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Biological Mechanisms and Therapeutic Opportunities in Mammographic Density and Breast Cancer Risk. Cancers (Basel) 2021; 13:cancers13215391. [PMID: 34771552 PMCID: PMC8582527 DOI: 10.3390/cancers13215391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 12/13/2022] Open
Abstract
Mammographic density is an important risk factor for breast cancer; women with extremely dense breasts have a four to six fold increased risk of breast cancer compared to women with mostly fatty breasts, when matched with age and body mass index. High mammographic density is characterised by high proportions of stroma, containing fibroblasts, collagen and immune cells that suggest a pro-tumour inflammatory microenvironment. However, the biological mechanisms that drive increased mammographic density and the associated increased risk of breast cancer are not yet understood. Inflammatory factors such as monocyte chemotactic protein 1, peroxidase enzymes, transforming growth factor beta, and tumour necrosis factor alpha have been implicated in breast development as well as breast cancer risk, and also influence functions of stromal fibroblasts. Here, the current knowledge and understanding of the underlying biological mechanisms that lead to high mammographic density and the associated increased risk of breast cancer are reviewed, with particular consideration to potential immune factors that may contribute to this process.
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Li S, Zhang L, Zhou Q, Jiang S, Yang Y, Cao Y. Characterization of Stem Cells and Immune Cells in Preterm and Term Mother's Milk. J Hum Lact 2019; 35:528-534. [PMID: 31026180 DOI: 10.1177/0890334419838986] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Human milk is known to be rich in cellular components, including stem cells and immune cells. However, the dynamics of these cellular components at different lactation stages, and the differences between milk for preterm and term infants, are poorly understood. RESEARCH AIM To identify changes in the cellular components of human milk at different lactation stages, and to explore the associations of these changes with maternal and infant characteristics. METHODS Forty mothers of newborns of different gestational ages were enrolled. Colostrum, transitional, and mature milk samples were collected. Stem cell and immune cell molecule markers were detected using flow cytometry. Pluripotent genes (SOX2, NANOG, OCT4, and KLF4) were detected via quantitative real-time PCR. RESULTS Human milk contained some stem cells but more immune cells. The percentages of hemopoietic stem cells were significantly higher in mature milk than in colostrum, and the percentages of total immune cells were lower in mature milk than in colostrum. The percentages of hemopoietic stem cells in colostrum and transitional milk were influenced by gestational age. Some minor differences in the cell composition of human milk could be explained by maternal body mass index, the mode of delivery, and parity. CONCLUSION Our results again confirmed that human milk contains stem cells. Additionally, the percentages of hemopoietic stem cells and major immune cells changed dynamically at different lactation stages and were associated with gestational age at delivery.
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Affiliation(s)
- Shujuan Li
- 1 Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Lan Zhang
- 1 Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Qi Zhou
- 1 Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Siyuan Jiang
- 1 Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Yi Yang
- 2 NHC Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China.,3 Pediatric Institute, Children's Hospital of Fudan University, Shanghai, China
| | - Yun Cao
- 1 Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
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Huo CW, Hill P, Chew G, Neeson PJ, Halse H, Williams ED, Henderson MA, Thompson EW, Britt KL. High mammographic density in women is associated with protumor inflammation. Breast Cancer Res 2018; 20:92. [PMID: 30092832 PMCID: PMC6085707 DOI: 10.1186/s13058-018-1010-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/27/2018] [Indexed: 01/27/2023] Open
Abstract
Background Epidemiological studies have consistently shown that increased mammographic density (MD) is a strong risk factor for breast cancer. We previously observed an elevated number of vimentin+/CD45+ leukocytes in high MD (HMD) epithelium. In the present study, we aimed to investigate the subtypes of immune cell infiltrates in HMD and low MD (LMD) breast tissue. Methods Fifty-four women undergoing prophylactic mastectomy at Peter MacCallum Cancer Centre or St. Vincent’s Hospital were enrolled. Upon completion of mastectomy, HMD and LMD areas were resected under radiological guidance in collaboration with BreastScreen Victoria and were subsequently fixed, processed, and sectioned. Fifteen paired HMD and LMD specimens were further selected according to their fibroglandular characteristics (reasonable amount [> 20%] of tissue per block on H&E stains) for subsequent IHC analysis of immune cell infiltration. Results Overall, immune cell infiltrates were predominantly present in breast ducts and lobules rather than in the stroma, with CD68+ macrophages and CD20+ B lymphocytes also surrounding the vasculature. Macrophages, dendritic cells (DCs), B lymphocytes, and programmed cell death protein 1 (PD-1) expression were significantly increased in HMD epithelium compared with LMD. Moreover, significantly higher levels of DCs, CD4+ T cells, and PD-1 were also observed in HMD stroma than in LMD stroma. The increased expression of interleukin (IL)-6 and IL-4, with unaltered interferon-γ, indicate a proinflammatory microenvironment. Conclusions Our work indicates that the immune system may be activated very early in breast cancer development and may in part underpin the breast cancer risk associated with HMD. Electronic supplementary material The online version of this article (10.1186/s13058-018-1010-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cecilia W Huo
