A novel ΔNp63-dependent immune mechanism improves prognosis of HPV-related head and neck cancer

Background

Deconvoluting the heterogenous prognosis of Human Papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OSCC) is crucial for enhancing patient care, given its rapidly increasing incidence in western countries and the adverse side effects of OSCC treatments.

Methods

Transcriptomic data from HPV-positive OSCC samples were analyzed using unsupervised hierarchical clustering, and clinical relevance was evaluated using Kaplan-Meier analysis. HPV-positive OSCC cell line models were used in functional analyses and phenotypic assays to assess cell migration and invasion, response to cisplatin, and phagocytosis by macrophages in vitro.

Results

We found, by transcriptomic analysis of HPV-positive OSCC samples, a ΔNp63 dependent molecular signature that is associated with patient prognosis. ΔNp63 was found to act as a tumor suppressor in HPV-positive OSCC at multiple levels. It inhibits cell migration and invasion, and favors response to chemotherapy. RNA-Seq analysis uncovered an unexpected regulation of genes, such as DKK3, which are involved in immune response-signalling pathways. In agreement with these observations, we found that ΔNp63 expression levels correlate with an enhanced anti-tumor immune environment in OSCC, and ΔNp63 promotes cancer cell phagocytosis by macrophages through a DKK3/NF-κB-dependent pathway.

Conclusion

Our findings are the first comprehensive identification of molecular mechanisms involved in the heterogeneous prognosis of HPV-positive OSCC, paving the way for much-needed biomarkers and targeted treatment.

The EXTREME Regimen Associating Cetuximab and Cisplatin Favors Head and Neck Cancer Cell Death and Immunogenicity with the Induction of an Anti-Cancer Immune Response

(1) Background: The first line of treatment for recurrent/metastatic Head and Neck Squamous Cell Carcinoma (HNSCC) has recently evolved with the approval of immunotherapies that target the anti-PD-1 immune checkpoint. However, only about 20% of the patients display a long-lasting objective tumor response. The modulation of cancer cell immunogenicity via a treatment-induced immunogenic cell death is proposed to potentially be able to improve the rate of patients who respond to immune checkpoint blocking immunotherapies. (2) Methods: Using human HNSCC cell line models and a mouse oral cancer syngeneic model, we have analyzed the ability of the EXTREME regimen (combination therapy using the anti-EGFR cetuximab antibody and platinum-based chemotherapy) to modify the immunogenicity of HNSCC cells. (3) Results: We showed that the combination of cetuximab and cisplatin reduces cell growth through both cell cycle inhibition and the induction of apoptotic cell death independently of p53. In addition, different components of the EXTREME regimen were found to induce, to a variable extent, and in a cell-dependent manner, the emission of mediators of immunogenic cell death, including calreticulin, HMGB1, and type I Interferon-responsive chemokines. Interestingly, cetuximab alone or combined with the IC₅₀ dose of cisplatin can induce an antitumor immune response in vivo, but not when combined with a high dose of cisplatin. (4) Conclusions: Our observations suggest that the EXTREME protocol or cetuximab alone are capable, under conditions of moderate apoptosis induction, of eliciting the mobilization of the immune system and an anti-tumor immune response in HNSCC.

Histone hypoacetylation contributes to CXCL12 downregulation in colon cancer: impact on tumor growth and cell migration

