The ability of TRAIL to target cancer cells for apoptosis without affecting normal cells has generated interest for its potential use in cancer therapy, however its efficacy in the treatment of ovarian granulosa cell tumors (GCT) has yet to be evaluated. Human ovarian cancers of granulosa cell origin currently represent approximately 3 to 5% of diagnosed cancers involving the ovary. Nevertheless, there is little known regarding either the etiology or selective treatment of GCTs as compared to those originating from surface epithelial cells. Recent studies have demonstrated that TRAIL treatment, in vitro, does not induce apoptosis in healthy ovarian granulosa cells, despite the expression of a functional TRAIL death receptor, DR5. Results obtained using two human GCT lines, COV434 and KGN (both of which were established to be p53 wildtype), demonstrate a slight, but significant, decrease in cell viability in response to TRAIL (100 ng/ml) treatment (KGN, fold vs control = 0.90 ± 0.02; COV434, fold vs control = 0.89 ± 0.015; p < 0.05). This loss of cell viability is not correlated with an increase in DR5 mRNA or protein expression. Rather, treatment with TRAIL significantly decreases DR5 mRNA in both GCT lines (fold-decrease vs control: KGN, 0.28 ± 0.21; COV434, 0.68 ± 0.04; p < 0.05). By comparison, treatment with the conventional chemotherapeutic, cisplatin (25 μM), significantly increases DR5 mRNA (mRNA fold-increase vs control: KGN, 2.02 ± 0.05; COV434, 1.55 ± 0.021; p < 0.05) and protein expression. Furthermore, pretreatment of KGN with cisplatin for 18 h, a time sufficient for upregulation of DR5 expression, led to a significant increase in TRAILinduced cell death upon both acute and long-term challenge (4 h: 22% increase in cell death vs cisplatin treatment alone; 18 h: 34% increase; p < 0.05). Treatment with cisplatin also significantly increases pro-apoptotic Bax protein expression, with similar high levels of expression maintained following co-treatment with TRAIL. To investigate whether the effects of cisplatin-induced sensitization to TRAIL are p53-dependent, transfection with a GFP construct (pEGFP-N1-p53) expressing nuclear-localized p53 was utilized. GCT cultures over-expressing p53 were found to be hypersensitive to treatment with TRAIL (cell death increased 33%, as compared to mock-transfected cells), cisplatin (cell death increased 45%), and TRAIL treatment combined with cisplatin (cell death increased 75%). These cells also show increased Bax protein expression as compared to cells transfected with pEGFP-N1 alone. Moreover, transfection with siRNA duplexes specifically targeting p53 results in a partial reversal of TRAIL plus cisplatin-induced cell death (by 34% compared to cells transfected with nonsense RNA). Taken together, these data indicate that, unlike normal granulosa cells, TRAIL treatment promotes a loss of cell viability in GCT, and that sensitivity to TRAIL is enhanced following treatment with cisplatin. Finally, p53 expression plays at least a partial role in the sensitization effect of cisplatin on TRAIL-induced apoptosis. This occurs by modulating both levels of DR5 and downstream proapoptotic mediators, including Bax. These results provide evidence that a greater efficacy in treating GCTs can be achieved with a regime of cisplatin followed by treatment with TRAIL. (Supported by DAMD17-03- 1-0206, and the Notre Dame Cancer Institute.) (platform)
Read full abstract