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Distinct molecular mechanisms underlying clinically relevant subtypes of breast cancer: gene expression analyses across three different platforms.

BACKGROUND: Gene expression profiling has been used to define molecular phenotypes of complex diseases such as breast cancer. The luminal A and basal-like subtypes have been repeatedly identified and validated as the two main subtypes out of a total of five molecular subtypes of breast cancer. These two are associated with distinctly different gene expression patterns and more importantly, a significant difference in clinical outcome. To further validate and more thoroughly characterize these two subtypes at the molecular level in tumors at an early stage, we report a gene expression profiling study using three different DNA microarray platforms. RESULTS: Expression data from 20 tumor biopsies of early stage breast carcinomas were generated on three different DNA microarray platforms; Applied Biosystems Human Genome Survey Microarrays, Stanford cDNA Microarrays and Agilent's Whole Human Genome Oligo Microarrays, and the resulting gene expression patterns were analyzed. Both unsupervised and supervised analyses identified the different clinically relevant subtypes of breast tumours, and the results were consistent across all three platforms. Gene classification and biological pathway analyses of the genes differentially expressed between the two main subtypes revealed different molecular mechanisms descriptive of the two expression-based subtypes: Signature genes of the luminal A subtype were over-represented by genes involved in fatty acid metabolism and steroid hormone-mediated signaling pathways, in particular estrogen receptor signaling, while signature genes of the basal-like subtype were over-represented by genes involved in cell proliferation and differentiation, p21-mediated pathway, and G1-S checkpoint of cell cycle-signaling pathways. A minimal set of 54 genes that best discriminated the two subtypes was identified using the combined data sets generated from the three different array platforms. These predictor genes were further verified by TaqMan Gene Expression assays. CONCLUSION: We have identified and validated the two main previously defined clinically relevant subtypes, luminal A and basal-like, in a small set of early stage breast carcinomas. Signature genes characterizing these two subtypes revealed that distinct molecular mechanisms might have been pre-programmed at an early stage in different subtypes of the disease. Our results provide further evidence that these breast tumor subtypes represent biologically distinct disease entities and may require different therapeutic strategies. Finally, validated by multiple gene expression platforms, including quantitative PCR, the set of 54 predictor genes identified in this study may define potential prognostic molecular markers for breast cancer.

Biomarkers, Tumor↗

Adeno-associated virus (AAV) vectors in cancer gene therapy.

Gene delivery vectors based on adeno-associated virus (AAV) have been utilized in a large number of gene therapy clinical trials, which have demonstrated their strong safety profile and increasingly their therapeutic efficacy for treating monogenic diseases. For cancer applications, AAV vectors have been harnessed for delivery of an extensive repertoire of transgenes to preclinical models and, more recently, clinical trials involving certain cancers. This review describes the applications of AAV vectors to cancer models and presents developments in vector engineering and payload design aimed at tailoring AAV vectors for transduction and treatment of cancer cells. We also discuss the current status of AAV clinical development in oncology and future directions for AAV in this field.

Capsid Proteins↗

Cancer genes: current status, future prospects, and applications in radiotherapy/oncology.

There is a sense of excitement in contemporary cancer research, generated largely by the discovery, and subsequent characterization, of oncogenes. These genes are part of the normal complement of cells, and become altered in their structure or expression, during the development of the neoplastic phenotype. In this review, I highlight some of the important advances in the field, starting with the relationships between viral oncogenes and their cellular homologs. I illustrate some of the molecular mechanisms whereby a harmless, or quiescent, cellular gene can be converted ("activated") by radiation or by other carcinogens to a full-blown oncogene involved in carcinogenesis. Next, I discuss two areas where oncogene research has specific relevance for professionals working with radiation, namely the question of radiation-induced cancer, and the issue of the radiocurability of tumors. I also assess the important role of tumor-suppressor genes in oncogenesis. I then describe a genetic model, to illustrate the current status of our understanding of carcinogenesis. Finally, I discuss potential applications of specific interest to oncologists: topics such as prognostic indicators, novel therapeutic strategies, and gene-replacement techniques, are critically reviewed.

Animals↗

In vitro and in vivo evaluation of novel cationic liposomes utilized for cancer gene therapy.

