doi:10.1016/j.yexmp.2006.08.002
Copyright © 2006 Elsevier Inc. All rights reserved.
In situ detection of global DNA hypomethylation in exfoliative urine cytology of patients with suspected bladder cancer
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Hans-Helge Seiferta,
,
, Viola Schmiemannb, Mirko Muellera, Marietta Kazimirekb, Fabiana Onofreb, Anne Neuhausena, Andrea R. Florla, Rolf Ackermanna, Alfred Boeckingb, Wolfgang A. Schulza and Hans Juergen Groteb
aDepartment of Urology, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany
bInstitute of Cytopathology, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany
Received 20 May 2006;
revised 4 August 2006.
Available online 5 October 2006.
Abstract
Global DNA hypomethylation is a common phenomenon in bladder cancer. Therefore we investigated whether it is possible to detect and assess global DNA hypomethylation in bladder cancer using a specific monoclonal antibody for 5-methyl-cytosine. Cytospins from exfoliative urine cytology specimens of patients with bladder cancer or a history of bladder cancer, control patients with benign urological diseases and of young healthy volunteers were analyzed.
Urothelial carcinoma (UC) cells showed various degrees of nuclear destaining indicating global DNA hypomethylation whereas all specimens from healthy volunteers showed granular nuclear staining indicating regular methylation of repeated DNA sequences. Lowest 5-methylcytosine immunostaining scores were observed in carcinoma cells and a statistically significant difference was observed between urothelial cells of healthy controls or patients with benign disease compared to bladder cancer patients (p < 0.01, p < 0.05, respectively). In UC cases even morphologically normal urothelial cells often displayed evident hypomethylation. Likewise, in patients with a history of UC, but no cystoscopic evidence of recurrence, morphologically non-malignant urothelial cells presented with some degree of demethylation.
Our results strongly support the hypothesis of early global demethylation in bladder cancer. Immunocytochemical staining with the 5-methylcytosine antibody allows simultaneous individual assessment of nuclear morphology and methylation status of a given sample.
Keywords: Hypomethylation; Bladder cancer; Cytological detection; 5-methyl-cytosine
Fig. 1. Southern blot analysis of LINE-1 hypomethylation in bladder cancer cell lines. DNA isolated from leukocytes (left) was used as control. H: HpaII digestion; M: MspI digestion. Hypomethylation is detectable by the appearance of bands in the 1.4–3.5 kb range in the H lane. Results of densitometric quantification are depicted at the bottom of the figure.
Fig. 2. Cell cultures of urothelial carcinomas showing heterogenous and patchy nuclear staining with 5-mc antibody (original magnification × 400). (A) HT1376. A considerable portion of the cells is hypomethylated with granular staining pattern (in this picture staining score 2.3) (B) T24. Cells display mostly a stronger staining intensity compared to HT1376 (in this picture staining score 2.8).
Fig. 3. Urine samples of healthy controls demonstrating strong nuclear staining with 5-mc antibody (original magnification × 630). (A) Squamous cells with a homogenous fine granular staining pattern. (B) Basal transitional cell with dense nuclear staining. (C) Intermediate urothelial cells with a fine granular staining pattern comparable to that of squamous cells.
Fig. 4. Urine samples of two different patients (A + B) with urothelial carcinoma stained with 5-mc antibody (original magnification × 630). Cells of urothelial carcinoma (large arrows) display various degrees of destaining and often a patchy staining pattern. Compare to the strong homogenous staining of adjacent neutrophils (small arrows).
Fig. 5. Comparison of mean 5-mc immunostaining scores with 95%-confidence intervals in different groups, uninvolved epithelia and tumor cells. Hx: History.
Fig. 6. Comparison of methylation scores in tumor cells and matched uninvolved urothelial cells of individual patients. Each line displays the relationship between the methylation scores in the urothelial carcinoma and its paired normal epithelium.
Table 1.
Clinicopathological characteristics and 5-mc immunostaining scores of patients with urothelial carcinoma of the bladder

nd = not done (urine sample without cancer cells).
Table 2.
5-mc immunostaining scores in healthy controls, patients with benign disease of the bladder, patients with histologically confirmed urothelial carcinoma and patients with history of urothelial carcinoma but no evidence of recurrence


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