Altering the Microbiome Inhibits Tumorigenesis in a Mouse Model of Oviductal High-Grade Serous Carcinoma

Studies have shown bacteria influence the initiation and progression of cancers arising in sites that harbor rich microbial communities, such as the colon. Little is known about the potential for the microbiome to influence tumorigenesis at sites considered sterile, including the upper female genital tract. The recent identification of distinct bacterial signatures associated with ovarian carcinomas suggests microbiota in the gut, vagina, or elsewhere might contribute to ovarian cancer pathogenesis. Here, we tested whether altering the microbiome affects tumorigenesis in a mouse model of high-grade serous carcinoma (HGSC) based on conditional oviduct-specific inactivation of the Brca1, Trp53, Rb1, and Nf1 tumor suppressor genes. Cohorts of control (n = 20) and antibiotic-treated (n = 23) mice were treated with tamoxifen to induce tumor formation and then monitored for 12 months. The antibiotic cocktail was administered for the first 5 months of the monitoring period in the treatment group. Antibiotic-treated mice had significantly fewer and less advanced tumors than control mice at study endpoint. Antibiotics induced changes in the composition of the intestinal and vaginal microbiota, which were durable in the fecal samples. Clustering analysis showed particular groups of microbiota are associated with the development of HGSC in this model. These findings demonstrate the microbiome influences HGSC pathogenesis in an in vivo model that closely recapitulates the human disease. Because the microbiome can modulate efficacy of cancer chemo- and immunotherapy, our genetically engineered mouse model system may prove useful for testing whether altering the microbiota can improve the heretofore poor response of HGSC to immunotherapies. SIGNIFICANCE: This study provides strong in vivo evidence for a role of the microbiome in ovarian cancer pathogenesis.

The role of the microbiome in ovarian cancer: mechanistic insights into oncobiosis and to bacterial metabolite signaling

Ovarian cancer is characterized by dysbiosis, referred to as oncobiosis in neoplastic diseases. In ovarian cancer, oncobiosis was identified in numerous compartments, including the tumor tissue itself, the upper and lower female genital tract, serum, peritoneum, and the intestines. Colonization was linked to Gram-negative bacteria with high inflammatory potential. Local inflammation probably participates in the initiation and continuation of carcinogenesis. Furthermore, local bacterial colonies in the peritoneum may facilitate metastasis formation in ovarian cancer. Vaginal infections (e.g. Neisseria gonorrhoeae or Chlamydia trachomatis) increase the risk of developing ovarian cancer. Bacterial metabolites, produced by the healthy eubiome or the oncobiome, may exert autocrine, paracrine, and hormone-like effects, as was evidenced in breast cancer or pancreas adenocarcinoma. We discuss the possible involvement of lipopolysaccharides, lysophosphatides and tryptophan metabolites, as well as, short-chain fatty acids, secondary bile acids and polyamines in the carcinogenesis of ovarian cancer. We discuss the applicability of nutrients, antibiotics, and probiotics to harness the microbiome and support ovarian cancer therapy. The oncobiome and the most likely bacterial metabolites play vital roles in mediating the effectiveness of chemotherapy. Finally, we discuss the potential of oncobiotic changes as biomarkers for the diagnosis of ovarian cancer and microbial metabolites as possible adjuvant agents in therapy.

Assessment of peritoneal microbial features and tumor marker levels as potential diagnostic tools for ovarian cancer

Epithelial ovarian cancer (OC) is the most deadly cancer of the female reproductive system. To date, there is no effective screening method for early detection of OC and current diagnostic armamentarium may include sonographic grading of the tumor and analyzing serum levels of tumor markers, Cancer Antigen 125 (CA-125) and Human epididymis protein 4 (HE4). Microorganisms (bacterial, archaeal, and fungal cells) residing in mucosal tissues including the gastrointestinal and urogenital tracts can be altered by different disease states, and these shifts in microbial dynamics may help to diagnose disease states. We hypothesized that the peritoneal microbial environment was altered in patients with OC and that inclusion of selected peritoneal microbial features with current clinical features into prediction analyses will improve detection accuracy of patients with OC. Blood and peritoneal fluid were collected from consented patients that had sonography confirmed adnexal masses and were being seen at SIU School of Medicine Simmons Cancer Institute. Blood was processed and serum HE4 and CA-125 were measured. Peritoneal fluid was collected at the time of surgery and processed for Next Generation Sequencing (NGS) using 16S V4 exon bacterial primers and bioinformatics analyses. We found that patients with OC had a unique peritoneal microbial profile compared to patients with a benign mass. Using ensemble modeling and machine learning pathways, we identified 18 microbial features that were highly specific to OC pathology. Prediction analyses confirmed that inclusion of microbial features with serum tumor marker levels and control features (patient age and BMI) improved diagnostic accuracy compared to currently used models. We conclude that OC pathogenesis alters the peritoneal microbial environment and that these unique microbial features are important for accurate diagnosis of OC. Our study warrants further analyses of the importance of microbial features in regards to oncological diagnostics and possible prognostic and interventional medicine.

Multiresistent opportunistic talaromycosis in a patient with ovarian cancer

BACKGROUND

Talaromycosis (penicillinosis) is multiresistent opportunistic mycosis. The infection can be inapparent and it can simmulate malignant tumor dissemination in some patients.

