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McGrath SE, Annels N, Madhuri TK, Tailor A, Butler-Manuel SA, Morgan R, Pandha H, Michael A. Engrailed-2 (EN2) - a novel biomarker in epithelial ovarian cancer. BMC Cancer 2018; 18:943. [PMID: 30285763 PMCID: PMC6171236 DOI: 10.1186/s12885-018-4816-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/13/2018] [Indexed: 11/11/2022] Open
Abstract
Background Epithelial ovarian cancer is a common malignancy, with no clinically approved diagnostic biomarker. Engrailed-2 (EN2) is a homeodomain-containing transcription factor, essential during embryological neural development, which is dysregulated in several cancer types. We evaluated the expression of EN2 in Epithelial ovarian cancer, and reviewed its role as a biomarker. Methods We evaluated 8 Epithelial ovarian cancer cell lines, along with > 100 surgical specimens from the Royal Surrey County Hospital (2009–2014). In total, 108 tumours and 5 normal tissue specimens were collected. En2 mRNA was evaluated by semi-quantitative RT-PCR. Histological sub-type, and platinum-sensitive/−resistant status were compared. Protein expression was assessed in cell lines (immunofluorescence), and in > 150 tumours (immunohistochemistry). Results En2 mRNA expression was elevated in serous ovarian tumours compared with normal ovary (p < 0.001), particularly in high-grade serous ovarian cancer (p < 0.0001) and in platinum-resistant tumours (p = 0.0232). Median Overall Survival and Progression-free Survival were reduced with high En2 expression (OS = 28 vs 42 months, p = 0.0329; PFS = 8 vs 27 months; p = 0.0004). Positive cytoplasmic EN2 staining was demonstrated in 78% of Epithelial ovarian cancers, with absence in normal ovary. EN2 positive high-grade serous ovarian cancer patients had a shorter PFS (10 vs 17.5 months; p = 0.0103). Conclusion The EN2 transcription factor is a novel ovarian cancer biomarker. It demonstrates prognostic value, correlating with worse Overall Survival and Progression-free Survival. It is hoped that further work will validate its use as a biomarker, and provide insight into the role of EN2 in the development, progression and spread of ovarian cancer.
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Affiliation(s)
- Sophie Elena McGrath
- Oncology, School of Biosciences and Medicine, FHMS, University of Surrey, Leggett Building, Daphne Jackson Road, Guildford, GU2 7WG, UK.,Present Address: The Royal Marsden NHS Foundation Trust, Downs Rd, Sutton, London, SM2 5PT, UK
| | - Nicola Annels
- Oncology, School of Biosciences and Medicine, FHMS, University of Surrey, Leggett Building, Daphne Jackson Road, Guildford, GU2 7WG, UK
| | | | - Anil Tailor
- Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | | | - Richard Morgan
- Oncology, School of Biosciences and Medicine, FHMS, University of Surrey, Leggett Building, Daphne Jackson Road, Guildford, GU2 7WG, UK.,Present Address: The Institute of Cancer Therapeutics, University of Bradford, Bradford, West Yorkshire, BD7 1DP, UK
| | - Hardev Pandha
- Oncology, School of Biosciences and Medicine, FHMS, University of Surrey, Leggett Building, Daphne Jackson Road, Guildford, GU2 7WG, UK
| | - Agnieszka Michael
- Oncology, School of Biosciences and Medicine, FHMS, University of Surrey, Leggett Building, Daphne Jackson Road, Guildford, GU2 7WG, UK.
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Abstract
Despite extensive efforts to identify a clinically useful diagnostic biomarker in prostate cancer, no new test has been approved by regulatory authorities. As a result, this unmet need has shifted to biomarkers that additionally indicate presence or absence of "significant" disease. EN2 is a homeodomain-containing transcription factor secreted by prostate cancer into the urine and can be detected by enzyme-linked immunoassay. EN2 may be an ideal biomarker because normal prostate tissue and benign prostatic hypertrophic cells do not secrete EN2. This review discusses the enormous potential of EN2 to address this unmet need and provide the urologist with a simple, inexpensive, and reliable prostate cancer biomarker.
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Affiliation(s)
- Sophie E McGrath
- Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Agnieszka Michael
- Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Richard Morgan
- Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Hardev Pandha
- Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom.
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