Carcinoma of the oral cavity evaluated by specific red cell adherence test

Aberrant glycosylation in oral malignant and premalignant lesions

Cell surface carbohydrates serve as differentiation and developmental markers characteristic of different cell and tissue types. The expression of these carbohydrate antigens is often significantly altered in tumors, particularly in those arising from epithelial tissues. Analysis of cell surface carbohydrates in oral epithelium have shown that in normal epithelium they are expressed in a way that shorter carbohydrates are found on basal cells and that these carbohydrate structures are elongated parallel to terminal differentiation. The carbohydrate expression is altered in oral carcinomas and in some oral premalignant lesions. The change in carbohydrate expression can at present be explained by the lack of synthesis of specific glycosyltransferases. We have found mosaicism in the expression of carbohydrate antigens in all tumors and have found that the expression of a specific carbohydrate in the deep invasive parts of the tumor correlates with tumor prognosis.

Tumor-associated blood group antigen expressions and immunoglobulins associated with tumors

As outlined in Figures 1 and 2, the biosynthetic pathways for the expression of the A, B and H, and the Lewis determinant carbohydrate sequence structures, as well as sialylated structures, involves both type 1 and type 2 precursor chains (which may be present as glycolipids and N- or O-linked glycoproteins), and many glycosyltransferases. For tumor cells, there appears to be increased expressions of fucosyl- and sialyltransferases yielding such structures as the Le(x), sialyl-Le(a), and many other similar determinants, which are not found on the normal cell progenitor of the tumor. The types of structures expressed on tumor cells is dependent on the particular fucosyl-, sialyl- and other glycosyltransferase genes activated in the transformation and tumor progression events, the availability of the substrates for the glycosyltransferases (both the precursor sequences and the nucleotide-sugar substrates) which is partly dependent on metabolites available to the tumor mass, and on the genotype of the individual regarding particular glycosyltransferases. Both the loss of A, B and/or H blood group antigen expressions of tumor cells and the relative expressions of the Lewis and sialylated-oligosaccharide determinants may be a consequence of the competing biosynthetic pathways and the glycosyltransferases for common substrate sequences, as well as due to the loss of particular glycosyltransferases concomitant with transformation. All of these factors probably account for the variable expressions of the complex of carbohydrate sequence determinants when comparing tumor sections of different individuals as well as the heterogeneity of expression of particular determinants within a single tumor tissue section. As described above, the A, B and/or H determinants, and the precursor sequences, are also expressed to differing extents on epithelial cells depending on the tissue type and cellular location in the tissue. Thus, the differentiation state of the particular epithelial cell also determines the quantity and types of carbohydrate sequences expressed. However, because of the complex nature of the competing biosynthetic pathways for the carbohydrate sequences of glycolipids and glycoproteins, and the relative activations of fucosyl- and sialyltransferases of tumor cells, it would seem that simple deductions as to the state of differentiation of particular tumors with A, B, H and precursor sequence expressions is not warranted.(ABSTRACT TRUNCATED AT 400 WORDS)

Expression of blood group H antigen type 2 chain by oral carcinoma cells after radiotherapy

The blood group H antigen type 2 was investigated immunohistochemically in sections of 44 surgical specimens from the oral mucosa. These comprised 35 squamous cell carcinomas obtained from 22 patients and 9 specimens of clinically healthy mucosa. The carcinoma specimens included 10 primary lesions and 25 recurrent lesions from patients who had undergone radiotherapy. The results showed that the specimens of normal oral mucosa stained at higher antibody titers than either group of carcinomas, and that postradiation recurrent tumors stained at higher titers than primary tumors. In 10 patients, both preradiation and postradiation carcinomas were examined; the postradiation lesions showed increased reactivity in 5 patients, no change in 3 patients, and a decrease in antigen reactivity in 2 patients. The expression of antigen H type 2 in the recurrent tumors appeared to correlate with the estimated daily tumor radiation dose; tumors with specific antigen staining took twice as long to recur after radiotherapy than tumors without similar staining. The results suggest that the expression of the blood group H antigen type 2 substance, being a differentiation antigen, is enhanced by the effect of radiation on the malignant cell.

