CCCTC-binding factor (CTCF) binds DNA, thereby helping to partition the mammalian genome into discrete structural and regulatory domains. In doing so, it insulates chromatin and fine-tunes gene activation, repression, and silencing. Complete removal of CTCF from mammalian cells causes catastrophic genomic dysregulation, most likely due to widespread collapse of 3D chromatin looping within the nucleus. In contrast, Ctcf hemizygous mice with lifelong reduction in CTCF expression are viable but have an increased incidence of spontaneous multi-lineage malignancies. In addition, CTCF is mutated in many human cancers and is thus implicated as a tumour suppressor gene. This study aimed to interrogate the genome-wide consequences of a reduced genomic concentration of Ctcf and its implications for carcinogenesis. In a genetically engineered mouse model, Ctcf hemizygous cells showed modest but robust changes in almost a thousand sites of genomic CTCF occupancy; these were enriched for lower affinity binding events with weaker evolutionary conservation across the mouse lineage. Furthermore, several hundred genes concentrated in cancer-related pathways were dysregulated due to changes in transcriptional regulation. Global chromatin structure was preserved but some loop interactions were destabilised, often around differentially expressed genes and their enhancers. Importantly, these transcriptional alterations were also seen in human cancers. These findings were then examined in a hepatocyte-specific mouse model of Ctcf hemizygosity with diethylnitrosamine-induced liver tumours. Ctcf hemizygous mice had a subtle liver-specific phenotype, although the overall tumour burden in Ctcf hemizygous and wild-type mice was the same. Using whole genome sequencing, the highly reproducible mutational signature caused by DEN exposure was characterised, revealing that Braf(V637E), orthologous to BRAF(V600E) in humans, was the predominant oncogenic driver in these liver tumours. Taken together, while Ctcf loss is partially physiologically compensated, chronic CTCF depletion dysregulates gene expression by subtly altering transcriptional regulation. This study also represents the first comprehensive genome-wide and histopathological characterisation of this commonly used liver cancer model.

<p>To ameliorate Hepatitis C Virus (HCV) therapeutic and diagnostic challenges requires robust intervention strategies, including approaches that leverage the plethora of rich data published in biomedical literature to gain greater understanding of HCV pathobiological mechanisms. The multitudes of metadata originating from HCV clinical trials as well as low and high-throughput experiments embedded in text corpora can be mined as data sources for the implementation of HCV-specific resources. HCV-customized resources may support the generation of worthy and testable hypothesis and reveal potential research clues to augment the pursuit of efficient diagnostic biomarkers and therapeutic targets. This research thesis report the development of two freely available HCV-specific web-based resources: (i) Dragon Exploratory System on Hepatitis C Virus (DESHCV) accessible via http://apps.sanbi.ac.za/DESHCV/ or http://cbrc.kaust.edu.sa/deshcv/ and (ii) Hepatitis C Virus Protein Interaction Database (HCVpro) accessible via&nbsp / http://apps.sanbi.ac.za/hcvpro/ or http://cbrc.kaust.edu.sa/hcvpro/. DESHCV is a text mining system implemented using named concept recognition and cooccurrence based&nbsp / approaches to computationally analyze about 32, 000 HCV related abstracts obtained from PubMed. As part of DESHCV development, the pre-constructed dictionaries of the&nbsp / Dragon Exploratory System (DES) were enriched with HCV biomedical concepts, including HCV proteins, name variants and symbols to enable HCV knowledge specific&nbsp / exploration. The DESHCV query inputs consist of user-defined keywords, phrases and concepts. DESHCV is therefore an information extraction tool that enables users to&nbsp / computationally generate association between concepts and support the prediction of potential hypothesis with diagnostic and therapeutic relevance. Additionally, users can&nbsp / retrieve a list of abstracts containing tagged concepts that can be used to overcome the herculean task of manual biocuration. DESHCV has been used to simulate previously&nbsp / reported thalidomide-chronic hepatitis C hypothesis and also to model a potentially novel thalidomide-amantadine hypothesis. HCVpro is a relational knowledgebase dedicated to housing experimentally detected HCV-HCV and HCV-human protein interaction information obtained from other databases and curated from biomedical journal articles.