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Robert H. Lurie Comprehensive Cancer Center [J. M. S., E. S. L., V. C. J.], Division of Medical Oncology [R. M. O.], and Department of Surgery [K. Y.], Northwestern University Medical School, Chicago, Illinois 60611
ABSTRACT
MCF-7 cells are used routinely to study tamoxifen-stimulated drug resistance in vivo. However, unlike MCF-7 cells, T47D cells express mutant p53 protein and lose the estrogen receptor (ER) during long-term estrogen deprivation in vitro [Pink et al., Br. J. Cancer, 74: 12271236, 1996 (erratum, Br. J. Cancer, 75: 1557, 1997)]. As a result, T47D tumors may respond differently from MCF-7 tumors to long-term tamoxifen treatment. Ovariectomized athymic mice were given injections bilaterally with T47D cells (5 x 105) into the mammary fat pads. A rapidly growing estradiol responsive tumor (T47D:E2) was established and 0.5 mg of tamoxifen given daily blocked estrogen-stimulated growth. In subsequent experiments, low doses of tamoxifen (0.17 mg or 0.5 mg) did not produce tamoxifen-stimulated tumors at 14 weeks, whereas high-dose tamoxifen (1.5 mg) consistently produced tamoxifen-stimulated tumors (T47D:Tam; 17 tumors/20 sites) at 8 weeks. In contrast, 1.5 mg of tamoxifen produced tamoxifen-stimulated MCF-7 tumors (MCF-7:Tam2) at a slower rate (20 weeks) and less consistently (14 tumors/26 sites). When the T47D:Tam tumor was passaged, it grew maximally with either 1.5 mg of tamoxifen or a 1-cm estradiol (premenopausal levels) capsule, and similar results were obtained with MCF-7:Tam2 tumors. Interestingly, when T47D:Tam tumors were treated with the 0.5 mg of tamoxifen, tumors grew only to 50% maximum. All of the tumors originating from MCF-7 and T47D cells expressed ER at similar levels; therefore, tamoxifen did not select for an ER-negative tumor. In conclusion, we have shown that tamoxifen-stimulated T47D p53 mutant tumors can be developed rapidly with high-dose therapy (1.5 mg daily). The results from this model provide new opportunities to investigate the rapid development of drug resistance to adjuvant tamoxifen in patients with mutant p53 breast tumors.
INTRODUCTION
Tamoxifen is the endocrine treatment of choice for all stages of breast cancer (1) . Up to 5 years of adjuvant treatment of patients with ER-positive disease confers a long-term survival benefit that can extend for at least 5 years after tamoxifen treatment is stopped (2) . Although early studies with indefinite tamoxifen treatment illustrated the benefits of tamoxifen on preventing the appearance of primary mammary tumors in carcinogen-induced models (3) , clonal selection of metastatic breast cancer in patients results in tamoxifen-stimulated disease. This is illustrated clinically by a withdrawal response when tamoxifen treatment is stopped (4, 5, 6) . Tumors with acquired resistance to tamoxifen often retain the ER5 (7) and respond to a second line endocrine therapy such as a pure antiestrogen (ICI 182,780; Ref. 8 ), which has no estrogen-like properties, or an aromatase inhibitor (9) , which blocks the synthesis of endogenous estradiol.
Only one laboratory model in vivo has been used routinely to study drug resistance to antiestrogens. MCF-7 human breast cancer cells are ER-positive and can grow into nonmetastatic solid tumors in athymic mice with estrogen supplementation (10 , 11) . Tamoxifen is able to block estrogen-stimulated growth (12) . However, extended tamoxifen treatment for 8 months results in the appearance of ER-positive tamoxifen-stimulated tumors (13) that are transplantable (14, 15, 16) . Although several hypotheses have been advanced to explain tamoxifen-stimulated growth, such as local metabolism of drug or mutant ERs (17, 18, 19, 20) , there is no unifying theory of tamoxifen-stimulated tumor growth or drug resistance. This is, however, not a surprise because all studies use tumors derived from one cell line that has a wild-type p53 protein (21) . Because 50% of human breast cancer have mutant p53 (22 , 23) , we believed it was important to determine what effect a mutant p53 would have on acquired antiestrogen resistance.
