Squamous cell carcinoma of the tongue has a low survival rate, with cure rate reduced by half if cervical lymph node metastasis is present. Standard treatment regimen includes surgical resection of the tumor, radiotherapy and chemotherapy. These treatment modalities, however, can result in irreversible side effects including loss of form and function of the tongue. So far, there is no efficient treatment regime targeting migration and invasion of tongue carcinoma. Curcumin is a natural polyphenol extracted from Curcuma longa. Recent studies indicated that curcumin is a potential anti-cancer agent. The anticancer effects have been demonstrated in numerous cancers including lung cancer, liver cancer, breast cancer, prostate cancer and melanoma. In head and neck cancers, the number studies is limited and its inhibitory effects in migration and invasion is rarely explored. To explore the global expression changes in tongue cancer, we used microarray to evaluate the genes responsive to curcumin treatment and focused on genes related to migration and invasion of tongue cancer cell line HN21B. The genes down-regulated by curcumin were validated in HN21B and two other tongue cancer cell line CAL27 and HN96 using qRT-PCR, Western blotting and immunostaining. The identified genes were quantified in tongue carcinoma tissues to examine whether it was up-regulated in human tongue tissues. Scratch wound assay and radial-migration assay were used to assess the degree of inhibition on migration. Adhesion and invasion assays were also performed to assess the adhesion and invasion ability. Transcriptomic analyses showed that MMP-10 was 2.36 fold down-regulated in HN21B in response to curcumin. Curcumin treatment resulted in down-regulation of MMP-10 gene in all the 3 tongue carcinoma cell lines at mRNA and protein levels. Out of 24 tongue carcinoma cases, 55% tumor tissue had obvious up-regulation of MMP-10 expression in comparison with the normal counterpart. Adhesion, migration and invasion ability of tongue carcinoma cell lines was significantly reduced upon IC50 of curcumin treatment in all TSCC cell lines. In conclusion, our results indicated that curcumin could reduce migration, adhesion and invasion in tongue carcinoma cells partly through reducing MMP-10 expression. Further investigations are warranted to explore the potential therapeutic use of curcumin to inhibit migration and invasion of tongue carcinoma cells. / published_or_final_version / Surgery / Master / Master of Philosophy

Emerging evidences have documented that aberrant expression of FOXM1 is closely associated with human cancers. A recent comprehensive genome analysis has revealed that FOXM1 signaling is one of the major pathways involved in ovarian cancer oncogenesis. However, the regulatory network of FOXM1 in exerting the metastatic phenotypes remains unknown. Therefore, the identification of FOXM1 downstream targets will assist in understanding of its molecular mechanism in ovarian cancer oncogenesis. In this study, by bioinformatics and a series of functional analyses, we identified DLX1 as a novel target of FOXM1. Our results clearly demonstrated that enforced expression of FOXM1 (FOXM1B and FOXM1C) could increase DLX1 in mRNA and protein levels. Conversely, depletion of FOXM1 by Thiostrepton (FOXM1 specific inhibitor) or RNAi knockdown could reduce DLX1 expression. Importantly, we demonstrated that the changes of DLX1 expression were in concomitant with the expression of a positive control gene, Cyclin-D1. Additionally, the luciferase promoter assay further showed that there are two conserved FOXM1 binding sites TFBS1 and TFBS2 which located at -61~-52bp upstream and -737~727bp upstream of the transcription factor binding sites (TSS) of DLX1 promoter respectively. In comparison of two binding sites, the more conserved binding site, TFBS1, seems have higher importance of FOXM1 binding in DLX1 transcriptional activation. Furthermore, our study using immunohistochemical and Q-PCR analyses showed that DLX1 was frequently up-regulated in ovarian cancer samples. Noticeably, clinicopathological analysis revealed that the upregulated DLX1 was significantly associated with not only the overexpressed FOXM1 (P=0.001) but also high grade ovarian cancer (P<0.001). Previous studies have reported that DLX1 is a homeobox transcription factor controlling neuron migration and proliferation in embryogenesis. However, the