Inflammatory gene variants and the risk of biliary tract cancers and stones: a population-based study in China

Meta-analyses of the relationship between five CXCL8 gene polymorphisms and overall cancer risk, and a case-control study of oral cancer

BACKGROUND

C-X-C motif chemokine ligand (CXCL8), also known as interleukin-8, is a prototypical CXC family chemokine bearing a glutamic acid-leucine-arginine (ELR) motif that plays key roles in the onset and progression of a range of cancers in humans. Many prior studies have focused on exploring the relationship between CXCL8 gene polymorphisms and the risk of cancer. However, the statistical power of many of these reports was limited, yielding ambiguous or conflicting results in many cases.

METHODS

Accordingly, the PubMed, Wanfang, Scopus and Web of Science databases were searched for articles published until July 20, 2023 using the keywords 'IL-8' or 'interleukin-8' or 'CXCL8', 'polymorphism' and 'cancer' or 'tumor'. Odds ratios (ORs) and 95% confidence intervals (CIs) were utilized to examine the association. The CXCL8 +781 polymorphism genotypes were assessed with a TaqMan assay.

RESULTS

About 29 related publications was conducted in an effort to better understand the association between these polymorphisms and disease risk. The CXCL8 -353A/T polymorphism was associated with an increased overall cancer risk [A vs. T, odds ratio (OR) = 1.255, 95% confidence interval (CI) (1.079-1.459), Pheterogeneity = 0.449, P = 0.003]. The CXCL8 +781 T/C allele was similarly associated with a higher risk of cancer among Caucasians [TT vs. TC + CC, OR = 1.320, 95%CI (1.046-1.666), Pheterogeneity = 0.375, P = 0.019]. Furthermore, oral cancer patients carrying the CXCL8 +781 TT + TC genotypes exhibited pronounced increases in serum levels of CXCL8 as compared to the CC genotype (P < 0.01), and also shown similar trend as compared to genotype-matched normal controls (P < 0.01). Finally, several limitations, such as the potential for publication bias or heterogeneity among the included studies should be paid attention.

CONCLUSION

Current study suggested that the CXCL8 -353 and +781 polymorphisms may be associated with a greater risk of cancer, which might impact cancer prevention, diagnosis, or treatment through the different expression of CXCL8. At the same time, the +781 polymorphism may further offer value as a biomarker that can aid in the early identification and prognostic evaluation of oral cancer.

The Role of Inflammatory Biomarkers in Mediating the Effect of Inflammatory Bowel Disease on nonmalignant Digestive System Diseases: A Multivariable Mendelian Randomized Study

Background

While observation studies have shown a positive correlation between inflammatory bowel disease (IBD) and the risk of nonmalignant digestive system diseases, a definitive causal relationship has not yet been clearly established.

Methods

Mendelian randomization (MR) was employed to investigate the potential causal association between genetic susceptibility to IBD and nonmalignant gastrointestinal diseases. Genetic variants were extracted as instrumental variables (IVs) from a genome-wide association study (GWAS) meta-analysis, which included 12,194 cases of Crohn's disease (CD) and 28,072 control cases of European ancestry. The GWAS for ulcerative colitis (UC) included 12,366 UC and 33,609 control cases of European ancestry. All IVs reached genome-wide significance (GWAS p value <5 × 10-8). Summary-level data for acute pancreatitis (AP), irritable bowel syndrome (IBS), gastroesophageal reflux disease, cholelithiasis, and CeD (celiac disease) were obtained from the GWAS meta-analysis and the FinnGen dataset. Summary-level data on relevant inflammatory factors were provided by the International Genetic Consortium. Univariate MR analysis was conducted using inverse variance weighting as the primary method for estimating causal effects. Multivariate MR analyses were also performed to detect possible mediators.

Results

Genetic susceptibility to UC was associated with an increased risk of AP (OR = 1.08; 95% CI = 1.03-1.13; p=0.002) and IBS odds ratio (OR] = 1.07; 95% confidence interval (CI] = 1.03-1.11; (p < 0.001). In terms of potential mediators, interleukin 6 (IL-6) had a driving effect on the association between UC and AP. There was no apparent evidence of increased risk with CD. Meanwhile, genetic susceptibility to CD increases the risk of CeD (OR = 1.14; 95% CI = 1.03-1.25; p=0.01).

