Association of chemokine and chemokine receptor expression with the invasion and metastasis of lung carcinoma.

The chemokine system has been reported to be utilized and manipulated by tumor cells in order to promote local tumor growth and distant dissemination. The present study aimed to investigate the expression of three chemokine ligand-receptor axes in lung carcinoma tissues. Tumor and healthy normal tissue samples were obtained from 120 lung carcinoma patients following surgical resection. Immunohistochemistry and reverse transcription quantitative polymerase chain reaction were used in order to identify the protein and messenger (m)RNA expression of chemokines, including chemokine (C-X-C motif) ligand (CXCL)12/stromal cell-derived factor (SDF)-1, CXCL8/interleukin (IL)-8, chemokine (C-C motif) ligand (CCL)19 and CCL21, and the corresponding chemokine receptors, chemokine (C-X-C motif) receptor (CXCR)4, CXCR1, CXCR2 and chemokine (C-C motif) receptor (CCR)7, respectively. The results revealed that compared with the normal lung tissues, lung carcinoma tissues expressed significantly higher mRNA levels of CXCL12/SDF-1, CXCR4, CXCL8/IL-8, CXCR2, CCL19 and CCR7 (P<0.01). In four histological subtypes, adenocarcinoma presented dominant expression of CXCR4, CXCR2, CXCL8/IL-8 and CCL19 (P<0.05). In addition, it was demonstrated that tumor staging was inversely correlated with chemokine receptor CCR7 and CXCR2 mRNA expression as well as positively correlated with CXCL12/SDF-1, CXCL8/IL-8 and CCL19 mRNA levels (P<0.05). Lymph node metastasis presented a positive correlation with CXCR4, CXCR2 and CXCL8/IL-8 expression and a negative correlation with CCL19 and CCR7 expression (P<0.05). Furthermore, vascular invasion was more prevalent in patients with higher expression levels of CXCR4, CCR7 or CCL19 (P<0.01). In conclusion, these data suggested that the ligand-receptor interaction of CXCL8-CXCR2, CXCL12-CXCR4 and CCL19-CCR7 may be involved in the tumorigenesis of lung carcinoma. Higher expression levels of chemokines and lower expression of chemokine receptors indicated poor tumor staging. The CXC chemokine receptors, CXCR4 and CXCR2, promoted lymphatic metastasis through the activation of their specific ligands, while CCL19 and its receptor CCR7 had an essential role in hematogenous metastasis of lung carcinoma.

KRAS and BRAF gene mutations and DNA mismatch repair status in Chinese colorectal carcinoma patients.

AIM: To investigate gene mutations and DNA mismatch repair (MMR) protein abnormality in Chinese colorectal carcinoma (CRC) patients and their correlations with clinicopathologic features. METHODS: Clinical and pathological information for 535 patients including 538 tumors was reviewed and recorded. Mutation analyses for exon 2 of KRAS gene and exon 15 of BRAF gene were performed by Sanger sequencing except that in 9 tumors amplification refractory mutation system PCR was used. Expression of MMR proteins including MHL1, MSH2, MSH6 and PMS2 was evaluated by immunohistochemistry. Correlations of KRAS and BRAF mutation status and the expression status of MMR proteins with age, gender, cancer stage, location, and histology were analyzed. Correlations between KRAS or BRAF mutations and MMR protein expression were also explored. RESULTS: The overall frequencies of KRAS and BRAF mutations were 37.9% and 4.4%, respectively. KRAS mutations were more common in patients ≥ 50 years old (39.8% vs 22% in patients < 50 years old, P < 0.05). The frequencies of BRAF mutants were higher in tumors from females (6.6% vs males 2.8%, P < 0.05), located in the right colon (9.6% vs 2.1% in the left colon, 1.8% in the rectum, P < 0.01), with mucinous differentiation (9.8% vs 2.8% without mucinous differentiation, P < 0.01), or being poorly differentiated (9.5% vs 3.4% well/moderately differentiated, P < 0.05). MMR deficiency was strongly associated with proximal location (20.5% in the right colon vs 9.2% in the left colon and 5.1% in the rectum, P < 0.001), early cancer stage (15.0% in stages I-II vs 7.7% in stages III-IV, P < 0.05), and mucinous differentiation (20.2% vs 9.2% without mucin, P < 0.01). A higher frequency of MLH1/PMS2 loss was found in females (9.2% vs 4.4% in males, P < 0.05), and MSH2/MSH6 loss tended to be seen in younger (<50 years old) patients (12.0% vs 4.0% ≥ 50 years old, P < 0.05). MMR deficient tumors were less likely to have KRAS mutations (18.8% vs 41.7% in MMR proficient tumors, P < 0.05) and tumors with abnormal MLH1/PMS2 tended to harbor BRAF mutations (15.4% vs 4.2% in MMR proficient tumors, P < 0.05). CONCLUSION: The frequency of sporadic CRCs having BRAF mutation, MLH1 deficiency and MSI in Chinese population may be lower than that in the Western population.

