Dihydropyrimidine Dehydrogenase mRNA Levels Research Articles

Thymidine phosphorylase affects clinical outcome following surgery and mRNA expression levels of four key enzymes for 5‑fluorouracil metabolism in patients with stage�I and II non‑small cell lung cancer

The expression levels of thymidine phosphorylase (TP), dihydropyrimidine dehydrogenase (DPD), thymidylate synthase (TS) and orotate phosphoribosyltransferase (OPRT) may predict the clinical efficacy of 5-fluorouracil-based chemotherapy in patients with cancer. We herein investigated the differences in the mRNA levels of these enzymes in non-small-cell lung cancer (NSCLC) and evaluated their prognostic value for NSCLC treated by surgical resection. The intratumoral mRNA levels of TP, DPD, TS, and OPRT were quantified in 66 patients with pathological stage I and II NSCLC (adenocarcinoma or squamous cell carcinoma) following complete resection according to the Danenberg Tumor Profile method. The TP level was the only significant prognostic factor for disease-specific survival (DSS) following complete resection; the mean TP mRNA level differed significantly between the high and low mRNA expression groups. The DSS at 5 years was significantly higher in the low TP mRNA compared with that in the high TP mRNA expression group (83.4 vs. 58.6%, respectively; P=0.005). A Cox proportional hazards model revealed that pathological stage, sex, and TP expression were independent prognostic factors for DSS in patients with stage I and II NSCLC following complete resection. Thus, TP level may be used to monitor treatment efficacy and predict the outcome of NSCLC patients.

The Impact of the Expression Level of Intratumoral Dihydropyrimidine Dehydrogenase on Chemotherapy Sensitivity and Survival of Patients in Gastric Cancer: A Meta-Analysis.

The potential impact that the intratumoral expression level of dihydropyrimidine dehydrogenase (DPD) has on chemotherapy sensitivity and long-term survival for gastric cancer (GC) patients remains controversial; therefore, this study seeks to clarify this issue. Our meta-analysis was performed using Review Manager (RevMan) 5.3 software. In vitro drug sensitivity tests, correlation coefficients between sensitivity to 5-fluorouracil (5-FU), and expression levels of intratumoral DPD were used as effective indexes to analyse. Overall survival (OS) and progression-free survival (PFS) were used as endpoints for patient outcome, and hazard ratios (HRs) and 95% confidence intervals (CIs) were noted as measures of effect. There were 15 eligible studies including 1805 patients for the final analysis. The analysis revealed a statistically significant difference between the expression level of intratumoral DPD activity, DPD mRNA levels, and sensitivity to 5-FU in GC patients, with high expression levels of intratumoral DPD resulting in low sensitivity to 5-FU. However, no matter what therapeutic regimens were used, there was no significant difference for patient outcomes between high and low DPD expression groups, either in OS or in PFS. In conclusion, high levels of intratumoral DPD expression have a negative impact on sensitivity to 5-FU in GC patients, but no prognostic value for long-term survival was uncovered.

Intratumor dihydropyrimidine dehydrogenase mRNA expression levels are decreased in extramammary Paget's disease.

S-1, a 5-fluorouracil (5-FU)-based anti-cancer agent, is an important drug for treating metastatic extramammary Paget's disease (EMPD). Although intratumor expression levels of 5-FU metabolism enzymes have been studied widely in many solid tumors, no studies have examined on the expression levels of thymidylate synthase (TS), orotate phosphoribosyl-transferase (OPRT) or dihydropyrimidine dehydrogenase (DPD) in skin cancers. The aim of this study was to estimate the intratumoral mRNA expression levels of these genes in EMPD by real time PCR. Intratumoral DPD mRNA levels were decreased in EMPD compared to those in normal skin, but its intratumoral DPD mRNA expression levels were not correlated with clinical manifestations. Intratumoral DPD mRNA levels were positively correlated with OPRT mRNA levels in EMPD. Based on these results, low expression of intratumoral DPD mRNA in EMPD may contribute to the pathogenesis of this disease.

Abstract 5028: Reverse translational research for identifying the correlation between EGFR mutation status and DPD protein expression in lung adenocarcinoma

