Kaposi's Sarcoma and Pregnancy

We read with interest the recent article published by Bryant et al, in which they report the first case of isolated pulmonary Kaposi's sarcoma (KS) in a pregnant patient.[1] The authors correctly point out the increasing incidence of KS reported in women, particularly in Africa, and also that HIV-infected women afflicted with KS appear to follow a more aggressive and often fatal course. However, they did not mention two very interesting points regarding KS in pregnancy.

First, although the infant in the paper reported by Bryant et al remained HIV and HHV-8 negative, KS has been documented in infants,[2] [3] demonstrating the potential for vertical transmission of this neoplasm. In an intriguing and related paper, investigators studying recipients of renal transplants proved that KS cells from organ donors may indeed enter the blood circulation and thereby contribute to the development of post-transplant KS.[4]

Second, the authors did not discuss why KS in some pregnant individuals has been reported to undergo spontaneous remission.[5] In nude mice the inhibition of KS during early pregnancy, when chorionic gonadotropin-like activity is maximal, has also been shown.[6] These findings are in keeping with recent experiments showing that urinary preparations of human chorionic gonadotropin (hCG) are capable of inducing apoptosis in KS cells,[7] and exhibit the ability to inhibit KS-associated angiogenesis and matrix metalloprotease activity.[8] [9]

Bryant's case of pulmonary KS in a pregnant woman is particularly noteworthy given the aforementioned anti-KS properties of hCG, but is in line with a study of African HIV-infected women, in which pregnancy was not associated with lower KS rates.[10] Further investigations are warranted to elucidate the interplay between pregnancy and KS, as well as the potential benefit of hCG as an anti-KS therapeutic.

REFERENCES

• 1 Bryant A E, Genc M, Hurtado R M, Chen K T. Pulmonary Kaposi's sarcoma in pregnancy.  Am J Perinatol. 2004;  21 355-363
• 2 Gutierrez-Ortega P, Hierro-Orozco S, Sanchez-Cisneros R, Montano L F. Kaposi's sarcoma in a 6-day-old infant with human immunodeficiency virus.  Arch Dermatol. 1989;  125 432-433
• 3 McCarty K A, Bungu Z. Kaposi's sarcoma in a two week old infant born to a mother with Kaposi's sarcoma/AIDS.  Cent Afr J Med. 1995;  41 330-331
• 4 Barozzi P, Luppi M, Facchetti F et al.. Post-transplant Kaposi sarcoma originates from the seeding of donor-derived progenitors.  Nat Med. 2003;  9 554-561
• 5 Bisacchi D, Noonan D M, Carlone S, Albini A, Pfeffer U. Kaposi's sarcoma and human chorionic gonadotropin: mechanisms, moieties and mysteries.  Biol Chem. 2002;  383 1315-1320
• 6 Lunardi-Iskandar Y, Bryant J L, Zeman R A et al.. Tumorigenesis and metastasis of neoplastic Kaposi's sarcoma cell line in immunodeficient mice blocked by a human pregnancy hormone.  Nature. 1995;  375 64-68
• 7 Samaniego F, Bryant J L, Liu N et al.. Induction of programmed cell death in Kaposi's sarcoma cells by preparations of human chorionic gonadotropin.  J Natl Cancer Inst. 1999;  91 135-143
• 8 Masood R, McGarvey M E, Zheng T et al.. Antineoplastic urinary protein inhibits Kaposi's sarcoma and angiogenesis in vitro and in vivo.  Blood. 1999;  93 1038-1044
• 9 Pfeffer U, Bisacchi D, Morini M et al.. Human chorionic gonadotropin inhibits Kaposi's sarcoma associated angiogenesis, matrix metalloprotease activity, and tumor growth.  Endocrinology. 2002;  143 3114-3121
• 10 Rabkin C S, Chibwe G, Muyunda K, Musaba E. Kaposi's sarcoma in pregnant women [letter].  Nature. 1995;  377 21