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Sharma YK, Gawande M, Reche A, Bardia MR. Circulating Tumor Cells in Oral Cancer. Cureus 2024; 16:e51684. [PMID: 38318575 PMCID: PMC10839405 DOI: 10.7759/cureus.51684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/04/2024] [Indexed: 02/07/2024] Open
Abstract
Till now, oral squamous cell carcinoma (OSCC) is graded as well-differentiated, moderately-differentiated, poorly-differentiated, and undifferentiated. However, this grading does not have a prediction of the prognosis of the patient. Also, prognosis impacts lymph node metastases, surgical margins, and vascular invasions (neural invasion, muscular invasion, salivary gland invasion). The prognosis of lymph node metastases is significant, which affects the survival of the patients which is 50%. So, a dependable blood marker is needed for prognosis in OSCC patients with loco-regional and distant recurrence. Some factors can be assisted only after surgery and invasive techniques to check the prognosis of the disease. Despite the ease of examining the oral cavity, there is no practical approach for non-invasive screening and detecting cancer. As it is abrupt to use such invasive procedures from time to time, there is a need for nonsurgical and reliable techniques to assess the progression of tumors. Also, frozen sections are helpful during the intraoperative procedure to evaluate the lymph node metastases. An increase in the number of tumor cells through blood is a significant event in disease metastases toward the peripheral blood. Oral health impact assessment instruments could aid in determining the quality of life, and their usage in the initial stages of oral carcinoma could help physicians choose the best treatment option for enhancing the quality of life.
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Affiliation(s)
- Yashika K Sharma
- Oral Pathology and Microbiology, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Madhuri Gawande
- Oral Pathology and Microbiology, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amit Reche
- Public Health Dentistry, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Muskan R Bardia
- Oral Pathology and Microbiology, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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2
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Conarty JP, Wieland A. The Tumor-Specific Immune Landscape in HPV+ Head and Neck Cancer. Viruses 2023; 15:1296. [PMID: 37376596 DOI: 10.3390/v15061296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Human papillomaviruses (HPVs) are the causative agent of several anogenital cancers as well as head and neck cancers, with HPV+ head and neck squamous cell carcinoma (HNSCC) becoming a rapidly growing public health issue in the Western world. Due its viral etiology and potentially its subanatomical location, HPV+ HNSCC exhibits an immune microenvironment which is more inflamed and thus distinct from HPV-negative HNSCC. Notably, the antigenic landscape in most HPV+ HNSCC tumors extends beyond the classical HPV oncoproteins E6/7 and is extensively targeted by both the humoral and cellular arms of the adaptive immune system. Here, we provide a comprehensive overview of HPV-specific immune responses in patients with HPV+ HNSCC. We highlight the localization, antigen specificity, and differentiation states of humoral and cellular immune responses, and discuss their similarities and differences. Finally, we review currently pursued immunotherapeutic treatment modalities that attempt to harness HPV-specific immune responses for improving clinical outcomes in patients with HPV+ HNSCC.
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Affiliation(s)
- Jacob P Conarty
- Department of Otolaryngology, The Ohio State University, Columbus, OH 43210, USA
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA
- Biomedical Sciences Graduate Program, The Ohio State University, Columbus, OH 43210, USA
| | - Andreas Wieland
- Department of Otolaryngology, The Ohio State University, Columbus, OH 43210, USA
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH 43210, USA
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3
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Shome M, Gao W, Engelbrektson A, Song L, Williams S, Murugan V, Park JG, Chung Y, LaBaer J, Qiu J. Comparative Microbiomics Analysis of Antimicrobial Antibody Response between Patients with Lung Cancer and Control Subjects with Benign Pulmonary Nodules. Cancer Epidemiol Biomarkers Prev 2023; 32:496-504. [PMID: 36066883 PMCID: PMC10494706 DOI: 10.1158/1055-9965.epi-22-0384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/15/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND CT screening can detect lung cancer early but suffers a high false-positive rate. There is a need for molecular biomarkers that can distinguish malignant and benign indeterminate pulmonary nodules (IPN) detected by CT scan. METHODS We profiled antibodies against 901 individual microbial antigens from 27 bacteria and 29 viruses in sera from 127 lung adenocarcinoma (ADC), 123 smoker controls (SMC), 170 benign nodule controls (BNC) individuals using protein microarrays to identify ADC and BNC specific antimicrobial antibodies. RESULTS Analyzing fourth quartile ORs, we found more antibodies with higher prevalence in the three BNC subgroups than in ADC or SMC. We demonstrated that significantly more anti-Helicobacter pylori antibodies showed higher prevalence in ADC relative to SMC. We performed subgroup analysis and found that more antibodies with higher prevalence in light smokers (≤20 pack-years) compared with heavy smokers (>20 pack-years), in BNC with nodule size >1 cm than in those with ≤1 cm nodules, and in stage I ADC than in stage II and III ADC. We performed multivariate analysis and constructed antibody panels that can distinguish ADC versus SMC and ADC versus BNC with area under the ROC curve (AUC) of 0.88 and 0.80, respectively. CONCLUSIONS Antimicrobial antibodies have the potential to reduce the false positive rate of CT screening and provide interesting insight in lung cancer development. IMPACT Microbial infection plays an important role in lung cancer development and the formation of benign pulmonary nodules.
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Affiliation(s)
- Mahasish Shome
- Biodesign Institute, Arizona State University, Tempe, Arizona
| | - Weimin Gao
- Biodesign Institute, Arizona State University, Tempe, Arizona
| | | | - Lusheng Song
- Biodesign Institute, Arizona State University, Tempe, Arizona
| | - Stacy Williams
- Biodesign Institute, Arizona State University, Tempe, Arizona
| | - Vel Murugan
- Biodesign Institute, Arizona State University, Tempe, Arizona
| | - Jin G. Park
- Biodesign Institute, Arizona State University, Tempe, Arizona
| | - Yunro Chung
- Biodesign Institute, Arizona State University, Tempe, Arizona
| | - Joshua LaBaer
- Biodesign Institute, Arizona State University, Tempe, Arizona
| | - Ji Qiu
- Biodesign Institute, Arizona State University, Tempe, Arizona
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Current Infections of the Orofacial Region: Treatment, Diagnosis, and Epidemiology. Life (Basel) 2023; 13:life13020269. [PMID: 36836626 PMCID: PMC9966653 DOI: 10.3390/life13020269] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/07/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Undoubtedly, diagnosing and managing infections is one of the most challenging issues for orofacial clinicians. As a result of the diversity of symptoms, complicated behavior, and sometimes confusing nature of these conditions, it has become increasingly difficult to diagnose and treat them. It also highlights the need to gain a deeper insight into the orofacial microbiome as we try to improve our understanding of it. In addition to changes in patients' lifestyles, such as changes in diet, smoking habits, sexual practices, immunosuppressive conditions, and occupational exposures, there have been changes in patients' lifestyles that complicate the issue. Recent years have seen the development of new infection treatments due to the increased knowledge about the biology and physiology of infections. This review aimed to provide a comprehensive overview of the types of infections in the mouth, including the types that viruses, fungi, or bacteria may cause. It is important to note that we searched the published literature in the Scopus, Medline, Google Scholar, and Cochran databases from 2010 to 2021 using the following keywords: "Orofacial/Oral Infections," "Viral/Fungal/Bacterial Infections", "Oral Microbiota" And "Oral Microflora" without limiting our search to languages and study designs. According to the evidence, the most common infections in the clinic include herpes simplex virus, human papillomavirus, Candida albicans, Aspergillus, Actinomycosis, and Streptococcus mutans. The purpose of this study is to review the new findings on characteristics, epidemiology, risk factors, clinical manifestations, diagnosis, and new treatment for these types of infectious diseases.
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Galati L, Chiocca S, Duca D, Tagliabue M, Simoens C, Gheit T, Arbyn M, Tommasino M. HPV and head and neck cancers: Towards early diagnosis and prevention. Tumour Virus Res 2022; 14:200245. [PMID: 35973657 PMCID: PMC9420391 DOI: 10.1016/j.tvr.2022.200245] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/29/2022] [Accepted: 08/08/2022] [Indexed: 01/13/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide with an increasing trend of its incidence. Alcohol consumption, smoking, and viral infections, such as the mucosal high-risk (HR) human papillomaviruses (HPVs) are major risk factors for HNSCC development. In particular, HR HPVs are mainly associated with a subset of oropharyngeal squamous cell carcinoma (OPSCC), while other head and neck sites are marginally affected by HPV infection. HPV16 is the most frequently HR HPV type associated with HNSCC. In contrast to the cervix, no screening programs or identifiable pre-malignant lesions have been characterized for HPV-related HNSCC. Therefore, identification of general diagnostic algorithms and HPV biomarkers that could facilitate the early diagnosis, disease evolution and recurrence for HPV-driven HNSCCs are urgently needed. We herein review the role of HPV in HNSCC with a focus on epidemiology, biology, applied diagnostic algorithms and available biomarkers in body fluids as early diagnostic tools in HPV-driven HNSCCs.
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Affiliation(s)
- Luisa Galati
- International Agency for Research on Cancer, F-69372, Lyon, France
| | - Susanna Chiocca
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20139, Milan, Italy
| | - Daria Duca
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20139, Milan, Italy
| | - Marta Tagliabue
- Department of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, 20141, Milan, Italy; Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Cindy Simoens
- Unit of Cancer Epidemiology/Belgian Cancer Centre, Sciensano, 1050, Brussels, Belgium
| | - Tarik Gheit
- International Agency for Research on Cancer, F-69372, Lyon, France.
| | - Marc Arbyn
- Unit of Cancer Epidemiology/Belgian Cancer Centre, Sciensano, 1050, Brussels, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
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Dahlstrom KR, Anderson KS, Guo M, Kwon MC, Messick CA, Pettaway CA, Asomaning N, Hopper M, Price A, Xu L, Day AT, Gillenwater AM, Sturgis EM. Screening for HPV-related oropharyngeal, anal, and penile cancers in middle-aged men: Initial report from the HOUSTON clinical trial. Oral Oncol 2021; 120:105397. [PMID: 34182223 DOI: 10.1016/j.oraloncology.2021.105397] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Human papillomavirus (HPV)-related Oropharyngeal and Uncommon Cancers Screening Trial of Men (HOUSTON) was designed to determine the prevalence of IgG antibodies to HPV type 16 E proteins (HPV16EAbs), to screen for persistence of HPV and/or detect HPV-related premalignancies and cancers, and to assess acceptance of screening among middle-aged men. METHODS HOUSTON consists of a cross-sectional study and a longitudinal cohort study of men aged 50-64 years. Serologic HPV16EAb status and oral rinse HPV16 status were determined. All HPV16EAb-positive (HPV16EAb+) men and a matched cohort of HPV16EAb-negative (HPV16EAb-) men as well as all oral rinse HPV16-positive (HPV16+) men were included in the longitudinal study (blinded to their results) and underwent oropharyngeal screening every 6 months as well as one-time anal and penile screening. RESULTS Of 553 men enrolled in the cross-sectional study, six (1.1%) were HPV16EAb+ (two were also oral rinse HPV16+), and 41 (7.4%) were HPV16EAb- but oral rinse HPV16+. These 47 men, along with five matched controls, were invited to participate in the longitudinal study, and 42 (81%) agreed and completed baseline in-person screening, with 93% and 90% completeing 6-month and 12-month follow-up visits. One HPV16EAb+ (also oral rinse HPV16+) man, who declined participation in the longitudinal study, presented 4 months after enrollment with an early-stage HPV16-related pharyngeal cancer. Additionally, one HPV16EAb+ (oral rinse HPV16-) man and two oral rinse HPV16+ (HPV16EAb-) men were diagnosed with oncogenic HPV-associated anal dysplasia. CONCLUSIONS This biomarker panel deserves further prospective study to explore potential utility for HPV-related cancer screening among men.
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Affiliation(s)
- Kristina R Dahlstrom
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Karen S Anderson
- Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, AZ, United States
| | - Ming Guo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Michael C Kwon
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Craig A Messick
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Curtis A Pettaway
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nancy Asomaning
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Marika Hopper
- Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, AZ, United States
| | - Anthony Price
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Li Xu
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Andrew T Day
- Department of Otolaryngology - Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Ann M Gillenwater
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Erich M Sturgis
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States.
