1.Effect and Mechanisms of Luteolin on Gout
Jinlai CHENG ; Xiaoyu ZHANG ; Yuyan XU ; Huajing WANG ; Yuqing TAN ; Feng SUI ; Miyi YANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(1):140-149
ObjectiveTo integrate network pharmacology prediction with multi-level experimental verification methods, and to explore in depth the therapeutic efficacy and potential mechanism of luteolin in treating gout. MethodsDatabases were used to obtain potential pharmacodynamic targets of luteolin. Protein-protein interaction (PPI) network construction and network pharmacology analysis techniques were used to screen key core targets of luteolin in gout treatment. Further biological function enrichment analysis and signaling pathway analysis were performed on these targets. Molecular docking simulation was used to calculate the binding energy between luteolin and potential core targets, clarifying the strength of their interactions. In the in vivo experiment for hyperuricemia, 48 mice were randomly divided into a blank group, a model group, an allopurinol group (5 mg·kg-1), and low-dose (10 mg·kg-1), medium-dose (30 mg·kg-1), and high-dose (90 mg·kg-1) luteolin groups. For the first three days, the blank and model groups were gavaged with an equal volume of normal saline, while the allopurinol group and luteolin groups were gavaged with corresponding drugs. From day 4 onwards, modeling was performed by intraperitoneal injection at 12:00 daily (normal saline for the blank group, and oxonic acid potassium-hypoxanthine mixture for other groups, with 300 mg·kg-1 for each group). Gavage intervention was administered at 18:00 daily (normal saline for the blank/model groups, and corresponding drugs for the treatment groups) until day 7. After sampling, levels of serum uric acid (UA), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were measured. Levels of xanthine oxidase (XO) in the liver and kidney, ATP-binding cassette transporter G2 (ABCG2) and malondialdehyde (MDA) in the kidney, and superoxide dismutase (SOD) in the liver were determined. Renal HE staining was also performed. In the pharmacodynamic study of gouty arthritis, 36 rats were randomly divided into a blank group, a model group, a colchicine group (0.315 mg·kg-1), and low-dose (7 mg·kg-1), medium-dose (21 mg·kg-1), and high-dose (63 mg·kg-1) luteolin groups. The model was established by vertically injecting 100 µL of 25 g·L-1 monosodium urate suspension into the posterior lateral aspect of the right ankle joint (the blank group was injected with an equal volume of normal saline), with repeated injections every two days for reinforcement. From day 2 after modeling, daily gavage administration was performed (normal saline for the blank/model groups, and corresponding drugs for the treatment groups) for a total of 16 days. During the experiment, ankle swelling and pain threshold were measured regularly. After sampling, levels of serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β) were determined. Ankle joints were subjected to HE, Masson, and safranin O-fast green staining, and HE staining was also performed on ankle synovial tissue and various organs. Western blot was used to determine the expression levels of key proteins in gout-related signaling pathways. ResultsNetwork pharmacology analysis predicted that luteolin may regulate over 20 core targets, such as XO, ABCG2, nuclear factor erythroid 2-related factor 2 (Nrf2), and SOD, through acting on signaling pathways including NF-κB, phosphoinositide 3-kinase/protein kinase B (PI3K/Akt), and ABC transporters, thereby affecting uric acid metabolism and inflammatory responses. In the hyperuricemia model, compared with the blank group, the model group showed significantly increased serum UA level, liver and kidney XO activity, renal ABCG2 expression, and liver SOD activity (P<0.01). Compared with the model group, the high-dose luteolin group significantly reduced serum UA level (P<0.01), inhibited liver and kidney XO activity (P<0.01), and significantly increased renal ABCG2 expression and liver SOD activity (P<0.01), effectively alleviating renal oxidative stress damage and improving renal histopathological status. In the gouty arthritis model, compared with the blank group, the model group showed significant ankle swelling, decreased pain threshold, and significantly increased levels of IL-6, IL-1β, and TNF-α in serum and synovial tissue (P<0.01). The high-dose luteolin group significantly reduced ankle swelling, prolonged hot plate pain threshold, effectively decreased the levels of the above inflammatory factors in serum and synovial tissue (P<0.01), and significantly improved ankle pathological damage, showing good analgesic and anti-inflammatory effects. Western blot results further confirmed that luteolin significantly upregulated Nrf2 protein expression and downregulated XO and nucleotide-binding oligomerization domain (NOD)-like receptor protein 3 (NLRP3) expression in animals. ConclusionLuteolin can improve symptoms of hyperuricemia and gouty arthritis, and its potential mechanism may be related to inhibiting XO activity, increasing ABCG2 and SOD levels, and regulating Nrf2-mediated oxidative stress-related pathways.
