1
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Yin F, Wu ZH, Lai JP. New insights in diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasms. World J Gastroenterol 2022; 28:1751-1767. [PMID: 35633912 PMCID: PMC9099195 DOI: 10.3748/wjg.v28.i17.1751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/06/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are rare epithelial neoplasms derived from pluripotent endocrine cells along the gastrointestinal tract and pancreas. GEP-NENs are classified into well-differentiated neuroendocrine tumors and poorly differentiated neuroendocrine carcinomas. Despite overlapping morphological features, GEP-NENs vary in molecular biology, epigenetic, clinical behavior, treatment response, and prognosis features and remain an unmet clinical challenge. In this review, we introduce recent updates on the histopathologic classification, including the tumor grading and staging system, molecular genetics, and systemic evaluation of the diagnosis and treatment of GEP-NENs at different anatomic sites, together with some insights into the diagnosis of challenging and unusual cases. We also discuss the application of novel therapeutic approaches for GEP-NENs, including peptide receptor radionuclide therapy, targeted therapy, and immunotherapy with immune checkpoint inhibitors. These findings will help improve patient care with precise diagnosis and individualized treatment of patients with GEP-NENs.
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Affiliation(s)
- Feng Yin
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO 65212, United States
| | - Zi-Hao Wu
- Department of Surgery, University of Missouri, Columbia, MO 65212, United States
| | - Jin-Ping Lai
- Department of Pathology, Kaiser Permanente Sacramento Medical Center, Sacramento, CA 95825, United States
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2
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Shi LY, Lu JB, Lai JP. [Metastasis of malignant transformation of pleomorphic adenoma to the lungs, brain and bones: report of a case]. Zhonghua Bing Li Xue Za Zhi 2022; 51:250-252. [PMID: 35249295 DOI: 10.3760/cma.j.cn112151-20210706-00488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- L Y Shi
- Department of Pathology, Sun Yet-Sen University Cancer Center, Guangzhou 510030, China
| | - J B Lu
- Department of Pathology, Sun Yet-Sen University Cancer Center, Guangzhou 510030, China
| | - J P Lai
- Department of Pathology, Sun Yet-Sen University Cancer Center, Guangzhou 510030, China
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3
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Abstract
NY-ESO-1 (CTAG 1B) is highly expressed in the majority of synovial sarcomas and myxoid/round cell liposarcomas as well as in a subset of melanomas, but only rarely in other mesenchymal tumors. This points to a potential for using NY-ESO-1 in the differential diagnosis of these lesions. Furthermore, promising results have been obtained in clinical trials testing NY-ESO-1-targeted immunotherapy in subsets of melanoma and synovial sarcoma patients.
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Affiliation(s)
- Jin-Ping Lai
- Laboratory of Pathology; National Cancer Institute; NIH; Bethesda, MD USA
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4
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Desai A, Sandhu S, Lai JP, Sandhu DS. Hepatocellular carcinoma in non-cirrhotic liver: A comprehensive review. World J Hepatol 2019; 11:1-18. [PMID: 30705715 PMCID: PMC6354117 DOI: 10.4254/wjh.v11.i1.1] [Citation(s) in RCA: 169] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/22/2018] [Accepted: 01/01/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, which in turns accounts for the sixth most common cancer worldwide. Despite being the 6th most common cancer it is the second leading cause of cancer related deaths. HCC typically arises in the background of cirrhosis, however, about 20% of cases can develop in a non-cirrhotic liver. This particular subgroup of HCC generally presents at an advanced stage as surveillance is not performed in a non-cirrhotic liver. HCC in non-cirrhotic patients is clinically silent in its early stages because of lack of symptoms and surveillance imaging; and higher hepatic reserve in this population. Interestingly, F3 fibrosis in non-alcoholic fatty liver disease, hepatitis B virus and hepatitis C virus infections are associated with high risk of developing HCC. Even though considerable progress has been made in the management of this entity, there is a dire need for implementation of surveillance strategies in the patient population at risk, to decrease the disease burden at presentation and improve the prognosis of these patients. This comprehensive review details the epidemiology, risk factors, clinical features, diagnosis and management of HCC in non-cirrhotic patients and provides future directions for research.
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Affiliation(s)
- Aakash Desai
- Department of Internal Medicine, Case Western Reserve University/MetroHealth Medical Center, Cleveland, OH 44109, United States
| | - Sonia Sandhu
- Department of Hematology and Oncology, Cleveland Clinic/Akron General Medical Center, Akron, OH 44307, United States
| | - Jin-Ping Lai
- Department of Pathology, University of Florida, Gainsville, FL 32611, United States
| | - Dalbir Singh Sandhu
- Division of Gastroenterology and Hepatology, Case Western Reserve University/MetroHealth Medical Center, Cleveland, OH 44109, the United States
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5
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Affiliation(s)
- Richard Dunn
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, USA
| | - Wei Zhang
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, USA
| | - Jenny Lai
- University College, Washington University in St. Louis, St. Louis, USA
| | - Tyler Litton
- Department of Radiology, Saint Louis University School of Medicine, St. Louis, USA
| | - Yihua Zhou
- Department of Radiology, Saint Louis University School of Medicine, St. Louis, USA
| | - Jin-Ping Lai
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, USA
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6
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Affiliation(s)
- Marshall W Meeks
- Department of Internal Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd, St Louis, MO, 63104, USA.
| | - Shane Grace
- Department of Internal Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd, St Louis, MO, 63104, USA
| | - Grace Montenegro
- Department of General Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Martin W Schoen
- Department of Internal Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd, St Louis, MO, 63104, USA
| | - Danielle Carpenter
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Jin-Ping Lai
- Department of Pathology, University of Florida, Gainesville, FL, USA
| | - Nishant Poddar
- Department of Internal Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd, St Louis, MO, 63104, USA
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7
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Zhang W, Burton S, Wu S, Qian X, Rajeh MN, Schroeder K, Shuldberg M, Merando A, Lai JP. Primary Gastric ALK-negative EBV-negative Anaplastic Large Cell Lymphoma Presenting with Iron Deficiency Anemia. ACTA ACUST UNITED AC 2018; 31:701-704. [PMID: 28652442 DOI: 10.21873/invivo.11116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/09/2017] [Accepted: 04/10/2017] [Indexed: 02/08/2023]
Abstract
Anaplastic large cell lymphoma (ALCL) is a rare subtype of non-Hodgkin lymphoma (NHL). Primary gastric anaplastic lymphoma kinase (ALK) negative ALCL is extremely rare. Diagnosis of primary gastric ALK-negative ALCL is difficult to establish and prognosis is worse than ALK-positive ALCL. Here, we report a case of an 82-year-old man with a history of cerebrovascular disease presented with weakness and iron deficiency anemia. He denied any abdominal discomforts. The esophagogastroduodenoscopy revealed a large ulcerated, friable mass in the gastric body which encompassed about 80% of entire stomach. Biopsy showed a high grade malignant tumor composed of undifferentiated epithelioid atypical cells, making it difficult to determine the cell of origin. Immunostains for lymphoma, carcinoma, and sarcoma were performed. The tumor cells were positive for CD30, CD4, and CD43, negative for CD20, CD3, ALK-1 and Epstein-Barr virus (EBV)-encoded small RNAs (EBERs) in situ hybridization, establishing the diagnosis of primary gastric ALK-negative ALCL. The patient is currently undergoing chemotherapy with clinical improvement. To the best of our knowledge, this is the first reported case of primary gastric ALK-negative and EBV-negative anaplastic large T-cell lymphoma that presented without gastroenterological symptoms.
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Affiliation(s)
- Wei Zhang
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, U.S.A
| | - Samuel Burton
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, U.S.A
| | - Shaobin Wu
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO, U.S.A
| | - Xia Qian
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO, U.S.A
| | - Mhd Nabeel Rajeh
- Division of Hematoloy and Medical Oncology, Saint Louis University School of Medicine, St. Louis, MO, U.S.A
| | - Katie Schroeder
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, MO, U.S.A
| | - Mark Shuldberg
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO, U.S.A
| | - Adam Merando
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, U.S.A
| | - Jin-Ping Lai
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO, U.S.A. .,Department of Pathology, Immunology and Laboratory Medicine, University of Florida, College of Medicine, Gainesville, FL, U.S.A
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8
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Hammami MB, Talkin R, Al-Taee AM, Schoen MW, Goyal SD, Lai JP. Autologous Graft-Versus-Host Disease of the Gastrointestinal Tract in Patients With Multiple Myeloma and Hematopoietic Stem Cell Transplantation. Gastroenterology Res 2018; 11:52-57. [PMID: 29511407 PMCID: PMC5827903 DOI: 10.14740/gr925w] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/15/2017] [Indexed: 11/17/2022] Open
Abstract
Multiple myeloma (MM) is the most common indication for autologous hematopoietic stem cell transplantation (HSCT) in North America. Despite occurring in up to 50% of patients undergoing allogeneic HSCT, the incidence of graft-versus-host disease (GVHD) after autologous HSCT is reportedly only 5-20%. Gastrointestinal involvement with graft-versus-host disease (GI GVHD) is a common and serious complication of allogeneic HSCT. GI GVHD after autologous transplant, which is referred to as autologous GVHD (auto-GVHD), has also been described. Auto-GVHD is usually less severe than allogeneic GVHD, and it can be one of the manifestations of engraftment syndrome with release of inflammatory cytokines and infiltration of auto-reactive T cells into affected tissue. Seventy-nine percent of patients respond well to corticosteroids without evidence of recurrence. However, cases of severe auto-GVHD lacking good response to corticosteroids have been reported, most notably in MM patients. Here we present two cases of autologous GI GVHD in recipients of autologous HSCT for treatment of MM. Our cases demonstrate two distinct clinical and endoscopic presentations of this uncommon entity. In the first case, the patient had more severe clinical symptoms accompanied by radiographic, endoscopic, and pathologic findings. The hospital course was complicated by cryptosporidium enteritis and acute cholecystitis in the setting of increased immunosuppression with a corticosteroid for presumed auto-GVHD. In contrast, the second case presented a patient with normal radiologic and endoscopic findings. Pathology revealing frequent apoptotic bodies led to auto-GVHD as a diagnosis. Both our patients received similar courses of chemotherapy prior to autologous HSCT (four cycles of a proteasome inhibitor, lenalidomide, and dexamethasone). Our work highlights the importance of maintaining a high level of clinical suspicion for auto-GVHD in patients presenting with GI symptoms after autologous HSCT, as it is a potentially treatable pathology that may be easily confused with other conditions. Health care providers should be aware of the potential complications of auto-GVHD after autologous HSCT and should be suspicious of auto-GVHD if GI symptoms occur, especially in patients receiving immunomodulatory therapy for MM, even in the absence of gross endoscopic findings.