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Sensitivity and Specificity of Human Papillomavirus (HPV) 16 Early Antigen Serology for HPV-Driven Oropharyngeal Cancer: A Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13123010. [PMID: 34208476 PMCID: PMC8234521 DOI: 10.3390/cancers13123010] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Serum antibodies against human papillomavirus 16 (HPV16) proteins are associated with HPV-driven oropharyngeal cancer (HPV-OPC). The HPV status of OPC cases is clinically relevant because patients with HPV-OPC show improved survival and treatment response compared to tobacco- or alcohol-induced OPC. In clinical settings, molecular HPV tumor status is usually determined by tissue-based methods detecting molecular markers, such as viral nucleic acids or p16 overexpression. Antibodies against HPV16 in peripheral blood were shown to be very accurate in determining the molecular HPV tumor status in multiple studies. In this work, we reviewed and summarized the available literature on the performance of HPV16 serology for E2, E6 and E7 antibodies to determine molecular HPV tumor status in OPC cases in comparison with tissue-based reference methods. We calculated summary estimates across different studies for sensitivity and specificity, and we investigated factors influencing test performance. Abstract Antibodies against HPV16 early proteins have been shown to be promising biomarkers for the identification of HPV-driven oropharyngeal cancer (HPV-OPC) among OPC cases in multiple studies. A systematic literature search was performed to identify original research articles comparing HPV early antigen serology with established reference methods to determine molecular HPV tumor status. Random-effects models were used to calculate summary estimates for sensitivity and specificity of HPV16 E2, E6 and E7 serology for HPV-OPC. Subgroup analyses were performed to explore heterogeneity across studies and describe variables associated with test performance. We identified n = 23 studies meeting all eligibility criteria and included these in the meta-analysis. E6 serology showed the best performance with pooled sensitivity and specificity estimates of 83.1% (95% confidence interval (CI) 72.5–90.2%) and 94.6% (95% CI 89.0–97.4%), respectively, while E2 and E7 serological assays were highly specific (E2: 92.5% (95% CI 79.1–97.6%); E7: 88.5% (95% CI 77.9–94.4%)) but moderately sensitive (E2: 67.8% (95% CI 58.9–75.6%); E7: 67.0% (95% CI 63.2–70.6%)). Subgroup analyses revealed increased pooled sensitivity for bacterially (89.9% (95% CI 84.5–93.6%)) vs. in vitro expressed E6 antigen (55.3% (95% CI 41.0–68.7%)), while both showed high specificity (95.2% (95% CI 93.0–96.7%) and 91.1% (95% CI 46.6–99.2%), respectively). Pooled specificity estimates for HPV16 E2, E6 and E7 serology were significantly lower in studies utilizing HPV DNA PCR as the only molecular reference method compared to those using a combination of any two reference methods (HPV DNA, RNA, in situ hybridization (ISH), p16 immunohistochemistry (IHC)), or histopathological reference methods (ISH or p16 IHC) as stand-alone marker. In conclusion, HPV16 E6 seropositivity is a highly sensitive and specific biomarker for HPV-OPC. However, its performance differs between serological assays and depends on molecular reference methods.
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Miles BA, Posner MR, Gupta V, Teng MS, Bakst RL, Yao M, Misiukiewicz KJ, Chai RL, Sharma S, Westra WH, Kim‐Schulze S, Dayal B, Sobotka S, Sikora AG, Som PM, Genden EM. De-Escalated Adjuvant Therapy After Transoral Robotic Surgery for Human Papillomavirus-Related Oropharyngeal Carcinoma: The Sinai Robotic Surgery (SIRS) Trial. Oncologist 2021; 26:504-513. [PMID: 33675133 PMCID: PMC8176976 DOI: 10.1002/onco.13742] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Treatment of human papillomavirus-related oropharyngeal squamous cell carcinoma (HPVOPC) results in unprecedented high survival rates but possibly unnecessary toxicity. We hypothesized that upfront surgery and neck dissection followed by reduced-dose adjuvant therapy for early and intermediate HPVOPC would ultimately result in equivalent progression-free survival (PFS) and overall survival while reducing toxicity. METHODS This study was a nonrandomized phase II trial for early-stage HPVOPC treated with transoral robotic surgery (TORS) followed by reduced-dose radiotherapy. Patients with previously untreated p16-positive HPVOPC and <20 pack years' smoking history were enrolled. After robotic surgery, patients were assigned to group 1 (no poor risk features; surveillance), group 2 (intermediate pathologic risk factors [perineural invasion, lymphovascular invasion]; 50-Gy radiotherapy), or group 3 (poor prognostic pathologic factors [extranodal extension [ENE], more than three positive lymph nodes and positive margin]; concurrent 56-Gy chemoradiotherapy with weekly cisplatin). RESULTS Fifty-four patients were evaluable; there were 25 in group 1, 15 in group 2, and 14 in group 3. Median follow-up was 43.9 months (9.6-75.8). Disease-specific survival was 98.1%, and PFS was 90.7%. PFS probability via Kaplan-Meier was 91.3% for group 1, 86.7% for group 2, and 93.3% for group 3. There were five locoregional failures (LRFs), including one distant metastasis and one contralateral second primary. Average time to LRF was 18.9 months (9.6-59.0); four LRFs were successfully salvaged, and the patients remain disease free (11.0-42.7 months); one subject remains alive with disease. CONCLUSION The results indicate that upfront surgery with neck dissection with reduced-dose radiation for T1-2, N1 stage (by the eighth edition American Joint Committee on Cancer staging manual) HPVOPC results in favorable survival with excellent function in this population. These results support radiation dose reduction after TORS as a de-escalation strategy in HPVOPC. IMPLICATIONS FOR PRACTICE Transoral robotic surgery can provide a safe platform for de-escalation in carefully selected patients with early-stage human papillomavirus-related oropharyngeal cancer. In this clinical trial, disease-specific survival was 100%, over 90% of the cohort had a reduction of therapy from standard of care with excellent functional results, and the five patients with observed locoregional failures were successfully salvaged.
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Affiliation(s)
- Brett A. Miles
- Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Otolaryngology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Marshall R. Posner
- Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Hematology/Oncology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Marita S. Teng
- Department of Otolaryngology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Richard L. Bakst
- Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Radiation Oncology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Mike Yao
- Department of Otolaryngology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - Raymond L. Chai
- Department of Otolaryngology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - William H. Westra
- Department of Pathology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Seunghee Kim‐Schulze
- Department of Immune Monitoring, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Bheesham Dayal
- Department of Otolaryngology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Stanislaw Sobotka
- Department of Otolaryngology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Biostatistics, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Andrew G. Sikora
- Department of Otolaryngology, Baylor College of MedicineHoustonTexasUSA
| | - Peter M. Som
- Department of Radiology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Eric M. Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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von Witzleben A, Currall E, Wood O, Chudley L, Akinyegun O, Thomas J, Bendjama K, Thomas GJ, Friedmann PS, King EV, Laban S, Ottensmeier CH. Correlation of HPV16 Gene Status and Gene Expression With Antibody Seropositivity and TIL Status in OPSCC. Front Oncol 2021; 10:591063. [PMID: 33575210 PMCID: PMC7871909 DOI: 10.3389/fonc.2020.591063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/02/2020] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION Human papillomavirus 16 (HPV16) is the main cause of oropharyngeal squamous cell carcinoma (OPSCC). To date, the links between HPV16 gene expression and adaptive immune responses have not been investigated. We evaluated the correlation of HPV16 DNA, RNA transcripts and features of adaptive immune response by evaluating antibody isotypes against E2, E7 antigens and density of tumor-infiltrating lymphocytes (TIL). MATERIAL AND METHODS FFPE-tissue from 27/77 p16-positive OPSCC patients was available. DNA and RNA were extracted and quantified using qPCR for all HPV16 genes. The TIL status was assessed. Immune responses against E2 and E7 were quantified by ELISA (IgG, IgA, and IgM; 77 serum samples pre-treatment, 36 matched post-treatment). RESULTS Amounts of HPV16 genes were highly correlated at DNA and RNA levels. RNA co-expression of all genes was detected in 37% (7/19). E7 qPCR results were correlated with higher anti-E7 antibody (IgG, IgA) level in the blood. Patients with high anti-E2 IgG antibody (>median) had better overall survival (p=0.0311); anti-E2 and anti-E7 IgA levels had no detectable effect. During the first 6 months after treatment, IgA but not IgG increased significantly, and >6 months both antibody classes declined over time. Patients with immune cell-rich tumors had higher levels of circulating antibodies against HPV antigens. CONCLUSION We describe an HPV16 qPCR assay to quantify genomic and transcriptomic expression and correlate this with serum antibody levels against HPV16 oncoproteins. Understanding DNA/RNA expression, relationship to the antibody response in patients regarding treatment and outcome offers an attractive tool to improve patient care.
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Affiliation(s)
- Adrian von Witzleben
- CRUK and NIHR Experimental Cancer Medicine Center & School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Department of Otorhinolaryngology, Head & Neck Surgery, University of Ulm, Ulm, Germany
| | - Eve Currall
- CRUK and NIHR Experimental Cancer Medicine Center & School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Oliver Wood
- CRUK and NIHR Experimental Cancer Medicine Center & School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Lindsey Chudley
- CRUK and NIHR Experimental Cancer Medicine Center & School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Oluyemisi Akinyegun
- Southampton University Hospitals NHS Foundation Trust, Southampton, United Kingdom
| | - Jaya Thomas
- CRUK and NIHR Experimental Cancer Medicine Center & School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Kaïdre Bendjama
- Department Affaires Médicinales, Research, Project, Transgene SA, Illkirch, France
| | - Gareth J. Thomas
- CRUK and NIHR Experimental Cancer Medicine Center & School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Southampton University Hospitals NHS Foundation Trust, Southampton, United Kingdom
| | - Peter S. Friedmann
- CRUK and NIHR Experimental Cancer Medicine Center & School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Emma V. King
- CRUK and NIHR Experimental Cancer Medicine Center & School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Department of Otorhinolaryngology, Head & Neck Surgery, Poole Hospital, Poole, United Kingdom
| | - Simon Laban
- Department of Otorhinolaryngology, Head & Neck Surgery, University of Ulm, Ulm, Germany
| | - Christian H. Ottensmeier
- CRUK and NIHR Experimental Cancer Medicine Center & School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Liverpool Head and Neck Centre, Institute of Translational Medicine, Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
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Rutkoski H, Tay DL, Dixon BL, Pinzon LM, Mooney R, Winkler JR, Kepka D. A Multi-state Evaluation of Oral Health Students' Knowledge of Human Papillomavirus-Related Oropharyngeal Cancer and HPV Vaccination. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:1017-1025. [PMID: 31222578 PMCID: PMC6923618 DOI: 10.1007/s13187-019-01561-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Human papillomavirus-related oropharyngeal cancers (HPV-OPCs) are on the rise, yet HPV knowledge among dental professionals remains low. The purpose of this multi-state study was to examine sociodemographic factors associated with final year dental hygiene (DH), third year dental (DS3), and fourth year dental (DS4) students' knowledge regarding HPV, HPV-OPC, and HPV vaccination. Twenty dental programs in the USA were approached in the implementation phase to complete an online, 153-item, self-administered questionnaire that was developed and tested in a previous study. Descriptive statistics and chi-square analyses were conducted in SAS version 9.4 to examine the relationship between sociodemographic variables with HPV, HPV-OPC, and HPV vaccination knowledge levels. This study included the participation of students from 15 dental programs (n = 380) with an overall response rate of 28%. Although the results cannot be generalized to the entire population of dental students in the USA, most students had inadequate overall HPV knowledge (65%), HPV-OPC knowledge (80%), and HPV vaccination knowledge (55%). While all student groups displayed adequate general HPV knowledge levels (≥ 70% correct responses), gender, racial, religious, age, and regional differences were observed. Future dental professionals need to have adequate levels of HPV knowledge to aid in reducing the HPV-OPC burden. This study identified sociodemographic factors related to lower knowledge of HPV, HPV-OPC, and HPV vaccination, and highlights groups of students with greater needs for HPV education. This study provides a foundation for future research and interventions to be developed. Dental institutions can use findings to strengthen curricula development.
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Affiliation(s)
- Holdunn Rutkoski
- University of Nevada, Las Vegas: School of Dental Medicine, Las Vegas, NV, USA
| | - Djin L Tay
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Barbara L Dixon
- School of Dentistry, College of Nursing; Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Room 4707, Salt Lake City, UT, 84112, USA
| | - Lilliam M Pinzon
- School of Dentistry, College of Nursing; Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Room 4707, Salt Lake City, UT, 84112, USA
| | - Ryan Mooney
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - James R Winkler
- School of Dentistry, College of Nursing; Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, 2000 Circle of Hope, Room 4707, Salt Lake City, UT, 84112, USA
| | - Deanna Kepka
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA.
