Jun Miki

The Jikei University School of Medicine, Tokyo, Tokyo-to, Japan

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Publications (29)65.18 Total impact

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    ABSTRACT: To investigate and characterize ERG oncoprotein expression in Japanese patients with prostate cancer (PCa), we evaluated 92 index tumors from Japanese patients who had undergone radical prostatectomy for PCa, using an antibody-based detection method to determine ERG expression. Expression status was compared with clinicopathological findings including patient age, body mass index and preoperative prostate-specific antigen (PSA) levels, specimen Gleason score, pathological stage, positive surgical margin, size of index tumor, prostatic volume, zonal origin of index tumor and biochemical failure. Overall, ERG protein was expressed in 16.3% (15/92) of the index tumors, but not in benign glands. Younger patient age, lower Gleason score and negative surgical margins were found to be independently associated with its expression in the multivariate analysis (P= 0.015, 0.003 and 0.038, respectively). ERG expression was not associated with biochemical failure. Though not statistically significant, ERG expression was more frequently observed in peripheral zone than in transition zone cancers (28.2% vs 10%, respectively). In conclusion, ERG protein was less frequently expressed in this Japanese PCa cohort compared with Western reports. ERG expression was associated with a less aggressive tumor phenotype, and its biological significance needs to be further investigated.
    Pathology International 11/2012; 62(11):742-8. · 1.72 Impact Factor
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    ABSTRACT: A 31-year-old man underwent living-related kidney transplantation in 2004 as a consequence of primary focal segmental glomerulosclerosis (FSGS). Four years after the transplantation, we confirmed nephrotic syndrome caused by recurrent FSGS. We performed plasmapheresis and low-density lipoprotein adsorption. We also combined steroid therapy with a reduction in the dose of tacrolimus and an increased dose of mycophenolate mofetil. The nephrotic syndrome improved dramatically with this combined therapeutic approach. However, 10 months after these treatments, he revisited our hospital because of altered consciousness. We detected multiple tumor masses in his brain that were ring enhanced on contrast magnetic resonance imaging. Consequently, we suspected primary central nervous system post-transplantation lymphoproliferative disorder (CNS-PTLD). We performed a craniotomy to biopsy the brain tumors. The biopsy specimen showed Epstein-Barr virus-associated diffuse large B-cell lymphoma. There is no definitive treatment for CNS-PTLD. Therefore, we treated the primary CNS-PTLD successfully with whole-brain radiation and discontinuation of immunosuppression therapy.
    Transplant Infectious Disease 08/2012; 14(5):E102-6. · 1.98 Impact Factor
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    ABSTRACT: Here, we report the successful treatment of a 38-yr-old Japanese man diagnosed with recurrent immunoglobulin A nephropathy (IgAN) with chronic active antibody-mediated rejection (CAAMR), three yr after undergoing living-related donor kidney transplantation. Immediately after transplantation, the allograft function was well maintained with a serum creatinine (S-Cr) level of <1.8 mg/dL. About three yr after transplantation, urine protein excretion had reached 4.59 g/d, and the S-Cr level had increased to more than 2.0 mg/dL. Based on the allograft biopsy, we diagnosed nephrotic syndrome because of recurrence of IgAN with CAAMR. Subsequently, we performed a tonsillectomy, administered three sessions of steroid pulse therapy, and added losartan for the recurrence of IgAN. We also changed his immunosuppressant from mizoribine to mycophenolate mofetil to treat the CAAMR. The nephrotic syndrome improved with the multiple therapeutic approaches; however, the S-Cr level did not decrease below 2.0 mg/dL. We possibly could have performed additional treatments such as rituximab and intravenous immunoglobulin for the CAAMR, but therapeutic strategies for CAAMR have not yet been established.
    Clinical Transplantation 07/2011; 25 Suppl 23:28-33. · 1.63 Impact Factor
  • Jun Miki, Shin Egawa
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    ABSTRACT: Lymph node dissection is a standard procedure for treatment of several cancers, but its role in prostate cancer (PCa) as an adjunct of radical prostatectomy is still debated and controversial. Pelvic lymph node dissection (PLND) is currently the most reliable means of diagnosis of lymph node metastases. A uniform PLND surgical template cannot be determined, but recent evidence shows that extended PLND provides more lymph nodes, increases the accuracy of detection of lymph node metastases, and affects decision making with regard to adjuvant therapy. Several nomograms have been developed to predict those who may need more extensive PLND, while sparing the rest. Importantly, no prospective data indicate that extension of PLND improves cancer control or benefits survival. A well designed prospective randomized study is needed to resolve these issues. We present a comprehensive literature review and critical discussion of the diagnostic and therapeutic role of PLND in PCa.
