Efficacy of adjuvant mitomycin-C and triamcinoloneimpregnated nasal packing for endoscopic dacryocystorhinostomy

●AIM:To compare the success rate and complications of adjuvant use of mitomycin C and triamcinoloneimpregnated biodegradable nasal packing(TABP)in endoscopic dacryocystorhinostomy(DCR).And to evaluate the efficacy of combining intraoperative mitomycin C and TABP for endoscopic DCR.●METHODS:A total of 198 eyes of 148 patients who underwent endoscopic DCR for acquired nasolacrimal duct obstruction were retrospectively analysed.The patients were randomly divided into three groups:Group A included patients treated without intraoperative mitomycin C but with TABP,Group B included patients treated without triamcinolone but with intraoperative mitomycin C and normal saline-impregnated nasal packing,and Group C included patients treated with intraoperative mitomycin C and TABP.●RESULTS:The results revealed no significant difference in the overall success rates between Groups A(86.8%)and B(89.2%;P=0.377).However,Group C(97.5%)showed a significantly higher overall success rate than Groups A and B.The incidence of granulomas was significantly lower in group C(5%)than in Groups A(20.8%)and B(15.2%;P=0.009).Other complications,such as crust,synechiae,and revision surgery,did not differ significantly among the three groups.●CONCLUSION:The combination of intraoperative mitomycin C and TABP effectively prevents granulomas and enhances surgical success rate.Additionally,there is no statistically significant difference observed between the use of mitomycin C or TABP alone.

Transepithelial photorefractive keratectomy without mitomycin-C for irregular astigmatism after femtosecond laser-assisted in situ keratomileusisflap complications

Dear Editor,W e write to present a case report of transepithelial photorefractive keratectomy(TPRK)without mitomycin-C(MMC)for irregular astigmatism after femtosecond laser-assisted in situ keratomileusis(FS-LASIK)flap complications.Written informed consent was obtained from the patient to allow the publication of this case and associated accompanying images.The study was conducted in accordance with the Helsinki Declaration.TPRK is a surgical procedure which uses an excimer laser to ablation of both the corneal epithelium and stroma,which is widely used in clinic[1-2].The procedure may be conducted in cases where there is notable topographic irregularity or scarring following complications with the LASIK flap.Corneal haze is a potential complication following TPRK,and the use of MMC as a prophylactic agent against postoperative corneal haze has been demonstrated to significantly reduce its formation after TPRK/photorefractive keratectomy(PRK).

Posterior scleral application of a mitomycin C-soaked sponge during trabeculectomy

AIM:To evaluate the safety and efficacy of posterior scleral application(a modified technique)of an antimetabolite mitomycin C-soaked sponge in trabeculectomy for patients with glaucoma.METHODS:This retrospective study included 101 patients(115 eyes)with glaucoma(aged 12–83y)who underwent trabeculectomy using a modified mitomycin C-soaked sponge placement method.A piece of 3.5×10 mm2 sponge was placed vertically and posteriorly with the long side perpendicular to the limbus.The mitomycin C concentration and exposure time were 0.2–0.5 mg/m L and 1–5min,respectively.Intraocular pressure,bestcorrected visual acuity,and hypotensive medications were recorded at baseline and at the final visit.Complications,interventions required,and bleb morphology were recorded postoperatively.The primary outcome was trabeculectomy safety,including complications and bleb morphology;the secondary outcome was the trabeculectomy success rate.RESULTS:At the final follow-up[median 28mo,range 7–67mo and interquartile range(IQR)13mo],the qualified(cumulative)success rate was 93.0%and the complete success rate was 60.0%.No bleb-related complications were observed.The mean height,extent,and vascularity grades were 0.6±0.9,1.1±0.4,and 2.4±0.9,respectively.All Seidel tests were negative.The mean posteriority grade was 0.8±0.4.CONCLUSION:Trabeculectomy with the long side of a mitomycin C-soaked sponge placed perpendicular to the corneal limbus is safe and effective.

