Tumour cell and stromal features in metastatic and non-metastatic non-small cell lung carcinomas

Mesenchymal stem cells promote metastasis through activation of an ABL-MMP9 signaling axis in lung cancer cells

Mesenchymal stem cells (MSCs) are recruited and activated by solid tumors and play a role in tumor progression and metastasis. Here we show that MSCs promote metastasis in a panel of non-small cell lung cancer (NSCLC) cells. MSCs elicit transcriptional alterations in lung cancer cells leading to increased expression of factors implicated in the epithelial-to-mesenchymal transition (EMT) and secreted proteins including matrix metalloproteinase-9 (MMP9). MSCs enhance secretion of enzymatically active MMP9 in a panel of lung adenocarcinoma cells. High expression of MMP9 is linked to low survival rates in lung adenocarcinoma patients. Notably, we found that ABL tyrosine kinases are activated in MSC-primed lung cancer cells and functional ABL kinases are required for MSC-induced MMP9 expression, secretion and proteolytic activity. Importantly, ABL kinases are required for MSC-induced NSCLC metastasis. These data reveal an actionable target for inhibiting MSC-induced metastatic activity of lung adenocarcinoma cells through disruption of an ABL kinase-MMP9 signaling axis activated in MSC-primed lung cancer cells.

Different morphology, stage and treatment affect immune cell infiltration and long-term outcome in patients with non-small-cell lung carcinoma

AIMS

Development of effective immune-based therapies for patients with non-small-cell lung carcinoma (NSCLC) depends on an accurate characterization of complex interactions that occur between immune cells and the tumour environment.

METHODS AND RESULTS

Innate and adaptive immune responses were evaluated in relation to prognosis in 65 patients with surgically excised NSCLC. Immunohistochemistry and morphometry were used to determine the abundance and distribution of immune cells. We found low numbers of immune cells and levels of cytokines in the tumour environment when compared with surrounding parenchyma. Smoking was associated inversely with the adaptive immune response and directly with innate immunity. We observed a prominent adaptive immune response in squamous cell carcinomas (SCC) but greater innate immune responses in adenocarcinomas and large cell carcinomas. Cox model analysis showed a low risk of death for smoking <41 packs/year, N0 tambour stage, squamous carcinoma, CD4(+)  > 16.81% and macrophages/monocytes >4.5%. Collectively, the data indicate that in NSCLC there is not a substantive local immune cell infiltrate within the tumour.

CONCLUSION

Although immune cell infiltration is limited in NSCLC it appears to have an impact on prognosis and this may be of relevance for new immunotherapeutic approaches.

Promotion of lung tumor growth by interleukin-17

Recent findings demonstrate that inhaled cigarette smoke, the predominant lung carcinogen, elicits a T helper 17 (Th17) inflammatory phenotype. Interleukin-17A (IL-17), the hallmark cytokine of Th17 inflammation, displays pro- and antitumorigenic properties in a manner that varies according to tumor type and assay system. To investigate the role of IL-17 in lung tumor growth, we used an autochthonous tumor model (K-Ras(LA1) mice) with lung delivery of a recombinant adenovirus that expresses IL-17A. Virus-mediated expression of IL-17A in K-Ras(LA1) mice at 8-10 wk of age doubled lung tumor growth in 3 wk relative to littermates that received a green fluorescent protein-expressing control adenovirus. IL-17 induced matrix metalloproteinase-9 (MMP-9) expression in vivo and in vitro. In accord with this finding, selective and specific inhibitors of MMP-9 repressed the increased motility and invasiveness of IL-17-treated lung tumor cells in culture. Knockdown or mutation of p53 promoted the motility of murine lung tumor cells and abrogated the promigratory role of IL-17. Coexpression of siRNA-resistant wild-type, but not mutant, human p53 rescued both IL-17-mediated migration and MMP-9 mRNA induction in p53 knockdown lung tumor cells. IL-17 increased MMP-9 mRNA stability by reducing interaction with the mRNA destabilizing serine/arginine-rich splicing factor 1 (SRSF1). Taken together, our results indicate that IL-17 stimulates lung tumor growth and regulates MMP-9 mRNA levels in a p53- and SRSF1-dependent manner.

