Immunologic indicators of prognosis in bladder cancer: the importance of cell surface antigens

Shared genetic links between bladder cancer and obesity-related traits: A conjunctional false discovery rate study

Bladder cancer (BCa) is a common cancer worldwide and is often linked with obesity-related comorbidities, but little is known about the underlying genetic mechanisms. To investigate these mechanisms, we used various quantitative tools, including conditional quantile-quantile (Q-Q) plots, conditional false discovery rate (cFDR), and conjunctional conditional false discovery rate (ccFDR), to explore the pleiotropic enrichment of risk loci between BCa and obesity-related traits. We also performed an expression quantitative trait locus (eQTL) analysis to assess the relationship between shared risk loci and gene expression. Finally, we conducted functional annotation using Kyoto Encyclopedia of Genes and Genomes (KEGG) and gene ontology (GO) analysis. Our findings indicated that there was successive enrichment for a range of obesity-related traits, including body fat percentage, body mass index, fasting insulin, type 2 diabetes mellitus, fasting glucose, high-density lipoprotein cholesterol, total triglycerides, and waist-to-hip ratio. Using the tools mentioned above, we identified 18 significant SNPs and 18 closely related genes (cFDR<0.01) under the condition of 8 obesity-related traits. The SNPs included rs143004880, rs73301337, rs10798572, rs11594929, rs17019138, rs2877, rs149795948, rs142509736, rs12727575, rs1571277, rs12131828, rs635634, rs76895963, rs118081211, rs7044247, rs138895564, rs4135275, and rs148023060. Additionally, we identified 15 novel loci using ccFDR, including rs143004880, rs73301337, rs10798572, rs11594929, rs17019138, rs2877, rs142509736, rs1571277, rs635634, rs76895963, rs12131828, rs118081211, rs7044247, rs138895564, and rs4135275. Of the 2 significant loci that modify gene expression, rs12131828 and rs635634 were identified. The functional annotation indicated that the conditional risk genes mainly participated in the regulation of gene silencing. Our study provided evidence of pleiotropic enrichment between BCa and 8 obesity-related traits, and we identified potential genetic mechanisms underlying this relationship. These findings may help in developing targeted clinical treatments for BCa.

ABO genotyping of various hematopoietic cell lines to select model cells for research purposes

Various cells from humans and animals have been established as cell lines, and their features, characteristics, and origins have been reported. Many laboratories use cell lines as model cells, which are selected to suit research purposes. We attempted to identify the ABO genotypes of 31 human leukemia and lymphoma cell lines stored in our laboratory using three methods: the PCR amplification of specific alleles (PASA), PCR-restriction fragment length polymorphism (RFLP), and the direct DNA sequencing of PCR products. We distinguished 31 human leukemia and lymphoma cell lines examined into six major ABO genotypes: A/O (A101/O01: n = 1, A101/O12: n = 4, A101/O26: n = 1, A101/O49: n = 1, A102/O01: n = 3), A/A (A101/A101: n = 1, A102/A102: n = 2), B/O (Bw29/O01: n = 1), B/B (B101/B101: n = 2), O/O (O01/O01: n = 9, O01/O02: n = 1, O01/O26: n = 1, O02/O03: n = 1), and A/B (A102/B101: n = 3). To the best of our knowledge, this is the first study to identify the ABO genotypes of various cell lines. The ABO genotypes of cell lines are important when selecting an experimental model cell for an ABO blood group study, and are essential information for cell lines. These results may be employed by research and clinical laboratories as well as in the forensic field.

Genetic alterations in bladder cancer and their clinical applications in molecular tumor staging

Molecular biology is expected to provide new tools and approaches to assess the prognosis of patients with bladder cancer, by providing information on the risks of tumor recurrence and progression from superficial bladder cancer to an invasive phenotype. Genetic and epigenetic alterations have been closely associated with bladder carcinogenesis and progression, although most of these are still under investigation in a preclinical setting. This article highlights current findings from molecular studies, and describes their potential application in molecular staging of bladder cancer.

