Background
Radiation therapy (RT) improves the prognosis of locally advanced lung cancer. However, most patients succumb to distant metastasis [
1]. Previous studies showed that a sublethal RT dose induces the up-regulation of matrix metalloproteinase 9 (MMP-9), which promotes cancer cell survival and metastasis [
2]. The upstream targets that promote the up-regulation of MMP-9 in irradiated lung cancer cells remain unclear.
The epidermal growth factor receptor (EGFR) family is a group of transmembrane proteins that affect tumor cell viability [
3]. As proto-oncogenes, overexpressions of EGFR families are found in multiple cancers. These genes play important roles in tumor progression by helping cells escape apoptosis and by promoting DNA repair and malignant cell metastasis [
4]. Radiation stimulates the dimerization and auto-phosphorylation of EGFR family proteins and activates downstream signaling pathways [
5‐
8]. Prior clinical investigations showed that EGFR inhibition sensitizes cancer cells to RT and improves locoregional cancer control [
9].
For EGFR mutated NSCLC, EGFR tyrosine kinase inhibitors (TKIs) including afatinib and erlotinib show higher response rates and longer progression-free survival than platinum-based chemotherapy [
10]. Afatinib covalently binds to EGFR, HER2, and HER4, and irreversibly inhibits tyrosine kinase autophosphorylation and downregulates ErbB signaling. Compared with erlotinib, a reversible EGFR tyrosine kinase inhibitor, afatinib has a broader spectrum with a theoretically better radio-sensitizing effect on cancer cell survival and a lower risk of metastasis [
11]. Although the clinical efficacy of TKIs is well-established in patients with NSCLC, the benefit of combining EGFR TKIs with RT in this population remains uncertain.
We hypothesize that sublethal radiation activates EGFR and HER2, which subsequently up-regulates MMP-9 and associates with lung cancer cell survival and invasiveness. In this study, we showed that sublethal radiation doses increase phosphorylation of EGFR, HER2, and downstream Akt, ERK, and p38, and increase MMP-9 production in Lewis lung carcinoma (LLC) cells in vitro. Dual inhibition of radiation-induced EGFR and HER2 activation with afatinib strongly inhibited MMP-9 up-regulation and cell invasiveness in vitro and abolished pulmonary metastases in vivo in mice. HER2 inhibition with afatinib or its knock-down sensitized cancer cells to sublethal radiation.
Methods
Cell lines and cultures
The murine LLC cell line was obtained from the American Type Culture Collection. Cells were cultured at 37 °C in a humidified atmosphere of 5% CO2 and 95% air. Cell cultures were maintained in DMEM supplemented with 10% fetal bovine serum and penicillin/ streptomycin.
Radiation treatment
LLC cells cultured in flasks were irradiated with different doses of radiation (0-10Gy), using a Cobalt-60 unit. The distance from the radiation source to the bottom of the flask was set at 80 cm. The dose rate was around 1 Gy/minute.
Reagents
Afatinib and erlotinib were both purchased from Selleck Chemicals (Houston, TX). Afatinib and erlotinib were prepared in DMSO and 50% acetonitrile, and further diluted in culture medium before dosing for in vitro experiments. Both of them were suspended in a vehicle [0.5% methylcellulose (w/v) and 0.4% Tween 80 (v/v) in sterile water] for oral administration. For in vivo experiments, a daily dose of 10 mg/kg for afatinib or 50 mg/kg for erlotinib was administered to C57BL/6 mice (n = 42) bearing tumors for 7 days.
Western blot analysis
Aliquots of cell lysates containing the protein extracts were loaded in each lane and separated by SDS-PAGE (8–15% polyacrylamide). After blocking, the membranes were probed with various antibodies. Bound antibodies were detected using the appropriate peroxidase-coupled secondary antibodies followed by the enhanced chemiluminescence detection system.
Gelatin zymography
The supernatant of LLC cells (5 μl) was analyzed by sodium dodecyl sulfate–polyacrylamide gel electrophoresis on 10% polyacrylamide gels containing 1 mg/ml gelatin. The detailed method was previously described [
12].