Mitomycin C and capecitabine: An additional option as an advanced line therapy in patients with metastatic colorectal cancer

BACKGROUND In recent years survival of patients with metastatic colorectal cancer(mCRC),though still limited,has improved significantly;clearly,when the disease becomes refractory to standard regimens,additional treatment options are needed.Studies have shown that mitomycin C(MMC),an antitumor antibiotic,and capecitabine,a precursor of 5-fluorouracil,may act synergistically in combination.The efficacy of MMC/capecitabine has been demonstrated in the first-line setting,but only a few small studies have tested it in the advanced-line setting,with contradictory results.received a median of 2 MMC/capecitabine cycles(range 0.5-9.0).Thirty-four patients(28.6%)experienced grade≥3 toxicity,including 2(1.7%)with grade 4;there was no drug-related mortality.The objective response rate was 0.8%,and the disease control rate,24.4%.Median progression-free survival(PFS)was 2.1 mo(range 0.2-20.3),and median overall survival,4.8 mo(range 0.2-27.5).The 6-month overall survival rate was 44%;8.7%of patients remained progression-free.Factors associated with longer PFS were lower gamma-glutamyl transferase level(P=0.030)and primary tumor location in the left colon(P=0.017).Factors associated with longer overall survival were lower gamma-glutamyl transferase level(P=0.022),left-colon tumor location(P=0.044),low-to-moderate histological grade(P=0.012),Eastern Cooperative Oncology Group performance status 0-1(P=0.036),and normal bilirubin level(P=0.047).CONCLUSION MMC/capecitabine is an active,available,and relatively safe regimen for use beyond standard lines of therapy in mCRC.Several clinical and laboratory parameters can identify patients more likely to benefit.

Value of selective chemoembolization in treatment of hepatic metastases in colorectal carcinoma

AIM To explore the therapeutic effect of chemoembolization in hepatic metastases in colorectal carcinoma. METHODS Forty patients underwent chemoembolization of metastatic liver lesion from colorectal carcinoma. Selective angiography of the hepatic artery was performed to identify the feeding vessels of the metastatic lesion. The injected chemoemulsum consisted of 100*!mg 5 fluorouracil, 10*!mg mitomycin C and 10*!mL lipiodol ultra fluid in a total volume of 30*!mL . Gel foam embolization then followed until stagnation of blood flow was achieved. Patients were evaluated for response, over all survival, and side effects. RESULTS Overall median survival time from date of first chemoembolization was ten months. Median survival time of cirrhotic patients with class A and B by Child Pugh classification was 24 and 3 months, respectively. The difference was significant, ( P <0 01) . Patients with metastatic disease confined to the liver did better than those who also had extrahepatic disease, with median survivals of 14 and 3 months, respectively ( P <0 02) . There were significant differences in that median survival of patients with hypervascular metastases was longer than that of patients with hypovascular metastases. The most common side effects were transient fever, abdominal pain and fatigue. Three patients died within one month from the procedure. CONCLUSION The therapeutic effect of systemic chemotherapy in hepatic metastases of large intestinal carcinoma was not satisfactory and there were more side effects, whereas the therapeutic effect of selective chemoembolization was promising and there were less side effects. Selective chemoembolization may be an effective first line therapy in hepatic metastases of large intestinal carcinoma.

丝裂霉素C诱发小鼠外周血和骨髓细胞微核率的比较

微核实验自创建以来,已得到广泛应用。但仅有小鼠骨髓嗜多染红细胞(polyc-hromatic erythrocytes,PCE)微核实验发展为标准实验。而以骨髓为实验材料易受采样限制,也不能对动物进行长期动态观察。1980年,MacGregor等首先证明小鼠外周血PCE微核(micronuclei,MN)率与骨髓PCE微核率相当,若能以外周血作为材料,实验无疑会大大简化。但近年来国内外有关外周血微核率的报道结果有些混乱。为了进一步研究微核在外用血PCE、正染红细胞(normochromatic erythrocytes,NCE)和骨髓PCE中的分布情况,我们以丝裂霉素C)(mitomycinC,MMC)为诱变剂,观察了小鼠外周血PCE、NCE以及骨髓PCE微核率之间的关系。

Relationship between Fas/ FasL expression and apoptosis of colon adenocarcinoma cell lines

INTRODUCTIONFas/ FasL system has been identified as a keymediator of apoptosis in tumor cells[1-4]. Theoccurrence and development of neoplasm are closelyrelated to apoptosis[5-7] Most chemotherapeuticdrugs kill cancer cells mainly by inducingapoptosis[8-14].'