&nbsp / Additionally, the database contains consolidated biological information consisting of hepatocellular carcinoma (HCC) related genes, comprehensive reviews on HCV biology and drug development, functional genomics and molecular biology data, and cross-referenced links to canonical pathways and other essential biomedical databases. Users can retrieve enriched information including interaction metadata from HCVpro by using protein identifiers, gene chromosomal locations, experiment types used in detecting the interactions, PubMed IDs of journal articles reporting the interactions, annotated protein interaction IDs from external databases, and via &ldquo / string searches&rdquo / . The utility of HCVpro&nbsp / has been demonstrated by harnessing integrated data to suggest putative baseline clues that seem to support current diagnostic exploratory efforts directed towards vimentin.&nbsp / Furthermore, eight genes comprising of ACLY, AZGP1, DDX3X, FGG, H19, SIAH1, SERPING1 and THBS1 have been recommended for possible investigation to evaluate their&nbsp / diagnostic potential. The data archived in HCVpro can be&nbsp / utilized to support protein-protein interaction network-based candidate HCC gene prioritization for possible validation by experimental biologists.&nbsp / </p>

Hepatocellular carcinoma (HCC) is the second most common cancer in Taiwan and transcatheter arterial chemoembolization (TACE) is now the mainstay of treatment for noncurative HCC. Due to increasing medical costs yearly and financial problem of the Bureau of National Health Insurance, it is important to reduce medical resource utilization including hospital stay and medical costs. The aim is to figure out the risk factors of extended hospital stay, and increased in-hospital medical costs in hepatocellular carcinoma patients receiving transcatheter arterial chemoembolization. The result of this study should be available for further improvement of medical care quality in the limited medical resource. From January 2008 to January 2010, 162 patients (121 male and 41 female) with histologically proven hepatocellular carcinoma underwent TACE only (131 pts) or TACE followed by catheter placement for hepatic artery infusion chemotherapy (HAIC) (31pts) at district teaching hospital. The extended hospital stay (EHS) and extended post-procedure stay (EPS) are defined as stay larger than their median values (11 & 7 days respectively). Clinical demographic, disease factors, tumor factors, procedure (TACE)-related factors and complications are used to identify the univariate factors related to EHS and EPS statistically. To find out predictors of EHS, EPS and increased in-hospital medical costs, multiple linear regression analyses are used. The risk factors for EPS are procedure-related, including complications and procedure methods ( TACE + HAIC related to TACE only) (R2=.367, p<.001), while those for EHS are complications, encephalopathy, procedure methods, Child-Pugh classification C (related to classification A) and age (R2=.490, p<.001). The predictors for increased in-hospital medical costs include procedure methods, AJCC stage IV, T4 stage, hepatoencephalopathy and complications (R2=0.615, p<.001). Taking total hospital stay into consideration, the most important risk factor related to increased medical cost is total hosptial stay itself. The most powerful risk factor for EPS, EHS is procedure-related complication. The different procedure methods also affect hospital stay and medical costs. In order to reduce medical resource utilization, we should avoid post-procedure complication and pay attention to cirrhotic degree as well as American Joint Committee of Cancer (AJCC) tumor stage system. The result of this study can provide some ideas to adjust medical expense polices for the Bureau of National Health Insurance and to control medical cost for the hospitals.

