H. pylori genotypes and cytokine gene polymorphisms influence the development of gastric intestinal metaplasia in a Chinese population

BACKGROUND

Cytokine gene polymorphisms and Helicobacter pylori (HP) genotypes have been linked to gastric cancer development in Western countries. We determined the role of host cytokine polymorphisms and bacterial virulent factors in the development of gastric intestinal metaplasia (IM) in a Chinese population with a high background gastric cancer incidence.

METHODS

Three hundred two HP-infected noncancer individuals living in Shandong province of China with available DNA were studied. Polymorphisms in different loci of inflammatory cytokines Interleukin IL-1B, IL-1RN, Interleukin IL-8, IL-10, IL-18, tumor necrosis factor-A (TNF-A), and Transforming growth factor (TGF-B), were determined by allelic discriminating TaqMan polymerase chain reaction (PCR) or a variable number of tandem repeats. Presence of HP virulence factors in cagA, vacA, and babA2 were determined by PCR. Baseline gastric biopsies were assessed for the presence of IM.

RESULTS

Among HP-infected subjects, carriers of the IL-1B-511 T allele were associated with a modestly greater prevalence of IM (adjusted OR 2.0, 95% CI 1.0-3.7). There was no association between the presence of IM and polymorphisms in other inflammatory cytokines. Although most subjects from this region harbored the virulent HP strains, carriage of the vacA m1 strain was associated with a significantly higher prevalence of IM (adjusted OR 1.8, 1.1-3.0). The presence of both host (IL-1B-511 T) and HP (vacA m1) genotypes further increased the risk of IM (OR 5.7, 2.0-16) when compared with individuals with the low-risk genotype.

CONCLUSION

The carriage of proinflammatory IL-1B-511 and HP vacA m1 genotypes was associated with the development of gastric IM in the Chinese.

Association of a distinctive strain of Epstein-Barr virus with gastric cancer

Epstein-Barr virus (EBV) has been linked to gastric carcinoma (GC) with worldwide geographical variations attributable to types and variants of EBV. Here, we compare EBV strains between EBVaGC and healthy donors in Latin America, a high frequency area for EBVaGC. Tumor samples from 73 EBVaGC cases and throat washings from 329 healthy adults were examined for types 1 and 2 EBV and polymorphism at BamHI-F and BamHI-W1/I1 boundary regions and XhoI restriction site in LMP1 gene. Type 1 and prototype F of BamHI- F polymorphism accounted 59 (81%) and 69 (95%) of EBVaGC cases and 257 (78%) and 267 (81%) of healthy donors, respectively. Types I and "i" of BamHI W1/I1 polymorphism accounted 2 (3%) and 62 (85%) of EBVaGC and 85 (26%) and 170 (52%) of healthy donors, respectively (p<0.001). XhoI+ and - polymorphism accounted 60 (82%) and 4 (5%) of EBVaGC and 142 (43%) and 92 (28%) of healthy donors, respectively (p<0.001). Cosegregation analysis demonstrated that most of the 62 type "i" EBVaGC cases harbor XhoI+ strain (81%). However, among 143 type "i" healthy adults, both XhoI polymorphism were present in relatively similar frequencies (XhoI+ 58% and XhoI- 42%) (OR 9.0; 95% CI 1.2-69). Our findings are against to the proposed hypothesis that EBV strains are geographically but not disease-restricted. We conclude that most of the EBVaGC cases harbor a distinctive EBV strain (type "i"/XhoI +), but in healthy donors, this strain was as common as other strains. This finding is contrary to the proposed hypothesis that EBV strains are geographically but not disease-restricted and identified a healthy population group that share the same strain that predominate in EBVaGC cases.

Correlation of Epstein-Barr virus and its encoded proteins with Helicobacter pylori and expression of c-met and c-myc in gastric carcinoma

AIM

To investigate the interrelationship of Epstein-Barr virus (EBV) and EBV- encoded proteins with Helicobacter pylori (H pylori) infection and the expression of c-met and c-myc oncogene proteins in gastric carcinoma, and to explore their role in gastric carcinogenesis.

