Background
Oral cancer is a major public health problem worldwide, and OSCC is the most common type of oral cancer. The survival rates of patients with OSCCs have remained largely unchanged for decades, with a 5-year survival rate of around 50 % despite advances in therapeutics [
1‐
4]. In addition to that, even when patients with advanced OSCCs survive after surgery, large tissue defects of the maxillofacial region pose a serious problem. Therefore, early and accurate detection of OSCCs is important not only to improve the survival rate of patients with OSCCs but also to maintain good QOL of the patients.
For the early detection of OSCCs, a finding of oral premalignant lesions with high-risk malignant transformation is important. OL is the most common premalignant lesion in the oral cavity, and OLs often precede OSCCs. The transition frequency from OLs into OSCCs ranges widely, from 0.13 % to 36.4 % [
5]. Histologically, the presence of dysplasia is often associated with the development of OSCCs [
6‐
8]. However, the molecular mechanism underlying malignant transformation of OLs has not been elucidated yet, and molecular markers to identify patients at higher risk of developing OSCC have not been isolated [
9].
As a molecular marker to identify lesions with a higher risk of malignant transformation, DNA methylation might be useful [
10‐
14]. The accumulation of aberrant methylation in non-cancerous lesions, such as gastric mucosae with
Helicobacter pylori infection, produces epigenetic field defects leading to malignant transformation [
15,
16]. In the field of oral malignancy, although many reports describe methylation silencing in OSCCs [
17‐
21], few reports focus on methylation in OLs, especially OLs with a high-risk of malignant transformation [
18,
22‐
26].
In this study, we aimed to identify aberrant promoter methylation in OLs at high risk of malignant transformation.
Methods
Cell lines, tissue samples, and DNA extraction
Human OSCC cell lines (Ca9–22, HSC-2, HO-1-N-1, HSC-3 and SCC-4) were purchased from the Human Science Research Resources Bank (HSRRB, Osaka, Japan). A total of 24 OL tissues (average age, 64.0 years [range, 38–84 years]; 10 male and 14 female) and a total of 26 OSCC tissues (average age, 64.6 years [range, 42–89 years]; 17 male and 9 female) were obtained from patients who underwent biopsies or operations at the University of Tokyo Hospital between Dec. 2009 and Nov. 2011. The OSCCs were graded according to the Union for International Cancer Control (UICC)’s TNM classification. OL was defined as “a predominantly white lesion of the oral mucosa that can not be characterized as any other definable lesion”[
27]. The presence or absence of dysplasia in OLs is determined by the degree of cellular abnormality above the epithelial basement membrane as originally defined by the World Health Organisation (WHO) [
28]. Normal oral mucosae were obtained from 16 healthy volunteers. Samples were stored in RNAlater (Applied Biosystems, Foster City, CA, USA) at -80 °C until the extraction of genomic DNA. Genomic DNA was extracted by the phenol-chloroform method. This research was approved by the research ethics committee of Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, approval #2819-(1), and informed consent was obtained from all patients and volunteers. Each patient’s tobacco smoking history was obtained in an interview.
5-Aza-2′-deoxycytidine treatment
Ca9–22 and HSC-2 cells were seeded at a density of 2 × 105 cells ⁄ 10 cm plate on day 0. For 5-aza-2′-deoxycytidine (5-aza-dC; Sigma, St Louis, MO, USA) treatment, the cells were exposed to medium containing 3-μM 5-aza-dC or control medium for 24 h on days 1 and 3, and then harvested on day 5. The doses of 5-aza-dC were adjusted so that the growth of the treated cells was suppressed to 40–80 % that of nontreated cells.
Methylated DNA immunoprecipitation (MeDIP) − CpG island (CGI) microarray analysis
MeDIP − CGI microarray analysis was performed as previously described [
29,
30]. Briefly, 5 μg of genomic DNA was immunoprecipitated with an anti-5-methylcytidine antibody (Diagnode, Liége, Belgium), and the precipitated DNA and input DNA were labeled with Cy5 and Cy3, respectively. A human CGI oligonucleotide microarray (Agilent Technologies, Santa Clara, CA, USA) was hybridized with the labeled probes and scanned with a G2565BA microarray scanner (Agilent Technologies). Scanned data were processed with Feature Extraction 9.1 and ChIP Analytics 1.3 software (Agilent Technologies). The signal of the probe was converted into a “Me value,” which represents the methylation level as a value from 0 (unmethylated) to 1 (methylated) [
29]. Differentially methylated regions were detected by a comparison of the Me values of the two samples. When three or more consecutive probes in a locus showed differences in the Me value larger than 0.6, the locus was considered to have different methylation statuses. Promoter regions of three genes (
HOXA11,
NPY, and
UCHL1) reported as frequently methylated in multiple cancers, including OSCCs, were used as a methylated control [
31‐
33]. Promoter regions of three genes (
ACTB,
B2M, and
GAPDH) known as housekeeping genes were used as unmethylated control.
