1   231 116 ADAPTIVE CARDIORESPIRATORY CHANGES TO CHRONIC CONTINUOUS AND INTERMITTENT HYPOXIA. THIS CHAPTER REVIEWS CARDIORESPIRATORY ADAPTATIONS TO CHRONIC HYPOXIA (CH) EXPERIENCED AT HIGH ALTITUDE AND CARDIORESPIRATORY PATHOLOGIES ELICITED BY CHRONIC INTERMITTENT HYPOXIA (CIH) OCCURRING WITH OBSTRUCTIVE SLEEP APNEA (OSA). SHORT-TERM CH INCREASES BREATHING (VENTILATORY ACCLIMATIZATION TO HYPOXIA) AND BLOOD PRESSURE (BP) THROUGH CAROTID BODY (CB) CHEMO REFLEX. HYPERPLASIA OF GLOMUS CELLS, ALTERATIONS IN ION CHANNELS, AND RECRUITMENT OF ADDITIONAL EXCITATORY MOLECULES ARE IMPLICATED IN THE HEIGHTENED CB CHEMO REFLEX BY CH. TRANSCRIPTIONAL ACTIVATION OF HYPOXIA-INDUCIBLE FACTORS (HIF-1 AND 2) IS A MAJOR MOLECULAR MECHANISM UNDERLYING RESPIRATORY ADAPTATIONS TO SHORT-TERM CH. HIGH-ALTITUDE NATIVES EXPERIENCING LONG-TERM CH EXHIBIT BLUNTED HYPOXIC VENTILATORY RESPONSE (HVR) AND REDUCED BP DUE TO DESENSITIZATION OF CB RESPONSE TO HYPOXIA AND IMPAIRED PROCESSING OF CB SENSORY INFORMATION AT THE CENTRAL NERVOUS SYSTEM. VENTILATORY CHANGES EVOKED BY LONG-TERM CH ARE NOT READILY REVERSED AFTER RETURN TO SEA LEVEL. OSA PATIENTS AND RODENTS SUBJECTED TO CIH EXHIBIT HEIGHTENED CB CHEMO REFLEX, INCREASED HYPOXIC VENTILATORY RESPONSE, AND HYPERTENSION. INCREASED GENERATION OF REACTIVE OXYGEN SPECIES (ROS) IS A MAJOR CELLULAR MECHANISM UNDERLYING CIH-INDUCED ENHANCED CB CHEMO REFLEX AND THE ENSUING CARDIORESPIRATORY PATHOLOGIES. ROS GENERATION BY CIH IS MEDIATED BY NONTRANSCRIPTIONAL, DISRUPTED HIF-1 AND HIF-2-DEPENDENT TRANSCRIPTIONS AS WELL AS EPIGENETIC MECHANISMS.	2022	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
2  1062  16 CLINICAL SIGNIFICANCE OF DNA METHYLATION IN CHRONIC LYMPHOCYTIC LEUKEMIA PATIENTS: RESULTS FROM 3 UK CLINICAL TRIALS. CHRONIC LYMPHOCYTIC LEUKEMIA PATIENTS WITH MUTATED IMMUNOGLOBULIN HEAVY-CHAIN GENES (IGHV-M), PARTICULARLY THOSE LACKING POOR-RISK GENOMIC LESIONS, OFTEN RESPOND WELL TO CHEMOIMMUNOTHERAPY (CIT). DNA METHYLATION PROFILING CAN SUBDIVIDE EARLY-STAGE PATIENTS INTO NAIVE B-CELL-LIKE CLL (N-CLL), MEMORY B-CELL-LIKE CLL (M-CLL), AND INTERMEDIATE CLL (I-CLL), WITH DIFFERING TIMES TO FIRST TREATMENT AND OVERALL SURVIVAL. HOWEVER, WHETHER DNA METHYLATION CAN IDENTIFY PATIENTS DESTINED TO RESPOND FAVORABLY TO CIT HAS NOT BEEN ASCERTAINED. WE CLASSIFIED TREATMENT-NAIVE PATIENTS (N = 605) FROM 3 UK CHEMO AND CIT CLINICAL TRIALS INTO THE 3 EPIGENETIC SUBGROUPS, USING PYROSEQUENCING AND MICROARRAY ANALYSIS, AND PERFORMED EXPANSIVE SURVIVAL ANALYSIS. THE N-CLL, I-CLL, AND M-CLL SIGNATURES WERE FOUND IN 80% (N = 245/305), 17% (53/305), AND 2% (7/305) OF IGHV-UNMUTATED (IGHV-U) CASES, RESPECTIVELY, AND IN 9%, (19/216), 50% (108/216), AND 41% (89/216) OF IGHV-M CASES, RESPECTIVELY. MULTIVARIATE COX PROPORTIONAL ANALYSIS IDENTIFIED M-CLL AS AN INDEPENDENT PROGNOSTIC FACTOR FOR OVERALL SURVIVAL (HAZARD RATIO [HR], 0.46; 95% CONFIDENCE INTERVAL [CI], 0.24-0.87; P = .018) IN CLL4, AND FOR PROGRESSION-FREE SURVIVAL (HR, 0.25; 95% CI, 0.10-0.57; P = .002) IN ARCTIC AND ADMIRE PATIENTS. THE ANALYSIS OF EPIGENETIC SUBGROUPS IN PATIENTS ENTERED INTO 3 FIRST-LINE UK CLL TRIALS IDENTIFIES M-CLL AS AN INDEPENDENT MARKER OF PROLONGED SURVIVAL AND MAY AID IN THE IDENTIFICATION OF PATIENTS DESTINED TO DEMONSTRATE PROLONGED SURVIVAL AFTER CIT.	2019	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
3  3018  19 GENETICS AND EPIGENETICS OF LIVER CANCER. HEPATOCELLULAR CARCINOMA (HCC) REPRESENTS A MAJOR FORM OF PRIMARY LIVER CANCER IN ADULTS. CHRONIC INFECTIONS WITH HEPATITIS B (HBV) AND C (HCV) VIRUSES AND ALCOHOL ABUSE ARE THE MAJOR FACTORS LEADING TO HCC. THIS DEADLY CANCER AFFECTS MORE THAN 500,000 PEOPLE WORLDWIDE AND IT IS QUITE RESISTANT TO CONVENTIONAL CHEMO- AND RADIOTHERAPY. GENETIC AND EPIGENETIC STUDIES ON HCC MAY HELP TO UNDERSTAND BETTER ITS MECHANISMS AND PROVIDE NEW TOOLS FOR EARLY DIAGNOSIS AND THERAPY. RECENT LITERATURE ON WHOLE GENOME ANALYSIS OF HCC INDICATED A HIGH NUMBER OF MUTATED GENES IN ADDITION TO WELL-KNOWN GENES SUCH AS TP53, CTNNB1, AXIN1 AND CDKN2A, BUT THEIR FREQUENCIES ARE MUCH LOWER. APART FROM CTNNB1 MUTATIONS, MOST OF THE OTHER MUTATIONS APPEAR TO RESULT IN LOSS-OF-FUNCTION. THUS, HCC-ASSOCIATED MUTATIONS CANNOT BE EASILY TARGETED FOR THERAPY. EPIGENETIC ABERRATIONS THAT APPEAR TO OCCUR QUITE FREQUENTLY MAY SERVE AS NEW TARGETS. GLOBAL DNA HYPOMETHYLATION, PROMOTER METHYLATION, ABERRANT EXPRESSION OF NON-CODING RNAS AND DYSREGULATED EXPRESSION OF OTHER EPIGENETIC REGULATORY GENES SUCH AS EZH2 ARE THE BEST-KNOWN EPIGENETIC ABNORMALITIES. FUTURE RESEARCH IN THIS DIRECTION MAY HELP TO IDENTIFY NOVEL BIOMARKERS AND THERAPEUTIC TARGETS FOR HCC.	2013	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
