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The development of metastases is the main reason for cancer-related death in non–small cell lung cancer (NSCLC). The initiation of metastasis involves an increase in cell motility mediated by the loss of cell-cell adhesion caused by E-cadherin repression, in a process commonly known as epithelial-to-mesenchymal transition. A role for microRNA-200 family members in regulating epithelial-to-mesenchymal transition has recently been indicated but data about their expression in lung tumors is still unavailable. The present study investigated the expression of miR-200c in a panel of NSCLC cell lines (n = 9), and a strong inverse correlation with invasion was detected. Reintroduction of miR-200c into highly invasive/aggressive NSCLC cells induced a loss of the mesenchymal phenotype by restoring E-cadherin and reducing N-cadherin expression, and inhibited in vitro cell invasion as well as in vivo metastasis formation. Moreover, miR-200c overexpression restored the sensitivity of NCI-H1299 cells to cisplatin and cetuximab. Hypermethylation of the promoter region was found to be responsible for the loss of miR-200c in invasive cells, as evaluated by 5-aza-2′-deoxycytidine treatment, methylation-specific PCR, and bisulfite sequencing. In primary tumor specimens obtained from 69 patients with consecutively resected NSCLC, lower miR-200c expression levels were found to be associated with a poor grade of differentiation (P = 0.04), a higher propensity to lymph node metastases (P < 0.01), and with a lower E-cadherin expression (P = 0.01). These data indicate that the loss of miR-200c expression induces an aggressive, invasive, and chemoresistant phenotype, and that assessment of its expression could contribute to a better clinicopathologic definition of patients with NSCLC. Mol Cancer Res; 8(9); 1207–16. ©2010 AACR.

Supplementary Figures S1-S4.

SUPPLEMENTARY FIGURE 1 Correlation of VIM/CDH1 ratios in different datasets. The list of 35 genes significantly correlated with EMT. Lack of correlation between AKR1B10 mRNA levels and EMT. SUPPLEMENTARY FIGURE 2 AKR1B1 levels are modulated by ZEB1, but not in a direct fashion. SUPPLEMENTARY FIGURE 3 Characteristics of the NSCLC patients stained with immunohistochemistry and impact on survival. Alterations of AKR1B1 levels influence cancer cells growth and cancer stemness. SUPPLEMENTARY FIGURE 4 Impact of SORD knockdown on cancer cells growth and invasion. The combination of the inhibition of polyol pathway gene and cisplatin suppresses in vitro growth. Oxidative consumption rate and ECAR/OCR ratios in polyol pathway-deficient cells. SUPPLEMENTARY FIGURE 5 Co-expression patterns of AKR1B1 and SORD in TCGA datasets. SUPPLEMENTARY FIGURE 6 Effects of treatment with excess glucose on the generation of polyols, on the alteration of EMT and stemness markers, and on the activation of TGF-Beta signaling and TGF-Beta-related genes.

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List of differentially expressed genes in all analyzed datasets

Cancer cells alter their metabolism to support their malignant properties. In this study, we report that the glucose-transforming polyol pathway (PP) gene aldo-keto-reductase-1-member-B1 (AKR1B1) strongly correlates with epithelial-to-mesenchymal transition (EMT). This association was confirmed in samples from lung cancer patients and from an EMT-driven colon cancer mouse model with p53 deletion. In vitro, mesenchymal-like cancer cells showed increased AKR1B1 levels, and AKR1B1 knockdown was sufficient to revert EMT. An equivalent level of EMT suppression was measured by targeting the downstream enzyme sorbitol-dehydrogenase (SORD), further pointing at the involvement of the PP. Comparative RNA sequencing confirmed a profound alteration of EMT in PP-deficient cells, revealing a strong repression of TGFβ signature genes. Excess glucose was found to promote EMT through autocrine TGFβ stimulation, while PP-deficient cells were refractory to glucose-induced EMT. These data show that PP represents a molecular link between glucose metabolism, cancer differentiation, and aggressiveness, and may serve as a novel therapeutic target.Significance: A glucose-transforming pathway in TGFβ-driven epithelial-to-mesenchymal transition provides novel mechanistic insights into the metabolic control of cancer differentiation. Cancer Res; 78(7); 1604–18. ©2018 AACR.

