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Scientific Discoveries Supporting Theories in Science: From Thinking to Practice

A special issue of International Journal of Molecular Sciences (ISSN 1422-0067). This special issue belongs to the section "Molecular Pathology, Diagnostics, and Therapeutics".

Deadline for manuscript submissions: closed (15 June 2022) | Viewed by 60167

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Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
Interests: translational research in medicine; experimental oncology; health; exosomes; regulation of pH in health and diseases; cell-in-cell phenomena
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Special Issue Information

Dear Colleagues,

Financial Times, in 2008, published an apparently provocative article with the title “Drug research needs serendipity” (1). In this visionary article, the authors state that, in the last two decades, the Pharma industry did not introduce new drugs to the market that showed some effectiveness against major diseases, despite huge investment, and they tried to propose some explanation for this. In their own words: “What went wrong? The answer, we suggest, is the mis-measure of uncertainty, as academic researchers underestimated the fragility of their scientific knowledge, while pharmaceuticals executives overestimated their ability to domesticate scientific research.’’ and ‘‘Medical research is particularly hampered by the scarcity of good animal models for most human disease, as well as by the tendency of academic science to focus on the ‘‘bits and pieces’’ of life – DNA, proteins, cultured cells – rather than on the integrative analysis of entire organisms, which can be more difficult to study.’’ All readers of these few sentences should realize that pharmaceutical industries have failed in their investment, and the authors of the article provide an explanation for this: academic researchers have overestimated their findings and the headquarters of Pharma were unable to achieve perfect control over what came from the scientific research. One paradox of this low effectiveness of the new drugs is that a new field in pharmacology is dedicated to discovering the off-targeting of known drugs through their side effects, (2) and this is leading to further thought regarding using drugs thought to be specific to a particular disease for the treatment of other diseases. However, this is not surprising as the vast majority of drugs that pioneered the pharmacology of neurologic diseases have been considered for other uses (3). From this dreadful awareness, some doubts may surface regarding the future of current research, that is, concerns about proceeding without breaks in the same direction. However, the authors provide a possible attempt to adjust this, to course-correct, to change the strategy of research in medicine in order to obtain results that may really change the health, and therefore the fate, of humanity. They wrote that, in the past, the majority of discoveries were mostly done through serendipity. In fact, serendipity was a fairly common occurrence in science.

We have clear examples of past discoveries that really changed history regarding devastating diseases, such as infectious diseases, through incidental findings, and, therefore, we can recall amazing moments of serendipity. The most known example of this is the discovery of penicillin. Fleming was studying ‘‘Staphylococcus influenzae’’ when one of his culture plates became contaminated and developed a mold that created a bacteria-free circle. Then, he found within the mold a substance that was very active against the vast majority of the bacteria infecting human beings (4). However, although Fleming’s example is the most known, it is not the only one we can provide. One other example, while much less known, is that of the 1931 Nobel Prizewinner Otto H. Warburg. He left some plates containing tumor cells seeded in culture medium in the laboratory’s incubator overnight with the usual 37°C and O2/CO2 atmosphere. The morning after, he realized that the O2 dropped down within the incubator, expecting to find all the cells dead due to the hypoxic conditions. However, the cells were pretty well and, after his initial astonishment, he thought that cancer cells likely did not need oxygen to live. After a series of experiments, his conclusion was that, differently to normal cells, cancer cells do not need oxygen for their metabolism, while they ferment sugar-producing lactate, thus contributing to extracellular acidification. Warburg has become a mentor for scientists who think that tumor acidity is a common phenotype of cancers, and antiacidic therapy should be listed for implementation alongside the current anti-cancer approach. Warburg’s discovery on tumor metabolism convinced me that it is crucial, in science, to have a look to what is occurring with an open mind, not thinking that what looks like failure of your experiment is actually a failure, but instead, hopefully, something that may represent a discovery (5, 6). Therefore, we should identify serendipity as part of the scientific process, suggesting that ‘‘unexpected discoveries’’, should become part of life science. Serendipity should likely be considered an essential part of the scientific method and, particularly, a tool for progress, and it should be taken as a rational approach to scientific practice, an attitude, and a happy accident. We should not think of serendipity as merely luck, chance, or happenstance, but instead as a process in which a fortunate event leads to the discovery of a new, unexpected solution to a problem (7).

This Special Issue, hosted and proposed by the International Journal of Molecular Science, would like to collect reviews and original articles that relate to the topics I have discussed.

Original articles should represent a solid background boosting and feeding new theories on disease pathogenesis. Some examples are given in the following:

  1. Logozzi M, Angelini DF, Giuliani A, Mizzoni D, Di Raimo R, Maggi M, Gentilucci A, Marzio V, Salciccia S, Borsellino G, Battistini L, Sciarra A, Fais S. Increased Plasmatic Levels of PSA-Expressing Exosomes Distinguish Prostate Cancer Patients from Benign Prostatic Hyperplasia: A Prospective Study. Cancers (Basel). 2019 Sep 27;11(10). pii: E1449. doi: 10.3390/cancers11101449.

THIS PAPER SUGGESTS THAT PLASMATIC EXOSOMES EXPRESSING TUMOR BIOMARKERS, SUCH AS PSA, MAY WELL REPRESENT REAL TUMOR BIOMARKERS

  1. Logozzi M, Angelini DF, Mizzoni D, Di Raimo R, Battistini L, Fais S. Nanovesicles released by OKT3 hybridoma express fully active antibodies.Enzyme Inhib Med Chem. 2021 Dec;36(1):175-182. doi: 10.1080/14756366.2020.1852401.

THIS PAPER SUGGESTS THAT THE MOST EFFICIENT AND NATURAL WAY TO PRODUCE THERAPEUTIC ANTIBODIES MAY BE ON EXOSOMES.