4  5243  17 PROGNOSTIC IMPACT OF EPIGENETIC CLASSIFICATION IN CHRONIC LYMPHOCYTIC LEUKEMIA: THE CASE OF SUBSET #2. BASED ON THE METHYLATION STATUS OF 5 SINGLE CPG SITES, A NOVEL EPIGENETIC CLASSIFICATION OF CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) WAS RECENTLY PROPOSED, CLASSIFYING CLL PATIENTS INTO 3 CLINICO-BIOLOGICAL SUBGROUPS WITH DIFFERENT OUTCOME, TERMED MEMORY LIKE CLL (M-CLL), NAIVE LIKE CLL (N-CLL), AND A THIRD INTERMEDIATE CLL SUBGROUP (I-CLL). WHILE M-CLL AND N-CLL PATIENTS AT LARGE CORRESPONDED TO PATIENTS CARRYING MUTATED AND UNMUTATED IGHV GENES, RESPECTIVELY, LIMITED INFORMATION EXISTS REGARDING THE LESS DEFINED I-CLL GROUP. USING PYROSEQUENCING, WE INVESTIGATED THE PROGNOSTIC IMPACT OF THE PROPOSED 5 CPG SIGNATURE IN A WELL-CHARACTERIZED CLL COHORT (135 CASES), INCLUDING IGHV-MUTATED AND UNMUTATED PATIENTS AS WELL AS CLINICALLY AGGRESSIVE STEREOTYPED SUBSET #2 PATIENTS. OVERALL, WE CONFIRMED THE SIGNATURE'S ASSOCIATION WITH ESTABLISHED PROGNOSTIC MARKERS. MOREOVER, IN THE PRESENCE OF THE IGHV MUTATIONAL STATUS, THE EPIGENETIC SIGNATURE REMAINED INDEPENDENTLY ASSOCIATED WITH BOTH TIME-TO-FIRST-TREATMENT AND OVERALL SURVIVAL IN MULTIVARIATE ANALYSES. AS A PRIME FINDING, WE OBSERVED THAT SUBSET #2 PATIENTS WERE PREDOMINANTLY CLASSIFIED AS I-CLL, PROBABLY REFLECTING THEIR BORDERLINE IGHV MUTATIONAL STATUS (97-99% GERMLINE IDENTITY), THOUGH HAVING A SIMILARLY POOR PROGNOSIS AS N-CLL PATIENTS. IN SUMMARY, WE VALIDATED THE EPIGENETIC CLASSIFIER AS AN INDEPENDENT FACTOR IN CLL PROGNOSTICATION AND PROVIDE FURTHER EVIDENCE THAT SUBSET #2 IS A MEMBER OF THE I-CLL GROUP, HENCE SUPPORTING THE EXISTENCE OF A THIRD, INTERMEDIATE EPIGENETIC SUBGROUP.	2016	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
5  2359  48 EPIGENETIC REGULATION OF REDOX STATE MEDIATES PERSISTENT CARDIORESPIRATORY ABNORMALITIES AFTER LONG-TERM INTERMITTENT HYPOXIA. KEY POINTS: THE EFFECTS OF SHORT-TERM (ST; 10 DAYS) AND LONG-TERM (LT; 30 DAYS) INTERMITTENT HYPOXIA (IH) ON BLOOD PRESSURE (BP), BREATHING AND CAROTID BODY (CB) CHEMOSENSORY REFLEX WERE EXAMINED IN ADULT RATS. ST- AND LT-IH TREATED RATS EXHIBITED HYPERTENSION, IRREGULAR BREATHING WITH APNOEA AND AUGMENTED THE CB CHEMOSENSORY REFLEX, WITH ALL THESE RESPONSES BECOMING NORMALIZED DURING RECOVERY FROM ST- BUT NOT FROM LT-IH. THE PERSISTENT CARDIORESPIRATORY RESPONSES TO LT-IH WERE ASSOCIATED WITH ELEVATED REACTIVE OXYGEN SPECIES (ROS) LEVELS IN THE CB AND ADRENAL MEDULLA, WHICH WERE A RESULT OF DNA METHYLATION-DEPENDENT SUPPRESSION OF GENES ENCODING ANTI-OXIDANT ENZYMES (AOES). TREATING RATS WITH DECITABINE EITHER DURING LT-IH OR DURING RECOVERY FROM LT-IH PREVENTED DNA METHYLATION OF AOE GENES, NORMALIZED THE EXPRESSION OF AOE GENES AND ROS LEVELS, REVERSED THE HEIGHTENED CB CHEMOSENSORY REFLEX AND HYPERTENSION, AND ALSO STABILIZED BREATHING. ABSTRACT: RODENTS EXPOSED TO CHRONIC INTERMITTENT HYPOXIA (IH), SIMULATING BLOOD O(2) SATURATION PROFILES DURING OBSTRUCTIVE SLEEP APNOEA (OSA), HAVE BEEN SHOWN TO EXHIBIT A HEIGHTENED CAROTID BODY (CB) CHEMOSENSORY REFLEX AND HYPERTENSION. CB CHEMOSENSORY REFLEX ACTIVATION ALSO RESULTS IN UNSTABLE BREATHING WITH APNOEAS. HOWEVER, THE EFFECT OF CHRONIC IH ON BREATHING IS NOT KNOWN. IN THE PRESENT STUDY, WE EXAMINED THE EFFECTS OF CHRONIC IH ON BREATHING ALONG WITH BLOOD PRESSURE (BP) AND ASSESSED WHETHER THE AUTONOMIC RESPONSES ARE NORMALIZED AFTER RECOVERY FROM CHRONIC IH. STUDIES WERE PERFORMED ON ADULT, MALE, SPRAGUE-DAWLEY RATS EXPOSED TO EITHER SHORT-TERM (ST; 10 DAYS) OR LONG-TERM (LT, 30 DAYS) IH. RATS EXPOSED TO EITHER ST- OR LT-IH EXHIBITED HYPERTENSION, IRREGULAR BREATHING WITH APNOEAS, AN AUGMENTED CB CHEMOSENSORY REFLEX AS INDICATED BY ELEVATED CB NEURAL ACTIVITY AND PLASMA CATECHOLAMINE LEVELS, AND ELEVATED REACTIVE OXYGEN SPECIES (ROS) LEVELS IN THE CB AND ADRENAL MEDULLA (AM). ALL THESE EFFECTS WERE NORMALIZED AFTER RECOVERY FROM ST-IH BUT NOT FROM LT-IH. ANALYSIS OF THE MOLECULAR MECHANISMS UNDERLYING THE PERSISTENT EFFECTS OF LT-IH REVEALED INCREASED DNA METHYLATION OF GENES ENCODING ANTI-OXIDANT ENZYMES (AOES). TREATMENT WITH DECITABINE, A DNA METHYLATION INHIBITOR, EITHER DURING LT-IH OR DURING RECOVERY FROM LT-IH, PREVENTED DNA METHYLATION, NORMALIZED THE EXPRESSION OF AOE GENES, ROS LEVELS, CB CHEMOSENSORY REFLEX AND BP, AND ALSO STABILIZED BREATHING. THESE RESULTS SUGGEST THAT PERSISTENT CARDIORESPIRATORY ABNORMALITIES CAUSED BY LT-IH ARE MEDIATED BY EPIGENETIC RE-PROGRAMMING OF THE REDOX STATE IN THE CB CHEMOSENSORY REFLEX PATHWAY.	2017	