2.Identification of shared key genes and pathways in osteoarthritis and sarcopenia patients based on bioinformatics analysis.
Yuyan SUN ; Ziyu LUO ; Huixian LING ; Sha WU ; Hongwei SHEN ; Yuanyuan FU ; Thainamanh NGO ; Wen WANG ; Ying KONG
Journal of Central South University(Medical Sciences) 2025;50(3):430-446
OBJECTIVES:
Osteoarthritis (OA) and sarcopenia are significant health concerns in the elderly, substantially impacting their daily activities and quality of life. However, the relationship between them remains poorly understood. This study aims to uncover common biomarkers and pathways associated with both OA and sarcopenia.
METHODS:
Gene expression profiles related to OA and sarcopenia were retrieved from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) between disease and control groups were identified using R software. Common DEGs were extracted via Venn diagram analysis. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted to identify biological processes and pathways associated with shared DEGs. Protein-protein interaction (PPI) networks were constructed, and candidate hub genes were ranked using the maximal clique centrality (MCC) algorithm. Further validation of hub gene expression was performed using 2 independent datasets. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of key genes for OA and sarcopenia. Mouse models of OA and sarcopenia were established. Hematoxylin-eosin and Safranin O/Fast Green staining were used to validate the OA model. The sarcopenia model was validated via rotarod testing and quadriceps muscle mass measurement. Real-time reverse transcription PCR (real-time RT-PCR) was employed to assess the mRNA expression levels of candidate key genes in both models. Gene set enrichment analysis (GSEA) was conducted to identify pathways associated with the selected shared key genes in both diseases.
RESULTS:
A total of 89 common DEGs were identified in the gene expression profiles of OA and sarcopenia, including 76 upregulated and 13 downregulated genes. These 89 DEGs were significantly enriched in protein digestion and absorption, the PI3K-Akt signaling pathway, and extracellular matrix-receptor interaction. PPI network analysis and MCC algorithm analysis of the 89 common DEGs identified the top 17 candidate hub genes. Based on the differential expression analysis of these 17 candidate hub genes in the validation datasets, AEBP1 and COL8A2 were ultimately selected as the common key genes for both diseases, both of which showed a significant upregulation trend in the disease groups (all P<0.05). The value of area under the curve (AUC) for AEBP1 and COL8A2 in the OA and sarcopenia datasets were all greater than 0.7, indicating that both genes have potential value in predicting OA and sarcopenia. Real-time RT-PCR results showed that the mRNA expression levels of AEBP1 and COL8A2 were significantly upregulated in the disease groups (all P<0.05), consistent with the results observed in the bioinformatics analysis. GSEA revealed that AEBP1 and COL8A2 were closely related to extracellular matrix-receptor interaction, ribosome, and oxidative phosphorylation in OA and sarcopenia.
CONCLUSIONS
AEBP1 and COL8A2 have the potential to serve as common biomarkers for OA and sarcopenia. The extracellular matrix-receptor interaction pathway may represent a potential target for the prevention and treatment of both OA and sarcopenia.
Sarcopenia/genetics*
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Osteoarthritis/genetics*
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Computational Biology/methods*
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Humans
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Protein Interaction Maps/genetics*
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Animals
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Mice
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Gene Expression Profiling
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Gene Ontology
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Transcriptome
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Male
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Signal Transduction/genetics*
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Gene Regulatory Networks
3.Mechanism by which mechanical stimulation regulates chondrocyte apoptosis and matrix metabolism via primary cilia to delay osteoarthritis progression.
