CONDITIONAL NEOPLASMS AND SUBTHRESHOLD NEOPLASTIC STATES : A STUDY OF THE TAR TUMORS OF RABBITS

Rethinking cancer initiation: The role of large-scale mutational events

Cancer initiation is revisited in light of recent discoveries in cancer pathogenesis. Of note is the detection of mutated cancer genes in benign conditions. More significantly, somatic clones, which harbor mutations in cancer genes, arise in normal tissues from early development through adulthood, but seldom do they transform into cancer. Further, clustered mutational events-kataegis, chromothripsis and chromoplexy-are widespread in cancer, generating point mutations and chromosomal rearrangements in a single cellular catastrophe. These observations are contrary to the prevailing somatic mutation theory, which states that a cancer is caused by the gradual accumulation of mutations over time. A different perspective is proposed within the framework of Waddington's epigenetic landscape wherein tumorigenesis is viewed primarily as a disruption of cell development. Cell types are defined by their specific gene-expression profiles, determined by the gene regulatory network, and can be regarded as attractor states of the network dynamics: they represent specific, self-stabilizing patterns of gene activities across the genome. However, large-scale mutational events reshape the landscape topology, creating abnormal "unphysiological" attractors. This is the crux of the process of initiation. Initiation primes the cell for conversion into a tumor phenotype by oncogenes and tumor suppressor genes, which drive cell proliferation and clonal diversification. This view of tumorigenesis calls for a different approach to therapy.

The PMA phorbol ester tumor promoter increases canonical Wnt signaling via macropinocytosis

Activation of the Wnt pathway lies at the core of many human cancers. Wnt and macropinocytosis are often active in the same processes, and understanding how Wnt signaling and membrane trafficking cooperate should improve our understanding of embryonic development and cancer. Here, we show that a macropinocytosis activator, the tumor promoter phorbol 12-myristate 13-acetate (PMA), enhances Wnt signaling. Experiments using the Xenopus embryo as an in vivo model showed marked cooperation between the PMA phorbol ester and Wnt signaling, which was blocked by inhibitors of macropinocytosis, Rac1 activity, and lysosome acidification. Human colorectal cancer tissue arrays and xenografts in mice showed a correlation of cancer progression with increased macropinocytosis/multivesicular body/lysosome markers and decreased GSK3 levels. The crosstalk between canonical Wnt, focal adhesions, lysosomes, and macropinocytosis suggests possible therapeutic targets for cancer progression in Wnt-driven cancers.

Addition of exogenous diacylglycerol enhances Wnt/β-catenin signaling through stimulation of macropinocytosis

Activation of Wnt signaling triggers macropinocytosis and drives many tumors. We now report that the exogenous addition of the second messenger lipid sn-1,2 DAG to the culture medium rapidly induces macropinocytosis. This is accompanied by potentiation of the effects of added Wnt3a recombinant protein or the glycogen synthase kinase 3 (GSK3) inhibitor lithium chloride (LiCl, which mimics Wnt signaling) in luciferase transcriptional reporter assays. In a colorectal carcinoma cell line in which mutation of adenomatous polyposis coli (APC) causes constitutive Wnt signaling, DAG addition increased levels of nuclear β-catenin, and this increase was partially inhibited by an inhibitor of macropinocytosis. DAG also expanded multivesicular bodies marked by the tetraspan protein CD63. In an in vivo situation, microinjection of DAG induced Wnt-like twinned body axes when co-injected with small amounts of LiCl into Xenopus embryos. These results suggest that the DAG second messenger plays a role in Wnt-driven cancer progression.

The PMA Phorbol Ester Tumor Promoter Increases Canonical Wnt Signaling Via Macropinocytosis

Activation of the Wnt pathway lies at the core of many human cancers. Wnt and macropinocytosis are often active in the same processes, and understanding how Wnt signaling and membrane trafficking cooperate should improve our understanding of embryonic development and cancer. Here we show that a macropinocytosis activator, the tumor promoter Phorbol 12-myristate 13-acetate (PMA), enhances Wnt signaling. Experiments using the Xenopus embryo as an in vivo model showed marked cooperation between the PMA phorbol ester and Wnt signaling, which was blocked by inhibitors of macropinocytosis, Rac1 activity, and lysosome acidification. Human colorectal cancer tissue arrays and xenografts in mice showed a correlation of cancer progression with increased macropinocytosis/multivesicular body/lysosome markers and decreased GSK3 levels. The crosstalk between canonical Wnt, focal adhesions, lysosomes, and macropinocytosis suggests possible therapeutic targets for cancer progression in Wnt-driven cancers.

Fine particle air pollution and lung cancer risk: Extending the long list of health risks

Exposures to fine particulate matter (PM_2.5) concentrations above the WHO guidelines affect 99% of the world population. In a recent issue of Nature, Hill et al. dissect the tumor promotion paradigm orchestrated by PM_2.5 inhalation exposures in lung carcinogenesis, supporting the hypothesis that PM_2.5 can increase your risk of lung carcinoma without ever smoking.

Inflammation and Gastric Cancer

Gastric cancer remains a major killer globally, although its incidence has declined over the past century. It is the fifth most common cancer and the third most common reason for cancer-related deaths worldwide. Gastric cancer is the outcome of a complex interaction between environmental, host genetic, and microbial factors. There is significant evidence supporting the association between chronic inflammation and the onset of cancer. This association is particularly robust for gastrointestinal cancers in which microbial pathogens are responsible for the chronic inflammation that can be a triggering factor for the onset of those cancers. Helicobacter pylori is the most prominent example since it is the most widespread infection, affecting nearly half of the world’s population. It is well-known to be responsible for inducing chronic gastric inflammation progressing to atrophy, metaplasia, dysplasia, and eventually, gastric cancer. This review provides an overview of the association of the factors playing a role in chronic inflammation; the bacterial characteristics which are responsible for the colonization, persistence in the stomach, and triggering of inflammation; the microbiome involved in the chronic inflammation process; and the host factors that have a role in determining whether gastritis progresses to gastric cancer. Understanding these interconnections may improve our ability to prevent gastric cancer development and enhance our understanding of existing cases.