Association between decreases in type V collagen and apoptosis in mouse lung chemical carcinogenesis: a preliminary model to study cancer cell behavior

OBJECTIVE

The importance of type V collagen and its relationships with other types of collagen and with vascular and epithelial apoptosis were studied in a model of chemical carcinogenesis in the mouse lung.

METHODS

TWO GROUPS OF MALE BALB/C MICE WERE STUDIED: a) animals that received two intraperitoneal doses of 3 g/kg urethane carcinogen (urethane group = 24); and b) animals submitted to a sham procedure, comparable to the test group (control group = 7). Both groups were sacrificed after 120 days. In situ detection of apoptosis, immunohistochemistry, immunofluorescence and histomorphometry were used to evaluate the fraction occupied by the tumor, vascular and epithelial apoptosis, and type V, III and I collagen fibers in the lung parenchyma from both groups.

RESULTS

The lung parenchyma from the urethane group showed low fractions of vascular and epithelial apoptosis as well as reduced type V collagen fibers when compared to the control group. A significant direct association was found between type V and III collagen fibers and epithelial apoptosis, type V collagen fibers and vascular apoptosis, and type V and type I collagen fibers.

CONCLUSION

The results show that a direct link between low amounts of type V collagen and decreased cell apoptosis may favor cancer cell growth in the mouse lung after chemical carcinogenesis, suggesting that strategies aimed at preventing decreased type V collagen synthesis or local responses to reduced apoptosis may have a greater impact in lung cancer control.

14-3-3ζ Overexpression and abnormal β-catenin expression are associated with poor differentiation and progression in stage I non-small cell lung cancer

Recent studies have shown that 14-3-3ζ interacted with other key cellular proteins involved in the tumor development and progression. Knowledge of 14-3-3ζ and β-catenin expression and clinical significance in the same tumor tissues is limited. The purpose of this study was to investigate the expression and significance of 14-3-3ζ and β-catenin in stage I non-small-cell lung cancer (NSCLC). Specimens of NSCLC and adjacent normal lung tissues were collected from 110 patients. The expressions of 14-3-3ζ and β-catenin were detected by western blotting, double labeling immunofluorescence, confocal laser scanning microscopy and immunohistochemistry. The expression of 14-3-3ζ was upregulated in stage I NSCLC. Further, the overexpression of 14-3-3ζ correlated with histological grades, lymph node metastasis and poor clinical outcome. Abnormal expression of β-catenin was significantly correlated with poor differentiation and lymph node metastasis. Abnormal β-catenin expression was associated significantly with positive 14-3-3ζ expression. In conclusion, 14-3-3ζ and β-catenin might have an important role in development, progression and metastatic process of NSCLC. 14-3-3ζ might be used as prognostic biomarkers for NSCLC.

Role of immunohistochemistry in the diagnosis of lung cancer

The role of immunohistochemistry is to recognize antigens and, consequently, to identify and classify specific cells within a cell population whose morphology is heterogenous or apparently homogenous. The visualization of the antigen-antibody complex is made possible through the addition of either a fluorochrome conjugate or an enzyme to the antibody, which is then viewed under microscopy. Immunohistochemistry can be used in the routine diagnosis of lung cancer, in order to identify biological markers (diagnostic and prognostic). The essential immunohistochemistry panels will be discussed in this review.

Refractory remodeling of the microenvironment by abnormal type V collagen, apoptosis, and immune response in non-small cell lung cancer

