Immunoglobulin class of antibody to herpes simplex virus in patients with oral cancer

Low Prevalence of HSV-1 and Helicobacter pylori in HNSCC and Chronic Tonsillitis Patients Compared to Healthy Individuals

Recent studies identified viral and bacterial factors, including HSV-1 and H. pylori, as possible factors associated with diseases such as chronic tonsillitis and cancers, including head and neck squamous cell carcinoma (HNSCC). We assessed the prevalence of HSV-1/2 and H. pylori in patients with HNSCC, chronic tonsillitis, and healthy individuals using PCR after DNA isolation. Associations were sought between the presence of HSV-1, H. pylori, and clinicopathological and demographic characteristics and stimulant use. HSV-1 and H. pylori were most frequently identified in controls (HSV-1: 12.5% and H. pylori: 6.3%). There were 7 (7.8%) and 8 (8.6%) patients with positive HSV-1 in HNSCC and chronic tonsillitis patients, respectively, while the prevalence of H. pylori was 0/90 (0%) and 3/93 (3.2%), respectively. More cases of HSV-1 were observed in older individuals in the control group. All positive HSV-1 cases in the HNSCC group were associated with advanced tumor stage (T3/T4). The prevalence of HSV-1 and H. pylori was highest in the controls compared to HNSCC and chronic tonsillitis patients, which indicates that the pathogens were not risk factors. However, since all positive HSV-1 cases in the HNSCC group were observed only in patients with advanced tumor stage, we suggested a possible link between HSV-1 and tumor progression. Further follow-up of the study groups is planned.

Assesment of Correlation of Herpes Simplex Virus-1 with Oral Cancer and Precancer- A Comparative Study

INTRODUCTION

Most common malignant neoplasm in the oral cavity is squamous cell carcinoma. Herpes simplex virus (HSV) may enhance the development of oral carcinoma in individuals who are already at increased risk of the disease because of tobacco consumption and cigarette smoking and so must be considered as a possible etiologic agent in oral cancer and precancer.

AIM

To assess and compare the correlation of HSV-1 in oral cancer and precancerous lesions/conditions with healthy subjects.

MATERIALS AND METHODS

The study comprised of 150 subjects who were divided into three groups as oral cancer, precancer and control group. Their blood samples were collected and were tested for HSV-1 IgG antibody level, using 'Herpe Select-1' ELISA kit.

RESULTS

There was statistically insignificant difference between the HSV-1 IgG level in cancer and precancer but statistically significant difference was found between the HSV-1 IgG level among control group and cancer/precancer.

CONCLUSION

The present study clearly indicates that quantitative estimation of IgG antibody against HSV-1 in cancer/precancer patients will give the clue in the etiology of cancer or precancer. However, further studies with a large sample size should be carried out to determine the role of HSV-1 in etiology of oral cancer and precancer.

Evidences suggesting involvement of viruses in oral squamous cell carcinoma

Oral cancer is one of the most common cancers and it constitutes a major health problem particularly in developing countries. Oral squamous cell carcinoma (OSCC) represents the most frequent of all oral neoplasms. Several risk factors have been well characterized to be associated with OSCC with substantial evidences. The etiology of OSCC is complex and involves many factors. The most clearly defined potential factors are smoking and alcohol, which substantially increase the risk of OSCC. However, despite this clear association, a substantial proportion of patients develop OSCC without exposure to them, emphasizing the role of other risk factors such as genetic susceptibility and oncogenic viruses. Some viruses are strongly associated with OSCC while the association of others is less frequent and may depend on cofactors for their carcinogenic effects. Therefore, the exact role of viruses must be evaluated with care in order to improve the diagnosis and treatment of OSCC. Although a viral association within a subset of OSCC has been shown, the molecular and histopathological characteristics of these tumors have yet to be clearly defined.

