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Jang BG, Kim HS, Chang WY, Bae JM, Oh HJ, Wen X, Jeong S, Cho NY, Kim WH, Kang GH. Prognostic significance of stromal GREM1 expression in colorectal cancer. Hum Pathol 2016; 62:56-65. [PMID: 28041973 DOI: 10.1016/j.humpath.2016.12.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 12/23/2022]
Abstract
Cancer-associated fibroblasts are the dominant cell population in the cancer stroma. Gremlin 1 (GREM1), an antagonist of the bone morphogenetic protein pathway, is expressed by cancer-associated fibroblasts in a variety of human cancers. However, its biological significance for cancer patients is largely unknown. We applied RNA in situ hybridization to evaluate the prognostic value of stromal GREM1 expression in a large cohort of 670 colorectal cancers (CRCs). Overall, GREM1 expression in CRCs was lower than that of the matched normal mucosa, and GREM1 expression had a strong positive correlation with BMI1 and inverse correlations with EPHB2 and OLFM4. RNA in situ hybridization localized the GREM expression to smooth muscle cells of the muscularis mucosa and fibroblasts around crypt bases and in the submucosal space of a normal colon. In various colon polyps, epithelial GREM1 expression was exclusively observed in traditional serrated adenomas. In total, 44% of CRCs were positive for stromal GREM1, which was associated with decreased lymphovascular invasion, a lower cancer stage, and nuclear β-catenin staining. Stromal GREM1 was significantly associated with improved recurrence-free and overall survival, although it was not found to be an independent prognostic marker in multivariate analyses. In addition, for locally advanced stage II and III CRC, it was associated with better, stage-independent clinical outcomes. In summary, CRCs are frequently accompanied by GERM1-expressing fibroblasts, which are closely associated with low lymphovascular invasion and a better prognosis, suggesting stromal GREM1 as a potential biomarker and possible candidate for targeted therapy in the treatment of CRCs.
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Affiliation(s)
- Bo Gun Jang
- Department of Pathology, Jeju National University School of Medicine and Jeju National University Hospital, Jeju, 690-767 Republic of Korea
| | - Hye Sung Kim
- Department of Pathology, Jeju National University School of Medicine and Jeju National University Hospital, Jeju, 690-767 Republic of Korea
| | - Weon Young Chang
- Department of General Surgery, Jeju National University School of Medicine and Jeju National University Hospital, Jeju, 690-767 Republic of Korea
| | - Jeong Mo Bae
- Department of Pathology, Seoul National University College of Medicine, Seoul, 110-799 Republic of Korea; Laboratory of Epigenetics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 110-799 Republic of Korea
| | - Hyeon Jeong Oh
- Department of Pathology, Seoul National University College of Medicine, Seoul, 110-799 Republic of Korea
| | - Xianyu Wen
- Department of Pathology, Seoul National University College of Medicine, Seoul, 110-799 Republic of Korea; Laboratory of Epigenetics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 110-799 Republic of Korea
| | - Seorin Jeong
- Laboratory of Epigenetics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 110-799 Republic of Korea
| | - Nam Yun Cho
- Laboratory of Epigenetics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 110-799 Republic of Korea
| | - Woo Ho Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, 110-799 Republic of Korea
| | - Gyeong Hoon Kang
- Department of Pathology, Seoul National University College of Medicine, Seoul, 110-799 Republic of Korea; Laboratory of Epigenetics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 110-799 Republic of Korea.
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Brechbuhl HM, Finlay-Schultz J, Yamamoto TM, Gillen AE, Cittelly DM, Tan AC, Sams SB, Pillai MM, Elias AD, Robinson WA, Sartorius CA, Kabos P. Fibroblast Subtypes Regulate Responsiveness of Luminal Breast Cancer to Estrogen. Clin Cancer Res 2016; 23:1710-1721. [PMID: 27702820 DOI: 10.1158/1078-0432.ccr-15-2851] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 09/12/2016] [Accepted: 09/19/2016] [Indexed: 01/02/2023]
Abstract
Purpose: Antiendocrine therapy remains the most effective treatment for estrogen receptor-positive (ER+) breast cancer, but development of resistance is a major clinical complication. Effective targeting of mechanisms that control the loss of ER dependency in breast cancer remains elusive. We analyzed breast cancer-associated fibroblasts (CAF), the largest component of the tumor microenvironment, as a factor contributing to ER expression levels and antiendocrine resistance.Experimental Design: Tissues from patients with ER+ breast cancer were analyzed for the presence of CD146-positive (CD146pos) and CD146-negative (CD146neg) fibroblasts. ER-dependent proliferation and tamoxifen sensitivity were evaluated in ER+ tumor cells cocultured with CD146pos or CD146neg fibroblasts. RNA sequencing was used to develop a high-confidence gene signature that predicts for disease recurrence in tamoxifen-treated patients with ER+ breast cancer.Results: We demonstrate that ER+ breast cancers contain two CAF subtypes defined by CD146 expression. CD146neg CAFs suppress ER expression in ER+ breast cancer cells, decrease tumor cell sensitivity to estrogen, and increase tumor cell resistance to tamoxifen therapy. Conversely, the presence of CD146pos CAFs maintains ER expression in ER+ breast cancer cells and sustains estrogen-dependent proliferation and sensitivity to tamoxifen. Conditioned media from CD146pos CAFs with tamoxifen-resistant breast cancer cells are sufficient to restore tamoxifen sensitivity. Gene expression profiles of patient breast tumors with predominantly CD146neg CAFs correlate with inferior clinical response to tamoxifen and worse patient outcomes.Conclusions: Our data suggest that CAF composition contributes to treatment response and patient outcomes in ER+ breast cancer and should be considered a target for drug development. Clin Cancer Res; 23(7); 1710-21. ©2016 AACR.
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Affiliation(s)
- Heather M Brechbuhl
- Department of Medicine, Division of Medical Oncology, University of Colorado Denver, Aurora, Colorado.
| | | | - Tomomi M Yamamoto
- Department of Medicine, Division of Medical Oncology, University of Colorado Denver, Aurora, Colorado
| | - Austin E Gillen
- Department of Medicine, Division of Medical Oncology, University of Colorado Denver, Aurora, Colorado
| | - Diana M Cittelly
- Department of Pathology, University of Colorado Denver, Aurora, Colorado
| | - Aik-Choon Tan
- Department of Medicine, Division of Medical Oncology, University of Colorado Denver, Aurora, Colorado
| | - Sharon B Sams
- Department of Pathology, University of Colorado Denver, Aurora, Colorado
| | - Manoj M Pillai
- Section of Hematology, Division of Hematology, Yale Cancer Center and Yale University School of Medicine, New Haven, Connecticut
| | - Anthony D Elias
- Department of Medicine, Division of Medical Oncology, University of Colorado Denver, Aurora, Colorado
| | - William A Robinson
- Department of Medicine, Division of Medical Oncology, University of Colorado Denver, Aurora, Colorado
| | - Carol A Sartorius
- Department of Pathology, University of Colorado Denver, Aurora, Colorado
| | - Peter Kabos
- Department of Medicine, Division of Medical Oncology, University of Colorado Denver, Aurora, Colorado.
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