Mutations of the gene encoding the protein kinase A type I-alpha regulatory subunit in patients with the Carney complex.

Carney complex (CNC) is a multiple neoplasia syndrome characterized by spotty skin pigmentation, cardiac and other myxomas, endocrine tumours and psammomatous melanotic schwannomas. CNC is inherited as an autosomal dominant trait and the genes responsible have been mapped to 2p16 and 17q22-24 (refs 6, 7). Because of its similarities to the McCune-Albright syndrome and other features, such as paradoxical responses to endocrine signals, genes implicated in cyclic nucleotide-dependent signalling have been considered candidates for causing CNC (ref. 10). In CNC families mapping to 17q, we detected loss of heterozygosity (LOH) in the vicinity of the gene (PRKAR1A) encoding protein kinase A regulatory subunit 1-alpha (RIalpha), including a polymorphic site within its 5' region. We subsequently identified three unrelated kindreds with an identical mutation in the coding region of PRKAR1A. Analysis of additional cases revealed the same mutation in a sporadic case of CNC, and different mutations in three other families, including one with isolated inherited cardiac myxomas. Analysis of PKA activity in CNC tumours demonstrated a decreased basal activity, but an increase in cAMP-stimulated activity compared with non-CNC tumours. We conclude that germline mutations in PRKAR1A, an apparent tumour-suppressor gene, are responsible for the CNC phenotype in a subset of patients with this disease.

A single-injection protein kinase A-directed antisense treatment to inhibit tumour growth.

Expression of the RI alpha subunit of cAMP-dependent protein kinase type I is enhanced in human cancer cell lines, in primary tumours, in cells after transformation and in cells upon stimulation of growth. We have investigated the effect of sequence-specific inhibition of RI alpha gene expression on in vivo tumour growth. We report that single injection RI alpha antisense treatment results in a reduction in RI alpha expression and inhibition of tumour growth. Tumour cells behaved like untransformed cells by making less protein kinase type I. The RI alpha antisense, which produces a biochemical imprint for growth control, requires infrequent dosing to halt neoplastic growth in vivo.

Cyclic AMP receptor triggers nuclear protein phosphorylation in a hormone-dependent mammary tumor cell-free system.

Adenosine 3',5'-monophosphate (cyclic AMP) receptor protein of 56,000 daltons increases markedly in mammary tumors induced by 7,12-dimethylbenz[a]anthracene (DMBA) after incubation of tumor slices with cyclic AMP, benzamide, and arginine. Incubation of cytosol from these tumor slices with nuclei from unincubated tumors results in nuclear uptake of the 56,000-dalton cyclic AMP receptor and in phosphorylation of the 76,000-dalton nuclear protein. Binding of the 56,000-dalton receptor and phosphorylation of the 76,000-dalton protein also occur in DMBA tumor nuclei when protein kinase type II of bovine heart is used. The results suggest that cyclic AMP receptor is involved in the nuclear events of a hormone-dependent mammary tumor.

In vivo inhibition of growth of two hormone-dependent mammary tumors by dibutyryl cyclic AMP.

Growth of hormone-dependent rat mammary tumors was arrested in vivo by N(6),O(2)'-dibutyryl cyclic adenosine 3',5'-monophosphate. Estrogen concentration did not change, but acid ribonuclease activity and synthesis increased during treatment with the dibutyryl cyclic nucleotide, as was shown during tumor regression due to hormonal deprivation. Growth arrest, thus, appears to derive from enhanced tissue catabolism.

Dibutyryl cyclic AMP mimics ovariectomy: nuclear protein phosphorylation in mammary tumor regression.

Growth of mammary carcinoma induced by 7,12-dimethyl-benz(a) anthracene is arrested by either ovariectomy or treatment with N6,O2-dibutyryl cyclic adenosine 3',5'-monophosphate (dibutyryl cyclic AMP). When this occurs, a new nonhistone protein species becomes the predominant endogenous substrate of cyclic AMP-dependent protein kinase in the tumor nuclei. Phosphorylation of this regression-associated protein ceases when resumption of tumor growth is induced by either the injection of 17 beta-estradiol or cessation of dibutyryl cyclic AMP treatment. Thus phosphorylation of regression-associated protein may play a role in the regression of hormone-dependent mammary tumors.

