APNG as a prognostic marker in patients with glioblastoma

Sigurd Fosmark, Sofie Hellwege, Rikke H Dahlrot, Kristian L Jensen, Helene Derand, Jesper Lohse, Mia D Sørensen, Steinbjørn Hansen, Bjarne W Kristensen


AIM: Expression of the base excision repair enzyme alkylpurine-DNA-N-glycosylase (APNG) has been correlated to temozolomide resistance. Our aim was to evaluate the prognostic value of APNG in a population-based cohort with 242 gliomas including 185 glioblastomas (GBMs). Cellular heterogeneity of GBMs was taken into account by excluding APNG expression in non-tumor cells from the analysis.

METHODS: APNG expression was evaluated using automated image analysis and a novel quantitative immunohistochemical (IHC) assay (qIHC), where APNG protein expression was evaluated through countable dots. Non-tumor cells were excluded using an IHC/qIHC double-staining. For verification, APNG was measured by a quantitative double-immunofluorescence (IF) assay. As validation APNG mRNA expression was evaluated using independent TCGA data.

RESULTS: Using qIHC, high levels of APNG were associated with better overall survival (OS) in univariate (HR = 0.50; P < 0.001) and multivariate analysis (HR = 0.53; P = 0.001). Patients with methylated MGMT promoters and high APNG expression demonstrated better OS, than patients with methylated MGMT promoters and low APNG expression (HR = 0.59; P = 0.08). Retesting the cohort using IF showed similar results in both univariate (HR = 0.61; P = 0.002) and multivariate analysis (HR = 0.81; P = 0.2). The results were supported by data from the TCGA database.

CONCLUSIONS: Using two different assays combined with quantitative image analysis excluding non-tumour cells, APNG was an independent prognostic factor among patients with a methylated MGMT promoter. We expect that APNG qIHC can potentially identify GBM patients who will not benefit from treatment with temozolomide.

Original languageEnglish
JournalPLoS One
Issue number6
Pages (from-to)e0178693
Publication statusPublished - 2017
Externally publishedYes


  • Aged
  • Biomarkers, Tumor/metabolism
  • Brain Neoplasms/enzymology
  • DNA Glycosylases/genetics
  • Databases, Genetic
  • Female
  • Glioblastoma/enzymology
  • Humans
  • Immunohistochemistry
  • Male
  • Middle Aged
  • Prognosis
  • Survival Analysis


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