Determination of oestrogen responsiveness of breast cancer by competitive reverse transcription-polymerase chain reaction

Genetic and genomic markers of anti-TNF treatment response in rheumatoid arthritis

Despite the success of anti-TNF drugs in the treatment of rheumatoid arthritis, a significant rate of nonresponse remains. Current clinical factors confer little power for predicting response and, in current practice, an unsatisfactory ‘trial and error’ approach governs therapeutic decisions. Candidate gene and unbiased genome-wide investigations have sought to identify genetic biomarkers that predict who will respond to anti-TNF drugs before the drug is administered. To date, few studies have yielded robust associations; herein, we discuss currently identified associations and the issues that need to be addressed in future investigations including insufficient power and an inadequate measure of disease activity. The potential for alternative predictors of anti-TNF therapy response from transcriptomic and epigenetic data will also be explored.

The potential use of expression profiling: implications for predicting treatment response in rheumatoid arthritis

Whole genome expression profiling, or transcriptomics, is a high throughput technology with the potential for major impacts in both clinical settings and drug discovery and diagnostics. In particular, there is much interest in this technique as a mechanism for predicting treatment response. Gene expression profiling entails the quantitative measurement of messenger RNA levels for thousands of genes simultaneously with the inherent possibility of identifying biomarkers of response to a particular therapy or by singling out those at risk of serious adverse events. This technology should contribute to the era of stratified medicine, in which patient specific populations are matched to potentially beneficial drugs via clinical tests. Indeed, in the oncology field, gene expression testing is already recommended to allow rational use of therapies to treat breast cancer. However, there are still many issues surrounding the use of the various testing platforms available and the statistical analysis associated with the interpretation of results generated. This review will discuss the implications this promising technology has in predicting treatment response and outline the various advantages and pitfalls associated with its use.

Are trefoil factors oncogenic?

Trefoil factors (TFFs), in particular TFF1, are classical estrogen-regulated genes and have served as markers of estrogen gene regulation by various environmental estrogens. TFFs are also regulated by several other factors including growth hormone (hGH), insulin-like growth factor-1 (IGF-1), epidermal growth factor (EGF) and various oncogenic stimuli. TFFs are secreted proteins present in serum and possess the potential to act as growth factors promoting cell survival, anchorage-independent growth and motility. Recent compelling evidence has emerged from experimental and clinical studies to indicate a pivotal role of TFFs in oncogenic transformation, growth and metastatic extension of common human solid tumours. This review will summarize the current evidence for the involvement of TFFs in human cancer.

Interaction between TFF1, a Gastric Tumor Suppressor Trefoil Protein, and TFIZ1, a Brichos Domain-Containing Protein with Homology to SP-C

TFF1 is a gastric tumor suppressor that protects gastric epithelial cells from damage but can promote invasive properties of tumor cells. Antibodies were raised against correctly folded TFF1 protein. These showed that the 6.67 kDa secreted trefoil protein is present as an approximately 25 kDa complex in normal human gastric mucosa. The TFF1 complex was immunopurified from human gastric mucosa and shown to comprise two proteins joined by a disulfide bond. Both were identified by amino-terminal sequencing and MALDI TOF mass spectrometry. The TFF1 protein partner is a previously unknown protein that we have called TFIZ1 for trefoil factor interactions(z) 1. TFIZ1 is expressed and secreted in normal gastric mucosa. TFIZ1 mRNA was cloned from gastric mucosa and sequenced. TFIZ1 is an 18.31 kDa protein and contains an approximately 100 amino acid brichos domain and homology with smart00019.10, SF_P. This is the first demonstration that a member of the trefoil factor family of proteins is bound covalently to a brichos domain-containing protein. The apparent molecular mass of the TFF1:TFIZ1 heterodimer is remarkably close to the theoretical molecular mass of 24.98 kDa. In conclusion, the heterodimer comprises one molecule each of TFF1 and TFIZ1, and the disulfide bond between TFF1 and TFIZ1 is the most important factor stabilizing the heterodimer.

