Immunohistologic and histochemical methods for detection of steroid binding in breast cancer: a reappraisal

Purification and identification of an estrogen binding protein from rat brain: oligomycin sensitivity-conferring protein (OSCP), a subunit of mitochondrial F0F1-ATP synthase/ATPase

Early studies have suggested the presence in the central nervous system of possible estrogen binding sites/proteins other than classical nuclear estrogen receptors (nER). We report here the isolation and identification of a 23 kDa membrane protein from digitonin-solubilized rat brain mitochondrial fractions that binds 17beta-estradiol conjugated to bovine serum albumin at C-6 position (17beta-E-6-BSA), a ligand that also specifically binds nER. This protein was partially purified using affinity columns coupled with 17beta-E-6-BSA and was recognized by the iodinated 17beta-E-6-BSA (17beta-E-6-[125I]BSA) in a ligand blotting assay. The binding of 17beta-E-6-BSA to this protein was specific for the 17beta-estradiol portion of the conjugate, not BSA. Using N-terminal sequencing and immunoblotting, this 23 kDa protein was identified as the oligomycin-sensitivity conferring protein (OSCP). This protein is a subunit of the FOF1 (F-type) mitochondrial ATP synthase/ATPase required for the coupling of a proton gradient across the F0 sector of the enzyme in the mitochondrial membrane to ATP synthesis in the F1 sector of the enzyme. Studies using recombinant bovine OSCP (rbOSCP) in ligand blotting revealed that rbOSCP bound 17beta-E-6-[125I]BSA with the same specificity as the purified 23 kDa protein. Further, in a ligand binding assay, 17beta-E-6-[125I]BSA also bound rbOSCP and it was displaced by both 17beta-E-6-BSA and 17alpha-E-6-BSA as well as partially by 17beta-estradiol and diethylstilbestrol (DES), but not by BSA. This finding opens up the possibility that estradiol, and probably other compounds with similar structures, in addition to their classical genomic mechanism, may interact with ATP synthase/ATPase by binding to OSCP, and thereby modulating cellular energy metabolism. Current experiments are addressing such an issue.

Heterogeneity of c-myc expression in histologically similar infiltrating ductal carcinomas of the breast

Anti-c-myc monoclonal antibody was used to evaluate the distribution of the c-myc protein in normal and tumor cells of infiltrating ductal carcinoma. A semi-quantitative method for reporting immunohistochemical assay results (c-myc score) that enables correlations on a more quantitative basis was used in this study. HL-60 cells demonstrated the strongest nuclear staining when fixed in cold acetone (4 degrees C) for 10 min. All 24 specimens of infiltrating ductal carcinomas of the breast and 7 of 11 samples of normal breast tissues studied revealed the presence of c-myc protein. The level of expression in normal breast tissue was much lower than that in breast cancer. Heterogeneity in expression was found within individual tumors and there were substantial differences in the level of expression among different tumors. The subcellular site of staining was predominantly nuclear, occasionally nuclear and cytoplasmic in the same cell, and rarely only cytoplasmic. All four patients with tumor cells located in close proximity to the ductal basement membrane and over-expressing c-myc protein had positive lymph nodes, suggesting that these tumors are more likely to metastasize.

Immunocytochemical detection of progesterone receptor by monoclonal KD-68 antibody in operable breast cancer: correlations with biochemical assay, pathological features and cell proliferative rate

