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    Pomegranate fruit as a rich source of biologically active compounds. Sreekumar Sreeja,Sithul Hima,Muraleedharan Parvathy,Azeez Juberiya Mohammed,Sreeharshan Sreeja BioMed research international Pomegranate is a widely used plant having medicinal properties. In this review, we have mainly focused on the already published data from our laboratory pertaining to the effect of methanol extract of pericarp of pomegranate (PME) and have compared it with other relevant literatures on Punica. Earlier, we had shown its antiproliferative effect using human breast (MCF-7, MDA MB-231), and endometrial (HEC-1A), cervical (SiHa, HeLa), and ovarian (SKOV3) cancer cell lines, and normal breast fibroblasts (MCF-10A) at concentration of 20-320 μg/mL. The expressions of selected estrogen responsive genes (PR, pS2, and C-Myc) were downregulated by PME. Unlike estradiol, PME did not increase the uterine weight and proliferation in bilaterally ovariectomized Swiss-Albino mice models and its cardioprotective effects were comparable to that of 17 β -estradiol. We had further assessed the protective role of PME on skeletal system, using MC3T3-E1 cells. The results indicated that PME (80 μg/mL) significantly increased ALP (Alkaline Phosphatase) activity, supporting its suggested role in modulating osteoblastic cell differentiation. The antiosteoporotic potential of PME was also evaluated in ovariectomized (OVX) rodent model. The results from our studies and from various other studies support the fact that pomegranate fruit is indeed a source of biologically active compounds. 10.1155/2014/686921
    Placental type alkaline phosphatase tissue expression in ovarian serous carcinoma. Orsaria Maria,Londero Ambrogio P,Marzinotto Stefania,Di Loreto Carla,Marchesoni Diego,Mariuzzi Laura Cancer biomarkers : section A of Disease markers OBJECTIVE:To analyze the expression profile of placental type alkaline phosphatase (PLAP), cancer antigen 125 (CA125), and human epididymis protein 4 (HE4) in serous ovarian cancer and to correlate their expression with the tumor aggressiveness and progression. METHODS:Retrospective study considering a tissue microarray of 82 women affected by ovarian serous cancer. Protein expression was assessed by immunohistochemistry on ovarian serous cancer tissue samples. Immunohistochemical staining was semiquantitatively evaluated as H-score. RESULTS:Median H-score values were lower for PLAP, 1 (IQR 0-4) than CA125, 10 (IQR 6-12) or HE4, 8 (IQR 5-12). Even if PLAP was less expressed in the cells of serous ovarian cancer than CA125 or HE4 it was relatively more expressed in the fourth quartile of its H-score distribution among cases with low CA125 or HE4 expression. Furthermore, PLAP and HE4 high expression resulted to be significantly correlated with a better prognosis. CONCLUSIONS:PLAP could be an additional marker for early detection of serous ovarian carcinoma, together with the established CA125 and HE4. In addition, PLAP expression is correlated with prognosis, giving, in this way, an additional tool for improving treatment approach. 10.3233/CBM-160665
    Serum enzyme changes during chemotherapy for ovarian cancer. Skillen A W,Harrison J,Guthrie D,Turner G A Clinical biochemistry Serum lactate dehydrogenase (LD), gamma-glutamyl transferase (gamma GT) and alkaline phosphatase (ALP) activities have been measured in 105 patients with ovarian cancer for periods of up to 4 years. The extent of the disease was assessed at laporotomy according to the FIGO classification. Chemotherapy was started one week after surgery, at which time 25% of patients had elevated LD, 29% elevated gamma GT and 21% elevated ALP. Of 51 patients who went into complete remission, 4% still showed elevated LD, 25% elevated gamma GT and 12% elevated ALP. Reactivation of tumour growth was apparent in 32 patients; there was a significant increase in the serum LD, gamma GT and ALP activities when remission and recurrence were first detected in 65%, 50% and 35% of patients respectively. With 14 patients, there was an unexplained increase in the activity of one or more of the enzymes 1-6 months prior to recurrence being detected; these changes may predict that chemotherapy is losing effect. During long-term remission, serum LD was increased in patients suffering from urinary tract infection or bladder dysfunction.