Expression and motogenic activity of TFF2 in human breast cancer cells

The expression of TFF2 in breast cancer cells and the effect of recombinant TFF2 on breast cancer cell migration were assessed. TFF2 expression was detected by PCR in estrogen receptor-negative and at lower levels in estrogen receptor-positive breast cancer cells. TFF2 expression was detected in nine out of 10 primary breast tumors but its expression was not related to that of the estrogen receptor. Focal expression was observed in normal and tumor cells by immunohistochemistry. TFF2 stimulated the migration of estrogen-responsive MCF-7 and non-responsive MDA-MB231 cells. We conclude that TFF2 is expressed in normal and malignant breast epithelial cells and that it stimulates the migration of breast cancer cells.

The estrogen-regulated protein, TFF1, stimulates migration of human breast cancer cells

The human trefoil protein TFF1 is a small cysteine-rich secreted protein that is frequently expressed in breast tumors under the control of estrogen. The function of TFF1 in breast cancer is unknown. To test the hypothesis that it promotes tumor dissemination, we produced recombinant TFF1 and assessed its ability to stimulate the movement of breast cancer cells by using in vitro wounding and migration assays. Recombinant TFF1 stimulated migration at concentrations of TFF1 found in culture medium. Migration of MCF-7 breast cancer cells, which secrete TFF1, was stimulated by lower concentrations of TFF1 than MDA MB231 cells that do not produce TFF1. Dimeric TFF1, linked by a disulfide bond, and monomeric TFF1 are produced by estrogen-responsive breast cancer cell lines. Recombinant TFF1 dimer was eightfold more potent than TFF1 monomer, implying that the interaction of TFF1 with its receptor is facilitated by dimerization. The majority of TFF1-stimulated migration resulted from chemotaxis, but dimeric TFF1 stimulated some chemokinesis. These results show that estrogens can stimulate the motility of breast cancer cells via the induction of TFF1 and suggest that one reason for the efficacy of hormonal therapies is their ability to reduce expression of TFF1 and, hence, the migration of breast tumor cells.

Changes in expression of estrogen receptors alpha and beta in relation to progesterone receptor and pS2 status in normal and malignant endometrium

To clarify changes in estrogen receptor (ER) alpha and ERbeta during endometrial tumorigenesis, 48 endometrial carcinomas (endometrioid type), as well as 40 samples of normal endometrial tissue, were investigated using a combination of reverse-transcription and polymerase chain reaction with Southern blot hybridization and western blot assays, and the results were compared with findings for progesterone receptor (PR) and pS2 mRNA status. In addition, 166 carcinomas were also examined for immunohistochemistry, along with 171 normal specimens. Relative amounts of ERalpha at both mRNA and protein levels were significantly greater than those for ERbeta in normal and malignant endometrial lesions. ERalpha mRNA showed a stepwise decrease from normal or grade (G) 1 through to G3 tumor lesions, in line with changes in the protein levels, in contrast to ERbeta mRNA or protein expression, which did not alter, suggesting a shift in the ratio of the two ER subtypes during endometrial tumorigenesis. PR mRNA expression was significantly correlated with ERalpha, but not ERbeta mRNA status. Although significantly higher expression of pS2 mRNA or protein was observed in carcinomas than in the normal cases, there was no apparent association with the ER status. The findings suggest that alteration in estrogen signaling pathways may occur during endometrial tumorigenesis, and provide evidence that ERalpha expression may play an important role in the regulation of PR, but not pS2 expression in normal and malignant endometrium.

