Background
The prevalence of mammography screening, and the routine use of large core needle biopsies for the diagnosis of clinically occult breast lesions have led to an increased detection of early precursor lesions or precancerous breast conditions, such as atypical lobular hyperplasia (ALH), atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS) and ductal carcinoma in situ (DCIS) [
1]. Several large cohort studies have agreed that the risk of breast cancer in women with ALH, ADH and LCIS is about 4–8 times higher than that of the general population [
2‐
5]. ALH, ADH and LCIS are thought to be reversible, and the efficacy of chemoprevention with tamoxifen, raloxifene, and exemestane has been established in large prospective trials [
6‐
9]. However, concerns about serious side effects preclude the widespread and long-term use of these medical options [
10,
11]. On average, only 4% of high-risk women decide to take these chemopreventive drugs [
12]. DCIS is referred as “stage zero breast cancer” and it has become one of the most commonly diagnosed breast conditions in recent years. Appropriate treatment for DCIS is crucial to prevent invasive breast cancer. However, although nearly all conceivable combinations of surgery, radiotherapy and systemic treatments have been tested in different trials, the situation is still unsatisfactory [
13]. Hence, new breast cancer chemopreventive agents with acceptable efficacy and little toxicity that suitable for long-term use are in urgent need.
Traditional Chinese Medicine (TCM), with thousands of years clinical practice history, has been widely used for disease prevention and management, and is gaining popularity worldwide for promoting healthcare [
14‐
16]. The advantages of “multi-component, multi-target and multi-pathway” combinational regulatory mechanism and relative low toxicity make the TCM herb formula promising for new drug development [
17,
18]. We have used the Yanghe Huayan (YHHY) Decoction, which was originally derived from “
Wai Ke Yi Jing” (Qing Dynasty) more than a century ago, to treat patients with chronic breast fibrosis and palpable lump in our clinic, and the average curative rate, defined as complete resolution or marked improvement of lumps and pain for at least two months with the herbal treatment, was 90% (560 women)(unpublished data). The YHHY Decoction is an aqueous preparation of herbal mixture and consists mainly of extracts from 8 Chinese medicinal herbs: Lu Jiao Jiao (
Cornu Cervi Pantotrichum, CCP), Tu Beimu
(Rhizoma bolbostemmae, RB), Bai Jie Zi (
Semen brassicae, SB), Rou Gui (
Cinnamomum cassia, CC), Pao Jiang (
Baked ginger, BG), Ma Huang (
Ephdra vulgaris, EV), Hu Tao Rou (
Juglans regia L, JRL), and Sheng Gan Cao (
Glycyrrhiza uralensis, GU). Although several individual herbs in the formula have been studied to have anti-tumor activity on cancer cell lines or tumor models [
19‐
23], clinical benefits of these components on breast cancer prevention have ever been achieved only when mixing them together.
The current study investigated the underlying mechanism of the formula cocktail on preventing tumorigenesis in chemical carcinogen DMBA induced mammary tumors. Environmental chemical carcinogen exposure, majorly the polycyclic aromatic hydrocarbon chemicals (PAH), plays a significant role in causing breast cancer as evidenced by many epidemiological and laboratory studies [
24,
25]. DMBA is a prototypical PAH that has been used extensively to induce mammary carcinomas in female Sprague-Dawley (SD) rats to study the process of carcinogenesis. Features of this process that make the model comparable to human disease include similarities in histologic progression, hormone dependence, angiogenic phenotype and oncogenic signaling activation [
26‐
28]. In our study, YHHY Decoction was given to the animals starting 1 wk. before and 4 wks following DMBA induction as a chemopreventive regimen. Our results from both “dry” lab bioinformatics data mining and “wet” lab experimental analyses demonstrated that the YHHY Decoction exerted chemopreventive efficacy in the DMBA model of breast cancer by targeting multiple tumorigenic pathways simultaneously.