Growth arrest and morphological change of human breast cancer cells by dibutyryl cyclic AMP and L-arginine.

The growth in vitro of human breast cancer cells, line MCF-7, was inhibited by a daily supplement of L-arginine (1 milligram per milliliter). Arginine acted synergistically with dibutyryl adenosine 3',5'-monophosphate (cyclic AMP) (10(-6) molar) to enhance the growth inhibitory effect: the cell replication ceased completely within 2 days after treatment. The growth arrest accompanied a change in cell morphology and was preceded by increases in the cellular concentration of cyclic AMP, adenylate cyclase, and type II cyclic AMP-dependent protein kinase activities as well as a decrease of estrogen binding activity. The results suggest that growth of human breast cancer cells is subject to cyclic AMP-mediated regulation and that arginine may play a specific role in this process.

Autoantibody biomarker opens a new gateway for cancer diagnosis.

The list of cancer markers of current interest has grown considerably, but none of the markers used in clinical work is a true tumor marker. These cancer biomarkers are based on the determination of tumor antigens. Here, we report a single method of autoantibody enzyme immunoassay (EIA) screens for a spectrum of serum tumor markers. A comparison of the autoantibody-based EIA to conventional antigen EIA kits, using receiver operating characteristic (ROC) plots, showed that the autoantibody EIA can significantly enhance the sensitivity and specificity of tumor markers. The detection of serum autoantibodies for a spectrum of serum tumor markers, as demonstrated here, suggests that most, if not all, serum cancer biomarkers produce autoantibodies. A unique autoantibody biomarker screening method, as presented here, might therefore facilitate achieving the accurate and early diagnosis of cancer.

Downregulation of mdr-1 expression by 8-Cl-cAMP in multidrug resistant MCF-7 human breast cancer cells.

8-Cl-cAMP, a site-selective analogue of cAMP, decreased mdr-1 expression in multidrug-resistant human breast cancer cells. A sixfold reduction of mdr-1 mRNA expression by 8-Cl-cAMP began within 8 h of treatment and was associated with a decrease in the synthesis of P-glycoprotein and with an increase in vinblastine accumulation. A reduction in mdr-1 expression after 8-Cl-cAMP treatment was also observed in multidrug-resistant human ovarian cancer cell lines. 8-Cl-cAMP is known to change the ratio between the two regulatory subunits, RI and RII, of protein kinase A (PKA). We observed that RI alpha decreased within 24 h of 8-Cl-cAMP treatment, that RII beta increased after as few as 3 h of treatment, and that PKA catalytic activity remained unchanged during 48 h of 8-Cl-cAMP treatment. The results are consistent with the hypothesis that mdr-1 expression is regulated in part by changes in PKA isoenzyme levels. Although 8-Cl-cAMP has been used to differentiate cells in other model systems, the only differentiating effect that could be detected after 8-Cl-cAMP treatment in the MCF-7TH cells was an increase in cytokeratin expression. Evidence that the reduction of mdr-1 mRNA occurred at the level of gene transcription was obtained by measuring chloramphenicol acetyltransferase (CAT) mRNA in MCF-7TH cells transfected with an mdr-1 promoter-CAT construct prior to 8-Cl-cAMP treatment. Thus, 8-Cl-cAMP is able to downregulate mdr-1 expression and suggests a new approach to reversal of drug resistance in human breast cancer.

Involvement of microtubules in the regulation of Bcl2 phosphorylation and apoptosis through cyclic AMP-dependent protein kinase.

