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Liebold F, Adler W, Jansen S, Klussmann JP, Meyer M, Nehrlich L, Schmitz J, Vingerhoets A, Heindl LM, Hinkelbein J. Evaluation of colour vision impairment during acute hypobaric hypoxia in aviation medicine: a randomized controlled trial. J Physiol Sci 2024; 74:6. [PMID: 38311742 PMCID: PMC10840265 DOI: 10.1186/s12576-024-00898-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 01/18/2024] [Indexed: 02/06/2024]
Abstract
The digitization of aircraft cockpits places high demands on the colour vision of pilots. The present study investigates colour vision changes upon acute exposure to hypobaric hypoxia. The digital Waggoner Computerized Color Vision Test and the Waggoner D-15 were performed by 54 healthy volunteers in a decompression chamber. Respective altitude levels were sea level, 10,000 or 15,000 ft for exposure periods of 15 and 60 min, respectively. As for 60 min of exposure a significant decrease in colour perception was found between subjects at 15,000 ft as compared to the control group as well as between subjects at 15,000 ft as compared to subjects at 10,000 ft. No significant difference was found in the comparison within the 15,000 ft groups across time points pre-, peri-, and post-exposure. Thus, pilots appear to experience only minor colour vision impairment up to an exposure altitude of 15,000 ft over 60 min of exposure.
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Affiliation(s)
- F Liebold
- Department of Anaesthesiology und Intensive Care Medicine, University Hospital and Faculty of Medicine Cologne, Cologne, Germany.
- Department of Anaesthesiology und Intensive Care Medicine, University Hospital and Faculty of Medicine Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - W Adler
- Institute for Medical Informatics, Biometry and Epidemiology (IMBE), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - S Jansen
- Department of Otorhinolaryngology, University Hospital and Faculty of Medicine Cologne, Cologne, Germany
| | - J P Klussmann
- Department of Otorhinolaryngology, University Hospital and Faculty of Medicine Cologne, Cologne, Germany
| | - M Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - L Nehrlich
- Department of Anaesthesiology und Intensive Care Medicine, University Hospital and Faculty of Medicine Cologne, Cologne, Germany
| | - J Schmitz
- Department of Anaesthesiology und Intensive Care Medicine, University Hospital and Faculty of Medicine Cologne, Cologne, Germany
- Department of Sleep and Human Factor, German Aerospace Centre, Linder Höhe, 51147, Cologne, Germany
| | - A Vingerhoets
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - L M Heindl
- Department of Ophthalmology, University Hospital and Faculty of Medicine Cologne, Cologne, Germany
| | - J Hinkelbein
- Johannes Wesling Klinikum Minden, University Hospital, Ruhr University Bochum, Bochum, Germany
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Mayer M, Isik TB, Nachtsheim L, Wolber P, Hansen KK, Grosheva M, Klussmann JP, Shabli S. Analysis of the Quality of Parotidectomy Videos on YouTube Using the IVORY-Grading-System. Laryngoscope 2023; 133:2631-2637. [PMID: 36734324 DOI: 10.1002/lary.30593] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/23/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the quality and the educational content of YouTube videos showing parotidectomy. METHODS We searched for videos displaying parotidectomy on YouTube. To rate parotidectomy videos, we introduced the "Instructional Videos in Otorhinolaryngology by YO-IFOS (IVORY)-grading-system (GS)" derived from the IVORY Guidelines, which pose established consensus recommendations for the production of educational surgical videos in otolaryngology. The videos were rated using the IVORY-GS, and the total score was tested for statistical association with views, likes, likes/dislikes-ratio, age, and length of the videos for validation of the IVORY-GS. RESULTS Overall, 50 parotidectomy videos were identified. Sixty-eight (68%) of the videos showed a superficial parotidectomy. The mean IVORY-GS total score was 24.9 (out of a maximum of 44 points). Video education quality was rated as moderate in 22% and high in 4%. There was a statistically significant correlation between the total score and the number of views (p = 0.03), the total score and the number of likes (p < 0.01), and the total score and the likes/dislikes ratio (p < 0.01). A higher total score was a significant predictor of more likes (p = 0.01) and a higher likes/dislikes ratio (p < 0.01). CONCLUSION Our modification of the IVORY Guidelines is otolaryngology-specific, suitable, and recommended to evaluate parotidectomy videos. To date, most videos are of poor educational quality. Future efforts in otolaryngology surgical video education could focus on the establishment of an online video platform. LEVEL OF EVIDENCE NA Laryngoscope, 133:2631-2637, 2023.
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Affiliation(s)
- Marcel Mayer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Tarik B Isik
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Lisa Nachtsheim
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Philipp Wolber
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kevin K Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Maria Grosheva
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Jens P Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Sami Shabli
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
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Kuzkina A, Rößle J, Seger A, Panzer C, Kohl A, Maltese V, Musacchio T, Blaschke SJ, Tamgüney G, Kaulitz S, Rak K, Scherzad A, Zimmermann PH, Klussmann JP, Hackenberg S, Volkmann J, Sommer C, Sommerauer M, Doppler K. Combining skin and olfactory α-synuclein seed amplification assays (SAA)-towards biomarker-driven phenotyping in synucleinopathies. NPJ Parkinsons Dis 2023; 9:79. [PMID: 37248217 DOI: 10.1038/s41531-023-00519-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/05/2023] [Indexed: 05/31/2023] Open
Abstract
Seed amplification assays (SAA) are becoming commonly used in synucleinopathies to detect α-synuclein aggregates. Studies in Parkinson's disease (PD) and isolated REM-sleep behavior disorder (iRBD) have shown a considerably lower sensitivity in the olfactory epithelium than in CSF or skin. To get an insight into α-synuclein (α-syn) distribution within the nervous system and reasons for low sensitivity, we compared SAA assessment of nasal brushings and skin biopsies in PD (n = 27) and iRBD patients (n = 18) and unaffected controls (n = 30). α-syn misfolding was overall found less commonly in the olfactory epithelium than in the skin, which could be partially explained by the nasal brushing matrix exerting an inhibitory effect on aggregation. Importantly, the α-syn distribution was not uniform: there was a higher deposition of misfolded α-syn across all sampled tissues in the iRBD cohort compared to PD (supporting the notion of RBD as a marker of a more malignant subtype of synucleinopathy) and in a subgroup of PD patients, misfolded α-syn was detectable only in the olfactory epithelium, suggestive of the recently proposed brain-first PD subtype. Assaying α-syn of diverse origins, such as olfactory (part of the central nervous system) and skin (peripheral nervous system), could increase diagnostic accuracy and allow better stratification of patients.
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Affiliation(s)
- A Kuzkina
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
- Division of Movement Disorders, Department of Neurology, Brigham and Women's Hospital, Boston, MA, 02115, USA.
| | - J Rößle
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - A Seger
- University Hospital Cologne, Department of Neurology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - C Panzer
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - A Kohl
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - V Maltese
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - T Musacchio
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - S J Blaschke
- University Hospital Cologne, Department of Neurology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - G Tamgüney
- Institut für Physikalische Biologie, Heinrich-Heine-Universität Düsseldorf, 40225, Düsseldorf, Germany
- Institute of Biological Information Processing (Structural Biochemistry: IBI-7), Forschungszentrum Jülich, 52428, Jülich, Germany
| | - S Kaulitz
- University Hospital Würzburg (UKW), Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - K Rak
- University Hospital Würzburg (UKW), Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - A Scherzad
- University Hospital Würzburg (UKW), Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - P H Zimmermann
- University of Cologne, Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Kerpener Strasse 62, 50931, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University Hospital Cologne, Robert-Koch-Strasse 21, 50931, Cologne, Germany
| | - J P Klussmann
- University of Cologne, Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Kerpener Strasse 62, 50931, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University Hospital Cologne, Robert-Koch-Strasse 21, 50931, Cologne, Germany
| | - S Hackenberg
- University Hospital Würzburg (UKW), Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
- RWTH Aachen University, Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Aachen, Germany
| | - J Volkmann
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - C Sommer
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - M Sommerauer
- University Hospital Cologne, Department of Neurology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - K Doppler
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
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Zech HB, Betz CS, Hoffmann TK, Klussmann JP, Deitmer T, Guntinas-Lichius O. [Radiation or Surgery for HPV-positive oropharyngeal cancer? The ORATOR2 Trial - Comparing apples and oranges]. Laryngorhinootologie 2023; 102:169-176. [PMID: 36858059 DOI: 10.1055/a-2014-5733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
ORATOR2 was a randomized phase II trial aiming to assess an optimal approach for therapy de-escalation in early (T1-T2, N0-N2) human papillomavirus (HPV)-related oropharyngeal squamous cell carcinomas (OPSCC). Radiotherapy (RT) (consisting of a reduced dose of 60 Gy with concurrent weekly cisplatin in N+ patients) was compared to trans-oral surgery (TOS) and neck dissection (ND) (with adjuvant reduced-dose RT depending on pathologic findings) in 61 patients. The primary endpoint, overall survival, favored the radiotherapy approach. This was mainly due to 3 mortality events in the surgery arm (2 surgery-related) which resulted in an early trial termination. The authors, who speak on behalf of the German Society of Otorhinolaryngology, Head & Neck Surgery (working group for oncology) warn to draw conclusions for clinical practice pointing out the main shortages/weaknesses of this trial especially in the surgery arm (at least 1 cm margins, recommending re-operation if not achieved, prohibition of regional or free flaps, high rates of tracheotomy, low rate of TLM). Small patient numbers, a highly selected patient cohort and a short follow-up time further limit this study's relevance. Therefore, patients with HPV-related OPSCC should not receive de-escalating (radiation) therapy outside of clinical trials. When deciding between a surgical or a radio-therapeutical approach, patients should be informed about the pros and cons of both modalities after interdisciplinary consent in a tumor board, as long as clinical trial results` (e. g. EORTC 1420) are pending.
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Affiliation(s)
- H B Zech
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf
- Mildred-Scheel Cancer Career Center HaTriCS4
| | - C S Betz
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf
| | - T K Hoffmann
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - J P Klussmann
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Fakultät, Universität zu Köln
| | - T Deitmer
- Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V
| | - O Guntinas-Lichius
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena
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Zietzer A, Nachtsheim L, Duesing P, Von Krosigk M, Hosen MR, Breitrueck N, Goody PR, Klussmann JP, Nickenig G, Jansen F, Jansen S. Low blood levels of the lncRNA MRPL20-AS1 are associated with severe obstructive sleep apnea. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Obstructive sleep apnea syndrome (OSAS) is the most common sleep disorder and it is associated with arterial hypertension, heart failure, coronary artery disease as well as atrial fibrillation. The underlying pathomechanisms for this association are only incompletely understood. In recent years long non-coding RNAs (lncRNA) have been shown to be involved in various cardiovascular pathologies. The aim of this study is to identify lncRNAs which are associated with OSAS in order to provide potential therapeutic targets.
Methods and results
In order to tackle this issue, we included 23 Patients with a suspected OSAS in a pilot study and sampled blood on the evening before and on the morning after polysomnographic analysis. Citrate was used to inhibit clotting of the blood and cellular components were removed by centrifugation, before the plasma was stored at −80°C. One patient had no sign of OSAS as indicated by an Apnea/Hypopnea-Index (AHI) <5 per hour and was therefore excluded. The remaining 22 patients had a mean age of 44.45 years and a mean AHI of 28.38 per hour. Three of the patients were female and nineteen were male. In four of those patients with high AHI levels, we performed a RNA sequencing analysis from the citrate plasma and found MRPL20-AS1 to be the most significantly regulated lncRNA after the night of polysomnographic analysis (A). Low coding potential of MRPL20-AS1 was confirmed in silico via the Coding-Potential Assessment Tool (http://lilab.research.bcm.edu/) resulting in a coding probability of 0.06148. Then MRPL20-AS1 levels were measured via qPCR in the remaining patients. From 19 patients, we obtained evaluable results. We found that MRPL20-AS1 blood levels had the tendency to be lower after the night of polysomnographic assessment (B). Interestingly MRPL20-AS1 levels were inversely correlated with the AHI of the OSAS patients (C). This indicates that severe OSAS was associated with low levels of MRPL20-AS1 in our cohort (D). In order to further investigate these results in vitro, we subjected human coronary artery endothelial cells (HCAECs) to hypoxia (1% and 5% O2) for 24 h. We found that hypoxia leads to a significant downregulation of MRPL20-AS1 in HCAECs (E).
Conclusion
MRPL20-AS1 blood levels are lower in patients with severe OSAS after nocturnal hypoxia. In endothelial cells MRPL20-AS1 is downregulated after hypoxia. MRPL20-AS1 can therefore be useful to identify patients suffering from severe OSAS. Further investigations are needed to elucidate the biological function of MRPL20-AS1 in the context of OSAS and to investigate MRPL20-AS1 as a potential therapeutic target to counteract cardiovascular effects of OSAS
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Unviversity of BonnUniversity of Cologne
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Affiliation(s)
- A Zietzer
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - L Nachtsheim
- University of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery , Cologne , Germany
| | - P Duesing
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - M Von Krosigk
- University of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery , Cologne , Germany
| | - M R Hosen
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - N Breitrueck
- University of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery , Cologne , Germany
| | - P R Goody
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - J P Klussmann
- University of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery , Cologne , Germany
| | - G Nickenig
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - F Jansen
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - S Jansen
- University of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery , Cologne , Germany
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Nachtsheim L, Mayer M, Meyer MF, Oesterling F, Kajueter H, Arolt C, Quaas A, Klussmann JP, Wolber P. Incidence and clinical outcome of primary carcinomas of the major salivary glands: 10-year data from a population-based state cancer registry in Germany. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04278-6. [PMID: 35994118 DOI: 10.1007/s00432-022-04278-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/10/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this project was to provide an overview of the epidemiology of primary salivary gland carcinomas (SGC) in terms of incidence, distribution of clinicopathological features and survival in one of the largest cancer registries in Europe. METHODS Data were collected from patients with SGC of the major salivary glands registered in the population-based state cancer registry (Landeskrebsregister LKR) in North Rhine-Westphalia (NRW), Germany from 01/01/2009 to 12/31/2018. Age standardization of incidence was performed and relative survival estimates were computed by sex, histological group, age group and T-, N-, and M-stage. RESULTS A total of 1680 patients were included in this analysis. The most frequent tumor localization was the parotid gland (78%). Adenocarcinoma (not otherwise specified) was the most common tumor entity (18.5%). Most tumors were found in stages T1-T3 (29% T1; 29% T2; 28% T3). The age-standardized incidence rate (ASR) for SGC was 0.65/100,000 and remained stable during the observation period. There was an age-dependent incidence increasing especially from the age 70 years and onwards. The overall 5-year relative survival (RS) for all patients with SGC was 69.2%. RS was 80-95.6% for T1-2 stage tumors, 60.3% for T3, 47.3% for T4 stage, 87.4% for N0 and 51.2% for N1-2, 74.4% for M0 and 44.9% for M1. CONCLUSION Age-standardized incidence for SGC has been stable for the observed 10-year period. Smaller tumors and those without lymph node or distant metastases had a better RS than more advanced tumors.
