIOSS, Inc., Beijing, China). Then, the suspension was incubated at room temperature and centrifuged at 400 rpm to wash out unbound unconjugated antibodies. Fluorescence microscopy and flow cytometry were used to evaluate the physical and chemical properties and the combined ratio of the targeted ultrasound microbubbles. The microbubbles that were not incubated with the antibody were used as the nontargeted microbubbles.

2.2 MI model

Eight-month-old adult miniswine (weight, 21.4 ± 1.55 kg) were provided by the Experimental Animal Research Center of Xinjiang Medical University. The miniswine were treated following the policies and regulations approved by the Animal Ethics Committee of the First Affiliated Hospital of Xinjiang Medical University. The animal research complied with all relevant national regulations and institutional policies for the care and use of animals.

Surgical procedures on the MI model were performed as previously described [12]. Briefly, the miniswine were anesthetized using ketamine (10–15 mg/kg, intramuscularly) and atropine (25 μg/kg, intramuscularly), and venous channels were established through the porcine ear vein using a bolster. During the operation, the swine were given intravenous anesthetics (ketamine hydrochloride and midazolam, 4.0 mg/kg), and suxamethonium chloride injection (0.2 mg/kg) before establishing mechanical breathing passages using tracheal intubation. The electrocardiogram, heart rate, and oxygen saturation were monitored using an electrocardiogram (ECG, USA, HP Cm XL+) monitor during the operation. An electrical defibrillation instrument was used for emergencies. Three tablets of Betaloc were applied after anesthesia was induced, and an intravenous drip of lidocaine (at a speed of 50 μg/kg per minute) was used to prevent ventricular fibrillation and maintain the heart rate at 60–100 bpm. Thoracotomy and ligature of the left anterior descending coronary artery were initiated according to aseptic processing. The thorax was opened along the fourth intercostal space at the left edge of the sternum, and the pericardium was cut to expose the heart. From the starting point of the left anterior descending artery to the apex of the heart, ligation was conducted in the middle, that is, at 50% of the distance. The slipknot was released after 50 min. The chest was closed with suture layer by layer, and ECG monitoring was continued for 30 min after the operation. All animals received analgesics (buprenorphine: 0.3 mg twice a day) and antibacterial treatment (penicillin: 2400 IU) within 3 days after the operation. Preoperative and postoperative ECG and echocardiogram were used in all of the experimental animals, and serum myocardial enzymes were monitored within 24 h after the operation.

The MI model was confirmed by the following tests: ECG, emission computed tomography, pathology, and echocardiography (Figure 1).

Figure 1 
                  Confirmation of the acute MI model. (a) ECG: ST segments increased by >0.5 mV in the chest leads. ECG, electrocardiogram. (b) Ultrasonic cardiograms: Segmental weakening of left ventricular wall motion on motion mode echocardiography. (c) ECT: Local defects and/or decreases were observed in the radioactive signal. (d) Pathology: The infarcted myocardium showing edema, neutrophil infiltration, coagulative necrosis, and nuclear degeneration. Bar = 200 μm.
Figure 1

Confirmation of the acute MI model. (a) ECG: ST segments increased by >0.5 mV in the chest leads. ECG, electrocardiogram. (b) Ultrasonic cardiograms: Segmental weakening of left ventricular wall motion on motion mode echocardiography. (c) ECT: Local defects and/or decreases were observed in the radioactive signal. (d) Pathology: The infarcted myocardium showing edema, neutrophil infiltration, coagulative necrosis, and nuclear degeneration. Bar = 200 μm.

  1. Ethical approval: The research related to animal use has complied with all the relevant national regulations and institutional policies for the care and use of animals, and has been approved by the Animal Ethics Committee of the First Affiliated Hospital of Xinjiang Medical University.

2.3 Animal grouping

Three of the 39 miniswine were randomly selected as the control group (n = 3, sham operation group: open chest without ligation of the coronary artery). The remaining 36 MI model miniswine were randomly divided into six groups as the experimental group according to the duration after infarction (1 day, 3 days, 1 week, 2 weeks, 3 weeks, and 4 weeks after infarction). In the experimental group, MSCs were injected through the coronary artery to detect the number of transplanted MSCs at different time points after MI. All of the groups were injected with the nontargeted ultrasound contrast agent (T + C group) or targeted microbubble ultrasound contrast agent (T + T group) successively.

2.4 Real-time myocardial contrast echocardiography

Myocardial contrast echocardiography was performed. Briefly, a Philips IE-33 (Philips Electronics, Andover, MA, USA) ultrasound imaging instrument with an S5-1 cardiac probe was used with a frequency in the range of 2–6 MHz. After miniswine were anesthetized, 1 mL of the nontargeted contrast agent was injected through the marginal ear vessel. In the parasternal short-axis view of the left ventricular papillary muscle, scintigraphy was triggered when myocardial imaging was stable, and a high mechanical index pulse was initiated to completely and instantly destroy the microbubbles in the myocardium. Then, the instrument automatically switched to the low mechanical index and recorded the dynamic image of the entire process until the contrast agent was cleared. Thirty minutes after the contrast agent was completely cleared, the ultrasound parameters were kept unchanged, 1 mL of the targeted ultrasound microbubbles contrast agent was injected, and the above steps were repeated.

