The Basic Research And Clinical For Kaposi’s Sarcoma

Background:Kaposi’s sarcoma is a multifocal mesenchymal neoplasm, mainly constructed by abnormal endothelial cells, characterized by neoangiogenesis, inflammatory infiltration and endothelial-derived, spindle shaped tumour cells. It is associated with infection by human herpesvirus 8 (HHV8; also known as Kaposi’s sarcoma-associated herpesvirus). However, the majority of KS cases occur when infected patients also suffer from some coincident form of chronic inflammatory cell infiltration and immune deregulation, providing a favorable microenvironment for tumor development. HHV-8 is mainly spreaded among gays, and occasionally through the mother to child transmission and organ transplantation, and even through saliva, etc. HHV-8 infection rates are considerable variation in different regions of different populations, but parallel with the morbidity of KS. With the universal morbidity of AIDS after the 1980s, the incidence of KS has risen dramatically and Kaposi’s sarcoma is a relatively common neoplasm. The current treatment is not completely cured KS, but can only alleviate the symptoms, reduce the tumor and prevent further development.Object:In order to completion of the basic and clinical study of Kaposi’s sarcoma by finding out the pathogenesis of Kaposi’s sarcoma in genome and molecular biology level, and analyzing the clinical characteristics of Kaposi’s sarcoma.Methods:The literatures associated with the pathogenesis and clinical features of kaposi’s sarcoma were retrieved in PUBMED (http://www.ncbi.nlm.nih.gov/pubmed/). The pathogenesis of Kaposi’s sarcoma in genome and molecular biology level was studied based on the reported in the literatures. At the same time, combining with the patient’s medical history, physical examination, laboratory examination, imaging examination and histopathologic examination of a patient with kaposi’s sarcoma, we further studied the epidemiological and clinical characteristics of kaposi’s sarcoma.Results:A 77-year-old man of Chinese Han, had a fever for ten days, maroon nodule on his right lower extremities, dorsum of feet, extremities and cheek two months, gastrointestinal bleeding, left pleural effusion six months. HIV was negative, Cd4+/Cd8 +ratio was 0.44 (range:1.02-1.95). Multiple nodular, patchy high density shadow was in thorax CT. Biopsies and immunohistochemical stains from one nodule and hyperkeratotic lesion were assessed as KS.There are four types of KS:1)classical KS:mainly occurred in elderly male patients,with lesions incipient diffused distribution of the purple pigment spots,and plaque and nodules in progression tage mostly in the extremes of limbs.There are four stage:a. Spotted nodules period,during which skin lesion confined to the limb;b.infiltration stage,larger skin lesion confined to the limb than former.c.worsening period,besides larger lesions,at least one sites with ulcer.d.spread stage,skin lesions have already developed to other parts except limbs.2)African KS:main effect children and adolescents in sub-saharan Africa.Its clinical course various a lot and common type is the typical skin lesions scattered the Limbs.Visceral is often involved,and sometimes leaves fatal sequelae.Systemic lymph node enlargement is a common characteristicsand oral damage is also common,too.3) Epidemic type or acquired immunodeficiency syndrome type((AIDS-KS), was most common and invasive, especially on the progress of HIV/AIDS with poorly prognosis. With the decline in the number of CD4 cells and impaired immune function, the skin lesions are quickly formed nodules. More than half of the patients had visceral damage, mostly affected gastrointestinal tract and lung, characterized by vomiting, diarrhea, abdominal pain, weight loss, cough, hemoptysis and dyspnea and so on, mainly independent of skin damage.4) Organ transplant type KS:more closely to HHV-8 infection.KS happened after organ reansplanted hints that potential virus infection can lead to the occurrence of KS,and virus from organ donors may be a fisk factor of KS.5/8 Patients of kidney transplant is HHV-8 positive also explains that HHV-8 is a main reason of KS.Conclusions:The medical history, skin lesions and imageological examination of the KS patients is helpful to diagnosis, and biospy is confirmed diagnosis.As to the pathogenesis of KS,it is thought at present to due to the immune system defects,normal endothelial cells are continuous proliferation under the stimulus of some angiogenic factor.Lots of studies have revealed that the happening and development of HIV-related KS is related to body immunity(CD4).The lower the CD4 is,the higher the morbidity is.In the early stages of the patients started HAART(Immune reconstruction phase),the morbidity is obviously increased.Since 1994,the research of KS related virus become hotspot.The detection rate of HHV-8 is 95% in the KS focus tissue.However,since the KSHVDNA in the endothelial cells is also negative,its role in the mechanism of tumor transformation is still unclear.Now the role of HHV-8 in the happening and development of KS and related therapy is under study.After infected by KSHV, whether the body will develop KS is depend on the unique microenvironment of the virus and the host, which include four aspects:1.the initial infection virus process;2.proliferation, and migration of the infected endothelial cells;3.induction of the inflammatory response;4.the formation of tumor.Also,multiply cytokines secreted by virus and cells play an important role in the formation of KS.Till now,most of the datas of the happening and development of KS were gained from genes analysis which is also of great value.However,it is more important to bulid an assessment level of KS.Moreover,the relationship of therapy and virus needs to be verified during animal experiences as well as to do severe clinical assessment for KSHV serumpositive patients with no-symptoms and symptoms.We can get a comprehensive understanding of KS only after we gained more informations of the interaction between virus encoding proteins and host immune system as well as this interaction can lead to the happening of KS.Nowadays the virus immune escape, oncogenesis, the role of inflammatory cytokines and vascular proliferation which are related to the happening of KS give direction of clinical therapy.Elementary effects have gained on numerous clinical tests such as the role of paralyser of VGEF and MMPs and cytolines pathways.What we can look forward to is the study of the molecular mechanism of KS will certainly provide a large number of valuable treatment for clinic.