Epstein-Barr virus and Interleukin-28B polymorphism in the prediction of response to interferon therapy in hepatitis C patients

BACKGROUND AND STUDY AIMS

In chronic hepatitis C virus (HCV), viral and host factors are known to be predictors for anti-viral therapy. IL-28B genotype strongly influences treatment outcome, while Epstein-Barr virus (EBV) co-infection could accelerate the course of chronic HCV infection. This study was conducted to assess whether EBV co-infection adds to the predictive value of IL-28B.

PATIENTS AND METHODS

A total of 105 patients with chronic HCV were classified according to their response to treatment into two groups: 38 sustained virological responders (SVRs) and 67 nonresponders (NRs). Collected sera at baseline and follow-up (FUP) were used for assessing EBV antibodies by enzyme-linked immunosorbent assay (ELISA) and the expression of EBV genes (BNLF-1, BZLF-1, and EBER-2) by polymerase chain reaction (PCR). Collected peripheral blood was used for detecting IL-28B rs.12979860 single-nucleotide polymorphism.

RESULTS

Regarding IL-28B genotype frequencies, a significant difference (p=0.003) was observed between SVRs (C/C=51.4%, C/T=48.6%, T/T=0%) and NRs (C/C=25%, C/T=55%, T/T=20%). On assessing EBV infection at baseline and FUP, it was found that 61% and 55% were positive, respectively, with no significant difference between SVRs and NRs. As for anti-viral capsid antigen (VCA) antibodies, the NRs had significantly higher baseline anti-VCA immunoglobulin M (IgM) levels than SVRs (p=0.01). While FUP anti-Epstein-Barr nuclear antigen-1 (EBNA-1) IgG reported a significant decline within SVR patients (p=0.02), neither baseline nor FUP anti-VCA IgG levels showed a statistically significant viral response. Finally, on comparing EBV markers with CC versus CT and TT genotypes, it was found that FUP anti-VCA IgG levels were significantly increased in CC genotype (p=0.003).

CONCLUSION

Interleukin-28B polymorphism could be a possible predictor of response to pegylated interferon/ribavirin therapy (PEG-IFN/RBV). Furthermore, co-infection with EBV did not affect the response to IFN-based therapy in HCV-infected patients.

Abstract 4174: Molecular changes in the EGFR pathway and RAS/RAF genes identify subtypes of metastatic and nonmetastatic colorectal cancer associated with different outcomes

Background: Categorization of colon cancers into distinct subtypes using a combination of pathway-based biomarkers and RAS/RAF mutations provides better insight into the variability in patient outcomes. We assessed the incidence, prognostic and predictive values of KRAS/BRAF mutations and some EGFR pathway genes in metastatic and non- metastatic CRC (mCRC and nmCRC) patients from Egypt.

Methods: 396 CRC patients (240 metastatic& 156 non metastatic) were assessed for KRAS/BRAF mutations by conventional PCR and immunohistochemistry (IHC). EGFR, PI3K, MEK and ERK expressions were assessed by quantitative real time PCR (qPCR) and IHC. Results were correlated to standard prognostic factors, response to treatment overall and disease free survival (OS&DFS).

Results: We detected KRAS mutations in 47.7% (27% in codon 12, 35.6% in codon 13 and 14.3% in 12/13), BRAF in 31.3% and EGFR in 54.6% of the cases. KRAS and EGFR were significantly higher in mCRC cases (p = 0.012& p = 0.045). Tumors were categorized into 4 genetically different groups: EGFR-/KRAS+, EGFR-/KRAS-, EGFR+/KRAS-, EGFR+/KRAS+ (30.3%,28.3%,24%, 17.4%). Significant correlations were found between EGFR, KRAS/BRAF mutations and PI3K-RNA in metastatic and non metastatic CRC (0.02&<0.001). In mCRC, correlations were found between 1) RAS mutations and all markers except EGFR (0.028&<0.001), 2) RAF and MEK/EGFR (0.045&<0.005), 3) PI3K and all genes (<0.001) except BRAF, 4) ERK and MEK (<0.001). In nmCRC, correlations were reported between 1) PI3K and EGFR (p<0.001), 2) RAS and MEK/ERK (p<0.001), 3) MEK and ERK (p<0.001), 4) EGFR and PI3K (p<0.001). DFS significantly correlated with K13RAS mutations, PI3K and positive family history (p<0.05). OS correlated with K13 RAS/BRAF mutation, PI3K and age (p<0.05).

Conclusions: KRAS/BRAF mutations and aberrations in EGFR pathway contribute differently to the development and progression of metastatic and non metastatic CRC cases in Egypt. These markers could be used for monitoring patients during treatment with conventional chemotherapy regimens and can provide candidates for targeted therapy.

Citation Format: Abeer A. Bahnassy, Salem E. Salem, Nehal Hussein,Hend F. Yousif, Marwa, Iman Al-Desouky, Abdel-Rahman N. Zekri. Molecular changes in the EGFR pathway and RAS/RAF genes identify subtypes of metastatic and nonmetastatic colorectal cancer associated with different outcomes. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4174. doi:10.1158/1538-7445.AM2015-4174

Abstract 4258: Genetic profiling of breast cancer confirms a pivotal Role of EGFR pathway in the development of acquired resistance to Tamoxifen in locally recurrent and metastatic breast cancer patients

Background: Acquisition of resistance to Tamoxifen is a major drawback in the treatment of estrogen receptor (ER)-positive breast cancer (BC) patients. The role of CYP2D6 in predicting response to Tamoxifen is debatable. We assessed the involvement of aberrant EGFR pathway genes expressions and CYP2D6 polymorphism in predicting response to Tamoxifen in a cohort of BC patients from Egypt.

Patients and methods: This prospective study included 157 females with hormone receptor positive, locally recurrent inoperable and/or metastatic BC patients treated in the National Cancer Institute, Cairo. Patients were categorized according to their response to Tamoxifen into: responders and refractory groups. RNA and DNA were extracted from tumour and normal tissue samples obtained from all patients. The expression of 92 genes in the EGFR pathway was evaluated using the SABioscience array (Qiagen) with four house-keeping genes and CYP2D6 polymorphism was assessed by PCR.

