Human Primary Squamous Cell Carcinoma Research Articles

155 A biomarker function of HMGA2 in cutaneous squamous cell carcinoma development

The high mobility group AT-hook 2 (HMGA2) gene encodes a transcription factor that is expressed during embryonic development but down-regulated in adult tissues. Re-expression of HMGA2 in adult tissues is often associated with both benign and malignant tumor formation. HMGA2 has been identified as a biomarker of melanoma progression and prognosis, but its role in non-melanoma skin cancer development remains controversial. In this study, we measured HMGA2 expression in normal human keratinocytes and found a significant decrease in HMGA2 mRNA expression in adult keratinocytes compared to neonatal keratinocytes. HMGA2 is highly expressed in human cutaneous squamous cell carcinoma (SCC) cell lines and primary human SCC tumors, but not detected in adjacent normal skin. In mouse skin, Hmga2 has been found to be translocated from the cell membrane into the nucleus during DMBA/TPA-induced skin tumorigenesis. While Hmga2 expression is absent in the hair follicle in non-UV-irradiated mouse, UV irradiation increased Hmga2 expression in both the epidermis and hair follicles. In agreement, we found enhanced Hmga2 expression in UV-induced mouse skin SCCs and also Hmga2 reactivation in the dermis from UV-irradiated mice. Furthermore, oncogene depletion such as FOXM1 and TRIP13 in human SCC cell lines using CRISPR/Cas9 decreased the expression of HMGA2 coupled with decreased cell proliferation and survival. Taken together, these results demonstrate that the upregulation of HMGA2 is an important biomarker of skin SCC tumorigenesis. Moreover, understanding of the mechanism for HMGA2 overexpression in skin hair follicle cells can develop the new drug for skin cancer treatment.

697 Epidermal tissue differentiation requires the uncharacterized protein RED1

The human genome encodes >4,000 uncharacterized open reading frames (ORFs) with undiscovered biological functions. To identify potentially novel mediators of epidermal differentiation from this candidate pool, RNA-Seq of primary human keratinocytes during calcium-induced differentiation was used to screen for uncharacterized ORFs whose transcript levels are increased during this process. The top up-regulated ORF encodes a 50 kD protein that we have termed Regulator of Epidermal Differentiation (RED) 1. An orthogonal screen also identified RED1 as highly down-regulated in primary human squamous cell carcinomas compared to patient-matched normal skin. As malignant neoplasms frequently demonstrate loss of differentiation, we hypothesized that RED1 is required for epidermal differentiation. To test this possibility, we undertook gain- and loss-of-function experiments in organotypic human epidermal tissue. Enforced expression of RED1 accelerated differentiation in regenerated human skin while CRISPR/Cas9-mediated depletion attenuated this process. In each case, whole transcriptome profiling to assess the global impact of altering RED1 expression identified gene groups that control skin differentiation, development, and function. Proximity-dependent biotin ligation assays in organotypic human epidermal tissue identified validated RED1 interactors including envoplakin (EVPL) and periplakin (PPL), genes known to be essential to skin differentiation, as well as genes not previously implicated in skin homeostasis, such as calcyclin binding protein (CACYBP). Gene set enrichment analysis suggests RED1 and its interacting proteins co-control distinct subsets of genes that induce epidermal differentiation and drive neoplastic transformation. Efforts are underway to study RED1s impacts on epidermal neoplasia. RED1 therefore represents a new regulator of epidermal differentiation with potential roles in skin carcinogenesis.

104 Melanoma associated antigen A3 (MAGE-A3) influences proliferation of metastatic squamous cell carcinoma (SCC) in vitro