6  2678  18 EVALUATION OF A PROGNOSTIC EPIGENETIC CLASSIFICATION SYSTEM IN CHRONIC LYMPHOCYTIC LEUKEMIA PATIENTS. BACKGROUND: METHYLATION AT 5 CPG SITES WAS PREVIOUSLY SHOWN TO CLASSIFY CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) INTO 3 PROGNOSTIC SUBGROUPS. HERE, WE AIMED TO VALIDATE THE MARKER SET IN AN ADDITIONAL COHORT AND TO EVALUATE ITS CLINICAL UTILITY FOR CLL PATIENT STRATIFICATION. METHODS: WE EVALUATED THIS EPIGENETIC MARKER SET IN 79 GERMAN PATIENTS USING BISULFITE TREATMENT FOLLOWED BY PYROSEQUENCING AND CLASSIFICATION USING A SUPPORT VECTOR MACHINE-LEARNING TOOL. RESULTS: THE N-CLL, I-CLL, AND M-CLL CLASSIFICATION WAS DETECTED IN 28 (35%), 10 (13%), AND 41 (51%) PATIENTS, RESPECTIVELY. EPIGENETIC GROUPING WAS ASSOCIATED WITH IGHV MUTATIONAL STATUS (P = 2 X 10(-12)), ISOLATED DEL13Q (P = 9 X 10(-6)), DEL17P (P = .015), COMPLEX KARYOTYPE (P = .005), VH-USAGE, AND CLINICAL OUTCOME AS TIME TO FIRST TREATMENT (P = 1.4 X 10(-12)) AND OVERALL SURVIVAL (P = .003). MULTIVARIATE COX REGRESSION ANALYSIS IDENTIFIED N-CLL AS A FACTOR FOR EARLIER TREATMENT HAZARD RATIO (HR), 6.3 (95% CONFIDENCE INTERVAL [CI] 2.4-16.4; P = .0002) COMPARED TO IGHV MUTATIONAL STATUS (HR 4.6, 95% CI 1.9-11.3, P = .0008). IN ADDITION, WHEN COMPARING THE PROGNOSTIC VALUE OF THE EPIGENETIC CLASSIFICATION SYSTEM WITH THE IGHV CLASSIFICATION, EPIGENETIC GROUPING PERFORMED BETTER COMPARED TO IGHV MUTATIONAL STATUS USING KAPLAN-MEIER ESTIMATION AND ALLOWED THE IDENTIFICATION OF A THIRD, INTERMEDIATE (I-CLL) GROUP. THUS, OUR STUDY CONFIRMED THE PROGNOSTIC VALUE OF THE EPIGENETIC MARKER SET FOR PATIENT STRATIFICATION IN ROUTINE CLINICAL DIAGNOSTICS.	2022	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
7  3520  17 IGLV3-21R110 IDENTIFIES AN AGGRESSIVE BIOLOGICAL SUBTYPE OF CHRONIC LYMPHOCYTIC LEUKEMIA WITH INTERMEDIATE EPIGENETICS. B-CELL RECEPTOR (BCR) SIGNALING IS CRUCIAL FOR CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) BIOLOGY. IGLV3-21-EXPRESSING B CELLS MAY ACQUIRE A SINGLE POINT MUTATION (R110) THAT TRIGGERS AUTONOMOUS BCR SIGNALING, CONFERRING AGGRESSIVE BEHAVIOR. EPIGENETIC STUDIES HAVE DEFINED 3 CLL SUBTYPES BASED ON METHYLATION SIGNATURES REMINISCENT OF NAIVE-LIKE (N-CLL), INTERMEDIATE (I-CLL), AND MEMORY-LIKE (M-CLL) B CELLS WITH DIFFERENT BIOLOGICAL FEATURES. I-CLL CARRIES A BORDERLINE IGHV MUTATIONAL LOAD AND SIGNIFICANTLY HIGHER USE OF IGHV3-21/IGLV3-21. TO DETERMINE THE CLINICAL AND BIOLOGICAL FEATURES OF IGLV3-21R110 CLL AND ITS RELATIONSHIP TO THESE EPIGENETIC SUBTYPES, WE CHARACTERIZED THE IMMUNOGLOBULIN GENE OF 584 CLL CASES USING WHOLE-GENOME/EXOME AND RNA SEQUENCING. IGLV3-21R110 WAS DETECTED IN 6.5% OF CASES: 30 (38%) OF 79 I-CLLS, 5 (1.7%) OF 291 M-CLLS, AND 1 (0.5%) OF 189 N-CLLS. ALL STEREOTYPE SUBSET 2 CASES CARRIED IGLV3-21R110, WHEREAS 62% OF IGLV3-21R110 I-CLL CASES HAD NONSTEREOTYPED BCR IMMUNOGLOBULINS. IGLV3-21R110 I-CLL HAD A SIGNIFICANTLY HIGHER NUMBER OF SF3B1 AND ATM MUTATIONS AND TOTAL NUMBER OF DRIVER ALTERATIONS. HOWEVER, THE R110 MUTATION WAS THE SOLE ALTERATION IN 1 I-CLL AND WAS ACCOMPANIED ONLY BY DEL(13Q) IN 3. ALTHOUGH IGHV MUTATIONAL STATUS VARIED, IGLV3-21R110 I-CLL TRANSCRIPTOMICALLY RESEMBLED N-CLL/UNMUTATED IGHV CLL WITH A SPECIFIC SIGNATURE INCLUDING WNT5A/B OVEREXPRESSION. IN CONTRAST, I-CLL LACKING IGLV3-21R110 MIRRORED M-CLL/MUTATED IGHV. PATIENTS WITH IGLV3-21R110 I-CLL HAD A SHORT TIME TO FIRST TREATMENT AND OVERALL SURVIVAL SIMILAR TO THOSE OF N-CLL/UNMUTATED IGHV PATIENTS, WHEREAS PATIENTS WITH NON-IGLV3-21R110 I-CLL HAD A GOOD PROGNOSIS SIMILAR TO THAT OF PATIENTS WITH M-CLL/MUTATED IGHV. IGLV3-21R110 DEFINES A CLL SUBGROUP WITH SPECIFIC BIOLOGICAL FEATURES AND AN UNFAVORABLE PROGNOSIS INDEPENDENT OF IGHV MUTATIONAL STATUS AND EPIGENETIC SUBTYPE.	2021	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
