Expression of CD44H and CD44v3 in normal oesophagus, Barrett mucosa and oesophageal carcinoma

CD44v3 is a marker of invasive cancer stem cells driving metastasis in gastric carcinoma

BACKGROUND

Cancer stem cells (CSCs) are at the origin of tumour initiation and progression in gastric adenocarcinoma (GC). However, markers of metastasis-initiating cells remain unidentified in GC. In this study, we characterized CD44 variants expressed in GC and evaluated the tumorigenic and metastatic properties of CD44v3+ cells and their clinical significance in GC patients.

METHODS

Using GC cell lines and patient-derived xenografts, we evaluated CD44+ and CD44v3+ GC cells molecular signature and their tumorigenic, chemoresistance, invasive and metastatic properties, and expression in patients-derived tissues.

RESULTS

CD44v3+ cells, which represented a subpopulation of CD44+ cells, were detected in advanced preneoplastic lesions and presented CSCs chemoresistance and tumorigenic properties in vitro and in vivo. Molecular and functional analyses revealed two subpopulations of gastric CSCs: CD44v3+ CSCs with an epithelial-mesenchymal transition (EMT)-like signature, and CD44+/v3- CSCs with an epithelial-like signature; both were tumorigenic but CD44v3+ cells showed higher invasive and metastatic properties in vivo. CD44v3+ cells detected in the primary tumours of GC patients were associated with a worse prognosis.

CONCLUSION

CD44v3 is a marker of a subpopulation of CSCs with metastatic properties in GC. The identification of metastasis-initiating cells in GC represents a major advance for further development of anti-metastatic therapeutic strategies.

Expression of CD44 and CD133 stem cell markers in squamous cell carcinoma of esophagus

CONTEXT

Role of cancer stem cells in the esophageal carcinogenesis is not clear.

AIM

To assess the expression of CD44 and CD133 cancer stem cell markers in esophageal squamous cell carcinoma (ESCC) and its predisposing lesions by immunohistochemistry.

SETTING AND DESIGN

Prospective study as a part of an intramural research project.

MATERIALS AND METHODS

Tissues samples were obtained with endoscopic biopsy and from surgically resected esophageal specimens. Fifty cases each of histopathologically diagnosed cases of esophageal squamous cell carcinoma and its predisposing lesions (mild, moderate, and severe dysplasia and esophagitis) were evaluated for stem cell marker CD44 and C133 by immunohistochemistry using a scoring system.

STATISTICAL ANALYSIS

Chi-square test, analysis of variance (ANOVA), post-hoc tests (Tukey-HSD) were used as appropriate for data analysis. Two sided P < 0.05 was considered as significant.

RESULTS

CD44 expression was significantly higher in ESCC as compared to dysplasia and esophagitis (mean IS 7.92 ± 1.45 vs. 6.34 ± 0.80 vs 5.15 ± 0.86 respectively, P < 0.001). CD133 expression was also significantly higher in ESCC as compared to dysplasia (mean IS 6.82 ± 1.57 vs. 1.00 ± 0.00 respectively, P < 0.001) while esophagitis showed no expression. CD44 and CD133 expressions were significantly higher in poorly differentiated ESCC than moderately differentiated and well differentiated lesions (CD44 mean IS 6.94 ± 1.44 vs 8.17 ± 1.38 vs. 8.63 ± 1.02 respectively, P < 0.001 and CD 133 mean IRS 5.63 ± 0.81 vs 6.00 ± 00 vs. 9.0 ± 00 respectively, P < 0.001).

CONCLUSION

Significantly higher expression of CD44 and CD133 cancer stem cell markers in ESCC as compared to its predisposing lesions (esophagitis and dysplasia) suggests its role in esophageal carcinogenesis.

