1.Lysosomes as Regulators of Cancer Stemness and Drug Resistance
Fa-Xiao ZHOU ; Di-Ping YU ; Si-Qi TAN ; Hong-Yu DUAN ; Xiao-Ming WU
Progress in Biochemistry and Biophysics 2026;53(4):951-967
Cancer stem cells (CSCs) represent a distinct subpopulation of cells characterized by self-renewal capacity, differentiation potential, and critical roles in driving tumor progression, therapeutic resistance, recurrence, and maintenance of the tumor microenvironment. Targeting CSCs has emerged as a pivotal direction in cancer research, offering novel strategies to overcome drug resistance and prevent metastasis and relapse. Lysosomes, traditionally recognized as central organelles for intracellular degradation and recycling, are indispensable for cellular homeostasis. Dysregulation of lysosomal function is intimately linked to various diseases, including cancer. In tumors, aberrant lysosomal activity can promote malignant progression through mechanisms such as altering metabolic pathways, enhancing lysosomal exocytosis, modulating drug resistance, and interfering with autophagy-lysosomal pathways. Recent studies have underscored the involvement of lysosomes in regulating CSC properties. This review synthesizes findings on lysosomal regulation of CSCs through the following aspects. (1) Lysosomes exert complex and critical bidirectional control over CSC stemness maintenance through three degradation pathways that are dependent on their degradative function. (i) The lysophagy pathway. This pathway exhibits dual roles. Activation can sustain CSC functions; for instance, in glioblastoma, hypoxia upregulates Gal-8 via the STAT3/HIF1α signaling axis to induce autophagy, supporting stem cell survival. In head and neck squamous cell carcinoma, degradation of GSK3β activates the Wnt pathway, enhancing stemness. Conversely, this pathway can suppress stemness by degrading stemness-related proteins such as BMI-1 and OCT4A, thereby impairing CSC self-renewal capacity. (ii) Mitophagy pathway. In non-small cell lung cancer stem cells, mitophagy-related mechanisms, such as the accumulation of mitochondrial DNA (mtDNA) activating the TLR9-Notch1-AMPK signaling axis, have been shown to promote CSC proliferation. (iii) Autophagosome-dependent lysosomal degradation pathway. This pathway directly regulates stemness-related proteins in a bidirectional manner. Enhanced degradative function can promote CSC properties, exemplified by the degradation of NUMB to activate Notch signaling. Conversely, attenuated degradative function can also enhance stemness by stabilizing oncoproteins (e.g., protecting Frizzled-1 from degradation to sustain Wnt signaling) or preventing the degradation of tumor suppressors (e.g., inhibiting Notch degradation). (2) Constituent proteins of lysosomes, including membrane proteins and luminal acid hydrolases, participate in regulating CSC stemness. Regarding membrane proteins, LAMP2A facilitates chaperone-mediated autophagy to maintain stemness in glioblastoma and ovarian cancer. V-ATPase, by maintaining an acidic luminal environment, promotes proliferation and drug resistance in glioma stem cells. Among hydrolases, cathepsins B and L are highly expressed in pancreatic and ovarian cancers and correlate with poor prognosis. Furthermore, targeting lysosomes to induce lysosomal membrane permeabilization (LMP) triggers lysosome-mediated cell death, presenting a potential therapeutic strategy for eradicating CSCs.(3) The acidic luminal environment, single-membrane structure, and the presence of transmembrane transporters (e.g., ABCA3) enable lysosomes to passively trap or actively uptake and sequester chemotherapeutic drugs. Subsequent drug extrusion via exocytosis confers drug resistance. In CSCs, this lysosome-mediated drug sequestration, often cooperating with autophagy, establishes multimodal drug resistance. Therefore, targeting lysosomal function represents a potential strategy to overcome therapy resistance. The central role of lysosomes in regulating CSC stemness and resistance positions them as highly promising therapeutic targets. Strategies aimed at disrupting lysosomal function to selectively eliminate CSCs include: inhibiting the lysosome-autophagy system using agents like IITZ or lovastatin; inducing lysosomal membrane permeabilization (LMP) with compounds such as hexamethylene amiloride to compromise membrane stability; and disrupting the acidic luminal environment using drugs like siramesine or the K/H transport compound 2. In conclusion, lysosomes critically regulate CSC stemness maintenance and drug resistance through degradative pathways, membrane protein functions, luminal hydrolase activities, and drug sequestration mechanisms. This redefines the lysosome from a traditional “waste disposal unit” to a “signal integration center” in CSCs. The duality and context-dependency of lysosomal function in CSCs offer novel insights into the heterogeneity observed across different tumors. Targeting lysosomal vulnerabilities—such as inducing LMP, disrupting acidity, or blocking autophagic flux—provides a strategy to bypass canonical CSC resistance mechanisms and directly trigger cell death. This establishes the lysosome as a key target to overcome CSC-mediated therapy resistance, paving the way for developing diverse candidate drugs and innovative combination therapies in oncology.