Mast cells or not? - CD117 positive cells in esophageal leiomyoma.

The presence of CD117 positive cells in esophageal leiomyoma may lead to a misdiagnosis of GIST. We reviewed 46 esophageal tumors which were smooth muscle tumors or GIST. Based on morphology, immunohistochemistry and mutation analysis, there were 44 (95.6%) leiomyomas, 1 (2.2%) leiomyosarcoma, and 1 (2.2%) GIST. Variable numbers of CD117 positive cells were seen in all leiomyomas. Tryptase immunostaining identified mast cells in 93.2% (41/44) of leiomyomas, and the number of mast cells per tumor decreased significantly from tumors of the upper esophagus to the esophageal-gastric junction (p<0.01). Immunofluorescence study further confirmed the presence of two types of CD117 positive spindle cells which included spindle-shaped mast cells and DOG-1-positive interstitial cells of Cajal. This is the first study to systemically review mast cells in esophageal leiomyomas and tumors which may be included in the differential diagnosis. We demonstrate that both spindled mast cells and hyperplastic interstitial cells of Cajal are present within esophageal leiomyomas. The immunoreactivity of these cells with CD117 may suggest a diagnosis of GIST, but the presence of mast cells itself supports a diagnosis of esophageal leiomyoma.

[Anaplastic lymphoma kinase fusion gene expression, clinical pathological characteristics and prognosis in 95 Chinese patients with non-small cell lung cancer].

OBJECTIVE: To examine the prevalence of anaplastic lymphoma kinase (ALK) fusion gene in Chinese patients with non-small cell lung cancer (NSCLC). METHODS: In this study, 95 patients with NSCLC and corresponding clinical information and formalin-fixed paraffin-embedded (FFPE) tissue blocks were included. Hematoxylin & eosin (HE) staining, conventional ALK immunochemistry (IHC) staining and intercalated antibody-enhanced polymer (iAEP) IHC staining, and dual-color split fluorescence in situ hybridization (FISH) for ALK fusion gene were performed. RESULTS: Eight ALK-positive cases were detected using anti-ALK immunohistochemistry with the iAEP method, and FISH analyses revealed 4 patients of them who harbored the ALK fusion gene (4.2%, 4/95), including 2 cases of female patients with solid signet-ring cell adenocarcinoma and 2 cases of male patients with adenosquamous carcinoma. The positive cases were all non-smokers without EGFR/KRAS mutations. Furthermore, the positive cases all survived, and the overall postsurgery survival time of 2 cases was more than 5 years. CONCLUSION: ALK IHC with the iAEP method is better than conventional ALK IHC, and the percentage of the positive cells is more important than that of the intensity. ALK translocations were infrequent in the entire NSCLC patient population (<5%) with better prognosis.

Screening for EGFR and KRAS mutations in non-small cell lung carcinomas using DNA extraction by hydrothermal pressure coupled with PCR-based direct sequencing.

EGFR and KRAS mutations correlate with response to tyrosine kinase inhibitors in patients with non-small cell lung carcinoma (NSCLC). We reported a hydrothermal pressure method of simultaneous deparaffinization and lysis of formalin-fixed paraffin embedded (FFPE) tissue followed by conventional chaotropic salt column purification to obtain high quality DNA for mutation analysis using PCR-base direct sequencing. This study assessed the feasibility of using this method to screen for exons 18-21 of EGFR and exon 2 of KRAS gene mutations in surgical resection and core needle biopsy specimens from 251 NSCLC patients. EGFR mutations were identified in 140 (55.8%) NSCLC patients (118 in adenocarcinoma, 11 in squamous cell carcinoma, 7 in adenocarcinoma and 4 in NSCLC-not otherwise specified), including four novel substitutions (L718M, A743V, L815P, V819E). EGFR mutations were frequently present in female patients (72 of 113, 63.7%) and NSCLC with adenocarcinoma component (125/204, 61.3%) with statistical significance. Twenty-one patients had multiple mutations at different exons of EGFR, in which seventeen patients had deletions in exon 19. KRAS mutations were found in 18 (7.2%) patients (15 in adenocarcinoma, 2 in squamous cell carcinoma and one in NSCLC-not otherwise specified), including an uncommon substitution G13C. Deparaffinization and lysis by hydrothermal pressure, coupled with purification and PCR-based sequencing, provides a robust screening approach for EGFR and KRAS mutation analysis of FFPE tissues from either surgical resection or core needle biopsy in clinical personalized management of lung cancer.

