Yuji Kaneoka

Ogaki Municipal Hospital, Gihu, Gifu, Japan

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Publications (125)291.46 Total impact

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    ABSTRACT: Background/aim: Intrahepatic cholangiocarcinoma (ICC) is one of the most aggressive malignant tumours, so the identification of molecular targets for ICC is an important issue. Zinc finger E-box binding homeobox 1 (ZEB1) is a key inducer of epithelial-mesenchymal transition (EMT). The aim of the present study was to clarify the clinical significance of ZEB1 in ICC and the associations between ZEB1 expression and EMT-related proteins. Methods: We immunohistochemically examined the expression of EMT-related proteins, namely ZEB1, vimentin and E-cadherin, in ICC specimens from 102 patients. The clinicopathological and prognostic values of these markers were evaluated. Results: ZEB1 and vimentin were expressed in 46.1% and 43.1% of tumours, respectively, and E-cadherin expression was lost in 44.1% of tumours. ZEB1 expression showed a significant inverse correlation with E-cadherin expression (p=0.004) and a positive correlation with vimentin expression (p=0.022). Altered expression of ZEB1 was associated with aggressive tumour characteristics, including advanced tumour stage (p=0.037), undifferentiated-type histology (p=0.017), lymph node metastasis (p=0.024) and portal vein invasion (p=0.037). Moreover, overall survival rates were significantly lower for patients with high ZEB1 expression than for patients with low ZEB1 expression (p=0.027). Kaplan-Meier analysis also identified E-cadherin expression (p=0.041) and vimentin expression (p=0.049) as prognostic indicators for overall survival. Conclusions: ZEB1 expression is associated with tumour progression and poor prognosis in patients with ICC through positive correlations with vimentin and negative correlations with E-cadherin. ZEB1 expression is associated with a poor prognosis and might be an attractive target for the treatment of ICC.
    No preview · Article · Dec 2015 · Journal of Clinical Pathology
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    ABSTRACT: Unlabelled: Backgrounds and study aims: Endoscopic sphincterotomy (ES) is widely accepted as first-line therapy for bile duct stones (BDS). The major long-term pancreaticobiliary complication is BDS recurrence. Whether cholecystectomy should be performed after ES, especially in elderly patients, remains controversial. The aim of this study is to investigate the short-term and long-term outcomes after therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for BDS and to analyze risk factors for pancreaticobiliary complications. We also compared long-term outcomes in patients older and younger than age 80. Patients and methods: A total of 1210 patients who underwent therapeutic ERCP for BDS were retrospectively reviewed to identify risk factors for pancreaticobiliary complications. We divided these patients into two groups: Group Y (< 80 years; 960 patients) and Group O (≥ 80 years; 250 patients). There were 192 matched pairs in the propensity score analysis. Results: The incidence of pancreaticobiliary complications was 13.1 % (126/960) in Group Y and 20.4 % (51/250) in Group O (P < 0.00001). Multivariate analysis showed that a gallbladder left in situ with stones was a significant independent risk factor (hazard ratio, 2.81; 95 % confidence interval, 1.62 - 4,89; P = 0.0002). There were no significant differences in the incidence of pancreaticobiliary complications between the propensity score-matched groups. Conclusions: A gallbladder in situ with stones was the only significant risk factor for pancreaticobiliary complications after treatment for BDS. Age per se should not be the major factor when deciding on treatment that minimizes the occurrence of pancreaticobiliary disease.