Abstract [Background] Reverse translation research is often described as “From the Bedside to the Bench”, which means taking an understanding gained by observations in a patient population to create hypotheses and confirmation of the hypothesis in the laboratory. According to current chemotherapy treatment for lung adenocarcinoma, empirically, clinicians know that epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (EGFR-TKI) tend to be effective for radiological ground glass nodule- type lung adenocarcinomas. On the other hand, it has been shown that 5-FU sensitivity in patients with non-small cell lung cancer (NSCLC) is associated with EGFR mutation status. From such clinical hints, we identified a relationship between dihydropyrimidine dehydrogenase (DPD), a 5-FU degrading enzyme, and EGFR mutation status. [Methods] We firstly focused on clinicopathologic factors and in vitro correlations between DPD expression and EGFR mutation status. Secondly, we analyzed crosstalk between the EGFR signal cascade and DPD protein expression using EGFR mutated and not mutated cell lines. [Clinicopathological Study] EGFR mutations and messenger RNA (mRNA) levels of DPD were analyzed in 47 resected NSCLC tumors by laser-capture microdissection. EGFR mutation status and the immunohistochemical expression of DPD in 49 resected NSCLC tumors were also examined. As a result, adenocarcinoma in situ showed significantly higher DPD mRNA levels and more EGFR mutation frequency than other histological types (P < 0.05). DPD immunopositive cases were more frequently observed in adenocarcinoma, in females, and in nonsmokers; which were correlated with EGFR mutation status (P < 0.003). [Basic Study] In vitro, EGFR-mutated cell lines (PC9, HCC827; exon19 E746-A750 and H1975; exon21 L858R, T790M, gefitinib resistant) showed higher DPD mRNA and protein expression than wild types (H1437, H1299). The DPD gene (DPYD), and DPD protein expression were known to be regulated by the transcription factor Sp1. In the PC9 study, EGF treatment induced up-regulation of both Sp1 and DPD. Gefitinib, an EGFR-TKI, and mithramycin A, specific Sp-1 inhibitors, suppressed them. However, the phenomena were not observed in EGFR-wild types and EGFR-TKI resistant cell lines. These results suggest DPD is regulated mainly in EGFR signal cascade enhanced lung cancers such as EGFR mutated adenocarcinomas. 5-FU and its derivatives such as uracil-tegafur (UFT) or S-1 might be effective for EGFR wild type adenocarcinomas because of the low DPD expression. [Conclusion] Reverse translational research can provide useful information for clinical treatment. In the present study, we identified crosstalk between the EGFR signal cascade and DPD protein expression, which might affect therapeutic strategy for lung adenocarcinomas. Citation Format: Tomoshi Tsuchiya, Tetsuo Tominaga, Koji Mochinaga, Naoya Yamasaki, Keitaro Matsumoto, Takuro Miyazaki, Go Hatachi, Yuka Kitajima, Takeshi Nagayasu. Reverse translational research for identifying the correlation between EGFR mutation status and DPD protein expression in lung adenocarcinoma. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 5028.

Abstract 2159: In vitro characterization of PTAU and FU interactions in colon cancer cells

Abstract Background: Fluorouracil (FU) remains a main anticancer therapy for colorectal cancer (CRC) and other solid tumors. The mechanism of action of FU is associated with inhibition of thymidylate synthase (TS) and incorporation of its metabolites into RNA and DNA. High toxicity and wide-spread chemoresistance, however, have limited the utilization of FU-based therapies. Five intracellular enzymes, thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), methylenetetrahydrofolate reductase (MTHFR), thymidine phosphorylase (TP), and uridine phosphorylase (UP) are key determinants of FU sensitivity or resistance. Combination therapies aimed at improving the bioavailability of FU and reducing host toxicity has been evaluated. Recently, our group developed a new uridine phosphorylase inhibitor, 5-phenylthio-acyclouridine (PTAU) that has shown promise in reducing host toxicity and increasing FU efficacy in vivo. The current studies were to characterize interactions of PTAU and FU in vitro and to assess its effects on key metabolic enzymes in human colon cancer cells. Hypothesis: We hypothesized that inhibition of uridine phosphorylase by PTAU would ameliorate the toxic effects of FU and enhance its efficacy by permitting increased doses of FU. Methods: Three colon cancer cell lines with differing p53 status, HCT116-p53wt (wild-type), HCT116-p53null, and HT-29 (p53-mutant); and a normal colonic epithelial cell line, CRL-1790, were used. Doubling times were determined, and IC50 values for FU were derived from kill curves using MTT assay. Cells were treated for 72 hours with IC50 doses of FU, PTAU (100 μM) or uridine (25 μM), alone or in combination, or with the solvent, DMSO. mRNA levels for DPD, TS, TP, and UP were quantitated by qRT-PCR; for intracellular protein expression, cells were fixed and stained with monoclonal antibodies and analyzed by flow cytometry. Results: FU sensitivity correlated with cell doubling times. Basal expression of FU metabolic enzymes differed between CRC and normal cells. mRNAs for DPD and UP were higher in normal relative to cancer cells, but TS mRNA was higher in cancer cells. FU treatment upregulated mRNA expression of DPD, UP, and TS in cancer cells but not in normal cells. Only in cancer cells, DPD induction by FU was potentiated by PTAU. In contrast, treatment with FU decreased protein levels of DPD, TP, and TS in cancer cells. PTAU induced TS protein expression in cancer cells, an effect that was reduced by co-treatment with FU. Conclusions: FU induces mRNA levels of DPD, UP, and TS in cancer cell lines, but protein levels are reduced; the discrepancy between mRNA and protein levels following FU treatment underscores the need for evaluation of colon cancer samples to assess response to FU therapy. This work was supported by a Supplement of the MSM/TU/UABCCC U54 Partnership grant (3U54-CA118948-09S1) from NIH. Citation Format: Esther A. Suswam, Gaurav Kumar, Hyung-Gyoon Kim, Mohamed Osmar, Mahmoud H. el Kouni, Upender Manne. In vitro characterization of PTAU and FU interactions in colon cancer cells. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2159.

