Recent advances in understanding the role of lysophosphatidic acid in the pathogenesis of gastrointestinal tumors

Lysophosphatidic acid is an important intercellular lipid mediator that acts through G-protein coupled receptors to mediate the development and progression of a variety of tumors. In this article, we will summarize the structure and physiological function of lysophosphatidic acid and review its role in the pathogenesis of colon cancer, gastric cancer, liver cancer and other gastrointestinal tumors.

Alphastatin downregulates vascular endothelial cells sphingosine kinase activity and suppresses tumor growth in nude mice bearing human gastric cancer xenografts

AIM: To investigate whether alphastatin could inhibit human gastric cancer growth and furthermore whether sphingosine kinase (SPK) activity is involved in this process.

METHODS: Using migration assay, MTT assay and Matrigel assay, the effect of alphastatin on vascular endothelial cells (ECs) was evaluated in vitro. SPK and endothelial differentiation gene (EDG)-1, -3, -5 mRNAs were detected by reverse transcription-polymerase chain reaction (RT-PCR). SPK activity assay was used to evaluate the effect of alphastatin on ECs. Matrigel plug assay in nude mice was used to investigate the effect of alphastatin on angiogenesis in vivo. Female nude mice were subcutaneously implanted with human gastric cancer cells (BGC823) for the tumor xenografts studies. Micro vessel density was analyzed in Factor VIII-stained tumor sections by the immunohistochemical SP method.

RESULTS: In vitro, alphastatin inhibited the migration and tube formation of ECs, but had no effect on proliferation of ECs. RT-PCR analysis demonstrated that ECs expressed SPK and EDG-1, -3, -5 mRNAs. In vivo, alphastatin sufficiently suppressed neovascularization of the tumor in the nude mice. Daily administration of alphastatin produced significant tumor growth suppression. Immunohistochemical studies of tumor tissues revealed decreased micro vessel density in alphastatin-treated animals as compared with controls.

CONCLUSION: Downregulating ECs SPK activity may be one of the mechanisms that alphastatin inhibits gastric cancer angiogenesis. Alphastatin might be a useful and relatively nontoxic adjuvant therapy in the treatment of gastric cancer.

Xiaotansanjie recipe inhibits growth and metastasis of human gastric adenocarcinoma cell SGC-7901transplanted in nude mouse

AIM: To investigate the effects of the Xiaotansanjie recipe on the nude mouse model of human gastric carcinoma cells using orthotopic transplantation.

METHODS: Firstly we established the metastatic gastric carcinoma model of nude mice by orthotopic implantation. On the second day they were devided into four groups at random. The inhibitary rates of tumour growth were detected, and local invasiveness, the rates of metastasis in the local lymph node, lung, liver and peritoneum were compared between different groups. By Envision immunohistochemical method and semiquantitative reverse transcription polymerase chain reation, the expression of P21ras, P185, Ras, CerbB₂, VEGF and KDR in gastric carcinoma were determined.

RESULTS: The inhibitary rates of Xiaotansanjie recipe group, 5-Fu group and combined group were 72.0% , 51.3% and 70.1% respectively. Compared with the control group,the rates of local invasiveness, metastasis in the lymph node and distal organs in other three groups were significantly lower (P < 0.05). The positive rate of P21ras, P185, Ras, CerbB₂, VEGF and KDR in Xiaotansanjie recipe group obviously lower than those in control group (P < 0.05).

CONCLUSION: Xiao Recipe has a strong inhibitory effect on both growth and metastasis of gastric cancer, and the mechanism of that may related with the reduced expression of oncogene cerbB2, ras,VEGF and KDR.

Effect of Chinese medicine Weikangning on expression of VEGF and its receptors Flt and KDR in gastric carcinoma cells

AIM: To study effect of traditional Chinese medicine Weikangning (WKN) on the expression of VEGF and its receptors Flt and KDR in gastric carcinoma cells.

METHODS: We used different dosage of WKN on rats to prepare serum containing WKN.The gastric carcinoma cells were cultured in the RPMI1640 media with serum containing WKN for 48 h. The expression of VEGF, Flt-1 and KDR was determined by reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry in gastric cancer cell lines respectively.

RESULTS: All gastric cancer cell lines analyzed expressed VEGF Flt-1 and KDR. But the expression of fVEGF (186.82±0.22, 195.35±0.45, 172.62±0.52), Flt-1 (198.44±0.44, 188.66±0.46, 197.01±0.91) in cells cultured in serum containing WKN decreased in a dose-dependent manner as compared with control (VEGF162. 78±0.58, Flt: 172.65±0.65)(P < 0.05).

CONCLUSION: VEGF and its receptors KDR and Flt-1 are expressed widely in gastric carcinoma cells and WKN can inhibit their expression.

Relationship between expression of VEGF, Flt1, bFGF and P53and outcome in patients with gastric carcinoma

AIM: To investigate the relationship between the expression of VEGF, Flt1, bFGF and P⁵³, the clinicopathological characteristics and outcome in patients with gastric carcinoma.

