Journal of Traditional Chinese Medicine ›› 2025, Vol. 45 ›› Issue (4): 896-908.DOI: 10.19852/j.cnki.jtcm.2025.04.020
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Reversal of amino acid metabolism patterns between circulating blood and tumors as a new biomarker for the Zhengxu Xieshi syndrome in patients with esophageal squamous cell carcinoma
WANG Siliang1, MA Yushui1,2, LIU Lei3, WANG Pei4, WU Jia1,2, JIN Xing1,2, JIN Qiang1,2, WANG Congcong1,2, QIN Chentai1,2, ZHENG Miaomiao1,2, YANG Xi5, PAN Jun6, XU Hanchen2,7, DONG Changsheng1,2(
), CHEN Wenlian1,2()
- 1 Cancer Institute, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
2 Shanghai Frontiers Science Center of Disease and Syndrome Biology of Inflammatory Cancer Transformation, Shanghai 200032, China
3 Department of Thoracic Surgery, the Affiliated Tumor Hospital of Nantong University, Nantong 226300, China
4 Traditional Chinese Medicine department, the Affiliated Tumor Hospital of Nantong University, Nantong 226300, China
5 Department of Oncology, Shanxi Provincial Hospital of Traditional Chinese Medicine, Shanxi 030001, China
6 Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
7 Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
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Received:2024-04-12Accepted:2024-11-18Online:2025-07-25Published:2025-07-25 -
Contact:DONG Changsheng,CHEN Wenlian -
About author:CHEN Wenlian, Cancer Institute, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China and Shanghai Frontiers Science Center of Disease and Syndrome Biology of Inflammatory Cancer Transformation, Shanghai 200032, China. chenwl8412@shutcm.edu.cn，Telephone: +86-17756177005
DONG Changsheng, Cancer Institute, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China and Shanghai Frontiers Science Center of Disease and Syndrome Biology of Inflammatory Cancer Transformation, Shanghai 200032, China. csdong@shutcm.edu.cn;
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Supported by:Natural Science Foundation-funded Project: Establishment of Syndrome-Disease Warning System and Investigation of the Clinical Features and Evolution Patterns of Traditional Chinese Medicine Syndromes in Esophageal Cancer under Modern Medical Diagnosis and Treatment(2023YFC3503200);Natural Science Foundation-funded Project: Establishment of Syndrome-Disease Warning System and Investigation of the Clinical Features and Evolution Patterns of Traditional Chinese Medicine Syndromes in Esophageal Cancer under Modern Medical Diagnosis and Treatment(2023YFC3503201);Biological Basis of the Pathogenesis of Cancer Toxin in Traditional Chinese Medicine(2022YFC3500200);Biological Basis of the Pathogenesis of Cancer Toxin in Traditional Chinese Medicine(2022YFC3500202);Natural Science Foundation-funded Project: Mechanistic Study of the Nucleolar Methyltransferase Fibrillarin to Promote Neoplastic Growth of Esophageal Squamous Cell Carcinoma via Activating Nucleoside Synthesis(32170778);Mechanistic Study of Renal Cancer Neoplastic Growth Driven by Glucose Transporter 5-Mediated Fructose Metabolism Reprogramming(31970708);Mechanistic Study of Methionine Cycle Modulating the Growth of Esophageal Squamous Cell Carcinoma through "DNA Methylation-DNA Stability-p53/p21-cell Cycle" Pathway(82002953);Antitumor Mechanism of Oleanolic Acid via Autophagy by Regulating Adenosine Monophosphate-Activated Protein