About 80% of hepatocellular carcinoma (HCC) cases are related to Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV). SOX is a family of related transcription factors implicated in cancer development. SOX2 gene has clinical applications including screening in asymptomatic individuals, confirming a suspect diagnosis and early detection of recurrent disease. This study was conducted on 58 biopsy specimens from malignant (24) and peri-malignant (34) hepatic tissues taken from patients suffering of HCC of HCV pathogenesis. Immunohistochemical staining of liver sections using anti-SOX2 monoclonal antibody was performed and the expression parameters were scored and evaluated in relation to hepatitis activity and stage of fibrosis as well as the grade of HCC. HCC showed significantly high percentage of positive SOX2 expression (83.3%) compared to non-malignant hepatic tissue (13.3%), while all cases of dysplasia showed positive expression of SOX2 (100.0%). We also found a highly increase in the percentage of positive SOX2 expression in high grade tumors (100.0%) in comparison to low grade tumors (75.0%). No significant correlations were found between hepatitis activity or the stage of fibrosis with the different parameters of SOX2 expression. In conclusion, lower SOX2 expression in fibrotic and non-malignant tissues and its higher expression in malignant and dysplastic tissues as well as in cirrhotic hepatic tissue indicated that SOX2 up-regulation represents early one of the events in the development of HCV-related hepatocellular carcinoma. Accordingly, SOX2 might prove to be a reliable marker in the diagnosis of premalignant changes associated with HCV infection.
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