Radiological treatment of HCC: Interventional radiology at the heart of management

International audience

Brivanib alaninate, a dual inhibitor of vascular endothelial growth factor receptor and fibroblast growth factor receptor tyrosine kinases, induces growth inhibition in mouse models of human hepatocellular carcinoma

PURPOSE: Hreceptor (VEGFR) and FGF receptor (FGFR) signaling pathways. EXPERIMENTAL DESIGN: Six different s.c. patient-derived HCC xenografts were implanted into mice. Tumor growth was evaluated in mice treated with brivanib compared with control. The effects of brivanib on apoptosis and cell proliferation were evaluated by immunohistochemistry. The SK-HEP1 and HepG2 cells were used to investigate the effects of brivanib on the VEGFR-2 and FGFR-1 signaling pathways in vitro. Western blotting was used to determine changes in proteins in these xenografts and cell lines. RESULTS: Brivanib significantly suppressed tumor growth in five of six xenograft lines. Furthermore, brivanib-induced growth inhibition was associated with a decrease in phosphorylated VEGFR-2 at Tyr(1054/1059), increased apoptosis, reduced microvessel density, inhibition of cell proliferation, and down-regulation of cell cycle regulators. The levels of FGFR-1 and FGFR-2 expression in these xenograft lines were positively correlated with its sensitivity to brivanib-induced growth inhibition. In VEGF-stimulated and basic FGF stimulated SK-HEP1 cells, brivanib significantly inhibited VEGFR-2, FGFR-1, extracellular signal-regulated kinase 1/2, and Akt phosphorylation. CONCLUSION: This study provides a strong rationale for clinical investigation of brivanib in patients with HCC.

Targeting oxidative stress in cancer

Importance of the field: Reactive oxygen species (ROS) occur as natural by-products of oxygen metabolism and have important cellular functions. Normally, the cell is able to maintain an adequate balance between the formation and removal of ROS either via anti-oxidants or through the use specific enzymatic pathways. However, if this balance is disturbed, oxidative stress may occur in the cell, a situation linked to the pathogenesis of many diseases, including cancer. Areas covered in this review: HDACs are important regulators of many oxidative stress pathways including those involved with both sensing and coordinating the cellular response to oxidative stress. In particular aberrant regulation of these pathways by histone deacetylases may play critical roles in cancer progression. What the reader will gain: In this review we discuss the notion that targeting HDACs may be a useful therapeutic avenue in the treatment of oxidative stress in cancer, using chronic obstructive pulmonary disease (COPD), NSCLC and hepatocellular carcinoma (HCC) as examples to illustrate this possibility. Take home message: Epigenetic mechanisms may be an important new therapeutic avenue for targeting oxidative stress in cancer. © 2010 Informa UK, Ltd.

Advanced mass spectrometry-based multi-omics technologies for exploring the pathogenesis of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the primary hepatic malignancies and is the third most common cause of cancer related death worldwide. Although a wealth of knowledge has been gained concerning the initiation and progression of HCC over the last half century, efforts to improve our understanding of its pathogenesis at a molecular level are still greatly needed, to enable clinicians to enhance the standards of the current diagnosis and treatment of HCC. In the post-genome era, advanced mass spectrometry driven multi-omics technologies (e.g., profiling of DNA damage adducts, RNA modification profiling, proteomics, and metabolomics) stand at the interface between chemistry and biology, and have yielded valuable outcomes from the study of a diversity of complicated diseases. Particularly, these technologies are being broadly used to dissect various biological aspects of HCC with the purpose of biomarker discovery, interrogating pathogenesis as well as for therapeutic discovery. This proof of knowledge-based critical review aims at exploring the selected applications of those defined omics technologies in the HCC niche with an emphasis on translational applications driven by advanced mass spectrometry, toward the specific clinical use for HCC patients. This approach will enable the biomedical community, through both basic research and the clinical sciences, to enhance the applicability of mass spectrometry-based omics technologies in dissecting the pathogenesis of HCC and could lead to novel therapeutic discoveries for HCC.

