I have investigated epigenetic mechanisms of acquired endocrine-resistance in breast cancer using an in vitro model system based on estrogen-dependent MCF7 cells and their derivatives, LCC1 and LCC9. LCC1 cells, derived from MCF7 after passage in ovariectomised mice and routinely cultured in vitro in the absence of estrogen, exhibit estrogen-independent growth. They retain sensitivity to tamoxifen and fulvestrant. LCC9 cells, derived from LCC1 cells by growing them in increasing concentrations of fulvestrant, are completely estrogen-independent and are resistant to fulvestrant and cross-resistant to tamoxifen. When compared to MCF7 cells, LCC1 cells have marked up-regulation of the estrogen receptor α (ERα) protein that is not concomitant with increased estrogen receptor 1 (ESR1) transcription, suggesting a role for estrogen in controlling the proteasomal degradation of ERα. However, despite being grown in the same estrogen-deprived conditions, LCC9 cells do not have up-regulated ERα levels. As LCC1 cells retain sensitivity to tamoxifen and fulvestrant, these data suggest that LCC1 have developed estrogen-independence through ERα uncoupled from its ligand. However, LCC9 cells appear to have developed an alternative mechanism which is not dependent on ERα, presumably explaining their resistance to fulvestrant. I have studied global gene expression changes in the presence and absence of estrogen in these cell lines, using oligonucleotide microarrays, and correlated these data with global DNA methylation data derived from methylation arrays, which interrogate the methylation status of approximately 27,000 CpG dinucleotides in the genome. The analysis led to the discovery of more than 5,000 genes that were potentially either up-regulated or down-regulated by estrogen in MCF7 cells, either directly or indirectly. The transcriptional response to estrogen was generally muted in LCC1 and LCC9 compared with MCF7, but was not completely absent. I used various methods based on differential gene expression to parse the data, including gene ontology analysis, aiming to select genes for further mechanistic study. However, none of these methods led to the conclusive identification of a specific gene (or set of genes) that might have accounted for the physiological differences between the cell lines. In one strategy, I reasoned that, as the endocrine-resistant cells had lost their estrogen-dependence, genes involved might be regulated in an estrogen-dependent manner in MCF7 cells, without exhibiting misregulation in LCC9. This led to the identification of DUSP1 as a candidate gene, which was taken forward for mechanistic study because of its potential role in regulating ERα expression. However, when over-expressing DUSP1 in LCC9 cells, I could not demonstrate any effect on ERα levels. The final approach taken was to identify genes that might have been epigenetically deregulated, being both estrogen-regulated and deregulated in association with aberrant DNA methylation in the estrogen-independent cell lines. Surprisingly, given the phenotypic differences between the cell lines, only a very few genes were significantly methylated between cell lines. Of those that were differentially methylated between MCF7 cells and LCC1/9, only three exhibited the expected inverse correlation between methylation and expression. Of these, the gene CYBA was selected for further investigation. CYBA is a critical component of the NAPDH oxidase complex which is involved in generating oxygen free-radicals. My work suggests CYBA expression is estrogen-dependent, and that chronic estrogen deprivation leads to the epigenetic inactivation of CYBA in breast cancer cells. I speculate that the epigenetic suppression of CYBA may protect cells from the oxidant damage that results from estrogen deprivation and may be part of the mechanism that leads to acquired endocrine-resistance in previously sensitive cells.

Resistance to antiestrogen therapy remains a significant problem in breast cancer. Low expression of inhibitor of growth 4 (ING4) in primary tumors has been correlated with increased rates of recurrence in estrogen receptor-positive (ER+) breast cancer patients, suggesting a role for ING4 in ER signaling. This study provides evidence that ING4 inhibits ER activity. ING4 overexpression increased the sensitivity of T47D and MCF7 ER+ breast cancer cells to hormone deprivation. ING4 attenuated maximal estrogen-dependent cell growth without affecting the dose-response of estrogen. These results indicated that ING4 functions as a noncompetitive inhibitor of estrogen signaling and may inhibit estrogen-independent ER activity. Supportive of this, treatment with fulvestrant but not tamoxifen rendered T47D cells sensitive to hormone deprivation as did ING4 overexpression. ING4 did not affect nuclear ER alpha protein expression, but repressed selective ER-target gene transcription. Taken together, these results demonstrated that ING4 inhibited estrogen-independent ER activity, suggesting that ING4-low breast tumors recur faster due to estrogen-independent ER activity that renders tamoxifen less effective. This study puts forth fulvestrant as a proposed therapy choice for patients with ING4-low ER+ breast tumors.

