CD109 is a glycosylphosphatidylinositol (GPI)-anchored glycoprotein whose expression is up-regulated in squamous cell carcinomas (SCCs) of the lung, esophagus, and uterus. The purpose of this study was to evaluate CD109 expression in oral tumors, including premalignant lesions, and to assess the clinical application of CD109 in oral cancer. CD109 expression in oral normal and tumor tissues from 124 patients was examined by immunohistochemical staining with anti-CD109 antibody, and significant relations between clinical features and CD109 expression were statistically assessed. We found that high levels of CD109 expression were frequently detected in SCCs and premalignant lesions of the oral cavity, but not in normal squamous epithelia. The CD109 expression level was higher in well-differentiated SCCs than in poorly differentiated SCCs. Furthermore, premalignant lesions highly expressing CD109 showed higher risk to progress to SCCs. Oral SCC cell lines overexpressing CD109 exhibited accelerated cell growth in vitro compared with control cell lines. In addition, overexpression of CD109 impaired the transforming growth factor (TGF)-b1-mediated suppression of cell growth. These findings suggest that CD109 plays a role in the development of oral cancers, and is a useful prognostic marker to predict malignant transformation of premalignant lesions. (Cancer Sci 2008; 99: 1916-1923 U p-regulation or down-regulation of the expression of some genes, including oncogenes and tumor suppressor genes, trigger the development of human tumors; the products of these genes are potentially good molecular targets for cancer diagnosis and treatment. In oral cancers, despite the ease of clinical examination, most cancer patients are diagnosed with advanced-stage cancer and are difficult to treat because of the anatomic location of the lesions or because the treatment would impact on the patients' quality of life. Therefore, early diagnosis of high-risk premalignant lesions is most important for good prognosis.CD109 is a glycosylphosphatidylinositol (GPI)-anchored cellsurface glycoprotein and is a member of the α2-macroglobulin-C3, C4, and C5 family of thioester-containing proteins.(1-3) The CD109 protein was first identified as a cell-surface antigen detected by a monoclonal antibody raised against the primitive lymphoid/ myeloid cell line KG1a.(1) It has been reported that CD109 is expressed on a subset of fetal and adult CD34 + bone marrow mononuclear cells, mesenchymal stem cell subsets, phytohemagglutinin (PHA)-activated T lymphoblasts, thrombin-activated platelets, leukemic megakaryoblasts, endothelial cells, and some human tumor cell lines, but not on fresh peripheral leukocytes and normal bone marrow leukocytes.(1,2,4,5) It was also shown that CD109 carries the biallelic platelet-specific alloantigen Gov, which is implicated in refractoriness to platelet transfusion, post-transfusion purpura, and neonatal alloimmune thrombocytopenia. We identified CD109 as a gene up-regulated in cells overexpressing oncogenic RET tyrosine kinas...