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Miller YE, Ghosh M, Merrick DT, Kubala B, Szabo E, Bengtson L, Kocherginsky M, Helenowski IB, Benante K, Schering T, Kim J, Kim H, Ha D, Bergan RC, Khan SA, Keith RL. Phase Ib trial of inhaled iloprost for the prevention of lung cancer with predictive and response biomarker assessment. Front Oncol 2023; 13:1204726. [PMID: 37711198 PMCID: PMC10499515 DOI: 10.3389/fonc.2023.1204726] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/26/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Iloprost, a prostacyclin analog, has lung cancerpreventive activity in preclinical models and improved dysplasia in former smokers in a phase IIb trial. Oral iloprost is currently unavailable. We performed a phase Ib trial of inhaled iloprost in former smokers to assess tolerance and compliance. Methods Participants self-administered nebulized iloprost (5ug) or placebo four (QID) or two (BID) times daily. As QID dose was well tolerated and due to expiration of the placebo, the BID dosing and placebo were eliminated early on in the trial. Bronchoscopy with biopsyat six standard sites was performed at treatment initiation and two months post-iloprost, with exploratory histological analysis. Bulk RNA sequencing, single cell RNA sequencing and an in vitro assay of epithelial progenitor cell iloprost response were performed on a subset of biopsies in an exploratory investigation of response mechanisms and predictive biomarkers. Results and discussion Thirty-four of a planned 48 participants were recruited to the trial.Inhaled iloprost was well tolerated with no adverse events > grade 2. Compliance was 67% in the QID group. The trial was not powered to detect histologic response and none was found. Bulk RNA sequencing of biopsies pre/post iloprost suggest that iloprost is immunomodulatory and downregulates cell proliferation pathways. Single cell RNA sequencing showed an increase in CD8-positive T cells with upregulation of genes in interferon γ signaling. In vitro iloprost response by epithelial progenitor cells correlated with histologic response with kappa coefficient of 0.81 (95% CI 0.47, 1.0). Inhaled iloprost was well tolerated with suboptimal compliance. Molecular analysis suggested that iloprosthas immunomodulatory and antiproliferative effects.The progenitor cell iloprost response assay may be a promising avenue to develop predictive biomarkers. Clinical trial registration https://clinicaltrials.gov/study/NCT02237183, identifier NCT02237183.
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Affiliation(s)
- York E. Miller
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO, United States
- Pulmonary and Critical Care Section, RMR VAMC Rocky Mountain Regional Veteran Administration Medical Center, Aurora, CO, United States
| | - Moumita Ghosh
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO, United States
| | - Daniel T. Merrick
- Department of Pathology, University of Colorado, Aurora, CO, United States
| | - Brandi Kubala
- Cancer Center Clinical Trial Core, University of Colorado, Aurora, CO, United States
| | - Eva Szabo
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, United States
| | - Lisa Bengtson
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, United States
| | - Masha Kocherginsky
- Department of Preventative Medicine, Northwestern University, Evanston, IL, United States
| | - Irene B. Helenowski
- Department of Preventative Medicine, Northwestern University, Evanston, IL, United States
| | - Kelly Benante
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Evanston, IL, United States
| | - Tia Schering
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Evanston, IL, United States
| | - Jihye Kim
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Hyunmin Kim
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Duc Ha
- Pulmonary and Critical Care Section, RMR VAMC Rocky Mountain Regional Veteran Administration Medical Center, Aurora, CO, United States
