Back to the future of oridonin: again,compound from medicinal herb shows potent antileukemia efficacies in vitro and in vivo

Traditional Chinese Medicine （TCM） has been widely and successfully used in treating illnesses ranging from inflammation to cancer, and compounds from medicinal herbs and minerals are playing more and more important roles in taming various kinds of diseases [1 ], exemplified by artemisinin and arsenic trioxide （ATO）. Artemisinin （or Qinghaosu in Chinese） is isolated from a plant called sweet wormwood （Artemisia annua; or Qinghao in Chi- nese） which has been used as an antipyretic remedy for more than 1500 years in China. Artemisinin has impressive parasiticidal properties in vitro and in vivo, and is now one of the most important class of antimalarial agents [2, 3]. ATO is a common, naturally occurring substance which had been used in China for a long time as a therapeutic agent for some severe diseases with the ancient philosophy of ＇treating an evil with a toxic＇ [4]. In 1990s, ATO was shown to be able to cause partial differentiation at low dose and apoptosis at high concentration of acute promyelocytic leukemia （APL） cells [5], and induce complete remission in 90% of patients with relapsed or refractory APL [6-8]. These paradigms suggest that TCM is the treasure house not only for the Chinese people, but also for the whole human beings. It is our responsibility to develop evidence-based therapeutic approaches from TCM for diseases with poor prognosis.

Rig-I^-/- mice develop colitis associated with downregulation of Gαi2

RIG-I （retinoid acid-inducible gene-I）, a putative RNA helicase with a cytoplasmic caspase-recrultment domain （CARD）, was identified as a pattem-recognition receptor （PRR） that mediates antiviral immunity by inducing type I interferon production. To further study the biological function of RIG-I, we generated Rig-I^-/- mice through homologous recombination, taking a different strategy to the previously reported strategy. Our Rig-I^-/- mice are viable and fertile. Histological analysis shows that Rig-I^-/ mice develop a colitis-like phenotype and increased susceptibility to dextran sulfate sodium-induced colitis. Accordingly, the size and number of Peyer＇s patches dramatically decreased in mutant mice. The peripheral T-cell subsets in mutant mice are characterized by an increase in effector T cells and a decrease in naive T cells, indicating an important role for Rig-I in the regulation ofT-cell activation. It was further found that Rig-I deficiency leads to the downregulation of G protein αi2 subunit （Gαi2） in various tissues, including T and B lymphocytes. By contrast, upregulation of Rig-I in NB4 cells that are treated with ATRA is accompanied by elevated Gαi2 expression. Moreover, Gαi2 promoter activity is increased in co-transfected NIH3T3 cells in a Rig-I dose-dependent manner. All these findings suggest that Rig-I has crucial roles in the regulation of Gαi2 expression and T-cell activation. The development of colitis may be, at least in part, associated with downregulation of Gαi2 and disturbed T-cell homeostasis.

Antigen-induced chimeric antigen receptor multimerization amplifies on-tumor cytotoxicity

Ligand-induced receptor dimerization or oligomerization is a widespread mechanism for ensuring communication specificity,safeguarding receptor activation,and facilitating amplification of signal transduction across the cellular membrane.However,cell-surface antigeninduced multimerization(dubbed AIM herein)has not yet been consciously leveraged in chimeric antigen receptor(CAR)engineering for enriching T cell-based therapies.We co-developed ciltacabtagene autoleucel(cilta-cel),whose CAR incorporates two B-cell maturation antigen(BCMA)-targeted nanobodies in tandem,for treating multiple myeloma.Here we elucidated a structural and functional model in which BCMA-induced cilta-cel CAR multimerization amplifies myeloma-targeted T cell-mediated cytotoxicity.Crystallographic analysis of BCMA–nanobody complexes revealed atomic details of antigen–antibody hetero-multimerization whilst analytical ultracentrifugation and small-angle X-ray scattering characterized interdependent BCMA apposition and CAR juxtaposition in solution.BCMA-induced nanobody CAR multimerization enhanced cytotoxicity,alongside elevated immune synapse formation and cytotoxicity-mediating cytokine release,towards myeloma-derived cells.Our results provide a framework for contemplating the AIM approach in designing next-generation CARs.

Safety and efficacy of thalidomide in patients with transfusiondependentβ-thalassemia:a randomized clinical trial

