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The expression and clinical significance of syncytin-1 in serum exosomes of hepatocellular carcinoma patients

  • Xuewei Zhuang EMAIL logo , Xiao Shi , Hui Zhao , Shuai Shang , Xinyu Xu , Xiaomin Wang , Xin Zheng and Jing He
Published/Copyright: September 19, 2024

Abstract

This study aimed to investigate the expression and clinical significance of syncytin-1 in the serum exosomes of hepatocellular carcinoma (HCC) patients. Serum samples were collected from 61 patients with newly diagnosed HCC and 61 healthy individuals. Exosomes were extracted from serum samples and identified using transmission electron microscopy and Western blot. The relative expression levels of syncytin-1 in exosomes were determined by real-time quantitative PCR. The protein expression levels of alpha-fetoprotein and syncytin-1 in HCC patients were detected using enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed to evaluate the sensitivity and specificity of serum exosomal syncytin-1 in diagnosing HCC. The relationships between syncytin-1 expression and clinical pathological features were analyzed using receiver operating characteristic curve analysis. The results showed that the expression level of syncytin-1 in the serum of patients with newly diagnosed HCC was significantly higher than that in the normal control group (P < 0.0001). Using pathological diagnosis as the gold standard, the sensitivity and specificity of syncytin-1 for the auxiliary diagnosis of HCC were 91.3% and 75.5%, respectively, which were significantly higher than those of alpha-fetoprotein (P < 0.0001). The relative expression level of serum exosomal syncytin-1 was significantly associated with lymph node metastasis, degree of differentiation, and CNLC staging of HCC patients (P < 0.05). In conclusion, syncytin-1 in serum exosomes has high sensitivity and specificity for diagnosing HCC and can serve as a novel tumor marker for early screening, detection, and staging of HCC.

1 Introduction

Liver cancer is a common malignant tumor of the digestive system in China. According to data released by GLOBOCAN 2020, the global incidence and mortality rates of liver cancer rank fifth and third, respectively, making it one of the deadliest malignancies [1]. Early stages of liver cancer often progress silently, and by the time it is clinically detected, it has usually reached an advanced stage, leading to low 5-year survival rates. It is estimated that 55% of global liver cancer patients are from China [2]. The causes of liver cancer include hepatitis B virus, hepatitis C virus infection, excessive alcohol consumption, non-alcoholic fatty liver disease, cirrhosis caused by other factors, and a family history of liver cancer [3,4,5]. Primary liver cancer can be histologically classified into hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma, and a mixed type of HCC-intrahepatic cholangiocarcinoma. Although these three types are all primary liver cancers, they exhibit significant differences in etiology, treatment methods, and prognosis, with HCC being the most common pathological type [6,7].

Despite advancements in the diagnosis and treatment of HCC, the prognosis for patients in China remains unsatisfactory, with the overall 5-year net survival rate increasing only from 11.7% in 2000–2004 to 14.1% in 2010–2014 [8]. Patients usually exhibit no obvious symptoms in the early stages. By the time clinical symptoms appear, the disease has often progressed to the middle or late stages. Common clinical manifestations include liver pain, hepatomegaly, and ascites. At this point, most patients have missed the optimal window for surgery and have a poor prognosis [9]. Current diagnostic methods for HCC include imaging techniques, tumor markers, and tumor tissue biopsy. However, in clinical practice, there are cases where alpha-fetoprotein (AFP) is negative, and ultrasound, computed tomography, and magnetic resonance imaging results are atypical. It often occurs in the early stages of HCC, where a definitive diagnosis is usually difficult. Tissue biopsy is an invasive procedure and not easily widespread. Therefore, there is a need for a non-invasive, effective diagnostic method to provide a basis for the early diagnosis of HCC.

Liquid biopsy technology is a diagnostic technique that analyzes blood and body fluid samples from patients. Clinical trials have confirmed that liquid biopsy technology has high sensitivity and can be used for early tumor screening [10]. Additionally, liquid biopsy is minimally invasive, easy to obtain, repeatable, and capable of dynamic detection, providing more comprehensive clinical references and wide applicability. Exosomes are nano-sized extracellular vesicles (30–150 nm) endogenously produced by almost all cell types. They facilitate intercellular communication by delivering mRNA, non-coding RNA (i.e. microRNA and long non-coding RNA), and proteins to recipient cells. It has also been found that the secretion of exosomes by cancer cells is higher than that by normal cells [11].

Tumor markers play a crucial role in the early diagnosis of HCC. Common tumor markers include AFP, AFU, and DCP, but their sensitivity ranges from 67.7 to 81.7%, with specificities ranging from 70.7 to 90% [12]. The detection capability for large liver cancers is limited, and small liver cancers often go undetected. Neither individual nor combined detection methods achieve a sensitivity of 90%. Therefore, identifying new molecular diagnostic and therapeutic targets is essential for the early diagnosis and prognosis of HCC. Research has shown that the envelope protein syncytin-1 of the human endogenous retrovirus W1 is associated with conditions such as preeclampsia, malignant tumors of the reproductive system, lymphomas, and melanomas [13]. Syncytin-1 can activate various types of malignant tumors, including colorectal cancer, endometrial cancer, ovarian cancer, and testicular cancer [14,15,16]. However, there are few reports on the expression and significance of syncytin-1 in serum exosomes of HCC. This study aimed to detect the expression levels of syncytin-1 in the serum exosomes of HCC patients and analyze the correlation between syncytin-1 expression and clinical pathological parameters, thereby providing new insights into early clinical diagnosis of HCC.

