Effect of Helicobacter pylori eradication on expression of cyclin D2 and p27 in gastric intestinal metaplasia

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Abstract
Background and aims: Cyclins and cyclin‐dependent kinase inhibitors play a crucial role in the control of cell cycle transitions. Enhanced expression of cyclin D2 and reduced expression of p27kip1 (p27) have been implicated in the pathogenesis of cancer. Because intestinal metaplasia has been regarded as a pre‐malignant lesion, we investigated the expression of cyclin D2 and p27 in Helicobacter pylori‐associated chronic gastritis with and without intestinal metaplasia, and followed the changes after H. pylori eradication. Methods: Expression of cyclin D2 and p27 was studied by immunohistochemistry in 59 patients (including 35 patients with intestinal metaplasia) and in 10 gastric cancer patients. Among them, 29 H. pylori‐infected patients had serial gastric biopsies taken before and at 1‐year after eradication of H. pylori. Results: Expression of cyclin D2 was significantly higher in gastric cancers when compared to their adjacent non‐tumour tissues (median score 3 vs. 1, P=0.015). Over‐expression of cyclin D2 was detected in H. pylori‐associated chronic gastritis and intestinal metaplasia, which was reduced after eradication of the organism (median score 2 vs. 1, P=0.037 in chronic gastritis; median score 2 vs. 0, P=0.008 in intestinal metaplasia). While the normal gastric mucosa showed strong p27 expression, five of the 10 gastric cancer tissues exhibited reduced p27 expression (P=0.039). Diminished p27 expression was also seen in intestinal metaplasia, which was restored 1‐year after H. pylori eradication (eight out of 16 vs. one out of 16, P=0.018). Reduced expression of p27 was frequently associated with increased cyclin D2 expression in H. pylori‐associated intestinal metaplasia (P=0.02). Conclusion: Over‐expression of cyclin D2 and reduced expression of p27 are closely linked to H. pylori‐associated intestinal metaplasia. Eradication of H. pylori infection reverses the aberrant expression of cyclin D2 and p27 in intestinal metaplasia.