To better understand the underlying pathways of cervical carcinogenesis, cDNA microarray analysis was performed on 2 sets of squamous cell carcinomas (SCCs) and their adjacent normal squamous epitheliums. Consistently altered expression was detected for 32 genes. Real-time RT-PCR analysis was conducted on a selected subset of these genes (S100A2, GPC4, p72, IGFBP-5, TRIM2 and NAB2) for 14 additional SCCs and 10 normal epithelia. This found that, of the 6 candidate genes, only the insulin-like growth factor binding protein-5 (IGFBP-5) mRNA was generally and significantly under-expressed in SCCs (p < 0.001). All normal cervical epithelia (30 of 30) stained positively for IGFBP-5 protein, with 70% showing strong staining, whereas 65% (17/26) of SCC had complete loss of IGFBP-5, and only 8% (2/26) SCC retained strong expression (p < 0.001). Immunohistochemistry of premalignant cervical intraepithelial neoplasia (CIN) lesions shows a significantly weaker or negative staining in advanced CIN3 lesions compared with normal squamous epithelia (p 5 0.001). This is the first study to show that down-regulation of IGFBP-5 protein correlates with cervical carcinogenesis and does so at a preneoplastic stage. ' 2007 Wiley-Liss, Inc.Key words: squamous cell carcinoma (SCC); cervical intraepithelial neoplasia (CIN); human papillomavirus (HPV); insulin-like growth factor binding protein-5 (IGFBP-5); cDNA microarray; real-time RT-PCR; immunohistochemistry Uterine cervical cancer is the second most common malignancy among women worldwide, 1 with an estimated 470,000 new cases per year 2 and mortality rate which ranks third worldwide, with the highest rates occurring in developing countries.3 Squamous cell carcinomas account for the majority of cervical cancers, followed by adenocarcinomas which comprise 10-18% of cases, and the remainder of tumors consists of a few rare types. 4,5 The squamous cell carcinomas and adenocarcinomas are mainly caused by infection with one of the high-risk types of human papillomaviruses (HPV), exemplified by the HPV-16 and -18 strains; so called highrisk because of their consistent detection in high-grade squamous intraepithelial cervical lesions and carcinomas.6,7 The E6 and E7 viral oncoproteins of high-risk HPV play critical roles in initiating cervical carcinogenesis by binding to and degrading or inactivating the cellular tumor suppressor proteins p53 and Rb.8-13 These viral-oncogenic properties have provided the general basis for the extensive investigations of the role of HPV in carcinogenesis of the HPV-infected cervix, demonstrating how they subvert key cell cycle and regulatory processes to transform and immortalize the host cell. 14,15 It follows that alterations of protein and mRNA expressions in cervical cancer have been investigated specific to the HPV infection; however, the more global profile of gene expression variation between cervical cancer and normal squamous epithelium is still largely unknown. The exploration of cancer-specific up-and down-regulation of genes based on expression ...