Loss of blood group A antigen expression in bladder cancer caused by allelic loss and/or methylation of the ABO gene

Loss of ABO blood group antigen expression has been reported in transitional cell carcinoma (TCC) of the bladder. Synthesis of the ABO blood group antigen was genetically determined by allelic variants of the ABO gene assigned on 9q34.1. We analyzed loss of heterozygosity (LOH) and promoter hypermethylation of the ABO gene in TCC and compared them with alterations of A antigen expression in TCC, dysplasia and normal urothelium. A total of 81 samples of TCC of the bladder obtained from transurethral resection (TUR) (n=44) and radical cystectomy (n=37) were examined. Expression of the A antigen was evaluated by immunohistochemical staining (IHC) using anti-A antigen monoclonal antibody. LOH of the ABO gene locus was examined by blunt-end single-strand DNA conformational polymorphism (SSCP) analysis using flouresence-based auto sequencer. Promoter hypermethylation of the ABO gene were examined by bisulfite PCR-SSCP (BiPS) analysis and/or methylation-specific PCR (MSP). Loss of A allele and/or hypermethylation were significantly associated with abnormal expression of the A antigen in cases undergoing TUR (P=0.02) and radical cystectomy (P=0.0005). For the analysis of the concomitant dysplasia in 23 cases with TCC of the bladder, the expression of the A antigen was maintained, regardless of the A allelic loss or methylation status in the tumor. In conclusion, A allelic loss and hypermethylation in the promoter region of the ABO gene showed significant correlation with reduction of A antigen expression in TCC, while the expression of the A antigen is maintained in concomitant dysplasia or normal urothelium, suggesting that loss of the ABO gene and/or its promoter hypermethylation is a specific marker for TCC.

Pathology of transitional cell carcinoma of the bladder and its clinical implications

Transitional cell carcinomas are divided into superficial and muscle-invasive tumors. Most of them are superficial tumors, and approximately 15-20% are muscle-invasive carcinomas. Pathologists play a significant role in diagnosing bladder tumors and in reporting features important for determining prognosis. We will review the cytologic and histopathologic features that help determine prognosis, including depth of invasion, tumor grade, multicentricity, tumor size, and the presence of vascular/lymphatic invasion, blood group antigen expression, proliferative indices, and molecular markers. Brief mention will be made of specimen handling, interpretation, reporting, and histologic variants of transitional cell carcinoma.

Cell surface carbohydrates as prognostic markers in human carcinomas

Tumour development is usually associated with changes in cell surface carbohydrates. These are often divided into changes related to terminal carbohydrate structures, which include incomplete synthesis and modification of normally existing carbohydrates, and changes in the carbohydrate core structure. The latter includes chain elongation of both glycolipids and proteins, increased branching of carbohydrates in N-linked glycoproteins, and blocked synthesis of carbohydrates in O-linked mucin-like glycoproteins. In mature organisms, expression of distinct carbohydrates is restricted to specific cell types; within a given tissue, variation in expression may be related to cell maturation. Tumour-associated carbohydrate structures often reflect a certain stage of cellular development; most of these moieties are structures normally found in other adult or embryonic tissues. There is no unique tumour carbohydrate structure, since certain structures which are tumour-related in one organ may be normal constituents of other tissues. Tumour-associated carbohydrate changes have been used in the diagnosis of human cancers. Recently, however, it has been demonstrated that the expression of some carbohydrate structures is associated with prognosis. Tn, sialyl-Tn, and T are cell membrane-bound mucin-like carbohydrate structures that may be expressed in tumours due to blocked synthesis of the core carbohydrate chain of mucin-like structures. Their expression is strongly associated with prognosis in certain tumours, but the biological relationship between their expression and tumour progression is at present unknown. The blood group-related carbohydrate structures Le(x), sialyl-Le(x), ABH, and Le(y) are examples of terminal carbohydrate structures which are related to tumour prognosis. These structures are of increasing interest since they may function as adhesion molecules; adhesion of tumour cells to endothelial cells of blood vessels may be mediated by an interaction between sialosyl-Le(x) and E-selectin and studies indicate that Le(y) is related to cell motility. These findings are now the basis for tumour therapeutic experiments.

A study of prognosis and clinicopathology of bladder cancer to blood group type of host patients in Japan

A total of 538 patients with transitional cell carcinoma of the bladder with a mean follow up period of 5.8 years (range 1-25) were retrospectively analysed to see if there were any associations between blood group and grade, stage, or prognosis of the tumour. In contrast to previous findings among European and Americans, there were no significant differences among blood groups for stage, histological grade, or survival rate.