The reviews should contain theories based on recent scientific data. Some examples might be:

  1. Cappello F, Logozzi M, Campanella C, Bavisotto CC, Marcilla A, Properzi F, Fais S. EXOSOME LEVELS IN HUMAN BODY FLUIDS: A TUMOR MARKER BY THEMSELVES? Eur J Pharm Sci. 2017 Feb 15;98:64-69. doi: 10.1016/j.ejps.2016.11.007. PMID:27840195.
    THE THEORY PRESENTED HERE IS THAT THE PLASMATIC EXOSOMES LEVELS MAY REPRESENT A REAL DISEASE MARKER, AS THEY ARE ALWAYS HIGHER IN PATIENTS THAN IN HEALTHY DONORS.
  2. Spugnini E, Fais S. Proton pump inhibition and cancer therapeutics: A specific tumor targeting or it is a phenomenon secondary to a systemic buffering? Semin Cancer Biol. 2017 Jan 11. pii: S1044-579X(17)30003-2. doi: 10.1016/j.semcancer.2017.01.003.
    THE THEORY PRESNTED HERE IS THAT PROTON PUMP INHIBITORS, WHILE HAVING A SPECIFIC CELLULAR TARGET, MAY CONTRIBUTE TO BODY ALKALINIZATION BY BUFFERING THE STOMACH.
  3. Fais S, Overholtzer M. Cell-in-cell phenomena in cancer. Nature Reviews in Cancer. 2018 2018 Dec;18(12):758-766.
    THE THEORY PRESENTED IN HERE IS THAT CELL-IN-CELL PHENOME MAY REPRESENT A KEY CANCER PHENOTYPE AND A TUMOR MARKER.

 All the scientific papers and reviews that are related to the above examples will be welcome in this Special Issue.

References

  1. Shaywitz D, Taleb N. Drug research needs serendipity. Financial Times; July 30, 2008.
  2. Campillos M, Kuhn M, Gavin AC, et al. Drug target identification using side-effect similarity. Science 2008;321:263–6.
  3. Ban TA. The role of serendipity in drug discovery. Dialog Clin Neurosci 2006;8:335–44.
  4. Gaynes, R. The Discovery of Penicillin—New Insights After More Than 75 Years of Clinical Use. Emerg Infect Dis 2017, 23, 849–853.
  5. Otto, A.M. Warburg effect(s)—a biographical sketch of Otto Warburg and his impacts on tumor metabolism. Cancer Metab 2016, 4.
  6. Schwartz L, Seyfried T, Alfarouk KO, Da Veiga Moreira J, Fais S. Out of Warburg effect: An effective cancer treatment targeting the tumor specific metabolism and dysregulated pH. Semin Cancer Biol. 2017 Jan 22. pii: S1044-579X(17)30005-6. doi: 10.1016/j.semcancer.2017.01.005. PMID:28122260.
  7. Foletti A, Fais S. Unexpected Discoveries Should Be Reconsidered in Science-A Look to the Past? Int J Mol Sci. 2019 Aug 15;20(16). pii: E3973. doi: 10.3390/ijms20163973.

Prof. Dr. Stefano Fais
Guest Editor

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Published Papers (22 papers)

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Editorial

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6 pages, 234 KiB  
Editorial
Scientific Discoveries Supporting Theories in Science: From Thinking to Practice
by Stefano Fais
Int. J. Mol. Sci. 2022, 23(23), 15025; https://doi.org/10.3390/ijms232315025 - 30 Nov 2022
Viewed by 852
Abstract
The idea to propose this ambitious title for a Special Issue in the International Journal of Molecular Science came, on one hand, from my personal experience in research in medicine, lasting 41 years, which has often been inspired by chance [...] Full article

