Inflammatory Proteins HMGA2 and PRTN3 as Drivers of Vulvar Squamous Cell Carcinoma Progression

SIMPLE SUMMARY: Our study aimed to advance the understanding of vulvar squamous cell carcinoma (VSCC) biology by recognizing biological pathways that drive the progression of this disease. We applied the experimental path from global proteomic analysis of vulvar tumors to the targeted and quantitative assessment of specific proteins both in the tumors and blood of VSCC patients. The proteomic analysis has advanced the knowledge on VSCC biology by pointing at inflammation as a driver of progression and by providing grounds for the hypothesis of vulvovaginal microflora disturbances as a trigger for the inflammatory response. The study results indicate prognostic protein markers and potential therapeutic targets for improved and personalized management of VSCC. ABSTRACT: Current knowledge on the biology of squamous cell vulvar carcinoma (VSCC) is limited. We aimed to identify protein markers of VSCC tumors that would permit to stratify patients by progression risk. Early-stage tumors from patients who progressed (progVSCC) and from those who were disease-free (d-fVSCC) during follow-up, along with normal vulvar tissues were examined by mass spectrometry-based proteomics. Differentially expressed proteins (DEPs) were then verified in solid tissues and blood samples of patients with VSCC tumors and vulvar premalignant lesions. In progVSCC vs. d-fVSCC tumors, the immune response was the most over-represented Gene Ontology category for the identified DEPs. Pathway profiling suggested bacterial infections to be linked to aggressive VSCC phenotypes. High Mobility Group AT-Hook 2 (HMGA2) and Proteinase 3 (PRTN3) were revealed as proteins predicting VSCC progression. HMGA2 and PRTN3 abundances are associated with an aggressive phenotype, and hold promise as markers for VSCC patient stratification. It appears that vulvovaginal microflora disturbances trigger an inflammatory response contributing to cancer progression, suggesting that bacterial rather than viral infection status should be considered in the development of targeted therapies in VSCC.