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Viehweger F, Hoop J, Tinger LM, Bernreuther C, Büscheck F, Clauditz TS, Hinsch A, Jacobsen F, Luebke AM, Steurer S, Hube-Magg C, Kluth M, Marx AH, Krech T, Lebok P, Fraune C, Burandt E, Sauter G, Simon R, Minner S. Frequency of Androgen Receptor Positivity in Tumors: A Study Evaluating More Than 18,000 Tumors. Biomedicines 2024; 12:957. [PMID: 38790919 PMCID: PMC11117763 DOI: 10.3390/biomedicines12050957] [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: 02/27/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Androgen receptor (AR) is a transcription factor expressed in various normal tissues and is a therapeutic target for prostate and possibly other cancers. A TMA containing 18,234 samples from 141 different tumor types/subtypes and 608 samples of 76 different normal tissue types was analyzed by immunohistochemistry. AR positivity was found in 116 tumor types including 66 tumor types (46.8%) with ≥1 strongly positive tumor. Moderate/strong AR positivity was detected in testicular sex cord-stromal tumors (93.3-100%) and neoplasms of the prostate (79.3-98.7%), breast (25.0-75.5%), other gynecological tumors (0.9-100%), kidney (5.0-44.1%), and urinary bladder (5.4-24.2%). Low AR staining was associated with advanced tumor stage (pTa versus pT2-4; p < 0.0001) in urothelial carcinoma; advanced pT (p < 0.0001), high tumor grade (p < 0.0001), nodal metastasis (p < 0.0001), and reduced survival (p = 0.0024) in invasive breast carcinoma; high pT (p < 0.0001) and grade (p < 0.0001) in clear cell renal cell carcinoma (RCC); and high pT (p = 0.0055) as well as high grade (p < 0.05) in papillary RCC. AR staining was unrelated to histopathological/clinical features in 157 endometrial carcinomas and in 221 ovarian carcinomas. Our data suggest a limited role of AR immunohistochemistry for tumor distinction and a prognostic role in breast and clear cell RCC and highlight tumor entities that might benefit from AR-targeted therapy.
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Affiliation(s)
- Florian Viehweger
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
| | - Jennifer Hoop
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
| | - Lisa-Marie Tinger
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
| | - Christian Bernreuther
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
| | - Franziska Büscheck
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
| | - Till S. Clauditz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
| | - Andrea Hinsch
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
| | - Frank Jacobsen
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
- Pathologie-Hamburg, Labor Lademannbogen Medizinisches Versorgungszentrum (MVZ) GmbH, 22339 Hamburg, Germany
| | - Andreas M. Luebke
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
| | - Claudia Hube-Magg
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
| | - Martina Kluth
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
| | - Andreas H. Marx
- Department of Pathology, Academic Hospital Fuerth, 90766 Fuerth, Germany;
| | - Till Krech
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
- Institute of Pathology, Clinical Center Osnabrueck, 49076 Osnabrueck, Germany
| | - Patrick Lebok
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
- Institute of Pathology, Clinical Center Osnabrueck, 49076 Osnabrueck, Germany
| | - Christoph Fraune
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
- Institute of Pathology, Clinical Center Osnabrueck, 49076 Osnabrueck, Germany
| | - Eike Burandt
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
| | - Sarah Minner
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (F.V.); (J.H.); (C.B.); (F.B.); (T.S.C.); (A.H.); (F.J.); (A.M.L.); (S.S.); (C.H.-M.); (M.K.); (T.K.); (P.L.); (C.F.); (E.B.); (G.S.); (S.M.)
