肺部占位性病变经纤支镜取材Survivin检测的意义

目的探讨新的凋亡抑制基因survivin在肺部占位性病变经纤支镜取材标本中的表达，及其临床应用价值。方法用原位杂交和免疫细胞化学的方法检测60例在经纤支镜抽吸物脱落细胞中survivin mRNA及其相应蛋白的表达。结果Survivin基因在NSCLC病例纤支镜抽吸物脱落细胞中呈高表达，survivin mRNA阳性表达与其蛋白表达呈正相关。Survivin和脱落细胞学联合检测较单用脱落细胞学检测敏感性和阴性预测值均提高。结论Survivin在非小细胞肺癌的发生发展中起重要作用，联合脱落细胞学和survivin基因分子生物学检测有助于肺癌的早期诊断。     

Transforming growth factor-beta 1 and its receptors in human lung cancer and mouse lung carcinogenesis

The transforming growth factor-betas (TGF-beta s) are multifunctional proteins that inhibit the proliferation of many epithelial cells through a set of cell protein receptors that includes the TGF-beta type I (RI) and type II (RII) receptors. Loss of growth inhibition by TGF-beta is thought to contribute to the development of many types of tumors. In the present study, we have examined expression of the proteins and mRNAs for TGF-beta 1, TGF-beta RI, and TGF-beta RII in normal human lung, well-characterized non-small cell lung cancer (NSCLC) cell lines, and primary NSCLC specimens. Immunohistochemical staining for TGF-beta 1, TGF-beta RI, and TGF-beta RII using specific antibodies in normal human lung showed expression of the 3 proteins in the epithelium of bronchi and bronchioles as well as in alveoli. Differential expression of TGF-beta RI and TGF-beta RII proteins was detected in 5 NSCLC cell lines using Western blot analysis, with reduced levels in 3 cell lines. A panel of 45 formalin-fixed and paraffin-embedded NSCLC specimens showed positive immunostaining for TGF-beta 1, TGF-beta RI, and TGF-beta RII, with reduced TGF-beta RII in poorly differentiated adenocarcinomas and squamous cell carcinomas and some moderately differentiated adenocarcinomas. In situ hybridization studies conducted with specific riboprobes for TGF-beta 1, TGF-beta RI, and TGF-beta RII showed corresponding localization of expression of the mRNAs in the specimens that showed positive immunostaining for the proteins. To investigate the roles of TGF-beta 1, TGF-beta RI, and TGF-beta RII in chemically induced mouse lung tumorigenesis, we examined the expression of their proteins and mRNAs in 2 mouse model systems. Whereas expression of the proteins and mRNAs for TGF-beta 1 and TGF-beta RI was comparable in lung adenomas and bronchioles of A/J mice treated with benzo(alpha)pyrene, decreased immunostaining and hybridization for TGF-beta RII protein and mRNA was detected in 50% of lung adenomas in these mice. Interestingly, expression of TGF-beta 1 and the TGF-beta receptor proteins was similar to that of bronchioles in C57B1/6 mice and their littermates heterozygous for deletion of the TGF-beta 1 gene treated with diethylnitrosamine. These data show that reduced levels of expression of TGF-beta RII occur in some, but not all, human and mouse lung tumors. This suggests that different mechanisms of action, some of which may involve the TGF-beta signaling pathway, may contribute to the progression of lung tumorigenesis.     

Different susceptibility of increased DNMT1 expression by exposure to tobacco smoke according to histology in primary non-small cell lung cancer

