Tsutomu Takeda

Expression and clinical significance of erb-B receptor family in hepatocellular carcinoma

In order to elucidate the clinical significance of the erbB family, epidermal growth factor receptor (EGF-R), c-erbB-2, c-erbB-3 and c-erbB-4 in hepatocellular carcinoma (HCC), we investigated the expression of these proteins by means of immunohistochemistry for HCC as well as adjacent noncancerous lesions. EGF-R was expressed in 68% of the HCC examined and showed correlation with the proliferating activity, stage, intrahepatic metastasis and carcinoma differentiation. c-erbB-2 was expressed in only 21% of the cases and showed no relationships with the clinicopathological parameters. c-erbB-3 protein was observed in 84% of the HCC and 38.1% of the noncancerous lesions. Its expression in HCC was equal to or greater than noncancerous lesions in 90.5% of the cases, and was related to the stage, portal invasion, cell proliferating activity, tumour size, intrahepatic metastasis and carcinoma differentiation. c-erbB-4 protein was expressed in 61.0% of HCC and in as much as 86.1% of the noncancerous lesions. Unlike the expression of c-erbB-3, that of c-erbB-4 in HCC was less than that of the adjacent noncancerous lesions in 51.2% of the cases. No statistical significance could be established between this protein expression in HCC and clinicopathological features. EGF-R and c-erbB-3 affected disease-free survival, but were not recognized as independent prognostic factors by multivariate analysis. The present study suggests that, of the four receptors, EGF-R and c-erbB-3 play important roles in the progression of HCC.

The status of Fas and Fas ligand expression can predict recurrence of hepatocellular carcinoma

The status of Fas and Fas ligand (Fas L) expression was investigated in this study for 103 hepatocellular carcinomas (HCC). We studied the expression of the following three factors, Fas and Fas L expression in carcinoma cells and Fas L expression in stromal mononuclear cells (defined as stromal Fas L index). Fas expression in HCC cells was significantly decreased in cases with poor differentiation (P< 0.0001) and of larger size (P = 0.0058). Fas L expression in carcinoma cells was observed exclusively in moderately or poorly differentiated cases. Furthermore, each factor had prognostic significance for disease-free survival (DFS) (P< 0.0001, P = 0.0222 and 0.0027 respectively). We then scored the results of each factor and defined the total score as ‘Fas-Fas L risk score’. The P -value of the score for DFS was even lower than that of the clinical stage by multivariate analysis. These results suggest that the evaluation of Fas and Fas ligand expression potentially has a significant prognostic value for DFS of HCC patients, in addition to the clinical stage, and can be regarded as a new prognostic marker.

Both cell proliferation and apoptosis significantly predict shortened disease-free survival in hepatocellular carcinoma

In this study, we investigated the proliferating cell index by the percentage of Ki-67 expressing cells (Ki-67 LI) and the apoptotic index (AI) by the number of morphologically apoptotic cells per 1000 carcinoma cells in haematoxylin and eosin sections of 76 hepatocellular carcinomas (HCC). Both indices showed excellent correlation with each other (P < 0.0001) and were significantly higher in cases of poor differentiation, of advanced stages, with portal invasion and with intrahepatic metastasis. Furthermore, cases with higher Ki-67 LI or higher AI displayed poor outcomes for disease-free survival (P = 0.0001 and P = 0.0005) by univariate analysis. By multivariate analysis, both indices could be regarded as independent prognostic factors. These results strongly suggest that Ki-67 LI and AI have very similar clinical significance, reflecting the existence of biologically aggressive phenotypes and poor disease-free survival rate in HCC.

