Loss of REST in breast cancer promotes tumor progression through estrogen sensitization, MMP24 and CEMIP overexpression

BACKGROUND

Breast cancer is the most common malignancy in women, and is both pathologically and genetically heterogeneous, making early detection and treatment difficult. A subset of breast cancers express normal levels of REST (repressor element 1 silencing transcription factor) mRNA but lack functional REST protein. Loss of REST function is seen in ~ 20% of breast cancers and is associated with a more aggressive phenotype and poor prognosis. Despite the frequent loss of REST, little is known about the role of REST in the molecular pathogenesis of breast cancer.

METHODS

TCGA data was analyzed for the expression of REST target genes in breast cancer patient samples. We then utilized gene knockdown in MCF-7 cells in the presence or absence of steroid hormones estrogen and/ progesterone followed by RNA sequencing, as well as chromatin immunoprecipitation and PCR in an attempt to understand the tumor suppressor role of REST in breast cancer.

RESULTS

We show that REST directly regulates CEMIP (cell migration-inducing and hyaluronan-binding protein, KIAA1199) and MMP24 (matrix metallopeptidase 24), genes known to have roles in invasion and metastasis. REST knockdown in breast cancer cells leads to significant upregulation of CEMIP and MMP24. In addition, we found REST binds to RE-1 sites (repressor element-1) within the genes and influences their transcription. Furthermore, we found that the estrogen receptor (ESR1) signaling pathway is activated in the absence of REST, regardless of hormone treatment.

CONCLUSIONS

We demonstrate a critical role for the loss of REST in aggressive breast cancer pathogenesis and provide evidence for REST as an important diagnostic marker for personalized treatment plans.

Abstract P5-04-05: Loss of REST in breast cancer promotes tumor progression through estrogen sensitization, MMP24 and CEMIP overexpression

Breast cancer is the most common malignancy in women and is the second leading cause of cancer-related deaths. Breast cancer is both pathologically and genetically heterogeneous, making early detection and treatment difficult. A subset of breast cancers expresses normal levels of REST (Repressor Element 1 Silencing Transcription factor) mRNA but lacks functional REST protein. Loss of REST function is seen in ~20% of breast cancers and is associated with a more aggressive phenotype and poor prognosis. Despite the frequent loss of REST, little is known about the role of REST in the molecular pathogenesis of breast cancer. TCGA data was analyzed for the expression of REST and its target genes in breast cancer patient samples. MCF7, an estrogen and progesterone receptor positive breast cancer cell line, and MDA-MB-231, a triple-negative breast cancer cell line were used for in vitro studies to understand the function of REST. To evaluate the role of REST in the regulation of hormone receptor pathways, RNA sequencing was carried out on total RNA from MCF7 cells after siRNA knockdown of REST followed by treatment of hormones estrogen and progesterone. Chromatin Immunoprecipitation and PCR were performed on REST knockdown cells to evaluate gene regulation by REST and understand its tumor suppressor role in breast cancer. We show that REST directly regulates CEMIP (Cell Migration-Inducing and Hyaluronan-Binding Protein, KIAA1199) and MMP24 (Matrix Metallopeptidase 24), genes known to have roles in invasion and metastasis. REST knockdown in breast cancer cell lines leads to significant upregulation of CEMIP and MMP24. In addition, we found that REST binds to RE-1 sites (Repressor Element-1) within the genes and influences their transcriptional regulation. Aberrant expression of CEMIP and MMP24 results in CD44 dependent cell signaling that promotes cell proliferation and survival. We also found that the estrogen receptor signaling pathway is activated in the absence of REST regardless of hormone treatment. Our studies show that REST plays a significant role in altering the estrogen signaling pathway in hormone-sensitive breast cancers. REST transcriptionally regulates genes known to affect cell invasion and metastasis. Importantly, we demonstrate that loss of REST promotes aggressive breast cancer and see REST as an attractive therapeutic target.

Citation Format: Aditya M. Vargheese, Ashley S. Cloud, Sumedha Gunewardena, Raeann M. Shimak, Sornakala Ganeshkumar, Easwari Kumaraswamy, Roy A. Jensen, Vargheese M. Chennathukuzhi. Loss of REST in breast cancer promotes tumor progression through estrogen sensitization, MMP24 and CEMIP overexpression [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 P5-04-05.

Abstract 4703: Role of REST in the regulation of MMP24 and estrogen sensitivity in breast cancer

Breast cancer, the most common malignancy in women, is very difficult to detect and treat due to its heterogeneity. An important subset of breast cancers, Luminal or ER/PR positive tumors, lack REST (repressor element 1 silencing transcription factor) protein but not its mRNA. REST is a tumor suppressor and is known to play a role in regulating neurodegenerative diseases such as Alzheimer's. The loss of REST leads to the dysregulation of its target genes, many of which are involved in tumorigenesis. About 20% of breast cancers show loss of REST expression, yet little to nothing is currently known about the role REST plays in tumor growth. We hypothesized that the loss of REST promotes breast cancer growth by altering cell signaling. Our results show that knockdown of REST in MCF7 cells (ER/PR positive) causes similar gene dysregulation as seen in aggressive forms of breast cancers. Also, Ingenuity Pathway Analysis (IPA®) of our RNA sequencing results showed that REST knockdown leads to significant increase in estrogen receptor signaling in MCF7 cells. Upregulation of estrogen receptor expression has been associated with tumor progression. In addition, REST knockdown led to significant increases in the expression of MMP24 (>20-fold, p<10−85), a matrix modifying enzyme which could play a role in tumor metastasis, as well as KCNK3 (19-fold, p<10−40), a biomarker associated with poor patient survival. Thus, the poor survival of patients with RESTless breast cancers may be related to the activation of its target genes and elevated estrogen receptor signaling. Furthermore, these patients may respond differently to estrogen receptor antagonists compared to those with REST positive breast cancers. Our results will help with the future development of individualized therapies for breast cancer.

Citation Format: Aditya M. Vargheese, Ashley Cloud, Sumedha Gunewardena, Raeann Shimak, Easwari Kumaraswamy, Roy A. Jensen, Vargheese M. Chennathukuzhi. Role of REST in the regulation of MMP24 and estrogen sensitivity in breast cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4703.