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Isfoss BL, Holmqvist B, Sand E, Forsell J, Jernström H, Olsson H. Stellate cells and mesenchymal stem cells in benign mammary stroma are associated with risk factors for breast cancer - an observational study. BMC Cancer 2018; 18:230. [PMID: 29486751 PMCID: PMC6389039 DOI: 10.1186/s12885-018-4151-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 02/19/2018] [Indexed: 12/19/2022] Open
Abstract
Background It is not known whether stromal cells in benign breast tissue can mediate risk of breast cancer. We recently described aldehyde dehydrogenase 1 A1 (ALDH1) positive (+) cells in morphologically normal breast stroma of premenopausal women, and the data indicated that their distribution is associated with clinical risk factors for breast cancer. The aim of the present study was to define the identities of these cells using histologic and immunohistologic methods, and to investigate associations between those cells and hormonal and genetic risk factors in pre- and postmenopausal women. Methods Stroma of morphologically normal tissue was analyzed in samples from 101 well-characterized women whose breasts had been operated. Morphology and immunolabeling were applied to determine cell identities based on the putative stem cell markers ALDH1 and stage-specific embryonic antigen-3 (SSEA3), and immunophenotypes indicating mast cells or stellate cells. The results were compared with the patients’ risk factors using regression analysis (two-tailed). Results ALDH1+ round/oval cells were associated with low parity in BRCA1/2 carriers (p = 0.022), while in non-BRCA1/2-carriers they were negatively associated with nulliparity (p = 0.057). In premenopausal women ALDH1+ round/oval cells were associated with family history (p = 0.058). SSEA3+ round/oval cells were morphologically and immunohistologically consistent with multilineage stress-enduring (Muse) cells, and these cells were independently associated with the breast cancer risk factors low parity (p = 0.015), family history (p = 0.021), and hormone use after menopause (p = 0.032). ALDH1+ spindle-shaped/polygonal cells were immunohistologically consistent with stellate cells, and were negatively associated with family history of breast cancer (p = 0.001). Conclusion This study identified novel stromal cell types in benign breast tissue that have a potential for stratifying women for breast cancer risk. Electronic supplementary material The online version of this article (10.1186/s12885-018-4151-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Björn Logi Isfoss
- Department of Clinical Sciences, Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden. .,Department of Pathology, Skane University Hospital, Lund, Sweden. .,Department of Pathology, Telemark Hospital, Ulefossv. 55, 3710, Skien, Norway.
| | - Bo Holmqvist
- Department of Clinical Sciences, Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,ImaGene-iT, Medicon Village, Lund, Sweden
| | - Elin Sand
- ImaGene-iT, Medicon Village, Lund, Sweden
| | | | - Helena Jernström
- Department of Clinical Sciences, Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Håkan Olsson
- Department of Clinical Sciences, Lund, Division of Oncology and Pathology, Lund University, Lund, Sweden.,Department of Clinical Sciences, Lund, Division of Cancer Epidemiology, Lund University, Lund, Sweden
