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Chung KM, Chen YT, Hong CC, Chang IC, Lin SY, Liang LY, Chen YR, Yeh CT, Huang SF. CA10 is associated with HBV-related hepatocarcinogenesis. Biochem Biophys Rep 2022; 31:101303. [PMID: 35800619 PMCID: PMC9254355 DOI: 10.1016/j.bbrep.2022.101303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the main threat for the patients infected with hepatitis B virus (HBV), but the oncogenic mechanism of HBV-related HCC is still controversial. Previously, we have found that several HBV surface gene (HBS) non-sense mutations are oncogenic. Among these mutations, sW182* was found to have the most potent oncogenicity. In this study, we found that Carbonic Anhydrase X (CA10) level was specifically increased in sW182* mutant-expressing cells. CA10 overexpression was also associated with HBS nonsense mutation in HBV-related HCC tumor tissues. Transformation and tumorigenesis assays revealed that CA10 had significant oncogenic activity. In addition, CA10 overexpression resulted in dysregulation of apoptosis-related proteins, including Mcl-1, Bcl-2, Bcl-xL and Bad. While searching for the regulatory mechanism of CA10, miR-27b was found to downregulate CA10 expression by regulating its mRNA degradation and its expression was decreased in sW182* mutant cells. Moreover, CA10 overexpression was associated with down-regulation of miR-27b in human HBV-related HCC tumor tissues with sW182* mutation. Therefore, induction of the expression of CA10 through repression of miR-27b by sW182* might be one mechanism involved in HBS mutation-related hepatocarcinogenesis.
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Affiliation(s)
- Kuei-Min Chung
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
- Liver Research Unit, Linko Chang Gung Memorial Hospital, Chang-Gung University, Taoyuan, Taiwan
| | - Ya-Ting Chen
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
| | - Chih-Chen Hong
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
- Liver Research Unit, Linko Chang Gung Memorial Hospital, Chang-Gung University, Taoyuan, Taiwan
| | - Il-Chi Chang
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
| | - Si-Ying Lin
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
| | - Li-Yu Liang
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
| | - Yi-Rong Chen
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
| | - Chau-Ting Yeh
- Liver Research Unit, Linko Chang Gung Memorial Hospital, Chang-Gung University, Taoyuan, Taiwan
| | - Shiu-Feng Huang
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
- Department of Anatomic Pathology, Linko Chang Gung Memorial Hospital, Chang-Gung University, Taoyuan, Taiwan
- Department of Anatomical Pathology, Chung-Shan Medical University Hospital, Taichung, Taiwan
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Manara F, Jay A, Odongo GA, Mure F, Maroui MA, Diederichs A, Sirand C, Cuenin C, Granai M, Mundo L, Hernandez-Vargas H, Lazzi S, Khoueiry R, Gruffat H, Herceg Z, Accardi R. Epigenetic Alteration of the Cancer-Related Gene TGFBI in B Cells Infected with Epstein-Barr Virus and Exposed to Aflatoxin B1: Potential Role in Burkitt Lymphoma Development. Cancers (Basel) 2022; 14:1284. [PMID: 35267594 PMCID: PMC8909323 DOI: 10.3390/cancers14051284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 01/25/2023] Open
Abstract
Burkitt lymphoma (BL) is a malignant B cell neoplasm that accounts for almost half of pediatric cancers in sub-Saharan African countries. Although the BL endemic prevalence is attributable to the combination of Epstein-Barr virus (EBV) infection with malaria and environmental carcinogens exposure, such as the food contaminant aflatoxin B1 (AFB1), the molecular determinants underlying the pathogenesis are not fully understood. Consistent with the role of epigenetic mechanisms at the interface between the genome and environment, AFB1 and EBV impact the methylome of respectively leukocytes and B cells specifically. Here, we conducted a thorough investigation of common epigenomic changes following EBV or AFB1 exposure in B cells. Genome-wide DNA methylation profiling identified an EBV-AFB1 common signature within the TGFBI locus, which encodes for a putative tumor suppressor often altered in cancer. Subsequent mechanistic analyses confirmed a DNA-methylation-dependent transcriptional silencing of TGFBI involving the recruitment of DNMT1 methyltransferase that is associated with an activation of the NF-κB pathway. Our results reveal a potential common mechanism of B cell transformation shared by the main risk factors of endemic BL (EBV and AFB1), suggesting a key determinant of disease that could allow the development of more efficient targeted therapeutic strategies.