Q-Lab software was used to obtain the myocardial perfusion parameters. A is the myocardial blood volume, β is the myocardial blood flow velocity, and A × β is the myocardial blood flow volume (Figure 2).

Figure 2 
                  Myocardial contrast echocardiography. After injecting the microbubble contrast agent in vivo, the acoustic signal intensity of the MI area was detected.
Figure 2

Myocardial contrast echocardiography. After injecting the microbubble contrast agent in vivo, the acoustic signal intensity of the MI area was detected.

2.5 Stem cell transplantation and detection

MSCs, which were provided by the Xinjiang Medical University Laboratory (Xinjiang, China), were extracted from the bone marrow of miniswine and identified by flow cytometry as CD44/CD29-positive and CD45-negative. The cells were cultured with Dulbecco’s modified Eagle’s medium (DMEM) (Hyclone, Logan, UT, USA) containing 10% fetal bovine serum (FBS) (Gibco, Thermo Fisher Scientific, Waltham, MA, USA) at 37°C in 5% CO2. MSCs were transplanted at different time points after infarction (1 day, 3 days, 1 week, 2 weeks, 3 weeks, 4 weeks) according to the grouping.

Before each transplantation, MSCs were labeled with 5-bromo-2-deoxyuridine (BrdU; Invitrogen). In brief, the third-generation MSCs were incubated in the culture medium containing BrdU (10 µmol/L) to label MSCs 48 h before transplantation. Then, BMCs were harvested and washed three times with heparinized saline, and the cells were resuspended with heparinized saline to prepare cell suspension (1 × 108 cells/mL). Cell transplantation was performed via the intracoronary administration route [14] using 4–6 fractional infusions parallel to balloon inflation over 2–4 min of 5 mL of cell suspension (1 × 108 cells/mL). All cells were infused directly into the infarcted zone through the infarct-related artery via an angioplasty balloon catheter, which was inflated for approximately 2 min to block the coronary blood flow. This prevented the backflow of cells and produced stop flow beyond the site of balloon inflation to maximize the time of cells staying in the microcirculation area of the infarct-related artery and facilitate high-pressure infiltration of cells into the infarcted zone. Heparinization and filtration were carried out to prevent cell clotting and microembolization during intracoronary transplantation. Angiography was performed after intra-arterial cell transplantation to evaluate the blood flow of the artery.

Three hours after transplantation, the myocardial tissue was collected after euthanasia, fixed with 4% paraformaldehyde, and embedded. Immunohistochemical staining of BrdU was conducted following the manufacturer’s protocol (BrdU staining kit, Invitrogen). Briefly, the prepared paraffin-embedded sections of the myocardium were fixed in acetone and incubated with 10% goat serum for 30 min. The sections were then incubated with anti-BrdU monoclonal antibody (1:100, Invitrogen, Thermo Fisher Scientific) at 4°C overnight. The tissues were washed extensively in phosphate buffer saline (PBS), and detection was performed using a horseradish peroxidase-conjugated secondary antibody followed by colorimetric detection using a DAB (3,3′-diaminobenzidine) kit. The tissue was counterstained with hematoxylin (Sigma) and dehydrated with ethanol and xylene. The nuclei were stained brown in positive cells, and the positively stained area was counted under an Olympus IX70 light microscope (Olympus Inc., Melville, USA) to observe the transplanted MSCs in the myocardial tissue at the border of the infarction. Buffy BrdU represented positively labeled cells to show transplanted MSCs, and the number of transplanted stem cells was counted from the analysis of at least five randomly selected areas from each slice.

2.6 Statistical analysis

All data are presented as the mean ± SD. The data were analyzed using IBM SPSS statistics version 23.0 (SPSS, Inc., Chicago, IL, USA). The differences in the transplanted stem cell number among the groups were evaluated using one-way ANOVA. A t-test was used for comparisons between the two groups. Pearson correlation was used to analyze the correlations between the transplanted stem cell number and the myocardial perfusion parameters, and the level of P < 0.05 was considered statistically significant.

3 Results

3.1 Transplantation of MSCs

On day 1, day 3, week 1, week 2, week 3, and week 4 after the MI, the cell nuclei took on a Buffy BrdU marker of transplanted cells. The results showed that the number of transplanted cells was the greatest and the most concentrated at 1 week after MI (P < 0.05), as shown in Figure 3.

Figure 3 
                  (a) Number of MSCs in myocardial tissue with cell transplantation at different time points after MI. (b) Representative image of BrdU immunohistochemical staining in the stem cell transplantation group at 1 week after MI. The positive cells labeled with BrdU are brown and show transplanted MSCs. Bar = 20 μm; *P < 0.05 vs other groups.
Figure 3

(a) Number of MSCs in myocardial tissue with cell transplantation at different time points after MI. (b) Representative image of BrdU immunohistochemical staining in the stem cell transplantation group at 1 week after MI. The positive cells labeled with BrdU are brown and show transplanted MSCs. Bar = 20 μm; *P < 0.05 vs other groups.