    No preview · Article · Dec 2015
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    ABSTRACT: Background: In some cases, hepato-biliary-pancreatic (HBP) surgery requires hepatic artery resection and hepatic artery reconstruction (HAR) for histologically curative resection. We describe our surgical HAR technique, which involves continuous suturing, and we report the results of a study of the surgical outcomes. Methods: Between 2000 and 2014, 380 patients underwent radical surgery for advanced HBP malignancies (118 bile duct cancers, 189 pancreatic head cancers, and 73 gallbladder cancers), 24 of whom (6.3 %) underwent HAR (for complete cure of 16 bile duct cancers, 5 pancreatic cancers, and 3 gallbladder cancers). The 24 surgical procedures included 8 hepato-pancreatoduodenectomies, 10 hepatectomies, and 6 pancreatoduodenectomies. The ends of the 2 arteries were spatulated, and the reconstruction was performed with a continuous 7-0 polypropylene suture under loupe magnification. Results: Eighteen right hepatic arteries, 4 left hepatic arteries, and 2 proper hepatic arteries were resected and reconstructed. Median HAR time was 18 min (range 9-31 min). End-to-end anastomosis was performed in 7 patients, and heterogeneous reconstruction was performed in 17 patients (with 9 colic arteries, 4 gastroduodenal arteries, and 4 others). Doppler ultrasonography performed upon vessel reconstruction depicted pulsatile flow within the intrahepatic arteries in all cases, and patency of the reconstructed vessel was confirmed postoperatively by contrast-enhanced CT in 19 patients (82.6 %). Morbidity occurred in 10 patients (42 %), including 4 HAR-related complications: 3 bile leakages and 1 hepatic abscess. Conclusion: Our HAR method can be performed safely and easily by general surgeons. It may be a time-saving procedure that yields acceptable patency and morbidity rates.
    No preview · Article · Nov 2015 · World Journal of Surgery
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    ABSTRACT: The purpose of this study was to clarify the diagnostic value of contrast-enhanced ultrasonography (CEUS) with perflubutane in determining the histologic grade in hepatocellular carcinoma (HCC). A total of 147 surgically resected HCCs were dichotomized as well differentiated HCC (wd-HCC) and moderately- or poorly-differentiated HCC (mp-HCC). CEUS findings were evaluated during the arterial phase (vascularity, level and shape of enhancement), portal phase (presence or absence of washout) and post-vascular phase (echo intensity and shape). Receiver operating characteristic (ROC) curve analysis for the diagnosis of mp-HCC yielded area under the ROC curve (Az) values for arterial phase vascularity and portal phase washout of 0.910 and 0.807, respectively. The Az value for the combination of vascularity and washout for the diagnosis of mp-HCC was 0.956 (95% confidence interval, 0.910-0.979), corresponding to high diagnostic value. In conclusion, CEUS can provide high-quality imaging assessment for determining the histologic grade of HCCs.
    No preview · Article · Sep 2015 · Ultrasound in medicine & biology
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    ABSTRACT: The results of surgical treatment for T2 gallbladder carcinoma are equivocal, while the precise preoperative TNM staging and localization of gallbladder carcinoma are difficult. The aim of this study was to report the validity of segment 4b and 5 (S4b+5) hepatectomy with extrahepatic bile duct resection for these tumors. We reviewed 30 patients with pT2 gallbladder cancer who underwent S4b+5 hepatectomy with extrahepatic bile duct resection. The median number of lymph nodes retrieved in the S4b+5 hepatectomy group was 11 (0-23) nodes, and lymph node metastasis was observed in 9 of 30 (30 %) cases. Although all surgical margins were macroscopically negative, 4 of the 30 patients (13 %) had pathologically positive margins. The overall survival rate of patients was 85.1 % at 5 years. Of the 30 patients with S4b+5 hepatectomy, surgical margin alone was analyzed as a prognostic factor in univariate and multivariate analysis. The survival rate was comparable between the tumor on the hepatic side and peritoneal side (P = 0.856). Nine patients with additional S4b+5 hepatectomy after simple cholecystectomy because of incidental diagnosis of gallbladder cancer also had comparable survival compared to the remaining 21 patients with simultaneous S4b+5 hepatectomy (P = 0.624). S4b+5 hepatectomy with extrahepatic bile duct resection could be good treatment modality for T2 gallbladder cancers because precise preoperative diagnosis of tumor depth, location, and lymph node metastasis for these tumors is difficult.
