Genome-Wide DNA Methylation Analysis Reveals GABBR2 As A
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Published OnlineFirst May 10, 2017; DOI: 10.1158/1078-0432.CCR-16-2688 Cancer Therapy: Clinical Clinical Cancer Research Genome-wide DNA Methylation Analysis Reveals GABBR2 as a Novel Epigenetic Target for EGFR 19 Deletion Lung Adenocarcinoma with Induction Erlotinib Treatment Xiaomin Niu1, Fatao Liu2,3, Yi Zhou4, Zhen Zhou1, Daizhan Zhou5, Ting Wang2,3, Ziming Li1, Xiangyun Ye1, Yongfeng Yu1, Xiaoling Weng6,7, Hong Zhang6,7, Junyi Ye6,7, Meilin Liao1, Yun Liu6, Zhiwei Chen1, and Shun Lu1 Abstract Purpose: The past decade has witnessed the rapid development CBFA2T3 and GABBR2, were clearly validated. A same dif- of personalized targeted therapies in lung cancer. It is still unclear ferential methylated region (DMR) between exon 2 and exon whetherepigeneticchangesareinvolvedintheresponsetotyrosine 3ofGABBR2 gene was confirmed consistently in both kinase inhibitor (TKI) treatment in epidermal growth factor recep- patients. GABBR2 was significantly downregulated in EGFR tor (EGFR)-mutated lung cancer. 19 deletion cells, HCC4006 and HCC827, but remained Experimental Design: Methyl-sensitive cut counting sequenc- conserved in EGFR wild-type A549 cells after erlotinib treat- ing (MSCC) was applied to investigate the methylation changes in ment. Upregulation of GABBR2 expression significantly res- paired tissues before and after erlotinib treatment for 42 days with cued erlotinib-induced apoptosis in HCC827 cells. GABBR2 partial response (PR) from stage IIIa (N2) lung adenocarcinoma was significantly downregulated, along with the reduction of patients (N ¼ 2) with EGFR 19 deletion. The Sequenom EpiTYPER S6, p-p70 S6, and p-ERK1/2, demonstrating that GABBR2 assay was used to validate the changed methylated candidate may play an important role in EGFR signaling through the genes. Up- or downregulation of the candidate gene was per- ERK1/2 pathway. formed to elucidate the potential mechanism in the regulation of Conclusions: We demonstrated that GABBR2 gene might be a erlotinib treatment response. novel potential epigenetic treatment target with induction erlo- Results: Sixty aberrant methylated genes were screened tinib treatment for stage IIIa (N2) EGFR 19 deletion lung adeno- using MSCC sequencing. Two aberrant methylated genes, carcinoma. Clin Cancer Res; 23(17); 5003–14. Ó2017 AACR. Introduction Lung cancer has been the leading life-threatening cancer in the world (1). With the development of molecular biology, targeted 1 Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shang- therapy has been more and more involved in anticancer treat- hai Jiao Tong University, Shanghai, P.R. China. 2Department of General Surgery, ment. In the clinical treatment of non–small cell lung cancer Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. 3Institute of Biliary Tract Disease, Shanghai Jiao Tong Univer- (NSCLC), targeted therapy against epidermal growth factor recep- sity School of Medicine, Shanghai, P.R. China. 4Institute for Nutritional Sciences, tor (EGFR) has gradually matured and significantly contributed to Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, the improvement of patient outcomes and quality of life (2). The Shanghai, P.R. China. 5Bio-X Institutes, Key Laboratory for the Genetics of results of the IRESSA Pan Asia Study (IPASS) make it common Developmental and Neuropsychiatric Disorders (Ministry of Education), Shang- practice to screen for EGFR mutations before NSCLC treatment, as hai Jiao Tong University, Shanghai, P.R. China. 6Institutes of Biomedical 75% of NSCLC patients carrying EGFR mutation benefit from Sciences, Fudan University, Shanghai, P.R. China. 7Key Laboratory of Molecular Medicine, The Ministry of Education, Department of Biochemistry and Molecular tyrosine kinase inhibitor (TKI) treatment (3). However, the ben- Biology, Fudan University Shanghai Medical College, Shanghai, P.R. China. efit of EGFR-TKI regimens for patients with stage IIIa NSCLC Note: Supplementary data for this article are available at Clinical Cancer remains uncertain. The goal of the treatment in locally advanced Research Online (http://clincancerres.aacrjournals.org/). NSCLC is to cure without long-term therapy related complica- tions. With the successful integration of TKIs in the treatment of X. Niu and F. Liu contributed equally to this article and share lead authorship. advanced NSCLC with mutated EGFR, it is reasonable to wonder Y. Liu, Z. Chen, and S. Lu are co-senior authors of this article. whether we could extend this benefit to locally advanced NSCLC Corresponding Author: Shun Lu, Department of Shanghai Lung Cancer Center, and actually improve long-term survival rates for these patients. Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, There are some clinical trials (NCT01822496, NCT00600587) Shanghai 200030, P.R. China. Phone: 86-21-62821990; Fax: 86-21-62804970; evaluating the value of induction erlotinib therapy before thora- E-mail: [email protected] cotomy or radiotherapy in stage IIIa (N2) EGFR-mutated NSCLC. doi: 10.1158/1078-0432.CCR-16-2688 However, an important question is why the recurrence rates after Ó2017 American Association for Cancer Research. complete surgical resection still remain as high as 70% (4). www.aacrjournals.org 5003 Downloaded from clincancerres.aacrjournals.org on September 27, 2021. © 2017 American Association for Cancer Research. Published OnlineFirst May 10, 2017; DOI: 10.1158/1078-0432.CCR-16-2688 Niu et al. help to discover how epigenetic changes are involved in the Translational Relevance response to TKI therapy and further indicate new potential com- The is the first study to investigate the changes in DNA bined induction therapy in EGFR-mutated NSCLC. methylation before and after induction tyrosine kinase inhib- itor (TKI) treatment for epidermal growth factor receptor Materials and Methods (EGFR)-mutated lung adenocarcinoma at the whole-genome Patients and samples level. A differential methylated region (DMR) of GABBR2 gene The patients from Shanghai Chest Hospital were confirmed to was confirmed in the two patients involved in the present have locally advanced stage IIIa-N2 lung adenocarcinomas with study. Upregulation of GABBR2 expression significantly res- mediastinal lymphadenopathies confirmed by mediastinoscopy cued erlotinib-induced apoptosis, which indicated that that were unresectable at the first diagnosis, carrying EGFR 19 GABBR2 gene might be a novel potential epigenetic treatment deletion mutations by direct sequencing. After two cycles of target with induction erlotinib treatment for stage IIIa (N2) induction erlotinib treatment (21 days for one cycle of treatment, EGFR 19 deletion lung adenocarcinoma. Our research pro- a total of 42 days), the patients exhibited a partial response (PR) vides a new theoretical basis for the epigenetic study of EGFR- according to the Response Evaluation Criteria in Solid Tumors mutated lung adenocarcinoma treatment and suggests that (RECIST) version 1.1 (13) and then subsequently received a targeting GABBR2 together with EGFR inhibition may radical sleeve lobectomy after multidiscipline discussion on improve clinical outcomes in patients with EGFR-mutated tumor board. The current study conformed to the Declaration lung adenocarcinoma. of Helsinki and was performed after approval by the Institutional Review Board (IRB) of Shanghai Chest Hospital (No. of ethics approval: KS1307). The two patients signed the IRB-approved written informed Considering the current clinical issue, our research is to investigate consents and were further enrolled for this study, allowing for whether epigenetic changes such as DNA methylation are the collection and genomic analysis of archived tissue speci- involved in the response to induction TKI treatment in EGFR- mens. The metastatic mediastinal lymph nodes before TKI mutated lung cancer. treatment were collected using mediastinoscopy, and post-TKI Recent studies have demonstrated that DNA methylation plays treatment metastatic mediastinal lymph nodes were collected a role in the targeted therapy of NSCLC (5–7). DNA methylation duringthesleevelobectomyoperation(N ¼ 2, a total of 4 status of Wnt antagonist genes from 155 NSCLC patients who samples). After surgery, the samples were collected and stored received EGFR-TKI treatment were investigated using methyla- at À80C immediately. A total of 4 samples (2 matched pairs) tion-specific PCR, showing that DNA methylation status of Wnt were used for whole-methylome screening and were then antagonist SFRP5 can predict the response to EGFR-TKI therapy in verified by a Sequenom EpiTYPER assay to double confirm the NSCLC, and methylated SFRP5 may contribute to shorter pro- changed methylated candidate genes. gression-free survival (PFS; ref. 8). The EGFR 19 deletion cell line PC-9, with the unmethylated promoter region of EGFR gene, was more sensitive to gefitinib compared with the other EGFR 19 Genomic DNA extraction deletion cell line H1650 with the methylated promoter region, Genomic DNA was isolated from the four samples using the which was "resistant" to gefitinib, suggesting that EGFR gene QIAamp DNA Mini Kit (Qiagen). A Thermo NanoDrop 2000 fi fl promoter methylation may be a potential mechanism for (Thermo Scienti c) and a Qubit 2.0 uorometer (Life Technol- acquired resistance to gefitinib (9). Methylation of death-associ- ogies) were used to detect the DNA concentrations. An Agilent fi ated protein kinase (DAPK) is reported to be a novel target with 2100 Bioanalyzer