The T47D human breast cancer cell line is ER/progesterone receptor-positive and is derived from a pleural effusion (24) . These cells express a mutant p53 (25) , and clones have been derived that are exquisitely sensitive to the stimulatory effects of estradiol (26 , 27) . The p53 protein comprises three functional domains: transactivating domain, sequence-specific zinc-binding domain, and tetradimerization domain. Within the zinc-binding domain are two regions, L2 and L3 loops, also called zinc-binding domains (residues 163195 and 236251), that are important for DNA binding and protein stabilization (28) . Missense mutations in the zinc-binding domain are the most frequently found and have been shown to predict poor outcome in patients (29 , 30) .
T47D cells contain only single copies of a missense mutation at residue 194 (within the zinc-binding domain, L2) which could explain why p53 is nonfunctional in these cells (25) . If p53 cannot bind response elements in DNA, this may diminish or abolish its ability to regulate the cell cycle. Another study that analyzed the regulation of subcellular compartmentation of mutant versus wild-type p53 proteins as a function of the cell cycle showed that mutant p53 present in T47D cells was present in the nucleus at different times compared with the wild-type p53 expressed in MCF-7 cells (31) . Interestingly, transfection of wild-type p53 into T47D cells is incompatible with cellular growth, whereas in MCF-7 cells, which express wild-type p53, transfection of wild-type p53 has no effect on cellular growth (21) .
Early attempts to grow solid tumors from T47D cells were unsuccessful in athymic mice because, it was believed, T47D cells required prolactin in addition to estrogen supplementation for optimal growth. Interestingly, tumors would grow only if athymic mice were cotransplanted with the rat pituitary cell line GH3 (32) . We have reexamined this observation and successfully developed estrogen-stimulated T47D tumors. Unlike MCF-7 cells, which retain the ER under estrogen-deprived conditions in vitro (33, 34, 35) , T47D cells lose ER expression in vitro and become refractory to both estrogen and antiestrogens (36 , 37) . Naturally, we believed this phenomenon could be related to the difference in p53 status and encouraged us to pursue additional studies in vivo. Our initial hypothesis was that T47D cells would not form an antiestrogen-stimulated tumor because the drugs would cause selection pressure and encourage the growth of an ER-negative clone. However, this was not the case, because ER-positive T47D tumors rapidly become resistant and form ER-positive tamoxifen-stimulated tumors during high-dose tamoxifen therapy.
MATERIALS AND METHODS
The human breast cancer cell lines T47D and MCF-7 were originally obtained from American Type Culture Collection (Rockville, MD). These cells were karyotyped by Cellmark (Germantown, MD) and shown to be authentic T47D or MCF-7 cells (data not shown). DNA sequence analysis of the p53 gene in T47D cells was performed by OncorMed (Gaithersburg, MD) and revealed only homozygous mutation in exon 6 at nucleotide 580 of codon 194 changing leucine (CCT) to phenylalanine (TTT; data not shown). This mutation is reported in the Thiery Soussi database. Analysis of the exons 59 of the p53 gene in MCF-7 cells revealed only wild-type sequence.
Athymic Mouse Model.
The T47D and MCF-7 tumors used in these parallel experiments originated
from a bilateral inoculation of 5 x 105
T47D or MCF-7 cells suspended in Hanks buffered saline solution into
the mammary fat pads of ovariectomized BALB/c nu/nu mice supplemented
with estrogen as described previously (38)
. Ovariectomized
45 week old athymic mice (Harlan Sprague Dawley, Madison, WI) were
subsequently bilaterally transplanted s.c. in the axillary mammary fat
pads with 1-mm3 pieces of T47D or MCF-7 tumor
using a trochar. The Animal Care and Use Committee of Northwestern
University approved all of the procedures involving animals.
Hormone and Drug Treatments.
