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ORIGINAL ARTICLES |
From the Laboratory of Epithelial Cancer, Biology, and Head and Neck Service (SGT, PO-c, PR, IN, CNC, BS), Department of Surgery, Memorial Sloan-Kettering Cancer Center; the Department of Pathology (RG), Memorial Sloan-Kettering Cancer Center; Division of Thoracic Oncology (MGK), Department of Medicine, Memorial Sloan-Kettering Cancer Center; Division of Thoracic Surgery (ISS, VWR), Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
Correspondence: Address correspondence and reprint requests to: Bhuvanesh Singh, MD, FACS, Head and Neck Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021; Fax: 212717-3304; Email: singhb{at}mskcc.org
| ABSTRACT |
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Methods: Fresh tissue was collected at Memorial Sloan-Kettering Cancer Center from 34 patients undergoing primary resection of lung squamous cell carcinomas. RNA was extracted from this tissue, reverse-transcribed, and real-time polymerase chain reaction (RT-PCR) was carried out using a BioRad iQ iCycler with SYBR green fluorophore. Microvessel counting was performed on the tumor specimens using CD34 immunohistochemistry.
Results: The expression of both SCCRO and VEGF-A mRNA varies widely in both tumor and normal tissue. SCCRO and VEGF-A co-expression was significantly correlated (R2 = 0.63; P < 0.032). Microvessel counts were not associated with expression of SCCRO or VEGF-A and failed to significantly predict survival. VEGF-A expression in this patient group is a predictor of overall survival (P < 0.032).
Conclusions: VEGF-A expression correlates with SCCRO expression in these primary human lung squamous cell carcinomas and is a predictor of clinical behavior. This data supports the association of SCRRO and VEGF-A in the induction of angiogenesis.
Key Words: Squamous cell carcinoma Angiogenesis Lung cancer
| INTRODUCTION |
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Induction of neovascularization is one mechanism by which tumor cells attain their growth advantage.7 Moreover, angiogenesis is often quoted as a sine qua non of tumor growth and progression to become clinically important disease or metastases.8,9 The use of anti-angiogenic agents has long been suggested as a potential therapeutic tumor target,10 and considerable recent work has focused on the use of anti-angiogenesis as an adjunct to chemo-radiotherapy.11
Our previous work has investigated the link between SCCRO and angiogenesis (Talbot SG, personal communication, April 1, 2002). Our in vitro experiments confirmed that SCCRO is a potent inducer of angiogenesis, showing transformation of human umbilical vein endothelial cells (HUVEC) into vascular structures in a co-culture assay with SCCRO-transfected 3T3-cells, but not in control cells. In addition, in vivo experiments demonstrated significant neovascularization and microvessel formation in vivo in tumors resulting from NIH-3T3 cells stably transfected with SCCRO. Screening of SCCRO-transfected cell lines with Affymetrix oligonucleotide microarray (Affymetrix MG_U74Av2) revealed a core group of nuclear proteins, cytokines, growth factors, receptors, signaling molecules, enzymes, transporters, and ion channels with greater-than 2-fold up-regulation relative to vector transfected controls (Sarkaria IS, et al., unpublished data). The only prominent angiogenic factor in the genes dysregulated by SCCRO was vascular endothelial growth factor (VEGF)-A, showing between 4.3 and 11.3-fold up-regulation in two stably-transfected NIH-3T3 clones. The temporal relationship between SCCRO and VEGF-A mRNA and protein expression was confirmed using a tetracycline-inducible (Tet-off) SCCRO-3T3 cell line showing the induction of VEGF-A mRNA and protein expression with the induction of SCCRO by real-time RT-PCR and western blot analyses. The angiogenic effects of VEGF-A are induced by secretion of the protein and subsequent activation of stromal cells. In concordance, we showed the soluble, secreted fraction of VEGF-A protein in higher levels (P < 0.009) in the cell conditioned media of SCCRO-transfected cells and confirmed that it was secreted by these cells using ELISA assay.
Vascular endothelial growth factor (VEGF)-A is one protein of the VEGF family (known as VEGF-A through E). In humans it is expressed as numerous splice variants of which the 121, 165, 189, and 206 amino acid variants are most common, with the smaller of these being more soluble due to loss of the exon 6 heparin-binding domain.1214 The mouse VEGF gene contains a frame-shift mutation and translates into 120, 164, and 188 amino acid splice variants.15 VEGF-A is known to act on three tyrosine kinase receptors (VEGFR1-R3, also known as flt1, KDR/flk1, and flt4), but the exact pathways of VEGF action are poorly characterized. Importantly, however, increased VEGF-A expression has repeatedly been shown to be related to increased lymph node metastases, poorer treatment response, and poorer survival in squamous cell carcinoma patients.1619 The present paper investigates the link between SCCRO and VEGF-A expression in primary human squamous cell carcinoma samples and determines its effects on outcome.
| PATIENTS AND METHODS |
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RNA Preparation and Reverse-Transcription
Total RNA was extracted from all tumor and normal samples simultaneously. 100 µg of tissue was used, and RNA was extracted using TRIzol® reagent (Invitrogen, Life Technologies) following the manufacturers protocol. Samples were further purified using RNeasy Mini Kits (Qiagen). DNase I was added to remove remaining genomic DNA. Two micrograms of total RNA was reverse-transcribed using Taqman® Reverse Transcriptase Reagents (Applied Biosystems) and following the manufacturers protocol.