The need to assess human exposures to foodborne and environmental carcinogens, particularly in populations at high risk for cancer and disease, has led to the development of chemical-specific biomarkers. Sensitive biomarkers for aflatoxin and polycyclic aromatic hydrocarbons (PAHs) have been useful in providing information on population exposure and reducing associated public health impacts. Aflatoxins are fungal metabolites found in a variety of foods. Among these toxins, aflatoxin B1 (AFB1) is the most predominant and hepatocarcinogenic. Acutely, AFB1 can cause disease and death, necessitating safe and effective intervention strategies. Inclusion of NovaSil (NS) clay in the diet represents a practical, sustainable approach. NS has been shown to prevent aflatoxicosis in multiple animal species by binding aflatoxins in the gastrointestinal tract, reducing toxin bioavailability. Co-exposure to PAHs, hazardous environmental contaminants, has been shown to increase the risk for hepatocellular carcinoma (HCC). Therefore, objectives of this research were to utilize biomarkers to assess aflatoxin and PAH exposures in susceptible populations in Ghana and the U.S. and to evaluate the safety and efficacy of NS intervention in Ghana (a population at risk for aflatoxicosis). After 3-month intervention with 3.0g NS/day, median aflatoxin M1 (an AFB1 metabolite) was significantly reduced (up to 58 percent) compared to the placebo group. Furthermore, no significant differences were found in levels of nutrient minerals between NS and placebo groups at baseline and 3-months suggesting NS can be used to effectively sorb AFB1 without affecting serum concentrations of important minerals. PAH biomarker results showed participants in Ghana were significantly exposed to high levels of PAHs based on the presence of 1-hydroxypyrene (1-OHP) in the majority of urines (98.9 percent). NS treatment had no effect on 1-OHP levels, further confirming the preferential binding of aflatoxins by NS. U.S. population data from a Hispanic community in Texas with an elevated incidence of HCC demonstrated a lower percentage and level of aflatoxin and PAH biomarkers. Aflatoxin M1 excretion, however, was associated with increased consumption of certain foods prone to aflatoxin contamination; thus, some individuals may be more vulnerable to exposure and associated interactions that increase the risk for HCC (e.g., PAHs or hepatitis infection).

Κατά τη διάρκεια της τελευταίας δεκαετίας παρατηρείται ένα προοδευτικώς αυξανόμενο ενδιαφέρον για την διερεύνηση της ύπαρξης ή μη συσχέτισης, ανάμεσα στην γενετική ποικιλομορφία της περιοχής του πυρηνικού υποκινητή (Core Promoter, CP, 1700-1849), της προπυρηνικής περιοχής (Precore, PC, 1814-1901) και της περιοχής του κυρίως πυρηνικού αντιγόνου (Core, 1901-2450) του ιού της Ηπατίτιδας Β, τόσο σε νουκλεοτιδικό όσο και σε πρωτεϊνικό επίπεδο, και στην κλινική εικόνα της Οξείας ή Χρόνιας Ηπατίτιδας Β, την πιθανότητα εξέλιξης και το ρυθμό εξέλιξης της χρόνιας HBV λοίμωξης σε Χρόνια Ενεργό Ηπατίτιδα, Κίρρωση του Ήπατος και Ηπατοκυτταρικό Καρκίνωμα (ΗΚΚ). Στόχοι Έρευνας: Λαμβάνοντας υπόψη όλες τις προηγουμένως δημοσιευθείσες εργασίες και δεδομένης της ολοένα και αυξανόμενης σημασίας που αποκτά η γενετική ποικιλομορφία της περιοχής του πυρηνικού αντιγόνου στην εξέλιξη της χρόνιας HBV λοίμωξης, προχωρήσαμε σε ανάλυση της γονιδιακής αλληλουχίας των περιοχών του κυρίως