Reverse transcription-polymerase chain reaction
The detailed method was previously described [
12]. Specific gene cDNA was cloned and amplified by PCR with following primers: β-actin (sense 5′-CTCCTATGTGGGTGACGAGG-3′ and antisense 5′-CTTTTCACGGTTGGCCTT-3′ amplified a 202-bp fragment), and mouse MMP-9 (sense 5′-AACCCTGTGTGTTCCCGTT-3′ and antisense 5′-GGATGCCGTCTATGTCGTCT-3′ amplified a 486-bp fragment).
Boyden chamber invasion assay
A total of 10
5 cells were added to the upper chamber of invasion chamber inserted 50 μl (10 mg/ml) of Matrigel (Becton-Dickinson, Bedford, MA). After cell attachment, the medium was changed to serum-free medium, with each drug added for 30 mins, and the cells were irradiated. The detailed methods were previously described [
12]. The experiments were repeated for three times.
LLC cells (1 × 103/well) were cultured in 6-well plates, treated with different doses of radiation following a 1-h pretreatment with afatinib or erlotinib on day 1, incubated for 7 days, and stained with 0.5% crystal violet in 10% methanol for 30 min at room temperature. The number of colonies (clusters of more than 50 cells) was counted in each well using an inverted phase-contrast microscope at 100x magnification and photographed. The experiments were repeated for three times.
HER2 RNAi and stable transfection
To knock down HER2 gene expression, we used a target-specific lentiviral vector plasmid encoding a 19–25 nt hairpin shRNA (Santa Cruz Biotechnology; cat. no. sc-29,405-SH). The methods were previously described [
12]. The efficiency of the HER2 knockdown (HER2-KD) in LLC cells was confirmed by Western blot analysis.
In vivo ectopic tumor model
Male, 5- to 6-week-old, C57BL/6 mice (National Taiwan University Animal Center, Taipei, Taiwan) were used. Ectopic tumors were established by subcutaneous injection of LLC cells (1 × 10
6) into right hind limb of mice. At 8 days after implantation, mice were immobilized in a customized harness that the right hind leg exposed. The thigh tumor was irradiated with five 10-Gy fractions on days 8–12 with a linear accelerator (Elekta Oncology System Ltd., Crawley, West Sussex, UK). Small animal positron emission tomography (PET)/ computed tomography (CT) scans with [
18F]-2-fluoro-2-deoxyD-glucose (FDG) were performed on days 9 and 11. All the animal care, handling procedures, and experimental protocols were approved by the Committee of Experimental Animal Management at College of Medicine, National Taiwan University. The detailed methods were previously described [
13].
Histological evaluation and interpretation
Mice from each group were sacrificed on day 10. The tumor was fixed in 10% neutral buffered formalin and processed for histopathological and IHC staining. After fixation, tumor tissues were embedded in paraffin blocks and sectioned (10 μm). Tumor cells were identified in representative stained sections. The expressions of HER2 (Roche, Ventana, PA) and MMP-9 (BioSB, Santa Barbara, CA) were evaluated after immunohistochemical staining using specific antibodies. All images were digitally captured on an AxioImager. M1 (Zeiss) under 100x field and imaged. The color deconvolution tool, a plugin of TMARKER software [
14], was used to count the total cell counts under the fields and the indicated stained cells.
Statistical analysis
Data were presented as the mean ± standard deviation for the indicated number of separate experiments. Differences between pairs of treatment group were tested using the Student’s t-test, and a p value less than 0.05 was considered statistically significant.
Discussion
NSCLC is one of the leading causes of cancer-related mortality worldwide. More than 60% of the patients have unresectable disease when they are diagnosed. In NSCLC, the overexpression of the EGFR and HER2 proto-oncogenes is closely associated with tumor progression, treatment resistance, invasion, and metastasis [
4,
15]. In published meta-analyses on NSCLC patients, HER2 overexpression was associated with poor prognosis, and a prognostic impact was confirmed in up to 35% of the patients [
16‐
18]. The standard treatment for unresectable locally advanced NSCLC is RT combined with concomitant chemotherapy [
19,
20]. The current treatment paradigm is ineffective, as the majority of the patients succumb to distant metastatic dissemination. Previous study showed that MMP-9 derived from sublethally irradiated lung carcinoma cells plays an important role in radioresistance and in initiating metastatic cascades [
12]. Furthermore, other studies have shown that not only EGFR expression up-regulates the MMP-9 production, radiation stimulated HER2 and EGFR heterodimerization also activates the AKT signaling pathway and eventually increases MMP-9 production [
21]. In this study, we underscore the crucial role of HER2 expression in MMP-9-mediated radiation-induced LLC cell invasiveness and metastasis. Though Afatinib or Erlotinib alone showed no significant difference in tumor cells proliferation activity. Compared to the inhibition of EGFR by erlotinib, the dual inhibition of EGFR/HER2 by afatinib more effectively suppressed MMP-9 transcription and translation in vitro. HER2 inhibition by afatinib or the genetic knockdown of HER2 effectively mitigated cell invasiveness, radioresistance, and metastases of the irradiated LLC tumors in vivo.
