Heat Shock Proteins and Ovarian Cancer: Important Roles and Therapeutic Opportunities
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cancers Review Heat Shock Proteins and Ovarian Cancer: Important Roles and Therapeutic Opportunities Abdullah Hoter 1,2 and Hassan Y. Naim 2,* 1 Department of Biochemistry and Chemistry of Nutrition, Faculty of Veterinary Medicine, Cairo University, Giza 12211, Egypt; [email protected] 2 Department of Physiological Chemistry, University of Veterinary Medicine Hannover, 30559 Hannover, Germany * Correspondence: [email protected]; Tel.: +49-511-953-8780; Fax: +49-511-953-8585 Received: 29 August 2019; Accepted: 16 September 2019; Published: 18 September 2019 Abstract: Ovarian cancer is a serious cause of death in gynecological oncology. Delayed diagnosis and poor survival rates associated with late stages of the disease are major obstacles against treatment efforts. Heat shock proteins (HSPs) are stress responsive molecules known to be crucial in many cancer types including ovarian cancer. Clusterin (CLU), a unique chaperone protein with analogous oncogenic criteria to HSPs, has also been proven to confer resistance to anti-cancer drugs. Indeed, these chaperone molecules have been implicated in diagnosis, prognosis, metastasis and aggressiveness of various cancers. However, relative to other cancers, there is limited body of knowledge about the molecular roles of these chaperones in ovarian cancer. In the current review, we shed light on the diverse roles of HSPs as well as related chaperone proteins like CLU in the pathogenesis of ovarian cancer and elucidate their potential as effective drug targets. Keywords: ovarian cancer; heat shock proteins (HSPs); clusterin; therapeutic resistance; HSP inhibitors; ovarian cancer treatment 1. Introduction 1.1. Ovarian Cancer Is a Serious Problem in Gynaecological Oncology Ovarian cancer (OC) is a major life-threatening problem in the field of gynecological oncology. Globally, it stands as the foremost cause of death in women accounting for approximately 239,000 newly diagnosed cases and over 150,000 deaths per year [1]. Recent reports in the United States estimated 22,240 new cases with ovarian cancer and 14,070 deaths owing to the disease [2]. Notably, the highest incidence and mortality rates have been linked to Eastern and Central Europe [1]. Therefore, great efforts are required to improve the therapeutic outcomes for diseased women. Additionally, thorough understanding of the molecular mechanisms and key elements contributing the disease is substantial in combating ovarian cancer [3]. Indeed, ovarian tumors can arise from three ovarian cell types namely, surface epithelium, sex cord stromal cells and germ cells [4]. Epithelial tumors account for 90% of ovarian malignancies while non-epithelial tumors including sex cord stromal and germ cell tumors represent 10% of the diagnosed cases. Epithelial ovarian cancer (EOC) are histologically categorized into serous, endometrioid, clear cell and mucinous carcinomas; the serous type itself is subclassified into high grade serous carcinoma (HGSC), low grade serous carcinoma (LGSC) and serous tubal intraepithelial carcinoma (STIC) [3] (a brief classification of OC histology is illustrated in Figure1). Cancers 2019, 11, 1389; doi:10.3390/cancers11091389 www.mdpi.com/journal/cancers Cancers 2019, 11, 1389 2 of 29 Cancers 2019, 11, x FOR PEER REVIEW 2 of 29 FigureFigure 1.1. HistologicalHistological stratificationstratification ofof ovarianovarian cancercancer aa.(. (a)) HighHigh gradegrade serousserous carcinomacarcinoma (HGSC)(HGSC) isis distinguisheddistinguished byby increasedincreased nuclearnuclear atypia,atypia, highhigh nuclear-to-cytoplasmicnuclear-to-cytoplasmic ratio and abundantabundant mitosis. ((bb)) SerousSerous tubaltubal intraepithelialintraepithelial carcinomacarcinoma (STIC)(STIC) resemblesresembles HGSCHGSC inin manymany morphologicalmorphological aspectsaspects suchsuch asas severesevere atypia,atypia, defectivedefective cellularcellular polaritypolarity andand mitoses.mitoses. Therefore, STIC is believedbelieved toto bebe aa precursorprecursor ofof HGSC.HGSC. ((cc)) LowLow gradegrade serousserous carcinomacarcinoma (LGSC)(LGSC) isis characterizedcharacterized byby increasedincreased papillae,papillae, mildmild nuclearnuclear atypia atypia and and low low nuclear-to-cytoplasmic nuclear-to-cytoplasmic ratio. ratio. (d) Clear(d) Clear cell carcinoma cell carcinoma exhibits exhibits large tumor large celltumor sizes cell and sizes frequent and clearingfrequent of clearing the cytoplasm of the togethercytoplasm with together stromal with hyalinization. stromal hyalinization. (e) Endometrioid (e) adenocarcinomaEndometrioid adenocarcinom can be differentiateda can be by glanddifferentiated formation by thatgland recapitulates formation endometrial