Myofibroblasts are frequent in the stroma and invasive front of oral squamous cell carcinomas where they control the tumoral behavior by stimulating cellular proliferation and matrix metalloproteinase 2 activity of the tumor cells / Miofibroblastos são frequentes no estroma e no fronte invasivo dos carcinomas espinocelulares orais onde controlam o comportamento tumoral por estimular a proliferação celular e a atividade da metaloproteinase de matriz 2 das celulas tumorais

Michele Gassen Kellermann

Myofibroblasts are characterized by the expression of elevated amounts of growth factors, proteases and extracellular matrix, which may influence the tumor progression. Recent studies have detected myofibroblasts in the stroma of several tumors, including those of breast, kidney, liver, bladder, colon and prostate, being the presence of those cells associated with a worse prognosis for the patient. The goals of this study were to evaluate the presence of myofibroblasts in samples of normal oral mucosa, pre-malignant leucoplakia, and 2 groups of squamous cell carcinomas (SCC), and to determine whether their presence is associated with clinicopathological features of the tumors. The first group was composed exclusively by tongue lesions, whereas the second group was formed by 38 SCCs of several sites of the oral cavity. We also investigated in vitro the mutual paracrine effects of tumor cells and myofibroblasts on fibroblast-myofibroblast transdifferentiation and tumor cell proliferation and production of matrix metalloproteinases (MMP). Immunohistochemical analysis showed the lack of myofibroblasts in the stroma of normal oral mucosa and pre-malignant oral leucoplakias. In contrast, ~60% of the SCCs contained myofibroblasts in the tumor stroma and/or deep invasive front of the tumor. In the first group, the abundant presence of myofibroblasts in the stroma or deep invasive front significantly correlated with N stage, vascular and lymphatic invasion, histopathologically confirmed lymph node metastasis, and extracapsular spread of lymph node metastasis. The abundant presence of myofibroblasts was also correlated with a shorter patient s survival and the proliferative potential of the tumor cells. In the second group of oral SCCs, the abundant presence of myofibroblasts correlated significantly with N stage, presence of tumor cells at the surgical margins, and regional recurrence. Using 4 oral SCC cell lines and 3 primary oral normal fibroblasts (ONF) from buccal mucosa, we demonstrated that tumor cells induced transdifferentiation of ONFs to myofibroblasts via secretion of transforming growth factor-β1 (TGF-β1). Additionally, we demonstrated that transdifferentiated myofibroblasts secreted factors that significantly stimulated the cellular proliferation and production of MMP-2 by the oral SCC cell lines. The results of this study suggest that during tumor invasion SCC-derived TGF-β1 promote fibroblast to myofibroblast transdifferentiation, and in turn, myofibroblasts synthesize factors that induce cellular proliferation and production of MMP-2 by the tumor cells, favoring tumor growth and invasion.

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