8    27  15 A B-CELL EPIGENETIC SIGNATURE DEFINES THREE BIOLOGIC SUBGROUPS OF CHRONIC LYMPHOCYTIC LEUKEMIA WITH CLINICAL IMPACT. PROSPECTIVE IDENTIFICATION OF PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) DESTINED TO PROGRESS WOULD GREATLY FACILITATE THEIR CLINICAL MANAGEMENT. RECENTLY, WHOLE-GENOME DNA METHYLATION ANALYSES IDENTIFIED THREE CLINICOBIOLOGIC CLL SUBGROUPS WITH AN EPIGENETIC SIGNATURE RELATED TO DIFFERENT NORMAL B-CELL COUNTERPARTS. HERE, WE DEVELOPED A CLINICALLY APPLICABLE METHOD TO IDENTIFY THESE SUBGROUPS AND TO STUDY THEIR CLINICAL RELEVANCE. USING A SUPPORT VECTOR MACHINE APPROACH, WE BUILT A PREDICTION MODEL USING FIVE EPIGENETIC BIOMARKERS THAT WAS ABLE TO CLASSIFY CLL PATIENTS ACCURATELY INTO THE THREE SUBGROUPS, NAMELY NAIVE B-CELL-LIKE, INTERMEDIATE AND MEMORY B-CELL-LIKE CLL. DNA METHYLATION WAS QUANTIFIED BY HIGHLY REPRODUCIBLE BISULFITE PYROSEQUENCING ASSAYS IN TWO INDEPENDENT CLL SERIES. IN THE INITIAL SERIES (N=211), THE THREE SUBGROUPS SHOWED DIFFERENTIAL LEVELS OF IGHV (IMMUNOGLOBULIN HEAVY-CHAIN LOCUS) MUTATION (P<0.001) AND VH USAGE (P<0.03), AS WELL AS DIFFERENT CLINICAL FEATURES AND OUTCOME IN TERMS OF TIME TO FIRST TREATMENT (TTT) AND OVERALL SURVIVAL (P<0.001). A MULTIVARIATE COX MODEL SHOWED THAT EPIGENETIC CLASSIFICATION WAS THE STRONGEST PREDICTOR OF TTT (P<0.001) ALONG WITH BINET STAGE (P<0.001). THESE FINDINGS WERE CORROBORATED IN A VALIDATION SERIES (N=97). IN THIS STUDY, WE DEVELOPED A SIMPLE AND ROBUST METHOD USING EPIGENETIC BIOMARKERS TO CATEGORIZE CLLS INTO THREE SUBGROUPS WITH DIFFERENT CLINICOBIOLOGIC FEATURES AND OUTCOME.	2015	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
9  6849  14 [MOLECULAR MECHANISM OF HEPATOCARCINOGENESIS]. HEPATOCELLULAR CARCINOMA (HCC) IN JAPAN IS CLOSELY ASSOCIATED WITH THE CHRONIC LIVER DISEASES OF INFECTION WITH THE HEPATITIS B OR C VIRUSES. ANALYSIS OF HCC TISSUES FREQUENTLY DETECTS LOSS OF HETEROZYGOSITY AT CHROMOSOMES 1P, 4, 6Q, 8P, 10Q, 13Q, 16Q, 17P, AND MANY GENOMIC AND EPIGENOMIC ABNORMALITIES HAVE BEEN FOUND IN P53, BETA-CATENIN, P16CDKI, DNA MISMATCH REPAIR GENES, AND OTHERS. HOWEVER, NO SPECIFIC ABNORMAL GENETIC OR EPIGENETIC CHANGES FOR HCC HAVE BEEN FOUND SO FAR. THE DEVELOPMENT OF HCC HAS BEEN REPORTED IN MICE TRANSGENIC FOR THE HEPATITIS B VIRUS X GENE OR THE HEPATITIS C VIRUS CORE GENE, AND THESE VIRAL PROTEINS MIGHT PLAY ESSENTIAL ROLES IN HEPATOCARCINOGENESIS. CHRONIC HEPATITIS AND FIBROSIS DUE TO PERSISTENT VIRAL INFECTION MIGHT ALSO INFLUENCE THE GENOMIC INSTABILITY OF HEPATOCYTES, LEADING TO ACCUMULATION OF GENOMIC CHANGES.	1999	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
10  3522  17 IL-10 PRODUCTION BY CLL CELLS IS ENHANCED IN THE ANERGIC IGHV MUTATED SUBSET AND ASSOCIATES WITH REDUCED DNA METHYLATION OF THE IL10 LOCUS. CHRONIC LYMPHOCYTIC LEUKEMIAS (CLLS) WITH UNMUTATED (U-CLL) OR MUTATED (M-CLL) IGHV HAVE VARIABLE FEATURES OF IMMUNOSUPPRESSION, POSSIBLY INFLUENCED BY THOSE CLL CELLS ACTIVATED TO PRODUCE INTERLEUKIN 10 (IL-10). THE TWO SUBSETS DIFFER IN THEIR LEVELS OF ANERGY, DEFINED BY LOW SURFACE IMMUNOGLOBULIN M LEVELS/SIGNALING CAPACITY, AND IN THEIR DNA METHYLATION PROFILE, PARTICULARLY VARIABLE IN M-CLL. WE HAVE NOW FOUND THAT LEVELS OF IL-10 PRODUCED BY ACTIVATED CLL CELLS WERE HIGHLY VARIABLE. LEVELS WERE HIGHER IN M-CLL THAN IN U-CLL AND CORRELATED WITH ANERGY. DNA METHYLATION ANALYSIS OF IL10 LOCUS REVEALED TWO PREVIOUSLY UNCHARACTERIZED 'VARIABLY METHYLATED REGIONS' (CLL-VMRS1/2) IN THE GENE BODY, BUT SIMILARLY LOW METHYLATION IN THE PROMOTER OF BOTH U-CLL AND M-CLL. CLL-VMR1/2 METHYLATION WAS LOWER IN M-CLL THAN IN U-CLL AND INVERSELY CORRELATED WITH IL-10 INDUCTION. A FUNCTIONAL SIGNAL TRANSDUCER AND ACTIVATOR OF TRANSCRIPTION 3 (STAT3) BINDING SITE IN CLL-VMR2 WAS CONFIRMED BY PROXIMITY LIGATION AND LUCIFERASE ASSAYS, WHEREAS INHIBITION OF SYK-MEDIATED STAT3 ACTIVATION RESULTED IN SUPPRESSION OF IL10. THE DATA SUGGEST EPIGENETIC CONTROL OF IL-10 PRODUCTION. HIGHER TUMOR LOAD MAY COMPENSATE THE REDUCED IL-10 PRODUCTION IN U-CLL, ACCOUNTING FOR CLINICAL IMMUNOSUPPRESSION IN BOTH SUBSETS. THE OBSERVATION THAT SYK INHIBITION ALSO SUPPRESSES IL-10 PROVIDES A POTENTIAL NEW RATIONALE FOR THERAPEUTIC TARGETING AND IMMUNOLOGICAL RESCUE BY SYK INHIBITORS IN CLL.	2017	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