Detection of Premalignant Gastrointestinal Lesions Using Surface-Enhanced Resonance Raman Scattering-Nanoparticle Endoscopy

Cancers of the gastrointestinal (GI) tract are among the most frequent and most lethal cancers worldwide. An important reason for this high mortality is that early disease is typically asymptomatic, and patients often present with advanced, incurable disease. Even in high-risk patients who routinely undergo endoscopic screening, lesions can be missed due to their small size or subtle appearance. Thus, current imaging approaches lack the sensitivity and specificity to accurately detect incipient GI tract cancers. Here we report our finding that a single dose of a high-sensitivity surface-enhanced resonance Raman scattering nanoparticle (SERRS-NP) enables reliable detection of precancerous GI lesions in animal models that closely mimic disease development in humans. Some of these animal models have not been used previously to evaluate imaging probes for early cancer detection. The studies were performed using a commercial Raman imaging system, a newly developed mouse Raman endoscope, and finally a clinically applicable Raman endoscope for larger animal studies. We show that this SERRS-NP-based approach enables robust detection of small, premalignant lesions in animal models that faithfully recapitulate human esophageal, gastric, and colorectal tumorigenesis. This method holds promise for much earlier detection of GI cancers than currently possible and could lead therefore to marked reduction of morbidity and mortality of these tumor types.

Platelet 12-lipoxygenase and stem cells in Barrett's esophagus

Esophageal adenocarcinoma has shown a significant increase in incidence in recent years. It is thought that the development of gastroesophageal reflux disease (GERD), followed by columnar-lined esophagus and the development of dysplasia, leads to invasive adenocarcinoma. The exact pathogenesis of this process, the diagnosis and differentiation of the metaplastic and dysplastic esophageal lesions have yet to be determined. The purpose of this immunohistochemical study was to investigate the expression of pro-tumorigenic enzyme platelet 12-lipoxygenase (p12LOX) using two new available antibodies in non-dysplastic and dysplastic Barrett's esophagus. The stem cell markers nestin, CD117 and CD44, were then evaluated. The comparative group included GERD carditis, gastric intestinal metaplasia and colorectal adenoma. The overexpression of p12LOX detected by two specific antibodies in the non-dysplastic and dysplastic Barrett's mucosa clearly demonstrated that this enzyme plays an important role in the development of esophageal adenocarcinoma.

Altered expression of CD44 and DKK1 in the progression of Barrett's esophagus to esophageal adenocarcinoma

Barrett's esophagus (BE) is an acquired condition in which the normal lining of the esophagus is replaced by intestinal metaplastic epithelium. BE can evolve to esophageal adenocarcinoma (EAC) through low-grade dysplasia (LGD) and high-grade dysplasia (HGD). The only generally accepted marker for increased risk of EAC is the presence of HGD, diagnosed on endoscopic biopsies. More specific markers for the prediction of EAC risk are needed. A tissue microarray was constructed comprising tissue samples from BE, LGD, HGD, and EAC. Marker expression was studied by immunohistochemistry using antibodies against CD44, DKK1, CDX2, COX2, SOX9, OCT1, E-cadherin, and beta-catenin. Immunostaining was evaluated semi-quantitatively. CD44 expression decreased in HGD and EAC relative to BE and LGD. DKK1 expression increased in HGD and EAC relative to BE and LDG. CDX2 expression increased in HGD but decreased in EAC. COX2 expression decreased in EAC, and SOX9 expression increased only in the upper crypt epithelial cells in HGD. E-cadherin expression decreased in EAC. Nuclear beta-catenin was not significantly different between BE, LGD, and HGD. Loss of CD44 and gain of DKK1 expression characterizes progression from BE and LGD to HGD and EAC, and their altered expression might indicate an increased risk for developing an EAC. This observation warrants inclusion of these immunohistochemically detectable markers in a study with a long patient follow-up.

Pathogenic role of macrophage migration inhibitory factor in inflammatory bowel disease

AIM: To explore the pathogenic role of macrophage migration inhibitory factor (MIF) in patients with inflammatory bowel disease.