Expression level of dihydropyrimidine dehydrogenase is associated with clinical outcome in patients with T1G3 bladder cancer treated with Bacillus Calmette-Guerin

BackgroundRecently, it has been shown that 5-fluorouracil (5-FU) with a strong dihydropyrimidine dehydrogenase (DPD) inhibitor elicits a significant response in bladder cancer with a high level of DPD. However, only a few studies investigated the association between the level of the enzyme that regulates the metabolism of 5-FU and prognosis in bladder cancer. Furthermore, to our knowledge, there has also been no such report in T1G3 bladder tumors treated with BCG. Therefore, we evaluated enzymes that regulate the metabolism of 5-FU in T1G3 tumors treated with BCG immunotherapy using the Danenberg tumor profile (DTP) method, a highly accurate measurement of RNA from paraffin-embedded specimens.MethodsThis study included 28 patients with T1G3 bladder cancer, each of whom underwent complete transurethral tumor resection and BCG intravesical instillation at our institution. The median follow-up period was 39 months (range, 3 to 159 months). The DTP method was used to analyze the mRNA expression of 3 enzymes related to 5-FU: DPD, orotate phosphoribosyltransferase (OPRT), and thymidylate synthase (TS).ResultsAmong the 28 patients, 13 developed recurrences (46.4%) and 5 experienced disease progression (17.9%). An elevated DPD mRNA level was significantly associated with recurrence (p = 0.048) and progression (p = 0.045). However, TS and OPRT mRNA levels were not significantly associated with any other clinical features or outcomes. Furthermore, the high DPD group had a significantly lower recurrence-free survival rate than the low DPD group (p = 0.047). Among patients with low DPD, the 2- and 5-year recurrence-free survival rates were 88.9% and 74.1%, respectively; while among patients with high DPD, the corresponding rates were 61.3% and 36.8%, respectively. TS and OPRT were not significantly associated with recurrence-free survival rates.ConclusionDPD is significantly associated with recurrence and progression among T1G3 bladder cancer patients treated with BCG.

High Expression of Dihydropyrimidine Dehydrogenase in Lung Adenocarcinoma is Associated With Mutations in Epidermal Growth Factor Receptor: Implications for the Treatment of Non–Small-Cell Lung Cancer Using 5-Fluorouracil

BackgroundIt has been shown that 5-fluorouracil (5-FU) sensitivity in patients with non–small-cell lung cancer (NSCLC) is associated with epidermal growth factor receptor (EGFR) mutation status. However, the relationship between dihydropyrimidine dehydrogenase (DPD), a 5-FU degrading enzyme, and EGFR mutation status is unknown. Here, we focus on clinicopathologic factors and in vitro correlations between DPD expression and EGFR mutation status. Patients and MethodsEGFR mutations and messenger RNA (mRNA) levels of DPD and thymidylate synthase (TS) were analyzed in 47 resected NSCLC tumors by laser-capture microdissection. In addition, relationships between EGFR mutation status and the immunohistochemical expression of DPD and TS in 49 patients with primary NSCLC who were treated with a 5-FU derivative of S-1 postoperatively were examined. Correlations among clinicopathologic factors were evaluated. The effect of epidermal growth factor on DPD expression was also investigated in vitro in various cell lines. ResultsAdenocarcinoma in situ showed significantly higher DPD mRNA levels and more EGFR mutation frequency than other histological types (P < .05). DPD immunopositive cases were more frequently observed in adenocarcinoma, in females, and in nonsmokers. DPD immunopositive cases were correlated with EGFR mutation status (P < .003). The prognoses of wild-type EGFR and mutated EGFR populations were similarly favorable with postoperative S-1 treatment, which overcomes the problem of 5-FU degradation in mutated EGFR. In vitro, EGFR-mutated cell lines showed high DPD mRNA and protein expression. ConclusionHigh DPD expression was shown to be correlated with EGFR mutation in adenocarcinoma cells and tissues. Clinicians should take this finding into consideration when using 5-FU to treat patients with NSCLC.

Scutellaria barbata D. Don extract synergizes the antitumor effects of low dose 5-fluorouracil through induction of apoptosis and metabolism

Traditional Chinese medicines have been recognized as a new source of anticancer drugs or chemotherapy adjuvant to enhance the efficacy of chemotherapy and to ameliorate the side effects. This study aimed to investigate the antitumor effects of combined Scutellaria barbata D. Don extract (SBE) and 5-FU treatment in vitro and in vivo and the potential mechanisms. SBE was prepared and analyzed by HPLC. Tumor growth inhibition both in vitro and in vivo, cell apoptosis, apoptosis related protein expressions (P53, bid, bax, bcl-2), caspase-3 activities and 5-FU related enzymes were assessed. SBE could significantly synergize the antitumor effects of low dose 5-FU both in vivo and in vitro. SBE could increase the apoptosis inducing effect of low dose 5-FU in both Bel-7402 and HCT-8 cells. Also, caspase-3 activities, P53 and bax expressions were significantly increased, while bid and bcl-2 expressions were significantly decreased in drug combination groups, compared with individual drug treatment groups. Furthermore, SBE could significantly decrease the mRNA levels of dihydropyrimidine dehydrogenase. These results showed that combined treatment with SBE and low dose 5-FU can significantly inhibit the tumor growth both in vitro and in vivo, which might be related with apoptosis and regulations of 5-FU metabolism.

