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Rolesi R, Paciello F, Paludetti G, De Corso E, Sergi B, Fetoni AR. Study of Angiogenic, Pro-Apoptotic, and Pro-Inflammatory Factors in Congenital and Acquired Cholesteatomas. J Pers Med 2023; 13:1189. [PMID: 37623440 PMCID: PMC10455083 DOI: 10.3390/jpm13081189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVES Despite recent advances in biomolecular research that have improved our knowledge of cholesteatoma pathogenesis, the reasons behind its highly variable clinical course are still not clarified. It has been proposed that biological signaling between peri-matrix and matrix cells could play a critical role in disease homeostasis. The aim of our study was to analyze the expression of inflammatory (IL-1β), hyper-proliferative (STAT-3, TGF-β), and angiogenic (VEGF-C, PDGFr) factors in congenital and acquired cholesteatomas (both in adults and children), which might correlate with the clinical features observed. We performed an experimental study on 37 patients (29 males and 8 females, ranging from 4 to 66 years of age) who were diagnosed with cholesteatoma between 2020 and 2021 in our institution. All patients underwent clinical, audiologic, and radiologic assessments. Bone erosion grading and staging of cholesteatoma growth were assessed through preoperative evaluation and intraoperative middle ear findings, according to the PTAM System proposed by the Japan Otological Society (2016). Retro-auricular skin specimens were intraoperatively collected in all patients. Skin and cholesteatoma samples were analyzed through histopathological, western blot, and immunohistochemical evaluations. The expression rate was measured to find out the differences between congenital and acquired cholesteatomas as well as between the adult and pediatric populations. Expression of angiogenic, inflammatory, and proliferative biomarkers is significantly increased in acquired cholesteatomas in children as compared to congenital and acquired forms in adults, in accordance with the higher stage of disease shown by imaging, surgical, and histological features. Our data suggest that pathways already supposed to be involved in the pathogenesis of cholesteatomas could be differently activated in more destructive forms, typically found in children. The identification of potential biomarkers of cholesteatoma aggressiveness could lead to more personalized management (timing of intervention, recurrence prevention) and the future identification of anti-growth/anti-proliferative agents as non-surgery therapeutic options.
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Affiliation(s)
- Rolando Rolesi
- Department of Otolaryngology Head and Neck Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.P.); (E.D.C.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Fabiola Paciello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Department of Neuroscience, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gaetano Paludetti
- Department of Otolaryngology Head and Neck Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.P.); (E.D.C.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Eugenio De Corso
- Department of Otolaryngology Head and Neck Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.P.); (E.D.C.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Bruno Sergi
- Department of Otolaryngology Head and Neck Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.P.); (E.D.C.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Anna Rita Fetoni
- Department of Neuroscience, Reproductive Sciences and Dentistry-Audiology Section, University of Naples Federico II, 80131 Naples, Italy;
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A Role for Mast Cell-Mediated Antibodies in the Formation of Cholesteatoma and Cholesteatoma-Induced Bone Erosion. Diagnostics (Basel) 2023; 13:diagnostics13030455. [PMID: 36766559 PMCID: PMC9914080 DOI: 10.3390/diagnostics13030455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
The study aimed to evaluate the effects and relationships between mast cells in the matrix, mast cell enzymes tryptase and chymase, epithelial proliferation, microvascular density, and bone destruction in cholesteatoma. Thirty-five biopsies diagnosed with cholesteatoma and seven healthy skin tissues taken from the retro-auricular region for control were evaluated. Immunohistochemical studies were performed with CD117, CD34, Ki-67, chymase, and tryptase antibodies, in a single session for all cases and the control group. The relationship between erosion size and antibody load was determined. The mean cholesteatoma epithelium Ki-67 was higher than the control group (p < 0.001). CD117-positive mast cells, chymase-positive mast cells, tryptase-positive mast cells, and microvessel density were significantly higher in the cholesteatoma matrix compared to the control group (p < 0.002, p < 0.001, p < 0.005). In the group with bone erosion scores of two and above, immunohistochemical markers tended to be higher. A positive correlation was found between CD117 and chymase, tryptase, and microvessel density; between tryptase, chymase, and microvessel density; and between chymase and microvessel density. CD117-positive mast cells and chymase-positive mast cells stimulate angiogenesis, increase the epithelium's proliferative capacity in the cholesteatoma matrix, and form cholesteatoma. The increased proliferation of cholesteatoma epithelium and increased vascular density in the matrix exacerbate bone erosion.