3.2 Correlation analysis of the myocardial perfusion parameters and the number of transplanted stem cells

Changes in the myocardial angiography parameters were analyzed in our previous study [12]. The myocardial perfusion parameters A T, β T, and (A × β)T of the targeted contrast agent varied with time but were consistent with the changing tendency of the number of transplanted stem cells in the myocardium at different time points after infarction. All of the parameters peaked 7 days after the infarction, as shown in Figure 4.

Figure 4 
                  The changing tendency of myocardial perfusion parameters of the SDF-1α-targeted contrast agent and the number of transplanted stem cells in the myocardium at six different time points.
Figure 4

The changing tendency of myocardial perfusion parameters of the SDF-1α-targeted contrast agent and the number of transplanted stem cells in the myocardium at six different time points.

We showed the correlation between the myocardial perfusion parameters A T, β T, and (A × β)T of the targeted contrast agent and the number of transplanted stem cells (P < 0.05). However, there was no correlation between the myocardial perfusion parameters A c, β c, and (A × β)c of the nontargeted contrast agent and the number of transplanted stem cells, as shown in Table 1. β T(X), (A × β)T(X) and the number of transplanted stem cells were used to establish the regression equation as follows: Y = 36.11 + 17.601X; Y = 50.023 + 3.348X (R 2 = 0.605, 0.604, P < 0.05).

Table 1

Correlation analysis of myocardial perfusion parameters and the number of stem cells homing r(P)

Contrast agent Myocardial perfusion parameters n r P
Non-targeted A c (dB/s) 18 0.292 0.239
β c (s−1) 18 0.366 0.135
(A × β)c (dB/s) 18 0.499 0.035
Targeted A T (dB/s) 18 0.658 0.003
β T (s−1) 18 0.778 0.000
(A × β)T (dB/s) 18 0.777 0.000

4 Discussion

SDF-1α plays a significant role in the repairing of myocardial injury and promotes stem cell mobilization, migration, and survival. SDF-1α is expressed at different levels at different time points after MI. In this study, SDF-1α-targeted ultrasound microbubbles were prepared, and ultrasound molecular imaging was applied for the evaluation after cell transplantation. The research adopted reperfusion modeling after MI in miniswine, simulating clinical treatment of percutaneous coronary artery angioplasty as early as possible for patients with coronary artery disease who suffered MI, and stem cell transplantation was then performed. The results showed that after intracoronary injection of MSCs, the number of transplanted cells in the damaged myocardial area was the greatest on the seventh day after MI (P < 0.05), and the myocardial perfusion parameters of SDF-1α-targeted microbubbles correlated with the number of transplanted stem cells.

MSCs transplanted into damaged myocardial tissue are regulated by many factors, such as the SDF-1α/CXCR4 signal axis, intracellular signal pathway, adhesion molecules, and proteases. It has been reported that these factors are related to the mechanism of stem cell homing and heart repair. Among many inflammatory cytokines, SDF-1α has a stronger dose-dependent chemotaxis on stem cells and plays a protective role in limiting stem cell apoptosis, so it attracts much attention [15]. The content of SDF-1α is closely related to the homing of stem cells. Through the specific binding of antigen and antibody, analyzing the myocardial perfusion curve of microbubbles carrying anti-SDF-1α antibodies can indirectly indicate the expression of SDF-1α in the MI area. Based on the results of this study, the myocardial perfusion parameters of targeted microbubbles showed a unimodal curve change after MI and peaked at 7 days after MI. This trend was consistent with the changes in the number of transplanted stem cells in the infarcted myocardium at different time points after MI, and there was a correlation between the two. However, there was no correlation between the changes in the myocardial perfusion parameters of nontargeted microbubbles and the number of transplanted stem cells. The results confirm that SDF-1α-targeted ultrasound microbubbles can achieve noninvasive measurement of myocardial SDF-1α in vivo and guide the optimal timing of stem cell transplantation to ensure stem cell homing as much as possible, which shows great potential for screening MI patients before stem cell transplantation. In addition, bone marrow-derived MSCs were used in our study. Rigorous quality control is critical to reducing the batch-to-batch variation in MSC products. Recently, induced pluripotent stem cells-derived MSCs (iPSC-MSCs) [16] have displayed a higher proliferative capacity. Li et al. demonstrated that iPSC-MSCs were superior to bone marrow-derived MSCs in anti-apoptotic/pro-proliferative capacity through paracrine secretion of SCF and TGF-β1/2/3 [17,18]. Thus, iPSC-MSCs may become an alternative resource for bone marrow-derived MSCs in the future [19].

Targeted ultrasound contrast agents have the advantages of high specificity, good repeatability, and noninvasiveness. Compared with other existing quantitative research methods, this research method can monitor the expression of SDF-1α in vivo, noninvasively, and in real time. The disadvantage is that the damaged myocardial tissue and other tissues and organs cannot be assessed at the same time, and it is impossible to assess other inflammatory factors at the same time by one-time myocardial contrast echocardiography. In addition, targeted microbubbles are less stable under high shear forces, and these issues remain to be further explored in future targeted ultrasound contrast agent studies [20].

