Expression of glioma-associated antigens in pediatric brain stem and non-brain stem gliomas

We investigated the protein expression of three glioma-associated antigens (GAAs) in pediatric brain stem glioma (BSG) and non-brain stem glioma (NBSG) cases with a view to their possible use in immunotherapy. Expression of EphA2, IL-13Rα2 and Survivin were studied by immunohistochemistry on paraffin-embedded tissues using a series of 15 BSG cases and 12 NBSG cases. Thirteen of 15 BSGs and all 12 NBSGs expressed at least one of GAAs; and 7 BSGs and 9 NBSGs expressed at least two of these GAAs at higher levels than non-neoplastic brain. There was no association between the tumor grade and levels of GAA expression. Although many cases demonstrated diffuse expression of GAAs throughout specimens, partial or patchy expression was noted in a small number of cases, suggesting a need for targeting multiple GAAs in immunotherapy. These results suggest that EphA2, IL-13Ralpha2 and Survivin are suitable targets for developing vaccine strategies for pediatric glioma.     

Analysis of interleukin-13 receptor alpha2 expression in human pediatric brain tumors

BACKGROUND: Compared with normal brain tissue cells, human malignant glioma cells express higher levels of interleukin-13 receptor (IL-13R). However, whether this receptor is expressed in situ has not been carefully examined. With IL-13R-targeted cytotoxin (IL13-PE38QQR, comprising IL-13 and a mutated form of Pseudomonas exotoxin [PE]) being tested in three Phase I/II clinical trials for the treatment of adult human glioma, and with pediatric studies being planned, the authors set out to analyze pediatric brain tumor tissue specimens for the expression of IL-13R. METHODS: Using in situ hybridization and immunohistochemical staining, the authors examined 58 pediatric brain tumor specimens for expression of the predominant IL-13 binding and internalizing protein (IL-13Ralpha2) chain at the mRNA and protein levels. RESULTS: Overall, approximately 83% of pediatric brain tumor samples expressed IL-13Ralpha2. One hundred percent (11 of 11) high-grade astrocytoma, 79% (26 of 33) low-grade astrocytoma, 67% (4 of 6) medulloblastoma, and 67% (2 of 3) ependymoma samples were positive for IL-13Ralpha2. Among IL-13Ralpha2-positive samples, 88% (42 of 48 samples) had positive expression in > or = 50% of all tumor fields. The results obtained using both assays were consistent with each other. CONCLUSIONS: The current study established that pediatric brain tumor specimens expressed the IL-13Ralpha2 chain. Because the IL-13Ralpha2 chain is a major binding component of the IL-13R complex, these results suggest that the targeting of IL-13R may represent a useful approach for the treatment of pediatric brain tumors.     

Tumor antigen precursor protein profiles of adult and pediatric brain tumors identify potential targets for immunotherapy

Objectives We evaluated and compared tumor antigen precursor protein (TAPP) profiles in adult and pediatric brain tumors of 31 genes related to tumor associated antigens (TAA) for possible use in immunotherapy. Antigens were selected based on their potential to stimulate T cell responses against tumors of neuroectodermal origin. Methods Thirty-seven brain tumor specimens from 11 adult and 26 pediatric patients were analyzed by quantitative real-time PCR for the relative expression of 31 TAPP mRNAs. The age range of adults (4F:7M) was 27–77 years (median 51.5 ± 14.5 years) and for pediatrics (12F:14M) was 0.9–19 years (median 8.3 ± 5.5 years). Histological diagnoses consisted of 16 glioblastomas, 4 low grade astrocytomas, 10 juvenile pilocytic astrocytomas, and 7 ependymomas. Results The adult gliomas expressed 94% (29 of 31) of the TAPP mRNAs evaluated compared with pediatric brain tumors that expressed 55–74% of the TAPP mRNAs, dependent on tumor histological subtype. Four types of TAPP expression patterns were observed: (1) equal expression among adult and pediatric cases, (2) greater expression in adult than pediatric cases, (3) expression restricted to adult GBM and (4) a random distribution. The pediatric brain tumors lacked expression of some genes associated with engendering tumor survival, such as hTert and Survivin. Conclusions The potential TAA targets identified from the TAPP profiles of 31 genes associated with adult and pediatric brain tumors may help investigators select specific target antigens for developing dendritic cell- or peptide-based vaccines or T cell-based immunotherapeutic approaches against brain tumors. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. Elizabeth W. Newcomb and Martin R. Jadus contributed equally as senior authors.     