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Urík M, Hurník P, Žiak D, Machač J, Šlapák I, Motyka O, Jabandžiev P. Immunohistochemical analysis of retraction pocket pars tensa of tympanic membrane in children. Int J Pediatr Otorhinolaryngol 2019; 122:111-116. [PMID: 30999159 DOI: 10.1016/j.ijporl.2019.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/09/2019] [Indexed: 11/25/2022]
Abstract
AIMS Immunohistochemical analysis of retraction pocket pars tensa of tympanic membrane in children. Identification of signs typical for cholesteatoma and support of retraction theory of cholesteatoma. STUDY DESIGN a prospective study analysing 31 surgically removed retraction pockets. DEPARTMENT University Hospital, Children's Medical Centre Methods: Retraction pockets processed by a standard process for immunohistochemical analysis. The observed findings were specified using antibodies CD45 LCA (leukocyte common antigen), CD31 (platelet endothelial cell adhesion molecule), D2-40 (marker of lymphatic endothelium), MMP9 (marker of degradation of connective tissue extracellular matrix) and Ki67 (cellular marker of proliferation). RESULTS All observed parameters except for MMP9 had a significantly higher incidence in retraction pocket stage III compared to stage II according to Charachon. CONCLUSION We described immunohistochemical signs of retraction pocket pars tensa of tympanic membrane in children resulting in cholesteatoma. All the observed signs occur in the structure of matrix and perimatrix of cholesteatoma. A significantly higher incidence of all observed parameters except from MMP9 was proved in retraction pocket stage III, unlike in stage II. This observation proves the fact that retraction pocket is a progressive disease and is a procholesteatoma stage.
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Affiliation(s)
- Milan Urík
- Department of Paediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic.
| | - Pavel Hurník
- Department of Pathology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Dušan Žiak
- Department of Pathology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Josef Machač
- Department of Paediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Ivo Šlapák
- Department of Paediatric Otorhinolaryngology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Oldřich Motyka
- Nanotechnology Centre, VŠB-Technical University of Ostrava, Ostrava, Poruba, Czech Republic; ENET - Energy Units for Utilization of Non-Traditional Energy Sources, VŠB-Technical University of Ostrava, Ostrava, Poruba, Czech Republic
| | - Petr Jabandžiev
- Department of Pediatrics, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
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Hamed MA, Nakata S, Shiogama K, Suzuki K, Sayed RH, Nishimura Y, Iwata N, Sakurai K, Badawy BS, Inada KI, Tsuge H, Tsutsumi Y. Cytokeratin 13, Cytokeratin 17, and Ki-67 Expression in Human Acquired Cholesteatoma and Their Correlation With Its Destructive Capacity. Clin Exp Otorhinolaryngol 2017; 10:213-220. [PMID: 28073243 PMCID: PMC5545701 DOI: 10.21053/ceo.2016.01263] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/10/2016] [Accepted: 12/14/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Cholesteatoma is a nonneoplastic destructive lesion of the temporal bone with debated pathogenesis and bone resorptive mechanism. Both molecular and cellular events chiefly master its activity. Continued research is necessary to clarify factors related to its aggressiveness. We aimed to investigate the expression of Ki-67, cytokeratin 13 (CK13) and cytokeratin 17 (CK17) in acquired nonrecurrent human cholesteatoma and correlate them with its bone destructive capacity. METHODS A prospective quantitative immunohistochemical study was carried out using fresh acquired cholesteatoma tissues (n=19), collected during cholesteatoma surgery. Deep meatal skin tissues from the same patients were used as control (n=8). Cholesteatoma patients were divided into 2 groups and compared (invasive and noninvasive) according to a grading score for bone resorption based upon clinical, radiologic and intraoperative findings. To our knowledge, the role of CK17 in cholesteatoma aggressiveness was first investigated in this paper. RESULTS Both Ki-67 and CK17 were significantly overexpressed in cholesteatoma than control tissues (P<0.001 for both Ki-67 and CK17). In addition, Ki-67 and CK17 were significantly higher in the invasive group than noninvasive group of cholesteatoma (P=0.029, P=0.033, respectively). Furthermore, Ki-67 and CK17 showed a moderate positive correlation with bone erosion scores (r=0.547, P=0.015 and r=0.588, P=0.008, respectively). In terms of CK13, no significant difference was found between cholesteatoma and skin (P=0.766). CONCLUSION Both Ki-67 and CK17 were overexpressed in cholesteatoma tissue and positively correlated with bone resorption activity. The concept that Ki-67 can be a predictor for aggressiveness of cholesteatoma was supported. In addition, this is the first study demonstrating CK17 as a favoring marker in the aggressiveness of acquired cholesteatoma.