No description available.

No description available.

Le cancer du sein est le cancer qui a la plus forte fréquence au Canada. En 2012, on estime que 23 200 nouveaux cas de cancer du sein seront diagnostiqués. Deux tiers des tumeurs mammaires expriment ou surexpriment le récepteur des oestrogènes α (ERα). De même, les oestrogènes sont importants pour la croissance de ces tumeurs. La présence des récepteurs hormonaux est un critère qui détermine le choix de la thérapie; à cet égard, le ciblage des récepteurs des oestrogènes par les antioestrogènes a pour but d’inactiver ces récepteurs et diminuer leur contribution à la croissance tumorale. Les antioestrogènes sont des inhibiteurs compétitifs de ERα. Tamoxifene est le médicament le plus utilisé pour traiter les tumeurs mammaires ER+ de tous les stades, avant ou après la ménopause. Tamoxifene est antioestrogène partiel ou SERM qui a un profile mixte d’activités agonistes et antagonistes. Fulvestrant ou ICI 182, 780 est un antioestrogène de type total ou SERD dépourvu de toute activité agoniste. Ce composé est utilisé en clinique chez les femmes après la ménopause ayant des tumeurs mammaires avancées. Fulvestrant constitue, donc, une deuxième ligne thérapeutique en cas de rechute après à un traitement par Tamoxifene. Afin de comprendre le potentiel thérapeutique de Fulvestrant, il est primordial d’étudier son impact sur ERα. Actuellement, la polyubiquitination et la dégradation de ERα sont les mécanismes les plus connus pour expliquer l’inactivation de ERα par Fulvestrant. Par ailleurs, en utilisant des modèles cellulaires ER+ et ER-; nous avons montré que les antioestrogènes totaux induisent une insolubilité de ERα indépendamment de leur capacité à induire sa dégradation. L’insolubilité corrèle avec l’association de ERα avec la matrice nucléaire et avec l’inhibition de sa transactivation. L’hélice H12 du domaine de liaison du ligand joue un rôle important dans l’insolubilité et l’inactivation de ERα par les antioestrogènes totaux. Par ailleurs, les antioestrogènes totaux se distinguent par leur capacité à induire la SUMOylation de ERα par SUMO1 et SUMO2/3. La SUMOylation est rapide et précède la dégradation de ERα dans cellules ER+. À l’aide de dérivés de l’antioestrogène total ICI 164, 384, nous avons montré que la chaine latérale des antioestrogènes totaux est à la base de l’induction de la SUMOylation et de l’inactivation de ERα. De plus, la SUMOylation semble être une marque d’inhibition, car la déSUMOylation restaure une activité de ERα en présence des antioestrogènes totaux. L’hélice H12 du LBD et le domaine de liaison à l’ADN sont requis pour l’induction de la SUMOylation. La recherche de protéines impliquées dans l’inactivation et dans la SUMOylation a permis d’identifier le facteur de remodelage de la chromatine ACF dans le même complexe que ERα. De manière similaire à la SUMOylation, le recrutement de ACF est précoce et constitue une propriété spécifique des antioestrogènes totaux. D’autre part, Fulvestrant induit le recrutement de ACF au niveau du promoteur du gène cible des oestrogènes pS2, ce qui suggère une contribution du remodelage de la chromatine dans les mécanismes d’action des antioestrogènes totaux. La surexpression de la DéSUMOylase SENP1 abolit le recrutement de ACF ce qui indique un rôle de la SUMOylation dans le recrutement de ACF. De même, l’hélice H12 du LBD de ERα constitue un lien entre l’inactivation de ERα et le recrutement de ACF. L’insolubilité, la SUMOylation et l'interaction du complexe ACF sont le reflet des mécanismes d’action des antioestrogènes totaux. Ces observations peuvent être utilisées comme des critères fonctionnels pour identifier d’autres composés avec de meilleures propriétés pharmacologiques que Fulvestrant. / Approximately 70% of breast tumors express or overexpress estrogen receptor alpha (ERα) and are treated with antiestrogens (AEs), which act as competitive inhibitors of this receptor. Tamoxifen has been widely used for the treatment of ERα-positive tumors, but intrinsic or acquired resistance can lead to tumor recurrence. Full AEs such as Fulvestrant (ICI182, 780) are currently used to treat postmenopausal women with ERα-positive breast cancers with disease progression following Tamoxifen therapy. Unlike Tamoxifen