published_or_final_version / Pathology / Master / Master of Philosophy

published_or_final_version / Pathology / Master / Master of Medical Sciences

Breast cancer is the most common malignancy in women and represents one of the major causes of death worldwide. The PI3K-Akt-FOXO3a signalling pathway has been shown to play a crucial role in tumorigenesis and the development of drug resistance in many cancer types. However, previous studies on FOXO3a using breast cancer tissues were controversial. So this study aims at better understanding of the role of FOXO3a in the development of drug resistance, especially endocrine resistance and anthracycline resistance in breast cancer. Examination of FOXO3a and phosphorylated-Akt (P-Akt) expressions in breast cancer tissue microarrays revealed nuclear FOXO3a was significantly associated with poor prognosis (p=0.014) and lymph node positivity (p=0.052) in invasive ductal carcinoma. Using the tamoxifen and anthracycline-sensitive and -resistant breast cancer cell lines as models, we found that the nuclear accumulation of FOXO3a was associated with enhanced anthracycline-resistance but not tamoxifen-resistance. This was consistent with the finding that sustained nuclear FOXO3a was associated with poor prognosis, as cytotoxic chemotherapy resistance is linked to limited therapeutic options and poor prognosis. We demonstrated a possible feedback mechanism in which induction of FOXO3a activity in the anthracycline-sensitive MCF-7 cells induced Akt phosphorylation and promoted cell proliferation arrest. Using MDA-MB-231-FOXO3a(A3):ER cells in which FOXO3a activity could be induced by 4-hydroxytamoxifen, we showed that FOXO3a induction could up-regulate PI3K-Akt activity but had little effect on cell proliferation, which indicates impaired Akt-FOXO3a axis in chemoresistant cell models. To further uncover the precise mechanism of Akt-FOXO3a deregulation in the development of chemoresistance, we have explored the post-translational regulation of FOXO3a by miRNAs. Through a series of Gain-and-Loss functional experiments and luciferase reporter assays in vitro, three miRNAs, including miR-222, miR-221 and miR-29a, were found to suppress FOXO3a protein expression through binding directly to FOXO3a 3’UTR. Moreover, the aberrant expressions of the miR-222/221 cluster and miR-29a in drug resistant cell lines could confer a proliferation advantage to cancer cells through suppressing FOXO3a expression. We further demonstrated that FOXO3a as a transcription factor could transactivate the oncogenic miR-222 and miR-221 expressions under certain chemotherapy stimulation. This suggests the existence of a feedback regulatory loop composed of the miR-222/221 cluster and FOXO3a which may not only play a self-protective role under drug treatment in chemosensitive cells, but also partially explain the tolerated nuclear FOXO3a in the breast cancer with poor prognosis. Taken together, our study suggested that lymph node metastasis and poor survival in invasive ductal breast carcinoma are linked to an uncoupling of the Akt-FOXO3a signalling axis, as in these breast cancers the nuclear-located FOXO3a was unable to induce cell death or cell cycle arrest. We also demonstrated post-translational regulation of FOXO3a by miR-222/221 and miR-29a, while aberrant expressions of miR-222/221 and miR-29a may promote cell resistance to therapy through directly suppressing FOXO3a. FOXO3a could further contribute to the deregulation of the miR-222/221 cluster as a transcription factor in breast cancer. Studying this Akt-FOXO3a-miRNAs signalling circuit will provide us better understanding in predicting and monitoring treatment response in breast cancer and other malignancies. / published_or_final_version / Pathology / Doctoral / Doctor of Philosophy