- College of Nursing, University of Utah, Salt Lake City, UT, USA.
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11
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Wendland EM, Kops NL, Comerlato J, Horvath JDC, Bessel M, Sperb D, Pimenta C, de Souza FMA, Mendes Pereira GF, Falcetta FS. STOP HPV study protocol: a nationwide case-control study of the association between oropharyngeal cancer and human papillomavirus (HPV) infection in Brazil. BMJ Open 2020; 10:e031602. [PMID: 32001492 PMCID: PMC7045017 DOI: 10.1136/bmjopen-2019-031602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/06/2019] [Accepted: 11/20/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) is the most common sexually transmitted infection and is associated with several types of cancer. The number of cases of HPV-associated head and neck squamous cell carcinomas (HNSCCs), especially oropharyngeal carcinomas, has increased significantly in recent years despite decreased tobacco smoking rates. Currently, no data concerning the risk factors and prevalence of HPV in HNSCC patients in all regions of Brazil are available, making it difficult to promote advances in this field of public health. Therefore, our goal is to determine the impact of infection by HPV, including HPVs with different genotypes, on head and neck cancer and the risk factors associated with the development of head and neck cancer in all regions of Brazil. METHODS AND ANALYSIS This is a case-control study that will include 622 patients and 622 controls from all regions of Brazil. A questionnaire will be applied to gather information on sociodemographic, behavioural and health factors. Oral, cervical or penile/scrotal, and anal specimens and serum samples will be collected from all participants. Formalin-fixed paraffin-embedded tissue from tumour biopsies will be analysed only in the case group. Molecular and serological analyses will be performed to evaluate the presence and role of HPV in the development of head and neck cancer. ETHICS AND DISSEMINATION This project was approved by the research ethical committee of the proposing institution (Hospital Moinhos de Vento, number 2.852.060). Ethical approval from the collaborators is currently under evaluation and is not yet complete. The results of this study will be presented at meetings with the Brazilian Ministry of Health through technical reports and to the scientific community at national and international events, with subsequent publication of scientific articles.
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Affiliation(s)
- Eliana Marcia Wendland
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Natalia Luiza Kops
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Juliana Comerlato
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Marina Bessel
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Daniel Sperb
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cristina Pimenta
- Department of STIs, AIDS and Viral Hepatitis, Ministry of Health, Brasilia, Brazil
| | | | | | - Frederico Soares Falcetta
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
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12
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Burbelo PD, Chaturvedi A, Notkins AL, Gunti S. Luciferase-Based Detection of Antibodies for the Diagnosis of HPV-Associated Head and Neck Squamous Cell Carcinoma. Diagnostics (Basel) 2019; 9:diagnostics9030089. [PMID: 31390810 PMCID: PMC6787723 DOI: 10.3390/diagnostics9030089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/16/2022] Open
Abstract
Point-of-care tests are needed for the screening of head and neck squamous cell carcinoma (HNSCC) and other malignancies. Luciferase immunoprecipitation systems (LIPS), employing light-emitting proteins, were used to examine serum antibodies against several cancer-associated targets in blood donor controls and subjects with colon cancer (CC) and HNSCC. The assessment of antibodies against the wild type p53 tumor antigen showed that approximately 25% of the CC and 20% of the HNSCC patients were seropositive. In addition, humoral responses against two p53 mutants, p53-R175H and p53-R273H, generally tracked the antibody responses seen against wild type p53. Analysis of antibodies against highly specific biomarkers of HPV-16-associated malignancy, E2, E6, and E7 oncoproteins, revealed no seropositivity in blood donors and CC patients. However, 45% (9/20) of the HNSCC patients showed E6 seropositivity, which overlapped all the detectable E2 (40%; 8/20) and E7 seropositive subjects (35%; 7/20). Using neodymium magnets, ultrarapid LIPSTICKS testing of HPV-16 E6 antibodies in <60 s per HNSCC sample demonstrated almost the same diagnostic performance (40% sensitivity and 100% specificity) as LIPS testing in 2.5 h. While additional improvements and standardization are needed, these results highlight the possibility of using these approaches for the diagnosis of HPV-16-associated HNSCC.
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Affiliation(s)
- Peter D Burbelo
- Dental Clinical Research Core, National Institutes of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Adrija Chaturvedi
- Dental Clinical Research Core, National Institutes of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Abner L Notkins
- Experimental Medicine Section, National Institutes of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sreenivasulu Gunti
- Experimental Medicine Section, National Institutes of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892, USA
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13
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Albano PM, Salvador C, Orosa J, Racelis S, Leaño M, Michel A, Ramos JD, Holzinger D, Pawlita M. Human Papillomavirus Serologic Profiles of Selected Filipinos with Head and Neck Squamous Cell Carcinoma. J Pathol Transl Med 2019; 53:273-279. [PMID: 31142100 PMCID: PMC6755648 DOI: 10.4132/jptm.2019.05.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background The low prevalence of human papillomavirus (HPV) DNA and mRNA in biopsy samples of Filipinos with head and neck squamous cell carcinoma (HNSCC) has been reported previously. Here, the HPV serologic profiles of HNSCC cases were analyzed and associated with lifestyle and sexual practices. Methods Serum samples were collected between May 2012 and September 2013 from HNSCC patients (n = 22) in the northwest region of the Philippines, and age- and sex-matched clinically healthy controls. Antibodies to capsid and early oncoproteins of HPV16, 18, 31, 33, 45, 52, 58, 6, and 11 were analyzed using multiplex serology. Results Most of the cases were males with tumors of the oral cavity or larynx. Two of the cases tested positive for at least one of the early oncoproteins (E6, E7, E1, and/or E2) of HPV16, and 11 did not display reactivity to any HPV early or late oncoproteins. Of the controls, four tested positive for at least one of the HPV16 early oncoproteins, and 10 were non-reactive to all HPV types. Titers to HPV16 E6 or E7 of the seropositive cases and controls were considerably lower than those typically observed in economically developed countries. Conclusions The low HPV titers seen here are consistent with the results of molecular analyses for this population. Hence, the seropositivity of some of the HNSCC cases is likely an indication of prior exposure to the virus and not the presence of HPV-driven tumors.
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Affiliation(s)
- Pia Marie Albano
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infection and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Biology, College of Science, University of Santo Tomas, Manila, Philippines.,Research Center for the Natural and Applied Sciences, University of Santo Tomas, Manila, Philippines
| | - Christianne Salvador
- Department of ENT Head and Neck Surgery, Mariano Marcos Memorial Hospital and Medical Center, Ilocos Norte, Philippines
| | - Jose Orosa
- Department of ENT Head and Neck Surgery, Mariano Marcos Memorial Hospital and Medical Center, Ilocos Norte, Philippines
| | - Sheryl Racelis
- Department of Pathology and Laboratories, Mariano Marcos Memorial Hospital and Medical Center, Ilocos Norte, Philippines
| | - Modesty Leaño
- Department of Pathology and Laboratories, Mariano Marcos Memorial Hospital and Medical Center, Ilocos Norte, Philippines
| | - Angelika Michel
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infection and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - John Donnie Ramos
- Department of Biology, College of Science, University of Santo Tomas, Manila, Philippines.,Research Center for the Natural and Applied Sciences, University of Santo Tomas, Manila, Philippines
| | - Dana Holzinger
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infection and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Pawlita
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infection and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
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14
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Mirghani H, Lang Kuhs KA, Waterboer T. Biomarkers for early identification of recurrences in HPV-driven oropharyngeal cancer. Oral Oncol 2018; 82:108-114. [PMID: 29909884 DOI: 10.1016/j.oraloncology.2018.05.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/04/2018] [Accepted: 05/17/2018] [Indexed: 11/17/2022]
Abstract
One of the major concerns in oncology lies in the ability to detect recurrences at their earliest stage to increase the likelihood of cure following second line, or salvage, therapy. Although human papillomavirus (HPV)-driven oropharyngeal cancers have a good prognosis, 20-25% of patients will recur within 5 years of treatment and a significant portion will die from their disease. In recent years, great effort has been put toward evaluating the potential clinical utility of HPV-related biomarkers for early diagnosis of recurrent disease. Indeed, following completion of treatment, detection of HPV-DNA in oral rinses or blood and serologic assays against HPV oncoproteins could be helpful to track residual disease or recurrence. Several recent studies have reported promising findings, thus potentially paving the way for the use of biomarkers in the management of HPV-OPC. In this review, we evaluate and discuss the current knowledge on this topic and provide some directions for future research.
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Affiliation(s)
- Haitham Mirghani
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif, France.
| | - Krystle A Lang Kuhs
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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15
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Huang CG, Lee LA, Liao CT, Yen TC, Yang SL, Liu YC, Li JC, Gong YN, Kang CJ, Huang SF, Fang KH, Chang KP, Lee LY, Hsueh C, Shih SR, Tsao KC. Molecular and serologic markers of HPV 16 infection are associated with local recurrence in patients with oral cavity squamous cell carcinoma. Oncotarget 2018; 8:34820-34835. [PMID: 28422732 PMCID: PMC5471014 DOI: 10.18632/oncotarget.16747] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 03/20/2017] [Indexed: 01/11/2023] Open
Abstract
Human papillomavirus (HPV) infections predict mortality in Taiwanese patients with oral cavity squamous cell carcinoma (OCSCC). To address their prognostic significance for local recurrence (LR), in this retrospective cohort study we investigated different serologic and molecular markers of HPV 16 infection in 85 consecutive patients with primary OCSCC who received standard treatment and had their sera stored before treatment. Resected tumor specimens were examined with PCR-based assays for HPV 16 E6/E7 mRNA expression. Sera were tested with suspension arrays for the presence of HPV-specific antibodies using synthetic L1 and E6 peptides as well as a synthetic E7 protein. HPV 16 E6/E7 mRNA, anti-L1, anti-E6, and anti-E7 antibodies tested positive in 12%, 25%, 38%, and 41% of the study patients, respectively. Multivariate analysis identified pathological T3/T4, E6/E7 mRNA, and anti-E7 antibodies as independent risk factors for LR, whereas anti-E6 antibodies were an independent protective factor. In patients with ≥ 3 (high-risk group), 2 (intermediate-risk), and ≤ 1 (low-risk) independent risk factors (predictors), the 5-year LR rates were 75%, 42%, and 4%, respectively. Results were validated in an independent cohort. Together, our preliminary data indicate that HPV 16 infections as well as low and high serum levels of anti-E6 and anti-E7 antibodies, respectively, can serve as biomarkers of LR in patients with OCSCC, whereas the clinical usefulness of anti-HPV 16 antibodies for risk stratification of newly diagnosed cases deserves further scrutiny.
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Affiliation(s)
- Chung-Guei Huang
- Department of Laboratory Medicine, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.,Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan, ROC.,Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Ang Lee
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Chun-Ta Liao
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Tzu-Chen Yen
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Molecular Imaging Center, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Shu-Li Yang
- Department of Laboratory Medicine, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.,Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yi-Chun Liu
- Department of Laboratory Medicine, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Jung-Chin Li
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yu-Nong Gong
- Department of Laboratory Medicine, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Chung-Jan Kang
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Shiang-Fu Huang
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Ku-Hao Fang
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Kai-Ping Chang
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Li-Yu Lee
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Pathology, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Chuen Hsueh
- Faculty of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Pathology, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Shin-Ru Shih
- Department of Laboratory Medicine, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.,Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan, ROC.,Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Kuo-Chien Tsao
- Department of Laboratory Medicine, Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.,Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan, ROC
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16
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Race CM, Kwon LE, Foreman MT, Huang Q, Inan H, Kesiraju S, Le P, Lim SJ, Smith AM, Zangar RC, Demirci U, Anderson KS, Cunningham BT. An Automated Microfluidic Assay for Photonic Crystal Enhanced Detection and Analysis of an Antiviral Antibody Cancer Biomarker in Serum. IEEE SENSORS JOURNAL 2018; 18:1464-1473. [PMID: 29881332 PMCID: PMC5986186 DOI: 10.1109/jsen.2017.2777529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
We report on the implementation of an automated platform for detecting the presence of an antibody biomarker for human papillomavirus-associated oropharyngeal cancer from a single droplet of serum, in which a nanostructured photonic crystal surface is used to amplify the output of a fluorescence-linked immunosorbent assay. The platform is comprised of a microfluidic cartridge with integrated photonic crystal chips that interfaces with an assay instrument that automates the introduction of reagents, wash steps, and surface drying. Upon assay completion, the cartridge interfaces with a custom laser-scanning instrument that couples light into the photonic crystal at the optimal resonance condition for fluorescence enhancement. The instrument is used to measure the fluorescence intensity values of microarray spots corresponding to the biomarkers of interest, in addition to several experimental controls that verify correct functioning of the assay protocol. In this work, we report both dose-response characterization of the system using anti-E7 antibody introduced at known concentrations into serum and characterization of a set of clinical samples from which results were compared with a conventional enzyme-linked immunosorbent assay (ELISA) performed in microplate format. The demonstrated capability represents a simple, rapid, automated, and high-sensitivity method for multiplexed detection of protein biomarkers from a low-volume test sample.
