1029

CDKN2A

cyclin-dependent kinase inhibitor 2A;CDKN2A;cyclin-dependent kinase inhibitor 2A

CDK4 inhibitor p16-INK4|cell cycle negative regulator beta|cyclin-dependent kinase 4 inhibitor A|cyclin-dependent kinase inhibitor 2A (melanoma, p16, inhibits CDK4)|multiple tumor suppressor 1

9p21

protein-coding

OBJECTIVE: To investigate the homozygous deletion (HZD), hypermethylation and mutation of p16 gene in human breast cancer and the relationship between the structural alterations of p16 gene and its expression. METHODS: PCR and PCR-methylation assay with silver staining (PCR-MASS) were used to detect HZD and hypermethylation of p16 gene exon 1 in 60 fresh breast cancers and 24 normal breast tissues adjacent to cancer (as control tissues). PCR-SSCP and DNA sequencing were used for the analysis of p16 gene mutation. Moreover, p16 gene and mRNA were also detected in the 60 cases. RESULTS: Of the 60 breast cancers, HZD was found in 7 cases, hypermethylation and mutation were found in 16 and 4 cases respectively, and the difference was statistically significant. The positive rates of p16 protein and mRNA in breast cancer were 28/60 and 39/60 respectively. CONCLUSION: The results demonstrate that several kinds of p16 gene structural changes exist in breast cancer. The structural changes of p16 gene cause abnormal p16 expression, the main mechanisms are hypermethylation, while HZD or mutation are the secondary causes. Abnormal expression of p16 gene then becomes involved in the development and metastasis of breast cancer.

BACKGROUND: The p16(INK4A) protein (p16) is a cyclin-dependent kinase inhibitor that arrests the cell cycle in the G1 phase. AIM: To explore the potential of p16 as a predictive marker for lymph node (LN) metastasis and prognosis in cervical carcinomas. METHODS: 145 patients diagnosed with FIGO stage I to IV cervical carcinoma were studied; 95 underwent LN dissection. The expression of p16 protein was studied by immunohistochemistry using tissue microarrays. RESULTS: Overexpression of p16 was seen in 108 of 145 (74.5%) invasive carcinomas. There was a significant correlation between p16 expression and LN metastasis (p=0.007). Patients with p16 overexpression had poorer survival than patients with p16 underexpression (59.3% vs 83.8% 5-year survival rate, log-rank p=0.015). In univariate analysis, p16 expression was a significant predictor of survival (RR 2.76, p=0.02). CONCLUSIONS: Results suggest that p16 expression is an important predictive factor of LN metastasis in cervical cancer patients. Moreover, p16 overexpression is associated with a poor prognosis. Therefore, immunohistochemical evaluation of p16 expression is of potential value for treatment planning in cervical carcinomas.

Most colorectal carcinomas (CRCs) arise from adenomas through an archetypal pathogenic pathway, the adenoma-carcinoma-metastasis sequence. Aberrant expression of beta-catenin, p16, E-cadherin and c-myc appears to have played important roles in the development and/or progression of CRC, but their precise distribution pattern and associations in different pathologic loci along CRCs pathogenic pathway have not been thoroughly examined. In this study, a tissue microarray (TMA) containing 85 advanced CRCs in different Dukes stages was constructed. In each of 85 cases, tissue specimens from normal mucosa and primary carcinomas in different layers of the bowel wall were included in the TMA. Tissue specimens from matched adenoma, lymph node metastases and distant metastases were obtained from 22, 21 and 21 cases, respectively. expression patterns of beta-catenin, p16, E-cadherin and c-myc were evaluated by immunohistochemistry. The results revealed that nuclear expression of beta-catenin, p16 and c-myc was quantitatively increased from normal mucosa to premalignant adenoma, primary carcinoma and lymph node metastatic carcinoma; the frequency of nuclear overexpression of beta-catenin and p16 in lymph node metastases was significantly higher than that in distant metastases (p < 0.05). These results suggest an association between nuclear overexpression of beta-catenin and/or p16 and CRC lymph node metastasis but not distant metastasis. The results also showed that correlative high nuclear expression of beta-catenin and c-myc was observed in primary carcinomas involving the serosa and lymph node metastases (p < 0.05) but not in other pathologic regions of CRCs, suggesting that the tumor microenvironment in different pathologic loci of colorectal tumorigenesis and progression may influence c-myc responsiveness to beta-catenin/Tcf activation.

