(American Journal of Pathology. 2001;158:1185-1190.)
© 2001 American Society for Investigative Pathology
A Case of Tumor Betrayal
Biphasic Effects of TIMP-1 on Burkitts Lymphoma
Li Yan and
Marsha A. Moses
From the Department of Surgery, Childrens Hospital, Harvard
Medical School, Boston, Massachusetts
Among a number of different proteinases that are capable
of digesting extracellular matrix (ECM) components, the matrix
metalloproteinases (MMPs), a family of zinc-dependent endopeptidases,
play a major role.1
Collectively, MMPs have been shown to
cleave most ECM components either independently or in a collaborative
manner. Because excessive digestion of ECM is a hallmark of many
pathological conditions including tumor growth and metastasis, it is
critical that MMP activity be precisely regulated both spatially and
temporally. In addition to the transcriptional and translational
control of MMP expression by growth hormones/factors, cytokines,
cell-ECM or cell-cell contacts, and oncogene expression, MMP activity
is regulated by their endogenous inhibitors, the tissue inhibitors of
matrix metalloproteinases (TIMPs). TIMPs not only directly control the
activity of active MMPs, but also have substantial influence on the
activation process of MMP zymogens.2-5
Given the ability of TIMPs to inhibit the proteolytic activity of MMPs,
it is not surprising to find that TIMPs are capable of blocking tumor
metastasis, either by inhibiting tumor invasion of basement membrane or
by restraining tumor angiogenesis.6
However, recent
studies have suggested that the inhibitory effects of TIMPs on tumor
progression are not only due to their ability to inhibit MMP activity,
but also because of their ability to directly modulate the cell growth
and apoptosis of tumor cells, as well as host endothelial cells (ECs).
In an intriguing study published in this issue of The American
Journal of Pathology, divergent effects of TIMP-1 on Burkitts
lymphoma growth in nude mice are reported by Guedez and
co-workers.96
When Epstein-Barr virus-negative Burkitts
lymphoma cells were forced to overexpress TIMP-1 by retroviral
transfection, a biphasic tumor growth pattern was observed. After
injection into nude mice, these cells showed an initial fast
proliferation phase due to the stimulation of tumor cell proliferation
and the protection from apoptosis elicited by TIMP-1. However, once
these tumors reached a certain size (0.4 mm2),
the initial fast growth phase was replaced by a slowdown of tumor
progression accompanied by tumor necrosis and regression. The authors
provide convincing evidence to show that this late stage inhibition was
caused by the suppression of tumor-induced host angiogenesis. These
novel in vivo results highlight the importance of MMPs and
their endogenous inhibitors during tumor progression and angiogenesis.
TIMPs and Tumor Growth
TIMPs and Cell Proliferation
Since first being discovered as having the ability
to stimulate the proliferation of erythroid progenitor
cells,7
in addition to inhibiting MMP
activity,8
TIMP-1s growth promoting effects have been
extended to a variety of cells, including mammary epithelial
cells,9
keratinocytes,10
lymphoid, myeloid,
endothelial, fibroblasts, hepatoma, breast carcinoma, and chondrocyte
cells.11
Like TIMP-1, TIMP-2 was shown to stimulate cell
proliferation in human osteosarcoma cells and cultured rabbit corneal
epithelial cells, potentially via a tyrosine kinase-dependent signaling
pathway,12,13
and to promote fibroblast or fibrosarcoma
cell growth by stimulating cAMP production.14
Unlike
TIMP-1,11
TIMP-2 also exhibits inhibitory effects on the
proliferation of ECs,15
renal carcinoma
cells,16
and several other carcinoma cells.17
Interestingly, TIMP-1 and TIMP-2 exert different effects on EC
processes in that TIMP-2 inhibits fibroblast growth factor-driven EC
proliferation and TIMP-1 does not.15
In fact, the latter
has been shown to exert a stimulatory effect on EC growth in
vitro.11
Both inhibitors can, however, suppress
capillary EC migration and tube formation in response to angiogenic
stimuli.18
These regulatory effects of TIMPs on cell proliferation may not
necessarily be a function of their MMP inhibitory
activity.15,19
For example, modulation of cell
proliferation by TIMPs has been attributed to their interactions with
unknown cell surface receptors,10,14
as well as to their
potential regulation of DNA synthesis in the nucleus.20,21
Moreover, the divergent and sometimes even contradictory effects of
TIMPs on cell growth in vitro are cell type-specific.