    No preview · Article · Aug 2015
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    ABSTRACT: An extremely rare case of intrapancreatic bile duct metastasis from sigmoid colon adenocarcinoma is herein presented. Sigmoid colon cancer (T3, N0, M0, stage IIA) had been diagnosed and treated by sigmoidectomy in October 1993. In December 2002, a liver metastasis with intrabiliary growth was found, and this was treated by extended right hepatic lobectomy and caudate lobectomy with extrahepatic bile duct resection. In February 2014, intrapancreatic bile duct metastasis was found, and this was treated by subtotal stomach-preserving pancreatoduodenectomy. The intrapancreatic metastasis was judged to have arisen from cancer cell implantation, either by spontaneous shedding of cancer cells or as a complication of percutaneous transhepatic biliary drainage. Twelve months have passed since the last surgical intervention, and there has been no sign of local recurrence or distant metastasis. Differential diagnosis between intrahepatic cholangiocarcinoma and intrabiliary growth of a liver metastasis originating from colorectal adenocarcinoma is difficult but very important for determining the therapeutic strategy. Careful examination is needed to diagnose intrahepatic biliary dilatation, especially for patients with a history of carcinoma in the digestive tract and even if years have passed since curative resection of the digestive tract cancer. Aggressive surgical management for localized recurrence of a hepatic metastasis from colorectal adenocarcinoma may improve patient survival.
    Preview · Article · Aug 2015 · World Journal of Surgical Oncology
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    ABSTRACT: Serum tumor markers for hepatocellular carcinoma (HCC) have less prognostic significance in early-stage. Serum Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA(+) -M2BP) levels are reportedly associated with hepatocarcinogenic potential in patients with chronic liver diseases. We investigated the prognostic significance of pretreatment serum WFA(+) -M2BP levels in patients with early-stage HCC. A total of 240 patients who underwent hepatic resection for naïve Barcelona Clinic Liver Cancer (BCLC) class 0 or A HCC were analyzed. WFA(+) -M2BP and tumor markers for HCC were measured from serum obtained just prior to treatment. Postoperative recurrence and survival rates were compared according to these serum markers, tumor stage, and Child-Pugh class. There was an association between serum WFA(+) -M2BP levels and the fibrosis grade of resected noncancerous liver tissue, whereas no association was found between WFA(+) -M2BP levels and tumor progression or liver function. In a multivariate analysis, pretreatment serum WFA(+) -M2BP level was associated with recurrence and survival, respectively, independent of HCC progression by BCLC stage or fibrosis grade of resected noncancerous liver tissue. Recurrence rates after hepatic resection were significantly higher in patients with a pretreatment serum WFA(+) -M2BP ≥ 3.00 than those with a pretreatment serum WFA(+) -M2BP < 3.00 (P=0.0038). Survival rates were lower in patients with a pretreatment serum WFA(+) -M2BP ≥ 3.00 than those with a pretreatment serum WFA(+) -M2BP < 3.00 (P=0.0187). Serum WFA(+) -M2BP level is a prognostic factor for recurrence and survival, in addition to tumor progression and liver function, in patients with early-stage HCC treated with curative hepatic resection. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · Jul 2015 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: We aimed to define the benefit of extended radical surgery for incidental gallbladder carcinoma (IGC), the most appropriate treatment for which remains controversial. We analyzed retrospectively the management strategies and prognoses of 28 patients with IGC treated in our hospital. After initial cholecystectomy, 10, 5, and 13 of the 28 patients were found to have T1a (m), T1b (mp), and T2 (ss) disease, respectively. The patients with T1a disease (T1a group) had a good prognosis; however, 9 of the 18 patients with T1b or T2 disease required additional S4a + 5 segmentectomy of the liver and bile duct resection (extended radical surgery; re-resected group), while 9 did not undergo additional treatment because of their poor general condition (no-treatment group). The re-resected group had a favorable prognosis, with an 88.9 % 5-year disease-specific survival (DSS) rate, which was significantly better than that of the non-treatment group (30.5 %, p = 0.015) and comparable to that of the T1a group (90.0 %, p = 0.97). Examination of the re-resected specimens revealed residual disease in 44 % (4/9). Additional extended radical surgery improved the prognosis of patients with IGC, suggesting that there is curative potential in most cases.