    Evaluation of an inflammation-based prognostic score in patients with advanced ovarian cancer. Sharma Rohini,Hook Jane,Kumar Munish,Gabra Hani European journal of cancer (Oxford, England : 1990) BACKGROUND:There is increasing evidence that the presence of an ongoing systemic inflammatory response is associated with poor outcome in patients with advanced cancer. The aim of this study was to validate whether an inflammation-based prognostic score (Glasgow Prognostic Score, GPS) is associated with survival in patients with advanced stage (stage III/IV) ovarian cancer. PATIENTS AND METHODS:An audit was conducted of patients with a new diagnosis of stage III or IV ovarian cancer presenting to the West London Gynae-Oncology Centre between October 2003 and June 2006 (n=154). The GPS was constructed as follows: Patients with both an elevated C-reactive protein (>10 mg/l) and hypoalbuminaemia (<35 g/l) were allocated a score of 2. Patients in whom only one or none of these biochemical abnormalities was present were allocated a score of 1 or 0, respectively. RESULTS:On univariate analysis GPS, histological type, ALP, performance status, primary surgery and ascites were predictors of overall survival. On multivariate a high GPS score, non-serous histology, high ALP and no initial surgery were independent predictors of worse overall survival in this population. CONCLUSIONS:The presence of a systemic inflammatory response, as measured by the GPS, is an independent predictor of poor overall survival in patients with advanced ovarian cancer independent of treatment received. 10.1016/j.ejca.2007.11.011
    Ovarian cancer stem-like cells show induced translineage-differentiation capacity and are suppressed by alkaline phosphatase inhibitor. Liu Kuei-Chun,Yo Yi-Te,Huang Rui-Lan,Wang Yu-Chi,Liao Yu-Ping,Huang Tien-Shuo,Chao Tai-Kuang,Lin Chi-Kang,Weng Shao-Ju,Ma Kuo-Hsing,Chang Cheng-Chang,Yu Mu-Hsien,Lai Hung-Cheng Oncotarget Spheroid formation is one property of stem cells-such as embryo-derived or neural stem cells-that has been used for the enrichment of cancer stem-like cells (CSLCs). However, it is unclear whether CSLC-derived spheroids are heterogeneous or whether they share common embryonic stemness properties. Understanding these features might lead to novel therapeutic approaches. Ovarian carcinoma is a deadly disease of women. We identified two types of spheroids (SR1 and SR2) from ovarian cancer cell lines and patients' specimens according to their morphology. Both types expressed stemness markers and could self-renew and initiate tumors when a low number of cells were used. Only SR1 could differentiate into multiple-lineage cell types under specific induction conditions. SR1 spheroids could differentiate to SR2 spheroids through epithelial-mesenchymal transition. Alkaline phosphatase (ALP) was highly expressed in SR1 spheroids, decreased in SR2 spheroids, and was absent in differentiated progenies in accordance with the loss of stemness properties. We verified that ALP can be a marker for ovarian CSLCs, and patients with greater ALP expression is related to advanced clinical stages and have a higher risk of recurrence and lower survival rate. The ALP inhibitor, levamisole, disrupted the self-renewal of ovarian CSLCs in vitro and tumor growth in vivo. In summary, this research provides a plastic ovarian cancer stem cell model and a new understanding of the cross-link between stem cells and cancers.This results show that ovarian CSLCs can be suppressed by levamisole. Our findings demonstrated that some ovarian CSLCs may restore ALP activity, and this suggests that inhibition of ALP activity may present a new opportunity for treatment of ovarian cancer. 10.18632/oncotarget.1424
