Isoantigens A, B, and H in morphologically normal mucosa and in carcinoma of the larynx

Expression of peanut agglutinin-binding mucin-type glycoprotein in human esophageal squamous cell carcinoma as a marker

Background

The TF (Thomson – Friedenreich) blood group antigen behaves as an onco-foetal carcinoma-associated antigen, showing increased expression in malignancies and its detection and quantification can be used in serologic diagnosis mainly in adenocarcinomas. This study was undertaken to analyze the sera and tissue level detectable mucin-type glycoprotein (TF-antigen) by Peanut agglutinin (PNA) and its diagnostic index in serum as well tissues of human esophageal squamous cell carcinoma as marker.

Results

We examined 100 patients for serological analysis by Enzyme Linked Lectin Assay (ELISA) and demonstrated a sensitivity of 87.5%, specificity of 90% and a positive predictive value of 95%. The immuno-histochemical localization of TF antigen by Fluorescence Antigen Technique (FAT) in 25 specimens of normal esophageal squamous epithelium specimens and 92 specimens with different grades of, allowed a quicker and more precise identification of its increased expression and this did not correlate with gender and tumor size. There was a positive correlation between membrane bound TF antigen expression with different histological progression, from well differentiated to poorly differentiated, determined by PNA binding. Specimens showed morphological changes and a pronounced increase in PNA binding in Golgi apparatus, secretory granules of the cytosol of well differentiated and an increased cell membrane labeling in moderately and poorly differentiated, when compared with ESCC and normal tissues.

Conclusion

The authors propose that the expression of TF-antigen in human may play an important role during tumorigenesis establishing it as a chemically well-defined carcinoma-associated antigen. Identification of the circulating TF-antigen as a reactive form and as a cryptic form in the healthy individuals, using PNA-ELLA and Immunohistochemical analysis of TF antigen by FAT is positively correlated with the different histological grades as a simple and cost-effective method for the early diagnosis of ESCC. The present study reveals that, during tumorigenesis, an aberrant glycosylation takes place in Golgi apparatus leading to over secretion of TF antigen into the cytoplasm along with mucin granules and later into cell membrane. We suggest that the further characterization of TF antigen may unravel pathogenetic aspects of this silent disease.

Effect of tissue fixatives on the immunohistochemical expression of ABH blood group isoantigens

Immunohistochemical analysis of ABH blood group isoantigens has been shown to be a useful ancillary technique for resolving problems associated with specimen mix-ups in the daily practice of surgical pathology. However, the effects of different fixatives on the expression of these antigens in paraffin-embedded tissues are not known. Therefore, the effects of seven different fixatives on the immunohistochemical expression of ABH blood group isoantigens were studied in tissues from several organs. The following fixatives were used: acetone, 70% ethanol, B5, Bouin, Carnoy, methanol, and 10% formalin. After fixation for 6, 12, and 72 hours, the tissue blocks were embedded in paraffin, and immunohistochemistry was performed on 4 microm-thick tissue sections using monoclonal antibodies to blood group isoantigens (A, B, and H) and the avidin-biotin detection method. Also, immunostaining was performed on step tissue sections with and without antigen retrieval using citrate buffer at pH 6.0. The expression of the blood group isoantigens was concordant with the blood group of the patient in all the cases studied, irrespective of the fixative and time of fixation. However, in the absence of antigen retrieval, the intensity of the staining reaction was diminished. These results showed that irrespective of the fixative used, immunohistochemical staining of paraffin-embedded tissue sections with ABH blood group antibodies is a rapid, reliable, and cost-effective method for sorting out interpretative problems of tissue contaminants (floaters) and specimen mix-ups in surgical pathology.

Squamous cell carcinoma antigen in patients with cancer of the larynx

The purpose of this study was to evaluate the clinical usefulness of squamous cell carcinoma antigen (SCC Ag) in patients with squamous cell carcinoma of the larynx. Plasma specimens were obtained from 70 patients with cancer of the larynx before and after treatment and during follow-up. Disease status and the marker levels were determined blind to each other. Microparticle enzyme immunoassay (IMx SCC) was used to measure the SCC Ag level. Applying standard normal limits the sensitivity of the marker at diagnosis was 25.7%. SCC Ag levels were generally lower after therapy than before. Relapse occurred more often in patients with an abnormal pretreatment SCC Ag level, which was more frequent in those with nodal invasion. The marker level increased in 70% of the patients with relapse before the clinical detection of recurrence. SCC Ag is of limited usefulness in the primary diagnosis of cancer of the larynx, but is useful in detecting recurrence of cancer.

