title: Evidence that loss of sonic hedgehog is an indicator of Helicobater pylori-induced atrophic gastritis progressing to gastric cancer.
abstract: BACKGROUND
  The absence of sonic hedgehog (Shh) correlates with the development of intestinal metaplasia (IM) suggesting the possibility of an association between Shh expression and neoplastic transformation.
  
  
  OBJECTIVE
  To examine Shh expression in the noncancerous mucosa of patients with gastric cancer and compare it to Shh expression in Helicobater pylori-infected and uninfected controls. We also assessed the relationship between the type of IM and Shh expression.
  
  
  METHODS
  Fifty-three patients with endoscopic mucosal resection (EMR) for early gastric cancer and 48 sex- and age-matched controls were studied. Two specimens each were obtained from the greater and lesser curves of the corpus and from the greater curve of the antrum. The histopathological grading used was the updated Sydney System. IM was categorized by staining with Alcian blue/high iron diamine. Expression of Shh was evaluated by immunostaining.
  
  
  RESULTS
  The Shh immunostaining in the corpus lesser curve significantly correlated with the scores of atrophy and IM. Shh staining in the antrum was significantly higher in H. pylori-negative controls than those in H. pylori-positive controls as well as in patients without IM compared to those with IM (p < 0.001). The Shh staining in the corpus lesser curve decreased in H. pylori-negative controls, -positive controls and the cancer group respectively (p= 0.003), and was significantly higher (p= 0.006) in the complete IM group compared to those in the incomplete IM group.
  
  
  CONCLUSIONS
  Loss of Shh is an early change that occurs in the mucosa prior to neoplastic transformation. Its loss correlates with the type of IM and may play a role in carcinogenesis.
authors.affiliation: Health Administration Center, Wakayama University, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Shiotani
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iishi
authors.forename: Noriya
authors.initials: N
authors.lastname: Uedo
authors.forename: Shingo
authors.initials: S
authors.lastname: Ishiguro
authors.forename: Masaharu
authors.initials: M
authors.lastname: Tatsuta
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Nakae
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Kumamoto
authors.forename: Juanita L
authors.initials: JL
authors.lastname: Merchant
mesh_terms: D001284:Atrophy; D002471:Cell Transformation, Neoplastic; D018450:Disease Progression; D004947:Esophagus / Q000473:pathology; D005757:Gastritis, Atrophic / Q000473:pathology; D053823:Hedgehog Proteins; D016481:Helicobacter Infections / Q000473:pathology*; D016480:Helicobacter pylori; D006801:Humans; D007150:Immunohistochemistry; D008679:Metaplasia; D009092:Mucous Membrane / Q000473:pathology; D011706:Pyloric Antrum / Q000473:pathology; D013274:Stomach Neoplasms / Q000473:pathology; D015534:Trans-Activators / Q000032:analysis*
chemical_list: D053823:Hedgehog Proteins; C509239:SHH protein, human; D015534:Trans-Activators