CXCL12 has been shown to be involved in colon cancer metastasis, but its expression level and molecular mechanisms regulating its expression remain controversial. We thus evaluated CXCL12 expression in a large cohort of colon adenomas and carcinomas, investigated for an epigenetic mechanism controlling its expression and evaluated the impact of CXCL12 levels on cell migration and tumor growth. CXCL12 expression was measured in human colon adenomas and carcinomas with transcriptome array and RT-qPCR. The promoter methylation was analyzed with whole-genome DNA methylation chips and protein expression by immunohistochemistry. We confirm a reduced expression of CXCL12 in 75% of MSS carcinomas and show that the decrease is an early event as already present in adenomas. The methylome analysis shows that the CXCL12 promoter is methylated in only 30% of microsatellite-stable tumors. In vitro, treatments with HDAC inhibitors, butyrate and valproate restored CXCL12 expression in three colon cell lines, increased acetylation of histone H3 within the CXCL12 promoter and inhibited cell migration. In vivo, valproate diminished (65%) the number of intestinal tumors in APC mutant mice, slowed down xenograft tumor growth concomitant to restored CXCL12 expression. Finally we identified loss of PCAF expression in tumor samples and showed that forced expression of PCAF in colon cancer cell lines restored CXCL12 expression. Thus, reduced PCAF expression may participate to CXCL12 promoter hypoacetylation and its subsequent loss of expression. Our study is of potential clinical interest because agents that promote or maintain histone acetylation through HDAC inhibition and/or HAT stimulation, may help to lower colon adenoma/carcinoma incidence, especially in high-risk families, or could be included in therapeutic protocols to treat advanced colon cancer.

Gallium(III)- and calcium(II)-catalyzed Meyer–Schuster rearrangements followed by intramolecular aldol condensation or endo-Michael addition

The first gallium- and calcium-catalyzed Meyer–Schuster rearrangements are described. The incipient conjugated ketones can undergo calcium-catalyzed aldol condensation (a) or endo-Michael addition (b) with β-keto esters or amides.

Subcellular localization of meta-tetra (hydroxyphenyl) chlorin in human tumor cells subjected to photodynamic treatment

Subcellular localization of meta-tetra (hydroxyphenyl) chlorin (mTHPC) in HT29 human colon adenocarcinoma cells has been studied by means of fluorescence microscopy. The observed diffuse intracellular distribution of mTHPC fluorescence outside the nucleus indicates general staining of cellular organelles. No changes in dye fluorescence pattern are evident during and immediately after cell illumination. Alternatively, the changes in mTHPC fluorescence pattern are observed upon subsequent cell incubation, and are characterized by the appearance of distinct bright fluorescence zones. Reaching a maximum 1 h after illumination, modifications of the fluorescence pattern then gradually disappear in parallel with the formation of plasma membrane blebs, suggesting that cell necrotic lysis is taking place. Photosensitized damage to mitochondria and the Golgi apparatus has been studied using fluorescent probes 1 h after irradiation, the stage of extensive cytoplasm vacuolization, and reveal alterations of these organelles. Changes in the mTHPC fluorescence pattern and mTHPC photocytotoxicity, as measured by the MTT test 24 h after illumination, are inhibited by sodium azide, a singlet oxygen quencher.

Intracellular distribution of tamoxifen in resistant human breast adenocarcinoma cells using tamoxifen-eosin association

A tamoxifen-resistant cell line (MCF7TAM) was established from tamoxifen-sensitive MCF-7 human breast cancer cells expressing estrogen receptors. Though the resistant cell line grows in the presence of tamoxifen, estrogen receptors continue to be expressed at similar levels as in the parental cell line. However, estrogen receptors appeared to be altered in the resistant cell line since important discrepancies are observed between results obtained with ligand binding assays and immunoenzymatic assays, tending to show modifications of estrogen receptor ligand binding capacity. The intracellular distribution of tamoxifen in sensitive and resistant cell lines was investigated using fluorescence of eosin-tamoxifen ionic association. Fluorescence emission spectra of eosin, tamoxifen and eosin-tamoxifen complex (lambda(ex)=480 nm) were analyzed and the maximal fluorescence intensity found for the complex (lambda(em)=540 nm) was four times higher than that of eosin alone, while tamoxifen alone did not emit any fluorescence in this spectral range. In MCF-7 cells, tamoxifen was found to be mainly located surrounding the nucleus, although nuclear fluorescence intensity was significantly lower. No highly fluorescent granules were observed in the resistant cell lines as opposed to sensitive cells. Improvement of this fluorescence microscopy methodology could appear of interest, taking into account the complexity of tamoxifen resistance molecular pathways.

