Pathways of metastasis suppression in bladder cancer

Despite the recent advances in the diagnosis of bladder cancer, recurrence after surgical intervention for muscle invasive disease is still problematic as nearly half of the patients harbor occult distant metastases and this, in turn, is associated with poor 5-year survival rate. We have recently identified Rho family GDP dissociation inhibitor 2 (RhoGDI2) protein as functional metastasis suppressor and a prognostic marker in patients after cystectomy. In identifying the mechanisms underlying metastasis suppression by RhoGDI2, we found this protein to be associated with the c-Src kinase in human tumors, where the expression of both is diminished as a function of stage. Interestingly, c-Src bound to and phosphorylated RhoGDI2 resulting in enhanced metastasis suppressive potency. In this review, we will discuss the established roles of c-Src and RhoGDI2 in bladder cancer and speculate on their therapeutic relevance.     

Targeting tumor hypoxia: suppression of breast tumor growth and metastasis by novel carbonic anhydrase IX inhibitors

Carbonic anhydrase IX (CAIX) is a hypoxia and HIF-1-inducible protein that regulates intra- and extracellular pH under hypoxic conditions and promotes tumor cell survival and invasion in hypoxic microenvironments. Interrogation of 3,630 human breast cancers provided definitive evidence of CAIX as an independent poor prognostic biomarker for distant metastases and survival. shRNA-mediated depletion of CAIX expression in 4T1 mouse metastatic breast cancer cells capable of inducing CAIX in hypoxia resulted in regression of orthotopic mammary tumors and inhibition of spontaneous lung metastasis formation. Stable depletion of CAIX in MDA-MB-231 human breast cancer xenografts also resulted in attenuation of primary tumor growth. CAIX depletion in the 4T1 cells led to caspase-independent cell death and reversal of extracellular acidosis under hypoxic conditions in vitro. Treatment of mice harboring CAIX-positive 4T1 mammary tumors with novel CAIX-specific small molecule inhibitors that mimicked the effects of CAIX depletion in vitro resulted in significant inhibition of tumor growth and metastasis formation in both spontaneous and experimental models of metastasis, without inhibitory effects on CAIX-negative tumors. Similar inhibitory effects on primary tumor growth were observed in mice harboring orthotopic tumors comprised of lung metatstatic MDA-MB-231 LM2-4(Luc+) cells. Our findings show that CAIX is vital for growth and metastasis of hypoxic breast tumors and is a specific, targetable biomarker for breast cancer metastasis.     

Eph receptors in breast cancer: roles in tumor promotion and tumor suppression

Eph receptor tyrosine kinase signaling regulates cancer initiation and metastatic progression through multiple mechanisms. Studies of tumor-cell-autonomous effects of Eph receptors demonstrate their dual roles in tumor suppression and tumor promotion. In addition, Eph molecules function in the tumor microenvironment, such as in vascular endothelial cells, influencing the ability of these molecules to promote carcinoma progression and metastasis. The complex nature of Eph receptor signaling and crosstalk with other receptor tyrosine kinases presents a unique challenge and an opportunity to develop therapeutic intervention strategies for targeting breast cancer.     

Functional analysis of tumor metastasis: modeling colon cancer

The primary cause of death from colon cancer results from metastases that withstand conventional therapy and escape locoregional control. The molecular regulation of the tumor cell’s acquired ability for invasion and metastasis is still not completely understood and progress in this field may generate novel therapeutic targets. Osteopontin (OPN) has recently been identified as a lead marker for colon cancer progression with elevated OPN expression correlating with advanced stage and poor survival. This key regulator of metastasis has been shown to induce invasive mechanisms, increase motility, adhesiveness, angiogenesis, and enhance evasion of the immune system to augment the metastatic potential in colon cancer cells. This review will discuss the basic mechanisms underlying tumor metastasis, recent innovations used to screen and identify metastatic genes in colon cancer, and model systems used to analyze these potential targets. Target genes associated with activation of OPN, a master regulator of tumor metastasis, will be described in the context of a colon cancer model. Finally, the innovative techniques of RNA interference and aptamer technology for targeting metastasis genes will be reviewed.     