METHODS

One hundred and eighty-five gastric carcinoma tissues were detected by polymerase chain reaction (PCR)-Southern blot for EBV genome and in situ hybridization (ISH) for EBV-encoded small RNA 1 (EBER1). Gastric carcinoma with positive EBER1 signals was confirmed EBV-associated gastric carcinoma (EBVaGC). The status of H pylori infection in 185 gastric carcinomas was assessed by rapid urease test and PCR. The samples with positive PCR and urease test were defined as H pylori infection. The expression of c-met and c-myc oncogene proteins in tissues of EBVaGC and matched EBV-negative gastric carcinoma (EBVnGC) were examined by immunohistochemistry. RT-PCR and Southern hybridization were used to detect the expression of nuclear antigens (EBNAs) 1 and 2, latent membrane protein (LMP) 1, early genes BARF1 and BHRF1 in EBVaGC cases.

RESULTS

The positive rate of H pylori and EBV in 185 gastric carcinomas was 59.45% (110/185) and 7.03% (13/185) respectively. No difference was found in sex, age, pathological differentiation, clinical stages and lymph node metastasis between H pylori-positive and H pylori-negative gastric carcinomas. However, the positive rate of H pylori infection in the antrum gastric carcinomas was higher than that of cardia and body gastric carcinomas. In our series, age, pathological differentiation, clinical stages, lymph node metastasis and location of cancer were not different between EBVnGC and EBVaGC, while the positive rate of EBV in male patients was significantly higher than that of female patients. The positivity of H pylori in EBV-associated and EBV-negative gastric carcinomas was 46.15% (6/13) and 81.40%(104/172) respectively. There was no significant correlation between EBV and H pylori infection. The c-met overexpression was significantly higher in the EBVaGC group than in the EBVnGC group. However, c-met and c-myc expression did not show significant difference between the two groups. Transcripts of EBNA1 were detected in all 13 EBVaGCs, while both EBNA2 and LMP1 mRNA were not detected. Six of the 13 cases exhibited BARF1 transcripts and 2 exhibited BHRF1 transcripts.

CONCLUSION

The positivity of H pylori in EBVnGCs is higher than that of EBVaGCs, but no significant correlation is found between EBV infection and H pylori infection. H pylori-positive gastric carcinoma is predominant in antrum location, while EBVaGC has a tendency of predominance in cardia/body location. EBV infection is associated with c-met abnormal expression but not with c-myc protein in EBVaGC. c-met overexpression is not induced by LMP1. BARF1 and BHRF1 may play important roles in the tumorigenesis of EBVaGC through different pathways.

Helicobacter pylori-Induced invasion and angiogenesis of gastric cells is mediated by cyclooxygenase-2 induction through TLR2/TLR9 and promoter regulation

Cyclooxygenase-2 (COX-2) plays a crucial role in Helicobacter pylori-associated gastric cancer. In this study, we report that H. pylori-induced COX-2 expression enhances the cancer cell invasion and angiogenesis via TLR2 and TLR9, which can be attenuated by the specific COX-2 inhibitor NS398 or celecoxib. The cAMP response element (CRE) and AP1 sites, but not kappaB on the COX-2 promoter, are involved in MAPKs-regulated COX-2 expression. Differential bindings of the CREB-1, ATF-2, c-jun to the CRE site, and the c-fos, c-jun, ATF-2 to the AP1 site are demonstrated by DNA affinity protein-binding, supershift, and chromatin immunoprecipitation assays. Activations of these transcription factors were attenuated by different MAPKs inhibitors. The mutants of TLR2, TLR9, or MAPKs inhibited H. pylori-induced COX-2 promoter, CRE, and AP-1 activities. MAPKs inhibitors attenuated the H. pylori-induced COX-2 mRNA and protein expressions. These results indicate that H. pylori acts through TLR2 and TLR9 to activate MAPKs, especially p38, and their downstream transcription factors (CREB-1, ATF-2, c-jun, and c-fos), resulting in the activations of CRE and AP-1 on the COX-2 promoter. These intracellular networks drive the COX-2-dependent PGE2 release and contribute to cell invasion and angiogenesis.

[Significance of the expression of P53 protein and P21WAF1 protein in the gastric carcinoma tissues associated with Epstein-Barr virus (EBV) infections]

BACKGROUND

To study the difference in gene expression between the EBV associated gastric carcinoma (EBVaGC) tissues. To explore the mechanism of gastric carcinoma pathogenesis initiated by EBV.

METHODS

In situ hybridization was used to study the frequencies of EBV small RNA expression in 155 cases of gastric carcinoma tissues. The expression levels of P53 protein and P21WAF1 protein were detected by immunohistochemistry in all gastric carcinoma tissues.

