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Gastrointestinal cancer
The Roles of Ninjurin1 and Estrogen in Modulating Azoxymethane/Dextran Sodium Sulfate–Induced Colitis-Associated Colorectal Cancer in Male Mice
Chin-Hee Song, Nayoung Kim, Ryoung Hee Nam, Jae Young Jang, Eun Hye Kim, Sungchan Ha, Eun Shin, Ha-Na Lee, Hoon Choi, Kyu-Won Kim, Sejin Jeon, Goo Taeg Oh
Cancer Res Treat. 2025;57(4):1115-1134.   Published online January 13, 2025
DOI: https://doi.org/10.4143/crt.2024.959
AbstractAbstract PDFPubReaderePub
Purpose
Nerve injury–induced protein 1 (Ninj1) is associated with inflammation and tumor progression and shows increased expression in various cancers. This study aimed to investigate the role of Ninj1 in colitis-associated colorectal cancer (CRC) by focusing on its interaction with 17β-estradiol (E2).
Materials and Methods
Using an azoxymethane (AOM)/dextran sodium sulfate (DSS) mouse model of colitis-associated CRC, wild-type (WT) and Ninj1 knockout (KO) male mice were treated with or without E2.
Results
At week 2, Ninj1 KO mice exhibited attenuated colitis symptoms than WT mice following AOM/DSS treatment. E2 administration significantly alleviated these symptoms in both WT and Ninj1 KO mice, with reductions in the disease activity index, colon length shortening, and histopathological damage. The levels of pro-inflammatory mediators were reduced by E2 treatment in both groups, with the Ninj1 KO group showing a more pronounced response. At week 13, tumor development in Ninj1 KO mice was significantly lower than that in WT mice, particularly in the distal colon. E2 treatment inhibited tumor formation in WT mice and had a stronger inhibitory effect on distal colon tumorigenesis in Ninj1 KO mice. Immune cell populations, including the populations of macrophages and T cells, were also modulated by E2 in WT mice; however, these effects were diminished in Ninj1 KO mice.
Conclusion
These findings suggest that Ninj1 plays a role in modulating colitis and CRC progression, with E2 exerting anti-inflammatory and anti-tumorigenic effects that are influenced by Ninj1 status.
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Sex-Specific Molecular Markers NRF2 and PD-L1 in Colon Carcinogenesis: Implications for Right-Sided Colon Cancer
Chin-Hee Song, Yonghoon Choi, Nayoung Kim, Ryoung Hee Nam, Jin Won Kim, Jae Young Jang, Eun Hye Kim, Sungchan Ha, Ha-Na Lee
Cancer Res Treat. 2025;57(4):1090-1103.   Published online December 27, 2024
DOI: https://doi.org/10.4143/crt.2024.818
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
This study examined the roles of nuclear factor erythroid 2-related factor 2 (NRF2) and programmed death ligand 1 (PD-L1) in colon carcinogenesis, underscoring on sex and differences in tumor location.
Materials and Methods
A total of 378 participants were enrolled from Seoul National University Bundang Hospital: 88 healthy controls (HC), 139 patients with colorectal adenoma (AD), and 151 patients with colorectal cancer (CRC). Quantitative real-time polymerase chain reaction (PCR), methylation-specific PCR, and immunohistochemistry (IHC) were performed utilizing tumor samples from patients and normal mucosa in the HC group.
Results
NRF2 mRNA expression was higher in the CRC group than in the HC and AD groups, with decreased NRF2 methylation in the AD and CRC groups. NRF2 protein expression, as evaluated by IHC, increased in the AD and CRC groups relative to that in the HC group. PD-L1 protein expression was remarkably higher in the CRC group than in the HC and AD groups. These patterns were consistent in both males and females. In sex- and CRC location-specific analyses, NRF2 methylation was lower in female than in male patients with CRC. NRF2 protein expression was significantly higher in females, particularly in patients with right-sided CRC. Moreover, females exhibited increased PD-L1 mRNA expression compared to males in the AD group, and PD-L1 mRNA levels were higher in females with right-sided CRC than in those with cancer at other locations.
Conclusion
Differences in NRF2 and PD-L1 expression indicate site-specific colon carcinogenesis based on sex, particularly in females with right-sided CRC.