The aim of the present study was to determine if p16 methylation in the serum can serve as a candidate marker for the malignancy of colorectal carcinoma, real-time quantitative methylation-specific PCR (RTQ-MSP) was performed for p16 methylation in serum and the relationship between p16 methylation levels and clinicopathological findings of colorectal carcinoma was evaluated. RESULTS: The p16 methylation score significantly increased with tumor stage (stage I=0.94+/-0.47, stage 11=2.33+/-0.90, stage 111=8.49+/-2.37, stage IV=10.03+/-4.30) (p=0.021; ANOVA). The p16 methylation score was significantly higher in patients with lymph node metastasis (p=0.001) and tumor invasion to the veins (p=0.020). The cumulative survival of patient groups according to the p16 methylation score (more or less than 1) was examined. Interestingly, the group with a high p16 methylation score showed significantly worse survival rates than the group with a low p16 expression score (p= 0.006). CONCLUSION: The p16 methylation score might serve as a new parameter for the prognosis of colorectal carcinoma. Moreover, p16 methylation was found in the serum of patients in all clinical stages, suggesting that early colorectal carcinoma could be detected using the RTQ-MSP method.

Genetic alterations in metastatic cutaneous squamous cell carcinoma (CSCC) which might serve as prognostic biomarkers are not well investigated. We investigated the mutation status and protein expression of the CDKN2A (INK4a-ARF) and TP53 genes in metastatic CSCCs and correlated this with clinicopathological variables, HPV presence, and survival data. Sequence analysis was performed on formalin-fixed and paraffin-embedded tissue of 35 metastases and their primary tumors, and was correlated with immunohistochemical stainings for p53, p16 and p14. Beta-PV and alpha-PV DNA was detected using PCR-based assays. Kaplan-Meier and Cox regression methods were used for survival assessment. CDKN2A was mutated in 31% of the metastases and their primary tumors, while the TP53 gene was mutated in 51% of the metastases. P53 protein expression was significantly associated with missense type of mutations (p = 0.002). No persistent HPV types were detected. CDKN2A mutations were significantly associated with disease-specific death (p = 0.001). A significant difference was observed in disease-specific survival between patients with or without a CDKN2A mutation (p = 0.010), while this was not the case for TP53. At univariate Cox's regression analysis tumor size (p = 0.010), invasion depth (p = 0.030) and CDKN2A mutations (p = 0.040) were significantly related to shorter disease-specific survival. At multivariate Cox's regression only tumor size had an adverse effect on survival (p = 0.002). In conclusion, our study indicates that the CDKN2A mutation status might be of prognostic value in metastatic CSCCs. In most cases, CDKN2A and TP53 mutations are early genetic events in CSCC tumorigenesis. The possible role of HPV in metastatic CSCC needs further exploration.

In the current mini-review, we present a short overview of genetic as well as immunohistochemical p14(ARF) alterations either in primary human endometrial carcinomas (ECs) or in metastatic lesions originated from malignant endometrium. The prognostic utility of p14(ARF) in uterine malignancies has also been briefly discussed.