Size-mediated cytotoxicity of nanocrystalline titanium dioxide, pure and zinc-doped hydroxyapatite nanoparticles in human hepatoma cells

Nanoparticles are highly used in biological applications including nanomedicine. In this present study, the interaction of HepG2 hepatocellular carcinoma cells (HCC) with hydroxyapatite (HAp), zinc-doped hydroxyapatite, and titanium dioxide (TiO2) nanoparticles were investigated. Hydroxyapatite, zinc-doped hydroxyapatite and titanium dioxide nanoparticles were prepared by wet precipitation method. They were subjected to isochronal annealing at different temperatures. Particle morphology and size distribution were characterized by X-ray diffraction and transmission electron microscope. The nanoparticles were co-cultured with HepG2 cells. MTT assay was employed to evaluate the proliferation of tumor cells. The DNA damaging effect of HAp, Zn-doped HAp, and TiO2 nanoparticles in human hepatoma cells (HepG2) were evaluated using DNA fragmentation studies. The results showed that in HepG2 cells, the anti-tumor activity strongly depend on the size of nanoparticles in HCC cells. Cell cycle arrest analysis for HAp, zinc-doped HAp, and TiO2 nanoparticles revealed the influence of HAp, zinc-doped HAp, and titanium dioxide nanoparticles on the apoptosis of HepG2 cells. The results imply that the novel nano nature effect plays an important role in the biomedicinal application of nanoparticles.

Pravastatin inhibits cell proliferation and increased MAT1A expression in hepatocarcinoma cells and in vivo models

Background: Statins may have therapeutic effects on hepatocarcinoma (HCC). This type of disorder is the most common malignant primary tumour in the liver. Our objective was to determine whether pravastatin had a therapeutic effect in vitro and in vivo models. Method: We design in vitro and in vivo model. In vitro we used PLC and determine cell proliferation. In vivo, we used and animal model to determined, PCNA and MAT1A expression and transaminases levels. Results: We found that pravastatin decreases cell proliferation in vitro (cell proliferation in pravastatin group was 82%, in sorafenib group 51% and in combined group 40%) and in vivo (in pravastatin group 80%, in sorafenib group 76.4% and in combined group 72.72%). The MAT1A levels, was significantly higher in Pravastatin group (D 62%, P 94%, S 71%, P + S 91%). The transaminases levels, decreased significantly in Pravastatin group (GOT and GPT levels D 619.5 U/L; 271 U/L) (P 117.5 U/L; 43.5 U/L) (S 147 U/L; 59 U/L) (P + S 142 U/L; 59 U/L). Conclusion: The combination of pravastatin + sorafenib were more effective than Sorafenib alone.

肝癌细胞与内皮细胞的粘附力学特性研究

采用细胞同步技术和微管吸吮技术，从细胞周期的角度研究不同细胞周期肝癌细胞（hepatocellular carcinoma cells,HCC)与脐静脉内皮细胞（HUVEC）的粘附力学特性。结果表明，未同步化肝癌细胞各周期时相的细胞百分比为：G0／G1期，53.51；G2／M期，11.01；S期，35.48。采用胸腺嘧啶脱氧核苷、秋水仙碱顺序阻断和胸腺嘧啶脱氧核苷双阻断后释放培养的方法可分别获得G1期和S期的肝癌细胞，其平均同步率分别为69.02和96.50。G1期肝癌细胞与人脐静脉内皮细胞的粘附力比S期相应值明显降低（P＜0.01)，与未同步化肝癌细胞组比较也得到同样结果，而S期与未同步化肝癌细胞组的粘附力值无明显差别。肝癌细胞与脐静脉内皮细胞的粘附力随着附时间的变化而变化，在30-60min内迅速增长，60min之后维持在较稳定的水平，即300×10~-10N左右。提示：在肝癌细胞与内皮细胞的粘附过程中，S期细胞可能起的作用更大；肝癌细胞和内皮细胞上粘附分子表达呈现时间效应，从而体现出粘附和去粘附的行为特征。

New Oncogenic Drivers in Hepatocellular Carcinoma: Role of the RNA Binding Protein Hu antigen R

156 p. : graf.

ELF (Enhanced Liver Fibrosis) como marcador não invasivo de fibrose hepáticana hepatite C crônica