Kinase-Mammalian Target of Rapamycin- Unc51 Like Kinase 1 Pathway and Inhibiting Purine Salvage Pathway(82004177);USP14 Cooperates with Ubiquitin C-Terminal Hydrolase L5 to Regulate Constitutive Photomorphogenic 9 Signalosome-mediated Programmed Death-Ligand 1 Deubiquitination and Promote Immune Evasion in Hepatocellular Carcinoma(81972214);National Scientific and Technological Major Special Project of China: Shuang Huang Sheng Bai Oral Liquid: Efficacy and Safety Evaluation of Traditional Chinese Medicine Compound Based on Systems Biology Approaches(2019ZX09201004-002-013);A special clinical research initiative for the health business sponsored by the Shanghai Municipal Health Commission(202040155);Shanghai Municipal Science and Technology Commissions Special Biomedical Technology Support Plan(20S31904100);Shanghai "Science and Technology Innovation Action Plan" Medical Innovation Research Project--Shanghai Clinical Research Center of Traditional Chinese Medicine Oncology(21MC1930500);Shanghai 13th Five-Year Plan Key Specialty of Traditional Chinese Medicine Oncology(shslczdzk03701);Tracking Programme for Eastern Scholar at Shanghai Institutions of Higher Learning, Shanghai High-level Talent Leadership Programme of Traditional Chinese Medicine(ZY(2021-2023)-0403);Scientific Research Project of Industry Development Center of Shanghai University of Traditional Chinese Medicine(602076D)
Cite this article
WANG Siliang, MA Yushui, LIU Lei, WANG Pei, WU Jia, JIN Xing, JIN Qiang, WANG Congcong, QIN Chentai, ZHENG Miaomiao, YANG Xi, PAN Jun, XU Hanchen, DONG Changsheng, CHEN Wenlian. Reversal of amino acid metabolism patterns between circulating blood and tumors as a new biomarker for the Zhengxu Xieshi syndrome in patients with esophageal squamous cell carcinoma[J]. Journal of Traditional Chinese Medicine, 2025, 45(4): 896-908.
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Table 1 Basic characteristics of enrolled human subjects
| Variable | Study 1 | Study 2 | ||||
|---|---|---|---|---|---|---|
| HC (n = 34) | ESCC (n = 34) | P value | ESCC (n = 24) | |||
| Age (years) | Median | 67 | 67 | 0.745 | 68 | |
| Range | 56-78 | 54-77 | 50-76 | |||
| Gender [n (%)] | Male | 21 (61.76) | 26 (76.47) | 0.291 | 15 (62.50) | |
| Female | 13 (38.24) | 8 (23.53) | 9 (37.50) | |||
| BMI | Median | 22.18 | 22.01 | |||
| Range | 18.37-30.37 | 18.37-28.31 | ||||
| Hypertension [n (%)] | Yes | 6 (17.65) | 4 (16.67) | |||
| No | 28 (82.35) | 19 (79.17) | ||||
| Not available | 0 | 1 (4.17) | ||||
| Diabetes [n (%)] | Yes | 0 | 2 (8.33) | |||
| No | 34 (100) | 21 (87.50) | ||||
| Not available | 0 | 1 (4.17) | ||||
| Alcohol use [n (%)] | Never a drinker | 29 (85.29) | 1 (4.17) | |||
| Drinker | 5 (14.71) | 22 (91.67) | ||||
| Not available | 0 | 1 (4.17) | ||||
| Cigarette use [n (%)] | Never a smoker | 20 (58.82) | 4 (16.67) | |||
| Smoker | 14 (41.18) | 19 (79.17) | ||||
| Not available | 0 | 1 (4.17) | ||||
| WBC (109/L) | Median | 5.8 | 5.4 | |||
| Range | 3.4-11.6 | 2.2-8.4 | ||||
| RBC (1012/L) | Median | 4.63 | 4.39 | |||
| Range | 3.59-5.59 | 3.41-5.32 | ||||
| TNM stage [n (%)] | Ⅰ | 9 (26.47) | 1 (4.17) | |||
| Ⅱ | 18 (52.94) | 14 (58.33) | ||||
| III | 6 (17.65) | 7 (29.17) | ||||
| Ⅳ | 1 (2.94) | 2 (8.33) | ||||
| Metastasis [n (%)] | Yes | 12 (35.29) | 8 (33.33) | |||
| No | 22 (64.71) | 16 (66.67) | ||||
Table 1 Basic characteristics of enrolled human subjects
