Background
Breast cancer is the most frequent malignancy in women and the second leading cause of cancer-related deaths worldwide [
1]. Despite great progress in the systemic treatment of tumors over recent years, tumor progression and distant metastasis are still the primary issues affecting the survival of patients with breast cancer [
2]. Recent extensive research has indicated that introduction of an increasing number of individualized molecular targeted therapies into routine clinical treatment mirrors their importance in modern cancer prevention and treatment. For example, targeted therapy for hereditary breast cancer has become a reality with the approval of olaparib for breast cancer gene 1 (
BRCA)-associated breast cancer [
3]. Therefore, better understanding of potential biomarkers and therapeutic targets of breast cancer will facilitate improvement in the survival rate of patients with breast cancer.
The beta-thymosins, which were originally identified from the thymus, are subfamilies of thymosins [
4]. The beta-thymosin family, primarily including thymosin beta 4 (TMSB4), TMSB10 and TMSB15, function as actin-sequestering proteins to inhibit actin polymerization and disrupt the formation of F-actin [
5]. Furthermore, beta-thymosins exhibit diverse physiological functions beyond actin sequestration, including tissue development and regeneration, anti-inflammatory effects, and induction of insulin secretion [
6‐
10]. Recent studies have focused on the biological roles of beta-thymosins in the progression and metastasis of various types of cancer. For example, TMSB4 overexpression correlates with advanced stages of cancer and shorter overall survival by regulating invasiveness and stemness in glioma cells [
11]; TMSB15A is upregulated in transforming growth factor beta 1-treated breast cancer cells, and TMSB15B is involved in epidermal growth factor-induced migration of prostate cancer cells [
12]. TMSB10 is generally upregulated in many cancers [
13‐
16]. It is worth noting that Bouchal et al. report that TMSB10 is positively associated with high-grade aggressive breast cancer [
17], but the underlying mechanism by which TMSB10 promotes breast cancer progression and metastasis remains unclear, which is yet to be further elucidated.
In this study, we report that TMSB10 is significantly elevated in human breast cancer cells and tissues, and correlates with advanced clinicopathological features, metastasis status and poor prognosis. Overexpression of TMSB10 promotes, while silencing of TMSB10 inhibits, proliferation, invasion and migration of breast cancer cells in vitro and in vivo. Our results further reveal that upregulating TMSB10 promoted the proliferation, migration and invasion of breast cancer cells by activating AKT/FOXO signaling. Importantly, we found that the expression level of TMSB10 in the serum of patients with breast cancer positively correlates with clinical stages of cancer in these patients. These findings indicate that TMSB10 may be used as a valuable serum biomarker for the diagnosis of breast cancer and as a potential therapeutic target for the treatment of breast cancer.
Discussion
TMSB10 is upregulated in multiple human cancers and upregulation of TMSB10 contributes to cancer cell proliferation, migration and invasion via different mechanisms, and predicts poor survival [
13,
15,
31‐
33]. However, the expression of TMSB10 has also been shown to be downregualted in ovarian cancer tissues and cells and overexpression of TMSB10 diminishes tumor growth and proliferation [
34,
35]. These findings indicate that TMSB10 functions as both an oncogenic and tumor-suppressive gene depending on the tumor type. Notably, Santelli and the colleagues demonstrated that overexpression of TMSB10 is a general phenomenon in human carcinogenesis, including that of breast cancer [
31]. Furthermore, Verghese et al. report that the intensity of TMSB10 staining positively correlates with the overall grade in breast cancer cells that are characterized by poor differentiation and high mitotic activity, suggesting that TMSB10 may promote the progression of breast cancer by accelerating the cell cycle of breast cancer cells [
36]. However, the biological role and clinical significance of TMSB10 in breast cancer remains largely unknown.