[Application of combined telomerase activity analysis and immunocytochemistry in cytopathologic diagnosis].

OBJECTIVE: To evaluate the application of traditional cytomorphology, telomerase activity analysis and immunocytochemistry in cytopathologic diagnosis of pleural effusion and bronchoalveolar lavage samples. METHODS: A total of 123 agar-paraffin double-embedded pleural effusion and bronchoalveolar lavage fluid samples were enrolled into study. The cytomorphologic features were reviewed and correlated with immunocytochemical findings and telomerase activity. RESULTS: Telomerase activity was detected in 53 specimens using the real-time telomeric repeat amplification protocol. Amongst the cases studied, 39 samples (31.7%) contained overtly malignant cells while 20 cases (16.0%) were equivocal by conventional cytology. After verification by immunocytochemistry and clinical follow-up data, the diagnostic accuracy of telomerase activity and cytology was 87.0% and 82.1%, respectively. The sensitivity (97.6%) and specificity (100.0%) of cytology examination, when combined with telomerase activity analysis, were greater than those of cytology examination or telomerase activity analysis alone. CONCLUSIONS: Telomerase activity analysis can be used as an adjunctive investigative tool in cytology assessment of pleural effusion and bronchoalveolar lavage samples. The diagnostic accuracy can be further improved with the application of immunocytochemistry on agar-paraffin double-embedded cell block tissues.

Quantification of alternative splicing variants of human telomerase reverse transcriptase and correlations with telomerase activity in lung cancer.

Telomerase plays important roles in the development and progression of malignant tumors, and its activity is primarily determined by transcriptional regulation of human telomerase reverse transcriptase (hTERT). Several mRNA alternative splicing variants (ASVs) for hTERT have been identified, but it remains unclear whether telomerase activity is directly associated with hTERT splicing transcripts. In this study, we developed novel real-time PCR protocols using molecular beacons and applied to lung carcinoma cell lines and cancerous tissues for quantification of telomerase activity and three essential hTERT deletion transcripts respectively. The results showed that lung carcinoma cell lines consistently demonstrated telomerase activity (14.22-31.43 TPG units per 100 cells) and various hTERT alternative splicing transcripts. For 165 lung cancer cases, telomerase activity showed significant correlation with tumor differentiation (poorly->moderately->well-differentiated, P<0.01) and with histotypes (combined small cell and squamous cell carcinoma>squamous cell carcinoma>adenosquamous carcinoma>adenocarcinoma, P<0.05). Although the overall hTERT transcripts were detected in all the samples, they were not associated with telomerase activity (r = 0.092, P = 0.24). Telomerase activity was significantly correlated with the transcriptional constituent ratio of α-deletion (r = -0.267, P = 0.026), ß-deletion (r = -0.693, P = 0.0001) and γ-deletion (r = -0.614, P = 0.001). The positive rate and average constituent ratio of ß-deletion transcripts (92.12%, 0.23) were higher than those of α-deletion (41.82%, 0.12) or γ-deletion (16.36%, 0.18) transcripts. The combined small-cell and squamous cell carcinomas expressed less deletion transcripts, especially ß-deletion, than other histotypes, which might explain their higher telomerase activity. In conclusion, the molecular beacon-based real-time PCR protocols are rapid, sensitive and specific methods to quantify telomerase activity and hTERT ASVs. Telomerase activity may serve as a reliable and effective molecular marker to assist the evaluation of histological subtype and differentiation of lung carcinomas. Further studies on hTERT deletion splicing transcripts, rather than the overall hTERT transcripts, may improve our understanding of telomerase regulation.

Detection of telomerase activity in cultured cells and tumor tissue of lung carcinoma by modified telomeric repeat amplification protocol.

Telomerase activity is found in various cell types including stem cells, neoplastic cells, and immortalized cells, suggesting a close association with their proliferation capacity. The telomeric repeat amplification protocol (TRAP) has been traditionally used to detect semi-quantitatively the telomerase activity by polyacrylamide gel electrophoresis (PAGE), which is difficult to apply for large scale analysis because of laborious post-PCR manipulation and potential carryover contamination. In the present study, a specific reverse primer was designed and the TRAP protocol was adapted to either PAGE or real-time PCR assay. Using cultured cell lines, the real-time TRAP showed a dramatic improvement in the reliability and accuracy of quantitation of telomerase activity and was able to discriminate the A549 cells from hundreds-fold human embryonic lung cells. Using clinical samples of 60 lung cancers and 8 inflammatory lesions, the real-time TRAP was also superior in quantitation, high-throughput capability and standardization. Our modified real-time TRAP should be applicable for the detection of telomerase activity for the initial screening and progression monitoring of lung cancer patients. Our approach is particularly useful when only limited clinical specimen is available, such as fine needle aspiration or other cytological specimens that may contain only a small number of tumor cells.

