Worse prognosis in breast cancer patients can be predicted by immunohistochemical analysis of positive MMP-2 and negative estrogen and progesterone receptors / Pacientes com câncer de mama de pior prognóstico podem ser estimadas por análise imuno-histoquímica de MMP-2 positiva e receptores de estrógeno e progesterona negativos

Summary Introduction: Breast cancer is the most cause of death, and approximately 90% of these deaths are due to metastases. Matrix metalloproteinase-2 (MMP-2) gelatinase activity is able to degrade a major constituent of the tumor microenvironment, type IV collagen. Two well-established proteins used as markers in clinical practice for breast cancer are the receptors for estrogen (ER) and progesterone (PR). Although the presence of these receptors has been associated with a better prognosis, loss of these proteins can occur during tumor progression, with subsequent resistance to hormone therapy. Objective: To study the correlation among MMP-2, ER, and PR, as well as the establishment of the metastatic process in primary breast tumors. Method: Breast cancer samples (n=44) were analyzed by immunohistochemistry for MMP-2, ER, and PR. Results: We observed that 90% of patients who had metastases and died showed positive staining for MMP-2 (p=0.0082 for both). Using Kaplan-Meier analysis, we found that negative ER patients who were also positive for MMP-2 had even worse disease-free survival (DFS) and overall survival (OS) (p= 0.012 and p=0.005, respectively). Similar results were found in PR-negative patients for DFS (a trend p=0.077) and OS (p=0.038). Conclusion: Regardless of our small sample size (n=44), the data obtained strongly suggest that MMP-2 in combination with already well-established markers could help to predict the emergence of metastases and death in patients with breast cancer.

Resumo Introdução: o câncer de mama é a segunda causa de morte no mundo, sendo 90% dessas mortes decorrentes de metástases. A metaloprotease de matriz 2 (MMP-2) possui atividade de gelatinase capaz de degradar o principal constituinte do microambiente tumoral, o colágeno do tipo IV. Há duas proteínas bem estabelecidas utilizadas como marcadores na prática clínica para o câncer de mama, os receptores de estrógeno (RE) e de progesterona (RP). Embora a presença desses receptores tenha sido associada a um melhor prognóstico, a perda delas pode ocorrer durante a progressão do tumor, com subsequente resistência à terapia hormonal. Objetivo: analisar a correlação entre as proteínas MMP-2, RE e RP por imuno-histoquímica e estabelecer o processo metastático em tumores de mama primários. Método: amostras de tumor de mama (n=44) foram analisadas por imuno-histoquímica para MMP-2, receptor de estrógeno e progesterona. Resultados: observou-se que 90% das pacientes que tinham metástases e morreram apresentaram coloração positiva para a MMP-2 (p=0,0082 para ambos). Usando a análise de Kaplan-Meier, verificou-se que as pacientes RE negativas, também positivas para MMP-2, apresentaram sobrevida livre de doença (SLD) e sobrevida global (SG) (p=0,012 e p=0,005, respectivamente) piores quando comparadas às pacientes MMP-2 negativas. Resultados semelhantes foram encontrados em pacientes RP negativas para SLD (p=0,077) e SG (p=0,038). Conclusão: embora o número de amostras avaliadas tenha sido baixo (n=44), esses dados iniciais permitem inferir que a MMP-2 em combinação com os marcadores já bem estabelecidos poderia ajudar na previsão do surgimento de metástase e morte em pacientes com câncer de mama.

Programmed cell death 1 gene (PDCD1) polymorphism and pemphigus foliaceus (fogo selvagem) disease susceptibility

Pemphigus foliaceus, also known as fogo selvagem, is an autoimmune disease of the epidermis characterized by superficial blisters and antibodies against desmoglein 1. It is a multifactorial disease and genetic susceptibility is oligogenic or polygenic. Considering the crucial function of the programmed cell death 1 molecule (PD-1) in the immune response, the aim of this study was to verify if variants of the PDCD1 gene influence susceptibility and resistance to pemphigus foliaceus, in a case - control disease association study. We analyzed patients (n = 154) and unaffected control individuals (n = 325) of the Brazilian population, in respect to the PD1.3(G,A) PD1.5(C,T) and PD1.6(A,G) single nucleotide polymorphisms (SNPs) and also investigated, for the first time, the exon 5 PDCD1 microsatellite (CTG)n. The patient and control samples were divided into strata, according to the predominant ancestry of the individuals (African or European). The PD1.5 genotype distribution in the patients sample was almost indistinguishable from that in the control sample, in both population strata. A possible negative association between pemphigus foliaceus and allele PD1.3A was observed in the total African and European ancestry population sample (odds ratio (OR) = 0.55, p = 0.066) and should be investigated in forthcoming studies. The PD1.6A allele was over-represented among the patients of predominantly European ancestry due to an increase of both the G/A and the A/A genotypes (OR = 2.12 and 1.74, respectively; p = 0.035). We conclude that polymorphisms of the PDCD1 gene may influence susceptibility to pemphigus foliaceus, at least in Brazilians of predominantly European ancestry.