that recapitulates glands. Thisendometrial type is furtherglands. categorized This type is according further categorized to cellular architectureaccording to and cellular nuclear architecture atypia. ( fand) Mucinous nuclear adenocarcinomaatypia. (f) Mucinous is characterized adenocarcinoma by increased is characterized cellular mucin by increased and formation cellular of goblet mucin cells. anda formationHistological of imagesgoblet cells. are adapted a Histological from Nature images Reviews are adapted Disease from Primers Nature [ 3Reviews]. Disease Primers [3]. OCOC isis oftenoften diagnoseddiagnosed atat relativelyrelatively oldold ageage ofof life,life, withwith aa medianmedian ageage ofof 6363 yearsyears inin thethe US womenwomen populationpopulation (https:(https://seer.cancer.gov/statfacts/html/ovary.html//seer.cancer.gov/statfacts/html/ovary.html). In). addition,In addition, current current data data show show that 59%that of59% the of cases the cases have have metastatic metastatic forms forms of theof the disease, disease while, while only only 15% 15% are are diagnosed diagnosed at at thethe locallocal stage. OfOf particularparticular importance,importance, earlyearly detectiondetection ofof ovarian malignancies is associated with higher cure rates, withwith aa five-yearfive-year survivalsurvival exceedingexceeding 92%92% forfor localizedlocalized ovarianovarian cancer,cancer, whereaswhereas latelate stagestage diagnosisdiagnosis ofof thethe metastaticmetastatic diseasedisease lowerslowers curecure ratesrates toto 20%20% [[5,6].5,6]. TheThe standardstandard treatment treatment protocol protocol for humanfor human ovarian ovarian cancer cancer includes includes maximal maximal cytoreductive cytoreductive surgical debulkingsurgical debulking followed byfoll theowed platinum-based by the platinum chemotherapy.-based chemotherapy. Concurrent with Concurrent surgical cytoreduction,with surgical stagingcytoreduction, of the disease staging remains of the importantdisease remains [7,8]. Current important therapeutic [7,8]. Current regimens therapeutic to the first-line regimens treatment to the whichfirst‑line involve treatment bevacizumab which involve and bevacizumab paclitaxel have and shown paclitaxel improved have shown survival improved among survival patients among with OCpatients [7,9]. with Unfortunately, OC [7,9]. despiteUnfortunately, initial remarkable despite initial response remarkable to chemotherapy, response the to majority chemotherapy, of advanced the OCmajority cases of recur advanced after primary OC cases drug recur treatment after primary with drug fatal outcometreatment [ 10with]. According fatal outcome to Ovarian [10]. According Cancer Researchto Ovarian Alliance Cancer (OCRA),Research currentAlliance reports (OCRA), show current that re patientsports show diagnosed that patients at stages diagnosed I and II at have stages a recurrenceI and II have chance a recurrence of 10% and chance 30%, of respectively, 10% and 30%, whereas respectively the chance, whereas of recurrence the chance in those of recurrence of stage IIIin andthose IV of ranges stage betweenIII and IV 70% ranges and 95%between (https: 70%//ocrahope.org and 95% (https://ocrahope.org/patients/about/patients/about-ovarian-cancer/recurrence-ovarian/).- cancer/recurrMultipleence/ treatment). approaches have been adapted for management of relapsed ovarian cancer. For instanceMultiple, agents treatment targeting approaches angiogenesis have been include adapted Bevacizumab, for management a monoclonal of relapsed antibody ovarian that cancer. binds humanFor instance, vascular agents endothelial targeting growthangiogenesis factor include (VEGF) Bevacizumab, and inhibits itsa monoclonal activity. Cediranib antibody isthat an binds oral VEGFhuman receptor vascular and endothelial c-KIT inhibitor growth factor that displays (VEGF) antitumorand inhibits activity its activity. in relapsed Cediranib EOC is an in oral phase VEGF I/II studies.receptor Trebananiband c-KIT inhibitor is a peptide that thatdisplays suppresses antitumor angiogenesis activity in by relapsed inhibiting EOC angiopoietin-1 in phase I/II studies. and -2. Moreover,Trebananib other is a treatmentpeptide that strategies suppresses involve angiogenesis PARP inhibitors by inhibiting (PARPi) angiopoietin which render-1 PARPand -2. enzymes Moreover, no moreother capabletreatment of performingstrategies involve DNA repairPARP processesinhibitors and (PARPi) ultimately which leading render toPARP synthetic enzymes lethality no more [11]. Thesecapable PARP of performing inhibitors include DNA repair olaparib processes (AZD2281), and ultimately niraparib (MK4827),leading to rucaparibsynthetic (CO338,lethality AGO14699,[11]. These andPARP PF01367338), inhibitors veliparibinclude olaparib (ABT-888) (AZD2281), and talazoparib