Background
Matrix metalloproteinase
(MMP)-1 (Collagenase-1) is a major proteinase of the
MMP family that specifically degrades type I collagen, which is a major component of the extracellular matrix (ECM), as well as other fibrillar collagens of types II, III, V and IX [
1,
2].
MMP-3 (Stromelysine-1) is responsible for degradation of type IV collagen, which forms the basement membrane, and collagen V, IX, X [
3].
MMP-3 also has a role in activation of
proMMP-1 in tumor tissue into the active form of
MMP-1 [
4]. Gene expression data in our previous report demonstrated enhanced expression of
MMP family genes in OSCC tissues, and suggested correlation of high expression levels of
MMP-1 and
MMP-3 with aggressive behavior, such as metastasis, and clinical prognosis [
5]. Similar correlations have been reported in pharyngeal, colon and various other tumor types [
6‐
8]. Colocalization of
MMP-1 and
MMP-3 with destruction of ECM in the invasive front of cancer tissue suggests a direct role in cancer invasion [
9].
It has also been shown that a function of
MMPs affects susceptibility to different kinds of carcinoma. To date, polymorphisms of the promoter domain have been described in
MMP-1, -3, -9, -12 to influence the expression level of the genes [
10]. A 2G type of single nucleotide polymorphism (SNP) at -1607 bp site in the promoter domain of
MMP-1 creates a sequence, 5'-GGA-3,' that is the core recognition sequence of the binding site for Ets family transcription factors. The 2G type promoter results in higher transcription activity of the
MMP-1 gene than does a 1G type promoter [
11]. A 5A type promoter at -1171 bp site of
MMP-3 is also known to have a twofold higher transcriptional activity in vitro than that of a 6A type [
12]. It has been documented that the 2G type SNP of
MMP-1 confers increased susceptibility to colorectal [
13], ovarian [
14], lung [
15], endometrial [
16], renal cell [
17] and head and neck [
18] cancers; and the 5A type SNP of
MMP-3 is associated with an increased susceptibility to breast cancer [
19].
An in situ hybridization study revealed that
MMP-1 expression in normal oral mucosa is controlled at a low level, whereas a remarkably elevated expression level is observed in cases of oral epithelial dysplasia, which becomes even higher in cases of OSCC [
20]. It has also been documented that cases of oral epithelial dysplasia showing high expression level of
MMP-1 developed into OSCC at higher frequency than cases with low expression of
MMP-1 [
21]. Taking all the observations noted above into consideration, it seems likely that
MMPs may serve as key factors in all stages of the OSCC progression from carcinogenesis in the early precancerous condition to the advanced invasive and metastatic phases.
The purpose of this study is to document the effect of genomic polymorphisms of MMP genes in the development of OSCC. We compared genotype distribution in the promoter domains of the functional SNPs that influence the transcriptional activity of MMP-1 and MMP-3 between OSCC patients and healthy control groups. Multivariate analysis was effectively used to assess correlations among parameters such as OSCC, the genotypes, age and sex. In this report, we describe the role of functional SNP of the MMP-1 gene in susceptibility to OSCC and, as a remarkable finding; we discuss the crucial impact of the MMP-1 2G allele in the development of OSCC in younger individuals.
Methods
Study subjects
The tested cases were all unrelated native Japanese comprising 170 cases of OSCC (107 males, 63 females; average age 56.5 ± 13.9 years) who were histopathologically diagnosed as differentiated squamous cell carcinoma. The controls comprised 164 (104 males, 60 females) healthy subjects who did not have a history of malignant tumors and were frequency-matched to the cases by age (± 5 years; average age 51.5 ± 14.7 years). All OSCC subjects were patients who had been treated in the Dental Department of Niigata University Medical and Dental Hospital, Special Dental Care and Oral Surgery, Shinshu University Hospital, and Division of Oral Surgery, Nagaoka Red Cross Hospital.
Blood samples were taken after obtaining the patients' informed consent to participate in the study and processed anonymously. All cases were diagnosed histopathologically as OSCC. The study protocol was approved by the ethics committees of each institution.