Methods
Preparation of YHHY decoction
The YHHY Decoction is an aqueous preparation from 8 Chinese medicinal herbs: CCP 15 g, RB 9 g, SB 6 g, CC 3 g, BG 3 g, EV 9 g, JRL 6 g, and GU 6 g. The raw herb materials were purchased from Bozhou Huqiao Pharmaceutical Co Ltd. (Anhui, China) in September 2015, and were authenticated by Dr. Feng Li at the Department of Pharmacognosy, Shandong University of TCM. A voucher specimen was deposited at TCM Pharmacy, Affiliated Hospital of Shandong University of TCM, with the voucher numbers as CCP 1508160116, RB 1507180227, SB 1507270896, CC 1508030119, BG 1506080417, EV 1507210325, JRL 1508200021, and GU 1507290632. Each raw herb was homogenized to fine powder and the eight herbs were mixed thoroughly. A 8.4 g sample of the mixed fine-ground powder was accurately weighted and extracted with 84 mL of boiling H2O for 6 h and then centrifuged at 12,000 rpm for 15 min, both the volatile oil and the supernatant were collected. The pellet was resolved in 60% ethanol (1:1.5 volume) and statically stewed for 24 h. The mixture was then centrifuged at 12,000 rpm for 15 min, and the supernatant was collected. The two supernatants were combined and dried in the rotary evaporator at 160 rpm at 30 °C. Then the dried powder was accurately weighed and dissolved in the volatile oil Tween-80 solution (1:1 volume) at 1 mg/ml.
Chemicals and reagents
DMBA was purchased from Sigma-Aldrich (St. Louis, MO). Primary antibodies, c-myc (NCL-cMYC, RRID:AB_563665, from Leica Microsystems), phosphor-c-myc (PA5–35814, RRID:AB_2553124, from Thermo Fisher Scientific), CD-105/Endoglin (NCL-CD105, RRID:AB_563482, from Leica Microsystems), and Ki-67 (sc-23,900, RRID:AB_627859), Bax (sc-70,407, RRID:AB_1119412), Bcl-2 (sc-7382, RRID:AB_626736), ERK1/2 (sc-135,900, RRID:AB_2141283), pERK1/2 (sc-136,521, RRID:AB_10856869), PI3K (sc-365,290, RRID:AB_10846944), AKT (sc-5298, RRID:AB_626658), KDR (sc-101,559, RRID:AB_1123212) and β-actin (sc-47,778, RRID:AB_2714189) from Santa Cruz Biotechnology (Santa Cruz, CA) were used. Antioxidant assay kit (cs0790) and In Situ Cell Death Detection Kit (11,684,817,910 ROCHE) were purchased from Sigma-Aldrich (St. Louis, MO). Ventana Basic DAB (3,3-diaminobenzidine) Detection kit was from Boster Biotechnology, Wuhan, China.
Animals
The animal study was conducted upon the approval by the Institutional Animal Care and Use Committee of Shandong University of TCM (SDUTCM2012042001). All experiments were performed in accordance with relevant guidelines and regulations. Pathogen-free virgin female Sprague-Dawley rats (MGI Cat# 5651135, RRID:MGI:5651135), approximately 42 days of age, weight 150 ± 10 g, were provided by Experimental Animal Center of Shandong University of TCM and housed in an animal facility accredited by the Chinese Association for the Accreditation of Laboratory Animal Care. The rats were acclimatized to standard housing conditions, including ambient temperature of 22 ± 2 °C, relative humidity at 30–50%, and a 12-h light-dark cycle, in plastic cages (maximum 4 animals/cage) for 1 wk. before initiation of the experiment. The animals had free access to the nutrition formula rodent diet (NTP-2000 standard) and drinking water.
