Die Inzidenz chronischer Lebererkrankungen und des hepatozellulären Karzinoms (HCC) mit nutritiv toxischer Genese ist in den vergangenen Jahren in den Industrienationen stetig angestiegen. Daher wird bereits seit längerem über eine Stadien-basierte Therapie bis hin zur Lebertransplantation intensiv diskutiert. In diesem Kontext zeigt die Stadien-spezifische Analyse der MikroRNA-(miRNA)-Profile ein großes Potenzial. In der vorliegenden Studie wurden erstmals die miRNA-Profile in Gewebeproben von Patienten mit einem hepatozellulärem Karzinom (HCC) und Leberzirrhose analysiert. Von 189 lebertransplantierten Patienten zeigten 93 eine nutritiv toxische Genese. Die Aufteilung der Patienten in zwei Studiengruppen erfolgte nach histopathologischer Beurteilung. So konnte bei 59 Patienten eine äthyltoxische Leberzirrhose ohne HCC (Gruppe A) und bei 34 Patienten ein HCC in äthyltoxischer Leberzirrhose (Gruppe B) nachgewiesen werden. In Gruppe B erfolgte die Probenentnahme aus dem HCC-Tumor („T“) und dem umgebenden Leberzirrhosegewebe („sT“). Zur Extraktion der Gesamt-RNA aus den Gewebeproben von 30 Patienten mit nutritiv toxischem Leberschaden, wurde Trizol® genutzt (16 Gruppe A „Ex“, 14 Gruppe B „sT“, 7 Gruppe B „T“). Die miRNA-Analyse dieser Gewebeproben wurde mittels miRCURY LNA Array (6. und 7. Generation) und Agilent G2565BA Microarray Scanner durchgeführt. Die Untersuchung der laboranalytischen Parameter und des präoperativen Lab-MELD ergab keinen statistisch signifikanten Unterschied zwischen beiden Untersuchungsgruppen. Die Patienten der Gruppe A war signifikant jünger als die Patienten der Gruppe B. 40 miRNA zeigten einen signifikanten Unterschied zwischen T- und sT-Gewebe, 29 miRNA zwischen T- und Ex-Gewebe und 56 miRNA zwischen Ex- und sT-Gewebe. Unter Berücksichtigung der bekannten Zielproteine der identifizierten miRNA wird das diagnostische Potenzial der miRNA-Profiländerungen bei der nutritiv toxischen Genese der Leberzirrhose mit und ohne HCC diskutiert.

The incidence of hepatocellular carcinoma (HCC) in cirrhotic patients is increasing worldwide. Cirrhotic patients are recommended by the American Association for the Study of Liver Disease (AASLD) to receive HCC screening and surveillance every 6 months to a year. The purpose of this study was to identify the current screening and surveillance patterns for cirrhotic patients with HCC in clinical practice. Hepatocellular carcinoma can be detected by radiological studies in addition to laboratory testing. It is important to implement the AASLD screening guidelines, as early identification might decrease the mortality rate of patients with cirrhosis and HCC. The research question guiding this study was: What are the screening patterns of cirrhotic patients diagnosed with cirrhosis and HCC that have been referred to the Hepatology Division? A retrospective, descriptive, cross-sectional design was used for this study. Data were collected from subjects who were referred to a Specialty Hepatology Division for evaluation and treatment. Approval was obtained from the IRB. Cirrhotic patients diagnosed with HCC meeting the inclusion and exclusion criteria were used in this study. The aim of the study was to identify the clinical patterns of practitioners screening for HCC in cirrhotic patients. Validity and reliability for the data collection tool was not established. Variables that were studied included demographic data, etiology of cirrhosis, type of HCC screening, time increments of screening, and size of tumor at the time of diagnosis. The data were analyzed with the use of crosstabs, frequency, and correlation statistics. Despite the recommended HCC screening and surveillance guidelines cirrhotic patients were not screened. The different screening patterns that were identified were none, sporadic, and annual (every 6 months to 1 year). The patterns differed by the practitioner managing the patient. Also, cirrhosis was diagnosed late in the disease process, although many of the patients are followed by gastroenterologists. It can be assumed that the late diagnosis of cirrhosis was another factor that was preventing the implementation of HCC screening and surveillance. Implications for practice were identified. Practitioners are responsible for performing HCC screening and surveillance of cirrhotic patients based on the recommended guidelines of the AASLD for the management of cirrhotic patients and the detection of small lesions. Only 33% of the patients were screened with the use of ultrasound, and 43% were screened with alpha-fetoprotein. The lesions that were diagnosed were larger in the non-screened patients than the screened patients. The Hepatology Division was the only setting that was screening the patients based on the recommended guidelines. The recommendation based on the results of this study is for all cirrhotic patients to be managed by hepatology services if one is available.

In a preliminary cDNA microarray data-mining, stathmin (STMN1) was identified to be up-regulated in the Hepatocellular carcinomas (HCC). A further screening on HCC cell lines and some tissue specimens at both the mRNA and protein levels, STMN1 was confirmed to be a HCC tumor marker. However, the underlying mechanism that regulates STMN1 up-regulation in HCC is still unknown. The objective of this study was to identify the potential factors that up-regulate STMN1 mRNA and protein levels in HCC. Three HCC cell lines (SK-Hep1, Hep-3B and Hep-G2) and fifty-eight specimens (liver tumor and adjacent nontumor tissues in the same patient) were obtained. Quantitative real-time polymerase chain reaction and western blotting identified up-regulations of STMN1 at both mRNAs and proteins levels in three HCC cell lines and 58 specimens. Immunofluorescence assays further detected its cytoplasmical subcellular localization. Among tumor specimens, the STMN1 protein was significantly correlated with its mRNA expression level (In HCC; N=35; r=0.843; p<0.05; In Metastasis; N=11; r=0.947; p<0.05). In 46 tissue specimens (HCC=35; Metastasis=11), the expression level of E2F1 transcription factor was found to be up-regulated significantly in tumor specimens (p<0.05) and parallel to the STMN1 protein (In HCC; N=35; r=0.556; p<0.05; In Metastasis; N=11; r=0.524; p<0.05). In synchronized SK-Hep1 and Hep-3B cells, it hypothesizes that STMN1 expression is, in part, under the control of E2F1 transcription factors. Moreover, comparative mapping and chromatin immunoprecipitation assay confirmed two E2F1 and three MYC binding sites (the E box) in the STMN1 proximal promoter region. STMN1 proteins were down regulated after the electroporation of shE2F1 in SK-Hep1 cells in 31~36%. In conclusion, the high level of STMN1 protein was resulted from STMN1 mRNA up-regulation and E2F1 might play an important role to transactivate STMN1 gene in HCC and liver metastasis.

