非可控性炎症的恶性转化

炎症和肿瘤之间存在内源性及外源性两条通路,它们在非可控性炎症恶性转化的过程中起重要作用.机体内有多种消炎机制的存在,当炎性因素如组织损伤或者感染消除后,炎症很快结束;如果存在持续的或低强度刺激时,炎症将不可控制.在非可控性炎症状态下,炎症介质尤其是活性氧氮介质引起原癌基因活化和抑癌基因灭活,启动肿瘤;NF-κ B和STAT3通路活化后与促炎细胞因子间存在正反馈循环,共同促进肿瘤的发展,新生血管的形成,上皮间质转化(EMT)的发生;炎症细胞释放的金属蛋白酶(MMP)有利于肿瘤的侵袭和转移.此外,肿瘤微环境中的炎症细胞如肿瘤相关性巨噬细胞(TAMs)、骨髓来源抑制细胞(MD-sC),炎症介质如肿瘤坏死因子(TNF)等影响肿瘤发生、发展及侵袭转移.研究非可控性炎症恶性转化的机制可为肿瘤的预防和治愈提供新的思路.     

炎症与肿瘤的关系研究进展

炎症与肿瘤关系密切,慢性炎症与1/4以上癌症发生相关.炎症微环境中细胞因子,自由基,前列腺素,生长因子等炎性应答介质能诱导DNA甲基化,抑癌基因点突变和翻译后修饰等基因和表观学变化,引起维持正常细胞内环境稳定关健通路的改变并导致癌症的发生和演进;近年来,对炎症中microRNA和免疫应答相互作用的研究进一步加深了人们对炎症与肿瘤相关性的了解.本文就炎症与肿瘤的间的桥梁分子予以综述,鉴定这些关键细胞成分及相互通路特异性的改变能为炎症相关性肿瘤的早期诊断、预防和治疗提供分子靶标.     

综述:乙型肝炎病毒所致非可控性炎症恶性转化的可能机制

肝细胞癌(HCC)占我国大陆地区恶性肿瘤死亡原因的第二位,主要由乙型肝炎病毒(HBV)慢性感染所致.人类白细胞Ⅱ类抗原遗传多态性与HBV感染的慢性化有关.HBV与免疫系统相互作用导致的非可控性炎症是HBV进化和HCC发生的必要因素.持续的、非充分的抗病毒免疫对HBV变异有选择作用.在炎症促癌过程中病毒和肝细胞基因组均经历了"变异-选择-适应"的进化过程.HBV变异不但能预测HCC的发生,而且具有促癌功能.HBV在肝细胞基因组中整合,尤其是羧基端截短型X基因的整合不但促进HCC的发生和转移,而且抵抗抗病毒治疗.明确HBV致癌机制可为降低和推迟HCC的发生和转移奠定基础.     

慢性炎症与动脉粥样硬化关系的研究进展

动脉粥样硬化(atherosclerosis,AS)的发病机制非常复杂,对其研究经历了一个半世纪,直到1999年Ross提出"动脉粥样硬化是一种炎症性疾病",各种炎症细胞和炎症因子参与动脉粥样硬化的发生和发展过程。已有众多的基础和临床研究都证实炎症在AS中的重要作用,但仍需要对AS发生发展的深入研究,使我们更准确认识和有效的防治AS。本文就近年来慢性炎症与动脉粥样硬化关系的研究进展作一综述。     

慢性炎症与动脉粥样硬化关系的研究进展

动脉粥样硬化（atherosclerosis,AS）的发病机制非常复杂,对其研究经历了一个半世纪,直到1999年Ross提出”动脉粥样硬化是一种炎症性疾病”,各种炎症细胞和炎症因子参与动脉粥样硬化的发生和发展过程。已有众多的基础和临床研究都证实炎症在AS中的重要作用,但仍需要对AS发生发展的深入研究,使我们更准确认识和有效的防治AS。本文就近年来慢性炎症与动脉粥样硬化关系的研究进展作一综述。     