104 Melanoma associated antigen A3 (MAGE-A3) influences proliferation of metastatic squamous cell carcinoma (SCC) in vitro A Santana, N Roudiani, J Therrien, JH Lee, D Felsen and J Carucci 1 Dept. of Derm., NYU Langone Med. Ctr., New York, NY, 2 Stiefel Laboratories, Research Triangle Park, NC and 3 Inst. for Ped. Urol., Weill Cornell Medicine, New York, NY In order to identify novel targets for cancer immune therapy, our lab has profiled the expression of cancer testis antigens (CTA) in primary human SCC. CTAs are immunogenic and may be suitable targets for immunotherapy, or as biomarkers for aggressive biological behavior. We recently showed that MAGE-A3 is highly expressed in aggressive SCC with poor prognosis. We hypothesized that MAGE-A3 may be a novel target for immunotherapy and/or a biomarker for metastatic SCCs. In this study we determined MAGE-A3 expression in and the effect of antibody treatment on growth of human (A431) and murine (Pam 212 and LY2, BALB/c) SCC cell lines. Pam 212 cells develop locally invasive SCC in syngeneic hosts and LY2 were isolated from a rare Pam 212 metastasis (Yuspa et al., JID, 1983; Dong et al., J Cell Biochem 1997). A431, Pam 212, and LY2 cell lines express MAGE-A3 at the transcript and protein level as measured by qRT-PCR and immunoblot, respectively. Moreover, A431 SCC growth and proliferation was significantly inhibited after MAGE-A3 antibody treatment measured by MTT (P 0.001) and crystal violet (P 0.001). We found that cell growth and proliferation of locally invasive Pam 212 cells was unaffected by anti-MAGE-A3 treatment. However, metastatic tumor derived LY2 cell growth and proliferation was significantly inhibited after MAGE-A3 antibody treatment measured by MTT (P 0.01) and crystal violet (P 0.01). MAGE-A3 expression could potentially serve both as a cancer biomarker and vaccine candidate due to its expression by SCC cells in vitro. Interestingly, MAGE-A3 antibody treatment inhibited the growth of A431 and LY2, SCCs that metastasize in vivo. These results suggest that metastatic SCC may rely on signaling events downstream of MAGE-A3 to support proliferation. Ongoing studies focus on elucidation of pathways involved in MAGE driven SCC proliferation in vivo using immune competent BALB/c mice. 105 Keratinocyte p38a loss results in increased tumor initiation, decreased malignant progression, and altered tumor type specification during two-stage chemical carcinogenesis in murine skin A Kiss, AC Koppel, C Cataisson, J Anders, S Yuspa, P Bible, M Kellett, MI Morasso and T Efimova 1 Anatomy and Regenerative Biology, George Washington University School of Medicine and Health Sciences, Washington, DC, 2 Laboratory of Cancer Biology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD and 3 Laboratory of Skin Biology, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD The p38a signaling pathway not only regulates the inflammation and stress responses, but also controls, in a context-specific manner, the homeostatic balance of cell proliferation, differentiation and survival, deregulation of which is known to contribute to tumor development. Studies in mouse models revealed both tumor-suppressing and tumor-promoting roles of p38a, depending on tissue and tumor type, and tumor stage. However, the in vivo functional contributions of p38a to the skin carcinogenesis remain incompletely understood. We explored the in vivo role of p38a in two-stage chemical skin carcinogenesis using mice with conditional epidermal keratinocyte-specific genetic ablation of p38a (p38a-cKO). Mutant mice exhibited a significantly increased tumor multiplicity, and, in addition to characteristic benign and malignant squamous tumors, developed benign well-differentiated sebaceous adenomas containing a signature activating Hras mutation. Only 4% of tumors in p38a-cKO mice underwent malignant conversion to squamous cell carcinomas (SCCs), compared with 38% of tumors in wild-type (WT) mice (p<0.0001). p38a deficiency resulted in a significantly reduced size and a more differentiated morphology of p38a-cKO SCCs, relative to WT SCCs. RNA sequencing revealed p38a-dependent transcriptional changes in genes involved in cell differentiation, development, proliferation, cell death, and inflammation, both in control and in v-ras-transformed keratinocytes. Altogether, our data reveal novel roles for p38a signaling in control of tumor initiation, malignant progression, and tumor type specification.