11  3825  22 INVESTIGATION OF CTNNB1 GENE MUTATIONS AND EXPRESSION IN HEPATOCELLULAR CARCINOMA AND CIRRHOSIS IN ASSOCIATION WITH HEPATITIS B VIRUS INFECTION. HEPATITIS B VIRUS (HBV), ALONG WITH HEPATITIS C VIRUS CHRONIC INFECTION, REPRESENTS A MAJOR RISK FACTOR FOR HEPATOCELLULAR CARCINOMA (HCC) DEVELOPMENT. HOWEVER, MOLECULAR MECHANISMS INVOLVED IN THE DEVELOPMENT OF HCC ARE NOT YET COMPLETELY UNDERSTOOD. RECENT STUDIES HAVE INDICATED THAT MUTATIONS IN CTNNB1 GENE ENCODING FOR BETA-CATENIN PROTEIN LEAD TO ABERRANT ACTIVATION OF THE WNT/ BETA-CATENIN PATHWAY. THE MUTATIONS IN TURN ACTIVATE SEVERAL DOWNSTREAM GENES, INCLUDING C-MYC, PROMOTING THE NEOPLASTIC PROCESS. THE PRESENT STUDY EVALUATED THE MUTATIONAL PROFILE OF THE CTNNB1 GENE AND EXPRESSION LEVELS OF CTNNB1 AND C-MYC GENES IN HBV-RELATED HCC, AS WELL AS IN CIRRHOTIC AND CONTROL TISSUES. MUTATIONAL ANALYSIS OF THE BETA-CATENIN GENE AND HBV GENOTYPING WERE CONDUCTED BY DIRECT SEQUENCING. EXPRESSION OF BETA-CATENIN AND C-MYC GENES WAS ASSESSED USING REAL-TIME PCR. AMONG THE HCC CASES, 18.1% SHOWED MISSENSE POINT MUTATION IN EXON 3 OF CTNNB1, MORE FREQUENTLY IN CODONS 32, 33, 38 AND 45. THE FREQUENCY OF MUTATION IN THE HOTSPOTS OF EXON 3 WAS SIGNIFICANTLY HIGHER IN NON-VIRAL HCCS (29.4%) RATHER THAN HBV-RELATED CASES (12.7%, P = 0.021). THE EXPRESSION OF BETA-CATENIN AND C-MYC GENES WAS FOUND UPREGULATED IN CIRRHOTIC TISSUES IN ASSOCIATION WITH HBV INFECTION. MUTATIONS AT BOTH PHOSPHORYLATION AND NEIGHBORING SITES WERE ASSOCIATED WITH INCREASED ACTIVITY OF THE WNT PATHWAY. THE RESULTS DEMONSTRATED THAT MUTATED BETA-CATENIN CAUSED ACTIVATION OF THE WNT PATHWAY, BUT THE RATE OF CTNNB1 GENE MUTATIONS WAS NOT RELATED TO HBV INFECTION. HBV FACTORS MAY DEREGULATE THE WNT PATHWAY BY CAUSING EPIGENETIC ALTERATIONS IN THE HBV-RELATED HCC.	2020	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
12  4903  14 P16 PROMOTER HYPERMETHYLATION IN HUMAN HEPATOCELLULAR CARCINOMA WITH OR WITHOUT HEPATITIS VIRUS INFECTION. BACKGROUND: EPIGENETIC ALTERATION THROUGH METHYLATION IS ONE OF THE MOST IMPORTANT STEPS IN CARCINOGENESIS. HOWEVER, THE RELATION BETWEEN HEPATITIS VIRUS INFECTION AND EPIGENETIC ALTERATIONS IS POORLY UNDERSTOOD. METHODS: SIXTEEN PATIENTS WITHOUT HEPATITIS B VIRUS (HBV) AND HEPATITIS C VIRUS (HCV) AND 35 PATIENTS WITH HBV OR HCV WHO UNDERWENT LIVER RESECTION FOR HEPATOCELLULAR CARCINOMA (HCC) WERE STUDIED. MUTATION OF P53 WAS DETECTED BY DIRECT SEQUENCING. METHYLATION STATUS OF P16 WAS EVALUATED IN TUMOR AND NONCANCEROUS LIVER TISSUES BY METHYLATION-SPECIFIC POLYMERASE CHAIN REACTION. RESULTS: IN HCC WITHOUT HBV AND HCV, P53 MUTATIONS WERE DETECTED IN 5 (31%) OF 16 HCCS. METHYLATION OF P16 PROMOTER WAS DETECTED IN 2 (25%) OF 8 MODERATELY DIFFERENTIATED HCCS, 6 (75%) OF 8 POORLY DIFFERENTIATED HCCS, AND NONE OF 16 NONCANCEROUS TISSUE SPECIMENS. IN HCC WITH HBV OR HCV, P53 MUTATIONS WERE DETECTED IN 8 (23%) OF 35 HCCS. METHYLATION OF P16 PROMOTER WAS DETECTED IN 2 (100%) OF 2 WELL-DIFFERENTIATED HCCS, 13 (76%) OF 17 MODERATELY DIFFERENTIATED HCCS, 12 (75%) OF 16 POORLY DIFFERENTIATED HCCS, AND 9 (26%) OF 35 NONCANCEROUS LIVER TISSUE SPECIMENS. CONCLUSIONS: OUR RESULTS SUGGEST THAT HEPATITIS VIRUSES MIGHT INDUCE METHYLATION OF P16 PROMOTER IN LIVER WITH CHRONIC INFLAMMATION, BEFORE APPEARANCE OF HCC.	2004	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
13  1830  21 EFFECTS OF LONG-TERM ASPIRIN USE ON MOLECULAR ALTERATIONS IN PRECANCEROUS GASTRIC MUCOSA IN PATIENTS WITH AND WITHOUT GASTRIC CANCER. THE RISK OF GASTRIC CANCER (GC) REMAINS EVEN AFTER H. PYLORI ERADICATION; THUS, OTHER COMBINATION TREATMENTS, SUCH AS CHEMOPREVENTIVE DRUGS, ARE NEEDED. WE EVALUATED THE EFFECTS OF ASPIRIN ON GENETIC/EPIGENETIC ALTERATIONS IN PRECANCEROUS CONDITIONS, I.E., ATROPHIC MUCOSA (AM) AND INTESTINAL METAPLASIA (IM), IN PATIENTS WITH CHRONIC GASTRITIS WHO HAD TAKEN ASPIRIN FOR MORE THAN 3 YEARS. A TOTAL OF 221 BIOPSY SPECIMENS FROM 74 PATIENTS, INCLUDING ATROPHIC GASTRITIS (AG) CASES WITHOUT ASPIRIN USE (CONTROL), AG CASES WITH ASPIRIN USE (AG GROUP), AND GC CASES WITH ASPIRIN USE (GC GROUP), WERE ANALYZED. ASPIRIN USE WAS ASSOCIATED WITH A SIGNIFICANT REDUCTION OF CDH1 METHYLATION IN AM (OR: 0.15, 95% CI: 0.06-0.41, P = 0.0002), BUT WAS LESS EFFECTIVE IN REVERSING THE METHYLATION THAT OCCURRED IN IM. FREQUENT HYPERMETHYLATION INCLUDING THAT OF CDH1 IN AM INCREASED IN THE GC GROUP COMPARED TO THE AG GROUP, AND CDH1 METHYLATION WAS AN INDEPENDENT PREDICTIVE MARKER OF GC (OR: 8.50, 95% CI: 2.64-25.33, P = 0.0003). IN PATIENTS WITH LONG-TERM ASPIRIN USE, THE CHANGES OF MOLECULAR EVENTS IN AM BUT NOT IM MAY BE AN IMPORTANT FACTOR IN THE REDUCTION OF CANCER INCIDENCE. IN ADDITION, METHYLATION OF THE CDH1 GENE IN AM MAY BE A SURROGATE OF GC.	2017	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