and other Selective estrogen receptor modulators (SERMs), full AEs (SERDs) are devoid of any agonistic activity. It is currently thought that the capacity of full AEs to induce rapid polyubiquitination and degradation of ERα underlies their complete suppression of ERα signalling. On the one hand, we show a correlation between ICI 182, 780 induced ERα inhibition and its association with the insoluble fraction. This insolubility corresponds to an immobilization within the nuclear matrix and takes place in the absence of an accelerated turn over. The helix 12 in the ligand binding domain is important in the induction of insolubility and inactivation. On the other hand, we identify ERα as a target for Small Ubiquitin-like Modifier (SUMO) posttranslational modification by SUMO1 and SUMO2/3 specifically when liganded with full AEs. Induction of SUMOylation is rapid and precedes receptor degradation in ERα-positive breast cancer cells. On the other hand, the SERMs do not induce SUMOylation. The helix 12 in the ligand binding domain and the DNA binding domain play a role in the induction of SUMOylation in the presence of full AEs. Structure activity relationship experiments with full AE derivatives showed that the induction of SUMOylation is correlated with the degree of inhibition of ERα-mediated transcription. In addition, preventing SUMOylation by overexpression of a SENP1 deSUMOylase abolished the inverse agonist properties of full AEs without increasing activity in the presence of agonists or of Tamoxifen. In our attempt to screen for factors with a possible role in SUMOylation and inactivation, we show that the treatment with SERDs but not SERMs, induces a rapid interaction between ERα and the human ATP-utilizing chromatin assembly and remodeling factor (ACF) in ERα-negative and ERα-positive cell lines. The helix 12 is important since introducing single point mutations in this helix lead to an increased solubility and abrogate ACF recruitment. Using ChIP, we find an increase of ACF1 subunit association with proximal promoter of estrogen target gene pS2 suggesting a possible role of ACF in remodeling in this promoter. ACF recruitment is SUMOylation dependant since the overexpression of DeSUMOylase SENP1 abolishes the interaction between ERα and ACF. Together, induction of insolubility, SUMOylation and ACF recruitment are characteristic properties of full antiestrogens that contribute to their specific activity profile. They can be used to screen for new compounds with an improved therapeutic potential.

Objetivo: Estimar a utilização de recursos e custos diretos relacionados à terapia endócrina (TE) versus quimioterapia (QT) no tratamento de câncer de mama avançado (CMA) receptores hormonais positivos (RH+) em pacientes pós menopáusicas,depois de pelo menos uma TE anterior. Métodos: Estudo longitudinal retrospectivo analisou pacientes pós menopáusicas com CMA em tratamento com fulvestranto ou QT entre 2006 e 2008, em um serviço público de oncologia ambulatorial. Apenas pacientes sem crise visceral e com pelo menos uma terapia anterior hormonal foram considerados elegíveis. Os prontuários foram revisados e as informações sobre diagnóstico, tratamento, e utilização de recursos foram obtidas. Resultados: As pacientes eram do sexo feminino e a idade média foi de 64,6 ± 12,6 anos. As pacientes estavam bem balanceados entre os grupos, considerando as características basais. Vinte e cinco pacientes foram incluídas no estudo, 13 pacientes receberam QT e 12 pacientes receberam fulvestranto. O esquema de QT mais usado foi o regime com paclitaxel (n = 5, 38%). O número médio de ciclos foi de 7,6 e 5,8 para fulvestranto e QT, respectivamente. O custo médio de tratamento por paciente foi de R$ 16.679 (USD11,914, 2005 índice de paridade de poder de compra 1USD = 1,4BRL) para fulvestranto e BRL 32946 (USD 23, 533) para QT. O custo médio por ciclo foi de R$ 2,199 (US$ 1,571) e BRL 5,710 (USD 4,079) para fulvestranto e QT, respectivamente, resultando em BRL 3,511(USD 2,508) de custo incremental por ciclo. Conclusões: Nossos resultados indicam que TE com fulvestranto pode ser economicamente adequada em pacientes com CMA RH + que falharam a pelo menos uma linha anterior de TE. Futuras pesquisas são necessárias para validar estes resultados em