2 Materials and methods

2.1 Clinical data

We collected serum samples from 61 patients diagnosed with primary HCC at Tai’an Municipal Hospital from July 2021 to July 2022. All patients diagnosed with primary HCC had not received any surgical, radiation, or chemotherapy treatments. Postoperative pathological results confirmed HCC in all cases. The exclusion criteria were as follows: ① presence of other malignant tumors; ② females who were pregnant or lactating; and ③ presence of abnormal cardiac and renal functions. Additionally, serum samples from 61 individuals undergoing health examinations at our hospital were collected as a healthy control group. This study was approved by the Ethics Committee of Tai’an Municipal Hospital, and all participants provided informed consent prior to enrollment.

  1. Informed consent: Informed consent has been obtained from all individuals included in this study.

  2. Ethical approval: The research related to human use has been complied with all the relevant national regulations, institutional policies and in accordance with the tenets of the Helsinki Declaration, and has been approved by the Ethics Committee of Tai’an Municipal Hospital.

2.2 Reagents

Hifair III 1st Strand cDNA Synthesis SuperMix for qPCR (gDNA digester plus) kit (Yeasen Biotechnology (Shanghai) Co., Ltd.), Hieff UNICON Universal Blue qPCR SYBR Green Master Mix kit (Yeasen Biotechnology (Shanghai) Co., Ltd.), anti-ALIX antibody 1:500 (HuaBio Company), anti-CD63 antibody 1:500 (HuaBio Company), anti-CD81 antibody 1:1,000 (HuaBio Company), anti-Calnexin antibody 1:1,000 (HuaBio Company), HRP conjugated goat anti-rabbit IgG antibody 1:50,000 (HuaBio Company).

2.3 Methods and result determination

2.3.1 Extraction of serum exosomes

Pre-processing of Specimens: Serum samples were thawed at room temperature and transferred to centrifuge tubes. They were centrifuged at 300g, 4°C for 30 min. The supernatant was then transferred to new centrifuge tubes and centrifuged at 3,000g for 30 min. The remaining supernatant was further centrifuged at 20,000g for 30 min.

Ultracentrifugation method was used to extract serum exosomes. The supernatant was centrifuged with the Beckman Coulter Optima XPN-100 Intelligent Ultracentrifuge at 100,000g for 80 min, repeated twice. After discarding the supernatant, exosomes were obtained in approximately 100 μL volume. The exosomes were repeatedly pipetted for thorough mixing, transferred to RNase-free centrifuge tubes, and then stored at −80°C for future use.

2.3.2 Exosome identification under electron microscope

Using the negative staining technique, 30 μL of the resuspended solution was placed on a dedicated copper grid for electron microscopy and left at room temperature for 2 min. After staining with 20 μL of 2% phosphotungstic acid for 10 min, exosomes were observed using a Japan Electron JEOL transmission electron microscope (JEM-1200EX II) with a magnification of 25,000×. Exosomes were shown as disc-shaped membrane-bound vesicles, with a diameter of 30–150 nm under transmission electron microscopy.

2.3.3 Immunoblotting

Exosomes were obtained from 20 serum samples using ultracentrifugation. Then, exosomal total protein was extracted using an exosome protein extraction kit. SDS-PAGE electrophoresis was performed with the following steps: gel preparation, sample loading, electrophoresis, gel extraction, membrane transfer, blocking, primary antibody incubation, secondary antibody incubation, and visualization. The expression levels of surface-specific marker proteins CD63, Alix, and CD81 on exosomes were assessed, using protein markers to determine molecular weight. The negative control protein was Calnexin.

2.3.4 Extraction of total RNA

Total RNA was extracted by adding TRIZOL lysis reagent to the exosome suspension (n = 61). After thorough mixing, the mixture was left at room temperature for 5 min. Subsequently, 200 μL of chloroform was added and mixed for 5 min, followed by a 5-minute incubation. The mixture was then centrifuged at 12,000g for 15 min at 4°C. The upper aqueous phase (approximately 500 μL) was carefully transferred to a new tube, and an equal volume of isopropanol was added. The mixture was inverted and allowed to stand for 10 min at room temperature. After centrifugation at 12,000g for 10 min at 4°C, the supernatant was discarded, and 500 μL of 75% ethanol was added to the pellets, followed by centrifugation at 7,500g for 5 min. The supernatant was discarded, and the pellet was air-dried before being resuspended in 40 μL of DEPC-treated water.

2.3.5 Measurement of total RNA concentration and purity

The concentration and purity of total RNA were assessed by a NanoDrop 2000C UV-visible spectrophotometer (Thermo Evolution, USA). The OD260/OD280 values of the RNA samples were measured.

2.3.6 Reverse transcription of RNA to cDNA

Reverse transcription of RNA was carried out using the Hifair III 1st Strand cDNA Synthesis SuperMix for qPCR (with gDNA digester plus) kit on ice. The reaction system was 20 μL, including 3 μL of DNA digester mix, 1 μg of extracted RNA, and DEPC-treated water to 15 μL. The reaction mixture was first incubated at 42°C for 3 min for digestion, followed by the addition of 5 μL of 4× Hifair III SuperMix Plus for reverse transcription. The reaction conditions were as follows: 25°C for 5 min, 55°C for 15 min, 85°C for 5 min, and then held at 4°C. The reverse-transcribed cDNA was stored at −80°C for future use.