Conclusions

The evidence suggests that UC is associated with an elevated risk of AP and IBS, and IL-6 may be responsible in AP. CD is associated with an increased risk of developing CeD. Implementing a proactive monitoring program for assessing the risk of gastrointestinal diseases in UC patients, particularly those with elevated IL-6 levels, may be of interest. In addition, the presence of AP and IBS may indicate the presence of UC. Preventing CeD is an essential consideration in the therapeutic management of patients with CD.

Genetic association of MMP14 promoter variants and their functional significance in gallbladder cancer pathogenesis

Gallbladder cancer (GBC) is relatively rare but shows high frequency in certain geographical regions and ethnic groups, which include Northern and Eastern states of India. Previous studies in India have indicated the possible role of genetic predisposition in GBC pathogenesis. Although matrix metalloproteinase-14 (MMP14) is known modulator of tumour microenvironment and tumorigenesis and TCGA data also suggests its upregulation yet, its role in genetic predisposition for GBC is completely unknown. We explored MMP14 promoter genetic variants as risk factors and their implication in expression modulation and the pathogenesis of GBC. We genotyped all single nucleotide polymorphisms of MMP14 promoter by Sanger's sequencing in approximately 300 GBC and 300 control study subjects of Indian ethnicity and, in 26 GBC tissue samples. Protein expression of MMP14 in GBC tissue samples was checked by immunohistochemistry. In vitro luciferase reporter assay was carried out to elucidate role of promoter genetic variants on expression levels in two different cell lines. MMP14 promoter variants, rs1003349 (p value = 0.0008) and rs1004030 (p value = 0.0001) were significantly associated with GBC. Luciferase reporter assay showed high expression for risk alleles of both the SNPs. Genotype-phenotype correlation for rs1003349 and rs1004030, in patient sample, confirmed that risk allele carriers had higher expression levels of MMP14; moreover, the correlation pattern matched with genetic association models. Overall, this study unravels the association of MMP14 promoter SNPs with GBC which contribute to pathogenesis by increasing its expression.

Association of Cholecystectomy with the Risk of Prostate Cancer in Patients with Gallstones

Objectives: To assess the association of cholecystectomy with the risk of prostate cancer in patients with gallstones. Methods: This nationwide population-based cohort study was conducted by retrieving the Longitudinal Health Insurance Research Database (LHID2000) for inpatient claims in the Taiwan National Health Insurance (NHI) program. The study cohort consisted of 72,606 men aged ≥ 20 years with gallstones undergoing cholecystectomy between 2000 and 2010. The control cohort consisted of the men with gallstones, but without cholecystectomy, by 1:1 propensity score matching with the study cohort based on age, sex, urbanization, occupation, comorbidities, and the index date. We compared the hazard ratio of prostate cancer between both of the cohorts. Results: The incidence of prostate cancer was 0.76/1000 person-years for the non-cholecystectomy cohort and 1.28/1000 person-years for the cholecystectomy cohort [aHR (adjusted hazard ratio) = 1.67, 95% confidence interval (CI = 1.45–1.92), respectively (p < 0.001). When compared with the non-cholecystectomy cohort, the hazard ratio of prostate cancer for the cholecystectomy cohort was 1.49-fold greater (95% CI = 1.04–2.11) for follow-up ≤ 1 year, 1.52-fold greater (95% CI = 1.24–1.86) for follow-up 1–5 years, and 1.99-fold greater (95% CI = 1.56–2.53) for follow-up > 5 years, respectively. Conclusions: Cholecystectomy is associated with an increased hazard ratio of prostate cancer in gallstones patients, and the risk increases with an incremental period of follow-up. This observational study cannot ascertain the detrimental mechanisms of cholecystectomy for the development of prostate cancer, and cholecystectomy is not recommended for the prevention of prostate cancer based on our study.

