bims-instec Biomed News
on Intestinal stem cells and chemoresistance in colon cancer and intestinal regeneration
Issue of 2022‒09‒25
thirteen papers selected by
Maria-Virginia Giolito
Free University of Brussels
  1. Clone wars: From molecules to cell competition in intestinal stem cell homeostasis and disease.
  2. Colorectal cancer organoid models uncover oxaliplatin-resistant mechanisms at single cell resolution.
  3. Autophagic state prospectively identifies facultative stem cells in the intestinal epithelium.
  4. Construction and Validation of an Oxaliplatin-Resistant Gene Signature in Colorectal Cancer Patients Who Underwent Chemotherapy.
  5. ARID1A mutations confer intrinsic and acquired resistance to cetuximab treatment in colorectal cancer.
  6. From organoids to bedside: advances in modeling, decoding and targeting of colorectal cancer.
  7. Promotion or remission: a role of noncoding RNAs in colorectal cancer resistance to anti-EGFR therapy.
  8. The Evolving Landscape of Immunotherapy in Locally Advanced Rectal Cancer Patients.
  9. Complement downregulation promotes an inflammatory signature that renders colorectal cancer susceptible to immunotherapy.
  10. Intestinal epithelial c-Maf expression determines enterocyte differentiation and nutrient uptake in mice.
  11. Inhibition of GABAA receptors in intestinal stem cells prevents chemoradiotherapy-induced intestinal toxicity.
  12. DPYD and TYMS polymorphisms as predictors of 5 fluorouracil toxicity in colorectal cancer patients.
  13. Oxaliplatin inhibits colorectal cancer progression by inhibiting CXCL11 secreted by cancer-associated fibroblasts and the CXCR3/PI3K/AKT pathway.
  1. Exp Mol Med. 2022 Sep 18.
    Clone wars: From molecules to cell competition in intestinal stem cell homeostasis and disease.
    Gabriele Colozza, So-Yeon Park, Bon-Kyoung Koo.
      The small intestine is among the fastest self-renewing tissues in adult mammals. This rapid turnover is fueled by the intestinal stem cells residing in the intestinal crypt. Wnt signaling plays a pivotal role in regulating intestinal stem cell renewal and differentiation, and the dysregulation of this pathway leads to cancer formation. Several studies demonstrate that intestinal stem cells follow neutral drift dynamics, as they divide symmetrically to generate other equipotent stem cells. Competition for niche space and extrinsic signals in the intestinal crypt is the governing mechanism that regulates stemness versus cell differentiation, but the underlying molecular mechanisms are still poorly understood, and it is not yet clear how this process changes during disease. In this review, we highlight the mechanisms that regulate stem cell homeostasis in the small intestine, focusing on Wnt signaling and its regulation by RNF43 and ZNRF3, key inhibitors of the Wnt pathway. Furthermore, we summarize the evidence supporting the current model of intestinal stem cell regulation, highlighting the principles of neutral drift at the basis of intestinal stem cell homeostasis. Finally, we discuss recent studies showing how cancer cells bypass this mechanism to gain a competitive advantage against neighboring normal cells.
    DOI:  https://doi.org/10.1038/s12276-022-00854-5
  2. Cell Oncol (Dordr). 2022 Sep 22.
    Colorectal cancer organoid models uncover oxaliplatin-resistant mechanisms at single cell resolution.
    Guanglong Chen, Ting Gong, Zhe Wang, Zeyu Wang, Xiaolin Lin, Sunrui Chen, Chu Sun, Weijie Zhao, Ye Kong, Huihan Ai, Hang Yang, Yusheng Liu, Fangyan Wu, Jiawei Kang, Shasha Zhao, Xiuying Xiao, Jing Sun, Aina He, Zhi Li.
      PURPOSE: Oxaliplatin-based chemotherapy is a standard treatment for advanced colorectal cancer (CRC) patients. However, chemoresistance-induced resistance is an essential cause for mortality. Therefore, it is necessary to study the mechanism of drug resistance in CRC.METHODS: Here, we established two strains of patient-derived organoids (PDOs) selected from oxaliplatin-resistant and treatment-naïve CRC patients. To dissect the drug-resistant mechanisms, these CRC-PDOs were subjected to single-cell RNA sequencing (scRNA-Seq).
