Background
Mortality from colorectal cancer (CRC), the fourth most frequent cause of cancer deaths, is mainly due to metastatic liver disease. Much is known about the adenoma-carcinoma progression of CRC [
1‐
3] and sporadic CRC is recognised as a heterogeneous and complex disease involving many genes and pathways [
4,
5]. There has been intensive analysis of the prognostic value of molecular markers for CRC in risk assessment and disease management [
6‐
11]. Despite intense study of the metastatic process many aspects of its molecular genetic basis remain unclear. Improved understanding of the molecular events underlying metastasis is crucial for the development of new methods for early detection and treatment of colorectal cancer.
Traditionally, loss of heterozygosity (LOH) analyses were used to map regions harbouring tumour suppressor genes; this method exploits Knudson's two hit hypothesis of tumorigenesis [
12] We reasoned that LOH analyses could be used to map chromosomal regions specifically disrupted in metastases, and might therefore highlight the presence of a gene(s) involved in metastasis.
Chromosome 8p is frequently lost in CRC, many studies implicate loss in later stage disease and metastases [
13‐
15], and several 8p genes have been implicated in metastasis [
16‐
19]. However, to date no strong candidate CRC metastasis suppressor has been identified showing loss of expression and/or function in a significant proportion of tumours, as compared to the frequent mutation and/or silencing of genes involved in adenoma-carcinoma progression [
20]. We therefore concentrated our analysis on 8p, identified a region of metastasis-specific loss, and screened genes within this region for changes at the DNA, mRNA and/or protein level associated with metastasis.
Methods
Samples
48 sporadic CRC patients undergoing surgery at Wakefield Gastroenterology Centre for primary colon and/or secondary liver tumour resection were included, along with 20 patients with sporadic CRC and no liver metastases (follow-up 2.5–8.5 years, Mean 5.1 +/- 1.9). Matched primary colon tumour and liver metastasis samples were available for 11 patients. Informed, written consent was obtained from each patient. The Central Regional Ethics Committee approved the study (CEN/05/02/004), which complied with the Helsinki Declaration for human research. Immediately post-surgery tumour samples were dissected macroscopically to remove non-tumour tissue, snap-frozen and stored at -80°C. Blood samples were obtained for all patients.
Tumour DNA and RNA were extracted with Qiagen (Valencia, CA, USA) DNA Purification kit and Trizol reagent (Invitrogen Corp, Carlsbad, CA USA) respectively. Blood DNA was extracted using the Qiagen DNA Blood kit.
Microsatellite markers and PCR
35 microsatellite markers, spanning 8p21-22 and part of 8q (D8S277, D8S1819, D8S351, D8S 721, D8S542, D8S520, D8S1759, D8S552, D8S1754, D8S511, D8S1827, D8S1731, D8S254, D8S261, D8S258, LPL, D8S136, D8S1786, D8S1752, D8S1734, D8S1181, D8S360, NEFL, D8S1725, D8S1739, D8S1048, D8S1809, D8S283, D8S513, D8S505, D8S325, D8S1821, D8S1745, D8S1773, D8S1833) were used. PCR used: 20 ng DNA 50 pmol each primer, 200 μM dNTPs, 1.5 mM MgCl2, and 0.15 units FastStart Taq (Roche Applied Science, Indianapolis, IN, US) in 50 μl volume. Cycling conditions were: 1 cycle 95°C 10 min, 30 cycles 95°C 30s 55 or 60°C 30s 72°C 30s, and 1 cycle 72°C 8 min.
Loss of heterozygosity
As previously [
21,
22]. Briefly, 5 μl PCR product was denatured prior to electrophoresis and DNA visualized by silver staining. Scoring was carried out independently by 2 scientists, and a 3
rd scientist independently reviewed all results
cDNA synthesis and semi-quantitative real-time PCR
500 ng of RNA was reverse transcribed using random hexamers and Superscript III (Invitrogen) as per the manufacturer. To identify a robust internal control an ABI Human Endogenous Control Plate was run against 4 paired normal colon (CN) and colon tumour (CT) samples. GAPDH (glyceraldehyde-3-phosphate dehydrogenase), acidic ribosomal protein and 18s were selected for further validation in CN, CT and liver metastases (LM). All 3 showed minimal variation between and among tissues (data not shown). TaqMan quantitative real-time PCR was performed using ABI (Applied Biosystems Foster City, CA, USA) reagents and assay on demands (Additional file
1) as per the manufacturer. Amplification efficiency and primer interference were checked using standard curves. Samples were run and analysed in triplicate on an ABI 7300 or 7700. Test gene expression was normalised to 18s (dCt). Fold change (FC) of CT or LM gene expression was calculated relative to matched normal using mean dCt values and FC = 2
-ddCt. KRT8 was used as an epithelial cell-specific marker [
23].
