Regulation of EZH2 protein stability: new mechanisms, roles in tumorigenesis, and roads to the clinic

The importance of EZH2 as a key methyltransferase has been well documented theoretically. Practically, the first EZH2 inhibitor Tazemetostat (EPZ6438), was approved by FDA in 2020 and is used in clinic. However, for most solid tumors it is not as effective as desired and the scope of clinical indications is limited, suggesting that targeting its enzymatic activity may not be sufficient. Recent technologies focusing on the degradation of EZH2 protein have drawn attention due to their potential robust effects. This review focuses on the molecular mechanisms that regulate EZH2 protein stability via post-translational modifications (PTMs), mainly including ubiquitination, phosphorylation, and acetylation. In addition, we discuss recent advancements of multiple proteolysis targeting chimeras (PROTACs) strategies and the latest degraders that can downregulate EZH2 protein. We aim to highlight future directions to expand the application of novel EZH2 inhibitors by targeting both EZH2 enzymatic activity and protein stability.

A hybrid breast cancer/mesenchymal stem cell population enhances chemoresistance and metastasis

Patients with triple-negative breast cancer remain at risk for metastatic disease despite treatment. The acquisition of chemoresistance is a major cause of tumor relapse and death, but the mechanisms are far from understood. We have demonstrated that breast cancer cells (BCCs) can engulf mesenchymal stem/stromal cells (MSCs), leading to enhanced dissemination. Here, we show that clinical samples of primary invasive carcinoma and chemoresistant breast cancer metastasis contain a unique hybrid cancer cell population coexpressing pancytokeratin and the MSC marker fibroblast activation protein-α. We show that hybrid cells form in primary tumors and that they promote breast cancer metastasis and chemoresistance. Using single-cell microfluidics and in vivo models, we found that there are polyploid senescent cells within the hybrid cell population that contribute to metastatic dissemination. Our data reveal that Wnt Family Member 5A (WNT5A) plays a crucial role in supporting the chemoresistance properties of hybrid cells. Furthermore, we identified that WNT5A mediates hybrid cell formation through a phagocytosis-like mechanism that requires BCC-derived IL-6 and MSC-derived C-C Motif Chemokine Ligand 2. These findings reveal hybrid cell formation as a mechanism of chemoresistance and suggest that interrupting this mechanism may be a strategy in overcoming breast cancer drug resistance.

Personalized Oncology by In Vivo Chemical Imaging: Photoacoustic Mapping of Tumor Oxygen Predicts Radiotherapy Efficacy

We hereby apply the approach of photoacoustic chemical imaging, performing an in vivo chemical analysis that is spatially resolved (200 μm) and in real time, to predict a given tumor's response to therapy. Using triple negative breast cancer as a model, we took photoacoustic images of tumors' oxygen distributions in patient-derived xenografts (PDXs) in mice using biocompatible, oxygen-sensitive tumor-targeted chemical contrast nanoelements (nanosonophores), which function as contrast agents for photoacoustic imaging. Following radiation therapy, we established a quantitatively significant correlation between the spatial distribution of the initial oxygen levels in the tumor and its spatial distribution of the therapy's efficacy: the lower the local oxygen, the lower the local radiation therapy efficacy. We thus provide a simple, noninvasive, and inexpensive method to both predict the efficacy of radiation therapy for a given tumor and identify treatment-resistant regions within the tumor's microenvironment.

Abstract PD5-06: PD5-06 CCN6 suppresses spindle metaplastic breast carcinoma in part via antagonizing Wnt/β-catenin signaling

Background: Metaplastic breast carcinomas (mBrCAs) are a rare and highly aggressive subtype of triple negative breast cancer, with histological evidence of non-glandular differentiation and frequent activation of the canonical (-catenin-dependent) Wnt pathway. Our laboratory has reported that CCN6 is expressed in normal mammary epithelium, but CCN6 expression is lost in 68% of spindle mBrCAs. We found mice with mammary epithelial cell-specific conditional deletion of Ccn6 (MMTV-Cre; Ccn6fl/fl mice) develop mammary tumors that recapitulate human spindle mBrCAs, including upregulation of Wnt pathway genes. We investigated if and how secreted CCN6 protein functions in tumor suppression in spindle mBrCA via effects on the canonical Wnt pathway. Methods: To investigate CCN6 binding to the Wnt co-receptors LRP6 and FZD8 proteins, we performed Flag-IPs on MDA-MB231 mesenchymal-like breast cancer cells expressing Flag-CCN6 or vector. Effects of CCN6 on b-catenin subcellular localization and gene and protein expression were studied by IHC, IF, qRT-PCR and immunoblot in human cell lines and MMTV-Cre;Ccn6fl/fl tumors. To test effects of recombinant CCN6 on canonical Wnt signaling, we used the Leading-Light Wnt Reporter Assay and also tested CCN6 effects in WNT3A- and WNT10B-mediated Wnt signaling activation and on MDA-MB231 cell invasion. To study b-catenin/TCF function in invasive growth of CCN6-deficient cancer cells, we employed two independent approaches: i) expression of a dominant-negative Tcf4 (dnTcf4) versus control vector in MMTV-Cre; Ccn6fl/fl tumor-derived cells; and ii) expression of a constitutively active mutant (S33Y) b-catenin in concert with treatment with recombinant human CCN6 (rhCCN6; 500 ug/ml) versus BSA control. Syngeneic orthotopic mammary tumor transplants of MMTV-Cre;Ccn6fl/fl were used in vivo for rescue experiments with i.p. injections of rhCCN6 or BSA. We monitored tumor growth and morphology, and performed IHC to determine b-catenin localization and expression. Results: We found in co-IPs that CCN6 interacts with LRP6 and FZD8 to form a complex that antagonizes canonical Wnt signaling. CCN6 ectopic expression in MDA-MB231 cells led to reduced nuclear and increased membrane localization of b-catenin and decreased invasive growth in vitro. In vivo, CCN6 protein administration to MMTV-Cre; Ccn6fl/fl mice reduced tumor growth and was linked to decreased nuclear b-catenin in the tumors. Conclusion: CCN6 antagonizes canonical Wnt/b-catenin in part by binding Wnt ligands, leading to reduced active b-catenin in the cytoplasm and nucleus. Our data indicate a critical role for b-catenin activation for CCN6-deficient mBrCA tumor phenotypes. In vivo, rhCCN6 protein reduces tumorigenesis in MMTV-Cre; Ccn6fl/fl mBrCA tumors, highlighting how CCN6 restoration or b-catenin inhibition could be new therapeutic approaches for mBrCAs.

Citation Format: Maria E. Gonzalez, Eric R. Fearon, Celina Kleer. PD5-06 CCN6 suppresses spindle metaplastic breast carcinoma in part via antagonizing Wnt/β-catenin signaling [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD5-06.

Abstract P5-06-06: Hybrid cells generated by Mesenchymal Stem/Stromal Cell Engulfment enhance breast cancer metastasis upon Doxorubicin treatment in mouse model

Introduction: Our previous findings evidenced that BCCs engulf MSCs in clinical samples of breast cancer metastasis. Among the BCC-engulfing MSCs, we observed that some of them retain some markers of MSCs, resulting in the generation of hybrid cancer cell population. However, the mechanisms of hybrid cancer cell formation and the phenotypic features of hybrid cancer cells are still unclear. Here, we tested the hypothesis that hybrid cancer cells may acquire in vivo a dormant phenotype, with an increased survival advantage and chemoresistant features. Method: MSC labeled with DsRED (DsRED-MSC) were cultured with MDA-MB-231 labeled with GFP (GFP-231) to generate a hybrid cell-enriched co-culture. Live imaging microscopy, flow cytometry, cytokine array and western blot were used to characterize the hybrid cancer cells. GFP-231 were incubated with phRodo labeled MSC and subjected to phagocytosis assay. In the co-culture of DsRED-MSC with GFP-231 treated with Doxorubicin (Doxo) or untreated, we analyzed the percentage of DsRED+/GFP+ hybrid population. Hybrid-enriched co-culture or GFP-231 in single culture labeled with firefly luciferase were intracardially injected in NOD/SCID mice and monitored for metastases by bioluminescence imaging (BLI), upon Doxo treatment. After collecting the tissues at necropsy, metastases were identified by GFP fluorescence microscopy. Results: In co-cultures, DsRED+/GFP+ hybrid cells had a higher percentage of Ki-67 low in G1 and polyploidy compared to GFP-231+ cells. Hybrid cancer cells have a distinct cytokine profile than control BCCs with increased levels of senescence-associated secretory phenotype (SASP) factors. Hybrid cancer cell formation occurs through a phagocytosis-like mechanism, which involves WNT5A and MSR1. Doxo treatment increased the percentage of DsRED+/GFP+ hybrid cells, whereas reduced the percentage of GFP-231+ cells. In animal study, we observed a lower qualitative BLI intensity in mice injected with hybrid cell-enriched co-cultures compared to control. Doxo treatment increased the metastatic burden in mice inoculated with hybrid cell-enriched co-cultures compared to untreated Conclusions: MSC engulfment by BCCs results in a hybrid multinucleated cell population. Hybrid cells acquire a dormant phenotype characterized by a higher percentage of Ki-67low cells in G1 and a senescent phenotype compared to controls. Hybrid-cell-enriched co-cultures established less metastasis compared to control in vivo, but became resistant and acquire the ability to form metastasis upon doxo treatment.