Quantitative glycohistochemistry defines new prognostic markers for cancers of the oral cavity

BACKGROUND

Histopathologic grading and clinical staging cannot provide a precise prognosis of oral cavity cancer patients. The use of glycohistochemical markers may improve the level of prognostic accuracy of such conventional classification systems.

METHODS

Computer-assisted microscopy was employed in a series of 40 oral cavity cancers to determine quantitatively the percentage of positive cells, the staining intensity, and the level of staining heterogeneity for 3 glycohistochemical markers, including peanut agglutinin (PNA), Thomsen-Friedenreich antigen (T antigen) as part of a neoglycoprotein, and sarcolectin. Data were evaluated by discriminant analysis.

RESULTS

Although the level of differentiation (P < 0.01 to P < 0.001) and the T variable of the TNM staging system (P < 0.05 to P < 0.01) related mainly to the level of expression of the acceptor sites for PNA and the T antigen, the patient survival period (P < 0.05) was largely a fraction of the level of expression of the acceptor sites for the carrier-immobilized T antigen and for sarcolectin.

CONCLUSIONS

In oral cavity cancer, determining the level of acceptor sites for PNA, T antigen, and sarcolectin provides useful information on histopathologic differentiation, clinical staging, and survival. Because these processes of determination were carried out quantitatively, a discriminant model was set up, which enabled the level of oral cavity cancer aggressiveness to be characterized precisely. The current methodology described in this article should therefore afford pathologists original and quantitative (and thus objective) prognostic markers for oral cavity cancers.

Lectin binding characteristics of squamous cell carcinomas of the head and neck

Lectins are polyvalent proteins of non-immune origin with exquisite carbohydrate binding specificity making them ideal for investigation of cell surface glycoprotein and glycolipid antigens. We examined the cell surface lectin binding phenotypes of 20 UM-SCC squamous cell carcinoma cell lines established from 17 patients with head and neck cancers using a panel of fluorescein-conjugated lectins and inhibition by the appropriate monosaccharide to confirm specificity of using a panel of fluorescein-conjugated lectins and inhibition by the appropriate monosaccharide to confirm specificity of binding. Conconavalin A (Con A) from Canavalia ensiformis and the peanut agglutinin (PNA) from Arachis hypogaea bound all SCC cell lines tested and wheat germ agglutinin (WGA) from Triticum vulgaris bound to 12 of 13 tumor cell lines. The blood group O specific lectin UEA 1 from Ulex europeus also bound to all cell lines regardless of the donor blood type. Lectins of Dolichos biflorus (DBA) and Griffonia simplicifolia (GS I-B4 or BSA I-B4) with binding specificity for glycoproteins associated with blood group A and B respectively, had reactivity that did not directly correlate with blood group antigen expression. In contrast to the other lectins in our panel which exhibited broad reactivity with SCC antigens, the BSA-II lectin from Griffonia simplicfolia, (GS II or BSA II) which has sugar binding specificity for terminal non-reducing GlcNAc, did not bind to any of the screened cell lines. Our results demonstrate a common pattern of lectin-defined carbohydrate expression on the cell surface of squamous cell carcinomas of head and neck that appears promising in defining the malignant cellular phenotype. Lectin binding profile may be useful in differentiating benign from malignant histopathology.