Association between VEGFA gene polymorphisms and bleeding complications in patients maintaining therapeutic international normalized ratio

Aim: This study was designed to identify the possible effects of VEGFA polymorphisms on the occurrence of bleeding complications in patients with mechanical heart valves who have achieved therapeutic international normalized ratio (INR). Materials & methods: 13 SNPs of VEGFA were analyzed. Uni- and multi-variate analyses were conducted to identify associations between polymorphisms and bleeding complications. Results & conclusion: Patients with the CC genotype of rs35410204 had an approximately tenfold higher bleeding complication than those with the T allele. For rs866236, patients who had wild-type homozygotes showed an approximately 2.9-fold higher bleeding complication than C allele carriers. This study demonstrated that bleeding complications during warfarin therapy are associated with VEGFA polymorphisms in patients with mechanical heart valves.

Ampullary carcinoma-A genetic perspective

Ampulla of vater carcinoma (AVC) is a rare gastrointestinal tumour that is associated with a high mortality rate and it's often diagnosed at later stages due to lack of clinical symptoms. Early diagnosis of this condition is essential to effectively treat patients for better prognosis. A significant amount of advancement has been made in understanding the molecular nature of cancer in the past decade. A substantial number of mutations and alterations have been detected in various tumors. Despite the occurrence of AVC across the globe, the number of studies conducted on this tumor type remains low; this is largely due to its rare occurrence. Moreover, AVC tissues are complex and contain mutations in oncogenes, tumour suppressors, apoptotic proteins, cell proliferation proteins, cell signaling proteins, transcription factors, chromosomal abnormalities and cellular adhesion proteins. The frequently mutated genes included KRAS, TP53 and SMAD4 and are associated with prognosis. Several molecules of the PI3K, Wnt signaling, TGF-beta pathway and cell cycle have also been altered in AVCs. This review comprises of all the genetic mutations, associated pathways and related prognosis that are involved in AVCs from the year 1989 to 2017. This report can be used as a stepping-stone to establish biomarkers for early diagnosis of AVC and to discover molecular targets for drug therapy.

Association between gallbladder stone disease and prostate cancer: A nationwide population-based study

Objectives

Chronic inflammation and abnormal cholesterol metabolism are involved in the pathogenesis of gallbladder stone disease (GSD) and that of prostate cancer in experimental studies. We assessed the association between GSD and prostate cancer in this population-based study.

Results

The cumulative incidence of prostate cancer (log-rank test: P <.001) and the risk of prostate cancer (1.64 vs 1.14 per 10 000 person-y, adjusted hazard ratio [aHR] = 1.30, 95% confidence interval [CI] = 1.22-1.39) were greater in the patients with GSD than in those without GSD. Furthermore, the risk of prostate cancer increased with the time of follow-up after a diagnosis of GSD, particularly after 9 years of follow-up (aHR = 1.95, 95% CI = 1.74-2.19).

Materials and Methods

We identified 9496 patients who were diagnosed with GSD between 1998 and 2011 from Taiwan's Longitudinal Health Insurance Database 2000 as the study cohort. We randomly selected 37 983 controls from the non-GSD population and used frequency matching by age, sex, and index year for the control cohort. All patient cases were followed until the end of 2011 to measure the incidence of prostate cancer.

Conclusion

GSD is associated with an increased risk of prostate cancer, and the risk increases with the time of follow-up after a diagnosis of GSD.

Gallbladder cancer epidemiology, pathogenesis and molecular genetics: Recent update

Gallbladder cancer is a malignancy of biliary tract which is infrequent in developed countries but common in some specific geographical regions of developing countries. Late diagnosis and deprived prognosis are major problems for treatment of gallbladder carcinoma. The dramatic associations of this orphan cancer with various genetic and environmental factors are responsible for its poorly defined pathogenesis. An understanding to the relationship between epidemiology, molecular genetics and pathogenesis of gallbladder cancer can add new insights to its undetermined pathophysiology. Present review article provides a recent update regarding epidemiology, pathogenesis, and molecular genetics of gallbladder cancer. We systematically reviewed published literature on gallbladder cancer from online search engine PubMed (http://www.ncbi.nlm.nih.gov/pubmed). Various keywords used for retrieval of articles were Gallbladder, cancer Epidemiology, molecular genetics and bullion operators like AND, OR, NOT. Cross references were manually searched from various online search engines (http://www.ncbi.nlm.nih.gov/pubmed,https://scholar.google.co.in/, http://www.medline.com/home.jsp). Most of the articles published from 1982 to 2015 in peer reviewed journals have been included in this review.

