Phase Ⅲ Clinical Trials of the Cell Differentiation Agent-2 （CDA-2）： Therapeutic Efficacy on Breast Cancer, Non-Small Cell Lung Cancer and Primary Hepatoma

OBJECTIVE The objective of this study was to explore the effect of CDA-2, a selective inhibitor of abnormal methylation enzymes in cancer cells, on the therapeutic efficacy of cytotoxic chemotherapy. METHODS Advanced cancer patients, all of whom had previously undergone chemotherapy, were randomly divided into 2 groups, one receiving chemotherapy only as the control group, and the other receiving CDA-2 in addition to chemotherapy as the combination group. The therapeutic efficacies and the toxic maniestations of the 2 groups were compared based on the WHO criteria. RESULTS Of 454 cancer patients enrolled in phase Ⅲ clinical trials of CDA-2, 80, 188, and 186 were breast cancer, NSCLC, and primary hepatoma patients, respectively. Among them 378 patients completed treatments according to the protocols. The results showed that the overall effective rate of the combination group was 2.6 fold that of the control group, 4.8 fold in the case of breast cancer, 2.3 fold in the case of primary hepatoma, and 2.2 fold in the case of NSCLC. Surprisingly, the combination therapy appeared to work better for stage Ⅳ than stage Ⅲ patients. CDA-2 did not contribute additional toxicity. On the contrary, it reduced toxic manifestations of chemotherapy, particularly regarding white blood cells, nausea and vomiting. CONCLUSION Modulation of abnormal methylation enzymes by CDA-2 is definitely helpful to supplement chemotherapy. It significantly increased the therapeutic efficacy and reduced the toxic manifestation of cytotoxic chemotherapy on breast cancer and NSCLC.     

Relationship between Expression of Cell Adhesion Molecules and the Metastatic Mechanism in Invasive Micropapillary Carcinoma of the Breast

OBJECTIVE To explore the expression and the function of cell adhesion molecules in invasive micropapillary carcinoma (IMPC) of the breast, and to investigate the metastatic mechanism of IMPC. METHODS The expression of E-cadherin, α-catenin and β-catenin was detected by imrnunohistochemical staining in 64 cases of IMPC, and compared with that of invasive ductal carcinoma (IDC). RESULTS E-cadherin and β-catenin were mainly expressed on the cell membrane of tumors, and cc-catenin was expressed in the cytoplasm and/or on the cell membrane. The expression of E-cadherin in IMPC was significantly higher than that in IDC. Furthermore, the expression of E-cadherin was mainly on the intercellular contact surface of the tumor cell clusters in IMPC, while that on the outer surface of the tumor cell clusters decreased or could not be detected. The degree of lymph nodes metastases in IMPC was significantly higher than that in IDC. The co-expressions of α-catenin and β-catenin in cases of lymph nodes metastases along with the expression of E-cadherin in IMPC were significantly higher than that in IDC. CONCLUSIONS These findings indicated that the adhesiveness of the intercellular contact surfaces of tumor clusters in IMPC was strong, while that of the outer surface of tumor clusters was decreased or lost. It is suggested that the adhesive characteristic of the cells in IMPC might play an important role in its higher metastatic potential.     

The Significance of CXCR4 Expression for the Prediction of Lymph Node Metastasis in Breast Cancer Patients

OBJECTIVE The chemokine receptor(CXCR4)CXC chemokine receptor 4)plays an important role in cancer metastasis.We therefore studied differential expression of the CXCR4,as well as that of the biomarker HER2,so as to evaluate whether these biomarkers can be used to predict axillary lymph node metastasis in breast cancer patients. METHODS Immunohistochemistry was used to evaluate the CXCR4 and HER2 expressions and to examine the paraffin sections of the breast cancers at various stages.Positive lymph node expression was found in 80 of the cases,and in 7 there was negative expression. RESULTS Compared to the cases with negative lymph nodes, there was a high expression of CXCR4(26.3% vs.14.3%,P=0.013), and an over-expression of HER2(28.8% vs.14.3%,P=0.011). Moreover,there was a direct correlation between the CXCR4 and HER2 expressions and the tumor staging(P=0.000)and lymph node metastasis(P=0.032).When the two biomarkers,i.e.CXCR4 and HER2,were concurrently labeled,a high expression of one of the biomarkers could be seen in the cases with positive lymph nodes(51.3% vs.28.6%,P<0.003). CONCLUSION The chemokine receptor,CXCR4,is a new-type biomarker in predicting axillary lymph-node metastasis in breast cancers.Compared with the other markers,such as HER2 etc., assessment of CXCR4 can improve the prediction of the presence and extent of lymph node involvement.     

