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Molecular Oncology, Markers, Clinical Correlates |
Applied Molecular Technology, Department of Clinical Biochemistry, Saint-Luc Clinical University, Université Catholique de Louvain, 1200 Brussels, Belgium [J-L. G., M. H., P. D. N.]; Queen Astrid Military Hospital, 1120 Brussels, Belgium [J-L. G.]; Clinical Biochemistry Laboratory, St. Antoine University Hospital, 75012 Paris, and Cellular Differentiation Laboratory, Pasteur Institute, CNRS URA 1960, 75015 Paris, France [S. L.]; Departments of Pathology [Y. G.] and Urology [P. V. C., B. T.], Saint-Luc Clinical University, Brussels 1200, Belgium; Johns Hopkins Oncology Center, Baltimore, Maryland 21287 [S. R. D., A. G.]; Ludwig Institute for Cancer Research, Brussels 1200, Belgium [F. B.]; and Department of Urology, Hôpital Bicêtre, Le Kremlin-Bicêtre 94270, France [P. E.]
| ABSTRACT |
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2 versus 41%
for pT
3) and 2-year survival rate (81% in the PSMA-negative group
versus 29% in the PSMA-positive group). Although the
clinical usefulness of this assay requires confirmation in larger
prospective randomized trials, current preliminary results suggest that
a blood-borne PSMA mRNA PCR assay may be a useful tool to predict a
poor outcome in TCC patients. | INTRODUCTION |
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80% of TCCs are initially superficial, recurrence after
localized therapy occurs in 3090% of the cases. Despite significant
improvement in localized therapy, intravesical chemotherapy, and
immunotherapy, 1520% of these recurrences evolve to invasive and/or
metastatic stages that require radical and/or systemic therapies
(2)
. There is clearly a subgroup of patient
(i.e., <50%) who will survive after radical surgery and
adjuvant therapy (4)
. The major problem is selecting those
patients at risk of progression, who may benefit from earlier
aggressive treatment (i.e., radiotherapy, chemotherapy, and
immune therapy). Because no bladder urothelium-specific serum marker is
currently available, the diagnosis of advanced TCC relies on
conventional imaging technologies (i.e., computed tomography
scan, ultrasound, and magnetic resonance imaging), the resolution
sensitivities of which limit the detection to metastases >1 cm.
Therefore, any biological marker capable of improving the detection of
early metastatic disease would be of great clinical benefit. PSMA is a Mr 100,000 type II membrane glycoprotein identified by Horoszewicz et al. (5) from crude membrane extract of the androgen-dependent prostate cancer cell line, LNCaP. The expression of PSMA is low in the normal prostatic epithelium, increases markedly in prostate cancer, and is maintained in poorly differentiated tumors and prostate cancer metastasis (6) . In contrast to secreted prostate-specific antigen, PSMA is a membrane-bound antigen, the expression of which increases after androgen ablation protein (reviewed in Ref. 7 ). Several successful strategies have been developed to detect PSMA protein or mRNA to identify and target prostatic cells (8 , 9) . Initially believed to be highly prostate specific, PSMA has been shown recently, however, to be expressed in nonprostatic tissues such as breast carcinoma, duodenum, and in normal and malignant renal tissues (10, 11, 12) .
In the present study, the expression of PSMA mRNA, protein, and enzymatic activity is demonstrated in the normal bladder, in TCC specimens, and in primary cell lines established in vitro from TCC specimens. In addition, preliminary clinical data suggest that circulating PSMA-expressing cells can be detected in TCC and that detection of PSMA transcript seems to correlate with stage and survival.
| MATERIALS AND METHODS |
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pT1, 27
pT3). Specimens were snap-frozen in liquid
nitrogen for RNA analysis and formalin-fixed/paraffin-embedded for
pathological analysis and immunohistochemical detection of PSMA. Blood
samples were obtained preoperatively from an additional series of 27
consecutive patients scheduled to undergo radical cystoprostatectomy
for invasive or recurrent TCC. All patients were males, ages 4982
(mean, 67) years. Preoperative stratification and follow-up of TCC
disease were performed by chest, abdominal, and pelvic computed
tomography scan, abdominal ultrasounds, and liver tests. None of the
patients had detectable metastases preoperatively. Screening for
concomitant prostate cancer was based on digital rectal examination and
serum prostate-specific antigen value. All patients diagnosed with
pT3 have received a standard adjuvant MVAC regimen (methotrexate,
vinblastine, Adriamycin, cisplatin). Prostatic and bladder specimens
were analyzed separately, and tumor invasion was stratified according
to the Tumor-Node-Metastasis classification. Local and invasive node
metastatic disease was investigated both by performing pathological
analysis on tissues obtained at surgery as well as by using
radiological and bone scan investigations. Venous blood (2 x 10
ml; Sarstedt, Nümbrecht, Germany) was collected in EDTA-treated
tubes. All tubes were processed within 1 h of collection.
