Bone metastasis is a leading cause of morbidity and mortality in prostate cancer. While cancer stem-like cells have been implicated as a cell of origin for prostate cancer metastasis, the pathways that enable metastatic development at distal sites remain largely unknown. In this study, we illuminate pathways relevant to bone metastasis in this disease. We observed that cyclin A1 (CCNA1) protein expression was relatively higher in prostate cancer metastatic lesions in lymph node, lung, and bone/bone marrow. In both primary and metastatic tissues, cyclin A1 expression was also correlated with aromatase (CYP19A1), a key enzyme that directly regulates the local balance of androgens to estrogens. Cyclin A1 overexpression in the stem-like ALDHhigh subpopulation of PC3M cells, one model of prostate cancer, enabled bone marrow integration and metastatic growth. Further, cells obtained from bone marrow metastatic lesions displayed self-renewal capability in colony-forming assays. In the bone marrow, cyclin A1 and aromatase enhanced local bone marrow-releasing factors, including androgen receptor, estrogen and matrix metalloproteinase MMP9 and promoted the metastatic growth of prostate cancer cells. Moreover, ALDHhigh tumor cells expressing elevated levels of aromatase stimulated tumor/host estrogen production and acquired a growth advantage in the presence of host bone marrow cells. Overall, these findings suggest that local production of steroids and MMPs in the bone marrow may provide a suitable microenvironment for ALDHhigh prostate cancer cells to establish metastatic growths, offering new approaches to therapeutically target bone metastases. Cancer Res; 76(8); 2453–64. ©2016 AACR.
Malignant stem cells may arise within the normal stem cell population or through carcinogenic transformation of a differentiated cell type, enabling the adoption of stem-like features (1–3). It is believed that only a subset of cells, termed cancer stem cells, are capable of initiating metastatic dissemination to distant organs (3–6). Cancer stem cells have been identified in malignancies, including leukemia, brain, breast, colon, and prostate cancers as well (2, 4, 7–12).
In prostate cancer, only rare, phenotypically distinct prostate cancer tumor-initiating cells, also termed stem-like prostate cancer cells, have the capacity to form new tumors (4, 7–9). Metastatic prostate cancer remains a major clinical challenge, as most of prostate cancer patients die from bone metastases (13, 14). Prostate cancer are believed to favor the bone marrow, which are the unique sites enriched with hematopoietic cells, osteoblasts, stromal, extracellular matrixes, and multiple cytokines (5, 13, 15, 16). The stem-like prostate cancer cells are believed to produce high levels of chemokine receptors that enable interaction of prostate cancer with the infiltrated bone marrow cells to facilitate distant metastases (16–18). The growth and metastases of stem-like prostate cancer cells are also influenced by various types of steroid hormones, including androgens and estrogens and their receptors (19–23). Recent reported studies suggest that estrogen and its receptor ERα are present in the hematopoietic stem cells (HSC) and bone cells (24–26). However, it remains largely unknown whether the steriod hormones may promote metastatic growth of the stem-like prostate cancer cells in the bone marrow.
Aromatase is a steroid biosynthesis enzyme that is encoded by the CYP19A1 gene and catalyzes the conversion from androgens to estrogen (27). Aromatase expression in prostate epithelial cells and the infiltrated inflammatory cells is induced by the cytokines and is associated with the progression of prostate cancer (28). CYP19A1 expression is elevated in prostate cancer metastatic tissue with 30-fold higher than that in primary tumors (19, 21, 29). Conversely, deletion of CYP19A1 alleles reduces incidence of prostate cancer in mice after exposure to testosterone and estrogen (19).
The cell-surface markers that recognize cancer stem cells provide possibility to study the unique mechanisms underlying cancer metastases in mouse models (30, 31). Aldehyde dehydrogenase 1 (ALDH1) is a detoxifying enzyme responsible for the oxidation of intracellular aldehydes and has emerged as an ideal marker for isolation of stem-like cells from heterogeneous tumors (32–35). As the ALDH activity is increased in cancer stem cell populations isolated from multiple myeloma, acute myeloid leukemia (15), breast cancer lung, head and neck, gastric and colorectal cancers and recently in prostate cancer (36–45), it is therefore considered as a reliable marker for isolation of cancer stem cells. Importantly, isolated ALDHhigh stem-like prostate cancer cells initiate growth of tumors in orthotopic mouse models (40).
