Hormonal therapy for hepatocellular carcinoma

Dexamethasone-stimulated glucocorticoid receptor signaling positively regulates the endoplasmic reticulum-associated degradation (ERAD) mechanism in hepatocellular carcinoma cells

Hepatocellular carcinoma is one of the most common types of primary liver cancer in adults and also it is the third leading cause of cancer-related deaths worldwide. Although there are various treatment options such as surgery, radiation, targeted drug therapy, immunotherapy and chemotherapy, most hepatocellular carcinomas are highly resistant to systemic treatments. Today, the molecular pathogenesis of hepatocellular carcinoma remains largely obscure. Therefore, there is a need for detailed research for the characterization of molecular signaling networks related to the development of hepatocellular carcinoma. Recent studies have attention to the hormonal regulation of hepatocellular carcinoma cells mediated by systemic hormones such as glucocorticoids. However, glucocorticoid-mediated regulation of endoplasmic reticulum-associated degradation (ERAD) and unfolded protein response (UPR), which are known to be important survival mechanisms for cancer cells remains unknown in hepatocellular carcinoma. In the present study, we showed that dexamethasone-induced glucocorticoid receptor signaling mediated advanced regulation of ERAD and UPR signaling in hepatocellular carcinoma cells. Glucocorticoid signaling positively regulates mRNA and protein levels of ERAD components and also protein kinase RNA-like ER Kinase (PERK) and inositol-requiring enzyme 1⍺ (IRE1⍺) branches of UPR signaling are accompanied the glucocorticoid signaling. In addition, putative glucocorticoid response elements (GREs) were determined in the promoter regions of ERAD members in in-silico analyses. Additionally, silencing of ERAD components significantly reduced the tumorigenic features of hepatocellular carcinoma cells, including cell proliferation, metastasis, invasion and 3D tumor formation. Collectively, these results reveal a novel pattern of regulation of ERAD components by glucocorticoid-mediated in human hepatocellular carcinoma cells.

Surgery for pregnancy-associated primary hepatocellular carcinoma: Report of four cases

INTRODUCTION

Hepatocellular carcinoma (HCC) occurring in pregnancy is quite rare. The prognosis is usually poor because of a delay in diagnosis. Reported cases of HCC in pregnancy are largely isolated with no large experience. Thus the effect of pregnancy on the prognosis of patients with HCC and the risk factors of developing HCC in pregnancy are not well documented. Our aim was to review our experience with management of four young pregnant women with HCC.

PRESENTATION OF CASE

Laboratory tests were performed before surgery. We analyzed the effects of age, hepatitis B surface antigens status, cirrhosis at presentation, gestational age of fetus, and maternal outcome.

DISCUSSION

Increase in alpha-fetoprotein (AFP) level was somewhat useful for diagnosis. Three patients died in 5 months, 6 months, and 24 months from HCC recurrence, and another patient is alive without disease 12 months postoperatively.

CONCLUSION

Surgery for HCC during pregnancy should be similar to that for non-pregnant women. Complete excision of tumor without termination of pregnancy provides the greatest chance of survival for women with HCC during pregnancy but depends on gestational age of the fetus. Adjuvant treatments are required to improve the long-term results of this type of surgery. The 28-week gestational week is a critical point of fetal maturation which is very important in deciding whether pregnancy should be terminated or not. The pregnancy was terminated in two of our patients when spontaneous rupture of HCC was diagnosed to save the mother's life.

Roles of the glucocorticoid receptor in resectable hepatocellular carcinoma

BACKGROUND

The glucocorticoid receptor (GR) was discovered in the cytosol of hepatocellular carcinoma (HCC) cells more than 10 years ago. However, the influence of the GR on the prognosis of HCC after liver resection remains unclear.

METHODS

Ninety-two consecutive patients with HCC who survived liver resection and who did not receive any preoperative neoadjuvant therapy were enrolled in this study. The GR level in cytosol of cancerous tissue was determined by the dextran-coated charcoal method. The clinicopathologic characteristics and long-term prognosis of patients with GR-positive tumors (GR-positive group) were compared with those of patients with GR-negative tumors (GR-negative group).

RESULTS

GR was found in 63 patients (68.5%) with a mean +/- SEM concentration of 26.97 +/- 4.05 fmol/g protein. There were no significant differences in patient clinicopathologic characteristics between GR-positive and GR-negative groups. The 5-year disease-free and actuarial survival rates for GR-positive and GR-negative groups were 21.6% and 44.4% (P =.002) and 57.2% and 83.3% (P =.0003), respectively. After multivariate analysis was performed, GR positivity was found to be an independent prognostic factor of disease-free and actuarial survival after liver resection for HCC.

CONCLUSIONS

The GR can be found in the cytosol of most HCCs and is an independent prognostic factor of HCC after liver resection. Patients with GR-positive HCC have lower survival rates than those with GR-negative HCC.