Although these provocative findings could be taken to presage the
divergent effects of tumor growth and angiogenesis that is demonstrated
by Guedez and co-workers,96
their study is the first to
document these two divergent in vivo effects within the same
tumor system. It will be important to learn whether this biphasic
effect is observed in other tumor systems and whether all TIMPs are
capable of exerting this same effect.
TIMPs and Tumor Cell Apoptosis
In addition to their growth-promoting ability, TIMPs can also
affect programmed cell death, or apoptosis, in both normal cells and
transformed tumor cells. TIMP-1 expression levels have been shown to
correlate with cell apoptosis in a series of B lymphoma
cells.22,23
Overexpression of TIMP-1 can rescue mammary
epithelial cells from apoptosis induced by uncontrolled ECM
degradation.24
Similarly, TIMP-2 expression has inhibitory
effects on apoptosis of melanoma cells.25
In contrast,
however, it has been reported that TIMP-3, a matrix-associated
inhibitor, induces cell apoptosis in melanoma cells,26
colon carcinoma cells,27
and vascular smooth muscle
cells.28
The cell-death domain of TIMP-3 has been
localized to the amino terminus and its apoptotic effect appears to
correlate with the inhibition of metalloproteinase
activity.29
According to Guedez and colleagues,96
the initial
growth-stimulatory effect of TIMP-1 on Burkitts lymphoma in
vivo is likely achieved through its inhibition of apoptosis. In
fact, the same group has recently reported that TIMP-1 expression in
Burkitts lymphoma cell lines inhibits induction of apoptosis by
Fas-dependent and -independent pathways, and up-regulates
BCL-XL expression.22
Based simply on
the anti-apoptotic effect of TIMP-1, one would expect that
TIMP-1-positive tumors would grow much more aggressively than their
TIMP-1-negative counterparts. However in this study, after reaching a
certain size (0.4 mm2), the growth rate of
TIMP-1-positive tumors decreased significantly. These
observations led the authors to invoke the anti-angiogenic activity of
TIMP-1 as a potential mechanism for the tumor suppression
observed in their model. This anti-angiogenic mechanism is
strongly supported by the immunostaining and microvessel counts
provided in this study. In addition, their finding that tumor
regression after the initial period of increased tumor growth was
marked by the presence of only microscopic foci of residual
proliferating tumor cells observed only on biopsy of the tumor site is
reminiscent of the tumor dormancy elicited by a number of angiogenesis
inhibitors30-32
and begs the question as to how long this
dormant period might last. Based on recent work demonstrating that MMPs
may be required for the acquisition of the angiogenic phenotype during
tumor progression,33,34
we would hypothesize that any
shift in the proteolytic balance in favor of MMP activity would
activate the switch to the angiogenic phenotype, thereby bringing an
end to the period of tumor dormancy.
TIMPs and Tumor Metastasis
The inhibitory function of TIMPs during tumor metastasis has been
well demonstrated in a variety of tumors. Overexpression of TIMP-1 or
TIMP-2 inhibits the invasive behavior of highly invasive and metastatic
B16F10 murine melanoma cells,25
fibrosarcoma
cells,35
the osteolytic bone metastases of breast
carcinoma,36
and the extravasation of pulmonary metastasis
of a bladder carcinoma.37
The newly identified TIMP-4 has
also been shown to inhibit breast carcinoma cell invasion in
vitro and tumor metastasis in vivo.38
Furthermore, targeted disruption of TIMP-1 expression increases the
invasive behavior of primitive mesenchymal cells derived from embryonic
stem cells.39
Adenovirus-mediated expression of TIMP-3
resulted in a similar, and even more potent, inhibition of cell
invasion than that caused by TIMP-1 and TIMP-2, in melanoma,
fibrosarcoma, and ovarian carcinoma cells.26,40
In
addition, TIMP-3 can also induce apoptosis by preventing cell adhesion
to underlying matrix.26
TIMPs and Tumor Angiogenesis
Tumor angiogenesis is required for sustained tumor growth because
the new capillaries are conduits for oxygen and nutrients. Without
angiogenesis, tumor growth is restricted to the tissue diffusion
distance of
0.2 mm.41
MMPs and TIMPs have been shown to
be involved in various stages of the angiogenic process, from EC
migration and proliferation, to deposition and remodeling of basement
membrane of newly formed blood vessels.18
Furthermore,
modulation of MMP or TIMP expression has a profound influence on
angiogenesis at various stages in different
tumors.33,34,42-44
TIMPs and EC Proliferation and Migration
It is only in recent years that the notion that certain TIMPs
might be capable of exerting a pleiotropic effect on tumor growth,
metastasis, and angiogenesis has come to be appreciated. Since the
first report that a TIMP could inhibit angiogenesis in vitro
and tumor angiogenesis in vivo,45,46
a series
of studies using a variety of endogenous MMP inhibitors have supported
this suppression of neovascularization.15,47,48
At the
time, the potential mechanisms of action focused on the ability of
TIMPs to suppress mitogen-driven angiogenic events such as capillary EC
proliferation, migration, and capillary tube and sprout formation.