Thalidomide inducesγ-globin expression in erythroid progenitor cells,but its efficacy on patients with transfusion-dependentβ-thalassemia(TDT)remains unclear.In this phase 2,multi-center,randomized,double-blind clinical trial,we aimed to determine the safety and efficacy of thalidomide in TDT patients.A hundred patients of 14 years or older were randomly assigned to receive placebo or thalidomide for 12 weeks,followed by an extension phase of at least 36 weeks.The primary endpoint was the change of hemoglobin(Hb)level in the patients.The secondary endpoints included the red blood cell(RBC)units transfused and adverse effects.In the placebo-controlled period,Hb concentrations in patients treated with thalidomide achieved a median elevation of 14.0(range,2.5 to 37.5)g/L,whereas Hb in patients treated with placebo did not significantly change.Within the 12 weeks,the mean RBC transfusion volume for patients treated with thalidomide and placebo was 5.4±5.0 U and 10.3±6.4 U,respectively(P<0.001).Adverse events of drowsiness,dizziness,fatigue,pyrexia,sore throat,and rash were more common with thalidomide than placebo.In the extension phase,treatment with thalidomide for 24 weeks resulted in a sustainable increase in Hb concentrations which reached 104.9±19.0 g/L,without blood transfusion.Significant increase in Hb concentration and reduction in RBC transfusions were associated with nonβ0/β0 and HBS1L-MYB(rs9399137 C/T,C/C;rs4895441 A/G,G/G)genotypes.These results demonstrated that thalidomide is effective in patients with TDT.

GPCR信号通路调控微环境的免疫特征和介导EB病毒相关淋巴瘤的发生

EB病毒(EBV)是多种肿瘤的致癌驱动因素.然而,肿瘤发生过程中病毒与肿瘤免疫相互作用的潜在机制仍不清楚.自然杀伤T细胞淋巴瘤(NKTCL)是研究EBV相关淋巴瘤发生的代表性疾病模型.本文整合基因组、转录组和蛋白质组数据,全面报道了NKTCL的蛋白质基因组特征.多组学分析发现EBV基因模式与免疫介导的致癌信号相关.单细胞转录组分析进一步描绘肿瘤微环境的免疫炎症、缺陷和沙漠三种表型特征,与肿瘤-免疫循环的不同设定点相关.EBV与转录因子相互作用引起GPCRome重编程,肿瘤细胞和免疫抑制细胞上CCR1的高表达,从而调控微环境中病毒与肿瘤的相互作用.在NKTCL类器官中,靶向CCR1可清除EBV、激活T细胞和杀伤淋巴瘤细胞,具有潜在的靶向治疗作用.综上,本研究首次发现了一种GPCR介导的肿瘤发生发展机制,将病毒分子的感知效应转化为针对EBV的特异性抗肿瘤疗法.

Using sound Clinical Paths and Diagnosis-related Groups(DRGs)-based payment reform to bring benefits to patientcare: A case study of leukemia therapy

China has been undertaking a profound reform on health care.Although more than 1.16 billion people have been covered by rural and urban medical insurance to date,the level of reimbursement from insurance is very limited,especially for critical diseases such as leukemia.This places heavy economic burdens on patients.Under these circumstances,systems innovation is imperative for the efficient utilization of limited funding.In this respect,certain valuable experience from other countries may prove helpful.The prospective payment system of Diagnosis-related Groups(DRGs),Clinical Paths,and the Comparative Effectiveness Analysis adopted by the National Institute of Health and Clinical Excellence(NICE,UK),can befine tools to reduce medical costs and improve quality of services.Treatments of acute promyelocytic leukemia at Rui-Jin Hospital,and childhood acute lymphoblastic leukemia at Shanghai Children’s Medical Center,can be taken as suitable models to illustrate the crucial role of Clinical Paths in guaranteeing clinical and cost effectiveness of medical services for critical diseases,and to satisfactorily justify the feasibility of DRGs in China.

Positron emission tomography-adapted therapy in low-risk diffuse large B-cell lymphoma:results of a randomized,phase Ⅲ,non-inferiority trial

Background:The current standard of care for non-bulky diffuse large B-cell lymphoma(DLBCL)patients with an International Prognostic Index(IPI)of 0 is four cycles of rituximab plus cyclophosphamide,doxorubicin,vincristine and prednisone(R-CHOP)but whether the same efficacy can be achieved with reduced chemotherapy regimen of four cycles for non-bulky DLBCL patients with an IPI of 1 remains unclear.This study compared four cycles versus six cycles of chemotherapy in non-bulky low-risk DLBCL patients with negative interim positron emission tomography with computed tomography(PET-CT,Deauville 1-3),irrespective of age and other IPI risk factors(IPI 0-1).Methods:This was an open-label,randomized,phaseⅢ,non-inferiority trial.Patients aged 14-75 years with newly diagnosed low-risk DLBCL,according to IPI,achieving PET-CT confirmed complete response(CR)after four cycles of R-CHOPwere randomized(1:1)between four cycles of rituximab(4R-CHOP+4R arm)or two cycles of R-CHOP plus two cycles of rituximab(6R-CHOP+2R arm).The primary endpoint was 2-year progression-free survival(PFS),conducted in the intention-to-treat population.Safety was assessed in patients with at least one cycle of assigned treatment.The non-inferiority margin was-8%.Results:A total of 287 patients were included in the intention-to-treat analysis,the median follow-up was 47.3 months,and the 2-year PFS rate was 95%(95%confidence interval[CI],92%to 99%)and 94%(95%CI,91%to 98%)for the 4R-CHOP+4R and 6R-CHOP+2R arm.The absolute difference in 2-year PFS between the two arms was 1%(95%CI,-5%to 7%),supporting the non-inferiority of 4R-CHOP+4R.Grade 3-4 neutropenia was lower in the last four cycles of rituximab alone in the 4R-CHOP+4R arm(16.7%versus 76.9%),with decreased risk of febrile neutropenia(0.0%versus 8.4%)and infection(2.1%versus 14.0%).Conclusions:For newly diagnosed low-risk DLBCL patients,interim PET-CT after four cycles of R-CHOP was effective in identifying patients with Deauville 1-3 who would have a good response and Deauville 4-5 patients who might have high-risk biological features or develop resistance.Reducing the standard six cycles to four cycles of chemotherapy had comparable clinical efficacy and fewer adverse events in low-risk,non-bulky DLBCL with interim PET-CT confirmed CR.