πυρηνικού υποκινητή , και της προπυρηνικής περιοχής καθώς και σε ανάλυση της γονιδιακής και πρωτεϊνικής αλληλουχίας του πυρηνικού αντιγόνου σε στελέχη του ιού που απομονώθηκαν από 23 Χρόνιους Ασυμπτωματικούς Φορείς (ΧΑΦ) του ιού HBV, χρησιμοποιώντας ως μάρτυρες (controls) στελέχη του ιού που απομονώθηκαν από 4 ασθενείς με Χρόνια Ενεργό Ηπατίτιδα Β (ΧΕΗΒ) προ της ενάρξεως οποιασδήποτε θεραπευτικής αγωγής και κλωνοποιήθηκαν. Οι στόχοι της παρούσας έρευνας συνοψίζονται ως εξής: α) Να καταγράψουμε το σύνολο των μεταλλάξεων στις υπό μελέτη περιοχές και το σύνολο των αμινοξικών αντικαταστάσεων στο πυρηνικό αντιγόνο χωρίς να εστιάσουμε μόνο σε 3-4 μεταλλάξεις οι οποίες αποτέλεσαν μεμονωμένο αντικείμενο μελέτης στην συντριπτική πλειονότητα των έως τώρα δημοσιευμένων ερευνών, β) Να εξακριβώσουμε την συχνότητα εμφάνισης κάθε μετάλλαξης και πως αυτή διαφοροποιείται ανάλογα με την κλινική κατάσταση και το ορολογικό προφίλ των ασθενών, τον γονότυπο, και τον υπότυπο του ιού, γ) να προτείνουμε ένα ακριβές προφίλ μεταλλάξεων και αμινοξικών αντικαταστάσεων που χαρακτηρίζει τους ΧΑΦ και να δείξουμε πως αυτό διαφοροποιείται στους ασθενείς με ΧΕΗΒ, δ) Να ερευνήσουμε την ποσοτική αλλά και ποιοτική επίπτωση των διαπιστούμενων, στην κωδικοποιούσα το πυρηνικό αντιγόνο αλληλουχία, νουκλεοτιδικών αλλαγών επί της αμινοξικής αλληλουχίας του πυρηνικού αντιγόνου, και πως αυτή επηρεάζει την σύσταση των αντιστοίχων επί του πυρηνικού αντιγόνου αντιγονικών επίτοπων, ε) Να προτείνουμε νέες τεχνικές απομόνωσης ιικού DNA και πολυμερισμού τμημάτων του ιικού γονιδιώματος σε ασθενείς με πολύ χαμηλά επίπεδα ιαιμίας, όπως οι ΧΑΦ, στ) Να επιβεβαιώσουμε ή να αντικρούσουμε τα δεδομένα της διεθνούς βιβλιογραφίας, που αφορούν στην συχνότητα εμφάνισης μεταλλάξεων και την εντόπιση τους στις υπό μελέτη περιοχές, την διαφοροποίηση αυτών μεταξύ διαφορετικών κατηγοριών ασθενών, διαφορετικών γονότυπων και διαφορετικών υπότυπων του αυτού γονότυπου του ιού. / Infection with HBV may lead to a wide spectrum of liver disease that ranges, in acute infection from mild self-limited to fulminant hepatitis, and in persistent infection from an ASC state to severe chronic hepatitis, cirrhosis and HCC. Several host factors are important in determining outcome, including age at infection, immune competence and MHC haplotype. Viral factors may also play an important role. Over the past decade, there has been considerable interest in whether certain genetic variants of HBV are associated with increased pathogenicity, such as the development of acute liver failure and progression of persistent infections to Chronic Active Hepatitis B, Liver Cirrhosis and Hepatocellular Carcinoma. Aims We proceeded to the sequencing of the entire CP, PC and Core regions of the HBV genome and the analysis of the Molecular variation in them in HBV isolates derived from 23 ASCs and 4 patients with CHB. 17 ASCs were Greeks (genotype D [ayw3]) and 6 were Chinese (Genotype C [ayr]) while all CHB patients were Greeks (though 3 of Genotype D ayw3 and 1 of Genotype D ayr). Our ultimate aims were the identification of all nucleotide and amino acid substitutions within the aforementioned regions and Core protein, respectively, and the demonstration of the differential presentation, distribution and frequency patterns of these substitutions and their respective combinations, in terms of clinical, virological and immunological characteristics of the patients.