Animal treatment protocol
The potential chemopreventive role of YHHY Decoction was investigated using a well-established DMBA-induced rat mammary tumorigenesis model [
27,
29]. Following 1-wk acclimatization period, the rats were randomly divided into 4 groups with
n = 6 per each group: group A-normal control with vehicle treatment; group B-DMBA induction with vehicle treatment, group C-DMBA induction with YHHY Decoction treatment and group D-normal control with YHHY Decoction treatment. The experiments were independently repeated three times, so the final sample size for each group is
n = 18 rats. YHHY Decoction was fed through oral gavage (p.o.) once daily for 5 wks (1 wk. before and 4 wk. following DMBA treatment). A human equivalent dose of YHHY Decoction at 1 mg/ml, given by 0.02 ml/g body weight, was used based on the human to animal dose conversion formula (
https://www.fda.gov/downloads/drugs/guidances/ucm078932.pdf, page 7). Following 1 wk. feeding with the YHHY Decoction, rats in the Groups B and C were administered a single dose of DMBA at 50 mg/kg body weight (dissolved in corn oil) by oral gavage to induce mammary carcinogenesis. This dose of DMBA was chosen so that substantial tumor incidence could be produced but not so high as to overwhelm chemopreventive action of YHHY Decoction. The specific time for DMBA exposure is based on previous carcinogenic bioassays indicating that rats at this age possess high frequency of terminal end buds that are sensitive to the established mammary carcinogen DMBA [
30]. Rats in Group C were continually fed with YHHY Decoction for another 4 weeks after the DMBA administration (totally for 5 wks). Food, water intake and behavioral patterns were monitored daily, body weights were recorded twice a week. Palpation of mammary glands started 4 wks following DMBA treatment with a frequency of twice per week. The length of time before palpable tumor is examined is defined as tumor-free survival time. The experiments were terminated at 16 wks post-DMBA administration.
Tissue harvest and histopathology analyses
Animals were euthanized by cervical dislocation after overnight fast. The mammary tumors were carefully excised from mammary gland parenchyma and rinsed with phosphate-buffered saline (PBS) (pH = 7.4). Each tumor was measured in 2 perpendicular directions by a caliper to obtain an average diameter, then was cut into 2 halves. One half was immediately snap frozen in liquid nitrogen and used for molecular analysis. The other half was fixed in 4% paraformaldehyde and used for histopathological and immunohistochemical analysis. Serial tumor sections at 10 μm thickness were prepared for hematoxylin and eosin (H&E) and relevant immunohistochemistry staining. The mammary tumors were classified according the established criteria [
31].
Immunohistochemical staining
Tumor sections were stained with primary Ki-67 antibody, and CD-105 antibody with the Ventana Basic DAB Detection kit for cell proliferation and microvessel detection. Apoptotic cells were detected by TUNEL reaction with In Situ Cell Death Detection Kit. The slides were evaluated by an independent pathologist who was blinded to group assignment and outcome assessment using a light microscope (BX41, Olympus). Five random fields under 20× objective for each slide, and at least 5 slides for each tumor sample were analyzed.
Tissue lysate antioxidant capacity analysis
Similar as previous described [
32], two sets of measurements were performed on the excised mammary tissues: (i) antioxidant enzyme activities – superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT); and (ii) biochemicals – malondialdehyde (MDA) and total nitrate (NOx). Each frozen mammary tissue was divided into two portions (each approximately 0.5 g). One portion was homogenized in 1.5% ice-cold KCl solution to give a 10% suspension and used for the MDA assay. The other portion was cut into several small pieces, homogenized in PBS (pH 7.4), with a
w/
v ratio of 1:5, and spun at 13,000×g for 15 min, at 4 °C. The supernatant was separated for the measurements of SOD, CAT, GPx activities and NOx levels. The protein level in the supernatant was determined spectrophotometrically by the method of Lowry et al. [
33] using BSA as a standard. SOD activity was expressed as the amount causing 50% inhibition of the reduction of cytochrome c per milligram of protein (U/mg of protein), with bovine copper–zinc SOD (Cu/Zn SOD) as standard [
34]. CAT activity was measured by the method of Luck [
35]. The decomposition of the substrate H
2O
2 was monitored spectrophotometrically at 240 nm. Specific activity was defined as micromole substrate decomposed per minute per milligram of protein (expressed as U/mg protein). GPx activity was measured as before [
36]. Specific GPx activity (U/mg protein) was calculated as micromole NADPH consumed per minute per milligram of protein using an appropriate molar absorption coefficient (6220/M per cm). The level of MDA, determined using the method of Mihara and Uchiyama [
37], was expressed as nmol/mg protein. The level of NOx was measured by the method developed by Sastry et al. [
38]. A calibration standard involving potassium nitrate was used to calculate the total concentrations of nitrate, which was expressed as μmol/mg protein.