Studies on Mitomycin C Dextran-microspheres

In this paper,the preparation and properties of mitomycin C dextran-microspheres(MMC-DMS)were reported.The characteristics of pharmacokinetics and embolization effects of MMC-DMS in vivo were studied in dogs.The average diameter of the microspheres was 75±19μm and the content was 5% of MMC.In in vitro experiment, the release rate of drug demonstrated that the microspheres had sustained-release properties. The microspheres and conventional MMC were infused into the hepatic artery of dogs through a catheter for embolization,respectively.The plasma concentration of MMC was de- termined by HPLC.Results showed that the peak concentration of conventional MMC was 2.6 times as much as MMC-DMS.Angiograms revealed that peripheral blood vessels de- creased obviously in liver.The histopathologic examination showed that the microspheres lodged in the hepatic artery and displayed nodular necrosis in the embolized segment.The MMC-DMS were used in clinical trial in 100 patients with hepatic cancer.The tumor reduc- tion and improvement of symptoms in patients were observed after hepatic arterial embolization.The survival duration was prolonged.Results showed that the MMC-DMS is a promising embolic agent for treatment of hepatic cancer.It could aid in the use of intensive chemotherapy with minimum systemic side effect.

丝裂霉素C胶原膜用于兔眼非穿透小梁术的安全性研究

目的评价不同浓度丝裂霉素C(mitomycin C,MMC)胶原膜应用于非穿透性小梁手术的安全性。方法建立测定MMC兔眼玻璃体浓度的高效液相色谱法(HPLC),离心法制猪巩膜干态胶原膜,浸泡在MMC溶液中制成不同浓度的MMC胶原膜。健康纯种日本长耳白兔随机分为6组,双眼行非穿透性小梁手术。A、B、C、D四组分别联合植入不同浓度的MMC胶原膜,E组术中一次使用200mg/L MMC,F组为空白组。术后1周比较术区角巩膜缘情况,分别于1周和4周时应用HPLC法检测各组玻璃体腔内MMC浓度并比较。结果本色谱条件下,MMC在玻璃体腔中的线性范围为0.1～2.5mg/L,相关系数(r)为0.9970。术后1周时,C组、D组MMC浓度显著高于E组(P<0.001);术后4周时,A组与E组无明显差异(P>0.05),B组、C组、D组高于E组(P<0.01)。结论玻璃体腔内MMC浓度随胶原膜载释MMC浓度的增加而增加,载释低浓度MMC(50mg/L)玻璃体腔内MMC浓度的安全性更高。

Interaction between Mitomycin C and DNA at Paraffined Graphite Electrode

Aim To investigate the electrochemical behaviors of Mitomycin C （MC） and its interaction with calf thymus DNA （ctDNA）. Methods The cyclic vohammetry （CV） was carried out at a paraffined graphite electrode. Results MC showed a well-defined oxidation-reduction peak. As a result of reaction with ctDNA, the peak current of MC decreased apparently. According to corresponding electrochemical equations, the diffusion coefficient of both free and MC-DNA complex have been determined, and the heterogeneous rate constants were also obtained simultaneously. Conclusion The solid paraffined graphite electrode could be used to estimate parameters of the interaction between DNA and MC, and provide the convenient and sensitive analysis.

Tumour Localization of A Mitomycin C-Monoclonal Antibody MGb_2 Conjugate in Nude Mice with Human Gastric Carcinoma Xenografts

MGb2 is a monoclonal antibody againstgastric cancer.It can be well localized in thetumour tissue and has been successfully used inthe radioimmunoimaging in the patients withgastric cancer.The conjugate of MGb2 withchemotherapeutic drug mitomycin C（MMC）al-so shows highly selective cytotoxic effect uponhuman gastric cancer cells in vitro.

