Isabela Werneck da Cunha

Absence of TMPRSS2:ERG fusions and PTEN losses in prostate cancer is associated with a favorable outcome

TMPRSS2:ERG gene fusions and PTEN deletions are the most common genomic aberrations in prostate cancer. Recent work has suggested that the TMPRSS2:ERG fusion is associated with a more aggressive phenotype. Similarly, PTEN deletion has been associated with biochemical recurrence and lymph node metastasis. To date, there has been no systematic analysis of the combined influence of genomic PTEN deletion with TMPRSS2:ERG gene fusions on clinical parameters of prostate cancer progression. We carried out a retrospective analysis of 125 prostate cancers with known clinical outcome using interphase fluorescence in situ hybridization to detect the relative prevalence of TMPRSS2:ERG rearrangements and/or PTEN genomic deletions. TMPRSS2:ERG rearrangement was found in 60 of 125 (48%) prostate cancers. Duplication of TMPRSS2:ERG fusion was observed in seven (6%) tumors. Gleason grade (P=0.0002)/score (P=0.001), median tumor volume (P=0.0024), preoperative PSA (P=0.001) and perineural invasion (P=0.0304) were significantly associated with biochemical recurrence by univariate analysis with TMPRSS2:ERG approaching significance (P=0.0523). By multivariate analysis, relevant factors associated with recurrence were Gleason scores 7 (P=0.001) and 8–10 (P=0.015), PTEN homozygous deletion (P=0.013) and concurrent TMPRSS2:ERG fusion and PTEN deletion (P=0.036). Kaplan–Meier analysis indicated that the presence of TMPRSS2:ERG fusion was marginally less favorable in comparison to no fusion. Duplication of fusion gene showed worse prognosis. It was possible to determine the relative frequencies of PTEN deletion and/or TMPRSS2:ERG fusions in 82 of 125 prostate cancers. With biochemical recurrence as an endpoint, the genomic biomarkers identified three patient groups: (1) ‘poor genomic grade’ characterized by both PTEN deletion and TMPRSS2:ERG fusions (23/82, 28%); (2) ‘intermediate genomic grade’ with either PTEN deletion or TMPRSS2:ERG fusion (35/82, 43%) and (3) ‘favorable genomic grade’ in which neither rearrangement was present (24/82, 29%). Kaplan–Meier and multivariate analysis indicate that TMPRSS2:ERG fusion and PTEN loss together are a predictor of earlier biochemical recurrence of disease.

Glut1 and Glut3 as potential prognostic markers for oral squamous cell carcinoma

We associated clinical-pathological features of 142 OSCC with the expression pattern of GLUT1 and GLUT3 in order to estimate their prognostic value. Methods: Clinical-pathological features and overall survival data of 142 patients with Oral Squamous Cell Carcinoma (OSCC) were retrospectively reviewed from A.C.Camargo hospital records. A tissue microarray (TMA) was built for the immunohistochemical (IHC) analysis of GLUT 1 and GLUT 3. IHC results were evaluated according to the staining pattern and number of positive cells. Results: GLUT 1 was over expressed in 50.3% of OSSC cases showing membrane staining pattern. However, nuclear expression was observed in 49.7% of the analyzed cases. GLUT 3 over expression was detected in 21.1% of OSCC cases. The pattern of GLUT 1 expression showed significant association with alcohol consumption (p = 0.004). Positive cell membrane GLUT 3 protein expression was associated with advanced clinic-staging of tumours (p = 0.005) as well as with vascular embolization (p = 0.005). Positive expression of GLUT 3 was associated with unfavorable free-disease survival (p = 0.021). Conclusion: GLUT1 and GLUT3 protein expression evaluated by immunohistochemistry are, significantly, indicators of poor prognosis outcome in oral squamous cell carcinoma, probably due to the enhanced glycolytic metabolism of more aggressive neoplastic cells.