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Huwait HF, Nassir AM, Abd Elmone HM, Kamel HFM, Toni ND, Babtain NA, Barhamain AS, Malibari ABS, Munassar SF, Rawa RS, Kufiah AZ. Clinical Significance and Potential Utility of Cancer Stem Cell Markers: ALDH1A1 and CD133 in Prostate Tumors. ACTA ACUST UNITED AC 2017. [DOI: 10.3923/ijcr.2018.39.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Stromal expression of ALDH1 in human breast carcinomas indicates reduced tumor progression. Oncotarget 2016; 6:26789-803. [PMID: 26305673 PMCID: PMC4694953 DOI: 10.18632/oncotarget.4628] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 07/06/2015] [Indexed: 12/25/2022] Open
Abstract
Interactions between cancer cells and microenvironment are emerging issue in tumor progression. Aldehyde dehydrogenase 1 (ALDH1) is a recognized cancer stem cell marker but little is known about its role in intratumoral stroma. Therefore, we focused on ALDH1 expression in tumor-associated stroma of breast carcinomas (BrCa). Stromal and tumoral ALDH1 expression was evaluated immunohistochemically in BrCa and their lymph node metastases (LNMs), and related to clinico-pathological characteristics, patients’ outcome, presence of CD68, HLADR, retinoic acid (RA) in stroma, and selected proteins in tumor cells. ALDH1(+) stromal cells were detected in 53% of 374 BrCa and 61% of 102 LNMs. ALDH1(+) stroma in primary tumor correlated to longer disease-free (p = 0.030), metastasis-free (p = 0.024), and overall survival (p = 0.043) having an independent prognostic impact on DFS (multivariate analysis, p = 0.047). It was associated with concomitant presence of HLA-DR(+) stromal cells and RA in tumor cells (both p < 0.001), and inversely associated with vimentin expression in tumor cells (p = 0.036). ALDH1(+) stroma in LNMs correlated inversely to presence of disseminated tumor cells in patients’ bone marrow (p = 0.014) and was independent prognosticator of shorter DFS and MFS (multivariate analysis, p = 0.004 and p = 0.002, respectively). In conclusion, ALDH1 expression in tumor-associated stromal cells indicates reduced BrCa progression, possibly via RA secretion.
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Isfoss BL, Holmqvist B, Jernström H, Alm P, Olsson H. The absence of aldehyde dehydrogenase 1 A1-positive cells in benign mammary stroma is associated with risk factors for breast cancer. BREAST CANCER-TARGETS AND THERAPY 2016; 8:117-24. [PMID: 27313475 PMCID: PMC4890687 DOI: 10.2147/bctt.s106097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In this study, aldehyde dehydrogenase 1 (ALDH1)-expressing cells in stroma of histologically normal breast tissue from premenopausal women were investigated in situ regarding cellular morphology, cell distribution, and relation to the additional stem cell markers, CD44 (+) and CD24 (−). These results were correlated with hormonal and genetic risk factors for breast cancer. Triple immunofluorescence labeling was performed on tissues from premenopausal women with a family history of breast cancer, and breast reduction specimens from premenopausal women with no family history of breast cancer were used as a control group. The majority of ALDH1-immunoreactive cells in stroma were spindle-shaped or polygonal, and such cells that were CD44− and CD24− were absent in the breast stroma of a significantly larger number of nulliparous than parous women. A less common morphological type of ALDH1-positive cells in stroma was round or oval in shape, and such cells that were CD44+ and CD24− were absent in a significant number of women with a family history of breast cancer. The CD44+/CD24− immunophenotype is consistent with stem cells, and the round/oval morphology suggests mesenchymal cells. This study demonstrates that there are two morphologically distinct types of ALDH1-positive cells in histologically benign mammary stroma, and the absence of these cells is correlated with clinical risk factors for breast cancer in premenopausal women.
