Progress in breast cancer research

Clinical factors affecting the long-term survival of breast cancer patients

OBJECTIVE

The average 5-year survival rate of breast cancer (BC) patients has been significantly prolonged with new therapeutic methods. However, their effects on BC patient long-term survival rates are unclear. Therefore, this study aimed to analyze the specific clinical factors that can affect BC long-term survival.

METHODS

Here, we conducted a retrospective study and analyzed long-term survival using data of 3,240 BC patients from 1977 to 2005 from the Genotype-Tissue Expression (GTEx) database using the Kaplan-Meier method.

RESULTS

Breast tumor size and stage were negatively correlated with long-term survival, but age showed no significant correlation. Estrogen receptor (ER) and progesterone receptor (PR) expression were each positively correlated with patient survival time, while ERBB2 receptor (HER2) expression was negatively correlated with survival time. Patients with high Nottingham prognostic index (NPI) values did not benefit from available therapies. Furthermore, breast-conserving surgery is more conducive to BC patient long-term survival than mastectomy.

CONCLUSIONS

Early detection and breast-conserving surgery may support long-term survival for BC patients. Elevated expression of ER and PR were both associated with longer patient survival time, while positive expression of HER2 showed the opposite trend. The long-term survival rates of patients with high NPI values can potentially be increased.

Estrogen receptor-α signaling in post-natal mammary development and breast cancers

17β-estradiol controls post-natal mammary gland development and exerts its effects through Estrogen Receptor ERα, a member of the nuclear receptor family. ERα is also critical for breast cancer progression and remains a central therapeutic target for hormone-dependent breast cancers. In this review, we summarize the current understanding of the complex ERα signaling pathways that involve either classical nuclear “genomic” or membrane “non-genomic” actions and regulate in concert with other hormones the different stages of mammary development. We describe the cellular and molecular features of the luminal cell lineage expressing ERα and provide an overview of the transgenic mouse models impacting ERα signaling, highlighting the pivotal role of ERα in mammary gland morphogenesis and function and its implication in the tumorigenic processes. Finally, we describe the main features of the ERα-positive luminal breast cancers and their modeling in mice.

CCN5 activation by free or encapsulated EGCG is required to render triple-negative breast cancer cell viability and tumor progression

Epigallocatechin-3-gallate (EGCG) has been considered an anticancer agent despite conflicting and discrepant bioavailability views. EGCG impairs the viability and self-renewal capacity of triple-negative breast cancer (TNBC) cells and makes them sensitive to estrogen via activating ER-α. Surprisingly, the mechanism of EGCG's action on TNBC cells remains unclear. CCN5/WISP-2 is a gatekeeper gene that regulates viability, ER-α, and stemness in TNBC and other types of cancers. This study aimed to investigate whether EGCG (free or encapsulated in nanoparticles) interacts with the CCN5 protein by emphasizing its bioavailability and enhancing its anticancer effect. We demonstrate that EGCG activates CCN5 to inhibit in vitro cell viability through apoptosis, the sphere-forming ability via reversing TNBC cells' stemness, and suppressing tumor growth in vivo. Moreover, we found EGCG-loaded nanoparticles to be functionally more active and superior in their tumor-suppressing ability than free-EGCG. Together, these studies identify EGCG (free or encapsulated) as a novel activator of CCN5 in TNBC cells and hold promise as a future therapeutic option for TNBC with upregulated CCN5 expression.

The AF-1-deficient estrogen receptor ERα46 isoform is frequently expressed in human breast tumors

BACKGROUND

To date, all studies conducted on breast cancer diagnosis have focused on the expression of the full-length 66-kDa estrogen receptor alpha (ERα66). However, much less attention has been paid to a shorter 46-kDa isoform (ERα46), devoid of the N-terminal region containing the transactivation function AF-1. Here, we investigated the expression levels of ERα46 in breast tumors in relation to tumor grade and size, and examined the mechanism of its generation and its specificities of coregulatory binding and its functional activities.

METHODS

Using approaches combining immunohistochemistry, Western blotting, and proteomics, antibodies allowing ERα46 detection were identified and the expression levels of ERα46 were quantified in 116 ERα-positive human breast tumors. ERα46 expression upon cellular stress was studied, and coregulator bindings, transcriptional, and proliferative response were determined to both ERα isoforms.

RESULTS

ERα46 was expressed in over 70% of breast tumors at variable levels which sometimes were more abundant than ERα66, especially in differentiated, lower-grade, and smaller-sized tumors. We also found that ERα46 can be generated via internal ribosome entry site-mediated translation in the context of endoplasmic reticulum stress. The binding affinities of both unliganded and fully-activated receptors towards co-regulator peptides revealed that the respective potencies of ERα46 and ERα66 differ significantly, contributing to the differential transcriptional activity of target genes to 17β estradiol (E2). Finally, increasing amounts of ERα46 decrease the proliferation rate of MCF7 tumor cells in response to E2.