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Prue Hill
- Department of Pathology, St Vincent's Hospital, Melbourne, Australia
| | - Grace Chew
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Paul J Neeson
- Pathology Department, University of Melbourne, Melbourne, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | | | - Elizabeth D Williams
- Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Michael A Henderson
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Erik W Thompson
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.,Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Kara L Britt
- Peter MacCallum Cancer Centre, Melbourne, Australia. .,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
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Huo CW, Waltham M, Khoo C, Fox SB, Hill P, Chen S, Chew GL, Price JT, Nguyen CH, Williams ED, Henderson M, Thompson EW, Britt KL. Mammographically dense human breast tissue stimulates MCF10DCIS.com progression to invasive lesions and metastasis. Breast Cancer Res 2016; 18:106. [PMID: 27776557 PMCID: PMC5078949 DOI: 10.1186/s13058-016-0767-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/05/2016] [Indexed: 12/22/2022] Open
Abstract
Background High mammographic density (HMD) not only confers a significantly increased risk of breast cancer (BC) but also is associated with BCs of more advanced stages. However, it is unclear whether BC progression and metastasis are stimulated by HMD. We investigated whether patient-derived HMD breast tissue could stimulate the progression of MCF10DCIS.com cells compared with patient-matched low mammographic density (LMD) tissue. Methods Sterile breast specimens were obtained immediately after prophylactic mastectomy from high-risk women (n = 10). HMD and LMD regions of each specimen were resected under radiological guidance. Human MCF10DCIS.com cells, a model of ductal carcinoma in situ (DCIS), were implanted into silicone biochambers in the groins of severe combined immunodeficiency mice, either alone or with matched LMD or HMD tissue (1:1), and maintained for 6 weeks. We assessed biochamber weight as a measure of primary tumour growth, histological grade of the biochamber material, circulating tumour cells and metastatic burden by luciferase and histology. All statistical tests were two-sided. Results HMD breast tissue led to increased primary tumour take, increased biochamber weight and increased proportions of high-grade DCIS and grade 3 invasive BCs compared with LMD. This correlated with an increased metastatic burden in the mice co-implanted with HMD tissue. Conclusions Our study is the first to explore the direct effect of HMD and LMD human breast tissue on the progression and dissemination of BC cells in vivo. The results suggest that HMD status should be a consideration in decision-making for management of patients with DCIS lesions. Electronic supplementary material The online version of this article (doi:10.1186/s13058-016-0767-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cecilia W Huo
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Melbourne, VIC, 3156, Australia
| | - Mark Waltham
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Melbourne, VIC, 3156, Australia.,St Vincent's Institute of Medical Research, Melbourne, VIC, 3156, Australia
| | - Christine Khoo
- Department of Pathology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC, 3000, Australia
| | - Stephen B Fox
- Department of Pathology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC, 3000, Australia.,Department of Pathology, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Prue Hill
- Department of Pathology, St Vincent's Hospital, Melbourne, VIC, 3156, Australia
| | - Shou Chen
- Department of Pathology, St Vincent's Hospital, Melbourne, VIC, 3156, Australia
| | - Grace L Chew
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Melbourne, VIC, 3156, Australia.,Austin Health and Northern Health, Melbourne, VIC, 3084, Australia
| | - John T Price
- College of Health and Biomedicine, Victoria University, St Albans, VIC, 8001, Australia.,Department of Biochemistry and Molecular Biology, School of Biomedical Sciences, Monash University, Clayton, VIC, 3800, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, University of Melbourne and Western Health, Sunshine Hospital, St Albans, VIC, 3021, Australia
| | - Chau H Nguyen
- College of Health and Biomedicine, Victoria University, St Albans, VIC, 8001, Australia
| | - Elizabeth D Williams
- Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4001, Australia.,Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia.,Australian Prostate Cancer Centre - Queensland, Brisbane, QLD, 4102, Australia
| | - Michael Henderson
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Melbourne, VIC, 3156, Australia.,Division of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3002, Australia
| | - Erik W Thompson
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Melbourne, VIC, 3156, Australia. .,St Vincent's Institute of Medical Research, Melbourne, VIC, 3156, Australia. .,Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, 2 George Street, Brisbane, QLD, 4001, Australia. .,Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia.