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Affiliation(s)
- Muhammad B Hammami
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Rebecca Talkin
- School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Ahmad M Al-Taee
- Department of Internal Medicine, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Martin W Schoen
- Division of Hematology, Oncology & Cellular Therapy, Department of Internal Medicine, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Sagun D Goyal
- Division of Hematology, Oncology & Cellular Therapy, Department of Internal Medicine, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Jin-Ping Lai
- Department of Pathology, University of Florida, Gainesville, FL, USA
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9
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Zhang W, De D, Mohammed KA, Munigala S, Chen G, Lai JP, Bacon BR. New scoring classification for primary biliary cholangitis-autoimmune hepatitis overlap syndrome. Hepatol Commun 2018; 2:245-253. [PMID: 29507900 PMCID: PMC5831022 DOI: 10.1002/hep4.1148] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/03/2017] [Accepted: 12/17/2017] [Indexed: 02/05/2023] Open
Abstract
Autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) are two major immune‐mediated chronic liver diseases. Overlap syndrome (OS) is diagnosed if patients have features of both AIH and PBC; however, there is no consensus on the definition or diagnostic criteria for OS. Here, we report a new scoring classification for OS and evaluate its usefulness. This new scoring classification was developed by modifying the International Autoimmune Hepatitis Group classification by selecting histologic features of AIH and PBC along with modifications of biochemical and immunologic characteristics. We evaluated 272 patients with chronic liver disease, including 105 with AIH, 102 with PBC, and 65 with OS. The best performance for the diagnosis of OS was noted among patients with an overlap score of ≥21 who had a sensitivity of 98.5%, a specificity of 92.8%, a positive predictive value of 81.0%, and a negative predictive value of 99.5%. By using a cut‐off score of 21, 64 (98.5%) patients were diagnosed with OS as opposed to 9 (8.8%) and 6 (5.7%) with PBC and AIH, respectively. All patients with OS had an aggregate score of >19, whereas most patients with PBC or AIH scored <19, making this a safe discriminatory cut‐off point against OS. Conclusion: The new scoring system for the diagnosis of OS has a high sensitivity and specificity for scores ≥21, while a score <19 suggests a diagnosis other than OS. This classification can identify patients and diagnose OS with a reasonable amount of accuracy and may be superior to current OS scoring systems in detecting mild forms of OS. (Hepatology Communications 2018;2:245‐253)
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Affiliation(s)
- Wei Zhang
- Department of Internal Medicine Saint Louis University School of Medicine St Louis MO
| | - Debapriya De
- Division of Gastroenterology and Hepatology Saint Louis University School of Medicine St Louis MO
| | - Kahee A Mohammed
- Department of Internal Medicine Saint Louis University School of Medicine St Louis MO.,Saint Louis University Center for Outcomes Research St. Louis MO
| | - Satish Munigala
- Saint Louis University Center for Outcomes Research St. Louis MO
| | - Guilan Chen
- Department of Pathology Saint Louis University School of Medicine St. Louis MO
| | - Jin-Ping Lai
- Department of Pathology Saint Louis University School of Medicine St. Louis MO.,Department of Pathology, Immunology, and Laboratory Medicine University of Florida, College of Medicine Gainesville FL
| | - Bruce R Bacon
- Division of Gastroenterology and Hepatology Saint Louis University School of Medicine St Louis MO.,Saint Louis University Liver Center St Louis MO
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10
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Lee AA, Poddar N, Hammami MB, Veerapong J, Cao D, Lai JP. Gastric Spindle Cell Neuroendocrine Tumor Mimicking Gastrointestinal Stromal Tumor: Unique Morphology and Diagnostic Pitfall. Anticancer Res 2017; 37:5893-5897. [PMID: 28982917 DOI: 10.21873/anticanres.12035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 08/07/2017] [Accepted: 08/10/2017] [Indexed: 02/08/2023]
Abstract
Gastric neuroendocrine tumors (GNETs) with spindle cell morphology are extremely rare. We present a case of a 49-year-old female patient with a history of systemic lupus erythematosus, Sjogren's syndrome, and gastroesophageal reflux disease. She was initially thought to have a spindle cell gastrointestinal stromal tumor per histological studies of the fundic polypectomy samples. Immunohistochemically, the tumor cells were negative for CD117, and CD34, but positive for chromogranin, synaptophysin, and CD56 with a 6% Ki-67 index, consistent with a spindle cell-type well differentiated neuroendocrine tumor, World Health Organization (WHO) Grade 2. To the best of our knowledge, this is the first case report of a gastric spindle cell neuroendocrine tumor in the English literature.
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Affiliation(s)
- Alexandria A Lee
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO, U.S.A
| | - Nishant Poddar
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, U.S.A
| | - Muhammad B Hammami
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, U.S.A
| | - Jula Veerapong
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, U.S.A
| | - Dengfeng Cao
- Department of Pathology and Immunology, Washington University, St. Louis, MO, U.S.A
| | - Jin-Ping Lai
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO, U.S.A. .,Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, U.S.A
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11
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Roberts RO, Kang YN, Hu C, Moser CD, Wang S, Moore MJ, Graham RP, Lai JP, Petersen RC, Roberts LR. Decreased Expression of Sulfatase 2 in the Brains of Alzheimer's Disease Patients: Implications for Regulation of Neuronal Cell Signaling. J Alzheimers Dis Rep 2017; 1:115-124. [PMID: 30035253 PMCID: PMC6052874 DOI: 10.3233/adr-170028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: The human sulfatase 1 (SULF1) and sulfatase 2 (SULF2) genes modulate cell signaling and homeostasis in many tissues. Gene expression analyses have implicated SULF2 in disease pathogenesis, including Alzheimer’s disease (AD), but changes in brain SULF2 expression have not been directly established. Objective: To investigate the expression of SULF1 and SULF2 in brain tissues from AD cases and cognitively normal controls. Methods: Autopsy tissue from AD cases (n = 20) and age-and gender-matched cognitively normal controls (n = 20) were identified from the Mayo Clinic Alzheimer’s Disease Patient Registry neuropathology database. Tissue slides were stained for SULF1 and SULF2 protein expression in the hippocampus and frontal lobe and an expression score computed from the proportion of cells stained and the intensity of staining (range 0 [no expression] to 9 [marked expression]). Results: SULF2 expression was reduced in AD cases. Compared to cognitively normal controls, SULF2 expression in AD cases was significantly decreased in the hippocampal Cornu Ammonis (CA) (mean score of 6.5 in cases versus 8.3 in controls; p = 0.003), in the gray matter of the parahippocampal gyrus (5.6 in cases versus 7.6 in controls; p = 0.003), and in the frontal lobe gray matter (5.4 in cases versus 7.4 in controls; p = 0.002). There was no difference in SULF1 expression in the hippocampus or frontal lobe of AD cases and controls. As expected there were no differences in SULF1 or SULF2 expression in white matter in AD cases compared to cognitively normal controls. Conclusion: Decreased SULF2 in specific regions of the brain occurs in AD.
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Affiliation(s)
- Rosebud O Roberts
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Yoo Na Kang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.,Department of Pathology, Keimyung University, Daegu, South Korea
| | - Chunling Hu
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Catherine D Moser
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Shaoqing Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Michael J Moore
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jin-Ping Lai
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Ronald C Petersen
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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12
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Lai JP, Yue Y, Zhang W, Zhou Y, Frishberg D, Jamil LH, Mirocha JM, Guindi M, Balzer B, Bose S, Cao D, Lo S, Fan X, Rutgers JK. Comparison of endoscopic ultrasound guided fine needle aspiration and PET/CT in preoperative diagnosis of pancreatic adenocarcinoma. Pancreatology 2017; 17:617-622. [PMID: 28501471 DOI: 10.1016/j.pan.2017.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 04/11/2017] [Accepted: 04/13/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) is the procedure of choice to investigate and sample pancreatic masses for the preoperative diagnosis of pancreatic ductal adenocarcinoma (PDAC). The role of 18fluoro-deoxyglucose positron emission tomography/computed tomography (PET/CT) in PDAC is debated. This study evaluates the role of EUS-FNA as compared to PET/CT in the preoperative evaluation of PDAC. METHODS Preoperative evaluation by PET/CT and EUS-FNA was performed on 25 patients with pancreatic solid lesions, who underwent a subsequent Whipple procedure or partial pancreatic resection. RESULTS This series included 19 PDACs and 6 non-PDACs including 1 metastatic breast ductal adenocarcinoma, 2 low grade neuroendocrine tumors, 2 chronic pancreatitis and 1 gastrointestinal tumor abutting the pancreas. EUS-FNA correctly diagnosed 18 of 19 PDACs, 1 metastatic breast ductal adenocarcinoma and all 5 of the other non-PDAC cases. One case of well differentiated PDAC was negative on EUS-FNA. PET/CT provided excellent size and was positive in 14 of 19 PDACs and the metastatic breast ductal adenocarcinoma. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for EUS-FNA in diagnosis of selected pancreatic tumors were 91%, 100%, 100%, 50% and 92%, respectively, while they were 65%, 100%, 100%, 20% and 68% for PET/CT, respectively. CONCLUSIONS Compared to PET/CT, EUS-FNA has a higher sensitivity and accuracy for preoperative diagnosis of PDAC. However, PET/CT provides excellent size, volume and stage information. A combination of both PET/CT and EUS will better help guide diagnosis and treatment of pancreatic adenocarcinoma.
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Affiliation(s)
- Jin-Ping Lai
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Department of Pathology, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
| | - Yong Yue
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Wei Zhang
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | - Yihua Zhou
- Department of Radiology, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | - David Frishberg
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Laith H Jamil
- Division of Gastroenterology and Hepatology, Digestive Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - James M Mirocha
- Biostatistics Core, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Maha Guindi
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Bonnie Balzer
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Shikha Bose
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Dengfeng Cao
- Department of Pathology, Immunology and Laboratory Medicine, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Simon Lo
- Division of Gastroenterology and Hepatology, Digestive Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Xuemo Fan
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Joanne K Rutgers
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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13
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Grace SA, Meeks MW, Chen Y, Cornwell M, Ding X, Hou P, Rutgers JK, Crawford SE, Lai JP. Adipose Triglyceride Lipase (ATGL) Expression Is Associated with Adiposity and Tumor Stromal Proliferation in Patients with Pancreatic Ductal Adenocarcinoma. Anticancer Res 2017; 37:699-703. [PMID: 28179319 DOI: 10.21873/anticanres.11366] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 12/12/2016] [Accepted: 12/16/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Obesity is an established risk factor for the development of pancreatic ductal adenocarcinoma (PDAC). However, the pathophysiology of how increased adiposity increases the risk for PDAC has not been fully elucidated. Adipose triglyceride lipase (ATGL) is a lipase that catabolizes triglyceride hydrolysis and has been implicated in the development of breast cancer. We hypothesized that overweight patients with PDAC would demonstrate higher tumor ATGL expression compared to non-overweight patients with PDAC. MATERIALS AND METHODS Immunohistochemical analysis for ATGL expression was performed on PDAC tissues from 44 patients after Whipple procedure or distal pancreatectomy. Correlation of ATGL expression with clinicopathological features was evaluated. RESULTS A total of 23/44 (52.2%) PDACs showed low level ATGL immunoreactivity, while 21/44 (47.8%) showed a high level, with moderate to strong positive ATGL immunoreactivity in more than 50% of the tumor cells. Chi-squared testing revealed a statistically significant association between high ATGL expression and both BMI >25 kg/m2 (χ2=5.74, p=0.017) and increased tumor stroma (χ2=19.14, p<0.001). Chi-squared testing failed to reveal a statistically significant association when comparing ATGL expression by lymph node metastasis, histological grade, tumor size, patient age, patient sex and presence of fat invasion. CONCLUSION Our results suggest that increased ATGL expression is associated with increased adiposity and stromal proliferation in patients with PDAC, making it a possible key protein in how obesity increases the risk of PDAC.
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Affiliation(s)
- Shane A Grace
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO, U.S.A
| | - Marshall W Meeks
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO, U.S.A
| | - Yongxin Chen
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO, U.S.A
| | - Mona Cornwell
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO, U.S.A
| | - Xianzhong Ding
- Department of Pathology, Loyola University Medical Center, Maywood, IL, U.S.A
| | - Ping Hou
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO, U.S.A
| | - Joanne K Rutgers
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, U.S.A
| | - Susan E Crawford
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO, U.S.A
| | - Jin-Ping Lai
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO, U.S.A.
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14
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Piao J, Friedman P, Siddiqui S, Veerapong J, Lai JP. Synchronous Type 1 Papillary Renal Cell Carcinoma in a Patient with Rectal Adenocarcinoma. Anticancer Res 2017; 36:4821-4. [PMID: 27630335 DOI: 10.21873/anticanres.11043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/09/2016] [Indexed: 02/08/2023]
Abstract
Synchronous colorectal cancer (CRC) and renal cell carcinoma (RCC) is relatively rare, particularly when the synchronous RCC is of papillary subtype, which is exceedingly rare. We report a case of a 63-year-old Caucasian man with synchronous CRC and type 1 papillary RCC. After the patient presented with three episodes of melena, colonoscopy followed by biopsy confirmed rectal adenocarcinoma. The computed tomographic imaging also showed an incidental mass of the upper pole of the left kidney suspicious for RCC. Once chemoradiation therapy was successfully completed, an ultra low anterior resection and partial nephrectomy were performed concurrently. Histological examination showed colorectal adenocarcinoma (ypT1 N0 Mx) and papillary RCC type I (pT1a Nx Mx). Although the exact pathogenesis of synchronous CRC and RCC is unknown, it has been suggested that almost all patients with this entity do not have Lynch syndrome. The majority of these patients usually present with CRC-related symptoms and then, during workup, are subsequently found to have an incidental renal mass that is most often diagnosed as clear cell subtype of RCC. To the best of our knowledge, this is only the second reported case of synchronous CRC and type 1 papillary RCC.
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Affiliation(s)
- Jinhua Piao
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO, U.S.A
| | - Paul Friedman
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO, U.S.A
| | - Sameer Siddiqui
- Department of Surgery, Saint Louis University School of Medicine, Saint Louis, MO, U.S.A
| | - Jula Veerapong
- Department of Surgery, Saint Louis University School of Medicine, Saint Louis, MO, U.S.A
| | - Jin-Ping Lai
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO, U.S.A.