The Bcl2 family of proteins plays a significant role in regulation of apoptosis. In this study, the microtubule-damaging drugs paclitaxel, vincristine, and vinblastine induced Bcl2 hyperphosphorylation and apoptosis in MCF-7 and MDA-MB-231 cells and reduced Bcl2-Bax dimerization. Paclitaxel or vincristine induced increased expression of Bax, while overexpression of Bcl2 in these cell lines counteracted the effects of low doses of these drugs. In addition, paclitaxel- and vincristine-induced activation of cyclic AMP (cAMP)-dependent protein kinase (protein kinase A [PKA]) induced Bcl2 hyperphosphorylation and apoptosis, which were blocked by the PKA inhibitor Rp diastereomers of cAMP (Rp-cAMP). This finding suggests that activation of PKA due to microtubule damage is an important event in Bcl2 hyperphosphorylation and induction of apoptosis. These microtubule-damaging drugs caused growth arrest in G2-M phase of the cell cycle and had no effect on p53 induction, suggesting that hyperphosphorylation mediated inactivation of Bcl2 and apoptosis without the involvement of p53. By comparison, the DNA-damaging drugs methotrexate and doxorubicin had no effect on Bcl2 hyperphosphorylation but induced p53 expression. Interestingly, paclitaxel or vincristine induced activation of caspase 3 and cleavage of poly(ADP-ribose) polymerase downstream of Bcl2 hyperphosphorylation. These data suggest that there may be a signaling cascade induced by agents that disrupt or damage the cytoskeleton that is distinct from (i.e., p53 independent), but perhaps related to (i.e., involves kinase activation and leads to apoptosis), the cellular response to DNA damage.

Relationship of hormone dependency to estrogen receptor and adenosine 3',5'-cyclic monophosphate-binding proteins in rat mammary tumors.

Estrogen-binding activity and the binding activity of adenosine 3',5'-cyclic monophosphate (cAMP) were assayed in the cytosol of biopsy specimens from 70 rat mammary tumors. The response of these tumors to host ovariectomy was followed. The hormone dependency of the tumors was closely related to the relative concentrations of estrogen receptor (ER) and cAMP-binding protein (CR) in the tumor cytosol. When ER and CR were expressed as the ER/CR ratio, 36 of 38 (95%) hormone-dependent tumors had ratios of 35 X 10(-3) or more, whereas 31 of 32 (97%) hormone-independent tumors had ratios of less than 35 X 10(-3). When ER alone was measured, hormone dependency could be correctly predicted in only 60% of the tumors because the ER range for individual tumors of both types greatly overlapped. Ratios of ER/CR were also elevated in normal estrogen target tissues as compared to those in normal estrogen nontarget tissues. Thus determination of the ER/CR ratio in tumor cytosols appeared to be a more reliable method of predicting hormone dependency than was determination of ER alone.

Cyclic adenosine 3',5'-monophosphate-binding protein: role in ovariectomy-induced regression of a hormone-dependent mammary tumor in Sprague-Dawley female rats.

Cyclic AMP- and estrogen-binding activities were present in 7,12-dimethylbenz[a]anthracene-induced mammary carcinomas in Sprague-Dawley female rats. Soon after ovariectomy of the host, cyclic AMP binding markedly increased and estrogen binding decreased in regressing tumors. These changes were reversed when tumor growth was resumed following the injection of estradiol-17beta. The data suggested the possible involvement of cyclic AMP binding in the growth control of a hormone-dependent mammary tumor.

Regression of hormone-dependent mammary tumors in Sprague-Dawley rats as a result of tamoxifen or pharmacologic doses of 17 beta-estradiol: cyclic adenosine 3',5'-monophosphate-mediated events.

The estrogen and cyclic adenosine 3',5'-monophosphate (cAMP)-binding activities changed markedly when 7,12-dimethylbenz[a]anthracene-induced mammary tumors of Sprague-Dawley rats regressed following daily injections of either tamoxifen or pharmacologic doses of 17 beta-estradiol. cAMP binding increased eightfold to tenfold, whereas estrogen binding increased twofold to threefold in regressing tumor nuclei at 5 days after either treatment, which resulted in an inversion of the ratio of estrogen binding to cAMP binding found in growing tumor nuclei. Concomitantly, both binding activities were depleted from the cytosol. In the regressing tumors, the cAMP level increased twofold and nuclear cAMP-dependent protein kinase activity increased threefold to fourfold, with a 70-80% decrease in the cytoplasmic protein kinase activity. The rise in the nuclear protein kinase activity was abolished when cycloheximide was given with tamoxifen or with high doses of 17 beta-estradiol, which suggests that the increased activity is due to new protein synthesis. In the regressing tumor nuclei, the phosphorylation of the regression-associated proteins increased, whereas the phosphorylation of growth-associated proteins decreased. These data suggest that the mammary tumor regression induced by tamoxifen or high doses of estrogen proceed through a series of cAMP-mediated events.