A new immunocytochemical assay (ICA) for progesterone receptor (PgR), employing the rat monoclonal KD-68 antibody and a sensitive peroxidase-anti-peroxidase (PAP) technique as the displaying system, was performed in 129 human breast cancer specimens. PgR-ICA staining was almost all electively located in neoplastic cell nuclei with a substantial heterogeneity in distribution and intensity. To study the basic relationship of the results of the ICA method with the biochemical dextran-coated charcoal (DCC) assay we compared, in all the same specimens, the antibody nuclear staining with the PgR positivity by DCC (cut-off value of 10 fmol/mg of protein). We found an overall agreement of 77% between the two methods and a PgR-ICA sensitivity of 83% and a specificity of 72%, assuming that biochemical PgR is truth. PgR-ICA false-negative results were only nine out of 53 (17%); and false-positive were 21 out of 76 (28%). Using both methods no significant association was observed between PgR positivity with menopausal status, histological type, tumor size and lymph node status. The correlations between PgR expression and cell kinetics were assessed by an immunocytochemical method employing the monoclonal Ki-67 antibody. While a significant negative relationship was found between high Ki-67 score and PgR-ICA positivity (P less than 0.01) no correlation was found with DCC positivity. The present results demonstrate that ICA is a practical, reliable and inexpensive method with a good correlation to the conventional biochemical assay to determine the PgR status. Moreover, ICA recognizes PgR expression at the single cell level, thus providing additional information to the quantitative DCC assay that should improve the prognostic evaluation and the prediction of responsiveness to endocrine therapy in breast cancer.

Uteroglobin as progesterone-binding protein in the preimplantation uterine epithelium of the rabbit: histochemical studies

[3H] progesterone was injected into the uterine lumen of rabbits toward the end of preimplantation period (162 h post coitum). Light-microscopic autoradiography showed accumulation of label in single cell groups of the uterine epithelium. Fluorographs of thin layer chromatograms of steroid extracts indicated the metabolization of progesterone in the uterine tissue. Incubation of uterine sections with fluorescein isothiocyanate-conjugated progesterone-rabbit serum albumin revealed binding sites for this reagent: 162 h post coitum, staining was also localized in single cell groups of the uterine epithelium. Pretreatment with a monospecific antiserum showed uteroglobin to be the binding protein.

Comparison of the immunocytochemical assay (ER-ICA) and the biochemical assay for estrogen receptor in human breast cancer cell lines

Estrogen receptor content of 8 cell lines from non-malignant human breast tissues was determined by an immunocytochemical assay using the Abbott ER-ICA monoclonal kit. The results were in accordance with those obtained by the conventional radiochemical (DCC) assay. Primary cultures of breast tissues are suggested as an important field for in situ application of the ER-ICA.

Fluorescence-based assay of estrogen receptor using 12-oxo-9(11)-dehydroestradiol-17 beta

12-Oxo-9(11)-dehydroestradiol-17 beta (12-oxo-E2) was used to assay estrogen receptor binding in uterine cytosol preparations by an indirect fluorescence assay. In alkaline solution, 12-oxo-E2 has a fluorescence excitation maximum at 402 nm (epsilon = 24,000) and an emission maximum at 480 nm (phi f = 0.57), and its fluorescence can be observed down to 5 X 10(-11) M. The minimum detection limit of 12-oxo-E2 is 25 fmol by spectrofluorometry and 5 fmol by HPLC-fluorometry. Although this compound is not appreciably fluorescent at neutral pH (i.e., at conditions under which it binds to the estrogen receptor), receptor binding by fluorometry can be measured indirectly: After equilibration of 12-oxo-E2 with the receptor preparation and removal of excess free ligand, the receptor-12-oxo-E2 complex is disrupted, and fluorescence measurements are made on the dissociated 12-oxo-E2 in alkaline medium. This fluorometric assay was validated quantitatively by performing simultaneously, on the same receptor preparation, radiometric and fluorometric assays with [3H]E2 and [3H]-12-oxo-E2. The radiometric determinations with both compounds gave nearly equivalent estimates of receptor site concentrations, but the fluorometric estimate of binding site concentration was somewhat less (70-85%) than that expected on the basis of the [3H]E2 radiometric assay. The use of 12-oxo-E2 in an indirect spectro- or HPLC-fluorometric assay provides a means for assaying estrogen receptor concentrations by fluorescence with a sensitivity approaching that of radiometric techniques.