Recurrent somatic mutation in DROSHA induces microRNA profile changes in Wilms tumour

Wilms tumour (WT) is an embryonal kidney neoplasia for which very few driver genes have been identified. Here we identify DROSHA mutations in 12% of WT samples (26/222) using whole-exome sequencing and targeted sequencing of 10 microRNA (miRNA)-processing genes. A recurrent mutation (E1147K) affecting a metal-binding residue of the RNase IIIb domain is detected in 81% of the DROSHA-mutated tumours. In addition, we identify non-recurrent mutations in other genes of this pathway (DGCR8, DICER1, XPO5 and TARBP2). By assessing the miRNA expression pattern of the DROSHA-E1147K-mutated tumours and cell lines expressing this mutation, we determine that this variant leads to a predominant downregulation of a subset of miRNAs. We confirm that the downregulation occurs exclusively in mature miRNAs and not in primary miRNA transcripts, suggesting that the DROSHA E1147K mutation affects processing of primary miRNAs. Our data underscore the pivotal role of the miRNA biogenesis pathway in WT tumorigenesis, particularly the major miRNA-processing gene DROSHA.

Penile Squamous Cell Carcinoma Clinicopathological Features, Nodal Metastasis and Outcome in 333 Cases

PURPOSE We evaluated clinicopathological features and outcomes in patients with penile squamous cell carcinoma. MATERIALS AND METHODS We studied 333 patients with homogeneous surgical treatment, including circumcision in 4, local excision in 2, partial penectomy in 194 and total penectomy in 133. Of the patients 153 also underwent bilateral groin dissection. Followup was 8 to 453 months (average 100). RESULTS The usual type of squamous cell carcinoma was noted in 65% of cases. Higher histological grade, deeper anatomical infiltration, and vascular and perineural invasion were common findings in sarcomatoid, basaloid and adenosquamous carcinoma cases, correlating with a higher rate of nodal metastasis and mortality. These features were unusual in verrucous, papillary and warty carcinoma cases. Recurrence in 22% of cases was common for the sarcomatoid, basaloid and adenosquamous types but was not noted for verrucous carcinoma. Locoregional relapse was more common in cases of usual, mixed, papillary and warty carcinoma, and systemic relapse was typical in sarcomatoid and basaloid carcinoma cases. The overall metastasis rate was 24% and the 10-year survival rate was 82%. The highest mortality rate was observed within the first 3 years of followup. High grade tumors were more common in penectomy cases and carcinoma exclusive of the foreskin had a better prognosis. The nodal metastasis risk groups were low--verrucous, papillary and warty, intermediate--usual and mixed, and high risk--sarcomatoid, basaloid and adenosquamous. Mortality risk groups were low--mixed, papillary and warty, intermediate--usual and basaloid, and high risk--sarcomatoid. CONCLUSIONS These data should help clinicians to design therapeutic strategies and followup protocols.

GLUT1 expression in malignant tumors and its use as an immunodiagnostic marker

OBJECTIVE: To analyze glucose transporter 1 expression patterns in malignant tumors of various cell types and evaluate their diagnostic value by immunohistochemistry. INTRODUCTION: Glucose is the major source of energy for cells, and glucose transporter 1 is the most common glucose transporter in humans. Glucose transporter 1 is aberrantly expressed in several tumor types. Studies have implicated glucose transporter 1 expression as a prognostic and diagnostic marker in tumors, primarily in conjunction with positron emission tomography scan data. METHODS: Immunohistochemistry for glucose transporter 1 was performed in tissue microarray slides, comprising 1955 samples of malignant neoplasm from different cell types. RESULTS: Sarcomas, lymphomas, melanomas and hepatoblastomas did not express glucose transporter 1. Forty-seven per cent of prostate adenocarcinomas were positive, as were 29% of thyroid, 10% of gastric and 5% of breast adenocarcinomas. Thirty-six per cent of squamous cell carcinomas of the head and neck were positive, as were 42% of uterine cervix squamous cell carcinomas. Glioblastomas and retinoblastomas showed membranous glucose transporter 1 staining in 18.6% and 9.4% of all cases, respectively. Squamous cell carcinomas displayed membranous expression, whereas adenocarcinomas showed cytoplasmic glucose transporter 1 expression. CONCLUSION: Glucose transporter 1 showed variable expression in various tumor types. Its absence in sarcomas, melanomas, hepatoblastomas and lymphomas suggests that other glucose transporters mediate the glycolytic pathway in these tumors. The data suggest that glucose transporter 1 is a valuable immunohistochemical marker that can be used to identify patients for evaluation by positron emission tomography scan. The function of cytoplasmic glucose transporter 1 in adenocarcinomas must be further examined.