    International Journal of Clinical Oncology 06/2011; 16(3):195-202. · 1.41 Impact Factor
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    ABSTRACT: Research into molecular and genetic mechanisms underlying prostate carcinogenesis in high-risk African American men would be greatly advanced by in vitro models of African American prostate tumors representing primary tumors. However, the generation of immortalized primary African American prostate cancer cells that will accurately reflect the in situ characteristics of malignant epithelium is currently limited but is greatly needed. We have successfully established immortalized cell lines of a pair of non-malignant and malignant tumors derived from an African American prostate cancer patient with HPV-16E6E7 (RC-77N/E and RC-77T/E). RC-77N/E and RC-77T/E cells are currently growing well at passage 40. Both cells exhibit epithelial morphology and are androgen sensitive. The RC-77T/E cells produced tumors in SCID mice whereas the RC-77N/E cells produced no tumor in SCID mice. These cells expressed androgen-regulated prostate-specific homobox gene, NKX 3.1, epithelial cell specific cytokeratn 8, androgen receptor (AR), prostate specific antigen (PSA), and p16. Chromosome analysis showed that both cell lines are similar; near diploid human male (XY) with most chromosome counts in the 45-48 range. However, RC-77T/E cell line has new marker chromosomes: M1B=del/t(4;?)(q28;?), M5=16q+ in addition to those observed in the RC-77N/E cell line (M1=del(4)(q28q34)+hsr in some, M1A=t(4q;?),M2=der(9?),M2A=del(M2p-),M3=iso(?), M4=der(22?)). This is the first documented case of the establishment of pair of non-malignant and malignant tumors derived from an African American prostate cancer patient. These models will provide novel tools to study the molecular and genetic mechanisms of prostate carcinogenesis, especially for high-risk African American men.
    International Journal of Oncology 12/2010; 37(6):1477-82. · 2.66 Impact Factor
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    ABSTRACT: Laparoscopic radical prostatectomy for localized prostate cancer offers several advantages, including creation of a pneumoperitoneum that results in less blood loss than is seen with the corresponding open procedure. Transection of the deep dorsal vein complex remains among the most challenging aspects, however. Safe and secure completion of this procedure is important to minimize blood loss and maximize the chance of cure. Liberal use of coagulation for hemostasis at the dorsal vein complex (DVC) risks thermal damage to the sphincteric muscle. DVC ligation before transection, though commonly performed, can cause loss of some sphincteric fibers and potentially result in delayed recovery of urinary continence. Furthermore, ligation may at times prove difficult, especially in obese patients with a short and broad DVC, a large prostate gland, and a narrow pelvis. The presence of prominent pubic tubercles may further increase the difficulty. We have found that bleeding from the DVC is easily controlled without suture ligation through a combination of a modest pneumoperitoneum with pinpoint coagulation of one or two small arteries that are consistently found in the superficial layer of the complex. Precise, even-level transection is possible under direct vision with no more than modest blood loss. A stitch in a Z-shaped fashion is then applied to the entire transected stump of the DVC. This procedure is simple and easily performed, even by those with limited experience. Here we provide an overview of our current technique.
    International Journal of Urology 11/2010; 17(11):960-1. · 1.73 Impact Factor
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    Jun Miki
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    ABSTRACT: Although both prostate epithelial stem cells and prostate cancer stem cells are implicated in the differentiation of the normal prostate gland and carcinogenesis of prostate cancer, there has, until recently, been little information regarding their biology. This review summarizes the recent advancements in cell biological research including various in vitro culture systems that have offered the characterization and isolation of prostate epithelial stem cells and prostate cancer stem cells. In addition, the stromal niche or microenvironment of stem cells plays an essential role in proliferation and differentiation of normal stem cells. Stroma surrounding cancer cells, which also provide another unique niche, may involve the initiation and development of cancer stem cells. Investigation of stem cells and their microenvironments in the prostate should lead to the elucidation of biological features and the development of novel treatments for prostate cancer.