| Variable | Study 1 | Study 2 | ||||
|---|---|---|---|---|---|---|
| HC (n = 34) | ESCC (n = 34) | P value | ESCC (n = 24) | |||
| Age (years) | Median | 67 | 67 | 0.745 | 68 | |
| Range | 56-78 | 54-77 | 50-76 | |||
| Gender [n (%)] | Male | 21 (61.76) | 26 (76.47) | 0.291 | 15 (62.50) | |
| Female | 13 (38.24) | 8 (23.53) | 9 (37.50) | |||
| BMI | Median | 22.18 | 22.01 | |||
| Range | 18.37-30.37 | 18.37-28.31 | ||||
| Hypertension [n (%)] | Yes | 6 (17.65) | 4 (16.67) | |||
| No | 28 (82.35) | 19 (79.17) | ||||
| Not available | 0 | 1 (4.17) | ||||
| Diabetes [n (%)] | Yes | 0 | 2 (8.33) | |||
| No | 34 (100) | 21 (87.50) | ||||
| Not available | 0 | 1 (4.17) | ||||
| Alcohol use [n (%)] | Never a drinker | 29 (85.29) | 1 (4.17) | |||
| Drinker | 5 (14.71) | 22 (91.67) | ||||
| Not available | 0 | 1 (4.17) | ||||
| Cigarette use [n (%)] | Never a smoker | 20 (58.82) | 4 (16.67) | |||
| Smoker | 14 (41.18) | 19 (79.17) | ||||
| Not available | 0 | 1 (4.17) | ||||
| WBC (109/L) | Median | 5.8 | 5.4 | |||
| Range | 3.4-11.6 | 2.2-8.4 | ||||
| RBC (1012/L) | Median | 4.63 | 4.39 | |||
| Range | 3.59-5.59 | 3.41-5.32 | ||||
| TNM stage [n (%)] | Ⅰ | 9 (26.47) | 1 (4.17) | |||
| Ⅱ | 18 (52.94) | 14 (58.33) | ||||
| III | 6 (17.65) | 7 (29.17) | ||||
| Ⅳ | 1 (2.94) | 2 (8.33) | ||||
| Metastasis [n (%)] | Yes | 12 (35.29) | 8 (33.33) | |||
| No | 22 (64.71) | 16 (66.67) | ||||
Figure 1 Repressed amino acid metabolism in patient sera A: comparative analysis of amino acid metabolic features in the sera between ESCC and HCs; B: heatmap showing the differentially expressed amino acids in the sera of patients with ESCC compared to those of HCs. (1): essential amino acids; (2): non-essential amino acids; (3): non-canonical amino acids. C: KEGG pathway-based differential abundance analysis revealing differences in amino acid metabolic pathways in the sera of patients relative to those of HCs. HC: healthy control; ESCC: esophageal squamous cell carcinoma; FC: foldchange; KEGG: kyoto encyclopedia of genes and genomes.
Figure 1 Repressed amino acid metabolism in patient sera A: comparative analysis of amino acid metabolic features in the sera between ESCC and HCs; B: heatmap showing the differentially expressed amino acids in the sera of patients with ESCC compared to those of HCs. (1): essential amino acids; (2): non-essential amino acids; (3): non-canonical amino acids. C: KEGG pathway-based differential abundance analysis revealing differences in amino acid metabolic pathways in the sera of patients relative to those of HCs. HC: healthy control; ESCC: esophageal squamous cell carcinoma; FC: foldchange; KEGG: kyoto encyclopedia of genes and genomes.
Figure 2 Heightened amino acid metabolism in clinical ESCC tissues A: comparative assessment of amino acid metabolic features of clinical ESCC tissues and matched NATs from patients; B: heatmap presenting differentially expressed amino acids in clinical ESCC tissues and matched NATs from patients. (1): essential amino acids; (2): non-essential amino acids; (3): non-canonical amino acids; C: KEGG pathway-based differential abundance analysis depicting alterations in amino acid metabolic pathways in clinical ESCC tissues compared to those in matched NATs. NATs: paired normal adjacent tissues; ESCC: esophageal squamous cell carcinoma; KEGG: kyoto encyclopedia of genes and genomes dataset.