Research

Jump to: Editorial, Review, Other

20 pages, 2663 KiB  
Article
Cellular Stress Assay in Peripheral Blood Mononuclear Cells: Factors Influencing Its Results
by Belay Tessema, Janine Riemer, Ulrich Sack and Brigitte König
Int. J. Mol. Sci. 2022, 23(21), 13118; https://doi.org/10.3390/ijms232113118 - 28 Oct 2022
Cited by 4 | Viewed by 1539
Abstract
Cellular stress is central to the understanding of pathological mechanisms and the development of new therapeutic strategies and serves as a biomarker for disease progression in neurodegeneration, diabetes, cancer, cardiovascular and other chronic diseases. The common cellular stress assay (CSA) based on Seahorse [...] Read more.
Cellular stress is central to the understanding of pathological mechanisms and the development of new therapeutic strategies and serves as a biomarker for disease progression in neurodegeneration, diabetes, cancer, cardiovascular and other chronic diseases. The common cellular stress assay (CSA) based on Seahorse technology in peripheral blood mononuclear cells (PBMCs) shows inconsistent results, which prevents its use as a biomarker for the progression of chronic diseases. Therefore, the aim of this study was to investigate potential factors that affect the CSA in PBMCs. We measured the CSA parameters in PBMCs from study participants and compared the results according to the potential factors, namely, the PBMC isolation method, age, seasonal variation and the gender of the study participants. PBMCs were isolated by OptiPrep® and RobosepTM-S methods. PBMCs isolated with the OptiPrep method showed much higher extracellular acidification and higher respiration compared to Robosep-isolated cells. Moreover, OptiPrep-isolated cells showed a higher number of outliers for the proton production rate (PPR) and a high respiratory quotient, indicating impurities with other cells, such as platelets, and technical inconsistencies. PBMCs from older individuals showed higher maximal respiration, spare capacity and extracellular acidification than younger participants. Additionally, in winter, maximal respiration and spare capacity decreased. From spring until early autumn, spare capacity and maximal respiration continuously increased. Elderly males also showed higher basal respiration, spare capacity and extracellular acidification than females. In conclusion, the findings of this study clearly demonstrate that the results of CSA parameters measured in PBMCs are influenced by the PBMC isolation method, age, seasonal variation and gender. Therefore, we recommend that researchers and physicians properly interpret the results of CSA parameters in PBMCs by considering these factors. It is important to use separate CSA evaluation standards based on the isolation method, age, gender and season-dependent factors. To assess the cellular stress situation in PBMCs, both extracellular acidification and mitochondrial respiration should be taken into account. Further study of additional factors, such as mitochondrial mass, should be conducted to improve the measurement of CSA parameters for the assessment of the real mitochondrial fitness. Full article
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15 pages, 3120 KiB  
Article
An Ultra-Rare Manifestation of an X-Linked Recessive Disorder: Duchenne Muscular Dystrophy in a Female Patient
by Zsuzsanna Szűcs, Éva Pinti, Irén Haltrich, Orsolya Pálné Szén, Tibor Nagy, Endre Barta, Gábor Méhes, László Bidiga, Olga Török, Anikó Ujfalusi, Katalin Koczok and István Balogh
Int. J. Mol. Sci. 2022, 23(21), 13076; https://doi.org/10.3390/ijms232113076 - 28 Oct 2022
Cited by 2 | Viewed by 2472
Abstract
Duchenne muscular dystrophy (DMD) is the most common inherited muscle dystrophy. Patients are characterized by muscle weakness, gross motor delay, and elevated serum creatinine kinase (CK) levels. The disease is caused by mutations in the DMD gene located on the X chromosome. Due [...] Read more.
Duchenne muscular dystrophy (DMD) is the most common inherited muscle dystrophy. Patients are characterized by muscle weakness, gross motor delay, and elevated serum creatinine kinase (CK) levels. The disease is caused by mutations in the DMD gene located on the X chromosome. Due to the X-linked recessive inheritance pattern, DMD most commonly affects males, who are generally diagnosed between the age of 3–5 years. Here we present an ultra-rare manifestation of DMD in a female patient. Cytogenetic examination showed that she has a t(X;10)(p21.1;p12.1) translocation, which turned out to affect the DMD gene with one of the breakpoints located in exon 54 (detected by genome sequencing). The X-inactivation test revealed skewed X-inactivation (ratio 99:1). Muscle histology and dystrophin immunohistochemistry showed severe dystrophic changes and highly reduced dystrophin expression, respectively. These results, in accordance with the clinical picture and a highly elevated serum CK, led to the diagnosis of DMD. In conclusion, although in very rare cases, DMD can manifest in female patients as well. In this case, a balanced X-autosome reciprocal translocation disrupts the DMD gene and skewed X-inactivation leads to the manifestation of the DMD phenotype. Full article
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17 pages, 2035 KiB  
Article
Higher Na+-Ca2+ Exchanger Function and Triggered Activity Contribute to Male Predisposition to Atrial Fibrillation
by Simon Thibault, Valérie Long and Céline Fiset
Int. J. Mol. Sci. 2022, 23(18), 10724; https://doi.org/10.3390/ijms231810724 - 14 Sep 2022
Cited by 3 | Viewed by 1492
Abstract
Male sex is one of the most important risk factors of atrial fibrillation (AF), with the incidence in men being almost double that in women. However, the reasons for this sex difference are unknown. Accordingly, in this study, we sought to determine whether [...] Read more.
Male sex is one of the most important risk factors of atrial fibrillation (AF), with the incidence in men being almost double that in women. However, the reasons for this sex difference are unknown. Accordingly, in this study, we sought to determine whether there are sex differences in intracellular Ca2+ homeostasis in mouse atrial myocytes that might help explain male predisposition to AF. AF susceptibility was assessed in male (M) and female (F) mice (4–5 months old) using programmed electrical stimulation (EPS) protocols. Males were 50% more likely to develop AF. The Ca2+ transient amplitude was 28% higher in male atrial myocytes. Spontaneous systolic and diastolic Ca2+ releases, which are known sources of triggered activity, were significantly more frequent in males than females. The time to 90% decay of Ca2+ transient was faster in males. Males had 54% higher Na+-Ca2+ exchanger (NCX1) current density, and its expression was also more abundant. L-type Ca2+ current (ICaL) was recorded with and without BAPTA, a Ca2+ chelator. ICaL density was lower in males only in the absence of BAPTA, suggesting stronger Ca2+-dependent inactivation in males. CaV1.2 expression was similar between sexes. This study reports major sex differences in Ca2+ homeostasis in mouse atria, with larger Ca2+ transients and enhanced NCX1 function and expression in males resulting in more spontaneous Ca2+ releases. These sex differences may contribute to male susceptibility to AF by promoting triggered activity. Full article
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18 pages, 4188 KiB  
Article
Connexin Lateralization Contributes to Male Susceptibility to Atrial Fibrillation
by Simon Thibault, Anh-Tuan Ton, François Huynh and Céline Fiset
Int. J. Mol. Sci. 2022, 23(18), 10696; https://doi.org/10.3390/ijms231810696 - 14 Sep 2022
Cited by 5 | Viewed by 1516
Abstract
Men have a higher risk of developing atrial fibrillation (AF) than women, though the reason for this is unknown. Here, we compared atrial electrical and structural properties in male and female mice and explored the contribution of sex hormones. Cellular electrophysiological studies revealed [...] Read more.
Men have a higher risk of developing atrial fibrillation (AF) than women, though the reason for this is unknown. Here, we compared atrial electrical and structural properties in male and female mice and explored the contribution of sex hormones. Cellular electrophysiological studies revealed that action potential configuration, Na+ and K+ currents were similar in atrial myocytes from male and female mice (4–5 months). Immunofluorescence showed that male atrial myocytes had more lateralization of connexins 40 (63 ± 4%) and 43 (66 ± 4%) than females (Cx40: 45 ± 4%, p = 0.006; Cx43: 44 ± 4%, p = 0.002), with no difference in mRNA expression. Atrial mass was significantly higher in males. Atrial myocyte dimensions were also larger in males. Atrial fibrosis was low and similar between sexes. Orchiectomy (ORC) abolished sex differences in AF susceptibility (M: 65%; ORC: 38%, p = 0.050) by reducing connexin lateralization and myocyte dimensions. Ovariectomy (OVX) did not influence AF susceptibility (F: 42%; OVX: 33%). This study shows that prior to the development of age-related remodeling, male mice have more connexin lateralization and larger atria and atrial myocyte than females. Orchiectomy reduced AF susceptibility in males by decreasing connexin lateralization and atrial myocyte size, supporting a role for androgens. These sex differences in AF substrates may contribute to male predisposition to AF. Full article
