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Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p

An erratum for this article can be found here: https://doi.org/10.1515/med-2023-0755
  • Chen-Min Sun , Wen-Yi Zhang , Shu-Yan Wang , Gang Qian , Dong-Liang Pei and Guang-Ming Zhang EMAIL logo
Published/Copyright: September 13, 2021

Abstract

Aim

Renal fibrosis (RF) is a common clinical condition leading to irreversible renal function loss. Tyrosine kinase proteins and microRNAs (miRs) are associated with pathogenesis and we aim to investigate the role of Fer and its partner miR(s) in RF.

Method

In silico reproduction of Mouse Kidney FibrOmics browser was performed to identify potential miR(s) and target gene(s). In vivo validation was performed in C57BL/6 mice with unilateral ureteral obstruction (UUO). In vitro validation was performed in rat kidney fibroblast NRK-49F cells. Mimics and inhibitors of miR-29c-3p were constructed. The target gene Fer was monitored by RT-PCR and western blotting. The levels of interleukin (IL)-6, IL-1β, and tumor necrosis factor (TNF)-α in serum and media were measured by ELISA.

Results

The Fer expression and protein level were gradually increased during 14 days of UUO modeling. miR-29c-3p expression was strongly correlated with that of Fer. In vivo validation showed increased expressions of fibrosis-associated genes and increased phospoho-Smad3 level in the UUO model. Fer-knockdown (KD) significantly decreased expressions of fibrosis-associated genes. Pharmaceutical inhibition of Fer showed similar effects to miR-29c-3p, and miR inhibition showed a significant decrease of excretion of inflammatory factors.

Conclusion

Dysregulation of miR-29c-3p and Fer plays a role in RF. Pharmaceutical or genetic inhibition of Fer may serve as the potential treatment for RF.

1 Introduction

Renal fibrosis (RF) is not only the main pathological basis of end-stage renal disease but also a hallmark of kidney aging [1]. Effective prevention and treatment of RF are of great significance for delaying the progression of kidney disease and reducing the occurrence of uremia. However, currently, there is no effective treatment for preventing and reversing RF [2].

MicroRNAs (miRs) are endogenous noncoding RNAs that are involved in the occurrence and development of many diseases. miR combines with different target gene mRNAs to form an RNA-induced gene silencing complex (RISC). First, the nucleus is transcribed by RNA polymerase II or III to produce pri-microRNA with a stem-loop structure. Pri-microRNA is then processed into a double strand that is composed of 70 nucleotides under the action of nuclease Drosha and its cofactor Pasha pre-microRNA. RNA–GTP and Exportin 5 deliver pre-microRNA into the cytoplasm. Next, another nuclease Dicer cuts it to produce a microRNA of 20 to 22 nucleotides in length, the double-strand microRNA, which is quickly led into RISC, where a mature single-stranded microRNA is retained in this complex. The remaining mature microRNA binds to a specific region of the 3′ untranslated end (3′UTR) of its complementary mRNA to degrade the target mRNA or inhibit its translation, thereby regulating gene expression [3].

RF is characterized by the proliferation of interstitial fibroblasts, excessive deposition of extracellular matrix (ECM), and renal tubular atrophy [4]. Transforming growth factor-β (TGF-β) is an important growth factor that activates its downstream regulatory factor Smad protein. The signaling of TGF-β is transferred from the membrane receptor to the nucleus, mediating the occurrence of renal tissue fibrosis [5]. Recent studies have found that TGF-β signaling regulates microRNA expression in renal tissue fibrosis, which features up-regulation of miR-21, miR-192, miR-491-5p, miR-382, miR-377, miR-214, and miR-433 and down-regulation of miR-29, miR-133, and the miR-200 family. It has been found in several rat models of kidney injury;microRNA changes with the severity of kidney injury, suggesting that miRs play an important role in TGF-β-mediated fibrosis [6].

The miR-29 family has been established as a protective miR in the fibrosis of several vital organs. Both miR-29a and miR-29b have been shown to play a role in RF, interacting with different gene products. Nonetheless, miR-29c has not been investigated in RF, and in the current study, we performed in silico, in vitro, and in vivo studies to evaluate the role of miR-29c-3p and its target gene Fer in RF.

