1
|
Zhang Y, Zhu Y, Wang S, Feng YC, Li H. Erythropoietin receptor is a risk factor for prognosis: A potential biomarker in lung adenocarcinoma. Pathol Res Pract 2023; 251:154891. [PMID: 37844485 DOI: 10.1016/j.prp.2023.154891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/18/2023]
Abstract
Lung cancer has the highest mortality rate of all cancers, and LUAD's survival rate is particularly poor. Erythropoietin receptor (EPOR) can be detected in lung adenocarcinoma (LUAD), however, the expression levels and prognostic value of EPOR in LUAD are still unclear. In our study, clinicopathological data of 92 LUAD patients between January 2008 and June 2016, multiple bioinformatics databases and immunohistochemistry were used to explore the EPOR expression, the mutant genes affecting EPOR expression, and the correlation of EPOR expression with oxidative stress - related genes, prognosis, immune microenvironment. All statistical analyses were performed in the R version 4.1.1. The study found that EPOR expression might be down-regulated at the mRNA levels and significantly up-regulated at the protein levels in LUAD, which indicates that the mRNA and protein levels of EPOR are inconsistent. The muTarget showed that the expression of EPOR was significantly different between the mutant group and the wild group of 15 genes, including DDX60L and C1orf168. Importantly, we found that EPOR was associated with VEGF and HIF family members, and had significant positive correlation with oxidative stress - related genes such as CCS, EPX and TXNRD2. This suggests that EPOR may be involved in the regulation of oxidative stress. The Kaplan-Meier Plotter and PrognoScan databases consistently concluded that EPOR was associated with prognosis in LUAD patients. Our clinicopathological data showed that high EPOR expression was associated with poorer overall survival (29.5 vs 46 months) and had a good predictive ability for 4-year and 5-year survival probability. EPOR is expected to be a potential new prognostic marker for LUAD.
Collapse
Affiliation(s)
- Yajing Zhang
- Clinical Laboratory Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China; Xinjiang Key Laboratory of Oncology, Tumor Hospital Affiliated to Xinjiang Medical University, Xinjiang, China
| | - Yousen Zhu
- Clinical Laboratory Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Senyu Wang
- Xinjiang Key Laboratory of Oncology, Tumor Hospital Affiliated to Xinjiang Medical University, Xinjiang, China
| | - Yang Chun Feng
- Xinjiang Key Laboratory of Oncology, Tumor Hospital Affiliated to Xinjiang Medical University, Xinjiang, China.
| | - Hui Li
- Clinical Laboratory Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China.
| |
Collapse
|
2
|
Aboouf MA, Guscetti F, von Büren N, Armbruster J, Ademi H, Ruetten M, Meléndez-Rodríguez F, Rülicke T, Seymer A, Jacobs RA, Schneider Gasser EM, Aragones J, Neumann D, Gassmann M, Thiersch M. Erythropoietin receptor regulates tumor mitochondrial biogenesis through iNOS and pAKT. Front Oncol 2022; 12:976961. [PMID: 36052260 PMCID: PMC9425774 DOI: 10.3389/fonc.2022.976961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Erythropoietin receptor (EPOR) is widely expressed in healthy and malignant tissues. In certain malignancies, EPOR stimulates tumor growth. In healthy tissues, EPOR controls processes other than erythropoiesis, including mitochondrial metabolism. We hypothesized that EPOR also controls the mitochondrial metabolism in cancer cells. To test this hypothesis, we generated EPOR-knockdown cancer cells to grow tumor xenografts in mice and analyzed tumor cellular respiration via high-resolution respirometry. Furthermore, we analyzed cellular respiratory control, mitochondrial content, and regulators of mitochondrial biogenesis in vivo and in vitro in different cancer cell lines. Our results show that EPOR controls tumor growth and mitochondrial biogenesis in tumors by controlling the levels of both, pAKT and inducible NO synthase (iNOS). Furthermore, we observed that the expression of EPOR is associated with the expression of the mitochondrial marker VDAC1 in tissue arrays of lung cancer patients, suggesting that EPOR indeed helps to regulate mitochondrial biogenesis in tumors of cancer patients. Thus, our data imply that EPOR not only stimulates tumor growth but also regulates tumor metabolism and is a target for direct intervention against progression.
