Novel Long Non-Coding Rnas Are Specific Diagnostic and Prognostic Markers for Prostate Cancer

www.impactjournals.com/oncotarget/ Oncotarget, Vol. 6, No.6 Novel long non-coding RNAs are specific diagnostic and prognostic markers for prostate cancer René Böttcher1,3, A. Marije Hoogland2, Natasja Dits1, Esther I. Verhoef2, Charlotte Kweldam2, Piotr Waranecki1, Chris H. Bangma1, Geert J.L.H. van Leenders2, Guido Jenster1 1Dept. of Urology, Erasmus MC, Rotterdam, The Netherlands 2Dept. of Pathology, Erasmus MC, Rotterdam, The Netherlands 3Dept. of Bioinformatics, Technical University of Applied Sciences Wildau, Wildau, Germany Correspondence to: Guido Jenster, e-mail: [email protected] Keywords: Long non-coding RNA, prostate cancer, in situ hybridization, exon array, biomarkers Received: August 22, 2014 Accepted: December 08, 2014 Published: February 17, 2015 ABSTRACT Current prostate cancer (PCa) biomarkers such as PSA are not optimal in distinguishing cancer from benign prostate diseases and predicting disease outcome. To discover additional biomarkers, we investigated PCa-specific expression of novel unannotated transcripts. Using the unique probe design of Affymetrix Human Exon Arrays, we identified 334 candidates (EPCATs), of which 15 were validated by RT-PCR. Combined into a diagnostic panel, 11 EPCATs classified 80% of PCa samples correctly, while maintaining 100% specificity. High specificity was confirmed by in situ hybridization for EPCAT4R966 and EPCAT2F176 (SChLAP1) on extensive tissue microarrays. Besides being diagnostic, EPCAT2F176 and EPCAT4R966 showed significant association with pT-stage and were present in PIN lesions. We also found EPCAT2F176 and EPCAT2R709 to be associated with development of metastases and PCa-related death, and EPCAT2F176 to be enriched in lymph node metastases. Functional significance of expression of 9 EPCATs was investigated by siRNA transfection, revealing that knockdown of 5 different EPCATs impaired growth of LNCaP and 22RV1 PCa cells. Only the minority of EPCATs appear to be controlled by androgen receptor or ERG. Although the underlying transcriptional regulation is not fully understood, the novel PCa-associated transcripts are new diagnostic and prognostic markers with functional relevance to prostate cancer growth. INTRODUCTION unnecessary biopsies and overtreatment of patients due to a lack of prognostic markers. Up to date this remains Despite continuous research efforts over the past a challenge and additional prognostic factors, such as decades, prostate cancer (PCa) remains one of the leading disease associated genes, are needed [3]. causes of male cancer deaths, with an estimated 70,100 Earlier studies discovered several other PCa- deaths in Europe in 2014. Incidence rates are highest in associated genes, among them two long non-coding RNAs countries of the western hemisphere including Europe, (lncRNAs) that show disease-associated overexpression, North America and Oceania, which can be partly explained PCGEM1 and PCA3 (DD3) [4, 5]. The latter has since by the widely applied blood test for prostate specific been extensively studied as diagnostic urine marker for antigen (PSA) [1, 2]. Although the serum PSA level offers PCa, offering better performance for detecting PCa when high sensitivity for PCa detection, its specificity is limited compared to PSA [6]. With the introduction of high as PSA levels can also be elevated in benign prostate throughput technologies, such as tiling arrays and next diseases such as benign prostate hyperplasia (BPH) and generation sequencing, several other PCa-associated prostatitis. Thus, the most important drawback of PSA lncRNAs such as PRNCR1, PCAT1, PCAT18, PCAT29 screening is a high number of false positives leading to and SChLAP1 were identified [7–14]. www.impactjournals.com/oncotarget 4036 Oncotarget LncRNAs have been associated with several were resolved by a union of all TCs involved in a functions, including epigenetic regulation of gene expression particular EPCAT to maximize its size. Our meta-analysis by acting as regulatory factors in cis, as well as in trans by of three available Exon Array datasets resulted in 334 involvement in chromatin remodeling [15–18]. Additionally, EPCATs comprising 2086 TCs that exhibited a prostate direct binding to active androgen receptor (AR) and cancer-specific expression profile (see Supplementary recruitment of additional factors for AR-mediated gene Tables 1–2). We observed that combining several datasets expression has been reported [19]. However, a recent study severely reduced the number of EPCATs identified by one found contradicting evidence for these findings and thus dataset alone, suggesting a reduction in false positives in further research is required to clarify lncRNA involvement doing so (see Figure 2a). Next, we classified the identified in AR activity [20]. Still, many functional relationships of EPCATs based on their genomic origin with regard to lncRNAs as well as their tissue-specific regulation remain UCSC known genes, and observed that 75 EPCATs were unclear. Currently, lncRNAs are gaining more interest as being classified as intergenic or antisense transcripts. The potential biomarkers for various malignant diseases, due to majority of EPCATs (259) overlapped/extended either their highly tissue-specific expression profiles [17, 21]. 