编者按:非可控性炎症与肿瘤——古老的科学问题，新的研究前沿

正炎症(inflammation)是机体对病原体感染以及各种组织损伤等产生的一种防御反应,是最常见而又最重要的基本病理生理过程之一[1].炎症与肿瘤发生发展的关系是一个古老的科学问题,早在1863年,德国著名病理学家Rudolf Virchow就证实了肿瘤组织中有大量的白细胞浸润,从而提出肿瘤起源于慢性炎症这一假说[2],但这一假说当时并未引起足够的重视.直到21世纪初,炎症与肿瘤的关系才重新引起研究者们的极大兴趣[3],科学家们发现     

炎症-肿瘤转化在眼部相关疾病中的研究进展

炎症向癌症转化的机制一直是癌症研究中的重点。作为炎症-肿瘤转化起始时所处的环境，炎性微环境是一个多种调控因子、细胞的大集合，其中包含的肿瘤干细胞、肿瘤相关巨噬细胞以及细胞因子（如趋化因子、生长因子）等在常见的眼部肿瘤中对肿瘤的起始、发生、演进乃至恶性转化和转移的过程起到了至关重要的调控作用。基于此，主要讨论了在炎性微环境中的肿瘤相关细胞、细胞因子以及细胞外基质等对肿瘤细胞的增殖、转移、浸润、侵袭过程的影响，着重探讨了眼部炎症-肿瘤转化相关的分子机制；并综述了视网膜母细胞瘤、腺样囊性癌等常见眼部肿瘤的特征及其由炎症到肿瘤发生过程中起重要调控作用的分子；最后，针对这些眼部肿瘤普遍存在的信号通路和分子靶点做出了对未来诊断及治疗方法的展望，以期在今后对眼科肿瘤的诊治过程中，能够针对提及的炎性成分设计思路，最大化防止炎症-肿瘤转化和恶性转归出现。     

糖胺聚糖与炎症的关系

以肝素为代表的糖胺聚糖类药物,可作用于肥大细胞脱颗粒、补体激活和白细胞与内皮细胞的黏附等多个环节,从而发挥其抗炎活性.     

Livin与恶性肿瘤的关系

livin属于凋亡抑制蛋白基因家族,与恶性肿瘤发生发展关系密切。根据livin基因结构特点,Livin可能参与调控胱蛋白天冬酶信号通路、丝裂原激活蛋白激酶途径,参与Wnt／beta-catenin信号通路。探讨了Livin与恶性黑色素瘤、膀胱癌、肺癌等多种恶性肿瘤的关系,为临床治疗这些疾病提供新的方法和思路。     

A comparative study between open-face and closed-face masks for head and neck cancer (HNC) in radiation therapy

AimTo determine the setup reproducibility in the radiation treatment of Head and Neck (HN) patients using open face head and shoulder masks (OHSM) with customized headrest (CHR) versus standard closed head and shoulder masks (CHSM) and to determine the patient’s level of comfort and satisfaction for both masks.MethodsForty patients were prospectively randomized into two groups using simple random sampling. Group 1 was assigned with CHSMs, immobilized with a standard HR (SHR) while Group 2 was assigned with OHSMs, and immobilized with CHR. Cone beam computed tomography (CBCT) was taken the first 3 days, followed by weekly CBCT (prior treatment) with results registered to the planning CT to determine translational and rotational inter-fraction shifts and to verify accuracy. Mean (M) and standard deviation (SD) of the systematic and random setup errors of the 2 arms in the translational and rotational directions were analyzed, using Independent t-test and Mann–Whitney U test. Patient comfort was measured using a Likert questionnaire.ResultsThe vertical, lateral, longitudinal and Z/roll rotational shifts were not significantly different between the two masks. X/yaw and Y/pitch rotational shifts were significantly greater in Group 2 versus Group 1, for both systematic (p = 0.009 and 0.046, respectively) and random settings (p = 0.016 and 0.020) but still within three degrees. Patients reported higher neck and shoulder comfort (p = 0.020) and overall satisfaction (p = 0.026) using the OHSM with the CHR versus the CHSM with the SHR during CT simulation.ConclusionOpen masks provide comparable yet comfortable immobilization to closed masks for HN radiotherapy.     

