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Cancer Therapy: Preclinical |
Departments of Pathology and Interdisciplinary Oncology, University of South Florida College of Medicine and Programs of Molecular Oncology and Drug Discovery, H. Lee Moffitt Cancer Center, Tampa, Florida
Requests for reprints: Wenlong Bai, Department of Pathology, University of South Florida College of Medicine, 12901 Bruce B. Downs Boulevard, MDC 11, Tampa, FL 33612-4799. Phone: 813-974-0563; Fax: 813-974-5536; E-mail: wbai{at}hsc.usf.edu.
| ABSTRACT |
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Experimental Design: The response of human ovarian cancer cells to 1,25(OH)2D3 and EB1089 were first compared in cell growth, gene transcription, and apoptotic assays. Then, nude mice bearing OVCAR3 tumor xenografts were treated with EB1089 at different dosages, and tumor volumes were monitored. The effect of EB1089 and 1,25(OH)2D3 on the level of serum calcium was also examined. After the treatment, tumors were excised and processed for histologic examination, Ki-67 staining, and tissue terminal deoxynucleotide transferasemediated dUTP nick end labeling (TUNEL) assays to evaluate the morphologic, proliferative, and apoptotic changes induced by EB1089, respectively.
Results: The study shows that EB1089 suppresses the in vitro growth of ovarian cancer cells and transcriptionally activates the GADD45 reporter gene more effectively than 1,25(OH)2D3. Clinically more importantly, EB1089 suppresses the growth of OVCAR3 tumor xenografts in nude mice without inducing hypercalcemia. Ki-67 staining and tissue TUNEL assays showed that both inhibition of cell proliferation and induction of apoptosis contribute to the EB1089-induced tumor suppression in vivo.
Conclusions: This study is the first demonstration that ovarian cancer responds positively in vivo to treatment with a 1,25(OH)2D3 compound and thus supports continued development of 1,25(OH)2D3 analogues for possible use as an alternative or complementary therapy for human ovarian cancer.
Key Words: Apoptosis 1,25(OH)2D3 Nude mice Proliferation VDR
| INTRODUCTION |
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32% survive for >5 years. The dismal response of advanced ovarian cancer to current treatments necessitates the development of alternative therapies to curb this deadly disease. The active form of vitamin D, 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], has been shown to regulate differentiation and proliferation of multiple human cancer cell lines and thus is a potential therapeutic agent for cancers. A suppressive role for 1,25(OH)2D3 in ovarian cancer has been speculated based on the inverse correlation between ovarian cancer incidence and mortality rates and sunlight exposure (3, 4). In addition, a case-control study in Mexico reported an inverse association between dietary vitamin D content and risk for ovarian cancer (5). Consistent with these epidemiologic analyses, recent studies in our laboratories have shown that 1,25(OH)2D3 inhibits the growth of multiple ovarian cancer cell lines, including OVCAR3, CAOV3, A2008, etc. (6), by causing cell cycle arrests at G1-S (6) and G2-M (7) checkpoints. These findings provide a molecular foundation for further investigation of the in vivo growth-suppressing effects of 1,25(OH)2D3 compounds.
Because the concentration that induces the growth suppression of ovarian cancer cell lines is expected to cause hypercalcemia in vivo, 1,25(OH)2D3 cannot be directly used clinically to treat ovarian cancer patients. Chemical modifications of the 1,25(OH)2D3 have yielded several analogues that display enhanced tumor-suppressing but less calcemic activity (8). Among these is EB1089, a deltanoid derivative generated by Leo Pharmaceutical Products (Ballerup, Denmark) through structural alteration of the side chain of 1,25(OH)2D3 (9). EB1089 has been shown to suppress the growth of prostate (10, 11), breast (12), colon (13), and retinoblastoma (14) tumors, but the in vivo response of human ovarian cancer xenografts to EB1089 has not been examined.