2.3.7 qRT-PCR detection of syncytin-1 mRNA

The Hieff UNICON Universal Blue qPCR SYBR Green Master Mix kit was used for the qRT-PCR reaction, and all operations were performed on ice. Each sample was run in triplicate. The reaction system was 20 μL, including 10 μL of PCR SYBR Green Master Mix, 0.4 μL of Forward Primer (10 μM), 0.4 μL of Reverse Primer (10 μM), 2 μL of cDNA, and 7.2 μL of ddH2O. The reaction conditions were as follows: initial denaturation at 95°C for 2 min, followed by 40 cycles of denaturation at 95°C for 10 s, annealing and extension at 60°C for 30 s. Dissociation curve analysis was performed by gradually increasing the temperature from 72 to 95°C. GAPDH was used as the internal reference gene.

syncytin-1 forward primer: 5′-GCAACTGCTATCACTCTGCCACT-3′,

syncytin-1 reverse primer: 5′-GAGTATGGGTACGGAGGGTTTC -3′

2.3.8 Measurement of serum AFP levels

Serum AFP levels were measured using the electrochemiluminescence method with the Roche Cobas e602 electrochemiluminescence fully automated immunoassay system and original imported reagents. The measurements were conducted strictly according to the manufacturer’s instructions. The normal reference range for AFP is 0 to 7 ng/mL.

2.3.9 Enzyme-linked immunosorbent assay (ELISA)

The ELISA method was employed to detect the expression levels of syncytin-1 protein in exosomes. The assay was conducted using a kit, and the empty well was used for blank calibration. The absorbance (OD value) of each well was measured sequentially at a wavelength of 450 nm.

2.4 Statistical analysis

All experiments were repeated three times, each performed in triplicate. IBM SPSS Statistics 27 and GraphPad Prism software were used for data analysis and visualization. The clinical experimental data in this study were calculated and analyzed using the 2-ΔΔCT formula to obtain the relative expression level of syncytin-1. The data between groups did not conform to a normal distribution. Therefore, the Mann–Whitney U-test was used for comparisons between the two groups, and analysis of variance was employed for comparisons within groups. Receiver operating characteristic curves (ROC curves) were constructed based on the relative expression levels of syncytin-1 and serum AFP levels. The Youden index (sensitivity + specificity −1) was used to determine the cut-off value. A significance level of P < 0.05 was considered statistically significant for all tests.

3 Results

3.1 Identification of exosomes

Electron microscopy was used to identify the extracted exosomes (Figure 1a). Under a transmission electron microscope, the exosomes exhibited a diameter ranging from 30 to 150 nm, displaying a characteristic of a double-disc structure. Western blot (Figure 1b) showed positive expression of exosomal surface markers Alix, CD63, and CD81 in the serum precipitate, while the negative marker Calnexin was not expressed.

Figure 1 
                  Identification of exosomes: (a) electron microscopy; (b) western blot analysis.
Figure 1

Identification of exosomes: (a) electron microscopy; (b) western blot analysis.

3.2 Total RNA determination results

The optical density ratio of total RNA extracted from the serum of HCC patients ranged from 50 to 220 ng/μL, with OD260/OD280 values ranging from 1.8 to 2.1.

3.3 Relative expression levels of syncytin-1 in serum exosomes of HCC patients

There was no significant difference in age and gender between the HCC and control groups. Syncytin-1 in serum exosomes was expressed in both HCC patients and the healthy control group. However, the expression level of syncytin-1 in the HCC group was significantly higher than that in the healthy control group, with statistical significance (P < 0.001) (Figure 2).

Figure 2 
                  Serum mRNA levels of syncytin-1 measured by qRT-PCR.
Figure 2

Serum mRNA levels of syncytin-1 measured by qRT-PCR.

3.4 The relationships between relative expression levels of syncytin-1 in serum exosomes and clinical pathological features of HCC patients

The relative expression levels of syncytin-1 in serum exosomes of HCC patients showed statistically significant differences in relation to lymph node metastasis, degree of differentiation, CNLC staging, and whether they were infected with hepatitis B virus (P < 0.05), but not with age, gender, or history of alcohol consumption (P > 0.05) (Table 1).

Table 1

The relationships between syncytin-1 expression in HCC patients and clinical pathological features

Pathological parameters Case number Relative syncytin-1 expression level P value
Age (years) 0.0885
<60 28 7.243(0.102–21.47)
≥60 33 4.474(0.02–17.56)
Gender ( n ) 0.3003
Male 40 5.164(0.018–19.4)
Female 21 7.079(1.287–18.56)
Differentiation degree ( n ) 0.0075
Mid-high 41 11.08(1.534–9.4)
Low 20 3.366(2.058–6.34)
CNLC staging ( n ) 0.0147
I 17 3.649(0.017–13.87)
II 13 8.497(1.301–19.40)
III 17 6.593(1.814–17.56)
IV 14 3.653(0.156–12.95)
Distant metastasis ( n ) 0.0079
Yes 33 3.635(0.156–11.4)
No 28 7.319(0.416–19.4)
History of alcohol consumption ( n ) 0.2622
Yes 32 5.459(0.1565–17.56)
No 29 7.997(0.0178–20.03)
Infected with hepatitis B virus
Yes 38 7.453(0.1565–21.47) 0.0082
No 23 3.244(0.4159–10.02)

3.5 ELISA examination

Results from ELISA examination showed that the expression level of syncytin-1 in serum exosomes was significantly higher in the HCC group compared to the control group (Figure 3).

Figure 3 
                  Serum protein levels of syncytin-1 measured by ELISA.
Figure 3

Serum protein levels of syncytin-1 measured by ELISA.

3.6 The diagnostic efficiency of serum exosomal syncytin-1 in HCC patients

Based on the relative expression levels of syncytin-1 in serum exosomes of HCC patients and healthy controls, we constructed an ROC curve. The cut-off value for syncytin-1 was 0.668, with an AUC of 0.863 (95% CI: 0.795–0.931, P < 0.0001). The sensitivity and specificity were 91.3% and 75.5%, respectively. Another ROC curve was constructed based on the serum AFP levels of HCC patients and healthy controls. The cut-off value for AFP was 0.406, with an AUC of 0.715 (95% CI: 0.625–0.806, P < 0.0001). The sensitivity and specificity were 63.2% and 77.4%, respectively. The AUCs from the two ROC curves were significantly different (differed by 0.148, P < 0.0001), suggesting that syncytin-1 has a better diagnostic value than AFP (Figure 4).

