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Increased Plasma Levels of Serine Proteinase Inhibitors in Lung Cancer Patients

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Increased Plasma Levels of Serine Proteinase Inhibitors in Lung Cancer Patients ANTICANCER RESEARCH 24: 241-248 (2004) Increased Plasma Levels of Serine Proteinase Inhibitors in Lung Cancer Patients INGA ZELVYTE1, ANDERS WALLMARK1, EEVA PIITULAINEN2, ULLA WESTIN3 and SABINA JANCIAUSKIENE1 Departments of 1Medicine, 2Respiratory Medicine and 3Otorhinolaryngology, University Hospital Malmö, 20502 Malmö, Sweden Abstract. Background: Tumor growth and invasiveness occur In pathological conditions like tumorogenesis, the balance through infiltration of tumor cells into the host cells and by between proteolysis and its inhibition is disrupted (1, 2). angiogenesis, which is modulated by proteinases and Tumor progression is generally associated with extensive antiproteinases released from tumor cells that carry out tissue tissue remodelling to provide a suitable environment for remodelling. A number of studies have revealed variations in the tumor growth, invasion and metastasis, and it is known that plasma levels of serine proteases and their inhibitors among proteinases expressed by cancer cells and/or host cells play a tumor types. Patients and Methods: By immunological methods key role in this process (3, 4). At least four classes of we analysed the levels of serine protease inhibitors AAT, ACT proteinases are frequently involved in tumor growth and and SLPI in newly diagnosed lung cancer patients (n=14) invasiveness: MMPs, serine, aspartic and cysteine proteinases compared to non-smoker and smoker, age- and gender- (5-9). Of these, MMPs and serine proteinases have been most matched control groups (n=16), and also in an expanded group closely linked to tumor progression (10, 11). of lung cancer patients with local tumors (n=14) and with Among serine proteinases, leukocyte elastase, plasmin, metastasis (n=18). Results: Our data show that plasma levels thrombin, trypsin and cathepsin G are suggested to be of AAT, ACT and SLPI were elevated in lung cancer patients particularly important in lung tumor progression (12-18). by 1.43-fold, p<0.01, 2.57-fold, p<0.01 and 1.6-fold, p<0.001, For example, cathepsin G not only actively degrades the respectively when compared to controls. In addition, we found extracellular matrix, but also can control cell growth and that levels of AAT and ACT were higher by 1.47-fold, p<0.001 activate pro-MMPs, which are typically released in a latent and 2.27-fold, p<0.001, respectively in lung cancer cases with form (6). Neutrophil elastase is the only proteinase that is metastasis compared to localized tumor. Conclusion: These able to degrade insoluble elastin and it can also hydrolyse inhibitor levels may provide measures of cancer progression in other proteins, including collagens, fibronectins and individual patients and possibly offer useful information for an proteoglycans (19-21). It was reported that elastase is understanding of the mechanisms of metastasis. produced and secreted by various types of tumor cells, including non-small lung cancer cells, and that the local Under physiological conditions, a balance exists between production of elastase is associated with poor disease proteolytic activity and the regulated inhibition of proteolysis. prognosis (13, 21, 22). The regulation of proteolytic enzyme activity in the respiratory airways by endogenous inhibitors is a prerequisite for the maintenance of tissue integrity and for the repair of tissue damage. Proteinase inhibitors that Abbreviations: AAT, ·1-antitrypsin; ACT, ·1-antichymotrypsin; SLPI, secretory leukoprotease inhibitor; MMPs-matrix metalloproteinases; provide protection against the extracellular activity of proMMP-2, progelatinase A; SKALP, elafin/skin–derived antileuko- serine proteinases include AAT, ACT, SLPI and SKALP. proteinase; NSCLC, non-small cell lung carcinoma; SCLS, small cell Whereas AAT and ACT are produced mainly by the liver lung carcinoma; ELISA, quantitative sandwich enzyme immunoassay. and reach the tissue via passive diffusion (23), SLPI and SKALP are produced locally (24, 25). Because of their Correspondence to: Dr. Sabina Janciauskiene, Department of ability to inhibit proteinases, proteinase inhibitors have Medicine, Wallenberg Laboratory, Ing.46, UMAS, S-20502, Malmö, generally been considered to counteract tumor progression Sweden. Tel: +46-40-33-14-14, Fax: +46-40-33-70-41, e-mail: [email protected] and metastasis (26). However, it has also become increasingly apparent that inhibitors of proteinases may Key Words: Antitrypsin, antichymotrypsin, secretory leukocyte express other than inhibitory functions and therefore may proteinase inhibitor, lung tumor, inflammation. have multiple effects on tumor growth. Indeed, it has been 0250-7005/2004 $2.00+.40 241 ANTICANCER