Endothelial Cell-Secreted EGF Induces Epithelial to Mesenchymal Transition and Endows Head and Neck Cancer Cells with Stem-like Phenotype

Emerging evidence suggests that endothelial cell-secreted factors contribute to the pathobiology of squamous cell carcinoma (SCC) by enhancing invasive migration and resistance to anoikis. Here, we report that SCC cells within the perivascular niche have undergone epithelial to mesenchymal transition (EMT) in a primary human SCC of a patient that developed distant metastases. Endothelial cell-secreted EGF induced EMT of human SCC cells in vitro and also induced acquisition of a stem-like phenotype. In vivo, tumor xenografts vascularized with EGF-silenced endothelial cells exhibited a smaller fraction of cancer stem-like cells (ALDH(+)CD44(+)) and were less invasive than tumors vascularized with control endothelial cells. Collectively, these results demonstrated that endothelial cell-EGF induces EMT and acquisition of stem-like properties by head and neck tumor cells. On this basis, we suggest that vascular endothelial cells contribute to tumor dissemination by secreting factors that endow carcinoma cells with enhanced motility and stemness.

Isolation and Characterization of Squamous Cell Carcinoma-Derived Stem-like Cells: Role in Tumor Formation

In human epidermis, keratinocyte stem cells (KSC) are characterized by high levels of β1-integrin, resulting in the rapid adhesion to type IV collagen. Since epithelial tumors originate from KSC, we evaluated the features of rapidly adhering (RAD) keratinocytes derived from primary human squamous cell carcinoma of the skin (cSCC). RAD cells expressed higher levels of survivin, a KSC marker, as compared to non-rapidly adhering (NRAD) cells. Moreover, RAD cells proliferated to a greater extent and were more efficient in forming colonies than NRAD cells. RAD cells also migrated significantly better than NRAD cells. When seeded in a silicone chamber and grafted onto the back skin of NOD SCID mice, RAD cells formed tumors 2–4 fold bigger than those derived from NRAD cells. In tumors derived from RAD cells, the mitotic index was significantly higher than in those derived from NRAD cells, while Ki-67 and survivin expression were more pronounced in RAD tumors. This study suggests that SCC RAD stem cells play a critical role in the formation and development of epithelial tumors.

Human skin cancer stem cells: a tale of mice and men

Carcinomas, cancers of epithelial tissues, are the commonest malignancies and cause the greatest cancer mortality worldwide. Among these, the incidence of keratinocyte-derived non-melanoma skin cancers (NMSC), by far the greatest, is increasing rapidly. Yet despite access to tumor tissue, acceptance of human NMSC as a model carcinoma has been hindered by the lack of a reliable xenograft model. Instead, we have relied on the murine two-step carcinogenesis protocol as a reproducible squamous cell carcinoma (SCC) model, but this differs from their human counterpart in cause, site, genetic basis and biological behaviour. By xeno-engraftment of primary human SCC, we were recently successful in demonstrating the presence of primary human SCC cancer stem cells or tumor-initiating cells. These findings once more align the study human SCC as the archetypal carcinoma model. In this review, we describe the evidence for the existence of tumor-initiating cells, with emphasis on skin cancer, limiting our discussions to primary human cancer studies where possible.

A Humanized Stromal Bed Is Required for Engraftment of Isolated Human Primary Squamous Cell Carcinoma Cells in Immunocompromised Mice

Epithelial cancers are the most common malignancies and the greatest cause of cancer mortality worldwide. The incidence of keratinocyte-derived (non-melanoma) skin cancers (NMSCa) is increasing rapidly. Despite access to abundant tumor tissue and ease of observation, acceptance of NMSCa as model carcinomas has been hindered by the lack of a reliable xenograft model. Herein we describe conditions that allow routine xenoengraftment of primary human squamous cell carcinoma (SCCa) cells. Tumor development required creation of an appropriate stromal bed prior to xenografting tumor tissue onto the backs of athymic nude mice. We also demonstrate that the stromal bed must be “humanized” if primary human SCCa is to be propagated from cell suspensions. SCCa xenografts recapitulated the histological grade and phenotype of the original tumors with considerable fidelity, even after serial passage, irrespective of the histological grade of the primary human SCCa. To our knowledge this previously unreported model can be used for drug testing, as well as for studies that are relevant to the biology of primary human SCCa and other epithelial cancers.