2 Materials and methods

2.1 In silico analysis

Candidate miRs and genes were selected using the Mouse Kidney FibrOmics online database. The platform was a comprehensive and combined multi-omics dataset (proteomics, mRNA, and small RNA transcriptomics) of fibrotic kidneys that is searchable through the website: http://hbcreports.med.harvard.edu/fmm/. Two commonly used mouse models were utilized in the dataset, a reversible chemical-induced injury model (folic acid (FA)-induced nephropathy) and an irreversible surgically induced fibrosis model, unilateral ureteral obstruction (UUO). mRNA and small RNA sequencing, as well as 10-plex tandem mass tag (TMT) proteomics, were performed with kidney samples at different time points over the course of fibrosis development and were included in the dataset. Values were z-scores of the log2-normalized abundance for each molecule. The predicted interactions between miRNA and the candidate target gene were according to Targetscan DB, which was also imbedded in the platform [7].

2.2 Mouse models

Male BALC/c mice were obtained from Shanghai Silaike Experiment Animal Co., Ltd. All animal studies were conducted in accordance with the Ethical Guide for the Care and Use of Laboratory Animals. Mice were housed in groups of six on a 12 h light/dark cycle with access to food and water ad libitum. The experiment was commenced when mice reached 8−10 weeks of age. To construct the UUO model, mice were anesthetized with 10 μL ketamine + 1 μL xylazine/g of body weight. The abdominal cavity was opened and the left ureter was ligated twice. Sham operations were done without ureteral ligation. On day 3 and day 14, mice were sacrificed to collect renal tissues and blood samples.

2.3 Cell culture and transfection

Rat kidney fibroblast cell NRK-49F was obtained from Millipore Sigma and was cultured in Dulbecco's modified Eagle’s medium (DMEM) supplemented with 10% FBS. Cells were treated with TGF-β1 (10 ng/mL) for 48 h to induce fibrosis according to our pilot experience [8]. To modulate miR-29c-3p expression levels, NRK-49F cells were transfected with miR mimic or inhibitor, both synthesized by Ribobio (Guangzhou, China). The Fer inhibitor DS21360717 was obtained from ChemSrc. Adenoviral over-expression was performed using a Fer cDNA clone obtained from Origene. The Fer knockdown (KD) modeling was constructed using shRNA, the sequence of which was obtained from TRC (TRCN0000361140). The treatment dose was designated at 5 nM for the interaction for 24 h before testing. All transfections were done using Lipofectamine 2000 system according to the manufacturer’s instructions. The cells were harvested 48 h after transfection for further studies.

2.4 Real-time PCR

Total RNA was extracted by Trizol and converted to cDNA. Quantitative real-time PCR was carried out using SYBR ExScript RT-PCR on ABI 7500 Real-Time PCR, according to the manufacturer’s protocol. Glyceraldehyde-3-phosphate dehydrogenase (Gapdh) was used as an endogenous control. Expression of miR-29c-3p was measured using a Hairpin-it miRNA qPCR Quantitation Kit. U6 small nuclear RNA was used as an internal control for miR. The primers used are listed in Table 1.

Table 1

Primers used in the study (5′ to 3′)

Gene Forward Reverse
Acta2 CCCAACTGGGACCACATGG TACATGCGGGGGACATTGAAG
Col1a1 GCTCCTCTTAGGGGCCACT CCACGTCTCACCATTGGGG
Fn1 ATGTGGACCCCTCCTGATAGT GCCCAGTGATTTCAGCAAAGG
Gapdh AGGTCGGTGTGAACGGATTTG GGGGTCGTTGATGGCAACA
U6 CTCGCTTCGGCAGCACA AACGCTTCACGAATTTGCGT
Reverse transcription: AACGCTTGACGAATTTGCGC
miR-29c CTAGCCTGCAGGAGGCAG ATCCGGCCGGCCAAAAATA
TGATAGTGAGAAAG GTAGATAAAACAG
Mimic: UAGCACCAUUUGAAAUCGGUUA
Mimic control: UUUGUACUACACAAAAGUACUG
Inhibitor: UAACCGAUUUCAAAUGGUGCUA
Inhibitor control: UUUGUACUACACAAAAGUACUG

2.5 Western blotting

Protein samples (20 μg/lane) were separated by electrophoresis on 10% polyacrylamide gel and then transferred onto polyvinylidene fluoride (PVDF) membranes. The membranes were blocked with 5% nonfat milk and incubated with primary antibodies overnight at 4°C. Membranes were subsequently incubated with horseradish peroxidase (HRP)-conjugated secondary antibody at room temperature. The blots were visualized with the enhanced chemiluminescence method using an ECL kit. Primary antibodies used were Col1a1 (E8I9Z) Rabbit mAb (#91144, Cell Signaling), Actar2 Rabbit mAb (#19245, Cell Signaling), Fn1 Rabbit pAb (ab2413, Abcam), Fer Mouse mAb (Cell Signaling, #4268), and Gapdh antibody (ab9484) (Abcam).

2.6 Measurement of inflammatory factors

Inflammatory factors of IL-1β, IL-6, and tumor necrosis factor (TNF)-α were detected in blood samples and cell culture supernatants. BD OptEIA and ELISA kits for mouse cytokines (rat-compatible) were used, respectively.

2.7 Statistical analysis

In vitro experiments were performed in triplicates. For comparisons in more than 2 factors in more than 2 groups, the two-way analysis of variance (ANOVA), followed by post-hoc tests (Bonferroni) was used. For the rest of the experiments, the one-way ANOVA with Tukey’s multiple comparison test was used. The significance was designated as p < 0.05.

3 Results

Using in silico reproduction, we first identified continuous elevation of Fer mRNA and protein levels and the corresponding decrease of miR-29c-3p expression in the UUO model throughout 14 days of modeling (Figure 1a, left). This trend of change was not observed in the FA model. We, therefore, constructed a UUO model and detected significant elevation of Fer expression at 14 days of modeling (Figure 1a, right). Along with increased Fer level, increased levels of a series of fibrosis-associated gene products were observed in our UUO model (Figure 1b and c).

Figure 1 
               Pairs of Fer and miR-29c are dysregulated in UUO-induced RF. (a) Reproduced from the Mouse Kidney FibrOmics online database, changes in miR-29c expression and Fer expression/protein level over the 14-day course in the FA- and the unilateral ureteral obstruction (UUO)-induced RF mouse model on the left panel, and in vivo validation of Fer expression in kidneys harvested on day 14 post-op from mice (N = 6 per group) undergoing either sham surgery or UUO modeling. (b) Protein and (c) mRNA levels of fibrosis markers and Fer in kidneys harvested on day 14 post-op from mice (N = 6 per group) undergoing either sham surgery or UUO modeling (*P < 0.05; **P < 0.01).
Figure 1

Pairs of Fer and miR-29c are dysregulated in UUO-induced RF. (a) Reproduced from the Mouse Kidney FibrOmics online database, changes in miR-29c expression and Fer expression/protein level over the 14-day course in the FA- and the unilateral ureteral obstruction (UUO)-induced RF mouse model on the left panel, and in vivo validation of Fer expression in kidneys harvested on day 14 post-op from mice (N = 6 per group) undergoing either sham surgery or UUO modeling. (b) Protein and (c) mRNA levels of fibrosis markers and Fer in kidneys harvested on day 14 post-op from mice (N = 6 per group) undergoing either sham surgery or UUO modeling (*P < 0.05; **P < 0.01).

In rat renal fibroblast cells, Fer-KD not only decreased the levels of fibrosis-associated genes at the protein (Figure 2a) and mRNA (Figure 2b) levels, respectively, but also resulted in decreased phospho-Smad3 levels (Figure 2c). When normalized to the total Smad3 level, Fer-KD also resulted in a significant decrease of the ratio (Figure 2c). We then applied TGF-ß1 treatment and found that TGF-ß1 significantly increased expressions of fibrosis-associated genes that could be abolished by Fer-KD (Figure 3a). Fer-KD also significantly reduced the phospho-Smad3 level (Figure 3b). TGF-ß1 significantly increased expressions of fibrosis-associated genes that could be further augmented by Fer overexpression (Figure 3c). Fer overexpression also significantly increased the phospho-Smad3 level (Figure 3d). Similar to Fer-KD, pharmaceutical inhibition of Fer using DS21360717 significantly abolished the expression of fibrosis-associated genes induced by TGF-ß1 (Figure 3e). DS21360717 also significantly reduced the phospho-Smad3 level (Figure 3f).

Figure 2 
               Silencing Fer ameliorates RF. Rat renal fibroblast cells NRK-49F were treated with control and shRNA targeting Fer. (a) Protein level, (b) mRNA level of fibrosis-associated genes, and (c) phospho (p)-Smad3 ratio calculated by the p-Smad3 level normalized to the total Smad3 densitometry level, all detected at 48 h after transfection (*P < 0.05; **P < 0.01).
Figure 2

Silencing Fer ameliorates RF. Rat renal fibroblast cells NRK-49F were treated with control and shRNA targeting Fer. (a) Protein level, (b) mRNA level of fibrosis-associated genes, and (c) phospho (p)-Smad3 ratio calculated by the p-Smad3 level normalized to the total Smad3 densitometry level, all detected at 48 h after transfection (*P < 0.05; **P < 0.01).

