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Mei W, Faraj Tabrizi S, Godina C, Lovisa AF, Isaksson K, Jernström H, Tavazoie SF. A commonly inherited human PCSK9 germline variant drives breast cancer metastasis via LRP1 receptor. Cell 2024:S0092-8674(24)01326-6. [PMID: 39657676 DOI: 10.1016/j.cell.2024.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 08/12/2024] [Accepted: 11/10/2024] [Indexed: 12/12/2024]
Abstract
Identifying patients at risk for metastatic relapse is a critical medical need. We identified a common missense germline variant in proprotein convertase subtilisin/kexin type 9 (PCSK9) (rs562556, V474I) that is associated with reduced survival in multiple breast cancer patient cohorts. Genetic modeling of this gain-of-function single-nucleotide variant in mice revealed that it causally promotes breast cancer metastasis. Conversely, host PCSK9 deletion reduced metastatic colonization in multiple breast cancer models. Host PCSK9 promoted metastatic initiation events in lung and enhanced metastatic proliferative competence by targeting tumoral low-density lipoprotein receptor related protein 1 (LRP1) receptors, which repressed metastasis-promoting genes XAF1 and USP18. Antibody-mediated therapeutic inhibition of PCSK9 suppressed breast cancer metastasis in multiple models. In a large Swedish early-stage breast cancer cohort, rs562556 homozygotes had a 22% risk of distant metastatic relapse at 15 years, whereas non-homozygotes had a 2% risk. Our findings reveal that a commonly inherited genetic alteration governs breast cancer metastasis and predicts survival-uncovering a hereditary basis underlying breast cancer metastasis.
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Affiliation(s)
- Wenbin Mei
- Laboratory of Systems Cancer Biology, The Rockefeller University, New York, NY, USA
| | | | - Christopher Godina
- Division of Oncology, Department of Clinical Sciences in Lund, Lund University Cancer Center/Kamprad, Lund, Sweden
| | - Anthea F Lovisa
- Laboratory of Systems Cancer Biology, The Rockefeller University, New York, NY, USA
| | - Karolin Isaksson
- Division of Surgery, Department of Clinical Sciences in Lund, Lund University and Department of Surgery Kristianstad Hospital, Lund, Sweden
| | - Helena Jernström
- Division of Oncology, Department of Clinical Sciences in Lund, Lund University Cancer Center/Kamprad, Lund, Sweden
| | - Sohail F Tavazoie
- Laboratory of Systems Cancer Biology, The Rockefeller University, New York, NY, USA.
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Lindgren H, Ademi D, Godina C, Tryggvadottir H, Isaksson K, Jernström H. Potential interplay between tumor size and vitamin D receptor (VDR) polymorphisms in breast cancer prognosis: a prospective cohort study. Cancer Causes Control 2024; 35:907-919. [PMID: 38351438 PMCID: PMC11130020 DOI: 10.1007/s10552-023-01845-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/11/2023] [Indexed: 05/28/2024]
Abstract
PURPOSE Vitamin D has some anticancer properties that may decrease breast cancer risk and improve prognosis. The aim was to investigate associations between four previously studied VDR SNPs (Taq1, Tru91, Bsm1, and Fok1) and prognosis in different groups of breast cancer patients. METHODS VDR genotyping of 1,017 breast cancer patients included 2002-2012 in Lund, Sweden, was performed using Oncoarray. Follow-up was until June 30, 2019. Clinical data and patient information were collected from medical records and questionnaires. Cox regression was used for survival analyses. RESULTS Genotype frequencies were as follows: Fok1 (AA 15.7%, AG 49.1%, GG 35.1%), Bsm1 (CC 37.2%, CT 46.1%, TT 16.7%), Tru91 (CC 77.8%, CT 20.7%, TT 1.5%), and Taq1 (AA 37.2%, AG 46.2%, GG 16.6%). During follow-up there were 195 breast cancer events. The homozygous variants of Taq1 and Bsm1 were associated with reduced risk of breast cancer events (adjusted HR = 0.59, 95% CI 0.38-0.92 for Taq1 and adjusted HR = 0.61, 95% CI 0.40-0.94 for Bsm1). The G allele of the Fok1 was associated with increased risk of breast cancer events in small tumors (pT1, adjusted HR = 1.83, 95% CI 1.04-3.23) but not in large tumors (pT2/3/4, adjusted HR = 0.80, 95% CI 0.41-1.59) with a borderline interaction (Pinteraction = 0.058). No interactions between VDR genotypes and adjuvant treatments regarding breast cancer prognosis were detected. CONCLUSION VDR genotypes were associated with breast cancer prognosis and the association might be modified by tumor size. Further research is needed to confirm the findings and elucidate their potential clinical implications.