Citation Format: Giuseppina Augimeri, Maria E. Gonzalez, Daniela Bonofiglio, Sebastiano Andò, Celina G. Kleer. Hybrid cells generated by Mesenchymal Stem/Stromal Cell Engulfment enhance breast cancer metastasis upon Doxorubicin treatment in mouse model [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-06-06.

The matricellular protein CCN6 differentially regulates mitochondrial metabolism in normal epithelium and in metaplastic breast carcinomas

Metaplastic breast carcinoma (MBC) is an aggressive subtype of triple negative breast cancer with undefined precursors, limited response to chemotherapy, and frequent distant metastasis. Our laboratory has reported that CCN6/WISP3, a secreted protein that regulates growth factor signaling, is downregulated in over 85% of MBCs. Through generation of a mammary epithelial cell-specific Ccn6 knockout mouse model (MMTV-cre;Ccn6^fl/fl) we have demonstrated that CCN6 is a tumor suppressor for MBC; MMTV-cre;Ccn6^fl/fl mice develop tumors recapitulating the histopathology and proteogenomic landscape of human MBC, but the mechanisms need further investigation. In this study, we report that preneoplastic mammary glands of 8-week-old MMTV-Cre;Ccn6^fl/fl female mice show significant downregulation of mitochondrial respiratory chain genes compared to controls, which are further downregulated in MBCs of MMTV-Cre;Ccn6^fl/fl mice and humans. We found that CCN6 downregulation in non-tumorigenic breast cells reduces mitochondrial respiration and increases resistance to stress-induced apoptosis compared to controls. Intracellular ectopic CCN6 protein localizes to the mitochondria in MDA-MB-231 mesenchymal-like breast cancer cells, increases mitochondrial respiration and generation of reactive oxygen species, and reverses doxorubicin resistance of MBC cells. Our data highlight a novel function of CCN6 in the regulation of redox states in preneoplastic progression and suggest potential preventative and treatment strategies against MBC based on CCN6 upregulation.

Subcellular localization of EZH2 phosphorylated at T367 stratifies metaplastic breast carcinoma subtypes

BACKGROUND

Metaplastic carcinoma is an aggressive, triple-negative breast cancer (TNBC) with differentiation towards squamous, spindle, or mesenchymal cell types. The molecular underpinnings of the histological subtypes are unclear. Our lab discovered a cytoplasmic function of EZH2, a transcriptional repressor, whereby pEZH2 T367 binds to cytoplasmic proteins in TNBC cells and enhances invasion and metastasis. Here, we investigated the expression and subcellular localization of pEZH2 T367 protein in metaplastic carcinomas.

METHODS

Thirty-five metaplastic carcinomas (17 squamous, 10 mesenchymal, and 8 spindle) were evaluated and immunostained with anti-pEZH2 T367. We analyzed staining intensity (score 1-4), subcellular localization (nuclear/cytoplasmic), and localization within the tumor (center/invasive edge). Protein expression of pEZH2 T367-binding partners was measured from a quantitative multiplex proteomics analysis performed in our lab.

RESULTS

Cytoplasmic pEZH2 T367 was significantly upregulated in squamous (14 of 17, 82%) compared to mesenchymal (4 of 10, 40%) and spindle (2 of 6, 33%) subtypes (p = 0.011). Twenty-five of 34 (73%) tumors with available tumor-normal interface showed accentuated cytoplasmic pEZH2 T367 at the infiltrative edge. Cytoplasmic pEZH2 T367 was upregulated in 9 of 10 (90%) tumors with lymph node metastasis (p = 0.05). Bioinformatics analyses identified an EZH2 protein network in metaplastic carcinomas (p value: < 1.0e-16). Using quantitative proteomics, we found significantly increased expression of cytoplasmic EZH2-binding partners in squamous compared to spindle and mesenchymal subtypes.

CONCLUSIONS

pEZH2 T367 expression and subcellular localization may be useful to distinguish metaplastic carcinoma subtypes. pEZH2 T367 may play a role in the histological diversity and behavior of these tumors.

Mesenchymal Stem/Stromal Cell Engulfment Reveals Metastatic Advantage in Breast Cancer

Twenty percent of breast cancer (BC) patients develop distant metastasis for which there is no cure. Mesenchymal stem/stromal cells (MSCs) in the tumor microenvironment were shown to stimulate metastasis, but the mechanisms are unclear. Here, we identified and quantified cancer cells engulfing stromal cells in clinical samples of BC metastasis by dual immunostaining for EZH2 and ALDH1 expression. Using flow cytometry and a microfluidic single-cell paring and retrieval platform, we show that MSC engulfment capacity is associated with BC cell metastatic potential and generates cells with mesenchymal-like, invasion, and stem cell traits. Whole-transcriptome analyses of selectively retrieved engulfing BC cells identify a gene signature of MSC engulfment consisting of WNT5A, MSR1, ELMO1, IL1RL2, ZPLD1, and SIRPB1. These results delineate a mechanism by which MSCs in the tumor microenvironment promote metastasis and provide a microfluidic platform with the potential to predict BC metastasis in clinical samples.

Integrating untargeted metabolomics, genetically informed causal inference, and pathway enrichment to define the obesity metabolome

BACKGROUND

Obesity and its associated diseases are major health problems characterized by extensive metabolic disturbances. Understanding the causal connections between these phenotypes and variation in metabolite levels can uncover relevant biology and inform novel intervention strategies. Recent studies have combined metabolite profiling with genetic instrumental variable (IV) analysis (Mendelian randomization) to infer the direction of causality between metabolites and obesity, but often omitted a large portion of untargeted profiling data consisting of unknown, unidentified metabolite signals.

METHODS

We expanded upon previous research by identifying body mass index (BMI)-associated metabolites in multiple untargeted metabolomics datasets, and then performing bidirectional IV analysis to classify metabolites based on their inferred causal relationships with BMI. Meta-analysis and pathway analysis of both known and unknown metabolites across datasets were enabled by our recently developed bioinformatics suite, PAIRUP-MS.

RESULTS

We identified ten known metabolites that are more likely to be causes (e.g., alpha-hydroxybutyrate) or effects (e.g., valine) of BMI, or may have more complex bidirectional cause-effect relationships with BMI (e.g., glycine). Importantly, we also identified about five times more unknown than known metabolites in each of these three categories. Pathway analysis incorporating both known and unknown metabolites prioritized 40 enriched (p < 0.05) metabolite sets for the cause versus effect groups, providing further support that these two metabolite groups are linked to obesity via distinct biological mechanisms.

CONCLUSIONS

These findings demonstrate the potential utility of our approach to uncover causal connections with obesity from untargeted metabolomics datasets. Combining genetically informed causal inference with the ability to map unknown metabolites across datasets provides a path to jointly analyze many untargeted datasets with obesity or other phenotypes. This approach, applied to larger datasets with genotype and untargeted metabolite data, should generate sufficient power for robust discovery and replication of causal biological connections between metabolites and various human diseases.

Synthesis of carbon nanotubes using biochar as precursor material under microwave irradiation

Biochar is a carbon-rich porous material obtained by the thermochemical treatment of biomass. Biochar presents a suitable composition as precursor material for carbon nanotubes (CNTs) growth, and can be used as a sustainable alternative in the valorization of biomass. In this study, the synthesis of CNTs using biochar as biological precursor material is presented. CNTs were synthesized using a mixture of biochar and ferrocene including microwave assisted heating. Biochar samples used in the synthesis of CNTs were obtained from agroindustrial waste such as wheat straw, oat hulls, rapeseed cake and hazelnut hulls pyrolyzed at 400 °C and 600 °C. Synthesized CNTs were examined by dynamic light scattering, UV-VIS spectroscopy, Raman spectroscopy and transmission electron microscopy. The results indicate that the physicochemical properties of CNTs were influenced by pyrolysis temperature of biomass. Biochars obtained at 600 °C produced higher CNTs concentration and smaller hydrodynamic diameter. Moreover, CNTs synthesized from biochar of hazelnut hulls and wheat straw show a higher degree of wall graphitization, suggesting superior CNT quality. The results of this study show the feasible production of CNTs using biochar as precursor material.

A reproducible scaffold-free 3D organoid model to study neoplastic progression in breast cancer

While 3D cellular models are useful to study biological processes, gel-embedded organoids have large variability. This paper describes high-yield production of large (~1 mm diameter), scaffold-free, highly-spherical organoids in a one drop-one organoid format using MCF10A cells, a non-tumorigenic breast cell line. These organoids display a hollow lumen and secondary acini, and express mammary gland-specific and progenitor markers, resembling normal human breast acini. When subjected to treatment with TGF-β, the hypoxia-mimetic reagent CoCl2, or co-culture with mesenchymal stem/stromal cells (MSC), the organoids increase collagen I production and undergo large phenotypic and morphological changes of neoplastic progression, which were reproducible and quantifiable. Advantages of this scaffold-free, 3D breast organoid model include high consistency and reproducibility, ability to measure cellular collagen I production without noise from exogenous collagen, and capacity to subject the organoid to various stimuli from the microenvironment and exogenous treatments with precise timing without concern of matrix binding. Using this system, we generated organoids from primary metaplastic mammary carcinomas of MMTV-Cre;Ccn6fl/fl mice, which retained the high grade spindle cell morphology of the primary tumors. The platform is envisioned to be useful as a standardized 3D cellular model to study how microenvironmental factors influence breast tumorigenesis, and to potential therapeutics.

