Surveillance for gastrointestinal malignancies

SERS detection platform based on a nucleic acid aptamer-functionalized Au nano-dodecahedron array for efficient simultaneous testing of colorectal cancer-associated microRNAs

A surface-enhanced Raman scattering (SERS) detection platform was constructed based on Au nano-dodecahedrons (AuNDs) functionalized with nucleic acid aptamer-specific binding and self-assembly techniques. SERS labels were prepared by modifying Raman signaling molecules and complementary aptamer chains and were bound on the aptamer-functionalized AuNDs array. Using this protocol, the limits of detection (LODs) of miR-21 and miR-18a in the serum were 6.8 pM and 7.6 pM, respectively, and the detection time was 5 min. Additionally, miR-21 and miR-18a were detected in the serum of a mouse model of colorectal cancer. The results of this protocol were consistent with quantitative real-time polymerase chain reaction (qRT-PCR). This method provides an efficient and rapid method for the simultaneous testing of miRNAs, which has great potential clinical value for the early detection of colorectal cancer (CRC).

Hyperthermic intraperitoneal chemotherapy with recombinant mutant human TNF-α and raltitrexed in mice with colorectal-peritoneal carcinomatosis

Peritoneum is one of the most common metastatic sites of colorectal cancer (CRC). It has been reported that cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) prolongs the lifespan of patients with peritoneal carcinomatosis of colorectal origin (CRC-PC), while the drugs used for HIPEC are limited. We investigated the application of recombinant mutant human tumor necrosis factor-α (rmhTNF) combined with raltitrexed in the HIPEC treatment in a mice model with CRC-PC. In vitro, we detected the cytotoxicity and apoptosis of human colorectal cancer cells by 3–(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) assay, Western blot, and TdT-mediated dUTP Nick End Labeling (TUNEL) assay. In vivo, we established xenograft models of CRC-PC and assessed the antitumor effect by in vivo imaging, peritoneal cancer index scoring, and TUNEL assay. The results showed that the combination of rmhTNF and raltitrexed under hyperthermia with a temperature of 42°C inhibited the growth of colorectal cancer cells significantly in vitro, and after HIPEC treatments with rmhTNF and raltitrexed, peritoneal tumor growth was prohibited in vivo. Our findings about the efficacy of rmhTNF and raltitrexed used for HIPEC to treat CRC-PC will provide experimental data and basis for their potential clinical application.

Impact statement

Colorectal peritoneal carcinomatosis exhibits poor prognosis and presents a treatment challenge. At present, the main treatment is surgery, supplemented by hyperthermic intraperitoneal chemotherapy (HIPEC), but the drugs used for HIPEC are limited. Our study found that the combination of recombinant mutant human TNF-α (rmhTNF) and raltitrexed (RTX) under hyperthermia with a temperature of 42°C had antitumor effect both in vitro and vivo. The findings will provide experimental data and basis for the potential clinical application of rmhTNF and RTX, which might offer patients a new choice of therapeutic drugs.

The Increasing Incidence of Remote Metastasis: A Case Report of Metastatic Hepatocellular Carcinoma to the Rectosigmoid

As the fifth most common malignancy worldwide, survival rates of hepatocellular carcinoma (HCC) have only slightly improved over the years due to early-stage detection. HCC is well known to metastasize to the lung, lymph nodes, and musculoskeletal regions; however, only 0.5% to 6% of HCCs metastasize to the gastrointestinal tract. In the case described here, a CT scan and subsequent colonoscopy of a 51-year-old Asian male with a history of hepatitis B and HCC revealed a mass lesion of metastatic HCC 12 cm from the anal verge. Because metastatic HCC to the lower gastrointestinal tract has only recently been reported, it is speculated that the prolonged survival of patients is also increasing the incidence of extrahepatic metastasis, giving the disease greater opportunity to spread to more distant regions of the body. This case may be the farthest metastasis within the gastrointestinal tract to date.

Expression of microRNAs in the ascites of patients with peritoneal carcinomatosis and peritonitis

BACKGROUND

Peritoneal carcinomatosis (PCA) has a prognostic role in patients with gastrointestinal cancers. The differential diagnosis may be challenging due to the low sensitivity of cytology. Although microRNAs (miRNAs) have been a focus of various specimens and diseases, to the best of the authors' knowledge only limited knowledge exists regarding ascites. Herein, the authors systematically evaluated preanalytical factors and the potential of miRNAs as biomarkers of ascites.

METHODS

The authors prospectively analyzed samples from patients with PCA, spontaneous bacterial peritonitis (SBP), and portal hypertension (no SBP/PCA). Various preanalytical factors such as extraction kits, sample storage, stability, and processing were systematically evaluated. MiRNA expression profiling using TaqMan Low Density Array and quantitative reverse transcriptase-polymerase chain reaction were used to evaluate miRNA expression.

RESULTS

All selected miRNAs were found to be reliably detectable in ascites samples. Ascites miRNAs were well preserved from degradation with required short-term and long-term stability. MiRNA expression profiling in patients with PCA compared with those with no SBP/PCA revealed miR-21, miR-186, miR-222, and miR-483-5p to be upregulated and miR-26b to be downregulated. MiRNA expression validation analysis confirmed higher expression levels of miR-21 and miR-186 in patients with PCA compared with those with no SBP/PCA, whereas miR-223 was significantly upregulated in patients with SBP. A simple proportion score between miR-21 and miR-223 allowed the authors to discriminate between the patients with PCA and those with SBP with an area under the curve of 0.982 (95% confidence interval, 0.943-1.022).

CONCLUSIONS

The data from the current study provide novel evidence of the differential expression of miRNAs in ascites from patients with PCA and SBP, which may offer an additional miRNA-based molecular approach for the differential diagnosis of PCA. Cancer Cytopathol 2018;126:353-63. © 2018 American Cancer Society.

Sensitivity and Specificity of Fractal Analysis to Distinguish Between Healthy and Pathologic Rectal Mucosa Microvasculature Seen During Colonoscopy

PURPOSE

Conventional endoscopy is limited by human capability to recognize and to differentiate pathology. Fractal analysis of blood vessels has been used in other organs, such as the retina, but never before to supplement colonoscopy. The aim of this study was to assess whether it is possible to differentiate between healthy and pathologic rectal mucosa using fractal analysis of the mucosal microvascular architecture seen during colonoscopic examination (Supplemental Digital Content 1, http://links.lww.com/SLE/A145).

METHODS

A total of 300 consecutive patients, 133 females and 167 males with a mean age of 49.1 (±11.3) years, undergoing endoscopy were included in the prospective cohort study. Colonoscopy of the sigmorectal region was performed, and then analyzed with computer-assisted image fractal analysis.

RESULTS

Fractal analysis of mucosal vasculature allowed for differentiation between healthy and pathologic rectal mucosa, as well as different pathologies (P<0.0001). The sensitivity of fractal analysis to diagnose rectal neoplasia was 92.8% to 96.4%, while the specificity was 91.9% to 98.5% depending on the fractal parameter. The sensitivity of fractal analysis to diagnose rectal colitis was 84.2% to 92.1%, while the specificity was 95.0% to 96.0%, depending on the fractal parameter.

CONCLUSIONS

Computer-assisted fractal analysis allows for differentiation between healthy and pathologic rectal mucosa, as well as between different mucosal pathologies, seen during colonoscopy. Fractal analysis improves the sensitivity and specificity of colonoscopy to aid in the diagnosis of neoplasia or colitis, and should be included in the screening and surveillance of these pathologies.