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Ramachandran D, Dennis J, Fachal L, Schürmann P, Bousset K, Hülse F, Mao Q, Wang Y, Jentschke M, Böhmer G, Strauß HG, Hirchenhain C, Schmidmayr M, Müller F, Runnebaum I, Hein A, Stübs F, Koch M, Ruebner M, Beckmann MW, Fasching PA, Luyten A, Dürst M, Hillemanns P, Easton DF, Dörk T. OUP accepted manuscript. Hum Mol Genet 2022; 31:2483-2497. [PMID: 35157032 PMCID: PMC9396939 DOI: 10.1093/hmg/ddac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Dhanya Ramachandran
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Laura Fachal
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Peter Schürmann
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Kristine Bousset
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Fabienne Hülse
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Qianqian Mao
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Yingying Wang
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Matthias Jentschke
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | | | - Hans-Georg Strauß
- Department of Gynaecology, University Clinics, Martin-Luther University, Halle-Wittenberg, Germany
| | - Christine Hirchenhain
- Department of Gynaecology, Clinics Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - Monika Schmidmayr
- Department of Gynaecology, Technische Universität München, Munich, Germany
| | - Florian Müller
- Martin-Luther Hospital, Charite University, Berlin, Germany
| | - Ingo Runnebaum
- Department of Gynaecology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena 07747, Germany
| | - Alexander Hein
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Frederik Stübs
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Martin Koch
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Matthias Ruebner
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Matthias W Beckmann
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Peter A Fasching
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Alexander Luyten
- Dysplasia Unit, Department of Gynaecology and Obstetrics, Mare Klinikum, Kronshagen, Germany
- Department of Gynaecology, Wolfsburg Hospital, Wolfsburg, Germany
| | - Matthias Dürst
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen–Nuremberg (FAU), Erlangen 91054, Germany
| | - Peter Hillemanns
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover 30625, Germany
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge CB1 8RN, UK
| | - Thilo Dörk
- To whom correspondence should be addressed at: Gynaecology Research Unit (OE6411), Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Tel: +49 5115326075; Fax: +49 5115326081;
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Klischke L, von Ehr J, Kohls F, Kampers J, Hülse F, Schmitz M, Hennig A, Dörk T, Hillemanns P, Jentschke M. Performance of a six-methylation-marker assay on self-collected cervical samples - A feasibility study. J Virol Methods 2021; 295:114219. [PMID: 34175345 DOI: 10.1016/j.jviromet.2021.114219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 01/27/2021] [Accepted: 06/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES In high-income countries, a high proportion of cervical cancers is diagnosed in screening non-attendees. One approach to improve screening coverage is to offer self-sampling for human papillomavirus (HPV) testing. However, especially young women are often HPV positive without having a precancerous lesion in need of treatment. To improve the rather low specificity of HPV testing additional markers such as DNA-methylation can be used. The aim of this feasibility study was to examine the performance of the methylation marker assay GynTect®, comprising six methylation markers, on dry self-collected cervico-vaginal samples compared to physician-taken samples. METHODS We recruited 89 patients from our colposcopy clinic of whom 87 qualified for the study. The women took a self-sample with the Evalyn-Brush. Afterwards the planned colposcopy was performed and smears for cytology and reference HPV testing were taken as well as a biopsy in cases of abnormalities. Physician-taken and self-collected samples were tested for HPV DNA and were analyzed with GynTect®. RESULTS We obtained 95.5 % valid results for the self-collected samples which was very close to the physician-taken samples. Only about half of the self-collected samples were GynTect® positive in comparison to the physician-taken samples. GynTect® scores were significantly lower for self-collected than for physician-taken samples (p = 0.001, paired t-test). The overall concordance for GynTect® results was moderate (kappa 0.394; p < 0.001). For HPV testing we obtained a good concordance (kappa 0.586; p < 0.001). The GynTect® results for the self-collected samples showed a sensitivity for the detection of cervical intraepithelial neoplasia 2 or worse (CIN2+) of 26.1 % (95 %-CI: 0.13-0.46) and a specificity of 95.6 % (95 %-CI: 0.85-0.99), in comparison to a sensitivity of 45.5 % (95 %-CI: 0.27-0.65) and a specificity of 78.3 % (95 %-CI: 0.64-0.88) for the physician-taken samples. CONCLUSIONS GynTect® methylation marker testing has a satisfactory amount of valid results on self-collected samples. However, the results of the self-collected samples differed clearly in comparison to the reference samples. To justify an application in screening, a larger study with more cases of high-grade cervical dysplasia and HPV positive patients will be needed.