Advances of recurrent risk factors and management of choledocholithiasis

Gallstone disease is a common and frequently occurring disease in human, and it is the main disease among the digestive system diseases. The incidence of gallstone disease in western countries is about 5%-22%, and common bile duct stones (CBDS) accounts for 8%-20%. CBDS easily lead to biliary obstruction, secondary cholangitis, pancreatitis, and obstructive jaundice, even endanger life. Therefore, it needs timely treatment once diagnosed. The recurrence of choledocholithiasis after bile duct stones clearance involves complicated factors and cannot be completely elaborated by a single factor. The risk factors for recurrence of choledocholithiasis include bacteria, biliary structure, endoscopic and surgical treatment, and inflammation. The modalities for management of choledocholithiasis are endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic or open common bile duct exploration, dissolving solutions, extracorporeal shockwave lithotripsy (ESWL), percutaneous radiological interventions, electrohydraulic lithotripsy (EHL) and laser lithotripsy. We compare the different benefits between surgery and ERCP. And finally, we make a summary of the current strategy for reducing the recurrence of CBDS and future perspectives for CBDS management.

Lipopolysaccharide-pathway proteins are associated with gallbladder cancer among adults in Shanghai, China with mediation by systemic inflammation

PURPOSE

We examined inflammation as a mediator of associations between bacterial infection markers and gallbladder cancer (GBC).

METHODS

Bacterial response proteins (lipopolysaccharide [LPS], soluble cluster of differentiation 14 [sCD14], and LPS-binding protein [LBP]) were measured in 40 GBC cases and 126 gallstone controls with data on 63 serum inflammation markers. The relationships of LPS, LBP, and sCD14 with GBC were examined by logistic regression, which also was used to evaluate whether these associations are influenced by systemic inflammation as measured by a combinatorial inflammation score.

RESULTS

The third versus the first tertiles of sCD14 and of LBP were associated with an increased GBC risk (odds ratio [95% confidence interval]: 5.41 [2.00-16.75] for sCD14, and 6.49 [2.24-23.79] for LBP). sCD14 and LBP were strongly associated with inflammation score (above vs. below the median), which itself was associated with a more than 21-fold increased risk of GBC for the third versus first tertiles. Associations between GBC and sCD14 and LBP were markedly attenuated when the inflammation score was included in the model. While LPS was not associated with GBC or inflammation, only 35% of cases and 22% of controls had detectable levels.

CONCLUSIONS

These findings suggest that these LPS-pathway proteins are associated with GBC via inflammation-related pathways.

Association of inflammatory and other immune markers with gallbladder cancer: Results from two independent case-control studies

Most gallbladder cancer (GBC) cases arise in the context of gallstones, which cause inflammation, but few gallstone patients develop GBC. We explored inflammation/immune-related markers measured in bile and serum in GBC cases compared to gallstone patients to better understand how inflammatory patterns in these two conditions differ. We measured 65 immune-related markers in serum and bile from 41 GBC cases and 127 gallstone patients from Shanghai, China, and calculated age- and sex-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for GBC versus gallstones. We then focused on the markers that were significantly elevated in bile and serum to replicate the findings in serum from 35 GBC cases and 31 gallstone controls from Chile. Comparing the highest versus lowest quantile, 15 markers (23%) were elevated in both serum and bile from GBC versus gallstone patients in the Shanghai study (p<0.05). The strongest OR was for CXCL8 (interleukin-8) in serum (96.8, 95% CI: 11.9-790.2). Of these 15 markers, 6 were also significantly elevated in serum from Chile (CCL20, C-reactive protein, CXCL8, CXCL10, resistin, serum amyloid A). Pooled ORs from Shanghai and Chile for these 6 markers ranged from 7.2 (95% CI: 2.8-18.4) for CXCL10 to 58.2 (95% CI: 12.4-273.0) for CXCL8. GBC is associated with inflammation above and beyond that generated by gallstones alone. This local inflammatory process is reflected systemically. Future longitudinal studies are needed to identify the key players in cancer development, which may guide translational efforts to identify individuals at high risk of developing GBC.