Late onset of tonsillar metastasis from breast cancer.

A 71-year-old woman non-smoker referred for repeated haemoptysis showed a tumoral lesion of the left tonsil. Pathological analysis of the biopsy showed characteristics compatible with a breast carcinoma metastasis, in which oestrogen and progesterone receptors were present. The patient had undergone mastectomy and had received adjuvant radiotherapy 24 years previously for a breast cancer with no complaints or signs of recurrence since. Investigations showed disseminated bone metastases but no other soft-tissue deposits. Anti-oestrogen therapy was applied. Only seven similar cases of tonsillar metastasis from breast cancer have been reported.     

UV-induced immune suppression and photocarcinogenesis: chemoprevention by dietary botanical agents

Studies of immune-suppressed transplant recipients and patients with biopsy-proven skin cancer have confirmed that ultraviolet (UV) radiation-induced immune suppression is a risk factor for the development of skin cancer in humans. UV radiation suppresses the immune system in several ways. The UVB spectrum inhibits antigen presentation, induces the release of immunosuppressive cytokines, and elicits DNA damage that is a molecular trigger of UV-mediated immunosuppression. It is therefore important to elucidate the mechanisms underlying UV-induced immunosuppression as a basis for developing strategies to protect individuals from this effect and subsequent development of skin cancer. Dietary botanicals are of particular interest as they have been shown to inhibit UV-induced immune suppression and photocarcinogenesis. In this review, we summarize the most recent investigations and mechanistic studies regarding the photoprotective efficacy of selected dietary agents, including, green tea polyphenols, grape seed proanthocyanidins and silymarin. We present evidence that these chemopreventive agents prevent UVB-induced immunosuppression and photocarcinogenesis through: (i) the induction of immunoregulatory cytokine interleukin (IL)-12; (ii) IL-12-dependent DNA repair; and (iii) stimulation of cytotoxic T cells in the tumor microenvironment. The new information regarding the mechanisms of action of these agents supports their potential use as adjuncts in the prevention of photocarcinogenesis.     

Micronutrients and cancer chemoprevention

Accumulating evidence suggests that a number of micronutrients may decrease the incidence of cancer of epithelial cell origin. These include vitamins A, C and E, beta-carotene and selenium. Few lines of research, apart from means to reduce cigarette smoking or heavy alcohol consumption, are as promising in terms of substantially decreasing human cancer incidence as studies of such micronutrients as dietary inhibitors of cancer. In this paper, we review the mechanisms by which these micronutrients may act to inhibit carcinogenesis, as well as the current animal and epidemiologic evidence supporting their role as chemopreventive agents. With respect to areas of future study, valuable information can be obtained from basic research as well as observational analytic epidemiologic studies utilizing dietary questionnaires which are more specifically focused and have been more rigorously evaluated than those previously employed. Another promising avenue of epidemiologic research is prospective studies of cancer incidence in relation to biochemical parameters in stored blood samples collected at baseline. The most reliable way to test directly whether a micronutrient prevents the development of human cancer is a large, randomized placebo-controlled trial among individuals with no previous history of the disease. The timely conduct of such trials is particularly important, since regular intake of nutritional supplements is already widespread in the United States, despite the lack of reliable evidence as to their benefits.     

Downregulation of osteopontin contributes to metastasis suppression by breast cancer metastasis suppressor 1

