肝癌组织及外周血单核细胞端粒酶异常对肝癌诊断价值的研究

目的探讨肝癌组织及外周血单核细胞中端粒酶表达对肝癌诊断的临床价值。方法以0.05%2-乙基氨基芴(2-FAA)饲料饲养SD大鼠诱发肝癌发生,在肝细胞癌变过程中观察端粒酶的动态变化及与总RNA的关系。并从人肝癌和非癌组织中制备总RNA,采用端粒重复扩增法-ELISA分析肝组织及外周血单核细胞端粒酶活性及其对肝癌的诊断与鉴别价值。结果经大鼠诱癌后,在肝细胞经细胞变性、癌前病变和肝癌形成的过程中,肝内总RNA和端粒酶显著表达,并呈正相关关系(r=0.83,P<0.01);在人肝癌组端粒酶活性明显高于它的非癌组织,而总RNA则是非癌组明显高于癌组;外周血单核细胞中,癌组端粒酶活性明显高于肝硬化组、慢性肝炎组及正常对照(P<0.01);外周血AFP浓度与单核细胞端粒酶活性联合分析,对肝癌具有互补诊断价值。结论肝癌发生过程中端粒酶表达异常,外周血中端粒酶活性检测有助于肝癌的诊断及预后观察。     

肝癌组织及外周血端粒酶表达对肝癌的诊断和鉴别价值

目的　探讨肝癌组织端粒酶表达及外周血端粒酶分析对肝癌的诊断价值。方法　从人肝癌的癌灶和癌周组织制备总RNA ,肝组织及外周血单核细胞端粒酶活性 ,采用端粒重复扩增法 酶联免疫吸附试验分析 ,并观察了外周血中端粒酶活性对肝癌的诊断与鉴别诊断价值。结果　肝癌组织中端粒酶活性表达明显高于它的癌周组织 ,而总RNA则是癌周组织明显高于癌灶 ;在外周血单核细胞中 ,未经治疗的肝癌组端粒酶活性明显高于肝硬化组、慢性肝炎组及正常对照组 (P <0 0 1) ,经过TAE治疗后肝癌病人端粒酶活性明显下降 (P <0 0 1) ;外周血AFP浓度与单核细胞端粒酶活性联合分析 ,对肝癌具有互补诊断价值。结论　肝癌发生过程中端粒酶表达异常 ,分析外周血中端粒酶活性有助于肝癌的诊断及预后观察     

Advantages of assaying telomerase activity in ascites for diagnosis of digestive tract malignancies

AIM： To evaluate the diagnostic value of assaying telomerase activity in ascites cells for the differential diagnosis of malignant and non-malignant ascites.METHODS: Ascites from 40 patients with hepatocellular carcinoma (HCC), 31 with non-HCC gastrointestinal carcinoma (CA), and 24 with liver cirrhosis (LC) were analyzed for telomerase activity. The telomerase activities in cell pellets from ascites were measured according to the Telomeric Repeat Amplification Protocol (TRAP) and quantified with a densitometer.RESULTS: Positive telomerase activity was detected in 16 of 31 (52%) CA patients, 10 of 40 (25%) HCC patients, and 1 of 24 (4%) LC patients (P&lt;0.001). The telomerase activity was higher in the ascites of CA patients than in the ascites of HCC or LC patients (CA: 22.9&#177;5.8, HCC: 6.7&#177;2.5, LC:1.3&#177;1.3, P= 0.001). Cytology was positive in 18 CA patients (58%) and 1 HCC patient (2.5%), respectively. The positive telomerase activity was not related to patients‘ age, gender,and ascitic protein concentration, but to white blood count (r = 0.31, P = 0.002), neutrophil count (r= 0.29, P = 0.005),and the C-reactive protein level (r = 0.29, P = 0.018). When the results of both cytological examination and telomerase assay were considered together, the sensitivity increased to 77% for CA patients, 25% for HCC patients, and 48% for all 71 gastrointestinal cancer patients.CONCLUSION: Combining cytological examination of ascites with telomerase activity assay significantly improves the differential diagnosis between malignant and non-malignant ascites.     