EGFR mutations are more frequent in well-differentiated than in poor-differentiated lung adenocarcinomas.

Somatic mutations in epidermal growth factor receptor (EGFR) tyrosine kinase domain, particularly deletions in exon 19 and point mutation in exon 21, are associated with clinical outcome in patients with lung adenocarcinoma, suggesting that EGFR mutation would have an important role in clinical decision making. DNA was extracted from the excised specimens of 60 lung adenocarcinoma patients with phenol-chloroform and ethanol precipitation. Exon 19 and 21 were amplified by PCR, and direct sequenced from both sense and antisense directions. EGFR somatic mutations were present in 13 of 60 patients (21.67%), including seven cases of in-frame deletion in exon 19 around codon 746 and six cases of amino acid substitution in exon 21. Exon 21 mutation is more frequent in adenocarcinomas with bronchi-alveolar component than exon 19 deletions. Mutations were more prevalent in well-differentiated adenocarcinomas (9/27, 33.33%) than in moderate to poor-differentiated adenocarcinomas (4/33, 12.12%) (P < 0.05). Adenocarcinomas with bronchi-alveolar components had higher mutation frequency (8/22,36. 36%) than those without bronchi-alveolar components (5/38, 13.16%) (P < 0.05). In this study, female patients had more mutation rate than male patients. This trend was also observed in the patients with pathologic stage I-II compared with stage III-IV, but neither of them was statistically significant. Patients with cisplatin-based adjuvant chemotherapy had no significantly prolonged survival compared with single radical resection. But patients with EGFR mutation had relative longer survival. In conclusion, our study suggest that EGFR mutations may be a valuable prognostic factor for disease free survival of surgically treated lung adenocarcinoma patients independently from adjuvant chemotherapy.

[A clinicopathologic study on complications of orthotopic liver transplantation in 54 patients with chronic hepatitis B virus infection].

OBJECTIVE: To study the complication incidence of 54 patients with chronic HBV infection following their orthotopic liver transplantation (OLT), and factors associated with HBV recurrence and hepatocellular carcinoma (HCC) recurrence or metastasis post-OLT. METHODS: The light-microscopic appearance of hepatic allograft biopsies in 54 patients with chronic HBV infection following OLT was examined. The related clinical data were analyzed. The incidence and occurrence time of post-OLT complications were studied. Furthermore, the relationship between recurrent type B viral hepatitis and acute rejection and the relationship among HCC recurrence/metastasis, acute rejection, the tumor diameter, and the portal vein invasion were particularly studied. RESULTS: The frequent complications of patients with chronic HBV infection following OLT were acute rejection [38(70.4%); occurrence time: 5-365 d], chronic rejection [ 1(1.9%); occurrence time: 10.7 months],bile duct complications [24(44.4%); occurrence time: 7-940 d], HBV recurrence [7(13.0%); occurrence time: 1-540 d], HCV infection [3(5.6%); occurrence time: 60 d, 60 d, 33 months], CMV infection [8(14.8%); occurrence time: 67-90 d], and HCC recurrence or metastasis [17(31.5%); occurrence time: 2-41 months]. At the end of 1 year post-OLT, 95% of patients with post-hepatitis B cirrhosis were alive; At the end of 3 years post-OLT, 85% of patients with post-hepatitis B cirrhosis were alive. However, at the end of 1 year post-OLT, 67.6% of patients with post-hepatitis B HCC were alive; At the end of 3 years post-OLT, 50% of patients with post-hepatitis B HCC were alive. The number of acute rejection episodes in patients with recurrent HBV infection and that without recurrent HBV infection was (0.86+/-1.46) time/patient and (1.07+/-0.90) time/patient respectively(P>0.05); the number of moderate acute rejection episodes(RAI>or=score 4) in patients with recurrent HBV infection and that without recurrent HBV infection was (0.29+/-0.49) time/patient and (0.50+/-0.63) time/patient(P>0.05); Incidence of patients with >or=3 episodes of acute rejection in patient with recurrent HBV infection and that without recurrent HBV infection was 14.3% and 10.6%(P>0.05). Furthermore, the number of acute rejection episodes in patients with HCC recurrence or metastasis and that without HCC recurrence or metastasis was (1.12+/-0.93) time/patient and (1.06+/-1.39) time/patient respectively(P>0.05); the number of moderate acute rejection episodes(RAI>or=score 4) in patients with HCC recurrence or metastasis and that without HCC recurrence or metastasis was (0.65+/-0.79) time/patient and (0.65+/-1.06) time/patient respectively(P>0.05); Incidence of patients with >or=3 episodes of acute rejection in patient with HCC recurrence or metastasis and that without HCC recurrence or metastasis was 5.9% and 17.6% respectively(P>0.05). The tumor diameter in patients with HCC recurrence or metastasis was (6.72+/-3.40)cm, however, that in patients without HCC recurrence or metastasis was (3.55+/-2.17)cm(P=0.004 7).The incidence of Portal vein invasion in patients with HCC recurrence or metastasis and that without HCC recurrence or metastasis was 68.75% and 33.3% respectively(P=0.006). CONCLUSION: There was no significant difference among HBV recurrence and acute rejection post-liver transplantation in patients with chronic HBV infection. There was no significant difference between HCC recurrence and acute rejection. The tumor diameter of patients with HCC recurrence or metastasis was significantly greater than that of no HCC recurrence or metastasis. The portal vein invasion of patients with HCC recurrence or metastasis was significantly frequent than that of no HCC recurrence or metastasis.