| | - Kara L Britt
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia.,Department of Anatomy and Developmental Biology, Monash University, Melbourne, VIC, 3800, Australia.,Metastasis Research Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia
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Huo CW, Huang D, Chew GL, Hill P, Vohora A, Ingman WV, Glynn DJ, Godde N, Henderson MA, Thompson EW, Britt KL. Human glandular organoid formation in murine engineering chambers after collagenase digestion and flow cytometry isolation of normal human breast tissue single cells. Cell Biol Int 2016; 40:1212-1223. [PMID: 27590622 DOI: 10.1002/cbin.10675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 08/28/2016] [Indexed: 11/07/2022]
Abstract
Women with high mammographic density (MD) are at increased risk of breast cancer (BC) after adjustment for age and body mass index. We have developed a murine biochamber model in which both high MD (HMD) and low MD (LMD) tissue can be propagated. Here, we tested whether cells isolated by collagenase digestion and fluorescence-activated cell sorting (FACS) from normal breast can be reconstituted in our biochamber model, which would allow cell-specific manipulations to be tested. Fresh breast tissue was collected from women (n = 7) undergoing prophylactic mastectomy. The tissue underwent collagenase digestion overnight and, in some cases, additional FACS enrichment to obtain mature epithelial, luminal progenitor, mammary stem, and stromal cells. Cells were then transferred bilaterally into biochambers in SCID mice (n = 5-7) and incubated for 6 weeks, before harvesting for histological analyses, and immunohistochemical staining for cytokeratins (CK), vimentin, Ki-67, murine macrophages, and Cleaved Caspase-3. Biochambers inoculated with single cells after collagenase digestion or with flow cytometry contained glandular structures of human origin (human vimentin-positive), which expressed CK-14 and pan-CK, and were proliferating (Ki-67-positive). Glandular structures from the digested tissues were smaller than those in chambers seeded with finely chopped intact mammary tissue. Mouse macrophage infiltration was higher in the chambers arising from digested tissues. Pooled single cells and FACS fractionated cells were viable in the murine biochambers and formed proliferating glandular organoids of human origin. This is among the first report to demonstrate the success of formed human glandular organoids from isolated primary mammary cells in the murine biochamber model.