RESULTS

The expression of EBV small RNA was positive in 10 out of 155 cases (6.45%). The expression of P53 protein was weakly positive in 4 of the 10 cases. The expression level of P53 protein in EBVaGC was much lower than that in EBVnGC and was weakly positive in 30 of 145 cases with EBVnGC). P21WAF1 expression was detected in 7 of 10 cases with EBVaGC, but in 55 out of 145 cases with EBVaGC, P21WAF1 expression in EBVaGC was much higher than that in EBVnGC.

CONCLUSION

There seems existing a special mechanism of pathogenesis in EBVaGC. In which P53 gene mutation may not play an important role.

CDH1 Gene Promoter Hypermethylation in Gastric Cancer

Hypermethylation of the CDH1 promoter region seems to be the most common epigenetic mechanism in this gene silencing in gastric cancer. In this study, CDH1 promoter hypermethylation was observed in 54.8% (46/84) of the analyzed sporadic gastric carcinomas. We introduce a new relation: clustering of Goseki grading into 3 grade was determined by CDH1 promoter hypermethylation. The percentage of methylation in Goseki III cancers was significantly higher (83%) when compared with other grades; the lowest proportion was detected in IV (36%) and II (38%) groups, whereas grade I demonstrated typical percentage of promoter hypermethylation. A novel polymorphism R732R in exon 14 of the CDH1 gene was detected by mutational analysis. Additionally, all cases with the MSI-high phenotype revealed CDH1 promoter hypermethylation. In MSI-low and MSS gastric cancers, this percentage was lower, reaching 71% and 41%, respectively. Moreover, the methylation status was correlated with the LOH phenotype. We detected CDH1 promoter hypermethylation in all EBV-positive gastric cancers (5/5), whereas methylation in the EBV-negative group occurred in 58% of cases. We also report that "methylated" tumors were slightly larger than "nonmethylated," whereas the second group revealed a higher probability of longer patient survival, though these relationships were not statistically significant. These results suggest that downregulation of E-cadherin, caused by promoter hypermethylation, in sporadic gastric carcinomas may be associated with a worse prognosis and specific tumor phenotype.

P16 protein abnormality in Epstein-Barr virus-associated gastric carcinomas

BACKGROUND

The Epstein-Barr virus (EBV) has been detected in lymphoepithelioma of the nasopharynx and lymphoepithelioma-like carcinomas in various organs. Ten percent of gastric carcinomas, including lymphepithelioma-like carcinoma and adenocarcinoma, are associated with EBV infection. The p16 protein is a cyclin-dependent kinase (CDK) inhibitor that decelerates the cell cycle, inactivating the CDKs that phosphorylate retinoblastoma (Rb) protein.

MATERIALS AND METHODS

To clarify the relationship between p16 overexpression and EBV-associated gastric carcinomas, immunohistochemical analysis of p16 and detection of EBV by in situ hybridization were performed on 238 formalin-fixed and paraffin-embedded samples of gastric carcinomas.

RESULTS

The non-expression of p16 protein in EBV-positive and -negative carcinoma was 81.5% (53 out of 65 samples) and 26.6% (46 out of 173 samples), respectively (p < 0.001).

CONCLUSION

We suggest that the carcinogenesis of EBV-associated gastric cancers may be closely associated with a p16 abnormality.

Epstein-Barr virus involvement is a predictive factor for the resistance to chemoradiotherapy of gastric diffuse large B-cell lymphoma

Primary gastric diffuse large B-cell lymphomas are generally well controlled by non-surgical treatment with combination chemotherapy followed by radiotherapy. We have previously reported that over 90% of patients achieved complete response (CR) with this therapeutic strategy: three cycles of cyclophosphamide, adriamycin, vincristine and prednisone followed by radiotherapy (40.5 Gy). Although the CR rate was very high, some patients still showed resistance to this combination therapy. In order to clarify the factors related to therapy resistance, we examined the relationship between Epstein-Barr virus (EBV), which was examined using an in situ hybridization technique, and the patients' clinical courses. Out of the 50 patients, four were EBV positive; over half of lymphoma cells were positive for EBV by in situ hybridization. Of the three EBV-positive patients, two showed progressive disease and one achieved partial response (PR). Two of the patients died of disease progression. The other patient achieved CR, but the lymphoma recurred with distant metastasis in the cerebellum 3 months after remission. In the present study, eight patients did not achieve CR or they relapsed, four patients showed progressive disease, one patient achieved PR, and three patients achieved CR with recurrence. Therefore, half of these unfavorable patients were EBV positive. This finding strongly indicated that EBV-associated gastric diffuse large B-cell lymphomas frequently show resistance to standard chemoradiotherapy, although some other adverse factors remain unclear.

Epstein-Barr virus (EBV) infection and p53 protein expression in gastric carcinoma

In the presented studies p53 protein expression was evaluated in samples of gastric carcinoma originating from 32 selected adult patients (with documented diagnosis of adenocarcinoma of the stomach and without the presence of Helicobacter pylori infection). Among the patients 14 individuals carried EBV-positive gastric carcinoma (group 1) while the 18 remaining patients carried EBV-negative gastric carcinoma (group 2). EBV infection was detected testing the tissue material for the presence of EBER by RNA in situ hybridization (ISH) and testing sera of the patients for EBV-specific antibodies. Expression of p53 protein was analysed using immunohistochemistry. Presence of p53 protein was noted in 9 (64.3%) cases of EBV-positive gastric cancer (group 1) and in 10 (55.5%) cases of EBV-negative gastric cancer (group 2). No significant differences were detected in the frequencies of p53 protein expression in the two studied groups. The results permit to conclude that abnormalities in p53 in gastric cancer are independent of EBV infection, even if EBV may participate in development of the tumour.

Morphological Evidence of an Activated Cytotoxic T-Cell Infiltrate in EBV-Positive Gastric Carcinoma Preventing Lymph Node Metastases

Recently, we showed that Epstein-Barr virus (EBV)-positive gastric carcinoma (GC) forms a distinct clinicopathologic entity with a better prognosis due to lower incidence of lymph node metastases (LN+). Here we investigated whether in EBV-positive GC more pronounced activation of cellular immune responses is associated with absence of (micro)metastases. Twenty EBV-positive primary tumors (PT) (9 LN+) were matched with 28 EBV-negative GC (11 LN+) for T- and N-stage, gender, and age. The PT (n = 28) and its LNs were analyzed by EBER RNA in situ hybridization and by immunohistochemistry for MHC class I and II expression, for CD3, CD8, CD4, CD20, CD56, CD83, and Granzyme B (GzB) expression. In LN metastases of EBV-positive GC, the EBV genome is maintained, excluding tumor escape by virus deletion. All GC express MHC class I independently of EBV status. In comparison with EBV-negative GC, EBV-positive GC have higher expression of MHC class II on the tumor cells (P = 0.029) and a more extensive infiltrate (P < 0.0001) of activated GzB+ CD8+ T cells (P = 0.028), which is most abundant in those EBV-positive tumors that do not metastasize (P < 0.0001). In addition, in EBV-positive GC without metastases, the infiltrate contains higher numbers of mature dendritic cells (DC) (P = 0.018). At present, the antigenic target has to be determined. These data support the notion that local triggering of cellular immune responses in EBV-positive GC prevents lymph node metastasis formation.

Environmental factors related to Epstein-Barr virus-associated gastric cancer in Japan

Epstein-Barr virus (EBV)-encoded small RNA can be detected in about 1-17% of gastric carcinomas. To elucidate the lifestyles and other factors related to the EBV-associated gastric carcinoma (EBV-GC), we interviewed 43 EBV-GC cases and 162 non EBV-GC cases in Kagoshima Prefecture, Japan from 1996-2001. We mainly focused on lifestyles predominant among men because of its male predominance. Although the prevalence of smokers in EBV-GC cases was higher than among non EBV-GC cases, the difference was not significant (P = 0.131). Frequent drinking of coffee and high-temperature drinks, as well as frequent intake of salty and spicy foods, were more prevalent among EBV-GC cases, but only frequent intake of salty food showed a significant difference between EBV-GC and non EBV-GC cases (P = 0.026). In addition, EBV-GC cases tended to be exposed to wood dust and/or iron filings (P = 0.068) and tar (P = 0.097). These findings, together with a high frequency of EBV-GC among remnant cancers after partial gastrectomy, suggest an association between mechanical injuries to the stomach membrane and the high frequency of EBV-GC. The present study also showed that EBV-GC cases tended to be elder brothers/sisters (P for trend = 0.029) suggesting that age at primary infection with EBV may be older in EBV-GC cases than non EBV-GC cases.

Lymphoproliferative disorders in Costa Rica and simian virus 40

BACKGROUND AND OBJECTIVES

Simian virus 40 (SV40) is an oncogenic DNA virus implicated in some human malignancies, including lymphomas. In the present masked case-control study, we investigated the prevalence of SV40 sequences and the expression of the viral oncoprotein, large tumor antigen (T-ag), in lymphomas and control specimens from patients negative for the human immunodeficiency virus in Costa Rica.

DESIGN AND METHODS

Coded specimens were anlyzed by polymerase chain reaction for SV40 and Epstein-Barr virus (EBV). SV40 sequences were confirmed by Southern blot and DNA sequence analysis. Immunohistochemistry was used to detect the expression of SV40 T-ag in coded samples and to immunophenotype the lymphomas.

RESULTS

When samples were decoded, SV40 DNA sequences were detected significantly more often in lymphomas than in control samples (30/125, 24% vs. 0/91, 0%; p=0.001). SV40 DNA was detected in 26% and 10% of non-Hodgkin's and Hodgkin's lymphomas, respectively. EBV DNA was detected in 10% of lymphomas and 33% of control specimens. None of the lymphomas was positive for both SV40 and EBV. Expression of SV40 T-ag was detected in 64% of B-cell lymphomas that contained T-ag DNA sequences and in none of the samples negative for viral DNA. Not all cells in a positive tumor expressed T-ag and the reactions were relatively low intensity. A germinal center B-cell-like profile was frequently associated with SV40-positive lymphomas. Of note, 20% of patients with SV40-related lymphomas were born in the 1970s and 1980s.

INTERPRETATION AND CONCLUSIONS

These results indicate that SV40 is significantly associated with some B-cell neoplasms in Costa Rica today.

Cell-cycle regulators, bcl-2 and NF-kappaB in Epstein-Barr virus-positive gastric carcinomas

The mechanism by which Epstein-Barr virus (EBV) contributes to the carcinogenesis of gastric mucosa remains unanswered. In this study, the role of cell-cycle regulators (p53, p21, p27, p16, cyclin D1, Rb), bcl-2 and NF-kappaB p65 (Rel A) was evaluated. Immunohistochemistry for these proteins was performed in EBV-positive (n=55) and EBV-negative gastric carcinomas (n=72). The bcl-2 protein by western blot and EBV transcripts using RT-PCR were studied in cell lines. The p27 loss, p16 loss, cyclin D1 expression and NF-kappaB nuclear positivity were more frequent in EBV-positive gastric carcinomas than those in EBV-negative gastric carcinomas, while p53 overexpression seldom occurred in EBV-positive carcinomas (p<0.001). EBV-positive gastric carcinoma showed unique p53 immunostaining (heterogeneous, weak to moderate, focal staining), and rare bcl-2 positivity (1 case). Western blot showed bcl-2 to be irrespective of EBV status in stomach cancer cell lines. However, bcl-2 was highly expressed in EBV-positive lymphoma or EBV-positive lymphoblastoid cell lines. The BARF1 transcript was confirmed in both EBV-positive stomach cancer and EBV-positive lymphoma, suggesting tissue type-specific bcl-2 activation by BARF1. The pathological tumor stage was the only independent prognostic factor. A small size of tumor, p16 preservation and NF-kappaB nuclear positivity were associated with a good prognosis in univariate analysis (p<0.05). p27, p16, cyclin D1 and NF-kappaB may be associated with oncogenesis in EBV-positive gastric carcinomas. EBV-positive gastric carcinomas showed infrequent p53 overexpression, wild-type p53 stabilization and rare bcl-2 involvement. The characteristic expression of proteins may relate to both EBV and tissue type.

Silencing and CpG island methylation of GSTP1 is rare in ordinary gastric carcinomas but common in Epstein-Barr virus-associated gastric carcinomas

BACKGROUND

The GSTPI gene encodes for glutathione S-transferase pi (GST-pi), which protects cells from cytotoxic agents. The carcinogenic role of this enzyme is at issue because functional polymorphisms have been shown to be a risk factor of human cancer. Moreover, GST-pi protein loss has frequently been reported in various human cancers.

MATERIALS AND METHODS

The expression of GST-pi and the methylation status of the promoter area of GST-pi were investigated in gastric carcinomas. Eleven human SNUgastric cancer cell lines, PC-3 prostate cancer cell lines, various cancer tissues and normal gastric mucosa tissues were analyzed by immunohistochemistry, in situ hybridization, Western blot and methylation specific PCR.

RESULTS

Only 22 (2.0%o) out of 1081 cases showed loss of GST-pi expression. Interestingly, 16 out of 22 GST-pi-negative cases were Epstein-Barr virus (EBV)-associated gastric carcinomas. The loss of expression of GST-pi among EBV-associated gastric carcinomas was found to be 27.1% (16/59), but to be 0.6% (6/1022) in EBV-negative gastric carcinomas (p < 0.001). Eight out of 16 cases with loss of GST-pi expression showed CpG island methylation in the GSTP1 promoter region, while none of the normal gastric mucosa or EBV-negative gastric carcinomas showed methylation (p < 0.001).

CONCLUSION

These findings demonstrate that the loss of GST-pi expression is clustered in a subset of gastric carcinomas with EBV incorporation, and that the methylation of the promoter of the GSTP1 gene is correlated with this loss of GST-pi expression. Our results suggest that GST-pi abrogation by CpG island hypermethylation may account for EBV-associated gastric carcinoma.

Intratumour T cells, their activation status and survival in gastric carcinomas characterised for microsatellite instability and Epstein-Barr virus infection

Gastric carcinomas (GCs) with high microsatellite instability (MSI) or an Epstein-Barr virus (EBV) infection are prevalently poorly differentiated adenocarcinomas with abundant lymphoid infiltration. The aims of the study were to clarify (1) if tumour-infiltrating lymphocytes (TILs) and cytotoxic-activated TILs are associated with a better clinical outcome in patients with GCs characterised for the presence of MSI and EBV; (2) if the nature and the activation status of TILs are involved in tumour cell apoptosis, evaluated using the M30 antibody, directed against a fragment of cytokeratin-18 caspase-cleaved during early steps of epithelial cell apoptosis. The immunophenotype of TILs and the tumour cell apoptosis were analysed with immunohistochemistry in 96 GCs, including 35 MSI GCs, and 61 GCs without MSI [microsatellite stable (MSS)], 17 of which were EBV+. MSI and MSS/EBV+ GCs displayed a significantly higher mean number of cytotoxic-activated TILs and apoptotic tumour cells than MSS/EBV- GCs (CD8+ TILs/HPF, 21.7 and 69.6 vs 6.4; T-cell intracellular antigen (TIA)-1+ TILs/HPF, 16.7 and 32.05 vs 5.2; granzyme B+ TILs/HPF, 7.5 and 8.6 vs 0.8; perforin+ TILs/HPF, 5.9 and 9.2 vs 0.9; and M30 IR tumour cells, 5.9 and 2.9 vs 2.3%). In addition to the most reliable clinico-pathological parameters (lymph node status, depth of tumour invasion and tumour stage), a univariate analysis showed that the presence of CD3+ TILs higher than 14.9 (p=0.01), CD8+ TILs higher than 9.5 (p<0.05) and MSI (p=0.02) were associated with better overall patient survival. Using a Cox regression model, only a high number of CD3+ TILs (p=0.02) and a low tumour stage (p=0.00001) were identified as independent prognostic factors. In conclusion, our study demonstrates that a high number of CD3+ and CD8+ TILs is a characteristic of MSI- and EBV-associated GCs and represents a favourable prognostic factor, independently of the pathogenesis of GCs.

Epstein-Barr virus-associated gastric carcinoma: Evidence of age-dependence among a Mexican population

AIM: To investigate features of Epstein-Barr virus (EBV)-associated gastric carcinoma (EBVaGC) among a Mexican population.

METHODS: Cases of primary gastric adenocarcinoma were retrieved from the files of the Departments of Pathology at the Instituto Nacional de Cancerología and the Instituto Nacional de la Nutrición in Mexico City. The anatomic site of the gastric neoplasia was identified, and carcinomas were histologically classified as intestinal and diffuse types and subclassified as proposed by the Japanese Research Society for Gastric Cancer. EBV-encoded small non-polyadenylated RNA-1 (EBER-1) in situ hybridization was conducted to determine the presence of EBV in neoplastic cells.

RESULTS: We studied 330 consecutive, non-selected, primary gastric carcinomas. Among these, there were 173 male and 157 female patients (male/female ratio 1.1/1). EBER-1 was detected in 24 (7.3%) cases (male/female ratio: 1.2/1). The mean age for the entire group was 58.1 years (range: 20-88 years), whereas the mean age for patients harboring EBER-1-positive gastric carcinomas was 65.3 years (range: 50-84 years). Age and histological type showed statistically significant differences, when EBER-1-positive and -negative gastric carcinomas were compared. EBER-1 was detected in hyperplastic- and dysplastic-gastric mucosa surrounding two EBER-1-negative carcinomas, respectively.