Cyclin A1 is an important cell-cycle regulator and its expression is elevated in prostate cancer (46, 47). It acts as a coregulator of AR on VEGF promoter activity to regulate VEGF expression (46, 47). Induced overexpression of cyclin A1 in PC3 cells initiated metastatic growth in lymph node, lung and liver in subcutaneous and orthotropic xenograft mouse models (47). In metastatic PC3 cells, cyclin A1 is functionally associated with VEGF and MMP2/MMP9 (47). Recently, we reported that cyclin A1 interacts with ERα to promote breast cancer progression in xenograft mouse models (48). Cyclin A1 function is required for hematopoietic stem and progenitor cells (HSPC) to home to their bone marrow niches (49). In this study, we showed that ALDHhigh stem-like cells facilitate metastatic growth by utilizing cyclin A1 and aromatase to increase androgen to estrogen conversion and recruiting extracellular matrix metalloproteinases (MMP9) from the host bone marrow.
Materials and Methods
Tissue specimens, tissue microarrays, cDNA microarrays, and CGH arrays
Tissue microarrays (TMA) containing primary prostate cancer (n = 17) and metastatic prostate cancer lesions (n = 43) from 14 prostate cancer patients, and paired benign prostate hyperplasia (BPH; n = 48) versus prostate cancer tissues (n = 48) from 48 patients were constructed at the Department of Clinical Pathology and Cytology, Skåne University Hospital, Malmö. The mRNA expression data of cyclin A1 and aromatase (CYP19A1) were extracted from the cBioPortal database with GEO accession number GSE21032 as described (50, 51). The study was approved by the Ethics Committee, Lund University, and the Helsinki Declaration of Human Rights was strictly observed.
Cell culture and generation of vectors and stable and transient transfection
The androgen-insensitive cell line PC3M was kindly provided by Dr. J Fidler (Department of Urology, MD Anderson Cancer Center, Houston, TX; ref. 52). The cell lines were authenticated by the suppliers. The PC3M cells were received in 2011, and fresh-frozen stocks were used. The total span of years in using PC3M cells in our labs is approximately three years. For transient transfection studies, pMSCV-cyclinA1-EGFP was generated by cloning the full-length (1.8 kb) human cyclin A1 cDNA into the EcoRI site of the pMSCV–EGFP construct (Clonetech Inc.).
Prostate tumor spheroid formation assays
PC3M cells were cultured in polyhema-coated flasks at 5,000/mL in spheroid medium modified from protocols used for mammosphere formation as described (53). To generate second passage spheres, cells derived from the first passage spheres were plated again at a density of 5 × 103 cells/mL and grown in culture medium for 7 days as mentioned above.
The ALDEFLUOR kit (StemCell Technologies) was used to isolate the population with a high ALDH enzymatic activity (stem-like ALDHhigh cells) according to the manufacturer's protocol. Cells were stained with 7AAD (BD Biosciences) to distinguish viable cells from dead cells and analysis on CyAn ADP flow cytometer or FACS Aria (Beckman Coulter). FACS data were analyzed using FCS Express software (DeNovo Software).
Mouse model of prostate cancer distant metastases
The animal studies were approved by the Swedish Regional Ethical Animal Welfare Committee and the guidelines were strictly followed. Athymic NMRI nude male mice ages 8 to 12 weeks (Taconic Europe) were used. For intravenous injection of tumor cells, mice were sublethally irradiated with two doses of 2 Gy administered 2 hours apart using a 137Cs source at a dose rate of 1 Gy/minutes as described (54). Equal amounts of ALDHhigh cells (1 × 105 cells/mouse) or unsorted PC3M cells (2 × 106 cells/mouse) were injected into mice via tail veins. For intracardiac injection, 1 × 105 cells/mouse were injected into the left ventricle of anaesthetized mice (1% isoflurane through inhalation). In vivo imaging device IVIS imaging system was used (PerkinElmer). For HLA-ABC antibody-based imaging, mice were injected intraperitoneally with 30 μg of HLA-ABC antibody conjugated with 680 DyLight NHS-ester (Life Technologies; ref. 55).
Identification of metastatic prostate cancer cells in the bone marrow of mice by FACS
To identify metastatic prostate cancer cells in the bone marrow of irradiated recipients after transplantation, bone marrow cells from long bones of the recipient mice were isolated and were assessed using FACS methods as described (49).
