Richard H Bell

University of Rochester, Rochester, NY, United States

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Publications (50)194.41 Total impact

  • Journal of Surgical Education 01/2011; 68(4):294-7. · 1.07 Impact Factor
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    ABSTRACT: To investigate the effects and mechanism of Frondanol-A5P, a polar extract from Cucumaria frondosa, on growth inhibition and apoptosis in S2013 and AsPC-1 human pancreatic cancer cells. The effects of Frondanol-A5P on proliferation, cell cycle, expression of cell cycle proteins and p21, phosphorylation of MAP kinases, annexin V binding, and caspase-3 activation were examined. Frondanol-A5P inhibited proliferation and induced G2/M phase cell cycle arrest in both cell lines with decreased expression of cyclin A, cyclin B, and cdc25c. Frondanol-A5P induced phosphorylation of stress-activated protein kinase and Janus kinase (SAPK/JAK) and p38 mitogen-activated protein kinase (MAP) within 5 minutes. Frondanol-A5P markedly increased expression of p21 messenger RNA and protein at 3 hours in both cell lines. This effect was reduced by the p38 kinase inhibitor, SB203580. Frondanol-A5P markedly increased annexin V binding and activated caspase-3. Frondanol-A5 causes cell cycle arrest and apoptosis in human pancreatic cancer cells. These changes are associated with decreased expression of cyclin A, cyclin B, and cdc25c and increased expression of p21 that, at least in part, is mediated by a p38 kinase-dependent mechanism. Because Frondanol-A5P is derived from an edible, nontoxic, sea cucumber, it may be valuable for nutritional therapy or prevention of pancreatic cancer.
    Pancreas 07/2010; 39(5):646-52. · 2.95 Impact Factor
  • Carla M Pugh, Debra A Darosa, Richard H Bell
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    ABSTRACT: The purpose of this study was to compare the intraoperative learning needs and educational resource use of junior and senior residents. Our goal was to gain a better understanding of the progression of learning needs in surgical training. Residents (n = 125) completed a previously validated, 27-item survey indicating the following: (1) the extent to which traditional learning resources are used when preparing for cases in the operating room, and (2) which intraoperative management topics in which they believed they were deficient despite preoperative preparation. On a scale of 1 to 5, with 5 indicating frequent use, postgraduate year (PGY)-5 residents (n = 39) indicated surgical atlases (4.15; SD, .90) and surgical texts (4.15; SD, .90) were their most frequently used resources when preparing for a case in the operating room. In contrast, PGY-1 residents (n = 32) indicated anatomy atlases (3.97; SD, .93) and advice from colleagues (3.64; SD, .90) were their most frequently used resources when preparing for a case in the operating room. Despite the differences in how the PGY-5 group and the PGY-1 group prepared for a case, of 12 intraoperative management topics both groups believed they were the least prepared for instrument use/selection and suture selection. Today's residents represent a heterogeneous group of individuals with different learning needs based on level of experience, knowledge, and learning style. Our study highlights unexpected but critical learning needs for senior-level residents that can and should be readily addressed.
    American journal of surgery 04/2010; 199(4):562-5. · 2.36 Impact Factor
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    ABSTRACT: To design a Web-based system to track adverse and near-miss events, to establish an automated method to identify patterns of events, and to assess the adverse event reporting behavior of physicians. A Web-based system was designed to collect physician-reported adverse events including weekly Morbidity and Mortality (M&M) entries and anonymous adverse/near-miss events. An automated system was set up to help identify event patterns. Adverse event frequency was compared with hospital databases to assess reporting completeness. A metropolitan tertiary care center. Identification of adverse event patterns and completeness of reporting. From September 2005 to August 2007, 15,524 surgical patients were reported including 957 (6.2%) adverse events and 34 (0.2%) anonymous reports. The automated pattern recognition system helped identify 4 event patterns from M&M reports and 3 patterns from anonymous/near-miss reporting. After multidisciplinary meetings and expert reviews, the patterns were addressed with educational initiatives, correction of systems issues, and/or intensive quality monitoring. Only 25% of complications and 42% of inpatient deaths were reported. A total of 75.2% of adverse events resulting in permanent disability or death were attributed to the nature of the disease. Interventions to improve reporting were largely unsuccessful. We have developed a user-friendly Web-based system to track complications and identify patterns of adverse events. Underreporting of adverse events and attributing the complication to the nature of the disease represent a problem in reporting culture among surgeons at our institution. Similar systems should be used by surgery departments, particularly those affiliated with teaching hospitals, to identify quality improvement opportunities.