The limitations of this study are as follows: this study only analyzed the optimal time window for MSC transplantation to damaged myocardium from the perspective of SDF-1α/CXCR4 and did not consider other factors that might affect the number of homed stem cells. Furthermore, there may be some intra-arterial cell aggregation of transplanted cells by coronary injection, and the intratissue location of the transplanted cells needs to be determined. Immunosuppressants are required before and after cell transplantation in vivo [21] but, in our study, we did not use immunosuppressant agents after MSC transplantation, so the loss of BMSCs caused by immune rejection could not be excluded.

5 Conclusions

The concentration of SDF-1α in the infarcted myocardium is an important factor affecting the homing of stem cells. In this study, targeted microbubbles carrying SDF-1α antibody were used to explore the best time window for stem cell transplantation after MI. By observing the contrast ultrasound parameters of SDF-1α-targeted microbubbles and the number of transplanted MSCs after transplantation, the results show that the best time for transplantation of MSCs is 1 week after acute MI. With the establishment of the regression equation, our study confirmed that the SDF-1α-targeted contrast agent can be used to predict the number of transplanted stem cells after transplantation in the myocardial tissue, providing a theoretical basis for subsequent research on stem cell transplantation.


# L.Y. and R.H. contributed equally to this study.


  1. Funding information: We gratefully acknowledge the funding support of the National Natural Science Foundation of China (Nos 81271590, 82260347 and 82060321).

  2. Author contributions: Yang L.J. and Hu R. were responsible for experiments and writing the manuscript. Mu Y.M. was mainly responsible for the experimental design and manuscript review. Chen Yuan, Lina Guan, Lingjie Yang, and Rong Hu participated in the experiments and data analysis.

  3. Conflict of interest: Authors state no conflict of interest.

  4. Data availability statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Received: 2022-12-04
Revised: 2023-04-04
Accepted: 2023-04-27
Published Online: 2023-06-21