CASE

We present a case of 33-years-old patient with mucinous adenocarcinoma of left ovary, initially FIGO IIC. The patient had had hysterectomy, bilateral adnexectomy, omentectomy and port-site metastasis extirpation. Six cycles of 1st chemother-apy paclitaxel and carboplatin had been administered to patient follow-ing the surgery. Positron emission tomography / computed tomography (PET/CT) scan after the treatment, had shown metabolic activity infiltrat-ing both lung apexes, supposedly with no dis-ease correlation, and hypermetabolic foci in spleen, suspicious of be-ing metastases. Pa-cient showed no clinical symp-toms, nor markers of inflammation elevation. Initially elevated serum tumor markers CA125 and CA72-4 had decreased after the treatment. Bronchoalveolar lavage cytology described presence of inflammatory infiltration with fungiform-ing hyphae - most probably an aspergillosis. Mannan and galactomannan serology was negative. In regard to splenectomy plans, treatment with voriconazol was initiated empirically. Result of fungi cultivation out of bronchoalveolar lavage was finalized later, show-ing sporadic presence o Penicillium sp. with resistance to antimycotic treatment except for amphotericin B. Liposomal amphotericin B treatment was administered in two cures, 28 days in total. Immunomodulatory treatment of secondary cellular immunodeficiency and vaccination against encapsulated bacteria was given to the patient. Splenectomy was performed 6 months after the end of chemother-apy treatment. Histopathology showed chronic granulomatous inflammation without mycotic hyphae, with no evidence of tumor cells. After the splenectomy, patient was treated by surgical incision and drainage and by klindamycin for intraabdominal abscess in left hypogastric area.

CONCLUSION

Patient is under follow up by oncologist, immunologist and gynecologist 12 months after the splenectomy, she is surveilled by PET/CT and serum tumor markers. Talaromycosis can be clinically inapparent in spite of its dissemination. It can be present in diffuse, granulomatous and mixed form. Therapeutic agent is sometimes limited to amphotericin B due to its resistence. Liposomal form of amphotericin B is recommended regard-ing its pharmacokinetic properties. In case of dissemination, administration period of more than 14 days is recommended, even in inapparent form. Immunomodulatory treatment is recommended due to opportunistic infection.

Frontline Science: Microbiota reconstitution restores intestinal integrity after cisplatin therapy

Due to their cytotoxic activities, many anticancer drugs cause extensive damage to the intestinal mucosa and have antibiotic activities. Here, we show that cisplatin induces significant changes in the repertoire of intestinal commensal bacteria that exacerbate mucosal damage. Restoration of the microbiota through fecal-pellet gavage drives healing of cisplatin-induced intestinal damage. Bacterial translocation to the blood stream is correspondingly abrogated, resulting in a significant reduction in systemic inflammation, as evidenced by decreased serum IL-6 and reduced mobilization of granulocytes. Mechanistically, reversal of dysbiosis in response to fecal gavage results in the production of protective mucins and mobilization of CD11b+ myeloid cells to the intestinal mucosa, which promotes angiogenesis. Administration of Ruminococcus gnavus, a bacterial strain selectively depleted by cisplatin treatment, could only partially restore the integrity of the intestinal mucosa and reduce systemic inflammation, without measurable increases in the accumulation of mucin proteins. Together, our results indicate that reconstitution of the full repertoire of intestinal bacteria altered by cisplatin treatment accelerates healing of the intestinal epithelium and ameliorates systemic inflammation. Therefore, fecal microbiota transplant could paradoxically prevent life-threatening bacteremia in cancer patients treated with chemotherapy.

Distinguishing potential bacteria-tumor associations from contamination in a secondary data analysis of public cancer genome sequence data

BACKGROUND

A variety of bacteria are known to influence carcinogenesis. Therefore, we sought to investigate if publicly available whole genome and whole transcriptome sequencing data generated by large public cancer genome efforts, like The Cancer Genome Atlas (TCGA), could be used to identify bacteria associated with cancer. The Burrows-Wheeler aligner (BWA) was used to align a subset of Illumina paired-end sequencing data from TCGA to the human reference genome and all complete bacterial genomes in the RefSeq database in an effort to identify bacterial read pairs from the microbiome.

RESULTS

Through careful consideration of all of the bacterial taxa present in the cancer types investigated, their relative abundance, and batch effects, we were able to identify some read pairs from certain taxa as likely resulting from contamination. In particular, the presence of Mycobacterium tuberculosis complex in the ovarian serous cystadenocarcinoma (OV) and glioblastoma multiforme (GBM) samples was correlated with the sequencing center of the samples. Additionally, there was a correlation between the presence of Ralstonia spp. and two specific plates of acute myeloid leukemia (AML) samples. At the end, associations remained between Pseudomonas-like and Acinetobacter-like read pairs in AML, and Pseudomonas-like read pairs in stomach adenocarcinoma (STAD) that could not be explained through batch effects or systematic contamination as seen in other samples.

CONCLUSIONS

This approach suggests that it is possible to identify bacteria that may be present in human tumor samples from public genome sequencing data that can be examined further experimentally. More weight should be given to this approach in the future when bacterial associations with diseases are suspected.

Clostridium septicum can cause distant myonecrosis in patients with ovarian cancer

A case report of lethal distant myonecrosis with gas gangrene is presented. Blood cultures and tissue biopsies revealed Clostridium septicum. The 55-year-old female patient presented with recurrent ovarian cancer of transitional cell type, initially diagnosed as FIGO IIb in January 2011, with hepatic metastasis and invasion of the ceacal wall. She underwent several operations, including partial bowel and liver resection in September 2011. Second-line therapy with topotecan three weekly was started in October 2011 while the patient was still in the hospital. During this chemotherapy, the patient revealed symptoms of severe pain and erythema of the skin. Within hours she died of sceptic shock after a debridement. The diagnosis was gas gangrene due to Clostridium septicum. Because it is a rare and severe disease and the time slot in which therapeutic measures can be taken is narrow, we discuss clinical symptoms and therapeutic options.

[Correlation between bacterial L-form infection, expression of HIF-1α/MMP-9 and vasculogenic mimicry in epithelial ovarian cancer]

The aim of the present study is to explore whether vasculogenic mimicry (VM) and bacterial L-form infection exist in human epithelial ovarian cancer (EOC) or not and to elucidate the correlation of L-form infection, expression of hypoxia inducible factor 1α (HIF-1α)/MMP-9 and VM. In 87 specimens of EOC and 20 specimens of ovarian benign epithelial tumor tissues, L-form infection was detected by Gram's staining, expression of HIF-1α/MMP-9 and VM were detected by immunohistochemical and histochemical staining. The results showed that the positive rates of HIF-1α and MMP-9 protein in EOC were 52.9% and 66.7%, while in benign epithelial tumor tissues, the positive rates were 10.0% and 10.0% respectively, and there were significant differences between them (P < 0.05). In EOC and benign epithelial tumor tissues, L-form infections ratios were 24.1% and 0, respectively, and the difference was also significant (P < 0.01). Expression of VM, HIF-1α and MMP-9 in EOC was significantly related to differentiation, abdominal implantation and lymph node metastasis and FIGO stage (P < 0.01). L-form infection had relationship with abdominal implantation, lymph node metastasis and FIGO stage (P < 0.01 or 0.05). The expression of HIF-1α had positive relationship with expression of MMP-9 and VM (r = 0.505, 0.585, respectively, P < 0.01); there was also a positive relationship between MMP-9 expression and VM (r = 0.625, P < 0.01). Overexpression of VM, HIF-1α and MMP-9 were related to poor prognosis: the survival rates were significantly lower in positive patients than those in negative patients (P < 0.05). And the group with L-form infection also had poor prognosis: the survival rates were lower than those in group without infection (P < 0.05). FIGO stage, expression of VM, HIF-1α and MMP-9 were independent prognosis factors of EOC (P < 0.05). The results suggest that L-form infection, the expression of HIF-1α, MMP-9 and VM in EOC are related to differentiation, lymph node metastasis, clinical stage and prognosis. Combined detection of these indexes has an important role in predicting the progression and prognosis of EOC.

The superinfection of a dermoid cyst

Mature cystic teratoma may be complicated by torsion, rupture, and malignant change, but is rarely complicated by infection. Here we report the case of a patient who presented with a tubo-ovarian abscess following a dilation and curettage (D&C) procedure in the setting of an ovarian dermoid cyst.

Gene alterations identified by expression profiling in tumor-associated endothelial cells from invasive ovarian carcinoma

Therapeutic strategies based on antiangiogenic approaches are beginning to show great promise in clinical studies. However, full realization of these approaches requires identification of key differences in gene expression between endothelial cells from tumors versus their normal counterparts. Here, we examined gene expression differences in purified endothelial cells from 10 invasive epithelial ovarian cancers and 5 normal ovaries using Affymetrix U133 Plus 2.0 microarrays. More than 400 differentially expressed genes were identified in tumor-associated endothelial cells. We selected and validated 23 genes that were overexpressed by 3.6- to 168-fold using real-time reverse transcription-PCR and/or immunohistochemistry. Among these, the polycomb group protein enhancer of Zeste homologue 2 (EZH2), the Notch ligand Jagged1, and PTK2 were elevated 3- to 4.3-fold in tumor-associated endothelial cells. Silencing these genes individually with small interfering RNA blocked endothelial cell migration and tube formation in vitro. The present study shows that tumor and normal endothelium differ at the molecular level, which may have significant implications for the development of antiangiogenic therapies.

Could epithelial ovarian cancer be associated with chlamydial infection?

PURPOSE OF INVESTIGATION

Epithelial ovarian cancer (EOC) is the leading cause of death from gynaecological malignancy in the UK. The pathogenesis of this disease is poorly understood. Our hypothesis was that chlamydial infection might play a role in the pathogenesis of EOC.

METHODS

122 serum samples of patients undergoing surgery for benign or malignant gynaecological conditions were analysed. There was a total of 41 patients with EOC (33.6%), 27 with benign cystadenomas (22.1%) and 54 with normal ovaries (44.3%).

RESULTS

There was a higher incidence of IgA seropositivity and lower incidence of IgG seropositivity in the EOC group compared with the other groups; however, this was not statistically significant. There was no statistical difference in the serum IgM antibodies to chlamydia in the three different groups.

CONCLUSION

Although chronic infection and persistent inflammation may contribute to the pathogenesis of EOC, and chlamydia is a common genital tract pathogen, our study did not find an association between chlamydia and EOC.