OBJECTIVE: To study the methylation status of retinoic acid receptor beta2 (RARbeta2) and p16(INK4alpha) genes in peripheral blood and tumor tissues and the perioperative dynamic changes of free RARbeta2 and p16(INK4alpha) in the peripheral blood, and to investigate the relationship between RARbeta2 and p16(INK4alpha) methylation in peripheral blood and clinicopathological characteristics of esophageal squamous cell carcinoma (ESCC) and their value in evaluating the completeness of surgical resection. METHODS: Real-time methylation specific polymerase chain reaction (real-time MSP) technique was used to detect the methylation status of RARbeta2 and p16(INK4alpha) in tumor tissue, adjacent normal tissue and peripheral blood perioperatively in 76 cases of ESCC. Sixty age-matched healthy volunteers were randomly selected as a control. RESULTS: RARbeta2 and p16(INK4alpha) hypermethylation presented in both tumor tissue [72.4% (55/76) and 86.8% (66/76)] and peripheral blood [63.2% (48/76) and 71.1% (54/76)] in the ESCC patients, showing a good agreement between them. RARbeta2 and p16(INK4alpha) hypermethylation was significantly related with pathological stage, lymph node metastasis, and invasion of nerves and vessels (P < 0.05). The DNA methylation rate in peripheral blood was increasing first and then decreasing in the preoperative, intraoperative and postoperative periods. Moreover, the RARbeta2 methylation in peripheral blood was shown to be significantly associated with family history of cancer (P = 0.023). CONCLUSION: RARbeta2 and p16(INK4alpha) methylation in the peripheral blood in ESCC patients may reflect the tumor-bearing status in the body, and may serve as a valuable marker in assessment of the degree of completeness of surgical resection in ESCC patients.

BACKGROUND: cancer of the gallbladder is a relatively rare neoplasm with a poor prognosis. The exact mechanisms of its genesis are not known and very little information is available on molecular events leading to labeling this as an orphan cancer. MATERIALS AND METHODS: In this prospective case control study we evaluated the expression of p16, pRb and cyclin D1 by immunohistochemistry to study the G1-S cell-cycle check point and its possible role in gallbladder carcinogenesis. A total of 25 patients with gallbladder carcinoma (group I), 25 with cholelithiasis (group II) and 10 normal controls. were enrolled. RESULTS: Cyclin D1 expression was seen in 10 (40%) patients each with carcinoma and cholelithiasis while only in 2 (20%) of the normal gallbladders but differences were not statistically significant (p value=0.488). p16 was expressed in 12% patients of carcinoma of the gallbladder and 28% of cholelithiasis, however this difference was not statistically significant (p value=0.095). Retinoblastoma protein was found to be expressed in 50% of normal gallbladders and 6 (24%) of carcinoma and 8 (32%) of gallstones. The present study failed to demonstrate any conclusive role of cyclin D1/RB/ p16 pathway in carcinoma of the gallbladder. CONCLUSIONS: The positive relation observed between tumor metastasis and cyclinD1 expression and p16 with nodal metastasis suggested that higher cyclin D1/p16 expression may act as a predictive biomarker for aggressive behavior of gallbladder malignancies.

OBJECTIVE: To investigate the relationship between p16 expression and cell proliferation and prognosis in gastric cancer patients. METHODS: Gastric cancer cell lines SGC-7901, MKN45, MKN28, human embryonic kidney cell line HEK293, human fibroblast cell line MRC-5, and surgical specimens of gastric carcinoma and adjacent normal gastric mucosa from 65 patients were included in this study. RT-PCR, MTT and FCM assays were used to detect p16 expression in gastric cancer cell lines and surgical specimens of gastric cancer. MTT assay was used to determine cancer cell viability and FCM to detect cell cycle. Kaplan-Meier survival curve and Log-Rank statistics were used to analyze the relationship between p16 expression and survival of petients with gastric cancer. RESULTS: Gastric cancer cell lines were mostly negative for p16 expression, and p16 was re-expressed after the cells transfected with p16 gene by adenovirus AdCMV-p16. p16 re-expression resulted in the decrease of cancer cell viability and cancer cell cycle arrest with increased G(1) phase and decreased S phase. p16 expression in cancer specimens was 32.3% (21/65), significantly lower than the 81.5% (53/65) in normal mucosa (chi(2) = 32.124, P < 0.001). The disease-free survival was significantly shorter in p16-negative patients than that in p16-positive patients (P < 0.01), but not the overall survival (P > 0.05). p16 expression was significantly correlated with differentiation and lymph node metastasis, but not significantly correlated with sex, age, tumor size or invasion depth of the gastric cancer. CONCLUSIONS: p16 gene is important for cancer cell proliferation. The inactivation gives cancer cells a high activity for proliferation and metastasis, and then influences the disease-free survival of gastric cancer patients.