Identification and Characterization of Tumor-Initiating Cells in Human Primary Cutaneous Squamous Cell Carcinoma

Primary human squamous cell carcinoma (SCCa) are heterogeneous invasive tumors with proliferating outer layers and inner differentiating cell masses. To determine if tumor initiating cells (TIC) are present in SCCa, we utilized newly developed reliable in vitro and in vivo xenograft assays that propagate human SCCa, and demonstrated that a small subset of SCCa cells (~1%) expressing Prominin-1 (CD133) in the outer layers of SCCa were highly enriched for TIC (~1/400) compared to unsorted SCCa cells (TIC ~1/106). Xenografts of CD133+ SCCa recreated the original SCCa tumor histology and organizational hierarchy, while CD133- cells did not, and only CD133+ cells demonstrated the capacity for self-renewal in serial transplantation studies. We present a model of human SCCa in which tumor projections expand with outer leading edges that contain CD133+ TIC. Successful cancer treatment will likely require that the TIC identified in cancers be targeted therapeutically. The demonstration that TIC are present in SCCa and are enriched in a CD133-expressing subpopulation to our knowledge has not previously been reported.

An in vitro three-dimensional model of primary human cutaneous squamous cell carcinoma.

Squamous cell carcinomas (SCC) represent a substantial clinical problem because of increases, frequent recurrences and successive de novo tumors, especially in organ transplant recipients. To improve upon the current surgical and other non-selective therapies, a validated organotypic in vitro model of primary human SCC needs to be developed. Such a model will have obvious advantages over current cell line and animal based approaches, and may render the latter partly obsolete. In a first approach, an explant technique of primary SCC biopsies onto dermal constructs was used to emulate tumor expansion in an in vitro model. Histological analysis revealed the formation of nests of squamous cells, mimicking an invasive morphological feature of primary SCC. Immunohistochemical analysis comprised an array of markers characteristic of keratinocyte (hyper) proliferation (K6, K16, K17 and Ki67), differentiation (K1, K10 and involucrin), basement membrane (collagen types IV and VII, integrins alpha(6) and beta(4) and laminin 332) and SCC (K4, K13 and Axl). The generated human SCC models displayed disturbed differentiation and keratins associated with hyperproliferation, but a low frequency of Ki67 positive cells. Basement membrane composition of the in vitro SCC model resembled that of normal skin. These results show for the first time that in vitro modelling of three-dimensional growth of primary cutaneous human SCC is feasible. This model may provide a platform to develop refined preventive and curative treatments and thereby gain understanding of SCC pathogenesis.

Tumor–stroma interactions influence cytokine expression and matrix metalloproteinase activities in paired primary and metastatic head and neck cancer cells

This study evaluates the effects of gingival fibroblasts, type I collagen and autocrine/paracrine elements on cytokine expression in paired primary and metastatic human squamous cell carcinoma (HNSCC) cell lines. Additionally, the effects of IL-1alpha, IL-1beta, IL-6, TNF-alpha, TGF-beta and HGF on MMPs and cell invasion were investigated. RT-PCR results indicated the presence of mRNAs for IL-1alpha, IL-1beta, IL-6, TNF-alpha, and TGF-beta in primary and metastatic HNSCC cell lines but high expression of cytokines was not a prerequisite for metastatic cancer cells. HGF mRNA was not detected in the cancer cell lines. Co-culturing of HNSCC cells with fibroblasts caused increases in cytokine expression. Type I collagen and conditioned media derived from HNSCC cells or fibroblasts enhanced cytokine expression in the cancer cells. Cytokines also enhanced MMP-2 and MMP-9 enzymatic activities as well as HNSCC cell invasion. Our findings suggest that the interactions between cancer cells, the extracellular matrix and fibroblasts, as mediated by cytokines, play important roles in the progression of HNSCC.

Critical Role of Peroxisome Proliferator-Activated Receptor γ on Anoikis and Invasion of Squamous Cell Carcinoma