Results: We found that 58.6% of the patients were ER/PR positive, 32.48% were ER positive and 8.91% were PR positive. Response to Tamoxifen correlated significantly with the site of the disease (patients with bone only disease demonstrated better and maintained response compared to those with visceral involvement; p. = 0.005) and CYP2D6 polymorphism (p. = 0.034). CYP2D6 *3, *4 were significantly prevalent in the refractory group (86.6%), whereas variants *10/*10 and *10/*3 were more common in the in the responders (85.5%) (p. = 0.027). RNA profiling of the EGFR pathway showed that 56 genes were differentially over-expressed in the refractory group compared to the responders, of which only JAK1, COL1A1, GAB1, FN1, MKNK1, AKT1, EGFR, NFKB1 and HGDC showed a significant difference between the groups (p<0.05).. Thirty four genes were differentially reduced, of which only STAT5A, RHOA, MAPK9, MAPK10, CCND1 showed significant difference between groups (p<0.05)..

Conclusion: The EGFR pathway contributes significantly to patients’ response to Tamoxifen in locally advanced/ metastatic breast cancer. A panel of 13 genes (JAK1, COL1A1, GAB1, FN1, MKNK1, EGFR, NFKB1, HGDC, STAT5A, RHOA, MAPK9, MAPK10, CCND1) in this pathway together with CYP2D6 polymorphisms can predict response to Tamoxifen though this has to be verified in a larger study.

Citation Format: Abdel-Rahman N. Zekri, Abeer Bahnassy, Ibrahim Malash, Mohammad Mansour,Sabry Shaarawy, Hoda Abdel-Raouf, Rabab Gaafar. Genetic profiling of breast cancer confirms a pivotal Role of EGFR pathway in the development of acquired resistance to Tamoxifen in locally recurrent and metastatic breast cancer patients. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4258. doi:10.1158/1538-7445.AM2015-4258

Abstract 2914: Gold magneto nanoparticles induced apoptosis in liver cancer cells through changes of Ca channel pump detected by LIBS Technique and RT-PCR array

Laser-induced breakdown spectroscopy technique (LIBS) was used in thesis study to address the effect of gold magneto nanoparticles on the liver cancer cells (HepG2) by examining the variation in genotoxicity and cytotoxicity.

HepG2 cell line was cultured at 105 cells/ml and expanded, after which, they were incubated with gold magneto nanoparticles at concentrations 10, 25, 50 μg/ml respectively for 12 hours. The effect of these nanoparticles in cell apoptosis as well as in autophagy was evaluated by acridine orange staining and Annexin V/propidium iodide double staining as well as apoptosis specific PCR array assay for evaluation of apoptosis in the treated cells.

At a concentration of nanocomposite 10, 25, 50 μg/ml, cells showed increase in the apoptosis figure from 11.25% ± 3.1% to 28% ± 2.04%, 39% ± 3.6%, 60% ± 4.3% respectively. Apoptosis specific PCR array also, showed very high expression of TNF, BIRC3 and NFKB1 with increasing in the fold regulation ratio of 155.03,158.03 and 149.2- fold respectively.

On the other hand, extra investigation of these treated cells by LIBS shows an increasing in the iron oxide nanoparticles concentration as well as calcium concentration. This increase in the calcium content in the treated cells may play an important role in the program cell apoptosis which was prove in our study by both Flow cytometry as well as by profile apoptosis PCR array.

Finally, our data showed the possibility of the using LIBS as inductor of cells apoptosis by measurement Ca concentration changes in liver cancer cells (HepG2 cells).

Keywords: Apaptosis, LIBS; HepG2 cell; Genotoxicity

Citation Format: Ola Ahmed, Hisham Imam, Abdel-Rahman N. Zekri. Gold magneto nanoparticles induced apoptosis in liver cancer cells through changes of Ca channel pump detected by LIBS Technique and RT-PCR array. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2914. doi:10.1158/1538-7445.AM2015-2914

Abstract 2217: Prognostic and predictive values of CD68+ macrophage and aberrant expression of cathepsin L, IL-12, CTL4A genes in classic Hodgkin's lymphoma

Background: Despite advances in the treatment of classic Hodgkin lymphoma (CHL), current therapies fail to cure 10%-15% of patients, and a similar proportion of patients may be over treated, resulting in both short-term and long-term treatment-related complications. Current prognostic models predict the outcome of treatment with imperfect accuracy, and clinically relevant biomarkers have not been established to improve on international prognostic score.

Patients and Methods: CD 68 protein and RNA expression were assessed in 81 classic Hodgkin's lymphoma patients from Egypt by immunohistochemistry and Quantitative real time PCR (Q-RTP) respectively. Then CD 68 positive and CD 68 negative cases where profiled using the SABioscience array (Qiagen). Genetic aberrations were correlated to standard prognostic factors, patients response to the treatment, progression free and overall survival (PFS, OS) rates.

Results: Increased CD68 protein and RNA expression were detected in 70.3% and 53.1% of the cases, respectively. Increased CD68 protein associated significantly with old age >40 (p = 0.035), advanced stage (p = 0.007), and poor response to treatment (DP/SD, p = 0.001). CD68 RNA expression significantly associated with age (p = 0.035), and poor response to treatment (DP/SD, p = 0.001). CD68+ positive patients, showed high expression of cathepsin L, IL-12, ATXN2L, CTL4A and MMP11. The 5 years OS correlated significantly with CD68, IL-12, MMP11 and CTL4A-RNA expression (p< 0.001) as well as with age (p<0.001) and stage (p<0.001). The 5 years PFS correlated significantly with age (p = 0.003), stage (p = 0.012), CD68 protein and RNA expression (p< 0.001) as well as with cathepsin L, IL-12, CTL4A and MMP11 (p<0.01). CD68 protein expression significantly correlated with 2 years OS (p< 0.001).

Conclusions: in classic Hodgkin's lymphoma, CD68+ macrophage and aberrant expression of cathepsin L, IL-12, CTL4A and MMP11 provide sensitive biomarkers that can accurately predict patients response to treatment and survival with high accuracy.

Citation Format: Abdel-Rahman N. Zekri, Abeer A. Bahnassy, Ahmad E-S El-Bastawisi, Osama Hammad, Nasr M. Ali, John E. Diks, Hend F. Yousif. Prognostic and predictive values of CD68+ macrophage and aberrant expression of cathepsin L, IL-12, CTL4A genes in classic Hodgkin's lymphoma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2217. doi:10.1158/1538-7445.AM2015-2217

The impact of repeated autologous infusion of haematopoietic stem cells in patients with liver insufficiency

INTRODUCTION

The worldwide shortage of donor livers has prompted the search for alternative cell therapies. Previous data from our laboratory proved a supportive role for stem cell therapy in the treatment of end-stage liver disease patients. Therefore; this study was conducted to assess the clinical and biochemical effects of repeated stem cell infusion.