    No preview · Article · Jun 2015 · Surgery Today
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    ABSTRACT: The correct timing of hepatectomy in patients with synchronous colorectal liver metastases is unclear. The aim of this study was to assess the clinical value of simultaneous resection (SR) for patients with colorectal cancer and synchronous liver metastases. Between January 2006 and December 2013, 158 patients underwent resection of primary colorectal cancer and liver metastases. Sixty-three patients possessed synchronous colorectal liver metastases. Of those with synchronous colorectal liver metastases, 41 patients (65 %) underwent SR, and 22 (35 %) underwent delayed resection (DR). The clinicopathologic and operative data and the surgical outcomes of the patients in the SR and DR groups were retrospectively analyzed. The type of primary/liver resection, liver resection time, total blood loss volume, R0 resection rate, and morbidity rate were similar between the two groups. The SR group was associated with a shorter total postoperative hospital stay (21 vs 32 days, p < 0.001). However, the overall survival rate was similar between the two groups (3-year survival, 65.6 % in the SR group versus 66.8 % in the DR group, p = 0.054). Simultaneous resection of colorectal cancer and synchronous liver metastases is associated with a comparable morbidity rate and shorter hospital stay, even when following rectal resection and major hepatectomy.
    No preview · Article · May 2015 · Surgery Today
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    ABSTRACT: One-stage colectomy with intraoperative colonic irrigation (OCICI) may be useful in early resolution of acute left-sided malignant colonic obstruction (ALMCO). However, the clinical benefit of this technique has not been fully investigated. Between January 2007 and July 2014, 451 patients underwent left hemicolectomy or sigmoidectomy for colon cancer, of whom 25 underwent OCICI for ALMCO. The medical records of the patients who underwent OCICI for ALMCO were compared to 174 medical records of a control population (without ALMCO) who were matched for tumor characteristics. There were no statistically significant differences between the two groups in regard to age, sex, American Society of Anesthesiologists Physical Status, location of tumor, preoperative CEA levels, and previous abdominal surgeries. The OCICI for ALMCO group was associated with a longer operation time (153 ± 33 vs. 111 ± 47 min, p < 0.001). However, no significant differences were found in patient morbidity, the duration of the postoperative hospital stay, or the tumor pathology between the two groups. Univariate and multivariate analyses indicated that OCICI for ALMCO did not increase the risk of postoperative morbidity in patients with left-sided colon cancer. OCICI for ALMCO did not increase the rate of morbidity or prolong the hospital stay duration compared to treatment of a control population.
    No preview · Article · Apr 2015 · World Journal of Surgery

  • No preview · Article · Apr 2015 · Gastroenterology
  • Yuji Kaneoka · Atsuyuki Maeda · Yuichi Takayama

    No preview · Article · Apr 2015 · Gastroenterology
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    ABSTRACT: The effectiveness of tumor markers in evaluating outcomes of patients with hepatocellular carcinoma (HCC) remains to be clarified. The usefulness of the HCC tumor markers, alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3), and des-gamma-carboxy prothrombin (DCP) was reviewed. Elevations in these tumor markers at the time of HCC diagnosis correlate with disease progression as assessed by both imaging studies and pathologic examinations. The combination of these three tumor markers results in good predictive ability for patient survival after diagnosis. In addition, combination at the time of HCC diagnosis of these three tumor markers (as a measure of tumor progression) and serum albumin and bilirubin levels (as indicators of remnant liver function) can be used for HCC staging and further predicts prognosis in patients with HCC. The prognosis of patients with HCC can be well discriminated based solely on serum markers. Staging of HCC with serum markers is objective; if stored serum samples are available, HCC stages can be standardized across different countries and time periods.