14  6656  21 UPDATED UNDERSTANDING OF CANCER AS A METABOLIC AND TELOMERE-DRIVEN DISEASE, AND PROPOSAL FOR COMPLEX PERSONALIZED TREATMENT, A HYPOTHESIS. IN THIS REVIEW, WE PROPOSE A HOLISTIC APPROACH TO UNDERSTANDING CANCER AS A METABOLIC DISEASE. OUR SEARCH FOR RELEVANT STUDIES IN MEDICAL DATABASES CONCLUDES THAT CANCER CELLS DO NOT EVOLVE DIRECTLY FROM NORMAL HEALTHY CELLS. WE HYPOTHESIZE THAT ABERRANT DNA DAMAGE ACCUMULATES OVER TIME-AVOIDING THE NATURAL DNA CONTROLS THAT OTHERWISE REPAIR OR REPLACE THE RAPIDLY REPLICATING CELLS. DNA DAMAGE STARTS TO ACCUMULATE IN NON-REPLICATING CELLS, LEADING TO SENESCENCE AND AGING. DNA DAMAGE IS LINKED WITH GENETIC AND EPIGENETIC FACTORS, BUT THE DEVELOPMENT OF CANCER IS FAVORED BY TELOMERASE ACTIVITY. EVIDENCE INDICATES THAT TELOMERE LENGTH IS AFFECTED BY CHRONIC INFLAMMATIONS, ALTERATIONS OF MITOCHONDRIAL DNA, AND VARIOUS ENVIRONMENTAL FACTORS. EMOTIONAL STRESS ALSO INFLUENCES TELOMERE LENGTH. CHRONIC INFLAMMATION CAN CAUSE OXIDATIVE DNA DAMAGE. OXIDATIVE STRESS, IN TURN, CAN TRIGGER MITOCHONDRIAL CHANGES, WHICH ULTIMATELY ALTER NUCLEAR GENE EXPRESSION. THIS VICIOUS CYCLE HAS LED SEVERAL SCIENTISTS TO VIEW CANCER AS A METABOLIC DISEASE. WE HAVE PROPOSED COMPLEX PERSONALIZED TREATMENTS THAT SEEK TO CORRECT MULTIPLE CHANGES SIMULTANEOUSLY USING A PSYCHOLOGICAL APPROACH TO REDUCE CHRONIC STRESS, IMMUNE CHECKPOINT THERAPY WITH REDUCED DOSES OF CHEMO AND RADIOTHERAPY, MINIMAL SURGICAL INTERVENTION, IF ANY, AND MITOCHONDRIAL METABOLIC REPROGRAMMING PROTOCOLS SUPPLEMENTED BY INTERMITTENT FASTING AND PERSONALIZED DIETARY PLANS WITHOUT INTERFERING WITH THE OTHER THERAPIES.	2020	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
15   817  17 CHARACTERISTIC PATTERNS OF ALTERED DNA METHYLATION PREDICT EMERGENCE OF HUMAN HEPATOCELLULAR CARCINOMA. WE AIMED TO IDENTIFY THE SPECIFIC SUBSET OF TUMOR SUPPRESSOR GENES (TSGS) THAT ARE METHYLATION-SILENCED DURING THE EARLIEST STEPS OF HEPATOCARCINOGENESIS, AND TO FURTHER EVALUATE WHETHER THESE GENES CAN SERVE AS PREDICTIVE BIOMARKERS OF HEPATOCELLULAR CARCINOMA (HCC) EMERGENCE. A TOTAL OF 482 LIVER TISSUES INCLUDING 177 PAIRS OF HCCS AND MATCHED NONTUMOR LIVERS AND 128 LIVER BIOPSIES FROM CHRONIC HEPATITIS C (CHC) PATIENTS WERE ANALYZED FOR QUANTITATIVE METHYLATION ANALYSIS IN 24 TSG PROMOTERS AND THREE MINT LOCI. THE TUMORS WERE CLASSIFIED AS EARLY, LESS-PROGRESSED, AND HIGHLY PROGRESSED HCCS USING HISTOLOGY AND RADIOLOGICAL APPROACHES. A SUBSET OF TSGS THAT HARBORED DISTINCTLY HIGH LEVELS OF METHYLATION IN EARLY HCCS WERE SELECTED. BASED ON THE METHYLATION PROFILES OF THESE GENES, KAPLAN-MEIER ANALYSES WERE PERFORMED TO DETERMINE TIME-TO-HCC OCCURRENCE IN CHC PATIENTS. SUBSEQUENTLY, MULTIVARIATE ANALYSIS WAS PERFORMED USING AGE, GENDER, FIBROSIS STAGE, AND NUMBER OF METHYLATED TSGS AS COVARIATES. AMONG TSGS ANALYZED, A SUBSET OF EIGHT TSGS (HIC1, GSTP1, SOCS1, RASSF1, CDKN2A, APC, RUNX3, AND PRDM2) DEMONSTRATED A DISTINCT CLUSTER BY HIERARCHICAL CLUSTERING AND RECEIVER OPERATING CHARACTERISTIC ANALYSES. THIS SUBSET OF TSGS SHOWED SIGNIFICANTLY HIGHER METHYLATION LEVELS IN THE EARLY HCCS (P < 0.0001). IN THE CHC PATIENTS, METHYLATION FREQUENCIES IN THESE TSGS WERE ASSOCIATED WITH SHORTER TIME-TO-HCC OCCURRENCE (P < 0.0001), AND NUMBER OF METHYLATED GENES WAS AN INDEPENDENT RISK FACTOR FOR HCC (HAZARD RATIO = 5.21, 95% CONFIDENCE INTERVAL = 2.25-11.76, P = 0.0002). CONCLUSION: EPIGENETIC INACTIVATION OF A SUBSET OF TSGS PLAYS A CRITICAL ROLE IN THE EARLIEST STEPS OF HEPATOCARCINOGENESIS. FURTHERMORE, EPIGENETIC INACTIVATION OF THESE GENES IN CHC PROVIDES A PROGNOSTIC VALUE FOR DETERMINING THE RISK FOR DEVELOPING HCC LATER IN LIFE.	2012	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
16  3392  17 HOST AND VIRAL GENETIC VARIATION IN HBV-RELATED HEPATOCELLULAR CARCINOMA. HEPATOCELLULAR CARCINOMA (HCC) IS THE FIFTH MOST COMMON CANCER IN MEN AND THE SECOND LEADING CAUSE OF CANCER DEATHS GLOBALLY. THE HIGH PREVALENCE OF HCC IS DUE IN PART TO THE HIGH PREVALENCE OF CHRONIC HBV INFECTION AND THE HIGH MORTALITY RATE IS DUE TO THE LACK OF BIOMARKERS FOR EARLY DETECTION AND LIMITED TREATMENT OPTIONS FOR LATE STAGE HCC. THE OBSERVED INDIVIDUAL VARIANCE IN DEVELOPMENT OF HCC IS ATTRIBUTABLE TO DIFFERENCES IN HBV GENOTYPE AND MUTATIONS, HOST PREDISPOSING GERMLINE GENETIC VARIATIONS, THE ACQUISITION OF TUMOR-SPECIFIC SOMATIC MUTATIONS, AS WELL AS ENVIRONMENTAL FACTORS. HBV GENOTYPE C AND MUTATIONS IN THE PRES, BASIC CORE PROMOTER (BCP) OR HBX REGIONS ARE ASSOCIATED WITH AN INCREASED