    Gamma-glutamyltransferase as a preoperative differential diagnostic marker in patients with adnexal mass. Reiser Elisabeth,Aust Stefanie,Seebacher Veronika,Reinthaller Alexander,von Mersi Hannah,Schwameis Richard,Polterauer Stephan,Grimm Christoph,Helmy-Bader Samir European journal of obstetrics, gynecology, and reproductive biology OBJECTIVE:Gamma-glutamyltransferase (GGT) is involved in tumor development, progression and chemotherapy resistance. The present study evaluated GGT serum levels as a preoperative predictive marker for ovarian cancer in patients with adnexal mass. STUDY DESIGN:Preoperative GGT serum levels of 2235 patients with adnexal mass and subsequent surgery were ascertained (patients with benign ovarian tumors: n = 1811; borderline tumor of the ovary [BTO]: n = 85; epithelial ovarian cancer [EOC]: n = 339). Standardized expert transvaginal ultrasound was documented. RESULTS:Median (interquartile range) GGT serum levels in patients with benign ovarian tumors, BTO, and EOC were 15.0 U/l (11.0-23.0), 17.0 U/l (10.0-23.5), and 20.0 U/l (13.0-34.0), respectively (p = 0.002). Elevated GGT serum levels were associated with the presence of BTO/EOC in univariate analysis (p < 0.0001, hazard ratio 1.8, confidence interval 1.5-2.3). GGT did not outperform established tools for preoperative prediction of BTO/EOC in patients with adnexal mass, such as CA-125 measurement or transvaginal ultrasound. CONCLUSION:Elevated GGT serum levels were not associated with the presence of BTO/EOC in women with suspicious adnexal mass in multivariate analysis. GGT serum levels did not outperform established risk factors and therefore might add only limited additional value to CA-125 serum levels in the differential diagnosis between benign and malignant adnexal masses. 10.1016/j.ejogrb.2019.05.031
    Lactate dehydrogenase is correlated with clinical stage and grade and is downregulated by si‑SAΤB1 in ovarian cancer. Xiang Jiangdong,Zhou Lina,Zhuang Yan,Zhang Jin,Sun Ya,Li Shuangdi,Zhang Zhenbo,Zhang Gao,He Yinyan Oncology reports Lactate, which is regulated by gene expression, is largely believed to favor tumor growth and survival. Elevated lactate dehydrogenase (LDH) is a negative prognostic biomarker because it is a key enzyme involved in cancer metabolism. Our previous study revealed that special AT‑rich‑binding protein 1 (SATB1), a genome‑organizing protein, was strongly associated with high metastasis rates in ovarian cancer. However, its underlying molecular mechanisms in ovarian cancer are unclear. In the present study, we investigated whether SATB1 modulated LDH expression and examined the relationship between SATB1 and LDH in ovarian cancer. We employed transient siRNA‑mediated knockdown of SATB1 in ovarian cancer and explored the effects of this knockdown on the expression levels of key glucose metabolism‑related enzyme genes (G6PD, LDH, MDH1, PFK1 and TGM1) and the glucose metabolism‑related protein monocarboxylate transporter 1 (MCT1). We comprehensively analyzed the cellular and molecular role of LDH in ovarian cancer to determine whether it could be a conventional clinicopathological parameter. SATB1 knockdown significantly downregulated both LDH and MCT1 levels and markedly upregulated BRCA1 and BRCA2 levels in ovarian cancer cells (P<0.05). Serum LDH levels in ovarian cancer patients were significantly higher than those in patients with benign ovarian tumors (P<0.05). LDH levels at different stages and grades differed significantly in ovarian cancer. Survival curves revealed that higher LDH expression was correlated with shorter survival (P<0.05). SATB1 may reprogram energy metabolism in ovarian cancer by regulating LDH and MCT1 levels to promote metastasis. Serum LDH levels presented diagnostic accuracy with high specificity and may have potential as a conventional clinicopathological parameter for ovarian cancer. 10.3892/or.2018.6658