Cell Lines and Reagents.
LB831, LB796, and LB905 bladder carcinoma cell lines are primary
cultures established from invasive TCC tumors and were generously
provided by the Ludwig Institute for Cancer Research (Brussels,
Belgium). LB831 has been characterized recently (13)
.
Cells were grown in Iscoves modified Dulbeccos medium containing
10% FCS, 116 µg/ml L-arginine, 36 µg/ml
L-asparagine, 219 µg/ml L-glutamine, and
antibiotics (200 units/ml penicillin and 100 µg/ml streptomycin) in a
95% air/5% CO2 incubator at 37°C.
Androgen-dependent human prostate cancer cell lines LNCaP,
androgen-independent human prostate cancer cell line PC-3, and
myeloblastic leukemia cell line K562 were obtained from American Type
Tissue Collection (Manassas, VA). An androgen-independent human
prostate cancer cell line, TSU, was generously provided by Dr.
John Isaacs (Johns Hopkins Oncology Center, Baltimore, MD). Cell
lines were grown in RPMI 1640 supplemented with
L-glutamine, nonessential amino acids, and 10% FCS (Life
Technologies, Inc., Gent, Belgium) in a 90% air/5%
CO2 incubator at 37°C.
PSMA RT-PCR Assay.
Total RNA from bladder tissue was obtained by
guanidinium/thiocyanate/phenol/chloroform extraction technique
(14)
. Total RNA from cell lines and buffy coats obtained
after centrifugation on Ficoll Hypaque of blood samples was extracted
using Trizol reagent (Life Technologies, Inc., Grand Island, NY)
according to the manufacturers instruction. Details regarding reverse
transcription, amplification, and control measurements for preventing
carryover have been described previously (15)
. To simplify
the assay procedure, the previously described nested RT-PCR, with two
rounds of 19 cycles each, was replaced by a single round of 32 cycles.
Amplification was performed in a DNA thermal cycler 480 (Perkin-Elmer,
Foster City, CA) by using the previously described internal PSMA
primers (15)
. The limit of detection for PSMA with the
single-round, 32-cycle PCR assay was assessed on serial dilution of
LNCaP in blood, LNCaP in the PSMA-negative cell line K562, and finally
with serial dilution of 1.2-kb PSMA cDNA plasmid pJRD184, as detailed
previously. The limit of detection was defined as the last dilution
giving a positive PCR result with an inter-assay coefficient variation
<20% (15)
. Blood specimens used as negative controls
were obtained from 200 healthy blood donors (100 females and 100
males).
Northern Blotting.
The pSPORT plasmid coding for the 2.6-kb PSMA cDNA probe is a generous
gift from W. D. W. Heston (Memorial Sloan-Kettering Cancer Center,
New York, NY). Northern blot and hybridization were performed on nylon
membranes with UV-fixed poly(A+) RNA (2 µg/lane) extracted from
normal adult tissues (Clontech, Palo Alto, CA) according to the
manufacturers instruction. Gels were autoradiographed, and results
were normalized for actin expression. Scanning densitometry was
performed to semiquantitatively assess the level of expression.
DNA Sequencing and Analysis.
The PSMA cDNA product from TCC lines (n = 3), TCC
surgical specimens (n = 10), and normal bladder
urothelia (n = 5) were sequenced in both orientations.
The sequencing reactions were carried out on an automated ABI 373 A
apparatus by using the Taq Dye Deoxy Terminator Cycle Sequencing kit
(Applied Biosystems) according to the manufacturers instruction. The
specificity of the remaining PSMA cDNA PCR products was assessed by
Southern transfer, probe radiolabeling, hybridization, and
autoradiography as described (15)
.
Immunohistochemical Detection of PSMA.
Paraffin-embedded sections, 5-µm thick, from 3 normal and 4 malignant
urothelial tissues, and 3 lymph node metastases from prostatic
adenocarcinoma were dewaxed, rehydrated, and processed as described
previously (16)
. Cells growing in culture were collected,
cytospun onto glass slides, fixed in 4% paraformaldehyde, and
permeabilized. Cells were incubated overnight at 4°C with an
anti-PSMA monoclonal antibody, CYT-351 (dilution 1:300), generously
provided by Cytogen Corp. (Princetown, NJ), and revealed with an
anti-mouse EnVision-Peroxidase system (Dako, Golstrup, Denmark). A
prostate cancer lymph node metastasis and LNCaP cell line were used as
positive controls. Myeloid K562 and prostate PC-3 cell lines were used
as negative controls (8
, 15)
. Staining intensity was
semiquantitatively expressed as described (17)
.