RISK OF HCC. GENOME-WIDE ASSOCIATION STUDIES HAVE IDENTIFIED COMMON POLYMORPHISMS IN KIF1B, HLA-DQ, STAT4, AND GRIK1 WITH ALTERED RISK OF HBV-RELATED HCC. HBV INTEGRATION INTO GROWTH CONTROL GENES (SUCH AS TERT), PRO-ONCOGENIC GENES, OR TUMOR SUPPRESSOR GENES AND THE ONCOGENIC ACTIVITY OF TRUNCATED HBX PROMOTE HEPATOCARCINOGENESIS. SOMATIC MUTATIONS IN THE TERT PROMOTER AND CLASSIC CANCER SIGNALING PATHWAYS, INCLUDING WNT (CTNNB1), CELL CYCLE REGULATION (TP53), AND EPIGENETIC MODIFICATION (ARID2 AND MLL4) ARE FREQUENTLY DETECTED IN HEPATIC TUMOR TISSUES. THE IDENTIFICATION OF HBV AND HOST VARIATION ASSOCIATED WITH TUMOR INITIATION AND PROGRESSION HAS CLINICAL UTILITY FOR IMPROVING EARLY DIAGNOSIS AND PROGNOSIS; WHEREAS THE IDENTIFICATION OF SOMATIC MUTATIONS DRIVING TUMORIGENESIS HOLD PROMISE TO INFORM PRECISION TREATMENT FOR HCC PATIENTS.	2018	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
17  3307  17 HIGH-RESOLUTION GENOMIC PROFILING OF LIVER CANCER LINKS ETIOLOGY WITH MUTATION AND EPIGENETIC SIGNATURES. BACKGROUND & AIMS: HEPATOCELLULAR CARCINOMA (HCC) IS A MODEL OF A DIVERSE SPECTRUM OF CANCERS BECAUSE IT IS INDUCED BY WELL-KNOWN ETIOLOGIES, MAINLY HEPATITIS C VIRUS (HCV) AND HEPATITIS B VIRUS. HERE, WE AIMED TO IDENTIFY HCV-SPECIFIC MUTATIONAL SIGNATURES AND EXPLORED THE LINK BETWEEN THE HCV-RELATED REGIONAL VARIATION IN MUTATIONS RATES AND HCV-INDUCED ALTERATIONS IN GENOME-WIDE CHROMATIN ORGANIZATION. METHODS: TO IDENTIFY AN HCV-SPECIFIC MUTATIONAL SIGNATURE IN HCC, WE PERFORMED HIGH-RESOLUTION TARGETED SEQUENCING TO DETECT PASSENGER MUTATIONS ON 64 HCC SAMPLES FROM 3 ETIOLOGY GROUPS: HEPATITIS B VIRUS, HCV, OR OTHER. TO EXPLORE THE LINK BETWEEN THE GENOMIC SIGNATURE AND GENOME-WIDE CHROMATIN ORGANIZATION WE PERFORMED CHROMATIN IMMUNOPRECIPITATION SEQUENCING FOR THE TRANSCRIPTIONALLY PERMISSIVE H3K4ME3, H3K9AC, AND SUPPRESSIVE H3K9ME3 MODIFICATIONS AFTER HCV INFECTION. RESULTS: REGIONAL VARIATION IN MUTATION RATE ANALYSIS SHOWED SIGNIFICANT ETIOLOGY-DEPENDENT REGIONAL MUTATION RATES IN 12 GENES: LRP2, KRT84, TMEM132B, DOCK2, DMD, INADL, JAK2, DNAH6, MTMR9, ATM, SLX4, AND ARSD. WE FOUND AN ENRICHMENT OF C->T TRANSVERSION MUTATIONS IN THE HCV-ASSOCIATED HCC CASES. FURTHERMORE, THESE CASES SHOWED REGIONAL VARIATION IN MUTATION RATES ASSOCIATED WITH GENOMIC INTERVALS IN WHICH HCV INFECTION DICTATED EPIGENETIC ALTERATIONS. THIS SIGNATURE MAY BE RELATED TO THE HCV-INDUCED DECREASED EXPRESSION OF GENES ENCODING KEY ENZYMES IN THE BASE EXCISION REPAIR PATHWAY. CONCLUSIONS: WE IDENTIFIED NOVEL DISTINCT HCV ETIOLOGY-DEPENDENT MUTATION SIGNATURES IN HCC ASSOCIATED WITH HCV-INDUCED ALTERATIONS IN HISTONE MODIFICATION. THIS STUDY PRESENTS A LINK BETWEEN CANCER-CAUSING MUTAGENESIS AND THE INCREASED PREDISPOSITION TO LIVER CANCER IN CHRONIC HCV-INFECTED INDIVIDUALS, AND UNVEILS NOVEL ETIOLOGY-SPECIFIC MECHANISMS LEADING TO HCC AND CANCER IN GENERAL.	2023	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
18  3190  18 HCV-INDUCED EPIGENETIC CHANGES ASSOCIATED WITH LIVER CANCER RISK PERSIST AFTER SUSTAINED VIROLOGIC RESPONSE. BACKGROUND & AIMS: CHRONIC HEPATITIS C VIRUS (HCV) INFECTION IS AN IMPORTANT RISK FACTOR FOR HEPATOCELLULAR CARCINOMA (HCC). DESPITE EFFECTIVE ANTIVIRAL THERAPIES, THE RISK FOR HCC IS DECREASED BUT NOT ELIMINATED AFTER A SUSTAINED VIROLOGIC RESPONSE (SVR) TO DIRECT-ACTING ANTIVIRAL (DAA) AGENTS, AND THE RISK IS HIGHER IN PATIENTS WITH ADVANCED FIBROSIS. WE INVESTIGATED HCV-INDUCED EPIGENETIC ALTERATIONS THAT MIGHT AFFECT RISK FOR HCC AFTER DAA TREATMENT IN PATIENTS AND MICE WITH HUMANIZED LIVERS. METHODS: WE PERFORMED GENOME-WIDE CHIPMENTATION-BASED CHIP-SEQ AND RNA-SEQ ANALYSES OF LIVER TISSUES FROM 6 PATIENTS WITHOUT HCV INFECTION (CONTROLS), 18 PATIENTS WITH CHRONIC HCV INFECTION, 8 PATIENTS WITH CHRONIC HCV INFECTION CURED BY DAA TREATMENT, 13 PATIENTS WITH CHRONIC HCV INFECTION CURED BY INTERFERON THERAPY, 4 PATIENTS WITH CHRONIC HEPATITIS B VIRUS INFECTION, AND 7 PATIENTS WITH NONALCOHOLIC STEATOHEPATITIS IN EUROPE AND JAPAN. HCV-INDUCED EPIGENETIC MODIFICATIONS WERE MAPPED BY COMPARATIVE ANALYSES WITH MODIFICATIONS ASSOCIATED WITH OTHER LIVER DISEASE ETIOLOGIES. UPA/SCID MICE WERE ENGRAFTED WITH HUMAN HEPATOCYTES TO CREATE MICE WITH HUMANIZED LIVERS AND GIVEN INJECTIONS OF HCV-INFECTED SERUM SAMPLES FROM PATIENTS; MICE WERE GIVEN DAAS TO ERADICATE THE VIRUS. PATHWAYS ASSOCIATED WITH HCC RISK WERE IDENTIFIED BY INTEGRATIVE PATHWAY ANALYSES AND VALIDATED