Abstract Aldehyde dehydrogenases (ALDHs) are a group of enzymes that are responsible for oxidation of a variety of aldehydes. ALDH isoforms (ALDH1A1 and ALDH3A1) are highly expressed in non-small cell lung cancer (NSCLC) cell lines. Recent evidence suggests that elevated levels of these enzymes may be associated with malignant behavioral properties of cell subsets in epithelial malignancies. It is not known whether cell subsets with high ALDH expression are present in advance stage lung cancer patients, or whether ALDH expression is associated with malignant behaviors (e.g. tumorigenicity) in lung cancer cell subsets. We hypothesized that the ALDH1A1-biomarker is present in advanced lung cancer, and that as in other epithelial malignancies, its expression predicts for lethal behavioral properties. We isolated lung tumor cells from advanced stage lung cancer patients (MPE), and maintained them in primary culture in presence of MPE fluid (an “autologous tumor microenvironment”). ALDH labeling by immunohistological methods revealed high intratumoral variability with respect to biomarker expression. To live detect MPE-primary culture cells, the Aldefluor (StemCell Technologies Inc.) method of Fluorescence Activated Cell Sorting (FACS) was used. 4-8% of MPE-primary culture cells expressed high level of ALDH1A1, whereas the majority of the cultured cells expressed intermediate or low levels of ALDH1A1. Interestingly, the ALDH1A1hi cell subset also expressed high levels of the CD44 surface biomarker. CD44 is another widely studied biomarker that has been associated with “cancer stem cell” properties. The ALDH1A1hi subset co-expresses 2 to 20 times higher CD44 expression, as compared to the ALDH1A1lo subset. Importantly, the cells that dually label for CD44hi and ALDH1A1hi exhibit increased soft agar colony forming efficiency in vitro, and increased tumorigencity in vivo. Limiting dilution studies of xenotransplantation in NOD/SCID mice also provide experimental evidence that clinical (MPE) biospecimens of some lung cancers possess ALDH1A1hi/CD44hi “cancer stem cells” (as evidenced by tumorigenesis following less than 1000 implanted cells). The tumors that emerge from the implantation of these lung “cancer stem cells” display phenotypic heterogeneity with respect to both CD44 and ALDHA1 expression. Collectively, these data provide experimental evidence for tumorigenic subsets in clinical lung cancer biospecimens, and suggest that ALDHA1 and CD44 expression are jointly regulated by a common oncogenic program in lung cancer cells. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 492. doi:10.1158/1538-7445.AM2011-492
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