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15
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Zhang W, Chen B, Chen Y, Chamberland R, Fider-Whyte A, Craig J, Varma C, Befeler AS, Bisceglie AMD, Horton P, Lai JP. Epstein-Barr Virus-Associated Acute Liver Failure Present in a 67-Year-Old Immunocompetent Female. Gastroenterology Res 2016; 9:74-78. [PMID: 27785330 PMCID: PMC5040549 DOI: 10.14740/gr718e] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2016] [Indexed: 02/07/2023] Open
Abstract
Acute liver failure (ALF) is a rare illness with a high mortality rate. The only favorable management is emergent liver transplantation. About 13% of ALF cases have no clear etiology. Epstein-Barr virus (EBV)-associated ALF accounts for less than 1% of all ALF cases, and is seen mostly in adults younger than 40 years. There are only a few cases of EBV-associated ALF in elderly immunocompromised adults. We report a case of ALF in an immunocompetent 67-year-old woman caused by EBV infection that was treated by orthotopic liver transplantation (OLT). The diagnosis of EBV-associated ALF was established by EBV-DNA polymerase chain reaction (PCR) and EBV-encoded RNA (EBER-RNA) in situ hybridization (EBER-RISH). The patient is currently doing well 6 months after transplantation without any evidence of clinical EBV infection. This case illustrates the importance of early recognition and diagnosis of EBV-associated ALF by detection of EBV from liver biopsy, especially when patients are immunocompetent and other causes are excluded. To the best of our knowledge, this is the first case of EBV-associated ALF present in an immunocompetent elderly female.
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Affiliation(s)
- Wei Zhang
- Department of Pathology, Saint Louis University School of Medicine, St Louis, MO 63104, USA; Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, MO 63104, USA
| | - Betty Chen
- Department of Pathology, Saint Louis University School of Medicine, St Louis, MO 63104, USA
| | - Yongxin Chen
- Department of Pathology, Saint Louis University School of Medicine, St Louis, MO 63104, USA
| | - Robin Chamberland
- Department of Pathology, Saint Louis University School of Medicine, St Louis, MO 63104, USA
| | - Alexa Fider-Whyte
- Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, MO 63104, USA
| | - Julia Craig
- Department of Surgery, Saint Louis University School of Medicine, St Louis, MO 63104, USA
| | - Chintalapati Varma
- Department of Surgery, Saint Louis University School of Medicine, St Louis, MO 63104, USA
| | - Alex S Befeler
- Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, MO 63104, USA
| | - Adrian M Di Bisceglie
- Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, MO 63104, USA
| | - Peter Horton
- Department of Surgery, Saint Louis University School of Medicine, St Louis, MO 63104, USA
| | - Jin-Ping Lai
- Department of Pathology, Saint Louis University School of Medicine, St Louis, MO 63104, USA
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16
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Affiliation(s)
- Marshall Meeks
- Department of Pathology, Saint Louis University School of Medicine, 1402 S. Grand Blvd, St Louis, MO, 63104, USA
| | - Shane Grace
- Department of Pathology, Saint Louis University School of Medicine, 1402 S. Grand Blvd, St Louis, MO, 63104, USA
| | - Jula Veerapong
- Department of Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Yongxin Chen
- Department of Pathology, Saint Louis University School of Medicine, 1402 S. Grand Blvd, St Louis, MO, 63104, USA
| | - Dengfeng Cao
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Yihua Zhou
- Department of Radiology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Jin-Ping Lai
- Department of Pathology, Saint Louis University School of Medicine, 1402 S. Grand Blvd, St Louis, MO, 63104, USA.
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17
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Lai JP, Lee CC, Crocker M, Najmuddin M, Lange E, Merino M, Stratakis CA. Isolated Large Cell Calcifying Sertoli Cell Tumor in a Young Boy, not Associated with Peutz-Jeghers Syndrome or Carney Complex. ACTA ACUST UNITED AC 2015; 3:2. [PMID: 26587565 DOI: 10.21767/2386-5180.10002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Large cell calcifying sertoli cell tumor (LCCSCT) is an exceedingly rare lesion of the testicle. It is most often seen in patients with Carney complex (CNC) or Peutz-Jeghers syndrome (PJS). We now report the first pediatric patient with what appears to be bilateral LCCSCT and no other conditions or a genetic syndrome, such as PJS or CNC, have been associated with it. METHODS A 10-year-old boy was found to have a right testicular mass during a routine pediatric examination; he underwent right orchiectomy. He was then evaluated clinically for PJS or CNC and underwent genetic testing. His tumor was studied by immunohistochemistry for the expression of calretinin, NY-ESO-1, inhibin, CD99, S100, PLAP, AE1/AE3, Bcl-2, p53, and Mib1. RESULTS Patient did not have clinical features or genetic abnormalities of CNC and PJS. Microscopic features showed large, round or cubical intratubular and aggregated tumor cells with prominent nuclear atypia, large and prominent nucleoli and extensive calcification. In the Immunohistochemical studies, calretinin and inhibin alpha were up regulated in LCCSCT as compared to the adjacent benign Sertoli cells. Meanwhile, NY-ESO-1 and CD99 were down-regulated in LCCSCT. Focally and weakly positive S100 was found in the tumor tissue, but no S100 expression was present in the adjacent Sertoli cells. There was no expression of PLAP, P53, Bcl-2, Mib1 and AE1/AE3 in LCCSCT and adjacent Sertoli cells. Micro-calcifications were found in the other gonad by ultrasonography, suggesting LCCSCT. CONCLUSION LCCSCT is a rare testicular neoplasm, and may present in isolated rather than in more typical association with syndromes such as CNC and PJS.
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Affiliation(s)
- Jin-Ping Lai
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA ; Department of Pathology, Saint Louis University School of Medicine, St Louis, MO 63104, USA
| | - Chyi-Chia Lee
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Melissa Crocker
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology Genetics (PDEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), USA ; Inter-Institute Pediatric Endocrinology Training Program, National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Mufaddal Najmuddin
- Department of Pathology, Saint Louis University School of Medicine, St Louis, MO 63104, USA
| | - Eileen Lange
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology Genetics (PDEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), USA ; Inter-Institute Pediatric Endocrinology Training Program, National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Maria Merino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology Genetics (PDEGEN), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), USA ; Inter-Institute Pediatric Endocrinology Training Program, National Institutes of Health (NIH), Bethesda, MD 20892, USA
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18
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Mohanty SK, Lai JP, Gordon OK, Pradhan D, Bose S, Dadmanesh F. BRCA-mutated Invasive Breast Carcinomas: Immunohistochemical Analysis of Insulin-like Growth Factor II mRNA-binding Protein (IMP3), Cytokeratin 8/18, and Cytokeratin 14. Breast J 2015; 21:596-603. [PMID: 26390986 DOI: 10.1111/tbj.12494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To evaluate the expression of insulin-like growth factor II mRNA-binding protein (IMP3), CK8/18, and CK14 in BRCA mutated and sporadic invasive breast carcinoma. Immunohistochemistry for IMP3, CK8/18, and CK14 was performed on 39 cases of invasive breast carcinomas with BRCA mutation (24 BRCA1, 14 BRCA2, and 1 dual BRCA1/BRCA2) and 54 cases of sporadic invasive breast carcinomas. The relationship between the IMP3, CK8/18, and CK14 and the tumor grade and molecular phenotypes were analyzed. IMP3, CK8/18, and CK14 positivity were present in 20 (51%), 22 (56%), and 14 (36%) of 39 BRCA-mutated breast carcinomas, and 11 (20%), 53 (98%), and 24 (44%) of 54 sporadic breast carcinomas respectively. The rates of IMP3 expression and absence of CK8/18 (44% versus 2%) in BRCA-mutated breast carcinomas was significantly higher than the sporadic breast carcinomas (p = 0.002 and p < 0.001). No significant difference was observed for CK14 among the two groups (p = 0.408). No significant difference was observed among BRCA1-related and BRCA2-related breast carcinomas in the immunoprofile for IMP3, CK8/18, and CK14. No significant correlation was identified between the expression of IMP3 and CK8/18 and the tumor grade in both BRCA-mutated and sporadic breast carcinomas (p > 0.05). In cases with luminal A and B phenotypes, the rates of expression of IMP3 and loss of CK8/18 were significantly higher in BRCA-mutated as compared to sporadic breast carcinoma (p < 0.001). In cases with basal-like phenotype, the absence of CK8/18 expression was significantly higher in BRCA-mutated breast carcinomas (54% versus 0%, p = 0.001), while no difference was observed for IMP3 expression (p = 0.435). Regardless of mutation type, histologic grade, or molecular phenotype, the absence of CK8/18 expression and presence of IMP3 expression are seen at much higher rate in BRCA mutated breast carcinomas.
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Affiliation(s)
- Sambit K Mohanty
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jin-Ping Lai
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ora K Gordon
- Department of Genetics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dinesh Pradhan
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Shikha Bose
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Farnaz Dadmanesh
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
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19
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Chen L, Huang K, Himmelfarb EA, Zhai J, Lai JP, Lin F, Wang HL. Diagnostic value of maspin in distinguishing adenocarcinoma from benign biliary epithelium on endoscopic bile duct biopsy. Hum Pathol 2015; 46:1647-54. [PMID: 26362203 DOI: 10.1016/j.humpath.2015.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 07/09/2015] [Accepted: 07/10/2015] [Indexed: 02/08/2023]
Abstract
Histopathologic distinction between benign and malignant epithelia on endoscopic bile duct biopsy can be extremely challenging due to small sample size, crush artifact, and a propensity for marked inflammatory and reactive changes after stent placement. Our previous studies have shown that the insulin-like growth factor II mRNA-binding protein 3, S100P, and the von Hippel-Lindau gene product (pVHL) can help the distinction. This study analyzed 134 endoscopic bile duct biopsy specimens (adenocarcinoma 45, atypical 31, and benign 58) by immunohistochemistry for the expression of maspin, a serine protease inhibitor. The results demonstrated that (1) maspin expression was more frequently detected in malignant than in benign biopsies; (2) malignant biopsies frequently showed diffuse, strong/intermediate, and combined nuclear/cytoplasmic staining patterns for maspin, which were much less commonly seen in benign biopsies; (3) the malignant staining patterns for maspin observed in atypical biopsies were consistent with follow-up data showing that 67% of these patients were subsequently diagnosed with adenocarcinoma; (4) a maspin+/S100P+/pVHL- staining profile was seen in 75% of malignant biopsies but in none of the benign cases. These observations demonstrate that maspin is a useful addition to the diagnostic immunohistochemical panel (S100P, pVHL, and insulin-like growth factor II mRNA-binding protein 3) to help distinguish malignant from benign epithelia on challenging bile duct biopsies.
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Affiliation(s)
- Lihong Chen
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095; Department of Pathology, School of Basic Medical Sciences of Fujian Medical University, Fuzhou, Fujian 350004, China.
| | - Kevin Huang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095
| | | | - Jing Zhai
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048
| | - Jin-Ping Lai
- Department of Pathology, Saint Louis University School of Medicine, St Louis, MO 63104
| | - Fan Lin
- Department of Laboratory Medicine, Geisinger Medical Center, Danville, PA 17822
| | - Hanlin L Wang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095.
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20
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Wardell SE, Ellis MJ, Alley HM, Eisele K, VanArsdale T, Dann SG, Arndt KT, Primeau T, Griffin E, Shao J, Crowder R, Lai JP, Norris JD, McDonnell DP, Li S. Efficacy of SERD/SERM Hybrid-CDK4/6 Inhibitor Combinations in Models of Endocrine Therapy-Resistant Breast Cancer. Clin Cancer Res 2015; 21:5121-5130. [PMID: 25991817 DOI: 10.1158/1078-0432.ccr-15-0360] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/11/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE Endocrine therapy, using tamoxifen or an aromatase inhibitor, remains first-line therapy for the management of estrogen receptor (ESR1)-positive breast cancer. However, ESR1 mutations or other ligand-independent ESR1 activation mechanisms limit the duration of response. The clinical efficacy of fulvestrant, a selective estrogen receptor downregulator (SERD) that competitively inhibits agonist binding to ESR1 and triggers receptor downregulation, has confirmed that ESR1 frequently remains engaged in endocrine therapy-resistant cancers. We evaluated the activity of a new class of selective estrogen receptor modulators (SERM)/SERD hybrids (SSH) that downregulate ESR1 in relevant models of endocrine-resistant breast cancer. Building on the observation that concurrent inhibition of ESR1 and the cyclin-dependent kinases 4 and 6 (CDK4/6) significantly increased progression-free survival in advanced patients, we explored the activity of different SERD- or SSH-CDK4/6 inhibitor combinations in models of endocrine therapy-resistant ESR1(+) breast cancer. EXPERIMENTAL DESIGN SERDs, SSHs, and the CDK4/6 inhibitor palbociclib were evaluated as single agents or in combination in established cellular and animal models of endocrine therapy-resistant ESR1(+) breast cancer. RESULTS The combination of palbociclib with a SERD or an SSH was shown to effectively inhibit the growth of MCF7 cell or ESR1-mutant patient-derived tumor xenografts. In tamoxifen-resistant MCF7 xenografts, the palbociclib/SERD or SSH combination resulted in an increased duration of response as compared with either drug alone. CONCLUSIONS A SERD- or SSH-palbociclib combination has therapeutic potential in breast tumors resistant to endocrine therapies or those expressing ESR1 mutations. See related commentary by DeMichele and Chodosh, p. 4999.