    RESULTS: We found that the drug sensitivity test outcome from these organoids subjected to oxaliplatin and 5-FU exposure was consistent with the clinic readout. CRC-PDOs well recapitulated the morphology and histology of their parental biopsies based on HE and IHC staining of pathological biomarkers. The scRNA-Seq data filtered drug-resistant cell populations and related signaling pathways (e.g. oxidative phosphorylation and ATP metabolic process). The data also revealed several putative drug resistant-driven genes (STMN1, VEGFA and NDRG1) and transcription factors (E2F1, BRCA1, MYBL2, CDX2 and CDX1).
    CONCLUSION: We generated an oxaliplatin-resistant CRC organoid model that was employed to provide potential therapeutic targets for treating CRC patients exhibiting oxaliplatin-resistance.
    Keywords:  Colorectal cancer (CRC); Drug resistance; Organoid; Oxaliplatin-resistance; Single-cell RNA sequencing (scRNA-Seq)
    DOI:  https://doi.org/10.1007/s13402-022-00705-5
  3. EMBO Rep. 2022 Sep 19. e55209
    Autophagic state prospectively identifies facultative stem cells in the intestinal epithelium.
    Nicolette M Johnson, Louis R Parham, Jeeyoon Na, Keara E Monaghan, Hannah M Kolev, Alena Klochkova, Melissa S Kim, Charles H Danan, Zvi Cramer, Lauren A Simon, Kaitlyn E Naughton, Stephanie Adams-Tzivelekidis, Yuhua Tian, Patrick A Williams, N Adrian Leu, Simone Sidoli, Kelly A Whelan, Ning Li, Christopher J Lengner, Kathryn E Hamilton.
      The intestinal epithelium exhibits a rapid and efficient regenerative response to injury. Emerging evidence supports a model where plasticity of differentiated cells, particularly those in the secretory lineages, contributes to epithelial regeneration upon ablation of injury-sensitive stem cells. However, such facultative stem cell activity is rare within secretory populations. Here, we ask whether specific functional properties predict facultative stem cell activity. We utilize in vivo labeling combined with ex vivo organoid formation assays to evaluate how cell age and autophagic state contribute to facultative stem cell activity within secretory lineages. Strikingly, we find that cell age (time elapsed since cell cycle exit) does not correlate with secretory cell plasticity. Instead, high autophagic vesicle content predicts plasticity and resistance to DNA damaging injury independently of cell lineage. Our findings indicate that autophagic status prior to injury serves as a lineage-agnostic marker for the prospective identification of facultative stem cells.
    Keywords:  autophagy; facultative stem cell; organoid formation; paligenosis; regeneration
    DOI:  https://doi.org/10.15252/embr.202255209
  4. Pharmaceuticals (Basel). 2022 Sep 13. pii: 1139. [Epub ahead of print]15(9):
    Construction and Validation of an Oxaliplatin-Resistant Gene Signature in Colorectal Cancer Patients Who Underwent Chemotherapy.
    Yixin Yin, Siqi Li, Xinqiang Liang, Kezhi Li, Mingzhi Xie, Bangli Hu.
      Aberrant expression of genes contributes to the chemoresistance of colorectal cancer (CRC) treatment. This study aimed to identify genes associated with the chemoresistance of oxaliplatin-based chemotherapy in CRC patients and to construct a signature. Oxaliplatin resistance-related genes were screened by analyzing the gene profiles of cell lines and tissue samples that underwent oxaliplatin-based treatment. Oxaliplatin resistance-related genes were used to establish a signature. The association of the signature had clinical significance, so the prognostic value of the signature was analyzed. Independent cohorts and CRC cell lines were used to validate the value of the gene signature and the oxaliplatin-resistant genes. There were 64 oxaliplatin resistance-related genes identified after overlapping the genes from the dataset of oxaliplatin-treated CRC cells and the dataset of patients treated with oxaliplatin-based chemotherapy. A gene signature based on five oxaliplatin resistance-related genes was established. This gene signature effectively predicted the prognosis of CRC patients who underwent chemotherapy. No significant associations were found between the gene mutations and survival of the patients; however, two genes were associated with microsatellite instability status. Two external independent cohorts and CRC cell line experiments validated the prognostic values of the signature and expression of the genes after oxaliplatin treatment. In conclusion, the oxaliplatin resistance-related gene signature involving five genes was a novel biomarker for the prediction of the chemotherapy response and prognosis of CRC patients who underwent oxaliplatin-based chemotherapy.
