Fluctuations of epstein-barr virus serological antibodies and risk for nasopharyngeal carcinoma: a prospective screening study with a 20-year follow-up

Background

The impact of variation of Epstein-Barr virus (EBV) antibody titers before the development of nasopharyngeal carcinoma (NPC) is still unclear. We analyzed the fluctuations of antibodies against EBV before histopathological diagnosis to assess the risk of NPC and aimed to provide a reliable basis for screening in high risk populations.

Methods

This study was based on a population-based screening program in Sihui County in Guangdong Province of China. A total of 18,986 subjects were recruited in 1987 and 1992, respectively. Baseline and repeated serological tests were performed for IgA antibodies against EBV capsid antigen (VCA/IgA) and early antigen (EA/IgA). Follow-up until the end of 2007 was accomplished through linkage with population and health registers. Cox proportional hazards regression model was used to estimate the relative risk of NPC in association with EBV antibodies. Time-dependent receiver operating characteristic curve (ROC) analysis was used to further evaluate the predictive ability.

Results

A total of 125 NPCs occurred during an average of 16.9 years of follow-up. Using baseline information alone or together with repeated measurements, serological levels of VCA/IgA and EA/IgA were significantly associated with increased risks for NPC, with a striking dose-response relationship and most prominent during the first 5 years of follow-up. Considering the fluctuant types of serological titers observed during the first three tests, relative risk was highest among participants with ascending titers of EBV VCA/IgA antibodies with an adjusted hazard ratio (HR) of 21.3 (95% confidence interval [CI] 7.1 to 64.1), and lowest for those with decreasing titers (HR = 1.5, 95% CI 0.2 to 11.4), during the first 5 years of follow-up. Time-dependent ROC analysis showed that VCA/IgA had better predictive performance for NPC incidence than EA/IgA.

Conclusion

Our study documents that elevated EBV antibodies, particularly with ascending titers, are strongly associated with an increased risk for NPC.     

Serological follow-up study on the antibody levels to Epstein-Barr virus-determined nuclear antigen (EBNA) patients with nasopharyngeal carcinoma (NPC) after radiation therapy

Serological follow-up studies for up to 4 years on the levels of IgG antibody to EBV-determined nuclear antigen (EBNA) were carried out on 36 patients with nasopharyngeal carcinoma (NPC). The serum levels of IgA antibody specific to EBV capsid antigen (VCA) were also measured in some of the patients. The titers of EBNA antibody were measured by enzyme-linked immunosorbent assay (ELISA) and those of IgA antibody to VCA were measured by the indirect immunofluorescence method. The EBNA antibody titers in most sera from the patients before radiation therapy were found to be at least 4 times the mean values in the sera of healthy control adults. Within 2 to 8 months after completion of therapy by 4-MV liniac X-ray irradiation with total doses of 60 to 80 Gy, the titers of EBNA antibody in the sera of 6 patients had returned to normal levels, and low levels of EBNA antibody were maintained for a long time after therapy. These serological data were associated with a good clinical prognosis without recurrence or metastases. But in 6 patients, the patterns of change in the EBNA antibody levels were different: the levels remained high after therapy or first decreased to the normal level and then rose to at least 4 times this level. These 6 patients showed recurrence or metastases. The patterns of change in the EBNA antibody levels were well correlated with those of change in the levels of IgA antibody specific to VCA.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical and immunological effect of intravesical interleukin-2 on superficial bladder cancer

TheBamHI Z EBV replication activator (ZEBRA) protein is involved in the switch from latency to productive cycle of Epstein-Barr virus. A recombinant ZEBRA protein was synthesized and assessed in enzymelinked immunosorbent assay (ELISA) for serum IgG response in nasopharyngeal carcinoma (NPC) patients. In 100 NPC serum samples that were positive for IgA to the EBV viral capsid antigen (VCA), 75% had IgG anti-ZEBRA antibodies. In contrast, only 3/83 (3.6%) serum samples from healthy donors and 2/50 (4%) from other cancers were positive for IgG to ZEBRA. Interestingly, in a selected group of 100 NPC sera negative for IgA to VCA, 25% contained IgG anti-ZEBRA antibodies. This suggests that the ELISA for IgG anti-ZEBRA may also identify earlier cases of NPC not detected by the conventional immunofluorescence test for IgA to VCA.     

用PO4细胞为靶细胞检测人血清中Epstein-Barr病毒IgA/MA抗体以诊断鼻咽癌

近年来,常用未经丙酮固定的、由丁酸和巴豆油激活的B95-8细胞或P3HR-1细胞为靶细胞,检测人血清中EB病毒IgA/MA抗体以早期诊断鼻咽癌,效果良好。但由于B95-8细胞含有多种EB病毒抗原,不能用丙酮固定,需多次离心沉淀,在浮悬状态下检测,技术比较复杂。     

用重组Epstein-Barr病毒早期蛋白P83为抗原检测鼻咽癌病人血清中IgA抗体

以重组EB病毒早期蛋白P83为抗原,用Western blot检测了135份鼻咽癌病人和100份正常人血清中IgA/P83抗体,阳性率分别为96％和0,以常规的间接免疫酶法检测这两种血清中IgA/EA抗体,阳性率分别为71％和0。IgA/P83抗体的几何平均滴度较IgA/EA高4倍以上。这表明,用Western blot查IgA/P83敏感、特异,可替代用间接免疫酶法查IgA/EA用于鼻咽癌的早期诊断。     

Nasopharyngeal carcinoma patients from Norway show elevated Epstein-Barr virus IgA and IgG antibodies prior to diagnosis