oncogenic functions of DLX1 are rarely reported. In this study, we revealed that DLX1 could promote ovarian cancer cell proliferation and cell migration which are the main phenomena found in high grade tumors. To the best of our knowledge, this is the first report showing the regulation of FOXM1 on DLX1 and the metastatic functions exerted by DLX1 in ovarian cancer cells. Although ovarian cancer cells are epithelial cell type which is different from neurons, the similar cell functions derived from DLX1 reflecting that both cell types share the similar signaling pathway of DLX1. However, further investigation on the downstream network of DLX1 and the in vivo tumorigenic capacities in ovarian cancer cells are warranted. To conclude, we have identified DLX1 as a novel target of FOXM1 and frequently up-regulated in high grade ovarian cancer. The in vitro tumorigenic assay demonstrated DLX1 could promote cell proliferation and cell migration which are the metastatic properties usually found in high grade ovarian cancer. Therefore, these data highlight the possibilities of using DLX1 as a biomarker and therapeutic target in combating ovarian cancer in the future. / published_or_final_version / Obstetrics and Gynaecology / Master / Master of Philosophy

Cervical cancer is a largely preventable malignancy due to the availability of cytology screening and vaccination against the essential initiation factor of cervical carcinogenesis, human papillomavirus (HPV). However, cervical cancer remains a significant medical burden worldwide, particularly in developing countries where large scale screening or vaccination programs are not financially feasible. Molecular tests such as HPV DNA tests have the potential to improve the speed and sensitivity of cervical cancer screening but suffer from limited specificity. Additional adjunct molecular markers are therefore desirable for enhancing molecular tests. Our previous research has revealed miR-143, a microRNA downregulated in a number of cancers, could be detected in liquid based cytology samples and is significantly reduced in cervical cancer samples and cell lines. Cellular role of miR-143 and mechanism behind its downregulation remain an unknown in cervical carcinogenesis. To explore the cellular roles of miR-143 in cervical cancer, a construct expressing miR-143 was transfected into cervical cancer cell lines HeLa, SiHa and C33A. miR- 143 overexpression was verified by qPCR. The miR-143 overexpressing cell lines were used to conduct a number of cellular function assays. It has been reported that miR-143 is able to suppress cell growth in HPV-positive HeLa. We followed up the findings and revealed miR-143 overexpression in HPV-negative C33A did not suppress cell growth in an MTT cell proliferation assay. ERK5 and KRAS, two targets of miR-143, are downregulated in colon cancer and bladder cancer to suppress cell grwoth. However, mRNA level of ERK5 and KRAS were not altered in all three miR-143 overexpressed cervical cancer cell lines, suggesting that miR-143 may not target ERK5 and KRAS transcriptionally in cervical cancer. Ability of miR-143 in regulating cell differentiation was evaluated by the expression of K10, an early keratinocyte differentiation marker. K10 was upregulated only in miR-143 overexpressed HeLa and SiHa as revealed by qPCR. A parallel increase in hSkn-1a mRNA, a transcription factor of K10, was also observed specifically in the two miR-overexpressed HPV-positive cell lines. miR-143 level is inversely correlated with cytology grading and progression of cervical disease, hinting its role in mediating cell migration and invasion during cancer progression and metastasis. A reduction of cell migration as demonstrated in wound healing assay and in vitro transwell migration assay was observed exclusively in miR-143 overexpressed HeLa and SiHa. miR-143 overexpression in C33A did not introduce any effect in cell migration. A reduction of cell invasion was also observed merely in miR-143 overexpressed HeLa and SiHa as revealed in a transwell invasion assay. Apart from studying the cellular roles of miR-143 in cervical cancer, this study has also explored mechanisms behind miR-143 downregulation in cervical cancer owing to the fact that certain miR-143 mediated cellular functions were observed only in HPV-positive cervical cancer cell lines. We hypothesized that HPV E6 and E7 oncoprotein may