    Serum HE4, CA125, YKL-40, bcl-2, cathepsin-L and prediction optimal debulking surgery, response to chemotherapy in ovarian cancer. Chudecka-Głaz Anita Monika,Cymbaluk-Płoska Aneta Alicja,Menkiszak Janusz Leszek,Sompolska-Rzechuła Agnieszka Monika,Tołoczko-Grabarek Aleksandra Izabela,Rzepka-Górska Izabella Anna Journal of ovarian research BACKGROUND:The most important prognostic factor in the ovarian cancer is optimal cytoreduction. The neoadjuvant chemotherapy, an only optional method of treatment in this case and is still the subject of debate. The object of this study was to evaluate the usefulness of markers: CA 125, HE4, YKL-40 and bcl-2 as well as cathepsin L in predicting optimal cytoreduction and response to chemotherapy. METHODS:Sera were secured preoperatively. The division into groups was performed retrospectively depending on the method of treatment (surgery vs neoadjuvant chemotherapy) as well as on response to chemotherapy (sensitive vs resistant vs refractory). Comparisons were made between groups, and the diagnostic usefulness of tested proteins was examined. RESULTS:We found that statistically significant differences between primary operated patients and patients undergoing neoadjuvant chemotherapy were applicable only to the tumour markers (CA125 1206.79 vs 2432.38, p=0.000191; HE4 78.87 vs 602.45, p=0.000004; YKL-40 108.13 vs 203.96, p=0.003991). Cathepsin-L and Bcl-2 were statistically insignificant. The cut-off point values were determined for the CA 125 (345 mIU/ml), HE4 (218.43 pmol/L) and YKL-40 (140.9 ng/ml). The sensitivity, specificity, PPV and NPV were as follows: CA125 (83.3%; 75%; 80.6%; 78.3%), HE4 (86.6%; 91.3%; 92.9%; 84%) and YKL-40 (75%; 83.3%; 84%; 74.1%). CONCLUSION:Among the tested proteins the HE4 marker appears to be helpful in forecasting of optimal cytoreduction and possibly also of the prediction of response to platinum analogues used in first-line treatment of ovarian cancer. 10.1186/1757-2215-7-62
    Association of gamma-glutamyltransferase with severity of disease at diagnosis and prognosis of ovarian cancer. Grimm C,Hofstetter G,Aust S,Mutz-Dehbalaie I,Bruch M,Heinze G,Rahhal-Schupp J,Reinthaller A,Concin N,Polterauer S British journal of cancer BACKGROUND:Gamma-glutamyltransferase (GGT) - a membrane-bound enzyme crucially involved in the cell's detoxification pathway and apoptotic balance - is involved in tumour development, progression and chemotherapy resistance. Elevated GGT serum levels are associated with increased cancer risk in women and worse prognosis in gynaecologic cancers. The present study investigated the prognostic role of GGT in ovarian cancer patients. METHODS:In this multicenter study, pre-therapeutic GGT levels were ascertained in 634 consecutive patients with epithelial ovarian cancer (EOC, n=567) and borderline tumour of the ovary (BTO, n=67). Gamma-glutamyltransferase serum levels were associated with clinicopathological parameters and uni- and multivariate survival analyses were performed. Immunohistochemistry of GGT was performed in ovarian cancer tissue and correlated with GGT serum levels. RESULTS:Pre-therapeutic GGT serum levels were higher in patients with EOC (28.56 (38.24) U l(-1)) than in patients with BTO (20.01 (12.78) U l(-1), P=0.01). High GGT serum levels were associated with advanced FIGO stage (P<0.001) and with worse overall survival in univariate (P<0.001) and multivariable analysis (P=0.02, HR 1.2 (1.1-1.5)). We further investigated the association between systemic GGT serum levels and local GGT expression in EOC tumour tissue and observed an association between these two parameters (P=0.03). CONCLUSION:High pre-therapeutic GGT serum levels are associated with advanced tumour stage and serve as an independent prognostic marker for worse overall survival in patients with EOC. Gamma-glutamyltransferase expression in ovarian cancer tissue is reflected in GGT serum levels. 10.1038/bjc.2013.323
