Notch Signaling Mediates Differentiation in Barrett's Esophagus and Promotes Progression to Adenocarcinoma

BACKGROUND & AIMS

Studies are needed to determine the mechanism by which Barrett's esophagus (BE) progresses to esophageal adenocarcinoma (EAC). Notch signaling maintains stem cells in the gastrointestinal tract and is dysregulated during carcinogenesis. We explored the relationship between Notch signaling and goblet cell maturation, a feature of BE, during EAC pathogenesis.

METHODS

We measured goblet cell density and levels of Notch messenger RNAs in BE tissues from 164 patients, with and without dysplasia or EAC, enrolled in a multicenter study. We analyzed the effects of conditional expression of an activated form of NOTCH2 (pL2.Lgr5.N2IC), conditional deletion of NOTCH2 (pL2.Lgr5.N2fl/fl), or loss of nuclear factor κB (NF-κB) (pL2.Lgr5.p65fl/fl), in Lgr5+ (progenitor) cells in L2-IL1B mice (which overexpress interleukin 1 beta in esophagus and squamous forestomach and are used as a model of BE). We collected esophageal and stomach tissues and performed histology, immunohistochemistry, flow cytometry, transcriptome, and real-time polymerase chain reaction analyses. Cardia and forestomach tissues from mice were cultured as organoids and incubated with inhibitors of Notch or NF-kB.

RESULTS

Progression of BE to EAC was associated with a significant reduction in goblet cell density comparing nondysplastic regions of tissues from patients; there was an inverse correlation between goblet cell density and levels of NOTCH3 and JAG2 messenger RNA. In mice, expression of the activated intracellular form of NOTCH2 in Lgr5+ cells reduced goblet-like cell maturation, increased crypt fission, and accelerated the development of tumors in the squamocolumnar junction. Mice with deletion of NOTCH2 from Lgr5+ cells had increased maturation of goblet-like cells, reduced crypt fission, and developed fewer tumors. Esophageal tissues from in pL2.Lgr5.N2IC mice had increased levels of RelA (which encodes the p65 unit of NF-κB) compared to tissues from L2-IL1B mice, and we found evidence of increased NF-κB activity in Lgr5+ cells. Esophageal tissues from pL2.Lgr5.p65fl/fl mice had lower inflammation and metaplasia scores than pL2.Lgr5.N2IC mice. In organoids derived from pL2-IL1B mice, the NF-κB inhibitor JSH-23 reduced cell survival and proliferation.

CONCLUSIONS

Notch signaling contributes to activation of NF-κB and regulates differentiation of gastric cardia progenitor cells in a mouse model of BE. In human esophageal tissues, progression of BE to EAC was associated with reduced goblet cell density and increased levels of Notch expression. Strategies to block this pathway might be developed to prevent EAC in patients with BE.

BarrettNET-a prospective registry for risk estimation of patients with Barrett's esophagus to progress to adenocarcinoma

Risk stratification in patients with Barrett's esophagus (BE) to prevent the development of esophageal adenocarcinoma (EAC) is an unsolved task. The incidence of EAC and BE is increasing and patients are still at unknown risk. BarrettNET is an ongoing multicenter prospective cohort study initiated to identify and validate molecular and clinical biomarkers that allow a more personalized surveillance strategy for patients with BE. For BarrettNET participants are recruited in 20 study centers throughout Germany, to be followed for progression to dysplasia (low-grade dysplasia or high-grade dysplasia) or EAC for >10 years. The study instruments comprise self-administered epidemiological information (containing data on demographics, lifestyle factors, and health), as well as biological specimens, i.e., blood-based samples, esophageal tissue biopsies, and feces and saliva samples. In follow-up visits according to the individual surveillance plan of the participants, sample collection is repeated. The standardized collection and processing of the specimen guarantee the highest sample quality. Via a mobile accessible database, the documentation of inclusion, epidemiological data, and pathological disease status are recorded subsequently. Currently the BarrettNET registry includes 560 participants (23.1% women and 76.9% men, aged 22-92 years) with a median follow-up of 951 days. Both the design and the size of BarrettNET offer the advantage of answering research questions regarding potential causes of disease progression from BE to EAC. Here all the integrated methods and materials of BarrettNET are presented and reviewed to introduce this valuable German registry.