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Affiliation(s)
- Mahmood A Hamed
- Department of Otorhinolaryngology, Banbuntane-Hotokukai Hospital, Fujita Health University School of Medicine, Nagoya, Japan.,Department of Otorhinolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Seiichi Nakata
- Department of Otorhinolaryngology, Banbuntane-Hotokukai Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Kazuya Shiogama
- Department of Pathology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kenji Suzuki
- Department of Otorhinolaryngology, Banbuntane-Hotokukai Hospital, Fujita Health University School of Medicine, Nagoya, Japan.,Department of Otorhinolaryngology, Yonaha General Hospital, Kuwana, Japan
| | - Ramadan H Sayed
- Department of Otorhinolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Yoichi Nishimura
- Department of Otorhinolaryngology, Banbuntane-Hotokukai Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Noboru Iwata
- Department of Otorhinolaryngology, Banbuntane-Hotokukai Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Kouhei Sakurai
- Department of Pathology, Banbuntane-Hotokukai Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Badawy S Badawy
- Department of Otorhinolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ken-Ichi Inada
- Department of Pathology, Banbuntane-Hotokukai Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Hayato Tsuge
- Department of Otorhinolaryngology, Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yutaka Tsutsumi
- Department of Pathology, Fujita Health University School of Medicine, Toyoake, Japan
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Hamed MA, Nakata S, Sayed RH, Ueda H, Badawy BS, Nishimura Y, Kojima T, Iwata N, Ahmed AR, Dahy K, Kondo N, Suzuki K. Pathogenesis and Bone Resorption in Acquired Cholesteatoma: Current Knowledge and Future Prospectives. Clin Exp Otorhinolaryngol 2016; 9:298-308. [PMID: 27440129 PMCID: PMC5115149 DOI: 10.21053/ceo.2015.01662] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 11/22/2022] Open
Abstract
Cholesteatoma is a cystic non tumorous lesion of the temporal bone that has the ability to destroy nearby structures by its power to cause bone resorption and as a result, fatal complications prevail. We aimed to conduct a comprehensive review for pathogenesis of acquired cholesteatoma, bone resorption mechanisms, and offer a future vision of this serious disease. We have reviewed different theories for pathogenesis of acquired cholesteatoma including the most relevant and updated ones with special emphasis on the mechanisms of bone resorption through Medline/PubMed research using the keywords 'aetiopathogenesis, bone resorption, acquired cholesteatoma, temporal bone, and cytokines.' In order to strengthen our study, we searched the reference lists of identified reviews. Cholesteatoma is a subject of debate among otolaryngologists since it was prescribed firstly. Over many decades, several theories were postulated for aetiopathogenesis of cholesteatoma with a tendency to follow more than one theory to explain the proper nature of that disease. Until now, the mechanism of bone resorption has yet to be more clarified. In the last century, a leap has occurred in the field of biomolecular cholesteatoma research which improved our knowledge about its pathophysiology and bone destructive mechanism. However, surgery is still the only available treatment. We conclude that discovery of new therapeutic choices for cholesteatoma other than surgery by the use of anti-growth, anti-proliferative, apoptotic agents as well as medications that antagonize osteoclastogenesis should be the main concern in the future clinical and experimental research work. Also, searching for predictors of the aggressiveness of cholesteatoma can affect the timing of intervention and prevent occurrence of complications.
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Affiliation(s)
- Mahmood A Hamed
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan.,Department of Otolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Seiichi Nakata
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Ramadan H Sayed
- Department of Otolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Hiromi Ueda
- Department of Otolaryngology, Aichi Medical University, Nagakute, Japan
| | - Badawy S Badawy
- Department of Otolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Yoichi Nishimura
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Takuro Kojima
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Noboru Iwata
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Ahmed R Ahmed
- Department of Pathology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Khalid Dahy
- Department of Otolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Naoki Kondo
- Department of Pathology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Kenji Suzuki
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan.,Department of Otolaryngology, Yonaha General Hospital, Kuwana, Japan
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Xie S, Xiang Y, Wang X, Ren H, Yin T, Ren J, Liu W. Acquired cholesteatoma epithelial hyperproliferation: Roles of cell proliferation signal pathways. Laryngoscope 2016; 126:1923-30. [PMID: 26989841 DOI: 10.1002/lary.25834] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Shumin Xie
- Department of Otolaryngology-Head and Neck Surgery; Xiangya Hospital of Central South University; Changsha Hunan Province China
| | - Yuyan Xiang
- Department of Human Anatomy; University of South China; Hengyang Hunan Province China