Expression of p57/Kip2 Protein in Hepatocellular Carcinoma

Evaluation of the biological character of carcinomas requires understanding of cell cycle regulators. In the present study, we investigated the expression of p57 (Kip2) in 90 hepatocellular carcinomas and 66 noncancerous lesions. The average p57 labeling index in noncancerous lesions was 72.3 ± 19.7. The labeling index significantly decreased (p < 0.0001) in hepatocellular carcinoma (54.9 ± 19.7). It was significantly lower in hepatocellular carcinoma cases with high biological aggressiveness such as advanced stage (p = 0.0041), poor differentiation (p < 0.0001), larger size (p = 0.0400), portal invasion (p < 0.0001), satellite tumor (p = 0.0023), high proliferating activity (p = 0.0002) and cyclin D1 overexpression (p = 0.0416). Furthermore, cases with low p57 expression showed worse outcomes for disease-free survival in univariate analysis (p = 0.0235), although p57 expression could not be recognized as an independent prognostic factor. These findings suggest that p57 contributes to the downregulation of cell proliferation and to the progression of hepatocellular carcinoma.

Expression and Prognostic Role of Cyclin-Dependent Kinase 1 (cdc2) in Hepatocellular Carcinoma

The expression of cyclin-dependent kinase 1 (cdc2), cyclin A and cyclin B1 was immunohistochemically studied in 101 hepatocellular carcinomas (HCC). cdc2 overexpression was directly related to advanced stage, portal invasion, intrahepatic metastasis, poor differentiation, high α-fetoprotein level, large size, high Ki-67 labeling index and poor prognosis. Cyclin A and B1 overexpression showed similar tendency to that of cdc2, but they were not recognized as independent prognostic factors by multivariate analysis. These findings suggest that cdc2 plays the most crucial role of the G2/M modulators in cell cycle progression and cell proliferation of HCC and significantly predicts the recurrence of this carcinoma.

Elevated expression of UDP‐N‐acetylglucosamine: αmannoside β1,6 N‐acetylglucosaminyltransferase is an early event in hepatocarcinogenesis

Previous reports have suggested that changes in oligosaccharide structures, especially β1–6 branching in N‐glycans, which are biosynthesized by UDP‐N‐acetylglucosamine:α mannoside β1,6 N‐acetylglucosaminyltransferase (GnT‐V), are linked to tumor metastasis and invasion. In the present study, we investigated GnT‐V expression in human hepatocellular carcinoma (HCC) tissues. High expression of GnT‐V mRNA was observed in both HCC and the surrounding tissues but not in normal liver. Immunohistochemical study using a newly established monoclonal antibody against GnT‐V revealed that positive staining of GnT‐V was observed in 75% of HCC tissues and 60% of surrounding tissues and that liver cirrhosis showed much stronger staining of GnT‐V than chronic hepatitis without liver cirrhosis (p = 0.0035). In contrast, all of 12 cases of atypical adenomatous hyperplasia diffusely expressed GnT‐V. β1–6 branching in N‐glycans, products of GnT‐V, was increased in HCC tissues with high expression of GnT‐V, as judged by lectin blotting. Levels of GnT‐V expression in HCC tissues were positively correlated with a low Ki‐67 labeling index (p = 0.0009), small size (p < 0.0001), poor differentiation (p < 0.0001) and absence of portal invasion (p = 0.018). Furthermore, HCC cases with low or no expression of GnT‐V were more likely to show recurrence than cases with high expression (p = 0.0373). These findings strongly suggest that GnT‐V expression is concerned mainly with an early phase of hepatocarcinogenesis.

Protection of islet allografts transplanted together with Fas ligand expressing testicular allografts