Citations

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  • Silibinin Anticancer Effects Through the Modulation of the Tumor Immune Microenvironment in Triple-Negative Breast Cancer
    Shubham D. Mishra, Patricia Mendonca, Sukhmandeep Kaur, Karam F. A. Soliman
    International Journal of Molecular Sciences.2025; 26(13): 6265.     CrossRef
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  • 2 Web of Science
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Anti–PD-L1 Antibody and/or 17β-Estradiol Treatment Induces Changes in the Gut Microbiome in MC38 Colon Tumor Model
Chin-Hee Song, Nayoung Kim, Ryoung Hee Nam, Soo In Choi, Jae Young Jang, Jina Choi, Ha-Na Lee
Cancer Res Treat. 2023;55(3):894-909.   Published online January 9, 2023
DOI: https://doi.org/10.4143/crt.2022.1427
AbstractAbstract PDFPubReaderePub
Purpose
17β-Estradiol (E2) supplementation suppresses MC38 tumor growth by downregulating the expression of programmed death-ligand 1 (PD-L1). This study aims to figure out the gut microbiota that respond to anti–PD-L1 and/or estrogen treatment in MC38 colon cancer model.
Materials and Methods
A syngeneic colon tumor model was developed by injection of MC38 cells into C57BL/6 background male and female mice. Three days before MC38 cells injection, E2 was supplemented to male mice daily for 1 week. Male and female mice with MC38 tumors (50-100 mm3) were injected with anti–PD-L1 antibody. Fresh feces were collected 26 days after injection of MC38 cells and 16S rRNA metagenomics sequencing of DNA extracted from feces was used to assess gut microbial composition.
Results
At the taxonomic family level, Muribaculaceae was enriched only in the MC38 male control group. In male mice, linear discriminant analysis effect size analysis at the species level revealed that the four microorganisms were commonly regulated in single and combination treatment with anti–PD-L1 and/or E2; a decrease in PAC001068_g_uc and PAC001070_s (family Muribaculaceae) and increase in PAC001716_s and PAC001785_s (family Ruminococcaceae). Interestingly, in the anti–PD-L1 plus E2 group, a decrease in opportunistic pathogens (Enterobacteriaceae group) and an increase in commensal bacteria (Lactobacillus murinus group and Parabacteroides goldsteinii) were observed. Furthermore, the abundance of Parabacteroides goldsteinii was increased in both males and females in the anti–PD-L1 group.
Conclusion
Our results suggest that gut microbial changes induced by the pretreatment of estrogen before anti–PD-L1 might contribute to treatment of MC38 colon cancer.

Citations

Citations to this article as recorded by  
  • Association between serum short-chain fatty acid levels and the risk of all-cause and cardiovascular disease mortality in Chinese patients undergoing maintenance hemodialysis: a retrospective cohort study
    Xiu-Nan Zhao, Shu-Xin Liu, Shuang Zhang, Zhen-Zhen Wang, Zi Lin, Xue-Lian Jian, Cui Dong, Yi-Nan Zhang
    Clinical Kidney Journal.2025;[Epub]     CrossRef
  • Parabacteroides as a promising target for disease intervention: current stage and pending issues
    Jing Liu, Hui Qiu, Jiamin Zhao, Nan Shao, Chao Chen, Zhixu He, Xu Zhao, Juanjuan Zhao, Ya Zhou, Lin Xu
    npj Biofilms and Microbiomes.2025;[Epub]     CrossRef
  • Therapeutic potential of the gut commensal bacterium Parabacteroides goldsteinii in human health and disease treatment
    Ziyun Li, Li Zhang, Zhenxia Wan, Huijuan Liu, Ting Zhang, Yan Li
    Frontiers in Microbiology.2025;[Epub]     CrossRef
  • Mechanism of the AMPK/SIRT1 pathway in gut dysbiosis–mediated postoperative cognitive dysfunction in aged mice
    Fu Xu, Yang Yue, Defeng Sun
    International Journal of Neuropsychopharmacology.2025;[Epub]     CrossRef
  • Unveiling the interplay between microbiota and PD1/PD-L1 axis in tumor immunity and immunotherapy
    Qiguang Lu, Jiasheng Wu, Xiaoyan Yu, Juanjuan Qian, Zhengwei Song
    Frontiers in Immunology.2025;[Epub]     CrossRef
  • Distribution and roles of Ligilactobacillus murinus in hosts
    Zhou Chuandong, Jicong Hu, Jiawen Li, Yuting Wu, Chan Wu, Guanxi Lai, Han Shen, Fenglin Wu, Changli Tao, Song Liu, Wenfeng Zhang, Hongwei Shao
    Microbiological Research.2024; 282: 127648.     CrossRef
  • Sex differences in colorectal cancer: with a focus on sex hormone–gut microbiome axis
    Zihong Wu, Yuqing Huang, Renyi Zhang, Chuan Zheng, Fengming You, Min Wang, Chong Xiao, Xueke Li
    Cell Communication and Signaling.2024;[Epub]     CrossRef
  • 17β-estradiol in colorectal cancer: friend or foe?