Breast cancer metastasis suppressor 1 (BRMS1) inhibits the ability of multiple human and murine cancer cell lines to metastasize to lymph nodes, bones and lungs. Comparison of mRNA expression in metastatic MDA-MB-435 human carcinoma cells (435) and metastasis-suppressed BRMS1 transfectants (435/BRMS1) showed a marked (>90%) reduction of osteopontin (OPN) mRNA and protein expression in BRMS1-overexpressing cells. OPN expression is associated with disease progression in patients, with higher levels of OPN produced by cancer cells associated with poorer patient survival. Furthermore, OPN has been suggested to promote survival of cancer cells in response to stress, although the mechanisms by which this may occur remain poorly understood. This study tested the hypothesis that re-expression of OPN in metastasis-suppressed 435/BRMS1 cells would reverse metastasis suppression and confer protection from stress-induced apoptosis. A stable pooled population of OPN overexpressing 435/BRMS1 cells was created (435/BRMS1/OPN). OPN re-expression did not affect in vitro cell growth rates; however, increased anchorage independent growth/survival and protection from hypoxia-induced apoptosis was observed (p < 0.05). In vivo, OPN re-expression in BRMS1 transfected cells did not affect in vivo primary tumor growth but did increase the incidence of spontaneous metastasis to lymph nodes and lungs in mice. These novel findings suggest that OPN downregulation by BRMS1 may be responsible, at least in part, for BRMS1-mediated metastasis suppression by sensitizing cancer cells to stress induced apoptosis. These studies clarify one mechanism by which BRMS1 can suppress metastasis.     

Breast cancer chemoprevention: beyond tamoxifen

A large number of new potential chemoprevention agents are available that target molecular abnormalities found in estrogen receptor (ER)-negative and/or ER-positive precancerous breast tissue and have side effect profiles that differ from tamoxifen. Classes of agents currently undergoing evaluation in clinical prevention trials or those for which testing is planned in the near future include new selective ER modulators, aromatase inactivators/inhibitors, gonadotrophin-releasing hormone agonists, monoterpenes, isoflavones, retinoids, rexinoids, vitamin D derivatives, and inhibitors of tyrosine kinase, cyclooxygenase-2, and polyamine synthesis. New clinical testing models will use morphological and molecular biomarkers to select candidates at highest short-term risk, to predict the response to a particular class of agent, and to assess the response in phase II prevention trials. If validated, morphological and molecular markers could eventually replace cancer incidence as an indicator of efficacy in future phase III trials.     

Gastric tumor from metastasis of breast cancer

Metastatic tumours of the stomach have been reported to result from various types of cancer. Among them, gastric metastasis from breast cancer has been recognised in 0.3-18% patients (1-4). Here, a rare case of metastatic gastric tumour derived from breast carcinoma is reported. Gastric endoscopy confirmed a large, friable mass (approximately 5 cm in diameter) in the upper part of the gastric body. The mass within the stomach was difficult to distinguish from primary gastric cancer, although biopsies of this lesion revealed the characteristics of adenocarcinoma. In addition, immunohistochemistry showed the positive expression of mammaglobin. Taken together, the evidence pointed to metastasis of breast cancer to the stomach. The patient was treated with hormonal therapy (letrozole), and the size of the metastasis in the stomach was markedly reduced. Therefore, a gastric metastasis from breast cancer was diagnosed successfully using immunohistochemistry and unnecessary surgery was avoided. In conclusion, although gastric metastatic tumours derived from breast carcinoma are rare, their accurate pre-operative diagnosis and appropriate systemic treatment is essential.     

Cytoglobin in tumor hypoxia: novel insights into cancer suppression

Emerging new and intriguing roles of cytoglobin (Cygb) have attracted considerable attention of cancer researchers in recent years. Hypoxic upregulation of Cygb as well as its altered expression in various human cancers suggest another possible role of this newly discovered globin in tumor cell response under low oxygen tension. Since tumor hypoxia is strongly associated with malignant progression of disease and poor treatment response, it constitutes an area of paramount importance for rational design of cancer selective therapies. However, the mechanisms involved during this process are still elusive. This review outlines the current understanding of Cygb’s involvement in tumor hypoxia and discusses its role in tumorigenesis. A better perception of Cygb in tumor hypoxia response is likely to open novel perspectives for future tumor therapy.     

乳腺癌转移抑制基因1抑制肿瘤转移的作用机制

乳腺癌转移抑制基因1 (BRMS1)在多种恶性肿瘤细胞中表达降低或缺失,具有明显降低癌细胞侵袭和转移的作用.BRMS1基因通过磷酸肌醇信号及核转录因子-κB(NF-κB)信号通路等调节基因转录和蛋白翻译,还可与mSin3-组蛋白去乙酰化酶(HDAC)复合体、雌激素受体等蛋白相互作用、修复细胞间隙通讯等途径抑制肿瘤细胞的侵袭及转移.BRMS1基因将可能成为有效抑制肿瘤转移基因治疗的新靶点.     