Advanced peritoneal carcinomatoses is very difficult to treat. We have explored the potential therapeutic application of gene therapy using cationic liposomes in this disease. The lacZ gene was introduced in vitro into ovarian and endometrial cancer cells using cationic liposomes. The transfection efficiency was similar to that of commercially available liposomes in serum-free medium (11.0-20.9% vs. 5.4-26.0%). In serum-containing medium, the efficiency was 1.9-18.1%, which is comparable with the efficiency in serum-free medium. However, the efficiency of commercial liposomes decreased drastically to between 0.1% and 4.7% in the serum-containing medium. When cultured cells were transfected with the herpes simplex virus thymidine kinase (HSV-tk) gene and ganciclovir (GCV) was added, the anti-tumor effect of GCV was 47-640 times greater than when the same experiment was performed with lacZ gene. Evaluation of anti-tumor effect was performed with the MTT assay. In vivo, the HRA and mEIIL ascitic mice were treated with HSV-tk gene and GCV using the peritoneal route, a significant prolongation of the mean survival time was observed by Kaplan-Meier analysis (16-18 days and 15-30 days, respectively, p < 0.05). These results indicate a potential role for gene therapy in the treatment of advanced intraperitoneal carcinomatoses using the novel cationic liposomes.

Animals↗

Papillomaviruses as targets for cancer gene therapy.

The human papillomaviruses (HPVs) are a diverse group of infectious agents, some of which are a causative agent of human cancers. Cervical cancer and oral cancer are closely associated with specific types of HPV, and the tumors grow only if there is continual expression of the viral E6 and E7 genes. Evidence from in vitro studies shows that when expression of these genes is inhibited by gene therapy approaches such as antisense RNA, ribozymes, or siRNA, the transformed phenotype of the cells is lost. Although it seems possible that clinical applications of this approach could help in the management of cervical and oral cancers there have been no clinical trials of gene therapy for HPV-associated cancers. Since the basic information is now available, a shift to translational research would be greatly welcomed.

Cell Transformation, Neoplastic↗

Transcriptional targeting for cancer gene therapy.

Novel treatment strategies incorporating gene transfer technology represent a new frontier in the treatment of cancer made possible through recent developments in molecular biology. Targeting of gene therapy strategies that rely on in situ gene modifications can theoretically occur at the gene entry or gene expression level. Regulation of gene transcription is made possible through the incorporation of cell-specific promoter and enhancer sequences within the transgene construct. This article provides a brief review of transcriptional processes and a description of the most widely studied cell-specific regulatory elements.

Gene Targeting↗

Modified adenoviruses for cancer gene therapy.

Adenoviral gene therapy is an exciting novel approach for treating cancers resistant to currently available therapies. However, currently there is little evidence supporting significant clinical benefits with replication-incompetent adenoviruses. Recent data suggest that expression of the primary receptor, the coxsackie-adenovirus receptor (CAR), may be highly variable on tumor cells, resulting in resistance to infection. Consequently, various strategies have been evaluated to modify adenovirus tropism in order to circumvent CAR deficiency, including retargeting complexes or genetic capsid modifications. To improve tumor penetration and local amplification on the antitumor effect, selectively oncolytic agents, i.e., conditionally replicating adenoviruses, have been constructed. Infection of tumor cells results in replication, oncolysis and subsequent release of the virus progeny. Normal tissue is spared due to lack of replication. This review focuses on the various modifications that have been investigated for improving the antitumor effect of adenoviral gene therapy.

Adenoviridae↗

What are cancer genes, and how do they upset cell behaviour?

Some of the cellular changes underlying the presentation of cancer in a patient can already be understood in terms of mutations affecting specific gene functions. So far, only a few of the mutated genes responsible for carcinogenesis have been identified and these are chiefly involved in deregulation of cell growth rather than with the processes of invasion and metastasis. Proto-oncogenes are important cellular genes which can acquire gain in function mutations as random events in somatic cells. In their mutated, activated forms they are called cellular oncogenes or c-oncs. This distinguishes them from homologous DNA sequences captured by viruses from host cells in the course of retroviral evolution that cause cancers in animal hosts (viral oncogenes or v-oncs). In recent years, loss of function mutations have been identified in regulatory genes that normally serve to constrain cell growth. These are called tumour suppressor genes. Loss of function mutations may be transmitted in the germline, as in hereditary retinoblastoma, or arise de novo in somatic cells. The normal molecular mechanisms disrupted by mutations in tumour suppressor genes include processes regulating progression through the cell cycle.