Tamoxifen is the most widely used endocrine therapy for both early and advanced estrogen receptor (ER) positive breast cancer patients. About half of the patients that initially respond to the antiestrogen become estrogen-independent and ultimately develop resistance to the treatment. The precise molecular mechanisms of tamoxifen resistance remain poorly understood. Dysregulation of microRNAs (miRNAs) has been frequently reported in breast cancer and linked to cancer development, progression and therapeutic response. To gain a more comprehensive picture of the miRNA regulatory network for modulating tamoxifen responsiveness, we examined global expression profiles of more than 600 miRNAs in a matched pair of tamoxifen-sensitive ZR75 and tamoxifen-resistant AK47 breast cancer cell lines using TaqMan Low Density Array (Applied Biosystems). Under 4-hydroxytamoxifen treatment, 102 miRNAs displayed differential responses between the sensitive cells and the resistant cells. At basal levels, upregulation of 32 miRNAs and downregulation of 75 miRNAs were observed in the resistant cells as compared to the sensitive cells. Among the 9 miRNAs of significant differential expression selected for validation, expression profiles of the 7 miRNAs could be reproduced. Of these, 4-hydroxytamoxifen treatment greatly increased miR-449a/b expression in sensitive ZR75 cells, whereas miR-449a/b expression was significantly reduced in resistant AK47 cells at basal levels, which was further confirmed in a panel of tamoxifen-resistant breast cancer cell lines. Such downregulation of miR-449a/b in the resistant cells was partially attributed to DNA methylation-mediated repression of miR-449a/b. Notably, miR-449a/b expression exhibited a significant positive correlation with ER-α status (miR-449a: P=0.006, miR-449b: P=0.013) and progesterone receptor (PR) status (miR-449a: P=0.010, miR-449b: P=0.021), and a prominent inverse association with tumor grade in 61 breast cancer tissues (miR-449a: P=0.001; miR-449b: P=0.009). Also, breast cancer patients with high miR-449a/b expression tended to have increased disease-free survival (miR-449a: P=0.019; miR-449b: P=0.117). To further support the tumor suppressor function of miR-449, stable miR-449b overexpression in the resistant cells reduced cell proliferation. More intriguingly, restoring miR-449b expression increased sensitivity to 4-hydroxytamoxifen-induced apoptosis via suppression of AKT activity without restoring ER-α expression. In contrast, miR-449a/b knockdown reduced ER-α and PR expression, but enhanced phosphorylation of AKT, extracellular signal-regulated kinase- 1/2 (ERK1/2), c-Jun N-terminal kinases (JNK) and also ER-α at serine 167 and serine 118 residues. Furthermore, we demonstrated c-Myc is a target gene of miR-449 as confirmed by bioinformatics and experimental analyses. Computational algorithms predicted a highly conserved miR-449a/b binding site within C-MYC 3’untranslated region (3’UTR). Compared to the parental sensitive cells, c-Myc was overexpressed in the resistant cells. Forced expression of miR-449b suppressed c-Myc protein level. To further support the notion that c-Myc is a direct target of miR-449, interactions between miR-449b and C-MYC 3’UTR were confirmed by co-expression of miR-449b and c-Myc expression constructs and luciferase reporter assay. Taken together, our data strongly suggest the critical role of miR-449 in modulating altering response to tamoxifen via targeting c-Myc. Suppression of miR-449 repressed genomic ER action and concomitantly activated non-genomic ER pathways. These findings may provide insights to improve breast cancer management and open a wide avenue for therapeutic interventions for overcoming tamoxifen resistance. / published_or_final_version / Pathology / Doctoral / Doctor of Philosophy