Mutational analysis
PCR used: 10 ng DNA, 400 μM primer (Additional file
2), 200 μM dNTPs, 2.0 mM MgCl
2, and 0.8 units FastStart Taq (Roche) in 30 μl, and cycling conditions: 1 cycle 95°C 4 min, and 38 cycles of 94°C 30s annealing (supplementary information) 20s 72°C 60s. DR5 (NM_003842) was amplified from cDNA as 2 over-lapping amplicons. An aliquot of each PCR product was checked before clean-up (Qiagen PCR purification columns) by agarose gel electrophoresis, sequencing was performed in both directions and anomalies verified by repeat analysis. Restriction analyses of DR4 were as previously described [
24,
25].
Immunohistochemistry (IHC)
Immunohistochemistry was undertaken on formalin-fixed paraffin-embedded (FFPE) archival material. Mouse or rabbit Vectastain ABC Peroxidase Kit and Vecta Red Peroxidase substrate kits (Vector Laboratories, Burlingame, CA, USA) were used according to the manufacturer and sections counterstained with haemotoxylin. DR5 (Imgenex Corp, San Diego, CA, USA clone 45B872.1) and PDLIM2 [
26] antibodies were incubated for 1 h at 37°C and used at 1:1000 and 1:500 respectively.
Western blot
Frozen cryosections were extracted in cell lysis buffer. Tumour tissue contained >95% pure tumour as determined by haematoxylin and eosin staining of every fifth section. Samples were resolved by SDS-PAGE, transferred to nitrocellulose membrane and probed with antibodies against DR5 (1:10 000 Imgenex, clone 45B872.1), GAPDH (1:20 000 Imgenex, clone IMG-5019A-1) or ADAMDEC1 (1:600 Abnova, Taipei City, Taiwan, Clone 64C). Signals were developed using SuperSignal West Femto Maximum Sensitivity Substrate (Pierce Biotechnology, Rockford, IL, USA).
Statistical analyses
Statistical analysis of polymorphism frequency and haplotype (LD) data involved the use of contingency tables. The strength and probability of association were measured using the R-squared statistic and chi-squared distribution respectively. Comparison of mean Ct values in real-time gene expression analyses was assessed using the independent samples T-test. An alpha level of 0.05 was set as the significance threshold.
Discussion
Disruption of 8p is common in many cancers and could simply indicate the relative instability of this region such that disruption is a consequence of disease rather than playing a causative role in tumour progression. In CRC 8p loss has been implicated in later stage disease and metastasis [
13‐
15] and this study again highlights 8p identifying a 2 Mb region of metastasis-specific loss at 8p21-22. In addition, there is compelling evidence for the role of several 8p genes in carcinogenesis, including a number studied here, such as the prostate tumour suppressor NKX3.1, TRAILR DR5, DBC2 and STC1. This tends to argue against 8p disruption being primarily a consequence of tumourigenesis.
In this study the most promising candidate at the mRNA level was ADAMDEC1. We observed decreased mRNA expression in CT and LM compared to CN (Figure
4b). No detectable protein was expressed in 13 LM, and in 3/13 matched CT samples ADAMDEC1 was detected which adds weight to the possibility that loss of expression is progressive through tumourigenesis and may play a role in metastasis. (Figure
5). ADAM family members are involved in cancer progression[
49] adding further support to the possibility that this unique family member also has a role in tumourigenesis.
We also identified a germline mutation of DR5 which may provide additional insights into the function of this TRAILR. C790T truncates DR5 (Figure
3b) resulting in a protein devoid of the death domain and a potential functional similarity to DcR2. Several studies have also identified truncating mutations of DR5 located prior to the death domain [
52‐
55]. One (another germline mutation) showed loss of the growth suppressive function of wild-type DR5 in HNSCC (head and neck squamous cell carcinoma), ovarian and CRC cell lines [
53]. Despite the diagnosis of synchronous liver metastases the C790T patient did not develop extra-hepatic metastases, responded well to hepatic chemotherapy (5-flurouracil (5-FU)) and SIRT (selective internal radiation) and had > 5-year survival post LM diagnosis. Inducible loss of DR5 protein expression promotes the growth of colon tumours in mice and confers resistance to 5-FU, without causing resistance to TRAIL-induced apoptosis [
56]. This is in contrast to the clinical observations for the C790T patient (slow tumour growth and p53-responsiveness to 5FU and SIRT).