Collagen V shows promise as an inducer of the death response via caspases. Remodeling of the microenvironment by collagen V, tumoral/vascular apoptosis, and the immune response were evaluated, based on the prognosis of 65 patients with surgically excised non-small cell lung cancer. Immunofluorescence, immunohistochemistry, morphometry, tridimensional reconstruction, and a real-time polymerase chain reaction were used to evaluate the amount, structure, and molecular chains of collagen V, tumoral and vascular apoptosis, immune cells, and microvessel density. The impact of these markers was tested on follow-up until death from recurrent lung cancer occurred. A decreased and abnormal synthesis of collagen V was found to lead to increased angiogenesis due to a low endothelial death rate and a low immune response. A Cox model analysis, controlled for the lymph node stage, demonstrated that only collagen V and vascular apoptosis variables were significantly associated with survival time. A point at the median for collagen V and vascular apoptosis divided patients into 2 groups, each with a distinctive prognosis. Those with a collagen V higher than 9.40% and vascular apoptosis higher than 1.09% had a low risk of death (0.27 and 0.41, respectively) compared to those with a collagen V lower than 9.40% and vascular apoptosis lower than 1.09%. Collagen V and vascular apoptosis in resected non-small cell lung cancer was strongly related to the prognosis, suggesting that strategies aimed at preventing low collagen V synthesis, or local responses to low vascular apoptosis may have a greater impact in lung cancer treatment.

Prognostic relevance of TTF-1 and MMP-9 expression in advanced lung adenocarcinoma

BACKGROUND

The thyroid transcription factor-1 (TTF-1) is a tissue-specific transcription factor that could play an important role in cell differentiation and morphogenesis of lung tumors. Matrix metalloproteinase-9 (MMP-9) is a protease commonly expressed in non-small cell lung cancer, conferring angiogenic and metastatic potential.

METHODS

We assessed TTF-1 and MMP-9 tumor expression by immunohistochemistry in 51 patients with lung adenocarcinoma, stage IIIB or IV, treated with platinum regimens. A bicategorical prognostic model was obtained using the Kaplan-Meier method, Cox regression, and conjunctive consolidation.

RESULTS

The median expression of TTF-1 was 30.0% (range: 0-85.9%). All tumors expressed MMP-9 (median: 78.7%; range: 15.2-96.1%). Median survival was 41.6 weeks, with estimated 1- and 2-year survival rates of 45.0% and 22.0%, respectively. Poor performance status (Karnofsky scale) - hazards ratio (HR): 1.03, 95% confidence interval (CI): 1.01-1.06; low TTF-1 expression (<40%) - HR: 4.00, 95% CI: 1.75-9.09; and high MMP-9 expression (> or =80%) - HR: 2.82, 95% CI: 1.30-6.08 were independent prognostic factors. Patients could be stratified in three death risk groups according to markers expression: low risk (high TTF-1 and low MMP-9; median survival: 127.6 weeks), intermediate risk (low TTF-1 or high MMP-9; median survival: 39.0 weeks); and high risk (low TTF-1 and high MMP-9; median survival: 16.4 weeks).

CONCLUSION

TTF-1 and MMP-9 tumor expression as detected by immunohistochemistry may allow identification of different, clinically meaningful, prognostic groups of advanced lung adenocarcinoma patients treated with platinum regimens.

Expression of matrix metalloproteinases 7 and 9 in non-small cell lung cancer

Matrix metalloproteinases (MMPs) have been shown to have a significant role in determining cancer cell behaviour. The present study was undertaken to analyze the expression and prognostic value of MMP-7 and MMP-9 in non-small cell lung cancer (NSCLC). The relationship of MMP-7 with beta-catenin was also evaluated. The study consists of 212 patients with resected NSCLC. Tumour samples were stained immunohistochemically, and the expression of MMP-7 and MMP-9 was evaluated in both tumour cells and peritumoural stromal tissue. The results were compared to clinicopathological factors of the patients. A high staining of MMP-7 and MMP-9 in tumour cells was noted in 62 (30%) and 113 (57%) cases, respectively. Expression of MMP-7 was noted more often in adenocarcinomas than in other histological types (p=0.022). High cancer cell associated MMP-7 was related to lower T-factor (p=0.037), better tumour differentiation (p=0.005) and normal beta-catenin expression in tumour cells (p=0.001). A high MMP-9 expression in tumour cells was related to poor tumour differentiation (p=0.016). The stromal signal for MMP-9 was observed in 58 (32%) cases and was linked with higher tumour grade (p=0.031). In survival analyses the significant predictors of survival were histological type of tumour and tumour stage (p=0.0009 and 0.0012, respectively). MMP-7 or MMP-9 signals were not related to patient's outcome. The results show that high MMP-9 expression indicates aggressive, and high MMP-7 less aggressive tumour behaviour in NSCLC. However, MMP-7 and MMP-9 expressions had no prognostic value in NSCLC.