Real-Time PCR
Primers were designed using Primer3 program20 and Qiagen Operon Toolkit,21 according to parameters outlined in the BioRad iCycler Manual. Specificity of primers was confirmed by BLAST analysis.22 SCCRO PCR primers used were as follows: forward 5'-TCTGTGATGACCTGGCACTC, reverse 5'-TGTTTGGAGAACTCGCACTG. VEGF-A PCR primers used were designed from exon 3 as published in GenBank as follows: forward 5'-CCAATCGAGACCCTGGTG, reverse 5'-CACACAGGATGGCTTGAAGA. 18S rRNA was used as a reference for normalization as previously described,23,24 and relative quantification was analyzed using iCycler iQ Optical System Software Version 3.0a (BioRad Laboratories, Ltd). Samples negative for 18S rRNA were excluded from analysis as RNA was assumed to be of too poor a quality for further analysis.
Real-time PCR was performed using a BioRad iQ iCycler Detection System (BioRad Laboratories, Ltd) with SYBR green fluorophore. Reactions were performed in a total volume of 20µLincluding 10µL 2x SYBR Green PCR Master Mix (Applied Biosystems), 5µL of each primer at 5µM concentration, and 1µL of the previously reverse-transcribed cDNA template.
Protocols for each primer set were optimized using five serial 10x dilutions of template cDNA obtained from human head and neck squamous cell carcinoma cell line MDA1186. The protocols used are as follows: denaturation (95°C for 10 mins), amplification repeated 30 to 50 times (95°C for 30 s, specific annealing temperature for 30 s, 72°C for 30 s, and acquisition temperature for 15 s). For SCCRO, 50 cycles were used with a 55°C annealing temperature. For VEGF-A, 50 cycles were used with a 64°C annealing temperature. The 18S rRNA reference required 30 cycles with a 55°C annealing temperature. A melt curve analysis was performed following every run to ensure a single amplified product for every reaction. PCR fluorophore acquisition temperatures were set at 1°C below the melt curve peak.
All reactions were carried out in at least duplicate for every patient sample. The same reference standard dilution series (described above) was repeated on every experimental plate and semi-quantification of both the gene of interest and the 18S rRNA normalizations are based on this. Duplicate negative controls (no template cDNA) were also run with every experimental plate to assess specificity and indicate potential contamination.
Microvessel Density Assessment
For each of the 34 patients, original tumor and normal paraffin-embedded tissue blocks were obtained. These were reviewed by a single pathologist (RG) and 5µm sections cut from each. Slides were subjected to immunoperoxidase staining using the streptavidin-biotin method. Briefly, sections were submitted to antigen retrieval by microwave treatment for 30 minutes in 0.01M citrate buffer at pH 6.0. Primary mouse monoclonal antibody against human CD34 was used at a 1:2000 dilution (Beckmann Coulter, Brea, CA). Diaminobenzidine was used as the chromogen and hematoxylin as the nuclear counterstain. Microvessel density was determined using an Olympus BX40F U-DO microscope at 400x magnification with 2 observers (RG, ST) according to standard published protocols.25
Statistical Analysis
Data were analyzed using the JMP 4.0 Statistical Package (SAS Institute). For comparison of VEGF-A levels in SCCRO positive or negative tumors, an unpaired, two-tailed t-test was used. For the correlation between SCCRO and VEGF-A mRNA, Spearmans rank correlation was used. Survival data are based on the Kaplan-Meier method and differences were calculated using the log-rank test. A two-tailed p-value of less than or equal to 0.05 was considered significant.
| RESULTS AND DISCUSSION |
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VEGF-A is a Predictor of Poorer Overall Survival
Having established a correlation between SCCRO and VEGF-A, we investigated if VEGF-A expression was a clinical outcome predictor. VEGF-A levels above the mean for the entire cohort were associated with poorer overall survival in those with higher VEGF-A expression (P < 0.032, Fig. 4). This finding is consistent with the role of VEGF-A in angiogenesis and the maintenance of tumor vascularity. We have previously shown the association between SCCRO and survival.1 Our current findings support VEGF-A as one possible target mediating SCCRO associated aggressive behavior.
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| ACKNOWLEDGMENTS |
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| FOOTNOTES |
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Received for publication March 6, 2003. Accepted for publication January 13, 2004.
| REFERENCES |
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