The role of viruses in squamous cell carcinoma of the oropharyngeal mucosa

The development of squamous cell carcinomas of the oropharyngeal mucosa may involve many factors, including viruses. This review examines the evidence that viruses could be involved in the etiology of oral cancer, and shows that the evidence for a role of different viruses varies from very weak to very persuasive. Papillomaviruses are probably involved in the etiology of some carcinomas, particularly those of the oropharynx, and some herpes viruses may be involved as well. On the other hand some viruses can cause cancer in experimental situations but not in humans. Thus the importance of viruses in oral cancer is not always clear and must be evaluated with care. Those viruses that are associated with the disease provide targets for therapy and for diagnostic assays.

Oral cancer; the evidence for sexual transmission

The incidence of oral cancer amongst young adults is increasing in many European and high incidence countries. Most oral cancer is aetiologically linked to the use of tobacco and/or alcohol but nearly two decades ago, we produced the first evidence for the presence of viral nucleic acids in oral squamous cell carcinoma (OSCC) tissues, hypothesising that there may be a viral involvement in at least some OSCC. Subsequently, human papillomaviruses (HPV) in particular have been implicated in OSCC. Antibody responses to HPV are seen and HPV-DNA detected in tumours by us and many others, the virus being mainly HPV-16, the genotype associated with ano-genital cancer. Recent studies have indicated that HPV may be aetiologically important particularly in some types of oropharyngeal cancer, at least in tonsillar carcinogenesis, and may represent an alternative pathway in carcinogenesis to the established factors of tobacco and alcohol. Studies of patients with OSCC have suggested possible sexual transmission of HPV.

Oral squamous cell carcinoma; from an hypothesis about a virus, to concern about possible sexual transmission

Nearly two decades ago, we produced the first evidence for the presence of viral nucleic acids in oral squamous cell carcinoma (OSCC) tissues, hypothesising that there may be a viral involvement in at least some OSCC. Subsequently, human papillomaviruses (HPV) in particular have been implicated in OSCC. Antibody responses to HPV are seen and HPV-DNA detected in tumors by us and many others, the virus being mainly HPV-16, the genotype associated with ano-genital cancer. HPV are seen by in situ hybridisation only in tumour and premalignant tissue but not in surrounding normal mucosa suggesting HPV has a causal relationship. HPV may also be integrated in the host genome, further suggesting a causal role. Studies of patients with OSCC have suggested possible sexual transmission of HPV. Recent studies have indicated that HPV may be aetiologically important particularly in some types of oropharyngeal cancer, at least in tonsillar carcinogenesis, and may represent an alternative pathway in carcinogenesis to the established factors of tobacco and alcohol. We have come a very long way in the two decades since our first suggestion of a viral aetiopathogenesis was greeted with incredulity, and data from on-going studies by the International Agency for Research on Cancer, Johns Hopkins Oncology Center and others are eagerly awaited.

High prevalence of hepatitis C virus antibody and RNA in patients with oral cancer

We have investigated the correlation between the prevalence of hepatitis C virus (HCV), which is detectable in saliva, and oral cancer and other digestive tract cancers in the Northern Kyushu region of Japan. Anti-HCV antibodies were detected in sera from 24 of the 100 patients with oral cancer (24%, p < 0.05 vs the control group, p < 0.01 vs the stomach cancer group), in 11 of 104 patients with non-malignant diseases receiving dental treatment (the control group, 10.6%), and in 12 of 113 patients with stomach cancer (10.6%). HCV-RNA was detected in sera from 17 of 100 oral cancer patients (17%, p < 0.05 vs the control group) and 4 of 104 patients of the control group (3.9%). These results indicate a high prevalence of HCV infection in oral cancer patients, which warrants a systematic study of etiological associations between oral cancer and HCV.

The effect on cell phenotype of the mutagenic peptide of herpes simplex virus type-1

The transforming region of the genome of herpes simplex virus type-1 (HSV-1) encodes a peptide that raises the mutation frequency of cells. To find the effect of this peptide on cell phenotype, three types of cells were transfected with a shuttle vector plasmid that expressed the peptide. When immortalised rat fibroblasts were transfected they rapidly became anchorage-independent with high efficiency, but were not tumorigenic in nude mice. When monkey kidney cells were transfected, five clonal cell lines were isolated, of which one became anchorage-independent but was not tumorigenic in nude mice. When human oral keratinocytes were transfected they did not become immortalised. The peptide therefore induced some of the features of transformation in different cell types, but did not induce a malignant phenotype in any cell. This suggests that interaction with co-factors would be necessary for the peptide to contribute to the development of oral cancer.

Gene therapy--its potential in the management of oral cancer

Gene therapy is an important new approach to the treatment of many diseases. This review summarises the methods that are available for developing gene therapy, and demonstrates that oral cancer is probably susceptible to these approaches.

Oncogenes, tumor suppressors and viruses in oral squamous carcinoma

The pathogenesis of oral squamous cell carcinoma involves recognised carcinogens in tobacco and/or alcohol but other factors, including viruses, may also have a role. This paper reviews the gene changes revealed in oral carcinoma, the evidence implicating viruses, and mechanisms whereby viruses may affect gene function.

Antibody to a mutagenic peptide of herpes simplex virus in young adult patients with cancer of the head and neck

Cancer of the head and neck has been associated with herpes simplex virus type-1 by serologic studies that have used virus particles or complex mixtures of viral proteins as antigens. Recently a peptide was found to be encoded by the transforming region of the virus that is mutagenic and is postulated to be involved in cell transformation. Sera from young adult patients with head and neck cancer and from control subjects were examined for the presence of antibody to this peptide with the use of an enzyme-linked immunosorbent assay. Antibody to the peptide was detected in many sera and showed a significant correlation with antibody to the virus in sera from control subjects. Antipeptide antibodies were largely of the IgM isotype, and patients had significantly higher levels of antibody than control subjects. This study is consistent with an association between HSV-1 and head and neck cancer and suggests that this viral peptide should be investigated further for its role in carcinogenesis.

Viruses and chronic disorders involving the human oral mucosa

Viruses have been implicated in the etiology of several chronic disorders of the oral mucosa. Most of these associations have been with DNA viruses, particularly certain herpesviruses, which are associated, for example, with some cases of erythema multiforme and with hairy leukoplakia. Papillomaviruses are associated with various papillomatous lesions, focal epithelial hyperplasia, and possibly with some carcinomas. Viruses may possibly be associated with recurrent aphthae, Behçet's syndrome, and some dermatoses. The literature concerning these possible associations is reviewed. However, much more research needs to be done before the full story of viral associations with oral mucosal disorders can be written.

Reactivity against herpes simplex virus in patients with head and neck cancer

The relation between herpes simplex virus (HSV) and head and neck cancer was examined. A total of ninety patients were analyzed for IgG antibodies against HSV. Antibody titers were established with an enzyme-linked immunosorbent assay and antibodies against specific HSV-antigens were analyzed by Western blot. These patients' seroreactivity was compared to that of an age-matched control group of patients with arteriosclerotic disease in their lower limbs, a disease also closely related to heavy tobacco consumption. Prevalence of antibodies against HSV was around 90% and did not differ significantly between cancer patients and controls, but antibody titers against HSV were significantly higher in the cancer patients. The cancer patients also reacted more constantly (80%) in Western blot analysis against the early immediate protein, ICP-4, than controls (50%). This suggests a different course of an earlier herpetic infection in these patients with a prolonged exposure to early immediate HSV-proteins which may be related to an increased risk of developing head and neck cancer. We propose that heavy smoking may contribute to this phenomenon.

Viruses and oral cancer

Oral cancer is a disease with a complex etiology. There is evidence for important roles of smoking, drinking, and genetic susceptibility, as well as strong indications that DNA viruses could be involved. The herpes simplex virus type 1 has been associated with oral cancer by serological studies, and animal models and in vitro systems have demonstrated that it is capable of inducing oral cancer. Papillomaviruses are found in many oral cancers and are also capable of transforming cells to a malignant phenotype. However, both virus groups depend on co-factors for their carcinogenic effects. Future research on viruses and oral cancer is expected to clarify the role of these viruses, and this will lead to improvements in diagnosis and treatment of the disease.

Induction of anterior chamber associated immune deviation in rats receiving intracameral injections of retinal S antigen

The injection of a variety of antigens, including transplantation antigens, haptens, and viral glycoproteins, into the anterior chamber of eyes of mice produces a characteristic spectrum of immune responses in which suppressed cell mediated immunity dominates. This phenomenon is called Anterior Chamber Associated Immune Deviation (ACAID). Having recently demonstrated that soluble antigens also can induce ACAID in mice, we examined the possibility that an important soluble ocular antigen, retinal S antigen (S Ag) may be capable of inducing ACAID in rats. We have found that injection of S Ag with adjuvant into the anterior chamber of eyes of adult Lewis rats evokes neither a humoral nor a cell mediated immune response that can be detected. However, animals that received S Ag intracamerally in this manner did respond to a subsequent immunogenic dose of S Ag in CFA injected into the hind foot pads, by producing serum anti S Ag antibodies. Importantly, these rats failed to display antigen-specific delayed hypersensitivity. Moreover, lymphoid cells from anterior chamber pre-treated animals, when adoptively transferred, inhibited the development of S Ag-specific delayed hypersensitivity in naive recipients indicating that an active suppression mechanism had been generated. Thus, a soluble antigen injected intracamerally in adult Lewis rats can generate ACAID. The possibility that ACAID may be relevant to the development of S Ag induced uveitis is discussed.

Oncogenic potential of sexually transmitted viruses with special reference to oral cancer

Recent changes in social mores have been accompanied by a noted increase in the frequency of sexually transmitted diseases. Viruses that have been identified as causative agents for a large proportion of these diseases have also been associated with various malignant states. Concomitantly, the number of cases of oral cancer (considered to occur usually around or after the fifth decade of life) reportedly has been increasing among young adults. The oncogenic potential of several sexually transmitted viruses (HSV, HPV, CMV, and LAV/HTLV III) and their possible role in the development of malignant conditions, in particular oral cancer, are discussed in this review.

Five-year survival of patients with oral cancer and its association with antibody to herpes simplex virus

Levels of antibody to herpes simplex virus type 1 (HSV-1) were measured in 70 patients with untreated squamous cell carcinoma of the mouth. After treatment the actuarial survival was determined at quarterly intervals for 5 years and was found to be associated with the pretreatment level of antibody to the virus. Patients with levels of IgM antibody to HSV-1 which were above the median level had a 5-year survival of only 56% whereas those with levels below the median had a higher survival of 72%. Patients with no detectable IgM antibody to HSV-1 had a 5-year survival of 81%. The reverse was seen with IgG antibody to HSV-1. Patients with higher than the median level of IgG antibody had a 5-year survival of 73%, whereas those with IgG antibody below the median had a 5-year survival of 56%. No relationship was seen between survival and levels of IgA antibody to HSV-1, or between survival and antibody of any class to cytomegalovirus. The data are consistent with the reported association between oral cancer and HSV-1.

Phenotypic identification of mononuclear cells in oral premalignant lesions and cancer by monoclonal antibodies

To explore the nature and importance of mononuclear cells of different phenotypes in oral premalignant lesions and oral cancer, we studied biopsy specimens from 21 oral red and/or white lesions (6 hyperkeratosis, 3 mild dysplasia, 4 severe dysplasia and 8 squamous cell carcinoma), using monoclonal antibodies and avidin-biotin-peroxidase complex staining. Peripheral blood samples (PB) from 4 normal subjects and 5 reactive lymph nodes (LN) were used as controls for the technique. T11-positive cells were the predominant phenotype (74-78%) in all cases examined. The T4/T8 ratio in severe dysplasia was significantly lower than that in mild dysplasia (p less than or equal to 0.05). These observations support the hypothesis of a role for cellular immune responses in oral premalignant lesions and oral cancer. The predominance of T cells may represent the local expression of immunity against antigens (viral or other). The decreased T4/T8 ratio observed in severe dysplasia may represent a transitory stage of local immunosuppression, which may be of critical importance for the progression into carcinoma. Phenotypic variations in mononuclear cell infiltrates in these conditions could be diagnostic value.

Detection of herpes simplex virus proteins in cultured cells by monoclonal antibodies and the avidin-biotin-immunoperoxidase complex method

The distribution of 5 proteins of herpes simplex virus Type 1 was observed in cells that had been infected for various periods. The cells were stained with monoclonal antibodies to ICP4, ICP5, ICP6, ICP8, and gB, using the avidin-biotin-peroxidase complex (ABC) method. Each protein had a characteristic pattern of time of appearance and translocation by which it could be distinguished from the others. The sensitivity of the ABC technique, its ease of use, and the permanence of the preparations make this method well suited for the study of viral proteins.

Erythema multiforme and herpes simplex virus

It has been suggested that herpes simplex virus (HSV) can trigger erythema multiforme (EM) at different times. One recent study showed HSV antigen in immune complexes of patients with EM. The purpose of our study was to assess a possible association between EM and HSV. Sixteen patients and 16 matched controls were studied using an enzyme-linked immunosorbent assay (ELISA) to measure antibody of the IgG, IgA, and IgM classes against HSV-1. From our study on patients with oral erythema multiforme, we found no evidence to correlate the occurrence and/or severity of EM and the HSV-1.

The importance of tumor markers in oral pathology. II. Cell membrane and cytoplasmic antigens as tumour markers

Important tumour markers in tumours of the oral mucosa and salivary glands are intermediate filaments of cytoskeleton, oncofetal and proliferative antigens, lectin receptors and blood group substances, enzymes, metalloproteins and viral antigens. The special occurrence of the following tumour markers was demonstrated: keratin, vimentin, carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), lectins (helix pomatia antigen = HPA, peanut agglutinin = PNA), Thomsen-Friedenreich-antigen, blood group substances A and B, amylase, lactoferrin, viral antigens of papilloma virus (group 11 and 16). In oral dysplasia and squamous cell carcinomas, relationships exist between the presence of keratin filaments and cell differentiation. Lectins represent membrane-orientated markers of differentiation. A loss of blood group substances A and B can be observed in oral dysplasias. Papilloma viruses and viral antibodies can be demonstrated in papillomas, leukoplakias and carcinomas. The salivary gland tumours show a distinct pattern of distribution for keratin, vimentin, CEA, TPA, metalloproteins and enzymes. Transplanted human salivary gland tumours in athymic nude mice keep the same tumour marker profile as in the primary tumor.

Humoral immune responses to adenoviruses, herpes virus type 1, and Candida albicans in sera of dental patients with oral neoplastic and periodontal diseases

Levels of immunoglobulin class-specific antibodies as determined by solid phase radioimmunoassays to herpes simplex virus type 1 (HSV-1), human adenovirus types 5, 21, and 31 and to Candida albicans in sera from untreated healthy dental patients were not significantly different from levels of these antibodies in sera from untreated dental patients with benign oral tumors, oral carcinoma, or periodontal disease. These results show that higher levels of immunoglobulin class-specific antibodies to HSV-1, the three adenoviruses, or Candida albicans are not a consistent finding in sera from patients with oral cancer when comparisons are made with healthy patients and patients with other oral diseases.

Antibody to early and late antigens of herpes simplex virus type 1 in patients with oral cancer

HEp-2 cells were infected with herpes simplex virus type 1 (HSV-1) and harvested at selected times thereafter. IgG, IgA, and IgM antibody to virus antigens present in these cells at each time was measured in sera from oral cancer patients, and in matched controls. The IgA response of oral cancer patients was significantly greater than that of controls both at 8 and at 48 hours after infection, but showed no difference in response to HSV-1 virus particles. IgM antibody detected two peaks of antigen synthesis, at 4 and 48 hours after infection. Oral cancer patients had a stronger IgM response than did controls to both early and late peaks; the latter was significant at the 5% level. Oral cancer patients also had a significantly higher IgM response to the virus particle. These results imply the existence of at least two different HSV-1 antigens associated with oral cancer. Both are late antigens; one is recognized by IgA, and the other is recognized by IgM antibody.

Microbial pathogenicity in oral soft tissue diseases

Recent work implicating microbial factors in the pathogenesis of several oral soft tissue diseases is discussed. These conditions include recurrent aphthous ulceration, oral cancer, Sjogren's syndrome, and the oral lesions of AIDS (the acquired immune deficiency syndrome). This paper reviews some recent work on these topics, with emphasis on investigations in our laboratory.