Transfection of the Human Sodium/Iodide Symporter （NIS） Gene with Liposomes and the Expression of the NIS Protein in Human Lung A549 Cancer Cells

OBJECTIVE To examine the possibility of human sodium iodide symporter （hNIS） protein expression in lung cancer cells. METHODS Human lung A549 cancer cells were thawed and cultured in vitro. The cells were divided into an experimental group transfected with a recombinant pcDNA3-hNIS plasmid and a control group transfected only with a pcDNA3 plasmid. The recombinant plasmid vector encoding the hNIS gene （pcDNA3-hNIS） was amplified, purified and identified. The hNIS gene was followed by DNA sequencing. A Western blot and an immunohistochemical assay were applied to detect the hNIS protein expression in the transfected human lung A549 cancer cells. RESULTS Restriction enzyme digestion and DNA sequencing results showed the size and direction of the inserted gene in the recombinant pcD- NA3-hNIS plasmid was correct. The Western blot method and immunohistochemical analysis showed a positive NIS protein expression in the experimental group. The NIS protein was detected mainly in the cell membranes showing a positive rate up to 70.6% with no expression of the NIS protein in the control group. There was a significant difference between two groups （P=0.000）. CONCLUSION The hNIS gene was transfected effectively into human lung A549 cancer cells mediated by Lipofectamine 2000, and was expressed with its protein in vitro.     

PD-L1 Expression of Tumor Cells,Macrophages, and Immune Cells in Non–Small Cell Lung Cancer Patients with Malignant Pleural Effusion

Introduction

Whether immunohistochemical staining of programmed death ligand 1 (PD-L1) on cells of pleural effusion could be used to predict response to immunotherapy treatment has not been reported.

Influence of the Calmodulin Antagonist EBB on Cyclin B1 and Cdc2-p34 in Human Drug-resistant Breast Cancer MCF-7/ADR Cells

OBJECTIVE To investigate the influence of O-(4-ethoxyl-butyl)- berbamine(EBB)on the expression of cyclin B1 and cdc2-p34 in the human drug-resistant breast cancer MCF-7/ADR cell line. METHODS The MTT assay was used to assess the cytotoxicity of EBB.Different levels of EBB were added to different cell lines at series of time points solely or combined with doxorubicin(DOX) to detect the effect on the expression of cyclinB1 and cdc2-p34 by Western blots.cdc2-p34 tyrosine phosphorylation was detected by immunoprecipitation.In addition,apoptosis and cytoplastic Ca 2 concentrations were systematically examined by laser scanning confocal microscopy(LSCM). RESULTS EBB showed little inhibitory activity on human umbilical vein endothelial cells(ECV304),whereas EBB inhibited cell growth(IC50 range,4.55~15.74μmol/L)in a variety of sensitive and drug-resistance cell lines.EBB also down-regulated the expression of cyclin B1 and cdc2-p34 in a concentration and time dependent manner,which was an important reason for the G2/M phase arrest.EBB was shown to induce apoptosis of MCF-7/ADR cells while increasing the level of cytoplastic Ca 2 . CONCLUSION The low cytotoxicity of EBB suggests it may be useful as a rational reversal agent.The effect of EBB on cell cycle arrest and related proteins,apoptosis,and cytoplastic Ca 2 concentration may be involved in reversing multidrug resistance.     