Figure 4 
                  The ROC curves for serum exosomal syncytin-1 and AFP expression levels in the diagnosis of HCC.
Figure 4

The ROC curves for serum exosomal syncytin-1 and AFP expression levels in the diagnosis of HCC.

4 Discussion

Primary HCC is currently the fourth most common malignant tumor and the second leading cause of tumor-related deaths in China, posing a serious threat to the lives and health of our people [17]. Patients with HCC often have a concealed onset, high malignancy, and are prone to liver failure and death after surgery, which results in a high mortality rate [18,19]. Therefore, studying the early diagnosis of HCC is of great clinical significance.

Exosomes are extracellular vesicles with a double-layered membrane structure, ranging in size from 30 to 150 nm. They are widely present in various bodily fluids, including blood, urine, and saliva, and can be produced by most cells. Exosomes play diverse physiological roles, including immune regulation, cell differentiation and migration, and intercellular signaling [20,21,22]. Exosomes act as key messengers in the complex intercellular communication that occurs during cancer progression, as they can transmit information between tumor cells or between malignant and normal cells. Increasing evidence shows that specific cellular components originating from primary tumor cells accumulate in exosomes. These exosomes can then regulate functional responses through interactions with target tumor cells and by restructuring various types of cancer cells [23]. Research on exosomes primarily aims to explore their capacity as carriers of disease biomarkers. For instance, exosomes found in plasma and cerebrospinal fluid have been discovered to contain α-synuclein, a protein associated with Parkinson’s disease [24,25,26]. Previous study also demonstrates that exosomes isolated from urine can reflect acute kidney injury [27]. Furthermore, exosomes have been identified as carriers of markers for pancreatic cancer and lung cancer [28,29].

Syncytin-1, a member of the human endogenous retrovirus W gene family, is a ubiquitous envelope protein in the human reproductive system, localized in the syncytiotrophoblast layer during early pregnancy, playing a crucial role in fetal development [15,30]. Inoue et al. [16] observed cell proliferation phenomena during estrogen therapy for endometrial cancer. Further studies have shown that transforming growth factor-beta acts as a regulatory switch for the fusion and non-fusion activities of syncytin-1. In the absence of transforming growth factor-beta, syncytin-1 expression exhibits fusion activity; in its presence, it can increase tumor cell proliferation. Thus, non-fusion activity of syncytin-1 may lead to a malignant proliferation of tumors. In recent years, increasing evidence has confirmed abnormal expression of HERVW in various diseases, participating in the occurrence and development of diseases such as cancer, autoimmune diseases, and neurological disorders [1719].

The results of this study demonstrate that serum exosomal syncytin-1 is expressed in both HCC patients and the healthy control group. However, the expression level of syncytin-1 in the HCC group is significantly higher than that in the healthy control group. Additionally, the relative expression level of serum exosomal syncytin-1 in HCC patients correlates significantly with lymph node metastasis, degree of differentiation, and CNLC staging. This suggests that a higher relative expression level of serum exosomal syncytin-1 may be associated with increased lymph node metastasis and later CNLC staging. Therefore, the relative expression level of serum exosomal syncytin-1 in HCC patients holds clinical diagnosis value.

Serum AFP is a commonly used tumor marker for HCC diagnosis and holds a certain reference value, but it exhibits poor sensitivity and specificity for detecting HCC. The results of this study revealed that the sensitivity and specificity of serum exosomal syncytin-1 for HCC were 91.3% and 75.5%, respectively, which were significantly higher than AFP, suggesting that the diagnostic efficacy of syncytin-1 is higher than that of AFP. This result provides a foundation for further research in the application of syncytin-1 in HCC diagnosis.

5 Strengths and limitations

This study represents the first analysis investigating the correlation between syncytin-1 expression in serum exosomes of HCC patients and clinical pathological parameters. By focusing on this novel biomarker in serum exosomes, the study provides valuable insights into the potential role of syncytin-1 in HCC diagnosis and prognosis. However, the limitations of this study should also be addressed. First, the study was conducted at a single center, which may limit the generalizability of the findings to broader populations. In addition, the sample size of the study was limited, which might affect the statistical power and reliability of the results. Lastly, subgroup analysis based on different patient characteristics or disease stages was not performed, which could provide more detailed insights into the correlation between syncytin-1 expression and specific clinical parameters. Future studies should involve larger sample sizes recruited from multiple centers to enhance the robustness and generalizability of the findings. Preclinical and animal studies are also warranted to elucidate the molecular mechanisms underlying the involvement of syncytin-1 in HCC development, which could provide insights into potential therapeutic targets or diagnostic markers for HCC [31].

6 Conclusion

In summary, serum exosomal syncytin-1 demonstrates higher sensitivity and specificity compared to AFP. It can serve as a more accurate, simple, and safe early screening biomarker. Therefore, syncytin-1 holds significant practical value in early HCC screening and can complement computed tomography scans for mutual confirmation, thereby achieving the goal of early detection of liver cancer.

  1. Funding information: Authors state no funding involved.

  2. Author contributions: Xiao Shi: writing – review & editing, writing – original draft, visualization, validation. Hui Zhao: writing – review & editing, writing – original draft, visualization, Shuai Shang: writing – review & editing, writing – original draft, visualization, validation. Xinyu Xu: writing – review & editing, writing – original draft, visualization, Validation. Xiaomin Wang: writing – review & editing, writing – original draft, Visualization, Validation. Xin Zheng: writing – review & editing, writing – original draft, visualization, validation. Jing He: writing – review & editing, writing – original draft, visualization, and validation. Xue-wei Zhuang: writing – review & editing, writing – original draft, supervision, project administration, methodology, funding acquisition, formal analysis, data curation, and conceptualization.