Purpose DNA methyltransferase 1 (DNMT1) is known to play an important role in the development of cancers. However, the underlying mechanisms responsible for the altered expression of DNMT1 in non-small cell lung cancers (NSCLCs) remain to be elucidated. Methods We investigated the relationships of mRNA expression levels of DNMT1 to the altered expression of retinoblastoma (Rb) and p53 and to the clinicopathological variables in 153 NSCLCs. The expression of DNMT1 was determined by quantitative real-time PCR, and the altered expressions of p53 and Rb were assessed by immunohistochemistry. Results The increased expression of DNMT1 was found in 47 (31%) of 153 NSCLC patients examined. The prevalence of increased DNMT1 expression was significantly different between adenocarcinoma and squamous cell carcinoma (42% vs. 19%, respectively; P = 0.004). Patients who had smoked more than 65 packyears showed a 4.17 times [95% confidence interval (CI) = 1.17–69.49; P = 0.007] higher risk of increased DNMT1 expression compared to those who had smoked less than 45 packyears in adenocarcinoma. The expressions of Rb and p53 proteins were not associated with the increased expression of DNMT1 in 153 NSCLCs (P = 0.18 and 0.54, respectively). Conclusions The present study suggests that the susceptibility of increased DNMT1 expression by exposure to tobacco smoke may be different according to histologic subtypes in NSCLC. Young-Mi Kwon and Jung Ho Park have contributed equally for this project.     

Epidermal growth factor receptor variant III mutations in lung tumorigenesis and sensitivity to tyrosine kinase inhibitors

The tyrosine kinase inhibitors gefitinib (Iressa) and erlotinib (Tarceva) have shown anti-tumor activity in the treatment of non-small cell lung cancer (NSCLC). Dramatic and durable responses have occurred in NSCLC tumors with mutations in the tyrosine kinase domain of the epidermal growth factor receptor (EGFR). In contrast, these inhibitors have shown limited efficacy in glioblastoma, where a distinct EGFR mutation, the variant III (vIII) in-frame deletion of exons 2-7, is commonly found. In this study, we determined that EGFRvIII mutation was present in 5% (3/56) of analyzed human lung squamous cell carcinoma (SCC) but was not present in human lung adenocarcinoma (0/123). We analyzed the role of the EGFRvIII mutation in lung tumorigenesis and its response to tyrosine kinase inhibition. Tissue-specific expression of EGFRvIII in the murine lung led to the development of NSCLC. Most importantly, these lung tumors depend on EGFRvIII expression for maintenance. Treatment with an irreversible EGFR inhibitor, HKI-272, dramatically reduced the size of these EGFRvIII-driven murine tumors in 1 week. Similarly, Ba/F3 cells transformed with the EGFRvIII mutant were relatively resistant to gefitinib and erlotinib in vitro but proved sensitive to HKI-272. These findings suggest a therapeutic strategy for cancers harboring the EGFRvIII mutation.     

Expression of Cancer-Testis Antigens MAGE-A3/6 and NY-ESO-1 in Non-Small-Cell Lung Carcinomas and Their Relationship with Immune Cell Infiltration

Cancer-testis antigens (CTAs) are expressed only in many cancers and limited immunoprivileged sites such as the testis and placenta. Dendritic cells (DCs) and CD8+ T lymphocytes (CTLs) play roles in the immune responses to tumor growth and may affect the prognosis of cancers. This study was designed to investigate the clinicopathologic significance of CTA expression in non-small-cell lung carcinomas (NSCLCs) and its relationship with immune cells. Immunohistochemical staining to CTAs such as MAGE-A3/6 and NY-ESO-1 was performed using paraffin blocks from 132 cases of NSCLCs, including 75 cases of squamous cell carcinoma (SqCC) and 57 cases of adenocarcinoma (AdC), and the results were evaluated to correlate with tumor-infiltrating DCs and CTLs and clinicopathologic features. MAGE-A3/6 and NY-ESO-1 were expressed in 50.0% (66/132) and 18.2% (24/132) of NSCLCs, respectively. MAGE-A3/6 was expressed more frequently in SqCC than in AdC, but the expression of NY-ESO-1 showed no difference in both types. CTAs revealed a higher expression in male than in female. In advanced stage III, NY-ESO-1-positive patients showed poorer survival than NY-ESO-1-negative patients. Otherwise, the CTA expression did not correlate with clinicopathologic parameters. No relationship was found between DC and CTL infiltration in all NSCLCs. Regarding DC infiltration, the group showing negative expression to CTAs displayed an even higher number of infiltrating DCs than those showing positivity to one or the other or both CTAs. Although the aberrant expression of MAGE-A3/6 and NY-ESO-1 in NSCLC did not directly influence clinical prognostic factors, the higher expression of MAGE-A3/6 in SqCC suggests its value as a potential target for immunotherapy in this type of NSCLC. The inverse relationship between DCs and CTA expression may indicate that CTA-positive tumor cells would be akin to tumor stem cells escaping host immune response.     