© 2023 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  37. The apatinib and pemetrexed combination has antitumor and antiangiogenic effects against NSCLC
  38. Radiotherapy for primary thyroid adenoid cystic carcinoma
  39. Design and functional preliminary investigation of recombinant antigen EgG1Y162–EgG1Y162 against Echinococcus granulosus
  40. Effects of losartan in patients with NAFLD: A meta-analysis of randomized controlled trial
  41. Bibliometric analysis of METTL3: Current perspectives, highlights, and trending topics
  42. Performance comparison of three scaling algorithms in NMR-based metabolomics analysis
  43. PI3K/AKT/mTOR pathway and its related molecules participate in PROK1 silence-induced anti-tumor effects on pancreatic cancer
  44. The altered expression of cytoskeletal and synaptic remodeling proteins during epilepsy
  45. Effects of pegylated recombinant human granulocyte colony-stimulating factor on lymphocytes and white blood cells of patients with malignant tumor
  46. Prostatitis as initial manifestation of Chlamydia psittaci pneumonia diagnosed by metagenome next-generation sequencing: A case report
  47. NUDT21 relieves sevoflurane-induced neurological damage in rats by down-regulating LIMK2
  48. Association of interleukin-10 rs1800896, rs1800872, and interleukin-6 rs1800795 polymorphisms with squamous cell carcinoma risk: A meta-analysis
  49. Exosomal HBV-DNA for diagnosis and treatment monitoring of chronic hepatitis B
  50. Shear stress leads to the dysfunction of endothelial cells through the Cav-1-mediated KLF2/eNOS/ERK signaling pathway under physiological conditions
  51. Interaction between the PI3K/AKT pathway and mitochondrial autophagy in macrophages and the leukocyte count in rats with LPS-induced pulmonary infection
  52. Meta-analysis of the rs231775 locus polymorphism in the CTLA-4 gene and the susceptibility to Graves’ disease in children
  53. Cloning, subcellular localization and expression of phosphate transporter gene HvPT6 of hulless barley
  54. Coptisine mitigates diabetic nephropathy via repressing the NRLP3 inflammasome
  55. Significant elevated CXCL14 and decreased IL-39 levels in patients with tuberculosis
  56. Whole-exome sequencing applications in prenatal diagnosis of fetal bowel dilatation
  57. Gemella morbillorum infective endocarditis: A case report and literature review
  58. An unusual ectopic thymoma clonal evolution analysis: A case report
  59. Severe cumulative skin toxicity during toripalimab combined with vemurafenib following toripalimab alone
  60. Detection of V. vulnificus septic shock with ARDS using mNGS
  61. Novel rare genetic variants of familial and sporadic pulmonary atresia identified by whole-exome sequencing
  62. The influence and mechanistic action of sperm DNA fragmentation index on the outcomes of assisted reproduction technology
  63. Novel compound heterozygous mutations in TELO2 in an infant with You-Hoover-Fong syndrome: A case report and literature review
  64. ctDNA as a prognostic biomarker in resectable CLM: Systematic review and meta-analysis
  65. Diagnosis of primary amoebic meningoencephalitis by metagenomic next-generation sequencing: A case report
  66. Phylogenetic analysis of promoter regions of human Dolichol kinase (DOLK) and orthologous genes using bioinformatics tools
  67. Collagen changes in rabbit conjunctiva after conjunctival crosslinking
  68. Effects of NM23 transfection of human gastric carcinoma cells in mice
  69. Oral nifedipine and phytosterol, intravenous nicardipine, and oral nifedipine only: Three-arm, retrospective, cohort study for management of severe preeclampsia
  70. Case report of hepatic retiform hemangioendothelioma: A rare tumor treated with ultrasound-guided microwave ablation
  71. Curcumin induces apoptosis in human hepatocellular carcinoma cells by decreasing the expression of STAT3/VEGF/HIF-1α signaling
  72. Rare presentation of double-clonal Waldenström macroglobulinemia with pulmonary embolism: A case report
  73. Giant duplication of the transverse colon in an adult: A case report and literature review
  74. Ectopic thyroid tissue in the breast: A case report
  75. SDR16C5 promotes proliferation and migration and inhibits apoptosis in pancreatic cancer
  76. Vaginal metastasis from breast cancer: A case report
  77. Screening of the best time window for MSC transplantation to treat acute myocardial infarction with SDF-1α antibody-loaded targeted ultrasonic microbubbles: An in vivo study in miniswine
  78. Inhibition of TAZ impairs the migration ability of melanoma cells
  79. Molecular complexity analysis of the diagnosis of Gitelman syndrome in China
  80. Effects of maternal calcium and protein intake on the development and bone metabolism of offspring mice
  81. Identification of winter wheat pests and diseases based on improved convolutional neural network
  82. Ultra-multiplex PCR technique to guide treatment of Aspergillus-infected aortic valve prostheses
  83. Virtual high-throughput screening: Potential inhibitors targeting aminopeptidase N (CD13) and PIKfyve for SARS-CoV-2
  84. Immune checkpoint inhibitors in cancer patients with COVID-19
  85. Utility of methylene blue mixed with autologous blood in preoperative localization of pulmonary nodules and masses
  86. Integrated analysis of the microbiome and transcriptome in stomach adenocarcinoma
  87. Berberine suppressed sarcopenia insulin resistance through SIRT1-mediated mitophagy
  88. DUSP2 inhibits the progression of lupus nephritis in mice by regulating the STAT3 pathway
  89. Lung abscess by Fusobacterium nucleatum and Streptococcus spp. co-infection by mNGS: A case series
  90. Genetic alterations of KRAS and TP53 in intrahepatic cholangiocarcinoma associated with poor prognosis
  91. Granulomatous polyangiitis involving the fourth ventricle: Report of a rare case and a literature review
  92. Studying infant mortality: A demographic analysis based on data mining models
  93. Metaplastic breast carcinoma with osseous differentiation: A report of a rare case and literature review
  94. Protein Z modulates the metastasis of lung adenocarcinoma cells
  95. Inhibition of pyroptosis and apoptosis by capsaicin protects against LPS-induced acute kidney injury through TRPV1/UCP2 axis in vitro
  96. TAK-242, a toll-like receptor 4 antagonist, against brain injury by alleviates autophagy and inflammation in rats