PAIRUP-MS: Pathway analysis and imputation to relate unknowns in profiles from mass spectrometry-based metabolite data

Metabolomics is a powerful approach for discovering biomarkers and for characterizing the biochemical consequences of genetic variation. While untargeted metabolite profiling can measure thousands of signals in a single experiment, many biologically meaningful signals cannot be readily identified as known metabolites nor compared across datasets, making it difficult to infer biology and to conduct well-powered meta-analyses across studies. To overcome these challenges, we developed a suite of computational methods, PAIRUP-MS, to match metabolite signals across mass spectrometry-based profiling datasets and to generate metabolic pathway annotations for these signals. To pair up signals measured in different datasets, where retention times (RT) are often not comparable or even available, we implemented an imputation-based approach that only requires mass-to-charge ratios (m/z). As validation, we treated each shared known metabolite as an unmatched signal and showed that PAIRUP-MS correctly matched 70–88% of these metabolites from among thousands of signals, equaling or outperforming a standard m/z- and RT-based approach. We performed further validation using genetic data: the most stringent set of matched signals and shared knowns showed comparable consistency of genetic associations across datasets. Next, we developed a pathway reconstitution method to annotate unknown signals using curated metabolic pathways containing known metabolites. We performed genetic validation for the generated annotations, showing that annotated signals associated with gene variants were more likely to be enriched for pathways functionally related to the genes compared to random expectation. Finally, we applied PAIRUP-MS to study associations between metabolites and genetic variants or body mass index (BMI) across multiple datasets, identifying up to ~6 times more significant signals and many more BMI-associated pathways compared to the standard practice of only analyzing known metabolites. These results demonstrate that PAIRUP-MS enables analysis of unknown signals in a robust, biologically meaningful manner and provides a path to more comprehensive, well-powered studies of untargeted metabolomics data.

Untargeted metabolomics can systematically profile thousands of metabolite signals in biological samples and is an increasingly popular approach for discovering biomarkers and predictors for human traits and diseases. However, currently, a significant portion of the measured signals cannot be identified as known metabolites or easily compared across datasets, and thus are usually excluded from downstream analyses. Here, we present PAIRUP-MS, a suite of computational methods designed to analyze unknown, unidentified signals across multiple mass spectrometry-based profiling datasets. Specifically, PAIRUP-MS contains a flexible imputation-based approach for pairing up unknown signals across datasets, allowing for meta-analysis of matched signals across studies that would otherwise be incompatible. PAIRUP-MS also offers a pathway annotation and enrichment analysis framework that links metabolite signals to plausible biological functions without using their chemical identities. Importantly, we validated both components of PAIRUP-MS using genetic data and applied them to study an example trait, body mass index. Overall, our results demonstrate that PAIRUP-MS enables previously infeasible analyses of unknown, unidentified signals across multiple datasets, thereby greatly improving power for discovery and biological inference.

CCN6 regulates IGF2BP2 and HMGA2 signaling in metaplastic carcinomas of the breast

PURPOSE

Metaplastic breast carcinomas are an aggressive subtype of triple-negative breast cancer (TNBC) in which part or all of the adenocarcinoma transforms into a non-glandular component (e.g., spindled, squamous, or heterologous). We discovered that mammary-specific Ccn6/Wisp3 knockout mice develop mammary carcinomas with spindle and squamous differentiation that share upregulation of the oncofetal proteins IGF2BP2 (IMP2) and HMGA2 with human metaplastic carcinomas. Here, we investigated the functional relationship between CCN6, IGF2BP2, and HMGA2 proteins in vitro and in vivo, and their expression in human tissue samples.

METHODS

MMTV-cre;Ccn6^fl/fl tumors and spindle TNBC cell lines were treated with recombinant CCN6 protein or vehicle. IGF2BP2 was downregulated using shRNAs in HME cells with stable CCN6 shRNA knockdown, and subjected to invasion and adhesion assays. Thirty-one human metaplastic carcinomas were arrayed in a tissue microarray (TMA) and immunostained for CCN6, IGF2BP2, and HMGA2.

RESULTS

CCN6 regulates IGF2BP2 and HMGA2 protein expression in MMTV-cre;Ccn6^fl/fl tumors, in MDA-MB-231 and - 468, and in HME cells. CCN6 recombinant protein reduced IGF2BP2 and HMGA2 protein expression, and decreased growth of MMTV-cre;Ccn6^fl/fl tumors in vivo. IGF2BP2 shRNA knockdown was sufficient to reverse the invasive abilities conferred by CCN6 knockdown in HME cells. Analyses of the TCGA Breast Cancer Cohort (n = 1238) showed that IGF2BP2 and HMGA2 are significantly upregulated in metaplastic carcinoma compared to other breast cancer subtypes. In clinical samples, low CCN6 is frequent in tumors with high IGF2BP2/HMGA2 with spindle and squamous differentiation.

CONCLUSIONS

These data shed light into the pathogenesis of metaplastic carcinoma and demonstrate a novel CCN6/IGF2BP2/HMGA2 oncogenic pathway with biomarker and therapeutic implications.

p38-mediated phosphorylation at T367 induces EZH2 cytoplasmic localization to promote breast cancer metastasis

Overexpression of EZH2 in estrogen receptor negative (ER-) breast cancer promotes metastasis. EZH2 has been mainly studied as the catalytic component of the Polycomb Repressive Complex 2 (PRC2) that mediates gene repression by trimethylating histone H3 at lysine 27 (H3K27me3). However, how EZH2 drives metastasis despite the low H3K27me3 levels observed in ER- breast cancer is unknown. Here we show that in human invasive carcinomas and distant metastases, cytoplasmic EZH2 phosphorylated at T367 is significantly associated with ER- disease and low H3K27me3 levels. p38-mediated EZH2 phosphorylation at T367 promotes EZH2 cytoplasmic localization and potentiates EZH2 binding to vinculin and other cytoskeletal regulators of cell migration and invasion. Ectopic expression of a phospho-deficient T367A-EZH2 mutant is sufficient to inhibit EZH2 cytoplasmic expression, disrupt binding to cytoskeletal regulators, and reduce EZH2-mediated adhesion, migration, invasion, and development of spontaneous metastasis. These results point to a PRC2-independent non-canonical mechanism of EZH2 pro-metastatic function.

Abstract 176: DDR2-depleted mesenchymal stem cells attenuate the tumor-promoting effect of breast cancer cell engulfment

Background: Mesenchymal stem cells (MSCs) are recruited to the tumor microenvironment and promote tumor progression. We have demonstrated that MSC expressing DDR2, a collagen receptor, mediates stromal-breast cancer direct interactions and promotes metastatic growth. Tumor microenvironment studies have shown that transfer of cellular constituents from stromal cells to cancer cells stimulate malignant behavior but the mechanisms need further study. Pathologists have noticed that metastatic carcinoma cells in tissues display cell “cannibalism”, and MDA-MB-231 cells were recently found to cannibalize MSC, but the in vivo consequences and mechanisms are unclear. We hypothesize that breast cancer cells engulf MSC which enables metastatic dissemination, and that DDR2 inhibition in MSC may block this effect.

Methods: We used GFP labeled breast cancer cells (BCC) of high metastatic potential (MDA-MB-231 and -436), non-metastatic (MCF7), and non-tumorigenic (HME and MCF10A), and Ds-RED labeled MSC controls (MSC-shC) and with DDR2 shRNA knockdown (MSC-shDDR2). 3D-Co-culturing MSC-Ds-Red and BCC-GFP and Image Stream flow cytometry single cell system were used to quantify cell engulfing. Live Imaging Delta Vision was used to visualize engulfing. We developed a microfluidic high-throughput cell paring and retrieval platform to study BCC-MSC-shC and shDDR2 engulfing clones which allowed selective retrieval of single cells. RNA sequencing of engulfing MSC-shC or MSC-shDDR2 BCCs clones was compared to non-engulfing BCCs. The in vitro and in vivo relevance of engulfment of MSC-shC or MSC-shDDR2 by BCCs was assessed by WB, invasion, migration, mammosphere assays, and xenografts.

Results: Subpopulations of metastatic MDA-MB-231 and -436 cells engulf MSCs. MSC engulfment was not detected in non-metastatic and non-tumorigenic breast cells. Using our high-throughput cellular pairing platform we visualized MSC engulfment, and retrieved engulfing and non-engulfing BCCs. RNA sequencing revealed a 7-gene engulfing signature by comparing BCC engulfing MSC-shC, and BCC engulfing MSC-shDDR2, BCC non-engulfing. Functionally, MSC engulfment enhances EMT, mammospheres, migration and invasion of BCCs.

