title: Sorafenib delays recurrence and metastasis after liver transplantation in a rat model of hepatocellular carcinoma with high expression of phosphorylated extracellular signal-regulated kinase.
abstract: Liver transplantation (LT) is one of the curative treatments for hepatocellular carcinoma (HCC). However, cancer recurrence and metastasis after LT are common in some HCC patients with high-risk factors (even in those within the Milan criteria). It remains unclear whether adjuvant therapy with sorafenib inhibits HCC recurrence and metastasis after LT. Therefore, we performed orthotopic LT in an August Irish Copenhagen (ACI) rat model of HCC. Because LT involves immune rejection and tolerance and it is unknown whether sorafenib influences the immune response, we also investigated the effects of sorafenib on immune balance. In this study, we established an allogeneic rat LT model in which liver grafts were taken from Lewis rats and transplanted into ACI rats with orthotopic HCC, and they were administered cyclosporine A to prevent acute allograft rejection. From day 7 after LT, sorafenib was administrated at 30 mg/kg/day for 3 weeks. Our results showed that the serum levels of vascular endothelial growth factor and hepatocyte growth factor significantly increased after LT, and the T helper 1 (T(h)1)/T helper 2 (T(h)2) immune balance was shifted toward a T(h)2 response after immunosuppressant administration. In comparison with controls, the rats in the sorafenib group showed significantly inhibited extracellular signal-regulated kinase phosphorylation and improved progression-free survival and overall survival. The tumor proliferation rate and angiogenesis in posttransplant recurrent tumor tissues decreased in the sorafenib group, and the tumor apoptosis rate increased. There was no significant difference in the T(h)1/T(h)2 immune balance between the sorafenib and control groups. In conclusion, adjuvant therapy with sorafenib is highly effective at inhibiting cancer recurrence and metastasis without influencing the immune balance after LT for HCC with high expression of phosphorylated extracellular signal-regulated kinase. This study suggests that sorafenib may have potential, particularly as part of a stratified medicine approach to HCC treatment after LT.
authors: Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
authors: Jun
authors: J
authors: Yan
authors: Changjun
authors: C
authors: Tan
authors: Fangming
authors: F
authors: Gu
authors: Jiahao
authors: J
authors: Jiang
authors: Min
authors: M
authors: Xu
authors: Xiuzhen
authors: X
authors: Huang
authors: Zhi
authors: Z
authors: Dai
authors: Zheng
authors: Z
authors: Wang
authors: Jia
authors: J
authors: Fan
authors: Jian
authors: J
authors: Zhou
mesh_terms: D000818:Animals; D017209:Apoptosis / Q000187:drug effects; D004195:Disease Models, Animal; D018572:Disease-Free Survival; D048049:Extracellular Signal-Regulated MAP Kinases / Q000378:metabolism*; D008114:Liver Neoplasms, Experimental / Q000378:metabolism / Q000401:mortality / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009389:Neovascularization, Pathologic / Q000517:prevention & control; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D010766:Phosphorylation; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D051381:Rats; D011912:Rats, Inbred ACI; D011917:Rats, Inbred Lew; D000077157:Sorafenib; D046888:Tissue Array Analysis
chemical_list: D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D009536:Niacinamide; D000077157:Sorafenib; D048049:Extracellular Signal-Regulated MAP Kinases