1787 DIHYDROPYRIMIDINE DEHYDROGENASE IS ASSOCIATED WITH CLINICAL OUTCOME IN T1G3 BLADDER CANCER PATIENTS TREATED WITH BACILLUS CALMETTE-GUERIN

You have accessJournal of UrologyBladder Cancer: Superficial (II)1 Apr 20131787 DIHYDROPYRIMIDINE DEHYDROGENASE IS ASSOCIATED WITH CLINICAL OUTCOME IN T1G3 BLADDER CANCER PATIENTS TREATED WITH BACILLUS CALMETTE-GUERIN Hiroki Ide, Eiji Kikuchi, Shuji Mikami, Akira Miyajima, and Mototsugu Oya Hiroki IdeHiroki Ide Tokyo, Japan More articles by this author , Eiji KikuchiEiji Kikuchi Tokyo, Japan More articles by this author , Shuji MikamiShuji Mikami Tokyo, Japan More articles by this author , Akira MiyajimaAkira Miyajima Tokyo, Japan More articles by this author , and Mototsugu OyaMototsugu Oya Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2877AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recently, it was reported that thymidylate synthase (TS), a target enzyme of 5-fluorouracil (5-FU), and dihydropyrimidine dehydrogenase (DPD), which degraded most of 5-FU, were significant prognostic factors for invasive bladder cancer. However, few studies that evaluated the roles of them in recurrence focused on non-muscle invasive bladder cancer, especially T1G3 tumors. In the present study, we used the Dannenberg tumor profile (DTP) method, which is a highly accurate method for the measurement of RNA that involves a special technique for its extraction from paraffin-embedded specimens, to evaluate the role of 5-FU related enzymes as predictive biomarkers in T1G3 tumors. METHODS The subjects were 45 patients with T1G3 tumors who were surgically treated at our institution. The median follow-up was 37 months (3 to 159 months). Twenty-eight patients received adjuvant BCG instillation. The mRNA levels of TS and DPD were analyzed using the DTP method. Recurrence-free survival (RFS) and progression-free survival (PFS) were evaluated by the Kaplan-Meier method. Cox proportional hazards regression analysis was used to assess the predictors for RFS and PFS. RESULTS Overall, the mean DPD and TS mRNA levels were 1.255±0.179 and 9.273±1.098, respectively. BCG instillation was significantly associated with RFS and an independent predictor for RFS (p<0.01). The TS and DPD mRNA levels were not significantly associated with RFS and PFS. Recurrence and progression were observed in 13 (46.4%) and 6 (21.4%) patients, respectively, among those treated with BCG. In patients treated with BCG, the mean DPD mRNA level with recurrence was 1,341±0.426, compared to 0.994±0.335 without it (p<0.05). On the other hand, no significant difference in TS level between patients with recurrence and without it was observed. In patients treated with BCG, DPD was significantly associated with PFS (p=0.047). Multivariate analysis revealed DPD (p=0.048, hazard ratio 4.759, 95%CI: 0.868-26.098) was an independent predictor for PFS. The 5-year PFS rate was 85.6% in patients with lower DPD compared to 63.5% in those with higher DPD. The mean DPD mRNA level with progression was 1.884±0.679, compared to 0.980±0.279 without it (p<0.05). Meanwhile, the TS mRNA level was not significantly associated with PFS. CONCLUSIONS DPD may be a key enzyme involved in recurrence and progression in T1G3 patients treated with BCG therapy. Combination therapy of BCG with a 5-FU-based agent having a strong DPD inhibitor such as S-1 might be a novel therapeutic strategy in T1G3 tumors. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e734 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hiroki Ide Tokyo, Japan More articles by this author Eiji Kikuchi Tokyo, Japan More articles by this author Shuji Mikami Tokyo, Japan More articles by this author Akira Miyajima Tokyo, Japan More articles by this author Mototsugu Oya Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Factors predicting the response to oral fluoropyrimidine drugs: A phase II trial on the individualization of postoperative adjuvant chemotherapy using oral fluorinated pyrimidines in stage III colorectal cancer treated by curative resection (ACT-01 Study)