[Status and clinicopathologic implication of epidermal growth factor receptor mutation in non-small cell carcinoma of lung].

OBJECTIVE: To investigate mutations of epidermal growth factor receptor (EGFR) exon 19 and 21 in non-small cell lung carcinoma and to explore their clinicopathological correlations. METHOD: DNA was extracted from the excised tumor specimens of 66 non-small cell lung carcinoma patients by traditional phenol-chloroform and ethanol precipitation. Exons 19 and 21 were amplified by polymerase chain reaction (PCR), followed by direct sequencing in both sense and antisense directions. RESULTS: EGFR somatic mutations were present in 11 of 66 patients (16.7%), including 7 cases of in-frame deletion involving exon 19 and 4 cases of amino acid substitution involving exon 21. Mutations were more frequently observed in women (9/34, 26.5%) than in men (2/32, 6.3%), in adenocarcinomas (10/43, 23.3%) than squamous (0/13) and adenosquamous carcinomas (1/10). There was no difference in the mutation rates between smokers and non-smokers. Those with adenocarcinoma with bronchiolo-alveolar carcinoma (BAC) components had higher frequency of EGFR mutation (6/11) than those without non-BAC element (4/32, 12.5%). CONCLUSIONS: The mutations appear to occur in highly selected subgroups of lung cancer patients: adenocarcinomas with BAC components and patients of the female gender. The results may offer practical approach to the rapid identification of lung cancer patients who likely respond to EGFR inhibitor therapy.

[P2Y purinergic receptor activated PI-3K/Akt signaling pathway in regulation of growth and invasion of prostatic cancer].

OBJECTIVE: To investigate P2Y purinergic receptor activated PI-3K/Akt signaling pathway in the regulation of growth and invasion of prostate cancer in vitro. METHODS: Western blot was used to detect phosphorylation of Akt (a downstream target molecule of PI-3K) by P2Y receptor agonist in 1E8 cells (a highly metastatic subclone derived from PC-3 prostatic cancer cell line). Cell counts, flow cytometry, Matrigel invasion assay, wound healing assay and gelatin zymography were used to detect changes of biological behaviors of 1E8 cells after P2Y receptor activation. RESULTS: AMP-PNP, one non-hydrolysis ATP analogue and P2Y receptor agonist, induced significant phosphorylation of Akt in a time- and dose-dependent manner in IE8 cells. LY294002, a specific inhibitor of PI-3K, effectively blocked Akt phosphorylation induced by AMP-PNP. Continuous exposure to AMP-PNP induced significant growth inhibition of 1E8 cells (inhibition rate at 50.2% at the 8th day), and this inhibition was mainly due to an arrest at S phase of the cell cycle (the S phase fraction of AMP-PNP treated cells was 22.3% higher than that of the control). Application of LY294002 did not reverse the growth inhibition effect of AMP-PNP. Matrigel invasion assay showed that AMP-PNP stimulation increased invasive ability of 1E8 cells, and this effect was effectively blocked by LY294002. No significant changes in the activation of MMP-2 and MMP-9 were detected by gelatin zymography, although wound healing assay showed 21.2% increase in cell migration after AMP-PNP treatment. CONCLUSIONS: PI-3K/Akt signaling pathway participates in P2Y receptor-stimulated prostate cancer invasion by enhancing cell motility, rather than up-regulating MMP-2 and MMP-9 activities. PI-3K signaling pathway plays an important role in prostate cancer proliferation, but is not involved in P2Y receptor mediated growth inhibition.