METHODS: A total of 38 patients with ulcerative colitis (UC) at the active stage, 18 patients with Crohn's disease (CD), 23 patients with other forms of colitis and 20 normal controls were enrolled in the study. The levels of MIF in the sera and intestinal tissue were detected by enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry, respectively. Meanwhile, the levels of high sensitivity C-reactive protein (hs-CRP) were measured by latex-enhanced immunoturbidimetry.

RESULTS: The levels of MIF in the sera were significantly higher in UC, CD and other forms of colitis than those in normal controls (10.599 ± 1.895, 8.981 ± 1.409, 8.498 ± 2.242 μg/L vs 5.363 ± 1.841 μg/L; all P < 0.01). The serum MIF levels were significantly higher in the hs-CRP-positive cases with UC than those in the hs-CRP-negative cases (11.025 ± 1.863 μg/L vs 9.408 ± 1.485 μg/L, P < 0.05). However, the levels of MIF in CD patients were not significantly different from those levels in other forms of colitis. The rate of MIF express was significantly increased in colonic mucosa in UC than that in CD or other forms of colitis (100.00% vs 66.67%, 78.26%, 65.00%; P < 0.01).

CONCLUSION: MIF may play a role in the pathogenesis of UC. MIF may be used as a marker of disease activity in UC and control of MIF production may have therapeutic effects.

A novel CD44 v3 isoform is involved in head and neck squamous cell carcinoma progression

OBJECTIVES

CD44 comprises a family of isoforms involved in tumorigenesis. Here we investigate the role of CD44 isoforms in head and neck squamous cell carcinoma (HNSCC) progression.

MATERIALS AND METHODS

HNSCC specimens underwent reverse transcriptase-polymerase chain reaction (RT-PCR) followed by Southern blot analysis. After surface biotinylation, FaDu (hypopharyngeal HNSCC) and CD44v3-transfected COS-7 cells were CD44 antibody-precipitated and compared by Western blot analysis. FaDu cells underwent double immunofluorescence staining and growth assays.

RESULTS

Southern blot analysis suggested differential CD44v3 isoform expression in tumor and normal tissue. Cloning and sequencing revealed 2 novel CD44v isoforms. Western blot analysis suggested CD44v3 expression in COS-7 transfectants and FaDu. Double immunofluorescence staining revealed co-localization of CD44v3 and actin in FaDu projections. Anti-CD44v3 antibody decreased FaDu growth.

CONCLUSION

HNSCC tissue and FaDu appear to express CD44v3 isoforms. These isoforms may promote tumorigenesis.

CLINICAL SIGNIFICANCE

CD44v3 isoforms may be effective tumor markers and targets for HNSCC therapy.

Molecular biology of Barrett's adenocarcinoma

OBJECTIVE

To review the current knowledge on the genetic alterations involved in the development and progression of Barrett's esophagus-associated neoplastic lesions.

SUMMARY BACKGROUND DATA

Barrett's esophagus (BE) is a premalignant condition in which the normal squamous epithelium of the esophagus is replaced by metaplastic columnar epithelium. BE predisposes patients to the development of esophageal adenocarcinoma. Endoscopic surveillance can detect esophageal adenocarcinomas when they are early and curable, but most of the adenocarcinomas are detected at an advanced stage. Despite advances in multimodal therapy, the prognosis for invasive esophageal adenocarcinoma is poor. A better understanding of the molecular evolution of the Barrett's metaplasia to dysplasia to adenocarcinoma sequence may allow improved diagnosis, therapy, and prognosis.

METHODS

The authors reviewed data from the published literature to address what is known about the molecular changes thought to be important in the pathogenesis of BE-associated neoplastic lesions.

RESULTS

The progression of Barrett's metaplasia to adenocarcinoma is associated with several changes in gene structure, gene expression, and protein structure. Some of the molecular alterations already showed promise as markers for early cancer detection or prognostication. Among these, alterations in the p53 and p16 genes and cell cycle abnormalities or aneuploidy appear to be the most important and well-characterized molecular changes. However, the exact sequence of events is not known, and probably multiple molecular pathways interact and are involved in the progression of BE to adenocarcinoma.