Diagnostic and Therapeutic Uses of the Microbiome in the Field of Oncology

Cancer is a leading cause of death worldwide and it can affect almost every part of the human body. Effective screening and early diagnosis of cancers is extremely difficult due to the multifactorial etiology of the disease and delayed presentation of the patients. The available treatments are usually not specific to the affected organ system, leading to intolerable systemic side effects and early withdrawal from therapies. In vivo and in vitro studies have revealed an association of specific microbiome signatures with individual cancers. The cancer-related human microbiome has also been shown to affect the response of tissues to chemotherapy, immunotherapy, and radiation. This is an excellent opportunity for us to design specific screening markers using the microbiome to prevent cancers and diagnose them early. We can also develop precise treatments that can target cancer-affected specific organ systems and probably use a lesser dose of chemotherapy or radiation for the same effect. This prevents adverse effects and early cessation of treatments. However, we need further studies to exactly clarify and characterize these associations. In this review article, we focus on the association of the microbiome with individual cancers and highlight its future role in cancer screenings, diagnosis, prognosis, and treatments.

TUMOR CELL MALIGNANCY: A COMPLEX TRAIT BUILT THROUGH RECIPROCAL INTERACTIONS BETWEEN TUMORS AND TISSUE-BODY SYSTEM

Since the discovery of oncogenes and tumor suppressor genes in the late past century, cancer research has been overwhelmingly focused on the genetics and biology of tumor cells and hence has addressed mostly cell-autonomous processes with emphasis on traditional driver/passenger genetic models. Nevertheless, over that same period, multiple seminal observations have accumulated highlighting the role of non-cell autonomous effectors in tumor growth and metastasis. However, given that cell autonomous and non-autonomous events are observed together at the time of diagnosis, it is in fact impossible to know whether the malignant transformation is initiated by cell autonomous oncogenic events or by non-cell autonomous conditions generated by alterations of the tissue-body ecosystem. This review aims at addressing this issue by taking the option of defining malignancy as a complex genetic trait incorporating genetically determined reciprocal interactions between tumor cells and tissue-body ecosystem.

Advances in molecular mechanisms of interaction between Mycobacterium tuberculosis and lung cancer: a narrative review

Objective

We systematically review the molecular mechanism of the interaction between lung cancer (LC) and tuberculosis (TB), and put forward the existing problems in order to provide suggestions for early intervention and future research direction.

Background

TB and LC are two global public health problems affecting human health. LC is the main cause of cancer-related death worldwide and TB is one of the leading causes of death among infectious diseases, especially in resource-poor areas. Previous studies have suggested that a history of TB may be associated with an increased risk of LC. With the improvement of LC treatment, the occurrence of pulmonary tuberculosis in the course of LC treatment is also frequently reported recently.

Methods

The molecular immunological mechanisms of interaction between LC and TB, and related epidemiological literature are reviewed. The research progress and problems to be solved are summarized.

Conclusions

Chronic inflammation, immune abnormalities, scar formation, gene mutations and drug effects caused by TB may be associated with the occurrence of LC induced by abnormalities in various molecular pathways. LC and decreased immunity during treatment may also increase the risk of latent TB activation or new TB infection through immune pathways. Data on dual burden areas of TB and LC are still lacking, and more clinical studies are needed to elucidate the association.

The cancer puzzle: Welcome to organicism

During the fifty years since President Nixon declared the "War on Cancer", those inside and outside the cancer community have witnessed the systematic moving of the goalposts attitude to accommodate evidence into an inadequate theory, that is, the Somatic Mutation Theory (SMT). This sorry state promoted a renewable yearly promise that at the end of the next 10-year period the promises uttered in 1971 would become reality. Each failure triggered calls to do more of the same research under the same theory, routinely using more and more sophisticated technology. Meanwhile, in the last few years, an unambiguous general consensus has emerged acknowledging that this overall long, intensive effort has failed, and that it is likely that the solution to the cancer problem resides elsewhere, namely, in alternative theoretical principles of biology. In this essay we concentrate, first, on the big picture, from the philosophical stance (reductionism versus organicism) to the need to adopt rigorous theories. From this novel perspective we conceptualize cancer as a disease of tissue organization akin to development gone awry. Finally, having identified both a promising stance and a useful theory, i.e., the tissue organization field theory (TOFT), we call for abandoning the SMT and for adopting the more promising TOFT.

Elastolytic activity is associated with inflammation in bladder cancer

Cancer development and progression is often associated with inflammation. Late diagnosis of inflammation that directly leads to the development of neoplasm - cancer is associated with a reduction in the chance of successful treatment or is associated with therapeutic difficulties. A panel of chromogenic substrates was used for the qualitative determination of specific activity of enzymes in urine of patients with confirmed inflammatory reaction and/or epithelial neoplasms in particular tumors at various stages of development. Urine of people with excluded inflammation was used as a control group. Proteolytic activity was determined in urine samples collected from patients with epithelial neoplasms and/or inflammation. What is more, we determine human neutrophil elastase (HNE) activity related inflammation based on the examination of urine samples. We suspect that the proteolytical activity of urine samples is due to neutrophil response to inflammation, which is directly related to cancer. This is the first study to determine elastolytic activity in bladder cancer urine samples. It supports wider use of urine for inflammation screening.