2.Accumulated Effects of 24 Hours Physical Activity,Sedentary Behavior,and Sleep on Cardiorespiratory Fitness in College Students.
Yun-Feng SONG ; Chi XU ; Kai-Xin LI ; Si-Jie TAN ; Yu-Gang QI
Acta Academiae Medicinae Sinicae 2025;47(2):155-163
Objective To explore the accumulated effects of physical activity,sedentary behavior,and sleep on cardiorespiratory fitness(CRF)among college students and provide effective measures for enhancing their CRF. Methods From May to June in 2023,223 college students aged 18 to 24 years old were recruited from Tianjin University of Science and Technology for a 24 hours activity behavior survey and CRF testing.Compositional analysis was employed to investigate the relationships of physical activity,sedentary behavior,and sleep with CRF.Isotemporal substitution models were established to predict the effects of substituting various activity behaviors on CRF.Results The proportion of time spent on moderate-to-vigorous physical activity(MVPA)was positively correlated with CRF of college students(β=6.40,P=0.002),while the proportion of time spent on sedentary behavior was negatively correlated with CRF(β=-3.02,P=0.004).Light physical activity(LPA)and sleep were not correlated with CRF(β=-1.06,P=0.504).Isotemporal substitution results for 15-min increments showed that replacing other activity behaviors with MVPA significantly increased the CRF of college students[SB:1.72 mL/(kg·min),95% CI=0.94-2.51;LPA:1.82 mL/(kg·min),95% CI=0.95-2.68;sleep:1.64 mL/(kg·min),95% CI=0.84-2.45].In the dose-response relationship from -30 min to 30 min,reallocating time from other behaviors to MVPA had greater adverse effect on CRF than reallocating time from MVPA to other behaviors.Among all the substitutions,replacing LPA with MVPA had the most beneficial effect on improving CRF.Additionally,a 5-min increment was considered the optimal tipping point for MVPA replacing other activities.Conclusions This study underscores the importance of participating in MVPA for improving the CRF of college students.The isotemporal substitution model provides clear goals for the allocation of time for these behaviors,aiding in future intervention measure development and policy-making.
Humans
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Sedentary Behavior
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Sleep
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Students
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Cardiorespiratory Fitness
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Exercise
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Young Adult
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Adolescent
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Universities
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Male
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Female
3.Effects of Compositional Isotemporal Substitutions of 24 Hours Activity Behaviors on Novel Obesity Indicators in College Students.
