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Short Communication |




From the Division of Gynecologic Oncology,*
the
Department of Obstetrics and Gynecology, Taichung Veterans General
Hospital, Taichung, Taiwan, Republic of China; the Department of
Obstetrics and Gynecology,
Chung Shan Medical
College, Taichung, Taiwan, Republic of China; the Department of
Pathology,
Taichung Veterans General
Hospital, Taichung, Taiwan, Republic of China; the Department of
Pathology,
Chung Shan Medical College,
Taichung, Taiwan, Republic of China; and the Department of
Pathology,¶
University of Virginia Health Sciences
Center, Charlottesville, Virginia
| Abstract |
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| Introduction |
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A major cause of this disease is the infection of cervical epithelium with specific strains of human papilloma virus (HPV), whose E6 and E7 proteins inactivate tumor suppressors p53 and pRb, respectively.3,4 Pathologically, the HPV-infected cervical epithelial cells present morphological changes and cause dysplastic lesions or intraepithelial neoplasia, the precursors of invasive carcinoma. Therefore HPV infection is thought to function as an initiator in cervical carcinogenesis.5 Additional genetic changes, however, are required to maintain the malignant phenotype.6 For example, amplification of c-myc and HER2/neu were reported to play a role in the pathogenesis of cervical cancer.7,8 Another tumor suppressor gene, fragile histidine triad (FHIT), could also be involved in cervical carcinogenesis.9,10 The genetic and molecular factors contributing to the progression and metastasis of cervical cancer, however, are poorly understood. Recently a metastasis suppressor gene, KAI1, was identified from the p11.2 region of human chromosome 11 in prostatic cancer. KAI1 was able to suppress metastasis when introduced into metastatic rat prostate cancer cells and its expression was reduced in cell lines derived from metastatic human prostate tumors.11 In addition, KAI1 protein expression was down-regulated during the progression of human prostate cancers.12 A similar role of the KAI1 gene has also been suggested for lung and pancreatic cancers, as it has been demonstrated that the down-regulation of the KAI1 at the RNA level is correlated with poor survival in patients with lung cancer13,14 and is correlated with lymph node and distant metastases in patients with advanced stages of pancreatic cancer.15,16
Recently, down-regulation of KAI1 has also been found in other common types of human malignancies, including bladder, breast, gastric, hepatocellular, colorectal, ovarian, and esophageal cancers.17-23 These observations suggest that the presence of KAI1 might influence the ability of cancer cells to metastasize.
Using the immunohistochemical method, a recent study demonstrated that extensive loss of KAI1 staining occurred frequently in squamous cell neoplasms, including cervical carcinoma.24 To further confirm this finding and investigate the role of KAI1 in the progression of cervical cancer, we analyzed KAI1 expression with a real-time quantitative polymerase chain reaction (PCR) method in various stages of primary cervical carcinomas and metastatic or recurrent lesions. Immunohistochemical staining of KAI1 in these paraffin-embedded tumors was also performed.
| Materials and Methods |
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To avoid contamination with normal tissue, only patients with bulky cervical cancer were selected for tissue sampling. Tumor tissue from 84 primary cervical cancers of various stages (IB, 35 cases; IIA, 3 cases; IIB, 18 cases; III, 22 cases; and IV, 6 cases) was obtained through biopsy or surgical resection. In addition, three metastatic lesions from lymph nodes and three recurrent vaginal tumors were also obtained for study. All of the specimens were cut into two parts. One was taken for pathological examination and the other was stored in RNAlater (Ambion, Austin, TX) at -20°C for subsequent RNA extraction. Microscopically each tissue specimen contained at least 80% tumor cells. Cervical epithelium taken from 22 patients who underwent hysterectomy due to leiomyoma was used as the normal control. All of them had no history of cervical dysplasia and no abnormal finding was noted on their Pap smear. A KAI1-highly expressed colon cancer cell line (SW480) and a KAI1-negatively expressed prostate cancer cell line (PC-3) were used as positive and negative control, respectively. A cervical cancer cell line (HeLa) was also evaluated for KAI1 expression.