We evaluated the predictive relevance of several biomarkers on the survival of patients with stage III colorectal cancer treated with adjuvant chemotherapy of oral fluoropyrimidines. This was a multicenter phase II trial on adult patients with histologically confirmed resected stage III (Dukes' C) colorectal cancer. Patients received oral doxifluridine (800 mg/m2/day) in 3 divided doses, or oral uracil/tegafur (UFT) (400 mg/m2/day) in 2 divided doses for 5 days, every 7 days for 12 months with a 5-year follow-up. Outcome measures were disease-free survival and tissue markers [thymidine phosphorylase (TP), dihydropyrimidine dehydrogenase (DPD) protein levels and TP, DPD, thymidylate synthase (TS) and orotate phosphoribosyltransferase (OPRT) mRNA levels in tumor samples and TS tandem-repeat type in blood samples]. There was a significant association between the intratumoral TP/DPD enzyme ratio and disease-free survival when the model included the drug, the parameter and the interactions between them [hazard ratio (HR)=2.76; P=0.00469]. The 5-year disease-free survival rate was statistically significantly higher in patients with high TP/DPD ratios [median ≥2.63: 71.9%; 95% confidence interval (CI) 61.4-80.0] compared to patients with low TP/DPD ratios (<2.63: 57.0%; 95% CI 46.3-66.3) (log-rank P=0.0277) following adjuvant therapy with oral fluoropyrimidines. No significant association was observed between the intratumoral TP/DPD enzyme ratio (cut-off value 2.0) and the disease-free survival rate in the doxifluridine group; primary endpoint (log-rank P=0.6850). The magnitude of the intratumoral TP/DPD enzyme ratio may be a potential indicator for the individualization of postoperative adjuvant chemotherapy with oral fluoropyrimidines for stage III colorectal cancer.

TS and DPD mRNA levels on formalin‐fixed paraffin‐embedded specimens as predictors for distant recurrence of rectal cancer treated with preoperative chemoradiotherapy

Distant metastatic relapse occurs in approximately 20% of rectal cancer patients treated with 5-fluorouracil (5-FU)-based chemoradiotherapy (CRT) followed by surgery. This study aimed to investigate mRNA level of 5-FU metabolizing enzymes in post-treatment specimens and to evaluate their predictive value of distant recurrence after CRT. Forty patients with rectal cancer underwent 5-FU-based CRT followed by surgery. After microdissection, total RNA of residual cancer was isolated from formalin-fixed paraffin-embedded (FFPE) specimens. Thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), thymidine phosphorylase (TP), and orotate phosphoribosyl transferase (OPRT) as 5-FU metabolizing enzyme were measured using real-time reverse transcription polymerase chain reaction. Patients (n = 6) who developed distant recurrence had a significantly higher TS (P = 0.01), DPD (P = 0.02), and TP (P = 0.01) levels, compared with those patients (n = 34) without recurrence. High TS, DPD, and positive lymph node metastasis (pN) were significantly poorer prognostic factors for DFS (TS: P < 0.01, DPD: P < 0.01, pN: P < 0.05). High TS and DPD mRNA levels on FFPE specimens may predict distant recurrence of rectal cancer treated with 5-FU-based preoperative CRT followed by surgery. Expression analysis of 5-FU metabolizing enzyme in residual cancer may be useful for treatment stratification and clinical management in these patients.

Abstract 5249: Analysis of gene expression levels associating with metabolism of 5-fluorouracil and folate in primary colorectal cancer and corresponding synchronous or metachronous liver metastasis

Abstract Background Gene expression levels of thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), thymidine phosphorylase (TP) and orotate phosphoribosyl transferase (OPRT) have been shown to be associated with response to 5-fluorouracil-based therapies. Folylpolyglutamate synthase (FPGS), gamma-glutamyl hydrolase (GGH) and dihydrofolate reductase (DHFR) are associated with folate metabolism which regulates intracellular folate level. Analyzing these gene expression levels in liver metastases is important to obtain the prediction of therapy, however, only surgical specimens of the primary tumor are readily available for analysis in many cases. Our aim is to determine how TS, DPD, TP, OPRT, FPGS, GGH and DHFR gene expression levels in primary colorectal cancer (CRC) are related to those in liver metastases. Methods Formalin-fixed, paraffin-embedded tumor specimens from 50 pairs of primary CRC and corresponding liver metastases, including 30 synchronous and 20 metachronous metastases, were dissected by using laser-captured microdissection. Total RNA was extracted and cDNA was prepared by reverse-transcription. Quantitation of target genes and internal reference gene, beta-2-microglobulin, was performed using real-time RT-PCR. Results Significant difference was seen between mRNA expression levels of TS, DPD, FPGS and DHFR in primary tumor and those in corresponding synchronous liver metastases (median value: TS 1.18 vs. 0.05; p&amp;lt;0.0001, DPD 0.18 vs.0.05; p&amp;lt;0.0001, FPGS 0.07 vs. 0.02; p=0.0005, DHFR 0.31 vs. 0.03; p&amp;lt;0.0001), TS, DPD, TP, OPRT, FPGS and DHFR in primary tumor and those in corresponding metachronous liver metastases (TS 0.23 vs. 0.06; p&amp;lt;0.0001, DPD .0.31 vs. 0.03; p&amp;lt;0.0001, TP 0.21 vs. 0.14, p=0.021, OPRT 0.35 vs. 0.17; p=0.016, FPGS 0.11 vs. 0.04; p=0.0003, DHFR 0.41 vs. 0.03, p&amp;lt;0.0001). When matched tissue sets were compared on an individual basis, there was a significant correlation for TP, OPRT and FPGS mRNA expression between primary tumor and corresponding synchronous liver metastases (TP rs=0.64; p=0.018, OPRT rs=0.62; p=0.006, FPGS rs=0.51; p=0.004), DPD and GGH in primary tumor and corresponding metachronous liver metastases (DPD rs=0.54; p=0.014, GGH rs=0.59; p=0.007). Conclusion A good prediction of TP, OPRT and FPGS mRNA levels in synchronous liver metastases as well as DPD and GGH mRNA levels in metachronous liver metastasis can be obtained by measuring those of primary CRC, although no correlation was seen for other genes. We are currently investigating more number of cases and genes related with sensitivity to antitumor drugs. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 5249. doi:10.1158/1538-7445.AM2011-5249