Lewis blood group antigen expression by cultured normal ureteral epithelial cells

The importance of Lewis blood group antigens in recurrent urinary tract infections has led to a more detailed study of the expression of these antigens in an in vitro culture system. Expression of A, B, H, and Lewis blood group antigens by primary cultures of ureter epithelial cells was analyzed by flow cytometry. Cells maintained blood group determinants for up to 7 weeks in culture over three passages. In several specimens, the cells that exhibited expression of Lewis A (Le(a) and Lewis B (Le(b)) antigens increased dramatically over 2-3 passages in culture. Lewis Y (Le(y)) antigen expression was positive on all primary cultures tested. The effect of fetal bovine serum (FBS) on blood group antigen expression was evaluated. Increased concentrations of FBS in the growth media increased the expression of Le(a) and Le(b) antigens in certain specimens, but did not affect expression of the other blood group antigens. The effect of FBS on blood group antigen expression of cultured cells depended on the Lewis blood type of the individual donating the specimen. To evaluate the heterogeneity often seen in Le(a) and Le(b) antigen expression, dual staining of cells for Le(a) and Le(b) antigens was performed. The results of these studies show for the first time that Lewis blood group antigens are expressed by cultured normal ureteral epithelial cells and that the pattern of expression of Le(a) and Le(b) changes over time. Furthermore, an individual cell may simultaneously express more than one Lewis antigen on its surface.

Detection of blood group surface antigens of urinary bladder tumours using monoclonal antibodies with the avidin-biotin complex technique

We examined 8 normal bladder transitional epithelia and 65 transitional cell carcinomas of the urinary bladder of various stages and grades for the presence of ABO(H) blood group surface isoantigens using the immunoperoxidase staining via the Avidin-Biotin Complex (ABC) methods. It was found that 27% of patients with grade I tumours, 50% with grade II tumours and 82% with grade III tumours had loss of cell surface isoantigens. When correlated with the clinical stage the tumours showed no surface isoantigens in stage D, while 65% of patients with stage A tumours were positive for surface antigens. From among 37 patients (57%), 28 (43%) survived for more than five years. Our results suggest that surface antigens of transitional cell carcinoma of the urinary bladder tended to disappear as the histologic changes of the tumour progressed. It also was noted that a loss of ABH(O) surface isoantigens was a bad prognostic sign.

Quantitative interrelations of Lewis antigens in normal mucosa and transitional cell bladder carcinomas

The factors regulating the expression of the Lewis blood group related antigens in tissues have yet to be clarified. In an attempt to resolve some of the existing controversies the quantitative interrelationship of the Le(a), Le(b), X and Y antigens in normal urothelium and transitional cell carcinomas (TCC) was studied using biopsy specimens derived from 22 patients whose ABO and Lewis red blood cell phenotype was known. A quantitative scale was devised to encompass both the extent and intensity of the immunohistochemical reactivity in one numerical value (score). The expression of these four antigens in the normal urothelium followed a characteristic pattern that is related to but not identical with the red blood cell phenotype. An excess of Le(b) and Y in the urothelium correlated with the Le(a-b+) red blood cell phenotype, while a relative increase in Le(a) and X (at the expense of Le(b) and Y) was associated with the Le(a+b-) red blood cell phenotype. This pattern can be accounted for by the combined effects of differential gene expression and substrate availability. The quantitative comparison of the antigenic make-up of TCCs with the corresponding normal tissue phenotype shows consistent trends, suggesting that the changes associated with neoplasia derive primarily from the suppression of specific gene products and, secondarily, from altered competitive substrate utilisation.

The relationship of ABH(O) blood group antigen expression in intraepithelial dysplastic lesions to clinicopathologic properties of associated transitional cell carcinoma of the bladder

Paraffin-embedded, giant-step sections of 13 bladders with transitional cell carcinomas were stained with monoclonal anti-A or anti-B antibodies to investigate whether intraepithelial dysplastic lesions are related to obvious tumors. Normal and/or hyperplastic lesions were retained in only eight bladders; severe dysplasia and/or carcinoma in situ were found in all bladders except two. AB-antigen expression was retained in intraepithelial lesions of bladders with invasive carcinoma. Most intraepithelial lesions were AB-antigen negative in bladders with frequently recurrent tumors. In bladders with initially multiple tumors, AB-antigen expression was negative in almost one half of the intraepithelial lesions. Therefore, it appears likely that most multiple or recurrent bladder carcinomas arise from dysplastic cells in intraepithelial lesions which have acquired malignant potential; initially invasive tumors quickly develop from a limited lesion acquiring a high malignant potential without changes of cell phenotype in most intraepithelial lesions.