p53 and PCNA Expression in Malignant Melanomas of the Head and Neck

Mutation in the p53 tumor suppressor gene is the most common genetic alteration in human cancer. As in mutant p53 the protein is stabilised and the half-life is extended, it becomes detectable by immunohistological staining. p53 immunoreactivity thus seems to be a potential biomarker for the assessment of the oncogenic potential of malignant melanomas. In 103 tissue sections of primary and metastatic malignant melanomas of the head and neck detectable levels of p53 were only found in 3 of the primary tumors and in none of the metastases. At the same time the proliferation status of the malignant melanoma lesions was determined using the cell cycle specific antibody PCNA. 55 primary and metastatic tumors were stained with a PCNA-MAb to determine the proliferation activity of the tumors. The results of our immunohistochemical investigation suggest that immunoreactivity of p53 cannot be used to determine the malignant potential of melanomas in the head and neck. PCNA staining showed that the majority of the tumors and metastases were proliferating rapidly.     

头颈部鳞状细胞癌相关肿瘤标志物的研究进展

头颈部鳞状细胞癌(head and neck squamous cell carcinoma,HNSCC)是头颈部恶性肿瘤的主要病理类型,约占所有头颈部肿瘤的90%。而据我们临床所见,大约有70%~80%的患者就诊时已为局部晚期,其治疗效果欠佳,预后差。肿瘤标志物又叫做肿瘤标记物,是指特征性存在于恶性肿瘤细胞,或是由恶性肿瘤细胞异常而产生的物质,或是宿主对于肿瘤的刺激反应而产生的物质,并且能够反映肿瘤发生、发展,以及监测肿瘤对治疗反应的一类物质。作为近年来研究热点的肿瘤标志物,具有简便、经济、快速、无创的特点,更重要的是一些标志物在组织器官发生形态学变化之前就有表达。因此,肿瘤标志物的研究对头颈部鳞状细胞癌的早期诊断以及判断预后都具有十分重要的意义。本文综述近几年来发现的可能与头颈部鳞状细胞癌的发生发展或者预后相关的肿瘤标志物。     

功能与分子影像在头颈部肿瘤放射治疗计划和疗效评价中的应用

目前临床普遍采用功能与分子影像检测手段能来评价头颈部肿瘤的放射治疗计划和疗效,可指导个体化治疗从而提高疗效。文章概述了功能与分子影像技术CT,MRI,PET-CT,超声检测技术在头颈部肿瘤放射治疗计划制定和疗效评价中的应用进展。结果显示,不同分子影像检测方法如在检查时机的选择、诊断和鉴别诊断的价值、观察放射治疗后肿瘤的残存和复发、预测放射治疗效果、指导后续治疗等方面均可起到重要作用。采用图像融合技术进行联合应用,如PET-CT和MRI-CT等,可提高检测的准确率。临床医生需在常规影像学手段的基础上,根据头颈部肿瘤患者病情和治疗方法的不同选用正确的功能和分子影像检测手段,更好地指导制定放射治疗计划及综合评价放射治疗后的疗效。     

Simultaneous Integrated Boost Radiotherapy in Unresectable Stage IV (M0) Head and Neck Squamous Cell Cancer Patients: Daily Clinical Practice

AimTo evaluate clinical outcome in locally-advanced stage IV (M0) head and neck cancer patients treated using intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) in daily clinical practice.BackgroundDespite SIB-IMRT has been reported as a feasible and effective advanced head and neck cancer treatment, there are few data about its concurrent use with systemic therapies.Material and MethodsWe reviewed 41 staged IV (M0) head and neck cancer patients treated in two radiotherapy units in the city of Messina (Italy) during the last six years, using intensity modulated techniques-SIB. 22/41 patients had concomitant chemotherapy or cetuximab. Acute and late toxicities, objective response (OR) rate, local control (LC) and overall survival (OS) have been evaluated.Results37/41 patients received the planned doses of radiotherapy, 2 patients died during the therapy. The major acute regional toxicities were skin reaction and mucositis. A case of mandibular osteoradionecrosis was recorded. At completion of treatment, OR was evaluated in 38 patients: 32/38 patients (84.2%) had complete (55.3%) and partial (28.9%) response. The 1- and 5-year LC rates were 73.4% and 69.73%, respectively. The 1-, 3-, and 5-year OS rates were 85.93%, 51.49% and 44.14%, respectively. No statistically significant differences in outcomes have been observed in patients treated with radiotherapy alone vs. irradiation concomitant to chemo/biotherapy. The median OS was 45 months.ConclusionSIB-IMRT is safeand can be used with concomitant chemotherapy/biotherapy in real-life daily clinical practice. SIB-IMRT alone is a valid alternative in patients unfit for systemic therapies.     