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Kranjčević JK, Čonkaš J, Ozretić P. The Role of Estrogen and Estrogen Receptors in Head and Neck Tumors. Cancers (Basel) 2024; 16:1575. [PMID: 38672656 PMCID: PMC11049451 DOI: 10.3390/cancers16081575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 04/21/2024] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the most common histological form of head and neck tumors (HNTs), which originate from the epithelium of the lips and oral cavity, pharynx, larynx, salivary glands, nasal cavity, and sinuses. The main risk factors include consumption of tobacco in all forms and alcohol, as well as infections with high-risk human papillomaviruses or the Epstein-Barr virus. Regardless of the etiological agent, the risk of developing different types of HNTs is from two to more than six times higher in males than in females. The reason for such disparities probably lies in a combination of both biological and psychosocial factors. Therefore, it is hypothesized that exposure to female sex hormones, primarily estrogen, provides women with protection against the formation and metastasis of HNTs. In this review, we synthesized available knowledge on the role of estrogen and estrogen receptors (ERs) in the development and progression of HNTs, with special emphasis on membrane ERs, which are much less studied. We can summarize that in addition to epidemiologic studies unequivocally pointing to the protective effect of estrogen in women, an increased expression of both nuclear ERs, ERα, and ERβ, and membrane ERs, ERα36, GPER1, and NaV1.2, was present in different types of HNSCC, for which anti-estrogens could be used as an effective therapeutic approach.
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Affiliation(s)
| | | | - Petar Ozretić
- Laboratory for Hereditary Cancer, Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička cesta 54, 10000 Zagreb, Croatia (J.Č.)
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Boccellino M, De Rosa A, Di Domenico M. An ELISA Test Able to Predict the Development of Oral Cancer: The Significance of the Interplay between Steroid Receptors and the EGF Receptor for Early Diagnosis. Diagnostics (Basel) 2023; 13:2001. [PMID: 37370896 DOI: 10.3390/diagnostics13122001] [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: 03/04/2023] [Revised: 05/14/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Oral disorders including non-homogeneous leukoplakia, erythroplakia, erosive lichen planus, and many others can potentially progress to oral squamous cell carcinoma (OSCC). Currently, the late diagnosis of OSCC contributes to high mortality rates, emphasizing the need for specific markers and early intervention. In this study, we present a novel, quick, sensitive, and non-invasive method for the early detection and screening of oral cancer, enabling the qualitative assessment of neoplastic forms even before the onset of symptoms. Our method directly examines the expression of oral cancer biomarkers, such as the epithelial growth factor receptor (EGFR), and steroid receptors, including the androgen receptor (AR) and the estrogen receptor (ER). The crosstalk between sexual hormones and the EGF receptor plays a crucial role in the progression of different types of cancers, including head and neck squamous cell carcinoma. To implement our method, we developed a kit box comprising nine wells or stations, each containing buffers, lysis systems, and dried/lyophilized antibodies stored at room temperature. The kit includes instruments for sample collection and a PVDF strip (Immobilon) with specific primary antibodies immobilized on it. These antibodies capture the target proteins from cytological samples. Additionally, complementary tools are provided to ensure efficient utilization and optimal test performance. The technique can be performed outside the laboratory, either "patient side" with an instant chemocolorimetric response or with a digital reader utilizing the enzyme-linked immunosorbent assay (ELISA) method.
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Affiliation(s)
- Mariarosaria Boccellino
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Alfredo De Rosa
- Multidisciplinary Medical-Surgical Department, Odontostomatology Section, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Marina Di Domenico
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
- Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA 19140, USA
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Sengupta N, Sarode SC, Sarode GS, Anand R. Sex bias phenomenon in oral cancer: an insight. Future Oncol 2023; 19:1381-1384. [PMID: 37403625 DOI: 10.2217/fon-2023-0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Affiliation(s)