Yun-Feng SONG ; Chi XU ; Si-Jie TAN ; Yu-Gang QI
Acta Academiae Medicinae Sinicae 2025;47(2):164-174
Objective To explore the effects of time reallocation among moderate-to-vigorous physical activity(MVPA),light physical activity(LPA),sedentary behavior(SB),and sleep on a body shape index(ABSI),body roundness index(BRI),conicity index(CI),and relative fat mass(RFM)of college students by the compositional isotemporal substitution method,thus providing measures for alleviating the obesity problem of college students. Methods Two hundred and ten college students(111 males and 99 females)aged 18-22 years old were recruited from Tianjin University of Science and Technology from April to June in 2023.Three-dimensional acceleration sensors were used to collect data of MVPA,LPA,SB,and sleep of college students.The body height,body weight,and waist circumference were measured,and four novel obesity indicators(ABSI,BRI,CI,and RFM)were calculated.The effects of substituting each activity behavior for 15 min on the obesity indicators were predicted,and the dose-effect relationship was explored at intervals of 5 min from -30 to 30 min.Results MVPA was negatively correlated with ABSI(β=-0.03,P=0.001),BRI(β=-0.27,P=0.049),CI(β=-0.10,P=0.001),and RFM(β=-9.95,P=0.004).LPA was negatively correlated with CI(β=-0.05,P=0.011)and RFM(β=-8.74,P=0.007).Neither SB nor sleep had correlations with ABSI,BRI,CI,and RFM.The results of 15 min isotemporal substitutions showed that increasing the MVPA time decreased the ABSI,BRI,CI,and RFM by 0.006-0.008,0.306-0.393,0.162-0.205,and 2.468-2.897,respectively.Decreasing the MVPA time increased the ABSI,BRI,CI,and RFM by 0.012-0.014,0.548-0.632,0.286-0.328,and 4.358-4.748,respectively.In the dose-effect relationship from -30 min to 30 min,MVPA was irreplaceable,and the negative benefits from substituting MVPA for other activity behaviors were much greater than the positive benefits from substituting MVPA for other activity behaviors.Conclusions Future research should take 24 hours activity behaviors as a whole.Increasing the time spent on MVPA and LPA and decreasing the time spent on SB is one of the effective ways to alleviate the obesity problem among college students.
Humans
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Male
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Students
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Female
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Young Adult
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Obesity
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Sleep
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Adolescent
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Exercise
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Universities
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Sedentary Behavior
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Body Mass Index
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Body Weight
4.Establishment of amachine learning-based precision recruitment method at the county level
Xiaoyan FU ; Zihan ZHANG ; Fang ZHAO ; Chunlan ZHOU ; Wenbiao LIANG ; Cheng YU ; Yingzhi YAN ; Wei SI ; Weibin TAN ; Hui XUE
Chinese Journal of Blood Transfusion 2025;38(12):1752-1758
Objective: To establish a machine learning-based precision blood donor recruitment model at the county level and assess its generalizability and applicability. Methods: A retrospective study was conducted using blood donation and SMS recruitment data from the Taicang Branch of the Suzhou Blood Center between 2019 and 2024. Multiple machine learning algorithms were employed, including extreme gradient boosting, support vector machine, k-nearest neighbor, logistic regression, decision tree, random forest, and multilayer perceptron. These were combined with techniques such as synthetic minority oversampling, undersampling, and cost-sensitive learning (using MFE and MSFE loss functions). Model parameters were optimized through grid search to identify the best-performing model. Results: In a prospective comparative study against conventional methods, the machine learning models increased the recruitment success rate among high-willingness donors by an average of 129.15%, and the recruitment efficiency per SMS improved by 125.02% compared with the traditional method. Under full-scale SMS sending, the recruitment rate per SMS increased by 42.61%, and SMS sending efficiency improved by 31.77%, significantly enhancing recruitment performance. Conclusion: This study represents the first application of a machine learning-based precision donor recruitment model at the county-level in China. The precise recruitment framework not only improves recruitment efficiency and reduces recruitment costs but also demonstrates strong scalability and generalizability. It provides a scientific and feasible intelligent pathway to ensure the safety and sustainability of the blood supply.
