Reflux of acid and bile acids, and the subsequent development of intestinal metaplasia of the esophagus (Barrett's esophagus) or gastric cardia are risk factors for the development of adenocarcinoma at the GEJ. However, the molecular mechanisms translating reflux exposure to epithelial cell transformation in the upper gastrointestinal tract remain undefined. Here, quantitative RT-PCR revealed increased expression of guanylyl cyclase C (GC-C), the receptor for bacterial heat-stable enterotoxins (STa) and a marker of differentiated enterocytes, in adenocarcinomas of the esophagus and stomach, but not in squamous carcinomas of the esophagus, gastrointestinal stromal tumors, or normal esophageal or gastric mucosae. Similarly, the human GEJ adenocarcinoma cell line OE19 expressed GC-C mRNA and accumulated cyclic GMP in response to STa. Interestingly, exposure of OE19 to the bile acid deoxycholate (DCA) stimulated GC-C promoter activity, mRNA expression, protein expression (Western blot), and function (STa-induced cyclic GMP accumulation). Moreover, treatment with DCA increased expression of the homeodomain proteins Cdx-2 (mRNA and protein) and Oct1 (protein), upstream transcription factors important in regulating intestine-specific expression of GC-C. Of significance, hydrophilic bile acids such as cholate, taurodeoxycholate and ursodeoxycholate were ineffective compared to the hydrophobic bile acids chenodeoxycholic acid and DCA in inducing GC-C and Cdx-2 mRNA expression. These observations suggest that transformation at the GEJ is initiated, in part, by induction of the transcriptional program mediating enterocyte differentiation, including Oct1, Cdx-2, and GC-C, upon exposure to specific bile acids. Further, they suggest that suppression of hydrophobic bile acid production, for example by treatment with ursodeoxycholate, which does not activate the intestinal transcription program in epithelial cells, might be effective chemoprevention for GEJ tumorigenesis. Clinical Pharmacology & Therapeutics (2004) 75, P10–P10; doi: 10.1016/j.clpt.2003.11.038
Read full abstract