Western blot analysis
Equal quantities of protein from the tumor tissue lysate were processed for Western blotting. Each sample was denatured, electrophoresed, and transferred onto a PVDF membrane. After blocking the membrane, blots were incubated in specific primary antibodies and then secondary antibodies following the manufacturer’s instructions. Densitometric analysis was conducted using ImageJ software. The primary antibodies used include: anti-c-myc (1:5000), anti-phospho-c-myc (0.5 μg/ml), anti-Bax (1:1000), anti-Bcl-2 (1:2000), anti-ERK1/2 (1:500), anti-pERK1/2 (1:500), anti-PI3K (1:1000), anti-AKT (1:800), anti-KDR (1:400) and anti-β-actin (1:2000). No grouping of gels/blots cropped from different parts of the same gel or from different gels, fields, or exposures was performed.
HPLC analyses
The reference standards of eight chemical constituents, including adenosine, uracil, tubeimoside A, allyl isothiocyanate, trans-cinnamic acid, cinnamic aldehyde, 6-shogaol and polysaccharides (purity≥98%) were purchased from Chengdu Biopurify Phytochemicals Ltd., (Chengdu, China). Methanol, acetonitrile (Fisher Scientific, USA), and acetic acid (Tianjin Chemical Regent Co., Ltd., Tianjin, China) were of HPLC grade. The distilled water was obtained from Wahaha Co., Ltd. (Hangzhou, China).
An Agilent 1100 liquid chromatography system was used for the analysis, equipped with a diode array detector working in the range of 190-400 nm, a quaternary solvent delivery system, a column temperature controller, and an autosampler. The chromatographic data was recorded and processed with Agilent Chromatographic Work Station software.
For HPLC analysis and quantification of each constituents, 1 mg/ml decoction was filtered through a membrane filter (0.45 μm pore size) prior to injection and analyzed three times. Adenosine and uracil, cinnamic acid and cinnamaldehyde were examined simultaneously in one aliquot of the decoction sample, and other constituents were examined individually. Previously validated chromatographic conditions were applied to detect the concentrations of each constituent [
39‐
45]:
For simultaneously detection of adenosine and uracil analysis, C18 analytical column (TIANHE Kromasil C18, 4.6 mm × 250 mm, 5 μm) was used. The mobile phase consisted of water (A)-acetonitrile (B); A:B was as follows: o min, 99:1; 5 min, 98:2; 10 min, 98:2; 20 min, 96:4; 42 min, 45:55; 55 min, 40:60; 60 min, 0:100. The flow rate and column temperature were set constantly at 0.3 ml/min and 30 °C. The detection wavelength was at 260 nm.
For simultaneously detection of cinnamic acid and cinnamaldehyde, C18 analytical column (Gemini C18, 4.6 mm × 250 mm, 5 μm) was used. The mobile phase consisted of solvent A (1.0%, v/v, aqueous acetic acid) and solvent B (1.0%, v/v, acetic acid in acetonitrile). The gradient flow of A:B was as follows: 0 min, 95:5; 40 min, 30:70; 45 min, 0:100, hold for 5 min; 55 min, 95:5, hold for 15 min. The flow rate and column temperature were set constantly at 1 ml/min and 40 °C. The detection wavelength was at 280 nm.
For detection of tuberimoside A, C18 analytical column (RP C18, 4.6 mm × 250 mm, 5 μm) was used. The mobile phase consisted of methanol-water (V:V = 68:32). The flow rate and column temperature were set constantly at 0.1 ml/min and 25 °C. The detection wavelength was at 214 nm.