    No preview · Article · Mar 2015
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    ABSTRACT: Liver fibrosis is associated with the prognosis of patients with hepatocellular carcinoma (HCC) after treatment. The laboratory marker for liver fibrosis, the FIB-4 index, is reportedly correlated with the degree of liver fibrosis. We evaluated the predictive value of FIB-4 index on the recurrence and survival of HCC patients who underwent curative hepatectomy. A total of 431 consecutive patients who underwent hepatectomy for primary, nonrecurrent HCC were analyzed. The FIB-4 index was calculated from the patient's age, serum alanine aminotransferase and aspartate aminotransferase levels, and platelet count at the time of HCC diagnosis. Postoperative recurrence and survival rates were compared according to tumor characteristics, tumor markers, Child-Pugh class, and the FIB-4 index. The pretreatment FIB-4 index was associated with recurrence and survival rates, independent of HCC progression or tumor marker levels in a multivariate analysis. Recurrence rates after hepatectomy were higher in patients with a FIB-4 index >3.25 versus ≤3.25 (5-year recurrence rates 69.6% vs 54.8%; P = .0049). Survival was also worse in patients with a FIB-4 index >3.25 than those with a FIB-4 index ≤3.25 (5-year survival rates 67.1% vs 72.2%; P = .0030). The FIB-4 index is a predictive marker for long-term outcomes in patients with HCC treated with curative hepatic resection. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Feb 2015 · Surgery
  • M Kiriyama · T Ebata · T Aoba · Y Kaneoka · T Arai · Y Shimizu · M Nagino
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    ABSTRACT: The aim of the study was to investigate the prognostic impact of lymph node metastasis in cholangiocarcinoma using three different classifications. Patients who underwent pancreaticoduodenectomy for distal cholangiocarcinoma in 24 hospitals in Japan between 2001 and 2010 were included. Survival was calculated by means of the Kaplan-Meier method and differences between subgroups were assessed with the log rank test. The Cox proportional hazards model was used to identify independent predictors of survival. χ(2) scores were calculated to determine the cut-off value of the number of involved nodes, lymph node ratio (LNR) and total lymph node count (TLNC) for discriminating survival. Some 370 patients were included. The median (range) TLNC was 19 (3-59). Nodal metastasis occurred in 157 patients (42·4 per cent); the median (range) number of involved nodes and LNR were 2 (1-19) and 0·11 (0·02-0·80) respectively. Four or more involved nodes was associated with a significantly shorter median survival (1·3 versus 2·2 years; P = 0·001), as was a LNR of at least 0·17 (1·4 versus 2·3 years; P = 0·002). Involvement of nodes along the common hepatic artery, present in 21 patients (13·4 per cent), was also associated with a shorter survival (median 1·3 versus 2·1 years; P = 0·046). Multivariable analysis among 157 node-positive patients identified the number of involved nodes as an independent prognostic factor (risk ratio 1·87; P = 0·002). The number of involved nodes was a strong predictor of survival in patients with distal cholangiocarcinoma. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.
    No preview · Article · Jan 2015 · British Journal of Surgery
  • Yuji Kaneoka · Atsuyuki Maeda · Masatoshi Isogai
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    ABSTRACT: En bloc resection of the hepatoduodenal ligament (HDL) for advanced biliary malignancy by hepato-ligamento-pancreatoduodenectomy (HLPD) or hepatoligamentectomy (HL) remains challenging, and only short-term outcomes have been reported. We showed our surgical technique of HLPD and HL, and retrospectively investigated surgical outcomes of the patients. Between 2003 and 2014, we performed four HLPD and three HL including major hepatectomy with concomitant caudate lobectomy. Portal vein reconstruction (PVR) was performed with a right external iliac vein graft, and hepatic artery reconstruction (HAR) was accomplished with the heterogeneous artery using the continuous suturing method. Mean operation time and blood loss were 575 ± 111 min and 1539 ± 950 mL, respectively, and patency of the reconstructed vessels was confirmed postoperatively in all cases. Histologically, negative surgical margins (R0) were achieved in 57 % of patients, while the resected vascular invasion was confirmed in all patients. Overall morbidity was high at 57 %, but we have achieved no postoperative mortality. Overall median survival time of the patients was 36 months, and a patient of HL survived over 5 years. En bloc resection of the HDL based on steady vascular reconstruction can improve the surgical outcome of biliary cancer in selected patients.
