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The growth rate of tissues including tumors is determined by the difference between cell replication and cell death. Among different types of cell death, apoptosis, a form of programmed cell death, is of particular importance. Nongenotoxic carcinogens exert their carcinogenic effects not only via stimulation of cell replication but also by modulating the incidence of apoptosis. This can be seen at different stages of carcinogenesis: a) After initiation in the liver, many initiated cells may undergo apoptosis and never develop into preneoplastic foci, as suggested by both biological and mathematical studies. Thus, apoptosis appears to determine the efficiency of initiation. b) In the promotion stage, early preneoplastic hepatic foci originate either from treatment with a genotoxic carcinogen or spontaneously exhibit much higher rates of cell replication than normal cells, but nevertheless show little preferential growth. This is due to enhanced rates of apoptosis. Some tumor promoters were found to inhibit apoptosis and thereby accelerate foci growth and carcinogenesis. c) In neoplastic nodules and tumors, apoptosis has been shown to be an important growth determinant and to be regulated by growth regulatory hormones, which thereby may decrease or accelerate tumor growth. Studies on the regulation of apoptosis revealed that in the liver, transforming growth factor TGF-beta 1 is involved in the initiation of apoptosis. This was based on three lines of evidence: TGF-beta 1 induced apoptosis in isolated hepatocytes, b) in vivo hepatocytes undergoing apoptosis showed positive immunostaining with antibodies against a precursor of TGF-beta 1.(ABSTRACT TRUNCATED AT 250 WORDS)

Apoptosis is a type of programmed cell death involved in growth control of tissues. It is considered as a cellular suicide functionally opposite to mitosis. It may serve to remove "unwanted" damaged or dangerous, e.g. precancerous, cells. Chemical compounds can interfere with the regulatory network which controls apoptosis and can thereby stimulate or prevent cell death. Both induction or inhibition of apoptosis may result in various diseases such as of the immune system, malformation or tumor development. The protective role of apoptosis against carcinogenesis is described in some detail. Tumor formation seems to occur through several stages, namely initiation, promotion, progression, and involves formation and growth of premalignant cell populations. At least in some model systems initiated cells and premalignant cell populations have been found to exhibit enhanced cell replication, but also enhanced apoptotic activity as compared to the normal tissue. Therefore, initiated cells may be eliminated by apoptosis. Tumor promoters can inhibit apoptosis in putative preneoplastic cells and thereby accelerate tumor development. Furthermore, in hormone-dependent cancers malignant cells may undergo massive apoptosis in response to hormone withdrawal or antihormone treatment. Finally, the regulation of apoptosis will be addressed. Our results suggest that transforming growth factor beta 1, a negative regulator of epithelial tissue growth, is a signal inducing apoptosis of liver cells.

Recently old rats were found to be much more susceptible than young rats to the hepatocarcinogenic effect of a 55-59-week treatment with the peroxisome proliferator nafenopin (NAF) (B. Kraupp-Grasl, W. Huber, H. Taper, and R. Schulte-Hermann, Cancer Res., 51: 666-671, 1991). In the present study indicators of oxidative stress were measured in the livers of the same animals (male Wistar). NAF enhanced peroxisomal beta-oxidation 10-12-fold and reduced glutathione peroxidase activity by 40-50%. Indicators of lipid peroxidation like thiobarbituric acid reactive substances and malondialdehyde were both decreased by one-third and two-thirds, respectively. Of the oxidation-sensitive polyunsaturated fatty acids linoleic acid and docosahexaenoic acid were decreased by 40% and two-thirds, respectively, but the particularly sensitive arachidonic acid remained unchanged. Taken together these data suggest that NAF did not significantly enhance lipid peroxidation in the present experiment. All NAF effects were of the same magnitude in the old and young animals. Therefore, the considerably stronger induction of hepatocarcinoma by NAF in the old animals was not associated with evidence of enhanced oxidative stress. These findings are consistent with the hypothesis that NAF acts hepatocarcinogenically by promotion of tumor development from preneoplastic lesions occurring spontaneously with age.

