Expression of apoptosis-related proteins in Barrett's metaplasia-dysplasia-carcinoma sequence: A switch to a more resistant phenotype

CJ Van der Woude*, PLM Jansen, ATGM Tiebosch, A Beuving, M Homan, JH Kleibeuker, H Moshage

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

69 Citations (Scopus)


Barrett's esophagus, or colonmar-lined esophagus (CLE), is a premalignant disorder in which the stratified squamous epithelium is replaced by metaplastic epithelium. To gain more insight into the process of carcinogenesis in CLE, we studied several factors involved in the apoptotic pathway in biopsies with gastric metaplasia (GM), intestinal metaplasia (IM), dysplasia, and/or adenocarcinoma. Immunohistochemistry was performed for Fas, Bcl-2, Bax, Bcl-xl, inducible nitric oxide synthase (iNOS), and cyclooxagenase 2 (COX-2). Fas staining was positive in the epithelium of all biopsies from patients with CLE but negative in normal gastric mucosa. Fas staining was positive in all tumor cells of the 8 cases containing adenocarcinoma. Bcl-2 was positive in lamina propria immune cells of all specimens. Bax staining was positive in the epithelium of all biopsies, including tumor cells. Bcl-xl was positive in dysplasia and tumor cells, but negative in 8 of 17 biopsies containing IM. iNOS was positive in 20 of 21 biopsies with IM and in 4 of 8 dysplasia biopsies. COX-2 was positive in 7 of 8 adenocarcinomas. We conclude that the apoptotic balance in the transformation from IM to adenocarcinoma switches to an antiapoptotic phenotype because of increased Bcl-xl expression and decreased Bax expression. Fas can be used as a marker for the of gastric mucosa and metaplasia in the esophagus. iNOS is highly positive in CLE-associated intestinal metaplasia. COX-2 is negative in nonmalignant CLE. Therefore, pharmacologic inhibition of COX-2 activity is unlikely to be effective in the preventing CLE-associated adenocarcinoma. There was no clear correlation between iNOS expression and activation of proapoptotic and antiapoptotic genes. Hum PATHOL 33:686-692. Copyright 2002, Elsevier Science (USA). All rights reserved.

Original languageEnglish
Pages (from-to)686-692
Number of pages7
JournalHuman Pathology
Issue number7
Publication statusPublished - Jul-2002


  • Barrett's esophagus
  • apoptosis
  • gastric metaplasia
  • intestinal metaplasia
  • dysplasia
  • adenocarcinoma
  • iNOS
  • COX-2
  • Bax
  • Fas
  • Bcl-2
  • Bcl-xl
  • P53

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