[Status and clinical implication of c-kit and PDGFRA mutations in 165 cases of gastrointestinal stromal tumor (GIST)].

OBJECTIVE: To investigate the status of c-kit and PDGFRA mutations of GIST in a the large sample of Chinese patients. METHOD: One hundred and sixty-five cases were evaluated for the presence of c-kit and PDGFRA mutations. Exon 9, 11, 13, 17 of c-kit and exon 12, 18 of PDGFRA were analyzed by PCR amplification and direct sequencing. RESULTS: Immunohistochemical demonstrations of KIT (CD117) were seen in 94% of the cases (155/165). Overall, c-kit mutations were identified in 76.1% (118/155) of CD117 positive cases: 67.1% (104/155) involving exon 11, 7.1% (11/155) involving exon 9, 1.3% (2/155) involving exon 13 and 0.6% (1/155) involving exon 17. The c-kit exon 11 mutations were mostly heterogeneous and clustered in the classic "hot spot" at the 5' end of the exon, including in-frame deletion and point mutation. The second "hot spots" were internal tandem duplications (ITD) at the 3' end of the exon, which were associated with female patient, older age, stomach location and low mitotic counts. The exon 9 mutations correlated with a distinct subset of GISTs involving the small bowel of young male patients. A new point mutation of L641P was identified in exon 13. PDGFRA mutations were present in 50% (5/10) of CD117-negative GISTs, all involving exon 18 with the majority of mutations being D842V. One novel in-frame deletion of IMHD mutation at codon 843 - 846 with S847T was identified. GISTs with PDGFRA mutations were often larger tumors arising from the omentum/mesentery of young male patients with high risk of aggressive behavior. CONCLUSIONS: The vast majority of GISTs in this study harbored c-kit and PDGFRA mutations, there were non-random relations between the gene mutation patterns and the locations of GISTs. It appears that Chinese GIST patients have some unique mutation patterns. It is necessary to evaluate the gene mutations status of GISTs to guide target therapy.

[PTCH gene mutations in odontogenic keratocysts].

OBJECTIVE: To investigate the frequency, type and distribution of PTCH mutations in odontogenic keratocysts (OKC) and to analyze the molecular pathological relationship between sporadic OKC and OKC associated with nevoid basal cell carcinoma syndrome (NBCCS). METHODS: Genomic DNA was extracted from 8 cases of OKC lesions (4 sporadic OKCs and 4 NBCCS-related OKCs). PTCH gene mutations were detected by PCR-direct sequencing. RESULTS: Six novel PTCH mutations were identified in 6 out of 8 cases (2 sporadic and 4 NBCCS-related OKCs). Two of these were missense mutations leading to substitution of an amino acid residue respectively. The other 4 mutations were identified as insertion or deletion ranging from one single base to 7 bases, three of which caused frame-shift leading to premature truncation of PTCH protein and one resulted in an insertion of 2 amino acid residues. All these identified mutations were novel and have not been previously described. CONCLUSIONS: PTCH gene mutation is a common event in NBCCS-related OKCs and could also be detected in some sporadic OKCs. Abnormalities of PTCH gene may be involved in the pathogenesis of OKC.

[Detection of Mycobacterium tuberculosis DNA in sarcoidosis samples using real-time fluorescence polymerase chain reaction].

OBJECTIVE: To study the role of Mycobacterium tuberculosis in the pathogenesis of sarcoidosis. METHODS: Archival material of 22 patients with a histologic diagnosis of sarcoidosis were retrieved. Real-time fluorescent polymerase chain reaction (PCR) was used to detect DNA fragments of the complex-specific insertion sequence IS6110 of Mycobacterium tuberculosis in formalin-fixed and paraffin-embedded biopsy samples. RESULTS: Among the 22 samples studied, Mycobacterium tuberculosis DNA was detected in 11 cases. The sequence of PCR amplified IS6110 DNA fragments completely matched with the related sequence in Mycobacterium tuberculosis gene. CONCLUSIONS: Mycobacterium tuberculosis DNA is identified in a certain proportion of patients with a clinicopathologic diagnosis of sarcoidosis. Mycobacterium tuberculosis may be an important etiologic agent, at least in some of these patients.

[c-kit and PDGFRA mutations in 60 cases of gastrointestinal stromal tumors (GISTs)].