RNA Extraction and cDNA Synthesis
Total cellular RNA was isolated from the cervical specimens using the SV Total RNA Isolation System (Promega, Madison, WI) according to the manufacturers protocol. RNA was solubilized in RNase free water/ethanol (1:2) and stored at -70°C. First strand cDNA was synthesized from 1 µg of total RNA. Reverse transcription was performed in a volume of 30 µl containing 50 mmol/L Tris-HCl (pH 8.3), 75 mmol/L KCl, 3 mmol/L MgCl2, 10 mmol/L dithiothreitol, 2 µmol/L dNTPs, 300 ng of random hexamers (Promega), 600 units of MMLV reverse transcriptase (Life Technologies, Gaithersburg, MD), and 40 units of RNasin (Promega). After denaturation at 95°C for 5 minutes, the reaction was incubated at 42°C for 60 minutes and boiled for 5 minutes.
Real-Time Quantitative PCR
Amplification of KAI1 cDNA was performed using a real-time PCR method and the relative amounts of indicated transcripts were calculated as described previously.25 Primers and probes used in the PCR were chosen with the assistance of the computer program Primer Expression 1.0 (Perkin-Elmer Applied Biosystems, Foster City, CA). The nucleotide sequences of the primer were as follows: 5'CCGACAAGAGCAGTTTCATCTCT3' (forward) and 5'AAGACATAGGCCCCCATCCT3' (reverse). The nucleotide sequence of the probe was 6FAM-CCTGCAAACCTCCTCCAGCTCGCT-TAMRA. The PCR amplification was performed in 25-µl reactions containing 1 µl of first-strand cDNA, 2X Master Mix buffer (TaqMan Universal PCR Master Mix, Perkin-Elmer), 5 µmol/L probe, and 10 µmol/L of forward and reverse primers. The reaction mixture underwent an initial denaturation at 95°C for 10 minutes, then was subjected to 40 PCR cycles with 94°C for 15 seconds, and 60°C for 1 minute. A housekeeping gene 18S rRNA (Perkin-Elmer Applied Biosystems) was used as the internal control. All reactions were performed in the ABI Prism 7700 Sequence Detection System (Perkin-Elmer Applied Biosystems), which detects the signal from the fluorogenic probe during PCR. Samples with high starting copy number of target gene show an increase in fluorescence early in the PCR process, resulting in a low threshold cycle (Ct) number, whereas lower starting copy number results in higher Ct numbers. A comparative Ct method was used to quantitate KAI1 cDNA levels.26
Immunohistochemistry
The procedure of immunohistochemical staining was described elsewhere.22 Briefly, paraffin sections of 4 µm were dewaxed, rehydrated, and then heated with citrate buffer (pH 6.0). After being rinsed in phosphate-buffered saline (pH 7.6) and preincubated in serum blocking solution (10% goat serum), slides were reacted with the anti-KAI1 rabbit polyclonal antibody, C-16 (Santa Cruz Biotechnology, Santa Cruz, CA) for 1 hour at a dilution of 1:30. Following incubation with the biotinylated secondary antibody (Histostain-Plus Kit, Zymed, South San Francisco, CA) and peroxidase-labeled streptavidin (Zymed LAB-SA), slides were rinsed again and were developed with the enzyme substrate diaminobenzidine. In each specimen, lymphocytes and endothelial cells in tumor stroma were used as internal positive controls and normal mouse IgG was used as a negative control.
Staining intensity on cell membrane was estimated to be positive when it appeared to be similar to that of lymphocytes and endothelial cells. The staining pattern of KAI1 expression was classified as positive when more then 50% of tumor cells within the tumor tissue were positively stained, decreased if 5 to 50% of tumor cells were positively stained, and negative if less than 5% of tumor cells were positively stained.