For detection of allyl isothiocyanate, sphereclone ODS-2 column (4.6 mm × 15cmm, 5 μm) was used. The mobile phase was acetonitrile. The flow rate and column temperature were set constantly at 0.1 ml/min and 25 °C. The detection wavelength was at 242 nm.
For detection of 6-shogaol, C18 analytical column (Alltima HP C18, 4.6 mm × 250 mm, 5 μm) was used. The mobile phase consisted of water (A) and acetonitrile (B). The A:B flow was as follows; 0 min, 55:45; 8 min, 50:50; 17 min, 35:65; 32 min, 0:100 B, 38 min, 0:100, 43 min, 55:45, 48 min, 55:45. The flow rate and column temperature were set constantly at 1 ml/min and 30 °C. The detection wavelength was at 230 nm.
The reference standards were accurately weighed and dissolved in 60% ethanol, and then diluted to appropriate concentration ranges for the establishment of calibration curves. All stock and working standard solutions were stored in brown bottles at 4 °C until used for analysis.
Data mining using ingenuity pathway analysis (IPA)
Except tubeimosides A, other seven chemical constituents of the YHHY Decoction were found in the IPA database (Qiagen, USA), (RRID: SCR_008653) and their direct interacting molecules and endogenous chemicals, totally 293, were added to the analysis list. Core Analysis/Expression Analysis was performed using the Ingenuity Knowledge Base (RRID: SCR_008117) as a reference for p value calculation of the gene populations, and Experimentally Observed Direct Relationship was set to generate function networks.
Statistical analysis
Cumulative percentage of animals with tumor occurrence was plotted against time (weeks). Data were analyzed using Kaplan–Maier Analysis followed by Log-Rank test. The incidence of mammary tumor development in various groups was analyzed by Fisher’s exact probability test. Other data are presented as mean ± SD. Significant differences among various groups were determined by two-sided student t test followed by Holm-Sidak test. P < 0.05 was considered to be statistically significant. The commercial software SigmaPlot 11.0 (Systat Software, Inc., San Jose, CA) was used for all statistical analysis.
Discussion
The present study provides evidence for the first time that the ancient TCM herb cocktail YHHY Decoction exerts a notable chemopreventive activity in the experimentally-induced mammary tumorigenesis model, and more importantly, our bioinformatics and experimental approach systematically revealed the multi-components and multi-targeting mechanisms of the YHHY Decoction.
Our results indicate that daily oral intake of YHHY Decoction could significantly prevent or delay the development of mammary tumor in the rats. First, significantly lower percentage of YHHY-fed animals developed tumor within 16 wks after DMBA administration than the controls (61 vs. 94%,
P = 0.041). Second, for the YHHY-fed rats that showed tumors, a much longer latent time was observed for the tumor development in compared to the controls (mean = 12.9 vs. 10.7 weeks,
P = 0.015), and third, YHHY-treated tumors progressed much slowly than the control tumors within same time period, as manifested by a decreased tumor weight in the YHHY group (5.1 ± 1.7 vs. 19.5 ± 4.5,
P < 0.05). These observations suggest that 1) the YHHY Decoction could substantially suppress the carcinogenic effect of DMBA; 2) the YHHY Decoction may selectively reverse the DMBA induced hyperplasia, thereby prohibit the development of breast cancer [
13]. .
We observed suppressed myc activation by the YHHY decoction which may contribute to the prevention of tumorigenesis. Furthermore, the YHHY Decoction contains multiple bioactive components that work in a concert to modulate multiple dys-regulated pathways in precancerous cells and microenvironment (Table.
4). myc is one of the most potent oncogenes for cell transformation, but myc activation alone generally cannot induce tumorigenesis [
47]. Tumorigenesis is a multifactorial process, in which carcinogenic factors disrupt the homeostatic molecular signaling networks, providing cells with essential physiological alterations to lead tumor formation. Sustained myc activation in a permissive epigenetic and/or genetic context orchestrates alterations of self-sustained growth, limitless replicative potential, angiogenesis, evasion of apoptosis, inflammation and oxidative stress [
56‐
61]. These alterations are highly interconnected [
56,
57]. For example, the carcinogen DMBA is demonstrated to induce high levels of oxidative stress in mammary gland [
53,
54], subsequently induces overexpression of numbers of transcription factors (including c-myc) to promote the expression of genes related to cell proliferation, apoptosis and invasion [
61]. To this end, the observed chemopreventive action of YHHY Decoction can be attributed to its capacity in regulating free radical scavenging and suppressing myc activation to potentiate tissue homeostasis.