outros contextos, mas consideramos que as nossas estimativas refletem o mundo real da prática clínica no Brasil / OBJECTIVES: To estimate the resource utilization and costs related to endocrine therapy (ET) versus chemotherapy (CT) in the treatment of hormonal receptor positive (HR+), advanced breast cancer (ABC) patients, after at least one previous ET. METHODS: This retrospective longitudinal study analyzed ABC patients treatment with fulvestrant or CT between 2006 and 2008 in a public oncology outpatient service. Only patients without visceral crisis and with at least one previous hormonal therapy were considered eligible. Medical charts were reviewed by two investigators and information about diagnosis, course of treatment, and resource utilization was obtained. RESULTS: Patients were all female and the mean age was 64,6 ± 12,6 years. Patients were well matched between groups considering baseline characteristics. Twenty-five patients were enrolled in the study, 13 patients received CT and 12 patients received fulvestrant. The most common CT regimen was paclitaxel (n = 5, 38%). The mean number of cycles was 7,6 and 5,8 for fulvestrant and CT, respectively. The mean treatment cost per patient was BRL 16,679 (USD 11,914; 2005 purchasing power parity index 1USD = 1.4BRL) for fulvestrant and BRL 32,946 (USD 23,533) for CT. The mean cost per cycle was BRL 2,199 (USD 1,571) and BRL 5,710 (USD 4,079) for fulvestrant and CT, respectively, resulting in BRL 3,511 (USD 2,508) incremental cost per cycle. CONCLUSIONS: Our study results indicate that subsequent ET with fulvestrant can be economically appropriate among HR+ ABC patients. Further researches could validate these findings in other contexts, but we consider that our estimations reflect the real world clinical practice in Brazil

Le cancer du sein est le cancer qui a la plus forte fréquence au Canada. En 2012, on estime que 23 200 nouveaux cas de cancer du sein seront diagnostiqués. Deux tiers des tumeurs mammaires expriment ou surexpriment le récepteur des oestrogènes α (ERα). De même, les oestrogènes sont importants pour la croissance de ces tumeurs. La présence des récepteurs hormonaux est un critère qui détermine le choix de la thérapie; à cet égard, le ciblage des récepteurs des oestrogènes par les antioestrogènes a pour but d’inactiver ces récepteurs et diminuer leur contribution à la croissance tumorale. Les antioestrogènes sont des inhibiteurs compétitifs de ERα. Tamoxifene est le médicament le plus utilisé pour traiter les tumeurs mammaires ER+ de tous les stades, avant ou après la ménopause. Tamoxifene est antioestrogène partiel ou SERM qui a un profile mixte d’activités agonistes et antagonistes. Fulvestrant ou ICI 182, 780 est un antioestrogène de type total ou SERD dépourvu de toute activité agoniste. Ce composé est utilisé en clinique chez les femmes après la ménopause ayant des tumeurs mammaires avancées. Fulvestrant constitue, donc, une deuxième ligne thérapeutique en cas de rechute après à un traitement par Tamoxifene. Afin de comprendre le potentiel thérapeutique de Fulvestrant, il est primordial d’étudier son impact sur ERα. Actuellement, la polyubiquitination et la dégradation de ERα sont les mécanismes les plus connus pour expliquer l’inactivation de ERα par Fulvestrant. Par ailleurs, en utilisant des modèles cellulaires ER+ et ER-; nous avons montré que les antioestrogènes totaux induisent une insolubilité de ERα indépendamment de leur capacité à induire sa dégradation. L’insolubilité corrèle avec l’association de ERα avec la matrice nucléaire et avec l’inhibition de sa transactivation. L’hélice H12 du domaine de liaison du ligand joue un rôle important dans l’insolubilité et l’inactivation de ERα par les antioestrogènes totaux. Par ailleurs, les antioestrogènes totaux se distinguent par leur capacité à induire la SUMOylation de ERα par SUMO1 et SUMO2/3. La SUMOylation est rapide et précède la dégradation de ERα dans cellules ER+. À l’aide de dérivés de l’antioestrogène total ICI 164, 384, nous avons montré que la chaine latérale des antioestrogènes totaux est à la base de l’induction de la SUMOylation et de l’inactivation de ERα. De plus, la SUMOylation semble être une marque d’inhibition, car la déSUMOylation restaure une activité de ERα en présence