Escape from microenvironmental control and progression of intraepithelial neoplasia

C/EBP transcription factors in human squamous cell carcinoma: selective changes in expression of isoforms correlate with the neoplastic state

The CCAAT/Enhancer Binding Proteins (C/EBPs) are a family of leucine-zipper transcription factors that regulate physiological processes such as energy metabolism, inflammation, cell cycle, and the development and differentiation of several tissues including skin. Recently, a role for C/EBPs in tumor cell proliferation and differentiation has been proposed, but the incomplete characterization in the literature of multiple translational isoforms of these proteins has made interpretation of these roles difficult. Therefore, we have carefully reexamined C/EBP isoform expression in human non-melanoma skin cancers. C/EBPα, C/EBPβ, and C/EBPδ were analyzed histologically in squamous cell carcinomas (SCC). The individual isoforms of C/EBPα and C/EBPβ were examined by immunofluorescent digital imaging, western blotting and DNA binding activity (electrophoretic mobility shift analysis). Expression of all C/EBP family proteins was decreased in SCC tumors. Suppression was greatest for C/EBPα, less for C/EBPβ, and least for C/EBPδ. Western analyses confirmed that C/EBPα p42 and p30 isoforms were decreased. For C/EBPβ, only the abundant full-length isoform (C/EBPβ−1, LAP*, 55 kD) was reduced, whereas the smaller isoforms, C/EBPβ−2 (LAP, 48 kD) and C/EBPβ−3 (LIP, 20 kD), which are predominantly nuclear, were significantly increased in well- and moderately-differentiated SCC (up to 14-fold for C/EBPβ−3). These elevations correlated with increases in PCNA, a marker of proliferation. Although C/EBPβ displayed increased post-translational modifications in SCC, phosphorylation of C/EBPβ−1 (Thr 235) was not altered. C/EBP-specific DNA binding activity in nuclear and whole-cell extracts of cultured cells and tumors was predominantly attributable to C/EBPβ. In summary, two short C/EBPβ isoforms, C/EBPβ−2 and C/EBPβ−3, represent strong candidate markers for epithelial skin malignancy, due to their preferential expression in carcinoma versus normal skin, and their strong correlation with tumor proliferation.

Low-dose methotrexate enhances aminolevulinate-based photodynamic therapy in skin carcinoma cells in vitro and in vivo

PURPOSE

To improve treatment efficacy and tumor cell selectivity of delta-aminolevulinic acid (ALA)-based photodynamic therapy (PDT) via pretreatment of cells and tumors with methotrexate to enhance intracellular photosensitizer levels.

EXPERIMENTAL DESIGN

Skin carcinoma cells, in vitro and in vivo, served as the model system. Cultured human SCC13 and HEK1 cells, normal keratinocytes, and in vivo skin tumor models were preconditioned with methotrexate for 72 h and then incubated with ALA for 4 h. Changes in protoporphyrin IX (PpIX) levels and cell survival after light exposure were assessed.

RESULTS

Methotrexate preconditioning of monolayer cultures preferentially increased intracellular PpIX levels 2- to 4-fold in carcinoma cells versus normal keratinocytes. Photodynamic killing was synergistically enhanced by the combined therapy compared with PDT alone. Methotrexate enhancement of PpIX levels was achieved over a broad methotrexate concentration range (0.0003-1.0 mg/L; 0.6 nmol/L-2 mmol/L). PpIX enhancement correlated with changes in protein expression of key porphyrin pathway enzymes, approximately 4-fold increase in coproporphyrinogen oxidase and stable or slightly decreased expression of ferrochelatase. Differentiation markers (E-cadherin, involucrin, and filaggrin) were also selectively induced by methotrexate in carcinoma cells. In vivo relevance was established by showing that methotrexate preconditioning enhances PpIX accumulation in three models: (a) organotypic cultures of immortalized keratinocytes, (b) chemically induced skin tumors in mice; and (c) human A431 squamous cell tumors implanted subcutaneously in mice.

CONCLUSION

Combination therapy using short-term exposure to low-dose methotrexate followed by ALA-PDT should be further investigated as a new combination modality to enhance efficacy and selectivity of PDT for epithelial carcinomas.

[Relevance of cell culture models in cutaneous tumour biology: part II: complex culture systems]

There are several limitations to the use of the classical monolayer cell culture and the results obtained by means of it. The two-dimensional architecture and the analysis of pure cell populations of individual cell lines are the most several deviations from the situation prevailing in tissues in vivo, with inevitable consequences for the phenotypic traits displayed on the one hand, and for the genome structure and expression on the other hand. Newer developments in cell culture methodology seek approaches to mimic the in vivo situation in the cell culture as closely as possible. Remarkable variety of such approaches can be noticed, ranging from relative simple three-dimensional conditions of culturing pure cell lines on collagen gels or in form of multicell tumor spheroids. More complex forms try to combine multiple cell types in a single co-culture, e.g. of tumour cells and stromal fibroblasts. The most complex and most revealing among the three-dimensional culture arrangements is unquestionably the organotypic skin culture, in which all the relevant skin cell types are combined in a tissue-resembling construct, with resulting marked similarity to the anatomical structure of normal human skin. Several crucial results were obtained thereby, among others an intrinsic difference in the development of invasive squamous cell carcinoma and melanoma could be demonstrated. Just another experimental direction aims at direct tumourigenic transformation of normal human keratinocytes and melanocytes using highly efficient retroviral vectors. Immediately after establishing of the organotypic skin culture are such directly transformed primary cells transplanted on a nude mouse and the whole tumourigenic process is then essentially followed in vivo. This example illustrates finally the various possibilities of combination of in vitro and in vivo experimental approaches.

A new classification system of anticancer drugs - based on cell biological mechanisms

The arrival of a great number of new anticancer agents has made it necessary to reclassify all of them. We established a new classification system based on cell biological mechanisms. Anticancer drugs were grouped as cytotoxic drug and modifier, which could regulate the interaction of tumor, host and drugs. The modifiers were subdivided into three groups: cell biological modifier which reverses the abnormal biological behaviour of tumor cells, biological response modifier which regulates the host response of tumor and biochemical modulator which affects the host's metabolic pathway of cytotoxic drug to enhance the chemosensitivity or reduce the adverse reaction. Combination with cell biological modifiers and cytotoxic drugs play a double role of killer and rectifier for tumor cells, whereas biological response modifiers and cytotoxic drugs are combined to regulate the tumor-host interaction. Biochemical modulators and cytotoxic drugs are combined to enhance the chemosensitivity or improve the dose of cytotoxic drugs.