CONCLUSIONS

Further research into the molecular biology of BE-associated adenocarcinoma will enhance our understanding of the genetic events critical for the initiation and progression of Barrett's adenocarcinoma, leading to more effective surveillance and treatment.

The diagnosis of dysplasia and malignancy in Barrett's oesophagus

Barrett's metaplasia is associated with an increased risk for adenocarcinoma. Adenocarcinoma develops through a multistep process characterized by defects in genes and morphological abnormalities. The early morphological changes of the process are called 'dysplasia'. Dysplasia is defined as an unequivocal neoplastic (premalignant) transformation confined within the basement membrane. For most Western pathologists malignancy is defined as invasion and characterized by a breach through the basement membrane. Japanese pathologists rely on cytological atypia and complex branching of crypts. Cytological and architectural abnormalities allow identification of dysplasia on routinely stained sections. A distinction is made between low- and high-grade dysplasia. The differential diagnosis between low-grade dysplasia and reactive changes can be difficult. Therefore a second opinion is strongly recommended, not only for high-grade dysplasia but also for low-grade. Immunohistochemistry for p53 and flow cytometry for detection of aneuploidy can support the diagnosis. Identification of dysplasia and malignancy depends on the number of biopsy samples examined. The minimum number of biopsies required has not yet been determined and depends partly on the length of the metaplastic segment. It has been proposed to sample with four quadrant biopsies at 20-mm intervals. New endoscopic techniques can increase the diagnostic yield. Endoscopically visible lesions increase the risk of finding malignancy. The time sequence for the progression of dysplasia is not known but progression from low- to high-grade and cancer has been shown to occur over a period of years although it may not be inevitable.

Altered expression of CD44 and variant isoforms in human adenocarcinoma of the endocervix during progression

OBJECTIVE

Altered expression of the CD44 family of cell adhesion molecules has been associated with tumor progression and metastasis. The aim of this study was to investigate the expression of the gene products of CD44 standard (CD44s) and several alternatively spliced variants (CD44v4, v6, v7, and v9) in adenocarcinoma of the endocervix and to correlate the degree of their expression with disease progression.

METHODS

Immunohistochemical staining for CD44s and CD44v4, v6, v7, and v9 was performed on formalin-fixed, paraffin-embedded endocervical specimens. Seventeen cases of adenocarcinoma in situ (AIS) and 22 cases of invasive adenocarcinoma of the endocervix were included in this study, and the immunoreactivity was compared with that of normal endocervical epithelium.

RESULTS

(1) In the normal endocervical mucosa, immunoreactivity for CD44s and the splice variants was lacking or was confined to only the basal portion of the glandular epithelium along the basement membrane; (2) CD44s was diffusely expressed along the entire cytoplasmic membrane, including the luminal surface of the tumorous glands in 94% of AIS and 95% of invasive adenocarcinomas; (3) a significantly stronger expression of CD44s was observed in invasive adenocarcinomas than in AIS; (4) in contrast to all other splice variants, CD44v9 demonstrated an increased expression in nearly all in situ and invasive lesions compared to the normal tissue; (5) CD44v4 and v6 were expressed only in a small proportion of invasive adenocarcinomas and were near totally absent in the in situ lesions; and (6) CD44 v7 was totally absent in all normal, in situ, and invasive lesions studied.

CONCLUSIONS

It appears that neoplastic transformation of endocervical epithelium is associated with qualitative and quantitative changes in the expression of CD44 standard molecule and some CD44 splice variants.

Plasticity of the gastrointestinal epithelium: the M cell paradigm and opportunism of pathogenic microorganisms

The maintenance during adult life of a large spectrum of pluripotency by stem cells originating from the endoderm seems to be the grounds for the striking plasticity of the digestive epithelium, which is able to drastically modify its differentiation pattern depending on the microenvironment. As a paradigm, Peyer's patch M cell development appears to be induced by crosstalk between lymphoid cells and/or microorganisms. Examples of pathological transdifferentiation of epithelia, also described as 'metaplasia' and affecting various organs, support the concept of intestinal plasticity. Though, the molecular processes involved in epithelial transdifferentiation have not been identified, histological analyses of these metaplastic tissues and experimental induction of transdifferentiation of normal epithelia provide lines of evidence suggesting that a modification of the local environment, such as occurs during contact of the epithelium with lymphoid cells or microorganisms, plays a key role in this process.

