CIAPIN1 Is a Potential Target for Apoptosis of Multiple Myeloma

Materials Express

CIAPIN1 is a potential target for apoptosis of multiple myeloma

Xiao-Bo Wang1,†,Le-PingYan1,2,†,Li-HuaYuan3,†,BoLu1, Dong-Jun Lin1,∗, and Xiao-Jun Xu1,∗ 1Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518106, PR China 2Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518106, PR China 3The University of Hong Kong—Shenzhen Hospital, Shenzhen, 518053, PR China

ABSTRACT This study ﬁrstly aimed to reveal the gene expression differences of CIAPIN1 between myelomas cells from bone marrow cells of multiple myeloma patients and normal human, and subsequently investigate the regulation role of this gene on tumorigenicity ability of multiple myeloma (MM) cell line U266 via in vitro colony formation and in vivo xenograftIP: studies. 192.168.39.151 RT-PCR resultsOn: Fri, obtai 01 Octned 2021 from 18:58:12 18 MM patients and 10 health people showed that the expression of CIAPIN1Copyright: gene American was 4 times Scientific higher Publishers in normal human compared to MM patients. Besides, CIAPIN1 siRNA (si-CIAPIN1) transfectedDelivered U266 by cellsIngenta presented higher proliferation ratio and superior colony forming ability than U266 cells and U266 cells transfected with non-coding siRNA (controls) evaluated

Article by CCK8 test and soft agar colony formation assay, respectively. In a mice MM xenograft model, the si-CIAPIN1 transfected U266 cells induced the biggest tumor compared to the controls. Furthermore, CIAPIN1 overex- pressed U266 cells were developed and compared with the si-CIAPIN1 transfected U266 cells to study the role of CIAPIN1 in the production of apoptosis related proteins in U266 cells. Results indicated that CIAPIN1 facilitated apoptosis promoting proteins expression in U266 cells, such as upregulation of BAX, BAK, Bcl-xs and BIM, and downregulation of p38, PKC, Bcl-2 and Bcl-xl proteins. Therefore, CIAPIN1 can be a potential suppression target gene in multiple myeloma. Keywords: CIAPIN1, Multiple Myeloma, Apoptosis, Tumorigenicity.

1. INTRODUCTION However, since the pathogenesis of the MM still remains As a type B lymphocyte clone malignant tumor, multi- unclear, it is of essence to explore the underlying ple myeloma (MM) is characteristic of the over-growth mechanism. of plasma cells from bone marrow, insufﬁcient apopto- Cytokine induced apoptosis inhibitor 1 (CIAPIN1 or sis, as well as the abnormal globulin secretion. After anamorsin) was a new cell regulator that found in 2004, more than 20 years of research and practice, the appli- which was independent of Apoptosis-regulatory Genes cation of high-dose chemotherapy and transplantation Bcl2 family and caspase family [4]. In different tumor of autologous hemopoietic stem cell [1], Immunomod- cells, CIAPIN1 played different regulatory roles. Our pre- ulator [2] and proteasome inhibitors [3], have signif- vious study has conﬁrmed that CIAPIN1 could inhibit the icantly extended the survival rates in MM patients. proliferation of multiple myeloma cells [5]. Therefore, we aimed to continually explore the gene expression differences of CIAPIN1 in MM patients and health human, as ∗Authors to whom correspondence should be addressed. Email: [email protected], [email protected] well as its role in regulation of multiple myeloma cells in †These three authors contributed equally to this work. current study.

1106 Mater. Express, Vol. 9, No. 9, 2019 CIAPIN1 is a potential target for apoptosis of multiple myeloma Materials Express Wang et al.