5.Chemical constituents from Asteris Radix et Rhizoma and their anti-inflammatory activities
Pei LI ; Fu-xia ZHAO ; Si-qi YANG ; Jin-yan TAN ; Ying-li WANG ; Yan-gang CHENG
Chinese Traditional Patent Medicine 2025;47(2):473-479
AIM To study the chemical constituents from Asteris Radix et Rhizoma and their anti-inflammatory activities.METHODS The extract from Asteris Radix et Rhizoma was isolated and purified by column chromatography and high performance liquid chromatography,then the structures of obtained compounds were identified by physicochemical properties and spectral data.Their anti-inflammatory activities were evaluated by RAW264.7 model.RESULTS Thirteen compounds were isolated and identified as(Z)-9,10,11-trihydroxy-12-octadecenoic acid(1),tianshic acid(2),6,6-dimethyl-2-methlenebicyclo[3.1.1]hept-3-O-(6-O-apiofuranosyl)-β-D-glucopyranoside(3),ent-16β,17-dihydroxy-kauran-19-oic acid(4),ent-17-hydroxy-19-kauranoic acid(5),7β,17-dihydroxy-16α-ent-kauran-19-oic acid 19-O-β-D-glucopyranoside ester(6),paniculoside Ⅳ(7),thomimarine A(8),cyclo-(S-Pro-R-Leu)(9),4,5-di-O-caffeoylquinic acid 1-methyl ether(10),methyl 3,5-di-O-caffeoyl quinate(11),5-acetyl-3β-hydroxy-2β-(1-hydroxyisopropyl)-2,3-dihydrobenzofurane(12),4-ally-2,6-dimethoxyphenyl glucoside(13).Compounds 1 and 3-12 had inhibition on the release of NO in RAW264.7 cells,and 4-6,8,10-12 were better than the positive control.CONCLUSION Compounds 1,6,8-9 are isolated from Compositae family for the first time,and 2-5,7,10 and 11-13 are first isolated from this plant.Compounds 1,3-12 have anti-inflammatory activities.
6.Improvement Effect of Sofalcone on Alleviates Nonsteroidal Anti-inflammatory Drug-induced Small Intestinal Mucosal Injury in Rats by RIPK1/RIPK3/MLKL Signaling Pathway
Jie TAN ; Yuping CAO ; Junxian WANG ; Si CHEN
Herald of Medicine 2025;44(6):854-861
Objective To investigate the protective effects and possible mechanisms of sofalcone on small intestinal mucosal damage induced by nonsteroidal anti-inflammatory drugs(NSAIDs)in rats.Methods In the first group of animal experiments,rats were randomly divided into five groups:normal control group,diclofenac group(diclofenac 7.5 mg·kg-1),and sofalcone high-doses groups(sofalcone 10 mg·kg-1+diclofenac 7.5 mg·kg-1),sofalcone medium-doses groups(sofalcone 5 mg·kg-1+diclofenac 7.5 mg·kg-1),and sofalcone low-doses groups(sofalcone 2 mg·kg-1+diclofenac 7.5 mg·kg-1).Each group received daily gavage for seven days.Serum D-lactate levels were measured,and histological damage to the small intestine was assessed through HE staining and pathological scoring.In the second group,rats were separated into three groups:normal control group,diclofenac group(diclofenac 7.5 mg·kg-1),and sofalcone group(sofalcone 2 mg·kg-1+diclofenac 7.5 mg·kg-1).Concurrently,the rats'body mass,24-hour diet,and water intake were monitored.Additionally,serum levels of pro-inflammatory cytokines such as IL-6,IFN-γ,TNF-α,inflammatory markers CRP and D-lactate,as well as measurements of tissue reactive oxygen species(ROS),lactate dehydrogenase(LDH),and mitochondrial membrane potential were conducted using appropriate kits.Western blotting was applied to assess the expression levels of intercellular junction proteins(Occludin,Claudin-1,α-Catenin),programmed necrosis pathway-associated proteins including receptor-interacting protein kinase 1(RIPK1),RIPK3,and mixed lineage kinase domain-like pseudokinase(MLKL)along with p-MLKL.Results In the first experiment,the diclofenac group exhibited significant histological damage to the small intestine,with elevated levels of D-lactic acid and pathological scores compared to the normal control group(P<0.01).Following intervention with sofalcone,both the histological damage and the levels of D-lactic acid and pathological scores in the small intestine were notably reduced(P<0.05 or