The accelerating incidence and dismal mortality of hepatocellular carcinoma (HCC) (5-yr survival <12%) highlight the urgent need to improve prediction and prevention of this deadly neoplasm. HCC develops from advanced fibrosis due to hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol, or non-alcoholic fatty liver disease (NAFLD). A 186-gene prognostic signature in stromal cirrhotic liver, previously identified and validated in HCV-related cirrhosis, holds promise to identify patients with highest HCC risk and provide clues to HCC prevention targets. It remains unknown whether this signature is also prognostic for other HCC etiologies. Moreover, the signature has not yet been adapted as a clinically applicable test. Our long-term goal is to develop clinically applicable prognostic biomarkers for the global cirrhosis population caused by variety of etiologies to enable more effective, personalized HCC surveillance and prevention. The objective here is to establish prognostic relevance of the 186-gene signature in the non-HCV etiologies, identify etiology-specific molecular prognostic factors, implement and refine the signature as a clinically applicable assay, and develop genomic database for prognostic biomarker assessment. Our central hypotheses are that the 186-gene signature is universally prognostic irrespective of etiology, and that there are also complementary, etiology-specific prognostic indicators. We will test these hypotheses and address the unmet need by the following interrelated Specific Aims: 1. Establish a gene signature of HCC risk and poor prognosis in patients with non-HCV etiologies of advanced liver disease. We will perform whole-genome expression profiling of stromal cirrhotic liver tissues (905 cirrhosis and 1025 HCC cases affected by HBV, HCV, alcohol, or NAFLD), and validate predictive capability for HCC development as well as cirrhosis progression and death. Etiology-specific prognostic gene signatures will also be identified using the whole-genome datasets. 2. Develop a clinically applicable prognostic test using gene signature that defines HCC risk. We will implement the signature in the digital transcript counting technology specifically designed for clinical lab (nCounter assay, NanoString), and optimize experimental and analytical methods. Transcriptome sequencing-based prediction will also be evaluated as a potential future platform of a clinical test. 3. Develop a web resource for in silico prognostic biomarker assessment for cirrhosis and HCC. Our new and existing datasets, representing a global cirrhosis patient population, will be assembled as a public database that enables quick and easy clinical utility assessment of a user's prognostic molecular signatures.

Public Health Relevance

Liver cirrhosis and cancer are extremely prevalent and lethal diseases, in which key prognostic drivers are still elusive. We propose to establish prognostic biomarkers and generate a panel of genomic datasets comprehensively representing the patient population with liver cirrhosis and cancer worldwide. These data and resources will enable more precise, individualized patient management and contribute to significant improvement in liver cancer's dismal prognosis.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
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Cancer Biomarkers Study Section (CBSS)
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Sherker, Averell H
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Icahn School of Medicine at Mount Sinai
Internal Medicine/Medicine
Schools of Medicine
New York
United States
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Fujiwara, Naoto; Nakagawa, Hayato; Enooku, Kenichiro et al. (2018) CPT2 downregulation adapts HCC to lipid-rich environment and promotes carcinogenesis via acylcarnitine accumulation in obesity. Gut 67:1493-1504
Kancherla, Venkatesh; Abdullazade, Samir; Matter, Matthias S et al. (2018) Genomic Analysis Revealed New Oncogenic Signatures in TP53-Mutant Hepatocellular Carcinoma. Front Genet 9:2
Golob-Schwarzl, Nicole; Bettermann, Kira; Mehta, Anita Kuldeep et al. (2018) High Keratin 8/18 Ratio Predicts Aggressive Hepatocellular Cancer Phenotype. Transl Oncol 12:256-268
Hirschfield, Hadassa; Bian, C Billie; Higashi, Takaaki et al. (2018) In vitro modeling of hepatocellular carcinoma molecular subtypes for anti-cancer drug assessment. Exp Mol Med 50:e419
Fujiwara, Naoto; Friedman, Scott L; Goossens, Nicolas et al. (2018) Risk factors and prevention of hepatocellular carcinoma in the era of precision medicine. J Hepatol 68:526-549
Van Renne, Nicolaas; Roca Suarez, Armando Andres; Duong, Francois H T et al. (2018) miR-135a-5p-mediated downregulation of protein tyrosine phosphatase receptor delta is a candidate driver of HCV-associated hepatocarcinogenesis. Gut 67:953-962
Li, Shen; Ghoshal, Sarani; Sojoodi, Mozhdeh et al. (2018) Pioglitazone Reduces Hepatocellular Carcinoma Development in Two Rodent Models of Cirrhosis. J Gastrointest Surg :
Lally, James S V; Ghoshal, Sarani; DePeralta, Danielle K et al. (2018) Inhibition of Acetyl-CoA Carboxylase by Phosphorylation or the Inhibitor ND-654 Suppresses Lipogenesis and Hepatocellular Carcinoma. Cell Metab :
Rodriguez-Bravo, Veronica; Pippa, Raffaella; Song, Won-Min et al. (2018) Nuclear Pores Promote Lethal Prostate Cancer by Increasing POM121-Driven E2F1, MYC, and AR Nuclear Import. Cell 174:1200-1215.e20
Alter, Harvey; Block, Timothy; Brown, Nathaniel et al. (2018) A research agenda for curing chronic hepatitis B virus infection. Hepatology 67:1127-1131

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