| | - Xiaoli Wang
- Department of Otolaryngology-Head and Neck Surgery; The Second Xiangya Hospital of Central South University; Changsha Hunan Province China
| | - Hongmiao Ren
- Department of Otolaryngology-Head and Neck Surgery; The Second Xiangya Hospital of Central South University; Changsha Hunan Province China
| | - Tuanfang Yin
- Department of Otolaryngology-Head and Neck Surgery; The Second Xiangya Hospital of Central South University; Changsha Hunan Province China
| | - Jihao Ren
- Department of Otolaryngology-Head and Neck Surgery; The Second Xiangya Hospital of Central South University; Changsha Hunan Province China
| | - Wei Liu
- Department of Otolaryngology-Head and Neck Surgery; The Second Xiangya Hospital of Central South University; Changsha Hunan Province China
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Analysis of histopathological aspects and bone destruction characteristics in acquired middle ear cholesteatoma of pediatric and adult patients. Int J Pediatr Otorhinolaryngol 2016; 82:73-7. [PMID: 26857319 DOI: 10.1016/j.ijporl.2016.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/03/2016] [Accepted: 01/06/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the proliferative and apoptotic activity of middle ear cholesteatoma in pediatric and adult patients, in addition to comparing its histopathological aspects and the severity of advanced bone destruction. MATERIALS AND METHODS Medical records of 223 patients treated for chronic otitis media with cholesteatoma at the Otolaryngology Department of Dokuz Eylul University between January 1992 and December 2013 were retrospectively evaluated. Sixty-one patients subjected to tympanomastoidectomy due to middle ear cholesteatoma, with sufficient specimens for histopathological examination, were included in the study. Sections of archived tissues in paraffin blocks were subjected to new histopathological examinations. The proliferative and apoptotic activities of cholesteatoma were determined by immunohistochemical staining for epithelial thickness (ET), and Ki-67 and caspase-3 expression. A novel scoring system, the Bone Erosion Score (BES), was developed to estimate the severity of bone destruction. The Austin-Kartush classification score (AKCS) was also calculated. RESULTS ET and Ki-67 expression was higher in adult patients than in the pediatric patients (p=0.009 and 0.01, respectively); however, caspase-3 immunopositivity did not show any significant intergroup differences (p=0.106). The differences in AKCS and BES between pediatric and adult patients were not statistically significant. According to the correlation analysis, a significant positive correlation was observed between AKCS and BES (p=0.001), and between ET and Ki-67 expression (when histopathological data were compared) (p=0.001). CONCLUSION The proliferative activity of cholesteatoma was higher in adult patients. Therefore, these findings do not support the theory that the aggressive clinical course of cholesteatoma in pediatric patients is correlated with its histopathological characteristics.
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The role of EGFR/PI3K/Akt/cyclinD1 signaling pathway in acquired middle ear cholesteatoma. Mediators Inflamm 2013; 2013:651207. [PMID: 24311896 PMCID: PMC3839121 DOI: 10.1155/2013/651207] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/24/2013] [Indexed: 12/21/2022] Open
Abstract
Cholesteatoma is a benign keratinizing and hyper proliferative squamous epithelial lesion of the temporal bone. Epidermal growth factor (EGF) is one of the most important cytokines which has been shown to play a critical role in cholesteatoma. In this investigation, we studied the effects of EGF on the proliferation of keratinocytes and EGF-mediated signaling pathways underlying the pathogenesis of cholesteatoma. We examined the expressions of phosphorylated EGF receptor (p-EGFR), phosphorylated Akt (p-Akt), cyclinD1, and proliferating cell nuclear antigen (PCNA) in 40 cholesteatoma samples and 20 samples of normal external auditory canal (EAC) epithelium by immunohistochemical method. Furthermore, in vitro studies were performed to investigate EGF-induced downstream signaling pathways in primary external auditory canal keratinocytes (EACKs). The expressions of p-EGFR, p-Akt, cyclinD1, and PCNA in cholesteatoma epithelium were significantly increased when compared with those of control subjects. We also demonstrated that EGF led to the activation of the EGFR/PI3K/Akt/cyclinD1 signaling pathway, which played a critical role in EGF-induced cell proliferation and cell cycle progression of EACKs. Both EGFR inhibitor AG1478 and PI3K inhibitor wortmannin inhibited the EGF-induced EGFR/PI3K/Akt/cyclinD1 signaling pathway concomitantly with inhibition of cell proliferation and cell cycle progression of EACKs. Taken together, our data suggest that the EGFR/PI3K/Akt/cyclinD1 signaling pathway is active in cholesteatoma and may play a crucial role in cholesteatoma epithelial hyper-proliferation. This study will facilitate the development of potential therapeutic targets for intratympanic drug therapy for cholesteatoma.
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Activation of the EGFR/Akt/NF-κB/cyclinD1 survival signaling pathway in human cholesteatoma epithelium. Eur Arch Otorhinolaryngol 2013; 271:265-73. [DOI: 10.1007/s00405-013-2403-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 02/12/2013] [Indexed: 12/17/2022]
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