Collapse
Affiliation(s)
- Mostafa A. Aboouf
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
- Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Department of Biochemistry, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Franco Guscetti
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Nadine von Büren
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Julia Armbruster
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Hyrije Ademi
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Maja Ruetten
- PathoVet AG, Pathology Diagnostic Laboratory, Tagelswangen, Switzerland
| | | | - Thomas Rülicke
- Department of Biomedical Sciences, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Alexander Seymer
- Department for Sociology and Social Geography, Paris Lodron University of Salzburg (PLUS), Salzburg, Austria
| | - Robert A. Jacobs
- Department of Human Physiology & Nutrition, University of Colorado Colorado Springs (UCCS), Colorado Springs, CO, United States
| | - Edith M. Schneider Gasser
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Center of Neuroscience Zurich (ZNZ), University of Zurich, Zurich, Switzerland
| | - Julian Aragones
- Hospital Universitario Santa Cristina, Autonomous University of Madrid, Madrid, Spain
| | - Drorit Neumann
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Max Gassmann
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Markus Thiersch
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
- Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- *Correspondence: Markus Thiersch,
| |
Collapse
|
3
|
Zheng Y, Deng Z, Tang M, Cai P. Erythropoietin promoter polymorphism is associated with treatment efficacy and severe hematologic toxicity for platinum-based chemotherapy. Expert Opin Drug Metab Toxicol 2021; 17:495-502. [PMID: 33461346 DOI: 10.1080/17425255.2021.1879048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Erythropoietin (EPO) plays a substantial role in cancer development and probably affects clinical outcomes. A functional polymorphism (rs1617640, G > T) in the promoter region of the EPO increases protein expression. This study investigated the association of EPO rs1617640 with treatment efficacy and severe toxicity in non-small cell lung cancer (NSCLC) patients undergoing platinum-based regimens.Methods: 437 Chinese NSCLC patients treated with platinum-based chemotherapy were recruited. Association between EPO rs1617640 and clinical outcomes was calculated by multivariable logistic regression.Results: The TT genotype of EPO rs1617640 was significantly correlated with a higher response rate to platinum-based treatment than the other genotypes (OR, 0.507; 95% CI: 0.305-0.842; P = 0.009), particularly in elderly patients (>55 years), male gender, smokers, IV stage, cisplatin-based chemotherapies, and platinum-gemcitabine regimen subgroups. As for toxicity, EPO rs1617640 TT genotype demonstrated poorer tolerance to grade 3-4 hematologic toxicity (OR, 1.783; 95% CI: 1.098-2.898; P = 0.019), particularly in subgroups of elderly patients (>55 years), male gender, smokers, IIIA+IIIB stage, and cisplatin-based chemotherapies.Conclusion: Our results demonstrated the role of EPO rs1617640 as a possible predictive marker of treatment efficacy and severe toxicity for platinum-based chemotherapy.
Collapse
Affiliation(s)
- Yi Zheng
- Department of Pharmacy, Hunan Provincial Maternal and Child Health Care Hospital, Changsha People's Republic of China
| | - Zheng Deng
- General Department, Hunan Institute for Tuberculosis Control Changsha, People's Republic of China.,General Department, Hunan Chest Hospital, Changsha, People's Republic of China
| | - Mimi Tang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Pei Cai
- Department of Pharmacy, Hunan Provincial Maternal and Child Health Care Hospital, Changsha People's Republic of China
| |
Collapse
|
4
|