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Affiliation(s)
- Suzanne E Wardell
- Department of Pharmacology and Cancer Biology Duke University School of Medicine Durham, NC 27710
| | - Matthew J Ellis
- Lester and Sue Smith Breast Center, Baylor College of Medicine Houston TX 77030
| | - Holly M Alley
- Department of Pharmacology and Cancer Biology Duke University School of Medicine Durham, NC 27710
| | | | | | | | - Kim T Arndt
- Pfizer Oncology Research Unit Pearl River, NY 10965
| | - Tina Primeau
- Division of Oncology, Department of Internal Medicine Washington University in St Louis, MO 63110
| | - Elizabeth Griffin
- Division of Oncology, Department of Internal Medicine Washington University in St Louis, MO 63110
| | - Jieya Shao
- Division of Oncology, Department of Internal Medicine Washington University in St Louis, MO 63110
| | - Robert Crowder
- Division of Oncology, Department of Internal Medicine Washington University in St Louis, MO 63110
| | - Jin-Ping Lai
- Department of Pathology Saint Louis University, MO 63104
| | - John D Norris
- Department of Pharmacology and Cancer Biology Duke University School of Medicine Durham, NC 27710
| | - Donald P McDonnell
- Department of Pharmacology and Cancer Biology Duke University School of Medicine Durham, NC 27710
| | - Shunqiang Li
- Division of Oncology, Department of Internal Medicine Washington University in St Louis, MO 63110.,Siteman Cancer Center Breast Cancer Program Washington University in St. Louis, MO 63110
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21
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Lai JP, Conley A, Knudsen BS, Guindi M. Hypoxia after transarterial chemoembolization may trigger a progenitor cell phenotype in hepatocellular carcinoma. Histopathology 2015; 67:442-50. [PMID: 25425262 DOI: 10.1111/his.12623] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 11/22/2014] [Indexed: 02/05/2023]
Abstract
AIMS To test the hypothesis that the hypoxia marker carbonic anhydrase IX (CAIX), and the cholangiocytic/progenitor markers cytokeratin (CK) 19 and epithelial cell adhesion molecule (EpCAM), may be expressed in areas of hypoxia in hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE). METHODS AND RESULTS Immunohistochemistry for CAIX, CK19 and EpCAM (BerEP4) was performed in 57 HCCs, including 40 residual/recurrent tumours adjacent to the TACE treatment site and 17 untreated tumours from the same 40 patients. CAIX was exxpressed in 19 of 40 residual/recurrent HCCs and in two of 17 untreated HCCs. The rate of CAIX immunoreactivity in the treated tumours was significantly higher than that in the non-treated tumours (47.5% versus 11.8%, P = 0.015). CK19 and EpCAM were expressed in six of 19 and in seven of 19 CAIX-positive TACE-treated HCCs, respectively, but were not expressed in CAIX-negative tumours or untreated tumours. There were significant associations between CK19 and CAIX immunoreactivity, and between EpCAM and CAIX immunoreactivity (P = 0.007 and P = 0.003, respectively). Double staining of CAIX and CK19 showed co-localization of both proteins in five of six cases. Three of seven EpCAM-positive tumours were also positive for CK19. CONCLUSIONS Hypoxia may trigger the expression of proteins that are normally associated with cholangiocytic/progenitor cell differentiation, suggesting that TACE paradoxically causes an aggressive tumour phenotype.
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Affiliation(s)
- Jin-Ping Lai
- Departments of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew Conley
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Beatrice S Knudsen
- Departments of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Maha Guindi
- Departments of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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22
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Shire A, Lomberk G, Lai JP, Zou H, Tsuchiya N, Aderca I, Moser CD, Gulaid KH, Oseini A, Hu C, Warsame O, Jenkins RB, Roberts LR. Restoration of epigenetically silenced SULF1 expression by 5-aza-2-deoxycytidine sensitizes hepatocellular carcinoma cells to chemotherapy-induced apoptosis. ACTA ACUST UNITED AC 2015; 3:1-18. [PMID: 26236329 PMCID: PMC4520440 DOI: 10.1159/000375461] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Hepatocellular carcinoma (HCC) is the second most frequent cause of cancer death worldwide. Sulfatase 1 (SULF1) functions as a tumor suppressor in HCC cell lines in vitro but also has an oncogenic effect in some HCCs in vivo. Aim The purpose of this study was to examine the mechanisms regulating SULF1 and its function in HCC. Methods First, SULF1 mRNA and protein expression were examined. Second, we examined SULF1 gene copy numbers in HCC cells. Third, we assessed whether DNA methylation or methylation and/or acetylation of histone marks on the promoter regulate SULF1 expression. Finally, we examined the effect of 5-aza-2′-deoxycytidine (5-Aza-dC) on sulfatase activity and drug-induced apoptosis. Results SULF1 mRNA was downregulated in nine of eleven HCC cell lines, but only in six of ten primary tumors. SULF1 mRNA correlated with protein expression. Gene copy number assessment by fluorescence in situ hybridization showed intact SULF1 alleles in low-SULF1-expressing cell lines. CpG island methylation in the SULF1 promoter and two downstream CpG islands did not show an inverse correlation between DNA methylation and SULF1 expression. However, chromatin immunoprecipitation showed that the SULF1 promoter acquires a silenced chromatin state in low-SULF1-expressing cells through an increase in di/trimethyl-K9H3 and trimethyl-K27H3 and a concomitant loss of activating acetyl K9, K14H3 marks. 5-Aza-dC restored SULF1 mRNA expression in SULF1-negative cell lines, with an associated increase in sulfatase activity and sensitization of HCC cells to cisplatin-induced apoptosis. Conclusion SULF1 gene silencing in HCC occurs through histone modifications on the SULF1 promoter. Restoration of SULF1 mRNA expression by 5-Aza-dC sensitized HCC cells to drug-induced apoptosis.
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Affiliation(s)
- Abdirashid Shire
- Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, 55905 USA
| | - Gwen Lomberk
- Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, 55905 USA
| | - Jin-Ping Lai
- Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, 55905 USA
| | - Hongzhi Zou
- Division of Experimental Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN 55905 USA
| | - Norihiko Tsuchiya
- Department of Urology, Akita University School of Medicine, Akita 010-8543 Japan
| | - Ileana Aderca
- Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, 55905 USA
| | - Catherine D Moser
- Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, 55905 USA
| | - Kadra H Gulaid
- Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, 55905 USA
| | - Abdul Oseini
- Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, 55905 USA
| | - Chunling Hu
- Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, 55905 USA
| | - Omar Warsame
- Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, 55905 USA
| | - Robert B Jenkins
- Division of Laboratory Genetics, Department of Laboratory Medicine and Pathology College of Medicine, Mayo Clinic, Rochester, MN 55905 USA
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, 55905 USA
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23
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Grace S, Muzaffar R, Veerapong J, Alkaade S, Poddar N, Phillips N, Guzman M, Batanian J, Vogler C, Lai JP. Synchronous quadruple primary neoplasms: glioblastoma, neuroendocrine tumor, schwannoma and sessile serrated adenoma in a patient with history of prostate cancer. Anticancer Res 2015; 35:2121-7. [PMID: 25862868 DOI: pmid/25862868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Quadruple synchronous primary neoplasms are exceedingly rare with only one case reported in the English literature. We herein report a case of synchronous quadruple primary neoplasms in a 70-year-old Arabic male with a history of prostate cancer who presented to our hospital for work-up of a brain mass found at an outside hospital. Subsequent (18)Fluorodeoxyglucose (FDG) positron emission tomography demonstrated a 5.9-cm temporoparietal mass and three additional lesions, each with increased maximum standardized uptake value (SUV(max)). Histologic examination, immunohistochemistry and cytogenetic analyses of the lesional tissue revealed four primary neoplastic lesions: primary glioblastoma, inguinal schwannoma, well-differentiated neuroendocrine tumor of the terminal ileum and an appendiceal sessile serrated adenoma/polyp. This case is unique among previous reports as our patient presented with four primary neoplasms synchronously. To the best of our knowledge, this combination of synchronous multiple primary neoplasms has not been reported in the English literature.
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Affiliation(s)
- Shane Grace
- Department of Pathology, Saint Louis University, Saint Louis, MO, U.S.A
| | - Razi Muzaffar
- Department of Radiology, Saint Louis University, Saint Louis, MO, U.S.A
| | - Jula Veerapong
- Department of Surgery, Saint Louis University, Saint Louis, MO, U.S.A
| | - Samer Alkaade
- Department of Internal Medicine, Saint Louis University, Saint Louis, MO, U.S.A
| | - Nishant Poddar
- Department of Internal Medicine, Saint Louis University, Saint Louis, MO, U.S.A
| | - Nancy Phillips
- Department of Pathology, Saint Louis University, Saint Louis, MO, U.S.A
| | - Miguel Guzman
- Department of Pathology, Saint Louis University, Saint Louis, MO, U.S.A
| | | | - Carole Vogler
- Department of Pathology, Saint Louis University, Saint Louis, MO, U.S.A
| | - Jin-Ping Lai
- Department of Pathology, Saint Louis University, Saint Louis, MO, U.S.A.
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Lai JP, Mertens RB, Mirocha J, Koo J, Venturina M, Chung F, Mendez AB, Kahn M, Dhall D. Comparison of PAX6 and PAX8 as immunohistochemical markers for pancreatic neuroendocrine tumors. Endocr Pathol 2015; 26:54-62. [PMID: 25433656 DOI: 10.1007/s12022-014-9346-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To compare the utility of PAX6 and PAX8 as immunohistochemical markers for neuroendocrine tumors (NETs) of pancreatic origin, we performed PAX6 and PAX8 immunostains on 178 NETs, including 110 primary NETs (26 pancreatic, 10 gastric, 12 duodenal, 22 jejuno-ileal, 10 rectal, 30 pulmonary) and 68 NETs metastatic to the liver (24 pancreatic, 1 duodenal, 37 jejuno-ileal, 1 rectal, 5 pulmonary). Among primary NETs, PAX6 and PAX8 were positive in 65 % (17/26) and 73 % (19/26) of pancreatic, 0 % (0/10) and 10 % (1/10) of gastric, 92 % (11/12) and 92 % (11/12) of duodenal, 0 % (0/22) and 0 % (0/22) of jejuno-ileal, 90 % (9/10) and 80 % (8/10) of rectal, and 0 % (0/30) and 23 % (7/30) of pulmonary NETs, respectively. PAX6 and PAX8 positivity was seen in 46 % (11/24) and 50 % (12/24) of metastatic pancreatic NETs to the liver, respectively. None of the nonpancreatic NETs metastatic to the liver were immunoreactive for either PAX6 or PAX8. PAX6 showed a slightly but statistically significant higher specificity for pancreatic NETs than did PAX8 (P = 0.039), while the sensitivities were similar (P = 0.51). PAX6 had the additional advantages over PAX8 of not exhibiting nonspecific cytoplasmic staining of tumor cells and only infrequently staining background lymphocytes. Since rectal NETs rarely present with metastatic disease, positive staining of a metastatic NET of unknown primary origin for PAX6 and/or PAX8 favors a pancreatic or duodenal origin. This information may be helpful in directing further diagnostic studies to identify the primary site of the metastatic tumor.
