Overexpression of the orphan nuclear receptor NR2F6 is associated with improved survival across molecular subgroups in endometrial cancer patients

INTRODUCTION

NR2F6 (nuclear receptor subfamily 2 group F member 6, also called Ear-2) is known to be an orphan nuclear receptor that has been characterized as an intracellular immune checkpoint in effector T cells and, therefore, may control tumor development and growth. The prognostic impact of NR2F6 in endometrial cancers is evaluated in this study.

MATERIALS AND METHODS

Expression analysis of NR2F6 in 142 endometrial cancer patients was performed by immunohistochemistry of primary paraffin‑embedded tumor samples. Staining intensity of positive tumor cells was automatically assessed semi-quantitatively, and results were correlated with clinicopathological characteristics and survival.

RESULTS

Forty five of 116 evaluable samples (38.8%) showed an overexpression of NR2F6. This leads to an improvement of the overall survival (OS) and progression-free survival (PFS). In NR2F6-positive patients, the estimated mean OS was 156.9 months (95% confidence interval (CI) 143.1-170.7) compared to 106.2 months in NR2F6-negative patients (95% CI 86.2-126.3; p = 0.022). The estimated PFS differed by 63 months (152 months (95% CI 135.7-168.4) vs. 88.3 months (95% CI 68.5-108.0), p = 0.002). Furthermore, we found significant associations between NR2F6 positivity, MMR status, and PD1 status. A multivariate analysis suggests NR2F6 to be an independent factor influencing the OS (p = 0.03).

CONCLUSION

In this study, we could demonstrate that there is a longer progression-free and overall survival for NR2F6-positive patients with endometrial cancer. We conclude that NR2F6 might play an essential role in endometrial cancers. Further studies are required to validate its prognostic impact.

TRIM21 Expression as a Prognostic Biomarker for Progression-Free Survival in HNSCC

Patients with head and neck squamous cell carcinoma (HNSCC) continue to have a rather poor prognosis. Treatment-related comorbidities have negative impacts on their quality of life. TRIM21 is a cytosolic E3 ubiquitin ligase that was initially described as an autoantigen in autoimmune diseases and later associated with the intracellular antiviral response. Here, we investigated the role of TRIM21 as a biomarker candidate for HNSCC in predicting tumor progression and patient survival. We analyzed TRIM21 expression and its association with clinical-pathological parameters in our HNSCC cohort using immunohistochemistry. Our HNSCC cohort included samples from 419 patients consisting of primary tumors (n = 337), lymph node metastases (n = 156), recurrent tumors (n = 54) and distant metastases (n = 16). We found that cytoplasmic TRIM21 expression was associated with the infiltration of immune cells into primary tumors. In addition, TRIM21 expression was significantly higher in primary tumors than in lymph node metastases, and increased TRIM21 expression was correlated with shorter progression-free survival in HNSCC patients. These results suggest that TRIM21 could be a new biomarker for progression-free survival.

Deglycosylation of pathological specimens alters performance of diagnostic PDL1 antibodies

Immunohistochemical (IHC) predictive quantitation of PDL1 expression is obligatory in many cancer entities with improved response to immune checkpoint inhibition in PDL1-positive subgroups. With recent demonstration of increased positivity rates after enzymatic deglycosylation in breast cancer specimens, a comparative analysis with two different antibodies and extended controls was performed in a cohort of head and neck squamous cell cancer samples (HNSCC).Formalin-fixed paraffin-embedded tissue from HNSCC specimens was used for initial on-slide method optimization based on the PNGase F assay. SDS-PAGE and immunoblotting with the PDL1 antibody 28-8 was performed to evaluate deglycosylation efficiency. A tissue micro array of n = 527 tissue cores of 181 patients with HNSCC was used to determine the effects of deglycosylation on staining pattern and intensity with PDL1 antibodies 28-8 and E1L3N.Successful on-slide deglycosylation with PNGase F was confirmed by immunoblot but varied across replicates. Using E1L3N (intracellular binding domain, most probably not glycosylated), mean signal intensity as well as the fraction of PDL1 positive cells was increased by deglycosylation. Opposite effects were observed with 28-8 (extracellular binding domain, glycosylated).Deglycosylation reduces diagnostic performance of the PDL1 antibody 28-8. In contrast, effects for E1L3N are complex and probably involve reduction of off-target binding leading to specifically improved signal intensity. However, enzymatic deglycosylation adds further variance to IHC.