The inflammatory inception of gallbladder cancer

Gallbladder cancer is a lethal disease with notable geographical variations worldwide and a predilection towards women. Its main risk factor is prolonged exposure to gallstones, although bacterial infections and other inflammatory conditions are also associated. The recurrent cycles of gallbladder epithelium damage and repair enable a chronic inflammatory environment that promotes progressive morphological impairment through a metaplasia-dysplasia-carcinoma, along with cumulative genome instability. Inactivation of TP53, which is mutated in over 50% of GBC cases, seems to be the earliest and one of the most important carcinogenic pathways involved. Increased cell turnover and oxidative stress promote early alteration of TP53, cell cycle deregulation, apoptosis and replicative senescence. In this review, we will discuss evidence for the role of inflammation in gallbladder carcinogenesis obtained through epidemiological studies, genome-wide association studies, experimental carcinogenesis, morphogenetic studies and comparative studies with other inflammation-driven malignancies. The evidence strongly supports chronic, unresolved inflammation as the main carcinogenic mechanism of gallbladder cancer, regardless of the initial etiologic trigger. Given this central role of inflammation, evaluation of the potential for GBC prevention removing causes of inflammation or using anti-inflammatory drugs in high-risk populations may be warranted.

Essential role of polymorphism of Gab1, EGFR, and EGF for the susceptibility of biliary tract cancer

Cholangiocarcinoma is a malignant neoplasm arising from the epithelial cells lining the biliary ducts and its occurrence can be anatomically classified as within the liver (intrahepatic) or outside the liver (extrahepatic). Extrahepatic cholangiocarcinoma, which can be called as biliary tract cancer (BTC), is the most common form of this malignancy, and its etiology is still unclear. In this study, we tried to elucidate the complicated association between receptor tyrosine kinase (RTK) gene polymorphisms and susceptibility of BTC by analyzing frequency distribution of genotypes and alleles of GRB2-associated-binding protein 1 (Gab1), endothelial growth factor receptor (EGFR), and endothelial growth factor (EGF) and identified potential risk of BTC for people carrying specific genotype of Gab1 and EGFR. Two hundred twenty-five and 300 patients with BTC and cholelithiasis (gallstone (GS)), respectively, and 300 controls matched by age, sex, and ethnicity with patients were recruited from Shengjing Hospital of China Medical University from January 2008 to July 2011 with informed consents. Genomic DNA of BTC group was extracted and purified from formalin-fixed, paraffin-embedded tumor tissue sections using QiAamp DNA FFPE Tissue kit. For GS group and controls, DNA was extracted from peripheral blood leukocytes using genomic DNA extraction kit from Aid Lab. Target genes of RTK family were identified from National Center of Biotechnology Information (NCBI) SNP database and Japanese Single Nucleotide Polymorphisms (JSNP) database. Frequency distribution of genotypes and alleles was analyzed using HapMap Project database. All of the statistical analysis was conducted with SPSS 13.0 software. Eight loci were identified for Gab1 (4), EGFR (3), and EGF (1) as the target single-nucleotide polymorphisms (SNPs) for the association of gene polymorphisms and BTC. A/A genotype and A allele of rs3805246 in Gab1 and G/G genotype and G allele of rs2017000 in EGFR were significantly higher in BTC group than in GS group or controls. After controlling for BMI, age, gender, and smoking habit, patients with "A/A + G/A" had 2.154 times odds to have BTC; as for patients with "A/A" only, they still had 1.976 times odds to have BTC. In the rs2017000 of EGFR, patients with "G/G + G/A" had 1.772 times odds to have BTC, and patients with "G/G" only had 1.530 times odds to have BTC. Furthermore, patients with A/A in rs3805246 and G/G in rs2017000 simultaneously had 1.620 times chance to have BTC than people with other genotypes. This study explored the independent potential effect of EGFR signaling transduction pathway and its downstream element Gab1 and the gene-gene interaction on the disease mechanism of BTC in the perspective of genetics and molecular epidemiology.