Determination of steroid hormone-dependency of tumours utilizing tissue sections. Survey of histochemical techniques and their application in surgical pathology

The growth of neoplasms originating from steroid hormone target tissues may be hormone-dependent. It has been clearly demonstrated that the oestrogen and/or progestagen receptor status predicts the response to endocrine treatment and the prognosis of breast cancer. However steroid receptor determination in tumour cytosols has several limitations, which can partly be resolved by (immuno) histochemical detection of steroid hormone-responsive tumour cells. A variety of histochemical techniques including autoradiography of tritiated steroids, immunohistochemistry with antibodies to steroid hormones, histochemistry with fluorescent ligands of low molecular weight and fluorochrome- or enzyme-labelled macromolecular probes are discussed. It is concluded that there is as yet no substantial evidence that these methods visualize steroid receptors or detect steroid hormone-responsiveness of tumour cells. On the other hand, immunohistochemical demonstration of oestrogen receptors with monospecific antibodies seems validated and indications have been obtained that this information is clinically relevant. Recent developments suggest that immunocytochemistry of receptors and specific hormone-induced proteins, flow cytometric analysis and probably hybridocytochemistry in the future will help to improve management of steroid hormone-dependent tumours.

Histochemical estrogen binding. An independent predictor of recurrence and survival in stage II breast cancer

Cox's proportional hazards regression model was used to analyze the prognostic significance of multiple variables affecting recurrence and survival in patients with Stage II breast cancer. Among the variables were biochemical estrogen (ER) and progesterone receptor (PgR) values and results of a histochemical estrogen-binding assay using a fluoresceinated bovine serum albumin-estradiol conjugate where carrier and label were bound at position 17. In 190 cases ER and PgR were not found to be significantly associated with either disease recurrence or patient survival. On the other hand, patients with tumors that were demonstrably "rich" in estradiol ligand conjugate binding by histochemistry experienced both a longer disease-free interval (P less than 0.03) and survival (P less than 0.02) than did patients whose tumors were "poor" in conjugate binding or showed a heterogeneous population of positively and negatively stained cells. A patient with a tumor rich in estrogen binding was five times more likely to survive than a patient with a neoplasm that was poor in estrogen binding by histochemistry. These results indicate that the histochemical technique used provides new and independent parameters for determination of prognosis in Stage II breast cancer.

Comparative histological, histochemical, immunohistochemical and biochemical studies on oestrogen receptors, lectin receptors, and Barr bodies in human breast cancer

The present study performed on a total of 567 cases of human female breast cancer compares the results of the biochemical assay (dextran-coated charcoal assay = DCC) for oestrogen receptor (ER) with those of several morphological methods developed for the detection of the ER or for the prediction of prognosis by use of other systems (FSA = fluorescent ligand binding assay, ER-ICA = monoclonal antibody assay for ER, LRA = lectin receptor assay using peanut agglutinin, and Barr body estimation). Whereas no correlation at all was observed among the results of the DCC and those of the FSA and Barr body estimation, the ER-ICA and the LRA showed an unanimous tendency towards higher values of ER with increasing intensity of the staining product. The results of the ER-ICA may be expressed by an immuno-reactive score (IRS) calculated from the staining intensity (SI) and the percentage of positive cells (PP). The morphological methods are evaluated with special regard to their correlation with the DCC, their theoretical basis, and their practical application. In summary, the ER-ICA appears to be the sole method directly visualizing the ER protein and--in contrast to the DCC--is therefore completely independent of the content of endogenous or exogenous oestrogens in the tumor tissue. The LRA provides valuable additional information concerning tumour differentiation and possible response to endocrine therapy, whereas the FSA and Barr body estimation should be considered as obsolete and should therefore be abandoned.

What's new in endocrine factors of tumor growth?

