Predominant gastric mucosal IL-8 mRNA expression level, H. pylori infection, and low PG I/II ratio are relative risks for Thai gastric cancer without correlation with cagA mutation.

IntroductionA 42 year old male with Behcet's disease (BD) had endovascular treatment of a symptomatic infrarenal abdominal aortic aneurysm (AAA). Thirteen months later he developed haematemesis and melaena.MethodsComputed tomography (CT) and angiography showed an aorto-enteric fistula with migration and kinking of the stent graft. Explantation of the infected graft and axillobifemoral bypass, aneurysm sac debridement, and jejunal repair with omental interposition was performed on this severely contaminated patient.DiscussionThere are no reports of an aorto-enteric fistula secondary to endovascular repair in the literature and this case describes the potential consequences of endovascular repair of AAA in BD. The aorto-enteric fistula was associated with persistent inflammatory aortitis, stent graft kinking, and infection. Five cases of secondary aorto-enteric fistulas following open AAA repair in BD patients have been reported including this case resulting from endovascular repair.

AIM:To evaluate (1) the association of the Helicobacter pylori (H. pylori ) test and interleukin-8 (IL-8 ) mRNA expression alone and the severity of gastric cancer (GC); (2) the association of both tests were added to patients' characteristics to identifli Thai suspected patients of gastric cancer who would receive the most benefit; and (3) diagnostic value of levels of IL-8 mRNA expression for gastric cancer. METHODS:A cross-sectional analytical study was completed with 220 patients with 86 GC patients who underwent endoscopy with gastric surgery divided into non-metastasis and metastasis groups, and 134 patients with benign lesions who underwent endoscopic examination, at the Gastrointestinal Surgery and Endoscopy Unit, Chiang Mai University Hospital between 2006 and 2010. Of 220 patients, 86 cases of diagnosed gastric adenocarcinoma were in an advanced stage and 134 cases were non-cancer patients. RESULTS:The IL-8 mRNA expression showed predominant association with advanced GC when compared to H. pylori infection alone [OR (95%CI); 0.86 (0.49-1.53) vs 5.44 (3.08-9.62)] when including the patients' characteristics the highest of the area under the receiver operating characteristic curves (AuROC) of the model were males older than 40 years of age [AuROC (95%CI); 0.81 (0.75-0.86)]. However, preliminary testing for diagnostic indices of four cut-off points of IL-8 mRNA expression to predict the severity of GC cases found an increasing suboptimal trend from the likelihood ratio of positive to differentiate the severity in the GC group. The IL-8 mRNA expression showed a predominant association with GC when compared to H. pylori infection, especially in males older than 40 years of age who may benefit most from this test. CONCLUSION:The future research of IL-8 mRNA expression to predict severity in the gastric cancer group should be warranted.

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Background: Interleukine-8 (IL-8) gene expression was reported in vitro that it may relate to cagA gene in Japanese. There is no in vivo study demonstrated how its level related to cagA genotype and serum pepsinogen I/II ratio in other Asian Ethnic beside of East Asian such as in Japanese. We aimed to study the relative risk of the cytokine gene expression level in Thai gastric cancer and how its correlation to other co-factors Methods: There were 86 Thai gastric cancer patients and 134 Thai non-cancer volunteers who underwent endoscopic mucosal biopsies. The serum pepsinogen I, II, and Helicobacter pylori Immunoglobulin G antibody were tested. The extracted H.pylori DNA was genotyped for cagA mutation. The IL-8 mRNA expression was measured by Real Time relative quantitation polymerase chain reaction in all Thai tissue samples from the specific site of biopsy, 17 Japanese gastric cancer, and 12 non-cancer gastric mucosal samples. The multivariate analysis was used for the risk study. The student t-test and Mann-Whitney were used for quantitative analysis. The correlation study was done in the subgroup analysis. The STATA 11.0, USA, and SPSS version 16, USA were used for statistical analysis. The p-value <0.05 was considered as a statistically significant. Results: There is high level of IL-8 mRNA expression in positive H.pylori in Thai gastric cancer cases. However,negative cagA gene is found in 86.8 per cent of Thai gastric cancer though high yields of East Asian type in positive cagA cases. The PGI/II ratio in gastric cancer is significant lower than in non-cancer group, p =0.045. The mean level of IL-8 mRNA expression in Thai and Japanese advance gastric cancer were 9,615.65 (log 10= 2.62) and 1509.11 (log 10=2.17), respectively, p= 0.014. The total mean IL-8 mRNA expression in non-cancer Thais is 2,262 (log 10=1.49) while that in Japanese non-cancer is 10.79(log10= 0.69), p<0.001. The IL-8 expression is about 2 fold level higher in gastric cancer than in non-cancer gastric mucosal tisuues in both nations, p = 0.05. For gastric cancer risk cut off IL-8 expression level is log10>2 in both Thais and Japanese, Odds ratio= 7.97 (95%CI=3.75-16.97, p<0.001) and Odd ratios= 4 (95%CI=1.29-12.40), respectively. Serum PGI/II ratio at less than 3.0 and IL-8 mRNA expression ≥100 or log10 ≥2 are significantly cut off risk difference between Thai cancer and non-cancer, p= 0.03 and p < 0.001, respectively.Conclusion: The IL-8 mRNA expression level and pepsinogen I/II ratio reflect individualized ethnic host stomach mucosal defense difference and cancer inflammation in Thai gastric cancer. H.pylori is at risk for gastric cancer but there is negative cagA gene in this population. Gastric mucosal IL-8 mRNA expression may be a useful marker for poorly differentiated type gastric cancer treatment in near by future. Citation Format: Sirikan Yamada, Shunji Kato, Takeshi Matsuhisa, Luksana Makonkawkeyoon, Bandhuphat Chakrabandhu, Thiraphat Chakrabandhu, Takeshi Azuma. The factual evidence of gastric mucosal IL-8 mRNA expression, cagA gene H.pylori infection, and pepsinogen I/II ratio in Thai gastric cancer . [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1148. doi:10.1158/1538-7445.AM2013-1148