    Zihong Wu, Chong Xiao, Jiamei Wang, Min Zhou, Fengming You, Xueke Li
    Cell Communication and Signaling.2024;[Epub]     CrossRef
  • Sexual dimorphism of gut microbiota in colorectal cancer
    Zihong Wu, Ziming Wang, Jiamei Wang, Chong Xiao, Fengming You, Xueke Li
    Chinese Science Bulletin.2024; 69(35): 5142.     CrossRef
  • Direct and indirect effects of estrogens, androgens and intestinal microbiota on colorectal cancer
    Zihong Wu, Yi Sun, Wenbo Huang, Zhenzhen Jin, Fengming You, Xueke Li, Chong Xiao
    Frontiers in Cellular and Infection Microbiology.2024;[Epub]     CrossRef
  • Targeting metabolic pathways: a novel therapeutic direction for type 2 diabetes
    Zhihui Song, An Yan, Zehui Guo, Yuhang Zhang, Tao Wen, Zhenzhen Li, Zhihua Yang, Rui Chen, Yi Wang
    Frontiers in Cellular and Infection Microbiology.2023;[Epub]     CrossRef
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  • 9 Web of Science
  • 11 Crossref
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Changes in Gut Microbiome upon Orchiectomy and Testosterone Administration in AOM/DSS-Induced Colon Cancer Mouse Model
Chin-Hee Song, Nayoung Kim, Ryoung Hee Nam, Soo In Choi, Jae Young Jang, Ha-Na Lee
Cancer Res Treat. 2023;55(1):196-218.   Published online July 1, 2022
DOI: https://doi.org/10.4143/crt.2022.080
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Sex hormones are known to affect the gut microbiota. Previously, we reported that endogenous and exogenous testosterone are associated with colorectal cancer (CRC) development and submucosal invasion. In the present study, we investigated whether the gut microbiota is affected by orchiectomy (ORX) and testosterone propionate (TP) administration using an azoxymethane/dextran sulfate sodium (AOM/DSS)-induced CRC mouse model.
Materials and Methods
Gut microbiota was evaluated by means of 16S rRNA gene sequencing of stool DNA extracted from feces that were obtained at 13 weeks after AOM injection (from 22-week-old animals) and stored in a gas-generating pouch.
Results
The increase in microbial diversity (Chao1 and Phylogenetic Diversity index) and Firmicutes/Bacteroidetes (F/B) ratio upon AOM/DSS treatment in ORX mice was significantly decreased by TP supplementation. The ratio of commensal bacteria to opportunistic pathogens was lower in the TP-administered females and ORX mice than in the AOM/DSS group. Opportunistic pathogens (Mucispirillum schaedleri or Akkermansia muciniphila) were identified only in the TP group. In addition, microbial diversity and F/B ratio were higher in male controls than in female and ORX controls. Flintibacter butyricus, Ruminococcus bromii, and Romboutsia timonensis showed similar changes in the male control group as those in the female and ORX controls.
Conclusion
In conclusion, testosterone determines the dysbiosis of gut microbiota, which suggests that it plays a role in the sex-related differences in colorectal carcinogenesis.