Bruce Nathan Ames - Paradigm shifts inside the cancer research revolution

Dr. Bruce Ames turned 92 on December 16, 2020. He considers his most recent work linking adequate consumption of 30 known vitamins and minerals with successful aging to be his most important contribution. With the passage of time, it is not uncommon for the accomplishments of a well-known scientist to undergo a parsimonious reductionism in the public mind - Pasteur's vaccine, Mendel's peas, Pavlov's dogs, Ames' test. Those of us in the research generation subsequent to Dr. Ames' are undoubtedly affected by our own unconscious tendencies toward accepting the outstanding achievements of the past as commonplace. In doing so, seminal advances made by earlier investigators are often inadvertently subsumed into common knowledge. But having followed Ames' work since the mid-1970s, we are cognizant that the eponymous Ames Test is but a single chapter in a long and rich narrative. That narrative begins with Ames' classic studies on the histidine operon of Salmonella, for which he was elected to the National Academy of Sciences. A summary of the historical progression of the understanding of chemical carcinogenesis to which Ames and his colleagues contributed is provided. Any summary of a topic as expansive and complex as the ongoing unraveling of the mechanisms underlying chemical carcinogenesis will only touch upon some of the major conceptual advances to which Ames and his colleagues contributed. We hope that scientists of all ages familiar with Ames only through the eponymous Ames Test will further investigate the historical progression of the conceptualization of cancer caused by chemical exposure. As the field of chemical carcinogenesis gradually moves away from primary reliance on animal testing to alternative protocols under the rubric of New Approach Methodologies (NAM) an understanding of where we have been might help to guide where we should go.

Cancer Grand Challenges: Embarking on a New Era of Discovery

Cancer Grand Challenges is a unique funding platform that dares global, multidisciplinary teams of researchers to come together, think differently, and tackle some of the toughest challenges in cancer research. Here, we discuss the nine intractable challenges currently open for application.

Evidence for immortality and autonomy in animal cancer models is often not provided, which causes confusion on key issues of cancer biology

Modern research into carcinogenesis has undergone three phases. Surgeons and pathologists started the first phase roughly 250 years ago, establishing morphological traits of tumors for pathologic diagnosis, and setting immortality and autonomy as indispensable criteria for neoplasms. A century ago, medical doctors, biologists and chemists started to enhance "experimental cancer research" by establishing many animal models of chemical-induced carcinogenesis for studies of cellular mechanisms. In this second phase, the two-hit theory and stepwise carcinogenesis of "initiation-promotion" or "initiation-promotion-progression" were established, with an illustrious finding that outgrowths induced in animals depend on the inducers, and thus are not authentically neoplastic, until late stages. The last 40 years are the third incarnation, molecular biologists have gradually dominated the carcinogenesis research fraternity and have established numerous genetically-modified animal models of carcinogenesis. However, evidence has not been provided for immortality and autonomy of the lesions from most of these models. Probably, many lesions had already been collected from animals for analyses of molecular mechanisms of "cancer" before the lesions became autonomous. We herein review the monumental work of many predecessors to reinforce that evidence for immortality and autonomy is essential for confirming a neoplastic nature. We extrapolate that immortality and autonomy are established early during sporadic human carcinogenesis, unlike the late establishment in most animal models. It is imperative to resume many forerunners' work by determining the genetic bases for initiation, promotion and progression, the genetic bases for immortality and autonomy, and which animal models are, in fact, good for identifying such genetic bases.

Spontaneous Cancers, But Not Many Induced Ones in Animals, Resemble Semi-New Organisms that Possess a Unique Programmed Cell Death Mode Different from Apoptosis, Senescent Death, Necrosis and Stress-Induced Cell Death

There are four basic cell death modes in animals, i.e. physiological senescent death (SD) and apoptosis as well as pathological necrosis and stress-induced cell death (SICD). There have been numerous publications describing “apoptosis” in cancer, mostly focused on killing cancer cells using radio- or chemo-therapy, with few on exploring how cancer cells die naturally without such treatments. Spontaneous benign or malignant neoplasms are immortal and autonomous, but they still retain some allegiance to their parental tissue or organ and thus are still somewhat controlled by the patient's body. Because of these properties of immortality, semi-autonomy, and semi-allegiance to the patient's body, spontaneous tumors have no redundant cells and resemble “semi-new organisms” parasitizing the patients, becoming a unique tissue type possessing a hitherto unannotated cell death mode besides SD, apoptosis, necrosis and SICD. Particularly, apoptosis aims to expunge redundant cells, whereas this new mode does not. In contrast to spontaneous tumors, many histologically malignant tumors induced in experimental animals, before they reach an advanced stage, regress after withdrawal of the inducer. This mortal and non-autonomous nature disqualifies these animal lesions as authentic neoplasms and as semi-new organisms but makes them a good tissue type for apoptosis studies. Ruminating over cell death in spontaneous cancers and many inauthentic tumors induced in animals from these new slants makes us realize that “whether cancer cells undergo apoptosis” is not an easy question with a simple answer. Our answer is that cancer cells have an uncharacterized programmed cell death mode, which is not apoptosis.

Evaluating the Remote Control of Programmed Cell Death, with or without a Compensatory Cell Proliferation

Organisms and their different component levels, whether organelle, cellular or other, come by birth and go by death, and the deaths are often balanced by new births. Evolution on the one hand has built demise program(s) in cells of organisms but on the other hand has established external controls on the program(s). For instance, evolution has established death program(s) in animal cells so that the cells can, when it is needed, commit apoptosis or senescent death (SD) in physiological situations and stress-induced cell death (SICD) in pathological situations. However, these programmed cell deaths are not predominantly regulated by the cells that do the dying but, instead, are controlled externally and remotely by the cells' superior(s), i.e. their host tissue or organ or even the animal's body. Currently, it is still unclear whether a cell has only one death program or has several programs respectively controlling SD, apoptosis and SICD. In animals, apoptosis exterminates, in a physiological manner, healthy but no-longer needed cells to avoid cell redundancy, whereas suicidal SD and SICD, like homicidal necrosis, terminate ill but useful cells, which may be followed by regeneration of the live cells and by scar formation to heal the damaged organ or tissue. Therefore, “who dies” clearly differentiates apoptosis from SD, SICD and necrosis. In animals, apoptosis can occur only in those cell types that retain a lifelong ability of proliferation and never occurs in those cell types that can no longer replicate in adulthood. In cancer cells, SICD is strengthened, apoptosis is dramatically weakened while SD has been lost. Most published studies professed to be about apoptosis are actually about SICD, which has four basic and well-articulated pathways involving caspases or involving pathological alterations in the mitochondria, endoplasmic reticula, or lysosomes.

