Practical management of hepatocellular carcinoma

Somatostatin and Somatostatin Receptors in Tumour Biology

Somatostatin (SST), a growth hormone inhibitory peptide, is expressed in endocrine and non-endocrine tissues, immune cells and the central nervous system (CNS). Post-release from secretory or immune cells, the first most appreciated role that SST exhibits is the antiproliferative effect in target tissue that served as a potential therapeutic intervention in various tumours of different origins. The SST-mediated in vivo and/or in vitro antiproliferative effect in the tumour is considered direct via activation of five different somatostatin receptor subtypes (SSTR1-5), which are well expressed in most tumours and often more than one receptor in a single cell. Second, the indirect effect is associated with the regulation of growth factors. SSTR subtypes are crucial in tumour diagnosis and prognosis. In this review, with the recent development of new SST analogues and receptor-specific agonists with emerging functional consequences of signaling pathways are promising therapeutic avenues in tumours of different origins that are discussed.

Potent induction of apoptosis in human hepatoma cell lines by targeted cytotoxic somatostatin analogue AN-238

BACKGROUND/AIMS

The efficacy of a targeted cytotoxic hybrid somatostatin analogue AN-238 and of its superactive radical 2-pyrrolinodoxorubicin (AN-201) to induce apoptosis of HepG2 and Hep3B human hepatoma cell lines were studied. AN-238 was designed to selectively target tumor cells expressing somatostatin receptor subtypes (sst(s)). Its effects on HepG2 or Hep3B cells displaying or lacking tumor suppressor p53, respectively, were compared. Normal rat isolated hepatocytes were also tested.

METHODS

sst(s) were characterized by binding assays and RT-PCR. Cytotoxicity was quantified by flow cytometry. DNA fragmentation was studied by gel electrophoresis, PARP cleavage by Western blot and ROS formation using fluorescent probes.

RESULTS

Specific binding of iodinated RC-160 to HepG2 and Hep3B cells, and its displacement by AN-238 was characterized. mRNA for hsst(2A) was found in both cell lines. Flow cytometry showed a stronger effect of AN-238 than AN-201 to induce sub-G1 phase. DNA fragmentation, nuclear bodies, and PARP cleavage were observed. In addition, AN-238 increased formation of ROS more potently than AN-201. However, no inductions of DNA fragmentation by AN-201 or AN-238 were observed on rat hepatocytes.

CONCLUSIONS

Our results indicate that, in liver cancer, the cytotoxic somatostatin analogue AN-238 is a powerful agent that can induce apoptosis, through sst(s) and independently of p53.

Role and limitation of FMPSPGR dynamic contrast scanning in the follow-up of patients with hepatocellular carcinoma treated by TACE

AIM

To evaluate the role and limitation of fast multiplanar spoiled gradient-recalled (FMPSPGR) MR dynamic contrast scanning in the follow-up of patients with HCC treated by transarterial chemoembolization (TACE).

METHODS

Twenty-two patients with 24 HCC lesions confirmed by biopsy or surgical resection underwent MR imaging in 4-9wks after TACE with a superconducting 1.5 T MR scanner, including SE T(1)WI, T(2)WI and FMPSPGR dynamic contrast scanning. The signal intensities of all lesions on SE T(1)WI,T(2)WI and the enhancement patterns on FMPSPGR dynamic contrast scanning were observed, and the comparison was made between MRI findings and pathological results in all the cases.

RESULTS

Of the 24 lesions, the signal intensities were various on SE T(1)WI and T(2)WI. On T(1)WI, 13 lesions appeared as hyperintense, 4 lesions were isointense and the other 7 lesions were hypointensese. Histologically, hyperintense lesions showed on T(1)WI were viable tumor or hemorrhage; isointensities were coagulative necrosis or inflammatory infiltration; hypointensities were tumor, liquified necrosis, coagulative necrosis or inflammatory infiltration. On T(2)WI, 15 lesions appeared as hyperintense, 3 lesions were isointense and the other 6 lesions were hypointensese. Hyperintense lesions showed on T(2)WI were residuals of viable tumor, hemorrhage, liquefied necrosis or inflammatory infiltration; isointense lesions were residuals of viable tumor or inflammatory infiltration; hypointense lesions were coagulative necrosis. On FMPSPGR dynamic contrast scanning, 18 of the 24 lesions enhanced on early-phase dynamic scanning corresponding to residuals of viable tumor and the other 6 lesions had no enhancement at this phase because complete necrosis were seen in the histologic examination. On delayed-phase dynamic scanning, 6 lesions had permanent enhancement appeared as inhomogeneous hyperintensity and both residuals of viable tumor and inflammatory infiltration were found by histologic examination. 18 lesions were hypointense at this phase and 8 of them coexisted with peripheral ring-like enhancement of the lesions resulting from viable tumors or inflammatory infiltration.

CONCLUSION

FMPSPGR MR dynamic contrast scanning can reflect the pathologic changes of HCC treated by TACE. Especially, early-phase dynamic scanning can evaluate accurately residuals of viable tumor and necrosis in HCC lesions. FMPSPGR dynamic contrast scanning is useful in the follow-up of patients with HCC treated by TACE combined with SE T(1)WI and T(2)WI, but it is difficult to differentiate peripheral viable tumors from inflammatory infiltration.