2. MATERIALS AND METHODS corresponding cycle values. The gene copy numbers ratio The current study (including the use of human samples and of CIAPIN1:GAPDH in the samples was employed as the animal study) followed the guideline of the Declaration of relative CIAPIN1 gene expression level. Helsinki and got approval from the Ethics Committee of The Seventh Affiliated Hospital, Sun Yat-sen University 2.5. CCK8 Assay (Shenzhen). All participants signed informed consent and Exponentially growing U266 cells in each group were agreed for the publication of the results. seeded in the 96-well plate (0.8 × 104/mL/well). The cells were Incubated at 37 C for 1 to 4 days. Subsequently, 2.1. Samples of Patients and Normal People the cells were further cultured with 10 L of CCK8 for All the specimens were collected from patients at 4 hours. The optical density was measured under 450 nm The Seventh Affiliated Hospital, Sun Yat-sen Univer- in a microplate reader (iMARK; Bio-Ras, CA, USA). sity (Shenzhen) from 2017 to 2018. The CD138 positive myeloma cells were obtained from the bone marrow in 18 2.6. Soft Agar Colony Forming Assay patients (13 males and 5 females, with age ranged from U266 cells were set up in each group and the cell sus- 45–69 years old) in whom multiple myeloma had been pension of 500 cells/mL was prepared by the RPMI 1640 pathologically confirmed and were purified with CD138 medium (20% FBS). Cell and agarose suspensions were antibody accordingly [6]. The bone marrow mononuclear made by 9 mL of each group cell suspension and 1 mL 3% cells were extracted from 10 normal people (5 males and low melting point agarose solution. The cell and agarose 5 females, with age ranged from 30–57 years old). suspensions were inoculated into the 6-well plate, each well for 3 mL. The 6-well plate were placed in the 4 C 2.2. Cells Culture refrigerator about 10 minutes for solidification, and cul- The U266 cells were obtained from the ATCC (USA) and tured in cell incubator for 16 days. The cells were stained the RPMI 1640 medium (Gibco®, Thermal Fisher Scien- with crystal violet (0.05%) and the numbers of colonies

tific, Waltham, MA, USA) containing 15% FBS (Gemini were recorded under microscope observation. Article Bio Products, Broderick, CA, USA) was used for the cell culture. Standard culture conditions were employed 2.7. Nude Mouse Tumorigenicity Assay IP: 192.168.39.151 On: Fri, 01 Oct 2021 18:58:12 (37 C, 5% CO2). Copyright: American Scientific24 female Publishers BALB/c nude mice (age 4–6 weeks, weight Delivered by18–20 Ingenta g,) were randomly divided into 4 groups. 0.2 mL 2.3. Cell Transfection and Screening of 1 × 107/ mL cells were subcutaneously inoculated into The U266 cells were firstly transfected with CIAPIN1- the forelimb of the nude mouse to form the skin rash at small interfering RNA (U266-siRNA), non-coding siRNA ∼3 mm in diameter. The mice were sacrificed after 20 days (U266-NC) for cell proliferation, soft agar colony and of the inoculation. The tumors were measured by a venire nude mice tumorigenicity model studies. In the following caliper and the tumor volume was calculated as: V = A Western blot study, the U266, U266-siRNA and U266- (long diameter)×B2 (short-diameter)/2. The tumor in nude NC cells were further transfected with CIAPIN1 overex- mouse of each group was proved to be a xenograft by pression lentivirus vectors and the names of the groups pathological examination (H&E staining, Fig. 4). were as following: U266-O, U266-NC-O, U266-siRNA- O. The construction of CIAPIN1-small interfering RNA, 2.8. Western Blotting non-coding siRNA and CIAPIN1-overexpressing lentivirus The viable cells were collected and the total protein was vectors, cells transfection procedure were performed as extracted. A BCA Quantitative Kit (Beyotime Biotech- previously described [5]. The nucleotide sequence of nology, CHINA) was employed to test concentrations of CIAPIN1 could be found in the GENBANK database as the proteins. Subsequently, the proteins were run in SDS- (GENBANK: 020313.2 NM). PAGE. After transferring the gel to the PVF membrane (Millipore Corporation, USA), blocking of the membrane 2.4. Real-Time PCR was conducted by using the non-fat dry milk. Dilution Trizol method was used to extract the total RNA of the and incubation of primary antibodies the mouse-anti- cells and the concentrations of total RNA were quan- human P38 (ab170099, Abcam, USA), PKC(ab109539, tified by the spectrophotometer. cDNA was synthesized Abcam, USA), BCL-Xs (PA5-32203, Thermo Fisher Sci- according to the instruction of the Kit (BoShan bio- entific, USA), BAK (ab32371, Abcam, USA), BCL- logical technology co., LTD). Real-time PCR was con- 2(ab185002, Abcam, USA), BCL-xl (ab32370, Abcam, ducted in the ABI 7500 system with the cycle as follow: USA), BAX (ab32503, Abcam, USA), BIM (ab32158, 50 C (2 minutes)-95 C (2 minutes)-95 C (15 seconds)- Abcam, USA) and GAPDH, and monoclonal antibody 60 C (30 seconds) to read board, total 40 cycles. IgG, and secondary antibodies (goat anti-mouse IgG) The GAPDH gene was used as an internal reference. The were adjusted according to the manufacturers’ instruc- amounts of gene copies was calculated according to the tion (PL03b-0297M, PL Laboratories, Port Moody, BC,

Mater. Express, Vol. 9, 2019 1107 Materials Express CIAPIN1 is a potential target for apoptosis of multiple myeloma Wang et al.