Helicobacter species infection may be associated with cholangiocarcinoma: a meta-analysis

OBJECTIVE

Since the discovery of Helicobacter species in human biliary system, the association between Helicobacter species infection and cholangiocarcinoma is under debate. This meta-analysis aims to explore this issue.

METHODS

Literature search was carried out to identify all eligible articles. We performed overall meta-analysis of all included studies and subgroup analysis based on regional distribution. Subgroup analysis in the light of detection methods and specimens was also conducted.

RESULTS

Ten case-control studies were included. Overall meta-analysis favoured a significant association between Helicobacter species infection and cholangiocarcinoma (cumulative OR 8.88, 95% CI 3.67-21.49). Subgroup analysis based on geographic distribution indicated that Helicobacter species infection may serve as a risk factor not only in a region with high cholangiocarcinoma incidence (Asia, OR 6.68, 95% CI 2.29-19.49) but also in low incidence region (Europe, OR 14.90, 95% CI 4.79-46.35). The other subgroup analysis showed that PCR was the most effective and efficient method to detect Helicobacter species in surgically resected tissue and bile. There was significant heterogeneity among studies and obvious publication bias.

CONCLUSION

Our meta-analysis supports the possible association between Helicobacter species infection and cholangiocarcinoma. Further investigations are required to clarify the role of Helicobacter species in this malignancy.

Gastrointestinal stromal tumors: a case-only analysis of single nucleotide polymorphisms and somatic mutations

Background

Gastrointestinal stromal tumors are rare soft tissue sarcomas that typically develop from mesenchymal cells with acquired gain-in-function mutations in KIT or PDGFRA oncogenes. These somatic mutations have been well-characterized, but little is known about inherited genetic risk factors. Given evidence that certain susceptibility loci and carcinogens are associated with characteristic mutations in other cancers, we hypothesized that these signature KIT or PDGFRA mutations may be similarly fundamental to understanding gastrointestinal stromal tumor etiology. Therefore, we examined associations between 522 single nucleotide polymorphisms and seven KIT or PDGFRA tumor mutations types. Candidate pathways included dioxin response, toxin metabolism, matrix metalloproteinase production, and immune and inflammatory response.

Methods

We estimated odds ratios and 95% confidence intervals for associations between each candidate SNP and tumor mutation type in 279 individuals from a clinical trial of adjuvant imatinib mesylate. We used sequence kernel association tests to look for pathway-level associations.

Results

One variant, rs1716 on ITGAE, was significantly associated with KIT exon 11 non-codon 557–8 deletions (odds ratio = 2.86, 95% confidence interval: 1.71-4.78) after adjustment for multiple comparisons. Other noteworthy associations included rs3024498 (IL10) and rs1050783 (F13A1) with PDGFRA mutations, rs2071888 (TAPBP) with wild type tumors and several matrix metalloproteinase SNPs with KIT exon 11 codon 557–558 deletions. Several pathways were strongly associated with somatic mutations in PDGFRA, including defense response (p = 0.005) and negative regulation of immune response (p = 0.01).

Conclusions

This exploratory analysis offers novel insights into gastrointestinal stromal tumor etiology and provides a starting point for future studies of genetic and environmental risk factors for the disease.

Chronic inflammation and gallbladder cancer

Gallbladder cancer (GBC) is the most common biliary tract malignancy with an extremely poor prognosis. Epidemiological data have demonstrated that chronic inflammation resulting from infection of gallbladder or gallstones predispose individuals to GBC. Recent studies have begun to elucidate molecular mechanisms underlying the development of GBC in the setting of chronic inflammation. It is possible that persistently local inflammatory reactions may contribute to the development and progression of GBC through inducing genetic alterations, and subsequent promoting survival and proliferation of mutated sells, inhibiting apoptosis, stimulating angiogenesis and metastasis. This article reviews the current understanding of the involvement of chronic inflammation in gallbladder tumorigenesis.