Tobacco carcinogen mediated up-regulation of AP-1 dependent pro-angiogenic cytokines in head and neck carcinogenesis

Tobacco is notably genotoxic and associated with head and neck carcinogenesis. Cigarette carcinogens have the capacity to alter early response gene expression in tobacco-related malignancies via genes such as nuclear factor kappa B (NFκB). A number of early response gene activation events are also facilitated by fos/jun activator protein 1 (AP-1) associated pathways. In the present study, we hypothesize that tobacco products may induce microenvironment alterations, promoting angiogenesis and providing a permissive environment for head and neck cancer progression. In an in vitro analysis, we employed immortalized oral keratinocyte (HOK-16B) and laryngeal squamous carcinoma (UM-SCC-11A) cells to investigate interleukin (IL)-8 and vascular endothelial growth factor (VEGF) induction by cigarette smoke condensate (CSC). IL-8 and VEGF expression is based on interactions between NFκB, AP-1, and NF-IL6. We identified at least 1.5-fold dose-dependent induction of AP-1, VEGF, and IL-8 promoter/reporter gene activity after 24 h exposure to CSC. Next, we stably transfected UM-SCC-11A cells with A-Fos, a dominant negative AP-1 protein. Treatment with CSC of the A-Fos cell lines compared to empty vector controls significantly down-regulated AP-1, VEGF, and IL-8 promoter/reporter gene expression. We also performed ELISAs and discovered significant up-regulation of IL-8 and VEGF secretion by UMSCC 11A after treatment with phorbol 12-myristate 13-acetate, tumor necrosis factor alpha, and CSC, which was down-regulated by the A-Fos dominant negative protein. We conclude tobacco carcinogens up-regulate AP-1 activity and AP-1 dependent IL-8 and VEGF gene expression in head and neck cancer. This up-regulation may promote an angiogenic phenotype favoring invasion in both premalignant and squamous cancer cells of the head and neck.

Abstract PR-10: Randomized placebo controlled trial of pioglitazone for oral premalignant lesions: A cross-consortium collaborative study in progress

There are currently no proven safe and effective oral cancer prevention treatments. Overall, approximately 5% of oral leukoplakias progress to squamous cell carcinoma and are therefore considered an important precursor lesion for cancer prevention intervention. Nuclear receptor agonists are agents that can affect cell maturation pathways in the oral cavity and other sites. The hypothesis of this National Cancer Institute/Division of Cancer Prevention (NCI/DCP)-sponsored trial is that 6 months of 45 mg pioglitazone daily will shrink oral premalignant lesions and favorably modulate surrogate endpoint biomarkers of cancer prevention. The study agent, pioglitazone, is a PPARγ agonist shown to modulate critical cellular pathways. There is preclinical evidence suggesting the potential efficacy of PPARγ ligands in prevention of cancer. Moreover, in an earlier nonrandomized phase IIa study, response rates of over 70% were achieved in patients with oral leukoplakia after 3 months of treatment. In this current study, 100 participants with dysplastic oral premalignant lesions are being recruited and randomized to active drug or placebo for a period of 6 months. The primary endpoint is lesion size reduction or histologic improvement after 6 months of drug intervention. The secondary endpoints are the following biomarkers: PPARγ, cyclin D1, p21, TUNEL assay for apoptosis, Ki-67 for proliferation, transglutaminase, involucrin, 15-PGDH, LOH, and the change in plasma level of CRP. Plasma drug levels and cotinine levels are also measured. Accrual and evaluation is planned for 24 months. Due to the large size of this study and the relative rarity of these lesions, an international interconsortium study was designed to facilitate accrual.

The lead DCP Consortia institutions, University of Wisconsin Carbone Cancer Center (UWCCC) and University of Texas MD Anderson Cancer Center (MDACC), and their nine participating organizations, Memorial Sloan-Kettering Cancer Center, Columbia University Medical Center, Weill Medical College of Cornell University, University of Maryland, University of Minnesota, University of Iowa, University of Alabama, Roswell Park Cancer Institute, and European Institute of Oncology (EIO) in Milan, Italy, make up the 11 sites for accrual for this study.

During the process of protocol development, a streamlined centralized pathology review system was developed to improve consistency in histological diagnosis utilizing a web-based Aperio system. Additionally, to insure high-quality data an extensive Manual of Procedures (MOP) delineating all protocol activities is used by all sites. Centralized data entry utilizing Westat-developed Remote Data Capture database is used. The data analysis will include stratification by group (UWCCC vs. MDACC vs. EIO) and severe vs. mild dysplasia. Study drug and placebo are encapsulated by Fisher BioServices. The repository for banked biological specimen for future studies is held at the Analytical Instrumentation Laboratory for Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics (3P) lab at UWCCC. In conclusion a large oral cancer prevention inter-consortium study has been designed and implemented at 10 U.S. sites and one Italian site to evaluate the efficacy of pioglitazone treatment in oral premalignant lesions.

This talk is also presented as Poster A73.

Citation Information: Cancer Prev Res 2010;3(12 Suppl):PR-10.

Abstract A73: Randomized placebo-controlled trial of pioglitazone for oral premalignant lesions: A cross-consortium collaborative study in progress

This abstract is being presented as a short talk in Concurrent Session 14. A full abstract is printed in the Proffered Abstracts section (PR-10) of the Conference Proceedings.

Citation Information: Cancer Prev Res 2010;3(12 Suppl):A73.

The role of inhibitor of DNA-binding (Id1) in hyperproliferation of keratinocytes: the pathological basis for middle ear cholesteatoma from chronic otitis media

OBJECTIVES

A hallmark of cholesteatoma is hyperproliferation of keratinocytes with abundant production of keratins in the middle ear under chronic inflammatory conditions. However, little is known about the driving force of cellular proliferation and keratin production of cholesteatomal matrix. The purpose of this study was to investigate the cellular proliferation and keratin production of keratinocytes under the influence of Id1, a candidate transcription factor to cell proliferation.

MATERIALS AND METHODS

Keratinocytes were transfected with Id1 and the responses of keratinocytes to Id1 were studied by using cellular and molecular biologic methods.

RESULTS

Id1 positively contributed to the cell cycle progression and negatively to the p16(Ink4a) downregulation via the nuclear factor-kappa B (NF-κB)/cyclin D1 pathway. Id1 significantly increased the promoter activity of NF-κB which, in turn, up-regulated the expression of cyclin D1 and keratin 10 in keratinocytes. Specific NF-κB inhibitors (pyrrolidine dithiocarbamate, PDTC), or dominant-negative inhibitor (I kappa B alpha mutant, IκBαM) abrogated the Id1-induced cell proliferation and keratin 10 production whereas p65, a subunit of the NF-κB heterodimer and an enhancer of the NF-κB activity, strengthened the Id1-induced cell proliferation and keratin 10 production.

CONCLUSIONS

Id1 contributed to hyperproliferation of keratinocytes via enhancement of cell cycle progression, removal of cell cycle inhibition, and simultaneously increased keratin production.

Conference Report: Eighth Annual AACR International Conference on Frontiers in Cancer Prevention Research

The Eighth Annual Frontiers in Cancer Prevention Research meeting was held in Houston, Texas, in November 2009. This report highlights significant presentations that advance the fields of chemoprevention, clinical trial recruitment and retention, cancer screening including optical imaging, energy balance, and nutritional epidemiology, and health communications and decision making. In findings from the randomized Reduction by Dutasteride of Prostate Cancer Events trial, dutasteride reduced the risk of biopsy-detectable prostate cancer in high-risk men by 23% compared with placebo. Important clues about the dosing and window of susceptibility for supplementation with choline, vitamin D, and folate were revealed from epigenetic research that has implications for future nutritional epidemiology research. Noninvasive optical imaging techniques using endoscopic ultrasound and autofluorescence for the early detection of cancers in the lung, pancreas, and oral cavity are being studied. The report also addresses the challenges of promoting cancer prevention. Understanding how individuals process risk information and make sustained behavior changes and the effect of socioeconomic status on health disparities were identified as critical areas of research. This multidisciplinary research meeting of basic, clinical, and behavioral scientists and epidemiologists continues to play a major role in identifying the research priority areas of cancer prevention, elucidating new mechanisms of carcinogenesis for targeted chemoprevention therapies and delivering a comprehensive strategy for engaging individuals in the unifying goal to reduce cancer incidence.

Abstract 3802: PPAR gamma mediated induction of transglutaminase in aerodigestive preneoplasia in vitro

Currently there are no validated biomarkers or therapies for human aerodigestive preneoplasia. There is increasing interest in the utilization of PPAR gamma mediated therapy for oral leukoplakia reversal based on preliminary clinical trial results. Transglutaminases (TGMs) are associated with squamous differentiation, and therefore might be hypothesized to be upregulated with PPAR gamma differentiation therapies. In the present study we sought to examine the feasibility of utilizing transglutaminases as a downstream readout for PPAR gamma activator treatment of oral leukoplakia. First we examined our Affymetrix database of human head and neck tumors for the presence or absence of transglutaminases 1-3 in 41 tumors compared to 13 normal oral mucosa samples. We discovered that TGM 1 and 3 were significantly upregulated in normal tissues compared to tumors (p<0.0001). Next, we examined whether PPAR gamma activators could activate TGM1 reporter genes in cell lines. We found that TGM1 luciferase reporters were significantly activated by ciglitazone (0-5uM) and pioglitazone (0-10 uM) in MSK leuk and HOK oral preneoplastic cell lines, as well as CA-9-22 oral cancer cells in several experiments. Next we examined pioglitazone activation of transglutaminases in these cell lines by real time PCR. We found that pioglitazone significantly activated TGM 1 and 2 in MSK leuk and CA-9-22 oral cancer cells on qRT-PCR. We conclude that the clinically relevant PPAR gamma activator, pioglitazone, can activate transglutaminases in aerodigetsive cancer cell lines and may be useful in upregulating differentiation in oral preneoplasia in clinical trials. We also conclude that transglutaminases may provide a family of proteins for PPAR gamma effects and should be included as exploratory biomarkers in leukoplakia clinical trials with PPAR gamma activators.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3802.

A metaproteomic analysis of the human salivary microbiota by three-dimensional peptide fractionation and tandem mass spectrometry

Metagenomics uses gene expression patterns to understand the taxonomy and metabolic activities of microbial communities. Metaproteomics applies the same approach to community proteomes. Previously, we used a novel three-dimensional peptide separation method to identify over 2000 salivary proteins. This study used those data to carry out the first metaproteomic analysis of the human salivary microbiota. The metagenomic software MEGAN generated a phylogenetic tree, which was checked against the Human Oral Microbiome Database (HOMD). Pathway analyses were performed with the Clusters of Orthologous Groups and MetaCyc databases. Thirty-seven per cent of the peptides were identifiable only at the level of cellular organisms or bacteria. The rest were distributed among five bacterial phyla (61%), archea (0.5%), and viruses (0.8%); 29% were assignable at the genus level, and most belonged to Streptococcus (17%). Eleven per cent of all peptides could be assigned to species. Most taxa were represented in HOMD and they included well-known species such as periodontal pathogens. However, there also were 'exotic' species including aphid endosymbionts; plant, water, and soil bacteria; extremophiles; and archea. The pathway analysis indicated that peptides were linked to translation (37%), followed by glycolysis (19%), amino acid metabolism (8%), and energy production (8%). The taxonomic structure of the salivary metaproteome is very diverse but is dominated by streptococci. 'Exotic' species may actually represent close relatives that have not yet been sequenced. Salivary microbes appear to be actively engaged in protein synthesis, and the pathway analysis is consistent with the metabolism of salivary glycoproteins.

Inhibitor of differentiation 1 contributes to head and neck squamous cell carcinoma survival via the NF-kappaB/survivin and phosphoinositide 3-kinase/Akt signaling pathways

PURPOSE

A key issue in cancer is apoptosis resistance. However, little is known about the transcription factors that contribute to cellular survival of head and neck squamous cell carcinoma (HNSCC).

EXPERIMENTAL DESIGN

Three batches (54, 64, and 38) of HNSCC specimens were used for cellular and molecular analyses to determine the major molecular signaling pathways for cellular survival in HNSCC. Animal models (cell culture and xenografts) were used to verify the importance of apoptosis resistance in HNSCC.

RESULTS

Inhibitor of differentiation (Id) family member, Id1, was significantly upregulated in clinical HNSCC specimens and acted to protect keratinocytes from apoptosis. Transfection of HNSCC cells with Id1 in vitro induced the phosphorylation of Akt (p-Akt) via phosphoinositide 3-kinase and increased the expression of survivin via NF-kappaB. Blockage of both pathways by specific inhibitors (LY294002 and IkappaBalphaM, respectively) abrogated Id1-induced cell survival of keratinocytes. In vivo studies showed that increased expression of Id1 allowed nontumorigenic keratinocytes (Rhek-1A) to become tumorigenic in nude mice by increased expression of survival genes such as p-Akt and survivin. More importantly, short interfering RNA for Id1 significantly reduced HNSCC tumor volume of HNSCC in xenograft studies. Analysis of clinical data verified the importance of the Id1 downstream molecule, survivin, in the prognosis of HNSCC patients.

CONCLUSIONS

The above data, taken together, suggest that Id1 and its downstream effectors are potential targets for treatment of HNSCC because of their contribution to apoptosis resistance.

Expression of fibroblast growth factor binding protein in head and neck cancer

OBJECTIVES

To characterize the expression of fibroblast growth factor binding protein (FGF-BP) messenger RNA (mRNA) in head and neck squamous cell carcinoma (HNSCC) and to study the association of FGF-BP with vascularity.

DESIGN

The expression of FGF-BP mRNA in HNSCC was studied in 35 primary and 8 metastatic HNSCC specimens and 7 control tissues using in situ hybridization and reverse transcriptase-polymerase chain reaction (RT-PCR). Microvessels in tumor specimens were identified with endothelial cell markers (von Willebrand factor [vWF] and CD34-specific antibodies). Correlates between FGF-BP and microvessel counts were evaluated statistically.

SETTING

University of Minnesota Hospitals and Clinics.

PATIENTS

Forty-two surgically treated patients with HNSCC.

INTERVENTIONS

The patients were routinely treated in the study hospitals and clinics.

MAIN OUTCOME MEASURES

The expression of FGF-BP and angiogenesis in tumors were evaluated.

RESULTS

In situ hybridization and RT-PCR demonstrated that FGF-BP mRNA transcripts were expressed in 34 of 35 primary HNSCC specimens and 5 of 8 metastatic tumor specimens but not in adjacent control tissues. The microvessel counts in HNSCC specimens were closely related to the expression level of FGF-BP (P < .001).

CONCLUSION

The expression of FGF-BP is statistically linked to the angiogenesis of HNSCC, suggesting that FGF-BP participates in the angiogenesis of HNSCC.

Ototoxicity after combined platinum and fractionated radiation in a novel guinea pig model

PURPOSE

Cis-platinum and radiation in combination are current organ preservation treatment strategies for head and neck cancer. Their individual ototoxicity has been investigated, with recent demonstration of ototoxicity in clinical studies. Currently, no ototoxicity studies have been performed in animals receiving similar schedules of radiation or cis-platinum to those patients with head and neck cancer.

MATERIALS AND METHODS

In the present study, an animal model was developed to investigate the effects of combined modality therapy on hearing. Albino guinea pigs were given equivalent protocol dosages of cis-platinum (3 parenteral courses), fractionated radiation (25 fractions over 5 weeks), or both. Click and tone burst auditory brainstem response (ABR) measurements were performed before and 6 weeks after the completion of treatment.

RESULTS

Animals receiving radiation or cis-platinum and radiation experienced permanent significant ABR shifts at all frequencies, with 33% of the animals experiencing complete unilateral sensorineural hearing loss at 2 or more frequencies in the ear receiving the full radiation dose (7075 cGy over 25 fractions) (P < .05, paired t test analysis). The animals receiving 3 doses of cis-platinum had no significant ABR threshold shifts at 6 weeks. These data suggest that cis-platinum and radiation cause greater ototoxicity than cis-platinum alone. These findings correlate closely with sensorineural hearing loss in combined modality patients at our institution and in recent studies.

CONCLUSIONS

We conclude that the current animal results parallel those seen clinically and serve as a model for ototoxicity from combined modality therapies in future protocols.

Presence of otitis media with effusion and its risk factors affect serum cytokine profile in children

Otitis media with effusion (OME) is a condition that has significant impact on the quality of life of children. Although the etiology is multi-factorial, certain risk factors such as an allergic predisposition, daycare, and cigarette smoke exposure contribute to its pathogenesis.

OBJECTIVE

(1) To determine whether there is a tendency for children with chronic or recurrent OME (cases) to have higher serum levels of the T-helper 2 cell (Th-2) allergenic-type cytokines, interleukin-4 (IL-4), and IL-5, or the T-helper 1(Th-1) infectious-type cytokines, interferon-gamma (IFN-gamma), and tumor necrosis factor-alpha (TNF-alpha), compared to children without a history of recurrent OME (controls) and (2) to determine any possible correlations between the cytokine levels and risk factors associated with OME.

METHODS

We analyzed serum levels of these four cytokines by enzyme-linked immunosorbent assays of 19 cases and 17 controls.

RESULTS

Cases, independent of age, had increased levels of serum IL-5 compared to controls (p=0.014). While a significant difference in serum IL-4 levels did not exist between cases and controls, children exposed to cigarette smoke had significantly higher levels of serum IL-4 (p=0.003). While serum levels of IFN-gamma were statistically significantly higher in cases than controls with univariate analysis (p=0.011), when controlling for age and smoke exposure with multivariate analyses, the difference did not reach significance (p=0.086).

CONCLUSION

These results suggest that patients with chronic or recurrent OME and those exposed to cigarette smoke mount a Th-2 allergic-like response, as demonstrated by their serum cytokines.

A Method of Producing Carcinoma in Upper Aerodigestive Tree and Esophagus of the Syrian Golden Hamster Using Wounding and Instillation of N-Methylnitrosourea

Details of a method for producing carcinoma of the aerodigestive tree of the Syrian golden hamster and the use of this model to evaluate putative agents for chemoprevention of these carcinomas are described. The method produces a majority of squamous carcinomas of the trachea and glottis that follow squamous metaplasia of respiratory epithelium. In addition, seen are adenocarcinomas arising in glands of the respiratory tree. Squamous carcinomas of the digestive epithelium arise in primary squamous epithelium. These tumors of digestive epithelium have a growth pattern that differs from that of the respiratory epithelium in that they grow and invade without filling the epithelial layer with tumor cells.

Efficacy of an osmotic pump delivered, GM-CSF-based tumor vaccine in the treatment of upper aerodigestive squamous cell carcinoma in rats

PURPOSE

Upper aerodigestive tract (UADT) cancer has not experienced significant overall survival improvement for over 20 years, and no successful treatments for systemic disease exist. Most patients with UADT cancer experience immune suppression, therefore immune restorative therapies may offer promise for these patients. We presently tested the efficacy of granulocyte macrophage-colony stimulating factor (GM-CSF) delivered via 28-day continuous infusion pump, in combination with irradiated tumor cells, in a flank model of UADT cancer.

METHODS

Five groups of rats were inoculated with syngeneic mucosally derived squamous carcinoma cells (FAT-7). Osmotic minipumps were implanted in the contralateral flank to deliver GM-CSF at 0 (PBS), 0.1, 1, 10, or 100 ng/day (n = 6 per group) for 28 days; 10(6) irradiated FAT-7 cells (ITC) were injected at the site of the GM-CSF infusion on days 0, 3, 7, 14, and 21 immune infiltrates in tumors were analyzed.

RESULTS

Rats that received 10 or 100 ng/day GM-CSF/ITC had a significantly slower tumor growth rate compared to those who received 0, 0.1, or 1 ng/day (ANOVA, P < 0.01). There were increased CD 4+, CD 8+, and CD 68+ cells in tumors of GM-CSF/ITC treated animals over controls.

CONCLUSION

GM-CSF (10 or 100 ng/day) delivered locally via osmotic pump with ITC slows the growth rate of mucosally derived squamous cell carcinoma in rats while improving immune cell infiltrates. The efficacy of locally delivered GM-CSF immunotherapy in this model may be a first step toward this immunotherapy strategy for humans.

Inositol Hexaphosphate and Paclitaxel: Symbiotic Treatment of Oral Cavity Squamous Cell Carcinoma

OBJECTIVES/HYPOTHESIS

Nuclear factor (NF)-kappaB is an early response gene that has been associated with head and neck squamous cell cancer (HNSCC) progression. NF-kappaB activation is induced by some chemotherapy agents, including paclitaxel. The activation of this gene can be correlated with apoptosis resistance. Inositol hexaphosphate (IP6) is a naturally occurring polyphosphorylated carbohydrate. NF-kappaB levels were evaluated in oral cavity HNSCC lines after treatment with paclitaxel and IP6, alone and in combination. Resulting levels of cell death and apoptosis were assessed, and conclusions are drawn regarding a possible synergistic relationship between paclitaxel and IP6.

METHODS

NF-kappaB activation in cancer cells treated with paclitaxel and IP6, alone and in combination, was measured by transient transfection, and results were interpreted by luminometry. Cell proliferation of treated cells was measured by MTT assay. Cell viability and apoptosis of cancer cells treated with paclitaxel and IP6 combinations were quantitated by trypan blue staining and Caspase-Glo 3/7 assay, respectively.

RESULTS

IP6 was observed to significantly downregulate NF-kappaB activation in both NA and CA-9-22 oral cavity HNSCC cell lines. Paclitaxel treatments caused increased NF-kappaB activation in the same cell lines. IP6 was observed to mitigate paclitaxel-induced NF-kappaB activation in the CA-9-22 cell line. IP6, when combined with paclitaxel, reduces CA-9-22 cell proliferation, increases cell death, and increases apoptosis, when compared with treatment with paclitaxel alone.

CONCLUSIONS

IP6 reduces paclitaxel induced NF-kappaB activation and increases paclitaxel-mediated cell killing and apoptosis. As a well-tolerated and safe supplement, IP6 deserves further study in the treatment of oral cavity squamous cell carcinoma.

Pneumococcal peptidoglycan-polysaccharides induce the expression of interleukin-8 in airway epithelial cells by way of nuclear factor-kappaB, nuclear factor interleukin-6, or activation protein-1 dependent mechanisms

Cell envelope compounds of bacteria trigger immune and inflammatory reactions by way of chemokines/cytokines. In this study, we demonstrated that pneumococcal peptidoglycan-polysaccharides (PGPS) induced the production of interleukin (IL)-8 by way of nuclear factor (NF)-kappaB, nuclear factor interleukin (NF-IL)6, and activation protein (AP)-1 dependent mechanisms in the human bronchial epithelial cells (NL-20) in a dose- and time-dependent manner in vitro, and the mutation of either the NF-kappaB, NF-IL6, or AP-1 binding sites in the promoter of IL-8 abrogated the IL-8 transcriptional activity. In a similar way, lipopolysaccharides induced the promoter activation of IL-8 in NL-20. However, the PGPS-induced IL-8 promoter activation in rodent middle ear epithelial cells required NF-kappaB and NF-IL6 but not AP-1.

Id1 induces the proliferation of cochlear sensory epithelial cells via the nuclear factor-κB/cyclin D1 pathway in vitro

Inhibitors of differentiation (Id) play an essential role in the neurogenesis of the central nervous system. However, the expression and function of Id in the development of cochlear sensory epithelial cells have yet to be elucidated. In this study, we demonstrate the Id1 gene was expressed in the rapidly growing otocyst on embryonic day 12 (E12) and in the organ of Corti, spiral ganglions, and stria vascularis on postnatal day 1 (P1) by cellular and molecular biologic techniques. Knockdown of the Id1 gene with short interfering RNA (siRNA) in a cochlear sensory epithelial cell line (OC1) significantly reduced its proliferation, whereas overexpression of Id1 in OC1 significantly increased the proliferation of OC1, suggesting a role of Id1 in the development of cochlear sensory epithelial cells. The proliferative action of Id1 on OC1 was mediated by nuclear factor-kappaB (NF-kappaB) and cyclin D1 (a downstream molecule of NF-kappaB). Blockage of the NF-kappaB activity with pyrrolidine dithiocarbamate (PDTC) or enhancement of the NF-kappaB activity with p65 (a subunit of NF-kappaB) in OC1 significantly inhibited or increased, respectively, the cell proliferation and transcription of cyclin D1 induced by Id1. Truncation of the NF-kappaB binding site in the cyclin D1 promoter fully abrogated the transcription of cyclin D1, suggesting that the cyclin D1 transcription is dependent on NF-kappaB. We concluded from this study that Id1 induces the proliferation of OC1 via the NF-kappaB/cyclin D1 pathway.

Sensorineural Hearing Loss in Vogt-Koyanagi-Harada Syndrome

BACKGROUND

Vogt-Koyanagi-Harada (VKH) syndrome is a systemic condition characterized by ocular inflammatory disease as well as skin, ear, and meningeal manifestations. Patients with VKH often report tinnitus and hearing loss, but these symptoms tend to be given secondary consideration because most undergo treatment with steroids to prevent blindness resulting from granulomatous uveitis, exudative retinal detachment, and optic nerve inflammation.

METHODS/STUDY DESIGN

In the current retrospective review, 24 patients with this syndrome were screened for auditory system abnormalities. All patients denied history of noise exposure or ototoxic agent exposure. The age range of the patients was 13 to 42 years.

RESULTS

Three patients reported tinnitus and two patients reported sudden hearing loss. One patient experienced vertigo and aural fullness. Eight of 24 patients had pure-tone thresholds greater than 25 dB hearing loss at two or more frequencies. Five of 24 of these patients experienced hearing loss outside of the 95% confidence interval for published age-matched control populations. There was sloping sensorineural hearing loss at 4 kHz and above in five of 24 patients. All eight patients with hearing loss experienced some degree of hearing loss at 4 kHz or above. Three patients had mild to moderate low-frequency sensorineural hearing loss. There were no tympanometric abnormalities suggestive of conductive involvement. Abnormal acoustic reflex decay was observed in one patient.

CONCLUSIONS

We conclude that a significant number of patients with VKH experience sensorineural hearing loss and that every patient with VKH should undergo a review of systems for auditory abnormalities and referral for audiologic testing if symptomatic. It is possible that untreated patients may experience worse symptoms.

Genes associated with early development, apoptosis and cell cycle regulation define a gene expression profile of adenoid cystic carcinoma

Adenoid cystic carcinoma (ACC) is an uncommon salivary gland malignancy characterized by indolent yet relentless growth that exhibits inherent resistance to systemic chemotherapy, surgical salvage and conventional radiotherapy. We used microarray analysis to characterize gene expression changes associated with ACC. Eight ACC patient specimens were compared with normal parotid gland tissue and the ACC3 cell line. Differentially expressed genes were identified (512 total) using supervised analysis methods and functional categories assigned using OntoExpress. Genes associated with morphogenesis, neurogenesis, proliferation and apoptosis characterized ACC tumors. Genes associated with saliva production and immune response characterized normal parotid tissues while the ACC3 cell line expressed genes primarily associated with proliferation, chromosome maintenance and the cell cycle. These results demonstrate that ACC tumors express genes associated with early developmental processes including morphogenesis and neurogenesis implicating oncogenic events that result in dedifferentiation of normal salivary glands.