BackgroundIgA antibodies against few Epstein-Barr virus (EBV) proteins are established serological markers for nasopharyngeal carcinoma (NPC). We recently validated a novel, comprehensive EBV marker panel and showed that IgA, but also IgG antibodies against multiple EBV proteins are highly sensitive and specific for EBV-positive NPC at diagnosis. However, data about these novel biomarkers as prospective markers for NPC are sparse.MethodsThis study included 30 incident NPC cases and 60 matched controls from the Norwegian Janus Serum Bank. For 21 NPCs, molecular EBV and human papillomavirus (HPV) status were assessed by EBER-ISH and HPV DNA/RNA testing by PCR, respectively. IgA and IgG serum antibodies against 17 EBV antigens were analyzed in prediagnostic sera of cases (median lead time 14 years) and controls using multiplex serology. Sensitivities were calculated using receiver operating characteristic analysis pre-specified to yield 90% specificity in the control group. From 10 cases, serial samples were available.ResultsQuantitative EBV antibody levels were significantly elevated among all cases (p < 0.05) for three IgA and six IgG antibodies. The highest sensitivities for defining 12 EBER-ISH-positive NPCs were observed for BGLF2 IgA (67%) and BGLF2 IgG (83%). Increased IgA and IgG antibody levels between the first and last draw before diagnosis were observed for EBER-ISH positive, but not for EBER-ISH negative NPCs. Among 21 molecularly analyzed NPCs, 4 EBER-ISH negative NPCs showed concomitant positivity to HPV type-specific DNA and RNA; 3 NPCs were HPV16 and 1 NPC was HPV18 positive.ConclusionBoth, EBV IgA and IgG antibody levels are significantly elevated many years before diagnosis of EBV-positive NPCs in Norway, an NPC low-incidence region. This study provides insights into one of the largest available prospective sample collections of NPCs in a non-endemic country.     

鼻咽癌患者血清中抗Epstein-Barr病毒早期和晚期膜抗原抗体的检测

对Epstein-Barr(EB)病毒抗原的研究,发现有淋巴细胞确定的膜抗原(Lydma)、早期抗原(EA)、壳抗原(VCA)、核抗原(EBNA)、早期膜抗原(EMA)和晚期膜抗原(LMA)。除了Lydma抗原外,鼻咽癌患者对上述抗原均产生相应的IgG和IgA抗体。因而研究这些抗体,对阐明EB病毒与鼻咽癌的关系及鼻咽癌的早期诊断都十分有价值。     

4号染色体短臂微卫星多态性与鼻咽癌相关性的研究

鼻咽癌（NPC）是一种多因素复杂疾病。其发病过程涉及EB病毒慢性感染、环境致癌因素及宿主基因之间的相互作用。在这一过程中,那些宿主基因在EB病毒感染及鼻咽癌的发生发展中起了关键作用仍不清楚。 本研究的目的是发现与鼻咽癌发生发展中两个关键步骤相关的遗传变异,即EB病毒持续性感染鼻咽部上皮细胞和鼻咽癌的形成。我们在广西梧州市及苍梧县鼻咽癌高发区收集汉族鼻咽癌患者350例、EB病毒壳抗原IgA抗体阳性者(IgA/VCA+)288例和EB病毒壳抗原IgA抗体阴性者(IgA/VCA-)346例。对先前鼻咽癌家系研究显示的鼻咽癌易感区4号染色体短臂（4p15.1-q12）进行了微卫星精细扫描,在 18 Mb的范围内选择34个微卫星标记,包括319个等位基因,对其进行基因分型。比较分析NPC 组和IgA/VCA+组等位基因频率结果显示,9个等位基因与鼻咽癌呈相关,其中5个为易感等位基因（OR=1.51-5.36, p=0.01-0.03）,4个为限制性等位基因（OR值为0.3-0.71, p值为0.02-0.045）。比较分析IgA/VCA+组和IgA/VCA-组及比较所有IgA/VCA+者（包括NPC患者）和IgA/VCA-者等位基因频率的结果显示,12个等位基因与EB病毒壳抗原IgA抗体持续存在相关,其中3个在两组比较中均呈显著相关。等位基因 D4S3241-136 (p=0.004, OR=1.9, 95%CI=1.2-3.0) 和D4S3347-213 (p=0.001, OR=1.6, 95%CI=1.2-2.1) 可增加EB病毒 IgA/VCA抗体形成的危险,为易感基因;而等位基因D4S174-202 (p=0.001, OR=0.5, 95%CI=0.3-0.7) 可限制IgA/VCA抗体的形成。 但上述结果经多因素比较校正后,均失去相关性。我们的研究结果不能 确定该区域与鼻咽癌的形成相关,而另一个家系研究的结果也未得出相关的结果,但本研究却提供了进一步发现鼻咽癌相关基因的研究模式。有关4号染色体短臂 与EB病毒慢性持续感染及鼻咽癌的形成仍值得进一步深入研究。     

The Chinese epidemiological approach of nasopharyngeal carcinoma research and control

Nasopharyngeal carcinoma (NPC), the major cancer killer in Cantonese Chinese, represents one of the three cancer research priorities in China. Apart from some fundamental research projects on the Epstein-Barr virus (EBV), their main efforts are epidemiologically and clinically oriented. Major surveys in GuangDong and GuangXi provinces showed that high EBV/IgA/VCA serum levels can detect NPC at an early stage of the disease. Characterization of "precancerous lesions" in the nasopharynx and among the EBV/IgA positive individuals is in progress in the Zangwu county of the GuangXi Autonomous Region. Preventive anti-viral intervention in these individuals is being discussed. Search for genetic and environmental chemical carcinogens is also carried out. This Chinese epidemiological approach complements well the fundamental Western studies on EBV and NPC.