Background: Ionotropic glutamate receptors of the N-methyl-D-aspartate receptor (NMDAR) type are expressed on keratinocytes and play a role in the proliferation, differentiation, and cornification of keratinocytes. However, the expression profile of NMDAR and its role in cutaneous malignancy is unclear. Objective: We analyzed the expression of NMDAR-1 in cutaneous squamous cell carcinoma (SCC) and investigated the relationship between NMDAR-1 expression and clinicopathological parameters. Methods: Thirty-two patients with biopsy-proven cutaneous SCC were enrolled in this study. Each patient was analyzed for tumor diameter, location, local recurrence, and metastasis by conducting a chart review. The SCC specimens were histologically divided into differentiated and undifferentiated groups based on Broders' system. NMDAR-1 expression was examined by performing immunohistochemistry, and the relative staining intensity in the SCCs was graded into 5 levels. According to the staining intensity of NMDAR-1, the specimens were categorized into two groups: the higher group and the lower group. Results: Fifteen (88%) of 17 tumors in the higher group were differentiated SCC, whereas 14 (93%) of 15 tumors in the lower group were undifferentiated SCC. In addition, NMDAR-1 expression was inversely correlated with metastasis (p=0.049). Local recurrence was associated with a lower staining intensity, but the results were not statistically significant. Conclusion: Our results demonstrate that NMDAR-1 expression in cutaneous SCC is significantly correlated with its differentiation and metastasis. Therefore, it may be a prognostic indicator for cutaneous SCC.
INTRODUCTIONGlutamate is an essential amino acid and neurotransmitter in the central nervous system (CNS). It plays a major role in excitotoxicity as well as in learning and memory. In addition, it functions as a trophic factor for cancer cells in vitro 1 , suggesting an involvement of glutamate and its receptors in tumor cell proliferation and migration. Glutamate activates various glutamate receptors, including N-methyl-D-aspartate (NMDA), alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid, kainite, and metabotropic receptors 2,3 . NMDAR has two distinct subunits: the main subunit, NMDAR-1, and the modulatory subunit, NMDAR 2A-2D. NMDAR-1 is essential and sufficient to form an active NMDA receptor channel, in contrast to the NMDAR-2 subunits 4 . The NMDAR is a ligand-gated ion-channel that is permeable to the cations Na + , K + , and most importantly, Ca 2+ .Although the expression of the glutamate receptor was initially restricted to the CNS, glutamate signaling occurs in non-neuronal tissues such as bone, pancreas, and skin, raising the possibility of a more widespread glutamate receptor activity 5 . Moreover, NMDAR-1 is expressed on keratinocytes 6 . NMDAR-1 expression increased with keratinocytic differentiation in the epidermis of normal human These results suggest that NMDAR could play a role in the proliferation and differentiation of normal keratinocytes. In ad...