Immunohistochemical Expression of MUC4, CD44, and Ki67/MIB1 in Different Meningioma Grades. A New Promise to Overcome the Chemoresistance Problem in Aggressive Meningioma

Background: MUC4 and CD44 have been addressed as major players in the progression and chemoresistance of several tumors. Aim of Study: We aimed to elucidate the role of MUC4, CD44, and ki67 in meningiomas to detect if anti-cancer agents with mucin-depleting and proteolytic effects could help in overcoming chemoresistance in meningiomas. Material and Methods: Fifty meningioma cases were immunohistochemically tested for CD44 and MUC4. In addition to grading of meningioma, Ki67/MIB 1 labeling index was evaluated. Results: MUC4 and CD44 were expressed in 84% and 100% of our cases respectively. Significant correlation ( p =0.007) was detected between meningioma subtypes and MUC4 intensity being highest in meningothelial and lowest in fibroblastic variant. Moreover, advanced meningioma grades were positively correlated with CD44 intensity ( p <0.001) and Ki67/MIB1 labeling index ( p <0.001). In addition, both CD44 and MUC4 immunohistochemical expression showed a significant positive association with Ki67/MIB 1 labeling index ( p =0.011 and p =0.004) respectively. Conclusion: MUC4 and CD44 are upregulated in advanced meningioma WHO grades II and III and correlated with a higher Ki67/MIB 1 labeling index. Subsequently, they can adversely influence the outcome and recurrence rate in meningioma and can be targeted by an agent with mucolytic and proteolytic effects helping in overcoming the common problem of chemoresistance in aggressive meningiomas.