ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up

Our increasing appreciation of the importance of inflammation in vascular disease has focused attention on the molecules that direct the migration of leukocytes from the blood stream to the vessel wall. In this review, we summarize roles of the chemokines, a family of small secreted proteins that selectively recruit monocytes, neutrophils, and lymphocytes to sites of vascular injury, inflammation, and developing atherosclerosis. Chemokines induce chemotaxis through the activation of G-protein-coupled receptors, and the receptors that a given leukocyte expresses determines the chemokines to which it will respond. Monocyte chemoattractant protein 1 (MCP-1), acting through its receptor CCR2, appears to play an early and important role in the recruitment of monocytes to atherosclerotic lesions and in the formation of intimal hyperplasia after arterial injury. Acute thrombosis is an often fatal complication of atherosclerotic plaque rupture, and recent evidence suggests that MCP-1 contributes to thrombin generation and thrombus formation by generating tissue factor. Because of their critical roles in monocyte recruitment in vascular and nonvascular diseases, MCP-1 and CCR2 have become important therapeutic targets, and efforts are underway to develop potent and specific antagonists of these and related chemokines.

Chemokines in the Pathogenesis of Vascular Disease

Chemokines and atherosclerosis

The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11-13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically-relevant questions about endometrial cancer relating to the following four areas: prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each recommendation, are detailed in this article. All participants have approved this final article.

https://ijgc.bmj.com/content/ijgc/26/1/2.full.pdf

ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up.

Several groups have demonstrated apoptotic cell death in atherosclerotic plaques. The significance of apoptosis in atherosclerosis depends on the stage of the plaque, localization and the cell types involved. Both macrophages and smooth muscle cells undergo apoptosis in atherosclerotic plaques. Apoptosis of macrophages is mainly present in regions showing signs of DNA synthesis/repair. Smooth muscle cell apoptosis is mainly present in less cellular regions and is not associated with DNA synthesis/repair. Even in early stages of atherosclerosis smooth muscle cells become susceptible to undergoing apoptosis since they increase different pro-apoptotic factors. Moreover, recent data indicate that smooth muscle cells may be killed by activated macrophages. The loss of the smooth muscle cells can be detrimental for plaque stability since most of the interstitial collagen fibers, which are important for the tensile strength of the fibrous cap, are produced by SMC. Apoptosis of macrophages could be beneficial for plaque stability if apoptotic bodies are removed. Apoptotic cells that are not scavenged in the plaque activate thrombin which could further induce intraplaque thrombosis. It can be concluded that apoptosis in the primary atherosclerosis is detrimental since it could lead to plaque rupture and thrombosis. Recent data of our group indicate that apoptosis decreases after lipid lowering which could be important in our understanding of the cell biology of plaque stabilization.

/pdf/apoptosis-in-atherosclerosis-beneficial-or-detrimental-35xfjsqbzq.pdf

Apoptosis in atherosclerosis: beneficial or detrimental?

The important role of the p53 gene in tumour progression and cellular response to DNA damage has prompted investigation of the clinical significance of alterations to this gene. We examined both p53 overexpression and mutation of the gene in endometrial carcinoma in order to evaluate the prognostic significance of these changes. Of 122 endometrial carcinomas, 33 (27%) showed overexpression of p53 in the nucleus and 66 (54%) in the cytoplasm. Mutation in the p53 gene was found in 16 (13%) cases but showed no significant association with patient survival. Nuclear p53 overexpression was associated with poor survival (48% vs 80% alive in negative tumours 5 years post operatively, P < 0.001). In contrast, cytoplasmic p53 overexpression was associated with better survival (85% vs 55%, P < 0.001). When patients were separated into prognostic subgroups according to established clinical markers, these associations remained significant within most subgroups examined. In multivariate analysis adjusted for surgical stage, histological grade and type and vascular invasion, both nuclear p53 overexpression [hazard ratio 4.9 (95% CI 1.3-17.6). P = 0.016] and cytoplasmic overexpression [0.25 (0.06-0.98), P = 0.047] were independent prognostic factors. Immunohistochemical assessment of p53 overexpression in the nucleus and cytoplasm could provide useful prognostic information for the management of patients with endometrial cancer.

Overexpression of p53 protein is an independent prognostic indicator in human endometrial carcinoma

The effects of triiodothyronine administration and of hypothyroidism on the rapidly developing enzymes UDP galactose: sphingosine galactosyltransferase and 2′:3′-nucleotide 3′-phosphohydrolase associated with central nervous system myelination were investigated. The activity of these enzymes in the spinal cords of young rats injected daily with triiodothyronine up to sacrifice on day 5 was significantly increased over control animals. In normal animals, circulating plasma thyroxine increased gradually from the second postnatal day to a maximum value at days 15–17. Rats, born of mothers treated with n-propylthiouracil from the thirteenth day of pregnancy, did not exhibit the increase in plasma thyroxine. Determination of the specific activity of these enzymes in central nervous tissue of such hypothyroid rats at day 12 showed a significant reduction compared with normal animals. Intraperitoneal injection of the hypothyroid rats with triiodothyronine on day 8 resulted in a partial restoration of the activity of the enzymes in brain and of 2′:3′-nucleotide 3′-phosphohydrolase in spinal cord when assayed on day 12. Restoration of UDPgalactose: sphingosine galactosyltransferase activity did not occur in the spinal cord of such animals. However, when hypothyroid rats were injected with triiodothyronine on days 1, 4, and 7, the psychosine-synthesising activity in their spinal cords on day 8 was restored to that of normal animals. This suggests that there is a critical period during the first 8 days of postnatal life when thyroid hormone levels must be adequate in order that spinal cord activity of this enzyme develops normally. It is concluded that the flux in circulating thyroid hormone is a factor in the normal development of these enzymes.