CDK5 regulatory subunit associated protein 3 (CDK5RAP3) is a novel activator of PAK4 and processes important pro-metastatic function in hepatocarcinogenesis. However, it remains unclear if there are other mechanisms by which CDK5RAP3 promotes HCC metastasis. Here, we showed that in CDK5RAP3 stable knockdown SMMC-7721 HCC cells, p14(ARF) tumor suppressor was upregulated at protein and mRNA levels, and ectopic expression of CDK5RAP3 was found to repress the transcription of p14(ARF). Using chromatin immunoprecipitation assay, we demonstrated that CDK5RAP3 bound to p14(ARF) promoter in vivo. Furthermore, knockdown of p14(ARF) in CDK5RAP3 stable knockdown HCC cells reversed the suppression of HCC cell invasiveness mediated by knockdown of CDK5RAP3. Taken together, our findings provide the new evidence that overexpression of CDK5RAP3 promotes HCC metastasis via downregulation of p14(ARF).

Ectopic expression of oncogenes such as Ras induces expression of p19(Arf), which, in turn, activates p53 and growth arrest. Here, we used a multistage model of squamous cell carcinoma development to investigate the functional interactions between Ras, p19(Arf), and p53 during tumor progression in the mouse. Skin tumors were induced in wild-type, p19(Arf)-deficient, and p53-deficient mice using the DMBA/TPA two-step protocol. Activating mutations in Hras were detected in all papillomas and carcinomas examined, regardless of genotype. Relative to wild-type mice, the growth rate of papillomas was greater in p19(Arf)-deficient mice, and reduced in p53-deficient mice. Malignant conversion of papillomas to squamous cell carcinomas, as well as metastasis to lymph nodes and lungs, was markedly accelerated in both p19 (Arf)- and p53-deficient mice. Thus, p19(Arf) inhibits the growth rate of tumors in a p53-independent manner. Through its regulation of p53, p19(Arf) also suppresses malignant conversion and metastasis. p53 expression was upregulated in papillomas from wild-type but not p19( Arf)-null mice, and p53 mutations were more frequently seen in wild-type than in p19( Arf)-null carcinomas. This indicates that selection for p53 mutations is a direct result of signaling from the initiating oncogenic lesion, Hras, acting through p19(Arf).

Alterations in the p16/cyclinD1/Rb and ARF/Mdm2/p53 pathways are frequent events in the pathogenesis of squamous cell carcinomas. Different mechanisms of p16 regulation have been described for penile carcinomas so far. Therefore, expression of p16 and p53 was immunohistochemically detected with monoclonal antibodies in 52 primary invasive penile squamous cell carcinomas. The carcinomas were analyzed for allelic loss (LOH) in p16(INK4A) and p53, as well as for mutations in the p16(INK4A) and the p53 gene. In addition, we examined the promoter status of p16(INK4A) by methylation-specific PCR. The presence of human papilloma virus (HPV) 6/11, HPV 16 and HPV 18 DNA was analyzed by PCR. Data were compared to clinical data. Concerning p16, 26 (50%) tumors showed positive immunohistochemistry, 32 (62%) tumors showed allelic loss and 22 tumors (42%) showed promoter hypermethylation. All tumors with negative p16 immunohistochemistry showed LOH near the p16(INK4A) locus and/or hypermethylation of the p16(INK4A) promoter. HPV 16 DNA was detected in 17 tumors, ten of them with positive p16 immunostaining. The remaining seven tumors with negative p16 staining showed allelic loss and/or promoter hypermethylation. Evidence of lymph node metastasis was significantly associated with negative p16 immunohistochemistry as well as with combined LOH and promoter hypermethylation (p = 0.003 and p = 0.018, respectively). Allelic loss around p53 was found in 22 tumors (42%), and seven mutations of the p53 gene could be demonstrated in our tumors. No correlations could be found between any p53 alteration and clinical parameters.