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Affiliation(s)
- Hampus Lindgren
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Barngatan 4, SE 221 85, Lund, Sweden
| | - David Ademi
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Barngatan 4, SE 221 85, Lund, Sweden
| | - Christopher Godina
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Barngatan 4, SE 221 85, Lund, Sweden
| | - Helga Tryggvadottir
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Barngatan 4, SE 221 85, Lund, Sweden
| | - Karolin Isaksson
- Division of Surgery, Department of Clinical Sciences, Lund, Lund University, SE 221 85, Lund, Sweden
- Department of Surgery, Kristianstad Hospital, J A Hedlunds väg 5, SE 291 33, Kristianstad, Sweden
| | - Helena Jernström
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Barngatan 4, SE 221 85, Lund, Sweden.
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Nilsson L, Khazaei S, Tryggvadottir H, Björner S, Bressan A, Jirström K, Adrian G, Falck AK, Borgquist S, Isaksson K, Jernström H. Pre- and Postoperative Antioxidant Use, Aryl Hydrocarbon Receptor (AhR) Activation and Clinical Outcome in Different Treatment Groups of Breast Cancer Patients. Clin Breast Cancer 2024; 24:e152-e166.e9. [PMID: 38307727 DOI: 10.1016/j.clbc.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/08/2023] [Accepted: 12/10/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Cancer patients often use antioxidants that may interact with adjuvant treatments. The purpose was to investigate pre- and postoperative antioxidant use in relation to clinicopathological characteristics and prognosis in different breast cancer treatment groups. METHODS AND PATIENTS Pre- and postoperative antioxidant (vitamin A, C, E, carotenoids, or Q10) or multivitamin use was self-reported by patients from Lund (n = 1855) and Helsingborg (n=478), Sweden. Patients were followed for up to 15 years. Clinical data were obtained from patient charts. The aryl hydrocarbon receptor (AhR) was evaluated in tumor tissue arrays from 915 patients from Lund and with Western blot in MCF-7 and MDA-MB-231 cells. RESULTS About 10% of patients used antioxidants. Nuclear AhR (AhRnuc) positivity was twice as common in preoperative antioxidant users compared to non-users. In mechanistic studies vitamin C increased AhR levels and its downstream target CYP1B1, indicating AhR activation. There were significant interactions between tumor AhRnuc status and preoperative antioxidant use in relation to clinical outcome. In all patients, antioxidant use (other than multivitamins) at both visits was associated with poorer prognosis, while use only at the follow-up visit was associated with better prognosis, compared with no use at either visit. CONCLUSION The clinical impact of antioxidants depended on antioxidant type, timing of use, and tumor AhR activation. Antioxidants may influence clinical outcome by activation of the master regulator AhR in addition to interference with free radicals. Further studies are needed to identify breast patients that might improve or worsen their prognosis when using antioxidants postoperatively.
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Affiliation(s)
- Linn Nilsson
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden; Department of Medical Physics and Engineering, Växjö Central Hospital and Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Somayeh Khazaei
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden
| | - Helga Tryggvadottir
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden; Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sofie Björner
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden
| | - Alessandra Bressan
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden
| | - Karin Jirström
- Department of Clinical Sciences, Division of Oncology and Therapeutic Pathology, Lund University, Lund, Sweden
| | - Gabriel Adrian
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden; Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Anna-Karin Falck
- Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden
| | - Signe Borgquist
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden; Department of Oncology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Karolin Isaksson
- Department of Clinical Sciences, Division of Surgery, Lund University, Lund, Sweden; Department of Surgery, Kristianstad Hospital, Kristianstad, Sweden
| | - Helena Jernström
- Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden.
