Article Text

Download PDFPDF
Alpha-methylacyl coenzyme A racemase overexpression in gallbladder carcinoma confers an independent prognostic indicator
  1. Li-Ching Wu1,
  2. Li-Tzong Chen2,
  3. Yueh-Ju Tsai3,
  4. Chun-Mao Lin4,
  5. Ching-Yih Lin5,
  6. Yu-Fang Tian6,
  7. Ming-Juen Sheu5,
  8. Yih-Huei Uen6,
  9. Yow-Ling Shiue7,
  10. Yu-Hui Wang8,
  11. Shu-Jing Yang1,9,
  12. Wen-Ren Wu7,
  13. Shau-Hsuan Li10,
  14. Masaya Iwamuro11,
  15. Naoya Kobayasshi11,
  16. Hsuan-Ying Huang12,
  17. Chien-Feng Li1,2,7,13
  1. 1Department of Pathology, Chi-Mei Foundational Medical Center, Tainan, Taiwan
  2. 2National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
  3. 3Department of Ophthalmology, Chang Gung Memorial Hospital-LinKo Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
  4. 4College of Medicine, Taipei Medical University, Taipei, Taiwan
  5. 5Department of Internal Medicine, Chi-Mei Foundational Medical Center, Tainan, Taiwan
  6. 6Department of Surgery, Chi-Mei Foundational Medical Center, Tainan, Taiwan
  7. 7Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
  8. 8Institute of Biosignal Transduction, National Cheng Kung University, Tainan, Taiwan
  9. 9Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
  10. 10Department of Medical Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
  11. 11Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
  12. 12Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
  13. 13Department of Biotechnology, Southern Taiwan University, Tainan, Taiwan
  1. Correspondence to Dr Chien-Feng Li, Department of Pathology, Chi-Mei Foundation Medical Center, Tainan, 710, Taiwan; angelo.p{at}


Aims Increased β-oxidation of branched-chain fatty acids provides an additional metabolic advantage for cancer cells thereby enhancing tumour development and progression. Alpha-methylacyl coenzyme A racemase (AMACR) is an enzyme essential for the catabolism of branched-chain fatty acids that allows their subsequent β-oxidation and thus plays an important role in generating biological energy. However, the expression of AMACR has never been systemically investigated in gallbladder carcinoma. This study evaluated the expression status, associations with clinicopathological variables and prognostic implications of AMACR in a well-defined cohort of gallbladder carcinoma and confirmed their expression status in gallbladder carcinoma cells.

Methods AMACR immunostaining was assessable in 89 cases on tissue microarrays of gallbladder carcinoma, and it was correlated with clinicopathological factors and patient survival. In three gallbladder carcinoma cell lines and one non-tumorigenic cholangiocyte, AMACR mRNA expression was measured by real-time reverse transcription PCR and the endogenous expression of AMACR protein was analysed by western blotting.

Results AMACR overexpression was significantly associated with an advanced primary tumour status (p=0.027) and American Joint Committee on Cancer stage (p=0.027), an increased histological grade (p=0.002) and vascular invasion (p=0.017). Importantly, AMACR overexpression independently predicted worse disease-specific survival (p=0.0452, RR 1.887). Expression levels of AMACR mRNA and total protein in various cells were comparable. The abundance of AMACR expression increased in tumour cells and was even higher in the metastatic cell line.

Conclusions In primary gallbladder carcinoma, AMACR overexpression was correlated with important prognosticators and independently portended worse outcomes, highlighting the potential prognostic and therapeutic utility of AMACR in gallbladder carcinoma.

  • AIDS
  • bacteriology
  • cancer
  • cholangiocarcinoma
  • gallbladder carcinoma
  • GI neoplasms
  • MALT-lymphoma
  • molecular genetics
  • molecular oncology
  • oncogenes
  • pancreatic cancer

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • LCW, YJT and CML contributed equally to this work.

  • Funding This work was supported in part by grants from the National Science Council, Taiwan (NSC99-2320-B-384-001-MY2), the Department of Health, Taiwan (DOH99-TD-C-111-004) and Chi-Mei Medical Center (99-CM-TMU-03).

  • Competing interests None.

  • Ethics approval The retrospective cohort study including immunohistochemistry and clinicopathological and survival analyses were approved by the Institutional Review Board (IRB09908-003).

  • Provenance and peer review Not commissioned; externally peer reviewed.