Blood serum proteins as biomarkers for prediction of survival, locoregional control and distant metastasis rate in radiotherapy and radio-chemotherapy for non-small cell lung cancer. BMC Cancer 2019; 19:427. [PMID: 31068179 PMCID: PMC6507220 DOI: 10.1186/s12885-019-5617-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies have documented that blood biomarkers can improve basic prognostic models in radiotherapy and radio-chemotherapy for non-small cell lung cancer. The current study evaluated the prognostic impact of six markers focusing on their utility in homogenous subsets, compared to the significance in a large heterogeneous group. METHODS Blood samples of 337 patients who were referred for curative or palliative external beam thoracic radiotherapy for non-small cell lung cancer were collected. The concentration of osteopontin (OPN), vascular endothelial growth factor (VEGF), erythropoetin (EPO), high mobility group box 1 protein (HMGB1), insulin-like growth factor 1 (IGF-1) and platelet-derived growth factor (PDGF) in serum were measured by ELISA assay and the prognostic potential was assessed using univariable and multivariable survival models. RESULTS Multivariable analysis revealed that out of several variables studied six dichotomized features: namely: cigarette smoking, lack of chemotherapy, palliative doses of radiotherapy, high OPN concentration, advanced T stage and high VEGF concentration had a highly significant (p < 0.005) and independent influence on overall survival in the group of 337 patients. In a subset of patients treated with curative radio-chemotherapy or radiotherapy (N = 148) tumor pathology, EPO concentration and VEGF concentration, significantly and independently influenced overall survival. In a subset of patients with squamous cell cancer (N = 206) OPN had a highly significant impact on overall survival. In contrast, in a subset of patients with nonsquamous histology (N = 131) only VEGF had a significant influence on survival. CONCLUSIONS Blood serum proteins appear to be clinically useful prognosticators of overall survival in radio-chemotherapy and radiotherapy for non-small cell lung cancer. In unselected heterogeneous groups, dichotomized concentrations of OPN and VEGF emerged among the strongest independent prognosticators of overall survival. VEGF and EPO concentration (dichotomized) were found to be independent prognostic factors among the patients treated with curative doses of radiotherapy. The utility of OPN as a prognostic marker appeared restricted to the patients with squamous histology.
Collapse
|
5
|
He L, Wu S, Hao Q, Dioum EM, Zhang K, Zhang C, Li W, Zhang W, Zhang Y, Zhou J, Pang Z, Zhao L, Ma X, Li M, Zhang Q. Local blockage of self-sustainable erythropoietin signaling suppresses tumor progression in non-small cell lung cancer. Oncotarget 2017; 8:82352-82365. [PMID: 29137269 PMCID: PMC5669895 DOI: 10.18632/oncotarget.19354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/30/2017] [Indexed: 12/18/2022] Open
Abstract
Functional significance of co-expressed erythropoietin (EPO) and its receptor (EPOR) in non-small cell lung cancer (NSCLC) had been under debate. In this study, co-overexpression of EPO/EPOR was confirmed to be positively associated with poor survival in NSCLC. The serum EPO in 14 of 35 enrolled NSCLC patients were found elevated significantly and decreased to normal level after tumor resection. With primary tumor cell culture and patient-derived tumor xenograft (PDX) mouse model, the EPO secretion from the tumors of these 14 patients was verified. Then, we proved the patient derived serum EPO was functionally active and had growth promotion effect in EPO/EPOR overexpressed but not in EPO/EPOR under-expressed NSCLC cells. We also illustrated EPO promoted NSCLC cell proliferation through an EPOR/Jak2/Stat5a/cyclinD1 pathway. In xenograft mouse model, we proved local application of EPO neutralizing antibody and short hairpin RNA (shRNA) against EPOR effectively inhibited the growth of EPO/EPOR overexpressed NSCLC cells and prolonged survivals of the mice. Finally, EPO/EPOR/Jak2/Stat5a/cyclinD1 signaling was found to be a mediator of hypoxia induced growth in EPO/EPOR overexpressed NSCLC. Our results illustrated a subgroup of NSCLC adapt to hypoxia through self-sustainable EPO/EPOR signaling and suggest local blockage of EPO/EPOR as potential therapeutic method in this distinct NSCLC population.