Evaluation of ability of single cells from metastatic tumors of mice to form colony-forming unit using methylcellulose-based medium
To assess the repopulating ability and differentiation potential of the bone marrow progenitor cells or metastatic prostate cancer cells in the bone marrow, we used a methylcellulose-based colony-forming assay according to the manufacturer's description (MethoCult, Stem Cell Technologies). Colonies containing 30 and more cells were scored after 14 days.
For immunofluorescence analysis, cell suspensions were fixed on slides in 4% paraformaldehyde (Merck KGaA) for 15 minutes at room temperature. The slides were stained with primary antibodies including anti-HLA (Biosite) and anti-cyclin A1 (BD Pharmingen).
Treatment of ALDHhigh or ALDHlow cells with 17-β-estradiol or DTH
For estrogen treatment, ALDHhigh or ALDHlow populations were sorted from PC3M cells and were maintained in 10% charcoal-stripped phenol red free medium (CSS; Gibco, Life Technologies) for 24 hours prior to treatment with 17-β-estradiol at 10 nmol/L and DTH at 5 nmol/L (Sigma-Aldrich Inc.). The effects of 17-β-estradiol and DTH on ALDHhigh or ALDHlow cells were determined using the nonradioactive tetrazolium dye-based proliferation assay (MTS; Promega Biotech) according to the manufacturer's protocol.
Coculture of ALDHhigh or ALDHlow cells with the bone marrow and measurement of estradiol production
For the MTS assay, ALDHhigh or ALDHlow cells were cultured in serum-free phenol red free RPMI medium containing 50% of the bone marrow extracts of NMRI-nude mice. The cells were cultured for 48 hours and were subjected to the MTS assay. For measurement of estradiol production, the Estradiol Assay kit (R&D Systems Ltd.) was used according to the manufacturer's protocol. For treatment with the Aromatase inhibitor, a Type I aromatase inhibitor (Merck Millipore) was used at 100 nmol/L concentration. Concentrations were determined by measuring absorbance on an Infinite M200 multimode microplate reader (Tecan Sunrise). Testosterone and estradiol levels were determined using an immunoassay from Roche Diagnostics (Estradiol III) on a Cobas 6000 Analyzer (Roche Diagnostics).
Statistical analysis was performed. Distribution of overall survival (OS) was estimated by the method of Kaplan–Meier, with 95% confidence intervals. Differences between survival curves were calculated using the log-rank test using statistical program (SPSS, 16.0).
Description of experimental procedures and methods are given in Supplementary Materials and Methods.
Expression of cyclin A1 and aromatase in patients with prostate cancer
Immunohistochemical analysis was performed to assess protein expression of cyclin A1 and aromatase on TMAs consisting of BPH (n = 48 patients), primary prostate cancer (n = 65) and metastatic prostate cancer in lymph nodes, bone marrows and lungs (n = 43) from 14 prostate cancer patients who suffered bone metastasis. Cyclin A1 expression was predominantly nuclear, while aromatase expression was cytoplasmic in primary and metastatic prostate cancer tissues (Fig. 1A). Expression of cyclin A1 was higher in primary prostate cancer than in BPH (for cyclin A1, P < 0.001; Fig. 1B). Metastatic lesions displayed increased cyclin A1 expression compared with that of primary prostate cancer (P = 0.019; Fig. 1C). Although aromatase expression did not show significant increase in metastatic prostate cancer compared with primary tumors (Fig. 1C), it was significantly higher in primary prostate cancer than in BPH (P = 0.001; Fig. 1B). Further, expression of cyclin A1 was positively correlated with aromatase expression in both primary and metastatic prostate cancer as determined by the Spearman rank correlation test (R2 = 0.398, P < 0.001).
We next examined mRNA expression of cyclin A1 and aromatase using a prostate cancer cohort consisting of primary (n = 131) and metastatic (n = 19) prostate cancer tissues extracted from the publicly available databases (50). Cyclin A1 and aromatase mRNA expression remained to be similar between primary and metastatic prostate cancer tissues (Fig. 1D). Somatic mutations or amplifications in genes encoding cyclin A1 and aromatase appeared to be rare. Only 4% (8 out of 216) amplifications in gene encoding for cyclin A1 and 2% (4 out of 216) amplifications in the CYP19A1 gene were observed (Fig. 1E). This suggests that overexpression of cyclin A1 and aromatase in prostate cancer may be due to the alterations at protein levels. Nevertheless, we observed that a subset of patients with higher CYP19A1 expression suffered poorer BCR-free survival as compared with those with lower CYP19A1 (P < 0.001; Fig. 1F). Cyclin A1 expression was not associated with disease-free survival of prostate cancer patients in these two cohorts (P = 0.348; Fig. 1F).