Canada). Blots were obtained using the ECL chemilumi- nescence detection reagent (GE Healthcare, USA). The expression of P38, PKC, BCL-Xs, BAK, BCL-2, BCL-xl, BAX, BIM and GAPPH were quantiﬁed by densitometry analysis with ImageJ (National Institutes of Health, USA).

2.9. Statistical Analysis SPSS 20.0 (IBM SPSS, NY, USA) was used for data analysis and the results are displayed as the means ± standard deviation. T -test was used to compare the differences between groups and P<0.05 was considered statistically signiﬁcant difference.

Fig. 1. CIAPIN1 m-RNA gene expressions of bone marrow cells from 3. RESULTS AND DISCUSSION patients with multiple myeloma and adjacent paired normal persons. 3.1. CIAPIN1 Gene Expression of MM Patients The expression level of CIAPIN1 gene in normal bone marrow tissue Due to the application of some proteasomes, such as the is about 5 times that in multiple myeloma tissues (10.661 ± 1.219 vs. ± ∗P< Bortezomib, Kyprolis, and Ixazomib, the median survival 53.901 2.978). 0.05. rate of the incurable multiple myeloma (MM) has been extended to six years [2], while most of the patients died mice MM xenograft model. The soft agar colony study from tumor recurrence in the end. During the past decade, consistently confirmed that the U266-siRNA group formed it has been demonstrated that by breaking the code of can- significantly higher amount of colonies compared with the cer cells’ apoptosis can be an promising strategy for the control groups (Fig. 3). In the nude mice xenograft model, treatment of relapse and refractory cancers [7]. With this tumor formation was observed in the mice (Fig. 4, left) in mind, we tried to look for new therapy target for the which confirmed the tumorigenicity ability of the U266 healing of MM in our research. By carefully comparing cells and the U266-siRNA. Moreover, the H&E staining IP: 192.168.39.151 On: Fri, 01 Oct 2021 18:58:12 the gene expression of MM cells fromCopyright: small amount American of Scientificimages displayedPublishers that the U266-siRNA seemed to present patients and normal human ( ≤ 6 for each group)Delivered in a pilot bymore Ingenta viable cancer cells compared to the controls (Fig. 4, study, we found that the CIAPIN1 gene outstood among right). We quantified the tumor volume and found that others. Therefore, we focused on studying the effect of this the U266-siRNA group led to the biggest tumor volume

Article gene on the behavior and tumorigenicity ability of MM among the groups (Fig. 5), which are in good correlation cell line U266 cells in current study. with the above results. These results were in good agree- We expanded the sample pool by comparing more ment with our previous study using RPMI-8226 human patients and normal human samples in this study. The lev- MM cell line [5]. These ﬁndings inspired us that MM may els of CIAPIN1-mRNA were evaluated in CD138 posi- be inhibited by improving the CIAPIN1 level. tive myeloma cells and normal bone marrow mononuclear cells. Figure 1 showed that the expression of CIAPIN1 mRNA was dramatically reduced in multiple myeloma patients compared to normal human (10.661 ± 1.219 ver- sus 53.901±2.978). This result strongly revealed that there was a link between decreased CIAPIN1 gene level and MM, and CIAPIN1 may possess therapeutic potential as a target gene for healing of MM. Therefore, we studied the behavior of si-CIAPIN1 transfected U266 cells (U266- siRNA) and compared with U266 cells and non-coding siRNA transfected U266 cells (U266-NC) in the following studies.

3.2. Proliferation, Soft Agar Colony and Xenograft Studies Interestingly, it was found that U266-siRNA group showed Fig. 2. Effect of CIAPIN1 gene on the proliferation of U266 cells. Proliferation rates of cells were determined by CCK8 assays. ∗ indi- improved proliferation compared to controls (Fig. 2). This cated P<0.05 when compared U266-siRNA to U266 or U266-NC; result indicated that the reduced CIAPIN1 gene level may ∗∗ indicated P<0.01 when compared U266-siRNA to U266 or U266- facilitate the development of MM. We further conﬁrm this NC. siRNA: small interfering RNA. NC: non-coding siRNA negative by performing soft agar colony forming assay and in vivo control.