A fibrose hepática é o aspecto mais relevante e o mais importante determinante de morbimortalidade na hepatite C crônica (HCC). Historicamente, a biópsia hepática é o método de referência para avaliação da fibrose causada pela HCC, apesar de apresentar limitações. O estudo de marcadores não invasivos, que possam obviar a necessidade da biópsia, é uma área de constante interesse na hepatologia. Idealmente, a avaliação da fibrose hepática deveria ser acurada, simples, prontamente disponível, de baixo custo e informar sobre o prognóstico da patologia. Os marcadores não invasivos mais estudados são a elastografia hepática transitória (EHT) e os laboratoriais. A EHT já foi extensamente validada na HCC e está inserida na rotina de avaliação destes pacientes. Dentre os laboratoriais, existem diversos testes em continua experimentação e, até o momento, nenhum foi integrado à prática clínica no Brasil, embora já aplicados rotineiramente em outros países. O Enhanced Liver Fibrosis (ELF), um teste que dosa no soro ácido hialurônico, pró-peptídeo amino-terminal do colágeno tipo III e inibidor tissular da metaloproteinase 1, tem se mostrado bastante eficaz na detecção de fibrose hepática significativa e de cirrose na HCC. Neste estudo o ELF teve o seu desempenho avaliado em relação a biópsia hepática e demonstrou apresentar boa acurácia na detecção tanto de fibrose significativa quanto de cirrose. Na comparação com a EHT apresentou acurácia semelhante para estes mesmos desfechos, com significância estatística. No entanto, foi observada uma superestimação da fibrose com a utilização dos pontos de corte propostos pelo fabricante. Este achado está em acordo com a literatura, onde não há consenso sobre o melhor ponto de corte a ser empregado na prática clínica. Com a ampliação da casuística foi possível propor novos pontos de corte, através da análise clássica, com a biópsia hepática como padrão ouro. O resultado obtido vai ao encontro do observado por outros autores. Em seguida, os novos pontos de corte do ELF foram reavaliados sem que a biópsia hepática fosse a referência, através da análise de classes latentes. Mais uma vez o ELF apresentou bom desempenho, inclusive com melhora de suas sensibilidade e especificidade em comparação com a análise clássica, onde a biópsia hepática é a referência. Assim sendo, é possível concluir que o ELF é um bom marcador não invasivo de fibrose hepática. No entanto, para detecção de fibrose significativa e cirrose, deve ser considerada a aplicação na prática clínica dos novos pontos de corte aqui propostos.

Influência do polimorfismo genético de citocinas na hepatite C crônica em uma população do Rio de Janeiro

A infecção pelo vírus da hepatite C (VHC) é uma das mais comuns infecções ao redor do mundo. Aproximadamente, 20% dos pacientes infectados eliminam espontaneamente o vírus, porém a maioria dos indivíduos infectados desenvolve infecção crônica com amplo espectro de lesões hepáticas, desde inflamação leve até cirrose. A resposta imune do hospedeiro exerce grande influência sobre o desfecho da infecção pelo VHC. O objetivo deste trabalho foi analisar a influência dos polimorfismos genéticos de citocinas na susceptibilidade ou persistência da infecção por VHC e no clareamento espontâneo em uma amostra de pacientes da população do Rio de Janeiro (Brasil). Os polimorfismos genéticos das citocinas TNFA (-308), TGFB1 (codon 10 e 25), IL10 (-1082, -592), IL6 (-174) e IFNG (+874) foram analisados por PCR-SSP em 245 pacientes com hepatite C crônica (HCC), 41 pacientes que alcançaram o clareamento viral espontâneo e 189 indivíduos controle saudáveis. Além disso, os polimorfismos próximos ao gene da citocina IL28B (rs12979860, rs12980275 e rs8099917) foram analisados por PCR em tempo real em todos os grupos. O grau de fibrose e inflamação, a resposta ao tratamento e o genótipo do vírus também foram levados em consideração quanto ao desfecho da HCC Os genótipos IL28B rs12979860 CC e CT e rs12980275 AA e AG foram significativamente associados ao clareamento espontâneo e à resposta à terapia anti-viral. Da mesma forma, o alelo C (rs12979860) e o alelo A (rs12980275) foram significativamente maior no grupo Clareamento. O alelo C de IL6 (-174) foi associado com o Clareamento. Nenhuma associação entre as demais citocinas e o desfecho da HCC foi encontrada. O Genótipo TNFA (-308) GG parece estar associado com menor grau de inflamação. Além disso, a etnia auto declarada influencia a distribuição dos polimorfismos em IL6 (-174) e IL28B rs12979860 e rs8099917. Nossas observações indicam que os polimorfismos próximos ao gene da IL28B estão associados com o clareamento viral e resposta ao tratamento na população do Rio de Janeiro. Além disso, nossos resultados podem ser úteis para futuras investigações entre os polimorfismos de citocinas e a infecção por VHC numa população heterogênea como a Brasileira.