Collapse
Affiliation(s)
- Lei He
- State Key Laboratory of Cancer Biology, Biotechnology Center, School of Pharmacy, The Fourth Military Medical University, Xi'an, China
| | - Shouzhen Wu
- Shaanxi Institute of Pediatric Diseases, Xi'an Children's Hospital, Xi'an, China
| | - Qiang Hao
- State Key Laboratory of Cancer Biology, Biotechnology Center, School of Pharmacy, The Fourth Military Medical University, Xi'an, China
| | - Elhadji M Dioum
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Current/Present address: Diabetes Department, Nestle Institute of Health Science, EPFL Campus, Lausanne, Switzerland
| | - Kuo Zhang
- State Key Laboratory of Cancer Biology, Biotechnology Center, School of Pharmacy, The Fourth Military Medical University, Xi'an, China
| | - Cun Zhang
- State Key Laboratory of Cancer Biology, Biotechnology Center, School of Pharmacy, The Fourth Military Medical University, Xi'an, China
| | - Weina Li
- State Key Laboratory of Cancer Biology, Biotechnology Center, School of Pharmacy, The Fourth Military Medical University, Xi'an, China
| | - Wei Zhang
- State Key Laboratory of Cancer Biology, Biotechnology Center, School of Pharmacy, The Fourth Military Medical University, Xi'an, China
| | - Yingqi Zhang
- State Key Laboratory of Cancer Biology, Biotechnology Center, School of Pharmacy, The Fourth Military Medical University, Xi'an, China
| | - Jiming Zhou
- State Key Laboratory of Cancer Biology, Biotechnology Center, School of Pharmacy, The Fourth Military Medical University, Xi'an, China
| | - Zhijun Pang
- State Key Laboratory of Cancer Biology, Biotechnology Center, School of Pharmacy, The Fourth Military Medical University, Xi'an, China
| | - Lijuan Zhao
- State Key Laboratory of Cancer Biology, Biotechnology Center, School of Pharmacy, The Fourth Military Medical University, Xi'an, China
| | - Xiaowen Ma
- State Key Laboratory of Cancer Biology, Biotechnology Center, School of Pharmacy, The Fourth Military Medical University, Xi'an, China
| | - Meng Li
- State Key Laboratory of Cancer Biology, Biotechnology Center, School of Pharmacy, The Fourth Military Medical University, Xi'an, China
| | - Qiuyang Zhang
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Current/Present address: Center for Esophageal Research, Baylor University Medical Center, Dallas, Texas, USA
| |
Collapse
|
6
|
Rades D, Käsmann L, Schild SE, Janssen S. A Survival Score for Patients Receiving Palliative Irradiation for Locally Advanced Lung Cancer. Clin Lung Cancer 2016; 17:558-562. [DOI: 10.1016/j.cllc.2016.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/21/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
|
7
|
Schild SE, Tan AD, Wampfler JA, Ross HJ, Yang P, Sloan JA. A new scoring system for predicting survival in patients with non-small cell lung cancer. Cancer Med 2015; 4:1334-43. [PMID: 26108458 PMCID: PMC4567018 DOI: 10.1002/cam4.479] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/24/2015] [Accepted: 04/27/2015] [Indexed: 12/19/2022] Open
Abstract
This analysis was performed to create a scoring system to estimate the survival of patients with non-small cell lung cancer (NSCLC). Data from 1274 NSCLC patients were analyzed to create and validate a scoring system. Univariate (UV) and multivariate (MV) Cox models were used to evaluate the prognostic importance of each baseline factor. Prognostic factors that were significant on both UV and MV analyses were used to develop the score. These included quality of life, age, performance status, primary tumor diameter, nodal status, distant metastases, and smoking cessation. The score for each factor was determined by dividing the 5-year survival rate (%) by 10 and summing these scores to form a total score. MV models and the score were validated using bootstrapping with 1000 iterations from the original samples. The score for each prognostic factor ranged from 1 to 7 points with higher scores reflective of better survival. Total scores (sum of the scores from each independent prognostic factor) of 32–37 correlated with a 5-year survival of 8.3% (95% CI = 0–17.1%), 38–43 correlated with a 5-year survival of 20% (95% CI = 13–27%), 44–47 correlated with a 5-year survival of 48.3% (95% CI = 41.5–55.2%), 48–49 correlated to a 5-year survival of 72.1% (95% CI = 65.6–78.6%), and 50–52 correlated to a 5-year survival of 84.7% (95% CI = 79.6–89.8%). The bootstrap method confirmed the reliability of the score. Prognostic factors significantly associated with survival on both UV and MV analyses were used to construct a valid scoring system that can be used to predict survival of NSCLC patients. Optimally, this score could be used when counseling patients, and designing future trials.