Age at start of using tobacco on the risk of head and neck cancer: Pooled analysis in the International Head and Neck Cancer Epidemiology Consortium (INHANCE)

BackgroundTobacco use is a well-established risk factor for head and neck cancer (HNC). However, less is known about the potential impact of exposure to tobacco at an early age on HNC risk.MethodsWe analyzed individual-level data on ever tobacco smokers from 27 case-control studies (17,146 HNC cases and 17,449 controls) in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using random-effects logistic regression models.ResultsWithout adjusting for tobacco packyears, we observed that younger age at starting tobacco use was associated with an increased HNC risk for ever smokers (OR_{<10 years vs. ≥30 years}: 1.64, 95% CI: 1.35, 1.97). However, the observed association between age at starting tobacco use and HNC risk became null after adjusting for tobacco packyears (OR_{<10 years vs. ≥30 years}: 0.97, 95% CI: 0.80, 1.19). In the stratified analyses on HNC subsites by tobacco packyears or years since quitting, no difference in the association between age at start and HNC risk was observed.ConclusionsResults from this pooled analysis suggest that increased HNC risks observed with earlier age at starting tobacco smoking are largely due to longer duration and higher cumulative tobacco exposures.     

Paucity of HPV-Related Head and Neck Cancers (HNC) in Nigeria

IntroductionThe burden of HPV-related Head and Neck Cancers (HNC) has been rising in the U.S. and other developed countries but this trend has not been reported in Africa. Objective of study was to evaluate the prevalence of HPV infection in HNC cancer cases seen between 1990 and 2011 at the tertiary health care institutions in Nigeria.MethodsWe retrieved 149 head and neck cancer formalin fixed, paraffin embedded tumor specimens diagnosed between 1990 and 2011 from four teaching hospitals in Nigeria. One hundred and twenty-three blocks (83%) contained appropriate HNC for analysis while DNA extraction was successful in 60% (90/149). PCR amplification was successful in 33% (49/149) and Linear Array genotyping for HPV was successful in 11% (17/149) of these cases. These were in tumors from the larynx (6), cervical lymph nodes (3), nasal cavity (2), parotid (1), palate (1), maxillary sinus (1) and mandible (1). Two cases were non-specific and none were from the oropharynx. Histologically, 41% (7/17) of the successfully genotyped blocks were squamous cell carcinomas (larynx 6, maxillary sinus 1).

Results and Conclusion

We were unable to detect HPV in any of the HNC samples in our study. Our result may suggest that there is a low prevalence of HPV-related HNC among the adult population in Nigeria. Our results provide a benchmark to compare future incidence of HPV -related HNC in this community in future. We had significant analytical challenges from possible poor tissue processing and urge that future studies should prospectively collect samples and ensure high quality sample processing.     

Mitoferrin-2-dependent Mitochondrial Iron Uptake Sensitizes Human Head and Neck Squamous Carcinoma Cells to Photodynamic Therapy