Citations

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  • The Role of Gut Microbiota Dysbiosis in Erectile Dysfunction: From Pathophysiology to Treatment Strategies
    Aris Kaltsas, Ilias Giannakodimos, Eleftheria Markou, Konstantinos Adamos, Marios Stavropoulos, Zisis Kratiras, Athanasios Zachariou, Fotios Dimitriadis, Nikolaos Sofikitis, Michael Chrisofos
    Microorganisms.2025; 13(2): 250.     CrossRef
  • The Antioxidant and Chemopreventive Activity of a Nutraceutical Derived from Brassicaceae Seed Extracts for Colorectal Cancer
    Ana Guzmán-Carrasco, Cristina Mesas, Kevin Doello, Jesús M. Porres, Alejandro García-Beltrán, Rosario Martínez, Francisco Bermúdez, Mercedes Peña, Consolación Melguizo, Jose Prados
    Nutrients.2025; 17(8): 1358.     CrossRef
  • AI for rapid identification of major butyrate-producing bacteria in rhesus macaques (Macaca mulatta)
    Annemiek Maaskant, Donghyeok Lee, Huy Ngo, Roy C. Montijn, Jaco Bakker, Jan A. M. Langermans, Evgeni Levin
    Animal Microbiome.2025;[Epub]     CrossRef
  • Juvenile Rats Exposed to Antibiotics Early in Life Display Sexual Dimorphisms on Social Behaviour and Sex Hormone Deconjugating Activity
    Ivanka M. Kuehnel, Cristofer E. González‐Irarrázabal, Renato Pardo, Marcela Julio‐Pieper, Javier A. Bravo
    Journal of Neurochemistry.2025;[Epub]     CrossRef
  • Delineating the fecal microbiome of healthy domestic short-hair cats in South Korea
    Hyun-Young Cho, Hyung-Joon Park, Jin-Sik Choi, Se-Hoon Kim, Min-Ok Ryu, Kyoung-Won Seo
    Frontiers in Veterinary Science.2025;[Epub]     CrossRef
  • Sexual dimorphism in colon is mediated by an androgen-IL33+ stromal cell axis
    Haoyu Wang, Baowei Jing, Juan Zou, Tian Lan, Mengxin Hu, Lan Lin, Hanhua Cheng, Rongjia Zhou
    Cell & Bioscience.2025;[Epub]     CrossRef
  • Sex differences in colorectal cancer: with a focus on sex hormone–gut microbiome axis
    Zihong Wu, Yuqing Huang, Renyi Zhang, Chuan Zheng, Fengming You, Min Wang, Chong Xiao, Xueke Li
    Cell Communication and Signaling.2024;[Epub]     CrossRef
  • Comparison of the fecal bacterial microbiota in mice, rats, and pigs after oral administration of alpha-glycosyl isoquercitrin
    Hong Liu, Ryo Inoue, Mihoko Koyanagi, Shim-mo Hayashi, Gen Watanabe, Kentaro Nagaoka
    The Journal of Toxicological Sciences.2024; 49(4): 151.     CrossRef
  • Gut Microbes in Polycystic Ovary Syndrome and Associated Comorbidities; Type 2 Diabetes, Non-Alcoholic Fatty Liver Disease (NAFLD), Cardiovascular Disease (CVD), and the Potential of Microbial Therapeutics
    Vineet Singh, Kanika Mahra, DaRyung Jung, Jae-Ho Shin
    Probiotics and Antimicrobial Proteins.2024; 16(5): 1744.     CrossRef
  • Role of sex steroids in colorectal cancer: pathomechanisms and medical applications
    Jianglan Wu
    American Journal of Cancer Research.2024; 14(7): 3200.     CrossRef
  • Gender-affirming hormonal therapy induces a gender-concordant fecal metagenome transition in transgender individuals
    Timur Liwinski, Matthias K. Auer, Johanna Schröder, Ina Pieknik, Christian Casar, Dorothee Schwinge, Lara Henze, Günter K. Stalla, Undine E. Lang, Alina von Klitzing, Peer Briken, Thomas Hildebrandt, Jeanne C. Desbuleux, Sarah V. Biedermann, Paul-Martin H
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  • N-acyl glycines produced by commensal bacteria potentiate GLP-1 secretion as GPCR ligands
    Anna Drzazga, Przemysław Bernat, Adriana Nowak, Marcin Szustak, Eliza Korkus, Edyta Gendaszewska-Darmach, Maria Koziołkiewicz