    Archives of surgery (Chicago, Ill.: 1960) 05/2009; 144(4):305-11; discussion 311. · 4.32 Impact Factor
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    ABSTRACT: Technological advancements, along with economic and political issues, have resulted in major changes in surgical education. The development of high fidelity simulators and the widespread availability of the Internet have allowed learning to be shifted away from the operating room. Furthermore, the Internet provides an opportunity for surgical educators to standardize general surgery training and assessment and to develop collaborations nationally and globally. This paper highlights presentations about the challenges as well as the rewards of surgical education in the age of the Internet from the 2009 Academic Surgical Congress.
    Journal of Surgical Research 05/2009; 156(2):177-82. · 2.02 Impact Factor
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    ABSTRACT: Arachidonic acid metabolism via the cyclooxygenase (COX) and 5-lipoxygenase (5-LOX) pathways modulates cell growth and apoptosis. Many studies have examined the effects of COX inhibitors on human colorectal cancer, but the role of 5-LOX in colonic cancer development has not been well studied. The purpose of this study was to evaluate the expression of 5-LOX in colonic polyps and cancer and the effect of 5-LOX inhibition on colon cancer cell proliferation. Colonic polyps, cancer, and normal mucosa were evaluated for 5-LOX expression by immunohistochemistry. Reverse transcription-PCR was used to establish 5-LOX expression in colon cancer cells. Thymidine incorporation and cell counts were used to determine the effect of the nonspecific LOX inhibitor Nordihydroguaiaretic Acid and the 5-LOX inhibitor Rev5901 on DNA synthesis. A heterotopic xenograft model in athymic mice using HT29 and LoVo human colon cancer cells was used to evaluate the effect of the 5-LOX inhibitor zileuton on tumor growth. 5-LOX is overexpressed in adenomatous polyps and cancer compared with that of normal colonic mucosa. LOX inhibition and 5-LOX inhibition decreased DNA synthesis in a concentration- and time-dependent manner in the Lovo cell line (P < 0.05). Inhibition of 5-LOX in an in vivo colon cancer xenograft model inhibited tumor growth compared with that of controls (P < 0.05). This study showed that 5-LOX is up-regulated in adenomatous colon polyps and cancer compared with normal colonic mucosa. The blockade of 5-LOX inhibits colon cancer cell proliferation both in vitro and in vivo and may prove a beneficial chemopreventive therapy in colon cancer.
    Clinical Cancer Research 10/2008; 14(20):6525-30. · 7.84 Impact Factor
  • Thomas K Varghese, Richard H Bell
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    ABSTRACT: Duodenum-preserving pancreatic head resections (DPPHRs) have been shown in European randomized clinical trials to be superior to pancreaticoduodenectomy for chronic pancreatitis, but DPPHR procedures have been slow to be adopted in the United States. To assess national attitudes of surgeons toward DPPHR, a web-based survey was administered to the U.S. members of the Pancreas Club, which is a national organization of pancreatic surgeons. We also performed a retrospective review of 21 DPPHRs, performed by the senior author, for chronic pancreatitis between January 2000 and March 2005. The web-based national survey was completed by 64 of 118 members of the Pancreas Club (54.24%). Of the 59 surgeons who perform operations for chronic pancreatitis, 34 had performed a DPPHR at least once. Only 23 U.S. surgeons continue to perform these procedures. Most surgeons who are not performing DPPHRs responded that, despite the published literature, existing procedures such as the Whipple and Puestow were better procedures. In our clinical series, 12 men and 9 women with a mean age of 48.2 +/- 9.6 years underwent DPPHR. The median length of stay was 9 days with 6 patients (28%) who had complications in the postoperative period. Ten of 20 potentially evaluable patients completed a visual analog pain scale and EORTC C-30 quality-of-life questionnaire. Pancreatic functioning approached the normal range in all domains. As compared with a general population of patients with chronic pancreatitis, significant improvement occurred in pancreatic-related pain and digestive function. Self-reported pain was significantly better after operation than before operation. DPPHR provides excellent functional results with relatively low postoperative morbidity and duration of stay. These procedures are underused in the United States, with very few surgeons who use, teach them, or report their results.