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Huss L, Gulz-Haake I, Nilsson E, Tryggvadottir H, Nilsson L, Nodin B, Jirström K, Isaksson K, Jernström H. The Vitamin D Receptor as a Prognostic Marker in Breast Cancer-A Cohort Study. Nutrients 2024; 16:931. [PMID: 38612962 PMCID: PMC11013402 DOI: 10.3390/nu16070931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/14/2024] Open
Abstract
Previous research has indicated an association between the presence of the vitamin D receptor (VDR) in breast cancer tissue and a favorable prognosis. This study aimed to further evaluate the prognostic potential of VDR located in the nuclear membrane or nucleus (liganded). The VDR protein levels were analyzed using immunohistochemistry in tumor samples from 878 breast cancer patients from Lund, Sweden, included in the Breast Cancer and Blood Study (BCBlood) from October 2002 to June 2012. The follow-up for breast cancer events and overall survival was recorded until 30 June 2019. Univariable and multivariable survival analyses were conducted, both with complete case data and with missing data imputed using multiple imputation by chained equations (MICE). Tumor-specific positive nuclear membrane VDR(num) staining was associated with favorable tumor characteristics and a longer breast cancer free interval (BCFI; HR: 0.64; 95% CI: 0.44-0.95) and overall survival (OS; HR: 0.52; 95% CI: 0.34-0.78). Further analyses indicated that VDRnum status also was predictive of overall survival when investigated in relation to ER status. There were significant interactions between VDR and invasive tumor size (Pinteraction = 0.047), as well as mode of detection (Pinteraction = 0.049). VDRnum was associated with a longer BCFI in patients with larger tumors (HR: 0.36; 95% CI: 0.14-0.93) or clinically detected tumors (HR: 0.28; 95% CI: 0.09-0.83), while no association was found for smaller tumors and screening-detected tumors. Further studies are suggested to confirm our results and to evaluate whether VDR should and could be used as a prognostic and targetable marker in breast cancer diagnostics.
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Affiliation(s)
- Linnea Huss
- Department of Clinical Sciences, Division of Oncology, Lund University, 221 85 Lund, Sweden; (I.G.-H.); (E.N.); (H.T.); (L.N.); (B.N.); (K.J.)
- Department of Surgery, Helsingborg Hospital, 251 87 Helsingborg, Sweden
| | - Igis Gulz-Haake
- Department of Clinical Sciences, Division of Oncology, Lund University, 221 85 Lund, Sweden; (I.G.-H.); (E.N.); (H.T.); (L.N.); (B.N.); (K.J.)
| | - Emma Nilsson
- Department of Clinical Sciences, Division of Oncology, Lund University, 221 85 Lund, Sweden; (I.G.-H.); (E.N.); (H.T.); (L.N.); (B.N.); (K.J.)
| | - Helga Tryggvadottir
- Department of Clinical Sciences, Division of Oncology, Lund University, 221 85 Lund, Sweden; (I.G.-H.); (E.N.); (H.T.); (L.N.); (B.N.); (K.J.)
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, 221 85 Lund, Sweden
| | - Linn Nilsson
- Department of Clinical Sciences, Division of Oncology, Lund University, 221 85 Lund, Sweden; (I.G.-H.); (E.N.); (H.T.); (L.N.); (B.N.); (K.J.)
- Department of Medical Physics and Engineering, Växjö Central Hospital and Department of Research and Development, Region Kronoberg, 352 34 Växjö, Sweden
| | - Björn Nodin
- Department of Clinical Sciences, Division of Oncology, Lund University, 221 85 Lund, Sweden; (I.G.-H.); (E.N.); (H.T.); (L.N.); (B.N.); (K.J.)
| | - Karin Jirström
- Department of Clinical Sciences, Division of Oncology, Lund University, 221 85 Lund, Sweden; (I.G.-H.); (E.N.); (H.T.); (L.N.); (B.N.); (K.J.)
| | - Karolin Isaksson
- Department of Clinical Sciences, Division of Surgery, Lund University, 221 85 Lund, Sweden;
- Department of Surgery, Kristianstad Hospital, 291 85 Kristianstad, Sweden
| | - Helena Jernström
- Department of Clinical Sciences, Division of Oncology, Lund University, 221 85 Lund, Sweden; (I.G.-H.); (E.N.); (H.T.); (L.N.); (B.N.); (K.J.)