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Affiliation(s)
| | - Lydia E Kwon
- Department of Bioengineering
- College of Medicine, University of Illinois at Urbana-Champaign
| | | | | | - Hakan Inan
- Canary Center for Cancer Early Detection, Stanford University
| | | | | | | | | | | | - Utkan Demirci
- Canary Center for Cancer Early Detection, Stanford University
| | | | - Brian T Cunningham
- Department of Electrical and Computer Engineering
- Department of Bioengineering
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17
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Sacco AG, Cohen EE. Serum antibodies open the door to prediction and prognostication in human papillomavirus-related head and neck cancer. Cancer 2017; 123:4310-4313. [DOI: 10.1002/cncr.30970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/03/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Assuntina G. Sacco
- Department of Internal Medicine, Division of Hematology-Oncology; UC San Diego Moores Cancer Center; La Jolla California
| | - Ezra E. Cohen
- Department of Internal Medicine, Division of Hematology-Oncology; UC San Diego Moores Cancer Center; La Jolla California
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18
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Dahlstrom KR, Anderson KS, Field MS, Chowell D, Ning J, Li N, Wei Q, Li G, Sturgis EM. Diagnostic accuracy of serum antibodies to human papillomavirus type 16 early antigens in the detection of human papillomavirus-related oropharyngeal cancer. Cancer 2017; 123:4886-4894. [PMID: 28898394 DOI: 10.1002/cncr.30955] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Because of the current epidemic of human papillomavirus (HPV)-related oropharyngeal cancer (OPC), a screening strategy is urgently needed. The presence of serum antibodies to HPV-16 early (E) antigens is associated with an increased risk for OPC. The purpose of this study was to evaluate the diagnostic accuracy of antibodies to a panel of HPV-16 E antigens in screening for OPC. METHODS This case-control study included 378 patients with OPC, 153 patients with nonoropharyngeal head and neck cancer (non-OPC), and 782 healthy control subjects. The tumor HPV status was determined with p16 immunohistochemistry and HPV in situ hybridization. HPV-16 E antibody levels in serum were identified with an enzyme-linked immunosorbent assay. A trained binary logistic regression model based on the combination of all E antigens was predefined and applied to the data set. The sensitivity and specificity of the assay for distinguishing HPV-related OPC from controls were calculated. Logistic regression analysis was used to calculate odds ratios with 95% confidence intervals for the association of head and neck cancer with the antibody status. RESULTS Of the 378 patients with OPC, 348 had p16-positive OPC. HPV-16 E antibody levels were significantly higher among patients with p16-positive OPC but not among patients with non-OPC or among controls. Serology showed high sensitivity and specificity for HPV-related OPC (binary classifier: 83% sensitivity and 99% specificity for p16-positive OPC). CONCLUSIONS A trained binary classification algorithm that incorporates information about multiple E antibodies has high sensitivity and specificity and may be advantageous for risk stratification in future screening trials. Cancer 2017;123:4886-94. © 2017 American Cancer Society.
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Affiliation(s)
- Kristina R Dahlstrom
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen S Anderson
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, Arizona
| | - Matthew S Field
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, Arizona
| | - Diego Chowell
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, Arizona.,Simon A. Levin Mathematical, Computational, and Modeling Sciences Center, Arizona State University, Tempe, Arizona
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nan Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qingyi Wei
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Guojun Li
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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19
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Pre-diagnostic dynamic HPV16 IgG seropositivity and risk of oropharyngeal cancer. Oral Oncol 2017; 73:132-137. [PMID: 28939065 DOI: 10.1016/j.oraloncology.2017.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/21/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The aim of this study was to determine the association of HPV16 antibodies (Abs) and oropharyngeal cancer (OPC) risk in sera obtained prior to clinical diagnosis. METHODS We identified 92 participants with incident OPC and 460 matched controls from the Janus Serum Bank Cohort in Norway. Archived tumor specimens were requested for a subset of the cases. Serum samples were collected from cases, on average, 9.3years before diagnosis (range, 0.1-14.9years). Ten cases had serum samples from multiple time points. IgG seropositivity to 8 HPV16 antigens was determined, and a logistic regression classifier of a panel of all early-antigen (EA) Abs for the predictive diagnosis of OPC was applied. RESULTS HPV16 EA seropositivity was present in 25.0% of patients with OPC and 7.6% of controls (odds ratio (OR), 4.1; 95% CI, 2.3-7.2, p<0.0001). Abs to E2 were strongly associated with cases 0-2years pre- diagnosis (OR, 150.1; 95% CI, 27.4-1040.0, p<0.0001), and the probability of seropositivity was inversely associated with time to diagnosis (OR, 0.7 per additional year; 95% CI, 0.6-0.9, p=0.0002). Abs to E2 were also strongly associated with tumor HPV status (OR, 35.6; 95% CI, 8.7-200.0, p<0.0001). A positive score on the binary classifier was associated with an overall OR of 15.8 (95% CI, 5.6-53.4) compared with controls (p<0.05), and was strongly associated with tumor HPV status (OR, 27.4; 95% CI, 8.6-99.6, p<0.001). CONCLUSIONS HPV16 Abs are detectable years prior to diagnosis of OPC, and the probability of seropositivity increases closer to diagnosis.
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20
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Hanna GJ, Sridharan V, Margalit DN, La Follette SK, Chau NG, Rabinowits G, Lorch JH, Haddad RI, Tishler RB, Anderson KS, Schoenfeld JD. Salivary and serum HPV antibody levels before and after definitive treatment in patients with oropharyngeal squamous cell carcinoma. Cancer Biomark 2017; 19:129-136. [DOI: 10.3233/cbm-160071] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Glenn J. Hanna
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Danielle N. Margalit
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, MA, USA
| | - Stephanie K. La Follette
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, MA, USA
| | - Nicole G. Chau
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Jochen H. Lorch
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Robert I. Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Roy B. Tishler
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, MA, USA
| | - Karen S. Anderson
- School of Life Sciences, Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Jonathan D. Schoenfeld
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, Boston, MA, USA
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21
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Inan H, Wang S, Inci F, Baday M, Zangar R, Kesiraju S, Anderson KS, Cunningham BT, Demirci U. Isolation, Detection, and Quantification of Cancer Biomarkers in HPV-Associated Malignancies. Sci Rep 2017; 7:3322. [PMID: 28607383 PMCID: PMC5468352 DOI: 10.1038/s41598-017-02672-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/13/2017] [Indexed: 11/09/2022] Open
Abstract
Human Papillomavirus (HPV) infection has been recognized as the main etiologic factor in the development of various cancers including penile, vulva, oropharyngeal and cervical cancers. In the development of cancer, persistent HPV infections induce E6 and E7 oncoproteins, which promote cell proliferation and carcinogenesis resulting elevated levels of host antibodies (e.g., anti-HPV16 E7 antibody). Currently, these cancers are clinically diagnosed using invasive biopsy-based tests, which are performed only in centralized labs by experienced clinical staff using time-consuming and expensive tools and technologies. Therefore, these obstacles constrain their utilization at primary care clinics and in remote settings, where resources are limited. Here, we present a rapid, inexpensive, reliable, easy-to-use, customized immunoassay platform following a microfluidic filter device to detect and quantify anti-HPV16 E7 antibodies from whole blood as a non-invasive assisting technology for diagnosis of HPV-associated malignancies, especially, at primary healthcare and remote settings. The platform can detect and quantify anti-HPV16 E7 antibody down to 2.87 ng/mL. We further validated our immunoassay in clinical patient samples and it provided significantly high responses as compared to control samples. Thus, it can be potentially implemented as a pretesting tool to identify high-risk groups for broad monitoring of HPV-associated cancers in resource-constrained settings.
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Affiliation(s)
- Hakan Inan
- Demirci Bio-Acoustic-MEMS in Medicine (BAMM) Laboratory, Stanford University School of Medicine, Department of Radiology, Canary Center at Stanford for Cancer Early Detection, 3155 Porter Drive, Palo Alto, CA, 94304, USA
| | - Shuqi Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fatih Inci
- Demirci Bio-Acoustic-MEMS in Medicine (BAMM) Laboratory, Stanford University School of Medicine, Department of Radiology, Canary Center at Stanford for Cancer Early Detection, 3155 Porter Drive, Palo Alto, CA, 94304, USA
| | - Murat Baday
- Demirci Bio-Acoustic-MEMS in Medicine (BAMM) Laboratory, Stanford University School of Medicine, Department of Radiology, Canary Center at Stanford for Cancer Early Detection, 3155 Porter Drive, Palo Alto, CA, 94304, USA
| | - Richard Zangar
- Pacific Northwest National Laboratory, Richland, WA, USA
| | - Sailaja Kesiraju
- Biodesign Institute, School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Karen S Anderson
- Biodesign Institute, School of Life Sciences, Arizona State University, Tempe, AZ, USA.
| | - Brian T Cunningham
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Utkan Demirci
- Demirci Bio-Acoustic-MEMS in Medicine (BAMM) Laboratory, Stanford University School of Medicine, Department of Radiology, Canary Center at Stanford for Cancer Early Detection, 3155 Porter Drive, Palo Alto, CA, 94304, USA. .,Department of Electrical Engineering (by courtesy), Stanford University, Stanford, CA, USA.
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22
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Broglie MA, Jochum W, Michel A, Waterboer T, Foerbs D, Schoenegg R, Stoeckli SJ, Pawlita M, Holzinger D. Evaluation of type-specific antibodies to high risk-human papillomavirus (HPV) proteins in patients with oropharyngeal cancer. Oral Oncol 2017. [PMID: 28622890 DOI: 10.1016/j.oraloncology.2017.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES High risk human papillomavirus (HR-HPV) infection leads to a subgroup of oropharyngeal cancer (OPSCC) characterized by improved treatment response. However an universally accepted definition of an HR-HPV-attributable cancer is lacking. METHODS Detailed, type-specific HPV antibody responses were analyzed by multiplex serology in HR-HPV-attributable OPSCC patients, defined by p16INK4A overexpression and HR-HPV DNA detection by PCR amplification and sequencing. RESULTS Fifty patients were prospectively enrolled. 26/50 (52%) tumor samples were positive for both p16INK4A expression and HR-HPV DNA (22 HPV16, 4 HPV33). Seropositivity was present in 26/26 HPV-attributable OPSCC and one p16INK4A-positive/HPV DNA-negative case. The sensitivity and specificity to diagnose an HR-HPV-attributable tumor was 100% and 96%, respectively for anti-E6 reactivity, 82% and 100%, respectively for anti-E2 reactivity, and clearly lower for anti-E7, anti-E1, anti-E4 and anti-L1-reactivity. 3yr-overall (OS) and disease specific survival (DSS) was higher in patients with HR-HPV-attributable tumors (OS 88% vs 64%, p=0.02; DSS 90% vs 80%, p=0.07) and seropositive patients (OS 88% vs 62%, p=0.01; DSS 92% vs 78%, p=0.05) than HR-HPV-negative or seronegative patients. CONCLUSIONS Detection of HR-HPV type-specific antibodies highly correlated with HPV-attributable OPSCC and was associated with better survival. HR-HPV antibodies are promising diagnostic, prognostic and potentially screening markers in HR-HPV-attributable OPSCC.
