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Functional TLR5 Genetic Variants Affect Human Colorectal Cancer Survival

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Functional TLR5 Genetic Variants Affect Human Colorectal Cancer Survival Published OnlineFirst October 23, 2013; DOI: 10.1158/0008-5472.CAN-13-1746 Cancer Prevention and Epidemiology Research Functional TLR5 Genetic Variants Affect Human Colorectal Cancer Survival Sascha N. Klimosch1, Asta Forsti€ 4,9, Jana Eckert4, Jelena Knezevic5, Melanie Bevier4, Witigo von Schonfels€ 6, Nils Heits6, Jessica Walter6, Sebastian Hinz6, Jesus Lascorz4, Jochen Hampe7, Dominik Hartl2, Julia-Stefanie Frick3, Kari Hemminki4,9, Clemens Schafmayer6,8, and Alexander N.R. Weber1,5 Abstract Toll-like receptors (TLR) are overexpressed on many types of cancer cells, including colorectal cancer cells, but little is known about the functional relevance of these immune regulatory molecules in malignant settings. Here, we report frequent single-nucleotide polymorphisms (SNP) in the flagellin receptor TLR5 and the TLR downstream effector molecules MyD88 and TIRAP that are associated with altered survival in a large cohort of Caucasian patients with colorectal cancer (n ¼ 613). MYD88 rs4988453, a SNP that maps to a promoter region shared with the acetyl coenzyme-A acyl-transferase-1 (ACAA1), was associated with decreased survival of patients with colorectal cancer and altered transcriptional activity of the proximal genes. In the TLR5 gene, rs5744174/ F616L was associated with increased survival, whereas rs2072493/N592S was associated with decreased survival. Both rs2072493/N592S and rs5744174/F616L modulated TLR5 signaling in response to flagellin or to different commensal and pathogenic intestinal bacteria. Notably, we observed a reduction in flagellin-induced p38 phosphorylation, CD62L shedding, and elevated expression of interleukin (IL)-6 and IL-1b mRNA in human primary immune cells from TLR5 616LL homozygote carriers, as compared with 616FF carriers. This finding suggested that the well-documented effect of cytokines like IL-6 on colorectal cancer progression might be mediated by TLR5 genotype-dependent flagellin sensing. Our results establish an important link between TLR signaling and human colorectal cancer with relevance for biomarker and therapy development. Cancer Res; 73(24); 7232–42. Ó2013 AACR. Introduction germline-encoded receptors of the Toll-like receptor (TLR) fl The innate immune system detects molecular patterns family (1). For example, TLR5 senses bacterial agellin, a representative for entire classes of microbes by means of component of the bacterial motility apparatus (1). TLRs engage their ligands through leucine-rich repeat (LRR) extracellular Authors' Affiliations: 1Department of Immunology, Interfaculty Institute for domains (ECD; refs. 2, 3). Intracellular signaling is mediated by Cell Biology, University of Tubingen,€ Auf der Morgenstelle; 2Department of Toll/interleukin (IL)-1 receptor (TIR) signaling domains, cou- Pediatrics I; 3Institute for Medical Microbiology and Hygiene, University pling TLR activation to different TLR adaptor molecules, for Hospital Tubingen,€ Tubingen,€ Germany; 4Division of Molecular Genetic Epidemiology; 5Junior Research Group Toll-Like Receptors and Cancer, example, myeloid differentiation 88 (MyD88) and MyD88- German Cancer Research Center (DKFZ), Heidelberg, Germany; 6Depart- adaptor like (Mal; encoded by TIR domain-containing adaptor ment of General and Thoracic Surgery, University Hospital Schleswig- 7 8 protein; TIRAP, ref. 1). Subsequent signaling events culminate Holstein; Department of General Internal Medicine; POPGEN Biobank k Project, Christian-Albrechts University, Kiel, Germany; and 9Center for in the activation of the transcription factor NF- B and p38 and Primary Health Care Research, Clinical Research Center, Lund University, extracellular signal regulated kinase (ERK) mitogen-activated € Malmo, Sweden protein kinases (MAPK), which together regulate a plethora of Note: Supplementary data for this article are available at Cancer Research genes, for example, cytokines, required for subsequent immune Online (http://cancerres.aacrjournals.org/). responses. Thus, TLRs influence complex inflammatory, auto- S.N. Klimosch and A. Forsti€ contributed equally to this work. immune, and malignant diseases as well as tissue homeostasis, particularly in the gut (1, 4). Current address for J. Knezevic: Laboratory of Translational Medicine, The gut represents a unique environment for host–pathogen Division of Molecular Medicine, Rud er Boskovi c Institute, Zagreb, Croatia. interactions with a commensal microflora in direct proximity Corresponding Authors: Asta Forsti,€ German Cancer Research Center fi (DKFZ), Molecular Genetic Epidemiology, Im Neuenheimer Feld 580, 69120 of intestinal epithelial cells, stromal cells, and in ltrating Heidelberg, Germany. Phone: 