Patients undergoing abdominal surgery often develop delirium, which greatly influences their postoperative course of clinical recovery and length of hospital stay (LOS).^1-3 Delirium affects 13% to 50% of patients undergoing noncardiac surgery,⁴ and the health care costs attributable to delirium are more than $164 billion per year in the United States.^5,6 Older surgical patients (≥65 years of age) have a particularly high risk for developing delirium, with detrimental effects on their recovery.⁶ Delirium has been associated with alterations in cholinergic activity, inflammatory processes induced by neural signaling, and excessive depth of anesthesia and sedation.^7,8 Delirium may also be precipitated by factors such as infection, malnutrition, electrolyte and fluid imbalances, anemia, and social isolation.^4,9,10 Nevertheless, 30% to 40% of cases of delirium are preventable¹¹; thus, implementing effective interventions to prevent incident delirium and reduce LOS is a clinical priority.

Hypoxia-inducible factor-1α (HIF-1α) is widely considered to be one of the key regulators of tumor angiogenesis. The upstream regulation is complex and involves several growth factors, cytokines, and hypoxia. Herein, we have identified miR-519c as a hypoxia-independent regulator of HIF-1α, acting through direct binding to the HIF-1α 3′ untranslated region and leading to reduced tumor angiogenesis. Overexpression of miR-519c resulted in a significant decrease of HIF-1α protein levels and reduced the tube formation of human umbilical vein endothelial cells; similarly, antagomir inhibition of miR-519c increased the level of HIF-1α protein and enhanced angiogenic activity, suggesting an important role of miR-519c in HIF-1α–mediated angiogenesis. Consistent with the overexpression of miR-519c in cancer patients with better prognosis, mice injected with miR-519c–overexpressing cells exhibited dramatically reduced HIF-1α levels, followed by suppressed tumor angiogenesis, growth, and metastasis. In addition, we found that hepatocyte growth factor (HGF), a known HIF-1α inducer, reduced the miR-519c levels through an Akt-dependent pathway. This regulation was posttranscriptional and may be mediated by suppression of miR-519c maturation. Taken together, our findings provide the first evidence that miR-519c is a pivotal regulator of tumor angiogenesis and that microenvironmental HGF contributes to regulating miR-519c biogenesis in cancer cells. Cancer Res; 70(7); 2675–85

The association of cytokine genotypes with gastric carcinoma (GC) may be influenced by environmental factors and varies among different populations. Few studies have addressed the impact of different cytokine genotypes on the development and progression of GC. We analyzed 11 functional polymorphisms in tumor necrosis factor‐α (TNF‐α), interleukin (IL)‐1, IL‐4 and IL‐10 genes in 220 Taiwanese Chinese with GC and in 230 healthy controls. The risk of genotypes was adjusted with confounding environmental risks. Our results revealed that the frequency of Helicobacter pylori infection [odds ratio (OR) 1.7, 95% confidence interval (CI) 1.19–2.56], cigarette smoking (OR 2.02, 95% CI 1.38–2.95) and high IL‐10 producer genotype (OR 2.67, 95% CI 1.29–5.50) was significantly increased in the entire GC patients. Among different subtypes of GC, a higher risk of developing diffuse type (OR 1.64, 95% CI 1.01–2.67) or cardia cancer (OR 2.44, 95% CI 1.13–2.67) was observed for the CT/CC genotype of IL‐4 at the position −590, whereas the high IL‐10 producer genotype was significantly linked with the risk of cardia cancer (OR 3.21, 95% CI 1.06–9.73) or advanced stage (OR 2.29, 95% CI 1.12–4.64). No association was noted between GC and controls in the distribution of IL‐1 and TNF‐α genotypes. Logistic regression analyses revealed that H. pylori infection (OR 1.7, 95% CI 1.14–2.52), cigarette smoking (OR 1.87, 95% CI 1.27–‐2.96) and IL‐10 genotype (OR 2.54, 95% CI 1.24–5.61) are independent risks for GC. Independent effects of IL‐10 genotype, H. pylori infection and cigarette smoking indicate that carcinogenesis of GC is influenced by a variety of host and environmental factors.