1108 Mater. Express, Vol. 9, 2019 CIAPIN1 is a potential target for apoptosis of multiple myeloma Materials Express Wang et al.

Fig. 3. Effect of CIAPIN1 gene on cell colony formation in U266 cells. ∗∗ indicated P<0.01 when compared U266-siRNA to U266 or Fig. 5. Effect of CIAPIN1 gene on the tumor size in a nude U266-NC. siRNA: small interfering RNA. NC: non-coding siRNA neg- mice xenograft model. H and E staining was used to confirm that ative control. the formed tumors were multiple myeloma. Results were obtained from ≥ 3 independent experiments. ∗∗ indicated P<0.01 when compared U266-siRNA to U266 or U266-NC. siRNA: small interfering 3.3. Apoptosis Protein Production RNA. NC: non-coding siRNA negative control. In order to figure out the underlying mechanism of CIAPIN1 gene on MM apoptosis, we studied the changes using western-blotting, we found that P38, PKC, BCL-2 of a number of apoptosis-related proteins in U266 cells. and BCL-xl were decreased whereas Bax, Bak, Bcl-xs and As far as we know, this may be the first study to sys- BIM were increased in the U266-CIAPIN1 group, com- tematic screen the apoptosis protein expression of MM pared with U266-siRNA group (Fig. 6). cells by modulating the CIAPIN1 gene. For doing this, we transfected the U266 cells with CIAPIN1 overex- It was found that the overexpression of CIAPIN1 can pression lentivirus vector and compared the apoptosis efficiently modulate the expression of many key media- Article proteins production of these cells (U266-CIAPIN1) and tors in cell apoptosis. Firstly, it downregulated the expres- compared to the ones from U266-siRNA.IP: 192.168.39.151 By means On: of Fri,sion 01 Oct of Bcl-22021 18:58:12 family molecules Bcl-2 and Bcl-x1 and Copyright: American Scientific Publishers Delivered by Ingenta

Fig. 4. Nude mouse tumorigenicity model. The U266, U266-NC and U266-siRNA cells were cultured in plates for 96 hours. Then viable cells (2.0 × 106) were injected into the dorsal ﬂanks of 8 BALB/c Fig. 6. Expression of cell cycle-regulatory proteins via Western blot. nude mice per group. Representative photographs of the mouse in each The expression of P38, PKC, BCL-Xs, Bak, BCL-2, BCL-Xl, Bax and group after tumor formation and H and E staining of the corresponding Bim proteins were evaluated before and after transfection of CIAPIN1 tumor tissues in mouse were taken and shown: (A, C and E) mice with overexpressing lentivirus vector. P38, mitogen-activated protein kinases tumor formation after injection of U266, U266-NC, U266-siRNA cells, P38; PKC, Protein kinase C; Bak, BCL2-antagonist/killer; BCL-2, respectively. (B, D and F) corresponding H and E staining images of B-cell lymphoma 2 protein; Bax, BCL2-associated X protein; Bim, A, C and E. Bcl-2 interacting mediator.

Mater. Express, Vol. 9, 2019 1109 Materials Express CIAPIN1 is a potential target for apoptosis of multiple myeloma Wang et al.

