Antibiotic treatment decreases microbial burden associated with pseudomyxoma peritonei and affects β-catenin distribution

Clin Cancer Res. 2013 Jul 15;19(14):3966-76. doi: 10.1158/1078-0432.CCR-13-0616. Epub 2013 Jun 6.


Purpose: Pseudomyxoma peritonei is an understudied cancer in which an appendiceal neoplasm invades the peritoneum and forms tumor foci on abdominal organs. Previous studies have shown that bacteria reside within pseudomyxoma peritonei tumors and mucin. Thus, we sought to analyze the effect of antibiotics on bacterial density and β-catenin expression within pseudomyxoma peritonei samples.

Experimental design: The study included 48 patients: 19 with disseminated peritoneal adenomucinosis (DPAM) and 29 with peritoneal mucinous carcinomatosis (PMCA). Fourteen patients were given antibiotics (30 mg lansoprazole, 1 g amoxicillin, and 500 mg clarithromycin) twice a day for 14 days. One week after completion of therapy, surgery was conducted and specimens were harvested for pathology, bacterial culture, ISH, and immunohistochemistry.

Results: ISH showed the presence of bacteria in 83% of the patient samples, with a higher Helicobacter pylori density observed in PMCA versus DPAM. PMCA patients treated with antibiotics had a significantly lower bacterial density and decreased β-catenin levels in the cytoplasm, the cell nuclei, and mucin-associated cells. Although not significant, similar trends were observed in DPAM patients. Cell membrane β-catenin was significantly increased in both DPAM and PMCA patients receiving antibiotics.

Conclusions: Bacteria play an important role in pseudomyxoma peritonei. Antibiotic treatment improved the histopathology of tissue, particularly in PMCA patients. In PMCA, antibiotics decreased bacterial density and were associated with a significant β-catenin decrease in the cytoplasm, cell nuclei, and mucin along with a small membrane increase. These results suggest that antibiotics offer potential protection against cell detachment, cellular invasion, and metastasis.

Publication types

  • Clinical Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adenocarcinoma, Mucinous / drug therapy
  • Adenocarcinoma, Mucinous / microbiology*
  • Adenocarcinoma, Mucinous / surgery
  • Amoxicillin / pharmacology
  • Amoxicillin / therapeutic use
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use*
  • Bacterial Load / drug effects
  • Cell Membrane / metabolism
  • Cell Nucleus
  • Clarithromycin / pharmacology
  • Clarithromycin / therapeutic use
  • Combined Modality Therapy
  • Helicobacter Infections / drug therapy*
  • Helicobacter pylori / genetics
  • Humans
  • In Situ Hybridization
  • Lansoprazole / pharmacology
  • Lansoprazole / therapeutic use
  • Middle Aged
  • Peritoneal Neoplasms / drug therapy
  • Peritoneal Neoplasms / microbiology*
  • Peritoneal Neoplasms / surgery
  • Protein Transport
  • Pseudomyxoma Peritonei / drug therapy
  • Pseudomyxoma Peritonei / microbiology*
  • Pseudomyxoma Peritonei / surgery
  • Treatment Outcome
  • beta Catenin / metabolism*


  • Anti-Bacterial Agents
  • CTNNB1 protein, human
  • beta Catenin
  • Lansoprazole
  • Amoxicillin
  • Clarithromycin