Role of cyclic AMP receptor proteins in growth, differentiation, and suppression of malignancy: new approaches to therapy.

Two isoforms of the regulatory subunits of cyclic AMP (cAMP)-dependent protein kinase that bind cAMP are inversely expressed during ontogeny and cell differentiation. These cAMP-binding receptor proteins in harmony may regulate the growth of normal cells and their differentiation into nondividing states. Cancer cells can also be made to differentiate and stop growing when the functional balance of these cAMP receptor proteins is restored by treatment with site-selective cAMP analogues or by the use of an antisense oligodeoxynucleotide, suggesting new approaches to cancer treatment.

Anticarcinogenic effect of N6,O2'-dibutyryl cyclic adenosine 3':5'-monophosphate on 7,12-dimethylbenz(a)anthracene mammary tumor induction in the rat and its relationship to cyclic adenosine 3':5'-monophosphate metabolism and protein kinase.

A single intubation of 7,12-dimethylbenz(a)anthracene (DMBA) (20 mg in 1 ml sesame oil) to female Sprague-Dawley rats at 50 days of age produces primary mammary carcinomas in 80% of rats at 100 to 150 days of age. Administration of N6,O2'-dibutyryl cyclic adenosine 3':5'-monophosphate (DBcAMP) p.o. beginning at 1 day prior to DMBA intubation resulted in marked delay and reduction of tumor production: only 15% as many DBcAMP-treated rats had tumors as in the control group (DMBA only) with 60 days of delay in the first tumor appearance. DMBA-induced tumor production was preceded by changes in the cyclic adenosine 3':5'-monophosphate (cAMP) metabolism and protein kinase of the mammary gland. Within 24 hr post-DMBA intubation, the intracellular cAMP level and adenylate cyclase activity increased with an increase in type I isozyme of cAMP-dependent protein kinase, a form which has been associated with increased proliferative activity and a less differentiated cellular state in other tissues. The increases in cAMP level, adenylate cyclase activity, and the protein kinase activity were transient, and the values decreased to below the control values by Day 10 post-DMBA intubation. In mammary glands of rats that had received DBcAMP, the cAMP level and protein kinase isozyme pattern were similar to those of older rats that are no longer susceptible to the carcinogen. The inhibitory effect on DMBA-induced carcinogenesis may be related to the modifications that DBcAMP induces on cAMP level, adenylate cyclase activity, and cAMP-dependent protein kinase of the mammary gland.

Relationship between the anticarcinogenic effect of N6,O2'-dibutyryl cyclic adenosine 3',5'-monophosphate and modulation of gene expression and inhibition of binding of 7,12-dimethylbenz(alpha)anthracene to DNA of mammary cells.

Carcinogenic doses of 7,12-dimethylbenz(alpha)anthracene (DMBA) failed to induce mammary carcinoma in the rats that have received N6,O2'-dibutyryl cyclic adenosine 3',5'-monophosphate (DBcAMP) (Cancer Res., 43: 2736, 1983). We now report that the anticarcinogenic effect of DBcAMP correlates with its effect on DNA binding of the carcinogen and on gene expression. Cultured mammary epithelial cells in exponential phase of growth were used to determine the effect of DBcAMP on DMBA binding to DNA. DBcAMP inhibited the DMBA binding in carcinogen-susceptible mammary cells of 50-day-old rats, but it had no effect on the binding in the DMBA-resistant mammary cells of 35- and 110-day-old rats. The inhibitory effect of DBcAMP was appreciable at the concentration of 10(-7) M, one tenth the concentration of [3H]DMBA. DBcAMP at 10(-6) M concentration exhibited the maximal inhibition of DMBA binding; i.e., binding in DMBA-susceptible mammary cells was reduced to the level of binding observed in DMBA-resistant mammary cells. Polyadenylate-containing RNAs isolated from mammary glands of DMBA-susceptible rats (50-day-old) yielded translation products in vitro which bear a greater resemblance to translation products of growing DMBA-induced tumors than they do to products of messenger RNAs from regressing tumors or DMBA-resistant mammary glands of 110-day-old rats. DBcAMP administered to the susceptible rats resulted in changes in the translation products of the mammary glands; the translation products of the glands became similar to those of DMBA-resistant mammary glands or regressing tumors. DMBA feeding 1 day after DBcAMP treatment could not reverse this effect of DBcAMP. These data suggest that the role of cyclic adenosine 3',5'-monophosphate at the genomic level is responsible for the anticarcinogenesis of mammary cells.