Collapse
Affiliation(s)
- Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, 5881 E. Mayo Blvd, Phoenix, Arizona, 85054
| | - Angelina D Tan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St S.W., Rochester, Minnesota, 55905
| | - Jason A Wampfler
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St S.W., Rochester, Minnesota, 55905
| | - Helen J Ross
- Division of Medical Oncology, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, Arizona, 85259
| | - Ping Yang
- Epidemiology-Cancer Research, 200 First St S.W., Rochester, Minnesota, 55905
| | - Jeff A Sloan
- Cancer Center Statistics, Mayo Clinic, 200 First St S.W., Rochester, Minnesota, 55905
| |
Collapse
|
8
|
Debeljak N, Solár P, Sytkowski AJ. Erythropoietin and cancer: the unintended consequences of anemia correction. Front Immunol 2014; 5:563. [PMID: 25426117 PMCID: PMC4227521 DOI: 10.3389/fimmu.2014.00563] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 10/22/2014] [Indexed: 01/12/2023] Open
Abstract
Until 1990, erythropoietin (EPO) was considered to have a single biological purpose and action, the stimulation of red blood cell growth and differentiation. Slowly, scientific and medical opinion evolved, beginning with the discovery of an effect on endothelial cell growth in vitro and the identification of EPO receptors (EPORs) on neuronal cells. We now know that EPO is a pleiotropic growth factor that exhibits an anti-apoptotic action on numerous cells and tissues, including malignant ones. In this article, we present a short discussion of EPO, receptors involved in EPO signal transduction, and their action on non-hematopoietic cells. This is followed by a more detailed presentation of both pre-clinical and clinical data that demonstrate EPO’s action on cancer cells, as well as tumor angiogenesis and lymphangiogenesis. Clinical trials with reported adverse effects of chronic erythropoiesis-stimulating agents (ESAs) treatment as well as clinical studies exploring the prognostic significance of EPO and EPOR expression in cancer patients are reviewed. Finally, we address the use of EPO and other ESAs in cancer patients.
Collapse
Affiliation(s)
- Nataša Debeljak
- Faculty of Medicine, Institute of Biochemistry, University of Ljubljana , Ljubljana , Slovenia
| | - Peter Solár
- Department of Cell and Molecular Biology, Institute of Biology and Ecology, Faculty of Sciences, Pavol Jozef Šafárik University , Košice , Slovakia
| | - Arthur J Sytkowski
- Oncology Therapeutic Area, Quintiles Transnational , Arlington, MA , USA
| |
Collapse
|
9
|
Rózsás A, Berta J, Rojkó L, Horváth LZ, Keszthelyi M, Kenessey I, László V, Berger W, Grusch M, Hoda MA, Török S, Klepetko W, Rényi-Vámos F, Hegedűs B, Döme B, Tóvári J. Erythropoietin receptor expression is a potential prognostic factor in human lung adenocarcinoma. PLoS One 2013; 8:e77459. [PMID: 24155958 PMCID: PMC3796497 DOI: 10.1371/journal.pone.0077459] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 08/31/2013] [Indexed: 11/19/2022] Open
Abstract
Recombinant human erythropoietins (rHuEPOs) are used to treat cancer-related anemia. Recent preclinical studies and clinical trials, however, have raised concerns about the potential tumor-promoting effects of these drugs. Because the clinical significance of erythropoietin receptor (EPOR) signaling in human non-small cell lung cancer (NSCLC) also remains controversial, our aim was to study whether EPO treatment modifies tumor growth and if EPOR expression has an impact on the clinical behavior of this malignancy. A total of 43 patients with stage III–IV adenocarcinoma (ADC) and complete clinicopathological data were included. EPOR expression in human ADC samples and cell lines was measured by quantitative real-time polymerase chain reaction. Effects of exogenous rHuEPOα were studied on human lung ADC cell lines in vitro. In vivo growth of human ADC xenografts treated with rHuEPOα with or without chemotherapy was also assessed. In vivo tumor and endothelial cell (EC) proliferation was determined by 5-bromo-2’-deoxy-uridine (BrdU) incorporation and immunofluorescent labeling. Although EPOR mRNA was expressed in all of the three investigated ADC cell lines, rHuEPOα treatment (either alone or in combination with gemcitabine) did not alter ADC cell proliferation in vitro. However, rHuEPOα significantly decreased tumor cell proliferation and growth of human H1975 lung ADC xenografts. At the same time, rHuEPOα treatment of H1975 tumors resulted in accelerated tumor endothelial cell proliferation. Moreover, in patients with advanced stage lung ADC, high intratumoral EPOR mRNA levels were associated with significantly increased overall survival. This study reveals high EPOR level as a potential novel positive prognostic marker in human lung ADC.