Immunohistochemical detection of HCV infection in patients with hepatocellular carcinoma and other liver diseases

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Enhanced glypican-3 expression differentiates the majority of hepatocellular carcinomas from benign hepatic disorders

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is a common malignant tumour worldwide, and its differential diagnosis from benign lesions of the liver is often difficult yet of great clinical importance. In the present study, we analysed whether glypican-3 is useful in differentiating between benign and malignant liver diseases and whether it influences the growth behaviour of HCC. METHODS: Northern blot analysis and in situ hybridisation. RESULTS: Northern blot analysis indicated that expression of glypican-3 mRNA was either low or absent in normal liver, in focal nodular hyperplasia (FNH), and in liver cirrhosis. In contrast, expression of glypican-3 mRNA was markedly increased in 20 of 30 and moderately increased in five of 30 HCC samples. The average increase in glypican-3 mRNA expression in HCC was significant compared with expression in normal liver (21.7-fold increase, p<0.01). In comparison with FNH or liver cirrhosis, glypican-3 mRNA expression in HCC was increased 7.2- (p<0.05) and 10.8-fold (p<0.01), respectively. In addition, pushing HCCs exhibited significantly higher glypican-3 mRNA expression than invading tumours (p<0.05). In situ hybridisation analysis demonstrated weak expression of glypican-3 mRNA in normal hepatocytes and bile ductular cells, and weak to occasionally moderate signals in hepatocytes forming nodules of liver cirrhosis and in regenerated hepatic nodules of FNH. In contrast, glypican-3 in situ hybridisation signals were intense in hepatic cancer cells with even higher levels in pushing HCCs than in invading HCCs. CONCLUSIONS: These findings suggest that glypican-3, in many cases, has the potential to differentiate between benign and malignant liver diseases.     

Quantification of telomerase activity in human liver tissues by fluorescence-based TRAP analysis

Normal human liver cells have a limited proliferactive capacity, but immortalized cells prevent the shortening of the end of chromosomes by the expression of telomerase, the enzyme that elongates telomeric DNA. In view of the wide variety of different methods of detecting telomerase activity, a quantitative standard system is needed. Therefore, we constructed a quantitative system based on a TRAP-eze^TM (ONCOR^®) and the Fluorescence-based TRAP assay, and we quantified telomerase activity in normal liver tissues, livers with chronic liver disease, and livers with hepatocellular carcinoma (HCC). With this method, the average quantitative telomerase activity in chronic hepatitis tissues (n = 17) was 7.97 with a standard error of 6.07, in liver cirrhosis tissues (n = 19) it was 10.82 with a standard error of 5.87, and in HCC tissues (n = 20) it was 46.87 with a standard error of 4.55. In all normal tissues (n = 3), telomerase activity was not detected. No difference between chronic hepatitis tissues and liver cirrhosis tissues was detected. But, the difference was highly significant (P < 0.001) between normal liver tissues and other liver tissues, between chronic hepatitis tissues and HCC tissues, and between liver cirrhosis tissues and HCC tissues. The possibility is great that chronic hepatitis tissues and liver cirrhosis tissues become HCC when telomerase activity is high. Namely, patients with high telomerase activity in chronic hepatitis and liver cirrhosis may be at the risk of developing HCC. This study showed the assay of telomerase activity in chronic hepatitis tissues and liver cirrhosis tissues could play a useful role in screening HCC.     

Liver expression of Nrf2-related genes in different liver diseases

BACKGROUND: The KEAP1-Nrf2 antioxidant signaling pathway is important in protecting liver from various insults. However,little is known about the expression of Nrf2-related genes in human liver in different diseases.METHODS: This study utilized normal donor liver tissues(n=35), samples from patients with hepatocellular carcinoma(HCC, n=24), HBV-related cirrhosis(n=27), alcoholic cirrhosis(n=5) and end-stage liver disease(n=13). All of the liver tissues were from the Oriental Liver Transplant Center, Beijing,China. The expressions of Nrf2 and Nrf2-related genes, including its negative regulator Kelch-like ECH-associated protein 1(KEAP1), its targeted gene NAD(P)H-quinone oxidoreductase 1(NQO1), glutamate-cysteine ligase catalytic subunit(GCLC) and modified subunit(GCLM), heme oxygenase 1(HO-1) and peroxiredoxin-1(PRDX1) were evaluated. RESULTS: The expression of Nrf2 was decreased in HCC, increased in alcoholic cirrhosis and end-stage liver disease. The expression of KEAP1 was increased in all of the liver samples.The most notable finding was the increased expression of NQO1 in HCC(18-fold), alcoholic cirrhosis(6-fold), endstage liver disease(5-fold) and HBV-related cirrhosis(3-fold).Peri-HCC also had 4-fold higher NQO1 m RNA as compared to the normal livers. GCLC m RNA levels were lower only in HCC, as compared to the normal livers and peri-HCC tissues.GCLM m RNA levels were higher in HBV-related cirrhosis and end-stage liver disease. HO-1 m RNA levels were increased in all liver tissues except for HCC. Peri-HCC had higher PRDX1 m RNA levels compared with HCC and normal livers.CONCLUSION: Nrf2 and Nrf2-related genes are aberrantly expressed in the liver in different diseases and the increase of NQO1 was the most notable finding, especially in HCC.     