downregulate miR-143 in cervical cancer. The hypothesis was supported by our findings where normal cervical epithelial cell line immortalized by E6 and E7 had an undetectable level of endogenous miR-143 level. The same primary cells immortalized by shp16-hTERT expressed residual amounts of miR-143 as revealed by qPCR. Owing to the low miR-143 expression in shp16-hTERTimmortalized normal cervical epithelial cell line, downregulation of miR-143 in cervical cancer cell lines may also be contributed to hTERT overexpression and p16 silencing. Overall, miR-143 plays an important role in suppressing cell proliferation, enhancing keratinocyte differentiation marker expression, reducing migration and invasion in HPV-positive cervical cancer. Downregulation of miR-143 level may be an effect as manifested by E6 and E7 in HPV-positive cervical cancer. Differential cellular effects in miR-143 overexpressed HPV-positive and HPV-negative cervical cancer cell lines suggest that HPV oncoprotein mediates miR-143 cellular functions. / published_or_final_version / Pathology / Master / Master of Medical Sciences

Background Esophageal carcinoma mainly affects middle aged to elderly males. It ranks the ninth most common cancer world-wide. The main histological types are squamous cell carcinoma and adenocarcinoma. In Hong Kong, esophagus squamous cell carcinoma (ESCC) is by far the more common. BARX2 is a human homeobox gene located at 11q24-q25, encoding a protein of 254 amino acids. Recent researches show that its expression in breast cancer promotes cellular invasion. Objectives The study aimed to test the hypothesis that BARX2 is a prognostic marker in ESCC. BARX2 expression in ESCC was correlated with patient survival and other clinicopathologic parameters in a cohort of patients. Material and Methods Records of ESCC patients were obtained retrospectively from the computerized database of Queen Mary Hospital. ESCC patients, who underwent esophagectomy in the hospital from 1998 to 2005 but without receiving prior chemotherapy or radiotherapy directed to the tumor, were selected. Tumor staging was done according to the 6th edition of AJCC Cancer Staging Manual. Immunohistochemical staining for BARX2 expression was performed on paraffin sections of the primary ESCC tissues sampled in a tissue microarray constructed for research purposes. The pattern of BARX2 expression in nucleus and cell cytoplasm of tumor cells was recorded and the staining intensity scored on a 4-point scale. The scores were statistically analyzed together with the various clinicopathologic parameters. BARX2 expression and patient survival time were analyzed by the log-rank test. Results A total of 78 ESCC patients were recruited. At the time of data analysis, 52 (66.7%) patients were dead. The overall median survival of patients was 14.3 months. BARX2 was found to be mainly expressed in the cytoplasm of tumor cells while non-tumor epithelium showed strong nuclear expression. Patients with high level BARX2 expression had short survival time, though the difference did not reach statistical significance (p=0.075). Within the subgroup of lower T-stage ESCC (T1-3), high level BARX2 expression was significantly associated with shorter survival time (p=0.042). However, differential BARX2 expression did not affect survival time within the group of patients who had advanced stage (T4) disease (p=0.525). In patients who had no regional lymph node metastasis (N0), high level BARX2 expression was associated with shorter survival time (p=0.023). However, when patients had regional lymph node metastases (N1), BARX2 expression did not affect patient survival time (p=0.533). Patients whose ESCC showed moderate differentiation in a three-tier tumor grading system, when accompanied with low level BARX2 expression, had longer survival time (p=0.029). However, BARX2 expression did not affect survival time when ESCC showed either well differentiation (p=0.462) or poor differentiation (p=0.637). Multivariate analysis showed patient age and T-stage to be the only two independent parameters of prognostic significance (p=0.025 and p=0.036 respectively). Conclusions BARX2 expression in ESCC was aberrant and mainly cytoplasmic. It was inversely correlated with patient survival time in early ESCC disease (T1-T3 or N0). BARX2 expression evaluated by immunohistochemistry could be a useful and practical prognostic marker of ESCC in its early stages, when the proper decision on treatment would be critical for the patients. / published_or_final_version / Pathology / Master / Master of Medical Sciences