Mice were divided into groups of 10 and were treated with E2 (Sigma,
St. Louis, MO), tamoxifen (Sigma), or combinations. E2 pellets
containing 1.7 mg of E2 (Innovative Research of America, Toledo, OH)
were implanted s.c. in the back of the mouse on the same day as tumor
transplantation. Silastic E2 capsules (0.3 cm or 1 cm in length) were
made as described previously (39)
, implanted s.c., and
replaced after 810 weeks of treatment. The 0.3-cm estradiol capsules
produced a mean 83.8 pg/ml of serum E2, whereas 1.0 cm E2 capsules
produced a mean 379.5 pg/ml serum E2 (40)
. Each was
designed to represent the low or high E2 levels observed in post- or
premenopausal women respectively. Tamoxifen was first dissolved in
ethanol and suspended in a solution of 90%
carboxymethylcellulose (1% carboxymethylcellulose in double
distilled water) and 10% polyethylene glycol 400/Tween
80 (99.5% polyethylene glycol and 0.5% Tween 80). Ethanol was
evaporated under nitrogen before use. Tamoxifen was administered p.o.
by gavage at various doses: 0.17, 0.5, or 1.5 mg per mouse per day 5
days a week. Tamoxifen at 0.5 mg resulted in serum levels of tamoxifen
of 58 ± 7 ng/ml and at 1.5 mg 203 ± 100 ng/ml (mean ±
SD; 40
).
Tumor Measurements.
Tumor measurements were performed weekly using Vernier calipers. The
cross-sectional area was calculated using the formula: length x
width/4 x
.
Statistical Analysis.
Comparisons in mean tumor between the animal groups were analyzed by
ANOVA each week and were followed by unpaired Students t
test. The two-tailed P of the last previous week of each
experiment was reported using StatMost 2.5 (Datamost Corp., Salt Lake,
UT). Analysis of covariance was used to compare slopes of the rate of
development of T47D and MCF-7 tamoxifen-stimulated tumors.
Western Blot Analysis.
Cells were seeded at various concentrations into T-75
cm2 tissue culture flasks and treated with
hormone for 24 h. Tumors were homogenized by grinding in liquid
nitrogen. The cell or tumor cell pellet was resuspended in protein
extraction buffer [0.5% NP40, 2% Glycerol, 1 mM DTT, 1
mM EDTA, 150 mM NaCl, 50 mM Tris
(pH 7.4), 1 mM EGTA, 3 mM phenylmethanesulfonyl
fluoride, 25 µg/ml leupeptin, 9 µg/ml aprotinin, 25 µg/ml trypsin
inhibitor, 25 µg/ml t-chymotrypsin]. Samples were incubated on ice
with intermittent vortexing for 30 min and then pelleted. Supernatant
was then collected and stored at -80°C. Protein concentration was
measured using the Bio-Rad Protein Assay kit, and equal amounts of
protein were run in a standard Western blot protocol. The ER primary
antibody used was AER311 (Neomarkers, Fremont, CA) and ß-actin
antibody AC-15 (Sigma, St. Louis, MO) was used to standardize
loading. The appropriate secondary antibody conjugated with horseradish
peroxidase kit (Amersham Corp.) was used to visualize bands using an
ECL visualization kit (Amersham Corp., Arlington Heights, IL).
The membrane was wrapped in plastic wrap and exposed to Kodak X-OMAT
film for 10 s to 1 h.
RESULTS
Ovariectomized athymic mice were injected bilaterally with 5 x 105 T47D human breast cancer cells and
supplemented with E2 pellets (14
, 38)
to create T47D:E2
tumors. Initial tumor take was 5 tumors/8 sites after 8 weeks. When
T47D:E2 tumors reached 0.8 cm2 (data not shown),
a single tumor was passaged into 40 mice by retransplanting 1
mm3 tumor pieces and treating 10 mice each with
premenopausal estradiol levels delivered by a 1-cm E2 capsule (379.5
pg/ml), p.o. tamoxifen (0.5 mg), or a combination (Fig. 1)
. The final group served as the
untreated control. After 12 weeks of treatment, tumors from the
estradiol-treated animals grew rapidly and tamoxifen inhibited
estradiol-stimulated growth, which demonstrated that tamoxifen was
acting as an antiestrogen in this model. In this experiment, 0.5 mg
tamoxifen alone stimulated the growth of only a single tumor which,
when retransplanted and treated with 0.5 mg of tamoxifen, did not grow
after 15 weeks of tamoxifen treatment (data not shown).
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These data support the theory that selection pressure from high doses of tamoxifen will facilitate tamoxifen-stimulated tumor growth compared with the effect of lower doses. In addition, the data show that the T47D tumor line was more prone to tamoxifen failure compared with the MCF-7 tumor line. Using analysis of covariance to compare the slopes of the 1.5-mg-tamoxifen treatments of T47D and MCF-7 tumors, we determined that the T47D tumors produced tamoxifen-stimulated tumors at a faster rate and to a significantly greater extent compared with MCF-7 tumors (P < 0.001).