    No preview · Article · Jan 2015 · Journal of Gastrointestinal Surgery
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    ABSTRACT: A 49-year-old woman was found to have a tumor behind the pancreas by abdominal ultrasonography. Abdominal CT showed a solitary tumor measuring 20 mm in diameter, to the right anterior side of the superior mesenteric artery (SMA). Laparoscopic tumor resection was performed based on the preoperative diagnosis of schwannoma. Intraoperatively, the tumor was found to be in proximity to the superior mesenteric plexus, and resected. Histopathologic examination of the tumor revealed that it was composed of spindle cells. Immunohistologically, the tumor cells were positive for S-100 protein and negative for c-kit, CD34 and α-SMA. The tumor was definitively diagnosed as a schwannoma arising from the superior mesenteric plexus. At present, 7 months since the operation, the patient remains alive without recurrence.
    Preview · Article · Jan 2015 · Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
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    ABSTRACT: A 30-year-old man presented with acute lower abdominal pain. Multi detector-row computed tomography (MDCT) revealed a 5-cm cystic lesion of the ileum supplied by the superior mesenteric artery. These findings indicated the preoperative diagnosis of cystic ileal duplication. Laparoscopy confirmed that the lesion was located on the same side of the mesentery approximately 80 cm from the ileal end, and the lesion was extracorporeally resected with the adjacent ileum. The orbicular cystic lesion in the specimen was 6 × 4 cm and separated from the bowel. Microscopically, the cystic wall consisted of intestinal mucosa, submucosa, and two layers of smooth muscle that were shared with the normal intestine of the region. Cystic duplication in adults is relatively rare and its clinical features are not clear. Here we reported on the clinical features of small intestinal duplication in an adult.
    Preview · Article · Jan 2015 · Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
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    ABSTRACT: A 63-year-old woman was referred to our hospital with an increasing splenic cyst. On physical examination, the tumor was not palpable. Hematological examination was within normal limits. Contrast-enhanced CT showed a splenic tumor with heterogeneous enhancement (3.5×4 cm). PET-CT showed high up-take in the same area (SUVmax 9.41). MRI showed the same tumor with increased signals.With a preoperative diagnosis of suspected malignant lymphoma, laparoscopic splenectomy was performed. The tumor size was 3.5×4 cm. Histological examination showed inflammatory pseudotumor suspected to be IgG4-related disease.
    Preview · Article · Jan 2015 · Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
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    ABSTRACT: We previously demonstrated that the expression of HSP20, a small heat shock protein, is inversely correlated with the progression of HCC. Inflammation is associated with HCC, and numerous cytokines, including TNF-α, act as key mediators in the progression of HCC. In the present study, we investigated whether HSP20 is implicated in the TNF-α-stimulated intracellular signaling in HCC using human HCC-derived HuH7 cells in the presence of TNF-α. In HSP20-overexpressing HCC cells, the cell growth was retarded compared with that in the control cells under long-term exposure of TNF-α. Because NF-κB pathway is the main intracellular signaling system activated by TNF-α, we investigated the effects of HSP20-overexpression of this pathway. The protein levels of IKK-α, but not IKK-β, in the HSP20-overexpressing cells were decreased. Short-term exposure to TNF-α-induced phosphorylation and degradation of IκB, and the phosphorylation and transactivational activity of NF-κB were suppressed in the HSP20-overexpressing HCC cells. Furthermore, the increase in IKK-α levels was accompanied by a decrease in the HSP20 levels in human HCC tissues. These findings strongly suggest that HSP20 might decrease the IKK-α protein level and that it down-regulates the TNF-α-stimulated intracellular signaling in HCC, thus resulting in the suppression of HCC progression. Copyright © 2014. Published by Elsevier Inc.
    No preview · Article · Oct 2014 · Archives of Biochemistry and Biophysics