ABSTRACT
Background: The impact of renin-angiotensin system inhibitors (RASIs) on the outcome of hypertensive cancer patients undergoing immune checkpoint inhibitor (ICIs) therapy remains ambiguous. This investigation sought to elucidate the consequences of RASIs use on the prognosis for this specific patient group within the context of ICIs treatment, aspiring to provide a clearer basis for rational, evidence-driven choices in the clinical prescription of these medications. Methods: A comprehensive search was conducted on PubMed, Embase, Web of Science, and the Cochrane Library for original studies published up to 6 August 2023. Studies published in English reporting hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival (OS) and/or progression-free survival (PFS) were included. All statistical analyses were executed utilizing R software (version 4.2.2). Results: A total of 13 studies, encompassing approximately 12,595 patients, satisfied the inclusion criteria. Meta-analyses demonstrated a statistically significant association between the use of RASIs and a favorable outcome in OS (HR, 0.74; 95% CI, 0.62-0.88) and PFS (HR, 0.77; 95% CI, 0.62-0.96) among cancer patients receiving ICIs treatment. Conclusion: This investigation provides compelling evidence supporting the beneficial prognostic impact of RASIs on cancer patients receiving ICIs. RASIs present a viable option as antihypertensive agents for cancer patients with hypertension undergoing ICIs treatment. Further exploration and validation through prospective studies are necessary to establish definitive guidelines for the use of RASIs in managing hypertensive cancer patients undergoing immunotherapy with ICIs. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023454886.
ABSTRACT
Clear cell renal cell carcinoma (ccRCC) is the most common type of human malignancies of the urological system. Soyasapogenol B (Soy B), an ingredient of soybean, has been found to exert anti-proliferative activities in vitro in human breast cancer cells. Our current study aimed to evaluate the effectiveness of Soy B against ccRCC. The effect of Soy B on cell viability was assessed by Cell Counting Kit-8 (CCK-8) assay. The effect of Soy B on cell proliferation was determined by colony formation assay. Apoptotic percentage was determined by flow cytometry following annexin V-FITC/propidium iodide (PI) double staining. JC-1 staining was performed to examine the change in mitochondrial membrane potential. Western blotting was used to determine the level of relevant proteins. Isobaric tags for relative and absolute quantification (iTRAQ) was then performed to identify the potential targets of Soy B. Quantitative real-time PCR (qRT-PCR) was performed to determine the mRNA level of sphingosine kinase 1 (SphK1). The SphK1 expression in ccRCC tissue from patients was examined by immunohistochemistry (IHC) assay. To validate the role of SphK1 involved in the pro-apoptotic activities of Soy B, overexpressed SphK1 vectors and shRNA targeting of SphK1 were utilized to transfected ccRCC cells. Moreover, a ccRCC xenograft murine model was used to analyze the therapeutic efficacy of Soy B in vivo. Soy B incubation led to a decrease in the number of viable cells in ccRCC cell lines and primary ccRCC cells. Soy B also suppressed the proliferation of two model ccRCC cell lines. Soy B promoted apoptotic cell death in a caspase-dependent manner. Moreover, our results showed that both extrinsic and intrinsic apoptotic signaling pathways were involved in Soy B-induced apoptosis. ITRAQ analysis identified SphK1 as most profoundly altered after the treatment of Soy B in ACHN cells. The mediatory role of SphK1 was validated when the pro-apoptotic activity of Soy B was significantly blocked by SphK1 overexpression, while SphK1 knockdown sensitized the ccRCC cells to Soy B. Moreover, in vivo studies also showed that Soy B could exhibit anti-cancer activities against ccRCC. Soy B triggers apoptotic cell death in vitro and in vivo in ccRCC by down-regulating SphK1. Our results highlight the possibility of using Soy B as a chemotherapeutic agent in the prevention and treatment of ccRCC.