Influence of SDZ-PSC833 on daunorubicin intracellular accumulation in bone marrow specimens from patients with acute myeloid leukaemia

The multidrug resistance (MDR) modulating activity of SDZ-PSC833 (PSC), a non-immunosuppressive cyclosporine analogue, was investigated and compared with cyclosporin A (CSA) in bone marrow clinical specimens from 45 patients with acute myeloid leukaemia (AML) taken at diagnosis, using double-labelling flow cytometry with simultaneous determination of P-glycoprotein (PGP) expression and intracellular daunorubicin fluorescence (IDF). On the basis of pre-clinical results in multidrug-resistant K562 leukaemic cells, concentrations leading to iso-effective complete restoration of IDF were used: 5 and 10 micromol/l, respectively for PSC and CSA. In the clinical specimens, PGP expression was correlated with a significant decrease in IDE PSC was found to be significantly more potent than CSA since it was found to induce a significant increase in IDF in a higher number of cases and to a higher extent than CSA. PGP-unrelated activity of PSC was also observed in specimens expressing no PGP but exhibiting low IDF, thus probably expressing alternative resistance mechanisms. The results confirm the potency of PSC as MDR-modulating agent in clinical AML specimens whose resistance pattern differed from that of highly resistant cell models and suggest that the activity of PSC is not limited to P-glycoprotein inhibition.

The posterior interosseous nerve and the radial tunnel syndrome: an anatomical study

Twenty anatomical specimens were carefully studied in order to establish a possible connection between the posterior interosseous nerve and the radial tunnel syndrome. Our results show that the posterior interosseous nerve distal to the supinator muscle may be compressed by various structures. These include the distal border of the supinator muscle, the ramifications of the anterior and posterior interosseous vessels, and the septum between the extensor carpi ulnaris and the extensor digitorum minimi. The posterior interosseous nerve is also stressed during passive supination (elongation and rotation), and during passive pronation (compression). This suggests that the interosseous nerve distal to the supinator muscle should be explored in radial tunnel compression syndromes.

Scapho-trapezio-trapezoid arthrodesis in the treatment of Kienböck's disease. A study of 16 cases

Sixteen scapho-trapezio-trapezoid arthrodeses were performed for Kienböck's disease. In ten cases, a prosthetic replacement of the lunate was inserted at the same time. Clinical results were good with regard to pain and fair with regard to grip strength which was improved by an average of 32%. In contrast, the arc of flexion-extension was 38% less than on the unoperated side. Long-term radiographic assessment showed the efficacy of the procedure in maintaining carpal height. Biomechanical observations and a review of poor results showed the limits of the method and the importance of correct positioning of the scaphoid. We concluded that triscaphe arthrodesis was a useful procedure for the treatment of Kienböck's disease in Decoulx's stage 3.

[Lipofibroma of the median nerve. Apropos of a case]

Lipofibroma is a rare, benign nerve tumour corresponding to diffuse fibroadipose infiltration of the nerve, dissociating the fasciculi without invading them. The authors report a case of lipofibroma of the median nerve in a 32 year old man presenting with a soft swelling of the palmar surface of the thumb. Treatment consisted of intraneurodissection of the tumour arising exclusively from the medial collateral nerve of the thumb. With a follow-up of two years, there has been no recurrence of the tumour, but the patient has persistent decreased sensation of the ulnar half of the thumb pulp. The features of the lipofibroma and the therapeutic options are discussed in the light of the data reported in the literature.

Human nerve xenografting in nude mouse: experimental study of graft revascularization