  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: 2024-04-12
Revised: 2024-06-20
Accepted: 2024-06-26
Published Online: 2024-09-19

© 2024 the author(s), published by De Gruyter

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

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  10. PTTG1 induces pancreatic cancer cell proliferation and promotes aerobic glycolysis by regulating c-myc
  11. Role of serum B-cell-activating factor and interleukin-17 as biomarkers in the classification of interstitial pneumonia with autoimmune features
  12. Effectiveness and safety of a mumps containing vaccine in preventing laboratory-confirmed mumps cases from 2002 to 2017: A meta-analysis
  13. Low levels of sex hormone-binding globulin predict an increased breast cancer risk and its underlying molecular mechanisms
  14. A case of Trousseau syndrome: Screening, detection and complication
  15. Application of the integrated airway humidification device enhances the humidification effect of the rabbit tracheotomy model
  16. Preparation of Cu2+/TA/HAP composite coating with anti-bacterial and osteogenic potential on 3D-printed porous Ti alloy scaffolds for orthopedic applications
  17. Aquaporin-8 promotes human dermal fibroblasts to counteract hydrogen peroxide-induced oxidative damage: A novel target for management of skin aging
  18. Current research and evidence gaps on placental development in iron deficiency anemia
  19. Single-nucleotide polymorphism rs2910829 in PDE4D is related to stroke susceptibility in Chinese populations: The results of a meta-analysis
  20. Pheochromocytoma-induced myocardial infarction: A case report
  21. Kaempferol regulates apoptosis and migration of neural stem cells to attenuate cerebral infarction by O‐GlcNAcylation of β-catenin
  22. Sirtuin 5 regulates acute myeloid leukemia cell viability and apoptosis by succinylation modification of glycine decarboxylase
  23. Apigenin 7-glucoside impedes hypoxia-induced malignant phenotypes of cervical cancer cells in a p16-dependent manner
  24. KAT2A changes the function of endometrial stromal cells via regulating the succinylation of ENO1
  25. Current state of research on copper complexes in the treatment of breast cancer
  26. Exploring antioxidant strategies in the pathogenesis of ALS
  27. Helicobacter pylori causes gastric dysbacteriosis in chronic gastritis patients
  28. IL-33/soluble ST2 axis is associated with radiation-induced cardiac injury
  29. The predictive value of serum NLR, SII, and OPNI for lymph node metastasis in breast cancer patients with internal mammary lymph nodes after thoracoscopic surgery
  30. Carrying SNP rs17506395 (T > G) in TP63 gene and CCR5Δ32 mutation associated with the occurrence of breast cancer in Burkina Faso
  31. P2X7 receptor: A receptor closely linked with sepsis-associated encephalopathy
  32. Probiotics for inflammatory bowel disease: Is there sufficient evidence?
  33. Identification of KDM4C as a gene conferring drug resistance in multiple myeloma
  34. Microbial perspective on the skin–gut axis and atopic dermatitis
  35. Thymosin α1 combined with XELOX improves immune function and reduces serum tumor markers in colorectal cancer patients after radical surgery
  36. Highly specific vaginal microbiome signature for gynecological cancers
  37. Sample size estimation for AQP4-IgG seropositive optic neuritis: Retinal damage detection by optical coherence tomography
  38. The effects of SDF-1 combined application with VEGF on femoral distraction osteogenesis in rats
  39. Fabrication and characterization of gold nanoparticles using alginate: In vitro and in vivo assessment of its administration effects with swimming exercise on diabetic rats
  40. Mitigating digestive disorders: Action mechanisms of Mediterranean herbal active compounds
  41. Distribution of CYP2D6 and CYP2C19 gene polymorphisms in Han and Uygur populations with breast cancer in Xinjiang, China
  42. VSP-2 attenuates secretion of inflammatory cytokines induced by LPS in BV2 cells by mediating the PPARγ/NF-κB signaling pathway
  43. Factors influencing spontaneous hypothermia after emergency trauma and the construction of a predictive model
  44. Long-term administration of morphine specifically alters the level of protein expression in different brain regions and affects the redox state
  45. Application of metagenomic next-generation sequencing technology in the etiological diagnosis of peritoneal dialysis-associated peritonitis
  46. Clinical diagnosis, prevention, and treatment of neurodyspepsia syndrome using intelligent medicine
  47. Case report: Successful bronchoscopic interventional treatment of endobronchial leiomyomas
  48. Preliminary investigation into the genetic etiology of short stature in children through whole exon sequencing of the core family
  49. Cystic adenomyoma of the uterus: Case report and literature review
  50. Mesoporous silica nanoparticles as a drug delivery mechanism
  51. Dynamic changes in autophagy activity in different degrees of pulmonary fibrosis in mice
  52. Vitamin D deficiency and inflammatory markers in type 2 diabetes: Big data insights
  53. Lactate-induced IGF1R protein lactylation promotes proliferation and metabolic reprogramming of lung cancer cells
  54. Meta-analysis on the efficacy of allogeneic hematopoietic stem cell transplantation to treat malignant lymphoma
  55. Mitochondrial DNA drives neuroinflammation through the cGAS-IFN signaling pathway in the spinal cord of neuropathic pain mice
  56. Application value of artificial intelligence algorithm-based magnetic resonance multi-sequence imaging in staging diagnosis of cervical cancer
  57. Embedded monitoring system and teaching of artificial intelligence online drug component recognition
  58. Investigation into the association of FNDC1 and ADAMTS12 gene expression with plumage coloration in Muscovy ducks
  59. Yak meat content in feed and its impact on the growth of rats