Genotyping of MMP-1 and MMP-3
5 ml of blood was obtained from the subjects and used as the source of peripheral blood lymphocytes. 0.2% NaCl was added for destruction of red blood cells, followed by addition of TNE buffer, 10% SDS and Proteinase K (MERCK Co., Darmstadt, Germany). After incubation at 58°C for more than six hours, genomic DNA was extracted by phenol-chloroform treatment and ethanol precipitation. The reaction was performed in a 25 μl volume made up of 70 ng genomic DNA, 2.25 μl of the specific forward/reverse primer (10 μM), 1 μl of TaqMan® MGB probes (5 μM), 12.5 μl of TaqMan® Universal Master Mix (Applied Biosystems, Foster City, CA, USA). PCR cycling conditions were 10 min of initial denaturation at 95°C followed by 35 cycles of 15 sec denaturation at 92°C and 1 min of one step annealing/extension at 60°C for MMP-1 or 62°C for MMP-3 (ABI Prism® 7900 HT Sequence Detection System, Applied Biosystems). Combination of the probe/primer used for the MMP-1 SNP were: Forward primer, 5'-TGCCACTTAGATGAGGAAATTGTAGT-3' and reverse primer, 5'-ACACTTTCCTCCCCTTATGGATTC-3', TaqMan® MGB probes, FAM for 1G, 5'-ATAATTAGAAAGATATGACTTATC-3' and VIC for 2G, 5'-ATAATTAGAAAGGATATGACTTAT-3'; used for the MMP-3 SNP were: Forward primer, 5'-ACATCACTGCCACCACTCTGTT-3' and reverse primer, 5'-GGCACCTGGCCTAAAGACATT-3', TaqMan® MGB probes, FAM for 5A, 5'-AAGACATGGTTTTTC-3' and VIC for 6A, 5'-AGACATGGTTTTTTC-3'.
Statistical analysis
The Chi-square test was used to examine the differences in genotype distribution of the MMP-1 and MMP-3 promoters between the OSCC cases and control groups, and to estimate correlation or synergistic effects of MMP-1 genotypes with regard to clinical consequences as well as environmental factors among the OSCC cases. A p-value of < 0.05 was considered as statistically significant. Univariate analysis was performed by Fisher's exact test (two-sided) on gender, carrier state of MMP-1 1G allele (1G+ or 1G-) and 2G allele (2G+ or 2G-) between the OSCC and control groups. In the consideration of latent interrelations between factors, the effects of MMP-1 2G allele, age and gender were estimated by a multivariate logistic regression model. For each parameter, the OSCC risk was accounted by Odds Ratios (OR) and 95% Confidence Intervals (95% CI). All of the statistical analyses were performed using the SPSS 11.5J software package (SPSS Japan Inc., Tokyo, Japan).
Discussion
In this study, we examined SNPs in the promoter regions of
MMP-1 and
MMP-3 genes in relation to OSCC risk with case-control analyses. Significant differences, i.e., high frequency of 2G/2G genotype and decreased frequency of 1G/1G genotype, were observed in the
MMP-1 genotype distribution in OSCC cases (
p = 0.034, Table
1). Similarly, in comparisons of allele frequency a significant correlation was detected between onset of OSCC and genotypes that carry the
MMP-1 promoter 2G allele in homo- or hetero-form (
p = 0.016, OR = 2.39, 95%CI = 1.21–4.72).