In this article, we report that EB1089 inhibits the growth of OVCAR3 xenograft tumors in nude mice without causing hypercalcemia. Further analysis indicates that the suppression of the tumor growth in vivo is due to the combined effect of EB1089 in inhibiting cell proliferation as well as inducing apoptosis.
| MATERIALS AND METHODS |
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Cell Culture and Assays for Growth, Apoptosis, and Transcriptional Activation of the GADD45 Reporter. OVCAR3 human ovarian cancer cells (HTB-161, obtained from American Type Culture Collection, Rockville, MD) were cultured in RPMI 1640 supplemented with 15% fetal bovine serum (Life Technologies, Grand Island, NY), 2 mmol/L L-glutamine, 50 units/mL penicillin, 50 µg/mL streptomycin, 10 mmol/L HEPES, 1 mmol/L sodium pyruvate, 4.5 g/L glucose, 1.5 g/L sodium bicarbonate, and 10 µg/mL bovine insulin. BG-1 cells were cultured in DMEM/F-12 medium supplemented with 10% fetal bovine serum.
To determine cell numbers, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays were done as described (15). Absorption at 595 nm (A595 nm) was measured on a MRX microplate reader (Dynex Technologies, Chantilly, VA). Cell numbers were calculated based on a standard curve. Apoptosis was determined by flow cytometry analysis after cells were stained with Annexin V-FITC and propidium iodide following manufacturer's instructions (Santa Cruz Biotechnology, Santa Cruz, CA). Transcriptional activation of the vitamin D receptor was done as described (6). Briefly, 4 hours post-transfection with GADD45Luc and pCMVgal, OVCAR3 cells were treated with vehicle, EB1089, or 1,25(OH)2D3 in fresh medium for 36 hours. Cells were harvested and luciferase and ß-galactosidase activities were determined as described (6).
Nude Mouse Studies of OVCAR3 Tumor Xenografts. All mice were handled according to the Guide for the Care and Use of Laboratory Animals. Mouse studies were carried out following the procedures approved by the Institutional Animal Care and Use Committee at University of South Florida. For inoculation into nude mice, OVCAR3 cells were washed with PBS, digested with trypsin, resuspended in RPMI 1640 containing fetal bovine serum, and pooled. After centrifugation, cells were resuspended in Matrigel (BD Biosciences Discovery Labware, Bedford, MA)-RPMI 1640 (1:1) at a concentration of 5x 106 cells per 100 µL. Cell/Matrigel mixture of 100 µL was injected s.c. into 6-week-old female athymic nu/nu mice (Harlan Sprague-Dawley, Indianapolis, IN) on the dorsal surface. The mice were fed a vitamin Ddeficient diet supplemented with 0.47% calcium (Harlan Teklad, Madison, WI) for the duration of the study. Tumor volumes were monitored by caliper measurement of the length and width and calculated using the formula of length x width x 0.5 the greater of length or width. Treatment was begun when tumors reached volumes of
150 mm3 in average, which took
4 weeks. Mice were randomized and treated daily by gavage with placebo or EB1089 at 0.3 or 1.0 µg/kg body weight in a volume of 20 µL. Tumor volumes and body weights were monitored every 5 days over the course of treatment. Mice were sacrificed after 30 days of treatments and tumors were removed and fixed in 10% neutral buffered formalin for histologic and immunohistochemical analyses.
Calcium Measurements. To determine the effect of active vitamin D compounds on serum calcium, nude mice without tumor xenografts were treated with placebo, EB1089, or 1,25(OH)2D3. Blood samples were obtained from the retro-orbital sinus at 0, 15th, and 30th days of the treatment. Blood samples from three mice were used for each group. Serum calcium was measured as a paid service by Antech Diagnostics (Southaven, MS) using a colorimetric method on Hitachi 747 analyzer. The measurement was repeated twice.