Huixian LING ; Sha WU ; Ziyu LUO ; Yuyan SUN ; Hongwei SHEN ; Haiqi ZHOU ; Yuanyuan FU ; Wen WANG ; Thai Namanh NGO ; Ying KONG
Journal of Central South University(Medical Sciences) 2025;50(5):864-875
OBJECTIVES:
Osteoarthritis (OA) is one of the most common chronic degenerative diseases, with chondrocyte apoptosis and extracellular matrix (ECM) degradation as the major pathological changes. The mechanical stimulation can attenuate chondrocyte apoptosis and promote ECM synthesis, but the underlying molecular mechanisms remain unclear. This study aims to investigate the role of primary cilia (PC) in mediating the effects of mechanical stimulation on OA progression.
METHODS:
In vivo, conditional knockout mice lacking intraflagellar transport 88 (IFT88flox/flox IFT88 knockout; i.e., primary cilia-deficient mice) were generated, with wild-type mice as controls. OA models were established via anterior cruciate ligament transection combined with destabilization of the medial meniscus, followed by treadmill exercise intervention. OA progression was evaluated by hematoxylin-eosin staining, safranin O-fast green staining, and immunohistochemistry; apoptosis was assessed by TUNEL staining; and limb function by rotarod testing. In vitro, primary articular chondrocytes were isolated from mice and transfected with lentiviral vectors to suppress IFT88 expression, thereby constructing a primary cilia-deficient cell model. Interleukin-1β (IL-1β) was used to induce an inflammatory environment, while cyclic tensile strain (CTS) was applied via a cell stretcher to mimic mechanical loading on chondrocytes. Immunofluorescence and Western blotting were used to detect the protein expression levels of type II collagen α1 chain (COL2A1), primary cilia, IFT88, and caspase-12; reverse transcription polymerase chain reaction was performed to assess COL2A1 mRNA levels; and flow cytometry was used to evaluate apoptosis.
RESULTS:
In vivo, treadmill exercise significantly reduced Osteoarthritis Research Society International (OARSI) scores and apoptotic cell rates, and improved balance ability in wild-type OA mice, whereas IFT88-deficient OA mice showed no significant improvement. In vitro, CTS inhibited IL-1β-induced ECM degradation and apoptosis in primary chondrocytes; however, this protective effect was abolished in cells with suppressed primary cilia expression.
CONCLUSIONS
Mechanical stimulation delays OA progression by mediating signal transduction through primary cilia, thereby inhibiting cartilage degeneration and chondrocyte apoptosis.
Animals
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Chondrocytes/cytology*
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Apoptosis/physiology*
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Mice
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Cilia/metabolism*
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Osteoarthritis/pathology*
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Extracellular Matrix/metabolism*
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Mice, Knockout
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Disease Progression
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Interleukin-1beta
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Male
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Cells, Cultured
4.Setd2 overexpression rescues bivalent gene expression during SCNT-mediated ZGA.
Xiaolei ZHANG ; Ruimin XU ; Yuyan ZHAO ; Yijia YANG ; Qi SHI ; Hong WANG ; Xiaoyu LIU ; Shaorong GAO ; Chong LI
Protein & Cell 2025;16(6):439-457
Successful cloning through somatic cell nuclear transfer (SCNT) faces significant challenges due to epigenetic obstacles. Recent studies have highlighted the roles of H3K4me3 and H3K27me3 as potential contributors to these obstacles. However, the underlying mechanisms remain largely unclear. In this study, we generated genome-wide maps of H3K4me3 and H3K27me3 in mouse pre-implantation NT embryos. Our analysis revealed that aberrantly over-represented broad H3K4me3 domain and H3K27me3 signal lead to increased bivalent marks at gene promoters in NT embryos compared with naturally fertilized (NF) embryos at the 2-cell stage, which may link to relatively low levels of H3K36me3 in NT 2-cell embryos. Notably, the overexpression of Setd2, a H3K36me3 methyltransferase, successfully restored multiple epigenetic marks, including H3K36me3, H3K4me3, and H3K27me3. In addition, it reinstated the expression levels of ZGA-related genes by reestablishing H3K36me3 at gene body regions, which excluded H3K27me3 from bivalent promoters, ultimately improving cloning efficiency. These findings highlight the excessive bivalent state at gene promoters as a potent barrier and emphasize the removal of these barriers as a promising approach for achieving higher cloning efficiency.