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Affiliation(s)
- Martina A Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.
| | - Wolfram Jochum
- Institute of Pathology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
| | - Angelika Michel
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infections, Inflammation and Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Tim Waterboer
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infections, Inflammation and Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Diana Foerbs
- Institute of Pathology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
| | - René Schoenegg
- Institute of Pathology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
| | - Sandro J Stoeckli
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
| | - Michael Pawlita
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infections, Inflammation and Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Dana Holzinger
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infections, Inflammation and Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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23
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Holzinger D, Wichmann G, Baboci L, Michel A, Höfler D, Wiesenfarth M, Schroeder L, Boscolo‐Rizzo P, Herold‐Mende C, Dyckhoff G, Boehm A, Del Mistro A, Bosch FX, Dietz A, Pawlita M, Waterboer T. Sensitivity and specificity of antibodies against HPV16 E6 and other early proteins for the detection of HPV16‐driven oropharyngeal squamous cell carcinoma. Int J Cancer 2017; 140:2748-2757. [DOI: 10.1002/ijc.30697] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/21/2017] [Accepted: 02/27/2017] [Indexed: 01/12/2023]
Affiliation(s)
- Dana Holzinger
- Division of Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer ProgramGerman Cancer Research Center (DKFZ)Heidelberg Germany
| | - Gunnar Wichmann
- Department of OtorhinolaryngologyUniversity Hospital LeipzigLeipzig Germany
| | - Lorena Baboci
- Division of Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer ProgramGerman Cancer Research Center (DKFZ)Heidelberg Germany
- Department of Oncology and Surgical SciencesUniversity of PaduaPadua Italy
| | - Angelika Michel
- Division of Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer ProgramGerman Cancer Research Center (DKFZ)Heidelberg Germany
| | - Daniela Höfler
- Division of Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer ProgramGerman Cancer Research Center (DKFZ)Heidelberg Germany
| | - Manuel Wiesenfarth
- Division of BiostatisticsGerman Cancer Research CenterHeidelberg Germany
| | - Lea Schroeder
- Division of Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer ProgramGerman Cancer Research Center (DKFZ)Heidelberg Germany
| | - Paolo Boscolo‐Rizzo
- Department of NeurosciencesENT Clinic and Regional Center for Head and Neck Cancer, University of PaduaTreviso Italy
| | - Christel Herold‐Mende
- Department of Otorhinolaryngology, Head and Neck SurgeryHeidelberg UniversityHeidelberg Germany
- Department of Neurosurgery, Division of Experimental NeurosurgeryHeidelberg UniversityHeidelberg Germany
| | - Gerhard Dyckhoff
- Department of Otorhinolaryngology, Head and Neck SurgeryHeidelberg UniversityHeidelberg Germany
| | - Andreas Boehm
- Department of OtorhinolaryngologyUniversity Hospital LeipzigLeipzig Germany
| | - Annarosa Del Mistro
- Department of Immunology and Molecular OncologyIRCCS Veneto Institute of Oncology (IOV)Padua Italy
| | - Franz X. Bosch
- Department of Otorhinolaryngology, Head and Neck SurgeryHeidelberg UniversityHeidelberg Germany
| | - Andreas Dietz
- Department of OtorhinolaryngologyUniversity Hospital LeipzigLeipzig Germany
| | - Michael Pawlita
- Division of Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer ProgramGerman Cancer Research Center (DKFZ)Heidelberg Germany
| | - Tim Waterboer
- Division of Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer ProgramGerman Cancer Research Center (DKFZ)Heidelberg Germany
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24
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Wang HF, Li LF, Guo SH, Zeng QY, Ning F, Liu WL, Zhang G. Evaluation of antibody level against Fusobacterium nucleatum in the serological diagnosis of colorectal cancer. Sci Rep 2016; 6:33440. [PMID: 27678333 PMCID: PMC5039407 DOI: 10.1038/srep33440] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/24/2016] [Indexed: 12/14/2022] Open
Abstract
Fusobacterium nucleatum (F. nucleatum, Fn) is associated with the colorectal cancer (CRC). Fn-infection could induce significant levels of serum Fn-specific antibodies in human and mice. The objective of this study was to identify Fn-infection that elicit a humoral response in patients with CRC and evaluate the diagnostic performance of serum anti-Fn antibodies. In this work, we showed the mean absorbance value of anti-Fn-IgA and -IgG in the CRC group were significantly higher than those in the benign colon disease group and healthy control group (P < 0.001). The sensitivity and specificity of ELISA for the detection of anti-Fn-IgA were 36.43% and 92.71% based on the optimal cut-off. The combination of anti-Fn-IgA and carcino-embryonic antigen (CEA) was better for diagnosing CRC (Sen: 53.10%, Spe: 96.41%; AUC = 0.848). Furthermore, combining anti-Fn-IgA with CEA and carbohydrate antigen 19-9 (CA19-9) (Sen: 40.00%, Spe: 94.22%; AUC = 0.743) had the better ability to classify CRC patients with stages I-II. These results suggested that Fn-infection elicited high level of serum anti-Fn antibodies in CRC patients, and serum anti-Fn-IgA level may be a potential diagnosing biomarker for CRC. Serum anti-Fn-IgA in combination with CEA and CA19-9 increases the sensitivity of detecting early CRC.
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Affiliation(s)
- Hai-Fang Wang
- Department of Microbial and Biochemical Pharmacy, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
| | - Lin-Fang Li
- Department of Clinical Laboratory Medicine, Sun Yat-sen University cancer center, Guangzhou, China
| | - Song-He Guo
- Department of Microbial and Biochemical Pharmacy, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
| | - Qiu-Yao Zeng
- Department of Clinical Laboratory Medicine, Sun Yat-sen University cancer center, Guangzhou, China
| | - Fen Ning
- Guangzhou Institute of Pediatrics, Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wan-Li Liu
- Department of Clinical Laboratory Medicine, Sun Yat-sen University cancer center, Guangzhou, China
| | - Ge Zhang
- Department of Microbial and Biochemical Pharmacy, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
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25
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Katchman BA, Smith JT, Obahiagbon U, Kesiraju S, Lee YK, O'Brien B, Kaftanoglu K, Blain Christen J, Anderson KS. Application of flat panel OLED display technology for the point-of-care detection of circulating cancer biomarkers. Sci Rep 2016; 6:29057. [PMID: 27374875 PMCID: PMC4931450 DOI: 10.1038/srep29057] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 06/10/2016] [Indexed: 01/07/2023] Open
Abstract
Point-of-care molecular diagnostics can provide efficient and cost-effective medical care, and they have the potential to fundamentally change our approach to global health. However, most existing approaches are not scalable to include multiple biomarkers. As a solution, we have combined commercial flat panel OLED display technology with protein microarray technology to enable high-density fluorescent, programmable, multiplexed biorecognition in a compact and disposable configuration with clinical-level sensitivity. Our approach leverages advances in commercial display technology to reduce pre-functionalized biosensor substrate costs to pennies per cm2. Here, we demonstrate quantitative detection of IgG antibodies to multiple viral antigens in patient serum samples with detection limits for human IgG in the 10 pg/mL range. We also demonstrate multiplexed detection of antibodies to the HPV16 proteins E2, E6, and E7, which are circulating biomarkers for cervical as well as head and neck cancers.
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Affiliation(s)
- Benjamin A Katchman
- Center for Personalized Diagnostics, Biodesign Institute at Arizona State University, Tempe, AZ 85281 USA
| | - Joseph T Smith
- Flexible Electronics and Display Center at Arizona State University, Tempe, AZ 85284 USA
| | - Uwadiae Obahiagbon
- School of Electrical Engineering at Arizona State University, Tempe, AZ 85281 USA
| | - Sailaja Kesiraju
- Center for Personalized Diagnostics, Biodesign Institute at Arizona State University, Tempe, AZ 85281 USA
| | - Yong-Kyun Lee
- Flexible Electronics and Display Center at Arizona State University, Tempe, AZ 85284 USA
| | - Barry O'Brien
- Flexible Electronics and Display Center at Arizona State University, Tempe, AZ 85284 USA
| | - Korhan Kaftanoglu
- Flexible Electronics and Display Center at Arizona State University, Tempe, AZ 85284 USA
| | | | - Karen S Anderson
- Center for Personalized Diagnostics, Biodesign Institute at Arizona State University, Tempe, AZ 85281 USA
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26
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Dahlstrom KR, Anderson KS, Cheng JN, Chowell D, Li G, Posner M, Sturgis EM. HPV Serum Antibodies as Predictors of Survival and Disease Progression in Patients with HPV-Positive Squamous Cell Carcinoma of the Oropharynx. Clin Cancer Res 2016; 21:2861-9. [PMID: 26078432 DOI: 10.1158/1078-0432.ccr-14-3323] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Oropharyngeal carcinoma positive for human papillomavirus type 16 (HPV16) has a significantly better prognosis than oropharyngeal carcinoma unrelated to HPV. Within HPV16-positive oropharyngeal carcinoma, biomarkers of prognosis are urgently needed to individualize care. We hypothesized that serum antibodies specific to HPV16, the major HPV type causing oropharyngeal carcinoma, have biologic relevance and are potential biomarkers for improved prognosis among patients with HPV16-positive oropharyngeal carcinoma. EXPERIMENTAL DESIGN IgG antibodies to the HPV16 antigens E1, E4-E7, L1, L2, and the N-terminal and C-terminal fragments of E2 (NE2, CE2) were quantified using a custom programmable enzyme-linked immunosorbent assay. Sera were obtained at diagnosis from 209 oropharyngeal carcinoma patients (96 HPV16-positive). The ratios of median fluorescent intensity (MFI) for each antigen to MFI for control GST protein were determined. Kaplan-Meier survival curves and Cox proportional hazards regression were used to determine survival differences between groups. ROC curves were used to determine the best combination of E antibodies to predict disease recurrence. RESULTS E1, NE2, and E6 antibody positivity were all strongly associated with improved overall and progression-free survival in the entire cohort and in patients with known HPV16-positive tumors (P < 0.05). For both overall and progression-free survival among HPV-positive patients, hazard ratios were 0.2 for NE2, 0.3 for E1, and 0.3 for E6 antibody positivity. CONCLUSIONS We identified three HPV16-specific antibodies that are associated with improved overall and progression-free survival in patients with HPV-related oropharyngeal carcinoma. These results suggest that differential serologic responses in patients may reflect differential biologic processes within the host and tumor and may have prognostic value.
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Affiliation(s)
- Kristina R Dahlstrom
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen S Anderson
- Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, Arizona
| | - Julia N Cheng
- Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, Arizona
| | - Diego Chowell
- Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, Arizona. Simon A. Levin Mathematical, Computational, and Modeling Sciences Center, Arizona State University, Tempe, Arizona
| | - Guojun Li
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas. Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marshall Posner
- Tisch Cancer Institute, Icahn School of Medicine at Mt. Sinai, New York City, New York
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas. Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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27
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Ewaisha R, Meshay I, Resnik J, Katchman BA, Anderson KS. Programmable protein arrays for immunoprofiling HPV-associated cancers. Proteomics 2016; 16:1215-24. [PMID: 27089055 DOI: 10.1002/pmic.201500376] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 02/10/2016] [Accepted: 02/24/2016] [Indexed: 11/12/2022]
Abstract
Over 600,000 cancers each year are attributed to the human papillomavirus (HPV), including cervical, anogenital and oropharyngeal cancers (OPC). A key challenge in understanding HPV immunobiology is the diversity of oncogenic HPV types and the need for multiplexed display of HPV antigens to measure antibody responses. We have generated custom HPV protein microarrays displaying 98 proteins as C-terminal GST fusion proteins, representing eight antigens of two low-risk HPV types (HPV6 and 11) and ten oncogenic high-risk HPV types (HPV16, 18, 31, 33, 35, 39, 45, 51, 52 and 58). We demonstrate robust and reproducible protein expression of 96/98 of the antigens using a human cell lysate expression system. The target epitopes and specificities of four monoclonal antibodies were identified. Using sera from ten patients with newly diagnosed OPC and ten controls, we demonstrate specific IgG seroreactivity to HPV16 E1, E2, and E7 (a fold increase of 1.52, 2.19 and 1.35 in cases vs. controls, respectively, all p < 0.005), confirming our prior data on an ELISA platform. We also detect HPV52 E7 Abs in serum from a patient with cervical cancer. The HPV protein array has potential for rapid identification of serologic responses to 12 HPV types.
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Affiliation(s)
- Radwa Ewaisha
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Ian Meshay
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Jack Resnik
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Benjamin A Katchman
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Karen S Anderson
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, USA
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28
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Gutierrez-Xicotencatl L, Salazar-Piña DA, Pedroza-Saavedra A, Chihu-Amparan L, Rodriguez-Ocampo AN, Maldonado-Gama M, Esquivel-Guadarrama FR. Humoral Immune Response Against Human Papillomavirus as Source of Biomarkers for the Prediction and Detection of Cervical Cancer. Viral Immunol 2016; 29:83-94. [PMID: 26780189 DOI: 10.1089/vim.2015.0087] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Cervical cancer (CC) is one of the main causes of death among women of reproductive age. Although there are different tests, the disease tends to be diagnosed at late stages. In recent years, the use of complementary tests or sequential diagnostic tests has been implemented. Nevertheless, the results are variable and not conclusive; therefore, more studies for improving the usefulness of these tests in diagnostics are necessary. The human papillomavirus (HPV) infection has been associated with both benign and malignant proliferation of skin and mucosal tissues. Furthermore, some HPV types have been classified as high risk due to their potential to cause cancer, and HPV16 is most frequently associated with this disease. Although between 70% and 80% of precancerous lesions are eliminated by the host's immune system, there is no available test to distinguish between regressive lesions from those that could progress to CC. An HPV infection generates a humoral immune response against L1 and L2 capsid proteins, which can be protective and a response against early proteins. The latter is not a protective response, but these antibodies can be used as markers to determine the stage of the infection and/or the stage of the cervical lesion. Up to now, the humoral immune response resulting from the HPV infection has been used to study the biology of the virus and the efficacy of the HPV vaccines. Although there are no conclusive results regarding the use of these antibodies for diagnosis, we hereby review the actual panorama of the antibody response against the HPV proteins during the development of the disease as well as their possible use as biomarkers for the progression of cervical lesions and of CC.