des antioestrogènes totaux. L’hélice H12 du LBD et le domaine de liaison à l’ADN sont requis pour l’induction de la SUMOylation. La recherche de protéines impliquées dans l’inactivation et dans la SUMOylation a permis d’identifier le facteur de remodelage de la chromatine ACF dans le même complexe que ERα. De manière similaire à la SUMOylation, le recrutement de ACF est précoce et constitue une propriété spécifique des antioestrogènes totaux. D’autre part, Fulvestrant induit le recrutement de ACF au niveau du promoteur du gène cible des oestrogènes pS2, ce qui suggère une contribution du remodelage de la chromatine dans les mécanismes d’action des antioestrogènes totaux. La surexpression de la DéSUMOylase SENP1 abolit le recrutement de ACF ce qui indique un rôle de la SUMOylation dans le recrutement de ACF. De même, l’hélice H12 du LBD de ERα constitue un lien entre l’inactivation de ERα et le recrutement de ACF. L’insolubilité, la SUMOylation et l'interaction du complexe ACF sont le reflet des mécanismes d’action des antioestrogènes totaux. Ces observations peuvent être utilisées comme des critères fonctionnels pour identifier d’autres composés avec de meilleures propriétés pharmacologiques que Fulvestrant. / Approximately 70% of breast tumors express or overexpress estrogen receptor alpha (ERα) and are treated with antiestrogens (AEs), which act as competitive inhibitors of this receptor. Tamoxifen has been widely used for the treatment of ERα-positive tumors, but intrinsic or acquired resistance can lead to tumor recurrence. Full AEs such as Fulvestrant (ICI182, 780) are currently used to treat postmenopausal women with ERα-positive breast cancers with disease progression following Tamoxifen therapy. Unlike Tamoxifen and other Selective estrogen receptor modulators (SERMs), full AEs (SERDs) are devoid of any agonistic activity. It is currently thought that the capacity of full AEs to induce rapid polyubiquitination and degradation of ERα underlies their complete suppression of ERα signalling. On the one hand, we show a correlation between ICI 182, 780 induced ERα inhibition and its association with the insoluble fraction. This insolubility corresponds to an immobilization within the nuclear matrix and takes place in the absence of an accelerated turn over. The helix 12 in the ligand binding domain is important in the induction of insolubility and inactivation. On the other hand, we identify ERα as a target for Small Ubiquitin-like Modifier (SUMO) posttranslational modification by SUMO1 and SUMO2/3 specifically when liganded with full AEs. Induction of SUMOylation is rapid and precedes receptor degradation in ERα-positive breast cancer cells. On the other hand, the SERMs do not induce SUMOylation. The helix 12 in the ligand binding domain and the DNA binding domain play a role in the induction of SUMOylation in the presence of full AEs. Structure activity relationship experiments with full AE derivatives showed that the induction of SUMOylation is correlated with the degree of inhibition of ERα-mediated transcription. In addition, preventing SUMOylation by overexpression of a SENP1 deSUMOylase abolished the inverse agonist properties of full AEs without increasing activity in the presence of agonists or of Tamoxifen. In our attempt to screen for factors with a possible role in SUMOylation and inactivation, we show that the treatment with SERDs but not SERMs, induces a rapid interaction between ERα and the human ATP-utilizing chromatin assembly and remodeling factor (ACF) in ERα-negative and ERα-positive cell lines. The helix 12 is important since introducing single point mutations in this helix lead to an increased solubility and abrogate ACF recruitment. Using ChIP, we find an increase of ACF1 subunit association with proximal promoter of estrogen target gene pS2 suggesting a possible role of ACF in remodeling in this promoter. ACF recruitment is SUMOylation dependant since the overexpression of DeSUMOylase SENP1 abolishes the interaction between ERα and ACF. Together, induction of insolubility, SUMOylation and ACF recruitment are characteristic properties of full antiestrogens that contribute to their specific activity profile. They can be used to screen for new compounds with an improved therapeutic potential.