    Detection and analysis of multiple biomarkers in ovarian cancer: clinical significance in diagnosis, treatment, and prognosis evaluation. Ji Rui,Li Yong,He Chenyun,Zhu Xinghua,He Aiqin,Lu Yunyan Gland surgery Background:The purpose of this study was to explore the clinical significance of CA125, CK7, CK20, ER, PR, C-erbb2, and P-gp in ovarian cancer. Methods:Ovarian cancer patients were recruited from Nantong Cancer Hospital between March 2006 and July 2011. The expressions of CA125, CK7, CK20, ER, PR, C-erbb2, and P-gp were determined by immunohistochemistry (IHC).The chi-square test (χ) was used to analyze the correlation between each index and the clinical characteristics of the patients. The patients were followed up to record the cancer recurrence time. The Kaplan-Meier method was used to map the cumulative recurrence-free survival (RFS) rate, and COX regression analysis was established for multivariate analysis. Results:The results of IHC showed that the positive expression rates of CA125, CK7, ER, C-erbb2, and P-gp in malignant ovarian cancer tissues were significantly higher than those in benign ovarian cancer tissues. CA125 expression in malignant ovarian cancer was significantly correlated with the age of patients and the Federation of International Gynecology and Obstetrics (FIGO) stage. CK7 expression in malignant ovarian cancer was significantly correlated with the age, tissue differentiation, and number of residual lesions. CK20 expression in malignant ovarian cancer was significantly correlated with the age and tissue differentiation of the patients. ER expression in malignant ovarian cancer was significantly correlated with the age of patients and FIGO stage. PR expression in malignant ovarian cancer was significantly correlated with the age of the patients. C-erbb2 expression in malignant ovarian cancer was significantly correlated with the age of the patients. P-gp expression in malignant ovarian cancer was significantly correlated with the patient age, pathological type, and tissue differentiation. The expression of CA125, CK7, CK20, C-erbb2, and P-gp had significant effects on the prognosis of patients with ovarian cancer. The COX regression analysis showed that was an independent risk factor for ovarian cancer. Conclusions:In malignant ovarian cancer tissues, CA125, CK7, CK20, ER, PR, C-erbb2, and P-gp are over-expressed. The expression of P-gp is an independent risk factor for ovarian cancer, and it can be an important target for the treatment of malignant ovarian cancer. 10.21037/gs-20-811
    Microvessel density and p53 mutations in advanced-stage epithelial ovarian cancer. Nadkarni Niyati J,Geest Koen De,Neff Traci,Young Barry De,Bender David P,Ahmed Amina,Smith Brian J,Button Anna,Goodheart Michael J Cancer letters We planned to determine the relationship between angiogenesis and p53 mutational status in advanced-stage epithelial ovarian cancer. Using 190 tumor samples from patients with stage III and IV ovarian cancer we performed p53 sequencing, immunohistochemistry, and CD31 microvessel density (MVD) determination. MVD was elevated in tumors with p53 null mutations compared to p53 missense mutation or no mutation. Disease recurrence was increased with higher MVD in both unadjusted and adjusted analyses. In adjusted analysis, p53 null mutation was associated with increased recurrence and worse overall survival. Worse overall survival and increased recurrence risk were also associated with the combination of CD31 MVD values >25 vessels/HPF and any p53 mutation. P53 mutation status and MVD may have prognostic significance in patients with advanced-stage ovarian cancer. Tumors with p53 null mutations are likely to be more vascular, contributing to decreased survival and increased recurrence probability. 10.1016/j.canlet.2012.12.016
