title: Increased HMGB1 and cleaved caspase-3 stimulate the proliferation of tumor cells and are correlated with the poor prognosis in colorectal cancer.
abstract: BACKGROUND
  Dying tumor cells after irradiation could promote the proliferation of living tumor cells might cause tumor relapse and treatment failure. Our previous study showed that activated caspase-3 after irradiation probably participates in tumor repopulation. In this study, we investigated whether high mobility group box 1(HMGB1) is also involved in tumor repopulation.
  
  
  METHODS
  Colorectal tumor cells were irradiated. The cleaved caspase-3 (CC3) in irradiated tumor cells and HMGB1 in the supernatant of irradiated tumor cells were detected by Western blot. A large number of irradiated colorectal tumor cells (feeder cells) were then co-cultured with a small number of luciferase-labeled living colorectal tumor cells (reporter cells) and proliferation of reporter cells was measured by bioluminescence imaging. The CC3 and HMGB1 protein expression in colorectal tumor and peritumoral tissues were detected by immunohistochemistry and their correlation with prognosis were analyzed.
  
  
  RESULTS
  The irradiated colorectal tumor cells underwent apoptosis and necrosis and produced CC3 in tumor cells and HMGB1 in the supernatant of cultured cells. The increased expression of secretory HMGB1 correlated with CC3 level and proliferating cell nuclear antigen (PCNA) after irradiation in vitro. The irradiated dying cells remarkably stimulated living tumor cell proliferation. Interestedly, immunohistochemistry staining showed that positive HMGB1, CC3, and Ki67 expression were significantly higher in colorectal tumor tissues than in peritumoral tissues (p <0.01). The Kaplan-Meier survival analysis revealed that high HMGB1, CC3, and Ki67 levels were significantly associated with poor prognosis (p <0.05, p <0.01). Multivariate analysis using Cox proportional hazards model showed that TNM staging and HMGB1 were independent prognostic factors in patients with colorectal cancer (CRC) (p <0.01, p <0.001).
  
  
  CONCLUSIONS
  Both apoptotic and necrotic cells could stimulate proliferation of living tumor cells, and the increased expression of CC3 and HMGB1 in tumor cells could be new markers for poor prognosis in colorectal cancer patients.
authors.affiliation: The Comprehensive Cancer Center & Shanghai Key Laboratory for Pancreatic Diseases, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 201620, China. kanardo@163.com.
authors.forename: Zhengxiang
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: The Department of Surgery, The Branch Hospital of Shanghai General Hospital, Shanghai, 200080, China. minniewang01@163.com.
authors.forename: Min
authors.initials: M
authors.lastname: Wang
authors.affiliation: The Department of Surgery, The Branch Hospital of Shanghai General Hospital, Shanghai, 200080, China. zhouling_2005@126.com.
authors.forename: Ling
authors.initials: L
authors.lastname: Zhou
authors.affiliation: The Comprehensive Cancer Center & Shanghai Key Laboratory for Pancreatic Diseases, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 201620, China. fxngtg@163.com.
authors.forename: Xiao
authors.initials: X
authors.lastname: Feng
authors.affiliation: The Comprehensive Cancer Center & Shanghai Key Laboratory for Pancreatic Diseases, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 201620, China. ajinch@163.com.
authors.forename: Jin
authors.initials: J
authors.lastname: Cheng
authors.affiliation: The Comprehensive Cancer Center & Shanghai Key Laboratory for Pancreatic Diseases, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 201620, China. yuyang1611@163.com.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Experimental Research Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 201620, China. yanpinggong2003@aliyun.com.
authors.forename: Yanping
authors.initials: Y
authors.lastname: Gong
authors.affiliation: The Department of Surgery, The Branch Hospital of Shanghai General Hospital, Shanghai, 200080, China. rabbityy1975@163.com.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Dermatology, Medical Center, Duke University, Durham, NC, 27710, USA. chuan.li@duke.edu.
authors.forename: Chuanyuan
authors.initials: C
authors.lastname: Li
authors.affiliation: Experimental Research Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 201620, China. tl09168@hotmail.com.
authors.forename: Ling
authors.initials: L
authors.lastname: Tian
authors.affiliation: The Comprehensive Cancer Center & Shanghai Key Laboratory for Pancreatic Diseases, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 201620, China. qianh2011@126.com.
authors.forename: Qian
authors.initials: Q
authors.lastname: Huang
mesh_terms: D000123:Acetyltransferases / Q000378:metabolism*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D045744:Cell Line, Tumor; D049109:Cell Proliferation; D015179:Colorectal Neoplasms / Q000378:metabolism* / Q000401:mortality* / Q000473:pathology; D005260:Female; D024243:HMGB1 Protein / Q000378:metabolism*; D006801:Humans; D053208:Kaplan-Meier Estimate; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D059748:Proteolysis; D000067759:Receptor for Advanced Glycation End Products / Q000378:metabolism; D014157:Transcription Factors / Q000378:metabolism*
chemical_list: D024243:HMGB1 Protein; D019394:Ki-67 Antigen; D000067759:Receptor for Advanced Glycation End Products; D014157:Transcription Factors; D000123:Acetyltransferases; C111246:HTATIP2 protein, human