    International Journal of Urology 02/2010; 17(2):139-47. · 1.73 Impact Factor
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    ABSTRACT: To assess the impact of lateral view apical dissection in laparoscopic radical prostatectomy (LRP) on the reduction of positive surgical margin rates and recovery of postoperative continence. One hundred and forty-four consecutive patients underwent LRP from October 2004 to March 2008. Lateral view dissection of the prostato-urethral junction was conducted in 76 of them (Group 2). Standard dissection was used in the remaining patients (Group 1). The effect of this technical modification on the reduction of positive surgical margin rates and postoperative recovery of urinary continence was assessed in the two groups. Overall, the incidence of positive margins decreased from 23 (35.9%) in Group 1 to 16 cases (21.9%) in Group 2 (P = 0.07). Positive margin rates in pT2 decreased from 30.6% to 6.5% (P = 0.006). Apical and dorso-apical margins were reduced from 26.5% to 4.3% (P = 0.009) and from 10.2% to 0% (P < 0.001), respectively. Postoperative recovery of urinary continence improved significantly, with a pad-free rate over the first 3 months of 55.9% in Group 1 vs 71.7% in Group 2 (P = 0.01). Multivariate logistic regression analysis showed this modified surgical technique to predict a lower rate of positive margins. Lateral view dissection of the prostato-urethral junction is an easily applicable technical modification. It provides better visualization of apical anatomy substantially contributing to the reduction of positive surgical margin rates, especially at the level of prostatic apex.
    International Journal of Urology 09/2009; 16(8):664-9. · 1.73 Impact Factor
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    ABSTRACT: Using high molecular-weight proteomic analysis, we previously showed that Staphylococcal nuclease domain-containing protein 1 (SND1) is highly expressed in recurrent androgen-insensitive prostate cancer tissues. SND1 is a component of the RNA-induced splicing complex that mediates RNA interference, leading to degradation of specific mRNAs. The objective of this study was to further characterize SND1 expression and to investigate its biological potential in prostate cancer. Radical prostatectomy specimens were obtained from 62 prostate cancer patients. SND1 immunohistochemical staining patterns were evaluated using an in-house polyclonal antibody. We confirmed SND1 mRNA expression in prostate cancer cells using an in situ hybridization technique. To determine the importance of SND1 mRNA, we knocked down SND1 in vitro with small interfering RNA and observed a significant decrease in cell growth. SND1 was expressed in 60 of 62 prostate cancers (97%), appearing in the cytoplasm as small, granular structures; it was also present at high levels in prostate cancer specimens, while in hyperplasia specimens and normal epithelium, it was weakly or negatively expressed. SND1 expression intensity increased with increasing grade and aggressiveness of the cancer. As SND1 mRNA was overexpressed in cancer cells, the growth of these cells was suppressed following SND1 knockdown in vitro, thus representing a promising prostate cancer biomarker and therapeutic target.
    American Journal Of Pathology 06/2009; 174(6):2044-50. · 4.60 Impact Factor
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    ABSTRACT: The relationship between surgical methods and clinical parameters was analyzed retrospectively in 32 patients operated for adrenal pheochromocytoma (laparoscopic surgery, 13 patients; open surgery, 19 patients) in Jikei University Hospital from 1997 to 2006. The mean tumor size was higher in open surgery patients. Preoperative hypertension was recorded in 7 open surgery patients and 15 laparoscopic surgery patients; 5 and 16 patients, respectively, were administered an alpha1-blocker preoperatively. Despite only slight differences in background data, blood loss was significantly less in the laparoscopic surgery patients than in the open surgery patients. However, intraoperative variation in blood pressure was greater in the former, probably because of technical difficulties or inadequate preoperative management. The duration of operation was not significantly different between the 2 groups. Tumor size did not show a significant correlation with either duration of surgery or blood loss. On the other hand, a significant correlation was noted between blood loss and duration of surgery only in open surgery patients. Postoperative recovery time was significantly shorter in laparoscopic surgery patients. After considering factors such as tumor size, hormone activity, preoperative management, and surgeon's skill, we believe that compared to open surgery, laparoscopic surgery is a less invasive and more useful method for adrenal pheochromocytoma.
    Hinyokika kiyo. Acta urologica Japonica 06/2009; 55(5):245-8.