Characterization of a cancer/testis (CT) antigen gene family capable of eliciting humoral response in cancer patients

Cancer/testis (CT) antigens are immunogenic proteins expressed in normal gametogenic tissues and in different types of tumors. CT antigens are promising candidates for cancer immunotherapy, and the identification of novel CT antigens is a prerequisite for the development of cancer vaccines. We have identified a CT antigen, named CTSP-1, with partial similarity to the breast differentiation antigen NY-BR-1. CTSP-1 presents several splicing and polyadenylation variants and has a very restricted expression pattern among normal tissues. CTSP-1 is exclusively expressed in normal testis and is aberrantly expressed in 47.6% (10 of 21) of tumor cell lines and in 44.4% (75 of 169) of tumors from different histological types. The highest percentages of positive expression were observed in melanomas (59.0%) followed by prostate (58.0%) and lung (57.0%) tumors. CTSP-1 is part of a highly conserved gene family, and members of this family also have a restricted expression pattern and similar protein structure. Antibodies against members of this gene family were detected in 10% (14 of 141) of plasma samples from patients with a wide spectrum of tumors. The highest percentages of antibody response were observed in patients with prostate (20.8%), thyroid (20.0%), and breast (16.6%) tumors. Because of its very restricted expression pattern in normal tissues and immunogenicity in different types of tumors, CTSP-1 should be considered a promising candidate for cancer immunotherapy.

ERBB4 confers metastatic capacity in Ewing sarcoma

Metastatic spread is the single‐most powerful predictor of poor outcome in Ewing sarcoma (ES). Therefore targeting pathways that drive metastasis has tremendous potential to reduce the burden of disease in ES. We previously showed that activation of the ERBB4 tyrosine kinase suppresses anoikis, or detachment‐induced cell death, and induces chemoresistance in ES cell lines in vitro. We now show that ERBB4 is transcriptionally overexpressed in ES cell lines derived from chemoresistant or metastatic ES tumours. ERBB4 activates the PI3K‐Akt cascade and focal adhesion kinase (FAK), and both pathways contribute to ERBB4‐mediated activation of the Rac1 GTPase in vitro and in vivo. ERBB4 augments tumour invasion and metastasis in vivo, and these effects are blocked by ERBB4 knockdown. ERBB4 expression correlates significantly with reduced disease‐free survival, and increased expression is observed in metastatic compared to primary patient‐matched ES biopsies. Our findings identify a novel ERBB4‐PI3K‐Akt‐FAK‐Rac1 pathway associated with aggressive disease in ES. These results predict that therapeutic targeting of ERBB4, alone or in combination with cytotoxic agents, may suppress the metastatic phenotype in ES.

Pseudoglandular (Adenoid, Acantholytic) penile squamous cell carcinoma: A clinicopathologic and outcome study of 7 patients

Almost half of penile squamous cell carcinomas (SCCs) are of the usual type but there is a variegated spectrum of morphologically distinctive subtypes. In a pathologic review of 375 uniformly diagnosed and treated patients with penile SCC, we found 7 tumors with predominant pseudoglandular or adenoid features. The aim of the study was to delineate clinicopathologic features and outcome of an unusual variant of penile SCC. Clinical charts and pathologic materials were reviewed. The following informations were obtained: patients age, tumor site, size, histologic grade (1, 2, and 3), thickness in millimeters, anatomic level of invasion [corpus spongiosum, corpus cavernosum (CC)], vascular and perineural invasion, groin nodal status, and follow-up in months. These features were compared with those of 224 cases of usual SCCs. Median age of the patients was 54 years. Tumors were large (average 4.6 cm) and involved multiple sites in 4 cases; exclusively the glans in 2 and site was unknown in 1. Microscopically, tumors were SCC with acantholytic areas ranging from solid nests with early necrosis or empty pseudoluminal spaces lined by 1 layer of squamous cells or cylindrical cells strikingly simulating glands. Tumors were deeply infiltrating (4 invaded CC, 2 corpus spongiosum, and 1 invaded preputial dermis) and were of high histologic grade (6 cases). Vascular invasion was present in 4 cases and perineural invasion in 2. The differential diagnosis was with gland forming penile tumors (surface adenosquamous, mucoepidermoid, and urethral adenocarcinomas) and the angiosarcomatoid variant of sarcomatoid carcinomas. There was regional nodal metastasis in 3 patients, 2 of which died from disease. The other 5 were either alive with no evidence of disease (12 and 21 y after diagnosis) or died from causes other than penile cancer (3, 4, and 7 y after diagnosis). Comparing with usual SCCs, pseudoglandular SCCs were of higher grade (88% vs. 44%), invaded deeper into CC (71% vs. 52%), and showed a higher incidence of regional metastasis (42% vs. 25%) and higher mortality (29% vs. 19%).