Conclusions: We developed a high-throughput cellular pairing platform to study MSC engulfment by BCC, and demonstrated that engulfment of MSC by BCC is a key mechanism enabling tumor progression. Our study suggests that DDR2 knockdown in MSC reduces their ability to enhance tumorigenic functions after engulfment by BCC. We identify an MSC engulfment gene signature with potential for developing of new tissue-based biomarkers of metastasis.

Citation Format: Maria E. Gonzalez, Yu-Chi Chen, Celina G. kleer. DDR2-depleted mesenchymal stem cells attenuate the tumor-promoting effect of breast cancer cell engulfment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 176.

Mesenchymal Stem Cell-Induced DDR2 Mediates Stromal-Breast Cancer Interactions and Metastasis Growth

Increased collagen deposition by breast cancer (BC)-associated mesenchymal stem/multipotent stromal cells (MSC) promotes metastasis, but the mechanisms are unknown. Here, we report that the collagen receptor discoidin domain receptor 2 (DDR2) is essential for stromal-BC communication. In human BC metastasis, DDR2 is concordantly upregulated in metastatic cancer and multipotent mesenchymal stromal cells. In MSCs isolated from human BC metastasis, DDR2 maintains a fibroblastic phenotype with collagen deposition and induces pathological activation of DDR2 signaling in BC cells. Loss of DDR2 in MSCs impairs their ability to promote DDR2 phosphorylation in BC cells, as well as BC cell alignment, migration, and metastasis. Female ddr2-deficient mice homozygous for the slie mutation show inefficient spontaneous BC metastasis. These results point to a role for mesenchymal stem cell DDR2 in metastasis and suggest a therapeutic approach for metastatic BC.

Abstract P4-03-03: Microenvironment induced DDR2 mediates stromal-cancer interactions and metastasis growth in breast cancer

This abstract was not presented at the symposium.

Abstract 4397: Mesenchymal stem cell-derived collagen I plays a role in organizing breast cancer cell migration and metastasis

Background: Accumulating evidence suggests that mesenchymal stem cells (MSCs) are recruited to the tumor microenvironment and play roles in tumor progression; however the underlying mechanisms by which MSCs promote breast cancer migration and invasion need further investigation. Studies have demonstrated that collagen plays an important role in breast tumorigenesis by activating signaling pathways. We hypothesize that MSCs may promote breast cancer progression through regulating collagen-induced signaling in breast cancer cells.

Methods: We isolated carcinoma-associated MSCs (CA-MSCs) from human breast cancer metastasis to lymph node (LNM) and liver (LM). CA-MSCs were subjected to multilineage differentiation assays and labeled with Ds-Red. COAL I expression and its receptor discoidin domain receptor 2 (DDR2) were downregulated in the CA-MSCs-DsRED using specific shRNA. We established single culture and co-cultures of CA-MSCs with GFP labeled breast cancer cells (BCCs) MDA-MB-231 and MCF10ACA1a which were used for Live Imaging Microscopy, IHC, RT-PCR, WB, immunofluorescence, 3D proliferation and invasion assays, and in vivo xenograft experiments.

Results: CA-MSCs had spindle morphology, normal karyotype, were nontumorigenic in vivo, and possessed tri-lineage differentiation ability (osteoblast, adipocyte, and chondrocyte). CA-MSCs exhibited high mRNA and protein levels of collagen I (COAL I) and its receptor DDR2. ShRNA-mediated knockdown of COAL I or DDR2 in CA-MSCs induced a change in morphology towards epithelial, decreased expression of epithelial to mesenchymal transition (EMT) markers, and impaired migration. Co-culture of CA-MSCs with BCCs led to increased BCC proliferation, EMT, invasion, and increased DDR2 expression in BCCs compared to single cultures of BCCs, which was blocked by COAL1 and DDR2 shRNA in CA-MSCs. Live imaging studies revealed that shCOAL1 and shDDR2 was sufficient to completely disrupt the organized migration pattern of BCCs aligned with CA-MSCs. In vivo, xenografts derived from MDA-MB-231 cells co-cultured with shControl CA-MSCs exhibited increased collagen I deposition in the tumor microenvironment, increased tumor growth, and metastasis compared to the single cultures of MDA-MB-231 cells. Remarkably, shDDR2 in CA-MSCs reduced tumorigenesis and metastasis.

Conclusion: We successfully isolated and characterized CA-MSCs, confirming their presence in human breast cancer metastasis. Our findings suggest that collagen I and its receptor DDR2 play a role in directional migration of breast cancer cells in alignment with CA-MSCs, a function that may be implicated in breast cancer invasion and metastasis. Downregulation of collagen I expression and signaling reduces tumor growth and metastasis in vivo. Modifying tumor microenvironment by manipulating collagen I and/or DDR2 levels in MSCs might be therapeutically useful in preventing metastasis.

Citation Format: Maria E. Gonzalez, Emily Martin, Caroline Arellano-Gracia, Arjun Lama, Celina G. Kleer. Mesenchymal stem cell-derived collagen I plays a role in organizing breast cancer cell migration and metastasis. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4397.

Abstract 5078: Human breast carcinoma-associated mesenchymal stem cells promote breast cancer cell proliferation, irreversible EMT and invasion through Collagen I

Background: Accumulating evidence suggests that mesenchymal stem cells (MSCs) are recruited to the tumor microenvironment and play roles in tumor progression; however their specific mechanisms and functions need further investigation. In this study, we identified the presence of carcinoma-associated MSCs (CA-MSCs) isolated from breast cancer metastasis to a human lymph node (LNM) and liver (LM). We hypothesized that CA-MSCs may increase the invasive abilities of breast cancer cells and that they may enhance collagen expression to promote breast cancer progression.

Methods: We isolated CA-MSCs from fresh samples of breast cancer metastasis to a lymph node and liver obtained from the operating room. A portion of each specimen was subjected to H&E staining to confirm the diagnosis, and another portion was mechanically dissected and digested with collagenase. Red blood cells were lysed with ACK buffer and cell suspensions were cultured in Human Epithelial Medium. Once isolated, adherent CA-MSCs were subcultured in MSC medium for up to 12 passages for each experiment. CA-MSCs were subjected to multilineage differentiation assays (osteogenic, chrodrogenic, and adipogenic differentiation), and labeled with Ds-Red and co-cultured with a panel of breast cancer cells including MDA-MB-231, MCF7, DCIS.COM. We performed RT-PCR, WB, 3D proliferation assays, and invasion assays, and immunoshistochemistry. COAL1 expression was downregulated in the CA-MSCs-DsRED using specific shRNA. Control and CA-MSCs-DsRed-shCOAL1 were co-cultured with MDA-MB-231 and MCF7 breast cancer cells, and subjected to proliferation and invasion assays, and to RT-PCR and WB to investigate EMT proteins.

Results: CA-MSCs had spindle morphology, normal karyotype, were nontumorigenic, and possessed tri-lineage differentiation ability (osteoblast, adipocyte, and chondrocyte). In co-cultures, CA-MSCs promote proliferation, invasion, irreversible EMT through serial passages, compared to single cultures of breast cancer cells. CA-MSCs increased COAL1 expression and collagen 1 deposition in the 3D co-cultures by IHC and RT-PCR. COAL1 shRNA knockdown in CA-MSCs rescued the effect in proliferation and invasion of breast cancer cells in the co-cultures.

Conclusion: We successfully isolated and characterized CA-MSCs, confirming their presence in human breast cancer metastasis. We found that CA-MSCs enhance breast cancer cell proliferation, promote irreversible EMT and invasion and increased COAL1 expression and collagen 1 deposition. We demonstrated that COAL1 expression is required for the effect of CA-MSCs on breast cancer cell proliferation and invasion.

Citation Format: Maria E. Gonzalez, Emily E. Martin, Celina G. Kleer. Human breast carcinoma-associated mesenchymal stem cells promote breast cancer cell proliferation, irreversible EMT and invasion through Collagen I. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5078. doi:10.1158/1538-7445.AM2015-5078

Tyrosine kinase discoidin domain receptors DDR1 and DDR2 are coordinately deregulated in triple-negative breast cancer

Receptor kinases Discoidin Domain Receptors (DDRs) 1 and 2 are emerging as new therapeutic targets in breast cancer (BC). However, the expression of DDR proteins during BC progression and their association with BC subtypes remain poorly defined. Herein we report the first comprehensive immunohistochemical analyses of DDR protein expression in a wide range of breast tissues. DDR1 and DDR2 expression was investigated by immunohistochemistry in 218 samples of normal breast (n = 10), ductal carcinoma in situ (DCIS, n = 10), and invasive carcinomas (n = 198), arrayed in tissue microarrays with comprehensive clinical and follow-up information. Staining was evaluated for cell type, subcellular localization, percentage and intensity (scores 1-4), and association with disease subtype and outcome. In normal epithelium and DCIS, DDR1 was highly expressed, while DDR2 was negative in normal epithelium, and in DCIS it localized to cells at the epithelial-stromal interface. Of the 198 invasive carcinomas, DDR1 was high in 87 (44 %) and low in 103 (52 %), and DDR2 was high in 110 (56 %) and low in 87 (44 %). High DDR2 was associated with high tumor grade (P = 0.002), triple-negative subtype (TNBC) (P < 0.0001), and worse survival (P = 0.037). We discovered a novel concordant deregulation of DDR expression, with a DDR1(Low)/DDR2(High) profile significantly associated with TNBC, compared to luminal tumors (P = 0.012), and with worse overall survival. In conclusion, DDR2 upregulation occurs in DCIS, before stromal invasion, and may reflect epithelial-stromal cross-talk. A DDR1(Low)/DDR2(High) protein profile is associated with TNBC and may identify invasive carcinomas with worse prognosis.