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Affiliation(s)
- Björn Logi Isfoss
- Department of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Pathology, Skane University Hospital, Lund, Sweden; Department of Pathology, Telemark Hospital, Skien, Norway
| | - Bo Holmqvist
- Department of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; ImaGene-iT AB, Medicon Village, Lund, Sweden
| | - Helena Jernström
- Department of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Per Alm
- Department of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Håkan Olsson
- Department of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Division of Cancer Epidemiology, Department of Clinical Sciences, Lund University, Lund, Sweden
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Qian X, Ma C, Nie X, Lu J, Lenarz M, Kaufmann AM, Albers AE. Biology and immunology of cancer stem(-like) cells in head and neck cancer. Crit Rev Oncol Hematol 2015; 95:337-45. [DOI: 10.1016/j.critrevonc.2015.03.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 03/14/2015] [Accepted: 03/30/2015] [Indexed: 12/22/2022] Open
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Sjöström M, Hartman L, Honeth G, Grabau D, Malmström P, Hegardt C, Fernö M, Niméus E. Stem cell biomarker ALDH1A1 in breast cancer shows an association with prognosis and clinicopathological variables that is highly cut-off dependent. J Clin Pathol 2015; 68:1012-9. [PMID: 26175266 DOI: 10.1136/jclinpath-2015-203092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/22/2015] [Indexed: 01/01/2023]
Abstract
AIMS Aldehyde dehydrogenase family 1 member A1 (ALDH1A1) is a putative marker of breast cancer stem cells (CSCs) with prognostic implications when expressed in cancer or stroma. However, previous results are contradictory and we therefore aimed to further evaluate the impact of ALDH1A1 on distant disease-free survival (DDFS) and correlation with clinicopathological variables in breast cancer, specifically by evaluating different cut-offs. METHODS Two breast cancer cohorts (N=216 and N=210) were evaluated with immunohistochemistry for ALDH1A1 on tissue microarrays with three different cut-offs in cancer cells and in stromal cells. The association of ALDH1A1 with DDFS and other clinicopathological variables was assessed. As further validation, gene expression levels of ALDH1A1 and association with survival were analysed in one of the cohorts and a separate cohort. RESULTS ALDH1A1 expression in cancer cells was associated with either a better or a worse prognosis, depending on cut-off. Considering weakly stained cancer cells as positive, ALDH1A1+ was associated with a better prognosis in both cohorts. Considering only strongly stained cells as positive, ALDH1A1+ was associated with oestrogen receptor and progesterone receptor negativity in both cohorts and worse prognosis in one of the cohorts. Stromal ALDH1A1 staining was associated with improved DDFS in one cohort. Gene expression analysis showed that a high ALDH1A1 expression was associated with a better prognosis. CONCLUSIONS ALDH1A1 is associated with DDFS and clinicopathological variables, both in cancer cells and stroma, but is highly cut-off dependent. Only the strongly ALDH1A1-stained cells show a more aggressive phenotype typical for CSCs.
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Affiliation(s)
- Martin Sjöström
- Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund, Sweden
| | - Linda Hartman
- Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund, Sweden
| | - Gabriella Honeth
- Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund, Sweden
| | - Dorthe Grabau
- Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund, Sweden Division of Pathology, Skåne University Hospital, Lund, Sweden
| | - Per Malmström
- Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund, Sweden Division of Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Cecilia Hegardt
- Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund, Sweden
| | - Mårten Fernö
- Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund, Sweden
| | - Emma Niméus
- Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund, Sweden Division of Surgery, Skåne University Hospital, Lund, Sweden
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Pan H, Wu N, Huang Y, Li Q, Liu C, Liang M, Zhou W, Liu X, Wang S. Aldehyde dehydrogenase 1 expression correlates with the invasion of breast cancer. Diagn Pathol 2015; 10:66. [PMID: 26070788 PMCID: PMC4465310 DOI: 10.1186/s13000-015-0301-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 05/19/2015] [Indexed: 01/06/2023] Open
Abstract
Background Aldehyde dehydrogenase 1 (ALDH1) is an important marker of tumor-initiating cells. We aimed to investigate ALDH1 expression in benign breast disease and human breast cancer of different histologic stages. Methods Immunohistochemical staining of ALDH1 was applied to 21 cases with benign breast diseases, 47 ductal carcinoma in situ (DCIS) cases, 62 cases diagnosed with invasive cancer with extensive intraductal component (EIC), and 58 cases diagnosed with invasive cancer without EIC. Results ALDH1 was expressed in tumor cells in 61.0 % of 164 breast cancer cases, which was higher than that in benign breast disease (3/21) (P < 0.001). Of these 167 breast cancer cases, a significantly higher rate (54/58) of intratumoral ALDH1 expression was observed in invasive cancer without EIC cases than that in DCIS cases (19/46, one case not available) and invasive cancer with EIC cases (27/60, two cases not available) (P < 0.001). Interestingly, a significantly higher rate (22/48) of intratumoral ALDH1 expression in invasive component was observed than that in in situ component (7/48) in the same tumor (P = 0.001). In 47 DCIS cases, no significant association was observed between ALDH1 positivity and any clinicopathological parameter (all P > 0.05). However, ALDH1 positive invasive breast cancers were significantly more likely to be with large tumor size (P = 0.001), high grade (P < 0.001), and high Ki67 expression (P = 0.009). Conclusions ALDH1 may play an important role in the invasion of breast cancer, and may be associated with aggressive phenotypes of breast cancer. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1608671725154947.