Ovarian cancer is a leading cause of death among of gynecological cancers. Current therapies are ineffective with a poor 5-year survival of only ~25%. p70 S6 kinase (p70 S6K) is a downstream target of the phosphatidylinositol 3-kinase pathway and is frequently activated in human ovarian cancer. However, the molecular targets and signaling pathways by which p70 S6K may affect tumor development and progression are poorly understood. Interestingly, in the laboratory, Mdm2, an important negative regulator of the p53 tumor suppressor, was identified in a yeast two hybrid screening of potential interacting partners for p70 S6K. In this study, I aimed to investigate the specific interaction of p70 S6K and Mdm2 and determine how this may contribute to ovarian tumorigenesis. Using a co-immunoprecipitation assay, the in vivo interaction of p70 S6K and Mdm2 in human ovarian cancer cells was confirmed. Upon UV-induced genotoxic stress, p70 S6K activation was associated with Mdm2 phosphorylation on S166 and subsequent p53 accumulation. This could be reversed by the use of rapamycin and p70 S6K siRNA to inhibit its kinase activity and expression respectively, confirming that the effect was p70 S6K specific. Conversely, ectopic expression of wildtype p70 S6K or a constitutively active mutant of p70 S6K, D3E-E389 (D3E) was sufficient to induce phosphorylation of Mdm2. Moreover, the p70 S6K mediated activation of Mdm2 was independent of p53 mutations. Similar results were observed upon other stress challenges such as hypoxia using hypoxia mimicking agent desferrioxamine (DFX). These findings identify Mdm2 as a new target of p70 S6K and reveal that p70 S6K intervenes the Mdm2-p53 regulatory loop in ovarian cancer, which may provide a survival advantage to cancer cells under stress conditions. / published_or_final_version / Biological Sciences / Master / Master of Philosophy

Breast cancer is the most common cancer in women in most part of the world. Although there are multiple risk factors which have been reported to be related to breast factors, by far one of the highest risk of breast cancer is the inheritance of the BRCA1 and BRCA2 cancer susceptibility genes. The lifetime risk of breast cancer can be as high as 60-80% for BRCA mutation carriers. As the breast cancer epidemiology and genetic predisposition is increasingly understood, it transpires that ethnic differences exist. Although variations of genetic factors may play a role, the reasons for these differences remain unclear. Most published data are Caucasian based and there are limited publications on hereditary breast cancer in Asians available to date. This thesis hypothesizes that due to the known differences in genetic predisposition in different ethnic groups, it is likely that the mutation spectrum of BRCA mutations and breast cancer characteristics of Hong Kong Chinese, a relatively unexplored cohort, will differ to that of Caucasians. Moreover, the ancestors of local Hong Kong population migrated from Mainland China of which majority were from Southern China. They then remained in Hong Kong and populated and hence similar to smaller countries such as Iceland and Poland where founder mutations are identified, it is likely that a founder mutation will be present. Lastly due to different cultural differences and availability of screening facilities, management options of those found to carry the BRCA mutation may differ to that of other countries. The aims of this study are as follows 1) Perform a comprehensive genetic and phenotypic analysis using Full Gene Sequencing and Multiplex ligation-dependent probe amplification (MLPA) testing of Hong Kong Chinese cohort or breast cancer patients/families who are clinically high risk and to develop a registry to collect data related to this study. 2) To identify the spectrum of BRCA mutation in Hong Kong. 3) To report, any novel mutations, founder mutations, large rearrangements and deletions (using MLPA) if any are found. 4) If founder mutations are present, to develop a fasting and cheaper technique so that rapid screening can be offered. 