Thymidylate synthetase and dihydropyrimidine dehydrogenase mRNA levels in esophageal cancer

This study investigated the mRNA levels of thymidylate synthetase (TYMS) and dihydropyrimidine dehydrogenase (DPYD) in esophageal squamous cell carcinoma (ESCC). TYMS and DPYD gene expression was quantified using real-time RT-PCR in 56 patients with ESCC, co-amplified with glyceraldehyde-3-phosphate dehydrogenase as an internal standard. The results were analyzed with reference to the clinicopathological characteristics and the prognosis of the ESCC patients. The TYMS and DPYD expression levels in patients positive with lymphatic invasion were significantly higher compared to those in patients who exhibited negative lymphatic invasion (TYMS P=0.0127, DPYD P=0.0127). Patients were classified into the groups high TYMS/DPYD, high TYMS but low DPYD, low TYMS but high DPYD and low TYMS/DPYD. The highest survival rate was found in the group with low TYMS/DPYD and the lowest survival rate in the group with high TYMS/DPYD (P=0.017). It was concluded that, on the basis of the multivariate analysis, TYMS mRNA expression is a candidate that serves as an independent prognostic factor for ESCC patients.

Relationship between the expression of thymidylate synthase, thymidine phosphorylase and dihydropyrimidine dehydrogenase and survival in epithelial ovarian cancer

The mRNA and protein expression of thymidylate synthase (TS), thymidine phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD) and their relationship with prognosis were investigated. Real-time quantitative RT-PCR (Taqman) was used to detect the mRNA expression of TS, TP and DPD in formalin-fixed and paraffin-embedded 106 samples of epithelial ovarian cancer and 29 normal ovaries. A TATA box-binding protein (TBP) was used as an endogenous reference gene. A relationship between TS, TP, DPD expression and clinicopathologic features was investigated. The protein location and expression of TS, TP and DPD was examined in the same patients by an avidin-biotin-peroxidase immunohistochemistry. TS and TP mRNA expression levels were significantly higher in tumor group than in normal controls, with the average value of TS and TP mRNA being 6.14+/-0.62 and 0.59+/-0.06 in tumor tissue, and 0.71+/-0.14 and 0.16+/-0.04 in normal tissue, respectively. DPD mRNA expression levels were significantly lower in tumor group (0.11+/-0.02) than in normal controls (0.38+/-0.05). There was statistically significant difference in TS and TP mRNA expression levels among different pathological grades and clinical stages (P<0.05), but histological subtype was not significantly associated with TS and TP mRNA expression. DPD gene expression was not significantly associated with any clinicopathological parameters. Immunohistochemistry revealed that TP protein was mainly distributed in nucleus, and TS and DPD mainly in cytoplasm. The protein expression intensity of TS, TP and DPD was coincided with the mRNA expression levels. It was concluded that TS, TP mRNA and protein expression levels were significantly higher in epithelial ovarian cancer, and DPD mRNA and protein expression levels were significantly lower. The expression levels of TS and DPD were related to the patients' prognosis and survival. Combined gene expression levels of TS, TP and DPD represent a new variable to predict the clinical outcome in ovarian cancer. The association of TS, TP and DPD expression levels with survival suggests an importance of these genes for tumor occurrence and progression.

Wogonin potentiates the antitumor effects of low dose 5-fluorouracil against gastric cancer through induction of apoptosis by down-regulation of NF-kappaB and regulation of its metabolism

Traditional Chinese medicines have been recognized as a new source of anticancer drugs or chemotherapy adjuvant to enhance the efficacy of chemotherapy and to ameliorate the side effects. Wogonin (WOG) has a potential for therapeutic use in the treatment of antitumor and chemoprophylaxis. 5-Fluorouracil (5-FU) is a key systemic chemotherapy drug and widely use in the treatment of solid tumors. In this study, we found that combination of WOG and 5-FU inhibited the viability of MGC-803 cells in a concentration-dependent manner and exhibited a synergistic anticancer effect (CI < 1) when 5-FU was used at relatively low concentrations. The pro-apoptotic activity of two-drug combination was much stronger than single. Furthermore, WOG could decrease the mRNA levels of dihydropyrimidine dehydrogenase (DPD), the metabolic enzymes of 5-FU. WOG could inhibit the NF-κB nuclear translocation and I-κB phosphorylation. Moreover, combined treatment caused significantly growth inhibition of human tumor xenografts. In addition, WOG markedly enhanced the antitumor activity of low dose 5-FU (i.p. 10 mg/kg/day), however there is no toxicity and influence on diet consumption in experimental animals. Taken together, our data's showed that WOG increased 5-FU retention for a prolonged catabolism by modulating 5-FU metabolic enzymes and sensitized the MGC-803 cells to 5-FU induced apoptosis by inhibiting the NF-κB nuclear translocation. The anti-gastric cancer effect of two-drug combination was much stronger than that of WOG or 5-FU alone. These results may be relevant to design new clinical therapeutic strategies against gastric cancer in future.

