Introduction
Ovarian cancer is the most lethal malignant tumors among female reproductive carcinoma. The most deaths are of patients with advanced stage, high-grade serous ovarian cancer. Despite improved diagnosis method and high initially response to treatment, high recurrence rate and high chemotherapy resistant rate are the main reason for low survival rate [
1]. It is important to identify key prognosis factors and predictive biomarkers to provide evidence for effective targeting therapies and treatment decisions.
Epigenetic regulation plays an important role in carcinoma progress and chemo-resistance. DNA methylation changes are integral to all aspects of cancer genomics. Hypomethylation has been shown to be important in cancer progression [
2]. TETs, including TET1, TET2, and TET3, are a newly discovered family of DNA demethylases that converts 5methylcytosine to generate 5hydroxymethylcytosine, which is subsequently converted to un-methylated cytosine, leading to DNA demethylation and gene activation [
3‐
5]. The epigenetic modification mechanisms of TETs are functionally implicated in tumorigenesis. Large scale of articles reported that TETs mutations are found most commonly in lymphoma especially in T-cell lymphomas. In ovarian cancer, TET3 is reported as oncogene or tumor suppressor during tumorigenesis [
6]. The expression of nuclear TETs was positively correlated with residual tumor and chemotherapeutic response in human ovarian cancer tissues. It showed that TET expression can influence the chemotherapy sensitivity [
7], suggesting a potentially important role of TETs in the pathogenesis and chemotherapy sensitivity in ovarian cancer.
Due to tissue or sample heterogeneity among each independent experiment and the difference technological detection platforms, the identification of significantly expressed genes or proteins is inconsistent or discrepant in different studies. Thus, integration analysis with an unbiased approach should be performed [
8,
9]. Therefore, we use meta-analysis in Oncomine platform to assess TET3 gene expression in ovarian cancer [
10], followed by integration analysis using a larger sample size including 14 studies in GEO datasets [
11], and further validated with gene expression from TCGA and GTEx. Furthermore, the survival was assessed by Kaplan-Meier plotter and validated by PrognoScan database [
12,
13]. Then we identified the regulatory mechanism of genes by STRING [
14,
15], and determined if the CNAs of TET3 were correlated with cancer pathological status based on cBioPortal [
16,
17]. This study firstly described the expression pattern of TET3 in ovarian cancer, and the relationship between TET3 and clinic-pathological functions based on bioinformatics.
Discussion
Ovarian cancer are highly heterogeneous in terms of histopathology, treatment options, and clinical outcomes. Emerging evidence shows that genetic mutations and copy number alteration underlie the pathogenesis and heterogeneity of ovarian cancer. For example, high grade serous ovarian cancer, which is the most common and most aggressive histotype, generally shows gross copy number variations [
38]. But low grade serous ovarian cancer appears to possess Ras family of genes mutations [
39]. Ovarian cancer has a variety of histotypes, thus more and more work has done to identify genetic differences between histotypes, and epigenetic changes are emerged to be characterized.
The TET proteins (including TET1, TET2, and TET3) are a newly found family. TETs are DNA demethylases that act to oxidize 5-methylcytosine to generate 5-hydroxymethylcytosine, which is subsequently converted to unmethylated cytosine and leading to DNA demethylation and gene activation. They have the critical role on gene methylation and epigenetic regulation. Usually less TET3 is detected in normal ovary tissues. In current study, we observed that TET3 was upregulated in ovarian cancer tissues compared with normal controls. And we addressed that high TET3 is correlated with higher stage and poor clinicopathological features, suggesting a potentially important role of TETs in the pathogenesis of ovarian cancer.
Interestingly, Kaplan-Meier Plotter and PrognoScan database analysis showed that high level of TET3 expression results in shorter survival rate in ovarian cancers, especially in high-grade (II-III), advanced stage (III-IV) ovarian cancers (Fig.
3), indicating that high TET3 expression in OC predicts poor survival. Thus, TET3 may be an oncogene in ovarian cancer. But it is unclear that why TET3 is upregulated in ovarian cancer and what the specific mechanism is for the epigenetic regulation.
This increased expression of TET3 in OC may be partly contributed by DNA copy number amplification. TET3 CNA and gene mutation data showed that TET3 amplification or TET3 gain is the most commonly frequency in ovarian cancer, not only in the high-grade but also in low-grade serous adenocarcinoma. Subsequently, drugs inhibiting TET3 DNA amplification can rescue ovarian cancer progression and survival. But we still need more evidence to explain the upregulation of TET3.
DNA methylation (methyl CpG) is the most commonly studied epigenetic modification, through the attachment of a methyl group to the C5 position of cytosines (5mC) in a CpG context. TET3 is one kind of demethylase, and TET3 was ever thought to have effect on the methylation status’ changes. Our study demonstrated that proteins related with TET3 are mainly DNA methylase or demethylases such as DNMT, and most of these genes showed amplification in ovarian cancer. When treatment of acquired platinum-resistant ovarian cancer with guadecitabine (DNMT inhibitor) and carboplatin, TET3 expression is dramatically up-regulated (logFC = 1.04, GSE102118 [
40], data not shown), indicating that TET3 can have a role with the combination of DNMT or other methylases. Despite the enormous medical and economic impact of ovarian cancers, there are few options for the OC treatments. The main feature of ovarian cancer is the chemotherapy resistant and late diagnosis. About 75% of advanced ovarian cancer patients respond to chemotherapy treatment initially, but most of themwould have the chemotherapy resistance. Han X [
6,
7] showed that TET1 promotes cisplatin-resistance via demethylating the vimentin promoter in ovarian cancer. GSE1926 also compared the carboplatin sensitive and resistant primary ovarian cancer cells from patients [
41], and the result showed that TET3 is dramatically up-regulated in carboplatin resistant cells (
P = 3.26–05, logFC = 0.48, data not shown). This indicated that TET3 may play a role in carboplatin resistance and sensitivity restoration by changing methylation status. Our identification of TET3 as a prognostic factor and maybe a chemotherapy sensitive marker suggests a potentially unifying clinical role of TET3. It will be fascinating to test in the future whether targeting TET3 leads to new treatment options of ovarian cancer especially platinum resistance ovarian cancer.
In conclusion, here we firstly indicated the role of TET3 in ovarian cancer progression. By the interpretation of all the oncogenic data with the bioinformatics, we addressed the molecular mechanisms related with methylation in ovarian cancer.
Conclusions
In summary, this study used bioinformatics analyses by different database and revealed that TET3 is correlated with cancer progression, prognosis. TET3 is demethylase and related to epigenetic modification, so TET3 might be a good target for cancer treatment.
Acknowledgments
We are grateful for the contribution of all databases including TCGA, GTEx, GEO, Oncomine, Kaplan-Meier plotter, PrognoScan, cBioPortal data, STRING analysis and ICGC that provide free online tools and resources.
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