CONCLUSION: Among Latin-American countries, Mexico has the lowest frequency of EBVaGC. Indeed, the Mexican population >50 years of age was selectively affected. Ethnic variations are responsible for the epidemiologic behavior of EBVaGC among the worldwide population.

Changes in gene expression profiles induced by parvovirus H-1 in human gastric cancer cells

OBJECTIVE

The autonomous parvovirus H-1 exhibits preferential toxicity for transformed or tumor cells. The precise molecular mechanism of H-1 virus-associated cytotoxicity is not fully understood. The present study aimed at gaining more information about parvovirus-induced cellular disturbances.

METHODS

The H-1 virus-sensitive human gastric cancer cell line HGC27 was analyzed in the present study. cDNA microarrays were used to determine the global cellular gene expression changes which occur during the process of H-1 virus-induced death of HGC27 cells. A subset of differential expressed genes was further tested by RT-PCR and Northern blot analyzes.

RESULTS

A total of 920 genes belonging to various functional groups were found to be differentially expressed in H-1 virus- versus mock-infected cells in cDNA microarrays. Among them, 363 genes were upregulated, whilst 557 genes were downregulated. The differential expressions of some of these genes were further confirmed by RT-PCR and Northern blot analysis.

CONCLUSION

Some of genes known to be involved in cell signal transduction, apoptosis, DNA replication, DNA repair, DNA binding and transcription were differentially expressed after parvovirus H-1 infection, they might play a role in H-1 virus-induced gastric cancer cell death. These genes represent interesting candidates to be tested at the functional level for their contribution to the disturbances triggered by H-1 virus in tumor cells.

Synchronous Adenocarcinoma and Mucosa-associated Lymphoid Tissue (MALT) Lymphoma in a Single Stomach

BACKGROUND

Synchronous gastric adenocarcinoma and primary gastric mucosa-associated lymphoid tissue (MALT) lymphoma are rare, and the characteristics of these tumors are still unclear.

METHODS

Histology of endoscopic and surgical specimens of 6012 gastric adenocarcinoma and 25 primary gastric MALT lymphoma cases were reviewed.

RESULTS

Five cases of synchronous tumors were found among 25 primary gastric MALT lymphoma patients (20.0%) and among 6012 gastric adenocarcinoma patients (8.3%). Helicobacter pylori was detected only in two cases (40.0%) of these five synchronous cases. In only one case, two types of malignant cells were mingled each other as a colliding tumor. In other four cases, two pathologies coexisted separately. These two types of malignant tumors were not distinguished by endoscopic or gross findings.

CONCLUSIONS

Although gastric adenocarcinoma coexists with MALT lymphoma at a relatively high frequency, synchronous carcinoma can be misinterpreted as a multifocal separated lesion of MALT lymphoma owing to their macroscopic resemblance. Therefore, gastric MALT lymphoma patients should be carefully examined by endoscopy, and any suspicious area must be biopsied considering the possibility of coexisting adenocarcinoma. In addition, etiologies other than H. pylori should be considered in these synchronous tumors.

Soft and hard keratin expression in Epstein-Barr-virus-associated gastric carcinoma

BACKGROUND

Epstein-Barr-virus-associated gastric carcinoma (EBVaGC) is a distinct subset of gastric carcinoma (GC). The expressions of cytokeratins (CK)7, 8, 18, 19 and 20 and truncated basic hair keratin 1 (hHb1-deltaN) were investigated in GC to clarify the characteristics of EBVaGC.

MATERIALS AND METHODS

For immunohistochemical evaluation, 173 GC tissues were examined and 31 GC tissues and 5 GC cell lines were used for quantitative real-time RT-PCR (qrt-RT-PCR) and RT-PCR.

RESULTS

EBVaGC showed significantly lower immunohistochemical positivity of CK7 (-/(+/-)/+/+ +/+ + +; 27/15/4/1/1) compared to EBV-negative GC (12/29/27/44/13), even after stratification by histological types. The qrt-RT-PCR test demonstrated decreased amounts of CK7, 18 and 19 mRNAs in EBVaGC. Two among 5 GC cell lines showed a decrease of CK7 mRNA level after recombinant EBV infection. hHb1-deltaN expression was not specific to EBVaGC.

