Abstract
Background and aims
Patients with primary sclerosing cholangitis (PSC) have an increased risk for biliary and gallbladder malignancy and markers of early malignancy in PSC are lacking. The aims were to evaluate biomarkers to look for premalignancy/malignancy.
Methods
All available gallbladder specimens (n = 53) in patients with PSC at Karolinska University Hospital between 1985 and 2006 were reviewed. Immunohistochemical staining for p53, Ki-67, Cyclin D1 and the thioredoxin family redox proteins; Thioredoxin reductase 1 (TrxR1), isoform-TrxR1-v.2.3.5, Thioredoxin (Trx1) and Glutaredoxin1 (Grx1) was performed on tissues from patients with carcinoma (n = 6), dysplasia (n = 7) and non-cancerous gallbladder epithelium (n = 6).
Results
Dysplasia and carcinoma were found in 16/53 (30%) cases. Inflammation and fibrosis of the gallbladder wall were more common in tissue with gallbladder dysplasia/carcinoma than in benign tissue 12/25 (48%) versus 4/28 (12%) (p < 0.01) and in 13/21 (62%) versus 3/32 (9%) (p < 0.0001), respectively. Immunoreactivity for p53, Ki67, Cyclin D1 was detected in significantly more cases of dysplasia/carcinoma of the gallbladder than in non-cancerous epithelium. 2/19 (11%) of the samples were positive in non-cancerous epithelium versus 7/17 (41%) in dysplasia/carcinoma (p < 0.05) for TrxR1-v.2.3.5. Grx1 was down regulated; more specifically 15/19 (79%) positive cases in non-cancerous epithelium versus 7/17 (41%) in dysplasia/carcinoma.
Conclusion
PSC patients have a frequency of gallbladder dysplasia/carcinoma of 30% in operative specimens. The overexpression of TrxR1-v2,3,5 and down regulation of Grx1 in dysplastic gallbladder epithelium suggest that these proteins should be further evaluated as possible future immunohistochemical markers in the early diagnosis of biliary malignancy in PSC.
Similar content being viewed by others
Abbreviations
- GR:
-
Glutathione reductase
- Grx:
-
Glutaredoxin
- GSH:
-
Glutathione
- PSC:
-
Primary sclerosing cholangitis
- PMN:
-
Polymorphonuclear
- Trx:
-
Thioredoxin
- TrxR:
-
Thioredoxin reductase
References
LaRusso NF, Wiesner RH, Ludwig J, MacCarty RL. Current concepts. Primary sclerosing cholangitis. N Engl J Med. 1984;310:899–903.
Said K, Glaumann H, Bergquist A. Gallbladder disease in patients with primary sclerosing cholangitis. J Hepatol. 2008;48:598–605.
Buckles DC, Lindor KD, Larusso NF, Petrovic LM, Gores GJ. In primary sclerosing cholangitis, gallbladder polyps are frequently malignant. Am J Gastroenterol. 2002;97:1138–1142.
Leung UC, Wong PY, Roberts RH, Koea JB. Gall bladder polyps in sclerosing cholangitis: does the 1-cm rule apply? ANZ J Surg. 2007;77:355–357.
Bergquist A, Ekbom A, Olsson R, et al. Hepatic and extrahepatic malignancies in primary sclerosing cholangitis. J Hepatol. 2002;36:321–327.
Pan JS, Hong MZ, Ren JL. Reactive oxygen species: a double-edged sword in oncogenesis. World J Gastroenterol. 2009;15:1702–1707.
Abraham SC, Cruz-Correa M, Argani P, Furth EE, Hruban RH, Boitnott JK. Diffuse lymphoplasmacytic chronic cholecystitis is highly specific for extrahepatic biliary tract disease but does not distinguish between primary and secondary sclerosing cholangiopathy. Am J Surg Pathol. 2003;27:1313–1320.
Jeffrey GP, Reed WD, Carrello S, Shilkin KB. Histological and immunohistochemical study of the gall bladder lesion in primary sclerosing cholangitis. Gut. 1991;32:424–429.
Jessurun J, Bolio-Solis A, Manivel JC. Diffuse lymphoplasmacytic acalculous cholecystitis: a distinctive form of chronic cholecystitis associated with primary sclerosing cholangitis. Hum Pathol. 1998;29:512–517.
Lewis JT, Talwalkar JA, Rosen CB, Smyrk TC, Abraham SC. Prevalence and risk factors for gallbladder neoplasia in patients with primary sclerosing cholangitis: evidence for a metaplasia-dysplasia-carcinoma sequence. Am J Surg Pathol. 2007;31:907–913.
Rizzi PM, Ryder SD, Portmann B, Ramage JK, Naoumov NV, Williams R. p53 Protein overexpression in cholangiocarcinoma arising in primary sclerosing cholangitis. Gut. 1996;38:265–268.
Sugimachi K, Aishima S, Taguchi K, et al. The role of overexpression and gene amplification of cyclin D1 in intrahepatic cholangiocarcinoma. J Hepatol. 2001;35:74–79.
Urig S, Becker K. On the potential of thioredoxin reductase inhibitors for cancer therapy. Semin Cancer Biol. 2006;16:452–465.
Gromer S, Urig S, Becker K. The thioredoxin system–from science to clinic. Med Res Rev. 2004;24:40–89.
Lillig CH, Berndt C, Holmgren A. Glutaredoxin systems. Biochim Biophys Acta. 2008;1780:1304–1317.