Σκοπός: Η μελέτη βιολογικών και θεραπευτικών συσχετισμών σε ασθενείς με ηπατοκυτταρικό καρκίνωμα και ο δυνητικός ρόλος της απόπτωσης. Ασθενείς και Μέθοδοι: Η μελέτη περιέλαβε 35 παρασκευάσματα μερικών ηπατεκτομών από ισάριθμους ασθενείς με ηπατοκυτταρικό καρκίνωμα, μη ινοπεταλιώδους τύπου, που αφαιρέθηκαν με ηπατεκτομή για θεραπευτικό σκοπό. Σε αυτούς τους όγκους εκτιμήθηκαν διάφορα μακροσκοπικά και μικροσκοπικά χαρακτηριστικά, διαβαθμίστηκαν και συσχετίστηκαν με το διάστημα ελεύθερο νόσου. Επιπρόσθετα, σε τομές παραφίνης εκτιμήθηκε η έκφραση του bcl-2 και του bax (ανοσοϊστοχημεία/mRNA in-situ υβριδισμός) και της πρωτεΐνης p53. Αποτελέσματα: Η αγγειακή διήθηση η οποία είναι ο ισχυρότερος προβλεπτικός παράγοντας υποτροπής της νόσου, σχετίζεται με το μέγεθος των όγκων, την ύπαρξη γιγαντοκυττάρων και νέκρωσης, τον επικρατούντα και το χειρότερο βαθμό διαφοροποίησης και τον αποπτωτικό/μιτωτικό δείκτη. Ο in-situ υβριδισμός ανέδειξε έκφραση του mRNA του bcl-2 σε 25 από τους 35 ασθενείς (70%). Η ανοσοϊστοχημική χρώση δεν ανέδειξε έκφραση της πρωτεΐνης του bcl-2 στα καρκινικά κύτταρα. Αντίθετα, το bax mRNA και η πρωτεΐνη bax έδειξαν παρόμοιο τρόπο έκφρασης και ανευρέθηκαν μέσα στα ηπατοκύτταρα και στα χολαγγεία. Η έκφραση του bax mRNA ήταν υψηλότερη σε όγκους καλής διαφοροποίησης. Η έκφραση του p53 ήταν μικρότερη στον μικροδοκιδώδη τύπο από το συμπαγή τύπο και ήταν υψηλότερη σε πτωχά διαφοροποιημένους όγκους από τους καλά ή μετρίως διαφοροποιημένους όγκους. Συμπεράσματα: Η ηπατική καρκινογένεση στον άνθρωπο είναι μια πολυπαραγοντική και πολυεστιακή διαδικασία. Η αγγειακή διήθηση σχετίζεται με τον αποπτωτικό/μιτωτικό δείκτη και υψηλότερος αποπτωτικός/μιτωτικό δείκτης σχετίζεται με καλύτερο ελεύθερο νόσου διάστημα. Επιπλέον, η πρωτεΐνη bcl-2 δεν εκφράζεται ενώ εκφράζεται το mRNA, το οποίο εισηγείται μετα-μεταφραστικό λάθος και δείχνει ότι το bcl-2 δεν παίζει σημαντικό ρόλο στην εξέλιξη του ηπατοκυτταρικού καρκινώματος. / Aim: The study of biologic and therapeutic correlations in patients with hepatocellular carcinomas and the potential role of apoptosis. Patients and Methods: The study included 35 partial hepatectomy specimens removed from equal number of patients with nonfibrolamellar hepatocellular carcinomas (HCCs) for therapeutic reasons. In these tumors several macroscopic and microscopic features were assessed, graded and correlated with disease free survival. In addition, in paraffin sections the expressions of bcl-2 and bax (protein immunohistochemistry / mRNA-in situ hybridization) and p53 protein were assessed. Results: Vascular invasion, which is the strongest predictor of disease recurrence, correlates significantly with tumor size, tumor giant cells and necrosis, the predominant and worst degree of differentiation, and the apoptosis/mitosis ratio. Immuno-histochemical staining failed to reveal any bcl-2 protein expression in tumor cells of HCC. In the contrary, bax MRNA and protein displayed somehow a similar pattern of expression. They were detected within hepatocytes, bile duct epithelial and cholangiolar epithelial cells. Ηigher bax mRNA expression was noted in grade I carcinomas. Expression of p53 protein was less in the microtrabecular type than in the solid type and it was higher in poorly differentiated tumors than in those that were well or moderately well differentiated. Conclusions: Liver carcinogenesis in humans is a multistep and multifocal process. Vascular invasion correlates with the apoptosis/mitosis ratio and a higher apoptosis/mitosis ratio correlates with improved disease free survival. In addition, bcl-2 gene is frequently present but its protein product is absent. This suggests a post-translational mechanism of bcl-2 protein degradation, indicating that bcl-2 does not play a substantial role in the progress of hepatocellular carcinoma.