Hepatocellular carcinoma (HCC) or hepatoma is the top one cause of death in Taiwan based on the Cause of Death Statistics from the Department of Health, Executive Yuan, Taiwan, for many years. To identify any reliable HCC markers and further applied with the AFP measurement to improve the early diagnosis of HCCs is the most important thing. A high expression level of S-phase protein kinase associated protein 2 (SKP2) protein and its cofactor CDC28 protein kinase regulatory subunit 1B (CKS1B) involved in ubiquitination of some cyclin-dependent kinase (Cdk) inhibitors has been reported in various carcinoma. In this study, we examined the expression of CKS1B in HCC tissues and cell lines, and tested the cell cycle effect caused by specific small interference RNA (siRNA) of CKS1B in SK-hep1 cell line. Up-regulated CKS1B mRNAs in HCC cell lines and tissues were identified in our study, when comparing to the normal liver tissues. But we also found lack of up-regulated CKS1B proteins in our HCC tissues at the same time, indicated that CKS1B proteins might be unstable in HCCs. Down regulation of the Cdk inhibitors p27 was only partially associated with HCCs, and the expressions of CKS1B and p27 were not correlated to each other in HCCs, suggesting other pathway(s) might involve in the regulation(s) of CKS1B and p27 proteins in the HCCs. Down-regulation of the p21 proteins was also found to be not significantly associated with HCCs tissues, this result strongly suggested a post-translational stabilization way might regulate(s) the p21 protein levels in HCCs tissues. On the other hands, in time course experiment, disruption of CKS1B mRNA by si-CKS1B up-regulated the expressions of p27 and SKP2 protein levels and down-regulated the p21 protein level in the SK-hep1 hepatoma cell lines for 24 hrs later. But the mRNA expression level of p21 and p27 were actually both up-regulated for 48 hrs after transfected with si-CKS1B. We also tested the mRNA expression level of many cell cycle regulatory factors for 48 hrs after transfected with si-CKS1B. The results exhibited almost all of the factors (excepted p21, p27 and Cyclin D2) were down-regulated. Furthermore, we saw the apoptosis appearance of SK-hep1 cell after transfected with si-CKS1B for 48 hrs, suggesting the abnormal cell proliferation and tumorigenesis were controlled by siRNA transfection. Taken together, these results suggest that SCFSKP2-CKS1B pathway might not direct involved in ubiquitination of Cdk inhibitors. Another pathway(s), either known or novel, in addition to APC/CCHD1 (G0-G1 phase) and SCFSKP2-CKS1B (G1-S phase) regulation pathways, might regulate the tumorigenesis of HCCs.

Abstract The metabolism of reactive oxygen species (ROS) in cancer cells is a research area that has not been intensively pursued. It is generally believed that cancer cells are persistently oxidative stressed. The consequence of this phenomenon will result in changes of the characteristic of a cancer cell. Whether or not the oxidative stress has a role in regulating the metastatic potential of a cancer cell is a research area that has been totally neglected. Using a group of human hepatocellular carcinoma (HCC) cell lines with distinct disparity in their differentiation status, established by their morphological observation and the abilities of synthesizing at least 15 plasma proteins, as the experimental model, we proposed to investigate the possibility that the constitutive oxidative stress status of these HCC cells may be modulated by their differentiation status. As a result, varying degrees of oxidative stress status of these cells will affect the propensity of expression of a few redox-sensitive transcription factors, such as NF-kB and AP-1, which may eventually modulate the metastasis- related gene expression. If these proposed hypotheses turn out to be true, we will then investigate the underlying mechanism(s) associated with the phenomena observed. Firstly, we demonstrated previously (Liu et al., 2000) that the total antioxidative capacity (as expressed by the composite propensities of expressing 4 antioxidant enzymes and the intracellular glutathione contents) as well as GSH/GSSG ratios of the HCC cells we studied were excellently correlated with their differentiation status, with an order of HepG2 > Hep3B > J5 > SK-Hep-I. To further confirm this observed phenomenon, we quantified the steady state mRNA expressions of the four antioxidant enzymes by duplex RT-PCR method. In this study, we further confirmed that well-differentiated HCC cells, such as HepG2 and Hep3B expressed higher levels of extracellular GPx (eGPx) and catalase mRNAs. Conversely, the expression of mRNA for both enzymes in a poorly-differentiated HCC cells, such as SK-Hep-I and Mahlavu, was trace or even negligible. Since GSH biosynthesis is controlled by g-glutamylcysteine synthetase (g-GCS), a rate-limiting enzyme composing of a catalytic heavy subunit ( gGCS h ) and a regulatory light subunit ( gGCSl) ,we wanted to further substantiate that differentiation status-mediated upregulation of GSH is regulated by this enzyme. We demonstrated that the g-GCSh expression was again differentiation status regulated, established by using either a HPLC or a duplex RT-PCR method. The order of ranking for the expression of g-GCS was HepG2 > Hep3B > J5 > SK-Hep-I. In contrast, we found that g-GCSl mRNA seemed not to be influenced by the differentiation status. It has been documented