    Surgery 11/2007; 142(4):588-93; discussion 593.e1-3. · 3.37 Impact Factor
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    ABSTRACT: The Accreditation Council for Graduate Medical Education (ACGME) duty-hour requirements prompted program directors to rethink the organizational structure of their residency programs. Many surgical educators have expressed concerns that duty-hour restrictions would negatively affect quality of resident education. This article summarizes evaluation research results collected to study the impact of our reengineered residency program designed to preserve important educational activities while meeting duty-hour accreditation requirements. The traditional residency structure was redesigned to include a mixture of apprenticeship, small team, and night-float models. Impact evaluation data were collected using operative case logs, standardized test scores, quality assurance data, resident perception surveys, a faculty survey, and process evaluation measures. PGY1s and PGY2s enjoyed a substantial increase in operative cases. Operative cases increased overall and no resident has failed to meet ACGME volume or distribution requirements. American Board of Surgery In-Training Examination performance improved for PGY1s and PGY2s. Patient outcomes measures, including monthly mortality and number of and charges for admissions, showed no changes. Anonymously completed rotation evaluation forms showed stable or improved resident perceptions of case load, continuity, operating room teaching, appropriate level of faculty involvement and supervision, encouragement to attend conferences, and general assessment of the learning environment. A quality-of-life survey completed by residents before and after implementation of the new program structure showed substantial improvements. Faculty surveys showed perceived increases in work hours and job dissatisfaction. New physician assistant and nurse positions directly attributed to duty-hour restrictions amounted to about 0.2 full-time equivalent per resident. Duty-hour restrictions produce new challenges and might require additional resources but need not cause a deterioration of surgical residents' educational experience.
    Journal of the American College of Surgeons 10/2007; 205(3):393-404. · 4.50 Impact Factor
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    ABSTRACT: We have previously shown that the leukotriene B4 receptor antagonist, LY293111 inhibits proliferation and induces apoptosis in human pancreatic cancer cells both in vitro and in vivo. In the current study, we investigated the molecular mechanisms of LY293111-induced apoptosis and cell cycle arrest. Two human pancreatic cancer cell lines were used in this study, MiaPaCa-2 and AsPC-1. Cell cycle analysis by flow cytometry showed a dramatic increase in the percentage of apoptotic cells as well as S-phase arrest after treatment with 250 nmol/l LY293111 for up to 48 h. Western blotting indicated that LY293111 treatment induced cytochrome c release from the mitochondria into the cytosol, accompanied by caspase-9, caspase-7 and caspase-3 activation, and cleavage of poly ADP-ribose polymerase. Caspase-8 was not activated by LY293111. A decrease was found in the expression of the antiapoptotic proteins, Bcl-2 and Mcl-1, and an increase in the proapoptotic protein, Bax. LY293111 reduced the expression of CDK2, cyclin A and cyclin E, consistent with the S-phase arrest observed in these cells. The expression of cyclin-dependent kinase inhibitors, p21 and p27 was not affected by LY293111 treatment. In conclusion, LY293111 induces apoptosis in human pancreatic cancer cells through the mitochondria-mediated pathway. LY293111 also induces S-phase arrest with downregulation of CDK2, cyclin A and cyclin E. Blockade of leukotriene B4 metabolic pathway may provide a novel treatment for human pancreatic cancer.
    Anti-Cancer Drugs 07/2007; 18(5):535-41. · 2.23 Impact Factor
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    ABSTRACT: Resveratrol is a phenolic compound found in grape skins, mulberries, and certain nuts that has been shown to have antitumorigenic and anti-inflammatory properties. Macrophage inhibitory cytokine (MIC-1) is a member of the transforming growth factor beta (TGF-beta) superfamily that has been shown to have antitumorigenic activity and is up-regulated in resveratrol-treated cancer cells. Resveratrol inhibits proliferation of human pancreatic cancer cells; however, the exact mechanism of action is not known. In this study, we investigated the role of MIC-1 in resveratrol-induced growth inhibition of human pancreatic cancer cell lines. Proliferation assays conducted with resveratrol-treated human pancreatic cancer cell lines (CD18 and S2-013) at 24, 48, and 72 h revealed inhibition of cell proliferation compared to controls. Using oligonucleotide microarray analysis, we identified marked up-regulation of MIC-1 gene expression in resveratrol-treated human pancreatic cancer S2-013 cells. Real-time RT-PCR performed in CD18 and S2-013 cells treated with resveratrol (0-100 mum) for 24 h confirmed concentration and time-dependent up-regulation of expression of one particular gene, MIC-1. Both cell lines pretreated with actinomycin D (a transcriptional inhibitor) and then resveratrol had reduced up-regulation of MIC-1 gene expression compared to those treated with resveratrol alone. Finally, resveratrol-induced growth inhibition was abolished in CD18 cells transfected with MIC-1 short interfering RNA. Resveratrol up-regulates MIC-1 gene expression in part at the transcriptional level in pancreatic cancer cells. Furthermore, MIC-1 appears to play a key role in resveratrol-induced growth inhibition in these cells.
