Possible involvement of leptin and leptin receptor in developing gastric adenocarcinoma

AIM： To investigate the expression of leptin and leptin receptor （ob-R） in intestinal-type gastric cancer and precancerous lesions, and to explore the possible mechanism and role of the leptin system in developing intestinal-type gastric adenocarcinoma.METHODS： Immunohistochemistry was performed to examine the expression of leptin and leptin receptor in archival samples of gastric adenocarcinoma and preneoplastic lesions, including intestinal metaplasia and mild to severe gastric epithelial dysplasia. Positive staining was identified and percentage of positive staining was graded.RESULTS： Dual expression of leptin and leptin receptor were detected in 80% （16/20） intestinal metaplasia, 86.3% （25/30） mild gastric epithelial dysplasia, 86.7% （26/30） moderate gastric epithelial dysplasia, 93.3% （28/30） severe gastric epithelial dysplasia, 91.3% （55/60） intestinal-type gastric adenocarcinoma and 30.0% （9/30） diffuse-type gastric carcinoma. The percentage of dual expression of leptin and leptin receptor in intestinal-type gastric adenocarcinoma was significantly higher than that in diffuse-type gastric adenocarcinoma （χ^2 = 37.022, P〈0.01）.CONCLUSION： Our results indicate the presence of an autocrine loop of leptin system in the development of intestinal-type gastric adenocarcinoma.

Randomized Double-Blind Clinical Trial of Moluodan(摩罗丹)for the Treatment of Chronic Atrophic Gastritis with Dysplasia

Objective： To assess the efficacy and safety of Moluodan （摩罗丹~） in treating dysplasia in chronic atrophic gastritis （CAG） patients. Methods： This was a multi-centered, double-blind, randomized controlled trial. The total of 196 subjects were assigned to receive either Moluodan or folic acid in a 2：1 ratio by blocked randomization. Mucosa marking targeting biopsy （MTB） was used to insure the accuracy and consistency between baseline and after 6-month treatment. Primary outcomes were histological score, response rate of pathological lesions and dysplasia disappearance rate. Secondary endpoints included gastroscopic findings, clinical symptom and patient reported outcome （PRO） instrument. Results： Dysplasia score decreased in Moluodan group （P=0.002）, significance was found between groups （P=0.045）. Dysplasia disappearance rates were 24.6% and 15.2% in Moluodan and folic acid groups respectively, no significant differences were found （P=0.127）. The response rate of atrophy and intestinal metaplasia were 34.6% and 23.0% in Moluodan group, 24.3% and 13.6% in folic acid group. Moluodan could improve erythema （P=0.044）, and bile reflux （P=0.059）, no significance between groups. Moluodan was better than folic acid in improving epigastric pain, epigastric suffocation, belching and decreased appetite （P〈0.05）, with symptom disappearance rates of 37% to 83%. Conclusions： Moluodan improved dysplasia score in histopathology, and erythema and bile reflux score in endoscopy, and superior to folic acid in improving epigastric pain, epigastric suffocation, belching and decreased appetite.