12.07.2011 -
Two characteristics in particular make breast tumours especially
aggressive: the presence of mutations in malignant cells that
transform factor p53 into a dangerous tumour promoter and the
expression at abnormal levels of a specific protein, enzyme
Pin1.
It is already known that in cancerous cells, mutated p53
dramatically influences tumour progression. Now however, a
new and vital piece of the puzzle has been added to the complex
mosaic that is breast cancer: mutated p53 and Pin1 together form a
lethal combination that subverts cell functions.
The molecular trait resulting from the combination of these two
elements is associated with a total hijacking of the genetic
programme active within the cells, which leads to the expression of
a specific group of genes that allow tumour cells to acquire
aggressive characteristics and the ability to migrate and invade
other tissues. These are the essential factors responsible for the
cancer cell's journey outwards from the original organ, leading to
metastases that invade other organs.
The discovery, arising from a study conducted by the
international research team headed by Giannino Del Sal, Full
Professor of Cell Biology at the Faculty of Medicine, University of
Trieste and Head of the Molecular Oncology Unit at the CIB National
Laboratory at Trieste Area Science Park, is of particular clinical
relevance. Indeed, expert analyses carried out on over 200 breast
cancer cases have shown that in breast tumours, the presence of
excessive levels of Pin1 combined with the presence of factor p53
gene mutations are linked to poor disease outcome.
Objective: more efficient prognoses for specific new
treatments
"A critical aspect at the time of disease classification,"
states Del Sal, "is the identification, through specific
biomarkers, of those cases with a high risk of recurrence and the
ability to predict patient response to treatments, a fundamental
requirement that will allow the improvement of treatment strategies
and help guide treatment decisions. Our work provides a significant
contribution in this very area."
The researcher explains, "Mutations in the gene that encode the
p53 protein are alterations that frequently occur in women with a
breast tumour. Most of these alterations have not in
fact resulted in the destruction of the protein,
but have instead converted it into a powerful tumour promoter.
In characterising the disease we often rely on tests that reveal
this type of aberration.
However, what clearly emerges from our studies, is that in order
to get a detailed picture of the aggressiveness of the tumour and
the progression of the disease, it is important to combine the
analysis of the Pin1 protein levels with this research study.
A prognostic method of this type, which is based on the
identification of the state of p53 mutation and the amount of Pin1
in tumour cells, would discriminate better, between the various
cases of breast carcinoma, those with a lower probability of
survival and those that have an ineffective response to treatment,
particularly to a certain type of adjuvant chemotherapy. To
understand which patients exhibit these characteristics and why it
is crucial to design new strategies to combat tumours."
According to Del Sal, it is not only through mutated p53 and
Pin1 that important information on the disease could be obtained,
but also from the evaluation of the gene expression that makes up
the molecular signature associated with the action of these two
proteins.
From the entire genetic programme activated in cancerous cells
by mutated p53 and Pin1, a group of 10 genes can be extracted and,
if used as indicators, such genes reveal important aspects of
tumour development.
Their expression is in fact linked to the clinical outcome of
the disease: using a data base comprising over 800 breast cancer
cases, researchers found that in patients expressing higher than
average levels of these genes, the time interval between diagnosis
of the primary tumour and diagnosis of metastasis in other parts of
the body was shorter, and survival was reduced.
Breast cancer in women is not only the most frequently diagnosed
form of cancer but is also the leading cause of death from cancer.
It is estimated that each year over one million women worldwide are
diagnosed with breast cancer.
Over the years, progress made in diagnosis, prevention
programmes and the development of new treatment strategies has
resulted in a marked decrease in mortality. Nevertheless, too many
women continue to die each year as a result of the disease.
A strong heterogeneity characterises this and other types of
tumour and does not only relate to the different types of cells
that make up the breast tissue but also, for example, to the
differential response of patients to therapeutic treatments. The
complexity of this tumour is not associated with a full
understanding of its biology.
The tools currently available in clinical practice, albeit
valid, do not fully grasp this heterogeneity and do not always
allow an accurate prognosis to be made nor a determination of the
likelihood of treatment success, essential factors when deciding on
the treatment solution to be adopted and, where necessary,
promoting the development of new intervention strategies.
The discovery made by Del Sal and his colleagues, in this
respect represents an important advance in understanding the
complex nature of breast carcinoma and at the same time provides
potential new tools for carrying out highly efficient and targeted
prognostic analyses for the development of specific and innovative
treatments.
"Furthermore," concludes Del Sal, "its value is not limited to
breast tumours alone. Tumours that have the same type of gene
mutations for factor p53, may in fact reveal features similar to
those found in breast carcinomas. In this event, the clinical
implications of the discovery could be greater, and even in other
tumours the mutated Pin1/p53 molecular axis could turn out to be
associated with the progression of the disease and provide
interesting treatment targets."
This study was conducted thanks mainly to funding received from
the Italian Association for Cancer Research (AIRC - Associazione
Italiana per la Ricerca sul Cancro), the Friuli Venezia Giulia
Region and the European Community.
p53 and Pin1, together for better or for
worse
It has been known for some time that the protein p53, once
mutated, is transformed from the "master guardian" of the genetic
integrity of the cell into an extremely dangerous catalyst of
malignant transformation and of the process that leads to the
formation of metastases. What was not known until now is that,
apart from the changes that lead mutated factor p53 to take
on a new and disturbing identity, this molecular "Mr Hyde" needs an
"accomplice", to fully express its potential as a tumour promoter
within the cell dynamics.
Even less known, was the fact that the very protein Pin1, the
ally thanks to which normal p53 is able to fulfil its
important task as a tumour suppressor, was the perfect
partner for the dangerous mutated p53.
Pin1, like the two-faced Janus, with one side towards the vital
suppression of malignant transformation and the other towards the
powerful tumour promoter, is an enzyme that, in response
to specific signals, causes a change in the structure of the
proteins with which it interacts, leading to the end of the
modulation of the protein functions.
What the research work headed by Giannino Del Sal, and published
in the journal Cancer Cell, now brings to light, is an
almost indissoluble relationship between Pin1 and p53, whether
normal or mutated, without which the factor, for better in the
normal cell or for worse in the tumour cell, is unable to fully
carry out its functions. Indeed the authors of the study have used
a variety of approaches to demonstrate the dependence of mutated
p53 on Pin1 in terms of carrying out its functions: in its absence,
it is as if the mutated p53 were crippled.
Together, the two proteins open the way to a genetic programme
that is decisive for tumour aggression and crucial from a clinical
standpoint.