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Affiliation(s)
- Cecilia W Huo
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
| | - Dexing Huang
- St. Vincent's Institute of Medical Research, Melbourne, Australia
| | - Grace L Chew
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Prue Hill
- Department of Pathology, St. Vincent's Hospital, Melbourne, Australia
| | - Ambika Vohora
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Wendy V Ingman
- School of Medicine at the Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Danielle J Glynn
- School of Medicine at the Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Nathan Godde
- Cell Cycle and Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Michael A Henderson
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.,Division of Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Erik W Thompson
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.,Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology and Translational Research Institute, Brisbane, Australia
| | - Kara L Britt
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Metastasis Research Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
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Cordova A, Woodrick J, Grindrod S, Zhang L, Saygideger-Kont Y, Wang K, DeVito S, Daniele SG, Paige M, Brown ML. Aminopeptidase P Mediated Targeting for Breast Tissue Specific Conjugate Delivery. Bioconjug Chem 2016; 27:1981-90. [PMID: 26965452 DOI: 10.1021/acs.bioconjchem.5b00481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cytotoxic chemotherapies are used to treat breast cancer, but are limited by systemic toxicity. The key to addressing this important issue is the development of a nontoxic, tissue selective, and molecular specific delivery system. In order to potentially increase the therapeutic index of clinical reagents, we designed an Aminopeptidase P (APaseP) targeting tissue-specific construct conjugated to a homing peptide for selective binding to human breast-derived cancer cells. Homing peptides are short amino acid sequences derived from phage display libraries that have the unique property of localizing to specific organs. Our molecular construct allows for tissue-specific drug delivery, by binding to APaseP in the vascular endothelium. The breast homing peptide evaluated in our studies is a cyclic nine-amino-acid peptide with the sequence CPGPEGAGC, referred to as PEGA. We show by confocal microscopy that the PEGA peptide and similar peptide conjugates distribute to human breast tissue xenograft specifically and evaluate the interaction with the membrane-bound proline-specific APaseP (KD = 723 ± 3 nM) by binding studies. To achieve intracellular breast cancer cell delivery, the incorporation of the Tat sequence, a cell-penetrating motif derived from HIV, was conjugated with the fluorescently labeled PEGA peptide sequence. Ultimately, tissue specific peptides and their conjugates can enhance drug delivery and treatment by their ability to discriminate between tissue types. Tissue specific conjugates as we have designed may be valuable tools for drug delivery and visualization, including the potential to treat breast cancer, while simultaneously minimizing systemic toxicity.
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Affiliation(s)
- Antoinette Cordova
- Center for Drug Discovery, Georgetown University Medical Center , 3970 Reservoir Road NW Washington, DC 20057, United States
| | - Jordan Woodrick
- Georgetown University Medical Center , 3900 Reservoir Road NW, Washington, DC 20057, United States
| | - Scott Grindrod
- Center for Drug Discovery, Georgetown University Medical Center , 3970 Reservoir Road NW Washington, DC 20057, United States
| | - Li Zhang
- Center for Drug Discovery, Georgetown University Medical Center , 3970 Reservoir Road NW Washington, DC 20057, United States
| | - Yasemin Saygideger-Kont
- Georgetown University Medical Center , 3900 Reservoir Road NW, Washington, DC 20057, United States
| | - Kan Wang
- Center for Drug Discovery, Georgetown University Medical Center , 3970 Reservoir Road NW Washington, DC 20057, United States
| | - Stephen DeVito
- Georgetown University Medical Center , 3900 Reservoir Road NW, Washington, DC 20057, United States
| | - Stefano G Daniele
- Georgetown University Medical Center , 3900 Reservoir Road NW, Washington, DC 20057, United States
| | - Mikell Paige
- George Mason University , Department of Chemistry and Biochemistry, 10900 University Boulevard, Manassas, Virginia 20110, United States
| | - Milton L Brown
- Center for Drug Discovery, Georgetown University Medical Center , 3970 Reservoir Road NW Washington, DC 20057, United States
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Shawky MS, Ricciardelli C, Lord M, Whitelock J, Ferro V, Britt K, Thompson EW. Proteoglycans: Potential Agents in Mammographic Density and the Associated Breast Cancer Risk. J Mammary Gland Biol Neoplasia 2015; 20:121-31. [PMID: 26501889 DOI: 10.1007/s10911-015-9346-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/16/2015] [Indexed: 12/28/2022] Open
Abstract
Although increased mammographic density (MD) has been well established as a marker for increased breast cancer (BC) risk, its pathobiology is far from understood. Altered proteoglycan (PG) composition may underpin the physical properties of MD, and may contribute to the associated increase in BC risk. Numerous studies have investigated PGs, which are a major stromal matrix component, in relation to MD and BC and reported results that are sometimes discordant. Our review summarises these results and highlights discrepancies between PG associations with BC and MD, thus serving as a guide for identifying PGs that warrant further research towards developing chemo-preventive or therapeutic agents targeting preinvasive or invasive breast lesions, respectively.