that the transcription factors NF-kB and AP-1 are redox-sensitive. Thus, we wanted to see if both transcription factors could constitutively be activated. Also, is the expression propensity of these transcription factors modulated by the oxidative stress status of these HCC cells? Using EMSA and supershift techniques, we demonstrated that varying degrees of expressions of both transcription factors can be seen, with an order of expression propensity of SK-Hep-I > Mahlavu > J5 > Hep3B > HepG2. Having known that both NF-kB and AP-1 could modulate a group of metastasis-related gene expression, we then investigate if the constitutive metastatic potential of these HCC cells can be varied depending upon how extensive the expression propensity of both NF-kB and AP-1, we used a panel of markers for evaluating the metastatic potential, namely: Matrix metalloproteinase (MMP), interleukin 8 (IL-8) and an adhesion molecular E-cadherin. Using both activity and duplex RT-PCR methods, we demonstrated that only a poorly differentiated HCC cells were capable of expressing MMPs (SK-Hep-I predominately expressed a large amount of MMP-9 and mRNA; Mahlavu predominately expressed MMP-2 along with a trace amount of MMP-9). HepG2, Hep3B and J5 were completely devoid of MMP expression. Using ELISA assay, we measured the secretion of IL-8 in the culture media by these HCC cells and demonstrated that the propensity of secretion having an order of SK-Hep-I > HepG2 > Hep3B (J5 and Mahlavu expressed only a trace amount). Next, we used western blotting and duplex RT-PCR techniques to demonstrate that the expressions of E-cadherin were predominately existed in only well-differentiated cell lines, HepG2 and Hep3B. J5, Mahlavu and SK-Hep-I were all devoid of expression. Finally, for the purpose of demonstrating that the intracellular oxidative stress status does have a role in regulating the above-mentioned metastasis-related gene expression, we transfected g-GCSh cDNA to SK-Hep-I cell and obtained a cell type, termed GCS 30, in which its g-GCSh activity, mRNA and GSH content has been proved to be higher than its untransfected counterpart, SK-Hep-I. We then measured the oxidative stress status of GCS 30 using DCFDA-flowcytometric method. From our data, we did demonstrate that the oxidative-stress status of GCS 30 was shown to be decreased as compared to its counterpart. However, we were surprised to find out that GSH/GSSG ratio remained unchange in GCS-30 as compared to SK-Hep-I cells. Using EMSA technique, we showed that GCS 30 cells only exhibited relative strong binding activity to NF-kB, but not for AP-1 binding. Surprisingly, we found that the MMPs activities in GCS 30 cells were relatively comparable to SK-Hep-I, indicating that MMP expression might be regulated by a pathway other than AP-1. The mechanism(s) underlying this observed phenomenon await further clarification.

O carcinoma hepatocelular (HCC) é o sexto mais frequente e a segunda maior causa de mortalidade por câncer no mundo, além de apresentar alta taxa de recidiva. A associação de sorafenibe (SO) com agentes quimiopreventivos representa uma estratégia importante para aumentar a eficácia do tratamento e minimizar a reincidência da doença. Em estudos anteriores demonstrou-se o potencial quimiopreventivo da tributirina (TB), pró-fármaco do ácido butírico (AB), em modelo de hepatocarcinogênese experimental. A atividade da TB tem sido relacionada à inibição do desenvolvimento de lesões préneoplásicas, bem como à indução de apoptose. Assim, o presente estudo teve como objetivo avaliar a ação anticarcinogênica da TB e do SO, isoladamente ou em associação no HCC. Nesse sentido, implantes singênicos foram realizados no flanco de ratos Fischer- 344 a partir de células da linhagem neoplásica JM-1. Os animais foram distribuídos nos seguintes grupos: Grupo controle isocalórico [CO; Maltodextrina (300 mg/100 g p.c.) e solução veículo (solução de etanol a 12.5% e Cremofor a 12.5% em água estéril)]; Grupo TB (200 mg/100 g p.c. e solução veículo); Grupo SO [Maltodextrina (300 mg/100 g p.c. tosilato de SO (3 mg/100 g p.c.) em solução veículo] e Grupo associação [AS; TB (200 mg/100 g p.c) e tosilato de SO (3 mg/100 g p.c.) em solução veículo]. Os implantes de células JM-1 originaram neoplasias com características pouco diferenciadas. Os tratamentos com SO e AS retardaram (p<0,05) o desenvolvimento das neoplasias, além de reduzirem (p<0,05) suas massa e aumentem (p<0,05) a sobrevida em relação ao grupo CO. Não houve diferença na porcentagem de área necrótica das neoplasias entre os tratamentos. Porém, foi observada uma correlação negativa (p<0,05) entre o tamanho da neoplasia e a área necrótica, sendo que quanto menor a área da neoplasia maior a extensão da necrose, independente do tratamento. Foi observado aumento (p<0,05) das concentrações hepáticas de AB nos grupos TB, SO e AS. Já na neoplasia, apenas os grupos TB e SO demonstraram aumento (p<0,05) na concentração de AB. Além disso, os tratamentos com SO e AS aumentaram (p<0,05) a concentração tecidual de SO na neoplasia em relação ao CO. Nesse sentido, foi observado que grupo AS apresentou 5 vezes mais SO na neoplasia quando comparado ao grupo SO. Os tratamentos com TB e SO isoladamente ou em associação reduziram (p<0,05) a expressão de CK19 em relação ao grupo CO. Em relação à avaliação da proliferação celular, os grupos TB, SO e AS apresentaram redução (p<0,05) do índice de proliferação celular quando