Cyclin A1 promoted growth of “tumor spheres” in vitro
The stem-like ALDHhigh and non-stem–like ALDHlow subpopulations of PC3M cells were sorted by FACS using the ALDEFLUOR assay (Fig. 2A and B), and were examined for the expression of cyclin A1 and aromatase. Both ALDHhigh and ALDHlow cells expressed cyclin A1 and aromatase (Fig. 2C). Next, the role of cyclin A1 in tumor-initiating property of stem-like cells was assessed. We used three-dimensional (3-D) culture systems, as this method is well established for assessment of breast cancer stem cells (56, 57). PC3M cells that were stably transfected with pMSCV-EGFP or pMSCV-EGFP-A1 were seeded in 3-D medium and were cultured for a period of 7 days. One of the characteristics of the stem-like cells is the ability to form “tumor spheres.” PC3M cells expressing cyclin A1 formed larger “tumor spheres” with increased cell numbers as compared with the controls (P = 0.03; Fig. 2D and E). We next re-plated the single-cell suspensions prepared from the spheres to test their self-renewal ability. The re-plated cells expressing cyclin A1 again formed larger spheres with higher cell numbers compared with the controls (P = 0.015; Fig. 2D and E). Further, PC3M cells expressing cyclin A1 contained higher frequency of the ALDHhigh subpopulation (5.43% ± 2.69%) with approximately 3-fold increase compared with the controls (1.89% ± 0.85%; P < 0.001; Fig. 2F). These data suggest that PC3M cells contain stem-like cells and that cyclin A1 overexpression increases frequency of the tumor-initiating cells in vitro.
Cyclin A1 and aromatase promote metastatic dissemination of ALDHhigh stem-like cells to the bone marrow in mouse xenografts
To investigate whether the ALDHhigh stem-like cells may invade to the bone marrow, we established an in vivo mouse model. Nude mice were sublethally irradiated with low dose γ-irradiation to inhibit host immune function prior to the transplantation of the tumor cells. We observed that expression of aromatase and ERα was higher in ALDHhigh cells overexpressing cyclin A1 compared with the controls (Fig. 3A). Equal amounts of ALDHhigh subpopulations sorted from PC3M cells expressing the vectors were introduced into the irradiated mice via intravenous injection (Fig. 3B). The human HLA-ABC antibody conjugated with fluorescent dye was administrated into the mice for bioluminescent in vivo imaging analysis (Fig. 3C). Tumors that were positive to HLA-ABC fluorescent antibody were detected in both groups of mice using imaging device after 80 days of transplantation (Fig. 3C). We performed FACS analysis and confirmed that the transplanted cancer cells positive to HLA-ABC integrated into the bone marrow (Fig. 3D). There was a clear trend that a higher frequency of ALDHhigh cells overexpressing cyclin A1 homed the host bone marrow compared with the controls (n = 4 mice/per group; P = 0.076; Fig. 3D).
Because the FACS analysis is dependent on the quality of HLA-ABC antibody and its ability to bind tumor-producing HLA-ABC antigens in vivo, this method presents certain difficulties with large variations. We therefore examined expression of cytokeratins that specifically recognize human prostate cancer cells in the bone marrow (Fig. 3E). A significantly higher number of cytokeratin-positive cells and Ki-67–positive cells was observed in the bone marrow of mice that received ALDHhigh cells expressing cyclin A1 vector (for cytokeratins, P = 0.024; for Ki-67, P < 0.001; Fig. 3E–H). These data showed that ALDHhigh cells integrated into the bone marrow and that cyclin A1 overexpression enhanced metastatic growth of the ALDHhigh cells.