PSMA Enzymatic Assay.
In previous studies, PSMA has been demonstrated to express a
folate hydrolase enzymatic activity (18)
and an NAALADase
activity (19)
. Non-PSMA
-glutamyl hydrolases are
ubiquitously found in the lysosomes of cells and are also secreted by
many tumor cell types (20)
. To specifically determine PSMA
enzymatic activity, the NAALADase activity of PSMA was assayed using
[3
H]NAAG, adapted as described previously by
Tiffany et al. (21)
. The NAALADase activity of
LNCaP human prostate cancer cells has been characterized previously,
and membranes from these cells were used as positive controls. The
prostate cancer cell lines TSU and PC-3, which do not express PSMA by
immunohistochemical or enzymatic analysis, were used as negative
controls (21)
.
Membranes were prepared and amount of [3 H]NAAG hydrolysis determined for each cell type assessed. Briefly, LNCaP, TSU, PC-3, LB905, LB831, and LB796 cell lines were grown to 8090% confluence in serum-containing media as described above. Ten to 50 million cells were scraped in cold HBSS and pelleted at 1000 x g at 4°C. The cell pellet was resuspended in cold 50 mM Tris (pH 7.4), sonicated three times for 5 min each, and then centrifuged at 100,000 x g for 10 min at 4°C. The pelleted membranes were resuspended in 50 mM Tris and assayed for protein content, and additional Tris buffer was added to bring the concentration of protein to 0.5 mg/ml. Samples were stored at -80°C before use.
Regarding the determination of NAALADase activity, 100 µg of protein (i.e., 200 µl) from each cell line were added to PSMA assay buffer (100 µl of 10 mM CoCl2, 250 µl of 200 mM Tris, pH 7.4), and the volume was brought to 950 µl. To determine PSMA-specific activity, the highly potent PSMA inhibitor 2-(phosphonomethyl)-pentanedioic acid(Alexis, San Diego, CA; Ref. 22 ) was added to a final concentration of 1 µM to a second identical sample. After a 10-min incubation at room temperature, 50 µl of 1 µm [3 H]NAAG (DuPont NEN, Boston, MA) were added, and reactions incubated for 28 h. For assays using LNCaP membranes, 5 µg of total protein were used per assay, and [3 H]NAAG hydrolysis was assayed after only 3 h. At the end of the incubation period, 200 µl from each assay were loaded on a column constructed by placing a 3-mm solid glass bead into a 9-inch Pasteur pipette to which 5 cm of ion exchange resin preconditioned with distilled H2O. The column was washed with 2 ml of 1 M formic acid into 10 ml of scintillation mixture, and total counts were determined using a Beckman LS 8100 scintillation counter. Specific PSMA activity was determined by subtracting activity in samples containing membranes plus inhibitor from samples containing membranes only. A standard curve was plotted using increasing concentrations of [3 H]NAAG to convert measured counts to pmol [3 H]glutamate released. Results were expressed in pmol [3 H]glutamate released/(min x mg) of total protein and are the mean of three separate assays ± SE. Each experiment was done in duplicate. Activity was considered not detectable if <0.001 pmol/(min x mg).
| RESULTS AND DISCUSSION |
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Expression of PSMA mRNA in a Panel of Normal Human Tissues.
Northern blotting from normal human tissues confirmed the expression of
PSMA mRNA in several tissues. Besides a very strong prostate
expression, PSMA transcripts were also clearly detected in RNAs
extracted from the small intestine, the bladder (Fig. 1)
, and in extracts from several other
tissues including kidney, brain, and liver (data not shown). Scanning
densitometry of the detected products demonstrates that PSMA expression
was
500 times lower in the normal bladder than in the normal
prostatic tissue.
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These results demonstrate that a weak but consistent expression of PSMA enzymatic activity can be found in the membrane of TCC-derived cell lines. In addition, the difference of the amount of enzymatic activity between these cell lines and the highly PSMA-positive prostate cancer cell line LNCAP accurately reflects the difference of intensity staining detected by immunohistochemistry.
Molecular Detection of PSMA mRNA in Blood Samples from Patients
Treated for TCC of the Bladder.
