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BNIP3 expression in endometrial cancer relates to active hypoxia inducible factor 1á pathway and prognosis
  1. Alexandra Giatromanolaki (targ{at}
  1. Democritus University of Thrace, Greece
    1. Michael I. Koukourakis (agiatrom{at}
    1. Democritus University of Thrace, Greece
      1. Kevin C. Gatter (kevin.gatter{at}
      1. University of Oxford, United Kingdom
        1. Adrian L. Harris (harrisa{at}
        1. University of Oxford, United Kingdom
          1. Efthimios Sivridis (esivrid{at}
          1. Democritus University of Thrace, Greece


            Aims: BNIP3 is a pro-apoptotic mitochondrial protein induced under hypoxic stress with the BNIP3 gene being under direct regulation of the hypoxia inducible HIF1á transcription factor. Induction of BNIP3 leads to caspase-independent necrosis-like cell death and an aggressive tumor phenotype. We examined the role of BNIP3 in endometiral cancer.

            Methods: The immunohistochemical patterns of BNIP3 expression in 72 early endometrial adenocarcinomas of the endometrioid cell type were studied. Correlation of BNIP3 with the hypoxia inducible factor HIF1á-pathway and with prognosis was also examined.

            Results: BNIP3 was strongly and extensively expressed in the cytoplasm of cancer cells in 23/72 (31.9%) cases. This high BNIP3 reactivity was not related to histological grade, the depth of myometrial invasion or steroid hormone receptor expression. There was, however, a significant association of BNIP3 reactivity with HIF1á (p=0.05), VEGF (p=0.05) and, particularly, LDH-5 expression (p<0.0001). Furthermore, high BNIP3 was associated with poor survival in both univariate and multivariate models.

            Conclusion: BNIP3 seems to be an important hypoxia-regulated molecule involved in endometrial cancer pathology. Given that high BNIP3 reactivity, being linked with poor post-operative outcome, has been linked with a favourable response to cytotoxic therapy (as previously indicated in experimental studies), high BNIP3 expression may be an indicator for adjuvant chemo-radiotherapy in stage I endometrial carcinomas.

            • BNIP3
            • HIF1á
            • LDH
            • endometrial cancer
            • hypoxia

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