National Research Center for Translational Medicine· Shanghai——National Key Scientific Infrastructure for Translational Medicine

In July 2013, the National Development and Reform Com- mission formally approved the ＂National Research Center for Translational Medicine-Shanghai＂ （hereinafter ＂the Center＂）, a piece of the national key scientific infrastruc- ture. As a national-level institution, the Center will be co-administered by the Ministry of Education and the Shanghai Municipal Government.

DNA crosslinking and recombination-activating genes 1/2(RAG1/2)are required for oncogenic splicing in acute lymphoblastic leukemia

Background:Abnormal alternative splicing is frequently associated with carcinogenesis.In B-cell acute lymphoblastic leukemia(B-ALL),double homeobox 4 fused with immunoglobulin heavy chain(DUX4/IGH)can lead to the aberrant production of E-26 transformation-specific family related gene abnormal transcript(ERGalt)and other splicing variants.However,the molecular mechanism underpinning this process remains elusive.Here,we aimed to know how DUX4/IGH triggers abnormal splicing in leukemia.Methods:The differential intron retention analysis was conducted to identify novel DUX4/IGH-driven splicing in B-ALL patients.X-ray crystallography,small angle X-ray scattering(SAXS),and analytical ultracentrifugation were used to investigate how DUX4/IGH recognize double DUX4 responsive element(DRE)-DRE sites.The ERGalt biogenesis and B-cell differentiation assays were performed to characterize the DUX4/IGH crosslinking activity.To check whether recombination-activating gene 1/2(RAG1/2)was required for DUX4/IGH-driven splicing,the proximity ligation assay,co-immunoprecipitation,mammalian two hybrid characterizations,in vitro RAG1/2 cleavage,and shRNA knock-down assays were performed.Results:We reported previously unrecognized intron retention events in Ctype lectin domain family 12,member A abnormal transcript(CLEC12Aalt)and chromosome 6 open reading frame 89 abnormal transcript(C6orf89alt),where also harbored repetitive DRE-DRE sites.Supportively,X-ray crystallography and SAXS characterization revealed that DUX4 homeobox domain(HD)1-HD2 might dimerize into a dumbbell-shape trans configuration to crosslink two adjacent DRE sites.Impaired DUX4/IGH-mediated crosslinking abolishes ERGalt,CLEC12Aalt,and C6orf89alt biogenesis,resulting in marked alleviation of its inhibitory effect on B-cell differentiation.Furthermore,we also observed a rare RAG1/2-mediated recombination signal sequence-like DNA edition in DUX4/IGH target genes.Supportively,shRNA knock-down of RAG1/2 in leukemic Reh cells consistently impaired the biogenesis of ERGalt,CLEC12Aalt,and C6orf89alt.Conclusions:All these results suggest that DUX4/IGH-driven DNA crosslinking is required for RAG1/2 recruitment onto the double tandem DRE-DRE sites,catalyzing V(D)J-like recombination and oncogenic splicing in acute lymphoblastic leukemia.

Healthy people, healthy journal

Birth-to-death,with disease shares the contours.That is everyone’s destiny.But in health we care,we struggle for healthier life,better medicine,and dignified survival.The past six decades have witnessed China’s tremendous advances in the development of living condition and health-care system.The life expectancy of Chinese people increased from 36.5 years in 1949 to 73 years in 2005,and will reach 85 years by 2050.The infant mortality rate decreased from 200 per 1000 in 1949 to 14.9 per 1000 in 2008.While other countries are suffering and recovering from the financial crisis,China has passed the long-awaited health reform plan which will provide citizens with improved health care service,reduced economic burdens,and extended health coverage.

The LIFR-targeting small molecules EC330/EC359 are potent ferroptosis inducers

Ferroptosis is a form of regulated cell death characterized by iron-dependent overaccumulation of lipid peroxides,which causes membrane damage and cell lysis.Ferroptosis can be prevented by cellular antioxidant mechanisms such as glutathione peroxidase 4(GPX4)-mediated elimination of the lipid peroxides at the cost of glutathione(GSH).As the rate-limiting step of GSH synthesis,the availability of intracellular cystine is controlled by the cell membrane-located cystine/glutamate antiporter system xc−.Indeed,the initially identified small molecule inducers of ferroptosis,RSL3 and erastin,turned out to be inhibitors of GPX4 and system xc−,respectively.