Next tamoxifen-stimulated MCF-7:Tam2 and T47D:Tam tumors were harvested
and retransplanted to compare the growth characteristics of these two
tumor models under similar conditions. Thirty athymic mice implanted
with the MCF-7:Tam2 tumor were treated with 0.3-cm E2 capsule, 1.5 mg
tamoxifen, or no drug (control). E2 resulted in very rapid growth of
these tumors, which reached an average tumor area of 1
cm2 by 8 weeks (Fig. 5)
. The same experiment was performed
using the T47D:Tam tumors implanted into 30 athymic mice and treated
with the same regimens. Low-dose E2 (0.3 cm capsule) resulted in growth
of T47D:Tam to 1 cm2 after 14 weeks (Fig. 6)
and tamoxifen produced an almost
identical growth response. Clearly, both tumors respond to estrogen and
tamoxifen for growth.
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Although tamoxifen is the endocrine treatment of choice for all stages of breast cancer (1 , 2) , approximately one-half of the patients with ER-positive breast cancer either do not respond to tamoxifen or rapidly fail tamoxifen treatment (2) . A study of drug resistance to tamoxifen is, therefore, a priority in breast cancer either to predict who will not benefit from therapy or to counter the process and extend the antitumor actions of an effective treatment.
Laboratory investigations of drug resistance to tamoxifen have, almost exclusively, used the MCF-7 breast cancer cell line (13 , 14 , 20 , 42) . However, it is obvious that studies with a single cell line from a single patient (10 , 11) cannot adequately describe all of the possible mechanisms involving drug resistance to tamoxifen that occur spontaneously in the clinic. Breast cancer growth is heterogeneous and multifaceted with numerous genetic alterations such as HER2 amplification (43, 44, 45) , BCAR-1 amplification (46 , 47) , and p53 mutation (48 , 49) modifying the response to tamoxifen through the ER signal transduction pathway.
MCF-7 and T47D cells are both ER-positive and sensitive to the stimulatory effects of E2 and the inhibitory effects of antiestrogens in cell culture (27 , 50 , 51) . However, unlike the MCF-7 cell line (37) , T47D cells can lose the ER during long-term estrogen deprivation (36 , 52) . The mechanism is unknown but the finding that p53 is mutated in T47D cells (53) and that MCF-7 and T47D cells have different control mechanisms for ER regulation (35 , 54) raised the possibility that T47D cells would lose sensitivity to tamoxifen in vivo and would develop ER-negative hormone-independent tumors. In fact, our hypothesis was incorrect.
It is difficult to establish tamoxifen-stimulated tumors in athymic mice using estrogen-stimulated MCF-7 tumors. This is not surprising inasmuch as it has been difficult to demonstrate tamoxifen-stimulated breast cancer clinically (4, 5, 6) , and the phenotype is only inferred by a second-line response to either a pure antiestrogen (8) or an aromatase inhibitor (9) . In contrast, the p53 mutant T47D tumors produced tamoxifen-stimulated tumors with p.o. 1.5-mg tamoxifen faster and to a significantly greater extent compared with MCF-7 tumors. We believe that this is an important observation that could provide clues to the causes of tamoxifen failure.
Mice rapidly excrete tamoxifen, and high daily doses are required to
replicate the circulatory levels observed in patients
(55)
. In patients, tamoxifen accumulates to reach steady
state within the first 4 weeks (56)
, and blood levels of
tamoxifen are around 100200 ng/ml using a 20-mg/day treatment regimen
(57)
. The initial daily dose selected in our study (0.5 mg
per day p.o.) was based on previous experience by Osbornes group who
used 0.35 mg per day via i.p. injection (12
, 13)
. We
demonstrate that 0.5 mg tamoxifen per day is effective as an antitumor
agent when premenopausal levels of E2 are used to stimulate tumor
growth (Fig. 1)
. However, 1.5 mg tamoxifen per day caused the
development of tamoxifen-stimulated tumors with both MCF-7 and T47D
breast cancers.