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Affiliation(s)
- Hong Pan
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China.
| | - Naping Wu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China. .,Department of Breast Surgery, The Third Affiliated Hospital with Suzhou University, 185 Juqian Street, Changzhou, 213000, China.
| | - Yaoyu Huang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China.
| | - Qin Li
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China.
| | - Chenghao Liu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China.
| | - Mengdi Liang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China.
| | - Wenbin Zhou
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China.
| | - Xiaoan Liu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China.
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China.
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Honeth G, Lombardi S, Ginestier C, Hur M, Marlow R, Buchupalli B, Shinomiya I, Gazinska P, Bombelli S, Ramalingam V, Purushotham AD, Pinder SE, Dontu G. Aldehyde dehydrogenase and estrogen receptor define a hierarchy of cellular differentiation in the normal human mammary epithelium. Breast Cancer Res 2014; 16:R52. [PMID: 24887554 PMCID: PMC4095680 DOI: 10.1186/bcr3663] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 04/29/2014] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Although estrogen and progesterone play a key role in normal mammary development and in breast cancer, the potential for proliferation and lineage differentiation as well as origin of cells that express the estrogen receptor (ER) in normal breast epithelium are not known. Some evidence suggests that normal human mammary stem/progenitor cells are ER-, but the identity of these cells and the cellular hierarchy of breast epithelium are still subjects of controversy. It is likely that elucidation of these aspects will bring insight into the cellular origin of breast cancer subtypes. METHODS We used fluorescence-activated cell sorting of primary human mammary epithelial cells along with in vitro and in vivo functional assays to examine the hierarchic relation between cells with aldehyde dehydrogenase enzymatic activity (ALDH+ cells) and ER+ cells in the normal human breast epithelium. We assessed the proliferation and lineage differentiation potential of these cells in vitro and in vivo. A gene reporter assay was used to separate live ER+ and ER- mammary epithelial cells. With shRNA-mediated knockdown, we investigated the role of ALDH isoforms in the functionality of mammary epithelial progenitor cells. RESULTS We describe a cellular hierarchy in the normal human mammary gland in which ER-/ALDH+ cells with functional properties of stem/progenitor cells generate ER+ progenitor cells, which in turn give rise to cells of luminal lineage. We show that the ALDH1A1 isoform, through its function in the retinoic acid metabolism, affects the proliferation and/or early differentiation of stem/progenitor cells and is important for branching morphogenesis. CONCLUSIONS This study presents direct evidence that ER+ cells are generated by ER-/ALDH+ stem/progenitor cells. We also show that ER+ cells are able to generate cell progeny of luminal lineage in vitro and in vivo. Loss of ALDH1A1 function impairs this process, as well as branching morphogenesis and clonogenicity in suspension culture. This latter effect is reversed by treatment with retinoic acid.