| | - Raymond C. Bergan
- Fred and Pamela Buffett Cancer Center, Division of Oncology & Hematology, Genitourinary Oncology, University of Nebraska, Evanston, IL, United States
| | - Seema A. Khan
- Department of Surgery, Northwestern University, Omaha, NE, United States
| | - Robert L. Keith
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO, United States
- Pulmonary and Critical Care Section, RMR VAMC Rocky Mountain Regional Veteran Administration Medical Center, Aurora, CO, United States
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Laville D, Casteillo F, Yvorel V, Tiffet O, Vergnon JM, Péoc’h M, Forest F. Immune Escape Is an Early Event in Pre-Invasive Lesions of Lung Squamous Cell Carcinoma. Diagnostics (Basel) 2020; 10:diagnostics10070503. [PMID: 32708311 PMCID: PMC7399898 DOI: 10.3390/diagnostics10070503] [Citation(s) in RCA: 4] [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: 06/15/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/25/2022] Open
Abstract
Bronchial dysplasia is the pre-neoplastic lesion recognized for invasive squamous cell carcinoma. The mechanisms leading to invasive squamous cell carcinoma for this lesion are not fully known. Programmed Death-Ligand 1 (PD-L1) expression by the bronchial dysplasia neoplastic epithelium might suggest a response to immunotherapy. The objective of this work is to further characterize PD-L1 and CD8 expression in bronchial dysplasia and bronchial metaplasia compared to normal bronchial epithelium. Immunohistochemical analysis of PD-L1 and CD8 staining were characterized in bronchial dysplasia of 24 patients and correlated with clinical data. We also compared PD-L1 expression in dysplasia samples to 30 normal epithelium and 20 samples with squamous bronchial metaplasia. PD-L1 was never expressed in normal epithelium and in metaplastic epithelium whereas 37.5% of patients with bronchial dysplasia were stained by PD-L1 (p < 0.001). PD-L1 expression was not related to the degree of dysplasia or a medical history of invasive squamous cell carcinoma, while CD8 expression and its localization were related to medical history of squamous cell carcinoma (p = 0.044). Our results show that PD-L1 is expressed in roughly one third of patients with bronchial dysplasia and is not expressed in normal and metaplastic epithelium. This suggests that PD-L1 is expressed in preneoplastic lesions of squamous cell carcinoma.
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Affiliation(s)
- David Laville
- Pathology Department, North Hospital, University Hospital of Saint Etienne, Avenue Albert Raimond, CEDEX 2, 42055 Saint Etienne, France; (D.L.); (F.C.); (V.Y.); (M.P.)
| | - Francois Casteillo
- Pathology Department, North Hospital, University Hospital of Saint Etienne, Avenue Albert Raimond, CEDEX 2, 42055 Saint Etienne, France; (D.L.); (F.C.); (V.Y.); (M.P.)
| | - Violaine Yvorel
- Pathology Department, North Hospital, University Hospital of Saint Etienne, Avenue Albert Raimond, CEDEX 2, 42055 Saint Etienne, France; (D.L.); (F.C.); (V.Y.); (M.P.)
| | - Olivier Tiffet
- Thoracic Surgery Department, North Hospital, University Hospital of Saint Etienne, Avenue Albert Raimond, CEDEX 2, 42055 Saint Etienne, France;
| | - Jean-Michel Vergnon
- Pneumology Department, North Hospital, University Hospital of Saint Etienne, Avenue Albert Raimond, CEDEX 2, 42055 Saint Etienne, France;
| | - Michel Péoc’h
- Pathology Department, North Hospital, University Hospital of Saint Etienne, Avenue Albert Raimond, CEDEX 2, 42055 Saint Etienne, France; (D.L.); (F.C.); (V.Y.); (M.P.)
- Corneal Graft Biology, Engineering and Imaging Laboratory, BiiGC, EA2521, Federative Institute of Research in Sciences and Health Engineering, Faculty of Medicine, Jean Monnet University, 42000 Saint-Etienne, France
| | - Fabien Forest
- Pathology Department, North Hospital, University Hospital of Saint Etienne, Avenue Albert Raimond, CEDEX 2, 42055 Saint Etienne, France; (D.L.); (F.C.); (V.Y.); (M.P.)
- Corneal Graft Biology, Engineering and Imaging Laboratory, BiiGC, EA2521, Federative Institute of Research in Sciences and Health Engineering, Faculty of Medicine, Jean Monnet University, 42000 Saint-Etienne, France
- Correspondence: ; Tel.: +33-(0)4-7712-7734; Fax: +33-(0)4-7782-8296
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Merrick DT, Edwards MG, Franklin WA, Sugita M, Keith RL, Miller YE, Friedman MB, Dwyer-Nield LD, Tennis MA, O'Keefe MC, Donald EJ, Malloy JM, van Bokhoven A, Wilson S, Koch PJ, O'Shea C, Coldren C, Orlicky DJ, Lu X, Baron AE, Hickey G, Kennedy TC, Powell R, Heasley L, Bunn PA, Geraci M, Nemenoff RA. Altered Cell-Cycle Control, Inflammation, and Adhesion in High-Risk Persistent Bronchial Dysplasia. Cancer Res 2018; 78:4971-4983. [PMID: 29997230 PMCID: PMC6147150 DOI: 10.1158/0008-5472.can-17-3822] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 12/11/2017] [Revised: 05/16/2018] [Accepted: 07/06/2018] [Indexed: 01/01/2023]
Abstract
Persistent bronchial dysplasia is associated with increased risk of developing invasive squamous cell carcinoma (SCC) of the lung. In this study, we hypothesized that differences in gene expression profiles between persistent and regressive bronchial dysplasia would identify cellular processes that underlie progression to SCC. RNA expression arrays comparing baseline biopsies from 32 bronchial sites that persisted/progressed to 31 regressive sites showed 395 differentially expressed genes [ANOVA, FDR ≤ 0.05). Thirty-one pathways showed significantly altered activity between the two groups, many of which were associated with cell-cycle control and proliferation, inflammation, or epithelial differentiation/cell-cell adhesion. Cultured persistent bronchial dysplasia cells exhibited increased expression of Polo-like kinase 1 (PLK1), which was associated with multiple cell-cycle pathways. Treatment with PLK1 inhibitor induced apoptosis and G2-M arrest and decreased proliferation compared with untreated cells; these effects were not seen in normal or regressive bronchial dysplasia cultures. Inflammatory pathway activity was decreased in persistent bronchial dysplasia, and the presence of an inflammatory infiltrate was more common in regressive bronchial dysplasia. Regressive bronchial dysplasia was also associated with trends toward overall increases in macrophages and T lymphocytes and altered polarization of these inflammatory cell subsets. Increased desmoglein 3 and plakoglobin expression was associated with higher grade and persistence of bronchial dysplasia. These results identify alterations in the persistent subset of bronchial dysplasia that are associated with high risk for progression to invasive SCC. These alterations may serve as strong markers of risk and as effective targets for lung cancer prevention.Significance: Gene expression profiling of high-risk persistent bronchial dysplasia reveals changes in cell-cycle control, inflammatory activity, and epithelial differentiation/cell-cell adhesion that may underlie progression to invasive SCC. Cancer Res; 78(17); 4971-83. ©2018 AACR.
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Affiliation(s)
- Daniel T Merrick
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Michael G Edwards
- Department of Medicine/Division of Pulmonary Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Wilbur A Franklin
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michio Sugita
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Robert L Keith
- Department of Medicine/Division of Pulmonary Medicine, Denver Veterans Affairs Medical Center, Aurora, Colorado
- Department of Medicine/Division of Pulmonary Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - York E Miller
- Department of Medicine/Division of Pulmonary Medicine, Denver Veterans Affairs Medical Center, Aurora, Colorado
- Department of Medicine/Division of Pulmonary Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Micah B Friedman
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lori D Dwyer-Nield
- Department of Medicine/Division of Pulmonary Medicine, Denver Veterans Affairs Medical Center, Aurora, Colorado
- School of Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Meredith A Tennis
- Department of Medicine/Division of Pulmonary Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Mary C O'Keefe
- Department of Pathology, Denver Health Medical Center, Denver, Colorado
| | - Elizabeth J Donald
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jessica M Malloy
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Adrie van Bokhoven
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Storey Wilson
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Peter J Koch
- Department of Regenerative Medicine and Stem Cell Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Charlene O'Shea
- Department of Regenerative Medicine and Stem Cell Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - David J Orlicky
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Xian Lu
- Department of Biostatistics and Informatics, Colorado School of Public Health, Denver, Colorado
| | - Anna E Baron
- Department of Biostatistics and Informatics, Colorado School of Public Health, Denver, Colorado
| | - Greg Hickey
- Department of Medicine/Division of Pulmonary Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Timothy C Kennedy
- Department of Medicine/Division of Pulmonary Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Roger Powell
- School of Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lynn Heasley
- Department of Craniofacial Biology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Paul A Bunn
- Department of Medicine/Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Mark Geraci
- Department of Medicine, Indiana University, Bloomington, Indiana
| | - Raphael A Nemenoff
- Department of Medicine/Division of Pulmonary Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Medicine, Division of Renal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Correia LL, Johnson JA, McErlean P, Bauer J, Farah H, Rassl DM, Rintoul RC, Sethi T, Lavender P, Rawlins EL, Littlewood TD, Evan GI, McCaughan FM. SOX2 Drives Bronchial Dysplasia in a Novel Organotypic Model of Early Human Squamous Lung Cancer. Am J Respir Crit Care Med 2017; 195:1494-1508. [PMID: 28199128 PMCID: PMC5470746 DOI: 10.1164/rccm.201510-2084oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 10/27/2015] [Accepted: 02/15/2017] [Indexed: 12/25/2022] Open
Abstract
RATIONALE Improving the early detection and chemoprevention of lung cancer are key to improving outcomes. The pathobiology of early squamous lung cancer is poorly understood. We have shown that amplification of sex-determining region Y-box 2 (SOX2) is an early and consistent event in the pathogenesis of this disease, but its functional oncogenic potential remains uncertain. We tested the impact of deregulated SOX2 expression in a novel organotypic system that recreates the molecular and microenvironmental context in which squamous carcinogenesis occurs. OBJECTIVES (1) To develop an in vitro model of bronchial dysplasia that recapitulates key molecular and phenotypic characteristics of the human disease; (2) to test the hypothesis that SOX2 deregulation is a key early event in the pathogenesis of bronchial dysplasia; and (3) to use the model for studies on pathogenesis and chemoprevention. METHODS We engineered the inducible activation of oncogenes in immortalized bronchial epithelial cells. We used three-dimensional tissue culture to build an organotypic model of bronchial dysplasia. MEASUREMENTS AND MAIN RESULTS We recapitulated human bronchial dysplasia in vitro. SOX2 deregulation drives dysplasia, and loss of tumor promoter 53 is a cooperating genetic event that potentiates the dysplastic phenotype. Deregulated SOX2 alters critical genes implicated in hallmarks of cancer progression. Targeted inhibition of AKT prevents the initiation of the dysplastic phenotype. CONCLUSIONS In the appropriate genetic and microenvironmental context, acute deregulation of SOX2 drives bronchial dysplasia. This confirms its oncogenic potential in human cells and affords novel insights into the impact of SOX2 deregulation. This model can be used to test therapeutic agents aimed at chemoprevention.
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Affiliation(s)
| | | | - Peter McErlean
- Department of Asthma, Allergy, and Lung Biology, Guy’s Hospital, King’s College London, London, United Kingdom; and
| | - Julien Bauer
- Cambridge Genomic Services, Department of Pathology, and
| | - Hassan Farah
- Department of Asthma, Allergy, and Lung Biology, Guy’s Hospital, King’s College London, London, United Kingdom; and
| | | | - Robert C. Rintoul
- Department of Thoracic Oncology, Papworth Hospital Foundation National Health Service Trust, Papworth Everard, Cambridge, United Kingdom
| | - Tariq Sethi
- Department of Asthma, Allergy, and Lung Biology, Guy’s Hospital, King’s College London, London, United Kingdom; and
| | - Paul Lavender
- Department of Asthma, Allergy, and Lung Biology, Guy’s Hospital, King’s College London, London, United Kingdom; and
| | | | | | | | - Frank M. McCaughan
- Department of Biochemistry
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Asthma, Allergy, and Lung Biology, Guy’s Hospital, King’s College London, London, United Kingdom; and
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Merrick DT, Gao D, Miller YE, Keith RL, Baron AE, Feser W, Kennedy TC, Blatchford PJ, Braudrick S, Hirsch FR, Heasley L, Bunn PA, Franklin WA. Persistence of Bronchial Dysplasia Is Associated with Development of Invasive Squamous Cell Carcinoma. Cancer Prev Res (Phila) 2016; 9:96-104. [PMID: 26542061 PMCID: PMC4706769 DOI: 10.1158/1940-6207.capr-15-0305] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 08/05/2015] [Accepted: 10/26/2015] [Indexed: 12/22/2022]
Abstract
Bronchial dysplasia (BD), a presumed precursor of pulmonary squamous cell carcinoma (SCC), rarely progresses to invasive cancer. A high-risk cohort at the University of Colorado provided an opportunity to directly sample airway epithelium at mapped sites on successive bronchoscopies. We have hypothesized that persistent dysplastic lesions showing a similar or higher level of dysplasia on follow-up biopsy, are associated with increased risk for the development of SCC. Endoscopic biopsies from 188 high-risk subjects were histologically classified according to the current WHO classification for BD using a numeric histology score ranging from 1 to 8 representing normal bronchial mucosa through invasive lung cancer. Differences in follow-up histology scores were compared between sites classified by clinical, histologic, and immunohistochemical variables. Subjects with a higher frequency of sites that persist or progress to high-grade dysplasia (≥37.5% persist/progress, N = 35 versus <37.5% persist/progress, N = 114) show a significant association with development of incident invasive SCC (adjusted HR, 7.84; 95% confidence interval, 1.56-39.39), and those with incident lung SCC have adjusted mean follow-up histology scores 1.55 U higher than in subjects without lung cancer. Current smoking, elevated Ki67 growth fraction, histologic features of angiogenic squamous dysplasia (ASD) and higher histology score in baseline biopsies are significantly associated with increased follow-up histology scores. These results show that persistent BD is associated with the development of invasive SCC. Furthermore, increased expression of Ki67, the presence of angiogenic change and degree of baseline atypia are associated with persistence of BD.
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Affiliation(s)
- Daniel T Merrick
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Dexiang Gao
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - York E Miller
- Division of Pulmonary Medicine, Department of Medicine, Denver Veterans Affairs Medical Center, Denver, Colorado. Division of Pulmonary Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Robert L Keith
- Division of Pulmonary Medicine, Department of Medicine, Denver Veterans Affairs Medical Center, Denver, Colorado. Division of Pulmonary Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anna E Baron
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - William Feser
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Timothy C Kennedy
- Division of Pulmonary Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Patrick J Blatchford
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sarah Braudrick
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Fred R Hirsch
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lynn Heasley
- Department of Craniofacial Biology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Paul A Bunn
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Wilbur A Franklin
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Törmänen U, Nuorva K, Soini Y, Pääkkö P. Apoptotic activity is increased in parallel with the metaplasia-dysplasia-carcinoma sequence of the bronchial epithelium. Br J Cancer 1999; 79:996-1002. [PMID: 10070903 PMCID: PMC2362669 DOI: 10.1038/sj.bjc.6690159] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
A high level of apoptotic activity and an independence of apoptosis from the expression of p53 and bcl-2 have been observed in non-small-cell lung carcinoma. We examined 44 samples of normal, metaplastic and premalignant (i.e. mild, moderate and severe dysplasias and carcinoma in situ) bronchial epithelia to evaluate whether differences in the apoptotic activity could already be seen in the stages preceding squamous cell carcinoma of the lung (SQCLC). Apoptotic cells and bodies were visualized by 3' end labelling. The expression of p53 and members of the bcl-2 gene family, such as bcl-2, bax and mcl-1, were determined immunohistochemically with specific antibodies. The relative number of apoptotic cells and bodies [apoptotic index (AI%)] was already increased threefold as the normal bronchial epithelium changed to squamous metaplasia, and the AIs of the dysplastic lesions were about four times higher than those of the normal epithelium. Apoptosis was significantly associated with cell proliferation, as determined by proliferating cell nuclear antigen (PCNA) immunohistochemistry. However, the extent of apoptosis did not correlate with the expression of p53, bcl-2, bax and mcl-1. We conclude that, in the metaplasia-dysplasia-carcinoma sequence in the lung, the elevation of the AI% is an early event associated with cell proliferation activity, but is independent of the expression of p53, bcl-2, mcl-1 and bax.
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Affiliation(s)
- U Törmänen
- Department of Pathology, University of Oulu, Finland
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