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17 pages, 1840 KiB  
Article
Development of the Method for Nusinersen and Its Metabolites Identification in the Serum Samples of Children Treated with Spinraza for Spinal Muscular Atrophy
by Sylwia Studzińska, Maria Mazurkiewicz-Bełdzińska and Bogusław Buszewski
Int. J. Mol. Sci. 2022, 23(17), 10166; https://doi.org/10.3390/ijms231710166 - 5 Sep 2022
Cited by 3 | Viewed by 2618
Abstract
The application of oligonucleotides as drugs for different genetic diseases is increasing rapidly. Since 2016 they are used during spinal muscular atrophy treatment with the use of nusinersen oligonucleotide. The purpose of this study was to improve methods for the analysis of serum [...] Read more.
The application of oligonucleotides as drugs for different genetic diseases is increasing rapidly. Since 2016 they are used during spinal muscular atrophy treatment with the use of nusinersen oligonucleotide. The purpose of this study was to improve methods for the analysis of serum samples of patients treated with nusinersen. The results showed that liquid-liquid extraction (with phenol/chloroform) is insufficient and an additional purification step using solid-phase extraction is necessary. The best results were obtained for microextraction by packed sorbents. Important parameters in the optimization of the method were mainly the type of amine in the mobile phase and the stationary phase. Both influenced the selectivity of metabolite separation and thus their correct identification; while amine type impacted also the intensity of signals. Finally, the highest resolution of separation and the highest peak areas were obtained for N,N-dimethylbutylamine or N,N-diisopropylthylamine with an octadecyl column with a terminal aryl group. Over a dozen of metabolites were successfully identified with the use of methods developed during the study. The 3′ exonucleases and 5′ exonucleases were mainly responsible for nusinersen metabolism, consequently, 3′end shortmers, and 5′end shortmers were observed, as well as metabolites with simultaneous loss of bases at both ends of the sequence. However, some depurination and depyrimidination products were also identified. To the best of our knowledge, this is the first report on nusinersen and its metabolite identification in serum samples by liquid chromatography and mass spectrometry. Full article
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16 pages, 3902 KiB  
Article
Changes in Radiosensitivity to Gamma-Rays of Lymphocytes from Hyperthyroid Patients Treated with I-131
by Valentina Dini, Massimo Salvatori, Mauro Belli, Maria Elena Lago, Alessandra Nosdeo, Donatella Pia Dambra, Luisa Lo Conte, Ilaria Pecchia and Alessandro Giordano
Int. J. Mol. Sci. 2022, 23(17), 10156; https://doi.org/10.3390/ijms231710156 - 5 Sep 2022
Cited by 1 | Viewed by 1436
Abstract
This study investigated the peripheral blood lymphocytes (PBL) response to a dose of γ-rays in patients treated with radioiodine (I-131) for hyperthyroidism vs. healthy controls, to gain information about the individual lymphocytes’ radio-sensitivity. Blood samples were taken from 18 patients and 10 healthy [...] Read more.
This study investigated the peripheral blood lymphocytes (PBL) response to a dose of γ-rays in patients treated with radioiodine (I-131) for hyperthyroidism vs. healthy controls, to gain information about the individual lymphocytes’ radio-sensitivity. Blood samples were taken from 18 patients and 10 healthy donors. Phosphorylated histone variant H2AX (γ-H2AX) and micronuclei (MN) induction were used to determine the change in PBL radio-sensitivity and the correlations between the two types of damage. The two assays showed large inter-individual variability in PBL background damage and in radio-sensitivity (patients vs. healthy donors). In particular, they showed an increased radio-sensitivity in 36% and 33% of patients, decrease in 36% and 44%, respectively. There was a scarce correlation between the two assays and no dependence on age or gender. A significant association was found between high radio-sensitivity conditions and induced hypothyroidism. PBL radio-sensitivity in the patient group was not significantly affected by treatment with I-131, whereas there were significant changes inter-individually. The association found between clinical response and PBL radio-sensitivity suggests that the latter could be used in view of the development of personalized treatments. Full article
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12 pages, 1387 KiB  
Article
Investigating the Expression and Function of the Glucose Transporter GLUT6 in Obesity
by Sing-Young Chen, Ellen M. Olzomer, Martina Beretta, James Cantley, Craig S. Nunemaker, Kyle L. Hoehn and Frances L. Byrne
Int. J. Mol. Sci. 2022, 23(17), 9798; https://doi.org/10.3390/ijms23179798 - 29 Aug 2022
Cited by 1 | Viewed by 1870
Abstract
Obesity-related insulin resistance is a highly prevalent and growing health concern, which places stress on the pancreatic islets of Langerhans by increasing insulin secretion to lower blood glucose levels. The glucose transporters GLUT1 and GLUT3 play a key role in glucose-stimulated insulin secretion [...] Read more.
Obesity-related insulin resistance is a highly prevalent and growing health concern, which places stress on the pancreatic islets of Langerhans by increasing insulin secretion to lower blood glucose levels. The glucose transporters GLUT1 and GLUT3 play a key role in glucose-stimulated insulin secretion in human islets, while GLUT2 is the key isoform in rodent islets. However, it is unclear whether other glucose transporters also contribute to insulin secretion by pancreatic islets. Herein, we show that SLC2A6 (GLUT6) is markedly upregulated in pancreatic islets from genetically obese leptin-mutant (ob/ob) and leptin receptor-mutant (db/db) mice, compared to lean controls. Furthermore, we observe that islet SLC2A6 expression positively correlates with body mass index in human patients with type 2 diabetes. To investigate whether GLUT6 plays a functional role in islets, we crossed GLUT6 knockout mice with C57BL/6 ob/ob mice. Pancreatic islets isolated from ob/ob mice lacking GLUT6 secreted more insulin in response to high-dose glucose, compared to ob/ob mice that were wild type for GLUT6. The loss of GLUT6 in ob/ob mice had no adverse impact on body mass, body composition, or glucose tolerance at a whole-body level. This study demonstrates that GLUT6 plays a role in pancreatic islet insulin secretion in vitro but is not a dominant glucose transporter that alters whole-body metabolic physiology in ob/ob mice. Full article
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26 pages, 3562 KiB  
Article
Comparative Proteomic Analysis of Liver Tissues and Serum in db/db Mice
by Yu Zhang, Xiumei Wu, Mengyun Xu, Tong Yue, Ping Ling, Tingyu Fang, Sihui Luo, Suowen Xu and Jianping Weng
Int. J. Mol. Sci. 2022, 23(17), 9687; https://doi.org/10.3390/ijms23179687 - 26 Aug 2022
Cited by 5 | Viewed by 2896
Abstract
Background and Aims: Non-alcoholic fatty liver disease (NAFLD) affects one-quarter of individuals worldwide. Liver biopsy, as the current reliable method for NAFLD evaluation, causes low patient acceptance because of the nature of invasive sampling. Therefore, sensitive non-invasive serum biomarkers are urgently needed. Results: [...] Read more.
Background and Aims: Non-alcoholic fatty liver disease (NAFLD) affects one-quarter of individuals worldwide. Liver biopsy, as the current reliable method for NAFLD evaluation, causes low patient acceptance because of the nature of invasive sampling. Therefore, sensitive non-invasive serum biomarkers are urgently needed. Results: The serum gene ontology (GO) classification and Kyoto encyclopedia of genes and genomes (KEGG) analysis revealed the DEPs enriched in pathways including JAK-STAT and FoxO. GO analysis indicated that serum DEPs were mainly involved in the cellular process, metabolic process, response to stimulus, and biological regulation. Hepatic proteomic KEGG analysis revealed the DEPs were mainly enriched in the PPAR signaling pathway, retinol metabolism, glycine, serine, and threonine metabolism, fatty acid elongation, biosynthesis of unsaturated fatty acids, glutathione metabolism, and steroid hormone biosynthesis. GO analysis revealed that DEPs predominantly participated in cellular, biological regulation, multicellular organismal, localization, signaling, multi-organism, and immune system processes. Protein-protein interaction (PPI) implied diverse clusters of the DEPs. Besides, the paralleled changes of the common upregulated and downregulated DEPs existed in both the liver and serum were validated in the mRNA expression of NRP1, MUP3, SERPINA1E, ALPL, and ALDOB as observed in our proteomic screening. Methods: We conducted hepatic and serum proteomic analysis based on the leptin-receptor-deficient mouse (db/db), a well-established diabetic mouse model with overt obesity and NAFLD. The results show differentially expressed proteins (DEPs) in hepatic and serum proteomic analysis. A parallel reaction monitor (PRM) confirmed the authenticity of the selected DEPs. Conclusion: These results are supposed to offer sensitive non-invasive serum biomarkers for diabetes and NAFLD. Full article