Peroxisome proliferator-activated receptor gamma (PPARgamma) plays a important role in various physiological functions. We examined whether PPARgamma is expressed in primary squamous cell carcinoma and lymph node metastasis and whether PPARgamma is a potential target for tumor therapy. A high-level expression of PPARgamma was observed in tumor cells of human primary squamous cell carcinoma, lymph node metastasis, and squamous cell carcinoma cell lines. Treatment with PPARgamma-specific antagonists, but not agonists, caused apoptotic cell death on squamous cell carcinoma cell lines in a concentration-dependent manner. Small interfering RNA for PPARgamma also inhibited cell adhesion and growth of squamous cell carcinomas. The phosphorylation of focal adhesion kinase (FAK) was decreased by treatment with PPARgamma antagonists, and resulted in decreases in phosphorylation of Erk and mitogen-activated protein kinase. Furthermore, PPARgamma antagonists decreased the adhesion of squamous cell carcinomas into fibronectin-coated plates, indicating the inhibition of interaction between squamous cell carcinomas and fibronectin. Expression of integrin alpha5, a counter adhesion molecule for fibronectin, was inhibited by the treatment with PPARgamma antagonists. These results indicate that the decrease in integrin alpha5 and following inhibition of cell adhesion may cause the inhibition of FAK signaling pathways. PPARgamma antagonists also strongly inhibited invasion of squamous cell carcinoma via down-regulation of CD151 expression. The cell death caused by the PPARgamma antagonists was a result of direct interference with cell adhesion "anoikis" involving intracellular FAK signaling pathways. These results imply a potentially important and novel role for the inhibition of PPARgamma function via the use of specific antagonists in the treatment of squamous cell carcinoma and the prevention of tumor invasion and metastasis.

Immunohistochemical localization of plakophilins (PKP1, PKP2, PKP3, and p0071) in primary oropharyngeal tumors: correlation with clinical parameters

Plakophilins (PKPs) are members of the armadillo multigene family. Armadillo-related proteins function in both cell adhesion and signal transduction, and also play a central role in tumorigenesis. Here we report the immunohistochemical localization of PKPs in 37 cases of human primary squamous cell carcinoma of the oropharynx lacking overt distant metastases that were followed clinically for 3 years. Immunoreactivity for the PKPs PKP1, PKP2, PKP3, and p0071 (also known as PKP4) was assessed on frozen unfixed sections using a semiquantitative scoring system. Results were correlated with tumor grade, clinicopathologic parameters, and patient survival. Only p0071 was associated with tumor growth, demonstrating an inverse correlation with tumor size. PKP1 and PKP3 immunoreactivity was inversely correlated with tumor histological grade and was observed only in tumors that did not metastasize. In contrast, strong PKP2 immunoreactivity was observed in 85.7% of metastatic tumors. Interestingly, patients with tumors in which PKP1 and PKP3 immunoreactivity was reduced or absent exhibited local recurrences or metastases, or both, as well as poor survival. Correlation of the subcellular localization of PKPs with routine histological and clinical parameters suggests that these proteins may serve as useful markers for predicting the clinical outcome of the disease. Although the 4 PKPs displayed different levels and patterns of subcellular distribution in tumors, there was a positive correlation between immunoreactivity for PKP2 and PKP3, as well as for PKP2 and p0071, suggesting possible functional similarities associated with differentiation, tumor growth, and disease prognosis. Nevertheless, the mechanisms involved in altering the subcellular localization in tumors compared with normal epithelium are unknown, and further investigation is needed to determine whether PKPs are causative factors for oral carcinogenesis or are merely characteristic of the phenotype.

Photodynamic therapy for newly established human squamous cell carcinoma cell line and its cisplatin-resistant subline

Photodynamic therapy (PDT) is a modality for the treatment of various tumors. Although PDT has been proposed as an alternative in overcoming multi-drug resistance, the impact of Photofrin-mediated PDT on cisplatin-resistant cells has not been addressed thus far. We established two new human primary squamous cell carcinoma derived cell lines and its cisplatin-resistant subline to investigate resistance mechanisms. We investigated the efficacy of Photofrin-mediated PDT on cells which were cisplatin-sensitive and -resistant phenotype. The 50% inhibitory concentration (IC 50) showed no statistically significant difference between both parent cell and its resistant subline. Twenty-four hours after PDT, both parent and cisplatin-resistant sublines showed the same DNA content pattern. The data reported in this study show that Photofrin-mediated PDT revealed equal photo-cytotoxicity in both sensitive and cisplatin-resistant cells.

Determination of the prognostic significance of cyclin B1 overexpression in patients with esophageal squamous cell carcinoma.