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Aldehyde dehydrogenase 1 expression in basal cell carcinoma, actinic keratosis and Bowen's disease. Mol Clin Oncol 2014; 1:621-624. [PMID: 24649218 PMCID: PMC3916212 DOI: 10.3892/mco.2013.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 04/04/2013] [Indexed: 01/16/2023] Open
Abstract
Aldehyde dehydrogenase (ALDH) is an enzyme responsible for oxidizing aldehydes to carbonic acids. ALDH1 is an isoform that is thought to be a stem cell marker as it is highly expressed in the stem cells of various organs. However, its expression in basal cell carcinoma (BCC), actinic keratosis (AK) and Bowen’s disease (BD) of the skin has not yet been analyzed. Twenty-five consecutive operative cases each of BCC, AK and BD, as well as 10 normal skin tissues were assessed for ALDH1 expression by immunohistochemistry. In normal skin, ALDH1 expression was observed in the suprabasal cells of the follicular infundibulum, inner cells of the outer root sheath and sebocytes. BCC cases (88%) showed no or focal-positive immunoreactivity for ALDH1. Focal immunopositivity for ALDH1 was observed in 44% of AK cases, while the remaining cases were ALDH1-negative. By contrast, diffuse positive immunoreactivity for ALDH1 was observed in 64% of BD cases. Differential expression patterns of ALDH1 in AK and BD may reflect the distinct cells of origin of these two conditions. Moreover, a low ALDH1 expression in BCC may also reflect the possible origin of BCC, the basal cells of the outer root sheath.
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Isfoss BL, Holmqvist B, Jernström H, Alm P, Olsson H. Women with familial risk for breast cancer have an increased frequency of aldehyde dehydrogenase expressing cells in breast ductules. BMC Clin Pathol 2013; 13:28. [PMID: 24188377 PMCID: PMC4175100 DOI: 10.1186/1472-6890-13-28] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 10/30/2013] [Indexed: 01/16/2023] Open
Abstract
Background Knowledge is limited regarding the association between stem cells in histologically benign breast tissue and risk factors for breast cancer, and hence we addressed this issue in the present study. Recently, we assessed the histology of benign breast tissue from cancer and non-cancer patients for cells positive for the putative stem cell marker aldehyde dehydrogenase 1 A1 (ALDH), and the findings indicated an association between expression of ALDH and the hormonal factors menopause and hormone therapy. The current investigation examined possible associations between various known clinical and genetic risk factors for breast cancer and cellular expression of ALDH in ductules in benign human breast tissue. Methods The study included breast surgery patients that were BRCA1/2 mutation carriers without breast cancer (n = 23), had BRCA1/2 (n = 28) or sporadic (n = 21) breast cancer, or required non-cancer-related mammoplasty (n = 34). The distribution and frequency of ALDH-immunolabelled cells were correlated to patient subgroups with different risk factors, using mammoplasty patients as a control group. Statistical analyses comprised linear and logistic regression, Spearman’s rank test, Pearson’s test, and Fisher’s exact test. In two-tailed tests, p < 0.05 was considered significant. Results A strong association was found between family history of breast cancer and a high frequency of ALDH+ cells (p = 0.001) at all ductular levels in all groups, regardless of BRCA status, age, parity, or occurrence of cancer. In pre-menopausal non-BRCA cancer patients, the frequency of ALDH+ cells increased with age (p < 0.01) but decreased with increasing parity (p < 0.03). High frequencies of ALDH+ cells were found in the non-basal ductular levels in BRCA1 mutation carriers (p = 0.03), but in the basal ductular level in BRCA2 cancer patients (p = 0.02). Among post-menopausal patients, only on-going hormone replacement therapy was correlated with a high number of ALDH+ cells (p < 0.03). Conclusion In histologically normal breast tissue, we found a positive association between the frequency of ductular ALDH+ cells and several breast cancer risk factors, particularly family history of this disease, which supports previous evidence that ALDH plays a role in breast cancer.
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Affiliation(s)
- Björn L Isfoss
- Department of Oncology, Clinical Sciences Lund, Lund University, SE-221 85 Lund, Sweden.
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Tsukabe M, Shimazu K, Morimoto K, Naoi Y, Kagara N, Shimoda M, Shimomura A, Maruyama N, Kim SJ, Noguchi S. Clinicopathological Analysis of Breast Ductal Carcinoma in situ with ALDH1-Positive Cancer Stem Cells. Oncology 2013; 85:248-56. [DOI: 10.1159/000355476] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 09/02/2013] [Indexed: 01/06/2023]
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