Abstract
Multidrug resistance (MDR) and more specifically the expression of P-glycoprotein (Pgp) have been studied extensively in vitro. Unfortunately, it appears that the predictive value of MDR recognized in vitro is mostly an incorrect measure to determine the responsiveness of a particular tumour in the clinic. This misunderstood or overvalued role of MDR might explain the failure of strategies to reverse Pgp function by the use of modulators in solid tumours. To obtain more insight in in vivo drug resistance we investigated a panel of 15 human ovarian cancer xenografts consisting of the most common histological subtypes known in ovarian cancer patients. The response rate to cisplatin, cyclophosphamide and doxorubicin in the xenografts resembled the results of phase II trials with these agents in ovarian cancer patients. This resemblance justifies drug resistance studies in this experimental in vivo human tumour system. We determined the expression levels of MDR 1, MRP 1, LRP and topoisomerase IIα mRNA by the RNase protection assay and the presence of MRP1 and LRP proteins by immunohistochemistry. The S-phase fraction was investigated as a separate parameter by flow cytometry. In none of the 15 ovarian cancer xenografts was MDR 1 expression detectable. The expression levels of MRP 1 and LRP were low to moderate and resembled the presence of the MRP1 and LRP proteins. There was a weak, inverse relationship between the expression levels of LRP and sensitivity to cisplatin and cyclophosphamide (r = –0.44 and –0.45), but not to doxorubicin. The levels of topoisomerase IIα varied among the xenografts (0.73–2.66) and failed to correlate with doxorubicin resistance (r = 0.14). The S-phase fraction, however, showed a relation with the sensitivity to cisplatin (r = 0.66). Among the determinants studied in ovarian cancer in vivo, LRP mRNA and the S-phase fraction were the best predictive factors for drug response and most specifically for the activity of cisplatin. © 2000 Cancer Research Campaign
Keywords: ovarian cancer xenografts, drug resistance, LRP, S-phase fraction
Full Text
The Full Text of this article is available as a PDF (91.8 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Arts H. J., Katsaros D., de Vries E. G., Massobrio M., Genta F., Danese S., Arisio R., Scheper R. J., Kool M., Scheffer G. L. Drug resistance-associated markers P-glycoprotein, multidrug resistance-associated protein 1, multidrug resistance-associated protein 2, and lung resistance protein as prognostic factors in ovarian carcinoma. Clin Cancer Res. 1999 Oct;5(10):2798–2805. [PubMed] [Google Scholar]
- Baas F., Jongsma A. P., Broxterman H. J., Arceci R. J., Housman D., Scheffer G. L., Riethorst A., van Groenigen M., Nieuwint A. W., Joenje H. Non-P-glycoprotein mediated mechanism for multidrug resistance precedes P-glycoprotein expression during in vitro selection for doxorubicin resistance in a human lung cancer cell line. Cancer Res. 1990 Sep 1;50(17):5392–5398. [PubMed] [Google Scholar]
- Bourhis J., Goldstein L. J., Riou G., Pastan I., Gottesman M. M., Bénard J. Expression of a human multidrug resistance gene in ovarian carcinomas. Cancer Res. 1989 Sep 15;49(18):5062–5065. [PubMed] [Google Scholar]
- Boven E., Winograd B., Berger D. P., Dumont M. P., Braakhuis B. J., Fodstad O., Langdon S., Fiebig H. H. Phase II preclinical drug screening in human tumor xenografts: a first European multicenter collaborative study. Cancer Res. 1992 Nov 1;52(21):5940–5947. [PubMed] [Google Scholar]