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Affiliation(s)
- Jin-Ping Lai
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA,
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Yu JR, Huang Q, Hou P, Lai JP. Collision tumor of colonic adenocarcinoma and EBV-driven large B-cell lymphoma: A case report and review of literature. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.ctrc.2014.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Lai JP, Chen ZME, Lok T, Chan OTM, Himmelfarb E, Zhai Q, Lin F, Wang HL. Immunohistochemical stains of proliferating cell nuclear antigen, insulin-like growth factor 2 and clusterin help distinguish malignant from benign liver nodular lesions. J Clin Pathol 2014; 67:464-9. [PMID: 24407433 DOI: 10.1136/jclinpath-2013-201907] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS To explore the immunohistochemical utility of proliferating cell nuclear antigen (PCNA), insulin-like growth factor 2 (IGF2) and clusterin in the distinction between malignant and benign liver nodular lesions. METHODS Immunohistochemical stains for PCNA, IGF2 and clusterin were performed on 284 liver nodular lesions, including 33 hepatocellular adenomas (HCA), 40 focal nodular hyperplasias (FNH), 77 large regenerative nodules (LRN) and 134 hepatocellular carcinomas (HCC). RESULTS Strong and diffuse nuclear PCNA immunoreactivity was observed in 103 (77%) HCCs but in only 2 (6%) HCAs. None of the FNH and LRN cases showed a strong and diffuse staining pattern. All HCAs, 95% of FNHs and 92% of LRNs showed cytoplasmic IGF2 expression, with a strong staining observed in 70% of HCAs, 20% of FNHs and 30% of LRNs. This was in marked contrast to that observed in HCCs, where 66% of HCCs demonstrated a weak and focal/patchy immunostaining pattern and another 25% showed no detectable IGF2 immunoreactivity. In comparison with their adjacent non-lesional hepatocytes, 75% of HCCs showed decreased IGF2 expression. However, decreased IGF2 expression was not evident in HCAs, FNHs and LRNs. Cytoplasmic staining for clusterin was seen in both benign and malignant nodular lesions. However, an enhanced and exaggerated pericanalicular staining pattern was observed in 75% of HCCs, which was not demonstrated in HCAs, FNHs and LRNs. CONCLUSIONS PCNA, IGF2 and clusterin show unique immunostaining characteristics in HCCs, which can be useful adjuncts to other currently available markers to aid in the distinction of HCC from benign liver nodular lesions.
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Affiliation(s)
- Jin-Ping Lai
- Department of Pathology and Laboratory Medicine, University of California in Los Angeles, Los Angeles, California, USA Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Zong-Ming E Chen
- Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Terry Lok
- Department of Pathology and Laboratory Medicine, University of California in Los Angeles, Los Angeles, California, USA
| | - Owen T M Chan
- Department of Pathology, University of Hawaii, Honolulu, Hawaii, USA
| | | | - Qihui Zhai
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, USA
| | - Fan Lin
- Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Hanlin L Wang
- Department of Pathology and Laboratory Medicine, University of California in Los Angeles, Los Angeles, California, USA
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Lai JP, Liu YC, Alimchandani M, Liu Q, Aung PP, Matsuda K, Lee CCR, Tsokos M, Hewitt S, Rushing EJ, Tamura D, Levens DL, DiGiovanna JJ, Fine HA, Patronas N, Khan SG, Kleiner DE, Oberholtzer JC, Quezado MM, Kraemer KH. The influence of DNA repair on neurological degeneration, cachexia, skin cancer and internal neoplasms: autopsy report of four xeroderma pigmentosum patients (XP-A, XP-C and XP-D). Acta Neuropathol Commun 2013; 1:4. [PMID: 24252196 PMCID: PMC3776212 DOI: 10.1186/2051-5960-1-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 02/27/2013] [Indexed: 02/08/2023] Open
Abstract
Background To investigate the association of DNA nucleotide excision repair (NER) defects with neurological degeneration, cachexia and cancer, we performed autopsies on 4 adult xeroderma pigmentosum (XP) patients with different clinical features and defects in NER complementation groups XP-A, XP-C or XP-D. Results The XP-A (XP12BE) and XP-D (XP18BE) patients exhibited progressive neurological deterioration with sensorineural hearing loss. The clinical spectrum encompassed severe cachexia in the XP-A (XP12BE) patient, numerous skin cancers in the XP-A and two XP-C (XP24BE and XP1BE) patients and only few skin cancers in the XP-D patient. Two XP-C patients developed internal neoplasms including glioblastoma in XP24BE and uterine adenocarcinoma in XP1BE. At autopsy, the brains of the 44 yr XP-A and the 45 yr XP-D patients were profoundly atrophic and characterized microscopically by diffuse neuronal loss, myelin pallor and gliosis. Unlike the XP-A patient, the XP-D patient had a thickened calvarium, and the brain showed vacuolization of the neuropil in the cerebrum, cerebellum and brainstem, and patchy Purkinje cell loss. Axonal neuropathy and chronic denervation atrophy of the skeletal muscles were observed in the XP-A patient, but not in the XP-D patient. Conclusions These clinical manifestations and autopsy findings indicate advanced involvement of the central and peripheral nervous system. Despite similar defects in DNA repair, different clinicopathological phenotypes are seen in the four cases, and therefore distinct patterns of neurodegeneration characterize XP-D, XP-A and XP-C patients.
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Mu X, Wu C, Lai J, Chen J, Zheng J, Li C, Zhao Y. A facile and general approach for the synthesis of fluorescent silica nanoparticles doped with inert dyes. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s11434-011-4727-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Lai JP, Oseini AM, Moser CD, Yu C, Elsawa SF, Hu C, Nakamura I, Han T, Aderca I, Isomoto H, Garrity-Park MM, Shire AM, Li J, Sanderson SO, Adjei AA, Fernandez-Zapico ME, Roberts LR. The oncogenic effect of sulfatase 2 in human hepatocellular carcinoma is mediated in part by glypican 3-dependent Wnt activation. Hepatology 2010; 52:1680-9. [PMID: 20725905 PMCID: PMC2967616 DOI: 10.1002/hep.23848] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
UNLABELLED Heparan sulfate proteoglycans (HSPGs) act as coreceptors or storage sites for growth factors and cytokines such as fibroblast growth factor and Wnts. Glypican 3 (GPC3) is the most highly expressed HSPG in hepatocellular carcinoma (HCC). Sulfatase 2 (SULF2), an enzyme with 6-O-desulfatase activity on HSPGs, is up-regulated in 60% of primary HCCs and is associated with a worse prognosis. We have previously shown that the oncogenic effect of SULF2 in HCC may be mediated in part through up-regulation of GPC3. Here we demonstrate that GPC3 stimulates the Wnt/β-catenin pathway and mediates the oncogenic function of SULF2 in HCC. Wnt signaling in vitro and in vivo was assessed in SULF2-negative Hep3B HCC cells transfected with SULF2 and in SULF2-expressing Huh7 cells transfected with short hairpin RNA targeting SULF2. The interaction between GPC3, SULF2, and Wnt3a was assessed by coimmunoprecipitation and flow cytometry. β-catenin-dependent transcriptional activity was assessed with the TOPFLASH (T cell factor reporter plasmid) luciferase assay. In HCC cells, SULF2 increased cell surface GPC3 and Wnt3a expression, stabilized β-catenin, and activated T cell factor transcription factor activity and expression of the Wnt/β-catenin target gene cyclin D1. Opposite effects were observed in SULF2-knockdown models. In vivo, nude mouse xenografts established from SULF2-transfected Hep3B cells showed enhanced GPC3, Wnt3a, and β-catenin levels. CONCLUSION Together, these findings identify a novel mechanism mediating the oncogenic function of SULF2 in HCC that includes GPC3-mediated activation of Wnt signaling via the Wnt3a/glycogen synthase kinase 3 beta axis.
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Affiliation(s)
- Jin-Ping Lai
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic, Mayo Clinic Cancer Center, Rochester, MN 55905, USA
| | - Abdul M Oseini
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic, Mayo Clinic Cancer Center, Rochester, MN 55905, USA
| | - Catherine D Moser
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic, Mayo Clinic Cancer Center, Rochester, MN 55905, USA
| | - Chunrong Yu
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
| | - Sherine F Elsawa
- Schulze Center for Novel Therapeutics, Mayo Clinic Cancer Center, Rochester, MN 55905, USA
| | - Chunling Hu
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic, Mayo Clinic Cancer Center, Rochester, MN 55905, USA
| | - Ikuo Nakamura
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic, Mayo Clinic Cancer Center, Rochester, MN 55905, USA
| | - Tao Han
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic, Mayo Clinic Cancer Center, Rochester, MN 55905, USA
| | - Ileana Aderca
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic, Mayo Clinic Cancer Center, Rochester, MN 55905, USA
| | - Hajime Isomoto
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic, Mayo Clinic Cancer Center, Rochester, MN 55905, USA
| | - Megan M Garrity-Park
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Abdirashid M Shire
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic, Mayo Clinic Cancer Center, Rochester, MN 55905, USA
| | - Jia Li
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic, Mayo Clinic Cancer Center, Rochester, MN 55905, USA
| | - Schuyler O Sanderson
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Alex A Adjei
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
| | - Martin E Fernandez-Zapico
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic, Mayo Clinic Cancer Center, Rochester, MN 55905, USA,Schulze Center for Novel Therapeutics, Mayo Clinic Cancer Center, Rochester, MN 55905, USA
| | - Lewis R Roberts
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic, Mayo Clinic Cancer Center, Rochester, MN 55905, USA
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Lai JP, Sandhu DS, Yu C, Moser CD, Hu C, Shire AM, Aderca I, Murphy LM, Adjei AA, Sanderson S, Roberts LR. Sulfatase 2 protects hepatocellular carcinoma cells against apoptosis induced by the PI3K inhibitor LY294002 and ERK and JNK kinase inhibitors. Liver Int 2010; 30:1522-8. [PMID: 21040406 PMCID: PMC3042145 DOI: 10.1111/j.1478-3231.2010.02336.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Sulfatase 2 (SULF2), an extracellular heparan sulphate 6-O-endosulphatase, has an oncogenic effect in hepatocellular carcinoma (HCC) that is partially mediated through glypican 3, which promotes heparin-binding growth factor signalling and HCC cell growth. SULF2 also increases phosphorylation of the anti-apoptotic Akt kinase substrate GSK3β and SULF2 expression is associated with a decreased apoptotic index in human HCCs. METHODS We investigated the functional and mechanistic effects of SULF2 on drug-induced apoptosis of HCC cells using immunohistochemistry, Western immunoblotting, gene transfection, real-time quantitative polymerase chain reaction, MTT and apoptosis assays and immunocytochemistry. RESULTS The increased expression of SULF2 in human HCCs was confirmed by immunohistochemistry and immunoblotting. Treatment with inhibitors of MEK, JNK and PI3 kinases decreased the viability of SULF2-negative Hep3B HCC cells and induced apoptotic caspase 3 and 7 activity, which was most strongly induced by the PI3K inhibitor LY294002. Forced expression of SULF2 in Hep3B cells significantly decreased activity of the apoptotic caspases 3 and 7 and induced resistance to LY294002-induced apoptosis. As expected, LY294002 inhibited activation of Akt kinase by PI3K. Conversely, knockdown of SULF2 using an shRNA construct targeting the SULF2 mRNA induced profound cell growth arrest and sensitized the endogenously SULF2-expressing HCC cell lines Huh7 and SNU182 to drug-induced apoptosis. The effects of knockdown of SULF2 on HCC cells were mediated by decreased Akt phosphorylation, downregulation of cyclin D1 and the anti-apoptotic molecule Bcl-2, and upregulation of the pro-apoptotic molecule BAD. CONCLUSION The prosurvival, anti-apoptotic effect of SULF2 in HCC is mediated through activation of the PI3K/Akt pathway.
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Affiliation(s)
- Jin-Ping Lai
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, USA
| | - Dalbir S. Sandhu
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, USA
| | - Chunrong Yu
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Catherine D. Moser
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, USA
| | - Chunling Hu
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, USA
| | - Abdirashid M. Shire
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, USA
| | - Ileana Aderca
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, USA
| | - Linda M. Murphy
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, USA
| | - Alex A. Adjei
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Schuyler Sanderson
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, USA
| | - Lewis R. Roberts
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN, USA
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Lai JP, Sandhu DS, Moser CD, Cazanave SC, Oseini AM, Shire AM, Shridhar V, Sanderson SO, Roberts LR. Additive effect of apicidin and doxorubicin in sulfatase 1 expressing hepatocellular carcinoma in vitro and in vivo. J Hepatol 2009; 50:1112-21. [PMID: 19376607 PMCID: PMC2756527 DOI: 10.1016/j.jhep.2008.12.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 11/11/2008] [Accepted: 12/07/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIMS There are limited chemotherapy options for hepatocellular carcinoma (HCC). The heparin-degrading endosulfatase SULF1 functions as a liver tumor suppressor. We investigated the effects of the histone deacetylase inhibitor apicidin in combination with doxorubicin in SULF1-expressing HCC cells in vitro and in SULF1-expressing xenografts in nude mice. METHODS We evaluated the effects of apicidin alone or combined with doxorubicin on apoptosis, caspase activity, and phosphorylation of Erk and Akt in SULF1-transfected Huh7 and Hep3B cells in vitro and in vivo. RESULTS Apicidin induced HCC cell apoptosis and caspase activation in a dose- and time-dependent manner. Apicidin-induced caspase activation was significantly inhibited by the caspase inhibitor Z-Vad-fmk. Apicidin also decreased phosphorylation of both Erk and Akt. Expression of constitutively-active Mek1 and Akt significantly decreased apicidin-induced apoptosis. The combination of doxorubicin with apicidin significantly increased the anti-tumor effect in the SULF1-expressing Huh7 and Hep3B cells as compared to either apicidin or doxorubicin alone, both in vitro and in vivo. CONCLUSIONS The combination of a histone deacetylase inhibitor with doxorubicin may be a novel and promising therapeutic modality for HCCs, particularly for SULF1-expressing HCCs.