CONCLUSION

Abnormalities of CK7, 18 and 19 expressions, especially a decreased amount of CK7 expression, are characteristics of EBV-associated epithelial malignancies and might be important in carcinogenesis.

Epstein-Barr virus (EBV)-encoded BARF1 gene is expressed in nasopharyngeal carcinoma and EBV-associated gastric carcinoma tissues in the absence of lytic gene expression

The BARF1 gene is located in the BamHI-A fragment of the Epstein-Barr virus (EBV) genome, encodes 221 amino acids, and has activity as an oncogene. Several reports have demonstrated that BARF1 is expressed in the tissues of various EBV-associated epithelioid malignancies. However,BARF1 is thought to be a lytic gene, since its expression is induced upon induction of the lytic cycle in Burkitt's lymphoma cell lines. Therefore, the possibility cannot be excluded that BARF1 expression in EBV-associated epithelioid malignancies reflects spontaneous induction of the lytic cycle in carcinoma cells. The present study aimed to clarify whether BARF1 was expressed as a latent gene or a lytic gene in epithelioid malignancies. Quantitative real-time RT-PCR assay revealed that BARF1 was highly expressed in nasopharyngeal carcinoma (NPC) and EBV-positive gastric carcinoma tissues in the absence of expression of lytic genes. On the other hand, BARF1 protein was detectable only in two of seven NPC tissue samples by immunoblot analysis. Analysis of BARF1-transfected CNE1 cells revealed that BARF1 was quickly secreted into culture medium and was hardly detectable in the cell lysate, which would account for why some NPC tissues were negative for BARF1 protein expression even though they were strongly positive forBARF1 expression at the transcriptional level. The present findings indicate that BARF1 is expressed in NPC and EBV-positive gastric carcinoma tissues as a latent gene and suggest that BARF1 plays a role in the pathogenesis of these malignancies.

[Clinical and molecular features of cardial gastric cancer associated to Epstein Barr virus]

BACKGROUND

Mortality caused by cardial gastric cancer in Chile, is increasing. Previously we demonstrated an association between Epstein Barr virus and this specific location of gastric cancer.

AIM

To perform a clinical and molecular characterization of cardial gastric cancer associated to Epstein Barr virus.

MATERIAL AND METHODS

Epstein Barr virus was identified in 93 cardial gastric tumors, by in situ hybridization. Clinical and pathological features, survival and expression of p53 and c-erbB2 were compared between tumors with or without the presence of the virus.

RESULTS

Twenty two (23.6%) tumors expressed Epstein Barr virus. No difference in sex or age of patients with tumors positive or negative for the virus was observed. Epstein Barr positive tumors had a tendency to have a higher frequency of Bormann III endoscopic appearance and a lower frequency of p53 accumulation (p=0.06). Five years survival was 67% and 42% of tumors positive and negative for the presence of the virus, respectively (p=0.57).

CONCLUSIONS

Our results, although not significant, show a tendency towards unique characteristics of cardial gastric tumors associated to Epstein Barr.

Mucin and differentiation in Epstein-Barr virus-associated gastric carcinoma

BACKGROUND/AIMS

Epstein-Barr virus (EBV) is present in roughly 1 in 10 cases of gastric carcinoma, particularly in undifferentiated adenocarcinomas. To clarify the histological developmental processes in EBV-associated gastric carcinoma, we investigated the presence of EBV infection, changes in the degree of differentiation within lesions, and mucin phenotypes of gastric carcinomas.

METHODOLOGY

We had already examined 124 gastric carcinomas using in situ hybridization for EBV-encoded small RNA1 (EBER-1) and 12 lesions were EBER-1-positive. From these lesions we selected 8 carcinomas positive for EBER-1, and then chose 16 EBER-1-negative carcinomas as controls. Hematoxylin and eosin (H&E) stained specimens were examined for changes in histological type within each lesion. Mucin phenotypes of the specimens were determined using human gastric mucin (HGM), MUC2 and CD10 immunostaining.

RESULTS

Of the EBER-1-positive lesions, 50% exhibited the gastric type mucin phenotype, whereas only 19% of the EBER-1-negative lesions were of the gastric phenotype. Changes in the histological type were seen within 75% of the EBER-1-positive lesions and within 62.5% of the EBER-1-negative lesions.

CONCLUSIONS

The gastric mucin phenotype tended to be more common in the EBV-associated gastric carcinomas. The influence of EBV infection on the change in the histological type within the lesion was considered to be slight.