In the nude mouse, the congenital absence of T lymphocytes makes it possible to implant human nerve grafts without rejection or iatrogenic modifications (by immunosuppression) of human and murine tissues. Medial antebrachial cutaneous nerves were harvested from human cadavers 1-18 hours after death. These nerve grafts were implanted using different techniques in nude mice. All the grafts were macroscopically and microscopically revascularized 3 days after implantation. The modifications in time of this vascularization could be studied with precision through the use of repeated biopsies. The absence of human blood group antigens on the neovessel endothelium suggested a murine origin for angiogenesis. In situ DNA hybridizations with human and mouse DNA confirmed this origin. The topography of the revascularization (maximal in the perineurium and endoneurium) and the almost complete absence of human cells other than Schwann cells in the grafts at the peak of angiogenesis (26 days after grafting) suggested that Schwann cells had a determining role in graft vascularization. The irradiation of the nerve grafts with a dose of 30 grays before implantation did not modify significantly their histologic appearance compared to the control group, whereas an irradiation of 60 grays led to massive lesions. The neurotization of murine axons led to chimerical structures of normal histologic appearance, with vascularization similar to that observed in nonneurotized nerves. Through chimerism (human Schwann cells, murine vessels and axons) this model makes it possible to dissociate the respective role of the host and of the nerve graft in angiogenesis and suggests the existence of growth factors produced by the human Schwann cells.

Tendon transfers for treatment of the paralyzed hand following brachial plexus injury

The correction of functional deficits of the hand after a brachial plexus lesion is difficult; treatment should be provided by a well-knit team of surgeons and therapists. The patient should be fully aware of the limitations of surgical treatment before surgery, and should be entrusted to the care of a physical therapist during the critical period of nerve regeneration after initial surgical treatment to ensure optimal results. This article presents therapeutic possibilities and discusses specific problems of tendon transfers in brachial plexus palsy.

[The socio-economic costs of finger replantation. Apropos of 40 replantations of the thumb]

Microsurgical techniques are becoming increasingly important in the emergency treatment of hand trauma and in secondary reconstructive surgery. In the light of the current concern with financial feasibility, we thought it important to determine whether this surgery, sometimes wrongly described as being luxury surgery, is economically feasible. The cost of 40 reimplantations and revascularisations of the thumb treated in the context of work accidents was studied. Although the short-term cost of reimplantation is higher than that of amputation, in the long-term, a successful reimplantation constitutes a definite economy for society and justifies this type of specialist surgery.

[A single-use vascular clamp. An experimental and clinical study]

Twelve rabbit femoral arteries were clamped for one hour with a TKS2 clamp in order to confirm the atraumatic nature of the Tamai disposable clamp. After 15 or 30 minutes of revascularisation, the arteries were excised and studied by light microscopy and scanning electron microscopy. Temporary dilatation of the artery was observed after removal of the clamp, as the patency test was always positive. Light microscopy revealed parietal flattening without any cellular disorganisation and scanning electron microscopy revealed flattening of the endothelial cells without any tearing. On the basis of these favourable results, combined with the ease of use, we now use the Tamai clamp daily.

Hyperostotic macrodactyly

There is a rare and special type of macrodactyly that is called the hyperostotic variety. This disease occurs later than the classical forms of macrodactyly and shows massive osteocartilaginous deposits around the joints. A new case is reported. The cause of this disease could be previous trauma.

Effects of cyclosporin A and predegeneration on survival and regeneration of peripheral nerve allografts in rabbits

Axonal regeneration across 64 median nerve grafts in 34 rabbits was studied histologically to determine the optimal conditions for nerve allografting. Axonal regeneration across allografts in cyclosporin A-treated animals was satisfactory, but it occurred more slowly and with more inflammation and fibrosis than in autografts. Without immunosuppression, fresh allografts were rejected. However, in immunocompetent hosts, allografts rendered less immunogenic by predegeneration were not rejected, and axonal regeneration occurred. The combination of cyclosporin A and nerve graft predegeneration produced the most substantial axonal regeneration, comparable to autografts. The observations suggest that nerve allograft survival may be optimally effected by cyclosporin A treatment coupled with reduction in the immunogenicity of the grafts, such as by predegeneration.

[Trans-triquetral triquetral-lunate arthrodesis]

Transtriquetral triquetro-lunate arthrodesis is an original technique for partial arthrodesis of the wrist. This operation is indicated in the treatment of certain forms of triquetro-lunate instability and represents a new approach to the treatment of Decoulx's stages I and II of Kienböck's disease. The incision is medial and limited. The use of a special trephine guided by a pine allows the extraction of a triquetro-lunate osteocartilaginous cylinder. A cancellous bone graft is then performed to fill in the loss of substance. This new, simple surgical procedure, but demanding in terms of its technique, should decrease the failure rate and should improve the chances of lunate revascularisation.