comparados ao grupo CO. Foi observado por meio da análise imunoistoquímica para pERK, que os animais tratados com SO e AS reduziram (p<0,05) as áreas positivas quando comparadas às dos animais do grupo CO. Além disso, também foi observada por meio de marcação imunoistoquímica uma redução (p<0,05) nas áreas positivas para CK8 nos grupos SO e AS quando comparadas às do grupo CO. Em relação à caspase-3 clivada, foi observado por imunoistoquímica que o tratamento com TB aumentou (p<0,05) o índice de células positivas para caspase-3 clivada quando comparado ao CO. Esse dado foi comprovado pela análise de western blot. Foi observado por meio da análise imunoistoquímica para H3K9, um aumento (p<0,05) da acetilação no grupo TB quando comparado ao grupo CO. Em relação à expressão em nível proteico de pAKT, foi observado por meio da análise imunoistoquímica uma redução (p<0,05) no grupo TB em comparação ao grupo CO. O presente estudo demonstrou que os implantes de células JM-1 no flanco de ratos Fischer-344 originaram neoplasias com características que lembram a organização hepatocítica de um HCC convencional. O tratamento com TB foi capaz de reduzir a proliferação celular e induzir apoptose. Os tratamentos com SO e com a AS foram capazes de retardar o desenvolvimento, aumentar a sobrevida, reduzir a massa das neoplasias, induzirem diferenciação celular e reduzirem a proliferação celular, melhorando o prognóstico da doença. Os tratamentos com SO e AS apresentaram atividade quimioterápica semelhante. No entanto, a coadministração de SO e TB foi capaz de aumentar a biodisponibilidade do SO para a neoplasia. / Hepatocellular carcinoma (HCC) is the sixth most frequent and the second largest cause of cancer mortality in the world, besides presenting a high rate of recurrence. The association of sorafenib (SO) with chemopreventive agents represents an important strategy to increase the efficacy of the treatment and to minimize recurrence of the disease. In previous studies the chemopreventive potential of tributyrin (TB), a butyric acid prodrug (AB), was demonstrated in a model of experimental hepatocarcinogenesis. TB activity has been linked to inhibition of the development of pre-neoplastic lesions as well as to the induction of apoptosis. Thus, the present study aimed to evaluate the anticarcinogenic action of TB and SO, either alone or in combination in HCC. In this sense, syngeneic implants were performed on the flank of Fischer-344 rats from cells of the JM-1 neoplastic lineage. The animals were divided into the following groups: Control group [CO; Maltodextrin (300 mg / 100g p.c.) and carrier solution (12.5% ethanol solution and 12.5% Cremophor in sterile water)]; TB group (200 mg / 100 g p.c. and carrier solution); Group SO [Maltodextrin (300 mg / 100 g pc tosylate of SO (3 mg / 100 g pc) in vehicle solution] and Association group [AS; TB (200 mg / 100 g pc) and SO tosylate (3 mg / 100 (p <0.05), the development of the neoplasms, as well as the reduction (p <0.05), and the survival rate was higher (p <0.05) than the CO group. There was no difference in the percentage of necrotic area of the neoplasms between the treatments. (p <0.05) of the hepatic AB concentrations in the TB, SO and AS groups, although the size of the neoplasia and the necrotic area were higher. In the neoplasia, only the TB and SO groups showed an increase (p <0.05) in AB concentration. In addition, treatments with SO and AS increased (p <0.05) the tissue concentration of SO in the neoplasia in relation to CO. In this sense, it was observed that AS group presented 5 times more SO in the neoplasia when compared to the SO group. Treatments with TB and SO alone or in combination reduced (p <0.05) the expression of CK19 in relation to the CO group. In relation to the evaluation of cell proliferation, the TB, SO and AS groups presented a reduction (p <0.05) in the cell proliferation index when compared to the CO group. It was observed by the immunohistochemical analysis for pERK that the animals treated with SO and AS reduced (p <0.05) the positive areas when compared to the animals of the CO group. In addition, a reduction (p <0.05) in the CK8 positive areas in the SO and AS groups when compared to the CO groups was also observed by immunohistochemical labeling. In relation to the cleaved caspase-3, it was observed by immunohistochemistry that the TB treatment increased (p <0.05) the index of caspase-3 positive cells cleaved when compared to CO. This was confirmed by western blot analysis. It was observed by immunohistochemical analysis for H3K9, an increase (p <0.05) in the acetylation of the TB group when compared to the CO group. Regarding the protein level expression of pAKT, a reduction (p <0.05) in the TB group was observed through the immunohistochemical analysis when compared to the CO group. The present study demonstrated that JM-1 cell implants in the flank of Fischer-344 mice originated neoplasms with features reminiscent of the hepatocyte organization of a conventional HCC. TB treatment was able to reduce cell proliferation and induce apoptosis. SO and AS treatments were able to delay the development, increase survival, reduce the mass of neoplasms, induce cell differentiation and reduce cell proliferation, improving the prognosis of the disease. SO and AS treatments showed similar chemotherapy activity. However, co-administration of SO and TB was able to increase the bioavailability of SO to the neolasia.