Recent studies have identified a family of proteins referred to as cyclins, which control the cell cycle. Cyclin B1 activates cdc2, which regulates cell progression through the G2 and M phases. The main aim of this study was to examine the relationships between the cyclin B1 expression in human esophageal squamous cell carcinoma (SCC) and clinicopathological factors and prognosis of the patients. Eighty-seven cases of primary human SCC consecutively obtained at esophagectomy were immunohistochemically studied using an anti-human cyclin B1 protein antibody (2H1-H6). The relationship between cyclin B1 expression and clinicopathological factors, including prognosis, were also statistically assessed. Positive immunostaining of cancer cells, mainly in the cytoplasm, was detected in 72.4% (63/87): heterogeneous pattern in 37.9% (33/87) and homogeneous pattern in 34.5% (30/87). The prevalence of cyclin B1 expression was significantly higher in cases with invasion deeper than the muscularis propria (P<0.005) and with venous invasion (P<0.01) than in other cases. Patients whose SCCs expressed high levels of cyclin B1 protein had a significantly poorer prognosis than did the other patients (P<0.05). Multivariate analysis demonstrated that cyclin B1 status was an important factor affecting survival (P<0.05). These findings demonstrated that overexpression of cyclin B1 protein is associated with tumor behavior and prognosis for patients with human esophageal SCC.

Alterations in levels of different protein kinase C isotypes and their influence on behavior of squamous cell carcinoma of the oral cavity: epsilon PKC, a novel prognostic factor for relapse and survival.

Recent results suggest that some PKC isotypes, when overexposed, confer to cultured fibroblasts certain proliferative advantages, and enhanced tumorigenicity in nude mice, suggesting their participation in carcinogenic process. These findings need to be validated through the investigation of potential alterations of these kinases in common forms of human cancers. In this prospective study we determined levels of different PKC isozymes by Western blot in tissue extracts from 29 human primary squamous cell carcinomas of the oral cavity, and their respective controls. These expressions were correlated with behavior of tumor and histologic characteristics. Dramatic alterations in different PKC isotypes were found. Thus, increased levels of isotypes alpha, beta, or gamma, and zeta were found in most of the patients, as well as significant correlations between levels of the isotype epsilon and survival-relapse rate and classical PKC isotypes with irregular morphology of tumoral interphase. These results suggest participation of some PKC isotypes (alpha, beta, gamma, and zeta) in the genesis and behavior (epsilon) of oral cancers. Levels of epsilon PKC could be used as prognostic marker.

Ras gene mutation and amplification in human nonmelanoma skin cancers

Our previous studies have shown that human skin cancers occurring on sun-exposed body sites frequently contain activated Ha-ras oncogenes capable of inducing morphologic and tumorigenic transformation of NIH 3T3 cells. In this study, we analyzed human primary squamous cell carcinomas (SCCs) and basal cell carcinomas (BCCs) occurring on sun-exposed body sites for mutations in codons 12, 13, and 61 of Ha-ras, Ki-ras, and N-ras oncogenes by amplification of genomic tumor DNAs by the polymerase chain reaction, followed by dot-blot hybridization to synthetic oligonucleotide probes designed to detect single base-pair mutations. In addition to the primary human skin cancers, we also analyzed Ha-ras-positive NIH 3T3 transformants for mutations in the Ha-ras oncogene. The results indicated that all three NIH 3T3 transformants, 11 of 24 (46%) SCCs, and 5 of 16 (31%) BCCs contained mutations at the second position of Ha-ras codon 12 (GGC----GTC), predicting a glycine-to-valine amino acid substitution, whereas only 1 of 40 skin cancers (an SCC) displayed a mutation in the first position of Ki-ras codon 12 (GGT----AGT), predicting a glycine-to-serine amino acid change. In addition, three of the SCCs contained highly amplified copies of the N-ras oncogene in their genomic DNA. Interestingly, two of the SCCs containing amplified N-ras sequences also had G----T mutations in codon 12 of the Ha-ras oncogene. These studies demonstrate that mutations in codon 12 of the Ha-ras oncogene occurred at a high frequency in human skin cancers originating on sun-exposed body sites, whereas mutation in codon 12 of Ki-ras or amplification of N-ras occurred at a low frequency. Since the mutations in the Ha-ras and Ki-ras oncogenes were located opposite potential pyrimidine dimer sites (C-C), it is likely that these mutations were induced by ultraviolet radiation present in sunlight.