We transplanted unsorted PC3M cells expressing cyclin A1 or EGFP vector into the irradiated mice via intravenous injection. Metastatic tumors in prostate, lung, and liver appeared in 3 of 5 mice that received PC3M cells expressing cyclin A1, while a large subcutaneous tumor was formed near the proximal end of the tail in 1 of 5 control mice (Supplementary Fig. S1). There was a clear trend that elevated levels of cyclin A1 in tumors were positively correlated with poorer overall survivals of the xenograft mice (Supplementary Fig. S1). No metastases to the bone marrow were detected in these xenograft mice. We therefore induced unsorted PC3M cells expressing cyclin A1 or EGFP vectors into mice via intracardiac injection, which allows tumor cells entering directly into systemic circulation, and homing to the bone marrow. Tumor metastases were detected in both groups of mice after 33 days of transplantation (5 mice/group) using bioluminescent in vivo imaging analysis (Supplementary Fig. S2A and S2B). FACS analysis revealed that HLA-ABC–positive PC3M cells integrated into the bone marrow (Supplementary Fig. S2C and S2D). Overexpression of cyclin A1 increased frequency of PC3M homing to the bone marrow relative to controls, as determined by using cytokeratin stainings of tumor cells (P = 0.016 for CK5 and P = 0.0014 for CK20; Supplementary Fig. S3).
Metastatic growth of ALDHhigh PC3M cells in the bone marrow through cyclin A1 and aromatase-associated pathways
We next wanted to assess whether metastatic lesions initiated by ALDHhigh PC3M cells may retain stem-like properties such as self-renewal and differentiation. We isolated bone marrow cells from the mice bearing bone marrow metastases initiated by ALDHhigh cells expressing cyclin A1 or control vector. The isolated bone marrow cells were then subjected to colony-forming unit (CFU) assay in the semisolid MethoCult medium, which is commonly used for the assessment of self-renewal and differentiation ability of the hematopoietic cells (Fig. 4A). Bone marrow cells containing prostate cancer metastatic lesions isolated from the mice (4 mice/group) formed colonies (Fig. 4B). To assess whether the CFUs might be derived from both host hematopoietic stem/progenitor cells, and metastatic ALDHhigh cells, single-cell suspensions were prepared from the colonies and were examined for the coexpression of cyclin A1 and HLA-ABC, a specific human tumor antigen. We observed that the subset of cells collected from the CFUs indeed coexpressed cyclin A1 and HLA-ABC, and the signals were enhanced in cells overexpressing cyclin A1 (Fig. 4C). By using the combination of Giemsa staining and visualization of EGFP positivity in CFUs, we further identified CFUs derived from ALDHhigh cells (Fig. 4D–G). This suggests that the metastatic lesions derived from ALDHhigh cells are able to self-renew and repopulate into new tumor cells in CFU assays, and this characteristic is similar to the host bone marrow hematopoietic stem/progenitor cells. Further, we observed that there was a higher proportion of prostate cancer cells in the CFUs derived from the bone marrow samples of mice bearing metastases with elevated level of cyclin A1 as compared with the controls (P < 0.001; Fig. 4H). These new findings showed that the metastatic lesions derived from ALDHhigh PC3M cells retained self-renewal and repopulating properties.
We examined the expression of aromatase and ERα in the CFUs derived from the metastatic bone marrow of xenograft mice. Expression of aromatase and ERα retained in the CFUs-derived from the metastatic lesions initiated by the ALDHhigh cells and was enhanced by overexpression of cyclin A1 (Fig. 4I and J). The absence of both aromatase and ERα in the CFUs of tumor-free bone marrow was observed (Fig. 4I and J). In contrast, AR expression was absent in the CFUs derived from the metastatic lesions but was present in the CFUs of tumor-free bone marrow (Fig. 4K), suggesting that AR is produced by the host bone marrow microenvironment. We observed that overexpression of cyclin A1 was positively associated with the decreased apoptosis, as determined by examining the expression of cleaved caspase-3 in the CFUs derived from the metastatic prostate cancer lesions (Fig. 4L).
Cyclin A1 overexpression in ALDHhigh cells increased MMP9 expression in the bone marrow cells
We further examined aromatase expression in a series of bone marrow sections of the xenograft mice bearing metastases using immunohistochemical analysis. Approximately 10% aromatase-positive cells were observed in the metastatic bone marrow of control xenograft mice (Fig. 5A and B). Overexpression of cyclin A1 increased aromatase-positive cells by 60% (P < 0.001) and staining intensity of aromatase (Fig. 5A–C). The integration of ALDHhigh cells overexpressing cyclin A1 into the bone marrow significantly increased MMP9 expression in the host bone marrow (P = 0.016; Fig. 5D, G and H). Similar to AR, MMP9 expression was absent in ALDHhigh cells, but was present in the host bone marrow cells (Fig. 5E and F). These data suggest that ALDHhigh cells with elevated level of cyclin A1 influence the bone marrow–releasing factor such as MMP9.
ALDHhigh stem-like subpopulation of PC3M cells are more sensitive to aromatase inhibition than the ALDHlow cells
We further investigated whether the ability of ALDHhigh cells to initiate metastatic growth in the bone marrow is related to their stem-like characteristics with growth advantages. We subjected equal amount of ALDHhigh and ALDHlow cells sorted from PC3M cells expressing EGFP-cyclin A1 or control vectors to the MTS-based proliferation assays. The growth rate of the ALDHhigh subpopulation was significantly higher with 20% increase compared with the ALDHlow cells (P = 0.012; Fig. 6A). Overexpression of cyclin A1 increased growth of ALDHhigh cells by 60% as compared with the ALDHlow cells (P < 0.001; Fig. 6A). Further, overexpression of cyclin A1 increased growth rate only in ALDHhigh cells (P = 0.012) but not in ALDHlow cells (Fig. 6A). This suggests that ALDHhigh cells with cyclin A1 overexpression have growth advantages over that of ALDHlow cells. Next, we inhibited aromatase production in ALDHhigh versus ALDHlow cells using an irreversible type I aromatase inhibitor. Inhibition of aromatase reduced proliferation of control ALDHhigh cells (P = 0.008) and ALDHhigh cells overexpressing cyclin A1 (P < 0.001; Fig. 6B), but had no significant effect on ALDHlow cells. We further examined the effect of bone marrow microenvironment on the growth of ALDHhigh versus ALDHlow cells. We cocultured equal amount of the sorted cells with the bone marrow extracts of mice. ALDHhigh cells displayed higher ability to adapt and grow in the bone marrow–containing medium compared with the ALDHlow cells as determined by MTS proliferation assays (Fig. 6C). Overexpression of cyclin A1 significantly enhanced ability of ALDHhigh cells, but not that of ALDHlow cells to grow in the bone marrow–containing medium (Fig. 6C). Next, we measured the concentration of estradiol, an end product of androgen to estrogen conversion, in ALDHhigh PC3M cells, in bone marrow cells alone and in cocultures of ALDHhigh PC3M cells and bone marrow cells. Estradiol levels in ALDHhigh PC3M cell cultures were similar to those in the medium only (RPMI1640 containing 10% FBS; Fig. 6D), suggesting that ALDHhigh PC3M cells do not produce detectable levels of estrogen in vitro. Bone marrow cells produced detectable levels of estradiol, which were significantly increased in coculture with ALDHhigh (Fig. 6D and E). Overexpression of cyclin A1 further increased estradiol production (for bone marrow alone vs. coculture of bone marrow and ALDHhigh cells expressing EGFP, P < 0.001; for coculture of bone marrow and ALDHhigh cells expressing EGFP-A1 vs coculture of bone marrow and ALDHhigh cells expressing EGFP, P = 0.029; Fig. 6D). Inhibition of aromatase by the aromatase inhibitor in ALDHhigh cells overexpressing cyclin A1 prior to the coculture with the bone marrow cells in serum-free medium led to a significant reduction in the estradiol level in the coculture (P < 0.001; Fig. 6E).
Increasing evidence has suggested that cancer stem cells are the cell origin to initiate distant metastases (3–5). However, the unique cellular pathways that enable cancer stem cells to establish metastatic lesions into the distant organs remain largely unknown. In this study, we observed that cyclin A1 protein expression was significantly higher in prostate cancer metastatic lesions from prostate cancer patients. In agreement with a previously reported study (58), our data also showed that aromatase was abnormally expressed in human prostate cancer. Expression of both cyclin A1 and aromatase proteins was significantly higher in primary prostate cancer than in BPH. A subset of patients with upregulated aromatase mRNA expression suffered poorer BCR-free survival, although this finding was limited to fewer patients. Nevertheless, the present study adds new information on the clinical importance of aromatase expression in prostate cancer progression.