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Affiliation(s)
- Lourdes Gutierrez-Xicotencatl
- 1 Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública , Cuernavaca, Morelos, México
| | - Dolores Azucena Salazar-Piña
- 1 Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública , Cuernavaca, Morelos, México
| | - Adolfo Pedroza-Saavedra
- 1 Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública , Cuernavaca, Morelos, México
| | - Lilia Chihu-Amparan
- 1 Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública , Cuernavaca, Morelos, México
| | | | - Minerva Maldonado-Gama
- 1 Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública , Cuernavaca, Morelos, México
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29
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Boscolo-Rizzo P, Pawlita M, Holzinger D. From HPV-positive towards HPV-driven oropharyngeal squamous cell carcinomas. Cancer Treat Rev 2016; 42:24-9. [DOI: 10.1016/j.ctrv.2015.10.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 10/22/2015] [Indexed: 11/15/2022]
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30
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Abstract
Immune monitoring is critical in settings of infection, autoimmunity, and cancer, but our understanding of the diversity of the antibody immune repertoire has been limited to selected target antigens and epitopes. Development of new vaccines requires monitoring of B cell immunity and identification of candidate antigens. As vaccines become more complex, novel techniques are required for monitoring the diversity of the B cell immune response. Since antibodies recognize both linear and conformational protein and glycoprotein epitopes, recent advances in proteomic and glycomic technologies for rapid display of antigenic structures are leading to methods for proteome-wide immune monitoring. Here, we review different approaches for protein display for immune monitoring, and provide methods for in situ protein display for the rapid detection and validation of antibody repertoires.
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Affiliation(s)
- Radwa Ewaisha
- Center for Personalized Diagnostics, School of Life Sciences, The Biodesign Institute, Arizona State University, 876401, Tempe, AZ, 85287, USA
| | - Karen S Anderson
- Center for Personalized Diagnostics, School of Life Sciences, The Biodesign Institute, Arizona State University, 876401, Tempe, AZ, 85287, USA.
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31
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Yang L, Wang J, Li J, Zhang H, Guo S, Yan M, Zhu Z, Lan B, Ding Y, Xu M, Li W, Gu X, Qi C, Zhu H, Shao Z, Liu B, Tao SC. Identification of Serum Biomarkers for Gastric Cancer Diagnosis Using a Human Proteome Microarray. Mol Cell Proteomics 2015; 15:614-23. [PMID: 26598640 DOI: 10.1074/mcp.m115.051250] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Indexed: 12/27/2022] Open
Abstract
We aimed to globally discover serum biomarkers for diagnosis of gastric cancer (GC). GC serum autoantibodies were discovered and validated using serum samples from independent patient cohorts encompassing 1,401 participants divided into three groups, i.e. healthy, GC patients, and GC-related disease group. To discover biomarkers for GC, the human proteome microarray was first applied to screen specific autoantibodies in a total of 87 serum samples from GC patients and healthy controls. Potential biomarkers were identified via a statistical analysis protocol. Targeted protein microarrays with only the potential biomarkers were constructed and used to validate the candidate biomarkers using 914 samples. To provide further validation, the abundance of autoantibodies specific to the biomarker candidates was analyzed using enzyme-linked immunosorbent assays. Receiver operating characteristic curves were generated to evaluate the diagnostic accuracy of the serum biomarkers. Finally, the efficacy of prognosis efficacy of the final four biomarkers was evaluated by analyzing the clinical records. The final panel of biomarkers consisting of COPS2, CTSF, NT5E, and TERF1 provides high diagnostic power, with 95% sensitivity and 92% specificity to differentiate GC patients from healthy individuals. Prognosis analysis showed that the panel could also serve as independent predictors of the overall GC patient survival. The panel of four serum biomarkers (COPS2, CTSF, NT5E, and TERF1) could serve as a noninvasive diagnostic index for GC, and the combination of them could potentially be used as a predictor of the overall GC survival rate.
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Affiliation(s)
- Lina Yang
- From the Shanghai Center for Systems Biomedicine, Ministry of Education Key Laboratory of Systems Biomedicine, and Shanghai Key Laboratory of Gastric Neoplasms, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, 200240, China; State Key Laboratory of Oncogenes and Related Genes, Shanghai Jiao Tong University, Shanghai, 200240, China; Department of Integrative Oncology, Shanghai Cancer Center, Fudan University, Shanghai, 200032, China
| | - Jingfang Wang
- From the Shanghai Center for Systems Biomedicine, Ministry of Education Key Laboratory of Systems Biomedicine, and Shanghai Key Laboratory of Gastric Neoplasms, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Jianfang Li
- From the Shanghai Center for Systems Biomedicine, Ministry of Education Key Laboratory of Systems Biomedicine, and Shanghai Key Laboratory of Gastric Neoplasms, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Hainan Zhang
- From the Shanghai Center for Systems Biomedicine, Ministry of Education Key Laboratory of Systems Biomedicine, and Shanghai Key Laboratory of Gastric Neoplasms, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, 200240, China; State Key Laboratory of Oncogenes and Related Genes, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Shujuan Guo
- From the Shanghai Center for Systems Biomedicine, Ministry of Education Key Laboratory of Systems Biomedicine, and Shanghai Key Laboratory of Gastric Neoplasms, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, 200240, China; State Key Laboratory of Oncogenes and Related Genes, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Min Yan
- From the Shanghai Center for Systems Biomedicine, Ministry of Education Key Laboratory of Systems Biomedicine, and Shanghai Key Laboratory of Gastric Neoplasms, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Zhenggang Zhu
- From the Shanghai Center for Systems Biomedicine, Ministry of Education Key Laboratory of Systems Biomedicine, and Shanghai Key Laboratory of Gastric Neoplasms, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Bin Lan
- Department of Gastroenterology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Youcheng Ding
- Shanghai East Hospital Affiliated to Tongji University, Shanghai, 200120, China
| | - Ming Xu
- Tongren Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200050, China
| | - Wei Li
- Shanghai Putuo Center Hospital, Shanghai, China
| | - Xiaonian Gu
- Shanghai Pudong Gongli Hospital, Shanghai, China 200135
| | - Chong Qi
- Shanghai Fifth People's Hospital affiliated to Fudan University, Shanghai, 200240 China
| | - Heng Zhu
- Department of Pharmacology and Molecular Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205
| | - Zhifeng Shao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Bingya Liu
- From the Shanghai Center for Systems Biomedicine, Ministry of Education Key Laboratory of Systems Biomedicine, and Shanghai Key Laboratory of Gastric Neoplasms, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, 200240, China;
| | - Sheng-Ce Tao
- From the Shanghai Center for Systems Biomedicine, Ministry of Education Key Laboratory of Systems Biomedicine, and Shanghai Key Laboratory of Gastric Neoplasms, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, 200240, China; State Key Laboratory of Oncogenes and Related Genes, Shanghai Jiao Tong University, Shanghai, 200240, China;
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Human papillomavirus E7 serology and association with p16 immunohistochemistry in squamous cell carcinoma of the head and neck. Exp Mol Pathol 2015; 99:335-40. [DOI: 10.1016/j.yexmp.2015.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 06/22/2015] [Indexed: 12/14/2022]
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Biologic predictors of serologic responses to HPV in oropharyngeal cancer: The HOTSPOT study. Oral Oncol 2015; 51:751-8. [PMID: 26094591 DOI: 10.1016/j.oraloncology.2015.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/19/2015] [Accepted: 05/24/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVES We hypothesized that viral and host factors impact the serologic responses to HPV early antigens in HPV-positive oropharyngeal cancer (HPVOPC). MATERIALS AND METHODS We conducted a multicenter study to measure HPV16-specific IgG among patients with HPVOPC, their long-term sexual partners, and healthy volunteers. Risk factor surveys and rinse and gargle specimens were collected. Peripheral blood samples at diagnosis were evaluated for IgG Abs to HPV16 antigens using a programmable ELISA assay. Predictors for HPV16 serologic responses were evaluated using univariate and multivariable linear regression. RESULTS 116 patients with HPVOPC, 43 partners, and 81 healthy volunteers were enrolled and had baseline sera for analysis. Cases were primarily male (90%), with a median age of 56 years. Abs to E1, E2, E6 or E7 antigens were detected more often in HPVOPC compared with volunteers or partner sera (p<0.0001). HPV16 Abs to at least one early protein (E1, E2, E4, E5, E6, or E7) were detected in the sera of 90.6% of cases, 0% of partners and 7.4% of healthy volunteers. Gender, race, sexual behavior, and viral integration were not associated with antibody response. Younger age and higher oral HPV16 copy number were associated with higher HPV16 E6 and NE2 antibody levels. CONCLUSIONS HPV16 seroreactivity is commonly detected among patients with HPVOPC at diagnosis, but not among partners or healthy volunteers. Seroreactivity among cases are correlated with viral load and stage and not with other demographic or behavioral factors. Positive HPV16 serology was strongly associated with HPV 16 oropharyngeal cancer.
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Anderson KS, Dahlstrom KR, Cheng JN, Alam R, Li G, Wei Q, Gross ND, Chowell D, Posner M, Sturgis EM. HPV16 antibodies as risk factors for oropharyngeal cancer and their association with tumor HPV and smoking status. Oral Oncol 2015; 51:662-7. [PMID: 25957822 DOI: 10.1016/j.oraloncology.2015.04.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 03/16/2015] [Accepted: 04/15/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND Antibodies (Abs) to the HPV16 proteome increase risk for HPV-associated OPC (HPVOPC). The goal of this study was to investigate the association of a panel of HPV16 Abs with risk for OPC as well as the association of these Abs with tumor HPV and smoking status among patients with OPC. METHODS IgG Abs to the HPV16 antigens E1, E2, E4, E5, E6, E7, L1, L2 were quantified using a programmable ELISA assay. Sera were obtained from 258 OPC patients at diagnosis and 250 healthy controls. HPV16 tumor status was measured by PCR for 137 cases. Multivariable logistic regression was used to calculate odds ratios for the association of HPV16 Abs with risk for OPC. RESULTS HPV16 E1, E2, E4, E5, E6, E7 and L1-specific IgG levels were elevated in OPC patients compared to healthy controls (p<0.05). After multivariable adjustment, Ab positivity for NE2, CE2, E6, and/or E7 was associated with OPC risk (OR [95% CI], 249.1 [99.3-624.9]). Among patients with OPC, Ab positivity for these antigens was associated with tumor HPV status, especially among never or light smokers (OR [95% CI], 6.5 [2.1-20.1] and OR [95% CI], 17.5 [4.0-77.2], respectively). CONCLUSIONS Antibodies to HPV16 proteins are associated with increased risk for HPVOPC. Among patients with OPC, HPV16 Abs are associated with tumor HPV status, in particular among HPV positive patients with no or little smoking history.