Animals
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Mice
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Histone-Lysine N-Methyltransferase/biosynthesis*
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Histones/genetics*
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Nuclear Transfer Techniques
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Female
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Gene Expression Regulation, Developmental
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Promoter Regions, Genetic
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Epigenesis, Genetic
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Embryo, Mammalian/metabolism*
5.WANG Xixing's Experience in Differentiation and Treatment of Advanced Breast Cancer with Anxiety and Depression:Based on Shaoyang Pivot Theory
Wenbo ZHAI ; Xinyue WANG ; Dongxin ZHANG ; Zhiyao SHI ; Yuyan GUO ; Xi YANG ;
Journal of Traditional Chinese Medicine 2025;66(23):2421-2425
To summarize Professor WANG Xixing's clinical experience in treating advanced breast cancer with anxiety and depression from the perspective of shaoyang pivot. It is believed that the core pathogenesis of advanced breast cancer with anxiety and depression lies in the dysfunction of shaoyang pivot (referring to the imbalanced regulatory function of the shaoyang meridian system that governs the transportation and transformation of qi, blood, and body fluids). This dysfunction can lead to abnormal circulation of qi, blood, and body fluids, as well as the intermingling of phlegm and blood stasis, which further promotes the spread and diffusion of cancer toxin. Meanwhile, it disturbs mental activity, resulting in a condition characterized by stagnation of cancer toxin and concurrent disorders of both the physical body and the spirit. Based on this pathogenesis, the basic therapeutic principles of harmonizing shaoyang, regulating the pivot to calm the spirit, and dissipating masses and resolving toxins are proposed. Clinically, the disease is classified into three syndromes for differentiation and treatment. For shaoyang pivot dysfunction syndrome, treatment should use self-prescribed Chaiqin Hengshu Ningxin Decoction (柴芩衡枢宁神汤); for sanjiao pivot dysfunction syndrome, treatment should prescribe Chaigui Tongshu Dashen Decoction (柴归通枢达神饮); for gallbladder function disorder syndrome, treatment should apply Wendan Qishu Shoushen Decoction (温胆启枢守神汤). Throughout the treatment process, the concept of "simultaneous treatment of cancer and depression" is implemented to smooth the shaoyang pivot, block the vicious cycle where cancer toxin and emotional abnormalities mutually reinforce each other.
6.Exploration on the Prevalence of Dengue Fever in Guangzhou from 2012 to 2023 Based on Circuit-Qi Theory
Siqi WU ; Jieyi DENG ; Wenyi WANG ; Yuyan JIN ; Hongrui ZHAO ; Fang LI
Journal of Guangzhou University of Traditional Chinese Medicine 2025;42(7):1582-1588
Objective To analyze the prevalence of dengue fever in Guangzhou based on circuit-qi theory.Methods Data on dengue fever cases in Guangzhou from January 21,2012,to January 19,2024 were collected.And then the incidence of dengue fever was analyzed under the circuit-qi conditions of dominant qi,guest qi,celestial qi,joining of guest qi with dominant qi,and dissimilation of circuit and qi.Results Higher incidence of dengue fever in Guangzhou was presented under the circuit-qi conditions of the fifth qi of the dominant qi in each year,shaoyang minister fire of the guest qi,shaoyin monarch fire of the celestial qi,guest qi restricting dominant qi in the joining of guest qi with dominant qi,shaoyang minister fire(guest qi)joining with yangming dry-metal(dominant qi)in the pattern of guest qi restricting dominant qi.The outbreak of dengue fever under the circuit-qi conditions of dissimilation of circuit and qi showed no statistically significant difference.Conclusion Over the 12-year period from 2012 to 2024,the prevalence of dengue fever in Guangzhou exhibited a 4-5-year cyclical pattern,often with consecutive outbreaks over two years.The prevalence of dengue fever in Guangzhou is associated with the factors of dampness and heat in the theory of five circuits and six qi,while has less relation with dissimilation of circuit and qi.