Comparison of manual and automated digital image analysis systems for quantification of cellular protein expression

OBJECTIVE

Quantifying protein expression in immunohistochemically stained histological slides is an important tool for oncologic research. The use of computer-aided evaluation of IHC-stained slides significantly contributes to objectify measurements. Manual digital image analysis (mDIA) requires a user-dependent annotation of the region of interest (ROI). Others have built-in machine learning algorithms with automated digital image analysis (aDIA) and can detect the ROIs automatically. We aimed to investigate the agreement between the results obtained by aDIA and those derived from mDIA systems.

METHODS

We quantified chromogenic intensity (CI) and calculated the positive index (PI) in cohorts of tissue microarrays (TMA) using mDIA and aDIA. To consider the different distributions of staining within cellular sub-compartments and different tumor architecture our study encompassed nuclear and cytoplasmatic stainings in adenocarcinomas and squamous cell carcinomas.

RESULTS

Within all cohorts, we were able to show a high correlation between mDIA and aDIA for the CI (p<0.001) along with high agreement for the PI. Moreover, we were able to show that the cell detections of the programs were comparable as well and both proved to be reliable when compared to manual counting.

CONCLUSION

mDIA and aDIA show a high correlation in acquired IHC data. Both proved to be suitable to stratify patients for evaluation with clinical data. As both produce the same level of information, aDIA might be preferable as it is time-saving, can easily be reproduced, and enables regular and efficient output in large studies in a reasonable time period.

Elevated LSD1 and SNAIL Expression Indicate Poor Prognosis in Hypopharynx Carcinoma

Head and neck squamous cell carcinomas (HNSCC) are among the most common cancers worldwide and are associated with a poor prognosis for patients. Among HNSCC, those originating in the hypopharynx have the worst prognosis. The histone demethylase LSD1 has been shown to promote cancer initiation, progression, and relapse through various mechanisms and is upregulated in many cancer tissues. LSD1 physically interacts with SNAIL and is required for SNAIL mediated transcriptional repression. Previous studies of the prognostic value of LSD1 in HNSCC have been limited in their analysis of sub-sites, and a correlation between LSD1 and SNAIL has not been shown in HNSCC patient samples. Here we used a large, representative, and clinically well-characterized cohort of 339 HNSCC patients to investigate the co-expression of LSD1 and SNAIL and their prognostic value in all HNSCC using immunohistochemical staining. Elevated LSD1 expression correlated with advanced tumor stage and poor progression-free survival (PFS) in HNSCC originating in the hypopharynx. Overexpression of the transcription factor SNAIL independently correlated with worse overall survival (OS) and PFS in HNSCC in general and prominently in tumors of the hypopharynx. Furthermore, increased LSD1 expression significantly correlated with elevated SNAIL expression in patient samples. Therefore, the presented data implicates LSD1 and SNAIL as independent prognostic biomarkers.

Spatial Distribution of Immune Cells in Head and Neck Squamous Cell Carcinomas

Background

Head and neck squamous cell carcinomas (HNSCCs) have a very moderate response rate to immune checkpoint inhibitor (ICI) treatment compared to other cancer types. Lacking predictive markers for treatment response, we analyzed the immune status of HNSCC and assessed the spatial distribution of immune cells.

Materials and Methods

Via assessing hematoxylin–eosin (H&E) stains, we divided HNSCCs by the immune cell distribution in hot, cold, and excluded tumors. For each group, each with 10 tumors, we performed serial immunohistochemical (IHC) staining of the immune cell markers, checkpoint molecules, and immune regulators.

Results

The spatial distributions were different for each immune cell type, allocating regulatory T cells (Tregs) and CD11b cells predominantly in the stroma. CD4 and CD8 cells were present either in the tumor stroma or between cancer cells. Interestingly, the expressions of PD-1 (programmed cell death 1 receptor) and PD-L1 (programmed death-ligand 1) were higher in hot tumors in comparison to cold and excluded tumors. The expression of pSMAD [indicating active transforming growth factor beta (TGF-β)] was higher in excluded tumors.