[Littler's operation (SORL = spiral oblique retinacular ligament) in the treatment of "swan neck"]

The surgical treatment of "swan-neck" deformities secondary to mallet finger using Littler's technique (Spiral Oblique Retinacular Ligament) in a series of 35 cases, led to a complete correction of the PIP joint hyperextension in 95% of the cases and a correction of the DIP joint flexure in 70% of the cases. This active tenodesis restores the physiology of the extension of the PIP and DIP joints as far as the surgical technique has been strictly respected.

[Miniaturized osteosynthesis of articular fractures of the fingers. Results of a series of 60 cases]

The importance of anatomical reduction of articular fractures and early mobilisation of these severe forms of trauma which frequently damage the extensor apparatus (58% of cases, led us to propose direct miniaturised osteosynthesis as described by the Nancy-Strasbourg team. Of the 1,000 cases of osteosynthesis performed between 1978 and 1985, we selected 12 fractures of the MP joint, 38 fractures of the PIP joint and 10 fractures of the DIP joint, differentiated into 4 stages according to the condition of the skin and tendons and into 9 categories according to the anatomical type and the site of the fracture. Direct osteosynthesis (screw, bolt, pin) was used in every case. The clinical results were evaluated in terms of the Total Active Range of Movements, the local trophic state, the amount of pain and return to work, for each joint. When well conducted and with effective skin cover, this technique allows almost normal reconstruction in simple fractures and is valuable in more complex fractures by preserving sliding of the tendinous apparatus due to early mobilisation.

Automated photography in microsurgery

An automated method is proposed for photographing a microsurgical field that avoids missed photographs and time-consuming manipulations. The basic principles applied to microscopic photography are briefly reviewed and instructions are provided for standardized, reproducible, high quality photographs. A limitation at present is that auto-focusing cameras have not yet been adapted for use with surgical microscopes. One type of microscope is discussed and details about the only camera system currently suitable for such a microscope are described.

[Pseudolinitis plastica of breast origin]

The most common type of gastric metastases secondary to carcinoma of the breast is the one showing a linitis plastica appearance. The roentgenologic aspect when performing an upper gastrointestinal examination with barium contrast is typical and allows the differential diagnosis with the primitive linitis. The linitis plastica type of metastatic breast carcinoma results from transmural infiltration of the stomach wall with initial deposit of tumor cells in the submucosal or subserosal regions. CT provide valuable information concerning the metastatic spread.

Sarcoid tenosynovitis in the hand. A case report and literature review

We report a case of involvement of a finger flexor tendon by sarcoidosis. A review of twelve cases suggests that this is a rare manifestation of the illness that most often affects the finger extensors at the wrist. It tends to present in established sarcoidosis and is associated with a higher than usual incidence of polyarthritis. The main differential diagnosis would be tuberculous tenosynovitis. We suggest that a histological spectrum exists running from a predominantly cellular picture to one of fibrotic nodules, perhaps explaining previously described instances of pseudo-tumour. We would recommend tenosynovectomy in conjunction with corticosteroid therapy as the treatment of choice.

Sarcoid tenosynovitis in the hand. A case report and literature review

We report a case of involvement of a finger flexor tendon by sarcoidosis. A review of twelve cases suggests that this is a rare manifestation of the illness that most often affects the finger extensors at the wrist. It tends to present in established sarcoidosis and is associated with a higher than usual incidence of polyarthritis. The main differential diagnosis would be tuberculous tenosynovitis. We suggest that a histological spectrum exists running from a predominantly cellular picture to one of fibrotic nodules, perhaps explaining previously described instances of pseudo-tumour. We would recommend tenosynovectomy in conjunction with corticosteroid therapy as the treatment of choice.