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Affiliation(s)
- Lisa Nachtsheim
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Medical Faculty, Cologne, Germany.
| | - M Mayer
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Medical Faculty, Cologne, Germany
| | - M F Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Duisburg-Essen, Medical Faculty, Essen, Germany
| | - F Oesterling
- Cancer Registry North Rhine-Westphalia, Bochum, Germany
| | - H Kajueter
- Cancer Registry North Rhine-Westphalia, Bochum, Germany
| | - C Arolt
- Institute of Pathology, University of Cologne, Medical Faculty, Cologne, Germany
| | - A Quaas
- Institute of Pathology, University of Cologne, Medical Faculty, Cologne, Germany
| | - J P Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Medical Faculty, Cologne, Germany
| | - P Wolber
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Medical Faculty, Cologne, Germany
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Uzun S, Korkmaz Y, Wuerdemann N, Arolt C, Puladi B, Siefer OG, Dönmez HG, Hufbauer M, Akgül B, Klussmann JP, Huebbers CU. Comprehensive Analysis of VEGFR2 Expression in HPV-Positive and -Negative OPSCC Reveals Differing VEGFR2 Expression Patterns. Cancers (Basel) 2021; 13:cancers13205221. [PMID: 34680369 PMCID: PMC8533978 DOI: 10.3390/cancers13205221] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 01/08/2023] Open
Abstract
VEGF signaling regulated by the vascular endothelial growth factor receptor 2 (VEGFR2) plays a decisive role in tumor angiogenesis, initiation and progression in several tumors including HNSCC. However, the impact of HPV-status on the expression of VEGFR2 in OPSCC has not yet been investigated, although HPV oncoproteins E6 and E7 induce VEGF-expression. In a series of 56 OPSCC with known HPV-status, VEGFR2 expression patterns were analyzed both in blood vessels from tumor-free and tumor-containing regions and within tumor cells by immunohistochemistry using densitometry. Differences in subcellular colocalization of VEGFR2 with endothelial, tumor and stem cell markers were determined by double-immunofluorescence imaging. Immunohistochemical results were correlated with clinicopathological data. HPV-infection induces significant downregulation of VEGFR2 in cancer cells compared to HPV-negative tumor cells (p = 0.012). However, with respect to blood vessel supply, the intensity of VEGFR2 staining differed only in HPV-positive OPSCC and was upregulated in the blood vessels of tumor-containing regions (p < 0.0001). These results may suggest different routes of VEGFR2 signaling depending on the HPV-status of the OPSCC. While in HPV-positive OPSCC, VEGFR2 might be associated with increased angiogenesis, in HPV-negative tumors, an autocrine loop might regulate tumor cell survival and invasion.
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Affiliation(s)
- Senem Uzun
- Jean-Uhrmacher-Institute for Otorhinolaryngological Research, University of Cologne, 50937 Cologne, Germany; (S.U.); (O.G.S.)
| | - Yüksel Korkmaz
- Department of Periodontology and Operative and Preventive Dentistry, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany;
| | - Nora Wuerdemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Cologne, 50937 Cologne, Germany;
- Centre for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne and University Hospital Cologne, 50931 Cologne, Germany
| | - Christoph Arolt
- Institute for Pathology, University Hospital of Cologne, 50937 Cologne, Germany;
| | - Behrus Puladi
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, 52074 Aachen, Germany;
| | - Oliver G. Siefer
- Jean-Uhrmacher-Institute for Otorhinolaryngological Research, University of Cologne, 50937 Cologne, Germany; (S.U.); (O.G.S.)
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Cologne, 50937 Cologne, Germany;
| | - Hanife G. Dönmez
- Institute of Virology, University of Cologne, Medical Faculty and University Hospital Cologne, 50935 Cologne, Germany; (H.G.D.); (M.H.); (B.A.)
- Department of Biology, Hacettepe University, Ankara 06800, Turkey
| | - Martin Hufbauer
- Institute of Virology, University of Cologne, Medical Faculty and University Hospital Cologne, 50935 Cologne, Germany; (H.G.D.); (M.H.); (B.A.)
| | - Baki Akgül
- Institute of Virology, University of Cologne, Medical Faculty and University Hospital Cologne, 50935 Cologne, Germany; (H.G.D.); (M.H.); (B.A.)
| | - Jens P. Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Cologne, 50937 Cologne, Germany;
- Centre for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne and University Hospital Cologne, 50931 Cologne, Germany
- Correspondence: (J.P.K.); (C.U.H.)
| | - Christian U. Huebbers
- Jean-Uhrmacher-Institute for Otorhinolaryngological Research, University of Cologne, 50937 Cologne, Germany; (S.U.); (O.G.S.)
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Cologne, 50937 Cologne, Germany;
- Correspondence: (J.P.K.); (C.U.H.)
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Watermann C, Meyer MT, Valerius KP, Kleefeldt F, Wagner S, Wittekindt C, Klussmann JP, Ergün S, Baumgart-Vogt E, Karnati S. Peroxisomes in the mouse parotid glands: An in-depth morphological and molecular analysis. Ann Anat 2021; 238:151778. [PMID: 34091056 DOI: 10.1016/j.aanat.2021.151778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/16/2020] [Revised: 04/16/2021] [Accepted: 05/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The parotid gland is a major salivary gland that has important roles in the digestive and immune system. Peroxisomes are ubiquitous, single-membrane-bound organelles that are present in all eukaryotic cells. Peroxisomes help mediate lipid and reactive oxygen species metabolism, as well as polyunsaturated fatty acid, cholesterol and plasmalogen synthesis. Much of the knowledge on peroxisomes has derived from metabolic organs, however no detailed knowledge is available on peroxisomes in the parotid glands. We thus aimed to comprehensively delineate the localization and characterization of peroxisomal proteins in the murine parotid gland. METHODS We characterized peroxisomes in the acinar and striated duct cells of the murine parotid gland by fluorescence and electron microscopy, as well as protein and mRNA expression analyses for important peroxisomal genes and proteins. RESULTS We found that peroxisomes are present in all cell types of the mouse parotid gland, however, exhibit notable cell-specific differences in their abundance and enzyme content. We also observed that mouse parotid glands contain high levels of peroxisomal β-oxidation enzymes (including Acox1, Mfp2 and Acaa1), catalase and other peroxisomal anti-oxidative enzymes. CONCLUSIONS This data suggests that peroxisomes are highly abundant in the murine parotid gland and might help to protect against oxidative stress. This comprehensive description of peroxisomes in the parotid gland lays the groundwork for further research concerning their role in the pathogenesis of parotid gland diseases and tumors.
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Affiliation(s)
- Christoph Watermann
- Institute for Anatomy and Cell Biology II, Medical Cell Biology, Justus Liebig University, Giessen D-35385, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, Justus Liebig University, Giessen D-35392, Germany
| | - Malin T Meyer
- Institute for Anatomy and Cell Biology II, Medical Cell Biology, Justus Liebig University, Giessen D-35385, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, Justus Liebig University, Giessen D-35392, Germany
| | - Klaus P Valerius
- Institute for Anatomy and Cell Biology II, Medical Cell Biology, Justus Liebig University, Giessen D-35385, Germany
| | - Florian Kleefeldt
- Institute for Anatomy and Cell Biology, Julius Maximilians University, Würzburg D-97070, Germany
| | - Steffen Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, Justus Liebig University, Giessen D-35392, Germany
| | - Claus Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, Justus Liebig University, Giessen D-35392, Germany
| | - Jens P Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Justus Liebig University, Giessen D-35392, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne D-50931, Germany
| | - Süleyman Ergün
- Institute for Anatomy and Cell Biology, Julius Maximilians University, Würzburg D-97070, Germany
| | - Eveline Baumgart-Vogt
- Institute for Anatomy and Cell Biology II, Medical Cell Biology, Justus Liebig University, Giessen D-35385, Germany
| | - Srikanth Karnati
- Institute for Anatomy and Cell Biology II, Medical Cell Biology, Justus Liebig University, Giessen D-35385, Germany; Institute for Anatomy and Cell Biology, Julius Maximilians University, Würzburg D-97070, Germany.
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Hansen K, Nolte A, Klussmann JP. Vocal cord augmentation with autologous fat in unilateral vocal cord paralysis. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 3:103-104. [PMID: 34053889 DOI: 10.1016/j.anorl.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022]
Affiliation(s)
- K Hansen
- University of Cologne, Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Cologne, Germany.
| | - A Nolte
- University of Cologne, Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Cologne, Germany.
| | - J P Klussmann
- University of Cologne, Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Cologne, Germany.
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Harbeck N, Schneeweiss A, Thuss-Patience P, Miller K, Garbe C, Griesinger F, Eberhardt WEE, Klussmann JP, Wollenberg B, Grimm MO, Zander T, Lüftner D. Neoadjuvant and adjuvant end-points in health technology assessment in oncology. Eur J Cancer 2021; 147:40-50. [PMID: 33611103 DOI: 10.1016/j.ejca.2021.01.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 11/26/2022]
Abstract
Health technology assessment (HTA) of clinical and economic value of a new intervention is an integral step in providing the access of patients to innovative cancer care and treatment. Overall survival (OS) is the preferred criterion for demonstrating the therapeutic efficacy in HTA given its direct clinical and patient relevance. However, with often long life expectancy of patients with early cancer, analysis of OS becomes less practical. Partially due to this reason, pathological complete response (pCR) and time-to-event end-points like disease-free survival are frequently incorporated into the pivotal clinical trials in the neoadjuvant and adjuvant settings. However, there exists a discrepancy between different national HTA bodies regarding the acknowledgement of patient relevance of these end-points. In this article, we analysed the perspectives of patients on different aspects of end-points used in clinical trials in early cancer. Gathered evidence strongly suggests that complete tumour eradication and reduced risk of recurrence provide important psychological benefits thus signifying that pCR and time-to-event end-points are directly relevant to patients. Additionally, we reviewed opinions on patient relevance of neoadjuvant and adjuvant therapy end-points adopted by HTA bodies during the recent evaluations. We found that improvements in end-points used in the adjuvant setting were commonly considered as valuable to patients. In contrast, opinions on patient relevance of neoadjuvant therapy end-points varied between the national HTA bodies. Universal acknowledgement of patient relevance of therapeutic end-points for early cancer by HTA bodies is necessary to balance the inequality in uptake of innovative therapies into national healthcare systems.
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Affiliation(s)
- Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology and Comprehensive Cancer Center, University of Munich (LMU), 81377 Munich, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Division of Gynecologic Oncology, University Hospital and German Cancer Research Center, 69120 Heidelberg, Germany
| | - Peter Thuss-Patience
- Department of Hematology, Oncology and Tumor Immunology, Campus Virchow-Klinikum, Charité University Hospital Berlin, 12203 Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité University Hospital Berlin, 12203 Berlin, Germany
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, Pius-Hospital, University Department Internal Medicine-Oncology, University of Oldenburg, 26121 Oldenburg, Germany
| | - Wilfried E E Eberhardt
- Department of Medical Oncology, West German Cancer Centre, Ruhrlandklinik, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Jens P Klussmann
- Department of Otolaryngology, Head and Neck Surgery, Medical Faculty, University Hospital Cologne, 50937 Cologne, Germany
| | - Barbara Wollenberg
- Department of Otolaryngology, Head and Neck Surgery, University Hospital MRI, Technical University Munich, 81675 Munich, Germany
| | - Marc-Oliver Grimm
- Department of Urology, Jena University Hospital, 07747 Jena, Germany
| | - Thomas Zander
- Department of Internal Medicine I, University Hospital Cologne, 50924 Cologne, Germany
| | - Diana Lüftner
- Department of Hematology, Oncology and Tumour Immunology, Charité Campus Benjamin Franklin, University Medicine Berlin, 12200 Berlin, Germany.
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11
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Stöver T, Dazert S, Plontke SK, Kramer S, Ambrosch P, Arens C, Betz C, Beutner D, Bohr C, Bruchhage KL, Canis M, Dietz A, Guntinas-Lichius O, Hagen R, Hosemann W, Iro H, Klussmann JP, Knopf A, Lang S, Leinung M, Lenarz T, Löwenheim H, Matthias C, Mlynski R, Olze H, Park J, Plinkert P, Radeloff A, Rotter N, Rudack C, Bozzato A, Schipper J, Schrader M, Schuler PJ, Strieth S, Stuck BA, Volkenstein S, Westhofen M, Wolf G, Wollenberg B, Zahnert T, Zenk J, Hoffmann TK. [Effects of the SARS-CoV‑2 pandemic on the otolaryngology university hospitals in the field of research, student teaching and specialist training]. HNO 2021; 69:633-641. [PMID: 33502578 PMCID: PMC7839289 DOI: 10.1007/s00106-021-01001-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Abstract
Hintergrund Ab Frühjahr 2020 kam es zur weltweiten Verbreitung von SARS-CoV‑2 mit der heute als erste Welle der Pandemie bezeichneten Phase ab März 2020. Diese resultierte an vielen Kliniken in Umstrukturierungen und Ressourcenverschiebungen. Ziel unserer Arbeit war die Erfassung der Auswirkungen der Pandemie auf die universitäre Hals-Nasen-Ohren(HNO)-Heilkunde für die Forschung, Lehre und Weiterbildung. Material und Methoden Die Direktorinnen und Direktoren der 39 Universitäts-HNO-Kliniken in Deutschland wurden mithilfe einer strukturierten Online-Befragung zu den Auswirkungen der Pandemie im Zeitraum von März bis April 2020 auf die Forschung, Lehre und die Weiterbildung befragt. Ergebnisse Alle 39 Direktorinnen und Direktoren beteiligten sich an der Umfrage. Hiervon gaben 74,4 % (29/39) an, dass es zu einer Verschlechterung ihrer Forschungstätigkeit infolge der Pandemie gekommen sei. Von 61,5 % (24/39) wurde berichtet, dass pandemiebezogene Forschungsaspekte aufgegriffen wurden. Von allen Kliniken wurde eine Einschränkung der Präsenzlehre berichtet und 97,5 % (38/39) führten neue digitale Lehrformate ein. Im Beobachtungszeitraum sahen 74,4 % der Klinikdirektoren die Weiterbildung der Assistenten nicht gefährdet. Schlussfolgerung Die Ergebnisse geben einen Einblick in die heterogenen Auswirkungen der Pandemie. Die kurzfristige Bearbeitung pandemiebezogener Forschungsthemen und die Einführung innovativer digitaler Konzepte für die studentische Lehre belegt eindrücklich das große innovative Potenzial und die schnelle Reaktionsfähigkeit der HNO-Universitätskliniken, um auch während der Pandemie ihre Aufgaben in der Forschung, Lehre und Weiterbildung bestmöglich zu erfüllen.