Methylation of tumor associated genes in tissue and plasma samples from liver disease patients

To investigate whether aberrant hypermethylation in plasma DNA could be used as diagnosis makers for hepatocellular carcinoma (HCC), we performed methylation-specific PCR (MSP) to check the methylation status of five tumor associated genes in 36 cases of

唾液酸转移酶Ⅰ（ST6GalⅠ）及甲胎蛋白（AFP）上肝癌特异糖链在肝细胞肝癌细胞系和肝病患者血液中的表达

肝癌（HCC）是一种重要的恶性肿瘤，具有高发病率和不良预后的特点，在中国有很多的肝癌患者。早期发现和精确区分肝癌与其他肝病，对于肝癌的临床诊断治疗有十分重要的作用。由于肝脏所处位置较深，以及检测仪器和手段的限制，肝癌的早期诊断相对困难，所以比较好的血清学标记物应用于早期区分肝癌和其他肝病显得尤为重要。目前应用较多的标记物是甲胎蛋白AFP。由于单独的AFP其敏感性和特异性并不高，更为理想的检测手段正在研究中。 Beta-galactoside alpha-2,6-sialyltransferase Ⅰ(ST6GalⅠ)是唾液酸转移酶家族中的一员，主要调控蛋白的唾液酸化。有研究发现ST6Gal在肝癌中表达升高，而且随着肝实体瘤的恶化而可能被释放到外周血中。所以血液中的ST6GalⅠ水平可能是一种有潜力的肝癌指标。另外，有研究显示，AFP的糖链结构在肝癌和其他肝病中是不同的，如果能用AFP上肝癌特异糖链作为检测目标，联合已有的检测体系，可能有助于早期精确诊断肝癌。 目的：我们选择ST6Gal Ⅰ和AFP上肝癌特异糖链TF（Thomsen-Friedenreich）抗原，H2血型抗原，Lewis Y血型抗原作为主要的研究内容，通过对其在肝癌细胞系和肝病血液中的表达研究，探讨其应用于肝癌早期诊断的可能。 方法：1）用合成的ST6Gal Ⅰ多肽免疫兔子，制备抗ST6Gal Ⅰ多克隆抗体；2）通过免疫细胞化学，ELISA和western blot等方法对制作的兔多克隆抗体进行效价分析；3）通过western blot方法对肝癌、肝硬化和正常人的血浆和血清中ST6Gal表达进行研究；4）通过免疫沉淀的方法对肝癌细胞系和肝癌血浆中AFP上肝癌特异糖链进行研究。 结果：1）制备的兔抗人ST多克隆抗血清，效价可达1:400000，能够通过 免疫细胞化学和western blot检测到肝癌细胞系中的ST6GalⅠ；2）所选的3例肝癌血浆和2例肝癌血清中都有ST6GalⅠ阳性，在所选的2例肝硬化血浆和2例肝硬化血清中，分别只有1例有ST6GalⅠ的阳性，在3例正常人血浆中有2例有ST6GalⅠ阳性；3）AFP上肝癌特异的糖链TF抗原、H2抗原、Lewis Y抗原可以通过免疫沉淀的方法在肝癌病人血浆和肝癌细胞系HepG2中检出。 结论：制备的兔抗人ST6GalⅠ多克隆抗体具有较高效价，并可以检测到自然状态和变性状态的目标蛋白，可以应用于ST6GalⅠ的研究；通过western blotting对肝病血液的检测，发现在肝癌、肝硬化和正常人血液中的ST6GalⅠ的表达有差异，为ST6GalⅠ作为一种肿瘤标记物进行血清学检测提供了可能的前提；免疫沉淀的结果，证实了在肝癌病人的AFP上有TF、H2、LewisY等糖链的存在，为AFP上肝癌特异糖链作一种区分肝癌和其他良性肝病的标记物提供了证据。