OBJECTIVE: To explore the status of activating mutations of c-kit and PDGFRA in GIST of Chinese patients. METHODS: Sixty GISTs, confirmed by immunoreactivity of CD117, CD34, SMA, S-100 and Desmin, were evaluated for the presence of c-kit exons 9, 11, 13 and 17 mutations, and PDGFRA exons 12 and 18 mutations. The PCR products were sequenced directly for mutations, using DNA extracted from paraffin-embedded tissue. RESULTS: 53% of the tumors were located in the stomach, 22% in the small bowel, 8% in the colo rectum, 2% in the esophagus and 15% in the extragastrointestinal tract. Immunohistochemical demonstrations of c-kit (CD117) were seen in 90% cases. Overall, c-kit mutations were detected in 63.3% of patients as follows: 58.3% in exon 11, 3.3% in exon 9, 1.7% in exon 13 and none in exon 17. The types of c-kit exon 11 mutations were mostly heterogeneous and clustered in the classic "hot spot" at the 5' end of exon 11, 42.9% being point mutation and in-frame deletion at Codon 557-560. 14.3% of cases showed internal tandem duplications (ITD) at the 3' end of exon 11 in a region of a second hot spot for c-kit mutations. Interestingly, these cases were associated with female predominance, stomach location and occurrence in older patients. The present study failed to identify a significant association between c-kit mutation status and risk of aggressive behavior in GISTs. Exon 9 mutations consisted of ITP of six nucleotides encoding Ala-Tyr. A new point mutation of L641P was revealed in exon 13. PDGFRA mutations were found in 5% of all the 60 cases with none of the positive cases expressed detectable KIT protein. The type of mutation was the commonest point mutation of D842V of exon 18. CONCLUSION: Most KIT expressing GIST show c-kit mutations that are preferentially located within the classic hot spot of exon 11. A second hot spot -ITD at the 3' end of exon 11 seems to associate with a subgroup of gastric GISTs in older females. c-kit exons 9, 13 and 17 mutations are rare events in GIST of China. PDGFRA oncogenic mutations are more likely seen in KIT-negative GISTs arising in the peritoneal surface and have an unfavorable clinical course.

[Correlation of expression of connexin to growth and progression of cervical carcinoma in situ].

BACKGROUND & OBJECTIVE: Gap junction intercellular communication (GJIC), mediated by connexin (CX), is the unique type of intercellular communication in carcinoma in situ (CIS). Changes in expression of CXs and function of GJIC may play roles in carcinogenesis of cervical cancer and progression of CIS. This study was to investigate the expression of CXs in normal epithelium (NE), hyperplasia, CIS, and invasive carcinoma (IC) of cervix, to explore correlation of expression of CXs to pathogenesis and progression of cervical CIS. METHODS: Expression of CX43 (mRNA, protein), CX26 (mRNA), and Ki-67 (protein) in 30 specimens of cervical NE, 22 specimens of cervical hyperplasia, 30 specimens of cervical CIS, and 26 specimens of cervical IC were detected by immunohistochemistry and in situ hybridization. RESULTS: In cervical NE, hyperplasia, CIS, and IC, positive rates of CX43 protein were 83%, 55%, 50%, and 30%, respectively, and positive rates of CX43 mRNA were 97%, 64%, 58%, and 46%, respectively; positive rates of CX26 mRNA was 93%, 68%, 55%, and 42%, respectively. Positive rates of CX43 (mRNA, protein) and CX26 (mRNA) were gradually decreased. Positive rate of CX was significantly lower in CIS group than in NE group (P < 0.05). The expressions of CX26 and CX43 were weaker in CIS group than in NE groupu their expressions were obviously decreased, or even vanished in the area of CIS adjacent to NE. Proliferating index (PI), indicated by expression of Ki-67 protein, was increased gradually in NE (5%), hyperplasia (12%), CIS (30%), and IC (62%)u the differences were significant (P < 0.05) between CIS group and other groups. CONCLUSIONS: CX26 and CX43 may play important roles in carcinogenesis of cervical cancer. CXs may inhibit tumorigenesis and cell proliferation; it might be key factors in earlier stages when cellular malignant phenotypes have been established, or NE has been transformed into CIS.

[Diagnosis of lymph node micrometastases in human lung carcinoma: determination of p53 gene mutations by polymerase chain reaction-temperature gradient gel electrophoresis (PCR-TGGE)].

