分子病理检测在实体肿瘤诊疗中的应用现状及前景展望

在后基因组时代,随着分子病理检测技术的不断提高,肿瘤的预防与诊疗模式已发生显著变化,分子病理检测在实体肿瘤的全流程管理中的应用愈发深入,并逐渐成为提高实体肿瘤患者总体生存率的重要手段。近年来,以第二代测序技术为代表的分子病理检测在肿瘤遗传易感基因鉴定、泛实体肿瘤早期筛查与恶性实体肿瘤个体化治疗策略的制定等方面发挥重要作用。本文对不同分子病理检测平台在不同实体肿瘤防治阶段的实际应用场景及潜在问题进行概述。     

小鼠甲状腺细胞原代培养及鉴定

目的分离培养小鼠甲状腺细胞，为探讨甲状腺功能调节和疾病发生提供一种体外模型。方法取6～8周龄Balb／c小鼠甲状腺，用胶原酶-中性蛋白酶双酶法分离甲状腺滤泡上皮细胞。用含10％胎牛血清（FCS）的F-12培养基培养，细胞贴壁后FCS降至5％，另外添加促甲状腺激素（TSH）、氢化可的松、转铁蛋白、胰岛素和L．谷氨酰胺。光镜下对不同培养时间的细胞进行形态学观察，并结合免疫细胞化学染色法、RT—PCR法和电化学发光免疫法对培养小鼠甲状腺细胞从形态、甲状腺球蛋白（取）、取特异抗原蛋白表达、甲状腺过氧化物酶（TPO）、钠碘转运子（NIS）、促甲状腺激素受体（TSH—R）等特异基因mRNA表达和甲状腺激素T3、T4分泌功能等方面进行鉴定。结果小鼠甲状腺细胞在体外呈贴壁式生长，具有上皮样细胞特点；取染色呈胞浆阳性，并具有特异TPO、Tg、NIS、TSH—RmRNA表达和分泌T3、T4的功能，但其表达与分泌量有随培养时间的延长呈递减趋势。结论成功建立小鼠甲状腺细胞原代培养模型，可用于甲状腺功能与疾病研究。     

碘过量对NOD和Balb/c鼠甲状腺TRAIL和TRAIL-sR1表达的影响

Objective To investigate the influence of iodine excess on expression of TRAIl/TRAIL-sR1 in NOD and Balb/c mice and to study the effect of TRAIl/TRAIL-sR1 on the pathogenesis of experimental autoimmune thyroiditis(EAT). Methods Both Balb/c and NOD mice were divided randomly into control and iodine excess group by feeding with water containing no NaI or 0.05% Nal. The mice were sacrificed after 8 weeks. TRAIL and TRAIL-sR1 mRNA levels were detected by RT-PCR. The function, morphology and apoptosis of thyroids were also observed by ELISA and Tunnel stain. Results Treated by HI, enlarged follicles and flattened epithelium by accumulation of colloid were found in thyroids of both NOD and Balb/c mice. But significant lymphoid cell infiltration and local fibrosis were only found in thyroids of NOD HI group. The relative weight of thyroids of NOD mice in HI group[(104.8±14.5)mg/kg]was heavier than that of control group [(71.8±20.4)mg/kg]. The level of TT4 declined in HI group[(30.77±3.59)mmol/L]compared with control group[(36.43±2.66)mmol/L], meanwhile, the level of TSH was higher in HI group[(6.98±0.66)μg/L]than that in control group [(5.55±0.56)μg/L]. The difference being statistically significant(t=7.773,-9.526,-4.458, all P < 0.05). The relative weight of thyroids of Balb/c mice of HI group[(155.8±20.8)mg/kg]also heavier than that of control group [(105.1±22.0) mg/kg]. The level of TT4 droped in HI group [(19.75±3.32) mmoL/L]was higher than that in control group[(23.46±6.21)mmoL/L], the level of TSH in HI group[(4.14±1.71)μg/L]was higher than that in control group[(3.55±1.41)μg/L], the difference being statistically significant(t=7.554,-7.239,3.140, all P< 0.05). A great deal of apoptotie ceils observed in NOD (3.97±0.91) and Balb/c mice (1.05±0.45) by Tunnel stain were greater than control groups (0.21±0.15, 0.10±0.03), the difference being statistically significant in beth of the two species(t=-7.167,-17.772, both P < 0.05). The apoptosis index of thyroid follicular epithelium in NOD was obviously higher than Balb/c(t=-7.625, P<0.05). The level of TRAIL mRNA did not remarkably change in Balb/c between control group(0.000 59±0.000 39) and HI group(0.001 24±0.000 46, t=-1.940, P>0.05), but it increased apparently in NOD mice HI group(0.018 88±0.005 77) than that of control group(0.009 61± 0.00591, t=-2.71, P<0.05). The level of the expression of TRAIL-sR1 mRNA increased in HI groups of NOD (0.000 53±0.000 15) and Balb/c mice(0.000 42±0.000 09) than that in control groups of NOD(0.000 28± 0.000 05) and Balb/c mice (0.000 17±0.000 06) and the differences were statistically significant between the two species(t=3.050,3.990, all P<0.05). The differences of the expression of TRAIL and TRAIL-sR1 mRNA between the two species were significant(t=-3.37,-4.76, all P<0.05). Conclusions Iodine excess induces colloid goiter in beth species of mice and thyroiditis in NOD mice. The increase of TRAIL and TRAIL-sR1 influenced by iodine excess is one of the molecular bases of follicular epithelium apoptosis and inflammation in thyroids. Genetic factor is a key factor in the pathogenesis of thyroiditis.     

