Transcatheter arterial chemotherapy with miriplatin for hepatocellular carcinoma patients with chronic renal failure: report of three cases

Transarterial Chemoembolization for Patients With Hepatocellular Carcinoma Using Miriplatin Without the Need for Hydration

Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide, with a rising incidence. The most common therapeutic choice for HCC is transarterial chemoembolization (TACE). While the standard protocol of TACE adopts cisplatin, the application of cisplatin needs hydration before and after the procedure to alleviate adverse effects on kidney function. Miriplatin, a lipophilic platinum complex, enables the omission of periprocedural hydration compared to cisplatin-based TACE. This study aimed to compare the survival benefit between miriplatin-based TACE and cisplatin-based TACE. Briefly, a retrospective cohort study in a single hospital was designed. Patients with HCC complicated by vascular invasion or distant metastasis were excluded. Background variability was adjusted using a propensity score matching; then, overall survival rates were compared using the Gehan-Breslow-Wilcoxon test. As a result, cisplatin and miriplatin were administered to 166 and 120 patients in TACE procedures. After adjusting baseline characteristics using a propensity score including age, sex, tumor burden, functional hepatic reserve, baseline year, and HbA1c, a pair of 99-patient cohorts was generated. Overall survivals did not differ significantly, despite poorer serum creatinine at baseline (0.89 vs. 0.74 mg/dL, p < 0.0001) and fewer patients being prepared for TACE through prehydration (18 patients vs. 38 ones, p = 0.0025) in the miriplatin group than in the cisplatin group. The median survival time was 1490 days for the miriplatin group and 1,830 days for the cisplatin group (p = 0.4022; ratio = 0.814; 95% confidence interval 0.546-1.215). In conclusion, miriplatin will benefit patients with HCC who cannot tolerate perioperative hydration.

SIRT1 Inhibition-Induced Mitochondrial Damage Promotes GSDME-Dependent Pyroptosis in Hepatocellular Carcinoma Cells

Hepatocellular carcinoma (HCC) is a malignant tumor that affects the liver and poses a significant threat to human health. Further investigation is necessary to fully understand the role of SIRT1, a protein linked to tumorigenesis, in HCC development. To investigate the effect of SIRT1 on HCC and elucidate the underlying mechanism. Eight pairs of HCC and paracancerous normal tissue specimens were collected. The levels of SIRT1 and GSDME in tissue samples were assessed using immunohistochemistry and western blotting. SIRT1 levels were determined in HCC (Huh7, HepG2, SNU-423, SNU-398, and HCCLM3) and L-02 cells using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and western blotting. SNU-423 and HCCLM3 cells were transfected with si-SIRT1 and/or si-GSDME to knock down SIRT1 or GSDME expression. RT-qPCR and western blotting were performed to measure the expression of SIRT1, pro-casp-3, cl-casp-3, GSDME, GSDME-N, PGC-1α, Bax, and cytochrome c (Cyto C). Cell proliferation, migration, invasion, and apoptosis were assessed using the cell counting kit-8 (CCK-8), wound healing assay, Transwell invasion assay, and flow cytometry, respectively. The release of lactate dehydrogenase (LDH) was evaluated using an LDH kit. SIRT1 was upregulated in HCC tissues and cells, and a negative correlation was observed between SIRT1 and GSDME-N. SIRT1 silencing suppressed the proliferation, migration, and invasion of HCC cells while also promoting apoptosis and inducing mitochondrial damage. Additionally, the silencing of SIRT1 resulted in the formation of large bubbles on the plasma membrane of HCC cells, leading to cellular swelling and aggravated GSDME-dependent pyroptosis, resulting in an increase in LDH release. Inhibition of GSDME reduced SIRT1 silencing-induced cell swelling, decreased LDH release rate, and promoted apoptosis. SIRT1 silencing promotes GSDME-dependent pyroptosis in HCC cells by damaging mitochondria.

Transarterial chemoembolization for hepatocellular carcinoma: A review of techniques

Hepatocellular carcinoma (HCC) is one of the most common malignant diseases worldwide. While curative therapies, including resection, liver transplantation, and percutaneous ablation (percutaneous ethanol injection and radiofrequency ablation), are applicable for only a portion of the HCC population, transcatheter arterial chemoembolization (TACE) has been recognized as an effective palliative treatment option for patients with advanced HCC. TACE is also used even for single HCCs in which it is difficult to perform surgical resection or locoregional treatment due to systemic co-morbidities or anatomical problems. TACE has become widely adopted in the treatment of HCC. By using computed tomography-angiography, TACE is capable of performing diagnosis and treatment at the same time. Furthermore, TACE plays an important role in the multidisciplinary treatment for HCC when combined with other treatment. In this review, we first discuss the history of TACE, and then review the previous findings about techniques of achieving a locoregional treatment effect (liver infarction treatment, e.g., ultra-selective TACE, balloon-occluded TACE), and the use of TACE as a drug delivery system for anti-cancer agents (palliative, e.g., platinum complex agents, drug-eluting beads) for multiple lesions.