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Chew GL, Huo CW, Huang D, Hill P, Cawson J, Frazer H, Hopper JL, Haviv I, Henderson MA, Britt K, Thompson EW. Increased COX-2 expression in epithelial and stromal cells of high mammographic density tissues and in a xenograft model of mammographic density. Breast Cancer Res Treat 2015; 153:89-99. [PMID: 26227474 DOI: 10.1007/s10549-015-3520-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 07/22/2015] [Indexed: 11/25/2022]
Abstract
Mammographic density (MD) adjusted for age and body mass index is one of the strongest known risk factors for breast cancer. Given the high attributable risk of MD for breast cancer, chemoprevention with a safe and available agent that reduces MD and breast cancer risk would be beneficial. Cox-2 has been implicated in MD-related breast cancer risk, and was increased in stromal cells in high MD tissues in one study. Our study assessed differential Cox-2 expression in epithelial and stromal cells in paired samples of high and low MD human breast tissue, and in a validated xenograft biochamber model of MD. We also examined the effects of endocrine treatment upon Cox-2 expression in high and low MD tissues in the MD xenograft model. Paired high and low MD human breast tissue samples were immunostained for Cox-2, then assessed for differential expression and staining intensity in epithelial and stromal cells. High and low MD human breast tissues were separately maintained in biochambers in mice treated with Tamoxifen, oestrogen or placebo implants, then assessed for percentage Cox-2 staining in epithelial and stromal cells. Percentage Cox-2 staining was greater for both epithelial (p = 0.01) and stromal cells (p < 0.0001) of high compared with low MD breast tissues. In high MD biochamber tissues, percentage Cox-2 staining was greater in stromal cells of oestrogen-treated versus placebo-treated tissues (p = 0.05).
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Affiliation(s)
- G L Chew
- University of Melbourne Department of Surgery, St Vincent's Hospital, Melbourne, VIC, Australia,
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Huo CW, Chew G, Hill P, Huang D, Ingman W, Hodson L, Brown KA, Magenau A, Allam AH, McGhee E, Timpson P, Henderson MA, Thompson EW, Britt K. High mammographic density is associated with an increase in stromal collagen and immune cells within the mammary epithelium. Breast Cancer Res 2015; 17:79. [PMID: 26040322 PMCID: PMC4485361 DOI: 10.1186/s13058-015-0592-1] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/20/2015] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Mammographic density (MD), after adjustment for a women's age and body mass index, is a strong and independent risk factor for breast cancer (BC). Although the BC risk attributable to increased MD is significant in healthy women, the biological basis of high mammographic density (HMD) causation and how it raises BC risk remain elusive. We assessed the histological and immunohistochemical differences between matched HMD and low mammographic density (LMD) breast tissues from healthy women to define which cell features may mediate the increased MD and MD-associated BC risk. METHODS Tissues were obtained between 2008 and 2013 from 41 women undergoing prophylactic mastectomy because of their high BC risk profile. Tissue slices resected from the mastectomy specimens were X-rayed, then HMD and LMD regions were dissected based on radiological appearance. The histological composition, aromatase immunoreactivity, hormone receptor status and proliferation status were assessed, as were collagen amount and orientation, epithelial subsets and immune cell status. RESULTS HMD tissue had a significantly greater proportion of stroma, collagen and epithelium, as well as less fat, than LMD tissue did. Second harmonic generation imaging demonstrated more organised stromal collagen in HMD tissues than in LMD tissues. There was significantly more aromatase immunoreactivity in both the stromal and glandular regions of HMD tissues than in those regions of LMD tissues, although no significant differences in levels of oestrogen receptor, progesterone receptor or Ki-67 expression were detected. The number of macrophages within the epithelium or stroma did not change; however, HMD stroma exhibited less CD206(+) alternatively activated macrophages. Epithelial cell maturation was not altered in HMD samples, and no evidence of epithelial-mesenchymal transition was seen; however, there was a significant increase in vimentin(+)/CD45(+) immune cells within the epithelial layer in HMD tissues. CONCLUSIONS We confirmed increased proportions of stroma and epithelium, increased aromatase activity and no changes in hormone receptor or Ki-67 marker status in HMD tissue. The HMD region showed increased collagen deposition and organisation as well as decreased alternatively activated macrophages in the stroma. The HMD epithelium may be a site for local inflammation, as we observed a significant increase in CD45(+)/vimentin(+) immune cells in this area.