    Journal of Surgical Research 05/2007; 138(2):163-9. · 2.02 Impact Factor
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    ABSTRACT: Retinoids are potent growth inhibitory and differentiating agents in a variety of cancer cell types. We have shown that retinoids induce growth arrest in all pancreatic cancer cell lines studied, regardless of their p53 and differentiation status. However, the mechanism of growth inhibition is not known. Since TGF-beta2 is markedly induced by retinoids in other cancers and mediates MUC4 expression in pancreatic cancer cells, we investigated the role of TGF-beta in retinoic acid-mediated growth inhibition in pancreatic cancer cells. Retinoic acid markedly inhibited proliferation of two cell lines (Capan-2 and Hs766T) in a concentration and time-dependent manner. Retinoic acid increased TGF-beta2 mRNA content and secretion of the active and latent forms of TGF-beta2 (measured by ELISA and bioassay). The concentrations of active and TGF-beta2 secreted in response to 0.1 - 10 muM retinoic acid were between 1-5 pM. TGF-beta2 concentrations within this range also inhibited proliferation. A TGF-beta neutralizing antibody blocked the growth inhibitory effects of retinoic acid in Capan-2 cells and partially inhibitory the effects in Hs766T cells. These findings indicate that TGF-beta can cause growth inhibition of pancreatic cancer cells, in a p53-independent manner. Furthermore, it demonstrates the fundamental role of TGF-beta in growth inhibition in response to retinoic acid treatment is preserved in vitro.
    Molecular Cancer 02/2007; 6:82. · 5.13 Impact Factor
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    ABSTRACT: The purpose of this study was to gain an understanding of faculty and resident perception of residents' learning needs regarding operative management. Our hypothesis is that surgical faculty and residents have significantly different perceptions of residents' learning needs. This study used a 27-item survey designed to determine (1) the extent to which traditional learning resources are used by residents when preparing for cases in the operating room, (2) which Web-based resources residents use for operating room preparation, and (3) which operative management topics residents were deficient in despite preoperative preparation. The settings for this study were the exhibit hall area during the 90th American College of Surgeons' Clinical Congress Meeting and a weekly resident conference. Participants for this study included a convenience sample of faculty and resident volunteers from the Clinical Congress and residents of our program (N = 246). On a scale of 1-5, with 5 indicating frequent use, residents rated their most frequently used resources as Major Surgical Texts (3.99) and Advice from colleagues (3.97). The top 3 operative management topics residents felt least prepared for after studying were "instrument use" (67.7%), "suture selection" (65.3%), and "operative field exposure" (50.0%). The top 3 operative management topics faculty felt residents were least prepared for were "anatomy" (73.9%), "natural history of disease" (73.9%), and "procedure choices" (69.6%). Chi-square analysis comparing faculty and resident perceptions of resident learning needs showed significant differences (p < 0.05) in 12 of the 12 operative management topics rated. A critical step in guiding development and proper use of learning technologies for surgical education is the conduct of needs assessments. The disparity between faculty and resident perception of residents' learning needs in the operating room underscores the need for residents to be included in needs assessments relating to surgical training.
