Esophageal fibrosis and stricture
after endoscopic submucosal dissection
(ESD) are serious postoperative complications. Previous evidence has
highlighted an anticancer role of β-elemene in esophageal squamous
cell carcinoma. This study put forward a hypothesis on the inhibitory
effect of β-elemene on esophageal fibrosis after ESD and aimed
to elaborate the underlying mechanisms. Our initial network pharmacology
analyses determined hypoxia-inducible factor-1alpha (HIF-1α),
hexokinase 2 (HK2), and p38MAPK in association with the effect of
β-elemene. We validated that the levels of HIF-1α, HK2,
and p-p38MAPK were elevated in esophageal granulation tissue after
ESD and corresponding fibroblasts. Esophageal fibroblasts were treated
with β-elemene of gradient concentrations. The results indicated
that β-elemene repressed the proliferation of esophageal fibroblasts
and the levels of fibrosis-related factors. Further, β-elemene
inhibited HIF-1α expression leading to restricted proliferation
and augmented apoptosis of fibroblasts. HIF-1α induced p38MAPK
phosphorylation by activating the HK2 transcription and consequently
accelerated fibroblast proliferation. Together, β-elemene diminished
HIF-1α expression and impaired the HK2-mediated p38MAPK phosphorylation,
thereby repressing the esophageal fibrosis.
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