Post-Traumatic Glioma. Report of Four Cases and Review of the Literature

Aims and background

To add a further contribution to the literature supporting the relationship between previous head trauma and development of glioma.

Methods

We report on four patients who developed brain gliomas in the scar of an old brain injury.

Results

All cases fulfilled the widely established criteria for brain tumors of traumatic origin. In all of our cases there was radiological evidence of absence of tumor at the time of the injury.

Conclusions

We believe that in specific cases it is reasonable to acknowledge an etiological association between a severe head trauma and the development of a glioma. This assumption is further sustained if there is radiological and surgical documentation of the absence of neoplasia at the moment of the trauma.

Ricerche Sull'Azione Promovente della Follicolina nel Duplice Meccanismo della Carcinogenesi

Studies were undertaken on an eventual initiating or promoting action of follicular hormone in the twofold mechanism of carcinogenesis on the mouse skin. Animals were grouped into two series. The first series was divided into two groups: one was painted with a folliculin oleous solution (Estrene 5) every 3 days, the other with a 5 per cent dilution of croton oil in estrene. The mice of the second series, previously submitted to three paintings with 3:4-benzpyrene, were divided into four groups: 1) control group, 2) painted with Estrene every 3 days, 3) treated with 5 per cent croton oil solution in olive oil, and 4) treated with 5 per cent dilution of croton oil in oleous solution of follicular hormone. Results show that the follicular hormone, either alone or combined with croton oil, fails to produce any initiating and promoting action when painted on mouse skin previously treated with sub-maximal doses of 3:4-benzpyrene. Folliculin, on the contrary, enhances considerably the promoting action of croton oil when painted with it on the skin sensitized with benzpyrene: a rather early appearance of epithelial projections without basal membrane and composed of atypical elements is seen, whereas in animals of the same series, long treated with paintings of croton oil diluted with olive oil or with oleous folliculin this picture is not observed.

Potential Role of Intercellular Communication in the Rate-Limiting Step in Carcinogenesis

In order to ascertain whether there might be a scientific basis for determining practical “thresholds” for “carcinogens,” the concepts of thresholds and carcinogens were examined in the context of some current ideas on cardnogenesis. The observation that cardnogenesis seems to involve the donal expansion of a pre-malignant cell through a series of pheno-typic changes was explained by the initiation/promotion model of cardnogenesis. Unrepaired DNA lesions, acting as substrates for mutations in dividing cells, were speculated to play a role in the initiation phase of cardnogenesis (and indirectly to the promotion phase if the lesions lead to significant cell killing, forcing “compensatory hyperplasia”). Inhibition of intercellular communication, either by cell removal, cell death, growth factors or chemical promoters, was speculated to allow the donal expansion of initiated cells to reach a “critical mass.” During that donal expansion of initiated cells, additional phenotypic changes were speculated to occur during cell replication by mutational and/or epigenetic events. Therefore, it was concluded, on the basis of this model, that conditions which prevented the inhibition of intercellular communication between normal cells and the initiated cell(s) contributed to the rate limiting step of cardnogenesis.

Assuming the initiation and promotion model of cardnogenesis, the classical concepts of “thresholds” and “carcinogens” were viewed as grossly inadequate because they did not symbolically represent the known determinants of the complex carcinogenic process. Unless genetic, developmental stage, tissue, nutritional, stress, life style, as well as concurrent antagonists and/or synergists, factors are known, extrapolation about the potential carcinogenicity of a given chemical from molecular, in vitro or even in vivo experiments or epidemiological data would be extremely risky. It was concluded that, at this stage of our understanding of the mech-anism(s) of carcinogenesis, attempts to determine “thresholds” for “carcinogens” naively assume “carcinogens” are the single determinants for carcinogenesis, and that all chemicals which might influence the appearance of tumors act the same way.

The Origin and Significance of Hyperplastic Hepatocellular Islands and Nodules in Hepatic Carcinogenesis

Results of many studies, summarized in this review, support the hypothesis that carcinogen-induced hepatocellular carcinomas develop from phenotypically-altered hyperplastic hepatocellular nodules; these in turn apparently arise from smaller focal collections of hyperplastic cells referred to as hepatocellular islands. The very recent recognition that phenobarbital, when administered after carcinogens, fosters the outgrowth of hepatocellular islands and carcinomas, now provides the means for studying stages of initiation and promotion in hep-atocarcinogenesis. In addition, the recognition that enzymatic alterations, particularly the acquisition of canalicular gamma glutamyl transpeptidase activity, loss of ATP'ase activity, and loss of glucose-6-phosphatase activity that characterize many islands, have been particularly useful for measuring and evaluating the growth kinetics and heterogeneity of the islands. Evidence is presented that periportal gamma glutamyl transpeptidase positive hepatocytes are considerably more abundant after four weeks of feeding .02% 2-acetyl-aminofluorene to young rats than in control animals, and that the outgrowth of these cells is fostered by a distinctive type of periportal reparative hyperplasia. The cells appear to arise from a pool of cells that are normally abundant in periportal location in young growing rats. The studies suggest that it may now be possible to develop short term in vivo bioassays for initiators, promoters, and complete carcinogens in the rodent liver.