P<0.01).However,there was no substantial difference in pathological scores among different doses of sofaclone groups(P>0.05).In the second experiment,compared with normal control group,rats in the diclofenac group showed decreased body mass,24-hour average diet and water intake,along with elevated levels of IL-6,IFN-γ,TNF-α,CRP,D-lactic acid,tissue ROS,LDH activity,RIPK1,RIPK3,and p-MLKL/MLKL protein expression levels,as well as mitochondrial membrane potential(P<0.05 or P<0.01).Moreover,Occludin,Claudin-1,and α-Catenin protein expression levels were reduced(P<0.05 or P<0.01).Following sofalcone intervention,the previously mentioned parameters were reversed(P<0.05 or P<0.01).Notably,there was no statistically significant difference observed in the reduction of RIPK1 protein expression(P>0.05).Conclusions Sofalcone reduces NSAID-induced small intestinal mucosal injury in rats by inhibiting the RIPK1/RIPK3/MLKL-dependent programmed necrosis pathway.
7.Predictors of moderate, severe, and critical COVID-19 infection in a largely vaccinated kidney transplant recipient cohort during the Omicron era: the importance of timely booster vaccinations and early presentation to care
Cherie Le Si GAN ; Shimin Jasmine CHUNG ; Quan Yao HO ; Thuan Tong TAN ; Ban Hock TAN ; Ian Tatt LIEW ; Carolyn Shan-Yeu TIEN ; Sobhana THANGARAJU ; Terence KEE
Clinical Transplantation and Research 2025;39(1):46-54
Background:
Kidney transplant recipients (KTRs) are at risk of coronavirus disease 2019 (COVID-19) complications and mortality. This study examined factors associated with moderate, severe, or critical COVID-19 infection among KTRs during the Omicron-predominant period.
Methods:
This single-center retrospective study included KTRs aged ≥18 years diag-nosed with COVID-19 between January 1, 2022, and December 31, 2023. Mild infection was defined as symptomatic illness without lower respiratory tract infection (LRTI);moderate infection as LRTI without hypoxia; severe infection as oxygen saturation <94% on room air; and critical infection as respiratory failure, septic shock, or multiple organ dysfunction. We compared the characteristics of KTRs with asymptomatic or mild COVID-19 versus those with moderate to critical disease. Logistic regression analysis was performed to identify factors associated with moderate to critical illness.
Results:
Most KTRs (94.4%) had received three or more vaccine doses. Of 603 episodes of COVID-19 infection during the study period, 554 (91.9%) were asymptomatic or mild, while 49 (8.1%) were moderate to critical. Multivariate analysis revealed that older age (adjusted odds ratio [aOR], 1.037; 95% confidence interval [CI], 1.006–1.069) and longer symptom duration before seeking care (aOR, 1.288; 95% CI, 1.155–1.436) were associated with higher odds of moderate to critical disease. Protective factors included receiving a vaccine booster within the past year (aOR, 0.414; 95% CI, 0.212–0.809) and higher glomerular filtration rate (aOR, 0.971; 95% CI, 0.956–0.986).
Conclusions
KTRs should seek care early if infected with COVID-19 and keep their COVID-19 vaccine boosters updated within 1 year of the last dose.
8.Predictors of moderate, severe, and critical COVID-19 infection in a largely vaccinated kidney transplant recipient cohort during the Omicron era: the importance of timely booster vaccinations and early presentation to care
Cherie Le Si GAN ; Shimin Jasmine CHUNG ; Quan Yao HO ; Thuan Tong TAN ; Ban Hock TAN ; Ian Tatt LIEW ; Carolyn Shan-Yeu TIEN ; Sobhana THANGARAJU ; Terence KEE
Clinical Transplantation and Research 2025;39(1):46-54
Background:
Kidney transplant recipients (KTRs) are at risk of coronavirus disease 2019 (COVID-19) complications and mortality. This study examined factors associated with moderate, severe, or critical COVID-19 infection among KTRs during the Omicron-predominant period.