49-6221-421803; Fax: 49-6221 421810; immune cells, all of which express TLRs (5). Although TLR E-mail: [email protected]; and Alexander N. R. Weber, Interfaculty Institute € signaling is vital for protection against gut injury and associ- for Cell Biology, Department of Immunology, University of Tubingen, Auf – der Morgenstelle 15, 72076 Tubingen,€ Germany. Phone: 49-7071-29- ated mortality (5 7), it is also thought to play a decisive role in 87623; Fax: 49-7071-29-4579; E-mail: the context of a gut-related malignancy, like colorectal cancer, [email protected] the third most frequent cancer in men and second most doi: 10.1158/0008-5472.CAN-13-1746 frequent in women worldwide (5, 8). However, the exact Ó2013 American Association for Cancer Research. mechanisms by which TLRs influence colorectal cancer 7232 Cancer Res; 73(24) December 15, 2013 Downloaded from cancerres.aacrjournals.org on September 27, 2021. © 2013 American Association for Cancer Research. Published OnlineFirst October 23, 2013; DOI: 10.1158/0008-5472.CAN-13-1746 TLR Variants Affect Colorectal Cancer Survival progression remain controversial: in some murine models of (S. typhimurium; Imgenex), lipopolysaccharide (LPS), or R848 colorectal cancer, genetic loss of MyD88 (9) or TLR4 (10) (Invivogen) as indicated. reduced the incidence of colorectal cancer suggesting that TLR-dependent signaling promotes colorectal cancer progres- Cell culture sion (11, 12). Other studies observed the opposite, where the HEK293T Flp-In T-REx (Life Technologies; obtained from A. lack of MyD88 or TLR5 enhanced tumor growth (13). Despite Pichlmair, CeMM, Vienna; cells were not retested or authen- this ambiguity, the association of certain sequence variants, ticated) and HCT116 cells (a gift from S. Stevanovic, Depart- for example, single-nucleotide polymorphisms (SNP), of TLRs ment of Immunology, Tubingen,€ Germany; cells were not with different aspects of colorectal cancer, for example, survival retested or authenticated) were cultured in Dulbecco's Mod- or response to therapy, can be highly informative as diagnostic ified Eagle Medium supplemented with 10% fetal calf serum, markers to guide decision making on therapeutic approaches L-glutamine (2 mmol/L), penicillin (100 U/mL), streptomycin m in patients with colorectal cancer, which currently relies on (100 g/mL; all from Life Technologies) at 37 C and 5% CO2. clinicopathologic staging in newly diagnosed patients (14). Flp-In T-REx cells (Life technologies) were cultured with Recently, we reported a TLR3 SNP as a potential prognostic tetracycline-free fetal calf serum (VWR). marker for stage II colorectal cancer (15). To explore additional genetic variants in TLR pathway genes as prognostic markers, Bacterial strains and culture we analyzed 36 additional SNPs in eight TLR pathway genes in a S. typhimurium [(SALTY LT2; American Type Culture Col- German colorectal cancer study (n ¼ 613). We identified a total lection (ATCC) code: 700720] was a gift from S. Wagner of five SNPs in the MYD88, TIRAP, and TLR5 genes as signif- (Medical Microbiology, Tubingen,€ Germany), Escherichia coli icantly associated with colorectal cancer survival. MYD88 and Nissle (wt, delta FliC) was obtained from T. Olschl€ €ager (Institute TLR5 SNPs were found to have functional effects and thus, of Molecular Infection Biology, University of Wurzburg,€ apart from serving as biomarkers for colorectal cancer decision Wurzburg,€ Germany). ATCC strains of Alcaligenes faecalis ssp. making, may directly impact on colorectal cancer survival. Faecalis (35655), Enterobacter cloacae (13047), Enterococcus faecalis (19433), Escherichia coli (11229), Exiguobacterium spe- Materials and Methods zies (Gr. A; 49676), Klebsiella oxytoca (700324), Morganella Study populations morganii (25830), Proteus mirabilis (14153), Proteus vulgaris Colorectal cancer SNP associations were investigated in a (13315), and Bacillus fragilis (25285) were used. Bacteria were registry- and hospital-based series of 613 patients belonging to propagated using appropriate conditions, harvested at log the population-based PopGen project in Schleswig-Holstein phase, and washed in PBS. The cells were heat inactivated (Germany, see Supplementary Information, Table S1; ref. 16). and protein levels were measured by bicinchoninic acid. Functional analyses were performed with whole blood (see MYD88/ACAA1 Supplementary Fig. S3) from healthy volunteers from the promoter reporter assays Department of Immunology, Tubingen,€ Germany. Written The normalized promoter activities of MYD88 and coen- informed consent was obtained from all study participants zyme-A acyl-transferase-1 (ACAA1) were studied using cus- and all study protocols were approved by the local ethics tom-made reporter plasmids (GeneCopoeia) containing an committees. inducible Gaussia luciferase (GLuc) MYD88/ACAA1 promoter and a constitutive
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