Antitumor efficacy of lidamycin on hepatoma and active moiety of its molecule

AIM: To study the in vitro and in vivo antitumor effect of lidamycin (LDM) on hepatoma and the active moiety of its molecule.METHODS: MTT assay was used to determine the growth inhibition of human hepatoma BEL-7402 cells, SMMC-7721cells and mouse hepatoma H22 cells. The in vivo therapeutic effects of lidamycin and mitomycin C were determined by transplantable hepatoma 22 (H22) in mice and human hepatoma BEL-7402 xenografts in athymic mice.RESULTS: In terms of IC50values, the cytotoxicity of LDM was 10 000-fold more potent than that of mitomycin C (MMC)and adriamycin (ADM) in human hepatoma BEL-7402 cells and SMMC-7721 cells. LDM molecule consists of two moieties,an aproprotein (LDP) and an enediyne chromophore (LDC). In terms of IC50 values, the potency of LDC was similar to LDM. However, LDP was 105-fold less potent than LDM and LDC to hepatoma cells. For mouse hepatoma H22 cells, the IC50value of LDM was 0.025 nmol/L. Given by single intravenous injection at doses of 0.1, 0.05 and 0.025 mg/kg, LDM markedly suppressed the growth of hepatoma 22 in mice by 84.7%, 71.6% and 61.8%,respectively. The therapeutic indexes (TI) of LDM and MMC were 15 and 2.5, respectively. By 2 iv. Injections in two experiments, the growth inhibition rates by LDM at doses of 0.1, 0.05, 0.025, 0.00625 and 0.0125 mg/kg were 88.8-89.5%, 81.1-82.5%, 71.2-74.9%, 52.3-59.575%,and 33.3-48.3%, respectively. In comparison, MMC at doses of 5, 2.5, and 1.25 mg/kg inhibited tumor growth by 69.7-73.6%, 54.0-56.5%, and 31.5-52.2%,respectively. Moreover, in human hepatoma BEL-7402 xenografts, the growth inhibition rates by LDM at doses of 0.05 mg/kg ×2 and 0.025 mg/kg ×2 were 68.7%and 27.2%, respectively. However, MMC at the dose of 1.25 mg/kg ×2 showed an inhibition rate of 34.5%. The inhibition rate of tumor growth by LDM was higher than that by MMC at the tolerated dose.CONCLUSION: Both LDM and its chromophore LDC display extremely potent cytotoxicity to hepatoma cells. LDM shows a remarkable therapeutic efficacy against murine and human hepatomas in vivo.

A pharmacological review on intraperitoneal chemotherapy for peritoneal malignancy

Perioperative intraperitoneal chemotherapy in combination with cytoreductive surgery has been shown to be of benefit for treating selected patients with peritoneal surface malignancy.It has become a new standard of care in the management of diffuse malignant peritoneal mesothelioma and peritoneal dissemination of appendiceal malignancy.Numerous recent publications on carcinomatosis from colorectal cancer and gastric cancer identify groups of patients that would benef it from this local-regional approach for prevention and treatment of carcinomatosis.This review focuses on pharmacological information regarding intraperitoneal chemotherapeutic agents commonly used in gastrointestinal oncology.

Therapeutic upper gastrointestinal tract endoscopy in Paediatric Gastroenterology

Since the first report of use of endoscopy in children in the 1970 s, there has seen an exponential growthin published experience and innovation in the field. In this review article we focus on modern age therapeutic endoscopy practice, explaining use of traditional as well as new and innovative techniques, for diagnosis and treatment of diseases in the paediatric upper gastrointestinal tract.

Clinical analysis of risk factors contributing to recurrence of pterygium after excision and graft surgery

AIM: To find the risk factors related to the reproliferation of the pterygial tissue after excision and graft surgery.METHODS: Charts of 130 eyes of 130 patients who had pterygial excision from March 2006 to April 2011 were reviewed. Preoperative pterygium morphology, surgical methods, and adjunctive treatments were statistically analyzed for their relationship with recurrence.RESULTS: During the follow-up period, recurrence was observed in 20 eyes(15.4%). None of the preoperative morphologic features were affected the rate of the recurrence. However, an age 【40y [P =0.085, odds ratio(OR) 3.609, 95% confidence interval(CI) 0.838-15.540]and amniotic membrane graft instead of conjunctival autograft(P =0.002, OR 9.093, 95% CI 2.316-35.698) were statistically significant risk factors for recurrence.Multivariate analysis revealed that intraoperative mitomycin C(MMC)(P =0.072, OR 0.298, 95% CI 0.080-1.115)decreased the rate of recurrence. CONCLUSION: Younger age is a risk factor for reproliferation of pterygial tissue after excision and amniotic membrane transplantation(AMT) are less effective in preventing recurrence of pterygium after excision based on the comparison between conjunctival autograft and AMT. Intraoperative MMC application and conjunctival autograft reduce recurrence.