However, it was also reported that select TIMPs might also exert a
stimulatory effect on EC functions required for successful
angiogenesis. For example, TIMP-1 unlike TIMP-2, did not inhibit
capillary EC proliferation15
but rather was reported to
stimulate it.11
The inhibitory effects of TIMPs on EC migration have been shown both
in vitro and in vivo.25,45,47,49
Given the critical role of EC migration during
angiogenesis,50
this inhibition may account, at least in
part, for the reduced tumor angiogenesis observed in TIMP-1-positive
lymphoma tumor implants in vivo.
MMPs and TIMPs: Regulators of Angiogenic Signals
The process of tumor angiogenesis is governed by a complex
signaling network.50
The establishment of the
neovasculature is modulated by soluble growth factors, hormones, and
cytokines,51
as well as by insoluble ECM that underlies
the participating vessels.52,53
Metalloproteinases,
together with TIMPs, have been shown to play pivotal roles during the
angiogenic process, from processing latent growth factors and shedding
receptors, to maintaining and remodeling EC basement
membrane.18
These roles are discussed briefly here.
Bioavailability of Soluble Factors
Many growth factors involved in angiogenesis reside in the ECM,
associated with either their endogenous inhibitors or extracellular
proteoglycans.54
Therefore, to actively participate in
angiogenesis, these sequestered growth factors must be released from
their ECM compartments. A recent study has demonstrated that MMP-9 can
liberate vascular endothelial growth factor from its ECM storage in a
mouse pancreatic-islet carcinoma model.34
MMP-9 has also
been shown to process latent transforming growth factor-ß or
interleukin-8, which in turn, promote tumor invasion and angiogenesis,
or activate neutrophils, respectively.55,56
In addition to
governing the releasing and processing of active growth factors, MMPs
and TIMPs are also involved in modulating cell surface receptors for
these signaling molecules. For example, proteolytic cleavage mediated
by MMP-2 has been shown to release a soluble active ectodomain of
fibroblast growth factor receptor 1.57
In another case,
the processing of cell-surface tumor necrosis factor-
and its
receptors can be inhibited by broad-spectrum MMP inhibitors, as well as
by TIMP-2 and TIMP-3.27,58-60
This inhibition, in turn,
augments tumor necrosis factor-
signaling and induces tumor cell
apoptosis in vitro and suppresses tumor growth in
vivo.27,61
MMPs also process extracellular molecules into fragments with potent
anti-angiogenic activities. For example, angiostatin, an internal
fragment of plasminogen, is a potent inhibitor of angiogenesis, which
specifically inhibits EC proliferation and tumor
growth.31,62
The production of angiostatin has been linked
to various MMPs,63
including tumor-expressed
MMP-2,64
MMP-12 derived from tumor-associated
macrophage,65
MMP-3,66
MMP-7, and
MMP-9.67,68
Another angiogenesis inhibitor, endostatin, a
20-kd C-terminal fragment of collagen type XVIII, specifically inhibits
endothelial cell proliferation and potently inhibits angiogenesis and
tumor growth.32
Several lines of evidence have
demonstrated that the release of endostatin from its precursor is
mediated by a metal-dependent early step, followed elastase
cleavage.69
The production of endostatin may also be
mediated by cathepsin L secreted from endothelial-origin
tumor cells.70
Recently, more matrix-derived peptide
fragments have been shown to have anti-angiogenesis
activity.71,72
Although the identity of proteases
responsible for their release is still unclear, MMPs are expected to
play an essential role in these anti-angiogenic-processing events as
well.