Statistical Analysis
One-way analysis of variance test and Scheffé method were used to analyze KAI1 expression in each group of cervical lesions. The relation of KAI1 expression to cell differentiation and histological type were evaluated by t-test and Mann-Whitney U test, respectively. The difference was considered significant when the P value was <0.05.
| Results |
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Ct
(KAI1 Ct -18S rRNA Ct). Real-time quantitative PCR analysis confirmed
a high KAI1 expression in the positive control (SW480) with the value
of
Ct = 3.78. In contrast, very low KAI1 expression level was
observed in the negative control (PC-3) with the value of
Ct =
10.36. The cervical cancer cell line HeLa also showed a marked
reduction in KAI1,
Ct = 13.02.
The expression of KAI1 in normal cervical squamous epithelium and
various stages of cervical cancer were compared. For statistical
analysis,
Ct was compared in 4 groups of specimens, ie, normal
cervical squamous epithelium (n = 22), stages IB
and IIA (n = 38), stage IIB
(n = 18), and stages III and IV
(n = 28). The
Ct for each group is shown in
Table 1
. Statistically, expression of
KAI1 in each cervical cancer group was decreased in comparison with the
normal squamous epithelium of the cervix (P <
0.05). However, there was no significant difference in KAI1 expression
among the three cervical cancer groups. The sensitivity and specificity
for reduced KAI1 expression was 82.1% and 72.7%, respectively, when
the cut-off point of
Ct value was 7, and it was 65.5% and 90.9%
when the cut-off point of
Ct value was 8. Using
Ct of 8 as the
cut-off, frequent reduction of KAI1 expression was seen in each
cervical cancer groups with 22 of 38 (60%) stages IB and IIA, 13 of 18
(72%) stage IIB, and 20 of 28 (71%) stages III and IV cases had
Ct
BORDER="0">8.
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Ct from 8.7 to 10.48. No apparent decrease in
KAI1 (
Ct = 6.33) was noted in one lesion taken from a vaginal
recurrence. Immunohistochemical stain of the recurrent tumor was also
positive (Figure 1D)
|
Ct
10)
had a negative staining pattern. Examples of the staining are shown in
Figure 1
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| Discussion |
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KAI1 specifies a protein of 267 amino acids. It belongs to a structurally distinct family of cell surface glycoproteins, the transmembrane 4 superfamily (TM4SF), which all have four hydrophobic transmembrane domains and one large extracellular N-glycosylated domain. Because of their membrane localization and extensive glycosylation, it is suggested that these proteins may function via cell-cell and cell-extracellular matrix interactions, thereby potentially influencing the ability of cancer cells to invade and to metastasize.11 Transcript of KAI1 was detected in all of the human tissues tested, including various surface epithelia and activated lymphocytes.11,24,29 In addition, the KAI1 coding sequence is conserved in various animals. These findings suggest that KAI1 has an essential biological function in evolution.11
Using an immunohistochemical study, Geradts et al24 noted a loss of KAI1 expression in 12 of 14 cervical squamous cell carcinomas and suggested an important role of the gene in the suppression of invasion in this malignancy.
In the present study, we further confirmed that KAI1 is down-regulated in cervical carcinoma by a real-time quantitative PCR method. Because the high and low KAI1 expression levels were seen in positive and negative control cell lines (SW480 and PC-3), respectively, this recently developed methodology is confirmed to be a reliable and practical technique for determining KAI1 mRNA expression. To exclude contamination of non-neoplastic cells that may express KAI1 at high levels, only bulky cervical tumors were used in this study and the tumor content in each specimen was more than 80% as confirmed by pathological examination. The data presented in this study should reflect properly the level of KAI1 expression in cervical cancers.