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Pazaitis N, Kaiser A. TMA-Mate: An open-source modular toolkit for constructing tissue microarrays of arbitrary layouts. HARDWAREX 2023; 14:e00419. [PMID: 37128356 PMCID: PMC10148229 DOI: 10.1016/j.ohx.2023.e00419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/02/2023] [Accepted: 04/07/2023] [Indexed: 05/03/2023]
Abstract
Biomedical research and quality control procedures often demand a variety of microscopic analysis of numerous formalin-fixed and paraffin-embedded (FFPE) tissue samples from different individuals of both healthy and diseased regions of interest. Depending on the number of samples to be analyzed, conventional processing of each FFPE block separately can be laborious or impracticable. This effort can be drastically reduced by using tissue microarrays (TMAs). TMAs have a wide range of applications and can be considered as a high-throughput method to process up to hundreds of miniaturized tissue samples simultaneously on a single microscopy slide, in order to reduce labor, costs and sample consumption, and to increase results comparability. Several commercial and self-made solutions to fabricate TMAs with varying degrees of automation are available. However, these solutions may not be suitable for every situation, either due to high costs, high complexity, lack of precision or lack of flexibility, especially when diagnostically oriented pathology institutes or laboratories with constrained resources are considered. This article introduces the TMA-Mate, an open-source 3D printable modular toolkit for constructing high-density TMAs of arbitrary layouts, providing an affordable, lightweight, and accessible procedure to implement TMAs into existing histology processing pipelines. Step-by-step demonstrations for replicating the hardware and constructing TMAs are included.
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Popović M, Silovski T, Križić M, Dedić Plavetić N. HER2 Low Breast Cancer: A New Subtype or a Trojan for Cytotoxic Drug Delivery? Int J Mol Sci 2023; 24:ijms24098206. [PMID: 37175916 PMCID: PMC10179462 DOI: 10.3390/ijms24098206] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/23/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Despite the great progress made in the understanding of the biological behavior of certain types of invasive breast cancer, there is still no single histological or molecular classification that encompasses such diversity and accurately predicts the clinical course of distinct breast cancer subtypes. The long-lasting classification of breast cancer as HER2-positive vs. HER2-negative has recently come into question with the discovery of new antibody drug conjugates (ADC), which are proven to be remarkably efficient in treating HER2-low breast cancer. The HER2-low paradigm has challenged the traditional understanding of HER2 overexpression and emphasized the need for more robust HER2 testing in order to encompass HER2 intratumoral heterogeneity and spatial distribution more accurately. It is yet to be seen if low HER2 will remain merely a marker of HER2-equipped tumors targetable with ADCs or if distinctive molecular and phenotypic groups within HER2-low tumors will eventually be discerned.
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Affiliation(s)
- Marina Popović
- Department of Oncology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Tajana Silovski
- Department of Oncology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Marija Križić
- Department of Oncology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Natalija Dedić Plavetić
- Department of Oncology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Godina C, Tryggvadottir H, Bosch A, Borgquist S, Belting M, Isaksson K, Jernström H. Caveolin-1 genotypes as predictor for locoregional recurrence and contralateral disease in breast cancer. Breast Cancer Res Treat 2023; 199:335-347. [PMID: 37017811 PMCID: PMC10175335 DOI: 10.1007/s10549-023-06919-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/18/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE Caveolin-1 (CAV1) has been implicated in breast cancer oncogenesis and metastasis and may be a potential prognosticator, especially for non-distant events. CAV1 functions as a master regulator of membrane transport and cell signaling. Several CAV1 SNPs have been linked to multiple cancers, but the prognostic impact of CAV1 SNPs in breast cancer remains unclear. Here, we investigated CAV1 polymorphisms in relation to clinical outcomes in breast cancer. METHODS A cohort of 1017 breast cancer patients (inclusion 2002-2012, Sweden) were genotyped using Oncoarray by Ilumina. Patients were followed for up to 15 years. Five out of six CAV1 SNPs (rs10256914, rs959173, rs3807989, rs3815412, and rs8713) passed quality control and were used for haplotype construction. CAV1 genotypes and haplotypes in relation to clinical outcomes were assessed with Cox regression and adjusted for potential confounders (age, tumor characteristics, and adjuvant treatments). RESULTS Only one SNP was associated with lymph node status, no other SNPs or haplotypes were associated with tumor characteristics. The CAV1 rs3815412 CC genotype (5.8% of patients) was associated with increased risk of contralateral breast cancer, adjusted hazard ratio (HRadj) 4.26 (95% CI 1.86-9.73). Moreover, the TTACA haplotype (13% of patients) conferred an increased risk for locoregional recurrence HRadj 2.24 (95% CI 1.24-4.04). No other genotypes or haplotypes were associated with clinical outcome. CONCLUSION CAV1 polymorphisms were associated with increased risk for locoregional recurrence and contralateral breast cancer. These findings may identify patients that could derive benefit from more tailored treatment to prevent non-distant events, if confirmed.