Prognostication of pancreatic adenocarcinoma by expression of thymidine phosphorylase/dihydropyrimidine dehydrogenase ratio and its correlation with survival

Background: Dihydropyrimidine dehydrogenase (DPD) is the first rate limiting enzyme that catabolizes 5-fluorouracil. Thymidine phosphorylase (TP) catalyzes the last step that converts capecitabine into 5-fluorouracil. The TP/DPD ratio has suggested a positive correlation with the efficacy of capecitabine in human xenograft models. This is the first human study that analyzes the association of TP/DPD ratio with overall survival and disease-free survival in cases of locally advanced pancreatic cancer (LAPC). Methods: A total of 35 patients with newly diagnosed LAPC received 50.4 Gy radiotherapy with capecitabine 1,600 mg/m2 followed by capecitabine 2,000 mg/m2 × 14 days every 3 weeks till progression. Tumor specimens were procured with endoscopic ultrasound-guided fine-needle aspiration before and after week 2 of starting capecitabine radiotherapy to evaluate TP and DPD mRNA levels by reverse transcription polymerase chain reaction (RT-PCR). Results: The paired t-tests showed no relationship between mRNA TP or DPD levels or TP/DPD ratio and disease-free survival. The log-rank test revealed that the lower TP/DPD ratio was statistically significantly associated with a higher overall survival with an average of 304 days in the lower TP/DPD ratio group and 172 days in the higher TP/DPD group (a difference of 132 days). Conclusions: We found a survival benefit of ∼ 4 months in our study correlating with lower TP/DPD ratio and this is quite significant in a disease whose > 5-year survival is < 5%. The TP/DPD ratio may be used as an independent marker for prognostication for LAPC and it may help in determining the chemotherapy duration, choices and possibly toxicities as well. Larger studies are needed to study the relation ship between TP/DPD ratio with these efficacy parameters.

Significance of dihydropyrimidine dehydrogenase and thymidylate synthase mRNA expressions in hepatocellular carcinoma

The significance of dihydropyrimidine dehydrogenase (DPD) and thymidylate synthase (TS) gene expressions for the post-surgical prognosis of hepatocellular carcinoma (HCC) has not yet been determined. In the present study, we clarified the significance of DPD and TS gene expressions for the prognosis of HCC. Seventy-four patients, who underwent curative hepatic resection for primary HCC, were evaluated. The DPD and TS mRNA levels of the resected HCC specimens were evaluated using a microdissection technique and quantative real-time RT-PCR. The patients were categorized into high and low groups for each mRNA based on the median value. Various clinicopathological factors, including prognosis, and proliferation index using Ki-67 staining were evaluated in association with the DPD and TS mRNA expression levels. The low DPD mRNA expression was related to younger age, advanced clinical stage, undifferentiated histology, and microscopic intrahepatic metastasis. The overall and recurrence-free survival were significantly lower in the low DPD group than in the high DPD group (P < 0.05). Furthermore, the proliferation index in the low DPD group was significantly higher than that in the high DPD group (P < 0.01). On the other hand, the high TS group showed a tendency of better prognosis than the low TS group, although it was not statistically significant. The low DPD mRNA expression is a significant poor prognostic factor. after curative resection of HCC.

Thymidylate synthase, dihydropyrimidine dehydrogenase, ERCC1, and thymidine phosphorylase gene expression in primary and metastatic gastrointestinal adenocarcinoma tissue in patients treated on a phase I trial of oxaliplatin and capecitabine

