title: Proliferation and hypoxia in human squamous cell carcinoma of the cervix: first report of combined immunohistochemical assays.
abstract: OBJECTIVE
  To characterize the distribution of hypoxia and proliferation in human squamous cell carcinoma of the cervix via an immunohistochemical approach prior to initiation of therapy.
  
  
  METHODS
  Patients with primary squamous cell carcinoma of the cervix uteri received a single infusion of the 2-nitroimidazole, pimonidazole (0.5 g/m2 i.v.), and 24 h later punch biopsies of the primary tumor were taken. Tissue was formalin fixed, paraffin embedded, and sectioned for immunohistochemistry. Hypoxia was detected by monoclonal antibody binding to adducts of reductively activated pimonidazole in malignant cells. Staining for endogenous MIB-1 and PCNA was detected in tumor cells via commercially available monoclonal antibodies. Point counting was used to quantitate the fraction of tumor cells immunostained for MIB-1, PCNA, and hypoxia marker binding.
  
  
  RESULTS
  Immunostaining for pimonidazole binding was distant from blood vessels. There was no staining in necrotic regions, and only minimal nonspecific staining, mostly in keratin. In general, cells immunostaining for MIB-1 and PCNA did not immunostain for pimonidazole binding. Cells immunostaining for MIB-1 and PCNA showed no obvious geographic predilection such as proximity to vasculature. Quantitative comparison showed an inverse relationship between hypoxia marker binding and proliferation.
  
  
  CONCLUSIONS
  Immunohistochemical staining for pimonidazole binding is consistent with the presence of hypoxic cells in human tumors and may be useful for estimating tumor hypoxia prior to radiation therapy. Immunostaining for pimonidazole binding is an ideal complement to immunohistochemical assays for endogenous proliferation markers allowing for comparisons of tumor hypoxia with other physiological parameters. These parameters might be used to select patients for radiation protocols specifically designed to offset the negative impact of hypoxia and/or proliferation on therapy. The inverse relationship between pimonidazole binding and proliferation markers is a preliminary result requiring verification.
authors.affiliation: Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill 27599-7512, USA.
authors.forename: A S
authors.initials: AS
authors.lastname: Kennedy
authors.forename: J A
authors.initials: JA
authors.lastname: Raleigh
authors.forename: G M
authors.initials: GM
authors.lastname: Perez
authors.forename: D P
authors.initials: DP
authors.lastname: Calkins
authors.forename: D E
authors.initials: DE
authors.lastname: Thrall
authors.forename: D B
authors.initials: DB
authors.lastname: Novotny
authors.forename: M A
authors.initials: MA
authors.lastname: Varia
mesh_terms: D000328:Adult; D034961:Antigens, Nuclear; D015415:Biomarkers; D002294:Carcinoma, Squamous Cell / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology*; D002455:Cell Division; D015687:Cell Hypoxia / Q000502:physiology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen; D009593:Nitroimidazoles / Q000378:metabolism*; D009687:Nuclear Proteins / Q000378:metabolism*; D018809:Proliferating Cell Nuclear Antigen / Q000378:metabolism*; D011838:Radiation-Sensitizing Agents / Q000378:metabolism*; D002583:Uterine Cervical Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology*
chemical_list: D034961:Antigens, Nuclear; D015415:Biomarkers; D019394:Ki-67 Antigen; D009593:Nitroimidazoles; D009687:Nuclear Proteins; D018809:Proliferating Cell Nuclear Antigen; D011838:Radiation-Sensitizing Agents; C033815:pimonidazole