CONCLUSIONS

We found that, besides the full-length ERα66, the overlooked ERα46 isoform is also expressed in a majority of breast tumors. This finding highlights the importance of the choice of antibodies used for the diagnosis of breast cancer, which are able or not to detect the ERα46 isoform. In addition, since the function of both ERα isoforms differs, this work underlines the need to develop new technologies in order to discriminate ERα66 and ERα46 expression in breast cancer diagnosis which could have potential clinical relevance.

Diagnostic performance of shear wave elastography of the breast according to scanning orientation

OBJECTIVES

To evaluate the influence of the scanning orientation on diagnostic performance measured by the mean elasticity, maximum elasticity, and fat-to-lesion elasticity ratio on ultrasound-based shear wave elastography in differentiating breast cancers from benign lesions.

METHODS

In this study, a total of 260 breast masses from 235 consecutive patients were observed from March 2012 to November 2012. For each lesion, the mean elasticity value, maximum elasticity value, and fat-to-lesion ratio were measured along two orthogonal directions, and all values were compared with pathologic results.

RESULTS

There were 59 malignant and 201 benign lesions. Malignant masses showed higher mean elasticity, maximum elasticity, and fat-to-lesion ratio values than benign lesions (P < .0001). The areas under the receiver operating characteristic curves were as follows: average mean elasticity on both views, 0.870; mean elasticity on the transverse view, 0.866; maximum elasticity on both views, 0.865; maximum elasticity on the transverse view, 0.864; mean elasticity on the longitudinal view, 0.849; fat-to-lesion ratio on both views, 0.849; maximum elasticity on the longitudinal view, 0.845; fat-to-lesion ratio on the transverse view, 0.841; and fat-to-lesion ratio on the longitudinal view, 0.814. Intraclass correlation coefficients for agreement between the scanning directions were as follows: mean elasticity, 0.852; maximum elasticity, 0.842; fat-to-lesion ratio, 0.746, for masses; and mean elasticity, 0.392, for anterior mammary fat.

CONCLUSIONS

Mean elasticity, maximum elasticity, and fat-to-lesion elasticity ratio values were helpful in differentiating benign and malignant breast masses. The scanning orientation did not significantly affect the diagnostic performance of shear wave elastography for breast masses.

Understanding breast cancer stem cell heterogeneity: time to move on to a new research paradigm

Human breast cancer (BC) is one of the leading causes of death for women worldwide, and is characterized by a group of highly heterogeneous lesions. The morphological and biomolecular heterogeneity of BC cells, accompanied by dynamic plasticity of the BC microenvironment and the presence of stem-like cells, make tumor categorization an urgent and demanding task.The major limitations in BC research include the high flexibility rate of breast cancer stem cells (BCSCs) and the difficulty of their identification. Improved profiling methods and extensive characterization of BCSCs were recently presented in BMC Cancer, highlighting that the majority of BC cells had a luminal EpCAMhigh/CD49f+ phenotype, and identification of CD44high/CD24low subpopulation of cancer stem cells significantly improves the flow cytometry measurement of BCSCs with higher stem/progenitor ability.Future developments in single-cell omics will potentially revolutionize cancer biology and clinical practice, providing better understanding of BC heterogeneity, how BCSCs evolve, and which BC cells to target to avoid drug resistance.Please see related research published in BMC Cancer: http://www.biomedcentral.com/1471-2407/13/289/abstract.

Metal-Arene Complexes with Indolo[3,2-c]-quinolines: Effects of Ruthenium vs Osmium and Modifications of the Lactam Unit on Intermolecular Interactions, Anticancer Activity, Cell Cycle, and Cellular Accumulation

Six novel ruthenium(II)- and osmium(II)-arene complexes with three modified indolo[3,2-c]quinolines have been synthesized in situ starting from 2-aminoindoloquinolines and 2-pyridinecarboxaldehyde in the presence of [M(p-cymene)Cl(2)](2) (M = Ru, Os) in ethanol. All complexes have been characterized by elemental analysis, spectroscopic techniques ((1)H, (13)C NMR, IR, UV-vis), and ESI mass spectrometry, while four complexes were investigated by X-ray diffraction. The complexes have been tested for antiproliferative activity in vitro in A549 (non-small cell lung), SW480 (colon), and CH1 (ovarian) human cancer cell lines and showed IC(50) values between 1.3 and >80 μM. The effects of Ru vs Os and modifications of the lactam unit on intermolecular interactions, antiproliferative activity, and cell cycle are reported. One ruthenium complex and its osmium analogue have been studied for anticancer activity in vivo applied both intraperitoneally and orally against the murine colon carcinoma model CT-26. Interestingly, the osmium(II) complex displayed significant growth-inhibitory activity in contrast to its ruthenium counterpart, providing stimuli for further investigation of this class of compounds as potential antitumor drugs.