RESEARCH 24: 241-248 (2004) demonstrated that over-expression of a number of serine and 7 women, mean age 65.8 (ranging from 56 to 78)) and proteinase inhibitors from the serpin and kunitz families metastatic tumor (n=18, 13 men and 5 women, mean age 70.3 results in enhancement of cancer cell malignancy (27-29). (ranging from 49 to 83)). All cases with local tumors were NSCLC, while among the cases with metastatic tumor were 12 NSCLC, 5 Several studies have reported that increased expression of SCLC and 1 mesothelioma. The cases with local tumor included 4 SLPI, a member of the kazal-type serine proteinase smokers and those with metastatic tumors 12 smokers. inhibitory family, promotes the tumorogenic and metastatic All individuals gave a signed, informed consent to take part in potential of cancer cells (30). Moreover, serum SLPI levels this study, which has been approved by the research ethical in patients with primary lung carcinoma were found to committee of Lund University, Sweden. correlate with tumor stage and response to therapy (31). Venous blood samples were taken from patients on initial Similarly, a direct relationship was shown between lung diagnosis before treatment and in parallel from healthy volunteers. Plasma samples were obtained by centrifugation and were stored cancer progression and the levels of the serpins, AAT and at -80ÆC until assayed. ACT, which are the principal inhibitors of neutrophil elastase and cathepsin G, respectively. In addition, it has Assay for plasma SLPI. Plasma samples were analysed for SLPI by been found that high AAT and ACT expression levels in using a commercially available kit based on ELISA (BIOTRAK, lung adenocarcinoma are associated with enhanced tumor Amersham Pharmacia Biotech, UK) according to the progression (32, 33). manufacturer’s instructions. The intensity of color development is The mechanisms by which serine proteinase inhibitors measured by using a microplate reader (Labsystems, USA). Duplicate readings for each standard and plasma sample were promote tumor progression and whether these effects performed. The lower detection limit for SLPI is 25 pg/ml. may counteract the inhibition of the degradation of extracellular matrix proteins during tumor invasion and Assay for plasma AAT. Plasma samples were analysed for AAT metastasis remains to be investigated. It is likely that this based on an immunonephelometric method according to the may depend on several factors, including the proteinase manufacturer’s instructions (Beckman image automatic machine). activity and the profiles and/or molecular forms of the The nephelometric method measures the agglutination of particles inhibitors released. by quantifying scattered light. The coefficient of variation (CV) for AAT is 7% at 1.5 g/l and 5% at 2.0 g/l. To our knowledge, the plasma levels of serine proteases such as AAT, ACT and SLPI have not been evaluated in the Assay for plasma ACT. Individual plasma samples were analysed by same experimental setting. Therefore, the objective of the rocket immunoelectrophoresis as described by Laurell (34) using current study was to measure plasma levels of AAT, ACT monospecific antisera against ACT (DAKO; Denmark), 5.5 Ìg per and SLPI in a group of newly diagnosed lung cancer square gel area. Plasma samples were diluted 40 times in sterile patients (n=14) relative to age- and gender-matched 0.9% NaCl. For the calibration curve, a standard plasma healthy subjects (n=16). We then expanded the lung cancer Seronormì (Sero AS, Norway) with known concentration of ACT was used. The immunoprecipitates were stained with Coomassie patient group (n=32) and compared the levels of these brilliant blue R-250. inhibitors among cases without and with metastases. Statistical analysis. All variables were log-transformed to achieve a Patients and Methods normal distribution and all calculations were performed with normally distributed variables. The differences of the means in Study population. A total of 32 newly diagnosed lung cancer experimental results were analyzed for their statistical significance patients and 16 healthy controls were included in this study. The with the independent-two-samples (two-sided) t-test. Statistical study population was divided into two sets: the first was 14 lung Package for Social Sciences (SPSS for Windows, release 11) was cancer patients and 16 age- and gender-matched healthy used for the calculations. controls, the second consisted of 32 newly diagnosed lung cancer patients with and without metastases. The first set included 14 Results and Discussion selected lung cancer patients (among them 4 with metastases) with confirmed diagnosis at the Department of Respiratory In the present study we showed that plasma levels of three Medicine, University Hospital Malmö, Sweden. NSCLC was serine proteinase inhibitors, AAT, ACT and SLPI, are diagnosed
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