Serum soluble interleukin-2 receptor and immunohistochemical staining of IL-2R/Tac antigen in gastric cancer

In the present study, we investigated the significance of serum soluble IL-2R as a tumor marker, and examined the existence and localization of positive cells for IL-2R/Tac antigen in gastric cancer tissues and its regional lymph nodes. Eighty-two patients with gastric cancer were included. Levels of serum soluble-IL-2R were measured by an enzyme-linked immunosorbent assay. In the tissues obtained from 19 cases, immunohistochemical staining was performed with the use of avidin-biotin-peroxidase complex technique, in which mouse anti-human interleukin-2 receptor antibody was used. The preoperative levels of serum soluble IL-2R in patients-with gastric cancer were significantly higher than those of normal controls (p<0.001). The levels of serum soluble IL-2R in cases with metastatic lymph nodes were also significantly higher than those without metastatic lymph nodes (p<0.05). Concerning the tumor markers, there were significant differences of serum soluble IL-2R levels between those who were positive and those negative for CA19-9, CEA, alpha-FTP, and IAP. In the immunohistochemical staining of IL-2R, 13 of 19 cases (68.4%) showed IL-2R positive cells in the gastric cancer tissues. In regard to the metastatic lymph nodes, 3 of 5 cases (60.0%) showed IL-2R positive cells. On the other hand, IL-2R positive cells were not recognized in normal gastric tissues and non-metastatic lymph nodes. These results may suggest that activated T-lymphocytes infiltrating into the cancer tissues play an antitumor role and release a large amount of alpha-chain of IL-2R, resulting in the high levels of serum soluble IL-2R in patients with gastric cancer.     

恶性胶质瘤中IL-13Rα2和PCNA的表达及其与病理特征和预后的关系

目的：检测人脑恶性胶质瘤组织中IL13Rα2和增殖细胞核抗原（proliferating cell nuclear antigen, PCNA）的表达强度,分析其与患者临床病理特点和预后之间的关系。方法：选取20022006年温州医学院附属第一医院手术治疗的43例恶性胶质瘤标本;采用免疫组织化学法检测并用图像分析系统分析IL13Rα2和PCNA在恶性胶质瘤组织中的表达,分析两者间的相关性;分析它们与临床特征和预后的关系。结果：(1) 43例恶性胶质瘤标本有40例(93%)IL13Rα2阳性表达和36例(84%)PCNA阳性表达;(2) IL13Rα2和PCNA表达强度与肿瘤部位和肿瘤大小无相关性(P>0.05);在WHOⅢ级与Ⅳ级间两者表达强度差异均有统计学意义（P=0.031, P=0.002）;在生存时间≤6个月与>6个月患者间IL13Rα2 表达强度差异有统计学意义(P=0.028)。(3)IL13Rα2和PCNA的表达强度呈显著的正相关(r=0.653,P=0.000)。结论：人恶性胶质瘤组织中IL13Rα2和PCNA均高表达,前者表达强度与肿瘤恶性分级和患者预后密切相关,在恶性胶质瘤的诊断和预后判断中具有潜在的临床应用价值。     

MicroRNA-30c as a novel diagnostic biomarker for primary and secondary B-cell lymphoma of the CNS