Expression of CD44 variant proteins in adenocarcinoma of Barrett's esophagus and its relation to prognosis

BACKGROUND

None of the commonly used staging criteria accurately determine the prognosis of a patient with adenocarcinoma of Barrett's esophagus. The authors therefore assessed the expression pattern and prognostic impact of CD44 standard and CD44 isoforms CD44v4, v5,v6,v7, and v10 in adenocarcinoma of Barrett's esophagus.

METHODS

Specimens from 41 patients with adenocarcinoma of Barrett's esophagus who underwent esophageal resection were embedded in paraffin and studied immunohistochemically to determine the expression of CD44 splice variants. Histomorphologic parameters and survival time were not known at the time of the investigation.

RESULTS

Correlations between favorable clinical or histomorphologic parameters and CD44s or any of the split variants could not be established. Down-regulation of CD44s and the split variant v10 was significantly correlated with pT classification. Furthermore, down-regulation of CD44v10 and up-regulation of CD44v7 were significantly correlated with ploidy. There was a significant correlation between CD44s and split variants in tumorous and nontumorous tissue from the same patient. Down-regulation of CD44s and CD44v4 had a significant influence on prognosis in that it was associated with shortened life expectancy. Multivariate analysis revealed that the expression of CD44v4 was an independent factor in prognosis.

CONCLUSIONS

The results obtained for this small patient sample suggest that CD44v4 is a new independent prognostic parameter for adenocarcinoma of Barrett's esophagus that can be determined preoperatively by biopsy. It may therefore be helpful in planning therapy by allowing the identification of patients who may benefit from esophageal resection as well as those who are at high risk for morbidity and mortality even when the tumor is otherwise resectable. Further studies of larger patient samples are required to validate the results of the current study.

Expression of CD44 in premalignant and malignant Barrett's oesophagus

AIMS

To establish the prevalence of CD44 protein expression in a large surgical series of Barrett's adenocarcinoma and associated preneoplastic lesions and to correlate this expression with clinicopathological data and prognosis.

METHODS AND RESULTS

CD44H and variants (V4/V5, V6) expression was detected by immunohistochemistry in formalin-fixed, paraffin wax tissue samples of Barrett's mucosa (50) and Barrett's adenocarcinoma (73) obtained from surgical resections from 73 patients. This expression was correlated with pathological features of the tumour and prognosis. CD44H and V6 expression was found in 62% and 55% of Barrett's specialized mucosa negative for dysplasia and in 70% and 63% of Barrett's adenocarcinoma, respectively. CD44H and V6 expression was restricted to the lower part of the crypts in Barrett's specialized mucosa negative for dysplasia and reached the upper part of the crypts in high-grade dysplasia. A significant relation was found between CD44V6 expression and depth of tumour invasion in the oesophageal wall (P = 0.05), neoplastic vascular invasion (P = 0.0001), neoplastic perineural invasion (P = 0.0004) and stage in Rosenberg's classification (P = 0.02). Cancers with CD44V6 expression had a significantly poorer prognosis (5-year survival: 17%) than those without (5-year survival: 44%) (P = 0.02) in univariate analysis. However, multivariate analysis showed that CD44V6 expression had no independent prognostic value when tumour invasion and lymph node involvement were taken as explanatory variables.

CONCLUSION

CD44H and V6 are frequently expressed in Barrett's oesophagus. The pattern of expression that we observed from mucosa negative for dysplasia to adenocarcinoma suggests that CD44H and V6 may be involved in the carcinogenesis of Barrett's mucosa. CD44V6 expression in adenocarcinoma is correlated to aggressive pathological features.