Figure 3 
               Inhibition of Fer restores TGF-ß1-induced RF. Rat renal fibroblast cells NRK-49F were modified with overexpression (adenovirus-delivered) and silencing (shRNA) of Fer and treated with TGF-β1 (10 ng/mL) for 48 h. (a) Expression of fibrosis-associated genes with TGF-ß1 addition and (b) Smad3 phosphorylation level upon Fer-KD; (c) expression of fibrosis-associated genes with TGF-ß1 addition and (d) Smad3 phosphorylation level upon Fer overexpression; (e) expression of fibrosis-associated genes with TGF-ß1 addition and (f) Smad3 phosphorylation level upon Fer inhibition (*P < 0.05; **P < 0.01).
Figure 3

Inhibition of Fer restores TGF-ß1-induced RF. Rat renal fibroblast cells NRK-49F were modified with overexpression (adenovirus-delivered) and silencing (shRNA) of Fer and treated with TGF-β1 (10 ng/mL) for 48 h. (a) Expression of fibrosis-associated genes with TGF-ß1 addition and (b) Smad3 phosphorylation level upon Fer-KD; (c) expression of fibrosis-associated genes with TGF-ß1 addition and (d) Smad3 phosphorylation level upon Fer overexpression; (e) expression of fibrosis-associated genes with TGF-ß1 addition and (f) Smad3 phosphorylation level upon Fer inhibition (*P < 0.05; **P < 0.01).

Next, we validated the target miR in the in silico prediction, the miR-29c-3p. We first demonstrated the matching sequence of the miR and Fer (Figure 4a). We then showed that Fer-KD resulted in the decreased miR-29c-3p expression (Figure 4b) and vice versa for Fer overexpression (Figure 4c), indicating dependent expressions of the pairs. miR-29c-3p mimics significantly reduced expressions of fibrosis-associated genes (Figure 4d), and the miR-29c-3p inhibitor significantly resulted in a significant increase of expressions of fibrosis-associated genes (Figure 4e). We then studied the secretion of inflammatory cytokines in NRK-49F cells. We found that TGF-ß1 induced, as expected, significantly elevated the cytokine level that could be abolished by miR-29c-3p mimics and by miR-29c-3p inhibitors (Figure 5a–c).

Figure 4 
               miR-29c-3p targets Fer in NRK-49F cells. (a) Binding sequence between miR-29c-3p and Fer. Expression of miR-29c-3p in cells with or without (b) Fer silencing within 48 h of shRNA transfection and (c) Fer overexpression within 48 h of adenoviral transfection. Expressions of fibrosis-associated genes in (d) miR-29c-3p mimic and (e) miR-29c-3p inhibitor-treated cells, detected 48 h post-treatment (*P < 0.05; **P < 0.01).
Figure 4

miR-29c-3p targets Fer in NRK-49F cells. (a) Binding sequence between miR-29c-3p and Fer. Expression of miR-29c-3p in cells with or without (b) Fer silencing within 48 h of shRNA transfection and (c) Fer overexpression within 48 h of adenoviral transfection. Expressions of fibrosis-associated genes in (d) miR-29c-3p mimic and (e) miR-29c-3p inhibitor-treated cells, detected 48 h post-treatment (*P < 0.05; **P < 0.01).

Figure 5 
               Overexpression of miR-29c-3p inhibits inflammation. (a) IL-6, (b) IL-1β, and (c) TNF-α in NRK-49F cells treated with TGF-β1 (10 ng/mL), TGF-β1 with miR-29c-3p inhibitor (miR-Inh), and miR-29c-3p mimic, all for 48 h before measurement using ELISA (*P < 0.05; **P < 0.01).
Figure 5

Overexpression of miR-29c-3p inhibits inflammation. (a) IL-6, (b) IL-1β, and (c) TNF-α in NRK-49F cells treated with TGF-β1 (10 ng/mL), TGF-β1 with miR-29c-3p inhibitor (miR-Inh), and miR-29c-3p mimic, all for 48 h before measurement using ELISA (*P < 0.05; **P < 0.01).