Non-melanoma skin cancer in mouse and man

As a frontier organ, skin is exposed to different environmental and/or occupational chemicals which cause cutaneous cancers in experimental animals. In mice, 7,12-dimethylbenz[a]anthrancene (DMBA) and the phorbol ester 12-O-tetradecanoylphorbol-13-acetate (TPA) are frequently used as skin model tumor initiator and promoter, respectively. The sequential administration of DMBA and TPA leads to the appearance of a large number of benign papillomas, of which some convert later into invasive squamous cell carcinomas (SCC). At the molecular level, initiation of carcinogenesis in mouse skin consists in the mutational activation of the Ha-ras oncoprotein. HA-RAS mutations are rare in human SCC, but HA-RAS-mutated tumors appear in melanoma patients treated with B-raf inhibitors, indicating that initiated, HA-RAS-mutated stem cells also reside in human skin. Similarly, UV-induced human SCC show footprint mutations in the tumor suppressor gene TP53 which are also observed in UV-induced mouse SCC. Strong species differences exist with respect to phorbol ester-mediated tumor promotion. While certain mouse strains are very susceptible, other rodent species are much less sensitive. Likewise, humans appear to be much more resistant to phorbol ester-mediated skin toxicity. Papilloma formation as a result of a chemical insult is uncommon in men, questioning the relevance of this preneoplastic lesion for humans. However, skin tumorigenesis in the experimental situation and in humans appears to follow common molecular mechanisms, even though there are species differences in the morphological correlates to the preneoplastic state. Therefore, we recommend not simply labeling them as irrelevant for human risk assessment.

Elevated levels of anti inflammatory IL-10 and pro inflammatory IL-17 in malignant pleural effusions

Background

Pleural effusions can be caused by highly different underlying diseases and are characterized by complex interactions of various local and circulating cells as well as numerous soluble parameters like interleukins (IL). Knowledge of this complex network can be helpful in order to make the differential diagnosis in known malignant pleural effusions and understand the underlying immunochemistry of each disease or condition.

Methods

We investigated immunoreactive concentrations of Interleukin 10 (IL-10) and Interleukin 17 (IL-17) in malignant pleural effusions and peripheral blood from patients with bronchial carcinomas and other carcinomas, excluding other conditions such as congestive heart failure (CHF) and pneumonias in twenty four (24) patients (9 men/15 women), 37-74 years (mean:61) with already diagnosed malignant pleural effusions applying the ELISA method.

Results

The SPSS 15 program for Windows was used. Quantitative analysis showed high concentrations of IL-10 and IL-17 in pleural fluid and blood. Even though IL-17 levels -both blood and pleural- were lower than IL-10’s, statistical correlation between blood and pleural concentations was proven, confirming once more the systematic action of these cytokines. At the same time high IL-17 levels in malignant effusions shows maybe a new perspective in understanding the pathophysiology of malignant pleural effusions.

Conclusions

Our results confirm the pathogenetic role of these cytokines in malignant pleural effusions combining for the first time a pro- and an anti- inflammatory cytokine. The observation that IL-17 is elevated in malignant pleural effusions may give a new meaning in Virchow’s remarks 100 years ago. Larger number of patients is needed to confirm our hypothesis.

Intersecting pathways in inflammation and cancer: Hepatocellular carcinoma as a paradigm

Viral infection and chemical carcinogens trigger somatic changes resulting in activation of oncogenes during tumor initiation in the development of cancer. However, a critical interaction resides in the synergism between these somatic changes and an inflamed tumor microenvironment where myeloid and hematopoietic cells are subverted to enhance tumor progression. The causative molecular mechanisms leading to the development of hepatocellular cancer remain incompletely understood but appear to result from multiple factors related to direct hepatocyte injury and the ensuing inflammatory changes mediated by the host response to tissue injury, DNA damage, repair of cellular damage, and chronic, repetitive injury. In this review, the molecular and cellular changes that regulate inflammation and tissue repair will be compared to the activated local tumor microenvironment. Cell-cell signaling within this microenvironment that enhances tumor progression and inhibits anti-tumor immunity will be discussed

Targeting stroma to treat cancers

All cancers depend on stroma for support of growth. Leukemias, solid tumors, cancer cells causing effusions, metastases as well as micro-disseminated cancer cells release factors that stimulate stromal cells, which in turn produce ligands that stimulate cancer cells. Therefore, elimination of stromal support by destroying the stromal cells or by inhibiting feedback stimulation of cancer growth is in the focus of many evolving therapies. A stringent evaluation of the efficacy of stromal targeting requires testing in animal models. Most current studies emphasize the successes of stromal targeting rather than deciphering its limitations. Here we show that many of the stromal targeting approaches, while often reducing tumor growth rates, are rarely curative. Therefore, we will also discuss conditions where stromal targeting can eradicate large established tumors. Finally, we will examine still unanswered questions of this promising and exciting area of cancer research.

Basic concepts of inflammation and its role in carcinogenesis

While the normal inflammatory cascade is self-limiting and crucial for host protection against invading pathogens and in the repair of damaged tissue, a wealth of evidence suggests that chronic inflammation is the engine driving carcinogenesis. Over a period of almost 150 years the link between inflammation and cancer development has been well established. In this chapter we discuss the fundamental concepts and mechanisms behind normal inflammation as it pertains to wound healing. We further discuss the association of inflammation and its role in carcinogenesis, highlighting the different stages of cancer development, namely tumour initiation, promotion and progression. With both the innate and adaptive arms of the immune system being central to the inflammatory process, we examine the role of a number of immune effectors in contributing to the carcinogenic process. In addition, we highlight the influences of host genetics in altering cancer risk.

Cancer risks after radiation exposure in middle age

BACKGROUND

Epidemiological data show that radiation exposure during childhood is associated with larger cancer risks compared with exposure at older ages. For exposures in adulthood, however, the relative risks of radiation-induced cancer in Japanese atomic bomb survivors generally do not decrease monotonically with increasing age of adult exposure. These observations are inconsistent with most standard models of radiation-induced cancer, which predict that relative risks decrease monotonically with increasing age at exposure, at all ages.

METHODS

We analyzed observed cancer risk patterns as a function of age at exposure in Japanese atomic bomb survivors by using a biologically based quantitative model of radiation carcinogenesis that incorporates both radiation induction of premalignant cells (initiation) and radiation-induced promotion of premalignant damage. This approach emphasizes the kinetics of radiation-induced initiation and promotion, and tracks the yields of premalignant cells before, during, shortly after, and long after radiation exposure.