Nucleolar accumulation of cyclic adenosine 3':5'-monophosphate receptor proteins during regression of MCF-7 human breast tumor.

Cyclic adenosine 3':5'-monophosphate (cAMP) receptor proteins (high-affinity binding proteins) present in growing and regressing MCF-7 human breast tumors were identified and characterized by the use of the photoaffinity-labeled 8-azido[32P]-cAMP and the affinity-purified antibodies to type I and type II regulatory subunits (RI and RII, respectively) of cAMP-dependent protein kinase. The cytosol fraction of growing MCF-7 tumors contained four major types of the 8-azido[32P]cAMP-binding proteins with molecular weights of 35,000, 47,000, 50,000, and 52,000. Following estrogen withdrawal, the amount of these proteins increased in the cytosol of regressing tumors. RI antibody immunoprecipitated cAMP receptor protein with a molecular weight of 47,000, whereas RII antibody immunoprecipitated Mr 50,000 and 52,000 proteins. The Mr 35,000 protein was not precipitated by either RI or RII antibodies. In the nuclear extracts of the growing tumors, the 8-azido-[32P]cAMP-binding proteins with molecular weights of 34,000, 35,000, 44,000, and 47,000 were detected. Following estrogen withdrawal, the 8-azido[32P]cAMP-binding proteins with molecular weights of 50,000 and 52,000 newly appeared in the nuclei of regressing tumors. The Mr 47,000 protein was immunoprecipitated by RI antibody and the Mr 34,000, 44,000, 50,000, and 52,000 proteins were precipitated by RII antibody. An indirect immunofluorescence revealed that, during regression of MCF-7 tumors, the intensity of immunofluorescence of RII proteins dramatically increased in the nucleoli, whereas immunofluorescence of RI remained the same in the nuclei. These results suggest that, during hormone-induced regression of human breast tumors, the Mr 50,000 and Mr 52,000 RII cAMP-binding proteins are translocated to the nucleoli from cytoplasm. Thus, the accumulation of these cAMP receptor proteins at nucleolar site(s) correlates with the regression of MCF-7 tumors.

Prognostic significance of the expression of a ras protein with a molecular weight of 21,000 by human breast cancer.

Expression of the cellular ras Mr 21,000 protein (p21) has been measured in tumors from breast cancer patients who at time of presentation had no evidence of metastatic disease. Western blotting analysis revealed that 37 of 54 (69%) tumors contained p21 levels 2- to 10-fold greater than those of control breast tissues. An excessive increase of p21 (5- to 10-fold over the control value) occurred more frequently in tumors of T3 and T4 stages [15 of 25 (60%)] than in tumors at T2 stage [6 of 29 (21%)], suggesting a correlation between advancement of disease and high p21 levels. p21 levels were positively related to the involvement of axillary lymph nodes at the time of primary treatment. As no correlations were detected between p21 levels and a gross pathological parameter, tumor grade, it is possible that p21 levels may reflect the degree of cellular malignancy. This is supported by data on tumor recurrence; 13 of 16 patients (81%) with tumors expressing low p21 levels were disease free for greater than or equal to 4 years after primary treatment, whereas only 5 of 9 patients (56%) with high p21 tumors remained disease free. These results suggested that a quantitative enhancement of p21 oncogene protein is associated with both the progression and prognosis of breast cancer.

Alteration in gene expression at the onset of hormone-dependent mammary tumor regression.

