ANÁLISE DA ALTERAÇÃO DO NÚMERO DE CÓPIAS DE GENES ENVOLVIDOS NA VIA DE SINALIZAÇÃO CELULAR EGFR/PI3K/AKT/PTEN EM CÂNCER PENIANO.

Abstract

Penile cancer (PeCa) is a rare neoplasm in developed countries; however, its incidence is high in underdeveloped countries. In Brazil, regions North and Northeast are those with the higher number of cases for the disease. Among the factors associated with this neoplasm we highlight: poor hygiene, phimosis, chronic inflammation and infection by human papilloma virus (HPV). Changes in the PI3K/AKT/PTEN cell signaling pathway have been reported for several malign neoplasms, but little is known about the involvement of this pathway in penile tumors. Thus, the aim of this study was to verify the role of HPV infection and the occurrence of copy number alterations (CNA) in genes from the signaling pathway mediated by receptors of growth factors and PI3K in a population characterized by advanced tumors and high frequency of high risk HPV. To achieve that, we collected tumor tissue samples (both fresh and in formalin-fixed paraffin-embedded tissue-FFPE) from 34 patients from two reference hospitals: Instituto Maranhense de Oncologia Aldenora Belo (IMOAB) and the Hospital Universitário Presidente Dutra from the Universidade Federal do Maranhão (HU-UFMA). Fresh tumors were submitted to detection and genotyping of HPV by Nested PCR (Polymerase Chain Reaction) and direct sequencing. CNA analyzes were carried out in FFPE tissue from a subgroup HPV positive (91.2%), of which 88.2% were at high oncogenic risk. TaqMan® Copy Number Assays (Life TechnologiesTM) and CopyCaller software version v2.0 were performed to determine copy number for EGFR, HER3, HER4, AKT1, AKT2, PI3KCA and PTEN. Increase of 3 and 4 copies was considered gains, while increase of 5 or more copies was considered amplifications. The presence of a single gene copy was referred to as loss, while the absence of two copies was named deletion. Clinical and histopathological parameters were analyzed as to the presence of HPV and to CNAs. Our data showed that EGFR/PI3K/AKT/PTEN signaling pathway is highly altered in PeCa. The results showed that 100% of the tumors presented an increase of the number of copies for HER3; out of those, 93.9% were amplified, with 84.4% having 10 or more copies. EGFR also showed an increase of copies in 87.8% of tumor samples, out of which 65.6% were amplifications, with 48.2% having more than 10 copies. Furthermore, HER4 and AKT1 also presented an increase in the number of copies of 20.6% and 15%, respectively. AKT1 had a higher frequency of tumors with a regular number of copies (78.8%). On the other hand, PI3KCA, HER4, PTEN and AKT2 presented a higher frequency of samples with deletions, presenting 56%, 52.9%, 39% and 36%, respectively. Loss of copies was also frequent on tumors, so that genes AKT2, PTEN and PI3KCA appeared in heterozygosis in 60.6%, 54.5% and 37.5%, respectively. Our data show the occurrence of genetic alterations that may justify the differential expression of growth factor receptors and the downstream genes of the PI3K/ AKT pathway in penile carcinoma. However, in this study there was no association between CNAs and clinical and histopathological variables. On the other hand, taking into consideration the high frequency of HPV in the evaluated tumors, we suggest that CNAs are related to HPV integration into genome host. Finally, we highlight the high frequency of tumors with amplifications in HER3 and EGFR, reinforcing these markers as targets for specific therapies in CaPe.