    Keywords:  chemoresistance; colorectal cancer; gene signature; oxaliplatin
    DOI:  https://doi.org/10.3390/ph15091139
  5. Nat Commun. 2022 Sep 19. 13(1): 5478
    ARID1A mutations confer intrinsic and acquired resistance to cetuximab treatment in colorectal cancer.
    Radia M Johnson, Xueping Qu, Chu-Fang Lin, Ling-Yuh Huw, Avinashnarayan Venkatanarayan, Ethan Sokol, Fang-Shu Ou, Nnamdi Ihuegbu, Oliver A Zill, Omar Kabbarah, Lisa Wang, Richard Bourgon, Felipe de Sousa E Melo, Chris Bolen, Anneleen Daemen, Alan P Venook, Federico Innocenti, Heinz-Josef Lenz, Carlos Bais.
      Most colorectal (CRC) tumors are dependent on EGFR/KRAS/BRAF/MAPK signaling activation. ARID1A is an epigenetic regulator mutated in approximately 5% of non-hypermutated CRC tumors. Here we show that anti-EGFR but not anti-VEGF treatment enriches for emerging ARID1A mutations in CRC patients. In addition, we find that patients with ARID1A mutations, at baseline, are associated with worse outcome when treated with cetuximab- but not bevacizumab-containing therapies; thus, this suggests that ARID1A mutations may provide both an acquired and intrinsic mechanism of resistance to anti-EGFR therapies. We find that, ARID1A and EGFR-pathway genetic alterations are mutually exclusive across lung and colorectal cancers, further supporting a functional connection between these pathways. Our results not only suggest that ARID1A could be potentially used as a predictive biomarker for cetuximab treatment decisions but also provide a rationale for exploring therapeutic MAPK inhibition in an unexpected but genetically defined segment of CRC patients.
    DOI:  https://doi.org/10.1038/s41467-022-33172-5
  6. Int J Cancer. 2022 Sep 19.
    From organoids to bedside: advances in modeling, decoding and targeting of colorectal cancer.
    Johannes Betge, Rene Jackstadt.
      Patient derived organoids closely resemble the biology of tissues and tumors. They are enabling ex vivo modeling of human diseases and dissecting key features of tumor biology like anatomical diversity or inter- and intra-tumoral heterogeneity. In the last years, organoids were established as models for drug discovery and explored to guide clinical decision making. In this review, we discuss the recent developments in organoid based research, elaborating on the developments in colorectal cancer as a prime example. We focus our review on the role of organoids to decode cancer cell dynamics and tumor microenvironmental complexity with the underlying bi-directional crosstalk. Additionally, advancements in the development of living biobanks, screening approaches, organoid based precision medicine and challenges of co-clinical trials are highlighted. We discuss ongoing efforts to overcome challenges that the field faces and indicate potential future directions. This article is protected by copyright. All rights reserved.
    Keywords:  Organoid; drug screening; heterogeneity; microenvironment; precision medicine
    DOI:  https://doi.org/10.1002/ijc.34297
  7. Cell Commun Signal. 2022 Sep 21. 20(1): 150
    Promotion or remission: a role of noncoding RNAs in colorectal cancer resistance to anti-EGFR therapy.
    Shanshan Wei, Wenwei Hu, Jun Feng, Yiting Geng.
      Anti-epidermal-growth-factor-receptor (EGFR) monoclonal antibodies (mAbs) are of great significance for RAS and BRAF wild-type metastatic colorectal cancer (mCRC) patients. However, the generation of primary and secondary resistance to anti-EGFR mAbs has become an important factor restricting its efficacy. Recent studies have revealed that non-coding RNAs (ncRNAs), especially long non-coding RNAs (lncRNAs), microRNAs (miRNAs), and circular RNAs (circRNAs), are implicated in anti-EGFR antibodies resistance, affecting the sensitivity of CRC cells to Cetuximab and Panitumumab. This paper briefly reviewed the research advance of the expression, signaling network and functional mechanism of ncRNAs related to anti-EGFR mAbs resistance in CRC, as well as their relationship with clinical prognosis and the possibility of therapeutic targets. In addition, some ncRNAs that are involved in the regulation of signaling pathways or genes related to anti-EGFR resistance, but need to be further verified by resistance experiments were also included in this review, thereby providing more ideas and basis for ncRNAs as CRC prognostic markers and anti-EGFR therapy sensitizers. Video Abstract.