Gene expression analysis by oligonucleotide microarray
Expression microarray analysis was performed by a GeneChip Human Genome U133 Plus 2.0 expression microarray (Affymetrix, Santa Clara, CA, USA). From 8 μg of total RNA, first-strand cDNA was synthesized with SuperScript III reverse transcriptase (Invitrogen) and T7-(dT)24 primer (Amersham Biosciences, Little Chalfont, UK). Double-stranded cDNA was then synthesized, and biotin-labeled cRNA was synthesized using a Bio-Array HighYield RNA transcript-labeling kit (Enzo Life Sciences, Farmingdale, NY, USA). Twenty micrograms of labeled cRNA was fragmented and hybridized to the GeneChip oligonucleotide microarray with a GeneChip hybridization control kit. The microarray was stained and scanned according to the Affymetrix protocol. The scanned data were processed using GeneChip operating software 1.4. The signal intensity of each probe was normalized so that the average signal intensity of all the probes on a microarray would be 500. The average signal intensity of all the probes for a gene was used as its transcription level. Genes were classified into those with high (>1000), moderate (250–1000), or low (<250) transcriptions according to their signal intensities [
30].
Sodium bisulfite modification and methylation-specific PCR (MSP)
Sodium bisulfite treatment was performed as described previously [
29] using 500 ng of DNA digested with
BamHI (Toyobo, Tokyo, Japan) and suspended in 20 μl of Tris-EDTA (TE) buffer. For MSP, 1 μl of solution was used for PCR reaction with primers specific to methylated (Additional file
1: Table S1) and with primers that targeted the
Alu repeat sequence; the latter were used as a control of the amount of bisulfite-treated DNA [
34]. Fully methylated DNA was prepared by methylating genomic DNA using
SssI-methylase (New England Biolabs, Beverly, MA, USA). Fully unmethylated DNA was prepared by amplifying genomic DNA with phi29 DNA polymerase (GenomiPhi DNA Amplification kit; GE Healthcare UK, Buckinghamshire, UK).
Statistical analysis
Associations between methylation status and various clinical parameters were evaluated by Fisher’s exact test (two-sided). SPSS Statistics (IBM Corporation, Somers, NY, USA) software version 21.0 (SPSS Inc., Chicago, IL, USA) was used for analysis. P values < 0.05 were considered to indicate significance.
Discussion
We identified seven genes aberrantly methylated in their promoter regions not only in OSCCs but also in OLs. The number of methylated genes was significantly associated with the presence of dysplasia in OLs, which is known to be associated with a high risk of malignant transformation into OSCCs [
7,
8]. This result indicates that accumulation of aberrant methylation might be associated with the malignant transformation of OLs, Aberrant promoter methylation is known to accumulate also in other organs, in high-risk tissues such as gastric mucosae with
Helicobacter pylori infection, in liver tissue at the precancerous stage, in colonic mucosae with ulcerative colitis, and in esophageal mucosae [
15,
16,
34‐
38]. These previous reports support the hypothesis that the accumulation of aberrant methylation in OLs produces epigenetic field defects leading to malignant transformation.
In addition to the methylation of multiple genes, the methylation silencing of a specific gene may be functionally involved in malignant transformation. The five genes methylation-silenced in OLs (
TSPYL5,
CMTM3, NKX2–3, CLDN11, and
RBP4) were expressed in normal oral mucosae, which indicates the functional importance of these genes [
34]. Especially,
TSPYL5 was most frequently methylated in OLs and was associated with differentiation levels of OSCCs (
p < 0.01). The methylation silencing of
TSPYL5 has been reported in esophageal cancers, gastric cancers and malignant gliomas [
33,
39,
40], and
TSPYL5 has been suggested to be a tumor suppressor gene [
40]. Furthermore,
TSPYL5 is located on chromosome 8q22, which shows loss of heterozygosity (LOH) in OSCCs with high frequency [
41].
In histopathological diagnosis, the presence of dysplasia, remains the golden standard for predicting the risk of cancerization in oral premalignant lesions [
42]. However, this invasive approach cannot be repeated frequently because of its poor acceptance by patients. Furthermore, a diagnosis of dysplasia is also subject to the experience of a pathologist, and the consensus among pathologists is still poor [
43]. On the other hand, quantitative DNA methylation analysis is currently available and is considered to be objective. Moreover, sufficient numbers of cells for methylation analysis can be obtained by non-invasive procedures [
44], such as scraping of the oral mucosae. Thus, the risk characterization using aberrant DNA methylation in patients with OLs is considered clinically feasible. Accordingly, the accumulation of identified aberrant methylation is potentially useful as a risk marker of malignant transformation from OLs to OSCCs.
We identified a novel promoter methylation associated with the risk of malignant transformation of OLs. However, the number of OL samples was limited here. Therefore, it is necessary to validate the association by another larger population.
Conclusions
Here, we identified aberrant promoter methylation of multiple genes in high-risk OLs. This result demonstrates that the accumulation of aberrant methylation in oral premalignant lesions produces an epigenetic field of cancerization.
Abbreviations
5-aza-dC, 5-aza-2′-deoxycytidine; CGI, CpG island; LOH, loss of heterozygosity; MeDIP, methylated DNA immunoprecipitation; MSP, methylation-specific PCR; OL, oral leukoplakia; OSCC, oral squamous cell carcinoma; QOL, quality of life; TE, Tris-EDTA; UICC, Union for International Cancer Control; WHO, World Health Organisation.
Acknowledgment
The authors are grateful to Dr. T. Ushiku for his assistance of pathological diagnosis. This study was supported by a Grant-in-Aid for Scientific Research (KAKENHI).
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (
http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (
http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.