[Bone Metabolism of Multiple Myeloma Bone Disease Patients with Different Blood Separation Results].

OBJECTIVE: To investigate the clinical significance of bone metabolic indexes for disease assessment and curative effect monitoring in multiple myeloma (MM) bone disease (MBD) patients with different blood separation results. METHODS: A total of 134 newly diagnosed MM patients treated in Cangzhou Hospital of Integrated TCM-WM-Hebei were enrolled and divided into control group [119 cases, serum, colloid and red blood cell (RBC) from top to bottom of sample] and abnormal group (15 cases, serum, mixed layer of RBC and serum, colloid and RBC from top to bottom of sample) according to the results of blood separation. According to the imaging findings, MBD was classified into grade 0-4, grade 0-2 was mild, and grade 3-4 was severe. The MBD grade of patients in the two groups was analyzed. The curative effect of MBD patients after chemotherapy and the changes of blood separation results and bone metabolic indexes before and after treatment were evaluated. The correlation between ß2-microglobulin (MG) and bone metabolic indexes was analyzed by Pearson correlation analysis. RESULTS: In the control group, there were 69 cases of grade 0-2 and 50 cases of grade 3-4, while in the abnormal group, there were 5 cases of grade 0-2 and 10 cases of grade 3-4, the difference was statistically significant (P < 0.05). The serum ß2-MG, ß-CTX levels in abnormal group were both significantly higher than those in control group, while the levels of P1NP and osteocalcin (OC) were significantly lower (all P < 0.001). In the control group, there were 95 patients with ≥ partial response (PR) and the blood separation results were not changed, while 24 patients with 0.05). Compared with before treatment, the levels of ß-CTX and ß2-MG in the control group with unchanged blood separation results were significantly decreased (both P < 0.001), while the levels of P1NP and OC were significantly increased (P < 0.01, P < 0.001), and the level of each index in the patients transformed to abnormal blood separation result after treatment did not significantly change (P >0.05); the levels of ß-CTX and ß2-MG in the abnormal group transformed to normal blood separation result were significantly decreased (both P < 0.01), while the levels of P1NP and OC were significantly increased (P < 0.001, P < 0.01), and the level of each index in patients with unchanged blood separation results did not significantly change (P>0.05). Pearson correlation analysis showed that serum ß2-MG was positively correlated with ß-CTX (r =0.709, P < 0.001), and negatively correlated with P1NP and OC (r =-0.410,r =-0.412, both P < 0.001). CONCLUSION: MBD patients with abnormal blood separation results have higher bone disease grade and poor prognosis, which is closely related to the significant increase of bone resorption index ß-CTX level and decrease of bone formation index P1NP and OC levels, leading to more serious bone metabolic homeostasis disorder. The results of blood separation combined with the changes of bone metabolic indexes can be used as one of the comprehensive predictors of disease condition, efficacy monitoring and prognosis evaluation of MBD patients.

[Evolution Characteristics and Clinical Significance of Blood Separation in Patients with Multiple Myeloma].

OBJECTIVE: To investigate the evolution of blood separation results by gel extraction of multiple myeloma (MM) patients, and to evaluate the clinical value of abnormal blood separation results for the evaluation of disease and prognosis. METHODS: The clinical data of 5 patients diagnosed newly MM patients with abnormal blood separation of gel collection vessels in our hospital were retrospectively analyzed, and the changes of blood separation results and blood index levels were followed up with the improvement of treatment effect, and the correlation of different blood index levels was analyzed. RESULTS: In 5 patients with newly diagnosed MM, the blood separation result showed floating phenomenon after centrifugation, which divided into three layers and the order from top to bottom is separator gel, serum, and red blood cells(RBC). With partial remission of clinical symptoms, the blood separation results were still abnormal, which were divided into three layers from top to bottom: serum, RBC and separator gel. Finally, with complete remission of the disease, blood separation results returned to normal, from top to bottom: serum, separator gel, RBC. With the blood separation results from abnormal to normal, the blood routine indicators: Hb, Hct levels gradually increased, neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR) gradually decreased; biochemical indexes: TP, GLB, Ig and ß2-MG levels gradually decreased. Tumor load related indicators: serum IL-6, TNF-α, IL-17 levels gradually decreased, and IL-35 levels gradually increased; and the differences were statistically significant (P<0.05). Pearson correlation analysis showed that serum ß2-MG was positively correlated with IL-6, TNF-α and IL-17 levels (r=0.710, 0.756, 0.581, P<0.05), and negatively correlated with IL-35 level (r=-0565, P<0.05). CONCLUSION: Abnormal blood separation exists in MM patients, and there are significant differences in blood, tumor load and immune balance related indexes in patients with different blood separation results, which provides partial experimental basis for evaluation of disease, efficacy and prognosis with different blood separation results.

[Expression and Clinical Significance of IL-6, IL-10, TNF-α and ß2-MG in Multiple Myeloma Patients with Different Results of Blood Separation].