Purpose: Mitotane is the most broadly used systemic therapy for adrenocortical carcinoma (ACC), but its mechanism of action and possible predictors of treatment response are currently poorly defined. Our aim was to evaluate the gene expression of ribonucleotide reductase large subunit 1 (RRM1) and excision repair cross-complementation group 1 (ERCC1) in ACC as potential biomarkers for clinical outcome and response to mitotane.Experimental Design: Forty-five and 47 tissue samples from two cohorts (Orbassano, Italy; Wuerzburg, Germany) of completely resected ACC were centrally analyzed using real-time PCR for RRM1 and ERCC1 expression. Fifty-four patients received surgery alone and 38 received adjuvant mitotane after surgery. Clinical and pathologic features were highly comparable in the two series. H295R and SW-13 ACC cell lines were also used for pharmacologic tests.Results:ERCC1 gene expression was not associated to clinical outcome. In contrast, high RRM1 gene expression was associated to shorter disease-free survival (DFS) and overall survival at both univariate and multivariate analysis. In patients with low RRM1 gene expression, adjuvant mitotane was associated with improved DFS, whereas this effect was lost in cases with high RMM1 expression. In vitro mitotane induced strong up regulation of RRM1 transcription (up to 25-fold increase) in mitotane-insensitive SW-13 but not in mitotane-sensitive H295R cells. Furthermore, RRM1 silencing in SW-13 cells induced sensitivity to mitotane.Conclusion: Our in vitro and in vivo data indicate that RRM1 gene expression is functionally associated to mitotane sensitivity and support a possible role of RRM1 determination as a novel molecular biomarker predicting response to adjuvant mitotane in ACC. Clin Cancer Res; 18(12); 3452–61. ©2012 AACR.

Cancer cells alter their metabolism to support their malignant properties. In this study, we report that the glucose-transforming polyol pathway (PP) gene aldo-keto-reductase-1-member-B1 (AKR1B1) strongly correlates with epithelial-to-mesenchymal transition (EMT). This association was confirmed in samples from lung cancer patients and from an EMT-driven colon cancer mouse model with p53 deletion. In vitro, mesenchymal-like cancer cells showed increased AKR1B1 levels, and AKR1B1 knockdown was sufficient to revert EMT. An equivalent level of EMT suppression was measured by targeting the downstream enzyme sorbitol-dehydrogenase (SORD), further pointing at the involvement of the PP. Comparative RNA sequencing confirmed a profound alteration of EMT in PP-deficient cells, revealing a strong repression of TGFb signature genes. Excess glucose was found to promote EMT through autocrine TGFb stimulation, while PP-deficient cells were refractory to glucose-induced EMT. These data show that PP represents a molecular link between glucose metabolism, cancer differentiation, and aggressiveness, and may serve as a novel therapeutic target. This work was supported by the Interdisciplinary Center for Clinical Research (IZKF) of the University of Erlangen-Nuremberg, the Deutsche Krebshilfe grant number 70112536, the IALSC Lung Cancer Young Investigator Award (to P. Ceppi), and by the Clinical Research GroupKFO262 funded by the German Research Foundation. This work was partially presented at the American Association for Cancer Research 2017 annual meeting. Special thanks to Dr. H. Wurdak (University of Leeds) for critical discussion.

The development of metastases is the main reason for cancer-related death in non–small cell lung cancer (NSCLC). The initiation of metastasis involves an increase in cell motility mediated by the loss of cell-cell adhesion caused by E-cadherin repression, in a process commonly known as epithelial-to-mesenchymal transition. A role for microRNA-200 family members in regulating epithelial-to-mesenchymal transition has recently been indicated but data about their expression in lung tumors is still unavailable. The present study investigated the expression of miR-200c in a panel of NSCLC cell lines (n = 9), and a strong inverse correlation with invasion was detected. Reintroduction of miR-200c into highly invasive/aggressive NSCLC cells induced a loss of the mesenchymal phenotype by restoring E-cadherin and reducing N-cadherin expression, and inhibited in vitro cell invasion as well as in vivo metastasis formation. Moreover, miR-200c overexpression restored the sensitivity of NCI-H1299 cells to cisplatin and cetuximab. Hypermethylation of the promoter region was found to be responsible for the loss of miR-200c in invasive cells, as evaluated by 5-aza-2′-deoxycytidine treatment, methylation-specific PCR, and bisulfite sequencing. In primary tumor specimens obtained from 69 patients with consecutively resected NSCLC, lower miR-200c expression levels were found to be associated with a poor grade of differentiation (P = 0.04), a higher propensity to lymph node metastases (P < 0.01), and with a lower E-cadherin expression (P = 0.01). These data indicate that the loss of miR-200c expression induces an aggressive, invasive, and chemoresistant phenotype, and that assessment of its expression could contribute to a better clinicopathologic definition of patients with NSCLC. Mol Cancer Res; 8(9); 1207–16. ©2010 AACR.