Abstract 4802: Human breast carcinoma-associated mesenchymal stem cells from primary breast cancer metastasis promote proliferation, invasion and mammosphere formation in breast cancer

Background: Accumulating evidence suggests that mesenchymal stem cells (MSCs) are recruited to the tumor microenvironment; however controversy exists regarding their role in solid tumors. In this study, we identified the presence of carcinoma-associated MSCs (CA-MSCs) isolated from breast cancer metastasis to a human lymph node (LNM) and liver (LM).

Methods: Tissue harvesting and culture: CA-MSCs were isolated from fresh samples of lymph nodes and liver breast cancer metastasis obtained from the operating room. A portion of each specimen was mechanically dissected and digested with collagenase. Red cells were lysed with ACK buffer and cell suspensions were cultured in Human Epithelial Medium and isolated adherent CA-MSCs were subculture in MSC medium for up to 12 passages for each experiment. Another portion of the tumor samples were subjected to IHC for H&E staining.

Differentiation assays: For bone differentiation cells were plated in StemPro Osteogenesis differentiation or control medium and allowed to grow for 14 days, and then washed and stained with Alizarin Red S.

For cartilage differentiation cells were pelleted and grown in 15 ml tubes for 21 days, immobilized in histogel and stained with Alizarin Blue.

For adipose differentiation cells were plated in StemCell differentiation and control medium, after 21 days the cells were stained with 0.3% Oil Red O.

Proliferation, invasion, mammosphere assays, cytokine array and RT-PCR for EMT signature were performed seeding the same number of cells and comparing the single culture of CA-MSCs with co-culture of CA-MSCs and a panel of breast cancer cells lines

Results: CA-MSCs had spindle morphology, normal karyotype, were nontumorigenic, and possessed tri-lineage differentiation ability (osteoblast, adipocyte, and chondrocyte). When co-cultured with breast cancer cells, CA-MSCs promoted proliferation, invasion, and mammosphere formation, increased IL6 and IL8 secretion into the media, and induced a gene expression profile of EMT when compared to the single cultures.

Conclusion: We successfully isolated and characterized CA-MSCs, confirming their presence in human breast metastasis. We found that they provide a favorable microenvironment for tumor cell growth, enhance mammosphere formation, and promote an EMT signature and invasion in breast cancer cells.

Citation Format: Maria E. Gonzalez, Kathy A. Toy, Celina G. Kleer. Human breast carcinoma-associated mesenchymal stem cells from primary breast cancer metastasis promote proliferation, invasion and mammosphere formation in breast cancer. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4802. doi:10.1158/1538-7445.AM2014-4802

Lymphomatoid granulomatosis of central nervous system and lung driven by epstein barr virus proliferation: successful treatment with rituximab-containing chemotherapy

Lymphomatoid granulomatosis (LYG) is a very rare Epstein-Barr virus (EBV) associated B-cell lymphoproliferative disorder. We report the case of a 41-year-old man who presented with fever and respiratory symptoms. Computed tomography showed multiple nodules in both lung fields. Polymerase chain reaction (PCR) analysis for EBV was positive in bronchoalveolar lavage and biopsy of lung node yielded a diagnosis of LYG, grade III. Shortly after initiation of treatment with agressive chemotherapy, neurological deterioration appeared. Neuroimaging findings revealed hydrocephalus and PCR analysis of the cerebrospinal fluid (CSF) was positive for EBV. Treatment with intravenous rituximab led to rapid reduction of EBV load in CSF, along with clinical and radiological improvement. After completion of treatment with immunochemotherapy, an autologous stem cell transplantation was performed. Patient stays in remission 18 months after diagnosis.

EZH2 inhibition decreases p38 signaling and suppresses breast cancer motility and metastasis

EZH2 is a Polycomb group protein that exerts oncogenic functions in breast cancer, where its overexpression is associated with metastatic disease. While it reportedly acts a transcriptional repressor through trimethylation of histone H3 at lysine 27, EZH2 may exhibit context-dependent activating functions. Despite associations with worse outcome and metastasis in breast cancer, a functional role of EZH2 in breast cancer metastasis in vivo has not been demonstrated. Furthermore, whether EZH2 regulates cancer cell phenotype and motility are unknown. In this study, we discovered that knockdown of EZH2 induces a phenotypic reprogramming from mesenchymal to epithelial, reduces motility, and blocks invasion in breast cancer cell lines. In vivo, EZH2 downregulation in MDA-MB-231 cells decreases spontaneous metastasis to the lungs. We uncover an unexpected role of EZH2 in inducing the p38 mitogen-activated protein kinase signaling pathway, an important regulator of breast cancer invasion and metastasis. In breast cancer cells, EZH2 binds to phosphorylated p38 (p-p38) in association with other core members of the Polycomb repressive complex 2, EED, and SUZ12, and EZH2 overexpression leads to increased levels of p-p38 and of activated, downstream pathway proteins. The effect on p-p38 was confirmed in vivo, where it correlated with decreased spontaneous metastasis. In clinical specimens of matched primary and invasive breast carcinomas, we found that EZH2 expression was upregulated in 100 % of the metastases, and that EZH2 and p-p38 were coexpressed in 63 % of cases, consistent with the functional results. Together our findings reveal a new mechanism by which EZH2 functions in breast cancer, and provide direct evidence that EZH2 inhibition reduces breast cancer metastasis in vivo.

Abstract 2189: Novel transcriptional regulation of Notch1 by EZH2 in mammary stem cells

Background: EZH2 has oncogenic functions in the breast and other organs, and has been recently shown to regulate the differentiation of tissue specific stem cells. However, the underlying mechanisms are largely unknown. We hypothesized that EZH2 may regulate mammary stem cells by transcriptional mechanisms of key signaling pathways. Methods: We developed EZH2 KD in SUM149 breast cancer cells, and an inducible and transient cell culture model of EZH2 overexpression, (EZH2-OV), and its deletion mutants in MCF10A and in primary breast cells. Mammary stem cells were identified using ALDH1+ and CD44+/CD24- by FACS. ChIP assays were used to determine EZH2 recruitment to specific areas in NOTCH1 promoter. Ectopic expression of EZH2 and deletion mutants leads to identify the EZH2 domain responsible for the transcription up regulation of NOTCH1. Results: We identified that EZH2 KD in SUM149 significantly decreased NOTCH1 signaling in the stem cell population. We observed preferential expression of EZH2 in the stem cell population of normal primary breast cells compared to non-stem cells. In MCF10A cells, EZ-OV was predominantly increased in the ALDH-1+ population. We found that EZH2-OV increased the stem cell population of MCF10A cells. Consistently, EZH2-OV in MCF10A and primary breast cells increased Notch1 mRNA specifically in the ALDH1+ population. EZH2-OV increased Notch1 protein levels and promoter activity in MCF10A and primary cells. Mechanistically, Notch1 inhibition by GSI reversed the effect of EZH2-OV in the stem cell population of MCF10A cells. ChIP assays revealed that EZH2 is recruited to specific regions of the NOTCH1 promoter depending on EZH2 specific context. Moreover, ChIP assays with EZH2 deletion mutants identify that the Nter- EZH2 HII domain is responsible for the NOTCH1 promoter transcriptional up regulation and that this function is independent of the SET domain (methytransferase activity) and as shown by comparing the EZH2 tri-methylation mark (3H3K27) in the NOTCH1 promoter. Conclusion: Collectively, these results indicate that EZH2 regulates mammary stem cells and requires, at least in part the activation of Notch1 signaling by recruitment of EZH2 to the NOTCH1 promoter through the Nter domain.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2189. doi:1538-7445.AM2012-2189

Abstract 5309: Understanding the function of EZH2 as a determinant of breast cancer invasion and metastasis