    The Frequency and Prognostic Significance of the Histologic Type in Early-stage Ovarian Carcinoma: A Reclassification Study by the Spanish Group for Ovarian Cancer Research (GEICO). Leskela Susanna,Romero Ignacio,Cristobal Eva,Pérez-Mies Belén,Rosa-Rosa Juan M,Gutierrez-Pecharroman Ana,Santón Almudena,Gonzalez Belén O,López-Reig Raquel,Hardisson David,Vera-Sempere Francisco,Illueca Carmen,Vieites Begoña,López-Guerrero José A,Palacios José,Poveda Andrés The American journal of surgical pathology The frequency and prognostic significance of the histologic type in early-stage ovarian cancer (OC) is not as well established as in advanced stages. In addition, histologic typing based only on morphologic features may be difficult, especially in high-grade tumors. In this study, we have analyzed a prospective cohort of 502 early-stage OCs to investigate their frequency, immunohistochemical characteristics, and survival of the 5 main histologic types. Histotype was assigned according to not only the morphologic features but also according to the expression pattern of WT1, p53, Napsin A, and progesterone receptors. In addition, an extended panel including p16, β-catenin, HER2, Arid1A, HINF1B, CK7, CDX2, and CK20 was used to refine the diagnosis in difficult cases. In this series, the frequency of the 5 major histologic types was as follows: endometrioid carcinoma, 32.7%; clear cell carcinoma, 25.1%; high-grade serous carcinoma (HGSC), 24.7%; mucinous carcinoma, 10.2%; low-grade serous carcinoma, 4.6%; and others, 2.8%. The combination of morphology and immunohistochemistry allowed the reclassification of 23% of OCs. The lowest concordance was found between samples initially diagnosed as endometrioid, but finally classified as high-grade serous tumors (22% error rate). Endometrioid carcinoma was the most favorable histologic type, whereas HGSC and low-grade serous carcinoma had the worst prognosis. Clear cell carcinoma with abnormal p53 immunostaining pattern also had poor prognosis. Although histologic grade was not a prognostic factor among early-stage endometrioid OCs, distinction between grade 3 endometrioid OC and HGSC is recommended, taking into account differences in prognosis and molecular alterations that can guide different treatments. 10.1097/PAS.0000000000001365
    Transcription factors WT1 and p53 combined: a prognostic biomarker in ovarian cancer. Carter Julia H,Deddens James A,Mueller Gretchen,Lewis Thomas G,Dooley Mariah K,Robillard Michelle C,Frydl Molly,Duvall Lydia,Pemberton Jackson O,Douglass Larry E British journal of cancer BACKGROUND:New approaches to ovarian cancer are needed to improve survival. Wilms' tumour 1 (WT1) is a tumour-associated antigen expressed in many ovarian cancers. P53 is also often altered. The clinical significance of the combined expression of these two transcription factors has not been studied. METHODS:One hundred ninety-six ovarian tumours were classified histopathologically. Tumours were stained for WT1 and p53 immunohistochemically. Stains were analysed according to tumour type, grade and FIGO stage. Kaplan-Meier analyses on 96 invasive carcinomas determined whether categorical variables were related to survival. RESULTS:WT1 and p53 were related to ovarian tumour type, grade, FIGO stage and patient survival. Uniform nuclear p53 expression was associated with invasion and WT1 expression was associated with advanced grade, FIGO stage and poor survival. When WT1 and p53 were both in the age-adjusted Cox model, WT1 was significant while p53 was not. When we combined tumours expressing WT1 and p53, then adjusted for age and tumour subtype, the hazard ratio compared to tumours without WT1 and with normal p53 was 2.70; when adjusted for age and FIGO stage, the hazard ratio was 2.40. CONCLUSIONS:WT1, an antigen target, is a biomarker for poor prognosis, particularly when combined with altered p53. 10.1038/s41416-018-0191-x