5) To identify the choice of management in this high risk cohort. A total of 451 clinically high-risk breast and /or ovarian cancer patients from 1 March 2007 to 28 February 2011 were recruited. Based on sequencing results, 59 (13.1%) deleterious BRCA gene mutations were identified: 24 (41%) were in BRCA1 and 35 (59%) in BRCA2. Of the 59 deleterious mutations, 22 (37%) were novel mutations, 8 were BRCA1 and 14 were BRCA2 mutations. Eight recurrent mutations were identified of which four were proven to be founder mutations. These results showed that both BRCA1 and BRCA2 mutations account for a substantial proportion of hereditary breast/ovarian cancer in Sothern Chinese population. By using MLPA, four patients with large genomic rearrangement were identified and one of whom has a de novo BRCA1 mutation encompassing exons 1 to 12 deletion. Such mutations are rare and this de novo mutation has not been previously reported. Moreover another novel BRCA2 variant of unknown significance (c.7806-9T>G), a splice-site intronic mutation, was recharacterized to be pathogenic due to clinical suspicion based on its co-segregation. High Resolution Melting Technique in performing rapid screening for the founder mutations was developed and tested on a further cohort confirming the possibility of the use of founder mutations screening technique in future. Finally, concerning the management choice of BRCA mutation carriers undertaken in Chinese, BRCA mutation carriers in our cohort are more likely to choose intensive surveillance as an option of risk management rather than prophylactic interventions. In summary, this study provides valuable information on mutation spectrum of BRCA1 and BRCA2 in Southern Chinese population. Identifications founder mutations and knowledge of its prevalence in this Chinese population provides important information both to genetic counselling and risk assessment as well as to development of a cost-effective screening strategy. Furthermore, our study on the choice of management of mutation carriers allows us to have a baseline for development of future studies of psychological impact of genetic testing and management related to genetic testing, so that these high risk families can be better supported. / published_or_final_version / Surgery / Doctoral / Doctor of Philosophy

Cervical cancer is the second major cancer among women worldwide and is associated with persistent infection of human papillomaviruses (HPVs). However, exposure to high-risk type HPVs alone is insufficient for tumor formation. Additional factors are required for the HPV-infected cervical cells to become tumorigenic. Activation of ß-catenin/TCF signaling is essential for transformation of HPV-immortalized keratinocyte into cancer. ß-catenin is excessively expressed in cervical cancer. Dysregulation of microRNAs is profoundly observed in various cancers but their roles in cervical cancer are obscure. MicroRNA-135a (miR-135a) regulates one of the negative regulators of ß-catenin signaling, E3 ubiquitin ligase Seven In Absentia Human Homolog 1 (SIAH1). A 39-fold increase in the expression of miR-135a occurs in early stage cervical cancer. This study hypothesized that over-expression of miR-135a transformed HPV-infected cervical cells to cancer by activating ß-catenin/TCF signaling through down-regulation of SIAH1. In this study, miR-135a was confirmed to be specifically up-regulated in cervical cancer tissues when compared with precancerous lesions. Force-expression of miR-135a induced tumorigenic properties (anchorage independent growth and metastatic abilities) in vitro of a non-tumorigenic cervical epithelial cell line NC104 immortalized by HPV-16 E6 and E7 oncoproteins (NC104 E6/E7). The metastatic activities induced by miR-135a required the presence of E6 and E7 proteins as the activities were not observed in another immortalized cervical cell-line from the same parental cells but without the oncoproteins. The observations were confirmed by the observations that miR-135a knockdown did not impair the above tumorigenic properties in a HPV-negative cervical cancer cell line, but suppressed them in HPV-positive cervical cancer cell lines. The mechanism of action of miR-135a in cervical cancer was evaluated. The tumorigenic effects was due to the inhibitory action of miR-135a on SIAH1 leading to up-regulation of ß-catenin/TCF signaling. MiR-135a force-expression enhanced the growth of the cervical cancer cell line HeLa and NC104 E6/E7-derived tumor in vivo. The effect of miR-135a was partially nullified by SIAH1 force-expression. These