IntroductionCyclin-dependent kinase inhibitors (CKIs) are a group of lowmolecular-weight proteins that associate with cyclin-dependent kinases (CDKs), blocking their activity. 1,2 The inhibitors of CDK4 (INK4) family of CKIs is composed of p16 INK4a , p15 INK4b , p18 INK4c , and p19 INK4d , which specifically bind and inhibit CDK4 and CDK6, thereby preventing cyclin D-dependent phosphorylation of Rb. 1 Inactivation of the genes comprising the INK4 family of cell-cycle inhibitors is a frequent phenomenon in human cancer, although it seems to be mostly restricted to p16 INK4a and p15 INK4b silencing through genetic 3 and epigenetic 4 mechanisms. Alterations of both p16 INK4a and p15 INK4b have been described in non-Hodgkin lymphoma (NHL) [5][6][7] and Hodgkin lymphoma (HL). 8,9 In these hematologic neoplasias, hypermethylation of the 5Ј cytidine-phosphateguanosine (CpG) island of these genes seems to be a frequent event, whereas the incidence of homozygous deletion and mutations is relatively low. 10,11 Unsurprisingly, this hypermethylation status of the promoter region correlates with transcriptional repression of these genes and constitutes an alternative inactivating mechanism. 6,12 The human p18 INK4c gene was first identified in a yeast interaction screen that searched for CDK6-interacting proteins. 13 p18 INK4c was demonstrated to interact with CDK6 and more weakly with CDK4 (but not with other CDKs) both in vivo and in vitro, and to inhibit the kinase activity of cyclin D-CDK6 complexes. Ectopic expression of p18 INK4c was shown to suppress cell growth in a wild-type Rb-dependent manner. 13 p18 INK4c has been proposed to function as a tumor suppressor gene, based on the observation that p18 INK4c -null mice display an increased susceptibility to developing spontaneous and induced tumors, such as pituitary adenomas and others. 14,15 However, alterations in the p18 INK4c gene are strikingly less frequent than those affecting p16 INK4a or p15 INK4b , having been observed in human cancer only sporadically. [16][17][18][19] Although in normal lymphoid B cells the p18 INK4c protein has been implicated in key functions such as cell cycle control and terminal (plasma cell) differentiation, 19,20
Patients, materials, and methods
Tumor samples and cell linesThere were 316 retrospective cases of HL collected by collaborating members of the Spanish Hodgkin Lymphoma Study Group. 25 The histologic confirmation of HL and subtype was determined by central review using standard tissue sections, and diagnoses were made according to the criteria of the WHO classification. 28 Cases included 171 cases of nodular sclerosis HL, 112 cases of mixed-cellularity HL, 14 cases of lymphocyterich classical HL, 9 cases of lymphocyte-depletion HL, and 10 cases of nodular lymphocyte-predominant HL. All of the samples included represent at-diagnosis biopsies and all of the patients were treated following standard protocols: patients with advanced HL were mainly treated with 6 to 10 courses of combination chemotherapy (adriamycin, bleom...