Glioblastoma multiforme (GBM) is the most common primary brain tumor in adults. A variety of targeted agents are being tested in the clinic including cancer vaccines, immunotoxins, antibodies and T cell immunotherapy for GBM. We have previously reported that IL-13 receptor subunits α1 and α2 of IL-13R complex are overexpressed in GBM. We are investigating the significance of IL-13Rα1 and α2 expression in GBM tumors. In order to elucidate a possible relationship between IL-13Rα1 and α2 expression with severity and prognoses of subjects with GBM, we analyzed gene expression (by microarray) and clinical data available at the public The Cancer Genome Atlas (TCGA) database (Currently known as Global Data Commons). More than 40% of GBM samples were highly positive for IL-13Rα2 mRNA (Log2?≥?2) while only less than 16% samples were highly positive for IL-13Rα1 mRNA. Subjects with high IL-13Rα1 and α2 mRNA expressing tumors were associated with a significantly lower survival rate irrespective of their treatment compared to subjects with IL-13Rα1 and α2 mRNA negative tumors. We further observed that IL-13Rα2 gene expression is associated with GBM resistance to temozolomide (TMZ) chemotherapy. The expression of IL-13Rα2 gene did not seem to correlate with the expression of genes for other chains involved in the formation of IL-13R complex (IL-13Rα1 or IL-4Rα) in GBM. However, a positive correlation was observed between IL-4Rα and IL-13Rα1 gene expression. The microarray data of IL-13Rα2 gene expression was verified by RNA-Seq data. In depth analysis of TCGA data revealed that immunosuppressive genes (such as FMOD, CCL2, OSM, etc.) were highly expressed in IL-13Rα2 positive tumors, but not in IL-13Rα2 negative tumors. These results indicate a direct correlation between high level of IL-13R mRNA expression and poor patient prognosis and that immunosuppressive genes associated with IL-13Rα2 may play a role in tumor progression. These findings have important implications in understanding the role of IL-13R in the pathogenesis of GBM and potentially other cancers.     

An interleukin 13 receptor α 2-specific peptide homes to human Glioblastoma multiforme xenografts

Interleukin 13 receptor α 2 (IL-13Rα2) is a glioblastoma multiforme (GBM)-associated plasma membrane receptor, a brain tumor of dismal prognosis. Here, we isolated peptide ligands for IL-13Rα2 with use of a cyclic disulphide-constrained heptapeptide phages display library and 2 in vitro biopanning schemes with GBM cells that do (G26-H2 and SnB19-pcDNA cells) or do not (G26-V2 and SnB19-asIL-13Rα2 cells) over-express IL-13Rα2. We identified 3 peptide phages that bind to IL-13Rα2 in cellular and protein assays. One of the 3 peptide phages, termed Pep-1, bound to IL-13Rα2 with the highest specificity, surprisingly, also in a reducing environment. Pep-1 was thus synthesized and further analyzed in both linear and disulphide-constrained forms. The linear peptide bound to IL-13Rα2 more avidly than did the disulphide-constrained form and was efficiently internalized by IL-13Rα2-expressing GBM cells. The native ligand, IL-13, did not compete for the Pep-1 binding to the receptor and vice versa in any of the assays, indicating that the peptide might be binding to a site on the receptor different from the native ligand. Furthermore, we demonstrated by noninvasive near infrared fluorescence imaging in nude mice that Pep-1 binds and homes to both subcutaneous and orthotopic human GBM xenografts expressing IL-13Rα2 when injected by an intravenous route. Thus, we identified a linear heptapeptide specific for the IL-13Rα2 that is capable of crossing the blood-brain tumor barrier and homing to tumors. Pep-1 can be further developed for various applications in cancer and/or inflammatory diseases.     

Interleukin-13 receptor alpha 2, EphA2, and Fos-related antigen 1 as molecular denominators of high-grade astrocytomas and specific targets for combinatorial therapy.

PURPOSE: We investigated the expression of interleukin-13 receptor alpha2 (IL-13R alpha 2), EphA2, and Fos-related antigen 1 (Fra-1) in astrocytomas and normal brain. We sought to document whether the expression of the three factors changed with progression to higher grade malignancy and whether two or three targets in combination might be sufficient to target all patients with high-grade astrocytomas. EXPERIMENTAL DESIGN: Immunohistochemistry was done for IL-13R alpha 2, EphA2, and Fra-1 using human brain tumor tissue microarrays containing 30 specimens of WHO grades II and III astrocytomas, 46 glioblastoma multiformes (GBM), and 9 normal brain samples. Sections were scored based on frequency and intensity of expression. Western blotting was done for all three markers using GBM tumor specimens and xenograft cell lines. Two cytotoxins, IL-13.E13K.PE38QQR and ephrinA1-PE38QQR, which target IL-13R alpha 2 or EphA2, respectively, were tested for cytotoxicity against human GBM primary explant cells and established cells. RESULTS: Expression of all three proteins was significantly higher in GBM compared with normal brain, low-grade, and anaplastic astrocytomas. Greater than 95% of GBM overexpressed at least two of the three markers. Importantly, every GBM overexpressed at least one marker. Human GBM primary explant cells and cell lines were potently killed by IL-13.E13K.PE38QQR and ephrinA1-PE38QQR, in accordance with their level of expression of IL-13R alpha 2 and EphA2, respectively. CONCLUSIONS: IL-13R alpha 2, EphA2, and Fra-1 are attractive therapeutic targets representing molecular denominators of high-grade astrocytomas. One hundred percent of GBM tumors overexpress at least one of these proteins, providing the basis for rational combinatorial targeted therapies/diagnostics suitable for all patients with this disease.     

Study of chromosome 9q gain, Notch pathway regulators and Tenascin-C in ependymomas

Ependymomas are relatively uncommon tumours of the central nervous system which arise from the ependymal lining of the ventricles and spinal canal. The molecular changes leading to ependymal oncogenesis are not completely understood. We examined chromosome 9q33-34 locus for gain, potential oncogenes at this locus (Notch-1 and Tenascin-C) and Notch pathway target genes (Hes-1, Hey-2 & C-myc) in ependymomas by fluorescent in situ hybridization (FISH) and immunohistochemistry (IHC), respectively, to assess if they have any correlation with clinical characteristics. We analyzed 50 cases of ependymomas by FISH for 9q gain and by IHC for Notch-1 and its target gene proteins (Hes-1, Hey-2 and C-myc) expression. We also performed IHC for Tenascin-C to rule out any correlation with aggressiveness/grade of tumour. FISH study revealed significant chromosome 9q gain in ependymomas of adult onset (age > 18 years) and spinal cord origin. Notch-1 showed significantly more frequent immunohistochemical expression in supratentorial and anaplastic ependymomas. Tenascin-C (TN-C) expression was significant in intracranial, childhood (age ≤ 18 years) and anaplastic ependymomas. Of the three Notch pathway target gene proteins (Hes-1, Hey-2 and C-myc), Hes-1 and C-myc expression showed significant correlation with anaplastic and adult onset ependymomas, respectively. Genetic alterations are independent prognostic markers in ependymomas. A clinicopathological correlation with various molecular signatures may be helpful in the development of new therapeutic targets.     

Strong expression of IGF1R in pediatric gastrointestinal stromal tumors without IGF1R genomic amplification

Wildtype (WT) gastrointestinal stromal tumors (GISTs), lacking mutations in KIT or PDGFRA, represent 85% of GISTs in pediatric patients. Treatment options for pediatric WT GIST are limited. Recently, expression profiling of a limited number of pediatric and adult WT GISTs and more in depth study of a single pediatric WT GIST implicated the insulin‐like growth factor 1 receptor (IGF1R) as a potential therapeutic target in pediatric WT GIST. We performed immunoblotting, SNP and FISH studies to determine the extent of expression, biochemical activation and genomic amplification of IGF1R in a larger number of pediatric WT GISTs. Pediatric WT GISTs expressed IGF1R strongly, whereas typical adult KIT mutant GISTs did not. IGF1R gene amplification was not detected in pediatric WT GISTs, and some KIT‐mutant GISTs had IGF1R gene deletion due to monosomy 15. Despite the absence of apparent genomic activation mechanisms accounting for overexpression, clinical study of IGF1R‐directed therapies in pediatric WT GIST is warranted.     

人脑胶质瘤特异抗原肽白介素13α2受体的原核表达

目的：构建白介素13α2受体 （Interleukin-13α2 Receptor, IL-13Rα2） 基因的表达质粒, 并检测其在体外原核表达情况,为脑胶质瘤的免疫治疗奠定基础。方法： 用RT-PCR技术从U251胶质瘤细胞株扩增IL-13Rα2基因, 并与克隆质粒pMD19 Sim?ple T载体连接转入DH5α菌克隆, 筛选重组阳性菌落, 用Xho I和Hind Ⅲ将目的基因从克隆质粒上切下并与同样双酶切后的表达质粒pET-28a连接, 转入BL21 （DE3） 菌, 提取重组质粒进行酶切及测序鉴定正确后, 在IPTG诱导下原核表达IL-13Rα2抗原肽,并利用镍柱进行纯化回收, SDS-PAGE检测表达蛋白。结果： 成功扩增出IL-13Rα2基因序列, 大小为1 142 bp, 并表达纯化出IL-13Rα2抗原肽, 大小为60 kD, 于诱导第3 h表达量最高, 以包涵体形式表达。结论： IL-13Rα2基因表达质粒能在体外成功构建, 并能在IPTG诱导下成功表达及纯化得到IL-13Rα2抗原肽。     

