LIMP-2 enhances cancer stem-like cell properties by promoting autophagy-induced GSK3β degradation in head and neck squamous cell carcinoma / 国际口腔科学杂志·英文版

Cancer stem cell-like cells (CSCs) play an integral role in the heterogeneity, metastasis, and treatment resistance of head and neck squamous cell carcinoma (HNSCC) due to their high tumor initiation capacity and plasticity. Here, we identified a candidate gene named LIMP-2 as a novel therapeutic target regulating HNSCC progression and CSC properties. The high expression of LIMP-2 in HNSCC patients suggested a poor prognosis and potential immunotherapy resistance. Functionally, LIMP-2 can facilitate autolysosome formation to promote autophagic flux. LIMP-2 knockdown inhibits autophagic flux and reduces the tumorigenic ability of HNSCC. Further mechanistic studies suggest that enhanced autophagy helps HNSCC maintain stemness and promotes degradation of GSK3β, which in turn facilitates nuclear translocation of β-catenin and transcription of downstream target genes. In conclusion, this study reveals LIMP-2 as a novel prospective therapeutic target for HNSCC and provides evidence for a link between autophagy, CSC, and immunotherapy resistance.

Comparative Assessment of E-cadherin's Expression between the Metastatic and Non-metastatic Oral Squamous Cell Carcinoma: An Immunohistochemical Study

ABSTRACT Objective: To identify the clinicopathological correlation of E-cadherin expression in metastatic and non-metastatic oral squamous cell carcinoma (OSCC). Material and Methods: A total of 90 paraffin-embedded tissue sections of OSCC were retrieved from the registry. The total selected samples were 45 cases each from the primary lesions of metastatic and non-metastatic OSCC. One section was subjected to routine Hematoxylin and eosin stain and another to immunohistochemical analysis for E-cadherin expression. Results: A non-significant (p˃0.05) increased expression is seen in the non-metastatic group compared to the metastatic group, with predominantly membrane as the staining site in either group. However, the expression of E-cadherin did not reveal any statistically significant association with independent variables such as age, gender, and adverse habits of the patients (p>0.05). On the other hand, with respect to the histological differentiation of OSCC, a significant association (p<0.001) was observed with the well-differentiated type of metastatic OSCC. Conclusion: E-cadherin was useful to some extent in predicting regional metastasis. However, further studies using a panel of biomarkers with increased sample size may help us understand the process involved in metastasis.

Mutation-associated transcripts reconstruct the prognostic features of oral tongue squamous cell carcinoma / 国际口腔科学杂志·英文版

Tongue squamous cell carcinoma is highly malignant and has a poor prognosis. In this study, we aimed to combine whole-genome sequencing, whole-genome methylation, and whole-transcriptome analyses to understand the molecular mechanisms of tongue squamous cell carcinoma better. Oral tongue squamous cell carcinoma and adjacent normal tissues from five patients with tongue squamous cell carcinoma were included as five paired samples. After multi-omics sequencing, differentially methylated intervals, methylated loop sites, methylated promoters, and transcripts were screened for variation in all paired samples. Correlations were analyzed to determine biological processes in tongue squamous cell carcinoma. We found five mutated methylation promoters that were significantly associated with mRNA and lncRNA expression levels. Functional annotation of these transcripts revealed their involvement in triggering the mitogen-activated protein kinase cascade, which is associated with cancer progression and the development of drug resistance during treatment. The prognostic signature models constructed based on WDR81 and HNRNPH1 and combined clinical phenotype-gene prognostic signature models showed high predictive efficacy and can be applied to predict patient prognostic risk in clinical settings. We identified biological processes in tongue squamous cell carcinoma that are initiated by mutations in the methylation promoter and are associated with the expression levels of specific mRNAs and lncRNAs. Collectively, changes in transcript levels affect the prognosis of tongue squamous cell carcinoma patients.

Influência da via hippo em carcinomas de células escamosas de língua oral / Influence of the hippo pathway on oral tongue squamous cell carcinomas

O carcinoma de células escamosas de língua oral (CCELO) apresenta altas taxas de morbidade e mortalidade. Apesar dos progressos alcançados nesta área, os pesquisadores continuam em busca de biomarcadores moleculares que tenham valor preditivo no prognóstico dos pacientes e que possibilitem o desenvolvimento de novas estratégias terapêuticas. Neste contexto, várias pesquisas têm destacado o papel da via Hippo com esta finalidade. Portanto, esta pesquisa teve como objetivo avaliar se as proteínas relacionadas à Via Hippo, LATS2 e YAP1, exercem alguma influência sobre o comportamento biológico dos CCELOs. A amostra foi constituída por 26 casos de CCELO e 8 casos de mucosa oral normal como controle. Para avaliar a morfologia dos CCELOs foram utilizadas as gradações propostas pela OMS (2005) e por Almangush et al. (2014). O perfil imunoistoquímico de LATS2 e YAP1 foi avaliado por escores (0-3), com base na sua imunoexpressão em localização intracelular (núcleo e/ou citoplasma) e distribuição epitelial. Para a análise entre os parâmetros estudados foram realizados os testes estatísticos Qui-quadrado de Pearson e Exato de Fisher. A análise de sobrevida foi realizada através do método de Kaplan Meier e do teste log-rank. Para todas as avaliações foram considerados valores significativos com p<0,05. Foi observada alta expressão da LATS2 tanto em mucosa oral normal (100%) quanto na maioria dos CCELOs (73,1%), sem diferença estatística significativa (p=0,160). Foi possível evidenciar o aumento da imunoexpressão da YAP nos casos de CCELO em comparação à mucosa oral normal (p<0,001). Verificou-se ainda que a baixa expressão da LATS2 foi associada com menores taxas de sobrevida livre da doença (p=0,039). Além disso, constatou-se que a elevada expressão da YAP foi associada à classificação de alto risco do modelo BD (p=0,034), sugerindo que a imunoexpressão desta proteína pode estar associada a TEM e invasão celular em CCELO. A elevada expressão de ambas as proteínas, na maioria dos CCELOs, sugere que outras vias de sinalização, além da regulação através da LATS2, podem estar induzindo a expressão nuclear de YAP nestes tumores. Portanto, conclui-se que a via Hippo pode influenciar o comportamento biológico dos CCELOs (AU).

Oral tongue squamous cell carcinoma (OTSCC) has high morbidity and mortality rates. Despite the progress made in this area, researchers continue to search for molecular biomarkers that have predictive value in the prognosis of patients and allow the development of new therapeutic strategies. In this context, several studies have highlighted the role of the Hippo pathway for this purpose. Therefore, this research aimed to evaluate whether the proteins related to the Hippo pathway, LATS2 and YAP1, have some influence on the OTSCC biological behavior. The sample consisted of 26 OTSCC cases and 8 normal oral mucosa cases as control. For the morphological assessment of OTSCC, the gradations proposed by the WHO (2005) and by Almangush et al. (2014) were performed. The immunohistochemical profile of LATS2 and YAP1 was evaluated by scores (0-3), based on their immunoexpression in intracellular location (nucleus and/or cytoplasm) and epithelial distribution. Pearson's Chi-square and Fisher's Exact statistical tests were performed for the analysis of the studied parameters. Survival analysis was performed using the Kaplan-Meier method and the log-rank test. For all evaluations, values with p<0.05 were considered significant. High expression of LATS2 was observed both in normal oral mucosa (100%) and in most OTSCC (73,1%), with no statistically significant difference (p=0,160). It was possible to observe the increase in YAP immunoexpression in cases of OTSCC compared to the normal oral mucosa (p<0.001). It was also found that the LATS2 low expression was associated with lower rates of disease-free survival (p=0.039). Furthermore, YAP high expression was found associated with the BD model's high-risk classification (p=0.034), suggesting this protein immunoexpression may be associated with EMT and cell invasion in OTSCC. The high expression of both proteins in most OTSCC suggests that other signaling pathways, in addition to regulating through LATS2, may be inducing the nuclear YAP expression in these tumors. Therefore, it is concluded that the Hippo pathway can influence the OTSCC biological behavior (AU).