Epithelial ovarian cancer is a leading fatal malignancy in women. The high mortality rate of this cancer is due to the poor prognosis and that the majority of patients are diagnosed at late stage. Therefore, a combination of cytoreduction and adjuvant chemotherapy is the only choice for this disease at late stage. Platinum-based chemotherapy regimens are the first line treatment for ovarian cancer. However, the repetitive challenges of platinum-based agents and the frequent relapse cause acquired chemoresistance which is the major obstacle for clinical management of this disease. The underlying molecular mechanism for acquired chemoresistance remains largely unclear. Therefore, understanding the molecular mechanism in acquired chemoresistance of ovarian cancer is urgently needed. Emerging evidence has suggested that dysregulation of miRNAs is significantly involved in acquired chemoresistance in human cancers. In this study, the expression status and functional roles of miR-199b-5p were characterized in the chemoresistance of ovarian cancer. By miRCURY LNA™ miRNA array, miR-199b-5p was one of the downregulated miRNAs identified in acquired chemoresistant ovarian cancer cells. Further Q-PCR analysis found that miR-199b-5p exhibited a pattern of progressive reduction from early to advanced stage and from low to high grade ovarian cancer tissue samples (N=79). Interestingly, the expression of miR-199b-5p could be restored upon 5-Aza-2’-deoxycytidine (5-Aza-dC) treatment in ovarian cancer cells. Methylation-specific PCR and bisulfite genomic sequencing revealed that the promoter region of miR-199b-5p (Chromosome9q34) was frequently hypermethylated in chemoresistant ovarian cancer cells. Functionally, enforced expression of miR-199b-5p remarkably diminished the cisplatin-resistance in miR-199b-5p low expressing ovarian cancer cells, whereas depletion of miR-199b-5p by siRNA approach augmented cisplatin-resistance in miR-199b-5p high expressing ovarian cancer cells. A tumor xenograft mouse model further confirmed that miR-199b-5p could sensitize ovarian cancer cells to cisplatin-mediated tumor growth inhibition in vivo. On the other aspect, computational analysis plus luciferase reporter assay and western blotting identified JAG1, a key ligand of Notch1 signaling frequently associated with chemoresistance of human cancers, as a direct target of miR-199b-5p in ovarian cancer cells. Intriguingly, an inverse relationship between the downregulation of miR-199b-5p and the upregulation of JAG1 was found by in situ hybridization (ISH) and immunohistochemical (IHC) analyses in a commercial ovarian cancer tissue array (OVC1021). Functionally, enforced expression of JAG1 increased cisplatin resistance of ovarian cancer cells. In contrast, depletion of JAG1 by siRNA approach abrogated the cisplatin-resistance of ovarian cancer cells. This finding was in consistent with the effect of enforced expression of miR199b-5p in cisplatin-resistant ovarian cancer cells. Mechanistically, the Notch1 luciferase reporter assay and western blotting analysis demonstrated that the Notch1 signaling activity could be activated by JAG1 or conversely be inhibited by enforced expression of miR-199b-5p. Further investigation using the Notch specific inhibitor γ-secretase showed that JAG1-Notch1 signaling is a crucial pathway associated with chemoresistance of ovarian cancer in vitro and in vivo. Taken together, this is the first study showing that the epigenetic silencing of miR-199b-5p leads to aberrant activation of JAG1-Notch1 signaling and such signaling cascade plays a critical role in tumor progression and chemoresistance of ovarian cancer. / published_or_final_version / Obstetrics and Gynaecology / Doctoral / Doctor of Philosophy