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Affiliation(s)
- T Stöver
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Frankfurt a.M., Frankfurt a.M., Deutschland.
| | - S Dazert
- Klinik für Hals-Nasen-Ohrenheilkunde, Ruhr-Universität-Bochum, St. Elisabeth-Hospital, Bochum, Deutschland
| | - S K Plontke
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Halle/S., Halle/S., Deutschland
| | - S Kramer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Frankfurt a.M., Frankfurt a.M., Deutschland
| | - P Ambrosch
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Kiel, Kiel, Deutschland
| | - C Arens
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
| | - C Betz
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
| | - D Beutner
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Göttingen, Göttingen, Deutschland
| | - C Bohr
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - K-L Bruchhage
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Lübeck, Lübeck, Deutschland
| | - M Canis
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Universität München, LMU München, München, Deutschland
| | - A Dietz
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - O Guntinas-Lichius
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Jena, Jena, Deutschland
| | - R Hagen
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - W Hosemann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Greifswald, Greifswald, Deutschland
- Helios Hanseklinikum Stralsund, Stralsund, Deutschland
| | - H Iro
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - J P Klussmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Uniklinik Köln und Medizinische Fakultät, Universität zu Köln, Köln, Deutschland
| | - A Knopf
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Essen, Essen, Deutschland
| | - M Leinung
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Frankfurt a.M., Frankfurt a.M., Deutschland
| | - T Lenarz
- Klinik für Hals-Nasen-Ohrenheilkunde, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - H Löwenheim
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - C Matthias
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Mainz, Mainz, Deutschland
| | - R Mlynski
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Rostock, Deutschland
| | - H Olze
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - J Park
- Klinik für Hals-Nasen-Ohrenheilkunde, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - P Plinkert
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - A Radeloff
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Oldenburg, Oldenburg, Deutschland
| | - N Rotter
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | - C Rudack
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Münster, Münster, Deutschland
| | - A Bozzato
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum des Saarlandes, Saarlandes, Deutschland
| | - J Schipper
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - M Schrader
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Minden, Minden, Deutschland
| | - P J Schuler
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - S Strieth
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
| | - B A Stuck
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - S Volkenstein
- Klinik für Hals-Nasen-Ohrenheilkunde, Ruhr-Universität-Bochum, St. Elisabeth-Hospital, Bochum, Deutschland
| | - M Westhofen
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Aachen, Aachen, Deutschland
| | - G Wolf
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Justus-Liebig-Universität, Gießen, Deutschland
- Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Deutschland
| | - B Wollenberg
- Klinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - T Zahnert
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Dresden, Dresden, Deutschland
| | - J Zenk
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - T K Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
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Wuerdemann N, Pütz K, Eckel H, Jain R, Wittekindt C, Huebbers CU, Sharma SJ, Langer C, Gattenlöhner S, Büttner R, Speel EJ, Suchan M, Wagner S, Quaas A, Klussmann JP. LAG-3, TIM-3 and VISTA Expression on Tumor-Infiltrating Lymphocytes in Oropharyngeal Squamous Cell Carcinoma-Potential Biomarkers for Targeted Therapy Concepts. Int J Mol Sci 2020; 22:E379. [PMID: 33396515 PMCID: PMC7796181 DOI: 10.3390/ijms22010379] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/24/2020] [Accepted: 12/25/2020] [Indexed: 12/12/2022] Open
Abstract
Tumor growth and survival requires a particularly effective immunosuppressant tumor microenvironment (TME) to escape destruction by the immune system. While immunosuppressive checkpoint markers like programmed cell death 1 ligand (PD-L1) are already being targeted in clinical practice, lymphocyte-activation-protein 3 (LAG-3), T-cell immunoglobulin and mucin-domain containing-3 (TIM-3) and V-domain Ig suppressor of T cell activation (VISTA) inhibitors are currently under investigation in clinical trials. Reliable findings on the expression status of those immune checkpoint inhibitors on tumor-infiltrating lymphocytes (TILs) in the TME of oropharyngeal squamous cell carcinoma (OPSCC) are lacking. This work aims to describe the expression of LAG-3, TIM-3, and VISTA expression in the TME of OPSCC. We created a tissue microarray of paraffin-embedded tumor tissue of 241 OPSCC. Expression of the immune checkpoint protein LAG-3, TIM-3, and VISTA in OPSCC was evaluated using immunohistochemistry and results were correlated with CD8+ T-cell inflammation and human papillomavirus (HPV)-status. 73 OPSCC stained positive for LAG-3 (31%; HPV+:44%; HPV-:26%, p = 0.006), 122 OPSCC stained positive for TIM-3 (51%; HPV+:70%; HPV-:44%, p < 0.001) and 168 OPSCC (70%; HPV+:75%; HPV-:68%, p = 0.313) for VISTA. CD8+ T-cells were significantly associated with LAG-3, TIM-3 and VISTA expression (p < 0.001, p < 0.001, p = 0.007). Immune checkpoint therapy targeting LAG-3, TIM-3, and/or VISTA could be a promising treatment strategy especially in HPV-related OPSCC. Future clinical trials investigating the efficacy of a checkpoint blockade in consideration of LAG-3, TIM-3, and VISTA expression are required.
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Affiliation(s)
- Nora Wuerdemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Klinikstrasse 33, 35392 Giessen, Germany; (C.W.); (S.J.S.); (C.L.); (S.W.)
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (H.E.); (R.J.); (C.U.H.); (M.S.); (J.P.K.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Robert-Koch-Str. 21, 50931 Cologne, Germany
| | - Katharina Pütz
- Institute of Pathology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (K.P.); (R.B.); (A.Q.)
| | - Hans Eckel
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (H.E.); (R.J.); (C.U.H.); (M.S.); (J.P.K.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Robert-Koch-Str. 21, 50931 Cologne, Germany
| | - Rishabh Jain
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (H.E.); (R.J.); (C.U.H.); (M.S.); (J.P.K.)
| | - Claus Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Klinikstrasse 33, 35392 Giessen, Germany; (C.W.); (S.J.S.); (C.L.); (S.W.)
| | - Christian U. Huebbers
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (H.E.); (R.J.); (C.U.H.); (M.S.); (J.P.K.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Robert-Koch-Str. 21, 50931 Cologne, Germany
- Jean-Uhrmacher-Institute for Otorhinolaryngological Research, University of Cologne, Geibelstrasse 29–31, 50931 Cologne, Germany
| | - Shachi J. Sharma
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Klinikstrasse 33, 35392 Giessen, Germany; (C.W.); (S.J.S.); (C.L.); (S.W.)
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (H.E.); (R.J.); (C.U.H.); (M.S.); (J.P.K.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Robert-Koch-Str. 21, 50931 Cologne, Germany
| | - Christine Langer
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Klinikstrasse 33, 35392 Giessen, Germany; (C.W.); (S.J.S.); (C.L.); (S.W.)
| | - Stefan Gattenlöhner
- Institute of Pathology, University of Giessen, Langhansstrasse 10, 35392 Giessen, Germany;
| | - Reinhard Büttner
- Institute of Pathology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (K.P.); (R.B.); (A.Q.)
| | - Ernst-Jan Speel
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
| | - Malte Suchan
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (H.E.); (R.J.); (C.U.H.); (M.S.); (J.P.K.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Robert-Koch-Str. 21, 50931 Cologne, Germany
| | - Steffen Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Klinikstrasse 33, 35392 Giessen, Germany; (C.W.); (S.J.S.); (C.L.); (S.W.)
| | - Alexander Quaas
- Institute of Pathology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (K.P.); (R.B.); (A.Q.)
| | - Jens P. Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (H.E.); (R.J.); (C.U.H.); (M.S.); (J.P.K.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Robert-Koch-Str. 21, 50931 Cologne, Germany
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Waterboer T, Brenner N, Klussmann JP, Brennan P, Wieland U, Robbins HA. Study results and related evidence do not support use of HPV16 L1 DRH1 antibodies as a cancer screening test. EBioMedicine 2020; 62:103143. [PMID: 33249381 PMCID: PMC7701317 DOI: 10.1016/j.ebiom.2020.103143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/09/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Nicole Brenner
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jens P Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Paul Brennan
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Ulrike Wieland
- National Reference Center for Papilloma- and Polyomaviruses, University of Cologne, Cologne, Germany
| | - Hilary A Robbins
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
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14
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Wuerdemann N, Jain R, Adams A, Speel EJM, Wagner S, Joosse SA, Klussmann JP. Cell-Free HPV-DNA as a Biomarker for Oropharyngeal Squamous Cell Carcinoma-A Step Towards Personalized Medicine? Cancers (Basel) 2020; 12:cancers12102997. [PMID: 33076524 PMCID: PMC7602702 DOI: 10.3390/cancers12102997] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/01/2020] [Accepted: 10/10/2020] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) is a distinct tumor entity with relatively favorable overall survival. Nevertheless, up to 25% of HPV-related OPSCC patients develop recurrent or metastatic disease with a fatal outcomes. Biomarkers to enable early diagnosis and to monitor this disease are not established. Liquid biopsy presents a promising minimally invasive method to monitor the cell-free DNA of oncogenic HPV and to enable personalized therapy concepts. Few studies have investigated the role of cell-free HPV DNA (cfHPV-DNA) as a diagnostic marker in patients with OPSCC with variable outcomes. To emphasize the importance of cfHPV-DNA, we performed a literature review and meta-analysis. Our results demonstrate that cfHPV-DNA in patients with OPSCC presents a promising diagnostic tool with high specificity. Nevertheless, further studies with homogeneous inclusion criteria will be necessary to strengthen the role of cfHPV-DNA as a biomarker in the future. Abstract Global incidences of oropharyngeal squamous cell carcinoma (OPSCC) are rising due to an association with high-risk human papillomavirus (HPV). Although there is an improved overall survival of HPV-related OPSCC; up to 25% of the patients develop recurrent or distant metastatic disease with a fatal outcomes. Biomarkers to monitor this disease are not established. This meta-analysis reviews the role of cell-free HPV DNA in liquid biopsy (LB) as a biomarker for HPV-related OPSCC. Pubmed, Livivo, and Cochrane Library databases were searched from inception to August, 2020. All studies were analyzed by Meta-DiSc 1.4 and Stata 16.0 statistical software. In total, 16 studies were considered for systematic review, whereas 11 studies met inclusion criteria for meta-analysis, respectively. Pooled sensitivity of cfHPV-DNA at first diagnosis and during follow-up was 0.81 (95% CI; 0.78–0.84) and 0.73 (95% CI; 0.57–0.86), while pooled specificity was 0.98 (95% CI; 0.96–0.99) and 1 (95% CI; 0.99–1). The diagnostic odds ratio (DOR) at first diagnosis was 200.60 (95% CI; 93.31–431.22) and 300.31 (95% CI; 60.94–1479.88) during follow-up. The area under the curve (AUC) of summary receiver operating characteristic (SROC) was 0.99 at first diagnosis and 1.00 during follow-up, respectively. In conclusion, cfHPV-DNA presents a potential biomarker with high specificity in patients with HPV-related OPSCC.
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Affiliation(s)
- Nora Wuerdemann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50931 Cologne, Germany; (R.J.); (J.P.K.)
- Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Robert-Koch-Strasse 21, 50931 Cologne, Germany
- Correspondence: ; Tel.: +49-0221-478-4750
| | - Rishabh Jain
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50931 Cologne, Germany; (R.J.); (J.P.K.)
| | - Anne Adams
- Institute of Medical Statistics and Computational Biology, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany;
| | - Ernst-Jan M. Speel
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands;
| | - Steffen Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Klinikstrasse 33, 35392 Giessen, Germany;
| | - Simon A. Joosse
- Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany;
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jens P. Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50931 Cologne, Germany; (R.J.); (J.P.K.)
- Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Robert-Koch-Strasse 21, 50931 Cologne, Germany
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15
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Otte MS, Klussmann JP, Luers JC. Persisting olfactory dysfunction in patients after recovering from COVID-19. J Infect 2020; 81:e58. [PMID: 32592702 PMCID: PMC7313498 DOI: 10.1016/j.jinf.2020.06.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 01/19/2023]
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16
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Wuerdemann N, Gültekin SE, Pütz K, Wittekindt C, Huebbers CU, Sharma SJ, Eckel H, Schubotz AB, Gattenlöhner S, Büttner R, Speel EJ, Klussmann JP, Wagner S, Quaas A. PD-L1 Expression and a High Tumor Infiltrate of CD8+ Lymphocytes Predict Outcome in Patients with Oropharyngeal Squamous Cells Carcinoma. Int J Mol Sci 2020; 21:ijms21155228. [PMID: 32718057 PMCID: PMC7432501 DOI: 10.3390/ijms21155228] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 12/20/2022] Open
Abstract
Carcinogenesis of human papillomavirus (HPV)-related (+) oropharyngeal squamous cell carcinoma (OPSCC) differs from HPV-negative (–) OPSCC. HPV-related immune-escape-mechanism could be responsible for the development and progression of HPV+ tumors and an immunophenotype different from HPV– OPSCC is expected. The purpose of this study was to analyze the expression of programmed cell death protein 1 ligand 1 (PD-L1) and its prognostic relevance in relation to CD8+ tumor infiltrating lymphocytes (TILs) and the major histocompatibility complex (MHC) I expression in OPSCC. We quantified PD-L1 expression on tumor cells (TC) and macrophages and MHC I expression in association to CD8+ TILs by immunohistochemistry on tissue microarray derived from 171 HPV+/-OPSCC. HPV-status was determined by p16INK4a immunohistochemistry/HPV-DNA detection. Presence of CD8+ TILs, PD-L1 expression on TC, and a more frequent loss of MHC I in HPV+ compared to HPV- OPSCC was detected. A high amount of CD8+ TILs in the whole cohort and in HPV+ OPSCC and PD-L1 expression on TC in HPV- OPSCC was associated with favorable overall survival. There was a trend for an improved outcome according to PD-L1 expression (macrophages) in HPV+ OPSCC without reaching statistical significance. CD8+ TILs and PD-L1-expression have prognostic impact in OPSCC and might present useful biomarkers for predicting clinical outcome and personalized therapy concepts.
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Affiliation(s)
- Nora Wuerdemann
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikstrasse 33, University of Giessen, 35392 Giessen, Germany; (C.W.); (S.J.S.); (A.B.S.); (S.W.)
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (C.U.H.); (H.E.); (J.P.K.)
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Str. 21, 50931 Cologne, Germany
- Correspondence:
| | - Sibel E. Gültekin
- Department of Oral Pathology, Faculty of Dentistry, Biskek Caddesi, Emek, University of Gazi, Ankara 06510, Turkey;
| | - Katharina Pütz
- Institute of Pathology, Kerpener Strasse 62, University of Cologne, 50937 Cologne, Germany; (K.P.); (R.B.); (A.Q.)
| | - Claus Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikstrasse 33, University of Giessen, 35392 Giessen, Germany; (C.W.); (S.J.S.); (A.B.S.); (S.W.)
| | - Christian U. Huebbers
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (C.U.H.); (H.E.); (J.P.K.)
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Str. 21, 50931 Cologne, Germany
- Jean-Uhrmacher-Institute for Otorhinolaryngological Research, University of Cologne, Geibelstrasse 29-31, 50931 Cologne, Germany
| | - Shachi J. Sharma
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikstrasse 33, University of Giessen, 35392 Giessen, Germany; (C.W.); (S.J.S.); (A.B.S.); (S.W.)
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (C.U.H.); (H.E.); (J.P.K.)
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Str. 21, 50931 Cologne, Germany
| | - Hans Eckel
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (C.U.H.); (H.E.); (J.P.K.)
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Str. 21, 50931 Cologne, Germany
| | - Anna B. Schubotz
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikstrasse 33, University of Giessen, 35392 Giessen, Germany; (C.W.); (S.J.S.); (A.B.S.); (S.W.)
| | - Stefan Gattenlöhner
- Institute of Pathology, Langhansstrasse 10, University of Giessen, 35392 Giessen, Germany;
| | - Reinhard Büttner
- Institute of Pathology, Kerpener Strasse 62, University of Cologne, 50937 Cologne, Germany; (K.P.); (R.B.); (A.Q.)
| | - Ernst-Jan Speel
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastrichtthe, The Netherlands;
| | - Jens P. Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (C.U.H.); (H.E.); (J.P.K.)
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Str. 21, 50931 Cologne, Germany
| | - Steffen Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikstrasse 33, University of Giessen, 35392 Giessen, Germany; (C.W.); (S.J.S.); (A.B.S.); (S.W.)
| | - Alexander Quaas
- Institute of Pathology, Kerpener Strasse 62, University of Cologne, 50937 Cologne, Germany; (K.P.); (R.B.); (A.Q.)