PAK4 expression is associated with the prognosis in non-small cell lung cancer

This study attempted to determine the expression of p21-activated kinase 4 (PAK4) in non-small cell lung cancer (NSCLC) tissues and the normal lung tissues. The correlation between PAK4 expression and prognosis of NSCLC patients was also evaluated in the present study. The expression level of PAK4 was measured by high-performance liquid chromatography method. Chi-square test was adopted to explore the relationship of PAK4 expression and clinical features. Kaplan-Meier survival curves were plotted to delineate the overall survival rate of NSCLC patients. Cox regression analysis was performed to evaluate the prognostic significance of PAK4 expression in NSCLC. The PAK4 expression in NSCLC tissue samples was significantly higher than that in normal lung tissues (P<0.001) and shared significant correlation with Eastern Cooperative Oncology Group score, histological type, and distant metastasis (P<0.05). Survival curve revealed that NSCLC patients with high PAK4 expression had relatively higher mortality than those with low PAK4 expression (P = .001). Cox regression analysis explained that PAK4 expression was associated with the prognosis of NSCLC patients (P = .024; HR, 3.104; 95% CI, 1.164–8.278). In a word, PAK4 was highly expressed in NSCLC tissues and could act as a prognostic factor for NSCLC patients.     

Calcium-activated chloride channel ANO1 promotes breast cancer progression by activating EGFR and CAMK signaling

The calcium-activated chloride channel anoctamin 1 (ANO1) is located within the 11q13 amplicon, one of the most frequently amplified chromosomal regions in human cancer, but its functional role in tumorigenesis has remained unclear. The 11q13 region is amplified in ∼15% of breast cancers. Whether ANO1 is amplified in breast tumors, the extent to which gene amplification contributes to ANO1 overexpression, and whether overexpression of ANO1 is important for tumor maintenance have remained unknown. We have found that ANO1 is amplified and highly expressed in breast cancer cell lines and primary tumors. Amplification of ANO1 correlated with disease grade and poor prognosis. Knockdown of ANO1 in ANO1-amplified breast cancer cell lines and other cancers bearing 11q13 amplification inhibited proliferation, induced apoptosis, and reduced tumor growth in established cancer xenografts. Moreover, ANO1 chloride channel activity was important for cell viability. Mechanistically, ANO1 knockdown or pharmacological inhibition of its chloride-channel activity reduced EGF receptor (EGFR) and calmodulin-dependent protein kinase II (CAMKII) signaling, which subsequently attenuated AKT, v-src sarcoma viral oncogene homolog (SRC), and extracellular signal-regulated kinase (ERK) activation in vitro and in vivo. Our results highlight the involvement of the ANO1 chloride channel in tumor progression and provide insights into oncogenic signaling in human cancers with 11q13 amplification, thereby establishing ANO1 as a promising target for therapy in these highly prevalent tumor types.     

In vitro study on blocking mTOR signaling pathway in EGFR-TKI resistance NSCLC

Objective:To investigate the effect and mechanism of inhibitor everolimus on EGFR-TKI resistance NSCLC.Methods:MTT assay was used to detect proliferation of human non-small cell lung cancer cell line A549.Flow cytometry was used to detect the changes of apoptosis and cycle distribution in each group after 24 h and 48 h.RT-PCR was used to detect the changes of PTEN and 4EBP1 expression levels after 48 h of monotherapy and combination therapy.Results:MTT assay showed that everolimus had dose-dependent inhibition against growth of A549 cells.Flow cytometry showed when everolimus could induce apoptosis and induce G0/G1 phase cell cycle arrest,which was time-dependent(P0.05).RT-PCR showed everolimus could increase PTEN and 4EBP1 expression.Conclusions:mTOR inhibitor everolimus has an inhibitory effect on EGFR-TKI resistant NSCLC,which cannot reverse the resistance effect of EGFR-TKI resistant cell line A549.The relationship between EGFR/AKT signaling pathway and the mTOR signaling pathway and the mechanism in non-small cell lung cancer need further study.     

Bcl-2/Bax基因在非小细胞肺癌中的异常表达及其与吸烟的关系

目的探讨凋亡相关基因Bcl-2／Bax在非小细胞肺癌（NSCLC）中的表达及其与吸烟的关系。方法应用免疫组化S—P法对33例NSCLC及正常对照肺组织中的Bcl-2和Bax表达水平进行检测，并比较其与吸烟及临床病理特征的关系。结果Bcl-2和Pax蛋白在NSCLC中均有异常表达，Bcl-2为高表达，Bax为低表达；二者的表达均与吸烟有关，Bcl-2表达吸烟组高于非吸烟组，Bax表达吸烟组低于非吸烟组。Bcl-2和Bax在非小细胞肺癌中的表达与肺癌的组织学类型及淋巴结转移情况有关，Bcl-2表达鳞癌高于腺癌，淋巴结转移组高于无淋巴结转移组；Bax表达则鳞癌低于腺癌，淋巴结转移组低于无淋巴结转移组，二者呈负相关。结论凋亡相关基因Bcl-2／Bax在NSCLC中均有异常表达，且与肺癌的组织学类型及淋巴结转移有关，说明凋亡作用失衡在NSCLC发生发展中起重要作用。Bcl-2／Bax表达与吸烟有关，提示吸烟可影响机体的细胞凋亡，参与肺癌的发生。     

An NQO1- and PARP-1-mediated cell death pathway induced in non-small-cell lung cancer cells by beta-lapachone

Lung cancer is the number one cause of cancer-related deaths in the world. Patients treated with current chemotherapies for non-small-cell lung cancers (NSCLCs) have a survival rate of approximately 15% after 5 years. Novel approaches are needed to treat this disease. We show elevated NAD(P)H:quinone oxidoreductase-1 (NQO1) levels in tumors from NSCLC patients. beta-Lapachone, an effective chemotherapeutic and radiosensitizing agent, selectively killed NSCLC cells that expressed high levels of NQO1. Isogenic H596 NSCLC cells that lacked or expressed NQO1 along with A549 NSCLC cells treated with or without dicoumarol, were used to elucidate the mechanism of action and optimal therapeutic window of beta-lapachone. NSCLC cells were killed in an NQO1-dependent manner by beta-lapachone (LD50, approximately 4 microM) with a minimum 2-h exposure. Kinetically, beta-lapachone-induced cell death was characterized by the following: (i) dramatic reactive oxygen species (ROS) formation, eliciting extensive DNA damage; (ii) hyperactivation of poly(ADP-ribose)polymerase-1 (PARP-1); (iii) depletion of NAD+/ATP levels; and (iv) proteolytic cleavage of p53/PARP-1, indicating mu-calpain activation and apoptosis. Beta-lapachone-induced PARP-1 hyperactivation, nucleotide depletion, and apoptosis were blocked by 3-aminobenzamide, a PARP-1 inhibitor, and 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid acetoxymethyl ester (BAPTA-AM), a Ca2+ chelator. NQO1- cells (H596, IMR-90) or dicoumarol-exposed NQO1+ A549 cells were resistant (LD50, >40 microM) to ROS formation and all cytotoxic effects of beta-lapachone. Our data indicate that the most efficacious strategy using beta-lapachone in chemotherapy was to deliver the drug in short pulses, greatly reducing cytotoxicity to NQO1- "normal" cells. beta-Lapachone killed cells in a tumorselective manner and is indicated for use against NQO1+ NSCLC cancers.     

Netrin-1 expression confers a selective advantage for tumor cell survival in metastatic breast cancer

Netrin-1, an axon navigation cue was proposed to play a crucial role during colorectal tumorigenesis by regulating apoptosis. The netrin-1 receptors DCC and UNC5H were shown to belong to the family of dependence receptors that share the ability to induce apoptosis in the absence of their ligands. Such a trait confers on these receptors a tumor suppressor activity. Expression of one of these dependence receptors at the surface of a tumor cell is indeed speculated to render this cell dependent on ligand availability for its survival, hence inhibiting uncontrolled cell proliferation or metastasis. Consequently, it is a selective advantage for a tumor cell to lose this dependence receptor activity, as previously described with losses of DCC and UNC5H expression in human cancers. However, the model predicts that a similar advantage may be obtained by gaining autocrine expression of the ligand. We describe here that, unlike human nonmetastatic breast tumors, a large fraction of metastatic breast cancers overexpress netrin-1. Moreover, we show that netrin-1-expressing mammary metastatic tumor cell lines undergo apoptosis when netrin-1 expression is experimentally decreased or when decoy soluble receptor ectodomains are added. Such treatments prevent metastasis formation both in a syngenic mouse model of lung colonization of a mammary cancer cell line and in a model of spontaneous lung metastasis of xenografted human breast tumor. Thus, netrin-1 expression observed in a large fraction of human metastatic breast tumors confers a selective advantage for tumor cell survival and potentially represents a promising target for alternative anticancer therapeutic strategies.     

非小细胞肺癌中Survivin和Cyclin-D1的表达与细胞增殖及凋亡的相关性

目的　检测非小细胞肺癌(NSCLC)组织中Survivin和Cyclin- D1 基因的表达,探讨它们与NSCLC临床病理特征的关系。方法　应用免疫组织化学SP方法标记80例NSCLC组织(含癌旁组织和正常肺组织) ,应用TUNEL法检测癌细胞的凋亡指数。结果　在癌组织与癌旁组织及正常肺组织中survivin和cyclin- D1 表达差异有显著性(P <0 .0 1 )。在癌组织中有过表达,在癌旁组织中的表达较正常组织中的表达增强;癌组织中survivin和cyclin D1 表达呈正相关(P <0 .0 1 ) ,癌旁组织中survivin和cyclin- D1 表达也呈正相关(P <0 .0 1 )。癌组织类型、分化程度和淋巴转移与survivin和cyclin- D1 的表达均无相关性(P >0 .0 5)。不同临床分期的NSCLC ,其survivin和cyclin- D1 表达差异有显著性(P <0 .0 5)。survivin的表达评分与肿瘤的凋亡指数呈负相关(P <0 .0 5)。结论　survivin和cyclin- D1 在NSCLC的发生发展中可能起协同作用,过表达的survivin和cyclin- D1 可以作为反映NSCLC细胞分裂增殖、凋亡抑制能力和临床分期的指标之一。     

Expression and prognostic relevance of tumor carcinoembryonic antigen in stage IB non-small cell lung cancer

Background

High serum carcinoembryonic antigen (CEA) levels have been reported to be associated with poor prognosis in non-small cell lung cancer (NSCLC), while the prognostic role of tumor CEA expression remains to be defined. The present study investigated the expression of tumor CEA in stage IB NSCLC, and correlated it with clinicopathological features and prognosis.

Patients and methods

Immunohistochemistry for tumor CEA was assessed in the specimens of 183 patients with stage IB NSCLC. Receiver-operating characteristic (ROC) curve analysis was used to determine the cut-off score for tumor positivity.

Results

High CEA expression was detected more frequently in adenocarcinomas (72.2%) and other NSCLCs (69.0%) than in squamous cell carcinomas (25.4%, P<0.001). Both univariate and multivariate analysis indicated that tumor CEA was an independent prognostic factor for overall and disease-free survival (P<0.05).