    Biomedicine & Pharmacotherapy.2024; 180: 117467.     CrossRef
  • Role of intestinal testosterone-degrading bacteria and 3/17β-HSD in the pathogenesis of testosterone deficiency-induced hyperlipidemia in males
    Jun Tao, Wen Dai, Yongnan Lyu, Hang Liu, Juan Le, Ting Sun, Qian Yao, Zhiming Zhao, Xuejun Jiang, Yan Li
    npj Biofilms and Microbiomes.2024;[Epub]     CrossRef
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    Zihong Wu, Ziming Wang, Jiamei Wang, Chong Xiao, Fengming You, Xueke Li
    Chinese Science Bulletin.2024; 69(35): 5142.     CrossRef
  • Direct and indirect effects of estrogens, androgens and intestinal microbiota on colorectal cancer
    Zihong Wu, Yi Sun, Wenbo Huang, Zhenzhen Jin, Fengming You, Xueke Li, Chong Xiao
    Frontiers in Cellular and Infection Microbiology.2024;[Epub]     CrossRef
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  • Murine models of colorectal cancer: the azoxymethane (AOM)/dextran sulfate sodium (DSS) model of colitis-associated cancer
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    PeerJ.2023; 11: e16159.     CrossRef
  • 10,872 View
  • 253 Download
  • 19 Web of Science
  • 17 Crossref
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Effect of Estradiol in an Azoxymethane/Dextran Sulfate Sodium-Treated Mouse Model of Colorectal Cancer: Implication for Sex Difference in Colorectal Cancer Development
Hee Jin Son, Sung Hwa Sohn, Nayoung Kim, Ha-Na Lee, Sun Min Lee, Ryoung Hee Nam, Ji Hyun Park, Chin-Hee Song, Eun Shin, Hee Young Na, Joo Sung Kim, Dong Ho Lee, Young-Joon Surh
Cancer Res Treat. 2019;51(2):632-648.   Published online August 1, 2018
DOI: https://doi.org/10.4143/crt.2018.060
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
This study demonstrates that estradiol downregulates inflammation and inhibits colorectal cancer (CRC) development in azoxymethane/dextran sulfate sodium (AOM/DSS) mouse model.
Materials and Methods
AOM/DSS-treated male and female mice were sacrificed at weeks 2, 10, and 16, to assess estrogen effects on colitis and carcinogenesis. Macroscopic and histologic severity of colitis and Western blot and quantitative real-time polymerase chain reaction were evaluated, to measure inflammatory mediators and cytokines.
Results
Compared with AOM/DSS-treated male mice (M-AOM/DSS group), AOM/DSS-treated male mice with estradiol administration (M-AOM/DSS+estr group) displayed at week 2 significantly decreased severity of colitis. At weeks 10 and 16, AOM/DSS-treated female mice (F-AOM/DSS group) and the M-AOM/DSS+estr group showed significantly lower tumor multiplicity compared with the M-AOM/DSS group. At week 2, F-AOM/DSS group had a lower level of nuclear factor-κB (NF-κB) expression and higher level of nuclear factor erythroid 2-related factor 2 (Nrf2) expression, compared to the M-AOM/DSS group. At week 2, expression levels of NF-κB and its related mediators decreased in the M-AOM/DSS+estr group, while levels of Nrf2 and Nrf2-related anti-oxidant enzymes increased. In addition, estradiol significantly increased Nod-like receptor protein 3 (NLRP3) inflammasome expressions in AOM/DSS-treated male mice. In contrast, at weeks 10 and 16, Nrf2 and its-related anti-oxidant enzymes and NLRP3 inflammasome were highly expressed in M-AOM/DSS group and in F-AOM/DSS group, who developed cancer.
Conclusion
The data suggest that estradiol inhibits the initiation of CRC by regulating Nrf2-related pathways. Moreover, these imply the dual role of Nrf2 and NLRP3 inflammasome, including promotion of tumor progression upon tumor initiation.