OBJECTIVE: To investigate the expression level and the clinical significance of serum interleukin-6(IL-6) , IL-10, tumor necrosis factor α(TNF-α) and ß2-microglobulin(ß2-MG) in multiple myeloma(MM) patients with different blood separation results. METHODS: The clinical data of 124 newly diagnosed MM patients (76 cases of IgG type, 48 cases of IgA type) treated in our hospital from October 2015 to October 2019 were enrolled and analyzed. The blood samples were divided into control group (the order from top to bottom is serum, separator gel and red blood cells) and abnormal group (the order from top to bottom is serum, red blood cells, separator gel and red blood cells) according to the blood separation result. The differences of expression level in serum IL-6, IL-10, TNF-α and ß2-MG were compared between the two groups, and the changes of blood separation result and different indexes were analyzed after treatment. RESULTS: Abnormal separation results were found in 21 cases (16.94%), including 13 cases of IgG type and 8 cases of IgA type. The levels of serum IL-6, IL-10, TNF-α and ß2-MG in abnormal group were significantly higher than those in control group (P<0.05) . After treatment, 85 patients in control group (103 cases) achieved complete remission (CR) or very good partial remission (VGPR) and partial remission(PR). The results of blood separation showed no change. 18 patients achieved less than PR, and the separation result in 5 patients changed from normal to abnormal separation. The blood separation of 9 patients with CR and VGPR in abnormal group (21 cases) were changed from abnormal to normal. 8 patients achieved PR, and the separation result in 6 patients were changed from abnormal to normal and 2 cases showed no change, while the blood separation showed no changes in 4 cases MM patients who achieved less than PR in abnormal group. The expression levels of IL-6, IL-10, TNF-α and ß2-MG of patients in control group transformed to abnormal blood separation result after treatment showed significantly higher than those before treatment (P<0.05) , and the levels of IL-6 and ß2-MG were significantly lower in the patients with out change in blood separation results than those before treatment (P<0.05). The serum levels of IL-6, IL-10, TNF-α and ß2-MG of patients in abnormal group transformed to normal blood separation after treatment were significantly lower than those before treatment (P<0.05), and the serum levels of IL-6, IL-10, TNF-α and ß2-MG in abnormal group with no changes in blood separation results showed not significantly different from those before treatment (P>0.05). CONCLUSION: Abnormal separation phenomenon can be found after centrifugation in patients with multiple myeloma. The expression levels of serum IL-6, IL-10, TNF-α and ß2-MG in MM patients with different blood separation results are different, which suggesting different degrees of tumor burden. The changes of blood separation result and levels of IL-6, IL-10, TNF-α and ß2-MG after treatment can predict the therapeutic effect, and also provide the experimental basis for the evaluation of disease condition and prognosis of patients with different blood separation results.

Genomewide DNA Methylation Responses in Patients with ß-Thalassemia Treated with Yisui Shengxue Granules ().

OBJECTIVE: To examine the clinical effects of Yisui Shengxue Granules () in the treatment of ß-thalassemia and explore its mechanism on DNA methylation levels. METHODS: A randomized placebo-controlled double-blinded trial was conducted. Forty patients with ß-thalassemia were recruited and distributed randomly by envelope method into an experimental group and a control group, 20 patients in each group. The patients were given Yisui Shengxue Granules in the experimental group and placebo in the control group (12 g/bag three times a day) during a 3-month intervention. Before and after 1, 2, and 3 months of treatment, peripheral intravenous blood was sampled, and blood parameters such as hemoglobin (Hb), red blood cells (RBCs), reticulocytes (Ret), and fetal hemoglobin (HbF) were analyzed. Mononuclear cells from 5 patients, who showed an obvious treatment effect, were isolated by density gradient centrifugation. DNA methylation was analyzed using an Affymetrix USA GeneChip Human Promoter 1.0 Array and Input-promoter 1.0. RESULTS: Compared with pre-treatment, there was an obvious increase in Hb and RBCs counts after 1, 2, and 3 months in the experiment group (P<0.01 or P<0.05). Meanwhile, HbF increased from the 2nd to the 3rd month (P<0.05). In the control group, Hb and RBCs showed no obvioas change. After 3-month treatment, DNA methylation results from 5 patients revealed that there were 24 hypomethylated genes and 3,685 hypermethylated genes compared with pre-treatment. Genes of insulin-like growth factor 1 receptor (IGF1R) and Janus kinase 3 (JAK3) revealed the most relations with other genes (degree: 21) and genes of 1-phosphatidylinositol-4, 5-bisphosphate phosphodiesterase gamma 2 (PLCG2) and mitogen-activated protein kinase 10 (MAPK10) showed a stronger intermediary role (betweenness centrality=0.04). CONCLUSIONS: JAK3 and MAPK10 are two key genes in bone marrow and the lymphatic system, and JAK3 is likely to be related to hematopoietic cytokines in the process of early hematopoiesis. (Registration No. NCT01549080).

Molecular mechanism of yisui shengxue granule, a complex chinese medicine, on thalassemia patients suffering from hemolysis and anemia of erythrocytes.

The objective of this study was to investigate the therapeutic biological mechanism of Yisui Shengxue Granule (YSSXG), a complex Chinese medicine, on the hemolysis and anemia of erythrocytes from patient with thalassemia disease. Sixteen patients with thalassemia (8 cases of α-thalassemia and 8 cases of ß-thalassemia) disease were collected and treated with YSSXG for 3 months. The improvements of blood parameter demonstrated that YSSXG had a positive clinical effect on patients with thalassemia disease. For patients with α-thalassemia disease, RT-PCR showed that YSSXG upregulated the relative mRNA expression level of α-globin to ß-globin and downregulated DNMT1, DNMT3a, and DNMT3b mRNA compared with pretreatment. Western blotting showed that YSSXG downregulated the expression of DNMT1 and DNMT3a. For patients with ß-thalassemia disease, the relative expression level of (A) γ-globin to α-globin had an increasing trend and the level of BCL11A mRNA expression obviously increased. For all patients, RT-PCR showed that YSSXG upregulated mRNA expression of SPTA1 and SPTB. Activities of SOD and GSH-Px significantly increased and MDA obviously reduced on erythrocyte and blood serum after YSSXG treatment. TEM showed that YSSXG decreased the content of inclusion bodies. Activities of Na(+)K(+)-ATPtase and T-ATPtase of erythrocyte increased significantly after YSSXG treatment. This study provides the basis for mechanisms of YSSXG on thalassemia suffering with hemolysis and anemia of erythrocytes from patient.