  97. Primary mediastinum Ewing’s sarcoma with pleural effusion: A case report and literature review
  98. Association of ADRB2 gene polymorphisms and intestinal microbiota in Chinese Han adolescents
  99. Tanshinone IIA alleviates chondrocyte apoptosis and extracellular matrix degeneration by inhibiting ferroptosis
  100. Study on the cytokines related to SARS-Cov-2 in testicular cells and the interaction network between cells based on scRNA-seq data
  101. Effect of periostin on bone metabolic and autophagy factors during tooth eruption in mice
  102. HP1 induces ferroptosis of renal tubular epithelial cells through NRF2 pathway in diabetic nephropathy
  103. Intravaginal estrogen management in postmenopausal patients with vaginal squamous intraepithelial lesions along with CO2 laser ablation: A retrospective study
  104. Hepatocellular carcinoma cell differentiation trajectory predicts immunotherapy, potential therapeutic drugs, and prognosis of patients
  105. Effects of physical exercise on biomarkers of oxidative stress in healthy subjects: A meta-analysis of randomized controlled trials
  106. Identification of lysosome-related genes in connection with prognosis and immune cell infiltration for drug candidates in head and neck cancer
  107. Development of an instrument-free and low-cost ELISA dot-blot test to detect antibodies against SARS-CoV-2
  108. Research progress on gas signal molecular therapy for Parkinson’s disease
  109. Adiponectin inhibits TGF-β1-induced skin fibroblast proliferation and phenotype transformation via the p38 MAPK signaling pathway
  110. The G protein-coupled receptor-related gene signatures for predicting prognosis and immunotherapy response in bladder urothelial carcinoma
  111. α-Fetoprotein contributes to the malignant biological properties of AFP-producing gastric cancer
  112. CXCL12/CXCR4/CXCR7 axis in placenta tissues of patients with placenta previa
  113. Association between thyroid stimulating hormone levels and papillary thyroid cancer risk: A meta-analysis
  114. Significance of sTREM-1 and sST2 combined diagnosis for sepsis detection and prognosis prediction
  115. Diagnostic value of serum neuroactive substances in the acute exacerbation of chronic obstructive pulmonary disease complicated with depression
  116. Research progress of AMP-activated protein kinase and cardiac aging
  117. TRIM29 knockdown prevented the colon cancer progression through decreasing the ubiquitination levels of KRT5
  118. Cross-talk between gut microbiota and liver steatosis: Complications and therapeutic target
  119. Metastasis from small cell lung cancer to ovary: A case report
  120. The early diagnosis and pathogenic mechanisms of sepsis-related acute kidney injury
  121. The effect of NK cell therapy on sepsis secondary to lung cancer: A case report
  122. Erianin alleviates collagen-induced arthritis in mice by inhibiting Th17 cell differentiation
  123. Loss of ACOX1 in clear cell renal cell carcinoma and its correlation with clinical features
  124. Signalling pathways in the osteogenic differentiation of periodontal ligament stem cells
  125. Crosstalk between lactic acid and immune regulation and its value in the diagnosis and treatment of liver failure
  126. Clinicopathological features and differential diagnosis of gastric pleomorphic giant cell carcinoma
  127. Traumatic brain injury and rTMS-ERPs: Case report and literature review
  128. Extracellular fibrin promotes non-small cell lung cancer progression through integrin β1/PTEN/AKT signaling
  129. Knockdown of DLK4 inhibits non-small cell lung cancer tumor growth by downregulating CKS2
  130. The co-expression pattern of VEGFR-2 with indicators related to proliferation, apoptosis, and differentiation of anagen hair follicles
  131. Inflammation-related signaling pathways in tendinopathy
  132. CD4+ T cell count in HIV/TB co-infection and co-occurrence with HL: Case report and literature review
  133. Clinical analysis of severe Chlamydia psittaci pneumonia: Case series study
  134. Bioinformatics analysis to identify potential biomarkers for the pulmonary artery hypertension associated with the basement membrane
  135. Influence of MTHFR polymorphism, alone or in combination with smoking and alcohol consumption, on cancer susceptibility
  136. Catharanthus roseus (L.) G. Don counteracts the ampicillin resistance in multiple antibiotic-resistant Staphylococcus aureus by downregulation of PBP2a synthesis
  137. Combination of a bronchogenic cyst in the thoracic spinal canal with chronic myelocytic leukemia
  138. Bacterial lipoprotein plays an important role in the macrophage autophagy and apoptosis induced by Salmonella typhimurium and Staphylococcus aureus
  139. TCL1A+ B cells predict prognosis in triple-negative breast cancer through integrative analysis of single-cell and bulk transcriptomic data
  140. Ezrin promotes esophageal squamous cell carcinoma progression via the Hippo signaling pathway
  141. Ferroptosis: A potential target of macrophages in plaque vulnerability
  142. Predicting pediatric Crohn's disease based on six mRNA-constructed risk signature using comprehensive bioinformatic approaches
  143. Applications of genetic code expansion and photosensitive UAAs in studying membrane proteins
  144. HK2 contributes to the proliferation, migration, and invasion of diffuse large B-cell lymphoma cells by enhancing the ERK1/2 signaling pathway
  145. IL-17 in osteoarthritis: A narrative review
  146. Circadian cycle and neuroinflammation
  147. Probiotic management and inflammatory factors as a novel treatment in cirrhosis: A systematic review and meta-analysis
  148. Hemorrhagic meningioma with pulmonary metastasis: Case report and literature review
  149. SPOP regulates the expression profiles and alternative splicing events in human hepatocytes
  150. Knockdown of SETD5 inhibited glycolysis and tumor growth in gastric cancer cells by down-regulating Akt signaling pathway
  151. PTX3 promotes IVIG resistance-induced endothelial injury in Kawasaki disease by regulating the NF-κB pathway
  152. Pancreatic ectopic thyroid tissue: A case report and analysis of literature
  153. The prognostic impact of body mass index on female breast cancer patients in underdeveloped regions of northern China differs by menopause status and tumor molecular subtype
  154. Report on a case of liver-originating malignant melanoma of unknown primary