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16 pages, 3767 KiB  
Article
Cisplatin-Resistant CD44+ Lung Cancer Cells Are Sensitive to Auger Electrons
by Karina Lindbøg Madsen, Oke Gerke, Poul F. Høilund-Carlsen and Birgitte Brinkmann Olsen
Int. J. Mol. Sci. 2022, 23(13), 7131; https://doi.org/10.3390/ijms23137131 - 27 Jun 2022
Cited by 3 | Viewed by 1609
Abstract
Cancer stem cells (CSCs) are resistant to conventional therapy and present a major clinical challenge since they are responsible for the relapse of many cancers, including non-small cell lung cancer (NSCLC). Hence, future successful therapy should also eradicate CSCs. Auger electrons have demonstrated [...] Read more.
Cancer stem cells (CSCs) are resistant to conventional therapy and present a major clinical challenge since they are responsible for the relapse of many cancers, including non-small cell lung cancer (NSCLC). Hence, future successful therapy should also eradicate CSCs. Auger electrons have demonstrated promising therapeutic potential and can induce DNA damage while sparing surrounding cells. Here, we sort primary patient-derived NSCLC cells based on their expression of the CSC-marker CD44 and investigate the effects of cisplatin and a thymidine analog (deoxyuridine) labeled with an Auger electron emitter (125I). We show that the CD44+ populations are more resistant to cisplatin than the CD44 populations. Interestingly, incubation with the thymidine analog 5-[125I]iodo-2′-deoxyuridine ([125I]I-UdR) induces equal DNA damage, G2/M cell cycle arrest, and apoptosis in the CD44 and CD44+ populations. Our results suggest that Auger electron emitters can also eradicate resistant lung cancer CD44+ populations. Full article
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21 pages, 21052 KiB  
Article
MicroRNA-16 Restores Sensitivity to Tyrosine Kinase Inhibitors and Outperforms MEK Inhibitors in KRAS-Mutated Non-Small Cell Lung Cancer
by Francesca Fanini, Erika Bandini, Meropi Plousiou, Silvia Carloni, Petra Wise, Paolo Neviani, Mariam Murtadha, Flavia Foca, Francesco Fabbri, Ivan Vannini and Muller Fabbri
Int. J. Mol. Sci. 2021, 22(24), 13357; https://doi.org/10.3390/ijms222413357 - 12 Dec 2021
Cited by 6 | Viewed by 2876
Abstract
Background: Non-small cell lung cancer (NSCLC) is the leading cause of cancer death worldwide. Chemotherapy, the treatment of choice in non-operable cases, achieves a dismal success rate, raising the need for new therapeutic options. In about 25% of NSCLC, the activating mutations of [...] Read more.
Background: Non-small cell lung cancer (NSCLC) is the leading cause of cancer death worldwide. Chemotherapy, the treatment of choice in non-operable cases, achieves a dismal success rate, raising the need for new therapeutic options. In about 25% of NSCLC, the activating mutations of the KRAS oncogene define a subclass that cannot benefit from tyrosine kinase inhibitors (TKIs). The tumor suppressor miR-16 is downregulated in many human cancers, including NSCLC. The main objectives of this study were to evaluate miR-16 treatment to restore the TKI sensitivity and compare its efficacy to MEK inhibitors in KRAS-mutated NSCLC. Methods: We performed in vitro and in vivo studies to investigate whether miR-16 could be exploited to overcome TKI resistance in KRAS-mutated NSCLC. We had three goals: first, to identify the KRAS downstream effectors targeted by mir-16, second, to study the effects of miR-16 restoration on TKI resistance in KRAS-mutated NSCLC both in vitro and in vivo, and finally, to compare miR-16 and the MEK inhibitor selumetinib in reducing KRAS-mutated NSCLC growth in vitro and in vivo. Results: We demonstrated that miR-16 directly targets the three KRAS downstream effectors MAPK3, MAP2K1, and CRAF in NSCLC, restoring the sensitivity to erlotinib in KRAS-mutated NSCLC both in vitro and in vivo. We also provided evidence that the miR-16–erlotinib regimen is more effective than the selumetinib–erlotinib combination in KRAS-mutated NSCLC. Conclusions: Our findings support the biological preclinical rationale for using miR-16 in combination with erlotinib in the treatment of NSCLC with KRAS-activating mutations. Full article
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19 pages, 1171 KiB  
Article
Possibility of Venous Serum Cl Concentration ([Cl]s) as a Marker for Human Metabolic Status: Correlation of [Cl]s to Age, Fasting Blood Sugar (FBS), and Glycated Hemoglobin (HbA1c)
by Yoshinori Marunaka, Katsumi Yagi, Noboru Imagawa, Hironori Kobayashi, Masaru Murayama, Asami Minamibata, Yoshiaki Takanashi and Takashi Nakahari
Int. J. Mol. Sci. 2021, 22(20), 11111; https://doi.org/10.3390/ijms222011111 - 15 Oct 2021
Cited by 2 | Viewed by 1625
Abstract
The HCO3 concentration in venous serum ([HCO3]s) is a factor commonly used for detecting the body pH and metabolic conditions. To exactly detect [HCO3]s, the venous CO2 pressure should be [...] Read more.
The HCO3 concentration in venous serum ([HCO3]s) is a factor commonly used for detecting the body pH and metabolic conditions. To exactly detect [HCO3]s, the venous CO2 pressure should be kept as it is in the vein. The [HCO3]s measurement is technically complicated to apply for huge numbers of almost heathy persons taking only basic medical examinations. The summation of [HCO3]s and the venous serum Cl concentration ([Cl]s) is approximately constant; therefore, we studied if [Cl]s could be a marker detecting metabolic conditions instead of [HCO3]s. Venous blood was obtained from persons taking basic medical examinations (the number of persons = 107,630). Older persons showed higher values of [Cl]s, fasting blood sugar (FBS), and glycated hemoglobin (HbA1c) than younger ones. [Cl]s showed positive correlation to age and negative correlation to FBS and HBA1c. The negative correlation of [Cl]s to FBS/HbA1c was obvious in persons with high FBS/HbA1c, leading us to an idea that persons with high FBS/HbA1c show high [HCO3]s, which might be caused by low activity of carbonic anhydrase in the lung observed in persons with diabetes mellitus under acidotic conditions. Taken together, an easily measured serum electrolyte, [Cl]s, could be a useful marker estimating metabolic conditions. Full article
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17 pages, 3956 KiB  
Article
Nanovesicles from Organic Agriculture-Derived Fruits and Vegetables: Characterization and Functional Antioxidant Content
by Mariantonia Logozzi, Rossella Di Raimo, Davide Mizzoni and Stefano Fais
Int. J. Mol. Sci. 2021, 22(15), 8170; https://doi.org/10.3390/ijms22158170 - 29 Jul 2021
Cited by 28 | Viewed by 3237
Abstract
Dietary consumption of fruits and vegetables is related to a risk reduction in a series of leading human diseases, probably due to the plants’ antioxidant content. Plant-derived nanovesicles (PDNVs) have been recently receiving great attention regarding their natural ability to deliver several active [...] Read more.
Dietary consumption of fruits and vegetables is related to a risk reduction in a series of leading human diseases, probably due to the plants’ antioxidant content. Plant-derived nanovesicles (PDNVs) have been recently receiving great attention regarding their natural ability to deliver several active biomolecules and antioxidants. To investigate the presence of active antioxidants in fruits, we preliminarily analyzed the differences between nanovesicles from either organic or conventional agriculture-derived fruits, at equal volumes, showing a higher yield of nanovesicles with a smaller size from organic agriculture-derived fruits as compared to conventional ones. PDNVs from organic agriculture also showed a higher antioxidant level compared to nanovesicles from conventional agriculture. Using the PDNVs from fruit mixes, we found comparable levels of Total Antioxidant Capacity, Ascorbic Acid, Catalase, Glutathione and Superoxide Dismutase 1. Finally, we exposed the nanovesicle mixes to either chemical or physical lytic treatments, with no evidence of effects on the number, size and antioxidant capacity of the treated nanovesicles, thus showing a marked resistance of PDNVs to external stimuli and a high capability to preserve their content. Our study provides for the first time a series of data supporting the use of plant-derived nanovesicles in human beings’ daily supplementation, for both prevention and treatment of human diseases. Full article
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Review

