The Roles of KCNQ1 (Potassium Voltage-Gated Channel, KQT-Like Subfamily, Member 1) and CFTR (Cystic Fibrosis Transmembrane Condu
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The Roles of KCNQ1 (Potassium Voltage-Gated Channel, KQT-like Subfamily, Member 1) and CFTR (Cystic Fibrosis Transmembrane Conductance Regulator) in Mouse and Human GI Cancers A DISSERTATION SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL OF THE UNIVERSITY OF MINNESOTA By Bich Le Ngoc Than IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY Thesis Advisors: Robert Cormier, Ph.D. and Patricia Scott, Ph.D. September, 2013 Copyright © 2013 Bich Le Ngoc Than Acknowledgements I would like to thank and acknowledge my thesis advisors, Drs. Robert Cormier and Patricia Scott, for their mentorship on this thesis research project. They have been instrumental in my scientific development, from experimental design to writing. They have also provided support and guidance during the course of my graduate journey, for which I greatly appreciate. I am thankful for the service of my committee members: Drs. Kendall Wallace, Lester Drewes, David Largaespada and Fekadu Kassie. I greatly appreciate the helpful comments and advice they provided during my graduate training experience. i Dedication I would like to dedicate this dissertation to my family. Without their trust and constant encouragement, I would not be the way I am today. I would like to thank my mother, Kim-Chung Le, for her unyielding support. She has been with me every step of the way and given me the inspiration to keep moving forward. I thank my brother, Thanh Than, for his encouragement and confidence in me to follow all of my aspirations. I thank my sister, Phuong-Cac Than, for her support to pursue and complete this degree. I would also like to dedicate this work to my late father who passed away during the first year of my graduate training. He instilled in me a sense of hard work and dedication toward my goals. For my family, I have propelled my career towards the field of medicine, knowing, step by step, my research may help thousands of cancer patients out of the place where those more fortunate have never ventured. ii Abstract The ion-channel genes Kcnq1 and Cftr were identified as gastrointestinal (GI) tract cancer susceptibility genes in multiple Sleeping Beauty DNA transposon-based forward genetic screens in mice. Kcnq1 encodes for the pore-forming alpha subunit of a voltage- gated potassium channel and Cftr encodes for the chloride conductance channel. These ion channels act together to maintain ion homeostasis in the cellular and extracellular environment. To confirm that Kcnq1 and Cftr have a functional role in GI tract cancer, mouse models in which targeted mutant alleles of Kcnq1 and Cftr were intogressed into the intestinal tumor susceptible ApcMin strain of mice. Results demonstrated that Kcnq1 mutant mice developed significantly more intestinal tumors, especially in the proximal small intestine and colon, with some of these tumors in the proximal small intestine progressing to adenocarcinomas. Gross tissue abnormalities and neoplasia were also observed in the rectum, pancreas and stomach. Similarly, Cftr mutant mice developed significantly more intestinal tumors, both in the colon and the entire small intestine. Colon organoid formation was significantly increased in organoids created from Kcnq1 mutant and Cftr mutant mice compared with wildtype littermate controls, suggesting a role for Kcnq1 and Cftr in regulation of the intestinal crypt stem cell compartment. To identify gene expression changes due to loss of Kcnq1 and Cftr, we carried out microarray studies in the colon and proximal small intestine. We identified an overlapping set of altered genes involved in innate immune responses, goblet and Paneth cell function, ion channels, intestinal stem cells, EGFR and other growth regulatory signaling pathways. We also found genes implicated in inflammation and in cellular detoxification. Pathway analysis using Ingenuity Pathway Analysis (IPA) and gene set enrichment analysis (GSEA) confirmed the importance of these gene clusters and further identified significant overlap with genes regulated by MUC2, another important regulator of intestinal homeostasis. To investigate the role of KCNQ1 in human colorectal cancer (CRC) we measured protein levels of KCNQ1 by immunohistochemistry in tissue microarrays containing samples from CRC patients with liver metastases who had undergone hepatic resection. Results showed that low expression of KCNQ1 expression was significantly associated with poor overall survival (OS). Our results indicate that both KCNQ1 and CFTR are potent tumor suppressor genes in GI cancer. Defining the mechanisms of action of KCNQ1 and CFTR, and elucidating the nature of their interactions in GI cancer can lead to their use as prognostic biomarkers and potential therapeutic targets for human cancers. iii Table of Contents ACKNOWLEDGEMENTS………………………………………………………..