Immunohistochemical detection of beta-human chorionic gonadotropin in urothelial carcinoma

Histologic sections from the specimens of 60 patients with urothelial carcinoma were stained immunohistochemically to search for beta-human chorionic gonadotropin (B-HCG) production. There were 6 doubtful, 5 weak and 1 strong positive B-HCG stainings among 65 sections from 60 patients. De novo acquisition of B-HCG production capability of tumour cells seemed to be predictive for early haematogenous dissemination of the disease, but the data obtained in this particular study were insufficient to suggest B-HCG as a routine prognostic marker.

Characterization of squamous cell bladder tumors by flow cytometric deoxyribonucleic acid analysis: a report of 100 cases

We studied 100 cases of squamous cell carcinoma of the bladder by flow cytometry after cystectomy. Tumors were classified according to the deoxyribonucleic acid profile into diploid or aneuploid. Proliferation of the tumors was assessed from the proportions of S-phase cells. The flow cytometric data were correlated to the histopathological stage and grade. Grade 1 tumors could be subdivided into diploid and aneuploid in 60 and 40% of the cases, respectively, while 95% of the grade 2 and all grade 3 tumors were aneuploid. Diploid tumors had low proliferation rates, while aneuploid tumors had significantly higher values. A high frequency of muscle invasive diploid squamous cell tumors was noted. Tumor heterogeneity was studied by comparing cell material from superficial and deep tumor areas, which were in agreement in 77% of the cases. By comparing biopsy material with that obtained by bladder washings, biopsy material yielded better information regarding deoxyribonucleic acid ploidy in half of the aneuploid tumors. These results indicate that flow cytometry offers an additional objective method to characterize squamous cell carcinoma.

Bladder cancer

Bladder cancer is largely a preventable disease; epidemiologic studies indicate that the majority of cases occur as a result of cigarette smoking or occupational exposures. The impact of screening high-risk populations is uncertain, but prompt and early diagnosis is essential for optimal therapeutic results. The management of different stages of disease varies greatly and is currently in a state of evolution. The majority of cancers are superficial, of low malignant potential, and can generally be treated cystoscopically. Few studies have addressed whether intravesical therapy will prevent high-risk patients with superficial disease from developing muscle invasion or distant metastases. Controversy exists as to optimal management of patients with invasive cancers. Improvements in technique and methodologies of urinary diversion have made cystectomy more tolerable for patients. Although cystectomy remains the "gold standard," probably not all patients require it. The careful selection of those patients whose bladders can be preserved is currently being evaluated. Combination chemotherapy for patients with metastatic bladder cancer is very active, appears to prolong survival, and may offer durable remissions to some patients. Whether chemotherapy will permit greater numbers of patients with invasive bladder cancer to be cured and bladders preserved remains to be determined.

Blood group antigen expression in frozen sections of presenting bladder cancer: 3-year prospective follow-up of prognostic value

Blood group antigen (BGA) expression was studied on frozen sections from the initial, presenting, transitional cell bladder cancers of 73 patients. Clinical follow-up was prospective and, after 3 years, 59 patients were available for assessment. Of 32 tumours that retained substantial BGA (BGA+ and BGA +/- ), 11 progressed. Of 27 tumours with less than 5% or undetectable BGA expression (BGA-), 14 did not progress. Of 24 pTa tumours, 17 had substantial BGA expression and 7 were BGA-; 5 patients progressed, 4 substantially BGA positive and 1 BGA-, all to category pT1; 15 tumours were category pT1, 7 substantially BGA positive and 8 BGA-; 7 patients progressed, 1 substantially BGA positive and 6 BGA-, all of whom died from bladder cancer; 20 were pT2 or deeper, 8 substantially BGA positive and 12 BGA-; 12 patients progressed, 6 substantially BGA positive and 6 BGA-, all of whom died from bladder cancer. Despite improved understanding of the biochemistry and techniques of detection of BGA, these results preclude the use of BGA determination as a guide to prognosis in individual transitional cell carcinoma, whether used alone or in combination with pT category.

Changing expression of ABH blood group and cryptic T-antigens of noninvasive and superficially invasive papillary transitional cell carcinoma of the bladder from initial occurrence to malignant progression

Thirteen patients who developed malignant progression after frequent recurrence of noninvasive or superficially invasive (Ta or T1) papillary transitional cell carcinoma of the bladder were studied for expression of ABH-antigens in tumor tissues throughout their clinical courses and cryptic Thomsen-Friedenreich antigen (T-Ag) expression in the tumor tissues was examined simultaneously in nine of them. Five patients who experienced recurrent bladder tumors for more than 5 years without any malignant progression were served as control. ABH-antigens in initial tumors were negative in only two of 13 patients developing malignant progression and in two of five controls. Cryptic T-Ag was positive in all patients examined. Recurrent tumors revealed eliminated or decreased expression of ABH-antigens and cryptic T-Ag before malignant progression in, respectively, ten of 11 and six of nine patients with antigen-positive initial tumors. In contrast, recurrent tumor of controls with antigen-positive initial tumors showed neither elimination nor decrease in expression of antigens throughout their clinical courses.

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)

ABH isoantigens in bladder carcinoma patients grouped according to DNA changes over time

Eighteen patients with transitional cell bladder carcinoma and increasingly abnormal ploidy were assembled to evaluate the relation over time between ploidy and ABH isoantigen deletion. Fifteen patients with diploid recurrent tumors and 16 with aneuploid tumors over time were used as controls. ABH isoantigen deletion at diagnosis was closely related to cancer death, while isoantigen assessments on recurrences gave less prognostic information. Aneuploidy at diagnosis also indicated an adverse prognosis, as did recurrent bladder carcinoma with deteriorating ploidy. Patients with tumors deleted of isoantigen expression at diagnosis but with normal ploidy had as bad a prognosis as patients with deleted tumors and aneuploidy, indicating that isoantigen deletion may occur earlier than ploidy changes.

Clinical significance of A, B, H isoantigen deletion of urothelial cells in bladder carcinoma

The occurrence and/or deletion of A, B, H isoantigens in cytologic specimens was compared to a number of other clinical parameters commonly used for prediction of prognosis or monitoring of bladder carcinoma. Isoantigens were better preserved by our preparation for cytologic than for histologic specimens. Patients with isoantigen present on urothelial cells were more likely to have small or no visible tumors than large tumors. A strong correlation was found between isoantigen status and cytologic diagnosis (P less than 0.001), but not with ploidy (P = 0.059). For short-term prognosis of recurrence, tumor size appeared to be highly significant, whereas A, B, H isoantigen determinations had no predictive value. Intravesical chemotherapy did not per se influence expression/deletion of isoantigens.

Blood group-related antigens as markers of malignant potential and heterogeneity in human carcinomas

The expression of BGR-Ags is often aberrant in human carcinomas. The observation that BGR-Ag expression in human bladder carcinomas correlates with prognosis for patients with these tumors is especially interesting in light of the numerous reports of correlations between cell surface glycosylation and malignant phenotype in experimental animal tumors. Many observations suggest how this relation might be mediated. It seems reasonable to anticipate that the study of the BGR-Ags and their expression in carcinoma may emerge from its current predominantly descriptive phase and become an important part of the investigation of human tumor biology.

Blood group isoantigens ABO (H) in transitional carcinoma of the bladder: a clinicopathological study

Blood group A, B and H antigens were investigated in 183 paraffin embedded biopsies from 58 patients with transitional cell carcinoma of the urinary bladder, by a modified specific red cell adherence test, direct immunofluorescence with Ulex Europeus lectin and indirect immunoperoxidase method with monoclonal antibodies against blood group antigens. The results were correlated with pathological grade and stage and with the clinical course of patients evaluating the recurrence index and clinical state. Histological findings were roughly correlated with the expression of red cell tissue antigens but not with the presence of precursor H substance in biopsies from patients of blood group A or B, in which a higher proportion of H positive results was appreciated. The clinical course was also related to the presence or absence of blood group antigens in referential biopsies: 90 per cent of negative biopsies corresponded to patients who had high recurrence index whereas 75 per cent of positive biopsies corresponded to patients who had low recurrence index or did not have recurrence for five years; 25 per cent of recurrences observed in patients with referential positive biopsy were invasive whereas the proportion of invasive tumor in recurrence from negative biopsies rises to 73 per cent. In addition, all the final biopsies from patients who died of bladder tumor were negative for blood group antigens. The diagnostic and prognostic significance of these tissue antigens in transitional cell carcinoma of the urinary bladder is discussed, and we conclude that the analysis of blood group antigens in bladder biopsies by established techniques is a useful tool in clinical pathology for the screening and followup of bladder tumors, as previously suggested.

Concanavalin A-peroxidase labeling in cervical exfoliative cytopathology. I. Labeling of normal squamous cells and the detection of cancer

The lectin binding capacity of the cell surface of normal flattened exfoliated epithelial cells of the uterine cervix was investigated looking for differences between specimens from normal and cancer patients. The method used was a modified concanavalin A-horseradish peroxidase (Con A-HRP) labeling procedure. Both normal and cancer specimens contain labeled as well as unlabeled usual flattened cells. There is a distinct difference between the labeling intensity of labeled and that of unlabeled cells. Quantification of the labeling results has been achieved using a light microscope equipped with a computerized video system. Apparently healthy persons, having a percentage of labeled flattened cells between 54 and 94% (mean = 73%, SD = 10%, N = 40), were totally discriminated by this method from the cancer patients. These patients with a histologically confirmed squamous cell carcinoma, showed a labeling percentage between 10 and 22% (mean = 15%, SD = 4%, N = 10). Hormonal factors, such as phase of cycle and pill use, appeared to have no significant influence. Statistical analysis revealed that at least 99% of all healthy persons will have a labeling percentage above 45%, while at most 1% of the cancer patients will show a labeling percentage above 30%. When choosing the labeling percentage of 45% as critical value, the Con A-HRP labeling might serve as an additional detection method for cancer of the uterine cervix. Moreover, as it is based on the abundantly present normal cells, and not on the often scarce abnormal cells, the method is not liable to sampling and screening errors.

Immunohistological detection of T antigen and ABH blood group antigens in upper urinary tract tumours

The status of T antigen was assessed by means of peanut agglutinin (PNA) used in an immunoperoxidase technique, and the status of ABH blood group antigens was determined by the specific red cell adherence (SRCA) test. Thirty-eight patients with upper urinary tract tumours were examined. Our data indicated that T antigen status did not correlate with conventional prognostic indicators such as grade and stage of tumour and survival of patients, while the expression or deletion of ABH blood group antigens did correlate well. It was concluded that ABH blood group antigen determination might provide a useful prognostic probe in upper urinary tract tumours should it find clinical application.

Quantitative analysis of the A, B and H isoantigens in single transitional carcinoma cells

To obtain objective data on deletion of the ABH isoantigens in bladder carcinoma, microfluorometry was used. Slides were scanned in phase contrast to lessen fading of the immuno- or lectin-fluorescence stained cells. The fluorescence intensity was measured in relation to an external uranyl standard. Staining was most intense in the peripheral and cytoplasmic parts of the cells. The intra specimen fluorescence intensity varied as 1 to 10. In nondeleted cell populations fluorescence intensity means ranged from 1025 to 12,550 and in deleted populations from 304 to 510. Microfluorometry accurately separates deleted cell populations from those with a normal ABH antigen content.

A, B and H antigens in normal urothelium: an immunohistochemical study using monoclonal antibodies with the avidin-biotin complex technique

Immunohistochemical staining for the A, B and H blood group antigens was studied in 61 normal human ureters using monoclonal antibodies with avidin-biotin complex application. Thirty-seven of these were archival material, and 24 were processed prospectively. In 100 per cent of the prospectively processed ureters, A, B and H antigens were demonstrated corresponding to the blood type of the source. Archival material stained for A, B and H 65 per cent, 50 per cent and 100 per cent of the time, respectively. Serial sampling of prospectively processed ureters showed diminution of staining with prolongation of immersion in formalin. A characteristic staining pattern was found in ureters from patients with type B blood.

Further studies on specificity of red cell adherence test: nonmalignant bladder lesions

Specific red cell adherence test for blood group antigens was utilized in 32 nonmalignant bladder lesions, none of which was associated with bladder cancer, to determine the specificity of this test. All of the 14 lesions of cystitis cystica, cystitis glandularis, and chronic cystitis retained their antigens. Of the 18 lesions of squamous metaplasia, 13 (72%) were antigen positive. Testing for blood group antigens showed an overall 84 per cent specific rate in 27 of the 32 nonmalignant bladder lesions.

Avidin-biotin technique is more sensitive than lectin assay for detecting the Thomsen-Friedenreich antigen (T-antigen) in transitional cell carcinoma of the bladder

Avidin biotin technique and lectin assay has been compared in a double-blind study for detection of the T-antigen in transitional carcinoma of the bladder. Utilizing the tumor registry from the U.S. Naval Hospital in Bethesda, Maryland, patients with transitional cell carcinoma of the bladder were identified. Thirty-three patients were selected with a total of 43 specimens. Tissues from 26 patients with a total of 43 specimens that showed no lesions and had no known history of genitourinary diseases were used as controls. These tissues were studied for the presence of T-antigen utilizing avidin biotin or lectin techniques. T-antigen was detected in 60% of the specimens with lectin technique, while 95% was detected with avidin biotin methods. The T-antigen was not detected by either method even after the treatment with neuraminidase in six patients. These patients had high grade and high stage tumors. This study demonstrated that normal urothelium has concealed T-antigen that can be exposed by treating the tissue with neuraminidase. However, the T-antigen is unconcealed in low grade tumor but disappears in high grade invasive tumor. Avidin biotin technique appears to be a more sensitive method for detecting the presence or absence of the T-antigen.

Correlation of ABH antigenicity and urine cytology results in transitional cell carcinoma of bladder

Loss of ABH antigens from the cell surface of transitional cell carcinoma of the bladder has been proposed as an indicator of increased cellular dedifferentiation and the tendency toward invasive recurrence. An attempt was made to correlate the urinary cytology and the ABH antigen status of 57 patients with histologically confirmed bladder tumors and 28 with only dysplasia on biopsy. A review of the results of surface antigenicity studies and the preoperative urine cytologies showed no significant difference in the diagnostic sensitivity of cytology between comparable antigen negative and positive groups.

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.

Double blind comparison of T-antigen and ABO(H) cell surface antigens in bladder cancer

Transitional cell carcinoma of the bladder is a major cause of cancer deaths. Recently, much attention has been focused on ABO(H) antigen deletion in terms of prediction of prognosis. Furthermore, several studies have shown a correlation between T-antigen (a precursor of blood MN glycoprotein) expression in carcinomas of the breast, colon, and stomach. We have studied 56 specimens from 41 patients with transitional cell carcinoma of the bladder for T-antigen expression and ABO(H) antigen deletion. Results were analyzed with respect to tumor grade, tumor stage, and clinical course. The data indicate that T-antigen expression was not completely useful prognostically; it did not correlate with grade, stage, or clinical course. ABO(H) antigen expression or deletion was found to be a better predictor of tumor behavior than tumor grade, despite a false negative rate of 20 to 30 per cent in blood group O patients. We suggest that use of immunoperoxidase techniques will increase the sensitivity in group O patients, thus making ABO(H) deletion a useful predictive parameter of tumor aggressiveness. This is currently being evaluated in our patients.

ABH cell surface isoantigens in invasive bladder carcinoma associated with schistosomiasis

The immunoperoxidase technique for demonstrating blood group ABH isoantigens was used to compare 33 patients with invasive stages T2 and T3 bladder carcinoma with (18) and without (15) schistosomiasis. Of the 18 patients with schistosomiasis 11 (61 per cent) had cell surface antigens present (9 with squamous cell carcinoma and 2 with transitional cell carcinoma and areas of squamous metaplasia), while isoantigens were absent in the remaining 7 (1 with well differentiated squamous cell, 2 with moderately to poorly differentiated squamous cell and 4 with transitional cell carcinoma). Cell surface isoantigens were present in only 3 of the 15 patients (20 per cent) without schistosomiasis (2 with squamous cell and 1 with transitional cell carcinoma) and absent in the remaining 12 with transitional cell carcinoma. This preliminary study shows that a significant percentage of patients with schistosomiasis-associated invasive bladder carcinoma maintain the blood group isoantigens, in contrast to those with bladder carcinoma not associated with schistosomiasis. The better prognosis of schistosomiasis-associated carcinoma could be linked conceivably to isoantigen maintenance. If this speculation is supported by further studies the determination of blood group isoantigens in these patients would be of prognostic value.

Invasiveness of transformed bladder epithelial cells

The invasiveness of bladder tumors has been studied in man, experimental animals, and in tissue culture by numerous authors. The prognostic importance of cellular markers for invasiveness is stressed, and the usefulness of histopathological and cytologic grading, cytogenetic studies, antigenic investigations, and enzymatic characterization is discussed. The invasiveness of bladder cells has frequently been examined in transplantation and explantation experiments. In human urothelial cell cultures three grades of transformation are defined, and a correlation has been established between the invasiveness of these cell lines in a three-dimensional in vitro model and their tumorigenicity in nude mice. The mechanism of tumor invasion is discussed, and it is recommended in future research to make a distinction between invasion en bloc and cellular infiltration.

A comparison of clinical course with blood group antigen testing by specific red cell adherence and immunoperoxidase in ureteral and renal pelvic tumors

Specimens of transitional cell carcinoma of the ureter and renal pelvis from 20 patients were tested for blood group antigenicity using immunoperoxidase and specific red cell adherence methods. The results of antigen testing were correlated with tumor stage and grade as well as the subsequent clinical course of the patients. The specific red cell adherence test was negative in 80 per cent and the immunoperoxidase test was negative in 40 per cent of all tumors. Of the 4 patients with positive specific red cell adherence tests 3 had high grade (II to III), invasive tumors as did 7 of 12 with tumors that were positive by immunoperoxidase testing. Blood group antigen testing did not prove helpful in predicting the clinical course of our patients. In addition, a careful review of previously published data does not support the conclusion that blood group antigen testing is a valuable predictor of upper tract tumor aggressiveness.

Prognostic validity of the specific red cell adherence test in upper urothelial tumours

The specific red cell adherence (SRCA) test for blood group antigens was used in 32 patients with upper urinary tract tumours to determine whether their survival could be predicted by this test. The SRCA results correlated well with survival in each grade and stage of the tumours. Overall, patients with positive tests showed a significantly higher 5-year survival rate than those with negative tests (87.2% vs. 24.6%). These findings add support to the prognostic importance of this test in upper urinary tract tumours.

Specific red cell adherence test in benign and malignant lesions of the prostate

The specific red cell adherence test (SRCA) for blood group antigens has been shown to have some bearing on the invasive potential of bladder tumours. Hitherto there have been few data published from patients with prostatic disease. The results of SRCA testing in 69 such patients are presented. Each of the 30 cases of adenocarcinoma was antigen negative. However, as 18 of 39 patients with only benign hyperplasia were also antigen negative, the test clearly does not reflect extant tumour and is probably not an indicator of subsequent growth of prostatic cancer. Antigen expression was also negative in sections showing prostatitis. As the test was invariably negative in patients with adenocarcinoma, whether or not metastases were present and whatever the degree of differentiation of the primary tumour, it lacks the power to discriminate invasive potential.

The specific red cell adherence test in transitional cell carcinoma of the bladder before and after radiotherapy in patients with blood group A

Serial formalin-fixed specimens of bladder tumors before and after irradiation from 19 patients with blood group A were tested for the presence or absence of antigen by the specific red cell adherence test. All patients had at least grade B transitional cell cancer of the bladder. The specific red cell adherence test was negative before radiotherapy in 9 patients, 4 of whom (44 per cent) had positive tests after treatment. However, the test was positive before radiotherapy in 10 patients (56 per cent) and became negative after radiotherapy in only 1. Of the patients 47 per cent had tumors that were positive for specific red cell adherence before and after radiotherapy, and 26 per cent had tumors that were consistently negative for antigen.

Immunofluorescence study of the distribution of A, B and H cell surface antigens in bladder tumors

The distribution of A, B and H cell surface antigens was studied in 30 patients with bladder tumors using indirect immunofluorescence. These antigens, normally present at the surface of the healthy urothelium, disappear in various degrees in a large number of bladder tumors. Nevertheless, no close correlation exists between this loss of antigens, and the grade and stage of the vesical tumor, although when A, B and H antigens persist the prognosis generally seems better.

A, B, O (H) antigenic determinants in superficial transitional cell tumors of bladder

The initial tumors of 21 patients who earlier had presented with superficial noninvasive transitional cell carcinoma of the bladder and who subsequently underwent cystectomy for invasive disease were examined by the specific red cell adherence test. Eighteen of 21 initial tumors (85.7%) were antigen negative. The time from initial tumor resection ranged from twelve to 168 months (mean thirty-eight months). Loss of blood group antigens indicated enhanced biologic aggressiveness of tumors. However the interval to invasion is sufficiently variable as to preclude the use of this assay for timing of radical cystectomy.

Urothelium and the Specific Red Cell Adherence Test

The Specific Red Cell Adherence Test (SRCAT) has been modified to produce clearer, more consistent, permanent preparations. Normal urothelium, inflammatory lesions, squamous metaplasia, papillomata, flat in situ and papillary tumours and invasive neoplasms of the bladder have been studied. Inflammatory and squamous changes did not corrupt the test results. The SRCAT was found to be a highly significant test for identifying those patients at risk from invasive bladder tumour. ABH antigens in carcinoma in situ appeared to be non-uniformly distributed throughout the bladder urothelium; it is suggested that all subsequent biopsies from these patients should be tested.