4 Discussion

In the current study, we have shown that Fer expression and protein levels were gradually increased within 14 days of UUO modeling. miR-29c-3p showed a strong correlation with Fer expression in prediction. In vivo validation showed increased expressions of fibrosis-associated genes and an increased phospoho-Smad3 level in the UUO model. Fer-KD significantly decreased expressions of fibrosis-associated genes. The pharmaceutical Fer inhibition and miR-29c-3p showed similar effects. The miR inhibition showed a significant decrease of excretion of inflammatory factors. Our study showed that dysregulation of miR-29c-3p and Fer plays a role in RF. Pharmaceutical or genetic inhibition of Fer may serve as the potential treatment for RF.

Fibrosis is a pathological process characterized by excessive deposition of ECM components, which is mainly associated with the synthesis and degradation of ECM components. Such imbalance transforms normal functional epithelium into nonfunctioning fibrotic tissue [9]. miRs play an extremely important role in fibrotic diseases and are fully involved in almost every step of fibrosis. miR-29 is a newly discovered miR, along its family members that are closely related to development processes in fibrosis, including heart, liver, kidneys, lung fibrosis, systemic sclerosis, etc. [10]. RF features the disappearance of renal tubular epithelial cells in the kidney tissue under the action of various pathogenic factors (inflammation, injury, hypertension, diabetes, etc.). The normal kidney tissue is replaced by inflammatory cell infiltration, activation, and proliferation of renal interstitial fibroblasts and trans-differentiation. RF promotes excessive ECM accumulation in the renal interstitial and is the main pathological basis leading to end-stage renal disease [11, 12].

In 2001, miR-29a was successfully cloned using the direct miRNA gene cloning strategy in human HeLa cells for the first time, and its analogues miR-29b and miR-29c were obtained successively [13]. They share the same seeding sequence AGCACCA with only a few nucleotides at the tail being different: miR-29a and miR-29c each containing 22 nucleotides that are only one nucleotide different, while miR-29b contains 23 nucleotides [14].

We found that the expression level of miR-29c-3p in the mouse model of renal interstitial fibrosis induced by UUO was significantly reduced, and the severity of fibrosis was closely related to the expression level of miR-29c. These results confirmed that miR-29 could be closely related to RF [15]. Fang et al. found that TGF-β1 could stimulate SMAD3 to bind to the miR-29 promoter and down-regulate the expression of miR-29. miR-29 targets the ECM and is a downstream inhibitor of fibrosis mediated by the TGF-β/Smad3 signal pathway [16]. Liu et al. found that the removal of SMAD7 promoted RF and inflammation, which were mediated by Ang-II and may be related to the enhancement of Sp1-TGF-β/SMAD3-NF-κB signaling and miR-29 expression reduction [17]. Therefore, the Smad3/miR-29 axis is likely to be an important pathway for the treatment of fibrosis. It is also reported that compared with newborn mice, the expression of miR-29 in the kidneys of adult mice was significantly up-regulated. A similar expression pattern was also observed in other organs. By establishing a Dahl salt-sensitivity (Dahl/SS) rat model of hypertension and kidney injury using a high-salt diet for more than 3 days, scholars found that miR-29b was significantly expressed in the renal medulla of SS rats using anti-sense oligonucleotides administered intravenously to knock out miR29. Multiple ECM genes (COL1a1, COL3a1, COL4a1, Col5a1, Col5a2, Col5a3, COL7A1, COL8A1, MMP2, and Itgb1) have been shown to be the target of miR-29b in 13BN rats, supporting the renal-protective role of the miR.

Our findings that Fer is targeted by miR-29c-3p in RF and that Fer inhibition could potentially ameliorate RF not only provide novel biologic insight into the miR-29 family in modulating fibrotic process but also hold promise for the development of new treatment modalities.


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  1. Funding information: This work was supported by the Foundation of Tongren Xinxing (No. 2019shtrxx07), Sponsored by the Shanghai Sailing Program (No. 20YF1444000) and the Foundation of Science of Changning District (No. CNKW2018Y07).

  2. Author contributions: C.S., W.Z., S.W., and G.Q. performed experiments. C.S. and G.Z. designed the study. C.S. and D.P. wrote the manuscript.