Post-radiotherapy recurrence of conventional oral squamous cell carcinoma showing sarcomatoid components: an immunohistochemical study

Spindle cell squamous cell carcinoma (SpSCC) is a rare biphasic malignant neoplasm, uncommonly affecting the oral cavity. The SpSCC diagnosis is difficult, especially when it exhibits inconspicuous morphology, inadequate tissue sampling, or association with an exuberant inflammatory reaction. Post-radiotherapy recurrent SpSCC occurring at the same site of conventional SCC is a rare phenomenon. A 59-year-old man was complained of "painful injury on the tongue" with 20 days of duration. He reported smoking and alcohol consumption. Medical history revealed conventional SCC on the tongue treated with surgery and radiotherapy 10 years ago. Intraoral examination showed a polypoid lesion with ulcerated areas, measuring 3 cm in diameter, on the tongue and floor of the mouth, at the same site of previous conventional SCC. The microscopical analysis showed small foci of carcinomatous component admixed with an exuberant inflammatory reaction. Immunohistochemistry highlighted the sarcomatoid component. Both malignant components were positive for EMA, CD138, p40 (deltaNp63), p63, and p53. Moreover, CK AE1/AE3 evidenced the carcinomatous component, whereas vimentin stained the sarcomatoid component. The Ki-67 was >10%. The current case emphasizes the importance of immunohistochemistry in the differential diagnosis of SpSCC from mimics and documents a rare complication of Ionizing Radiation.

Association of Socio-Demographic and Clinicopathological Risk Factors with Oral Cancers: A 19-Year Retrospective Study

ABSTRACT Objective: To determine the association of socio-demographic and clinic-pathological risk factors with oral cancer in Kelantan, Malaysia. Material and Methods: A 19-year cross-sectional survey was performed in Hospital Universiti Sains Malaysia (HUSM), Malaysia. Medical record of 301 oral cancer patients was retrieved from the Medical Records office. Results: The majority of the oral cancer cases were male (62.8%), non-smokers (57.5%), non-alcohol consumers (83.4%), non-betel quid chewers (96.7%), and belonged to Malay ethnicity (68.8%). At the time of diagnosis, most of the patients were at stage II (38.9%). Approximately one-third (30.6%) of the total OC patients experienced loco-regional/distant metastasis, whereas no metastasis was detected in around two-thirds of cases (69.4%). A combination of surgery and radiotherapy was the most commonly employed treatment modality (27.2%). At the time of this study, the survival status of most of the patients was alive (69.1%). The most frequently encountered oral cancer in the Kelantanese population was oral squamous cell carcinoma (70.1%), with the tongue being the most frequently involved oral cavity site (35.5%). Conclusion: More than three-fourths of the cases were alive at follow-up, which included the cases that did not undergo any form of treatment.

Study of EGFR mutations in head and neck squamous cell carcinomas

Introduction Squamous carcinoma is the commonest malignancy of the head and neck region. It is associated with high morbidity and mortality. Epidermal growth factor receptor (EGFR) regulates downstream signaling pathways through its tyrosine kinase (TK) domains that play a role in cell proliferation and survival. EGFR mutations have been found to occur between exons 18 to 21 on chromosome 7. Limited studies are available on EGFR-TK mutations in the head and neck squamous cell carcinoma (HNSCC) globally. This study explores EGFR mutations in 30 HNSCC cases presenting to a tertiary care hospital over a period of two years. Material and Methods Fresh tumor tissue was collected from the resection specimens of cases of primary HNSCC. Cases with pre-operative therapy were not included. Parameters in the form of patients' age, gender, smoking/tobacco intake, site of the lesion were recorded. Tumor parameters after histopathological examination were recorded in the form of TNM stage, tumor grade. DNA was extracted from fresh tissue of all the cases. EGFR Mutation Analysis Kit assay was used to detect mutations of the EGFR gene. PCR was run and results were analyzed. Results EGFR Mutations were found in 6.7%of the patients. There was no significant association of the EGFR Mutation with the studied parameters. Conclusion EGFR mutations are present in a subset of patients of HNSCC. Patients having these mutations may benefit from targeted therapy with tyrosine kinase inhibitors.

Oral Squamous Cell Carcinoma Associated with Arsenic Exposure: A Case Series from Argentina / Carcinoma Oral de Células Escamosas Asociado con la Exposición al Arsénico: Una Serie de Casos de Argentina

ABSTRACT: Many areas of South America are directly affected by Arsenic (As) contaminated groundwater. A high percentage of the water samples taken in multiple areas of Argentina had As concentrations above the WHO level recommended guidelines. This condition was previously associated with an increased risk of chronic diseases, including different cancers. Long-term As exposure was proposed as a risk factor for Oral Squamous Cell Carcinoma (OSCC). The aim of this study is to present a series cases of Argentine patients diagnosed with OSCC who have consumed water contaminated with As for more than 10 years. Clinical data were obtained from the archive of Clinical Records Histories of the Oral Medicine Department of the Dentistry School, Universidad Nacional de Córdoba and Universidad Católica de Córdoba, Argentina. 15 cases of OSCC were included. The male: female sex ratio was 2:1. The average age was 66 years (31-89 years). Regarding location, the gum or edentulous alveolar ridge was the most prevalent site (6/15; 40 %), followed by the tongue margin. The average years of exposure to arsenical waters were 24 years (13 - 40 years of exposure). The majority of the presented cases were non drinkers non smokers. 60 % of the tumors were diagnosed at advanced stages. the epidemiological studies carried out in As-contaminated areas that address oral cancer should always incorporate the record of variables related to As exposure. Patients who live or lived at As-contaminated areas must be regularly followed up for early diagnosis of potentially malignant or malignant lesions. The high frequency of gum cancer among these cases, should raise awareness of periodontic specialists to perform a careful and thorough periodontal examination.

RESUMEN: Muchas regiones de América del Sur están directamente afectadas por aguas subterráneas contaminadas con arsénico (As). Un alto porcentaje de las muestras de agua tomadas en múltiples áreas de Argentina tenían concentraciones de As superiores al nivel aprobado por la OMS. Esta condición se asociaba previamente con un mayor riesgo de enfermedades crónicas, incluidos diferentes tipos de cáncer. La exposición a largo plazo se propuso como un factor de riesgo para el carcinoma oral de células escamosas (OSCC). El objetivo de este estudio es presentar una serie de casos de pacientes diagnosticados con OSCC que han consumido agua contaminada con As durante más de 10 años. Se obtuvieron datos clínicos del archivo de Historias de registros clínicos del Departamento de Medicina Oral de la Facultad de Odontología, Universidad Nacional de Córdoba y Universidad Católica de Córdoba, Argentina. Se incluyeron 15 casos de OSCC. La relación de género masculino: femenino fue de 2: 1. La edad promedio fue de 66 años (31-89 años). En cuanto a la ubicación, la encía o la cresta alveolar edéntula fue el sitio más frecuente (6/15; 40 %), seguido del borde de la lengua. El promedio de años de exposición a las aguas arsenicales fue de 24 años (13 - 40 años de exposición). La mayoría de los casos presentados fueron de pacientes no bebedores y no fumadores. El 60 % de los tumores fueron diagnosticados en etapas avanzadas. Los estudios epidemiológicos realizados en áreas contaminadas con As que abordan el cáncer oral siempre deben incorporar el registro de variables relacionadas con la exposición a As. Se debe hacer un seguimiento continuo de los pacientes que viven o que vivieron en áreas contaminadas con As para el diagnóstico temprano de lesiones potencialmente malignas. La alta frecuencia de cáncer de encías en estos casos, debe concienciar a los especialistas en periodoncia para que realicen un examen periodontal cuidadoso y completo.

Effect of ethanol extracts of Antrodia cinnamomea on head and neck squamous cell carcinoma cell line

Head and neck squamous cell carcinoma (HNSCC) is one of the most common malignant tumors. Ethanol extract of Antrodia cinnamomea (EEA) has been widely studied for its health benefits including anticancer effects. The purpose of this study was to assess the effects of EEA on HNSCC. Cell proliferation, transwell, and wound healing assays were performed. The impact of EEA on tumor growth was investigated using a xenograft model. Expressions of migration-related proteins (MMP-2, MMP-9, TIMP-1, and TIMP-2) and apoptosis-related proteins (cleaved caspase-9 and cleaved PARP) were determined using western blot analysis. The results indicated that EEA significantly inhibited the capacities of proliferation, invasion, and migration of HNSCC cells in a dose-dependent manner. Cleaved caspase-9 and cleaved PARP expressions were increased in cells treated with an increasing concentration of EEA, which suggested that EEA induced apoptosis of HNSCC. MMP-2 and MMP-9 were downregulated when cells were administered EEA, while TIMP-1 and TIMP-2 were not affected, which uncovered the mechanisms mediating the EEA-induced inhibition on cell invasion and migration. The animal experiment also suggested that EEA inhibited tumor growth. Our study confirmed the inhibitive effects of EEA on cell proliferation, invasion, and migration of HNSCC in vitro and in vivo, providing the basis for further study of the application of EEA as an effective candidate for cancer treatment.

Estudo imuno-histoquímico e in vitro de proteínas do sistema ativador de plasminogênio em carcinomas de células escamosas de língua oral / Immunohistochemical and in vitro study of plasminogen activator system proteins in oral tongue squamous cell carcinomas

O carcinoma de células escamosas (CCE) é a neoplasia maligna mais frequente da cavidade oral e apresenta prognóstico desfavorável. Assim sendo, pesquisas têm buscado esclarecer o papel de biomarcadores no comportamento biológico do CCE oral. Nesta perspectiva, destacam-se o ativador de plasminogênio tipo uroquinase (uPA) e seu receptor (uPAR), além do inibidor do ativador de plasminogênio-1 (PAI-1). O presente trabalho analisou, por meio de imuno-histoquímica, a expressão das proteínas uPA, uPAR e PAI-1 no CCE de língua oral (CCELO) e sua relação com parâmetros clinicopatológicos. Este experimento também avaliou os efeitos in vitro da proteína recombinante humana PAI-1 (rhPAI-1) na linhagem celular SCC25, derivada de CCELO. A imunoexpressão de uPA, uPAR e PAI-1 foi analisada em 60 casos de CCELO, de forma semiquantitativa, nas células neoplásicas do front de invasão tumoral. Visando a associação dos achados imuno-histoquímicos com variáveis clinicopatológicas e taxas de sobrevida, os casos foram classificados nas categorias baixa expressão (≤50% das células positivas) e alta expressão (>50% das células positivas). No experimento in vitro, foram analisados os seguintes grupos: G0 (controle; células cultivadas na ausência de rhPAI-1), G10 (células tratadas com rhPAI-1 a 10 nM) e G20 (células tratadas com rhPAI-1 a 20 nM). Diferenças entre estes grupos foram investigadas através dos ensaios: viabilidade celular (Alamar Blue), ciclo celular (marcação com iodeto de propídio, PI), apoptose/necrose (marcação com Anexina V e PI), atividade migratória (Wound healing) e invasão celular (Transwell). A análise imuno-histoquímica revelou alta expressão do uPA na maioria dos CCELOs, mas sem relações significativas com parâmetros clinicopatológicos. As expressões do uPAR e do PAI-1, em nível membranar, foram associadas a recidivas locais (p=0,019) e ao elevado tumor budding (p=0,046), respectivamente. A expressão membranar do PAI-1 também apresentou associação significativa com o alto escore de risco histopatológico (p=0,043). A análise estatística evidenciou ausência de associações significativas entre as variáveis imunohistoquímicas (uPA, uPAR e PAI-1) e indicadores de prognóstico do CCELO (sobrevida específica e sobrevida livre da doença). No estudo in vitro, decorridas 24 horas da administração da rhPAI-1, os grupos G10 e G20 exibiram maior viabilidade celular em comparação ao grupo controle (p=0,020), assim como aumento da progressão para a fase S do ciclo celular (p=0,024). No que concerne aos percentuais de células apoptóticas e necróticas, não foram encontradas diferenças significativas entre os grupos. Nos grupos celulares cultivados na presença da rhPAI1, também foi constatado aumento da atividade migratória (p=0,039) e do potencial de invasão (p=0,039), respectivamente, nos intervalos de 24 horas e 72 horas. Os achados deste estudo sugerem o envolvimento das proteínas uPA, uPAR e PAI-1 na patogênese do CCELO. Entretanto, a expressão destes biomarcadores pode não estar relacionada com a sobrevida dos pacientes. Os resultados in vitro demonstram que o PAI-1 exerce efeitos estimulatórios na proliferação, migração e invasão celular, podendo assim contribuir para a agressividade biológica do CCELO (AU).

Squamous cell carcinoma (SCC) is the most frequent malignant neoplasm of the oral cavity and has an unfavorable prognosis. Thus, studies have sought to clarify the role of biomarkers in the biological behavior of oral SCC. Within this context, urokinase-type plasminogen activator (uPA) and its receptor (uPAR), as well as plasminogen activator inhibitor 1 (PAI-1), are particularly interesting. The present study analyzed, by means of immunohistochemistry, the expressions of uPA, uPAR and PAI-1 in oral tongue SCC (OTSCC) and their relationship with clinicopathological parameters. This experiment also evaluated the in vitro effects of recombinant human PAI-1 (rhPAI-1) on the OTSCC-derived cell line SCC-25. The immunoexpression of uPA, uPAR and PAI-1 was analyzed semiquantitatively in neoplastic cells of the invasion front of 60 OTSCC cases. Aiming to determine the association between immunohistochemical findings, clinicopathological variables and survival rates, the cases were classified as low expression (≤50% of positive cells) and high expression (>50% of positive cells). The following groups were analyzed in the in vitro experiment: G0 (control; cells cultured in the absence of rhPAI-1), G10 (cells treated with 10 nM rhPAI-1), and G20 (cells treated with 20 nM rhPAI-1). Differences between these groups were investigated using the following assays: cell viability (Alamar Blue), cell cycle (staining with propidium iodide, PI), apoptosis/necrosis (staining with Annexin V and PI), migratory activity (Wound healing), and cell invasion (Transwell). Immunohistochemical analysis revealed high expression of uPA in most OTSCC cases, but there were no significant associations with clinicopathological parameters. The high membrane expression of uPAR and PAI-1 was associated with local recurrence (p=0.019) and high tumor budding (p=0.046), respectively. Membrane expression of PAI-1 also presented a significant association with high-risk cases (p=0,043). Statistical analysis demonstrated no significant associations between the immunohistochemical variables (uPA, uPAR and PAI-1) and prognostic indicators of OTSCC (disease-specific and disease-free survival). In the in vitro experiment, 24 hours after administration of rhPAI-1, G10 and G20 exhibited greater cell viability compared to the control group (p=0.02), as well as increased progression to the S phase of the cell cycle (p=0.024). There were no significant differences in the percentages of apoptotic or necrotic cells between groups. In the groups cultured in the presence of rhPAI-1, migratory activity (p=0.039) and invasion potential (p=0.039) were found to be increased after 24 and 72 hours, respectively. The findings of this study suggest the involvement of uPA, uPAR and PAI-1 in the pathogenesis of OTSCC. Nevertheless, the expression of these biomarkers may not be related to survival of patients. The in vitro results suggest that PAI-1 exerts stimulatory effects on cell proliferation, migration and invasion and may therefore contribute to the biological aggressiveness of OTSCC (AU).

Mortality due to oral and oropharyngeal cancer in Uruguay from 1997 to 2014

Abstract Oral and oropharyngeal cancer is considered a public health problem in several countries due to its high incidence and mortality rate. Objective: This study aimed to analyze oral and oropharyngeal cancer mortality in Uruguay from 1997 to 2014 by age, sex and country region. Methodology: A time series ecological study using secondary data was performed. Data on mortality due to oral and oropharyngeal cancers were obtained from the Vital Statistics Department of Uruguay's Ministry of Public Health. Results: The cumulative mortality rate due to oral and oropharyngeal cancer over the study period was of 19.26/100,000 persons in women and 83.61/100.000 in men, with a mean annual rate of 1.75/100,000 in women and 7.60/100,000 in men. Mortality rate from both sites during the study period was 4.34 times higher in men than in women. Malignant neoplasms of other parts of the tongue and base of tongue showed the highest mortality rate. The means of the annual coefficients of deaths were higher for the age groups between 50 and 69 years. Higher mortality rates of oral and oropharyngeal cancer were observed in Artigas (4.63) and Cerro Largo (3.75). Conclusions: Our study described a high mortality rate for oral and oropharyngeal cancer in Uruguay from 1997 to 2014. According to the country's health department, men, tongue cancer, and oral cavity had higher mortality rates, with some variation. Prevention strategies with control of risk factors and early diagnosis are necessary to improve survival in the Uruguayan population.

Análise dos efeitos biológicos associados ao fator de choque térmico 1 (HSF1) no carcinoma de células escamosas oral / Analysis of the biological effects associated with heat shock factor 1 (HSF1) in oral squamous cell carcinoma

O carcinoma de células escamosas oral exibe altas taxas de morbimortalidade e evidências em vários tipos tumorais mostram que processos associados à iniciação, à progressão e à resistência terapêutica são regulados por HSF1. Portanto, esclarecer as vias de participação de HSF1 no câncer oral pode auxiliar no entendimento do seu comportamento biológico. Em uma pesquisa previamente desenvolvida por nosso grupo, foram realizados a análise clinicopatológica e o estudo da imunoexpressão de HSF1 em 70 casos de carcinoma de células escamosas de língua oral (CCELO) em comparação com 30 espécimes de mucosa oral normal (MON). Nesta atual investigação, avaliou-se a participação de HSF1 na tumorigênese do CCELO, através de experimentos in vitro com a linhagem celular SCC15, silenciada e não silenciada, com silenciamento confirmado por qRT-PCR e Western Blot. Foram analisadas a viabilidade e proliferação celular, (CellTiter e BRDU, respectivamente), influência no ciclo celular (iodeto de propideo e análise por citometria de fluxo), capacidade de invasão (sistema transwell/Matrigel)e transição epitélio-mesenquimal (TEM) (expressão de E-caderina e vimentina por qRT-PCR). Nossos resultados anteriores evidenciaram que quanto aos casos de CCELO, 57,1% exibiram estadiamento clínico III ou IV, 82,9% foram gradados como de alto grau segundo Bryne (1998), 47,1% como de alto risco segundo Brandwein-Gensler et al. (2005) e 58,8% como de alto risco de acordo com o modelo BD. Observou-se repercussão da gradação de Bryne (1998) (p= 0,05) na sobrevida livre de doença. Tamanho do tumor T3 ou T4 (p= 0,04), recidiva local (p= 0,02) e modelo BD (p=0,02) repercutiram na sobrevida global. Encontrou-se previamente resultado significativo (p<0,01) quando se comparou a imunoexpressão de HSF1 entre a MON e o CCELO, sem associações significativas da imunoexpressão com os parâmetros clinicopatológicos. A partir dos estudos funcionais, observou-se que HSF1 é superexpresso na linhagem SCC15 comparada aos queratinócitos imortalizados (p<0,005) e que o silenciamento deste gene inibiu a proliferação celular (p< 0,005), avanço nas fases do ciclo celular, com aumento do número de células nas fases G0/G1 (p<0,01) e redução das células na fase S (p<0,001), capacidade de invasão (p<0,05) e TEM, com diminuição da expressão de vimentina (p<0,001) e aumento de E-caderina (p<0,05), quando comparadas as linhagens silenciada e controle. Diante destes resultados, sugere-se que HSF1 pode desempenhar diversas funções que ajudam a manter a estabilidade celular em meio às condições estressoras do microambiente tumoral. Assim, futuramente, estratégias envolvendo sua regulação pode ser uma terapia útil no controle da progressão do câncer oral (AU).

Oral squamous cell carcinoma exhibits high rates of morbimortality and evidence in several tumor types shows that processes associated with initiation, progression and therapeutic resistance are regulated by HSF1. Therefore, to clarify the pathways of HSF1 participation in the oral cancer may help in the understanding of its biological behavior. In research previously developed by our group, a clinicopathological analysis and an immunoexpression study of HSF1 of 70 cases of oral tongue squamous cell carcinoma (OTSCC) were performed in comparison with 30 samples of the normal oral mucosa (NOM). In this current investigation, the role of HSF1 in OTSCC tumorigenesis was evaluated, through in vitro experiments with the SCC15 cell line, silenced and non-silenced, with silencing confirmed by qRT-PCR and Western Blot. Cell viability and proliferation (CellTiter and BrdU, respectively), influence on cell cycle (propidium iodide and flow cytometry analysis), invasion capacity (transwell / Matrigel system), and epithelial-mesenchymal (EMT) (expression of E-cadherin and vimentin by qRT-PCR) were evaluated. Our previous results showed that as for the cases of OTSCC, 57.1% exhibited clinical stage III or IV, 82.9% were graded as high grade according to Bryne (1998), 47.1% as high risk according to BrandweinGensler et al. (2005) and 58.8% as high risk according to the BD model. Bryne's gradation (1998) (p = 0.05) had an impact on disease-free survival. Tumor size T3 or T4 (p = 0.04), local recurrence (p = 0.02) and BD model (p = 0.02) impacted overall survival. A significant initial result (p <0.01) was found when comparing an HSF1 immunoexpression between NOM and OTSCC, with no significant association of immunoexpression with clinicopathological tests. From the functional studies, it was observed that HSF1 is overexpressed in the SCC15 cell line compared to immortalized keratinocytes (p <0.005) and that the silencing of this gene inhibited cell proliferation (p <0.005), advance in the cell cycle phases, with an increase in the number of cells in phases G0/G1 (p <0.01) and reduction of cells in phase S (p <0.001), invasion capacity (p <0.05) and EMT, with decreased vimentin expression (p <0.001) and increased E-cadherin (p <0.05), when compared to silenced and control lines. Given these results, it is suggested that HSF1 can exert a range of functions that maintain cell stability amid the stressful conditions of the tumor microenvironment. Thus, in the future, strategies involving its regulation may be a useful therapeutic tool in controlling the progress of the oral cancer (AU).

Immunoexpression of human leukocyte antigen-DR in actinic cheilitis and lower lip squamous cell carcinoma

Abstract The aim of this study was to evaluate the immunoexpression of human leukocyte antigen-DR (HLA-DR) in actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC), and to correlate the findings with clinical (tumor size/extent, regional lymph node metastasis, and clinical stage) and histopathological (grade of epithelial dysplasia and inflammatory infiltrate for AC and histopathological grade of malignancy for LLSCC) parameters. Twenty-four AC and 48 LLSCC cases (24 with regional nodal metastasis and 24 without regional nodal metastasis) were selected. The scores of immunopositive cells for HLA-DR in the epithelial component of the lesions were assessed and the results were analyzed statistically using the nonparametric Mann-Whitney test. Epithelial expression of HLA-DR was observed in only five (20.8%) cases of AC (two low-grade and three high-grade lesions), with a very low median score of immunopositivity. By contrast, expression of HLA-DR was found in most LLSCC (97.9%), with a relatively high median score of positive cells. The score of HLA-DR-positive cells tended to be higher in tumors with regional lymph node metastasis, tumors in advanced clinical stages, and low-grade tumors, but the difference was not statistically significant (p > 0.05). In addition, there was a tendency towards higher expression of HLA-DR in highly/moderately keratinized tumors, and tumors with little/moderate nuclear pleomorphism (p > 0.05). The results suggest a potential role of HLA-DR in lip carcinogenesis, particularly in the development and progression of LLSCC. The expression of this protein can be related to the degree of cell differentiation in these tumors.

Sobrevida e fatores prognóstico do Carcinoma Epidermóide de Boca e Orofaríngeo: análise de 1776 casos / Survival and prognostic factors of oral and oropharyngeal squamous cell carcinoma: analysis of 1776 cases

O carcinoma epidermóide (CE), destaque para o de boca (CEB) e orofaríngeo (CEOf), é o tipo de câncer mais frequente na região de cabeça e pescoço, com mais de 90% de apresentação nessas regiões, representando 6% de todos os carcinomas. Avaliação epidemiológica dessa patologia com base populacional ainda é escassa e essa neoplasia é um problema de saúde pública no Brasil e no mundo. Diante desses fatos, este estudo tem o propósito de descrever e analisar a sobrevida com destaque para os principais fatores associados ao seu prognóstico. Para isso foi realizado um estudo de prognóstico retrospectivo em bancos de dados e prontuários, onde foram selecionados todos os casos com diagnóstico de CEB e CEOf da Liga Norte Riograndense Contra o Câncer, dos últimos 11 anos. As sobrevidas foram calculadas com Kaplan-Meier e comparação das funções com Log-Rank. Os riscos calculados em modelos univariados de Cox e modelos preditivos na análise multivariada de Cox. Para Sobrevida Livre da Doença (SLD) do CEB destacaram-se como fatores de pobre prognóstico, o Sistema de Gradação Histopatológica de Malignidade (SGHM) da Organização Mundial da Saúde (OMS) em pouco diferenciada, localização na região retromolar, não ter companheiro conjugal, estadiamento avançados e tratamentos mais complexos. Essas características se repetiram na Sobrevida Global (SG) para CEB, com exceção do estado conjugal atual. Na SG do CEOf, a localização em base de língua e o consumo de álcool obtiveram os piores prognósticos. Já para SLD do CEOf, o SGHM OMS em pouco diferenciado, tabagismo e não ter companheiro conjugal, obtiveram os piores prognósticos. O SGHM OMS parece ser um fator prognóstico eficaz para o CEB. Não ter companheiro pode comprometer a SLD (CEB e CEOf), com repercussão na qualidade de vida do paciente, adesão e manutenção do tratamento. Os fatores de riscos já bem estabelecidos, como consumo de álcool e fumo, parecem se comportar como fatores prognóstico importantes no CEOf, mas devem ser abordados com cautela, principalmente quando não verifica-se o tipo, tempo e quantidade utilizados. Mesmo com a melhora na sobrevida do CEO e CEOf mediante avanços no tratamento, ela ainda preocupa a medida que aumenta a dificuldade do diagnóstico (Lábio>Oral>Orofaringe). Tanto para CEB como para o CEOf as sobrevidas foram consideradas medianas, reafirmando fatores prognósticos já bem estabelecidos, como estadiamento clínico e localização, outros ainda controversos, como SGHM, habito de fumar e de beber, ganharam força como fatores prognósticos independentes e um coadjuvante inesperado, o estado conjugal atual (AU).

The most common type of cancer in the head and neck region is the squamous cell carcinoma (SCC), which is more frequent in the mouth (SCCM) and oropharyngeal (SCCO), with a presentation of more than 90% in these regions, representing 6% of all carcinomas. Epidemiological evaluation of this population-based pathology is still scarce and this neoplasm is a public health problem in Brazil and in the world. Faced with these facts, this study aims to describe and analyze survival, highlighting the main factors associated with its prognosis. For this, a retrospective prognostic study was carried out in databases and medical records, where all the cases diagnosed with SCCM and SCCO of the North League Riograndense Against Cancer of the last 11 years were selected. Survival were calculated with Kaplan-Meier and comparison of functions with Log-Rank. The risks calculated in univariate Cox models and predictive models in the multivariate analysis of Cox. For SCCM's Disease Free Survival (DFS) the poor prognostic factors, the histopathological gradation system of malignancy (HGSM) of the World Health Organization (WHO) in little differentiated, location in the retromolar region, not having conjugal companion, advanced staging and more complex treatments. These characteristics were repeated in the Global Survival (GS) for SCCM, with the exception of the current marital status. In the GS of the SCCO, localization in basis of language and alcohol consumption obtained the worst prognoses. Already for DFS of SCCO, the HGSM in little differentiated, smoking and having no marital partner, obtained the worst prognoses. The HGSM appears to be an effective prognostic factor for SCCM. Not having a partner can compromise DFS (SCCM and SCCO), with repercussion on patient's quality of life, adherence and maintenance of treatment. Wellestablished risk factors, such as alcohol and smoking, seem to be important prognostic factors in SCCO, but should be approached with caution, especially when the type, time, and quantity used are not checked. Even with the improvement in the SCCM's and SCCO's survival through advances in treatment, she is still worrisome, as the difficulty of diagnosis increases (Lip> Oral> Oropharynx). Both SCCM and SCCO were considered median, reaffirming already well established prognostic factors, such as clinical staging and localization, others still controversial, such as HGSM, smoking and drinking habits, gained strength as independent prognostic factors and an unexpected coadjutant, the current marital status. Keywords: Epidermoid carcinoma; mouth; oropharynx; prognosis (AU).

Imunoexpressão das proteínas APE1, XRCC1, p53 e Ki67 em carcinoma de células escamosas de língua oral / Immunoexpression of APE1, XRCC1, p53 and Ki67 proteins in oral tongue squamous cell carcinoma

O carcinoma de células escamosas oral (CCEO) resulta de processos de descontroles de eventos celulares provocados por mutações decorrentes de agentes genotóxicos, o que pode levar, dentre outros fatores, à perda de controle do processo de proliferação celular, sendo este considerado um dos precursores do câncer oral. A busca por biomarcadores para o CCEO constitui alvo de várias pesquisas, dentre as quais destacam-se proteínas de reparo do DNA como a XRCC1 e APE1 e proteínas do ciclo celular como p53 e Ki67. Assim, o objetivo desta pesquisa foi analisar a expressão imunoistoquímica das proteínas de reparo APE1, XRCC1 e das proteínas envolvidas no ciclo celular p53 e ki67, associando-as entre si e com parâmetros prognósticos clínicos e histopatológicos, em carcinoma de células escamosas de língua oral (CCELO), visando contribuir para o melhor entendimento da participação dessas proteínas no desenvolvimento desta neoplasia. A expressão imunoistoquímica de APE1 e XRCC1 foi avaliada de forma semiquantitativa e a de p53 e ki67 de forma quantitativa, em 58 casos de Carcinoma de células escamosas de língua oral (CCELO). Os dados clínicos foram coletados nos prontuários médico de cada paciente e a gradação histopatológica de Brandwein-Gensler efetuada para cada caso. Para a análise estatística foram realizados os testes de Qui-quadrado e Exato de Fisher e adotou-se significância de p<0,05. A maioria dos casos apresentou alta imunoexpressão para APE1 (n = 36; 62,1%), assim como para XRCC1 (n = 38; 65,5%). Já para as proteínas Ki67 e p53, houve uma distribuição igual quando os casos foram categorizados em baixa e alta expressão (n = 29, 50%). A imunoexpressão de XRCC1 foi significativamente maior nos casos de lesão em estágio inicial I e II (n = 23; 62,2%) em relação aos estágios avançados III e IV (n=16, 80%, p = 0,05). A imunoexpressão de p53 foi significativamente maior nos casos de lesão em estágio avançado (n = 19; 65,5%) e baixa em estágios iniciais (n=17, 60,7%; p = 0,047). Nenhuma das proteínas estudadas mostrou associação entre si, nem com os demais parâmetros clínicos e a gradação histopatológica. Apesar da associação significativa da maior imunoexpressão de XRCC1 com melhor estadiamento clínico e da p53 com o pior estadiamento clínico, estas não foram embasadas quando analisado o desfecho dos pacientes. Os resultados desta pesquisa indicam que XRCC1 e APE1 participam do processo de carcinogênese do CCELO, porém, a expressão imunoistoquímica destas e de p53 e Ki67 não mostraram associação com parâmetros prognósticos (AU).

Oral squamous cells carcinoma (OSCC) results from processes of decontrol of cellular events caused by mutations due genotoxic agents, which may lead, among other factors, to loss of control of the cellular proliferation process, being considered as one of the precursors of oral cancer. Searching biomarkers for OSCC is the target of several studies, among the markers it is highlighted the DNA repair proteins, such as XRCC1 and APE1, and cell cycle proteins, such as p53 and Ki67. Thus, the aim of this study was to analyze the immunohistochemical expression of APE1, XRCC1 and the proteins involved in the cell cycle, p53 and ki67, associating them with clinical and histopathological prognostic parameters in oral tongue squamous cell carcinoma (OTSCC), in order to contribute to the better understanding of the participation of these proteins in the development of this neoplasia. The immunohistochemical expression of APE1 and XRCC1 was evaluated semiquantitatively and the expression of p53 and ki67 quantitatively, in 58 cases of OTSCC. Clinical data were collected from the medical records of each patient and the histopathological grading of Brandwein-Gensler was carried out for each case. For the statistical analysis, Chi-square and Fisher's exact test were performed, and significance was set at p <0.05. The majority of cases showed high immunoexpression of APE1 (n = 36; 62.1%), as well as of XRCC1 (n = 38; 65.5%). In relation to the Ki67 and p53 proteins, there was an equal distribution when the cases were categorized into low and high expression (n = 29, 50%). XRCC1 immunoexpression was significantly higher in cases of early stage lesions I and II (n = 23; 62.2%) compared to advanced stages III and IV (n = 16, 80%, p = 0.05). The Immunoexpression of p53 was significantly higher in cases of advanced lesion (n = 19; 65.5%) and low in early stages (n = 17, 60.7%, p = 0.047). None of the studied proteins showed association with each other, nor with the other clinical parameters and histopathological grading. Despite the significant association of the highest XRCC1 immunoexpression with better clinical staging and of p53 with the worst clinical staging, these results were not supported when the patients' outcome were analyzed. The results of this study indicate that XRCC1 and APE1 participate in the process of carcinogenesis of OTSCC, but the immunohistochemical expression of these proteins and also p53 and Ki67 did not show any association with prognostic parameters (AU).

Vesículas extracelulares derivadas de macrófagos alteram o potencial de invasão, proliferação e migração de linhagens celulares do carcinoma de células escamosas de língua oral / Macrophage-derived extracellular vesicles alter the potential for invasion, proliferation, and migration of oral tongue squamous cell carcinoma cell lines

O câncer é composto pelas células malignas em proliferação associadas às diferentes células circunjacentes, formando o microambiente tumoral (TME), onde há uma constante troca de informações. Uma das formas de comunicação entre os diferentes tipos celulares do TME se dá por meio da liberação de vesículas extracelulares (EVs), um campo de estudo ainda pouco explorado. O presente estudo se propôs a avaliar os efeitos das EVs liberadas por macrófagos do TME, células altamente plásticas em seu fenótipo (M1 ­ perfil antitumoral; M2 ­ perfil pró-tumoral), em diferentes linhagens do carcinoma de células escamosas de língua oral (CCELO) no tocante à capacidade invasiva, proliferativa e migratória. Foi observado que as amostras de EVs extraídas dos macrófagos eram relativamente puras em EVs, porém subtipo inespecíficas. No ensaio de invasão em miomas, quando colocadas as células inflamatórias em cocultura com as células HSC-3, as células M1 inibiram a invasão e M2 aumentaram a capacidade invasiva das células malignas. Por outro lado, o tratamento com M1 EVs aumentou a capacidade invasiva das células HSC-3 e o tratamento com EVs de M2 inibiu a invasão dessas células, sendo observado um perfil semelhante nas células SCC-25 e SAS quando submetidas aos mesmos tratamentos. Na análise do marcador Ki-67 nos miomas, tanto as células HSC-3 quanto SCC-25 e SAS apresentaram o mesmo padrão de proliferação independentemente do tratamento utilizado, quando comparados com os respectivos controles negativos. Quando analisada a proliferação das células malignas no IncuCyte®, tratadas com EVs dos diferentes tipos de macrófagos em diferentes concentrações, foi identificado um aumento na capacidade proliferativa de células HSC-3 e SAS tratadas com M1 EVs em um padrão dose dependente. Um aumento da capacidade proliferativa seguindo um padrão dose dependente também ocorreu quando as células SAS foram tratadas com M2 EVs. Nos demais ensaios de proliferação no IncuCyte® também foram identificados efeitos na capacidade proliferativa, no entanto um padrão dose dependente não foi observado. No ensaio de migração no IncuCyte®, foram identificadas diferenças significativas na capacidade migratória de células SCC-25 e SAS tratadas com diferentes tipos de EVs nas diferentes concentrações, quando comparadas ao controle negativo. Os achados deste estudo sugerem que as EVs derivadas de macrófagos são fatores importantes na tumorigênese do CCELO, bem como abre discussões sobre os diferentes efeitos das células inflamatórias no TME a depender do tipo de comunicação celular executada (AU).

Cancer is an entity composed of proliferating malignant cells associated with the different types surrounding cells, forming the tumor microenvironment (TME), where there is a constant exchange of information. One of the ways of communicating between different types of TME cells is through the release of extracellular vesicles (EVs), a field of study that remains poorly understood. The aim of the present study was to evaluate the effects of EVs released from TME macrophages, which are cells highly plastic in their phenotype (M1 showing an anti-tumor profile and M2 exhibiting a pro-tumor profile) in different cell lines of tongue squamous cells carcinoma (TSCC) regarding to invasive, proliferative and migratory capacity. It was observed that EVs samples obtained from macrophages were relatively pure in EVs, although they were non-specific subtypes. In the myoma invasion assay, it was observed that when inflammatory cells were co-cultured with HSC-3 cells, M1 cells inhibited invasion and M2 increased the invasive ability of the malignant cells. On the other hand, treatment with M1 EVs increased the invasive capacity of HSC-3 cells, and treatment with M2 EVs inhibited the invasion of these malignant cells, and a similar profile was observed in SCC-25 and SAS cells when they were submitted to the same treatments. In the analysis of the Ki-67 marker in myomas, HSC-3, SCC-25 and SAS cells showed the same proliferation pattern regardless the type of the treatment used when compared to the respective negative controls. When it was analyzed the proliferation of malignant cells in IncuCyte® treated with EVs derived from different types of macrophages at different concentrations, an increase in the proliferative ability of HSC-3 and SAS cells treated with M1 EVs was observed in a dosedependent pattern. An increase in proliferative ability in dose-dependent profile was also observed when SAS cells were treated with M2 EVs. In the other proliferation assays performed in IncuCyte®, effects on proliferative capacity were also highlighted, however a dose-dependent pattern was not observed. In the IncuCyte® migration assay, significant differences were observed in the migration capacity of SCC-25 and SAS cells treated with different types of EVs at different concentrations when compared to the negative control. The findings of this study suggest that macrophages-derived EVs are pivotal factors in TSCC tumorigenesis, as well as permits discussions on the different effects of inflammatory cells on TME depending on the type of cell communication performed (AU).

Resposta imune e mecanismos de evasão na carcinogênese de lábio: um estudo imunoistoquímico / Immune response and evasion mechanisms in lip carcinogenesis: an immunohistochemical study

A vigilância imunológica, principalmente mediada por linfócitos T CD8+ , reconhece e destrói células malignas ou alteradas. Contudo, através de estratégias imunossupressoras, como as vias de sinalização do ligante de morte celular programada-1 (PD-L1) e do antígeno leucocitário humano-G (HLA-G), estas células mutadas conseguem escapar da resposta imune antitumoral. Este estudo investigou a imunoexpressão de PD-L1, HLA-G, CD8 e granzima B (GrB) no microambiente de carcinomas de células escamosas (CCEs) de lábio (n = 40), de queilites actínicas (QAs; n = 55) e de mucosa labial saudável (MLS; n = 10). As amostras foram submetidas à técnica da imunoistoquímica e as análises das imunomarcações seguiram métodos semi-quantitativos (PD-L1 e HLA-G) e quantitativos (CD8 e GrB). A expressão das proteínas foi comparada entre os três grupos de amostras, bem como com parâmetros clinicopatológicos das lesões e sobrevida global dos pacientes com CCE de lábio. A correlação entre as proteínas e o tipo do microambiente tumoral de acordo com a presença de PD-L1 e CD8 também foram avaliados. Os testes estatísticos incluíram o exato de Fisher, Mann-Whitney, Kruskal-Wallis, correlação de Spearman e log-rank para comparação das curvas de sobrevida global construídas pelo método Kaplan-Meier. O nível de significância foi estabelecido em 5%. Os números de células CD8+ e GrB+ aumentaram progressivamente de MLS para CCEs de lábio, com QAs exibindo números intermediários (p < 0,01). A menor expressão dessas proteínas foi associada à metástase para linfonodos e tumores pobremente diferenciados (p < 0,05). A expressão de PD-L1 e HLA-G em células neoplásicas/ceratinócitos e estroma/tecido conjuntivo foi significativamente maior em CCEs de lábio e QAs, em comparação com MLSs (p < 0,05). PDL1 não foi significativamente associado aos aspectos clinicopatológicos das lesões. A maioria dos CCEs de lábio mostrou coexistência de células PD-L1+ e CD8+ (72,5%) no microambiente tumoral. A expressão de PD-L1 foi diretamente correlacionada à infiltração linfocítica CD8+ e GrB+ em CCEs de lábio (p < 0,05). A expressão das proteínas não foi associada com a sobrevida global dos pacientes com CCEs de lábio (p > 0,05). Nossos achados sugerem que as moléculas imunossupressoras PD-L1 e HLA-G estão consistentemente expressas desde QAs e se mantém até fases avançadas dos CCE de lábio. A correlação entre a expressão de PD-L1 e a expressão de CD8 e GrB nos carcinomas sugere que PD-L1 pode surgir como um mecanismo de escape frente a uma resposta antitumoral ativa (AU).

Immune surveillance, mainly mediated by CD8 + T lymphocytes, recognize and destroy malignant or altered cells. However, through immunosuppressive strategies, such as the signaling pathways of the programmed cell death ligand-1 (PD-L1) and human leukocyte antigen-G (HLA-G), these mutated cells often escape the antitumor immune response. The aim of this study was to investigate and compare the immunoexpression of PD-L1, HLA-G, CD8 and granzyme B (GrB) in the microenvironment of lip squamous cell carcinomas (LSCCs; n = 40), actinic cheilitis (ACs; n = 55), and healthy lip mucosa (HLM; n = 10). The samples were submitted to immunohistochemistry and the analysis followed a semi-quantitative (PD-L1 and HLA-G) and quantitative methods (CD8 and GrB). Protein expression was compared between the three groups of samples, as well as with the lesion's clinicopathologic parameters and overall survival of patients with LSCC. Correlation between proteins and the type of tumor microenvironment according to a presence of PD-L1 and CD8 were also evaluated. Statistical tests included Fisher's exact, Mann-Whitney, Kruskal-Wallis, Spearman's correlation, as well as the log-rank for comparison of the overall survival built through Kaplan-Meier method. Significance was set at p < 0.05. The CD8+ and GrB+ cell numbers progressively increased from HLMs to LSCCs, with ACs exhibiting intermediate numbers (p < 0.01). Lower expression of these proteins was associated with lymph node metastasis and poor tumor differentiation (p < 0.05). PD-L1 and HLA-G expression in neoplastic cells/keratinocytes and stroma/connective tissue was significantly higher in LSCCs and ACs, compared to HLMs (p < 0.05). PD-L1 was not significantly associated with clinicopathological aspects of the lesions. Most LSCCs showed coexistence of PD-L1+ and CD8+ cells (72.5%) in the tumor microenvironment. PDL1 was directly correlated to CD8+ and GrB+ lymphocytic infiltration in LSCCs (p < 0.05). Proteins expression was not associated with overall survival of LSCCs patients (p > 0.05). Our findings suggest that immunosuppressive molecules PD-L1 and HLA-G are consistently expressed from ACs and are maintained until advanced stages of LSCCs. The correlation between PD-L1 expression and the expression of CD8 and GrB in carcinomas suggests that that PD-L1 may appear as an escape mechanism against an active antitumor response (AU).

Análise da forma fosforilada do fator de choque térmico 1 (pHSF 1) em carcinomas de células escamosas de língua oral / Analysis of the phosphorylated form of heat shock factor 1 (pHSF 1) in oral tongue squamous cell carcinomas

O carcinoma de células escamosas de língua oral (CCELO) apresenta altas taxas de morbimortalidade, apesar dos avanços recentes no tratamento das neoplasias. Assim, várias pesquisas vêm tentando detectar alterações morfológicas ou identificar biomarcadores que possam apresentar poder preditivo de recidiva e metástase e novas estratégias e/ou opções terapêuticas mais individualizadas com intuito de melhorar o prognóstico destes pacientes. O fator do choque térmico 1 (HSF1) atua de diferentes formas na progressão tumoral, favorecendo o surgimento, desenvolvimento e invasividade tumoral e sua superexpressão vem sendo pesquisada em neoplasias. Esta pesquisa objetivou analisar se a forma fosforilada do fator de choque térmico 1 (p-HSF1) exerce alguma influência na patogênese do CCELO. Foi realizado um estudo imunoistoquímico em 69 casos de CCELO, verificando-se a expressão do p-HSF1 e correlacionado esta imunoexpressão com alguns parâmetros clinicopatológicos e sobrevida dos pacientes. Foi avaliado e comparado o escore de imunopositividade do p-HSF1 entre CCELO e mucosa oral normal (MON) e esta expressão foi ainda correlacionada aos sistemas de gradação histológica propostos por Brandwein-Gensler et al. (2005) e pelo modelo BD (ALMANGUSH et al., 2014). As curvas de associação de análise de sobrevida aos outros parâmetros foram realizadas pelo método Kaplan Meier e as diferenças dessas curvas submetidas ao teste log-rank (p<0,05). Verificou-se maior escore de imunoexpressão (p<0,001) de p-HSF1 em CCELOs em relação a MON, sugerindo que esse fator pode influenciar a patogênese destes tumores. A imunoexpressão do p-HSF1 não foi associada aos parâmetros clinicopatológicos pesquisados nesta amostra. O tamanho do tumor (T) T3/T4 foi associado ao alto risco tanto pelo sistema de Brandwein-Gensler et al. (2005) quanto pelo modelo BD (ALMANGUSH et al., 2014), sugerindo que tumores maiores podem ser associados a piores parâmetros histopatológicos. Os resultados da análise por meio do método BD, mostraram relevância prognóstica, uma vez que pacientes classificados como de alto risco por este sistema, foram associados a uma menor sobrevida global e maior número de óbitos, sugerindo sua possível inclusão como uma ferramenta útil na determinação do prognóstico de pacientes com CCELO (AU).

The squamous cell carcinoma (SCC) of the oral tongue presents morbimortality high levels although recent achievements of malignancies treatment. This way, a lot of researches are trying to detect morphological alterations or identify biomarkers that may present recurrence prediction power and metastasis and new strategies and/or more individualized therapeutic options in order to improve the prognosis of these patients. The Heat shock factor 1 (HSF1) acts in different ways of tumoral progressing, facilitating the appearance, development and tumoral invasiveness and its overexpression has been researched in malignancies. This research had the aim to analize if the phosphorylated form of Heat shock factor 1 (p-HSF1) carries some influence in the SCC of the oral tongue pathogenesis. There was an immunohistochemical study in 69 cases of oral tongue squamous cell carcinoma observing the p-HSF1 expression and correlating this immunoexpression with some clinicopathological parameters and patients' survival. It was evaluated and compared the immunohistochemical score of the p-HSF1 between the squamous cell carcinoma (SCC) of the oral tongue and normal oral mucosa (MON) and this expression was correlated to the histological gradation systems proposed by Brandwein-Gensler et al. (2005) and by the model BD (ALMANGUSH et al., 2014). Survival analysis of association curves with the other parameters were carried out with the Kaplan Meier method and the differences of these curves submitted to the test logrank (p<0,05). It was found a bigger immunoexpression score (p<0,001) of p-HSF1 in squamous cell carcinoma (SCC) of the oral tongue in relation to the MON, suggesting this factor may influence the tumors pathogenesis.. The tumor size ( T ) T3/ T4 was associated to the high risk not only by system of Brandwein-Gensler et al. (2005) as by model BD (ALMANGUSH et al., 2014), suggesting bigger tumors may be associated to worse histopathological parameters. The analysis result through the BD method, showed prognostic implication, since as patients classified as high risk by this system were associated to a smaller global survival and bigger death number, suggesting its possible inclusion as a useful tool in the prognosis determination of patients with squamous cell carcinoma (SCC) of the oral tongue (AU).

Estaniocalcina 2 modula eventos importantes para a tumorigênese oral e é um marcador prognóstico para pacientes com carcinoma de células escamosas oral / Staniocalcin 2 modulates important events for oral tumorigenesis and is a prognostic marker for patients with oral squamous cell carcinoma

O hormônio glicoproteico estaniocalcina 2 (STC2) está envolvido na carcinogênese e progressão de muitos tipos de câncer. No entanto, seu significado clínico e mecanismos moleculares no carcinoma de células escamosas oral (CCEO) foram pouco estudados e permanecem incertos. O presente estudo investigou associações da expressão da STC2 com parâmetros clinicopatológicos e de sobrevida em pacientes com CCEO. Além disso, foram avaliados os efeitos biológicos causados pela redução dos níveis de STC2 em linhagens celulares de CCEO e fibroblastos associados ao câncer (do inglês CAF ­ carcinoma associated fibroblasts). A análise imunoistoquímica em 100 casos de CCEOs primários indicou que a superexpressão da STC2 foi associada com o parâmetro N do sistema TNM e foi um fator de risco independente para sobrevida específica da doença e sobrevida livre de doença em pacientes com CCEO. Usando ensaios in vitro, foi demonstrado que o silenciamento da STC2 em linhagens de CCEO promoveu a apoptose e reduziu a proliferação celular, migração, invasão e transição epitélio-mesenquimal. Análises adicionais revelaram que o CAF expressa maiores níveis de STC2 do que as células de CCEO. O silenciamento da STC2 no CAF reduziu a invasão celular do CCEO, sugerindo que a STC2 liberada por CAFs contribui para um fenótipo mais invasivo no CCEO. Esses resultados sugerem que a STC2 modula eventos importantes para a tumorigênese oral e pode ser um biomarcador prognóstico para pacientes com CCEO (AU).

The glycoprotein hormone stanniocalcin 2 (STC2) is involved in carcinogenesis and progression of several cancer types. However, its clinical significance and molecular mechanisms in oral squamous cell carcinoma (OSCC) have been partially studied and remain uncertain. In the present study, we investigated associations of STC2 expression with clinicopathological and survival parameters of OSCCs patients. We also determined the biological effects caused by STC2 downregulation in OSCC and cancer associated fibroblasts (CAF) cell lines. Immunohistochemical analysis in 100 cases of primary OSCC indicated that STC2 overexpression was associated with N stage (TNM staging) and was an independent risk factor for disease-specific survival and disease-free survival in patients with OSCC. Using in vitro assays, we demonstrated that STC2 knockdown in OSCC cell lines promoted apoptosis, and reduced cell proliferation, migration, invasion and epithelial-mesenchymal transition. Further analysis revealed that CAF expresses higher levels of STC2 than OSCC cells. Knockdown of STC2 in CAF reduced OSCC cell invasion, suggesting that STC2 released by CAF contributes to a more invasive phenotype in OSCC. These results suggest that STC2 modulates important events for oral tumorigenesis and can be a prognostic biomarker for OSCC (AU).

Análise do papel dos exossomos derivados das linhagens celulares SCC-15 e HSC-3 no processo de angiogênese tumoral / Analysis of the role of exosomes derived from cell lines SCC-15 and HSC-3 in the process of tumor angiogenesis

Os exossomos são vesículas extracelulares originadas por brotamento interno da membrana de endossomos tardios que representam uma eficiente forma de comunicação intercelular. Devido às suas múltiplas funções biológicas, o foco de alguns estudos atuais tem se concentrado na análise do seu papel no desenvolvimento do câncer, progressão da doença, invasão, angiogênese e formação de metástases tumorais. Nesta perspectiva, o presente estudo objetivou caracterizar os exossomos secretados por duas linhagens celulares de carcinomas epidermoide oral (CEO) (SCC-15 e HSC-3) e avaliar seus efeitos sobre uma linhagem de células endoteliais (HUVEC), em relação à sua capacidade de formação de estruturas vasculares, taxas de migração, proliferação e índices de apoptose/necrose. Médias significativamente maiores de células com potencial invasivo (p<0,0001) e migratório (p<0,0001) foram observadas para a linhagem HSC-3. Ultraestruturalmente, verificou-se que as partículas derivadas da linhagem SCC-15 exibiram morfologia arredondada e diâmetro inferior a 150 nm. Nenhuma diferença estatisticamente significativa foi revelada entre as linhagens celulares estudadas, considerando a quantificação de nanovesículas (p=0,2252) e tamanho exossomal (p=0,1765). Por imunofluorescência indireta, identificou-se que 22,15% dos exossomos secretados pelas células SCC-15 e 18,37% dos exossomos derivados da linhagem HSC-3 expressaram o anticorpo anti-Anexina. No que se refere aos ensaios funcionais com as HUVECs, o tratamento com exossomos derivados da linhagem SCC-15 induziu um aumento significativo da capacidade de formação de estruturas vasculares (p<0,0001), potencial migratório (p=0,0016) e taxa de apoptose (p<0,0001), enquanto que uma redução da proliferação celular foi apontada (p=0,0030). Por outro lado, o tratamento com exossomos secretados pela linhagem HSC-3 promoveu uma redução significativa da formação tubular (p<0,0001), motilidade (p=0,0042) e proliferação celular (p=0,0010), ao passo que nenhuma diferença estatisticamente significativa foi observada no índice apoptótico (p=0,3004). Os resultados do presente estudo indicaram a participação dos exossomos derivados de linhagens de CEO no processo de angiogênese tumoral, onde as células SCC-15 exibiram forte resposta proangiogênica e a linhagem HSC-3 demonstrou efeito antiangiogênico (AU).

Exosome are extracellular microvesicles originated by inward budding of late endosomal membrane that represent an efficient form of intercellular communication. Because of its multiple biological functions, the focus of some recent studies has concentrated on the analysis of its role in cancer development, disease progression, invasion, angiogenesis and tumor metastasis formation. In this perspective, the present study aimed to characterize the secreted exosomes by two cell lines of oral squamous cell carcinomas (OSCC) (SCC-15 and HSC-3) and to evaluate its effects on a cell line of endothelial cells (HUVEC), in relation to their ability to form vascular structures, rates of migration, proliferation, and apoptosis / necrosis indices. Significantly higher means of cells with invasive (p<0.0001) and migratory potential (p = <0.0001) were observed for the HSC-3 cell line. Ultrastructurally, it was found that particles derived from the SCC-15 cell line exhibited a rounded morphology and diameter of less than 150 nm. No statistically significant difference was revealed between the studied cell lines, considering the nanovesicles quantization (p=0.2252) and exossomal size (p=0.1765). By indirect immunofluorescence, it was found that 22.15% of exosomes secreted by SCC-15 cells and 18.37% of exosomes derived from HSC-3 cells expressed anti-annexin antibody. With regard to the functional tests with HUVECs, treatment with exosomes derived from SCC-15 cell line induced a significant increase in their capacity of formation of vascular structures (p = <0.0001), migratory potential (p=0.0016) and rate of apoptosis (p<0.0001), while a decrease in cell proliferation was noted (p = 0.0030). On the other hand, the treatment with exosomes secreted by HSC-3 cell line produced a significant reduction in tubule formation (p<0.0001), motility (p = 0.0042) and cell proliferation (p=0.0010), whereas no statistically significant difference was observed in the apoptotic index (p=0.3004). The results of this study indicated the involvement of exosomes derived from OSCC cell lines in tumor angiogenesis process, in which the SCC-15 cells exhibited strong proangiogenic response and HSC-3 cell line showed antiangiogenic effect (AU).