When compared with EBV(-) gastric cancers, somatic mutations occurred significantly more frequently in EBV(+) gastric cancers in AKT2 (38.2% vs 3%; P < .0001), CCNA1 (25%

vs 4%; P = .004), MAP3K4 (20.8% vs 4%; P = .013), and TGFBR1 (25% vs 8%; P = .029) ( Figure 2B and Supplementary Figures 4–7). We further evaluated the clinical implication of mutations in the putative oncogene AKT2, which is the only gene harboring 2 EBV-associated nonsynonymous mutations in AGS–EBV cells, and mutation in which the most significant association with primary EBV(+) gastric cancer was EX 527 mouse shown. In the examined cohort of 34 EBV(+) gastric cancers with known follow-up data, the mutation frequency of AKT2 was 38.2% (13 of 34) ( Supplementary Tables 9 and 10). Interestingly, as shown in the Kaplan–Meier survival curves ( Figure 2C), EBV(+) gastric cancer patients with an AKT2 mutation had significantly reduced survival times (median, 3.27 y) than those with wild-type AKT2 (median, 4.72 y; P = .006, log-rank test).

To systematically identify genes directly dysregulated by epigenetic alterations induced by EBV infection, transcriptome of AGS–EBV, and AGS were analyzed integratively with the epigenome data. Integrated analysis showed that 216 genes were hypermethylated and transcriptionally down-regulated in AGS–EBV Belinostat mw relative to AGS cells, whereas only 46 genes were demethylated and transcriptionally up-regulated in AGS–EBV (Figure 3A and Supplementary Table 11). Six randomly selected genes (ACSS1, FAM3B, IHH, NEK9, SLC7A8, and TRABD) were confirmed to

be down-regulated significantly in AGS–EBV compared with AGS and AGS-hygro cells by semiquantitative RT-PCR and quantitative RT-PCR ( Figure 3B). Down-regulation of these genes could be restored successfully in AGS–EBV cells by demethylation treatment using 5-Aza-2’deoxycytidine (5-Aza) ( Figure 3B). Higher methylation levels of these genes in AGS–EBV as compared with AGS and AGS-hygro cells were confirmed by bisulfite genomic sequencing, and the Demeclocycline methylation levels were decreased successfully by 5-Aza treatment ( Figure 3C). We have shown that DNA methyltransferase 3b (DNMT3b) was up-regulated in AGS–EBV compared with AGS cells. 3 There were no differences in messenger RNA expression; nuclear protein expression of DNMT1, DNMT3a, and DNMT3b; and the activity of DNMT3b between uninfected AGS and the vector-transfected, hygromycin-resistant AGS cells ( Supplementary Figure 8). These findings suggest that EBV infection causes a genome-wide aberrant methylation composed mainly of promoter/CpG island hypermethylation, which directly lead to gene transcriptional down-regulation. To clarify if aberrant methylation caused by EBV infection in AGS–EBV cells also occurred in primary gastric cancers, promoter methylation statuses of ACSS1, FAM3B, IHH, and TRABD were examined in EBV(+) and EBV(-) gastric cancers using bisulfite genomic sequencing.