IN ANALYSES OF PAIRED HCC TISSUES FROM 8 PATIENTS WITH AN SVR TO DAA TREATMENT OF HCV INFECTION. RESULTS: WE FOUND CHRONIC HCV INFECTION TO INDUCE SPECIFIC GENOME-WIDE CHANGES IN H3K27AC, WHICH CORRELATED WITH CHANGES IN EXPRESSION OF MRNAS AND PROTEINS. THESE CHANGES PERSISTED AFTER AN SVR TO DAAS OR INTERFERON-BASED THERAPIES. INTEGRATIVE PATHWAY ANALYSES OF LIVER TISSUES FROM PATIENTS AND MICE WITH HUMANIZED LIVERS DEMONSTRATED THAT HCV-INDUCED EPIGENETIC ALTERATIONS WERE ASSOCIATED WITH LIVER CANCER RISK. COMPUTATIONAL ANALYSES ASSOCIATED INCREASED EXPRESSION OF SPHK1 WITH HCC RISK. WE VALIDATED THESE FINDINGS IN AN INDEPENDENT COHORT OF PATIENTS WITH HCV-RELATED CIRRHOSIS (N = 216), A SUBSET OF WHICH (N = 21) ACHIEVED VIRAL CLEARANCE. CONCLUSIONS: IN AN ANALYSIS OF LIVER TISSUES FROM PATIENTS WITH AND WITHOUT AN SVR TO DAA THERAPY, WE IDENTIFIED EPIGENETIC AND GENE EXPRESSION ALTERATIONS ASSOCIATED WITH RISK FOR HCC. THESE ALTERATIONS MIGHT BE TARGETED TO PREVENT LIVER CANCER IN PATIENTS TREATED FOR HCV INFECTION.	2019	
                                                                                                                                                                                                                                              
19  1042  15 CLINICAL AND MOLECULAR BASIS OF HEPATOCELLULAR CARCINOMA AFTER HEPATITIS C VIRUS ERADICATION. HEPATOCELLULAR CARCINOMA (HCC) ARISES IN THE BACKGROUND OF CHRONIC LIVER DISEASES, INCLUDING HEPATITIS AND LIVER CIRRHOSIS CAUSED BY HEPATITIS C VIRUS (HCV) INFECTION. IT IS WELL KNOWN THAT HCV ERADICATION USING ANTIVIRAL DRUGS CAN EFFICIENTLY INHIBIT HEPATOCARCINOGENESIS. RECENT ADVANCES IN AND DEVELOPMENT OF DIRECT-ACTING ANTIVIRAL (DAA) DRUGS HAS REVOLUTIONIZED THE TREATMENT OF HCV INFECTION, AND THE VAST MAJORITY OF HCV PATIENTS CAN ACHIEVE HCV ERADICATION USING DAAS. HOWEVER, MOUNTING EVIDENCE CLEARLY INDICATES THAT HCC INEVITABLY OCCURS IN A SUBSET OF PATIENTS AFTER SUCCESSFUL VIRAL ERADICATION USING DAA THERAPY. CANCER IS A GENETIC DISEASE, AND THE ACCUMULATION OF GENETIC AND EPIGENETIC ABERRATIONS MAY CAUSE HEPATOCARCINOGENESIS IN CHRONICALLY DAMAGED LIVER, EVEN AFTER VIRUS ELIMINATION. IN THIS REVIEW, WE HIGHLIGHT HCC DEVELOPMENT AFTER HCV ERADICATION AND DISCUSS THE CURRENT UNDERSTANDING OF THE MOLECULAR MECHANISMS OF TUMORIGENESIS AFTER VIRUS ELIMINATION, FOCUSING ON THE GENETIC AND EPIGENETIC BACKGROUND OF CHRONICALLY DAMAGED LIVER TISSUES.	2022	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
20  4904  20 P16INK4A GENE ALTERATIONS ARE NOT A PROGNOSTIC INDICATOR FOR SURVIVAL IN PATIENTS WITH HEPATOCELLULAR CARCINOMA UNDERGOING CURATIVE HEPATECTOMY. BACKGROUND AND AIM: HEPATOCELLULAR CARCINOMA (HCC) IS A COMMON MALIGNANCY WORLDWIDE THAT IS HIGHLY ASSOCIATED WITH CHRONIC HEPATITIS B OR C INFECTION AND CIRRHOSIS. THE TUMOR SUPPRESSOR GENE P16INK4A IS AN IMPORTANT COMPONENT OF THE CELL CYCLE AND INACTIVATION OF THE GENE HAS BEEN FOUND IN A VARIETY OF HUMAN CANCERS. THE PRESENT STUDY WAS PERFORMED TO DETERMINE GENETIC AND EPIGENETIC ALTERATIONS IN THE P16INK4A TUMOR SUPPRESSOR GENE AND THE EFFECT OF THESE ON HCC PROGRESSION. METHODS: THE STATUS OF P16INK4A WAS EVALUATED IN 117 HCC TUMORAL NODULES AND 110 CORRESPONDING PERITUMORAL TISSUES BY LOSS OF HETEROZIGOSITY (LOH) AT THE 9P21-22 REGION, HOMOZYGOUS DELETIONS, SINGLE-STRAND CONFORMATION POLYMORPHISM-POLYMERASE CHAIN REACTION (PCR) MUTATIONAL ANALYSIS AND METHYLATION SPECIFIC PCR. RESULTS: THE MOST FREQUENT INACTIVATION MECHANISM WAS HYPERMETHYLATION OF THE PROMOTER REGION, WHICH WAS FOUND IN 63.2% OF THE TUMOR SAMPLES AND IN 28.2% OF THE PERITUMORAL SAMPLES. LOSS OF HETEROZYGOSITY AT THE 9P21 REGION WAS DETECTED IN 27.3% AND 10% OF TUMOR AND PERITUMORAL TISSUES, RESPECTIVELY. HOMOZYGOUS DELETIONS AND MUTATIONS WERE LESS COMMON EVENTS IN HEPATOCARCINOGENESIS. THE AUTHORS FOUND 5.9% OF THE TUMOR CASES WITH EXON 2 HOMOZYGOUS DELETIONS AND 8.6% WITH MUTATIONS. TWO POLYMORPHISMS WERE DETECTED, ONE AT CODON 148 (GCG --> ACG, ALA --> THR) IN THREE CASES AND THE OTHER IN EXON 3 AT 540 BP (34.2% OF THE SAMPLES). NO ASSOCIATION WAS FOUND BETWEEN INACTIVATION OF P16INK4A AND CLINICOPATHOLOGICAL CHARACTERISTICS OR PROGNOSIS. CONCLUSION: P16INK4A IS ALTERED FREQUENTLY AND EARLY IN HCC, BEING THE PREDOMINANT MECHANISM OF INACTIVATION PROMOTER HYPERMETHYLATION. THE PRESENT RESULTS SUGGEST THAT THE P16INK4A GENE PLAYS AN IMPORTANT ROLE IN THE PATHOGENESIS OF HCC.	2004