O câncer primário de fígado (CPF) apresenta mau prognóstico, o que torna importante sua quimioprevenção. Nesse sentido, a tributirina (TB), um pró-fármaco do ácido butírico (AB), presente em laticínios e no mel, mostrou-se um agente quimiopreventivo promissor da hepatocarcinogênese experimental. Os efeitos inibitórios da TB têm sido relacionados à inibição do desenvolvimento de lesões pré-neoplásicas, bem como indução de apoptose e hiperacetilação de histonas. A quimioterapia é uma das abordagens mais comuns para o tratamento de diversos tipos de câncer, inclusive o CPF. Neste caso, o tratamento com sorafenibe (SO) é capaz de prolongar a sobrevida média dos pacientes com a doença em fases avançadas em aproximadamente apenas três meses. Em vista disso, são necessários estudos da associação do sorafenibe com outros compostos que possam aumentar a eficácia do tratamento quimioterápico. Desta forma, a associação de fármacos anti-neoplásicos com compostos bioativos dos alimentos pode consistir em uma estratégia potencial para aumentar a eficácia contra o câncer. No presente estudo, foi avaliada a atividade anticarcinogênica da TB e do SO, isoladamente ou em associação, na etapa de progressão da hepatocarcinogênese. Para tanto, foram realizados implantes singênicos no flanco de ratos Fischer-344 a partir de células da linhagem tumoral GP7TB. Quando as neoplasias atingiram 1 cm3, os animais foram aleatorizados em grupos experimentais: Grupo controle (CO), constituído por 10 ratos Fischer 344 que receberam Maltodextrina (300mg/ 100 g. p. c.), controle isocolarico e solução de etanol à 12,5% e Cremofor à 12,5% em agua estéril; Grupo Tributirina (TB), constituído por 9 ratos Fischer 344 que receberam TB (200mg/ 100 g. p. c.) e solução de etanol à 12,5% e Cremofor à 12,5% em água estéril; Grupo sorafenibe (SO) constituído por 9 ratos Fischer 344 que receberam Maltodextrina (300 mg/ 100 g. p. c.), controle isocalorico e tosilato de sorafenibe (3mg / 100 g. p. c. ) em água estéril; Grupo associação da tributirina com o sorafenibe (AS) constituído por 9 ratos Fischer 344 que receberam TB (20 mg/ 100 g. p. c.) e tosiliato de sorafenibe (3mg/ 100 g. p. c.); tratados por administração intragástrica (i.g) diariamente por 5 semanas consecutivas. As concentrações de AB e SO foram analisadas por cromatografia gasosa associada à espectrometria de massa e as neoplasias foram caracterizadas por imunoistoquímica. Em relação à evolução do tamanho das neoplasias o grupo AS apresentou menor (p=0,009) tamanho das mesmas em relação ao grupo CO. No entanto, estas diferenças não atingiram diferenças significativas (p>0,05) entre os grupos TB e CO, bem como entre os grupos SO e CO. Contudo, quando ajustados os valores do tamanho da neoplasia pela latência, observou-se alterações significativas (p<0,05) nos diversos grupos quando comparados ao grupo CO. O grupo SO aumentou a área necrótica das neoplasias, embora esta diferença não tenha atingido diferença significativa (p>0,05), enquanto que o grupo TB reduziu essa área necrótica em relação ao grupo CO (p=0,005). O grupo TB e AS apresentaram significativamente maiores (p<0,05) concentrações hepáticas e neoplásicas de AB em relação ao grupo CO. O grupo SO e AS apresentaram significativamente maiores (p<0,05) concentrações neoplásicas de SO em relação ao grupo CO. Os grupos SO e AS reduziram a expressão de PTEN, quando comparados ao grupo CO, embora esta diferença não tenha atingido diferença significativa (p>0,05). O grupo TB por sua vez expressou maiores niveis de PTEN, embora esta diferença não tenha atigindo significância estatística (p>0,05). Todos os grupos expressaram maiores niveis de caspase 3 clivada quando comparada ao grupo CO (p>0,05). OS grupos TB e SO reduziram a expressão de pERK &#189; quando comparados ao grupo CO. embora estas diferenças não tenham atingidos diferença estatística (p>0,05). O grupo AS apresentou maior expressão de pERK &#189; quando comparada ao grupo CO, embora esta diferença não tenha atingido diferença significativa (p>0,05). A caracterização das neoplasias do grupo CO foi padronizada por imunoistoquímica, apresentando-se positivas para CK 7, CK8, CK19 e Arginase e negativas para HepPar1 e CK18. Assim, os resultados sugerem que as neoplasias obtidas por implantes com células da linhagem GP7TB apresentam características de CPF oriundo de células tronco neoplásicas. Além disso, os grupos experimentais TB e AS apresentaram atividade anticarcinogênica promissora no modelo de implantes singênicos com células GP7TB, que eventualmente envolvem mecanismos de ação distintos da atividade quimioterápica apresentada pelo SO. / Primary liver cancer (PLC) presents poor prognosis, which makes its chemoprevention important. In this sense, tributyrin (TB), a prodrug of butyric acid (AB), present in dairy products and honey, has been shown to be a promising chemopreventive agent for experimental hepatocarcinogenesis. The inhibitory effects of TB have been related to inhibition of the development of pre-neoplastic lesions, as well as induction of apoptosis and hyperacetylation of histones. Chemotherapy is one of the most common approaches for treating various types of cancer, including PLC. In this case, treatment with sorafenib (SO) is able to prolong the average survival of patients with the disease in advanced stages in approximately three months. In view of this, studies of the association of sorafenib with other compounds that may increase the efficacy of chemotherapeutic treatment are necessary. Thus, the association of anti-neoplastic drugs with bioactive compounds in food may be a potential strategy to increase efficacy against cancer. In the present study, the anticarcinogenic activity of TB and SO was evaluated, alone or in combination, in the progression stage of hepatocarcinogenesis. For this purpose, syngenic implants were performed on the flank of Fischer-344 mice from GP7TB tumor cells. When the neoplasms reached 1 cm3, the animals were randomized into experimental groups: Control group (CO), consisting of 10 Fischer 344 rats receiving Maltodextrin (300mg / 100 g.p.c), isocaloric control and 12.5% ethanol solution, and Cremofor to 12.5% in sterile water; Tributyrin group (TB), consisting of 9 Fischer 344 rats that received TB (200mg / 100 g.p.c.) and 12.5% ethanol solution and Cremofor 12.5% in sterile water; Sorafenib group (SO) consisting of 9 Fischer 344 rats receiving maltodextrin (300 mg / 100 g, w / w), isocaloric control and sorafenib tosylate (3 mg / 100 g, w / w) in sterile water; The association group of tributyrin and sorafenib (AS) consisted of 9 Fischer 344 rats receiving TB (20 mg / 100 g p.o.) and sorafenib tosylate (3 mg / 100 g p.o.); treated intragastric (i.g) daily for 5 consecutive weeks. The concentrations of AB and SO were analyzed by gas chromatography associated with mass spectrometry and the neoplasms were characterized by immunohistochemistry. In relation to the evolution of the size of the neoplasias, the AS group presented smaller (p = 0.009) size of the same ones in relation to the CO group. However, these differences did not reach significant differences (p> 0.05) between the TB and CO groups, as well as between the SO and CO groups. However, when adjusted for size of the neoplasm by latency, significant changes (p <0.05) were observed in the different groups when compared to the CO group. The SO group increased the necrotic area of the neoplasias, although this difference did not reach a significant difference (p> 0.05), while the TB group reduced this necrotic area in relation to the CO group (p = 0.005). The TB and AS groups presented significantly higher (p <0.05) hepatic and neoplastic AB concentrations than the CO group. The SO and AS groups presented significantly higher (p <0.05) neoplastic concentrations of SO in relation to the CO group. The SO and AS groups reduced the PTEN expression when compared to the CO group, although this difference did not reach a significant difference (p> 0.05). The TB group in turn expressed higher levels of PTEN, although this difference did not increase statistical significance (p> 0.05). All groups expressed higher levels of caspase 3 cleaved when compared to the CO group (p> 0.05). The TB and SO groups reduced the expression of pERK &#189; when compared to the CO group. although these differences did not reach statistical difference (p> 0.05). The AS group presented higher pERK &#189; expression when compared to the CO group, although this difference did not reach a significant difference (p> 0.05). Characterization of the neoplasias of the CO group was standardized by immunohistochemistry, presenting positive for CK 7, CK8, CK19 and Arginase and negative for HepPar1 and CK18. Thus, the results suggest that the neoplasias obtained by implants with GP7TB cells present CPF characteristics originating from neoplastic stem cells. In addition, the experimental groups TB and AS presented promising anticarcinogenic activity in the model of syngeneic implants with GP7TB cells, which eventually involve mechanisms of action distinct from the chemotherapy activity presented by SO.