碘过量和多聚肌苷酸-聚胞苷酸及甲状腺球蛋白诱发小鼠甲状腺炎对Toll样受体3表达的影响

Objective To observe the effect of iodine excess(HI),polyinosinic-polycytidylic acid[Poly(I:C),Poly]and thyroglobulin(TG)on the thyroid of mice by the expression of Toll-like receptor 3(TLR3)to reveal the functional role of TLR3 in autoimmune thyroiditis.Methods Forty-two non-obese diabetic mice,body weight (20±3)g,were divided into six groups:control group,HI group,Poly group,TG group,HI+TG group,HI+Poly group. Fed with deionized water and injected intraperitoneally with physiological saline 0.1 ml each day for a week, the mice in control group were injected with physiological saline every other day at the same dose for 1 week before they were sacrificed; HI group drank 0.05% NaI water and were injected intraperitoneally with physiological saline same as control group; Poly group drank deionized water and were injected intraperitoneally with poly 0.1 ml (1 g/L)each day of the week, then the mice were injected with Poly every other day at the same dose for 1 week before they were sacrificed; TG group drank deionized water and were injected intraperitoneally with physiological saline same as control group, immunized with 0.1 mg TG by subcutaneously injecting and the immunization was enhanced after they were fed half dose for 4 and 8 weeks separately. In HI + Poly group, the treatment was the same as HI group and Poly group; HI + TG group: the treatment was the same as HI group and TG group. Eight weeks later, mice were sacrificed and thyroids were taken to make frozen sections, Hematoxylin-Eosin (HE) staining was employed to observe the morphological change of the thyroids. The expression of TLR3 of thyroids was observed under fluorescence microscope after Immumofluorescence using TLR3 antibody and TR3-positive cells were analyzed in the thyroid density. Results HE staining showed thyroids of Poly group had no inflammation under microscope.There were different degrees of inflammatory cell infiltration in HI group and TG group. The inflammatory cell infiltration and the damage of follicular thyroid of HI + TG group and HI + Poly group were serious, and the degrees of inflammation were higher over "++". Thyroid follicular epithelial cell with TLR3 expression could be seen in Poly group and HI group, meanwhile, there were TLR3 strong positive inflammatory cells in HI group under fluorescent microscope. Using stereological analysis of TLR3-positive cell density in the thyroid, the difference between groups was statistically significant(F=7.870, P<0.01 ). TLR3-positive cell density in the thyroid of HI + Poly group was higher[ (9.287 ± 0.522)mm2] than control group[ (0.062 ± 0.025)mm2, P < 0.01] significantly, meanwhile, the density in HI + Poly group was higher than HI group [ (2.574 ± 0.257 )mm2] and Poly group[ (1.361 ± 0.148 )mm2, all P < 0.01]. The density in HI + TG group[ (4.843±0.405)mm2] was higher than HI group and TG group[(1.601 ±0.268)mm2, all P < 0.01 )]. Conclusions Excessive iodine and thyroglobulin can induce thyroiditis, and stimulate the expression of TLR3 in the thyroid follicular epithelial, Poly aggravated thyroiditis induced by iodine excess in NOD mice; TLR3 positive inflammatory cells also appeared in inflammatory region, suggesting that TLR3 is involved in the pathogenesis of autoimmune thyroiditis     