- Chevillard S., Pouillart P., Beldjord C., Asselain B., Beuzeboc P., Magdelénat H., Vielh P. Sequential assessment of multidrug resistance phenotype and measurement of S-phase fraction as predictive markers of breast cancer response to neoadjuvant chemotherapy. Cancer. 1996 Jan 15;77(2):292–300. doi: 10.1002/(SICI)1097-0142(19960115)77:2<292::AID-CNCR11>3.0.CO;2-X. [DOI] [PubMed] [Google Scholar]
- Cole S. P., Sparks K. E., Fraser K., Loe D. W., Grant C. E., Wilson G. M., Deeley R. G. Pharmacological characterization of multidrug resistant MRP-transfected human tumor cells. Cancer Res. 1994 Nov 15;54(22):5902–5910. [PubMed] [Google Scholar]
- Cornarotti M., Capranico G., Bohm S., Oriana S., Spatti G. B., Mariani L., Ballabio G., Zunino F. Gene expression of DNA topoisomerases I, II alpha and II beta and response to cisplatin-based chemotherapy in advanced ovarian carcinoma. Int J Cancer. 1996 Aug 7;67(4):479–484. doi: 10.1002/(SICI)1097-0215(19960807)67:4<479::AID-IJC3>3.0.CO;2-P. [DOI] [PubMed] [Google Scholar]
- Flens M. J., Scheffer G. L., van der Valk P., Broxterman H. J., Eijdems E. W., Huysmans A. C., Izquierdo M. A., Scheper R. J. Identification of novel drug resistance-associated proteins by a panel of rat monoclonal antibodies. Int J Cancer. 1997 Oct 9;73(2):249–257. doi: 10.1002/(sici)1097-0215(19971009)73:2<249::aid-ijc15>3.0.co;2-a. [DOI] [PubMed] [Google Scholar]
- Ghazal-Aswad S., Hogarth L., Hall A. G., George M., Sinha D. P., Lind M., Calvert A. H., Sunter J. P., Newell D. R. The relationship between tumour glutathione concentration, glutathione S-transferase isoenzyme expression and response to single agent carboplatin in epithelial ovarian cancer patients. Br J Cancer. 1996 Aug;74(3):468–473. doi: 10.1038/bjc.1996.384. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Giaccone G., van Ark-Otte J., Scagliotti G., Capranico G., van der Valk P., Rubio G., Dalesio O., Lopez R., Zunino F., Walboomers J. Differential expression of DNA topoisomerases in non-small cell lung cancer and normal lung. Biochim Biophys Acta. 1995 Dec 27;1264(3):337–346. doi: 10.1016/0167-4781(95)00171-9. [DOI] [PubMed] [Google Scholar]
- Hamaguchi K., Godwin A. K., Yakushiji M., O'Dwyer P. J., Ozols R. F., Hamilton T. C. Cross-resistance to diverse drugs is associated with primary cisplatin resistance in ovarian cancer cell lines. Cancer Res. 1993 Nov 1;53(21):5225–5232. [PubMed] [Google Scholar]
- Hamilton T. C., Young R. C., Ozols R. F. Experimental model systems of ovarian cancer: applications to the design and evaluation of new treatment approaches. Semin Oncol. 1984 Sep;11(3):285–298. [PubMed] [Google Scholar]
- Ishikawa T., Akimaru K., Kuo M. T., Priebe W., Suzuki M. How does the MRP/GS-X pump export doxorubicin? J Natl Cancer Inst. 1995 Nov 1;87(21):1639–1640. doi: 10.1093/jnci/87.21.1639. [DOI] [PubMed] [Google Scholar]
- Ishikawa T., Ali-Osman F. Glutathione-associated cis-diamminedichloroplatinum(II) metabolism and ATP-dependent efflux from leukemia cells. Molecular characterization of glutathione-platinum complex and its biological significance. J Biol Chem. 1993 Sep 25;268(27):20116–20125. [PubMed] [Google Scholar]
- Izquierdo M. A., Shoemaker R. H., Flens M. J., Scheffer G. L., Wu L., Prather T. R., Scheper R. J. Overlapping phenotypes of multidrug resistance among panels of human cancer-cell lines. Int J Cancer. 1996 Jan 17;65(2):230–237. doi: 10.1002/(SICI)1097-0215(19960117)65:2<230::AID-IJC17>3.0.CO;2-H. [DOI] [PubMed] [Google Scholar]
- Izquierdo M. A., van der Zee A. G., Vermorken J. B., van der Valk P., Beliën J. A., Giaccone G., Scheffer G. L., Flens M. J., Pinedo H. M., Kenemans P. Drug resistance-associated marker Lrp for prediction of response to chemotherapy and prognoses in advanced ovarian carcinoma. J Natl Cancer Inst. 1995 Aug 16;87(16):1230–1237. doi: 10.1093/jnci/87.16.1230. [DOI] [PubMed] [Google Scholar]