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Affiliation(s)
- Jin-Ping Lai
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, 200 First Street SW, Rochester, MN 55905, USA.
| | - Dalbir S. Sandhu
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN 55905 USA
| | - Catherine D. Moser
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN 55905 USA
| | - Sophie C. Cazanave
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN 55905 USA
| | - Abdul M. Oseini
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN 55905 USA
| | - Abdirashid M. Shire
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN 55905 USA
| | - Viji Shridhar
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN 55905 USA
| | - Schuyler O. Sanderson
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN 55905 USA
| | - Lewis R. Roberts
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN 55905 USA,Correspondence: Lewis R. Roberts, Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA, Phone: +1 507 284 0686; Fax: +1 507 284 0762, E-mail:
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Lai JP, Sandhu DS, Shire AM, Roberts LR. The tumor suppressor function of human sulfatase 1 (SULF1) in carcinogenesis. J Gastrointest Cancer 2009; 39:149-58. [PMID: 19373441 DOI: 10.1007/s12029-009-9058-y] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 03/18/2009] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Human sulfatase 1 (SULF1) was recently identified and shown to desulfate cellular heparan sulfate proteoglycans (HSPGs). Since sulfated HSPGs serve as co-receptors for many growth factors and cytokines, SULF1 was predicted to modulate growth factor and cytokine signaling. DISCUSSION The role of SULF1 in growth factor signaling and its effects on human tumorigenesis are under active investigation. Initial results show that SULF1 inhibits the co-receptor function of HSPGs in multiple receptor tyrosine kinase signaling pathways, particularly by the heparin binding growth factors--fibroblast growth factor 2, vascular endothelial growth factor, hepatocyte growth factor, PDGF, and heparin-binding epidermal growth factor (HB-EGF). SULF1 is downregulated in the majority of cancer cell lines examined, and forced expression of SULF1 decreases cell proliferation, migration, and invasion. SULF1 also promotes drug-induced apoptosis of cancer cells in vitro and inhibits tumorigenesis and angiogenesis in vivo. CONCLUSION Strategies targeting SULF1 or the interaction between SULF1 and the related sulfatase 2 will potentially be important in developing novel cancer therapies.
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Affiliation(s)
- Jin-Ping Lai
- Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Lai JP, Thompson JR, Sandhu DS, Roberts LR. Heparin-degrading sulfatases in hepatocellular carcinoma: roles in pathogenesis and therapy targets. Future Oncol 2009; 4:803-14. [PMID: 19086847 DOI: 10.2217/14796694.4.6.803] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is often diagnosed at an advanced stage at which there are limited treatment options. Two recently identified human heparin-degrading endosulfatases, named sulfatase 1 (SULF1) and sulfatase 2 (SULF2), have been found to be involved in liver carcinogenesis. SULF1 and SULF2 desulfate cell surface and extracellular matrix heparan sulfate proteoglycans and modulate heparin-binding growth factor signaling in multiple cancers, including HCCs. SULF1 inhibits HCC tumor cell growth in vitro and in nude mice in vivo, partially through effects on gene expression mediated through histone H4 acetylation. While SULF1 is downregulated in the majority of HCC cell lines and approximately 30% of primary HCCs, SULF2 is upregulated in almost all HCC cell lines and in 60% of primary HCCs. In contrast to the tumor suppressor effect of SULF1, expression of SULF2 activates MAPK and Akt pathways, promotes HCC cell growth in vitro and in vivo, and is associated with decreased survival of HCC patients. Targeting SULF2 or the interaction between SULF2 and SULF1 may lead to novel therapeutics for the treatment of HCCs.
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Affiliation(s)
- Jin-Ping Lai
- Center for Basic Research in Digestive Diseases, Miles and Shirley Fiterman Center for Digestive Diseases, Mayo Clinic College of Medicine and Mayo Clinic Cancer Center, 200 First Street, SW, Rochester, MN 55905, USA
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Lai JP, Sandhu DS, Yu C, Han T, Moser CD, Jackson KK, Guerrero RB, Aderca I, Isomoto H, Garrity-Park MM, Zou H, Shire AM, Nagorney DM, Sanderson SO, Adjei AA, Lee JS, Thorgeirsson SS, Roberts LR. Sulfatase 2 up-regulates glypican 3, promotes fibroblast growth factor signaling, and decreases survival in hepatocellular carcinoma. Hepatology 2008; 47:1211-22. [PMID: 18318435 PMCID: PMC2536494 DOI: 10.1002/hep.22202] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
UNLABELLED It has been shown that the heparin-degrading endosulfatase, sulfatase 1 (SULF1), functions as a liver tumor suppressor, but the role of the related sulfatase, sulfatase 2 (SULF2), in liver carcinogenesis remains to be elucidated. We investigated the effect of SULF2 on liver tumorigenesis. Expression of SULF2 was increased in 79 (57%) of 139 hepatocellular carcinomas (HCCs) and 8 (73%) of 11 HCC cell lines. Forced expression of SULF2 increased HCC cell growth and migration, whereas knockdown of SULF2 using short hairpin RNA targeting SULF2 abrogated HCC cell proliferation and migration in vitro. Because SULF1 and SULF2 desulfate heparan sulfate proteoglycans (HSPGs) and the HSPG glypican 3 (GPC3) is up-regulated in HCC, we investigated the effects of SULF2 on GPC3 expression and the association of SULF2 with GPC3. SULF2-mediated cell growth was associated with increased binding of fibroblast growth factor 2 (FGF2), phosphorylation of extracellular signal-regulated kinase and AKT, and expression of GPC3. Knockdown of GPC3 attenuated FGF2 binding in SULF2-expressing HCC cells. The effects of SULF2 on up-regulation of GPC3 and tumor growth were confirmed in nude mouse xenografts. Moreover, HCC patients with increased SULF2 expression in resected HCC tissues had a worse prognosis and a higher rate of recurrence after surgery. CONCLUSION In contrast to the tumor suppressor effect of SULF1, SULF2 has an oncogenic effect in HCC mediated in part through up-regulation of FGF signaling and GPC3 expression.
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Affiliation(s)
- Jin-Ping Lai
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN 55905, USA.
| | - Dalbir S. Sandhu
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN
| | - Chunrong Yu
- Department of Oncology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN
| | - Tao Han
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN
| | - Catherine D. Moser
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN
| | - Kenard K. Jackson
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN
| | - Ruben Bonilla Guerrero
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN
| | - Ileana Aderca
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN
| | - Hajime Isomoto
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN
| | - Megan M. Garrity-Park
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN
| | - Hongzhi Zou
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN
| | - Abdirashid M. Shire
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN
| | - David M. Nagorney
- Division of Gastroenterologic and General Surgery, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN
| | - Schuyler O. Sanderson
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN
| | - Alex A. Adjei
- Department of Oncology, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN
| | - Ju-Seog Lee
- Laboratory of Experimental Carcinogenesis, National Cancer Institute, Bethesda, MD
| | | | - Lewis R. Roberts
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Rochester, MN
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Abstract
Hepatocellular carcinoma (HCC) is frequently diagnosed at advanced stages and has a high mortality rate. With improved survival of patients with cirrhotic liver disease and increased prevalence of chronic hepatitis C viral infections, a rise in the number of HCC cases is being reported worldwide. Early diagnosis and treatment can significantly improve the prognosis of patients with HCC. Although surgical resection is an important potentially curative therapy for liver tumors, in appropriately selected patients, liver transplantation has been shown to achieve excellent survival rates for a solid tumor. Locally ablative and locoregional therapies in the form of percutaneous ethanol injection, radiofrequency ablation, transcatheter arterial chemoembolization and transcatheter arterial radioembolization (TheraSphere) are viable options in patients with unresectable HCC. Unfortunately, the role of systemic therapy has been very limited in the treatment of these patients. Novel treatment options based on an improved understanding of the molecular pathogenesis of HCC are being explored. These targeted molecular therapies are aimed at growth factors and their receptors, intracellular signal transduction and cell cycle control. A substantial improvement in outcomes of intermediate and advanced stage HCC is expected with the advent of these targeted therapies, used in combination with surgical or locoregional therapies. Recent positive results from a large Phase III study of the receptor tyrosine kinase inhibitor, sorafenib, hold great promise in the treatment of HCC.
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Affiliation(s)
- Dalbir S Sandhu
- Miles and Shirley Fiterman Center for Digestive Diseases, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Yu C, Friday BB, Lai JP, McCollum A, Atadja P, Roberts LR, Adjei AA. Abrogation of MAPK and Akt Signaling by AEE788 Synergistically Potentiates Histone Deacetylase Inhibitor-Induced Apoptosis through Reactive Oxygen Species Generation. Clin Cancer Res 2007; 13:1140-8. [PMID: 17317822 DOI: 10.1158/1078-0432.ccr-06-1751] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the effects of combining the multiple receptor tyrosine kinase inhibitor AEE788 and histone deacetylase (HDAC) inhibitors on cytotoxicity in a broad spectrum of cancer cell lines, including cisplatin-resistant ovarian adenocarcinoma cells. EXPERIMENTAL DESIGN Multiple cancer cell lines were treated in vitro using AEE788 and HDAC inhibitors (LBH589, LAQ824, and trichostatin A), either alone or in combination. Effects on cytotoxicity were determined by growth and morphologic assays. Effects of the combination on cell signaling pathways were determined by Western blotting, and the results were confirmed using pathway-specific inhibitors and transfection of constitutively active proteins. RESULTS Cell treatment with AEE788 and HDAC inhibitors (LBH589, LAQ824, and trichostatin A) in combination resulted in synergistic induction of apoptosis in non-small cell lung cancer (MV522, A549), ovarian cancer (SKOV-3), and leukemia (K562, Jurkat, and ML-1) cells and in OV202hp cisplatin-resistant human ovarian cancer cells. AEE788 alone or in combination with LBH589 inactivated mitogen-activated protein kinase (MAPK) and Akt cascades. Inhibition of either MAPK and/or Akt enhanced LBH589-induced apoptosis. In contrast, constitutively active MAPK or Akt attenuated LBH589 or LBH589 + AEE788-induced apoptosis. Increased apoptosis was correlated with enhanced reactive oxygen species (ROS) generation. The free radical scavenger N-acetyl-l-cysteine not only substantially suppressed the ROS accumulation but also blocked the induction of apoptosis mediated by cotreatment with AEE788 and LBH589. CONCLUSION Collectively, these results show that MAPK and Akt inactivation along with ROS generation contribute to the synergistic cytotoxicity of the combination of AEE788 and HDAC inhibitors in a variety of human cancer cell types. This combination regimen warrants further preclinical and possible clinical study for a broad spectrum of cancers.