Expression of Preprotachykinin-I(PPT-I), Neurokinin-1(NK-1) and Neurokinin-2(NK-2) in Breast Cancer Cells Improves Tumor Cell Survival in Bone Marrow in the Early Stage of Metastasis

OBJECTIVE To study the potential relationship between the expression of PPT-I, NK-1, NK2 and the development of breast cancer cells in bone marrow stroma and to provide evidence of potential molecular mechanisms of bone metastasis in early stage of breast cancer patients.METHODS The cocultures of breast cancer cell line T-47D and marrow-derived mesenchymal stem cells (MSC) were established with equal numbers. T-47D cells were separated from the coculture system at 48 h and 96 h after coculture by MACS magnetic cell sorting (MicroBeads). The expression of PPT-I, NK-1, NK-2 in T-47D was then examined before and after coculture by real-time PCR and by Western blot. Alterations in cellular ultrastructure of T-47D cells were detected before and after coculture under electron microscope. Finally, changes in cell cycle distribution were examined by flow cytometry, and growth curves from before and after coculture were drawn and analyzed. RESULTS Following coculture of T-47D and MSC, the expression of PPT-I mRNA and protein was significantly upregulated, while the expression of NK-1 and NK-2 mRNA and protein was greatly downregulated. The analysis of cell cycle distribution by flow cytometry showed that the proportion of T-47D during S phase was increased, and the duration of the G2/M phase was sharply decreased. Under electron microscope, we observed that the synthesis of hereditary material was increased, but the hepatin granules were shown prominent stacking in T-47D cells. These results suggest that although the synthesis of DNA was increased, the proliferation of cells was inhibited after coculture. The cellgrowth curve confirmed the findings from the observation under the electron microscope and flow cytometry. CONCLUSION Tumor cells could survive through the upregulation in expression of preprotachykinin-I gene during early bone metastasis in breast cancer. The phenomenon of growth suppression in breast cancer cells after coculture in the current study could be induced by downregulation in expression of NK-1 and NK-2.     

Detection of minimal residual disease in blood and bone marrow in early stage breast cancer

BACKGROUND:

The significance of circulating tumor cells (CTCs) in blood and of disseminated tumor cells (DTCs) in bone marrow (BM) in patients with early stage breast cancer is unclear. In this study, the authors investigated the occurrence of CTCs and DTCs in women with early stage breast cancer and evaluated the correlation of their presence with other prognostic markers.

METHODS:

Blood and BM aspirations were collected at the time of primary breast surgery. CTCs were detected by using the CellSearch assay, and DTCs were detected by immunostaining BM aspirates for pancytokeratin. The presence of CTCs and DTCs was correlated with tumor classification (T1 vs T2), tumor histologic grade, estrogen receptor (ER) status, progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER2) status, and lymph node (LN) status.

RESULTS:

Of 92 patients who were included in the study, 49 had T1 tumors, and 43 had T2 tumors. CTCs were detected in 31% of patients, and DTCs were detected in 27% of patients. There was no correlation between the occurrence of CTCs and DTCs with the tumor classification (T1 vs T2) or histologic grade. CTCs were detected in 33% of patients with ER‐positive disease versus 26% of patients with ER‐negative disease, in 32% of patients with PR‐positive disease versus 30% of patients with PR‐negative disease, and in 25% of patients with HER2‐positive disease versus 31% of patients with HER2‐negative disease. DTCs were observed in 23% of patients with ER‐positive disease versus 37% of patients with ER‐negative disease, in 22% of patients with PR‐positive disease versus 32% of patients with PR‐negative disease, and in 0% of patients with HER2‐positive disease versus 29% of patients with HER2‐negative disease. CTCs and DTCs were nearly equally prevalent in both LN‐positive women and LN‐negative women. There was no significant correlation between the occurrence of CTCs or DTCs with tumor classification (T1 vs T2), tumor histologic grade, positive ER status, positive PR status, or positive HER2 status, and axillary LN status.

CONCLUSIONS:

CTCs and DTCs in women with early stage breast cancer did not correlate with the standard prognostic indicators that were considered. The implications of their occurrence in patients with early stage disease will require further large‐scale studies. Cancer 2010. © 2010 American Cancer Society.     

