High prevalence of CD44 and its ligand low molecular weight hyaluronan in plasma of HNSCC patients: clinical significance.

BACKGROUND: This study aims to evaluate the role of cancer stem cell marker, CD44, and its ligand HA as potential molecular biomarker for early detection of HNSCC. METHODS AND RESULTS: The expression profile (mRNA/Protein) of CD44 variants were analysed in primary HNSCC lesions and plasma of the patients. Then, prevalence of HA variants was analysed in plasma of the patients. The mRNA expression of CD44 variants, CD44S and CD44v3, were significantly high in both early (stage I/II) and late (stage III/IV) invasive lesions, with predominant expression of CD44v3 in the late-stage lesions. In plasma of HNSCC patients, increased levels of SolCD44, CD44-ICD and unique 62 KD CD44 variants with respect to standard CD44S were seen, in comparison to their prevalence in plasma of normal individuals. The abundance of CD44-ICD and 62 KD variants were significantly high in plasma of late stage HNSCC patients. Interestingly, significantly high level of low molecular weight HA(LMW HA) with respect to high molecular weight HA(HMW HA) was seen in plasma of HNSCC patients irrespective of clinical stages. On the contrary, high HMW HA level in plasma of normal individuals was seen. The high level of LMW HA in plasma of HNSCC patients might be due to combinatorial effect of increased mRNA expression of HA synthesizing enzyme HAS1/2/3 and HA degrading enzyme HYAL1/2, as seen in the primary HNSCC samples. CONCLUSION: Thus, our data revealed the importance of specific CD44 and HA variants in plasma of HNSCC patients during its development as potential non-invasive molecular biomarker of the disease.

Pectoralis Major Myofascial (PMMF) Flap as a Valuable Alternative to Microvascular Free Flaps (MFF) in Females with Advanced Oral Squamous Cell Carcinomas: A Retrospective Institutional Analysis.

India contributes 60% of HNC cases worldwide among which OSCC has become the most common cancer in males and second most common in females (NCRCR 2020). As most cases present in advanced stage, surgical excision followed by flap reconstruction becomes mandatory to achieve functionality. Due to various logistics and financial issues, microvascular free flap reconstruction is not feasible in every case. Also in females, reconstruction with PMMC is challenging as it violates normal breast contour. As an alternative, we have explored the affectivity of pectoralis major myofascial (PMMF) flaps. A retrospective analysis was undertaken only in female patients with advanced stage oral malignancies who underwent surgery between September 2021 and January 2023. Patients having cutaneous involvement or requiring local flap reconstruction were excluded. Total 43 female patients were included in the study. Among them 8 had Tongue carcinoma and 35 had Alveobuccal carcinoma. 24 patients underwent PMMF reconstruction, whereas 19 patients underwent MFF reconstruction. The complication rates were 12.1% (3 out of 24) in PMMF and 89.4% (17 out of 19 cases)in MFF. Among PMMF group, 1 major complication (death, unrelated to flap) and 2 minor complications (wound infection) occured. Among the MFF group, major complications were e.g. Flap failure requiring re-exploration surgery (n = 4), wound dehiscence (n = 2), bleeding/hematoma (n = 1), donor site complications (n = 6). The minor complications being wound infections (n = 4). The goals of reconstruction of defects in oral cavity cancers are mainly functional and cosmetic integrity. Although MFF's provide a wide range of options for reconstruction of complex defects, as per our study the PMMF flap was more reliable and had lesser complications. PMMF flap is an invaluable alternative to MFF's in female patients for both reconstruction and breast contour preservation.

Prevalence of novel gamma HPV types 223 and 225 in oral cavity and skin of Indian normal and neoplastic participants.

Gamma-papillomaviruses, though traditionally classified as cutaneotropic, actual tissue tropism is largely unexplored. This study aimed to evaluate the tissue-specific prevalence of two novel-HPV 223 and 225 in samples of oral mucosa and keratinized epithelium of varied skin parts from 226 female and male subjects, with or without neoplastic/dysplastic lesions in oral cavity or cervix. The gamma-human papillomavirus (gamma-HPV) 223 and 225 DNA presences were determined by polymerase chain reaction (PCR) ursing the HPV type-specific primers and confirmed by Sanger sequencing. Viral load in the HPV 223 and HPV 225 positive samples were determined by absolute real-time quantification method. Alpha-HPV DNA prevalence was also checked in oral mucosa to ascertain coinfection status. Novel HPV 223 was present in 4.4% (10/226) oral mucosal samples of the study population; interestingly all were females with no prevalence in their corresponding skin swab samples. Whereas, the prevalence of HPV 225 was found both in the skin and oral mucosa of 28.2% (N = 37/131) female and 17.9% (N = 17/95) male participants. Alongside, HPV 223 viral load was found to be significantly higher (p = 0.02 < 0.05) in the oral mucosa of diseased participants, whereas, HPV 225 viral load was higher in the oral mucosa of normal participants. Our results suggest that gamma-HPV 223 has its prevalence only in the oral mucosal epithelium, whereas, HPV 225 has its prevalence on both mucosal and keratinized skin epithelium, indicating its dual tropism nature.