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Author Manuscript Published OnlineFirst on June 15, 2010; DOI: 10.1158/1078-0432.CCR-10-0889 AuthorPublished manuscripts OnlineFirst have been peer on reviewedJune 15, and 2010 accepted as 10.1158/1078-0432.CCR-10-0889for publication but have not yet been edited. Clinical implications of gene dosage and gene expression patterns in diploid breast carcinoma ∗ Toshima Z. Parris,1, Anna Danielsson,1 Szilárd Nemes,1 Anikó Kovács,2 Ulla Delle,1 Ghita Fallenius,1 Elin Möllerström,1 Per Karlsson,1 and Khalil Helou1 Running Title: Clinical relevance of integrative genomics in breast cancer Keywords: Diploid breast carcinoma, array-CGH, copy number aberration, gene expression microarray, aggressive phenotype Authors’ Affiliations: 1Department of Oncology, Institute of Clinical Sciences, and 2Laboratory of Clinical Pathology and Cytology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden Note: Supplementary data for this article are available at Clinical Cancer Research Online (http://clincancerres.aacrjournals.org/). ∗ Corresponding Author: Toshima Z. Parris, Department of Oncology, Sahlgrenska Academy at University of Gothenburg, Gula stråket 2, SE-41345 Gothenburg, Sweden. Phone: 46-31- 3427855; Fax: 46-31-820114; E-mail: [email protected]. Grant support: This work was supported by grants from the King Gustav V Jubilee Clinic Cancer Research Foundation (K. Helou) and the Wilhelm and Martina Lundgren Research Foundation (T. Parris). Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Copyright © 2010 American Association for Cancer Research Downloaded from clincancerres.aacrjournals.org on September 30, 2021. © 2010 American Association for Cancer Research. Author Manuscript Published OnlineFirst on June 15, 2010; DOI: 10.1158/1078-0432.CCR-10-0889 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Translational Relevance This study provides novel information on the specific DNA copy number aberrations and underlying changes in gene expression associated with clinicopathological features in diploid breast carcinoma (DBC). Using an integrative genomics approach, we identified transcripts whose expression patterns were directly impacted by gene dosage. In addition, the transcriptional levels of 12 genes were consistently associated with a more malignant phenotype in DBC. Integrating data on DNA and mRNA dysregulation in relation to breast cancer behavior is, therefore, a step toward understanding tumor initiation and progression contributing to unfavorable prognosis. Furthermore, these findings provide potential targets in the development of individualized patient therapy for aggressive breast neoplasms. Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Copyright © 2010 American Association for Cancer Research Downloaded from clincancerres.aacrjournals.org on September 30, 2021. © 2010 American Association for Cancer Research. Author Manuscript Published OnlineFirst on June 15, 2010; DOI: 10.1158/1078-0432.CCR-10-0889 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Abstract Purpose: Deregulation of key cellular pathways is fundamental for the survival and expansion of neoplastic cells. In cancer, regulation of gene transcription can be mediated in a variety of ways. The purpose of this study was to assess the impact of gene dosage on gene expression patterns, the effect of other mechanisms on transcriptional levels, and to associate these genomic changes to clinicopathological parameters. Experimental Design: We screened 97 invasive diploid breast tumors for DNA copy number alterations and changes in transcriptional levels using array comparative genomic hybridization and expression microarrays, respectively. Results: The integrative analysis identified an increase in the overall number of genetic alterations during tumor progression and fifteen specific genomic regions with aberrant DNA copy numbers in at least 25% of the patient population, i.e. 1q22, 1q22-q23.1, 1q25.3, 1q32.1, 1q32.1-q32.2, 8q21.2-q21.3, 8q22.3, 8q24.3, and 16p11.2 were recurrently gained, while 11q25, 16q21, 16q23.3, and 17p12 were frequently lost (P<0.01). An examination of the expression patterns of genes mapping within the detected genetic aberrations identified 47 unique genes and 1 Unigene cluster significantly correlated between the DNA and relative mRNA levels. In addition, more malignant tumors with normal gene dosage levels displayed a recurrent over-expression Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Copyright © 2010 American Association for Cancer Research Downloaded from clincancerres.aacrjournals.org on September 30, 2021. © 2010 American Association for Cancer Research. Author Manuscript Published OnlineFirst on June 15, 2010; DOI: 10.1158/1078-0432.CCR-10-0889 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. of UBE2C, S100A8 and CBX2, and down-regulation of LOC389033, STC2, DNALI1, SCUBE2, NME5, SUSD3, SERPINA11, AZGP1 and PIP. Conclusions: Taken together, our findings suggest that the dysregulated genes identified here are critical for breast cancer initiation and progression, which could be used as novel therapeutic targets for drug development to complement classical clinicopathological features. Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Copyright © 2010 American Association for Cancer Research Downloaded from clincancerres.aacrjournals.org on September 30, 2021. © 2010 American Association for Cancer Research. Author Manuscript Published OnlineFirst on June 15, 2010; DOI: 10.1158/1078-0432.CCR-10-0889 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Introduction Copy number alterations (CNA) are a fundamental feature of neoplastic cells that influence crucial cancer-specific processes (1). It is estimated that more than 1% of protein-coding genes in the human genome contribute to tumorigenesis, whereas only 3% of these have been implicated in sporadic breast carcinoma (2). In comparison with many tumor types of non-epithelial origin, breast carcinomas arising from epithelial cells have numerous genetic alterations (3). Many of the recurrent alterations occurring in carcinomas of the breast have been identified, including copy number gains on 1q, 8p, 8q, 11q, 16p, 17q, and 20q and losses on 1p, 6q, 11q, 16q, 17p, and 22q (4). Tumorigenesis is however a dynamic evolutionary process that promotes genetic heterogeneity and thereby produces a complex combination of random and non-random aberrations. To study complex phenotypes such as cancer, a straightforward approach is to provide comprehensive information on the disease by integrating multiple platforms on several biological levels (DNA-RNA-protein). Integrative analyses of data produced by genome-wide profiling techniques such as array comparative genomic hybridization (array-CGH; (5)) and expression microarrays can provide detailed information on the genomic locations of recurrently altered DNA regions, the impact of these CNAs on gene deregulation, as well as enhance our understanding of these genetic events coupled with clinicopathological parameters (6, 7). However, there are limitations associated with the array-CGH approach as it will not detect inversions, balanced translocations, polyploidy, Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. Copyright © 2010 American Association for Cancer Research Downloaded from clincancerres.aacrjournals.org on September 30, 2021. © 2010 American Association for Cancer Research. Author Manuscript Published OnlineFirst on June 15, 2010; DOI: 10.1158/1078-0432.CCR-10-0889 Author manuscripts have been peer reviewed and accepted for publication but have not yet been edited. mutations, or epigenetic modulations. It is, therefore, necessary to also study changes in gene expression patterns independent of copy number alterations. In the present investigation, we chose to conduct genome-wide screening on a series of diploid breast carcinomas (DBC). A previously suggested theory postulated that the aneuploid state is not fundamental to malignancy as diploid and aneuploid breast tumors share many of the acquired genetic aberrations characteristic of the disease, despite the increase in number of events in aneuploid disease (8-14). Approximately 1 in 4 diagnosed breast carcinoma cases have a diploid DNA content (15). Generally, diploid tumors are composed of a nearly homogenous mix of slow-growing cells which may permit these neoplasms to follow a more favorable clinical course than aneuploid tumors (16, 17). The more aggressive phenotype displayed by aneuploid tumors can possibly be explained by clonal heterogeneity represented by the presence of fewer cells expressing the steroid hormone receptors, increased proliferative activity, and a higher percentage of poorly differentiated tumors (18). Taken together, these observations suggest that despite diversity there are similar molecular mechanisms active in the development of breast carcinomas, regardless of ploidy status. It is, therefore, of particular interest to conduct integrative genomics using diploid breast carcinomas to mitigate some of the obstacles associated with the heterogeneity of genetic