Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2023; 11(9): 1963-1973
Published online Mar 26, 2023. doi: 10.12998/wjcc.v11.i9.1963
Clinicopathological features and expression of regulatory mechanism of the Wnt signaling pathway in colorectal sessile serrated adenomas/polyps with different syndrome types
Dan Qiao, Xiao-Yan Liu, Lie Zheng, Ya-Li Zhang, Ren-Ye Que, Bing-Jing Ge, Hong-Yan Cao, Yan-Cheng Dai
Dan Qiao, Xiao-Yan Liu, Ren-Ye Que, Bing-Jing Ge, Hong-Yan Cao, Yan-Cheng Dai, Department of Gastroenterology, Shanghai Traditional Chinese Medicine-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200082, China
Lie Zheng, Department of Gastroenterology, Traditional Chinese Medicine Hospital of Xi’an, Xi’an 730000, Shaanxi Province, China
Ya-Li Zhang, Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
Author contributions: Qiao D and Liu XY contributed equally to this work, and both collected cases and analyzed data; Zheng L and Zhang YL performed pathological examination; Que RY, Ge BJ, and Cao HY prepared the figures and tables; Qiao D and Dai YC wrote and reviewed the manuscript; Dai YC conceived and supervised the study; all authors contributed to the article and approved the submitted version.
Supported by the National Natural Science Foundation of China, No. 81873253; the Shanghai Natural Science Foundation, No. 22ZR1458800; the Hongkou District Health Committee, No. HKZK2020A01; and the Xinglin Scholar Program of Shanghai University of Traditional Chinese Medicine, No. [2020]23.
Institutional review board statement: The Ethics Committee of Shanghai Traditional Chinese Medicine-Integrated Hospital (2020-091-1) approved the experimental protocol.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
Data sharing statement: The data analyzed during this study can be obtained from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Cheng Dai, PhD, Associate Chief Physician, Department of Gastroenterology, Shanghai Traditional Chinese Medicine-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, No. 230 Baoding Road, Hongkou District, Shanghai 200082, China. daiyancheng2005@126.com
Received: November 22, 2022
Peer-review started: November 22, 2022
First decision: February 7, 2023
Revised: February 12, 2023
Accepted: March 3, 2023
Article in press: March 3, 2023
Published online: March 26, 2023
Research background

Colorectal cancer (CRC) is the third most common cancer worldwide, with the fourth highest mortality among all cancers. Reportedly, in addition to adenomas, serrated polyps, which account for 15%-30% of CRCs, can also develop into CRCs through the serrated pathway. Sessile serrated adenomas/polyps (SSAs/Ps) are a type of serrated polyps that are easily misdiagnosed under endoscopy.

Research motivation

Traditional Chinese medicine is based on syndrome differentiation and treatment. Whether the Wnt signaling pathway through β-catenin, adenomatous polyposis coli (APC), and mutated CRC (MCC) protein expression are different in SSAs/Ps patients with different syndrome types warrants research.

Research objectives

We aimed to observe the difference in the Wnt signaling pathway expression in SSA/P patients with different syndrome types.

Research methods

Thirty cases each of large intestine damp-heat (Da-Chang-Shi-Re, DCSR) syndrome and spleen-stomach weakness (Pi-Wei-Xu-Ruo) syndrome were reported. Baseline comparison of general data, typical tongue coatings, colonoscopic findings, the hematoxylin and eosin findings, and the β-catenin, APC, and MCC protein expression in the colonic mucosa of each group were analyzed.

Research results

Significant differences were observed between the two groups of patients with different syndrome types (P = 0.001) with respect to the SSA/P size. The other aspects did not differ between the groups. The Wnt signaling pathway was activated in patients with SSAs/Ps belonging to both groups, which was manifested as β-catenin protein translocation into the nucleus. However, SSA/P patients with DCSR syndrome had more nucleation, higher β-catenin expression, and decreased negative regulatory factor (APC and MCC) expression (P < 0.0001) than SSA/P patients with Pi-Wei-Xu-Ruo syndrome. In addition, the SSA/P size was linearly correlated with the related protein expression.

Research conclusions

Patients with DCSR syndrome had a more obvious Wnt signaling pathway activation and a higher risk of carcinogenesis.

Research perspectives

A high-quality colonoscopic diagnosis was essential. The thorough assessment of clinical diseases can be improved by combining the diseases of Western medicine with the syndromes of traditional Chinese medicine.