RESULTS

Radiation risks after exposure in younger individuals are dominated by initiation processes, whereas radiation risks after exposure at later ages are more influenced by promotion of preexisting premalignant cells. Thus, the cancer site-dependent balance between initiation and promotion determines the dependence of cancer risk on age at radiation exposure. For example, in terms of radiation induction of premalignant cells, a quantitative measure of the relative contribution of initiation vs promotion is 10-fold larger for breast cancer than for lung cancer. Reflecting this difference, radiation-induced breast cancer risks decrease with age at exposure at all ages, whereas radiation-induced lung cancer risks do not.

CONCLUSION

For radiation exposure in middle age, most radiation-induced cancer risks do not, as often assumed, decrease with increasing age at exposure. This observation suggests that promotional processes in radiation carcinogenesis become increasingly important as the age at exposure increases. Radiation-induced cancer risks after exposure in middle age may be up to twice as high as previously estimated, which could have implications for occupational exposure and radiological imaging.

THE EXPERIMENTAL DISCLOSURE OF LATENT NEOPLASTIC CHANGES IN TARRED SKIN

A carcinogenic tar applied to rabbit skin renders many more epidermal cells neoplastic than ever declare themselves by forming tumors. They may be present in large numbers and persist for a considerable time after brief tarring, yet give rise to no growths unless encouraged. The stimulus of wound healing will suffice to make some of them multiply and form tumors. No evidence has been obtained, in experiments specifically directed to the point, that the cells which tar renders neoplastic respond in this way because they are possessed of peculiarities not shared by the rest of the normal epithelium. The fact that non-specific stimulation (as e.g. wound healing) may act as the deciding influence in tumor formation brings out the need for a sharp distinction between the forces which induce neoplastic change and those which determine, or prevent, its realization in terms of a tumor. The distinction is vital to the appraisal of the many carcinogenic substances worked with nowadays. The ability of tumor cells to lie latent for long periods and respond to non-carcinogenic stimulation by multiplying into growths provides an explanation of those clinical instances in which cancer appears rapidly after acute injury to tissue that had seemed normal.

THE PATHOGENESIS OF TUMORS OF THE LIVER PRODUCED BY BUTTER YELLOW

A conspicuous feature of the cirrhosis that is produced by butter yellow is the new formation of bile ducts that sprout from ducts of the larger portal spaces and penetrate between "portal units" to anastomose with liver cell columns at the periphery of these units. Hyperplasia of the liver may occur with butter yellow administration in the absence of cirrhosis or other change associated with widespread destruction of liver tissue; it occurs as diffuse or focal lesions and affects both parenchymal cells and newly formed ducts. Focal hyperplasia is a precursor of trabecular and adenomatous hepatomas which arise as multiple tumors. Butter yellow causes localized cystic dilatation of newly formed bile ducts unaccompanied by acute or chronic inflammation and liver cells adjacent to them may undergo hyperplasia. Cystic ducts by proliferation of their epithelium may form cyst-adenomas. Butter yellow causes newly formed ducts to undergo dilatation, and with acute inflammation and fibrosis to produce circumscribed macroscopically recognizable lesions (cholangiofibrosis). Cholangiofibrosis is the precursor of tumors that reproduce the histological characters of small bile ducts (cholangiomas), and often proceed to the formation of scirrhous carcinoma. Hepatomas, cyst-adenomas, and cholangiomas may become malignant with formation of metastases in which the characteristics of the parent tumor are reproduced.

THE NEOPLASTIC POTENTIALITIES OF MOUSE EMBRYO TISSUES : II. CONTRIBUTORY EXPERIMENTS; RESULTS WITH THE SKIN OF C3H AND WEBSTER-SWISS EMBRYOS; GENERAL CONSIDERATIONS

Experiments were carried out to learn whether the widely differing liabilities to induced epidermal tumors of individual mice and rabbits are due to a previous localization out of the blood of an agent capable of undergoing change when the skin is exposed to carcinogenic influences, and of producing tumors in consequence. On the assumption that such an agent would localize in increased quantity where cutaneous inflammation exists, like various inert substances of large molecule and the epidermotrophic viruses when circulating, skin areas on adult and new-born animals were for some weeks kept inflamed, and months later, when the areas appeared normal, methylcholanthrene was applied to them and to control areas on the same or other individuals. No differences were observable in tumor incidence. These results led to attempts to test whether embryo epidermis is capable of undergoing neoplastic change, and the work of Paper I was done which showed that epidermal tumors arise with great rapidity and regularity from embryo skin transplanted to adults of homologous strain (C strain) together with methylcholanthrene. Webster-Swiss mice proved unsuited to experiments of the sort owing to heterogeneity of the breed, the transplanted embryo skin dying in most instances before the methylcholanthrene introduced with it could have been carcinogenic. The skin of C3H embryos also did badly, as if from incompatibility in some instances but mostly because its epidermal cells proliferated less vigorously than those of C embryos and did not tolerate methylcholanthrene nearly so well. Despite these difficulties, epidermal tumors were occasionally induced, as also in the transplanted skin of Webster-Swiss embryos, and the growths appeared quite soon, all things considered. The effect of methylcholanthrene on the skin of sucklings, their mothers, and young adult mice of the C strain was studied in order to find out whether the rapid rate of neoplastic change in the transplanted epidermis of embryos is indicative of some liability connected with its period of development. The skin of new-born animals proved very refractory to the carcinogen, hair coming in at the same rate as on control litters and no perceptible inflammation occurring for about 2 weeks, although within this period the mothers of the treated animals and the young adults became hairless where the methylcholanthrene had been put and their skin was much inflamed. Later on, as the applications were kept up, similar changes took place in the sucklings, but none of these developed tumors during some 6 weeks of observation whereas growths appeared within 3 weeks on more than half of the mother mice and on some of the young adults. The failure to produce tumors in the sucklings seems to have been due to cutaneous conditions preventing the necessary exposure of the deeper epidermal cells to methylcholanthrene. In any projected correlation of age differences with the response of cells to carcinogens allowance must be made for such factors. The present findings give no ground for the supposition that embryo skin has any special liability to neoplastic change. The results of transferring the tumors derived from embryo epidermis to new hosts have made plain that the neoplastic state not infrequently entails disabilities which are crucial, the tumor cells failing to succeed unless aided. This holds true of some carcinomas as well as of papillomas. By transplanting pieces of the organs of C embryos together with methylcholanthrene tumors of many sorts besides the epidermal have been obtained. As yet only those of the stomach have been worked with extensively. They can be elicited as quickly and regularly as those of the epidermis and can be as easily transplanted. The findings as a whole render it impossible to suppose that the neoplastic potentialities possessed by transplanted embryo tissues are due to the lodgement in them of tumor-producing viruses as specialized in their effects as those now known, or of precursor agents conferring neoplastic liabilities specialized to the same degree. Some other possibilities are mentioned. The rarity of neoplasms at birth is due to the circumstances of intrauterine life and to its brevity, not to any lack of capacity of the cells of the embryo to undergo neoplastic change.