upregulated the Bcl-xs. It has been reported that the 201911004); Shenzhen Science and Technology Plan expression and regulation of Bcl-2 family have the signifi- Basic Research Project (No. JCYJ20180307150408596). cant effects on apoptosis [8]. Bcl-2 and Bcl-xl were mainly located at the outer membrane of mitochondria and played References and Notes the anti-apoptotic effect through the activation of MOMP 1. Martinez-Lopez, J., Blade, J., Mateos, M.V., Grande, C., Alegre, A., and cytochrome c mediated death pathway [9]. Conversely, Garcia-Larana, J., Sureda, A., De, L.R.J., Conde, E., Martinez, R., the apoptosis-induced proteins, such as Bax, Bak, Bim and De, A.F., Viguria, M.C., Besalduch, J., Cabrera, R., Gonzalez-San, Bcl-xs, which were located at the outer membrane of mito- M.J.D., Guzman-Zamudio, J.L., Gomez, D.C.M.C., Moraleda, J.M., chondria, manipulated the release of cytochrome c. Con- Garcia-Ruiz, J.C., San, M.J. and Lahuerta, J.J., 2011. Long-term sequently, the combination of Apaf1 led to the formation prognostic significance of response in multiple myeloma after stem of apoptotic complex, which further promoted the pro- cell transplantation. Blood, 118(3), pp.529–534. 2. Kumar, S.K., Dispenzieri, A., Lacy, M.Q., Gertz, M.A., Buadi, cess of caspase-induced cell apoptosis [10]. Bcl-2 inhibitor F.K., Pandey, S., Kapoor, P., Dingli, D., Hayman, S.R., Leung, N., has been used to treat chronic lymphocytic leukemia Lust, J., Mccurdy, A., Russell, S.J., Zeldenrust, S.R., Kyle, R.A. and and presented its additive or synergistic anti-tumor effect Rajkumar, S.V., 2014. Continued improvement in survival in mul- when combining with other antitumor drugs [11, 12]. tiple myeloma: Changes in early mortality and outcomes in older Our experiment showed that CIAPIN1 could influence the patients. Leukemia, 28(5), pp.1122–1128. 3. Palumbo, A., Cavallo, F., Gay, F., Di, R.F., Ben, Y.D., Petrucci, M.T., Bcl-2-apoptotic pathway, through which CIAPIN1 protein Pezzatti, S., Caravita, T., Cerrato, C., Ribakovsky, E., Genuardi, M., may execute its synergistic effect with Bcl-2 inhibitor then Cafro, A., Marcatti, M., Catalano, L., Offidani, M., Carella, A.M., could be used as a new method to treat multiple myeloma. Zamagni, E., Patriarca, F., Musto, P., Evangelista, A., Ciccone, G., Besides, The influence of CIAPIN1 on other apoptosis Omede, P., Crippa, C., Corradini, P., Nagler, A., Boccadoro, M. related pathway marker were identified. PKC protein could and Cavo, M., 2014. Autologous transplantation and maintenance affect the apoptosis of cells by regulating the expression therapy in multiple myeloma. New England Journal of Medicine, 371(10), PP.895–905. of Bcl-2 gene [13]. In this study, we found that CIAPIN1 4. Li, X., Hao, Z., Fan, R., Zou, X., Jin, H., Pan, Y., He, L., Du, R., could affect the content of PKC protein. The p38-MAPK Gao, L., Liu, D. and Fan, D., 2007. CIAPIN1 inhibits gastric can- pathway is an important part of the four-known mitogen- cer cell proliferation and cell cycle progression by downregulating activated protein kinase (MAPK) pathway at present [14]. CyclinD1 and upregulating P27. Cancer Biology & Therapy, 6(10), This pathway is sensitive to aIP: variety 192.168.39.151 of stress (H On:O , Fri, 01pp.1539–1545. Oct 2021 18:58:12 2 2 5. 2015 heat shock, hypoxia, ultraviolet radiation,Copyright: etc.), inflamma- American ScientificWang, Publishers X., Pan, J. and Li, J., . Cytokine-induced apoptosis +Delivered by Ingentainhibitor 1 inhibits the growth and proliferation of multiple myeloma. tory factors (TNF-alpha, IL-1, FGF, LPS and G ) bacte- Molecular Medicine Reports, 12(2), pp.2056–2062. rial cell wall components and activation, thus would affect 6. Garcia-Sanz, R., Orfao, A., Gonzalez, M., Tabernero, M.D., the transcription, synthesis of protein, expression of cell Blade, J., Moro, M.J., Fernandez-Calvo, J., Sanz, M.A., Perez- Article surface receptor, cell biological functions, and ultimately Simon, J.A., Rasillo, A. and Miguel, J.F., 1999. Primary plasma cell affect the survival of the status of the cells [15]. More- leukemia: Clinical, immunophenotypic, DNA ploidy, and cytogenetic characteristics. Blood, 93(3), pp.1032–1037. over, p38-MAPK can importantly regulate the activity of 7. Strasser, A., Cory, S. and Adams, J.M., 2011. Deciphering the rules interleukin 6 (IL-6) [16], which is the key growth factor of programmed cell death to improve therapy of cancer and other of multiple myeloma [17]. We found that CIAPIN1 could diseases. EMBO Journal, 30(18), pp.3667–3383. down-regulate the content of p38 in U266. Therefore, we 8. Kelly, P.N. and Strasser, A., 2011. The role of Bcl-2 and its pro- speculated that CIAPIN1 might inhibit the biological activ- survival relatives in tumourigenesis and cancer therapy. Cell Death ities of multiple myeloma cells directly or indirectly by and Differentiation, 18(9), pp.1414–1424. 9. Abdelwahid, E., Rolland, S., Teng, X., Conradt, B., Hardwick, J.M. influencing p38. and White, K., 2011. Mitochondrial involvement in cell death of non- mammalian eukaryotes. Biochimica et Biophysica Acta-Molecular Basis of Disease, 1813(4), pp.597–607. 4. CONCLUSION 10. Li, Y., Liu, X. and Rong, F., 2011. PUMA mediates the apoptotic The expression level of CIAPIN1 m-RNA was reduced in signal of hypoxia/reoxygenation in cardiomyocytes through mito- multiple myeloma patients and inhibition of the CIAPIN1 chondrial pathway. Shock, 35(6), pp.579–584. gene in MM U266 cells not only promoted the prolifer- 11. Ackler, S., Oleksijew, A., Chen, J., Chyla, B.J., Clarin, J., Foster, K., ation of multiple myeloma cells, but also promoted the Mcgonigal, T., Mishra, S., Schlessinger, S., Smith, M. L., Tahir, S. K., Leverson, J.D., Souers, A.J., Boghaert, E.R. and Hickson, J., tumorigenicity ability of multiple myeloma cells. On the 2015. Clearance of systemic hematologic tumors by venetoclax (Abt- contrary, the upregulation of CIAPIN1 gene in U266 cells 199) and navitoclax. Pharmacology Research & Perspectives, 3(5), can activate the apoptosis pathways, such as Bcl-2 and p.e00178. p38-MAPK, holding great potential in apoptosis of MM 12. Cervantes-Gomez, F., Lamothe, B., Woyach, J.A., Wierda, W.G., cells. As a sum, CIAPIN1 has the potential to be a new- Keating, M.J., Balakrishnan, K. and Gandhi, V., 2015. Pharmaco- logical and protein profiling suggests venetoclax (ABT-199) as opti- targeted therapeutic marker for multiple myeloma in the mal partner with ibrutinib in chronic lymphocytic leukemia. Clinical future. Cancer Research, 21(16), pp.3705–3715. 13. Sakakura, C., Sweeney, E.A., Shirahama, T., Hakomori, S. and Acknowledgments: This study was supported by San- Igarashi, Y., 1996. Suppression of bcl-2 gene expression by sph- ming Project of Medicine in Shenzhen (No. SZSM ingosine in the apoptosis of human leukemic HL-60 cells during