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17
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Dietz A, Wichmann G, Kuhnt T, Pfreundner L, Hagen R, Scheich M, Kölbl O, Hautmann MG, Strutz J, Schreiber F, Bockmühl U, Schilling V, Feyer P, de Wit M, Maschmeyer G, Jungehülsing M, Schroeder U, Wollenberg B, Sittel C, Münter M, Lenarz T, Klussmann JP, Guntinas-Lichius O, Rudack C, Eich HT, Foerg T, Preyer S, Westhofen M, Welkoborsky HJ, Esser D, Thurnher D, Remmert S, Sudhoff H, Görner M, Bünzel J, Budach V, Held S, Knödler M, Lordick F, Wiegand S, Vogel K, Boehm A, Flentje M, Keilholz U. Induction chemotherapy (IC) followed by radiotherapy (RT) versus cetuximab plus IC and RT in advanced laryngeal/hypopharyngeal cancer resectable only by total laryngectomy-final results of the larynx organ preservation trial DeLOS-II. Ann Oncol 2019; 29:2105-2114. [PMID: 30412221 DOI: 10.1093/annonc/mdy332] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The German multicenter randomized phase II larynx organ preservation (LOP) trial DeLOS-II was carried out to prove the hypothesis that cetuximab (E) added to induction chemotherapy (IC) and radiotherapy improves laryngectomy-free survival (LFS; survival with preserved larynx) in locally advanced laryngeal/hypopharyngeal cancer (LHSCC). Patients and methods Treatment-naïve patients with stage III/IV LHSCC amenable to total laryngectomy (TL) were randomized to three cycles IC with TPF [docetaxel (T) and cisplatin (P) 75 mg/m2/day 1, 5-FU (F) 750 mg/m2/day days 1-5] followed by radiotherapy (69.6 Gy) without (A) or with (B) standard dose cetuximab for 16 weeks throughout IC and radiotherapy (TPFE). Response to first IC-cycle (IC-1) with ≥30% endoscopically estimated tumor surface shrinkage (ETSS) was used to define early responders; early salvage TL was recommended to non-responders. The primary objective was 24 months LFS above 35% in arm B. Results Of 180 patients randomized (July 2007 to September 2012), 173 fulfilled eligibility criteria (A/B: larynx 44/42, hypopharynx 41/46). Because of 4 therapy-related deaths among the first 64 randomized patients, 5-FU was omitted from IC in the subsequent 112 patients reducing further fatal toxicities. Thus, IC was TPF in 61 patients and TP in 112 patients, respectively. The primary objective (24 months LFS above 35%) was equally met by arms A (40/85, 47.1%) as well as B (41/88, 46.6%). One hundred and twenty-three early responders completed IC+RT; their overall response rates (TPF/TP) were 94.7%/87.2% in A versus 80%/86.0% in B. The 24 months overall survival (OS) rates were 68.2% and 69.3%. Conclusions Despite being accompanied by an elevated frequency in adverse events, the IC with TPF/TP plus cetuximab was feasible but showed no superiority to IC with TPF/TP regarding LFS and OS at 24 months. Both early response and 24 months LFS compare very well to previous LOP trials and recommend effective treatment selection and stratification by ETSS. Clinical trial information NCT00508664.
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Affiliation(s)
- A Dietz
- Department of Otolaryngology, Head and Neck Surgery, University Leipzig, Leipzig, Germany.
| | - G Wichmann
- Department of Otolaryngology, Head and Neck Surgery, University Leipzig, Leipzig, Germany
| | - T Kuhnt
- Department of Radiation Oncology, University Leipzig, Leipzig, Germany
| | - L Pfreundner
- Department of Radiation Oncology, University Würzburg, Würzburg, Germany
| | - R Hagen
- Department of Otolaryngology, Head and Neck Surgery, University Würzburg, Würzburg, Germany
| | - M Scheich
- Department of Otolaryngology, Head and Neck Surgery, University Würzburg, Würzburg, Germany
| | - O Kölbl
- Department of Radiation Oncology, University Regensburg, Regensburg, Germany
| | - M G Hautmann
- Department of Radiation Oncology, University Regensburg, Regensburg, Germany
| | - J Strutz
- Department of Otolaryngology, Head and Neck Surgery, University Regensburg, Regensburg, Germany
| | - F Schreiber
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Kassel, Kassel, Germany
| | - U Bockmühl
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Kassel, Kassel, Germany
| | - V Schilling
- Department of Otolaryngology, Head and Neck Surgery, Vivantes, Berlin, Neukölln, Germany
| | - P Feyer
- Department of Radiation Oncology, Vivantes, Berlin, Neukölln, Germany
| | - M de Wit
- Department of Hemato-Oncology, Vivantes, Berlin, Neukölln, Germany
| | - G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - M Jungehülsing
- Department of Otolaryngology, Head and Neck Surgery, Potsdam Klinikum, Potsdam, Germany
| | - U Schroeder
- Department of Otolaryngology, Head and Neck Surgery, University Lübeck, Lübeck, Germany
| | - B Wollenberg
- Department of Otolaryngology, Head and Neck Surgery, University Lübeck, Lübeck, Germany
| | - C Sittel
- Department of Otolaryngology, Head and Neck Surgery, Katharinen Hospital, Stuttgart, Germany
| | - M Münter
- Department of Radiation Oncology, Katharinen Hospital, Stuttgart, Germany
| | - T Lenarz
- Department of Otolaryngology, Head and Neck Surgery, MHH Hannover, Hannover, Germany
| | - J P Klussmann
- Department of Otolaryngology, Head and Neck Surgery, University Gießen, Gießen, Germany
| | - O Guntinas-Lichius
- Department of Otolaryngology, Head and Neck Surgery, Jena University Hospital, Jena, Germany
| | - C Rudack
- Department of Otolaryngology, Head and Neck Surgery, University Münster, Münster, Germany
| | - H T Eich
- Department of Radiation Oncology, University Münster, Münster, Germany
| | - T Foerg
- Department of Radiation Oncology, Head and Neck Surgery, St. Vincentius, ViDia Christliche Kliniken Karlsruhe, Karlsruhe, Germany
| | - S Preyer
- Department of Otolaryngology, Head and Neck Surgery, St. Vincentius, ViDia Christliche Kliniken Karlsruhe, Karlsruhe, Germany
| | - M Westhofen
- Department of Otolaryngology, Head and Neck Surgery, University Aachen, Aachen, Germany
| | - H J Welkoborsky
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Nordstadt, Hannover, Germany
| | - D Esser
- Department of Otolaryngology, Head and Neck Surgery, Helios Klinikum, Erfurt, Germany
| | - D Thurnher
- Department of Otolaryngology, Head and Neck Surgery, University Graz, Graz, Austria
| | - S Remmert
- Department of Otolaryngology, Head and Neck Surgery, Malteser Hospital Duisburg, Duisburg, Germany
| | - H Sudhoff
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Bielefeld, Germany
| | - M Görner
- Department of Hemato-Oncology, Klinikum Bielefeld, Bielefeld, Germany
| | - J Bünzel
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Nordhausen, Nordhausen, Germany
| | - V Budach
- Department of Radiation Oncology, CCC, Charité-University Medicine, Berlin, Germany
| | - S Held
- ClinAssess GmbH, Leverkusen, Germany
| | - M Knödler
- Department of Oncology, University Cancer Center Leipzig (UCCL), Leipzig, Germany
| | - F Lordick
- Department of Oncology, University Cancer Center Leipzig (UCCL), Leipzig, Germany
| | - S Wiegand
- Department of Otolaryngology, Head and Neck Surgery, University Leipzig, Leipzig, Germany
| | - K Vogel
- Department of Otolaryngology, Head and Neck Surgery, University Leipzig, Leipzig, Germany
| | - A Boehm
- Department of Otolaryngology, Head and Neck Surgery, St. Georg Hospital Leipzig, Leipzig, Germany
| | - M Flentje
- Department of Radiation Oncology, University Würzburg, Würzburg, Germany
| | - U Keilholz
- Charité Comprehensive Cancer Center, Berlin, Germany
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18
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Schmitt K, Molfenter B, Laureano NK, Tawk B, Bieg M, Hostench XP, Weichenhan D, Ullrich ND, Shang V, Richter D, Stögbauer F, Schroeder L, de Bem Prunes B, Visioli F, Rados PV, Jou A, Plath M, Federspil PA, Thierauf J, Döscher J, Weissinger SE, Hoffmann TK, Wagner S, Wittekindt C, Ishaque N, Eils R, Klussmann JP, Holzinger D, Plass C, Abdollahi A, Freier K, Weichert W, Zaoui K, Hess J. Somatic mutations and promotor methylation of the ryanodine receptor 2 is a common event in the pathogenesis of head and neck cancer. Int J Cancer 2019; 145:3299-3310. [PMID: 31135957 DOI: 10.1002/ijc.32481] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 11/23/2018] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 12/31/2022]
Abstract
Genomic sequencing projects unraveled the mutational landscape of head and neck squamous cell carcinoma (HNSCC) and provided a comprehensive catalog of somatic mutations. However, the limited number of significant cancer-related genes obtained so far only partially explains the biological complexity of HNSCC and hampers the development of novel diagnostic biomarkers and therapeutic targets. We pursued a multiscale omics approach based on whole-exome sequencing, global DNA methylation and gene expression profiling data derived from tumor samples of the HIPO-HNC cohort (n = 87), and confirmed new findings with datasets from The Cancer Genome Atlas (TCGA). Promoter methylation was confirmed by MassARRAY analysis and protein expression was assessed by immunohistochemistry and immunofluorescence staining. We discovered a set of cancer-related genes with frequent somatic mutations and high frequency of promoter methylation. This included the ryanodine receptor 2 (RYR2), which showed variable promoter methylation and expression in both tumor samples and cell lines. Immunohistochemical staining of tissue sections unraveled a gradual loss of RYR2 expression from normal mucosa via dysplastic lesion to invasive cancer and indicated that reduced RYR2 expression in adjacent tissue and precancerous lesions might serve as risk factor for unfavorable prognosis and upcoming malignant conversion. In summary, our data indicate that impaired RYR2 function by either somatic mutation or epigenetic silencing is a common event in HNSCC pathogenesis. Detection of RYR2 expression and/or promoter methylation might enable risk assessment for malignant conversion of dysplastic lesions.
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Affiliation(s)
- Katrin Schmitt
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Britta Molfenter
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Natalia Koerich Laureano
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany.,Molecular Mechanisms of Head and Neck Tumors, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Oral Pathology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Bouchra Tawk
- Division of Molecular and Translational Radiation Oncology, Heidelberg Ion Therapy Center (HIT), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg University Hospital, and Translational Radiation Oncology, German Cancer Consortium (DKTK), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matthias Bieg
- Division of Theoretical Bioinformatics, German Cancer Research Center (DKFZ), and Heidelberg Center for Personalized Oncology (DKFZ-HIPO), Heidelberg, Germany
| | - Xavier Pastor Hostench
- Division of Theoretical Bioinformatics, German Cancer Research Center (DKFZ), and Heidelberg Center for Personalized Oncology (DKFZ-HIPO), Heidelberg, Germany
| | - Dieter Weichenhan
- Cancer Epigenomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nina D Ullrich
- Institute of Physiology and Pathophysiology, Division of Cardiovascular Physiology, Heidelberg University, Heidelberg, Germany
| | - Viny Shang
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Daniela Richter
- Translational Medical Oncology, National Center for Tumor Diseases (NCT) Dresden, Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Fabian Stögbauer
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Lea Schroeder
- Division of Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Bianca de Bem Prunes
- Oral Pathology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Fernanda Visioli
- Oral Pathology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Adriana Jou
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany.,Molecular Mechanisms of Head and Neck Tumors, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michaela Plath
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Philippe A Federspil
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Julia Thierauf
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes Döscher
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Ulm, Ulm, Germany
| | | | - Thomas K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Ulm, Ulm, Germany
| | - Steffen Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - Claus Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - Naveed Ishaque
- Division of Theoretical Bioinformatics, German Cancer Research Center (DKFZ), and Heidelberg Center for Personalized Oncology (DKFZ-HIPO), Heidelberg, Germany
| | - Roland Eils
- Division of Theoretical Bioinformatics, German Cancer Research Center (DKFZ), and Heidelberg Center for Personalized Oncology (DKFZ-HIPO), Heidelberg, Germany
| | - Jens P Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - Dana Holzinger
- Division of Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christoph Plass
- Cancer Epigenomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Amir Abdollahi
- Division of Molecular and Translational Radiation Oncology, Heidelberg Ion Therapy Center (HIT), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg University Hospital, and Translational Radiation Oncology, German Cancer Consortium (DKTK), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kolja Freier
- Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Wilko Weichert
- Institute of Pathology, Technical University Munich (TUM), and German Cancer Consortium (DKTK) partner site, Munich, Germany
| | - Karim Zaoui
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jochen Hess
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany.,Molecular Mechanisms of Head and Neck Tumors, German Cancer Research Center (DKFZ), Heidelberg, Germany
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19
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Rasmussen JH, Grønhøj C, Håkansson K, Friborg J, Andersen E, Lelkaitis G, Klussmann JP, Wittekindt C, Wagner S, Vogelius IR, von Buchwald C. Risk profiling based on p16 and HPV DNA more accurately predicts location of disease relapse in patients with oropharyngeal squamous cell carcinoma. Ann Oncol 2019; 30:629-636. [PMID: 30657857 DOI: 10.1093/annonc/mdz010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In the era of precision medicine and HPV-related oropharyngeal squamous cell carcinoma (OPSCC), it is relevant to assess the risk of not only survival, but also the risk of local, regional, or distant treatment failure. The UICC 8th edition uses the surrogate marker p16 to stratify for HPV association but discordance between p16 status and HPV association has been shown. The purpose of this study was to develop a prognostic model to predict the risk of local, regional, and distant metastases and non-cancer-related death for patients with OPSCC, test the prognostic relevance of adding HPV DNA and p16 status, and validate the findings in an independent external dataset. PATIENTS AND METHODS Consecutive patients diagnosed with OPSCC and treated with curative radiotherapy with or without cisplatin in eastern Denmark from 2000 to 2014 were included. Characteristics included age, gender, TNM stage, smoking habits, performance status, and HPV status assessed with p16 and HPV DNA. The information was used to develop a prognostic model for first site of failure with four competing events: recurrence in T-, N-, and M-site, and death with no evidence of disease. RESULTS Overall 1243 patients were eligible for the analysis. A prognostic model with the four events was developed and externally validated in an independent dataset with a heterogeneously treated patient population from another institution. The individual prognostication from the competing risk analysis is displayed in a user friendly online tool (https://rasmussen.shinyapps.io/OPSCCmodelHPV_p16/). Replacing p16 status with the combined variable HPV/p16 status influenced the HR and patients with HPV-/p16+ had significantly higher HR of M-site recurrence than HPV+/p16+ with a HR = 2.56; CI [1.30; 5.02]; P = 0.006 (P = 0.013 in the validation cohort). CONCLUSION Patients with HPV-/p16+ have significantly higher risk of M-site recurrence and could potentially be relevant candidates for clinical trials testing systemic treatments in combination with conventional treatments.
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Affiliation(s)
- J H Rasmussen
- Departments of Otorhinolaryngology, Head and Neck Surgery and Audiology.
| | - C Grønhøj
- Departments of Otorhinolaryngology, Head and Neck Surgery and Audiology
| | - K Håkansson
- Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen
| | - J Friborg
- Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen
| | - E Andersen
- Department of Oncology, Herlev Hospital, University of Copenhagen, Copenhagen
| | - G Lelkaitis
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J P Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne
| | - C Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - S Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - I R Vogelius
- Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen
| | - C von Buchwald
- Departments of Otorhinolaryngology, Head and Neck Surgery and Audiology
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20
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Huebbers CU, Verhees F, Poluschkin L, Olthof NC, Kolligs J, Siefer OG, Henfling M, Ramaekers FCS, Preuss SF, Beutner D, Seehawer J, Drebber U, Korkmaz Y, Lam WL, Vucic EA, Kremer B, Klussmann JP, Speel EJM. Upregulation of AKR1C1 and AKR1C3 expression in OPSCC with integrated HPV16 and HPV-negative tumors is an indicator of poor prognosis. Int J Cancer 2019; 144:2465-2477. [PMID: 30367463 DOI: 10.1002/ijc.31954] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 02/07/2018] [Revised: 09/14/2018] [Accepted: 10/09/2018] [Indexed: 12/25/2022]
Abstract
Different studies have shown that HPV16-positive OPSCC can be subdivided based on integration status (integrated, episomal and mixed forms). Because we showed that integration neither affects the levels of viral genes, nor those of virally disrupted human genes, a genome-wide screen was performed to identify human genes which expression is influenced by viral integration and have clinical relevance. Thirty-three fresh-frozen HPV-16 positive OPSCC samples with known integration status were analyzed by mRNA expression profiling. Among the genes of interest, Aldo-keto-reductases 1C1 and 1C3 (AKR1C1, AKR1C3) were upregulated in tumors with viral integration. Additionally, 141 OPSCC, including 48 HPV-positive cases, were used to validate protein expression by immunohistochemistry. Results were correlated with clinical and histopathological data. Non-hierarchical clustering resulted in two main groups differing in mRNA expression patterns, which interestingly corresponded with viral integration status. In OPSCC with integrated viral DNA, often metabolic pathways were deregulated with frequent upregulation of AKR1C1 and AKR1C3 transcripts. Survival analysis of 141 additionally immunostained OPSCC showed unfavorable survival rates for tumors with upregulation of AKR1C1 or AKR1C3 (both p <0.0001), both in HPV-positive (p ≤0.001) and -negative (p ≤0.017) tumors. OPSCC with integrated HPV16 show upregulation of AKR1C1 and AKR1C3 expression, which strongly correlates with poor survival rates. Also in HPV-negative tumors, upregulation of these proteins correlates with unfavorable outcome. Deregulated AKR1C expression has also been observed in other tumors, making these genes promising candidates to indicate prognosis. In addition, the availability of inhibitors of these gene products may be utilized for drug treatment.