  60. A rare case of Richter transformation with breast involvement: A case report and literature review
  61. First report of Nocardia wallacei infection in an immunocompetent patient in Zhejiang province
  62. Rhodococcus equi and Brucella pulmonary mass in immunocompetent: A case report and literature review
  63. Downregulation of RIP3 ameliorates the left ventricular mechanics and function after myocardial infarction via modulating NF-κB/NLRP3 pathway
  64. Evaluation of the role of some non-enzymatic antioxidants among Iraqi patients with non-alcoholic fatty liver disease
  65. The role of Phafin proteins in cell signaling pathways and diseases
  66. Ten-year anemia as initial manifestation of Castleman disease in the abdominal cavity: A case report
  67. Coexistence of hereditary spherocytosis with SPTB P.Trp1150 gene variant and Gilbert syndrome: A case report and literature review
  68. Utilization of convolutional neural networks to analyze microscopic images for high-throughput screening of mesenchymal stem cells
  69. Exploratory evaluation supported by experimental and modeling approaches of Inula viscosa root extract as a potent corrosion inhibitor for mild steel in a 1 M HCl solution
  70. Imaging manifestations of ductal adenoma of the breast: A case report
  71. Gut microbiota and sleep: Interaction mechanisms and therapeutic prospects
  72. Isomangiferin promotes the migration and osteogenic differentiation of rat bone marrow mesenchymal stem cells
  73. Prognostic value and microenvironmental crosstalk of exosome-related signatures in human epidermal growth factor receptor 2 positive breast cancer
  74. Circular RNAs as potential biomarkers for male severe sepsis
  75. Knockdown of Stanniocalcin-1 inhibits growth and glycolysis in oral squamous cell carcinoma cells
  76. The expression and biological role of complement C1s in esophageal squamous cell carcinoma
  77. A novel GNAS mutation in pseudohypoparathyroidism type 1a with articular flexion deformity: A case report
  78. Predictive value of serum magnesium levels for prognosis in patients with non-small cell lung cancer undergoing EGFR-TKI therapy
  79. HSPB1 alleviates acute-on-chronic liver failure via the P53/Bax pathway
  80. IgG4-related disease complicated by PLA2R-associated membranous nephropathy: A case report
  81. Baculovirus-mediated endostatin and angiostatin activation of autophagy through the AMPK/AKT/mTOR pathway inhibits angiogenesis in hepatocellular carcinoma
  82. Metformin mitigates osteoarthritis progression by modulating the PI3K/AKT/mTOR signaling pathway and enhancing chondrocyte autophagy
  83. Evaluation of the activity of antimicrobial peptides against bacterial vaginosis
  84. Atypical presentation of γ/δ mycosis fungoides with an unusual phenotype and SOCS1 mutation
  85. Analysis of the microecological mechanism of diabetic kidney disease based on the theory of “gut–kidney axis”: A systematic review
  86. Omega-3 fatty acids prevent gestational diabetes mellitus via modulation of lipid metabolism
  87. Refractory hypertension complicated with Turner syndrome: A case report
  88. Interaction of ncRNAs and the PI3K/AKT/mTOR pathway: Implications for osteosarcoma
  89. Association of low attenuation area scores with pulmonary function and clinical prognosis in patients with chronic obstructive pulmonary disease
  90. Long non-coding RNAs in bone formation: Key regulators and therapeutic prospects
  91. The deubiquitinating enzyme USP35 regulates the stability of NRF2 protein
  92. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as potential diagnostic markers for rebleeding in patients with esophagogastric variceal bleeding
  93. G protein-coupled receptor 1 participating in the mechanism of mediating gestational diabetes mellitus by phosphorylating the AKT pathway
  94. LL37-mtDNA regulates viability, apoptosis, inflammation, and autophagy in lipopolysaccharide-treated RLE-6TN cells by targeting Hsp90aa1
  95. The analgesic effect of paeoniflorin: A focused review
  96. Chemical composition’s effect on Solanum nigrum Linn.’s antioxidant capacity and erythrocyte protection: Bioactive components and molecular docking analysis
  97. Knockdown of HCK promotes HREC cell viability and inner blood–retinal barrier integrity by regulating the AMPK signaling pathway
  98. The role of rapamycin in the PINK1/Parkin signaling pathway in mitophagy in podocytes
  99. Laryngeal non-Hodgkin lymphoma: Report of four cases and review of the literature
  100. Clinical value of macrogenome next-generation sequencing on infections
  101. Overview of dendritic cells and related pathways in autoimmune uveitis
  102. TAK-242 alleviates diabetic cardiomyopathy via inhibiting pyroptosis and TLR4/CaMKII/NLRP3 pathway
  103. Hypomethylation in promoters of PGC-1α involved in exercise-driven skeletal muscular alterations in old age
  104. Profile and antimicrobial susceptibility patterns of bacteria isolated from effluents of Kolladiba and Debark hospitals
  105. The expression and clinical significance of syncytin-1 in serum exosomes of hepatocellular carcinoma patients
  106. A histomorphometric study to evaluate the therapeutic effects of biosynthesized silver nanoparticles on the kidneys infected with Plasmodium chabaudi
  107. PGRMC1 and PAQR4 are promising molecular targets for a rare subtype of ovarian cancer
  108. Analysis of MDA, SOD, TAOC, MNCV, SNCV, and TSS scores in patients with diabetes peripheral neuropathy
  109. SLIT3 deficiency promotes non-small cell lung cancer progression by modulating UBE2C/WNT signaling
  110. The relationship between TMCO1 and CALR in the pathological characteristics of prostate cancer and its effect on the metastasis of prostate cancer cells
  111. Heterogeneous nuclear ribonucleoprotein K is a potential target for enhancing the chemosensitivity of nasopharyngeal carcinoma