Assessment of the radiological impacts of historical coal mining operations on the environment of Ny-Alesund, Svalbard

Mineral extraction activities, such as those conducted by oil, gas and coal industries, are widespread throughout the Arctic region. Waste products of these activities can result in significant contributions to the radioactive burden of the surrounding environment due to increased concentrations of naturally occurring radioactive materials (NORM) to levels that would not normally be found in the environment. Coal mining operations commenced in the early 1900s on Svalbard and have been conducted at a variety of locations on the archipelago since then. Coal contains radionuclides of the uranium and thorium series as well as 40K. Extraction and processing of coal can result in releases of these radionuclides to the broader environment with subsequent impact on the human and non-human inhabitants of the area. This paper presents the results of a study on environmental radioactivity resulting from historical coal mining operations conducted at Ny-Alesund, Spitsbergen, in the Svalbard archipelago. Activity concentrations of radionuclides found in materials associated with these operations are presented as well as the results of a spatial dosimetric survey conducted over an area affected by coal mining.

[Dangers in skiing]

The current study deals with the results of the examination of 685 patients, who were treated in the department of traumatology in the KKH Garmisch-Partenkirchen during the winter season 99/00 and 00/01. The study included 259 injured carvers (120 female, 139 male) with an average age of 33.9 years and 426 injured conventional skiers (212 female, 214 male) with an average age of 33.2 years. The aim of the investigation was to compare both ski groups concerning injuries, the pathomechanism and the skiing experience. The results of the investigation showed that the knee injuries of carvers were more severe than in the conventional skiers. The difference was significant (p < 0.05).

Gamma-emitting natural and anthropogenic radionuclides in the terrestrial environment of Kongsfjord, Svalbard

This paper presents results obtained from a radiometric survey, conducted by the Norwegian Radiation Protection Authority, into the levels of gamma-emitting radionuclides, both anthropogenic and natural, in the terrestrial environment of Kongsfjorden, which lies on the North-Western Coast of Spitsbergen in the Arctic archipelago of Svalbard (79 degrees N, 12 degrees E). Samples of terrestrial matrices were taken during field campaigns conducted between 2000 and 2002 and analysed for a range of gamma-emitting radionuclides. The objectives of this study included an assessment of the levels of gamma-emitting radionuclides in the terrestrial environment of the region, identification of processes and activities that influence the accumulation and redistribution of such nuclides within the region and elucidation of the behaviour of such radionuclides within a high arctic environment. Results indicate a quite homogenous spatial distribution of such radionuclides within the study area and highlight the relatively low levels of contamination by the anthropogenic radionuclide, 137Cs, on Svalbard. Average values and ranges of the radionuclides activities in surface soils (0-3 cm) were: 238U 42 Bq/kg (17-134), 226Ra 43 Bq/kg (12-137), 232Th 21 Bq/kg (4-52), 40K 283 Bq/kg (31-564), 137Cs 35 Bq/kg (1-146). Average levels of these nuclides in avian faecal materials were 238U 63 Bq/kg, 226Ra 54 Bq/kg, 232Th 19 Bq/kg, 40K 365 Bq/kg, 137Cs 78 Bq/kg. Enrichment of radionuclides is apparent in soils taken from locations close to bird colonies in the locale, maximum levels of the radionuclides being found in samples associated with such colonies. The results indicate that this is due to concentration of such radionuclides within the faecal material of the birds and subsequent enrichment of the nearby soils either via direct incorporation of the faeces into the soil or by leaching processes. The results indicate that this process may result in contamination of non-related species, such as Svalbard reindeer (Rangifer tarandus playrhynchus), via pathways other than the traditionally accepted route of atmospheric deposition-vegetation-reindeer.