In an earlier study, we examined the circulating levels of tamoxifen and found that a dose of 0.5 mg of tamoxifen produced serum levels of 58 ± 7 ng/ml (mean ± SD) and at a dose of 1.5 mg, 203 ± 100 ng/ml serum tamoxifen was produced (40) . It is difficult to relate the dose per mouse realistically to the clinical use of tamoxifen because, unlike in humans, tamoxifen is metabolized and excreted rapidly in mice. Furthermore, the optimal therapeutic dose that is used in humans is controversial. The initial selection of a dose to test for the treatment of breast cancer was only estimated (58 , 59) and subsequently established based on the observation that the drug was effective with no significant side effects. Depending on the country, tamoxifen is recommended at 20 mg per day (United States), 20 or 40 mg per day (United Kingdom), or 30 mg per day (Canada and Germany). There are suggestions that the doses used clinically are too high (60 , 61) , and a dose of 10 mg every other day is being considered for chemoprevention in well women (61) .
The observations that both the T47D and MCF-7 tamoxifen-stimulated tumors remain ER-positive and will grow with either estradiol or tamoxifen is consistent with clinical observation (7) . The mechanism for the alteration of tamoxifen from an antiestrogen to an estrogen appears to be consistent for the cell lines despite differences in ER regulation (35 , 54) . However, the observation that the development of tamoxifen-stimulated tumors occurs more rapidly with T47D cells is consistent with the fact that removal of effective cell cycle regulation by a mutant p53 could enhance the expression of the estrogen-like actions of tamoxifen during the development of resistance.
We have performed preliminary studies on the expression of VEGF, an angiogenesis promoter, in MCF-7 tamoxifen-stimulated tumors. In these tamoxifen-stimulated tumors, there is an increased expression of VEGF compared with that in MCF-7 estrogen-stimulated tumors, which supports the fact that tamoxifen-stimulated growth may be mediated by increased VEGF expression (62) . We are currently determining VEGF expression in both estrogen- and tamoxifen-stimulated T47D breast tumors.
Although T47D and MCF-7 cells have different regulatory mechanisms that
control the translation of the ER
gene (35
, 54)
, both
types of tamoxifen-simulated tumors contain measurable amounts
of ER
by Western blot (14)
. A model of cell selection
could occur that exploits the estrogen-like actions of tamoxifen at
ER
(63
, 64) . Recent studies have illustrated the
promiscuous nature of the ER
-tamoxifen complex at complex gene
targets based on the actual shape of the complex (65)
.
Other antiestrogens, however, present different external surfaces
(66)
, so that there is an opportunity to design new
antiestrogens that do not exhibit early drug resistance and are not
cross-resistant with tamoxifen. In conclusion, the MCF-7:Tam2 and
T47D:Tam tumors will be valuable not only in evaluating new
antiestrogens for potential clinical use but also in understanding the
molecular mechanism of drug resistance in vivo.
ACKNOWLEDGMENTS
We thank Henry Muenzner and Jay De Los Reyes for technical assistance. We also thank Dr. Fred Rademaker for the assistance with statistical analysis.
FOOTNOTES
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.
1 Supported by Department of Defense Breast Cancer
Training Grant DAMD 17-94-J-4466, DAMD 17-96-1-6169, and Breast Cancer
Program Development Grant P20 CA65764 and RO1-CA56143. Additional
support was provided by the Lynn Sage Breast Cancer Research Fund of
Northwestern Memorial Hospital and the Avon Products Foundation. ![]()
2 J. M. S. and E. S. L. contributed equally to
this work. ![]()
3 Present address: Department of General Surgery,
Korea University Ansan Hospital, 516 Kojan-Dong Ansan city Kyunggi-Do,
425-020 South Korea. Fax: 82-345-413-4829. ![]()
4 To whom requests for reprints should be
addressed, at Northwestern University Medical School, Robert H. Lurie
Comprehensive Cancer Center, 303 East Chicago Avenue, 8258 Olson
Pavilion, Chicago, IL 60611. Fax: (312) 908-1372. ![]()
5 The abbreviations used are: ER, estrogen
receptor; E2, 17ß-estradiol; 4-OHT, 4-hydroxytamoxifen; VEGF,
vascular endothelial growth factor. ![]()
Received 5/18/00; revised 8/11/00; accepted 8/14/00.
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