<p>To ameliorate Hepatitis C Virus (HCV) therapeutic and diagnostic challenges requires robust intervention strategies, including approaches that leverage the plethora of rich data published in biomedical literature to gain greater understanding of HCV pathobiological mechanisms. The multitudes of metadata originating from HCV clinical trials as well as low and high-throughput experiments embedded in text corpora can be mined as data sources for the implementation of HCV-specific resources. HCV-customized resources may support the generation of worthy and testable hypothesis and reveal potential research clues to augment the pursuit of efficient diagnostic biomarkers and therapeutic targets. This research thesis report the development of two freely available HCV-specific web-based resources: (i) Dragon Exploratory System on Hepatitis C Virus (DESHCV) accessible via http://apps.sanbi.ac.za/DESHCV/ or http://cbrc.kaust.edu.sa/deshcv/ and (ii) Hepatitis C Virus Protein Interaction Database (HCVpro) accessible via&nbsp / http://apps.sanbi.ac.za/hcvpro/ or http://cbrc.kaust.edu.sa/hcvpro/. DESHCV is a text mining system implemented using named concept recognition and cooccurrence based&nbsp / approaches to computationally analyze about 32, 000 HCV related abstracts obtained from PubMed. As part of DESHCV development, the pre-constructed dictionaries of the&nbsp / Dragon Exploratory System (DES) were enriched with HCV biomedical concepts, including HCV proteins, name variants and symbols to enable HCV knowledge specific&nbsp / exploration. The DESHCV query inputs consist of user-defined keywords, phrases and concepts. DESHCV is therefore an information extraction tool that enables users to&nbsp / computationally generate association between concepts and support the prediction of potential hypothesis with diagnostic and therapeutic relevance. Additionally, users can&nbsp / retrieve a list of abstracts containing tagged concepts that can be used to overcome the herculean task of manual biocuration. DESHCV has been used to simulate previously&nbsp / reported thalidomide-chronic hepatitis C hypothesis and also to model a potentially novel thalidomide-amantadine hypothesis. HCVpro is a relational knowledgebase dedicated to housing experimentally detected HCV-HCV and HCV-human protein interaction information obtained from other databases and curated from biomedical journal articles.&nbsp / Additionally, the database contains consolidated biological information consisting of hepatocellular carcinoma (HCC) related genes, comprehensive reviews on HCV biology and drug development, functional genomics and molecular biology data, and cross-referenced links to canonical pathways and other essential biomedical databases. Users can retrieve enriched information including interaction metadata from HCVpro by using protein identifiers, gene chromosomal locations, experiment types used in detecting the interactions, PubMed IDs of journal articles reporting the interactions, annotated protein interaction IDs from external databases, and via &ldquo / string searches&rdquo / . The utility of HCVpro&nbsp / has been demonstrated by harnessing integrated data to suggest putative baseline clues that seem to support current diagnostic exploratory efforts directed towards vimentin.&nbsp / Furthermore, eight genes comprising of ACLY, AZGP1, DDX3X, FGG, H19, SIAH1, SERPING1 and THBS1 have been recommended for possible investigation to evaluate their&nbsp / diagnostic potential. The data archived in HCVpro can be&nbsp / utilized to support protein-protein interaction network-based candidate HCC gene prioritization for possible validation by experimental biologists.&nbsp / </p>

Nicotinamide adenine dinucleotide (NAD) is a key regulator of several metabolic and signaling pathways that are relevant in cancer cell survival. Cancer cells have an increased energy demand associated with an increased NAD turnover. Nicotinamide phosphoribosyltransferase (NAMPT), a key enzyme of the NAD salvage pathway, plays a crucial role in maintaining the intracellular NAD levels and in regulating the activity of NAD-dependent enzymes, such as sirtuins (SIRTs). The inhibition of NAMPT activity and the use of phytochemicals, such as resveratrol, represent novel therapeutic approaches in cancer therapy. Based on these facts, this thesis aimed to investigate (1) the chemotherapeutic potential and molecular mechanisms of FK866, a specific NAMPT