Consistently, our results revealed that TMSB10 is elevated in human breast cancer cells and tissues. High expression of TMSB10 correlated with advanced clinicopathological features, poor prognosis and distant metastatic status. Importantly, TMSB10 was significantly elevated in the serum of patients with breast cancer and positively associated with the clinical stages of breast cancer. Our results further revealed that overexpression of TMSB10 promoted, while silencing of TMSB10 inhibited, proliferation, invasion and migration of breast cancer cells by activating the AKT/FOXO signaling pathway in vitro and in vivo. Our finding demonstrates that TMSB10 plays an important role in the progression and metastasis of breast cancer. Intriguingly, Sribenja et al. report that expression of TMSB10 is decreased in metastatic cholangiocarcinoma tissues compared with primary tumors. Silencing TMSB10 significantly increases, while overexpression of TMSB10 reduces, cell migration and invasion of cholangiocarcinoma cells in vitro [
37]. Taken together, our results in combination with others indicate that the pro-tumor and anti-tumor effects of TMSB10 on cancer are environmentally and tumor-type dependent.
There is evidence that overexpression of thymosin beta10 results in the increased motility and spread of breast cancer cells as actin-sequestering protein [
38]. Consistent with this finding, our results demonstrate that upregulating TMSB10 promotes the invasion and migration of breast cancer cells in vitro and in vivo. So, how might TMSB10 promote tumor metastasis? Emerging studies have revealed that TMSB10 regulates actin dynamics by inhibiting Ras and further disrupting actin polymerization [
34,
35]. Cytoskeleton-regulating proteins, including rhodopsin (RHO), CDC42 and ras-related C3 botulinum toxin substrate 1 RAC1 (RAC1), which are members of the RAS family due to high similarity, are implicated in tumor metastasis [
39]. Normal epithelial cells are characterized by cell polarity and a well-organized array of specialized cell–cell junctions, where RHO proteins are reported to be involved in the control of epithelial polarity [
39]. Furthermore, downregulation of RAC1 leads to a loss in polarity and the loss of epithelial-cell junctions owing to the failure to deposit the extracellular matrix (ECM) component laminin asymmetrically, and establish a more mesenchymal, motile phenotype [
40,
41].
Accumulating studies indicate that CDC42 and RAC play important roles in the assembly of actin-rich structures, such as filopodia, which are thought to sense tactic signals and drive the directionality of cell movement, and lamellipodia, which are assembled at the edge of the cells, both of which are demonstrated to be involved in forming integrin-based cell–ECM contacts [
42]. These studies indicate that the downregulation or loss of functions of certain cytoskeleton-associated protein might be crucial in the detachment of tumor cells from the ECM and drive the metastasis of tumor cells. Therefore, we speculate that TMSB10 promotes the metastasis of tumor cells probably by inhibiting RAS-related proteins and actin polymerization, leading to the loss of cell–cell junctions, cell polyrization and cell-ECM contacts. However, the specific mechanism is still to be studied further.
Emerging evidence reveals that several proliferation markers, such as Ki67, could predict chemotherapy response in breast cancer because rapidly dividing cells are generally susceptible to chemotherapy. Bertucci et al. analyzed the expression value of Ki67 IHC and mRNA status in node-positive patients with breast cancer treated with adjuvant anthracycline-based chemotherapy in the prospective PACS01 trial, and compared the correlation between Ki67 expression level and histo-clinical variables including disease-free survival (DFS). The patients with high expression of Ki67 exhibited longer disease-free survival compared to patients with low Ki67 expression after chemotherapy, suggesting that patients with high expression of Ki67 have better response to chemotherapy [
43]. Furthermore, another study reported that cancer cells with high proliferation rates display pathological complete response to neoadjuvant chemotherapy in breast cancer [
44]. These findings indicate that cells with high proliferation respond better to chemotherapy, which significantly improves the survival of patients with cancer.