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23 pages, 808 KiB  
Review
Senolytic Therapy: A Potential Approach for the Elimination of Oncogene-Induced Senescent HPV-Positive Cells
by Tareq Saleh, Ashraf I. Khasawneh, Nisreen Himsawi, Jumana Abu-Raideh, Vera Ejeilat, Ahmed M. Elshazly and David A. Gewirtz
Int. J. Mol. Sci. 2022, 23(24), 15512; https://doi.org/10.3390/ijms232415512 - 8 Dec 2022
Cited by 7 | Viewed by 2603
Abstract
Senescence represents a unique cellular stress response characterized by a stable growth arrest, macromolecular alterations, and wide spectrum changes in gene expression. Classically, senescence is the end-product of progressive telomeric attrition resulting from the repetitive division of somatic cells. In addition, senescent cells [...] Read more.
Senescence represents a unique cellular stress response characterized by a stable growth arrest, macromolecular alterations, and wide spectrum changes in gene expression. Classically, senescence is the end-product of progressive telomeric attrition resulting from the repetitive division of somatic cells. In addition, senescent cells accumulate in premalignant lesions, in part, as a product of oncogene hyperactivation, reflecting one element of the tumor suppressive function of senescence. Oncogenic processes that induce senescence include overexpression/hyperactivation of H-Ras, B-Raf, and cyclin E as well as inactivation of PTEN. Oncogenic viruses, such as Human Papilloma Virus (HPV), have also been shown to induce senescence. High-risk strains of HPV drive the immortalization, and hence transformation, of cervical epithelial cells via several mechanisms, but primarily via deregulation of the cell cycle, and possibly, by facilitating escape from senescence. Despite the wide and successful utilization of HPV vaccines in reducing the incidence of cervical cancer, this measure is not effective in preventing cancer development in individuals already positive for HPV. Accordingly, in this commentary, we focus on the potential contribution of oncogene and HPV-induced senescence (OIS) in cervical cancer. We further consider the potential utility of senolytic agents for the elimination of HPV-harboring senescent cells as a strategy for reducing HPV-driven transformation and the risk of cervical cancer development. Full article
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13 pages, 1962 KiB  
Review
Label-Free Enrichment of Circulating Tumor Plasma Cells: Future Potential Applications of Dielectrophoresis in Multiple Myeloma
by Nicolò Musso, Alessandra Romano, Paolo Giuseppe Bonacci, Grazia Scandura, Clarissa Pandino, Massimo Camarda, Giorgio Ivan Russo, Francesco Di Raimondo, Emma Cacciola and Rossella Cacciola
Int. J. Mol. Sci. 2022, 23(19), 12052; https://doi.org/10.3390/ijms231912052 - 10 Oct 2022
Cited by 3 | Viewed by 2110
Abstract
In multiple myeloma (MM), circulating tumor plasma cells (CTPCs) are an emerging prognostic factor, offering a promising and minimally invasive means for longitudinal patient monitoring. Recent advances highlight the complex biology of plasma cell trafficking, highlighting the phenotypic and genetic signatures of intra- [...] Read more.
In multiple myeloma (MM), circulating tumor plasma cells (CTPCs) are an emerging prognostic factor, offering a promising and minimally invasive means for longitudinal patient monitoring. Recent advances highlight the complex biology of plasma cell trafficking, highlighting the phenotypic and genetic signatures of intra- and extra-medullary MM onset, making CTPC enumeration and characterization a new frontier of precision medicine for MM patients, requiring novel technological platforms for their standardized and harmonized detection. Dielectrophoresis (DEP) is an emerging label-free cell manipulation technique to separate cancer cells from healthy cells in peripheral blood samples, based on phenotype and membrane capacitance that could be successfully tested to enumerate and isolate CTPCs. Herein, we summarize preclinical data on DEP development for CTPC detection, as well as their clinical and research potential. Full article
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27 pages, 2171 KiB  
Review
LAG-3 as a Potent Target for Novel Anticancer Therapies of a Wide Range of Tumors
by Natalia Sauer, Wojciech Szlasa, Laura Jonderko, Małgorzata Oślizło, Dominika Kunachowicz, Julita Kulbacka and Katarzyna Karłowicz-Bodalska
Int. J. Mol. Sci. 2022, 23(17), 9958; https://doi.org/10.3390/ijms23179958 - 1 Sep 2022
Cited by 21 | Viewed by 5620
Abstract
LAG-3 (Lymphocyte activation gene 3) protein is a checkpoint receptor that interacts with LSEC-tin, Galectin-3 and FGL1. This interaction leads to reduced production of IL-2 and IFN-γ. LAG-3 is widely expressed in different tumor types and modulates the tumor microenvironment through immunosuppressive effects. [...] Read more.
LAG-3 (Lymphocyte activation gene 3) protein is a checkpoint receptor that interacts with LSEC-tin, Galectin-3 and FGL1. This interaction leads to reduced production of IL-2 and IFN-γ. LAG-3 is widely expressed in different tumor types and modulates the tumor microenvironment through immunosuppressive effects. Differential expression in various tumor types influences patient prognosis, which is often associated with coexpression with immune checkpoint inhibitors, such as TIM-3, PD-1 and CTLA-4. Here, we discuss expression profiles in different tumor types. To date, many clinical trials have been conducted using LAG-3 inhibitors, which can be divided into anti-LAG-3 monoclonal antibodies, anti-LAG-3 bispecifics and soluble LAG-3-Ig fusion proteins. LAG-3 inhibitors supress T-cell proliferation and activation by disallowing for the interaction between LAG-3 to MHC-II. The process enhances anti-tumor immune response. In this paper, we will review the current state of knowledge on the structure, function and expression of LAG-3 in various types of cancer, as well as its correlation with overall prognosis, involvement in cell-based therapies and experimental medicine. We will consider the role of compounds targeting LAG-3 in clinical trials both as monotherapy and in combination, which will provide data relating to the efficacy and safety of proposed drug candidates. Full article
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36 pages, 3864 KiB  
Review
Enterohemorrhagic Escherichia coli and a Fresh View on Shiga Toxin-Binding Glycosphingolipids of Primary Human Kidney and Colon Epithelial Cells and Their Toxin Susceptibility
by Johanna Detzner, Gottfried Pohlentz and Johannes Müthing
Int. J. Mol. Sci. 2022, 23(13), 6884; https://doi.org/10.3390/ijms23136884 - 21 Jun 2022
Cited by 7 | Viewed by 2423
Abstract
Enterohemorrhagic Escherichia coli (EHEC) are the human pathogenic subset of Shiga toxin (Stx)-producing E. coli (STEC). EHEC are responsible for severe colon infections associated with life-threatening extraintestinal complications such as the hemolytic-uremic syndrome (HUS) and neurological disturbances. Endothelial cells in various human organs [...] Read more.