observations were in line with expression analyses in cervical biopsies, in which SIAH1 immunoreactivities were inversely correlated, whereas ß-catenin was positively correlated with the expression of miR-135a. The data illustrated an oncogenic role of miR-135a/SIAH1/ß-catenin signaling in cervical cancer formation. The role of miR-135a in the formation of cancer stem cells (CSCs) was also elucidated. The number of CD133+ cells was significantly higher in the miR-135a-transformed NC104 E6/E7 cells than the untreated group. The CD133+ cells isolated from the miR-135a-transformed NC104 E6/E7 possessed self-renewal, differentiation and multidrug resistance properties, up-regulation of miR-135a. They also expressed ß-catenin and the stemness genes OCT4, SSEA-4. CD133+ cells were also identified sporadically in fresh cervical tumors. The observations indicate that CD133+ cervical cancer cells possesses CSC properties. In conclusion, this thesis was the first to identify and characterize the functions of miR-135a as an oncomiR in cervical carcinogenesis. MiR-135a played a pivotal role in malignant transformation and cancer progression in HPV-infected cervical cells through miR-135a/SIAH1/ß-catenin signaling. The microRNA also enhanced the proportion of CD133-expressing cervical CSCs. / published_or_final_version / Obstetrics and Gynaecology / Doctoral / Doctor of Philosophy

Hepatocellular carcinoma (HCC) is the major type of liver cancer. In Hong Kong, thousands of deaths are related to this disease every year. Hepatitis B virus (HBV) infection is one of the major risk factors of HCC development. The high prevalence of HBV carriers in Southeast Asia including Hong Kong can account for the particularly high HCC cases in these areas. HCC is often asymptomatic. The diagnosis and treatment are often delayed which lead to inapplicable of surgical resection. Meanwhile, conventional treatment regimes such as systemic chemotherapy were found to have limited responses. Hence, the case mortality rate of HCC is the second highest among all the cancers. Granulin-epithelin Precursor (GEP) is a glycoprotein growth factor which regulates multiple cellular functions. Our group has demonstrated that GEP is over-expressed in more than 70% of HCC cases and GEP expression is positively correlated to tumor malignancy. Our group has also verified that suppression of GEP by monoclonal antibody leads to significant inhibition of HCC growth and reduction of malignancy. Therefore, GEP has the potential to be a novel therapeutic target of HCC. MicroRNAs (miRNAs) are short non-coding RNAs that regulate mRNA translation. Previous studies showed that miRNA dys- regulation is closely associated with HCC progression and the high stability of miRNAs allows them to be cancer biomarkers or therapeutic targets. This project aims to investigate the miRNAs that regulate GEP and their functions in HCC. Potential GEP-regulating miRNAs were identified by literature review and in silico prediction by bioinformatics tools. MiR-615-5p, miR-588, miR-29b, miR-195, and miR-659 were identified as the potential candidates. Quantitative polymerase chain reaction (qPCR) was utilized to examine the miRNAs’ expressions in HCC clinical samples. Only miR-29b and miR-195 were detected and hence they were selected for further study. Our results showed that miR-29b and miR-195 expression levels were significantly decreased in HCC comparing to adjacent non‐tumor tissue (P<0.001) in more than 70% of cases. MiR‐195 and miR‐29b were over‐expressed in Hep3B HCC cell lines by miRNA mimics and GEP protein level was significantly suppressed after miR-29b mimic transfection. The transcript level of GEP was found to be unchanged after the miR‐29b over-expression. This suggests miR‐29b does not regulate GEP protein expression by mRNA degradation. The effects of miR‐195 and miR‐29b on HCC proliferation were also examined. The growths of HCC cells were suppressed notably after over-expression of miR‐195 (P<0.005) and miR‐29b (P<0.005) respectively. In conclusion, miR‐195 and miR‐29b are frequently down-regulated in HCC. MiR‐29b can negatively regulate GEP expression and does not interfere with GEP mRNA level. Furthermore, miR‐195 and miR-29b can function to inhibit HCC cell growth significantly. / published_or_final_version / Surgery / Master / Master of Philosophy

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences