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Regulation by hypoxia may underlie the expression of vascular endothelial growth factor in bladder cancer. We have compared the distribution of vascular endothelial growth factor mRNA with a hypoxia marker, carbonic anhydrase 9 (CA IX). vascular endothelial growth factor mRNA was analysed by in situ hybridisation and CA IX by immunochemistry in 22 cases of bladder cancer. The relationship of microvessels to the distribution of CA IX was determined. In a separate series of 49 superficial tumours, CA IX immunostaining was compared with clinico-pathological outcome. In superficial and invasive disease there was overlap in the expression of vascular endothelial growth factor and CA IX, CA IX being more widespread. Both were expressed predominantly on the luminal surface, and surrounding areas of necrosis (invasive tumours). Expression of both factors was greater in superficial disease. Expression was absent within approximately 80 microm of microvessels. Unlike vascular endothelial growth factor, CA IX did not predict outcome in superficial disease. Differential responses to reoxygenation provide one explanation: vascular endothelial growth factor mRNA declined rapidly, while CA IX expression was sustained for >72 h. Expression of vascular endothelial growth factor mRNA in bladder tumours is consistent with hypoxic regulation and suggests differential regulation in superficial vs invasive disease. The expression of CA IX on the luminal surface justifies investigation of its utility as a therapeutic target/prognostic indicator.

Original publication




Journal article


Br J Cancer

Publication Date





1276 - 1282


Antigens, Neoplasm, Biomarkers, Tumor, Blotting, Western, Carbonic Anhydrase IX, Carbonic Anhydrases, Endothelial Growth Factors, Gene Expression Regulation, Neoplastic, Humans, Immunohistochemistry, In Situ Hybridization, Lymphokines, Neoplasm Invasiveness, Neoplasm Proteins, Prognosis, RNA, Messenger, Recurrence, Tumor Cells, Cultured, Urinary Bladder Neoplasms, Vascular Endothelial Growth Factor A, Vascular Endothelial Growth Factors