https://febs.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1432-1033.1972.tb01901.x

Influence of Thyroid Hormones on Enzyme Activities of Myelinating Rat Central‐Nervous Tissues

Monocyte chemoattractant protein-1 (MCP-1) and interleukin-8 (IL-8) are potent chemokines which attract circulating monocytes and neutrophils respectively to inflamed tissues. JE/MCP-1 gene expression has been previously studied in rabbit aortae after endothelial denudation and the rapid appearance of this transcript was thought to precede emigration of phagocytes. We now report MCP-1 gene expression following de-endothelialization of iliac arteries in the pig, a species which can develop spontaneous atherosclerosis. Using Northern blot analysis, we demonstrated that MCP-1 mRNA was rapidly induced in pig arteries at 2 h and continued to increase to reach a maximum at 8 h before returning to low levels at 16-24 h after injury. The increase seen for MCP-1 mRNA at 8 h was also observed for IL-8 mRNA but was not apparent for growth-related gene expressions, urokinase-type plasminogen activator (u-PA), and plasminogen activator inhibitor-1 (PAI-1). Since smooth muscle cells, endothelial cells, and phagocytes are all capable of expressing MCP-1, we examined pig arteries for immunostaining using a monoclonal antibody to human MCP-1 (5D3-F7). At 8 h after injury, the predominant cell type staining positive for MCP-1 was the monocyte/macrophage. Staining was also observed in occasional scattered neutrophils, but MCP-1 protein could not be detected in smooth muscle cells or on extracellular matrix within the sensitivity constraints posed by our methodology. Our results are consistent with invading monocyte/macrophages having a major input into the production of this chemokine in the arterial wall following injury. The fact that MCP-1 expression accompanied monocyte/macrophage presence in damaged artery, rather than preceding it, is suggestive that continued MCP-1 expression is required for functions other than chemoattraction.

Monocyte chemoattractant protein-1 gene expression in injured pig artery coincides with early appearance of infiltrating monocyte/macrophages.

Estrogen-inducible pS2 mRNA was previously detected in human cancer cell lines the growth of which was sensitive to estrogen. In the present study, the expression of the pS2 gene was analyzed in 111 gynecological carcinomas. The pS2 message was detected in greatest abundance in 6 primary carcinomas of the ovary (6 of 29), 4 of these being mucinous cystadenocarcinomas. A secondary carcinoma of the ovary, and another of the omentum (1 of 4), also contained detectable levels of pS2 mRNA. Weak pS2 mRNA signals were occasionally observed in endometrial (2 of 55) and cervical carcinomas (2 of 33) as well. There was a poor correlation between estrogen receptor and pS2 mRNA in ovarian carcinomas.

https://cancerres.aacrjournals.org/content/canres/50/6/1800.full.pdf

Detection of pS2 Messenger RNA in gynecological cancers

Excessive proliferation of smooth muscle cells (SMC) in the arterial intima is thought to be a major contributing factor to the development of atherosclerosis. One of the theories put forward to explain the aberrant growth is that genetic alterations similar to those observed in cancers also occur in the SMC. Since mutations in the p53 tumour suppressor gene and the c-Ki-ras oncogene are the most common genetic alterations observed in a wide variety of tumour types, we searched for evidence of mutation in human atherosclerotic tissue. DNA was extracted from atherosclerotic plaques and screened for p53 and c-Ki-ras gene mutations using polymerase chain reaction-single strand conformation polymorphism analysis. Tissue sections were also examined for overexpression of p53 protein using an immunohistochemical technique. The molecular analysis showed that wild-type p53 and c-Ki-ms gene sequences were present in all 54 specimens examined. Overexpression of p53 protein was found in 61% of samples. Our results do not support the view that genetic alterations similar to those occurring in cancer contribute to the abnormal proliferation of SMC, although we caution that only two cancer-related genes were studied. Epigenetic changes to the gene products could play a role however, as evidenced by overexpression of p53 protein in many of the atherosclerotic specimens.

S.J. Wysocki

Papers

Overexpression of p53 protein is an independent prognostic indicator in human endometrial carcinoma

Influence of Thyroid Hormones on Enzyme Activities of Myelinating Rat Central‐Nervous Tissues

Monocyte chemoattractant protein-1 gene expression in injured pig artery coincides with early appearance of infiltrating monocyte/macrophages.

Detection of pS2 Messenger RNA in gynecological cancers

The p53 tumor-suppressor gene is overexpressed but not mutated in human atherosclerotic tissue.