………i DEDICATION……………………………………………………………………...……..ii ABSTRACT………………………………………………………………………..…….iii TABLE OF CONTENTS…………………………………………………………...……iv LIST OF TABLES……………………………………………………………………….vi LIST OF FIGURES………………………………………………………………..……viii ABBREVIATIONS……………………………………………………………………...xii CHAPTER 1. Introduction – Battle against gastrointestinal cancer and the importance of targeted therapies The impact of CRC on society ………………………………………………….1 Risk factors contributing to CRC 1) Genetic factors…………………………………………………....……2 2) Environmental factors…………………………………………....…….3 The biology of the GI tract……………………………………………….………4 The biology of intestinal cancer…………………………………………….……8 Analysis of CRC mutational spectra……………………………………………17 Sleeping Beauty mutagenesis…………………………………………………...20 Ion channels……………………………………………………………...……...26 KCNQ1 (Kv7.1)………………………………………………………….29 CFTR…………………………………………………….……………….36 2. The role of KCNQ1 in mouse and human GI cancer……………………………..45 iv 3. The cystic fibrosis transmembrane conductance regulator (CFTR) is a tumor suppressor in the gastrointestinal tract…………………………………….…...141 4. Discussion Challenges in GI cancer…………………………………………..…………..164 Environmental Influences on GI cancer………………………………………165 KCNQ1 and CFTR………………………………………………..…………..166 Limitations in Our Studies…………………………………………..………..167 Implications for Human Diseases………………………………...…………..168 Potential Mechanisms of Action of KCNQ1 and CFTR…………..…………170 BIBLIOGRAPHY…………………………………………………………..…………..175 APPENDICES 1. A Sleeping Beauty transposon-mediated screen identifies murine susceptibility genes for adenomatous polyposis coli (Apc)-dependent intestinal tumorigenesis…………...…………………197 2. Loss of Kcnq1 delayed organoid differentiation in the small intestine of Apcwt mice……………………………………………….233 3. TCGA Report of: KCNQ1……………………………………………………………….…236 CFTR…………………………………………………………………....237 v List of Tables Chapter 2 Min Table 1. Loss of Kcnq1 enhances tumor multiplicity in Apc mice……………..…49 Min -/- Table 2. Apc Kcnq1 tumor phenotype is strongest in the proximal quarter of the small intestine……………………………………………..…49 Table 3. List of top known genes 1.5 fold (A) up-regulated and (B) down-regulated in -/- Kcnq1 mouse colons……………………..…..………..76-86 Table 4. List of top known genes 1.5 fold (A) up-regulated and (B) down-regulated in -/- Kcnq1 mouse small intestines……………….………86-118 Table 5. IPA Analysis of Colon Microarray……………………….……….…118-125 Table 6. IPA Analysis of Proximal Small Intestine Microarray……………………….…..126-136 Table 7. Core genes enriched in Kcnq1 KO…………………………………..136-137 Table 8. Expression of Areg……………………………………………….…..…..138 Table 9. Patient characteristics……………………………………………..…138-139 vi Chapter 3 Table 10. Top upregulated and downregulated genes identified by microarray in the small intestine………………….…..........151 Table 11. Top upregulated and downregulated genes identified by microarray in the colon…………………………..…………152 Appendices Table 12. Polyp number and age of death for transgenic mice………………….…202 Table 13. List of 33 CIS……………………………………………………………206 Table 14. LOH and MOH in ApcMin tumors based on the ratio of T:A trace peaks……………...………230 Table 15. Sequence read overlap between duplicate regions of a single GS FLX sequencing run………………230 Table 16. Human orthologous regions to the mouse CIS with recurrent chromosomal copy number changes based on published data………………..…230-231 Table 17. Knockdown of ApcMin CIS candidate genes affects viability of human colon cancer cells…………………………………………...…232 Table 18. Mapped transposon insertions in 96 tumors…………………………….232 vii List of Figures Chapter 1 Figure 1. The Anatomy of the Gastrointestinal Tract……………………………….5-6 Figure 2. The multi-layered organization of the mature GI tract…………………...6-7 Figure 3. Progression from Polyps to Cancer…………………………………………9 Figure 4. The organization of the small intestinal crypt-villus and the colon crypt…………………………………………………..…......10-11 Figure 5. Organization of the intestinal epithelium and the crypts of Lieberkühn and cell lineage determination in the intestinal epithelium……...…….12-13 Figure 6. Contribution of EMT to cancer progression………………………….…....17 Figure 7. Vogelgram……………………………………………………………...….18 Figure 8. Human Colorectal Cancer genome landscape……………………………..19 Figure 9. SB Transposon (T2/Onc2) can deregulate the expression of an oncogene or inactivate expression of a tumor suppressor gene…….…..21-22 Figure 10. Tissue-specific expression of the SB transposase…………………….….23 Figure 11. Scheme for validation of intestinal candidate cancer genes…...…………25 Figure 12. Structures of KCNE and KCNQ1 proteins………………………………30 Figure 13. CIS map of Kcnq1 in Apcwt screen………………………………………36 Figure 14. Proposed model of CFTR structure in the cell