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Affiliation(s)
- Karen S Anderson
- Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, AZ, United States.
| | - Kristina R Dahlstrom
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Julia N Cheng
- Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, AZ, United States
| | - Rizwan Alam
- Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, AZ, United States
| | - Guojun Li
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Qingyi Wei
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, United States
| | - Neil D Gross
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Diego Chowell
- Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, AZ, United States; Simon A. Levin Mathematical, Computational, and Modeling Sciences Center, Arizona State University, Tempe, AZ, United States
| | - Marshall Posner
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Erich M Sturgis
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Chai RC, Lambie D, Verma M, Punyadeera C. Current trends in the etiology and diagnosis of HPV-related head and neck cancers. Cancer Med 2015; 4:596-607. [PMID: 25644715 PMCID: PMC4402074 DOI: 10.1002/cam4.424] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/18/2014] [Accepted: 12/18/2014] [Indexed: 12/15/2022] Open
Abstract
Human papilloma virus (HPV) infection is a major risk factor for a distinct subset of head and neck squamous cell carcinoma (HNSCC). The current review summarizes the epidemiology of HNSCC and the disease burden, the infectious cycle of HPV, the roles of viral oncoproteins, E6 and E7, and the downstream cellular events that lead to malignant transformation. Current techniques for the clinical diagnosis of HPV-associated HNSCC will also be discussed, that is, the detection of HPV DNA, RNA, and the HPV surrogate marker, p16 in tumor tissues, as well as HPV-specific antibodies in serum. Such methods do not allow for the early detection of HPV-associated HNSCC and most cases are at an advanced stage upon diagnosis. Novel noninvasive approaches using oral fluid, a clinically relevant biological fluid, allow for the detection of HPV and cellular alterations in infected cells, which may aid in the early detection and HPV-typing of HNSCC tumors. Noninvasive diagnostic methods will enable early detection and intervention, leading to a significant reduction in mortality and morbidity associated with HNSCC.
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Affiliation(s)
- Ryan C Chai
- The University of Queensland Diamantina Institute, The University of Queensland, The Translational Research Institute, Woolloongabba, Queensland, 4102, Australia
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Kelsey KT, Nelson HH, Kim S, Pawlita M, Langevin SM, Eliot M, Michaud DS, McClean M. Human papillomavirus serology and tobacco smoking in a community control group. BMC Infect Dis 2015; 15:8. [PMID: 25572638 PMCID: PMC4296688 DOI: 10.1186/s12879-014-0737-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 12/22/2014] [Indexed: 01/10/2023] Open
Abstract
Background HPV infection is an established risk factor for oropharyngeal cancer, and it has been proposed that cigarette smoking may potentiate HPV infection in the oral epithelium. We sought to test the hypothesis that cigarette smoking increases HPV infection in an HPV16 serology study of cancer-free individuals. Methods Subjects were participants in a risk factor study for head and neck cancer, and were required to have no prior history of either HNSCC or any other cancer. Tobacco use and other risk factor data were gathered through interviewer-assisted questionnaires, while serology was conducted in a blinded fashion using a glutathione S-transferase capture enzyme-linked immunosorbent assay (ELISA) to detect antibodies against HPV16 L1, E1, E2, E4, E6 and E7 proteins. The differences in tobacco use by HPV serology were evaluated by ANOVA; and the reported odds ratios and 95% confidence intervals were determined by using unconditional logistic regression. Results We found no overall association of HPV16 serological markers with smoking. However, when the data were stratified by median age, smoking was positively associated with seropositivity for the HPV16 L1 capsid antigen in the younger controls while the older controls were less likely to be HPV16 L1 positive if they smoked (pinteraction < 0.002). There was no similar association of smoking and age with serological response to the early proteins (i.e E6, E7). Conclusions Exposure to HPV16 capsid protein (L1) is increased among relatively younger adults who smoke and diminished among older smokers. However, this pattern is not accompanied by a differential susceptibility for active infection (as determined by the early gene proteins such as E6 and E7) among young and older smokers.
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Affiliation(s)
- Karl T Kelsey
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA. .,Department of Pathology and Laboratory Medicine, Brown University School of Medicine, Providence, RI, USA.
| | - Heather H Nelson
- Masonic Cancer Center, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
| | - Stephanie Kim
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | - Michael Pawlita
- Research Program Infection and Cancer, German Cancer Research Center, DKFZ, Heidelberg, Germany.
| | - Scott M Langevin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA. .,Department of Environmental Health, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
| | - Melissa Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | - Dominique S Michaud
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | - Michael McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
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D'Souza G, Gross ND, Pai SI, Haddad R, Anderson KS, Rajan S, Gerber J, Gillison ML, Posner MR. Oral human papillomavirus (HPV) infection in HPV-positive patients with oropharyngeal cancer and their partners. J Clin Oncol 2014; 32:2408-15. [PMID: 24778397 DOI: 10.1200/jco.2014.55.1341] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To better understand oral human papillomavirus (HPV) infection and cancer risk among long-term sexual partners of patients with HPV-positive oropharyngeal cancer (HPV-OPC). PATIENTS AND METHODS An oral rinse sample, risk factor survey, cancer history, and oral examination (partners only) were collected from patients with HPV-OPC and their partners. Oral rinse samples were evaluated for 36 types of HPV DNA using PGMY 09/11 primers and line-blot hybridization and HPV16 copy number using quantitative polymerase chain reaction. Oral HPV prevalence was compared with infection among those age 45 to 65 years using National Health and Nutrition Examination Survey (NHANES) 2009-2010. RESULTS A total of 164 patients with HPV-OPC and 93 of their partners were enrolled. Patients were primarily men (90%), were never-smokers (51%), and had performed oral sex (97%), with a median age of 56 years; they had a high prevalence of oncogenic oral HPV DNA (61%) and oral HPV16 DNA (54%) at enrollment. Female partners had comparable oncogenic oral HPV prevalence compared with members of the general population of the same age (1.2% v 1.3%). Among the six male partners, no oncogenic oral HPV infections were detected. No precancers or cancers were identified during partner oral cancer screening examinations. However, a history of cervical disease was reported by nine partners (10.3%) and two female patients (11.8%), and three patients (2.0%) reported a previous partner who developed invasive cervical cancer. CONCLUSION Oral HPV16 DNA is commonly detected among patients with HPV-OPC at diagnosis, but not among their partners. Partners of patients with HPV-OPC do not seem to have elevated oral HPV infection compared with the general population.
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Affiliation(s)
- Gypsyamber D'Souza
- Gypsyamber D'Souza, Shirani Rajan, and Jennifer Gerber, Johns Hopkins Bloomberg School of Public Health; Sara I. Pai, Johns Hopkins Medical Institutions, Baltimore, MD; Neil D. Gross, Oregon Health and Science University, Portland, OR; Robert Haddad, Dana-Farber Cancer Institute, Boston, MA; Karen S. Anderson, Arizona State University, Tempe, AZ; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marshall R. Posner, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Neil D Gross
- Gypsyamber D'Souza, Shirani Rajan, and Jennifer Gerber, Johns Hopkins Bloomberg School of Public Health; Sara I. Pai, Johns Hopkins Medical Institutions, Baltimore, MD; Neil D. Gross, Oregon Health and Science University, Portland, OR; Robert Haddad, Dana-Farber Cancer Institute, Boston, MA; Karen S. Anderson, Arizona State University, Tempe, AZ; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marshall R. Posner, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sara I Pai
- Gypsyamber D'Souza, Shirani Rajan, and Jennifer Gerber, Johns Hopkins Bloomberg School of Public Health; Sara I. Pai, Johns Hopkins Medical Institutions, Baltimore, MD; Neil D. Gross, Oregon Health and Science University, Portland, OR; Robert Haddad, Dana-Farber Cancer Institute, Boston, MA; Karen S. Anderson, Arizona State University, Tempe, AZ; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marshall R. Posner, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert Haddad
- Gypsyamber D'Souza, Shirani Rajan, and Jennifer Gerber, Johns Hopkins Bloomberg School of Public Health; Sara I. Pai, Johns Hopkins Medical Institutions, Baltimore, MD; Neil D. Gross, Oregon Health and Science University, Portland, OR; Robert Haddad, Dana-Farber Cancer Institute, Boston, MA; Karen S. Anderson, Arizona State University, Tempe, AZ; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marshall R. Posner, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Karen S Anderson
- Gypsyamber D'Souza, Shirani Rajan, and Jennifer Gerber, Johns Hopkins Bloomberg School of Public Health; Sara I. Pai, Johns Hopkins Medical Institutions, Baltimore, MD; Neil D. Gross, Oregon Health and Science University, Portland, OR; Robert Haddad, Dana-Farber Cancer Institute, Boston, MA; Karen S. Anderson, Arizona State University, Tempe, AZ; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marshall R. Posner, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shirani Rajan
- Gypsyamber D'Souza, Shirani Rajan, and Jennifer Gerber, Johns Hopkins Bloomberg School of Public Health; Sara I. Pai, Johns Hopkins Medical Institutions, Baltimore, MD; Neil D. Gross, Oregon Health and Science University, Portland, OR; Robert Haddad, Dana-Farber Cancer Institute, Boston, MA; Karen S. Anderson, Arizona State University, Tempe, AZ; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marshall R. Posner, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jennifer Gerber
- Gypsyamber D'Souza, Shirani Rajan, and Jennifer Gerber, Johns Hopkins Bloomberg School of Public Health; Sara I. Pai, Johns Hopkins Medical Institutions, Baltimore, MD; Neil D. Gross, Oregon Health and Science University, Portland, OR; Robert Haddad, Dana-Farber Cancer Institute, Boston, MA; Karen S. Anderson, Arizona State University, Tempe, AZ; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marshall R. Posner, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maura L Gillison
- Gypsyamber D'Souza, Shirani Rajan, and Jennifer Gerber, Johns Hopkins Bloomberg School of Public Health; Sara I. Pai, Johns Hopkins Medical Institutions, Baltimore, MD; Neil D. Gross, Oregon Health and Science University, Portland, OR; Robert Haddad, Dana-Farber Cancer Institute, Boston, MA; Karen S. Anderson, Arizona State University, Tempe, AZ; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marshall R. Posner, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marshall R Posner
- Gypsyamber D'Souza, Shirani Rajan, and Jennifer Gerber, Johns Hopkins Bloomberg School of Public Health; Sara I. Pai, Johns Hopkins Medical Institutions, Baltimore, MD; Neil D. Gross, Oregon Health and Science University, Portland, OR; Robert Haddad, Dana-Farber Cancer Institute, Boston, MA; Karen S. Anderson, Arizona State University, Tempe, AZ; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marshall R. Posner, Icahn School of Medicine at Mount Sinai, New York, NY
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Järås K, Anderson K. Autoantibodies in cancer: prognostic biomarkers and immune activation. Expert Rev Proteomics 2014; 8:577-89. [DOI: 10.1586/epr.11.48] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Kreimer AR, Johansson M, Waterboer T, Kaaks R, Chang-Claude J, Drogen D, Tjønneland A, Overvad K, Quirós JR, González CA, Sánchez MJ, Larrañaga N, Navarro C, Barricarte A, Travis RC, Khaw KT, Wareham N, Trichopoulou A, Lagiou P, Trichopoulos D, Peeters PHM, Panico S, Masala G, Grioni S, Tumino R, Vineis P, Bueno-de-Mesquita HB, Laurell G, Hallmans G, Manjer J, Ekström J, Skeie G, Lund E, Weiderpass E, Ferrari P, Byrnes G, Romieu I, Riboli E, Hildesheim A, Boeing H, Pawlita M, Brennan P. Evaluation of human papillomavirus antibodies and risk of subsequent head and neck cancer. J Clin Oncol 2013; 31:2708-15. [PMID: 23775966 DOI: 10.1200/jco.2012.47.2738] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Human papillomavirus type 16 (HPV16) infection is causing an increasing number of oropharyngeal cancers in the United States and Europe. The aim of our study was to investigate whether HPV antibodies are associated with head and neck cancer risk when measured in prediagnostic sera. METHODS We identified 638 participants with incident head and neck cancers (patients; 180 oral cancers, 135 oropharynx cancers, and 247 hypopharynx/larynx cancers) and 300 patients with esophageal cancers as well as 1,599 comparable controls from within the European Prospective Investigation Into Cancer and Nutrition cohort. Prediagnostic plasma samples from patients (collected, on average, 6 years before diagnosis) and control participants were analyzed for antibodies against multiple proteins of HPV16 as well as HPV6, HPV11, HPV18, HPV31, HPV33, HPV45, and HPV52. Odds ratios (ORs) of cancer and 95% CIs were calculated, adjusting for potential confounders. All-cause mortality was evaluated among patients using Cox proportional hazards regression. RESULTS HPV16 E6 seropositivity was present in prediagnostic samples for 34.8% of patients with oropharyngeal cancer and 0.6% of controls (OR, 274; 95% CI, 110 to 681) but was not associated with other cancer sites. The increased risk of oropharyngeal cancer among HPV16 E6 seropositive participants was independent of time between blood collection and diagnosis and was observed more than 10 years before diagnosis. The all-cause mortality ratio among patients with oropharyngeal cancer was 0.30 (95% CI, 0.13 to 0.67), for patients who were HPV16 E6 seropositive compared with seronegative. CONCLUSION HPV16 E6 seropositivity was present more than 10 years before diagnosis of oropharyngeal cancers.