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

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

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Received: 2020-09-19
Revised: 2021-06-05
Accepted: 2021-06-17
Published Online: 2021-09-13

© 2021 Chen-Min Sun et al., published by De Gruyter

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

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  65. Ratios between circulating myeloid cells and lymphocytes are associated with mortality in severe COVID-19 patients
  66. Risk factors of left atrial appendage thrombus in patients with non-valvular atrial fibrillation
  67. Clinical features of hypertensive patients with COVID-19 compared with a normotensive group: Single-center experience in China
  68. Surgical myocardial revascularization outcomes in Kawasaki disease: systematic review and meta-analysis
  69. Decreased chromobox homologue 7 expression is associated with epithelial–mesenchymal transition and poor prognosis in cervical cancer
  70. FGF16 regulated by miR-520b enhances the cell proliferation of lung cancer
  71. Platelet-rich fibrin: Basics of biological actions and protocol modifications
  72. Accurate diagnosis of prostate cancer using logistic regression
  73. miR-377 inhibition enhances the survival of trophoblast cells via upregulation of FNDC5 in gestational diabetes mellitus
  74. Prognostic significance of TRIM28 expression in patients with breast carcinoma
  75. Integrative bioinformatics analysis of KPNA2 in six major human cancers
  76. Exosomal-mediated transfer of OIP5-AS1 enhanced cell chemoresistance to trastuzumab in breast cancer via up-regulating HMGB3 by sponging miR-381-3p
  77. A four-lncRNA signature for predicting prognosis of recurrence patients with gastric cancer
  78. Knockdown of circ_0003204 alleviates oxidative low-density lipoprotein-induced human umbilical vein endothelial cells injury: Circulating RNAs could explain atherosclerosis disease progression
  79. Propofol postpones colorectal cancer development through circ_0026344/miR-645/Akt/mTOR signal pathway
  80. Knockdown of lncRNA TapSAKI alleviates LPS-induced injury in HK-2 cells through the miR-205/IRF3 pathway
  81. COVID-19 severity in relation to sociodemographics and vitamin D use
  82. Clinical analysis of 11 cases of nocardiosis
  83. Cis-regulatory elements in conserved non-coding sequences of nuclear receptor genes indicate for crosstalk between endocrine systems
  84. Four long noncoding RNAs act as biomarkers in lung adenocarcinoma
  85. Real-world evidence of cytomegalovirus reactivation in non-Hodgkin lymphomas treated with bendamustine-containing regimens
  86. Relation between IL-8 level and obstructive sleep apnea syndrome
  87. circAGFG1 sponges miR-28-5p to promote non-small-cell lung cancer progression through modulating HIF-1α level
  88. Nomogram prediction model for renal anaemia in IgA nephropathy patients
  89. Effect of antibiotic use on the efficacy of nivolumab in the treatment of advanced/metastatic non-small cell lung cancer: A meta-analysis
  90. NDRG2 inhibition facilitates angiogenesis of hepatocellular carcinoma
  91. A nomogram for predicting metabolic steatohepatitis: The combination of NAMPT, RALGDS, GADD45B, FOSL2, RTP3, and RASD1
  92. Clinical and prognostic features of MMP-2 and VEGF in AEG patients
  93. The value of miR-510 in the prognosis and development of colon cancer
  94. Functional implications of PABPC1 in the development of ovarian cancer
  95. Prognostic value of preoperative inflammation-based predictors in patients with bladder carcinoma after radical cystectomy
  96. Sublingual immunotherapy increases Treg/Th17 ratio in allergic rhinitis
  97. Prediction of improvement after anterior cruciate ligament reconstruction
  98. Effluent Osteopontin levels reflect the peritoneal solute transport rate
  99. circ_0038467 promotes PM2.5-induced bronchial epithelial cell dysfunction
  100. Significance of miR-141 and miR-340 in cervical squamous cell carcinoma
  101. Association between hair cortisol concentration and metabolic syndrome
  102. Microvessel density as a prognostic indicator of prostate cancer: A systematic review and meta-analysis
  103. Characteristics of BCR–ABL gene variants in patients of chronic myeloid leukemia
  104. Knee alterations in rheumatoid arthritis: Comparison of US and MRI
  105. Long non-coding RNA TUG1 aggravates cerebral ischemia and reperfusion injury by sponging miR-493-3p/miR-410-3p
  106. lncRNA MALAT1 regulated ATAD2 to facilitate retinoblastoma progression via miR-655-3p
  107. Development and validation of a nomogram for predicting severity in patients with hemorrhagic fever with renal syndrome: A retrospective study
  108. Analysis of COVID-19 outbreak origin in China in 2019 using differentiation method for unusual epidemiological events
  109. Laparoscopic versus open major liver resection for hepatocellular carcinoma: A case-matched analysis of short- and long-term outcomes