Introduction: We performed a bioinformatic analysis to identify metabolic genes connected with the process of epithelial-to-mesenchymal-transition (EMT) and the results indicated a possible role for aldo-keto reductase family 1 member B1 (AKR1B1). AKR1B1 is a member of the polyol pathway responsible for catalyzing the reduction of numerous aldehydes, such as glucose. Based on the importance of EMT during carcinogenesis and metastatic progression and on the relevance of enhanced glycolytic rate in cancer cells, we investigated a direct role for AKR1B1 during EMT and tumor progression. Experimental Procedure: The bioinformatic analysis was performed on datasets from the NCI60 panel of cancer cell lines. Cancer cells from lung, breast and ovarian origin have been investigated in vitro: changes in EMT markers were monitored by western blotting as well as immunofluorescence, growth assays were performed using the IncuCyte® ZOOM, migration rate was tested by wound-healing assays. Changes in stem-like properties were determined by western blotting, FACS and sphere-formation assays. Immunohistochemistry (IHC) was performed on FFPE specimens from lung cancer patients. Additionally, IHC was performed on samples from a mouse model of AOM-induced colon tumorigenesis in mice with an intestinal epithelial cell-specific p53 deletion (which were shown to undergo EMT) and in the wildtype counterparts. Results: AKR1B1 gene and protein expression was found significantly higher (7-fold) in mesenchymal-like cells. ShRNA-mediated knockdown of AKR1B1 lead to mesenchymal-to-epithelial transition in vitro and suppressed EMT induced by TGF-β or by high glucose levels. Besides reduced migration, AKR1B1-deficient cells displayed decreased proliferation rate and colony-formation ability. Moreover, AKR1B1 knockdown or its inhibition with specific drugs diminished cancer stem cells. The phenotypes observed with AKR1B1 knockdown could be obtained by targeting sorbitol dehydrogenase (SORD), the second and last enzyme of the polyol pathway. Suppression of each enzyme resulted in an impaired glycolytic and oxidative metabolism and adding fructose, the end-product of the polyol pathway, rescued the expression of EMT markers. IHC on samples from the AOM-induced colon cancer model indicated a higher AKR1B1 expression in invasive tumors from p53ΔIEC mice as compared to both p53-deficient non-invasive or wildtype tumors. Finally, AKR1B1 staining of cancer tissues from a cohort of lung cancer patients confirmed a significant correlation with EMT and a negative prognostic value. Conclusion: In summary, we describe a glucose-related pathway with a previously unknown role in regulating cancer plasticity and EMT, which links altered glucose metabolism to growth and migratory ability, with several potential implications. Targeting polyol pathway enzymes could be a potentially effective therapeutic strategy to arrest cancer progression. Citation Format: Annemarie Schwab, Aarif Siddiqui, Maria Eleni Vazakidou, Francesca Napoli, Martin Boettcher, Bianca Menchicchi, Ida Rapa, Maximilian Waldner, Dimitrios Mougiakakos, Marco Volante, Florian Greten, Thomas Brabletz, Paolo Ceppi. Aldo-keto reductase family 1 member b1 links glucose metabolism to epithelial-to-mesenchymal transition [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 450. doi:10.1158/1538-7445.AM2017-450

The development of metastasis is the main reason for cancer-related death in non-small cell lung cancer (NSCLC). Initiation of metastasis involves an increase in cell motility mediated by the loss of cell-cell adhesion caused by E-cadherin repression, in a process commonly known as epithelial-to-mesenchymal transition (EMT). A central role for microRNA-200 family members in regulating EMT has been recently indicated, but data regarding the significance of their expression in lung tumors are still unavailable. The present study investigated the expression of mir-200c in a panel of NSCLC cell lines (n=9) and found a strong inverse correlation with cell invasive potential. Forced re-introduction of mir-200c into highly invasive/aggressive NSCLC cells induced a loss of mesenchymal phenotype, by restoring E-cadherin and reducing N-cadherin expression, and inhibited in vitro cell invasion as well as in vivo metastasis formation, as evaluated by chicken embryo metastasis assay. Moreover, mir-200c overexpression restored the sensitivity towards cisplatin and cetuximab, two chemotherapeutic agents widely used in the treatments of thoracic cancers, of the drug-resistant NCI-H1299 cells. Hyper-methylation of the promoter region was found to be the mechanism behind the loss of mir-200c in invasive cells, as evaluated by 5-aza-dC treatment and methylation specific PCR. In primary tumor specimens obtained from 45 consecutively resected NSCLC patients, mir-200c expression confirmed its role in malignant tumor progression, being significantly inversely associated with a poor grade of differentiation (p=0.01) and a higher propensity to lymph node metastases (p Citation Information: Clin Cancer Res 2010;16(7 Suppl):A24