Adult↗

Recent developments in RNA-based strategies for cancer gene therapy.

The introduction of RNA into mammalian cells is a relatively straightforward procedure with many therapeutic applications. An advantage of using mRNA is that protein expression can be achieved in post-mitotic or quiescent cells where there is usually little or no gene expression with non-viral DNA delivery systems. Furthermore, the cleavage of mRNA by catalytic RNA molecules, or ribozymes, is a useful strategy to downregulate aberrant gene expression. The purpose of this review is to provide an update of current applications that use RNA molecules such as mRNA and ribozymes as a basis for gene therapy strategies targeting the initiation and progression of cancer. In particular, we focus on recent developments that improve the delivery and stability of RNA molecules to achieve therapeutic efficacy.

Animals↗

Cancer gene therapy: strategies and clinical trials.

In recent years, great advances have been made in developing novel therapeutic systems based on the introduction of genetic material into damaged cells and designed to correct the error underlying the disease or destroy the pathological cell. One of the main applications of this new approach, known as gene therapy, is the treatment of malignant pathological tumours, in which classic treatments with radiotherapy, chemotherapy and surgery are only palliative. Strategies developed to date include the use of suicide genes, immunity-enhancing genes, apoptosis-inducing genes or genes that inhibit the neovascularization of the tumour, and the blocking of mutated tumour suppressor genes or their restoration in the tumour cell. The effectiveness shown in cell culture and animal experiments and some promising results in clinical trials suggest that gene therapy will help to improve the prognosis of cancer patients and may become the treatment of choice.

Animals↗

Telomerase as a promising target for human cancer gene therapy.

A number of different approaches have been developed to target human cancer on the basis of its specific expression of telomerase activity. The most common approach relies on inhibition of telomerase activity for reversion of the immortal phenotype of tumor cells. Different components and types of inhibitors targeting various regulatory levels have been regarded as useful for telomerase inhibition. Most methods, however, rely on successive telomere shortening. This process is very slow and causes a long time lag between the onset of inhibition and the occurrence of senescence or apoptosis as a reversal of the immortal phenotype. Many telomerase inhibitors seem to be most efficient when combined with conventional chemotherapeutics. There are some promising approaches to circumvent the slow track of telomere shortening and induce fast apoptosis in treated tumor cells. It has been demonstrated that telomerase may be involved in triggering apoptosis, but the underlying molecular mechanism remains unclear. Other important strategies are the use of telomerase promoters for the application of toxic or pro-apoptotic drugs into human cancer cells or the use of immunological properties of the telomerase enzyme for possible cancer therapies.

Apoptosis↗

Attitudes toward colon cancer gene testing: factors predicting test uptake.

OBJECTIVES: Genetic discoveries in hereditary nonpolyposis colorectal cancer (HNPCC) have made possible genetic testing to determine susceptibility to this form of colorectal cancer (CRC). This study measured the uptake of genetic testing for HNPCC among first-degree relatives of CRC patients and conducted a preliminary analysis of the predictors of test uptake. MATERIALS AND METHODS: We compared 77 test acceptors and 181 decliners on demographic, medical history, and psychological characteristics, controlling for distance from the testing center. The psychological factors studied were risk perception for CRC, frequency of cancer thoughts, and perceived ability to cope with unfavorable genetic information. RESULTS: In the final regression model, after accounting for all variables, the significant predictors of test uptake were increased risk perception, greater perceived confidence in ability to cope with unfavorable genetic information, more frequent cancer thoughts, and having had at least one colonoscopy. The association between risk perception and uptake was dependent on frequency of cancer thoughts. Among those who thought about getting CRC more often, the probability of testing increased as perceived risk increased to approximately 50% likelihood of getting CRC and then leveled off. In contrast, among those who never or rarely thought about getting CRC, risk perception was unrelated to testing decision. CONCLUSIONS: Our findings are consistent with the associations reported between psychological factors and other cancer screening behaviors.

Adaptation, Psychological↗

[Structure and function of DCC (deleted in colorectal cancer) gene and its product].

The DCC gene is one of several genes altered during tumorigenesis. Recent studies demonstrate the existence of 29 exons and it spans 1.4 Mb. DCC gene is a candidate tumor-suppressor gene encoding a protein with a sequence similarity to cell adhesion molecule. Although the mutation of DCC gene was few, high incidence of LOH and decreased mRNA expression in colorectal cancer especially with hepatic metastasis was observed. These DCC gene abnormalities possibly be related to predictive marker for liver metastasis.

Amino Acid Sequence↗

On the strategy of using nonviral carriers in cancer gene therapy.

Effectiveness and mode of therapeutic gene delivery in vivo as well as biological safety of such transfer must be improved before widespread application of gene therapy in the clinic becomes possible. Most research has so far focused on recombinant viral delivery systems. Clinical future seems to belong, however, to nonviral delivery systems. Such systems feature DNA complexed to lipid, protein, peptide or polymeric carriers with ligands allowing in vivo tissue targeting by the complex and nuclear translocation of the exogene. Nonviral gene carrier systems are discussed together with strategies of destroying cancer cells.

Genetic Therapy↗

Prostate cancer gene therapy: comparison of adenovirus-mediated expression of interleukin 12 with interleukin 12 plus B7-1 for in situ gene therapy and gene-modified, cell-based vaccines.

We have documented previously that adenovirus-mediated interleukin 12 (IL-12) gene therapy is effective for orthotopic tumor control and suppression of pre-established metastases in a preclinical prostate cancer model (Y. Nasu et al., Gene Ther., 6: 338-349, 1999). In this report, we directly compare the effectiveness of an adenovirus that expresses both IL-12 and the costimulatory molecule B7-1 (AdmIL12/B7) with one that expresses IL-12 alone (AdmIL-12) using the poorly immunogenic RM-9 orthotopic murine model of prostate cancer. We document AdmIL-12/B7-mediated secretion of IL-12 and increased surface expression of B7-1 in infected RM-9 tumor cells. A significant reduction in orthotopic tumor size and increased survival was demonstrated in mice treated with a single orthotopic injection of AdmIL-12/B7 compared with AdmIL-12 or controls. Six of 19 animals treated with AdmIL-12/B7 survived long term with apparent eradication of the primary tumor in contrast to one of 38 animals in the AdmIL-12-treated group. Orthotopic treatment of tumors with both vectors led to an infiltration of both CD4+ and CD8+ immunoreactive cells, with AdmIL-12/B7 treatment having a more prolonged infiltration of CD8+ cells. AdmIL-12/B7 was also more effective than AdmIL-12 or controls at suppression of pre-established metastases. We further developed a vaccine model based on s.c. injection of infected, irradiated RM-9 cells and found that both AdmIL-12 and AdmIL-12/B7 are effective at suppressing the development and growth of challenge orthotopic tumors using this protocol.

Adenoviridae↗

Of mice and men: cancer gene discovery using comparative oncogenomics.

With the proliferation of high-throughput technologies to profile the cancer genome, methods to distinguish causal from bystander genetic events are needed. Two recent reports by Zender et al. and Kim et al. in Cell use genetically defined mouse models to serve as biological filters to mine the human cancer genome. Integration of high-resolution copy number profiles of mouse tumor models and human tumors identified cIAP1 and Yap as oncogenes in human hepatocellular carcinoma, while NEDD9 was identified as a metastasis gene in human melanoma. Together, these reports demonstrate that a comparative oncogenomics approach can identify genes causally involved in oncogenesis and metastasis.

Adaptor Proteins, Signal Transducing↗

Replicating herpes simplex virus vectors for cancer gene therapy.

Attenuated viral vectors based on herpes simplex virus (HSV) are capable of killing cancer cells directly while sparing normal tissue in animal models of disease. This selective ability is likely due to the evolutionary constraints on the virus to establish lifelong infection in its host without causing destruction of normal tissues. However, extensive experimental animal data show that cancer cells are able to sustain a productive viral infection, which ultimately leads to cell death and tumour regression. Moreover, preliminary results generated in two Phase I clinical studies of modified replicating HSV for the treatment of brain tumours (e.g., glioblastoma multiforme) have been encouraging and suggest that the safety data generated in animals are predictive of human safety. Although much progress has been made in developing oncolytic HSV vectors for clinical use, there is still a long way to go to determine which combinations of virus, surgery, radiation and chemotherapy will provide improved therapy for the control and eradication of a variety of human cancers.

Animals↗