唾液酸转移酶Ⅰ（ST6GalⅠ）及甲胎蛋白（AFP）上肝癌特异糖链在肝细胞肝癌细胞系和肝病患者血液中的表达

肝癌（HCC）是一种重要的恶性肿瘤，具有高发病率和不良预后的特点，在中国有很多的肝癌患者。早期发现和精确区分肝癌与其他肝病，对于肝癌的临床诊断治疗有十分重要的作用。由于肝脏所处位置较深，以及检测仪器和手段的限制，肝癌的早期诊断相对困难，所以比较好的血清学标记物应用于早期区分肝癌和其他肝病显得尤为重要。目前应用较多的标记物是甲胎蛋白AFP。由于单独的AFP其敏感性和特异性并不高，更为理想的检测手段正在研究中。 Beta-galactoside alpha-2,6-sialyltransferase Ⅰ(ST6GalⅠ)是唾液酸转移酶家族中的一员，主要调控蛋白的唾液酸化。有研究发现ST6Gal在肝癌中表达升高，而且随着肝实体瘤的恶化而可能被释放到外周血中。所以血液中的ST6GalⅠ水平可能是一种有潜力的肝癌指标。另外，有研究显示，AFP的糖链结构在肝癌和其他肝病中是不同的，如果能用AFP上肝癌特异糖链作为检测目标，联合已有的检测体系，可能有助于早期精确诊断肝癌。 目的：我们选择ST6Gal Ⅰ和AFP上肝癌特异糖链TF（Thomsen-Friedenreich）抗原，H2血型抗原，Lewis Y血型抗原作为主要的研究内容，通过对其在肝癌细胞系和肝病血液中的表达研究，探讨其应用于肝癌早期诊断的可能。 方法：1）用合成的ST6Gal Ⅰ多肽免疫兔子，制备抗ST6Gal Ⅰ多克隆抗体；2）通过免疫细胞化学，ELISA和western blot等方法对制作的兔多克隆抗体进行效价分析；3）通过western blot方法对肝癌、肝硬化和正常人的血浆和血清中ST6Gal表达进行研究；4）通过免疫沉淀的方法对肝癌细胞系和肝癌血浆中AFP上肝癌特异糖链进行研究。 结果：1）制备的兔抗人ST多克隆抗血清，效价可达1:400000，能够通过免疫细胞化学和western blot检测到肝癌细胞系中的ST6GalⅠ；2）所选的3例肝癌血浆和2例肝癌血清中都有ST6GalⅠ阳性，在所选的2例肝硬化血浆和2例肝硬化血清中，分别只有1例有ST6GalⅠ的阳性，在3例正常人血浆中有2例有ST6GalⅠ阳性；3）AFP上肝癌特异的糖链TF抗原、H2抗原、Lewis Y抗原可以通过免疫沉淀的方法在肝癌病人血浆和肝癌细胞系HepG2中检出。 结论：制备的兔抗人ST6GalⅠ多克隆抗体具有较高效价，并可以检测到自然状态和变性状态的目标蛋白，可以应用于ST6GalⅠ的研究；通过western blotting对肝病血液的检测，发现在肝癌、肝硬化和正常人血液中的ST6GalⅠ的表达有差异，为ST6GalⅠ作为一种肿瘤标记物进行血清学检测提供了可能的前提；免疫沉淀的结果，证实了在肝癌病人的AFP上有TF、H2、LewisY等糖链的存在，为AFP上肝癌特异糖链作一种区分肝癌和其他良性肝病的标记物提供了证据。

Camera Canvas: Image Editing Software for People with Disabilities

Poster is based on the following paper: C. Kwan and M. Betke. Camera Canvas: Image editing software for people with disabilities. In Proceedings of the 14th International Conference on Human Computer Interaction (HCI International 2011), Orlando, Florida, July 2011.

Plasma miRNAs as early biomarkers for detecting hepatocellular carcinoma.

The early detection of hepatocellular carcinoma (HCC) presents a challenge because of the lack of specific biomarkers. Serum/plasma microRNAs (miRNAs) can discriminate HCC patients from controls. We aimed to identify and evaluate HCC-associated plasma miRNAs originating from the liver as early biomarkers for detecting HCC. In this multicenter three-phase study, we first performed screening using both plasma (HCC before and after liver transplantation or liver hepatectomy) and tissue samples (HCC, para-carcinoma and cirrhotic tissues). Then, we evaluated the diagnostic potential of the miRNAs in two case-control studies (training and validation sets). Finally, we used two prospective cohorts to test the potential of the identified miRNAs for the early detection of HCC. During the screening phase, we identified ten miRNAs, eight of which (miR-20a-5p, miR-25-3p, miR-30a-5p, miR-92a-3p, miR-132-3p, miR-185-5p, miR-320a and miR-324-3p) were significantly overexpressed in the HBV-positive HCC patients compared with the HBV-positive cancer-free controls in both the training and validation sets, with a sensitivity of 0.866 and specificity of 0.646. Furthermore, we assessed the potential for early HCC detection of these eight newly identified miRNAs and three previously reported miRNAs (miR-192-5p, miR-21-5p and miR-375) in two prospective cohorts. Our meta-analysis revealed that four miRNAs (miR-20a-5p, miR-320a, miR-324-3p and miR-375) could be used as preclinical biomarkers (pmeta  < 0.05) for HCC. The expression profile of the eight-miRNA panel can be used to discriminate HCC patients from cancer-free controls, and the four-miRNA panel (alone or combined with AFP) could be a blood-based early detection biomarker for HCC screening.