METHODS

Ninety patients with liver cirrhosis were randomized to receive either one session treatment (G-I) or two sessions 4 months apart (G-II) of autologous haematopoietic stem cells (HSCs) transplantation and a control group (G-III) who received regular liver treatment. G-CSF was administered to transplanted patients before infusion; HSCs were isolated from 400 cc bone marrow (BM) aspirate. CD34+/CD133+ cells were purified: 50 % of the cells were infused locally in the portal vein on the same day and the other 50 % were differentiated to MSC and infused systemically in a peripheral vein (one session treatment G-I). In G-II, the same process was repeated after 4 months from the first treatment (two session's treatment G-II). Liver function was monitored for 12 months after stem cell therapy (SCT).

RESULTS

Statistically significant improvement was reported in the transplanted patients (G-1) as regards the mean serum albumin, bilirubin and INR levels which started to improve after 2 weeks of treatment and continued to improve till the 6(th) month in the single infusion group. The two sessions infused group (G-II) showed sustained response which continued throughout the all follow-up period (12 month). By the end of the study, 36.7 % of the patients in G-I and 66.7 % in G-II showed improvement in the degree of ascites compared to the control group (G-III). We also reported an improvement in the hepatic functional reserve as assessed by the Child-Pugh and MELD score. Safety of the procedure was evidenced by the low incidence of complications encountered.

CONCLUSION

In patients with end-stage liver disease, the repeated infusion with combined routes portal and peripheral veins has a beneficial effect on liver functions with minimal adverse events and more lasting clinical efficacy after repeated HSCs infusion.

Aberrant expression of cancer stem cell markers (CD44, CD90, and CD133) contributes to disease progression and reduced survival in hepatoblastoma patients: 4-year survival data

Hepatoblastoma (HB) is an embryonal tumor of the liver in children. Prognosis and response to treatment in HB are highly variable. Cancer stem cells (CSCs) constitute a population of cells, which contribute to the development and progression of many tumors. However, their role in HB is not well defined yet. We assessed the prognostic and predictive values of some CSC markers in HB patients. Protein and messenger RNA expressions of the CSC markers CD133, CD90, and CD44 were assessed in 43 HB patients and 20 normal hepatic tissues using immunohistochemistry and quantitative real-time polymerase chain reaction. The expression levels of these markers were correlated to standard prognostic factors, patients' response to treatment, overall survival (OS), and disease-free survival (DFS). CD44, CD90, and CD133 proteins were detected in 48.8%, 32.6%, and 48.8% compared with 46.5%, 41.7%, and 58.1% RNA, respectively (concordance, 77.8%-96%). None of the normal tissue samples was positive for any of the markers. Significant correlations were reported between α-fetoprotein and both CD44 and CD133 (P = 0.02) as well as between tumor types CD90 and CD133 (P = 0.009). Reduced OS correlated with CD44, CD90, and CD133 expressions (P < 0.001), advanced stage (P < 0.001), response to treatment (P < 0.001), and total excision of the tumor. Reduced DFS correlated with CD44 and CD133 expressions (P < 0.001) only. In conclusion, CD133, CD44, and CD90 could be used as prognostic and predictive markers in HB. High expression of these markers is significantly associated with poor response to treatment and reduced survival. Moreover, complete surgical resection and systemic chemotherapy are essential to achieve good response and prolonged survival, especially in early stage patients.

New insight into HCV E1/E2 region of genotype 4a

Introduction

Hepatitis C virus (HCV) genome contains two envelope proteins (E1 and E2) responsible for the virus entry into the cell. There is a substantial lack of sequences covering the full length of E1/E2 region for genotype 4. Our study aims at providing new sequences as well as characterizing the genetic divergence of the E1/E2 region of HCV 4a using our new sequences along with all publicly available datasets.

Methods

The genomic segments covering the whole E1/E2 region were isolated from Egyptian HCV patients and sequenced. The resulting 36 sequences 36 were analyzed using sequence analysis techniques to study variability within and among hosts in the same time point. Furthermore, previously published HCV E1/E2 sequence datasets for genotype 4a were retrieved and categorized according to the geographical location and date of isolation and were used for further analysis of variability among Egyptian over a period of 15 years, also compared with non-Egyptian sequences to figure out region-specific variability.

Results

Phylogenetic analysis of the new sequences has shown variability within the host and among different individuals in the same time point. Analysis of the 36 sequences along with the Egyptian sequences (254 sequences in E1 in the period from 1997 to 2010 and 8 E2 sequences in the period from 2006 to 2010) has shown temporal change over time. Analysis of the new HCV sequences with the non-Egyptian sequences (182 sequences in E1 and 155 sequences in the E2) has shown region specific variability. The molecular clock rate of E1 was estimated to be 5E-3 per site per year for Egyptian and 5.38E-3 for non-Egyptian. The clock rate of E2 was estimated to be 8.48E per site per year for Egyptian and 6.3E-3 for non-Egyptian.

Conclusion

The results of this study support the high rate of evolution of the Egyptian HCV genotype 4a. It has also revealed significant level of genetic variability among sequences from different regions in the world.

Electronic supplementary material

The online version of this article (doi:10.1186/s12985-014-0231-y) contains supplementary material, which is available to authorized users.

Circulating tumor and cancer stem cells in hepatitis C virus-associated liver disease

AIM: To assess the role of circulating tumor cells (CTCs) and cancer stem cells (CSCs) in hepatitis C virus (HCV)-associated liver disease.

METHODS: Blood and/or tissue samples were obtained from HCV (genotype 4)-associated hepatocellular carcinoma patients (HCC; n = 120), chronic hepatitis C patients (CH; n = 30) and 33 normal control subjects (n = 33). Serum levels of alpha-fetoprotein (AFP), alkaline phosphatase, and alanine and aspartate aminotransferases were measured. Cytokeratin 19 (CK19) monoclonal antibody was used to enumerate CTCs, and CD133 and CD90 were used to enumerate CSCs by flow cytometry. The expression levels of the CSCs markers (CD133 and CD90) as well as telomerase, melanoma antigen encoding gene 1 (MAGE1) and MAGE3 were assessed by RT-PCR and quantitative real-time polymerase chain reactions. The number of CTCs and/or the expression levels of CK19, CD133, telomerase, MAGE1 and MAGE3 were correlated to the standard clinicopathologic prognostic factors and disease progression.

