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Blood group antigens in normal and neoplastic urothelium
Author(s) -
Sheinfeld Joel,
Reuter Victor E.,
Sarkis Alvaro S.,
CordonCardo Carlos
Publication year - 1992
Publication title -
journal of cellular biochemistry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.028
H-Index - 165
eISSN - 1097-4644
pISSN - 0730-2312
DOI - 10.1002/jcb.240501311
Subject(s) - urothelium , abo blood group system , antigen , immunohistochemistry , bladder cancer , population , urothelial cell , pathology , biology , transitional cell carcinoma , urinary bladder , immunology , microbiology and biotechnology , cancer , medicine , genetics , environmental health
The ABO and Lewis blood group antigens are cell surface carbohydrate determinants formed by the sequential addition of saccharides to precursor backbone structures of membrane lipids and proteins. Suppression of normally active glycosyltransferases results in the absence of antigens that are normally expressed. ABH antigen deletion in malignant and premalignant urothelium has been extensively evaluated; it appears to correlate with significantly higher rates of tumor recurrence and disease progression. However, we have recently shown that the ABH blood group system is differentially expressed in the normal urothelium of secretors in contrast to nonsecretor individuals. The normal urothelium of nonsecretors does not express A, B or H determinants; therefore, deletion of ABH antigens can only be ascertained in secretor individuals. Although nonsecretors only comprise 22–24% of the population, this observation mandates a reevaluation of earlier studies. Deletion of A, B or H antigens is noted in carcinoma in situ (CIS), and in invasive and metastatic transitional cell carcinoma (TCC) of secretor individuals. Increased synthesis or activation of normally quiescent glycosyltransferases in bladder tumors can result in the expression of aberrant tumor‐associated blood group antigens. Immunohistochemical analysis has demonstrated that Lewis X (Le x ) is not detected in normal adult urothelium except for occasional umbrella cells. However, papillomas, CIS and TCC expressed Le x in 84% of cases, regardless of grade, stage, blood type or secretor status of the individual. The presence of Le x positive cells in bladder lavage specimens enhanced the detection of urothelial tumor cells, correctly identifying bladder tumors in 253/293 (86%) cases compared to a 63% sensitivity for cytology alone. The specificity of Le x immunocytology was 87%; 57 of 65 control subjects were negative for the Le x antigen. Furthermore, the detection of the Le x antigen in exfoliated bladder cells is a useful marker for predicting bladder tumor relapse in high risk, disease‐free patients. All 17 Le x ‐positive patients recurred with clinical evidence of disease between 2 and 33 months (mean 8.4 month), while only 8 of 39 Le x ‐negative patients recurred; 31 patients remain NED (2–40 months, mean 16.2 months). © 1992 Wiley‐Liss, Inc.