In this review some aspects of endocrinological factors in cancer are discussed. The first part addresses the determination of steroid hormone receptors in cancer of the breast. The importance of steroid hormone receptor determination for the clinical management of breast cancer patients is emphasized. Current methods for receptor measurement are critically evaluated and it is concluded that rigorous standardization of tissue handling procedures and of radiochemical methodology is mandatory to improve the reliability of the presently available methods. The development of new techniques for receptor determination has been met with high expectations. Monoclonal antireceptor antibodies in principle allow the development of a radioimmunoassay but are not widely available as yet. Histochemical methods for receptor localization have so far failed to meet accepted criteria of specificity. Therefore radiochemical determination at present remains the only reliable method. The second part addresses the production of peptide hormones by endocrine tumours of the gastroenteropancreatic (GEP) system and by non-neuroendocrine neoplasms. In the endocrine tumours of the GEP system a wide range of peptide hormones can be detected by immunocytochemistry, but most frequently the pattern of hormone production is comparable with that in the normal organ of origin. Clinical symptoms of excess hormone production occur much less frequently than hormone production is found by immunological methods and is usually caused by one hormone. It is proposed that these neoplasms are classified according to the hormone which causes the leading clinical symptoms and/or the hormone with the highest serum level. Peptide hormone producing cells in classical carcinoma are an intriguing phenomenon which has shed some new light on the embryological origin of neuroendocrine cells in the relevant organs and also on the histogenesis of neuroendocrine as well as non-neuroendocrine neoplasms.

Heterogeneity of estrogen binding sites in breast cancer: morphologic demonstration and relationship to endocrine response

Breast cancer specimens from 184 patients were analyzed for estrogen binding by two different histochemical techniques using conjugates of estradiol, bovine serum albumin, and fluorescein. In one conjugate estradiol was bound at position 6, in the other at position 17. Results were in agreement in 64% (p less than .001), but obvious differences in ligand distribution were noted. Results were also correlated with estrogen receptor (ER) analysis by dextran-coated charcoal assay (DCC) and were in accord in 65% and 67% of specimens respectively (p less than .001). In 114 cases, the tissue samples were also studied with the estrogen receptor immunocytochemical assay (ERICA) of Greene and his colleagues, which employs monoclonal antibodies to ER protein. Results were in accord with DCC in 86% (p less than .001). The pattern of staining with ERICA differed from that of either histochemical method. In 43 cases assay results were correlated with clinical endocrine response. Overall, the best statistical prognostic parameters were obtained with ERICA. Analysis of combined assay results revealed that patients with assays positive by all techniques were the most likely to respond to hormonal treatment (p less than .001), whereas if one or more assays were negative the chances for a good response were significantly less favorable. These data suggest that DCC and ERICA are both a measure of the same estrogen binding site (type I) while the histochemical methods apparently identify two other separate and distinct sites (putative type II sites). A degree of positive interaction may exist between these multiple estrogen binding sites.

Flow cytometric analysis of fluorescein-conjugated estradiol (E-BSA-FITC) binding in breast cancer suspensions

With greater utilization of histochemical methods for detecting estrogen binding (ER) in tumor cells, there is an increasing need to quantitate objectively these fluorescently stained cells. This study utilizes flow cytometry (FCM) to examine the binding specificity and kinetics of 17 beta-estradiol-6-CMO-BSA-FITC(E-BSA-FITC) in two human mammary carcinoma cell lines, MCF-7 and 47-DN. Cells are rendered permeable to this ligand by freeze-thawing, a process analogous to the routine staining of frozen tumor sections with E-BSA-FITC for the clinical detection of ER. FCM quantification of E-BSA-FITC binding intensity demonstrates a saturable dose-response that is specifically reduced in the presence of diethylstilbestrol (DES) in doses known to saturate Type I ER. Scatchard analysis suggests that E-BSA-FITC binding occurs with receptors of varying affinities (Kd). Lineweaver-Burk plots show that the DES inhibition is competitive for a high-affinity receptor binding to E-BSA-FITC with a Kd of approximately 50 nM. This report also compares both FCM and biochemical methods of quantitating ER under two conditions of tumor cell growth potentially encountered in clinical specimens: quiescent versus actively proliferating cells, and cells pretreated with the antiestrogen tamoxifen. By FCM analysis, the cells with greater proliferating activity contain tenfold more specifically bound E-BSA-FITC, and tamoxifen pretreatment reduces this specific binding by 50%. These FCM measurements correlate well with biochemical results and suggest that this new methodology may supplement the detection of E-BSA-FITC binding by fluorescence microscopy.

Immunohistologic localization of estrogen receptors in breast cancer with monoclonal antibodies. Correlation with biochemistry and clinical endocrine response

Breast cancer specimens from 114 patients were assayed for the presence of estrogen receptors (ER) utilizing highly specific, monoclonal antiestrophilin antibodies and the peroxidase-antiperoxidase technique. Results were compared with conventional ER determinations by the dextran-coated charcoal method (DCC) and were in agreement as to positivity and negativity in 86%. Semiquantified immunocytologic assay results were in accord with the level of ER as measured by DCC in 66%. The tumors studied included 43 from patients with Stage IV disease where clinical response to hormonal manipulation was known. In the latter group, the immunohistologic method had a sensitivity similar to that of DCC but showed a superior positive predictive value and a significantly better specificity. These results indicate that this new method is a valuable laboratory tool, enabling prediction of hormone responsiveness in advanced mammary carcinoma and capable of performance at the community hospital level.

Heterogeneity of steroid binding sites in prostatic carcinoma: morphological demonstration and clinical implications

Prostatic neoplasms were studied for estrogen binding using four methods. Two employed fluorescent estrogen histochemical ligands, one was a new immunocytochemical technique using specific monoclonal antibodies to human estrophilin, and the last procedure was conventional biochemical dextran-coated charcoal assay. Results indicated that the fluorescent ligands recognized closely associated but separate estrogen-binding sites (putative type II sites) which in turn differed from the binding site measured biochemically. Studies with the monoclonal antibodies were nearly always negative, suggesting that prostatic estrogen receptor might vary antigenically from that present in breast and endometrium. Histochemical and biochemical androgen-binding studies were also compared and showed a close association. In the prediction of hormonal response in advanced prostate cancer both showed high sensitivity and low specificity. The addition of estrogen-binding data did not improve the predictive value of the androgen-binding histochemical assay. However, combining results of the biochemical and histochemical androgen-binding assays resulted in significant improvement of the specificity without loss of sensitivity, suggesting that there is a degree of positive interaction between the binding sites assayed by the two methods.

An update on the immunohistochemical localization of estrogen receptors in mammary carcinomas utilizing polyclonal anti-receptor antibodies

An immunohistochemical (IF) method utilizing polyclonal antibodies to cytoplasmic estrogen receptors (ER) and a tissue processing procedure which allows in situ precipitation of cytoplasmic ER without denaturation of antigenic sites were first described in this journal. In this report we present data on the immunohistochemical classification of 153 cases of human breast carcinomas (123 frozen sections, 28 cytological specimens) as ER-positive (IF+) or ER-negative (IF-). Results on correlation between the biochemical vs immunohistochemical assessment of the ER status and the relationship between quantity of ER and the proportion of IF+/IF- tumor cells are presented. In addition, a procedure which has been successfully applied to study in vitro translocation of cytoplasmic ER in cryostat sections of human breast carcinomas is described. A positive correlation between ER translocatability and status of progesterone receptors (PR) was obvious. All biochemical and immunohistochemical data are collectively reviewed and the question of whether the antibodies are detecting Type I ER is examined.