- Namrata Sengupta
- Department of Oral Pathology & Microbiology, Dr. D. Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune, Maharashtra, 411018, India
| | - Sachin C Sarode
- Department of Oral Pathology & Microbiology, Dr. D. Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune, Maharashtra, 411018, India
| | - Gargi S Sarode
- Department of Oral Pathology & Microbiology, Dr. D. Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune, Maharashtra, 411018, India
| | - Rahul Anand
- Department of Oral Pathology & Microbiology, Dr. D. Y. Patil Dental College & Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune, Maharashtra, 411018, India
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R S, R C, Mohideen K, Adtani PN, Subramani V, Balasubramaniam M. Expression of Sex Hormones in Oral Squamous Cell Carcinoma: A Systematic Review on Immunohistochemical Studies. Cureus 2022; 14:e25384. [PMID: 35765387 PMCID: PMC9233754 DOI: 10.7759/cureus.25384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 12/16/2022] Open
Abstract
Oral squamous cell carcinoma (OSCC) is the most widespread oral malignancy. In the western world, smoking and alcohol remain the most common risk factors, whereas smokeless tobacco and areca nut consumption are the prevalent etiological factors in South Asia. Numerous markers were studied till date to identify the disease. However, the role of sex hormones in OSCC is poorly defined. Hormonal receptors play a role in breast cancer, prostate cancer, and human papillomavirus (HPV) driven oropharyngeal cancers. It is proven that the expression of estrogen receptor-α improved the overall survival of the patient with HPV-positive oropharyngeal cancer. Thus, this review article aims to determine the expression of sex hormones by immunohistochemistry in OSCC. This systematic review was performed with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement Criteria 2020. Relevant articles were collected from the electronic database in PubMed and Cochrane till 2021. Immunohistochemical studies on sex hormones and their role in OSCC published in English literature were included. We excluded case reports, case series, and abstract-only articles. The sample size of the selected studies varied, and these studies measured the parameters such as sex hormones and OSCC. Furthermore, all the studies used different sex hormones and their association with oral cancer through the immunohistochemical process. Thus, this review summarizes that sex hormones influence the biopathology of oral cancer and have a prognostic significance in the tumor subgroups.
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Affiliation(s)
- Saranya R
- Oral and Maxillofacial Pathology, Sathyabama Dental College and Hospital, Sathyabama Institute of Science and Technology, Chennai, IND
| | - Chandini R
- Oral and Maxillofacial Pathology, Sathyabama Dental College and Hospital, Sathyabama Institute of Science and Technology, Chennai, IND
| | - Khadijah Mohideen
- Oral and Maxillofacial Pathology, Sathyabama Dental College and Hospital, Sathyabama Institute of Science and Technology, Chennai, IND
| | - Pooja N Adtani
- Basic Medical and Dental Sciences, College of Dentistry, Gulf Medical University, Ajman, ARE
| | - Vijayanirmala Subramani
- Oral and Maxillofacial Pathology, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Murali Balasubramaniam
- Oral and Maxillofacial Pathology, Sathyabama Dental College and Hospital, Sathyabama Institute of Science and Technology, Chennai, IND
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Doll C, Bestendonk C, Kreutzer K, Neumann K, Pohrt A, Trzpis I, Koerdt S, Dommerich S, Heiland M, Raguse JD, Jöhrens K. Prognostic Significance of Estrogen Receptor Alpha in Oral Squamous Cell Carcinoma. Cancers (Basel) 2021; 13:cancers13225763. [PMID: 34830915 PMCID: PMC8616512 DOI: 10.3390/cancers13225763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/02/2021] [Accepted: 11/11/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Although the survival rate has improved over the past decades, the prognosis of oral squamous cell carcinoma (OSCC) is still poor, and new treatment strategies are required. The aim of this study was to evaluate estrogen receptor alpha (ERα) expression in OSCC in a large patient cohort as a potential prognostic marker and therapeutic target. The findings indicated a rare expression of ERα that, however, was associated with a dramatic decrease of overall survival in male patients. In ERα-positive OSCC patients, an ER-based therapeutic (adjuvant) approach