Measurement and cellular sources of the soluble interleukin-2 receptor in primary central nervous system lymphoma

The aims of this study were to determine the diagnostic utility of the serum levels of the soluble interleukin 2 receptor (sIL-2R) as a tumor marker of primary central nervous system lymphoma (PCNSL) and to investigate the cellular source of sIL-2R using immunohistochemical staining. The serum sIL-2R levels of 37 samples from suspected PCNSL patients were measured. There were 13 patients with PCNSL and 24 patients with other diseases such as glioma, metastatic tumor, inflammation, or cerebrovascular disease. The serum sIL-2R levels of the PCNSL cases and other brain diseases were 629.5 ± 586.0 U/ml (mean ± SD; range 189–2220 U/ml) and 408.5 ± 250.7 U/ml (160–837 U/ml), respectively. The serum sIL-2R levels of the two groups overlapped, and hence the difference between them was not significant. sIL-2R is the α subunit of IL-2R. It is also known as CD25, and is cleaved from its position in the cell membrane and released into the blood. CD25 expression was immunohistochemically detected in 7 of 11 PCNSL samples. Confocal laser microscopy revealed that CD25 signals were present in atypical cells and mononuclear cells. We concluded that both lymphoma cells and infiltrating T cells express CD25, which is one of the cellular sources of sIL-2R.     

Alpha-internexin and altered CIC expression as a supportive diagnostic marker for oligodendroglial tumors with the 1p/19q co-deletion

α-Internexin (INA) has been proposed as a biomarker of oligodendroglial tumors with the 1p/19q co-deletion. On the other hand, sequence studies have recently linked the CIC mutation and subsequent altered CIC expression to the 1p/19q co-deletion in oligodendroglial tumors. We assessed the usability of combination immunohistochemical analysis using CIC and INA as a surrogate tool for the 1p/19q status in 39 cases of oligodendroglial tumors. The positive expression of INA was observed in 10 cases (52 %) of oligodendroglial tumors with the 1p/19q co-deletion, and in only 3 cases of oligodendroglial tumors without the 1p/19q co-deletion (15 %, P = 0.012). The lack of CIC expression was detected in 13 cases (68 %) of oligodendroglial tumors with the 1p/19q co-deletion, and in only 1 case of oligodendroglial tumors without the 1p/19q co-deletion (5 %, P < 0.0001). Combined immunohistochemical analysis assessed by INA expression and/or the lack of CIC expression was strongly associated with the 1p/19q co-deletion in oligodendroglial tumors, indicating a potential surrogate marker of the 1p/19q state. Although combined immunohistochemical analysis cannot be totally replaced by molecular genetic analysis as a definitive diagnostic technique, it may contribute to a steady morphological diagnosis by predicting the 1p/19q state in oligodendroglial tumors.     

凋亡抑制蛋白survivin在骨肉瘤中的表达对其发生和预后的意义

目的研究survivin凋亡抑制蛋白在骨肉瘤中的表达.探讨其在骨肉瘤发生及其预后中的可能作用.方法用免疫组化SP方法检测survivin蛋白在39例骨肉瘤和19例骨软骨瘤中的表达情况,并检查骨肉瘤患者的远处转移情况.结果Survivin在骨肉瘤中的阳性率为56.4%(22/39),明显高于对照组骨软骨瘤15.7%(3/19)的阳性率(x2=3.612,P＜0.05).在26例伴有远处转移的骨肉瘤病例中,survivin阳性率为61.5%(16/26),显著高于不伴有远处转移的骨肉瘤病例的阳性率30.8%(4/13)(x2=3.172,P＜0.05).结论Survivin的表达升高与骨肉瘤的发生机制有关,可能与骨肉瘤的远处转移相关.     