- Jansen W. J., Pinedo H. M., van der Wilt C. L., Feller N., Bamberger U., Boven E. The influence of BIBW22BS, a dipyridamole derivative, on the antiproliferative effects of 5-fluorouracil, methotrexate and gemcitabine in vitro and in human tumour xenografts. Eur J Cancer. 1995 Dec;31A(13-14):2313–2319. doi: 10.1016/0959-8049(95)00440-8. [DOI] [PubMed] [Google Scholar]
- Johnson S. W., Ozols R. F., Hamilton T. C. Mechanisms of drug resistance in ovarian cancer. Cancer. 1993 Jan 15;71(2 Suppl):644–649. doi: 10.1002/cncr.2820710224. [DOI] [PubMed] [Google Scholar]
- Kavallaris M., Leary J. A., Barrett J. A., Friedlander M. L. MDR1 and multidrug resistance-associated protein (MRP) gene expression in epithelial ovarian tumors. Cancer Lett. 1996 Apr 19;102(1-2):7–16. doi: 10.1016/0304-3835(96)04143-2. [DOI] [PubMed] [Google Scholar]
- Kolfschoten G. M., Pinedo H. M., Scheffer P. G., Schlüper H. M., Erkelens C. A., Boven E. Development of a panel of 15 human ovarian cancer xenografts for drug screening and determination of the role of the glutathione detoxification system. Gynecol Oncol. 2000 Mar;76(3):362–368. doi: 10.1006/gyno.1999.5689. [DOI] [PubMed] [Google Scholar]
- Kool M., de Haas M., Scheffer G. L., Scheper R. J., van Eijk M. J., Juijn J. A., Baas F., Borst P. Analysis of expression of cMOAT (MRP2), MRP3, MRP4, and MRP5, homologues of the multidrug resistance-associated protein gene (MRP1), in human cancer cell lines. Cancer Res. 1997 Aug 15;57(16):3537–3547. [PubMed] [Google Scholar]
- Langdon S. P., Hendriks H. R., Braakhuis B. J., Pratesi G., Berger D. P., Fodstad O., Fiebig H. H., Boven E. Preclinical phase II studies in human tumor xenografts: a European multicenter follow-up study. Ann Oncol. 1994 May;5(5):415–422. doi: 10.1093/oxfordjournals.annonc.a058872. [DOI] [PubMed] [Google Scholar]
- Lautier D., Canitrot Y., Deeley R. G., Cole S. P. Multidrug resistance mediated by the multidrug resistance protein (MRP) gene. Biochem Pharmacol. 1996 Oct 11;52(7):967–977. doi: 10.1016/0006-2952(96)00450-9. [DOI] [PubMed] [Google Scholar]
- List A. F., Spier C. S., Grogan T. M., Johnson C., Roe D. J., Greer J. P., Wolff S. N., Broxterman H. J., Scheffer G. L., Scheper R. J. Overexpression of the major vault transporter protein lung-resistance protein predicts treatment outcome in acute myeloid leukemia. Blood. 1996 Mar 15;87(6):2464–2469. [PubMed] [Google Scholar]
- Loe D. W., Deeley R. G., Cole S. P. Biology of the multidrug resistance-associated protein, MRP. Eur J Cancer. 1996 Jun;32A(6):945–957. doi: 10.1016/0959-8049(96)00046-9. [DOI] [PubMed] [Google Scholar]
- Molthoff C. F., Calame J. J., Pinedo H. M., Boven E. Human ovarian cancer xenografts in nude mice: characterization and analysis of antigen expression. Int J Cancer. 1991 Jan 2;47(1):72–79. doi: 10.1002/ijc.2910470114. [DOI] [PubMed] [Google Scholar]
- Neijt J. P., ten Bokkel Huinink W. W., van der Burg M. E., van Oosterom A. T., Vriesendorp R., Pinedo H. M. Current status of systemic chemotherapy in the treatment of advanced ovarian cancer with emphasis on CHAP-5. Radiother Oncol. 1984 Jun;2(1):19–29. doi: 10.1016/s0167-8140(84)80034-1. [DOI] [PubMed] [Google Scholar]
- Nielsen D., Maare C., Skovsgaard T. Cellular resistance to anthracyclines. Gen Pharmacol. 1996 Mar;27(2):251–255. doi: 10.1016/0306-3623(95)02013-6. [DOI] [PubMed] [Google Scholar]
- Noonan K. E., Beck C., Holzmayer T. A., Chin J. E., Wunder J. S., Andrulis I. L., Gazdar A. F., Willman C. L., Griffith B., Von Hoff D. D. Quantitative analysis of MDR1 (multidrug resistance) gene expression in human tumors by polymerase chain reaction. Proc Natl Acad Sci U S A. 1990 Sep;87(18):7160–7164. doi: 10.1073/pnas.87.18.7160. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pinedo H. M., Giaccone G. P-glycoprotein--a marker of cancer-cell behavior. N Engl J Med. 1995 Nov 23;333(21):1417–1419. doi: 10.1056/NEJM199511233332111. [DOI] [PubMed] [Google Scholar]