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Affiliation(s)
- Francesca Manara
- International Agency for Research on Cancer, World Health Organization, 69000 Lyon, France; (F.M.); (A.J.); (G.A.O.); (A.D.); (C.S.); (C.C.); (R.K.)
| | - Antonin Jay
- International Agency for Research on Cancer, World Health Organization, 69000 Lyon, France; (F.M.); (A.J.); (G.A.O.); (A.D.); (C.S.); (C.C.); (R.K.)
| | - Grace Akinyi Odongo
- International Agency for Research on Cancer, World Health Organization, 69000 Lyon, France; (F.M.); (A.J.); (G.A.O.); (A.D.); (C.S.); (C.C.); (R.K.)
| | - Fabrice Mure
- CIRI, Centre International de Recherche en Infectiologie, RNA Expression in Viruses and Eukaryotes Group, Universite Claude Bernard Lyon I, INSERM U1111, CNRS UMR5308, ENS Lyon, 69007 Lyon, France; (F.M.); (M.A.M.)
| | - Mohamed Ali Maroui
- CIRI, Centre International de Recherche en Infectiologie, RNA Expression in Viruses and Eukaryotes Group, Universite Claude Bernard Lyon I, INSERM U1111, CNRS UMR5308, ENS Lyon, 69007 Lyon, France; (F.M.); (M.A.M.)
| | - Audrey Diederichs
- International Agency for Research on Cancer, World Health Organization, 69000 Lyon, France; (F.M.); (A.J.); (G.A.O.); (A.D.); (C.S.); (C.C.); (R.K.)
| | - Cecilia Sirand
- International Agency for Research on Cancer, World Health Organization, 69000 Lyon, France; (F.M.); (A.J.); (G.A.O.); (A.D.); (C.S.); (C.C.); (R.K.)
| | - Cyrille Cuenin
- International Agency for Research on Cancer, World Health Organization, 69000 Lyon, France; (F.M.); (A.J.); (G.A.O.); (A.D.); (C.S.); (C.C.); (R.K.)
| | - Massimo Granai
- Department of Medical Biotechnology, Section of Pathology, University of Siena, 53100 Siena, Italy; (M.G.); (S.L.)
| | - Lucia Mundo
- Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland;
| | | | - Stefano Lazzi
- Department of Medical Biotechnology, Section of Pathology, University of Siena, 53100 Siena, Italy; (M.G.); (S.L.)
| | - Rita Khoueiry
- International Agency for Research on Cancer, World Health Organization, 69000 Lyon, France; (F.M.); (A.J.); (G.A.O.); (A.D.); (C.S.); (C.C.); (R.K.)
| | - Henri Gruffat
- CIRI, Centre International de Recherche en Infectiologie, RNA Expression in Viruses and Eukaryotes Group, Universite Claude Bernard Lyon I, INSERM U1111, CNRS UMR5308, ENS Lyon, 69007 Lyon, France; (F.M.); (M.A.M.)
| | - Zdenko Herceg
- International Agency for Research on Cancer, World Health Organization, 69000 Lyon, France; (F.M.); (A.J.); (G.A.O.); (A.D.); (C.S.); (C.C.); (R.K.)
| | - Rosita Accardi
- International Agency for Research on Cancer, World Health Organization, 69000 Lyon, France; (F.M.); (A.J.); (G.A.O.); (A.D.); (C.S.); (C.C.); (R.K.)