The heterogeneous or "patchy" C790T DR5 immunostaining and lack of a wild-type DR5 in C790T LM by western analysis suggests complete loss of the wild-type DR5 in C790T LM. The clinical data indicate that the C790T DR5 may have a dominant negative effect, similar to DcR2, including retention of the ability to respond to p53-dependent therapy, and prevention of controlled proliferation, in contrast to null DR5 experimental models [
56].
In light of the wealth of evidence implicating 8p in CRC progression it is perhaps surprising that no strong candidate tumour and/or metastatic suppressor has been identified. Other possibilities are that the 'candidate(s)' could be a microRNA or other non-coding RNA or that haploinsufficiency (rather than gene 'knock-out') is sufficient for tumourigenesis. Alternatively, a single gene/RNA may not be the main 'effector' but rather it could be a combinatorial effect whereby a number of genes are involved and perturbation of them all, or a subset thereof, results in tumour progression.
The 2 Mb region in this study certainly appears to be a hot-spot for genes involved in carcinogenesis, and contains 3 gene clusters, TRAILR, ADAM and NKX3.1/NKX2.6, each encoding members with a role in tumour progression. There is evidence for the clustering of co-expressed genes in eukaryotes [
57], as well as increasing recognition that dynamic chromosomal architecture and genomic repositioning play an important role in gene regulation [
58]. An indication that clustering is of functional importance at 8p21-22 is suggested by the observation of co-regulation at the mRNA transcriptional level and co-methylation patterns for the TRAILR pairs DcR1 and DcR2 and DR4 and DR5 in neuroblastoma cell lines [
59]. We performed Pearsons' correlation analysis on the gene expression data for the 13 candidate genes in both CT and LM. This revealed potential transcriptional relationships between a number of genes including DR4 and DR5 (Additional file
6) which adds support to the possibility that the clustering of 'tumour' genes within this region is of functional significance.
In addition, this possibility is further supported by recent evidence demonstrating that the nuclear protein SATB1 acts as a 'genomic organiser' involved in the epigenetic remodelling of chromatin to facilitate upregulation of metastasis-associated genes and down-regulation of tumour suppressors [
60]. Although the genes investigated by Han et al were not clustered, 8p21-22 may be a key candidate target of such regulation, the clustering providing a further mechanism for co-ordinated control.
Metastasis might be viewed as a complex disorder in which genetic and environmental factors interact, subtle modulations of cellular activity being required to facilitate survival. We propose that 8p21-22 may not contain a CRC metasatasis suppressor(s) and that the clustering of a large number of genes in one region under co-ordinated control bears closer resemblance to a complex disease, whereby the overall combined profile of multiple genes contributes to the phenotype.
Acknowledgements
We are very grateful to Anthony Croft, Annie Gibson and David Young for excellent technical assistance, to Lisa McCallum for preparation of the figures, to Aloka Bhattacharya for statistical advice, to John Groom for CRC samples, to Lorraine Berry for the excellent sequencing service (Alan Wilson Centre Genome Service, NZ) and The Wellington Medical Laboratories for preparation of tissue sections. We also thank The Wellington Medical Research Foundation, The Cancer Society of New Zealand (Wellington branch), The Wakefield Clinic, Wakefield Hospital, The Wakefield Gastroenterology Research Trust and The Institute of Environmental Science and Research capability fund for funding this work.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
DPM–C carried out the semi-quantitative real-time PCR, contributed to the mutation analyses and study design, and drafted the manuscript. KAH participated in the IHC, study design and manuscript preparation. AW and HjS performed the IHC. TW carried out the mutation analyses. RO'C was involved in the IHC and critical reading of the manuscript. DAH and RAL performed the statistical analyses. JAR participated in IHC, study design and manuscript preparation. RSS provided clinical expertise, clinical samples and critical reading of the manuscript. SR conceived the study, participated in its design, performed LOH analyses, and helped with manuscript preparation. All authors read and approved the final manuscript.