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Affiliation(s)
- Christopher Godina
- Division of Oncology, Department of Clinical Sciences in Lund, Lund University and Skåne University Hospital, Barngatan 4, 221 85, Lund, Sweden
| | - Helga Tryggvadottir
- Division of Oncology, Department of Clinical Sciences in Lund, Lund University and Skåne University Hospital, Barngatan 4, 221 85, Lund, Sweden
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund and Malmö, Sweden
| | - Ana Bosch
- Division of Oncology, Department of Clinical Sciences in Lund, Lund University and Skåne University Hospital, Barngatan 4, 221 85, Lund, Sweden
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund and Malmö, Sweden
| | - Signe Borgquist
- Division of Oncology, Department of Clinical Sciences in Lund, Lund University and Skåne University Hospital, Barngatan 4, 221 85, Lund, Sweden
- Department of Oncology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Mattias Belting
- Division of Oncology, Department of Clinical Sciences in Lund, Lund University and Skåne University Hospital, Barngatan 4, 221 85, Lund, Sweden
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund and Malmö, Sweden
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Karolin Isaksson
- Division of Surgery, Department of Clinical Sciences in Lund, Lund University and Kristianstad Hospital, Lund and Kristianstad, Sweden
| | - Helena Jernström
- Division of Oncology, Department of Clinical Sciences in Lund, Lund University and Skåne University Hospital, Barngatan 4, 221 85, Lund, Sweden.
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Sajjadi E, Venetis K, Ivanova M, Fusco N. Improving HER2 testing reproducibility in HER2-low breast cancer. CANCER DRUG RESISTANCE (ALHAMBRA, CALIF.) 2022; 5:882-888. [PMID: 36627898 PMCID: PMC9771736 DOI: 10.20517/cdr.2022.29] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/27/2022] [Accepted: 06/15/2022] [Indexed: 01/13/2023]
Abstract
HER2 is a pillar biomarker in breast cancer, and it is assessed by immunohistochemistry (IHC) using a three-tier scoring system and reflex in situ hybridization (ISH) for IHC score 2+. Novel HER2-directed antibody-drug conjugates have demonstrated significant antitumor activity in breast cancers with low levels of HER2 expression, i.e. IHC score 1+ or ISH-negative IHC score 2+. Both primary and acquired resistance to anti-HER2 therapies remains a challenge in the treatment of breast cancers according to the HER2 positivity continuum. Thus, the ability to precisely discriminate among HER2-zero, HER2-low, and HER2-positive breast cancers is no longer a mere academic exercise. HER2 testing criteria, guidelines, and quality controls are re-gaining momentum for this new clinical need. Therefore, all preanalytical and analytical variables that might trouble the sensitivity and reproducibility of this test should be carefully considered to address all possible issues and open all possible therapeutic opportunities for breast cancer patients.
