TY - JOUR
T1 - Characterization of cervical biopsies of women with HIV and HPV co-infection using p16ink4a, ki-67 and HPV E4 immunohistochemistry and DNA methylation
AU - Kremer, Wieke W.
AU - Vink, Frederique J.
AU - van Zummeren, Marjolein
AU - Dreyer, Greta
AU - Rozendaal, Lawrence
AU - Doorbar, John
AU - Bleeker, Maaike C.G.
AU - Meijer, Chris J.L.M.
N1 - Funding Information: Acknowledgements We gratefully acknowledge all the women participating in the described study. We are grateful for the active cooperation of the teams of the outpatient department of Obstetrics and Gynecology of the Steve Biko Academic Hospital and the HIV clinic at the Tshwane District Hospital. CJLMM was in part supported by European Research Council; Grant number: ERC-AdG-2012_322986_MASSCARE. Publisher Copyright: © 2020, The Author(s), under exclusive licence to United States & Canadian Academy of Pathology.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - This study aims to characterize cervical intraepithelial neoplasia (CIN) in women living with HIV using biomarkers. Immunohistochemical (IHC) staining for human papillomavirus (HPV) E4 protein indicates CIN with productive HPV infection, whereas Ki-67 and p16ink4a indicate CIN with transforming characteristics, which may be further characterized using DNA hypermethylation, indicative for advanced transforming CIN. Cervical biopsies (n = 175) from 102 HPV positive women living with HIV were independently reviewed by three expert pathologists. The consensus CIN grade was used as reference standard. IHC staining patterns were scored for Ki-67 (0–3), p16ink4a (0–3), and E4 (0–2) and correlated to methylation levels of four cellular genes in corresponding cervical scrapes. Reference standards and immunoscores were obtained from 165 biopsies:15 no dysplasia, 91 CIN1, 31 CIN2, and 28 CIN3. Ki-67 and p16ink4a scores increased with increasing CIN grade, while E4 positivity was highest in CIN1 and CIN2 lesions. E4 positive CIN1 lesions had higher Ki-67 and p16ink4a scores and higher methylation levels compared with E4 negative CIN1 lesions. E4 positive biopsies with low cumulative Ki-67/p16 ink4a immunoscores (0-3) had significantly higher methylation levels compared with E4 negative biopsies. No significant differences in Ki-67 and p16ink4a scores and methylation levels were observed between E4 negative and positive CIN2 or CIN3 lesions. The presence of high methylation levels in scrapes of CIN lesions with IHC characteristics of both productive (E4 positive) and transforming infections (increased Ki-67/p16ink4a expression) in women living with HIV might indicate a rapid aggressive course of HPV infections towards cancer in these women.
AB - This study aims to characterize cervical intraepithelial neoplasia (CIN) in women living with HIV using biomarkers. Immunohistochemical (IHC) staining for human papillomavirus (HPV) E4 protein indicates CIN with productive HPV infection, whereas Ki-67 and p16ink4a indicate CIN with transforming characteristics, which may be further characterized using DNA hypermethylation, indicative for advanced transforming CIN. Cervical biopsies (n = 175) from 102 HPV positive women living with HIV were independently reviewed by three expert pathologists. The consensus CIN grade was used as reference standard. IHC staining patterns were scored for Ki-67 (0–3), p16ink4a (0–3), and E4 (0–2) and correlated to methylation levels of four cellular genes in corresponding cervical scrapes. Reference standards and immunoscores were obtained from 165 biopsies:15 no dysplasia, 91 CIN1, 31 CIN2, and 28 CIN3. Ki-67 and p16ink4a scores increased with increasing CIN grade, while E4 positivity was highest in CIN1 and CIN2 lesions. E4 positive CIN1 lesions had higher Ki-67 and p16ink4a scores and higher methylation levels compared with E4 negative CIN1 lesions. E4 positive biopsies with low cumulative Ki-67/p16 ink4a immunoscores (0-3) had significantly higher methylation levels compared with E4 negative biopsies. No significant differences in Ki-67 and p16ink4a scores and methylation levels were observed between E4 negative and positive CIN2 or CIN3 lesions. The presence of high methylation levels in scrapes of CIN lesions with IHC characteristics of both productive (E4 positive) and transforming infections (increased Ki-67/p16ink4a expression) in women living with HIV might indicate a rapid aggressive course of HPV infections towards cancer in these women.
KW - Adult
KW - Biomarkers, Tumor/analysis
KW - Biopsy
KW - Cervical Intraepithelial Neoplasia/pathology
KW - Coinfection
KW - Cyclin-Dependent Kinase Inhibitor p16/analysis
KW - DNA Methylation
KW - Female
KW - HIV Infections/complications
KW - Humans
KW - Immunohistochemistry
KW - Ki-67 Antigen/analysis
KW - Middle Aged
KW - Neoplasm Grading/methods
KW - Oncogene Proteins, Viral/analysis
KW - Papillomavirus Infections/complications
KW - Uterine Cervical Neoplasms/pathology
UR - http://www.scopus.com/inward/record.url?scp=85083158169&partnerID=8YFLogxK
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85083158169&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/32249820
U2 - https://doi.org/10.1038/s41379-020-0528-x
DO - https://doi.org/10.1038/s41379-020-0528-x
M3 - Article
C2 - 32249820
SN - 0893-3952
VL - 33
SP - 1968
EP - 1978
JO - Modern Pathology
JF - Modern Pathology
IS - 10
ER -