MPO and cytokines in the serum of cancer patients in the context of Candida colonization and infection

This study investigated the immunological factors, such as neutrophils number, the level of myeloperoxidase and IL-12, IL-10, TNF-alpha, IFN-gamma, that additionally might correlate with increased susceptibility to Candida infections in cancer patients. A total of 105 cancer patients were evaluated. Patients were examined twice for Candida colonization and presence of Candida antigen and DNA in bloodstream. Serum concentrations of MPO and selected cytokines were quantified by ELISA. The values for myeloperoxidase were decreased in Candida-colonized as well as deep-infected cancer patients groups, compared to healthy persons. In the group of patients suspected of deep candidiasis, we observed significantly elevated level of IFN-gamma compared to control. In the group of Candida-colonized patients, the concentrations of IL-12, TNF- alpha and IFN-gamma were significantly heightened when compared to control.MPO deficiency seems to be one of the important risk factor for deep candidiasis independently of the neutrophil count. The disturbances in cytokines levels in cancer patients group can be connected with underlying cancer disease, its treatment as well as Candida infection. The decreased level of TNF-alpha, in particular may be connected with Candida invasion.

Ovarian cancer complicated by invasive pulmonary aspergillus

BACKGROUND

Invasive aspergillus is a rarely reported infection in patients with solid tumors.

CASE

A 59-year-old woman developed invasive pulmonary aspergillus after surgical debulking of an advanced ovarian adenocarcinoma and initiation of adjuvant combination chemotherapy.

CONCLUSION

Invasive pulmonary aspergillus is rarely diagnosed in patients with solid tumors such as ovarian cancer. Risk factors for development of the disease can include neutropenia, immunosuppression and chronic steroid use. Successful treatment of the infection relies upon prompt diagnosis and utilization of effective antifungal medications for a prolonged period of time.

Presence of nanobacteria in psammoma bodies of ovarian cancer: evidence for pathogenetic role in intratumoral biomineralization

AIMS

The presence of laminated, calcified extracellular debris known as psammoma bodies is a well-known histomorphological feature of ovarian adenocarcinomas and other human malignancies. Biomineralization has recently been found to be associated with a group of extremely small Gram-negative bacteria capable of precipitating calcium salts. The aim of the present study was to evaluate a possible pathogenic link between the development of psammoma bodies and nanobacteria infection.

MATERIAL AND RESULTS

Immunohistochemical staining and reverse transcriptase-polymerase chain reaction (RT-PCR) were used to analyse nanobacterial protein and gene expression in eight psammona body-containing adenocarcinomas and in 10 malignant ovarian tumours without signs of biomineralization. Nanobacterial proteins were detected in eight out of eight (100%) psammoma-positive tumour samples. Conversely, none of the 10 psammoma-negative tissues (0%) was positive for nanobacterial antigens. Furthermore, nanobacterial mRNA was detectable in all of the four tissues (100%) that contained psammoma bodies, but was absent in all 10 ovarian cystadenocarcinomas (0%) that were psammoma negative.

CONCLUSIONS

We found a 100% concordance between the expression of nanobacteria and the presence of psammoma bodies in malignant ovarian tumours. Several lines of evidence suggest the involvement of these organisms in the process of biomineralization. We therefore conclude that nanobacterial infection of malignant ovarian tissue contributes to mechanisms leading to the formation of calcified deposits known as psammoma bodies.

The prognostic and diagnostic markers of invasive candidiasis in patients during chemotherapy

The aim of the work was the early detection of Candida spp. in clinical samples of patients with carcinoma ovariorum undergoing chemotherapy by comparing three indicators of candidiasis: presence of mannan and yeast DNA in the bloodstream and colonization of mucosal membranes by Candida species as a prognostic marker of deep candidiasis. Thirty-one women with carcinoma ovariorum, during chemotherapy without symptoms of deep fungal infections, were examined twice over a six-day period. C. albicans was the dominant organism isolated from mucosal membranes. Two serum samples were positive for mannan on the first day of examination. All these patients were previously colonized by Candida spp. on mucous membranes. Four patients were positive on the last day of examination. Three of these patients were colonized by Candida spp. C. albicans infection was detected early in 4 out of 12 clinical samples by a combination of PCR and mannan-detecting methods. Colonization increases the risk of deep candidiasis. PCR and antigen detection are fast and reliable methods for early detection of Candida in bloodstream. For patients at risk, the clinical samples must be tested by at least two independent methods.

[Mycoplasma infection and cancer]

Mycoplasmas are widespread in nature as conditional pathogen, which may be the unique prokaryote that can cohabit with eukaryote and interact permanently with mammalian cells. Mycoplasma infection can be detected in many tumor tissues, continuous infection of mycoplasma can lead to transformation of mammalian cells, up-regulating expression of oncogenes, and some biologic changes of tumor cells, suggesting association of mycoplasma infection with tumorigenesis.

Nanobacteria promote crystallization of psammoma bodies in ovarian cancer

Serous papillary adenocarcinomas of the ovary are often associated with microcalcifications, namely psammoma bodies. Archebacteria such as nanobacteria are, for example, involved in kidney stone formation. Nanobacteria deserve close scrutiny as their cytotoxicity and ability to cross the placenta present a potential clinical risk. In this study we investigated whether nanobacteria are associated with psammoma bodies in ovarian cancer. We identified in all seven carcinomas with multiple psammoma body nanobacterial antigens in histological specimens and in the ascitic fluid. Control cases of adenocarcinomas without such calcifications did not present nanobacterial antigens. This finding indicates that apart from non-malignant conditions, nanobacteria could also be found in cancer. Hence, nanobacterial infection may be of clinical importance as these bacteria are related to microcalifications in ovarian cancer.

Serologic evidence of past infection with Chlamydia trachomatis, in relation to ovarian cancer

Pelvic inflammatory disease has been inconsistently linked with ovarian cancer. We measured antibodies to Chlamydia trachomatis, to chlamydial heat shock protein (CHSP) 60, and to CHSP10, in 117 women with ovarian cancer and in 171 age- and ethnicity-matched population-based control subjects from Oahu, Hawaii. IgG antibodies to serovar D of chlamydia elementary bodies (EB) and IgG antibodies to CHSP60-1, CHSP60-2, CHSP60-3, and CHSP10 were detected using an ELISA assay. The probability of having ovarian cancer was 90% greater in women with the highest, compared with the lowest (optical density, >or =0.40 vs. <0.10), levels of chlamydia-EB antibodies (P=.05). There was also a monotonic trend (P=.09) in ovarian cancer risk associated with CHSP60-1 but not with CHSP60-2, CHSP60-3, or CHSP10. These data suggest that past or chronic persistent infection with chlamydia may be a risk factor for ovarian cancer.

Pneumocystis carinii pneumonia in a patient with stage IV ovarian cancer

BACKGROUND

Immunocompromised persons are considered to be at risk of developing Pneumocystis carinii pneumonia, although the incidence of this condition is much lower compared to the human immunodeficiency virus-positive group. It is important to identify specific individuals at high clinical risk to guide the chemoprophylaxis of P. carinii pneumonia.

CASE

A 42-year-old female with stage IV ovarian cancer developed P. carinii pneumonia during radiotherapy for brain metastasis while receiving 7 weeks of prednisolone. Four weeks before the diagnosis, her lymphocyte count dropped to 350/microl. She was treated with pentamidine followed by trimethoprim-sulfamethoxazole with the support of mechanical ventilation. The patient could then be weaned from mechanical ventilatory support. However, she was not able to receive any additional therapy for her ovarian cancer.

CONCLUSION

Cancer patients who receive corticosteroids during chemotherapy or radiation therapy are at risk of developing P. carinii pneumonia and should receive P. carinii pneumonia prophylaxis.

Detection of Mycoplasma ribosomal DNA sequences in ovarian tumors by nested PCR

OBJECTIVE

The aim of this study was to investigate the reported association between mycoplasma infection and ovarian cancer by screening ovarian tumor tissues for the presence of mycoplasma DNA.

METHODS

Forty-six benign and malignant ovarian tumors were obtained from patients undergoing pelvic surgery at a regional cancer center. DNA was isolated from snap-frozen tumor tissues, and commercial nested polymerase chain reaction (PCR) kits were used to detect the presence of 12 species of mycoplasma in tumor DNA samples. PCR products were isolated from ethidium bromide-stained agarose gels, and sequenced with an automated DNA sequencer. Species were identified through nucleotide sequence similarity searches using the National Center for Biotechnology Information BLAST program.

RESULTS

Mycoplasma DNA was detected in 6 (13.0%) of the 46 tumor DNA samples. Nucleotide sequence similarity searches of nested PCR products revealed that one Mycoplasma salivarium and five M. arginini DNA sequences were amplified from the ovarian tissues.

CONCLUSIONS

Since M. salivarium and M. arginini are frequently encountered laboratory contaminants that do not have a recognized role as human pathogens, our findings do not support an association between human mycoplasma pathogens and ovarian cancer.

Brucella-infected ovarian dermoid cyst causing initial treatment failure in a patient with acute brucellosis

A 37-year-old woman was diagnosed with acute brucellosis. Despite appropriate antimicrobial therapy, high fever persisted. A contrast enhanced CT scan of the abdomen and pelvis revealed a left ovarian dermoid cyst. On the first postoperative day after left ovariectomy and right ovarian cystectomy were performed, the patient defervesced abruptly and continued to be completely afebrile. Cultures from bone marrow and dermoid cyst grew Brucella melitensis. The observation of a Brucella-infected ovarian dermoid cyst, which has not been previously reported, illustrates the importance of localized brucellosis as a cause of persistent infection despite appropriate antimicrobial therapy.

Prevalence of mycoplasma conserved DNA in malignant ovarian cancer detected using sensitive PCR-ELISA

Mycoplasmas are tiny polymorphic prokaryotic organisms (0.2-0.3 microm) that lack a cell wall and reside ubiquitously at the cell membrane or internalized into the cell. The organisms have been implicated in many diseases including functioning as cofactors catalyzing the HIV disease state. The oncogenic potential of mycoplasmas was only recently realized when they were shown to cause chromosomal changes and in vitro cell transformations through gradual progressive chromosomal loss and translocations. While a recent study linked mycoplasmas with gastric cancer, the association between mycoplasmas and ovarian cancer has not been established. Recently, a commercial assay which combined polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) methods was developed for the detection of mycoplasmas. The present objective was to determine the prevalence of mycoplasmas in archived paraffin-embedded malignant ovarian cancer tissue. The combined PCR-ELISA procedure was used with consensus primers targeting for 15 species of mycoplasmas and acholeplasmas. Archived human malignant ovarian cancer tissues (N = 27 cases) embedded in paraffin blocks were processed, and DNA was extracted and the presence of DNA verified. The extracted DNA specimens were randomly divided into three groups for analyses. PCR-ELISA assays were performed on extracted DNA together with appropriate negative and positive controls. The results showed mycoplasmas were present in 59.3% of the malignant ovarian cancer specimens. PCR-ELISA analysis of Neisseria gonorrhea and Chlamydia trachomatis controls did not produce cross-reacting false-positive results. The results suggest an association between mycoplasmas and malignant ovarian cancer. A 59.3% prevalence rate was demonstrated for mycoplasmas in paraffin-embedded ovarian cancer tissues. The mechanism involved in oncogenesis by mycoplasmas remains to be elucidated.

Association of herpesvirus infection with the development of genital cancer

Clinical observations and epidemiological studies on genital cancer have revealed an association with sexual behavior, thus motivating research into sexually transmitted agents which may be responsible for the neoplasia. In this study, we used the PCR technique to examine the presence of CMV, HSV and EBV viruses in 187 cases of human genital lesions and found that infection with CMV or HSV was associated with cervical cancer. When we stratified according to HPV status this association was found only for HPV-DNA-negative cases. These findings indicate that past infection with CMV or HSV could be interpreted as a surrogate marker of HPV infection. However, these viruses may play an important role themselves in cervical cancer.

Characterization of peripheral blood and ovarian cancer-infiltrating lymphocytes: effect of HIV infection on phenotypic expression and proliferative response

A study that focused on the identification of the phenotype and proliferative responses of peripheral blood and ovarian cancer-infiltrating lymphocytes in a patient with stage III ovarian cancer who had human immunodeficiency virus infection is presented. Monoclonal antibodies and flow cytometry were used to determine the phenotypic expression, while thymidine incorporation response to stimulation by phytohemagglutinin and concanavalin A was used to determine the proliferative response. These immunologic characteristics were compared with the results of similar analyses performed in four HIV-seronegative patients with stage III ovarian cancer. The CD4:CD8 ratio in peripheral blood and ovarian tumor in the HIV-seropositive patient was 0.43:1 and 0.46:1, respectively, while in the four seronegative patients it was 1.83:1 and 0.64:1, respectively. The absolute and mean CD4 counts in the peripheral blood in the HIV-seropositive patient and HIV-seronegative patients was 260/mm3 and 707/mm3 (611-743), respectively, while in the ovarian tumor the percentage distribution of CD4 was 13 and 21% (9-44%), respectively. Despite there being intratumor immunosuppression in all five cases, the proliferative response was most markedly suppressed in the HIV-seropositive patient. Although surgery and chemotherapy were well tolerated, the HIV-seropositive patient died 6 months later with rapidly progressive disease. The remaining four HIV-seronegative patients are all alive, between 9 and 14 months postoperatively.

Non-Hodgkin's lymphoma in four children infected with the human immunodeficiency virus. Association with Epstein-Barr Virus and treatment

BACKGROUND

Reports on lymphoid malignancy and its treatment in children infected with human immunodeficiency virus (HIV) are limited.

METHODS

Antibodies to Epstein-Barr virus (EBV) were detected by indirect immunofluorescence. DNA was extracted from peripheral blood lymphocytes or biopsy specimens. Polymerase chain reaction was run using primers for EBV. Reaction products underwent Southern blot analysis to confirm EBV specificity. Tumor clonality was assessed by immunohistochemistry and by Southern blot analysis of immunoglobulin heavy-chain and T-cell receptor beta-gene rearrangement.

RESULTS

Within 1 year, non-Hodgkin's lymphoma (NHL) was diagnosed in four children infected with HIV. All four were EBV-seropositive and had detectable EBV DNA in peripheral blood lymphocytes. The EBV-linked disorders lymphoid interstitial pneumonia and recurrent parotid enlargement preceded NHL in three and two of the children, respectively. In all four patients, NHL involved at one time the central nervous system (CNS). All three tested NHL tissues were positive for EBV DNA: A 12-week course of chemotherapy given to two children resulted in rapid tumor regression. One of these children experienced meningeal relapse and died 16 months after diagnosis. The other child, who in addition received local irradiation of the affected eye and who underwent surgical removal of the involved ovaries, has been in continuous remission for 20 months.

CONCLUSIONS

EBV-associated NHL may be seen more frequently in pediatric patients with HIV. Treatment protocols taking into account NHL propensity for the CNS in this age group need to be developed.

Differential interaction of cisplatin with the HIV-1 long terminal repeat in a resistant ovarian carcinoma cell line

We constructed a recombinant plasmid, pBHIV1, carrying the long terminal repeat (LTR) sequences of HIV-1 linked to the reporter chloramphenicol acetyl transferase (CAT) gene and to the aminoglycoside phosphotransferase (aph) gene as a selectable marker. We have introduced pBHIV1 in a human ovarian cancer cell line A2780 and in a cisplatin resistant variant 2780CP, and obtained stable geneticin resistant A27HIV1-1 and 27CPHIV1-1 cells, respectively. Both transfectant cells expressed CAT activity from the HIV LTR promoter. The response to the anti-neoplastic drug cisplatin was studied on the LTR regulated CAT activity in both cell lines. It was found that cisplatin at 2.5 x 10(-5) M concentration stimulates the expression of CAT by 26-fold from the HIV LTR in A27HIV1-1, but requires a concentration of 5 x 10(-5) M to enhance expression by 4.1-fold in the cisplatin resistant 27CPHIV1-1 cells. Carboplatin, over a range of concentrations (1 x 10(-6) to 1 x 10(-4) M), does not stimulate expression of CAT from the HIV-1 LTR in either of the transfected cells.

Detection of p53 gene mutations in human ovarian and endometrial cancers by polymerase chain reaction-single strand conformation polymorphism analysis

The presence of mutations in the p53 gene was examined in ovarian cancers by a polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis. The primers were designed to amplify exons 5 through 9 that contain phylogenetically conserved domains of the p53 gene. Mutations were detected in 5 out of 10 cases, one of which contained a deletion in the second allele. A single base substitution was detected in 4 cases at codons 162, 175, 205 and 273 and a single base insertion in one case within codon 315. A high frequency of p53 mutations in ovarian cancers and lack of mutation in 6 benign ovarian tumors and 2 normal ovaries suggested that the mutation of the p53 gene was associated with the genesis and/or progression of ovarian cancer. In 1 of 7 endometrial cancers, two mutations at codons 239 and 254 were detected.

Human papillomavirus in benign and malignant ovarian and endometrial tissues

Ovarian and endometrial cancer tissues were examined for the presence of human papillomavirus (HPV) and the results were compared with the findings in normal tissues by polymerase chain reaction. Putative DNA of HPV types 16 and 18 that target DNA sequences from paraffin-embedded tissues were amplified with paired oligonucleotide primers that encode the E6 gene of HPV. The amplified DNA sequences were then detected with Southern blot hybridization analysis. The HPV DNA sequences were detected in both benign (50% ovarian, 70% endometrial) and malignant ovarian (27.2%) and endometrial (37.5%) tissue samples. Interestingly, eight hepatoma samples were also analyzed as tissue controls. The results were negative in seven, but positive in one with repeated tests. The results suggest that the spread of HPV in the upper genital tract may not be uncommon. The explanation of a positive liver tissue study result will have to await further study.

A double-blind study of the efficacy of metronidazole gel in the treatment of malodorous fungating tumours

A double-blind placebo-controlled trial was undertaken to assess the value of topical metronidazole gel preparation in the palliation of the offensive odour of fungating tumours. This 5 day trial was followed by a 6 day period during which all patients received the active gel. Subjective odour assessments were performed by both patients and medical staff. 11 patients were entered and the randomisation was then halted because of an obvious overall benefit over the whole 11 days. There was a non-significant trend in favour of the active treatment during the initial double-blind placebo-controlled phase of the trial, and no side-effects were observed.

Genital-type human papillomavirus infection is not associated with surface epithelial ovarian carcinoma

Tumor tissues from 29 women with borderline or malignant epithelial ovarian tumors were examined for the presence of human papillomavirus (HPV) DNA by the polymerase chain reaction (PCR). The PCR analysis used a set of consensus primers that are complementary to highly conserved sequences in the genital HPVs (M. M. Manos, Y. Ting, D. K. Wright, A. J. Lewis, T. R. Broker, and S. M. Wolinsky, Cancer Cells 7, 209-214, 1989). Amplification products were detected by Southern hybridization with consensus oligonucleotide probes. A total of 70 paraffin-embedded tissue sections from ovarian carcinomas were tested and we did not detect genital-type HPV DNA sequences in any of these specimens. However, all of the tissue specimens were considered adequate for PCR analysis because a human cellular gene (beta-globin) was successfully amplified in each tissue specimen. In addition, HPV 16 DNA was found in a concurrent invasive squamous-cell carcinoma of the cervix from one ovarian cancer patient, indicating that the PCR was able to detect HPV in the lower genital tract of this individual. We conclude that there is no association between infection with the most common genital HPVs and borderline and malignant epithelial ovarian tumors.

Results of Pap smear examinations in women with abnormal ovaries

Using the VCE technique, the Pap smears of 249 women with abnormal ovaries were examined at the Cytological Laboratory, Siriraj Hospital. The cases, ranging in age from 15 to 85 years (the mean age being 42.1 +/- 14.7 years), were diagnosed as follows: 49 cases with cysts, 89 cases with tumours and 111 cases with cancer. The mean ages of the women with cysts, tumours and cancer of the ovaries were 34.0 +/- 8.6, 37.2 +/- 12.8 and 49.5 +/- 14.8 years, respectively. The percentages of women with cysts, tumours and cancer diagnosed cytologically as having a normal smear were 44.9, 28.1 and 23.4; and infection and inflammation of abnormal ovaries 49.0, 49.4 and 41.5, respectively. The percentages of those with abnormal cells at the uterine cervix were 6.1, 21.4, and 31.5; endometrial adenocarcinoma 0, 1.1 and 0; and ovarian adenocarcinoma 0, 0 and 3.6, respectively. Although Pap smear examination using the VCE technique is sensitive in the early detection of cervical cancer, it is not a sensitive method in the detection of ovarian cancer.

Investigation of ovarian neoplasia of low malignant potential for human papillomavirus

Recent in situ hybridization studies have suggested the presence of human papillomavirus type 6 (HPV-6) DNA in ovarian cancer cells. An association between HPV and ovarian neoplasia of low malignant potential (LMP) has not been previously identified. Paraffin-embedded tissue blocks from 24 patients with LMP ovarian tumors were screened for human papillomavirus DNA. The patients ranged in age from 18 to 73 years. Corresponding microscopic slides from each tissue block were reviewed to confirm the histopathologic diagnosis. For identification of HPV genome, deparaffinized sections were subjected to the polymerase chain reaction to achieve amplification of DNAs of HPV types 6, 11, 16, and 18. For each HPV type, a 120-base-pair region of the E6 gene was targeted for amplification. Human papillomaviral DNA was not detected in the tissue specimens subjected to polymerase chain reaction. These results suggest that HPV types 6, 11, 16, and 18 are not likely to play a role in LMP ovarian tumors. These results do not totally exclude possible contributions of other HPV types.

Human papillomavirus and epithelial ovarian neoplasia

In contrast to the strong association between human papillomavirus (HPV) and squamous cell carcinoma of the lower female genital tract, no viral DNA had been found in epithelial ovarian carcinoma. Recently, however, R. H. Kaufman, J. Bornstein, A. N. Gordon, E. Adam, A. L. Kaplan, and K. Adler-Storthy [Gynecol. Oncol. 27, 340-349 (1987)] reported the detection of HPV-6 DNA by in situ hybridization in 10 of 12 patients with advanced epithelial ovarian carcinoma. To further investigate the possible association between HPV and epithelial ovarian neoplasia, tumor from 12 patients with epithelial ovarian adenocarcinoma, 3 with epithelial ovarian tumors of low malignant potential, and 3 with epithelial ovarian tumors of low malignant potential, and 3 with epithelial ovarian adenomas was examined for HPV DNA by the Southern hybridization technique. All the tissues were tested under low stringency for HPV-6 and under high stringency for HPV-6, HPV-16, HPV-18, HPV-31, and HPV-35. In addition, all tissues were tested by polymerase chain reaction for the presence of HPV-6 and HPV-11. Of the 12 patients with adenocarcinoma, 5 were poorly differentiated, 4 serous, 1 endometrioid, 1 mucinous, and 1 mixed. The neoplasms were of grades 2-4 with a predominance of stages III and IV (83%). Of the 3 patients with tumors of low malignant potential, all were serous and stage I. Of the 3 patients with adenomas, 1 was mucinous, 1 serous, and 1 Brenner. We were unable to detect HPV-related sequences in any of the specimens. On the basis of these findings, there appears to be no association between HPV and epithelial ovarian neoplasia.

[Clostridium septicum and colonic cancer]

During the period 1980-1987, Clostridium septicum was identified at Statens Seruminstitut, from anaerobic blood cultures in six patients. Five of the patients had cancer of the colon or rectum (c. coli) and one had cancer of the ovary. Correspondingly great incidence of solid tumours, particularly c. coli with C. septicum infection without preceding trauma or compromizing of immunity has been reported in the literature. Meticulous bacteriological identification should be undertaken on anaerobic culture as the finding of C. septicum in the blood should instigate investigation for c. coli or another form of solid tumour if no other explanation for the infection is available.

Latent infection of human ovarian teratocarcinoma cells with human cytomegalovirus. Brief report

Persistent infection with human cytomegalovirus (HCMV) can be established in cultures of human ovarian teratocarcinoma (PA1) cells, and maintained for more than 200 days. Infected cultures maintained at 34 degrees C (PA1CMV34) and 37 degrees C (PA1CMV37) entered crisis and subsequently displayed massive cytopathic effects (CPE), whereas infected cultures maintained at 32 degrees C (PA1CMV32) and 39 degrees C (PA1CMV39) continued to release small amounts of infectious virus until 240 or 151 days post-infection (p.i.) respectively. PA1CMV32 cultures shifted to 37 degrees C at 258 days p.i. resumed synthesis of infectious virus which resulted in cell destruction, indicating that latent infection with HCMV was maintained in PA1 cells at 32 degrees C. In contrast, PA1CMV39 cells did not produce infectious virus even when cultured at 37 degrees C for more than 100 days after the temperature shift.

A suppurative ovarian cyst in pregnancy due to Salmonella typhi

A 23-year-old primigravida with suppurative ovarian dermoid cyst due to Salmonella typhi is presented. The organism could not be isolated from the blood, faeces or urine and it was felt that the patient was an example of non-excretory carrier in whom S. typhi was lying dormant in the ovarian tissue for a long time.

Virus replication and cell modifications in organ cultures of tumor tissue from chickens with Marek's disease

Organ cultures of lymphomas from chickens infected with Marek's disease (MD) virus were examined by electron microscopy at various periods after explantation. Non-enveloped herpes-type virions were observed in explants 18 days after the culture was initiated. Cytolytic virus was replicated often in lymphoblastoid cells and occasionally in other cell types (permissive and nonpermissive transformed). The permissive cells were numerous, but nonpermissive transformed cells were also present as indicated by the longevity of some cultures. The presence of both permissive and transformed cell types in the organ cultures and reasons for their sequential appearance were discussed. The results unequivocally demonstrated that lymphoid cells of tumors induced by MD virus were sites of virus replication under proper culture conditions.

Type C viral expression in primate tissues

Nucleic acid sequences homologous to a [(3)H]DNA transcript prepared from an endogenous baboon type C virus are readily detected in both the cellular DNA and RNA of several different Old World monkeys. Competitive radioimmunoassays for the major viral protein (p30) of baboon type C viruses detect viral antigen in a normal stumptail spleen and a rhesus ovarian carcinoma. The p30 antigen from these tissues is closely related by several immunologic criteria to the p30 protein of baboon type C viruses. The results indicate that normal primate tissues transcribe endogenous viral-specific RNA and translate at least one viral structural protein.