The reduction of KAI1 expression was observed in all stages of cervical
cancer with no significant difference between different stages (Table 1)
. This finding indicates that down-regulation of KAI1 in cervical
cancer, unlike in prostate, lung, and pancreatic cancers, is not only
limited to late stage or metastatic/recurrent tumors. A similar finding
was also noted in colorectal and ovarian carcinomas.21,22
Moreover, loss of KAI1 protein expression in a subset of high-grade
squamous intraepithelial lesions of the cervix has been
reported.24
Therefore, our finding is consistent with the
hypothesis that down-regulation of KAI1 is an important event in the
progression of squamous cell carcinoma from the in situ to
the invasive stage. In fact, it has been suggested that loss of CD82
(KAI1) is crucial for stromal invasion in squamous cell carcinoma of
the skin.30
In this study we did not perform mutational analysis of KAI1 in the cervical tumors. It is generally believed that mutation of the gene is rare in human tumors that revealed expression reduction. Although methylation of the 5' promoter region has been speculated as a possible mechanism for the down-regulation of KAI1,24 another study found no evidence for hypermethylation of the CpG island within the promoter region.31 In addition, it was found that the tumor suppressor gene p53 can directly activate the KAI1 gene by interacting with its 5' promoter region.32 Whether HPV induced inactivation of p53 in cervical cancer plays a role in the down-regulation of KAI1 is recently investigated by Schindl et al.33 In their study, KAI1 down-regulation was found by immunohistochemistry in 68% of 67 cervical cancer patients. However, the HPV infection rate was 91%. They concluded that KAI1 down-regulation in cervical cancer seems independent of HPV-E6 induced p53 inactivation. The mechanism of KAI1 down-regulation is thus still to be determined.
We also observed that poorly differentiated tumors showed further reduced expression than did well and moderately differentiated tumors. This finding is in agreement with the clinical observation that poorly differentiated cervical cancers are more apt to metastasize than well or moderately differentiated tumors. In addition, we noted that loss of KAI1 expression occurred in both the squamous cell carcinoma and adeno-/adenosquamous carcinoma with no difference in extent of expression loss.
Although five of the six metastatic/recurrent tumors displayed
decreased expression of KAI1, one tumor from a vaginal recurrence did
not show apparent KAI1 reduction. In addition, four of the 28 cases of
stages III and IV also revealed a preserved KAI1 level with the value
of
Ct
7. The higher KAI1 expression in these tumors needs
further investigation. Adachi et al suggested that an aberrant
glycosylation instead of down-regulation may occur at the N-linked
glycosylation sites of KAI1 protein, resulting in the loss of the
proteins function.13
One study also noted that KAI1 can
be re-expressed by addition of nerve growth factor in some prostate
cancer cell lines which are originally KAI1 negative.34
However, whether nerve growth factor is expressed in cervical cancer
remains to be investigated. Finally, other metastasis suppressor
gene(s) than KAI1 may also be involved in the metastasis of cervical
cancer. For example, some studies have shown that reduced expression of
nm23 was associated with lymph node metastasis in cervical
cancer.35,36
It is more likely that more than one
metastasis suppressor gene are involved in cervical cancer metastasis.
Since all of the tumor specimens analyzed in this study were taken within the last 2 years, the follow-up time is too short to provide survival information. However, KAI1 expression may not have prognostic significance in cervical cancer, because down-regulation in both early and late stages of tumor may preclude it as an effective prognostic factor.
In conclusion, using a real-time quantitative PCR method, we confirmed that KAI1 was frequently down-regulated in invasive, metastatic, and recurrent cervical carcinomas. Because decreased KAI1 expression is seen in early stages of cervical cancer and it has been shown in a subset of high-grade cervical dysplasias,24 we speculate that down-regulation of this gene may occur as an early event in the development of cervical cancer.
| Footnotes |
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Supported by grant TCVGH-896401C from the Taichung Veterans General Hospital (to F. S. L.).
Accepted for publication August 9, 2001.
| References |
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3ß1 integrin. Br J Dermatol 1997, 137:856-863[Medline]
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