    Journal of Surgical Education 01/2007; 64(5):250-5. · 1.63 Impact Factor
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    ABSTRACT: Protein kinase C (PKC) is involved in cell growth, differentiation, and apoptosis. We investigated the effects of the PKC activator, the tetradecanylphorbol acetate (TPA), in human pancreatic cancer cells. Cell proliferation was measured by thymidine incorporation. Expression of cell cycle proteins was investigated by Western blot. Real-time reverse transcriptase-polymerase chain reaction was used to measure p21 messenger RNA expression, whereas knockdown of its expression was accomplished with a specific small interferring RNA. Cell cycle phases were determined by flow cytometry. TPA time and concentration dependently inhibited thymidine incorporation in Panc-1 and CD18 cells and induced G2/M cell cycle arrest. The TPA decreased cyclin A and B expression, increased cyclin E, and markedly increased the expression of p21 at both the messenger RNA and protein levels. TPA-induced p21 expression and growth inhibition were blocked by the PKC inhibitor, bisindoylmaleimide. TPA induced extracellular signal-regulated kinase1/2 phosphorylation, whereas the MEK inhibitor, PD98059, blocked the TPA-induced p21 expression. Small interferring RNA targeted to p21 blocked TPA-induced p21 protein expression but not TPA-induced cell growth arrest. TPA-induced p21 expression is mediated by the MEK/ERK pathway but is not involved in TPA-induced growth inhibition. In contrast, cyclin A and cyclin B are likely involved in TPA-induced G2/M arrest because both proteins are involved in S phase and G2/M transition during cell proliferation.
    Pancreas 09/2006; 33(2):148-55. · 2.95 Impact Factor
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    ABSTRACT: We evaluated the incidence of chronic pancreatitis and chronic bile duct inflammation in patients undergoing pancreaticoduodenectomy (PD) for suspected periampullary cancer. Differences between clinical presentation, surgical management, and outcomes were compared between patients with malignancy and benign inflammatory disease. The incidence of chronic inflammatory disease was 12.9% (21/162). Patients with chronic inflammatory disease were associated with a higher incidence of smoking (75.0% versus 64.7%) and chronic alcohol use (66.7% versus 46.2%). Jaundice was significantly more frequent in patients with malignant disease (83.6% versus 42.9%, P < .05). Surgery for chronic inflammatory disease was associated with significantly more intraoperative bleeding (P < .05). The finding of chronic inflammatory disease after PD for suspected carcinoma is justifiable because (1) none of the available diagnostic modalities are infallible, (2) early treatment of pancreatic cancer is crucial for achieving cure, and (3) PD may relieve clinical symptoms in patients with chronic pancreatitis or pancreatic cancer.
    The American Journal of Surgery 03/2006; 191(3):437-41. · 2.52 Impact Factor
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    ABSTRACT: Patients with pancreatic cancer have little hope for cure because no effective therapies are available. Sansalvamide A is a cyclic depsipeptide produced by a marine fungus. We investigated the effect of a novel sansalvamide A analogue on growth, cell-cycle phases, and induction of apoptosis in human pancreatic cancer cells in vitro. The sansalvamide analogue caused marked time- and concentration-dependent inhibition of DNA synthesis and cell proliferation of two human pancreatic cancer cell lines (AsPC-1 and S2-013). The analogue induced G0/G1 phase cell-cycle arrest and morphological changes suggesting induction of apoptosis. Apoptosis was confirmed by annexin V binding. This novel sansalvamide analogue inhibits growth of pancreatic cancer cells through G0/G1 arrest and induces apoptosis. Sansalvamide analogues may be valuable for the treatment of pancreatic cancer.
    Biochemical and Biophysical Research Communications 03/2006; 340(4):1224-8. · 2.28 Impact Factor
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    ABSTRACT: Many chemotherapeutic agents have been used to treat pancreatic cancer without success. Apigenin, a naturally occurring flavonoid, has been shown to inhibit growth in some cancer cell lines but has not been studied in pancreatic cancer. We hypothesized that apigenin would inhibit pancreatic cancer cell growth in vitro. Apigenin caused both time- and concentration-dependent inhibition of DNA synthesis and cell proliferation in four pancreatic cancer cell lines. Apigenin induced G2/M phase cell cycle arrest. Apigenin reduced levels of cyclin A, cyclin B, phosphorylated forms of cdc2 and cdc25, which are all proteins required for G2/M transition. Apigenin inhibits growth of pancreatic cancer cells through suppression of cyclin B-associated cdc2 activity and G2/M arrest, and may be a valuable drug for the treatment or prevention of pancreatic cancer.
    Molecular Cancer 02/2006; 5:76. · 5.13 Impact Factor
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    Jeffrey D Wayne, Richard H Bell
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    ABSTRACT: Despite recent advancements in the staging and treatment of gastric cancer, overall survival remains poor. Extended or radical resections, to include the entire stomach, regional lymph nodes,or contiguous organs, have thus been proposed to alter the course of this fatal disease; however, no prospective randomized trial has validated this approach in a Western center. Furthermore, there are other malignant tumors that occur in the stomach and that may be successfully treated with a limited, nonanatomic, or subtotal gastrectomy, or in the case of gastric lymphoma, without surgery at all. Palliative approaches to patients who have advanced gastric cancer, which should be conservative by nature, are also outlined.