MMP-1 with the 2G type promoter caused a higher expression level of
MMP-1 in tissues [
11]. The biological mechanism of the elevated risk of OSCC as related to the 2G allele of
MMP-1 promoter includes genetic instability, which is accompanied by the cell cycle activation caused by a sequence of events led by increased
MMP-1 enzyme activity, i.e. activation of tissue disruption, reconstruction and resultant release of ECM binding growth factors. The relationship between
MMP-1 promoter polymorphism and risk of OSCC has been investigated by Lin
et al. in a group of 121 cases [
22] and by Cao
et al. in a group of 96 cases [
23] and by Vairaktaris
et al. in a group of 156 cases [
24]. Although both Lin
et al. and Cao
et al.reported an elevation of OSCC risk correlated with the
MMP-1 2G allele, further studies were needed to reach a conclusion mainly because the numbers of cases in the previous studies were relatively small, and there were differences between these reports in background analyses on correlation with environmental risk factors, such as smoking and areca use. In this study, significant correlations were found between the presence of the
MMP-1 promoter 2G allele and increased OSCC risk among 170 Japanese OSCC patients. These results are consistent with existing reports on malignant neoplasms in general. It is notable that a new finding on the molecular function of
MMP-1 in the onset of OSCC was obtained from the characteristic pattern of the
MMP-1 promoter genotype distribution in younger patients.
Interestingly, Vairaktaris
et al. reported an increased risk of oral cancer with MMP-1 1G/2G polymorphism [
24]. The discrepancy of the results of the Chinese studies and our report on one hand and the European (German and Greek) study on the other hand may be explained by the diverse ethnic background of the different studied populations. Another point of difference is the fact that their patient sample included patients with positive family history of thrombophilia.
The observed bias of the average age by the
MMP-1 promoter genotype among the 170 OSCC cases of this study suggested an influence of the
MMP-1 promoter 2G allele on the age of OSCC onset. The scatter plot of age on the
MMP-1 promoter genotypes also revealed disappearance of the 1G/1G-genotype distribution among the OSCC cases under 45 years old. In agreement with this observation, the ROC analysis suggested that the age of 45 years is the borderline age above which a change occurs in the incidence of OSCC. Although the specific reasons for these results have not been clarified, they suggest that some kind of biological conditions related to carcinogenesis have initiated around the age of 45. Carcinogenesis is caused by synergistic effects of various factors [
25,
26]. The multivariate logistic regression analysis showed that aging and presence of the
MMP-1 2G allele (i.e., 2G/2G or 1G/2G) are independently involved in onset of OSCC. In fact, it was clarified that the significance of the presence of the
MMP-1 2G allele was lower in the subject group 45 years old or older (
p = 0.238, OR = 1.65, 95% CI = 0.75–3.55), and that the impact of the allele was highly significant in the younger group, which was under 45 years old (
p = 0.014, OR = 9.67, 95% CI = 1.20–78.15) (data not shown).
As concrete causes of OSCC, mainly tobacco smoking and alcohol usage and, in some cases, viral infections have attracted attention as environmental causative factors [
25,
27]. It has been suggested that tobacco smoking and alcohol usage alone may not explain the mechanism of the entire early onset of OSCC, because the duration of exposure to these risk factors in young OSCC patients is shorter than in the older group, and also because there are some cases with stable incidence that have no known risk factors [
28]. The association with smoking and habitual drinking has been supported as the risk factors of OSCC, which generally shows a higher incidence in older age, but other investigators believe that the mechanism of the early onset OSCC is fundamentally different from that of elderly onset OSCC [
25]. Cao
et al. considered the relationship with smoking as a behavioral risk factor and the
MMP-1 2G allele as a genetic risk factor in the OSCC group [
23]. In lung cancer, it has been similarly shown that a genetic factor of the
MMP-1 promoter 2G allele increases the risk of cancer that occurs in a tobacco-usage-dependent manner only in cases with a history of tobacco use. These reports support the role of
MMP-1 promoter polymorphism as an endogenous background factor, in contrast to exogenous environmental factors [
15]. However, no evidence to support a notion of synergistic interactions between risk factors, such as habitual smoking and drinking and
MMP-1 promoter polymorphism in OSCC cases, was shown in this study. Further investigations with regard to frequency and duration of exposure are required to consider interactions between environmental factors and multiple genetic background factors.