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Affiliation(s)
- Elham Sajjadi
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan 20141, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan 20122, Italy
| | - Konstantinos Venetis
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan 20141, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan 20122, Italy
| | - Mariia Ivanova
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan 20141, Italy
| | - Nicola Fusco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan 20141, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan 20122, Italy.,Correspondence to: Prof. Nicola Fusco, Department of Oncology and Hemato-Oncology, University of Milan, Milan 20122, Italy. E-mail:
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9
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Interplay between Caveolin-1 and body and tumor size affects clinical outcomes in breast cancer. Transl Oncol 2022; 22:101464. [PMID: 35660849 PMCID: PMC9166433 DOI: 10.1016/j.tranon.2022.101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Caveolin-1 (CAV1) is associated with cholesterol-rich membrane raft domains and is a master regulator of cell signaling and membrane transport. Here, we investigated CAV1's role in cellular compartments of breast cancer in relation to signaling pathways, clinicopathological features, and clinical outcomes. METHODS CAV1 levels were evaluated with immunohistochemistry in cytoplasm of invasive tumor cells and stromal cells in tumor tissue microarrays from a cohort of 1018 breast cancer patients (inclusion 2002-2012, Sweden). Cytoplasmic and stromal CAV1 were categorized as positive/negative and strong/not strong, respectively. CAV1 expression in relation to clinical outcomes was assessed with Cox regression. Investigations into CAV1 functional pathways was conducted in the STRING, GOBO, and TCGA databases. RESULTS CAV1 expression was associated with non-luminal subtypes, cell cycle control, inflammation, epithelial-mesenchymal transition, and the IGF/Insulin system. Generally, CAV1 was not associated with recurrence risk. Stromal CAV1's impact on recurrence risk was modified by BMI ≥25 kg/m2 (Pinteraction = 0.002), waist ≥80 cm (Pinteraction = 0.005), and invasive tumor size (pT2/3/4) (Pinteraction = 0.028). In low-risk patients only, strong stromal CAV1 significantly increased recurrence risk (HRsadj ≥1.61). In all patients, positive cytoplasmic CAV1 conferred >2-fold risk for contralateral disease HRadj 2.63 (95% CI 1.36-5.10). Strong stromal CAV1 conferred nearly 2-fold risk for locoregional recurrence HRadj 1.88 (95% CI 1.09-3.24). CONCLUSIONS CAV1's prognostic impact depended on its localization, anthropometric, and tumor factors. Stromal CAV1 predicted high recurrence risk in a group of supposedly 'low-risk' patients. Cytoplasmic CAV1 predicted metachronous contralateral disease. If confirmed, CAV1 could be used as treatment target and for risk-stratification.
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Khazaei S, Nilsson L, Adrian G, Tryggvadottir H, Konradsson E, Borgquist S, Isaksson K, Ceberg C, Jernström H. Impact of combining vitamin C with radiation therapy in human breast cancer: does it matter? Oncotarget 2022; 13:439-453. [PMID: 35222809 PMCID: PMC8863110 DOI: 10.18632/oncotarget.28204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/14/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Somayeh Khazaei
- Division of Oncology, Clinical Sciences in Lund, Lund University and Skåne University Hospital, Lund, Sweden
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Linn Nilsson
- Division of Oncology, Clinical Sciences in Lund, Lund University and Skåne University Hospital, Lund, Sweden
- Department of Medical Physics and Engineering, Växjö Central Hospital and Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Gabriel Adrian
- Division of Oncology, Clinical Sciences in Lund, Lund University and Skåne University Hospital, Lund, Sweden
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Helga Tryggvadottir
- Division of Oncology, Clinical Sciences in Lund, Lund University and Skåne University Hospital, Lund, Sweden
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Elise Konradsson
- Department of Clinical Sciences in Lund, Medical Radiation Physics, Lund University, Lund, Sweden
| | - Signe Borgquist
- Division of Oncology, Clinical Sciences in Lund, Lund University and Skåne University Hospital, Lund, Sweden
- Department of Oncology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Karolin Isaksson
- Division of Surgery, Department of Clinical Sciences in Lund, Lund University, Lund, Sweden
- Department of Surgery, Kristianstad Hospital, Kristianstad, Sweden
| | - Crister Ceberg
- Department of Clinical Sciences in Lund, Medical Radiation Physics, Lund University, Lund, Sweden
| | - Helena Jernström
- Division of Oncology, Clinical Sciences in Lund, Lund University and Skåne University Hospital, Lund, Sweden
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Godina C, Khazaei S, Tryggvadottir H, Visse E, Nodin B, Jirström K, Borgquist S, Bosch A, Isaksson K, Jernström H. Prognostic impact of tumor-specific insulin-like growth factor binding protein 7 (IGFBP7) levels in breast cancer: a prospective cohort study. Carcinogenesis 2021; 42:1314-1325. [PMID: 34606580 PMCID: PMC8598394 DOI: 10.1093/carcin/bgab090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/07/2021] [Accepted: 09/27/2021] [Indexed: 12/25/2022] Open
Abstract
The prognostic impact of insulin-like growth factor binding protein 7 (IGFBP7) in breast cancer is unclear. Host factors, including lifestyle, anthropometry and metabolic profile, might influence tumor-specific IGFBP7. This study aimed to investigate whether IGFBP7 levels and messenger ribonucleic acid (mRNA) expression are associated with the patient and tumor characteristics and prognosis in breast cancer. Patients with primary breast cancer in Lund, Sweden, were included preoperatively in the study between 2002 and 2012 (n = 1018). Tumor-specific IGFBP7 protein levels were evaluated with immunohistochemistry using tissue microarrays in tumors from 878 patients. IGFBP7 mRNA expression and its corresponding clinical data were obtained from The Cancer Genome Atlas and analyzed for 809 patients. Tumor-specific IGFBP7 protein levels were categorized based on Histo 300 scores into IGFBP7low (6.2%), IGFBP7intermediate (75.7%) and IGFBP7high (18.1%). Both low IGFBP7 protein levels and mRNA expression were associated with less aggressive tumor characteristics. Overall, IGFBP7low conferred low recurrence risk. The prognostic impact of IGFBP7high varied according to any alcohol consumption and tamoxifen treatment. IGFBP7high was associated with low recurrence risk in alcohol consumers but high recurrence risk in alcohol abstainers (Pinteraction= 0.039). Moreover, the combination of IGFBP7high and estrogen receptor-positive tumors was associated with low recurrence risk only in tamoxifen-treated patients (Pinteraction= 0.029). To conclude, IGFBP7low might be a good, independent prognosticator in breast cancer. The prognostic impact of IGFBP7high depends on host factors and treatment. IGFBP7 merits further investigation to confirm whether it could be a suitable biomarker for treatment selection.