  112. PHB2 alleviates retinal pigment epithelium cell fibrosis by suppressing the AGE–RAGE pathway
  113. Anti-γ-aminobutyric acid-B receptor autoimmune encephalitis with syncope as the initial symptom: Case report and literature review
  114. Comparative analysis of chloroplast genome of Lonicera japonica cv. Damaohua
  115. Human umbilical cord mesenchymal stem cells regulate glutathione metabolism depending on the ERK–Nrf2–HO-1 signal pathway to repair phosphoramide mustard-induced ovarian cancer cells
  116. Electroacupuncture on GB acupoints improves osteoporosis via the estradiol–PI3K–Akt signaling pathway
  117. Renalase protects against podocyte injury by inhibiting oxidative stress and apoptosis in diabetic nephropathy
  118. Review: Dicranostigma leptopodum: A peculiar plant of Papaveraceae
  119. Combination effect of flavonoids attenuates lung cancer cell proliferation by inhibiting the STAT3 and FAK signaling pathway
  120. Renal microangiopathy and immune complex glomerulonephritis induced by anti-tumour agents: A case report
  121. Correlation analysis of AVPR1a and AVPR2 with abnormal water and sodium and potassium metabolism in rats
  122. Gastrointestinal health anti-diarrheal mixture relieves spleen deficiency-induced diarrhea through regulating gut microbiota
  123. Myriad factors and pathways influencing tumor radiotherapy resistance
  124. Exploring the effects of culture conditions on Yapsin (YPS) gene expression in Nakaseomyces glabratus
  125. Screening of prognostic core genes based on cell–cell interaction in the peripheral blood of patients with sepsis
  126. Coagulation factor II thrombin receptor as a promising biomarker in breast cancer management
  127. Ileocecal mucinous carcinoma misdiagnosed as incarcerated hernia: A case report
  128. Methyltransferase like 13 promotes malignant behaviors of bladder cancer cells through targeting PI3K/ATK signaling pathway
  129. The debate between electricity and heat, efficacy and safety of irreversible electroporation and radiofrequency ablation in the treatment of liver cancer: A meta-analysis
  130. ZAG promotes colorectal cancer cell proliferation and epithelial–mesenchymal transition by promoting lipid synthesis
  131. Baicalein inhibits NLRP3 inflammasome activation and mitigates placental inflammation and oxidative stress in gestational diabetes mellitus
  132. Impact of SWCNT-conjugated senna leaf extract on breast cancer cells: A potential apoptotic therapeutic strategy
  133. MFAP5 inhibits the malignant progression of endometrial cancer cells in vitro
  134. Major ozonated autohemotherapy promoted functional recovery following spinal cord injury in adult rats via the inhibition of oxidative stress and inflammation
  135. Axodendritic targeting of TAU and MAP2 and microtubule polarization in iPSC-derived versus SH-SY5Y-derived human neurons
  136. Differential expression of phosphoinositide 3-kinase/protein kinase B and Toll-like receptor/nuclear factor kappa B signaling pathways in experimental obesity Wistar rat model
  137. The therapeutic potential of targeting Oncostatin M and the interleukin-6 family in retinal diseases: A comprehensive review
  138. BA inhibits LPS-stimulated inflammatory response and apoptosis in human middle ear epithelial cells by regulating the Nf-Kb/Iκbα axis
  139. Role of circRMRP and circRPL27 in chronic obstructive pulmonary disease
  140. Investigating the role of hyperexpressed HCN1 in inducing myocardial infarction through activation of the NF-κB signaling pathway
  141. Characterization of phenolic compounds and evaluation of anti-diabetic potential in Cannabis sativa L. seeds: In vivo, in vitro, and in silico studies
  142. Quantitative immunohistochemistry analysis of breast Ki67 based on artificial intelligence
  143. Ecology and Environmental Science
  144. Screening of different growth conditions of Bacillus subtilis isolated from membrane-less microbial fuel cell toward antimicrobial activity profiling
  145. Degradation of a mixture of 13 polycyclic aromatic hydrocarbons by commercial effective microorganisms
  146. Evaluation of the impact of two citrus plants on the variation of Panonychus citri (Acari: Tetranychidae) and beneficial phytoseiid mites
  147. Prediction of present and future distribution areas of Juniperus drupacea Labill and determination of ethnobotany properties in Antalya Province, Türkiye
  148. Population genetics of Todarodes pacificus (Cephalopoda: Ommastrephidae) in the northwest Pacific Ocean via GBS sequencing
  149. A comparative analysis of dendrometric, macromorphological, and micromorphological characteristics of Pistacia atlantica subsp. atlantica and Pistacia terebinthus in the middle Atlas region of Morocco
  150. Macrofungal sporocarp community in the lichen Scots pine forests
  151. Assessing the proximate compositions of indigenous forage species in Yemen’s pastoral rangelands
  152. Food Science
  153. Gut microbiota changes associated with low-carbohydrate diet intervention for obesity
  154. Reexamination of Aspergillus cristatus phylogeny in dark tea: Characteristics of the mitochondrial genome
  155. Differences in the flavonoid composition of the leaves, fruits, and branches of mulberry are distinguished based on a plant metabolomics approach
  156. Investigating the impact of wet rendering (solventless method) on PUFA-rich oil from catfish (Clarias magur) viscera
  157. Non-linear associations between cardiovascular metabolic indices and metabolic-associated fatty liver disease: A cross-sectional study in the US population (2017–2020)
  158. Knockdown of USP7 alleviates atherosclerosis in ApoE-deficient mice by regulating EZH2 expression
  159. Utility of dairy microbiome as a tool for authentication and traceability
  160. Agriculture
  161. Enhancing faba bean (Vicia faba L.) productivity through establishing the area-specific fertilizer rate recommendation in southwest Ethiopia
  162. Impact of novel herbicide based on synthetic auxins and ALS inhibitor on weed control