  155. Case report: Herbal treatment of neutropenic enterocolitis after chemotherapy for breast cancer
  156. The fibroblast growth factor–Klotho axis at molecular level
  157. Characterization of amiodarone action on currents in hERG-T618 gain-of-function mutations
  158. A case report of diagnosis and dynamic monitoring of Listeria monocytogenes meningitis with NGS
  159. Effect of autologous platelet-rich plasma on new bone formation and viability of a Marburg bone graft
  160. Small breast epithelial mucin as a useful prognostic marker for breast cancer patients
  161. Continuous non-adherent culture promotes transdifferentiation of human adipose-derived stem cells into retinal lineage
  162. Nrf3 alleviates oxidative stress and promotes the survival of colon cancer cells by activating AKT/BCL-2 signal pathway
  163. Favorable response to surufatinib in a patient with necrolytic migratory erythema: A case report
  164. Case report of atypical undernutrition of hypoproteinemia type
  165. Down-regulation of COL1A1 inhibits tumor-associated fibroblast activation and mediates matrix remodeling in the tumor microenvironment of breast cancer
  166. Sarcoma protein kinase inhibition alleviates liver fibrosis by promoting hepatic stellate cells ferroptosis
  167. Research progress of serum eosinophil in chronic obstructive pulmonary disease and asthma
  168. Clinicopathological characteristics of co-existing or mixed colorectal cancer and neuroendocrine tumor: Report of five cases
  169. Role of menopausal hormone therapy in the prevention of postmenopausal osteoporosis
  170. Precisional detection of lymph node metastasis using tFCM in colorectal cancer
  171. Advances in diagnosis and treatment of perimenopausal syndrome
  172. A study of forensic genetics: ITO index distribution and kinship judgment between two individuals
  173. Acute lupus pneumonitis resembling miliary tuberculosis: A case-based review
  174. Plasma levels of CD36 and glutathione as biomarkers for ruptured intracranial aneurysm
  175. Fractalkine modulates pulmonary angiogenesis and tube formation by modulating CX3CR1 and growth factors in PVECs
  176. Novel risk prediction models for deep vein thrombosis after thoracotomy and thoracoscopic lung cancer resections, involving coagulation and immune function
  177. Exploring the diagnostic markers of essential tremor: A study based on machine learning algorithms
  178. Evaluation of effects of small-incision approach treatment on proximal tibia fracture by deep learning algorithm-based magnetic resonance imaging
  179. An online diagnosis method for cancer lesions based on intelligent imaging analysis
  180. Medical imaging in rheumatoid arthritis: A review on deep learning approach
  181. Predictive analytics in smart healthcare for child mortality prediction using a machine learning approach
  182. Utility of neutrophil–lymphocyte ratio and platelet–lymphocyte ratio in predicting acute-on-chronic liver failure survival
  183. A biomedical decision support system for meta-analysis of bilateral upper-limb training in stroke patients with hemiplegia
  184. TNF-α and IL-8 levels are positively correlated with hypobaric hypoxic pulmonary hypertension and pulmonary vascular remodeling in rats
  185. Stochastic gradient descent optimisation for convolutional neural network for medical image segmentation
  186. Comparison of the prognostic value of four different critical illness scores in patients with sepsis-induced coagulopathy
  187. Application and teaching of computer molecular simulation embedded technology and artificial intelligence in drug research and development
  188. Hepatobiliary surgery based on intelligent image segmentation technology
  189. Value of brain injury-related indicators based on neural network in the diagnosis of neonatal hypoxic-ischemic encephalopathy
  190. Analysis of early diagnosis methods for asymmetric dementia in brain MR images based on genetic medical technology
  191. Early diagnosis for the onset of peri-implantitis based on artificial neural network
  192. Clinical significance of the detection of serum IgG4 and IgG4/IgG ratio in patients with thyroid-associated ophthalmopathy
  193. Forecast of pain degree of lumbar disc herniation based on back propagation neural network
  194. SPA-UNet: A liver tumor segmentation network based on fused multi-scale features
  195. Systematic evaluation of clinical efficacy of CYP1B1 gene polymorphism in EGFR mutant non-small cell lung cancer observed by medical image
  196. Rehabilitation effect of intelligent rehabilitation training system on hemiplegic limb spasms after stroke
  197. A novel approach for minimising anti-aliasing effects in EEG data acquisition
  198. ErbB4 promotes M2 activation of macrophages in idiopathic pulmonary fibrosis
  199. Clinical role of CYP1B1 gene polymorphism in prediction of postoperative chemotherapy efficacy in NSCLC based on individualized health model
  200. Lung nodule segmentation via semi-residual multi-resolution neural networks
  201. Evaluation of brain nerve function in ICU patients with Delirium by deep learning algorithm-based resting state MRI
  202. A data mining technique for detecting malignant mesothelioma cancer using multiple regression analysis
  203. Markov model combined with MR diffusion tensor imaging for predicting the onset of Alzheimer’s disease
  204. Effectiveness of the treatment of depression associated with cancer and neuroimaging changes in depression-related brain regions in patients treated with the mediator-deuterium acupuncture method
  205. Molecular mechanism of colorectal cancer and screening of molecular markers based on bioinformatics analysis
  206. Monitoring and evaluation of anesthesia depth status data based on neuroscience
  207. Exploring the conformational dynamics and thermodynamics of EGFR S768I and G719X + S768I mutations in non-small cell lung cancer: An in silico approaches
  208. Optimised feature selection-driven convolutional neural network using gray level co-occurrence matrix for detection of cervical cancer
  209. Incidence of different pressure patterns of spinal cerebellar ataxia and analysis of imaging and genetic diagnosis
  210. Pathogenic bacteria and treatment resistance in older cardiovascular disease patients with lung infection and risk prediction model
  211. Adoption value of support vector machine algorithm-based computed tomography imaging in the diagnosis of secondary pulmonary fungal infections in patients with malignant hematological disorders