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3
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Hepatitis B Virus preS/S Truncation Mutant rtM204I/sW196* Increases Carcinogenesis through Deregulated HIF1A, MGST2, and TGFbi. Int J Mol Sci 2020; 21:ijms21176366. [PMID: 32887289 PMCID: PMC7503731 DOI: 10.3390/ijms21176366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 02/07/2023] Open
Abstract
Inevitable long-term therapy with nucleos(t)ide analogs in patients with chronic hepatitis B virus (HBV) infection has selected reverse-transcriptase (rt) mutants in a substantial proportion of patients. Some of these mutants introduce premature stop codons in the overlapping surface (s) gene, including rtA181T/sW172*, which has been shown to enhance oncogenicity. The oncogenicity of another drug-resistant mutant, rtM204I/sW196*, has not been studied. We constructed plasmids harboring rtM204I/sW196* and assessed the in vitro cell transformation, endoplasmic reticulum (ER) stress response, and xenograft tumorigenesis of the transformants. Cellular gene expression was analyzed by cDNA microarray and was validated. The rtM204I/sW196* transformants, compared with the control or wild type, showed enhanced transactivation activities for c-fos, increased cell proliferation, decreased apoptosis, more anchorage-independent growth, and enhanced tumor growth in mouse xenografts. X box-binding protein-1 (XBP1) splicing analysis showed no ER stress response. Altered gene expressions, including up-regulated MGST2 and HIF1A, and downregulated transforming growth factor beta-induced (TGFbi), were unveiled by cDNA microarray and validated by RT-qPCR. The TGFbi alteration occurred in transformants with wild type or mutated HBV. The altered MGST2 and HIF1A were found only with mutated HBV. The rtM204I/sW196* preS/S truncation may endorse the cell transformation and tumorigenesis ability via altered host gene expressions, including MGST2, HIF1A, and TGFbi. Downregulated TGFbi may be a common mechanism for oncogenicity in HBV surface truncation mutants.
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Chiu SY, Chung HJ, Chen YT, Huang MS, Huang CC, Huang SF, Matsuura I. A nonsense mutant of the hepatitis B virus large S protein antagonizes multiple tumor suppressor pathways through c-Jun activation domain-binding protein1. PLoS One 2019; 14:e0208665. [PMID: 30870427 PMCID: PMC6417713 DOI: 10.1371/journal.pone.0208665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/26/2019] [Indexed: 11/18/2022] Open
Abstract
Hepatitis B virus (HBV) is a major cause of hepatocellular carcinoma (HCC). Previous studies have identified recurrent nonsense mutations in the HBV large S (LHBs) gene from the liver from HBV core antigen-positive HCC patients. These nonsense mutants have been shown to be oncogenic in mouse xenograft models using a mouse embryonic fibroblast cell line. Here, we expressed in a liver cell line Huh-7 a carboxy terminally truncated protein from a nonsense mutant of the LHBs gene, sW182* (stop codon at tryptophane-182). Although the sW182* protein appeared not to be very stable in the cultured liver cells, we confirmed that the protein can be highly expressed and retained for a prolonged period of time in the hepatocytes in the mouse liver, indicating its stable nature in the physiological condition. In the Huh-7 cells, the sW182* mutant downregulated tumor suppressors p53 and Smad4. This downregulation was reversed by a proteasome inhibitor MG132, implying the involvement of proteasome-based protein degradation in the observed regulation of the tumor suppressors. On the other hand, we found that c-Jun activation domain-binding protein 1 (Jab1) physically interacts with the sW182*, but not wild-type LHBs. RNA interference (RNAi) of Jab1 restored the levels of the downregulated p53 and Smad4. The sW182* mutant inhibited the promoter activity of downstream target genes of the tumor suppressors. Consistently, Jab1 RNAi reversed the inhibition. These results suggest that the LHBs nonsense mutant antagonizes the tumor suppressor pathways through Jab1 in the liver contributing to HCC development.
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Affiliation(s)
- Shu-Yi Chiu
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan
| | - Hsiang-Ju Chung
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan
| | - Ya-Ting Chen
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan
| | - Min-Syuan Huang
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan
| | - Chien-Chih Huang
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan
| | - Shiu-Feng Huang
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan
| | - Isao Matsuura
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan
- * E-mail:
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Salpini R, Surdo M, Warner N, Cortese MF, Colledge D, Soppe S, Bellocchi MC, Armenia D, Carioti L, Continenza F, Di Carlo D, Saccomandi P, Mirabelli C, Pollicita M, Longo R, Romano S, Cappiello G, Spanò A, Trimoulet P, Fleury H, Vecchiet J, Iapadre N, Barlattani A, Bertoli A, Mari T, Pasquazzi C, Missale G, Sarrecchia C, Orecchini E, Michienzi A, Andreoni M, Francioso S, Angelico M, Verheyen J, Ceccherini-Silberstein F, Locarnini S, Perno CF, Svicher V. Novel HBsAg mutations correlate with hepatocellular carcinoma, hamper HBsAg secretion and promote cell proliferation in vitro. Oncotarget 2017; 8:15704-15715. [PMID: 28152517 PMCID: PMC5362517 DOI: 10.18632/oncotarget.14944] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 12/27/2016] [Indexed: 02/07/2023] Open
Abstract
Background An impaired HBsAg-secretion can increase HBV oncogenic-properties. Here, we investigate genetic-determinants in HBsAg correlated with HBV-induced hepatocellular carcinoma (HCC), and their impact on HBsAg-secretion and cell-proliferation. Methods This study included 128 chronically HBV-infected patients: 23 with HCC (73.9% D; 26.1% A HBV-genotype), and 105 without cirrhosis/HCC (72.4% D, 27.6% A) as reference-group. The impact of mutations on HBsAg-secretion was assessed by measuring the ratio [secreted/intracellular HBsAg] until day 5 post-transfection. The impact of mutations on cell-cycle advancement was assessed by flow-cytometry. Results Two HBsAg mutations significantly correlated with HCC: P203Q (17.4% [4/23] in HCC vs 1.0% [1/105] in non-HCC, P=0.004); S210R (34.8% [8/23] in HCC vs 3.8% [4/105] in non-HCC, P <0.001); P203Q+S210R (17.4% [4/23] in HCC vs 0% [0/110] in non-HCC, P=0.001). Both mutations reside in trans-membrane C-terminal domain critical for HBsAg-secretion. In in-vitro experiments, P203Q, S210R and P203Q+S210R significantly reduced the ratio [secreted/intracellular HBsAg] compared to wt at each time-point analysed (P <0.05), supporting an impaired HBsAg-secretion. Furthermore, P203Q and P203Q+S210R increased the percentage of cells in S-phase compared to wt, indicating cell-cycle progression (P203Q:26±13%; P203Q+S210R:29±14%; wt:18%±9, P <0.01. Additionally, S210R increased the percentage of cells in G2/M-phase (26±8% for wt versus 33±6% for S210R, P <0.001). Conclusions Specific mutations in HBsAg C-terminus significantly correlate with HBV-induced HCC. They hamper HBsAg-secretion and are associated with increased cellular proliferation, supporting their involvement in HCC-development. The identification of viral genetic markers associated with HCC is critical to identify patients at higher HCC-risk that may deserve intensive liver monitoring, and/or early anti-HBV therapy.
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Affiliation(s)
- Romina Salpini
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata" Rome, Italy
| | - Matteo Surdo
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata" Rome, Italy
| | - Nadia Warner
- Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, North Melbourne, Victoria, Australia
| | - Maria Francesca Cortese
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata" Rome, Italy
| | - Danny Colledge
- Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, North Melbourne, Victoria, Australia
| | - Sally Soppe
- Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, North Melbourne, Victoria, Australia
| | | | - Daniele Armenia
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata" Rome, Italy
| | - Luca Carioti
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata" Rome, Italy
| | - Fabio Continenza
- Laboratory of Monitoring Antiviral Drugs, National Institute for Infectious Diseases (INMI) "Lazzaro Spallanzani" Rome, Italy
| | - Domenico Di Carlo
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata" Rome, Italy
| | - Patrizia Saccomandi
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata" Rome, Italy
| | - Carmen Mirabelli
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata" Rome, Italy.,Institut Pasteur, Unité de Biologie des Virus Entériques, Paris, France