Breast cancer is the second most common cause of cancer-related deaths for women in the United States, and the mortality for those 20% of patients with recurrences and/or metastases is nearly 100%. EZH2 (Enhancer of Zeste Homolog 2), a Polycomb group protein that functions in transcriptional memory, is upregulated during progression from ductal carcinoma in situ to invasive carcinoma and distant metastasis. EZH2 protein is overexpressed in 55% of invasive breast carcinomas and women with tumors expressing high EZH2 have a worse disease free and overall survival than women with tumors expressing low EZH2. We hypothesize that EZH2 overexpression may give rise to breast cancers that are on a highly aggressive path from the outset and may enhance metastasis. To test our hypothesis, we have investigated the role of EZH2 in cell morphology, invasion and motility in vitro, and metastasis in vivo. Stable shRNA EZH2 knockdown was carried out in 3 breast cancer cell lines (MDA-MB-231, CAL51, SUM149) which normally express high levels of EZH2 and have motile and invasive abilities. EZH2 knockdown in all cell lines tested decreased their invasiveness using a modified Boyden chamber assay. Random motion motility assays using live cell imaging tracking on MDA-MB-231 vector and shEZH2 cells revealed that EZH2 knockdown significantly reduces the random motion average cell velocity of these cells. Concomitant with the effect of EZH2 knockdown in decreasing invasion and velocity of movement of breast cancer cells, we determined that EZH2 knockdown in MDA-MB-231 and SUM149 cells results in a morphological change and protein expression pattern consistent with a mesenchymal to epithelial transition (MET). Recent experiments have demonstrated that EZH2 knockdown in breast cancer cell lines decreases the levels of activated, phosphorylated p38 mitogen activated protein kinase (MAPK), a protein shown to regulate breast cancer cell motility and metastasis. The in vivo relevance is highlighted by our data showing that EZH2 knockdown in MDA-MB-231 cells significantly decreased the number of lung metastases per mouse, decreased the average size of lung metastases and decreased the proliferative index of the metastatic deposit as measured by decreased Ki67 immunostaining, when compared to controls. Decreased phosphorylated p38 staining has also been verified in the mouse xenograft lung metastases. Taken together, these data support a role for EZH2 in establishing rapid cell motion, invasion and metastasis in breast cancers. Experiments to further delineate the underlying mechanism and to determine the role of p38 in EZH2-mediated functions are underway.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5309. doi:1538-7445.AM2012-5309

Histone methyltransferase EZH2 induces Akt-dependent genomic instability and BRCA1 inhibition in breast cancer

Increased levels of EZH2, a critical regulator of cellular memory, signal the presence of metastasis and poor outcome in breast cancer patients. High levels of EZH2 are associated with nuclear pleomorphism, lack of estrogen receptor expression, and decreased nuclear levels of BRCA1 tumor suppressor protein in invasive breast carcinomas. The mechanism by which EZH2 overexpression promotes the growth of poorly differentiated invasive carcinomas remains to be defined. Here, we show that EZH2 controls the intracellular localization of BRCA1 protein. Conditional doxycycline-induced upregulation of EZH2 in benign mammary epithelial cells results in nuclear export of BRCA1 protein, aberrant mitoses with extra centrosomes, and genomic instability. EZH2 inhibition in CAL51 breast cancer cells induces BRCA1 nuclear localization and rescues defects in ploidy and mitosis. Mechanistically, EZH2 overexpression is sufficient for activation of the phosphoinositide 3-kinase/Akt (PI3K/Akt) pathway specifically through activation of Akt isoform 1. EZH2-induced BRCA1 nuclear export, aneuploidy, and mitotic defects were prevented by treatment with the PI3K inhibitors LY294002 or wortmannin. Targeted inhibition of Akt-1, Akt-2, and Akt-3 isoforms revealed that the EZH2-induced phenotype requires specific activation of Akt-1. The relevance of our studies to human breast cancer is highlighted by the finding that high EZH2 protein levels are associated with upregulated expression of phospho-Akt-1 (Ser473) and decreased nuclear expression of phospho-BRCA1 (Ser1423) in 39% of invasive breast carcinomas. These results enable us to pinpoint one mechanism by which EZH2 regulates BRCA1 expression and genomic stability mediated by the PI3K/Akt-1 pathway.

Blockade of CCN6 (WISP3) activates growth factor-independent survival and resistance to anoikis in human mammary epithelial cells

CCN6 is a secreted cysteine-rich matricellular protein (36.9 kDa) that exerts growth-inhibitory functions in breast cancer. Reduction or loss of CCN6 protein has been reported in invasive carcinomas of the breast with lymph node metastasis and in inflammatory breast cancer. However, the mechanism by which CCN6 loss promotes breast cancer growth remains to be defined. In the present study, we developed lentiviral-mediated short hairpin RNA CCN6 knockdown (KD) in nontumorigenic mammary epithelial cells MCF10A and HME. We discovered that CCN6 KD protects mammary epithelial cells from apoptosis and activates growth factor-independent survival. In the absence of exogenous growth factors, CCN6 KD was able to promote growth under anchorage-independent conditions and triggered resistance to detachment-induced cell death (anoikis). On serum starvation, CCN6 KD was sufficient for activation of the phosphatidylinositol 3-kinase (PI3K)/Akt pathway. Growth factor-independent cell survival was stunted in CCN6 KD cells when treated with either human recombinant CCN6 protein or the PI3K inhibitor LY294002. Targeted inhibition of Akt isoforms revealed that the survival advantage rendered by CCN6 KD requires specific activation of Akt-1. The relevance of our studies to human breast cancer is highlighted by the finding that low CCN6 protein levels are associated with upregulated expression of phospho-Akt-1 (Ser(473)) in 21% of invasive breast carcinomas. These results enable us to pinpoint one mechanism by which CCN6 controls survival of breast cells mediated by the PI3K/Akt-1 pathway.

Abstract 1111: Enhancer of Zeste homologue 2 (EZH2) regulates BRCA1 transiently nuclear export during the cell cycle, and induces tetraploidy of breast cells through AKT1

EZH2 is overexpressed in breast carcinomas with high propensity to metastasize. EZH2 is an oncogene essential to promote proliferation and capable to trigger neoplastic conversion in the breast. We have reported that EZH2 promotes proliferation of breast cancer through downregulation of BRCA1 protein, but the mechanism is unknown. BRCA1 shuttles between the cytoplasm and nucleus to maintain genomic stability. AKT1 up regulation disrupts BRCA1 function by altering its nuclear localization and inducing genomic instability. We hypothesize that EZH2 regulates nuclear-cytoplasmic shuttling of BRCA1 in breast cells through AKT1.

Methods: We developed two cell culture models: an inducible EZH2 up regulation system in MCF10A benign mammary cells and a lentivirus-mediated shRNA interference targeting EZH2 model in CAL51 breast cancer cells (tetraploid, hormone receptor negative, and with intact p53 and BRCA1 genes). Our recently developed EZH2 transgenic mouse model was analyzed to determine the in vivo relevance of our in vitro data obtained by Western blots, immunofluorescence, proliferation, and FACS.

Results: EZH2 shRNA knock-down in CAL51 cells increased BRCA1 nuclear localization in early S phase, decreased cell growth by delaying cell cycle progression, and tetraploidy. EZH2 overexpression in MCF10A cells decreased BRCA1 nuclear localization, increased proliferation and caused mitotic spindle defects and tetraploidy. EZH2 overexpression increased total and phoshporylated AKT1 at serine 473. Specific pharmacologic inhibition of AKT reverted the effect of EZH2 on BRCA1 nuclear localization, proliferation, mitotic defects and tetraploidy. We also found that EZH2 directly interacts with AKT1 protein. Mammary glands of EZH2 transgenic mice show up-regulation of AKT1 and a decreased in nuclear BRCA1 protein compared to wild type mice.

Conclusion: EZH2 regulates the nuclear-cytoplasmic shuttling of BRCA1 protein and influences BRCA1 functions on proliferation, mitotic spindle control, and maintenance of genomic stability in benign breast cells and in breast cancer cells. The regulation of BRCA1 localization and function by EZH2 requires AKT.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1111.

Abstract 336: Blockade of CCN6 (WISP3) activates growth factor-independent survival and resistance to anoikis in human mammary epithelial cells

CCN6 is a secreted cysteine rich matricellular protein (36.9 kDa) that exerts growth inhibitory functions in breast cancer. Reduction or loss of CCN6 protein has been reported in invasive carcinomas of the breast with lymph node metastasis and in inflammatory breast cancer. However, the mechanism by which CCN6 loss promotes breast cancer growth remains to be defined. In the present study we developed lentiviral mediated shRNA knockdown of CCN6 in nontumorigenic mammary epithelial cells MCF10A and HME. We discovered that CCN6 knockdown protects mammary epithelial cells from apoptosis and activates growth factor-independent survival. In the absence of exogenous growth factors, CCN6 knockdown was able to promote growth under anchorage independent conditions and triggered resistance to detachment-induced cell death (anoikis). Upon serum starvation, CCN6 knockdown was sufficient for activation of the phosphatidylinositol 3-kinase/Akt pathway. Growth factor-independent cell survival was stunted in CCN6 knockdown cells when treated with either human recombinant CCN6 protein or the phosphatidylinositol 3-kinase inhibitor LY294002. Targeted inhibition of Akt isoforms revealed that the survival advantage rendered by CCN6 knockdown requires specific activation of Akt-1. The relevance of our studies to human breast cancer is highlighted by the finding that low CCN6 protein levels are associated with upregulated expression of phospho-Akt-1 (Ser473) expression in 21% of invasive breast carcinomas. These results enable us to pinpoint one mechanism by which CCN6 controls survival of breast cells mediated by the PI3K/Akt-1 pathway.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 336.