BACKGROUND & OBJECTIVE: Metastasis is one of the most important factors in determining the prognosis of lung cancer patients. However, it is difficult to determine single cancer cell in lymph nodes by routine methods. This study was designed to investigate a sensitive method for detecting lymph node micrometastases in human lung carcinomas. METHODS: Mutation detection for p53 gene (exon 5-8) was performed in 39 cases of primary lung carcinomas and 110 corresponding lymph nodes (LNS) by PCR-TGGE method. Serial sectioning was performed to confirm micrometastases in some of these samples. RESULTS: p53 mutations were found in 23 of 39 cases with primary lung cancer. Forty LNSs showed p53 mutation in 67 corresponding LNSs. They were located at the same exon as their primary tumors. Only twenty-six LNSs were detected metastases by routine histopathology. Forty-three LNSs from sixteen cases of primary tumor without p53 mutation and ten LNSs from the patients without tumor disease did not have any p53 mutations. By PCR-TGGE assay p53 gene mutations were determined in fourteen LNSs without histopathological evidence of metastasis. Micrometastases were found in four of the serially sectioned cases. CONCLUSION: Mutation detection for p53 gene (exon 5-8) showed lymph node micrometastases in patients with lung carcinoma. It may be used as a complement for the routine histopathology.

[Activation of HIF-1 by bFGF in breast cancer: role of PI-3K and MEK1/ERK pathways].

OBJECTIVE: To explore the mechanism of basic fibroblast growth factor (bFGF)-mediated hypoxia inducible factor (HIF-1) activation and the down-stream signaling pathways involved. METHODS: Human breast cancer cells of the line T47D were cultured and lysed to extract the total protein in the supernatant. The amounts of extracellular signal kinase 1/2 (ERK1/2), Akt, p38, and beta-tubulin were measured. T47D cells were inoculated into a 24-well plate, co-transfected with luciferase vector OB-HRE containing HIF-1 functional sequence (HRE) and pRL-SV40 (as inner marker), pretreated with SU5402, inhibitor of FGFR1, SB203580, inhibitors of PI-3K, PD98059, inhibitors of MEK1, or LY294002, inhibitors of p38, treated with basic fibroblast growth factor (bFGF), and then lysed. The amounts of ERK1/2, Akt, p38, and beta-tubulin were measured. Western blotting was used to detect the HIF-1alpha level in total protein. Dual luciferase assay was used to analyze the transactivity of HIF-1. The firefly/renilla luciferase ratio was measured to access the transcription activity of HIF-1. Western blotting was used to detect the expression of HIF-1alpha protein and phosphorylated Akt, ERK1/2 and p38 in whole cell extract. RESULTS: After the addition of bFGF Western blotting showed that the and phosphorylation of Akt, ERK1/2 and p38 in the T47D cells were increased time- and dose-dependent manner, and dual luciferase assay showed that the fluorescent intensity was increased, signifying the increase of expression of HIF-1alpha protein. Ten minutes after the addition of CHX the expression of HIF-1alpha protein began to be decreased and ceased 90 minutes after. SU5402 remarkably dose-dependently blocked the bFGF-induced phosphorylation of ERK1/2, Akt and p38. 15 micromol/L LY294002 completely blocked the bFGF-induced phosphorylation of Akt. 5 micromol/L PD98059 blocked 80% of the bFGF-induced phosphorylation of ERK1/2. 10 approximately 20 micromol/L SB203580 basically blocked the bFGF-induced phosphorylation of p38. SU5402 and LY294002 100% inhibited the bFGF-induced expression of HIF-1alpha protein. However, PD98059 and SB203580 did not significantly influence the expression of HIF-1alpha protein induced by bFGF. Luciferase assay showed that SU5402 and PD98059 inhibited the bFGF-induced transcription activity of HIF-1 by 94.8% and 81.7% respectively. LY294002 not only completely inhibited the bFGF-induced transcription activity of HIF-1 but also inhibited the basic transcription of HIF-1, and SB203580 did not significantly influence the transcription activity of HIF-1. CONCLUSION: bFGF activates HIF-1 via the PI-3K/Akt and MEK1/ERK pathways that co-operatively and differentially regulate this process with PI-3K/Akt pathway playing a more important role.

[Gene detection of severe acute respiratory syndrome-related coronavirus].

OBJECTIVE: To develop a newly real-time RT-polymerase chain reaction assay for severe acute respiratory syndrome (SARS) related coronavirus in human whole blood. METHODS: A pair of primers and a probe (molecular beacon) had been designed that were specific for the recognition of a highly conservative region between 15 301 and 15 480 of the SARS-related coronavirus polymerase gene sequences obtained from GenBank (G130027616). RESULTS: In the real-time RT-PCR assay, the extent of SARS related coronavirus amplification was measured in terms of the increase in fluorescence during the amplification process. The 145 bp fragment of PCR product was further confirmed by conventional PCR assay and proved by DNA sequencing to be identical to the target sequence to which the probe was hybridized. CONCLUSION: This assay has a broad application for clinical diagnosis and surveillance investigation.