Enterohemorrhagic Escherichia coli (EHEC) are the human pathogenic subset of Shiga toxin (Stx)-producing E. coli (STEC). EHEC are responsible for severe colon infections associated with life-threatening extraintestinal complications such as the hemolytic-uremic syndrome (HUS) and neurological disturbances. Endothelial cells in various human organs are renowned targets of Stx, whereas the role of epithelial cells of colon and kidneys in the infection process has been and is still a matter of debate. This review shortly addresses the clinical impact of EHEC infections, novel aspects of vesicular package of Stx in the intestine and the blood stream as well as Stx-mediated extraintestinal complications and therapeutic options. Here follows a compilation of the Stx-binding glycosphingolipids (GSLs), globotriaosylceramide (Gb3Cer) and globotetraosylceramide (Gb4Cer) and their various lipoforms present in primary human kidney and colon epithelial cells and their distribution in lipid raft-analog membrane preparations. The last issues are the high and extremely low susceptibility of primary renal and colonic epithelial cells, respectively, suggesting a large resilience of the intestinal epithelium against the human-pathogenic Stx1a- and Stx2a-subtypes due to the low content of the high-affinity Stx-receptor Gb3Cer in colon epithelial cells. The review closes with a brief outlook on future challenges of Stx research. Full article
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21 pages, 1292 KiB  
Review
Targeting Cell Cycle Progression in HER2+ Breast Cancer: An Emerging Treatment Opportunity
by Nischal Koirala, Nandini Dey, Jennifer Aske and Pradip De
Int. J. Mol. Sci. 2022, 23(12), 6547; https://doi.org/10.3390/ijms23126547 - 11 Jun 2022
Cited by 12 | Viewed by 3107
Abstract
The development of HER2-targeted therapies has dramatically improved patient survival and patient management and increased the quality of life in the HER2+ breast cancer patient population. Due to the activation of compensatory pathways, patients eventually suffer from resistance to HER2-directed therapies and develop [...] Read more.
The development of HER2-targeted therapies has dramatically improved patient survival and patient management and increased the quality of life in the HER2+ breast cancer patient population. Due to the activation of compensatory pathways, patients eventually suffer from resistance to HER2-directed therapies and develop a more aggressive disease phenotype. One of these mechanisms is the crosstalk between ER and HER2 signaling, especially the CDK4/6-Cyclin D-Rb signaling axis that is commonly active and has received attention for its potential role in regulating tumor progression. CDK 4/6 inhibitors interfere with the binding of cell-cycle-dependent kinases (CDKs) with their cognate partner cyclins, and forestall the progression of the cell cycle by preventing Rb phosphorylation and E2F release that consequentially leads to cancer cell senescence. CDK 4/6 inhibitors, namely, palbociclib, ribociclib, and abemaciclib, in combination with anti-estrogen therapies, have shown impressive outcomes in hormonal receptor-positive (HR+) disease and have received approval for this disease context. As an extension of this concept, preclinical/clinical studies incorporating CDK 4/6 inhibitors with HER2-targeted drugs have been evaluated and have shown potency in limiting tumor progression, restoring therapeutic sensitivity, and may improving the management of the disease. Currently, several clinical trials are examining the synergistic effects of CDK 4/6 inhibitors with optimized HER2-directed therapies for the (ER+/-) HER2+ population in the metastatic setting. In this review, we aim to interrogate the burden of HER2+ disease in light of recent treatment progress in the field and examine the clinical benefit of CDK 4/6 inhibitors as a replacement for traditional chemotherapy to improve outcomes in HER2+ breast cancer. Full article
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15 pages, 1476 KiB  
Review
Next-Generation Probiotics for Inflammatory Bowel Disease
by Marcella Pesce, Luisa Seguella, Alessandro Del Re, Jie Lu, Irene Palenca, Chiara Corpetti, Sara Rurgo, Walter Sanseverino, Giovanni Sarnelli and Giuseppe Esposito
Int. J. Mol. Sci. 2022, 23(10), 5466; https://doi.org/10.3390/ijms23105466 - 13 May 2022
Cited by 10 | Viewed by 5587
Abstract
Engineered probiotics represent a cutting-edge therapy in intestinal inflammatory disease (IBD). Genetically modified bacteria have provided a new strategy to release therapeutically operative molecules in the intestine and have grown into promising new therapies for IBD. Current IBD treatments, such as corticosteroids and [...] Read more.
Engineered probiotics represent a cutting-edge therapy in intestinal inflammatory disease (IBD). Genetically modified bacteria have provided a new strategy to release therapeutically operative molecules in the intestine and have grown into promising new therapies for IBD. Current IBD treatments, such as corticosteroids and immunosuppressants, are associated with relevant side effects and a significant proportion of patients are dependent on these therapies, thus exposing them to the risk of relevant long-term side effects. Discovering new and effective therapeutic strategies is a worldwide goal in this research field and engineered probiotics could potentially provide a viable solution. This review aims at describing the proceeding of bacterial engineering and how genetically modified probiotics may represent a promising new biotechnological approach in IBD treatment. Full article
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13 pages, 536 KiB  
Review
The Potentiality of Plant-Derived Nanovesicles in Human Health—A Comparison with Human Exosomes and Artificial Nanoparticles
by Mariantonia Logozzi, Rossella Di Raimo, Davide Mizzoni and Stefano Fais
Int. J. Mol. Sci. 2022, 23(9), 4919; https://doi.org/10.3390/ijms23094919 - 28 Apr 2022
Cited by 26 | Viewed by 4516
Abstract
Research in science and medicine is witnessing a massive increases in literature concerning extracellular vesicles (EVs). From a morphological point of view, EVs include extracellular vesicles of a micro and nano sizes. However, this simplistic classification does not consider both the source of [...] Read more.
Research in science and medicine is witnessing a massive increases in literature concerning extracellular vesicles (EVs). From a morphological point of view, EVs include extracellular vesicles of a micro and nano sizes. However, this simplistic classification does not consider both the source of EVs, including the cells and the species from which Evs are obtained, and the microenvironmental condition during EV production. These two factors are of crucial importance for the potential use of Evs as therapeutic agents. In fact, the choice of the most suitable Evs for drug delivery remains an open debate, inasmuch as the use of Evs of human origin may have at least two major problems: (i) autologous Evs from a patient may deliver dangerous molecules; and (ii) the production of EVs is also limited to cell factory conditions for large-scale industrial use. Recent literature, while limited to only a few papers, when compared to the papers on the use of human EVs, suggests that plant-derived nanovesicles (PDNV) may represent a valuable tool for extensive use in health care. Full article
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Other