Tumor Histology and Immunohistochemical Analysis. Tumors were embedded in paraffin, sectioned at 5 µm, and stained with H&E. Cell proliferation was assessed by quantification with Ki-67 immunohistochemistry. The anti-human Ki-67 antibody was 1:400 diluted and immunostaining was done on the DAKO Autostainer using the Chemicon Mouse-to-Mouse Peroxidase Detection kit (Serologicals, Inc., Temecula, CA). Ki-67-positive cells were scored by visual examination of 40 randomly selected fields of x400 magnification containing at least 2,000 cells.
Tissue Terminal Deoxynucleotide TransferaseMediated dUTP Nick End Labeling Assay. Histologic analysis of DNA fragmentation was used to identify apoptotic cells in paraffin sections of the xenograft tumors. In situ terminal deoxynucleotide transferasemediated dUTP nick end labeling (TUNEL) was done using the Apoptag Peroxidase In situ Apoptosis Detection Kit (Serologicals). TUNEL-positive cells were quantified in 40 randomly selected high-power fields (x400) of each tissue section.
| RESULTS |
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Besides cell cycle arrests at G1-S and G2-M checkpoints, our studies showed that treatment of OVCAR3 cells with 1,25(OH)2D3 for 6 days induces apoptosis (Fig. 1D). To determine whether EB1089 also induces apoptosis in ovarian cancer cells, the apoptotic index of OVCAR3 cells treated with vehicle or EB1089 was determined by flow cytometry after staining for Annexin V. As shown in Fig. 1D, EB1089 induced apoptosis after 6-day treatment, whereas no increase in apoptosis was observed at earlier time points. Treatment for >6 days did not further increase the rate of apoptosis. Because the apoptotic analyses used EB1089 and 1,25(OH)2D3 at the saturating concentration, the magnitude of apoptotic induction by EB1089 is comparable with that induced by 1,25(OH)2D3.
Overall, the above analyses show that EB1089 is transcriptionally more active than 1,25(OH)2D3, inhibits the growth of ovarian cancer cells at lower concentrations, and induces apoptosis in a similar way as 1,25(OH)2D3. The analyses argue strongly for further investigation of its in vivo effects in whole animal experiments.
EB1089 Inhibits the Growth of OVCAR3 Tumor Xenografts in Nude Mice without Causing Hypercalcemia. After the growth-suppressing activity of EB1089 was verified in vitro using OVCAR3 and BG-1 cells, we next investigated its in vivo effect on the growth of OVCAR3 tumor xenografts as described in MATERIALS AND METHODS. As shown in Fig. 2A, the size of OVCAR3 tumor xenografts treated with the placebo increased proportionally during the treatment. Treatment with EB1089 at 0.3 or 1 µg/d/kg body weight almost completely suppressed the growth of the tumors. In comparison with the placebo controls, the tumor suppression by EB1089 at both concentrations after 30 days reached statistical significance (P<0.01). In contrast, no significant difference was observed between the size of the tumors treated with EB1089 at 0.3 and 1.0µg/d/kg for 30 days (P = 0.246). Due to the heterogeneity of the tumor sizes to begin with, there is a significant variation among the tumor volumes in each group, but the suppressive effect of EB1089 on the tumor growth is obvious when the representative tumors from the placebo and treated groups were placed side-by-side to compare their size (Fig. 2B).
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EB1089 Alters Tumor Histology and Decreases Proliferation but Increases Apoptosis of Ovarian Tumor Cells In vivo. EB1089 has been shown to change the histology of prostate tumor xenografts (11). To investigate the effect of EB1089 on the histology of OVCAR3 xenografts, tumor sections taken from mice treated with placebo or EB1089 at 0.3 or 1.0 µg/d/kg were stained with H&E. As shown in Fig. 3, the histologic appearance of tumors from mice treated with placebo (Fig. 3A) is quite different from that of mice treated with EB1089 (Fig. 3C). Tumors from placebo controls were composed primarily of epithelial cells (Fig. 3A). Mitotic figures are frequently visible (Fig. 3C) and apoptotic cells are rare. In contrast, mice treated with EB1089 at 0.3 µg/d/kg (data not shown) and 1.0 µg/d/kg (Fig. 3B) shared a histology that showed an increased proportion of noncellular stroma components. Compared with placebo controls, mitotic figures were fewer, whereas apoptotic cells with condensed or pyknotic nuclei and eosinophilic cytoplasm were more frequently seen (Fig. 3D).