In this study, we found that the ALDHhigh subpopulation of PC3M cells had higher growth ability compared with the ALDHlow subpopulation. It has been shown that γ-radiation at low dose (2–4 Gy) promoted tumor cell infiltration with no pronounced impact on host immune function in nude mice (54). The ALDHhigh subpopulation accounted for 1.89% ± 0.85% of the total PC3M cells that initiated metastatic growth in the bone marrow of the irradiated immune-suppressive host mice, whereas unsorted PC3M cells homed to the bone marrow only when tumor cells were implanted by intracardiac injection. Intracardiac injection delivers tumor cells directly into systemic circulation, while tail-vein injection necessitates that tumor cells pass through lung and liver vasculatures before reaching the bone marrow. Thus, our study establishes a robust mouse model and FACS-based analysis to study metastases of cancer cells and stem-like cancer cells to bone. Our findings are in agreement with the reported studies in breast cancer (36–38) and prostate cancer (39, 40), which suggest that rare subsets of cancer cells are sufficient to initiate metastases to distant organs.
Although ALDHhigh PC3M cells alone are sufficient to initiate metastases into the bone/bone marrow, overexpression of cyclin A1 increased the frequency of integrated ALDHhigh cells by 40% to 50%. These findings are coincident with that overexpression of cyclin A1 promoted proliferation of the ALDHhigh subpopulation, but not ALDHlow subpopulation. Aromatase facilitates the metabolism of testicular testosterone and androstenedione to estrogen and directly regulates the local balance of androgens to estrogens (59). Growing evidence suggests that the microenvironment has profound effects on cancer metastases to preferential tissues/organs. Aromatase is able to utilize exogenous testosterones and extracellular factors from the tumor-associated microenvironment to produce estradiols and other hormones (28).
We found that the expression of bone marrow–releasing factors, including AR, ERα, and MMP9, was induced as a result of metastatic integration of ALDHhigh cells. Our new data show that increased aromatase activity in the ALDHhigh population in the context of the bone marrow microenvironment enhances estradiol production. Moreover, incorporation of a pharmacologic inhibitor establishes the requirement for aromatase in estradiol production in our model. Overexpression of cyclin A1 further increases estradiol production, providing insight into how cyclin A1 overexpression in ALDHhigh cells can influence the tumor microenvironment in the bone marrow niches. We were unable to detect significant changes in the steady-state levels of androgens in monocultures or cocultures of ALDHhigh cells and bone marrow cells (data not included).
Our study suggests that cyclin A1 is a key factor that regulates aromatase-associated pathways. However, the precise cellular mechanisms by cyclin A1 regulates aromatase expression remain to be further explored in future studies. Taken together, our data suggest that the stem-like prostate cancer cells express high levels of several key factors that facilitate metastatic homing to the bone marrow environment. Our study will provide new insights into the prostate cancer bone metastases and help to design novel targeted therapy.
Disclosure of Potential Conflicts of Interest
N.P. Mongan is Adjunct Assistant Professor at Weill Cornell Medical College. No potential conflicts of interest were disclosed by the other authors.
Conception and design: R. Miftakhova, J.L. Persson
Development of methodology: R. Miftakhova, C. Allegrucci
Acquisition of data (provided animals, acquired and managed patients, provided facilities, etc.): R. Miftakhova, A. Hedblom, J. Semenas, B. Robinson, A. Simoulis, J. Malm, C. Allegrucci, J.L. Persson
Analysis and interpretation of data (e.g., statistical analysis, biostatistics, computational analysis): R. Miftakhova, A. Hedblom, J. Semenas, A. Simoulis, N.P. Mongan, N.J. Maitland, C. Allegrucci, J.L. Persson
Writing, review, and/or revision of the manuscript: R. Miftakhova, A. Hedblom, B. Robinson, A. Rizvanov, D.M. Heery, N.P. Mongan, N.J. Maitland, C. Allegrucci, J.L. Persson
Administrative, technical, or material support (i.e., reporting or organizing data, constructing databases): J. Semenas, B. Robinson, A. Rizvanov, N.J. Maitland, C. Allegrucci, J.L. Persson
Study supervision: N.J. Maitland, J.L. Persson
The authors acknowledge support from the University of Nottingham and the Royal Society of London (C. Allegrucci), the Yorkshire Cancer Research (N.J. Maitland), CRUK (D.M. Heery), and Kazan Federal University (A. Rizvanov). They thank Elise Nilsson, Nishtman Dizeyi, Pradeep Kumar, and Richard Karlsson for technical support.
This work was supported by the Swedish Cancer Foundation, the National Research council, the Government Health Grant, the Malmö Cancer Foundation, the Skåne University Hospital Foundation to J.L. Persson.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.