Conclusion

Different immune cell distribution patterns within tumors might be crucial for ICI treatment response since hot tumors have the highest expressions of PD-1 and PD-L1. TGF-β might be a key regulator for immune cell distribution and a promising therapeutic target that determines the formation of hot or excluded immune patterns.

Performance of Different Diagnostic PD-L1 Clones in Head and Neck Squamous Cell Carcinoma

Background: The approval of immune checkpoint inhibitors in combination with specific diagnostic biomarkers presents new challenges to pathologists as tumor tissue needs to be tested for expression of programmed death-ligand 1 (PD-L1) for a variety of indications. As there is currently no requirement to use companion diagnostic assays for PD-L1 testing in Germany different clones are used in daily routine. While the correlation of staining results has been tested in various entities, there is no data for head and neck squamous cell carcinomas (HNSCC) so far.

Methods: We tested five different PD-L1 clones (SP263, SP142, E1L3N, 22-8, 22C3) on primary HNSCC tumor tissue of 75 patients in the form of tissue microarrays. Stainings of both immune and tumor cells were then assessed and quantified by pathologists to simulate real-world routine diagnostics. The results were analyzed descriptively and the resulting staining pattern across patients was further investigated by principal component analysis and non-negative matrix factorization clustering.

Results: Percentages of positive immune and tumor cells varied greatly. Both the resulting combined positive score as well as the eligibility for certain checkpoint inhibitor regimens was therefore strongly dependent on the choice of the antibody. No relevant co-clustering and low similarity of relative staining patterns across patients was found for the different antibodies.

Conclusions: Performance of different diagnostic anti PD-L1 antibody clones in HNSCC is less robust and interchangeable compared to reported data from other tumor entities. Determination of PD-L1 expression is critical for therapeutic decision making and may be aided by back-to-back testing of different PD-L1 clones.

Immunologic "Cold" Squamous Cell Carcinomas of the Head and Neck Are Associated With an Unfavorable Prognosis

Background: Head and neck squamous cell carcinoma (HNSCC) represents a common cancer worldwide. Past therapeutic advances have not significantly improved HNSCC prognosis. Therefore, it is necessary to further stratify HNSCC, especially with recent advances in tumor immunology.

Methods: Tissue microarrays were assembled from tumor tissue samples and were complemented with comprehensive clinicopathological data of n = 419 patients. H&E whole slides from resection specimen (n = 289) were categorized according to their immune cell infiltrate as “hot,” “cold,” or “excluded.”

Results: Investigating tumor immune cell patterns, we found significant differences in survival rates. Immunologic “hot” and “excluded” HNSCCs are associated with better overall survival than “cold” HNSCC patients (p < 0.05). Interestingly, the percentage of all three patterns is nearly identical in p16 positive and negative HNSCCs.

Conclusions: Using a plain histological H&E approach to categorize HNSCC as being immunologic “hot,” “cold,” or “excluded” can offer a forecast of patients' prognosis and may thus aid as a potential prognostic tool in routine pathology reports. This “hot-cold-excluded” scheme needs to be applied to more HNSCC cohorts and possibly to other cancer types to determine prognostic meaning, e.g., regarding OS or DFS. Furthermore, our cohort reflects epidemiological data in the national, European, and international context. It may, therefore, be of use for future HNSCC characterization.

NR2F6 as a Prognostic Biomarker in HNSCC

Head and neck squamous cell carcinoma (HNSCC)is the 6th most common cancer in humans worldwide and is associated with a poor prognosis for patients. NR2F6 has been identified as an immune checkpoint molecule in tumor-infiltrating T lymphocytes and is associated with a poor prognostic outcome in various cancers. The prognostic value of NR2F6 in HNSCC has not been described yet. We used a large, representative and clinically well-characterized cohort of 383 HNSCC patients, of which 22.4% developed a local recurrence. The NR2F6 expression was analyzed by using immunohistochemistry and was afterward correlated with clinical characteristics and clinicopathological features of HNSCC patients. Primary tumors from patients who develop a local recurrence have a higher NR2F6 expression than primary tumors which do not develop a local recurrence. Furthermore, a high NR2F6 expression is associated with poorer recurrence-free survival, although there is no correlation with overall survival. NR2F6 expression is independent of the T stage and UICC stage. NR2F6 might be a new prognostic biomarker for the early detection of local recurrences in HNSCC patients. Therefore, it may help to improve the recognition of patients who would benefit from more frequent follow-up examinations.