    Keywords:  Anti-EGFR monoclonal antibody; Colorectal cancer; Resistance; cicrRNA; lncRNA; miRNA; ncRNA
    DOI:  https://doi.org/10.1186/s12964-022-00960-x
  8. Cancers (Basel). 2022 Sep 14. pii: 4453. [Epub ahead of print]14(18):
    The Evolving Landscape of Immunotherapy in Locally Advanced Rectal Cancer Patients.
    Marco Maria Germani, Martina Carullo, Alessandra Boccaccino, Veronica Conca, Gianluca Masi.
      Standard treatments of localized rectal cancer are surgery or the multimodal approach with neoadjuvant treatments (chemo-radiotherapy, short-course radiotherapy, induction, or consolidation chemotherapy) followed by surgery. In metastatic colorectal cancer (mCRC), immune checkpoint inhibitors (ICIs) are now the first choice in patients with a deficient mismatch repair system/microsatellite instability (dMMR/MSI-H) and are being explored in combination with chemotherapy to rewire the immune system against malignant cells in subjects with proficient mismatch repair system/microsatellite low (pMMR/MSI-L) cancers, with promising signals of efficacy. Recently, some efforts have been made to translate ICIs in earlier stages of CRC, including localized rectal cancer, with breakthrough efficacy and an organ preservation rate of mono-immunotherapy in dMMR/MSI-H patients and promising anti-tumor activity of immunotherapy plus neoadjuvant (chemo)radiotherapy in pMMR/MSI-L subjects. Here, we present the rationale, results, and limitations of the most remarkable trials assessing ICIs in dMMR/MSI-H and pMMR/MSI-L localized rectal cancer patients, at the same time highlighting the most promising research perspectives that have followed these studies.
    Keywords:  deficient mismatch repair system/microsatellite instability; immune checkpoint inhibitors; localized rectal cancer; non-operative management; proficient mismatch repair system/microsatellite stability
    DOI:  https://doi.org/10.3390/cancers14184453
  9. J Immunother Cancer. 2022 Sep;pii: e004717. [Epub ahead of print]10(9):
    Complement downregulation promotes an inflammatory signature that renders colorectal cancer susceptible to immunotherapy.
    Carsten Krieg, Lukas M Weber, Bruno Fosso, Marinella Marzano, Gary Hardiman, Monica M Olcina, Enric Domingo, Sahar El Aidy, Khalil Mallah, Mark D Robinson, Silvia Guglietta.
      BACKGROUND AND AIMS: The role of inflammatory immune responses in colorectal cancer (CRC) development and response to therapy is a matter of intense debate. While inflammation is a known driver of CRC, inflammatory immune infiltrates are a positive prognostic factor in CRC and predispose to response to immune checkpoint blockade (ICB) therapy. Unfortunately, over 85% of CRC cases are primarily unresponsive to ICB due to the absence of an immune infiltrate, and even the cases that show an initial immune infiltration can become refractory to ICB. The identification of therapy supportive immune responses in the field has been partially hindered by the sparsity of suitable mouse models to recapitulate the human disease. In this study, we aimed to understand how the dysregulation of the complement anaphylatoxin C3a receptor (C3aR), observed in subsets of patients with CRC, affects the immune responses, the development of CRC, and response to ICB therapy.METHODS: We use a comprehensive approach encompassing analysis of publicly available human CRC datasets, inflammation-driven and newly generated spontaneous mouse models of CRC, and multiplatform high-dimensional analysis of immune responses using microbiota sequencing, RNA sequencing, and mass cytometry.
    RESULTS: We found that patients' regulation of the complement C3aR is associated with epigenetic modifications. Specifically, downregulation of C3ar1 in human CRC promotes a tumor microenvironment characterized by the accumulation of innate and adaptive immune cells that support antitumor immunity. In addition, in vivo studies in our newly generated mouse model revealed that the lack of C3a in the colon activates a microbiota-mediated proinflammatory program which promotes the development of tumors with an immune signature that renders them responsive to the ICB therapy.
    CONCLUSIONS: Our findings reveal that C3aR may act as a previously unrecognized checkpoint to enhance antitumor immunity in CRC. C3aR can thus be exploited to overcome ICB resistance in a larger group of patients with CRC.