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    ABSTRACT: We investigated the long-term outcome of upper urinary tract transitional cell carcinoma (TCC) after surgery. The study population comprised 114 surgically treated patients with upper urinary tract TCC treated at Jikei University Hospital between March 1990 and December 2004. All these patients underwent radical surgery without any type of neoadjuvant therapy. Patterns of failure and patient survival were compared with clinicopathological parameters. The 5- and 10-year overall survival (OAS) rates for the patients were 85% (95% confidence interval [CI], 81%-89%) and 76% (95% CI, 69%-83%). To date, 19 patients (16.7%) have experienced distant or lymph node metastasis at a mean of 13.3 months following surgery (range, 1 to 50 months). The site of the primary tumor did not affect patient survival (P > 0.05). Both lymphovascular involvement (LVI) and positive lymph nodes were found to have poor prognosis in univariate analysis (P = 0.004 and P < 0.0001). Multivariate analysis indicated pathological stage and bladder recurrence (bladder recurrence being a better prognostic factor) to be independent predictors of metastasis-free survival, but not of OAS or cause-specific survival (CSS). Pathological stage and bladder recurrence were found to be the predictors of metastasis-free survival in this study. Further searching for reliable biomarkers is needed to accurately predict the prognosis of this malignancy.
    International Journal of Clinical Oncology 06/2009; 14(3):213-8. · 1.73 Impact Factor
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    ABSTRACT: Diagnostic criteria for preclinical Cushing's syndrome (PCS) were reported in 1996. However, requirement of postoperative steroid hormone replacement is still controversial issue. In this study, we observed recent surgical cases retrospectively and evaluate the use of postoperative steroid hormone replacement. Eighteen patients with PCS underwent surgery from 1997 to 2007 in Jikei University Hospital. Thirteen of them received postoperative steroid hormone replacement. We investigated preoperative hormone activity by 131I-adosterol scintigraphy and suppression of ACTH and evaluated the requirement of postoperative steroid hormone replacement. Preoperative serum cortisol was normal range in all patients. Serum ACTH was suppressed in 10 of them (56%). In 131I-adosterol scintigraphy, accumulation in ipsilateral side was observed in all patients. Accumulation in contralateral side was observed in 13 patients whose serum ACTH had tendency to be suppressed. Mean period of steroid hormone replacement was 19.8 weeks. Patients with lower preoperative ACTH tended to require longer period until withdrawal of steroid hormone replacement. In addition, patients received steroid hormone replacement with higher starting dose significantly required longer period. Three of them had complications during tapering of steroid hormone. Postoperative adrenal insufficiency is important issue as postoperative management of PCS patients whose function of contralateral adrenal or pituitary gland is suppressed. 131I-adosterol scintigraphy and preoperative serum ACTH were important factors to evaluate the requirement of postoperative steroid hormone replacement. Especially, patients with low preoperative serum ACTH tended to require long duration of postoperative steroid hormone replacement. On the other hand, patients with accumulation of contralateral side in 131I-adosterol scintigraphy and without suppression of serum ACTH may not require steroid hormone replacement. Decrease starting dose of steroid hormone replacement for appropriate patients could shorten the period of steroid hormone replacement safely.
    Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 04/2009; 100(3):479-85.
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    ABSTRACT: Infections caused by antibiotics-resistant Gram-positive bacteria have been reported from many pediatric hematology-oncology centers. The susceptibility profiles to meropenem, piperacillin, and vancomycin among oral flora isolates of alpha-hemolytic streptococci (AHS) obtained from six children with cancer who received several empirical therapies (ET) against febrile neutropenia, were investigated. Meropenem minimum inhibitory concentration (MIC) of AHS isolated from ET patients was 2.167 +/- 0.258 microg/mL (mean +/- SD), which was significantly higher than the MIC of AHS isolated from control groups. Intriguingly, AHS isolated approximately 6 months after hospital discharge indicated recovery of susceptibility to meropenem. AHS isolates from neutropenic children with cancer should be checked for antibiotic susceptibility, even against carbapenems.
    Pediatrics International 03/2009; 51(1):103-6. · 0.88 Impact Factor
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    ABSTRACT: Understanding prostate stem cells may provide insight into the origin of prostate cancer. Primary cells have been cultured from human prostate tissue but they usually survive only 15-20 population doublings before undergoing senescence. We report here that RC-170N/h/clone 7 cells, a clonal cell line from hTERT-immortalized primary non-malignant tissue-derived human prostate epithelial cell line (RC170N/h), retain multipotent stem cell properties. The RC-170N/h/clone 7 cells expressed a human embryonic stem cell marker, Oct-4, and potential prostate epithelial stem cell markers, CD133, integrin alpha2beta1(hi) and CD44. The RC-170N/h/clone 7 cells proliferated in KGM and Dulbecco's Modified Eagle Medium with 10% fetal bovine serum and 5 microg/ml insulin (DMEM+10% FBS+Ins.) medium, and differentiated into epithelial stem cells that expressed epithelial cell markers, including CK5/14, CD44, p63 and cytokeratin 18 (CK18); as well as the mesenchymal cell markers, vimentin, desmin; the neuron and neuroendocrine cell marker, chromogranin A. Furthermore the RC170 N/h/clone 7 cells differentiated into multi tissues when transplanted into the sub-renal capsule and subcutaneously of NOD-SCID mice. The results indicate that RC170N/h/clone 7 cells retain the properties of multipotent stem cells and will be useful as a novel cell model for studying the mechanisms of human prostate stem cell differentiation and transformation.
    Experimental Cell Research 02/2008; 314(1):92-102. · 3.56 Impact Factor
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    J Miki, J S Rhim
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    ABSTRACT: Current existing therapies for prostate cancer eradicate the majority of cells within a tumor. However, most patients with advanced cancer still progress to androgen-independent metastatic disease that remains essentially incurable by current treatment strategies. Recent evidence has shown that cancer stem cells (CSCs) are a subset of the tumor cells that are responsible for initiating and maintaining the disease. Understanding normal stem cells and CSCs may provide insight into the origin of and new therapeutics for prostate cancer. Normal stem cells and CSCs have been identified in prostate tissue by the use of several markers or techniques. Although research on stem cells has been limited by the lack of suitable in vitro systems, recent studies show that not only primary cells but also several established cell lines may exhibit stem cell properties. This review discusses various in vitro culture systems to propagate normal prostate stem cells and prostate CSCs together with molecular markers. These in vitro cell culture models should be useful for elucidating the differentiation of prostatic epithelium and the biological features of prostate cancer.
    Prostate cancer and prostatic diseases 02/2008; 11(1):32-9. · 2.10 Impact Factor
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    ABSTRACT: Cellular senescence is a program in normal cells triggered in response to various types of stress that cells experience when they are explanted into culture. In this study, functional analyses on the role of the class II polycomb complex in cellular senescence were performed using mouse embryo fibroblasts (MEFs) with a genetically deleted member of the complex, Mel18. Mel18-null MEFs undergo typical premature senescence accompanied by the up-regulation of ARF/p53/p16(INK4a) and decrease of Ring1b/Bmi1. Our results demonstrated that ARF or p53 deletion cancels the senescence in Mel18-null MEFs, and the fact that p16(INK4a) is up-regulated in double-null MEFs suggests that the ARF/p53 pathway plays a central role in stress-induced senescence. The in vivo binding of Ring1b and E2F3b to the ARF promoter decreased progressively in senescence, and Mel18 inactivation accelerated the exfoliation of Ring1b/E2F3b from the promoter sequence, indicating the cooperation of polycombs/E2F3b on ARF expression and cellular senescence. Taken together, it seems that class II polycomb proteins and E2F3b dually control cellular senescence via the ARF/p53 pathway.
    Genes to Cells 01/2008; 12(12):1371-82. · 2.73 Impact Factor
  • Journal of Urology - J UROL. 01/2008; 179(4):286-286.
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    ABSTRACT: Although epidemiological studies have suggested a positive correlation between environmental radon exposure and prostate cancer, the mechanism involved is not clear. In the present study, we examined the oncogenic transforming potency of alpha-particles using non-tumorigenic, telomerase-immortalized human benign prostate epithelial cells. We report the malignant transformation of human benign prostate epithelial cells after a single exposure to 0.6 Gy dose of alpha-particles. Transformed cells showed anchorage-independent growth in soft agar and induced progressively growing tumors when transplanted into SCID mice. The tumors were characterized histologically as poorly differentiated adenocarcinomas. The cell line derived from tumor (SCID 5015), like the unirradiated cells, expressed cytokeratin 5, 8 and 18, NKX3.1 and AMACR. The malignant cells showed increased secretion of MMP2. Stepwise chromosomal changes in the progression to tumorigenicity were observed. Chromosome abnormalities were identified in both irradiated and tumorigenic cells relative to the non-irradiated control cells. Prominent changes in chromosomes 6, 11 and 16, as well as mutations and deletions of the p53 gene were observed in the tumor outgrowth and tumor cells. These findings provide the first evidence of malignant transformation of human benign prostate epithelial cells exposed to a single dose of alpha-particles. This model provides an opportunity to study the cellular and molecular alterations that occur in radiation carcinogenesis in human prostate cells.
    International Journal of Oncology 10/2007; 31(3):537-44. · 2.66 Impact Factor
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    ABSTRACT: Understanding normal and cancer stem cells may provide insight into the origin of and new therapeutics for prostate cancer. Normal and cancer stem cells in prostate have recently been identified with a CD44(+)/alpha(2)beta(1)(high)/CD133(+) phenotype. Stromal cell-derived factor-1 (SDF-1) and its receptor, CXCR4, have multiple essential functions, including homing of stem cells and metastasis of cancer cells. We show here that human telomerase reverse transcriptase (hTERT)-immortalized primary nonmalignant (RC-165N/hTERT) and malignant (RC-92a/hTERT) tumor-derived human prostate epithelial cell lines retain stem cell properties with a CD133(+)/CD44(+)/alpha(2)beta(1)(+)/34betaE12(+)/CK18(+)/p63(-)/androgen receptor (AR)(-)/PSA(-) phenotype. Higher CD133 expression was detected in the hTERT-immortalized cells than in primary prostate cells. These immortalized cells exhibited "prostaspheres" in nonadherent culture systems and also maintained higher CD133 expression. The CD133(+) cells from these immortalized cell lines had high proliferative potential and were able to differentiate into AR(+) phenotype. In three-dimensional culture, the CD133(+) cells from RC-165N/hTERT cells produced branched structures, whereas the CD133(+) cells from RC-92a/hTERT cells produced large irregular spheroids with less branched structures. SDF-1 induced, but anti-CXCR4 antibody inhibited, migration of CD133(+) cells from RC-92a/hTERT cells, which coexpressed CXCR4. CXCR4/SDF-1 may sustain tumor chemotaxis in cancer stem cells. Furthermore, immunostaining of clinical prostate specimens showed that CD133 expression was detected in a subpopulation of prostate cancer cells and corresponded to the loss of AR. Expression of CXCR4 was also detected in CD133(+) cancer cells. These novel in vitro models may offer useful tools for the study of the biological features and functional integration of normal and cancer stem cells in prostate.
    Cancer Research 05/2007; 67(7):3153-61. · 8.65 Impact Factor
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    ABSTRACT: In vitro human prostate cell culture models are critical for clarifying the mechanism of prostate cancer progression and for testing preventive and therapeutic agents. Cell lines ideal for the study of human primary prostate tumors would be those derived from spontaneously immortalized tumor cells; unfortunately, explanted primary prostate cells survive only short-term in culture, and rarely immortalize spontaneously. Therefore, we recently have generated five immortal human prostate epithelial cell cultures derived from both the benign and malignant tissues of prostate cancer patients with telomerase, a gene that prevents cellular senescence. Examination of these cell lines for their morphologies and proliferative capacities, their abilities to grow in low serum, to respond to androgen stimulation, to grow above the agar layer, to form tumors in SCID mice, suggests that they may serve as valid, useful tools for the elucidation of early events in prostate tumorigenesis. Furthermore, the chromosome alterations observed in these immortalized cell lines expressing aspects of the malignant phenotypes imply that these cell lines accurately recapitulate the genetic composition of primary tumors. These novel in vitro models may offer unique models for the study of prostate carcinogenesis and also provide the means for testing both chemopreventive and chemotherapeutic agents.
    Experimental Cell Research 05/2006; 312(6):831-43. · 3.56 Impact Factor

Publication Stats

375 Citations
65.18 Total Impact Points

Institutions

  • 2002–2011
    • The Jikei University School of Medicine
      • Department of Urology
      Tokyo, Tokyo-to, Japan
  • 2010
    • Tuskegee University
      Tuskegee, Alabama, United States
  • 2006–2010
    • Uniformed Services University of the Health Sciences
      • Department of Surgery
      Maryland, United States
  • 2008
    • Shinshu University
      • Department of Pediatrics
      Shonai, Nagano, Japan