Table. 4
Composition and targeted pathways of the YHHY Decoction in preventing DMBA-induced mammary tumorigenesis
Lu Jiao Jiao |
Cornu Cervi Pantotrichum
| Adenosine Uracil | protect tissues against excessive inflammation and promote tissue repair |
Tu Beimu |
Rhizoma Bolbostemmae
| tubeimoside A | inhibit proliferation; induce apoptosis |
Bai Jie Zi |
Semen Brassicae
| allyl isothiocyanate | induce apoptosis; inhibit proliferation; anti-angiogenesis |
Rou Gui |
Cinnamomum cassia
| cinnamic acid cinnamic aldehyde | antioxidant |
Pao Jiang |
Baked Ginger
| 6-shogaol | induce apoptosis; anti-angiogenesis |
Ma Huang |
Ephdra Vulgaris
| | |
Hu Tao Rou |
Juglans regia L
| | |
Sheng Gan Cao |
Glycyrrhiza Uralensis
| Polysaccharides | induce apoptosis; antioxidant |
Each component of the YHHY Decoction has been studied to regulate several different tumorigenic alterations, and several different components could regulate the same alteration pathways, which may implicate synergy [
62,
63]. For example, 6-shogaol [
64] has been shown to inhibit cancer cell growth and invasion, induce apoptosis and cancer cell differentiation, as well as suppress angiogenic factors [
21,
65‐
67]. Cinnamic acid and cinnamic aldehyde have been identified with antioxidant, anti-inflammatory and cytotoxic properties [
68]. Allyl isothiocyanate from
Semen brassicae and tubeimoside A from
Rhizoma bolbostemmae have been reported to inhibit tumor proliferation which was associated with cell cycle arrest and/or induction of apoptosis [
23,
69,
70]. Allyl isothiocyanate also acts as an angiogenesis inhibitor in down-regulating VEGF and pro-inflammatory cytokines [
71]. The polysaccharides from
Glycyrrhiza uralensis exhibited antioxidant and immune-potentiation activities [
40,
72]. Adenosine extracted from
Cornu Cervi Pantotrichum can protect tissues against excessive inflammation and promote tissue repair [
73]. Induction of apoptosis can be achieved by 6-shogaol, allyl isothiocyanate and tubeimoside A, same for antioxidant by cinnamic acid, cinnamic aldehyde and polysaccharides, and suppression of angiogenic factors by 6-shogaol and allyl isothiocyanate.
The IPA analysis helped us identify some key synergistic interactions occur on multiple tumorigenic signaling as many of the molecules interact with multiple components in the IPA database. For example, ERK1/2 is the interacting molecule with allyl isothiocyanate and adenosine, and Bcl2 is the interacting molecule with cinnamic aldehyde and allyl isothiocyanate. Although not all potentially bioactive constituents from the YHHY formula were identified, our study gained insight into the composition and mechanism by which YHHY Decoction abrogated mammary tumorigenesis in rats, and also demonstrated the holistic mode of action of the YHHY herb formula in targeting multiple systems.
Importantly, we didn’t observe any altered food intake, water intake, behavioral patterns, and growth rate of experimental animals upon YHHY treatment. This finding may indicate that the observed chemopreventive effect of YHHY Decoction is devoid of any toxic manifestation. Indeed, in comparing with synthesized chemical agents for anti-tumor growth, induction of apoptosis, anti-oxidant and anti-angiogenesis, the natural substances in the YHHY Decoction would be much less toxic [
18]. Altogether, our study suggests that YHHY Decoction is a promising chemopreventive agent for breast cancer and merits further development.