Collapse
Affiliation(s)
- Anita Rózsás
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, Budapest, Hungary
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Judit Berta
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Lívia Rojkó
- Department of Bronchoscopy, National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - László Z. Horváth
- Department of Experimental Pharmacology, National Institute of Oncology, Budapest, Hungary
| | - Magdolna Keszthelyi
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - István Kenessey
- 2 Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Viktória László
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Walter Berger
- Institute of Cancer Research, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Grusch
- Institute of Cancer Research, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Mir Alireza Hoda
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
- Institute of Cancer Research, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Szilvia Török
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, Budapest, Hungary
- Department of Measurement Technology and Industrial Electrical Engineering, Lund University, Lund, Sweden
| | - Walter Klepetko
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Ferenc Rényi-Vámos
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
- Department of Thoracic Surgery, National Institute of Oncology, Budapest, Hungary
| | - Balázs Hegedűs
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
- 2 Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Balázs Döme
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, Budapest, Hungary
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
- 2 Department of Pathology, Semmelweis University, Budapest, Hungary
- Department of Thoracic Surgery, National Institute of Oncology, Budapest, Hungary
- * E-mail: (JT); (BD)
| | - József Tóvári
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, Budapest, Hungary
- Department of Experimental Pharmacology, National Institute of Oncology, Budapest, Hungary
- * E-mail: (JT); (BD)
| |
Collapse
|
10
|
Prognosis of patients with locally advanced squamous cell carcinoma of the head and neck. Impact of tumor cell expression of EPO and EPO-R. Strahlenther Onkol 2013; 189:559-65. [PMID: 23700207 DOI: 10.1007/s00066-013-0320-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 01/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE This study investigated the prognostic role of tumor cell expression of erythropoietin (EPO) and its receptor (EPO-R) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) treated with surgery plus radiotherapy. PATIENTS AND METHODS The impact of EPO, EPO-R, and 11 additional factors on locoregional control (LRC), metastases-free survival (MFS), and overall survival (OS) was retrospectively evaluated in 144 patients. Additional factors were age, gender, performance status, preradiotherapy (pre-RT) hemoglobin levels, tumor site, histologic grade, T category, N category, human papillomavirus (HPV) status, extent of resection, and chemotherapy. Univariate analyses were performed with the Kaplan-Meier method and the log-rank test, multivariate analyses with the Cox proportional hazard model. RESULTS On multivariate analysis, improved LRC was significantly associated with no EPO expression (risk ratio [RR] 3.72; 95 % confidence interval [CI] 1.35-15.42; p = 0.008), lower T category (RR 1.60; 95 %CI 1.14-2.32; p = 0.005), and oropharynx or larynx cancer (RR 1.23; 95 %CI 1.02-1.49; p = 0.033). Improved MFS was significantly associated with no EPO expression (RR 5.45; 95 %CI 1.13-97.81; p = 0.031), lower T category (RR 1.66; 95 %CI 1.11-2.65; p = 0.013), lower N category (RR 2.44; 95 %CI 1.04-6.66; p = 0.039), HPV positivity (RR 3.14; 95 %CI not available; p = 0.034), and oropharynx or larynx cancer (RR 1.28; 95 %CI 1.01-1.61; p = 0.041). Improved OS was significantly associated with no EPO expression (RR 4.77; 95 %CI 1.63-20.68; p = 0.003), no EPO-R expression (RR 2.36; 95 %CI 1.22-4.92; p = 0.010), lower T category (RR 1.44; 95 %CI 1.04-2.04; p = 0.027), oropharynx or larynx cancer (RR 1.30; 95 %CI 1.08-1.57; p = 0.007), and pre-RT hemoglobin ≥ 12 g/dl (RR 1.94; 95 %CI 1.03-3.65; p = 0.042). CONCLUSION EPO expression of tumor cells was an independent prognostic factor for LRC, MFS, and OS. EPO-R expression was an independent prognostic factor for OS.