Rundlof AK, Fernandes AP, Selenius M, et al. Quantification of alternative mRNA species and identification of thioredoxin reductase 1 isoforms in human tumor cells. Differentiation. 2007;75:123–132.
Olm E, Jonsson-Videsater K, Ribera-Cortada I, et al. Selenite is a potent cytotoxic agent for human primary AML cells. Cancer Lett. 2009;282:116–123.
Fernandes AP, Capitanio A, Selenius M, Brodin O, Rundlof AK, Bjornstedt M. Expression profiles of thioredoxin family proteins in human lung cancer tissue: correlation with proliferation and differentiation. Histopathology. 2009;55:313–320.
Lillig CH, Holmgren A. Thioredoxin and related molecules–from biology to health and disease. Antioxid Redox Signal. 2007;9:25–47.
Yoon BI, Kim YH, Yi JY, et al. Expression of thioredoxin during progression of hamster and human cholangiocarcinoma. Cancer Sci. 2010;101:281–288.
Cunnea P, Fernandes AP, Capitanio A, Eken S, Spyrou G, Bjornstedt M. Increased expression of specific thioredoxin family proteins; a pilot immunohistochemical study on human hepatocellular carcinoma. Int J Immunopathol Pharmacol. 2007;20:17–24.
Lincoln DT, Ali Emadi EM, Tonissen KF, Clarke FM. The thioredoxin–thioredoxin reductase system: over-expression in human cancer. Anticancer Res. 2003;23:2425–2433.
Yoon BI, Kim DY, Jang JJ, Han JH. Altered expression of thioredoxin reductase-1 in dysplastic bile ducts and cholangiocarcinoma in a hamster model. J Vet Sci. 2006;7:211–216.
Fleming KA, Boberg KM, Glaumann H, Bergquist A, Smith D, Clausen OP. Biliary dysplasia as a marker of cholangiocarcinoma in primary sclerosing cholangitis. J Hepatol. 2001;34:360–365.
Hameed O, Adams AL, Baker AC, et al. Using a higher cutoff for the percentage of HER2 + cells decreases interobserver variability in the interpretation of HER2 immunohistochemical analysis. Am J Clin Pathol. 2008;130:425–427.
Atkinson R, Fau-Mollerup J, Mollerup J, et al. Effects of the change in cutoff values for human epidermal growth factor receptor 2 status by immunohistochemistry and fluorescence in situ hybridization: a study comparing conventional brightfield microscopy, image analysis-assisted microscopy, and interobserver variation. 20110803 DCOM- 20110927(1543-2165 (Electronic)).
Bjornsson E, Olsson R, Bergquist A, et al. The natural history of small-duct primary sclerosing cholangitis. Gastroenterology. 2008;134:975–980.
Hasebe T, Tsuda H, Hirohashi S, et al. Fibrotic focus in infiltrating ductal carcinoma of the breast: a significant histopathological prognostic parameter for predicting the long-term survival of the patients. Breast Cancer Res Treat. 1998;49:195–208.
Menke A, Adler G. TGFbeta-induced fibrogenesis of the pancreas. Int J Gastrointest Cancer. 2002;31:41–46.
El-Serag HB, Rudolph KL. Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology. 2007;132:2557–2576.
Cutroneo KR, White SL, Chiu JF, Ehrlich HP. Tissue fibrosis and carcinogenesis: divergent or successive pathways dictate multiple molecular therapeutic targets for oligo decoy therapies. J Cell Biochem. 2006;97:1161–1174.
Batheja N, Suriawinata A, Saxena R, Ionescu G, Schwartz M, Thung SN. Expression of p53 and PCNA in cholangiocarcinoma and primary sclerosing cholangitis. Mod Pathol. 2000;13:1265–1268.
Bergquist A, Glaumann H, Stal P, Wang GS, Broome U. Biliary dysplasia, cell proliferation and nuclear DNA-fragmentation in primary sclerosing cholangitis with and without cholangiocarcinoma. J Intern Med. 2001;249:69–75.
Hui AM, Li X, Shi YZ, Takayama T, Torzilli G, Makuuchi M. Cyclin D1 overexpression is a critical event in gallbladder carcinogenesis and independently predicts decreased survival for patients with gallbladder carcinoma. Clin Cancer Res. 2000;6:4272–4277.
Itoi T, Shinohara Y, Takeda K, et al. Nuclear cyclin D1 overexpression is a critical event associated with cell proliferation and invasive growth in gallbladder carcinogenesis. J Gastroenterol. 2000;35:142–149.
Orban TI, Olah E. Emerging roles of BRCA1 alternative splicing. Mol Pathol. 2003;56:191–197.
Wikstrand CJ, Hale LP, Batra SK, et al. Monoclonal antibodies against EGFRvIII are tumor specific and react with breast and lung carcinomas and malignant gliomas. Cancer Res. 1995;55:3140–3148.
Acknowledgments
This study was supported by grants from Wallenberg Foundation, Bengt Ihre’s Foundation, Swedish Cancer Society, Swedish Cancer and Allergy Society.
Conflict of interest
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Said, K., Glaumann, H., Björnstedt, M. et al. The Value of Thioredoxin Family Proteins and Proliferation Markers in Dysplastic and Malignant Gallbladders in Patients with Primary Sclerosing Cholangitis. Dig Dis Sci 57, 1163–1170 (2012). https://doi.org/10.1007/s10620-012-2089-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-012-2089-4