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Affiliation(s)
- Lara Klischke
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Julia von Ehr
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Fabian Kohls
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Johanna Kampers
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Fabienne Hülse
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | | | - Anne Hennig
- Oncgnostics GmbH, Winzerlaer Str. 2, 07745, Jena, Germany
| | - Thilo Dörk
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Peter Hillemanns
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Matthias Jentschke
- Department of Gynaecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Ramachandran D, Wang Y, Schürmann P, Hülse F, Mao Q, Jentschke M, Böhmer G, Strauß HG, Hirchenhain C, Schmidmayr M, Müller F, Runnebaum I, Hein A, Koch M, Ruebner M, Beckmann MW, Fasching PA, Luyten A, Dürst M, Hillemanns P, Dörk T. Association of genomic variants at PAX8 and PBX2 with cervical cancer risk. Int J Cancer 2021; 149:893-900. [PMID: 33905146 DOI: 10.1002/ijc.33614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/19/2021] [Accepted: 03/31/2021] [Indexed: 12/15/2022]
Abstract
Cervical malignancy is triggered by human papillomavirus infection but the risk for cervical cancer has a hereditary component. From a recent Genome Wide Association Study meta-analysis, 2q14.1 (PAX8) and 6p21.32 (PBX2) have been proposed as novel cervical cancer susceptibility loci. We investigated the two main signals at these loci in an independent case-control series of 2578 cases with cervical dysplasia or carcinoma and 1483 healthy females. We find significant associations for both variants, rs10175462 at PAX8 and rs2856437 at PBX2, with overall cervical disease (rs10175462: odds ratio [OR] 0.82, 95% confidence interval [CI] 0.74-0.91, P = 2.4 × 10-4 ; rs2856437: OR 1.52, 95% CI 1.14-2.02, P = .004). Both variants showed evidence of association with invasive squamous cervical cancer (rs10175462: OR 0.80, 95% CI 0.68-0.94, P = .006; rs2856437: OR 1.56, 95% CI 1.03-2.36, P = .036) and with high-grade dysplasia (rs10175462: OR 0.79, 95%CI 0.70-0.90, P = 1.9 × 10-4 ; rs2856437: OR 1.58, 95% CI 1.15-2.17, P = .005). A combined analysis of high-grade dysplasia and invasive cervical cancer also showed significant associations for both variants (rs10175462: OR 0.81, 95% CI 0.73-0.91, P = 2.4 × 10-4 ; rs2856437: OR 1.57, 95% CI 1.18-2.10, P = .002). No association was detected for rs2856437 with low-grade dysplasia, while rs10175462 showed weak evidence of association (P = .05). RNA analyses in cervical samples revealed that PAX8 transcripts were upregulated in HPV-positive lesions (P = .008) but this was not observed in the presence of the protective minor allele of rs10175462. The rs10175462 genotype also correlated with reduced levels of the lncRNA PAX8-AS1 (P < .001). Taken together, our results extend the evidence for a link between genomic risk variants at the HLA region (PBX2) with cervical disease and support PAX8 as the first consistent non-HLA cervical cancer susceptibility locus.
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Affiliation(s)
- Dhanya Ramachandran
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Yingying Wang
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Peter Schürmann
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Fabienne Hülse
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Qianqian Mao
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Matthias Jentschke
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | | | - Hans-Georg Strauß
- Department of Gynaecology, University Clinics, Martin-Luther University, Halle-Wittenberg, Germany
| | - Christine Hirchenhain
- Department of Gynaecology, Clinics Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - Monika Schmidmayr
- Department of Gynaecology, Technische Universität München, Munich, Germany
| | - Florian Müller
- Martin-Luther Hospital, Charite University, Berlin, Germany
| | - Ingo Runnebaum
- Department of Gynecology, Jena University Hospital, Friedrich -Schiller-University Jena, Jena, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Martin Koch
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Alexander Luyten
- Dysplasia Unit, Department of Gynecology and Obstetrics, Mare Klinikum, Kronshagen, Germany
- Department of Gynecology, Wolfsburg Hospital, Wolfsburg, Germany
| | - Matthias Dürst
- Department of Gynecology, Jena University Hospital, Friedrich -Schiller-University Jena, Jena, Germany
| | - Peter Hillemanns
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Thilo Dörk
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
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Ramachandran D, Schürmann P, Mao Q, Wang Y, Bretschneider LM, Speith LM, Hülse F, Enßen J, Bousset K, Jentschke M, Böhmer G, Strauß HG, Hirchenhain C, Schmidmayr M, Tarbiat J, Runnebaum I, Dürst M, Hein A, Koch M, Ruebner M, Ekici A, Beckmann MW, Fasching PA, Luyten A, Petry KU, Hillemanns P, Dörk T. Association of genomic variants at the human leukocyte antigen locus with cervical cancer risk, HPV status and gene expression levels. Int J Cancer 2020; 147:2458-2468. [PMID: 32580243 DOI: 10.1002/ijc.33171] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/15/2020] [Accepted: 05/25/2020] [Indexed: 12/17/2022]
Abstract
The human leukocyte antigen (HLA) locus on chromosome 6 has been reported to be associated with cervical cancer. We investigated two independent single-nucleotide polymorphisms in a large case-control series of cervical dysplasia and carcinoma that has been newly established by the German Cervigen Consortium, comprising a total of 2481 cases and 1556 healthy females. We find significant associations for both variants, rs9272117 at HLA-DQA1 and rs2844511 at MICA and HCP5, with cervical disease. Both variants showed evidence of association with invasive cervical cancer (rs9272117: OR 0.89, 95% CI 0.79-0.99, P = .036; rs2844511: OR 1.17, 95% CI 1.04-1.31, P = .008) and with high-grade dysplasia (rs9272117: OR 0.78, 95% CI 0.70-0.87, P = 7.1 × 10-6 ; rs2844511: OR 1.13, 95% CI 1.01-1.26, P = .035), as well as in a combined analysis of both groups (rs9272117: OR 0.83, 95% CI 0.75-0.91, P = 6.9 × 10-5 ; rs2844511: OR 1.14, 95% CI 1.04-1.26, P = .005). Variant rs2844511, but not rs9272117, also showed modest evidence of association with low-grade dysplasia (OR 1.26, 95% CI 1.04-1.54, P = .019). In case-only analyses, rs2844511 tended to predict HPV status (P = .044) and rs9272117 tended to associate with HPV16 (P = .022). RNA studies in cervical samples showed a significant correlation in the transcript levels of MICA, HCP5 and HLA-DQA1, suggesting extensive co-regulation. All three genes were upregulated in HPV16-positive samples. In stratified analyses, rs9272117 was associated with HLA-DQA1 levels, specifically in HPV-positive samples, while rs2844511 was associated with MICA and HCP5 levels. The risk allele of rs2844511 was required for correlations between MICA or HCP5 with HLA-DQA1. Altogether, our results support 6p21.32-33 as the first consistent cervical cancer susceptibility locus and provide evidence for a link between genetic risk variants, HPV16 status and transcript levels of HLA-DQA1, HCP5 and MICA, which may contribute to tumor immune evasion.
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Affiliation(s)
- Dhanya Ramachandran
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Peter Schürmann
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Qianqian Mao
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Yingying Wang
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Lisa-Marie Bretschneider
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Lisa-Marie Speith
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Fabienne Hülse
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Julia Enßen
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Kristine Bousset
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Matthias Jentschke
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | | | - Hans-Georg Strauß
- Department of Gynaecology, University Clinics, Martin-Luther University, Halle-Wittenberg, Germany
| | - Christine Hirchenhain
- Department of Gynaecology, Clinics Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - Monika Schmidmayr
- Department of Gynaecology, Technische Universität München, Munich, Germany
| | | | - Ingo Runnebaum
- Department of Gynecology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matthias Dürst
- Department of Gynecology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Martin Koch
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Arif Ekici
- Institute of Human Genetics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Alexander Luyten
- Dysplasia Unit, Department of Gynecology and Obstetrics, Mare Klinikum, Kronshagen, Germany.,Department of Gynecology, Wolfsburg Hospital, Wolfsburg, Germany
| | | | - Peter Hillemanns
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
| | - Thilo Dörk
- Department of Gynaecology, Comprehensive Cancer Center, Hannover Medical School, Hannover, Germany
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