    Keywords:  Gastrointestinal Neoplasms; Immunity, Innate; Immunotherapy
    DOI:  https://doi.org/10.1136/jitc-2022-004717
  10. J Exp Med. 2022 Dec 05. pii: e20220233. [Epub ahead of print]219(12):
    Intestinal epithelial c-Maf expression determines enterocyte differentiation and nutrient uptake in mice.
    Catalina Cosovanu, Philipp Resch, Stefan Jordan, Andrea Lehmann, Markus Ralser, Vadim Farztdinov, Joachim Spranger, Michael Mülleder, Sebastian Brachs, Christian Neumann.
      The primary function of the small intestine (SI) is to absorb nutrients to maintain whole-body energy homeostasis. Enterocytes are the major epithelial cell type facilitating nutrient sensing and uptake. However, the molecular regulators governing enterocytes have remained undefined. Here, we identify c-Maf as an enterocyte-specific transcription factor within the SI epithelium. c-Maf expression was determined by opposing Noggin/BMP signals and overlapped with the zonated enrichment of nutrient transporters in the mid-villus region. Functionally, enterocytes required c-Maf to appropriately differentiate along the villus axis. Specifically, gene programs controlling carbohydrate and protein absorption were c-Maf-dependent. Consequently, epithelial cell-specific c-Maf deletion resulted in impaired enterocyte maturation and nutrient uptake, including defects in the adaptation to different nutrient availability. Concomitantly, intraepithelial lymphocytes were less abundant, while commensal epithelial cell-attaching SFB overgrew in a c-Maf-deficient environment, highlighting the close interdependence between the intestinal epithelium, immune system, and microbiota. Collectively, our data identified c-Maf as a key regulator of SI enterocyte differentiation and function, essential for nutrient, immune, and microbial homeostasis.
    DOI:  https://doi.org/10.1084/jem.20220233
  11. J Exp Med. 2022 Dec 05. pii: e20220541. [Epub ahead of print]219(12):
    Inhibition of GABAA receptors in intestinal stem cells prevents chemoradiotherapy-induced intestinal toxicity.
    Cuiyu Zhang, Yuping Zhou, Junjie Zheng, Nannan Ning, Haining Liu, Wenyang Jiang, Xin Yu, Kun Mu, Yan Li, Wei Guo, Huili Hu, Jingxin Li, Dawei Chen.
      Lethal intestinal tissue toxicity is a common side effect and a dose-limiting factor in chemoradiotherapy. Chemoradiotherapy can trigger DNA damage and induce P53-dependent apoptosis in LGR5+ intestinal stem cells (ISCs). Gamma-aminobutyric acid (GABA) and its A receptors (GABAAR) are present in the gastrointestinal tract. However, the functioning of the GABAergic system in ISCs is poorly defined. We found that GABAAR α1 (GABRA1) levels increased in the murine intestine after chemoradiotherapy. GABRA1 depletion in LGR5+ ISCs protected the intestine from chemoradiotherapy-induced P53-dependent apoptosis and prolonged animal survival. The administration of bicuculline, a GABAAR antagonist, prevented chemoradiotherapy-induced ISC loss and intestinal damage without reducing the chemoradiosensitivity of tumors. Mechanistically, it was associated with the reduction of reactive oxygen species-induced DNA damage via the L-type voltage-dependent Ca2+ channels. Notably, flumazenil, a GABAAR antagonist approved by the U.S. Food and Drug Administration, rescued human colonic organoids from chemoradiotherapy-induced toxicity. Therefore, flumazenil may be a promising drug for reducing the gastrointestinal side effects of chemoradiotherapy.
    DOI:  https://doi.org/10.1084/jem.20220541
  12. J Chemother. 2022 Sep 22. 1-10
    DPYD and TYMS polymorphisms as predictors of 5 fluorouracil toxicity in colorectal cancer patients.
    Yassine Khalij, Imtinen Belaid, Sana Chouchane, Dorra Amor, Asma Omezzine, Nabila Ben Rejeb, Slim Ben Ahmed, Ali Bouslama.
