VEGF in hepatocellular carcinoma and surrounding cirrhotic liver tissues

TO THE EDITOR We read with a great interest the recent work of Deli and colleagues.[1] in the World Journal of Gastroenterology reporting vascular endothelial growth factor (VEGF) expression in hepatocellular carcinoma (HCC) and cirrhotic liver tissues.     

血管内皮生长因子受体与肝细胞癌血管生成关系的研究进展

新生血管是肿瘤生长和转移的基础.肝细胞肝癌是典型的多血管肿瘤,其发生、发展、转移、侵袭都和血管生成密切相关.血管的生成主要依靠血管生长因子和血管生长抑制因子的调控,其中研究最多也是最重要的是血管内皮生长因子(VEGF)及其受体(VEGFR).VEGFR在机体内作用不同,参与肝癌血管生长的主要是VEGFR-1(flt-1)和VEGFR-2(flk-1).针对VEGFR的抗肿瘤血管治疗在实验室取得了不错的疗效,部分已经进入了临床试验.     

Effect of preoperative transcatheter arterial chemoembolization on angiogenesis of hepatocellular carcinoma cells

AIM： To evaluate the effects of four types of preoperative transcatheter arterial chemoembolization （TACE） on angiogenesis of hepatocellular carcinoma （HCC） ceils. METHODS： A total of 136 patients with HCC underwent liver resection. One to five courses of TACE prior to liver resection were performed in 79 patients （TACE group）, in which one to four courses of chemotherapy alone were performed in 11 patients （group A）; one to five courses of chemotherapy combined with iodized oil were performed in 33 patients （group B）; one to three courses of chemotherapy combined with iodized oil and gelatin sponge were performed in 23 patients （group C）, one to three courses of chemotherapy combined with iodized oil, ethanol and gelatin sponge were performed in 12 patients （group D）. The other 57 patients only received liver resection （non-TACE group）. The microvessels were marked by CD31. The expression of CD31 and vascular endothelial growth factor （VEGF） protein were detected by immunohistochemical methods. RESULTS： The mean microvessel density （MVD） in HCC cells was significantly higher in groups A, B, C and D than in the nonACE group （P 〈 0.05）. The expression of VEGF protein in HCC cells were significantly higher in groups A, B, C and D than in the non-TACE group （P 〈 0.05）. MVD and the expression of VEGF protein were positively correlated. Mean MVD and the expression of VEGF protein were closely related to the number of courses of TACE and the interval of TACE. CONCLUSION： Four different types of preoperative TACE regimens enhanced angiogenesis in HCC cells by up-regulating the expression of VEGF protein. It is necessary to repress angiogenesis of liver cancer after TACE.     

Apatinib as an alternative therapy for advanced hepatocellular carcinoma

Angiogenesis plays an important role in the occurrence and development of tumors. Registered tyrosine kinase inhibitors targeting vascular endothelial growth factor reduce angiogenesis. Apatinib, a tyrosine kinase inhibitor, can specifically inhibit vascular endothelial growth factor receptor 2, showing encouraging anti-tumor effects in a variety of tumors including advanced hepatocellular carcinoma(HCC). This article intends to review the clinical research and application prospects of apatinib in the field of HCC.     

肝细胞癌组织细胞因子信号转导抑制因子-1表达的研究

目的探讨细胞因子信号转导抑制因子(SOCS1)、血管内皮生长因子受体(VEGFR)-2和表皮生长因子受体(EGFR)在肝硬化、肝细胞癌组织中的表达变化。方法采用免疫组化法检测63例HCC组织、51例癌周肝组织、11例肝硬化组织及11例正常肝组织SOCS1蛋白的表达;另分别检测VEGFR2和EGFR在27例和41例HCC组织中的表达情况。结果癌周肝组织中SOCS1蛋白表达为阴性1例,弱阳性15例,阳性30例,强阳性5例,HCC组织中SOCS1蛋白表达为阴性11例,弱阳性38例,阳性14例,癌周肝组织中SOCS1蛋白表达强度显著高于HCC组织(P0.01);SOCS1蛋白在肝硬化组织和正常肝组织中无表达;SOCS1表达在瘤体大小间(瘤体5cm和≥5cm)有显著性差异(P0.001);SOCS1蛋白在HCC组织中的表达与VEGFR2和EGFR的表达无显著相关性(P0.05)。结论 SOCS1蛋白表达与HCC的发生发展密切相关。     

Increased expression of angiogenin in gastric carcinoma in correlation with tumor angiogenesis and proliferation

AIM: To investigate the implication of angiogenin (ANG) in the neovascularizaton and growth of human gastric carcinoma (HGC). METHODS: ANG mRNA expression in HGC specimens obtained by surgical resection from patients with HGC were examined by RT-PCR. ANG, Ki-67, VEGF protein expression and microvessel density (MVD) in HGC specimens were detected by immunohistochemistry. RESULTS: RT-PCR showed significantly higher ANG mRNA expression (0.482±0.094) in HGC tissues than in the surrounding nontumorous tissues (0.276±0.019, P=0.03). MVD within tumorous tissues increased significantly with ANG mRNA expression (r=0.380,P=0.001) and ANG protein expression (P<0.01). The ANG expression levels of cancer tissues were positively correlated with VEGF (P<0.01) and the proliferation index of cancer cells (P<0.01). CONCLUSION: ANG is one of the neovascularization factors of HGC. ANG may work in coordination with VEGF, and promote the proliferation of HGC cells.     