Photodynamic therapy (PDT) is a promising approach to treat head and neck cancer cells. Here, we investigated whether mitochondrial iron uptake through mitoferrin-2 (Mfrn2) enhanced PDT-induced cell killing. Three human head and neck squamous carcinoma cell lines (UMSCC1, UMSCC14A, and UMSCC22A) were exposed to light and Pc 4, a mitochondria-targeted photosensitizer. The three cell lines responded differently: UMSCC1 and UMSCC14A cells were more resistant, whereas UMSCC22A cells were more sensitive to Pc 4-PDT-induced cell death. In non-erythroid cells, Mfrn2 is an iron transporter in the mitochondrial inner membrane. PDT-sensitive cells expressed higher Mfrn2 mRNA and protein levels compared with PDT-resistant cells. High Mfrn2-expressing cells showed higher rates of mitochondrial Fe²⁺ uptake compared with low Mfrn2-expressing cells. Bafilomycin, an inhibitor of the vacuolar proton pump of lysosomes and endosomes that causes lysosomal iron release to the cytosol, enhanced PDT-induced cell killing of both resistant and sensitive cells. Iron chelators and the inhibitor of the mitochondrial Ca²⁺ (and Fe²⁺) uniporter, Ru360, protected against PDT plus bafilomycin toxicity. Knockdown of Mfrn2 in UMSCC22A cells decreased the rate of mitochondrial Fe²⁺ uptake and delayed PDT plus bafilomycin-induced mitochondrial depolarization and cell killing. Taken together, the data suggest that lysosomal iron release and Mfrn2-dependent mitochondrial iron uptake act synergistically to induce PDT-mediated and iron-dependent mitochondrial dysfunction and subsequent cell killing. Furthermore, Mfrn2 represents a possible biomarker of sensitivity of head and neck cancers to cell killing after PDT.     

Green tea (-)-epigallocatechin-3-gallate inhibits HGF-induced progression in oral cavity cancer through suppression of HGF/c-Met

Hepatocyte growth factor (HGF) and c-Met have recently attracted a great deal of attention as prognostic indicators of patient outcome, and they are important in the control of tumor growth and invasion. Epigallocatechin-3-gallate (EGCG) has been shown to modulate multiple signal pathways in a manner that controls the unwanted proliferation and invasion of cells, thereby imparting cancer chemopreventive and therapeutic effects. In this study, we investigated the effects of EGCG in inhibiting HGF-induced tumor growth and invasion of oral cancer in vitro and in vivo. We examined the effects of EGCG on HGF-induced cell proliferation, migration, invasion, induction of apoptosis and modulation of HGF/c-Met signaling pathway in the KB oral cancer cell line. We investigated the antitumor effect and inhibition of c-Met expression by EGCG in a syngeneic mouse model (C3H/HeJ mice, SCC VII/SF cell line). HGF promoted cell proliferation, migration, invasion and induction of MMP (matrix metalloproteinase)-2 and MMP-9 in KB cells. EGCG significantly inhibited HGF-induced phosphorylation of Met and cell growth, invasion and expression of MMP-2 and MMP-9. EGCG blocked HGF-induced phosphorylation of c-Met and that of the downstream kinases AKT and ERK, and inhibition of p-AKT and p-ERK by EGCG was associated with marked increases in the phosphorylation of p38, JNK, cleaved caspase-3 and poly-ADP-ribose polymerase. In C3H/HeJ syngeneic mice, as an in vivo model, tumor growth was suppressed and apoptosis was increased by EGCG. Our results suggest that EGCG may be a potential therapeutic agent to inhibit HGF-induced tumor growth and invasion in oral cancer.     

头颈部肿瘤基因组中HPV16DNA的同源序列

利用头颈部肿癌临床活检新鲜组织和石蜡包埋组织的两种处理标本,分别采用核酸分子杂交和聚合酶链反应(PCR)两种技术,分析了头颈部肿瘤组织基因组中人乳头瘤病毒16型的同源序列,并研究HPV16的感染同头颈部肿瘤发生发展的关系。结果表明:1.喉鳞状细胞癌DNA中有HPV16 DNA同源序列,检测频率在20.0％以上。2.PCR扩增石蜡包埋肿瘤组织DNA中HPV16的URR(病毒基因上游调控区)中的序列,电泳分析扩增产物在喉乳头状瘤、喉癌、鼻腔内翻性乳头瘤和口腔癌中检测率分别是11.1％、20.0％、42.9％和27.3％。3.研究表明HPV16 DNA阳性率与喉癌原发部位,分化程度和临床分期之间可能有一定的相关性。人乳头瘤病毒可能是头颈部肿瘤的病毒病因之