7.Constructing a research model for liver regeneration by using hepatocyte-like organoid derived from human pluripotent stem cells
Chenxi WANG ; Shuchun YANG ; Yuyan JIA ; Yue HUANG
Basic & Clinical Medicine 2025;45(5):589-598
Objective To construct an in vitro research model for studying human liver regeneration based on human pluripotent stem cells(hPSCs)-derived hepatocyte-like organoid(HLO).Methods The hPSCs-derived HLO was obtained by inducing differentiation and the regeneration model after liver injury was constructed by adding acetaminophen(APAP)at fixed time points in HLO culture conditions to simulate acute liver injury.Subse-quently,HLO with catenin/cadherin-associated protein beta 1(CTNNB1)knockout,a key gene regulating liver re-generation,was constructed using CRISPR/Cas9 gene editing technology,and regeneration experiments with APAP injury were performed.HLO as a model for liver regeneration studies was further evaluated by morphological observation,RT-qPCR,Western blot and pathological analysis.Results Morphology evidence as well as expres-sion of marker genes showed that hPSCs-derived HLO was able to initiate a post-injury regeneration response after APAP treatment.CTNNB1-deficient HLO showed delayed recovery in dimension and down-regulated or delayed ex-pression of related genes during post-injury regeneration as compared to control HLO.Conclusions A HLO-based hPSCs-derived human liver regeneration model is successfully constructed,which can be used for gene function studies during liver regeneration.
8.Dynamic alterations in blood-related indexes in rats exposed to high-altitude hypoxic environment
Yuyan WANG ; Xuefeng SHI ; Xiaokai FENG
Basic & Clinical Medicine 2025;45(9):1178-1183
Objective To investigate alteration of blood routine parameters,blood gas analysis profile,coagulation function,and inflammatory factors during exposure to high-altitude hypoxic environments.Methods Rats were raised in a hypobaric oxygen chamber to simulate the altitude of 5 500 meters.The animals were divided into groups with exposure duration of 0(control),1,3,5,7,14,and 28 days.Arterial blood gas was measured using a blood gas analyzer.The routine blood test was performed by an automatic five-differential animal hematology analyzer.The coagulation function was measured by a fully automatic coagulation analyzer.The level of plasma D-dimer(DD),erythropoietin(EPO),interleukin-10(IL-10),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)was detected by ELISA method.The protein expression of IL-10,IL-6,and TNF-α in lung tissues of the animals was detected by Western blot.Results As compare to control group,the arterial partial pressure of ox-ygen(PaO2)decreased at different durations of hypoxia exposure.The PaO2 in the group exposed to hypoxia for 7 d was the lowest(P<0.05).The red blood cell count(RBC),hemoglobin(HGB),hematocrit(HCT),mean cor-puscular volume(MCV),mean corpuscular hemoglobin concentration(MCHC)and mean platelet volume(MPV)were all higher than control group(P<0.05).Erythropoietin(EPO),prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB)and D-dimer(DD)all gradually increased(P<0.05).The white blood cell count(WBC)and platelet count(PLT),as well as the plasma inflammatory fac-tors including interleukin-10(IL-10),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP),and the expression of inflammatory factors in the lung tissue including IL-10,IL-6 and TNF-α pro-teins all showed a curve of increasing at beginning and then followed by a slow decrease with the prolongation of the hypoxia time(P<0.05).Conclusions In high-altitude hypoxic environment,the blood circulation undergoes dy-namic evolution of functional remodeling with higher risk of inflammatory response.As the hypoxia time prolongs,the animals adapt the environment and the level of inflammatory cytokines gradually decline but remains at a level which is still higher than that of control animals.