O câncer primário de fígado (CPF) apresenta mau prognóstico, o que torna importante sua quimioprevenção. Nesse sentido, a tributirina (TB), um pró-fármaco do ácido butírico (AB), presente em laticínios e no mel, mostrou-se um agente quimiopreventivo promissor da hepatocarcinogênese experimental. Os efeitos inibitórios da TB têm sido relacionados à inibição do desenvolvimento de lesões pré-neoplásicas, bem como indução de apoptose e hiperacetilação de histonas. A quimioterapia é uma das abordagens mais comuns para o tratamento de diversos tipos de câncer, inclusive o CPF. Neste caso, o tratamento com sorafenibe (SO) é capaz de prolongar a sobrevida média dos pacientes com a doença em fases avançadas em aproximadamente apenas três meses. Em vista disso, são necessários estudos da associação do sorafenibe com outros compostos que possam aumentar a eficácia do tratamento quimioterápico. Desta forma, a associação de fármacos anti-neoplásicos com compostos bioativos dos alimentos pode consistir em uma estratégia potencial para aumentar a eficácia contra o câncer. No presente estudo, foi avaliada a atividade anticarcinogênica da TB e do SO, isoladamente ou em associação, na etapa de progressão da hepatocarcinogênese. Para tanto, foram realizados implantes singênicos no flanco de ratos Fischer-344 a partir de células da linhagem tumoral GP7TB. Quando as neoplasias atingiram 1 cm3, os animais foram aleatorizados em grupos experimentais: Grupo controle (CO), constituído por 10 ratos Fischer 344 que receberam Maltodextrina (300mg/ 100 g. p. c.), controle isocolarico e solução de etanol à 12,5% e Cremofor à 12,5% em agua estéril; Grupo Tributirina (TB), constituído por 9 ratos Fischer 344 que receberam TB (200mg/ 100 g. p. c.) e solução de etanol à 12,5% e Cremofor à 12,5% em água estéril; Grupo sorafenibe (SO) constituído por 9 ratos Fischer 344 que receberam Maltodextrina (300 mg/ 100 g. p. c.), controle isocalorico e tosilato de sorafenibe (3mg / 100 g. p. c. ) em água estéril; Grupo associação da tributirina com o sorafenibe (AS) constituído por 9 ratos Fischer 344 que receberam TB (20 mg/ 100 g. p. c.) e tosiliato de sorafenibe (3mg/ 100 g. p. c.); tratados por administração intragástrica (i.g) diariamente por 5 semanas consecutivas. As concentrações de AB e SO foram analisadas por cromatografia gasosa associada à espectrometria de massa e as neoplasias foram caracterizadas por imunoistoquímica. Em relação à evolução do tamanho das neoplasias o grupo AS apresentou menor (p=0,009) tamanho das mesmas em relação ao grupo CO. No entanto, estas diferenças não atingiram diferenças significativas (p>0,05) entre os grupos TB e CO, bem como entre os grupos SO e CO. Contudo, quando ajustados os valores do tamanho da neoplasia pela latência, observou-se alterações significativas (p<0,05) nos diversos grupos quando comparados ao grupo CO. O grupo SO aumentou a área necrótica das neoplasias, embora esta diferença não tenha atingido diferença significativa (p>0,05), enquanto que o grupo TB reduziu essa área necrótica em relação ao grupo CO (p=0,005). O grupo TB e AS apresentaram significativamente maiores (p<0,05) concentrações hepáticas e neoplásicas de AB em relação ao grupo CO. O grupo SO e AS apresentaram significativamente maiores (p<0,05) concentrações neoplásicas de SO em relação ao grupo CO. Os grupos SO e AS reduziram a expressão de PTEN, quando comparados ao grupo CO, embora esta diferença não tenha atingido diferença significativa (p>0,05). O grupo TB por sua vez expressou maiores niveis de PTEN, embora esta diferença não tenha atigindo significância estatística (p>0,05). Todos os grupos expressaram maiores niveis de caspase 3 clivada quando comparada ao grupo CO (p>0,05). OS grupos TB e SO reduziram a expressão de pERK &#189; quando comparados ao grupo CO. embora estas diferenças não tenham atingidos diferença estatística (p>0,05). O grupo AS apresentou maior expressão de pERK &#189; quando comparada ao grupo CO, embora esta diferença não tenha atingido diferença significativa (p>0,05). A caracterização das neoplasias do grupo CO foi padronizada por imunoistoquímica, apresentando-se positivas para CK 7, CK8, CK19 e Arginase e negativas para HepPar1 e CK18. Assim, os resultados sugerem que as neoplasias obtidas por implantes com células da linhagem GP7TB apresentam características de CPF oriundo de células tronco neoplásicas. Além disso, os grupos experimentais TB e AS apresentaram atividade anticarcinogênica promissora no modelo de implantes singênicos com células GP7TB, que eventualmente envolvem mecanismos de ação distintos da atividade quimioterápica apresentada pelo SO. / Primary liver cancer (PLC) presents poor prognosis, which makes its chemoprevention important. In this sense, tributyrin (TB), a prodrug of butyric acid (AB), present in dairy products and honey, has been shown to be a promising chemopreventive agent for experimental hepatocarcinogenesis. The inhibitory effects of TB have been related to inhibition of the development of pre-neoplastic lesions, as well as induction of apoptosis and hyperacetylation of histones. Chemotherapy is one of the most common approaches for treating various types of cancer, including PLC. In this case, treatment with sorafenib (SO) is able to prolong the average survival of patients with the disease in advanced stages in approximately three months. In view of this, studies of the association of sorafenib with other compounds that may increase the efficacy of chemotherapeutic treatment are necessary. Thus, the association of anti-neoplastic drugs with bioactive compounds in food may be a potential strategy to increase efficacy against cancer. In the present study, the anticarcinogenic activity of TB and SO was evaluated, alone or in combination, in the progression stage of hepatocarcinogenesis. For this purpose, syngenic implants were performed on the flank of Fischer-344 mice from GP7TB tumor cells. When the neoplasms reached 1 cm3, the animals were randomized into experimental groups: Control group (CO), consisting of 10 Fischer 344 rats receiving Maltodextrin (300mg / 100 g.p.c), isocaloric control and 12.5% ethanol solution, and Cremofor to 12.5% in sterile water; Tributyrin group (TB), consisting of 9 Fischer 344 rats that received TB (200mg / 100 g.p.c.) and 12.5% ethanol solution and Cremofor 12.5% in sterile water; Sorafenib group (SO) consisting of 9 Fischer 344 rats receiving maltodextrin (300 mg / 100 g, w / w), isocaloric control and sorafenib tosylate (3 mg / 100 g, w / w) in sterile water; The association group of tributyrin and sorafenib (AS) consisted of 9 Fischer 344 rats receiving TB (20 mg / 100 g p.o.) and sorafenib tosylate (3 mg / 100 g p.o.); treated intragastric (i.g) daily for 5 consecutive weeks. The concentrations of AB and SO were analyzed by gas chromatography associated with mass spectrometry and the neoplasms were characterized by immunohistochemistry. In relation to the evolution of the size of the neoplasias, the AS group presented smaller (p = 0.009) size of the same ones in relation to the CO group. However, these differences did not reach significant differences (p> 0.05) between the TB and CO groups, as well as between the SO and CO groups. However, when adjusted for size of the neoplasm by latency, significant changes (p <0.05) were observed in the different groups when compared to the CO group. The SO group increased the necrotic area of the neoplasias, although this difference did not reach a significant difference (p> 0.05), while the TB group reduced this necrotic area in relation to the CO group (p = 0.005). The TB and AS groups presented significantly higher (p <0.05) hepatic and neoplastic AB concentrations than the CO group. The SO and AS groups presented significantly higher (p <0.05) neoplastic concentrations of SO in relation to the CO group. The SO and AS groups reduced the PTEN expression when compared to the CO group, although this difference did not reach a significant difference (p> 0.05). The TB group in turn expressed higher levels of PTEN, although this difference did not increase statistical significance (p> 0.05). All groups expressed higher levels of caspase 3 cleaved when compared to the CO group (p> 0.05). The TB and SO groups reduced the expression of pERK &#189; when compared to the CO group. although these differences did not reach statistical difference (p> 0.05). The AS group presented higher pERK &#189; expression when compared to the CO group, although this difference did not reach a significant difference (p> 0.05). Characterization of the neoplasias of the CO group was standardized by immunohistochemistry, presenting positive for CK 7, CK8, CK19 and Arginase and negative for HepPar1 and CK18. Thus, the results suggest that the neoplasias obtained by implants with GP7TB cells present CPF characteristics originating from neoplastic stem cells. In addition, the experimental groups TB and AS presented promising anticarcinogenic activity in the model of syngeneic implants with GP7TB cells, which eventually involve mechanisms of action distinct from the chemotherapy activity presented by SO.

O carcinoma hepatocelular (HCC) é o sexto mais frequente e a segunda maior causa de mortalidade por câncer no mundo, além de apresentar alta taxa de recidiva. A associação de sorafenibe (SO) com agentes quimiopreventivos representa uma estratégia importante para aumentar a eficácia do tratamento e minimizar a reincidência da doença. Em estudos anteriores demonstrou-se o potencial quimiopreventivo da tributirina (TB), pró-fármaco do ácido butírico (AB), em modelo de hepatocarcinogênese experimental. A atividade da TB tem sido relacionada à inibição do desenvolvimento de lesões préneoplásicas, bem como à indução de apoptose. Assim, o presente estudo teve como objetivo avaliar a ação anticarcinogênica da TB e do SO, isoladamente ou em associação no HCC. Nesse sentido, implantes singênicos foram realizados no flanco de ratos Fischer- 344 a partir de células da linhagem neoplásica JM-1. Os animais foram distribuídos nos seguintes grupos: Grupo controle isocalórico [CO; Maltodextrina (300 mg/100 g p.c.) e solução veículo (solução de etanol a 12.5% e Cremofor a 12.5% em água estéril)]; Grupo TB (200 mg/100 g p.c. e solução veículo); Grupo SO [Maltodextrina (300 mg/100 g p.c. tosilato de SO (3 mg/100 g p.c.) em solução veículo] e Grupo associação [AS; TB (200 mg/100 g p.c) e tosilato de SO (3 mg/100 g p.c.) em solução veículo]. Os implantes de células JM-1 originaram neoplasias com características pouco diferenciadas. Os tratamentos com SO e AS retardaram (p<0,05) o desenvolvimento das neoplasias, além de reduzirem (p<0,05) suas massa e aumentem (p<0,05) a sobrevida em relação ao grupo CO. Não houve diferença na porcentagem de área necrótica das neoplasias entre os tratamentos. Porém, foi observada uma correlação negativa (p<0,05) entre o tamanho da neoplasia e a área necrótica, sendo que quanto menor a área da neoplasia maior a extensão da necrose, independente do tratamento. Foi observado aumento (p<0,05) das concentrações hepáticas de AB nos grupos TB, SO e AS. Já na neoplasia, apenas os grupos TB e SO demonstraram aumento (p<0,05) na concentração de AB. Além disso, os tratamentos com SO e AS aumentaram (p<0,05) a concentração tecidual de SO na neoplasia em relação ao CO. Nesse sentido, foi observado que grupo AS apresentou 5 vezes mais SO na neoplasia quando comparado ao grupo SO. Os tratamentos com TB e SO isoladamente ou em associação reduziram (p<0,05) a expressão de CK19 em relação ao grupo CO. Em relação à avaliação da proliferação celular, os grupos TB, SO e AS apresentaram redução (p<0,05) do índice de proliferação celular quando comparados ao grupo CO. Foi observado por meio da análise imunoistoquímica para pERK, que os animais tratados com SO e AS reduziram (p<0,05) as áreas positivas quando comparadas às dos animais do grupo CO. Além disso, também foi observada por meio de marcação imunoistoquímica uma redução (p<0,05) nas áreas positivas para CK8 nos grupos SO e AS quando comparadas às do grupo CO. Em relação à caspase-3 clivada, foi observado por imunoistoquímica que o tratamento com TB aumentou (p<0,05) o índice de células positivas para caspase-3 clivada quando comparado ao CO. Esse dado foi comprovado pela análise de western blot. Foi observado por meio da análise imunoistoquímica para H3K9, um aumento (p<0,05) da acetilação no grupo TB quando comparado ao grupo CO. Em relação à expressão em nível proteico de pAKT, foi observado por meio da análise imunoistoquímica uma redução (p<0,05) no grupo TB em comparação ao grupo CO. O presente estudo demonstrou que os implantes de células JM-1 no flanco de ratos Fischer-344 originaram neoplasias com características que lembram a organização hepatocítica de um HCC convencional. O tratamento com TB foi capaz de reduzir a proliferação celular e induzir apoptose. Os tratamentos com SO e com a AS foram capazes de retardar o desenvolvimento, aumentar a sobrevida, reduzir a massa das neoplasias, induzirem diferenciação celular e reduzirem a proliferação celular, melhorando o prognóstico da doença. Os tratamentos com SO e AS apresentaram atividade quimioterápica semelhante. No entanto, a coadministração de SO e TB foi capaz de aumentar a biodisponibilidade do SO para a neoplasia. / Hepatocellular carcinoma (HCC) is the sixth most frequent and the second largest cause of cancer mortality in the world, besides presenting a high rate of recurrence. The association of sorafenib (SO) with chemopreventive agents represents an important strategy to increase the efficacy of the treatment and to minimize recurrence of the disease. In previous studies the chemopreventive potential of tributyrin (TB), a butyric acid prodrug (AB), was demonstrated in a model of experimental hepatocarcinogenesis. TB activity has been linked to inhibition of the development of pre-neoplastic lesions as well as to the induction of apoptosis. Thus, the present study aimed to evaluate the anticarcinogenic action of TB and SO, either alone or in combination in HCC. In this sense, syngeneic implants were performed on the flank of Fischer-344 rats from cells of the JM-1 neoplastic lineage. The animals were divided into the following groups: Control group [CO; Maltodextrin (300 mg / 100g p.c.) and carrier solution (12.5% ethanol solution and 12.5% Cremophor in sterile water)]; TB group (200 mg / 100 g p.c. and carrier solution); Group SO [Maltodextrin (300 mg / 100 g pc tosylate of SO (3 mg / 100 g pc) in vehicle solution] and Association group [AS; TB (200 mg / 100 g pc) and SO tosylate (3 mg / 100 (p <0.05), the development of the neoplasms, as well as the reduction (p <0.05), and the survival rate was higher (p <0.05) than the CO group. There was no difference in the percentage of necrotic area of the neoplasms between the treatments. (p <0.05) of the hepatic AB concentrations in the TB, SO and AS groups, although the size of the neoplasia and the necrotic area were higher. In the neoplasia, only the TB and SO groups showed an increase (p <0.05) in AB concentration. In addition, treatments with SO and AS increased (p <0.05) the tissue concentration of SO in the neoplasia in relation to CO. In this sense, it was observed that AS group presented 5 times more SO in the neoplasia when compared to the SO group. Treatments with TB and SO alone or in combination reduced (p <0.05) the expression of CK19 in relation to the CO group. In relation to the evaluation of cell proliferation, the TB, SO and AS groups presented a reduction (p <0.05) in the cell proliferation index when compared to the CO group. It was observed by the immunohistochemical analysis for pERK that the animals treated with SO and AS reduced (p <0.05) the positive areas when compared to the animals of the CO group. In addition, a reduction (p <0.05) in the CK8 positive areas in the SO and AS groups when compared to the CO groups was also observed by immunohistochemical labeling. In relation to the cleaved caspase-3, it was observed by immunohistochemistry that the TB treatment increased (p <0.05) the index of caspase-3 positive cells cleaved when compared to CO. This was confirmed by western blot analysis. It was observed by immunohistochemical analysis for H3K9, an increase (p <0.05) in the acetylation of the TB group when compared to the CO group. Regarding the protein level expression of pAKT, a reduction (p <0.05) in the TB group was observed through the immunohistochemical analysis when compared to the CO group. The present study demonstrated that JM-1 cell implants in the flank of Fischer-344 mice originated neoplasms with features reminiscent of the hepatocyte organization of a conventional HCC. TB treatment was able to reduce cell proliferation and induce apoptosis. SO and AS treatments were able to delay the development, increase survival, reduce the mass of neoplasms, induce cell differentiation and reduce cell proliferation, improving the prognosis of the disease. SO and AS treatments showed similar chemotherapy activity. However, co-administration of SO and TB was able to increase the bioavailability of SO to the neolasia.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20809号 / 医博第4309号 / 新制||医||1025(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 妹尾 浩, 教授 坂井 義治, 教授 戸井 雅和 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM