Molecular pathogenesis and prognostic factors in testicular tumor

Aim of this review article was to critically analyse the recently described zytogenetic and molecular markers for testicular germ cell tumors with regard to their clinical utility. The isochromosome i(12p) represents the most common and characteristic cytogenetic finding which already appears in testicular carcinoma in situ. A number of proto-oncogenes (Cyclin D and PTHLH) as well as putative tumor suppressor genes are localized on 12p; however, their role in pathogenesis and prognosis of testicular germ cell tumors has not been defined yet. Clinical characteristics of patients with familial testicular germ cell tumors indicate a genetic background for the development of testicular tumors. Although a number of chromsomal loci encoding potential testicular tumor susceptibility genes have been identified, the genetic basis of testicular cancer pathogenesis is still unknown. With regard to molecular prognostic risk factors most of the reported data on proliferation markers, tumor suppressor genes, proteases and adhesion molecules have to be confirmed in prospective randomized trials prior to their widespread clinical use. Based on the available data on prospective studies percentage of embryonal carcinoma and vascular invasion appear to be the most significant prognosticators. Investigation and identification of those factors determining the aggressive biologic behavior of embryonal carcinoma compared to all other histological components appear to be most promising in research for prognosticators of metastatic disease. In conclusion, the increasing knowledge of molecular genetic events involved in pathogenesis and prognosis of testicular germ cell tumors will not only help to better understand development and progression of testicular cancer, but it also will define new approaches to classification and management of germ cell tumors.     

Multistep carcinogenesis of breast cancer and tumour heterogeneity

Breast cancer emerges by a multistep process which can be broadly equated to transformation of normal cells via the steps of hyperplasia, premalignant change and in situ carcinoma. The elucidation of molecular interdependencies, which lead to development of primary breast cancer, its progression, and its formation of metastases is the main focus for new strategies targetted at prevention and treatment. Cytogenetic and molecular genetic analysis of breast cancer samples demonstrates that tumour development involves the accumulation of various genetic alterations including amplification of oncogenes and mutation or loss of tumour suppressor genes. Amplification of certain oncogenes with concomitant overexpression of the oncoprotein seems to be specific for certain histological types. Loss of normal tumour suppressor protein function can occur through sequential gene mutation events (somatic alteration) or through a single mutational event of a remaining normal copy, when a germline mutation is present. The second event is usually chromosome loss, mitotic recombination, or partial chromosome deletion. Chromosome loci 16q and 17p harbour tumour suppressor genes, which seem to be pathognomonic for the development or progression of a specific histological subtype. There are an overwhelming number of abnormalities that have been identified at the molecular level which fit the model of multistep carcinogenesis of breast cancer. When the functions of all of these genes are known and how they participate in malignant progression, we will have the tools for a more rational approach to diagnosis, prevention and treatment. This review deals only with the factors that are involved in the conversion of a normal breast cell into a malignant cell rather than those required for invasion and metastases. A key critical long-term step in the molecular analysis of breast cancer will be to link the specific molecular damage with the effects of environmental carcinogens.     

Estrogens, progestogens, normal breast cell proliferation, and breast cancer risk

Epidemiologic studies suggest that ovarian hormones contribute to the development of breast cancer at all stages. Early menopause and premenopausal obesity reduces the risk while postmenopausal obesity and menopausal estrogen replacement therapy increases the risk. Combined oral contraceptives and Depo-Provera do not reduce the risk. It appears that estrogens and progestogens act through and with proto-oncogenes and growth factors to affect breast cell proliferation and breast cancer etiology. Animal studies suggest that estrogen causes interlobular ductal cell division and progesterone causes increased terminal duct lobular unit cell division in the luteal phase. Most breast carcinomas originate from terminal duct lobular unit cells. During pregnancy, these cells fully multiply. Their reproduction is also increased during the luteal phase. Yet, there is considerable interpersonal variation. No studies examining breast cell division have compared cell division rates with serum hormone concentrations, however. The peak of mitosis occurs about 3 days before breast cell death in the late luteal and very early follicular phases. Other research suggests that breast stem cell proliferation is linked to breast cancer development. Endocrine therapy reduces mitotic activity, indicating the estrogen and progesterone receptor content of breast cancers. Hormone-dependent breast cancer cell lines are all estrogen-dependent. Progesterone can block the estrogen-dependent cell lines which act like endometrial cells. The results of the various breast cell proliferation studies in relation to breast cancer are unclear and research identifying a molecular explanation would help in understanding the different findings.     

Cloning and characterization of a cDNA encoding a novel heterogeneous nuclear ribonucleoprotein-like protein and its expression in myeloid leukemia cells

Breast cancer is the second leading cause of cancer-related deaths among women in the United States. Approximately 180,000 new cases of breast cancer are diagnosed each year and a quarter of these are fatal. Early detection is a key to survival of these patients. Unfortunately, no definitive markers are available to diagnose breast cancer at early stages. Identification of such early markers, therefore, is an important priority in breast cancer research. In order to identify early markers, we have focussed on understanding the molecular mechanisms that can lead to conversion of the normal mammary epithelial cells into precancerous immortal cells. Over last several years, we have developed in vitro models of human mammary epithelial cell immortalization which have allowed us to invoke the critical roles of the known tumor suppressor pathways in the maintenance of the untransformed state of mammary epithelial cells. These models are now being used to identify novel genes whose expression is important for normal mammary epithelial cell growth and whose altered expression contributes to breast cell transformation. Characterization of the molecular machinery whose alterations result in early preneoplastic transformation should help identify candidate genes for evaluation as potential early diagnostic markers.     

New directions in breast cancer research

Research in breast cancer extends in many directions, stimulated by concerns related to the high incidence of the disease and the relative unpredictability of its clinical course. Examples of work in several directions are presented here arranged by four levels of analysis. 1) Molecular, intracellular events (molecular genetics). Recent identification of genes that predispose to breast cancer, and the isolation of those genes and their protein products, permit investigations of the most critical issues: the roles of these genes in normal development and breast differentiation, and how their alteration permits or contributes to tumor initiation. Thus, we expect that understanding the functions of the genes involved in inherited susceptibility to breast cancer will also be informative for sporadic breast cancers. 2) Cellular biology (cellular models for preneoplastic disease). We examine models of breast cancer development and ask how they help to validate a morphologic sequence for human breast neoplasia and whether they permit investigation of how to modify disease progression. Two useful models, one in transgenic mice and the other using human breast stem cells capable of culture and xenograft growth, are now available. 3) Tissue and organ (the tumor and its local environment). We look at the relationship of the tumor cell population to its local environment (stroma, blood vessels, etc.). This leads naturally to questions of how neighboring tissues and cytokines may modify tumor growth. 4) The individual as an organism and member of a population (hormonal rise and chemoprevention). We address identification of the primarily hormonal risk factors and a possible related mode of cancer prevention.     

Identification of genes expressed in premalignant breast disease by microscopy-directed cloning

Histopathologic study of human breast biopsy samples has identified specific lesions which are associated with a high risk of development of invasive breast cancer. Presumably, these lesions (collectively termed premalignant breast disease) represent the earliest recognizable morphologic expression of fundamental molecular events that lead to the development of invasive breast cancer. To study molecular events underlying premalignant breast disease, we have developed a method for isolating RNA from histologically identified lesions from frozen human breast tissue. This method specifically obtains mRNA from breast epithelial cells and has identified three genes which are differentially expressed in premalignant breast epithelial lesions. One gene identified by this method is overexpressed in four of five noncomedo ductal carcinoma in situ lesions and appears to be the human homologue of the gene encoding the M2 subunit of ribonucleotide reductase, an enzyme involved in DNA synthesis.     

Animal welfare and colony management in cancer research

The use of animals in cancer research continues to be important for the study of tumor biology, the development and testing of new therapies, and risk assessment. The new knowledge generated from this research contributes to the health and welfare not only of human beings, but also of animals which develop cancer. However, the use of animals for cancer research is a privilege which carries with it scientific, professional, and moral obligations. The three tenets of a sound animal research program include good science, humane care, and regulatory compliance. Recognizing the complex interactions in the tumor-animal model, the investigator needs to address a wide range of issues during experimental design and implementation including animal welfare concerns, complicating factors in colony management, and compliance with laws, regulations, and policies. Therefore, both practical and philosophical considerations enjoin researchers to maintain the highest standards of animal care.     

Raf-1 protein expression in human breast cancer cells

BACKGROUND: The Raf-1 kinase, a 72-kDa cytoplasmic serine-threonine kinase, plays a central role as a second messenger in signal transduction. After ligand binding to a variety of transmembrane tyrosine kinase growth factor receptors including epidermal growth factor (EGF) receptor, the 72-kDa kinase is activated through phosphorylation to a 74-kDa phosphoprotein. The Raf-1 kinase is constitutively activated in many transformed cells either directly, by mutations within its amino-terminus regulatory region, or indirectly, due to overstimulation by autocrine growth factors or activated proximal oncogenes. The role of Raf-1 kinase in breast cancer has not been studied. METHODS: To investigate the role of Raf-1 kinase expression and its activation in breast cancer, we studied three human breast cancer cell lines expressing varying amounts of EGF receptor to determine the level of Raf-1 protein and the proportion expressed in the higher molecular weight form. Effects of serum starvation and stimulation with EGF on the Raf-1 protein were studied in T47D, BT474, and MDA-MB231 cells by precipitation of cell lysates with an anti-Raf-1 antibody followed by immunoblotting. [3H]Thymidine incorporation by these cells after EGF stimulation was also determined as a measure of DNA synthesis. RESULTS: In all three breast cancer cell lines studied, the Raf-1 protein was identified in a 70- and a 74-kDa form. The level of Raf-1 was similar in all three cell lines and appeared unrelated to EGF receptor expression on the cell surface. The majority of the protein was found in the 74-kDa form even after serum starvation. A minor shift from the lower to higher molecular weight form of Raf-1 was apparent in cells treated with EGF, and increased [3H] thymidine incorporation could be demonstrated in two of the cell lines after EGF stimulation. CONCLUSION: Baseline expression of the 74-kDa or activated form of the Raf-1 kinase appeared to be elevated in the breast cancer cells studied, indicating constitutive activation. Further investigation into the role of Raf-1 protein in the pathogenesis of breast cancer is indicated.     

Expression of cytosolic sulfotransferases in normal mammary epithelial cells and breast cancer cell lines

Breast cancers require the presence of estrogens for the maintenance of growth at some time in the course of their development, as does normal breast tissue. Sulfation is an important process in the metabolism and inactivation of steroids, including estrogens, because the addition of the charged sulfonate group prevents the binding of the steroid to its receptor. Also, many of the therapeutic and chemopreventive agents used in the treatment of breast cancer are substrates for the sulfotransferases (STs). The activity and expression of four cytosolic STs, which are the human phenol-sulfating and monoamine-sulfating forms of phenol ST (PST), dehydroepiandrosterone ST, and estrogen ST (hEST), were assayed in normal breast cells and in breast cancer cell lines. ST activities and immunoreactivities were assayed in the estrogen receptor-positive human breast cancer cell lines ZR-75-1, T-47D and MCF-7; in the estrogen receptor-negative breast cancer cell lines BT-20, MDA-MB-468, and MDA-MB-231; and in normal human mammary epithelial cells. The PSTs were the most highly expressed ST activities in the breast cancer cell lines, although the levels of activity varied significantly. ZR-75-1 and BT-20 cells possessed the highest levels of activity of the human phenol-sulfating form of PST. The breast cancer cell lines showed only trace levels of dehydroepiandrosterone ST and hEST activities. In contrast, hEST was the only ST detectable in human mammary epithelial cells. Understanding the regulation of ST activity in these breast cancer and normal breast cell lines will improve our knowledge of the role of sulfation in breast cancer and provide a model with which to study the mechanism of action of estrogens in mammary cells.     

Identification of the ADP-L-glycero-D-manno-heptose-6-epimerase (rfaD) and heptosyltransferase II (rfaF) biosynthesis genes from nontypeable Haemophilus influenzae 2019

PURPOSE: The rapidly growing field of molecular biology has caused exponential growth in our knowledge of the processes of embryogenesis. Since the cloning of the androgen receptor gene in 1988, investigators have been able to clarify many of the molecular events of male sexual differentiation that are mediated through the androgen receptor. We reviewed the current state of knowledge of the androgen receptor and its role in male genital development. MATERIALS AND METHODS: An intensive literature search was conducted to review reports on the androgen receptor and sexual differentiation since 1988. This review also includes ongoing research from our laboratory on the role of the androgen receptor in human genital development, as well as collaboration with other investigators. RESULTS: We reviewed the basic molecular biology of androgenic action mediated through the androgen receptor. This information has been integrated into the current understanding of human male sexual differentiation to clarify how androgens virilize the undifferentiated embryo. Defects in function of the androgen receptor may be manifested as a spectrum of phenotypes of the androgen insensitivity syndrome, and these phenotypes of male pseudohermaphroditism have been reviewed on a clinical and molecular basis. New molecular techniques have augmented the evaluation and diagnosis of the androgen insensitivity syndrome, and some groups have successfully diagnosed the condition prenatally. CONCLUSIONS: Basic scientific research of androgen receptor function and its role in male sexual development has provided a clearer understanding of the mechanisms responsible for the spectrum of defects secondary to the androgen insensitivity syndrome. This knowledge will enable clinicians to offer more accurate diagnosis and insightful counseling to affected patients and their families.     

Insulin-like growth factors and breast cancer

Several years of research have indicated that the insulin-like growth factor (IGF) family of ligands, receptors and binding proteins are expressed in human breast cancer. The ligands are potent mitogens for breast cancer cell lines, and blockade of IGF signaling inhibits tumor growth. The IGFs can be regulated in normal and neoplastic tissue, indicating their important role in proliferation. For example, estrogen, a hormone important in the growth and progression of breast cancer is able to alter expression of IGF ligands, receptors and binding proteins. In addition, recent data now indicate that IGF ligands can also activate estrogen receptor (ER) in a ligand-independent manner. The apparent cross-talk between IGF and ER signaling is especially important to consider since anti-estrogens, such as tamoxifen, are a major modality for the treatment of breast cancer. Recent data suggest that IGFs may also be involved in tamoxifen resistance, through upregulation of the IGF-I receptor. Thus blockade of IGF signaling in combination with tamoxifen may prove to be a beneficial treatment for breast cancer patients.     

Oncogenes--"reckless drivers" on signal pathways controlling cell division

Today, about 20 years after the discovery of cellular genes with oncogenic potential, we possess substantial knowledge on the regulation of normal cell growth and division. At the same time, we have gained insight into the loss of growth control which occurs in cancer cells. The following is a brief review of the progress made in oncogene research and the knowledge we have gained. It is important to stress that our understanding of the cellular and molecular mechanisms involved is still in its infancy. However, pieces are being added to the puzzle at an increasingly faster pace, primarily because of the progress in gene technology during the last two decades. Research methods have been set up to allow greater cooperation across disciplinary boundaries, thus increasing the speed with which important discoveries occur. A goal for the future will be to identify all oncogenes and tumor suppressor genes and elucidate their functions. At the same time, one of the major challenges will be to translate the knowledge thus gained into the development of more powerful and specific therapeutic strategies. As a result of the increasing insight gained by modern oncogene research, the need for detailed cancer diagnostics based on molecular genetics will increase significantly in the future.     

Female sex hormones increase the risk of breast cancer

The incidence of breast cancer in women in increasing, partly due to changes in age distribution in the population, and partly due to a real increase in risk. Changes in family patterns may, to some extent, explain the increased risk since giving birth to a first child late in life and bearing few children both increase the risk of breast cancer. The influence of female sex steroids on the breast plays a central role, but the biological mechanism is not clearly understood. There is a certain amount of risk involved in using hormonal medication (oral contraceptives or postmenopausal hormone replacement), but on ceasing to take the medication, risk will revert to the expected rate within a few years. Future epidemiological research on breast cancer will concentrate on events occurring during hormonally potent phases of life, such as growth and development during the fetal period, and sexual and somatic maturation during adolescence. Until now only modest interest has been shown in researching these two particular phases, but both may be important for the natural course of breast cancer.     

Future developments in genetic research. I. Technological possibilities

The attention in genetic research is shifting from the determination' of (rare) monogenic disorders to identification of genetic risk factors for important diseases at adult age. Mapping of all man's 80,000-100,000 genes will also provide more insight into the gene polymorphisms and mutations that are associated with various types of cancer, certain cardiovascular diseases, diabetes and neurodegenerative disorders, including Alzheimer dementia. Apart from new diagnostic possibilities, the DNA techniques create new prospects for the study of the pathogenesis of diseases and the devising of new strategies for treatment. Examples are familial hypercholesterolaemia, diabetes, breast cancer and colorectal carcinoma.     

Monitored high-dose azathioprine treatment reduces acute rejection episodes after renal transplantation

A novel complex mutation consisting of a small deletion/insertion (3958del5ins4) was found in the breast cancer-1 gene (BRCA-1) in three unrelated French breast and/or ovarian cancer families. These mutations occurred at the same nucleotide position of the 3' end of exon 11. The wild-type sequence, CTCAG, was deleted and replaced by AGGC in the three families. The consequence is the generation of a stop codon, TAG, resulting in a truncated protein. We propose two different mechanisms to explain the generation of this complex mutation: (i) the simultaneous occurrence of a deletion and an insertion in a stem-loop structure and (ii) the abortive integration of a human transposable element (Tigger 1) that deleted 5 nucleotides and inserted a 4-nucleotide "scar", corresponding to the 5' extremity of the transposon.     

Gene therapy for lung cancer

Gene therapy has received considerable attention and some speculation as to its value. Although few patients have been treated, the preliminary results of the phase I lung cancer gene therapy clinical trials are very promising. Clinically relevant basic research in the molecular pathogenesis and immunology of lung cancer is progressing. As improved vector technologies are developed, new opportunities will be available to initiate lung cancer gene therapy trials that are based on a more detailed understanding of lung cancer biology. In conclusion, although important biologic and technical questions remain unanswered, recent research suggests that gene therapy will have a profound impact on lung cancer treatment.     

Breast cancer metastasis-associated genes: prognostic significance and therapeutic implications

The metastatic spread of breast cancer accounts for most of its morbidity and mortality; therefore, identifying the genes and gene products involved in breast cancer metastasis formation should be useful for better diagnosis, prognosis, treatment, and follow-up of patients with metastatic breast cancer. Unfortunately, little is known about these genes or the functions of their encoded products. Abnormalities in at least three broad gene categories (oncogenes, regulatory genes or effector genes, and tumor-suppressor genes) have been shown to contribute to the origin and/or progression of breast neoplasias. Such abnormalities are mainly manifested by quantitative changes in gene expression, resulting in loss of normal cellular regulation and enhanced cellular diversification. In addition, qualitative genetic alterations, such as gene amplifications and mutations, may also be involved in breast cancer progression. The role(s) of different breast cancer metastasis-associated genes, if known, in the complex multistep process of invasion and metastasis is discussed along with studies that have identified new molecular probe(s) that may be useful in predicting metastasis formation and outcome in breast cancer and for selecting candidates for adjuvant therapy. Understanding the genetic and thus molecular basis of metastasis formation should also provide important insights on the development of new therapeutic approaches for treatment of metastatic breast cancers based on gene targeting and repair of genetic defects that control metastatic properties.     

Low frequency of somatic mutations in the LKB1/Peutz-Jeghers syndrome gene in sporadic breast cancer

Germ-line mutations in the LKB1 gene on chromosome 19p are responsible for most cases of the Peutz-Jeghers syndrome, in which intestinal hamartomas are associated with elevated risks of several cancer types, including breast cancer. We have evaluated the role of somatic mutations in LKB1 in breast cancer. Of 40 informative primary breast cancers, 3 showed loss of heterozygosity on chromosome 19p in the vicinity of LKB1, and no somatic mutations of LKB1 were observed in 62 primary breast cancers and 17 established breast cancer cell lines. The results indicate that mutations in LKB1 do not play an important role in the development of sporadic breast cancer.