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Affiliation(s)
- Chunrong Yu
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Yu C, Friday BB, Lai JP, Yang L, Sarkaria J, Kay NE, Carter CA, Roberts LR, Kaufmann SH, Adjei AA. Cytotoxic synergy between the multikinase inhibitor sorafenib and the proteasome inhibitor bortezomibin vitro: induction of apoptosis through Akt and c-Jun NH2-terminal kinase pathways. Mol Cancer Ther 2006; 5:2378-87. [PMID: 16985072 DOI: 10.1158/1535-7163.mct-06-0235] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study was undertaken to characterize preclinical cytotoxic interactions for human malignancies between the multikinase inhibitor sorafenib (BAY 43-9006) and proteasome inhibitors bortezomib or MG132. Multiple tumor cell lines of varying histiotypes, including A549 (lung adenocarcinoma), 786-O (renal cell carcinoma), HeLa (cervical carcinoma), MDA-MB-231 (breast), K562 (chronic myelogenous leukemia), Jurkat (acute T-cell leukemia), MEC-2 (B-chronic lymphocytic leukemia), and U251 and D37 (glioma), as well as cells derived from primary human glioma tumors that are likely a more clinically relevant model were treated with sorafenib or bortezomib alone or in combination. Sorafenib and bortezomib synergistically induced a marked increase in mitochondrial injury and apoptosis, reflected by cytochrome c release, caspase-3 cleavage, and poly(ADP-ribose) polymerase degradation in a broad range of solid tumor and leukemia cell lines. These findings were accompanied by several biochemical changes, including decreased phosphorylation of vascular endothelial growth factor receptor-2, platelet-derived growth factor receptor-beta, and Akt and increased phosphorylation of stress-related c-Jun NH2-terminal kinase (JNK). Inhibition of Akt was required for synergism, as a constitutively active Akt protected cells against apoptosis induced by the combination. Alternatively, the JNK inhibitor SP600125 could also protect cells from apoptosis induced by the combination, indicating that both inhibition of Akt and activation of JNK were required for the synergism. These findings show that sorafenib interacts synergistically with bortezomib to induce apoptosis in a broad spectrum of neoplastic cell lines and show an important role for the Akt and JNK pathways in mediating synergism. Further clinical development of this combination seems warranted.
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Affiliation(s)
- Chunrong Yu
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
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38
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Lai JP, Yu C, Moser CD, Aderca I, Han T, Garvey TD, Murphy LM, Garrity-Park MM, Shridhar V, Adjei AA, Roberts LR. SULF1 inhibits tumor growth and potentiates the effects of histone deacetylase inhibitors in hepatocellular carcinoma. Gastroenterology 2006; 130:2130-44. [PMID: 16762634 DOI: 10.1053/j.gastro.2006.02.056] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Accepted: 02/22/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) is the third most common cause of cancer death worldwide. Improved treatments for advanced HCC are urgently needed. The recently identified human sulfatase 1 enzyme (SULF1) desulfates cell surface heparan sulfate glycosaminoglycans and down-regulates cell growth signaling in HCC cells in vitro. While investigating the epigenetic regulation of SULF1, we discovered that histone H4 acetylation is up-regulated by SULF1 in HCC cells. Histone deacetylase (HDAC) inhibitors reprogram cellular gene expression through the acetylation of nucleosomal histones and promote cell growth arrest and apoptosis. Hence, they are a promising modality for cancer treatment. METHODS To explore the interaction between SULF1 expression and HDAC inhibitor action, we examined the effects of SULF1 expression on HCC cells and xenografts treated with HDAC inhibitors. RESULTS (1) Forced expression of SULF1 significantly delayed the growth of Huh7 and Hep3B xenografts in nude mice in vivo. (2) SULF1 increased histone H4 acetylation by modulation of cellular HDAC and histone acetyltransferase activities. (3) SULF1 enhanced the induction of apoptosis by the HDAC inhibitors apicidin and scriptaid. (4) SULF1 enhanced the inhibition of tumor growth, migration, and angiogenesis by HDAC inhibitors. We also demonstrate that knockdown of SULF1 with shRNA constructs up-regulates phosphorylation of AKT and Erk and attenuates apicidin-induced apoptosis. The interaction between SULF1 and apicidin was confirmed in vivo in Huh7 and Hep3B xenografts. CONCLUSIONS These results show that SULF1 promotes histone H4 acetylation, potentiates the effects of HDAC inhibitors, and inhibits HCC tumorigenesis.
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MESH Headings
- Acetylation
- Animals
- Apoptosis/drug effects
- Apoptosis/genetics
- Bile Duct Neoplasms/drug therapy
- Bile Duct Neoplasms/enzymology
- Carcinoma, Hepatocellular/drug therapy
- Carcinoma, Hepatocellular/enzymology
- Caspases/analysis
- Cell Line, Tumor/drug effects
- Cell Line, Tumor/enzymology
- Cell Survival
- Disease Models, Animal
- Enzyme Inhibitors/pharmacology
- Histone Deacetylase Inhibitors
- Histone Deacetylases/pharmacology
- Humans
- Immunohistochemistry
- Male
- Mice
- Mice, Inbred BALB C
- Mice, Nude
- Microscopy, Confocal
- RNA, Neoplasm/analysis
- Reverse Transcriptase Polymerase Chain Reaction
- Sensitivity and Specificity
- Statistics, Nonparametric
- Sulfatases/metabolism
- Transplantation, Heterologous
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Affiliation(s)
- Jin-Ping Lai
- Center for Basic Research in Digestive Diseases, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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Wang F, Denison S, Lai JP, Philips LA, Montoya D, Kock N, Schüle B, Klein C, Shridhar V, Roberts LR, Smith DI. Parkin gene alterations in hepatocellular carcinoma. Genes Chromosomes Cancer 2004; 40:85-96. [PMID: 15101042 DOI: 10.1002/gcc.20020] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The Parkin gene is an extremely large gene (1.5 Mb) within the highly unstable FRA6E common fragile site (CFS) region, which is frequently altered in ovarian, breast, and hepatocellular carcinomas. Because Parkin/FRA6E has genomic similarities to FHIT/FRA3B and WWOX/FRA16D, two other large tumor-suppressor genes that are within CFS regions, we were interested in characterizing Parkin gene alterations and their possible association with cancer. After analyzing 50 cancer-derived cell lines including 11 hepatocellular carcinoma (HCC) cell lines, we found that one HCC cell line, PLC/PRF/5, had a detectable homozygous deletion encompassing exon 3. Using quantitative duplex PCR and fluorescence in situ hybridization analysis to characterize the copy number changes of Parkin exons in HCC cell lines, we found that 4 of 11 HCC cell lines had heterozygous deletions of Parkin exons and one, Hep3B, had an exon duplication. Parkin protein expression was significantly decreased or absent in all 11 HCC cell lines. Furthermore, more than 50% of HCC primary tumors had decreased Parkin expression compared to that in normal liver tissue. Parkin gene-transfected PLC5 and Hep3B cells grew more slowly than vector-only transfectants and also showed increased sensitivity to apoptosis induced by cell-cycle inhibitors. Therefore, we suggest that Parkin may be involved in tumor suppression and that the loss of Parkin contributes to the development of hepatocarcinoma.
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Affiliation(s)
- Fang Wang
- Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Lai JP, Chien J, Strome SE, Staub J, Montoya DP, Greene EL, Smith DI, Roberts LR, Shridhar V. HSulf-1 modulates HGF-mediated tumor cell invasion and signaling in head and neck squamous carcinoma. Oncogene 2004; 23:1439-47. [PMID: 14973553 DOI: 10.1038/sj.onc.1207258] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Recently, we cloned a novel sulfatase domain-containing downregulated gene, HSulf-1, which modulates heparin-binding growth factor signaling in ovarian cancer. Based on the pilot data showing the loss of HSulf-1 in head and neck squamous cell carcinoma cell lines (SCCHN), we sought to employ SCCHN as a model to define the role of HSulf-1 in the molecular regulation of tumorigenicity. Three SCCHN lines (012SCC, WMMSCC, and 015SCC) had no detectable HSulf-1 mRNA. Clonal lines of HSulf-1-expressing 012SCC attenuated the activation of ERK/mitogen-activated protein kinase (MAPK) signaling mediated by fibroblast growth factor (FGF-2) and both ERK/MAPK and Akt signaling mediated by hepatocyte growth factor (HGF). Consistent with this downregulation, phosphorylation of HGF receptor, c-Met, which is frequently overexpressed in SCCHN, was also attenuated in HSulf-1 clonal 012SCC cell lines. HGF markedly enhanced the motility and migration of vector-transfected cells in a transwell invasion chamber. However, HGF-mediated motility and invasion was attenuated in HSulf-1 clonal 012SCC cell lines. In addition, transfected cells displayed significant growth inhibition concomitant with a decrease in mitogenicity, as measured by thymidine incorporation and increased sensitivity to staurosporine- and cisplatin-induced apoptosis. These data suggest that HSulf-1 normally functions as a negative regulator in cell growth and loss of HSulf-1 in SCCHN potentiates growth factor signaling, enhances motility, invasiveness and inhibits stress-induced apoptosis, with a resulting increase in tumorigenicity.
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Affiliation(s)
- Jin-Ping Lai
- Division of Gastroenterology and Hepatology, Mayo Clinic Cancer Center, Mayo Clinic and Foundation, Rochester, MN 55905, USA
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41
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Lai JP, Chien JR, Moser DR, Staub JK, Aderca I, Montoya DP, Matthews TA, Nagorney DM, Cunningham JM, Smith DI, Greene EL, Shridhar V, Roberts LR. hSulf1 Sulfatase promotes apoptosis of hepatocellular cancer cells by decreasing heparin-binding growth factor signaling. Gastroenterology 2004; 126:231-48. [PMID: 14699503 DOI: 10.1053/j.gastro.2003.09.043] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The heparin-binding growth factors fibroblast growth factor (FGF) and hepatocyte growth factor (HGF) are potent mitogens for hepatocellular carcinomas (HCCs). Heparin-binding growth factor signaling is regulated by sulfation of cell-surface heparan sulfate proteoglycans (HSPGs). We hypothesized that hSulf1, a recently described sulfatase, regulates growth signaling in HCCs. METHODS Expression of hSulf1 in human HCC tumors was determined by real-time PCR. Down-regulation of hSulf1 expression was investigated by analyzing loss of heterozygosity (LOH) at the hSulf1 locus and the effect of the DNA methylation inhibitor 5-aza-deoxycytidine on hSulf1 expression. The subcellular location of hSulf1 and sulfation state of cell-surface HSPGs were assessed by immunocytochemistry. FGF and HGF signaling was examined by phospho-specific immunoblot analysis. Cell growth was measured by trypan blue exclusion, and the MTT assay and apoptosis were quantitated by fluorescence microscopy. RESULTS hSulf1 expression was decreased in 29% of HCCs and 82% of HCC cell lines. There was LOH at the hSulf1 locus in 42% of HCCs. Treatment with 5-aza-deoxycytidine reactivated hSulf1 expression in hSulf1-negative cell lines. Low hSulf1-expressing cells showed increased sulfation of cell-surface HSPGs, enhanced FGF and HGF-mediated signaling, and increased HCC cell growth. Conversely, forced expression of hSulf1 decreased sulfation of cell-surface HSPGs and abrogated growth signaling. HCC cells with high-level hSulf1 expression were sensitive to staurosporine- or cisplatin-induced apoptosis, whereas low expressing cells were resistant. Transfection of hSulf1 into hSulf1-negative cells restored staurosporine and cisplatin sensitivity. CONCLUSIONS Down-regulation of hSulf1 contributes to hepatocarcinogenesis by enhancing heparin-binding growth factor signaling and resistance to apoptosis.
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Affiliation(s)
- Jin-Ping Lai
- Division of Gastroenterology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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42
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Betz CS, Lai JP, Xiang W, Janda P, Heinrich P, Stepp H, Baumgartner R, Leunig A. In vitro photodynamic therapy of nasopharyngeal carcinoma using 5-aminolevulinic acid. Photochem Photobiol Sci 2002; 1:315-9. [PMID: 12653468 DOI: 10.1039/b109817a] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to investigate the potential use of 5-aminolevulinic acid (5-ALA, 5-amino-4-oxovaleric acid) induced protoporphyrin IX (PPIX) for photodynamic therapy (PDT) of nasopharyngeal carcinoma (NPC) and its related mechanisms of inducing cell death. PPIX biosynthesis at I to 8 h after incubation of a cultured NPC cell line (HNE1) with 5-ALA (10-5,000 microg ml(-1)) was determined via fluorescence analysis HNEI cells were irradiated at 4 h after incubation with 5-ALA (10-200 microg ml(-1)) by diode laser (lambda = 630 nm) at various energy levels (1-50 J cm(-2)). The survival rates at 6, 12, 24 and 48 h after PDT were determined by MTT assay. Mechanisms of PDT-induced cell death were investigated via Anncxin-V/propidium iodide staining and DNA electrophoresis After incubation with 5-ALA, a time- and dose-dependent increase of cellular PPIX-fluorescence was recorded up to a threshold concentration of 1,000 microg ml(-1) 5-ALA, above which a decline of fluorescence intensities occurred. Similar values of PPIX-fluorescence were found at 100-1,000 microg ml(-1) of 5-ALA. Unlike sole incubation with 5-ALA or sole laser irradiation, the combination of both factors lead to a significant, concentration-, energy- and time-dependent increase of cell death (p < 0.01). At 100 microg ml(-1) ALA and 10 J cm 2 laser irradiation, cellular survival was <5% after 48 h. More than 80% of induced cell deaths thereby occurred via apoptosis within the first 12 h following irradiation; necrosis was accountable for less than 20%. High level induction of apoptosis by 5-ALA-PDT was confirmed by DNA electrophoresis. Our investigations show promising results of 5-ALA based PDT of nasopharyngeal carcinoma in vitro and set the basis for future studies in tumor models or humans, respectively.
