NAC-1, a Potential Stem Cell Pluripotency Factor, Contributes to Paclitaxel Resistance in Ovarian Cancer Through Inactivating Gadd45 Pathway
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Oncogene (2009) 28, 1941–1948 & 2009 Macmillan Publishers Limited All rights reserved 0950-9232/09 $32.00 www.nature.com/onc ORIGINAL ARTICLE NAC-1, a potential stem cell pluripotency factor, contributes to paclitaxel resistance in ovarian cancer through inactivating Gadd45 pathway N Jinawath1, C Vasoontara1, K-L Yap1, MM Thiaville1, K Nakayama2, T-L Wang1 andI-M Shih 1 1Departments of Pathology, Oncology, and Gynecology and Obstetrics, Johns Hopkins Medical Institutions, Baltimore, MD, USA and 2Department of Gynecology and Obstetrics, Shimane University, Izumo, Japan Nucleus accumbens-1 (Nac1 or NAC-1) belongs to the 22 430 new cases and15 280 deathsin 2007 (Jemal et al., BTB/POZ (Pox virus and Zinc finger/Bric-a-brac Tram- 2007). Unlike other histological types of ovarian track Broad complex) transcription factor family and is a epithelial tumors, high-grade serous carcinoma is the novel protein that potentially participates in self-renewal most aggressive andmost rapidly growing neoplasm, and pluripotency in embryonic stem cells. In human andhas a 5-year survival rate below 30%. Patients with cancer, NAC-1 is upregulated in several types of high-grade serous carcinomas always present their neoplasms, but particularly in recurrent chemoresistant diseases at the advanced stages. These patients routinely ovarian carcinomas, suggesting a biological role for NAC- receive cytoreduction surgery followed by a combined 1 in the development of drug resistance in ovarian cancer. carboplatin/paclitaxel chemotherapy regimen. Despite We have assessed this possibility and shown a correlation initial responsiveness to the chemotherapeutic drugs, between NAC-1 expression and ex vivo paclitaxel most patients eventually develop chemoresistant tumors resistance in ovarian serous carcinoma tissues and cell andsuccumb to their diseases.Therefore, treatment lines. We found that expression of Gadd45-c-interacting failure is often attributedto primary or acquired protein 1 (Gadd45gip1), a downstream target negatively resistance to chemotherapeutic agents, which remains regulated by NAC-1, was reduced in paclitaxel-resistant a clinically formidable problem in managing most cells. Ectopic expression of NAC-1 or knockdown of cancer patients. Understanding chemoresistance at the Gadd45gip1 conferred paclitaxel resistance, whereas molecular level shouldilluminate fundamental proper- NAC-1 knockdown or ectopic expression of Gadd45gip1 ties of drug resistance and provide new therapeutic increased paclitaxel sensitivity. Furthermore, silencing targets to treat advanced neoplastic diseases. NAC-1 expression or disrupting NAC-1 homodimeriza- In an effort to elucidate the molecular etiology of tion by a dominant negative NAC-1 protein that contained drug resistance, we have earlier identified and character- only the BTB/POZ domain induced the expression of izedthe nucleus accumbens-1 (Nac1 or NAC-1) as one Gadd45c, which interacted with Gadd45gip1. Reducing of the candidate chemoresistance genes in ovarian Gadd45c expression by small hairpin RNAs partially cancer (Nakayama et al., 2006a, b). NAC-1 is a nuclear enhanced paclitaxel resistance. Thus, this study provides protein belonging to the BTB/POZ (Pox virus andZinc new evidence that NAC-1 upregulation and homodimer- finger/Bric-a-brac Tramtrack Broadcomplex) domain ization contribute to tumor recurrence by equipping family. NAC-1 was originally identifiedandclonedas a ovarian cancer cells with the paclitaxel-resistant pheno- novel transcript from the NAC, a unique forebrain type through negative regulation of the Gadd45 pathway. structure involvedin rewardmotivation andaddictive Oncogene (2009) 28, 1941–1948; doi:10.1038/onc.2009.37; behaviors (Koob, 1996; Cha et al., 1997; Kalivas et al., publishedonline 23 March 2009 1999; Mackler et al., 2000), andit was later shown to be involvedin the acute behavioral andneurochemical Keywords: ovarian; NAC-1; chemoresistance; paclitaxel responses to psychomotor stimulants (Mackler et al., 2008). Recently, NAC-1 has been foundto be one of the factors associatedwith pluripotency in embryonic stem (ES) cells. NAC-1 transcriptionally regulates gene Introduction expression of other pluripotency factors, including Nanog, Oct4, Sox2, Klf4, Sall1 andSall4, andpartici- Ovarian cancer represents the most lethal gynecological pates in constituting the protein interaction and malignant disease in the United States with an estimated transcriptional regulatory networks that are critical to establish and/or maintain ES cell pluripotency (Wang Correspondence: Dr I-M Shih, Department of Pathology, Johns et al., 2006; Kim et al., 2008; Muller et al., 2008). In Hopkins Medial