Conclusions

Elevated expression of tumor CEA may be an adverse prognostic indicator in stages IB NSCLC.KEY WORDS : Non-small cell lung cancer, carcinoembryonic antigen, prognosis, receiver operating characteristic curve     

Expression of the multidrug resistance-associated protein 1 (MRP1) and the lung resistance-related protein (LRP) in human lung cancer

Fifty lung cancer samples (41 non-small cell lung cancer-NSCLC and 9 small cell lung cancer-SCLC) were immunohistochemically analyzed for lung resistance-related protein (LRP) and multidrug resistance-associated protein 1 (MRP1) expressions which were then correlated with histopathological subtype of the tumor. To detect these proteins, monoclonal antibodies LRP-56 and MRPm6 were used. NSCLC samples were divided into two groups, adenocarcinomas (17 samples) and squamous cell carcinomas (24 samples). Four categories of LRP and MRP1 quantity were distinguished: +++ = high level--90--100% of positive cells, ++ = lower level--10--90% of positive cells, + = low level--up to 10% of positive cells, - = negative cells--0% of positive cells. Within the NSCLC group the most samples (36/41) had the similar level of LRP and MRP1. Significantly higher expression of both proteins was observed in the adenocarcinomas in comparison with squamous cell carcinomas. The lowest positive staining for LRP and MRP1 proteins has been found in SCLC. It is suggested that our finding can confirm the overall empirical clinical knowledge about much higher chemosensitivity of untreated SCLC comparing to NSCLC.     

Survivin、Caspase-3在非小细胞肺癌中的表达及其临床意义

目的探讨非小细胞肺癌（non-small-cell lung cancer，NSCLC）中存活素（survivin）与半胱氨酸蛋白酶（Caspase-3）之间的关系及其临床意义。方法采用免疫组织化学法检测117例NSCLC中Survivin的表达，同时采用流式细胞技术检测Caspase-3；分析评估此二者在肿瘤细胞抗凋亡与凋亡促成之间的意义。结果Survivin阳性率明显高于对照组（P〈0．01），Survivin与肿瘤的分型无关（P〉0．05），在淋巴转移中无表达。Caspase-3定量分析中，癌组与对照组、鳞癌与腺癌组、高中低分化组、淋巴转移与无淋巴转移组均有不同程度的统计学意义。结论Survivin、结合Caspase-3定量分析，凋亡指数均有不同程度的衰减。通过生物学行为研究，了解肿瘤细胞的凋亡抑制，有助于临床正确制订化疗方案和判断预后。     

Chromosome arm 20q gains and other genomic alterations in esophageal squamous cell carcinoma, as analyzed by comparative genomic hybridization and fluorescence in situ hybridization

BACKGROUND/AIMS: Our recent analysis of gastric cancers and colorectal cancers using comparative genomic hybridization revealed a novel, high frequent copy number increases the long arm of chromosome 20 in association with possible involvement of liver metastases and poor prognosis. This led to further comparative genomic hybridization analysis of chromosomal aberrations in primary tumors of esophageal squamous cell carcinoma. The aim of the study presented here was to analyze the chromosomal aberrations and to determine the numbers of copies of AIB1, BTAK, DcR3 and E2F1 as putative target genes on chromosome 20q as well as their expression and relation to clinicopathological features in 41 primary tumors of esophageal squamous cell carcinoma. METHODOLOGY: We used comparative genomic hybridization to screen 41 primary tumors of esophageal squamous cell carcinoma for changes in the number of copies of DNA sequences. To further characterize the gain of DNA sequences at 20q, we also performed fluorescence in situ hybridization analysis. We examined the relationship between these changes and clinicopathological factors. RESULTS: Gains in chromosome arm 20q were detected (34.1%) as well as a high level of gain in 20q12-13 (4.8%). AIB1 amplification was observed in 4.9% (2/41), BTAK amplification in 9.8% (4/41), DcR3 amplification was in 4.9% (2/41), and E2F1 amplification in 7.3% (3/41). The survival of patients with BTAK or E2F1 amplification was significantly lower than that of patients without these abnormalities. CONCLUSIONS: These findings provide evidence for a number of previously unknown genomic aberrations in esophageal squamous cell carcinoma, suggesting the existence of target regions relevant to its progression. Esophageal squamous cell carcinoma with 20q gain showed extensive lung metastases, pleural effusion and liver metastases and poorer prognosis compared to cases without 20q gain. Our results suggest that amplification of BTAK or E2F1 are likely to lead to an increase in the number of malignant phenotypes of esophageal squamous cell carcinoma and that these aberrations can be expected to be useful as markers of poor prognosis.