BackgroundOver-expression of thymidylate synthase (TS) and dihydropyrimidine dehydrogenase (DPD) in tumor tissue is associated with insensitivity to 5-fluorouracil (5-FU). Over-expression of ERCC1 correlates with insensitivity to oxaliplatin (OX) therapy, while high thymidine phosphorylase (TP) levels predict for increased sensitivity to capecitabine (Xel).MethodsBiopsies of metastatic tumor were taken before OX (130 mg/m2 day 1) given with Xel (1200–3000 mg/m2 in two divided doses days 1–5 and 8–12) every 3-weeks. Micro-dissected metastatic and primary tumors were analyzed for relative gene expression by real-time quantitative polymerase chain reaction. The clinical protocol prospectively identified the molecular targets of interest that would be tested. Endpoints for the molecular analyses were correlation of median, first and third quartiles for relative gene expression of each target with response, time to treatment failure (TTF), and survival.ResultsAmong 91 patients participating in this trial; 97% had colorectal cancer. The median number of prior chemotherapy regimens was 2, and most had prior 5-FU and irinotecan. In paired samples, median mRNA levels were significantly higher in metastatic versus primary tumor (-fold): TS (1.9), DPD (3.8), ERCC1 (2.1) and TP (1.6). A strong positive correlation was noted between DPD and TP mRNA levels in both primary (r = 0.693, p < 0.0005) and metastatic tissue (r = 0.697, p < 0.00001). There was an association between TS gene expression and responsive and stable disease: patients whose intratumoral TS mRNA levels were above the median value had significantly greater risk of early disease progression (43% vs 17%), but this did not translate into a significant difference in TTF. ERCC1 gene expression above the third quartile was associated with a shorter TTF (median 85 vs 162 days, p = 0.046). Patients whose TS mRNA levels in metastatic tumor tissue were below the median had a longer overall survival (median 417 vs 294 days, p = 0.042).ConclusionTarget gene expression in primary tumor was significantly lower than that in paired metastatic tissue. High ERCC1 mRNA levels in metastatic tumor was associated with a shorter TTF. Lower expression of TS mRNA correlated with a lower chance of early PD with XelOX therapy and improved overall survival.

Prognostic value of 5-fluorouracil metabolic enzyme genes in Dukes' stage B and C colorectal cancer patients treated with oral 5-fluorouracil-based adjuvant chemotherapy

5-Fluorouracil (5-FU) is the most commonly used anticancer drug for colorectal cancer (CRC). In this study, we aimed to clarify the prognostic value of the expression of the 5-FU metabolic enzyme genes, including orptate phosphoribosyl transferase (OPRT), dihydropyrimidine dehydrogenase (DPD), thymidylate synthetase (TS) and thymidylate phosphorylate (TP) genes in CRC patients treated with oral 5-FU-based adjuvant chemotherapy. We examined 103 CRC patients with Dukes' stage B and C who underwent oral 5-FU-based adjuvant chemotherapy. Formalin-fixed, paraffin-embedded tumor specimens from primary CRC tissues were dissected by laser-captured microdissection and quantification of mRNA levels of OPRT, DPD, TS and TP were measured by real-time reverse transcription (RT) PCR. The relationship between these 5-FU metabolic enzyme gene levels and disease-free and overall survival rates were examined. The disease-free and overall survival curves of the OPRT mRNA high-expression group were significantly longer than that of the OPRT mRNA low-expression group. The disease-free and overall survival curves of the DPD mRNA high-expression group were significantly shorter than that of the DPD mRNA low-expression group. In contrast, there were no significant differences between the TS or TP mRNA high- expression and low-expression groups in the disease-free and overall survival curves. In a multivariate Cox regression analysis, it was demonstrated that the OPRT mRNA level is an independent prognostic variable for disease-free and overall survival. These results suggest that the OPRT mRNA is a useful indicator in the prediction of disease-free and overall survival in Dukes' B and C stage CRC patients treated with oral 5-FU-based adjuvant chemotherapy.

High intratumoral dihydropyrimidine dehydrogenase mRNA levels in pancreatic cancer associated with a high rate of response to S-1

Although the prognosis in patients with pancreatic cancer has been poor, we recently reported unusually high response rate and survival benefit of S-1 treatment in patients with pancreatic cancer. The aim of this study was to reveal genetic background of this unique activity of S-1 against pancreatic cancer. S-1 is a novel oral fluoropyrimidine derivative consisting of Tegafur (FT) and dihydropyrimidine dehydrogenase (DPD) inhibitor (5-chloro-2,4-dihydroxypyridine; CDHP). Accordingly, intratumoral DPD mRNA expression level was measured to reveal whether the level in pancreatic cancer was different from other GI cancer and whether it was relevant to chemosensitivity. Thirty-three recurrent pancreatic cancer patients treated with S-1 were studied. We obtained 15 responders and 13 non-responders according to the change of serum CA19-9. The mRNA was extracted from paraffin-embedded surgical specimens using laser captured microdissection, and relative expression levels of each DPD/beta-actin were measured using a quantitative reverse transcription polymerase chain reaction (RT-PCR) (Taqman) system. Forty-four colorectal cancer patients and 20 gastric cancer patients treated with S-1 were enrolled as control groups. Thymidylate synthase (TS) mRNA expression levels were also measured. Intratumoral DPD mRNA expression level was significantly higher in pancreatic cancer than that in colorectal cancer (P = 0.0003; median level, 1.38 vs. 0.44) and gastric cancer (P = 0.0061; 1.38 vs. 0.82). No difference in TS mRNA expression levels was observed among cancer types. DPD expression among responded pancreatic cancer was significantly lower than non-responded. (P = 0.012, Mann-Whitney U test). Intratumoral DPD mRNA expression level in pancreatic cancer was significantly higher than the other malignancies. This result may elucidate possible reasons for the high effectiveness of S-1 in pancreatic cancer.