Examples are known of malignant neoplasms caused by genetic factors, for example, mutations in
RB in Retinoblastoma [
29],
p53 in Li-Fraumeni Syndrome [
30], and
APC in familial adenomatous polyposis [
31]. There are also reports of mutations in
BRCA1 and
BRCA2, which affect familial breast cancer occurrence, though their penetrance is low [
32]. These are neoplasms that are all caused by loss-of-function mutations in molecules functionally classified as tumor-suppressor genes, and they are characterized by familial, juvenile or young onset and may be multicentric or bilateral. Although incidents are rare in the population, they are examples of germline mutations that directly involve heterofamilial tumorigenesis.
By contrast, the
MMP-1 promoter 2G allele is a genetic polymorphism that exists at the high allele frequency of 80% to 90% in the general population. It is possible to call this a hereditary trait that is shared among races or humans in general. Other genetic factors that are classified into similar polymorphism as
MMP-1 have also been reported, such as Cyclin D1 (
CCND1) in head and neck squamous cell carcinoma (HNSCC) and colorectal cancer [
33,
34], xeroderma pigmentosum complementary group D (
XPD), DNA damage binding protein 2 (
DDB2), and
MMP-9 in lung cancer [
35‐
37]. Similar to the effects of mutations in tumor suppressor genes, diversity in gene expression level and molecular structure caused by genetic polymorphisms affect monitoring and repair mechanism of DNA replication, as well as control of the cell cycle, ultimately resulting in genetic instability. The common mechanism of carcinogenesis caused by those genetic factors is an elevated carcinogenic risk due to this genetic instability.
As examples of genetic polymorphisms that affect onset age of cancers other than that examined in this study, some reports discuss
MMP-1 and
DDB2 in lung cancer [
15,
36], and
CCND1 in HNSCC and colorectal cancer [
33,
34]. These genetic factors, on the other hand, are present in patients with cancer as well as in the general population at certain frequencies. Therefore, it is hard to conclude that these genetic factors are the primary factors in early onset carcinogenesis, unlike germline single-gene mutations in
Rb and
APC that induce juvenile or early onset of cancers with high penetrance. Aging brings exposure to various carcinogenic factors and is associated with inevitable accumulation of genetic and epigenetic modifications of genes. These accumulations interact synergistically with biological background factors on the host side, and consequently cancer may develop [
26,
38]. It seems that inherited genetic factors play a larger role in development of early onset cancer that has undergone a relatively short duration of exposure to carcinogen through environment and lifestyle habits. Therefore, it is conceivable that the impact of these genetic factors would appear more directly in younger than in older cases, although we still expect a synergistic involvement of various environmental and genetic factors. Nevertheless, because of the disappearance ofthe
MMP-1 1G allele distribution observed in the OSCC cases with a clear boundary under the age of 45 years, the
MMP-1 promoter 2G allele should be recognized as an essential genetic precondition for the development of early onset OSCC.
It is said that an onset age of 45 years and younger accounts for about 6% of OSCC cases [
27]. It should be noted that in this study we found that the tongue was the primary site in 25 cases (86.2%) of 29 early onset OSCC cases in individuals under 45 years old. This primary site was obviously different from that in patients 45 years old and older in whom we noted 57 cases of tongue cancer (40.4%) out of 141 OSCC cases. Similar tendencies have been reported in previous studies [
39,
40]. These findings suggest the possibility that each primary tumor sites in the oral cavity may be associated with differences in cancer susceptibility, specific carcinogenic stimulation, or genetic background. However, no environmental or genetic factors specific to a particular site of the oral mucosa have been identified for OSCC. It is conceivable that it would be important to carry out further investigations on genetic and environmental risk factors for each anatomical site of the oral regions, though we are not able to discuss this aspect of OSCC because the number of cases was inadequate in this study.
Competing interests
The author(s) declare that they have no competing interests.
Authors' contributions
RN, MN participated in the design of the study. RN, MN and AAN drafted and wrote the manuscript. NK participated in the statistical analysis. RN, MN and AAN participated in the production of genotype data. RN, MN, KK, MO and HK participated in the acquisition and interpretation of data. RN, MI, HF, TK and AAN participated in the experimental studies. RN, MN, AAN, HH and SS carried out the clinical studies. SC, HY and RT participated in the review of the study. All authors read and approved the final manuscript.