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Affiliation(s)
- Christian S Betz
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany.
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Lai JP, Tong CL, Hong C, Xiao JY, Tao ZD, Zhang Z, Tong WM, Betz CS. Association between high initial tissue levels of cyclin d1 and recurrence of nasopharyngeal carcinoma. Laryngoscope 2002; 112:402-8. [PMID: 11889405 DOI: 10.1097/00005537-200202000-00036] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS Cyclin D1 expression and the rate of apoptosis have been reported to serve as important prognostic indicators in human cancers. The purpose of the present study was to determine the prognostic significance of both initial cyclin D1 expression and the apoptotic index in nasopharyngeal carcinoma. STUDY DESIGN Cohort study. METHODS Cyclin D1 protein levels and apoptosis in tumors and their corresponding adjacent, histologically normal tissues were determined at the time of initial diagnosis using immunohistochemical staining, Western blot analysis, and in situ end labeling, respectively, in 64 patients with T1-T4/N0-N2, poorly differentiated squamous cell carcinoma of the nasopharynx. All cases were treated by routine radiation therapy with a total median dose of 70 Gy and followed up for 10 years. RESULTS High levels of cyclin D1 were found in 35 of 64 tumor specimens (54.7%); no cyclin D1--positive cells were determinable in normal epithelium of the nasopharynx. Rates of early local recurrence (within 5 y) were significantly higher (P <.01) for patients with high levels of cyclin D1 before radiation therapy (24 of 35 patients [68.6%]) as compared with patients with low or no expression (3 of 29 [10.3%]). Furthermore, patients bearing high levels of cyclin D1 had a poorer prognosis concerning 10-year survival than the others (P <.001), whereas overexpression of cyclin D1 did not correlate with the initial TMN classification (P >.05). According to the rate of spontaneous apoptosis in tumors below or above the median, patients were divided into two groups. There was no statistically significant difference for the overall survival between the two groups (P >.05). CONCLUSIONS The present study demonstrates that cyclin D1 can be used as an indicator of recurrence and subsequent prognosis in nasopharyngeal carcinoma after radiation therapy. At the same time, the apoptotic state before radiation therapy is of no value in predicting the prognosis of patients with nasopharyngeal carcinoma.
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Affiliation(s)
- Jin-Ping Lai
- Department of Otolaryngology, Xiang Ya Hospital, Central South University, Changsha, Hunan, People's Republic of China
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Lai JP, Tao ZD, Xiao JY, Chen XH, Zhao SP, Tian YQ, Betz CS. Microinvasive Nd:YAG laser therapy of early glottic carcinoma and its effect on soluble interleukin-2 receptor, interleukin-2, and natural killer cells. Laryngoscope 2001; 111:1585-8. [PMID: 11568609 DOI: 10.1097/00005537-200109000-00017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the effectiveness of microinvasive Nd:YAG laser therapy in human glottic Tis and T1 carcinomas, as well as its effect on the cellular immune function of the tumor-bearing hosts. STUDY DESIGN We treated 34 patients with microinvasive Nd:YAG laser therapy and evaluated its effect on the cellular immune function of the host. METHODS Thirty-four patients with glottic Tis or T1 squamous cell carcinoma were treated with fiberoptic laryngoscopic Nd:YAG laser surgery. Both before and after therapy, serum levels of soluble interleukin-2 receptor (SIL-2R) and interleukin-2 (IL-2), as well as natural killer (NK) cell activity, were determined by means of double-antibody sandwich technique, tritiated thymidine-deoxyribonucleoside incorporation, and iodine 125-uridine-deoxyribonucleoside release technique, respectively. RESULTS All 34 patients tolerated the procedure well. A 3- to 7-year follow-up in a subgroup of 27 patients resulted in an estimated cure rate of 85.2% (23 of 27 patients). In all 27 patients with a regular follow-up, a subjective improvement of phonation was noted after therapy to various degrees. In 74% (20 of 27 patients), voice and speech subjectively recovered to almost normal levels. The post-therapy serum levels of SIL-2R were significantly declined (P <.001), whereas those of IL-2 and the NK activity were significantly elevated (P <.001) as compared with those detected before therapy. CONCLUSIONS Therapy with fiberoptic laryngoscopic Nd:YAG laser surgery is simple, safe, effective and only minimally invasive for patients with glottic Tis or T1 carcinoma. At the same time, it has an immunoenhancing effect on its host.
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Affiliation(s)
- J P Lai
- Department of Otolaryngology, XiangYa Hospital, Hunan Medical University, Changsha, Hunan, Peoples Republic of China.
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Abstract
BACKGROUND Heavy loading of the spine may induce musculoskeletal problems in children. Local surveys reported frequent overloading of school bags carried by primary school children. The effect of an overweight school bag on the child's lung function has not been reported. AIMS To investigate the effect of shoulder-girdle loading on forced expiratory lung volumes in primary school children and to compare this effect with that of an assumed kyphotic posture. STUDY DESIGN AND SUBJECTS Forty-three primary school children, mean age 9.6 years underwent spirometry lung-function measurements, while adopting the following five conditions in random order: free standing; kyphotic standing; standing wearing a backpack weighing 10%, 20% and 30% of their body weight. OUTCOMES MEASURES Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEF). RESULTS There were no significant differences in FEV1 and FVC between free standing and the 10% body weight load. However, both FEV1 and FVC decreased significantly when the student adopted the kyphotic posture and when the load in the backpack was increased to 20% and 30% of body weight. CONCLUSIONS This study demonstrates a restrictive effect on lung volumes when a school-bag load is heavier than 10% of a child's body weight. Our results also confirm the detrimental effect of a kyphotic posture on pulmonary mechanics and the necessity for health-care professionals to advocate proper postural advice to school children, teachers and parents.
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Affiliation(s)
- J P Lai
- Kwong Wah Hospital, Hong Kong, China
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Lai JP, Ho WZ, Zhan GX, Yi Y, Collman RG, Douglas SD. Substance P antagonist (CP-96,345) inhibits HIV-1 replication in human mononuclear phagocytes. Proc Natl Acad Sci U S A 2001; 98:3970-5. [PMID: 11274418 PMCID: PMC31163 DOI: 10.1073/pnas.071052298] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Substance P (SP) is a potent modulator of neuroimmunoregulation. We recently reported that human immune cells express SP and its receptor. We have now investigated the possible role that SP and its receptor plays in HIV infection of human mononuclear phagocytes. SP enhanced HIV replication in human blood-isolated mononuclear phagocytes, whereas the nonpeptide SP antagonist (CP-96,345) potently inhibited HIV infectivity of these cells in a concentration-dependent fashion. CP-96,345 prevented the formation of typical giant syncytia induced by HIV Bal strain replication in these cells. This inhibitory effect of CP-96,345 was because of the antagonism of neurokinin-1 receptor, a primary SP receptor. Both CP-96,345 and anti-SP antibody inhibited SP-enhanced HIV replication in monocyte-derived macrophages (MDM). Among HIV strains tested (both prototype and primary isolates), only the R5 strains (Bal, ADA, BL-6, and CSF-6) that use the CCR5 coreceptor for entry into MDM were significantly inhibited by CP-96,345; in contrast, the X4 strain (UG024), which uses CXCR4 as its coreceptor, was not inhibited. In addition, the M-tropic ADA (CCR5-dependent)-pseudotyped HIV infection of MDM was markedly inhibited by CP-96,345, whereas murine leukemia virus-pseudotyped HIV was not affected, indicating that the major effect of CP-96,345 is regulated by Env-determined early events in HIV infection of MDM. CP-96,345 significantly down-regulated CCR5 expression in MDM at both protein and mRNA levels. Thus, SP-neurokinin-1 receptor interaction may play an important role in the regulation of CCR5 expression in MDM, affecting the R5 HIV strain infection of MDM.
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Affiliation(s)
- J P Lai
- Division of Immunologic and Infectious Diseases, Joseph Stokes, Jr., Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA
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Abstract
Substance P, the most abundant neurokinin in the CNS, is a major modulator of the immune system. We have examined the gene expression of substance P and its receptor in human fetal brain microglia. Using reverse transcription-polymerase chain reaction and Southern blotting assay, the four isoforms of preprotachykinin-A gene transcripts (alpha, beta, gamma and delta) were detected in the microglia. The human fetal microglia produced significantly higher levels of endogenous substance P protein (640-850 pg/10(6) cells) than did human peripheral blood monocyte-derived macrophages (25-50 pg/10(6) cells), as determined by an enzyme immunoassay. Using immunohistochemical staining with an anti-substance P antibody, cell membrane substance P immunoreactivity was observed. In addition, we identified the presence of messenger RNA for neurokinin-1 receptor, a primary receptor for substance P in human fetal microglia.From these data, we propose that substance P and its receptor are biologically involved in regulating the functions of microglia, and potentially play an important role in host defense of the central nervous system.
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Affiliation(s)
- J P Lai
- Division of Immunologic and Infectious Diseases, Joseph Stokes Jr. Research Institute at The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia 19104, USA
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48
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Abstract
BACKGROUND The literature on facial fractures has emphasized obstruction of the airway as the most common associated life-threatening problem. Other life-threatening injuries associated with facial fractures are not as well documented. For this reason, we conducted a retrospective study involving 1,025 patients with facial fractures admitted to the trauma center at Chang Gung Memorial Hospital in Taiwan from January 1995 through December 1998. METHODS This study identifies the incidence of facial fractures and establishes a management plan. Life-threatening injuries associated with facial fractures were those that warranted immediate invasive rescue procedures. RESULTS Sixty-four (6.2%) of the patients with facial fractures required life-saving intervention; 21 patients had cerebral trauma prompting craniotomy, 19 had hemorrhagic shock, 17 had airway compromise, and 7 had pulmonary injury grave enough to necessitate tube thoracostomy. There were five mortalities, three due to cerebral trauma and two credited to hemorrhagic shock not identified until long after admission. CONCLUSION These findings illustrate the need for prompt identification and proper management of the associated life-threatening injuries in facial fracture patients. Clinical assessment should begin with evaluation of cerebral trauma, followed by hemorrhagic shock, airway compromise, and hemopneumothorax. Proper management may require a multidisciplinary and coordinated team approach.
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Affiliation(s)
- T C Tung
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
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49
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Abstract
The endoscope has been used to visualise the upper face and brow in aesthetic facial surgery which is performed without a coronal incision. We applied these principles to repair zygomatic fractures with the aid of a 4 mm, 30 degree telescope inserted through a small temporal incision. Fracture sites at the zygomatic arch and the zygomaticofrontal suture were exposed and fixed with miniplates under endoscopic control. This technique was used in 15 consecutive patients including 2 with isolated zygomatic arch comminuted fractures and 13 having displaced zygomatic fractures with segmental, displaced zygomatic arch fractures. Nine patients were men and six patients were women with a mean age of 35 years. Three patients had associated mandibular fractures. The periods of follow-up ranged from 3 to 22 months. Two patients developed transient frontal nerve palsy which recovered within 2 months. One patient had mild temporal hollowing on the side of the facial fracture. All patients achieved the adequate anatomic reduction and satisfactory malar symmetry. There has been no case of chewing problems, cheek numbness or progressive enophthalmos developing postoperatively. Application of the endoscope in zygomatic fracture repair minimises the scalp scar, avoids forehead numbness, provides a comfortable postoperative recovery and shortens hospital stay. Careful preoperative evaluation and proper surgical technique are mandatory for achieving optimal results in selected patients.
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Affiliation(s)
- C T Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC
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50
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Mak TW, Kam CW, Lai JP, Tang CM. Management of carbon monoxide poisoning using oxygen therapy. Hong Kong Med J 2000; 6:113-5. [PMID: 10793412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
The management of carbon monoxide poisoning requires an accurate assessment of the extent of blood oxygenation. Measuring the fractional oxyhaemoglobin content by using co-oximetry gives a true picture of the oxygen-carrying capacity of blood in the presence of carboxyhaemoglobin. The use of readings from pulse oximetry or a standard blood gas analyser is insufficient and can be misleading. We report on a case of carbon monoxide poisoning to illustrate this potential pitfall.
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Affiliation(s)
- T W Mak
- Department of Clinical Pathology, Tuen Mun Hospital, Tsing Chung Koon Road, Tuen Mun, Hong Kong
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