The EGFR/HER2 signaling network is pivotal in controlling cancer proliferation and metastasis through the downstream effectors of AKT, ERK, and STAT3 [
22‐
24]. Furthermore, hyperactivated HER2 signaling upregulates the cyclin D complex, promoting tumor cell invasion and metastasis [
25,
26]. Afatinib decreases phosphorylation between ErbB dimers more effectively than erlotinib and it has been reported to overcome therapy resistance to EGFR TKI in lung cancer clinically [
27,
28]. The off-target effect of afatinib on tumor metastasis cannot be underestimated and has been reported in previous studies [
29]. Besides the inhibition of MMP-9, MMP-2 expression and the ratio of Bax/Bcl-2 decreased evidently with increasing afatinib concentrations. MMP-2 was reported to be a determinant of metastatic potential for cancer cell. The decreased Bax expression was associated with distant metastases and a more infiltrative growth pattern in colorectal cancer [
30]. Furthermore, in patients with advanced NSCLC harboring common EGFR mutation (Del19/L858R), the overall survival improved with first-line afatinib use over chemotherapy [
31]. Previous studies have reported variable radiosensitizing effects of afatinib in different cell lines, including NSCLC cells with gefitinib resistant mutation, hypopharyngeal carcinoma cells and glioma cells [
32‐
34]. Although EGFR TKIs have been reported with the inhibitory activity on HER2 and MMP-9 at much higher concentrations [
35,
36], our data showed a less potent radiosensitizing effect of 1-μM erlotinib than 100-nM afatinib.
The LLC cell line is primarily used to model metastasis and evaluate the efficacy of therapeutic agents in vivo [
37]. Although the cell death following mitotic catastrophe induced by irradiation may occur up to 6 days following irradiation, invasiveness and tumor metastasis may develop within 48 h after irradiation [
38]. Thus, the early inhibition of cancer cell metastasis in the first 48 h post-RT is critical for improving therapeutic outcomes. In our study, afatinib, but not erlotinib, reduced MMP-9 expression in cell lysates 12 h following irradiation. The result implies that afatinib is able to reduce the metastatic potential of LLC cells in the early phases after RT. This finding emphasizes the importance of pretreatment with afatinib before RT, especially in a cell line overexpressing HER-2, to prevent initiating the metastatic cascade before the death of the primary irradiated tumor.
This study has a few limitations. First, afatinib may exert off-target effects on protein kinases other than EGFR and HER2. The potential off-target effects of afatinib may need to be tested in HER2-KD LLC cells. Second, angiogenesis has been one of the key mechanisms that mediate radiation-activated pulmonary metastasis. The association between HER2 signaling and angiogenesis cascade warrants further elucidation. Lastly, our findings in murine tumor model may not be fully translated to human lung cancer.
Conclusions
Afatinib is more effective than erlotinib in reducing survival and invasiveness of irradiated LLC cells in vitro by inhibiting cell proliferation/viability, deactivating the EGFR/HER2 signaling proteins, and partly by decreasing MMP-9 production. In mice, the pharmacological or genetic HER2 inhibition enhanced tumor control and decreased the metastatic potential of the irradiated LLC tumors. Therefore, targeting HER2 can effectively improve the response to RT in lung cancer and prevent subsequent metastatic cascades.
Acknowledgements
We thank the staff of the imaging core at the First Core Labs, National Taiwan University College of Medicine, and the Eighth Core Lab, Department of Medical Research, National Taiwan University Hospital for technical assistance during the study.
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