Study of Low-intensity 2450-MHz Microwave Exposure Enhancing the Genotoxic Effects of Mitomycin C Using Micronucleus Test and Comet Assay in vitro

Objective To determine the interaction between 2450-MHz microwaves (MW) radiation and mitomycin C (MMC). Methods The synergistic genotoxic effects of low-intensity 2450-MHz microwave and MMC on human lymphocytes were studied using single cell gel electrophoresis (SCGE) assay (comet assay) and cytokinesis-blocked micronucleus (CBMN) test in vitro. The whole blood cells from a male donor and a female donor were either only exposed to 2450-MHz microwaves (5.0 mW/cm2) for 2 h or only exposed to MMC (0.0125 μ/mL, 0.025 μg/mL, 0.05μg/mL and 0.1 μg/mL) for 24 h; and the samples were exposed to MMC for 24 h after exposure to MW for 2 h. Results In the comet assay, the comet lengths ( 29.1 μm and 25.9 μm) of MW were not significantly longer than those (26.3 μrn and 24.1 μm) of controls (P>0.05). The comet lengths (57.4 μm, 68.9 μm, 91.4 μm, 150.6μm and 50.6 μm, 71.7μm, 100.1 μm, 145.1 μm) of 4 MMC groups were significantly longer than those of controls (P<0.01). The comet lengths (59.1 μm, 92.3 μm, 124.5 μm, 182.7 μm and 57.4 μm, 85.5 μm, 137.5 μm, 178.3 μm) of 4 MW plus MMC groups were significantly longer than those of controls too (P<0.01). The comet lengths of MW plus MMC groups were significantly longer than those of the corresponding MMC doses (P<0.05 or P<0.01) when the doses of MMC were ≥50.025 μg/mL. In the CBMN, the micronucleated cell (MNC) rates of MW were 5% and 6%, which showed no difference compared with those (4‰ and 4‰) of controls (P>0.05). The MNC rates of 4 MMC groups were 8‰, 9‰, 14‰, 23‰ and 8‰, 8‰, 16‰, 30‰ respectively. When the doses of MMC were 3≥0.05 μg/mL, MNC rates of MMC were higher than those of controls (P<0.05). MNC rates of 4 MW plus MMC groups were 12‰, 13‰, 20‰, 32‰ and 8‰, 9‰, 23‰, 40‰. When the doses of MMC were 5≥0.05 μg/mL, MNC rates of MW plus MMC groups were much higher than those of controls (P<0.01). MNC rates of 4 MW plus MMC groups were not significantly higher than those of the corresponding MMC doses. Conclusion The low-intensity 2450-MHz microwave radiation can not induce DNA and chromosome damage, but can increase DNA damage effect induced by MMC in comet assay.

Bare sclera resection followed by mitomycin C and/or autograft limbus conjunctiva in the surgery for pterygium:a Meta-analysis

AIM: To evaluate the recurrence and complications after bare sclera resection (BSR) combined with mitomycin C (MMC) treatment and/or autograft limbus conjunctiva (ALC) in the surgery for pterygium. METHODS: Meta -analysis was used to evaluate the differences in patient outcomes between BSR of pterygium with or without MMC and/or ALC. All included studies were randomized trials of patients with pterygium who received BSR followed by MMC and/or ALC in the surgery. The recurrence of pterygium and other complications resulting from different treatments were extracted for analysis. RESULTS: Thirteen studies met the inclusion criteria. The recurrence of pterygium with intraoperative (10) MMC was higher than that with ALC (OR=2.38,95% confidence interval 1.45-3.91, I-2=29%). Postoperative MMC resulted in an incidence of recurrence similar to that of ALC (OR= 0.66, 95% confidence interval 0.30-1.42, I-2=0%), and 10 MMC treatment in combination with ALC produced similar patient outcomes to ALC alone (OR =0.41, 95% confidence interval 0.16-1.01, I-2=16%). Other complications such as punctate epitheliopathy, scleral thinning and ischemia, irritation and persistent epithelium defect, were more common in patients in the MMC group as compared to those treated with ALC. CONCLUSION: The recurrence of pterygium with BSR followed by ALC is lower than that of BSR followed by MMC, and the incidence of other complications is lower. While ALC is a more effective strategy for treating pterygium, the quality of the ALC transplant should be considered when the patient has a history of glaucoma.