Figure 2 Heightened amino acid metabolism in clinical ESCC tissues A: comparative assessment of amino acid metabolic features of clinical ESCC tissues and matched NATs from patients; B: heatmap presenting differentially expressed amino acids in clinical ESCC tissues and matched NATs from patients. (1): essential amino acids; (2): non-essential amino acids; (3): non-canonical amino acids; C: KEGG pathway-based differential abundance analysis depicting alterations in amino acid metabolic pathways in clinical ESCC tissues compared to those in matched NATs. NATs: paired normal adjacent tissues; ESCC: esophageal squamous cell carcinoma; KEGG: kyoto encyclopedia of genes and genomes dataset.
Figure 3 Amino acid metabolic pathways and biomarkers with opposite alterations between patient sera and clinical ESCC tissues A: depiction of seven amino acid metabolic pathways exhibiting opposite changes in patient sera and tumor tissues; B: heatmap illustrating expression shifts in 40 metabolic enzymes involved in the amino acid pathways shown in A, in clinical ESCC tissues and paired NATs in patients; C: comprehensive analysis of metabolic enzyme and amino acid alterations in the top three pathways from A: glutathione metabolism, pantothenate and CoA biosynthesis, and glycine/serine/threonine metabolism; D: identification of four amino acid metabolites with converse alterations in tumor tissues and sera of patients with ESCC. NATs: paired normal adjacent tissues; ESCC: esophageal squamous cell carcinoma; CoA: coenzyme A.
Figure 3 Amino acid metabolic pathways and biomarkers with opposite alterations between patient sera and clinical ESCC tissues A: depiction of seven amino acid metabolic pathways exhibiting opposite changes in patient sera and tumor tissues; B: heatmap illustrating expression shifts in 40 metabolic enzymes involved in the amino acid pathways shown in A, in clinical ESCC tissues and paired NATs in patients; C: comprehensive analysis of metabolic enzyme and amino acid alterations in the top three pathways from A: glutathione metabolism, pantothenate and CoA biosynthesis, and glycine/serine/threonine metabolism; D: identification of four amino acid metabolites with converse alterations in tumor tissues and sera of patients with ESCC. NATs: paired normal adjacent tissues; ESCC: esophageal squamous cell carcinoma; CoA: coenzyme A.
Figure 4 Interpreting ZXXS syndrome via amino acid metabolic reprogramming The interpretation of ZXXS syndrome in patients diagnosed with ESCC is underpinned by the profound perturbations observed across seven amino acid metabolic pathways. These pathways, which are implicated in immune modulation, generation of reducing agents, energy currency supply, and building block synthesis, are substantially dysregulated in both circulating blood and regional neoplastic tissues in patients with ESCC. Within patients, attenuated activity of these pathways in sera signifies compromised vital Qi, whereas enhanced activity in ESCC tissues indicates locally heightened evil Qi. Thus, this study delineates opposing amino acid metabolic changes between the systemic circulation and localized tumor tissues, offering insights into the biological hallmarks of ZXXS syndrome in patients with ESCC. NATs: paired normal adjacent tissues; ESCC: esophageal squamous cell carcinoma; ZXXS: Zhengxu Xieshi.
Figure 4 Interpreting ZXXS syndrome via amino acid metabolic reprogramming The interpretation of ZXXS syndrome in patients diagnosed with ESCC is underpinned by the profound perturbations observed across seven amino acid metabolic pathways. These pathways, which are implicated in immune modulation, generation of reducing agents, energy currency supply, and building block synthesis, are substantially dysregulated in both circulating blood and regional neoplastic tissues in patients with ESCC. Within patients, attenuated activity of these pathways in sera signifies compromised vital Qi, whereas enhanced activity in ESCC tissues indicates locally heightened evil Qi. Thus, this study delineates opposing amino acid metabolic changes between the systemic circulation and localized tumor tissues, offering insights into the biological hallmarks of ZXXS syndrome in patients with ESCC. NATs: paired normal adjacent tissues; ESCC: esophageal squamous cell carcinoma; ZXXS: Zhengxu Xieshi.
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