      Colorectal cancer (CRC) is the third most common cancer and the fourth leading cause of cancer death. 5-Fluorouracil (5-FU) is an essential component of systemic chemotherapy for CRC. Our objective was to determine the genotypic frequency of polymorphisms affecting dihydropyrimidine dehydrogenase (DPYD) and thymidylate synthetase (TYMS) genes and to correlate the genetic profile with the toxicity due to 5-FU, also considering nongenetic factors. This is a prospective study that involved 66 patients. We extracted DNA by salting out methods. We carried out the genotyping of the different polymorphisms by simple PCR for the TYMS 5'UTR and by PCR-RFLP for DPYD: 1905 + 1 G > A, 85 T > C, 496 A > G, 1679 T > G, c.483 + 18G > A and the TYMS: 5'UTR VNTR, 5'UTR G > C and 3'UTR. The study of the association of DPYD and TYMS polymorphisms with the various signs of toxicity under 5-FU revealed that the polymorphisms 496 A > G were significantly associated with hepatotoxicity: OR = 3.85 (p = 0.04). In addition, 85 T > C was significantly associated with mucositis and neurotoxicity: OR = 4.35 (p = 0.03), OR = 3.79 (p = 0.02). For TYMS, the only significant association we observed for 5'UTR with vomiting: OR = 3.34 (p = 0.04). The incidence of adverse reactions related to 5-FU appears to be influenced in patients with CRC by the identified DPYD and TYMS gene polymorphisms in the Tunisian population.
    Keywords:  Pharmacogenetics; biomarkers; dihydropyrimidine dehydrogenase; personalized medicine; pharmacokinetic; response; thymidylate synthetase
    DOI:  https://doi.org/10.1080/1120009X.2022.2125736
  13. Clin Transl Oncol. 2022 Sep 21.
    Oxaliplatin inhibits colorectal cancer progression by inhibiting CXCL11 secreted by cancer-associated fibroblasts and the CXCR3/PI3K/AKT pathway.
    Caifu Lu, Cong Zhang.
      PURPOSE: Colorectal cancer (CRC) is a malignant tumor. Oxaliplatin (OXA) can inhibit cancer-associated fibroblasts (CAFs)-induced cancer progression. This study sought to explore the mechanism of OXA in CAFs-induced CRC development.METHODS: CRC cell lines (Caco-2, SW620), normal fibroblasts (NFs), and CAFs were treated with OXA. NFs and CAFs were cultured. CAFs were treated with/without OXA (0.4 mM), and the supernatant was extracted as the conditioned medium (CM) to culture CRC cells. Cell malignant episodes, E-cadherin and Vimentin levels, CXCL1, CXCL2, CXCL3, CXCL8, and CXCL11 mRNA levels, CXCL11 protein level, and extracellular release were assessed. CAFs were transfected with interfering RNA sh-CXCL11 to silence CXCL11 or transfected with CXCL11 overexpression plasmids and treated with OXA to explore the role of CXCL11 in OXA-mediated CRC cells through CAFs. CXCL11 receptor CXCR3 levels in CRC cells and the PI3K/AKT pathway changes were examined. The xenogeneic tumor was transplanted in nude mice. CXCL11 and CXCR3 levels in tumor tissues, tumor volume, shape, size, weight, and Ki67 positive expressions were assessed.
    RESULTS: CRC cell growths and epithelial-mesenchymal transformation were stimulated after culture with CAFs-CM, while OXA averted these trends. CXCL11 mRNA level was elevated most significantly, and its protein and extracellular secretion levels were raised, while OXA diminished the levels. CXCL11 silencing weakened the effects of CAFs-CM on promoting CRC proliferation and malignant episodes and CXCL11 overexpression averted OXA property on inhibiting CAFs-promoted CRC cell growth. CXCR3 and PI3K and AKT1 phosphorylation levels were raised in the CAFs-CM group but diminished by OXA. CXCL11 overexpression in CAFs averted OXA property on inhibiting CAFs-activated CXCR3/PI3K/AKT in CRC cells. OXA also inhibited the progression of xenograft tumors by limiting CAFs-secreted CXCL11.
    CONCLUSIONS: OXA repressed CRC progression by inhibiting CAFs-secreted CXCL11 and the CXCR3/PI3K/AKT pathway.
    Keywords:  CXCL11; CXCR3; Cancer-associated fibroblasts; EMT; Oxaliplatin; PI3K/AKT
    DOI:  https://doi.org/10.1007/s12094-022-02922-8
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