Two hormone-dependent mammary carcinomas regressing after hormone removal, [one primary 7,12-dimethylbenz(alpha)-anthracene induced, and the other transplanted MTW9] were used as models to test the hypothesis that the regression of hormone-dependent mammary tumors is triggered by a modification of the genetic expression. In support of the hypothesis, we observed that: (1) the in vitro translation products of poly(A)+ RNAs differ between growing and regressing tumors; (b) the difference is localized in four protein bands (mr 53,000, 35,000, 22,000 and 20,000) of the electrophoretic pattern that decrease in their concentrations and one protein band (Mr 20,500) that increases during regression; (c) the changes in the translation products occur within 6 hr post-hormone removal, and the changes are reversed when resumption of tumor growth was induced by replenishment of the hormone to the host rats: and (d) three autonomously growing tumors exhibit a unique translation pattern which differs from that of hormone-dependent tumors, and the pattern does not change upon hormone removal. The results suggest that hormonal regulation of mammary tumor growth is related to specific genetic transcripts, and loss of hormone dependence of growth may correlate with the changes in this genetic control.

Inverse relation between estrogen receptors and cyclic adenosine 3':5'-monophosphate-binding proteins in hormone-dependent mammary tumor regression due to dibutyryl cyclic adenosine 3':5'-monophosphate treatment or ovariectomy.

During the growth arrest of 7,12-dimethylbenz(alpha) anthracene-induced rat mammary carcinomas following ovariectomy or N6, O2'-dibutyryl cyclic adenosine 3':5'-monophosphate (DBcAMP) treatment, a change in the specific estrogen and cAMP binding to tumor proteins is observed. Three days after ovariectomy or DBcAMP treatment of the hosts, cAMP binding increases 5- and 2-fold in the nuclei and cytosol of tumors, respectively, whereas nuclear and cytoplasmic estrogen binding decreases by 70 and 25%, respectively. These changes in cAMP- and estrogen-binding activities are detectable within 1 day after ovariectomy or DBcAMP treatment, and the changes are reversed when resumption of tumor growth is induced by the injection of estradiol valerate or cessation of DBcAMP treatment. When 7,12-dimethylbenz(alpha)anthracene-induced tumors fail to regress after ovariectomy or DBcAMP treatment, the change in estrogen and cAMP binding does not occur. Concomitant with the increase of cAMP-binding activity in regressing tumors are increases in histone kinase activity and the cAMP content of the tumors. These increases in cAMP-binding and protein kinase activities are blocked by cycloheximide. These data suggest an interaction between a steroid hormone and cAMP in the growth control of a hormone-dependent mammary tumor.

Arrest of hormone-dependent mammary cancer growth in vivo and in vitro by cholera toxin.

Growth of 7,12-dimethylbenz(alpha)anthracene-induced mammary carcinoma in rat was arrested by daily s.c. injections of cholera toxin. At a dose of 2 micrograms/200-g rat, tumors regressed to 50% of their initial size within 2 weeks, and 85% of tumors regressed completely within 4 to 5 weeks. The same response to cholera toxin was observed with another hormone-dependent mammary tumor, MTW9, but not with the hormone-independent tumors, DMBA No. 1 and MT 13762. The latter result was consistent with the lack of response of these hormone-independent tumors to hormone removal (ovariectomy) or N6,O2'-dibutyryl cyclic adenosine 3':5'-monophosphate treatment. The growth-inhibitory effect of cholera toxin was dose dependent, and upon cessation of treatment tumors resumed growth; after complete regression, however, tumors did not reappear until 6 months after termination of the treatment. An amount of cholera toxin as high as 10 micrograms/day/200-g rat s.c. injected over a 6-week period showed no systemic toxicity in the animals. The growth of human breast cancer cells (MCF-7) in culture was also inhibited by a daily supplement of cholera toxin. At a concentration of 100 ng/ml, the cell replication ceased completely within 2 days. The growth inhibitions, both in vivo and in vitro, were accompanied by marked increases in the cellular cyclic adenosine 3':5'-monophosphate content and type II cyclic adenosine 3':5'-monophosphate-dependent protein kinase activity as well as a decrease of estrogen binding activity. Thus, extinction of mammary cancer can be achieved by cholera toxin, an agent that stimulates the intracellular cyclic adenosine 3':5'-monophosphate system.