RESULTS: Levels of AFP, alkaline phosphatase and aspartate aminotransferase were significantly different among the HCC, CH and control groups (P < 0.001), whereas alanine aminotransferase differed significantly between patient (HCC and CH) and control groups (P < 0.001). At the specified cutoff values determine by flow cytometry, CK19 (49.8), CD90 (400) and CD133 (73) were significantly higher in the blood of HCC patients compared to those in the CH and control groups (P < 0.001). On the other hand, CD133 at a 69.5 cutoff was significantly higher in the CH compared to the control group (P≤ 0.001). Telomerase, MAGE1 and MAGE3 RNA were expressed in 55.71%, 60.00% and 62.86% of the HCC patients, respectively, but were not detected in patients in the CH or control groups, which were statistically significant (Ps < 0.001). The expression levels of telomerase, CD90, MAGE3, CD133 and CK19 were all significantly associated with high tumor grade and advanced stage in HCC patients (all Ps < 0.05).

CONCLUSION: CTC counts and AFP, CK19, telomerase, and MAGE1/MAGE3 expression predict disease progression in patients with HCV, whereas telomerase, MAGE3, CD90, CD133 and CK19 are prognostic markers in HCC.

Abstract 4735: Stem cells like phenotype of inflammatory breast cancer and locally advanced breast cancer: increased expression of sox2 and oct3/4 contributes to poor response to treatment and reduced survival rates

Background: Inflammatory breast cancer (IBC) is an aggressive form of locally advanced breast cancer (LABC) with poor response to treatment or metastasis in one-third of patients at presentation. The aggressive behavior of IBC was attributed to the cancer stem cell (CSC) component in these tumors. We assessed the correlation between CSC markers in IBC, LABC and the aggressive behavior of these tumors compared to invasive duct carcinoma (IDC-NOS).

Methods: CD44, CD90, CD133, nestin, SOX2 and OCT4 RNA and proteins expression were assessed in 30 cases of IDC-NOS, IBC and LABC (each) using quantitative real time PCR (qPCR) and immunohistochemistry (IHC). Markers expression was correlated to patients' characteristics, response to treatment, 4 years- overall and progression free survival (OS& PFS) .

Results: The expression levels in IBC and LABC was as follows: (CD44; 70%& 26.3%, p=0.003), (CD90; 49.2%& 28.1%, p=0.06), (CD133; 66.7%& 26.3%, p=0.006), (OCT4; 70%& 26.6%, p=0.004), (SOX2: 63.3%& 30%, p=0.02) and (Nestin; 53.3%& 31%, p=0.08). The difference in the expression levels of all studied markers between IDC-NOS and the other two groups was statistically significant (p.value: &lt;0.05- &lt;0.001). A significant relation was reported between the expression levels of SOX2, OCT-4 and the clinical response in IBC and LABC (p&lt;0.01). PFS significantly correlated with SOX2 and OCT4 expression (p=0.045) in IBC, whereas OS correlated with OCT4 in IBC and LABC (0.034& 0.04)

Conclusions: The aggressive phenotype of IBC and LABC could be attributed, at least partially, to the presence of CSC populations in these tumors. Therefore, CSC markers represent Interesting candidates for targeted therapy for this resistant type of breast tumors.

Citation Format: Abdel-Rahman N. Zekri, Abeer Bahnassy, Ahmed E. El-Bastawisy, Hanan R. Nassar, Neveen M. Elhady, John Effat. Stem cells like phenotype of inflammatory breast cancer and locally advanced breast cancer: increased expression of sox2 and oct3/4 contributes to poor response to treatment and reduced survival rates. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4735. doi:10.1158/1538-7445.AM2014-4735

Abstract 3184: Differential expression of viral agents in lymphoma tissues of patients with ABC diffuse large B-cell lymphoma from high and low endemic infectious disease region

Environmental factors play an important role in the development of cancer. Infectious organisms are one of the major causes of cancer among environmental factors. Several viruses have been classified as infectious agents causing cancer as EBV, HTLV-1, herpes virus-8 and hepatitis. Since the introduction of vaccines against viral infections as HPV and HBV, the incidence of cervical cancer and HCC respectively has decreased.

The aim of the study was to investigate the detection of viral and microbial agents in the lymphoma tissues of ABC DLBCL patients from Sweden (low infectious disease region) and Egypt (high infectious disease region) according to WHO classification. Microbial detection array (MDA) technique was used to identify viral detection in the tissue samples as well as antigen and antibody detection of serum samples of patients.

A differential detection of viruses in lymphoma tissues was noted comparing Swedish and Egyptian patients. Viruses that were detected in all groups (both controls and patients) were excluded leaving exclusively found viruses in each group. HBV had the highest expression including the complete genome and was only found in Egyptian patients. JCV was found both in Egyptian and Swedish patients but with a higher expression in the Egyptian patients while not detected in Swedish and Egyptian controls. Generally, the highest expressions were found in Egyptian patients compared to Swedish patients and controls from both countries. Few viruses were found in the control groups.

Based on serum HBV PCR, Egyptian patients were divided into a HBV antigen positive (HBV+) and HBV negative (HBV-) group. The relative expression of STAT3 did not differ between HBV+ and HBV- Egyptian patients but was significantly higher in the Swedish patients compared to the total Egyptian patient population. Since, miR-1234 might regulate STAT3, we also related the relative miR-1234 expression to HBV status. There was no difference in the relative expression of miR-1234 between HBV+ and HBV- Egyptian patients, while Swedish patients (HBV-) showed a significantly lower relative expression of miR-1234, compared to the total Egyptian patient population. miR-1234 related inversely to the expression patterns of STAT3.

The results indicate that Egyptian patients have a higher viral load and that HBV was the most common virus. However, our results may be of importance for treatment strategies in Egyptian patients since previous data have shown HBV reactivation in patients from high endemic infectious area during Rituximab treatment.

In summary, indicated that viral agents as JCV and HBV may be involved in the tumorigenesis of ABC DLBCL. We could not detect a relation of STAT3 expression to HBV. However, the regulation of STAT3 by miR-1234 might be associated to other viral infections and to the higher viral load as noted in the Egyptian patients.

