title: Low apoptotic index & bak expression in EBV-associated childhood classical Hodgkin lymphoma.
abstract: OBJECTIVE
  Association of Epstein-Barr virus (EBV) with Hodgkin lymphoma (HL) is particularly high in low-income countries, and resistance to apoptosis might play a role in pathogenesis and survival. Data from previous studies are not consistent, and none is available in children. Thus this study was undertaken on Indian children with classical Hodgkin lymphoma to assess the significance of bcl-2, bak and p53 expression, and apoptotic index in relation with EBV status and treatment outcome with chemotherapy alone.
  
  
  METHODS
  Children (age<15 yr) with classical HL (n=143) were included in the study. Bcl-2, bak, p53, Ki67 and latent membrane protein-1 (LMP1) were detected by immunohistochemistry in pre-treatment lymph node biopsies. Apoptotic index was assessed by TdT-dUTP nick-end labelling (TUNEL).
  
  
  RESULTS
  Bcl-2, bak, p53 were expressed above positivity threshold in 83.3, 94.0 and 7.1 per cent of the cases respectively. More than 10 per cent of apoptotic tumour cells were seen in 60.4 per cent of the cases. 131 (91.6%) cases were EBV associated. EBV-positive cases had a significantly lower mean bak expression (p=0.001) and a lower apoptotic index, without higher proliferation index. Advanced stage showed a borderline association with bcl-2 expression in >25 per cent of tumour cells and p53 negative tumours. In univariate analysis, p53 positive cases, which were significantly associated with B symptoms, had a poorer overall survival (P=0.03) while low proliferation index was associated with poorer failure-free survival. Neither EBV status nor any of the apoptotic parameters studied showed independent association with survival.
  
  
  CONCLUSIONS
  EBV detection in children with classical Hodgkin lymphoma was associated with significant lower bak expression and with lower spontaneous apoptosis of H-RS cells suggesting that EBV-LMP1 might downregulate bak pro-apoptotic protein. this needs to be substantiated further.
authors.affiliation: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. verodinand@fastem.com
authors.forename: Veronique
authors.initials: V
authors.lastname: Dinand
authors.forename: Ajay
authors.initials: A
authors.lastname: Malik
authors.forename: Binimaya
authors.initials: B
authors.lastname: Mohanty
authors.forename: Bal
authors.initials: B
authors.lastname: Chander
authors.forename: Laxman S
authors.initials: LS
authors.lastname: Arya
authors.forename: Ramesh
authors.initials: R
authors.lastname: Dawar
mesh_terms: D000293:Adolescent; D017209:Apoptosis; D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006689:Hodgkin Disease / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007194:India; D008297:Male; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000378:metabolism; D012189:Retrospective Studies; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism; D050998:bcl-2 Homologous Antagonist-Killer Protein / Q000378:metabolism
chemical_list: C494772:BAK1 protein, human; D019253:Proto-Oncogene Proteins c-bcl-2; C495901:TP53 protein, human; D016159:Tumor Suppressor Protein p53; D050998:bcl-2 Homologous Antagonist-Killer Protein