Objetivo: Estimar a utilização de recursos e custos diretos relacionados à terapia endócrina (TE) versus quimioterapia (QT) no tratamento de câncer de mama avançado (CMA) receptores hormonais positivos (RH+) em pacientes pós menopáusicas,depois de pelo menos uma TE anterior. Métodos: Estudo longitudinal retrospectivo analisou pacientes pós menopáusicas com CMA em tratamento com fulvestranto ou QT entre 2006 e 2008, em um serviço público de oncologia ambulatorial. Apenas pacientes sem crise visceral e com pelo menos uma terapia anterior hormonal foram considerados elegíveis. Os prontuários foram revisados e as informações sobre diagnóstico, tratamento, e utilização de recursos foram obtidas. Resultados: As pacientes eram do sexo feminino e a idade média foi de 64,6 ± 12,6 anos. As pacientes estavam bem balanceados entre os grupos, considerando as características basais. Vinte e cinco pacientes foram incluídas no estudo, 13 pacientes receberam QT e 12 pacientes receberam fulvestranto. O esquema de QT mais usado foi o regime com paclitaxel (n = 5, 38%). O número médio de ciclos foi de 7,6 e 5,8 para fulvestranto e QT, respectivamente. O custo médio de tratamento por paciente foi de R$ 16.679 (USD11,914, 2005 índice de paridade de poder de compra 1USD = 1,4BRL) para fulvestranto e BRL 32946 (USD 23, 533) para QT. O custo médio por ciclo foi de R$ 2,199 (US$ 1,571) e BRL 5,710 (USD 4,079) para fulvestranto e QT, respectivamente, resultando em BRL 3,511(USD 2,508) de custo incremental por ciclo. Conclusões: Nossos resultados indicam que TE com fulvestranto pode ser economicamente adequada em pacientes com CMA RH + que falharam a pelo menos uma linha anterior de TE. Futuras pesquisas são necessárias para validar estes resultados em outros contextos, mas consideramos que as nossas estimativas refletem o mundo real da prática clínica no Brasil / OBJECTIVES: To estimate the resource utilization and costs related to endocrine therapy (ET) versus chemotherapy (CT) in the treatment of hormonal receptor positive (HR+), advanced breast cancer (ABC) patients, after at least one previous ET. METHODS: This retrospective longitudinal study analyzed ABC patients treatment with fulvestrant or CT between 2006 and 2008 in a public oncology outpatient service. Only patients without visceral crisis and with at least one previous hormonal therapy were considered eligible. Medical charts were reviewed by two investigators and information about diagnosis, course of treatment, and resource utilization was obtained. RESULTS: Patients were all female and the mean age was 64,6 ± 12,6 years. Patients were well matched between groups considering baseline characteristics. Twenty-five patients were enrolled in the study, 13 patients received CT and 12 patients received fulvestrant. The most common CT regimen was paclitaxel (n = 5, 38%). The mean number of cycles was 7,6 and 5,8 for fulvestrant and CT, respectively. The mean treatment cost per patient was BRL 16,679 (USD 11,914; 2005 purchasing power parity index 1USD = 1.4BRL) for fulvestrant and BRL 32,946 (USD 23,533) for CT. The mean cost per cycle was BRL 2,199 (USD 1,571) and BRL 5,710 (USD 4,079) for fulvestrant and CT, respectively, resulting in BRL 3,511 (USD 2,508) incremental cost per cycle. CONCLUSIONS: Our study results indicate that subsequent ET with fulvestrant can be economically appropriate among HR+ ABC patients. Further researches could validate these findings in other contexts, but we consider that our estimations reflect the real world clinical practice in Brazil