Expression of A9 antigen and loss of blood group antigens as determinants of survival in patients with head and neck squamous carcinoma

The murine monoclonal antibody (A9), raised to the human squamous cell carcinoma (SCC) cell-line UM-SCC-1, defines a squamous cell antigen associated with aggressive biologic behavior of SCC cell lines in vivo and in vitro. In the present investigation, A9 antigen was detected in tissue sections from 37 consecutive, previously untreated patients with SCC of the head and neck. All tumors were positive for A9 binding, although three distinct patterns (reflecting different intensities of A9 expression) were identified. The intensity of A9 expression was independent of primary tumor site, tumor differentiation, keratinization, or growth pattern. The frequency of high expression (Pattern 1) grew with increasing T class, N class, and tumor stage, and was associated with loss of blood group expression in the tumor and with low levels of lymphocyte infiltration in the tumor. Strong A9 expression had a statistically significant association with low nuclear grade (i.e., tumors with more mature and fewer enlarged nuclei, P = 0.019), low vascular/stromal response (i.e., patchy response rather than continuous, P = 0.014), and impaired in vitro lymphokine production by peripheral blood leukocytes (P = 0.0011). Of greatest interest, however, was the strong association of high A9 expression with shortened disease-free interval (DFI) (P = 0.085) and survival (P = 0.081) relative to patients with weak A9 tumor staining (Patterns 2 and 3). Similarly, the loss of blood group antigen expression was strongly associated with decreased DFI (P = 0.038) and survival (P = 0.062). While neither Pattern 1 A9 expression nor loss of blood group reach statistical significance in prediction of survival, the combination of Pattern 1 A9 expression and loss of blood group expression in primary tumors was significantly associated, both with decreased disease-free interval (P = 0.017) and with decreased overall survival (P = 0.011) (median length of follow-up = 22 months). The length of follow-up (LFU) ranged from 2 to 38 months, with a median LFU of 22 months. While the number of patients (37) is small, the significant association between the expression of these cell-surface markers with relapse and survival indicates that immunohistologic staining of the primary tumor will be an important prognostic indicator useful in identification of individual patients at greatest risk of recurrence or early death from head and neck cancer, independent of tumor size, site, or stage at presentation. These markers may thus provide means of selecting patients who should receive adjuvant therapy and more intensive monitoring for the early detection of recurrent disease.

Altered H-antigen reactivity as an early indicator of malignant transformation in oral epithelium

This study was undertaken to determine whether or not the blood group H-antigen reactivity of oral epithelium has value in predicting malignant transformation. Tissue from 3 groups of patients was studied retrospectively, using an immunoperoxidase technique. Two biopsy specimens from each patient, obtained at different times but from the same site, were examined for the presence of H-antigen. Group I consisted of 16 patients in which the initial biopsy was histologically benign, but the subsequent biopsy revealed epidermoid carcinoma. The initial biopsies in Groups II (17 patients) and III (17 patients) revealed epithelial dysplasia. Whereas the subsequent biopsy in Group II revealed carcinoma, the subsequent biopsy in Group III remained non-invasive. Normal epithelium from 64 patients was also studied. The results showed that in normal epithelium, H-antigen-negative cells are rarely seen, but 81% of the initial benign specimens of Group I showed antigen-negative areas. Therefore, it was concluded that altered H-antigen reactivity in histologically benign epithelium may serve to predict eventual malignant transformation, and that immunologic dedifferentiation precedes histologic dedifferentiation. A comparison between the initial biopsy specimens of Groups II and III yielded nearly identical results and showed that it was not possible, on the basis of the H-antigen reactivity, to predict which dysplastic lesions would progress to epidermoid carcinoma.

Immunology and oral cancer

This paper summarises the evidence for the involvement of the immune response in the development of neoplasia, discusses the immunological abnormalities found in patients with head and neck carcinoma, and outlines recent attempts at treatment of patients with head and neck carcinoma by modulation of the immune response (immunotherapy).

Distribution of blood group antigens A, B and H in ameloblastomas

The histologic distribution of blood group antigens, A, B and H was examined in ameloblastomas and normal mucosa from 15 patients. The blood group antigens were demonstrated with a semiquantitative immunofluorescence staining method. Blood group antigens A and B were absent in the ameloblastomas, whereas the spinous cells of the oral mucosal epithelium showed a positive reaction in correspondence with the patient's blood group. Blood group antigen H was demonstrated in 14 of 15 ameloblastomas from patients belonging to blood group A, B, AB or O. In the oral mucosal epithelium from these patients blood group antigen H in all cases was located to the cell membranes of the spinous cells. The present findings suggest that a difference in ability to synthesize blood groups antigen H and the blood group antigens A and B exists in the ameloblastoma.

Distribution of blood antigen H in human buccal epithelium of secretors and non-secretors

The distribution of blood group antigen H in human buccal epithelium was examined in 22 individuals, 16 secretors and six non-secretors of blood group antigens in the saliva. An extract of Ulex europeus was used as marker of blood group antigen H in a triple layer immunofluorescence technique. The cell membranes of the spinous cell layer stained positively in all individuals, whereas the basal cells reacted negatively. Secretors and non-secretors had similar distributions of blood group antigen H in the buccal epithelium. However, a significantly higher amount of blood group antigen H was found in secretors than in non-secretors. The study indicates that an extract of Ulex europeus is a valuable marker for blood group antigen H in studying the distribution of this antigen in oral epithelium.

The expression of the epithelial blood-group substances: normal and malignant tissues

The blood-group isoantigens are macromolecules localized to the plasma membranes of certain epithelial tissues. These substances are not detectable on the epithelium once it has undergone malignant transformation. Results of this investigation have demonstrated that the loss of detectability of the blood-group isoantigens does not appear to be related to a "masking" effect by an increase in surface sialic acid. Using fluorescein-labeled lectins specific for sugar subunits which are components of the blood-group oligosaccharide chain, it was found that the malignant cells and cells of the parabasal layer of normal oral epithelium had high levels of N-acetyl-D-glucosamine (GlcNAC), the subterminal sugar residue of the blood-group chain. The basal cells of normal epithelium and a minority of the malignant cells demonstrated levels of D-galactose-N-acetyl-D-galactosamine, which are the most proximal blood-group sugar subunits, as well as subunits of other membrane antigens. Our results indicate that malignant cells seem to be capable of synthesizing the blood-group oligosaccharide chains to the same level as the normal cells of the parabasal layer of stratified squamous epithelium. This level is just subjacent to the terminal D-galactose residue of the blood-group precursor chain. Increased or decreased differentiation characteristics of squamous cell carcinomas did not alter the level of blood-group synthesis. However, there may be a correlation between the level of synthesis of these antigens and the ability of the cells to demonstrate motility and to proliferate.

The relationship between expression of epithelial B-like blood group antigen, cell movement and cell proliferation

Healing wounds in the oral mucosa of rhesus monkeys were examined by an immunofluorescence staining method to demonstrate the distribution of a blood group antigen cross reacting with human group B, and by labelling with tritiated thymidine to localize areas of cell proliferation. Within hours, blood group antigen reactivity was lost from epithelial cells adjacent to the wound margin. Reactivity was absent from the epithelial outgrowth into the wound, but returned with restoration of epithelial continuity. The zone of increased cell proliferation lay adjacent to, but outside of, the area of antigen loss. Antigen loss appeared to be associated with an area of increased cell movement, a finding of interest in relation to reports of antigen loss from epithelial tumors.

Selective loss of blood group antigens during wound healing

Frozen sections of healing wounds of the oral mucosa of 3 rhesus monkeys were examined by a double layer immunofluorescent technic for the presence of blood B-like antigens. Antigen activity was present in normal epithelium and in the epithelial outgrowth into the wounds but was absent from the outgrowth following treatment with lipid solvents. This finding suggests that glycoprotein but not glycolipid associated antigen is lost from the surface of epithelial cells during wound healing, a pattern of selective loss which may reflect a difference between regenerative and neoplastic lesions.