1110 Mater. Express, Vol. 9, 2019 CIAPIN1 is a potential target for apoptosis of multiple myeloma Materials Express Wang et al.

phorbol ester-induced terminal differentiation. FEBS Letters, 379(2), and IL-10 via JAK2/STAT3 and p38MAPK/ERK1/2 sig- pp.177–180. naling pathway. Journal of Clinical Immunology, 31(3), 14. Qi, M. and Elion, E.A., 2005. MAP kinase pathways. Journal of pp.472–478. Cell Science, 118(16), PP.3569–3572. 17. Gunn, W.G., Conley, A., Deininger, L., Olson, S.D., Prockop, 15. Bodero, A.J., Ye, R. and Lees-Miller, S.P., 2003. UV-light induces D.J. and Gregory, C.A., 2006. A crosstalk between myeloma cells p38 MAPK-dependent phosphorylation of Bcl10. Biochemical and and marrow stromal cells stimulates production of DKK1 and Biophysical Research Communications, 301(4), pp.923–926. interleukin-6: A potential role in the development of lytic bone dis- 16. Agrawal, S., Gollapudi, S., Su, H. and Gupta, S., 2011. ease and tumor progression in multiple myeloma. Stem Cells, 24(4), Leptin activates human B cells to secrete TNF-alpha, IL-6, pp.986–991.

Received: 27 September 2019. Accepted: 9 October 2019. Article

IP: 192.168.39.151 On: Fri, 01 Oct 2021 18:58:12 Copyright: American Scientific Publishers Delivered by Ingenta

Mater. Express, Vol. 9, 2019 1111