We investigated the mechanism of the hepatocarcinogenic action of nafenopin (NAF), a nongenotoxic peroxisome proliferator. Groups of male rats aged 13 wk (designated "young") or 57 wk (designated "old") were fed NAF for 13 mo; additional groups received a basal diet or a phenobarbital (PB)-containing diet as positive control. The following results were obtained. (a) NAF produced numerous hepatocellular adenomas and carcinomas in old animals but very few in young animals. A similar result, although less pronounced, was seen with PB. Adenomas of PB-treated groups mostly consisted of eosinophilic and glycogen-storing cells. However, adenomas and carcinomas of NAF-treated livers were composed of weakly basophilic cells. (b) Phenotypically altered foci, evaluated in hematoxylin:eosin-stained sections, appeared spontaneously in untreated livers. The majority of these foci was either of the eosinophilic-clear cell or the tigroid cell type. In addition, we identified foci which are characterized by weak, diffuse cytoplasmatic basophilia. Their phenotype was similar to that of adenomas and carcinomas in NAF-treated rats. The number and size of eosinophilic-clear cell and of tigroid cell foci increased considerably with the age of the animals. At the end of the experiment, approximately 2.4% of liver tissue was occupied by focal cells. NAF, but not PB, treatment led to a selective increase in number and size of weakly basophilic foci. This subtype has previously been described as a likely precursor lesion for liver tumors induced by an aflatoxin B1-NAF initiation-promotion regimen (B. Kraupp-Grasl et al., Cancer Res., 50:3701-3708, 1990). These findings suggest that the peroxisome proliferator NAF leads to tumor development in aging rat liver by promotion of spontaneously occurring preneoplastic lesions. The type of lesion appears to be different from that promotable by PB.

The involvement of tumor promotion in the hepatocarcinogenic action of peroxisome proliferators has not been generally accepted. We studied the effect of nafenopin (NAF) as a model compound in a two-stage initiation-promotion protocol. Carcinogenesis was initiated by a single dose of aflatoxin B1 (AFB1) in female (AFB1, 5 mg/kg) and male (AFB1, 2 mg/kg) Wistar rats. After recovery NAF was fed via the diet, providing a daily dose of 100 mg/kg body weight. Phenobarbital (PB) (50 mg/kg body weight) was fed to female rats as a positive control. The following results were obtained. (a) At weeks 40, 55, 59, and 70, significantly more and larger liver tumors were present in AFB1-NAF-treated rats than in rats receiving either compound alone, and the effect of the combined treatment was clearly more than additive, in three independent experiments including both sexes. This suggests tumor promotion by NAF. Male rats responded more strongly than females. Similarly, PB enhanced the yield of liver tumors. Histologically, tumors were hepatocellular adenoma or carcinoma. In group AFB1-PB the majority consisted of eosinophilic and glycogenstoring cells. However, adenoma and carcinoma of groups AFB1-NAF and O-NAF consisted of weakly basophilic cells. (b) Phenotypically altered foci were evaluated in hematoxylin- and eosin-stained liver sections from the female rats. NAF treatment after AFB1 had little effect on number and size of eosinophilic-clear cell foci and decreased the number of trigroid foci. However, it led to a dramatic increase (20-fold after 70 weeks of NAF treatment) in number and size of foci of a special phenotype that was extremely rare after AFB1 alone and virtually absent in group AFB1-PB. Hepatocytes in these foci are characterized by weak diffuse basophilia and some eosinophilia, similar to the phenotype in adenoma and carcinoma, and by absence of gamma-glutamyltranspeptidase (GGT) expression. Based on these findings, we propose the hypothesis that NAF promotes the development of liver tumors via a mechanism involving amplification of a specific subtype of altered hepatic foci.

Non-genotoxic hepatocarcinogens share the ability to induce liver growth in rodents. Phenobarbital (PB), as one prototype compound, promotes the development of liver tumors; altered cell foci of the clear-eosinophilic phenotype, also identified by gamma-glutamyltransferase expression, appear to be precursor lesions. These foci seem to over-respond to the growth-inducing effect of PB. In contrast, the question as to whether peroxisome inducers are also tumor promoters is still unsettled. We will present evidence which strongly suggests that the peroxisome inducer, nafenopin (Naf), promotes tumor development in rat livers by stimulating selective growth of a hitherto undescribed subtype of altered foci. This subtype is characterized by weak diffuse cytoplasmic basophilia of its hepatocytes. Initiation in rats by aflatoxin B1 followed by promotion with Naf produced numerous adenomas and carcinomas; their morphology resembled that of the weakly basophilic foci. Both clear-eosinophilic and weakly basophilic foci appear "spontaneously" in the liver of aging rats. Promotion of such lesions by PB-type compounds or peroxisome inducers may explain cancer formation by these non-genotoxic agents.