title: Relation of erythropoietin and erythropoietin receptor expression to hypoxia and anemia in head and neck squamous cell carcinoma.
abstract: OBJECTIVE
  The use of erythropoietin in head and neck squamous cell carcinoma (HNSCC) has been associated with poor survival. This study examines the protein and mRNA expression of erythropoietin and erythropoietin receptor in HNSCC and their relation to hypoxia, hemoglobin (Hb), and clinical outcome.
  
  
  METHODS
  The immunohistochemical expression of erythropoietin and erythropoietin receptor was assessed in 151 cases of HNSCC. Expression was compared with the hypoxia-dependent proteins hypoxia-inducible factor-1alpha (HIF-1alpha) and carbonic anhydrase-9 (CA-9) and correlated with clinical outcome. The mRNA expression of erythropoietin and erythropoietin receptor was measured in paired samples of HNSCC.
  
  
  RESULTS
  Erythropoietin and erythropoietin receptor were expressed in 95% and 99% of tumors, respectively. Using a weighed expression score, there was a positive correlation between erythropoietin and erythropoietin receptor expression (r = 0.18, P = 0.03). HIF-1alpha (r = 0.38, P < 0.01) and CA-9 (r = 0.26, P = 0.002) correlated with erythropoietin expression, but there was no correlation with erythropoietin receptor. No correlation was found between Hb and erythropoietin (r = 0.07, P = 0.36) or erythropoietin receptor (r = -0.02, P = 0.8), and no survival difference between high and low erythropoietin or erythropoietin receptor expression (P = 0.59 and P = 0.98, respectively). The mRNA expression of erythropoietin (P = 0.03) but not erythropoietin receptor (P = 0.62) was significantly increased in 11 paired samples of HNSCC.
  
  
  CONCLUSIONS
  In vivo, the HIF pathway regulates erythropoietin at the mRNA level but not erythropoietin receptor expression in HNSCC. Anemia does not seem to influence the hypoxic microenvironment of tumors sufficiently to alter the expression of erythropoietin. The effects of exogenous erythropoietin may be acting via receptors expressed on tumor cells in vivo, or on vascular cells, which also express the pathway.
authors.affiliation: Cancer Research UK Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford.
authors.forename: Stuart C
authors.initials: SC
authors.lastname: Winter
authors.forename: Ketan A
authors.initials: KA
authors.lastname: Shah
authors.forename: Leticia
authors.initials: L
authors.lastname: Campo
authors.forename: Helen
authors.initials: H
authors.lastname: Turley
authors.forename: Russell
authors.initials: R
authors.lastname: Leek
authors.forename: Rogan J
authors.initials: RJ
authors.lastname: Corbridge
authors.forename: Graham J
authors.initials: GJ
authors.lastname: Cox
authors.forename: Adrian L
authors.initials: AL
authors.lastname: Harris
mesh_terms: D000740:Anemia; D000951:Antigens, Neoplasm / Q000096:biosynthesis; D000071231:Carbonic Anhydrase IX; D002256:Carbonic Anhydrases / Q000096:biosynthesis; D002294:Carcinoma, Squamous Cell / Q000378:metabolism*; D003593:Cytoplasm / Q000378:metabolism; D018076:DNA, Complementary / Q000378:metabolism; D018572:Disease-Free Survival; D004921:Erythropoietin / Q000096:biosynthesis*; D005260:Female; D005500:Follow-Up Studies; D015972:Gene Expression Regulation, Neoplastic; D006258:Head and Neck Neoplasms / Q000378:metabolism*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D000860:Hypoxia; D007150:Immunohistochemistry; D008297:Male; D040081:Protein Array Analysis; D012313:RNA / Q000737:chemistry / Q000378:metabolism; D012333:RNA, Messenger / Q000378:metabolism; D017467:Receptors, Erythropoietin / Q000096:biosynthesis*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014158:Transcription, Genetic; D016896:Treatment Outcome
chemical_list: D000951:Antigens, Neoplasm; D018076:DNA, Complementary; D006454:Hemoglobins; D012333:RNA, Messenger; D017467:Receptors, Erythropoietin; D004921:Erythropoietin; D012313:RNA; C089226:CA9 protein, human; D000071231:Carbonic Anhydrase IX; D002256:Carbonic Anhydrases