Phyto-oestrogens and breast cancer chemoprevention

Phytoestrogens are polyphenol compounds of plant origin that exhibit a structural similarity to the mammalian steroid hormone 17β-oestradiol. In Asian nations the staple consumption of phyto-oestrogen-rich foodstuffs correlates with a reduced incidence of breast cancer. Human dietary intervention trials have noted a direct relationship between phyto-oestrogen ingestion and a favourable hormonal profile associated with decreased breast cancer risk. However, these studies failed to ascertain the precise effect of dietary phyto-oestrogens on the proliferation of mammary tissue. Epidemiological and rodent studies crucially suggest that breast cancer chemoprevention by dietary phyto-oestrogen compounds is dependent on ingestion before puberty, when the mammary gland is relatively immature. Phyto-oestrogen supplements are commercially marketed for use by postmenopausal women as natural and safe alternatives to hormone replacement therapy. Of current concern is the effect of phyto-oestrogen compounds on the growth of pre-existing breast tumours. Data are contradictory, with cell culture studies reporting both the oestrogenic stimulation of oestrogen receptor-positive breast cancer cell lines and the antagonism of tamoxifen activity at physiological phyto-oestrogen concentrations. Conversely, phyto-oestrogen ingestion by rodents is associated with the development of less aggressive breast tumours with reduced metastatic potential. Despite the present ambiguity, current data do suggest a potential benefit from use of phyto-oestrogens in breast cancer chemoprevention and therapy. These aspects are discussed.     

Socio-ethic of cancer chemoprevention

Cancer chemoprevention envisions a reduction in the incidence of the disease through direct action using various chemical products. Chemoprevention trials involve healthy subjects, as a consequence careful ethical consideration must be given to such interventions. The classical contract between the patient and his doctor is altered in this situation and the numerous consequences of extrapolation of results to the general population must be considered. In particular a calculation of the risk-benefit ratio must take into account not only the physical but also the mental and social well being of people whose lives will be medicalised as a result of such intervention. The primacy of collective benefit over individual interest mandates that chemoprevention be based on scientific and well conducted trials. When results are extrapolated to the whole population an evaluation process has also to be permanently performed. The target population must be well informed and the participation based on voluntary consent.     

Breast cancer stem cells: Multiple capacities in tumor metastasis

Breast cancer is the leading cause of cancer death among women worldwide. Accumulating evidence indicates that the local recurrent and/or distant metastatic tumors, the major causes of lethality in the clinic, are related to the aggressive phenotype of a small fraction of cancer cells loosely termed as cancer stem cells (CSCs), tumor initiating cells (TICs), or cancer metastasis-initiating cells (CMICs). Breast cancer stem cells (BCSCs) are shown to exhibit unique growth abilities including self-renewal, differentiation potential, and resistance to most anti-cancer agents including chemo- and/or radiotherapy, all of which are believed to contribute to the development and overall aggressiveness of the recurrent or metastatic lesions. It is in the urgent need not only to further define the nature of heterogeneity in each tumor but also to characterize the precise mechanisms governing tumor–host cross-talk which is assumed to be initiated by BCSCs. In this review, we will focus on recently identified key factors, including the BCSCs among circulating tumor cells, interaction of BCSCs with the host, epithelial mesenchymal transition (EMT), tumor microenvironment, the intrinsic resistance due to HER2 expression, potential biomarkers of BCSCs and cancer cell immune signaling. We believe that new evidence coming from both bench and clinical research will help to develop more effective approaches to control or significantly reduce the aggressiveness of metastatic tumors.     

Terpenoids and breast cancer chemoprevention

Cancer chemoprevention is defined as the use of natural or synthetic agents that reverse, suppress or arrest carcinogenic and/or malignant phenotype progression towards invasive cancer. Phytochemicals obtained from vegetables, fruits, spices, herbs and medicinal plants, such as terpenoids, carotenoids, flavanoids, phenolic compounds, and other groups of compounds have shown promise in suppressing experimental carcinogenesis in various organs. Recent studies have indicated that mechanisms underlying chemopreventive action may include combinations of anti-oxidant, anti-inflammatory, immune-enhancing, and anti-hormone effects. Further, modification of drug-metabolizing enzymes, and influences on cell cycling and differentiation, induction of apoptosis, and suppression of proliferation and angiogenesis that play a role in the initiation and secondary modification of neoplastic development, have also been under investigation as possible mechanisms. This review will highlight the biological effects of terpenoids as chemopreventive agents on breast epithelial carcinogenesis, and the utility of intermediate biomarkers as indicators of premalignancy. Selected breast chemoprevention trials are discussed with a focus on strategies for trial design, and clinical outcomes. Future directions in the field of chemoprevention are proposed based on recently acquired mechanistic insights into breast carcinogenesis.     

Primary prevention: phytoprevention and chemoprevention of colorectal cancer

Considering the various stages of carcinogenesis and the numerous tumor types and available chemoprevention agents, knowledge of the etiology and the type of cancer to be treated, or possibly prevented, and understanding of the mechanisms by which agents exert their chemoprevention benefits may provide for improved strategy in designing therapeutic regimens. Because cancer usually develops over a 10- to 20-year period, it may be necessary for some agents to be provided before or early in the initiation steps of carcinogenesis to have beneficial effects. On the other hand, some agents may be more suitable for CRC prevention if provided at a later stage of carcinogenesis. Gene array, genomics, and proteomics are useful tools in advancing our understanding of the molecular events involved in carcinogenesis and in identifying markers of risk and surrogate end-points for colorectal cancer progression. These techniques may also serve for screening, identifying, and providing treatment targets for high-risk patients populations. Treatment could be developed depending on a patient's individual needs and genomic tumor profile. Clinical markers and surrogate end-points should be considered, together with molecular measurements, to more accurately assess risk. NSAIDs and COXIBs are clinically recognized as chemoprevention agents, and clinical trials evaluating their efficacy are ongoing. Treatment protocols, including dose and timing, remain to be determined, however. DFMO may best be used in combination with other chemoprevention agents. Dietary fiber and calcium supplements, as part of an overall low-fat diet, may decrease CRC risk. Long-term compliance with this regimen may be necessary to effect a beneficial outcome. Folate holds promise but needs further investigation, especially because its beneficial effects may depend on cancer type. Phytochemicals have been identified as strong candidates for use as agents to prevent colorectal cancer in cell culture and in rodent models of carcinogenesis. Their potential as chemoprevention agents must be demonstrated in clinical trials. In vitro and animal studies indicated that combination therapy may be a promising strategy over the monotherapy approach; clinical trials addressing the safety and efficacy of some combinations (DFMO/sulindac, fiber/calcium) are underway. The gastrointestinal tract and other organs are constantly exposed to a mixture of potentially toxic compounds and molecules considered favorable to health. Homeostasis between stress-mediated by toxic compounds and defensive mechanisms, is key for the maintenance of health and the prevention of disease. Whereas aggressive pharmacologic treatment may be necessary for patients at high risk for cancer, dietary supplements may be useful for populations at normal risk. The message for cancer prevention in the general population may well remain: keep a balanced healthy diet, eating a variety from all food groups, as part of a healthy lifestyle that includes moderate exercise.     

乳腺癌转移抑制基因1抑制肿瘤转移的机制

乳腺癌转移抑制基因1(BRMS1)具有抑制肿瘤细胞转移的能力,可明显减少转移灶的发生,但不影响肿瘤的生长.其作用机制复杂,与细胞间通讯、磷酸肌醇信号转导以及与转录核因子-KB(NF-KB)的相互作用等有关.故探讨BRMS1抑制肿瘤转移的机制,希望用于肿瘤基因治疗.