Expression and significance of new inhibitor of apoptosis protein survivin in hepatocellular carcinoma

AM: To investigate expression and significance of inhibitor of apoptosis protein survivin in hepatocellular carcinoma (HCC). METHODS: The expression of survivin and vascular endothelial growth factor (VEGF) was investigated in 38 cases of HCC tissues and 38 liver cirrhosis tissues by immunohistochemistry and Western blot. The relationship between the expression of survivin and clinicopathological factors of HCC was analyzed. RESULTS: Survivin protein was detected in 23 (60.5%) of 38 HCCs and 3 (7.9%) of 38 liver cirrhosis tissues. In 23 cases of HCC which expressed survivin, the expression of VEGF was positive in 18 cases and slight positive or negative in 5 cases. While in 15 cases of HCC which did not express survivin, 12 cases did not express or slightly expressed, and 3 cases expressed VEGF. In liver cirrhosis tissues, the expression of VEGF was as follows: 24 cases were negative, 10 cases were weak positive and 4 cases were strong positive. The expression of survivin was coincident with the expression of VEGF in HCC (P<0.01). The expression of survivin in HCC had no relationship with the patients' age, gender, tumor size and differentiation level of HCC, while it was related to the metastasis of HCC. The protein quantitative analysis by Western blot also showed that overexpression of survivin in HCC was closely correlated to the expression of VEGF (P<0.01). Furthermore, stronger expression of survivin and VEGF was also found in patients with metastasis rather than in those with no metastasis (P<0.01). CONCLUSION: Survivin plays a pivotal role in the metastasis of HCC, and it has some correlation with tumorigenesis. The expression of survivin in the primary lesion is very useful as an indicator for metastasis and prognosis of HCC. It could become a new target of gene therapy of HCC.     

Tumor cyclooxygenase-2 levels correlate with tumor invasiveness in human hepatocellular carcinoma

ABM: Recent studies suggested that cyclooxygenase-2 (COX-2) enhances tumor angiogenesis via upregulation of vascular endothelial growth factor (VEGF). Although COX-2 expression has been demonstrated in hepatocellular carcinoma (HCC), the significance of COX-2 in progression of HCC remains unclear. This study evaluated the clinico-pathological correlation of COX-2 level and its relationship with VEGF level in HCC. METHODS: Fresh tumor tissues were obtained from 100 patients who underwent resection of HCC. COX-2 protein expression was examined by immunohistochemistry, and quantitatively by an enzyme immunometric assay (EIA) of tumor cytosolic COX-2 levels. Tumor cytosolic VEGF levels were measured by an ELISA. RESULTS: Immunostaining showed expression of COX-2 in tumor cells. Tumor cytosolic COX-2 levels correlated with VEGF levels (r = 0.469,P<0.001). Correlation with clinicopathological features showed significantly higher tumor cytosolic COX-2 levels in the presence of multiple tumors (P = 0.027), venous invasion (P = 0.030), microsatellite lesions (P=0.037) and advanced tumor stage (P = 0.008). Higher tumor cytosolic COX-2 levels were associated with worse patient survival. CONCLUSION: This study shows that elevated tumor COX-2 levels correlate with elevated VEGF levels and invasiveness in HCC, suggesting that COX-2 plays a significant role in the progression of HCC.     

Targeted systemic therapies for hepatocellular carcinoma: clinical perspectives, challenges and implications

Hepatocellular carcinoma(HCC) is a lethal disease in most patients,due to its aggressive course and a lack of effective systemic therapies for advanced disease.Surgical resection and liver transplantation remain the only curative options for a small subset of patients.Few patients with HCC are diagnosed early enough to be eligible for curative treatment.Angiogenesis inhibition is a natural therapeutic target for all solid tumors,but particularly for the highly vascularized HCC tumors.With the approval of the targeted agent sorafenib,there are now additional options for patients with HCC.Although sorafenib does produce some improvement in survival in HCC patients,the responses are not durable.In addition,there are significant dermatologic,gastrointestinal,and metabolic toxicities,and,as importantly,there is still limited knowledge of its usefulness in special subpopulations with HCC.Other angiogenesis inhibitors are in development to treat HCC both in the first-line setting and for use following sorafenib failure;the furthest in development is brivanib,a dual fibroblast growth factor pathway and vascular endothelial growth factor receptor inhibitor.Additional agents with antiangiogenic properties also in phase Ⅱ and Ⅲ development for the treatment of patients with HCC include bevacizumab,ramucirumab,ABT-869,everolimus and ARQ 197.     