- Raaijmakers H. G., Izquierdo M. A., Lokhorst H. M., de Leeuw C., Belien J. A., Bloem A. C., Dekker A. W., Scheper R. J., Sonneveld P. Lung-resistance-related protein expression is a negative predictive factor for response to conventional low but not to intensified dose alkylating chemotherapy in multiple myeloma. Blood. 1998 Feb 1;91(3):1029–1036. [PubMed] [Google Scholar]
- Remvikos Y., Beuzeboc P., Zajdela A., Voillemot N., Magdelénat H., Pouillart P. Correlation of pretreatment proliferative activity of breast cancer with the response to cytotoxic chemotherapy. J Natl Cancer Inst. 1989 Sep 20;81(18):1383–1387. doi: 10.1093/jnci/81.18.1383. [DOI] [PubMed] [Google Scholar]
- Roninson I. B. The role of the MDR1 (P-glycoprotein) gene in multidrug resistance in vitro and in vivo. Biochem Pharmacol. 1992 Jan 9;43(1):95–102. doi: 10.1016/0006-2952(92)90666-7. [DOI] [PubMed] [Google Scholar]
- Rubin S. C., Finstad C. L., Hoskins W. J., Saigo P. E., Provencher D. M., Federici M. G., Hakes T. B., Markman M., Reichman B. S., Lloyd K. O. Expression of P-glycoprotein in epithelial ovarian cancer: evaluation as a marker of multidrug resistance. Am J Obstet Gynecol. 1990 Jul;163(1 Pt 1):69–73. doi: 10.1016/s0002-9378(11)90670-x. [DOI] [PubMed] [Google Scholar]
- Scheffer G. L., Wijngaard P. L., Flens M. J., Izquierdo M. A., Slovak M. L., Pinedo H. M., Meijer C. J., Clevers H. C., Scheper R. J. The drug resistance-related protein LRP is the human major vault protein. Nat Med. 1995 Jun;1(6):578–582. doi: 10.1038/nm0695-578. [DOI] [PubMed] [Google Scholar]
- Schmidt R. A., Conrad E. U., 3rd, Collins C., Rabinovitch P., Finney A. Measurement and prediction of the short-term response of soft tissue sarcomas to chemotherapy. Cancer. 1993 Nov 1;72(9):2593–2601. doi: 10.1002/1097-0142(19931101)72:9<2593::aid-cncr2820720914>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
- Schröder C. P., Godwin A. K., O'Dwyer P. J., Tew K. D., Hamilton T. C., Ozols R. F. Glutathione and drug resistance. Cancer Invest. 1996;14(2):158–168. doi: 10.3109/07357909609018891. [DOI] [PubMed] [Google Scholar]
- Spyratos F., Briffod M., Tubiana-Hulin M., Andrieu C., Mayras C., Pallud C., Lasry S., Rouëssé J. Sequential cytopunctures during preoperative chemotherapy for primary breast carcinoma. II. DNA flow cytometry changes during chemotherapy, tumor regression, and short-term follow-up. Cancer. 1992 Jan 15;69(2):470–475. doi: 10.1002/1097-0142(19920115)69:2<470::aid-cncr2820690233>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
- Zaman G. J., Versantvoort C. H., Smit J. J., Eijdems E. W., de Haas M., Smith A. J., Broxterman H. J., Mulder N. H., de Vries E. G., Baas F. Analysis of the expression of MRP, the gene for a new putative transmembrane drug transporter, in human multidrug resistant lung cancer cell lines. Cancer Res. 1993 Apr 15;53(8):1747–1750. [PubMed] [Google Scholar]
- Zijlstra J. G., de Vries E. G., Mulder N. H. Multifactorial drug resistance in an adriamycin-resistant human small cell lung carcinoma cell line. Cancer Res. 1987 Apr 1;47(7):1780–1784. [PubMed] [Google Scholar]
- van der Zee A. G., Hollema H., de Jong S., Boonstra H., Gouw A., Willemse P. H., Zijlstra J. G., de Vries E. G. P-glycoprotein expression and DNA topoisomerase I and II activity in benign tumors of the ovary and in malignant tumors of the ovary, before and after platinum/cyclophosphamide chemotherapy. Cancer Res. 1991 Nov 1;51(21):5915–5920. [PubMed] [Google Scholar]