9.Berberine promotes osteogenic differentiation of bone marrow mesenchymal stem cells in a high-glucose environment
Qiutong GOU ; Wenhao LUO ; Pin WANG ; Yuyan LAN ; Min LIU ; Haixia HUANG
Chinese Journal of Tissue Engineering Research 2024;28(19):2974-2980
BACKGROUND:The implant osseointegration rate of patients with diabetes is low,and the failure rate is high,which seriously affects the quality of life.It is urgent to improve the implant osseointegration of patients with diabetes by effective means to elevate the success rate.Exploring the effect of berberine on the osteogenic differentiation of bone marrow mesenchymal stem cells under a high-glucose environment and its specific mechanism will provide effective theoretical support for solving the above problems. OBJECTIVE:To explore the effect of natural extract berberine on the osteogenic differentiation of rat bone marrow mesenchymal stem cells under the high-glucose microenvironment. METHODS:Bone marrow mesenchymal stem cells of SD rats were cultured by the whole bone marrow adherence method.CCK-8 assay was used to detect the effects of different concentrations of berberine on the proliferation of bone marrow mesenchymal stem cells under the high-glucose environment and to screen out the optimal berberine concentration.The expressions of Runx2 and Osx were detected by alkaline phosphatase activity,alicarin red staining and PCR to determine the effect of berberine on osteogenic differentiation of bone marrow mesymal stem cells under the high-glucose environment.To further explore the underlying mechanism,we introduced the AMPK-specific inhibitor Dorsomorphin and used a DCFH-DA reactive oxygen species fluorescent probe to examine reactive oxygen species levels.The p-AMPK expression was also determined by western blot assay. RESULTS AND CONCLUSION:(1)10 μmol/L was the optimal concentration of berberine to promote bone marrow mesenchymal stem cell proliferation.(2)Alberberine promoted alkaline phosphatase viability of bone marrow mesenchymal stem cells and mineralized nodule formation in a high-glucose microenvironment.(3)Alberberine promoted the expression of Runx2 and OSx in a high-glucose microenvironment.(4)Alberensine effectively inhibited the reactive oxygen species level of bone marrow mesenchymal stem cells in a high-glucose environment.(5)The effects of berberine on promoting bone marrow mesenchymal stem cell osteogenesis and inhibition of reactive oxygen species were reversed by the AMPK inhibitor.(6)Berberine activated AMPK and promoted p-AMPK expression.(7)The above results indicate that berberine(10 μmol/L)promotes the osteogenic differentiation of bone marrow mesenchymal stem cells in a high-glucose environment by activating AMPK and reducing intracellular reactive oxygen species levels.
10.Analysis of PD-L1 expression and immune cell infiltration characteristics in different molecular subtypes of endometrial cancer
Baohui JU ; Chunrui YANG ; Dong LIU ; Yuyan YANG ; Jianmei WANG ; Huiying ZHANG
Cancer Research and Clinic 2024;36(10):734-742
Objective:To investigate the differences in programmed death-ligand 1 (PD-L1) expression and immune cell infiltration characteristics in different molecular subtypes of endometrial cancer.Methods:A retrospective case series study was conducted. Ninety primary treated EC patients who underwent surgery without preoperative neoadjuvant therapy at the Second Hospital of Tianjin Medical University from November 2016 to May 2022 were collected. The surgical paraffin-embedded tissues were selected, and the molecular subtypes of endometrial cancer were classified according to 2020 World Health Organization (WHO) molecular subtypes using POLE gene Sanger sequencing and immunohistochemical staining. The expression of PD-L1, CD3, CD4, CD8, CD68, and CD20 proteins were detected by immunohistochemistry. Stained slides were digitally scanned for quantitative analysis of PD-L1 and immune cell infiltration density. The PD-L1-related scores were evaluated, including tumor cell score (TCS, the percentage of PD-L1 positive tumor cells among total tumor cells ≥1% was TCS positive, <1% was TCS negative), immune cell score (ICS, the percentage