Breast cancer is one of the most prevalent cancers affecting women worldwide. In the breast, estrogen receptor alpha (ERα), upon binding with ligands, activates gene transcription and promotes cell growth and proliferation. Tamoxifen, a selective antagonist of ERα in breast, has been proved to be effective therapeutically. In spite of this, resistance remains a prominent issue and underlying mechanisms are not yet fully understood. Aberrant regulation of ER expression at genetic and transcriptional levels has been implicated as the mechanisms accounting for tamoxifen resistance. However, regulation of ERα expression at translational level including protein synthesis and degradation has not yet been characterized and its relevance to tamoxifen resistance has not been described. At level of protein synthesis, eukaryotic translation initiation factor 4E (eIF4E) selectively enhances the translation of 4E-sensitive mRNAs which contain long and complex 5’-untraslated regions (5’-UTR). eIF4E is often over-expressed in cancers. In silico analysis revealed that ERα contained a highly structured 5’-UTR similar to reported eIF4E-sensitive mRNAs, suggesting that ERα mRNA might be eIF4Esensitive. We showed by polysome fractionation and subsequent Q-PCR quantification that the ERα mRNAs were more actively translated in the cell line expressing higher levels of eIF4E. Consistently, transient transfection of eIF4E into an ERα-positive cell line resulted in enhanced protein expression of ERα. Moreover, subcelluar fractionation showed that eIF4E was bound with ERα mRNAs in the nucleus thus participating in transportation of mRNAs from the nucleus into the cytoplasm. Therefore, eIF4E could positively modulate protein synthesis of ERα by enhancing mRNA export in the nucleus as well as translation in the cytoplasm. Their positive correlation was validated in vivo using 106 Chinese breast cancer samples (Chi-square test, p=0.004). It was also found that elevated expression of eIF4E could mediate resistance to tamoxifen treatment and enhance cell survival. This could be due to enhanced expression of ERα or activation of PI3K/Akt pathway upon eIF4E over-expression. At the level of degradation, ERα is conjugated to poly-ubiquitin chains catalyzed by multiple enzymes and degraded by 26S polysomes. Carboxyl-terminus of Hsc70- interacting protein (CHIP) is an E3 enzyme specific for ERα degradation through interaction with ERα’s ligand-binding domain (LBD). Various splicing variants of ERα have been reported and implicated in tamoxifen resistance by interfering with functions of ERα wild type. Variants ERαΔ4, ERαΔ5, ERαΔ6/7 and ERαΔ7 with different degrees of truncation in their LBDs and differential expression were detected or reported in human breast cancers. Their interactions with CHIP may be different, resulting in variations in degradation. We found that the degradation of ERαΔ6/7 through ubiquitin-proteasome pathway was impaired whilst the degradation of other variants were less affected. This finding suggests that the binding site of CHIP to ERαmight be located within the peptide sequences encoded by exon6. Furthermore, as ERαΔ6/7 plays a dominant negative role in regulating functions of ERα wild type, aborted degradation of this variant may result in accumulation of this variant in the cell, inhibiting and inactivating ERα, making the cells refractile to tamoxifen treatment. / published_or_final_version / Pathology / Master / Master of Philosophy

Esophageal squamous cell carcinoma (ESCC) is the predominant type of esophageal cancer in Asia. Cisplatin is commonly used as an agent for treating ESCC patients undergoing chemotherapy. However establishment of resistance over the course of treatment diminishes the clinical usefulness and is one reason explaining poor prognosis of ESCC patients. In order to gain insights into the mechanism of cisplatin resistance in ESCC, HPLC/nESI-MS/MS proteomic profiling was employed to examine the global protein alterations of cisplatin-resistant ESCC cell line HKESC2/CDDP comparing with its parental cisplatin-sensitive cell line HKESC2. Stable over-expression and knocked-down cell lines were established for pathway analysis and functional studies. Seventeen proteins were identified with more than 2-fold difference in expression levels. These proteins are involved in endoplasmic reticulum stress response, metabolic processes, DNA replication and repair, nucleotide binding and cell cycle control, while some of them are components of cytoskeletal proteins. Among them, 14-3-3σ was one of the most significantly upregulated proteins found in HKESC2/CDDP cells and its differential expression levels were validated using western blotting and real-time quantitative polymerase chain reaction. Pathway analysis revealed that ectopic overexpression of 14-3-3σ caused a general upregulation in DNA repairing genes. Furthermore, functional validation showed that elevated 14-3-3σ expression contributed considerably to the observed cisplatin resistance in HKESC2/CDDP cells. While knocking down 14-3-3σ expression reversed the above situations in SLMT1 cells. I conclude that up-regulation in 14-3-3σ, together with DNA repairing genes, contributes to the establishment of cisplatin resistance in HKESC2/CDDP cells. Knocking down 14-3-3σ expression sensitized ESCC cells to cisplatin treatment, and hence, opens a therapeutic opportunity for ESCC cisplatin resistance. / published_or_final_version / Surgery / Doctoral / Doctor of Philosophy