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| DISCUSSION |
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Our cell growth assays and reporter gene analysis showed that EB1089 is more potent than 1,25(OH)2D3 (Fig. 1), which concurs with data recently reported for OVCAR3 cells (17). The fact that the growth suppression of OVCAR3 xenografts by EB1089 was observed at 0.3 µg/d/kg, which is lower than the dose (0.5-1.0 µg/d/kg) used for other tumors (10, 11, 12, 13, 14) , suggests that ovarian cancer might be more sensitive than other cancers to the growth suppressive effect of EB1089. Because the use of EB1089 at a higher dose such as 1.0 µg/d/kg did not further enhance the tumor-suppressing effects but caused an increase in serum calcium, it is critical to determine the lowest dose of EB1089 that is effective in suppressing the growth of ovarian cancer but with minimal effect on the level of blood calcium.
Although EB1089 was found to induce apoptosis in vitro and in vivo, it did not cause regression of OVCAR3 tumor xenografts during a 4-week treatment as judged by the measurement of tumor volumes. Histologic examination showed that EB1089-treated tumors contained more prominent a cellular stroma compared with placebo controls, suggesting that the tumors may have undergone actual regression that was not reflected by simply measuring the tumor volume. Because a chemopreventive role of 1,25(OH)2D3 compounds has been suggested, the early application of EB1089 during tumor development may have allowed the detection of more dramatic in vivo antitumor effects or may have prevented the formation of tumors altogether. Furthermore, the combination of EB1089 with other therapeutic agents may clinically achieve more desirable therapeutic effects.
In summary, our study strongly argues for further investigation of EB1089 and other synthetic 1,25(OH)2D3 analogues in the therapeutic treatment of ovarian cancer patients. In addition, EB1089 has been reported to regulate genomic stability (18, 19), to suppress angiogenesis (20), and to inhibit in vivo tumor metastasis . Further studies may reveal more significant applications for synthetic 1,25(OH)2D3 compounds in the clinical management of ovarian cancer.
| ACKNOWLEDGMENTS |
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| FOOTNOTES |
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
Received 8/31/04; revised 10/18/04; accepted 10/21/04.
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,25-dihydroxyvitamin D(3) inhibits angiogenesis in vitro and in vivo. Circ Res 2000;87:21420.This article has been cited by other articles:
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M. E. Valrance, A. H. Brunet, and J. Welsh Vitamin D Receptor-Dependent Inhibition of Mammary Tumor Growth by EB1089 and Ultraviolet Radiation in Vivo Endocrinology, October 1, 2007; 148(10): 4887 - 4894. [Abstract] [Full Text] [PDF] |
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S. S. Tworoger, I-M. Lee, J. E. Buring, B. Rosner, B. W. Hollis, and S. E. Hankinson Plasma 25-Hydroxyvitamin D and 1,25-Dihydroxyvitamin D and Risk of Incident Ovarian Cancer Cancer Epidemiol. Biomarkers Prev., April 1, 2007; 16(4): 783 - 788. [Abstract] [Full Text] [PDF] |
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X. Zhang, P. Li, J. Bao, S. V. Nicosia, H. Wang, S. A. Enkemann, and W. Bai Suppression of Death Receptor-mediated Apoptosis by 1,25-Dihydroxyvitamin D3 Revealed by Microarray Analysis J. Biol. Chem., October 21, 2005; 280(42): 35458 - 35468. [Abstract] [Full Text] [PDF] |
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