THE INITIATING AND PROMOTING ELEMENTS IN TUMOR PRODUCTION : AN ANALYSIS OF THE EFFECTS OF TAR, BENZPYRENE, AND METHYLCHOLANTHRENE ON RABBIT SKIN

Benzpyrene brings about neoplastic changes in rabbit epidermis much sooner than has been supposed. The long interval that elapses before visible growths appear is due in the main to the relatively slight power of the carcinogen to encourage multiplication of the cells it renders neoplastic. Yet some slight power of this sort it has. Methylcholanthrene has somewhat more but not nearly so much as tar. It may initiate neoplastic changes within less than 17 days, as compared with less than 10 days for tar, but tumors due to it do not ordinarily appear until months after those called forth by tarring. All three agents give rise to growths of essentially the same kinds, but most of those due to benzpyrene and methlycholanthrene remain for a long while small, dry, and indolent whereas many of the tar tumors are fleshy, vigorous, and rapidly enlarging,—differences wholly consequent on differences in the ability to promote growth. Such ability is an important element in the effectiveness of carcinogens. Tar and the polycyclic hydrocarbons cause many more cells to become tumor cells than give rise to visible growths. Benzpyrene is as effective in initiating neoplastic changes when dissolved in mineral oil as when in benzene, yet no tumors result from it until months after the benzene solution has given rise to them, the reason being that when in oil it is almost devoid of influence to encourage cell proliferation. Benzene itself has a very slight influence of the sort. Solvents may determine not only whether carcinogens initiate neoplastic change but may condition to a crucial degree the influence of these agents to encourage tumor formation. Rabbit epidermis is much more responsive to carcinogenic influences than that of the mouse, as measured in terms of time taken to elicit benign neoplasms. Even benzene will call forth these growths from rabbit skin. In appraising the relative responsiveness to carcinogens of various animal species it is essential to reckon in terms of cells of identical type.

CELL STATE AS AFFECTING SUSCEPTIBILITY TO A VIRUS : ENHANCED EFFECTIVENESS OF THE RABBIT PAPILLOMA VIRUS ON HYPERPLASTIC EPIDERMIS

Rabbit skin can be rendered abnormally susceptible to papilloma virus infection by preliminary treatments with a variety of agents. The most effective agents thus far found are 0.3 per cent methylcholanthrene in benzene and a mixture in equal parts of turpentine and acetone, applied four or five times at 2 day intervals. When virus is inoculated into skin altered by these agents, either intradermally or by inunction after scarification, papillomas appear earlier and in greater number than on normal skin, and much higher dilutions give rise to growths. The method provides a means of detecting amounts of virus which cause no papillomas upon inoculation into normal skin. Papilloma virus material which is rubbed into scarified normal or hyperplastic skin is largely lost in the scabbing which ensues, and nearly all of it fails to reach susceptible cells. The preparatory agents which increase the effectiveness of the virus bring about marked epidermal hyperplasia, and the hyperplastic tissue regenerates with greater rapidity when scarified. The agents evidently act in large part by providing young epidermal cells in quantity to the virus, as also by inducing a richer vascularization than ordinary in support of the papillomatous proliferation. It is possible that they also act by providing especially susceptible cells. The implications of the findings are discussed.

On the stem cell origin of cancer

In each major theory of the origin of cancer-field theory, chemical carcinogenesis, infection, mutation, or epigenetic change-the tissue stem cell is involved in the generation of cancer. Although the cancer type is identified by the more highly differentiated cells in the cancer cell lineage or hierarchy (transit-amplifying cells), the property of malignancy and the molecular lesion of the cancer exist in the cancer stem cell. In the case of teratocarcinomas, normal germinal stem cells have the potential to become cancers if placed in an environment that allows expression of the cancer phenotype (field theory). In cancers due to chemically induced mutations, viral infections, somatic and inherited mutations, or epigenetic changes, the molecular lesion or infection usually first occurs in the tissue stem cells. Cancer stem cells then give rise to transit-amplifying cells and terminally differentiated cells, similar to what happens in normal tissue renewal. However, the major difference between cancer growth and normal tissue renewal is that whereas normal transit amplifying cells usually differentiate and die, at various levels of differentiation, the cancer transit-amplifying cells fail to differentiate normally and instead accumulate (ie, they undergo maturation arrest), resulting in cancer growth.

An overview of the therapeutic effects of leucine supplementation on skeletal muscle under atrophic conditions

The characterization of the mechanisms underlying skeletal muscle atrophy under different conditions has been a constant focus of research. Among anti-atrophic therapies, amino acid supplementation, particularly with leucine, has received a lot of attention. Supplementation has been shown to have remarkable effects on muscle remodeling through protein turnover modulation. This may then impact physiological parameters related to muscle function, and even quality of life. In light of this, leucine supplementation could be a useful therapy for mitigating the atrophic effects of catabolic conditions. The purpose of this review is to present the major results of human studies evaluating the effects of leucine supplementation on structure and function of skeletal muscle in atrophic conditions such as muscle disuse, sarcopenia, and cancer.

Precancer: sequentially acquired or predetermined?

