Interferon-alpha induces bcl-2 proto-oncogene in patients with neuroendocrine gut tumor responding to its antitumor action.

We have studied the expression of apoptosis regulating genes bcl-2 and bax in neuroendocrine gut tumors. The expression pattern of these genes was compared with the clinical response (changes in the tumor markers and changes of the tumor size determined by radiology) after treatment with interferon-alpha (IFN-alpha, n = 13), somatostatin analog (octreotide, n = 3; lanreotide, n = 2) or a combination of both (n = 5). Immunohistochemistry and in situ RT-PCR were performed and expressions were scored from 0 (no staining) to 6 (strong and wide-spread staining). With regard to clinical outcome, the scores (mean +/- SEM) of immunohistochemical staining of bcl-2 and bax were 1.77 +/- 0.25 and 4 +/- 0.22 for patients with stable disease and, 0.54 +/- 0.28 and 4.68 +/- 0.21 for patients with progressive disease. The scores of bcl-2 and bax staining for IFN-alpha-treated patients were 1.96 +/- 0.35 and 4.12 +/- 0.31 and for untreated patients were 0.5 +/- 0.25 and 4.5 +/- 0.21, respectively. Expression of bcl-2 was observed in all IFN-alpha-treated patients who responded to the drug but not in nonresponsive patients (p = 0.0027). In contrast, bax, a promotor of apoptosis was expressed in all patients with higher degree of expression seen in patients with progressive disease (p = 0.0364). We have also detected bcl-2 expression by western blot analysis in neuroendocrine tumor tissue grown in nude mice, which were treated with IFN-alpha for 28 days. Our results indicate that, IFN-alpha can induce bcl-2. Thus, we, propose that bcl-2 may be used as a prognostic marker for IFN-alpha sensitivity of neuroendocrine tumors.