Immunostains for blood group antigens lack prognostic significance in T1 lung carcinoma

Recent reports have suggested that the retention of blood group antigen expression on tumor cells may be an important prognostic factor for survival. From 1986 to 1991, 136 patients underwent operative resection for their T1 N0 non-small cell lung carcinoma. One hundred twenty tissue blocks were available for antigen testing, and the histologic types were as follows: adenocarcinoma (73 patients), squamous cell (39 patients), large cell/undifferentiated (7 patients), and mucoepidermoid (1 patient). Follow-up is complete for all patients (mean, 41 months). This distribution of patients among the blood groups was as follows: A, 56 (47%); O, 53 (44%); B, 9 (7.5%), and AB, 2 (1.7%). Immunostaining was performed for A, B, and H blood group antigens. The 5-year actuarial survival in the blood group A patients (53%) did not differ significantly from that in the blood group O patients (59%). Similarly, when tumors were examined for their respective antigens, no significant differences were found in the 5-year survival of either blood group A or O patients between the tumors that retain and those that lose blood group antigen expression. Retention or loss of blood groups A or O antigen expression does not predict survival in patients with early-stage lung carcinomas.

The expression of Lewis antigens in neoplasms of the gastrointestinal tract

The indirect immunoperoxidase technique has been used to demonstrate Lea and Leb antigens in paraffin sections of both morphologically normal gastric and colonic mucosae and their neoplastic counterparts. Expression differed in various regions of the gastrointestinal tract: Leb occurred most frequently in the stomach and Lea most frequently in the colon. Coexpression of Lea and Leb occurred in only 5% of cases of normal mucosa, in 65% of gastric carcinomas and in 82% of carcinomas of the colon. Furthermore, 75% of cases of intestinal metaplasia in gastric mucosa and 30% of tubular adenomas, 50% of villous adenomas and 70% of tubulovillous adenomas in the colon co-expressed Lea and Leb antigens. In this study, the expression of Lewis antigens in carcinoma was found to differ from that of adjacent normal mucosa in 95% of cases of gastric carcinoma and 100% of cases of colonic carcinoma. The differences were shown by antigen acquisition and/or deletion. Similar changes were shown in 88% of cases of intestinal metaplasia in gastric mucosa, 20% of cases of tubular adenomas and 57% of cases of villous and tubulovillous adenomas of colon.

ABO (H) blood group antigen expression in gastric mucosa

The A, B, O (H) blood group antigens (BGA) are glycolipids present in the plasma membranes of many different epithelial cells. Alterations in BGA expression have been described in malignant tumors and premalignant lesions. We have studied ABO (H) BGA expression in paraffin sections of gastric specimens using immunofluorescence techniques with monoclonal antibodies. 102 patients were studied. 15 with normal mucosa (NM); 16 with duodenal ulcer (DU); 23 with gastric ulcer (GU); 11 with pernicious anaemia (PA) and 37 with adenocarcinoma (AC). The expression of BGA in normal gastric mucosa is detected in surface epithelium, mucoid cell neck glands and parietal cells as well as 2/3 of antral glands. BGA expression in DU gastritis is very similar to that seen in NM. In atrophic chronic gastritis associated with GU and PA there is a significant decrease in BGA expression. In patients with PA, BGA expression is greater in antral mucosa than in fundic mucosa. Loss of BGA expression is more pronounced in atrophic chronic gastritis surrounding AC. Intestinal metaplasia shows variable BGA expression. Our results support the hypothesis that loss of BGA expression by epithelial gastric mucosal cells may be related to alterations in cellular differentiation and premalignant potential.

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.

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.

The occurrence of blood group substances (A, B, H, Le-a, Le-b) in salivary glands and salivary gland tumors. An immunohistochemical investigation

The distribution of blood group substances A, B, H, Le-a and Le-b in normal and neoplastic salivary gland tissue was evaluated by means of immunohistochemistry. The serological ABH blood group status of one third of the patients was known. Lewis blood group and secretory status were not known. In normal tissue, expression of blood group antigens corresponded to the serological blood group. Blood group substance H was present in almost every gland, regardless of the serological blood group. In submandibular glands, Le-b was rather selective for mucous acini. In tumors, a relationship of blood group expression to a glandular pattern and a high differentiation could be observed. Blood group substances were expressed at a high level in benign and highly differentiated malignant tumors. In poorly differentiated malignant tumors, they were mostly absent. Blood group expression evaluation could be of value in establishing the level of functional differentiation in salivary gland tumors.

Cell surface carbohydrates in psoriasis. Defective cytoplasmic transport by glycoconjugates carrying fucose residues suggested by lectin staining

Eleven biopsy specimens of normal skin and twenty-four biopsy specimens of psoriatic lesions were examined histochemically by using several lectins (Ulex europaeus, UEA-1; Dolichos biflorus, DBA; Bandeirea simplicifolia, BS-I; Concanvalia ensiformis, Con A; Triticum vulgaris, WGA; Ricinus communis, RCA; Arachis hypogoea, PNA) in order to evaluate the presence and distribution of various carbohydrates in normal and psoriatic keratinocytes. The findings revealed that keratinocytes from psoriatic lesions are distinguished by a different composition of carbohydrate residues incorporated in their plasma membranes. In particular, the intracellular transport of alpha-L-fucose, alpha-D-mannose, and alpha-D-glucose to the plasma cell membrane is impeded, whereas their synthesis in the cytoplasm of the psoriatic keratinocytes is largely unaltered. In addition, due to the lack of terminal alpha-L-fucose, the alpha-D-N-acetyl-galactosamine and alpha-D-galactose residues cannot be transferred to the plasma membranes and, therefore, the antigens for blood groups A and B remain incomplete in psoriatic epidermis. On the basis of these findings and in comparison with previous findings of our group on hyperproliferative, malignant keratinocytes, it is concluded that particularly the disordered cytoplasmic transport of alpha-L-fucose-carrying glycoconjugates may represent a specific defect in psoriasis, possibly linked with the pathogenesis of this 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.

Cultured human bronchial epithelial cells: blood group antigens, keratin, collagens, and fibronectin

Immunofluorescence and immunoperoxidase methods were used to identify constituents and products of cultured human bronchial epithelial cells and fibroblasts. Epithelial cells, but not fibroblasts, from patients with blood Types A or B reacted to the respective antisera to either the A or B blood group antigens. However, neither the epithelial cells nor the fibroblasts from patients with blood type O[H] reacted with the anti-H antisera. Epithelial cells in primary culture reacted with antibody to prekeratin proteins from human stratum corneum and fibroblasts did not react. Moreover, keratin filaments were assembled in vitro from proteins isolated from the epithelial cells. These immunological and biochemical data support previous morphological observations that human bronchial epithelial cells in primary culture shift progressively from a mucociliary epithelium to a keratinizing epithelium. Epithelial cells and fibroblasts could also be identified by their reactivity to anti-collagen antibodies. Fibroblasts reacted strongly with antibodies to Types I and III collagens and epithelial cells did not. On the other hand, epithelial cells reacted weakly with antibodies to Type IV collagen and fibroblasts were completely negative. Both epithelial cells and fibroblasts reacted with antibody to fibronectin; however, the distribution of fibronectin differed in the two cell types. In epithelial cells, fibronectin was restricted to the cell surface, whereas in fibroblasts it was found on the cell surface and in the extracellular matrix where fibrils of fibronectin were both cell associated and deposited on the surface of the dish where the fibroblasts had migrated.

Variability in the expression of the O(H) antigen in human transitional epithelium

In many organs the so-called blood group antigens A, B and O(H) are constituents of the surface of normal epithelial cells. Deletion of these antigens in cases of carcinoma may serve as a clinically useful tumor marker, especially in cases of carcinoma of the bladder. Further progress is hampered by uncertainty concerning the detectability of A, B and H tissue isoantigens on normal urothelium in tissue sections. We examined th expression of these tissue isoantigens on normal ureteral urothelium obtained at autopsy from 68 adults using the specific red cell adherence test and found that they were not detectable in normal urothelium from a significant fraction of individuals in blood group O and that results in blood groups A, B and AB also were somewhat variable. The variability did not appear related to the secretor status or postmortem interval. Our results suggest that the current specific red cell adherence test may not be suitable for detecting deletion of tissue isoantigens in bladder tumor patients in blood group O.