METHODS: The relationship between VEGF, Flt1, bFGF, P⁵³ expression and clinicopathological characteristics and outcome in the patient was assessed by streptoavidin-biotin method of immunohistochemistry with polyclonal antibodies against VEGF, Flt1, bFGF, and P⁵³ protein. The survival curves were formulated using Kaplan-Meier method and analyzed by the log-rank test, and the influence of each variable on suvival was assessed by the Cox' s proportional hazard model.

RESULTS: VEGF expression was closely correlated with serosal invasion (Se, Sei invasion vs Pm, SS and M, SM invasion, P < 0.01). Expression of P⁵³ was obviously higher in the patients with lymph node metastasis than those without (lymph node metastasis vs non-lymph node metastasis, P < 0.05). There was a positive correlation between VEGF and Flt1 expression (VEGF expression in Flt1 positive group vs Flt1 negative group, P < 0.01). The factors that affected the prognosis in patients with gastric carcinoma were PTNM stage, VEGF expression, serosal invasion, and surgical curability. Flt1, bFGF, and P⁵³ expression had no influence on the prognosis of patients with gastric carcinoma (P > 0.05).

CONCLUSION: P⁵³ expression has significant relationship with lymph node metastasis in gastric carcinoma. VEGF expression is correlated with serosal invasion and the prognosis and may be a good prognostic indicator in gastric carcinoma.

Clinical efficacy and mechanism of oxaliplatin in treating human gastric carcinoma

AIM

To evaluate the therapeutic effect of oxaliplatin on human gastric carcinoma and to explore the mechanisms.

METHODS

22 cases of stage IV gastric carcinoma patients received 4-6 (mean 4.6) cycles of first line combined chemotherapy with oxaliplatin (oxaliplatin 85 mg/m², ivgtt, 1 h, d 1; leukovorin 200 mg/m², iv, gtt, 1 h, d 1-5; 5-FU 300 mg/m², iv, d 1-2; 5-FU, continuously iv, gtt, 48 h; 1 cycle/2w). Response rate, progression-free survival (PFS), total survival time, toxic side effects were evaluated. The inhibitory effect of oxaliplatin on human gastric cell line SGC-7901 was calculated by MTT and IC50 was measured. Flow cytometry and TUNEL were applied to evaluate the apoptosis of cell line induced by the drug. The expression of caspase-3 mRNA was detected by RT-PCR.

RESULTS

Total response (complete and partial) occurred in 9 (40.9%) patients. Mean PFS was 4.2 months and mean total survival time was 7.2 months. Cumulative neurotoxicity (all grade I-II), vomiting and diarrhea, myelosuppression appeared in 93.5%, 20%, 32.9% of the patients, respectively. Apoptosis index was elevated after incubating with 1 mmol/L oxaliplatin for 30 min, but without statistic significance (P>0.05), but was much higher both by flowcytometry and TUNEL with statistical significance (P<0.05) after incubating with 1 mmol/L oxaliplatin for 2 days. Caspase-3 mRNA expression was elevated in oxaliplatin treated cells and correlated with apoptosis induced by the drug.

CONCLUSION

Oxaliplatin is effective and well-tolerated on human advanced gastric carcinoma. Oxaliplatin could significantly inhibit the growth of human gastric cell line SGC-7901, inducing caspase-3 mRNA expression and cell apoptosis.

Expression of estrogen inducing gene PS2/TFF1 in gastric cancer and precancerous lesions

AIM

To determine the significance of PS2/TFF1 protein expression in chronic superficial gastritis (CSG), gastric ulcer (GU),gastric mucosal intestinal metaplasia (IM), gastric mucosal dysplasia and gastric cancer(GC).

METHODS

Pathologic specimens of 121 patients with gastric mucosal diseases and 20 healthy volunteers were immunostained for PS2/TFF1.

RESULTS

Positive PS2/TFF1 staining was seen throughout all epithelia with normal gastric mucosas, CSG, GU and in complete type of intestinal metaplasia (20/21). On the contrary, 11 of 20 incomplete type of intestinal metaplasia had positive staining (P <0.01). The expressions of PS2/TFF1 protein in CSG and GU were significantly higher than that in control group (P <0.01), while the expressions of PS2/TFF1 protein in IM,gastric mucosal dysplasia and GC were obviously lower than that in control group (P <0.01).

CONCLUSION

Our results indicate that PS2/TFF1 may play an important role in gastric mucosal protection,and loss of PS2/TFF1 expression may occur as an early event in the malignant transformation process of intestinal-type tumors.

Association of VCAM-1 overexpression with oncogenesis, tumor angiogenesis and metastasis of gastric carcinoma

AIM: To investigate the relationship between the expression of vascular cell adhesion molecule-1 (VCAM-1) and oncogenesis, tumor angiogenesis and metastasis in gastric carcinoma, and to evaluate the clinical significance of serum VCAM-1 levels in gastric cancer.

METHODS: Specimens from 41 patients with gastric cancer, 8 patients with benign gastric ulcer, and 10 healthy subjects were detected for the expression of VCAM-1 by immunohistochemistry. Microvessel density (MVD) was measured by counting the endothelial cells immunostained with the monoclonal antibody CD34 at × 200 magnification. Serum VCAM-1 concentrations were measured by an enzyme linked immunosorbent assay in the 41 gastric cancer patients before surgery, and at 7 d after surgery as well as in 25 healthy controls. The association between preoperative serum VCAM-1 levels and clinicopathological features, and their changes following surgery was evaluated. In addition, serum carcinoembryonic antigen (CEA) was also examined.