Breast cancer is a major cause of cancer-related death among women throughout the world. Treatment of breast cancer often fails due to the development of resistance to both chemo- and radiotherapy. The aim of this study was to analyze and compare the response to radiation of MCF-7 breast adenocarcinoma cells and MCF-7 cells that are resistant to doxorubicin (MCF-7/DOX). The results presented in this thesis show that drug-resistant MCF-7/DOX cells survive high doses of radiation exposure better than MCF-7 cells. Moreover, the chemo- and radioresistance of MCF-7/DOX cells share common molecular mechanisms and loss of sensitivity to radiation in chemo-resistant cells may be explained by alterations in their DNA methylation profile. The results of experiments presented in this thesis may, therefore, serve as a first step for future analysis of tumour resistance to radio- and chemotherapy and for the development of novel epigenetic strategies for reversal of breast cancer resistance to cytotoxic treatment regimens. / xi, 98 leaves : ill. (some col.) ; 29 cm

Cytotoxic chemotherapy is extremely important in adjuvant treatment of breast cancer. Yet, tumours frequently acquire chemoresistance that correlates with increased aggressiveness and poor prognosis. Three theories exist describing how the resistance develops: genetic, epigenetic and karyotypic theory. The epigenetic theory is the least explored. Here we analyzed the role of the epigenetic phenomena in the acquisition of drug resistance. To do so, we employed genome wide screens of microRNA and gene expression, DNA methylation and complete genome hybridization. We identified three novel microRNA interactions involved in the chemoresistant phenotype. These three microRNAs displayed depressed expression in the resistant cell lines and we were able to re-establish some level of drug sensitivity through ectopic expression of these under expressed microRNAs. In addition, we described the role of DNA methylation in impacting expression of a wide range of genes, thus, contributing to the phenotype of chemoresistance. Furthermore, we revealed a distorted global DNA methylation pattern that coincides with massive instability of the resistant genome. Finally, our results present a striking similarity between gene expression, epigenetic profiles and chromosomal aberrations in two different drug resistant cell lines. Taken together, this project suggests that the acquisition of chemoresistant phenotype is epigenetic in nature and may arise with a predictable pattern. Elucidating the specifics of this pattern may in the future prove useful in developing treatment and prognostic chemoresistance biomarkers. / xiii, 116 leaves : ill. (some col.) ; 29 cm

Multidrug resistance (MDR) in small cell lung cancer is one of the major causes of failures of chemotherapy. MDR is a means of protection of tumor cells against chemotherapeutic drugs. Although the molecular basis of MDR is not fully understood, genes involved in apoptosis may be mutated. Recent finding of a link between over-expression of an apoptotic gene, cyclooxygenase 1 (cox 1), and MDR suggests that cox 1 is involved in the development of MDR phenotype. This research was an attempt to observe whether up-regulation of cox 1 contributes to the MDR phenotype in small cell lung cancer cells. This research ultimately may provide a mechanism to reverse the abberant up-regulation of apoptosis genes associated with multidrug resistance to either eliminate or control reproduction of cancer cells. Real time RT PCR was used to confirm the up-regulation of cox 1 in cultured MDR resistant small cell lung cancer cells (GLC4). The up-regulated cox 1 expression was down-regulated using RNA interference technology (RNAi) by transfection with an anti-cox 1 siRNA. More than 90% transfection of cells was confirmed using confocal microscopy. Down-regulation of cox 1 was validated as the protein expression significantly decreased (P=0.004) from multidrug resistant small cell lung cancer transfected cells compared to multidrug resistant nontransfected cells. There was decrease level of expression of cox 1 in multidrug resistant cells after the knockdown with siRNA specific to cox 1. The decreased level of cox 1 expression and, therefore, Cox 1 production increased the rate of apoptosis in small cell lung cancer cells as indicated by its sensitivity to the doxorubicin. / Department of Biology