in the future might be conceivable based on the findings of this study. Abstract Introduction: Several studies suggest an estrogen receptor alpha (ERα)-mediated influence on the pathogenesis of oral squamous cell carcinoma (OSCC), as described for other malignancies that are not considered to be primarily hormone-dependent. Recently, an association between ERα expression and improved survival in oropharyngeal squamous cell carcinoma (OPSCC) has been found. However, the prognostic relevance of ERα in OSCC has not been proven to date. Therefore, the aim of this study was to evaluate ERα expression in OSCC in a large patient cohort and analyze its influence on survival and recurrence. Material and Methods: A total of 316 patients with primary OSCC who received initial surgical therapy were included in this analysis. The expression of ERα was evaluated on tissue microarrays by immunohistochemistry in the primary tumor and/or primary lymph node metastases. The expression level was quantified by light microscopy using the immunoreactive score (IRS) for estrogen receptor detection. An IRS equal to or greater than 2 was considered positive. The 5-year overall survival (OS) and relapse-free survival (RFS) were examined by the Kaplan–Meier method and log-rank test. Results: A total of 316 patients (111 females; 205 males) with a mean age of 61.3 years (range 27–96 years) were included in this study. In 16 patients (5.1%; 6 females and 10 males), positive ERα expression was found in the primary tumor (n = 11; 11/302) or lymph node metastases (n = 5; 5/52). Patients with positive ERα expression in primary tumors/primary lymph node metastases had a significantly lower OS and RFS (p = 0.012; p = 0.0053) compared to ERα-negative patients. Sub-group analysis in relation to gender revealed a highly significant influence of ERα expression on OS and RFS in males but not in females, both for the ERα-positive primary tumor cohort (males: p = 0.0013; p < 0.0001; females: p = 0.56; p = 0.89) and the ERα-positive primary tumor/primary lymph node metastasis cohort (males: p < 0.0001; p < 0.0001; females: p = 0.95; p = 0.96). In multivariate cox regression analysis, the ERα IRS of primary tumors (dichotomized; ERα+ vs. ERα−) was an independent risk factor for OS (HR = 4.230; 95%CI 1.616–11.076; p = 0.003) and RFS (HR = 12.390; 95%CI 4.073–37.693; p < 0.001) in the male cohort. There was a significant difference (p = 0.006) of ERα positivity with regard to the localization of the primary tumor. ERα positivity in the primary tumor was significantly associated (p = 0.026) with UICC stage, with most of the cases being diagnosed in stage IV. Furthermore, there was a significantly (p = 0.049) higher rate of bone infiltration in ERα-positive patients. Conclusion: Expression of ERα is rare in OSCC; however, it is associated with a dramatic decrease in OS in male patients. Further studies are necessary to confirm our results and to evaluate the exact mechanism underlying this observation. Hence, ERα-positive OSCC patients might benefit from an ER-based therapeutic (adjuvant) approach in the future.
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Affiliation(s)
- Christian Doll
- Department of Oral and Maxillofacial Surgery, Charité—Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (C.B.); (K.K.); (I.T.); (S.K.); (M.H.)
- Correspondence: ; Tel.: +49-304-5065-5267
| | - Carolin Bestendonk
- Department of Oral and Maxillofacial Surgery, Charité—Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (C.B.); (K.K.); (I.T.); (S.K.); (M.H.)
| | - Kilian Kreutzer
- Department of Oral and Maxillofacial Surgery, Charité—Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (C.B.); (K.K.); (I.T.); (S.K.); (M.H.)
| | - Konrad Neumann
- Institute of Biometry and Clinical Epidemiology, Charité—Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.N.); (A.P.)
| | - Anne Pohrt
- Institute of Biometry and Clinical Epidemiology, Charité—Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; (K.N.); (A.P.)
| | - Irena Trzpis
- Department of Oral and Maxillofacial Surgery, Charité—Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (C.B.); (K.K.); (I.T.); (S.K.); (M.H.)
| | - Steffen Koerdt
- Department of Oral and Maxillofacial Surgery, Charité—Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (C.B.); (K.K.); (I.T.); (S.K.); (M.H.)
| | - Steffen Dommerich
- Department of Otorhinolaryngology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Charitéplatz 1, 10117 Berlin, Germany;
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité—Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (C.B.); (K.K.); (I.T.); (S.K.); (M.H.)
| | - Jan-Dirk Raguse
- Department of Oral and Maxillofacial Surgery, Fachklinik Hornheide, 48157 Münster, Germany;
| | - Korinna Jöhrens
- Institute of Pathology, Technische Universität Dresden, 01307 Dresden, Germany;
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Akyu Takei R, Tomihara K, Yamazaki M, Moniruzzaman R, Heshiki W, Sekido K, Tachinami H, Sakurai K, Yonesi A, Imaue S, Fujiwara K, Noguchi M. Protumor role of estrogen receptor expression in oral squamous cell carcinoma cells. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:549-565. [PMID: 34518137 DOI: 10.1016/j.oooo.2021.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 01/26/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Accumulating evidence has demonstrated the protumor role of estrogen receptor (ER)-mediated signaling in multiple cancer types, which is distinct from this signaling in sex steroid-dependent organs. However, its role in oral squamous cell carcinoma (OSCC) remains unclear. STUDY DESIGN We assessed the expression of ERα and ERβ in human OSCC tissues by immunohistochemistry and evaluated the expression of both receptors in OSCC cell lines by immunoblotting and flow cytometry. To further assess the contribution of ER-mediated signals to oral cancer progression, proliferation, invasion, and chemosensitivity, cell lines were stimulated with the ER agonist β-estradiol. RESULTS Immunohistochemical analysis of OSCC tissues showed that ERβ was present in the cytoplasm and nuclei of OSCC cells. In contrast, ERα was not detected in any of the cases analyzed. Additionally, the proliferation and invasiveness of OSCC cells were significantly elevated following stimulation with β-estradiol. Chemotherapeutic agent-induced apoptosis of cancer cells was attenuated by pretreatment with β-estradiol. CONCLUSIONS ER-mediated signaling plays a crucial role in oral cancer progression by facilitating the proliferation, invasion, and chemoresistance of OSCC cells, indicating its potential for developing novel targeted therapies for this type of cancer.
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Affiliation(s)
- Rie Akyu Takei
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan; Department of Oral and Maxillofacial Surgery, Saiseikai Toyama Hospital, Toyama, Japan
| | - Kei Tomihara
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan.
| | - Manabu Yamazaki
- Division of Oral Pathology, Department of Tissue Regeneration and Reconstruction, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Rohan Moniruzzaman
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Wataru Heshiki
- Department of Oral and Maxillofacial Surgery, Regional Independent Administrative Corporation Naha City Hospital, Naha, Japan
| | - Katsuhisa Sekido
- Department of Oral and Maxillofacial Surgery, Toyama Red Cross Hospital, Toyama, Japan
| | - Hidetake Tachinami
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Kotaro Sakurai
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Amirmoezz Yonesi
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Shuichi Imaue
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Kumiko Fujiwara
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Makoto Noguchi
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
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8
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Liu X, Qing S, Che K, Li L, Liao X. Androgen receptor promotes oral squamous cell carcinoma cell migration by increasing EGFR phosphorylation. Onco Targets Ther 2019; 12:4245-4252. [PMID: 31239703 PMCID: PMC6557262 DOI: 10.2147/ott.s200718] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/24/2019] [Indexed: 12/24/2022] Open
Abstract
Objectives: This study is aimed to investigate the role of androgen receptor (AR) in regulating oral squamous cell carcinoma (OSCC) cells migration. Materials and methods: Tumors from 23 patients with OSCC and five OSCC cell lines were used for analyzing AR expression. The effects of AR agonist and antagonist were used to examine the role of AR in regulating the migration of OSCC cells. Results: Ten of 23 tumors from patients with OSCC were AR positive. There was no significant difference in total EGFR (tEGFR) expression between AR-positive tumors and AR-negative tumors. However, the expression of phosphorylated EGFR (pEGFR) in AR-positive tumors was significantly higher than that in AR-negative tumors (p<0.01). Stimulation of AR by dihydrotestosterone in SCC9 (AR-positive OSCC cell) caused an increase in pEGFR and pAKT expression and promoted cell migration without changed tEGFR expression, whereas treatment with bicalutamide led to a decrement in pEGFR expression and pAKT and inhibited cell migration. No effects were found in SCC25 cell line (AR-negative) either treated by dihydrotestosterone or bicalutamide. Furthermore, SCC9 cell line treated by EGF or cetuximab (EGFR inhibitor) significantly promoted or inhibited cell migration. Conclusion: Our data indicate that OSSC tumors and OSCC cell lines express AR which is critical for promoting cell migration by increasing EGFR phosphorylation.
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Affiliation(s)
- Xin Liu
- Department of General Dentistry, Chongqing Savaid Stomatology Hospital, University of Chinese Academy of Sciences, Chongqing 400014, People's Republic of China
| | - Shanglan Qing
- Department of Stomatology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, People's Republic of China
| | - Keke Che
- Department of Pharmacology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, People's Republic of China
| | - Lihua Li
- Department of Stomatology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, People's Republic of China
| | - Xiaoming Liao
- Department of Stomatology, Chongqing Prevention and Treatment Hospital for Occupational Diseases, Chongqing 400060, People's Republic of China
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9
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Emfietzoglou R, Spyrou N, Mantzoros CS, Dalamaga M. Could the endocrine disruptor bisphenol-A be implicated in the pathogenesis of oral and oropharyngeal cancer? Metabolic considerations and future directions. Metabolism 2019; 91:61-69. [PMID: 30458176 DOI: 10.1016/j.metabol.2018.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/14/2018] [Indexed: 12/20/2022]
Abstract
Bisphenol-A (BPA), a prototype endocrine disrupting molecule, has been associated with many disease entities such as diabetes mellitus, obesity, polycystic ovarian disease, cardiovascular disease, reproductive and neurodevelopmental disorders. BPA has also been associated mainly with not only hormone sensitive cancers such as breast, prostate, endometrial, ovarian, testicular and thyroid cancers but also non-hormonal sensitive cancers such as cervical and lung cancers, osteosarcoma and meningioma. Recent research has investigated the sources of contamination which are responsible for higher BPA concentrations in the oral cavity and oropharyngeal space, representing the first site of BPA exposure after ingestion. Besides growing awareness and case registration, the incidence and prevalence of oral (OC) and oropharyngeal cancer (OPC) have increased during the last decades correlating with the increased production of BPA worldwide. So far, no study in the medical literature has explored the association of BPA with OC and OPC. BPA may be linked to the etiopathogenesis of OC and OPC through a multitude of mechanisms encompassing and interconnecting genetic, epigenetic, inflammatory, immune, metabolic, hormonal and oxidative stress alterations as well as modulation of oral microbiome. Hence, it is not possible to rule out a potential role of BPA exposure in oral and oropharyngeal tissue carcinogenesis, especially knowing its potential to participate in other non-hormonal sensitive malignancies and to deregulate signaling pathways implicated in OC and OPC. This perspective aims at outlining evidence and proposing for the first time a potential link between BPA with OC and OPC, the most frequent subtypes of head and neck malignancies.
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Affiliation(s)
- Rodopi Emfietzoglou
- School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str, Goudi, 115 27 Athens, Greece; Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias street, 115 27 Athens, Greece
| | - Nikolaos Spyrou
- 251 Airforce General Hospital, Kanellopoulou 3, 115 25 Athens, Greece
| | - Christos S Mantzoros
- Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA
| | - Maria Dalamaga
- Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias street, 115 27 Athens, Greece.
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10
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Zheng D, Williams C, Vold JA, Nguyen JH, Harnois DM, Bagaria SP, McLaughlin SA, Li Z. Regulation of sex hormone receptors in sexual dimorphism of human cancers. Cancer Lett 2018; 438:24-31. [PMID: 30223066 PMCID: PMC6287770 DOI: 10.1016/j.canlet.2018.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/24/2018] [Accepted: 09/03/2018] [Indexed: 02/07/2023]
Abstract
Gender differences in the incidences of cancers have been found in almost all human cancers. However, the mechanisms that underlie gender disparities in most human cancer types have been under-investigated. Here, we provide a comprehensive overview of potential mechanisms underlying sexual dimorphism of each cancer regarding sex hormone signaling. Fully addressing the mechanisms of sexual dimorphism in human cancers will greatly benefit current development of precision medicine. Our discussions of potential mechanisms underlying sexual dimorphism in each cancer will be instructive for future cancer research on gender disparities.
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Affiliation(s)
- Daoshan Zheng
- Department of Cancer Biology, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Cecilia Williams
- Department of Biosciences and Nutrition, KTH Royal Institute of Technology, Karolinska Institutet, Science for Life Laboratory, Stockholm, Sweden
| | - Jeremy A Vold
- Mayo Cancer Registry, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Justin H Nguyen
- Department of Surgery, and Mayo Clinic Cancer Center, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Denise M Harnois
- Department of Surgery, and Mayo Clinic Cancer Center, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Sanjay P Bagaria
- Department of Surgery, and Mayo Clinic Cancer Center, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Sarah A McLaughlin
- Department of Surgery, and Mayo Clinic Cancer Center, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Zhaoyu Li
- Department of Cancer Biology, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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11
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Apoptotic efficiency of aqueous extracts of turmeric, garlic and their active compounds in combination with Tamoxifen in lung and oral cancers: A comparative study. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2018. [DOI: 10.1016/j.bjbas.2017.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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12
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Mohamed H, Aro K, Jouhi L, Mäkitie A, Remes S, Haglund C, Atula T, Hagström J. Expression of hormone receptors in oropharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 2018; 275:1289-1300. [PMID: 29582173 DOI: 10.1007/s00405-018-4949-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/21/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Hormone receptors play an important role in many types of cancers. Alongside factors associated with human papillomavirus (HPV) infection, hormonal receptors may impact the tumorigenesis of oropharyngeal cancer. MATERIALS AND METHODS This study consists of 199 consecutive oropharyngeal squamous cell carcinoma (OPSCC) patients diagnosed and treated with a curative intent. We examined androgen (AR), estrogen (ER; both alpha and beta), and progesterone receptor (PR) expressions using immunohistochemistry comparing tumor and patient characteristics. RESULTS AR was expressed in 16%, PR in 27% and ER-beta in 63% of the tumors. HPV- and p16-positive tumors expressed more AR and less PR than their negative counterparts. High PR expression was associated with poor disease-specific and locoregional recurrence-free survival. CONCLUSION AR, PR, and ER-beta are expressed in OPSCC, and AR and PR expressions are associated with HPV and p16 status. Furthermore, PR appears to have prognostic significance. This may allow us to investigate the role of anti-hormone receptors in the treatment of OPSCC.
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Affiliation(s)
- Hesham Mohamed
- Department of Pathology, University of Helsinki, HusLab and Helsinki University Hospital, Haartmaninkatu 3, P.O. Box 21, 00014, Helsinki, Finland. .,Department of Histology, Omar Al-Mukhtar University, AlBayda, Libya.
| | - Katri Aro
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lauri Jouhi
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Satu Remes
- Department of Pathology, University of Helsinki, HusLab and Helsinki University Hospital, Haartmaninkatu 3, P.O. Box 21, 00014, Helsinki, Finland
| | - Caj Haglund
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
| | - Timo Atula
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Hagström
- Department of Pathology, University of Helsinki, HusLab and Helsinki University Hospital, Haartmaninkatu 3, P.O. Box 21, 00014, Helsinki, Finland.,Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
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13
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Grimm M, Biegner T, Teriete P, Hoefert S, Krimmel M, Munz A, Reinert S. Estrogen and Progesterone hormone receptor expression in oral cavity cancer. Med Oral Patol Oral Cir Bucal 2016; 21:e554-8. [PMID: 27475696 PMCID: PMC5005091 DOI: 10.4317/medoral.21182] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/03/2016] [Indexed: 12/15/2022] Open
Abstract
Background Recent studies have shown an increase in the incidence of oral squamous cell carcinoma (OSCC) in younger patients. The hypothesis that tumors could be hormonally induced during pregnancy or in young female patients without the well-known risk factors alcohol or tobacco abuse seems to be plausible. Material and Methods Estrogen Receptor alpha (ERα) and Progesterone Receptor (PR) expression were analyzed in normal oral mucosa (n=5), oral precursor lesions (simple hyperplasia, n=11; squamous intraepithelial neoplasia, SIN I-III, n=35), and OSCC specimen. OSCCs were stratified in a young female (n=7) study cohort and older patients (n=46). In the young female study cohort three patients (n=3/7) developed OSCC during or shortly after pregnancy. Breast cancer tissues were used as positive control for ERα and PR expression. Results ERα expression was found in four oral precursor lesions (squamous intraepithelial neoplasia, SIN I-III, n=4/35, 11%) and in five OSCC specimen (n=5/46, 11%). The five ERα positive OSCC samples were older male patients. All patients within the young female study cohort were negatively stained for both ERα and PR. Conclusions ER expression could be regarded as a seldom risk factor for OSCC. PR expression seems to be not relevant for the development of OSCC. Key words:Oral squamous cell carcinoma, estrogen receptor, progesterone receptor, hormone receptor.
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Affiliation(s)
- M Grimm
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstrasse 2-8, 72076, Tuebingen, Germany,
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14
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Wu TF, Luo FJ, Chang YL, Huang CM, Chiu WJ, Weng CF, Hsu YK, Yuan TC. The oncogenic role of androgen receptors in promoting the growth of oral squamous cell carcinoma cells. Oral Dis 2014; 21:320-7. [PMID: 25040852 DOI: 10.1111/odi.12272] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/13/2014] [Accepted: 06/27/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aims of this study were to examine the expression of androgen receptors (AR) in oral squamous cell carcinoma (OSCC) cells and tumors and to determine the role of AR in regulating OSCC cell growth. MATERIALS AND METHODS Four OSCC cell lines were used for analyzing AR expression and transcriptional activity. The effects of AR knockdown on the growth and tumorigenicity of OSCC cells were examined. A series of 11 benign, 22 premalignant, and 21 malignant lesions of the oral cavity were used for analyzing AR expression. RESULTS OSCC cells expressed AR proteins with differential activities. Stimulation of AR by dihydrotestosterone in OSCC cells caused an increase in cyclin D1 expression and promoted cell growth, whereas treatment with bicalutamide led to decreased cyclin D1 expression and inhibited cell growth. Knockdown of AR expression in OSCC cells resulted in decreased proliferation, increased apoptosis, and inhibited tumorigenicity. Results from immunohistochemical studies showed that AR immunoreactivity was found in 27% (3/11) of benign lesions, while 68% (15/22) of premalignant and 67% (14/21) of malignant lesions showed positive AR staining. CONCLUSION Our data suggest that OSCC cells express functional AR proteins which are critical for promoting cell growth and causing malignant disease.
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Affiliation(s)
- T-F Wu
- Department of Life Science and Institute of Biotechnology, National Dong Hwa University, Hualien, Taiwan
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15
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Bakry OA, Samaka RM, Shoeib MAM, Maher A. Immunolocalization of androgen receptor and estrogen receptors in skin tags. Ultrastruct Pathol 2014; 38:344-57. [PMID: 24830664 DOI: 10.3109/01913123.2014.911788] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Skin tags (STs) are benign connective tissue tumors of the dermis. Several clinical observations suggested the involvement of sex steroids in their development. This study aimed at investigating the possible role of androgen receptor (AR) and estrogen receptors (ERs) in STs pathogenesis through their immunohistochemical (IHC) localization in skin biopsies of this disease and to correlate their expression with different clinical and histopathological parameters. Using IHC techniques, we examined 62 cases with STs and 30 gender- and age-matched, healthy subjects, representing the control group. ERα, ERβ, and AR were upregulated in STs compared to normal skin in epidermis and dermis (p < .001 for all). Higher AR H score was significantly associated with axillary STs (p = .02), skin colored tags (p = .03), acanthosis, and papillomatosis (p = .04 for both). Higher ERα H score was significantly associated with hyperpigmented tags (p < .001) and positive family history (p = .003). Higher ERβ H score was significantly associated with female gender and obesity (p = .004 for both). Higher ERα and AR H scores were significantly associated with loose collagen arrangement (p = .02, p = .004, respectively). Higher AR, ERα, and ERβ H scores were significantly associated with the presence of mast cells (p = .01, p = .04, p = .002, respectively) and dilated blood vessels (p = .006, p = .04, p = .04, respectively). In conclusion, AR and ERs may share in STs pathogenesis through their effect on keratinocytes, fibroblasts, and mast cells.
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Jiang Q, Yu YC, Ding XJ, Luo Y, Ruan H. Bioinformatics Analysis Reveals Significant Genes and Pathways to Targetfor Oral Squamous Cell Carcinoma. Asian Pac J Cancer Prev 2014; 15:2273-8. [DOI: 10.7314/apjcp.2014.15.5.2273] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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