inhibitor, and resveratrol on hepatocarcinoma cells and to find out whether there are differences compared to primary human hepatocytes; (2) to address the impact of NAMPT inhibition on the energy metabolism in cancer cells; and (3) to investigate the roles of NAMPT and SIRT1 in resveratrol´s mode of action and chemotherapeutic effects. This work demonstrates that FK866 and resveratrol possess potent chemotherapeutic effects in hepatocarcinoma cells which were absent in human hepatocytes. Hepatocarcinoma cells display a dysregulation in the AMP-activated kinase (AMPK)/mammalian target of rapamycin (mTOR) signaling as well as in the NAMPT-mediated NAD salvage pathway compared to human hepatocytes. FK866-induced NAMPT inhibition induces ATP depletion associated with AMPK activation and mTOR inhibition whereas resveratrol induces caspase3-mediated apoptosis that is not dependent on NAMPT and SIRT1 function. NAMPT and SIRT1 are differentially regulated by resveratrol in hepatocarcinoma cells and human hepatocytes. This work also reveals that resveratrol activates p53-induced cell cycle arrest in hepatocarcinoma cells which is partly mediated by SIRT1 inhibition. In summary, this thesis provides new insight into the role of the NAMPT-mediated NAD salvage pathway in energy metabolism and characterized FK866 and resveratrol as promising potential chemotherapeutic agents for treatment of hepatocellular carcinoma.

Objective: The primary aim of this study was to assess patients’ preferences between radiofrequency ablation (RFA) versus hepatic resection (HR) for the treatment of small hepatocellular carcinomas (HCC). Methods: Decision analysis was performed by using probability trade-off (PTO) technique to elicit patients’ preferences and the strength of their decisions. Results: The vast majority of the study population preferred RFA over HR (70% vs. 30%, p=0.001). Their initial choice changed if 5-year survival benefit after surgery was at least 14% superior to RFA and if the 3-year disease-free survival advantage was at least 13% better than ablation. Conclusions: The results of this study suggest that fully informed cirrhotic patients would prefer RFA if diagnosed with early stage HCC even if able to undergo surgery.

There are currently two types of intra-arterial drug-delivery system (DDS) in clinical use in the palliative treatment of primary liver cancer. The chemotherapeutic drug doxorubicin (DOX) can be formulated into a drug-in-lipiodol emulsion (LIPDOX) or a microparticulate drug-eluting bead system (DEBDOX). To facilitate development of future DDSs, we need to understand the release and local distribution of drug from these DDSs into the complex, in vivo, pathological environment. The overall aim of this project was to assess and improve understanding of the in vivo release of DOX from LIPDOX and DEBDOX and its local disposition in the liver. These processes were investigated in detail in a multisampling-site, healthy pig model and in human patients with liver cancer. The mechanisms involved in DOX disposition were studied by examining potential interactions between DOX and lipiodol and/or cyclosporine A (CsA) in pigs.   In this project, the main elimination pathway for DOX and its primary metabolite doxorubicinol (DOXol) was via bile; their extensive canalicular carrier-mediated transport (e.g. ATP-binding cassette transporters ABCB1, ABCC1, ABCC2 and ABCG2) was inhibited by CsA. CsA had no effect on the carbonyl and aldo-keto reductases responsible for the metabolism of DOX into DOXol. LIPDOX released DOX more rapidly and to a greater extent into the circulation than DEBDOX, which had only released 15% of the dose in patients after 24 hrs. The systemic exposure to DOX was lower for DEBDOX than for LIPDOX. Greater fractions of DOXol were formed in blood and bile with LIPDOX than with DEBDOX. This may have been because DOX was more widely distributed into regions with increased metabolic capacity or because of increased intracellular uptake when DOX was delivered in LIPDOX. The excipient lipiodol in the LIPDOX formulation did not interact with transporters, enzymes or membranes that would explain the increased cellular uptake of DOX. In conclusion, the release of DOX from DEBDOX is more controlled in vivo than that from LIPDOX, indicating that DEBDOX is a more robust pharmaceutical product. The formulations for future optimized DDSs should therefore be more similar to DEBDOX than to LIPDOX.