  212. From slides to insights: Harnessing deep learning for prognostic survival prediction in human colorectal cancer histology
  213. Ecology and Environmental Science
  214. Monitoring of hourly carbon dioxide concentration under different land use types in arid ecosystem
  215. Comparing the differences of prokaryotic microbial community between pit walls and bottom from Chinese liquor revealed by 16S rRNA gene sequencing
  216. Effects of cadmium stress on fruits germination and growth of two herbage species
  217. Bamboo charcoal affects soil properties and bacterial community in tea plantations
  218. Optimization of biogas potential using kinetic models, response surface methodology, and instrumental evidence for biodegradation of tannery fleshings during anaerobic digestion
  219. Understory vegetation diversity patterns of Platycladus orientalis and Pinus elliottii communities in Central and Southern China
  220. Studies on macrofungi diversity and discovery of new species of Abortiporus from Baotianman World Biosphere Reserve
  221. Food Science
  222. Effect of berrycactus fruit (Myrtillocactus geometrizans) on glutamate, glutamine, and GABA levels in the frontal cortex of rats fed with a high-fat diet
  223. Guesstimate of thymoquinone diversity in Nigella sativa L. genotypes and elite varieties collected from Indian states using HPTLC technique
  224. Analysis of bacterial community structure of Fuzhuan tea with different processing techniques
  225. Untargeted metabolomics reveals sour jujube kernel benefiting the nutritional value and flavor of Morchella esculenta
  226. Mycobiota in Slovak wine grapes: A case study from the small Carpathians wine region
  227. Elemental analysis of Fadogia ancylantha leaves used as a nutraceutical in Mashonaland West Province, Zimbabwe
  228. Microbiological transglutaminase: Biotechnological application in the food industry
  229. Influence of solvent-free extraction of fish oil from catfish (Clarias magur) heads using a Taguchi orthogonal array design: A qualitative and quantitative approach
  230. Chromatographic analysis of the chemical composition and anticancer activities of Curcuma longa extract cultivated in Palestine
  231. The potential for the use of leghemoglobin and plant ferritin as sources of iron
  232. Investigating the association between dietary patterns and glycemic control among children and adolescents with T1DM
  233. Bioengineering and Biotechnology
  234. Biocompatibility and osteointegration capability of β-TCP manufactured by stereolithography 3D printing: In vitro study
  235. Clinical characteristics and the prognosis of diabetic foot in Tibet: A single center, retrospective study
  236. Agriculture
  237. Biofertilizer and NPSB fertilizer application effects on nodulation and productivity of common bean (Phaseolus vulgaris L.) at Sodo Zuria, Southern Ethiopia
  238. On correlation between canopy vegetation and growth indexes of maize varieties with different nitrogen efficiencies
  239. Exopolysaccharides from Pseudomonas tolaasii inhibit the growth of Pleurotus ostreatus mycelia
  240. A transcriptomic evaluation of the mechanism of programmed cell death of the replaceable bud in Chinese chestnut
  241. Melatonin enhances salt tolerance in sorghum by modulating photosynthetic performance, osmoregulation, antioxidant defense, and ion homeostasis
  242. Effects of plant density on alfalfa (Medicago sativa L.) seed yield in western Heilongjiang areas
  243. Identification of rice leaf diseases and deficiency disorders using a novel DeepBatch technique
  244. Artificial intelligence and internet of things oriented sustainable precision farming: Towards modern agriculture
  245. Animal Sciences
  246. Effect of ketogenic diet on exercise tolerance and transcriptome of gastrocnemius in mice
  247. Combined analysis of mRNA–miRNA from testis tissue in Tibetan sheep with different FecB genotypes
  248. Isolation, identification, and drug resistance of a partially isolated bacterium from the gill of Siniperca chuatsi
  249. Tracking behavioral changes of confined sows from the first mating to the third parity
  250. The sequencing of the key genes and end products in the TLR4 signaling pathway from the kidney of Rana dybowskii exposed to Aeromonas hydrophila
  251. Development of a new candidate vaccine against piglet diarrhea caused by Escherichia coli
  252. Plant Sciences
  253. Crown and diameter structure of pure Pinus massoniana Lamb. forest in Hunan province, China
  254. Genetic evaluation and germplasm identification analysis on ITS2, trnL-F, and psbA-trnH of alfalfa varieties germplasm resources
  255. Tissue culture and rapid propagation technology for Gentiana rhodantha
  256. Effects of cadmium on the synthesis of active ingredients in Salvia miltiorrhiza
  257. Cloning and expression analysis of VrNAC13 gene in mung bean
  258. Chlorate-induced molecular floral transition revealed by transcriptomes
  259. Effects of warming and drought on growth and development of soybean in Hailun region
  260. Effects of different light conditions on transient expression and biomass in Nicotiana benthamiana leaves
  261. Comparative analysis of the rhizosphere microbiome and medicinally active ingredients of Atractylodes lancea from different geographical origins
  262. Distinguish Dianthus species or varieties based on chloroplast genomes
  263. Comparative transcriptomes reveal molecular mechanisms of apple blossoms of different tolerance genotypes to chilling injury
  264. Study on fresh processing key technology and quality influence of Cut Ophiopogonis Radix based on multi-index evaluation
  265. An advanced approach for fig leaf disease detection and classification: Leveraging image processing and enhanced support vector machine methodology
  266. Erratum
  267. Erratum to “Protein Z modulates the metastasis of lung adenocarcinoma cells”
  268. Erratum to “BRCA1 subcellular localization regulated by PI3K signaling pathway in triple-negative breast cancer MDA-MB-231 cells and hormone-sensitive T47D cells”
  269. Retraction
  270. Retraction to “Protocatechuic acid attenuates cerebral aneurysm formation and progression by inhibiting TNF-alpha/Nrf-2/NF-kB-mediated inflammatory mechanisms in experimental rats”
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