Thrombin stimulates atrial natriuretic peptide secretion from rat cardiac atrium

Atrial natriuretic peptide (ANP) is a hormone secreted predominantly by atrial myocytes. Although atrial distension is the primary stimulus of ANP secretion, several hormones have also been implicated in the regulation of ANP secretion. alpha-Thrombin, a serine protease participating in the blood coagulation system, has additional hormone-like effects in several cell types, apparently via interaction with specific cell surface receptors. Here we report that alpha-thrombin enhanced ANP secretion from isolated rat atrium within 10 min, in a concentration-dependent manner. The protease also significantly increased ANP release from cultured atrial myocytes, in a concentration-dependent manner. The alpha-thrombin-induced release of ANP from cultured atrial myocytes was completely abolished by hirudin, a specific alpha-thrombin protease inhibitor. Furthermore, synthetic peptides, identical in their amino acid sequence to the N-terminal segment of the proteolytically cleaved thrombin receptor, enhanced ANP release from adult rat cultured atrial myocytes. Our data suggest that thrombin may regulate ANP release from the cardiac atrium. This action involves activation of thrombin receptors in atrial myocytes.

Diversification of Neu differentiation factor and epidermal growth factor signaling by combinatorial receptor interactions

The ErbB family includes two receptors, ErbB-1 and ErbB-3, that respectively bind to epidermal growth factor and Neu differentiation factor, and an orphan receptor, ErbB-2. Unlike ErbB-1 and ErbB-2, the intrinsic tyrosine kinase of ErbB-3 is catalytically impaired. By using interleukin-3-dependent cells that ectopically express the three ErbB proteins or their combinations, we found that ErbB-3 is devoid of any biological activity but both ErbB-1 and ErbB-2 can reconstitute its extremely potent mitogenic activity. Transactivation of ErbB-3 correlates with heterodimer formation and is reflected in receptor phosphorylation and the transregulation of ligand affinity. Inter-receptor interactions enable graded proliferative and survival signals: heterodimers are more potent than homodimers, and ErbB-3-containing complexes, especially the ErbB-2/ErbB-3 heterodimer, are more active than ErbB-1 complexes. Nevertheless, ErbB-1 signaling displays dominance over ErbB-3 when the two receptors are coexpressed. Although all receptor combinations activate the mitogen-activated protein kinases ERK and c-Jun kinase, they differ in their rate of endocytosis and in coupling to intervening signaling proteins. It is conceivable that combinatorial receptor interactions diversify signal transduction and confer double regulation, in cis and in trans, of the superior mitogenic activity of the kinase-defective ErbB-3.

Variations in bracket placement in the preadjusted orthodontic appliance

This study was conducted to determine the accuracy of bracket placement with the direct bonded technique. Ten orthodontic faculty members bonded a preadjusted orthodontic appliance on models of five cases of malocclusion in a simulated clinical situation (mannequin). A total of 50 sets of models served as the population of the study. Photographs of the models were measured to determine vertical and angular discrepancies in position between adjacent bracket pairs from a constructed reference line. Variations are evaluated with respect to the classification of malocclusion, specific tooth type, and intra/inter operator differences. A mean of 0.34 mm for the vertical discrepancies and a mean of 5.54 degrees for the angular discrepancies are found in placement of the orthodontic brackets.

The influence of extraction and nonextraction orthodontic treatment on brachyfacial and dolichofacial growth patterns

The effects of extraction and nonextraction orthodontic treatment mechanics on patients with dolichofacial and brachyfacial growth patterns between one and two standard deviations were studied. Groups underwent treatment of either nonextraction or extraction of four premolars with the appropriate mechanics for the facial type. Changes in the facial axis and correlation between maxillary molar movement and facial axis change were measured. A positive correlation was found between the amount of anteroposterior movement of the upper molar and change in the facial axis in brachyfacial and dolichofacial patients undergoing nonextraction treatment. A weak correlation was found in the extraction treatment groups. No statistically significant difference was found in the facial axis change among any of the groups studied, regardless of facial type or plan of treatment. There were indications of a more severe opening of the facial axis (Ba-Na plane to constructed gnathion) with greater degrees of maxillary molar distal movement in both facial patterns studied.

A cephalometric study of Korean adults

A cephalometric study of 18-year-old Korean subjects with acceptable profile and occlusion was carried out by means of the Downs, Steiner, Ricketts, and vertical analyses. The subjects in the study sample consisted of 35 men and 45 women. Means and standard deviations of the Korean subjects were established. Statistical analyses were performed to compare Koreans to Caucasians.

Expansion of the lower arch concurrent with rapid maxillary expansion

The effect of rapid maxillary expansion on the mandibular intercanine and intermolar widths during treatment and its stability after retention was studied. In addition, the relationships between the interarch change and the facial types and ages of the subjects of the sample were evaluated. The sample consisted of 17 cases for the study of intercanine width, and 22 nonextraction cases for the study of the intermolar width. Initial, final, at least 2-years postretention models, and initial lateral cephalograms were analyzed. Treatment and postretention changes for the intercanine width and the mesial and distal intermolar widths were calculated and tested for significance. Mean expansions of the intercanine width of 1.1 mm and of the intermolar width of 2.8 mm postretention were found to be statistically significant. There were no correlations found between the amount of increase in arch width and the facial types and ages of the subjects.

Force measurement and design of a torquing high-pull headgear

The dynamic extraoral force analyzer (DEFA) was found to be capable of measuring linear deflection as a function of force created by a headgear. Ten standard nontorqued face-bows with a cervical and a high-pull direction were tested to determine the reliability of the DEFA. Statistical analysis showed the DEFA to be reliable and accurate in differentiating various directions and deflections of maxillary molars. Doubled-over distal ends of the inner bow with 0 degree of torque and a parietal direction of pull were used as controls. The same face-bows with 9 degrees of buccal root torque were tested on the DEFA. These face-bows were tested to determine whether transverse translation without buccal crown tipping of the maxillary first molar will occur. Statistical analysis showed that transverse translation occurred at a force of 200 to 347 gm.

Rotation of rectangular wire in rectangular molar tubes. Part II. Pretorqued molar tubes

Buccal tubes from five manufactures producing the new generation of preadjusted (straight wire type) appliances were tested to determine the amount of rotation various-sized rectangular wires produced prior to binding within the tube. This rotation reflected the amount of torquing force dissipated because of the interaction of the wires and tube. In addition, it indicated the degree of compensatory third-order bends needed in the wire to deliver the desired torque force to the tooth. Wire and tube dimensions were measured and compared to manufacturers' stated specifications. The amount of rotation for each manufacturer's tube was compared to the theoretical values based on calculations. Theoretical calculations and published charts of deflection angles based on these calculations give a false impression in that they do not revealed a true expression of the amount of torque dissipated through rotation of the rectangular wire in that tube. There is variation between the manufacturer's stated lumen dimension and the actual lumen size, even beyond the manufacturer's stated tolerances. Rectangular wire will rotate within a rectangular buccal tube to varying degrees, depending upon the size of the wire used and the manufacturer of the appliance. This means that additional torsion or angulation may need to be placed in the wire prior to application intraorally. The amount of this additional torquing of the arch wire will depend upon the manufacturer of the appliance used and will vary from tube to tube of the same manufacturer.

Rotation of rectangular wire in rectangular molar tubes. Part I

The degree of angular rotation of rectangular orthodontic wires in rectangular molar tubes was measured using a rotatable mechanical stage on a Unitron metallograph and compared to theoretical data. It was found that square 0.016 inch wire did not bind in 0.018 by 0.022 inch or larger mandrel- or inconel-formed tubes, whereas rotations of 11 to 23 degrees were noted in cast tubes of this dimension. Although 0.016 by 0.022 inch wire did bind in these tubes, the degree of rotation was far greater than expected on the basis of theoretical calculations or clinical expectations. The results indicated that it was unrealistic to expect fine control of a few degrees of torque to occur as expected for delicate clinical control.