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Affiliation(s)
- Aimée R Kreimer
- National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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Karagiannis P, Gilbert AE, Josephs DH, Ali N, Dodev T, Saul L, Correa I, Roberts L, Beddowes E, Koers A, Hobbs C, Ferreira S, Geh JL, Healy C, Harries M, Acland KM, Blower PJ, Mitchell T, Fear DJ, Spicer JF, Lacy KE, Nestle FO, Karagiannis SN. IgG4 subclass antibodies impair antitumor immunity in melanoma. J Clin Invest 2013; 123:1457-74. [PMID: 23454746 PMCID: PMC3613918 DOI: 10.1172/jci65579] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 01/03/2013] [Indexed: 12/15/2022] Open
Abstract
Host-induced antibodies and their contributions to cancer inflammation are largely unexplored. IgG4 subclass antibodies are present in IL-10-driven Th2 immune responses in some inflammatory conditions. Since Th2-biased inflammation is a hallmark of tumor microenvironments, we investigated the presence and functional implications of IgG4 in malignant melanoma. Consistent with Th2 inflammation, CD22+ B cells and IgG4(+)-infiltrating cells accumulated in tumors, and IL-10, IL-4, and tumor-reactive IgG4 were expressed in situ. When compared with B cells from patient lymph nodes and blood, tumor-associated B cells were polarized to produce IgG4. Secreted B cells increased VEGF and IgG4, and tumor cells enhanced IL-10 secretion in cocultures. Unlike IgG1, an engineered tumor antigen-specific IgG4 was ineffective in triggering effector cell-mediated tumor killing in vitro. Antigen-specific and nonspecific IgG4 inhibited IgG1-mediated tumoricidal functions. IgG4 blockade was mediated through reduction of FcγRI activation. Additionally, IgG4 significantly impaired the potency of tumoricidal IgG1 in a human melanoma xenograft mouse model. Furthermore, serum IgG4 was inversely correlated with patient survival. These findings suggest that IgG4 promoted by tumor-induced Th2-biased inflammation may restrict effector cell functions against tumors, providing a previously unexplored aspect of tumor-induced immune escape and a basis for biomarker development and patient-specific therapeutic approaches.
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Affiliation(s)
- Panagiotis Karagiannis
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Amy E. Gilbert
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Debra H. Josephs
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Niwa Ali
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Tihomir Dodev
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Louise Saul
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Isabel Correa
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Luke Roberts
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Emma Beddowes
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Alexander Koers
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Carl Hobbs
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Silvia Ferreira
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Jenny L.C. Geh
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Ciaran Healy
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Mark Harries
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Katharine M. Acland
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Philip J. Blower
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Tracey Mitchell
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - David J. Fear
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - James F. Spicer
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Katie E. Lacy
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Frank O. Nestle
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
| | - Sophia N. Karagiannis
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ Hospitals and King’s College London, Cutaneous Medicine and Immunotherapy Unit, St. John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, King’s College London School of Medicine, Guy’s Hospital, King’s College London, London, United Kingdom.
Division of Asthma, Allergy and Lung Biology, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, Guy’s Campus, London, United Kingdom.
Skin Tumour Unit, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College London, and Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Division of Imaging Sciences, Rayne Institute, King’s College London School of Medicine, St. Thomas’ Hospital, and King’s College London, London, United Kingdom.
Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom.
Department of Plastic Surgery at Guy’s, King’s, and St. Thomas’ Hospitals, London, United Kingdom.
Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom.
Department of Academic Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, United Kingdom
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Anantharaman D, Gheit T, Waterboer T, Abedi-Ardekani B, Carreira C, McKay-Chopin S, Gaborieau V, Marron M, Lagiou P, Ahrens W, Holcátová I, Merletti F, Kjaerheim K, Talamini R, Simonato L, Castellsague X, Macfarlane TV, Biggs AM, Thakker N, Znaor A, Thomson P, Canova C, Conway DI, Healy CM, Tommasino M, Pawlita M, Brennan P. Human papillomavirus infections and upper aero-digestive tract cancers: the ARCAGE study. J Natl Cancer Inst 2013; 105:536-45. [PMID: 23503618 DOI: 10.1093/jnci/djt053] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is causally implicated in a subset of cancers of the upper aero-digestive tract (UADT). METHODS Associations between type-specific HPV antibodies were examined among 1496 UADT cancer case subjects and 1425 control subjects by estimating odds ratios (ORs) in logistic regression analyses adjusted for potential confounders. The agreement between serology and tumor markers of HPV infection, including presence of HPV DNA and p16 expression, were examined in a subset of tumors. RESULTS HPV16 L1 seropositivity was associated with increased risk of oral cavity and oropharyngeal cancer (OR = 1.94, 95% confidence interval [CI] = 1.03 to 3.65; OR = 8.60, 95% CI = 5.21 to 14.20, respectively). HPV16 E6 antibodies were present in 30.2% of oropharyngeal case subjects and only 0.8% of control subjects (OR = 132.0, 95% CI = 65.29 to 266.86). Combined seropositivity to HPV16 E6 and E7 was rare (n = 1 of 1425 control subjects). An agreement of 67% was observed between HPV16 E6 serology and the corresponding presence of an HPV-related cancer: four of six HPV DNA-positive/p16-overexpressing tumors were HPV16 E6 antibody positive. An HPV16 independent association was observed for HPV18 and oropharyngeal cancer (OR = 8.14, 95% CI = 2.21 to 29.99 for HPV18 E6 seropositivity) and HPV6 and laryngeal cancer (OR = 3.25, 95% CI = 1.46 to 7.24 for HPV6 E7 seropositivity). CONCLUSIONS These results confirm an important role for HPV16 infection in oropharyngeal cancer. HPV16 E6 antibodies are strongly associated with HPV16-related oropharyngeal cancers. Continuing efforts are needed to consider both HPV serology and p16 staining as biomarkers relevant to the etiology and natural history of HPV16-related oropharyngeal tumors. These results also support a marginal role for HPV18 in oropharyngeal cancer and HPV6 in laryngeal cancer.
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Affiliation(s)
- Devasena Anantharaman
- Genetic Epidemiology Group, International Agency for Research on Cancer (IARC), Lyon, France
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Chu A, Genden E, Posner M, Sikora A. A patient-centered approach to counseling patients with head and neck cancer undergoing human papillomavirus testing: a clinician's guide. Oncologist 2013; 18:180-9. [PMID: 23345545 PMCID: PMC3579602 DOI: 10.1634/theoncologist.2012-0200] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 11/13/2012] [Indexed: 12/21/2022] Open
Abstract
The International Agency for Research on Cancer and the National Cancer Institute have acknowledged human papillomavirus (HPV)-16 as an independent risk factor for oropharyngeal cancer (OPC). HPV-positive oropharyngeal cancer (HPVOPC) is a sexually transmitted entity that is on the rise; within the next 10 years, the annual number of HPV-associated OPC cases is projected to exceed the annual number of cervical cancer cases in the United States. Recognition of HPV status in OPC has broad implications beyond the traditional oncological concerns of timely diagnosis, accurate staging, and appropriate treatment of cancer patients. The National Comprehensive Cancer Network recommends testing the tumor site for HPV-status during OPC management; it is likely this will become a standard component of care for patients with high-probability tumors of the oropharynx. As the practice of HPV testing becomes more common, it behooves providers to be able to adequately address the concerns of patients with HPVOPC. Although there are currently few relevant studies focusing on this population, existing literature on HPV-infected women and patients with cervical cancer strongly supports the concept that patients with HPVOPC need education to optimally address concerns such as self-blame, guilt, intimacy, and interpersonal relationships. When HPV testing is done, it should be accompanied by evidence-driven and patient-centered counseling to best minimize negative psychosocial outcomes and ensure optimum health promotion. Based on the current state of the literature, this article is intended to be a reference for physicians to effectively manage psychosocial outcomes when diagnosing patients with HPV-associated OPC.
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Affiliation(s)
- Amy Chu
- Departments of Otolaryngology
| | | | | | - Andrew Sikora
- Departments of Otolaryngology
- Dermatology
- Oncological Sciences, and
- Immunology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Best SR, Niparko KJ, Pai SI. Biology of human papillomavirus infection and immune therapy for HPV-related head and neck cancers. Otolaryngol Clin North Am 2012; 45:807-22. [PMID: 22793854 PMCID: PMC3398423 DOI: 10.1016/j.otc.2012.04.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This article outlines the biology of human papillomavirus (HPV) infection of human mucosa and the cellular pathways that are altered through viral infection. The article provides a conceptual framework with which to understand the 2 major immunologic strategies to address HPV-related diseases: (1) prevention of primary HPV infection through the use of prophylactic vaccines and (2) treatment of established infection and diseases through therapeutic vaccines. Nonimmunologic therapy that targets cellular dysregulation induced by HPV infection is also discussed. The challenges in actualizing these conceptually attractive therapies on both a societal and biological level are examined.
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Affiliation(s)
- Simon R. Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Sara I. Pai
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Venuti A, Paolini F. HPV detection methods in head and neck cancer. Head Neck Pathol 2012; 6 Suppl 1:S63-74. [PMID: 22782225 PMCID: PMC3394157 DOI: 10.1007/s12105-012-0372-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 02/20/2012] [Indexed: 01/04/2023]
Abstract
Human papillomavirus (HPV) infection is emerging as a major prognostic and predictive marker in head and neck squamous cell carcinoma (HNSCC). Researches are focused on the development of HPV detection assays specially designed for HNSCC. The HPV diagnosis in these tumours is relevant toprognosis even in an already-developed tumour, whereas in the cervix, where the HPV is the cause of almost all tumours, this information has less clinical relevance. The better outcome of HPV-associated HNSCC raises the question about the best methodologies to distinguish between HPV and non-HPV-associated SCC. However, no consensus has been reached on the optimal way to identify HPV-associated SCC and ancillary studies have utilised many different methodologies, including HPV polymerase chain reaction testing, HPV in situ hybridization analysis, immunohistochemical staining for p16, and newer techniques that are currently under investigation. The objective of this review is to explain and give examples of various techniques of HPV detection highlighting how they might be used clinically. Although currently insufficiently specific due to the possibility of HPV infection originating at other sites, methodologies utilising serum and plasma to measure HPV infection will also be described, mostly for their potential future development and use. Finally, DNA/RNA microarray platforms will be briefly summarized for their capacity to identify the profile of molecular changes in any particular HPV+/HPV- cancer. In this way, it is expected to be possible to correlate the appropriate transcriptome-based diagnosis to the patients' specific cancer risk.
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Affiliation(s)
- Aldo Venuti
- Laboratory of Virology, Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Paolini
- Laboratory of Virology, Regina Elena National Cancer Institute, Rome, Italy
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2012; 20:148-51. [PMID: 22555614 DOI: 10.1097/moo.0b013e328351a36c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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HPV-associated head and neck cancer: molecular and nano-scale markers for prognosis and therapeutic stratification. SENSORS 2012; 12:5159-69. [PMID: 22666080 PMCID: PMC3355463 DOI: 10.3390/s120405159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 03/27/2012] [Accepted: 04/18/2012] [Indexed: 01/17/2023]
Abstract
Over the last 10 years, it has become clear that patients with head and neck cancer can be stratified into two distinct subgroups on the basis of the etiology of their disease. Patients with human papillomavirus-related cancers have significantly better survival rates and may necessitate different therapeutic approaches than those with tobacco and/or alcohol related cancers. This review discusses the various biomarkers currently in use for identification of patients with HPV-positive cancers with a focus on the advantages and limitations of molecular and nano-scale markers.
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47
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Jarboe EA, Hunt JP, Layfield LJ. Cytomorphologic diagnosis and HPV testing of metastatic and primary oropharyngeal squamous cell carcinomas: A review and summary of the literature. Diagn Cytopathol 2012; 40:491-7. [DOI: 10.1002/dc.22837] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 12/13/2011] [Indexed: 11/08/2022]
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48
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Human papillomavirus-16 E5 protein: oncogenic role and therapeutic value. Cell Oncol (Dordr) 2012; 35:67-76. [DOI: 10.1007/s13402-011-0069-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2011] [Indexed: 10/14/2022] Open
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49
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Abstract
After more than 40 years, immunoassays are still the backbone of protein biomarker analysis in clinical diagnostics and drug development. They have come a long way since their inception, incorporating technical developments including monoclonal antibodies, novel labels and lately microfluidics. A number of microfluidic platforms have been tested, such as centrifugational compact disc assays, lab-on-a-chip, arrays and digital electrochemical assays. This review focuses on commercial applications of microfluidic immunoassays with reference to some applied academic examples of interest. Advantages and disadvantages of the platform technologies are discussed in general.
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