RT-PCR amplification of PSMA mRNA transcripts in blood is reported to
improve early detection of advanced prostate cancer
(7, 8, 9)
. Because PSMA expression has been demonstrated in
bladder, it was legitimate to assess whether PSMA transcripts could be
detected in bladder cancer patients. Screening for concomitant prostate
cancer, based on digital rectal examination and serum prostate-specific
antigen value, was negative in all cases. Cross-sectional pathological
analysis of the prostatic specimens revealed the existence of a
concomitant prostatic adenocarcinoma in 10 patients. All of the
adenocarcinomas were classified pT2 or less. Seven of the 27 (26%)
preoperative blood samples tested positive for PSMA by RT-PCR. Only one
of the PSMA-positive patients showed histological evidence of
concomitant localized prostatic carcinoma (i.e., pT2a) and
invasive bladder cancer (i.e., pT3b). Nine of 10 patients
with both TCC and localized prostate cancer had no detectable PSMA mRNA
in the blood (i.e., 5 TCC
pT2 and 4 TCC
pT3). These results confirm the previously published low rate of RT-PCR
detection of PSMA transcripts in the blood of patients with localized
prostate cancer (i.e., 1525%; reviewed in Ref.
23
). TCC specimens were classified as follows: pT1 (4 of
27), pT2 (6 of 27), pT3 (16 of 27), and pT4 (1 of 27). As shown in
Table 2
, no PSMA transcript was found in
blood of patients presenting with TCC classified pT2 or less. In
contrast, 7 of the 17 patients diagnosed with TCC
pT3 tested
positive for PSMA in blood. According to the Tumor-Node-Metastasis
classification of TCC in the latter 7 PSMA-positive patients, 4 were M+
(2N+ M+ and N0 M+) and 3 were N0 M0. Among the 10 PSMA-negative
patients
pT3, 7 were N0 M0 and three were N+ M0.
|
pT3. In
patients with TCC
pT3, 1- and 2-year survival rates correlate
with the detection of PSMA transcripts in the preoperative blood
specimen. In patients with PSMA-negative assay, 1- and 2-year survival
rates were 88 and 79%, respectively, whereas positive detection was
associated with a drop of the survival rate to 75 and 29% at 1 and 2
years, respectively. Although confirmation requires larger prospective
studies, these results suggest that PSMA-positive patients have a worse
outcome. The possibility that molecular detection of PSMA transcripts
could be used as a preoperative predictive marker of advanced disease,
therefore, deserves further attention. The present study demonstrates that full-length, PSMA-specific transcripts are consistently detectable in normal and malignant urothelium, as well as in peripheral blood from patients presenting with progressive TCC of the bladder. Although PSMA expression is much weaker than in prostate-derived tissues, this transcript encodes a substantial amount of PSMA protein. In TCC-derived cell lines, PSMA is detectable by immunohistochemical staining and is enzymatically active, producing a level of enzymatic activity that correlates with the intensity of immunostaining.
Initially believed to be restricted to the prostatic epithelium, PSMA expression therefore appears to be more ubiquitous. Although this could theoretically impair prostate-specific anti-PSMA targeting strategies, it also generates new potential applications for this biological marker (24, 25, 26) . In patients presenting with invasive TCC of the bladder and no evidence of a concomitant PSMA-positive tumor, current results suggest that preoperative PSMA mRNA blood transcripts are associated with advanced disease and progression after radical treatment. Whether PSMA assay can be considered as an individual diagnostic and prognostic marker in TCC patients, however, remains to be determined in a larger cohort of patients.
| ACKNOWLEDGMENTS |
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| FOOTNOTES |
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1 Supported by Grant 3.4574.98 from the Fonds
National de la Recherche Scientifique, a grant from lOeuvre Belge du
Cancer, and Grant 1367 from the Association de Recherche Contre le
Cancer. ![]()
2 To whom requests for reprints should be
addressed, at Applied Molecular Technology, Department of Clinical
Biochemistry, Clos Chapelle-aux-Champs, 30-UCL/30.46, B-1200 Brussels,
Belgium. Phone: 00/32-2-764-31-65 or 00/32-2-764-39-26; Fax:
00/32-2-764-31-66; E-mail: gala{at}lbcm.ucl.ac.be ![]()
3 The abbreviations used are: TCC, transitional
cell carcinoma; PSMA, prostate-specific membrane antigen; RT-PCR,
reverse transcription-PCR; NAALADase,
N-acetylated-
-linked acidic dipeptidase; NAAG,
N-acetyl-aspartyl-glutamate. ![]()
Received 6/21/99; revised 7/13/00; accepted 7/24/00.
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