Oestradiol-BSA conjugates for receptor histochemistry: problems of stability and interactions with cytosol

The validity of histochemical methods for the localization of hormone receptors based on the binding of fluorescent bovine serum albumin conjugates of oestradiol was examined with respect to their stability and their interactions with the oestrogen receptor type I. Stability was assessed by measuring free oestrogen in conjugates by radioimmunoassay and/or receptor protein binding assay. Sufficient free oestrogen--in order to saturate type I and type II binding sites (ER I, ER II)--was detected in freshly prepared conjugates. This free oestrogen originates in inadequate removal of adsorptively bound original ligand after synthesis. Apart from this fact, conjugates appeared to be unstable in aqueous solutions, especially under the conditions used for for histochemical methods. Free oestrogen extracted from the conjugates was subjected to high performance liquid chromatography. Amongst the eluted peaks, oestradiol and/or the original ligand used for synthesis were identified. The in vitro interaction of conjugates with oestrogen receptors was studied by competitive binding analysis and by incubation of cytosol with a Sepharose-bound conjugate. The results, especially those concerning the amount of free oestrogen, suggest that neither ER I nor ER II is involved in the staining mechanism of conjugates.

Fluorescent ligands, used in histocytochemistry, do not discriminate between estrogen receptor-positive and receptor-negative human tumor cell lines

A cell line containing estrogen receptors (MCF-7) and a cell line lacking estrogen receptors (PC-93) were used for a comparison of biochemical and histochemical procedures to detect estrogen receptors. We evaluated three different fluorescent estrogen derivatives: 17 beta-estradiol-6-carboxymethyloxime-bovine serum albumin-fluorescein isothiocyanate, 17 beta-estradiol-17-hemisuccinate-fluoresceinamine, and coumestrol. The main results were: The relative binding affinities of these ligands for the estrogen receptor were between 0.1 and 2% of the affinity of estradiol. Fluorescent staining of the cells showed no relation to the presence of estrogen receptors. Staining was not suppressed with excess estradiol-17 beta, which is known to prevent binding of low affinity ligands to estrogen receptors. Cells with intact membranes were not stained after treatment with the albumin-linked estrogen derivative; only cells with damaged cell membranes were stained. Treatment of cells with 17 beta-estradiol-17-hemisuccinate-fluoresceinamine resulted in a fluorescent labeling of the cytoplasm in intact and artificially damaged cells. Coumestrol caused only fluorescence of the cytoplasm in intact cells. It is concluded that estrogen receptors cannot be detected with these low affinity ligands. Fluorescence of these cells is probably due to binding of the ligands to low affinity binding sites. The presence of these low affinity binding sites appears not to be related to the presence or absence of estrogen receptors and can therefore not be used to discriminate between estrogen receptor-positive and receptor-negative tumor cells.

Estrogen, progesterone, and androgen-binding sites in renal cell carcinoma. Observations obtained in Phase II trial of flutamide

A Phase II disease-oriented drug trial using flutamide (4'-nitro-3'trifluoro-methylisobutyranilide) 250 mg by mouth three times a day was undertaken in 28 patients with advanced, bidimensionally measurable renal cell carcinoma. Of 25 adequately treated cases, 1 (4%, 95% confidence limits 0-12%) had a partial remission lasting 9+ months, and 2 had stabilization of disease lasting 6 and 15 months, respectively. Flutamide demonstrated no significant antitumor activity in patients with disseminated renal cell carcinoma. Including patients entered in this study, 62 specimens were evaluated for steroid binding sites using a fluorescent method: 33 of 62 specimens assayed showed no hormone-binding sites, and only 12 cases had androgen binding. Of the 12 of 23 patients receiving flutamide who were biopsied and had an adequate sample for steroid-binding site determination, estrogen binding was demonstrated in 6, androgen binding in 3, and progesterone binding in 4. Since this study did not obtain a sufficient number of cases with androgen-binding positivity, the possible efficacy of flutamide in such cases cannot be excluded.

Histochemical androgen binding assay in prostatic cancer

A group of 60 patients with clinical stage C or D prostatic carcinoma was evaluated for androgen binding using a histochemical assay. Of the patients positive for binding 82 per cent either responded to hormonal therapy or remained stable, while 100 per cent of those negative for binding had progression. Of 6 men whose cancer was considered borderline positive 2 manifested a partial clinical response, while 4 had progression.