The aggressiveness of a tumor is partly attributed to its resistance to chemotherapeutic agent-induced apoptosis. Cysteine-rich 61 (Cyr61), from the CCN gene family, is a secreted and matrix-associated protein, which is involved in many cellular activities such as growth and differentiation. Here we established a cell model system to examine whether stable expression of Cyr61 in MCF-7 cells can confer resistance to apoptosis and identify possible participating mechanisms. We showed that stable cell lines overexpressing Cyr61 had acquired a remarkable resistance to apoptosis induced by paclitaxel, adriamycin, and β-lapachone. Most interesting, gel shift and reporter assays showed that the Cyr61-overexpressing cells had significantly increased NF-κB activity compared with neo control cells. Blockage of NF-κB activity in Cyr61-expressing cells by transfecting with a dominant negative (DN)-IκB or with an NF-κB decoy rendered them more susceptible to anti-cancer drugs-induced apoptosis. In addition, several NF-κB-regulated anti-apoptotic genes were examined, and we found that only XIAP showed a significant 3–4-fold increase in mRNA and protein in Cyr61-overexpressing cells but not in neo control cells. Treatment with inhibitor of apoptosis protein (XIAP)-specific antisense, but not sense, oligonucleotides abolished the apoptosis resistance of the Cyr61-overexpressing cells. At the same time, transfection of these stable cells with DN-IκB to block NF-κB activity also effectively reduced the elevated XIAP level. Function-neutralizing antibodies to α_vβ₃ and α_vβ₅ could inhibit Cyr61-mediated NF-κB activation as well as XIAP expression. Taken together, our data suggested that Cyr61 plays an important role in resistance to chemotherapeutic agent-induced apoptosis in human breast cancer MCF-7 cells by a mechanism involving the activation of the integrins/NF-κB/XIAP signaling pathway.

Resveratrol, a polyphenolic compound found in grapes and other fruits, has been reported to inhibit angiogenesis with an as yet elusive mechanism. Here, we investigate the detailed mechanism by which resveratrol inhibits vascular endothelial growth factor (VEGF)-induced angiogenic effects in human umbilical endothelial cells (HUVECs). Exposure of HUVECs to 1 to 2.5 μM resveratrol significantly blocked VEGF-mediated migration and tube formation but not cell proliferation. Under the same concentrations, resveratrol failed to affect VEGF-stimulated activation of VEGF receptor, extracellular signal-regulated protein kinase 1/2, p38 mitogen-activated protein kinase, and Akt. Of interest, resveratrol, at the dose of 1 or 2.5 μM, effectively abrogated VEGF-mediated tyrosine phosphorylation of vascular endothelial (VE)-cadherin and its complex partner, β-catenin. This inhibitory effect of resveratrol reflected on the retention of VE-cadherin at cell-cell contacts as demonstrated by immunofluorescence. Src kinase assay showed that VEGF-induced endogenous Src kinase activation was strongly inhibited by 1 and 2.5 μM resveratrol. Supportively, inhibition of Src activity by overexpression of Csk resulted in attenuation of the tyrosine phosphorylation of VE-cadherin and endothelial cell (EC) tube formation. Again, transfection with v-Src, an active form of Src, could reverse resveratrol inhibition of VE-cadherin tyrosine phosphorylation and EC tube formation. Reactive oxygen species (ROS) has been shown to be involved in VE-cadherin phosphorylation and its related functions. Flow cytometric analysis showed that VEGF stimulated an evident increase of peroxide, which was strongly attenuated by resveratrol. In addition, antioxidant N-acetyl-cysteine was demonstrated to strongly inhibit VEGF-mediated Src activation, VE-cadherin tyrosine phosphorylation, and HUVEC tube formation. Together, our data suggest that resveratrol inhibition of VEGF-induced angiogenesis was mediated by disruption of ROS-dependent Src kinase activation and the subsequent VE-cadherin tyrosine phosphorylation.