Collapse
|
11
|
Abstract
Erythropoietin (Epo) is an essential hormone that binds and activates the Epo receptor (EpoR) resident on the surface of erythroid progenitor cells, thereby promoting erythropoiesis. Recombinant human erythropoietin has been used successfully for over 20 years to treat anemia in millions of patients. In addition to erythropoiesis, Epo has also been reported to have other effects, such as tissue protection and promotion of tumor cell growth or survival. This became of significant concern in 2003, when some clinical trials in cancer patients reported increased tumor progression and worse survival outcomes in patients treated with erythropoiesis-stimulating agents (ESAs). One of the potential mechanisms proffered to explain the observed safety issues was that functional EpoR was expressed in tumors and/or endothelial cells, and that ESAs directly stimulated tumor growth and/or antagonized tumor ablative therapies. Since then, numerous groups have performed further research evaluating this potential mechanism with conflicting data and conclusions. Here, we review the biology of endogenous Epo and EpoR expression and function in erythropoiesis, and evaluate the evidence pertaining to the expression of EpoR on normal nonhematopoietic and tumor cells.
Collapse
|
12
|
Welsch T, Zschäbitz S, Becker V, Giese T, Bergmann F, Hinz U, Keleg S, Heller A, Sipos B, Klingmüller U, Büchler MW, Werner J, Giese NA. Prognostic significance of erythropoietin in pancreatic adenocarcinoma. PLoS One 2011; 6:e23151. [PMID: 21829709 PMCID: PMC3148251 DOI: 10.1371/journal.pone.0023151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 07/07/2011] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Erythropoietin (Epo) administration has been reported to have tumor-promoting effects in anemic cancer patients. We investigated the prognostic impact of endogenous Epo in patients with pancreatic ductal adenocarcinoma (PDAC). METHODOLOGY The clinico-pathological relevance of hemoglobin (Hb, n = 150), serum Epo (sEpo, n = 87) and tissue expression of Epo/Epo receptor (EpoR, n = 104) was analyzed in patients with PDAC. Epo/EpoR expression, signaling, growth, invasion and chemoresistance were studied in Epo-exposed PDAC cell lines. RESULTS Compared to donors, median preoperative Hb levels were reduced by 15% in both chronic pancreatitis (CP, p<0.05) and PDAC (p<0.001), reaching anemic grade in one third of patients. While inversely correlating to Hb (r = -0.46), 95% of sEPO values lay within the normal range. The individual levels of compensation were adequate in CP (observed to predicted ratio, O/P = 0.99) but not in PDAC (O/P = 0.85). Strikingly, lower sEPO values yielding inadequate Epo responses were prominent in non-metastatic M0-patients, whereas these parameters were restored in metastatic M1-group (8 vs. 13 mU/mL; O/P = 0.82 vs. 0.96; p<0.01)--although Hb levels and the prevalence of anemia were comparable. Higher sEpo values (upper quartile ≥ 16 mU/ml) were not significantly different in M0 (20%) and M1 (30%) groups, but were an independent prognostic factor for shorter survival (HR 2.20, 10 vs. 17 months, p<0.05). The pattern of Epo expression in pancreas and liver suggested ectopic release of Epo by capillaries/vasa vasorum and hepatocytes, regulated by but not emanating from tumor cells. Epo could initiate PI3K/Akt signaling via EpoR in PDAC cells but failed to alter their functions, probably due to co-expression of the soluble EpoR isoform, known to antagonize Epo. CONCLUSION/SIGNIFICANCE Higher sEPO levels counteract anemia but worsen outcome in PDAC patients. Further trials are required to clarify how overcoming a sEPO threshold ≥16 mU/ml by endogenous or exogenous means may predispose to or promote metastatic progression.
Collapse
Affiliation(s)
- Thilo Welsch
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefanie Zschäbitz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Verena Becker
- Division Systems Biology of Signal Transduction, German Cancer Research Center and Bioquant, Heidelberg University, Heidelberg, Germany
| | - Thomas Giese
- Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Frank Bergmann
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulf Hinz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Shereen Keleg
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Anette Heller
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Bence Sipos
- Institute of Pathology, University Hospital Tübingen, Tübingen, Germany
| | - Ursula Klingmüller
- Division Systems Biology of Signal Transduction, German Cancer Research Center and Bioquant, Heidelberg University, Heidelberg, Germany
| | - Markus W. Büchler
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jens Werner
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Nathalia A. Giese
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|