Apoptosis and expression of apoptosis-regulating proteins in hepatocellular, gallbladder and pancreatic carcinomas

Abstract

<div lang="en" class="abs"><p class="abs_header">Abstract</p><p>Apoptosis is a biochemically regulated mechanism leading to the destruction of an individual cell. An inadequate apoptosis is partly responsible for uncontrolled survival of malignantly transformed cells and formation of cancer. The growth of a tumor depends on the proliferative capacity and destruction of tumor cells either through apoptosis or necrosis. In this work, the extent of apoptosis and the expression of apoptosis-regulating proteins were studied by 3'-end labeling of fragmented DNA (TUNEL) and immunohistochemistry in a set of 166 tissue samples consisting of 33 HCCs, 39 gallbladder carcinomas, 7 gallbladder dysplasias and 87 pancreatic carcinomas. In addition, p53 protein and P-glycoprotein expression was studied immunohistochemically.</p><p>The extent of apoptosis was estimated by using apoptotic index, defined as a percentage of apoptotic cells in the entire tumor cell population. The present results show an average apoptotic index of 0.73% in HCC, 0.68% in gallbladder and 0.69% in pancreatic carcinoma. Bcl-2 positivity was found in only 3% of the HCCs, 10% of gallbladder and 13% of pancreatic carcinomas. Bax positivity was seen in all of the gallbladder and pancreatic carcinoma cases. Mcl-1 positivity was found in 87% of gallbladder and 86% of pancreatic tumors. The apoptotic index in bcl-2 positive cases was lower (0.35%) than in cases showing no immunoreactivity (0.64%) in pancreatic tumors (P = 0.013). Apoptotic index was higher in pancreatic tumors with strong bax immunoreactivity (0.70%) than in other cases (0.34%) (P = 0.002). Caspase 3, 6 and 8 expression was found in 92%, 92% and 73% of HCC, 95%, 77% and 77% of gallbladder carcinoma and 80%, 80% and 74% of pancreatic carcinoma cases, respectively. p53 positivity was found in 23% of hepatocellular, 57% of gallbladder and 41% of pancreatic carcinomas. P-glycoprotein was observed in 65% of the HCCs. Patients with Pgp positive tumors had a significantly shorter disease-free interval than those with Pgp negative tumors (P < 0.05). To evaluate the growth potential of HCC and pancreatic carcinoma, a growth index from the scores obtained for apoptosis, necrosis and cell proliferation was designed. Patients with a high degree of proliferation relative to the degree of necrosis and apoptosis (i.e. had a positive growth index) in HCC lesions had a significantly shorter survival (P = 0.004) and disease-free interval after operation (P = 0.019) than those with a tumor predominated by apoptosis and necrosis. Results were in line with HCC in pancreatic carcinoma, but the association did not reach statistical significance (P = 0.09).</p><p>According to the results the extent of apoptosis was similar in HCCs, gallbladder and pancreatic carcinomas. These tumors also showed here a similar expression pattern of the bcl-2 family of proteins and caspases. None of the individual parameters associated significantly with apoptosis except for bcl-2 and bax in pancreatic carcinoma, neither was there any association between p53 and P-glycoprotein expression and apoptosis. Calculation of a growth index might be helpful in assessing the prognosis of patients with tumors with a scant stroma, such as HCC.</p></div>