乳腺癌骨转移机制研究进展

乳腺癌是一种容易发生骨转移的女性常见恶性肿瘤。乳腺癌细胞的特异性、骨微环境及两者间相互作用是形成骨转移的共同因素。乳腺癌细胞表达的趋化因子受体、整合素、溶骨因子和成骨因子等使肿瘤细胞易于扩散到骨,而骨微环境可以为肿瘤细胞的生长提供丰富的生长因子和细胞因子。一旦乳腺癌细胞侵入骨质,肿瘤细胞分泌的因子就会作用于骨的外在结构和内在结构（如造血干细胞、T细胞、血小板、内皮细胞等）,使骨质破坏且分泌相关因子反作用于癌细胞,从而引起转移的级联反应和恶性循环形成。     

患乳腺癌大鼠骨髓间充质干细胞定向分化能力实验研究

目的：探讨患乳腺癌大鼠骨髓来源的骨髓间充质干细胞（BMSCs）多向分化潜能是否受到机体荷瘤状态影响。方法：以SHZ-88细胞接种sD大鼠,成瘤后,无菌取骨髓进行体外BMSCs的培养和传代,经不同诱导培养基培养后,分别检测其成脂、成骨和成心肌能力;将BMSCs经尾静脉移植于健康SD大鼠,观察患癌大鼠BMSCs的体内应用安全性。结果：患乳腺癌大鼠骨髓来源的BMSCs表达同正常骨髓来源的BMSCs相同的表面标志分子,可经体外诱导培养,分化为脂肪细胞、骨细胞或心肌细胞;体内应用患乳腺癌大鼠骨髓来源的BMSCs未见乳腺癌细胞污染所致的植入性肿瘤发生。结论：患乳腺癌大鼠骨髓来源的BMSCs具有多向分化能力,未受机体荷瘤状态影响,且体内应用较为安全。     

乳腺癌骨转移分子机制的研究进展

乳腺癌是女性最易患的恶性肿瘤,且发病率呈逐年上升趋势.大约有70%的患者在晚期发生骨转移,乳腺癌骨转移不仅可导致患者遭受贫血、骨折、截瘫、高血钙、疼痛和恶病质等痛苦,也是导致死亡率上升的重要原因.乳腺癌骨转移可分为若干个步骤,此篇综述介绍癌细胞的骨定向迁移及乳腺癌细胞和骨微环境的交互作用中涉及的重要因子.     

Selective interactions between epithelial tumour cells and bone marrow mesenchymal stem cells

This work is a comparative study on the features displayed by an epithelial metastatic breast cancer cell line (MCF-7) when set in co-culture with human bone marrow mesenchymal stem cells (MSC) or a feeder layer of 3T3 fibroblasts. MSC, a subset of non-haematopoietic cells in the marrow stroma, display a potential for self-renewal, proliferation and differentiation into precursors for bone, cartilage, connective and muscular tissue. Adhesion of MCF-7 cells to monolayers of MSC or 3T3 was high (95 and 85% respectively). Once attached, MCF-7 grow well on both monolayers. Morphology of MCF-7 cells, as analysed by light and epifluorescence microscopy, revealed that MCF-7 cells grow in clusters on 3T3, but disperse on MSC. Concomitant with the lost of their aggregation status, MCF-7 on MSC express low levels of the intercellular adhesion molecules, E-cadherin and epithelial-specific antigen (ESA). These results suggest that MSC represent an appropriate cell target to investigate the cellular and molecular events occurring at the interface of epithelial-marrow stromal interactions. Together, the model here described should permit to further evaluate the significance and prognostic impact of the shift of micrometastatic cells from a cluster-aggregated into a single-cell status.     