RESULTS: Of the 41 gastric cancer tissues, 31 (75.6%) were VCAM-1 positive. The VCAM-1 positive gastric cancers were more invasive and classified in the more advanced stage than the VCAM-1 negative ones. The VCAM-1 positive cancers were associated with more lymph node metastases than VCAM-1-negative ones (P < 0.05). The expression of VCAM-1 was detected in tissues of two of the eight patients with gastric ulcer and two of the 10 healthy controls. The expression of VCAM-1 in gastric cancer patients was significantly more frequent than that in the healthy controls and ulcer group (both P < 0.05). MVD in VCAM-1 expressing tissues was higher than that in VCAM-1 negative tissues (t = 2.13, P < 0.05). Serum VCAM-1 levels in gastric cancer patients were significantly higher than those in controls (t = 3.4, P < 0.05). There was a significant association between serum VCAM-1 levels and disease stage, as well as invasion depth of the tumor and the presence of distant metastases. The concentrations of serum CEA in gastric cancer were higher than normal controls. Both serum VCAM-1 and CEA levels decreased significantly after radical resection of the primary tumor (P < 0.05). Furthermore, the serum levels of VCAM-1 were positively correlated with the expression of VCAM-1 in the tumor tissue (r = 0.85, P < 0.05).

CONCLUSION: The expression of VCAM-1 is closely related to oncogenesis, tumor angiogenesis and metastasis in gastric carcinoma. Serum VCAM-1 level in gastric cancer patients is significantly increased compared with normal controls, which decreases significantly after radical resection of the primary tumor. The serum concentration of VCAM-1 may be considered as an effective marker of tumor burden of gastric cancer. Moreover, overexpression of VCAM-1 in gastric cancer tissue is likely a major source of serum VCAM-1.

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Intravenous chemotherapy for resected gastric cancer: meta-analysis of randomized controlled trials

AIM: To assess the safety and efficacy of different intravenous chemotherapeutic regimens in patients with gastric carcinomas who had undergone gastrectomy.

METHODS: A meta-analysis of all the relevant randomized controlled trials (RCTs) was performed. Language was restricted to Chinese and English. RCTs were identified from Medline and Embase (1980-2001/4), and Chinese Bio-medicine Database (1990-2001/1). Literature references were checked at the same time. We included randomized and quasi-randomized trials comparing the efficacy of intravenous chemotherapy after gastrectomy with that of surgery alone in patients with confirmed gastric carcinomas who had undergone gastrectomy. Selection criteria were: randomized or quasi-randomized trials with following-up results; Trials could be double-blind, single-blind or not blind; Chemotherapy groups were given intravenous chemotherapy after gastrectomy without neo-adjuvant chemotherapy, intraperitoneal hyperthermic perfusion, radiotherapy or chemoimmunotherapy; Controlled group included those receiving gastrectomy alone. The following data were extracted: the number of survival and death by the end of the follow-up; the different agents and doses of the intravenous chemotherapy; the baseline of the chemotherapy group and the controlled arm; the serious adverse events; the statistical consideration; cost-effectiveness analysis. The statistical analysis was performed by RevMan4.1 software which was provided by the Cochrane Collaboration. A P value of < 0.05 was considered statistically significant. Meta-analysis was done with random effects model. Heterogeneity was checked by chi-square test. Sensitivity analysis was performed by excluding the trials in which Jadad-scale was only 1 score. The result was expressed with odds ratio (OR) for the categorical variable.

RESULTS: Fourteen trials involving 4543 patients were included. Meta-analysis was done with random effects model Heterogeneity and sensitivity analysis were performed also. The effect of intravenous chemotherapy after gastrectomy was better than surgery alone (odds ratio 0.56, 95%CI 0.40-0.79). There was a significant difference between the two groups by u-test (P = 0.0008). Sensitivity analysis revealed the same difference (odds ratio 0.81, 95%CI 0.70-0.94). Of fourteen trials, only three studies were of high quality according to the Jadad-scale (with three score). There was one meta-analysis trial and the others, about ten trials, were of low quality. There was no trial which mentioned sample-size calculation, allocation concealment, intention-to-treat analysis. Most of the trials didn’t describe the blind-procedure. There were five trials which detailed the side-effects according to the toxicity grade by WHO standard. The side-effects halting treatment were haematologic and biochemical toxicity, debilitating nausea and vomiting. There were two patients died of chemotherapy toxicity.

CONCLUSION: Based on the review, intravenous chemotherapy after gastrectomy may have positive treatment effect on gastric cancer. However, the evidence is not strong because of the general low methodologic quality of the RCTs. Therefore, we can’t make the conclusion that intravenous chemotherapy after gastrectomy may have better treatment effect on gastric cancer than that of surgery alone. Rigorously designed, randomised, double-blind, placebo-controlled trials are required.