Macrophage colony-stimulating factor expressed in non-cancer tissues provides predictive powers for recurrence in hepatocellular carcinoma

AIM To investigate the role of macrophage colony-stimulating factor(M-CSF) in patients with hepatocellular carcinoma(HCC) after surgery. METHODS Expression of M-CSF, distribution of M2 macrophages(Mφs), and angiogenesis were assessed in the liver, including tumors and peritumoral liver tissues. The prognostic power of these factors was assessed. Mouse isolated hepatic Mφs or monocytes were cultured with media containing M-CSF. The concentration of vascular endothelial growth factor(VEGF) in media was assessed. Furthermore, the role of the M-CSF-matured hepatic Mφs on proliferation of the vascular endothelial cell(VEC) was investigated. RESULTS A strong correlation between the expressions of M-CSF and CD163 was observed in the peritumoral area. Also, groups with high density of M-CSF, CD163 or CD31 showed a significantly shorter time to recurrence(TTR) than low density groups. Multivariate analysis revealedthe expression of M-CSF or hepatic M2Mφs in the peritumoral area as the most crucial factor responsible for shorter TTR. Moreover, the expression of M-CSF and hepatic M2Mφs in the peritumoral area had better predictable power of overall survival. Values of VEGF in culture media were significantly greater in the hepatic Mφs compared with the monocytes. Proliferation of the VEC was greatest in the cells co-cultured with hepatic Mφs when M-CSF was present in media.CONCLUSION M-CSF increases hepatocarcinogenesis, most likely by enhancing an angiogenic factor derived from hepatic Mφ and could be a useful target for therapy against HCC.     

肝细胞癌患者血清VEGF水平检测及与临床分期的相关分析

目的 检测肝细胞癌（HCC）患者血清血管内皮生长因子（VEGF）含量并分析与临床分期的相关性.方法 用ELISA 法检测30例健康对照者和146例HCC患者血清VEGF含量,分析VEGF对HCC的诊断价值和临床分期的关系.结果 HCC组VEGF水平显著高于健康对照组VEGF水平（P＜0.01）.HCC患者VEGF水平与肿瘤大小呈正相关（P＜0.01）,HCC术后转移和复发患者血清VEGF水平明显升高（P＜0.05）,TNM Ⅲ、Ⅳ期患者血清VEGF水平也明显高于Ⅰ、Ⅱ期患者（P＜0.01）.结论 血清VEGF测定可作为诊断HCC和临床分期的重要指标.     

Inhibitory effect of the angiogenesis inhibitor TNP-470 on tumor growth and metastasis in nude mice bearing human hepatocellular carcinoma

The antitumor and anti-metastatic effects of a potent angiogenesis inhibitor,O-(chloroacetyl-carbamoyl)fumagillol (TNP-470), was investigated in a highly metastatic model of human hepatocellular carcinoma—LCI-D20. Small pieces of LCI-D20 tumor tissue were implanted subcutaneously into the right axillary region of 24 nude mice; the mice were then randomized into two groups. To one group, TNP-470 30 mg/kg was given as a subcutaneous injection every other day from day 1 to day 15 and the mice were sacrificed on day 26. An antitumor effect of TNP-470 was clearly demonstrated by tumor weight (0.97±0.34 g compared to 2.04±0.34 g,P<0.001) and -Fetoprotein value (93±59 g/L compared to 769±282 g/L,P<0.001). There was also an anti-metastatic effect of TNP-470. Lung metastases developed in only 1 of 12 mice in the treated group, while they developed in 6 of mice of the control group. No severe side-effect of TNP-470 was found in this study. In vitro study revealed that the purified hepatoma cells were insensitive to TNP-470 (the 50% inhibitory concentration was 43 g/ml). These results suggest that the angiogenesis inhibitor TNP-470 has both strong antitumor and anti-metastatic effects on a human hepatocellular carcinoma model in nude mice.Abbreviations TNP-470 O-(chloroacetyl-carbamoyl) Fumagillol - MTT 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide This work was partly supported by the CHina Medical Board of New York, grant 93-583, and a Leading Speciality grant of Shanghai Health Bureau     

Impact of biomarkers on disease survival and progression in patients treated with octreotide for advanced hepatocellular carcinoma

Background Current determination of prognosis for advanced hepatocellular carcinoma (HCC) is mainly based on clinical assessment. We aimed to determine the impact of biomarkers as predictive factors for HCC progression and survival during octreotide-based treatments.Patients and methods We included patients who had been prospectively randomised to receive either octreotide (30 mg) alone monthly (n = 39) or in combination with rofecoxib (up to 50 mg bid daily, n = 32) for a minimum of 6 months, or until death occurred.Results Overall median survival (154 days) and median time to progression (94 days) were not different for both treatments and the biomarkers investigated (VEGF-A, IGF-1, PGE-2, ET-A) were similarly distributed amongst treatment groups. Combined univariate group analysis revealed that survival was decreased for an uptake ratio of > 2 on initial octreoscan (P = 0.05); baseline serum VEGF-A and IGF-1 were further significantly associated with survival. On multivariate analysis, uncorrected serum VEGF-A appeared to be the most significant predictor for tumor progression and survival.Conclusions Biomarkers, in addition to established tumor markers, are independent predictors of tumor progression and survival in patients with advanced HCC treated with octreotide. Furthermore, the involvement of VEGF-A implies the inhibition of angiogenesis as a potential mechanism of action for this drug.