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Affiliation(s)
- Cecilia W Huo
- University of Melbourne Department of Surgery, St. Vincent's Hospital, Level 2, Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, 3065, Australia.
| | - Grace Chew
- University of Melbourne Department of Surgery, St. Vincent's Hospital, Level 2, Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, 3065, Australia.
| | - Prue Hill
- Department of Pathology, St. Vincent's Hospital, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
| | - Dexing Huang
- St. Vincent's Institute, 9 Princes Street, Fitzroy, VIC, 3065, Australia.
| | - Wendy Ingman
- Discipline of Surgery, Faculty of Health Sciences, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia. .,Robinson Research Institute, University of Adelaide, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide, SA, 5006, Australia.
| | - Leigh Hodson
- Discipline of Surgery, Faculty of Health Sciences, School of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia. .,Robinson Research Institute, University of Adelaide, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide, SA, 5006, Australia.
| | - Kristy A Brown
- Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, VIC, 3168, Australia.
| | - Astrid Magenau
- Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Australia. .,St Vincent's Clinical School, Faculty of Medicine, University of NSW, Sydney, Australia. .,St Vincent's Clinical School, Faculty of Medicine, University of NSW, Clayton, Australia.
| | - Amr H Allam
- Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Australia. .,St Vincent's Clinical School, Faculty of Medicine, University of NSW, Sydney, Australia. .,St Vincent's Clinical School, Faculty of Medicine, University of NSW, Clayton, Australia.
| | - Ewan McGhee
- St Vincent's Clinical School, Faculty of Medicine, University of NSW, Sydney, Australia.
| | - Paul Timpson
- Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Australia. .,St Vincent's Clinical School, Faculty of Medicine, University of NSW, Sydney, Australia. .,St Vincent's Clinical School, Faculty of Medicine, University of NSW, Clayton, Australia.
| | - Michael A Henderson
- University of Melbourne Department of Surgery, St. Vincent's Hospital, Level 2, Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, 3065, Australia. .,Peter MacCallum Cancer Centre, 2 St. Andrews Place, East Melbourne, VIC, 3002, Australia.
| | - Erik W Thompson
- University of Melbourne Department of Surgery, St. Vincent's Hospital, Level 2, Clinical Sciences Building, 29 Regent Street, Fitzroy, VIC, 3065, Australia. .,St. Vincent's Institute, 9 Princes Street, Fitzroy, VIC, 3065, Australia. .,Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia.
| | - Kara Britt
- The Beatson Institute for Cancer Research, Switchback Road, Bearsden Glasgow, G61 1BD, UK. .,The Sir Peter MacCallum Department of Oncology, University of Melbourne, St. Andrews Place, East Melbourne, VIC, 3002, Australia. .,Department of Anatomy and Developmental Biology, Monash University, 19 Innovation Walk, Clayton, VIC, s, Australia.
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10
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Effects of Tamoxifen and oestrogen on histology and radiographic density in high and low mammographic density human breast tissues maintained in murine tissue engineering chambers. Breast Cancer Res Treat 2014; 148:303-14. [PMID: 25332094 DOI: 10.1007/s10549-014-3169-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Abstract
Mammographic density (MD) is a strong risk factor for breast cancer. It is altered by exogenous endocrine treatments, including hormone replacement therapy and Tamoxifen. Such agents also modify breast cancer (BC) risk. However, the biomolecular basis of how systemic endocrine therapy modifies MD and MD-associated BC risk is poorly understood. This study aims to determine whether our xenograft biochamber model can be used to study the effectiveness of therapies aimed at modulating MD, by examine the effects of Tamoxifen and oestrogen on histologic and radiographic changes in high and low MD tissues maintained within the biochamber model. High and low MD human tissues were precisely sampled under radiographic guidance from prophylactic mastectomy fresh specimens of high-risk women, then inserted into separate vascularized murine biochambers. The murine hosts were concurrently implanted with Tamoxifen, oestrogen or placebo pellets, and the high and low MD biochamber tissues maintained in the murine host environment for 3 months, before the high and low MD biochamber tissues were harvested for histologic and radiographic analyses. The radiographic density of high MD tissue maintained in murine biochambers was decreased in Tamoxifen-treated mice compared to oestrogen-treated mice (p = 0.02). Tamoxifen treatment of high MD tissue in SCID mice led to a decrease in stromal (p = 0.009), and an increase in adipose (p = 0.023) percent areas, compared to placebo-treated mice. No histologic or radiographic differences were observed in low MD biochamber tissue with any treatment. High MD biochamber tissues maintained in mice implanted with Tamoxifen, oestrogen or placebo pellets had dynamic and measurable histologic compositional and radiographic changes. This further validates the dynamic nature of the MD xenograft model, and suggests the biochamber model may be useful for assessing the underlying molecular pathways of Tamoxifen-reduced MD, and in testing of other pharmacologic interventions in a preclinical model of high MD.