Institutions, CRB-II, Room 306, 1550 Orleans Street, human cancer, NAC-1 is upregulatedin several neo- Baltimore, MD 21231, USA. plasms, including ovarian high-grade serous carcinoma, E-mail: [email protected] Received14 October 2008; revised18 February 2009; accepted19 pancreatic carcinoma, colorectal carcinoma, breast February 2009; publishedonline 23 March 2009 carcinoma, renal cell carcinoma, hepatocellular carci- NAC-1 in paclitaxel resistance N Jinawath et al 1942 noma andcervical cancer (Nakayama et al., 2006a, b; a 100 OVCAR3 TR Yeasmin et al., 2008). In ovarian high-grade serous A2780 TR carcinomas, the levels of NAC-1 expression were 80 SKOV3 TR significantly higher in recurrent post-chemotherapy 60 OVCAR3 naive samples than in primary earlier untreatedtumors A2780 naive 40 SKOV3 naive (Nakayama et al., 2006a, b; Davidson et al., 2007). Furthermore, intense NAC-1 immunoreactivity Cell number 20 in primary ovarian serous carcinomas was associated (% of untreated cells) 0 with early recurrence, suggesting that NAC-1 is 0.0 0.5 2000 4000 6000 8000 10000 potentially involvedin the pathogenesis of drug Paclitaxel (nM) resistance. b At the molecular level, NAC-1 proteins form homo- OVCAR3 TR dimers through the BTB/POZ domain, and this process OVCAR3 naive is essential for tumor-cell growth andsurvival in tumors with NAC-1 overexpression (Nakayama et al., A2780 TR 2006a, b). NAC-1 has been shown to interact A2780 naive with nuclear proteins, including CoRest and histone deacetylases, HDAC3 and HDAC4, in which the SKOV3 TR binding with deacetylases is mediated by a unique SKOV3 naive BEN domain on NAC-1 protein (Korutla et al., 2005, 2007; Abhiman et al., 2008). Ectopic expression of full- 0 10 20 30 40 50 60 length NAC-1 proteins is sufficient to enhance tumor- Relative NAC-1 mRNA expression igenecity of ovarian surface epithelial cells andof Figure 1 Upregulation of NAC-1 transcript in paclitaxel-resistant NIH3T3 cells in athymic nu/nu mice. We have pre- ovarian cancer cell lines, including SKOV3, OVCAR3 and A2780. (a) Dose-dependent decrease in cell number in the presence of viously identified growth arrest and DNA-damage- paclitaxel. Paclitaxel-resistant cells (TR) are less sensitive to inducible Gadd45-g interacting protein (Gadd45gip1) paclitaxel than are the parental (naive) controls. (b) Paclitaxel- as one of the genes negatively regulatedby NAC-1, and resistant cell lines were analysedfor NAC-1 mRNA expression have shown that NAC-1 contributes to tumor growth using quantitative real-time reverse transcription PCR. NAC-1 expression levels were normalizedto the GAPDH expression level. andsurvival, at least in part, by inhibiting Gadd45gip1 NAC-1 is upregulatedin all paclitaxel-resistant cell lines. GAPDH, expression (Nakayama et al., 2007). The above findings glyceraldehyde-3-phosphate dehydrogenase; NAC-1, nucleus strongly suggest that NAC-1 is a tumor recurrence- accumbens-1. associatedgene in high-gradeovarian serous carcino- mas. In this study, by correlating NAC-1 expression and drug-resistance status, we determined that NAC-1 Table 1 Correlation of NAC-1 immunoreactivity andextreme drug resistance (EDR) status in ovarian cancer tissues causally contributes to chemoresistance for paclitaxel andcarboplatin andshowedthat the Gadd45pathway Taxol-EDR Taxol-LDR is involvedin NAC-1-mediatedchemoresistance in Positive staining 51 41 cancer cells. Negative staining 7 14 Fisher’s exact test P-value ¼ 0.05 Carbo-EDR Carbo-LDR Results Positive staining 44 48 Negative staining 9 12 Correlation of NAC-1 expression and paclitaxel Fisher’s exact test P-value ¼ 0.43 resistance in ovarian carcinoma Three ovarian cancer cell lines, SKOV3, OVCAR3 and Abbreviations: EDR, extreme drug resistance; LDR, low drug A2780, were usedto generate paclitaxel-resistant cells. resistance. Dose-dependent growth inhibition effects by paclitaxel are shown in Figure 1a. The IC50s of paclitaxel at 96 h for which the ex vivo drug-response status was available. were o0.1 nM in all the three parental naive cell lines, We showeda correlation between the intensity of NAC-1 but were more than 5000 nM in all the three paclitaxel- immunoreactivity andan extreme paclitaxel-resistance resistant cell lines. Quantitative real-time reverse tran- status (P ¼ 0.05) (Table 1). In contrast, there was no scription PCR was usedto determineNAC-1 transcript significant correlation (P ¼ 0.43) between carboplatin levels in the resistant andparental naive cells from each resistance andNAC-1 immunointensity. Therefore, we cell line. As shown in Figure 1b, NAC-1 mRNA was focusedon the mechanism underlying how NAC-1 highly expressedin paclitaxel-resistant cells as compared participates in paclitaxel resistance in ovarian cancer. with parental cells in all three different cell lines (Student’s t test P-value o0.001). To extrapolate the above findings to clinical specimens,