| | - Michela Pollicita
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata" Rome, Italy
| | - Roberta Longo
- Unit of Microbiology, "S. Pertini Hospital", Rome, Italy
| | - Sara Romano
- Unit of Microbiology, "S. Pertini Hospital", Rome, Italy
| | | | - Alberto Spanò
- Unit of Microbiology, "S. Pertini Hospital", Rome, Italy
| | - Pascale Trimoulet
- Laboratoire de Microbiologie Fondamentale et Pathogénicité, Hôpital Pellegrin Tripode, Bordeaux, France
| | - Herve Fleury
- Laboratoire de Microbiologie Fondamentale et Pathogénicité, Hôpital Pellegrin Tripode, Bordeaux, France
| | - Jacopo Vecchiet
- Department of Medicine and Aging Sciences, "SS Annunziata" Hospital, Chieti, Italy
| | - Nerio Iapadre
- Infectious Diseases Unit, "S Salvatore" Hospital, L'Aquila, Italy
| | | | - Ada Bertoli
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata" Rome, Italy
| | - Terenzio Mari
- Hepatology Unit, "Regina Margherita" Hospital, Rome, Italy
| | | | | | - Cesare Sarrecchia
- Tor Vergata University Hospital, Infectious Diseases Unit, Rome, Italy
| | - Elisa Orecchini
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata" Rome, Italy
| | - Alessandro Michienzi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata" Rome, Italy
| | - Massimo Andreoni
- Tor Vergata University Hospital, Infectious Diseases Unit, Rome, Italy
| | | | - Mario Angelico
- Tor Vergata University Hospital, Hepatology Unit, Rome, Italy
| | - Jens Verheyen
- Tor Vergata University Hospital, Hepatology Unit, Rome, Italy
| | | | - Stephen Locarnini
- Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, North Melbourne, Victoria, Australia
| | - Carlo Federico Perno
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata" Rome, Italy
| | - Valentina Svicher
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata" Rome, Italy
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Liang KH, Hsu CW, Chang ML, Chen YC, Lai MW, Yeh CT. Peginterferon Is Superior to Nucleos(t)ide Analogues for Prevention of Hepatocellular Carcinoma in Chronic Hepatitis B. J Infect Dis 2015; 213:966-74. [DOI: 10.1093/infdis/jiv547] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/09/2015] [Indexed: 02/07/2023] Open
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Ozawa D, Yokobori T, Sohda M, Sakai M, Hara K, Honjo H, Kato H, Miyazaki T, Kuwano H. TGFBI Expression in Cancer Stromal Cells is Associated with Poor Prognosis and Hematogenous Recurrence in Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 2014; 23:282-9. [PMID: 25448803 DOI: 10.1245/s10434-014-4259-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Esophageal squamous cell carcinoma (ESCC) is an important cause of cancer-related death worldwide. To improve prognoses in patients with ESCC, we evaluated the potential of transforming growth factor-beta-induced protein (TGFBI), which is overexpressed in ESCC, as a therapeutic candidate. METHODS We examined the clinical significance of TBFBI in 102 ESCC samples using real-time RT-PCR. Immunohistochemical studies were conducted to examine the localization of TGFBI. Knockdown of TGFBI in cocultured fibroblasts was performed to determine the roles of TGFBI in migration and invasion. RESULTS The level of TGFBI in ESCC tissues was higher than that in normal tissues. The high TGFBI expression group (n = 16) had higher TGFB1 expression and more frequent hematogenous recurrence than the low-expression group (n = 86). High TGFBI expression was an independent prognostic factor in patients with ESCC. TGFBI was mainly localized in stromal cells of ESCC. Moreover, suppression of TGFBI in fibroblasts inhibited the migration and invasion capacity of TE8 ESCC cells. CONCLUSIONS High TGFBI expression in ESCC tissues could be a powerful biomarker of poor prognosis and hematogenous recurrence. TGFBI in stromal cells might be a promising molecular target for ESCC treatment.
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Affiliation(s)
- Daigo Ozawa
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan.
| | - Takehiko Yokobori
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan
| | - Makoto Sohda
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan
| | - Makoto Sakai
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan
| | - Keigo Hara
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan
| | - Hiroaki Honjo
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan
| | - Hiroyuki Kato
- First Department of Surgery, Dokkyo Medical University, Mibu, Japan
| | - Tatsuya Miyazaki
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan
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