The ability of tumor cells to metastasize is increasingly viewed as an interaction between the primary tumor and host tissues. Deletion of the p19/Arf or p53 tumor suppressor genes accelerates malignant progression and metastatic spread of 7,12-dimethylbenz(a)anthracene (DMBA)/12-O-tetradecanoyl-phorbol-13-acetate (TPA)-induced squamous cell carcinomas, providing a model system to address mechanisms of metastasis. Here, we show that benign pre-metastatic papillomas from wild-type mice trigger lymphangiogenesis within draining lymph nodes, whereas there is no growth of primary tumor lymphatic vessels. Lymph node lymphangiogenesis is greatly accelerated in papilloma-bearing p19/Arf- or p53-deficient mice, which coincides with the greater propensity of these tumors to progress to carcinomas and to metastasize. The extent of accumulation of B cells within the tumor-draining lymph nodes of wild-type mice predicted the level of lymph node lymphangiogenesis and metastatic potential. Arf or p53 deficiency strongly accelerated lymph node immune cell accumulation, in a manner that was associated with the extent of lymph node lymphatic sinus growth. This immune cell accumulation and lymph node lymphangiogenesis phenotype identifies host anti-tumor responses that could drive metastatic spread of cancers via the lymphatics.

BACKGROUND: Inactivation of p16 by methylation of CpG islands is a frequent early event in human cancers, including papillary thyroid carcinoma (PTC). This study was to observe the methylation status of the p16 gene in papillary thyroid carcinoma (PTC) and its correlation with clinical parameters. METHODS: Methylation-specific PCR (MSP) was used to analyze the methylation status of the p16 gene in 74 PTCs and 21 adjacent normal thyroid tissues. RESULTS: Hypermethylation of p16 gene was observed in 27.0% (20/74) of PTC. None of the normal thyroid tissues was methylated, when compared to the PTCs (p < 0.05). There was no marked relationship between the methylation of p16 gene and the patients' age, gender, size of cancer, histological subtypes and occurrence of recurrent disease (p > 0.05). The methylation of p16 gene was positively associated with metastasis, a high AMES (age, metastasis to distant sites, extrathyroidal invasion, size) risk group (p < 0.05) and advanced pathological tumor-lymph node-metastasis stages. CONCLUSION: The methylation of the p16 gene, one event of significance in molecular biology, was common and correlated with biological metastasis and histological features in PTC, and may be involved in thyroid tumorigenesis and aggressiveness.

Interactions between the cyclin-dependent kinase inhibitors (CDKI) and human papillomavirus (HPV) infection in the pathogenesis of vulvar carcinoma are still incomplete. This study aimed to evaluate the prognostic relevance of these proteins in vulvar cancer. One hundred and thirty-nine patient specimens assembled in a tissue microarray were evaluated for p16, p21, p27, and pRb by immunohistochemistry. HPV status was assessed by a linear array HPV genotyping test. In 16 cases with available frozen tumor, quantitative real-time reverse transcriptase-polymerase chain reaction for CDKN2A(p16), CDKN1A, and Rb was performed. Protein expression was considered positive in 40 patients for p16, 35 for p21, 28 for p27, and 19 for pRb. HPV was positive in 43 of the 105 evaluable cases. expression of CDKIs and pRb, with the exception of p16, seem to be linked to the early phases of vulvar carcinogenesis. Although p16 and p21 protein expression was associated with early stages of disease, no prognostic significance was found when analyzing CDKI proteins or detecting HPV status, limiting their clinical usage. No association was observed between expression of CDKI proteins and HPV status, suggesting that in spite of this association found in cervical cancer, this seems not to be valid for vulvar carcinoma.