Up-regulation of pS2 expression during the development of adenocarcinomas but not squamous cell carcinomas of the uterine cervix, independently of expression of c-jun or oestrogen and progesterone receptors

The pS2 gene product was firstly identified as an oestrogen-induced molecule in a breast cancer cell line, while recent studies demonstrate a close association with mucus-secreting epithelia. To assess pS2 expression in uterine cervical adenocarcinomas (C-ACas) and invasive squamous cell carcinomas (C-ISCCs), a series of 94 and 86 cases, respectively, as well as 77 samples of normal cervix, were immunohistochemically investigated and the results compared with data for expression of oestrogen and progesterone receptors (ER and PR) and c-jun. RT-PCR and western blot assays were also applied to 21 cervical carcinomas and 24 normal tissues. With cervical glandular lesions, significant up-regulation of pS2 expression at both the mRNA and the protein levels was observed for adenocarcinomas in situ (AISs) and overt carcinomas, closely linked with mucinous differentiation and tumour grades. pS2 scores were inversely related to ERalpha status for all cervical glandular categories, while there was no association with ERbeta and PR values. In squamous lesions, pS2 values did not differ between normal and malignant lesions, in contrast to the significant down-regulation of ERalpha expression with tumour development. Although c-jun expression significantly correlated with ERalpha values for all squamous categories, it did not relate to pS2 status in either C-ACas or ISCCs. These results indicate that alterations in pS2 expression may occur relatively early in the development of cervical glandular, but not squamous lesions, independently of factors known to promote transcription of the pS2 gene.

Selective promoter usage of the human estrogen receptor-alpha gene and its regulation by estrogen

Three promoters have been identified for the human estrogen receptor-alpha gene. The positions of promoters A and B are known whereas that of the recently identified promoter C is not. Cloning and hybridization experiments demonstrated that promoter C is located more than 21 kb upstream of promoter A. The use of the three promoters was examined in estrogen receptor-positive breast cancer cell lines, cell lines derived from other malignancies, and some normal tissues by RT-PCR and transient transfection. All estrogen-responsive breast cancer cell lines used all three promoters, apart from ZR-75 cells, which did not use promoter B in one of two sublines examined. Cell lines derived from other malignancies and other normal tissues that express lower levels of estrogen receptor-alpha showed more selective promoter usage. This suggests that the level of expression of estrogen receptor-alpha is determined by the number of promoters used, rather than the selective use of specific promoters. We also show that promoter C is used more widely than suggested by others. Analysis of a series of estrogen receptor-positive primary breast tumors showed that all three promoters were used in all the tumors. All three promoters were modulated by estrogen in estrogen-responsive breast cancer cell lines: all three promoters were down-regulated by estrogen in MCF-7 cells in which estrogens reduce receptor expression whereas all promoters used were upregulated in T47D, ZR-75, and EFM-19 cells in which estrogens increase receptor expression. This suggests that it is the repertoire of transcription factors present within a cell rather than the selective use of a specific promoter that determines whether estrogen receptor-alpha expression is increased or decreased by estrogen.

pS2 (TFF1) levels in human breast cancer tumor samples: correlation with clinical and histological prognostic markers

The expression of pS2 (TFF1) has been previously shown to identify patients with improved response to anti-hormonal therapy and more favorable outcome. In the current study, 100 human breast carcinoma samples obtained from the Manitoba Breast Tumor Bank were analyzed for pS2 mRNA using a quantitative, competitive reverse transcriptase-polymerase chain reaction (qcRT-PCR) assay. A pS2/beta-actin cut-off criterion of 0.010 was established to classify tumors as either pS2 positive or pS2 negative. pS2 mRNA levels were positively associated with both ER and PR, with the majority of ER+ (59%) and PR+ (60%) tumors also being positive for pS2. In addition, a significant linear correlation was observed between the amount of pS2 mRNA and ER (p < 0.0001) and PR (p < 0.0001) protein. pS2 mRNA levels also exhibited an inverse association with tumor size and histological grade, consistent with the observation that pS2 is primarily expressed in small (T < 2.0 cm), but well differentiated tumors (Grades I and II). No associations were observed with tumor cell type, patient age, or lymph node status. The strong correlation displayed between pS2 and a number of currently used breast cancer prognostic markers supports the clinical use of pS2 to further assess tumor status and patient outcome.