  163. Perspectives of pteridophytes microbiome for bioremediation in agricultural applications
  164. Fertilizer application parameters for drip-irrigated peanut based on the fertilizer effect function established from a “3414” field trial
  165. Improving the productivity and profitability of maize (Zea mays L.) using optimum blended inorganic fertilization
  166. Application of leaf multispectral analyzer in comparison to hyperspectral device to assess the diversity of spectral reflectance indices in wheat genotypes
  167. Animal Sciences
  168. Knockdown of ANP32E inhibits colorectal cancer cell growth and glycolysis by regulating the AKT/mTOR pathway
  169. Development of a detection chip for major pathogenic drug-resistant genes and drug targets in bovine respiratory system diseases
  170. Exploration of the genetic influence of MYOT and MB genes on the plumage coloration of Muscovy ducks
  171. Transcriptome analysis of adipose tissue in grazing cattle: Identifying key regulators of fat metabolism
  172. Comparison of nutritional value of the wild and cultivated spiny loaches at three growth stages
  173. Transcriptomic analysis of liver immune response in Chinese spiny frog (Quasipaa spinosa) infected with Proteus mirabilis
  174. Disruption of BCAA degradation is a critical characteristic of diabetic cardiomyopathy revealed by integrated transcriptome and metabolome analysis
  175. Plant Sciences
  176. Effect of long-term in-row branch covering on soil microorganisms in pear orchards
  177. Photosynthetic physiological characteristics, growth performance, and element concentrations reveal the calcicole–calcifuge behaviors of three Camellia species
  178. Transcriptome analysis reveals the mechanism of NaHCO3 promoting tobacco leaf maturation
  179. Bioinformatics, expression analysis, and functional verification of allene oxide synthase gene HvnAOS1 and HvnAOS2 in qingke
  180. Water, nitrogen, and phosphorus coupling improves gray jujube fruit quality and yield
  181. Improving grape fruit quality through soil conditioner: Insights from RNA-seq analysis of Cabernet Sauvignon roots
  182. Role of Embinin in the reabsorption of nucleus pulposus in lumbar disc herniation: Promotion of nucleus pulposus neovascularization and apoptosis of nucleus pulposus cells
  183. Revealing the effects of amino acid, organic acid, and phytohormones on the germination of tomato seeds under salinity stress
  184. Combined effects of nitrogen fertilizer and biochar on the growth, yield, and quality of pepper
  185. Comprehensive phytochemical and toxicological analysis of Chenopodium ambrosioides (L.) fractions
  186. Impact of “3414” fertilization on the yield and quality of greenhouse tomatoes
  187. Exploring the coupling mode of water and fertilizer for improving growth, fruit quality, and yield of the pear in the arid region
  188. Metagenomic analysis of endophytic bacteria in seed potato (Solanum tuberosum)
  189. Antibacterial, antifungal, and phytochemical properties of Salsola kali ethanolic extract
  190. Exploring the hepatoprotective properties of citronellol: In vitro and in silico studies on ethanol-induced damage in HepG2 cells
  191. Enhanced osmotic dehydration of watermelon rind using honey–sucrose solutions: A study on pre-treatment efficacy and mass transfer kinetics
  192. Effects of exogenous 2,4-epibrassinolide on photosynthetic traits of 53 cowpea varieties under NaCl stress
  193. Comparative transcriptome analysis of maize (Zea mays L.) seedlings in response to copper stress
  194. An optimization method for measuring the stomata in cassava (Manihot esculenta Crantz) under multiple abiotic stresses
  195. Fosinopril inhibits Ang II-induced VSMC proliferation, phenotype transformation, migration, and oxidative stress through the TGF-β1/Smad signaling pathway
  196. Antioxidant and antimicrobial activities of Salsola imbricata methanolic extract and its phytochemical characterization
  197. Bioengineering and Biotechnology
  198. Absorbable calcium and phosphorus bioactive membranes promote bone marrow mesenchymal stem cells osteogenic differentiation for bone regeneration
  199. New advances in protein engineering for industrial applications: Key takeaways
  200. An overview of the production and use of Bacillus thuringiensis toxin
  201. Research progress of nanoparticles in diagnosis and treatment of hepatocellular carcinoma
  202. Bioelectrochemical biosensors for water quality assessment and wastewater monitoring
  203. PEI/MMNs@LNA-542 nanoparticles alleviate ICU-acquired weakness through targeted autophagy inhibition and mitochondrial protection
  204. Unleashing of cytotoxic effects of thymoquinone-bovine serum albumin nanoparticles on A549 lung cancer cells
  205. Erratum
  206. Erratum to “Investigating the association between dietary patterns and glycemic control among children and adolescents with T1DM”
  207. Erratum to “Activation of hypermethylated P2RY1 mitigates gastric cancer by promoting apoptosis and inhibiting proliferation”
  208. Retraction
  209. Retraction to “MiR-223-3p regulates cell viability, migration, invasion, and apoptosis of non-small cell lung cancer cells by targeting RHOB”
  210. Retraction to “A data mining technique for detecting malignant mesothelioma cancer using multiple regression analysis”
  211. Special Issue on Advances in Neurodegenerative Disease Research and Treatment
  212. Transplantation of human neural stem cell prevents symptomatic motor behavior disability in a rat model of Parkinson’s disease
  213. Special Issue on Multi-omics
  214. Inflammasome complex genes with clinical relevance suggest potential as therapeutic targets for anti-tumor drugs in clear cell renal cell carcinoma
  215. Gastroesophageal varices in primary biliary cholangitis with anti-centromere antibody positivity: Early onset?
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