Recognition of focal morphological intraepithelial lesions associated with the eventual development of invasive cancer has long been the sine qua non of precancer. Empirically, precancers are associated with a morphological continuum from atypia to dysplasia and invasive neoplasia. Such lesions are used as early indicators of cancers and have dramatically reduced mortality from cancers of the colon, uterine cervix, and breast. Progression has been modeled as a linear, stepwise process. Some molecular evidence supports a linear model. However, clinical studies now suggest that preexisting cofactors such as human papilloma virus (HPV) in cervical cancer determines the cell fate. Other clinical studies such as bladder, prostate, and breast suggest that many intraepithelial lesions do not progress to malignancy. The more recent experimental analyses reveal that the key molecular and genetic events even predate the emergence of visible lesions. Thus, a new nonlinear, parallel model is proposed. The parallel model suggests an origin in a putative progenitor cell that expands and invades. The clinical outcome is thus predetermined. If correct, this model suggests that "progression" to malignancy is epigenetic. Further, future assessment of biological potential will involve identification and genetic analysis of the progenitor cell populations.

Inflammation: its role and interplay in the development of cancer, with special focus on gynecological malignancies

The relationship between inflammation and cancer is intriguing. Mechanisms contributing to the pathobiology of carcinogenesis are multiple and complex. Many aspects still elude researchers and are subjects of intense speculation and debate, for example, the triggering factor for malignant transformation in inflammation. A comprehensive literature search was conducted from the Web sites of the National Library of Medicine and Pubmed Central, the US National Library of Medicine's digital archive of life sciences literature. The data were accessed from books and journals that published recent articles in this field. Several recent studies have identified nuclear factor-kappa B as a key modulator in driving inflammation to cancers. An inflammatory microenvironment inhabiting various inflammatory cells and a network of signaling molecules is essential for the malignant progression of transformed cells. This is attributed to the mutagenic predisposition of persistent infection-fighting agents at sites of chronic inflammation. The appreciation of the role of inflammation in carcinogenesis provides a mechanistic framework to understand clinical benefits of newer therapeutic strategies An in-depth knowledge about various pathogenic mechanisms involved in cancer will help clinicians in better management of the disease.

Disruption of tumor cell adhesion promotes angiogenic switch and progression to micrometastasis in RAF-driven murine lung cancer

Progression of non-small-cell lung cancer (NSCLC) to metastasis is poorly understood. Two genetic approaches were used to evaluate the role of adherens junctions in a C-RAF driven mouse model for NSCLC: conditional ablation of the cdh1 gene and expression of dominant-negative (dn) E-cadherin. Disruption of E-cadherin caused massive formation of intratumoral vessels that was reversible in the early phase of induction. Vascularized tumors grew more rapidly, developed invasive fronts, and gave rise to micrometastasis. beta-catenin was identified as a critical effector of E-cadherin disruption leading to upregulation of VEGF-A and VEGF-C. In vivo, lung tumor cells with disrupted E-cadherin expressed beta-catenin target genes normally found in other endodermal lineages suggesting that reprogramming may be involved in metastatic progression.

Comparison of mode of action of four hepatocarcinogens: a model-based approach

Within the scope of the Rat Liver Foci Bioassay the model carcinogens N-nitrosomorpholine (NNM), 2-acetylaminoflouren (2-AAF), phenobarbital (PB), and clofibrate (CF) were analyzed concerning their potency and dose-response relationship to induce foci of altered hepatocytes (FAHs), which are known to be precursor lesions of liver adenoma and carcinoma. The medium-term experiment follows an initiation-promotion protocol using diethylnitrosamine (DEN) as initiator. The present report deals with the application of two biologically based models for hepatocarcinogenesis, the two-stage clonal expansion model (TSCEM), and a color-shift model with beta distributed growth rates (CSMbeta). Both models yield similar conclusions concerning the mode of action of the carcinogens. However, the fit of CSMbeta appears closer to the observations than the fit of TSCEM. The analysis shows that application of a single dose of DEN has a persistent effect on the rate of FAH induction, especially in female rats. Overall, striking differences in the effect of the carcinogens were observed between male and female animals. 2-AAF shows a strong promoting effect in males, whereas in females the initiating effect dominates. NNM has both initiating and promoting effect, but in females, the rate of FAH formation seems to reach saturation at high dose. In the doses applied in the present experiment, PB has the weakest carcinogenic effect. Although PB alone does not induce FAH during the observation period, it increases the rate of FAH formation when applied following initiation with DEN. CF reduces the number and area fraction of GSTP-stained FAH, probably because it suppresses the placental form of glutathione S-transferase-positive phenotype.

Effect of a flue-curing process that reduces tobacco specific nitrosamines on the tumor promotion in SENCAR mice by cigarette smoke condensate

A 30-week dermal tumor promotion study was conducted to evaluate the dermal tumor-promoting potential of cigarette smoke condensate (CSC) collected from cigarettes containing flue-cured tobacco cured by a heat-exchange process (HE) relative to that of cigarettes containing flue-cured tobacco cured by the traditional direct-fire process (DF). Heat-exchange process cured tobacco contains significantly lower concentrations of tobacco specific nitrosamines (TSNAs) compared to traditional direct-fire cured tobacco. Mainstream CSCs were collected by cold trap from smoke generators using the Federal Trade Commission puffing regimen. Groups of 40 female SENCAR mice were initiated by a single application of 75 micro g 7,12-dimethylbenz[a]anthracene (DMBA) to the shaved dorsal skin. CSCs were then applied to the skin three times/week for 29 weeks at 9, 18, or 36mg tar/application. End-points included body weights, clinical observations, organ weights, dermal tumor development and histopathology. The numbers of dermal tumors and the numbers of tumor-bearing mice for each CSC were statistically different from the DMBA/acetone control group and increased with increasing dose. When corresponding doses of each CSC were compared, only the DMBA/mid-dose HE CSC group was statistically significantly different (lower) from the corresponding DMBA/mid-dose DF CSC group. In this assay, the dermal tumor-promotion potential of CSC from heat-exchange flue-cured tobacco did not differ from that of traditional direct-fire flue-cured tobacco CSC.