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Affiliation(s)
- Christopher Godina
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Barngatan 4, SE 221 85 Lund, Sweden
| | - Somayeh Khazaei
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Barngatan 4, SE 221 85 Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Helga Tryggvadottir
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Barngatan 4, SE 221 85 Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Edward Visse
- Division of Neurosurgery, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Björn Nodin
- Division of Oncology and Therapeutic Pathology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Karin Jirström
- Division of Oncology and Therapeutic Pathology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Signe Borgquist
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Barngatan 4, SE 221 85 Lund, Sweden.,Department of Oncology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ana Bosch
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Barngatan 4, SE 221 85 Lund, Sweden.,Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Karolin Isaksson
- Division of Surgery, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden.,Kristianstad Hospital, Kristianstad, Sweden
| | - Helena Jernström
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Barngatan 4, SE 221 85 Lund, Sweden
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12
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Tryggvadottir H, Sandén E, Björner S, Bressan A, Ygland Rödström M, Khazaei S, Edwards DP, Nodin B, Jirström K, Isaksson K, Borgquist S, Jernström H. The Prognostic Impact of Intratumoral Aryl Hydrocarbon Receptor in Primary Breast Cancer Depends on the Type of Endocrine Therapy: A Population-Based Cohort Study. Front Oncol 2021; 11:642768. [PMID: 34094928 PMCID: PMC8174786 DOI: 10.3389/fonc.2021.642768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/22/2021] [Indexed: 11/25/2022] Open
Abstract
The aryl hydrocarbon receptor (AhR) is a master regulator of multiple pathways involved in breast cancer, and influences the estrogen receptor alpha (ER) and aromatase/CYP19A1. The purpose of this study was to elucidate the interplay between intratumoral levels of AhR and aromatase, patient characteristics (including AhR and CYP19A1 genotypes), clinicopathological features, and prognosis in breast cancer patients receiving adjuvant treatments. A prospective cohort of 1116 patients with primary breast cancer in Sweden, included 2002-2012, was followed until June 30th 2019 (median 8.7 years). Tumor-specific AhR (n=920) and aromatase levels (n=816) were evaluated on tissue microarrays using immunohistochemistry. Associations between cytoplasmatic (AhRcyt) and nuclear (AhRnuc) AhR levels, intratumoral aromatase, clinicopathological features, and prognosis in different treatment groups were analyzed. Low AhRcyt levels (n=183) and positive intratumoral aromatase (n=69) were associated with estrogen receptor (ER)- status and more aggressive tumors. Genotypes were not associated with their respective protein levels. The functional AhR Arg554Lys GG genotype was associated with recurrence-free survival in switch-therapy (sequential tamoxifen/aromatase inhibitors (AI) or AI/tamoxifen) treated patients (HRadj 0.42; 95% CI 0.22-0.83). High AhRcyt levels were associated with longer recurrence-free survival during the first 10 years of follow-up among tamoxifen-only treated patients (HRadj 0.40; 95% CI 0.23-0.71) compared to low AhRcyt levels, whereas an almost inverse association was seen in patients with switch-therapy (P interaction=0.023). Intratumoral aromatase had little prognostic impact. These findings warrant confirmation in an independent cohort, preferably in a randomized clinical trial comparing different endocrine regimens. They might also guide the selection of breast cancer patients for clinical trials with selective AhR modulators.