Androgenetic alopecia in the paediatric population: a retrospective review of 57 patients

BACKGROUND

Hair loss is an unwelcome event at any age, but it can be particularly distressing for adolescents and their families. While androgenetic alopecia (AGA) is the most common form of hair loss in adults, little is known about its prevalence, clinical features and response to treatments in the paediatric population.

OBJECTIVES

To better characterize the causes of alopecia in a paediatric population.

METHODS

We performed a retrospective chart review to identify all patients with hair loss seen in an academic paediatric dermatology practice at New York University over a 12-year period to better characterize the causes of alopecia in this population. We review the clinical and histological features, natural progression and associated laboratory abnormalities of AGA in 57 paediatric patients.

RESULTS

AGA was identified as the most frequent cause of hair loss in adolescents and the second most common diagnosis overall. The male to female ratio was 2 : 1 and the average age at initial presentation with AGA was 14.8 years. Adolescent girls had diffuse thinning or thinning at the crown, and boys frequently presented with female pattern hair loss. When biopsies were performed, perifollicular inflammation was a common finding. A family history of AGA was reported in 83% of patients. Laboratory evaluation for androgens revealed polycystic ovarian syndrome in three girls and late-onset congenital adrenal hyperplasia in one boy.

CONCLUSIONS

AGA is the most common form of hair loss in adolescents, and can be the presenting sign of an underlying endocrine disorder. An accurate and timely diagnosis is essential for appropriate medical and psychosocial intervention when warranted.

Targeted overexpression of EZH2 in the mammary gland disrupts ductal morphogenesis and causes epithelial hyperplasia

The Polycomb group protein enhancer of zeste homolog 2 (EZH2), which has roles during development of numerous tissues, is a critical regulator of cell type identity. Overexpression of EZH2 has been detected in invasive breast carcinoma tissue samples and is observed in human breast tissue samples of morphologically normal lobules up to 12 years before the development of breast cancer. The function of EZH2 during preneoplastic progression in the mammary gland is unknown. To investigate the role of EZH2 in the mammary gland, we targeted the expression of EZH2 to mammary epithelial cells using the mouse mammary tumor virus long terminal repeat. EZH2 overexpression resulted in aberrant terminal end bud architecture. By the age of 4 months, 100% of female mouse mammary tumor virus-EZH2 virgin mice developed intraductal epithelial hyperplasia resembling the human counterpart accompanied by premature differentiation of ductal epithelial cells and up-regulation of the luminal marker GATA-3. In addition, remodeling of the mammary gland after parturition was impaired and EZH2 overexpression caused delayed involution. Mechanistically, we found that EZH2 physically interacts with beta-catenin, inducing beta-catenin nuclear accumulation in mammary epithelial cells and activating Wnt/beta-catenin signaling. The biological significance of these data to human hyperplasias is demonstrated by EZH2 up-regulation and colocalization with beta-catenin in human intraductal epithelial hyperplasia, the earliest histologically identifiable precursor of breast carcinoma.

Up-regulation of SEPT9_v1 stabilizes c-Jun-N-terminal kinase and contributes to its pro-proliferative activity in mammary epithelial cells

SEPT9_v1, the largest transcript of the septin gene family member, SEPT9, encodes a septin isoform implicated in the tumorigenic transformation of mammary epithelial cells. High levels of SEPT9_v1 expression also have been observed in both breast cancer cell lines, primary breast cancers as well as other solid tumor malignancies. We found a novel interaction between SEPT9_v1 and the c-Jun-N-terminal kinase (JNK), a mitogen-activated protein kinase important in cellular stress responses, cell proliferation, and cell survival. We found that up-regulation of SEPT9_v1 stabilizes JNK by delaying its degradation, thereby activating the JNK transcriptome. C-jun kinase assays in mammary epithelial cells expressing SEPT9_v1, compared to controls, exhibited increased JNK/c-Jun transcriptional activity. This increase was associated with increased levels of cyclin D1, a critical component of the proliferative response required for progression through G(1) of the cell cycle in many cell types. These findings demonstrate the first link between a septin protein and the JNK signaling pathway. Importantly, it suggests a novel functional role of SEPT9_v1 in driving cellular proliferation of mammary epithelial cells, a hallmark feature of oncogenesis that is directly relevant to breast cancer.

High SEPT9_v1 expression in human breast cancer cells is associated with oncogenic phenotypes

Altered expression of the human septin gene, SEPT9, and its murine homologue, Sept9, has been implicated in neoplasia. However, their role(s) in oncogenesis remains poorly understood. We found amplification of SEPT9 in 67% of breast cancer cells (BCC) when compared with immortalized human mammary epithelial cells (IHMEC) as well as high levels of SEPT9 expression in the majority (61%) of the BCCs studied, unlike IHMECs. Expression profiling of variant SEPT9 transcripts and translated products revealed that high expression of the variant, SEPT9_v1, in contrast to other variants, was widespread in BCCs (55% of the BCCs) but not in IHMECs. High expression of SEPT9_v1 was also observed in primary breast cancer samples by immunohistochemical studies. We subsequently examined the phenotypic consequences of SEPT9_v1 expression in human breast cells. Retroviral expression of SEPT9_v1 in IHMEC cell culture models showed that SEPT9_v1 accelerated growth kinetics, stimulated cell motility, promoted invasion in Matrigel Transwell assays, increased genomic instability with the development of aneuploidy, and stimulated morphologic changes. Significant cytokinesis defects and disruption of tubulin microfilaments were also observed by immunofluorescence when SEPT9_v1 was ectopically expressed in IHMECs. Furthermore, SEPT9_v1 markedly enhanced neoplastic transformation in Hs578T cells, a BCC with no endogenous expression of the SEPT9_v1 isoform. Small interfering RNA-mediated and short hairpin RNA-mediated inhibition of SEPT9_v1 expression in two BCCs with high levels of endogenous SEPT9_v1 expression inhibited neoplastic growth properties of the cells. Taken together, our findings suggest that increased SEPT9_v1 expression contributes to the malignant pathogenesis of some breast tumors.

Randomized clinical study of five days apostrophe therapy with mebendazole compared to quinacrine in the treatment of symptomatic giardiasis in children

AIM: To compare the efficacy and safety of five days apostrophe therapy of mebendazole (MBZ) versus quinacrine (QC) on human giardiasis in children.

METHODS: A clinical trial was carried out in paediatric patients (aged 5-15 years) with confirmed symptomatic G. duodenalis mono-infection. Patients were randomly assigned to receive either MBZ [200 mg taken three times per day (TID) (n = 61)] or QC [2 mg/kg bodyweight tid (n = 61)], both for five days. Follow-up faecal samples were obtained at 3, 5 and 7 d after the end of the treatment.

RESULTS: Although the frequency of cure was higher for QC (83.6%) than for MBZ (78.7%), the difference was not statistically significant (P > 0.05). Adverse events were reported more in the QC group (P < 0.05), all of them transient and self-limiting.

CONCLUSION: Despite final cure rates ocurring lower than expected, the overall results of this study reconfirmed the efficacy of MBZ in giardiasis and also indicate that, although comparable to QC, at least in this setting the 5 d course of MBZ did not appear to improve the cure rates in this intestinal parasitic infection.

Long-term outcome of allogeneic PBSC transplantation in pediatric patients with hematological malignancies: a report of the Spanish Working Party for Blood and Marrow Transplantation in Children (GETMON) and the Spanish Group for Allogeneic Peripheral Blood Transplantation (GETH)

We analyzed the clinical outcome in 90 children undergoing allogeneic PBSC transplantation from HLA-identical relative for leukemia. GvHD prophylaxis was CsA+ methotrexate in 50 and CsA+/-steroids in 40. Median CD34+ cells infused were 6 x 10(6)/kg (range, 1.4-32). Median follow-up was 60 months (range, 6-115). CI of transplant-related mortality (TRM) was 18.4+/-4%. On multivariate analysis, high Lansky score (>80) at transplantation was associated with lower TRM (HR, 0.9; P<0.0002). Relapse incidence (RI) was 33.6+/-6%. On multivariate analysis, high Lansky score at transplantation and cGvHD were associated with lower RI (HR, 0.04; P<0.0005 and HR, 0.23; P<0.03, respectively). Disease-free survival (DFS) was 57.8+/-5%. Disease status at transplantation (HR, 0.33; P<0.02), steroid treatment at day +90 (HR, 5.61; P<0.005) and cGvHD (HR, 0.23; P<0.005) had a significant impact on DFS in multivariate analysis. CI of cGvHD was 63.7+/-7%. Patients with cGvHD had better DFS (65+/-5%) because of lower RI (15.7+/-6%) and similar TRM (27.4+/-4%). These data suggest acceptable long-term outcomes after allogeneic PBSC transplantation in children despite the high incidence of cGvHD. These patients had a lower risk of relapse and a better DFS.