曲妥珠单抗对HER-2阳性早期乳腺癌骨髓微转移的影响

目的：检测HER-2阳性的早期乳腺癌患者应用曲妥珠单抗（Trastuzumab）治疗前后骨髓微转移的改变,探讨HER-2基因及Herceptin对骨髓微转移的影响。方法：应用实时定量逆转录-聚合酶链反应（qRT-PCR）方法检测15例HER-2阳性乳腺癌及18例HER-2阴性乳腺癌患者术前及化疗后骨髓CK19的表达水平,其中10例HER-2阳性乳腺癌患者在化疗结束后,继续应用Herceptin治疗,3月后再次抽取骨髓标本,qRT-PCR检测CK19的表达水平。结果：手术前,14例HER-2阳性乳腺癌患者骨髓CK19表达阳性（93.3%）,而HER-2阴性患者8例CK19表达阳性（44.4%）,二者差异显著（P=0.000）。化疗后,12例HER-2阳性乳腺癌患者CK19表达阳性（80.0%）,而HER-2阴性患者3例表达阳性（16.7%）,二者差异显著（P=0.000）。10例HER-2阳性乳腺癌患者化疗后继续应用Herceptin治疗3月后,骨髓CK19的表达明显下降（102.78±98.24 vs 66.92±49.18,P=0.036）。结论：HER-2基因的表达与早期乳腺癌患者骨髓微转移密切相关,而Herceptin可以降低骨髓微转移病灶,提示骨髓微转移情况可以作为Herceptin治疗疗效的早期预测指标。     

TGFBI modulates tumour hypoxia and promotes breast cancer metastasis

Breast cancer metastasis is a complex process that depends not only on intrinsic characteristics of metastatic stem cells, but also on the particular microenvironment that supports their growth and modulates the plasticity of the system. In search for microenvironmental factors supporting cancer stem cell (CSC) growth and tumour progression to metastasis, we here investigated the role of the matricellular protein transforming growth factor beta induced (TGFBI) in breast cancer. We crossed the MMTV‐PyMT model of mammary gland tumorigenesis with a Tgfbi ^Δ/Δ mouse and studied the CSC content of the tumours. We performed RNAseq on wt and ko tumours, and analysed the tumour vasculature and the immune compartment by IHC and FACS. The source of TGFBI expression was determined by qPCR and by bone marrow transplantation experiments. Finally, we performed in silico analyses using the METABRIC cohort to assess the potential prognostic value of TGFBI. We observed that deletion of Tgfbi led to a dramatic decrease in CSC content and lung metastasis. Our results show that lack of TGFBI resulted in tumour vessel normalisation, with improved vessel perfusion and decreased hypoxia, a major factor controlling CSCs and metastasis. Furthermore, human data mining in a cohort of breast cancer patients showed that higher expression of TGFBI correlates with poor prognosis and is associated with the more aggressive subtypes of breast cancer. Overall, these data reveal a novel biological mechanism controlling metastasis that could potentially be exploited to improve the efficacy and delivery of chemotherapeutic agents in breast cancer.

Abbreviations

CSC

cancer stem cell

ECM

extracellular matrix

EMT

epithelial‐to‐mesenchymal transition

FACS

fluorescence‐activated cell sorting

TGFBI

transforming growth factor beta induced

     

Primary breast cancer stem-like cells metastasise to bone,switch phenotype and acquire a bone tropism signature

Background:

Bone metastases represent a common and severe complication in breast cancer, and the involvement of cancer stem cells (CSCs) in the promotion of bone metastasis is currently under discussion. Here, we used a human-in-mice model to study bone metastasis formation due to primary breast CSCs-like colonisation.

Methods:

Primary CD44⁺CD24⁻ breast CSCs-like were transduced by a luciferase-lentiviral vector and injected through subcutaneous and intracardiac (IC) routes in non-obese/severe-combined immunodeficient (NOD/SCID) mice carrying subcutaneous human bone implants. The CSCs-like localisation was monitored by in vivo luciferase imaging. Bone metastatic CSCs-like were analysed through immunohistochemistry and flow cytometry, and gene expression analyses were performed by microarray techniques.

Results:

Breast CSCs-like colonised the human-implanted bone, resulting in bone remodelling. Bone metastatic lesions were histologically apparent by tumour cell expression of epithelial markers and vimentin. The bone-isolated CSCs-like were CD44⁻CD24⁺ and showed tumorigenic abilities after injection in secondary mice. CD44⁻CD24⁺ CSCs-like displayed a distinct bone tropism signature that was enriched in genes that discriminate bone metastases of breast cancer from metastases at other organs.

Conclusion:

Breast CSCs-like promote bone metastasis and display a CSCs-like bone tropism signature. This signature has clinical prognostic relevance, because it efficiently discriminates osteotropic breast cancers from tumour metastases at other sites.