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Affiliation(s)
- Helga Tryggvadottir
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Emma Sandén
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Sofie Björner
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Alessandra Bressan
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Maria Ygland Rödström
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Somayeh Khazaei
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Dean P. Edwards
- Department of Molecular & Cellular Biology and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - Björn Nodin
- Division of Oncology and Therapeutic Pathology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Karin Jirström
- Division of Oncology and Therapeutic Pathology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Karolin Isaksson
- Division of Surgery, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
- Department of Surgery, Kristianstad Hospital, Kristianstad, Sweden
| | - Signe Borgquist
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Lund, Sweden
- Department of Oncology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Helena Jernström
- Division of Oncology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Lund, Sweden
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13
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Nilsson L, Sandén E, Khazaei S, Tryggvadottir H, Nodin B, Jirström K, Borgquist S, Isaksson K, Jernström H. Patient Characteristics Influence Activated Signal Transducer and Activator of Transcription 3 (STAT3) Levels in Primary Breast Cancer-Impact on Prognosis. Front Oncol 2020; 10:1278. [PMID: 32850390 PMCID: PMC7403202 DOI: 10.3389/fonc.2020.01278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/19/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Activated signal transducer and activator of transcription 3 (pSTAT3) is often present in breast cancer, but its prognostic impact is still unclear. We investigated how breast tumor-specific pSTAT3Y705 levels are associated with patient and tumor characteristics and risk of recurrence. Materials and Methods: Primary breast cancer patients without preoperative treatment were included preoperatively. The patients were treated in Lund, Sweden, in 2002–2012 and followed until 2016. Levels of pSTAT3Y705 were evaluated in 867 tumors using tissue microarrays with immunohistochemistry and categorized according to the H-score as negative (0–9; 24.2%), intermediate (10–150; 69.9%), and high (160–300; 5.9%). Results: Patients were followed for up to 13 years, and 137 recurrences (88 distant) were recorded. Higher pSTAT3Y705 levels were associated with patient characteristics including younger age, any alcohol consumption, higher age at first child birth, and smaller body size, as well as tumor characteristics including smaller tumor size, lower histological grade, lymph node negativity, progesterone receptor positivity, and HER2 negativity (all Ptrends ≤ 0.04). Higher pSTAT3Y705 levels were associated with lower risk of early recurrences (LogRank Ptrend = 0.10; 5-year LogRank Ptrend = 0.004) and distant metastases (LogRank Ptrend = 0.045; 5-year LogRank Ptrend = 0.0007), but this was not significant in the multivariable models. There was significant effect modification between tamoxifen treatment and pSTAT3Y705 negativity on the recurrence risk in chemonaïve patients with estrogen receptor positive tumors [adjusted hazard ratio (HR) 0.38; Pinteraction = 0.046]. Conclusion: Higher pSTAT3Y705 levels were associated with several patient and tumor characteristics that are mainly associated with good prognosis and a tendency toward lower risk for early recurrences. In the future, these results may help guide the selection of patients for trials with drugs targeting the STAT3 pathway.
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Affiliation(s)
- Linn Nilsson
- Department of Clinical Sciences in Lund, Oncology, Lund University and Skåne University Hospital, Lund, Sweden.,Department of Medical Physics and Engineering, Växjö Central Hospital, Växjö, Sweden.,Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Emma Sandén
- Department of Clinical Sciences in Lund, Oncology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Somayeh Khazaei
- Department of Clinical Sciences in Lund, Oncology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Helga Tryggvadottir
- Department of Clinical Sciences in Lund, Oncology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Björn Nodin
- Department of Clinical Sciences in Lund, Oncology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Karin Jirström
- Department of Clinical Sciences in Lund, Oncology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Signe Borgquist
- Department of Clinical Sciences in Lund, Oncology, Lund University and Skåne University Hospital, Lund, Sweden.,Department of Oncology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Karolin Isaksson
- Department of Clinical Sciences in Lund, Surgery, Lund University, Lund, Sweden.,Department of Surgery, Central Hospital Kristianstad, Kristianstad, Sweden
| | - Helena Jernström
- Department of Clinical Sciences in Lund, Oncology, Lund University and Skåne University Hospital, Lund, Sweden
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