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Affiliation(s)
- Christian U Huebbers
- Jean-Uhrmacher-Institute for Otorhinolaryngological Research, University of Cologne, Cologne, Germany
| | - Femke Verhees
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Leonard Poluschkin
- Jean-Uhrmacher-Institute for Otorhinolaryngological Research, University of Cologne, Cologne, Germany
| | - Nadine C Olthof
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Molecular Cell Biology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jutta Kolligs
- Jean-Uhrmacher-Institute for Otorhinolaryngological Research, University of Cologne, Cologne, Germany
| | - Oliver G Siefer
- Jean-Uhrmacher-Institute for Otorhinolaryngological Research, University of Cologne, Cologne, Germany
| | - Mieke Henfling
- Department of Molecular Cell Biology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Frans C S Ramaekers
- Department of Molecular Cell Biology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Simon F Preuss
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Cologne, Cologne, Germany
| | - Dirk Beutner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Göttingen, Germany
| | - Julia Seehawer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Cologne, Cologne, Germany
| | - Uta Drebber
- Institute for Pathology, University Hospital of Cologne, Cologne, Germany
| | - Yüksel Korkmaz
- Institute for Experimental Dental Research and Oral Musculoskeletal Biology, University Hospital of Cologne, Cologne, Germany.,Department I of Anatomy, University Hospital of Cologne, Cologne, Germany.,Center for Biochemistry, University Hospital of Cologne, Cologne, Germany
| | - Wan L Lam
- Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, Canada
| | - Emily A Vucic
- Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, Canada
| | - Bernd Kremer
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jens P Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Cologne, Cologne, Germany
| | - Ernst-Jan M Speel
- Department of Pathology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
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21
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Lechner A, Schlößer HA, Thelen M, Wennhold K, Rothschild SI, Gilles R, Quaas A, Siefer OG, Huebbers CU, Cukuroglu E, Göke J, Hillmer A, Gathof B, Meyer MF, Klussmann JP, Shimabukuro-Vornhagen A, Theurich S, Beutner D, von Bergwelt-Baildon M. Tumor-associated B cells and humoral immune response in head and neck squamous cell carcinoma. Oncoimmunology 2019; 8:1535293. [PMID: 30723574 PMCID: PMC6350680 DOI: 10.1080/2162402x.2018.1535293] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 10/07/2018] [Accepted: 10/09/2018] [Indexed: 01/04/2023] Open
Abstract
B lymphocytes are important players in immune responses to cancer. However, their composition and function in head and neck squamous cell carcinoma (HNSCC) has not been well described. Here, we analyzed B cell subsets in HNSCC (n = 38), non-cancerous mucosa (n = 14) and peripheral blood from HNSCC patients (n = 38) and healthy controls (n = 20) by flow cytometry. Intratumoral B cells contained high percentages of activated (CD86+), antigen-presenting (CD86+/CD21-) and memory B cells (IgD-/CD27+). T follicular helper cells (CD4+/CXCR5+/CD45RA-/CCR7-) as key components of tertiary lymphoid structures and plasma cells made up high percentages of the lymphocyte infiltrate. Percentages of regulatory B cell varied depending on the regulatory phenotype. Analysis of humoral immune responses against 23 tumor-associated antigens (TAA) showed reactivity against at least one antigen in 56% of HNSCC patients. Reactivity was less frequent in human papillomavirus associated (HPV+) patients and healthy controls compared to HPV negative (HPV-) HNSCC. Likewise, patients with early stage HNSCC or MHC-I loss on tumor cells had low TAA responses. Patients with TAA responses showed CD4+ dominated T cell infiltration compared to mainly CD8+ T cells in tumors without detected TAA response. To summarize, our data demonstrates different immune infiltration patterns in relation to serological TAA response detection and the presence of B cell subpopulations in HNSCC that can engage in tumor promoting and antitumor activity. In view of increasing use of immunotherapeutic approaches, it will be important to include B cells into comprehensive phenotypic and functional analyses of tumor-associated lymphocytes.
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Affiliation(s)
- Axel Lechner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
- Cologne Interventional Immunology, Department I of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig Maximilians University, Munich, Germany
- Gene Center, Ludwig Maximilians University, Munich, Germany
| | - Hans A. Schlößer
- Cologne Interventional Immunology, Department I of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Martin Thelen
- Cologne Interventional Immunology, Department I of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), University Hospital of Cologne, Cologne, Germany
| | - Kerstin Wennhold
- Cologne Interventional Immunology, Department I of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), University Hospital of Cologne, Cologne, Germany
| | - Sacha I. Rothschild
- Department of Internal Medicine, Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Ramona Gilles
- Institute of Transfusion Medicine, University of Cologne, Cologne, Germany
| | - Alexander Quaas
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Oliver G. Siefer
- Jean-Uhrmacher-Institute for Clinical ENT Research, University of Cologne, Cologne, Germany
| | - Christian U. Huebbers
- Jean-Uhrmacher-Institute for Clinical ENT Research, University of Cologne, Cologne, Germany
| | - Engin Cukuroglu
- Computational and Systems Biology, Genome Institute of Singapore, Singapore
| | - Jonathan Göke
- Computational and Systems Biology, Genome Institute of Singapore, Singapore
- National Cancer Centre, Singapore
| | - Axel Hillmer
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Birgit Gathof
- Institute of Transfusion Medicine, University of Cologne, Cologne, Germany
| | - Moritz F. Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - Jens P. Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- Cologne Interventional Immunology, Department I of Internal Medicine, University of Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), University Hospital of Cologne, Cologne, Germany
| | - Sebastian Theurich
- Cologne Interventional Immunology, Department I of Internal Medicine, University of Cologne, Cologne, Germany
- Gene Center, Ludwig Maximilians University, Munich, Germany
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), University Hospital of Cologne, Cologne, Germany
- Cancer- and Immunometabolism Research Group, Dept. I of Internal Medicine, University Hospital Cologne, Cologne, Germany
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Dirk Beutner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Georg August University, Goettingen, Germany
| | - Michael von Bergwelt-Baildon
- Cologne Interventional Immunology, Department I of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- Department of Medicine III, University Hospital, LMU Munich, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Georg August University, Goettingen, Germany
- Partner Site, German Cancer Consortium (DKTK), Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
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22
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Wagner S, Böckmann H, Gattenlöhner S, Klussmann JP, Wittekindt C. [The innate immune system in oropharyngeal squamous cell carcinoma : Immune modulation by HPV]. HNO 2018; 66:301-307. [PMID: 29468275 DOI: 10.1007/s00106-018-0480-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Based on clinical and experimental data, oropharyngeal squamous cell carcinomas (OPSCC) associated with human papillomavirus (HPV) have been recognized as a distinct entity of head and neck cancers. However, outside of clinical trials, HPV status currently has no impact on treatment. The natural replication cycle of HPV takes place in epithelial cells, and is thus spatially separated from cytotoxic immune cells in the epidermis. Dendritic cells (Langerhans cells, LC), however, are frequent in this upper dermal layer. The ability of LC to process antigens, migrate, and, ultimately activate T cells is inhibited by the activity of the viral oncoproteins (E5-E7). Downregulation of functional human leukocyte antigen I (HLA-I) epithelial cell surface expression contributes to LC inhibition. However, due to their absence in upper skin layers, corresponding activation of natural killer (NK) cells via missing-self recognition is not relevant. Genome-wide analyses have revealed specific expression signatures for HPV-associated OPSCC that are distinct from HPV-negative cancers. Interestingly, aberrations in HLA-I genes were common in HPV-associated OPSCC. Our own findings indicate more frequent infiltration of HPV-associated OPSCC by CD56-positive (CD56+) NK cells, which might be related to HLA-I downregulation during HPV-associated carcinogenesis. In patients with OPSCC, CD56 positivity correlates with improved prognosis after conventional therapy. This could be evidence for HPV-associated OPSCC being especially eligible for novel immune-based therapies and an indication that immunological data should be included in the design of clinical trials.
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Affiliation(s)
- S Wagner
- Klinik für HNO-Heilkunde, Kopf‑, Halschirurgie, Universitätsklinikum Gießen, Justus-Liebig-Universität Gießen, Gießen, Deutschland. .,Kopf-Hals-Tumorforschung, Klinik für HNO-Heilkunde, Kopf‑/Halschirurgie, Justus-Liebig-Universität Gießen, Aulweg 128 (ForMED), 35392, Gießen, Deutschland.
| | - H Böckmann
- Klinik für HNO-Heilkunde, Kopf‑, Halschirurgie, Universitätsklinikum Gießen, Justus-Liebig-Universität Gießen, Gießen, Deutschland.,Kopf-Hals-Tumorforschung, Klinik für HNO-Heilkunde, Kopf‑/Halschirurgie, Justus-Liebig-Universität Gießen, Aulweg 128 (ForMED), 35392, Gießen, Deutschland
| | - S Gattenlöhner
- Institut für Pathologie, Universitätsklinikum Gießen, Justus-Liebig-Universität, Gießen, Deutschland
| | - J P Klussmann
- Klinik für HNO-Heilkunde, Kopf‑, Halschirurgie, Universitätsklinikum Gießen, Justus-Liebig-Universität Gießen, Gießen, Deutschland.,Kopf-Hals-Tumorforschung, Klinik für HNO-Heilkunde, Kopf‑/Halschirurgie, Justus-Liebig-Universität Gießen, Aulweg 128 (ForMED), 35392, Gießen, Deutschland
| | - C Wittekindt
- Klinik für HNO-Heilkunde, Kopf‑, Halschirurgie, Universitätsklinikum Gießen, Justus-Liebig-Universität Gießen, Gießen, Deutschland.,Kopf-Hals-Tumorforschung, Klinik für HNO-Heilkunde, Kopf‑/Halschirurgie, Justus-Liebig-Universität Gießen, Aulweg 128 (ForMED), 35392, Gießen, Deutschland
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23
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Sharma SJ, Linke JJ, Kroll T, Wuerdemann N, Klussmann JP, Guntinas-Lichius O, Wittekindt C. Rigid Triple Endoscopy Improves Clinical Staging of Primary Head and Neck Cancer. Oncol Res Treat 2018; 41:35-38. [DOI: 10.1159/000481173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 09/01/2017] [Indexed: 11/19/2022]
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24
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Huebbers CU, Adam AC, Preuss SF, Schiffer T, Schilder S, Guntinas-Lichius O, Schmidt M, Klussmann JP, Wiesner RJ. High glucose uptake unexpectedly is accompanied by high levels of the mitochondrial ß-F1-ATPase subunit in head and neck squamous cell carcinoma. Oncotarget 2016; 6:36172-84. [PMID: 26452026 PMCID: PMC4742169 DOI: 10.18632/oncotarget.5459] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 09/24/2015] [Indexed: 12/13/2022] Open
Abstract
A hallmark of solid tumors is the consumption of large amounts of glucose and production of lactate, also known as Warburg-like metabolism. This metabolic phenotype is typical for aggressive tumor growth, and can be visualized by 18F-fluorodeoxyglucose (18F-FDG) uptake detected by positron emission tomography (PET). High 18F-FDG uptake inversely correlates with survival and goes along with reduced expression of the catalytic beta-subunit of the H+-ATP synthase (β-F1-ATPase) in several tumor entities analyzed so far. For this study we characterized a series of 15 head and neck squamous cell carcinoma (HNSCC) by (i) determining 18F-FDG-uptake; (ii) quantitative expression analysis of β-F1-ATPase (Complex V), NDUF-S1 (Complex I) and COX1 (Complex IV) of the mitochondrial electron transport chain (ETC), as well as Hsp60 (mitochondrial mass) and GAPDH (glycolysis) in tumor cells; (iii) sequencing of the mtDNA of representative tumor samples. Whereas high 18F-FDG-uptake also correlates with poor prognosis in HNSCC, it surprisingly is accompanied by high levels of β-F1-ATPase, but not by any of the other analyzed proteins. In conclusion, we here describe a completely new phenotype of metabolic adaptation possibly enabling those tumors with highest levels of β-F1-ATPase to rapidly proliferate even in hypoxic zones, which are typical for HNSCC.
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Affiliation(s)
- Christian U Huebbers
- Jean-Uhrmacher-Institute for Otorhinolaryngological Research, University of Köln, 50924 Köln, Germany
| | - Alexander C Adam
- Department of Pathology, Medical Faculty, University of Köln, 50924 Köln, Germany
| | - Simon F Preuss
- Department of Otolaryngology, Medical Faculty, University of Köln, 50924 Köln, Germany
| | - Theresa Schiffer
- Center for Physiology and Pathophysiology, Institute of Vegetative Physiology, Medical Faculty, University of Köln, 50931 Köln, Germany
| | - Sarah Schilder
- Center for Physiology and Pathophysiology, Institute of Vegetative Physiology, Medical Faculty, University of Köln, 50931 Köln, Germany
| | | | - Matthias Schmidt
- Department of Nuclear Medicine, Medical Faculty, University of Köln, 50924 Köln, Germany
| | - Jens P Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, 35385 Giessen, Germany
| | - Rudolf J Wiesner
- Center for Physiology and Pathophysiology, Institute of Vegetative Physiology, Medical Faculty, University of Köln, 50931 Köln, Germany.,Center for Molecular Medicine Cologne, CMMC, University of Köln, 50931 Köln, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Ageing-associated Diseases (CECAD), 50674 Köln, Germany
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25
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Luers JC, Guntinas-Lichius O, Klussmann JP, Küsgen C, Beutner D, Grosheva M. The incidence of Warthin tumours and pleomorphic adenomas in the parotid gland over a 25-year period. Clin Otolaryngol 2016; 41:793-797. [PMID: 27343470 DOI: 10.1111/coa.12694] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Pleomorphic adenoma (PA) is reported to be the most common benign parotid tumour followed by Warthin tumour (WT), but the proportion of these two entities might have changed. DESIGN Retrospective file analysis. SETTING Tertiary referral head and neck centre. PARTICIPANTS Patients who underwent a parotidectomy within a period of 25 years (1990-2014). MAIN OUTCOME MEASURES Rate of occurrence of PA and WT as well as the development of the PA/WT ratio over the years. RESULTS Overall, 1818 patients with WT (707, 38.9%) and PA (1111, 61.1%) were identified. There was a dominance of PA over WT in all years. An increase in percentage of WT, from 24% in 1990 to 48% in 2014, in comparison with PA was evident. CONCLUSIONS In our single-institution hospital-based material of parotidectomies, the percentage of WT in comparison with PA has significantly increased over the last 25 years.
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Affiliation(s)
- J C Luers
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - O Guntinas-Lichius
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, Jena University Hospital, Jena, Germany
| | - J P Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, Giessen, Germany
| | - C Küsgen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - D Beutner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - M Grosheva
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
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26
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Reuschenbach M, Wagner S, Würdemann N, Sharma SJ, Prigge ES, Sauer M, Wittig A, Wittekindt C, von Knebel Doeberitz M, Klussmann JP. [Human papillomavirus and squamous cell cancer of the head and neck region : Prognostic, therapeutic and prophylactic implications]. HNO 2016; 64:450-9. [PMID: 26864190 DOI: 10.1007/s00106-016-0123-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Human papilloma viruses (HPV) are responsible for approximately half of all oropharyngeal squamous cell carcinomas (OPSCC) and incidence rates of HPV-associated OPSCC continue to increase substantially. The defined viral carcinogenesis permits development of specific diagnostic, therapeutic, and prophylactic approaches. Laboratory identification of HPV-associated OPSCC may be achieved by p16(INK4a) immunohistochemistry combined with HPV DNA detection by polymerase chain reaction (PCR) using tumor tissue. Patients with HPV-associated OPSCC have a relatively good prognosis; therefore, the HPV status plays an important role in patient guidance. Due to the relatively favorable prognosis, ongoing studies are evaluating whether less rigorous therapy for HPV-positive patients results in equally good cure rates. The criteria for patient selection are, however, still uncertain. Particularly markers for detection of HPV-positive patients with a high risk of treatment failure are lacking. Besides tumor stage and comorbidities, distinct genomic, epigenetic, and immunologic alterations are prognostically relevant for HPV-associated OPSCC, and might be of predictive value. Furthermore, the characteristic molecular alterations suggest the possibility of novel vigilant and specific therapy approaches. These may be inhibitors of the phosphatidylinositol 3‑kinase (PI3K) pathway, which is frequently activated in HPV-associated OPSCC, and immunotherapeutic methods, e. g., therapeutic vaccination. Although prophylactic HPV vaccinations may also prevent development of HPV-associated OPSCC, foreseeable effects on OPSCC incidence will be low, given the low vaccination rates in Germany. This highlights the fact that interdisciplinary research networks should enhance the necessary activities related to HPV-associated OPSCC.
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Affiliation(s)
- M Reuschenbach
- Abteilung für Angewandte Tumorbiologie, Institut für Pathologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland. .,The Human Papillomavirus Infection and Oropharyngeal Cancer Consortium (HOCC), .
| | - S Wagner
- The Human Papillomavirus Infection and Oropharyngeal Cancer Consortium (HOCC).,Klinik für HNO-Heilkunde, Kopf-, Halschirurgie, Universitätsklinikum Gießen, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - N Würdemann
- The Human Papillomavirus Infection and Oropharyngeal Cancer Consortium (HOCC).,Klinik für HNO-Heilkunde, Kopf-, Halschirurgie, Universitätsklinikum Gießen, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - S J Sharma
- The Human Papillomavirus Infection and Oropharyngeal Cancer Consortium (HOCC).,Klinik für HNO-Heilkunde, Kopf-, Halschirurgie, Universitätsklinikum Gießen, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - E-S Prigge
- Abteilung für Angewandte Tumorbiologie, Institut für Pathologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland.,The Human Papillomavirus Infection and Oropharyngeal Cancer Consortium (HOCC)
| | - M Sauer
- Abteilung für Angewandte Tumorbiologie, Institut für Pathologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland.,The Human Papillomavirus Infection and Oropharyngeal Cancer Consortium (HOCC)
| | - A Wittig
- The Human Papillomavirus Infection and Oropharyngeal Cancer Consortium (HOCC).,Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Gießen und Marburg, Philipps-Universität Marburg, Marburg, Deutschland
| | - C Wittekindt
- The Human Papillomavirus Infection and Oropharyngeal Cancer Consortium (HOCC).,Klinik für HNO-Heilkunde, Kopf-, Halschirurgie, Universitätsklinikum Gießen, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - M von Knebel Doeberitz
- Abteilung für Angewandte Tumorbiologie, Institut für Pathologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland.,The Human Papillomavirus Infection and Oropharyngeal Cancer Consortium (HOCC)
| | - J P Klussmann
- The Human Papillomavirus Infection and Oropharyngeal Cancer Consortium (HOCC).,Klinik für HNO-Heilkunde, Kopf-, Halschirurgie, Universitätsklinikum Gießen, Justus-Liebig-Universität Gießen, Gießen, Deutschland
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Speel EJM, Reuschenbach M, Huebbers CU, Prigge ES, Bermejo JL, Kalteis S, Preuss S, Kolligs J, Olthof NC, Kremer B, Wagner S, Klussmann JP, Vinokurova S, von Knebel Doeberitz M. Abstract 828: Methylation status of HPV16 E2-binding sites identifies subtypes of HPV-associated oropharyngeal squamous cell carcinomas. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The viral E2 protein is a transcriptional repressor of the HPV oncogenes E6/E7 and loss of E2 function is considered a key step in carcinogenesis. Integration of HPV into the host genome may disrupt the E2 gene. Furthermore, methylation of CpG dinucleotides in E2 binding sites (E2BSs) in the HPV upstream regulatory region (URR) may interfere with transcriptional repression of E6 and E7 by the E2 protein. We hypothesized that CpG methylation of the E2BS is found in a proportion of HPV16-associated oropharyngeal squamous cell cancers (OPSCC) in association with E2 gene integrity and viral integration.
Methods: Methylation of 10 CpGs within the URR, encompassing E2BSs 1, 2, 3 and 4, was quantitatively analyzed by bisulfite pyrosequencing in 57 HPV16-associated OPSCC. E2 status was analyzed by gene amplification and quantitative real-time RT-PCR. Viral integration was determined by integration-specific PCR methods.
Results: Three subgroups with differential E2BSs3 and 4 methylation were identified: a) complete methylation (>80%) associated with presence of integrated HPV genomes with intact E2 gene, b) intermediate methylation levels (20-80%) with predominantly episomal HPV genomes with intact E2, and c) no methylation (<20%) with integrated HPV with disrupted E2. Patients with complete and without methylation had poor 5-year overall survival compared to patients with intermediate methylation (stage-adjusted hazard ratio 3.8 (95%CI 1.3-11.2) and 3.1 (95%CI 1.14-8.28); p = 0.03).
Conclusions: E2BSs3 and 4 methylation in oropharyngeal cancers with episomal HPV and integrated HPV with intact E2 gene might explain deregulated viral oncogene expression in the presence of E2. The methylation level appears to be of prognostic significance for patients with HPV-associated OPSCC.
Citation Format: Ernst-Jan M. Speel, Miriam Reuschenbach, Christian U. Huebbers, Elena-Sophie Prigge, Justo L. Bermejo, Simon Kalteis, Simon Preuss, Jutta Kolligs, Nadine C. Olthof, Bernd Kremer, Steffen Wagner, Jens P. Klussmann, Svetlana Vinokurova, Magnus von Knebel Doeberitz. Methylation status of HPV16 E2-binding sites identifies subtypes of HPV-associated oropharyngeal squamous cell carcinomas. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 828. doi:10.1158/1538-7445.AM2015-828
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Klussmann JP, Knuth J, Wagner S. Abstract 2996: Hypoxia pathway activation in HPV-associated OSCC. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-2996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: HIF1A induces hypoxia dependent transcription of its target genes, resulting e.g. in increased glycolysis. However, increased glycolysis is found in a lot of tumors despite presence of oxygen, known as Warburg effect. Under normoxia HIF1A is hydroxylated by prolyl hydroxylases (PHDs) and degraded by the proteasome. According to literature, HIF1A protein level increase in the presence of HPV-oncoproteins. Nevertheless, HPV dependent induction of HIF1A and resulting downstream effects are still ambiguous for cervix carcinoma and even more for OSCC. We propose HPV-associated HIF1A induction in OSCC to be responsible for a Warburg-like effect, to gain nutrient resources for tumor growth and to be related to immune escape and metastasis. We investigated characteristic effects of HPV on the hypoxia signaling cascade and glycolysis for testing these hypotheses.
Experimental Procedure: HPV-positive and -negative cell lines were cultured under normoxic and hypoxic conditions or in the presence or absence of hypoxia mimics. We analyzed components of the hypoxia signaling pathway with molecular- and cell biological methods. Furthermore we analyzed HIF1A and its target gene expression in a cohort of 40 HPV-positive and -negative OSCC by immunohistochemistry.
Data: Immunoblot analysis showed 2.6 times higher HIF1A protein level (normalized relative expression) in normoxia and increased accumulation under hypoxic conditions in HPV-positive compared to HPV-negative (4.5 vs. 1.6 times more) cell lines. HPV-positive and -negative cell lines showed comparable PHD2 expression level under normoxia. Interestingly, PHD2 protein level increased more in HPV-positive than in HPV-negative cell lines (5.5 vs. 1.6 times) under hypoxia. Immunofluorescence also showed increased basal HIF1A expression and higher up-regulation after incubation with deferoxamine in HPV-positive vs. -negative cell lines. Immunohistochemistry of GLUT1 in HPV-associated OSCC showed a distinct “HPV-pattern” with a more evenly distributed expression compared to HPV-negative OSCC.
Conclusion: Our findings suggest a difference between HPV-induced and HPV-unrelated carcinogenesis in OSCC referring to up-regulation of HIF1A and activation of its target genes under normoxia as well as under hypoxia. This was shown for HPV-positive cell lines in vitro and indicated for clinical samples. Current analyzes focus on HPV-oncoprotein interactions with cellular factors related to HIF1A protein degradation and stabilization.
Citation Format: Jens P. Klussmann, JeJennifer Knuth, Steffen Wagner. Hypoxia pathway activation in HPV-associated OSCC. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2996. doi:10.1158/1538-7445.AM2015-2996
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Reuschenbach M, Huebbers CU, Prigge ES, Bermejo JL, Kalteis MS, Preuss SF, Seuthe IMC, Kolligs J, Speel EJM, Olthof N, Kremer B, Wagner S, Klussmann JP, Vinokurova S, von Knebel Doeberitz M. Methylation status of HPV16 E2-binding sites classifies subtypes of HPV-associated oropharyngeal cancers. Cancer 2015; 121:1966-76. [PMID: 25731880 DOI: 10.1002/cncr.29315] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 12/19/2014] [Accepted: 01/13/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND The human papillomavirus (HPV) E2 protein is a transcriptional repressor of the oncogenes E6/E7 and loss of E2 function is considered a key step in carcinogenesis. Integration of HPV into the host genome may disrupt the E2 gene. Furthermore, methylation of CpG dinucleotides in E2-binding sites (E2BSs) in the HPV upstream regulatory region may interfere with transcriptional repression of E6 and E7 by E2. The authors hypothesized that the CpG methylation status of E2BS identifies subtypes of HPV type 16 (HPV16)-associated oropharyngeal squamous cell cancers (OPSCC) in association with E2 gene integrity and viral integration. METHODS Methylation of 10 CpG dinucleotides within the upstream regulatory region, encompassing E2BSs 1, 2, 3, and 4, was quantitatively analyzed by bisulfite pyrosequencing in 57 HPV16-associated OPSCC cases. E2 status was analyzed by gene amplification and quantitative real-time reverse transcriptase-polymerase chain reaction. Viral integration was determined by integration-specific polymerase chain reaction methods. RESULTS Three subgroups with differential methylation at E2BS3 and E2BS 4 were identified: 1) complete methylation (>80%) associated with the presence of integrated HPV genomes with an intact E2 gene; 2) intermediate methylation levels (20%-80%) with predominantly episomal HPV genomes with intact E2; and 3) no methylation (<20%) with a disrupted E2 gene. Patients with high methylation levels tended to have a worse 5-year overall survival compared with patients with intermediate methylation (hazard ratio, 3.23; 95% confidence interval, 1.13-9.24 [P = .06]). CONCLUSIONS Methylation of E2BS3 and E2BS4 in OPSCC is associated with E2 integrity and viral physical status. It might explain deregulated viral oncogene expression in the presence of E2. The prognostic significance of E2BS methylation for patients with HPV-associated OPSCC needs to be analyzed further.
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Affiliation(s)
- Miriam Reuschenbach
- Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit, German Cancer Research Center, Heidelberg, Germany
| | - Christian U Huebbers
- Jean-Uhrmacher Institute for Oto-Rhino-Laryngological Research, University of Cologne, Cologne, Germany
| | - Elena-Sophie Prigge
- Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit, German Cancer Research Center, Heidelberg, Germany
| | - Justo Lorenzo Bermejo
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Martin S Kalteis
- Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit, German Cancer Research Center, Heidelberg, Germany
| | - Simon F Preuss
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Cologne, Cologne, Germany
| | - Inga M C Seuthe
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Cologne, Cologne, Germany
| | - Jutta Kolligs
- Jean-Uhrmacher Institute for Oto-Rhino-Laryngological Research, University of Cologne, Cologne, Germany
| | - Ernst-Jan M Speel
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nadine Olthof
- Department of Otorhinolaryngology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Steffen Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - Jens P Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - Svetlana Vinokurova
- Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit, German Cancer Research Center, Heidelberg, Germany
| | - Magnus von Knebel Doeberitz
- Department of Applied Tumor Biology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit, German Cancer Research Center, Heidelberg, Germany
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30
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Veit JA, Scheckenbach K, Schuler PJ, Laban S, Wiggenhauser PS, Thierauf J, Klussmann JP, Hoffmann TK. MicroRNA expression in differentially metastasizing tumors of the head and neck: adenoid cystic versus squamous cell carcinoma. Anticancer Res 2015; 35:1271-1277. [PMID: 25750274] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM Head and neck adenoid cystic carcinoma (HNACC) is a rare malignancy of the salivary glands with a tendency to metastasize in lung or liver without lymph node involvement, whereas squamous cell carcinoma (HNSCC) preferentially metastasizes to locoregional lymph nodes. The expression patterns of microRNA, a class of small non-coding RNA transcripts, involved in gene regulation and various developmental processes, could be of influence during the metastatic process. The aim of the present study was to compare mircoRNA expression patterns of HNACC and HNSCC. MATERIALS AND METHODS In a total of 21 tissue samples, a genome-wide screening for microRNAs was performed. A microRNA array platform was used for the identification of target microRNA. RESULTS Five microRNAs, hsa-MiR-214, hsa-MiR-125a-5p, hsa-MiR-574-3p, hsa-MiR-199a-3p/199b-3p and hsa-miR-199a-5p were identified to be over-expressed in HNACC compared to HNSCC, whereas hsa-MiR-452 showed a lower expression level. CONCLUSION Our data showed significantly different expression patterns of mircoRNA in HNACC and HNSCC supporting the theory of tumor-specific expression and giving hints for different clinical behavior.
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Affiliation(s)
- Johannes A Veit
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Kathrin Scheckenbach
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Düsseldorf University Medical Center, Düsseldorf, Germany
| | - Patrick J Schuler
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Simon Laban
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | | | - Julia Thierauf
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Jens P Klussmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Giessen University Medical Center, Giessen, Germany
| | - Thomas K Hoffmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
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31
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Ziemann F, Arenz A, Preising S, Wittekindt C, Klussmann JP, Engenhart-Cabillic R, Wittig A. Increased sensitivity of HPV-positive head and neck cancer cell lines to x-irradiation ± Cisplatin due to decreased expression of E6 and E7 oncoproteins and enhanced apoptosis. Am J Cancer Res 2015; 5:1017-1031. [PMID: 26045983 PMCID: PMC4449432] [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: 12/10/2014] [Accepted: 02/10/2015] [Indexed: 06/04/2023] Open
Abstract
Squamous cell carcinoma of the head and neck region (HNSCC), which is related to an infection with human papilloma virus (HPV), responds better to simultaneous radio-chemotherapy with Cisplatin based regimens than HPV-negative tumors. The underlying molecular mechanisms for this clinical observation are not fully understood. Therefore, the response of four HPV-positive (HPV+) (UM-SCC-47, UM-SCC-104, 93-VU-147T, UPCI:SCC152) and four HPV-negative (HPV-) (UD-SCC-1, UM-SCC-6, UM-SCC-11b, UT-SCC-33) HNSCC cell lines to x-irradiation ± Cisplatin incubation in terms of clonogenic survival, cell cycle progression, protein expression (cyclin A2, cyclin E2, E6, E7, p53) and induction of apoptosis, was investigated. HPV+ cells were more radio- and chemosensitive and were more effectively sensitized to x-irradiation by simultaneous Cisplatin incubation than HPV- cell lines. HPV+ cell lines revealed an increased and prolonged G2/M arrest after irradiation, whereas Cisplatin induced a blockage of cells in S phase. In comparison to irradiation only, addition of Cisplatin significantly enhanced apoptosis especially in HPV+ cell lines. While irradiation alone increased the amount of HPV E6 and E7 proteins, both were down-regulated by Cisplatin incubation either alone or in combination with x-rays, which however did not increase the expression of endogenous p53. Our results demonstrate that cell cycle deregulation together with downregulation of HPV E6 and E7 proteins facilitating apoptosis after Cisplatin incubation promote the enhanced sensitivity of HPV+ HNSCC cells to simultaneous radio-chemotherapy. Combined effects of irradiation and Cisplatin appear to be relevant in mediating the enhanced therapeutic response of HPV-related HNSCC and are indicative of the benefit of combined modality approaches in future treatment optimization strategies.
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Affiliation(s)
- Frank Ziemann
- Department of Radiotherapy and Radiooncology, Philipps-University, University Hospital Gießen and MarburgMarburg, Germany
| | - Andrea Arenz
- Department of Radiotherapy and Radiooncology, Philipps-University, University Hospital Gießen and MarburgMarburg, Germany
| | - Stefanie Preising
- Department of Radiotherapy and Radiooncology, Philipps-University, University Hospital Gießen and MarburgMarburg, Germany
| | - Claus Wittekindt
- Department of Otorhinolaryngology and Head and Neck Surgery, Justus Liebig University, University Hospital Gießen and MarburgGiessen, Germany
| | - Jens P Klussmann
- Department of Otorhinolaryngology and Head and Neck Surgery, Justus Liebig University, University Hospital Gießen and MarburgGiessen, Germany
| | - Rita Engenhart-Cabillic
- Department of Radiotherapy and Radiooncology, Philipps-University, University Hospital Gießen and MarburgMarburg, Germany
| | - Andrea Wittig
- Department of Radiotherapy and Radiooncology, Philipps-University, University Hospital Gießen and MarburgMarburg, Germany
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Sharma SJ, Kreisel M, Holler C, Kroll T, Gamerdinger U, Gattenloehner S, Klussmann JP, Wittekindt C. Compound lesion of a basal cell carcinoma and a malignant melanoma: is there a common genetic origin? Eur Arch Otorhinolaryngol 2014; 272:505-9. [PMID: 25297533 DOI: 10.1007/s00405-014-3318-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 09/29/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Shachi Jenny Sharma
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Germany, Klinikstrasse 33, 35392, Giessen, Germany,
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Olthof NC, Huebbers CU, Kolligs J, Henfling M, Ramaekers FCS, Cornet I, van Lent-Albrechts JA, Stegmann APA, Silling S, Wieland U, Carey TE, Walline HM, Gollin SM, Hoffmann TK, de Winter J, Kremer B, Klussmann JP, Speel EJM. Viral load, gene expression and mapping of viral integration sites in HPV16-associated HNSCC cell lines. Int J Cancer 2014; 136:E207-18. [PMID: 25082736 DOI: 10.1002/ijc.29112] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [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: 10/20/2013] [Accepted: 07/03/2014] [Indexed: 01/05/2023]
Abstract
HPV-related HNSCC generally have a better prognosis than HPV-negative HNSCC. However, a subgroup of HPV-positive tumors with poor prognosis has been recognized, particularly related to smoking, EGFR overexpression and chromosomal instability. Viral integration into the host genome might contribute to carcinogenesis, as is shown for cervical carcinomas. Therefore, all HPV16-positive HNSCC cell lines currently available have been carefully analyzed for viral and host genome parameters. The viral integration status, viral load, viral gene expression and the presence of aneusomies was evaluated in the cell lines UD-SCC-2, UM-SCC-047, UM-SCC-104, UPCI:SCC090, UPCI:SCC152, UPCI:SCC154 and 93VU147T. HPV integration was examined using FISH, APOT-PCR and DIPS-PCR. Viral load and the expression of the viral genes E2, E6 and E7 were determined via quantitative PCR. All cell lines showed integration-specific staining patterns and signals indicating transcriptional activity using FISH. APOT- and DIPS-PCR identified integration-derived fusion products in six cell lines and only episomal products for UM-SCC-104. Despite the observed differences in viral load and the number of viral integration sites, this did not relate to the identified viral oncogene expression. Furthermore, cell lines exhibited EGFR expression and aneusomy (except UPCI:SCC154). In conclusion, all HPV16-positive HNSCC cell lines showed integrated and/or episomal viral DNA that is transcriptionally active, although viral oncogene expression was independent of viral copy number and the number of viral integration sites. Because these cell lines also contain EGFR expression and aneusomy, which are parameters of poor prognosis, they should be considered suitable model systems for the development of new antiviral therapies.
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Affiliation(s)
- Nadine C Olthof
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands; Department of Molecular Cell Biology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands
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Vogt JF, Krombach GA, Wittekindt C, Klussmann JP, Wittekindt D. [Negative pressure pulmonary edema after peritonsillar abscess tonsillectomy]. HNO 2013; 63:373-5. [PMID: 24292222 DOI: 10.1007/s00106-013-2782-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report on a 19-year-old patient who developed negative pressure pulmonary edema (NPPE) with respiratory insufficiency following abscess tonsillectomy. NPPE is an unpredictable and life-threatening postoperative complication characterized by respiratory insufficiency. It may arise immediately after extubation or later in the postoperative period. NPPE is frequently observed after laryngospasm or in combination with space-occupying lesions in the pharynx and larynx. Treatment comprises the immediate correction of hypoxemia, preferably by noninvasive respiratory support using continuous positive airway pressure (CPAP), although in some cases reintubation is necessary.
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Affiliation(s)
- J-F Vogt
- Hals-Nasen-Ohren-Klinik und Kopf- und Halschirurgie, Universitätsklinikum Gießen, Klinikstr. 33, 35392, Gießen, Deutschland,
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35
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Mooren JJ, Gültekin SE, Straetmans JMJAA, Haesevoets A, Peutz-Kootstra CJ, Huebbers CU, Dienes HP, Wieland U, Ramaekers FCS, Kremer B, Speel EJM, Klussmann JP. P16(INK4A) immunostaining is a strong indicator for high-risk-HPV-associated oropharyngeal carcinomas and dysplasias, but is unreliable to predict low-risk-HPV-infection in head and neck papillomas and laryngeal dysplasias. Int J Cancer 2013; 134:2108-17. [PMID: 24127203 DOI: 10.1002/ijc.28534] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [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: 05/02/2013] [Accepted: 09/12/2013] [Indexed: 01/08/2023]
Abstract
Human papillomavirus (HPV) is a risk factor for the development of benign and malignant mucosal head and neck lesions. P16(INK4A) is often used as a surrogate marker for HPV-infection, although there is still controversy with respect its reliability. Our aim was to determine if p16(INK4A) overexpression can accurately predict both high-risk and low-risk-HPV-presence in (pre)malignant and benign head and neck lesions. P16(INK4A) immunohistochemistry was performed on paraffin-embedded tissue sections of 162 oropharyngeal squamous cell carcinomas (OPSCC), 14 tonsillar and 23 laryngeal dysplasias, and 20 tonsillar and 27 laryngeal papillomas. PCR, enzyme-immunoassay and FISH analysis were used to assess HPV-presence and type. Of the 162 OPSCC and 14 tonsillar dysplasias, 51 (31%) and 10 (71%) were HPV16-positive, respectively. All tonsillar papillomas were HPV-negative and four laryngeal dysplasias and 26 laryngeal papillomas were positive for HPV6 or -11. P16(INK4A) immunohistochemistry revealed a strong nuclear and cytoplasmic staining in 50 out of 51 HPV16-positive and 5 out of 111 HPV-negative OPSCC (p < 0.0001) and in all HPV16-positive tonsillar dysplasias, whereas highly variable staining patterns were detected in the papillomas and laryngeal dysplasias, irrespective of the HPV-status. In addition, the latter lesions generally showed a higher nuclear than cytoplasmic p16(INK4A) immunostaining intensity. In conclusion, our data show that strong nuclear and cytoplasmic p16(INK4A) overexpression is a reliable surrogate indicator for HPV16 in OPSCC and (adjacent) dysplasias. For HPV6 or -11-positive and HPV-negative benign and premalignant lesions of the tonsil and larynx, however, p16(INK4A) immunostaining is highly variable and cannot be recommended to predict HPV-presence.
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Affiliation(s)
- Jeroen J Mooren
- Department of Otorhinolaryngology, Head and Neck Surgery, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands
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Klussmann JP, Schädlich PK, Chen X, Rémy V. Annual cost of hospitalization, inpatient rehabilitation, and sick leave for head and neck cancers in Germany. Clinicoecon Outcomes Res 2013; 5:203-13. [PMID: 23717047 PMCID: PMC3662462 DOI: 10.2147/ceor.s43393] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Data on the economic burden of head and neck cancers (HNCs) in Germany is scarce. About 16%–28% of these cancers are associated with human papillomavirus (HPV) infection. Therefore, the study reported here aimed to assess the annual costs of HPV-related HNCs incurred by hospitalization, inpatient rehabilitation, and sick leave in Germany in 2008. Methods A cross-sectional retrospective analysis of five German databases covering hospital treatment, inpatient rehabilitation, and sick leave in 2008 was performed. All hospital, inpatient rehabilitation, and sick leave cases due to HNCs in 2008 were analyzed. Associated numbers of HNC hospitalizations, health care resource use, and costs were identified and extracted using the International Classification of Diseases, tenth revision (ICD-10; World Health Organization, Geneva, 1990) codes C01–C06, C09–C14, and C32 as the main diagnoses. Resources were valued with German official prices in 2008 euros (€). The annual costs of HPV-related HNCs were estimated based on the percentage of HNCs likely to be attributable to HPV infection. Results In 2008, there were 63,857 hospitalizations, 4898 inpatient rehabilitations, and 17,494 sick leaves due to HNCs, representing costs of €365.78 million. The estimated annual costs associated with HPV-related HNCs were €78.22 million, mainly attributed to males (80%). Direct costs accounted for 84% (80% for hospital treatment, 4% for inpatient rehabilitation) and indirect costs due to sick leave accounted for 16% of HPV-related HNC costs. Conclusion The economic burden of HPV-related HNCs in Germany in 2008 has been underestimated, since costs incurred by outpatient management, outpatient chemotherapy, long-term care, premature retirement, and premature death were not included. However, as far as we are aware, this study is the first analysis to investigate the economic burden of HNCs in Germany. The estimated annual costs of HPV-related HNCs contribute to a significant economic burden in Germany and should be considered when assessing the health and economic benefits of HPV vaccination in both sexes.
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Affiliation(s)
- Jens P Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen
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Klussmann JP, Olthof NC, Huebbers CU, Kolligs J, Ramaekers FCS, Preuss S, Drebber U, Vucic E, Lam W, Kremer B, Speel EJ. Abstract 4775: HPV16-E2/E4, -E6 and -E7 genes and HPV-disrupted human genes show large variation in expression levels in OSCC independent of the viral physical status. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-4775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Infection with high-risk human papillomavirus (HPV) type 16 is an independent risk factor for the development of oropharyngeal squamous cell carcinomas (OSCC). However, it is unclear whether viral integration is an essential hallmark in the carcinogenic process of OSCC and whether HPV integration correlates to the level of viral gene transcription and influences the expression of disrupted genes.
HPV16 integration sites were assessed in 75 patients with HPV16-DNA- and p16INK4A-positive OSCC using Detection of Integrated Papillomavirus Sequences (DIPS)- as well as Amplification of Papillomavirus Oncogene Transcripts (APOT)-PCR. Quantitative RT-PCR assays were carried out to determine the viral E2/E4, E6 and E7 gene expression levels. Expression levels of 7 human genes disrupted by the virus were extracted from mRNA expression profiling data of 32 OSCC. Nuclear localization of HPV16 was visualized using Fluorescence In Situ Hybridization (FISH) in 59 OSCC, and corresponding viral copy numbers were assessed by quantitative RT-PCR in 61 tumors.
We identified 37 HPV16-human fusion products indicating viral integration in 29 (39%) OSCC. In the remaining tumors (61%) only episome-derived PCR products were detected. When comparing OSCC with or without an integration-derived fusion product, we neither found significant differences in the mean expression of the viral genes E2/E4, E6 and E7, the nuclear FISH staining patters nor the viral copy numbers per cell. The expression of the HPV-invaded genes also did not significantly differ when comparing the expression in the affected tumor with the expression of that gene in either group of OSCC.
In conclusion, our data do not support the hypothesis that integration affects the levels of viral and/or HPV-disrupted human gene transcripts. Thus constitutive, rather than a high level, of expression of oncogene transcripts appears to be required in HPV-related OSCC.
Citation Format: Jens P. Klussmann, Nadine C. Olthof, Christian U. Huebbers, Jutta Kolligs, Frans CS Ramaekers, Simon Preuss, Uta Drebber, Emily Vucic, Wan Lam, Bernd Kremer, Ernst Jan Speel. HPV16-E2/E4, -E6 and -E7 genes and HPV-disrupted human genes show large variation in expression levels in OSCC independent of the viral physical status. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4775. doi:10.1158/1538-7445.AM2013-4775
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Affiliation(s)
| | | | - Christian U. Huebbers
- 3Jean-Uhrmacher-Institute for Otorhinolaryngological Research, University of Cologne, Cologne, Germany
| | - Jutta Kolligs
- 3Jean-Uhrmacher-Institute for Otorhinolaryngological Research, University of Cologne, Cologne, Germany
| | | | | | | | - Emily Vucic
- 5Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, Vancouver, British Columbia, Canada
| | - Wan Lam
- 5Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, Vancouver, British Columbia, Canada
| | - Bernd Kremer
- 2Maastricht University Medical Centre, Maastricht, Netherlands
| | - Ernst Jan Speel
- 2Maastricht University Medical Centre, Maastricht, Netherlands
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Qian X, Wagner S, Ma C, Klussmann JP, Hummel M, Kaufmann AM, Albers AE. ALDH1-positive cancer stem-like cells are enriched in nodal metastases of oropharyngeal squamous cell carcinoma independent of HPV status. Oncol Rep 2013; 29:1777-84. [PMID: 23483187 DOI: 10.3892/or.2013.2340] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 12/27/2012] [Indexed: 11/06/2022] Open
Abstract
Oropharyngeal squamous cell carcinoma (OSCC) is caused by high-risk (HR) human papillomavirus (HPV) or alcohol and tobacco abuse. Aldehyde dehydrogenase 1 (ALDH1) is a confirmed marker for cancer stem-like cells (CSCs) of OSCC responsible for therapy resistance, recurrence and metastasis. Associations between HR-HPV/p16, CSC frequency and clinicopathological parameters in patients with metastatic OSCC were investigated. In the present study, HPV genotypes and expression of ALDH1 and p16 was analyzed in 40 paired OSCC and metastases. A significant correlation between ALDH1 positivity with lower primary tumor differentiation grade (P=0.009) and higher nodal status (P=0.015) was noted. Compared to primary tumors, the proportion of ALDH1-expressing cells was significantly increased in metastases (P=0.012), while significantly fewer ALDH1-expressing cells were found in HR-HPV-DNA⁺/p16⁺ primary tumors (P=0.038) compared to HR-HPV-DNA⁻/p16⁻ primary tumors. Metastases showed no difference. ALDH1⁺ CSCs are detectable in OSCC and metastases. ALDH1 high-grade OSCC exhibits a more aggressive phenotype characterized by higher nodal classification and lower differentiation. This suggests a subpopulation contained in the ALDH1-positive OSCC cell pool able to complete the metastatic cascade and subsequently enriching in metastasis independent of tumor etiology and ALDH1 content.
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Affiliation(s)
- Xu Qian
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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Sharma SJ, Kreisel M, Kroll T, Gattenloehner S, Klussmann JP, Wittekindt C. Extracardiac juvenile rhabdomyoma of the larynx: a rare pathological finding. Eur Arch Otorhinolaryngol 2012; 270:773-6. [PMID: 23124718 DOI: 10.1007/s00405-012-2245-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 10/23/2012] [Indexed: 11/24/2022]
Abstract
The extracardiac juvenile rhabdomyoma is extremely rare in the field of Otorhinolaryngology. The tumour usually arises from the soft tissue of the face or from mucosal sites, especially the oropharynx and the oral cavity but only sporadic endolaryngeal cases have been described in literature so far with predominance of young males. Here, we describe the very rare case of endolaryngeal extracardiac juvenile rhabdomyoma in a 42-year-old male. Clinical examination showed a mass of the right vocal cord, resembling a cystic lesion. Microlaryngoscopy revealed a non-encapsulated lesion and histopathology including immunohistochemistry which consecutively led to the correct diagnosis. This case suggests that the endolaryngeal extracardiac juvenile rhabdomyoma can be easily confused with a vocal cord cyst. Malignant transformations have not been reported but recurrences have been described. When total excision cannot be accomplished, reoperation or narrow follow-up is indicated to prevent advanced revision surgeries.
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Affiliation(s)
- Shachi J Sharma
- Department of Otolaryngology/Head and Neck Surgery, University Hospital Giessen and Marburg, Justus Liebig University, Campus Giessen, Klinikstrasse 33, 35392 Giessen, Germany.
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Mikolajczak S, Quante G, Weissenborn S, Wafaisade A, Wieland U, Lüers JC, Klussmann JP, Beutner D. The impact of cidofovir treatment on viral loads in adult recurrent respiratory papillomatosis. Eur Arch Otorhinolaryngol 2012; 269:2543-8. [PMID: 22766836 DOI: 10.1007/s00405-012-2103-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 06/21/2012] [Indexed: 01/15/2023]
Abstract
Cidofovir is an antiviral agent used in the therapy of recurrent respiratory papillomatosis (RRP). In this study, we hypothesized that cidofovir is effective in decreasing the viral load of human papillomavirus (HPV). We established a type specific real-time PCR and measured HPV DNA loads. The course of viral load of HPV types 6 and 11 after repeated applications of cidofovir intralesionally was compared to the clinical outcome using a modified Derkay score. In 6 of the 8 (75 %) patients, we detected HPV 6. In 2 (25 %) patients, we detected HPV 11. In all of the patients, the viral load and the modified Derkay score decreased significantly during the treatment. We conclude that viral load of HPV can be monitored using the technique described here. Cidofovir in combination with surgical debulking reduces the viral load in patients with RRP. Relapses of the symptoms cannot be avoided but might be delayed.
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Affiliation(s)
- S Mikolajczak
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Kerpener Str. 62, 50924 Cologne, Germany
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Affiliation(s)
- S Wagner
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Halschirurgie und plastische Operationen, Universitätsklinikums Giessen & Marburg, Standort Giessen, Klinikstr. 33, 35392, Giessen, Deutschland.
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Stenner M, Demgensky A, Molls C, Hardt A, Luers JC, Grosheva M, Huebbers CU, Klussmann JP. Prognostic value of proliferating cell nuclear antigen in parotid gland cancer. Eur Arch Otorhinolaryngol 2011; 269:1225-32. [DOI: 10.1007/s00405-011-1740-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Accepted: 08/01/2011] [Indexed: 10/17/2022]
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Stenner M, Molls C, Luers JC, Beutner D, Klussmann JP, Huettenbrink KB. Occurrence of lymph node metastasis in early-stage parotid gland cancer. Eur Arch Otorhinolaryngol 2011; 269:643-8. [DOI: 10.1007/s00405-011-1663-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 05/30/2011] [Indexed: 10/18/2022]
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Albers AE, Chen C, Köberle B, Qian X, Klussmann JP, Wollenberg B, Kaufmann AM. Stem cells in squamous head and neck cancer. Crit Rev Oncol Hematol 2011; 81:224-40. [PMID: 21511490 DOI: 10.1016/j.critrevonc.2011.03.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 03/07/2011] [Accepted: 03/18/2011] [Indexed: 12/18/2022] Open
Abstract
The initiation and metastasis of head and neck squamous cell carcinomas (HNSCC) and other cancers have recently been related to the presence of cancer stem cells (CSC). CSC are cancer initiating, sustaining and are mostly quiescent. Specific markers that vary considerably depending on tumor type or tissue of origin characterize putative CSC. Compared to the bulk tumor mass, CSC are less sensitive to chemo- and radiotherapy and may also have low immunogenicity. Therapeutic targeting of CSC may improve clinical outcome of HNSCC which has two distinct etiologies: infection of epithelial stem cells by high-risk types of the human papillomavirus, or long-term tobacco and alcohol abuse. Recent knowledge on the role of CSC in HNSCC is reviewed and where necessary parallels to CSC of other origin are drawn to give a more comprehensive picture.
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Affiliation(s)
- Andreas E Albers
- Department of Otolaryngology and Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
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Speel EJM, Straetmans JM, Vent J, Mujagic Z, Henfling M, Haesevoets A, Haidl B, Huebbers CU, Ramaekers FCS, Kremer B, Klussmann JP. Abstract 2255: Diagnostic and prognostic value of oncogenic human papillomavirus in patients with carcinoma of unknown primary of the neck. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-2255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective. To date, there is no consensus on the optimal diagnostic and therapeutic strategy for patients with carcinoma of unknown primary (CUP) of the neck. These tumors are heterogeneous in their clinical and biological characteristics, and a pre-operative prognostic marker is desirable to optimize therapy and improve outcome and survival. Human papillomavirus (HPV) is an etiologic factor in a subgroup of head and neck squamous cell carcinomas and has been identified as a significant prognostic biomarker. We sought to determine if HPV also may add relevant information on the origin and prognosis of these tumors.
Material and method. 47 patients (mean age 58.7 years; 40 men, 7 women) presenting with CUP of the neck between 1994 and 2008 in Cologne were examined by standard diagnostic procedures including radiological imaging of the head, neck, thorax and abdomen, positron emission tomography (PET), panendoscopy, curettage of the nasopharynx, bilateral tonsillectomy and blind probes of the base of tongue. All patients were surgically treated with neck dissection of the diseased neck as well as adjuvant chemoradiation. The mean follow up time was 34 months.
Formaldehyde-fixed, paraffin-embedded tissue specimens of the 47 metastases were examined retrospectively by means of p16INK4A immunohistochemistry, HPV-specific PCR and fluorescence in situ hybridization. Results were correlated with clinical follow-up data.
Results. Oncogenic HPV was present in 12/47 (26%) metastases (10 with HPV 16), which showed also p16INK4A overexpression. In 42% of CUP patients the primary tumor was discovered during follow-up. A significant correlation between HPV positivity and later detection of the primary tumor in the oropharynx was found (p=0.038). Moreover, patients with a p16INK4A- (13/47) or HPV-positive tumor had a more favorable overall 5-year survival rate then p16INK4A- and HPV-negative tumors (69% vs 33%, p=0.05; 65% vs 37%, p=0.093; respectively).
Conclusion. HPV is present in a quarter of neck metastases of CUP patients and the presence of oncogenic HPV and p16INK4A expression can serve to locate the primary tumor in the oropharynx. In addition, both biomarkers are indicators of a favorable prognosis.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 2255. doi:10.1158/1538-7445.AM2011-2255
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Affiliation(s)
| | | | - Julia Vent
- 2University of Cologne, Cologne, Germany
| | | | | | | | - B Haidl
- 2University of Cologne, Cologne, Germany
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Stenner M, Demgensky A, Molls C, Hardt A, Klussmann JP. Abstract 2956: Prognostic value of PCNA expression in salivary gland cancer in consideration of different histological subtypes. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-2956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The expression of the cell proliferation-related marker Proliferating Cell Nuclear Antigen (PCNA) has shown to be a significant prognostic indicator in various human cancers. Its role in malignant tumors of the major salivary glands remains unclear.
Methods: We analysed the expression of PCNA in 159 patients with parotid gland cancer (12 different histological subtypes) by means of immunohistochemistry. Patients were divided into two groups due to the median PCNA expression level. The experimental findings were correlated with clinicopathological and survival parameters. The mean follow-up time was 56.6 months.
Results: Cytoplasmic expression of PCNA was found in 89% of cases. A high cytoplasmic expression of PCNA was found in 47% of the examined tumors. High cytoplasmic PCNA expression was an independent prognostic indicator for a significant poorer 5-year disease-free survival rate (50.6% versus 73.8%, p=0.036) as well as overall survival rate (57.0% versus 78.8%, p=0.006).
Conclusion: The correlation between cytoplasmic PCNA expression and survival probabilities of salivary gland cancer might make this an effective tool in patient follow-up, prognosis and therapy in future.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 2956. doi:10.1158/1538-7445.AM2011-2956
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Affiliation(s)
| | | | | | - Aline Hardt
- 1University Hospital of Cologne, Cologne, Germany
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Stenner M, Yosef B, Huebbers CU, Preuss SF, Dienes HP, Speel EJM, Odenthal M, Klussmann JP. Nuclear translocation of β-catenin and decreased expression of epithelial cadherin in human papillomavirus-positive tonsillar cancer: an early event in human papillomavirus-related tumour progression? Histopathology 2011; 58:1117-26. [DOI: 10.1111/j.1365-2559.2011.03805.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Klingenberg B, Hafkamp HC, Haesevoets A, Manni JJ, Slootweg PJ, Weissenborn SJ, Klussmann JP, Speel EJM. p16 INK4A overexpression is frequently detected in tumour-free tonsil tissue without association with HPV. Histopathology 2010; 56:957-67. [PMID: 20636796 DOI: 10.1111/j.1365-2559.2010.03576.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIMS Oncogenic human papillomavirus (HPV) type 16 has been strongly associated with tonsillar squamous cell carcinoma (TSCC) and appears to be of prognostic significance. Because HPV+ TSCC also accumulates p16(INK4A), this cyclin-dependent kinase inhibitor has been proposed as a potential biomarker for HPV in clinical diagnosis. The aim of this study was to determine the prevalence of HPV in tumour-free tonsillar tissue and the value of p16(INK4A) overexpression in predicting its presence. METHODS AND RESULTS p16(INK4A) overexpression was detected by immunohistochemistry in tissue sections of tumour-free tonsils of 262 patients. They were treated for non-oncological reasons (snoring or chronic/recurrent tonsillitis) consisting of tonsillectomy. Genomic DNA isolated from these tissues was subjected to HPV-specific polymerase chain reaction (PCR) analysis. p16(INK4A) immunoreactivity was detected in 28% of samples in both crypt epithelium (49/177) and lymphoid germinal centres (52/187), which correlated with each other (P < 0.0001). No reactivity was observed in superficial squamous cell epithelium. HPV16 and 18 were detected by PCR analysis in 2/195 cases (1%), which, however, were negative on fluorescence in situ hybridization analysis and discrepant on p16(INK4A) immunostaining. CONCLUSIONS No proof was found for the presence of HPV in tumour-free tonsil tissue, despite increased p16(INK4A) expression in a quarter of tonsil cases. Other mechanisms than HPV infection are therefore implicated in p16(INK4A) up-regulation.
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Affiliation(s)
- Boris Klingenberg
- Department of Molecular Cell Biology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
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Klussmann JP, Stenner M, Weinell A, Ponert T, Hardt A, Hahn M, Preuss S, Speel EJ. Abstract 1729: Cytoplasmic expression of survivin is an independent predictor of poor prognosis in patients with salivary gland cancer. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-1729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The expression of the inhibitor of apoptosis protein survivin is shown to be a significant prognostic indicator in various human cancers. Its role in cancer of the major salivary glands remains unclear.
Methods: We analysed the survivin expression in 171 patients with malignant parotid gland cancer (12 different histological subtypes) by means of immunohistochemistry. The experimental findings were correlated with clinicopathological and survival parameters. The mean follow-up time was 42 months.
Results: There was no significant correlation of cytoplasmic survivin expression levels with the patients’ clinicopathological characteristics. A strong cytoplasmic expression of survivin was found in 25% of the examined tumors. High cytoplasmic survivin expression was an independent prognostic indicator for a significant poorer 5-year disease-free survival rate (31% versus 67%, p<0.0005) and overall survival (45% versus 62%, p=0.048). In the multivariate analysis survivn expression and distant metastasis were significant predictors for patient outcome (p=0.001, p<0.0005).
Conclusions: The correlation between cytoplasmic survivin expression and survival probabilities of salivary gland malignancies might make this an effective tool in patient follow-up, prognosis and targeted therapy in future.
Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1729.
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Klussmann JP, Mooren JJ, Lehnen M, Claessen SMH, Stenner M, Huebbers CU, Weissenborn SJ, Wedemeyer I, Preuss SF, Straetmans JMJAA, Manni JJ, Hopman AHN, Speel EJM. Genetic signatures of HPV-related and unrelated oropharyngeal carcinoma and their prognostic implications. Clin Cancer Res 2009; 15:1779-86. [PMID: 19223504 DOI: 10.1158/1078-0432.ccr-08-1463] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Patients with human papillomavirus (HPV)-containing oropharyngeal squamous cell carcinomas (OSCC) have a better prognosis than patients with HPV-negative OSCC. This may be attributed to different genetic pathways promoting cancer. EXPERIMENTAL DESIGN We used comparative genomic hybridization to identify critical genetic changes in 60 selected OSCC, 28 of which were associated with HPV-16 as determined by HPV-specific PCR and fluorescence in situ hybridization analysis and positive p16(INK4A) immunostaining. The results were correlated with HPV status and clinical data from patients. RESULTS Two thirds of OSCC harbored gain at 3q26.3-qter irrespective of HPV status. In HPV-negative tumors this alteration was associated with advanced tumor stage (P=0.013). In comparison with HPV-related OSCC, the HPV-negative tumors harbored: (a) a higher number of chromosomal alterations and amplifications (P=0.03 and 0.039, respectively); (b) significantly more losses at 3p, 5q, 9p, 15q, and 18q, and gains/amplifications at 11q13 (P=0.002, 0.03; <0.001, 0.02, 0.004, and 0.001, respectively); and (c) less often 16q losses and Xp gains (P=0.02 and 0.03). Survival analysis revealed a significantly better disease-free survival for HPV-related OSCC (P=0.02), whereas chromosome amplification was an unfavorable prognostic indicator for disease-free and overall survival (P=0.01 and 0.05, respectively). Interestingly, 16q loss, predominantly identified in HPV-related OSCC, was a strong indicator of favorable outcome (overall survival, P=0.008; disease-free survival, P=0.01) and none of these patients had a tumor recurrence. CONCLUSIONS Genetic signatures of HPV-related and HPV-unrelated OSCC are different and most likely underlie differences in tumor development and progression. In addition, distinct chromosomal alterations have prognostic significance.
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Affiliation(s)
- Jens P Klussmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Jean-Uhrmacher Institute, University of Cologne, Cologne, Germany.
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