PS2 mRNA expression adds prognostic information to node status for 6-year survival in breast cancer

Expression of pS2, an oestrogen-regulated gene, has been associated with a good short-term prognosis and response to endocrine therapy. The aim of this study was to determine whether expression of mRNA for the pS2 gene in breast cancer could contribute useful information on disease behaviour and survival at medium-term follow-up. Northern blotting was used to detect pS2 messenger ribonucleic acid (mRNA) in the primary tumour tissue from each of 90 patients with breast cancer. Axillary node status was established by sampling or clearance, oestrogen receptor concentration by enzyme immunosorbant assay and follow-up was continued for at least 6 years or until death. At 83 months mean follow-up, 29 of 90 (32%) patients had recurrent disease and, of these, 18 (20%) had died from breast cancer. pS2 mRNA expression, present in 26 of 90 (29%) cancers, was associated with freedom from disease recurrence (P = 0.026) and was significantly associated with survival at a minimum of 6 years follow-up (P < 0.001). Pathological node status and tumour size were also significantly associated with disease recurrence (P < 0.001 and P = 0.002 respectively) and inversely with survival (P < 0.001 and P < 0.001 respectively). After multiple Cox regression analysis, pS2 expression was still a significant predictor of recurrence (but not survival) after adjusting for node status and tumour size; oestrogen receptor was an independent predictor of survival. The combination of node status and pS2 expression discriminated patients with particularly good prognosis (node negative, pS2 positive: no mortality at 6 years) or poor prognosis (node positive, pS2 negative; 41% mortality at 6 years). Evaluation of pS2 expression in breast cancer at diagnosis may provide additional useful prognostic information to conventional staging.

Abundance of BRCA1 transcripts in human cancer and lymphoblastoid cell lines carrying BRCA1 germ-line alterations

A competitive polymerase chain reaction has been developed for quantitation of BRCA1 mRNA. In human cancer cell lines, the amount of BRCA1 mRNA is relatively low, ranging from 6 to 38 copies per cell. The decay rate of these transcripts in actinomycin-treated cells indicates that the half-life of these molecules is about 4 hr, suggesting that the low concentration of BRCA1 messages is not due to molecular unstability. In human lymphoblastoid cell lines derived from patients carrying germ-line alterations of BRCA1, the amount of BRCA1 mRNA per cell is lowered only in cell lines exhibiting alterations leading to specific loss of transcripts from the mutated allele. These data indicate that the amount of BRCA1 available in these cells can be related directly to the number of "active" allele.

Immunohistochemical detection of oestrogen receptors in ductal carcinoma in situ of the breast

The expression of oestrogen receptor (ER) protein in invasive carcinoma of the breast and its clinical significance has been extensively evaluated. Little information is available regarding ER expression in ductal carcinoma in situ (DCIS). In this study, 46 formalin-fixed, paraffin-embedded tissue specimens of mammographically detected DCIS were evaluated immunohistochemically for the presence of ER using specific monoclonal antibodies against ER (ER-ICA Abbott Lab). The associations between ER expression and histological type, degree of differentiation and patient menopausal status were evaluated. Positive ER staining was present in 72% of cases. Non-comedo types of DCIS were more frequently ER-positive than comedocarcinoma. ER-positive tumours were inversely correlated with the presence of nuclear pleomorphism. The incidence of ER in pre-menopausal and post-menopausal women was similar. In conclusion, ER expression is present in a considerable percentage of DCIS, and ER-positivity is associated with the degree of differentiation and non-comedo carcinoma variants.

The detection of nodal metastasis in breast cancer using neural network techniques

Identification and treatment of involved axillary lymph nodes is important in the planning of strategies for adjuvant treatments of breast cancer. With the advent of the National Health Service Screening Programme, an increasing number of women with the disease are detected at an early stage, when the lymph nodes are not involved. In whom, therefore, is it necessary to carry out a formal axillary dissection? Are there accurate surrogates for lymph node involvement in the form of tumour markers or characteristics? This study, carried out on over 81 patients, examines the use of neural networks to predict the involvement of lymph nodes using readily available clinical and pathological data and also more specialized markers of possible prognostic significance. The study shows that neural networks are capable of providing strong indicators as to lymph node status using only basic measurements of the primary breast tumour. However, accuracy can be improved by the addition of less common markers.