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幽门螺杆菌相关胃癌发生的全貌

The Landscape of Helicobacter pylori-related Gastric Carcinogenesis.

作者信息

Assumpção Paulo Pimentel de, Genta Robert M, Camargo Maria Constanza, Silva Jessica Manoelli Costa da, Amieva Manuel Ricardo, Rugge Massimo

机构信息

Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Pará, Brazil.

Inform Diagnostics-Fulgent, Gastrointestinal Pathology, Irving, Texas; Departments of Pathology and Medicine (Gastroenterology), Baylor College of Medicine, Houston, Texas; USA.

出版信息

J Gastrointestin Liver Dis. 2024 Dec 28;33(4):524-534. doi: 10.15403/jgld-5959.

Abstract

The relationship between Helicobacter pylori (H. pylori) and humans remains a complex enigma. While other factors contribute to gastric cancer (GC), their impact pales in comparison to the central role of H. pylori. Various cofactors, such as dietary carcinogens and Epstein-Barr virus infection, can lead to GC independently of H. pylori. However, it is likely the combination of mechanisms, especially those driven by H. pylori, that represents the primary force behind GC development. Identifying individuals at high risk of developing H. pylori-related GC or detecting the disease in its earliest stages remains a significant challenge. To address this, we aim to refine the existing gastric carcinogenic model by incorporating molecular data, oncological concepts common to many cancers, and data from innovative experimental approaches. This updated model, applicable to both intestinal and diffuse GC, builds on Pelayo Correa's carcinogenesis pathway while expanding our understanding of H. pylori's role in gastric carcinogenesis. It not only emphasizes the direct cellular effects of H. pylori virulence factors but also integrates underrecognized carcinogenic mechanisms, including the interactions between H. pylori and stem cells, providing a more comprehensive view of H. pylori's contribution. By acknowledging additional molecular drivers in GC and recognizing H. pylori's potential involvement in these processes, this model could offer more precise interpretations of GC development and open new avenues for clinical interventions.

摘要

幽门螺杆菌(H. pylori)与人类的关系仍然是一个复杂的谜团。虽然其他因素也会导致胃癌(GC),但其影响与幽门螺杆菌的核心作用相比显得微不足道。各种辅助因素,如饮食致癌物和爱泼斯坦 - 巴尔病毒感染,可独立于幽门螺杆菌导致胃癌。然而,很可能是多种机制的组合,尤其是那些由幽门螺杆菌驱动的机制,才是胃癌发展背后的主要力量。识别幽门螺杆菌相关胃癌的高危个体或在疾病的最早阶段检测到该疾病仍然是一项重大挑战。为了解决这个问题,我们旨在通过纳入分子数据、许多癌症共有的肿瘤学概念以及来自创新实验方法的数据来完善现有的胃癌致癌模型。这个更新后的模型适用于肠型和弥漫型胃癌,它基于佩拉约·科雷亚的致癌途径构建,同时扩展了我们对幽门螺杆菌在胃癌发生中作用的理解。它不仅强调了幽门螺杆菌毒力因子的直接细胞效应,还整合了未被充分认识的致癌机制,包括幽门螺杆菌与干细胞之间的相互作用,从而更全面地展现了幽门螺杆菌的作用。通过认识到胃癌中的其他分子驱动因素,并认识到幽门螺杆菌可能参与这些过程,该模型可以为胃癌的发展提供更精确的解释,并为临床干预开辟新途径。

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