In this study, TMSB10 was upregulated in breast cancer cell lines and tissues and high expression of TMSB10 indicated poor prognosis in patients with breast cancer. Overexpression of TMSB10 promoted, while silencing TMSB10 inhibited, the proliferation and tumorigenesis of breast cancer cells in vitro and in vivo. These results suggest that TMSB10 promotes the progression of breast cancer by accelerating tumor cell proliferation. Therefore, we wondered whether high expression of TMSB10 can predict chemotherapy response in breast cancer as does Ki67. The analysis of breast cancer datasets from Kaplan-Meier Plotter revealed that patients with high TMSB10 expression had longer disease-free survival compared to patients with low TMSB10 expression after chemotherapy, but this was not seen in patients treated with endocrine therapy or without systemic treatment, because rapidly dividing cells are generally susceptible to chemotherapy.
These results imply that TMSB10 may be used as a potential indicator of chemotherapeutic response, to stratify patients for the treatment of breast cancer. Furthermore, we observed positive correlation between TMSB10 and Ki67 expression in clinical breast cancer tissue samples and tumor tissues formed by the TMSB10-overexpressing cells in vivo. Importantly, TMSB10 can be detected in the serum of patients with breast cancer, indicating that it is clinically more convenient to measure the expression of TMSB10 than Ki67, which will help to predict the chemotherapeutic response of patients with breast cancer. However, further validation is needed in a larger series of studies.
There is still one question pending: why do patients with breast cancer with high TMSB10 expression respond better to chemotherapy than to endocrine therapy? Probably the mechanisms by which chemotherapeutic agents and endocrine therapy kill cancer cells are totally different. Chemotherapy functions by influencing DNA synthesis, which occurs in the S phase of the cell cycle. The accelerated G1-S phase transition and high proliferation rate are important characteristics of cancer cells, which are crucial for cancer cells to be sensitive to chemotherapy. It is worth noting that TMSB10 expression from TCGA analysis was strikingly higher in basal-like and Her2 subtypes of breast cancer, both of which presented more aggressive and malignant phenotypes characterized by high proliferation and high metastatic tendency compared with other subtypes. Furthermore, chemotherapy is the primary therapeutic strategy for basal-like and Her2 subtype of breast cancer. Therefore, we speculate that TMSB10 will exhibit greater applicable values as an indicator for predicting chemotherapeutic response in patients with the basal-like and Her2 subtypes of breast cancer.
Aberrant TMSB10 expression has been implicated in the pathogenesis of human cancer. A study of non-small cell lung cancer (NSCLC) using methylation-specific PCR (MSP) found that TMSB10 promoter was unmethylated in most tumor tissues and became demethylated in 20 (14.4%) of the 139 NSCLCs. However, TMSB10 methylation status was not linked to its overexpression, indicating that hypomethylation may not be a common mechanism underlying TMSB10 overexpression [
15]. In this study, we analyzed the methylation array dataset of breast cancer from TCGA and found that there was no obvious discrepancy between tumors and the matched adjacent normal tissue samples in the methylation levels of TMSB10. Collectively, these results indicate that a potent, non-methylation-driven mechanism may underlie the deregulation of TMSB10 expression in breast cancer.
We further analyzed the breast cancer datasets from TCGA and Tumorscape (
http://www.broadinstitute.org/tumorscape/) and found that recurrent gains (amplification) were found in approximately 15% of patients with breast cancer. The average expression level of TMSB10 in patients with breast cancer and gains was dramatically higher than those without gains. Frequent amplification has been demonstrated to encode several gene signatures driving cancer growth and plays a crucial role in the progression of cancer [
45]. Mounting studies indicate that amplification frequently occurs in many well-known oncogenes, such as ERBB2 and CCND1 [
46,
47]. In this study, we examined TMSB10 in our nine paired breast cancer tissue samples using RT-PCR and detected amplification in two of the nine samples. The mRNA expression level of TMSB10 in patients with breast cancer and gains was significantly elevated compared to those without gains. Thus, it is generally believed that recurrent gains (amplification) are associated with high expression of TMSB10 in breast cancer.