    Surgical Clinics of North America 11/2005; 85(5):1009-20, vii. · 2.02 Impact Factor
  • Pancreas 11/2005; 31(3):218-20. · 2.95 Impact Factor
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    ABSTRACT: We have previously shown the importance of LTB4 in human pancreatic cancer. LTB4 receptor antagonists block growth and induce apoptosis in pancreatic cancer cells both in vitro and in vivo. Therefore, we investigated the effect of LTB4 on proliferation of human pancreatic cancer cells and the mechanisms involved. LTB4 stimulated DNA synthesis and proliferation of both PANC-1 and AsPC-1 human pancreatic cancer cells, as measured by thymidine incorporation and cell number. LTB4 stimulated rapid and transient activation of MEK and ERK1/2 kinases. The MEK inhibitors, PD98059 and U0126, blocked LTB4-stimulated ERK1/2 activation and cell proliferation. LTB4 also stimulated phosphorylation of p38 MAPK; however, the p38 MAPK inhibitor, SB203580, failed to block LTB4-stimulated growth. The activity of JNK/SAPK was not affected by LTB4 treatment. Phosphorylation of Akt was also induced by LTB4 and this effect was blocked by the PI-3 kinase inhibitor wortmannin, which also partially blocked LTB4-stimulated cell proliferation. In conclusion, LTB4 stimulates proliferation of human pancreatic cancer cells through MEK/ERK and PI-3 kinase/Akt pathways, while p38 MPAK and JNK/SAPK are not involved.
    Biochemical and Biophysical Research Communications 10/2005; 335(3):949-56. · 2.28 Impact Factor
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    ABSTRACT: Pancreatic cancer has an abysmal prognosis because of late diagnosis. Therefore, it is important to identify risk factors if we are to be able to prevent and detect this cancer in an early, noninvasive stage. Pancreatic intraepithelial neoplasias (PanIN) are the precursor lesions which could be an ideal target for chemoprevention. This study shows up-regulation of 5-lipoxygenase (5-LOX) in all grades of human PanINs and early lesions of pancreatic cancer in two different animal models (EL-Kras mice and N-nitrosobis(2-oxopropyl)amine-treated hamsters) by immunohistochemistry. The results were consistent in all tissues examined, including seven chronic pancreatitis patients, four pancreatic cancer patients, one multiorgan donor, nine EL-Kras mice, and three N-nitrosobis(2-oxopropyl)amine-treated hamsters, all with PanINs. Overexpression of 5-LOX in NIH3T3 cells resulted in greater sensitivity of these cells to the growth inhibitory effects of the 5-LOX inhibitor Rev5901. These findings provide evidence that 5-LOX plays a key role in the development of pancreatic cancer. Furthermore, the lipoxygenase pathway may be a target for the prevention of this devastating disease.
    Cancer Research 08/2005; 65(14):6011-6. · 8.65 Impact Factor

Publication Stats

810 Citations
194.41 Total Impact Points

Institutions

  • 2011
    • University of Rochester
      • Department of Surgery
      Rochester, NY, United States
  • 2004–2010
    • Northwestern University
      • • Robert H. Lurie Comprehensive Cancer Center
      • • Feinberg School of Medicine
      • • Department of Surgery
      Evanston, IL, United States
  • 2005–2007
    • Ann & Robert H. Lurie Children's Hospital of Chicago
      Chicago, Illinois, United States
    • Universit├Ąt Heidelberg
      • Department of Spine Surgery
      Heidelberg, Baden-Wuerttemberg, Germany
    • University of Pittsburgh
      • School of Medicine
      Pittsburgh, PA, United States
  • 2003
    • VA Puget Sound Health Care System
      Washington, Washington, D.C., United States
  • 1997–2002
    • University of Washington Seattle
      • Department of Surgery
      Seattle, WA, United States
  • 1992
    • Geisel School of Medicine at Dartmouth
      • Department of Pathology
      Hanover, New Hampshire, United States
  • 1987
    • University of Nebraska Medical Center
      Omaha, Nebraska, United States