12 pages, 305 KiB  
Perspective
Metabolic Shifts as the Hallmark of Most Common Diseases: The Quest for the Underlying Unity
by Laurent Schwartz, Marc Henry, Khalid O. Alfarouk, Stephan J. Reshkin and Miroslav Radman
Int. J. Mol. Sci. 2021, 22(8), 3972; https://doi.org/10.3390/ijms22083972 - 12 Apr 2021
Cited by 7 | Viewed by 2616
Abstract
A hyper-specialization characterizes modern medicine with the consequence of classifying the various diseases of the body into unrelated categories. Such a broad diversification of medicine goes in the opposite direction of physics, which eagerly looks for unification. We argue that unification should also [...] Read more.
A hyper-specialization characterizes modern medicine with the consequence of classifying the various diseases of the body into unrelated categories. Such a broad diversification of medicine goes in the opposite direction of physics, which eagerly looks for unification. We argue that unification should also apply to medicine. In accordance with the second principle of thermodynamics, the cell must release its entropy either in the form of heat (catabolism) or biomass (anabolism). There is a decreased flow of entropy outside the body due to an age-related reduction in mitochondrial entropy yield resulting in increased release of entropy in the form of biomass. This shift toward anabolism has been known in oncology as Warburg-effect. The shift toward anabolism has been reported in most diseases. This quest for a single framework is reinforced by the fact that inflammation (also called the immune response) is involved in nearly every disease. This strongly suggests that despite their apparent disparity, there is an underlying unity in the diseases. This also offers guidelines for the repurposing of old drugs. Full article
23 pages, 3383 KiB  
Hypothesis
Targeting the Stromal Pro-Tumoral Hyaluronan-CD44 Pathway in Pancreatic Cancer
by Tomas Koltai, Stephan Joel Reshkin, Tiago M. A. Carvalho and Rosa A. Cardone
Int. J. Mol. Sci. 2021, 22(8), 3953; https://doi.org/10.3390/ijms22083953 - 12 Apr 2021
Cited by 10 | Viewed by 4086
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest malignancies. Present-day treatments have not shown real improvements in reducing the high mortality rate and the short survival of the disease. The average survival is less than 5% after 5 years. New innovative treatments [...] Read more.
Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest malignancies. Present-day treatments have not shown real improvements in reducing the high mortality rate and the short survival of the disease. The average survival is less than 5% after 5 years. New innovative treatments are necessary to curtail the situation. The very dense pancreatic cancer stroma is a barrier that impedes the access of chemotherapeutic drugs and at the same time establishes a pro-proliferative symbiosis with the tumor, thus targeting the stroma has been suggested by many authors. No ideal drug or drug combination for this targeting has been found as yet. With this goal in mind, here we have explored a different complementary treatment based on abundant previous publications on repurposed drugs. The cell surface protein CD44 is the main receptor for hyaluronan binding. Many malignant tumors show over-expression/over-activity of both. This is particularly significant in pancreatic cancer. The independent inhibition of hyaluronan-producing cells, hyaluronan synthesis, and/or CD44 expression, has been found to decrease the tumor cell’s proliferation, motility, invasion, and metastatic abilities. Targeting the hyaluronan-CD44 pathway seems to have been bypassed by conventional mainstream oncological practice. There are existing drugs that decrease the activity/expression of hyaluronan and CD44: 4-methylumbelliferone and bromelain respectively. Some drugs inhibit hyaluronan-producing cells such as pirfenidone. The association of these three drugs has never been tested either in the laboratory or in the clinical setting. We present a hypothesis, sustained by hard experimental evidence, suggesting that the simultaneous use of these nontoxic drugs can achieve synergistic or added effects in reducing invasion and metastatic potential, in PDAC. A non-toxic, low-cost scheme for inhibiting this pathway may offer an additional weapon for treating pancreatic cancer. Full article
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