No association between the C-1562T polymorphism in the promoter of matrix metalloproteinase-9 gene and non-small cell lung carcinoma

The matrix metalloproteinases (MMPs) are a family of highly conserved metal-dependent proteolytic enzymes, their main function is to degrade different components of extracellular matrix (ECM). Moreover, they play roles in regulation of cell growth, apoptosis, angiogenesis and immune surveillance. Natural sequence variations in the MMP genes may result in differential expression of MMPs in different individuals and therefore may be associated with the development and progression of diseases. The aim of this study is to assess the effects of the C-1562T polymorphism in the MMP-9 promoter on the risk of occurrence and lymphatic metastasis of non-small cell lung carcinoma (NSCLC). The MMP-9 genotyping was performed in 243 pathologically diagnosed NSCLC patients and 350 healthy controls without overt cancer by using polymerase chain reaction-restriction fragment length polymorphism analysis. The distribution of the MMP-9 genotypes in NSCLC patients and healthy controls was in consistent with Hardy-Weinberg equilibrium. The frequency of the C/C, C/T and T/T genotypes in healthy controls was 79.4, 20.6 and 0%, respectively. Neither the overall genotype nor allelotype distribution in NSCLC patients showed significant difference from that in healthy controls (P=0.21 and 0.43, respectively). Compared with the C/C genotype, genotypes with the T allele did not show significant influence on the risk of NSCLC development (age and gender adjusted OR=1.13, 95% CI=0.76-1.68). Stratification by onset age, smoking status and tumor histological type also showed no association between the MMP-9 polymorphism and the risk of NSCLC. Furthermore, the genotype distribution between NSCLC patients with and without lymphatic metastasis was not significantly different. Therefore, the present study suggests that the MMP-9 C-1562T polymorphism may not be used as a useful marker to predicate susceptibility and lymphatic metastasis in NSCLC.

Quantitation of conventional histologic parameters and biologic factors in prostatic needle biopsy are useful to distinguish paramalignant from malignant disease

The scope of this work was to determine the potential use of prostatic conventional histologic parameters and biologic factors in distinguishing between paramalignant and malignant prostatic disease, taking into account benign fragments of biopsies obtained from patients with prostatic cancer or from patients suspected to have cancer. Each prostate sample was semi-quantified for macronucleoli, mucin, crystalloid, collagen micronodules, and quantified for glands, stroma, AgNOR, and p53. The database covered 185 biopsy specimens from 136 patients: 56 samples from the same number of patients in whom all the biopsies were benign; 49 samples from patients whose biopsies showed malignant features, and 80 malignant samples. Discriminant analysis of the results showed statistical differences for four parameters: macronucleoli, mucin, gland volume, and AgNOR, allowing us to identify three patterns of prostate involvement: normal, paramalignant, and malignant. The discriminant function permitted an adequate classification of the three patterns in 84% of the cases. Normal areas showed glands with a mean volume of 38.93 microm3, inconspicuous nucleoli, low mucin production, and a mean AgNOR area of 1.26 microm2. Prostatic biopsies with prominent nucleoli and the presence of mucin (60%), gland volume of 22.31 microm3, and AgNOR area of 2.14 microm2 characterized the paramalignant condition. Malignant areas were characterized by mean glands with a volume of 8.11 microm3, prominent nucleoli, high mucin secretion (100%), and AgNOR area of 4.47 microm2. We concluded that modifications in prostate histoarquitecture and function, such as the presence of macronucleoli, volume of glands, abnormal secretion of acid mucin and AgNOR expression, represent important parameters that must be incorporated in the pathologist's evaluation of prostate biopsies to the purpose of indicating a subsequent biopsy, particulary in those patients with clinical suspicion of malignancy, and whose prostate biopsy specimen showed paramalignant areas.