  110. Travelers’ vaccines and their adverse events in Nara, Japan
  111. Association between Tfh and PGA in children with Henoch–Schönlein purpura
  112. Can exchange transfusion be replaced by double-LED phototherapy?
  113. circ_0005962 functions as an oncogene to aggravate NSCLC progression
  114. Circular RNA VANGL1 knockdown suppressed viability, promoted apoptosis, and increased doxorubicin sensitivity through targeting miR-145-5p to regulate SOX4 in bladder cancer cells
  115. Serum intact fibroblast growth factor 23 in healthy paediatric population
  116. Algorithm of rational approach to reconstruction in Fournier’s disease
  117. A meta-analysis of exosome in the treatment of spinal cord injury
  118. Src-1 and SP2 promote the proliferation and epithelial–mesenchymal transition of nasopharyngeal carcinoma
  119. Dexmedetomidine may decrease the bupivacaine toxicity to heart
  120. Hypoxia stimulates the migration and invasion of osteosarcoma via up-regulating the NUSAP1 expression
  121. Long noncoding RNA XIST knockdown relieves the injury of microglia cells after spinal cord injury by sponging miR-219-5p
  122. External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients
  123. miR-128-3p reduced acute lung injury induced by sepsis via targeting PEL12
  124. HAGLR promotes neuron differentiation through the miR-130a-3p-MeCP2 axis
  125. Phosphoglycerate mutase 2 is elevated in serum of patients with heart failure and correlates with the disease severity and patient’s prognosis
  126. Cell population data in identifying active tuberculosis and community-acquired pneumonia
  127. Prognostic value of microRNA-4521 in non-small cell lung cancer and its regulatory effect on tumor progression
  128. Mean platelet volume and red blood cell distribution width is associated with prognosis in premature neonates with sepsis
  129. 3D-printed porous scaffold promotes osteogenic differentiation of hADMSCs
  130. Association of gene polymorphisms with women urinary incontinence
  131. Influence of COVID-19 pandemic on stress levels of urologic patients
  132. miR-496 inhibits proliferation via LYN and AKT pathway in gastric cancer
  133. miR-519d downregulates LEP expression to inhibit preeclampsia development
  134. Comparison of single- and triple-port VATS for lung cancer: A meta-analysis
  135. Fluorescent light energy modulates healing in skin grafted mouse model
  136. Silencing CDK6-AS1 inhibits LPS-induced inflammatory damage in HK-2 cells
  137. Predictive effect of DCE-MRI and DWI in brain metastases from NSCLC
  138. Severe postoperative hyperbilirubinemia in congenital heart disease
  139. Baicalin improves podocyte injury in rats with diabetic nephropathy by inhibiting PI3K/Akt/mTOR signaling pathway
  140. Clinical factors predicting ureteral stent failure in patients with external ureteral compression
  141. Novel H2S donor proglumide-ADT-OH protects HUVECs from ox-LDL-induced injury through NF-κB and JAK/SATA pathway
  142. Triple-Endobutton and clavicular hook: A propensity score matching analysis
  143. Long noncoding RNA MIAT inhibits the progression of diabetic nephropathy and the activation of NF-κB pathway in high glucose-treated renal tubular epithelial cells by the miR-182-5p/GPRC5A axis
  144. Serum exosomal miR-122-5p, GAS, and PGR in the non-invasive diagnosis of CAG
  145. miR-513b-5p inhibits the proliferation and promotes apoptosis of retinoblastoma cells by targeting TRIB1
  146. Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p
  147. The diagnostic and prognostic value of miR-92a in gastric cancer: A systematic review and meta-analysis
  148. Prognostic value of α2δ1 in hypopharyngeal carcinoma: A retrospective study
  149. No significant benefit of moderate-dose vitamin C on severe COVID-19 cases
  150. circ_0000467 promotes the proliferation, metastasis, and angiogenesis in colorectal cancer cells through regulating KLF12 expression by sponging miR-4766-5p
  151. Downregulation of RAB7 and Caveolin-1 increases MMP-2 activity in renal tubular epithelial cells under hypoxic conditions
  152. Educational program for orthopedic surgeons’ influences for osteoporosis
  153. Expression and function analysis of CRABP2 and FABP5, and their ratio in esophageal squamous cell carcinoma
  154. GJA1 promotes hepatocellular carcinoma progression by mediating TGF-β-induced activation and the epithelial–mesenchymal transition of hepatic stellate cells
  155. lncRNA-ZFAS1 promotes the progression of endometrial carcinoma by targeting miR-34b to regulate VEGFA expression
  156. Anticoagulation is the answer in treating noncritical COVID-19 patients
  157. Effect of late-onset hemorrhagic cystitis on PFS after haplo-PBSCT
  158. Comparison of Dako HercepTest and Ventana PATHWAY anti-HER2 (4B5) tests and their correlation with silver in situ hybridization in lung adenocarcinoma
  159. VSTM1 regulates monocyte/macrophage function via the NF-κB signaling pathway
  160. Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis
  161. Treatment of osteoporosis with teriparatide: The Slovenian experience
  162. New targets of morphine postconditioning protection of the myocardium in ischemia/reperfusion injury: Involvement of HSP90/Akt and C5a/NF-κB
  163. Superenhancer–transcription factor regulatory network in malignant tumors
  164. β-Cell function is associated with osteosarcopenia in middle-aged and older nonobese patients with type 2 diabetes: A cross-sectional study
  165. Clinical features of atypical tuberculosis mimicking bacterial pneumonia
  166. Proteoglycan-depleted regions of annular injury promote nerve ingrowth in a rabbit disc degeneration model
  167. Effect of electromagnetic field on abortion: A systematic review and meta-analysis
  168. miR-150-5p affects AS plaque with ASMC proliferation and migration by STAT1
  169. MALAT1 promotes malignant pleural mesothelioma by sponging miR-141-3p
  170. Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model
  171. miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway
  172. Identification of LIG1 and LIG3 as prognostic biomarkers in breast cancer
  173. MitoQ inhibits hepatic stellate cell activation and liver fibrosis by enhancing PINK1/parkin-mediated mitophagy
  174. Dissecting role of founder mutation p.V727M in GNE in Indian HIBM cohort
  175. circATP2A2 promotes osteosarcoma progression by upregulating MYH9
  176. Prognostic role of oxytocin receptor in colon adenocarcinoma
  177. Review Articles
  178. The function of non-coding RNAs in idiopathic pulmonary fibrosis
  179. Efficacy and safety of therapeutic plasma exchange in stiff person syndrome
  180. Role of cesarean section in the development of neonatal gut microbiota: A systematic review
  181. Small cell lung cancer transformation during antitumor therapies: A systematic review
  182. Research progress of gut microbiota and frailty syndrome
  183. Recommendations for outpatient activity in COVID-19 pandemic
  184. Rapid Communication
  185. Disparity in clinical characteristics between 2019 novel coronavirus pneumonia and leptospirosis
  186. Use of microspheres in embolization for unruptured renal angiomyolipomas
  187. COVID-19 cases with delayed absorption of lung lesion
  188. A triple combination of treatments on moderate COVID-19
  189. Social networks and eating disorders during the Covid-19 pandemic
  190. Letter
  191. COVID-19, WHO guidelines, pedagogy, and respite
  192. Inflammatory factors in alveolar lavage fluid from severe COVID-19 pneumonia: PCT and IL-6 in epithelial lining fluid
  193. COVID-19: Lessons from Norway tragedy must be considered in vaccine rollout planning in least developed/developing countries
  194. What is the role of plasma cell in the lamina propria of terminal ileum in Good’s syndrome patient?
  195. Case Report
  196. Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
  197. CTU findings of duplex kidney in kidney: A rare duplicated renal malformation
  198. Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
  199. Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review
  200. Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB
  201. Pulmonary parenchymal involvement caused by Tropheryma whipplei
  202. Mediastinal mixed germ cell tumor: A case report and literature review
  203. Ovarian female adnexal tumor of probable Wolffian origin – Case report
  204. Rare paratesticular aggressive angiomyxoma mimicking an epididymal tumor in an 82-year-old man: Case report
  205. Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review
  206. Primary orbital ganglioneuroblastoma: A case report
  207. Primary aortic intimal sarcoma masquerading as intramural hematoma
  208. Sustained false-positive results for hepatitis A virus immunoglobulin M: A case report and literature review
  209. Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature
  210. Chondroblastoma of mandibular condyle: Case report and literature review
  211. Trauma-induced complete pacemaker lead fracture 8 months prior to hospitalization: A case report
  212. Primary intradural extramedullary extraosseous Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (PIEES/PNET) of the thoracolumbar spine: A case report and literature review
  213. Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report
  214. High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib
  215. Rapid response of locally advanced oral squamous cell carcinoma to apatinib: A case report
  216. Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review
  217. Usage of intermingled skin allografts and autografts in a senior patient with major burn injury
  218. Retraction
  219. Retraction on “Dihydromyricetin attenuates inflammation through TLR4/NF-kappa B pathway”
  220. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part I
  221. An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers
  222. Breast cancer recurrence prediction with ensemble methods and cost-sensitive learning
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