Telomerase activity in peripheral blood for diagnosis of hepatoma

BACKGROUND: Telomerase activity may be used as a molecular marker for the detection of circulating hepatoma cells in blood of patients with hepatoma. METHODS: Telomerase activity in peripheral blood from hepatocellular carcinoma (HCC) patients was assessed by using a highly sensitive and non-radioisotope telomerase polymerase chain reaction (PCR) ELISA. Initially, tissue telomerase activity was measured in the hepatoma and non-tumour portions by using PCR ELISA within the same specimen, to compare its sensitivity with the conventional telomeric repeat amplification protocol (TRAP) method. Second, telomerase activity was measured in the peripheral blood obtained from patients with HCC, patients with chronic liver disease and in healthy controls. RESULTS: Of the 17 HCC patients, telomerase activity was found to be positive in 14 (82%) by using TRAP and 15 (88%) by using PCR ELISA, indicating that PCR ELISA is a reliable tool for the measurement of telomerase activity. By using the Telomerase PCR ELISA assay, telomerase activities in the peripheral blood of 20 HCC patients was 1.65 +/- 0.78 units. This was significantly greater than the results obtained for 20 chronic liver disease patients (0.43 +/- 0.36 units) and 20 healthy controls (0.39 +/- 0.14 units; P < 0.0001).When the arbitrary cut-off level was set at 0.7 units (maximum value of healthy controls + 0.1), the positive frequency of telomerase activity was 25% for chronic liver disease and 80% for HCC patients (sensitivity 80%, specificity 75%). Among the HCC patients, high telomerase activity in the peripheral blood was shown at stage III HCC with vascular invasion (2.10 +/- 0.62 units, n = 9). This was significantly higher than patients at stage II of HCC (1.28 +/- 0.72 units, n = 11, without vascular invasion; P = 0.012). CONCLUSION: These results suggest that peripheral blood telomerase activity, which may reflect haematogenous micrometastasis, is potentially a practical diagnostic/predictive marker of HCC.     

Expression of IGF-II in early experimental hepatocellular carcinomas and its significance in early diagnosis

AIM: To investigate the serum level and expression of insulin growth factor II (IGF-II) in liver tissues of rats with early experimental hepatocellular carcinomas (HCC) and its significance in early diagnosis. METHODS: Early experimental hepatocellular carcinomas were induced by diethylnitrosamine (DENA) in 180 male SD rats. Another 20 male SD rats served as control. The IGF-II serum level was measured by ELISA. Immunohistochemistry and electron microscopic immunohistochemistry were used to observe the expression of IGF-II in normal and tumor liver tissues and its ultrastructural location in malignant hepatocytes. The expressions of IGF-II in human hepatoma cell lines HepG2, SMMC7721 and human embryonic liver cell line L-02 were measured by immunocytochemistry. IGF-II mRNA level was studied by in situ hybridization. RESULTS: IGF-II was expressed in the cytoplasm of both sinusoidal cells in paracancerous cirrhotic liver tissue and malignant hepatocytes in early experimental HCC tissues. Gold particles were seen on the rough endoplasmic reticulum and the mitochondrion in malignant hepatocytes. IGF-II was expressed in the human hepatoma cell lines. The mRNA level of IGF-II was higher in rat liver tumor tissue than in normal rat liver tissue. The serum IGF-II level of the early experimental HCC group was 34.67+/-10.53 ng.ml(-1) and that of the control group was 11.75+/-5.84 ng.ml(-1). The rank sum test was used for statistical analysis. There was a significant difference between the two groups (P<0.01). CONCLUSION: During the induction of early experimental HCC by DENA, IGF-II may promote hepatocytic proliferation via a paracrine mechanism in the pre-cancerous stage. When hepatocytes are transformed into malignant cells, they may secrete IGF-II and promote malignant cell proliferation by an autocrine mechanism. IGF-II may be a possible biological marker in the early diagnosis of HCC.     