Summary Fas ligand (FasL) is highly expressed in testicular tissues and thought to be responsible for protection from allograft rejection by inducing apoptosis of anti-graft activated T cells. FasL-expressing islets have been shown to induce a granulocyte-mediated inflammatory reaction. We investigated whether a graft can be protected from alloimmune responses by manipulating the Fas/FasL-system. We transplanted allogeneic islets under the kidney capsule of streptozotocin-induced diabetic mice together with testicular tissue. Significant prolongation of survival of C3H islet allograft was observed in C57BL/6 (B6) recipients transplanted with C3H testicular tissue, but not in those transplanted with C3H-gld testicular tissue expressing non-functional FasL. No significant prolongation was observed in B6-lpr recipients expressing non-functional Fas. Immunohistochemical staining of C3H testicular tissue in the composite graft showed a high expression of FasL, but not that of the C3H-gld testicular tissue. In situ terminal deoxynucleotidyl transferase-mediated dUDP-biotin catalysed DNA nick-end labelling (TUNEL) staining of a composite graft of C3H islet and testicular tissue in B6 recipients demonstrated extensive apoptosis of infiltrating mononuclear cells around the graft. The protective effect of C3H testicular tissue was abrogated when anti-FasL monoclonal antibody was administered i. p. postoperatively. Our results suggest that FasL-positive testicular allografts protect composite islet allografts and indicate that manipulation of Fas/FasL mediated apoptosis is a suitable strategy for controlling rejection of islet allografts. [Diabetologia (1998) 41: 315–321]

Expression of heparin-binding epidermal growth factor-like growth factor in breast carcinoma.

The expression of heparin-binding epidermal growth factor-like growth factor (HB-EGF) was investigated for 76 cases of breast carcinoma. HB-EGF was expressed in 71.8% of the carcinoma cases but only slightly in normal mammary glands. Interestingly, its expression was inversely related to biological aggressiveness of the breast carcinoma. These results suggest that HB-EGF may play a crucial role in the early stage of this carcinoma.

Presence of Active Hepatitis Associated with Liver Cirrhosis Is a Risk Factor for Mortality Caused by Posthepatectomy Liver Failure

The histologic activity of associated hepatitis was examined in 285 patients who underwent hepatectomy for hepatocellular carcinoma (HCC), to determine if the histologic activity is an independent risk factor for postoperative mortality due to liver failure. The proportion of patients with liver cirrhosis who died due to liver failure (6/180, 3.3%) was not different from that of patients with chronic hepatitis (2/68, 2.9%). However, mortality was higher in patients with liver cirrhosis and active hepatitis (4/46, 8.7%) than in those with cirrhosis and inactive hepatitis (2/134, 1.5%, P < 0.05). Such difference was not observed in the chronic hepatitis group. Multivariate analysis showed that clearance of indocyanine green at 15 min (ICGR15) and activity of hepatitis were two independent risk factors for postoperative mortality due to liver failure. In conclusion, histologic activity of associated hepatitis should be taken into account in hepatic resection of HCC in cirrhotic liver, in addition to the functional reserve of the liver.

Expression of p21 (WAF1/CIP1) protein in clinical thyroid tissues

p21 (WAF1/CIP1) protein expression in various thyroid tissues, including thyroid carcinoma, was studied by means of immunohistochemistry using anti-p21 monoclonal antibody. Normal follicles and hyperplasias rarely expressed p21, whereas immunohistochemically positive cells were also too rarely found in follicular adenomas to justify these cases being classified as positive. Twenty eight of the 93 carcinomas examined (30.1%), however, were positive for p21. Of the p21-positive cases, 80% of the undifferentiated and 28.6% of the poorly differentiated carcinomas showed lesions co-expressing p21 and p53. If diffuse immunoreactivity of p53 reflects the p53 mutation, our results indicate that p21 in these carcinomas can be induced by p53-independent as well as by p53-dependent pathways. On the other hand, well-differentiated carcinomas did not co-express these two proteins and it therefore remains unclear whether p53-independent or p53-dependent pathways are predominant in this type of carcinoma. The incidence of expression of p21 was very similar in undifferentiated (26.3%), poorly (28.0%) and well-differentiated carcinomas (32.7%), even though they are characterised by different degree of malignancy. Furthermore, no correlation between p21 expression and either clinical parameters or patients prognosis could be established. These results suggest that p21 is only marginally related to the characteristics of thyroid carcinoma and can play only an adjuvant role in regulating the progression of this carcinoma.