碘过量对NOD和Balb/c鼠甲状腺TRAIL和TRAIL-sR1表达的影响

目的 观察碘过量对自身免疫性疾病敏感品系NOD鼠和非敏感品系Balb/c鼠甲状腺细胞凋亡相关基因肿瘤坏死因子的相关凋亡诱导配体(tumor necrosis factor-related apoptosis-inducing ligand, TRAIL)和其受体TRAIL刺激性受体1(TRAIL-sR1)表达的影响,了解碘过量诱导实验性自身免疫性甲状腺炎(EAT)发病过程中TRAIL和TRAIL-sR1的作用机制.方法 6～7周龄雌性NOD鼠和Balb/c鼠各16只,按体质量各随机分为对照组和碘过量(HI)组,每组8只.对照组饮高压灭菌水,HI组饮0.05%NaI添加水,饲养8周后处死.测量甲状腺相对质量,进行甲状腺组织形态学观察,测量血清甲状腺素(TT4)和甲状腺刺激激素(TSH),检测甲状腺滤泡上皮细胞凋亡情况,应用实时定量PcR(real time PCR)方法检测TRAIL和TRAIL-sR1 mRNA表达情况.结果 NOD鼠HI组甲状腺相对质量[(104.8±14.5)mg/kg]高于对照组[(71.8±20.4)mg/kg],血清TT4水平[(30.77±3.59)mmol/L]低于对照组[(36.43±2.66)mmol/L],TSH水平[(6.98±0.66)μg/L]高于对照组[(5.55±0.56)μg/L],组间比较差异均有统计学意义(t值分别为7.773、-9.526、-4.458,P均<0.05).HI组甲状腺出现滤泡扩张、胶质潴留及明显的淋巴细胞浸润伴灶性纤维化.Balb/c鼠川组甲状腺相对质量[(155.8±20.8)mg/kg]高于对照组[(105.1±22.0)mg/kg],血清TT4水平[(19.75±3.32)mmol/L]低于对照组[(23.46±6.21)mmol/L],TSH水平[(4.14±1.71)μg/L]高于对照组[(3.55±1.41)μg/L],组间比较差异均有统计学意义(t值分别为7.554、-7.239、3.140,P均<0.05);HI组甲状腺仅有甲状腺滤泡扩张,胶质潴留,而未见明显的淋巴细胞浸润.HI组NOD鼠和Balb/c鼠甲状腺滤泡上皮细胞的凋亡指数(3.97±0.91、1.05±0.45)分别高于对照组(0.21±0.15、0.10±0.03),组间比较差异均有统计学意义(t值分别为-7.167、-17.772,P均<0.05),Balb/c鼠HI组的甲状腺滤泡上皮细胞的凋亡指数低于NOD鼠HI组,组间比较差异有统计学意义(t=-7.625,P<0.05).NOD鼠HI组TRAIL mRNA表达水平(0.018 88±0.005 77)高于对照组(0.00961±0.005 91),组间比较差异有统计学意义(t=-2.710,P<0.05);Balb/c鼠HI组TRAIL表达水平(0.001 24±0.000 46)与对照组(0.000 59±0.000 39)比较,差异无统计学意义(t=-1.940,P>0.05);NOD鼠和Balb/c鼠HI组的TRAIL-sR1 mRNA表达水平(0.000 53±0.000 15、0.000 42±0.000 09)均高于对照组(0.000 28±0.000 05、0.000 17±0.000 06),组间比较差异有统计学意义(t值分别为3.050,3.990,P均<0.05),Balb/c鼠HI组的TRAIL和TRAIL-sR1的mRNA表达水平均低于NOD鼠HI组,组间比较差异均有统计学意义(t值分别为-3.370、-4.760,P均<0.05).结论 碘过量可使NOD和Balb/c鼠发生胶质潴留性甲状腺肿,并可造成NOD鼠甲状腺发生明显的炎症反应.TRAIL和TRAIL-sR1表达水平升高是碘过量导致甲状腺滤泡上皮凋亡和炎症发生的分子基础之一.遗传在甲状腺炎的发病过程中起到至关重要的作用.     

慢病毒介导的c-metRNA干扰对人乳头状甲状腺癌K1细胞生物学行为的影响

目的: 探讨c-Met在乳头状甲状腺癌(PTC)中的表达;构建针对人c-met基因的RNA干扰(RNAi)慢病毒载体,并观察其对K1细胞c-met基因的沉默效应及对细胞生物学行为的影响。方法: 免疫组化方法检测35例乳头状甲状腺癌及25例良性甲状腺疾病手术切除标本中c-Met的表达;构建人c-met基因的RNAi慢病毒载体,应用荧光定量RT-PCR与Western blotting检测其对c-met的干扰效率,应用克隆形成实验、流式细胞术、划痕实验和Transwell实验检测其对细胞克隆形成、周期、迁移、侵袭能力的影响,应用裸鼠模型评估RNA干扰后细胞成瘤能力的影响。结果: c-Met在PTC中的表达明显高于良性甲状腺组织;成功构建了c-met RNAi慢病毒载体,RT-PCR及Western blotting实验显示其对乳头状甲状腺癌K1细胞c-met mRNA 及蛋白表达的抑制均较明显;克隆形成实验显示c-met RNAi慢病毒载体能够抑制K1细胞的克隆形成能力;流式细胞术检测显示c-met RNAi慢病毒载体能够减少S细胞比列;划痕实验及Transwell实验显示c-met RNAi慢病毒载体能够抑制细胞迁移和侵袭;裸鼠成瘤实验显示RNA干扰后细胞的成瘤能力降低。结论: c-met RNAi慢病毒载体能够抑制K1细胞的克隆形成能力、细胞周期进程、迁移、侵袭及成瘤能力。     

碘诱发NOD和Balb/c小鼠甲状腺炎的实验研究

Objective To observe the different effects of iodine excess on inducing two strain mice thyroiditis. Methods NOD and Balb/c mice, each having 14 mice, were divided into NaI and control group. The mice were given 0.05% NaI water for 8 weeks in NaI group. RIA and ELISA were used respectively to detect TT4, TgAb, TPOAb and TSH level in serum. Morphology changes of thyroid and apoptosis of thyrocytes stained by immunohistochemistry were observed under light microscope. Lymphocytic proliferation of cervical lymph node and spleen to responding to Tg were detected by MTr method. Results After intake of iodine water for 8 weeks, NOD and Balb/c mice showed relative quality of thyroid in Nal group[(104.83±14.52), (155.79±20.77)mg/kg]obviously increased compared with control group[(71.80±20.42), (105.15±21.98)mg/kg, t values:-3.293,-4.429, all P< 0.01)], enlarged follicular lumen with colloid accumulation were observed in thyroid. Serum level of TT4 in Nal group [(29.52±4.42), (19.53± 2.35)nmol/L]to control group[33.40±5.38), (23.47±6.22)nmol/L]of NOD and Balb/c mice showed a decreasing tendency(t values: 1.374,1.567, all P > 0.05). TSH of Nal group showed an increasing tendency in Balb/c mice[(4.14±1.71)μg/L, compared with control [(3.55±1.41)μg/L, t values:-0.705, P > 0.05]and obviously increased in NOD mice [(6.98±0.66)μg/L, compared with control[(555±056)μg/L, t values:-3.562, P< 0.01], but no change of TgAb and TPOAb level in Nal group(1281,1364 cpm, 2.50×103, 0.14×103U/L were observed, compared with control(1297,1220 cpm, 3.17×103,0.03×103 U/L; Zvalues:-0.081,-0.703, -0.244,-1.293, all P > 0.05). In NOD mice NaI group, apoptosis of thyrocytes was more intense than Balb/c mice, obvious infiltration of lymphoeytes, disorganization and focus fibrosis was seen in thyroid. The cell amount of NaI group increased in NOD mice lymph node and spleen cells[(1.100±0.014), (1.076±0.033)]were more than that in the control group [(0.993±0.011), (1.005±0.003), t value:-11.672,-4.314, P < 0.01). Conclusions Iodine leads to enlargement of thyroid and malfunction of thyroid in Balb/c mice. Besides, NOD mice have generate inflammatory reaction in thyroid and produced sensitized lymphocytes to Tg. Iodine excess can induce NOD mice to occur autoimmune thyroiditis.     

碘过量和甲状腺球蛋白免疫诱发NOD小鼠甲状腺炎的病变特征

Objective To observe the pathological characteristics of thyroiditis induced by iodine excess and thyroglobulin (Tg) immunization and to explore the mechanism of thyroiditis induced by iodine excess. Methods NOD mice were used for intaking 0.05% Nal water and(or) Tg immunization. Morphologic change in thyroid and apoptosis were observed. The levels of serum TT4, TSH, thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) were measured. Responding to Tg, lymphocytic proliferation of lymph node and spleen, interleukin-4(IL-4)and γ-interferon(IFN-γ) levels in culture medium of splenocytes were detected. Real-time PCR Was used to detect mRNA expressions of IL-4, IFN-γ, chemokine ligand 10 (CXCL10) and intercellular adhesion molecular-1(ICAM-1) in thyroid. Results Distended thyroid follicles,colloid accumulation, intense lymphocytic infiltration and disorganization were seen in thyroid of iodine excess group, along with increased apoptosis of thyroid cells(34.66～ 2.78 vs 5.11±0.62 ,P<0.01). The levels of TT4 were lowered while TSH raised ,but no production of thyroid-specific autoantibodies was revealed. Lymph node and spleen cells showed positive respornse under stimulation of Tg. The level of IFN-γ[(1. 272±0.049 vs 1. 139±0. 025)ng/L,P<0. 01] was raised in culture medium of splenocytes but not IL-4. The expression of IFN-γ, CXCLI0 and ICAM-1 mRNA were increased in thyroid. But in Tg group, some lymphocytes were scattered in thyroid, autoantibodies emerged ,and the level of IL-4 was increased in cuhure medium of splenocytes[(18. 508±0. 113 vs 13. 368±0. 016)ng/L, P<0. 01]. ledine excess combined with Tg enhanced these inflammatory reaction. Conclusion Iodine excess induced thyroiditis in NOD mice. The process seems to be Th1 response dominant organ-specific autoimmune diseases. Iodine excess and Tg immunizatiou play a synergistic role in inducing experimental autoimmune thyroiditis.     

碘过量对NOD和Balb/c鼠甲状腺TRAIL和TRAIL-sR1表达的影响

Objective To investigate the influence of iodine excess on expression of TRAIl/TRAIL-sR1 in NOD and Balb/c mice and to study the effect of TRAIl/TRAIL-sR1 on the pathogenesis of experimental autoimmune thyroiditis(EAT). Methods Both Balb/c and NOD mice were divided randomly into control and iodine excess group by feeding with water containing no NaI or 0.05% Nal. The mice were sacrificed after 8 weeks. TRAIL and TRAIL-sR1 mRNA levels were detected by RT-PCR. The function, morphology and apoptosis of thyroids were also observed by ELISA and Tunnel stain. Results Treated by HI, enlarged follicles and flattened epithelium by accumulation of colloid were found in thyroids of both NOD and Balb/c mice. But significant lymphoid cell infiltration and local fibrosis were only found in thyroids of NOD HI group. The relative weight of thyroids of NOD mice in HI group[(104.8±14.5)mg/kg]was heavier than that of control group [(71.8±20.4)mg/kg]. The level of TT4 declined in HI group[(30.77±3.59)mmol/L]compared with control group[(36.43±2.66)mmol/L], meanwhile, the level of TSH was higher in HI group[(6.98±0.66)μg/L]than that in control group [(5.55±0.56)μg/L]. The difference being statistically significant(t=7.773,-9.526,-4.458, all P < 0.05). The relative weight of thyroids of Balb/c mice of HI group[(155.8±20.8)mg/kg]also heavier than that of control group [(105.1±22.0) mg/kg]. The level of TT4 droped in HI group [(19.75±3.32) mmoL/L]was higher than that in control group[(23.46±6.21)mmoL/L], the level of TSH in HI group[(4.14±1.71)μg/L]was higher than that in control group[(3.55±1.41)μg/L], the difference being statistically significant(t=7.554,-7.239,3.140, all P< 0.05). A great deal of apoptotie ceils observed in NOD (3.97±0.91) and Balb/c mice (1.05±0.45) by Tunnel stain were greater than control groups (0.21±0.15, 0.10±0.03), the difference being statistically significant in beth of the two species(t=-7.167,-17.772, both P < 0.05). The apoptosis index of thyroid follicular epithelium in NOD was obviously higher than Balb/c(t=-7.625, P<0.05). The level of TRAIL mRNA did not remarkably change in Balb/c between control group(0.000 59±0.000 39) and HI group(0.001 24±0.000 46, t=-1.940, P>0.05), but it increased apparently in NOD mice HI group(0.018 88±0.005 77) than that of control group(0.009 61± 0.00591, t=-2.71, P<0.05). The level of the expression of TRAIL-sR1 mRNA increased in HI groups of NOD (0.000 53±0.000 15) and Balb/c mice(0.000 42±0.000 09) than that in control groups of NOD(0.000 28± 0.000 05) and Balb/c mice (0.000 17±0.000 06) and the differences were statistically significant between the two species(t=3.050,3.990, all P<0.05). The differences of the expression of TRAIL and TRAIL-sR1 mRNA between the two species were significant(t=-3.37,-4.76, all P<0.05). Conclusions Iodine excess induces colloid goiter in beth species of mice and thyroiditis in NOD mice. The increase of TRAIL and TRAIL-sR1 influenced by iodine excess is one of the molecular bases of follicular epithelium apoptosis and inflammation in thyroids. Genetic factor is a key factor in the pathogenesis of thyroiditis.     

碘诱发NOD和Balb/c小鼠甲状腺炎的实验研究

Objective To observe the different effects of iodine excess on inducing two strain mice thyroiditis. Methods NOD and Balb/c mice, each having 14 mice, were divided into NaI and control group. The mice were given 0.05% NaI water for 8 weeks in NaI group. RIA and ELISA were used respectively to detect TT4, TgAb, TPOAb and TSH level in serum. Morphology changes of thyroid and apoptosis of thyrocytes stained by immunohistochemistry were observed under light microscope. Lymphocytic proliferation of cervical lymph node and spleen to responding to Tg were detected by MTr method. Results After intake of iodine water for 8 weeks, NOD and Balb/c mice showed relative quality of thyroid in Nal group[(104.83±14.52), (155.79±20.77)mg/kg]obviously increased compared with control group[(71.80±20.42), (105.15±21.98)mg/kg, t values:-3.293,-4.429, all P< 0.01)], enlarged follicular lumen with colloid accumulation were observed in thyroid. Serum level of TT4 in Nal group [(29.52±4.42), (19.53± 2.35)nmol/L]to control group[33.40±5.38), (23.47±6.22)nmol/L]of NOD and Balb/c mice showed a decreasing tendency(t values: 1.374,1.567, all P > 0.05). TSH of Nal group showed an increasing tendency in Balb/c mice[(4.14±1.71)μg/L, compared with control [(3.55±1.41)μg/L, t values:-0.705, P > 0.05]and obviously increased in NOD mice [(6.98±0.66)μg/L, compared with control[(555±056)μg/L, t values:-3.562, P< 0.01], but no change of TgAb and TPOAb level in Nal group(1281,1364 cpm, 2.50×103, 0.14×103U/L were observed, compared with control(1297,1220 cpm, 3.17×103,0.03×103 U/L; Zvalues:-0.081,-0.703, -0.244,-1.293, all P > 0.05). In NOD mice NaI group, apoptosis of thyrocytes was more intense than Balb/c mice, obvious infiltration of lymphoeytes, disorganization and focus fibrosis was seen in thyroid. The cell amount of NaI group increased in NOD mice lymph node and spleen cells[(1.100±0.014), (1.076±0.033)]were more than that in the control group [(0.993±0.011), (1.005±0.003), t value:-11.672,-4.314, P < 0.01). Conclusions Iodine leads to enlargement of thyroid and malfunction of thyroid in Balb/c mice. Besides, NOD mice have generate inflammatory reaction in thyroid and produced sensitized lymphocytes to Tg. Iodine excess can induce NOD mice to occur autoimmune thyroiditis.