The expression of ras p21 product in hepatocellular carcinoma]

To elucidate the cell biological significance of ras oncogene, the expression of ras-p21 was analyzed in 53 cases of liver tissues including 34 cases of hepatocellular carcinoma (HCC), by using immunohistochemical method. In result, 22 (65%) cases of 34 HCC and 34 (79%) cases of 43 liver cirrhosis were positive for p21, whereas all of chronic hepatitis and normal livers were negative. Especially, comparative study between the expression of p21 and clinicopathological background of HCC revealed that p21 was prominently expressed in well differentiated form, nodular type, small liver cancer, and the cases showing AFP levels below 400 ng/ml. From these results, it was indicated that ras oncogene might play an important role in malignant transformation of hepatocytes or differentiation of HCC.     

原发性肝癌患者外周血中甲胎蛋白mRNA的意义

目的由于ＰＣＲ技术的应用,血循环中癌细胞的检测近有很大进展．本文用ＲＴＰＣＲ检测肝癌（ＨＣＣ）和其他慢性肝病患者外周血中ＡＦＰｍＲＮＡ,藉以反映ＨＣＣ细胞的存在,并与其他血清标记物比较．方法ＨＣＣ患者２２例,肝硬变和慢性乙型肝炎患者各１０例,健康成人受试者（对照）５例．取患者和对照的外周血,分离单核细胞,提取总ＲＮＡ并作电泳鉴定,用合成的两对引物进行巢式ＲＴＰＣＲ扩增ＡＦＰｍＲＮＡ,同时分析血清ＡＦＰ和乙肝标记物．结果ＡＦＰｍＲＮＡ在１３例ＨＣＣ（５９１％）,２例肝硬变（２００％）患者外周血中测到,其余标本均为阴性．ＡＦＰｍＲＮＡ阳性的１３例患者肿瘤均大于５ｃｍ,为晚期患者．在该１３例患者中仅有６例（４６１％）在血清中测到ＡＦＰ,但有１２例（９２３％）ＨＢｓＡｇ,抗ＨＢｅ,抗ＨＢｃ全阳性,而ＡＦＰｍＲＮＡ阴性的５例该３标记物全阴性．结论ＲＴＰＣＲ扩增ＡＦＰｍＲＮＡ是检测ＨＣＣ和肝硬变患者循环肝癌细胞的敏感方法．患者外周血中的ＡＦＰｍＲＮＡ有可能作为肿瘤转移和复发的标记对ＨＣＣ诊断、随访观察和疗效评定有较大临床意义．     

Utility of alpha-fetoprotein (AFP) in the screening of patients with virus-related chronic liver disease: does different viral etiology influence AFP levels in HCC? A study in 350 western patients

BACKGROUND/AIMS: Dosage of serum AFP (alpha-fetoprotein) is widely used for HCC screening in patients with chronic liver disease. Virus-related chronic liver disease is the main cause of cirrhosis and HCC in Western and Far Eastern countries, but the relationship between viral etiology and AFP levels in HCC is still unclear. The aim of this study was to verify, in Western patients with post-viral chronic liver disease, the usefulness of AFP dosage for the detection of HCC, and the influence of viral etiology on AFP levels in HCC. METHODOLOGY: The study population included 350 patients with post viral chronic liver disease that underwent liver biopsy, serum AFP determination and ultrasound liver evaluation. Seven patients had normal liver histology, 197 had chronic hepatitis, 72 had cirrhosis, and 74 had cirrhosis and HCC. ROC (receiver operating characteristic) analysis was used to assess the best diagnostic AFP threshold value for HCC detection. Logistic regression analysis was performed to individuate independent predictors of HCC diagnosis. RESULTS: No difference was observed in AFP levels between HCV- and HBV-positive patients, neither in the whole population nor in the HCC patients only. ROC area under curve for AFP was 0.801 (95% CI: 0.721-0.867). The analysis individuated a best accurate AFP threshold value for HCC diagnosis of 50 ng/mL. HCC was detected with specificity > or = 95% only for AFP > 100 ng/mL. The sensitivity however was poor (25%). Male sex, age > 60, and AFP were independent predictors of HCC diagnosis. CONCLUSIONS: Serum AFP levels in HCC patients are not influenced by virus B or C hepatitis pattern. AFP dosage should not be used for HCC diagnosis in non-cirrhotic patients. Male patients with cirrhosis should be regarded with a more "aggressive" screening program compared to females.     

外周血白蛋白mRNA分析在肝癌诊断和转移监测中的价值

目的