5’ or 3’ ends or was located in intronic regions of genes In this study, we set out to discover novel PCa-specific known to LNCipedia [23] or UCSC (see Figure 2b). lncRNAs based on Affymetrix Human Exon Arrays by Visual inspection of these results confirmed that adapting a cancer outlier profile analysis (COPA, [22]). similar PCa-specific expression patterns occurred in Our approach made use of the unique design of these all three datasets with TCs grouped into one EPCAT arrays, which include probes against predicted sequences following the same PCa-specific outlier profile (see (‘full’) next to probes targeting known sequences (‘core’ Figure 3 and Supplementary Figures 1–6 for a subset of 15 and ‘extended’). This type of microarray has recently been EPCATs that were subsequently PCR-validated). We also successfully adapted for lncRNA profiling, showing the inspected EPCAT expression in other publicly available general potential of the platform in lncRNA studies [11]. datasets comprising samples from lung, brain, breast, To increase reliability of our results, we combined three colorectal and gastric cancer tissue as well as several Affymetrix Human Exon Array datasets and searched for normal tissues. For most of the EPCATs, expression reoccurring outlier patterns indicating novel transcripts. We was very low in virtually all samples, indicating a then used RNA-sequencing (RNA-seq) data to refine our PCa-specific expression of these transcripts similar transcript definitions and subsequently validated them via RT- to other previously reported lncRNAs ([12, 24], see PCR. Computational evaluation of the validated transcripts Supplementary Figures 3–6). However, some EPCATs confirmed absence of protein coding potential, suggesting such as EPCAT5R633 and EPCATXR234 were detected that these transcripts are indeed lncRNAs. Two transcripts in multiple lung, colorectal and breast tumors and appear were chosen for staining of tissue microarrays using in situ deregulated in different cancer types. To gain insight hybridization and successfully discriminated PCa from into their transcriptional regulation, we tested whether normal adjacent prostate (NAP) and benign prostate tissue. any EPCATs are androgen regulated by incorporating a publicly available dataset of R1881 treated LNCaP RESULTS cells. We observed that out of 301 EPCATs expressed in LNCaP 31 were significantly associated with androgen 334 candidate PCa-associated transcripts were treatment and showed more than 50% increase or decrease identified in expression (p < 0.05; 13 up-, 18 downregulated, see Supplementary Figure 7). In addition, we tested for Novel transcript candidates were identified by coexpression with known outlier genes ERG and ETV1 searching for unannotated Affymetrix Human Exon Array [22] by Spearman’s correlation coefficient, and found transcript clusters (TCs) that showed a PCa-specific outlier that 17 EPCATs showed significant correlation with ERG profile using a COPA transformation [22]. After removing (Spearman’s p ≥ 0.5 and p < 0.05, see Supplementary all TCs targeting known genes, we discarded TCs with Figure 8), while no significant coexpression with ETV1 fewer than 5% outliers in cancerous samples and with was observed. Public ChIP-seq data [25] targetting AR outliers in control groups. All remaining TCs were then and ERG was used as second source of evidence for grouped into ‘EPCATs’ (Erasmus MC PCa-associated AR and ERG regulation. We found that 15 of the 33 transcripts) based on proximity, strand and similarity in differentially expressed EPCATs (including 50 kb flanks) expression (see Figure 1). EPCAT names were assigned had overlapping AR peaks, whereas ERG peaks were to directly indicate genomic location and are based on found for 4 of the 17 coexpressed EPCATs (see methods). chromosome, strand and a unique identifier. For instance, To gather more evidence for the existence of EPCAT2F176 (SChLAP1) is located on the forward strand our transcript candidates, we performed a reference of chromosome 2. EPCATs had to be present in at least two guided assembly of RNA-seq data obtained from datasets to be considered for further analysis. Differences 18 patients with localized PCa as well as 5 samples between datasets (i.e. missing parts in one or the other)

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