Mitomycin C in pterygium treatment

Pterygium is a benign lesion usually growing from the nasal side of the conjunctiva onto the cornea.Most cases of pterygium does not cause problem or requires specific treatment.The exact cause of pterygium is not clear yet,but some factors are pointed as causes,being the most important the long-term ultraviolet ray exposure.Pterygium surgery is usually considered when there are symptoms that do not respond to conservative treatment.Recurrence is the main complication of the surgery,and much has been done to avoid it.Mitomycin C（MMC） has been used as a fibroblast proliferation inhibitor during the surgery to reduce the chance of recurrence of the pterygium.This review describes the use of MMC as an adjunctive,the optimal dosage,the duration of administration of MMC and possible complications,when used during,after and before the surgery.Most studies suggest that increased exposure（dose or duration） of MMC is associated with a lower recurrence,but with higher risks of complications.

Stable transfection of extrinsic Smac gene enhances apoptosis-inducing effects of chemotherapeutic drugs on gastric cancer cells

AIM: To explore the feasibility of enhancing apoptosis-inducing effects of chemotherapeutic drugs on human gastric cancer cells by stable transfection of extrinsic Smac gene. METHODS: After Smac gene was transferred into gastric cancer cell line MKN-45, subclone cells were obtained by persistent G_(418) selection. Cellular Smac gene expression was determined by RT-PCR and Western blotting. After treatment with mitomycin (MMC) as an apoptotic inducer, in vitro cell growth activities were investigated by trypan blue-staining method and MTT colorimetry. Cell apoptosis and its rates were determined by electronic microscopy, annexin V-FTTC and propidium iodide staining flow cytometry. Cellular caspase-3 protein expression and its activities were assayed by Western blotting and colorimetry. RESULTS: When compared with MKN-45 cells, the selected subclone cell line MKN-45/Smac had significantly higher Smac mRNA (3.12±0.21 vs 0.82±0.14, t=7.52, P＜0.01) and protein levels (4.02±0.24 vs0.98±0.11, t=8.32, P＜0.01). After treatment with 10 μg/mL MMC for 6-24 h, growth inhibition rate of MKN-45/Smac (15.8±1.2-54.8±2.9%) was significantly higher than that of MKN-45 (5.8±0.4-24.0±1.5%, t=6.42, P＜0.01). Partial MKN-45/Smac cancer cells presented characteristic morphological changes of apoptosis under the electronic microscope with an apoptosis rate of 36.4±2.1%, which was significantly higher than that of MKN-45 (15.2±0.8%, t=9.25, P＜0.01). Compared with MKN-45, caspase-3 expression levels in MKN-45/Smac were improved significantly (3.39±0.42 vs0.96±0.14, t=8.63, P＜0.01), while its activities were 3.25 times as many as those of MKN-45 (0.364±0.010 vs0.112±0.007, t=6.34, P＜0.01). CONCLUSION: Stable transfection of extrinsic Smac gene and its over-expression in gastric cancer cell line can significantly enhance cellular caspase-3 expression and activities, ameliorate apoptosis-inducing effects of mitomycin C on cancer cells, which is a novel strategy to improve chemotherapeutic effects on gastric cancer.

Mitomycin C induces apoptosis in human epidural scar fibroblasts after surgical decompression for spinal cord injury

Numerous studies have shown that topical application of mitomycin C after surgical decompression effectively reduces scar adhesion. However, the underlying mechanisms remain unclear. In this study, we investigated the effect of mitomycin C on the proliferation and apoptosis of human epidural scar fibroblasts. Human epidural scar fibroblasts were treated with various concentrations of mitomycin C （1, 5, 10, 20, 40 μg/mL） for 12, 24 and 48 hours. Mitomycin C suppressed the growth of these cells in a dose- and time-dependent manner. Mitomycin C upregulated the expression levels of Fas, DR4, DR5, cleaved caspase-8/9, Bax, Bim and cleaved caspase-3 proteins, and it downregulated Bcl-2 and Bcl-xL expression. In addition, inhibitors of caspase-8 and caspase-9 （Z-IETD-FMK and Z-LEHD-FMK, respectively） did not fully inhibit mitomycin C-induced apoptosis. Furthermore, mitomycin C induced endoplasmic reticulum stress by increasing the expression of glucose-regulated protein 78, CAAT/enhancer-binding protein homologous protein （CHOP） and caspase 4 in a dose-dependent manner. Salubrinal significantly inhibited the mitomycin C-induced cell viability loss and apoptosis, and these effects were accompanied by a reduction in CHOP expression. Our results support the hypothesis that mitomycin C induces human epidural scar fibroblast apoptosis, at least in part, via the endoplasmic reticulum stress pathway.