Citations

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  • Ninjurin1 deficiency differentially mitigates colorectal cancer induced by azoxymethane and dextran sulfate sodium in male and female mice
    Chin‐Hee Song, Nayoung Kim, Ryoung Hee Nam, Soo In Choi, Jae Young Jang, Eun Hye Kim, Sungchan Ha, Eun Shin, Hoon Choi, Kyu‐Won Kim, Sejin Jeon, Goo Taeg Oh, Yeong‐Jae Seok
    International Journal of Cancer.2025; 156(4): 826.     CrossRef
  • Standardization of a Preclinical Colon Cancer Model in Male and Female BALB/c Mice: Macroscopic and Microscopic Characterization from Pre-Neoplastic to Tumoral Lesions
    Elizabeth Correa, Juan Pablo Rendón, Vanesa Bedoya-Betancur, Juliana Montoya, Julian Muñoz Duque, Tonny W. Naranjo
    Biomedicines.2025; 13(4): 939.     CrossRef
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    Iveta Herichová, Richard Reis, Denisa Vanátová
    Oncology Letters.2025; 29(6): 1.     CrossRef
  • Development and Validation of Comprehensive Inflammatory Lifestyle Score and Association with Colorectal Cancer Risk
    Jiali Zheng, Longgang Zhao, Jingwen Dong, Edward Giovannucci
    Cancer Epidemiology, Biomarkers & Prevention.2025; 34(10): 1810.     CrossRef
  • The Roles of Ninjurin1 and Estrogen in Modulating Azoxymethane/Dextran Sodium Sulfate–Induced Colitis-Associated Colorectal Cancer in Male Mice
    Chin-Hee Song, Nayoung Kim, Ryoung Hee Nam, Jae Young Jang, Eun Hye Kim, Sungchan Ha, Eun Shin, Ha-Na Lee, Hoon Choi, Kyu-Won Kim, Sejin Jeon, Goo Taeg Oh
    Cancer Research and Treatment.2025; 57(4): 1115.     CrossRef
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    Yonghoon Choi, Nayoung Kim
    The World Journal of Men's Health.2024; 42(2): 256.     CrossRef
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  • 17β-estradiol in colorectal cancer: friend or foe?
    Zihong Wu, Chong Xiao, Jiamei Wang, Min Zhou, Fengming You, Xueke Li
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    Chinese Science Bulletin.2024; 69(35): 5142.     CrossRef
  • Direct and indirect effects of estrogens, androgens and intestinal microbiota on colorectal cancer
    Zihong Wu, Yi Sun, Wenbo Huang, Zhenzhen Jin, Fengming You, Xueke Li, Chong Xiao
    Frontiers in Cellular and Infection Microbiology.2024;[Epub]     CrossRef
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    Cancer Research and Treatment.2023; 55(1): 196.     CrossRef
  • Influence of location-dependent sex difference on PD-L1, MMR/MSI, and EGFR in colorectal carcinogenesis
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  • Anti–PD-L1 Antibody and/or 17β-Estradiol Treatment Induces Changes in the Gut Microbiome in MC38 Colon Tumor Model
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    Cancer Research and Treatment.2023; 55(3): 894.     CrossRef
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    Biomedicine & Pharmacotherapy.2023; 167: 115554.     CrossRef
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    Yujie Zhou, Songyan Yu, Wenyong Zhang
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    Liu Wenxuan, Li Liu, Lilong Zhang, Zhendong Qiu, Zhongkai Wu, Wenhong Deng
    Frontiers in Oncology.2023;[Epub]     CrossRef
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    Shivani Singla, Chittaranjan Sahu, Gopabandhu Jena
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  • Lactobacillus paracasei BD5115-Derived 2-Hydroxy-3-Methylbutyric Acid Promotes Intestinal Epithelial Cells Proliferation by Upregulating the MYC Signaling Pathway
    Zhenyi Qiao, Xiaohua Wang, Chaoyue Wang, Jin Han, Weiwei Qi, Huanchang Zhang, Zhenmin Liu, Chunping You
    Frontiers in Nutrition.2022;[Epub]     CrossRef
  • Combination treatment with 17β-estradiol and anti-PD-L1 suppresses MC38 tumor growth by reducing PD-L1 expression and enhancing M1 macrophage population in MC38 colon tumor model
    Chin-Hee Song, Nayoung Kim, Ryoung Hee Nam, Soo In Choi, Jae Young Jang, Jin Won Kim, Hee Young Na, Ha-Na Lee
    Cancer Letters.2022; 543: 215780.     CrossRef
  • Sex/Gender-related Differences in Reflux Esophagitis and Peptic Ulcer Disease in Terms of Sex Hormones
    Nayoung Kim
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2022; 22(2): 157.     CrossRef
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