Phase II study of megestrol acetate in the treatment of hepatocellular carcinoma

This is a report of a phase II study of megestrol acetate (160 mg/day, orally) in the treatment of hepatocellular carcinoma (HCC). Forty-six patients with advanced HCC were studied and tumour response, changes in appetite, bodyweight, a feeling of well-being, survival and toxicity were evaluated. Thirty-two patients were able to be evaluated for response; there were no complete responders or partial responders. Twelve patients (38%) had stable disease and seven of these patients had a minor response with a median size reduction in the tumour of 18%. Twenty patients (62%) had progressive disease. Five of 24 (21%) patients had a median reduction in alpha-fetoprotein levels of 59 ng/mL. The overall median survival was 4 months (range 1 week to 27 months). Twenty of 32 (62%) patients had an increased appetite and feeling of well-being. Fourteen of 22 (64%) patients had a median lean bodyweight gain of 5 kg (range 1-14 kg). Toxicities were minimal. Tests for glucocorticoid receptors were performed in 10 patients. Four of five patients who were positive for glucocorticoid receptors in the tumour had a stable disease and all five patients who were negative for glucocorticoid receptors had progressive disease. Megestrol acetate had no significant effect on the tumour in HCC patients. However, megestrol acetate is useful in the palliative management of HCC patients, with improvements in appetite, bodyweight and a feeling of well-being with minimal side effects. Some patients had stable disease, a minor reduction of tumour size and a prolonged survival after megestrol acetate treatment and this response may be related to the presence of glucocorticoid receptors in the HCC tumour.

CA 125, CA 15.3, CA 27.29, CEA, beta-hCG and alpha-fetoprotein levels in cyst fluid of breast macrocysts

OBJECTIVE

To determine the tumoral markers CA 125, CA 15.3, CA 27.29, CEA, beta-hCG and alpha-fetoprotein in serum and breast cystic fluid in women with fibrocystic breast disease.

METHODS

The study comprised 50 women diagnosed with fibrocystic breast disease but without breast macrocysts, and 60 women with macrocysts.

RESULTS

Significantly higher levels of CA 125, CA 27.29, beta-hCG and CEA were observed in the cyst fluid than in the serum of the same patients. According to their K+/Na+ quotient we found that when K+/Na+ was < 3, cyst fluid CA 125, CA 27.29, beta-hCG and CEA levels were significantly higher than serum levels. However, when K+/Na+ was > 3, only CA 27.29 and beta-hCG levels were significantly higher. Comparing cyst fluid marker levels with respect to the K+/Na+ ratio, the only difference observed was in CA 125 which was significantly greater when K+/Na+ was < 3. A negative correlation was found between CA 125 and the K+/Na+ quotient.

CONCLUSION

These results suggest that CA 125 could be used as a marker to identify cyst type.

Effect of ovariectomy and sex hormone replacement on glutathione and glutathione-related enzymes in rat hepatocarcinogenesis

The effects of ovariectomy and hormone replacement in control and carcinogen treated female rats were investigated by measuring whole blood and liver glutathione (WGSH, HGSH), glutathione S-transferase (GST), glutathione peroxidase (GPx), and glutathione reductase (GRx) and histological evaluation. Hepatocarcinogenesis was induced by diethylnitrosamine and 2-acetylaminofluorene. In control rats not receiving carcinogen, ovariectomy significantly increased the GST and GRx activities. Replacement with either estrogen or progesterone reduced the GST activities to below intact female values whereas replacement of both hormones together brought the GST activities to that of intact females. GRx activities were brought to intact female values by replacement with estrogen or progesterone, either singly or in combination. Neither ovariectomy nor sex hormone/s replacement influenced the levels of WGSH, HGSH and GPx activities. Carcinogen administration to intact rats increased all the parameters measured. Ovariectomized rats treated with carcinogen showed lower GPx and GRx activities at 2 mths. However, replacement with either progesterone or combined estrogen and progesterone increased GPx and GRx activities to original values. On the other hand GST and GPx activities in ovariectomized rats which had carcinogen treatment were lower than intact rats after 5 mths. Replacement with hormones either singly or both brought GST and GPx activities up to intact rat levels receiving carcinogen. The levels of WGSH, HGSH and GRx activities (5 mths) in carcinogen treated rats were not influenced by ovariectomy and/or hormone/s replacement. The results from this study suggested that ovariectomy reduced the severity of hepatocarcinogenesis which was restored by sex hormone/s replacement.

Flowcytometric analysis of the effect of berberine on the expression of glucocorticoid receptors in human hepatoma HepG2 cells

Berberine is an alkaloid found in many plants, including the Coptis chinensis and Arcangelisia flava. Berberine has been reported to have cytostatic effect on tumor growth. Previously, we have found that the level of glucocorticoid receptors (GR) was significantly higher in hepatoma than in adjacent liver tissues. Using human HepG2 hepatoma cells, we have found that GR were expressed not only in G0-G1 phases, but also in S and G2+M phases. The objective of the present study was to examine the effect of berberine on the expression of GR and its relation to cell cycle progression of HepG2 cells. Continuous exposure of HepG2 cells to various concentrations (1-50 microM) of berberine resulted in growth inhibition in a dose dependent manner. The viability of berberine-treated HepG2 cells was greater than 90% in all treatment groups. Flowcytometric analysis of berberine-treated HepG2 cells showed that the S phase fraction was significantly reduced. GR levels were higher in berberine-treated HepG2 cells than in vehicle (DMSO)-treated cells. In addition, the secretion of alpha-fetoprotein by HepG2 cells was inhibited by berberine. Finally, the berberine induced cell growth arrest was partially reversible in HepG2 cells.