胃癌组织中Survivin和HIF-1α的表达及临床意义

目的:研究胃癌组织中Survivin和HIF-1α的表达情况,初步分析它们与胃癌生物学行为之间的关系。方法:采用免疫组织化学SP法检测64例胃癌和15例正常胃黏膜组织中Survivin和HIF-1α的表达。结果:64例胃癌组织中Survivin和HIF-1α的阳性表达率分别为75%和65.63%,Survivin与HIF-1α在胃癌组织中的表达水平明显高于正常胃组织中的表达水平(P<0.05)。Survivin和HIF-1α的表达与胃癌的临床TNM分期、浸润深度和淋巴结转移有关(P<0.05);与患者的年龄、性别和组织学分级无关。Survivin和HIF-1α之间存在显著相关性(rs=0.328,P<0.05)。结论:Survivin和HIF-1α在胃癌的发生发展过程中起着重要的作用,联合检测可为胃癌的早期诊断、治疗和预后判断提供必要的理论依据。     

Stereotactic body radiation therapy and intensity modulated radiation therapy induce different plasmatic cytokine changes in non-small cell lung cancer patients: a pilot study

Purpose

To assess kinetics of plasmatic cytokines during radiation therapy (RT) for locally advanced and early-stage non-small cell lung cancer (NSCLC).

Methods

This prospective study was conducted on 15 early-stage NSCLC underwent to extreme hypofractionated regimen (52 Gy in 8 fractions) with stereotactic body RT (SBRT), and 13 locally advanced NSCLC underwent to radical moderated hypofractionated regimen (60 Gy in 25 fractions) with intensity modulated RT (IMRT). For patients undergoing SBRT, peripheral blood samples were collected on the first day of SBRT (TFd), the last day (TLd) and 45 days (T45d) after the end of SBRT. For patients undergoing IMRT, blood samples were collected at: TFd, 2 weeks (T2w), 4 weeks (T4w), TLd, and T45d. The following cytokines were measured: IL-1, IL-1ra, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-13, IL-15, IL-17A, EGF, FGF-2, INF-γ, MIP-1α, MIP-1β, TGF-α, TNF-α, and VEGF. Cytokine levels measured in different RT time and compared.

Results

No difference in baseline levels of cytokines was documented between patient radiation approaches (except for MIP-1α). For SBRT patients, a mean reduction of IL-10 and IL-17 plasma level was documented between TLd and TFd, respectively (p < 0.05). For IMRT patients, a statistically significant (p < 0.05) mean plasma level reduction was documented between T4w and TFd for all the following cytokines: IL-1, IL-1ra, IL-2, IL-12, FGF-2, MIP-1α, MIP-1β, TGF-α, TNF-α, VEGF.

Conclusions

SBRT and IMRT induce different plasmatic cytokine changes in NSCLC patients, supporting hypothesis that RT regimes of dose schedules and techniques have different impacts on the host immune response.

     

A multi-center retrospective analysis of treatment effects and quality of life in adult patients with cranial ependymomas

Long term quality of life data of adult patients harboring intracranial ependymomas have not been reported. The role of adjuvant radiation therapy in Grade II ependymomas is unclear and differs from study to study. We therefore sought to retrospectively analyze outcome and quality of life of adult patients that were operated on intracranial ependymomas at four different surgical centers in two countries. All patients were attempted to be contacted via telephone to assess quality of life (QoL) at the time of the telephone interview. The standard EORTC QoL Questionnaire C30 (EORTC QLQ-C30) and the EORTC QLQ-Brain Cancer Module (QLQ-BN20) were used. 64 adult patients with intracranial ependymomas were included in the study. The only factor that was associated with increased survival was age <55 years (p < 0.001). Supratentorial location was correlated with shorter progression free survival than infratentorial location (PFS; p = 0.048). In WHO Grade II tumors local irradiation did not lead to increased PFS (p = 0.888) or overall survival (p = 0.801). Even for incompletely resected Grade II tumors local irradiation did not lead to a benefit in PFS (p = 0.911). In a multivariate analysis of QoL, irradiated patients had significantly worse scores in the item “fatigue” (p = 0.037) than non-irradiated patients. Here we present QoL data of adult patients with intracranial ependymomas. Our data show that local radiation therapy may have long-term effects on patients’ QoL. Since in the incompletely resected Grade II tumors local irradiation did not lead to a benefit in PFS in this retrospective study, prospective randomized studies are necessary. In addition to age, supratentorial tumor location is associated with a worse prognosis in adult ependymoma patients.     

