Koike K
Department of Infectious Diseases, Internal Medicine, Graduate School of Medicine, University of Tokyo.
Nihon Rinsho. 2001 Jul;59(7):1265-70.
Overwhelming lines of epidemiological evidence have indicated that chronic infection with hepatitis C virus(HCV) poses a major risk toward development of hepatocellular carcinoma(HCC). In the pathogenesis of HCC associated with HCV, it remains controversial whether these hepatitis viruses play a direct role or merely serve for an indirect role. By virtue of transgenic mouse established by us, it has become evident hat the core protein of HCV has an oncogenic potential. The findings in our studies indicate that HCV is directly involved in hepatocarcinogenesis, albeit other factors such as continued cell death and regeneration associated with chronic hepatitis may play a role, as well. Combined, our results suggest that there would be a mechanism for the development of HCC in persistent infection with hepatitis C virus that is distinct from those for the other cancers. Similar to the pathogenesis of other malignancies represented by colorectal cancer, the accumulation of a set of genetic aberrations may also be necessary for a multi-stage development of HCC. However, HCV core protein, to which an oncogenic potential is ascribed, may allow some of the multiple stages skipped in hepatocarcinogenesis. Unlike for the other cancers, therefore, infection with HCV may be capable of eliciting HCC in the absence of a complete set of genetic aberrations. Such a scenario would explain unusually high incidence and multicentric nature of HCC developing in chronic hepatitis C.
大量流行病学证据表明,丙型肝炎病毒(HCV)慢性感染是肝细胞癌(HCC)发生的主要危险因素。在与HCV相关的HCC发病机制中,这些肝炎病毒是发挥直接作用还是仅起间接作用仍存在争议。借助我们建立的转基因小鼠,已明确显示HCV核心蛋白具有致癌潜力。我们的研究结果表明,HCV直接参与肝癌发生,尽管诸如与慢性肝炎相关的持续细胞死亡和再生等其他因素也可能起作用。综合来看,我们的结果表明,丙型肝炎病毒持续感染导致HCC发生的机制可能不同于其他癌症。与以结直肠癌为代表的其他恶性肿瘤发病机制类似,一系列基因畸变的积累对于HCC的多阶段发展可能也是必要的。然而,具有致癌潜力的HCV核心蛋白可能使肝癌发生过程中的某些多阶段过程得以跳过。因此,与其他癌症不同,HCV感染可能在缺乏完整基因畸变的情况下引发HCC。这种情况可以解释慢性丙型肝炎中HCC的异常高发病率和多中心性质。