Risk assessment and outcome of chronic graft-versus-host disease after allogeneic peripheral blood progenitor cell transplantation in pediatric patients

We retrospectively evaluated the incidence, risk factors for chronic graft-versus-host disease (cGvHD) and outcome in 80 pediatric patients (36 male) (median age 13 years) who underwent allogeneic peripheral blood progenitor cell transplantation. Patients were grafted from an HLA-identical sibling after myeloablative conditioning (total body irradiation (TBI) based 52; non-TBI 28). GvHD prophylaxis used were: cyclosporin A (CsA)+ short methotrexate (MTX) in 52 and CsA+/-prednisone in 28. The median number of CD34+ cells infused were 5.8 x 10(6)/kg (range: 1.4-32.8). The median follow-up was 24 months (range: 3-94). In all, 28 patients had cGvHD (confidence interval (CI): 54.2+/-10%). Factors that were significant on univariate analysis were diagnosis (P=0.03) and GvHD prophylaxis administered (P=0.04). On multivariate analysis, only GvHD prophylaxis used was associated with a significant risk of cGvHD (hazard ratio (HR): 3.94; 95% CI: 1.41-10.91, P=0.009). The CI of cGvHD for patients receiving CsA+MTX was 40.9+/-12 vs 76.5+/-18% for patients who did not (P=0.03). The probability of relapse was 36+/-6% for all patients (12.5+/-8% for patients with cGvHD vs 47.9+/-8% without cGvHD). The probability of disease-free survival was better for patients with cGvHD (69.9+/-10 vs 37.9+/-7%; HR: 3.59, 95% CI: 1.47-5.56; P=0.001). Our data suggest that the GvHD prophylaxis used is the most relevant predictor of cGvHD. Patients with cGvHD had a lower risk of relapse and a better survival.

Foster litters prevent hypothalamic-pituitary-adrenal axis sensitization mediated by neonatal maternal separation

Neonatal maternal separation of rat pups has been shown to produce long-term increases in hypothalamic-pituitary-adrenal (HPA) axis responsiveness, elevated levels of hypothalamic corticotropin releasing factor (CRF) mRNA in the hypothalamic paraventricular nucleus (PVN), and enhanced anxiety-like behavior. These effects appear to be at least partially mediated by subtle disruptions in the quality of maternal-pup interactions. This hypothesis was tested by providing half the dams with foster litters during the maternal separation paradigm, so that in those litters, only the pups and not the dams were experiencing a period of separation. The separation protocol took place daily from PND2-14 for either 15 min (HMS15, handled) or 180 min (HMS180, maternal separation). During the period of separation dams were either transferred to adjacent cages without any pups present (HMS15, HMS180) or to cages containing an age-matched foster litter (HMS15F, HMS180F). As adults, the HMS180 progeny exhibited the expected increased expression of CRF mRNA in the PVN, stress hyper-responsiveness to airpuff startle and evidence of impaired feedback both in the CORT response, as well as in response to the dexamethasone suppression test. The HMS180F rats, however, appeared to be resistant to these effects of maternal separation as they demonstrated CRF mRNA levels intermediate between HMS15 and HMS180 rats. Their stress responses and feedback regulation of the HPA axis was comparable to that of the HMS15 rats. GR mRNA was elevated in the cortex of HMS180F rats. Overall, these studies support the thesis that the long-term effects of neonatal maternal separation may largely result from alterations in the quality of maternal care rather than from direct effects of the separation per se on the pups.

A randomized trial comparing mebendazole and secnidazole for the treatment of giardiasis

To compare the efficacy of the two drugs in the treatment of giardiasis, 146 children (aged 5-15 years) with confirmed Giardia lamblia infection were randomly allotted to treatment with mebendazole (200 mg three times daily for 3 days) or secnidazole (30 mg/kg, in a single dose). Parasitological response to treatment was evaluated in each child by the microscopical examination of faecal samples collected 3, 5 and 7 days after he or she had completed treatment. Although the frequency of cure was higher for secnidazole (79.4%) than for mebendazole (78.1%), the difference was not statistically significant (P > 0.05). Both treatment regimens were well tolerated, with only mild, transient and self-limiting side-effects reported. Mebendazole may be preferable to secnidazole in the treatment of giardiasis cases who have an history of intolerance to 5-nitromidazoles, and where infections with Giardia and soil-transmitted helminths frequently co-occur.

Growth, soluble carbohydrates, and aloin concentration of Aloe vera plants exposed to three irradiance levels

Research was conducted on Aloe vera, a traditional medicinal plant, to investigate the effects of light on growth, carbon allocation, and the concentrations of organic solutes, including soluble carbohydrates and aloin. The plants were vegetatively propagated and grown under three irradiances: full sunlight, partial (30% full sunlight), and deep shade (10% full sunlight) for 12-18 months. After 1 year of growth, five plants from each treatment were harvested to determine total above- and below ground dry mass. Four plants from the full sunlight and the partial shade treatments were harvested after 18 months to assess the soluble carbohydrate, organic acid and aloin concentrations of the clear parenchyma gel and the yellow leaf exudate, separately. Plants grown under full sunlight produced more numerous and larger axillary shoots, resulting in twice the total dry mass than those grown under partial shade. The dry mass of the plants grown under deep shade was 8.6% that of plants grown under full sunlight. Partial shade increased the number and length of leaves produced on the primary shoot, but leaf dry mass was still reduced to 66% of that in full sunlight. In contrast, partial and deep shade reduced root dry mass to 28 and 13%, respectively, of that under full sunlight, indicating that carbon allocation to roots was restricted under low light conditions. When plants were sampled 6 months later, there were only minor treatment effects on the concentration of soluble carbohydrates and aloin in the leaf exudate and gel. Soluble carbohydrate concentrations were greater in the gel than in the exudate, with glucose the most abundant soluble carbohydrate. Aloin was present only in the leaf exudate and higher irradiance did not induce a higher concentration. Limitation in light availability primarily affected total dry mass production and allocation, without substantial effects on either primary or secondary carbon metabolites.

Off-pump myocardial revascularization for left main stem disease in a high-risk patient

Off-pump complete myocardial revascularization for three-vessel disease is often limited by the difficulty to approach the obtuse marginal branches. A method of coronary artery bypass grafting without cardiopulmonary bypass used in a high risk patient with left main stem and three-vessel disease is described.

In situ detection of apoptotic cells by TUNEL in the gill epithelium of the developing brown trout (Salmo trutta)

Apoptosis is a form of naturally occurring cell death during development and it is characterised by extensive DNA fragmentation. Apoptosis is easily detected in the gill epithelium of brown trout embryos in ultrathin sections (Rojo et al. 1997). Here we provide the first biochemical evidence for apoptosis in the gill epithelium of brown trout embryos, using in situ end-labelling of DNA breaks (Gavrieli et al. 1992). Embryos at d 57 of development as well as those at hatching, were processed to analyse the distribution of apoptotic cells in the gills. The extent of apoptosis revealed by the terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end-labelling method technique is considerably greater than apoptosis detected by nuclear morphology. This method revealed that apoptosis was frequent at hatching, although it was also present during embryonic development. The presence and distribution of stained nuclei were different depending on the developmental stage. In embryos of 57 d, apoptotic flattened nuclei were dispersed in the gill epithelium, whereas at hatching, they were mainly grouped in the tips of the filaments and in the gill arches. TUNEL also revealed a distinct pattern of nuclear staining: at hatching, the intense staining covered the entire cell, but in embryos it was restricted to the nucleus. These results show the functional relevance of apoptosis at hatching, when apoptosis seems to be the unique process by which cell numbers in the gill epithelium are adjusted, in order to prepare for the new extrinsic conditions affecting the free-living life of alevins.

Possible interactions of cyclosporine and hyperprolactinemia modulating the episodic secretion of prolactin

The interrelationship between the effects of prolactin and cyclosporine (CsA) appears to be very complex and until now poorly understood. The aim of the present work was to analyze whether chronic treatment with CsA could modify the episodic secretion of prolactin in male rats and whether the presence of an ectopic pituitary could counteract the effects of the drug on the pulsatile secretion pattern of this hormone. At 30 days of age, male rats were implanted with one anterior pituitary under the kidney capsule or where sham-operated. Both pituitary-grafted and sham-operated rats were injected sc for 30 days with the vehicle or CsA (5 mg/kg/day), beginning on the day of surgery. Pituitary grafting and/or CsA administration changed the pulsatile secretion pattern of prolactin. In pituitary-grafted male rats, mean serum prolactin levels, absolute pulse amplitude, and half-life of the hormone increased, while the pulse frequency decreased, compared with the values found in sham-operated rats. CsA administration to sham-operated rats increased the relative amplitude of prolactin peaks and diminished the half-life of the hormone, compared with rats of the same group treated with vehicle. However, CsA treatment in pituitary grafted rats led to lower mean serum prolactin levels and absolute amplitude, while the frequency, duration, and relative amplitude of prolactin pulses were not modified. Plasma prolactin levels did not change in control animals, whereas a reduction in circulating values of the hormone was found in pituitary grafted animals. These data suggest that CsA modifies the pulsatile secretory pattern of prolactin in pituitary-grafted male rats. The different effects observed in the control and pituitary-grafted animals might be due to a direct effect of the drug on the ectopic lactotrophs that are submitted to local regulatory influences different from those of the in situ pituitary which are submitted to the regulatory influence of the hypothalamus.