Citation Format: Ali Moshfegh, Therese Högfeldt, Crystal Jaing, Joachim Lundahl, Anders Osterborg, Kevin Mc Loughlin, Shea N. Gardner, Baback Gharizadeh, Anna Porwit, Abeer A. Bahnassy, Abdel-Rahman N. Zekri, Hussein M. Khaled, Hakan Mellstedt. Differential expression of viral agents in lymphoma tissues of patients with ABC diffuse large B-cell lymphoma from high and low endemic infectious disease region. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3184. doi:10.1158/1538-7445.AM2014-3184

Abstract 3991: Increased expression of cancer stem cells markers (CD44, CD90 and CD133) contributes to disease progression and reduced survival in hepatoblastoma patients from Egypt: four years survival data

Background: Hepatoblastoma (HB) is an embryonal tumor of the liver that occurs in infants and young children. Complete surgical resection and cisplatin-containing chemotherapy are crucial for cure in HB. Cancer stem cells (CSCs) constitute a newly identified subpopulation, which may differentiate into heterogeneous progenies of malignant cells. The aim of this study is to assess the prognostic and predictive values of CSCs markers (CD133, CD90 and CD44) in a cohort of HB patients from Egypt.

Methods: Disease status was evaluated for 43 HB patients at the main checkpoints of therapy and during follow-up. Protein and RNA expressions of CD44, CD 90 and CD 133 were assessed by immunohistochemistry and quantitative real time (qPCR).

Results: OS for all patients at 4 years was 58.2. OS significantly correlated with disease stages (stage I&II versus III&IV 81.9% and 30%, p&lt;0.001); tumor response (p&lt;0.001); CD44, CD 90, CD 133 expression (p&lt;0.001) versus treatment modality (total surgical resection versus incomplete or no resection, 83.8% versus 25.2 %; p&lt;0.001). Reduced DFS was associated with CD44 and CD133 expression (p&lt;0.001) only.

Conclusion: Complete surgical resection and systemic chemotherapy significantly improve outcome in HB with a significantly higher survival rates among patients with early stage disease. Expression of CSCs markers (CD133, 44, and 90) can predict poor outcome in HB patients with reduced OS and DFS rates. However further studies are required to confirm their prognostic and potential targeted therapy value.

Citation Format: Abdel-Rahman N. Zekri, Abeer A. Bahnassy, Mohamed Fawzy, Mohamed El-Wakil, Ahmed Abdel-Sayed, Marwa E. Sheta. Increased expression of cancer stem cells markers (CD44, CD90 and CD133) contributes to disease progression and reduced survival in hepatoblastoma patients from Egypt: four years survival data. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3991. doi:10.1158/1538-7445.AM2014-3991

Abstract 2824: Circulating tumor cells (CTCs) can predict survival and response to treatment in non-metastatic colorectal cancer (CRC): Correlation between flowcytometry, quantitative real-time pcr (qPCR) and cytomorphology

Background: Circulating tumor cells (CTCs) were detected in patients with metastatic epithelial malignancies using different methodologies. The number of CTCs before and during treatment of advanced CRC is an independent predictor of poor response to treatment, progression-free (PFS) and overall survival (OS). We investigated 1) whether CTC count can predict outcome in patients with CRC and 2) the utility of FCM supplemented with PCR and/or cyto-morphology (CM) in enumerating CTCs.

Methodology: CTCs were enumerated in 56 CRC cases and 20 normal controls (NC) by flowcytometry (FCM), and quantitative real time PCR (qPCR) using CK19, MUC, CD44, CD133 and ALDH1after immune-magnetic separation. Results were correlated to cytomorphology, standard prognostic factors, overall and progression free survival (OS&PFS).

Results: CTCs &lt; 3 were detected in 45% of the cases compared to 55% with ≥3 CTCs. CK19, MUC1, CD44, CD133 and ALDH1-RNA expression was detected in (55.4%, 44.6%, 53.6%, 43.6%, 46.4%; respectively). The concordance between FCM& qPCR, FCM&CM, qPCR& CM ranged from 82% to 96%. Significant correlations were reported between CTCs and tumor stage and grade (p&lt;0.01). OS was significantly associated with pathological tumor type, T stage, lymph nodes involvement, CTC, CK, MUC1, CD44 and CD133. PFS was significantly associated with pathological tumor type, disease stage, N stage, CTC, CK, MUC1, CD44 and CD133 (p=).

Conclusions:1)enumeration of CTCs, pre- and after initial treatment, can predict outcome in CRC patients, 2)FCM is a sensitive, rapid and easy technique for enumeration of CTCs, especially if supplemented with qPCR for detection of CRC cells biomarkers (CK19), MUC, CD44, CD133 and ALDH1).

Citation Format: Abeer Bahnassy, Abdel-Rahman N. Zekri, Salem E. Salem, Marwa Mohamad, Marwa Mohanad. Circulating tumor cells (CTCs) can predict survival and response to treatment in non-metastatic colorectal cancer (CRC): Correlation between flowcytometry, quantitative real-time pcr (qPCR) and cytomorphology. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2824. doi:10.1158/1538-7445.AM2014-2824

Abstract 3006: Serum insulin growth factor/insulin growth factor receptor1 (IGF-I, IGF-I-1R) and VEGF-A as prognostic factors and surrogate biomarkers in triple negative breast cancer patients (TNBC)

Background: We evaluated the prognostic and predictive values of serum IGF-I, IGF-I-1R, VEGF and TGF-β1 in triple-negative and non-triple-negative breast cancer (TNBC&NTNBC) patients through correlation with standard prognostic factors and survival.

Methods: serum expression of VEGF-A, TGF-β1, IGF-I and IGF-I-1R proteins was measured in of 43 TNBC, 53 NTNBC and 20 normal control (NC) by quantitative enzyme linked immune-sorbant assay (ELISA). Results were correlated to patients’ characteristics, disease free and overall survival (DFS&OS).

Results: The cutoff points that discriminate between TNBC and NTNBC were: 10.09 ng/ml, 412.54 pg/ml and 106.96 ng/ml for IGF-I-1R, VEGF-A, and IGF-I. VEGF, IGF-I and IGF-I-1R differed significantly between groups (p &lt;0.001) whereas TGF-β1 differed significantly between NC and the other groups (p&lt;0.001). TNBC was associated with positive lymph nodes (p&lt;0.001), relapse and metastasis (p&lt;0.001). Response rate (RR) was significantly lower in TNBC patients (p&lt;0.001) with high serum VEGF-A, IGF-I-I/IGF-I-IR (p= 0.004, 0.001/0.003). Reduced DFS associated with high tumor grade, high VEGF-A (p&lt;0.001), high IGF-I/ IGF-I-IR (P&lt;0.001/ p&lt;0.001). Reduced OS associated with relapse (p&lt;0.001), high VEGF-A (p=0.001) and high IGF-I/ IGF-I-IR (p= 0.012/p= 0.02). in multivariate analysis positive nodes (P&lt; 0.001), high VEGF-A (P = 0.02) and IGF-I/ IGF-I-1R (P= 0.03, P= 0.01) were independent factor for disease recurrence.

Conclusions: TNBC represents an aggressive subset of breast tumors. IGF-I, IGF-I-IR, VEGF-A could be used as surrogate biomarkers for TNBC, as prognostic marker since their expression level correlates with reduced OS and high incidence of relapse. They also represent promising candidates for targeted therapy in TNBC patients.

Citation Format: Abdel-Rahman N. Zekri, Abeer Bahnassy. Serum insulin growth factor/insulin growth factor receptor1 (IGF-I, IGF-I-1R) and VEGF-A as prognostic factors and surrogate biomarkers in triple negative breast cancer patients (TNBC). [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3006. doi:10.1158/1538-7445.AM2014-3006

Peripheral vein infusion of autologous mesenchymal stem cells in Egyptian HCV-positive patients with end-stage liver disease

Introduction

We have assessed the utility of autologous mesenchymal stem cell (MSC) peripheral vein infusion as a possible therapeutic modality for patients with end-stage liver diseases.

Methods

Forty patients with post-hepatitis C virus (HCV) end-stage liver disease were randomized into two groups: Group 1 (GI): 20 patients who received granulocyte colony-stimulating factor (G-CSF) for 5 days followed by autologous MSCs peripheral-vein infusion and group 2 (GII): 20 patients who received regular liver-supportive treatment only (control group).

Results

In MSC-infused patients (GI), 54% showed near normalization of liver enzymes and improvement in liver synthetic function. Significant changes were reported in albumin (P = 0.000), bilirubin (P = 0.002), increased international normalized ratio (INR) (P = 0.017), prothrombin concentration (P = 0.029) and alanine transaminase (ALT) levels (P = 0.029), with stabilization of clinical and biochemical status in 13% of cases. None of the patients in GII showed any significant improvement. Hepatic fibrosis was assessed in GI by detection of procollagen IIIC peptide level (PIIICP) and procollagen III N peptide level (PIIINP). The pretreatment values of s-PIIICP and s-PIIINP were 9.4 ± 4.2 and 440 ± 189, respectively, with a decrease to 8.1 ± 2.6 and 388 ± 102, respectively, 3 months after MSC therapy. However, the difference was statistically nonsignificant (P = 0.7). A significant correlation coefficient was reported after 3 months between the s-PIIINP and prothrombin concentration (P = -0.5) and between s-PIIICP and ascites (P = 0.550).

Conclusions

First, autologous MSC infusion into a peripheral vein is as effective as the previously reported intrahepatic infusion. Second, MSCs have a supportive role in the treatment of end-stage liver disease, with satisfactory tolerability and beneficial effects on liver synthetic functions and hepatic fibrosis. Third, IV infusion of MSCs after G-CSF mobilization improves s-albumin within the first 2 weeks and prothrombin concentration and alanine Taransaminase after 1 month. According to the data from this current study and those previously reported by our group, we recommend further studies on patients’ infusion with pure CD133 and CD34 followed by IV infusion of in vitro-differentiated MSCs within 1 week and another infusion after 3 months.

Trial registration

ClinicalTrials.gov NCT01729221. Registered 17 November 2012.

IL28B rs12979860 gene polymorphism in Egyptian patients with chronic liver disease infected with HCV

BACKGROUND

Egypt has one of the highest prevalences of hepatitis C virus (HCV) infection worldwide. Although the IL28B gene polymorphism has been shown to modify the course of chronic HCV infection, this has not been properly assessed in the Egyptian population.

MATERIALS AND METHODS

The IL28B rs12979860 single nucleotide polymorphism (SNP) was therefore examined in 256 HCV-infected Egyptian patients (group II) at different stages of disease progression and in 48 healthy volunteers (group I). Group II was subdivided into GII-A (chronic hepatitis patients, n=119), GII-B (post hepatitis cirrhosis, n=66) and GII-C (HCC on top of cirrhosis, n=71).

RESULTS

The C/T genotype was the commonest in all groups. It was more frequent in GI (52%) than in GII (48%). There was no significant difference in the frequency of C/T and C/C or T/T genotypes between groups and subgroups (p=0.82). Within the subgroups; the C/C genotype was more common in GII-B while C/T and T/T genotypes were more common in GII-C, though with no significant difference (p=0.59 and p=0.80). There was no significant association between IL28B rs12979860 SNP and viral load, ALT, AFP level, METAVIR scores for necro-inflammation and fibrosis, and Child-Pugh classification.

CONCLUSIONS

1) IL28Brs12979860 C/T genotype is the commonest genotype in HCV-associated CH and HCC in Egypt. 2) IL28Brs12979860 polymorphisms are not associated with disease progression or aggression (histological staging, severity of fibrosis in CH or the incidence of post-HCV HCC). 3) Differences in IL28Brs12979860 genotypes could be a consequence of environmental or ethnic variation.

Differential expression of p53 family proteins in colorectal adenomas and carcinomas: Prognostic and predictive values

BACKGROUND

We studied the contribution of p53 family proteins and their isoforms to the development and progression of colorectal carcinoma in relation to VEGF.

METHODS

p53, p63, p73 and VEGF proteins were assessed in 45 colorectal adenomas (CRAs), 80 carcinomas (CRCs) and 36 normal colonic tissue samples (NCT) by immunohistochemistry. Different p63 and p73 isoforms were assessed by RT-PCR. Aberrant protein and RNA expressions were correlated to patients' characteristics, disease free and overall survival (DFS and OS).

RESULTS

p53, p63, p73 and VEGF proteins were detected in 22.2%, 73.3%, 33.3%, 46.7% CRAs; in 68.8%, 38.8%, 62.5%, 62.5% CRCs and 16.7%, 83.3%; 13.9%, 41.7% NCT (p<0.05 except for VEGF). Commonest isoforms were TAp63α, ΔNp63, TAp73α in CRA and ΔNp63, TAp63α, ΔNp73, TAp73β in CRC. Significant correlations were found between aggressive tumor phenotypes and aberrations in p73, p53, p63, VEGF. DFS correlated with advanced stage, p73 and VEGF aberrations. While advanced stage, positive lymph nodes, p73 and p53 correlated with OS. Prognosis was worse in patients with aberrant p63 and p73 than in those with normal p63 and p73 expression regardless of p53 gene status (p⟨0.05).

CONCLUSIONS

p53 family proteins and VEGF play a pivotal role in colorectal carcinogenesis. p53 prognostic potential is augmented by p73 and p63 aberrations indicating a synergistic effect between the three family members. Nodal status, stage, p73, VEGF and p53 could be used as predictors of DFS and OS.

Molecular prognostic profile of Egyptian HCC cases infected with hepatitis C virus

BACKGROUND

Hepatocellular carcinoma (HCC) is a common and aggressive malignancy. Despite of the improvements in its treatment, HCC prognosis remains poor due to its recurrence after resection. This study provides complete genetic profile for Egyptian HCC. Genome-wide analyses were performed to identify the predictive signatures.

PATIENTS AND METHODS

Liver tissue was collected from 31 patients with diagnosis of HCC and gene expression levels in the tumours and their adjacent non-neoplastic tissues samples were studied by analyzing changes by microarray then correlate these with the clinico-pathological parameters. Genes were validated in an independent set by qPCR. The genomic profile was associated with genetic disorders and cancer focused on gene expression, cell cycle and cell death. Molecular profile analysis revealed cell cycle progression and arrest at G2/M, but progression to mitosis; unregulated DNA damage check-points, and apoptosis.

RESULT

Nine hundred fifty eight transcripts out of the 25,000 studied cDNAs were differentially expressed; 503 were up-regulated and 455 were down-regulated. A total of 19 pathways were up-regulated through 27 genes and 13 pathways were down-regulated through 19 genes. Thirty-seven genes showed significant differences in their expression between HCC cases with high and low Alpha Feto Protein (AFP≥600 IU/ml). The validation for the microarray was done by real time PCR assay in which PPP3CA, ATG-5, BACE genes showed down-regulation and ABCG2, RXRA, ELOVL2, CXR3 genes showed up-regulation. cDNA microarrays showed that among the major upregulated genes in HCC are sets.

CONCLUSION

The identified genes could provide a panel of new diagnostic and prognostic aids for HCC.

Dynamic interplay between CXCL levels in chronic hepatitis C patients treated by interferon

BACKGROUND

Combined pegylated interferon-α and ribavirin therapy has sustained virological response (SVR) rates of 54% to 61%. Pretreatment predictors of SVR to interferon therapy have not been fully investigated yet. The current study assesses a group of chemokines that may predict treatment response in Egyptian patients with chronic HCV infection.

PATIENTS AND METHODS

CXCL5, CXCL9, CXCL11, CXCL12, CXCL 13, CXCL 16 chemokines and E-Cadherin were assayed in 57 chronic HCV patients' sera using quantitative ELISA plate method. All studied patients were scheduled for combined pegylated interferon alpha and ribavirin therapy (32 patients received pegylated interferon α 2b, and 25 patients received pegylated interferon α 2a). Quantitative hepatitis C virus RNA was done by real time RT-PCR and HCV genotyping by INNOLIPAII.

RESULTS

There was no significant difference (p > 0.05) in baseline HCV RNA levels between responders and non-responders to interferon. A statistically significant difference in CXCL13 (p = 0.017) and E-Cadherin levels (P = 0.041) was reported between responders and nonresponders at week 12. Significant correlations were found between changes in the CXCL13 levels and CXCL9, CXCL16, E-cadherin levels as well as between changes in E-cadherin levels and both CXCL16 and ALT levels that were maintained during follow up. Also, significant changes have been found in the serum levels of CXCL5, CXCL13, and CXCL16 with time (before pegylated interferon α 2 a and α 2 b therapy, and at weeks 12 and 24) with no significant difference in relation to interferon type and response to treatment.

CONCLUSION

Serum levels of CXCL13 and E-Cadherin could be used as surrogate markers to predict response of combined PEG IFN-α/RBV therapy, especially at week 12. However, an extended study including larger number of patients is needed for validation of these findings.

CLINICAL TRIAL NO

NCT01758939.

Abstract 3540: Evaluation of Alpha-fetoprotein (AFP), telomerase, melanoma associated antigen (MAGE1 and MAGE 3), cancer stem cell markers cytokeratin (CK) and (CD133,) as potential biomarkers for hepatocellular carcinoma (HCC)

Background. Hepatocellular carcinoma (HCC) had been recently classified as a complex disease with a wide range of risk factors. Analysis of AFP level as a tumor marker is applied in patients with a high risk of developing HCC. However, the lack of AFP sensitivity and specificity has elucidated the need for novel tumor markers. Therefore, the aim of the current study is to assess AFP, MAGE1 and MAGE 3, CK, and HCC cancer stem cell (CSC) markers (CD133, CD90, CD44) as potential biomarkers for HCC patients.

Patients and Methods. This study was conducted on the peripheral blood lymphocytes (PBL) of one 130 participants involving 70 patients with HCC, thirteen patients with chronic hepatitis (CH) and 30 normal controls. For those patients, serum AFP was tested by ELISA. Telomerase, MAGE 1, and MAGE 3, CD90 and CD44 RNA expression was detected by qualitative reverse transcriptase-polymerase chain reaction (qPCR). CD133 and CK expression was measured by flowcytometry (FCM) and qPCR analysis in 10 ml of PBL of each patient.

Results. All CH and HCC patients were positive for HCV antibodies. The number of cells expressing CD 133 in the patients PBL was significantly lower in HCC patients than other groups while that of CD90 and CD44 was significantly higher in HCC than in the other groups (p&lt;0.01). Also, MAGE-1,MAGE-3, AFP, CD90 and CD44 expressions by qPCR were significantly higher (p&lt;0.001) in HCC group than in chronic hepatitis and normal control groups. There was a highly significant difference (p&lt;0.001) between groups for telomerase gene expression, which was detected in 10% and 42.3% of CHC and HCC patients respectively. The expression levels of AFP, CD44 and CD90 correlated significantly with HCC stage (r=.461, p=0.001), grade and multicentricity (r=.244, p=0.02) while CD133 showed a significant correlation with tumor size (r=.455, P=0.006) but not significantly correlated with multicentricity and HCC stage. Cellular expression of CK was significantly higher in HCC than in other groups, and showed a significant correlation with tumor size (r=.347, P=0.041) and multicentricity (r=0.513, P=0.02).

Conclusion. 1) AFP, MAGE1, MAGE 3 and the number of cells expressing CK in the PBL of HCC could be used as markers for early detection of HCC. 2) The CSC markers (CD90, CD44) and AFP are highly expressed in HCC and contribute to aggressive phenotype thus they could be used as prognostic and predictive markers.

Citation Format: Abdel-Rahman N. Zekri, Abeer Bahnassy. Evaluation of Alpha-fetoprotein (AFP), telomerase, melanoma associated antigen (MAGE1 and MAGE 3), cancer stem cell markers cytokeratin (CK) and (CD133,) as potential biomarkers for hepatocellular carcinoma (HCC). [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3540. doi:10.1158/1538-7445.AM2013-3540

Abstract 1162: Caspase recruitment domains: New potential markers for diagnosis of hepatocellular carcinoma in Egyptian patients

Background: Chronic HCV is a major leading cause of HCC development. Caspase Recruitment Domains (CARD) is protein modules that regulate apoptosis. Besides; numerous CARD proteins play an important role in various carcinogenesis processes. Aim: To assess the possible role of CARD9, CARD10 and Caspase only protein (COP) in progression of liver fibrosis and pathogenesis of HCC in chronic HCV G4 Egyptian patients.

Methods: One hundred and thirty patients were recruited and classified into 4 groups; group I: Chronic HCV, group II: Chronic active hepatitis, group III: Liver cirrhosis, group IV: HCV related HCC. Biochemical, virological studies, abdominal ultrasonography and liver biopsy were performed. Quantitative estimation of mRNA of CARD9, CARD10 and COP were performed by reverse transcription PCR in liver biopsy from all collected patients.

Results: In HCC patients; age, AFP and liver profile were significantly higher, HB and platelets were significantly lower, (p value &lt;0.01). The expression levels of mRNA of CARD9, CARD10 and COP in liver biopsies of HCC group (IV) were significantly higher than other groups (p value&lt;0.01). On differentiation between HCC and non HCC patients each CARD was assessed separately then in combination with others as follow; CARD 9, CARD 10, COP and AFP separately showed best cutoff at (87, 89.5, 20.3, 10.35) with sensitivity (80%, 90%, 90%, 87%) and specificity (80%, 63%, 81%, 68%) with positive predictive value (61%, 51.4%, 69.2%, 54%) and negative predictive value (85.7%, 93.3%, 94.8%, 91%) respectively. On combing AFP with CARD9 then CARD 10 then COP, they showed (93%, 100%, 100% sensitivity), (57%, 46%, 57% specificity), with positive predictive value (49%, 45%, 51%) and negative predictive value (94%, 100%, 100%) respectively. On combing the 3 CARDs (CARD 9, CARD 10, COP), the sensitivity was 100%, specificity was 48%, with positive predictive value 47% and negative predictive value 100% as shown in figure 1.

Conclusions: CARD9, CARD10 and COP had no role in liver fibrosis but may be involved in hepatic carcinogenesis processes and they could be used as markers for HCC diagnosis

Citation Format: Abdel-Rahman N. Zekri, Abeer Bahnassy. Caspase recruitment domains: New potential markers for diagnosis of hepatocellular carcinoma in Egyptian patients. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1162. doi:10.1158/1538-7445.AM2013-1162

Methylation of multiple genes in hepatitis C virus associated hepatocellular carcinoma

We studied promoter methylation (PM) of 11 genes in Peripheral Blood Lymphocytes (PBLs) and tissues of hepatitis C virus (HCV) associated hepatocellular carcinoma (HCC) and chronic hepatitis (CH) Egyptian patients. The present study included 31 HCC with their ANT, 38 CH and 13 normal hepatic tissue (NHT) samples. In all groups, PM of APC, FHIT, p15, p73, p14, p16, DAPK1, CDH1, RARβ, RASSF1A, O⁶MGMT was assessed by methylation-specific PCR (MSP). APC and O6-MGMT protein expression was assessed by immunohistochemistry (IHC) in the studied HCC and CH (20 samples each) as well as in a different HCC and CH set for confirmation of MSP results. PM was associated with progression from CH to HCC. Most genes showed high methylation frequency (MF) and the methylation index (MI) increased with disease progression. MF of p14, p73, RASSF1A, CDH1 and O⁶MGMT was significantly higher in HCC and their ANT. MF of APC was higher in CH. We reported high concordance between MF in HCC and their ANT, MF in PBL and CH tissues as well as between PM and protein expression of APC and O⁶MGMT. A panel of 4 genes (APC, p73, p14, O⁶MGMT) classifies the cases independently into HCC and CH with high accuracy (89.9%), sensitivity (83.9%) and specificity (94.7%). HCV infection may contribute to hepatocarcinogenesis through enhancing PM of multiple genes. PM of APC occurs early in the cascade while PM of p14, p73, RASSF1A, RARB, CDH1 and O⁶MGMT are late changes. A panel of APC, p73, p14, O6-MGMT could be used in monitoring CH patients for early detection of HCC. Also, we found that, the methylation status is not significantly affected by whether the tissue was from the liver or PBL, indicating the possibility of use PBL as indicator to genetic profile instead of liver tissue regardless the stage of disease.

Patients with activated B-cell like diffuse large B-cell lymphoma in high and low infectious disease areas have different inflammatory gene signatures

Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease with an association with inflammation and viral infections. We hypothesize that environmental factors may be involved in the pathogenesis of DLBCL. In this study, we compared gene expression profiles of lymph node tissues from patients with DLBCL from two different geographical areas with diverse environmental exposures. Specimens from Egyptian and Swedish patients with DLBCL as well as controls were studied. Gene expression analysis using microarray and quantitative polymerase chain reaction demonstrated significantly higher expression of signal transducer and activator of transcription 3 (STAT3) in Swedish as compared to Egyptian patients and control materials from both countries. This was confirmed at protein level using confocal microscopy. The receptor tyrosine kinase ROR1, a "survival factor" for malignant cells, was overexpressed and significantly related to the STAT3 expression pattern. The difference in the expression of genes involved in inflammatory responses and in the tumorigenic process of DLBCL might relate to infectious agents and/or other environmental exposures.