Taken together then, MMPs not only proteolytically release matrix-bound
pro-angiogenic growth factors, but can also directly process matrix
molecules into anti-angiogenic fragments. The balance of these two
opposing activities, pro-angiogenic and anti-angiogenic,
respectively, is regulated by the activity of TIMPs, which in
turn, can independently modulate the angiogenic process.
Modulation of Insoluble Factors Signaling
Tumor cell and EC behavior is also regulated by the
underlying ECM and signals transduced by integrins after engagement of
ligands.52,73
Both ECM integrity and subsequent signaling
events are profoundly influenced by the local balance between MMPs and
TIMPs. Changes in ECM structure and integrity can also feedback
to modulate the proteolytic activity elicited by ECs.74,75
Excessive proteolytic cleavage of ECM by MMPs results in cell
apoptosis, which can be rescued by overexpressing counteracting
TIMPs.24,25
MMPs also influence cell behavior by exposing
cryptic binding sites via proteolytic cleavage of ECM
molecules.76
Similarly, the angiogenic potential of
vascular EC is also regulated by the ECM, which in turn, is constantly
remodeled by the synchronized actions of MMPs and
TIMPs.74,77
TIMPs in Cancer Therapy and Diagnosis/Prognosis
For many of the reasons discussed above, MMP inhibitors, both
synthetic and endogenous, have become attractive therapeutic candidates
in recent years.78-80
The limited clinical success of
broad-spectrum MMP inhibitors has been suggested to be due, at least in
part, to their lack of specificity and associated side
effects.81
Some of these side effects could be limited by
designing more specific MMP inhibitors and a significant effort is
being made to do so.82
However, targeting MMP specificity
may represent only one of a number of potential approaches to resolving
these problems. As shown in the study by Guedez and
colleagues,96
TIMP-1 can initially promote tumor growth in
the early stage by inhibiting apoptosis, whereas at a later stage, the
secreted TIMP-1 acts on host ECs to block tumor angiogenesis and to
ultimately suppress tumor growth. Given such divergent and even
contradictory functions of MMPs and TIMPs during tumor progression and
angiogenesis, it becomes very important that the schedule of
administration of MMP inhibitors as cancer therapeutics be carefully
determined based on the stage of tumor progression in order to achieve
optimal therapeutic efficacy. Therefore, the clinical monitoring of
tumor progression becomes a critical adjunct to inhibitor therapy.
The detection of MMPs and TIMPs in body fluids may provide
a useful way to accomplish such monitoring. Elevated MMP levels in
biological fluids, including serum, plasma, and urine from animals
bearing experimental tumors or from cancer patients have been reported
in several studies.83-88
In addition, elevated plasma
levels of TIMP-1 and TIMP-2 have been detected in patients of late
stage breast, colorectal, lung, and gastric cancer.89-95
Some of these options represent highly sensitive, specific, and
noninvasive monitoring systems. For example, it has recently been
reported that intact and biologically active MMPs can be detected in
the urine of cancer patients and are independent predictors of disease
status.88
These urine samples were obtained from patients
with a variety of cancers, including prostate, renal, bladder, and
breast carcinomas. Urinary MMP-2 and MMP-9 have been shown to be
independent predictors of cancer. In addition to these two major
gelatinase species, several MMP activities with molecular sizes greater
than 100 kd were observed and were shown to be predictive of metastatic
diseases. Combined with other conventional diagnostic tools, the
detection of urinary MMP activity may provide the relevant information
regarding tumor burden, tumor staging, and tumor angiogenic status that
will be necessary to optimize both current and future cancer therapies.
Conclusion
The authors note in closing that their study highlights the need
for a further understanding of the role of TIMPs in tumor progression.
For example, it now becomes very important to identify the molecular
players regulating the switch in TIMP-1s activities in early and
later stage tumor progression. At the very least, this information
might lead to the discovery of new drug candidates for cancer therapy
and to a new therapeutic and diagnostic paradigm for the monitoring and
treatment of neoplastic disease.
Acknowledgements
We thank Dr. Jay Harper for helpful discussions.
Footnotes
Address reprint requests to Marsha A. Moses, Ph.D., Department of Surgery, Childrens Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115. E-mail: moses_m{at}a1.tch.harvard.edu
Supported in part by grants from The National Cancer Institute, National Institutes of Health (RO1 CA83106), and The American Cancer Society (RPG-97-013-04-CSM).
Accepted for publication February 2, 2001.
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