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Elsamany S, Alzahrani A, Elkhalik SA, Elemam O, Rawah E, Farooq MU, H Almatrafi M, K Olayan F. Prognostic value of mammographic breast density in patients with metastatic breast cancer. Med Oncol 2014; 31:96. [PMID: 25012685 DOI: 10.1007/s12032-014-0096-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 06/23/2014] [Indexed: 11/25/2022]
Abstract
Breast density is a modifiable trait linked with breast cancer predisposition. However, the relation between mammographic breast density and survival outcome is not yet clarified. The present study aims to study the prognostic value of mammographic density in patients diagnosed with metastatic breast cancer. In this observational study, breast cancer patients with metastatic disease at diagnosis were enrolled. Two-view mammograms were performed at diagnosis, and breast density was quantitatively assessed. Progression-free survival (PFS) was correlated with breast density and other prognostic variables in univariate and multivariate analyses. PFS, stratified by different prognostic factors, was assessed in low compared to high density patients to check for possible differential survival outcome in patients' subgroups. Among the sixty enrolled patients, median PFS in low density patients was significantly better than those with high density (18.4 months, 95 % CI 14.88-22.15 vs. 9.3 months, 95 % CI 8.51-13.60, respectively, p = 0.002). Significant correlation of breast density with PFS persisted after adjustment by body mass index (p = 0.003) and after multivariate analysis incorporating other prognostic variables (HR 6.16, 95 % CI (2.17-17.48), p = 0.001). PFS was better in low density patients older than 40 years at diagnosis (p = 0.001), with HER2-negative disease (p = 0.015), hormonal receptor-positive phenotype (p = 0.020), patients with single site of metastasis (p = 0.006), and patients with bone-only metastases (p = 0.042). Breast density assessed at the time of diagnosis was significantly correlated with PFS of metastatic breast cancer patients. Survival outcome is improved in certain patients' subgroups with low breast density.
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Pettersson A, Tamimi RM. Breast Density and Breast Cancer Risk: Understanding of Biology and Risk. CURR EPIDEMIOL REP 2014. [DOI: 10.1007/s40471-014-0018-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Huo CW, Chew GL, Britt KL, Ingman WV, Henderson MA, Hopper JL, Thompson EW. Mammographic density-a review on the current understanding of its association with breast cancer. Breast Cancer Res Treat 2014; 144:479-502. [PMID: 24615497 DOI: 10.1007/s10549-014-2901-2] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 02/24/2014] [Indexed: 01/07/2023]
Abstract
There has been considerable recent interest in the genetic, biological and epidemiological basis of mammographic density (MD), and the search for causative links between MD and breast cancer (BC) risk. This report will critically review the current literature on MD and summarize the current evidence for its association with BC. Keywords 'mammographic dens*', 'dense mammary tissue' or 'percent dens*' were used to search the existing literature in English on PubMed and Medline. All reports were critically analyzed. The data were assigned to one of the following aspects of MD: general association with BC, its relationship with the breast hormonal milieu, the cellular basis of MD, the generic variations of MD, and its significance in the clinical setting. MD adjusted for age, and BMI is associated with increased risk of BC diagnosis, advanced tumour stage at diagnosis and increased risk of both local recurrence and second primary cancers. The MD measures that predict BC risk have high heritability, and to date several genetic markers associated with BC risk have been found to also be associated with these MD risk predictors. Change in MD could be a predictor of the extent of chemoprevention with tamoxifen. Although the biological and genetic pathways that determine and perhaps modulate MD remain largely unresolved, significant inroads are being made into the understanding of MD, which may lead to benefits in clinical screening, assessment and treatment strategies. This review provides a timely update on the current understanding of MD's association with BC risk.
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Affiliation(s)
- C W Huo
- Department of Surgery, University of Melbourne, St. Vincent's Hospital, Melbourne, Australia,
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