of PD-L1 positive tumor-associated lymphocytes and macrophages among total tumor-associated lymphocytes and macrophages ≥1% was ICS positive, <1% was ICS negative) and combined positive score [CPS, PD-L1 positive stained cells (including tumor cells, lymphocytes and macrophages)/total number of viable tumor cells ×100 ≥ 1 was CPS positive, < 1 was CPS negative]. Clinicopathological characteristics, PD-L1 scores and immune cell infiltration densities among different molecular subtypes were analyzed. Kaplan-Meier method was used to plot disease-free survival (DFS) curves for molecular subtypes, PD-L1 scores and immune cell infiltration densities, with subgroup comparisons using log-rank test. Cox proportional hazards models were used for univariate and multivariate analyses of poor DFS in endometrial cancer patients.Results:The median age of 90 patients was 58 years old (range: 33-72 years old); endometrioid carcinoma was present in 78 cases (86.7%), and non-endometrioid carcinoma was present in 12 cases (13.3%). Molecular subtyping identified POLE-mutated subtype in 6 cases (6.7%), mismatch repair deficient (MMRd) subtype in 23 cases (25.6%), p53 abnormal subtype in 14 cases (15.6%), and non-specific molecular profile (NSMP) subtype in 47 cases (52.2%). Significant differences were observed among the 4 molecular subtypes in International Federation of Gynecology and Obstetrics (FIGO) stage, histological grade, morphological subtype, tertiary lymphoid structures, estrogen receptor expression, and progesterone receptor expression (all P < 0.05). Among the 90 cases, 18 cases (20.0%) were positive for TCS, 31 cases (34.4%) were positive for ICS, and 39 cases (43.3%) were positive for CPS. Significant differences were found among the 4 molecular subtypes in PD-L1 + cell density, distribution of patients with ICS positivity, and distribution of patients with CPS positivity (all P < 0.01), but not in distribution of patients with TCS positivity ( P = 0.090); compared to NSMP subtype, the proportions of ICS-positive patients in POLE-mutated and MMRd subtypes were higher, the proportion of CPS-positive patients and PD-L1 + cell density in MMRd and p53 abnormal subtypes were higher, and the differences were statistically significant (all P < 0.05). Significant differences in immune cell densities were observed among the 4 molecular subtypes (all P < 0.01); compared to NSMP subtype, POLE-mutated, MMRd and p53 abnormal subtypes had higher densities of CD3 + and CD8 + cells, MMRd subtype had higher CD4 + cell density, and POLE-mutated and MMRd subtypes had higher CD68 + and CD20 + cell densities (all P < 0.05). The median follow-up was 43 months (range: 7-75 months). Among the molecular subtypes, p53 abnormal patients had the worst DFS, and POLE-mutated patients had the best DFS, and the difference in DFS among the 4 subtypes was statistically significant ( P = 0.046). Grouping according to the median density of immune cells in the entire group, patients with high CD8 + cell density (45 cases) had better DFS than those with low density (45 cases) ( P = 0.010), PD-L1 ICS-positive patients had worse DFS than negative patients ( P = 0.019), and NSMP subtype patients with high CD4 + cell density (24 cases) had better DFS than those with low density (23 cases) ( P < 0.001). There was no statistically significant difference in DFS among patients grouping with other PD-L1 scoring modes and other immune cell infiltration density (all P > 0.05). Cox regression analysis indicated that high CD8 + cell density ( HR = 0.335, 95% CI: 0.113-0.990, P = 0.048) was an independent protective factor for poor DFS in endometrial cancer patients, and high CD4 + cell density was an independent protective factor for poor DFS in NSMP subtype patients ( HR = 0.035, 95% CI: 0.003-0.345, P = 0.004). Conclusions:There are significant differences in PD-L1 expression and immune cell infiltration density among the different molecular subtypes of endometrial cancer, which are correlated with the prognosis of patients, and may provide reference for the selection of immunotherapy strategies and prognosis judgment.

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