中国人原发性胆囊肿瘤nm23H1基因遗传不稳定性的研究

采用石蜡包埋组织抽提DNA,PCR-单链构象多态性(PCR-SSCP),常规银染,Envision免疫组织化学和Leica-Qwin计算机图像分析等方法,研究人类17号染色体D17S396位点微卫星不稳定性(microsatelliteinstablility,MSI)和杂合性缺失(lossofheterozygosity,LOH),对胆囊肿瘤nm23H1蛋白表达的影响,阐明nm23H1基因遗传不稳定性与胆囊肿瘤进展的关系,为揭示nm23H1基因与肿瘤发生和转移机理提供实验依据。在本实验中,原发性胆囊癌D17S396位点遗传不稳定发生率为42.55%,明显高于良性胆囊肿瘤的13.04%,而在胆囊炎组织中,未见该位点遗传不稳定的发生;其中,LOH的发生率随组织恶性程度的增高而增加(P<0.05)。在胆囊癌中,LOH和MSI发生率与肿瘤组织分化程度具有显著差异(P<0.05);LOH的发生率,在肝脏浸润和淋巴转移组高于无肝脏浸润和无淋巴转移组,在NevinⅣ Ⅴ期高于Ⅰ Ⅱ Ⅲ期(P<0.01);而MSI发生率则相反。nm23H1蛋白阳性率在胆囊癌、胆囊良性肿瘤和炎症组织中差异显著(P<0.05);在胆囊癌中,淋巴转移组低于无淋巴转移组(P<0.01);NevinⅣ Ⅴ期低于Ⅰ Ⅱ Ⅲ期(P<0.05)。此外,计算机图像定量分析显示,在各临床病理参数影响下,nm23H1蛋白的表达强度没有差异。在胆囊癌中,LOH阳性组中nm23H1蛋白阳性率显著低于LOH阴性组,两者差异显著(P<0.05)。实验结果提示,nm23H1基因的遗传不稳定性可能是胆囊肿瘤发生、发展的一个重要机制。nm23H1基因的MSI和LOH,通过相互独立的途径调控胆囊癌的发生和转移,MSI是胆囊癌早期分子指标,LOH可作为胆囊组织恶变的判断指标,可抑制胆囊癌局部nm23H1蛋白的表达,并赋予胆囊癌高淋巴结转移、低预后的特性。提高胆囊癌局部nm23H1蛋白的表达,可减缓肿瘤的浸润转移并提高预后率。

STUDY ON GENETIC INSTABILITY OF nm23H1 GENE IN CHINESE WITH ORIGINAL GALLBLADDER TUMOR

The aim of this study was to examine the microsatellite instability (MSI) and loss of heterozygosity (LOH) of locus D17S396 on chromosome 17 and their influence on the expression of nm23H1 in gallbladder tumors, which may provide experimental basis for the tumor occurrence and metastasis. Techniques such as DNA extraction from formalin-fixed paraffin-embedded tissues, polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP), ordinary silver stain were used to study MSI and LOH of locus D17S396. Envision immunohistochemistry and Leica-Qwin computer imaging techniques were used to assess the expression of gene nm23H1. In our experiment, the frequency of genetic instability of malignant gallbladder tumors was 42.55%, which was higher than that of gallbladder adenomas, while there were no genetic instability occurred in chronic cholecystitis tissue. The frequency of LOH seemed higher with the deteriorism of gallbladder tumor. Among 47 gallbladder carcinomas, the frequency of LOH and MSI were different between different differentiation cases (P < 0.05), and the frequency of LOH in liver and lymph node metastasis cases was significantly higher than those without metastasis (P < 0.01). Moreover, the frequency of LOH was higher in stage Nevin IV and V when compared with stage I, II and III. However, the frequency of MSI showed contrary correlation with some clinicopathologic characteristics. The expression of nm23H1 in gallbladder carcinoma, gallbladder adenoma and chronic cholecystitis tissue were different (P < 0.05). The case with lymph node metastasis showed significantly lower nm23H1 expression than those without lymph node metastasis (P < 0.01). Nevin stage IV and V also exhibited lower nm23H1 expression levels compared with stage I, II and Ill. Furthermore, there was no difference in nm23H1 protein expression intensity analyzed by computer imaging techniques. In gallbladder carcinomas, the positive frequency of nm23H1 protein in LOH positive group was lower than that of LOH negative group (P < 0.05). The results indicated that the genetic instability of nm23H1 gene might be implicated in pathogenesis and progression of gallbladder tumor. Both MSI and LOH of nm23H1 gene controlled the development of gallbladder tumor independently in different paths. MSI may be an early stage molecule marker of gallbladder carcinoma. LOH may be molecule marker for the deteriorism of gallbladder tissue, which could inhibit the expression of nm23H1 in local tissue of gallbladder carcinoma and endow it with high aggressive and poor prognosis. Increasing the amount of nm23H1 protein expression could effectively restrain gallbladder carcinoma metastasis and improve prognosis of patients.