Immunocytochemical studies of blood group A, H, I, and i antigens in gastric mucosae of infants with normal gastric histology and of patients with gastric carcinoma and chronic benign peptic ulceration

Indirect immunofluorescence studies of blood group A, H, I, and i antigens were performed on the gastric mucosae and tumor tissues of patients with gastric carcinoma, on the mucosae of patients with chronic benign gastric ulceration, and on the mucosae of infants who had died of causes other than gastrointestinal disease. The following findings were of particular interest: (1) Normal 'secretor' type mucosae were distinguishable from 'non-secretor' type mucosae by the uniform staining of the A or H antigens at the surface and in the pits. Normal 'non-secretor' type mucosae showed little staining of the H or A antigens but, instead, there was staining with anti-I(Ma) antibody. Staining with anti-I(Step) and anti-i(Den) did not show a clear correlation with the 'secretor'/'non-secretor' status of the normal mucosae. (2) Apparently normal areas of gastric mucosae of patients with gastric carcinoma or the normal part of gastric mucosae of patients with benign gastric ulcer frequently showed focal areas of loss or gain of the blood group antigens as is often seen in gastric carcinoma tissues. (3) In the mucosae of patients with intestinal metaplasia there was marked loss of A/H antigens in 'secretors' and I(Ma) antigen in 'non-secretors'. (4) Staining characteristics of tissues from gastric carcinoma were:(a) Focal loss of the expected A/H or I antigens was observed with much variation in staining from area to area, but only a minority showed complete loss of the expected staining. (b) A majority of the carcinomas from 'secretors' showed foci of substantial staining with anti-I(Ma) in contrast to normal 'secretor' mucosae. This is probably due to incomplete biosynthesis of A/H determinants. (c) Incompatible A-like staining by a rabbit anti-A serum was observed in one out of nine adenocarcinomas from blood group B or O persons. (d) A few cases showed substantial i antigen staining. The aberrant expression of blood group A, H, I, and i antigens in neoplastic as well as in some areas of morphologically normal mucosa of patients with benign and malignant diseases of the stomach is discussed in the context of current biochemical knowledge.

Plasma blood group changes in gastrointestinal tract carcinoma

The levels of A, H, I, and i plasma antigens and of anti-B, anti-I, and anti-T antibodies were measured in 70 subjects with colonic or gastric carcinoma. These studies showed a significant increase in A plasma activity of the A subjects, and in H plasma activity of the O subjects, while 25% of the tested subjects showed increased I plasma activity. There was no difference in i plasma activity between cancer patients and healthy subjects. These results take into account the marked polymorphism acquired by neoplastic tissue, which is capable also of producing a greater quantity of antigens than that of healthy subjects. Nevertheless this heterogeneity forms a barrier to the clinical measurement of these plasma antigens for screening neoplasms. The significant fall in the amount of anti-T antibodies seemed to be secondary to the absorption of these antibodies on the surface of the tumour cells.

Immunobiology of head and neck cancer: basic concepts

Patients with squamous cancer of the head and neck have unique perturbations of the immune system. These patients have marked depression of cellular immunity even in the early stages of disease. The known facts about the immunobiology and the immunodeficiencies that commonly occur are discussed. Also reviewed are the relationships of the immunologic deficits to stage of disease, to prognosis, and to the suspected etiologic factors of smoking, alcoholism, and malnutrition. Highlights are given of current immunotherapeutic trials. To date, most of the successful efforts in both immunologic research and immunotherapy of head and neck cancer have dealt with general, rather than specific, immune reactions. Further development in the area of specific immune responses may permit more meaningful measurements of tumor-specific reactions, thus yielding useful tools for immunodiagnosis as well as providing more effective and precise methods of immunotherapy.

Blood group isoantigen deletion in carcinoma in situ of the urinary bladder

Blood group isoantigens A and H (O) were measured by the Secific Red Cell Adherence (SRCA) Test in nine radical cystectomy specimens removed from patients with extensive carcinoma in situ of the urinary bladder. All bladders had areas of histologically normal epithelium and areas of epithelial atypia in addition to the carcinoma in situ. In eight cases, tissue-associated blood group isoantigens were deleted in areas showing either atypia or carcinoma in situ. Isoantigens were present in these areas in the ninth case. Blood group isoantigens were absent in approximately half of the sections of histologically normal epithelium. We propose that areas of epithelium which appear benign according to conventional histological criteria but in which the blood group isoantigens are absent may represent areas of low grade carcinoma in situ.