Methods:
This single-center retrospective study included KTRs aged ≥18 years diag-nosed with COVID-19 between January 1, 2022, and December 31, 2023. Mild infection was defined as symptomatic illness without lower respiratory tract infection (LRTI);moderate infection as LRTI without hypoxia; severe infection as oxygen saturation <94% on room air; and critical infection as respiratory failure, septic shock, or multiple organ dysfunction. We compared the characteristics of KTRs with asymptomatic or mild COVID-19 versus those with moderate to critical disease. Logistic regression analysis was performed to identify factors associated with moderate to critical illness.
Results:
Most KTRs (94.4%) had received three or more vaccine doses. Of 603 episodes of COVID-19 infection during the study period, 554 (91.9%) were asymptomatic or mild, while 49 (8.1%) were moderate to critical. Multivariate analysis revealed that older age (adjusted odds ratio [aOR], 1.037; 95% confidence interval [CI], 1.006–1.069) and longer symptom duration before seeking care (aOR, 1.288; 95% CI, 1.155–1.436) were associated with higher odds of moderate to critical disease. Protective factors included receiving a vaccine booster within the past year (aOR, 0.414; 95% CI, 0.212–0.809) and higher glomerular filtration rate (aOR, 0.971; 95% CI, 0.956–0.986).
Conclusions
KTRs should seek care early if infected with COVID-19 and keep their COVID-19 vaccine boosters updated within 1 year of the last dose.
9.Predictors of moderate, severe, and critical COVID-19 infection in a largely vaccinated kidney transplant recipient cohort during the Omicron era: the importance of timely booster vaccinations and early presentation to care
Cherie Le Si GAN ; Shimin Jasmine CHUNG ; Quan Yao HO ; Thuan Tong TAN ; Ban Hock TAN ; Ian Tatt LIEW ; Carolyn Shan-Yeu TIEN ; Sobhana THANGARAJU ; Terence KEE
Clinical Transplantation and Research 2025;39(1):46-54
Background:
Kidney transplant recipients (KTRs) are at risk of coronavirus disease 2019 (COVID-19) complications and mortality. This study examined factors associated with moderate, severe, or critical COVID-19 infection among KTRs during the Omicron-predominant period.
Methods:
This single-center retrospective study included KTRs aged ≥18 years diag-nosed with COVID-19 between January 1, 2022, and December 31, 2023. Mild infection was defined as symptomatic illness without lower respiratory tract infection (LRTI);moderate infection as LRTI without hypoxia; severe infection as oxygen saturation <94% on room air; and critical infection as respiratory failure, septic shock, or multiple organ dysfunction. We compared the characteristics of KTRs with asymptomatic or mild COVID-19 versus those with moderate to critical disease. Logistic regression analysis was performed to identify factors associated with moderate to critical illness.
Results:
Most KTRs (94.4%) had received three or more vaccine doses. Of 603 episodes of COVID-19 infection during the study period, 554 (91.9%) were asymptomatic or mild, while 49 (8.1%) were moderate to critical. Multivariate analysis revealed that older age (adjusted odds ratio [aOR], 1.037; 95% confidence interval [CI], 1.006–1.069) and longer symptom duration before seeking care (aOR, 1.288; 95% CI, 1.155–1.436) were associated with higher odds of moderate to critical disease. Protective factors included receiving a vaccine booster within the past year (aOR, 0.414; 95% CI, 0.212–0.809) and higher glomerular filtration rate (aOR, 0.971; 95% CI, 0.956–0.986).
Conclusions
KTRs should seek care early if infected with COVID-19 and keep their COVID-19 vaccine boosters updated within 1 year of the last dose.

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