Repair of oxidative DNA damage, cell-cycle regulation and neuronal death may influence the clinical manifestation of Alzheimer's disease.

Alzheimer’s disease (AD) is characterized by progressive cognitive decline associated with a featured neuropathology (neuritic plaques and neurofibrillary tangles). Several studies have implicated oxidative damage to DNA, DNA repair, and altered cell-cycle regulation in addition to cell death in AD post-mitotic neurons. However, there is a lack of studies that systematically assess those biological processes in patients with AD neuropathology but with no evidence of cognitive impairment. We evaluated markers of oxidative DNA damage (8-OHdG, H2AX), DNA repair (p53, BRCA1, PTEN), and cell-cycle (Cdk1, Cdk4, Cdk5, Cyclin B1, Cyclin D1, p27Kip1, phospho-Rb and E2F1) through immunohistochemistry and cell death through TUNEL in autopsy hippocampal tissue samples arrayed in a tissue microarray (TMA) composed of three groups: I) “clinical-pathological AD” (CP-AD) - subjects with neuropathological AD (Braak≥IV and CERAD = B or C) and clinical dementia (CDR≥2, IQCODE>3.8); II) “pathological AD” (P-AD) - subjects with neuropathological AD (Braak≥IV and CERAD = B or C) and without cognitive impairment (CDR 0, IQCODE<3.2); and III) “normal aging” (N) - subjects without neuropathological AD (Braak≤II and CERAD 0 or A) and with normal cognitive function (CDR 0, IQCODE<3.2). Our results show that high levels of oxidative DNA damage are present in all groups. However, significant reductions in DNA repair and cell-cycle inhibition markers and increases in cell-cycle progression and cell death markers in subjects with CP-AD were detected when compared to both P-AD and N groups, whereas there were no significant differences in the studied markers between P-AD individuals and N subjects. This study indicates that, even in the setting of pathological AD, healthy cognition may be associated with a preserved repair to DNA damage, cell-cycle regulation, and cell death in post-mitotic neurons.

Clinicopathological significance of ubiquitin-specific protease 2a (USP2a), fatty acid synthase (FASN), and ErbB2 expression in oral squamous cell carcinomas

Overexpression of fatty acid synthase (FASN) and ErbB2 has been described in oral squamous cell carcinomas (OSCC). FASN is the key lipogenic enzyme responsible for the endogenous synthesis of fatty acids and its expression can be regulated by ErbB2. The deubiquitinating enzyme (DUB) ubiquitin-specific protease 2a (USP2a) plays a critical role in prostate cancer cell survival by stabilizing the FASN protein. This study investigates whether the gene expression and the immunohistochemical status of FASN, ErbB2, and USP2a correlate with the clinicopathological characteristics of OSCC cases. A strong positive correlation among ErbB2, FASN, and USP2a expression (p=0.001) was observed by qRT-PCR in laser capture microdissected OSCC samples. Perineural infiltration was associated with ErbB2 mRNA expression (p=0.046). The presence of metastatic cervical lymph nodes was associated with FASN (p=0.002), ErbB2 (p=0.001), and USP2a (p=0.006) mRNA levels. ErbB2 staining at the cell membranes was stronger in well-differentiated lesions while a cytoplasmic positivity was found in poorly differentiated tumors. Most of the OSCC (97.06%) that showed a high positivity for FASN were also labeled for ErbB2 at the cell membranes (p=0.001). FASN and ErbB2 positivity was associated with tumor thickness and lymphatic embolization (p=0.006 and p=0.035, p=0.006 and p=0.024 respectively). The membrane expression of ErbB2 as well as FASN and Ki-67 staining were significantly associated with a high risk of recurrence by predicting both disease free survival (log-rank test, p=0.0056, p=0.0011, and p=0.0004, respectively) and overall survival (log-rank test, p=0.0005, p=0.0062, and p=0.0001, respectively). Taken together, the results presented here suggest a molecular connection among FASN, ErbB2, and USP2a in OSCC since their mRNA and protein levels were associated with tumor progression and poor prognosis.