Prognostic importance of survivin in breast cancer

Survivin is a member of the inhibitor of apoptosis (IAP) family, and is also involved in the regulation of cell division. Survivin is widely expressed in foetal tissues and in human cancers, but generally not in normal adult tissue. This study examined the expression of surviving protein in a series of 293 cases of invasive primary breast carcinoma. Survivin immunoreactivity was assessed using two different polyclonal antibodies, and evaluated semiquantitatively according to the percentage of cells demonstrating distinct nuclear and/or diffuse cytoplasmic staining. Overall, 60% of tumours were positive for survivin: 31% demonstrated nuclear staining only, 13% cytoplasmic only, and 16% of tumour cells demonstrated both nuclear and cytoplasmic staining. Statistical analysis revealed that survivin expression was independent of patient's age, tumour size, histological grade, nodal status, and oestrogen receptor status. In multivariate analysis, nuclear survivin expression was a significant independent prognostic indicator of favourable outcome both in relapse-free and overall survival (P<0.001 and P=0.01, respectively). In conclusion, our results show that survivin is frequently overexpressed in primary breast cancer. Nuclear expression is most common and is an independent prognostic indicator of good prognosis.     

Phosphorylated-insulin growth factor I receptor (p-IGF1R) and metalloproteinase-3 (MMP3) expression in advanced gastrointestinal stromal tumors (GIST). A GEIS 19 study

Background

Most GISTs have mutations in KIT or PDGFRA. Patients with advanced GIST with KIT exon 9, PDGFRA mutation or WT for KIT and PDGFRA have a worse progression-free survival (PFS) compared to patients with KIT exon 11 mutated tumors. We evaluated the immunohistochemical (IHC) expression of p-IGF1R (Y1316) and MMP3 as predictors of PFS or overall survival (OS).

Methods

Ninety-two advanced GIST patients included in GEIS-16 study with KIT and PDGFRA mutational information were examined for p-IGF1R (Y1316) and MMP3 expression in a tissue micro-array. To study activation of the IGF1R system, we have used an antibody (anti-pY1316) that specifically recognizes the active phosphorylated form of the IGF1R. DNA was extracted from paraffin-embedded tissues and intronic PCR primers were used to amplify exons 9, 11, 13 and 17 of KIT, 12 and 18 of PDGFRA. Bidirectional sequencing with specific primers was performed on a ABI3100 sequencer using the Big Dye Terminator v3.1 kit. Multivariate model was built using a stepwise automated variable selection approach with criterion to enter the variable in the model of p < 0.10 and criterion to keep the variable in the model of p < 0.05. PFS was computed as the date of imatinib initiation to progression or death. Overall survival was defined as the time from imatinib initiation to death.

Results

Phospho-IGF1R was expressed only in 9 % (2/22) of cases without KIT mutation. MMP3 expression was detected in 2/5 patients (40 %) with PDGFRA mutation, 1/16 patients (6 %) with WT genotype and 7/71 patients (10 %) of KIT mutant patients. At univariate analysis KIT exon 11/13 mutation had better PFS than patients with exon 9 mutation, PDGFRA mutation or WT genotype (p = 0.021; HR: 0.46; 95 %CI (0.28–0.76). Less than 24 months disease free-interval (HR 24.2, 95 % CI 10.5–55.8), poor performance status (PS) (HR 6.3, 95 % CI 2.5–15.9), extension of disease; >1 organ (HR 1.89; 95 % CI 1.03–3.4) and genotype analysis (HR 0.57, 95 % CI 0.37–0.97) but not immunophenotype analysis (HR 1.53; 95 % CI 0.76–3.06) were the strongest prognostic factors for PFS in the multivariate analysis.

Conclusions

Our results do not support p-IGF-1R and MMP3 evaluation in non-selected GIST patients but evaluation of this immunophenotype in WT and mutant PDGFR mutation in larger group of GIST patients, deserve merits.