Background
Sepsis is characterized by a complex immune response. This meta-analysis evaluated the clinical effectiveness of intravenous IgM-enriched immunoglobulin (IVIgGM) in patients with sepsis and septic shock.
Methods
Four databases, PubMed, the Cochrane Library, the ISI Web of Knowledge, and Embase, were systematically searched from inception to June 2018 to update the 2013 edition of the Cochrane review by two investigators, who independently selected studies, extracted relevant data, and evaluated study quality. Data were subjected to a meta-analysis and trial sequential analysis (TSA) for the primary and secondary outcomes. Level of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scale.
Results
Nineteen studies comprising 1530 patients were included in this meta-analysis. Pooled analyses showed that the use of IVIgGM reduced the mortality risk of septic patients (relative risk 0.60; 95% confidence interval [CI] 0.52–0.69,
I
2
= 0%). TSA showed that IVIgGM had a significant effect on mortality. Additionally, the meta-analysis suggested that use of IVIgGM shortened length of mechanical ventilation (mean difference − 3.16 days; 95% CI − 5.71 to − 0.61 days) and did not shorten length of stay in the intensive care unit (mean difference − 0.38 days; 95% CI − 3.55 to 2.80 days). The GRADE scale showed that the certainty of the body of evidence was low for both benefits and IVIgGM.
Conclusion
Administration of IVIgGM to adult septic patients may be associated with reduced mortality. Treatment effects tended to be smaller or less consistent when including only those studies deemed adequate for each indicator. The available evidence is not clearly sufficient to support the widespread use of IVIgGM in the treatment of sepsis.
Trial registration
PROSPERO registration number: CRD42018084120. Registered on 11 February 2018.
Electronic supplementary material
The online version of this article (10.1186/s13613-019-0501-3) contains supplementary material, which is available to authorized users.
Hepatocellular carcinoma (HCC) is one of the most common and lethal malignancies worldwide, and epithelial-mesenchymal transition (EMT) is a crucial factor affecting HCC progression and metastasis. Long noncoding RNAs (lncRNAs) have been validated to act as critical regulators of biological processes in various tumors. Herein, we attempted to elucidate the uncharacterized function and mechanism of lncRNA DLGAP1-AS1 in regulating tumorigenesis and EMT of HCC. In our study, DLGAP1-AS1 was shown to be upregulated in HCC cell lines and capable to promote HCC progression and EMT. Besides, DLGAP1-AS1 was proven to serve as a molecular sponge to sequester the HCC-inhibitory miRNAs, miR-26a-5p and miR-26b-5p, thus enhancing the level of an oncogenic cytokine IL-6, which could activate JAK2/STAT3 signaling pathway and reciprocally elevate the transcriptional activity of DLGAP1-AS1, thus forming a positive feedback loop. Moreover, we elaborated that the cancerogenic effects of DLGAP1-AS1 in HCC cells could be effectuated via activating Wnt/β-catenin pathway by positively regulating CDK8 and LRP6, downstream genes of miR-26a/b-5p. In conclusion, our results demonstrated the detailed molecular mechanism of DLGAP1-AS1 in facilitating HCC progression and EMT in vitro and in vivo, and suggested the potentiality of DLGAP1-AS1 as a therapeutic target for HCC.
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are the severe lung damage and respiratory failure without effective therapy. However, there was a lack of understanding of the mechanism by which exosomes regulate autophagy during ALI/ARDS. Here, we found lipopolysaccharide (LPS) significantly increased inflammatory factors, administration of exosomes released by human umbilical cord mesenchymal stem cells (hucMSCs) successfully improved lung morphometry. Further studies showed that miR-377-3p in the exosomes played a pivotal role in regulating autophagy, leading to protect LPS induced ALI. Compared to exosomes released by human fetal lung fibroblast cells (HFL-1), hucMSCs-exosomes overexpressing miR-377-3p more effectively suppressed the bronchoalveolar lavage (BALF) and inflammatory factors and induced autophagy, causing recoveration of ALI. Administration of miR-377-3p expressing hucMSCs-exosomes or its target regulatory-associated protein of mTOR (RPTOR) knockdown significantly reduced ALI. In summary, miR-377-3p released by hucMSCs-exosomes ameliorated Lipopolysaccharide-induced acute lung injury by targeting RPTOR to induce autophagy in vivo and in vitro.
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